1

preganant lady with EBV exposure oldrecall,,,,,,serology if symptoms

162.Old 50 year lady her daughter is going to be pregnant. Vaccination for that old lady
a)Variceela
b)Pertusis tetanus diphtheria
c)Influenz
d)Pneumecocal
e)Hiv
answer isb

84.16 yrs old gal bmi 32 , is starting her sexual life and has come to u for advice on
contraception . u will screen her for ?
a) chlamydia
b) pcos

answer is b she is not sexually active so best option out of 2 is pcos.but keep in mind that v got 3
options missing so must luk out for them also
77.old recall with jvp 4cm.diastolic murmur in aboriginal heavy drinker, leg edeme , cause?
Alcoholic cardiomyopathy, corpulmonale
answer- alcoholic cArdiomyopathy

79.Old recall renal failure, gout scenario, wot to give?

Steroid, colchicine, allopurinol
Answer is steroid

Symptoms of lower cancer rectum

Melenia, constipation and lower colicky pain
Diarrhea, bloody stool and abdominal pain
Constipation
External haemorrhoids
Answer is b\
368. Also skin CA related, young pt. come to you to check on his 2 chest normal looking nevuses, he's
computer programmer or something, his brother had mal. Melanoma that metastasized to the bones..what
to do?
A. Reassure

2
B. Do bone scan
C. Excise theses nevuses
D. Refer to dermatology
E. Regular skin exam - i think annually
326.a man feel that see waves are rolling toward him then he is observed to stare blankly and
irresponcively asking diagnosis
iv are EEG - Specific frontal lobe assesment
Answer is eeg

A 35-year-old man complains of

productive cough. Chest X-ray
showed bilateral patchy infiltrate.
What is the best management for this
patient?
A. Amoxicillin
B. Flucloxacillin
C. Azithromycin
D. Trimethoprim
E. No treatment is necessary at this

moment

A 30-year-old man presents to the

emergency department complaining
of a dry cough, fever, dyspnoea and
diarrhoea which began three days
after the onset of an URTI. On
physical examination his respiratory
rate is 20/min, temperature 40.5C
and the chest shows bibasal
inspiratory crackles. Chest X-ray
shows bilateral interstitial infiltrates.
Initial antimicrobial therapy should
be which one of the following?
A. Penicillin

B. Azithromycin
C. Ciprofloxacin
D. High dose trimethoprimsulphamethoxazole
E. Amoxycillin/clavulinic acid
A young woman presented with high fever, cough, sore throat,weakness, myalgia, headaches and
chills for the last 2 days. The most probable diagnosis is
A. The common cold
B. Influenza
C. Croup
D. Acute bronchitis
E. Exacerbation of COPD
1.

a pt with heart failure on many drugs stop medication for 2 weeks now came with odema upto knee,chest was clear and with sinus
tachycardia what to give?
1.digoxin
2.metoprolol

2 middle aged female with signs and symptoms of heart failure , lower limb edema and pulmonary crackles with
shortness of breath , presented to you, on ECG - FOLLOWED by a period of Asystoly or no pulse and after that the
rythm restored again)
during this period of asystoly the patient was normal and stable with no increased signs BP 120/84 what should be done
next
A)continue monitoring
B) give amiodarone
C)give lidocaine
d) give furosamide

======
K1 recalls 15th Sep 2015-09-15
Every body, let me give you some relieve before read these recalls: by the greate teamwork

5
of Amedixans, my MCQ exam was one of the easiest exam in all of my medical exams
3 year old comes with recurrent UTI, what investigation we should do to assess the renal scarring?
DMSA / DTPA
1.
A Nuclear Medicine DTPA or MAG3 Renal Scan is performed to look at the blood
supply, function and excretion of urine from the kidneys. The test can find out what
percentage each kidney contributes to the total kidney function.
same child what to do after confirmation of recurrent UTI -> cystoureterogram (PUV assessment

1. 1. A youn guy has noticed with a massin his right testis, sono given, what is the most

important next step in management?

Fine needle aspiration
Alfa fetoprotein.
Inguinal excision
Sclerotherapy

Clinical features of Testicular tumours

Young men aged 15-40 years
Painless lump in body of testis (commonest feature)
Up to 15% experience pain
Loss of testicular sensation
Associated presentations (may mask tumour):
- hydrocele

6
- varicocele
- epididymo-orchitis
- swollen testis with trivial injury
- gynaecomastia (teratoma)
2. a lady fear of going outside specially in large crowded spaces, loves to stay at home
and sometimes her friends visit her at her house. Diagnosis?
A agoraphobia
B social phobia
C.OCD
Agoraphobia is defined as anxiety and/or avoidance associated with situations where
help may not be available or where leaving the situation may be difficult or
embarrassing in the event of panic symptoms or a full blown panic attack. Commonly
feared situations include crowds, shopping malls, driving, public transportation, and
being away from home
The anxiety or phobic avoidance should not be related to another mental disorder such
as:
social phobia (eg, avoidance limited to social situations because of fear of
embarrassment),
specific phobia (eg, avoidance limited to a single situation like elevators),
obsessive-compulsive disorder (eg, avoidance of dirt in someone with an obsession
about contamination),
posttraumatic stress disorder (eg, avoidance of stimuli associated with a severe
stressor)
separation anxiety disorder (eg, avoidance of leaving home or relatives).
3. female 34 anxious about breast ca bcz read in magazine some celebrity got ca at
32.no positive sign and symptoms.no family hx
A)mammo
B)usg
C)MRI
D)reassure that no more inv is needed at this time
E) put her on breast screening program(but didnt said by now or from 50 years of age)
It is recommended that women aged 5069 years attend the BreastScreen Australia

7
Program every 2 years for
screening mammograms

Unmarried women presented with slight lower abdominal pain.On USG 6 cm SOLID
mass beside uterus.whats your DX
1.Teratoma
2.Mucynous cystadenoma
3.Corpus luteal cyst
2.
4.Endometriosis

4.
5. Old patient with iloischial abscess, has this problem recurrent many times, what s the
cause?
A. Anal fistula
B. Diverticular disease
C. Crohns bcz of reccurance
D. Diabetic
E. Immunodeficiency disorder
6- pregnant woman 10 weeks starts to have pain in the right iliac fossa specially when
she stands up or cough she had appendectomy when she was 12 year old , No
rebound tenderness and guarding. wts most likely the diagnosis
a. Round ligament pain .get better with walking
b. Complex ovarian cyst
c. Unrupture Ectopic pregnancy
d. Intestinal obstruction
6. 7- An old women presents with the history of purulent brownish green vaginal
discharge.She only has sexual relationship with his husband.P/S examination confirms
the discharge.Her pap smear previous were normal.What is the most likely cause of her
discharge?
a.chlamydia trachomatis YES
b.Endometrial Ca
c.Cervial Ca
7. 16 y/o girl with a BMI of 30, who has recently become sexually active, what to screen
for?
BP
Chlamydia
DM
Young female after sex with new partner got sorness in vagina, dysuria n also

8
discharge mild few days,spontaneously resolved in a week and now asymptomatic
came to u, cause?
Chlamydia ,
Gonorrhea ,
Hsv,
Candida its a typical case of candida and new partner is for mislead us

3.
11. 37 yrs. old woman with secondary amenorrhea, normal BMI, FSH: 55,

LH: 54, oestradiol: 77, Prolactin: normal, in USG of ovaries: 3-4 cyst, do not
want to conceive, what is the best treatment?
a. POP
b. menopause hormone therapy
c. clomiphene
d. OCP
e. Metformin
POF tx:
If dont want to conceive: hormone replacement therapy (HRT) until the
age of 50 to relieve the symptoms of oestrogen deficiency and prevent long
term complications
If want to conceive: egg donation (Some women try IVF or drugs to
stimulate egg production but these have a low chance of success)
12. male with sperm count 19 million, 40 motility and 65% abnormal sperm.
Spontaneous pregnancy is unlikely.
No chances for pregnancy.
Hormone therapy to male cane help
13. 28yr old lady lst childbirth 3yrs back, regular cycles, trying for the second one,
intercourse timed aroud ovulation .. no tubal pathologies- confirmed, whats the reason for
difficulty to conceive ?
A antibodies to semen
B. male infertility- abnormality of semen
c shortened luteal phase
D inappropriate timing

initial diagnostic evaluation consists of:

Semen analysis
evaluation of ovulatory function: Women with regular menses approximately every four
weeks with moliminal symptoms are almost always ovulatory.
rule out tubal occlusion: We usually perform a hysterosalpingogram (HSG), but
laparoscopy with chromotubation may be more appropriate in women suspected of having
endometriosis
14. A woman aged 42 yrs ,visits your clinic with a h/o abortion at 12 weeks, 3 months ago,
for the first time. She is trying to conceive for the past 2 years ,with her husband. Husband
has no problems .What will be your advise to her ?
IVF
OC pills
Advise Adoption
To conceive as soon as possible
Clomiphene citrate
There is no treatment available which slows the rate of oocyte ageing, and for many
women in their early to mid 40s, pregnancy with their own oocytes is usually not possible.
These women require donor oocytes to conceive successfully
http://www.racgp.org.au/afp/2012/october/assisted-reproductive-technology/
Following miscarriage for two weeks: avoid having sex or putting anything into the vagina,
such as a douche or tampon
Women have traditionally been told to wait two to three months before trying to become
pregnant again, although several studies have shown no increased risks with a shorter
interval. Any type of birth control, including an intrauterine device, may be started
immediately.
15.
selegiline and SSRI. Now pt come with drowsy, diarrhea and abd pain
a)reduce sertraline
b)reduce selegiline
c)stop sertraline
d)stop selegiline

10
e)stop both
The serotonin syndrome
This is a dangerous adverse reaction related to the use of the SSRis and is most likely to
occur with the combined
use of MAO I drugs and other agents. The diagnosis is based on three criteria:
Symptoms must coincide with the introduction or dose increase of a serotonergic agent.
Other causes, such as infection, substance abuse or withdrawal, must be excluded.
At least three of the symptoms or signs:
- mental status j behaviour changes (e.g. agitation,confusion, hypomania, seizures)
- altered muscle tone (e.g. tremor, shivering, myoclonus, hyper-reflexia)
- autonomic instability (e.g. hypertension or hypotension, tachycardia, fever, diarrhoea)
stop offending agents immediately + supportive therapy
U r an intern. Asked to witness a patients will. Patient is disoriented. what will u do?
a. Don't witness.
b. witness
c. talk to Medicolegal advisory committee report.
d. speak to his lawyer and witness the will
Amc Guidance :Intern Can not take Consents...BUT can Witness Will
Again a Doctor MUST work towards patient's best interest...RIGHT (as per GOOD
MEDICAL PRACTICE)
That dictates that a douche bag lawyer is in hurry n be done with thsi boring job so want U
to witness will so that he can go home...BUT U being doctor know YOUR PATIENT is not in
his Mental Capacity to do so...SO to protect Your patient...YOU JUST PLAINLY DENY.
You go to medico-legal advisory comity IF lawyer is messing with ur patient.
Lawyer has no power on U unless mentioned in advance directives. So plainly deny.
When it comes to Witnessing Wills...It is between U patient n Lawyer...so If U messed
up...it will be ur neck n not health departments or hospital
16. an elderly male who had a fall and fractured his leg. you give narcotic analgesic and he
becomes drowsy.a few month before this,when she was competent she made an advanced
directives and mentioned that if I become VERY SICK, dont do any treatment, what will you
do?/
transfer him immediately to emergency.

11
do nothing
give non narcotic analgesic
family meeting
Send her for palliative care
a legally competent person has a right to chose what occurs with respect to his or her own
person
Legal authority suggests that a medical practitioner should not provide treatment or
perform a procedure in an emergency where there is an unequivocal written direction by
the patient that such treatment is not to be provided in any circumstances. Should a patient
give such a written direction, a medical practitioner should take reasonable steps to
ascertain the true scope of the patients refusal to consent and whether the patient had the
capacity to decide at the time the direction was signed. In such a case, if the medical
practitioner establishes that the patients refusal was invalid or if the patient lacked the
capacity to give the direction, the medical practitioner can treat the patient in accordance
with his or her professional judgment of the patients best interests.
Advance Care Directives may not contain instructions for illegal activities, such as
euthanasia

4. Nerve pinch below inguinal ligament after operation, What muscle will be affected?
Ext Hall Longus
Flexor Hall longus
Fle Hall Bravis

Hamsrings
20. A medical condition is present in 8 out of 100 smokers. A new drug is under
investigation & desired to decrease the condition by 25%. How many patients are needed
for the study?
200
100
50
25
ARR=25% x 8/100=2/100
NNT=1/ARR=1/.02=50
25. 7 yo girl who start to act strange last months. Complain on headache, vomit, stomach

12
ache. Don't want to leave parents car when they drove her to school. If she attends kids
party she is never stays for night. Dx?
separation anxiety disorder
Common symptoms of separation anxiety disorder
worries and fears
Fear that something terrible will happen to a loved one. For example, the child may
constantly worry about a parent becoming sick or getting hurt.
Worry that an unpredicted event will lead to permanent separation. For example, they may
worry about being kidnapped or getting lost.
Nightmares about separation.
refusals and sickness
Refuse to go to school and almost anything to stay home.
Display reluctance to go to sleep and may make these children insomniacs
Complain of physical sickness like a headache or stomachache at the time of separation,
or before it
shadow you around the house or cling to your arm or leg if you attempt to step out
http://www.helpguide.org/articles/anxiety/separation-anxiety-in-children.htm

26. pic of an infant with cleft lip . mother drinks just a glass of wine with hwe dinner every
night . she is on carbamezapine for epilepsy . what could be the reason for it ?
a) genetic
b) carbamazepine
c) alcohol
ETIOLOGY:
Genes
Medications: Antiseizure agents (phenytoin , sodium valproate , and topiramate) and
methotrexate but not carbamezapine
Cigarette smoking
Alcohol (more than 70 g of alcohol per week or binge drinking one or two times per week)
Folate deficiency

13
the risk of alcohol related birth defects (ARBDs) was observed only after heavy prenatal
alcohol exposure (defined as consuming more than 70 g of alcohol per week or binge
drinking one or two times per week) in the first trimester [ 60 ]. There was no association
between ARBDs and moderate or low prenatal exposure.
5. yong woman with hx of 3 attacks of drowsiness last month, last episode occur
when she was in shop in the time of attck she feel detached from everthing but can
remember the event.what will lead u do dx?
1.ct head
2.eeg .Temporal Lobe Epilepsy
3.ask witnessno need when she can remember
4.LP
5.MRI

27. Truck driver having on and off abdominal pain and bloating for the last 3 months,
sometimes he has a foul smelling diarrhoea. He had colonoscopy and it was normal, what
is the best next management?
a. repeat colonoscopy
b. stool culture ............. giardiasis can be the mos likely diagnosis
c. abdominal ultrasound
d. sigmoidoscopy
e. CBC
HB 2.043:The most common symptoms of giardiasis are diarrhoea, stomach cramps,
bloating, nausea, loose and pale greasy stools, fatigue, and weight loss. The first signs of
the illness will appear between 3-25 days (average 7 days)
28. three days after parathioroid sx for parathyroid adenoma, develop finger and perioral
numbness
ca level was low wt to give
1.ca carbonate IV
2.ca carbonate and vit d3
3.calcitrolManagement of hypocalcemia after thyroid surgery day 2-4
Ca <7.5 mg/dL and symptomatic: IV calcium gluconate + oral Calcitriol + oral calcium
carbonate
Ca <7.5 mg/dL and asymptomatic: oral Calcitriol + oral calcium carbonate
29.

14

31. Mother brought her 16 year old ballet dancer girl..breast bud stage 2, tsh fsh and prl
was NL...amenorrhea present, next?
-USG
-reffer to adolescence unit or something like that
-reassure
-pop smear
I choosed sono
32. Scenario of anorexia nervosa,asking about wof will help you to reach the diagnosis?
Brady cardia
Downy hair I choosed it, but its better to check it out
Dont remember others
33

*
RACGP - Assisted reproductive technology - Whats new and whats important?
While definitions of infertility and estimations of its prevalence vary widely, there is
abundant agreement that the consequences of unresolved infertility on individuals, their
families, and the community are profound. Although there has been no recent dramatic
change in the proportion of couples w
racgp.org.au

54 mins
These are some of my recalls: Sept. 15th. Singapore. I apologise for the crude format
but I have not brought my laptop here so I had to type them on the phone. I'll post a
better version with more questions asap. This is for those of you going for exams in the

15

next few days. Good luck. May the fates be ever in your favour. wink emoticon
1)Photo of red macular skin lesion, but not erythema myltiformme or margimatum? With
a history of migrant, blood stained sputum with cough, weight loss, malaise
(Looked like a TB history to me)
1.bronchgenic ca
2.pulmonary TB
2)handbook question 3.042
3)old recall with the old man saying he can see waves crashing over ceiling. Asked to
identify where the lesion is
6. A patient presented with abdominal pain and vomiting.45 years ago he had
operation for uncomplicated appendicitis.xray looked like SBO, very similar to this
pic:

whats your next step of mx after iv flud?

1.CT abdomen
2.Gastrograffin follow through
3.olive oil enema
4.ct
5.rectosigmoidoscopy
7. Mother brought her 16 year old ballet dancer girl..breast bud stage 2, tsh fsh and
prl was NL...amenorrhea present, next?
-USG
-reffer to adolescence unit or something like that

16
-reassure
-pop smear
I choosed sono
8. An 18 months boy is presented with inspiratory stridor and subcostal recession and
cyanosis, T:37,6 puffs sulbutamol given, but didnt get better, O2 sat is 95%. Which
one of the following is the best way to manage his current problem?
A)IV hydrocortisone
B)nebulised salbutamol
C)inh bromocriptin
D)nebulised adrenaline
E)IV penicillin
***there wasnt any option for repeat sulbutamol(eg, 12 puff), I go for nebulised
adrenalin

9. pt do excess 2000 situp daily ,regular 4 hourly gym exercise bmi 19,checks in
mirror several times etc ,dx
anorexia nervosa,bdd,hypomania,ocd

10. An old man with congestive heart failure and hypothyroidism. On levothyroxine, digoxin, and
other medications came with light headedness and palpitations. His HR was 140 regular. The
ECG was sinus tachycardia as I've noticed. Wt should you do:

1. cease thyroxine
2 . stop digoxin
3. Decrease digoxin
4 . add metoprolol
Sinus tachycardia = Exogenous hyperthyroidism
The symptoms and signs in patients who take excessive doses of thyroid hormone: weight loss, heat
intolerance, tremor, palpitations, anxiety, increased frequency of bowel movements, and shortness of
breath
Discontinuation or reduction in the dose of thyroid hormone is usually the only

17
treatment needed IN LONG TERM,,,,. Beta-blockers will relieve many of the symptoms
of hyperthyroidism promptly
11.A young pt with repeated dizziness and fall when standing only. Head tilt test lowers
BP to 70/50
What advise will you give?
fludrocortisone
increase salt and water intake
initial intervention is to increase intravascular fluid volume by large daily salt intake,
either added to food or as salt tablets:
Continue with this until weight has increased by 1.3-2.3 kg; then can consider giving
fludrocortisone, if necessary, to increase sodium retention.
Can precipitate heart failure but peripheral oedema alone should not cause
cessation of treatment.
12.malingerer ask for certificate cause she did exam and she was not good in exam ,
certificate will help her
refer her to university medical section
give her certificate

refuse to give her certificate

13.As GP you get 3 cases of salmonella typhi. What study you will do find cause?
- Cohort
- Cross sectional
- Case control
- Randomized control
14.Best study for causal relationship between HTN and MI
A. cohort
B.Casecontrol
C. RCT
15.Some local institusion or something like that ask you to lecture for young males
about importance of self examination in preventing and better outcome of
testicular tumors, wof will better explanation for low efficacy of this method?

1-early dx of testicular mass will nor affect the outcome

2-some other options
3-a sentence which means low sensivity for me and I choosed it
Remember that A Good screen test should have high sensivity
16.Pt. with CHF taking b-blocker , furosemide , perindopril , K supplement , metformin
for DM , start amiodarone due to arrythmic problems , now complain of
lightheadednes and palpitation & feeling like syncope , what id the cause ? Same
ecg of Ali nazzari recalls was given
A) perindopril + lasix
B)bblocker + lasix
c) K supplement + bblocker
d)amiodarne + furosemide

18

Combining Amiodarone +frusemide can increase the risk of an irregular heart rhythm.
may need regular monitoring of your electrolyte (magnesium, potassium) levels. You
should seek immediate medical attention if you develop sudden dizziness,
lightheadedness, fainting, or fast or pounding heartbeats during treatment with
amiodarone. In addition, you should let your doctor know if you experience signs of
electrolyte disturbance such as weakness, tiredness, drowsiness, confusion, muscle
pain, cramps, dizziness, nausea, or vomiting
http://www.drugs.com/interactions-check.php?drug_list=167-0,1146-0

17.A 24year man came with SVT,Has complained of 4hours lightheadedness &
palpitations. HR 200 and PR 20/MIN Whats next step of management?
A.Oral Digoxin
B.B.B
C.IV adenosine
D.IV sotalol
Paroxysmal supraventricular tachycardia (PSVT) occurs in less than 10 percent of
patients after an acute MI, MxCABDC)
1- Carotid sinus massage or a valsalva maneuver
2- Intravenous adenosine or verapamil
3- Intravenous beta blockade with metoprolol or esmolol or amiodarone
4- Intravenous digoxin
5- If the arrhythmia persists Cardioversion

18.A very clear ecg of second degree / type 1, heart block, pt on poly pharmacy, acei,
frusimide, digoxin, what to do next. No option for temp pace,
Stop dig
Stop acei
Stop frusimde
Permanent pace maker
a progressively increasing PR interval until a P wave is not conducted

treatment for Mobitz type I AV block

1-Prior to initiating Tx, exclude reversible causes:
MI
increased vagal tone (younger persons or athletes)
medications(ABCD):STOP IF ANY
Aamiodarone & adenosine
Bbeta-blockers
Ccalcium channel blockers (especially verapamil and diltiazem )
Ddigoxin
2- If no reversible causes are present:

19

asymptomatic no specific therapy

symptomatic bradycardia implantation of a permanent pacemaker

19. normal phosphate and high calcium >4 while the normal about 2.5 may be with confusion
agitation and constipation asking diagnosis while calcium in urine was in normal range and the
condition started since 4 months,dx?
primary hyperparathyroidism - malignant osteolytic dis -familial hypocalcuric hypercalcemia
20. mother her son with 48 hours rhinorrhea and lots of abscence among his classmates dt influenzaLIKE illnesses asking best to de?
check influenza
7 days off school
wear a face mask
oseltamivir
No viral investigations are needed.
Recommend patients stay at home until symptoms have resolved.
Most patients do not require oseltamivir.
>>oseltamivir is given with 48 hours if patient has risk factors for more serious disease.
Recommend oseltamivir (prophylaxis) for family members (via LMO) if they have risk factors for
more serious disease, or
attend/work in 'vulnerable settings'.
-----------------------------------------------------------Risk factors for more serious disease
Indigenous people
Chronic illness:
pulmonary (including persistent asthma),
cardiovascular,
renal,
hepatic,
hematological (including sickle cell disease),
neurologic,
neuromuscular,
metabolic disorders (including diabetes mellitus)
Immunosuppression, including that caused by medications, asplenia
Long-term aspirin therapy
21.Cardio vascular risk assessment for a 45 y women with bp 142/66 non-smoker, nondiabetic, standard chart was given
10-15 %
22.Sever Ear pain in the presence of a firm submandibular mass; o/e ear and Tempan
membrane was compeletely NL, what help to diagnose ?
See his tongue
23.40 yrs pt with mass in left posterior angle of neck from 3 months ago, painless,
firm, mobile + some neurological symptoms such as dribbling from same side, what
best next inv?
a. Ct neck

20
b. Ct chest
c. FNA biopsy
d. x-ray
e. Ct abdomen
24. football player suddenly feel acute moderate pain in his right knee while playing, after
hours the pain bubsided but effusion expanded,after some days when the pain and swelling
were setteled, some times he feels his leg is giving away and some other times his knee is
locked DX?

A)antcruiciatelig injury
b)med menscial lig if effusion develops within 24 hours
c)medmenscial +ligamentous lesion effusion develops immediately and the pain would be more
severe
d)fracture patella
25.A 35 year old man came with severe back pain over years that is worse when he
wakes up in the morning , the pain and stiffness makes him stays in the bed for at
least 30 min, and getting better by walking along the day , it is getting worse now ,
after tried naproxen, what will u give next? ? this Xray was given:

a. azathioprine
b. adalimumab bamboo spine in ankylosing spondylitis
c. Aspirin
d. Prednisolon
e. Methotrexate
in patients with severe ankylosing spondylitis unresponsive to NSAIDs and physical
therapy: infliximab, etanercept, and golimumab
26.25 year female with unilateral mild painful loss of vision for the past 12 hours.no
headache,no redness, normal fundus examination.visual acuity is 6/60 LT and RT its
6/6. What investigation to do next?
A: CT
B: LP

21
C:temporal artery biopsy
D:Visual evoked potential
there is no MRI in option
unilateral painful loss of vision in a young pt Optic neuritis => Multiple sclerosis
27.Young man after a quarrel had a fracture of floor of eye what is the more consistent
symptom with that
A- conjunctival hge
B-can't open the mouth completely
C- loss of sensation in the skin around
D- reduce the visual acuity
uptodate
Orbital floor fracture (Blowout)
entrapment of the inferior rectus muscle and/or orbital fat
Enophthalmos (the eye is receded into the orbit)
Orbital dystopia (the eye on the affected side is lower in the horizontal plane
than the other)
Injury to the infraorbital nerve (resulting in decreased sensation along the
cheek, upper lip, or upper gingiva)
patient was hit in the left eye with a baseball

limitation of left upward gaze due to entrapment of the inferior rectus muscle.
Medscape
decreased visual acuity
blepharoptosis
binocular vertical or oblique diplopia (especially in upgaze)
ipsilateral hypesthesia, dysesthesia, or hyperalgesia in the distribution of the
infraorbital nerve
28.developmental q 4 year old child whats considered delayment
-2 weeled bicycle3y jm 845
- cant draw a man
- cant put on clothes.5 y
- cant stand one one foot for 20 sec
29.An 11 months old child comes, who is premature (32 weeks not 34), with history of
admission in NICU, low birth weight, normal Apgar, cannot sit without support, and
low weight,but other than everything is normal what is dx?
Normal because of 8 weeks prematurity sit without support 8 mo + 8 w prematurity
= 10 month

22
Douchen syndrome
Cerebral palsy
Polymiosits
Hypothyroidism
30.old pt with known bilateral chronic osteoarthritis, develop parasthesia and
numbness in the lateral side of leg below knee condition worse at night and
improve after walking for 10 min, wt is the important thing to examin in this pt
1.SLR sign positive
2.Any tenderness in lateral condyle
3.Any loss of sensation in the lateral side of leg

31.55yr anemic wt loss angular stomatitis , howell jolly bodies no hx of diarrhea or GI

symptoms ix
1.endoscop
2.electrophoresis
3.small bowel bipsy
32. young lady with breathless on climbling stares, microchromic microcytic anemai with hb 7
what is ur next management?

Packed cell

23
colonoscopy
Parental iron
Fobt
Small bowel biopsy
***there was no option for oral Fe

This pt is premenopausal but remember that All adult men and postmenopausal
women with iron deficiency anemia should be screened for gastrointestinal malignanc
http://www.aafp.org/afp/2013/0115/p98.html
33. boy hit to coffee table while playing, presents with epistaxis, lip nd mcosal bleeds, thigh
with bruises, no petachie, no hepatomegaly

a. ITP
B. Vwd
c. factor 8
ITP (Immune Thrombocytopenic Purpura)
isolated thrombocytopenia without anaemia, leucopenia or blood film changes
No pallor, hepatosplenomegaly or lymphadenopathy
Most children present with bruising and petechiae alone.
In some instances there is oral bleeding, epistaxis, rectal bleeding or haematuria.

24
Morbidity in ITP is usually minimal and parents need to be reassured of this.
Dx: FBE (including blood film)
bone marrow aspirate only if diagnosis is uncertain
34. mother present with her boy complaining persistant bleeding after tripping with a coffee
table..what is the treatmnet of this condition?

a)steroid
b)IgG
C)platelate
ITP Tx

Avoid aspirin and NSAIDS

Conservative Outpatient Management (no treatment)
platelet count > 20 x 109/l
platelet count < 20 x 109/l + child is otherwise well and no active bleeding
Any patient with ITP who has active bleeding even if resolved should be admitted and
considered for oral prednisolone

http://www.rch.org.au/clinicalguide/guideline_index/Immune_Thrombocytopenic_Purpura/
http://www.rch.org.au/clinicalguide/guideline_index/Von_Willebrand_Disease_vWD/
35.borderline personality for management ?
a.CBT
b.Dialectical therapy
c.Exposure therapy
Unipolar major depression with psychotic features
DEPRESSION= interpersonal therapy
social anxiety = role playing
adjustment = problem solving
schizophrenia, bipolar disorder, anorexia nervosa, alcohol dependency, and childhoodand adolescent-onset psychiatric disorders=family therapy
borderline personality disorder= DBT
36.pt with MS usually confused with which disease?
conversion syndrome.
Conversion disorder Symptoms or deficits of voluntary motor or sensory function
that suggest a neurologic or general medical condition and are associated with
psychologic factors ( table 5 ). Typically, there is a sudden onset of a dramatic, but
physiologically impossible condition like paralysis, aphonia, blindness, deafness, or
nonepileptic seizures. Unlike somatization disorder, patients with conversion disorder
focus upon only one symptom.
37.malingerer ask for certificate cause she did exam and she was not good in exam ,
certificate will help her
refer her to university medical section
give her certificate

refuse to give her certificate

25
38.teenager with suspiscious scenario of anorexia nervosa,wof lead to dx?
What do you think about yourself
39.pt who didnt make an appointment and didnt pay previous bills, what will you do?
Refer him to the nearest hospital
40. mammography picture given, typical scenario of fat necrosis what is nex investigation?

FNA
core biopsy
excision

etio: trauma or surgery

Initially, it can be seen as an ill-defined and irregular, spiculated mass-like area.
Associated calcification can be seen, which can mimic that of more malignant entities
such as DCIS
Dx: core biopsy is essential anyway
tx: follow up (there is no increased risk of subsequent breast cancer)
41.Mammogram of a breast . an old women with normal breast examination. She
had a history of trauma on chest 10 years ago with bruising in the breast ?What will
u do?
a.reassure
b.Percutaneous core biopsy
c.FNAC
d.repeat mammo after 6 months
The onset of fat necrosis can be considerably delayed, occurring 10 years or more after
surgery
42.Woman has the plan to become pregnant in near future,she asks about her alcohol
drinking habit,what s your advice:
Stop now
stop when you first know about pregnancy,
drink less then 2 st drink in week
drink 1st drink for 2 weeks and taper it slowly
stop alcohol,smoking and drugs whenever decides to become pregnant

26

43.A 12 week pregnant lady came, with standard alcoholic drink every day, use
cocaine, use marijuana, smoke, sometimes use amphetamine which one is more
teratogen for her baby?
Alcohol
Cocaine
marijuana
Nicotine
Amphetamine

We recommend abstinence from alcohol for women planning pregnancy, at conception, and during
pregnancy because a safe level of prenatal alcohol consumption has not been determined
44.scv obstruction senario with face flushing,arm swelling ,wt s the ix to do?
a.cxr
b.mri of cervical spine
d.ct with contrast
SVC syndrome
signs and symptoms of central venous obstruction:
Dyspnea is the most common symptom
facial swelling or head fullness, which may be exacerbated by bending forward or lying
down.
Other symptoms: arm swelling, cough, chest pain, or dysphagia
Patients with cerebral edema may have headaches, confusion, or possibly coma.
On physical examination, the most common findings are facial edema and venous
distension in the neck and on the chest wall

In most cases, symptoms are gradually progressive over several weeks and then get
better over time, due to the development of venous collaterals
Dx:
identification of the underlying cause of venous obstruction chest CT with
contrast
Gold standard for identification of SVC obstruction and the extent of associated
thrombus formation Venography ( Bilateral upper extremity venography )
It is superior to CT for defining the site and extent of SVC obstruction and for
visualizing collateral pathways. However, it does not identify the cause of SVC
obstruction unless thrombosis is the sole etiology
45.an 11 years old girl with intermittent abdominal pain, WBC 20 in U/A and in urine
culture: 100.000 E.coli/ml, what next?
a. Oral ciprofloxacin

27
b. IM penicillin
c. Oral nitrofurantoin
d. No treatment needed
e. IV gentamycin
100.000 E.coli/ml + 20 WBC abseloutely needs treatment, and I go for oral
nitrofurantoin, but please check it out yourself too

HB 3.297
Normal U/A
colonization < 10*8/L or 10*5/mL
WBC < 5/microlitre or per high power field
100.000 E.coli per litre without any symptom + up to 2 WBC/microlitre,should be
considered as an asymptomatic
bacteriuria and We do not recommend antibiotic treatment of asymptomatic bacteria
in children

guys these are all I remembered but let me reassure you that my other questions were also from
recent recalls, exept for about 20 questions which probably were pilot Qs!
I would like to thank every single member of Amedex, specially our angel Danijela
stojovski, my dear friend farzin yaghoubi and shah navvena, as well as all of you
Fortunately I had a good exam and as your little brother just can say 3-4 month recall
is enough, but find reasonable and conficent answer for them and repeat them
Wish you luck
All the best
Kind regards K1 Fallah

===========

46.A 30 yr old computer softwer programmer with hx of 3y outdoor work, with no FH of melanoma came for m
.wats the risk factor ?
A. melanoma in cousin
b. sunburn in child
c. BCC in family
d,hx of outdoor working
47.Pt. had child 3 months ago now she is very stressed & thinking that she may hurt the baby or may be falls
she lift hem , dx?
A) overvalued idea
B) obsessions
C)postpartum depression
D)postpartum psychosis

Obsessional thoughts and compulsive behaviors in OCD during pregnancy or postpartum often concern the ba
contaminating or harming the baby are a common theme. Harmful behaviors are relatively rare but warrant c
intervention as needed to ensure safety
Mild: CBT
Mod-severe: serotonergic antidepressant

28

gout / pseudogout in an elderly with acute knee pain.

melanoma pic (2 tests)

acute red eye in a Pt w hay fever and back pain I chose iritis
AF ECG (hx was a man with multiple episodes of fall)

SEVER pneumonia treatment in a child I chose flucloxacillin

two elders have sex in a nursery home. I chose we need to talk to the manager to provide security
prostate cancer screening (2 questions) I choosed PSA also DRE was. but I have read many articles that screening of prostate cancer is PSA with DRE
3 months constipation in a 88 year old man which Investigation I chose colonoscopy
tophus on a finger in a pt on allopurinol, he has come for surgery I chose surgery other choices were not relevant.
post-op Fever on day 3 with umbilical redness and severe pneumonia asked for source of infection I chose umbilical source

father comes with her child, her teacher has mentioned some inappropriate sexual behavior in school -> child abuse
Lewy body dementia asked for diagnosis - learn the clinical features
agitated pt -> Im halo
vit D study in Australia I choosed cross sectional
40 y old man comes with all lower motor manifestations eg. weakness, fasciculations asked for diagnosis, lacunar infarct/ lower motor disease
I chose the second one,
cuz in lacunar infarct should see ataxia, Parkinson signs and some sensory deficit
that famous case of DVT redness on thigh! answer was definitely unfractionated heparin

5 year old boy with recurrent AOM, had tympanostomy tube and now has discharge and many things more asked what is the best step for management I chose discharg
slapped chick cuz -> b19
vaginal redness with white plaque what is the next step in diagnosis -> look for clue cells, look for hyphae I chose the 2nd

acute mania case -> Risperidone

another one -> lithium
11 year old girl with staying away from school -> I chose truancy

29

hiatal hernia ct scan (pt comes with SOB and abd pain)
hyperkalemia ECG asked for treatment

BANGKOK 18 th September Recalls

PARDEEP OMANI

1.40 years old lady came to you because of 8 weeks ago her marriage was broken, 1 year ago she was referred for
(Shouting at colleagues) . After finishing her work she cant able to relax at home. What is the diagnosis?
A) Bipolar-II with depression
B) Cyclothymic disorder
C) GAD
D) Major depression
E) Borderline personality disorder
2. 37 yrs. old woman with secondary amenorrhea, normal BMI, FSH: 55, LH: 54, oestradiol: 77, Prolactin: normal,
cyst, want to conceive, what is the best treatment?
a. POP( I selected this no option for clomiphene)
b. menopause hormone therapy
c. OCP
d.. Metformin
3.Most teratogenic for fetus in pregnant lady :
I slected amphetamines no option of alcohol, cocaine or nicotine , others were diazepam and marijuana
4.Pregnant lady after post partaum ,, 6 weeks came with cervical erosion: 2 years back pap smear was negative:
a. repeat pap
b. punch biopsy
c.hpv vaccine
d.pcr
I selected pap smear.dnt knw it was right or not

5.female 35 yrs obese,,,husband 40 yrs of age , she has nrml regular cycle ( 5 days cyle ) no other disease,, can n
two yrs trying:previously had two children, whats initial :
a. semen analysis
b. us abdomen
c. check bmi
6. endometriosis is detected by : LAPROSCOPY

7. mother present 7 yr old girl,, well , no physical finding,, histry told that school friend lived here at home for three
a. give cefotexime to child 500mg iv

30
b. give cefotexime 500 mg to family
c. councell mother that its not spread thru this contact only
d. say mother to bring when symptoms develop

8. Pt with long standing back pain, no Rx at all, xray show bamboo spine, patient already took paractemol and code
A. Mtx
B. Indomethacin
C. Chloroquine
D. Infliximab
E. I dont remember
9. Pts unable to move his rt hand to abduct with loss of sensation in lateral aspect of arm. Lesion involved
a) C6 b) C5 c) C7 d) T1

10. screening of prostate cancer in pt whose father has prostatic cancer at same age 55 ,, DRE was done already
a. now do psa after 2 weeks.. it looks relevant , no other
11.Picture of para umblical hernia in 5 yrs child ,, no symptoms
a. surgical repair
b. reassure
c.rest were irrelevant
12. Picture of scabies.. treatment was asked

13. 55y old man after return from Bali after short holiday of 5 days with his wife presents with Fever, chill, abdomin
jaundice. All of liver function tests show impairment (AST, ALT, ALK). Dx? (August Recall 2015)
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Cholangitis
e. Malaria

14. pregnant at 10 weeks, she has done IVF after several years of infertilty , she is concerned about Down syndrom
had a baby with Down Syndrome
a- Nuchal Transclucency
b- amniocentesis
c- CVS
15. Most common cause of macroscopic hematuria.. bladder ca
16. Csf :
there is RBCs
Glucose low

31

Leukocytes were also there

a- zeil neilson stain
b- viral
c- bacterial culture
17. Waldenstrom macroglobulinemia (pic)
patient came with rigors and fever and right lower lobar pneumonia or some infection like this admitted and started
azithromycin minimal time generalised vesicular rash appeared asking management
a. Immunoglobulin
b. cease ampicillin and start ceftriaxone
c. prednisolone
d. Ganciclovir
e. Amphotericin

after long thinking I did Predinsole as it was generalized .. may be im wrong but there my mind said that not ganc

18. You are visiting home nursing for elderly and the nurse told you that there is 85 years old man and 74 old wom
this irritate the residents. Nuse asked you to change the medicine for them
Take to them
Take to each one alone
Take to their families
Do not change the medicine and say doctor has authority to decide and its final
19. one scenario of stone in upper calyx of kidney in young age no symptoms in urine..
I did ,, review xray after 6 weeks
rest of options were surgical
20.other renal stone at distal site with urinary problems size was 4mm=== ESWL was in option

21.man from veitnam 6 weeks before, now 5 dayss back developed constipation and then blood in stool what frst t
a. dre
b.us abdomen
c. ct scan
d. protoscopy
22. Old lady with Hx of prolapse, now has urgency but no stress incontinency.IX ?
A) Urodynamic studies
B) UMC
C) Anticholinergics

23. guy with hemothorax, trachea shfted to same side.. had stap wound to chest,, reduce air entry ,, no previous d
purcussion
a.. under seal drain
24. two PE scenario ask about inv CTPA,, one was having travelling histry nd d dimer was done

32

25. Picture of perianal abscess with pain in perieal region

26.that old recall of golden watch frm patient I selected ignore it

27. Vit c study in community

28. vitamin D study in two groups of university
29. Abgs..clear diagnosis was there for metabolic acidosis
30. ct scan for pancreatic pseudocyst
31. young age patient having scrotal swelling on left side, not retracted on lying ,, cord is palpable,, what intial do w
option for tumour markr

32. same type of scenario, this time was old in right side and non.transillumination I did also us here initially

33. grand mal seixure . Driver in local bus, no finding on any blood or physical investigation.. no eeg option.. advi
months and check ilicit drug in urine.. I did this one

34. a child with bacterial meningitis being treated with ceftriaxone n half daily requirement had a seizure >5min s/
s/Na=118mmol what is the cause of seizure?
Inappropriate ADH secretion
Dehydration
Antibiotic reaction
35. a young guy with symptoms of heart failure and generalized edema and bibasilar crackles, the urine showed pro
think on x ray normal cardiac sillohet and bilateral lung infiltrates
antiGBM
36. acute OM scenario ,, same old recall. Amoxicillin
37. One qs typical of ca pancreas asked what INITIAL invst u do.old with painless jaundice
Usg abdomen
CT abdomen
Cxr

38. clear USG pic of mets in liver. And the scenario was Sheep farmer with RUQ pain with H/O chole
hemicolectomy for carcinoma colon 2 yers ago.usg pic given.but I cant recognize the pic.
Next inv
1.Hydatid serology
2.Triphasic CT
39, old patient on morphinecomes with wife and drowsy next

33
I did ,,, hydrate first
40.
41. cellulitis scenario in diabetic with temp 38.2. asked investigation
Blood culture
Doppler
42. old recallmother wana knw abt hx of child she was 14 yrs old ..
option was come with daughter next visit..
43.one recall was about copd,, she hospitalized with agitation and dyspnea.. what next
a. abgs
b. ct scan
c. cxr
d.antibiotics change . Already taking and I went for abgs, as she was hospitalized

44. one more was 84 yrs old lady taking asspirin, bb, and oral , has type 2 dm and hypertension..... she hass recu
asked ? everythng was nrml , ecg was told as nrml ,, i did hypoglycemia
45.MgSO4 toxicity in eclampsi women first sign == Hypotension

46. i remeber one,, tongue lateral border has lesion white one, do not cuaterize and not removed on that ,, what di
cell carcinoma
57. one scenario of cystic fibrosis , same hb qs in child problem blah blahinvestigation asked
58.

60. 10 days boy becomes blue when he cries or on exertion. At birth all examinations were normal. APGAR score w
murmur found on cardiac exam.
a TOF
b ASD
a C. VSD
b D. TGA

61. 50 years male, MI case after angioplasty he feels a mass in inguinal area, pulsatile and expanding in nature. W
treatment?
a. Pressure on the area by hand
b. Urgent repair of femoral artery.
c. CT
d. nothing to do

34

=====

1.meningitis scenerio,lymphocyte increase,rbc 200 ,protein n,mx?

a.analgesic and observe
b.supportivec.do mri
d.ceftriaxon e. i/v acyclovir
I choose a as told by farzin

2. 55 yrs she got mennapause and now she is 62 yrs oldwho is sexual lyrics active with her husband with va
discharge, her all pap smear had been normal.what is the most likely diagnosis
A.candidiasis
B cervical cancer
C.cervical ectopic
D.chlamydia
e. endometrial ca
for most likely I chose Chlamydia only

3
4. 8 weeks of amenorrhea now present with vaginal delivery what will help to confirm pregnancy is norm
like that
a. bhcg levels
b. tvs
I choose b
5.pic ofcleft palate of a child and again asking the most common reason.. with carbamazipine and smoking h
6.
7.qs of some surgery and on 4th post op day pt presented with pain on left side and dyspnea want to know
to confirm the diagnosis
Keeping pe in mind but no ctpa and no v/q and I choose pulmonary angiogram
Other were d dimer and cxr and ecg
9.colles fracture scenario and with x ray and ask for when to reviw
I answered 2 weeks and same qs ask for the treatment also
10. Which of the following is least likely to be relieved on HRT
a.depression
b.insomnia

35

c.hot flushes
d.vaginal dryness
e.urinary frequency
answer is depression
11. pic of sialedinitis asked for the diagnosis

12. Asbestos exposed man came for advice. During work workers do not use mask, but they are exp
renovation. He is worried about asbestos related cancer, what advice:
Refer to respiratory specialist
Xray now and then 5 years later=YES
Inform government to take some legislation
Do nothing
Inform asbestos has very low risk for cancer
Answer is xray now and then 5 yrs later mentioned by frazin so m with it too
The same scenario
14. Child 4yr with 2 day prodromal then cough fever 39 nasal flaring, tracheal tug,inter
o2 sat 92% treatment
a)nebulized salbutamol,
b)nebulized bedosinuoed
c),im adrenaline croup
d), iv benzyl penicillin
e)iv fluxaacillin
ans as fever is pointing to pneumonia so I choose d

15. pt on many medications , indapamide, verapamil, prendopril , aspirin.. present wth

and exactly similar to above ecg given wt to do first
a- valsalva manover
b- cease verapamil
- temporary pace maker=YES
cease indapamide
I choose c

36

16. old pt with known bilateral chronic osteoarthritis, develop parasthesia and numbne
side of leg below knee condition worse at night and improve after walking for 10 min,
thing to examin in this pt
a- SLR sighn positive
b- Any tenderness in lateral condyle
- Any loss of sensation in the lateral side of leg
answer ic c
I choose c too
17. 55 yr anemic wt loss angular stomatitis , howell jolly bodies no hx of diarrhea or GI symptoms ix
- endoscop
- electrophoresis
- small bowel bx

ns is celiac ds so c
19. A chest x-ray given showing half of the left side lung field opaque. Asked for preferred investig
Ct chest
Bronchoscopy
Lung biopsy
Answer is choose was a
20.2 similar scenarios of capsular endoscopy only some choices they changed but qs is totally ide
21.again the scenario of primi gravid with her mother h/o diabetes mellitus during pregnancy. And
this girl now
a.fbs at 28 weeks
b.ogct at 26 to 28 weeks
c. ogtt at 26 to 28 weeks
d. ogtt at 20 weeks
e. blood insulin levels now
I choose d

22. Patint presented with wt loss for last 3 months and fever.on urine RE-pus cell,RBC b
growth of organism in culture.What is your DX
1.Renal TB
2.RCC
3.AIN
Answer I choose is 1.

37

23. 19 years Unmarried women presented with slight lower abdominal pain.On USG 6
beside uterus.whats your DX
1.Teratoma
2.Mucynous cystadenoma
3.Corpus luteal cyst
I choose 1 only

24.women with 2 days h/o vison problem on left eye and pain behind the eye rt eye
with 6/12 and rt with totally normal visionnormal papillary reflex and normal movem
particularly mentioned
1. ct head
2. visual evoked potential
3.lp
I choose ct keeping periorbital cellulitis in my mind

25. After removal of central venous line a lady developed facial swelling and swelling a
is the most appropriate inv
1.CT chest with contrast
2.CT head,neck

3.CXR
Answer is 1
28. Obstructive sleep apnea scenario obese with waist n neck circumstances
1.wt important mx in long term...?
A.wt loss
B.metformin
Answer is a wt loss for me
29. An old female patient on peritoneal dialysis for many months and well controlled o
suddenly refuses to be .Which of the following is the reason
A. depressed mood
B. disorientation
C. blunted affect
Answer is a

38

30. Old recall renal failure, gout scenario, wot to give?

Steroid, colchicine, allopurinol
Answer is steroid
31
33. 54 yr female 11 post menopause ,now presents with 3 days bleeding
a. return of follicular activity
b.cystic glandular hyperplasia
c.endometrial
d.cervical polyp
e.atrophic vaginitis
answer ia a for me
34. Engineer man in coal mine present with nocturnal cough, pt heavy smoker , on exa
thing normal chest clear and normal cxr, wt to do next
1.endoscop
2. Ct chest
3. repeat cxr after 6 month
4. Mri
Answer is 1 for me
35
36. Gp salmonella outbreak 3 weeks ago, wants to do the study, whixh study?
Case control
Case series
Cross- sectiona
I choose case control
37. Women brings in her child and tell that she is worried about him. He is sometimes very mischevious an
sometimes hard to control so have to even beat him and lock him sometime. What would you do first?
a. Call child protection authority
b. Get the collateral history from the father
c. Talk to the boy
answer is a

39. and scenario of varicose vein and mi and on clopidegral started 7 days before.pt is on stent and clopideg
a. refer surgery after 12 months and stop clopidegral 10 days before surgery
b. do surgery now
c.give platelets not and do surgery
I choose a
40. Old age female had a will not to admit her when she is terminally ill , today she fall
she became very drowsy after morhine inj. , what to do now ?
A)Operate her Fracture

39

B)arrange family meeting

C) admit her
D) Refer to Emergency department
E) Refer to Palliative care unit
Answer is choose d as told by frazin kindly see the discussion for this qs frazin said i
the same

41. man comes to ED with open wound at chest on examination, vital signs are stable
at the left lower lobe of chest & reduce breath sound in the left side. What to do?
a. strap the wound with pressure
b. intubation
c. underwater-sealed drainage
d.needle thoracotomy
I choose c only
42.
44.same scenario of premature child and now presenting late signs of development
I guess that is because they born immature
45. sign of familial hypercholesterolaemia
a. tendon xanthelesma
i choose it

46. Hyperkalemia ecg, poly pharmacy patien,onamidarone, amilodipine, fruesmide,

a.aspirin+amidaron
b.frusimide+ amidaron
c.frusimide+amilodipne
d.amidaron+amlodipine
answer is b as explained by frazin
47.
48.post surgery hypocalcemia scenario
Iv calcium I choose
49
50. patient with history of mi last month comes with cholecystitis pain not responsive to iv antibiotics what
a)change antibiotic
b)percutaneous cholecystostomy
c)ercp and extraction
d)surgery
answer i choose b

40

52. 9month old boy with complain of fever 39, cough, tracheal tug, intercoastal recessions and lethargy ca
fluids and oxygen.
A) pneumococal pneumonia
B) croup
C) bronchiolitis
D) anemia
Answer is a
=========

18 July Sydney
1. patient was oliguric after knee surgery : kidney angio
2. jaundice in baby in first 24 hrs after birth.indirect bill rised:

haemoly

3.

4. A university student ask for certificate cause she did exam and she wa
exam, certificate will help her..
A. refer her to university medical section
B. give her certificate
C. refuse to give her certificate

5. .mother come with 10 month old infant with increase head size from 25
birth to 75 percentile now and on examination child hypotonic with ope
fontanelle what will you do next??
a. CT SACN head
b. check CMV infection
c. TSH
d. head ultrasound

41

e. rubella test

6. Patient with painless hematuria .intermittent loin pain. Investigation:

Cystoscopy
Ct
7. Guy with ankle joint close trauma after MVA. Skin on feet is pale and co
detect pulse there. Asking next management
A/B
Debridement
Reduction of joint in ER
Tetanus prophylaxis

8. Worried mother of little son about MMR vaccination for her child who is
What to advise her
1- MMR is contraindicated in this case
2- MMR can be given safely

9. 2 year old with fever, upper abdominal pain and vomiting for last 2 day
PR 120/min RR 30/min and he looks unwell..xray done and it showed
lobe opacitytreatment PNUMONIA
A: amox/clav
b: IV pencilin
c: roxithromycin
d: IV flucloxacilin
10.

SLE scenario with pericarditis symptoms. investigation asked AN

11.

patient after 24 hours of surgery become confused and dyspnea

42

12.

scenario of DVT enoxaparin

13.

DVT scenario investigation Doppler

14.
young male with h/o asthma presented with c/o dysphygia on and
mentioned that with particular foods its worsened .diagnosis asked : e
esophagitis
15.
Another scenario of eosinophilic esophagitis, he was given PPI but
fluticasone
16.
17.
scenario of pontine infarct with typical features of sensory loss on
other on oppiste sidediagnosis was asked

18.
old lady with weakness, low back pain, cbc found to have low hb ,h
diagnosis was asked..myeloma
19.

scenario of endocarditis in IV drug user.asked for organism staph

20.

ECG of dig toxicity

21.

Paracetamol poisoning after 4 hr serum paracetamol level

22.
man went to police saying some people are trying to kill him and
him to u what next..collateral history
23.

Young women 25 years old with rash on face and hands with swell

43

.what is the consistant xray finding.

Ana is 1/640,speculated
Dna 25
Ra factor 14
1.chondrocalcinosi
2.punched out lesion
3.periarticular osteopenia
4.periarticular erosion

24.

Stats questions about naevi and melanoma

25.
The question about the lady with DM and amputation of her foot
with all high BP, lipids and glucose tighter glycemic control
26.

3 questions with asthma in children

27.
The question with CSF typical for TB young lady malaise for a
some PMN but mostly lymphocytes, protein high , glucose low

28.
Patient presented with wt loss for last 3 months and fever.on urine
RBC but there is no growth of organism in culture. What is your DX
1. Renal TB
2. RCC
3. AIN
29.

SVT ECG vasovagal stimulation

30.
Woman last period was 3 months ago, complains of hot flashes an
unpredictable bleeding cyclic HRT
31.

The old lady with redness in front of the tragus but clearly given p

44

lying in bed with IV lines and nasal prongs - I marked poor oral hygien
32.

Moluscum contagiosum asked exclusion from school no exclusion

33.
An adolescent boy with episode of sudden fall in the playground re
consciousness with 5 mins and started playing within 30 mins . diagno
a. postural hypotension
b. arythmias
c. vasovagal syncope
34.

Patient with anemia .endoscopy and colonoscopy was normal ca

35.

As GP you get 3 cases of salmonella typhi. What study you will do

Cohort
Cross sectional
Case control
Randomized control

36.
An obese 32 years old lady whose mother developed gestational d
later developed Diabetes, presented at 8 weeks of gestation what you
A fasting sugar now
B ogtt at 20th week
C ogtt at 28-34 week
37.

38.
Old lady patient of anxiety disorder, breast ca, mets in the bones,
requests u not to tell his mother about it . What shall u do? old recall w
option
1. Call a family meeting without mother
2.tell the son to book another appointment
3.come with his mother in next vis

45

==============

Ist important thing.dont only rely on recalls..use them for topics..coz I got very few recalls with change options.and almost
1.Easiest question of my exam..Common site of endometriosis
2.16yrs girls with BMI 30 just started her sexual life..what will u screen for her
Chalymdia
PCOS
Obesity
4.
5

6.another CTg finding asked

7.old recall of football player with knee injury.Anterior crutiate ligament
8.Pic of Dislocated Glenohumeral joint..asked for dx
9.pic of Melenoma
10.
11.
12.Xray oF SBO very weird..i made diagnosis with stem..asked initial ist in management
13.Ct of intracranial hramorhage..pt with 170/100 Bp..and on warfarin and aome other drugs..INR 4.5..what is initial bets
Stop warfarin
14.Anothere Ct of Heaorhage with high BP..initial istReduce the BP
15.5 ECGS..AF.VT.Hyperkalemia hypo kalemia..Complete heart block..asked for Dx and treatment
16.Drug interactions almost 5..dont remember..one was hyperkalemia old one recall..aspirin and amiodarone
16.Xray of pericarditis..asked treatment
17.Xray of Rupture of aortaPt with history of MVAasked Dx
18.Xray of TB..Pt with history of fever malaise wt loss and some other things..long snerion..but xray was clear
20.Atleast 10 qs of eletrolytes..so please study it carefully..i cant remember then coz very confusinghyponatremia..metaboli
alkalosisasked for reasons and management
21..Old recall of py with parathyroidectomy..came with numbness and blab la..initial immediate
CA iv
Calcitriol
CA carbonate
Ca and Vit D
22.old recall female old lady with T score -1.7
Aldrronate
Cal and VIT
HRT
23.Old recall of MVA pt with left side injury..BO 80/60 ..after fluid replacement what next
CT abd
USg Ab

46

Laprotomy
24.Old recall of renal TB
25.
26.
27.10 yrs girls fall from tree came to you she has protein +1..after three days urine test normal
IGA nephropathy
Underlying UTI
Resolving PSGN
Response of body to injury
28.
29.old recall of pt with 4th post op day.minor tear during delievery which was not stitched.fever and foul smelling discharge..w
Endometritis
UTI
Wound infection
30.Trichotillomania..Boy with loss of hair and eye brow in irregular [pattern..and aome other mood changes..ask for treatmen
Cognitive therapy(I opted this)
Family therapy
Antipsychotic
31.young girl with BMI(falling in obesity)all family members are obese.
Reduce exercise
Increase soft drinks
Strict dieting plan
Family counselling for obesity(I opted this)
32.Bilumia nervosa snerio..A girl with binge eating and laxative use..what is imp rizk factor for this conditionDont remem
history of sexual abuse in childhood(acc to HB all eating distorders shud b looked for sexual abuse history thats y I went for
33.Borderline personality disoreder..asked for Dx
34.Bipolar disorder snerio..asked for treatment
35.ADHD snerioasked for treatment
36.asperger child..asked for Dx
37.Obsessive compulsive disorder snerioasked for treatment
38.
39.old recall of lady in shopping mall..dont touch anything in fear of hepatitis and blab la..asked for treatment
40.Pt has snoring and reduce sleep..some time irritable and lonnggg snerio..what is best inv
Sleep study(I did this)
ECt
Ct
41
42.old recall of pt with recurrent falls and in shopping mall loss of consciousness but she remembers the event..what is initial
Witness
ECT
MRI
44.Drug interactions atleast 5..do drugs of CVS and HTN
45.Diabettes 1 and 2.2 snerios..dont remember
46.15 snerios of resp systemAsthma ..pneumonia..bronchiolitis..bronchitis..all with different stems ..so do it properly
47.Macular degeneration snerio..optic disc findings

47
48.Aboriogal child with ASOMtreatmentoral amoxy
49.Old recall aborigional mother with child ..no eye contact
Cultural issues
50.marjuana abusedont remember the stem
51.alcohlic pt with disorientation in emergency..IM halo
52.
53.
54.A
55.old recall of swelling infront of parotid ..what is initial best
CT(as everybody said on amadex)
FNAC
Biopsy
USG
56.PT with history of trauma to breats..Mamography was given.it was fat nacrosis..what is next
Excisional biopsy
58
======================
19th Sept 2015 - Melbourne
Swetha Iyer

1) Questions of Com med same as recalls got 3: rship of MI &Htn; melanoma n naevus; salmonella 3
exactly same as recalls so please just know the ans well so time not wasted much in these simple o

2) Ct scan of pancreatic psudocyst asking dx H/O pt alcoholic and binge drinking

a.

3) Another ecg of pt with 3rd drgree HB asking mxpacemaker, stop BB and add verapamil.stop digo
4) Effect of dothiepen arrhythmia

11) old lady with loss of vision in one eye for 2days, she has no other symptoms lf eye vision is 6/20 an
next to do
a. do carotid angiography
b. no options of vEP or MRI others irrelevant
13
14) pt with varicose veins and is on clopidogrel what to do:
a. do surgery now
b. give ffp and do surgery
c. delay surgery for 12months and stop clopidogrel a week before and do surgery

48

15)
16)Meningitis scenario with mononuclear cells very high some few neutrophils and rbcs given asking orga
strep pnuemother options of bac
17) 38 year old obese lady primigravida presents to u at 10weeks. Her mother diagnosed with DM at 52yrs
for it. What is the most appropriate management for the her?
a. Ogtt 26-28wks
b. Ogtt 20wks
c. Fbs 1yr
d. Ogtt 6-12 weeks postpartum
23.) abroriginal child comes with lf side green purulent ear discharge and nasal discharge both green and
dull retracted TM what is most app:
a) amoxcilin
b)ear toilet
c)prednisolone
d)reassure
24)
25)
26)man with loin pain and hematuria what in the options needs surgery:
a. severe pain for 48hrs
b.fever
c. vomiting nausea
27) again same scenario but ct done 1cm stone in renal pelvis what to do:
a. eswl
b. surgery
c. percutaneous nephrostomy
d. observe and hydrate
28)16 y/o girl with a BMI of 30, who has recently become sexually active, what to screen for?
BP
Chlamydia
DM

29)
30) 28yr old lady lst childbirth 3yrs back, regular cycles, trying for the second one, intercourse timed arou
pathologies- confirmed, whats the reason for difficulty to conceive ?
A antibodies to semen
B. male infertility- abnormality of semen
c shortened luteal phase
D inappropriate timing
31)mmr vaccine quest egg allergic child what to tell the mother
32)
32) abd xray of pt with LBO asking dx: sigmoid volvulus
a. psudoobs
b.sigmoid volvulus

49

c.ca cecum
33)pregnant lady with MVA comes with complaints of abd pain on examination tender uterus and bleeding
whats the most app next:
a. IV fluids
b.ultrasound
c.amniotomy
d.urgent cs
34
35) Pt. had child 3 months ago now she is very stressed & thinking that she may hurt the baby or may be f
when she lift hem , dx?
A) overvalued idea
B) obsessions
C)postpartum depression
D)postpartum psychosis

37) colles fracture xray give exactly dinner fork deformity and asking when to review pt after cast
a. 2wks
b. 1wk
c. 3months
d. no need
39)
40) An old recall of old man on morhine ,drowsy and dehydrated wife concerned that his medication is cau
a. decrease the dose of morphine
b. hydrate the patient
Thats all guys, I am saturated remembering the questions, will try and remember more and post more.
My exam was okay but I am not sure how i answered? I did get recalls but the options and words differ a lo
whole scenario but they r a must for everyone going for the exam please be active on the group and ans a
helps u remember in the exam. Just read JM, Hb and recalls thats what I did and also Medscape and few r
Finally my thanks to evey single person who helped me in amedex you guys are all amzing . sp

51. 3 days oliguria , after knee surgery , appro

next :

50

-US bladder
-CT
-IVP

After an explanation by dani i choose 1

52. 9month old boy with complain of fever 39, cough, tracheal tug, intercoastal recessions and lethargy ca
fluids and oxygen.
A) pneumococal pneumonia
B) croup
C) bronchiolitis
D) anemia
Answer is a

53.scenario of multiple mypeloma with anemia and esr 104 ask for d diagnosis
I went for bone marrow examination
54.that old scenario of football player got down and than stand up in few minutes and start playing after 30
I choose vasovagal attack
56.pt with gout attack and got renal failure and asked for the treatment and i choose steroids
57. pt on opioid become drowsy, dehydrated wife think opioid harming him, next
Reduce opioid, continue same dose, hydrate
I went for hydrate the patient first
58.2 qs about nocturnal dusuria in a 4 years old child and one with option urni and cs and no option of nothi
with the option of nothing to do now
So i choose urine cs in one and nothing to do in other
60.dvt two or 3 scenarios almost similar so nothing to worry its from repeated qs only
61.scenario of schock and asked for what to do next.. easy qs to start ns
62.scenario of rhabdomylysis and ask for Mx
Ns with desired 2ml/hr urine output
Ns with desired 1ml/hr uo
I went for 2ml / hr.. old qs
63. CT scan of a sheep farmer.. ct was not so clear but as dimensions were given I could have see cysts so I
cyst only
a. serology for hydatid cyst
b. aspiration of the cyst and cytology of its fluid
ANSWER IS A
64.same recall of svc syndrome and what to do next

51

Ct chest
65.that 19million sperm/ml qs
And m sure its not only 19million its 19million/ml
And answer is pregnancy is possible
66. two qs about smoking cessation with one in pregnant female
Non nicotine chew gums
Nicotine therapy
I went with chew gums
67. in other smoking cessation I guess normal lady want to stop smoking and ask for help.. what to do first
1. nrt
2. chew gums
3. first decide the plan for smoking cessation with her
I choose 3
68
69.old recall of pregnancy with 2 fetus 12weeks pregnant
Folic acid and iron
70. lady with 3 fall history in market which she remembers and feels like detached and i think its an old scen
1. eeg with vediometry
2. ask the witness
3. lp
I chose 1
72. A patient is confused and agitated, lawyer comes to you and asks you to witness his will. What will you
A- Witness will
B- Refuse to witness will

Answer is b
73.that scenario where mother dont want to immunise her child
Answer is respect her wish
74.scenario of iga nephropathy with h/o recurrent hematuria
75.scenario of engineer the old recall where we do endoscopy as all other conditions are normal
76. A 60 y.o. man develops lightheadedness and palpitations. He has hx of thyroid disease and we
failure. He is on thyroxine, ACEI, diuretic. ECG is given clearly showed AFib. What is the next ste
a. Cease thyroxine
b. Start digoxine
c. Start b-blocker
d. Start verapami
Answer is c

52

========

2 questions on skin with picture scc, bcc asking for diagnosis and management

SLE with diagnosis asked

X ray of COPD asking for management

X ray of SBO asking for management

Fracture of tibia and fibula, open communited #, what is the most important step in management?
a. Removal of dead and devitalized tissue with antibiotic cover
b. Urgent blood transfusion and oxygen.

Question on tetanus prophylaxis

Many questions on liver and jaundice.

Many questions on HOCM asking for immediate management, diagnostic test

ECG showing digoxin toxicity asking which is the causative drug.

ECG with second degree heart block asking for management

A young 24 year old presents with explosive diarrhoea irritable bowel syndrome/ inflammatory bowel disease

Atypical pneumonia asking for management (choice of antibiotics given in the options)

Child with slapped cheek syndrome. School exclusion asked

One CTG asking for management of labour.

Management of child with sepsis ceftriaxone and then admit to hospital.

These are all the questions i could remember, i apologise for some being incomplete. I had a lot of new questions
Study abdomen thoroughly, i got many questions in that field. Be sure to read topics thoroughly (especially comp
questions surprisingly nor did i get any CT scans. I really really hope i Pass!!!! Good luck to us all, thanks gold sta
bless.
=================

53

1-

3- 5yrs old child with vomiting and headache since 6 wks temp: 37.8. Exam: non tend
node in posterior triangle of neck best next inv?
A. Blood culture. B. Ct head. C. Urine culture
4
5- a picture of melanoma on face

===========

My recalls 19 sep 2015

1.ct scan medulloblastoma..with cerebellar signs..
5.teacher calls u regarding an update on a child who needs to go on a camping trip.she
tried to call the childs parents but could not reach them.it was mentioned that the childs
doctor should be contacted regarding such issues and she calls u..what should you do?
1.tell her to bring the child to see u
2.call the parents try to get in touch with them for permission
3.tell her to follow the previous plan
8.what is the area concern with drawing a pentagon? Paritels lobe=constructional apraxia=lewy body demen
9.capsule endoscopy 2 scenarios
10.follow up colon cancer
..
13.ecg-dogoxin
svt
heart block
17.ct scan of melanoma mets..pt with history of melanoma
19.varicocele examination findings?
..
21.pead hernia in scrotum pic what to do now?
usg,afp
22.truck driver with diarrhoea what inv?stool culture
23.x ray of an old man complains of constipation..the enema showed a stricture,he is on
clopidogrel for stent..what is the time of surgery?
24.holding the stick on osteoarthritis? opposite leg for the stick
?
26.one scenario of a herpetic rash on a child..it was really long with description of the
rash..
28.colles fracture follow up?2 weeks
29.post partum obsession scenario..fears of hurting the child..ask for the dx?

54

30.nurse smells of alcohol on confronting her she denies,what to do next?

tell her to meet her gp
nursing board
32.scenario asking for medical certificate for failed exam..don give
34.mother
35.cerebral tumour scenario from the HB
36
37.pt on polypharmacy taking anti parkinisons drugs who has pseudo obstruction..
38.old pt in nursing home who used laxative complains of distention of abdomen typical
sigmoid volvulus scenario..mx
39.pancreatic pseudocyst scenario with ct
40.?
initially it is asymptomatic
causes infertility
44.45.MALE who comes with urinary urgency but no stress incontinence what is ur mx?
guys,thats all i can rem for now.i didnt get any stats,dermato questions.
i didnt get too many recalls and some questions were new and twisted.im hoping those
were pilot..
the new questions took up a lot of time..luckily i was able to catch up cos of the
recalls..must do the recalls of last 3 months and the previous days..i got direct questions
from the last few days recalls..

====================

Sep 2015 Thanks to all amedex administration and members.

really i cannot remember the stem of this qestion but

read

about obstructive hydrocephalus management

55

1--

Mother bring her

baby 2 months age . live in family house ask about vaccines to protect her baby

DTP vaccine to parents and grandparents

DTP vaccine TO grand parents
Influe
2---a 32 weeks pregnant with motor vehicle accident came with bp 90/56,pulse 110,fundal height 36wk,next managmnt
1.cross match 4 bag blood
2.iv dextrose 2l over 6 hours
3.usg
4.cs
5.amniotomy

nza vaccine

3--5 years old boy with cough from 12 months before, was on salbutamole n also tkn oral prednisolone..he has an eczema history, both parents are smo
which one is the best medication for prevention which is used in INHALATION MODE?
a. l monte
b. Chromoglycate
c. Salbutamol
d. Fluticasone
e. budesonide
4-- worst interaction for renal disese
1.gentamicin+cloxacilin
2.gentamicin+cholramphneicol
3.gentamicin + cephalothin
4.interaction with penicillin

5--A young lady with H/O rhinorrhea,low grade feve,photophobia with some neck stiffness.
LPprotein,glucose both are normal,
rbc-100,
lymphocyte-3oo,
neutrophil -20
whats your management
1.iv ceftriaxone
2.iv acyclovir
3.analgesia and observation

6--question about man 64 yr old prostate cancer ..gleason score 4 ..small focus of adenocarcinom
Radical prostatectomy
External beam radiation

56

Orchidectomy
7--question about man 44 yr old prostate cancer discovered ..gleason score 7 .. t3 n0m0
Radical prostatectomy
External beam radiation
Orchidectomy
9--child 6 yr old with asthma mother gave 6 puff of salbutamol .NO improvement speak in words
Give another 12 puff of salbutamol
Give ipratropium

10--13 yofemale , change behavior in school , u had pemission to interview mother , what to check
-history of family mental dis.
-her mood and appetite
-her relation with parents
-change of her school grades..
10--old recall with pregnant with genital herpes, wot to diagnose latencyPcr
, igm now,
biopsy from ulcer( I marked pcr)
Send for Serology now

11--.a young woman present with sevre chest pain aggrevated by inspiration.on exam ahe has a c
sound (I clearly remember ) in left sterna border,she has H/o pulmonary embolism before.whatinv
1.antinuclear antibodies
2.ctpa
3.V/q scan
12-- 80 yr old woman fall from a low high chair and intramedullary nail is given for her femoral frac
advice during discharge??
1.alendronate

57

2.dual energy xray

3.warfarin for 6 mnth
4.heparin
13--What study will you do to find out association of naevus and occurrence of melanoma in your c
1.Case control
2.Cohort.

14--moderate croup scenario with 02 saturation 93% asking next initial appropriate?
.
1.supplemental o2
2.oralprednisole
3.iv methylprednisolone

15--salmonella case in your gp practice in the last week.what study will you do to find out the caus
1.Case control
16--.a man present with left hand and leg weakness.he is on aspirin.she has bilateral carotid arter
h/0 coronary angioplasty 5 years back.what to do?
1.add warfarin
2.addclopidogrel
3.carotidendarterctomy

58

4.continue same medication

17-- old lay taking carbamazepine and drink alcohol 1sd per day .pic of cleft lip.cause picture was
1.genetic
2.carbamazepine
3.alcoho
18-- a 3 month old child vomit out of milk for 3 days.he was gaining wight previously bt no wt gain l
electrolytes value was normal and urine tset also normal.dx
1.gerd
2.pyloric stenosis
19--uti young guy comes and says he cant sleep so has started on marijuana . he is a good studen
term relationship with his present gal , family v supportive , has come along . tells u to give him pill
so that he can get better as he is sure its sleep thats a problem . no suicide ideation .ur mx ?

1.zolpidem
2.sleep hygiene and routine
3.tell him to stop marijuana
venlafaxine
20--obstructive apnea in a fat man long term Mx
a-CPAP at night
b-Surgery
c-Wt reduction
21--iron deficiency anemia, endoscopy normal, colonoscopy normal but could not go beyond hepa
symptom of GI. Next?
Capsule endoscopy
CT colonography
22--orbital floor fracture.which will u find..dey asked similar one we discussed most consistent one
1.instable TMJ
2.subconjunctivalhemorrhage
3.loss of visual acquity

59

4-loss of sensation at cheek

23--Scenario of the female who was on peritoneal dialysis and cope with that and suddenly refuse
has fever of 38.2 and some rebound tenderness on abdomen.what is the consistent finding with th
1. blunted effect
2. depressed mood
3. denial
4.disorientation

24--A mother complaining that her 10 months old child cant sit supported, he was born 35 weeks,
of the delay
1.Normal delay
2.Due to prematurity
3.Cerebral palsy
25--scenaro of hyperkalemiapt present with confusion,K was 6.5,urea and CR also very high.next
1.urgenthemodialysis
2.rectal calcium resonium
3-5%dextrose with insulin 10 unit

26--old recall with cxr, not typical for sarcoidosis but hilar nodes prominent in one lobe and patient
intermittent abd pain with hematuria.what next investigation?
1.Ace level
2.Mt test
3.ct chest
4.ctabd
27-- patient presents with symptoms of dysuria and hematuria.She has a history of weight lossfrom
malaise.On U/E Rbcs and pus cells present.Your diagnosis?
a)Renal cell carcinoma
b)Renal tuberculosis
c)Bladder carcinoma
28--.xray of collesfracture.asking for follow up after

60

1.1 day
2.1 week
3- 2 wks
29--young guy taking about 20 or25 tablets of paracetamol for suicide his family bringed him to h
A-activated charcoal
B-paracetamol levels
C-N acetyl cysteine
30--a young 25 yr women with rash on face and hands with sewlling of joints .what is the consistan
Ana is 1/640,speculated
Dna 25
Ra factor 14
1.chondrocalcinosi
2.punched out lesion
3.periarticular osteopenia
4.periarticular erosion
31--a man on antidepressant rx for 2 years for 1st episode depression and now recover cmpltly an
rx.best advice
a.continue for another 3 years
b.decrase dose over 2wk interval and discntinue then
c.decrese dose every alternate day and then discntinue

32-Which of the following is least likely to be relieved on HRT

1.depression
2.insomna
3.hotflushes
4.vaginal dryness
5.urinary frequency
33-. A young woman with H/O blurring of vision for 2 days.O/E 6/12 on right eye 6/36 left eye.whats the ap
1.visual evoked potential
2.LP

61

3.CT

34--.Young patient presents withankle dislocation,loss of pulse and some paleness at ankle at ER.what will y
1.Reduction in ER
2.Send him to OT
3.Immobilize with plaster
4.surgery

35--.a middle aged man with long history of diabetes present with pain and redness in leg,temparure was rai
venous dicsolration around ankle.next inv.- previous H/O dvt and pt is on warfarin (mitu)
1.duplex usg of leg
2.blood culture

Angiography
36--9 mont old child present with fever 39,cough,dyspnoea,tracheal tug present but chest was clear.,whats u
1.rsv bronchiolitis
2.sterpto pneumonia

37--65 yr old lady with H/O DM,ischaemic heart disease was on antidabetic,anti htn drug.her routine inv sh
HbA1c-normal
RBS-normal
Cholesterol-4.4
She is on strict dietary control and do regular exercise for a long time.which is your next mx
1.start statin

62

2.increse her antidiabetic medication

38--.advise her to increase exercise
case of anal fissure and urine retention , after bladder catheter to relief retention wt to give next
1. GTN cream.
39--pt wth mass infront tragus with saliva dribbling next
1.ct head and neck
2.fnac3.us
d- intraoral xray
2.DRE
3.proctoscopy
39--pic of old lady with painful swelling infront of tragus with redness.cause
1.duct stenosis
2.duct stone
3.coxakie virus
4.poor oral hygiene
40--which of the following UNLIKELY cause fetal growth restriction
1.cmv
2.triosomy 13
3.thalassaemia minor with hb 8
4.mother with essential hypertension require methyldopa
5.lupus nephritis
41--young man accidentally discovered 5 mm stone at upper calyces.i Next?
a. ESWL
b. PCNL
c. IVU
d-review after 6 months or repeat ct after 6 months
42-- ctg scinerio meconium passed HR 144 variability 10 no acceleration no deceleration
>> 1. Normal ctg
>> abnormal ctg asBaby sleeping

63

>> Hypoxia 20 %
>> Hypoxia 10%
43--cardiovascular risk in 5 years for 54 yrs male non smoker diabetic bl.p 149/89 chart give
44-- cardiovascular risk in 5 years 34 yrs old male smoker non diabetic bi.p 125/35 chart given
1.

====
Read only high lighted
Read thz wdout high lighted

64

65

66

67

====

elderly pt came with swelling in rt jaw angle hx of dry eyes and polyarthralgia. For 5 y
done was nl next mx?
A. Sialography. B. Ct... C. Biopsy of sialo duct. D. Us

- 65 yrs old man after knee surgery developed abd distrntion and vomiting ( pain wasn
cause ? There was a ct wasn't realy diagnostic

68

A. Colon cancer
B. Psuedobstruction
C. Volvolus
D. Fecal impaction
18- A Q anout B12 deficiency sign and symp don't remember exactly just had segmen
neutrophil low HB MCV 118
A. B12 deficiency
B. Iron deficiency
C. Folic asid deficiency
19- a COPD pt with shortness of breath on 8L/min O2 then got worse next mx?
A. Intubate him
B. Change to lower O2
28- 48 yrs man sever depression refused to eat and drink and medication and refused
next?
A.take consent from his son to perform ECT
B.consent from mental health tribunal
C. Consent from higher authority
D. EcT without consent under the provision of duty of care
E. Give nasogastric feeding and antidepresant

==================

6.bmi chart plotting..marginally obese child..

12.jaundice in pregnancy..scenario of a gp asking a pregnant women to get surgery for
asymtomatic gallstones
20.milestone question cannot ride a bike at 4 years..dealy
41.frusemide,nifedipine drug interaction
===================

28) 2 scenarios of schizophrenia. One asking about lack of insight. Other asking for first drug in treatment of psychosis
29) case of achalasia
30) case of sigmoid volvulous..x ray shown
24) case of Q fever
25) case of congestive heart failure.
26) in case of acute stress what hormones increase.
a) increase TSH increase cortisol
17) case of enlarging parotid swelling with facial nerve involvement.What is your next investigation.
a) CT head and neck.

69

13) case of pancreatic pseudocyst. Man chronic alcohol consumer.

14) Fibroadenoma in a young female. What to do next:
a) FNA
b) core biopsy
15) case of PICA
8) case of sheehan syndrome
9) picture of melanoma
10) picture of erythema nodusum and case of sarcoidosis.
11) RBBB with AF ECG
7) a case of antepartum hemorrhage. Woman lost 1000ml ( i cant recall the exact number) blood loss. What will tell you it is p
a) tender uterus
b) abdominal pain
c) no fetal movements
d) high lying mobile fetal head.
6) A case of competitive gymnast with secondary amenorrhea. Asking cause..
a) hypothalamic pitutary
b) the rest of the options were irrelevant
1) scenario of whooping cough in a 5 month old child.child is not cyanosed.Asking what will be your action.
a) reassure mother it is not pertussis
b) prescribe oral abx for 5 days and discharge the baby home.
c) admit and observe.
27. Xray for ankylosing spond. Ask management.
28. Old recall of old patient with intestinal obstruction ask diagnosis. Xray given not clear.
=========

No milestone ques unfotunatly

Lots of ethic cases!
15 yo boy homless.. wt is ur more important advise :
There was an option abut STD prevention
Q fever case (pneumonia and hepatitis)
Coxiella
Pregnant lady in 3 trimester lost 200 cc blood ..now with bad condition .. bp :
Bp: 90/50..pr : 130.. garding and tenderness.. firs inv ?
Resuscitation
4 or 5 case about post operation complications!!!
2 case of anemia :
Coombs +high retic .. micrositic (I choosed autoimmune hemolytic )
Megaloblastic with some gastrointestinal problems ( I choosed pernisious anemia)
Lady mother diabetic, father hypertention has bp :160/80 BMI : 31 first management ?

70
Cardiovascular risk estimation I picked:
There was no option exercise or dietry plan
I think one was treatment of HTN
A photo of a smoker with finger amputation and history of discoloration in the cold weather
Burger(tromboangitis obliterans)
A long question about hyponatremia
A question of ecg hyperkalemia .asked rx?
Recall of child that can not communicate in school .. interest in matemathic .. no eye contact .. mild language delay?
Aspergaer was one of options
============
20. CTG q/s: meconium aspiration

==============
osteoporosis in a 61 year old man with BMI 18 -> I choosed BMD
6 hours after birth the child develops jaundice most common cuz -> ABO

postpartum psychosis / depression in the past now the lady is worry in her current pregnancy. I choosed delay SSRI to after pr
no signs of anything! risk of recurrence is 30-50 in post-postpartum psychosis and it is highly strongly recommended to start a
other diagnosis were awkward to be frank! the other one was conduct.
==========================

Impottant topics/chapters to revise ..

Arrythmias..i got 5 or 6 ecg s ..one of atr fib ..asking treatment..pulm embolism ecg very clear ..braycardia..
Hydatid cystgot one ct and one ques regarding def host..
Delirium..
Dementia..got 3 4 questions so read the topics carefully
Pyromania..one question
LFT s..most most important ..plz revise the chapter jaundice very carefully..there is a chart of diff LFT S in JM just revise tha
mcqs from that chart ..
Anemia..i got 3 to 4 mcqs ..revise that chapter the questions are like they give values hb ..mcv ..esr..values of LFT s RFT s
remember the values ..
Constipation chapter ..in children esp
Anal fissure..simple scenario streaks on tissue
Large bowel obstruction..
Apgar score
PPH
Labour ques about 2nd stage
CTG ..
Hypertonic..hypotonic..hartman and dextrose plz read that which solution to give when
I got recalls but the scenarios were diff so better to read the topics thats what I think..
and discussions on goldstar group r very helpful..so sorry for the delay ..
Most imp thing is time management that I didnt do well :/ need prayers

71

=============

. one man was frm village side,, drinking 14 drinks per weekned , family hx of cvd, heart disease, he
he is smoker too.. advice for hypertension
a. 24 hr bp monitoring ,
b. homebp check regularly
c. advice stop alcohol
d.admit
==================

ecg with complete heart block and svt of a child

I choose temporary pacemaker

8.scenario of pseudoobstruction with x ray given as pt with h/o of some surgery 25 years back not present
and x ray suggestive of toxic megacolon .. age is about 55 I guess..
Treatment
I choose gastrogaffin enema
COLLES # RX

18. lady going to be grandmother ask abt which vaccine necessary to her to protect baby
- infuenaza
- dpt
- Typhoid
answer is b i.i tp or dtp whichever in choices

32. 16 yrs old gal bmi 30 , is starting her sexual life and has come to u for advice on
will screen her for ?
a) chlamydia
b) pcos
answer is b for me

43.old scenario of marijuana pt taking it for pain relieved and now started hypnogog
1. refer to psychiatrist

72

2. refer to drug and alcohol assement center something

Rest were not valid option I choose 2

51. 3 days oliguria , after knee surgery , appropriate next :

-US bladder
-CT
-IVP
After an explanation by dani i choose
=======
48.Lady at 16th week of gestation with positive FH of down syn,what would you do?
Triple test 9-13w
amniocentesis
cvs
bhcg
Quader test

================

59.Young lady irritable and uneasy with periods..she has regular periods and no other complains..some symptoms of MMS..w
NO option for relaxation therapy..so I opted for evening primrose oil daily as no complaint of periods
child with sweeling and purulent discharge from ear..tenderness on back bone of ear(like that)what next inv
Culture of discharge
Blood culture
pt presented with oliguria in emergency..he has fracture of tibia 4 days back..what is initial inv
Usg
CT
Ranal angiogram
Urine culture
19.PT presents with 24 hrs history of vomiting and abd pain..tenderness in lower abdomen..Xray shows dilated small intestina
levels ..Dx
Pancreatitis
Cholangitis
Cholelithiasis
Crohns Ileitus(I pted for this)..dont know rt or wrong
pic of ant shoulder dislocation.wat u do istreduction in ER
fracture of clavicle Xray..management aske ..initial

73
Old recall..pregnant with family history of diabetes at 10weeks.wat will u do
Ogtt at 24-8wks
Ogtt at 20wks
FBS now
.some ctg was given.with no acc and deleration and gr 140..
Hypoxia 5% chance so monitor it regularly
Fetal demise
And some weird options.i went for A
=============

scenario of type2 dM in patient had amputated lf leg few yrs ago and now comes with long lab inv HBA1c i
HTN, inc lipids what to do to prevent other leg amputation:
a. meticulous foot care
b.tight glycemic control
c. lifestyle modification
d. cant remember

36) 26. pic of an infant with cleft lip . mother drinks just a glass of wine with hwe dinner every night . she is
epilepsy . what could be the reason for it ?
a) genetic
b) carbamazepine
c) alcohol

59.and another case with ct done for something else revealed 0.5cm stone at upper calyx.. no uti h/o is speci
to do now
a. eswl
b. nephrectomy
c. review after 6 months
no choice of doing nothing
i choose review in 6 months as it it is 5mm with no symptoms so v ll prefer spontaneous it ll come out
=======
12. Other q/s with hypercalcemia and clinical features: asking investigation, so hypercalcemia is not be missed.
13. Questions from renal system with long stem.and lab...which i think is new

26- a 22 years lady newly started sexual activity came with first pop results that was C
A. Pop after 6 mon
B. Colposcopy
C. LEETZ
No option for pop 1 yr later
20yr n young= cin 1=repat papa in 1 yr

74

>20-50 yr=papa 6 n 12 mnths,,hpv at 12 mnth

==============
A ques about pertussis profilaxy in family
(ERYTHRO??)

Cxr latral and ap ( I didnt found any thing )..history of intermittent respiratory symptoms and crackle in the left lower chest..n
hemoptysis
I picket chronic bronchitis
2. cause in child: 4 years with grunting and fever, resp distress: Pneumonia, croup, bronchiolitis

26) Trichotillomania scenario but I dont remember the question.

24) A lady with OA of left knee for 10 years presents with pain over the lateral aspect of the leg. What do you expect on exam
1. Positive straight leg raise test
2.Antalgic gait
3. Loss of sensation over lateral aspect of leg

19) Development milestones of a 4 year old child

2)handbook question 3.042

1)Photo of red macular skin lesion, but not erythema myltiformme or margimatum? With a history of migrant, blood stained s
loss, malaise
(Looked like a TB history to me)
1.bronchgenic ca
2.pulmonary TB

75
44 vaginal soreness
45PMS..mgt
38 GERD in baby
33 Diabetic with amputation...
34 SLE joint findings
35 Preseptal cellulitis mgt ...HB Q 2.081
36 Colles # ...F/U
37 CT gastric outlet obstruction

29knee sx...oliguria...inv
30 Antipsychotic drugs causing weight gain ...inv
Hyperkalemia with renal failure mgt
15. Phobia ...mgt
16. Renal stone mgt read very well.
17 meningitis Viral..mgt
18 Meningitis TB
19 Renal TB
20. Glomerulonephritis

13 wat will u do to find out the association btw melanoma and nevus?
a- cohort
b- Rct
c- case control

76
d- case series

8. X Ray LBO ...mgt

9. Picture of skin rash...? Varicella...asked school exclusion
10. TIA ...trt. Read TIA and Stroke management very well.
11. Endocarditis..trt

2.Pilonidal sinus treatment . HB Q

3 HB Q 3.283 asked the diagnosis.
a addisons disease
b cushings syndrome
c metabolic syndrome
d hypothyroidism
4. ECG PSVT...trt
5 ECG Heart block Type 2 mobitz 2...treatment
6. ECG MI...mgt

25. Scenario for female not pregnant and had mania ask about management i choosed lithium. No olanzapine.

26. Two Q asked with same Scenario of premature ovarion failure ask about diagnosis and another Q ask about ho
is not sexually active now and not like to be pregnant. I choosed HRT.
29. No statistics or ctg.
30. Old recall about grand mother vaccination before delivery of her daughter.

77

==========
20. Scenario of acute limb ischemia most important next mangment . I choosed iv heparin.
21. Old recall about brachial plexus injury.
22. Pic for molluscum ask about school isolation.
23. Scenario about alzehimer and IHD ask about management . I answered
Memantin.
24. Old recall about 10 cm psedopancreatic cyst behind stomach ask about managment.

17. Old recall about allergey to egg and MMR vaccine.

18. Patient with old mi and cholesterol 6,5 what to add to management, i choosed statin.
15.
Old recall about chlamydia is asymptomatic.
13. Same question os STEMI ask management, coronary angio.
12. Ecg inf STEMI ask diagnosis.
11. Senario of anaphylaxis what is management . Im adrenalin.
10. Senario of post partum convuloin . What is the most immediate management . I choosed, air way clearnace.
9. Senario about pulmonar embolism after surgery how to diagnose . Ct angio
5. Old recall htn and mi . Cohort study
4. Old recall about least effect for hormonal replacement therapy.depression.
3. Ulta sound liver looks metastasis for me
2. Ct brain ask about diagnosis intra cerebral hge.
1. Pic of erythema nodosum and patitent complaining from hemoptysis old recall ,TB.

27.i got many questions from ethics I cannt remember the scenarios as dey were new for me..but if you are perfect with wat to
should inform and all..u can answer dem same with psychiatryI had manyjust read d topics..questions were twisted for m
question in recalls..please read d topics
26.anterior dislocation of shoulder- treatment-closed reduction
23.case of effusion of knee,wat to do next-aspirate
.x ray of sbo given,asked for d cause-adhesions-patient had a h/o appendicitis surgery
study of number of diabetis patient in your area-cross sectional,which group to select for vitamin d-general practice patients
diabetis patient with ulcer on medial malleolus-venous ulcer
ECG OF AF-treatment asked-beta blocker
18.picture of amputated finger of foot-patient is diabetic-cause was asked

78

.ECG OF AF+LBBB+RVH
.CT OF OLD brain infarct..plz check it.it appears like a hmg but old infarct has hypodense area surroundin it
.HYPERKALEMIA 5.6,ECG not given,treatment-ca resonium
14.L4/L5 dis prolapse and a question on spinal canal stenosis..read how to differentiate these two a very long scenarios were g
12.22 yrs old boy comes with mild abdominal pain and painless hematuria,family h/o uncle died of cerebral hmg-wat is d diag
OPTIONS WERE renal contusion and AIN.
BMI 25,PCOD wants to conceive-chlomopine citrate
10.old lady menopause uterus removed comes with hot flushes.wat is d treatment-ostrogen only patch
. 2 scienarios on scrotal swelling asking for next line of investigation-u/s
.old lady after menopause comes with ovarian cyst-investigation asked-tumour markers
7.asthma in 5 yrs old with nocturnal cough and after excerise.wats d treatment-na cromogy
.old recall of ctg given which is normal..but 39 wks pregn lady not feeling the movements of baby.what to do next
question in which features of parkinsonism were given and diagnosis asked
.which feature differentiate alziemers from lewys dementiaParkinsonism features
=======

50. 6 months old infant vomiting gaining wt noramy-GERD

51.lots of questons about psych and ecgs

47.question about denial of depression

48. narcissim
49.dialysis pt now refusing-disorientation
mass infront of tragus,dripping of saliva ct
2.13 year old girl with history of unwanted sex-child protection authority

43.infant with systolic murmur

44.infant with hydrocele next investigation

girl with bmi 30 started sexual activity what to screen for-chlamydia

79

. a 16 weeks pregnant woman found to be HCV +what next

a-HIV testing
b-gonorhea pcr
c-chlamydia pcr
d-HCV PCR
1. .mother come with 10 month old infant with increase head size from 25 percentile at birth to 75 percentile now and on examina
open anterior fontanelle what will you do next??
a.CT SACN head
b.check CMV infection
c..Thyroid function test
D.head ultrasound
e.rubella test
2. 19 years Unmarried women presented with slight lower abdominal pain.On USG 6 cm SOLID mass beside uterus.whats your

1.Teratoma
2.Mucynous cystadenoma
3.Corpus luteal cyst

3. Women brings in her child and tell that she is worried about him. He is sometimes very mischevious and gets very naughty , s

have to even beat him and lock him sometime. What would you do first?
a. Call child protection authority
b. Get the collateral history from the father
c. Talk to the boy

4. scenario of varicose vein and mi and on clopidegral started 7 days before.pt is on stent and clopidegral..

a. refer surgery after 12 months and stop clopidegral 10 days before surgery
b. do surgery now
c.give platelets and do surgery
5. old pt with known bilateral chronic osteoarthritis, develop parasthesia and numbness in the lateral side of leg below knee condition worse
walking for 10 min, wt is the important thing to examin in this pt
a- SLR sighn positive
b- Any tenderness in lateral condyle
c- Any loss of sensation in the lateral side of leg
Months old child of fever 39, cough, tracheal tug, intercoastal recessions and lethargy came to ED. You gave Iv fluids and oxygen.
A) pneumococal pneumonia
B) croup
C) bronchiolitis
D) anemia

80

1. After removal of central venous line a lady developed facial swelling and swelling around neck.what is the most appropriate

1.CT chest with contrast

2.CT head,neck
3.CXR

6. Old age female had a will not to admit her when she is terminally ill , today she fall & had # femur , she became very drowsy a

now ?
A)Operate her Fracture
B)arrange family meeting
C) admit her
D) Refer to Emergency department
E) Refer to Palliative care unit

7. pt on many medications , indapamide, verapamil, prendopril , aspirin.. present wth light headedness and exactly similar to a

a- valsalva manover
b- cease verapamil
c- temporary pace maker
D- cease indapamide
8. patient with history of mi last month comes with cholecystitis pain not responsive to iv antibiotics what is next

a)change antibiotic
b)percutaneous cholecystostomy
c)ercp and extraction
d)surgery

===============

gout / pseudogout in an elderly with acute knee pain.

frostbite In a man (seemed not a gangrene)
follow in 4w / nothing to do
melanoma pic (2 tests)
acute red eye in a Pt w hay fever and back pain I chose iritis

81

AF ECG (hx was a man with multiple episodes of fall)

10 months old with multiple abscess
CIVD
SEVER pneumonia treatment in a child I chose flucloxacillin
prostate cancer screening (2 questions) I choosed PSA also DRE was. but I have read many
articles that screening of prostate cancer is PSA with DRE

tophus on a finger in a pt on allopurinol, he has come for surgery I chose surgery other choices
were not relevant.
post-op Fever on day 3 with umbilical redness and severe pneumonia asked for source of
infection I chose umbilical source
osteoporosis in a 61 year old man with BMI 18 -> I choosed BMD
ctg base was on 120 two accelerations asked for the next step.
I have forgotten the choices
6 hours after birth the child develops jaundice most common cuz -> ABO
father comes with her child, her teacher has mentioned some inappropriate sexual behavior in
school -> child abuse
Lewy body dementia asked for diagnosis - learn the clinical features
another question asked for the difference of Lewy body with dementia - answer all about the
prognosis / not the clinical features

vit D study in Australia I choosed cross sectional

40 y old man comes with all lower motor manifestations eg. weakness, fasciculations asked for
diagnosis, lacunar infarct/ lower motor disease
I chose the second one,
cuz in lacunar infarct should see ataxia, Parkinson signs and some sensory deficit

82
that famous case of DVT redness on thigh! answer was definitely unfractionated heparin
5 year old boy with recurrent AOM, had tympanostomy tube and now has discharge and many
things more asked what is the best step for management I chose discharge culture and
microscopy
slapped chick cuz -> b19
parvovirus infection was CONFIRMED in a pregnant woman -> next USS for 12 weeks
vaginal redness with white plaque what is the next step in diagnosis -> look for clue cells, look
for hyphae I chose the 2nd
primary amenorrhea -> what helps you to diagnosis: asking more questions about the pubarc! I
choosed this one cuz the step was leading me toward this :D I thought this would be the correct
one cuz the most common cuz of primary amenorrhea is constitutional growth delay
postpartum psychosis / depression in the past now the lady is worry in her current pregnancy. I
choosed delay SSRI to after pregnancy cuz here there was no signs of anything! risk of
recurrence is 30-50 in post-postpartum psychosis and it is highly strongly recommended to start
antipsychotics after delivery.
acute mania case ->Risperidone
another one -> lithium
11 year old girl with staying away from school ->I chose truancy
another case was a child who goes to school but does not speaks in class, enjoys breaks, and
fights with other classmates ->mutism?!
other diagnosis were awkward to be frank! the other one was conduct.
hiatal hernia ct scan (pt comes with SOB and abd pain)
same child what to do after confirmation of recurrent UTI ->cystoureterogram (PUV assessmen
BANGKOK 18 th September Recalls
PARDEEP OMANI
10.screening of prostate cancer in pt whose father has prostatic cancer at
same age 55 ,, DRE was done already
a. now do psa after 2 weeks.. it looks relevant , no other
11.Picture of para umblical hernia in 5 yrs child ,, no symptoms
a. surgical repair
b. reassure
c.rest were irrelevant

83
12. Picture of scabies..treatment was asked
13. 55y old man after return from Bali after short holiday of 5 days with his
wife presents with Fever, chill, abdominal pain, malaise and jaundice. All of
liver function tests show impairment (AST, ALT, ALK). Dx? (August Recall
2015)
a. Hepatitis A
b. Hepatitis B
c. Hepatitis C
d. Cholangitis
e. Malaria
14.pregnant at 10 weeks, she has done IVF after several years of infertilty ,
she is concerned about Down syndrome because her cousin had a baby with
Down Syndrome
a- Nuchal Transclucency
b- amniocentesis
c- CVS
15. Most common cause of macroscopic hematuria.. bladderca
16. Csf :
there is RBCs
Glucose low
Leukocytes were also there
a- zeilneilson stain
b- viral
c- bacterial culture
8.Pt with long standing back pain, no Rx at all, xray show bamboo spine,
patient already took paractemol and codeineRx?
A. Mtx
B. Indomethacin
C. Chloroquine
D. Infliximab
E. I dont remember
18. You are visiting home nursing for elderly and the nurse told you that
there is 85 years old man and 74 old woman both in realtion and this irritate
the residents. Nuse asked you to change the medicine for them
Take to them
Take to each one alone
Take to their families
Do not change the medicine and say doctor has authority to decide and its
final
20.other renal stone at distal site with urinary problems size was 4mm===

84
ESWL was in opti
19. one scenario of stone in upper calyx of kidney in young age no symptoms
in urine..
I did ,, review xray after 6 weeks
rest of options were surgical
22. Old lady with Hx of prolapse, now has urgency but no stress
incontinency.IX ?
A) Urodynamic studies
B) UMC
C) Anticholinergics
23.guy with hemothorax, trachea shfted to same side.. hadstap wound to
chest,, reduce air entry ,, no previous disease there,, dull on purcussion
a.. under seal drain
24.two PE scenario ask about invCTPA,, one was having travelling histrynd d
dimer was done
25. Picture of perianal abscess with pain in perieal region
26.that old recall of golden watch frm patient I selected ignore it
27. Vit c study in community
28. vitamin D study in two groups of university
29. Abgs..clear diagnosis was there for metabolic acidosis
30. ct scan for pancreatic pseudocyst
31. young age patient having scrotal swelling on left side, not retracted on
lying ,, cord is palpable,, what intial do we do.. I marked us , no option for
tumourmarkr
32. same type of scenario, this time was old in right side and
non.transillumination I did also us here initially
34. a child with bacterial meningitis being treated with ceftriaxone n half
daily requirement had a seizure >5min s/electrolytes show s/Na=118mmol
what is the cause of seizure?
Inappropriate ADH secretion
Dehydration
Antibiotic reaction
35. a young guy with symptoms of heart failure and generalized edema and
bibasilar crackles, the urine showed protien 3+ and blood 4+ i think on x ray
normal cardiac sillohet and bilateral lung infiltrates

85
antiGBM
36. acute OM scenario ,, same old recall. Amoxicillin
38. clear USG pic of mets in liver. And the scenario was Sheep farmer with
RUQ pain with H/O cholecystectomy and hemicolectomy for carcinoma colon
2 yersago.usg pic given.but I cant recognize the pic.
Next inv
1.Hydatid serology
2.Triphasic CT
39, old patient on morphinecomes with wife and drowsy next
I did ,,, hydrate fir
41.cellulitis scenario in diabetic with temp 38.2. asked investigation
Blood culture
Doppler
42. old recallmother wanaknwabthx of child she was 14 yrs old ..
option was come with daughter next visit..
43.one recall was about copd,, she hospitalized with agitation and dyspnea..
what next
a. abgs
b. ct scan
c. cxr
d.antibiotics change . Already taking and I went for abgs, as she was
hospitalized
44. one more was 84 yrs old lady taking asspirin, bb, and oral , has type 2
dm and hypertension..... shehass recurrent falls.. causes asked ? everythng
was nrml , ecg was told as nrml ,, i did hypoglycemia
45.MgSO4 toxicity in eclampsi women first sign == Hypotension
46.iremeber one,, tongue lateral border has lesion white one, do not
cuaterize and not removed on that ,, what diagnose,, i did squamous cell
carcinoma
48.one was confirmation of rhumatoid arthritis...
a. rh factor
b.antinuclear factor
c.intra articular effusion

86
49. one other wass ,, weight of baby wass 97 percentalie and height was 50
percentalie, he hass awkward gait.. hip , nrml, knee has some issue , dntknw
the word , it loooked new there for me :P ... options were , do refer to ortho
surgeon ,, second iremeber was reasuure , age was 3 yrs and it was
termadneverythngnrml with growth only gait issue and weight was high..
no advice was there to maintain strick diet , one other option was review
after 8 ... i weeks , i went for ortho surgeon
57.one scenario of cystic fibrosis , same hbqs in child problem blah blah
investigation asked
61. 50 years male, MI case after angioplastyhe feels a mass in inguinal area,
pulsatile and expanding in nature. What is the best treatment?
a. Pressure on the area by hand
b. Urgent repair of femoral artery.
c. CT
d. nothing to do
60. 10 days boy becomes blue when he cries or on exertion. At birth all
examinations were normal. APGAR score was normal. Now systolic murmur
found on cardiac exam.
c TOF
d ASD
c C. VSD
d D. TGA
====================
A 55-year-old man comes to your clinic concerned about his family history. His
father was
diagnosed with prostate cancer at the age of 85. His neighbour was recently
diagnosed with
metastatic prostate cancer and he says that there is screening to detect early
disease. On DRE
prostate was smooth, and median sulcus felt. No other symptoms. What is the next
step in
management?
1-PSA within 2 weeks
2-Reassure
3- Transrectal USG
4- DRE annually
According to RACGP guidelines, screening for prostate cancer is not recommended
unless the patient specifically asks for it, and after fully counseled about risks,
benefits, and uncertainties, both DRE and PSA should be done.

87
A farmer has experienced an acute upper quadrant pain for six hours then it's all
gone. He feels alright now. What is the possible diagnosis a bit the same picture

1 . hematoma
2. Simple hepatic cyst
3. Cholecystitis.
4. Hepatic abscess

Simple cyst: thin wall + homogenous low-density interior

88

a large simple hepatic cyst on sono

polycystic liver disease(PCLD)

89

large amebic abscess with multiloculated appearance

low attenuation center and
contrast enhanced periphery

, thick-walled cavity with

e

liver abscess: a collection of

fluid, with or without septated dividers

90

Hydatid cyst(Parasitic

abscess)

As a general rule, bacterial and fungal abscesses

are often multiple,
whereas amoebic abscesses are more frequently
single
new mother,dischargd 5days after delivery,wishes to breast feed for 12mnths,wants
to conceive after 12mnths,cntracptive of choice
a)low dose pop
b)low dose cocp
c)DMPA
d)mirena
e)iucd
POP is good in:
Migraine headaches
Age over 35 years and smoker or obese
History of thromboembolic disease
Cardiac disease, especially coronary artery disease or heart failure
Cerebrovascular disease
Early postpartum period
Hypertension with vascular disease or older than 35 years of age
Systemic lupus erythematosus with vascular disease, nephritis, or
antiphospholipid antibodies
Hypertriglyceridemia
A 4 yo boy with abdominal pain and vomiting on and off for 2 years. The episodes
resolve spontaneously usually within 12 hours. He has been developing normally.
a. Meckels diverticulum
b. Malrotation with volvulus
c. Pyloric stenosis

91
d. Duodenal atresia

http://emedicine.medscape.com/article/930313-clinical

milestone,,learn to cut with scissors,, which month ? 3y

10)milestone,,copy a straight line when shown? 3y

11)hand foot & mouth disease symptons ,,, coxsackievirus A16
13) fluoxetine & phnelezine drug interaction,,,diaphoresisboth increase serotonin levels
14)sildenafil & isorbid mononitarte drug intercn.potentially fatal hypotension
15)bromocriptine & pseudoepidherine drug intercn.. Hypertension, V tach
16) acute mesenteric ischemic scenario,,,acute abd pain,tenderness & blood stined stool
17)transient maculopapular itchy drug rash with ampicillin...mononucleosois inefcn (EBV)
18)same qns as 17 with symptoms asking for initial treatment
19)eye stays behind when looking outward (lateral diplopic),,,,which nerve is affected ?
abducens nerve (VI)
21)stiffness of the wrist & fingers, reginal pain,,,,,,,,,,,,,,,,,,,,,,,colles fracture
22)brachial artery impegiment ,,,,,,,,,,,,,,,,,,,,,,,,supracondylar fracture
23)mc cause of uterine inversion.. Over-traction of the cord
26)treatment of recalcitrant, not pregnant candiadis..... fluconazole or itraconazole. jm pg 998
27)best time for surgery for undescded testis & hypospadias 6mo
Treatment for the undescended testis is recommended as early as six months of age and
definitely should be completed before the child reaches two years of age
We suggest that hypospadias correction be performed at six months of age in full term
healthy infants ( Grade 2C ). At this age, adverse events from pediatric anesthesia and
surgery are similar to those of older children and less than younger infants. This timing also
allows for completion of a two-stage hypospadias repair by 18 months of age before the
beginning of gender identification, and parental separation anxiety is minimized. (See
'Timing' above.)
28)Charlie chaplin posture,,out toeing,,,initial management. No treatment
Jm 874
Out-toeing
Infants
Have restricted internal rotation of hip due to an external rotation contracture
Exhib it a 'Charlie Chaplin ' posture between 3 and 12 months-up to 2 years
Child weight-bears and walks normally
No treatment required as spontaneous resolution occurs
Surgery may be necessary in older children.

29)epiglottis scenario in 10 month old child and did not go fine with cefoxtamine,,fever does not
decrease,,,best managemet
Treatment of acute epiglottitis centers on maintenance of the airway and
administration of appropriate antimicrobial agents
Airway
Patients with epiglottitis and severe respiratory distress (eg, "sniffing" or "tripod"
posture, stridor, drooling, cyanosis) should undergo prompt placement of an
artificial airway. In those with impending or complete obstruction, endotracheal
intubation should be performed immediately in the emergency department.

92
Additional indications for urgent placement of an artificial airway may include
epiglottic abscess, comorbid diabetes mellitus (in adults), and immune deficiency.

"tripod" positioning (trunk leaning forward,

sniffing position
neck hyperextended, chin thrust forward)
Antimicrobials
third-generation cephalosporin (eg, ceftriaxone or cefotaxime ) + clindamycin ,
vancomycin for 7 to 10
Treatment response
Patients with epiglottitis should be monitored in ICU + Daily examination of the
supraglottis to assess the response to therapy, look for complications (eg, epiglottic
abscess), and monitor for delayed airway obstruction
Epiglottal swelling is generally improved after two to three days of antimicrobial
therapy. Persistence of epiglottal swelling may be caused by inadequate treatment
or development of an epiglottic abscess.

Persistent fever may be related to development of secondary focus of

infection (eg, pneumonia), nosocomial infection, or a reaction to antimicrobial
therapy (ie, drug fever, a diagnosis of exclusion). Patients should be
examined for extra-epiglottic manifestations (eg, pneumonia)

30)x ray of croup,,,steeple sing,ics retracted

93

tapering of the upper trachea, known as the "steeple sign" of croup

31)in which sleep pattern ,child can not remebr the dream & is
unarousable,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,sleep walking
deep non-REM sleep........JM(5th)771
33)which on can be endometrisis locn?#IMP
appendix,,,,,,no common places in options
second most common site of endometritis
a)ovary
b)brad ligament of uterus .. if there wasnt anterior and posterior cul-de-sac
c)abdominal cavity
d)round ligment
The most common sites of endometriosis, in decreasing order of frequency:
1-ovaries
2-anterior and posterior cul-de-sac
3-posterior broad ligaments
4-uterosacral ligaments
5-uterus
6-fallopian tubes
7-sigmoid colon and appendix
9-round ligaments

34)percentage of occurrence in cryptochidism in premature babies30%

Between 2 and 5 percent of full-term and 30 percent of premature male infants are born with an
undescended testicle
35)21month old child, hearing test,,,..Vra, abr, asr
Jm 454 ABR= Auditory Brainstem Response test
a grade 3 student is brought to you for assessment as his school performance is
deteriorating. no prob for the last 2 yrs in school although he was just an average
student. parents claim he doesnt listen and has some problem in written chores,
what will u do first?

94
visual assessment The first step in this process involves ruling out other possible
causes of the difficulties being experienced, such as a sensory problem (e.g., visual
or hearing impairment)
ENTevaluation
assess family dynamics
refer to psychiatrist
While individuals experiencing learning problems can be identified by observing
their behaviour and achievement, actual diagnosis of a specific learning disability
requires formal assessment conducted by a psychologist using standardised
psychological tests. These tests compare the person's level of ability to that which is
considered normal development for someone of that age and intelligence.
>>>>>>>>>>>>>The first step in this process involves ruling out other possible
causes of the difficulties being experienced, such as a sensory problem (e.g., visual
or hearing impairment), emotional disturbance (e.g., depression), environmental
factors (e.g., cultural or economic disadvantage or a lack of access to adequate
teaching) and intellectual disability. All of these can also have an effect on learning

AMC recalls- New Delhi 13th august 2015

Ahmed Y. N. Iraq
1. Picture of swelling in the inguinal area, old female with Hx of perianal abscess something like
that, Asking about the Dx
A.inguinal hernia
B.femoral hernia
C. Hidradinitis ..not sure until I see the pic
Hidradenitis suppurativa (HS) refers to a chronic, suppurative, subcutaneous process that results
from occlusion of follicles, secondary inflammation and sometimes infection of pilosebaceous
and (secondarily) apocrine glands. It is neither contagious nor due to poor hygiene.
The disease affects the axillae most commonly; genitofemoral region; gluteal folds and perianal
region; infraumbilical midline, inframammary and periareolar areas. The usual presentation is of
small painful subcutaneous nodules, but early symptoms consisting of pruritus, erythema,
burning, and local hyperhidrosis have been reported. Nodules develop and may rupture,
discharging purulent, sometimes malodorous material and forming sinus tracts. Unruptured
nodules eventually turn into indurated inflammatory masses. Hyperpigmentation, scars, and
pitting of the skin occur over time.

95

Moderate hidradenitis suppurativa

2. Pregnant lady with 2 days headache, BP 155/95 mild proteinuria

Whats next
A. CTG
B. Admit Per eclampsia = admission
D. Electrolytes
E. Coagulation panel
3. Pic of ct angiogram showing stenosed Rt. ilial artery, with complaint of PVD
Whatsthe best Rx :
A. Angioplasty
B. Heparin
C. Warfarin
5. Pregnant women ( I think at 39 w) presents with no fetal movement for 2 days,CTG Pic
normal (10 min showing 2 UC and 3 accelerations with good rate and variability), whats next
A. Repeat ctg after 24 hrs
B. Admit and monitor
C. Continue till next appointment

6. Pregnant women in early pregnancy complains of nocturia but no other signs of UTI, UA
shows only nitrates and leucocytes. Cultures are sent. Whats the best action?
A. Cephalexin
B. Reassure
C. Tell her to call as soon as she feels dysuria
D. Wait for culture results
The dipstick test is most accurate for predicting UTI when positive for either leukocyte esterase
or nitrite
Dipstick findings of urinary leucocytes or nitrite are suggestive of UTI and may be
an indication for empirical treatment if asymptomatic.....JM228 page

96

9. Mother came with 5 yr old child with nocturnal enuresis, he was dry before so she was angry
at him, and demanding for symptomatic treatment without further examinations..etc
You noticed some bruises on the child's leg and back which she attributed to his playing and
falling, what do u do ?
A. Prescribe Rx
B. Investigations
C. Report child abuse
D. Reassure
11. Newborn with bad apgar scores, not improving on Oxygen, o/e cyanosis,hr 140 only systolic
murmur, xray (not given) normal heart size with only mild lung plethora, likely Dx !
A. TGV
B. PDA. no cyanosis
C. TOF. Cyanosis in childhood not infancy
D. VSD. no cyanosis
13. Pt with 24 hr onset of lt. ear pain, salivation on same side, pic showing only ptosis of left
eyelid , Rx?
A. Acyclovir
B. Prednisone probably bells
C. AB
16. Two questions on ectopic preg., one scenario asking about best dx ?
A. TVUS showing empty uterine cavity
B. TVUS showing tubal mass
C. Serial hCGs
18. Lump in the neck , what feature is most significant clinical sign for malignancy
A. Rapidly growing
B. Hoarseness
C. Retrosternal extension
D. Causing face fussiness when pt. elevates his arm !!
19. A 54y woman presented with a month of dark discharge from her left nipple. Dx:
a. Benign duct papilloma
b. Intraductal carcinoma in situ
c. Mammary duct ectasia
d. Paget disease
20. Young lady presents with toothpaste like discharge and mild nipple inversion,
probably Dx?
And to make things worse, both Qs have the same answer options (as far as I
remember )
A. DCIS
B. Duct ectasia
C. Breast papiloma

97
D. Invasive CA
E. Some benign lesion
MCQ 3.127
Nipple discharge from multiple ducts of a thick and viscous discharge of toothpastelike material of greenish-yellow colour or bloodstained with duct dilatation: classical
mammary duct ectasia
Tx: excision of the main ducts below the nipple
22. Scenario of a gallstone ileus ..AXR of bowel obstruction with hx of recurrent GB
disease
A pregnant lady with multiple gallstones came to a GP. He advised her
cholecystectomy after delivery. Why?
a. risk of Ca gallbladder
b. increased risk of CHOLESTATIC jaundice in next pregnancy
c. increased risk of Ca pancreas
d. increased risk for primary biliary cirrhosis
23. Case of post cholecystectomy pt. 6 hrs presents with signs of shock, what to do
first
A. Return to OR
B. N.s.
24. Post c.s. Patient goes to the bathroom and feels dizzy near unconscious, o/e BP
difference sitting/ lying... Cause?
A. Vasovagal
B. Hypovolemia
C. Hypoglycemia
D. Other gyn problem
27. Old recall of most teratogenic substance among:
A. Cocaine
B. Marijuana
C. Alcohol
D. Others
28. You are giving a lecture in a primary school regarding skin cancer awareness,
What thing you wanna focus on most?
A. Using sunscreen in the morning
B. Lessen sun exposure from 10 am to 4 pm
C. Anual screening
D. Excision of skin lesions
29. young pt. come to you to check on his 2 chest normal looking nevuses, he's
computer programmer or something, his brother had mal. Melanoma that
metastasized to the bones..what to do?
A. Reassure
B. Do bone scan
C. Excise theses nevuses
D. Refer to dermatology

98
E. Regular skin exam - i think annual
30. Pt present with painful swollen ankle and wrist joints, after being treated for
chlamydial infection with doxidar .Whats best Rx now
A. Azithromycin
B. Prednisolone
C. Other antibiotics
Reactive arthritis is a painful form of inflammatory arthritis (joint disease due to
inflammation). It occurs in reaction to an infection by certain bacteria. Most often,
these bacteria are in the genitals (Chlamydia trachomatis) or the bowel
(Campylobacter, Salmonella, Shigella and Yersinia). - The early stage of reactive
arthritis is considered acute (early). Acute inflammation can be treated with NSAIDs.
These drugs suppress swelling and pain. They include naproxen (Aleve), diclofenac
(Voltaren), indomethacin (Indocin) or celecoxib (Celebrex).

32. 50s old Pt present with symptoms of OA, no Rx before, whats the best intial Rx?
A. Paracetol
B. Aspirin
C. Ibuprofen
D others i don't remember
33. ULcerative colitis pt., bp 90/60, hr 110, diarrhea with blood and abd. Distended, Axray
show dialated bowels, how do u treat him now?
A. Admit and monitor
B. Decompression
C. Colectomy
D. ABs
34. Old patient with iloischial abscess, has this problem recurrent many times, what s the cause?
A. Anal fistula
B. Diverticular disease
C. Crohns bcz of reccurance
D. Diabetic
E. Immunodeficiency disorder
35. Another case of immunodeficiency syndrome with recurrent infections with staph. Whats the
most likely
A. Neutrophils
B. Lymphocytes
C. Complements something
D. Other weird options
36. 6 day baby with erythema around umbilical cord, which is still attached and dry, he has mild
diarrhea..Whats the best Rx (options all all antibiotics)?
A. Cephalex
B. Penicillin
C. Flucloxacillin

99
D. Erythromycin i think
39. Case of calf pain relieved by resting , best Dx Ix?
A. Doppler
B. Venous venography
C. CT angio
D. MRI angio
40. Case of hypercalcemia with increased PTH, asking about further investigation for the cause?
A. Thyroid u/s
B. Parathyroid something scan
C. Ct scan
D. Bone scan
this cud be primary or tertiary hyperPTH.. next shud be ALP, PO4, renal function tests to exclude
tertiary.. bt if that choice isnt given, prarthyroid schintography brfore surgery to locate
adenoma...
41. Most common causative microorganism on infected gallbladder :
a. E.coli
b. fecalis
c. Bacteroides
d. some other normal flora bacterium
43. Your colleague witness a strong accident in the workplace, you notice that since she became
more hesitant and less confident in her work, u suspect alcohol abuse . What is the best thing to
do
A. Report her to you senior
B. Arrange a meeting with her
C. Tell her to take a vacation !
44. 16 yr old lady fought with her parents I dont know why and now living in the streets and
with her friends ,left school
Whats the best advice you can give when she comes to you
A. About alcohol abuse
B. About drugs dangerousness
C. About STDs and sexual matters
1.pt with longstanding ureteric stricture and history of recurrent UTI underwent
bladder dilation suddenly became pale, sweating, and BP 80/50.whats the cause?
AMI
PE
Bacterial infection
gram -ve sepsis causes sudden nd severe shock without signs of infection like
fever/raised wbc..pts r usually warm

100

2. female pt came for medical check-up for Airhostess job urine examination
done shows Haematuria and her blood frame shows Atypical nuclide. Next invest
Abd CT
Renal Biopsy
USG
Cystoscopy
In patients with asymptomatic microscopic hematuria who do not have risk factors
for transitional cell carcinoma, urinary cytology or cystoscopy may be used. If
cytology is chosen and malignant or atypical/suspicious cells are identified,
cystoscopy is required
3. Pregnant pt C/O frontal headache and flushes. BP 160/100 urine no proteinuria,
next invest
Serum electrolytes
USG .r/o IUGR
4. 5yrs pt c/o mild fever, jaundice , splenomegaly, blood exam: anaemia with
microsporocyte
I just remember H. Spherocytosis
5. Old lady c/o fatigue, malaise ,weight loss a long invest report with ESR 120 (I
just rem. This)
Multiple Melanoma
7
8.pt with history of valvular heart disease preparing to undergo tonsillectomy.what
he need for prophylysis
Amoxicillin
Azithromycin
Panicillin
Ceftriaxone
9. pt is admitted for ECT a day before get agitated, aggressive and refuse for
ECT.what to do next
Do nothing
Do ECT as she needed it
Do after her husband constant
Take consent from Mental Health Tribunal
HB 2.146 states that a person whose mental state preludes his ability to consent or
refuse treatment should be detained involuntarily in hospital and application made
to mental health review tribunal, if necessary, to immediately commence ECT.
Additionally the family must be informed but they are not legally able to consent
and refuse treatment

101
19. Asthma pt under solumedrol and steroid c/o exertion dyspnoea. What will you
give
Cromoglycate
LABA
Oral Steroid
21. 16yrs boy for routine check up ..no complain at present and all examination
normal blablaseems like asking about opportunistic examination..
BP
BSf
Testis
R.Ks Recalls:15-08-15
40 yo female , history of migraine , polycystic kidney ,sudden occipital headache ,
no neck stiffeness nor photophopia , ct normal and 2 LP unsuccessful , next
appropriate inv. ?
-repeat ct
-MRI
-cerebral angio
-Repeat LP
ct>>>>lp>>>ct angio
Elderly female patient lives in her own home is brought to GP clinic by her son due
to progressive gradual loss of personal care n forgetfulness so GP advised to
commence Donepzil. She insists that she is coping well without medication.Her son
refuses to start medicine n says that we dont care about her n family dont want to
start her on medication; what to do
a) respect sons wish
b) Tell him to take her medication when she out of her home
c)explain that she must take Medication if she wants to live in her own home(alone)
55 yrs male find it hard to perform his duties heavy smoker for 15 yrs ankle edema,
massive hepatomegaly splenomegaly and ascites high jvp and rises with inspiration
and drop with expiration dx?
A. Tamponade
B. Bud chiari synd.
C. Superior venacava obstruction
D. Constrictive pericarditis due to tuberculosis
E. Cirrhosis
Primigravida in labour presents with 2 cm cervical dilatation n fetal head above
ischial spine on PV examination. You do PV after 4hrs, which of the following feature
on this PV exam will lead u to do C-section?
a)everything unchanged of the previous exam
b)4 cm dilatation but same fetal position

102
c)4 cm n +1 station fetal head
d)2 cm +1 fetal head position
An academic presents to u severely distressed after his pubkication paper rejected
despite his previous good record. He thinks they are jealous of her n want to apply
against them in court. She has previously written complaint about her disrespect in
her academics performance. Diagnosis?
a.shizopherenia
b.Narcissistic
c.borderline
old 70s lady pap ve never positive before so what to advise further-no further
screening with pap required
26 a stat Q about prevalence of obesity, BMI>30 in a population of 200 in 2009
were 30 increased to 40 in 2010 assuming it remained static in the next year what
is prevalence in 2011?
40/200X100=20%
30.Meningitis 2 Q one with Mononuclear cells high(in thousands) in otherwise
Normal CSF findings-TB
32.Rx of U/L renal artery stenosis-Perindropril ACEis are choice
33.a lady withfamily History of obesity n CAD presents with
Hypercholeserolemia-5.5mmol n HTNMx?
Perindropril
34 a lady with persistently high BP on previous readings for 3 months range b/w
130/70-180/105, Rx?
initially life style modifications if not controlled thn ace inhibitors(Perindropril)
41pt 45 year old with H/o childhood DVT undergoing nissen fundoplication received
IPC for DVT prophylaxis would require? Heparin 10 days post op
Modified Caprini risk assessment model for VTE in general surgical patients:
1+3+2=6 => high risk
For high risk general and abdominal-pelvic surgery (Caprini score 5 or more) we
recommend the use of prophylactic anticoagulation over other methods
Reasonable choices include LMW heparin , low dose unfractionated heparin three
times daily, or fondaparinux
44 a lady with night sweats wt loss n axilliay Lymphadenopathy with Lymphocyte v
high platelets 70000 hw will u treat
A prednisolone
B radiotherapy
C platelets transfusion
D acyclovir
Most probably is Lymphoma

103
Treatment options include chemotherapy, radiotherapy and monoclonal antibodies
But if CLL: graft or cytotoxics
47.Ca head of pancreas initial investigation?
CT USGabdXRay
51 a man with attempted suicide discharged after Rx, now presents with loss of
interest in job n lack of concentration but sleep n eat well Diag??
A recurrent depression
B factitious disorder
C conversion

70 newonsetschizopherenia Rx-olanzapine
81 an elderly lady with constipation n s/electrolytes revealed mild-moderate
hypercalcemia with all other normal values which investigation to reach diagnosis?
Thyroid scan Abd CT Bone scan
PTH is the right answer but they don't give us what we know is right. I would go for
CT abdomen on this looking for paraneoplastic source for PTHrP in GI or pancreas

104

82 what charecterizes chronic ischemia in lower limb

rubor on dependeny
improvemet with walk
same old options
84usg testicular lump showing mixed cystic n solid component next investigation?
CEA AFP Aspiration FNAC
52 lady with depression after spouse death had same s/s at still birth of child some
years ago prompt treatment? ECT
53 same scenario-initial Rx?-citaloprim

My recalls 15-8'

--ct brain with minute hge and infarction asking next appropriate cease warfarin or
vit k or plasma

105
If serious or life-threatening bleeding is present, or if rapid reversal of
anticoagulation is required (eg, in preparation for emergency surgery), warfarin
should be stopped then vitamin K IV + FFP should be given

--haemolytic uremic syndrome easy diagnosed but asking invex? FBE u/a alb
Raised white cell count and low platelet count are early indicators of development
of HUS,, but hematuria and protinurea also occur early in HUS, so urinalysis must be
sent

--rash in a child with flu after ampicillin what to do invex? lymphocytes in FBE
it can be inf. Mononucleosis rash app after antibiotic or drug reaction => atypical
lymphocytes in FBE
--coach calling you asking for prescription of a boy with asthma you are his gp but
he couldn't reach parents what to do?
try to call parents or give him or ask him to bring the boy to you but it depends
to the full stem

Recalls Deepa 15/08/2015

1.
A pic very similar to this (the closest I cud find) and Long scenario of PAD asking
management? anioplasty
2. A 14 yr old ADHD boy refuses to take medication during lunch at school. His parents are
concerned and ask you for alternative. What will you advice?
a. Ask the parents to forcefully give the medicine
b. Ask the techer to force him to have the medicine

106
c. Ask for an appointment to meet the boy and talk to him regarding the situation
d. Prescribe him medicine to take in the night.

3. A 58yr old man returned from Thailand after 2 weeks holiday with his wife. Now presents
with fever, malaise, pain in the right upper quadrant. His lab findings were given with a
big list of all the FBE, LFTs, etc. Almost all his LFTs raised. GGT was very high. Whats the
diagnosis?
a. Hepatitis A
b. Cholangitis
c. Liver abscess
d. Acute pancreatitis
e. Cholecystitis
The incubation period averages 30 days (range 15 to 49 days), after which the illness begins
with the abrupt onset of prodromal symptoms including, fatigue, malaise, nausea, vomiting,
anorexia, fever, and right upper quadrant pain. Within a few days to one week, patients note
dark urine, acholic stool (light-colored stools lacking bilirubin pigment), jaundice, and
pruritus. The prodromal symptoms usually diminish when jaundice appears. The most
common physical findings are jaundice and hepatomegaly
Laboratory abnormalities may include marked elevations of serum aminotransferases
(usually >1000 IU/dL), serum total and direct bilirubin, and alkaline phosphatase
4. A young lady comes to your practice after 6 months of the death of her father. Her BMI is
23. She was on a strict diet and has lost 10kgs and is concerned about gaining weight.
On talking to her u find out she is not suicidal or majorly depressed. She also later
reveals having taken laxatives but reasons that its because she doesnot want any
constipation issues. She now dreads the idea of gaining weight and cannot trust herself
around food and wants you to prescribe some weight losing drugs. What is ur diagnosis
of her?
a. Depression
b. Anorexia nervosa
c. Abnormal grief disorder
d. Bulimia nervosa

5. An old patient with multiple drug history for various conditions posted for hip
replacement surgery. Whatsur management post op?
a. Warfarin for 1 month

107
b. Warfarin for 3 months
c. Dont give anything
d. LMWH for 1 week
For patients undergoing total hip replacement or hip fracture surgery, we recommend that
thromboprophylaxis be extended beyond 10 days and up to 35 days after surgery:
low molecular weight heparin
fondaparinux
rivaroxaban
dabigatran etexilate
6. Another similar question of a patient with both extra pulmonary and intrapulmonary
findings with photophobia, neck stiffness, headache, long stem on h/o symptoms there
was a mention on patient coughing rusty sputum and also something about a NNT
findings was given(honestly dont remember the exact value) CSF findings has protein
1.5 and Glucose 0.4. What is the causative organism?
a. Escherichia coli
b. Mycobacterium tuberculin
c. Mycobacterium pneumonia
d. Strep. Pneumonia

7. A young patient with asthma history complains of intermittent dysphagia on

esomeprazole 40mg for a few months, now asking management?
a. Change to pantoprazole
b. Increase dose of esomeprazole
c. Fluticasone

8. A patient with BMI >43 underwent Gastric Bypass surgery. Now presents to u after 2
months with c/o dumping syndrome 30 min after having breakfast of especially cereals
milk and toast. How will u manage?
a. Diet counselling
b. Post for a review of surgery
c. Vit. B12
d. Esomeprazole

108
9. A ct of closed skull fracture asking to identify.

right temporal fracture with subgaleal haetoma, subdural haemorrhage and subaracnoid
haemorrhage.
10. A pt. bought to ED after Motor vehicle accident with fracture of tibia. Paramedics already
did closed reduction in the ambulance on the way to the hospital. Whatwill be ur next
appropriate management?
a. Wound debridement
b. External fixation
c. Internal fixation
d. Suture wound

11. A middle aged female with h/o migraine 2 unsuccessful LP, normal CT, what will be ur
next appropriate management?
a. Repeat ct
b. Do another LP
c. MRI
d. Cerebral angio

12. A patient comes to you with burning sensation on the right side of his face and upper
and lower limb weakness of the left side. Abnormal gait. Diagnosis?

109
a. GBS
b. MS

13. 38 year old obese lady primigravida presents to u at 24weeks.Her fbs and 2hr ogtt in
early pregnancy was 5 and 7. Her mother diagnosed with DM at 52yrs is under
medication for it. What is the most appropriate management for the her?
e. Ogtt 26-28wks
f.

Ogtt now

g. Fbs 1yr
h. Ogtt 6-12 weeks postpartum

14. 4 yr old child with pertussis asking for Ix Nasopharyngeal swab

15. 4yr old child with cough, wheeze and inter costal recession. He uses his accessory
muscle while breathing. He has fever 39. O/E chest clear, he is treated with IV fluid and
O2. Which organism is responsible for his condition?
a. RSV
b. Strep pneumonia
c. Staphylococcus aureus
d. H. influenza

16. An old lady drowsy from morphine given after she fell and now brought to you for further
management. She has advancedirectives to not put her on any life support if she
becomes seriously ill. What is your management?
a. Admit her for further evaluation
b. Call for a family meeting
c. Sent her to a nearby physiotherapy centre
d. Respect her wishes
e. Do nothing

17. Mother brings her son who has measles rash now since 6 days. She wants to know if the

110
child needs to be excluded from school, as the teacher informed him that all the kids in
school are immunized. What advice will u give the mother?
a. No need to exclude.. 5 days exclusion from the onset of rash
b. Exclude for 4 days
c. Immunize immediately

18. child with measles what to do most urgently

a. check all the students of his class
b. inform authorities
19. You receive a call from a school about a boy who is your patient and asthmatic. They are
immediately about to leave for a camp and wants to know if the childs asthma
management plan can be given as they could not reach his parents. What will be ur next
step?
a. Give the teacher the prescription for management plan
b. Ask them to bring the child to your practice
c. Try contacting his parents

20. A group of guys returned from camping in the forrest. After a week they were admitted to
the ED with bruises on the skin, renal bleeding and shock. What is the most likely cause?
A.Giardia lamblia
B.Escherichia coli .. Hemolytic uremic syndrome
C.Disseminated intravascular coagulation
D.Staphylococcus aureus...
E.Ross River fever

21. Hemochromatosis scenario asking for most appropriate Ix?

A liver biopsy
B serum ferritin &transferrin
C hfe genotype
D uss
1- transferrin saturation and serum ferritin).
2- HFE gene testing or referral to gastroenterologist if: transferrin >45%, ferritin
>250g (pre-menopausal female) or >300g (post-menopausal female/male).

22. 5th POD lady presents with watery vaginal discharge slightly blood stained. Patient had
undergone hysterectomy before. What is the diagnosis?

111
a. Vesicovaginal fistula
b. Vaginal cuff dehiscence
c. Vaginal abscess
d. Vaginal vault granulation
e. Vaginal vault prolapse
f we use absorbable string as chromicfor closing vaginal cuf. chromic cut gut string is
absorbed between 3-7day post operation
23. Middle aged man who is hypertensive and just treated for his helicobacter pylori with
triple therapy. Now comes with urine protein and haematuria with 3-4renal cysts seen on
USG. Diagnosis?
a. PKD
b. IgA Nephropathy
c. Nephrotic syndrome
d. Acute Interstitial Nephritis

24. A young boy with symptoms of heart failure and generalised oedema and bilateral
basilar crackles, urine shoed protein 3+ and haematuria 4+. X ray normal cardiac
silhouette but bilateral lung infiltrates. Diagnosis?
a. IgA Nephropathy
b. Anti GBM
c.

16. female sore after sex with new partner dysuria n also discharge mild few days
now asymptomatic came to u.nothing more in hx for sure something in the scenario
"soreness coming down" Chlamydia ,Gonorrhea ,Hsv, candida
22)scenaria of tubercular meningitis asked about the organisms? Mycobacterium
tuberculosis
alcoholic with agitation or confusion 24 hours post operative what investigation
blood alcohol
blood glucose
The single most important laboratory test in a patient who appears intoxicated with
ethanol is a serum glucose level

112
Pulmonary atelectasis is the most common cause of early postoperative fever and
tachycardia after all classes of surgery
clear USG pic of mets in liver. And the scenario was Sheep farmer with RUQ pain
with H/O cholecystectomy and hemicolectomy for carcinoma colon 2 yers ago.usg
pic given.but I cant recognize the pic.
Next inv
1.Hydatid serology
2.Triphasic CT
32)54. scenaro of hyperkalemia pt present with confusion,K was 6.5,urea and CR
also very high.next 1.urgent hemodialysis 2.rectal calcium resonium 3.5%dextrose
with insulin 10 unit
36. patient with recurrant ischirectal abscess. Asked cause
Anal fistula
Chrons
Diverticulitis
37. acute gout scenario asked what to prescribe initial
Naproxen
Cochicine
Allopurinol
A patient presents with acute gout but has a low serum uric acid. Which of the
following drugs can be
responsible for a low serum uric acid?
a) Colchicine
b) Prednisolone
c) Indomethacin
d) Naproxyn
e) Salicylates

43. Mother of twins. Does not want contraception other than breastfeed. What will
indicate thatr she needs OCP?
-She has her period
-One twin doesnt eat
-Twins only breastfed at night
44. scenario of acute angle closure glaucoma with acute painful and hazy cornea.
asked treatment
Oral acetazolamide
Topical pilocarpine
Topical timolol.
45. alcoholic man, was OK, had a vehicle accident, after it was OK. Now confused,
slurred speech, weakness. ? cause (same/similar as blue book mcq)

113
- Subdural haematoma
-alcohol withdrawl
Mcq 2.059 A 70-year-Old woman presents with a blood-stained vaginal discharge.
Both the ectocervix and the vagina look atrophiC on speculum examination.
Cervical cytology shows no evidence of malignant cells, although no endocervical
cells were seen. Which one or the following is the most appropriate next step in
managment?
A. Vaginal swab far microscopy and culture.
B. Colposcopy.
C. Ultrasound assessment of endometrial thickness.
D. Hysteroscopy and dilatation and curettage (D&C) .
E. Laparoscopy.
would define the presence of an endometrial lesion and would faCilitate histologic
examination of any endometrium
which is present.
malignancy is less likely if the endometrial Ihickness is less Ihan 4mm, Ihe risk is not
excluded by such a finding
48. Mx of obese 9 y/o with obese family.
-Strict exercise
-Exercise + diet to maintain weight
-Obesity will disappear during puberty
- prescribe diet regimen
-replace soft drinks with fruit juice
50. You are asked to solve a dispute btw a nurse and a patient. The patient is
arguing that she want a vip room in the hospital and that she is a private patient .
when you reach the patient says you are a doctor you would understand what I
want .. I bet you are also on a private panel unlike these nurses. What is it?
Paranoid
histrionic
narcissism,,,
shizoaffective
18. Xray of sarcoidosis. Typical bilateral perihilar lymphnodes can be seen. Patient
had cough since long time(cant remember the duration exactly but I am sure it was
too long). And now presented with hematuria. Asked next investigation?
CT abdomen
Urine culture
If sarcoidosis..ACE level
If Anti gbm.first u/a then renal biopsy

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology that

affects individuals worldwide and is characterized pathologically by the presence of

noncaseating granulomas in involved organs. It typically affects young adults, and
initially presents with one or more of the following abnormalities:
Bilateral hilar adenopathy

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Pulmonary reticular opacities
Skin, joint, and/or eye lesions
In approximately one-half of cases, the disease is detected incidentally by
radiographic abnormalities (eg, bilateral hilar adenopathy, reticular opacities) on a
routine chest radiograph prior to the development of symptoms.
most common presenting symptoms include cough, dyspnea, and chest pain.
Common extrapulmonary abnormalities on presentation include eye and skin
lesions.
Other features of sarcoidosis include fatigue, malaise, fever, and weight loss.
Systemic inflammation may contribute to muscle weakness and exercise
intolerance. Patients over the age of 70 years appear to be more likely to present
with systemic symptoms, including fatigue and anorexia; however, dyspnea and
cough are generally present at the same time.
on chest examination wheezing may be present.

Young woman with acute

onset of erythema
nodosum and no
respiratory complaints.
Left: The chest radiograph
shows bilateral hilar
adenopathy (Stage I)

Bilateral enlarged hilar lymph nodes as well as right paratracheal and aortopulmonary lymph
nodes are visible. Fine linear and reticular opacities are present in the perihilar lung parenchyma.

115

Left: The chest radiograph shows interstitial disease (multiple small nodules in the mid-to-upper zones) with
shrinking hilar nodes (Stage III)

The chest radiograph shows interstitial opacities with upper zone predominance, volume loss, and advanced fibrosis
(Stage IV)

diagnostic test: Serum ACE (angiotensin converting enzyme)

LABORATORY ABNORMALITIES
Anemia of chronic disease
Leukopenia , eosinophilia and thrombocytopenia
Elevated ESR.
Hypercalciuria + hypercalcemia
Hypergammaglobulinemia, diminished skin test reactivity, and a positive
rheumatoid factor
elevation in the serum alkaline phosphatase

116

ABG may be normal, or may reveal hypoxemia and hypocapnia (hyperventilation)

Ayman Recall 15 August

1_A-34 years old, primigravida, preg. 36 weeks passed 200 ml blood clots at home, now there is
no bleeding, Abdominal examination revealed tense and very hard uterus, audibalefetal heart
sound, 140 per minute, blood pressure 90/60 and pulse 120/min.
What is the best management now
abcde-

Intravenous fluid.
CTG
Ultrasound
Induction of labour
Immediate CS

2 A --24 years old, primigravida, pregnant 37 weeks, initial examination revealed fundal level 36
cm ,fetal heart sound audibale, CTG baseline 140/min with good variability, vaginal examination
cervix post, long internal os 1cm vertex presentation, head 3 cm above ischial spine, after 4
hours, vaginal examination revealed cervix full effaced, os 3 cm, vertex 2 cm above ischial spine,
membrane intact.
Obstructed labour
Continue CTG
Induce labour
Normal Labour
Oxytocin derip
4- A-38 years old, having 3 children, taking oral combined pills and she is hypertensive on ttt,
and she is using ?cream, Pt c/o from milky discharge from both breast.
Stop ttt for hypertension
Local cream is the cause
Ask for serum prolactin

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Others, I forget.
6-56 years old woman live alone in her own home, was diagnosed as Al-zihymer dementia
She came with her son to your clinic. The woman is convinced that she is not suffering and
disorders and refused to take the medicine. Her son discloses that the family do not care about
her and she is ok without medicine and he do not want to give her the medicine.
What you will do?
Agree for their decision and do not give the medicine
Inform them that if she will stay alone in her own home, she have to take the medicine.
Arrange nurse to visit and give the medicine.......
8- 22 years old aboriginal man in the waiting list for the renal dialysis. He told you that he did
not want to continue the dialysis.What you will do?
Arrange for a donor for him.
Discus with him his decision to be sure he understand what is the sequences of his
decision
Other options can not remember
12-58 years old woman, is not happy from the primary school next to her home, some
halucinations that the owner of the school will extend his business to her home
Depression
Alcohol withdrawal less than 4 years
She do not have children
15- 12 years old boy came with his parent to your clinic, the boy is depressed and have decided
to be out of his father when he saw him teased by two men came inside his fathers home
Depression
Post traumatic depression
Panic
16- Child 12 month have missed his vaccination , came today with his mom. What is the
contraindication for vaccination for him now?
Temp. more than 38.5
Have allergy to egg and his due for MMR today
Some others.
17- A-36 years old day, 6 week postpartum is coming for check up. She c/o from lethargy,
fatigue, hair loss.What is the investigation
TSH
Haemoglobin & iron
Thyroxin
19- A 22 years old woman with 1ry infertility, her investigation is going with the diagnosis of
PCO.What question you can ask
She notice facial hair growth
She notice Deeping of her voice
Others
20-You are going to give lecture at primary school about healt.What is the important issue you
can discuss
Health food
Obesity

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Increase physical activity

Diabetes

http://www.racgp.org.au/your-practice/guidelines/redbook/preventive-activities-in-children-and-young-people/

21-You are going to give a lecture about obesity and BMI.What is the important information to
give
BMI is the best way of estimation of obesity alone.
BMI will give false estimate in elderly people because of fatty abdomen.
Waist circumference is the best wayto estimate
Waist circumference with BMI is the best for estimation of obesity
22 year old pregnant lady has come to you with headache, and visual disturbance. On
examination her BP was 150/80 mm of Hg. On investigations , in the urine the protein was +
+.what is the next most important investigation
A. USG
B. LFT
C.PLATELET COUNT
22-One of your colleague told you that he haveapatient who have delivered her 3 children and he
helped her to settle a problem between her and her partner. He told you that he had met her in the
city and both want their relation to be intimate. He asked your advise
Donot see her any more as a patient and ask some body else to see her
See her as a doctor and continue your sexual relation after 3 months
See her as a doctor and continue your sexual relation after 6 months.
Do not mix your sexual relation with your patient and cease her as a patient.
http://www.racgp.org.au/afp/2013/september/managing-professional-boundaries/
23- Junior doctor is hepatitis B +ve, the medical manager advised him not to do any aggressive
surgical manoeuvre and to keep this issue secret. Senior registrar told him that he is busy with a
major operation and asked him to do management for a deep lacerated wound, What he has to do
?
Do the surgical management and put two gloves
Inform the senior registrar that you have hepatitis B
Inform the senior registrar that you will not be able to do this job.
25- Picture for a baby with macrosomia and asking what investigation should be done to his
mum during her pregnancy
TSH
OGTT
Urin A/CS
27-54 years old man with history of depression and suicidal ideation, came today and asked you
for the best way to end his life
Advise him to go to other colleague who can help him
Discuss with him different ways to finish his life
Take with him about your principles of ethics
30 -6 month old boy after bath, his mom felt a hard mass in left hypochondria, non tender

119
Wilm's tumor
Neuroblastoma
Polycystic kidney disease
wilms 2-5 years.
Wilms even echogenic haloes
Wilms intrarenal mass
Wilms doesnt cross midline
Calcification wilms uncommon
calcifications.
Wilms Is well circumscribed
Wilms extends to renal vein
asymptomatic abd distension
thrombocytopenia (neuroblastoma)

Neuroblastoma <2 years.

neuroblastoma heterogenous.
neuroblastoma is extra renal mass.
neuroblastoma does cross midline.
90% case of neuroblastoma have
neuro is not.
neuroblastoma extends to chest.
fever weight loss leukopenia

In children both neuroblastoma (skull metastases are not infrequently the first sign
of disease) and Ewing sarcoma are encountered.

nuroblastoma

wilms
A 4 year old child has abdominal pain and nausea for the last few months. O/E he
has mass on the right side in the midline. He is not complaining of any other
symptoms. What is the cause?
a. Wilm, s tumor b. hepatoblastoma c. Neuoroblastoma#IMP
A
The age and not passing the midline

31-Picture of cellulitis,asked for treatment, the same Anthology page 171

32-picture of inguinal hernia the same on Anthology page 57, mother told that this mass is
present since birth of her 6 month boy, suddenly, it started to increase in size
Aspiration

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General anaesthesia and compression
US
Surgical repair
33-Symptoms of lower cancer rectum
Melenia, constipation and lower colicky pain
Diarrhea, bloody stool and abdominal pain
Constipation
External haemorrhoids
36-CT for a girl after fall from a horse with #IMP
Haematoma of the liver
Rupture spleen
39-42 yeears old with history of valve replacement, is going for teeth extraction.
What antibiotics for prophylaxis
Amoxi.
Gentamycin
Ceftriaxone
http://www.tg.org.au/etg_demo/desktop/tgc/abg/16628.htm
http://www.aapd.org/media/policies_guidelines/g_antibioticprophylaxis.pdf
http://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
43-33 year sold woman came for check up , speculum examination done revealed cervical
erosion, her pap smear two years back and was normal.
Refer her for colposcopy.
Treat her with local cream
Cauterization
Pap smear
44-29 years old lady came for check-up,for sexual health what investigation you have to take
with her
TSH, LH
Prolactin
Blood sugar
Pap smear
45- 37 years old woman with irritability, anxious, can not do her job, irregular menses for the last
few months.Investigations FSH 41
Prolactin 245
LH 4
Diagnosis
Hyperprolactinoma (Pitutary Tumour)
Premature ovarian failure
PCO

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See him in the presence of other health staff.
47-58 years old woman, cannot control her urination, as she will pass droplet of urine on
coughing or sneezing
Urinary incontinence (Stress)
Urgueincontence
Detrusor instability
UTI
48- 59 years old woman with wet bed at night. She is drinking 4 standard glass of peer every day
and coffee as well. Urodynamic study done and revealed detrusor instability. She had mild
descent of her uterus.Management
Surgical repair of cystocele
Bladder training
Urine analysis
49- 38 years old aboriginal complaining from painless blood in the urine, next?
Cystoscopy
CT scan
Urine analysis and culture.
50- 4 years old boy with blood in the urine and dysuria. Urine C/S revealed mixed growth.
Amox.
Nitrofuranton
Take a suprapubic sample and repeat the culture
51-33 years old man with endoscopy revealed gastritis and ulcer.Management
Prednisolon
Trial therapy for H Pylori
Gavicson
Antacid
52-X ray for the pelvis of 83 years old man, C/O from hip pain and inability to move to his
garden. He received paracetamol but no effect
Prednisolon
Indomethacin
Bone scan
53-X ray of large bowel obstruction, H/O constipation, enema tube was fixed but ineffective
Management
Surgrey
CT scan
MRI
Enema tube for 3 hours
54-52 years old man with H/O DVT and on warfarin, INR is 4
IV vitamin K
Oral tablet Vit K
Stop warfarin

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5658-7 years old boy with history of cough,auscultation revealed bilateral crackels on both sides
and wheeze
Investigation
X ray
CT abdomen
CT chest
MRI
60-A 73- years old man came to ER by his neighouer who informed that he live alone and since
3 weeks did not appear No body from his family leave near by..He c/o from shortness of breath
and anxiety.
Inform his family to take care
After his treatment and before discharge from the hospital, arrange a house for him to be near
from any of his relative.. Involve social worker or other stuff on this, the doctor can't take
care of this.
Other options
62- Man with haemophilia, but his wife does not have, Incidence in the children? zero
x-linked,wife normal.so zero,but daughters will be carriers
65- A 56 years old woman with sleep disturbance and depression, She came today with an
application for pension because she can not go for work and unable to do anything for education.
She is not taking your medication as she is using her herbal medicine .
What you will do
Inform the social security organisation
Refuse to sign the application
Refer her to another doctor who believes in herbal medicine
66- A somalian man 45 years old now became refuggie, C/O from bleeding with the stool.
What investigation
Do rectal examination
Occult test
CT abdomen
MRI
67- A 42 years old man with no risk factors of family history of cancer colon. His occult blood
test came positive.
Colonoscopy
Repeat occult blood test after 3 months
MRI
CT
68- A 64 years old man with incontinence of the urine after a long trip. He have to strain
strongly in order to evacuate his bladder.You did rectal examination, you felt enlargered irregular
prostate.

123
Prostate specific antigen
CT prostate
MRI
US
Cystoscopy

71-51 years old woman, menopause since 5 years, during checkup an ovarian cyst 4 cm in
diameter(simple, unilocular cyst)
What you will do?
Hysterectomy
Tumor markers
CT
MRI
Reassure and repeat us after 3 months
because ovarian Simple cyst (unilocular,without any vegetation or septum)in menopause
women ,under 5 cm in diameter >>reevaluate if growing occurred then tumor marker.but if it
was greater than 5cm or was complex cyst (multilocular ,septa the,with internal echo )then check
tumor markers

73- A 20 years old woman came to your clinic, preg. 16 weeks with history of abortion twice at
20 weeks.
What you will do?
USG .. usg at 14-24 weeks helps in dxing cervical incompetency!
Reassure her
To attend at 20 weeks for admission
OGTT
Suture her cervix
http://3centres.com.au/library/uploads/guideline/Cervical_shortening_9th_Aug_2011.pdf
75-An old man 85 years old attend to your clinic with history of shortness of breath and
hypertension and both well controlled. He came for renewal of his driving license.
What investigations or test you should do for him?
Check visual acuity
Mini-mental check test
Blood sugar
Cholesterol and LFT
78-patient with open chest wound. What to do first ?
Mouth to mouth
Chest drain

124
Close the wound with gauze.

79- A 22 years old girl fall down in the gym and shifted to ER, the trainer who accompanied her
mentioned that she is always doing vigorous exercise and trying to induce vomiting, What
character in this girl?
Depression
Schizophrenia
OCD
Worry about the shape of her face and her weight.
80- A 45 years old man came to ER after accident with gauze around his scalp and soaked with
blood, dyspnea, conscious, long senarion
What is the immediate action, ?
Ensure airway clear
O2
IV fluid
Care of the wound at the scalp
US

83- A 57 years old man with H/O tremors on resting, if you will observe him it will increase.
Scenario of Parkinsonism
Treatment
85- A medical student after she had finished her gastroenterology and surgery course, have a
phobia that she had cancer colon. No family history of cancer colon or even risk factors. She had
been seen by two surgeons but still not happy. She c/o from diarrhea, abdominal pain and
distension since long time
Depression
Irritable colon
In persons who fulfill symptom-based criteria of IBS, the absence of alarm features (e.g., rectal
bleeding; weight loss; iron deficiency anemia; nocturnal symptoms; family history of colorectal
cancer, inflammatory bowel disease, or celiac disease) should confirm an IBS diagnosis.
86-Patient had inf mi two days back. Today in hospital has bradycardia ,pulse 35/min
Adenosine
Atropine
Adrenaline
89- A 53 years old woman came to your clinic several times in a week, each time she is
complaining from something. Her BP 13/80, pulse 73, no risk factors.Last time she complained
from spotting.What you will do?
Ask her to go to another GP
Refuse to see her.

125
Just investigate her last complaint.
91- A mother bring her 7 month son with history of sudden bending of his trunk and flextion of
upper limbs. Treatment?#IMP
Risperidone
Steroids
Lithium
Nitrazepam
It is infantile spams - most effective treatment is IM injection of ACTH but mostly used is
corticosteroids
92- An old man 72 years old came to ER with chest pain and shortness of breath. ECG and
angiography done which revealed stenosis of Rt. Coronary 70% and left Coronary 30%.
Treatment
Pace maker
Digoxin
Angioplasty for both coronaries
Angioplasty for Rt.coronary
Angioplasty for Lt.coronary
***************Sumbla Khalid******************
MCQ 2.076
A 25 year old plimigravid patient a t 40 weeks of gestation presented because she
had not felt any fetal movements for 24 hours. The fetat heart beats were clearly
audible on auscultation at a rate of 140/min. and the cardiotocograph (CTG) was
normal and reactive. Her cervix was 2cm dilated and fully effaced. You therefore
reassured her and sent her home. She telephones you 24 hours later and tells you
that she has still not felt any fetal movements. now for 48 hours. Which one of the
following is the most appropriate next step in management?#IMP
A. Admit for induction of labour.
B. Immediate Caesarean section.
C. Urgent oxytocin challenge tesl.
D. Urgent ultrasound scan of the fetus.
E. Amniotic fluid volume assessment.
Where the fetal movements are still not being felt 24 hours after a normal CTG.
induction of labour should be performed. especially if the pregnancy is at or near
term and the cervix is favourable

Ultrasound examination of the fetus may show it was small, but is not necessary
at this time as delivery should be expedited anyway.

21)female 34 anxious about breast ca bcz read in magazine some celebrity got ca
at 32.no positive sign and symptoms.no family hx
A)mammo
B)usg

126
C)MRI
D)reassure that no more inv is needed at this time
E) put her on breast screening program(but didnt said by now or from 50 years of
age)
22)male old age with sudden fracture.esr raised around 104.low hb ,low
plt.wbcnormal.whsr next
A)bone marrow
B)pSA
C)cea
Rest dnt remember
23)female with painful periods on COC 30.want to conceive
A)mirena
b)NSAID n condoms
C)depot
35)female pregnant 32 weeks after Mva in emergency fundal height 36 .fetal heart
sound audible.but was raised.mother vitals borderline, What next?
A)cross match 4 unit
B)usg
C)amniotomy
D)c/section
E)2L NS in 2hr
35)old women with t score -1.2 I think next? calcium and vitamin D daily
........Osteopenia #IMP
Osteoporosis
Normal T-score: 1.0 or higher
Osteopenia: between 1.0 and 2.5

Osteoporosis: less than 2.5 (meaning a bone density that is two and a half standard deviations
below the mean of a thirty-year-old man/woman)

Prevention: calcium and vitamin D daily from 50 years

Pharmacological treatment indications:
minimal trauma fracture
70 years or over + T-score of 3.0 or lower
prolonged (at least 3 months) high dose corticosteroid treatment + T-score of 1.5 or
lower
Tx:
1- Vitamin D should be corrected to a level above 50 nmol/L before commencing
therapy
2- Bisphosphonates ( Alendronate, risedronate and zoledronic acid)
t-score, the number of standard deviations above or below the mean for a healthy
30 year old adult of the same sex and ethnicity as the patient
z-score, the number of standard deviations above or below the mean for the
patient's age, sex and ethnicity

127
http://www.racgp.org.au/afp/2012/march/osteoporosis-pharmacological-preventionand-management/
A lady fear of going outside specially in large crowded spaces, loves to stay at home
and sometimes her friends visit her at her house. Diagnosis?
A agoraphobia
B social phobia
Agoraphobia is defined as anxiety and/or avoidance associated with situations
where help may not be available or where leaving the situation may be difficult or
embarrassing in the event of panic symptoms or a full blown panic attack.
Commonly feared situations include crowds, shopping malls, driving, public
transportation, and being away from home
The anxiety or phobic avoidance should not be related to another mental disorder
such as:
social phobia (eg, avoidance limited to social situations because of fear of
embarrassment),
specific phobia (eg, avoidance limited to a single situation like elevators),
obsessive-compulsive disorder (eg, avoidance of dirt in someone with an
obsession about contamination),
posttraumatic stress disorder (eg, avoidance of stimuli associated with a severe
stressor),
separation anxiety disorder (eg, avoidance of leaving home or relatives).
Tx:
SSRI or CBT), or a combination of the two
K1 recalls 15th Sep 2015-09-15
Every body, let me give you some relieve before read these recalls: by the greate teamwork of Amedixans, my MCQ
exam was one of the easiest exam in all of my medical exams
1. A youn guy has noticed with a massin his right testis, sono given, what is the most important next step in
management?
Fine needle aspiration
Alfa fetoprotein.
Inguinal excision
Sclerotherapy

Clinical features of Testicular tumours

Young men aged 15-40 years
Painless lump in body of testis (commonest feature)
Up to 15% experience pain
Loss of testicular sensation
Associated presentations (may mask tumour):
- hydrocele
- varicocele

128
- epididymo-orchitis
- swollen testis with trivial injury
- gynaecomastia (teratoma)
2. a lady fear of going outside specially in large crowded spaces, loves to stay at home and sometimes her friends
visit her at her house. Diagnosis?
A agoraphobia
B social phobia
C.OCD
Agoraphobia is defined as anxiety and/or avoidance associated with situations where help may not be available or
where leaving the situation may be difficult or embarrassing in the event of panic symptoms or a full blown panic
attack. Commonly feared situations include crowds, shopping malls, driving, public transportation, and being away
from home
The anxiety or phobic avoidance should not be related to another mental disorder such as:
social phobia (eg, avoidance limited to social situations because of fear of embarrassment),
specific phobia (eg, avoidance limited to a single situation like elevators),
obsessive-compulsive disorder (eg, avoidance of dirt in someone with an obsession about contamination),
posttraumatic stress disorder (eg, avoidance of stimuli associated with a severe stressor)
separation anxiety disorder (eg, avoidance of leaving home or relatives).
3. female 34 anxious about breast cabcz read in magazine some celebrity got ca at 32.no positive sign and
symptoms.no family hx
A)mammo
B)usg
C)MRI
D)reassure that no more inv is needed at this time
E) put her on breast screening program(but didnt said by now or from 50 years of age)
It is recommended that women aged 5069 years attend the BreastScreen Australia Program every 2 years for
screening mammograms

1.meningitis scenerio,lymphocyte increase,rbc 200 ,protein n,mx?

a.analgesic and observe
b.supportivec.do mri
d.ceftriaxon e. i/v acyclovir
I choose a as told by farzin
2. 55 yrs she got mennapause and now she is 62 yrs oldwho is sexual lyrics active
with her husband with vaginal green brown discharge, her all pap smear had been

129

normal.what is the most likely diagnosis

A.candidiasis
B cervical cancer
C.cervical ectopic
D.chlamydia
e. endometrial ca
for most likely I chose Chlamydia only
19. A chest x-ray given showing half of the left side lung field opaque.
Asked for preferred investigation of choiceCt chest
Bronchoscopy
Lung biopsy
Answer is choose was a
38. old patients with stent and on clopidogrel ( but the time of stenting was not
mentioned!!!!) now falls and has a fracture of neck femur FBC and platlet
morphology normal but has bruises on the body what should be done?
A. stop clopidogrel immediately and do surgery in 1 week if there is no stent
B. do surgery Now
C. give FFP and do sergury now
d. give platelets and do surgery now
I choose d
39. and scenario of varicose vein and mi and on clopidegral started 7 days
before.pt is on stent and clopidegral..
a. refer surgery after 12 months and stop clopidegral 10 days before surgery
b. do surgery now
c.give platelets not and do surgery
I choose a
40. Old age female had a will not to admit her when she is
terminally ill , today she fall & had # femur , she became very
drowsy after morhine inj. , what to do now ?
A)Operate her Fracture
B)arrange family meeting
C) admit her
D) Refer to Emergency department
E) Refer to Palliative care unit
Answer is choose d as told by frazin kindly see the discussion
for this qs frazin said its d and I choose the same

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41. man comes to ED with open wound at chest on examination,

vital signs are stable, there is dullness at the left lower lobe of
chest & reduce breath sound in the left side. What to do?
a. strap the wound with pressure
b. intubation
c. underwater-sealed drainage
d.needle thoracotomy
I choose c only
42.scenario of mania and asked for the treatment I choose
lithium.. h/o of depression is also present
43.old scenario of marijuana pt taking it for pain relieved and
now started hypnogogic marijuana
1. refer to psychiatrist
2. refer to drug and alcohol assement center something
Rest were not valid option I choose 2
44.same scenario of premature child and now presenting late
signs of development
I guess that is because they born immature
45. sign of familial hypercholesterolaemia
a. tendon xanthelesma
i choose it
46. Hyperkalemia ecg, poly pharmacy patien,onamidarone,
amilodipine, fruesmide, aspirin.
a.aspirin+amidaron
b.frusimide+ amidaron
c.frusimide+amilodipne
d.amidaron+amlodipine
answer is b as explained by frazin
47. Patient on venflexin well controlled now developed pressure
speech, euphoria. What to do.
a.add Na volporate.
b.add olanzapine.
c.add chlorpromazine
answer Is a but I choose wrong I guess
48.post surgery hypocalcemia scenario
Iv calcium I choose

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49. Csf protein and glu was normal, but lymp was 290*10 to
power 6, and normal values were mentioned below 2 I think, and
neutrophil was high too. Next
a.obsever and supportive
b.acyclovir
c.iv ceftriaxone
answer is a m sure
50. patient with history of mi last month comes with cholecystitis pain not
responsive to iv antibiotics what is next
a)change antibiotic
b)percutaneous cholecystostomy
c)ercp and extraction
d)surgery
answer i choose b
51. 3 days oliguria , after knee surgery , appropriate next :
-US bladder
-CT
-IVP
After an explanation by dani i choose 1
52. 9month old boy with complain of fever 39, cough, tracheal tug, intercoastal
recessions and lethargy came to ED. You gave Iv fluids and oxygen.
A) pneumococal pneumonia
B) croup
C) bronchiolitis
D) anemia
Answer is a
53.scenario of multiple mypeloma with anemia and esr 104 ask for d diagnosis
I went for bone marrow examination
54.that old scenario of football player got down and than stand up in few minutes
and start playing after 30 minutes
I choose vasovagal attack
55.a child with scenario of meningitis and presents with seizures... rest
investigations were normal but na was 120.. asked what u ll do next.. i got puzzled
in 2 options
a. ns with 3% na
b. i/v hydracortisone
and i choose 1 as an answer i hope m right

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rest options were waste

56.pt with gout attack and got renal failure and asked for the treatment and i
choose steroids
57. pt on opioid become drowsy, dehydrated wife think opioid
harming him, next
Reduce opioid, continue same dose, hydrate
58.2 qs about nocturnal dusuria in a 4 years old child and one with option urni and
cs and no option of nothing to do and another with the option of nothing to do now
So i choose urine cs in one and nothing to do in other
60.dvt two or 3 scenarios almost similar so nothing to worry its from repeated qs
only
61.scenario of schock and asked for what to do next.. easy qs to start ns
62.scenario of rhabdomylysis and ask for Mx
Ns with desired 2ml/hr urine output
Ns with desired 1ml/hr uo
I went for 2ml / hr.. old qs
63. CT scan of a sheep farmer.. ct was not so clear but as dimensions were given I
could have see cysts so I think It was hydatid cyst only
a. serology for hydatid cyst
b. aspiration of the cyst and cytology of its fluid
ANSWER IS A
64.same recall of svc syndrome and what to do next
Ct chest
67. in other smoking cessation I guess normal lady want to stop smoking and ask
for help.. what to do first
1. nrt
2. chew gums
3. first decide the plan for smoking cessation with her
69.old recall of pregnancy with 2 fetus 12weeks pregnant
Folic acid and iron
70. lady with 3 fall history in market which she remembers and feels like detached
and i think its an old scenario
1. eeg with vediometry
2. ask the witness
3. lp
I chose 1
71.scenario of diabetic foot with very high hba1c i guess 9 or some thing and bit
high cholesterol and low hdl.. what to do to prevent amputation.. already amupted

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one leg history

1. strict glycemic control
2. strict hyperchloestremia control
3. meticulous foot carr
I went for 1
72. A patient is confused and agitated, lawyer comes to you and asks you to
witness his will. What will you do?
C- Witness will
D- Refuse to witness will
Answer is b
73.that scenario where mother dont want to immunise her child
Answer is respect her wish
74.scenario of iga nephropathy with h/o recurrent hematuria
75.scenario of engineer the old recall where we do endoscopy as all other
conditions are normal
76. A 60 y.o. man develops lightheadedness and palpitations. He has hx of
thyroid disease and well-controlled heart failure. He is on thyroxine, ACEI,
diuretic. ECG is given clearly showed AFib. What is the next step?
a. Cease thyroxine
b. Start digoxine
c. Start b-blocker
d. Start verapami
Answer is c
1)Photo of red macular skin lesion, but not erythema myltiformme or margimatum? With a history of
migrant, blood stained sputum with cough, weight loss, malaise
(Looked like a TB history to me)
1.bronchgenic ca
2.pulmonary TB
2)handbook question 3.042
3)old recall with the old man saying he can see waves crashing over ceiling. Asked to identify where
the lesion is
12)8 weeks premature infant At 10 months brought in by parents because his development seems to
be delayed: can roll over but can't sit propped up. He was in hospital for 6 wks after birth and also his
prematurity was due to maternal PIH. His centiles on corrected scales are 3% height, 20% wt( cant
rememeber that well).How can this delay be explained.

134
1.normal due to prematurity
2.CP
3.Duchenne muscular dystrophy
4.spinal muscular atrophy

19 september recalls
1) eye picture with history of back pain asking for diagnosis- uveitis
2) Growth chart asking kid is obese/ overweight
3) Rash on trunk looks like crusted,bled,painful ,blistered- Tx- famcicyclovir
4) Pic of burger disease asked dx
5) Pic of red testis swollen asking causative organism- ecoli, chlamydia,gonorrhoea
6) Pic of varicocele asking investigation- ct/ venogram
7) Pic of deputreyenes contracture asking ix- us
8) Pic of swelling of neck in posterior traingle with pain asking dx- cervical lymph node
abscess
9)
10)
11) Ecg of pulmonary embolism with scenario of flight journey asked for dx
12)
13)
14) X-ray of chest with h/o fever,malaise,abdominal pain,vomiting,dry cough- dxatypical pneumonia
15) X-ray of anterior shoulder dislocation- asking mx- reduction/ sling cuff
16) Ct brain with infarct -dx
17) Ct tumour in kid with ataxic gait- astrocytoma/ medulloblastoma
18) Screening for diabetes,bp,pap smear,colonoscopy- read all I've got 5 questions
19)Obese,bp-135/90, waist-103 cm,h/o family HTN - asked Mx- start anti
hypertensive,check 24 hour
ambulatory bp/check no at home
20)
21) Abi< 0.25, pulse less,parasthesie- asking mx- ct angio/ Doppler ultrasound
22) PVD scenario asking investigations- Doppler ultrasound
23) Rheumatic scenario- Tx- penicillin
24) Sle scenario asked Tx- anti platelet&
immunosuppressive,anticoagulant&immunosuppressive
26) Depressed with hypercalcemia next investigation - PTH
27) hyponatreamia cases 5asking dx,Ix,mx
28) Hypothyroid features - Ix- tsh assay

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29)
30) Lmn lesion in arm and leg,sensations of touch.proprioception lost on dorsum
hand,urinary incontinence- asking dx- c7/
cauda equina
31) Pckd with cerebral aneurysm scenario- ix- cerebral angio/ ct
32) Kawasaki disease scenario- Tx
33)

Sep 2015 Thanks to all amedex administration and members.

really i cannot remember the

stem of this qestion but read about obstructive hydrocephalus management
#IMP

2---a 32 weeks pregnant with motor vehicle accident came with bp 90/56,pulse
110,fundal height 36wk,next managmnt
1.cross match 4 bag blood
2.iv dextrose 2l over 6 hours
3.usg
4.cs
5.amniotomy
nza vaccin
13--What study will you do to find out association of naevus and occurrence
of melanoma in your community
1.Case control
2.Cohort.

136

15--salmonella case in your gp practice in the last week.what study will you
do to find out the cause of this outbreak?
1.Case control
18-- a 3 month old child vomit out of milk for 3 days.he was gaining wight
previously bt no wt gain last week.all electrolytes value was normal and
urine tset also normal.dx
1.gerd
2.pyloric stenosis
20--obstructive apnea in a fat man long term Mx
a-CPAP at night
b-Surgery
c-Wt reduction

28--.xray of collesfracture.asking for follow up after

1.1 day
2.1 week
3- 2 wks
30--a young 25 yr women with rash on face and hands with sewlling of
joints .what is the consistantxray finding.
Ana is 1/640,speculated
Dna 25
Ra factor 14
1.chondrocalcinosi

137

2.punched out lesion

3.periarticular osteopenia
4.periarticular erosion

34--.Young patient presents withankle dislocation,loss of pulse and some paleness

at ankle at ER.what will you do next
1.Reduction in ER
2.Send him to OT
3.Immobilize with plaster
4.surgery
36--9 mont old child present with fever 39,cough,dyspnoea,tracheal tug present but
chest was clear.,whats ur dx?
1.rsv bronchiolitis
2.sterpto pneumonia

case of anal fissure and urine retention , after bladder catheter to relief retention wt
to give next
1. GTN cream.
39--pt wth mass infront tragus with saliva dribbling next
1.ct head and neck
2.fnac3.us
d- intraoral xray
2.DRE
3.proctoscopy

138

43--cardiovascular risk in 5 years for 54 yrs male non smoker diabetic bl.p
149/89 chart give
44-- cardiovascular risk in 5 years 34 yrs old male smoker non diabetic
bi.p 125/35 chart given
1
9. After removal of central venous line a lady developed facial swelling and swelling around
neck.what is the most appropriate inv
1.CT chest with contrast
2.CT head,neck
3.CX-Ray
4. USG Doppler
10. a child with scenario of meningitis and presents with seizures... rest investigations were normal

but na was 120.. asked what u ll do next ?

a ) N/S with 3% na
b ) i/v hydrocortisone
12. old recall with previous dvthx, now pain and pigmentation around ankle, tx?

ivheprain,
antbtc,
enoxaparin
13. Women brings in her child and tell that she is worried about him. He is sometimes very

mischevious and gets very naughty , sometimes hard to control so have to even beat him and
lock him sometime. What would you do first?
a. Call child protection authority
b. Get the collateral history from the father
c. Talk to the boy
14. 19 years Unmarried women presented with slight lower abdominal pain.On USG 6 cm SOLID

mass beside uterus.whats your DX

1.Teratoma
2.Mucynous cystadenoma
3.Corpus luteal cyst
15. women with 2 days h/o vison problem on left eye and pain behind the eye rt eye is normal

lt. eye with 6/12 and rt with totally normal visionnormal papillary reflex and normal movements
of eye particularly mentioned

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1. ct head
2. visual evoked potential
3.lp

32.a young patient with history of sickle cell anemia, after along history of flight, came with calf pain,
all well wth respiratory part, which one of the following is the most appropriate next step in Rx?
O2 therapy
IVIG
enoxaparine
steroids
.anelgesics
38.girl with bmi 30 started sexual activity what to screen for-chlamydia
40.
41.:/
42.13 year old girl with history of unwanted sex-child protection authority

43.infant with systolic murmur

44.infant with hydrocele next investigation

45.massinfront of tragus,dripping of saliva ct

46. 47.question about denial of depression

48. narcissim
49.dialysis pt now refusing-disorientation

50. 6 months old infant vomiting gaining wtnoramy-GERD

51.lots of questons about psych and ecgs

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thses are my recalls friends!
my friendly advise would be just concentrate on HB and recalls!
Last 4-5 months recalls should be enough!
I dont know how was my exam! Need ur prayers!
Thank you

5) 6) A case of competitive gymnast with secondary amenorrhea. Asking cause..

a) hypothalamic pitutary
b) the rest of the options were irrelevant
7) a case of antepartum hemorrhage. Woman lost 1000ml ( i cant recall the exact number) blood
loss. What will tell you it is placenta previa?
a) tender uterus
b) abdominal pain
c) no fetal movements
d) high lying mobile fetal head.
8) 8) case of sheehan syndrome
9) picture of melanoma
10) picture of erythema nodusum and case of sarcoidosis.
11) RBBB with AF ECG
13) case of pancreatic pseudocyst. Man chronic alcohol consumer.
14) Fibroadenoma in a young female. What to do next:
a) FNA
b) core biopsy
15) case of PICA
16) man post angio for MI on heparin and now on clopidogrel. 24 hrs post procedure develops a
painful pulsatile expanding mass in the groin. What is your definitive permanent management
a) apply direct pressure on the swelling
b) thrombin injection in the mass
c) immediate surgery
d) stop clopidogrel and observe
17) case of enlarging parotid swelling with facial nerve involvement.What is your next
investigation.
a) CT head and neck.
18) woman 20wks gestation complaining of shortness of breath. Physical exam normal.
What next?
a) CTPA
b) D dimer
c) pelvic USS
d) ECHO

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20) case of osteopenia t score -1.5 asking management.
a) ca and vit d..
23) 24) case of Q fever
25) case of congestive heart failure.
26) in case of acute stress what hormones increase.
a) increase TSH increase cortisol
27).
28
29) case of achalasia
30) case of sigmoid volvulous..x ray shown.
15- a picture of melanoma on face
67
8- 65 yrs old man after knee surgery developed abd distrntion and vomiting ( pain wasnt
there)
cause ? There was a ct wasn't realy diagnostic
A. Colon cancer
B. Psuedobstruction
C. Volvolus
D. Fecal impaction

22- 2yrs old child with genital wart her mother had wart 4 yrs ago cause
A. Sexual abuse
B. From mother during labour
24- a student who works in a resturant got gastroenteritis mx?
A. Put on gloves when is in restaurants
B. Whash his hands frequently
C. Exclusion of school until full recovery
D. Give him sick leave for resturant
25
2627- pt on lithium and resperidone came with acne and obesity cause
A. Resperidone C. Drug interaction due to combination of lithium and resperidone
B. Lithium
2. Pic of erythema nodosum and patitent complaining from hemoptysis old recall ,TB.

142
3. Ct brain ask about diagnosis intra cerebral hge.
4. Ulta sound liver looks metastasis for me.
5. Old recall about least effect for hormonal replacement therapy.depression.
6. Old recall htn and mi . Cohort study
10. Senario about pulmonar embolism after surgery how to diagnose . Ct angio
11. Senario of post partum convuloin . What is the most immediate management . I
choosed, air way clearnace.
12. Senario of anaphylaxis what is management . Im adrenalin.
13. Ecg inf STEMI ask diagnosis.
14. Same question os STEMI ask management, coronary angio.
14. Old recall about chlamydia is asymptomatic...
18. Old recall about allergey to egg and MMR vaccine.
19. Patient with old mi and cholesterol 6,5 what to add to management, i choosed statin.
18. Ecg not clear looks LBBB ask about management, i didn't understand the Q .
21. Scenario of acute limb ischemia most important next mangment . I choosed iv
heparin.
22. Old recall about brachial plexus injury.
23. Pic for molluscum ask about school isolation.
24. Scenario about alzehimer and IHD ask about management . I answered
Memantin.

143

26. Scenario for female not pregnant and had mania ask about management i choosed
lithium. No olanzapine.
27. Two Q asked with same Scenario of premature ovarion failure (fsh menopausal
range=3- 250)ask about diagnosis and another Q ask about how to manage if the
patient is not sexually active now and not like to be pregnant. I choosed HRT.

144
(cyclical gv........continous gvn in late menopause)
28. Xray for ankylosing spond. Ask management.
29. Old recall of old patient with intestinal obstruction ask diagnosis. Xray given not
clear.
30. No statistics or ctg.
31. Old recall about grand mother vaccination before delivery of her daughter.

Recall of child that can not communicate in school ..interest in matemathic .. no eye contact ..
mild language delay?
Aspergaer was one of options

A photo of a smoker with finger amputation and history of discoloration in the cold weather
Burger(tromboangitisobliterans)
.
Lady mother diabetic, father hypertention has bp :160/80 BMI : 31 first management ?
Cardiovascular risk estimationI picked:
There was no option exercise or dietry plan
I think one was treatment of HTN
Lady drinksalchohol before pregnancy ..wt do u advise her?
Decrease amount
2 day week without alchohol
Immediately stop it
4 or 5 case about post operation complications!!!
Chillean woman with perianal problem and fissure in examination I dont remember anymore
I choosed intestinal shistozomiasis
Pregnant lady in 3 trimester lost 200 cc blood ..now with bad condition .. bp :
Bp: 90/50..pr : 130.. garding and tenderness.. firsinv ?
Resuscitation

145

15 yo boy homless..wt is ur more important advise :

There was an option abut STD prevention
Q fever case (pneumonia and hepatitis)
Coxiella
There is 2 ihd in a 200 member communication if asprin decrease the risk to 1 member wat is the
eficasy of asprin in IHD?
1%
2%
100%
200%
( the answer is 100% I choosed 200% wrongly)

7. 68. 13 years girl leaving for 8 months outside present with

unplanned intercourse last night. She is concerned about her
pregnancy and wants to check for that
8. 1. inform police
9. 2. inform parents
10. 3. inform social worker
11. 4. sexual assault services

146
6)which study u do to assess range and variance of vit D in Australia
A)cohort
B)cross sectional survey
C)case report
D)randomised control trial
7)4yr old with enuresis nocturnal 4-5 times a week.daytime dry next what
A)urine dipstick
B)renal ultrasound
C)urine culture
D)urea,creat and electrolyte
No option of reassurance
Pregnant women ( I think at 39 w) presents with no fetal movement for 2 days,CTG
Pic normal (10 min showing 2 UC and 3 accelerations with good rate and variability),
whats next
A. Repeat ctg after 24 hrs
B. Admit and monitor
C. Continue till next appointment
D. arrange to see her after 24 hrs n reassure.

4)it man concern about risk of sunburn in hx what will u see

A)previous sunburn
B)atypical naevus number
C)family hx
D)working environment