MARCH 16 2017 Plab 1 Recall.pdf

MARCH 16, 2017 Recalls 1 lateral femoral cutaneous Man with loss of sensation in the lateral aspect of thigh. Which nerve is affected? a. Obturator b. Genitofemoral c. Lateral femoral cutaneous d. Sural e. saphenous 2 celiac disease37 year old woman presents with intermittent episodes of abdominal bloating, abd pain and diarrhea for several years. She denies any weight loss and all other general physical examination is normal. But she states that abdominal pain worsens with wheat and eggs. What is the most likely diagnosis? a. IBS b. IBD c. Coeliac disease 3 Gram positive diplococci A 35yo man has a temp=39C, cough with purulent sputum and right sided chest pain on inspiration. He has herpes labialis. What is the single most likely causative organism? a. Cold agglutinins b. Gram -ve diplococci c. Gram +ve diplococci d. Coagulase +ve cocci 4 brucellosis A man travels from a farm in South America to UK, and presents with lymphadenopathy, night sweats, fever and splenomegaly. What is the likely diagnosis? a. Brucellosis b. TB c. Lymphoma d. Coccidiosis 5 observe in surgery A 8 year old boy falls from his bike hitting his abdomen against the handle. He develops a subcapsular hematoma as seen on CT. Vital signs are stable. What is the next best management for this? a. Observe in surgery b. Reassure c. Take to the theatre 6 Asperger syndrome A guy who does satisfactorily computer work in office and has satisfactory grade, but doesn’t have friends and don’t make eye contact. He is also awkward on non-verbal conversation..what’s the dx? a. Asperger syndrome b. Anti-social personality disorder c. Bipolar disorder

d. Tourette syndrome 7 neglect A 4 year old admitted with Chest infection weight 8kg (that was below third centile). He gained weight 1 kg in hospital. Then was admitted again with impetigo, weight again reverted to previous weight (loss of 1 kg). This increase and decrease in 1kg occurred yet again after 1 month. What is the most likely diagnosis? A) Cystic Fibrosis B) Celiac C ) Neglect D) DM 8 sertaline A patient with depression, post-MI 9 fluid overload A patient was given IV fluids and now has the following serum electrolytes value NA- low K- normal cl- normal What is the likely cause?

10 hyperaldosteronism 11 CTPA A 3 days post-op patient develops sudden RT chest pain, and breathlessness. What is the investigation of choice? 12 PTSD A man who was attacked at a bus station now fears to go out. What is he likely suffering from? a. GAD b. PTSD c. Panic attack 13 paralytic ileusA 70yo man had a right hemicolectomy for ceacal carcinoma 6days ago. He now has abdominal distension and recurrent vomiting. He has not opened his bowels since surgery. There are no bowel sounds. Temp=37.3C. What is the likely cause of this? a. anastomotic leak b. paralytic ileus 14 IV naloxone Woman who just had cholestectomy now on opioid Analgesia. Suddenly develops miosis, RR= 6cpm, reduced chest movements. What is the next best management? a. IV naloxone

b. Intubate and ventilate c. CT chest

15 ACE levels [sarcoidosis] Patient with tiredness and bilateral hilar lymphadenopathy. What investigation will help confirm diagnosis? a. serum ACE levels b. CxR c. Bronchoscopy 16 phosphate enema An 83yo woman who is a resident in a nursing home is admitted to hospital with a 4d hx of diarrhoea. She has had no weight loss or change in appetite. She has been on analgesics for 3wks for her back pain. She is in obvious discomfort. On rectal exam: fecal impaction. What is the single most appropriate immediate management? a. Codeine phosphate for pain relief b. High fiber diet c. Oral laxative d. Phosphate enema e. Urinary catheterization 17 pulmonary embolism A patient who had hip replacement surgery develops sudden breathlessness and chest pain, hemoptysis. What is the likely diagnosis? a. Pulmonary embolism b. Fat embolism c. DVT 18 CTPA An immobile patient who had calf tenderness suddenly develops breathlessness, chest pain and hyperpyrexia. What is the investigation to diagnosis this condition? a. D-dimer b. V/Q scan c. MRI chest d. CTPA e. CxR 19 febrile seizures resolve at 6years (two questions) Occurs normally in some children till about 6 years of age 20 pericarditis 21pathological fract/ herpes A 67 year old woman present with 2 week history of loss of sensation over the LT side of her chest in the region of t4/t5, then pain. What is the most likely diagnosis? a. Costochondritis b. Herpes zoster

c. osteoporotic vertebral fracture 22 vasovagal syncope A young girl suddenly loses consciousness especially whenever she is asked to make a presentation at school. What is the likely cause of her syncopal attacks? a. Vasovagal syncope b. Long QT syndrome c 23 siadh 24 Hyponatremia Man, chronic smoker. Then there's postural drop in BP. Sitting 140/80, lying 110/70. I think, they asked for electrolyte Imbalance. a. Hyponatremia b. Hyperkalemia 25 mirena 26 Woman with mixed (submucous and subserous) fibroids wants contraceptive. which will you give? a. COCP b. IUS c. Implanon d. Depo 27 laparoscopy Lady with dysmenorrhea and dysmenorrhagia, has primary infertility for 1 year, Abd uss was normal, what inv is next? a. Laparoscopy b. Laparotomy c. Hysteroscopy d. Endometrial biopsy 28 usd abdomen and pelvis 30 year old woman with abdominal pain, dysmenorrhea and cervical excitation tenderness on BM examination. What test will you do next? a. Urine MCS b. Abd Xray c. USS abd and pelvis d. Colposcopy 29 LymphedemaA woman who has had mastectomy for breast cancer with some axillary clearance was bitten by an insect in her RT forearm. The whole limb swells up. What could be the cause of this swelling? a. cellulitis b. lymphedema

c. 30 NAI A 4 month old child weighs 4.1kg. She presents with multiple bruises on her left and right lower leg. Her left ankle is swollen and she appears irritable. She also has a runny nose. What is the most likely diagnosis? a. Hemophilia b. Thrombocytopenia c. Non accidental injury 31 NAC A 22 year old woman is brought in unconscious, said to have ingested 25 tables of PCM 6 hours ago. What is the next best management? a. Activated charcoal b. NAC c. Serum PCM levels d. LFTs 32 erythropoietin A man who smokes presents with fatigue, dizziness and shortness of breath. HCT = 54%, Hb= 178g/dl. What hormone is most likely responsible for this? a. Renin b. Erythropoietin c. Thyroxin 33 staph aureus A lactating mother with abscess around the nipple. What is the causative organism? a. E. coli b. Staph aureus c. Streptococcus d. pneumococcus 34 treat in best interest of pt [Ethics] A woman was brought in unconscious with an empty bottle of medications (PCM or others, not sure) beside her. It is assumed she tried to commit suicide. What will you do? a. Go to court for warrant to treat her b. Start treating in her best interest and collect collateral info c. Wait for her to wake up and seek consent from her d. Ask her relatives for consent to treat her 35 blood transfusion A patient presents with Hb = 60g/dl, what is the next step in management? a. Blood transfusion b. IV fluids c. Iron tablets d. Folic acid

36 anemia of chronic disease A woman with RA for 30 years presents with tiredness, fatigue, and FBC shows HB (low), MCV (low) microcytic red cells. She has not being on any medications of recent. No other hx of note. What is the likely cause of her anemia? a. Anemia of chronic disease b. dietary deficiency of iron c. GI bleeding 37 Antipsychotics (Extra pyramidal symptoms) A patient presenting with pill rolling tremor, shuffling gait, mask-like facies, all due to the side effects of a drug he was taking. EEG was normal. What is the likely drug the patient was taking? a. Antidepressants b. Antipsychotics c. Benzodiazepines d. Anticonvulsants 38 citalopram A man who just got married within a year now develops symptoms of anhedonia, sleep disturbance, loss of interest in sex. What is the treatment? [Moderate depression] CBT ECT citalopram Olanzapine 39 ABCD2 A patient with TIA and BP= 140/80. What is the best scoring method to assess his risk of future stroke? a. ABCD2 b. FAST c. CHADS2 d. Wells score e. ROCKALL 40 ssri

41 carbamazapine level A woman with pain on the face has been on medications, and now presents with symptoms of overdosehorizontal nystagmus, ataxia. What drug level will you check? Lithium level Carbamazepine level Aspirin level Haloperidol level 42 carbamazapine (anticonvulsant) Woman with pain in the lower part of her mandible, which drug class will you treat her with? a. Anticonvulsants b. Antipsychotics c. Tricyclic Antidepressants

d. NSAIDS 43 Amitriptyline +/ gabapentin 44 Biliary atresia A 6-weeks old neonate not breastfed, who suddenly develops jaundice, hepatomegaly, poor weight gain and pale stools. What is the likely diagnosis? a. G6PD deficiency b. Galactosemia c. Biliary atresia 45 continue cocp, no interaction with Amoxyl Patient on COCP being placed on Amoxicillin -wants to know what interactions can occur, and if extra precautions needed. a. Tell patient to continue COCP, and no extra precaution needed b. Stop COCP c. Change antibiotics 46 Ulnar nerve Nerve affectation at the elbow affecting the medial side of the forearm and little and ring fingers, hypothenar eminence. Which nerve? a. Ulnar b. Radial c. Median 47 emollients- A child has flexural rash in the wrist, neck and elbow. No history of asthma, eczema or hay fever. What will you give as treatment? 48 analgesia for mumps??? A 15 year old presents with fever, and bilateral facial swelling then develops orchitis. What will you do? a. Give acyclovir b. Give analgesia c. Reassure/do nothing d. Give antibiotics 49 surgically explore testisA 17 year old boy who went playing football, suddenly develops unilateral swelling of the RT hemiscrotum, non-tender on raising it. What is the next appropriate management? A. Reassure B. Urgent surgical exploration C. IV antibiotics 50 admit and parenteral antibioticA child presented with hemoptysis 7d post-tonsillectomy. What is the next step? a. Packing b. Oral antibiotics + discharge c. Admit + IV antibiotics

d. Return to theatre and explore e. reassure 51 fluid for burn - - - No fluid 6% burn A 5 year child presents at the ED having sustained 6% burn following hot fluid which poured on her chest. What will you do? a. refer to burn unit b. give iv fluid c. give analgesia d. Give no fluid 52 bulimia nervosa A 26 year old woman with BMI=21 who binges on food and then vomits it afterwards because she believes she is overweight. a. Bulimia nervosa b. Anorexia nervosa c. OCD 53 iv antibiotic and csf A man with fever, neck stiffness, photophobia, but no raised ICP. What will you do? a. Give antibiotics and FBC b. Give antibiotics and Lumbar puncture c. give antibiotics only d. Give antipyretics and 54 corticospinal tract lesion Pt presented with bilateral lower limb weakness for 36hrs which has now progressed to both upper limbs....Reflexes were absent..plantars downgoing...Where is the lesion likely to have originated from? a. corticospinal tracts b. thoracic spine c. lumbar spine 55 l5/s1 lesion Patient with loss of sensation in the medial leg and foot. Which nerve root is involved? a. L5/S1 b. L1-L2 c. L3/4 d. S2 56 t1 lesion (not sure) 57 bppv A 25yo woman complains of dizziness, nausea, vomiting, visual disturbances and anxiety which keep coming from time to time. Most of the attacks are with sudden change in posture. What is the most likely dx? a. Panic disorder b. Postural hypotension c. BPPV

d. Vestibular neuritis 58 acute otitis media 59 Dix Hallpike A 43year old woman presents with severe vertigo on moving her head from side to side whilst sleeping, and on rising up. What test would you do to confirm the dx? a. Dix-Hallpike maneuver b. Romberg’s test c. Trendelenburg test

60 laryngeal candida A 10yo girl presents with hoarseness of the voice. She is a known case of bronchial asthma and has been on inhaled steroids for a while. What is the most likely cause of hoarseness? a. Laryngeal candidiasis b. Infective tonsillitis c. Laryngeal edema d. Allergic drug reaction e. Ludwigs angina 61 Achilles tendon A man suddenly feels pain at his Rt ankle joint while undergoing his usual activity, there is a swelling at the back of his leg. However, he can plantar flex and still bear weight on the foot. What structure is likely affected? a. Calcaneofibuar ligament b. Achilles tendon c. posterior Tibialis tendon d. posterior Talofibular ligament 62 closed reduction Pt with fracture of distal radius ... dorsal angulation >10 degrees . No neurovascular compromise. What is the appropriate treatment ? a. arm slab b. close reduction c. ORIF 63 pinch soft part of nose A child with epitaxis, what should he do to stop the bleeding? a. packing with gauze b. pinch soft part of nose c. pinch base of nose 64 flexor digitirum superficialis Man with inability to flex his proximal IP and metacarpophalangeal joints of his middle finger. Which muscle tendon is affected? a. Flexor digitorum superficialis b. Flexor digitorum Profundus

c. Extensor digitorum profundus d Lumbrical 65 ace inhibitor for nephropathy Diabetic patient on metformin 1gm twice daily with microalbuminuria, Cr=high, and Htn, already on aspirin and statin. Best drug to improve renal condition? a. Beta blocker b. Insulin c.Diuretic d. Ramipril 66 lifestyle modification/add statin A man with intermittent claudication and serum Total cholesterol- 5.2mmol/L (normal value given for T. Cholesterol < 5.2mmol/L). What advice will you give him? a. Start statin b. Lifestyle modification c. Reduce cholesterol in diet 67 campylobacter A patient who just arrived from travelling now presents with bloody diarrhea, what is the most likely cause? a. E coli b. Giardiasis c. Campylobacter

68 impaired glucose tolerance A patient with FBS-6mmol/L and RBS-9mmol/L 2 hours after a meal, diagnosis? A.Impaired glucose tolerance B. DM 1 C.DM 2 69 stress reactionA woman who had hyperglycermia post-surgical procedure which resolved/normalized when the blood sugar was rechecked 1 week after the procedure. What happened? a. Type 1 DM b. Type 2 DM c. Stress reaction 70 syphilis antenatalA pregnant woman has had routine antenatal check for Hep and HIV. What other test is routinely mandatory? a. Toxoplasmosis b. CMV c. Syphilis d. Rubella e. Varicella

71 RT Abducent nerve Patient with diplopia and pain on looking to the right. Which nerve is affected? a. Rt abducens b. Lt abducens c Rt oculomotor d. Lt oculomotor

72 review drugs for asthma 73 submandibular calculi A 35yo man has had acute pain and swelling below the mandible on the left side for 2h. The swelling occurred after eating a large meal. What is the single most likely dx? a. Ranula b. Neck abscess c. Parotid calculus d. Submandibular calculus 74 cystoscopy A 67 year old man with hematuria and proteinuria, frequency, incontinence, what investigation is next most appropriate? a. IVU b. Cystoscopy c. Abd USS+ KUB d. Renal biopsy 75 HUS A girl had diarrhoea, fever with reduced platelets, anemia and then petechial rash about 5 days after. What is the diagnosis? a. Hemolytic uremic syndrome b. HSP c. Hemophilia 76 minimal change disease 77 inform family and seek help (rx refused) - - - respect his wishes, he showed competence. 78 full blood count 79 minimal conscious Patient with GCS 6 and only responds to painful stimulus. What is the condition? a. minimally conscious state b. coma c. vegetative state d. locked-in syndrome

80 gastroscopy 54 year old man with dyspepsia and nausea, has features of GI bleeding. What is the next investigation? a. Gastroscopy b. Hydrogen breath test c. Fecal H. pylori test d. Abd uss 81 32 year old sexually active man with recurring pain in the scrotum that suddenly became severe. On examination, the RT testis is swollen, higher than the left, and tender. What will you do? a. give antibiotics b. reassure c. Refer to surgical unit d. Urgent USS e. give analgesia 82 pulmonary embolism or bakers/popliteal cyst+ Swelling of the knee and pain in calf. He takes medicine for osteoarthritis. What was it? a. PE b. Ruptured popliteal’s cyst c. DVT 83 hyperaldosteronism primary 84 cholangitis 40 year old woman with 2 children presents with jaundice and intermittent RUQ abd pain, passage of dark urine. What is the likely diagnosis? a. Ca head of pancreas b. Hepatitis c. Biliary colic d.Acute Cholangitis 85 iv fluid for calcium rise 86 IV Adenosine A man who collapsed but now conscious presents with hx of palpitations and chest pain, BP- was normal, Pulse- 100bpm (normal). What drug will you give him? a. Synchronous cardioversion b. IV amiodarone c. Iv adenosine d. Beta blocker e. Digoxin 87 mobility and analgesia A young man who just moved to new accommodation presents with severe back pain. What advise will you give him? a. Increase mobility and take analgesia b. bed rest

c. manipulation d. acupuncture 88 0.9% saline Hyperemesis gravidarum patient…choice of fluid? a. Dextrose saline b. 0.9% N/S c. No fluid 89 add iv antifungal and continue antibiotic Patient with WBC= high, fever and other signs of severe infection signs has been on lower IV antibiotics which was later changed to stronger antibiotics with little relief. What is the next best course of action? a. add IV fluconazole and continue antibiotics b.Give oral Fluconazole c. Change antibiotics

90 0.45% and dextrose + 20mmol potassium [You add K if value of serum potassium is normal or low. You don’t add K, only if hyperkaelemic.] Vomiting Child (of about 3 days) needing fluid resuscitation (for moderate dehydration). K= 2.8mmol/L a. 0.18% N/S with dextrose, no additives b. 0.18% with dextrose + 20mmol K c. 0.45% N/S + 5% dextrose, no additives d. 0.45% N/S + 5% dextrose + 20mmol K 91 Long acting insulin daily A patient developed focal weakness and headache due to brain secondaries and was started on dexamethasone. He now has poluria, thirst and his random blood glucose is very high. What should be done: a. Give long acting insulin daily b. Give oral hypoglycaemic drugs c. Stop dexamethasone 92 chalymydia for ectopic---not sure but I think it was PCOS 93 ca prostate A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 1.9 and he is anemic. His BP is 165/95 mmHg. What is the most probable dx? a. BPH b. Prostate carcinoma c. Chronic pyelonephritis d. Benign nephrosclerosis 94 ca caecum Patient with RT iliac fossa mass, weight loss, anemia. What is likely diagnosis? a. Crohn's b. CA caecum

c. Ileocecal TB d. Appendiceal mass 95 quetiapine [Diagnosis is Schizophrenia, and Olanzapine was not in the options] A man has been hearing voices in the house. When he goes outside, he claims to hear the voice of his uncle giving him instructions. What drug will you give him? a. Quetiapine b. Citalopram c. Diazepam d. Amitriptyline e. chlordiazepoxide 96 schizophrenia 97 mood stabilizers A man with depression last year, now has sexual disinhibition, excessive spending. Has been on medications previously. What drug class will you give to maintain his treatment? a. Mood stabilizers b. Antipsychotics c. Antidepressants d. Anticonvulsants 98 mid luteal progesterone A woman being investigated for primary infertility. Which test is most appropriate? a. Estrogen on day 2 of the menstrual cycle b. Mid-luteal progesterone c. LH d. prolactin e. thyroxin

99 blood culture (prosthetic valve) A man with prosthetic valve recovers from URTI but now presents with fever, chest pain and murmur. What investigation will you carry out? a. CxR b. Blood culture c. ECG d. FBC 100 blood culture (PROM) ---?? CXR A term neonate delivered after 48 hours of mother’s membranes ruptured, develops tachypnea, dyspnea, Temperature= 36.0C. What is the single most appropriate investigation for diagnosis? a. Blood culture b. CxR c. FBC 101 ssri

102 cbt [OCD] A middle-aged man washes his hand over and over everyday, and is bothered about minute details. Also has family hx of such. What treatment will you offer him? a. CBT b. Olanzapine c. ECT 103 gardenella Female with malodorous clear vaginal discharge. pH>4.5. what is the likely causative organism? Candida Gardnella Trichomonas vaginalis 104 CLL A 65 year old Woman with weight loss, lymphadenopathy and splenomegaly, with blood film showing mature lymphocytes. What is the diagnosis? a. CML b. CLL c. ALL d. AML 105 middle and index fingerThe parents of a 9 month old child whose cousin died of SIDS ask them for how to perform first aid in case of an emergency. What fingers are to be used? a. whole fist b. middle finger alone c. middle and index fingers d. both hands 106 bone marrow biopsy [Visceral leishmaniasis- Low P r/o splenic biopsy.] A man has just returned from South Africa. Has Hb- low PT- low WBC- low Has splenomegaly and hepatomegaly. He is also bleeding per rectum. What inv will you do? a. Bone marrow aspiration b. Rectal biopsy c. Splenic biopsy d. Lymph node biopsy e. Liver biopsy 107 Haemochromatosis A 38yo man has had a liver biopsy as part of inv for abnormal LFTs. The pathologist report states: special stains demonstrate the presence of a very large amount of iron pigment within the hepatocytes. What single condition is identified by the pathologists report? a. Alpha 1 antitrypsin deficiency b. Hemangioma c. Hemochromatosis

d. Hemosiderosis e. Wilson’s disease 108 Cataract Woman with gradual reduction in vision of her RT eye over 10 years which was not improved by wearing glasses. Now has V/A 6/18 in LT eye and hand movements in the RT. What is the diagnosis? a. Glaucoma b. Cataract c. CRVO d. Retinal detachment e. Macular degeneration 109 Hypertensive retinopathy Hypertensive man with BP 160/90. Now presents with flame and dot hemorrhages in the eyes. What is the diagnosis? a. Hypertensive retinopathy b. Diabetic retinopathy c. Macular degeneration d. Retrobulbar neuritis e. CVRO 110 Lymphoma – A 26 year old man travelled from New York to the U.K on business. He had night sweats, T= 37.5C, cervical lymphadenopathy for 3 weeks. Also had splenomegaly, What is the most likely diagnosis? Tuberculosis Lymphoma Bronchial CA Bronchitis 111 pernicious anemia 112 infectious mononucleosis 113 ITP 114 dexamethasone for croup A child is brought in with high grade fever, runny nose and bark-like cough. What is the most appropriate tx for this child? a. Dexamethasone b. Paracetamol c. Adrenaline nebulizer d. Antibiotics e. Intubation under GA 115 topical antifungal cream or Topical steroids A child presents with hot rashes on the face and neck for which mother has used OTC anti-infective agents without improvement. What is the next appropriate thing to give? a. Topical antibiotics

b. Topical antibiotics + steroids c. Topical antifungal cream d. Topical steroids 116 Change OHA to insulin before surgery?? [Endoscopy, particularly GI endoscopy, requires GI prep.] A patient with DM is controlled on Gliclazide. He will undergo elective endoscopy. What should be done regarding diabetic management? a. Stop oral hypoglycemic drug night before b. Give insulin, glucose and potassium during procedure c. change OHA to insulin before the procedure d. Reduce dose of OHA before the procedure 117 intercostal artery A 46yo man is being treated for a pleural effusion. A chest drain has been sited just below the 4th rib in the mid-axillary line on his right side. What single structure is at particular risk of injury? a. Arzygos vein b. Diaphragm c. Intercostal artery d. Internal thoracic artery e. Liver 118 ventricular aneurysm A patient that develops sudden chest pain and breathlessness on climbing uphill about 3 weeks post MI. ECG shows ST elevation from leads V1-4. What is the likely complication of MI he is suffering from? a. Pericarditis b. Ventricular Aneurysm c. Atrial fibrillation d. 119 vitamin b complex??? [Arguably the most difficult Q for the day] An alcoholic man who took a lot of alcohol started hearing voices which were disturbing to him. The voices have however reduced over the last two weeks since he stopped taking alcohol but have not disappeared. He comes to you for advice on what to do. He does not want a drug with unpleasant side effects. What drug will you give him? a. Acamprosate b. Disulfiram c. Chlordiazepoxide d. Olanzapine e. Vitamin B complex 120 chlordiazepoxide 121 wernicke-korsakof synd Alcoholic with symptoms of confusion, tremor, agitation and psychosis. What is the likely diagnosis?

122 vag bleed when give raloxifine A post menopausal woman on Ramoxifene. Which of this side effect of Raloxifene will bother you most?

a. Vaginal bleeding b. Hot flashes c. Headache

123 delay speech milestone – Normal [the second Q on developmental milestone too was normal!] A 14 month old child who walks with support, transfers object from hand to hand, but only babbles. What is the diagnosis? a. Normal b. Delayed speech milestone c. Delayed Fine motor d. Delayed Gross motor 124 Reject the valuable gift [Ethics] A patient of yours presents you with a valuable gift as appreciation. What should you do? a. Accept the valuable gift graciously b. Accept the valuable gift but give it to the clinic/ward c. Reject the valuable gift and explain that doctors can’t accept such valuable gifts 125 oral fluconazole Patient with anorexia, white lesions on tongue. What will you give? a. IV fluconazole b. P.o Fluconazole c. Steroids d. oral morphine

126 ssri A patient with moderate depression symptoms, what will you give to treat? a. SNRI b. SSRI c. TCA d. ECT 127 Bence-Jones protein [r/o MM] A 76 year old man presents with weakness and malaise, excessive thirst and bone pains. Hb= 106mg/dl (low for a man), BUN= 23mg/dl (high), Creatinine= 8mg/dl (high) and Ca= normal-high. What investigation will you do next? A. Check urine for Bence Jones proteins B. Mid stream urine for m/c/s C. PSA levels 128 1:2 cafe Woman with café au lait spots and bumps on her skin, what are the chances of her child also having the disease? a. 1:4 b. 2:3

c. 1:2 d. 0 e. 1:1 129 fibrinogenPregnant female bleeding continuously pv...what investigation will you do? A. HCT B. FBC C. Fibrinogen levels D. Chest x-ray 130 post partum depression 6 weeks Post-partum Woman with low mood, thoughts of harming her baby, general feeling of tiredness and lack of interest. What is diagnosis? a. Post partum blues b. Post partum depression c. postpartum psychosis 131 CBD/ PYLORUS Patient with CA head of pancreas, what structure is directly affected? a. Common bile duct b. Pylorus c. 132 ARF/AKI A girl who had diarrhoea sometimes back, and E coli 0157 was cultured, now presents with raised creatinine and urea, hematuria and proteinuria. What is happening? a. AKI b. Acute Tubular necrosis 133 bulimia nervosa 2 - - - - Atypical depression (no history of induced vomiting) 134 Picture of lower RT leg and foot with multiple macular erythematous rashes a. plantar erythema b. petechial rash c. lipodermatosclerosis d. telangiectasia 135 ECG 1- A-Fib (irregular RR) 136 ECG 2 – SVT (widened QRS, delta waves) 137 frontotemporal dementia A 76 year old man presents with progressive onset of dementia over the last few (6) months. Short-term memory is impaired. He says inappropriate language to the doctor. What is the most likely diagnosis?

a. Alzheimer's b. Fronto-temporal dementia c. Vascular dementia d. Lewy Body dementia e. Huntington’s 138 Post meningitis – (something to do with hearing test, audiometry probably) A patient who has been treated for meningitis successfully. What test is required afterwards? a. No test b. Audiometry c. (Repeat) Lumbar puncture d. CT scan 139 offer voluntary psychiatric admission ??? A 78yo man is depressed after his wife’s death. He has been neglecting himself. His son found him in a miserable state when he went to visit. The son can’t deal with his father. What is the appropriate management? a. Voluntary admission to psychiatry ward b. Hand over to social worker c. Request son to move in with father d. Send pt to care home e. Compulsory admission under MHA 140 emergency psychiatric admission (similar to the other psychiatry Q) A lady brings her 80 year old father to the hospital… 141 Cushings Lady with 10 months amenorrhea, hypokaelemia, BMI- 32 PCOS Cushings Primary Hyperaldosteronism Pheochromocytoma 142 NAI A 76 year old man with dementia who is brought to the ED by his daughter with bruises on his body. No history of falls. What is the most likely cause of this? a. SAH b. NAI c. Alcohol d. Stroke 143 CRVO A woman with sudden loss of vision in her eye. V/A RT eye was 6/36, LT V/A 6/18, no papilledema, but flame hemorrhages seen in one of the eye. what is the likely diagnosis? a. Macular degeneration b. CRVO c. Diabetic retinopathy d. CRAO

e. Vitreous hemorrhage 144 Obstructive Sleep apnoea A 42yo man has been tired and sleepy for the last few weeks in the morning. His work has started getting affected as he feels sleepy in meetings. His BMI=36. What is the single most likely dx? a. Idiopathic hypersomnia b. Narcolepsy c. Chest hyperventilation syndrome d. OSAS e. REM-related sleep disorder 145 child with wheeze, family history of hay fever, diagnostic test – Spirometry 146 lateral neck Xray– child playing with toys suddenly develops stridor, what investigation should be carried out? a. nasopharyngoscopy b. lateral neck Xray c. no test 147 2nd febrile convulsion question – resolve by 6 years (both) A child with fever suddenly suffers a seizure. The mother is concerned will this continue forever. a. Tell mother that febrile seizures can normally occur till about 6 years b. tell mother that the child has developed a seizure disorder c. tell mother can reoccur till about 10 years 148 Amitriptyline OD – do ECG 149 panic disorder A man feels agitated whenever he has to be in public places. What treatment will you recommend/give him for his disorder? [diagnosis is panic disorder 2 to agoraphobia]. a. Propanolol b. psychotherapy c. ECT 150 lithium with tremor – Patient on Lithium presents with tremors and other symptoms, what investigation should you now carry out? a. check drug level b. TFTs c. LFTS 151 Sudden headache in a woman, smoker with history of migraine, CT-normal, neurological signs are normal. What is the next step? a. Reassure/ do nothing b. Lumbar puncture c. MRI

152 Patient with abd pain of sudden onset dies. Autopsy reveals ruptured abd aneurysm, what is the pathophysiology resulting in this? – Atheroma a. Atheroma b. Aortic coarctation c. Dissecting aneurysm 153 supraclavicular node – gastric carcinoma 154 pregnancy hypertension – labetol A pregnant woman with BP= 160/100, what antihypertensive will you give? a. Hydralazine b. Labetalol c. Diuretic d. Propanolol e. Losartan 155 femoral embolus A woman who had obstructed labour 3 days ago suddenly develops left leg pain and swelling of the Lt leg up to inguinal crease. a. Post phlebitis Syndrome b. Aorto-iliac thrombosis c. DVT d. Femoral embolus e Varicose Veins 156 Broncholitis 6 month old child with wheeze, intercostal recession – a. bronchiolitis b. pulmonary dysplasia

157 IV morphine (?IM tramadol) What is the choice of post –op analgesia in a patient who had appendectomy for gangrenous appendix? IM tramadol IV Morphine Oral morphine Rectal diclofenac Oral codeine 158 basal cell ca A man has a lesion with umbilicated depression on his nose. What lesion is this? a. BCC b. SCC c. Malignant melanoma 159 50 year old, had sore throats for 4 weeks, was given antibiotics- Amoxyl 2 weeks ago and now has a Unilateral exudating enlarged tonsil – a. squamous cell Ca

b. infectious mononucleosis 160 Calcaneus A man falls from a height of 8m and lands on his heel with a fracture. What bone is likely to have been fractured? a. Talus b. Calcaneus c. Navicular d. Fibular 161 pt unconscious, petechiae, shallow breathing – iv ceftriaxone or something like that 162 HIV pt with cough, CD4+ =50/mm3, PCP has been ruled out. What drugs should be given? a. Isoniacid + Rifampicin b. Amoxyl c. Steroid d. Gancyclovir 163 young pt with high BP, haematuria INITIAL investigation – (possible APKD) a. Renal USS b. Renal biopsy c. CT abd d. Mid stream-Urine MCS 165 px treated for meningitis, follow-up investigation 166 Px with **pack years, productive cough, follow-up investigation 167 Abd uss (for child with hypertrophic pyloric stenosis) 6 week old neonate with projectile vomiting after feeds, passed stools just once in 2-3days. What investigation will you do? a. Abd uss b. CxR c. endoscopy 168 Reassure pregnant woman Pregnant woman with haematological indices- Hb= 105g/dl, HCT= 31%. MCV and MCHC= normal. What will you tell her? a. Reassure that it is physiological b. check serum Iron c. Check serum Ferritin 169 FSH Investigation for patient with Azoospermia. a. Testosterone b. FSH c. Estrogen

d. Prolactin

170 Reassure 8 year old girl, with recurrent abdominal pain, everything else is normal a. reassure b. Abd uss c. CT abd d. urinalysis

171. moderate dyskaryosis on cervical screening- refer for Colposcopy 172. InterosseousAfter failed attempts at iv assess in a child with severe dehydration, what is the preferred route? a. Saphenous cut down b. Interosseous c. Central line 173 Route of morphine administration in ACS a. SC b. IM c. IV d. Oral 174. Nephrotic syndrome A child presents with bilateral pitting edema and weight gain. There is no other history of note. What is the cause of this condition in the child? a. myxedema b. lymphedema c. nephrotic syndrome 175 Gastroscopy A 56 year old man presents with progressive dysphagia to solids, weight loss, and anemia. Which is the most diagnostic investigation? a. Esophageal manometry b. Barium meal c. gastroscopy 176. Repeat test A 65 year old whose BMI is 22 had fasting blood glucose= 7.1 mmol/L on routine checkup. What's next step? Repeat test Life style modification Metformin Oral hypoglycemic 177 A 6 year old child who attends a school is diagnosed with meningococcal meningitis. Who else should

receive rifampicin prophylaxis? a. Family members and those who came in contact with pt b. The whole school c. Nobody d. All classmates 178 IV Ca gluconate A patient with multiple pathologies- MI, hypertention, etc, also presents with bradycardia (PR= 40/min), K= 7.2mmol/L, Ca= low. What is the next step in management? a. IV Ca gluconate b. IV Atropine c. antihypertensives

179 Implanon Sexually active woman who uses barrier contraceptive (condoms) but does not remember to take pills. Smokes and has menorrhagia. Now needs contraception for at least 3 years, what is the best contraceptive for her? a. COCP b. Tranexamic acid c. POP d. Implanon e. Diaphragm 180 Accept patient’s wish [Ethics] A 72 year old man has been recently diagnosed with metastatic Ca Prostate, and he is symptomatic. A team of doctors have discussed the best treatment option of radiotherapy and chemo with him, and their possible side effects. He fully understands this best Ca P treatment options discussed with him but refuses the treatment. What should you as the primary doctor do? A. Override his wish. B. Invite the psychiatry team to assess his capacity to refuse treatment. C. Respect his wishes but counsel him on other treatment options available. D. Accept his wish, and let him know that should he change his mind at any time, you are always available e. Involve his relatives about him accepting the treatment option 181 Patient with jaundice who had test showing IgG hep A is positive...Which other test will be appropriate to do? a. Hep A IgM b. Hep B surface antigen c. Hep B core antibody 182 Continue Amitriptyline A middle-aged bereaved woman who has been placed on Amitriptyline for depression since losing her husband. She tells her doctor she wants to stop the medication because of its side effects. Yet, for the last

two weeks, she still speaks of her husband. Her sleep has improved and she now wants to stop medication but she still speaks about her husband. How would you manage her? a. Stop the drug b. Continue Amitriptyline c. Change to a different class- SSRI d. Bereavement counselling 183 Brochiectasis A 56 year old man with purulent sputum and symptoms of cough and breathlessness, occasional streaks of blood in his sputum. What is the most likely diagnosis? a. Bronchitis b. Bronchiectasis c. Pneumonia d. TB 184 MagnesiumA 17 year old boy suffering an acute exacerbation of asthma has been given nebulized salbutamol and ipratropium with little improvement. He has also been given 30mg of prednisolone. Which drug will you add to improve his symptoms? a. IV hydrocortisone b. Magnesium c. Oxygen 185 MethadonePatient with cocaine and heroin addiction seeking management for withdrawal symptoms, best drug for reversal? a. Naloxone b. Methadone c. SSRI 186 Retrobulbar neuritis A 45yo man has had impaired unilateral vision and pain on eye movement in his left eye for some days. In the left eye, the visual acuity is up to counting fingers. When the pupil is stimulated with light, it dilates. His fundus is normal. What is the single most appropriate clinical dx? a. Acute dacryocystitis b. Acute iritis c. Papillitis d. Retrobulbar neuritis e. Scleritis 187 SP [Ideally should be Trimethoprim/Septrin, or Pentamidine- but Fansidar can also be used!] Immunocompromised patient with PCP. What is the treatment of choice? Sulfadoxine + Pyrimethamine Steroids Amphotericin B Amoxycillin 188. Transvaginal USS A 32 year old woman who had normal cervical screening last year presents with intermenstrual bleeding. What investigation will you carry out?

A. Colposcopy B. Transvaginal USS C. CT abdomen D. Cervical smear E. Endometrial biopsy 189 Percutaneous Gastrostomy Patient with dysphagia due to Motor Neurone Disease, how would we feed? a. Percutaneous endoscopic gastrostomy, b. Nasogastric tube 190 PDA Machinery murmur in a premature neonate that closed soon after birth. a. VSD b. ASD c. PDA d. TOF