collection of mcqs for AMC PART 1

Discussion in 'Australian Medical Council (AMC) EXAM' started by bulimia's collection, Jan 24, 2007.

  1. 1. A women who has previously delivered a 4kg baby with troublesome delivery. She is para –2 and gravida 3. You should do all of the following except

    a) Do caesarean section at term****
    b) Check blood glucose level regularly from 30 weeks
    c) Do x-ray pelvimetry
    d) Induction of labour in 37-38 weeks



    2. No bleeding after withdrawing contraceptive pills would be due to
    a) Ovary
    b) Uterus
    c) Pituitary
    d) Hypothalamus


    3. All of the following could be cause of greenish foul smell discharge except
    a) trichomoniasis
    b) gardenella
    c) FB
    d) Cervical cancer

    4.benigh or malignant neoplasia will cause a watery and pink or blood stained discharge
    gardenella will cause a grey fuol smaling discharge



    5.A primigravida 38 wks in labour. On P/V pelvis was reduced. Station 0 cervix 4 cm dilated, membrane intact
    a) x-ray pelvimetry
    b) C/S
    c) Oxytocin
    d) Continious trial labour****

    6. a pt who has difficulties with pregnancy. She lost her 3 pregnancy in 6, 8, 10 weeks. Before that she had terminate 2 baby at 10 and12 wks. What could be the cause
    a) cervical in competence
    b) deficient luteal phase

    7. find out in correct association with pregnant lady which cause foetal effect on pregnancy
    a) IUGR- anticardiolipin
    b) platelet count 100,000 – intracranial haemorrhage
    c) heart block –antibody

    8. All of the following could be the cause of aneamia in infancy except
    a) Prematurity
    A child with multiple subperiostial hamotoma and calcification
    a) Scurvy****
    b) Accidental injury
    c) Unacidental injury
    d) Osteomyelitis

    Subperiosteal hemorrhage is a typical finding of infantile scurvy. The lower ends of the femur and tibia are the most frequently involved sites. The subperiosteal hemorrhage is often palpable and tender in the acute phase.


    9.A child was born normally WT3.2 kg. Apger score was 5 in 1 min and 8 in 5 min. He has delayed development. WOF condition is associated with his developmental delay?
    a) Paternal uncle has intellectual deficit
    b) Father is a alcoholic
    c) Sister has febrile seizure
    d) Mother has 2 café’s lait spots
    e) Paternal grandmother has hypothyroidism



    .10. A middle-aged man presents with BP80/60, HR120, back pain and slight abdominal guarding, WOF is most likely diagnosis
    a) Acute pancreatitis
    b) Acute myocardial infarction
    c) Leaking aortic aneurysm****
    d) Perforated peptic ulcer


    .11. 34 yr old man presents with acute abdomen for 3 days and he has H/O vomiting following by perineal pain. O/E abdomen distended but non tender, bowel sound absent. Abdominal x –ray shows multiple air fluid levels. What is the best management before surgery?
    a)2000 ml 4% in 0.45% nacl
    c) 2000ml of Hartman solution before operation****
    d) 2000ml of Hartman solution during surgery
    e) 2000ml of 5% dextrose



    12.Following the Biochemistry of a patient who under Rx of vomiting
    Na-117 cl 86 k+3.2 serum osmolality 900
    Most likely cause
    a)sodium depletion
    b)water intoxication
    C)SIADH
    d)DI

    it can not be SAIDH as serum osmolarity is too high
    can not be DI as Na is too low
    can not be water intoxication as osmolality is too high again
    i don't know about sodium depletion

    .13.Na-168 serum osm 200ml cl-10
    most likely cause
    a) DI
    b) SIADH
    c) ACUTE TUBULAR NECRosis



    14..55 year obese lady came with generalised pain, pulse irregular, BP 90/60 mmof Hg abdomen was tender and rebound tenderness present with distension. P/R denote blood stained
    a) ruptured diverticulitis***
    b) mesenteric ischemia
    c) Ca rectum




    .15. All the following are causeof ischemic pain except
    a) numbness in buttock
    b) calf pain
    c) paralysis of thigh muscle
    d) sudden shooting pain in thigh****


    16.A pt with ascitis ,paracentesis shows malignant cell. O/E what will be found
    a) splenomegaly
    b) hepatomegaly
    c) palpable node P/R
    d) SUPRACLAVICULAR NODE ****

    Malignant ascites is seen most commonly in patients with ovarian, endometrial, breast, colon, gastric, and pancreatic cancer

    17• A pathologic left-sided supraclavicular node (Virchow node) suggests the presence of upper abdominal malignancy


    18.A one-month-old baby presented with vomiting and wt. Loss for last two weeks. On examination baby found very week & lethargic, there was no mass in the abdomen. What will you do next?
    a)Ba meal follow through
    b)Gastric empting study
    c)Ultrasonograpphy
    d)Urine analysis
    e)Enquiry about feeding ****** take detailed history first


    19.A 62 yrs. male, smoker with background of COPD was normal 2 days ago, now neighbors discovered him as confused, difficulty in respiration, cough & asteristix in hands. What is the DX?
    A)Uremic encephalopathy
    B)Hepatic encephalopathy *******
    C)CO2 narcosis
    D)Respiratory acidosis


    20.A 68 yrs. old man presents with cough, dyspnoea, and recurrent haemorrghic pleural effusion. He has silicosis; he also worked in a mine for 10 yrs. now he works in a hydrocarbon plant, what could be the DX?
    A)Silicosis
    B)Tuberculosis
    C)Mesothelioma ***** due to asbestosis
    D)Asthma
    E)Metastatic carcinoma


    21.A man weighing 84 Kg., height 179 Cm. smoker, and drinks alcohol 4-6 glass on routine examination found to have BP of 150/[snip] mm of mercury, he doesn’t want to use his seatbelt while driving his car. Which of the following is one of the most important measures for his management?
    a) Reduce 14 Kg. of weight immediately
    b) Stop smoking
    c) Chorthiazide everyday
    d) Stop alcohol *****
    e) Ask him to wear seatbelts not sure


    22..A man presented with fever, cough and sore throat. His spleen was removed before. What will you give him?
    A)Haemophillus vaccine
    B)Pneumococcal vaccine
    C)Penicillin I/V *****
    D)Oral antibiotic
    E)Regular antibody estimation


    23.A man presented with fever, cough and sore throat. His spleen was removed before. What will you give him?
    A)Haemophillus vaccine
    B)Pneumococcal vaccine
    C)Penicillin I/V
    D)Oral antibiotic
    E)Regular antibody estimation


    24.Which of the following will assist in the diagnosis of infantile meningitis?
    a) Hyperthermia
    b) Bulging of fontanales is necessary
    c) Hypothermia
    d) Neck stiffness
    e) Apnoeic spell **** not sure


    25. A picture of intra-oral swelling, redness with little pus exudates said to be of submandibular gland, which of the following measure you will take?
    A)Sialogram *****
    B)M.R.I.
    C)Intra oral dental X-ray
    D)Ultrasonography
    E)Antibiotic

    26.-A picture -- black little indurations presented in the inner aspect of the little toe, the lady said she did noticed it very recently. which of the following is the most likely.
    a) Congenital benign naevus
    b) Carcinoma
    c) Vascular malformation ****
    d) Infection


    27-A patient in MND left a note , not to intubate, do not feed by nasogastric feeding. Now the patient can’t eat, can’t speak , he was sent to the diet and nutritional department. What will you do?
    a) Do intubation
    b) Insert a nasogastric feeding tube
    c) Give parenteral feeding *****
    d) Set a central venous line
    e) Send for terminal care


    28. In diabetic keto- acidosis which of the following is responsible for hyperkaelemia?
    a) Lack of sodium
    b) Lack of insulin ****
    c) Lack of electrolytes
    d) Lack of glucose


    29-A 28 weeks pregnant lady presents to you bruises and marks of violence on her body including her abdomen. On questioning she admits that her partner beats her. What will you advice to her?
    A)Call the police
    B)Treat her accordingly **** thats is to send her to a gyaneac
    C)Give her some addresses of safe house and counseling
    D)Ask her not to tell anybody
    E)Marriage counseling with including her husband *** this is also possible


    30-Which of the following could be the outcome of avoidend personality disorder?
    A)Delusional disorder
    B)Social phobia *****
    C)Aggressive behavior
    D)Persecutory delusion
    E)Anxiety disorder


    31-A mother came with her 5 yrs. old with asthma. She started with Flixotide inhalation 4 hourly. Now she fears of long term side effects of the flixotide (fluticasone propionate), what will you tell to her?
    a) Linear growth retardation
    b) Candidiasis *****
    c) Osteoporosis
    d) Wt. Gain
    e) Osteomalacia


    32.-A man visiting from Indonesia presenting with for fever & sore throat for last 3 days. On examination there was lymphadenopathy, but no splenomegali, lymphophenia, & monospot test was negative. Which of the following you will do?
    a)EBV serology
    b)Blood culture *****
    c)HIV test
    d)Throat swab culture
    e)Give him penicillin

    33-A man complaining of repeated blurring of vision for few weeks. Now he complains of blurring of vision feel like a curtain coming down over his vision. Which of the following can be the cause?
    a) Amaurosis Fugax ****
    b) Retinal detachment
    c) Carotid artery occlusion
    d)Central vein thrombosis

    33.Stephen, aged 18 yrs, presents with spontaneous epistaxis . What is the first step in managing Stephen?
    a. direct pressure to the lower nose for two minute intervals ****→ Q ask First Step Mx
    b. position Stephen so that he is sitting and leaning forward (positioning is the first step, if direct pressure is applied.. it must be for 10 minutes without interrupting, not 2 min intervals.)
    c. application of topical local anaesthetic
    d. cautery of bleeding vessels
    e. nasal packing with gauze
  2. 1.All of the following can cause excruciating abdominal pain EXCEPT:
    a) appendicitis
    b) M.I.
    c) renal colic****
    d) rupture of abdominal aorta
    e) mesenteric artery occlusion


    2. You may do all after membrane rupture for 2 days at 32 th week gestation EXCEPT
    a) take a swab
    b) give steroids
    c) check fibronectin in vaginal fluid
    d) induce labour even there is on evidence of infection


    3) Regarding OCP, all of the following are correct EXCEPT:
    a) increase triglyceride***
    b) reduce ovarian cancers
    c) reduce benign breast diseases
    d) reduce endometrial cancers

    4.A pt with 1.8 cm tumor in the pituitary and 3mm on optic chiasm. What is the initial Rx
    a) Transfrontal resection
    b) Transphenoidal resection
    c)Bromocriptine****

    Here it doesn't say that it is a prolactinoma. If it is a prolactinoma then we can give bromocriptine.

    5. Regarding immunology, WOF statement is correct?

    a) killer cells are T- subsets and kill tumor cells
    b) B cells produce first IgM and later IgG****
    c) IgM need the help of complement

    Statement C is also correct.

    6. A 14 YR old girl with phenytoin. She came to you for ocp .WOF IS MOST APPROPRIATE
    a) Microgynon 30****
    b) Microgynon 50
    a) Diane 35

    Since AEDs are enzyme inducers and Ocp metabolism is increased, a higher dose is most appropriate.

    7. A 8 weeks pregnant lady come with vaginal bleeding. You will do USG due to all of the following reason except
    a) To see the cause of bleeding
    b) To determine the gestational age
    c) To see the foetal malformation (molar pregnancy)****,
    d) the position of the sac in the uterus
    e) check the viability of the fetus
  3. Q.1
    George is a 19yrs old man who presents with dysuria. On exam. There is a thick yellow urethral discharge. Which one of the following is CORRECT with regard to gonococcal infection?
    a. Urine PCR is now the gold standard for diagnosing gonococcal urethritis.
    b. Spread to involve the prostate and epididymis is common.
    c. The incubation period is usually 14 to 21 days.
    d. Ceftriaxone IM as a single dose is an effective treatment. *****
    e. Pharyngeal gonorrhoea is diagnosed by finding gram –ve diplococci on a smear.

    Incub period is 2 to 5 days
    Culture is confirmatory
    epididymo orchitis is a complication


    Q.2
    Betty, who is aged 29 yrs and nulliparous, comes to you for a routine Pap smear. The cervix looks healthy and there are no abnormalities on clinical exam. A week later she returns for the Pathology result which is reported as: ‘Abnormal cells are present, consistent with a diagnosis of carcinoma in situ CIN 3’. What is the implication of this result?
    a. Betty requires a cone biopsy
    b. The smear should be repeated after Betty has applied clindamycin vaginal cream for 7 days
    c. Betty has a malignancy of the cervix and hysterectomy is required
    d. Betty has malignancy of the cervix and requires radiotherapy followed by hysterectomy
    e. Betty requires a colposcopy *******

    Q.3
    Female androgen insufficiency syndrome includes all of the following EXCEPT:

    a. Persistent fatigue
    b. Reduced body hair
    c. Decreased libido
    d. Blunted motivation
    e. Dysphoria *****?

    Q.4
    All of the following are effective first line topical treatment for severe dandruff EXCEPT:
    a. selenium sulphide
    b. zinc pyrithione ****
    c. betamethasone
    d. miconazole
    e. ketoconazole

    Mild topical steroids , antifungals are used. So why not miconazole?

    Q.5
    In assessing a patient for adult-onset asthma, which of the following is FALSE:

    a. There is usually a history of past or present cigarette smoking
    b. There is usually a long history of atopic disease *****
    c. Attacks can be triggered by chemical and physical agents
    d. The asthma tends to be more chronic than episodic
    e. The associated cough can be harse, suffusing and non productive

    late onset asthma is non atopic
    Q.6
    Which of the following factors would not be a poor prognostic indicator for joint replacement in hip osteoarthritis in a 65 yrs old man?

    a. Age
    b. A BMI of 33
    c. Associated diabetes
    d. Presence of osteoporosis
    e. A previous joint replacement ***********?
    not sure

    Q.7
    Tom, aged 18yrs, presents with a typical first episode of schizophrenia. Which of the following antipsychotic medications is the treatment of choice for him?

    a. chlorpromazine
    b. haloperidol
    c. thioridazine
    d. olanzapine ***********
    e. clozapine

    Q.8
    The diagnosis of acute gonorrhoea in a male is ideally made by:

    a. gonococcal complement fixation test
    b. VDRL reaction
    c. Dark ground illumination of urethral pus ****
    d. Gram stain and culture of urethral pus
    e. Prostatic massage

    Q.9
    A common side effect of the atypical antipsychotic drug, olanzapine, is :

    a. neutropenia
    b. hypotension
    c. sexual dysfunction
    d. weight gain **************
    e. parkinsonism

    Q.10
    A traumatic perforation of the ear that has occurred in wet conditions such as swimming or water-skiing will often :

    a. be associated with a purulent discharge
    b. be complicated by a staphylococcal infection
    c. require a short course of oral antibiotics *********
    d. not heal spontaneously
    e. require surgical repair

    NOT SURE
    Q.11
    When someone is referred to as being in the pre-contemplation stage with regard to change in behaviour, this means s/he is :
    a. resistant to change
    b. preparing for change
    c. receptive to change
    d. looking forward to specific advice
    e. has not yet considered change ****

    tHANK U ATOOSA FOR THE EXPLANATION
    Q.12
    Epistaxis is unlikely to arise from :

    a. injury to the turbinates
    b. spontaneous bleeding from little;s area
    c. anticoagulation therapy
    d. enlarge adenoids **********
    e. nasal fracture

    Q.13
    Stephen, aged 18 yrs, presents with spontaneous epistaxis . What is the first step in managing Stephen?
    a. direct pressure to the lower nose for two minute intervals**********
    b. position Stephen so that he is sitting and leaning forward
    c. application of topical local anaesthetic
    d. cautery of bleeding vessels
    e. nasal packing with gauze
    pOSITION SHOULD BE SITTING UP AND HEAD DOWNWARDS.

    Q.14
    What is the cause of the greater life expectancy at birth of females than males in Australia

    a. males exercise more than females
    b. genetic and biological differences
    c. females seek health care facilities more than the males *********
    d. males die more in accidents and violence than the females
    e. employment stress is more for males
    ???
    Q.15
    Whice one of the following situations will not require prophylactic antibiotics to manage a wound:
    a. an elderly debilitated patient
    b. the wound is more than 8 hrs old
    c. the patient has alcholic liver disease
    d. a deep wound to the hand
    e. a large superficial abrasion on the thigh of a 22 yrs old ********
  4. 1.A women who has previously delivered a 4kg baby with troublesome delivery. She is para –2 and gravida 3. You should do all of the following except

    a) Do caesarean section at term
    b) Check blood glucose level regularly from 30 weeks
    c) Do x-ray pelvimetry ****
    d) Induction of labour in 37-38 weeks
    i DON'T THINK x RAY PELVIMETRY IS OF USE HERE( for an expected big baby).
    If it progress to term then the possibility if cesarean section is most likely.

    2. No bleeding after withdrawing contraceptive pills would be due to
    a) Ovary
    b) Uterus
    c) Pituitary ****
    d) Hypothalamus ****

    this is post pill amenorrhoea which is due to over supression of hypothalamic pitutary axis by the estorgen and progesterone of OCP. So I think both C and D are correct.

    3. All of the following could be cause of greenish foul smell discharge except
    a) trichomoniasis
    b) gardenella
    c) FB
    d) Cervical cancer

    ? B and D

    4. A primigravida 38 wks in labour. On P/V pelvis was reduced. Station 0 cervix 4 cm dilated, membrane intact
    a) x-ray pelvimetry
    b) C/S
    c) Oxytocin
    d) Continious trial labour****

    I think choice D is appropriate since X ray pelvimetry is obsolete now a days and if the progress is well go for a trial.


    5. a pt who has difficulties with pregnancy. She lost her 3 pregnancy in 6, 8, 10 weeks. Before that she had terminate 2 baby at 10 and12 wks. What could be the cause
    a) cervical in competence **********
    b) deficient luteal phase


    Cervical incompetence causes mid trimester abortions only. So the choice is B only.

    6.. find out in correct association with pregnant lady which cause foetal effect on pregnancy
    a) IUGR- anticardiolipin
    b) platelet count 100,000 – intracranial haemorrhage ********
    c) heart block –antibody


    For an ICH the count should be less than 40,000.

    7.. All of the following could be the cause of aneamia in infancy except
    a) Prematurity
    b) Multiple pregnancy

    May be A


    8. A child with multiple subperiostial hamotoma and calcification
    a) Scurvy****
    b) Accidental injury
    c) Unacidental injury
    d) Osteomyelitis


    9. A child was born normally WT3.2 kg. Apger score was 5 in 1 min and 8 in 5 min. He has delayed development. WOF condition is associated with his developmental delay?
    a) Paternal uncle has intellectual deficit
    b) Father is a alcoholic
    c) Sister has febrile seizure
    d) Mother has 2 café’s lait spots ***********
    e) Paternal grandmother has hypothyroidism

    neurofibroma? .

    10. A middle-aged man presents with BP80/60, HR120, back pain and slight abdominal guarding, WOF is most likely diagnosis
    a) Acute pancreatitis
    b) Acute myocardial infarction
    c) Leaking aortic aneurysm****
    d) Perforated peptic ulcer


    11. 34 yr old man presents with acute abdomen for 3 days and he has H/O vomiting following by perineal pain. O/E abdomen distended but non tender, bowel sound absent. Abdominal x –ray shows multiple air fluid levels. What is the best management before surgery?
    a)2000 ml 4% in 0.45% nacl
    c) 2000ml of Hartman solution before operation****
    d) 2000ml of Hartman solution during surgery
    e) 2000ml of 5% dextrose



    12.Following the Biochemistry of a patient who under Rx of vomiting
    Na-117 cl 86 k+3.2 serum osmolality 900
    Most likely cause
    a)sodium depletion
    b)water intoxication
    C)SIADH
    d)DI







    13.55 year obese lady came with generalised pain, pulse irregular, BP 90/60 mmof Hg abdomen was tender and rebound tenderness present with distension. P/R denote blood stained
    a) ruptured diverticulitis
    b) mesenteric ischemia *******
    c) Ca rectum

    irregular pulse suggestive of AF and an embolus causing mesentric ischeamia.



    14.. All the following are causeof ischemic pain except
    a) numbness in buttock
    b) calf pain
    c) paralysis of thigh muscle
    d) sudden shooting pain in thigh****


    15.. A pt with ascitis ,paracentesis shows malignant cell. O/E what will be found
    a) splenomegaly
    b) hepatomegaly ********
    c) palpable node P/R
    d) SUPRACLAVICULAR NODE
  5. Guest

    Guest Guest

    1. A women who has previously delivered a 4kg baby with troublesome delivery. She is para –2 and gravida 3. You should do all of the following except

    a) Do caesarean section at term
    b) Check blood glucose level regularly from 30 weeks
    c) Do x-ray pelvimetry ***
    d) Induction of labour in 37-38 weeks

    if first one is vaginal delivery no need to do pelvimetry here.

    2. No bleeding after withdrawing contraceptive pills would be due to
    a) Ovary
    b) Uterus
    c) Pituitary ***
    d) Hypothalamus ***
    both

    3. All of the following could be cause of greenish foul smell discharge except
    a) trichomoniasis
    b) gardenella
    c) FB
    d) Cervical cancer



    4 A primigravida 38 wks in labour. On P/V pelvis was reduced. Station 0 cervix 4 cm dilated, membrane intact
    a) x-ray pelvimetry
    b) C/S
    c) Oxytocin
    d) Continious trial labour ***


    5. a pt who has difficulties with pregnancy. She lost her 3 pregnancy in 6, 8, 10 weeks. Before that she had terminate 2 baby at 10 and12 wks. What could be the cause
    a) cervical in competence
    b) deficient luteal phase
    Incomplete recall

    6. find out in correct association with pregnant lady which cause foetal effect on pregnancy
    a) IUGR- anticardiolipin
    b) platelet count 100,000 – intracranial haemorrhage
    c) heart block –antibody ***

    anti-Ro antibody associated congenital complete heart block

    7. All of the following could be the cause of aneamia in infancy except
    a) Prematurity
    b) Multiple pregnancy

    incomplete recall

    8 A child with multiple subperiostial hamotoma and calcification
    a) Scurvy ***
    b) Accidental injury
    c) Unacidental injury
    d) Osteomyelitis


    9 A child was born normally WT3.2 kg. Apger score was 5 in 1 min and 8 in 5 min. He has delayed development. WOF condition is associated with his **developmental delay?
    a) Paternal uncle has intellectual deficit -associated with mental retardation(fragile X)
    b) Father is a alcoholic (fetal alcohol syndom associated with alcoholic mother)
    c) Sister has febrile seizure
    d) Mother has 2 café’s lait spots (normal IQ-neurofibroma but 2 spots may be present with normal person)
    e) Paternal grandmother has hypothyroidism( what about the mother condition? )


    10. A middle-aged man presents with BP80/60, HR120, back pain and slight abdominal guarding, WOF is most likely diagnosis
    a) Acute pancreatitis
    b) Acute myocardial infarction
    c) Leaking aortic aneurysm ***
    d) Perforated peptic ulcer


    11. 34 yr old man presents with acute abdomen for 3 days and he has H/O vomiting following by perineal pain. O/E abdomen distended but non tender, **bowel sound absent. Abdominal x –ray shows ***multiple air fluid levels. What is the best management before surgery?
    a)2000 ml 4% in 0.45% nacl
    c) 2000ml of Hartman solution before operation
    d) 2000ml of Hartman solution during surgery
    e) 2000ml of 5% dextrose
    instinal Obs . Before operation we use normal saline.

    12..Following the Biochemistry of a patient who under Rx of vomiting
    Na-117 cl 86 k+3.2 serum osmolality 900
    Most likely cause
    a)sodium depletion
    b)water intoxication***
    C)SIADH ***
    d)DI


    13.Na-168 serum osm 200ml cl-10
    most likely cause
    a) DI ***
    b) SIADH
    c) ACUTE TUBULAR NECRosis


    14.55 year obese lady came with generalised pain, pulse irregular, BP 90/60 mmof Hg abdomen was tender and rebound tenderness present with distension. P/R denote blood stained
    a) ruptured diverticulitis
    b) mesenteric ischemia ***
    c) Ca rectum


    15. All the following are causeof ischemic pain except
    a) numbness in buttock
    b) calf pain
    c) paralysis of thigh muscle
    d) sudden shooting pain in thigh ***


    16. A pt with **ascitis ,paracentesis shows ***malignant cell. O/E what will be found
    a) splenomegaly ---lymphoma with matastasis
    b) hepatomegaly--2ndary malignancy
    c) palpable node P/R --colon carcinoma
    d) SUPRACLAVICULAR NODE --intra abd. malignancy
    all may be possible
  6. Guest

    Guest Guest

    A 16 year old girl presents to her GP with secondary amenorr

    T/F-- Q1. A 16 year old girl presents to her GP with secondary amenorrhoea of 7 months duration. She has no medical history of note and denies any sexual activity.

    i) Androgen insensitivity syndrome is a possible cause F

    ii) Given the history, a pregnancy test would be of little value F

    iii) Thyroid function tests should be included in the initial
    investigative tests. T

    iv) A progestin challenge followed by a withdrawral bleed is
    suggestive of an anovulatory disorder. T?

    v) Low levels of FSH and LH are suggestive of a hypothalamic disorder T

    Q2. Early pregnancy loss:

    i) Is more common in women with a retroverted uterus F

    ii) Should be detectable from lack of fetal heart activity on USS
    (ultrasound scan) at 5 weeks. F

    iii) Is greatly increased in syphilitic mothers F

    iv) Is associated with autoimmune thyroid disease T

    v) Requires uterine evacuation if there is incomplete abortion T

    Q3. These Gynaecological conditions and potential treatments are
    correctly matched:

    i) Hyperprolactinaemia + Cabergoline ( bromocriptin is use)

    ii) Hirsutism + Spironolactone F

    iii) Fibroids + GnRH agonists ?

    iv) Dysfunctional Uterine Bleeding + NSAID'S F

    v) Detrusor instability + Oxybutinin F

    Q4. Regarding congenital diaphragmatic hernias.

    i) Over 80% occur on the right F

    ii) They are associated with pulmonary hypoplasia and pulmonary
    hypotension. T
    iii) They may be diagnosed antenatally. T

    iv) They invariably present with respiratory distress at about 6
    weeks of age. F
    v) Affected babies may benefit from inhaled nitric oxide. F

    5. Regarding symptomatic pre-eclampsia

    i) It may develop from 12 weeks gestation F

    ii) Diuresis is a prodromal symptom prior to a fit F?

    iii) Hyporeflexia is a recognised sign. F

    iv) The circulating blood volume is decreased. F

    v) Diazepam is the treatment of choice for imminent eclampsia. F


    Q6. Oligohydramnios is associated with:

    i) Potters syndromeT

    ii) Anencephaly F

    iii) Rhesus alloimmunization F

    iv) Post maturity T

    v) Amniotic bands ?

    Q7. Anaphylaxis

    i) Is a type I hypersensitivity reaction T

    ii) Is mediated by IgG F

    iii) Histamine causes bronchoconstriction T
    iv) Steroids are used for their immediate effects on the immune process F

    v) Epinephrine (adrenalin) causes bronchodilatation mediated via its
    beta agonist effects T

    Q8. regarding placenta previa

    i) most patients present with vaginal bleeding T

    ii) the matenal mortality rate is about 3% F

    iii) smoking is a risk factor ??

    iv) it is more common in multiparous women T

    v) immadiate delivery is always indicated F

    Q9. In the management of Post Partum Haemorrhage:

    i) Uterine atonia is the commonest cause T

    ii) Patients should be sat upright to aid breathing. F

    iii) Uterine packing is an initial measure F

    iv) Platelets should be given early F

    v) if due to incomplete placental expulsion requires urgent
    exploration of the uterine cavity T

    Q10. An increased risk of ectopic preganancy is seen with:

    i) Previous Chlamydia infection?

    ii) Previous Candida infection ?

    iii) Conception whilst on COCP (combined oral contraceptive pill) T

    iv) Conception whilst on POP (progesterone only pill) ?

    v) Artificial insemination T
    Q19. Regarding genitourinary prolapse:

    i) Enterocele describes small bowel herniation into the vagina. T

    ii) Enterocele will inevitably accompany Procidentia ?

    iii) Surgical repair is contraindicated in eldery patients F

    iv) Ring pessaries may be left in place indefinitely F

    v) Postnatal pelvic floor exercises have a proven benefit in avoiding
    later prolapseT

    Q20. A 29 year old primigravid woman presents to A+E at 17 weeks of
    pregnancy with a fever, cough and breathlessness. She smokes 5
    cigarettes a day but does not drink alcohol. The following are true:

    i) If CXR and ECG are normal, P.E (pulmonary emoblism) may be excluded. F

    ii) A positive D-dimers result will confirm P.E. F

    iii) An ECG showing the 'S1Q3T3' pattern is pathognomonic of P.E in
    this case. T

    iv) If heparin therapy is initiated it should be continued throughout
    the pregnancy. T

    v) Warfarin is contraindicated in breastfeeding mothers. F


    Q21. Complications in Labour:

    i) Meconium aspiration is more common in post-term pregnancy T

    ii) Forceps or ventouse may only be used if the cervix is fully dilated T

    iii) Epidural analgesia increases the risk of aspiration of gastric
    contents T

    iv) Face presentation has an increased incidence of cord prolapse ??

    v) Suspected placenta praevia should be confirmed by digital examination F

    Q22. Regarding pain relief in labour:

    i) Entonox is given at a concentration of 50% Nitrous Oxide in oxygen T?

    ii) Pethidine is contraindicated in a mother taking Tricyclic
    antidepressants ?

    iii) Pethidine is containdicated in pre-eclampsiaF

    iv) Bupivicaine is commonly used in labour epidural Anaesthesia ?

    v) Headache is an immediate sign of accidental dural tap in epidurals ?



    Q23. The Menstrual Cycle

    i) Ovulation coincides with the LH (leutinising hormone) peak T

    ii) In the follicular phase, rising oestradiol initially provides
    negative FEEDBACK on FSH levelsT

    iii) Increasing progesterone leads to thinning of cervical mucus T

    iv) A normal 21 day progesterone is an indirect indicator of ovulation T

    v) The average length of each menstrual cycle tends to decrease with
    increasing age between the ages 20 and 50 ?

    Q24. Breech positions:

    i) Occur in less than 5% of labours?

    ii) Most commonly occur as the 'extended breech' T

    iii) Are more common in primiparous womenT

    iv) External Cephalic Version is successful in converting on average
    < 1/3 of breech presentations ?

    v) Require delivery at 38 weeks T

    Q25. Polycystic ovary syndrome

    i) Is the commonest cause of anovulatory infertility T

    ii) Requires the presence of ovarian cystsT

    iii) Is associated with insulin resistance T

    iv) May be associated with increased cardiovascular morbidity T

    v) Serum concentrations of testosterone are increased T



    Q26. In the diagnosis of infertility:


    i) Axillary pigmentation would support a diagnosis of PCOS T

    ii) A day 21 progesterone level of >30 nmol/L suggests that ovulation
    has occurred T

    iii) Daily temperature charting, if followed correctly, is 90%
    sensitive for detecting if and when ovulation has occured F

    iv) Sheehans syndrome is a differential diagnosis in patients who
    experience infertility despite ovulation occurring F

    v) When compared to the general population there is an increased
    prevalence of coeliac disease in infertile patients.F?

    27. Cervical cancer:

    i) is most common in women between 20 and 40 years of age. T

    ii) is more common in women who have had many sexual partners T

    iii) does not occur without pre-existing grade III cervical
    intraepithelial neoplasia (CIN) F

    iv) commonly presents with a painful abdomenF

    v) rarely responds to radiotherapy treatment F
  7. bulimia

    bulimia Guest

    :roll:

    WHERE ARE ATOOSA & RATAN's NAMES ????

    STILL NOT FAIR

    :lol: :D :p

    I have to ask Atoosa-- Her MCQs are too good & hard- so also Scary!!!

    I don't know where did she get those ??
  8. Q.1
    The drugs of choice for treatment of erysipelas is:

    a. penicillin****
    b. methicillin
    c. ampicillin
    d. tetracycline
    e. none of the above

    Q.2
    Which of the following criteria enable a clear distinction to be made between hemorrhage and thrombosis in a patient with a CVA?

    a. the progress of the clinical features
    b. the degree of loss of consciousness
    c. the abruptness of onset
    d. the presence and absence of headache
    e. none of the above*****AMCQ

    Q.3
    The nephritic syndrome can be cause by all EXCEPT

    a. minimal change disease
    b. amyloidosis****
    c. membranous nephropathy
    d. renal vein thrombosis
    e. diabetic nephropathy

    Q.4
    Which of the following statements concerning bee sting allergy is correct?

    a. if a patient has had a life-threatening episode in the past, he or she is at risk ofa future one.*****
    b. A mild reaction in the past puts a patient at risk of a future life threating episode
    c. Wasps only sting once
    d. A bee sting is smaller in volume than a wasp sting
    e. A raised serum IgG persists for yrs in those at risk of anaphylaxis

    Q.5
    Andrew, aged 60 yrs, complains of traces of blood in his stool for the past few weeks. Which of the following is the most likely cause?

    a. diverticulosis
    b. cancer of the rectum***
    c. haemorrhoids
    d. angiodysplasia
    e. colitis

    Q.6
    Cyanosis is least likely to occure in:
    a. ebstein’s anomaly
    b. TOF
    c. Tricuspid atresia
    d. VSD****
    e. Transposition of the great vessels

    Q.7
    Which of the following pathogens causing gastrointestinal infection is not associated with bloody diarrhea
    a. listeria monocytogenes
    b. campylobacter
    c. yersinia enterocolitica
    d. salmonella****
    e. shigella

    Q.8
    ESR is raised in all of the following except

    a. multiple myeloma
    b. polycythaemia rubra vera****
    c. macrocytic anaemia
    d. pregnancy
    e. chronic hepatitis

    Q.9
    Which of the following is the most common pathological condition associated with aortic aneurysm
    a. atherosclerosis*****
    b. syphilitic aortitis
    c. trauma
    d. rheumatic aortitis
    e. cystic medial necrosis

    Q.10
    Which of the following features is found in beri-beri

    a. cardiac failure, glossitis, dermatitis
    b. cardiac failure, neuropathy, dermatitis
    c. glossitis, dermatitis, memory loss
    d. glossitis, neuropathy, memory loss
    e. cardiac failure, neuropathy, memory loss*****
  9. bulimia

    bulimia Guest

    That was Ratan's collection-- Mr Photocopy Machine

    He had to type it & helped to U
  10. Guest

    Guest Guest

    1. A child is brought to you with a fever. On examination you find neck rigidity, protein is 1.2, sugar is normal and lymphocyte is 50x10. What is your probable diagnosis?
    a) tuberculosis
    b) echo virus
    c) bacterial meningitis *******
    d) typhoid
    e) rhino virus



    2. A patient after a motor traffic accident with a pelvic fracture. Five days after successful resuscitation, he develops severe dyspnoea. What is your initial management?
    a) oxygen inhalation
    b) I/V Heparin
    c) intubation and ventilation *********
    d) intensive antibiotic therapy.


    3. A patient with COPD came into the Emergency Department with severe dyspnoea, 28% O2 8L given by mask. After one hour, you did arterial blood gases and found that PO2 level was 42mm of Hg, PCO2 was 68mm of Hg. What will you do next?
    a) increase O2 inhalation by mask
    b) ask the patient for intubation and ventilation *****
    c) increase I/V fluid
    a) repeat arterial blood gas level after one hour.

    4. You will get erythema nosodum in all the following conditions, except:
    a) sarcoidosis
    b) bacterial myocardial infarction *****
    c) tuberculosis
    d) yersinia
    e) rheumatic fever.


    5. How does Microgynon 30 work?
    a) in the hypothalamus
    b) in the pituitary gland
    c) in the ovaries ****
    d) in the Uterus
    e) on both ovaries and Uterus.


    6. A primigravida woman’s height is 150cm. At 38 weeks gestation she is in labour. On pelvic examination, you think that the pelvis is apparently reduced but the cervix is fully effaced and 4cm dilated. The baby is in the longitudinal position and head is at 0 station. What is your management plan:
    a) trial of labour
    b) X-Ray pelvimetry
    c) start I/V oxytocin
    d) immediate caesarean section ***8
    e) wait and see.


    7. With a diabetic ulcer, what is your appropriate Rx:
    a) Amoxicillin + penicillin
    b) Ampicillin + Gentamycin + Metronidazol.
    c) Flucloxacillin + Gentamycin *****
    d) Ampicillin + Cloxacillin.


    8. After a difficult catheterisation, blood pressure suddenly decreases. What would be your diagnosis?
    a) internal haemorrhage ****
    b) septicaemia
    c) pylonephritis.



    9. After the first delivery in a twin pregnancy, you will do all of the following in the second delivery, except:
    a) external podalic version *****
    b) check the fetal lie
    c) check the bleeding
    d) check the fetal heart sound
    e) check the vaginal laceration/s.


    10. 23 year-old girl has abdominal colic, 2 weeks back she had viral infection, purpural rash. Most probable diagnosis is:
    a) ITP
    b) Ischaemic colitis
    c) Henoch-schonlein purpura ****
    d) glandular fever


    11. What differentiates between haemolytic and iron deficiency anaemia?
    a) polycythaemia
    b) polychromasia ****
    c) normal platelet count


    12. A 50 year-old woman came to you with complaint of slight vaginal bleeding. She also complains that she has amoenorrhoea for 11 months. What is your diagnosis?
    a) endometrial carcinoma
    b) ca. cervix
    c) oestrogenic stimulation of the ovary
    d) vaginal atrophy
    e) cervical polyp



    13. 30 year old cystic fibrosis with chest pain treated with nebulised tobramycin th./ DM , recent weight loss, steathhorrea. Correct management?
    a) decreased carbohydrated diet and stabilising glycaemic contro
    b) pancreatic enzyme
    c) continue nebulised tobramycin for another 3 weeks
    d) chest physiotherapy
    what is the question


    14. 37 year-old man with depression presents to emergency, drowsy and aggressive. He has taken a bottle of doxepin and scotch together. Important management include:
    a) admin for ECG monitoring for 4 hours
    b) serial doses of charcoal orally
    c) do serum paracetamol as the only drug screen
    d) as the patient is conscious significant T.C.A. overdose can be ruled out
    e) alkalisation of urine will aid excretion of doxepine, and will protect against arrhythmia ***


    15. A fifteen year-old girl presents with fever and painful left forearm two days after her cat had clawed the arm. There is regional lymph adenopathy present and temperature is 39oC. Which of the following statement is true?
    a) the implicated bacterium E.coli
    b) most suffer of cat fever are >60
    c) complication may include involvement liver, spleen, central nervous system, bowel and skin *****
    d) ampicillin and cephalosporin are inadequate therapy
    e) lympadenopathy in the field of drainage is invariable


    16. Louis, a 5 year-old boy is brought to you for testing his free lead level, which is significantly elevated. His physical and locomotor examination is completely normal. On questioning, the parents state that they have recently moved to an old terrace. The initial most appropriate management would be to?
    a) commence decontamination of the house
    b) commence a chelating agent ******
    c) commence d-penicillamine for 2-6 months
    d) check the free erthrocyte protoporphyrin
    e) check the urinary excretion of lead after administration of calcium EDTA


    17. Alf, a 74 year-old man recently admitted for management of respiratory failure asks about home-oxygen. The following are criteria for long-term continuous oxygen therapy except:
    a) PaO2 <55mmHg
    b) O2 saturation <88%
    c) treating the Hypoxia associated with the sleep apnoea *****
    d) if the patient has mental impairment oxygen should be withheld for safety reasons
    e) congestive heart failure with intractable angina

    18. All of the following statements about inflammatory bowel disease are true except:
    a) pseudopolyps developing in ulcerative colitis do not become malignant
    b) development of fistula between bowel and skin or bladder suggests granulomatous bowel disease, such as a regional enteritis *****8
    c) severe hypotension with fever, leucocytocis and abdominal distention suggests development of toxic megacolon which usually requires immediate surgery
    d) occult bleeding occurs in both ulcerative colitis and regional enteritis but gross bleeding is more characteristic of ulcerative colitis
    e) metronidazole may help to control acute diarrhoea in crohn’s disease


    19. Jose, 6 months-old boy is referred back to you by the local hospital where he has presented several times over three months due to a series of falls at home. The question of non-accidental injury (child abuse) has been raised. Your initial assessment would include:
    a) developmental milestone assessment
    b) a skeletal survey with radiograph of AP CXR, AP Pelvis AP views of extremities, AP lateral views of skull *****
    c) confrontation of
    d) prompt referral to a paediatrician
    e) funduscopy none other seems rite
  11. Guest

    Guest Guest

    1. A child is brought to you with a fever. On examination you find neck rigidity, protein is 1.2, sugar is normal and lymphocyte is 50x10. What is your probable diagnosis?
    a) tuberculosis
    b) echo virus
    c) bacterial meningitis *******
    d) typhoid
    e) rhino virus



    2. A patient after a motor traffic accident with a pelvic fracture. Five days after successful resuscitation, he develops severe dyspnoea. What is your initial management?
    a) oxygen inhalation
    b) I/V Heparin
    c) intubation and ventilation *********
    d) intensive antibiotic therapy.


    3. A patient with COPD came into the Emergency Department with severe dyspnoea, 28% O2 8L given by mask. After one hour, you did arterial blood gases and found that PO2 level was 42mm of Hg, PCO2 was 68mm of Hg. What will you do next?
    a) increase O2 inhalation by mask
    b) ask the patient for intubation and ventilation *****
    c) increase I/V fluid
    a) repeat arterial blood gas level after one hour.

    4. You will get erythema nosodum in all the following conditions, except:
    a) sarcoidosis
    b) bacterial myocardial infarction *****
    c) tuberculosis
    d) yersinia
    e) rheumatic fever.


    5. How does Microgynon 30 work?
    a) in the hypothalamus
    b) in the pituitary gland
    c) in the ovaries ****
    d) in the Uterus
    e) on both ovaries and Uterus.


    6. A primigravida woman’s height is 150cm. At 38 weeks gestation she is in labour. On pelvic examination, you think that the pelvis is apparently reduced but the cervix is fully effaced and 4cm dilated. The baby is in the longitudinal position and head is at 0 station. What is your management plan:
    a) trial of labour
    b) X-Ray pelvimetry
    c) start I/V oxytocin
    d) immediate caesarean section ***8
    e) wait and see.


    7. With a diabetic ulcer, what is your appropriate Rx:
    a) Amoxicillin + penicillin
    b) Ampicillin + Gentamycin + Metronidazol.
    c) Flucloxacillin + Gentamycin *****
    d) Ampicillin + Cloxacillin.


    8. After a difficult catheterisation, blood pressure suddenly decreases. What would be your diagnosis?
    a) internal haemorrhage ****
    b) septicaemia
    c) pylonephritis.



    9. After the first delivery in a twin pregnancy, you will do all of the following in the second delivery, except:
    a) external podalic version *****
    b) check the fetal lie
    c) check the bleeding
    d) check the fetal heart sound
    e) check the vaginal laceration/s.


    10. 23 year-old girl has abdominal colic, 2 weeks back she had viral infection, purpural rash. Most probable diagnosis is:
    a) ITP
    b) Ischaemic colitis
    c) Henoch-schonlein purpura ****
    d) glandular fever


    11. What differentiates between haemolytic and iron deficiency anaemia?
    a) polycythaemia
    b) polychromasia ****
    c) normal platelet count


    12. A 50 year-old woman came to you with complaint of slight vaginal bleeding. She also complains that she has amoenorrhoea for 11 months. What is your diagnosis?
    a) endometrial carcinoma
    b) ca. cervix
    c) oestrogenic stimulation of the ovary
    d) vaginal atrophy
    e) cervical polyp



    13. 30 year old cystic fibrosis with chest pain treated with nebulised tobramycin th./ DM , recent weight loss, steathhorrea. Correct management?
    a) decreased carbohydrated diet and stabilising glycaemic contro
    b) pancreatic enzyme
    c) continue nebulised tobramycin for another 3 weeks
    d) chest physiotherapy
    what is the question


    14. 37 year-old man with depression presents to emergency, drowsy and aggressive. He has taken a bottle of doxepin and scotch together. Important management include:
    a) admin for ECG monitoring for 4 hours
    b) serial doses of charcoal orally
    c) do serum paracetamol as the only drug screen
    d) as the patient is conscious significant T.C.A. overdose can be ruled out
    e) alkalisation of urine will aid excretion of doxepine, and will protect against arrhythmia ***


    15. A fifteen year-old girl presents with fever and painful left forearm two days after her cat had clawed the arm. There is regional lymph adenopathy present and temperature is 39oC. Which of the following statement is true?
    a) the implicated bacterium E.coli
    b) most suffer of cat fever are >60
    c) complication may include involvement liver, spleen, central nervous system, bowel and skin *****
    d) ampicillin and cephalosporin are inadequate therapy
    e) lympadenopathy in the field of drainage is invariable


    16. Louis, a 5 year-old boy is brought to you for testing his free lead level, which is significantly elevated. His physical and locomotor examination is completely normal. On questioning, the parents state that they have recently moved to an old terrace. The initial most appropriate management would be to?
    a) commence decontamination of the house
    b) commence a chelating agent ******
    c) commence d-penicillamine for 2-6 months
    d) check the free erthrocyte protoporphyrin
    e) check the urinary excretion of lead after administration of calcium EDTA


    17. Alf, a 74 year-old man recently admitted for management of respiratory failure asks about home-oxygen. The following are criteria for long-term continuous oxygen therapy except:
    a) PaO2 <55mmHg
    b) O2 saturation <88%
    c) treating the Hypoxia associated with the sleep apnoea *****
    d) if the patient has mental impairment oxygen should be withheld for safety reasons
    e) congestive heart failure with intractable angina

    18. All of the following statements about inflammatory bowel disease are true except:
    a) pseudopolyps developing in ulcerative colitis do not become malignant
    b) development of fistula between bowel and skin or bladder suggests granulomatous bowel disease, such as a regional enteritis *****8
    c) severe hypotension with fever, leucocytocis and abdominal distention suggests development of toxic megacolon which usually requires immediate surgery
    d) occult bleeding occurs in both ulcerative colitis and regional enteritis but gross bleeding is more characteristic of ulcerative colitis
    e) metronidazole may help to control acute diarrhoea in crohn’s disease


    19. Jose, 6 months-old boy is referred back to you by the local hospital where he has presented several times over three months due to a series of falls at home. The question of non-accidental injury (child abuse) has been raised. Your initial assessment would include:
    a) developmental milestone assessment
    b) a skeletal survey with radiograph of AP CXR, AP Pelvis AP views of extremities, AP lateral views of skull *****
    c) confrontation of
    d) prompt referral to a paediatrician
    e) funduscopy none other seems rite
  12. Guest

    Guest Guest

    Q.1
    All of the following tests should be a part of 1st antenatal screen except:
    a. full blood examination
    b. blood group and antibodies
    c. dating USG
    d. syphilis serology
    e. hepatitis B surface antigen

    Q.2
    Eve, 9wks pregnant, presents with a H/O 24 hrs of intermittent dark blood loss staining her underwear. On P/V exam. Uterus is the expected size and Cx os is closed and non tender. You should advice her that :
    a. she is likely to have miscarried
    b. b. approx. half of all pregnant women suffer from bleeding during 1st trimester
    c. she is requires admission to hospital for D & C
    d. she should have an USG exam.
    e. There is a higher incidence of congenital malformation during bleeding occurred in 1st trimester.

    Q.3
    Which of the following are not a risk factor for primary open angle glaucoma?
    a. DM
    b. Hypermetropia
    c. Steroid therapy
    d. Positive family history
    e. Age greater than 40 yrs

    Q.4
    Weber’s test is used in the clinical assessment of hearing . Which of the following statements about weber’s test is correct
    a. it is often unreliable
    b. it is performed with 128 Hz tuning fork
    c. in unilateral conductive deafness, sound is loudest in the normal ear
    d. in unilateral sensorineural deafness , sound is referred to the effected ear
    e. ear wax must be absent for the test to be accurate

    Q.5
    14 yrs old boy presents with long H/O RTI and recurrent viral gastroenteritis. But his bacterial resp.infections respond to antimicrobial therapy. His illness recure quickly. Other than suffering recurrent allergic rhinitis and vernal conjunctivitis, he is well. The most likely cause of his immunoglobin deficiency is
    a. IgA
    b. IgG
    c.IgG2
    d. IgE
    e. IgM

    Q.6
    Old man with heart failure signs, dyspnea, mild icterus, lower limb weakness, smooth hepatomegaly
    a. bud chari synd
    b. cirrhosis
    c. veno occlusive dis.
    d. IVC thrombosis with pul. Embolism

    Q.7
    Regarding psychiatric side effects of steroids, which is correct
    a. mania is more common when symp. Are severe
    b. depression is common when symp. Not severe
    c. delirium after withdrawal

    Q.8
    Lady with IVF at 38 wks can’t feel foetal movements for past 24 hrs, CTG are normal—next step
    a. induction of labour
    b. oxytocin challenge test
    c. check USG
    d. aminocentesis

    Q.9
    Absolute contraindication in ECT
    a. heart block
    b. MI 2 wks ago
    c. Itra cranial lesion
    d. Raise ICP
    e. H/O grandmal seizures

    Q.10
    In uterine cancer all of the following is arisk factor except
    a. H/O smoking
    b. Unopposed estrogen therapy
    c. Multiparity
    d. None of the above
  13. Dr. Honey

    Dr. Honey Guest

    .1. In a patient with myocardial infarction was found a new systolic murmur on examination. Cardiac ejection fraction was 55%. Which of the following is MOST probable cause:
    a. Aortic regurgitation
    b. Papillary muscle dysfunction
    c. Mitral valve stenosis
    d. Papillary muscle rupture ***
    e. Tricuspid valve regurgitation


    2.An obese patient with diabetes mellitus is under anti-hypertension treatment. His blood pressure is 160/100mmBg on examination. Which of the following is your INITIAL consideration for this patient:
    a. Decreased protein in his diet
    b. Concurrent hypertensive therapy
    c. Give diuretics
    d. Control sugar intake in the diet
    e. Ideal weight ****


    3. At which level of cholesteral you consider to give lipid-lowering statins (eg, simvastatin, pravastatin)
    a. 6 mmol/l
    b. 5.5 mmol/l
    c. 5 mmol/l
    d. 4.5 mmol/l ****JM
    e. 4 mmol/l


    4. Which of the following is the *MOST COMMON characteristic of pleura effusion of TB:
    a. Glucose decreased or absent
    b. Monocyte ---May be lymphocyte
    c. Blood stained
    d. Protein <2g
    e. Find TB bacillus



    5. Which following group is the MOST at RISK OF HIV infection:
    a. Heterosexual
    b. Homosexual
    c. Intravenous drug user ***
    d. Blood transfusion
    e. Haemophilias



    6. Which of the following group is LEAST LIKE of infection of HIV:
    a. Heterosexual
    b. Blood Transfusion ***due to screening
    c. Homosexual
    d. Haemodialysis
    e. Haemophiliacs



    7. Dengue fever, all followings are correct EXCEPT:
    a. Arbovirus
    b. Mosquito transmission
    c. Children get least severe illness
    d. There is no specific treatment
    e. Air droplet infection ***



    8. A patient with ???mycobacteria infection which of the following is most appropriate treatment
    a. cotrimoxazole
    b. tetracycline
    c. Amoxycilline
    d. Metronidazole
    e. Erithromycin
    ?? Which type of bacteria/ TB/ Pneumoniae

    9. What is compatible with critical illness:
    a. Increased cortisol , increased TSH
    b. Both cortisol and TSH decreased
    c. Increased cortisol, decreased TSH***
    d. Decreased cortisol, increased TSH
    e. Normal cortisol, increased TSH


    10.For an elderly man, which above following blood sugar level need further investigation
    a. 5 mmol/l
    b. 5.5 mmol/l
    c. 6 mmol/l
    d. 6.5 mmol/l
    e. 7 mmol/l ***


    11. A young patient comes from overseas with diarrhoea, no blood. Temperature 37.9C, stool examination showed few Salmonellas. What is your management:
    a. Observation and repeat stool examination 3 days later **?
    b. Broad spectrum antibiotic like amoxicillin
    c. Trimethoprine plus sulphasalazine
    d. Cotrimoxazole plus trimethoprim
    e. Reassure


    12.. Patient with supposed hepatoma. Which of the following questions is MOST helpful for diagnosis:
    a. Present liver cirrhosis ***
    b. Alcohol liver disease
    c. Acute hepatitis
    d. Cholangitis
    e. Family history of liver hepatoma



    13. In anaemia patient with increased transferrin. All of the following is correct EXCEPT:
    a. Increased serum ferritin***
    b. Decreased serum ferritin
    c. Increased total iron binding capacity
    d. Increased transferrin
    e. Decreased serum iron



    14. In haemolytic anaemia, all is correct EXCEPT:
    a. Increased urobilinogen
    b. Serum urobilin
    c. Erythrocyte count***
    d. Decreased MCV
    e. Increased serum iron

    15. A 67 year-old alcoholic man has backache, ESR 120mm/h. Which of the following is MOST LIKELY diagnosis:
    a. Multiple sclerosis
    b. Acute lymphatic leukaemia
    c. Hodgkin disease
    d. Non-Hodgkin disease
    e. Multiple myeloma***


    16. A 67 year-old patient with long standing alcoholism. Lab: HB 9.8; ***ESR 120: leukocytes 10000 and left shift. Which of the following is diagnosis:
    a. Viral hepatitis
    b. Multiple myeloma ***
    c. Iron deficiency anaemia
    d. Fatty liver
    High ESR> gaint cell arteritis, polymyalgia rheumatica, temporal arteritis, multiple myeloma, Tuberculosis, deep abscess, bacterial endocarditis, acute osteomyelitis


    17. A 28 year-old female with long standing alcoholism, history of bowel irritation. Lab: HB 9.8; ***MCV 110. Which is the MOST LIKELY diagnosis:
    a. Whipple’s disease
    b. Colorectal carcinoma
    c. Irritative bowel syndrome
    d. Ulcerative colitis
    e. Coeliac disease ***


    18. All following signs are present in Parkinson disease EXCEPT:
    a. Loss of postural reflexes
    b. Myoclonus
    c. Decreased reflexes *
    d. Muscle weakness
    e. Broad wide gait ***


    19. A 35 year-old female with facial pain, associated sensory delicate, no trigger zone. What is the diagnosis:
    a. Trigeminal neuralgia
    b. Ramsay – Hunt syndrome
    c. Bell’s palsy
    d. Multiple sclerosis ***
    e. Tolosa – Hunt syndrome



    20. These are all phenytoin side effects EXCEPT:
    a. Nystagmus
    b. Osteomalacia
    c. Stimulate osteoporosis
    d. Lymphoma
    e. Deafness ***



    21. Patient 64 year-old, suddenly occurred hemiparesis and paralysis of soft palate and Horner’s syndrome on the same side of the body. Where is the lesion:
    a. Middle cerebral artery
    b. Carotid artery occlusion
    c. Vertebro-basilar artery ***
    d. Giant cell arteritis
    e. Subclavian steal syndrome


    22. Patient 64 year-old, suddenly occurred hemiparesis and paralysis of soft palate and Horner’s syndrome on the same side of the body. Where is the lesion:
    a. Middle cerebral artery
    b. Carotid artery occlusion
    c. Vertebro-basilar artery ***
    d. Giant cell arteritis
    e. Subclavian steal syndrome


    23. A 55 year-old patient has blood pressure 200/130mmHg. His left kidney is small and urine tests and kidney functions are normal. What is your NEXT investigation:
    a. Intravenous pyelography
    b. Retrograde
    c. Renal CT scan
    d. Renal scan---Isotope scan ***
    Dx RAS> Definitive Ivx-- renal arteriography

    24. Patient has sudden dyspnea. Physical examination found left upper chest respiratory movements increased. In left lower part percussion dullness and decreased respiratory sounds. What is the diagnosis:
    a. Atelectasis
    b. Pneumonia
    c. Pleural effusion***
    d. Pulmonary thrombosis
    e. Pneumothorax



    25. Post-operative third day serum Na 165mmol/l and urine Osmo is 250 (normal 50 – 1000). The MOST LIKELY cause is:
    a. Thiazide diuretic dose is too high
    b. Diabetes mellitus
    c. Diabetes insipidus ***
    d. SIADH
    e. Acute renal failure



    3
  14. Dr. Honey

    Dr. Honey Guest

    .
    1. An obese patient with diabetes mellitus is under anti-hypertension treatment. His blood pressure is 160/100mmBg on examination. Which of the following is your INITIAL consideration for this patient:
    a. Decreased protein in his diet
    b. Concurrent hypertensive therapy
    c. Give diuretics
    d. Control sugar intake in the diet
    e. Ideal weight*****



    2. At which level of cholesteral you consider to give lipid-lowering statins (eg, simvastatin, pravastatin)
    a. 6 mmol/l
    b. 5.5 mmol/l
    c. 5 mmol/l****
    d. 4.5 mmol/l
    e. 4 mmol/l



    3. Which of the following is the MOST COMMON characteristic of pleura effusion of TB:
    a. Glucose decreased or absent
    b. Monocyte
    c. Blood stained
    d. Protein <2g
    e. Find TB bacillus





    4. Which following group is the MOST at RISK OF HIV infection:
    a. Heterosexual****
    b. Homosexual
    c. Intravenous drug user
    d. Blood transfusion
    e. Haemophilias


    HIV is transmitted primarily through sexual contact (over 70%); worldwide, it is more common in heterosexual men and women than in homosexual men.
    Parenteral transmission occurs largely among intravenous drug users; transmission by contaminated blood products is rare in the United States, though this remains a serious problem in developing countries.



    5. Which of the following group is LEAST LIKE of infection of HIV:
    a. Heterosexual
    b. Blood Transfusion
    c. Homosexual
    d. Haemodialysis****
    e. Haemophiliacs




    6. Dengue fever, all followings are correct EXCEPT:
    a. Arbovirus
    b. Mosquito transmission
    c. Children get least severe illness****
    d. There is no specific treatment
    e. Air droplet infection****


    The prognosis for uncomplicated dengue fever is very good, and almost 100% of patients fully recover. However, as many as 6-30% of all patients die when DHF occurs. The death rate is especially high among the youngest patients (under one year old).


    7. A patient with mycobacteria infection which of the following is most appropriate treatment
    a. cotrimoxazole
    b. tetracycline****
    c. Amoxycilline
    d. Metronidazole
    e. Erithromycin****


    8. What is compatible with critical illness:
    a. Increased cortisol , increased TSH****
    b. Both cortisol and TSH decreased
    c. Increased cortisol, decreased TSH
    d. Decreased cortisol, increased TSH
    e. Normal cortisol, increased TSH


    9.For an elderly man, which above following blood sugar level need further investigation
    a. 5 mmol/l
    b. 5.5 mmol/l
    c. 6 mmol/l
    d. 6.5 mmol/l****
    e. 7 mmol/l


    10. A young patient comes from overseas with diarrhoea, no blood. Temperature 37.9C, stool examination showed few Salmonellas. What is your management:
    a. Observation and repeat stool examination 3 days later
    b. Broad spectrum antibiotic like amoxicillin
    c. Trimethoprine plus sulphasalazine
    d. Cotrimoxazole plus trimethoprim
    e. Reassure


    11. Patient with supposed hepatoma. Which of the following questions is MOST helpful for diagnosis:
    a. Present liver cirrhosis****
    b. Alcohol liver disease
    c. Acute hepatitis
    d. Cholangitis
    e. Family history of liver hepatoma

    the most common causes of HCC are alcoholic cirrhosis, steroid use, and hemochromatosis.


    12. In anaemia patient with increased transferrin. All of the following is correct EXCEPT:
    a. Increased serum ferritin****
    b. Decreased serum ferritin
    c. Increased total iron binding capacity
    d. Increased transferrin
    e. Decreased serum iron

    it is iron deficiency


    13. In haemolytic anaemia, all is correct EXCEPT:
    a. Increased urobilinogen****
    b. Serum urobilin
    c. Erythrocyte count
    d. Decreased MCV
    e. Increased serum iron


    14 A 67 year-old alcoholic man has backache, ESR 120mm/h. Which of the following is MOST LIKELY diagnosis:
    a. Multiple sclerosis
    b. Acute lymphatic leukaemia
    c. Hodgkin disease
    d. Non-Hodgkin disease
    e. Multiple myeloma****


    15. A 67 year-old patient with long standing alcoholism. Lab: HB 9.8; ESR 120: leukocytes 10000 and left shift. Which of the following is diagnosis:
    a. Viral hepatitis
    b. Multiple myeloma
    c. Iron deficiency anaemia
    d. Fatty liver




    16. A 28 year-old female with long standing alcoholism, history of bowel irritation. Lab: HB 9.8; MCV 110. Which is the MOST LIKELY diagnosis:
    a. Whipple’s disease
    b. Colorectal carcinoma
    c. Irritative bowel syndrome
    d. Ulcerative colitis
    e. Coeliac disease




    17 All following signs are present in Parkinson disease EXCEPT:
    a. Loss of postural reflexes
    b. Myoclonus
    c. Decreased reflexes
    d. Muscle weakness
    e. Broad wide gait****


    18. A 35 year-old female with facial pain, associated sensory delicate, no trigger zone. What is the diagnosis:
    a. Trigeminal neuralgia
    b. Ramsay – Hunt syndrome
    c. Bell’s palsy
    d. Multiple sclerosis
    e. Tolosa – Hunt syndrome



    19. These are all phenytoin side effects EXCEPT:
    a. Nystagmus
    b. Osteomalacia
    c. Stimulate osteoporosis
    d. Lymphoma
    e. Deafness



    20. Patient 64 year-old, suddenly occurred hemiparesis and paralysis of soft palate and Horner’s syndrome on the same side of the body. Where is the lesion:
    a. Middle cerebral artery
    b. Carotid artery occlusion
    c. Vertebro-basilar artery
    d. Giant cell arteritis
    e. Subclavian steal syndrome


    21. Patient 64 year-old, suddenly occurred hemiparesis and paralysis of soft palate and Horner’s syndrome on the same side of the body. Where is the lesion:
    a. Middle cerebral artery
    b. Carotid artery occlusion
    c. Vertebro-basilar artery****
    d. Giant cell arteritis
    e. Subclavian steal syndrome


    22. A 55 year-old patient has blood pressure 200/130mmHg. His left kidney is small and urine tests and kidney functions are normal. What is your NEXT investigation:
    a. Intravenous pyelography
    b. Retrograde
    c. Renal CT scan
    d. Renal scan****


    23. Patient has sudden dyspnea. Physical examination found left upper chest respiratory movements increased. In left lower part percussion dullness and decreased respiratory sounds. What is the diagnosis:
    a. Atelectasis****
    b. Pneumonia
    c. Pleural effusion
    d. Pulmonary thrombosis
    e. Pneumothorax



    24.Post-operative third day serum Na 165mmol/l and urine Osmo is 250 (normal 50 – 1000). The MOST LIKELY cause is:
    a. Thiazide diuretic dose is too high
    b. Diabetes mellitus
    c. Diabetes insipidus****
    d. SIADH
    e. Acute renal failure



    25. Staghorn calculi can be found in the entire following situation EXCEPT:
    a. Recurrent pyelonephritis
    b. Immobilisation
    c. Idiopathic hypercalciuria
    d. Primary hyperparathyroidism



    26. A 7 yr with enuresis . What is the most likely cause?
    a. UTI
    b. Family disorder
    c. O.M
    d. Vesico -ureteric reflux
    e. Ectopic ureters


    27. A 6 yr boy found to have a systolic murmur on the left sternal border. His weight is on the 3rd centile. What is your advice to h is parents?
    a. That he has Atrial Septal Defect
    b. That he has Ventricular Septal Defect
    c. That he should be referred to a cardiologist
    d. That the murmur will remit spontaneously
    e. That surgery is essential to correct his condition


    28. WOF is the most likely cause of meningitis in the 4 y.o child?
    a. E.coli
    b. Haemophilus influence
    c. Adeno-virus
    d. N. Meningitidis
    e. Strep. Pneumoniae


    29. A 2 y.o presented with chronic constipation. AXR shower heavy faecal loading of the colon . P/R was uneventful. What is the most appropriated next step?
    a. Double contract barium enema
    b. Rectal biopsy
    c. Anal dilation
    d. AXR
    e. Laxatives

    30. 5 yo presented with a mass in the left lower abdominal quarant. Otherwise , he is well. What is the most likely cause?
    a. Neuroblastoma
    b. Acute leukaemia
    c. Nephroblastoma (Wilm’s tumour)
    d. Hodgkin’s disease
    e. Non-hodgkin lymphoma


    31. A full term neonate was born at 30/4, 1500 g was noticed to be cyanosed on the hands and feet . O/E the infant was responsive and jittery on handing. The respiratory rate is 40/ min and lung and heart are clinically normal . WOF is correct?
    a. The infant most probably has a convulsion
    b. O¬2¬¬ should be given
    c. Blood sugar level should be checked
    d. Blood calcium level should be checked
    e. The infant’s rectal temperature should be checked


    32. A woman presented with vaginal bleeding at 8/40 of her pregnancy. Blood loss was estimated as 1L. O/E her BP is 90/60, pulse is 130/1’. The fetus is dead. All the following is relevant to her treatment EXCEPT:
    a. Resuscitate her with I/V fluids under CVP control
    b. Do U/S to check ectopic pregnancy
    c. Order a coagulation profile
    d. Do U/S to check placenta praevia
    e. Insect a urinary catheter


    33. A 34y.o, G2 P1 presents at term with mild pre-eclampsia and a Bishop score of 4. WOF is INCORRECT in her management?
    a. Rupture the membranes
    b. Rupture the membranes then put up Syntocinon infusion
    c. Put up Syntocinon infusion in Hartman’s solution
    d. Apply prostaglandin PE2 ¬intra-vaginally



    34. A 8 wks pregnant woman comes into contact with a child who was recently diagnosed with Rubella. All of the following is true EXCEPT
    a. Give her anti-rubella specific IG
    b. If infection occurs the fetus may suffer from microcephaly, hearing loss and cardiac abnormalities
    c. Order IgG and IgM antibodies
    d. Repeat testing for IgG and IgM at 14-16/40 even if initial test was (-)
    e. Vaccinate her against rubella


    35. a 42 yo woman on O/C come to see you b/o mid-cycle spot bleeding. What is the most likely cause?
    a. Reduced oestrogen level
    b. Cervical ectropion(erosion)
    c. Cervical intra-epithelial neoplasia
    d. Endocervical cancer
    e. Atrophic vaginitis



    36. A 50 yr woman has been on tamoxifen for 5 yrs breast cancer . Present with mid –cycle vaginal bleeding . What is the most likely cause?
    a. Metastases from the breast
    b. Endometrial cancer
    c. Endometrial hyperplasia
    d. Endometrial hypoplasia because of tamoxifen
    e. Decreased oestrogen level because of tamoxifen


    37.Progestion against athorosclerosis mediated by HRT. May be due to all the following EXCEPT
    a. Decrease total cholesterol level
    b. Decrease LDL level
    c. Decrease HDL level
    d. Decrease total triglycerides levels
    e. Protective effect on vascular wall endothelium



    38.A 28 yo woman with 18/12 h/o post pill amenorrhoea [resents b/o infertility .All of the following investigations may need to be carried out EXCEPT
    a. S. Prolactin
    b. CT scan even if the prolactin level is normal
    c. S. oestrogen
    d. FSH
    e. Laparoscopy for PCO


    39. A young woman presents b/o acute pelvic pain after 8 wks of amenorrhoea .B_hcg is (-) and on U/S . She is found to have an 1.8cm cyst, what is the most appropriated action
    a. Ask to see her again after 3 wks
    b. Refer her fro laparoscopy
    c. Refer her for surgical remove of the cyst
    d. Prescribe oral contraceptive pill
    e. Prescribe her clomiphene



    40. A 24 yrs woman presents b/o acute pelvic pain and spotting after 8 wks of amenorrhoea . B-HCG is +, In the past she has had appendicectomy and cholecystectomy . what is the least likely cause of her pain
    a. Ectopic pregnancy
    b. Red degeneration of a fibroid
    c. Tortes ovarian cyst
    d. Pelvic abscess
    e. Inevitable abortion


    41. A woman is being investigation for infertility . Her gynaecologist advised laparoscopy and she asks your opinion about the procedure . you may tell her all the following EXCEPT
    a. Visceral damage is possible but unlikely to happen
    b. Vena caval or aortic rupture can cause cardiac arrest and death
    c. Laparoscopy is diagnostic of PCO
    d. Shoulder pain is common after the procedure
    e. Serious heart or lung disease usual, do not contraindicate the procedure


    42. A young man with bilateral weakness and wasting of thenar, hypothenar and interossei of hand , which of the following is the most possible cause
    a. Bilateral ulnar nerve palsies
    b. Bilateral median nerve palsies
    c. Multiple sclerosis
    d. Brain stem infarction


    43. A lady presents an engorged long saphenous veins and engorged tributaries in the calf and thigh , which of the following is the management?
    a. Ligation of saphenous vein
    b. Ligation of stripping vein
    c. Amputate the leg if varices are severe
    d. Sclerotherapy
    e. Remove varices vein under local Anaesthesia


    44. Management of bedridden in a patient include all of the followings EXCEPT:
    a. Keep dry the pressure area
    b. Use a water bed
    c. Use sheep skin on the bed
    d. Keep ventilation on both sides of feet
    e. Constant movement by turning the patient


    45. A woman presents sudden onset of abdominal pain, vomiting for 8 hrs. O/E: there were irregular pulse , terderness of abdomen, bowel sound absent and bloody discharge from rectum . Which of the following is the most likely diagnosis?
    a. Ulceration colitis
    b. Colon cancer
    c. Diverticulitis
    d. Mesenteric disease
    e. Crohn ‘s disease


    46. Five days after appendectomy , a patient develops 39C of fever, Which of the following is the most likely cause of the fever?
    a. Appendix abscess
    b. Wound infection
    c. Thrombophlebitis
    d. Pulmonary atelectasis
    e. Bronchopneumonia


    47. Lithogenesis of bile is increase by all of the following EXCEPT:
    a. Age
    b. Weight loss
    c. Malabsorption
    d. Crohn’s disease
    e. Hyperlipidaemia


    48. A man, middle age, complains that there was a mild abdominal pain with an abdominal distension , which was relied by passing flatus, There was semiformal stool motion . Which of the following is the most possible diagnosis?
    a. Irritable bowel syndrome
    b. Cancer of colon
    c. Coeliac disease
    d. Diverticular disease


    49. In a patient with spherocytosis, all of the following may happen after splenectomy EXCEPT
    a. Life span of RBC will become normal
    b. Reduce the rate of haemolysis
    c. Increase risk of infection
    d. Increase platelet
    e. Increase staphylococcus infection


    50. In third day after head surgery , a patient has reduced levels of serum Na+ k + and cl -, the urine osmolality is normal, but blood osmolality is low, which of the following is the most likely cause?
    a. Water intoxication
    b. Inappropriate ADH syndrome
    c. Acute renal failure
    d. Choric renal failure
    e. Diabetic insipidus

    51. Which of the following metastatic carcinoma have the WOST prognosis:
    a. Prostate
    b. Breast
    c. Stomach
    d. Uterus
    e. Colon



    52. What is CORRECT in normal Grief?
    a. effective reactivity is preserved
    b. Suicidal risk is increased
    c. Progression to pathological grief is common
    d. May precipitate schizophrenia
    e. May precipitate delusional disorder


    53. A 24 years old man was apprehended by the police in public park because of aggressive behaviour. He claimed total amnesia of the event. What is the MOST LIKELY explanation fro his behaviour:
    a. Global amnesia
    b. Brief psychotic reaction
    c. Alcohol and drug intoxication
    d. Organic brain disorder
    e. Epilepsy



    54. Which of the following is the BEST post-operation care for reversing the effect of neuromuscular blocking Anaesthesia :
    a. Atropine
    b. Physostigmine
    c. Pancuronium bromide

    d. Intubation & adequate ventilation
    e. Suxamethonium


    55. All the following are features of bulimia nervosa EXCEPT
    a. Hirsutism
    b. Teeth erosion
    c. Amenorrhoea
    d. Bilateral parotid swelling
    e. Hoarseness of voice
  15. booby

    booby Guest

    1. You are called to the ward to visit a child who was born at term by
    normal vaginal delivery but only weight 1800 g . You will except all of the
    following except:
    A. Idiopathic respiratory distress syndrome
    B. hypoglycaemia
    C. mecinoum aspiration ***
    D. Hypothermia due to low body weight



    2. A mother brings her 6 months old child to see you because since his last
    DTP vaccination 2 weeks ago,he no longer sleeps well at night and crys when
    she trys to leave him. Which of the following are you going to tell the mother:
    A. reassure the mother that this behavier is normal for his age and will pass ***?
    B. The child has must have any more vaccination
    C. this is a react to the vaccination
    D. take a urine sample for examination


    3. Jaundice appearing *16 hr after birth ( in a full term baby ). Most likely
    cause:
    A. excessive destruction of normal red blood cells
    B. iso-immunisation***
    C. liver immaturity
    D. infection
    E. physiological


    4.A child with birth weight 3125 g ( in 75 th percentile ) . After one month
    his weight is in the 10th percentile.He passes lots of urine and bowel opens
    twice a day. He feeds 6 hourly , 210 g formulary milk. What is the first
    step of management:
    A. check the strenght of the formula***
    B. do a sweat test
    C. test feeding the child
    D. examine the stools microscopically
    E. stool culture



    5.What is the most likely to be accossiated with in a child with atopic
    eczema :
    A. cow milk
    B. IgG accossiated
    C. effects only the extensor surfaces **
    D. cause dry skin
    E. only case in the nappy area


    6. A 3 y old boy with normal gross and fine motor skills, is only able to
    pronounce 3 words in incomprehensible manner . All could be responsible except:
    A. Autism
    B. mild mental retardation
    C. deafness
    D. cleft palate***
    E. dysphonia


    7.What is NOT true about helicobacter pylori?

    A. It is associated with gastric carcinoma
    B. It is associated with gastric lymphoma
    C. Gastritis
    D. Gastro-oesophageal reflux***
    E. Prepyloric ulcers


    8. Regarding angioplasty alone versus stent insertion, which one is true?

    A. Decreased restenosis but no increase in acute complications
    B. Stents should only be used if angioplasty has failed
    C. Stents are contraindicated in severe multivessel disease
    D. Decreased complications but not decreased re-stenosis rate ***


    9. A man , 56y old, had a *swollen knee. The aspiration shows cloudy fluid,
    neutrophils++++ and *no bacteria on microscopy and culture. What is the most
    likely diagnosis?

    A. Septic arthritis ???
    B. Reiter's***
    C. Gout
    D. Rheumatoid arthritis


    10. With regards to colorectal carcinoma which is correct?

    A. Over 50% of cancers detected with screening are Dukes A
    B. Flexible sigmoidoscopy picks up more than 40%
    C. Faecal occult blood testing is good screenining for the population ***
    D. 20% will be missed by faecal occult blood because the cancer is not bleeding at the time****
    E. Most of cancers do not arrise from villous adenomata


    11. Regarding a serum lipid profile and diet what is true:

    A.
    B.Olive oil will increase the LDL/HDL ratio
    C.Positive energy balances increase LDH
    D.100-300g of Fish per week will have no effect on plasma or membranes
    E. An increase in dietary Saturated fatty acids will increase VLDL ***


    12. Pulmonary hypertension and cor pulmonale are frequently secondary to:

    A. Emphysema ***
    B. Bronchiectasis


    13. A 60y old woman with along history of smoking presented with dyspnoea.
    On examination there were bibasal crepitations. FEV1 and FVC were both
    severely reduced but the ratio (not given but calculated) was 80%. What is
    the most likely dignosis?

    A. Fibrosing alveolitis***
    B. Interstitial lung disease
    C. Bronchogenic carcinoma
    D. Decreased lung compliance


    14. Photo of a diabetic leg that was red and shiny. What is the best treatment.
    A. Penicillin and flucloxacillin ***
    B. Penicillin and gentamicin
    C. Penicillin, gentamicin and metronidazole
    D. Metronidazole
    E. Ampicillin and gentamicin


    15. A 36 year old primigravida is worried about Down's syndrome. Which of the
    Following investigations is the *most specific and at the same time has the *lowest risk
    for the fetus?
    A. Maternal screening at 16 weeks gestation
    B. Amniocentesis at 18 weeks
    C. CVB at 12 weeks
    D. Ultrasound at 11 weeks to look for nuchal thickening ***
    E. Cordiocentesis at 24 weeks


    16.A woman of 48 years that had a CIN lesion removed 10 years ago and has
    recently had a hysterectomy but has left her ovaries left. Which of the
    following is *not true?
    A. Women that have had this type of operation have less chance of getting
    cancer of the ovaries than women that have not had this operation ***
    B. She will need to have vaginal vault smears every 2 years
    C. She will enter menopause at the normal age, perhaps just a little earlier.
    D. Oestrogen therapy will be beneficial to her when she enters menopause


    17. A 52 year old woman that has had a hysterectomy and a post operative
    DVT, comes to see you complaining of severe hot flushes . Which of the
    following would you recommend?
    A. The combined oral contraceptive pill
    B. Oestrogen transdermal patches
    C. Low dose oestrogen therapy per os ***
    D. Oestrogen and progesterone transdermal patch
    E. Progesterone therapy only



    18. A 18 y old female who has had multiple partner during last year, coming
    to you due to vaginal discharge.All of the following is true except:

    A. take HIV test.
    B. take endocervical swab for gonnorrhea
    C. take a swab from the posterior fornix for Chlamydia
    D.Treat sexual partner***
    E. Cervical smear cytology


    19. a 28-y old woman, G2, P 1 with a normal vaginal delivery in the past
    .Now pregnant in 37 week and comes to the delivery ward for induction due to
    pre-eclampsia.The baby lies longitudinal, cephalic, not engaged. At this
    time you rupture the membrane and give the patiente a syntocynon-infusion.
    In relation to the start of first uterine contraction the fetus has
    bradycardia of 60 .What do you do next:

    A. cesarian section
    B. Do abdominal CTG ***?
    C. Do vaginal examination ??
    D. just observe
    E. Oxytocin

    20. A woman after 10 h of obstructive labour delivers by cesarian section.
    3 days after she develops fever 37.9C What is the **least likely:

    A. UTI
    B. wound haematoma
    C. DVT
    D. endometrial infection
    E. engorgement of the breast ***?



    21. A mother brings her 4 year old girl with intermittent yellow vaginal
    discharge. In the examination you find that the vulva is normal structurely
    except little red and the girl tend to put the hand to the area, with sign
    of scratching. What is the most likely diagnosis:

    A. foreign body ***
    B. monilial infection.
    C. Gardarella vaginalis
    C. syphilis
    E. sexual abuse


    22. A woman who has previously delivered a 4 kg baby with troublesome, is
    now *33wks pregnant with breech presentation. You should do all the following
    *except

    A. Do x-ray for pelvimetry
    B. cesarean section if the baby > 4 kg *??
    C. may be you can try a normal delivery if the baby is <3.8kg, is in frank
    or complete breech
    D. Do a US to measure fetal size and position



    23. 37 weeks of pregnancy, with vaginal bleeding of 900ml. Haemoglobin
    decreased (6.8) BP 130/80. Examination uterus is tender and fetal dead is
    observed. Management should include all the following *except:
    A. US
    B. Anticoagulation profile
    C. If RH negative, give haemoglobin
    D. Blood transfusion and immediate surgery***
    E. Oxytocin infusion


    8. Regarding the interaction between GP's in Australia and psychiatric
    disorders, which of the following is true?
    A. One third of patients that present for primary care have a psychiatric
    disorder
    B. Most of the patients are not referred to a psychiatrist
    C. Alcohol and drug abuse are commonly overlooked by GP"s



    24.. Which of the following is a bad prognostic factor for a woman with
    diabetes mellitus and a history of depression of having a relapse?
    A. Hypertension
    B. Previous H.R.T.
    C. Previous history of alcohol abuse
    D. Previous good results with electroconvulsive therapy
    ???

    25. A 20 year old woman with IDDM and repeated episodes of "accidental" overdose
    of insulin was referred to the Psychiatric department by the department of
    General medicine. You find that she is a severe borderline case. Which of
    the following is true?
    A. The Physicians and Psychiatrists should work together closely on this
    case to reduce the risk of counter transference ***
    B. Recommend immediate psychotherapy
    C. Get a court order to make sure that she treats her diabetes properly
    D. Do not prescribe a phenothiazine
    E. Change her therapy from insulin to oral hypoglycaemics
  16. Dr.Sandra

    Dr.Sandra Guest

    Q1. What is the drug of choice to control supraventricular tachycardia?
    a) Adenosine ***
    b) Propranolol
    c) Verapamil
    d) Digoxin

    Q2. A 5 year old child is rushed to casualty reportedly electrocuted while playing in a park. The child is *apneic and is ventilated with bag mask. There are burns on each hand. What will be the next step in the management?
    a) Check pulses
    b) Start chest compressions
    c) Intubate ***
    d) Check oxygen

    Q3. Recurrent respiratory tract infections may occur in all of the following except:
    a) Ventricular sepal defect
    b) Tetrology of fallot ***
    c) Transposition of great arteries
    d) Total anomalous venous return

    Q4. A 6 month old boy weighting 3.2 kg presents with recurrent vomiting and polyuria Investigations show blood urea 60 mg/dL creatinine 0.7 mg/dL, calcium 12.8 mg/dL, phosphate 3 mg/dL, pH 7.45, bicarbonate 25 mEq/L and PTH 140 pg/ml (normal<60 pg/ml). Daily urinary calcium excretion is reduced. Ultrasound abdomen show bilateral nephrocalcinosis. The most likely diagnosis is:
    a) Bartter syndrome
    b) Mutation of the calcium sensing receptor.
    c) Pseudo-pseudohypoparathyroidism
    d) Parathyroid adenoma ***

    Q5. A female child has recently learned to eat with spoon without spilling; to dress and undress hereself with supervision; and to understand that she is a girl. These skills are FIRST mastered between the ages of:
    a) 2 & 3 years ***
    b) 3 & 4 years
    c) 4 & 5 years
    d) 5 & 6 years
  17. Dr.Sandra

    Dr.Sandra Guest

    1. False sense of perception without any external object or stimulus is known as:
    1. Illusion.
    2. Impulse.
    3.Hallucination.
    4. Phobia.

    2. A young female presents with history of dyspnoea on exertion. On examination, she has wide, fixed split of S2 with ejection systolic murmur (III/VI) in left second intercostals space. Her EKG shows left axis deviation. The most probable diagnosis is :
    1. Total anomalous pulmonary venous drainge.
    2. Tricuspid atresia.
    3. Ostium primum atrial septal defect.
    4. Ventricular septal defect with pulmonary arterial hypertension.

    3. A 62 years old man with caracioma of lung presented to emergency department with respiratory distress. His EKG showed electrical alternans. The most likely diagnosis is :
    1. Pneumothorax.
    2. Pleural effusion.
    3. Cardiac tamponade.
    4. Constrictive pericarditis.

    4. Atrial fibrillation may occur in all of the following conditions, except:
    1. Mitral stenosis.
    2. Hypothyroidism.
    3. Dilated cardiomyopathy.
    4. Mitral regurgitation.

    5. A patient with recent-onset primary generalized epilepsy develops drug reaction and skin rash due to phenytoin sodium, The most appropriate course of action is :
    1. Shift to clonazepam.
    2. Restart phenytoin sodium after 2 weeks.
    3. Shift to sodium valproate.
    4. Shift to ethosuximide.

    6. A patient undergoing surgery suddenly develops hypotension. The monitor shows that the end tidal carbon dioxide has decreased abruptly by 15mmHg. What is the probable diagnosis?
    1. Hypothermia.
    2. Pulmonary embolism
    3. Massive fluid deficit
    4. Myocardial depression due to anesthetic agents.

    7. Which of the following marker in the blood is the most reliable indicator of recent hepatitis B- infection?
    1. HBsAg
    2. lgG anti - HBs
    3. lgM anti - HBc
    4. lgM anti – Hbe

    8. The risk of developing infective endocarditis is the least in a patient with:
    1. Small ventricular septal defect
    2. Severe aortic regurgitation.
    3. Severe mitral regurgitation
    4. Large atrial septal defect.

    9. A 20 year old male had pain abdomen and mild fever followed by gastroenteritis. The stool examination showed presence of pus cells and RBCs on microscopy. The etiological agent responsible is most likely to be:
    1. Enteroinvasive E. coli.
    2. Enterotoxigenic E. coli.
    3. Enteropathiogenic E. coli.
    4. Enetroaggregative E. coli.

    10. In triple screening test for Down's syndrome during pregnancy all of the following are included except.
    1. Serum beta hCG
    2. Serum oestriol
    3. Maternal serum Alfa fetoprotein
    4. Acetyl cholinesterase

    11.An optic nerve injury may result in all of the following except.
    1. Loss of vision in that eye.
    2. Dilatation of pupil.
    3. Ptosis
    4. Loss of light reflex.

    12.Father to son inheritance is never seen in case of:
    1. Autosomal dominant inheritance
    2. Autosomal recessive inheritance
    3. X- linked recessive inheritance
    4. Multifactorial inheritance

    13. A 3- year old boy is detected to have bilateral renal calculi. Metabolic evaluation confirms the presence of marked hypercalciuria with normal blood levels of calcium, magnesium, phosphate, uric acid and creatinine. A diagnosis of idiopathic hypercalciuria is made. The dietary management includes all, except
    1. Increased water intake
    2. Low sodium diet
    3. Reduced calcium intake
    4. Avoid meat proteins.

    14. All of the following are characteristic features of Kwashiorkor, except :
    1. High blood osmolarity.
    2. Hypoalbuminemia.
    3. Edema.
    4. Fatty liver.

    15. A 55-year-old male accident victim in casualty urgently needs blood. The blood bank is unable to determine his ABO group, as his red cell group and plasma group do not match. Emergency transfusion of patient should be with:
    1. RBC corresponding to his red cell group and colloids/crystalloid.
    2. Whole blood corresponding to his plasma group.
    3. O positive RBC and colloids/ crystalloid.
    4. AB negative whole blood.

    16. Although more than 400 blood groups have been identified, the ABO blood group system remains the most important in clinical medicine because. :
    1. It was the blood group system to be discovered.
    2. It has four different blood groups A, B, AB, O(H).
    3. ABO (H) antigens are present in most body tissues and fluids.
    4. ABO (H) antibodies are invariably present in plasma when persons RBC lacks the corresponding antigen.

    17.After a minor head injury a young patient was unable to close his left eye and had drooling of saliva from left angle of mouth. He is suffering from :
    1. VIIth nerve injury.
    2. Vth nerve injury.
    3. IIIrd nerve injury.
    4. Combined VIIth and IIIrd nerve injury.

    18. Which one of the following does not produce cyanosis in the first year of life. :
    1. Atrial septal defect.
    2. Hypoplastic left heart syndrome.
    3. Truncus arteriosus.
    4. Double outlet right ventricle.

    19. The following drug is indicated in the treatment of pityriasis versicolar :
    1. Ketoconazole.
    2. Metronidazole.
    3. Griseofulvin.
    4. Chloroquine.

    20. A patient was administered epidural Anaesthesia with 15ml 1.5% lignocaine with adrenaline for hernia surgery. He developed hypotension and respiratory depression within 3 minutes after administration of block. The commonest cause would be.
    1. Allergy to drug administered.
    2. Systemic toxicity to drug administered.
    3. Patient got vasovagal shock.
    4. Drug has entered the sub arachnoid space.

    21. A 60 year old hypertensive patient on Angiotensin II receptor antagonists (losartan) is posted for hernia repair surgery. The anti-hypertensive drug should be :
    1. Continued till the day of operation.
    2. Discontinued 24 hrs. preoperatively.
    3. Discontinued one week preoperatively.
    4. Administered in an increased dosage on the day of operation.

    22. A 'Malignant pustule' is a term used for
    1. An infected malignant melanoma
    2. A carbuncle
    3. A rapidly spreading rodent ulcer.
    4. Anthrax of skin

    23. A warthin's tumour is:
    1. An adenolymphoma of parotid gland
    2. A pleomorphic adenoma of the parotid
    3. A carcinoma of the parotid.
    4. A carcinoma of submandibular salivary gland

    24. Hypocalcaemia characterized by all except.
    1. Numbness and tingling of circumoral region.
    2. Hyperactive tendon reflexes and positive Chvostek's sign.
    3. Shortening of Q-T interval in ECG.
    4. Carpopedal spasm

    25. Which of the following not true of gas gangrene.
    1. It is caused by clostridium perfringens
    2. Clostridium Perfringens is a gram-negative spore-bearing bacillus.
    3. Gas gangrene is characterized by severe local pain crepitus and signs of toxemia.
    4. High dose penicillin and aggressive debridement of affected tissue is the treatment of established infection.

    Obs and Gynae
    G1. The commonest cause of occipito- posterior position of fetal head during labour is:
    1.Maternal obesity
    2.Deflexion of fetal head
    3.Multiparity
    4.Android pelvis.

    G2. The commonest cause of breech presentation is
    1. Prematurity
    2. Hydrocephalus
    3. Placenta previa
    4. Polyhydramnios

    G3. The commonest congenital anomaly seen in pregnancy with diabetes mellitus is
    1. Multicystic kidneys
    2. Oesophageal atresia
    3. Neural tube defect
    4. Enalapril

    G4. Use of which of the following drug is contra-indicated in pregnancy.
    1. Digoxin
    2. Nifedipine
    3. Amoxycillin
    4. Ealapril

    G5. A 21 year old primigravida is admitted at 39 weeks gestation with painless antepartum haemorrhage. On examination uterus is soft, non tender and head engaged. The management for her would be:
    1. Blood transfusion and sedatives.
    2. A speculum examination
    3. Pelvic examination in OT
    4. Tocolysis and sedatives.

    G6. The treatment of choice for stage 1 cancer larynx is:
    1. Radical Surgery.
    2. Chemotherapy.
    3. Radiotherapy.
    4. Surgery followed by radiotherapy.

    G7. The following statements regarding Turner syndrome are true except.
    1. Occurrence of Turner syndrome is influenced by material age.
    2. Most patients have primary amenorrhoea.
    3. Most patients have short stature.
    4. Edema of hands and feet is an important feature during infancy.

    G8. Peroconceptional use of the following agent leads to reduced incidence of neural tube defects :
    1. Folic acid.
    2. Iron.
    3. Calcium.
    4. Vitamin A.

    G9. Use of tamoxifen in carcinoma of breast patients does not lead to the following side effects.
    1. Thromboembolic events
    2. Endometrial Carcinoma
    3. Cataract
    4. Cancer in opposite breast

    G10. The level of alpha fetoprotein is raised in all of the following except.
    1. Cirrohosis of liver.
    2. Hepatocellur carcinoma
    3. Yolksac tumor
    4. Dysgerminoma

    G11.What will be the BMI of a woman whose weight is 89 kg and height is 172 cm:
    1 27.
    2 30.
    3 33.
    4 36.

    Q12. A 36-year-old factory worker developed itchy, annular scaly plaques in both groins.
    Application of a corticosteroid ointment led to temporary relief but the plaques continued to extend at the periphery. The most likely diagnosis is:
    1 Erythema annulare centrifugum.
    2 Granuloma annulare.
    3 Annular lichen planus.
    4 Tinea cruris.

    Q13. A 16-year-old boy presented with asymptomatic, multiple, erythematous, annular lesions with a collarettes of scales at the periphery of the lesions present on the trunk. The most likely diagnosis is:
    1 Pityriasis versicolor.
    2 Pityriasis alba.
    3 Pityriasis rosea.
    4 Pityriasis rubra pilaris.

    Q14. A 40-year-old woman presents with a 2-year history of erythematous papulopustular lesions on the convexities of the face. There is a background of erythema and telangiectasia. The most likely diagnosis in the patient is:
    1 Acne vulgaris.
    2 Rossacea.
    3 Systemic lupus erythematosus.
    4 Polymorphic light eruption.

    Q15. A 27-year old sexually active male develops a vesiculobullous lesion on the glans soon after taking tablet paracetamol for fever. The lesion healed with hyperpigmentation. The most likely diagnosis is:
    1 Behcet’s syndrome.
    2 Herpes genitalis.
    3 Fixed drug eruption.
    4 Pemphigus vulgaris.

    Paediatrics
    PA1. In neonatal screening programme for detection of congenital hypothyroidism, the ideal place and time to collect the blood sample for TSH estimation is :
    1. Cord blood at time of birth.
    2. Heal pad blood at the time of birth.
    3. Heal pad blood on 4 day of birth.
    4. Peripheral venous blood on 28 day.

    PA2. A three years old boy presents with poor urinary stream. Most likely cause is :
    1. Stricture urethra.
    2. Neurogenic bladder.
    3. Urethral calculus.
    4. Posterior uretral valves.

    PA3. The treatment of choice for primary grade V vesico-ureteric reflux involving both kidneys in a 6 month old boy is:
    1. Antibiotic prophylaxis.
    2. Ureteric reimplantation.
    3. Cystoscopy followed by subureteric injection of teflon.
    4. Bilateral ureterostomies.

    PA4. Regarding neonatal circumcision, which one of the following is true :
    1. It should be done without Anaesthesia , as it is hazardous to give Anaesthesia .
    2. It should be done without anesthesia, as neonates do not perceive pain as adult.
    3. It should be done under local Anaesthesia only.
    4. General Anaesthesia should be given to neonate for circumcision as they also feel pain as adult.

    PA5. The treatment of choice in Attention Deficit Hyperactivity Disorder is :
    1. Haloperidol.
    2. Imipramine.
    3. Methylphenidate.
    4. Alprazolam.

    PA6. Hypochloremia hypokalemia and alkalosis are seen in:
    1. Congenital hypertrophic pyloric stenosis
    2. Hirschsprung's disease.
    3. Esophageal atresia
    4. Jejunal atresia

    PA7. A newborn baby had normal APGAR score at birth and developed excessive frothing and choking on attempted feeds. The investigation of choice is:
    1. Esophagoscopy
    2. Bronchoscopy
    3. MRI chest
    4. X-ray chest and abdomen with the red rubber catheter passed per orally into esophagus

    PA8. A new born baby has been referred to the casualty as a case of congenital diaphragmatic hernia. The first clinical intervention is to:
    1. Insert a central venous pressure line.
    2. Bag and mask ventilation
    3. Insert a nasogastric tube.
    4. Ventilate with high frequency ventilator

    PA9.One year old male child is presented with poor urinary stream since birth. The investigation of choice for evaluation is:
    1. Voiding cystourethrography (VCUG)
    2. USG bladder
    3. Intravenous urography
    4. Uroflowmetry

    PA10. Eisenmenger syndrome is characterized by all except:
    1. Return of left ventricle and right ventricle to normal size.
    2. Pulmonary veins not distended.
    3. Pruning of peripheral pulmonary arteries.
    4. Dilatation of central pulmonary arteries.

    PA11. Which one of the following is the common cause of congenital
    Hydrocephalus is?
    1 Craniosynostosis.
    2 Intra uterine meningitis
    3 Aqueductal stenosis
    4 Malformations of great vein of Galen.

    PA12. The most common malignant neoplasm of infancy is:
    1 Malignant Teratoma.
    2 Neuroblastoma.
    3 Wilms’ tumor.
    4 Hepatoblastoma.

    PA13. The most common presentation of a child with Wilm’s tumor is:
    1 An asymptomatic abdominal mass.
    2 Hematuria.
    3 Hypertension.
    4 Hemoptysis due to pulmonary secondary.

    PA14. The protective effects of breast milk are known to be associated with:
    1 Ig M antibodies.
    2 Lysozyme.
    3 Mast cells.
    4 Ig A antibodies.

    PA15. All of the following statements are true about Congenital Rubella except:
    1 It is diagnosed when the infant has IgM antibodies at birth.
    2 It is diagnosed when IgG antibodies persist for more than 6 months.
    3 Most common congenital defects are deafness, cardiac malformations and cataract.
    4 Infection after 16 weeks of gestation results in major congenital defects.

    Psychiataries
    PS1. A middle aged man presented with pain in back, lack of interest i recreational activities, low mood, lethargy, decreased sleep and appetite for two months. There was no history suggestive of delusions of hallucinations. He did not suffer from any chronic medical illness. There was no family history of psytchiatric illness. Routine investigations including haemogram, renal function tests, liver function testsm electrocadiogram did not reveal any abnormality. This patient should be treated with :
    1. Haloparidol.
    2. Sertraline.
    3. Alprazolam.
    4. Olanzapine.

    PS2. The following is a Schneider's first rank symptom :
    1. Persecutory delusion.
    2. Voices commenting on actions.
    3. Delusion of guilt.
    4. Incoherence.

    PS3. An elderly house wife lost her husband who died suddenly of Myocardial infarction couple of years ago. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. This however, provoked anxiety and sadness of mood where she was preoccupied with his thought. She should be treated with:
    1. Clomipramine.
    2. Alprazolam.
    3. Electroconvulsive therapy.
    4. Haloperidol.

    PS4. Yawning is a common feature of
    1. Alcohol withdrawal
    2. Cocaine withdrawal
    3. Cannabis withdrawal
    4. Opioid withdrawal

    PS5.A 40 year old male, with history of daily alcohol consumption for the last 7 years, is brought to the hospital emergency room with acute onset of seeing snakes all around him in the room, not recognizing family members, violent behavior and tremulousness for few hours. There is history of his having missed the alcohol drink since 2 days. Examination reveals increased blood pressure, tremors, increased psychomotor activity, fearful affect, hallucinatory behavior, disorientation, impaired judgement and insight. He is most likely to be suffering from:
    1. Alcoholic hallucinosis.
    2. Delirium tremens.
    3. Wernicke encephalopathy.
    4. Korsakoff’s psychosis.

    PS6. A 45 year male with a history of alcohol dependence presents with confusion, nystagmus and ataxia. Examination reveals 6th cranial nerve weakness. He is most likely to be suffering from:
    1. Korsakoff’s psychosis.
    2. Wernicke’s encephalopathy.
    3. De Clerambault syndrome.
    4. Delirium tremens.

    PS7. A 25year old female presents with 2year history of repetitive, irresistible thoughts of contamination with dirt associated with repetitive hand washing. She reports these thoughts to be her own and distressing; but is not able to overcome them along with medications. She is most likely to benefit from which of the following therapies:
    1. Exposure and response prevention.
    2. Systematic desensitization.
    3. Assertiveness training.
    4. Sensate focusing.

    PS8. An 18 year old boy came to the Psychiatry OPD with a complaint of feeling changed from inside. He described himself as feeling strange as if he is different from his normal self. He was very tense and anxious yet could not point out the precise change in him. This phenomena is best called as:
    1. Delusional mood.
    2. Depersonalization.
    3. Autochthonous delusion.
    4. Over valued idea.

    PS9. Dry mouth during antidepressant therapy is caused by blockade of:
    1. Muscarinic acetylcholine receptors.
    2. Serotonergic receptors.
    3. Dopaminergic receptors.
    4. GABA receptors.

    PS10. An 18-year-old student complains of lack of interest in studies for last 6 months. He has frequent quarrels with his parents and has frequent headaches. The most appropriate clinical approach would be to:
    1. Leave him as normal adolescent problem.
    2. Rule out depression.
    3. Rule out migraine.
    4. Rule out an oppositional defiant disorder.

    PS11. Preservation is:
    1. Persistent and inappropriate repletion of the same thoughts.
    2. When a patient feels very distressed about it.
    3. Characteristic of schizophrenia.
    4. Characteristic of obsessive compulsive disorder (OCD)

    PS12. One of the following usually differentiates hysterical symptoms from hypochondriacal symptoms:
    1. Symptoms do not normally reflect understandable physiological or pathological mechanisms.
    2. Physical symptoms are prominent which are not explained by organic factors.
    3. Personality traits are significant.
    4. Symptoms run a chronic course.

    Q13. .55 In which of the following conditions Splenectomy is not useful?
    1 Hereditary spherocytosis.
    2 Porphyria.
    3 Thalassemia.
    4 Sickle cell disease with large spleen.

    Q14. The following is ideal for the treatment with injection of sclerosing agents.
    1 External hemorrhoids.
    2 Internal hemorrhoids.
    3 Prolapsed hemorrhoids.
    4 Strangulated hemorrhoids.

    Q15. In an adult male, on per rectal examination, the following structures can be felt anteriorly except:
    1 Internal iliac lymph nodes.
    2 Bulb of the penis.
    3 Prostate.
    4 Seminal vesicle when enlarged.


    23. 37 weeks of pregnancy, with vaginal bleeding of 900ml. Haemoglobin
    decreased (6.8) BP 130/80. Examination uterus is tender and fetal dead is
    observed. Management should include all the following ****except:
    A. US
    B. Anticoagulation profile
    C. If RH negative, give haemoglobin
    D. Blood transfusion and immediate surgery
    E. Oxytocin infusion****
  18. Dr.Sandra

    Dr.Sandra Guest

    Q1. What is the drug of choice to control supraventricular tachycardia?
    a) Adenosine****
    b) Propranolol
    c) Verapamil
    d) Digoxin

    Q2. A 5 year old child is rushed to casualty reportedly electrocuted while playing in a park. The child is apneic and is ventilated with bag mask. There are burns on each hand. What will be the next step in the management?
    a) Check pulses
    b) Start chest compressions****
    c) Intubate
    d) Check oxygen


    * First, remove the patient from the circuit.

    * Patients who are in arrest then require basic and advanced cardiac life-support regimens. In electrically induced arrest, no underlying disease caused the arrest. Therefore, protracted efforts of resuscitation are met with success more often than with disease-caused arrest.

    * Patients who are unconscious but not in arrest require careful ventilatory observation and assistance, if indicated.

    * Patients with burns above the neck require supplemental oxygen and intubation because of the high probability of airway and lung damage.

    * Secondary blunt trauma often is encountered owing to falls caused by involuntary muscular contraction. It is dealt with identically to any other blunt trauma.

    Q3. Recurrent respiratory tract infections may occur in all of the following except:
    a) Ventricular sepal defect
    b) Tetrology of fallot****
    c) Transposition of great arteries
    d) Total anomalous venous return

    in VSD :Frequent respiratory infections may occur secondary to the pulmonary congestion.
    so in TF we don't have pulmonary congestion. as a result i think the rik of respiratory infection is low, but i am not sure

    Q4. A 6 month old boy weighting 3.2 kg presents with recurrent vomiting and polyuria Investigations show blood urea 60 mg/dL creatinine 0.7 mg/dL, calcium 12.8 mg/dL, phosphate 3 mg/dL, pH 7.45, bicarbonate 25 mEq/L and PTH 140 pg/ml (normal<60 pg/ml). Daily urinary calcium excretion is reduced. Ultrasound abdomen show bilateral nephrocalcinosis. The most likely diagnosis is:
    a) Bartter syndrome
    b) Mutation of the calcium sensing receptor.
    c) Pseudo-pseudohypoparathyroidism
    d) Parathyroid adenoma****

    Q5. A female child has recently learned to eat with spoon without spilling; to dress and undress hereself with supervision; and to understand that she is a girl. These skills are FIRST mastered between the ages of:
    a) 2 & 3 years
    b) 3 & 4 years****
    c) 4 & 5 years
    d) 5 & 6 years
  19. Dr.Sandra

    Dr.Sandra Guest

    1. 37 weeks of pregnancy, with vaginal bleeding of 900ml. Haemoglobin
    decreased (6.8) BP 130/80. Examination *uterus is tender and fetal dead is
    observed. Management should include all the following ****except:
    A. US
    B. Anticoagulation profile
    C. If RH negative, give haemoglobin
    D. Blood transfusion and immediate surgery
    E. Oxytocin infusion****



    This Q. goes in favour of abrubtio placenta. Because placenta praevia is painless and there is no other history. in case of Ut rupture, risk factors are-- previous C/S, Obs . labour, high forceps delivery, internal version, breech extraction and mother may present as unexplained tacycardia, sudden maternal shock, cessation of contractions, disappearance of presenting part, fetal distress, continuous PPH with a well-contracted Ut. We can do all according to this Q. in case of Abruptio placenta except immediate surgery but we need to resuscitation to mother. Fetal death best management is maternal resuscitation followed by induction of labour, aiming for a vaginal delivery. If fetus is alive, immediate delivery by C/S.
  20. Dr.Sandra

    Dr.Sandra Guest

    Q1. A patient presents with lower gastrointestianal bleed. Sigmoidoscopy shows ulcers in the sigmoid. Biopsy from this area shows ulcers in the sigmoid. Biopsy from this area shows flaskshaped ulcers. Which of the following is the most appropriate treatment ?
    a) Intravenous ceftriaxone
    b) Intravenous metronidazole ***
    c) Intravenous steroids and sulphasalazine
    d) Hydrocortisone enema

    Q2. A 25-year old farmer presented with history of high grade fever for 7 days and altered sensorium for 2 days. On examination, he was comatosed and had conjunctival he4morrhage. Urgent investigations showed a hemoglobin of 11 gm/dl, serum bilirubin 8 mg/dl and urea 78 mg/dl. Peripheral blood smear was nagative for malarial parasite. What is the most likely diagnosis ?
    a) Brucelloswis
    b) Weil's disease ***
    c) Acute viral hepatities
    d) Q fever


    Q3. A 50-year old lady presented with history of pain upper abdomen, nausea and decreased appetite for 5 days. She had undergone cholecystectomy 2 years back. Her bilirubin was 10 mg/dl, SGOT 900 IU/I SGPT 700 IU/I and serum alkaline phophatase was 280 IU/I. What is the most likely diagnosis ?
    a) Acute pancreatitis
    b) Acute cholagits
    c) Acute viral hepatitis ***
    d) Posterior penetration of peptic ulcer



    Q4. A 70- year old male patient presented to the emergency department with pain in epigastrium and difficulty in breathing for 6 hours. One examination, his heart rate was *56 per minute and the blood pressure was 106/60 mm Hg. Chest examination was normal. The patient has been taking omeprazole for gastroesophageal reflux disease for last 6 months. What should be the initial investigation ?
    a) An ECG Answer Inf wall MI***
    b) An upper GI endoscopy
    c) Urgent ultrasound of the abdomen
    d) An x-ray chest



    Q5. A 30-year old delivered a healthy baby at 37 week of gestation. She was a known case of chronic hepatitis B infection. She was positive for HBs Ag but negative for HBeAg. Which of the following is the most appropriate treatment for the baby ?
    a) Both active and passive immunization soon after birth.****
    b) Passive immunization soon after birth and active immunization at 1 year of age.
    c) Only passive immunization soon after birth.
    d) Only active immunization soon after birth
  21. Dr.Jova.

    Dr.Jova. Guest

    A 17 year old high school senior comes to the clinic because of pain during her menses for the past 2 years. She describes the pain as crampy, felt in the lower abdomen and radiating to the back. She says it is most severe the second day of the flow and subsides thereafter. Her medical history shows that menarche was at age 14 years. Physical examination is normal. The most appropriate next step is to

    a) begin a therapeutic trial of aspirin
    b) begin a therapeutic trial of ibuprofen
    c) determine serum CA-125 concentration
    d) do diagnostic laparoscopy
    e) do a dilatation and curettage
    View Answer B: Begin a therapeutic trial of ibuprofen



    Dysmenorrhea, "painful menstruation" is the chief complaint of this
    17 y/o pt. She experiences a typically
    lower abdominal pain consistently on the second day of menstruation, and
    apparently at no other interval. The
    pain irradiation to the back is probably a "red herring" as nothing else
    in the Hx suggest otherwise.
    Other remote possibilites on a differential dx of dysmenorrhea
    (secondary):
    * chronic PID - pt not sexually acive (?)
    * intrauterine device
    * leiomyomas - pt is too young
    * endometriosis - " "
    - interestingly enough this pt's menarche was 2 years ago, primary
    dysmenorrhea usually presents 2 years after
    the onset of menses.
    *An NSAID trial could prove beneficial since the cause for this type of
    "painful menst" is thought to be secondary
    to Pg-induced myometrial contractions.

    Estrogen therapy is an alternative, although beginning Ibuprofen a few
    days before the anticipated menses can often help.

    If the pt were older the endometriosis (a known cause of 2ary
    dysmenorrhea) would have been given greater consideration, and
    particularly if she had a Hx of "infertility."

    - CA-125 is often a "false +" in pre-menopausal women !!
  22. Dr.Jova.

    Dr.Jova. Guest

    12 year old girl is referred to the clinic by the school nurse for evaluation of scoliosis. Her scoliosis was detected during a routine screening examination at the school and appears mild (curve less than 10 degrees). She is athletic and is otherwise in good health. During the physical examination, particular attention should be given to:

    a) arm length
    b) blood pressure
    c) body weight
    d) cardiac examination
    e) stage of pubertal development

    View Answer E: Stage of pubertal development
    The term scoliosis denotes lateral curvature of the spine, which is always associated with some rotation of the involved vertebrae. Scoliosis is classified by its anatomic location, in either the thoracic or lumbar spine, with rare involvement of the cervical spine. The convexity of the curve is designated right or left. Thus, a right thoracic scoliosis would denote a thoracic curve in which the convexity is to the right; this is the most common type of idiopathic curve. Posterior curvature of the spine (kyphosis) is normal in the thoracic area, although excessive curvature may become pathologic. Anterior curvature is called lordosis and is normal in the lumbar and cervical spines. Idiopathic scoliosis generally begins at about 8 or 10 years of age and progresses during growth. In rare instances, infantile scoliosis may be seen in children 2 years of age or less.

    Idiopathic scoliosis is about four or five times more common in girls than in boys. The disorder is usually asymptomatic in the adolescent years, but severe curvature may lead to impairment of pulmonary function in later years. It is important to examine the back of any adolescent coming in for a routine physical examination in order to identify scoliosis early. The examination is performed by having the patient bend forward 90 degrees with the hands joined in the midline. An abnormal finding consists of asymmetry of the height of the ribs or paravertebral muscles on one side, indicating rotation of the trunk associated with lateral curvature.

    Diseases that may be associated with scoliosis include neurofibromatosis, Marfan's syndrome, cerebral palsy, muscular dystrophy, poliomyelitis, and myelodysplasia. Neurologic examination should be performed in all children with scoliosis to determine whether these disorders are present.

    Five to 7% of cases of scoliosis are due to congenital vertebral anomalies such as a hemivertebral or unilateral vertebral bridge. These curves are more rigid than the more common idiopathic curve (see below) and will often increase with growth, especially during adolescence.

    Eighty percent of scoliosis is idiopathic. Since 30% of family members are also affected, siblings of an affected child should be examined.

    Idiopathic infantile scoliosis, occurring in children 2-4 years of age, is quite uncommon in the United States; it is more common in Great Britain. If the curvature is less than 30 degrees, the prognosis is excellent, as 70% resolve spontaneously. If the curvature is more than 30 degrees, there may be progression, and the prognosis is therefore guarded.

    Postural compensation of the spine may lead to lateral curvature from such causes as unequal length of the lower extremities. Sciatic scoliosis may result from pressure on the spinal cord or roots by infectious processes or herniation of the nucleus pulposus; the underlying cause must be sought. The curvature will resolve as the primary problem is treated.

    Treatment of scoliosis depends on curve magnitude, skeletal maturity, and risk of progression. Curvatures of less than 20 degrees usually do not require treatment unless they show progression
  23. Dr.Jova.

    Dr.Jova. Guest

    Which of the following tumor characteristics confers a poor prognosis in patients with breast cancer?

    A. Estrogen receptor-positive
    B. Good nuclear grade
    C. Low proportion of cells in S-phase
    D. Overexpression of erbB2 (HER-2/neu)
    E. Progesterone receptor-positive

    The answer is D.


    Pathologic staging remains the most important determinant of overall prognosis. Other prognostic factors have an impact on survival and the choice of therapy. Tumors that lack estrogen and/or progesterone receptors are more likely to recur. The presence of estrogen receptors, particularly in postmenopausal women, is also an important factor in determining adjuvant chemotherapy. Tumors with a high growth rate are associated with early relapse. Measurement of the proportion of cells in S-phase is a measure of the growth rate. Tumors with more than the median number of cells in S-phase have a higher risk of relapse and an improved response rate to chemotherapy. Histologically, tumors with a poor nuclear grade have a higher risk of recurrence than do tumors with a good nuclear grade. At the molecular level, tumors that overexpress erbB2 (HER-2/neu) or that have a mutated p53 gene portend a poorer prognosis for patients. The overexpression of erbB2 is also useful in designing optimal treatment regimens, and a human monoclonal antibody to erbB2 (Herceptin) has been developed
  24. Dr.Jova.

    Dr.Jova. Guest

    Stem cell gene therapy has been attempted in patients with a variety of medical conditions. To date, this technique has had the most clinical success in which of the following conditions?

    A. Thalassemia
    B. Gaucher disease
    C. Fanconi's anemia
    D. Severe combined immune deficiency (SCID)
    E. Wiscott-Aldrich syndrome (WAS)

    The answer is D.


    Stem cell therapy has held enormous promise for the last two decades. Stem cells are undifferentiated progenitors that can develop into highly specialized cells that form the various organs. Totipotent stem cells can form a placenta and can develop into a complete embryo. Pluripotent stem cells are capable of forming tissues derived from the three major germ-line layers: endoderm, mesoderm, and ectoderm. Multipotent stem cells are the progenitors of cells in particular tissues. Stem cells are self-renewing and may differentiate. The concept of correcting inborn genetic defects in stem cells has been the central theme in most gene therapy strategies for correcting congenital disorders. The success of bone marrow transplantation in the treatment of many congenital and acquired hematopoietic disorders has stimulated numerous attempts at gene therapy for those disorders. A variety of methods have been developed to transfer new genetic material into cells. Direct injection of DNA and gene transfer using viruses are two of the main methods. Adenoviral and adenovirus-associated viruses are effective vectors but do not integrate into the genome and do not often produce continued transcription. Retroviral and lentiviral vectors have been modified to remove the pathogenic sequences, leaving only the sequences that are important for integration. In 2000, the first successful stem cell gene therapy was reported. Cord blood CD34+ stem cells from X-SCID newborns were transduced with a c retrovirus vector. Approximately [snip]% of circulating T lymphocytes contained the vector in transduced patients, compared with less than 0.1% in myeloid cells, representing selective expression. Many of the patients responded to clinical vaccinations and have remained healthy. However, two recipients developed acute hematologic disorders resembling leukemia, indicating aberrant integration of the vector into the patient's genome. Further studies have been suspended as researchers attempt to discover ways to avoid random integration of vectors into sites that are oncogenic.
  25. Dr.Jova.

    Dr.Jova. Guest

    The tumor that most commonly metastasizes to the heart is

    A. melanoma
    B. non-Hodgkin's lymphoma
    C. Hodgkin's lymphoma
    D. breast
    E. renal cell

    The answer is A.


    Melanoma is the tumor most likely to metastasize to the heart, although the most common primaries originating from tumors of the heart are breast and lung owing to the high incidence of these tumors
  26. Dr.Jova.

    Dr.Jova. Guest

    An 84 year old woman is brought to the office by her daughter, who is your patient. The mother has just moved in whith the family because she can no longer take care for herself due to progressive, long-standing dementia. The daughter hopes you will help take care of her mother. On physical examination the mother has no evidence of any other chronic disease. She does not respond to your words or to the physical examination. You notice that she smells of urine. On examination of the pelvis there is a diffuse erythematous rash extending over the prineum to the medial pages bilaterally. You suspect the rash relates to urinary incontinence. The daughter is present at the mother's examination. The best opening remark to the daughter is:

    a) "You should take better care of your mother"
    b) "How long have you left your mother in this condition?"
    c) "Your mother needs to wear diapers"
    d) "This rash should respond to cleansing with mild soap and drying with a clean towel three times a day"
    e) "This is a rash caused by urine. My nurse wll insert a Foley catheter"

    Answer D: "This rash should respond to cleansing..."
  27. Guest

    Guest Guest

    :shock:

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