September 2023 part 4 solved in zoom session

82 old man, bright red hard palate. Photo show redness over
palate.Advise on management?
a/Advise him that this condition is related to candida in the mouth and
can be managed initially with oral hygiene measures
b/ Advise him that this is a sign of improperly fitted dentures and he
should see the dental prosthetist again as soon as possible

74 male, fatigue, 2kg weight loss, nocturnal back pain x 6wks,

pallor,multiple wedge compression fractures on thoracic spine x-ray.
diagnosis?
a/Prostate specific antigen(PSA) level
b/Serum protein electrophoresis, immunofixation

Positive VDRL In pregnant woman.What to do

next?a/Termination ofpregnancy
b/treat mother now
c/treatbabypostbirth

Pt with frcture forearm reduction by ed consultant, history taken

byintern and surgery arranged by surgical resident. Who has duty to
take consentfrom pt??
a/
Consltantb/
Intern

c/Resident
Childbroughttohospitalbyparentswhomovedinrecentlybecauseof
fracture femur. Parents say child is playful and not cautious. That he’s
hadmany fractures before. On examination only swollen at site of
fracturefemur.
a/ Talk to school
teacherb/Nonaccidentali
njury
c/Osteogenisisimperfecta

Dribbling of urine while coughing on examination there was

smallcystocoeletreatmentwill be ???

Gynecomastia. 16 yo male athlete, BA controlled by salbutamol

andfluticasone. Reason?
a/ Normal
adolescentb/salbutam
ol
c/fluticasone
d/anabolicsteroid use

Smoker having enlarge lymph node in inguinal area and weight loss
withtendermass at the lowerpart where was theprimary tumor

Thereweretwo psychiatryquestionswhichreallyconfusedme,andI
haven’tseenthemanywhere.

Mother brings 32 year old man with learning disability. Recently

hestarted having aggressive outbursts with head banging plus insomnia
andweightloss. Best medication for him?
a/
Escitalopramb/
Olanzapinec/Di
azepam

Pregnant women is an asylum seeker, lives with husband in

community.Feels scared of people talking about her, frightened when
husband goestowork. Irritable.(No timeframegiven) likelydiagnosis?
a/
psychosisb/
PTSD
c/ GAD
 woman in labour meconium noticed on rom. Fetal head -1 position.
Ctgreassuring.Fetalposition ROP. Whattodo
a/Caesarean
b/ Epidural
analgesiac/Oxytocin

Fetus was behind the age but parts

palpable.Fundalheightwas4weeksbehind.
a/Iugr
b/ Constit
delayc/Renalagenesis

There was one woman who came with ankle disclocation in pregnancyand all
her symptoms (headache proteinuria) suggested she also haspreclampsia?
They asked forinvestigations
a/ ankle xrayb/lfts
c/24hour bpmonitoring

Boy from Sudan came with low vitamin D what can you
givea/Calcitriol
b/
Cholecalciferolc/Vitami
nB
d/Iron

Q-65 Woman has itchy vagina no discharge no sexual intercouse because of pain

1-ostogean cream

2-betamesthasone

3- something gel

Atrophic vaginitis
Q-woman was already on estrogen pessaries and there was no sign on examination. Options included

candidiasis,

e.coli,

lactose bacillus,

Bacterial vaginosis

gardenella

Man stiffness neck glicose and protein normal lymphocytes high (csf analysis)

1- penicillin

2-ceftriaxone

3-observation something in this meaning

Pt 14 week did cvs normal after the second screen for Down syndrome reveals 46xx

Next

1-2nd trimestwr screen

2-Aminocentesis

3-Do nothing

A 15 yr old in tattered soiled clothes is brought to emergency by police from park,

he says that he escaped his parents because they had barricade shut the

house, cutting of the internet, not allowing him to leave the house because of COVID.

What condition do the parents have?

1-Shared delusional

2-Conspiracy thinking
3-Schizo

4.Overvalued idea

An ECG Of elderly Bradycardia complete heart block

he was taking prindoril , Endapamid and thiazide what is next management

a-atropine

b- TPM

A 45-year-old man with history of viral orchitis presents with bilateral gynaecomastia.He has
hypertension treated with spironolactone and admits drinking of alcohol occasionally.

Physical examination reveals normal body hair distribution and 22ml testicles bilaterally.He has
moderate bilateral gynaecomastia.

Investigations show:

Serum testosterone 12 nmol/L (10-25)

Luteinising hormone less than 1 IU/L (1-9)

Oestradiol 250 pmol/L (40-110)

Prolactin 350 mIU/L(less than 400)

Dehydroepiandrosterone sulphate (DHEAS) 14 μmol/L (2-12).

Which of the following is the most important next step in management of his gynaecomastia?

a. Cease alcohol intake

b. MRI scan of pituitary gland

c. Testicular ultrasound

d. Karyotype analysis

e. Cease treatment with spironolactone

7year old child coming with multiple skin abscess, has healing scars of previous abscessess. History of
recurrent chest infections.

What function test will direct to the diagnosis ?

1) Lymphocytes

2) Neutrophils

3) Complements

4) Immunoglobulon

5) Eosinophils

Q-Child with frontal head large and flat occipit. Parents concern that head is too large. Child 25 th -
50th percentile on height and weight. Cause:

Premature closure

b. Arnold chiari malformation

Sign indicating more towards intestinal ischemia.

A. colicky pain to constant pain

b. Atrial fibrillation

Fitness instructor breast fed the baby for 4 months now presenting at 10 months with amenorrhea.
Had previous uncomplicated full term delivery. Had mirena insertion

A. lactational anovulation

b. endometrial suppression .. because of merina insertion

c. adhesions

Dr doing marijuana during patient’s consultation breaks. Who to notify.

A. medical board

b. practice manager

c. consult with him

Female patient sleeping 4 hours per day in post pregnancy. Enjoying life however husband doesn’t
co operate with house work. Management

a. refer for family counselling

b. temezepam short term

c. refer for cognitive therapy

 13 years old patient in emergency need emergency surgery. 19 year old sister together. Who to take
consent from

a. sister

b. contact parents

VSD scenario and teratology of fallot scenario

Patient with multiple drugs also on digoxin. Digoxin toxicity ecg given. Management asked?

Digifab/Digibind

Patient with injury. Difficulty breathing cant complete sentences. BP 90/60 and cardiac and
respiratory sign difficult to hear. Diagnosis

A. haemothorax

b. tension pneumothorax

b. pneumopericardium

Chest Xray with cavitation given. smoking history and fever. Diagnosis asked.

A. TB … fever

B. Lung cancer

C. Sarcoidosis
Rash picture given of leg. Asked what is the diagnosis.

A. Nephrotic syndrome

B. Henoch Scholein Purpura

c. ig A nephropathy

Ana, ENA and dsdna, and anticardiolipin positive patient. Management

a. Immunosupression and anticoagulation

b. immunosuppression anti platelet therapy

c. anticoagulation and anti platelet

17year old femail with fever, peritonsillor mass, uvula deviated, and drooling. Management.

A. endotracheal intubation

b. incision and drainage

c. IV antibiotics

Patient post delivery with lower abdominal tenderness and bleeding on 5 th day. Management with
cephalexin.

A. flucloxacillin

b. gentamicin

c. metronidazole

Endometritis
Elbow tenderness around lateral epicondyle with positive hand finding. Management:

Xray

b. rest the arm

c. US

Female with recent several partners. Recently started COCp. Intermenstrual bleeding. Management
a. screen for STIs

b. change dose of estrogen in COCP

Patient with schizophrenia coming in emergency disheveled and disoriented. Management

a. community treatment order

b. IM haloperidol

Infantile spasm scenario. Asking diagnosis

Shoulder injury with no neurological signs. Right shoulder with pain and swelling.

A. brachial plexus injury

b. radial nerve injury

c. regional pain syndrome?

Patient refusing blood transfusion due to religious reasons. Best solution to use?
 A. haemecel b. ringer lactate c. Hartman solution

Mother concerned for son’s diagnosis as father has schizophrenia. Symptoms of concern.

A decrease in school performance

b. isolation

55 year old found out that her biological mother has Huntington’s disease and died at 45 years of
age. Management?

Tell her she doesn’t need genetic testing

b. genetic testing

c. genetic counselling

Patient on multiple drugs and having orthostatis hypotension and recent fall injury. Patient is also
elderly management:

Refer for age care facility

b. stop antihypertensive drug

Patient hoarding garbage. Presented with wife. What to look for

a. childhood abuse history

b. ??

1. There is a some kind of study to implement early screening. Then they ask what is the most important
outcome?
A. The screening should treat all the future cases.

B. The screening tool must be readily available everywhere.

C. The early screening should change the management course

2. Patient has acute panic attack/anxiety attack. What is the ABG result?

3. Patient female to male. Come for testerone injection. The medication has been tampered. Only have
medication for next patient that supposed to come in 2 months.

A. Apologize and ask department to change the readily medication to the current patient

B. Prescribe new testerone and give new appointment

C. Just use the tampered drug

D. Inform authority on tampering problem

4. Patient has pain in the arm, but no neurological deficit, has mottled skin on the arm.

A. Brachial plexus injury

B. Radial nerve injury

C. Regional pain syndrome

5. Patient has a phobia towards dog. However, new boyfriend has a german shepherd and she wants to
overcome the fear. What psychotherapy we can give?

A. Keep diary about daily encounter with dogs

B. Listen to audio dog barking

C. Show picture of dogs

D. Ask her to volunteer in dog shelter

E. Talk about dog every day

6. Patient came with SOB, spo2 in ambulance 96, already given hudson mask 8L/min. SPO2 then 86
when reach hospital. Next best airflow management

A. Humidified Hudson mask 15L/min

B. Proper size fitted nasal prong 5L/min

C. Non rebreather mask 15L/min

D. Intubation

E. Venturi mask

1. Buttock intermittent claudication... where is the lesion

a.common illiac artery

b. Femoral artey

Ans. A

2. GBS pt. How do u monitor his pulmonary function ?

a. FVC

b. PEFR

Ans. A

3. Elderly pt with osteoarthritis. FBC given.its hb low,mcv and mchc low. Others normal

What is the diagnosis???

a. Chronic inflammation

b. Dietary Iron deficiency

: 4. Child with FTT, feeding difficulty, sweating while feeding. Tachypnoea, grey colour skin.left sternal
edge systolic murmur Diagnosis?

TOF
Vsd

Ans TOF

Pt with right shoulder pain, and some sensory loss reflecting radiculopathy, diagnosis?

a. Cervical radiculopathy

b. Ulnar nerve

c. Radial nerv

6. Female pt with acute pancreatitis with severe epigastric pain.Lipase increased. Iv fluids ,NG tube
given. Wat is the next mx?

a. Analgesics

b. AB

c, ERCP

I chose a

3yr old child with high fevr , coug, abd pain. CXR right consolidation. Organism

Strep pneumonia

Elderly female with chronic intermittent temporal headache and high ESR, diagnosis

Temporal arteritis

Junior doctor at ED is asking from surgical ward doctor whether he can take a photograph of a pts
uncommon Injury on leg for learning purpose. Wat to do ??
Take the consent from pt

Ask from surgical consultant

Refuse to take a photo

Bartholian Abscess pic given and asking wat is the investigation u do to diagnose.

Swab culture

No investigation needed

Paralytic ileus after post op on day 5, how do u manage?

NG

Colonoscopy

Gastogaffin enema

Girl with HOCM. Asking initial investigation

ecg

Echo

Stress test

Holter

: Mom in her 2nd pregnancy aat 12 weeks. First pregnancy Miscarriage. Wat is best for Screen for
downs?

CVS at 14 weeks

Amniocentesis at 18weks

Best screening test is USG

1.A one-year-old uncircumcised boy presents with 24 hours of fever, pain on urination and some blood
in the urine. Which one of the following is the most appropriate method of obtaining a urine sample?

A. Clean catch mid stream sample

B. Bladder pressure to obtain clean catch sample

C. Clean catch urine bag collection

D. Urinary catheter

E. Suprapubic bladder tap

2.A baby is born at term by ventouse delivery with light meconium staining of the liquor. At birth he is
slow to breathe and his Apgar scores are 3 at one minute, 5 at five minutes and 9 at ten minutes. Which
one of the following components is most important for successful resuscitation?

A. Mouth and nose suction

B. Guedel airway placement

C. Adequate ventilation

D. Supplemental oxygen

E. Tracheal intubation

3. A 20-month-old boy is with his mother in the supermarket. He puts a lollipop in the trolley and
becomes enraged when his mother puts it back. He starts to cry vigorously then suddenly stops
breathing. He becomes cyanosed, loses consciousness and has a brief tonic clonic seizure. On
examination 15 minutes later, he is alert and interactive. His BP is 95/60mmHg, pulse is 100/min,
temperature 37.6°C and neurological examination is normal. Which one of the following is the most
likely diagnosis?

A. Febrile convulsion

B. Breath-holding spell

C. Epilepsy

D. Syncopal episode

E. Encephalitis
4.A 9-year-old Aboriginal girl presents to a regional hospital with the complaint that her ankle has
become increasingly painful over the last three days. She had fallen from play equipment at school a
week earlier. Except for a recent episode of pharyngitis her previous health has been good. Her
temperature is 38.5ºC and her pulse rate is 95/min. On physical examination she has a mildly swollen
ankle with some pain on movement, but the examination is otherwise normal. The heart sounds are
normal and no murmur is heard. The lungs are clear. Which one of the following is the most appropriate
initial investigation?

A. X-ray of ankle.,

B. Full blood count and ESR

C. Ross River virus serology

D. Ankle joint aspiration

E. Rheumatoid serology

5. A 35-year-old woman presents following an intentional overdose. She called an ambulance and
admits to taking sertraline but refuses to give any further details. On examination she is irritable,
uncooperative and abusive. Her BP is 125/87 mmHg, pulse 112/min and temperature 37.2°C. In addition
to β-hCG, which one of the following is the most important investigation?

A. Arterial blood gas

B. Blood alcohol level

C. Urine drug screen

D. ECG

E. Paracetamol level

6. A 26-year-old woman has been diagnosed with schizophrenia. She lives with her parents. The history
is a gradual onset of symptoms from the age of 19. She is now stable on amisulpride 800 mg per day.
She has never worked but continues to make attempts to find employment. She complains of difficulty
concentrating and thinking clearly and of problems "feeling" her body. Which one of the following is
most likely to be associated with a poorer prognosis?

A. Use of high dose antipsychotic

B. Insidious onset of illness

C. Living with her parents

D. Somatic sensory deficits

E. Chronic thought disorder

7.A 14-year-old girl is brought in by her mother who is concerned about her daughter's low moods and
tearfulness. The girl describes six months of feeling sad and anxious with a decrease of energy and loss
of interest in recreational activities. Her school grades have deteriorated. She has occasional suicidal
thoughts but no plans. Which one of the following is the most appropriate next step in management?

A. Arrange admission

B. Commence sertraline

C. Commence fluoxetine

D. Cognitive behavioural therapy

E. Encourage physical and social activities

8.A 50-year-old man presents asking for a prostate cancer blood test. He says he has no obstructive or
irritative lower urinary tract symptoms. Which one of the following is the most appropriate next step?

A. Discuss the pros and cons of prostate cancer screening

B. Perform a digital rectal examination and prostate specific antigen (PSA) blood test

C. Arrange a urinary tract ultrasound to assess prostate morphology

D. Advise that screening is not necessary in the absence of symptoms

E. Arrange a prostate biopsy

9.A 45-year-old woman seeks information about her 18-year-old daughter during her own consultation
with the family's general practitioner. She is worried about her daughter and believes that she is
depressed and has been seeking contraceptive advice from the doctor. She seeks confirmation of this.
Which one of the following is the most appropriate action?

A. Ask that she attend with her daughter at the daughter's next appointment

B. Discuss the daughter's depression with her

C. Telephone the daughter now regarding her mother's request

D. Advise her you cannot discuss any other patients

E. Advise that you have not seen the daughter as a patient

10.A 27-year-old man with a history of heroin dependence presents to the Emergency Department with
abdominal pain and vomiting. He appears agitated in mood, and has tachycardia and fever and dilated
pupils. He admits recent use of cocaine and heroin. Which one of the following clinical findings is most
helpful in differentiating cocaine intoxication from heroin withdrawal?

A. Agitation

B. Abdominal pain and vomiting

C. Tachycardia

D. Dilated pupils

E. Fever

11.A 23-year-old woman presents to her general practitioner at 16 weeks gestation in her first
pregnancy with frequency and mild stinging when she passes urine. Her temperature is 37.3⁰C and pulse
84/min. On abdominal palpation there is suprapubic tenderness. Which one of the following is the most
appropriate management?

A. No treatment as these symptoms are common in pregnancy.

B. Request a midstream urine specimen and await culture.

C. Prescribe a wide-spectrum antibiotic after midstream urine specimen collection.

D. Insert an indwelling catheter to ensure free drainage of urine.

E. Perform a suprapubic bladder tap to obtain an uncontaminated urine specimen

12.A 37-year-old woman presents to the Emergency Department at 12 weeks gestation in her fourth
pregnancy with intermittent lower abdominal cramps and vaginal bleeding. She has a regular cycle with
five days of bleeding every 28 days, and is certain of her dates. Her previous three pregnancies each
ended in miscarriage before 10 weeks. Speculum examination confirms a moderate amount of blood
with clots in the vagina. On bimanual palpation, the uterus is anteverted with size equivalent to 8 weeks
gestation. The cervix easily admits one finger. Which one of the following is the most likely diagnosis?

A. Cervical incompetence

B. Threatened miscarriage

C. Missed miscarriage

D. Incomplete miscarriage

E. Ectopic pregnancy

13.A 29-year-old primigravid woman at 36 weeks gestation presents after not noticing any fetal
movements for 24 hours. The pregnancy has been uncomplicated until now, with all routine screening
tests normal. On examination the symphysiofundal height measures 34 cm. The fetus is in cephalic
presentation with the head 3/5 palpable abdominally. Which one of the following is the most
appropriate next step in management?

A. Serum estriol assay

B. Cardiotocograph (CTG)

C. Obstetric ultrasound

D. Biophysical profile

E. Induction of labour

14.A 19-year-old woman presents to her general practitioner with intermittent spotting from the vagina
since commencing a triphasic oral contraceptive pill one month ago. The bleeding is not associated with
sexual intercourse. She has been with the same partner for one year. A recent screen for sexually
transmitted infections was negative. On examination, the vagina and cervix appear normal. Which one
of the following is the most appropriate management?

A. Increase the estrogen dose

B. Increase the progestogen dose

C. Change to a biphasic pill

D. Recommend an etonogestrel contraceptive implant instead.

E. Continue the current medication and review in two months

15.A 75-year-old man presents following two episodes of blurring of vision affecting the right eye over
the past month. Each episode lasted for five minutes with complete resolution. Neurological
examination is normal. Ocular examination shows normal eye movements and pupil reactions. Which
one of the following is the most appropriate initial investigation?

A. Ocular tonometry

B. Carotid duplex Doppler studies

C. CT head

D. Holter blood pressure monitoring

E. ESR

16.A 23-year-old woman complains of diarrhoea with offensive stools and loss of 5 kg weight over the
previous 3 years. She now weighs 50 kg. There is no history of abdominal pain or abdominal operations.
Physical examination shows a slightly distended abdomen, muscle wasting and glossitis. Haemoglobin,90
g/L,(115-165) Mean Cell Volume,110 fL,(80-100) Which one of following is the most likely cause?

A. Multiple jejunal diverticulosis

B. Pernicious anaemia

C. Gluten-sensitive enteropathy

D. Ulcerative colitis

E. Crohn disease

17.A 79-year-old man presents complaining of pains in his thighs and arms. He has noticed increased
difficulty in climbing stairs for the last two weeks. His current medications are: Atorvastatin,80 mg daily
Sertraline,100 mg daily Frusemide,40 mg daily Digoxin,62.5 µg daily Atenolol,50 mg daily Enalapril,10 mg
daily On examination, there is some tenderness of upper arm and thigh muscles, and mild weakness of
hip flexion. Electrolytes, liver function tests and full blood examination are all normal. Creatine kinase is
8,000 U/L (70-380). Which one of the following is the most likely diagnosis?

A. Polymyalgia rheumatica

B. Atorvastatin induced myopathy

C. Stiff man syndrome

D. Sertraline-induced myositis

E. Hypokalaemic myopathy

18.A 27-year-old woman presents with a three week history of greenish brown discharge from the right
nipple. She first noticed this when she squeezed her nipple while washing in the shower. On
examination, she has no breast masses. The nipple appears normal. Small volumes of greenish brown
discharge can be produced from three openings in the central right nipple. Which one of the following is
the most likely diagnosis?

A. A,Mastitis

B. B,Duct ectasia

C. C,Breast cancer

D. D,Fibrocystic change

E. E,Physiological discharge

19.A 23-year-old moto-cross rider is brought to the Emergency Department following an accident. There
is a 6 cm laceration over the anterior aspect of his tibia which is clearly deformed. His foot is well
perfused. Which one of the following is the most appropriate initial step in management?

A. IV antibiotics

B. Fracture reduction

C. Lavage

D. Surgical debridement

E. Tetanus toxoid administration

20.A 32-year-old man is brought into the Emergency Department with a six hour history of increasing
pain in his right arm. He is confused and unable to give a clear history, but it appears that two days ago
he injured his arm, sustaining abrasions when he fell off his trailbike. He is disoriented, with a
temperature of 39.2°C, BP of 108/60 mmHg, pulse 110/min and oxygen saturation 96% breathing room
air. His right arm is red and swollen, with blistering visible away from the wound site. His haemoglobin is
146 g/L (130-180), white cell count 38 x109/L (4-11) and creatinine 155 umol/L (60- 120). Apart from the
immediate administration of antibiotics, which one of the following is the most appropriate next step in
management?

A. Intubation, ventilation and dialysis

\B. Wound biopsy

C. CT right arm

D. Hyperbaric therapy

E. Surgical debridement

21.A 50-year-old man presents with the 2 cm lesion shown (see image) on the left side of his upper
abdomen. This has been present for two months and is slowly getting larger. Which one of the following
is the most appropriate next step in management? (picture of melanoma)

A. Observe and review in one month

B. Cryotherapy and curette

C. Sentinel node biopsy

D. Punch biopsy

E. Excision biopsy

22.A 23-year-old moto-cross rider is brought to the Emergency Department following an accident. There
is a 6 cm laceration over the anterior aspect of his tibia which is clearly deformed. His foot is well
perfused. Which one of the following is the most appropriate initial step in management?

A. IV antibiotics

B. Fracture reduction

C. Lavage

D. Surgical debridement
E. Tetanus toxoid administration

23. A 24-year-old woman presents to the Emergency Department with a painful swelling on the right
side of the neck, worsening over the past three days. She is now having noisy breathing, difficulty
swallowing and is feeling sweaty. On examination she looks in distress, with a temperature of 38.2°C, BP
100/70 mmHg and pulse 110/min. She has tender, enlarged lymph nodes on the right side of her neck.

A view inside her mouth is shown in the photograph (see image). Which one of the following is the most
appropriate management?

A. Amoxycillin

B. Incision and drainage

C. CT head and neck

D. Ultrasound neck

E. Endotracheal intubation

Q-22 yo girl came to you today. She ?rolled left ankle during netball today,antalgic gait, mild lateral
swelling, no deformity or bony tenderness,reduced ROM. You suspect she has a mild uncomplicated
lateral ligament sprain and recommend rest, ice, compression and elevation. What is the best next mx?

a/Recommend immobilization in a back slab for two weeks

b/ Referral to her local physiotherapist for a six week rehabilitation program

Q- This was a pregnant lady and was found to have high BP , ankle edema and 1+ protein in her 2nd
trimester. Next best step asked. Options included:

xray of ankle,

LFTs,

BP monitoring at home.

Use Ottawa rule here for indication of xray. In pregnancy Ottawa rule becomes invalid, therefore xray
will not be the correct option.

Q-Indications of urgent surgery?

a/ Traumatic spleen rupture at lower pole

b/Upper pole of kidney rupture

c/Free fluid in the peritoneum

d/air under the diaphragm

Prime at 41weeks I labour. Cervix 4cm. Slightly meconium fluid. Wat to do ?

Review in 2hrs

Continuous CTG

5. Patient has a phobia towards dog. However, new boyfriend has a german shepherd and she wants to
overcome the fear. What psychotherapy we can give?

A. Keep diary about daily encounter with dogs

B. Listen to audio dog barking

C. Show picture of dogs

D. Ask her to volunteer in dog shelter

E. Talk about dog every day

6. Patient came with SOB, spo2 in ambulance 96, already given hudson mask 8L/min. SPO2 then 86
when reach hospital. Next best airflow management

A. Humidified Hudson mask 15L/min

B. Proper size fitted nasal prong 5L/min

C. Non rebreather mask 15L/min

D. Intubation

E. Venturi mask

There was no clue in actual option.

1. There is a some kind of study to implement early screening. Then they ask what is the most important
outcome?

A. The screening should treat all the future cases.

B. The screening tool must be readily available everywhere.

C. The early screening should change the management course

2. Patient has acute panic attack/anxiety attack. What is the ABG result?

3. Patient female to male. Come for testerone injection. The medication has been tampered. Only have
medication for next patient that supposed to come in 2 months.

A. Apologize and ask department to change the readily medication to the current patient

B. Prescribe new testerone and give new appointment

C. Just use the tampered drug

D. Inform authority on tampering problem

4. Patient has pain in the arm, but no neurological deficit, has mottled skin on the arm.

A. Brachial plexus injury

B. Radial nerve injury

C. Regional pain syndrome

Middle age man with DM hypertension, poor DM control , have difficulty reading, visually acquity r
duces when exposed to sunlight.

Cause
A-Diabetic retinopathy

B-Cataract

C-Macular degeneration

D-Closed angle glaucoma

E-recaller couldn't remember

Patient staying in aged care doesn’t talk or response seems happy brought by Aged care stuff. The stuff
is asking for sedative for the patient in case the patient requires anytime. What to do??

A. Give the prescription

B. Ask for patient’s sleep & activity data

C. Deny

D. Inform the aged care management

Which one is the absolute indication for the surgical intervention in a case of nephrolithiasis?

A. Fever

B. Persistent pain

C. Vomiting

D. Stone >6mm

Patient has rubella vaccine 2 weeks ago, a week before her expected next menstruation. She missed her
menses. What is next action

Do nothing else

Do serology

Counsel for termination of pregnancy

Patient came for review following a nuchal lucency on ultrasound. Karyotype confirms 46XY. What do u
do next
Continue regular antenatal visit

Do maternal serum assay

Reassure the patient

Patient in labour, cervix dialated from 2cm to 4 cm fully effaced. The presenting face is in the ROP. The
membrane ruptures and the amniotic fluid is greenish. Next line of management

Augment labor

Continue to moniter CTG

Caesarean section

33 week plus 6 days pregnant woman notice regular contractions every 3 minutes. Her BP was elevated
at 145/90 and urinalysis has + protein

Which is a contraindication for tocolysis

Preeclampsia

A woman had normal vaginal delivery with clear lochia over the next 5 days. She presented with copious
vaginal bleeding, cephalothin was commences. What else should be added

Gentamycin

Metronidazole

Ceftriaxone

Questions from 8 September exam

1.Psoriatic arthritis treatment options: methotrexate, steroids, nsaid, sulfasalazine

2. H pylori infection confirmed by breath test then treatment, post treatment investigation

Options: breath test, stool antigen, serology, endoscopy

3. Smoker with chest and abdominal pain with high BP dx

Options : esophagal perforation, MI, aortic dissection

4. Child with Systolic murmur and frequent infections investigation of choice

Options echo , ecg, cxr

5. Young female comes to clinic and was on an island with friends for a party, believes people are
conspiring against her dx

Paranoia,

Delusion,

depression

6. Agitated patient tried to commit suicide now in hospital wife has a restraining order due to past
violent behaviour

Next step

Inform wife, call police, tell child protection service, admit patient in hospital by mental act

7. Dog phobia 1st step

Talk about it, look at photos, watch videos,

8 Patient with resting symptoms of peripheral vascular disease ABI 0.25 next step

Doppler , Ct angio

9. Prostate biopsy infective endocarditis prophylaxis

Iv penicillin plus ceftriaxone,

oral penicillin plus metronidazole

find no need option in your exam

10. Pt has headache, mother had headaches and maternal uncle had stroke investigation of choice

Ct brain ,
mri brain
11. Female with secondary amenorrhea , IUD was placed right after birth of her last baby

Cause :

adhesions,

pcos,

endometrial hypoplasia

find lactation amenorrhea in your exam

12 SAH patient with increasing ICP

Next step

Ct brain,

Dexamethasone
A 63-year-old man who lives in a homeless shelter presents to the ED

complaining of headache with photophobia for 6 hours. Upon arrival to

the ED, the triage nurse places him in an isolation room. The triage note

states that the patient was alert and conversant during the nursing interview.

You enter the isolation room and attempt to speak to the patient, but

he is lethargic and combative. You note that his temperature is 103°F. He

is unwilling to move his neck and winces when you attempt to check his

pupillary reflexes with a penlight. The nurse informs you that laboratory

analyses are delayed this evening because of staffing issues. Which of the

following is the most appropriate next step in management?

a. Diagnostic LP

b. Initiation of IV antibiotic therapy

c. A loading dose of IV corticosteroids

d. Aggressive antipyretic therapy

e. Sedation of the patient and noncontrast head CT

The answer is b. (The clinical presentation

is consistent with meningitis. The patient’s mental status has declined

between initial nursing assessment and the physician’s interview. Delay in

antibiotic therapy in order to first confirm the diagnosis with CSF analysis

may lead to increased mortality.

LP (a) performed even several hours after initiation of antibiotic therapy

is often still culture positive for the causative organism. Administration

of IV corticosteroids before antibiotic administration (c) has been shown in

some studies to reduce the mortality of patients with bacterial meningitis.

Their use in the ED for undifferentiated cases of meningitis has not been

sufficiently studied. Antipyretics (d) are used to reduce fever but will not

stop the primary pathologic process. Noncontrast head CT (e) should be

obtained before LP when question of mass effect or increased ICP might

lead to herniation from CSF removal. Antibiotic therapy should not be

delayed in cases of suspected meningitis for neuroimaging.

13. Epileptic patient stable for 1 year had an attack last night , he was sober

Next step

Blood medicine level,

EEG,

ct brain
14. Patient on antipsychotic for schizophrenia pacing around and not sitting next step.. akatisia

Stop antipsychotic ,

add benztropine,

add propranolol

15. 6 month child recurrent uti usg shows hydronephrosis

NeXT investigation

Micturating cysto urethrogram,

Dmsa
16. Female with recent birth of child can’t sleep because child cries a lot at night no other symptom
she’s fine aside from tiredness husband hangs out with friends all the time

Next step

Marriage counseling,

prescribe benzo,

Psychotherapy,

nurse for house help

17. Patient normal BP and pulse on digoxin experienced dizziness ECG shows complete heartblock

Tx pacemaker,

atropine,

observe,

digoxin fab,

transcutaneous pacemaker

Alcoholic agitated patient with delusions tx…. Wernikie enceohalopathy

IM thiamine ,

oral diazepam

IM haloperidol find this option

A young female with dysuria and frequency urine culture are positive for E.coli

Rx

Nitrofurantoin

Trimethoprim

Cephalexin

Gentamycin
A female child presents with suprapubic pain, hesitancy and nocturia. Ultrasound reveals dilated ureter
and calyses. What's the next appropriate investigation

Ultrasound abdomen

DTPA

DMSA

15. 6 month child recurrent uti usg shows hydronephrosis

NeXT investigation

Micturating cysto urethrogram,

Dmsa
A female to male transgender came for progression in her sex change with hormones. U counsel her
that which change will be irreversible

Stopped menstruation

Change in voice

Breast removal

Patient has a core biopsy of a lesion on the face which was confirm to be basal cell carcinoma. How do u
treat

Repeat core biopsy

Excision biopsy with 0.5 to 1 cm margin

Fluorouracil

A patient has a skin lesion on the back that appears to be chicken pox. What's the time he can return to
school.

When the lesions have completely cleared

When the lesions have crusted

A woman brought her child to screen for familial hypercholesterolemia. She said her father has the
disease and her grandfather as well. What will be your response

Screen whole family

A 55 year old man presented for screening for Huntington chorea because his father died of the disease
at age 45 years.

What will be your response

Counciling

Go for screen now

In gas gangrene management . What is next?

Hyperbaric o2

Benzoyl penicillin

Surgical debridement

: A women with Rash on extensor surfaces, extending centrally from hands and feet. Previous history of
cold then rash developed suddenly. O/E she has 2 cm lesion with purpura and pale center.She states
that after trauma develops new lesions.What is the most common cause?

A)Lymphoma

B)TB

C)Mycoplasma Pneumonia

D) Herpes Zooster Virus

E) Herpes Simples virus

Kobner phenomena
Surgery of pt,smokes and drinks a lot.Recently had nose bleeding,platelate 90k. Awaiting herniorrhaphy.
How to avoid bleeding during surgery?

A.Transfuse platelate

B.Vit K

C.FFP

D.IV Tranexamic acid

A14yo boy w/ midthoracic spine pain for 12 wks, worse at night, not activity-related, no injury.

Relieved by ibuprofen. No spasm or tenderness, normal range of motion, strength, sensation,

reflexes, and pulses. No abnormality on straight-leg raising test.

Cause?

a/ Ankylosing spondylitis

b/ Disc herniation

c/ Osteoid osteoma

1.Bowen dx picture. Diognosis?

2.pt with heart failure symptoms. BP low. PR 50.already on ACE inhibitor,and some other drugs Iv fluids
given. Next mx?

A.Noradrenalin
B.Dobutamin

3.P3, c2 mother at 1st antenatal visit. 1st 2 pregnancys are IVF. this pregnancy is a natural conception.
Whant to do the diliver vwith minimal handling( exact word I don't remember.the idea i got was
Something like lesser medical interventions during labor such as she needs home delivery). Whom to
refer?

A.Hospital mid wife

b.private dilivery assistant

C.duola

D.obs specialist
4.svt ecg. 8yr old Child pale. HR difficult to count. Initial management. Has not mentioned about BP.
According to the question the impression i got was the child was concious alert and could say the histry.

A. Valsalva maneuver

5.48yr old women with premenstrual symptoms what to give?

A. Cocp if patient has no any cardiovascular risk factor obesity HTN smoking then OCP is best

6. You are a gp in a community and wants to reduce the consequences and occurrence of childhood
obesity in the children in the community. What is the best method?

A. Screen every child with measuring BMI to detect obesity

B.advice to reduce screen time

Exercise program

7.Man comes to you c/ o some symptoms. Ex is uneventful. He has previous long history of different
presentations with different symptoms and all the investigations previously done were normal.
Diognosis?

A. Illness anxiety disorder

B. hypochondriasis

C. Somatic disorder

8.chest xray was given with pneumothorax. In the question it was mentioned as moderate
pneumothorax. A heavy smoker after a severe bout of cough. Vitals are ok. Mx?

A.aspiration

Chest tube

Answer depends upon Xray

9. Pt with MVA. Impact on chest. Refused air entry on right side. Dull percussion on right side anterior
and posterior. Trachea deviated to left. Pain mx ws done. Mx?

A.wide bore chest tube drainage

10. Pt Presented with 4 day history of abdominal pain diarrhoea. Some other symptoms i dont
remember. Likes to go camping often. Diagnosis?

A. Ross river fever

11.acute diarrheal illness.liver palpable.fever+ Some other symptoms were there

12. Pt with malena. Ugi and lower gi were done could not find the course. Next investigation

A. Capsular endoscopy

13. Chest xray was given with left side apical fibrosis

What is the most likely finding on examination

A. Dullness on percussion on left apex

B horner's syndrom

14. Chest xray with bilateral hilar lymph adenopathy. Pt with low grade fever, fatigue, cough and some
other symptoms for about 2 weeks. Diognosis?

A. Sarcoidosis

Tb was not among options

15. Old pt heavy smoker with acute confusion. Long investigation list was given. Among them Na low. K
normal. Has right middle lobe shadow on xray.
Diognosis?

A. Lung cancer

16.18 month old child with fever 38. Something and chest wall resessions, b/l crepts and wheezing.
Diognosis?

A. Bronchopneumonia

B. Bronchiolitis
17. Had a question regarding the percentage of blood loss in an rta pt. Heart rate, BP and other
symptoms has been given

18. pt has read in a newspaper about a disease( I don't remember what it is) and think that he has it.
When the doctor says that he need to undergo investigations to diognosis the disease, He refuse it and
become offended and blame the doctor saying he is sure he has the disease. Diognosis?

A. Hypochondriasis

B. Overvalued idea

19. Pt with fever for (can't remember the duration)in a community which has covid cases high. Pt is
vaccinated. PCR was done and it was negative. Pt' s wife is taking chemo for cancer. Has a son aged 5.
Both are vaccinated against covid. What to do now?

A. Self isolation

20. Chld with plt 5000. Other investigations are normal. Has bruises and contusions all over the body.
Bleed with minor trauma. Had respiratory tract infection 2 weeks back. Treatment?

A. Plt transfusion

B. Iv ig

ITP.. initial must be steroids

21. A young pt with chronic back pain comes for a prescription for oxycodain and diazepam. He has a
written card from his treating doctor that he has severe vertibral disease that need above 2 drugs for
pain relief. And an xray that confirm the diognosis. The treating doctor is closed for the day. What to do

1. Refuse to treat

2. Give a prescription for panadene

3. Give prescription for only oxycodain for short duration

4. Give a prescription for only diazepam for a short duration

22. You are treating an inpatient. While looking at some aboriginal group of people he says to you that.
These people are lazy. They shoul be chased. What to do?

A. Say the patient that he cannot say such things

B. Respect patients freedom to express his thoughts and do nothing

C. Inform police regarding the pt's racism behavior

23. X ray of large bowel obstruction.sigmoid colon upto cecum dialated. Has a lesion at sigmoid colon.
Initial management was done. What to do next

A. Sigmoid colectomy

24. Asthma child around 10 yrs. Comes with symptoms of life threatening asthma( scilent
chest).satiration 83. Pr, rr was given.Initial nebulisation was done .now symptoms improved to
saturation 92. Widespread wheezing+. What to do next

A. Iv hydrocortisone

B. Iv mgso4
Woman on sodium valproate for an epilepsy history of 15 years.

Wants to concieve now. What to do?

- stop the drug

- Stop n start some other drug

- Reduce the dose

- Refer to a psychiatrist
In Hyperkalemia 6.5

Pt has confusion and urea creatinine very high- next what to do?

A. Dialysis…. best

B. Cal glu…next…calcium gluconate stabilizes the heart

C. Insulin and glucose

COVID vaccine question. SARS-COVID 1. After first dose, got a headache. What will you test?

A Thrombo something + D-dimer

B Antithrombin

35yr old whose mother was diagnosed of breast CA at 65yrs. Asking for risk to her.

1. CLINICAL BREAST EXAM ANNUALLY

2. TELL HER TO WATCH OUT FOR ANY CHANGE IN BREAST.

 Ans… C.. juvenile idiopathic
arthritis
 D

B
Ans B, depends upon Xray, B
C
Ans CT, thrombosis,A
B,B,A,A,A
C
IUGR

Screen STI
 DDH.. B.

Ans.1-A..2-Esinophils…3-cystic
fibrosis.. 4-A…5-B
ans. 1
Answer check reference
 Ans CT

ANS B

ans B

ans B
Amedex… upto 6 years it is normal..
ans di/flu
 ans A

ans. Radiotherapy

ans C
ans B Lung breast melanoma
 answer depends upon codition of
patient
 ans C

ans A..Primary fracture, immediate cardiac arrest

ans D
 ans. A/B..complete
question with all references in other file
 ans B

ans 3

ans B/C more references

in other file
ans 3

ans A

ans E

ans B
ans A
 ans B

3-rectal tube. 4-A..5-spinal.. 6.celaic

 ans A… answer depend upon dose of

Tenazepam
 ans B

ans..B
 ans A

ans if it is EBV.. D
ans B
ans..B

ans D
 Ans C

and B

ans.E
ans B

ans C
ans C
ans B
Some important points from September recalls

Huntington screening of 45 years old women.

Screening for Down syndrome in past hx woman of miscarriage.

Red ligament fibroid syndrome.

Baby delivered via C-sec.. immediately mother went into shock with heavy bleeding.

Emblyotic artery

Reason of prolactin 5700.. drug hx of resperidone.

Hemophemothorax.. trachea not displaced but vitals deterioting after trauma.

Basal cell carcinoma treatment.

Post viral infection child presents with wide gait & confusion.

Cause of non stop bleeding after c sec.. due to anaphylactic anesthesia drug/broad ligament
tear/amniotic fluid embolism.

Measles school exclusion.

During chemo alopecia treatment.

Fall of hx in hospital.. patient angry now on hospital staff.. tell him to stay calm.. this happens

Best investigation for osteoarthritis.

Deep laceration on neck.. patient conscious & shouting.. what to do initially.. primary & secondary
systemic survey.

White spots on tympanic membrane.

Floor orbit feature. What sign.. diplopia

6 months old child with limping.. diagnostic investigation.

Persistent tic motor disorder.

ADHD.. confirm from school Reports too before diagnosing.

Female..Pain in groin.. aggregates with walking.

Muscle weakness & Red hands and lower face while dressing up, otherwise normal.