Samreen's recalls! FEB 2013 1.

7 yr old child with irritability n low urine output, BP 150/90, protein ++, RBC ++. Next step in Mx?? a. anti HTN B. i/v methyprednisolone c. low protein, low salt n inc water intake d. low protein, high carbohydrate ,low salt e. high protein, low salt, low carbohydrate n dec water intake 2. 2 yr old girl presented with fever, neck stiffness n lethargy rhinnrohea, kernings sign positive, H/O Meningococcal vaccination. What the most probable Dx? a. Bacterial meningitis b. Viral meningitis c. SAH d. Meningioma 3. 2 wk old baby with fever n lethergy n poor feeding. LP findings:colur, opaque glucose 1.2 ( lower then normal) ,cell count 26 (<15), no growth on gram stain. Dx?? A. human simplex virus B. GBS C. E.Coli D.chlamydia 4. 5 yr old girl presented with high grade fever, poo feeding n dehydration. On exam tachycardia, sunken eyes, capillary refill > 3 sec. Initial fluid for resuscitation? a. Normal saline b. 0.45 n/s n Dextrose water c. Ringers d. Dextrose 50% 5.Postmenopausal lady with hysterectomy n h/o Dvt presented with hot flushes. Next step in Mx? a. Low dose Oestradiol valerate b. Low dose combine oestrogen n progesterone c. Low dose Oestriol d. Estrogens dermal patch e. Implano 6.Young patient has multiple fibroids and It is palpable upto the umbilicus. Her hb is 6gm/dl. She wants to have children in future. What to do. a. Open myomectomy after correcting her anemia with blood transfusion b. Gnrh analogue for 3 months followed by myomectomy c. OCP for 3 months followed by myomectomy d. hysterectomy e. immediate myomectomy 7.Lady at 10 wk of GA came for first antenatal visit. Which of the following will change the Mx at this gestation age? a. HIV b. GBS c. Glucose challenge test d. Vericella Antibodies e. Preeclampsia 8. 22 yr old lady presented to u n requested for ovarien ca screening as her friend is just dx with ovarian ca. What will u advise her? Ultrasound CA125 CA125 n U/S Laparoscopy 9. 35 yr old lady presented to u for breast ca screening as one of her paternal aunt is dx with Breast and ovatian ca. What will u advice her? a. 2 yarely mammography b. 2 yarely ultrasound c. Genetic risk screening

d. BRCA gene screening e. 6 monthly self breast examinations. 10. Known HTN pt presented with muscle weakness. K 6.5. what could be the cause? a. Enalapril b. Amiloride c. Simvastatin d. Thiazide 11.Young patient presented with pallor n lethargy. Labs: hypochromic microcytic anemia, Low calcium, and increase INR. What inv will u next? a. Ct abd b. u/S c. stool c/s d. Anti gliden antibodie e. Blood c/s 12. Young patient presented with pallor n lethargy. Labs: hypochromic microcytic anemia, Low calcium, and increase INR. What inv will u next? a. Ct abd b. u/S c. stool c/s d. tissue transglutaminase e. Blood c/s 13. 32 yr old lady presented for advice for screening. Her grandfather dx with colon ca at 76 yr, sister had cholecystectomy at 46 yr, brother dx with DM at 56 yr. What will u advice her? a. Yearly colonoscopy b. Yearly OGTT c. Yearly cholesterol d. No need for any screening now 14. ECG with ST elevation in lead II, III and AVF. Best step in Mx? a. Cardiac catherization b. Thrombolytic Tx 15.Which of the following r features of hyperthyroidism ? a. Course tremors b. Pain in shoulders c. Narrow pulse pressure d. Delayed reflex e. Wt gain 16. Old aged man presented with complaint of paleness of the fingurs when he is in bed. All lower limb pulses are good. What culd be the cause? a. DM b. Polycythemia vera c. Thrombocythemia d. Arterial thrombosis 17. 45 yr old male present with polyarthiritis, impotence and decrease libido. Which of the following inv will help to make Dx/ a. Iron studie b. Fasting blood sugar c. BP d. CT head e. Prolectin levels 18. 78 yr old man present in ER with upper abd pain which radiates to back and syncope. Next best inv? a. Ultrasound FAST b. Ct aortogram c. Xray abd 19. A 5 years old child who was a case of nephritic syndrome and initially responding with steroid now he has stopped responding to steroids and developed microscopic heamaturia and

hypertension , what is the diagnosisa)FSGN b) superimposed PSGN c) IgA d) membranous GN 20. Right sided inferior quadrentonope where is the lesiona) Temporal lobe b) parietal lobe c) optic chiasma d) optic tract 21. 30 years old female with diarrhoea for a one years and blood pic given with microscopic hypo chromic anaemia , upper and lower endoscopy normal, occult blood present in stool, next investigationa) Capsule endoscopy b) technetium scan c) MRI d) CT scan 22. Pt with migraine and vomiting in pregnancy , management? a) PCM b) PCM + Codine c) Codine + metachlopramide d) Codine +promethazine 23. Pt is K/C/O WPW and developed palpitation, lightheadness, BP=140/90, ECG as follows ....WPW+VT ( Wide complex, irregular RR interval ) what will be managementa) ameoderone b)adenosine c) verapamil d)metoprolol 24. A 5 year old boy with c/c hematuria, edema, hypertension. What will be seen a) IgA deficience b) decrease C3 level c) decrese platlets 25. A 45 year old female with menorragea and her consultation is due with a gynaecologist in few weeks , so what can you give her till that time? a) NET b)OCP c) Mirena d)Mydroxiprogesterone 26. women getting hot flushes what is most important? a) menopause before 48 yers b)nulliparity c)early menarche d) PID 27. 2 yrs use of HRT will help to a. Decrease symptom of hot flushes B. Reduce risk of future fracture 28. female with menopause , what will be the hormonal level a) high E low FSH b) very low E very high FSH c) moderately low E and moderately high FSH d)High E and high FSH 29. pt fall down from bycycle and his helmet splits in two parts, he did loose consciousness, now complaing of headache, only mild bruise under the left eye Dx? a) SDH b) EDH c)SAH d) cerebral hemorrhage 30. one pt on warferine and INR = 4.5 developed left sided weakness, CT given showing black irregular lesion , Dx? a) cerebral infarction b) SAH c) cerebral hemorrhage d)sdh 31. Husband bring her wife, she has started excessive cleaning of house , drinks alcohol a lot and fights with him, flirt with his friend, during consultation she was flirtatious initially then become angry and fights with you. Dx? a) OCD b) hypomaniac) Histrionic d) passive aggressive 32. One patient is asking for percentage risk for carcinoma colon. His father had been dignosed with carcinoma colon when he was 30 years old and underwent curative resection then he again developed carcinoma colon when he was 45 years old. Risk in the some is? A) .5 B) 1 C) .25 D) .1 33. One lady with lab values given indicating premature ovarian failure and wants to get pregnant. What will be your advice? a) Clomifene B) Ovum donation and IVF 34. 34 yr old man with a stent in aorto-femoral arteries for episodes of embolism now presents with deteriotating renal functions with +3 proteins, nitrites ++ , hematuria (slight) with decreased urinary output. Lab values given but nothing abnormal specifically. What could be the cause? A activation of Renin-angiotensin system B- decrease in Renin- sympathetic system C- increase in Renin- sympathetic system D- renal atherosclerosis

35. 25 yr old lady pacing around in the ED who came in with lower abdomen pain, rebound tenderness and slight vaginal bleeding. What is the next best test which will help in the diagnosis of her condition? A- B hcg B- USG C- PV examination D- CBC and culture 36. A man who used to walk 100 m easily now has pain in lower limbs in walking even upto 20 m uphill. Investigation? A arterial Doppler studies B- spinal canal stenosis C- Venography D- arteriogram E- Cardiac profile

37. X-ray chest pulmonary oedema .pt presented with exertional dyspnoea and deteriorating respiratory functions over 2 months. NEXT investigation? A- ECG B- ECHO C- ABGs D- EEG E- CBC 38. A 23 yr old male with IQ 60 was brought to the ED when he broke his wrist in the shelter home over a trivial issue turning into a brawl. Now he is non cooperative and agitated,doesnt allow to be examined by the x-rays. What will you do? a- call the care taker to calm him B- call the security C- IM olanzepine D- Send him back E- treat when calms down on his own 39. A 34 yr old man with burning sensation in the left cheek with a rash within 24 hours. Rx A- carbamazepine B- oral acyclovir C- TCA D- IGs E- paracetamol 40. 40 yr old man on long term aspirin and omeprazole for duodenal ulcer now presents with vomiting which is non bilous, non projectile and wt loss along with other features. Diagnosis? A- Duodenal ulcer B- Drug induced gastritis C- Ca cardia D- Ca duodenum E- Ca oesophagus 41. A father got his 8 yr old girl for an advice of HPV vaccination in an camp organized by your hospital. What would you do? A give her NOW B- give her when she starts sexual activity C- give her after 10 years of age D- Tell her its not required in her case E- after doing a pap smear @ 16-18 yrs of age 42. A lady comes to the ED complaining of episodes of feeling detached and momemtary loss of self sometime back. She has had 2 episodes before but nothing along with it. GPE normal. Which would help you diagnose the condition? A- EEG telemetry B- CT scan C- MRI D- Bone scan

E- CBC 43 . A lady comes to the ED complaining of episodes of feeling detached and momemtary loss of self sometime back. She has had 2 episodes before and has headaches which radiate to the back of head ocassionally. GPE/neuro exam normal. Diagnosis? A temporal lobe epilepsy B- migraine C- Meningioma D- Abcess E- Tuberculoma 44. Patient on metformin 500 mg bd for a few months now presented for general check up. Otherwise he is normal. Lab values given normal except HbAc levels as 6.9(normal 6.6). What would you do? A- increase metformin dose B- continue same C- add insulin 45. Computer operator with pain in the lateral aspect of arm. Treatment/ advice? A- band below elbow B- band around elbow C- band just above the elbow D- wrist to elbow strapping 46. A man presents with 5 x 6 cm patch on the scalp which is shiny and glossy. Rx? A- Steroid ointment B- oral steroids C- intrelesional methyl prednisone injection D- antifungal treatment 47. Man presents with foot drop, weakness of ankle reflex, inversion,eversion and dorsiflexion. Knee reflex normal. Which nerve is affected? A- Sciatic nerve B- tibial nerve C- CPN L5 S1

48. 50 yr old man got into a new relationship but has recently found out about his erectile dysfunction problem. He casually asks you for a prescription of Viagra for the same. NEXT to do? A- Prescribe him B- Ask him to reduce alcohol C- reduce weight D- Check testosterone levels E- check blood sugar 49. A young girl who was very normal looking now from 6 months referred by her teacher of poor concentration and a weight loss of 15 kgs with a BMI of 18. Which is indicative of the condition? A- negative feeling towards self B- not eating socially C- binge drinking D- drugs 50. Safest way to go off breast feeding A-bromocriptine B- tight bra and limit fluid intake C- OCP D- Danazol 51. A 4 yr old child operated for craniopharyngioma 6 months and on thyroid medications now presents with episodes of severe lethargy and gastroenteritis. Rx? A- Iv glucose B- Corticotrophine

C- Aldactone D- 0.9% NS E- Ct scan 52.Elderly female with cancer pain and osteoarthritis come to you for a prescription of morphine as her neighbor who recently died got benefits from his cancer pain from morphine immensely. She is on paracetamol 500 mg (bd/tds dont remember). She has cancer pain with pain in joints. Rx? A- increase parac dose B- increase frequency C- refer to rheumatologist D- reassure E- refer for CBT 53. Scenario of arotic dissection with hoarness and aortic knuckle. Mngmnt? A- intubate and ventilate B- PPV C- CT urgently D- USG fast

54. Which warrants immediate treatment in acute limb ischemia? A- Rubor on dependency B- Pain C- Paralysis of muscles D- Varicose veins E- Ulcers 55. Sign of chronic limb ischemia A- Rubor on dependency B- Pain C- Paralysis of muscles D- Varicose veins E- Ulcers 56. Which test has helped in maximum number of screening of diseases? A- Antenatal check up B- PAP smear C- BPP D- Breast CA screening 57. a young woman with rash, MCP and PIP joint pain with exertional dyspnoea. Which is the best test to diagnose? A- Anti- scl B- Ds- DNA C- Anti CCP D- ANCA E- RF +ve 58. Least injured organ in a trauma to abdomen? A- stomach B- liver C- intestine 59.CT scan of a big infarct in a 65 year-old patient, who is in coma and the court has given the right to his wife to have the power of attorney as he has no will or advance diretives. What is the responsibility of the wife in managing the disease? A- based on how she wants B-based on his values of life C- based on his previous wishes D-based on the risk and benefit of treatment E- based on you assessment of the whole condition and prognosis 60. A middle-aged man who was previously diagnosed with Wegeners granulomatosis and has been on azathioprine since then who now comes complaining of cough for 2 days with blood-streaked

sputum. He also has some mild exertional dyspnea. Physical examination was unremarkable. What is the diagnosis? A-azathioprine-induced interstitial pneumonia B-bronchopneumonia C-reactivation of Wegeners granulomatosis D-atypical pneumonia E- pneumocystitis infection 61. A recent immigrant and now he thinks his enemies from his country is following him and trying to kill him. What collateral history is imp? A-his immigrant status B-his financial status C-check if it is true or not with the others psychiatric assessment E- marital discord 62. CIN stage II, upper border of lesion not seen? What to do next ? A LLETz B Radiotherapy C- Chemotherapy D- cold knife conization/biopsy E- hysterectomy 63. A man with renal failure who needs to have haemodialysis. He has no problem during dialysis, but his BP decreases at the end of dialysis.What could be the reason? A- allergic reaction to the dialysate fluid B- dialysis for longer period of time C- ACE inhibitors overdose D- Hpokalemia 64. Parents brought their 10 yr old boy, who was riding a bicycle when he felt a stinging sensation at the lower part of his left leg. Snake bite suspected. Which is the best site to collect specimen from? A- Bite site B- Blood C- Clothes D- Urine E- CBC 65. man copd ptpresents wid dyspneao2 saturation is 85%...on his way to hosp he was given 8lit o2.wt is most app next step a.abgs b.cxr c.intubate 66. moon is cheese,ill travel by eggs. a.thought block b.disorganized behaviour c.dissociation 67. ac glaucoma.long term mx asked a.acetazolamide b.periphral irodotomy c.trabeculectomy d.pilocarpine 68. female wid no h/o parkinsonism,tremors r present wen at rest n stops wen she looks at her hands,she has resting tremors with rigidity. Treatment a.propanolol b.benzhexol c.levodop 69. A man on many drugs,throxine,carbamezapine presented in ED with confusion Na was 112. What you would do a.stop thyroxine n give nacl b.stop carba n restrict water

c.stop carba n give hypertonic saline d.stop thyroxine n give hypertonic saline 70. a women who was on warfarin presented wid LIF painher INR 6.5 she was started on amoxyxillin for sum reason by her gp.ct scan given no RSH seen..dx a.RSH b.abscess c.psudocysts 71. man 85 yrs old resident of nursing home has mmse of 12/30,he cudnt eat,has urinary n feacal incontinencewt is the most appropriate management for poor apetite a.arrange a family meeting n discuss b.nasogastric tube c.TPN d.dab his lips with wet cotton 72. A 10 day old infant brought by parents with rash on her body she is having good feed, thriving well, n had papulo pustular lesions on bodywhat is the most likely diagnosis? A. congenital Varicella B. Rubella C. toxic erythema D. Measles 73. 24 year aboriginal male with lack of interest in normal life and is having visual hallucination, he is saying my mother died last month but it is not the case n mother died year ago, what is the likely diagnosis? A. depression B. depression with unresolved grief C. Depression n Psychosis D. Schizophrenia 74. 8 weeks pregnant lady has severe vomiting and cannot take any solids but can take only small amounts of liquids. Invest ketones 3+ . her partner has recently been diagnosed with gastroenteritis. What investigation to do ? a.pelvic usg b.urine stool n culture c.Stool routine and culture d.quantitative HCG 75. A Lady ame with sudden sever pain in LLQ started after bout of coughing, shes pacing around the room. What is the most probable Diagnosis? A. Small bowel obstruction B. Rupture of ovarian cyst C. Fibroid D. Acute diverticulitis 76. Pt invites doc to dinner wid romantic intentionsdoc is also interested..wt will u do a.discontinue relation ship n decline her request b.accept her invitation c.accept her invi n refer to other doc d.decline invi n continue to tx her 77. 14yr old aboriginal boy presented with staring blankly, visual hallucinations ,was a good football player in past ,lives with his grandma coz of sum dispute in family. Dx?? Patrol sniffing Alcohol abuse Marijuana 78. woman in labour, cervix fully dilated, head at 2cm from ischial spine.. after 2 hrs.. head is at 3cm from ischial spine & mild caput & moulding.. what to do? a.oxytocin b.vaccum c.non rotational forcep d.rotational forcep e.CS

79. A foot ball player who has painful dusky odematous.left armhe has lymphadenopathy which is non tender,his pet cat is also unwellwts ur dx a.cat scratch dis b.cellulitis c.axillary vein thrombosis d.cervical rib 80. ECG given ( check drive slow's paper low voltage ecg it was similiar in paper) female who has hypothyroidism,shes on metformin,perindopril n many drugs..presents wid palpitations,chest pain,dizzinessHR was 170bp was 110how will u tx a.warfarin b.metoprolol c.digoxin 81. female whose mother n sis hav ca breastwts the risk of her getting ca breast a.1 b.0.5 c.o.25 d.0 82. old man neighbours saw him wandering in his garden in soiled pajamas..he ws well 2 weeks ago..his kitchen is full of dirty dishes..dx a.dementia b.delerium c.psychosis d.alzeimers 84. lady wid bilateral axilary LNfever night sweats,wt loss ..on cbc hb is low..lymphocytes inc,platelets decreaselot of ixat the end it says blast cells 66%(o.001)ur dx a.cll b.hodgkin c.ac.leukemia b.leukemoid reaction 85. lady calls her doc n told him tht her hubby drinks a lot n beats her uhes in great debtwt shud u do a.arrange social work n urgent accommodation b.advise her to call police c.do nothing 86. man hires a pvt detective whos doubtful abt his wifethey hav been married for 8 yearsshes sincere to her.wt is this called a.obsession b.mania c.overvalued idea I got this question twice exactly same stem! 87. gal presents wid sever abd painon usg thr is a cyst arising from rt ovary 5cm n its complexwt wud u do next a.exploratory laprotomy b.laproscopy c.tumour markers d.observe 88. man wants to go to papua new guinea his all vaccinations r upto datehe asks abt advise to prevent malaria as he will be staying in malaria endemic areaur advise a.mefloquin b.chloroquin c.proguanil d.doxycycline 89. man comes with hemetemsis bp is 100/7o n pulse is 120wts amount of blood loss A 20% B 15% C 25% D 35%

D 40% 90. A young 8 yo boy who is hard to be controlled. Teachers say he does not concentrate in class, has no friends, fights with everyone and doesnt listen to parents. What is the most appropriate thing to do? a. Refer to child welfare department b. Ask for his school performance records c. Refer him to the school counsellor d. Commence Ritalin 91. An 12 month old child who has normal developmental milestones. Mother is concerned about his intoeing gain. You will: a. Refer to orthopaedic b. Do nothing now c. Do an xray

92. A patient comes following an accident in extreme pain. You prescribe 10 mg of morphine. The nurse chose to give only 2 mg. After topping up to appropriate morphine dose what is the most appropriate next step? a. Talk to the nurse b. Report to nurse unit manager c. Write an incident report d. Do nothing

93. A young female with multiple sexual partners has been confirmed with Chlamydia. Apart from treatment with azithromycin what is the most appropriate advice you can give her? a. Trace all your sexual contacts in the last 6 months b. Use condoms for next 7 days c. Do not use an IUCD d. Trace your most recent sexual contact e. Do not have multiple sexual partners 94. 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 95. A tall young boy who is also very slim and want to start games. What would you do? a. Echo b. ECG c. FBC 96. 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 97. Which drugs combination is contraindicated? a. Lithium and diazepam b. Tranylcypramine and sertraline c. Lithium and carbamazepine 98. 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. b. c. d.

Reassess the need for surgery before surgery Stop clopidogrel and do surgery Stop clopidogrel 6 weeks before surgery Stop clopidogrel 10 days before surgery and give another appointment for surgery

99. 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. Facilitate referral for gastroentrologist b. Facilitate Referral to medical board c. Give him PPI 100. 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 101. 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

102. man and his partner come for HIV test, man 's HIV result +ve, partner negative, man ask u not to tell that he is HIV +ve, wat is ur best management a) tell man that u have to tell his partner result b) tell man that u will do wat man says and keep secret from him c) contact hospital HIV dept for contact tracing d) report infection center e) call his partner and tell him result 103. HB qs diabetes and fourth nerve palsy 104. Osteomylitis and MRI foot recall 105. One qs about syphilis in pregnancy vdrl positive tpha positive anti HBS positive I forgot options - offer her termination , treat her for syphilis , treat newborn and mother postpartum for syphilis 106. Swan ganz catheter measure wedge pressure of , difficult to recall options i think rt atrium , left atrium , superior vena cava 107. Sigmoid volvulous dx x ray given 108. Obstruction next investigation - contrast enema 109. JF papers paracetamol, warfarin ,amoxycillin drug interaction 110. Turkish woman MVA ct scan given i opted for no treatment and investigation required at this time 111. Jf's recall ct scan abdomen given i found shrunken liver...what cud increase the future risk of DVT- nicotine mark , spider naevi 112. While drawing sample of HIV positive patient doctor got stick injury options u will reassure nothin happened, u will refrain doctor for taking sample for next four weeks, u will check HIV status of doctor and patient 113. 24yr milestone - use two and other pronouns 114. Child lv for dinosaurs .. Behave" weirdooo. Exactly same word in exam what is imp Language assessment

IQ assessment 116. Pt presented with rt pleuritic chest pain on examination bronchial breath sound heard above the zone of absent breath sound , dull to percussion Collapse Pleural effusion Pneumothorax 117. One qs was patient presented in ED with syncope labs given potassium was 6.7 and also ecg given but no changes of hyperkalemia on ecg , pt was taking enalapril options were Cease enalapril Give insulin and NS Pacemaker 118. ace induced angioedema pt on enalapril typical recall 119. Pt presented in ed with history of back pain from one day after gardening,on examination flexion movement difficult , point tenderness l4/l5 What will you do MRI Spinal xray Symptomatic relief 120. Man now with difficult to ride his horse, fatigue, on blood mixed picture of micro and macrocytic anemia what will help u in diagnosis A.colonoscopy B.FOBt C.bone marrow biopsy 121. Capsule endoscopy 122. Post cricothyroidotomy pt developed breathing difficulty Open wound in ward Open wound in OT Intubate 123. A young lady 20 yr i guess with 2.5 cm lump firm in inner quadrant how will you investigate USG Mammography FNAC 124. A young boy with temp 38 c from one day with red tender scrotum how will u investigate Radionucleotide scan Urine culture Same as JF recall Ecgs were not good one ! Poor hand made ...difficult to read Ct .. :( Best of luck to everyone,may Allah bless all of us, remember in prayers! :-)

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