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) Patient has resting tremors (not on activity, and subside when he looks at them) and in parenthesis was written (mild tone involvement) but no cogwheel rigidity a. Selegeline b. Benzhexol c. Propranolol d. No option for levodopa 2.) Lady has diverticular disease and she has an abdominal surgery. Now her wound is not healing and she has given antibiotic courses four times already, but still everytime wound does not heal. She is taking the drugs sulfasalazine, meloxicam and some other drug cant remember. a. Cease sulfasalazine b. Cease meloxicam c. Surgical debridement. 3.) Man is on terminal care with prostatic carcinoma and is on pain controlled analgesia with morphine high dose. He is drowsy and disoriented, yet still complains of pain and irritability. Wife requests that you decrease morphine a. Increase morphine b. Decrease morphine c. Naloxone d. Midazolam 4.) Man comes in with a pole falling on his chest. Has chest wall injury, and is given 20 mg morphine prior to arriving at ED. What is your most appropriate initial management? a. Naloxone b. Paralyze, intubate, ventilate 5.) 15 year old boy comes in apprenhensive about his growth. He is on tanner stage 2. Dad is 170 cm and mom is 160 cm. What is the cause of his growth delay? a. CAH b. Familial short stature c. Hypothyroidism d. Constitutional delay 6.) A man has a culturally arranged marriage, and now suspects his wife of infidelity. What is this an example of? a. Over valued idea 7.) Painless hematuria with atypical nucei. What will you do to confirm diagnosis? a. CT b. IVP c. Cystoscopy d. Renal ultrasound 8.) There is a thyroid nodule on one side of neck. Patient has hoarseness of voice, dysphagia, and tracheal shift. What will you do to confirm the diagnosis? a. FNAC

b. CTscan c. Ultrasound d. 60 Thyroid scan 9.) 25 year old woman with BMI 45 and smokes about 20 cigarettes/day. What is the best approach to decrease the risk of breast cancer? a. Lose weight b. Stop smoking 10.) A man wants to travel to Papau New guinea and has depression. What drug will you prescribe for prophylaxis? a. Doxycycline b. Mefloquine c. Chloroquine 11.) Infected bartholin cyst a. Caused by staph aureus b. Will resolve after antibiotics 12.) 55 year old male with cough productive with green sputum. What is the best long term management? a. Postural drainage b. Low dose tetracycline for 12 days Similar xray given (https://www.google.com.au/search?q=xray+of+bronchiectasis&hl=en&safe=off&tb m=isch&tbo=u&source=univ&sa=X&ei=enZEUf3rHaWPiAf00oC4Bg&ved=0CDYQsAQ &biw=1600&bih=799#imgrc=AwJ4Cuyj341JJM%3A%3BBpHxVuXvyT_aFM%3Bhttp% 253A%252F%252F4.bp.blogspot.com%252FLD4Rx9nEnfw%252FTc7VBkggsYI%252FAAAAAAAAArA%252F6I3pcAu37c%252Fs1600%252Fbronchiectasis.jpg%3Bhttp%253A%252F%252Fradlog.blogspot.com%252F2011%252F05%252Fbronchiectasis-x-rayfeatures.html%3B576%3B634)

13.) 60 year old male, smoker for 30 years and a plumber comes in with typical SCC scenario. Xray given with hilum shadow near aorta. (kind of like this xrayhttps://www.google.com.au/search?q=xray+squamous+cell+carcinoma+of+lung&hl=en &safe=off&source=lnms&tbm=isch&sa=X&ei=E3dEUbtBOXxiAeWmYDwAQ&ved=0CAcQ_AUoAQ&biw=1600&bih=799#imgrc=SnTOfTsRMubNM%3A%3B2CDH6xCyrHyiBM%3Bhttp%253A%252F%252Fimages.radiop aedia.org%252Fimages%252F526616%252F5eed4b1a2e7c90273646921a095c50.jpg%3 Bhttp%253A%252F%252Fradiopaedia.org%252Fimages%252F526616%3B1772%3B1840 ) What is your most appropriate initial test?

a. Bronchoscopy and biopsy b. CT c. Percutaneous biopsy 14.) A 14 year old girl with with increased fasting blood glucose (11 mmol) and acanthosis nigricans was described. a. Options has 4 antidiabetics b. Last option was insulin 15.) One chronic paranoid schizophrenia man is obsessed with a lady and interested romantically. He openly writes her a letter, and he declares his love along with threatening her. What do you do? a. Confiscate letter and tell lady b. Report to the police 16.) Same CT as jahn heyrans paper kind of like this (https://www.google.com.au/search?q=xray+squamous+cell+carcinoma+of+lung&hl=en &safe=off&source=lnms&tbm=isch&sa=X&ei=E3dEUbtBOXxiAeWmYDwAQ&ved=0CAcQ_AUoAQ&biw=1600&bih=799#hl=en&safe=off&tbm=i sch&sa=1&q=sigmoid+volvulus+on+ct&oq=sigmoid+volvulus+on+ct&gs_l=img.3..0i24l2. 411451.416015.0.416306. gac&bav=on.2,or.r_cp.r_qf.&bvm=bv.43828540,d.dGI&fp=d1ccc09c53c22adc&biw=160 0&bih=799&imgrc=VTt1gSmcTcNF5M%3A%3BBvExEuNLBWTQzM%3Bhttp%253A%252F %252Fkonradreview.com%252FAbdomen%252Fimageq30.jpg%3Bhttp%253A%252F%252Fkonradreview.com%252FAbdomen%252FCT%25252 0Abdomen%252520and%252520Pelvis%252520Practice%252520Test.htm%3B832%3B4 95) Scenario had left lower quadrant pain and mass, colicky abdominal pain and distension. What is your most appropriate initial investigation? a. Laparotomy b. Colonoscopy c. NG tube d. CT 17.) 75 year old lady present with abdominal pain, distension, colic, no passage of fecus and there are some bowel sounds that are present. X ray had distended descending and transverse colon. But rectum seemed opaque. a. Colon carcinoma b. Fecal impaction c. Adhesion small bowel

18.) A 60 year old lady has hip replacement surgery and after 5 days she presents with abdominal colicky central pain, distension. a. Ng aspiration b. Colonoscopy c. Laparotomy d. Rectal tube 19.) HBV and CIN3- give vaccine and treat CIN 20.) Patient has ulcerative esophagitis- What key diagnostic finding makes you think of malignancy? a. Dysplasia 21.) HBV 3 children question- give all 22.) Warfarin interaction with glicazide or amoxicillin? 23.) Hypertensive patient with wide splitting, loud second heart sound with hepatomegaly, jvp 3 cm above, and ascites along with bilateral basal crep. What is cause? a. AS b. COPD c. COR PULMONALE 24.) SVT ECG GIVEN ..and bp 90/40. What is most appropriate initial management? a. i/v adenosine b. i/v metoprolol c. i/ve amiodarone d. dc cardioversion 25.) hypertensive patient on irbesartan/hydrochlorothiazide comes with palpitations (no chestpain) ecg shows diffuse global t wave inversion. M patten qrs complexes diffusely. What is most approp intitial investigation? a. Serum troponin b. Seum K+ c. Tte 26. afib drive slow paper question 27. hep c and breastfeeding a. contraindicated b. continue 28. medial meniscus injury a. posterior drawer test b. anterior drawer test

29. absent vas deferens in a male. Couple is trying to conceive for 2 years. What is the best test for screening in this couple? a. cf screening 30. widened mediastinum on xray with patient trying to withhold vomiting and restrosternal chest pain soon after. ECG was given (seemed like a distractor) a. ng b. troponin c. I/C drain 31.) couple has one child with CF. What is the probability that next child will be a carrier? a. 0% b. 25% c. 50% 32.) CT given with cerebral hemorrhage on right side. Patient on warfarin and has afib. INR 4.5. What is most approp initial? Looked like this (https://www.google.com.au/search?q=ecg+right+bundle+branch+block&hl=en&safe=off&tbm =isch&tbo=u&source=univ&sa=X&ei=dn1EUfv9DuS8iAfizYGgCQ&ved=0CDwQsAQ&biw=1600& bih=799#hl=en&safe=off&tbm=isch&sa=1&q=cerebral+hemorrhage+ct+scan&oq=cerebral+he morrhage+ct+scan&gs_l=img.3..0.558655.563338.2.563551. ..0.0...1c.1.6.img.B8fJiLoebQ&bav=on.2,or.r_cp.r_qf.&bvm=bv.43828540,d.dGI&fp=d1ccc09c53c22adc&biw=1600&bih= 799&imgrc=HsCF6t69a_YvYM%3A%3B1VkpQ1Tl5IxNcM%3Bhttp%253A%252F%252Fwww.uwm edicine.org%252FPatient-Care%252FeHealth-Articles%252FPublishingImages%252FCTIntracerebral-Hemorrhage.jpg%3Bhttp%253A%252F%252Fwww.uwmedicine.org%252Fpatientcare%252Four-services%252Fmedical-services%252Fstrokecenter%252Fpages%252Farticleview.aspx%253FsubId%253D79%3B570%3B40

a. ffp b. platelets c. vit k 33. perindopril/indapamide/warfarin hypoglycemia q 34. infant 1.6 kg at birth and 6kg at 6 months. Growth chart given a. weight is normal

b. overweight c. underweight d. the weight gain is relatively slow but acceptable. 35. 65 year old lady present with low grade fever and cough. Xray described as left lower lobe having patchy infiltrate (not given) a. amoxicillin/clav b. amox c. azithromycin 36. picture of legs given. One leg has laceration and femorotibial fracture described in scenario. What is ur next most approp initial manifestation? Tetanus prophylaxis

37. pregnant lady comes with hb low, and thrombocytopenia (200). What could be the investigation? a. ds dna b. antiplatelet antibodies c. bone marrow biopsy 38. child having ITP with platelet count less than 35,000 a. high dose steroid b. immunoglobins c. fbc 39. Scenario of varicose veins a. option had compression stockings b. rest were all related to the treatment of dvt

40. Male patient has trouble climbing stairs, and also shoulder movement problems. What is ur dx? a. polymyositis b. sle

c. myasthenia d. MS 50. A computer executive presents with pain in the lateral elbow. How will you manage? A. Rest B. Circumferential band below elbow C. Pain killers D. Band above elbow 51. What is the most urgent sign of acute limb ischemia? E. Pain F. Paralysis G. Rubor H. Swelling I. Pulseless 52. A patient has been diagnosed with GBS. Which is an appropriate way to monitor his respiratory function? J. FVC K. Blood gas analysis L. Oxygen saturation M. CXR 53. A 55-year-old man comes to your clinic concerned about his family history. His father was diagnosed with prostate cancer at the age of 85. His neighbour was recently diagnosed with metastatic prostate cancer and he says that there is screening to detect early disease. On DRE prostate was smooth, and median sulcus felt. No other symptoms. What is the next step in management? a. PSA within 2 weeks b. Reassure c. Transrectal USG d. DRE annually 54. A patient came in with weakness of wrist and finger extension. Tendon reflexes were normal. No other abnormalities noted. Where is the lesion? a. Anterior interosseus nerve b. Median nerve c. Ulnar nerve at the elbow d. Radial nerve e. Posterior interosseus nerve 55. A man comes complaining of weakness and dragging his left foot. On examination, Extension and flexion of the thighs are intact. There is loss of eversion, inversion, dorsiflexion and plantar flexion. Knee jerks is normal but there is decreased ankle jerk. Where is the lesion? a. L4

b. L5 c. Sciatic nerve d. Tibial nerve e. Common peroneal nerve 56. A 42-year-old female with 4 children came in due to a discrete patch of hair loss about 5x6cm in diameter. What is the most appropriate management? a. Hydrocortisone 1% cream b. Reassure that she will not become bald c. Clotrimazole cream d. Intralesional methyl prednisolone 57. A middle-aged man comes in complaining of bilateral leg weakness. He claims his legs feel deadless after walking 100m on level ground and 20 meters when it is inclined or on rough roads. What is the most appropriate next step in the evaluation of this patient? a. MRI b. Doppler Ultrasound c. Angiogram d. DSA Angio e. venogram 58. A 32-year-old woman comes in with 3 months history of palpitations and fatigue. On examination, she has fine tremors. Laboratory revealed TSH of 0.01 (low). What is the best investigation to come to a diagnosis? a. Anti-TSH receptor antibodies b. Low uptake on radioactive iodine c. High thyroxine and triiodothyronine d. Diffuse increased uptake on radioactive iodine 59. A patient was who underwent subtotal thyroidectomy a few hours ago complained of difficulty breathing and stridor. What is the next step in management? a. Intubate the patient b. Anesthetize the patient and explore the wound c. Remove superficial skin sutures d. Explore the wound in the ward e. Arrange operating room theater and explore the wound there 60. An elderly male presents with hemifacial paralysis. He cannot wrinkle his forehead and smile fully. He also has difficulty in swallowing and coughs when he sips water. What is the most likely diagnosis? a. Bell palsy b. Ramsay hunt syndrome c. Brainstem infarct d. Motor neuron disease 61. Picture of psoriasis similar to the one below but both legs were affected. What is the management?

a. Clotrimazole cream b. Ultraviolet B therapy c. Calcipotriol cream d. Oral corticosteroids 62. A middle-aged man who was previously diagnosed with Wegeners granulomatosis and has been on azathioprine comes complaining of cough for 2 days with clear sputum. Physical examination was unremarkable. What is the diagnosis? a. Azathioprine-induced interstitial pneumonia b. Bronchopneumonia c. Reactivation of Wegeners granulomatosis d. Atypical pneumonia e. Tuberculosis 63. An 80-year-old retired plumber who has an 80-pack-year smoking history comes to your clinic because of exertional dyspnea for a few months. Spirometry revealed FEV1 50 of predicted value and FVC <70 of predicted value which is not reversed by bronchodilators. CXR is shown similar to the one below (both lungs were hazy with blunting of costodiaphragmatic angles which looked like pleural effusion). What is the next step in management of the patient? a. Chest CT scan b. Thoracoscopy and biopsy c. Prescribe a full course of antiobiotcs d. Pleural biopsy e. Give a trial of bronchodilator therapy 64. A previously healthy 25-year-old basketball player came in due to swelling of the right limb for 1 week. On examination, his right arm including his hand and forearm are dusky, swollen and edematous. He has non-tender axillary lymphadenopathy. He noticed that his pet cat is also unwell. What is the most likely diagnosis? a. Cellulitis- non tender LAP with fever b. Cat-scratch disease- tende3r lymphadenopathy, low grade fever, pustules c. Subclavian vein thrombosis- no lymphadenopathy and fever, d. Cervical rib 65. Which of the following is an unequivocal sign of chronic limb ischemia? a. Dependent rubor

b. Intermittent pain c. Pallor d. Leg swelling 66. A female patient has had multiple sexual partners over the last 6 months and she is concerned she contracted Chlamydia. Urine PCR was positive for the organism. Aside from treating her, what advice would you like to give her? 1. Trace all her sexual contacts 2. Ask her most recent partner to come for examination and treat him with Azithromycin 3. Tell her to avoid multiple sexual partners in the future 4. Advise her to use condoms within the next 7 days 5. Tell her not to use IUD

A 34 weeks pregnant lady who is Rh negative had been given RhD injection during the first pregnancy three years ago. She underwent orthopedic surgery and received blood transfusion 12months ago. Now she is Rh+. What is the reason for sensitization? A. Previous pregnancy B. Blood Transfusion C. Occult fetomaternal bleeding D. RhD injection A 42-year-old woman comes in complaining of menorrhagia of 6 months duration. Bleeding usually lasts for 10 days. A few days ago, vaginal bleeding ensued despite having her last period 2 weeks back. Gynecologic assessment was scheduled. While waiting, what will you give in the interim? A. Norethisterone B. Low-dose combined OCP C. Combined HRT D. Insert an IUD 69. What is the management for a CIN 2 dysplasia which extends above the transformation zone and up the cervix? A. Brachytherapy B. Cehmotherapy C. Hysterectomy D. Laser knife Cone Biopsy E. LLETZ


A lady came in with severe vomiting. On investigation, ketones +++ but no nitrities. LMP was 4 weeks ago. Her husband had AGE. What would be your investigation of choice? A. Beta-hCG B. Microurine and culture C. Stool culture D. Blood Sugar levels

A 30-year-old lady presents with secondary amenorrhea for 12 months. Laboratory tests revealed FSH 55, LH 51, estradiol slightly reduced. Prolactin and TSH were normal. Ultrasound shows 3-4 cysts. What is your diagnosis? A. Premature ovarian failure B. Pituitary adenoma C. PCOS D. Pregnancy 72. A 53-year-old woman weighing 125kg has been amenorrheic for 24 months. What would you most likely find in her evalution? a. Very low estrogen and very low FSH b. Very low estrogen and very high FSH c. Slightly low estrogen and moderately high FSH
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A 10 weeks pregnant lady comes for antenatal checkup. Everything was found to be normal. Which of the following will affect the management of this patient at this time? a. HIV test b. Parvovirus antibodies c. Varicella antibodies d. No option for rubella antibodies

A pregnant lady comes concerned because she has been tested positive for hepatitis C. Which of the following statements is true regarding her pregnancy? a. She should bottlefeed the baby to avoid contracting the virus b. Hepatitis C testing must be carried out on the fetus c. Elective caesarean delivery should be done d. Fetal heart rate monitoring with scalp clips must be avoided e. Delivery will cause intrauterine hypoxia 75. A 56-year-old woman was managed as a case of colles fracture. Which of the following would increase her risk of recurrent fractures? a. Nulliparity b. Menopause at 48 years old c. Smoking 10 cigarettes per day d. Drinking 2 glasses of wine a day e. Vegetarian rd 76. An 8-year-old child is being evaluated because of his 3 episode of nephrotic syndrome. His progress is slow despite corticosteroid treatment of 2mg/kg/m2. He now has increased blood pressure and hematuria on urinalysis. What is the diagnosis? a. Membranoproliferative glomerulonephritis b. Post-streptococcal GN c. Focal segmental glomerulosclerosis d. RPGN


An 18-year-old male is seen in general practice with complaints of poor coordination and difficulty playing sports. He is more than 97th percentile for height and on the 3rd percentile for weight. Which investigation would likely lead to the diagnosis? a. Karyotyping b. Cardiac ultrasound c. FBC d. Bone scan e. Growth hormone test An 18-year-old male was brought by his father because he says that the boy is not developing like others. Father is 170cm and mother is 160cm in height. The boy was found to be on the 5th percentile for height and 25th percentile for weight. Pubic hair and testicular development was found to be at tanner stage 2. What is the probably diagnosis? a. Growth hormone deficiency b. Hypothyroidism c. Congenital adrenal hyperplasia d. Familial short stature e. Constitutional pubertal delay Lithium monitoring in a driver who has moved interstate a. 1month b. 3months c. 6 months d. 1year A husband comes to see you in your clinic with his wife because he noticed that his wife has recently had insomnia and kept on cleaning the house. She also began drinking alcohol and has been seen flirting with the husbands friends. On examination, she was flirtatious but then became irritable and aggressive. What is the most probable diagnosis? a. Hypomania b. Obsessive compulsive disorder c. Alcoholism d. Depression e. Histrionic personality disorder A 25-year-old male who is a heroin addict comes to you saying that he has been trying to kick off the habit. He asks for prescription of diazepam to help him. What is the most appropriate step in management? a. Tell him you cannot prescribe diazepam for this purpose b. Prescribe oxycodone instead c. Give him a 10-day prescription of diazepam d. Arrange a supervised daily dosing of diazepam in a pharmacy A 20-year-old girl was brought by ambulance to the emergency department after she was found collapsed in the toilet of a nightclub. In the ED, she was noted to have a












temperature of 40C, pulse rate of 110 and BP of 160/100mmHg. There were also some jerking movements of the hands noted. What is the initial step in management? a. Thiamine and oral rehydration b. Cold IV infusion and cold blanket c. IV dextrose/saline solution A young male was brought to the ED by his friends after they noticed behavioral changes. At the bar, he began to say that a gang wanted to hurt him because he did not pay his debt. His friends became more concerned especially when the patient started becoming agitated when he heard guns (forgot if it was gunshot or he heard people talking about guns). They admit that the patient uses amphetamines. Which is most important to consider in the management of the patient? a. Concomitant use of drugs b. Deleterious cardiovascular effect of amphetamine A patient was brought to your clinic for evaluation. When you asked what her mood was, she replied, Moon is not made out of cheese (+ 2 other unrelated statements). What is the diagnosis? a. Disorganized behavior b. Dissociation c. Depersonalization d. Delirium e. Depression A man with a mental impairment (IQ of 60) was brought to the hospital after a brawl. he got into a fight with a fellow in the institution over the television. On examination, he is agitated and verbally abusive. He has a suspected injury in the hand and cannot sit still for xray. What is the most appropriate step? a. Call the security to restrain him b. Call the police c. Give him IM olanzapine 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% .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. Implanon . 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





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CA125 CA125 n U/S Laparoscopy 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. Known HTN pt presented with muscle weakness. K 6.5. what could be the cause? a. Enalapril b. Amiloride c. Simvastatin d. Thiazide 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 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 . Right sided inferior quadrentonope where is the lesiona) Temporal lobe b) parietal lobe c) optic chiasma d) optic tract Pt with migraine and vomiting in pregnancy , management? a) PCM b) PCM + Codine c) Codine + metachlopramide d) Codine +promethazine e) ergotamine and metoclopramide Safest way to go off breast feeding A-bromocriptine B- tight bra and limit fluid intake C- OCP D- Danazol Turkish lady ct Drive slow afib question Venlafaxine overdose q

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 100. 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 101. 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 102. OA in right knee/stick question 103. A young athelete came in with a swollen,tender knee for 1 day. Management? A- MRI B- Aspiration C- Bed rest for 5 days D- Steroid injection 104. 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