1.

A man whose father got CRC at the age of 57 years and before that he got them at 35 years and were resected. There is no three generation family in this guy and he does not have familial polyps. What is the risk he would get CRC? a. 1 b. 0.25 c. 0.5 d. 0 e. 0.75 2. A female who had her last menstrual cycle 12 months back is worried and came to you ask your advice about osteoporosis as her mother got it at the age of 84 years and had a hip fracture and someone told her she would also have it. What is the most appropriate next action? a. Tell her no need for anything and she wont get it b. Check Vit D level c. Check calcium level d. LH & FSH level e. Write Vit D 3. An old man 75 years old who has IHD and now presents with CHF and palpitations. What is the ECG pic? a. VT b. 3rd degree heart block c. SVT d. Atrial Flutter 4. A man presents with sudden pain in his right hypochondrium and CT pic is given. He uses warfarin and his INR is 4.5. What is shown on CT? a. Rectus sheath hematoma b. Appendicitis c. CRC d. Peritonitis e. Abscess 5. A man presents with sudden onset of syncope and his ECG was given. He has history of IHD? What is shown in ECG? a. Torsades de pointes b. VT c. A. Fibrillation d. A. Flutter 6. An ECG of old man was given who had 3rd degree heart block. What is the most appropriate initial treatment?

a. Atropine b. Pacemaker c. Metoprolol d. CCB 7. A Woman whose mother got breast cancer at the age of 57 years and her sister also got breast cancer at the age of 50. What is the risk for her? a. 1 b. 0.5 c. 0.25 d. 0.75 e. 0 8. A lady 48 years old presents for checkup worried about her health and asks what screening she should have now as she has grandmother diagnosed with CRC at the age of 60, her father had lung cancer at the age of 65, her brother had diabetes at the age of 56, and her sis also had some prob I forgot , what investigation would you recommend now. a. Colonoscopy b. DM screening c. Breast cancer screening d. Lung cancer screening 9. A child is brought by his parents who complain that he does not stand quiet in lines in school, he feels irritated and school performance is deteriorating for the last 3 months and he plays games only at home. What is the next most appropriate step? a. Check his school results from the last year b. Send him for psychiatry consultation c. Advise her mother that its normal and it will settle down d. Prescribe him drugs 10. A child is brought who has fixed rigid routines and seems to be deaf. He does not reply to any questions and just utter two or three random words. He seems to be detached from the world but very busy with his buttons and when asked something, he just stares at you and bangs his head. Then he repeats your words and starts with his buttons again. What is this? a. Asperger disease b. Autism c. ADHD 11. A child is brought by parents who are worried about him and also school teacher complains about his behaviour at school. What would you do as next step? He does not have friends and is busy with games.

a. Ask for his school grades b. Give him drugs c. Refer to psychiatry d. Discuss with parents that its normal and will settle down 12. X-ray of LBO (Sigmoid volvulus I felt it was) and asked next most appropriate investigation? a. Contrast enema b. Gastrograffin follow through c. Barium enema d. CT scan 13. Ecg of Atrial fibrillation was given and asked for most appropriate treatment? a. Metoprolol b. Amiodarone c. Adenosine d. Verapamil 14. A patient presents with VT & he has history of WPW. What would you do as next step? a. Cardioversion b. Amiodarone c. Adenosine d. CCB e. Metoprolol 15. A lady who is 30 weeks pregnant now, her first antenatal checkup at 10 weeks and was found to be normal. Her fundal height is now 26 weeks though her pregnancy dates and first appointment confirms its 30 weeks, 4 weeks back she had a random checkup somewhere and it was 25 weeks. What could be the cause? a. Rubella b. Fetal alcohol syndrome c. Placental insufficiency 16. A man presents with (Pic of conjunctivitis given) for the last 4 weeks. He has previous history of repeated genital and oral ulcers. What would you give him? a. Topical chloramphenicol b. Oral steroids c. Topical steroids 17. Two groups are being studied for risk reduction for some disease with aspirin use. Tables are given as follows. Aspirin used aspirin not used Got disease 10 20 Disease free 990 980

Calculate NNT for this? a. 10 b. 100 c. 1000 18. Which of the following would change your treatment in a pregnant female? a. HIV b. HBV c. HCV 19. A lady comes to you with complaints of warts and asks you about HPV vaccine for this prob? What would you tell her? a. Its not indicated for this prob b. Get it now c. It would depend on your pap smear result d. It would depend on your cervical smear result 20. A pregnant lady for 20 weeks calls you and tells that her husband is who is heavy drinker beats her daily and punished her unduly. What is the next most appropriate step? a. Encourage her to call police b. Arrange immediate accommodation for her in some welfare house and complain to legal authorities c. Talk to her husband d. Ask her to come with husband 21. A tall young boy who is also very slim and want to start games. What would you do? a. Echo b. ECG c. FBC 22. A 65 years old man presents with icterus in conjunctiva, has bilirubin in urine and says his urine has been cloudy for the last few days. He has lost weight of 3 kg as well and there is mass in the right side in the midclavicular line. Lab results were given as under Bilirubin 50 ug (raised) ALP 450 (raised ALT (I think it was 3 times raised) What is the cause? a. Ca head of pancreas b. Alcoholic cirrhosis c. Viral cirrhosis d. Viral hepatitis e. Acute cholangitis

23. A lady who is in labour at term for 4 hours now at hospital. When she arrived, her cervix was fully dilated and now after 4 hours its still dilated and child is at +2 position and caput and moulding is present. She has been contracting forcefully all this time and contractions are really good and forceful. What would you do next? a. Nonrotational forceps b. Rotational forceps c. Oxytocin infusion d. CS section 24. A lady who presents at term and fetal presentation is OT and she has been contracting forcefully. Her fetal CTG is as under. Accelerations are about 120-150 Variations are about 6-20 However there are some decelerations also observed which come to as low as 60 beats and are for about 70 seconds. Some meconium can be seen coming out as her membranes have ruptures sometime ago which is dusky and cloudy. What would be the most appropriate next step? a. Ask her to push harder b. Continue with labour and monitor with CTG c. DO U/S d. C Section immediately 25. A lady who is HCV positive, what advice would you give her? A. C section is must B. Dont do fetal scalp electrode application sampling in labour C. Fetus needs vaccination 26. Same question as 25 but options were changed and lady was shown to be HCV antibody positive, HCV antigen positive and HCV RNA negative. What would you tell her? a. No fetal scalp PH sampling b. Fetus needs to be given drugs c. Dont breast feed d. C section 27. A man 45 years old who presents with the history of his father having CRC at the age of 57 years and some aunty at the age of 62 years. What is the best advice for him at this moment? a. Colonoscopy yearly b. FOBT 2 yearly c. Sigmoidoscopy 2 yearly d. DRE annually e. Nothing needed and reassure him

28. A person who has visual field defect in both lower lobes on the right side. Where is the lesion? a. Parietal lobe b. Temporal lobe c. TIA 29. A lady who presents with repeated history of being unaware of herself and then returns back to normal. This happened to her several times and then she is normal afterwards. What is best step to reach a diagnosis? a. Ask her relatives who witness the attack b. EEG videotelemetry c. CT scan of head d. Ask her 30. A person who has Alzheimer disease and his wife says he repeatedly urinates in his bed and he is not aware of it. Sometimes he does it deliberately in shopping mall parking area tree areas and he also short term memory loss and he does not talk much with you except repeatedly asking when he can he go home? His other physical symptoms are normal and nothing abnormal found. Cause? a. Worsening of Alzheimer b. Frontal lobe lesion c. He does it deliberately to irritate his wife 31. A person who has BPH comes to you and ask for help as he has nt passed urine for the last 24 hours and is in distress. What would you do? a. Suprapubic aspiration b. Urinary catheterization. c. Give him drugs 32. A person who came to you 2 weeks later after he fall from cycle, it was so hard that his helmet was torn apart and afterwards he was normal with no amnesia an no headache but now he has headache for the last one week. What is the cause? a. Cerebral hemorrhage b. Chronic subdural hematoma c. Extradural hematoma 33. A person who is on warfarin has sudden onset of his right arm and some other part mild weakness. CT is given what is the cause? INR was 3.9 I feel a. Lesion b. Cerebral hemorrhage c. Cerebral infarction The CT showed hyperdensed area which I feel was infarction 34. A person wants to visit Papua Guiana and asks for preventive drug for malaria?

a. Doxycycline b. Chloroquine c. Mefloquine 35. Which drugs combination is contraindicated? I was shocked to be honest when I saw the combination as I saw two combinations which were contraindicated. a. Lithium and diazepam b. Tranylcypromine and sertraline c. Lithium and carbamazepine I marked B though C is also correct but two cant be answered so was having a dilemma. 36. Which of the following is not side effect of steroids? a. Osteomyelitis 37. A person who is in coma and no advance medical directives are present. Wife says, he wont want to end up in nursing home so stop all this and sons do everything possible to save him. What is the next most appropriate step in the scenario with no given advance directives, 38. a. Arrange family meeting and discuss of end life issues b. Refer the case to guardianship court c. Listen to his son d. Listen to his wife 39. CT scan Rectus sheath hematoma was given and INR was 4.9. 40. A Turkish lady presents with MVA and on CT has some prob. (CTscan showed calcification). What is next most appropriate step as she has no problems right now? a. Dont inform her b. FNA cytology c. Percutaneous drainage d. Laparotomy 41. A lady who is very obese BMI 45 and not having menstruation for 12 months and U/S or CT of the ovary is normal. What would be the hormonal look? a. Very raised Estrogen & Very raised FSH b. Very raised estrogen & normal FSH c. Very low Estrogen & Very raised FSH d. Mild low estrogen and mild raised FSH. e. Normal FSH & estrogen 42. Another scenario was of a lady who was unable to conceive and lab results showed primary ovarian failure and her BMI was 30. What would you give? a. Metformin

b. Clomiphene citrate c. Ovarian drilling 43. A lady who has complex cyst in ovary, how would you treat? a. No need for treatment b. Laproscopy c. Laprotomy d. Review in 6 months 44. A man who has stent placed 6 months back and now has varicose veins and scheduled for surgery and he is having clopidogrel. What would you do? a. Reassess the need for surgery before surgery b. Stop clopidogrel and do surgery c. Stop clopidogrel 6 weeks before surgery d. Stop clopidogrel 10 days before surgery and give another appointment for surgery 45. A man presents with loss of dorsiflexion, planter flexion, inversion and eversion of foot and loss of ankle jerk. His knee jerk is fine and also flexion of knee is fine. Where is the lesion? a. Sciatic nerve b. L5 c. L4 d. Tibial Nerve 46. A man presents with weakness of extension of fingers and wrist. His brachioradialis jerk is fine and also supinator and triceps jerks are fine. Where is the lesion? a. PIN b. AIN c. Radial Nerve d. Median Nerve 47. A lady brings his brother and asks you for a certificate as she could nt go to work due to that. What would you do? a. Dont issue and refuse b. Ask her to make separate health prob issue c. Give her bro cert and tell her to show it to her boss d. Write in her cert that she brought her bro and could nt go to work 48. A child who passed his first stool at day 4 and now he is 7 days old, has abdominal distention and is irritable and also has vomiting. What could be the cause? a. Oesphygeal atresia b. Duodenal atresia c. Meconium ileus

49. A child 10 days old is having rash and is afebrile, thriving well, has no other prob. What is diagnosis? a. Toxic erythema b. Viral infection c. CMV d. Varicella infection 50. A child who is 90th percentile for weight and looks overweight. What would you do besides treating him for some minor complaint? a. Refer to eating disorder clinic b. Tell he needs more exercise and dieting to balance his weight for his height c. Do nothing as he is normal 51. A 3 year old child having neck stiffness, rhinorrhea and fever and is drowsy. He has been vaccinated for meningococcus. What is the cause? a. Viral b. GBHS c. Chlamydia d. Viral encephalitis 52. A child 4 years old who has neck stiffness, kerning sign positive and has fever. His lab results show CSF cloudy opaque coloured, WBC, s are 2600 and glucose is low. What is the cause and he has been vaccinated for meningococcus. Gram stain is negative. a. GBHS b. Viral c. Streptococcus penumonie d. Chlamydia 53. A person who is bed and family is fed up with his loss of control for bowel, urination and many other problems. They want him to be accommodated in welfare center. What would you for his feeding as his MMSE is 10/30. He has no control of his bowels, urination and cant do anything. a. NG feeding b. IV feeding c. Oral feeding d. Discuss end of life issues 54. A medical colleague of you comes to your clinic and asks for referral to gastroenterologist as he has some gastric prob. He says he came on insistence of his wife and he also accepts to drink before his work. What would you do? a. Arrange referral for gastro b. Refer to medical board ( it was exactly refer to medical board, not report) c. Give him PPI

55. An aborigin lady comes and says that she is very depressed since her father died one month back as she was very close to him. Medical records show he passed away one year back and she has tears in eyes during discussion and starts crying. She also complains of lack of sleep, and body pains and she is irritable and lack of interest in activities. What is the cause`? a. Psychosis b. Depression with unresolved grief c. Normal grief 56. An 8 year old aborigin child who lives in rural town has been brought by her grandmother who says he is irritable, rude and cannot concentrate on things for quite long time. She also says that mother of the kid was heavy drinker from the age of 15 and the guy is small for his age clearly. What is the cause? a. Fetal alcohol syndrome b. Normal variant c. Alcohol d. Some drug which I dont remember addiction 57. A man who has IHD now presents with SOB and CXR clearly showed pulmonary edema. His JVP was raised. What is next best investigation? a. CXR b. ECG c. Echo 58. A man who has COPD and now presents with acute SOB and he was given O2 8 liters but his Oxygen saturation is 84% and his condition has not improved. What is the next step? a. ABGs b. Spirometery c. Repeat 8 liters oxygen d. ECG 59. A man who is very SOB and brought to emergency dept, you gave him 6 liters of oxygen but no improvement is noticed. What would you do next to confirm the cause of the prob? a. CXR b. CT chest c. ECG 60. A man when gets into his bed has pallor of his fingers and there is no other prob. All his lab results are normal. What is the cause? a. Polycythemia Vera b. Arterial disease c. G6PD disease

61. A lady who is about to start IVF program and asks you about lithium as she has been taking it for two years now and is stable for the last 12 months. What is the most appropriate next step? a. Stop Lithium b. Check Lithium serum level c. Reduce dose of lithium now 62. A lady who has been taking some atypical antipsychotic (Zoclihauxide something) fortnightly (over 15 days) once now presents with non-cogwheel rigidity, tremor. What is the next step? a. Stop it b. Change to quetiapine now c. Start olanzapine now and stop zocli after 3 more doses over the next 45 days. d. Add quetiapine as next drug to the current regimen. 63. A lady presents with some fine tremors of her hand which disappears when she watches it. What will you give? a. Benzhexol b. Propranolol c. Diazepam 64. A lady who is alcoholic now presents with irritability, has prominent tremors and is alcoholic which she takes about 3 beers daily. What would you give as most appropriate next treatment? a. Diazepam b. Benzhexol c. Warfarin d. Paracetamol e. Propranolol 65. A girl who collapsed in party is brought to your clinic and she has agitative behaviour, her pulse is 130, BP is 180/ 140, and she is drowsy and her temperature is raised. She is very drowsy and confused. She has tremors and jerky movements. What would you give her? a. Thymine and oral feeds b. Cold normal saline and cooling blanket 66. A lady comes to your clinic and says, Oh well, my food!! My food is cheese, cheese is in air, air is blue and I came by bus: What is this? a. Schizophrenia b. Depression c. Dissociation d. Psychosis

67. A person is brought by care taker from a caring old nursing home and there he had some fight on TV remote. Now he is irritable and refusing to have xray of his hand which is fractured. What is next step? a. Ask his carer to calm him down b. Give diazepam c. Give some other drug. d. Restrain him under mental health act 68. A man recent immigrant comes and tells you that his country,s secret police are after him and they want to kill him as they are worried that I would leak the name of another person who was involved in killing of a person. What will you check in his history? a. Immigration visa status b. Family problems c. Psychosis history 69. A man comes and tells you that his wife is having affairs with others and is not loyal to him. He insists that one of his family members must be regularly monitoring her. What is this? a. Overvalued idea b. Psychosis c. Paranoid delusions d. Depression 70. CT scan of infarction 71. Xray of LBO ( Volvulus) 72. Xray of LBO ( Asked investigation) 73. A child, who was having glomerulonephritis and was responding to steroids, now stops responding to it. What is the cause? a. FSGN b. IgA nephropathy c. PSGN. 73. I got question 72 twice but scenario was a abit different. But options and Ans was the same. 74. A patient presents with diarrhea and his INR is raised and calcium is low. What will you do to reach diagnosis? a. Antigliadin antibodies b. Anti dsDNA antibodies c. serum electrolytes

75. A patient presents with pain in knee joints and on investigations, his ANA is strongly positive. His Ds DNA value is 4(1-5 normal), Anti Ro Antibodies strongly positive and RF is also negative. What is the cause? a. SLE b. Sjorgen syndrome c. RA d. OA 76. A lady 24 years old presents with rash on her face and has joint pain and has mild other problems. What will you do to reach her diagnosis? a. ANA b. Anti-Ds DNA c. RF 77. A young girl who underwent craniopharyngioma surgery and her mother call you that she is having gastroenteritis. What would you tell her? a. stop all drugs b. Give N/saline 78. A patient who underwent thyroid surgery 3 hours back now has very severe respiratory distress and is drowsy. What will be you next most appropriate step? a. Intubate b. Remove superficial sutures c. Remove all sutures 79. A lady undergoes for some surgery and she has stressor breathing and is looks pale and drowsy just three hours after surgery. What is next most appropriate step? a. Endotrachel intubation in bed b. Remove all sutures c. Remove only deep sutures

D. Remove only superficial sutures 80. A man who had surgery and now has passed 15 ml urine in 24 hours. His JVP is 15. What will you do to improve his urine output? a. Give 500 ml N/S b. Give 500 ml D/S c. Give dopamine d. Give adrenaline 81. A person is taking many drugs alongwith that add drug question and asked what you will add to his current regime. a. Clonazepam b. Mirtazapine c. Diazepam 82. A child 13 years old presents with severe knee pain which is worse after playing sports. The knee is tender on examination. What will you do? a. tell her mother it will resolve in 1-2 years b. Give antibiotics 3. Send him for MRI 83. X-ray from HB of that fractures clavicle and lady was not able to raise her arm above. 84. Most important sign in chronic limb ischemia a. rubor on dependency b. colour gets normal when resting on pillow c. pain 85. A person when walks 100 meters above a steep level, and 300 meters straight ground has pain in limbs. His pedal pulses are palpable and there is no colour change in his limbs. What investigation will you do? a. Digital colour subtraction angiography.

b. Arteriography of lower limbs c. CT scan d. MRI 86. A 7 year old child with some problem related to surgery and dehydrated. What is the best fluid for him immediately? a. N/S b. D/W 87. A lady with POG 34 weeks come for routine checkup and you find out that her BP is 130/90 mmHg and has proteinuria of +1. On checking records you find out that her BP was normal at 10th week of gestation and it was 120/80 mmHg. After taking rest for one hour in your clinic, you recheck her BP and its normal again and she has no proteinuria. What it the cause? a. Essential HTN b. Pregnancy induced HTN C. pre-Eclampsia d. Eclampsia 88. A man presents with Diabetes and his HbA1c is 6.9 (Normal is 6.1-6.6) and his FBS level was normal and LDL was also normal. What will you do next? a. Continue same b. Add Simvastatin c. Add metformin d. add insulin e. Add glitazone 89. A 42 years old lady has fibroids which O/E is up to the level of umbilicus. Her Hb is 6.0 (N11-14), what is the most appropriate next step? a. Immediate myomectomy after correcting her Hb b. Schedule her for next appointment for myomectomy and give iron supplements

c. Give GnRH for 3 months and then do myomectomy D. Hysterectomy after correcting her Hb. 90. A 57 year old man who has on/off diarrhea and constipation and bloating of abdomen for the last 3 months. He had similar symptoms 12 months back and had colonoscopy which was normal. What is the next step? a. Repeat colonoscopy b. Check stool culture and some other word was with it 3. X-ray 91. A 4 year old child has abdominal pain and nausea for the last few months. O/E he has mass on the right side in the midline. He is not complaining of any other symptoms. What is the cause? a. Wilm, s tumor b. hepatoblastoma c. Neuoroblastoma 92. An old man is brought by his relatives who say that he was absolutely normal few days back. He is known Alzheimer disease patient and his MMSE is 13/30. He is behaving strangely in the last few days. What is the cause? (NO delirium in options). It was scenario of SDH though I dnt remember the complete scenario but it was typical for SDH. a. subdural hematoma b. Hepatic encephalopathy c. Alzheimer 93.A 42 years old lady comes for checkup and you find out that her Hb is 10 g/dl (N-12-15 given), MCV is 118, MCHC etc. were normal. She is not having any other complaint. What can be the cause? a. Vit B12 b. iron deficiency C. Thalassemia

Two other options are also for Microcytic anemia and only VitB 12 was the one which could have caused this. 94. A 32 years old presents to your clinic for repeated vomiting, nausea for the last complete week. Her POG is 8 weeks. What will you do next? a. Pelvic U/S b. Urine R/E c. CBC There were no options of TVS and BHCG. 95. A lady presents with repeated hemoptysis for 3 days. O/E she looks very pale and confused. Her BP is 100/80 mmHg which falls to 80 mmHg on lying down and her Pulse is 120/min. What is the blood loss? a. 10% b. 20% c. 25% d. 30% e. 35% 96. Family members of any old person calls you and informs you he has been having bleeding P/R for the last 25 hours and he has lost about 500 ml blood and he is very drowsy. They want you to do anything possible and O/E, there is thread pulse palpable and he looks lethargic. What will you do? a. Tell them to wait and call you back if its not settled b. Arrange old care home accommodation c. Immediately arrange ambulance and transfer to Hospital 97. A lady has severe pain and the intensity of pain is as such that she cannot sit or stand still in her room and has to move constantly in her room. The pain is radiating from loin to groin and is very severe. She is sweating and is in very distress. What is the most appropriate investigation to reach diagnosis? I dont remember if there was anything mentioned about her LMP. a. CT scan

b. urine R/E 98. A boy presents with blow out fracture while playing squash. What will you see? a. horizontal diplopia b. enopathalmous c. Zygomatic arch depression 99. A young man presents with blow out fracture with tennis racket. What will you find O/E? a. Enopthalmous b. Horizontal diplopia c. Hypaema d. Zygomatic arch depression 100. A child who got severe eye injury in sports. O/E he has lower anterior chamber of eye filled with blood and he is having blurring of vision. He is not having any diplopia but he has blurring. What is the next most appropriate step? a. pad the eye and arrange consultation tomorrow b. Immediate ophthalmic consultation c. Pad the eye and ophthalmic consultation after one month d. Pad the eye and ophthalmic consultation after 1 week 101. A lady has consumed amphetamines in party and is not feeling well, what is the immediate risk to her from? a. Cardiovascular risk b. Stroke C. psychosis 102. A lady who has BMI of 45 kg and smokes 20 cigarettes daily, what would you advise to reduce her risk of breast cancer? a. Reduce weight b. Quit smoking

C. Eat healthy Diet & less alcohol consumption 103. A 42 years old lady whose has history of DVT and had hysterectomy at the age of 38 years now comes to you for Hormonal therapy. What will you give? a. Transdermal patch b. COC C.Progestrogen only pills d. Estrogen only pills 104. A Turkish lady who underwent endoscopy twice but was normal and still have GIT symptoms, what would you do next? a. Repeat Endoscopy b. Capsule endoscopy c. FBC 105. A lady has shinny and bright patch on her scalp, what would you give? a. Intralesional steroids b. oral steroids c. Topical griseofulvin d. Topical minoxidil

This is all I remember and do remember me in your prayers kindly. Best of luck to all of you.