mock4 11thmarch comp

P L A B T R A I N E R

PLAB 1 M O C K - T E S T : 11 t h March 2011 T I M E ALLOWED:3HRS

Theme: Investigation Of Children With Suspected Non-Accidental Injuries

Options:

A. CT scan of the brain F. Nuclear medicine (NM) bone scan

B. Cystoscopy G. Serum copper concentration

C. EEG H. Skeletal survey

D. Full blood count (FBC) I . Toxicology

E. Midstream urine (MSU) for culture

and sensitivity

Instruction: For each patient described below, choose the SINGLE most useful investigation from the above list. Each option may be used once, more than once or notat-all.

1. A previously well five months old boy has a fracture of the right femur. His parents report that he fell at home three days ago. ^^-r „ i [

2. A six week old boy had sudden onset of several convulsions over the last six hours. He is difficult to arouse. Ophthalmoscopy shows retinal'hemorrhage.

3. A two year old boy has multiple bruises on his back, thighs, upper arms and trunk. The bruises are of different shapes, sizes and colors. —" - H.Wus-'\

4. A three months old boy has prolonged and recurrent apnoea. His mother takes recreational drugs. Previous investigations have revealed' no cardiovascular, respiratory or neurological cause.

5. A five year old boy has bruises and a petechial rash over his body, lymphadenopathy and splenomegaly. His parents are separated and he lives with his father and father's girlfriend,

Theme: Diagnosis Of Respiratory Tract Infection

Options:

A. Bordetella pertussis

B. Group B Streptococcus

C. Haemophilus influenzae

(HiB) typeB

D. Mycobacterium tuberculosis

E. Mycoplasma pneumoniae

F. Pneumococcus

G. Pneumocystis jiroveci

H. Pseudomonas cepacia

I . Respiratory syncytial virus (RSV)

J. Staphylococcus aureus,

Instruction: For each child described below, choose the SINGLE most likely causative organism for their respiratory illness from the above list of options. Each option may be used once, more than once, or not at all.

£ 6. A 10 month old boy has had a paroxysmal cough associated with vomiting for one month. There is no abnormal sign on examination. His chest x-ray is normal. ' ! ' Cw^< \

C 7. A previously well eight month old boy who was born at full term has had increasing difficulty in breathing and feeding associated with wheeze and tachypnoea for'tgfo -days. He had preceding coryzal symptoms for three to four days, k^- • 1 " '<v^r-•^•' jy--

8. A two week old girl is extremely unwell with a temperature of 39.5° C, tachypnoea and marked respiratory distress. At her delivery there was prolonged rupture of membranes for 48 hours. Her mother was febrile and had received antibiotics. 1 >

S I N G L E BEST ANSWER:

9. A 68 year old man has had increasing dysphagia for solid food for three months and has lost 5 kg in weight.

What SINGLE investigation is most likely to lead to a definitive diagnosis?

A. Barium swallow

B. Chest x-ray

C. Computed tomography (CT) scan of the chest

( D) Endoscopy and biopsy

E. Video-fluoroscopy

SINGLE BEST ANSWER:

10. A three month old boy has been brought to the Emergency Department following an apnoeic episode at home. He is now completely well but his parents are anxious as his cousin died of sudden unexpected death in infancy at a similar age. The parents ask for guidance on basic life support for a baby of this age.

What is the SINGLE recommended technique for cardiac compressions?

A. A l l fingertips of both hands

B. A l l fingertips of one hand

C. Heel of one hand

D. Heels of both hands

[ E./Index and middle fingertips of one hand

Theme: Ovarian Carcinoma

Options:

A. Pelvic USG

B. Pelvic CT

C C A 125

D. CA 153

E. Laparotomy

F. Laparoscopy

G. Paracenthesis

Instructions: For each ,patient described below, choose the Single most appropriate investigation from the above list of options. Each option may be used once, more than once or not at all.

11. A lady with family history of ovarian carcinoma. Pelvic USG fails to reveal any abnormality.

12. A lady has undergone abdominal hysterectomy with bilateral salpingo-oophrectomy with omentectomy for carcinoma of the ovary. Now came for follow up. Her CA125 had come to normal levels after surgery, ' ^ ^ v e ^ v P

13. A lady underwent debulking surgery for ovarian carcinoma. Soon after the surgery she presents with signs pi'intestinal obstruction.

- '7 ^ \V>

^A A \<r •6 s

SINGLE BEST ANSWER:

14. A 73 year old woman has long standing rheumatoid arthritis. She is now unwell with a temperature of 38°C. Her right knee is swollen and hot with a tense effusion.

What is the SINGLE most appropriate diagnostic test?

A. Arthroscopy of the knee

Qij, Aspiration of the knee for microscopy and culture

C. Full blood count and erythrocyte sedimentation rate (ESR)

D. Magnetic resonance imaging (MRI) of the knee

E. X-ray of the knee

SINGLE BEST ANSWER:

15. A two year old girl has had a temperature of 39°C, poor appetite, abdominal pain and urinary frequency for three days.

What is the SINGLE most appropriate investigation?

A. Catheter specimen of urine for culture

MB. Clean catch urine specimen for culture

C. Full blood count / > ,» = I.TI

D. Renal ultrasound scan —^ - , l " ^ R '] ' ^ ' ^ '

E. Suprapubic aspirate of urine for culture

SINGLE BEST ANSWER:

16. A four month old girl has severe failure to thrive and increasing jaundice which was first noticed at one week of age. She has an enlarged liver and scratches on her skin. Her parents have seriously been unable to seek medical care.

What is the most likely diagnosis?

C~A.) Biliary atresia

B. G6PD deficiency

C. Gilbert syndrome

D. Hepatitis B

E. Spherocytosis

SINGLE BEST ANSWER:

17. A four year old boy has had a barking cough and runny nose for last 3 days. There is no previous medical history. He has temperature of 37.9° C, a respiratory rate of 40 and oxygen saturation 98 % on air. What is the SINGLE most appropriate treatment? ( X ^ \

A. Arninophylline(IV)

B. Ceftriaxone(rV)

C. Dexamethasone(oral)

D. Oxygen(by mask)

E. Salbutamol(nebulised) t->

Theme: Diagnosis Of Anxiety

Options:

A. Adjustment disorder G. Obsession compulsive disorder

B. Agoraphobia H. Panic disorder

C. Anorexia nervosa I . Posttraumatic stress disorder - > ^f^"

D. Bipolar disorder J. Social anxiety disorder ty^A Cn* ^ f L K„

E. Generalised anxiety disorder K.Specihc phobia '

F. Major depressive episode

Instructions: For each patient described below, choose the SINGLE most likely diagnosis from the above options. Each option may be used once, more than once, or not at all.

18. A 21 year old woman has had several sudden onset episodes of palpitations, sweating naus'ea and overwhelming fear. On one occasion she was woken from sleep and fears she is going insane. There is no previous psychiatric disorder.

19. A 40 year old man is worried that his alcohol consumption has reached dangerous level. He has recently changed his job which involves travelling and corporate hospitality. He feels increasingly difficult to give presentations to new business associates and finds alcohol helps him function better.

20. A 32 year old woman is in tears, describing constant irritability with her two small children and inability to relax. She describes herself as easily startled with poor sleep, disturbed nightmares, following a serious house fire one year ago, while the family slept.

-T 21. A 49 year old man has returned home six times daily from work for the last four years, worried that he has left his taps running. His employers are concerned about his poor productivity.

{3 22. A 35 year old woman has acute symptoms of palpitations, sweating, and difficulty in breathing, feeling unsteady on her feet. She has noticed that these symptoms occur only in crowjejjjublic places.

Theme: Management Of Labour

Options:

A. Repeat vaginal examination in 4 hours

B. Blood pressure monitoring

C. Cardiotocography

D. Caesarean section

E. Episiotomy

F. External rotation

G. Fetal scalp blood sample

H. Internal rotation

I . IV syntocin drip

Instructions: For each questions described below, choose the SINGL^most_appropriate action from the above list of options. Each option may be used once, more Than once, or not at all.

(\. A primipara, at full term in labour, has passed show and cervix is 3 cm dilated.

^ 24. A patient is at term, in labour. The head has been delivered and you suspect shoulder dystocia.

^ 25. A patient is at term and in labour, the membranes have ruptured, the liquor contains meconium but the CTG is normal. The cervix is 3 cm dilated. r> , t | , { (; .•/ e i —^

26. A patient with previous history of hypertension, the membranes have ruptured and the - cervix is 3 cm dilated. Examination 4 hours later showed that the cervix was still 3 cm

dilated.

SINGLE BEST ANSWER:

27. A 19 year old woman has had a progressive bilateral iliac fossa pain and dyspareunia for three days. She has an offensive vaginal discharge and been unwell and feverish. Her temperature is 39°C.

What is the SINGLE most appropriate initial antibiotic treatment?

A. Ceftriaxone and Metronidazole

B. Ciprofloxacin and Metronidazole

C. Doxycycline and Metronidazole

' D; Doxycycline, Ceftriaxone and Metronidazole LM&n c l v ^ ' - ^ t k ^ ~j \ t tf t ' .

E. Doxycycline, Ciprofloxacin and Metronidazole

Theme: Complications Of Myocardial Infarction

Options

A. Acute pericarditis

B. Atrial thrombus

C. Cardiac tamponade

D. Heart block

E. Left ventricular aneurysm

G. Post-myocardial infarction (Dressier's syndrome)

H. Right ventricular strain

I . Ruptured interventricular septum

J. Ruptured papillary muscle

K. Ventricular arrhythmia

F. Left ventricular endocardial thrombus

Instruction: For each patient described below, choose the SINGLE most likely explanation of the abnormal investigation results from the above list of options. Each option may be used once, more than once, or not at all.

"28. A 58 vear old man suddenly becomes shocked several days after suffering an acute anterior myocardial infarction. His chest x-ray shows a large globular-shaped heart and clear lung fields.

29. A 63 year old man continues to experience chest pain and has a temperature of 37.8° C two days after an acute myocardial infarction. His electrocardiogram (ECG) shows widespread ST elevation with upward concavity."

30. A 48 year old man has continuous anterior chest pain, worse on inspiration, and temperature of 37.5° C four weeks after a myocardial infarction. His erythrocyte sedimentation rate (ESR) is 45 mm/hour.

31. A 60 year old woman suddenly develops severe left ventricular failure following a myocardial infarction. Her echocardiogram demonstrates mitral regurgitation.

32. A 55 year old man returns for routine follow-up six weeks after a myocardial infarction. He gets breathless when walking uphill. His ECG shows ST elevation in chest leads V I , V2,

SINGLE BEST ANSWER:

33. A 21 year old woman with mild ulcerative colitis has had loose stools with mucus for 1 month. She has lost 3 kgs. She has intermittent abdominal pain and a normal appetite. Her periods are normal. Examination is normal. Her hemoglobin (Hb) is 9.5 g/dl. She is not on any medication.

What is the SINGLE most appropriate drug treatment?

A. Codeine phosphate

B. Ferrous sulphate

C. Loperamide

D. Mebeverine hydrochloride

E. Mesalazine

SLNGLE BEST ANSWER:

34. A 60 year old woman has:tiredness. She has noticed that her skin looks permanently tanned and she describes dizziness on standing up. J^J^/^'

What is the SINGLE most likely electrolyte pattern to be found?

B. Na 125 mmol/L, K 2.9 mmol/L <

C. Na 140 mmol/L, K 4.5 mmol/L

D. Na 150 mmol/L, K 3.5 mmol/L

E. Na 150 mmol/L, K 5.9 mmol/L

SINGLE BEST ANSWER:

35. A 70 year old woman who lives in a nursing home following a stroke has developed a reddish scaly rash on her trunk. She has many scratch marks on her limbs and trunk with scaling lesions on her hands and feet.

V3 and V4.

A.) Na 120 mmol/L, K 5.9 mmol/L

What is the SINGLE most appropriate initial treatment?

A. Aqueous cream

B. Qilorphenaramine

C. Coal tar

D. 1% Hydrocortisone ointment

E. Permcthrin ;

SINGLE BEST ANSWER:

36. A 38 year old man has had a liver biopsy as part of the investigations for abnormal liver function tests. The pathologists 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. Haemangioma ,

C. Haemochromatosis - •> oc<v,o<> cvtto^ ^ •' •' " • ' ' {p \ f ]pO* Hf^'^

D. Haemosiderosis :, tkjj^StA ~f 1 u l ^ C \

E. Wilson's disease

Theme: Diagnosis Of Facial Pain

Options:

A. Acute sinusitis G. Giant cell arteritis

B. Atypical facial pain H. Post-herpetic neuralgia

C. Carcinoma of maxillary antrum I . Salivary calculus

D. Carcinoma of tonsil J .Tempero-mandibular joint dysfunction

E. Cluster headaches K. Trigeminal neuralgia

F. Dental sepsis

Instruction : For each patient described below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

37. A 69 year old woman has transient severe electric shock—like pains in the right side of her face. The pain starts in-the region of the jaw and radiates to her forehead. Both Qpmeal reflexes are present. Her mean corpuscular haemoglobin concentration (MCHC) is 34g/L.

38. A 35 year old man has severe right-sided supraorbital pain with associated discomfort over the right maxilla. He has recently had a respiratory tract infection.

39. A 36 year old man has left sided facial pain radiating above the eye, which regularly --wakes him from sleep. The pain lasts for several hours and is associated with vomiting, nasal

congestion and drooping of the eyelid. The pain is not relieved by paracetamol.

40. A 75 year old man has severe burning pain in the right side of his face and his right eye, following a blistering painful eruption in the same-area.

SINGLE BEST ANSWER:

41. A man comes to Accident & emergency with history of pulsatile swelling in the abdomen, he has history of hypertension and on examination his pulse is 120/min and BP is 70/40 mm Hg. He is restless and is in shock. What emergency management on priority basis should be done?

A. Urgent CT scan of the Abdomen

B. Urgent USG scan of the Abdomen

C^rV infusion of fluids 0.9% Saline crystalloids to bring systolic BP to 90mmHg.

D. IV infusion of fluids 0.9% Saline crystalloids to bring systolic BP to 120mmHg.

E. Injection of Dopamine

SINGLE BEST ANSWER:

42. An employer sent his worker to the A&E department after having hit his head on a machine. On examination he is found to be normal. What investigation wil l you do?

A. Skull X-ray

B. CT scan head

C. MRIhead

D. Reassure

SINGLE BEST ANSWER:

43. A child, after falling, has facial lacerations on his right cheek, and sub-conjunctival hemorrhage, there is no history of loss of consciousness or any neurological features. What investigation should be done?

A. ) Facial x-ray

B. Skull x-ray

C. CT scan

D. MRI head

SINGLE BEST ANSWER:

44. A patient was admitted to the A&E department after head injury. When examined on arrival his GCS was 15, then at night his GCS deteriorated to 12. What investigation should be done?

^A. CT scan head L . o.r- ^ o [l- ] p <x j

B. X-ray skull

C. I/V Mannitol

D. Drill a Burr hole

E. Shift to OT

Theme: Management Of Dehydration

Options

A. Gastrostomy tube F. Ni l by mouth

B. Intravenous (IV) dextrose 5% G. No immediate action needed

C. Intravenous (IV) saline 0.9% H. Oral rehydration solution (sodium 60 mmol/L)

D. Intravenous (IV) saline 9% I . Oral rehydration solution (sodium 150 mmol/L)

E. Nasogastric tube J. Water by mouth

Instruction: For each patient described below, choose the SINGLE most appropriate action from the above list of options. Each option may be used once, more than once, or not at all.

J 45. A 15 month old boy was locked in a car in direct sunlight for three hours. When brought to the Emergency Department he is distressed and crying but his vital signs are normal.

46. A 28 year old woman who has type 1 diabetes has had diarrhoea and vomiting for the last 48 hours after returning home from a holiday in Greece. She has normal blood pressure and temperature, ketones+ in her urine and blood glucose of 18 mmol/L. ^ w /

(~ 47. A 20 year old man has extensive partial thickness burns over both arms and the front of chest after an accident in lighting a barbecue one hour ago.

A 48. An 89 year old man is unable to swallow properly following a dense left sided stroke one week ago. Hehashad intravenous (IV) fluids since admission. h>>y^,^ i*V ttjuj tfs

—=—49;—A-60 year old woman has had increasing urinary frequency and urgency , leading to occasionaljnc^ntinence for three months. Abdominal and rectal examinations arenormal.

SINGLE BEST ANSWER:

50. A 20 year old woman has been using depot medoxyprogesterone acetate (Depo-Provera) for nine months. She is concerned that she has had no menstrual bleeding in that time. A pregnancy test is negative.

What is the SINGLE most appropriate management?

A. Bone densitometry scan *

B. Calcium supplements

C. Change to combined oral contraceptive

D. Serum follicle stimulating hormone (FSH)

E. Stop administering Depo—Provera

SINGLE BEST ANSWER:

51. A 23 year old man has breathlessness. He says his mother and sister also had investigations for breathlessness in their twenties. He smokes cigarettes. His liver function tests are abnormal.

What SINGLE investigation is most likely to provide a definitive diagnosis of the underlying condition?

^ A ) Alphal antitrypsin levels

B. Mantoux test - - ^ T ( 2 >

C. Radioallergosorbenl test (RAST)—> "* ; F . ^ i n n r K - v

D. Serum ACE —> , * f « r . * U « U * ^ fr W ' W ^ ' * E. Sweat test ~? 'J^VH pilosis

SINGLE BEST ANSWER

52 . A 32 year old man with schizophrenia and a history of violence and distressing auditory hallucinations was admitted to the ward with aggressive behaviour and has already smashed A, his room. He is refusing any oral medication.-Wv i ¥- ' ^ f V - U A a i M a e v

What is the SINGLE most appropriate injection?

A. Flupenthixol ^ ^j^f]

(S/Fluphenazme ^ ttfk** ^ ^ ^ L ^ * * ^ C. Haloperidol ^ ft ^ ^ ® ^ , r ^ h ^ f ^ ¥ )

D. Paraldehyde

E. Risperidone

Theme: Selection And Interpretation Of Diagnostic Tests In Vertigo/Giddiness

Options:

A. Abnormal caloric vestibular tests E. High blood alcohol concentration

F. High serum paracetamol B. Cerebellar atrophy on brain scan

concentration

C. Enlarged heart on chest x-ray

D. Haemoglobin (Hb) 70 g/L

G. High serum salicylate concentration

H. Ischaemic electrocardiogram (ECG)

Instruction : For each patient described below, choose the SINGLE most likely test result to explain the symptoms from the above list of options. Each option may be used once, more than once, or all.

53. A 45 year old man has developed acute vertigo which lasts for three days and then gradually improves over three weeks. He continues to feel dizzy i f he changes posture

54. A 47 year old man has developed gradually increasing incoordination in his arms and unsteady gait during the last two years.

55. A 46 year old man who has êen treating himself for pain in the left shoulder has dizziness, tinnitus and unsteadiness.


56. A 69 year old man fell 4 meters from a ladder on to a concrete drive. In the Emergency Department he is speaking in partial sentences and opening his eyes to command. He is pale and cold with respiratory rate of 26 breaths/min., pulse rate of 130 beats/min. And his BP is 110/68mmHg. During primary assessment his respiratory rate rises rapidly to 38breaths/min and his BP falls to 80/55mmHg. Chest wall movements and breath soundsâre reduced on the rightîdg, neck veins are not distended and there is minimalTeft side tracheal deviation. His right femoral shaft is deformed and his left ankle is obviously fractured.

What is the Single most appropriate immediate management? ... ,

A. Bilateral large bore intravenous cannulation and rapid fluid replacement

B. External pelvic compression and X-ray

C. High flow 100% inhaled oxygen with urgent portable X-ray

15) Needle thoracocenthesis

E. Right femoral traction splintage with intravenous opioid analgesia

SINGLE BEST ANSWER:

57. A seven year old girl with allergy became acutely unwell while visiting a friend's house and has been brought immediately to the Emergency Department. She is fully conscious but has stridor, wheeze and generalized erythematosus rash. She is receiving oxygen.

What is the SLNGLE immediate management?

' A. d e c k airwav patency and prepare intubation

F3y G:ve 0.2? ml in 1000 epinephrine(adrenaline)by intramuscular injection

C. Give 10 mg chlorphenaramine by intramuscular injection

D. Give 50 ml hydrocortisone by intramuscular injection

E. Obtain secure intravenous access

Theme: Post-Operative Management

Options

A. Cefuroxime orally

B. Chlorphenaramine orally

C. Codeine/paracetamol combination

orally

D. Diclofenac-orally

E. Dihydrocodeine intramuscularly

F. Epidural analgesia

G. Heparin intravenously

Instruction: For each patient described below, choose the SINGLE most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.

58. A 35 year old woman had an uney^ntfuHapai^scopic cholecystectomy 18 hours ago. She has a pulse rate of 108 beats/minute and a temperature of 38° C. There are signs of reduced air entry at the right base but the chest x ray does not show any obvious abnormality.

H. Morphine intramuscularly

I . Morphine sustained release tablets

J. Ondansetron intramuscularly

K. Ondansetron orally

L. Physiotherapy to chest.

M . Salbutamol nebuliser

» 59. A 50 year old man has had anterior resection of the rectum for carcinoma. He expressed concerns about control of post-operative pain in discussions with the anesthetist before surgery.

60. A 40 year old woman has had varicose vein surgery, planned as a day patient. After the operation she is distressed by repeated retching and vomiting. Her pain is currently well

C 61. A 30 year old woman has had excision of a breast fibro-adenoma as a day patient. She has asthma controlled by a salbutamol inhaler. She has some pain at the site of operation and requires some analgesia to take home.

SINGLE BEST ANSWER:

62. A 28 year old woman is six months pregnant. The fetus is growing on the 10th centile. She has previously had two early miscarriages. She has now had a pulmonary embolus. Her sister has a thrombosis while using the oral contraceptive pill.

What is the SINGLE most likely abnormality on screening tests?

AJAnti - phospholipid antibody

B. Factor V Leiden assay

C. Factor X assay

D. Fibrinogen degradation products

E. Protein C and S


63. A four week old boy has been brought to the Emergency Department with vomiting for three weeks. His mother says he has lost weight and is constantly hungry. In the last week his vomiting has become projectile and forceful. An epigastric mass can be felt during feeding.

What is the SINGLE most urgent investigation?

A. Amino acid chromatography

B. Full blood count

C. Liver function tests

D. Serum calcium concentration

E. )Serum electrolytes concentration

controlled.

SINGLE B E S T ANSWER:

^ 64. A 79 year old woman has been diagnosed with type 2 diabetes. Her body mass index (BMI) is 22 kg/metre square. Random plasma glucose concentrations are 8 mmol/L and 10 mmol/L. Her pressure is 130/80 mmHg. Her fasting cholesterol is 5.7 mmol/L. She is currently symptom-free but has micro-albuminuria.

What is the SINGLE most appropriate drug management?

A. ACE inhibitor and glibenclamide

B. ACE inhibitor and metformin

C. Statin and ACE inhibitor

D. Statin and glibenclamide

E. Statin and metformin

SINGLE BEST ANSWER:

65. A 46 year old man is being treated for a pleural effusion. A chest drain has been sited just below the fourth rib in the midaxillary line on his right side.

What SINGLE structure is at particular risk of injury?

A. Azygosvein

B. Diaphragm

Cy Intercostal artery

D. Internal thoracic artery

E. Liver

Theme: Acute Abdomen

Options

A. Abdominal ultrasound scan G. MRI

B. Antiphsopholipid screen H. Maternal Karyotype

C. Blood group and cross matching I . Paternal blood group

D. Full blood count (FBC) J. Serum BHCG

E. Hysterosalpingiogram K. Transvaginal ultrasound scan

F. Laparoscopy

Instruction : For each patient described below, choose the SINGLE most appropriate investigation from the above list of options. Each option may be used once, more than once or not at all.

66. A 24 year old woman has had lower abdominal pain for 12 hours. She is otherwise well. She is at 10 weeks gestation in a planned pregnancy.

J 67. A 23 year old woman is being followed up six weeks after a surgical procedure to evacuate the uterus following a miscarriage. The histology has shown changes consistent with a hydatiform mole.

j \. A 28 years old woman was seen in the early pregnancy clinic with brown vaginal discharge. An ultrasound scan showed a gestation sac appropriate to her five week gestation. Three weeks later she returns with lower abdominal discomfort and further vaginal discharge.

Theme: Diagnosis Of Painful Eye

Options

J

A. Acute angle-closure glaucoma

B. Acute conjunctivitis

C. Acute dacryocystitis

D. Acute iritis

E. Corneal foreign body

F. Dysthyroid eye disease

G. Ethmoidal sinusitis

I . Keratitis due to Acanthamoeba spp

J. Keratitis due to acute Herpes simplex

K. Neurotrophic corneal ulcer

L. Orbital tumour

M . Papillitis

N . Retrobulbar neuritis

O. Scleritis

H. Intracranial space occupying lesion

Instruction : For each patient described below, choose the SINGLE most appropriate clinical diagnosis from the above list of options. Each option maybe used once, more than once, or not at all.

J \. A 77 year old woman has sudden painful blurred vision in the right eye associated with nausea, vomjtingjmd frontal headache. The vision in the right eye is less than 6/60, the cornea is hazy and has redness around it, the pupil is semi-dilated and non-reactive to light and the intraocular pressure is raised.

70. A 32 year old man has had a painful red left_eye for three days. The eye is photophobic and watery with a visual acuity of 6/18. There is a branching lesion on the periphery of the cornea with club-shaped terminal bulbs with fluorescein stain. The corneal sensitivity is decreased.

71. A 40 year old man has pain, redness and swelling over the nasal end of his right lower eyelid. The eye is watery with some purulent discharge. The redness extends on to the nasal peri-orbital area and mucoid discharge can be expressed from the lacrimal punctum.

72. A 52 year old man has had a painful red and photophobic right eye with slightly blurred vision and watering for three days. He has had no such episodes in the past. On slit lamp examination there are cells and flare in the anterior chamber and the pupil is sluggish to react.

7 -^ ^ , 7 3 . A 45 year old man has had impaired vision and pain on eye movement in his left eye

over the last five days. He also notes loss of colour vision in the same eye. In the left ,eye, the visual acuity is counting fingers. When the pupil is stimulated with light it dilates. His,fundus is normal

SINGLE BEST ANSWER:

74. A 71 year old man has liver metastases from an unknown primary. He has cerebrovascular dementia, with some right sided weakness and inability to talk. He is alert and responsive. He has stopped taking food in the last 24 hours having previously had a good appetite, although still takes his medication. There are white patches over the mucous membranes of the mouth and pharynx.

What is the SINGLE most appropriate treatment?

A) Amphotericin intravenously

B. Chlorhexidene mouthwash

C. Fluctoxacillin orally

D. Fluconazole suspension

E. Metronidazole orally


-75. A four year old boy with a febrile convulsion lasting eight minutes has been given intravenous (IV) lorazepam to control the convulsion.

What is the SINGLE most likely serious side-effect?

Amnesia

B. Anaphylactic shock

C. Apnoea

D. Bronchospasm

E. Cardiac arrhythmia


, 76. A 36 year old man had haematemesis and was found at endoscopy to have a duodenal ulcer; He was treated with H. pylori eradication therapy. Some months later he returns with epigastric pain.

What SINGLE investigation is most likely to provide the definitive diagnosis?

A. Barium meal

' "BX13 urea breath test

C. H. pylori serology

D. Repeat endoscopy

E. Serum gastrin


77. A 20 month old boy has developed a peri-oral blistering rash.: The size of the lesions range from 2-10 mm. Some of the lesions are weeping, straw-coloured fluid, others have formed crusts with surrounding redness. He has a temperature of 38.5° C but is otherwise well.

What is the SINGLE most likely diagnosis? -;

A^Bullous impetigo

B. Chickenpox

C. Hand, foot and mouth disease

D. Kawasaki disease

E. Shingles

Theme: Symptoms Of Advanced Breast Cancer

Options

F. Local recurrence of disease

G. Lymphoedema.

H. Pathological fracture

I . Pleural effusion

J. Spinal cord compression

Instruction: For each patient described below, choose the SINGLE most likely condition from the above list of options. Each option may be used once, more than once, or not at all.

A. Cereorai metastases

B. Hepatic metastases

C. Hypercalcaemia

D. Hypocalcaemia

E. Hypoglycaemia

/ - 78. A 40 year old woman, who was previously treated for breast cancer, was well until six ^ months ago when she developed shoulder pain, increased thirst and started passing large

amounts of urine. Recently she has become mbFe^cbnfused. There are no neurological signs but she appears to be clinically dehydrated. Fundoscopy is normal.

79. A 72 year old woman was treated for breast cancer five years ago by a left mastectomy and radiotherapy. She has stiffness and swelling of her fingers and 'heaviness' of her left arm. Her left arm is more swollen than her right, with limitation of movements in all joints.

A

80. A 50 year old woman, who was treated five years ago for breast cancer, has had a fall. She has pain in her right hip. She cannot bear weight and has significant limitation of right hip movements.

81. A 49 year old woman had a right mastectomy three years ago for breast cancer. For the past six weeks she has had headaches and, more recently, has become confused. There are no focal neurological signs. Fundoscopy reveals papilloedema. %

SINGLE BEST ANSWER:

82. A child has clean wound, has never been immunized as his parents were worried about it, there is no contradiction to immunization, what is the best management?

(GyFull course of diphtheria, tetanus, polio

B. 1 single injection DT ,

C. 1 single injection DTP

D. Only immunoglobin

SINGLE BEST ANSWER:

83. A nine month old girl has had mild diarrhoea and vomiting for 18 hours.

What is the SINGLE most appropriate initial investigation?

A. Flexible cystourethroscopy (R) Retrograde cystourethroscopy C. - Ultrasound scan of renal tract and pelvis D. Urinalysis for nitrites and leukocytes E. Uro-dynamic studies

Theme: Speech Disorder In Children

Options

F. Referral to child psychiatrist

G. Referral to ear, nose and throat (ENT) surgeon

I . Referral to speech therapist

A. Broad spectrum antibiotic

B. Hearing test

C. Magnetic resonance imaging (MRI) H. Referral to social services

of the brain

D. Reassurance

E. Referral for developmental assessment

Instruction:

For each child described below, choose the SINGLE most appropriate management from the above list of options. Each option may be used once, more than once, or not at all. 8§5^ag|8 ramUfa-e-ld buy ha& a vocabulmy uf 10 vvrji^s^t^Gms&tfofm-a^enteaee.

84. A 12 month old girl has no meaningful words, is unable to sit unaided and cannot play with her toys. She does not laugh and has poor interaction with her brother and sister.

SINGLE BEST ANSWER:

85. A 35 year old man has been trapped in a house fire. He has not been burned but is unconscious and has a carboxyhaemoglobtn level of 30%. There is no clinical evidence Of any injuries.


A. Chest X-ray

B. 100%) oxygen by face-mask

C. Start sodium chloride infusion

D j Transfer to hyperbaric oxygen unit

E. Ventilation with 100% oxygen "

SINGLE BEST ANSWER:

86. A 72 year old woman has been taking loop diuretics for left ventricular failure. She now

B. Na 130 mmol/L, K 5.5 mmol/L

C. Na 140 mmol/L, K 4.5 mmol/L

D. Na 150 mmOIlL. K 3.5 mmol/L

E. Na 150 mmol/L, K 5.5 mmol/L

Theme: Diagnosis Of Vaginal Discharge:

Options:

A. Adenomyosis G. Endometrial carcinoma

B. Atrophic vaginitis H. Endometrial polyp

C. Cervical cancer 11. Fibroid

D. Cervical ectropoin J. Function ovarian cysts

E. Cervical intraepithelial neoplasia K. Vaginal candidiasis

F. Chalmydial cervicitis

Instructions: For each patient below, choose the single most likely diagnosis from the above list of options, each option may be used once, more than once, or not at all.

87. A 23 year old woman who has had several recent partners has experienced post coital bleeding on, gentle contact.

88. A 68 year old woman presents with post coital bleeding following her first episode of sexual intercourse in 10 years.

89. A 60 year old woman with persistent brown vaginal discharge is referred for a transvaginal ultrasound scan. It reveals endometrial thickness of 12 mm.

90. A 30 year old woman on the combined oral contraceptives pill is referred following a routing normal cervical smear test where the doctor noted contact bleeding.

has palpitations and muscle weakness.

What is the SINGLE most likely electrolyte pattern to be found?

A^Na 130 mmol/L, K 2.5 mmol/L + puX.dteSM*-

SINGLE BEST ANSWER:

91. A 76 year old woman has recurrent dysuria. She is otherwise in good health. A renal ultrasound scan, cystoscopy and urine culture are all normal.

What is the SINGLE most appropriate treatment?

A. Aqueous gel lubricant

B. Long-term antibiotic

^C?)Low dose topical oestrogen

D. Oral anti-cholinergic

E. Topical anti-fungal

SINGLE BEST ANSWER:

92. A three year old boy has been brought to the Emergency Department with a nose bleed following a fall. The bleeding had persisted for an hour but he is otherwise well. Laboratory results show a normal bleeding time, normal prothrombin time, normal international normalised ratio and a 42 second activated partial thromboplastin time ( A P T I ' ) ^ ^ ^ ^

What is the SINGLE most likely underlying problem? ,

A. Functional platelet disorder

l\^B.y Haemophilia

C. Protein C deficiency

D. Vitamin K deficiency

E. Von Willebrand's disease

Theme: Diagnosis Of Rectal Pain

Options

A. Acute perianal haematoma

B. Anal fissure

C. Carcinoma of the rectum

D. Crohn's disease

E .Diverticular disease

F .Foreign body

G. Gonococcal proctitis

H. ischaemic colitis

I . Proctalgia fugax

J. Squamous carcinoma of the anus

K. Trauma

L. Ulcerative colitis

Instruction: For each patient described below, choose the SINGLE most likely diagnosis from the above list of options. Each option maybe used once, more than once, or not at all.

X 93. A 30 year old woman has brief episodes of severe shooting pains in the rectum. Rectal examination and flexible sigmoidoscopy are normal.

~~^) 94. A 32 year old woman has abdominal pain, bloody diarrhoea and rectal pain. Rectal examination reveals oedematous anal tags. Rectal biopsy shows granulomata.

( 2 95. A 22 year old woman with longstanding constipation has severe ano-rectal pain on defaecation. Rectal examination proves impossible because of pain and spasm.

96. A 60 year old man has increasing stool frequency, rectal pain and the passage of freshblood per rectum. Flexible sigmoidoscopy reveals a 2 cm diameter ulcer visible at 10 cm. •

97. A 62 year old man has had ano-rectal pain aggravated by defaecation for three days. Rectal examination reveals a purple, tender lump at the anal verge. Flexible sigmoidoscopy shows normal rectal mucosa and hard faeces.

SINGLE BEST ANSWER:

98. A 26 year old woman and her 28 year old partner come to the GP surgery complaining of primary infertility for 2 years. She gives a history of irregular menstrual cycle.

What would be the single best test to see whether she is ovulating or not?

A. Basal body temperature estimation

B. Cervical smear test

C. Day 2 LI 1 and I'SII

( D.j Day 21 progesterone level

E. Endometrial biopsy

99. A child with barking cough & both an inspiratory and expiratory stridor. A diagnosis of laryngotracheobronchitis was made. I f left untreated what will happen?

A. Bronclnectatsis

B. Chronic asthma

C. Chronic laryngitis

D ) Complete resolution

E. Trachael stenosis

A. Endomyseal antibodies 1 • A ^-,;vn

B. Sweat Test ' ! ' . \• '

C. Thyroid Function Test > - 1

AlOO. A child who was wasted on examination. C v < ^ ^ § 101. A child with repeated infections. C102. A child who is lethargic and constipated along with dry skin.

^ 103. A child with increasing jaundice and pale stools.

qc^r Theme: Diagnosis Of Tendon Injuries In The Hand

A. Abductor pollicis longus G. Extensor pollicis longus u")H^ tvAs^^L^1

B. Extensor carpi radialis Iongus H. Flexor carpi radialis

C. Extensor carpi ulnaris • I . Flexor carpi ulnaris

D. Extensor digitorum^ M I ^ J. Flexor digitorum profundus f^"- ^ ^ < pr^j ~* l l

E. Extensor indicis uvtex K .Flexor digitorum superficialisuMkt v-^f

Instruction: j # H J

F. Extensor pollicis brevis j V ^ ' ^ ^ ^ L. Flexor pollicis longus

For each patient described below, choose the SINGLE most Likely tendon to have been damaged from the above list of options. Each option may be used once, more than once, or not at all.

J 104. A 72 year old woman struck the little finger of her right hand while closing the door of her garage. She subsequently found that she was unable to flex the distal interphalangeal joint of the injured finger. Movement of the other fingers is normal.

_T) 105. A 22 year oid man injured his right ring finger when a cricket ball struck the end of the ^ finger during a match. When extending his fingers, the right ring finger remains flexed at the

distal interphalangeal joint. Movement of the other fingers is normal.

106. A 68 year old woman is unable to extend the interphalangeal joint of her right thumb seven weeks following a fracture of the right radius. Other finger and thumb movements are normal.

)107. A 73 year old woman with rheumatoid arthritis is unable to extend the fingers of her right hand at the metacarpophalangeal joints and at the interphalangeal joints following a fall

4- 108. A 62 year old man with rheumatoid arthritis struck his hand against a door. He subsequently found that, although he could extend the interphalangeal joint of his right thumb, the metacarpophalangeal joint of the thumb remained in a flexed position.

109. An 80 year old man has been breathless at rest for several months. His current medication is furosemide, isosorbide mononitrate and digoxin. He is in sinus rhythm with a heart rate of 78 beats/minute and a blood pressure of 145/85 mmHg. His serum urea and

Arc- K electrolytes are normal. - ^ ~ - ;

SINGLE BEST ANSWER:

110. A 30 year old woman has had intense itching of the perineum and between the lingers of her right hand for two weeks. The pruritis is more pronounced at night or after a hot shower. Occasional papulovesicular lesions with excoriation are visible on the perineum. A pelvic examination is normal.

What is the SINGLE most likely organism to account for this presentation?

A. Enterobius vermicularis ^ oc^mewM <>\ r ^ ^ ^ ••j

B. Herpes simplex

C. Ptbiris pubis

t D) Sarcoptes scabiei

E. Trichomonas vaginalis

SINGLE BEST ANSWER:

111. A 27 year old woman with anxiety and weight loss has a tachycardia, tremor and mild proptosis.

What SINGLE mechanism accounts for her weight loss?

A. Deficiency of thyroid hormone

B. Increased levels of calcitonin

C) Increased metabolic rate

D. Insulin resistance

E. Reduced calorie intake


112. A four year old boy is about to start nursery school. He wets the bed every night and also wets himself about once a week when he gets excited.


A. Amitriptyline

B. Behavioural modification treatment

C. Blood sugar

D. Desmopressin —* f A "> b ' ^ f

E. Reassurance

SINGLE BEST ANSWER:

113. A 23 year old woman who is 12 weeks pregnant has been admitted with nausea and vomiting.

What is the SINGLE most useful blood test in the immediate management?

A. Plasma estradiol

B. Serum beta human gonadotropine (BHCG)

C. Serum free thyroxine

D. Serum human placental lactogen (HP L) V\ ]'kour

E) Serum urea and elelrolytes ^ ^ < W ^ < ^ ^ ^ % ™* ' '


114. A woman comes to the A&E complaining of pain in right side of the abdomen, she is seven weeks amenorrhea. Her pregnancy test is positive and US scan shows an empty uterus. What is the next step?

A. Laparoseopy „ „ „,,

C. USG

D. Laparotomy

E. Culdocenthesis

SINGLE BEST ANSWER:

115. A couple not able to conceive after having regular sex for 2 years , the lady's menstrual cycles are regular and of 28 days, 21 days progesterone test shows low level. What is the best treatment for this clinical scenario?

A. Bromocriptine . , | ^ - j r \

^ C o m i p h e n ***** ( W y * * # - J ^ "

c. t v f i

D. Testosterone * -\

Theme: Diagnosis Of Haematuria

Options:

A. Anticoagulant therapy F. Pyelonephritis

B. Bladder cancer G. Renal cancer

C. Cystitis H. Tuberculosis of urinary tract

D. Glomerulonephritis I . Ureteric stone

E. Jogger's haematuria J. Urethritis

Instruction

For each patient described below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

f) 116. A 56 year old woman has painless frank haematuria. She has smoked 25 cigarettes a day throughout her adult life. |

T 117. A 34 year old man has had right loin pain for three days which has radiated to his iliac fossa over the last 24 hours. There are red blood cells present on microsocopy but no bacterial growth on culture.

~~AR 118. A 47 year old woman has painless haematuria. She has recurrent deep vein thrombosis.

T 119. A 22 year old woman has frequency, urgency and a constant feeling of the nged to pass, ^ urine. She has microscopic haematuria. bga-vu^ t^^2 , ^

Theme: Diagnostic Tests For Pneumonia

Options

A. Coagulase positive cocci in sputum

B. Cold agglutinins

C. Gram negative diplococci in sputum

D. Gram positive diplococci in sputum

E Malignant cells in sputum

F. Pneumocystis carinii in sputum

G. Serology for influenza viruses

H. Serology for Legionella

I . Sputum staining for Mycobacterium

tuberculosis

Instruction: For each patient described below, choose the SINGLE most appropriate list to confirm diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

120. A 16 year old girl has been unwell for five days with malaise, headache and dry cough. She has a few crackles in her chest. Her chest x-ray shows patchy consolidation in the lower lobes, ' ' ^ j 1 ' - ^ :. ',"J'

T ) 121. A 35 year old man has a temperature of 39° C, a cough with purulent sputum and right sided chest pain on inspiration. He has Herpes labialis. '

2£ 122. A 55 year old man has a chronic cough and sputum, night sweats and weight loss.

o1


123. A 22 year old woman is six weeks pregnant in her first pregnancy. She has been vomiting for the past 10 days and is unable to keep even water down. She is clinically dehydrated.


A. Anti-emetic orally

B. 5% dextrose intravenously T

C. Gelatine-based colloid intravenously

QD) Normal saline intravenously

E. Steroid intravenously

SINGLE BEST ANSWER:

124. A two year old boy fell off his tricycle, hurting his arm. He got up and started to cry but before there was any sound he went pale, unconscious and rigid. He recovered after 1-2 minutes but remained pale. After an hour he was back to normal. His mother says she was afraid he was going to die and that he had a similar episode three months previously after he fell down some steps, y - , r . j i f^V^

What SINGLE investigation is indicated?

A. Computed tomography (CT) scan of the head

\^I3, Electroencephalogram (EEG)

C. Full blood count"

D. None

E. Skeletal survey

SINGLE BEST ANSWER:

125. A "0 year old man had a right hemicolectomy for caecal carcinoma six days ago. He now has abdominal distension and recurrent vomiting. He has not opened his bowels since surgery. There are no bowel sounds. He has a white cell count of 9 x 109/L and a temperature of 37.3° C. / . - - . > j ( i l , ' f c / i - ... ...,„;> - ' - C c W

What is the SINGLE most appropriate nextmanagement?

A. Antibiotic therapy intravenously

B. Glycerine suppositoly

C^Laparotomy

D. Nasogastric tube suction and IV fluids

E. Total parenteral nutrition


126. A 14 year old girl has developed an itchy, scaly patch on her scalp. She had a similar patch that cleared spontaneously two years ago. Her aunt has a similar undiagnosed rash on the extensor aspects of her elbows and knees.

What is the SINGLE most Likely diagnosis?

A. Eczema ( M^YrrC

B. Fungal infection

C. Impetigo

D. Lichen planus

(jyPsoriasis ^ ^ +

Theme: Investigation Of A Patient With Headache

Options

A. Carotid arteriogram F. Nerve conduction studies

B. Computed tomography (CT) scan G. No investigation required

of the brain.

C. Erythrocyte sedimentation rate H. Temporal artery biopsy

D. Lumbar puncture I . X-ray of the skull

E .Magnetic resonance imaging

Instruction:

For each patient described below, choose the SINGLE most appropriate initial investigation from the above list of options. Each option may be used once, more than once, or not at all.

127. A 55 year old woman has right-sided headaches and feels generally unwell. She has weight loss and depression. G> -C • A:

£ 128. A 51 year old man has a sudden severe occipital headache, drowsiness and vomiting.

g 129. A 58 year old man has a headache and confusion three days after slipping and hitting his head in the garden. L "\ i - : v l >1 < ^ w " • iJ-'

s/-


13!). A four week old girl has been diagnosed of having breast- milk jaundice. She is otherwise well. What is the SINGLE most appropriate management? -

i^A. /Continue breastfeeding

B. Exchange transfusion

C. Increase fluid intake

D. Phototherpy

E. Stop breastfeeding

SINGLE BEST ANSWER:

131. A six week old girl has a high fever. She is found to have white blood cells in a suprapublic aspirate of urine, culture of which has shown a pure growth of E.Coli.

What is the SINGLE most appropriate initial investigation?

A. Intravenous urogram(IVU)

B. Micturating cystogram

C. No investigation indicated

D. Nuclear medicine(NM) renogram

I E . Ultrasound scan of the urinary tract. -' • ° tSL/i t

Theme: Diagnosis Of Pulmonary Diseases

A. Interstitial lung disease

B. Bronchiectasis

C. Extrinsic allergic alveolitis

D. Asthma

E. Wegenef's granulomatosis

F. Mycobacterium Tuberculosis

G. Ca bronchi

H. COPD

I . Cystic fibrosis

J. Amyloidosis

K. Sarcoidosis

L. Pneumonia

Instruction : For each patient described below choose the single most likely diagnosis from the above list of options. Each option may used once, more than once or not at all.

132. A 45 years old chronic smoker attends outpatient department with c/o persistent cough and copious amount of purulent sputum. He had h/o measles inthe past. On examination he has got finger clubbing, inspiratory crepitations on auscultation. " To , yO^ot'xrvucL-

133. A 25 years old diabetic patient came to outpatient dept with following complains fever for 3 days, cough & haemoptysis. He says that his stools are foul smelling and difficult to flush away. Investigations results are: CXR: Hyperinflation, Spirometry: obstructive defect.

134. A 20 years old student attends outpatient department with c/o breathlessness on and off, cough and sputum. His sleep is disturbed and skin is very dry in flexural areas of body. On examination he is tachypnoeic, hyper resonant percussion note and wheeze on auscultation.

135. A 50 years old chronic smoker came to outpatient department with c/o chronic productive cough shortness of breath and wheeze.

Investigations results are: FBC: Increase in PCV

CXR: >6 ribs anterior ribs seen above diaphragm in mid clavicular line.

ABG: p02 is decreased.

136. A 30 years old female came to outpatient department with c/o dry cough, progressive dyspnoea & chest pain. She has painful blue-red raised lesions on shins. v < a X 0 1 ; c* N ; ' N *

Investigations ESR and Serum Ca+ are raised.

Theme: Management Of Burns

Options:

A. Third degree burn.

B. 4ml of fluid multiply by body weight in (Kg) multiply by bum %=ml of Harman

solution/24 hour.

C. Second degree burn.

D. First degree burn. •

E. Required admission.

F. Does not require admission.

G. 1 ml of fluid multiply by Weight in Kg multiply by burn %= colloid/unit time

Instruction : From the options above choose the suitable management for each of the clinical scenario below. You may use the option once or more than once or not at all.

Q 137. The popular formula used in the U.K for replacement of fluid following burn. Pflrk-

138. A 42 years old male presents with erythema, no blisters but the area is painful.

^> 139. A 35 years old factory worker presents with partial thickness burns over the face and hands.

140. A 6 years old Child playing in the kitchen when the kettle of hot water dropped on him he presents with less than 10 percent with partial thickness burn over the trunk. 7 €> ^'

141. A 25 years old male presents with 20 percent burns over the trunk, neck and limbs while he tried to extinguish fire in his home.

Theme: Diagnosis Of Nerve Injuries Associated With Fractures

Options:

A. Axillary nerve. E. Musculocutaneous nerve.

B. Radial nerve. F. Median nerve.

C. Sciatic nerve. G. Facial nerve.

D. Gluteal nerve. H. Ulnar nerve.

Instruction : From the options above choose the most associated nerve injury for each of the clinical scenario below. You may use the option once or more than once or not at all.

-fa 142. A 24 years old male involved in road traffic accident. X-ray showed fracture neck of humerus. ,;•

Q 143. A 33 years old male involved in street fight presents with bruises and deformity in ^ the upper part of his leg. X-ray shows fracture of the neck of the fibula. ~ :' \ :

144. A 37 years old gentleman slipped while he was walking home and fell on out stretched hand he complain of pain in the right arm. X-ray showed fracture of the head of the radius.

" j ^ 145. A 78 years old male diabetic and hypertensive had fall and since he is unable to walk presents with deformity and tenderness over the right hip area. X-ray showed fracture of the neck of femur.

.p 146. A 37 years old female had fall without stretched hand present with dinner folk deformity and tenderness over the right arm. (jMt'-i frt*eta<< clm^ly h~i<~ ff:Jrxr^i-r>\


147. A 30 year old woman has a routine cervical smear which is reported as showing dyskaryosis.


A. Refer for biopsy

^BJ) Refer for colposcopy

C. Repeat smear in six months

D. Repeat smear in one year

E. Repeat smear in three years

SINGLE BEST ANSWER:

148. A 21 year old woman in her first pregnancy has been described as woman with a breach presentation. She has had fit-at home. She is conscious and her vitals are stable.

What is the SINGLE most appropriate intravenous (IV) drug to prevent further fits?

A. Chlorpromazine

B. Diazepam

C. Labetalol

[ d)j Magnesium sulphate

E. Phenytoin

SINGLE BEST ANSWER:

149. A 68 year old female has had a low level jight forearm fracture what will^yoi^ do to prevent more fractures in future? v'-^r'^ >^'' v l 1 " .'> v \

A. Calcitonin

B. Calcium supplement

(^C,)Bisphosphonates

D. Hormone replacement therapy HRT

Theme: Diagnosis Of Vascular Disease:

Options:

A. Thromboangitis obliterans.

B. Ruptured Baker's cyst.

C. Deep Vein Thrombosis.

D. Atherosclerosis.

E . Embolus.

F. Varicose veins.

G. Cellulites.

H. Sciatica.

Instruction : From the options above choose the most probable diagnosis for each of clinical scenario mentioned below. You may use the option once, more than once or not at all.

150. A 60 year old diabetic complains of pain in thigh and gluteal region t>n walking up the s J stairs for the last six months .She is a smoker and has ischemic heart disease. U/itrvv!.1. - '

^ 151. A 45 years old is admitted to casualty with excruciating pain in the right leg. On examination limb is pale and dorsalis pedis and posterior tibial pulse is absent. Pulse is 88/min, irregular and he has-pansystolic murmur at apex. d\ r<^^ — ' 1 > J

^ 152. An obese 4-0 year old lady, developed a painful leg on l O ^ o s t operation day following emergency surgery for a rupture red ectopic pregnancy. \

[\ 153. A 28 year old shipyard worker admitted for pain in calf while work which has been increasing over last 3 months. There is no history of hypertension or diabetes but heis a smoker. On examination, he has loss of posterior tibial and dorsalis pedis pulsations along with a non-healing ulcer at the base of right 1 s t MCP joint, ^ l ^ - ' i &Sc*K- " £y<W k J ^ \g

154. A 50 years old policeman comes with generalized aches on his lowerlimb. On examination, pigmentation around both ankles is seen and a swelling appears below left inguinal ligament when he coughs. ^

SINGLE BEST ANSWER:

155. A 4 year old is brought to the A & E department by ambulance. His mother reports that he has been unwell with a sore throat for eight hours. He is sitting on his mother's knee and is tolerating an oxygen mask but looks unwell. He has constant noisy breathing and he is drooling saliva. His temperature is 39°C. W. What is the most important diagnosis?

A. Acute asthma

B. Bronchiolitis

C. Croup

MCX Epiglottitis >\}\1' "

E. Tonsilitis

SINGLE BEST ANSWER:

156. A three month old boy is brought to the Emergency department following an apnoeic episode at home. He is now completely well but the parents are anxious as his cousin died of sudden unexpected death in infancy at a similar age. The parents ask for guidance on basic life support for a baby of this age.

What is SINGLE recommended technique for cardiac compression?

A. Fingertips of both hands

B. Fingertips of one hand

C. Palm of one hang

D. Palm of both hands

R/ 1 Index and middle fingertips of one hand.

Theme: Complication Of Thyroid Surgery

Options: A. Thyroid storm. B. Unilateral recurrent laryngeal nerve palsy.

C. Hypocalcaemia.

D. Reactionary haemorrhage.

E . External laryngeal nerve palsy. ,

F. Bilateral recurrent nerve palsy.

G. Tracheomalacia. P, «'-^[ ?- {' Y; v " ; "" ' ; / / '7y

Instruction : From the options above choose the most probable thyroid surgery complication for each of clinical scenario mentioned below. You may use the option once, more than once or not at all.

157. A 60 years old patient recovering from a surgery of toxic goitre is found to be hypotensive, cyanosed in the recovery room. On examination her neck is tense. There is oozing blood from the drain.

.1 158. A 44 years patient has sudden onset o f breathlessness and stridor few minutes after extudation for thyroidectomy. The patient had long standing goitre for which he had the surgery.

(2 159. A 38 years old patient presented with tingling, numbness, parasthesia, respiratory stridor and involuntary spasm of the upper extremities. She has undergone surgery for thyroid carcinoma a week ago. >"> Q ujJJyf*f rV"^W (f yo^rrrj :^<v

jy.^ 160. A 30 years old gentleman complains of hoarseness of voice. On examination an immobile vocal cord on one side is revealed.

•^C 161. 20 years old pop star singer complain of inability to raise the pitch of her voice. She attributes this to the thyroid surgery she underwent a few months back. [ >v ) \^ L

Theme: Fluid Management

Options

A. 0.45% saline over 48 hrs

B. Start hydration with 0.9 % saline

C. 20 ml kg of 0.9% saline bolus - ,

D. 20 ml kg of 0.18% saline bolus

E. Encourage plenty of fluids along with ORS orally

F. Give maintenance and deficit fluids I V

G. Continue regular child care.

Instruction : From the above list of options choose the single most likely management option. Each option maybe used once, more than once or not at all.

162. A 7 year old child presents to the A and E with vomiting. Mother gives a history of child being increasingly thirsty over the last few weeks. His blood sugar is 18 mmo 1/dll The child is slightly drowsy.

163. A 12 months old child presents to the A and E department with a 1 day history of loose stools. O/E the child's anterior fontanelle is slightly sunken, he is very irritable and is eager to drink.

164. A 17 month old child presents with history of loose stools and vomiting. O/E he is very drowsy and lethargic. His eyes are sunken, anterior fontanelle is depressed and his extremities are cold. .cvK.-:—^ ^ r v f^ , { * X l V S - ''• s bcR ^ find

165. A young mother brings her 12 months old daughter to the A and E with just one episode of vomiting over 24 hrs. O/E the child is active, playful, anterior fontanelle is not depressed, and is drinking normally.

166. A 12 months old child presents to the A and E department with a one day history of loose stools and vomiting. O/E the anterior fontanelle is slightly sunken; he is very irritable and vomits anything that he takes. k<u (\ih<\dp(hJ + > H "

Theme: Diagnosis Of Congenital Disorders

Options

A. Down's syndrome I . Congenital hypothyroidism

B. Klinefelter syndrome J. Congenital adrenal hyperplasia

C. Kabuki syndrome K. Marians syndrome

D. Prader vil l i syndrome L. Ehler danlos syndrome

E. Di George syndrome M . Noonans syndrome

F. Turners syndrome N. Turners syndrome

G. Pierre robin syndrome

H. Patau syndrome

Instruction : For each of the group of symptoms below choose the single most likely diagnosis. Each option may be used once, more than once or not at all.

^ 167. An 8 months old infant presented with failure to thrive, constipation. On examination he has large tongue and he also has a history of prolonged neonatal jaundice. r / , r ' - n ' ^ , ; i " L

U 168. A 3 month old infant has presented with recurrent infections, he has abnormal facies and on a chest X-ray shows absent thymic shadow. • "" - ' r > "i"!r"-

169. An 8 year old child who is tall for his age has a refractory error for which he wears glasses has presented with severe crushing cliest pain. """" &<&sw*x^\* Vciv*

170. A 2 months old baby who has ambiguous genitalia presents to the A and E with vomiting. Lab tests are as follows. A ^ ^ „ . : ^ w^Jpr* yy^\

Na: 125mmol/L y r / ^ f r f ^ ^ ^

K: 6 mmol/L

171. A neonates chest X ray shows double bubbje_sign. On O/E the neonate has lowest ears, flat occiput. ^cU-'dcjv"! oivt:£i>y

Theme: Haematology

A. . Macrocytes G. Halmet shape cell

B. Microcytes H. Sickle cells

C. Granulocyte without blast cells I . Spherocyte

D. Blast cells J. Target cell

E. Mature lymphocyte

F. Clumped platelets

Instruction : For each of the group of symptoms below choose the choose single cell type. Each option may be used once, more than once or not at all.

172. A 23 year old female presents with recurrent mild jaunduce since childhood. She has gallstones, her spleen is palpable, she is otherwise well ' - ^ ^ r ^ t ^ ^ ^ ^ f f l —

_ 173. A 55 year male, presents with malaise and tiredness, his spleen is approaching right illiac fossa, no lymphadenopathy. C , v - ~- ' y ' V \ . ^ ""r*.

.AP) w i t ^o.^CtOs " '" " ' " - " - 9 ^ J

' • - v

j - ^ 174. A 73 year old male, presents with enlarged cervical nodes, he has recurrent infections ^ over last one year, his conjuctiva is pale. QX\, ~ (^>*^J j v ^ - V * * ^ " l ^ ^ - j 'lJ^lfhiz'ul

~>) 175. A 6 year old boy is brought to the hospital for 3rd episode of sore throat in one month, his found to be bleeding from gums and nose, conjuctiva pale ^LL —> ^v-^'j ^<

j \. A 37 year old woman presents with more tiredness than usual, she is found to have angular stomatitis, no koilonychea.

SINGLE BEST ANSWER:

177. A healthy two year old boy is brought to the Emergency Department having cut his hand playing in the garden. He has a 2cm clean laceration. He has not received any routine immunizations as his parents are concerned about possible side effects. There are no contraindications to immunizations

What is the SINGLE most appropriate follow-up investigation?

A. Courses of diphtheria, pertusis and tetanus(DPT) vaccine

B. Courses of diphtheria/tetanus

C. Single injection of diphterial/ pertusis and tetahus(DPT) vaccine

) Single injection of diphterial/tetanus "' ^ 1 3 "' v ' ^

E.\e injection of tetanus immunoglobin

Theme: Congenital Heart Diseases

Options <K

A. Fallots tetralogy

B. Patent ductus arteriosus

C. ASD

D. VSD

E. Coarctation of aorta

F. Transposition of great vessels

G. Severe epsteins anomaly

H. Partial anomalous venous drainage

Instruction : For each of the group of symptoms below choose the single most likely

diagnosis. Each option may be used once, more than once or not at all.

178. A 45 year old lady has 10 months history of SOB. She is found to have irregularly irregular pulse and loud P2 with fixed splitting .and ejection systolic murmur in left 2 n d

intercostal space, rCmCU.»'r> t«.i 'r;,;: Vrn^ ' 1 1 uV.il wuicUX-

179. A 28 year old man with complains of headaches and nose bleeds, Also has pain lower limbs on exertion. Examination shows radio femoral delay^He also has cold legs with weak pulses and mid systolic murmur with normally audible SI and S2.

180. A 4 year old girl is found to have bounding pulse and continuous machinery murmur.

~V) 181. An 18 year old man complains of fatigue and dyspnea, he has left parasternal heave and systolic thrill with a harsh pansystolic murmur at left parasternal edge.

f \ l82 . A 12 year old child with episode of sudden bluish discoloration and brief loss of consciousness. Examination reveals clubbing, central cyanosis and systolic thrill with systolic ejection murmur in 2 n d left inter space. C &">ot<x

1

SINGLE BEST ANSWER:

183. A 26 year old lady with oligomenorrhea, acne and increased facial hair. She is suspected to have PCOS. What are the expected changes in LH, FSH in this condition?

A. Decreased LH/FSH ratio

( B.ilncreased LH/FSH ratio cy Ci& A X

C. Normal LH/FSH ratio

D. Both LH and FSH increased

E. Both LH and FSH decreased

SINGLE BEST ANSWER: ^

184. A young lady presents with gradually worsening headaches, visual disturbance, lack of energy. MRI shows 15 mm tumor in pituitary fossa. What is the treatment of choice?

A. Radiotherapy

B. Octreotide

C. Reassurance and followup after 6 months

DySurgeryANS

E. Chemotherapy

SINGLE BEST ANSWER:

185. A 45 year old lady c/o expressable galactorrhea, decreased libido and amenorrhea, weight gain and easy fatigue. Her serum prolactin levels are 11000mu/l. What is the likely cause of hyperprolactinemia?

A. Hypothyroidism

B. Stress

C. Pregnancy

[JlX/Prolactin secreting pituitary tumour < J i J ^ v ' r ^ > "v vvX

E. Polycystic ovarian syndrome

SINGLE BEST ANSWER:

186. A 45 years old man diagnosed as acromegaly had surgery and now on somatostatin analogues but still his GH and AGF levels are not in the safe range. What is the next step of management?

jfA) Start patient on pegvisomant

B. Repeat surgery and radiotherapy

C. Radiotherapy alone

D. Bromocriptine

E. Cyprohepatdine.

SINGLE BEST ANSWER:

187. A 80 yr old diabetic, hypertensive lady presented with acute onset vomiting and vertigo with tendency to fall to the right. She also had difficulty swallowing. Examination shows Right sided partial ptosis, constricted pupils and enophthalmos, right sided soft palatal palsy and sensory loss on face on right side and left half of the lower body. The diagnosis is

A. Weber syndrome

B. Lt.MCA territory infarct

C. Rt.post cerebral artery infarct s

( j £ lateral medullary syndrome l i - ^ ' J " n * ^

E. Lt. anterior cerebral artery infarct

SINGLE BEST ANSWER:

188. A woman 5 days after post operative for bilateral salphingo-opherectomy and abdominal hysterectomy has developed abdominal pain and vomiting with .associated abdominal distension and cannot pass gas. No bowel sounds heard, she is alsoiiydrated. Choose the most appropriated next step. • ^ y ^ l ^tfntVuy 1 V y ^ —> K pcra^-.v •

1 0 , , , • J\) Plain X-ray abdomen y'gvp,ry K i > ^ oiub^X£i 1 X H < ^

B. Exploratory Laparoscopy ^ ' ^ ' ^ ^ ctvi w.xi ItKiU

C. CT scan

D. USG

^"Barium Enema

SINGLE BEST ANSWER:

189. A man with anterior resection and end to end anastomosis done complains of severe pain in the chest and abdominal distention. What is the most appropriate investigation likely to review the cause to his deterioration? ^<<£H*Y>a.fci.L UAk- , v >r'vir (jy*wr< uwjfso*:

A. Plain X-ray abdomen . _oc>>'"i-^v:^ {v>'<! -J y

, Exploratory laparoscopy

C. CT scan

D. USG —? i w W j / 1 '

E. Barium Enema


190. A man presents with scrotal swelling, the swelling is cystic and is non tender, it is located at the upper pole of the posterior part of the testis. What is the most likely diagnosis?

I A. Epidydmal Cyst

B. Hydrocele

C. Teratoma

D. Testicular cancer


191. A mother has brought her three year old son to the Emergency department two hours after he has taken an unknown quantity of paracetamol suspension. He appears well and is playing normally.

What is the SINGLE most appropriate time to measure his serum paracetamol levels?

A . Immediately

B. In 2 hours

C. In 4 hours

D. In 8 hours

E. In 24 hours


192. A butcher stabbed accidently in his groin bleed so much the towel was soaked in blood

and BP 80/50, Pulse 130. What percent of circulatory blood did he loose?

A. Lessthanl5%

B. 15-30%

C. 30-40%

D. 40-50%

E. Above 50%


193. A 32 year miner rescued after being trapped under a fallen rock for 4 hours. After applying a bladder catheter, 15-20 ml reddish brown urine/hour was obtained. His HR is 120/min; systolic BP is 100 mm Hg. What would be the next appropriate step?

A. Dopamine IV

Fj. Fluid challenge

C. Furosemide IV

D. Mannitol 20 % IV

Theme: Drug Management

Options

A. Disulfiram H. Diazepam

B. Acomprostae I . Amitriptyline

C. Naloxone J. Disulpheram

D. Cholrdiazeproxide K. Glucose infusion

E. Chlorpromazine L. Glucose infusion

F. Citalopram M . Naltrexone

G. Clonidine N . Vitamin B complex

Instruction : For each patient described below, choose the SINGLE most appropriate drug treatment from the above list of options. Each option may be used once, more than once or not at all.

194. A 43 year old man has drunk alcohol excessively for several years. He has had several course of detoxification. He has now decided to stop drinking completely and is engaged with rehabilitation program me. He requests some additional help but is not prepared to experience any unpleasant systemic reactions.

y 195. A 30 year old man has been amphetamine for several years. He has experienced repeated withdrawal states with severe depressive symptoms. He has been injecting his drugs for the past year. He requests a safer alternative. %

\. A 49 year old man is homeless was brought to Emergency Department in severe alcohol withdrawal, a poor nutritional state with confusion and ataxia. His withdrawal symptoms

f \. A 21 year old woman has had heroin dependence for two years. She wishes to stop and create a safe home for her children. She is attempting to stay away from other drug users but is still finding it difficult to stabilize her life due to her craving for heroin.

SINGLE BEST ANSWER:

198. A 64 year old man with longstanding alcohojydj^endence has been brought to the Emergency department having been found wandering unsteadily. He is confused ataxic mucus membranes and bilateral opthalmoplegia. His blood pressure is 115/ 85mmHg, pulse rate of 96 beats/min, a temperature of 36.8° C and a capillary glucose of 3.5mmol/L. C

What is the SINGLE most urgent intravenous therapy? ' ;

A. Bolus of 50% glucose solution

B. Bolus of lorazepam

^Cy Bolus of thiamine

D. Infusion of 0.9% normal saline

E. Infusion of 5% dextrose solution

have settled with treatment.


199. A four year old boy has been brought to the Emergency department by ambulance. He has been unwell with a sore throat for eight hours. He is sitting on his mother's knee and is tolerating an oxygen mask but looks unwell. He has constant noisy breathing and he is dribbling saliva. His temperature is 39° C.

What is the SINGLE most appropriate action?

A. Administer IV pencillin

"B ) Call an anaesthetist

C. Examine the tonsils with a tongue depressor

D. Listen to the chest

E. Take blood culture ?

SINGLE BEST ANSWER:

200. A 44 year old male presents with painful erection with curving of the penis. What is this condition? A. Balanitis B. Phimosis , . r \ C. Priapism : 1 ^ "• - i — f , . ' . f _, _ D. Peyronies diseases : >w'r^O& ( r<' > ^ ' s 7

E. Paraphimosis : y'

mock4 11thmarch comp

Documents

month old boy

months old boy

year old boy

week old boy

list of options

t e s t

pelvic ct c c

hands e