Medicine

March 2011

Medicine
1. A 50 year old man came to you for screening o f colon cancer. His younger brother was diagnosed
of colon cancer 2 weeks ago. What is your most appropriate next step regarding to his situation?
A Fecal Occult Blood Test
B sigmoidoscopy
C colonoscopy
2. What would be an indication for ERCP in a woman with h/o cholecystitis?
A small gallstones
B thickened gallbladder
C dilated bile duct >7mm
3. a CT similar to this one found in google

A hepatic hydatid
B hepatocellular Ca
4. CT scan similar to this

A cerebral infarct
B cerebral abscess
C cerebral tumor
5. Picture o f fundoscope with A V nipping& flame-shaped haemorrhage. What is the Dx?
A . Diabetic retinopathy
B . Hypertensive retinopathy
C. Chronic Renal failure

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March 2011
D. CRAO
E. CRVO

6. Picture from A M C handbook 2.102

A n 72 yr old woman presents with a vesicular rash associated with burning pain.The rash has been
present for past 4 days & increasingly painful.Which of the following drugs should be given?
A . Oral acyclovir
B . IV famcyclovir
C. I M immunoglobulin
D . Oral Phenergan(Prometharzine)
E. continued analgesia
7. With regards to CPR,which of the following is correct?
A . there are 2 breaths in 5 compresions
B . the site of compression is the middle of the sternum
C. There is at least 100 compressions in 1 minute
D . the depth of the compression is 2cm.
8. Prophylactic treatment of Malaria
A . Doxycycline
B. Mefloquine i f febrile
C. Chloroquine & Mefloquine
D . Chloroquine & Quinine
9. Chest X-ray o f a 60 yr old man non-smoker,coal miner..What is the diagnosis?
A . Mesothelioma
B. Bronchogenic carcinoma
C. Silicosis
D . Abestosis
10. A woman complaints o f shortness o f breath, tachyponea,tachycardia at 5 post-op day,ECG o f
S1Q3T3 is given.Which investigation is the best to do?
A. CT pulmonary angiogram
B. Venogram
C. Doppler
D. Chest X-Ray
th

11. A man with enlarged inguinal lymph nodes.In microscopic examination o f lymph nodes,there are
malignant calls SCC origin.What is the primary site?
A. Stomach
B . Rectum
CAnus
D. Lung
12. A 70 yr old woman presents with painless lump in the cervical region.In microscopic
examination,there are malignant cells of SCC origin. What is the primary site?
A. Stomach
B. Breast
C. Bronchus
D. Rectum
13. A man with C O A D complaints of dysponea.Oxygen is given.What is his blood gas analysis?

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March 2011
A. P02
B. P02
C. P02
D . P02

102 m m H g , PC02 60 mmHg , pH 7.2

42 m m H g , PC02 40 m m H g , p H 7.38
78 mmHg , PC02 32mmHg, p H 7.5
90 mmHg, PC02 30 mmHg ,PH 7.58

14. ECG of ventricular tachycardia is given. What is the treatment?

A . Amiodarone
B. Adenosine
C. Verapamil
No option of cardioversion
15. A 52 yr old man comes to the clinic for routine check-up.Recently,his cousin o f 48yr old is
diagnosed of HNPCC.Which investigation to be done?
A . Gene mutation test
B. Sigmoidoscopy
C. Proctoscopy
D . Colonoscopy
16. A n old man with family history o f Colon cancer. What is the initial investigation?
A . Colonoscopy
B. Sigmoidoscopy
CFecal occult blood testing
D.Proctoscopy
17. What is the most appropriate investigation to diagnose the colorectal cancer?
A . Sigmoidoscopy
B . Colonoscopy
C. Proctoscopy
D . Fetal occult blood test
18. A man presents with dysarthria,dysphagia,ptosis,impaired sensory in left side o f face & right side
of body,reduced motor activity i n right side of body .Where is the lesion?
A . Right basilar artery
B . Left vertebral artey
C. Midbraiin
D . Posterior Cerebral artery
19. A n elderly man presents with painless lump in RHC ,which moves with respiration & marked
jaundice,high-coloured urine,pale coloured stool.
On Lab investigation, ALP,GGT-increased
AST,ALT- nomal
What is the diagnosis?
A . Cholangitis
B . Hepatitis
C. Ca ampulla o f Verter
D . Pancreatitis
20. 60 year old man complaining of loin to groin pain had 3 previous similar episodes. Previous stones
were carbon oxalate. What is the best method to prevent reoccurrence?
A . Allopurinol
B. Calcium free diet
C. Low Sodium diet

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M a r c h 2011

D . Hydrothiazide
21. Optic fundi with dot haemorrhages (not emboli) = H T N
22. Optic fundi with classic cotton wool spots = Diabetic retinopathy
23. Patient with weakness of plantar flexion and inversion. What is the probable lesion?
A . L5
B . Tibial nerve
C. Common peroneal nerve
D . L3
24. A patient has normal anion gap metabolic acidosis. Serum K is low, Na is within normal range. He
has no diarrhea. You diagnosed he has type 1 renal tubular acidosis (RTA). Which of the following is
the cause?
a. Chronic active hepatitis
b. Diabetes
c. Multiple myeloma
25. A young patient lost the consciousness during exercise. He regained the consciousness after
someone did CPR to him. The patient's father also died from heart disease. Cardiac echo showed
hypertrophic obstructive cardiomyopathy (HOCM). Which o f the following is the initial treatment?
a. Digoxin
b. Spirolactone
c. Lidocaine
d. Beta blocker
e. Myocardial alcohol injection
26. What is the best treatment for recurrent perirectal fistulas in patients with Crohn's disease?
a. Infliximab
b. Surgery
c. Steroid
d. Mesalamine
27. Which of the following diseases is most likely to do colectomy?
a. Familial adenomatous polyposis
b. Gardner's syndrome
c. Lynch syndrome
d. Peutz-Jeghers syndrome
e. Juvenile polyposis
28. Which of the following should not be given to a patient with IgA deficiency?
a. Immunoglobulin (iv)
b. Prednisone
c. Pneumococcal vaccination
29. A mid aged patient had gastro esophageal reflux symptoms (GERD). Upper G I endoscopy showed
Barrett's esophagus. A biopsy revealed low grade dysplastic changes. What is the most appropriate
next step?
a. PPI and repeat endoscopy in 6 month
b. PPI and repeat endoscopy in 2 years
c. Endoscopic mucosal resection

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Medicine

d. Nissen fundoplication
e. Esophagectomy
30. A n elderly woman complains feeling tired for a couple of month. Physical examinations, including
vital signs are normal. She was healthy before. Laboratory study shows normal free T4 level, but high
TSH was noted. What is the best next step i n the management o f this patient?
a. Start Thyroxin treatment
b. Repeat thyroid function test i n 1 month
c. Check thyroid antibodies
d. Start Methimazole treatment
e. Reassure
31. A patient has polycystic kidney disease. Which of the following is associated with it?
a. Colon diverticulum
b. A V malformation i n the brain
c. Liver adenoma
d. Bicuspid aortic valve
32. A patient has hematuria that occurred after an U R I episode 2 weeks ago. You diagnosed poststreptococcal GN. Which o f the following laboratory result is correct?
a. Low C3
b. Postive anti-GBM
c. Postive c-ANCA
d. Postive p-ANCA
33. A man has headache around the eye and tearing, The headache worsens after drinking. There is no
vomiting noted. What is the Dx?
a. Migraine
b. Cluster headache
c. Tension headache
34. A mid-aged woman complains weakness and tingling o f her lower limbs bilaterally over the last
several days. She had the same symptoms many years ago, but they resolved completely. What is the
Dx?
a. Transient ischemic stroke (TLA)
b. Multiple sclerosis
c. Conversion disorder
d. Factious
e. Malingering
35. A patient is using Warfarin and his PT (INR) is 4.6. Brain CT shows ICH. What is the next step?
a. Reduce Warfarin dose
b. Stop Warfarin
c. Give V i t - K
d. Give FFP
e. Blood transfusion
36. A patient has Diabetic ketone acidosis ( D K A ) and his K level is 7. What is the initial
management?
a. Calcium gluconate
b. Insulin
c. Potassium supplyment
d. Sodium bicarbonate

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March 2011
e. Normal saline

37. A mid-aged patient has H T N with calcium channel blocker and diuretic treatment. Then, the
patient developed diabetes symptoms. Laboratory data showed urine glucose (+), urine ketone (-), and
high serum sugar level (more than 7). What is the most appropriate next step?
a. Stop the diuretic treatment
b. Check urine protein
c. Commence Insulin
38. A mid-aged man has impotence and loss o f libido. He also has headache at left front head. Blood
test reveals the testosterone is a bit low, but still within normal range. What is the next management?
a. Check serum estrogen level
b. Check serum prolactin level
c. Do thyroid function test
d. Check Cortisol level
e. CT scan
39. A patient is a chronic hepatitis B carrier. Laboratory studies show normal AST, Alk-P, AFP, but
mild elevated A L T . His E antigen was negative. What is the most appropriate test to follow him?
a. Check AFP and abdominal ultrasound per 6 month
b. Check A L T , AST, AFP per 6 month
c. Check Full blood count per 6 month
d. Check abdominal CT per 12 month
40. A mid-aged man has heart burn for 10 years. There is no vomiting or abdominal pain mentioned.
The symptom subsided after using some over the counter antacid and PPI. What is the most reliable
test for his condition?
a. Manometry
b. Endoscopy for esophagus and stomach
c. Endoscopic ultrasound
d. 24 hours esophageal PH monitoring
41. A man work in the mine industry for 20 years. He had chest pain and dyspnea. There was no
coughing blood noted. CXR showed pleural effusion and it's bloody when the fluid was aspirated.
What is the diagnosis?
a. Wegener's granulomatosi
b. Squamous lcell carcinoma
c. Goodpasture syndrome
d. Small cell lung cancer
e. Mesothelioma s
42. A patient has hereditary spherocytosis. What is the treatment?
a. Blood transfusion
b. Splenectomy
c. Steroid
d. Chemotherapy
e. Iron supplyment
43. A picture o f sebaceous cyst. What is the treatment?
a. Wide excision and lymph node
b. Wide excision
c. Local excision

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March 2011

44. A girl has been stung on her leg and now admitted with her leg swollen and she complained of
local itching . what is your management?
a. Oral promethazine
b. I m promethiazine
c. Intubation
d. Iv cortisone
e. I m adrenaline
45. What is the difference between haemolytic anaemia and chronic blood loss
a. Decreased reticulocytes
b. Increased reticulocytes
c. Decreased haptoglobulin
d. Increased haptoglobulin
e. Increased serum ferritin
46. A picture o f the fundus . what does it look like(looked more like hypertensive disease)
a. Macular degeneration
b. Grade 3 hypertensive retinopathy
c. Diabetic retinopathy
d. Central venous occlusion
e. Central retinal occlusion
47. A women who is seizure free for 2 years and on anti epileptic medication wants to get pregnant.
apart from stopping her medication what do you want to prescribe?
a. Vit B 12
b. Folic acid
c. Iron tablets
d. Calcium
e. Pyridoxine
48. A 45 year old man with COPD is admitted with h/o dyspnoea and breathlessness
He is on oxygen and his saturation is 8 1 % not improving with 6 Its of oxygen.
What do you do?
a. Intubate him
b. Decrease the oxygen level
c. Increase the oxygen level
d. Start bronchodialator
49. A 60 year old man taking ace inhibitor, digoxin and statin has been prescribed roxithromycin by
his GP. He now comes w i t h complaints of muscle aches and pain. What do you do?
a. Stop roxithromycin
b. Stop statin
c. Stop ace inhibitor
d. Increase roxithromycin
e. Give paracetamol

50. A women diagnosed with H O C M wants to know how she can protect her children and what she
has to do about screening?
a. ECHO every 5 years
b. Ecg every 5 years
c. Immunise
d. Ultrasound every 2 years

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March 2011
e. X ray

51. A n old man presents to the ED with history o f not passing urine for the past 2 days and
constipation for 1 day. On examination the bladder is enlarged. What do you do next to relieve the
symptoms?
a. Give laxatives
b. Uretheral catherisation
c. Suprapubic aspiration
d. Intravenous pyelography
e. Ct abdomen
52. A person comes with foot drop where is the lesion?
a. L4
b. L5
c. SI
d. L3
53. A 28 year old female presents to ED with severe chest pain not radiating . what is the appropriate
investigation?
a. Troponin level
b. Endoscopy
c. Ecg
d. Xray
e. Barium swallow
54. What is the chance o f a autosomal recessive disease in a single parent being inherited by the
offsprings?
a. 0.2
b. 0.5
c. 0.8
d. 0.4
e. 0.1
55. What kind o f inheritance in the pedigree
a. Autosomal dominant
b. Aotusomal recessive
c. X linked recessive
d. Mitochondrial inheritance
e. Multifactorial cause
56. a farmer presents to your clinic with a history of his cat scratching his arm some days back ,and
now with severe pain and swelling at the site on examination there is axillary lymphadenopathy.what
is this ?
a. Cat scratch disease
b. Brusellosis
c. Cellulitis
d. Bergers disease
e. Torulosis
57. most ominous sign o f arterial ischemia is
a. Pain
b. Paralysis
c. Ulcer

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March 2011
d. Decrease in temperature
e. Prominent veins

58. a 60 year old man on ACE inhibitor, thiazide diutetics presents with polyuria, polydypsia
Muscle weakness. His HBA1C is 9% .you
a. Do GTT
b. Start him on metformin
c. Start him on metformin
d. Stop A C E inhibitor
e. Stop thiazide diutetics
59. A 55 year old man presents with haziness o f vision for the past 24 hours but now lost his vision
completely .he also had head ache for the last 3 days. ESR is elevated. What is your management?
a. Start patient on antibiotics
b. Start on prednisolone
c. Give him NSAIDS
d. Do carotid artey Doppler
e. Post him for embolectomy
60. A patient complaints o f dyspnoea and breathlessness on the 4th post op day .
How do you investigate the condition?
a. CTPA
b. Echo
c. Sputum culture
d. ankle brachial index
e. pulseoxymetry
61. A patient is on digoxin,verapamil and thiazide diuretics presents presents to ED because o f
syncope . on examination his pulse is 42/min. How do you manage him?
a. Stop digoxin
b. Stop verapamil
c. Stop digoxin and verapamil
d. Stop thiazide diuretic
62. A 55 year old man man comes to your office after his father is diagnosed with colorectal cancer at
85 years o f age. he asks for screening. What is your advice?
a. No screening is required
b. Faecal occult blood testing
c. Colonoscopy and five-yearly intervals thereafter
d. Colonoscopy and yearly thereafter
63. there was a question about a business man who returns from bali with A S T
ALK

A A A

,ALT

A A A

64. There was a case o f anaphylaxis for nut in a carrot cake

65. 70 yr old lady presented with a thyroid enlargement ( pic o f a symetrical enlargement)
horseness o f voice present.
a) multinodular goitre
b) haemorrhage into a nodule
c) anaplastic carcinoma
66. PCM poisoning 20 yr old girl presented after ingestion o f 20 tablets 2 hrs ago. Presented to the
ED, waht is the most appropriate management?.

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March 2011
a) activated charcoal
b) epigag
c) N - acetyl cystine

67. 20 yr old university student recently returned from a visit to India, presented with abdominal pain.
A l l examination was normal. What is the most likely diagnosis?.
a) Giardia
b) entamaebia
c) Irritable bowl disease
d) D V T
68. scenario discribing h/o gout. Pt already on Gout medication. Sudden attack o f gout ( picture
showing gout tophi)
Initial management ?
a) allopurinal
b) paracetamol
c) colchicine
d) DMASRS
69. History of organomegaly
a) praderwilli syndrome
b) Downs syndrome
c) Turners syndrome
70. pt presents to you with coughing at night regurgitation after meals. Dry cough. Most appropriate
investigation is.
a) gastrograffin enema
b) barium swallow
c) endoscopy
d) proctoscopy
71. colonic cancer scenario. Brother diagnosed with colon cancer at 35 yrs. Next step in management.
a) FOBT
b) endoscopy
c) barium studies
d) Colonoscopy
72. Claudication pain in the buttocks, thigh and calf. Which is the affected artery?
a) Superficial femoral
b) Illiac artery
73. streptococcal infection - treatment
a) penicillin
b) flucoxane
c) ceftriaxone
d) ticoplanin
74. A man presented with bloody d'a (not very severe) ,Fever,abd.pain, fatigue, for 3 days. He has had
a meal in a salad bar with his friends. Now, they all have similar symptoms. Vital signs are normal.
Patient is alert. What is your next step in management?
a. Stool culture
b. Give lomatil
c. contact the restaurant and inform
d. contact the police
e. Inform the relevant health department

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March 2011

75. Care of Hep C ; WOF is correct;

a. No chronicity
b. No sexual transmission
c. best Rx supportive fluids only.
76. Pt. presented with the symptoms of Cor- Pulmonale Elevated JVP, chest pain, difficulty in
breathing , decreased BP , increased heart rate. Best management;
a. Oxygen
b. CXR
c. pulse oxymetry
d. CTPA
e. Cardiocentesis
77. A confused 55 yrs old confused man presented to the ED , with low BP , Tachycardia ECg; ST
elevation V 3 , V 4 Diagnosis Posterior MI What is the best management ?
1) Aspirin 2) oxygen 3) CXR 4) Beta blockers
78. Picture of a seb. keratosis

Page 123 blue book.

79. Pt with a L / chest pain , mid diastolic murmur at the apex.

1) MS 2) AS 3) Cor pulmonale 4) pericarditis

5)

Lobar pneumonia

80. A patient had dysphagia and dyspepsia . GE Reflux was confirmed by the esophageoscopy
Received Omeprazole, Amoxicillin and Metronidazole for 2/52 . 6/12 after stopping the treatment
they did urea breath test confirming h. pylori + ve.
The reason for not eradicating H.Pylori is;
1) short duration of the treatment 2) prolong duration of the post RX investigation
3) wrong combination of the Rx.
4)wrong diagnosis
81. A picture of CXR ; widened Mediastinum Pt presented with a severe chest pain
What is the best next treatment?
1) CTPA 2) CT Scan 3) MRI 4)
Lat view X Ray 5) US Sacn.
82. Prophylaxis for Malaria for a 18/52 pregnant lady;
1) Chloroquine 2) Doxycyclin 3) Quinine 4) Primaquine
83. 48 yes female, presented with tiredness , oliguria, and pallor. O/E pale , confused, Lab
results; LOW HB , MCV, MCHC, Calcium, Sodium, High K , B. Urea, S. creatinine
Best Rx;
1) IV Fluids
2) Cross match for the blood group 3) Pelvic CT 4) Renal Dialysis
84. 65 yrs old lady with diagnosed coronary heart failure, hypercholestremia, and Hypertension
Is on enalapril, metaprolol, statins. GP Prescribed NSAID for her RA 4/52 ago. Now presents
with fatigability, tiredness Lab test same as Q 26.
What is the best management?
1) Cease statins
3) Add diuretics
2)
Cease NSAIDS
4) Increase the dose of beta-blockers.
85. WOF least common site for an Arterial Ulcer?
1) Tip of the toes. 2 ) Dorsum of the foot. 3) Lat. margin of the foot.
4) Planter surface of the foot.
5) around the ankle.

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March 2011

86. 15 yrs old boy presented with redness,swelling and pain of L/testes, T - 37.8c O/E swollen,
tender , PR - ant, mass. What is the most probable diagnosis?
1) Hydrocele 2) Epididymus
3) varicocele 4) Orchitis
5) Inguinal Hernia
87. 58 yrs heavy alcoholic female presented with vomiting confusion, painful eye movements,
ataxia, nystagmus What is the diagnosis?
1) Wernicke's encephalopathy 2) Alzimers 3) stroke - ischemia 4) Liver cirrhosis
88. 45 yrs old lady presented with progressive muscle weakness of both UL+ LL , fatigue, episodes
of drowsiness, has had a chest infection 2/12 ago. O/E unable to move L/Eye downwards and
inwards. Best diagnostic method ;
1) LP 2) CT
3) SE
4)
MRI
5) CXR

89. 65 yrs male presented with R / hand weakness, confusion, irritability, inability to produce
words, but his thoughts were preserved. What is the diagnosis ?
1) Lacunar infarction 2 ) Ischemic stroke 3) CPA tumour
4) Parkinsonism
90. A middle aged man presented with fever ,rigors, tiredness and sweating O/E : pallor, enlarged
spleen, enlarged rubbery cervical LN Lab; LOW HB , Increased WBC . Normal platelets.
What is the probable diagnosis?
1) Lymphoma 2) CLL 3) ALL 4)
CML 5) Myeloma
91. ECG WPW Syndrome
92. At your GP clinic, a 35 yrs old male wants advise about CA Colon. His father had FAP and died
from the disease. What is your recommendation?
1) FOBT from the age of 45.
2) Reassure
3) Colonoscopy now
4) Colonoscopy at the age of 45.
93. WOF is the probable steps of management of the trachoma infection? Had chosen one out of
FISTO.
94. A mother brought her 7 yrs old daughter ,who has a few patches of hair loss. What could be the
diagnosis?
1) Alopecia Areata 2) Tinea Capities 3)Tinea Pedis 4) Tinea Manume
95. Question from the blue book page; 76 / 2.093
96. A man has a lesion on the skin and undergo a wide excision, show BCC,what is most important
prognosis cause of the patient?
a. histology of the cell
b. Width of the lesion
c. Thickness of the lesion
97. A patient has right upper quadrant pain and jaundice(can't remember there is fever or not),all the
liver enzyme are significantly increased(more than 10times),what's the cause:
a. hepatitis A
b. Hepatitis B
c. Hepatitis C

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March 2011
d. Cholecystitis

98. A man has DM associated with an ulcer on the foot ,T 37.3 C,the ulcer is redden,surrounding skin
is swelling and has pus on top of the ulcer,what is your next management?
a. give antibiotic
b. Foot care
c. Ulcer toilet
99. PIC of Acne. Old book ME Q4
100. MCQ Handbook 3.322
101. A male, middle age with unilateral headache lacrimation specially at night. Pain comes for short
time. What is the most effective treatment?
a. High flow 02
b. Alcohol Somatriptan
c. Acetaminophen
101. A man with homonymous hemianopia. He only shave on the right of face and thinks he belongs
to only right side of his body. Which artery is involved?
a. Post Cerebral artery
b. Left Post Cerebral artery
c. Right middle Cerebral artery
d. Left middle Cerebral artery
e. Basilar artery
102. Immigrant patient came to Australia. The lady went to GP and diagnosed TB. She was on
Isoniazied for a long term. Then she developed butterfly rash and oral ulcer (Pic of SLE) What is the
best investigation?
a. ANA
b. Anti Ds DNA Ab
c. Anti Ro Ab
d. Anti Histome Ab
103. A lady present with two months illness you find splenomegaly and lymphadenopathy. WOF is
the most likely diagnosis?
a. CLL
b. ALL
c. Hodgkin
d. AML
104. A Female with new headache, by lateral pain in shoulder and hip, ESR high, what is the most
effective treatment?
a. Prednisolone
b. Paracetamol
c. Naproxen
105. PIC of Anthology Keratoacanthoma. What is the management?
a. Wide local excision
b. Excision of lymphnode
c. Local excision
106. Picture of a man's eye Kayser-Fleischer ring in Cornea. What is the investigation to diagnosis?

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March 2011
a. Increase Serum Ceroloplasmine
b. Decrease Serum Ceroloplasmine
c. Decrease Hepatic Copper

107. A male with history of URTI with hematuria, diarrhoea, vomiting. What is the diagnosis?
a. Post infection glomerolonephrities
b. Berger's Disease
c. Anti GBH Disease
108. Greek family bring hi 3 years old boy with abdominal distention, diarrhoea, poor weight gain,
anemia, what is the diagnosis?
a. Anti gliadine Ab
b. Small Bowel biopsy
c. Stool culture for Rota Virus
109. ECG with 3 degree block. What is your next step of management?
a. Atropine
b. Transcutaneous pacing
c. Transvenous pacing
rd

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OB&G

OB&G
1. In addition of giving folic acid, what else will you give to a pregnant women?
A vitamin D
B fish oil
C vitamin B12
2. An old woman with ovarian cancer.What is the most likely primary site?
A. Breast
B. Endometrium
C. Kidney
D. Lung
3. A woman with premenstrual headaches,takes 5 cigars daily comes to the clinic for OCP.Her mother
was diagnosed of breast cancer at 48 yr of age. What is the absolute contraindication to OCP?
A. Premenstrual headaches
B. Smoking
C. Family history of breast cancer
D. Age more than 40
4. A woman with hysterectomy comes to the clinic for HRT. Which should be given to her?
A. Conjugated equine oestrogen 0.625mg
B. Daily progesterone therapy with MPA
C. Daily treatment with diazepam
D. Continuous therapy with Oestrogen and MPA
5. A woman compaints of fever,tachycardia 7days after laproscopic hysterectomy .On
examination,there is redness in the umblical area. Which is the site of organism entry?
A. IV cannula site
B. umbilicus
C. Abscess
6. Breast screening on new mother- patient presents with abscess on one breast. What to do next?
A. Continue breast feeding
B. Stop breast feeding immediately
C. Breast feedin from other breast
7. A 32-year-old woman comes to your practice for an unimportant problem. (The question doesn't
mention she is still a virgin or not). What test would you recommend to her?
a. Cholesterol
b. Glucose
c. Pap smear
d. Endometrial sampling
8. A 46-year-old woman had heavy bleeding. What is the treatment?
a. There is no OCP in option
b. Estrogen
c. Progesterone
d. Hysterectomy
9. Which of the following is the risk of endometrial cancer?

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OB&G

a. Smoking
b. Obesity
c. Tamoxifen
d. HRT
e. OCP
10. A 12-week pregnant woman's blood test, which was done on the 4* week pregnancy, showed
positive CMV IgM. What do you do?
a. Do amniocentesis
b. Do baby's blood sampling
c. Do blood test again and send for CMV IgG
d. Use the old blood sample to check CMV IgG
11. A pregnant woman contact with a Rubella child. What do you do?
a. Termination the pregnancy
b. Check antibody tilter
c. Give vaccine
d. Give immunoglobulin
12. A pregnant nurse is coming for influenza vaccination. What do you advise her?
a. Defer the vaccine to 3rd trimester
b. Defer the vaccine to after delivery
c. Defer the vaccine, but ask the nurse to wear mask
d. Defer the vaccine, but ask the nurse to wash hands frequently
e. Give vaccine now
13. A pregnant woman has herpes infection. Which of the following antivirus drug is appropriate for
her?
a. Ganciclovir (po)
b. Acyclovir (iv)
c. Acyclovir (po)
d. Famciclovir (iv)
e. Famciclovir (po)
14. A pregnant woman is worried about premature delivery. What is the test to predict premature
delivery?
a. Cervical contraction
b. Cervical dilation
c. Fibronectin
15. A pregnant woman has hyperthyroidism. What is the most appropriate medication?
a. Methimazole
b. PTU
c. Beta blocker
16. A women 8 months of gestation in her 2nd pregnancy, wants to know how she can protect her chil
from familial atopy. Her 1st child has flexural eczema.
a. Breast feed for 6 months
b. Breast feed for 1 year
c. Give multivitamins
d. Regularly vaccum her house
e. House mites control

March 2011

OB&G

17. A 45 year old women presents with bloody discharge from a single duct in her nipple .
What is the most appropriate management?
a. Removal of the duct
b. Chemotherapy
c. Radical surgery
d. Radiotherapy
e. No treatment at all
18. 28 year old women wants to know about breast ca screening . mother is diagnosed with ca breast
at 55 years of age. What is your advice?
(usg not given in choice)
a. Mammography
b. FNAC
c. 6 monthly examination by gp
d. Breast self examination to be taught
e. No screening necessary
19. 70 year old women with osteoporosis what is you management?
a. Ca supplement
b. Biphosphonates
c. Radiotherapy
d. Vitamin D
e. Regular exercise
20. A girl 13 years old attended menarchy 15 days ago and now presents with continous bleeding .
what do you do ?
a. Full blood count
b. INR
c. USG
d. Antiphospholipid antibodies
e. Start her on OCP
21. Another question with same scenario, what will you do ?
a. Coagulation profile
b. INR
c. USG
d. Antiphospholipid antibodies
e. Start her on OCP
22. Patient at 39 weeks of gestation in her 3rd pregnancy is in labour. The duration of labour in her 1st
delivery was 6 hours and 2nd delivery was 4 hours. CTG shows sudden variable deceleration. On
pelvic examination cervix is fully dilated and effaced, vertex is at +2 station. Umbilical cord is seen
prolapsed in the vagina . what will you do next?
a. Reposition the cord and deliver the baby
b. Do caesarean delivery
c. Increase the contraction using oxytocins
d. Do nothing
23. A primigravida at 40 weeks gestation admitted with labour pains. at admission she is getting good
contractions and her cervix admits 1 finger, it is 1 cm long , posterior , vertex is at -2
station,membranes intact. After 4 hours she is 4 cms dilated ,well effaced,vertex at 0 station
What do you next?
a. Induce with prostaglandins

March 2011

OB&G

b. Augment with oxyotcin

c. Do nothing
d. Amniotomy
e. Take her for caesarean
24. A 60 year old lady complaints of mass per vagina while squatting , no other complaints .
How do you manage her?
a. Vaginal hysterectomy
b. Pessary treatment
c. Colposuspension
d. Abdominal hysterectomy
e. Do nothing
25. A 45 year old women who had 3 vaginal deliveries in the past complaints of frequent micturition
and UTI. On examination she has a huge cystocele.what is your management?
a. Pessary
b. Surgery for correction of cystocele
c. Colposuspension
d. Vaginal hysterectomy
26. How do you diagnose endometrioses at the earliest?
a. USG
b. Pelvic examination
c. Laproscopy
d. Hysteroscopy
e. Colposcopy
27. A Rh negative women in her 2nd pregnancy is found to be mildly rh sensatised at 34 weeks of
gestation. She was given anti D after her 1st delivery 3 years earlier and she received 2 units of blood
transfusion when she meet with MVA a year ago . coombes test was negative at 12 week gestation .
what is the cause for her sensatisation?
a. Anti D inj after her 1st delivery
b. Blood transfusion
c. Fetomaternal transfusion in previous pregnancy
d. Fetomaternal transfusion in her present pregnancy
28. A prime gravid with 8 weeks gestation presents with lower abdomen pain she is hypotensive, what
signs suggest a ruptured uterus?
a. Pain in right iliac fossa
b. Mass in right iliac fossa
c. Hypotension
d. Guarding of abdomen
e. size of uterus
29. a women complaints of bloody discharge from a single duct on squeezing
How do you manage?
a. Single ductectomy
b. Mastectomy
c. Conservative management
d. Radical hysterectomy
30. A Sudanese women in her 1st pregnancy at 3 months amenorrhoea has been tested for syphilis and
confirmed with all possible tests for syphilis . she denies having it.what do you do now?

OB&G

March 2011
a. Give her penicillin
b. Terminate pregnancy
c. Do nothing

31. A G2P1LI at 34 weeks of gestation, with normal pregnancy so far suddenly has pain abdomen
and loss of fetal movements. On examination uterus was tense , tender, and no fetal heart. her cervix
is closed and uneffaced. How do you manage ths situation?
a. Do amniotomy
b. Start a syntocinon drip
c. Vaginal prostaglandins
d. Caesarean section
32. 38 yr old patient presented to you concerned because her mother had breast cancer, older sister
was rescently diagnosed to have ovarian cancer at 35 yrs of age. What is the next step in
management?.
a) USG pelvis
b) mamography
c) pap smear
33. A couple came to you mid trimester scan showed 1/300 chance of having Down syndrome
affected child. They do not want to proceed with the pregnancy. What wound you do next?.
a) amniocentesis
b) terminate pregnancy
c) consult the guagdianship court
d) advise them that termination is unethical
34. 24 yr old with DUB scenario, the couple don't want to have children, and don't want to take oc
pills. They come to your GP asking for advise. What is the best management?.
a) endometrail ablation
b) OCP
c) Danazol
d) Hysterectomy
35. young female, not sexually active. Wants to start OCP. What is the most appropriate advise?.
a) prescribe OCP
b) OCP plus condom
c) Condom
d) IUCD
36. 25 yrs old pregnant lady of 28/52 presented with pain,redness and swelling of her 1/calf. What is
your best management?
a. heparin
b. warfarin
c. dopplar studies
d. pelvic x -ray
37. 20 yrs old P1G1 of 20/52 of pregnancy presented with bright red vaginal bleeding during coitus
The bleeding stops instantly after the coitus. Her last antenatal visit US Scan revealed Laterally up
located Placenta. What is the most probable cause of her bleeding.
a. Placenta Previa.
b. Abruptio Placenta
c. Cervical polyps
d. Vaginal CA

OB&G

March 2011

e. Endometriosis
38. At your GP clinic a 45 yrs woman requests an advice for a mammogram, her mother was
diagnosed CA breast at the age 53. What is your best recommendation?
a. Do biannual mammo from the age of 50 to 75.
c. Do the mammo at the age of 65.
d. send her for a mammo now.
e. do the physical examination now , ask her to come back after 6/12 for a check up.
39. 20 years old, pregnant lady of 32/52 , h/o vaginal yellow discharge. Has never had a pap smear
before. What is your management?
a. Antibiotics
b. Reassure
c. Do the pap smears now
d. Do the pap smear after delivery.
e. Do the pap smear close to the labour
40. 21 yrs old primi, At term, Membranes were ruptured an hour ago. Had regular contractions
every 5 minutes. O/E CX fully effaced ,5 cm dilated , Foetal heart rate is 144/ min. An hour later,
contractions come in 3 min. Foetal head is below the ischial spine , CX 8 cm dilated. Cord was
presenting with the head and foetal heart rate is below 60/min. What is the Next Best ?
1) do the LSCS immediately
2) DO Ventals vacuums delivery.
3) Induce with oxytocin and cyntocinon
4) Ask the pt, to push harder.
41. A 35 yrs old pregnant lady of 34/52 , Presented with premature rupture of the membranes, Her
BP_ 165/85 What would be the contra-indication for the administration of Tocolytics?
1) Pre eclampsia
2) foetal distress
3) Infection
42. A pregnant woman has HTN, about 145/93mmhg with oedema, no protein urine,what is the most
appropriate drug to use for her HTN?
a. Verapamil
b. Captopril
c. hydrochlorothiazide
43. A lady who went through a hydatidiform mole 4 months ago,have done a curettage,her B-hcg
gradually become normal in the last 13 weeks.for the recent 4 weeks ,her B-hcg now is 900MIU/ml,
she didn't have period after the curettage,what is the diagnosis:
a. choriocarcinoma
b. invasive hydatidiform mole
c. Normal pregnancy
44. MCQ BOOK 3.312
45. Woman has blood stain discharge from nipple, a 8MM swelling is palpable of the breast,what
could it be:
a. duct papilloma
b. Intraductal ca
c. Peget dz
46. A full term pregnancy woman come to hospital ,she request to delivery by herself without any
intervention if possible.during the labour her cervix is fully dilated and open 2cm,after 5 hours the
cervix is 4cm,uterus contraction is not very strong but still OK(can't really remember the time of the

OB&G

March 2011

contraction),the baby is in (LOT) position and descended from 0 station to +1 position,what's your
next step:
a. give oxytocin
b. Cesarean
c. Observation
47. Another full term pregnancy woman during labour (not at the second stage of labour),CTG shows
a deceleration down to 75bpm and last for 2 or 3 minutes,what's your next step:
a. Immediately cesarean
b. Continuous CTG
c. Give oxytocin
48. Pregnant lady, 20 w, comes with BP more than 160/110 protein ++++. What is the best
management?
a. Methyldopa
b. Magnesium Sulfate
c. Labetolol
49. A woman came to clinic one week after vaginal delivery. Her T=38. What is the most likely
diagnosis?
a. Endometriosis
b. UTI
c. Atelectasia
d. Mastitis
50. Lady with 16 w came with bleeding, cramps, cervix is open. No poc is expexted.
a. Missed abortion
b. Threatened abortion
c. Incomplete abortion
d. Inevitable abortion

Paediatric

March 2011

Paediatric
1. A 10 week old baby was found apnoeic. His parents immediately brought him to your clinic. You
found that the baby has no pulse or respiration. What is your next step?
A Inform Coroner
B write a death certificate of 'cot death'
C write a death certificate of 'Idiopathic baby sudden death syndrome'
D ask for a forensic autopsy
2. A school aged boy was brought by his mother for soiling of underwear with faeces with a h/o
constipation and diarrhea for past 2 month. He used to be well trained. What is your initial Mx?
A punishment
B laxative
C sigmoidoscopy
3. A 5 year old child came with bilateral calf tenderness followed by URTI. What would u do?
A oral steroid
B ibuprofen
C do nothing
4. A 6wk old child with sunken eyes,reduced skin turgor,reduced capillary permeability.WOF should
be given?
A. 0.9 % normal saline
B. Hatmann solution
C. 4% dextrose and 0.45% normal saline
D. 8% dextrose and 0.18% normal saline
5. A child present with shortness of breath & on examination all the vital signs are normal except there
is a systolic murmur.At birth,there was no cardiac anormalies.which of the following should be done?
A. Urgent referral to the hospital
B. Make an appointment with a paediatrician in later days
C. Do nothing
6. A child complaints of headache,vomiting,bitemporal hemianopia.What is the diagnosis?
A. Craniopharyngioma
B. Posterior fossa tumour
C. Meningitis
D. Encephalitis
7. 5 year old complaining of ataxia, presenting with bilateral hemianopia. What is the diagnosis?
A. Optic glioma
B. Meningioma
C. Cranial Pharyngioma
D. Medulloblastoma
8. A newborn is found having fever, redness, swelling of the belly button. When squeeze it the pus
comes out. What is the Dx?
a. Umbilical cellulites
b. Urachus tract infection
c. Patent urachus

Paediatric

March 2011

9. A 6-month-old child is crying and has abdominal pain, vomiting, and loose stool passage. The stool
is dark red and bloody. Physical examination reveals a mass at right side abdomen. What is the test for
the patient?
a. Full blood count and coagulation profile
b. Ultrasound
c. Oral Barium contrast study (not enema)
d. U/A, U/C
10. A child suffers from headache, nausea, and vomiting for 6 month. He has a family history of
migraine. What is the management?
a. Panadol
b. Brain CT
c. Reassure
11. A child has high serum lead level, no symptoms is mentioned. What is the most appropriate
management?
a. Check urine lead level to confirm the Dx
b. Arrange IQ assessment
c. Chelation therapy
12. A 5 months old baby born at 34 weeks gestation with a birth weight of 1.5 kg now weighs 6 kg,
what is your advice regarding his weight?
a. He is over weight for his age
b. He in under weight
c. He has caught up with his weight growth
13. A 4 week old baby presents with vomiting crying uncontrollably
On examnation a small mass palpable in the right iliac fossa. What is your management?
a. Do x ray
b. Laprotomy
c. Sedate the child
14. A 6months old baby is brought by the mother with history of constipation,
Solids were started at 4 months of age . baby is gaining weight normally.
What is the cause for constipation?
a. Cystic fibrosis
b. Inadequate calorie
c. Inadequate liquid intake
d. Toxic megacolon
15. A 4 year old girl presents with itching in her perineum. On examination the vulva is reddened
And no other signs. What is your diagnosis?
a. Sexual assault
b. Foreign body
c. Vulvovaginitis
d. Chlamydia
e. Ghonorrhoea
16. A 14 year old boy is brought by her mother as he is limping and is complaining of pain in the knee
for the past 4 days. On examnation hi s weight is on the 90th percentile and there is no tenderness in
the knee. There is some degree of movement restriction in the hip on the same side as the knee. What
is the diagnosis?
a. Slipped capital femoral epiphysis

March 2011

Paediatric

b. Congenital developmental dislocation of the hip

c. Osgood schlatters
d. Perthes disease
e. Posterior dislocation of the hip
17. A 3week old baby has vesiculo pustular rash all over the body sparing the face, the baby is afebrile
and in otherwise good health. What is the rash?
a. Measles
b. Scarlet fever
c. Erythema toxicum
d. Meningococcemia
18. A mother brings her 6 month old child for URTI. the child has never been immunised.
What should you do?
a. Advice the pros and cons of not immunising
b. Respect as she wishes
c. Immunise against her wish
d. Inform child protection
19. A indigenous mother brings her 3 year old son with recurrent ear pain.on examination there is
purulent nasal discharge and greenish discharge from his ear .what do you do next?
a. Take swab from nose
b. Take swab from ear
c. X ray of mastoid
d. Antibiotics
20. common cause of 1st day jaundice?
a. Physiological jaundice
b. Abo incompatibility
c. Biliary atresia
d. RH incompatibility
e. Breast milk jaundice
21. A 6 year old girl is totally dry during the day and never dry at night .mother is worried .what do
you do?
a. IVP
b. Urine microscopy and culture
c. Desmopressin
d. Tolteridine
e. Retrograde pyelography
22. 10 year old boy 5 days after fever who is afebrile now presents with bruise and rash all over his
body . how do you manage him?
a. Bed rest
b. Antibiotics
c. Do a full blood cell count
d. Start him with steroids
a. Do stool culture
23. A 12 year old girl is having acanthosis niagricans over her axilla .her HBA1C is 9. Her mother and
grand mother are diabetic. How do you treat her?
a. Do GTT
b. Start her on metformin

Paediatric

March 2011
c. Start her on insulin
d. Life style modification

24. 6 yr old child with a mass in the LIF. Previously toilet trained ( at 3 yrs) Now presented to you
with fecal soiling. Bed wetting. Next step in his management.
a) laxatives
b) metoclopramide
c) manual evacuation of rectum
25. UTT scenario with the child irritable, tever and chills. Best management?.
a) oral penicillin
b) cephtriaxone (iv)
c) Erythromycine
d) Trimeprim
26. 6 yr old boy undescended testis scenario, waht is the most appropriate advise to give to the
mother.?
a) sqeeze the testis
b) surgery after 2 yrs
c) reassure
27. VSD scenario. What is the next investigation?.
a) ecg
b) echo
c) saturation studies
28. 8 yrs old child present with tiredness , LOA Two weeks ago had URTI. Lab results; Low HB ,
MCV, Ferrous decreased RBC, WBC Normal, SE Normal. PI-normal, RFT normal.
What is the best management?
1) OralFE 2) IV FE 3) I M FE 4) reassure 5) Rpt EX after 4/12
29. 15 yrs child presented with fatigue, tiredness, LOA constipation Lab ; LowHB, RBC,
Normal plat, WBC , B12 , Folic acid , High MCV
What is the best investigation to confirm the diagnosis;
l)Gastroscope 2) Bone Scan 3) Blood Culture 4) T3, T4, TSH
30. 4 yrs old chid presented with fever ,rigors, sweating and generalised macular -papular rash.
Next best mx;
1)LP
2) blood culture 3) B. Penicillin 4 ) Ceftriaxone
5) Metronidazole
31. A 7 yrs old child presented with fever, vomiting, lower abd. pain, Dip stick method revealed
RBC 1+ Proteins 1+ and casts. In addition to the urine culture , what is the next step ;
1) Trimethiprim 2) IV Gentamycin 3)
Amoxyl + clav acid
4) PCM
32. A boy have a few months constipation, anal examination show fecal in his rectum, what's the
managment:
a. barium enema
b. Laxative
c. abdominal X-Ray
33. Same as Feb 2011 recalls ,a question about BMI of a child,there is a plotting table:
a. slightly overweight
b. is obese

Paediatric

March 2011
c. is healthy
d. is under weight
e. BMI is not have a very good correlation in children

34. A baby who brought by his mother complain about diarrhea with foul small stool, and the baby
has body weight lost,what is the reason cause this condition:
a. Giardia
b. Lactose intolerance
c. Toddler diarrhea
35. A four years old boy can not stand up when he wants to stand up he uses hand to push up thighs.
CK is high. What is the mode of the diagnosis?
a. AR
b. AD
c. Xlinked dominant
d. Xlinked recessive
e. Mitochondrial
36. A girl born with breach position with dislocated femoral head. US has been done. How you
manage patient?
a. SPICA Cast
b. Puvlic Harness
c. Open reduction
37. A child with history of new paint at home. He ate some pieces of paint. Mother bring him to ED.
You find wrist drop and foot drop. What is the first line of treatment?
a. N-acetylcysteine
b. Dimer-Caprol
c. 02
d. flumazenil
38. A child with anemia, jaundice, murmur and bone pain. What is the diagnosis?
a. Salmonella
b. Mycoplasma
c. Pseudomonas
d. Paro Virus

Psychiatry & Ethic

March 2011

Psychiatry & Ethic

1. A 16 year old girl came to see you because of she escaped from school. She felt very anxious. She
has 3 younger brothers and sisters. She used to be an excellent student in school. When she is talking
to you, she is shy at first. Later she is excited. She told you she was anxious also because that her
mum is now in hospital. What information will you get i f you keep talking with her?
A she got up early everyday.
B she has insomnia
C bully history in school
2. Man is brought to the hospital with agitation, irritability. He is an alcoholic. What will you give
him?
A haloperidol
B diazepam
C olanzapine
D thiamine
3. A man presents to ED with history of threatening to kill himself after his girlfriend left him. He tells
the doctor that he is a highly educated person with a lot of contacts in high places. What kind of
person is he?
A narcissistic personality
B Borderline
C Avoidant
D schizotypal
E histrionic
6. An 18 yr old girl comes to ED with her sister.She ran away from home.She needs urgent
appendicetomy.She doesn't want you to inform her parents.What will you do?
A. Contact her parents
B. Do the emergency operation with her consent
C. Consent from her sister
D. Tell her that consent from her parents is essential
7. One of your colleagues prescribes antipsychotic to himself.which of the following should you do?
A. Inform medical board of registrar
B. Tell him to consult with the psychiatrist
C. Inform hospital manager
8. Patient in ICU with multiple traumas with grave prognosis. You're the Intensivist. Relations say
patient was willing to donate organs and that relatives agree. What will you do?
A.
B.
C.
D.

Ask for his will

Make arrangements with organ donation coordinator
Go ahead with relatives wishes
Ask hospital board for legal advice

9. Screening for a young couple who has a first degree uncle with schizophrenia. What are the chances
of their child getting schizophrenia?
A. 47%
B. 12%
C. 30%
D. 5-6%

March 2011

Psychiatry & Ethic

10. Question about cohort study

11. Which of the following medication provides the best prognosis for Alzheimer's disease?
a. Donepezil
b. Rivastigmine
c. Galentamine
d. Fish Oil
12. A patient had TCA overdose and he was unconscious. What is the best treatment?
a. Nalaxone
b. Glucose
c. Thiamine
d. Sodium bicarbonate and intubation
13. An elderly man (around 70-year-old) drives bus in his community. His senellen visual acuity test
is 6/9 when he wears glass. What is your advice in regards to his driver's license?
a. He can keep driving
b. He shouldn't drive any more
c. He can drive his own car only
d. He can drive, but he has to wear his glass while driving
14. A woman has a history of couldn't move her left arm and every examination is normal. She lives
with her daughter who is going to marry. On her daughter's wedding day, she complained chest pain
and couldn't move the arm again. Physical examination is normal as well. Which of the following
comes to the Dx?
a. Cardiovascular test
b. Neurological test
c. Behavior test
d. Depression test
15. A young patient has anorexia and low BMI (16). She was admitted for NG feeding because of
unsuccessful oral feeding. Now, she is angry and requesting to go home. What should you do?
a. Respect her decision and let her discharge
b. Discharge her and follow up by an alternated hospital
c. Discharge her and ask her GP to follow up
c. Involuntary admitted for feeding
16. A 63 y/o retired man had oversea holiday with his wife and complained that he felt New Zealand
CIA was observation them during the holiday. Which of the following condition is most relevant to
the patient's condition?
a. He drank 2 liter of alcohol per day
b. He was caught of using cannabis when he was young
c. He has pathologic gambling on holiday
d. He suddenly decided to retire on the age of 63
17. You are doing a study. One of your patient's conditions becomes worse during the study. The
patient is unable to make any decision. He lives with his son who is the primary career. Who can
decide the patient should be withdrawn from or kept in the study?
a. Patient himself
b. The son
c. You
d. The ethical committee

Psychiatry & Ethic

March 2011

18. You prescribe 5mg Morphine to a patient, but the nurse only gave 2mg. What should you do?
a. Tell the nurse manager
b. Make a formal complaint (or report) to the head of nurse
c. Bring up the issue during lunch break
19. You find your colleague having dementia symptoms. What should you do?
a. Ask his family to take him to see a doctor
b. Inform the hospital boss
c. Report to medical board
20. A colleague is having problem of sleeping and he is asking you to prescribe sleeping pill. What
should you do?
a. Give him the pill
b. Advise him to make a formal appointment with an appropriate doctor
c. inform medical board
21. You find there are more and more diabetics in your practice and you want to do a research about
how many people are diabetic. What is the best study design?
a. Cohort study
b. Case-control study
c. Randomized-control trial
d. Cross-section study
22. A 70-year-old patient is coma and the court has given the right to his wife to have the power of
attorney as he has no will or advance dire five. What is the responsibility of the wife in managing the
disease?
a. Base on how she wants
b. Base on his values of life
c. Base on his previous wishes
d. Base on the risk and benefit of treatment
23. A 18yr old lady is on ocp and presents for the first time with seizure . she had early morning
muscle twitches for the past 4 years .now she is started on sodium valproate. She is planning to apply
for a learners license . what is your advice about her driving?
a. Cant drive for 6 months
b. Cant drive for 3 months
c. Cant drive for 1 year
d. Cant drive for 24 months
e. Can apply for the license right away
24. You visit an old lady at her home. She is happy to see you . offers coffee and snacks .
Suddenly becomes violent and thertens to kill you with a knife . what would you do next?
a. Leave
b. Restrain her
c. Call the police
d. Sedate her
e. Defend yourself
25. A young man comes to your office and tells you that he is a very influential person .he likes a well
known business women and has been writing letters to her for the past 10 years. He shows you the
letter and you see that the letter does not make much sense.
It is sexually indecsnt and very threatening. He is already on respiridone consta.

Psychiatry & Ethic

March 2011
What do you do?
a. Inform the police
b. Admit him
c. increase the dose of his medication
d. Change his medication
e. Inform the women

26. A 30 yr old women presents to the office for general review . she tells you that she feels very weak
and also says that she occasionally binges food and vomits. She agrees to taking laxatives . then she
says you she lost 30 kg weight when she was 20 years old and is worried thet she might become fat
again. Her BMI is 25 . no other abnormalities were noted on examination. What is your diagnosis?
a. Body dismorphic disorder
b. Somatisation
c. Bulimia nervosa
d. Anorexia nervosa
27. A 22 year old single mother comes to you with her 4 month old baby and complains of headache
and says that her husband abandoned her for another women and now she has lost touch with him .
you order some tests for the lady and make a n appointment with the investigation service .
You then learn that she has not turned up for the test. what do you do next?
a. Wait for 15 days to see i f she turns up
b. Don't bother
c. Call the childs daycare
d. Call child protection
e. Inform police
28. A man who has shifted his family to a rural area and his wife having delivered very recently calls
you telling that his wife is very tearful ,wears night dress all the time , does not want to got out and
wishes to stay indoor all the time. He si not able to help her much as he has to travel to work daily .
he says he is unable to cope with her. What do you do?
a. Prescribe the wife with SSRI.
b. Inform the child protection
c. Send the man for family help counselling
d. Visit them at their home
e. Inform family welfare office
29. A 70 year old man had a syncope and was admitted to the hospital. His condition deteriorates and
the son wants the doctors to perform any surgery that may save the old man . the old mans wife says
that he might not wish to undergo surgery if he would be able to make a decision . what do you do?
a. Apply to guardianship court
b. Do as per the son wishes
c. Do as per the wifes wish
d. Do what is best for the patient
30. A young women comes to you and has sexually transmitted diseases screened. You send the bill to
her house. Her husband calls you and asks you the detail, what do you do?
a. Give him the details
b. Ask him to talk to the laboratory and give him the number
c. Ask him to discuss the matter with his wife
31. A young man is agitated and presents to ED with a knife in his hand . he has been seeing a
psychiatrist in the past and refuses to give any details regarding his past illness. After some
negotiation he hands over the knife .what do you do next?

March 2011

Psychiatry & Ethic

a. Sedate him
b. Restrain him
c. Talk to him regarding his psychiatric illness once he is ready to talk to you
d. Talk to the psychiatrist against the patients wish
32. A 58 year old man presents to your office with premature ejaculation. He has recently married a
18 year old women. What is the cause?
a. Anxiety
b. Organic cause
c. Hypogonadism
d. Hypospadiasis
33. a driver from interstate has moved to your locality recently and is stable on lithium for the past 5
years . how do you monitor him?
a. Check lithium levels every 3 months
b. Check lithium levels every 6 months
c. Check lithium levels every month
d. Do full blood count
e. Do chest x ray every year
34. There was a question regarding the prognosis for Obsessive compulsive disorder
a. Whether it will remit and relapse in 1 year
b. Whether it will not progress at all
c. Whether it will worsen without treatment
35. a young agitated man comes to ED he is totally out of control and you obtain a history of drug
intake from his friends who brought him to ED. After some time he is stable and tells you that he is
frustrated as he has lost his job and his girl friend. He is seeking help for his situation .you treat him
with
a. Psycho therapy
b. Specific problem oriented treatment
c. Motivational treatment
d. Insight oriented therapy
36. there was a question about a 12 year old pregnant girl asking for termination of pregnancy.
(Similar to question 3.299 MCQ handbook)
37. pt came to GP, saying her 15 yr old son doesn't want to speak to his father. Most of his time is
spent playing computer games. School work is normal. What advise would you give her??.
a) reassure everything is normal
b) narsistic behaviour
c) anti social behaviour
d) borderline personality disorder
38. You invent a drug which affects progression of the disease, but not the mortality. Which is the
most appropriate statement?
a) increases prevalence
b) increase incidence
c) decrease prevalence
d) decrease incidence
39. Pt came to you saying he can't sleep properly at night. He cant sit still always changes his posture
and is worried because he believes he has a dangerous disease.

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Psychiatry & Ethic

a) obsessive compulsive disorder

b) generalized anxiety disorder
c) panic disorder
d) MDD
40. 17 yr old athelete. Very concerned about her BM1 of 17. She does heavy exercise daily and
presents to your GP c/o amenorrhoea. What is the most likely cause?, (blue book)
a) heavy exercise
b) Anorexia nervosa
c) Bulimia
d) Diet
41. 67 years old male presented with symptoms of AF. ECG- AF pt. refuses any medical intervention,
his wife insists on treatment, the patient is oriented to time and Place.what is your decision?
a. respect the patient's wish.
b. ignore the request of the patient and treat.A
c. do mental health assessment to decide the patient's ability to take the decision.
d. refer to mental health immediately.
42. 17 yrs old girl presented with amenorrhoea , constipation, drowsiness. HerBMI is 17 . H/O
binge eating and purging. Next step in the management;
1) CBT 2) SSRI 3) IV Fluids 4) check SE
43. 14 year old girl presented with signs of Anorexia Nervosa; What other feature match the
diagnosis;
1) Premature puberty 2) Abnormal RFT 3) Decreased body hair
44. Features of Autism, Possible management;
1) CBT 2) REF TO NEUROLOGIST

3) Ref to psychiatrist

4) sodium Valporate

45. A diagnosed pt of Depression ,takes lithium for the last 6/12. Presented with tremors, ataxia and
anorexia now. What is the best management?
1) Stop lithium
3) Do RFT 4) Do SE
2) Do CT Scan
46. 16 yrs old girl presented with depression ( a very long gigantic stem ) What is the best
management?
1) Fluoxitine 2) Tricyclic anti-depressants
3)diazepam
4) Clonazepam
5) Olanzepam
47. A man was brought by the officer of the prison,he harm himself several times ,and draw some
bizarre picture on the wall in his room/when talk to him he is just keep saying that he is OK,what is
the diagnosis:
a. antisocial disorder
b. Psychic problem
c. Factitious Disorder
48. I f both parents have psychosis problem,what's the percentage of their child will have the same
symptom?
A) 10%
B)<1%
Qabout one third
D) more than 50%

Psychiatry & Ethic

March 2011

49. An old lady was brought by her relative that developed recently some dementia, she can't dress by
herself (which looks like pressing apraxia to me) and some other symptoms,what is the diagnosis?
a. Alzhemer's dz
b. Lewy-body dementia
c. Frontal lobe dementia
d. Non-dominant parietal lobe
50. Another question about dementia,patient have visual hallucination and other symptoms ,what's the
diagnosis:
a. Frontal lobe
b. Lewy body
c. Vascular
51. Your colleague has HIV, he is going to work in a new company,what will you do:
a. report to the company
b. Inform the patient
c. Report to the medical board
52. A man present to a tertiary hospital asking for top doctor. He says I do not have time because I am
having so many businesses. His presentation is which of the following personality disorder
a. Anti social
b. Histrionic
c. Border Line
d. Narcissistic
e. Schizotypal
53. A 21 years old woman came with Amenorrhea, BMI15, dry skin, WOF tests you check to
diagnosis Anorexia nervosa?
a. Serum Electrolyte
b. TFT
c. LFT
d. FBE
e. fasting Blood Glucose
54. 60 years old man with forgetfulness can not remember routine things. He has done percotaneus
angioplasty. WOF is the most likely diagnosis?
a. Alzheimer disease
b. Pick disease
c. Vascular Dementia
d. Pseudo Dementia
55. A school age boy is brought to clinic by his parents. They state that he is unable to remain seated.
He behaves aggressively and does not complete his homework. WOF is the most likely diagnosis?
a. Autism
b. ADHD
c. Asperger Syndrome
d. Conducted disorder
56. WOF is a mature defence mechanism
a. Denial
d. Blocking
c. Sublimation
d. Suppression

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Psychiatry & Ethic

57. Angry agitated patient was brought to you by his wife. When you asked him why you are here he
said I love you sweaty. Which of following is the diagnosis?
a. Factitious disease
b. Histrionic personality
c. Mania
d. Somatization
58. 16 years old boys who is good in school his only problem is he is interested in wearing his
mother's cloths and like to buy ladies cloths. What is the diagnosis?
a. Transsexualism
b. Transvestitism
c. voyeurism

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Surgery
1. A 65 year old woman with h/o jaundice with dark urine, pale stools and palpable gall bladder which
moves with respiration. No h/o either alcohol intake or pancreatitis. What would be the possible
cause?
A CA ampulla of vater
B cholangitis
C choledocholithiasis
D cholecystitis
2. An accountant has symptoms of carpel tunnel syndrome. What is the most appropriate
investigation?
AEMG
B nerve conduction study
3. A man comes to ED with open wound at the chestOn examination,all the vital signs are
stable.There is dullness at the left lower lobe of chest& reduced breath sound in left side.What is your
immediate management?
A. Strap the wound with the pressure
B. Intubation
C. Underwater-sealed drainage
D.Needle tube thoracotomy
4. X-ray of the wrist with displaced Colle's fracture.After immediate management, what will you do
next?
A. Open reduction & internal fixation
B. Support the hand with arm sling
C. Support the hand with back slab
D. Do POP
5. A man with compressed fracture comes to the hospital.Which investigation should be done to get
the underlying Diagnosis?
A. Serum Calcium
B.Parathormone level estimation
C. Bone densitometry
6. A 29 yr old woman presents with painless soft lump in It lower inner quadrant.On
examination,both sides of the breasts are lumpy in consistency.On USG,there is a 3cm in diameter
well defined hypoechogenic lesion in left lower quadrant. What is the diagnosis?
A. Breast cancer
B. Fibroadenoma
C. Breast cyst
D. Cystosarcoma Phylloidies
7. A man presents with a swelling in the mouth.lt becomes increased in size&painful after
chewing. Which investigation will you do first?
A. Sailogram
B. Intraoral Plain X ray
C. USG
D. CT

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March 2011

8. At 1 post-op day,
Intake-2100ml
Output-4700ml
Balance -2600ml
What is the most propable underlying cause?
A. Polyuric phase of renal failure
B.Normal reaction to operation
C. Wrong amount of drip given
st

9. 62 year old man, post-op 24 hours, complains of pain in the lower abdomen. Previously operated
for strictureplasty for Crohn's disease and is on warfarin. What is the probable diagnosis? CT abdo
picture showing mass in the right iliac fossa.
A. Abdomen mass
B. Abdomen abscess
C. Strangulated hernia
10. Patient presents with ingrown toenail with lesion on one side of the toenail. Been to podiatrist on
four occasions. What is the best management?
A. Ablation
B. Wedge incision
C. Radical excision
D. Complete removal of the nail
11. Patient presents with ingrown toenail with lesion on both sides of the toenail. What is the best
management?
A. Ablation
B. Wedge resection
C. Radical excision
D. Complete removal of the nail
12. X-ray showing a Colles' fracture. After reduction, what is the plaster management?
A. Cylinder cast below elbow
B. Cylinder cast above elbow
C. Back slab below elbow
13. 60 year old patient complains of difficulty passing urine with retention for the last 6 hours. On
examination, there is a smooth enlarged prostate. What will you do?
A. Suprapubic aspiration
B. IDC
C. TURP
D. Radical prostatectomy
14. Patient in the ward presents with stridor and distress after a thyroid operation. What is the next
step in management?
A. Remove all sutures in the ward
B. Inform Senior Registrar
C. Give oxygen

Surgery

March 2011

D. Remove all sutures in the theater

15. Thyroid post op in the 1st 24 hours, patient develops stridor. Normal BP and pulse. Most probable
cause?
A. Bleeding into the wound
B. Thyroid storm
C. Wound infection
D. Septicaemia
E. Pulmonary atelectasis
16. Question/Pic from MCQ handbook 3.008 about pilonidal sinus
17. 20 year old female developed swelling in left side of neck, moving with swallowing. What is the
diagnosis?
A.
B.
C.
D.

Multiple nodular goitre

Solitary adenoma
Subacute thyroiditis
Graves Disease

18. Patient on Aspirin going for emergency surgery. What will you do?
A. Stop aspirin
B. Stop aspirin after one week
C. Cryoprecipitate
D. Platelets infusion
19. A patient injured the back of the spinal cord (posterior cord). What symptom does the patient
have?
a. Muscle weakness
b. Ataxia
c. Postive ? test (can't remember the name of the test)
20. A diabetic patient has a foot ulcer infection. After surgical debridement of the ulcer, which of the
following antibiotic should be given (The patient is allergic to Penicillin)?
a. Oxacillin
b. Ticarcillin/Clavulanate
c. Gentamycin
d. Clindamycin
e. Doxycyclin
21. Which of the following is the priority for admission for a patient who suffered from multiple
traumas?
a. Neck bruise with inspiratory stridor
b. Scortum laceration with bleeding
c. Abdominal muscle guarding and rigidity
22. A patient suffers from chest pain and dyspnea on the 5 day after operation. What is the next test?
a. EKG
b. CTPA
c. Cardiac enzyme
d. Oxygen
th

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Surgery

23. A man with severe vomiting due to small bowel obstruction. What is the fluid of choice?
a. 0.9% normal saline
b. Heamacel
c. 0.45% ns
d. Hartmanns solution
e. 5%dextrose
24. A young man with MVA injury admitted to emergency has multiple rib fracture and you see a part
of the chest moving separately .what do you do?
a. Intubate and positive pressure ventilation
b. Needle in the 2nd ICS
c. Insert a chest tube
d. Oxygen by mask
e. Do nothing
25. A young man with MVA injury admitted to emergency has multiple chest injury ,also has
hoarseness of voice, his x ray shows a widened mediastinum, his BP is dropping . what do you do
first?
a. Intubate and ventilate
b. Pericardiocentesis
c. Needle in the 2nd ICS
d. Chest drain
e. Oxygen by mask
26. A young man with MVA injury admitted to emergency has multiple chest injury and abdominal
injuries. His BP is 100/70mmhg, when his BP is measured in sitting position it drops to 90/50mmhg
pulse 100/min.
What amount of blood has been lost?
a. 10%
b. 20%
c. 30%
d. 40%
27. A young sports man has had a blow on his eye accidentally during a game. On examination of the
eye there is enophtalmos, blood in the anterior chamber and periorbital ecchymosis.
What do you do next?
a. Refer to ophthalmologist immediately
b. Ask him to make an appointment with the ophthalmologist later that day
c. Ask him to go to the emergency department tomorrow
28. A person with wrist drop which nerve is involved?
a. Ulnar nerve
b. Median nerve
c. Radial nerve
29. A photo of a hand with mallets fracture. What kind of injury coulh have caused it?
a. Injury of a hyper extended finger
b. Injury of a hyper flexed finger
c. Injury of extended finger
d. Injury of a flexed finger
30. an old lady visits your office after she has fractured her wrist, she says that she crashed in to a
wall, also she has lost her peripheral vision which she did not notice previously.

Surgery

March 2011
Her pupils are constricted and fundoscopy is difficult. What do you do next?
a. Send her home after treating her wrist fracture
b. Send her home after treating her eye problem
c. Do urgent ct
d. Do blood sugar levels
e. Ask her not to drive

31. An old lady has been posted for elective hip replacement .she is on warfarin what do you do?
a. Stop warfarin and post for surgery immediately
b. Stop warfarin and post for surgery after 3 days
c. Stop warfarin and post for surgery after 1 week,
d. Stop warfarin and start heparin 1 week before surgery
32. GB stones, pt had left epichondral colicky pain lasting leveral hours. What is the most appropriate
management? ( pic of USG GB - showing stones)
a) do nothing
b) Pethidine
c) laproscopic cholecystectomy
d) review after 1 hr
33. X- Ray - anterior dislocation of the shoulder
34. Old patient with Bladder outlet obstruction symptoms. PR showed one lobe of te prostate is
enlarged. Most appropriate initial investigaiton is,
a) USG
b) IVP
c) CT pelvis
d) proctoscopy
35. shoulder dislocation anaesthesia drug of choice
a) midazolam n fentanyl
b) Diazepam
c) No need to anesthesia
d) Pethedine
36. 36 yr old female with a sfh of 36 cm. She met with an accident, on rushing to the ED she looks
normal. BP - 90/60 and Pulse -120. O/E - tender uterus is present. Most appropriate diagnoses.
a) abruptio placenta
b) placenta previa
c) Intra uterine death.
37. Pic of big toe with ulcer. 17 yr old boy, sporty, active. Wears tennis shoes while playing sport, he
got the ulcer treated several times and changed the shoes, but the ulcer did not resolve. What is the
best management?.
a) Penicillin
b) Acyclovir
c) antifungal
38. A picture of right breast of a 60 years old lady, presented with chest pain to ED by her daughter,
while doing the ECG, found the right breast as illustrated: picture ; the breast is red from the nipple
upwards half way through no swelling no discharge, what is the diagnosis?,
a. breast abscess
b. breast CA

March 2011

Surgery

c. pager's disease of the nipple

39. A picture of a scaphoid fracture; Displaced. WOF is correct;
a. POP cast includes the wrist, and the thumb up to the tip of the thumb.
b. POp cast with thumb and the elbow only.
c. Open reduction and the internal fixation with a screw.
d. Malunion is a common complication
e. Non- Union is a common complication.
40. Patient presented to the ED with generalised abdominal pain, radiating to back, for 1 hour
duration. O/E Pulse 110 BP 90/60 Tender, rigid abdomen Echymotic bruises on the back. Next step
to confirm the diagnosis;
a. CT Abdomen
b. Erect and supine abdominal X ray.
c. US abd.
d. Colonoscope
e. Laporoscopy
41. A Picture of a brain CT X' Mas tree appearance;
1) cerebral infarction 2) EDH 3) brain abscess 4)

brain tumour 5) SAH

42. Picture of R/S submandibular swelling of a middle age man ; painless

What is the probable diagnosis?
1) Cholelithiasis 2) submandibular tumour 3) Parotid CA
43. What is the most probable metastasis site for a CA Prostate?
1) Lung 2) Bone 3) Cervical LN 4) stomach 5) liver
44. A pt with a h/o cholecystectomy . Part of CBD was removed. A T tube was inserted. 4 days
after the surgery, presented with fever, local pain, serous discharge from the tube. Best management;
1) Antibiotics
2) re - suture the wound 3) Laparoscopy
4) remove the T tube.
45. A diagnosed patient of BPH Male of 60 yrs. Trans urethral Prostectomy done. What is the most
common complication?
1) UTI 2) Bladder rupture
3)
ureteric stricture 4) recurrence
46. A 50 yrs old male presented with dysphagia for 2/52. Four weeks ago noticed horsiness of voice.
What is the best investigation?
1) MRI 2) CT 3) Bronchoscopy
4) Ba-meal
5) Laryngoscopy
47. Blue book page 183 / 2.124
48. Blue book page 185 / 2.126
49. A young man come to ED with a stab at the back of c6 position ,he is at shock BP and pulse,with
sever breathless,intravenous access have been done,what is the next most appropriate treatment?
a. cross matching
b. Intubation
c. Pull out the knife
50. A 34 years old women come to your clinic with a intoxic one eye swelling and red eye,other wise
everything is normal,no other complain,WOF history will lead to the diagnosis:
a. URTI
b. Domestic violence

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Surgery

51. A patient have fever after 36hours of a surgery, what's the reason about it:
a. Atelectasis
b. Wound infection
c. Wound dehiscence
d. abscess
52. Ischaemic strangulation is an important complication associated with hernias, WOF type of hernia
is most often associated with strangulation of it's contents?
a. indirect inguinal hernia
b. Direct inguinal hernia
c. Femoral hernia
53. A executive man with multiple rib fracture admit into hospital,after 3 days of rib fracture treatment
he suddenly developed irritable and see some people walk into his room but actually not,what's the
reason of his symptom?
a. Depression
b. Alcohol withdraw
c. psychosis
54. Picture of MCQ book page 99,adenolymphoma parotid picture,A male patient discovered a lump
of his neck ,what's the next step:
a. Fine needle aspiration
b. Cord biopsy
c. USG thyroid
55. A x-ray of anterior dislocation of humeral joint
56. A young sportsman found a painless swelling of his scrotum after a match,he cant really
remember i f he got impact or not during the game, examination showed one scrotum is enlarge ,a
swelling palpable ,no redness or pain, the other scrotum is normal ,what is the diagnosis:
a. Varicocele
b. Seminoma
c. hernia
56. An athlete has knee locked after a game trauma ,what's the diagnosis:
a. torn of medial meniscus
b. Rupture of anterior cruciate ligament
c. Rupture of posterior cruciate ligment
57. A patient after operation,his input is 2000ml ,output is 3200,serum potassium is 3mmol/l,what is
his next 24hours fluid infusion?
A) 2L normal saline+lL 5% dextrose+ K 50ml
B) 2L normal saline+lL 5% dextrose+ K 100ml
C) 3L normal saline+2L 5% dextrose+ K 50ml
D) 3L normal saline+2L 5% dextrose+ K 100ml
58. A patient after a rectum surgery with output chart more than input chart,what's the reason:
a. Dehydration
b. Wrong fluid chart
c. Resolved paralytic ileus

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March 2011

59. A man present to ED one day after having stab on his toe. He has painful foot, redness, and
swelling. He has been immunized five years ago. Which one of the following should be given for his
tetanus prophylaxis?
a. Tetanus toxoid and TIG
b. Penicillin G and TIG
c. Tetanus immunoglobulin alone
d. Tetanus Vaccine and TIG
60. A man with fracture of the both tibia due to MVA. Now he is confused. WOF is yor next step of
management
a. CTPA
b. Chest X-Ray
c. ABG
d. D-Dimer assay
61. Patient with mental state changes and sudden loss of consciousness with CT subdural hematoma