1. A skin lesion was suspected to be melanoma 2.7mm depth. Excised.

A
pathology report says that margins of 2.6 mm width are clear.
What is the best next step in management?
a. Wider Excision
b. radiation therapy of the scar
c. 3monthly follow up.
2. A 52 year old menopausal woman came is bleeding per vagina for 24 hours.
Her last menses were 1 year ago. Yesterday she had intercourse after 2 years of
sexual rest. Her last PAP smear 2 years ago was normal. Whats the most
probable diagnosis ??
a. Endometrial cancer
b. Cervical cancer
c. Vaginal atrophy
d. Menses
e. Endometrial hyperplasia
3. A lady has been feeling depressed for the last 4 years, she was in an abusive
relationship for 6 years her alcoholic husband left her one year ago. She was a
victim of bullying and was raped at school in high school. She complains of
feeling insomnia sometimes, increased appetite and depression. (Sounded like
she was abused all her life by whoever she meets). As soon as she started to live
with her mother who supports her, she feels better.
a. Post traumatic stress disorder
b. Borderline personality
c. Dependent personality disorder
4. Picture of slapped cheek disease. There are lot of pregnant moms in the school
where this child is studying. What to do?

a. No exclusion required
b. Call to school and notice them
c. Exclusion for 7 days until all the rash disappears.
5. Picture of chickenpox or molluscum contagiousum (1 element was with central
dimpling). School exclusion?

a. Not required
b. When the lesions scab over.
c. When all rash disappears.
6. Mom brings her 12 month old child. WOF will signify developmental delay?
a. Cannot understand no
7. 1 year old child. UTI suspected. How will you collect the urine for analysis?
a. MSU
b. Suprapubic aspiration
c. Clean catch
d. Urine bad
e. Catheter
8. Patient with known Waldenstrm's macroglobulinemia is admitted with fever.
He has a history of glandular fever infection and varicella infection in childhood.
He is given ampicillin and azythromycin. The next day he develops rash. Picture:
rash is on the abdomen and chest. It doesnt look like erythema multiforme at all.
Most of the elements are raised papules, but couples of them are pustules. What
would you do to determine the cause of rash?
a. swab from the lesion
b. biopsy of the lesion
c. bone marrow biopsy
d. drug allergy test
9. Pregnant lady at term, fetal head 4/5 per abdominally, no height of history
given. What is the most likely reason?
a. contracted pelvis
b. placenta praevia
c. cervical incompetence
d. macrosomia
e. occipito-posterior view
10. A 35 year old man came with severe back pain over years that is worse when
he wakes up in the morning , the pain and stiffness makes him stays in the bed
for at least 30 min. Then he gets better somehow along the day , it is getting
worse now , whats the best initial treatment for him ? (Xray of bamboo spine)

a. Naproxen
b. Azathioprine
c. Aspirin
d. Prednisolon
e. Methotrexate
11. A farmer had an injury while working in the farm, his knee fat is appearing
out of the wound and it is contaminated with soil, he had TT 5 months ago for a
similar injury. He doesnt recall having any other vaccination. What would you
give him now?
a. TT
b. TT and Igs
c. double-dose TT and Igs
d. Antibiotics
e. Just clean and dress the wound
12. An 8 year old boy with enuresis going to a camp with school, what is the best
treatment ?
a. Nasal desmopressin
13. A smoker man with bilateral leg pain when walking for 100 m. distance,
although he has no dorsalis pedis pulse, ABI is not given, but limbs are well
perfused and warm on examination. What is the treatment?
a. Surgical intervention
b. Walking program
c. Start B-blocker
d. Start nifedipine
14.How would you screen the woman after gestational diabetes?
a. Fasting blood glucose every 3 years
b. OGTT every 2 years
c. Random blood glucose every 3 years
d. Fasting blood glucose every year

15. 25 y.o. woman with PAP smear showing LSIL. What is the next management?
a. repeat PAP smear in 1 year
b. repeat PAP smear in 2 years
c. colposcopy
d. LLETZ
16. Mentally retarded girl with menorrhagia and non-complience of OCP.
Management?
a. Implanon
b. Depo-provera
c. IUCD (Cu)
d. Mirena
e. Endometrial ablation
17. An aboriginal woman comes with her 12 month old baby for appointment,
she doesnt look at you, coming out without saying anything. What do you think
the reason for this behavior?
a. Cultural issues
18. A middle-aged woman complaining of burning pain in the maxillary region
during last 24 hours. There some redness over the area of the projection of the
maxillary sinus. Nothing said about nasal symptoms. Dx?
a. Maxillary sinusitis
b. Trigeminal neuralgia
c. Cluster headache
d. Varicella infection
e. Herpes simplex infection
19. A 25 yo man with dyspnea, ankle oedema, ascitis. On auscultation - bilateral
crackles. On CXR bilateral infiltrates, although heart shape is normal. In urine
blood +++, protein +++. Dx?
a. SLE
b. IgA nephropathy
c. poststrep GN
d. polyarteritis nodosa
e. anti-glomerular basement dx.
20. 17 y.o. girl with primary amenorrhea. Breast development is Tanner 2,
although she has axillary and pubic hair of adult type. O/e no palpable masses in
the abdomen, vaginal examination is not performed. She is short (like 140 cm?).
a. Mellerian dysgenesis
b. Ovarian dysgenesis
c. Pitutary tumor
d. PCO
21. G2,P1 who had previous child delivered by CS, just gave birth per vaginum
for the second child. 5 minutes before this delivery FHT dropprd to 70 per min,
newborn was not well, resuscitation started. Woman is still bleeding. Despite
normal separation of placenta, she has lost 1000 ml already. BP 100/60, pulse
115. What is the cause?
a.inversion
b.rupture
c.atony

22. A 68 yo comes for a routine visit and says her daughter is pregnant. What
vaccination would you recommend?
a. DTPa
b. Hemophilus influenzae vaccine
c. Pneumococcal vaccine
23. A mother brings her child for MMR and is worrying that her son is allergic to
eggs. What is your advise?
a. MMR is grown not on the eggs
b. hospitalize her son and administer vaccine in parts under supervision
c. Cancel vaccination
24. A 25 yo man comes for routine for some reason. It is a good time for what
screening?
a. Testicular tumor
b. Non-melanotic skin cancer
c. BP
d. DM
25. A 13 year child was removed from biological parents for some reason. Now
she is with foster family. She is playing most of the day with her imaginary friend.
She doent talk a lot. She is very picky with food and eats only particular dishes.
At this moment she is at risk of developing what?
a. substance abuse
b. sexual abuse
c. anorexia nervosa
26. 40 yo alcoholic and smoker complains of a 2 cm painless lump on the left
tonsil. No other signs and symptoms described. What is the most likely dx?
a. Squamous cell carcinoma
b. nasopharyngeal cancer
c. body/aneurism on the carotid artery
d. mts from some place
e. non-Hodgkin lymphoma
27. A child with small VSD goes for tonsillectomy. No allergy. What is
prophylaxis?
a. amoxicillin
Other options are antibiotics. No option of no prophylaxis.
28. How would you establish correlation between a large number of naevi in
population and development of melanoma?
a. case- control
b. cohort
c. RCT
d. case study
e. cross-sectional
29. 45 yo woman with painful, round, firm 2 cm lump in the breast. What is the
most likely dx?
a. carcinoma
b. lipoma
c. fibroadenoma

d. cyst
30. Patient with coxarthrosis. What is your advice about walking stick?
a. keep in R arm, advance it with the R leg stepping forward
b. keep in R arm, advance it with the L leg stepping forward
c. keep in L arm, advance it with the R leg stepping forward
d. keep in R arm, advance it with the L leg stepping forward
31. A child has fever and purpuric rash a few days ago. Today his mom is feeling
unwell, fever, slight neck stiffness. CSF analysis of mom shows 15*10^6
mononuclears, glucose 3.2 mmol/L, protein 0.45 g/L. What is the most likely
cause?
a. Meningococcal meningitis
b. Pneumococcal memingitis
c. Viral meningitis
32. Neonate with hyaline membrane disease. Dyspnoea after birth, O2
requirement increased from 40% to 85% during last hours. Nothing said about
cyanosis.
a.cyanotic heart disease
b.pneumothorax
c. hyperviscocity syndrome
33. 13 y.o girl with intermittent abdominal pain. Urine analysis shows 10 WBC
(N<20). Culture gave pure growth of E.coli 10^5. Management?
a. oral nitrofurantoin
b. nitrofurantoin cefaclor (I have red few times, and its written like this)
c. ciprofloxacin
d. no treatment required
34. 65 y.o. woman with occasional urine incontinence. Urinalysis no WBS,
culture E.coli growth 10^6. Management?
a. 4 options of antibiotics
b. no treatment required
35. A 25 yo man with inguinoscrotal swelling that disappears almost completely
when he is supine. Dx?
a. Varicocoele.
b. Direct inguinal hernia
36. 65 y.o. lady has frequency, urgency occasional urine incontinence (nothing
sid aboud dysuria). WOF most likely will determine the cause?
a. Urine microscopy and culture
b. urodynamic studies
c. Blood glucose
37. A 60 yo man with no complaints (?). On DRE prostate is normal. PSA is 3.0
(n<4.0) On 12-direction USG-guided biopsy 1 locus pathology showed
adenocarcinoma of Gensel (?) 4 stage. What is the management?
a. continue surveillance
b. transurethral prostatectomy
c. radical prostatectomy
d. radiotherapy

e. brachitherapy
38. What part of brain do you test on MMSE with overlapping pentagons?
a. Non-dominant parietal lobe
39. A lady sees ocean waves coming towards her and then stares blankly. In
what part of brain MRI is most likely to find pathology?
a. Posterior occipital lobe
b. Non-dominant temporal lobe
c. Dominant temporal lobe
d. Frontal lobe
e. Temporal lobe
40. a 60 y.o. patient complains of fatigue and tiredness. Some non-specific
symptoms described. To tell you the truth, I do not remember the stem, because
there was huge blood analysis:
Hb low
RBC low
PLT low
WBC 5.0 (N 4.0-10.0)
Different forms of neutrophils from metamyelocytes to mature forms. Lymph, Eo,
Bas, Mon normal.
If I am not mistaken, in this question they mentioned rouleux cells formation
after blood count.
Dx?
a. Chronic aleukemic leukemia
b. multiple myeloma
41. Athlete had a blow out trauma of abdomen. Pain in LUQ. Stable. In few hours
complains of shoulder pain and BP starts dropping like 100/60, tachycardia. WOF
is the next step in management?
a. USG abdomen
b. CT abdomen
42. A 4 y.o. boy comes with intermittent abdominal pain. Usually it lasts for 12
hours, sometimes he is vomiting during this time, then the pain goes away
spontaneously. O/e no abnormalities mentioned. Today he is also complaining of
the left flank pain. WOF will help you in dx?
a. CT abdomen
b. Erect and supine X-ray of abdomen
c. USG abdomen during the episode
d. Micturition cystogram
e. Barium meal and follow through
43. A 50 y.o. patient after knee replacement. On the 4 th POD the develops chest
pain and dyspnea. ABG:
pO2 90 (N 95-100 mm)
p CO2 31 (N 35-45)
HCO3 21 (N 22-28)
pH 7.32 (N 7.35-7.45)
What is the next step in management?
a. Oxygen by Hudson mask
b. CTPA
c. ECG

d.CXR
44. Patient presents with a red eye and photophobia. Dx?
a.Keratitis
45. Patients ate chicken and a small bone stuck in his throat and he feels
somewhere on the neck. What to do?
a. Indirect laryngoscopy
46. A 4 y.o. girl fell out from the tree. At that moment urinalysis showed
proteinuria +, that disappeared in 1 week. What could it signify?
a. a reaction of the body to trauma
b. hidden pathology of urinary tract
c. kidney disease
47. Mom brings her 16 yo daughter for an appointment about knee pain. You see
the girl privately and she requested a test for chlamydia which you did. The test
came back positive. In few days mom call to your clinic as her daughter asked to
organise follow up on appointment (?). What would you say?
a . tell her test result
b."I cannot discuss anything about your daugher results with you" (There was no
please).
c. "Please, ask your daughter to call for results"
d. "Please, bring your daughter for another appointment"
48. A young lady with depression refuses to eat and drink. You have to do ECT.
She doesnt dive you consent. Management?
a. Take consent from husband
b. Take consent from Mental Health Tribunal
c. no need of consent as it is life-saving procedure
d. insert a nasogastral tube and feed her through this
49. A 4 y.o. girl presents with URTI. In urinalysis protein or blood +. What is your
next step?
a. Renal biopsy
b. Creatinine, urea, electrolytes
c. Repeat analysis when she gets better.
50. A man slept on his arm all night in the chair, In the morning it doesnt move
properly and hurts. Site of lesion?
a. Brachial plexus
51. A 65 y.o. complains of pain in the anterior aspect of the pelvis after the fall.
On X-ray fracture of one of the anterior pubic rami. What is the management?
a. Bed rest for 2 weeks
b. Mobilize with brace
c. Mobilize as tolerated
d. Surgical fixation
52. Picture of anterior glenohumeral dislocation. Treatment?
a. Close reduction
b. Paracetamol
c. Sling
53. A 35 y.o. lady complains of hot flushes. Hormonal profile:

Estrogene low
FSH high
Other hormones i did not even look at.
Treatment?
a. HRT
54. A 35 y.o. woman with intermittent hot flushes that do not disturb her a lot.
(And I had an impression that it is not a primary urogenital pathology). Menses
are regular. Her hormonal profile shown and all E is low, other hormones (TSH,
LH, FSH, Prolactin) are either borderline low-normal or low. What of the following
will determine the dx?
a. Vaginal USG
b. MRI of the head
all the option were related to OB&G, no option of TFT or smth like that
55. A 17 y.o. football player presents with gynaecomastia. He is on inhaled
steroids for asthma.
What is the cause of his gynaecomastia?
a. normal adolescence
b. steroids
c. anabolic
56. A young athlete presents with palpitations after marathon. What ECG would
you expect? (5 ECG strips given)
a. sunis arrhythmia (not SVT, as different RR intervals, and P wave is present
before every QRS)
b. atrial flutter with variable block
c. VTach
d. AFib
e. 1st degree heart block
57. A patient presents with chest pain of 2 hours onset in the metropolitan
hospital. ECG showing lateral STEMI in I, AVL and V5,V6. Morphine, Oxygen,
Nitrates, Aspirin given. What is the next step?
a. tPA
b. Coronary angiography
58. A 60 y.o. man develops lightheadedness and palpitations. He has hx of
thyroid disease and well-controlled heart failure. He is on thyroxine, ACEI,
diuretic. ECG is given clearly showed AFib. What is the next step?
a. Cease thyroxine
b. Start digoxine
c. Start b-blocker
d. Start verapamil
59. ECG of 1st degree heart block given and bradycardia around 50-60. A 30 yo
lady complains of proximal shoulder girdle pain bilaterally. What is the next
management?
a. Pacemaker
b. TFT
c. Atropine

60. A lady in her 20s with lightheadedness (and ECG given heart block 1 st
degree, I think). When you perform a table test (?) after head tilt for few
minutes her pulse drops to 50 and BP to 70/40. What is the management?
a. Pacemaker
b. Atropine
c. b-blocker
61. An ECG strip from one lead given. I have seen this ECG when pericarditis was
described smiley face ST elevation. Also, it seems that bradycardia is
present. Anyway, I didnt get what pathology they want me to see: bradycardia,
ST elevation or tall T-wave (although it was not peaked T wave of
hyperkalaemia).

Patient is on numerous medications: aspirin, amiodarone, nitrites, amlodipine.

What is the offensive drug combination?
I tried to figure out what combination could cause either brady or hyperkalaemia.
But none of them was suitable. I even will not provide you any options because I
do not remember them, I just picked one randomly.
62. A young guy with schizophrenia. What is the best option to start the Tx?
a. Olanzapine
63. A middle-aged lady had psychosis for 12 months. Olanzapine was prescribed
and she develops DM. WOF will you check?
a. Fasting lipids
b. Urea&creatinine
c. TFT
2 other incomprehensible options
64. A 50 y.o. woman complains of loss of interest in life, she is tearful. She also
admits of cutting herself. In the conversation she mentions that life is not worth
living. (You cannot clearly understand if she is suicidal or not). After treating
caring her wounds on the wrist, what is the management?
a. Start sertraline
b. Contact local mental health crisis team
c. Involuntary admission
d. Organise regular follow up
65. A young man sleeps all day long, doesnt want to do anything or socialize. It
is going on for 6 weeks after his girlfriend broke up with him after 3 months of
dating. He also has a very stressful job that drives hes fed up with. What is the
management?
a. discuss benefits and risks of antidepressants
b. advise him that his feeling are quite normal and understandable
c. advise to change the job

66. Stem clearly describing autism with language delay, repetitive acts and
social isolation in a toddler.
67. OCD case. SSRI prescribed, partial response. Patient would like to try some
non-medicament therapy. What is you advice?
a. refer him for long-term insight-oriented psychotherapy
b. advise him that compulsions are the form of anxiety reduction behaviour
no option of exposure-control therapy or smth similar.
68. A young man has depression. Partial response to SSRI but he still complains
of anhedonia. What would you recommend?
a. scheduled pleasures therapy
b. some well-sounding form of psychotherapy
69. A patient with recently placed stent and started on clopidogrel presenting for
varicose vein surgery. Management?
a. defer the surgery for 12 months, continue clopidogrel and then stop it 2 weeks
prior the surgery
b. stop clopidogrel, proceed to surgery
b. stop clopidogrel 7 days prior to surgery, PLT transfusion, proceed to surgery
c. continue clopidogrel, proceed to surgery
70. Elderly patient on clopidogrel (not mentioned for what reason) is admitted
with neck of femur fracture. PLT count is normal, although easy bruising.
Management?
a. Stop clopidogrel for 7 days and then proceed to surgery
b. Immediate surgery
c. Stop clopidogrel, PLT transfusion, then proceed to surgery
71. A lady is admitted to hospital and she is very demanding, verbal behaviour,
unhappy about the ward. Tells you I am sure you as a doctor understand me and
will be able to organise me a private ward, these nurses do not understand.
What do you suspect here?
No option of splitting.
a. Narcissistic personality disorder
b. Borderline personality disorder
c. Passive-aggressive
d. Dissociation
e. Some mental illness
72. Mom brings her girl with lead poisoning. They live in the mining city. Lead in
blood twice higher than normal. Your advice?
a. Move the family from the city
b. Refer to chelation
73. Where could be the primary malignancy in 60 yo woman assessed for
anemia?
a. Caecum
74. A 40 yo man asks for prostate cancer screening. Management?
a. DRE+PSA
b. Discuss pros and cons of screening

75. A 9 month old with fever, dry cough, breathlessness, grunting, wheezes.
Admitted, oxygen and IV fluids given. What is your next step?
a. steroids
b. nebulised adrenaline
c. antibiotics
d. observation
76. Pt with fever, cough. Chest auscultation: crepitations in the base of the right
lung. Xray right lobar pneumonia . Treatment?
a.amoxiclav
b.doxycycline
c. procaine penicillin
d.azithromycin
77. Agitated patient with alcohol withdrawal to the point when the security is
struggling to keep him. What is your management?
a. IV diazepam
b. IV thiamine
c. IM haloperidol
78. 13 yo girl living alone comes for abortion. Admits that she was raped. What is
next?
a.refer to pregnancy termination
b.inform police
c.inform sexual assault agency
79. A patient with vision 6/24. You prohibited him to drive. He went to another
doctor who permitted him to drive. Now he comes to you again and asks you to
change your conclusion. Your management?
a. Call to police
b. Call to this doctor to discuss the issue
c. Report the case to Road and Traffic department
d. Ask him to drive only is someone else is in the car
80. A 4 y.o. fell of the tree. No LOC. Vomited on the spot. On presentation he is
ok, no neurological signs. What is the next step?
a. Admit him for 24 h observation
b. CT head
c. Discharge him as no pathological sings found
d. Observe for 4 hours and let him go home
81. Patient is on sertraline and nifedipine. When he stands up tachycardia.
What is the cause?
a. Drug interaction
82. Patient is on risperidone and lithium. Acne and weight gain. Cause?
a. Lithium
b. Risperidone
c. Lithium and risperidone
d. Diabetes insipidus

83. Patient is on multiple medications. Blood count shown Hb low, MCV 70.
What is the cause?
a. Aspirin
b. Diclofenac
c. Chloroquine
2 options I do not remember as I picked one randomly.
84. A young girl collapsed after exercise. Hx of fathers death at 28. What is next
Ix?
a. ECHO
85. Patient presents with preauricular swelling. Sometimes it hurts when he eats.
Also he developed dry eyes and poliarthritis 2 years ago. USG done no specific
findings, just swelling, FNAC inflammatory cells, nothing specific. What is the
next Ix?
a. Sialography
b. MRI face
c. CT head
d. Biopsy of the swelling
86. Patient comes from some trip with fever and chills, jaundice and RUQ pain. In
blood ALP& GTT high. What is the management?
a. ERCP
87. 78 y.o. resident suddenly developed diarrhea of 4 days duration. Stool culture
is negative. Few days later authorities announced Salmonella outburst. You
patient is not improving despite the treatment. What is your next step?
a. Stool culture
b. Blood culture
c. Colonoscopy
88. A medical student sustained needle-stick injury. Blood from patient and
student is taken. Result of student: HbSAg positive. Management?
a. Immunoglobulin
b. Immunoglobulin and vaccine
c. Vaccine
d. Lamivudine
e. Nothing, but refer to counseling
89. Patient on dialysis is well during dialysis but between the sessions hast HTN.
What would you give give?
a.antihypertensive
b.frusemide
90. Patient on dialysis presents with dyspnea. What would you do initially?
a. Contact dialysis team
b. Give 100 mg frusemide
91. Afrer MVA patient is short of breath, blow out trauma to the chest. BP 90/60,
pulse 110. On auscultation breath sound diminished, dullness (not
hyperresonant) on percussion. What is ne next step?
a.needle thoracocentesis
b.chest tube under-water seal drainage

92. Elderly man with difficulty initiating urination and dribbling at the end. No
night frequency. Dx?
a. BPH
93. You are intern. Patient wishes you to witness her will in the presence of
lawyer.
a. Witness will
b. Refuse to witness
c. Ask surgical registrar if he can do it
d. Ask the patient if he is happy with intern witnessing his will
e. seek legal advice
94. A 20 yo patient is complaining that smth funny is going on around him, but
he doesnt understand exactly what. Smth is about to happen. What is the
reason?
a. schizophrenia prodromal
b. idea of reference
c. depression
95. What of the following drugs have the highest potential of fetal anomaly?
a. methadone
b.diazepam
c. methamphetamine
d. marijuana
96. Mother bring her child for consultation because he behaves and doesnt
listen to her, makes her to lose her temper. She beats him with the stick as a
punishment and locks his door for hours. What will you do?
a. report to child protection agency
b. send her for good parenting programme
c. ask further what could be the cause of childs misconduct.
97. What is the most common reason of not having enough milk for
breastfeeding in a new mom?
a. not putting a baby to the breast to eat frequently enough
b. not putting a baby to the breast to eat long enough
98. 6 yo child presents with asthma attack. Mom has given 6 puffs of salbutamol
for him. He improved, but now is worse again. He talks in words. Next
management?
a. give steroids orally
b. give ipratropium puffer
c. give inhaled steroids
d. give another 12 puffs of salbutamol