You are on page 1of 177

www.fischtest.co.

uk

Theme; Diagnosis of Infectious
Options
A. Pseudomonas aeruginosa
B. Escherichia Coli
C. Staphylococcus Aureus
D. Proteus Mirabilis.
E. Streptococcus viridians
F. Chlamydia Trachomatis
G. Chlamydia Psittaci
H. Trichomonas

lis

I. Neisseria Gonorrhoea
J. Neisseria Meningitides
K. Haemophilus Influenzae
Instructions
For each of the patients listed below, choose the most likely causative organism, from
the list of options above. Each option may be used once, more than once or not at all

1. A 20-year-old woman presents with a subacute onset of lower abdominal pain
associated with frequency & dysuria.
2. Pt with eye discharge & increased lacrimation. His 16-year-old brother has a
similar condition.
3. A 4-year-old boy who has just started school presents with a high fever,
vomiting, headache & a stiff neck.
4 A 30-year-old man presents with a fever, dyspnoea & palpitations. On
auscultation a pan-systolic murmur is heard in the tricuspid area. He was
previously healthy.
5 A 24-year-old man presents with a swelling in his right axilla. Aspiration yields
yellowish-green pus.

Answers.

www.fischtest.co.uk

Theme:

Side effects of anti-epileptic drugs
Options
A. Carbamizipine.
B. Na+ valproate
C. Phenytoin
D. Phenobarbitone
E. Benzodiazepines
F. Gabapentin
G. Vigabatrin
H. Paraldehyde
L. Lamotrigine
M. Ethosuximide
N. Tiagabine
O. Topiramate
P. Amitriptyline
N (again) Paraldehyde

Instructions
For the patients described above, choose the single most appropriate answer from the
list of Options above. Each option may be used once, more than once or not at all.
6 A 45-year-old man has been on anti-epileptic drugs for 5 years. He now presents with
nystagmus, unsteady movements & hyperplasia of the gums.
7 A 32-year-old man on anti-epileptic medication now presents with ankle swelling,
tremor, weight gain & hair thinning.
8 A 15-year-old boy who first presented with episodes of 'absences' at school has been
on anti-epileptics for 2-years. He now presents with ataxia, drowsiness, gum
hypertrophy & swelling of the tongue.
9 A 15-year-old boy was treated for status epileptics with intramuscular anti-epileptics
now presents with a sterile abscess at the site of injection.
10 A 12-year-old girl diagnosed with west syndrome (Infantile spasms) has been on antiepileptics for 3 months now presents with diplopia & nausea. She is found to have
marked visual field defects.
11 A 20-year-old woman is on treatment for epilepsy. A full blood count shows the
following, MCV-110 fl, MCHC-27 g/dl
12 A 34 years old on treatment for epilepsy C/O anorexia & nausea & general fatigue.
He has no body swelling. Blood investigations show Na+ -124-mmol/L. K+ -4 mmol/L.
Plasma osmolality is 200 mmol/kg. .
13 A 34-year-old woman, with given values suggesting acute renal failure.

Answers.

www.fischtest.co.uk

Theme-3; Transmission of Disease
Options
A BrucelIosis
B Staphylococcus Aureus
C Escherichia Coli
D Klebsiella Pneumoniae
E Hepatitis-C
F Pseudomonas aeruginosa
G Neisseria meningitis
H Typhoid
I Toxoplasmosis
J Hepatitis-A
K Hepatitis-B
L Scabies
M Tuberculosis
Instructions
For each of the conditions below, choose the most likely answer from the list of Options
above. Each option may be used once, more than once or not at all.

14 A 45-year-old sheep farmer C/O headache, anorexia, muscle & joint pain. He
has as 'undulating' fever.
15 It is a skin-to-skin contact disease.
16 A 32-year-old woman presents with dysuria, swinging fever & loin pain.
17 It is spread by faecal-oral route.
18 It is spread by oro-feacal route:
19 A 67-year-old man has lost 10-kg in weight, over the last 6 months.
addition he has as month H/O a productive cough.

Answers.

In

BM (glucose) 4.On initial examination her pulse rate is 80-beats/min. On initial examination his pulse rate is 90-beats/min. SaO 2 100% on air. she is sweating & has a SaO 2 of 98% on air. 23 A 45-year-old woman is brought to the A&E Department unconscious (GCS7). 24 A 31-year-old woman is brought to the A&E Depart unconscious (GCS-7).uk Theme: Immediate investigations of the unconscious patient Options A Arterial blood gases B Blood carbon monoxide C Blood culture D Blood glucose E Blood Paracetamol level F Blood salicyclate G Chest X -ray H CT-scan I ECG J Lumbar puncture K Serum osmolality L Skull x-ray M Temperature Instructions For each patient described below. temperature normal. more than once. BM (glucose) 4. Each option may be used once. 20 A 42-year-old woman is brought to the A&E unconscious (GCS-7) .3. BM (glucose) 4. On initial examination. 21 A 40-year-old woman is brought to the A&E Dept unconscious (GCS-7).www.5. On initial examination her pulse rate is 110-beats/min. BM (glucose) 5.3. SaO 2 97% on air. He smells of alcohol. her pulse rate is 100-beats/min. choose the single most useful discriminating investigation from the above list of Options.co. There are no external signs of Injury.A purpuric rash is noted on both her arms.6. or not at all. She was found with an empty bottle of antidepressant Dothiepin (Prothiaden). 22 A 43-year-old man is brought to the A&E Department unconscious (GCS-7). Answers. SaO 2 95% on air. . She is accompanied by other members of his family who also report feeling unwell.fischtest. O/E her pulse rate is 110-beats/min.

Ultrasound & mammography were inconclusive. O/E. 29 A 23-year-old woman says she feels lumps in her breasts during the time of her periods. She also feels anxious & irritable. . Each option may be used once. or not at all. The patient wants to be satisfied that this isn't malignant. Answers. .uk Theme: investigation of Breast disease Options A Open biopsy B Fine Needle Aspiration cytology C Ultrasound D Reassurance E Mammography. 27 A 36-year-old man comes with a hard mass in her breast the skin is tethered. F Wide excision G CT-scan H MRI I Lymphagiography Instructions For each of the patients described below. but a scaly lesion around the nipple is observed. 28 A 36-year-old woman presents with itching of her left nipple. more than once.www. 26 A 45-year-old woman presents with a mass in the right upper quadrant I of her right breast A round smooth mass is found in the axilla. no ulceration is seen.co. 25 A 35-year-old woman comes to the clinic for screening of her breasts.fischtest. choose the single most useful option from the list above.

5 oC) with warm hands & feet. 30 A 50-year-old woman underwent an anterior resection for carcinoma of the rectum one week ago. On the fourth post-operative day she becomes hypotensive (BP 60/40mmHg). Pulmonary embolism G. Wound dehiscence N. Following surgery.On clinical examination there is no obvious cause for this pyrexia. his BP was satisfactory. On the fourth post-operative day she was noted to have a sero-sanguineous discharge from the wound. Pelvic abscess H. Urinary retention L. 34 An 80-year-old woman underwent emergency laparotomy for peritonitis. Transfusion reaction K. but his urinary output was only 5 ml/hr in the first two hours.uk Theme: Post operative complications J Options A. 31 A 24-year-old man underwent an appendicectomy six days ago for a perforated appendix .She has pitting edema of the left ankle. Chest infection D.www. Answers. 32 A 69-year man underwent an emergency repair of an abdominal aortic aneurysm. Wound infection Instructions For each patient described below. She has pyrexia (38.He appeared to be making good progress but has developed intermittent pyrexia (up to 39 oC) .5 oC) & is complaining of pain in the left calf . Cardiac failure C. . Myocardial infarction F. He is tender anteriorly on rectal examination. Septicemia J. more than once. Acute tubular necrosis B. Urinary tract infection M.fischtest.co. Each option may be used once. She has a low-grade pyrexia (37. 33 A 60-year-old woman has undergone left hemicolectomy for carcinoma of the colon. Deep vein thrombosis E. or not at all. choose the single most likely postoperative complication from the above list of Options. pulse 130-beats/min. He had been severely hypotensive before & during surgery. Secondary hemorrhage I.

is found to have cervical lymphadenopathy. Epstein Barr Virus E. Psoriasis J. is admitted to hospital. Kawasaki's disease G. She has given Ampicillin & gets a generalized erythematous rash. a red & desquamating rash of the finger tips. Each option may be used once. Herpes Simplex virus F. Her fever subsides but on discharge develops a generalized erythematous rash.www. Answers. Roseala Infantum D. a headache.fischtest. . neck stiffness & photophobia.uk Theme: Fever & Rashes Options A. Erythema toxicum B. 35 A 16-year-old girl. 36 A young boy with fever. Measles H. Meningitis I. choose the single most appropriate answer from the list of Options above. is found to be febrile. Scabies L.co. 37 A 1-year-old child with edematous lips. is found to have a generalized non-blanching skin rash. 38 A 15 month old girl with a fever for 48 hours. Impetigo C. with a sore throat & fever. Ptyriasis rosea K. more than once or not at all. Varicella Instructions For each of the patients described below.

41 A 32-year-old woman presents with painful shallow. 40 A 28-year-old woman presents with a white curdly discharge from her Wet smear shows mycelium growth. Herpes Simplex Virus C. . Gonorrhea F. She has no gonorrhea. 39 A 34-year-old woman presents with a mal-odorous smear shows 'clue cells'. Endometrial carcinoma L. choose the single most likely diagnosis from the list of Options above. ulcers around the vulva & an offensive white discharge.www. offensive discharge & deep dyspaerunia. She bleeds after . Bacterial Vaginosis B.' l discharge. more than once or not at all. Syphilis D. Trichomonas lis I. Lymphogranuloma Inguinale G.uk Theme: Diagnosis Of a l Discharge Options A. Scabies J. Each option may be used once. 42 A 28-year-old woman presents with lower abdominal pain an.co. Candidiasis H. . Chlamydial pelvic infection E. Cervical carcinoma Instructions For each of the patients described below. Answers. 43 A 31-year-old woman C/O a chronic non-foul smelling discharge. Cervical erosion K.fischtest. A wet.

there is a haemotympanum. Answers. There are no external injuries found on him. He regains consciousness & C/O headache & is found to have neck stiffness O/E. . 46 Following a motoring accident. 47 A 32-year-old man is involved in a road traffic accident.fischtest.co. more than once or not at all. a patient is brought into the A&E with loss of consciousness. choose the single most likely diagnosis from the list of options above. He loses consciousness & regains it later. O/E. the GCS is 12.uk Theme: Diagnosis of Head injury Options A Subarachnoid hemorrhage B Subdural hemorrhage C Fracture base of skull D Mild injury E Moderate injury F Cerebral hemorrhage G Cephalohaematoma H Extradural hemorrhage I Granulomatous Meningitis J Fracture of involving occipital bone Instructions For each of the patients described below.www. Each option may be used once. O/E of the ear. 44 A cyclist is involved in an accident & is brought into the A&E with a GCS of 8 & no physical injuries. 45 An alcoholic has had recurrent falls. presents to the A&E with deterioration of consciousness.

48 A 19-year-old girl presents to her GP before she sits for her A-level weight. weight loss. B Malabsorption. She is divorced. D Depression. __ A middle-aged lady a company executive. she's feeling well an on general examination no significant findings are found.fischtest. Each option may be used once.uk Theme: Diagnosis of Weight loss Options A Starvation. Instructions For each of the patients described below choose the single most likely cause of weight loss. 49 A 45-year-old man presents to the A&E a H/O diarrhea. Now she C/O weight loss. G Dementia. C Anorexia nervosa. E Hyperthyroidism. She also C/O amenorrhoea.www. O/E. Answers. he had signs of weight loss & stigmata of liver disease. tiredness & insomnia. palpitations. F Atrophic gastritis. has had her company recently restructured. more than once or not at all. 50 An elderly man with liver disease associated with chronic alcoholism. . O/E there were no significant findings.co. but she has lost 15-kg.

co. 53 A 22-year-old university student is found to have microscopic haematuria on routine investigation. ureters & bladder D Isotope scanning E Micturating cysto-urethro-graphy F Intravenous urography G CT of the abdomen H Ultrasound of the abdomen I Cystoscopy Instructions For each of the patients described below choose the most appropriate investigation from the list of Options above. 54 A 50-year-old man C/O painless haematuria.www. Answers.uk Theme: Investigation of Haematuria Options A Mid stream urine microscopy & culture B Mid stream urine microscopy for casts C Ultra sound of kidney. more than once or not at all. 52 A 43-year-old man C/O severe right loin pain & haematuria. Each option may be used once. 51 A young woman C/O painful haematuria.fischtest. .

He reports bringing up green phlegm on coughing. A chest x-ray shows patchy consolidation 59 A young male a dry cough. more than once or not at all. 55 A homeless alcoholic with a chronic cough productive cough presents with haemoptysis.fischtest. with Kaposi's sarcoma C/O increasing breathlessness & . from the list of organisms above. The chest x-ray shows a cavitating lesion. choose the single most likely cause of pneumonia.uk Theme: Causes of Pneumonia Options A Chlamydia Psittaci B Staphylococcus Aureus C Streptococcus pneumoniae D Mycoplasma Pneumoniae E Legionella Pneumoniae F Mycoplasma tuberculosis G Haemophilus influenzae H Chlamydia trachomatis I Pneumocystis carinii Instructions For each of the patients described below. 56 A chronic smoker with.co. She C/O dry cough. Answers. 57 A 32-year-old woman who works in a pet shop C/O fever. 58 A 30-year-old woman has just returned from a holiday in Cyprus. chronic obstructive airways disease develops a fever. a dry cough & increasing breathlessness.www. fever & malaise. Each option may be used once.

& has lost considerable. 60 A 54-year-old man with metastatic liver disease develops exudative ascites. She frequently develops exudative ascites. . 62 An immigrant from India has been in the UK for 10 years. ascites. The ascetic fluid is found to be a transudate. On abdominal paracentesis numerous neutrophils are found in the ascitic fluid. but regularly goes back to her country for summer holidays.co. 63 A middle-aged man presents with bilateral pitting pedal edema. choose the single most likely cause of ascites from the list of Options above. 61 A 57-year-old man has a H/O recurrent ascites. Each option may be used once. Answers.fischtest. which is exudative in nature. a raised JVP. more than once or not at all.uk Theme: Causes of ascites Options A Carcinomatosis peritonei B Budd-chiari syndrome C Liver cirrhosis D Nephrotic syndrome E Primary Hepatoma F Hepatocellular carcinoma G Bacterial peritonitis H TB peritonitis I Congestive cardiac failure Instructions For each of the patients described below.www. .

which is mobile & non-tender & doesn't involve the axilla.uk Theme: Investigation of Breast Disease Options A Fine needle aspiration cytology B Stereotype cone biopsy C Wide excision D Mammography E Ultrasound F CT-scan G MRI H Family history I Ductulography Instructions For each of the patients described below. She has a morbid fear of needles. which seems to increase in size during her periods. 64 A 28-year-old woman presents with a mass in the upper lateral quadrant of her breast. She wants to know for sure that she has no malignancy. & there is no axillary involvement.fischtest. 65 A 24-year-old woman presents with a diffuse nodular breast swelling.co. O/E she has a discrete 2-cm mass. choose the single most appropriate investigation from the list of Options above. It showed diffuse calcifications. involvement & it disappears after her menses. 66 A 59-year-old woman has a mass in the upper lateral quadrant of her left breast. There is no axillary. 67 A 34 years old woman had a mammography done. The skin is pulled in. .www. Answers.

O/E it's relieved by elevation of the testis Answers. .uk Theme: Diagnosis of testicular pain Options A Orchitis B Epididymitis C Testicular torsion D Varicocoele E Inguinal hernia F Testicular tumour Instructions For each of the patients described below.fischtest.co. 70 A 54-year-old male C/O pain in his left testis on standing for a long time. 71 A middle-aged man C/O severe testicular pain. 69 A 24-year-old C/O pain in his right testis. Each option may be used once more than once or not at all. choose the single most likely diagnosis from the list of Options above.www. 68 An 18-year-old boy develops sudden pain in the left testis while cycling to school. He also reports pains on opening his mouth.

uk Theme: Treatment Of depression Options A: Electroconvulsive therapy (ECT) B: Flupenthixol C: Psychodynamic psychotherapy D: Cognitive therapy E: Behavioural therapy F: Marital therapy G: Lithium H: Imipramine I: No action J: Psychosurgery K: Hypnotherapy L: Abreaction M: Counseling Instructions For each patient of the patients below choose the single most appropriate treatment from the above list of Options. He is threatening to starve himself to death. 74 A 29-year-old woman presets with inability to sleep. Her husband says prior to this. Each option may be used once.fischtest. . 72 A 20-year-old first time mother presents with severe weight loss anorexia & believes that her husband is interested in killing her & their baby son & feels completely worthless. 73 A 40-year-old man has been treated for depression for 6 months: He is now beginning to lose weight & getting suicidal thoughts more frequently than before. She is not on the pill & the pregnancy test is negative.www. threatening to 'join her’. she was markedly withdrawn. 76 16-year-old girl with a BMI of 16 C/O 3 month H/O amenorrhoea. more than once or not at all. & blamed herself for their daughters death due to cancer. She wants to be a model.co. 75 A 12-year-old boy refuses to go to school because of constant failure to get grade A. Answers. & aggressiveness & increased libido.

78 A medical student who is about to sit for her exams is complaining of insomnia. 79 A divorced middle-aged woman who is a chief executive in a bank is found to have elevated liver enzymes. Each option may be used once.co.fischtest.www. Answers. more than once or not at all. She has a marked tachycardia & is found to have water intoxication. tremor & excessive sweating. 77 An 18-year-old girl is found collapsed outside Angenoir (a local discotheque).uk Theme: Alcohol & drug abuse Options A Alcohol B Ectasy C LSD D Amphetamines E Cocaine F Caffeine Instructions For each of the patients described below choose the single most likely cause of their symptoms from the list of Options above. . .

.uk Theme: Treatment of asthma in childhood Options A: As required oral bronchodilator B: Adrenaline C: Desensitization D: Inhaled long acting bronchodilator E: Inhaled Na+ cromoglycate F: Inhaled steroid. 82 A nine-year-old girl with chronic asthma presents to the A&E department with rapidly worsening wheeze not relieved with inhaled bronchodilators. using inhaled steroids & a bronchodilator comes to the A&E department with breathlessness & swollen lips after eating a peanut butter sandwich. Her parents refuse to give her any treatment containing corticosteroid. or not at all. 83 A four-year-old boy with eczema & recurrent wheeze whenever he gets a viral infection has now developed night cough. Steroids have been given orally. 81 A six-year-old girl with asthma uses her bronchodilator twice a day to relieve her mild wheeze. There as been no improvement inspite of using inhaled bronchodilator twice each night 84 A 14-year-old boy. Answers. 80 A nine-year-old boy has a mild cough & wheeze after playing football in the cold weather. Each option may be used once.www.co.fischtest. choose the single most appropriate treatment from the above list of Options. with well-controlled asthma. G: Intermittent inhaled bronchodilation H: Intravenous aminophyline I: Milk free diet J: Oral steroids K: Nebulized bronchodilators L: Oral theophyhine M: Regular inhaled bronchodilation N: Regular oral bronchodilator Instructions For each condition described below. more than once.

more than once. .fischtest. G Child neglect H Coeliac disease I Osteogenesis imperfecta J Osteoporosis K Sickle cell anaemia L Senile purpura M Precocious puberty Instructions "For each patient described below.www. The house Officer notices multiple fractures & that the baby has blue sclerae.uk Theme-Non accidental injury Options A Elderly abuse B child physical abuse C Child sexual abuse D Emotional abuse E Henoch schonlein purpura F Immune thrombocytopenic purpura. The girl has been staying with her stepmother & is found to be unkempt & smelly. The House Officer notices 'blue' discolorations of the skin in the back & further exam revealed more areas with similar lesions especially on the buttocks. or not at all. The nurse notices the baby has multiple bruises along both arms & legs & is crying excessively. 85 A mother 16 years brings her baby for immunization. 87 A 14-year-old girl asthmatic is brought in to the chest clinic for regular check up. 86 A 70-year-old man is receiving treatment for Alzheimer's disease. 89 A 12-year-old girl with a BMI of 16 is brought in by her auntie to hospital. but is otherwise normal. The SHO notices bruises on both wrists & back. choose the single most likely diagnosis from the above list of Options. The mother who is Afro-Caribbean fails to explain their occurrence. Answers. Six months prior to this presentation the girl had a confirmed streptococcal sore-throat infection.co. Each option may be used once. He is looked after by a 23-year-old grand-daughter. He has recently developed faecal incontinence. 88 An anxious mother brings her 6-year-old daughter who is bleeding per . The auntie is worried that the girl has taken an overdose of Paracetamol.

O/E his abdomen is distended. . guarding & rebound tenderness in the right iliac fossa. choose the single investigation most likely to assist in the diagnosis from the above list of Options. She drinks 30 units of alcohol per week. 91 A 22-year-old woman presents to the A&E department with a sudden onset of left iliac fossa pain.fischtest. more than once or not at all. but there is no tenderness.www. 92 A 35-year-old woman presents with a 12 hr H/O severe Epigastric pain associated with several episodes of vomiting.uk Theme: Investigation of patient with acute abdomen Options A Angiography B Arterial blood gases C Blood glucose concentration D CT-scan E Diagnostic Laporoscopy F Erect chest x-ray G Full blood count H Gastroscopy I Plain radiography of the abdomen J' Pregnancy test K Serum amylase activity L Sigmoidoscopy M VIS of abdomen N Urgent operation O Urine m&c P Water-soluble contrast enema Instructions For each patient described below. He is pyrexial with tenderness. Plain radiography shows no evidence of free gas. O/E of her abdomen she is tender in her left iliac fossa. 93 A 45-year-old man is admitted with a H/O 24 hrs of colicky central abdominal pain & bile stained vomiting. . Bowel sounds are increased.co. His only past medical history is an appendicectomy when he was 12. 90 A 71-year-old man with a previous H/O pain in his calves on walking is brought to the A&E Department. Each option may be used once. Answers. She is tender with guarding in the epigastrium. He C/O abdominal pain radiating to his back. She is pale & has a pulse rate of 120 beats/mill with a BP of 105/65-mmHg. 94 A fit 17-year-old man presents with a 12-hour H/O central pain localizing to his right iliac fossa. after having collapsed in the street.

. Following surgery.fischtest. 99 An 80-year-old woman underwent emergency laparotomy for peritonitis. 96 A 24-year-old man underwent an appendicectomy six days ago for a perforated appendix . Answers. more than once. his BP was satisfactory. 95 A 50-year-old woman underwent an anterior resection for carcinoma of the rectum one week ago. On the fourth pos-operative day she became hypotensive (BP 60/40mmHg).5 oC) & is complaining of pain in the left calf She has pitting edema of the left ankle. but his urinary output was only 5ml/hr in the first two hours. 97 A 69-year-old man underwent an emergency repair of an abdominal.5 oC) with warm hands & feet. He had been severely hypotensive before & during surgery.www. choose the single most likely postoperative complication from the above list of Options. Each option may be used once.He appeared to be making a good recovery but has developed impenitent pyrexia (up to 39 oC). or not at all. aortic aneurysm. pulse 130-beats/min. On the fourth post-operative day she was noted to have a sero-sanguineous discharge from the wound. She has pyrexia (38. He is tender anteriorly on rectal examination.co. On clinical examination there is no obvious cause for this pyrexia.uk Theme: Postoperative complications Options A Acute tubular necrosis B Cardiac failure C Chest infection D Deep vein thrombosis E Myocardial infarction F Pulmonary embolism G Pelvic abscess H Secondary hemorrhage I Septicemia J Transfusion reaction K Urinary retention L Urinary tract infection M Wound dehiscence N Wound infection Instructions For each patient described below. She has low-grade pyrexia (37. . 98 A 60-year-old woman has undergone left hemicolectomy for carcinoma of the colon.

J Space occupying lesions K Substance induced dementia L Toxin induced dementia M Vascular dementia Instructions For each patient described below. 104 A 62-year-old patient with chronic schizophrenia presents with mask like face & involuntary pill rolling movement in both hands. There is no H/O infectious diseases or trauma. choose the single most likely diagnosis from the above lists of Options.www. He is on anti-tubercular treatment. He C/O chronic cough & forgetfulness. poor concentration & inability to recognize household objects.co.uk Theme: Diagnosis of dementia Options A Alcoholic dementia B Alzheimer's dementia C Creutz-feldt-Jakob's disease D Head trauma E Human immunodeficiency virus (HIV) F Huntington's chorea G Parkinsonism H Pick's disease I Repeated trauma. He had a similar episode two years ago & became unable to identify objects & to make proper judgements. more than once or not at all 100 A 56-year-old man with no previous history is brought to the A&E by his wife who says that he has become progressively more forgetful.fischtest. 103 A 34-year-old woman presents with memory loss. 102 A 38-year-old haemophiliac who received several blood transfusions a few years ago presents with irritability & increasing memory deficit He is unable to speak properly. Answers. . O/E she has a right-handed involuntary writhing movement there is a strong family H/O similar complaints. tends to lose his temper & is emotionally labile. 101 A 74-year-old man presents with weakness in his arm & leg (from which he recovered within a few days) & short-term memory loss. He has an extensor plantar response. Each option may be used once.

A mother brings her 5-year-old son who has reportedly swallowed an unknown quantity of white tablets. His pulse rate is 100-beats/min & 50-ml of 50% dextrose is given intravenously. She is thought to have taken Ectasy (3. G Desferrioxamine + 100% Oxygen H Charcoal haemoperfusion in ITU I Increase urine. On questioning he says he sees yellow-green visual haloes & his pulse is irregular. Initial resuscitation has been done but her temperature is now 39. A blood screen reveals a salicyclate level of 8. 106. .www.5 oC. Each option may be used once. Answers.uk Theme: Management of drug overdosage &poisoning Options A Empty stomach with N-G tube B N-acetylcysteine iv C Dicobalt edetate 300-mg (iv) D Specific antibody fragments E Nevaripin +Lamuvidine F Nevaripin antidote immediately. 23-year-old girl is brought to A&E after having collapsed in a nightclub.4 Methylenedioxymethamphetamine). choose the single best management strategy from the above list of Options. 108 A 24-year-old male patient with heart failure takes an overdose of his medication. or not at all.co. O/E the child is breathing deeply & biochemical results show an increased anion-gap. output by alkaline diuresis J ITU K ITU + Propranolol + muscle relaxation L Flumanezil Instructions For each patient described below. 105. more. than once. 107 A 43-year-old chemist is thought to have swallowed cyanide & is brought to A&E confused.4 mmol/l & the child lapses into coma.fischtest.

110 A 5-year-old girl was born after a normal delivery has been developing normally. After an acute illness. Answers. The baby is found to have a head circumference of 32-cm.9-kg baby boy. She is able to stand but is yet to walk.uk Theme: Etiological Factors in developmental delay & mental handicap Options A Birth asphyxia B Duchenne's muscular dystrophy C Coeliac disease D Fetal Alcohol syndrome E Familial predisposition F Tay Sachs disease G Bacterial meningitis I Klinefletter’s Syndrome J Phenylketonuria K Normal finding L Fragile X syndrome Instructions For each patient described below. 113 A 25-year-old bartender gives birth to a 2. . 112 A 6-year-old boy with a birth head circumference of 29 cm & short palpebral fissure is found to be mentally-retarded. O/E unusually large testes are found. The mother says her other child had similar history. The mother also says the son has a very short temper.fischtest.co. 111 A 2-year-old girl was born weighing 4-kg after a labour that lasted 18-hrs in a mother of 2. The boys elder brother & uncle had similar complaints.www. The boy’s mother is on Acamprosate. She has had her job for the last 6 years. 109 A 10-year-old boy is getting very poor grades at school & according to the head teacher “seems to think like a 2 year old”. a regression of milestones has been noticed. more than once or not at all. Each option may be used once. choose the single most likely etiological factor from the list above.

www.fischtest.co.uk

Theme:

Decision making in head pathology
Options
A Consult Neurosurgeon at once
B iv 5-ml/kg of 20% solution of mannitol
C Emergency burr holes
D Urgent CT-scan
E Discharge after check skull X -ray
F A period of observation & discharge shortly after.
G 50-ml of a 50% solution of dextrose (iv bolus)
H Naloxone
I Pyrimethamine + sulphadiazine
J Lumbar puncture.

Instructions
For each patient descried below, choose the most appropriate action to be taken from
the list of above Options above.

114 A 40-year-old man involved in a road traffic accident is brought to A&E. O/E
GCS of 11 is found. He is found to have a bruise on the left temporal area.
115 A 25-year-old man is brought to A&E. He smells of alcohol Blood glucose is
5.0-mmol/l & his left pupil is dilated. GCS-7. The nearest consultant
neurosurgeon is 2-hrs away.
116 A 30-year-old man is brought to A&E after a drunken brawl, unconscious.
After initial resuscitation the patient breathing becomes progressively deeper
& then shallower & pupils constrict then later become fixed & dilated. A CTscan has been done.
117 A 17-year-old boy is brought to the A&E department following a road traffic
accident He has rhinnorhea & periorbital edema. His GCS is 5.
118 A 30-year-old i/v drug user is brought to the A&E department with a severe
headache & confusion. A CT-scan shows multiple ring enhancing lesions.
The pulse rate is 60-beats/min & BP is 150/100-mmHg. He is severely
wasted.

Answers.

www.fischtest.co.uk

Theme:

Diagnosis of hearing loss & painful ears
Options
A Acute suppurative otitis media
B Glue ear
C Otitis extern a
D Temporal-mandibular joint disease
E Cholesteatoma
F Ramsay-Hunt syndrome
G Wax
H Chronic otitis externa
I Ear drum perforation
J Aerotitis,
K Furunculosis
L Otosclerosis

Instructions
For each patient described below, choose the single most likely diagnosis from the
above list of Options. Each option may be used once, more than once, or not at all.

119 A 70-year-old man being treated for cancer of the prostate presents with
difficulty in hearing. Examination of his right ear reveals numerous vesicles
around the ear & on the meatus.
120 A 40-year-old C/O painful ears & also reports a H/O bruxism (teeth grinding)
sometimes associated with headaches. His symptoms seem to be worsened
by stress & anxiety.
121 A 16-year-old girl presents with hearing loss. She admits to a months H/O
vague right earache associated with a purulent discharge. She now reports
no pain.
122 A 40-year-old obese man presents with a painful right ear. Examination
reveals a swollen lesion in the external auditory meatus. The pain is so
severe & is worsened by jaw movement & traction on the tragus. The man
reports no other problem, but is currently on glibenclamide.
123 A 10-year-old boy diagnosed with acute otitis media 3 weeks ago, now
presents with hearing loss but no ear pain. On otoscopy, the eardrum is
concave, lusterless & has superficial radial vessels. Air puffed through the
otoscope doesn't move the eardrum (negative pneumatic otoscopy).

Answers.

www.fischtest.co.uk

Theme:

Diagnosis of pupil abnormalities
Options
A Neuro-syphilis
B Fracture base of skull
C Horner’s syndrome + rheumatoid arthritis
D Syringomyelia
E Myasthenia gravis
F Holmes-Adie pupil
G Holmes-A die syndrome
H Cavernous sinus thrombosis
I Subacute combined degeneration of the cord

Instructions
For each patient described below, choose the single most likely diagnosis from the
above list of Options. Each option may be used once, more than once, or not at all.

124 Examination of a 20-year-old male patient revealed bilateral miosis &
irregular pupils. There was no response to light, but good response to
accommodation.
125 O/E of a 42-year-old man, his pupils were fixed, dilated. The patient
presented with chemosis & grossly edematous eyelids.
126 A 32-year-old woman presented with wasting & weakness of the hands,
associated with dissociated sensory loss over the trunk & arm. The right
pupil is miotic & in addition has shows partial ptosis. Her right face is
anhidrotic & knees are swollen & grossly deformed.
127 A 21-year-old woman reports a sudden onset of blurring of near vision. The
pupil is slightly dilated & there is a delayed response to accommodation &
especially too, when light is shone in the eye. Her knee & ankle jerks are
noted to be absent.

Answers.

more than once. She is brought into 'he A&E department with slowly increasing drowsiness. Answers.fischtest. choose the single most likely diagnosis from the above list of Options. By the time you see her it has improved considerably. or not at all. O/E you find mild hemiparesis & unequal pupils. She now presents with sudden loss of vision in her left eye.www. Each option may be used once. 131 A woman previously in good health presents with sudden onset of severe occipital headache & vomiting. 130 A 74-year-old woman had a fall two weeks ago.uk Theme: Diagnosis of stroke/transient ischaemic attack (TIA) Options A Carotid artery stenosis B Cerebellar haemorrhage C Cerebral embolus D Cerebral haemorrhage E Cerebral vasculitis F Migraine G Subarachnoid haemorrhage H Subdural haematoma I Temporal arteritis J Vertebro-basilar TIA Instructions For each patient described below. . 128 A 27-year-old woman has a long-standing H/O headaches associated with nausea & vomiting. Her only physical sign O/E is a stiff neck.co. On this occasion she presents with sudden loss of vision in the right half of the visual field. 129 An 82-year-old woman C/O increasing weakness & muscle pain to the point where she is finding it difficult to brush her hair & get out of a chair.

who says the child is taking too long to walk normally. 132 A 5-year-old boy presents with a painful knee joint His mother notices the boy has started to limp. X-ray of the femoral head shows patchy density. all movements at the hip joint are limited. O/E her perineum appears wide & the lumbar lordosis appears to be increased. She C/O occasional hip pain & is seen to have a waddling gait 134 5-year-old boy presents with a painful right hip & is seen to be limping. O/E. Each option may be used once. There is no H/O trauma.co. F Perthe's disease G Septic arthritis Instructions For each patient described below. X-ray of the right hip appears normal & no other joints are involved.uk Theme: Diagnosis of painful joints children Options A Transient synovitis (Irritable hip) B Slipped upper femoral epiphysis C Congenital hip dislocation D Juvenile rheumatoid arthritis E Ankylosing spondylitis. more than once or not at all. . the boy has no complaints & is discharged.www. choose the single most likely diagnosis from the above list of options. 133 A 3-year-old girl is brought to hospital by an anxious mother.fischtest. The SHO in charge admits the boy & 24 hrs later. Answers.

or not at all.uk Theme: Diagnosis of sudden visual loss Options A Acute glaucoma B Cataract C Central retinal artery occlusion D Cerebral embolism E Cerebral haemorrhage F Chronic (simple) glaucoma G Hypertensive encephalopathy H Polymyalgia rheumatica I Retinal detachment J Temporal arteritis K Uveitis Instructions For each patient described below. 135. & is generally unwell. 139. 136. choose the single most likely diagnosis from the above list of options. A 50-year-old woman C/O sudden loss of vision in one eye. A 30-year-old man has recurrent episodes of an acutely painful red eye with reduced vision. Each option may be used once. 138. more than once.co. He cannot read any letter on visual acuity chart but can count fingers. An 84-year-old woman notices sudden increased visual impairment She is found to have homonymous hemianopia.fischtest. A 78-year-old man has had a painful scalp & headache for three weeks.www. The fundus is pale. C/O acute onset of blindness in his right eye. She describes the incident 'like a curtain coming down' 137. . Answers. A 68-year-old smoker suddenly notices markedly reduced vision in one eye.

140 A 52-year-old woman has had a H/O offensive l discharge & intermittent l bleeding over the past three months. .uk Theme: Investigation of l bleeding Options A Cervical inspection B Cervical smear C Endocervical swab D Endometrial sampling E Full blood count F Gonadotrophin levels G Hysteroscopy H Kleihauer test (fetal cells in maternal circulation) I Pregnancy test J Thyroid function tests K Ultrasound scan. An ultrasound scan reports "an empty uterus". She has been on the combined oral combined pill for the last six years. 143 A 26-year-old woman with a six-week H/O amenorrhoea presents to the A&E department with l bleeding. Clinical examination shows a normal size uterus with no adnexal masses. Her last cervical smear was taken four years ago.co. 144 A 49-year-old woman presents with a nine-month H/O prolonged. slightly irregular periods. She presents with a twomonth H/O breakthrough bleeding.fischtest. 141 A 23-year-old woman has a new partner. Answers.www. Her last period was when she started tamoxifen two years ago. 142 A 47-year-old woman who has breast cancer & is on tamoxifen has two episodes of bright red bleeding. choose the single most discriminating investigation from the above list of Options. Instructions For each patient described below. more than once or not at all. Each option may be used once.

or not at all. Ultrasound shows the fetus to be normal. 147 A 40-year-old lady 38 weeks pregnant is brought to A&E fitting. Her BP is found to be 200/110-mmHg. observation F Abdominal amniocentesis G Give diazepam rectally after a period observation H 4-5g iv MgSO4 over 20 minutes. Each option may be used once. para 3+1 presents at 20 th-week with a grossly distended abdomen. . she had complained of epigastric pain.co. 145 A 35-year-old gravida 4.www. more than once. She is dyspnoeic & C/O general abdominal discomfort.uk Theme: Management of abdominal discomfort in pregnancy Options A Give 500 mg stat P/O of Acetazolamide B Do emergency cardiotocography C Propranolol immediately D Induce labour & deliver immediately E No treatment. Abdominal ultrasound shows the deepest pool of amniotic fluid to be 10 cm & a normal fetus.fischtest. Prior to this. Answers. She is dyspnoeic & C/O indigestion & claims the abdomen has swollen to this size within a week. then 1-3g/hr + hypotensive. choose the single most appropriate management strategy from the above list of Options. 146 A 23-year-old primigravida presents at 36 weeks with abdominal discomfort & O/E her abdomen is found is to be larger for dates. initially Instructions For each patient described below.

choose the single best first management strategy from the above list of Options. 150 A 70-year-old man with prostatic symptoms develops dysuria & frequency. She has had frequency. 148 An 18-year-old woman became sexually active one month ago. . Mild stream specimen of urine grows E. Answers. Each option may be used once.www. The intravenous urogram is normal. more than once. coli on each occasion. dysuria & one episode of haematuria.fischtest.co.uk Theme: Management of cystitis Options A CT-scan B Cystoscopy C Intravenous urogram (lVU) D Long-term Trimethoprim E Mid stream urine culture in three months F Mid stream specimen of urine for culture & Trimethoprim G Monthly mid stream urine culture H No action I Nuclear medicine scan J Potassium citrate K Ultrasound of kidneys & bladder Instructions For each patient described below. or not at all. 149 A three-year-old boy has a first confirmed urinary tract infection. Urine testing reveals microscopic haematuria. 151 A previously uninvestigated 25-year-old woman has her third attack of frequency & dysuria. 152 A 25-year-old man has his first proven episode of urinary tract infection.

heat & swelling of the wrist. . 153. conjunctivitis & arthritis.uk Theme: Diagnosis of chronic joint pain Options A. swollen metetarsophalangeal joint.Gout D. Answers.Osteoarthritis I. 156.Rheumatoid arthritis Instructions For each patient below. An elderly woman started Frusemide two weeks ago & now presents with a . 154.Reactive arthritis L. worse in the morning. . A 22-year-old male soldier presents with a two-week H/O a swollen right knee.Ankylosing spondylitis B. more than once.Pyrophosphate arthropathy K. & one episode of iritis. A 30-year-old man presents with a 10-year H/O back pain. Each option may be used once.co.Medial cartilage tear H.Hyperparathyroidism F.Erythema nodosum C. 157. or not at all. A 73-year fit farmer presents with pain on weight bearing & restricted movements of the right hip.Haemochromatosis E.www. A 71-year-old woman with rheumatoid arthritis on immunosuppressive drugs presents with systemic malaise & fever & has redness.Joint sepsis G. 155.Psoriatic arthropathy J. choose the single most likely diagnosis from the above list of options.fischtest.

Immunization of paramedics who come into contact with body fluids 161. 163.Lyme disease I.Cirrhosis B.Infectious mononucleosis G. Avoidance of alcohol for six months after hepatitis-A. . Each option may be used once.www.uk Theme: Prevention/health promotion of jaundice/hepatitis Options A. 159. Care in the preparation of shellfish.Hepatocellular carcinoma F. more than once or not at all. 160.co. choose the single most likely disease to be prevented from the above list of options. Answers.Hepatitis-C E. 164. other than for the prevention of hepatitis-B. Avoidance of swimming in rivers and reservoirs.Hepatitis-A C Hepatitis-B D. Immunization of sewage workers.fischtest.Leptospirosis H. Mass immunization against hepatitis-B. 162. Counseling for intravenous (iv) drug users to use needle exchange facilities. 158.Sclerosing cholangitis Instructions For each strategy for prevention below.

Each option may be used once.Streptococcal pneumoniae Instructions For each presentation below. The X-ray shows peri-hilar fine mottling. The X-ray shows widespread upper zone shadowing. more than once.Pneumocytis carinii J. general malaise & productive cough.Mycoplasma Pneumoniae I.Staphylococcus Aureus K. . His chest is normal.www. The x-ray shows patchy shadowing throughout the lung fields. 165. 167. A 35-year-old previously healthy man returned from holiday five days ago.Bacteroids fragilis B. a dry cough & marked pyrexia. He is very distressed.Legionella pneumophilia F. He smokes 10 cigarettes a day. A 26-year-old man presents with severe shortness of breath & dry cough. choose the single most likely causative agent from the above list of options. A 20-year-old previously healthy woman presents with general malaise.Mycobacterium tuberculosis H. The blood film shows dumping of red cells with suggestion of cold Answers. which he has had for 24 hours. He has been an IV drug abuser. He presents with mild confusion.Mixed growth of organisms G. The X-ray shows right lower lobe consolidation. There is nothing significant to find O/E. severe cough & breathlessness.Escherichia coli (Gram -ve) D.Coxiella burrnetii C. which has not improved with a seven-day course of amoxycillin. A 25-year-old man has a three-day H/O shivering.co. 168.fischtest. 166. or not at all.uk Theme: Causes of pneumonia Options A.Haemophilus influenzae E.

fischtest. Diverticulosis G. Each option may be used once more than once or not at all. Irritable bowel syndrome L. Answers. Systemic Sclerosis I. A 65-year-old woman presents with constipation. & reports difficulty in starting or stopping to walk. A 60-year-old man with a H/O weight loss. Parkinsonism C. Carcinoma of the colon B. Bulimia F. .co. She is extremely afraid of eating and admits to sticking a finger down her throat to induce vomiting after meals. A 23-year old man being treated for myeloma is brought to A&E confused.He also reports a H/O diarrhea. Chronic pseudo obstruction H.4 mmol/l. His Hb is 10-g/dl. 171. A 16-year old girl c/o constipation. 170. Her BMI is found to be 17. presents with bleeding per rectum .uk Theme: Diagnosis of constipation Options A. 169. which seems to alternate with constipation. She admits to losing weight Her fasting blood glucose is 5. This followed a hour H/O severe abdominal pain. 173. polydipsia & constipation. She is unusually sensitive to cold.www. vomiting prior to this the pt had c/o polyuria polydipsia & constipation. 172.Myxodema E. Anorexia nervosa D. Choose the chose the single most likely diagnosis from the above list of option. Hypercalcaemia J. She has dysarthria & dribbling. Diabetic neuropathy K. A 42-year-old woman C/O excessive thirst polyuria. . Multiple Sclerosis Instructions For each patient described below.

uk Theme: Diagnosis of stridor in children Options A Laryngotracheobronchitis B Foreign body C Laryngomalacia D Acute epiglottitis E Mediastinal tumour F Recurrent laryngeal nerve paralysis G Laryngeal stenosis Instructions Choose the single most likely diagnosis for each patient described below from the above list of options.fischtest. Each option may be used once. or not at all 174 A 3-year-old girl with a running nose. fever & loss of appetite. Throat cultures done upon arrival revealed a growth of Haemophilus Influenzae type-b. This was followed by stridor & cough described by the mother as 'barking'. 175 A 4-year-old boy presents to the A&E department with severe difficulty in breathing & stridor. presents to hospital.www. more than once. Answers.co. He was febrile & had a pulse of 200-beats/min. .

or not at all. . 179 A 68-year-old diabetic on treatment for the last 5 years presents with calf pain exacerbated by movement. 182 A 30-year-old female insulin dependent diabetic who has been on treatment develops ulcers on the dorsum of his left foot He is unable to feel a pin prick on the dorsum of his left foot. more than once. 181 A 40-year-old male. choose the most likely complication from the list of options above.fischtest. 177 A 48-year-old female insulin dependent diabetic who has been on treatment for 20 years presents with urinary frequency but no dysuria or urgency.5 mmol/L. insulin dependent diabetic who has been on treatment for 20-years is unable to achieve/maintain an erection.uk Theme: Complications of Diabetes Mellitus Options A Hyperglycemia B Hypoglycemia C Urinary tract infection D Somatic neuropathy E Autonomic neuropathy F Intermittent claudication G Atherosclerosis H Arteriosclerosis I Lactic acidosis J Ketoacidosis K Amyotrophy L Diabetic nephropathy M Possible infection. 180 A 70-year-old diabetic on treatment with Metformin presents with severe epigastric pain. Each option may be used once. Her blood glucose is 17. 176 A 48-year-old female insulin dependent diabetic who has been on treatment for 20 years presents with a H/O 3 episodes of severe hypoglycemia. She has not changed her insulin requirement.co. Instructions For each of the patients listed below. 178 A 30-year-old female insulin dependent diabetic presents with failure to pass urine. drowsiness & confusion. diet or exercise pattern.www. Answers.

www.fischtest.co.uk

Theme:

Human Immunodeficiency Virus
Options
A Prophylactic AZT
B Needle exchange
C Refer to social worker
D Refer to your consultant
E Methadone
F Counseling
G Condoms
H Combination therapy
I Pentamidine
J Pyridoxine & sulphadiazine
K Co-trimoxazole

Instructions
For each of the patients described choose the single most appropriate intervention' from
the list of Options above. Each option may be used once, more than once or not at all.

183 23-year-old woman has been using heroin iv for 4 years. She is not willing to
stop using the heroin.
184 A Third year medical student was drawing blood from a known HIV positive
patient gets a needle stick injury.
185 A healthy 20-year-old pregnant woman whose partner is a haemophiliac.
186 A 28-year-old haemophiliac with a H/O 20 previous blood transfusions
presents with a dry cough & fever. His chest X-ray shows widespread
mottling.
187 A 20-year-old sexually active woman who is going to Thailand for a holiday
188 A known HIV positive patient presents with increasing dyspnoea. The chest
X-ray looks normal.

Answers.

www.fischtest.co.uk

Theme:

The treatment of menopausal symptoms
Options
A Clonidine
B Combined HRT
C
D Hypnotic preparations
E Mineral supplements
F Oestrogen only HRT
G Psychological support
H Referral to psychiatrist
I Regular exercise
J

l lubricant

K

l estrogens

Instructions
For each case below, choose the single most appropriate treatment from the above list
of Options. Each option may be used once, more than once, or not at all.

189 A 59-year-old woman whose periods stopped five years ago has become
increasingly depressed. She now feels “life is no longer worth living” &
threatens suicide.
190 A 72-year-old woman has experienced frequency of micturition intermittently
for the last few months. Mid-stream urine (MSU) cultures have been
persistently negative. She is well otherwise, but would like her symptoms to
be resolved.
191 A married 52-year-old woman who has a family H/O breast cancer has been
experiencing mild discomfort for a few hours following
for the last
month. She is worried about using hormones.
192 A 45-year-old woman who has had a total abdominal hysterectomy (TAH) &
bilateral salpingo-oophorectomy (BSO) for fibroids & menorrhagia C/O hot
flushes, night sweats & mood swings. She has no other medical problems.

Answers.

www.fischtest.co.uk

Theme:

Diagnosis of Renal Disease
Options
A Acute hypothyroidism
B Type iv renal tubular acidosis
C Acute adrenal insufficiency.
D Central nervous lesion with panhypopituitarism
E Cytomegalo-virus disease
F Type-I renal tubular acidosis.
G Syndrome of inappropriate ADH secretion (SIADH) with
nephrotic syndrome
H None of the answers
I Membranous nephropathy
J Type-II renal tubular acidosis

Instructions
For each patient described low, choose the single most appropriate diagnosis from the
above list of Options. Each option may be used once, more than once or not used at all.

193 A 30-year-old man with AIDS presented in shock. Serum biochemistry; K+
6.7 mmol/L HCO3 20-mmol/L Chloride 84-mmol/L Creatinine 160 umol/L
194 A 41-year-old Londoner developed a temperature of 41 oC, 5-weeks after
cadaveric renal transplantation WBC 2.1 x 1,000,000,000/L Hb 8.8g/dl
Creatinine 177-umol/L Aspartate aminotransferase (AST) 82-U/L Alanine
Aminotransferase (ALT) 132-U/L Na+ 137 mmol/L
195 A 36-year-old woman with leukemia has been treated with Amphotericin B
for a fungal pneumonia. She presents with muscle weakness. K+ 2.7 mmol/L
HCO3 19 mmol/L Chloride 11.0 mmol/L Creatinine 84-umol/L Urine pH 6.8mmol/L
196 An 83-year-old woman with Small cell lung cancer presents with ankle
edema & is found to have 8-g/day, Urine proteinuria. He is started on
Frusemide 10 days later his BP is 115/75-mmHg lying & 85/65-mmHg
standing. Serum Biochemistry was; Na+ 121 mmol/L, HCO3 24-mmol/L, K+
3.6-mmol/L, creatinine 113-umol/L, chloride 95-mmol/L Urea 11.5-mmol/L,
glucose 5.7-mmol/L, albumin 27-g, Osmolality 263-mOsm/L, Urine
Osmolality 417 mOsm/L.
197 A fit 50-year-old man is prescribed oral Acetazolamide by an
Ophthalmologist for suspected glaucoma. He presents with lethargy &
shortness of breath on exertion. Na+ 140-mmol/L, K+ 3. 2-mmol/L, HCO 3
18-mmol/L, Chloride 115-mmol/L, Urea 6.7-mmol/L, Creatinine I 14-umol/L.

Answers.

choose the single most discriminating investigation from the above list of Options. 202 A 75-year-old man with known mild Alzheimer’s disease became suddenly more confused yesterday. 199 A previously well 78-year-old woman has been noticed by her daughter. 198 An 84-year-old woman in a nursing home has been constipated for a week.co. Over the past few days she has become increasingly confused & incontinent. his BP was 90/60-mmHg & his pulse was 40/min & regular. confusion & drowsiness. She has deteriorated generally over the past two weeks with fluctuating confusion. She has gained weight & tends to stay indoors with the heating even in warm weather. 201 A frail 85-year-old woman presents with poor mobility & recent H/O falls. or not at all. Answers. 200 A 64-year-old man has recently been started on tablets by his GP.www. He is brought to the A&E by his wife with sudden onset of aggressive behavior. .fischtest. to be increasingly slow & forgetful over several months. Prior to starting the tablets he was losing weight & complaining of thirst.uk Theme: Investigation of confusion Options A Blood cultures B Blood glucose C Chest X -ray D CT E ECG F Full blood count (FBC) G Mid-stream specimen of urine H Stool culture I Thyroid function tests J Ultrasound abdomen K Urea & electrolytes Instructions For each presentation below. When seen in the A&E. more than once. O/E she has a mild hemiparesis. Each option may be used once.

www. 205. Each option may be used once. She is found to have angular stomatitis. A 50-year-old woman with a H/O thyroid disease presents with a six month H/O a sore tongue. 207. A 32-year-old man presents with spontaneous bruising & recurrent infections with marked lethargy. Answers. A 24-year-old woman presents with a two year H/O menorrhagia & C/O lethargy. 203.fischtest.co.uk Theme: Diagnosis of Anaemia Options A Anaemia of chronic of disorders B Aplastic anaemia C Autoimmune haemolytic anaemia D E Iron deficiency F Pernicious anaemia G Red cell aplasia H Sickle cell disease I Sickle cell trait J Beta thalassemia major K Beta thalassemia minor Instructions For each patient described below. choose the single most likely diagnosis from the above list of Options. A 14-year-old Jamaican boy C/O abdominal & joint pains of sudden onset He is found to be pyrexial & has recently had a chest infection. 206. . She is taking NSAIDs. Faecal blood is negative. more than once or not at all. A 62-year-old woman with joint deformities & subcutaneous nodules is found to be anaemic. 204. There is no recent treatment history.

210 A 38-year-old C/O infertility & is otherwise healthy.fischtest. or not at all 208 A 41-year-old woman C/O being unable to conceive for 2 years despite having regular unprotected sex. Her breasts are discharging. Her mother is asthmatic & she has eczema.co. . Her Body Mass Index (BMI) is just 20. O/E she is found to have an enlarged & tender uterus. 211 A 31-year-old woman C/O abdominal pain. frequent stools & says this explains her loss in weight in recent weeks. Each option may be used once more than once. She had been on Haloperidol treat a schizophreniform illness she had for six years.www. She C/O sweating all the time. Glycosylated Hemoglobin (HbAlc) 5%. she has noticed difficulty in breathing & chest pain associated with occasional haemoptysis. She has a healthy 3-year-old daughter. She has been unable to conceive. choose the single most likely diagnosis from the above list of Options. Over the last year. & has put on a lot of weight. following her periods. She denied starving herself & says she has a very good appetite.uk Theme: Diagnosis of Infertility Options A Polycystic ovary disease B Endometriosis C Adenomyosis D Chronic Salpingitis E Diabetes Mellitus F Hyperprolactinaemia G Hypopituitarism H Hyperthyroidism. I Hypothyroidism J Pulmonary tuberculosis K Possible Malignancy Instructions For each patient described below. 209 A 28-year-old woman C/O infertility for 3 years. Answers. which seems to increase during her periods. She has a low libido.

uk Theme: Risk factors for deep vein thrombosis (DVT) Options A Dehydration B HRT C Immobility D Inherited clotting abnormality E Malignancy F Multiple myeloma G Polycythaemia rubra-vera H Pregnancy I J Varicose veins Instructions For each patient described below who presents with a DVT. 214 A 60-year-old man with a plethoric appearance presents with pleuritic chest pain. 216 A 25-year-old woman with a family history of deep vein thrombosis was prescribed a combined oral contraceptive pill six months ago & has not missed any tablets. which has been present for three months. 212 A 60-year-old man presents with malaise & back pain. He has palpable splenomegaly. Each option may be used once.fischtest. He is found to have significant proteinuria.www. choose the single most likely underlying risk factors from the above lists of Options. 213 A 30-year-old woman presents with a three-month H/O amenorrhoea. 215 A 70-year-old man presents with back pain & jaundice. Answers. more than once or not at all. .co.

erythematous rash was noticed on the on the dorsum of the hand. . O/E. 217 A 29-year-old man with known arthritis presented with a painful red eye & a brownish rash on his feet. 219 A mother brought her 10-year-old son to the GP. She had earlier complained dysphagia.co. O/E the boy had hypopyon & mild conjunctivitis. which has been present for 3 weeks.A 40-year-old sheep farmer [Tom Kent presented to her GP complaining of muscle & joint pain with an associated chronic headache. red nodules on both lower limbs & forearms.www.uk Theme: Diagnosis of a rash Options A Pulmonary tuberculosis B Sarcoidosis C Reiter's syndrome D Urticaria E Lyme disease F Dystonia Myotonica G Herpes Simplex H Behcet's syndrome I Myasthenia J Dermatomyositis Instructions For each of the patients with a rash described below. She also reported having difficulty getting up & down stairs. with a H/O joint pains & recurrent oral ulcers. 218 A 30-year-old woman presented to the family GP complaining of difficulty in lifting her arms up. on her abdomen. She had painful joints & was febrile. 221 A 30-year-old woman presented with tender. He has recently been treated for dysentery. She had a month's H/O a productive cough & investigations revealed raised angiotensin converting enzyme levels. A scaly. & knuckles. she had an erythematous annular rash with a central clear area. 220.fischtest. choose the single most likely diagnosis from the above list of Options. Answers.

co. He is now lethargic. or not at all. 222 A two day old breast fed male infant is vomiting after each feed. Answers. more than once.fischtest. He is developmentally normal & is fed by the bottle at 260-ml/kg/day. . dehydrated & tachypnoeic.uk Theme: Diagnosis of acute vomiting in children Options A Acute appendicitis B Cyclical vomiting C Duodenal atresia D Gastro-esophageal reflux E Gastroenteritis F Meconium ileus G Meningitis H Mesenteric adenitis I Overfeeding J Pancreatitis K Psychogenic vomiting L Pyloric stenosis M Urinary tract infection (UTI) N Whooping cough Instructions For each child described below. 226 A 12-week-old thriving baby is vomiting after every feed. 225 An eight-year-old girl shows signs of moderate dehydration." 223 A six-week-old breast fed boy has had projectile vomiting after every feed for the past two weeks.www. She has had two similar episodes in the past year. which is occasionally blood stained & is associated with eying. Abdominal x-ray demonstrated a "double bubble. 224 A four-month-old baby who is thriving has persistent vomiting. She has vomited all fluids for 24 hours & the vomit is not bile stained. Her abdomen is now soft & non-tender. choose the single most likely diagnosis from the above list of Options. Each option may be used once.

228 A 40-year-old afro-Caribbean male presents with a swinging fever.www. 227 A 30-year-old woman being treated with Lithium for prophylaxis against her bipolar manic-depressive illness presents with polyuria & polydipsia. polydipsia. Answers. Plasma osmolality is found to be 600-mOsmol/kg & urine osmolality is 250 osmol/kg. . Each option may be used once more than once or not at all.uk Theme: Investigation of polyuria & polydipsia Options A Water deprivation test B Oral glucose tolerance test C Plasma calcium & ACE levels D Psychological & psychiatric assessment. In addition she has a one-month H/O unproductive cough & chest x-ray reveals bilateral hilar shadowing.co.fischtest. E ACTH Stimulation test F Diuretic stimulation trial G Echocardiography & blood cultures Instructions F or each patient described below chose the most appropriate investigation from the Options listed above. . polyuria & gradual onset exertional dyspnoea.

www.uk Theme: Association of skin lesions & specific disease. She says it started as a pustule one month ago. (Fasting blood glucose is 5.co. or not at all. 229 A fit 55-year-old gentleman. 231 A Welsh farmer with malaise & arthralgia is increasingly anxious about a skin lesion. Options A Hyperthyroidism B Diabetes Mellitus C Liver disease D Coeliac disease E Hypogonadism F Borrelia burgdorferi infection G Carcinoma of tail of pancreas H Measles I Deep vein thrombosis J Psoriasis K Leptospirosis L Borrelia duttoni infection Instructions For each of the patients described below. C/O recurrent episodes. Each option may be used once. . choose the most likely association from the Options given above. edges appear yellowish & are beginning to ulcerate with undermining.fischtest. of 'seeing visible veins on his body'. which she says are beginning to affect her feet. which started as a papule (Diameter approx 1-mm). The itch is becoming unbearable & she is contemplating suicide. more than once. which has progressed to a red ring (Diameter approx 50-mm) with central fading. The consultant dermatologist thinks he has thrombophlebitis migrans. which are tender. She responds to 180-mg of Dapsone within 48 hours of treatment.3 mmol/L) 233 A 32-year-old woman C/O palpitations & is found to have red edematous swellings above both lateral malleoli. She is found to have digital clubbing & periorbital puffiness. which are occurring in groups on her knees & elbows. 232 A 42-year-old man who reports a loss in weight presents with a shiny erythematous lesion on her shin. 230 A 49-year-old woman C/O itchy blisters. He has started to lose weight & attributes this to his diarrhea. Answers.

Her temperature is 39oC & her white cell count is elevated. 237 A 22-year-old woman who has had two terminations of pregnancy. the uterus is tender & bulky. choose the single most likely diagnosis from the above list of Options. She has not had a menstrual period for nine weeks & had a positive home pregnancy one week ago. worse on the left. Answers. 235 A 16-year-old woman presents with a sudden onset of severe right iliac. On l ultrasound examination a 6-cm diameter echogenic cystic mass is seen in the right fornix. . due to take her examinations. She has noted a small amount of watery brown discharge & is tender in the right iliac fossa. She has worsening abdominal pain. reports that she is pregnant again.fischtest. She is otherwise well. The cervical OS is open. reports that she missed her period & that a pregnancy test is negative. Each option may be used once. which has been troublesome for three months. When examined she has pain over the lower abdomen.co. 234 A 21-year-old woman presents as an emergency with [I four H/O lower abdominal pain & bright red l blood loss. 238 A 27 year old. who conscientiously uses the oral contraceptive pill.uk Theme: differential diagnosis of ectopic pregnancy Options A Appendicitis B Bacterial Vaginosis C Crohn's disease D Ectopic pregnancy E Endometriosis F Inevitable miscarriage G Irritable Bowel Syndrome (IBS) H Missed abortion I Normal pregnancy J Pelvic inflammatory disease K-Renal colic L Septic abortion M Threatened miscarriage N Torted ovarian mass O Ulcerative colitis Instructions For each patient described below.www. has experienced intermittent l bleeding & malodorous discharge for several weeks. fossa pain. On l examination. 236 An 18-year-old student. more than once or not at aI1.

fischtest. He had no other complaints apart from a 2-month H/O cough. the SHO in A&E notices micrognathia. Joint fluid aspiration was done & positively birefringent crystals were found. 239 A 15 year-old boy C/O pain the Temporal-mandibular Joint for three months. . loss of neck extension & unequal lengths of the boy’s lower limbs. Albumin 20-g/L 241 A 29-year-old male presented to the A&E with a markedly swollen & tender left knee.www. or not at all.uk Theme: Diagnosis of Joint Pain Options A Gout B Pseudogout C Osteoarthritis D Infective arthritis E Psoriatic arthropathy F Ankylosing Spondylitis G Still's disease H Rheumatoid arthritis I Reiter’s syndrome J Felty's syndrome K Osteogenesis Imperfecta Instructions For each of the patients described below. WBC. O/E. choose the single most likely diagnosis from the above list of Options. more than once. The patient drinks alcohol but doesn't smoke. 240 A 36-year-old lady presented with swollen. Each option may be used once. 242 A 40-year-old obese man presented with a painful & swollen ankle. Tests for Rheumatoid factor were negative. Hb 9-g/dl. Answers. He admitted losing weight & O/E a temperature of 38C was found. tender knee joints. She says they feel stiff especially in the morning. The symptoms had started gradually in the previous month. O/E she 'was found to have a temperature of 38C & ulcerated lower limb with evidence of hyperpigmentation. He is says its been present for about a month but has only recently become painful. which he attributed to his heavy smoking.co. platelet counts were decreased.

www.fischtest.co.uk

Theme:

Immediate investigations of the unconscious patient
Options
A ABGs
B Blood carbon monoxide levels
C Blood culture
D Blood glucose
E Blood Paracetamol level
F Blood salicyclate
G Chest x-ray
H CT brain scan
I ECG
J Lumbar puncture
K Serum osmolality
L Skull x-ray
M Temperature

Instructions
For each patient described below, choose the single most useful discriminating
investigation from the above list of Options. Each option may be used once, more than
once, or not at all.

243 A 43-year-old man is brought to the A&E unconscious (GCS-7). On initial
exam his HR is 80-beats/min, he is sweating & has a SaO2 of 98% on air.
244 A 45-year-old woman is brought to the A&E unconscious (GCS-7). O/E her
pulse rate is 110-beats/min, temperature normal, BM (glucose) 4.6 .She was
found with an empty bottle of antidepressant Dothiepin (prothiaden).
245 A 43-year-old man is brought to the A&E unconscious (GCS-7). On initial
examination his pulse rate is 90-beats/min, BM (glucose) 5.3, SaO 2 97% on
air. He smells of alcohol. There are no external signs of injury.
246 A 44-year-old man is brought to the A&E unconscious (GCS-7). On initial
examination, his pulse rate is 100-beats/min, SaO 2-100% on air, BM
(glucose) 4.3. He is accompanied by other members of his family who also
report feeling unwell.
247 A 41-year-old woman is brought to the A&E unconscious (GCS-7). On initial
examination her pulse rate is 110-beats/min, SaO 2 95% on air, BM (glucose)
4.5. A purpuric rash is noted on both her arms.

Answers.

www.fischtest.co.uk

Theme:

Diagnosis of a chronic bleeding disorder
Options
A Yon Willebrand's disease
B Liver disease
C Fibrinogen deficiency
D Factor vii deficiency
E Factor v deficiency
F Factor ix deficiency
G Platelet deficiency
H Calcium Deficiency
I Normal finding in some people.
J Phospholipid excess
K Increased tissue thromboplastin

Instructions
For each of the patients described below with hematological abnormalities, choose the
single most likely diagnosis from the above list of Options. Each option may be used
once more than once, or not at all.

248 A 30-year-old man with a chronic bleeding disorder has had the following
investigations done. Prothrombin Time (PT) 13 seconds, Partial
Thromboplastin Time with Kaolin (PTTK) 40 seconds, Thrombin Time (TT) 12
seconds, Bleeding Time (BT) prolonged.
249 A 42-year-old man with a chronic bleeding disorder has had the following
investigations done. PT 11 seconds, PTTK 47 seconds TT 13 seconds BT
prolonged.
250 A 52-year-old man is being seen by his GP for a chronic bleeding disorder &
mild pruritis. PT & PTTK prolonged, TT & BT normal. Factors 2, 5 & 10 are
normal.
251 A 29-year-old man with chronic bleeding disorder has had these
investigations & and results. PT & PTTK are prolonged, BT normal, TT
prolonged.

Answers.

www.fischtest.co.uk

Theme:

Natural history cervical cancer
Options
A 3-6 months
B 12 months
C 24-36 months
D 3-10 years.
E 20 years
F 30 years
G 45 years
H 50 years
I 55 years
J 65 years

Instructions
For each scenario below, choose the single most likely time or time interval from the
above list of options. Each option may be used once, more than once, or not at all.

252 The time span over which a percentage of women with cervical
intraepithelial neoplasia (CIN) untreated will develop cancer.
253 The age at which the peak incidence of cervical carcinoma occurs.
254 The interval for cervical smears to be taken in a woman treated one year
previously for cervical intraepithelial neoplasia (CIN-2).
255 The age at which screening stops for women with a normal smear history.
256 The timescale within which the 50% of patients with recurrent disease will
present, following treatment for stage 1 B cervical cancer.

Answers.

258 A male patient with H. Alkaline Phosphatase 98 iu/L. 000.000. Alanine aminotransferase 45 iu/L.9-g/dl.000. 000. His WBC count is 2. Platelets 90 x I. Hb 8. Endoscopy revealed a single deep ulcer in the lower third of the oesophagus. WBC 1.000/L. 000.IV presents to the STD clinic. 259 A 36-year-old journalist has had AIDS for 2 years. He presented with a 3 week H/O dysphagia.www. He was on Zidovudine-200-mg TDS & Dapsone/Pyrimethamine for Pneumocystic Carinii pneumonia prophylaxis. . O/E he is found to have Oral candidiasis. Mean Cell Volume (MCV) 06 fl.uk Theme: Management of HIV related Conditions Options A Iv ganciclovir B Emergency esophageal surgery C HAART (Highly Active Antiretroviral) D Adjust the treatment E Oral Acyclovir F Omeprazole + Amoxycillin + Metronidazole G Oral Nystatin H Vitamin supplements 257 A 25-year-old presents to his GP with bruises.4 x I.000/L.000/L. Answers.co. which he says are brought on by the slightest of trauma. which has failed to respond to fluconazole. Urea & Electrolytes not done.fischtest. The following investigations are done.000.9 x I.

tender feet & hands. 261 A 5-year-old South African boy is brought to the A&E deeply jaundiced. . His mucosae are pale.co. 263 A 10-year-old boy is brought to the A&E Department with a swollen right arm. On further examination he is found to have small firm testes. Answers. Blood culture confirms Salmonella typhi osteomyelitis. This is his second presentation this month & earlier presented with an acute onset hepatosplenomegaly associated with severe pallor. He is found '0 have mildly -6t swollen. The SHO does a Na+ Metabisulphite test on the. Hematological investigations were done & showed. or not at all. 260 A 15-year-old boy has very poor grades at school despite being very attentive & hard working. He is mildly asthmatic. Hb 8g/dl. He has small ears & an IQ score of 67. MCV 74-ft.5C & is unable to move his arm due to severe pain. 262 A 6-year-old Asian boy gets regular blood transfusion for his hematological abnormality. 264 A 39-year-old male is getting progressively forgetful & is later found to have Alzheimer’s disease. B Patau syndrome. Each option may be used once. more than once.www. C Down's syndrome D Turner's syndrome E Cri-du-chat syndrome F Fragile X Syndrome G Sickle cell disease " H Sickle cell trait I Beta Thalassemia J William’s syndrome K Prader Willi syndrome L Di George syndrome M Acute mye1oid leukemia N Edward's syndrome Instructions For each patient described below choose the single most appropriate diagnosis from the list of Options above.fischtest.uk Theme: Diagnosis of common genetical disorders Options A Klinefelter's syndrome. MCHC 25g/dl. His mucosae are pale & skull is grossly bossed. His mother reckons its because he is teased at school because his breasts look like girls'. patient's blood which turns out to be positive. His temperature is 38.

www. with associated diarrhoea. . There is no associated l discharge. Each option may be used once. & after breakfast. 265 A 4-year-old Irish girl looks wasted & appears short for his age. The SHO thinks he has an enteropathy & on serology IgA gliadin & Endomysial antibodies are found. since she C/O constant perianal & vulval irritation.fischtest. 268 A mother & her daughter have just returned from a tropical holiday & is concerned that her daughter has an STD. more than once. which typically starts in the morning with a constant urge to go to the toilet on waking. She has worms coming out of her bottom at night. 266 A mother brings her 5-year-old son who has been passing bloody stool associated with severe abdominal pain. choose the single most likely diagnosis from the Options listed above. The girl’s condition improves & she is thriving.co.uk Theme: Diagnosis of Malabsorption & Diarrhoea in Children Options A Lactose Intolerance B Chronic disease C Acrodermatitis Enteropathica D Chronic Non Specific diarrhoea E Coeliac disease F Ulcerative colitis G Giardia Lamblia infection H Enterobius Vermicularis infection I Ascaris Lumbricoides J Hirschsprungs's disease K Intussusception L Irritable Bowel syndrome M Endometriosis N Acute on chronic appendicitis O Endometriosis Instructions For each patient described below. The paediatrician recommends restricting fluids to meal times. 269 A 15-year girl C/O episodic diarrhoea. She has had the symptoms for 3 months. On each occasion the stool contains segments of undigested vegetables. 267 An 8-year-old girl has got repeated episodes of diarrhea. or not at all. O/E he is found to have mildly swollen tender wrists & red nodular tender lesions were found on her forearms. Answers. She says there is associated abdominal pain in the right iliac fossa relieved by defecation or flatus. The mother reports the daughter has been vomiting on several occasions in the past.

fischtest. 271 A 23-year-old woman. Oral combined pill for six months. who has been taking the oral combined pill for six months. 273 A 22-year-old woman. Her BP is 70/40-mmHg and she has raised neck veins. or not at all. presents with a H/O cough. & fever. 272 A 20-year-old woman. over the last two or three days. is brought to the A&E in a state of collapse. 270 A 29-year-old woman. Answers. producing green sputum. presents with bilateral ankle edema & a tender calf. choose the single most likely discriminating investigation from the above list of Options.uk Theme: Investigation of possible thromboembolic disease Options A Chest x-ray B Coagulation screen C Contrast spiral CT-scan D Digital subtraction angiography E Echocardiography F Femoral duplex Scan G MRI scan H Platelet count I Selective arteriogram J Ventilation perfusion scan Instructions For each patient described below.co. who has been taking the pill for six months. more than once.www. presents with palpitations & O/E has a diastolic murmur & thrill. . who has been taking the combined. who has been taking the combined pill for six months. Each option may be used once.

he has a crackling fe_ling under the skin around his neck. Since then he has been short of breath on exertion.co. 274 A tall young woman developed sharp pain on one side of his chest two days ago. 276 A 23-year old woman on the oral contraceptive pill suddenly gets tightness in her chest & becomes very breathless.5mg ) Sublingually B Iv 50ml of 50% dextrose C High flow O2 & RamipriI2. 275 After a heavy bout of drinking a 56-year-old man vomits several times & develops chest pain. choose the single most appropriate immediate measure to take from the above list of Options. When you examine him.fischtest.uk Theme: Management of acute chest pain Options A Glyceryl trinitrate ( 0. more than once or not at all.5mg/12hr PO D High flow O2 10mg iv morphine + anticoagulation E Cross match blood & inform surgeons F Insert a 16G cannula in second intercostal space G Iv heparin 5000-10.www. The pain is still present when he arrives in hospital an hour later. 278 A 57-year-old man develops crushing pain in the chest associated with nausea & profuse sweating. Answers. .000 iu over 5min H Underwater seal drainage I 10mg Iv diamorphine J Nifedine Instructions For each patient described below. 277 A 30-year-old man with Marfan's syndrome has sudden central chest pain going through to the back.Each option may be used once.

280 A 31-year-old woman with Aids presents with odynophagia. 282 A 62-year-old woman presents with dysphagia.uk Theme: Treatment of Oesophageal Pathology Options A Endoscopic dilatation B Ketonazole sytemically administered C Topical Nystatin D Iv ganciclovir E Iv Acyclovir (High dose) F Tv Acyclovir (Low dose) G Surgical resection H Endoscopic insertion of Atkinson tube I Heller's myotomy J Triple therapy K Surgical repair L Sclerotherapy Instructions For each of the patients described below. . having started with initial difficulty for swallowing solids.www.co. choose the most appropriate treatment from the Options listed above.fischtest. 281 A 29-year obese man presents with dysphagia. more than once. but now also now has involved liquids. Barium swallow demonstrates a smooth 'rat tail' appearance. Esophageal endoscopy reveals multiple small white plaques on background of an abnormally reddened mucosa. Oesophageal endoscopy reveals multiple shallow ulcers in the lower oesophagus. 279 A 32-year-old man has been receiving cyclosporin for the treatment of her rheumatoid arthritis presents with odynophagia (painful swallowing) & mild dysphagia. He has complained of heartburn for the last 6 months. The mucosa contains multiple vesicles. He says it's been progressive. or not at all. Answers. Each option may be used once. He looks wasted.

choose the single most definitive investigation from the above list of Options. 287 Bronchial carcinoid.uk Theme: Investigations of patient with haemoptysis Options A CT B Fibreoptic bronchoscopy C Fine needle aspiration D Mediastinoscopy E Mediastinotomy F MRI G Pulmonary angiogram H Selective arteriogram I Sputum culture' J Sputum cytology K Thoracoscopy L Ventilatiort perfusion scan Instructions For each suspected diagnosis below. 283 Tuberculosis.fischtest. 285 Pulmonary embolism 286 Bronchiectasis.www. 284 Carcinoma of the right main bronchus. more than once. Each option may be used once. or not at all.co. Answers. .

or not at all. choose the single most likely complication of cholecystectomy from the above list of Options. Each option may be used once.co.fischtest. . 291 Ultrasound scan shows dilated common bile duct with no free intraabdominal fluid or bowel distension. raised bilirubin. 292 Chest x-ray shows signs of left ventricular dilatation & an electrocardiograph (ECG ) shows Q waves with ST elevation.www. 289 Ultrasound scan shows intra-abdominal free fluid with paralytic ileus. 288 Chest x-ray shows raised right diaphragm with small pleural effusion above. 290 Liver function tests show raised alkaline phosphates. normal albumin & normal hepatocellular enzymes. more than once.uk Theme: Diagnosis of complications of Cholecystectomy Options A Acute pancreatitis B Acute renal failure C Biliary peritonitis D Inferior vena cava thrombosis E Myocardial infarction F Pulmonary embolism G Small bowel obstruction H Stone in common bile duct 1 Sub-phrenic abscess Instructions For each test result below. Answers.

His ECG is normal. on percussion at the right lung base. or not at all.uk Theme: Diagnosis of chest pain Options A Angina pectoris B Acute myocardial infarction C Bronchiectasis D Hiatus hernia E Pneumonia F Pulmonary embolism G Pleural effusion H Tension pneumothorax I Lung fibrosis J Reflux Oesophagitis K Spontaneous pneumothorax L Aortic dissection M Possible malignant change Instructions For each patient described below. Her chest x-ray & ECG are normal. 293 A 70-year-old man has had malaise for five days & fever for two days. Three days later she presents with sharp chest pain and breathlessness. 294 A 53-year-old woman returned by air to the UK from Washington. 295 A tall. 297 A 52-year-old obese man has had episodic anterior chest pain. for three weeks. thin 23-year-old man has a sudden pain in the chest pain & \ left shoulder & breathlessness while cycling.www. . Each option may be used once. more than once. Answers.fischtest.co. He has a cough & you find stony dullness. 296 A 49-year-old porter presents with a two-hour H/O chest pain radiating into the left arm. Chest x-ray & ECG are normal. particularly at night. choose the single most likely diagnosis from the list of Options above.

She is drowsy & disorientated. Her husband reports that she has been complaining of severe thirst for the past week. or not at all. 302 A 45-year woman treated three years ago for breast cancer is unable to walk. She does have blurring of the optic disc margins. radiotherapy & chemotherapy eight years ago for breast cancer. O/E of her respiratory system. which is dull to percussion & has absent breath sounds. metastasis E Cerebral F Hypercalcaemia G Left Ventricular failure H Liver metastases I Local occurrence J Lymphangitis Carcinomatosis K Peritoneal recurrence L Pleural effusion M Spinal cord compression Instructions For each patient described below. presents with a two-day H/O increasing confusion. she is drowsy but has no focal neurological signs. 298 A 56-year-old woman who underwent mastectomy for a breast tumor four years ago. more than once.O/E. headache & vomiting . Each option may be used once. 299 A 60-year-old woman is admitted to the A&E having fallen in the street She is complaining of pain in the right hip & the right lower limb is lying in external rotation. now C/O increasing breathlessness. she is noted to have decreased movement of the left hemithorax. She has been constipated & unable to pass urine for the last 24 hours.uk Theme: Progression of breast cancer Options A Asthma B Axillary recurrence C Bone marrow infiltration D Bony. She C/O increasing weakness in her left leg for the last seven days. Answers.fischtest. She had breast conserving surgery. choose the single most likely diagnosis from the above list of Options. 301 A 35-year-old woman treated one year ago for a breast cancer with 12/20 nodes positive. .co.www. 300 A 43-year-old woman treated two years ago for a Grade 3 axillary node positive breast cancer presents with increasing confusion.

She is pale & has a pulse of 120-beats/min with a BP 105/65mmHg. after having collapsed in the street. 304 A 24-year-old woman presents to the A&E with a sudden onset of left iliac fossa pain. but there is no tenderness. Plain radiography shows no evidence of free gas. His only past medical history is an appendicectomy when he was 8. She is tender with guarding in the epigastrium. He is complaining of abdominal pain radiating to his back. .www. On examination of her abdomen she is tender in her left iliac fossa.fischtest. guarding & rebound in the right iliac fossa. She drinks about 40 units of alcohol per week. 305 A 36-year-old woman presents with a 12-hour history severe epigastric pain associated with several episodes of vomiting. Bowel sounds are increased.co. Department. 0n examination his abdomen is distended. more than once-or not at all.uk Theme: Diagnosis of acute abdomen Options A Acute pancreatitis B Acute cholecystitis C Acute myocardial infarction D Pyloric stenosis E Intestinal obstruction F Appendicular abscess G Acute appendicitis H If Acute Pyelonephritis I Possible ruptured ectopic J Aortic dissection L Possible twisted ovarian cyst M Esophageal varices Instructions For each patient described below. He is pyrexial with tenderness. Each option may be used once. 303 A 74-year-old man with a previous H/O pain in his calves in walking is brought to the A&E. 306 A 40-year-old man is admitted with a H/O 24 hours of colicky central abdominal pain & bile stained vomiting. 307 A fit 18-year-old man presents with a 12-hour H/O central abdominal pain radiating to his right iliac fossa. Answers. choose the single most likely diagnosis from the list of Options above.

The chest x-ray shows bilateral interstitial infiltrates. diarrhea associated with blood per rectal.. the consolidation on his chest x-ray has not resolved.fischtest. 310 A 65-year-old man. 308 A 35-year-old woman presents with ao four month history cough. or not at all. currently 'undergoing chemotherapy for chronic leukemia. mid-zone consolidation. high fever prior to this. he had complained of abdominal pain. Two courses of antibiotics from his GP has produced no improvement. productive 0 sputum. 311 A 27-year-old male prostitute has felt generally unwell for two months with some weight loss.www. more than once.uk Theme: Causes of pneumonia Options A Aspiration B Bronchiectasis C Fungal D Haemophilus influenzae E Klebsiella F Lung cancer G Mycoplasma pneumonia H Pneumocystitis carinii I Staphylococcus Aureus J Streptococcus pneumoniae K Tuberculosis L Viral pneumonia M Legionella pneumophilia Instructions For each patient described below. She is deteriorating & has a swinging fever. choose the single most likely. vomiting. She has lost 5-kg in weight The chest x-ray shows right upper lobe consolidation. has felt unwell with fever & an unproductive cough for two weeks despite treatment with broad-spectrum intravenous antibiotics. underlying cause from the above list of Options.co. In the outpatient clinic four weeks later. The student health service gave him Amoxycillin. malaise & a dry cough. After a week he felt no better & his chest x-ray showed patchy bilateral consolidation. Over the last three weeks he has noticed a dry cough with increasing breathlessness. a 20-year-old student presented with the onset of fever. 314 A 27-year-old male patient has just returned from holiday abroad presents with mild flu-like illness. The chest x-ray shows an enlarging. Chest x-ray shows cavitating lesions. 309 A previously well 18-year-old has had influenzae for the last two weeks. right sided. She is coughing up copious purulent sputum. headaches. . & recent haemoptysis. 312 On return to university. 313 A 64-year-old man with chronic obstructive pulmonary disease presents with pneumonia. Answers. Clinically he improves with antibiotics. Each option may be used once.

choose the most appropriate treatment from the list of Options above. photophobia. + AZT J Fluconazole K Flucloxacillin L Ribavirin M Antihistamines & careful observation for one week. developed after taking Ampicillin at home. which she says. 316 A 20-year-old female air-hostess presents to the dermatology clinic where she is found to have Seborrheic dermatitis.fischtest. . Each option may be used once. She has lost weight in recent months. Echocardiography is normal.uk Theme: Treatment of infectious disease Options A Ganciclovir B Pyrimethamine + Sulphadiazine C No treatment required D 'Bed rest & avoid alcohol E Interferon alpha G Co-trimoxazole H Z idovudine ( AZT ). She is found to have enlarged axillary nodes & a maculo-papular rash allover the body. 315 A 23-year-old male presents with tachycardia. tachypnoea & a dry cough. He is found to have a CD4 count of 99 cells/ml . Further examination reveals axillary & supraclavicular lymphadenopathy.A CT-scan shows ringenhancing lesions.' 317 A 23-year-old woman presents with a mild dry cough & running nose. 318 A 32-year-old known HIV patient presents with headache. Instructions For each of the patients described. Chest x-ray shows a granular appearance. . more than once or not at all. O/E she is found to have oral candidiasis & dusky red lesions on the buccal mucosa.co. Stavudine.www.Didanosine ( ddi ) + Ritonavir I Camivudine. Answers. associated with exertional dyspnoea.

choose the single most likely diagnosis from the list of Options above. . presents with bilateral ankle edema which has been present for six months.co. but now presents with a sudden onset severe right calf pain. There is no calf tenderness but the skin over her legs is itchy & pigmented. who has been taking the oral contraceptive pill for six months. 322 A 30-year-old woman. H Mitral stenosis I Pulmonary embolism J Ruptured Baker's cyst K Venous insufficiency Instructions For each of the patients described below. presents with a H/O cough. for her illness.www. over the last two or three days. stiffness & swelling that are worse in the morning for 5 years & is receiving steroids. She has been off the pill for one year. who has been taking the combined oral contraceptive pill for six months. presents with palpitations & O/E a mid-diastolic murmur is found. Answers. 320 A 31-year-old woman. who has been taking the oral contraceptive pill for six months. producing green sputum. 323 A 23-year-old woman. 319 A 26-year-old female security who has been taking the combined oral contraceptive pill for six months. & fever. Her BP is 70/40-mmHg & her neck veins are raised.uk Theme: Diagnosis of thromboembolism Options A Inferior vena cava obstruction B Superior Vena cava obstruction C Lymphedema D Deep vein thrombosis E Pneumonia F Bronchiectasis G Aortic stenosis. 321 A 40-year-old woman who has complained of joint pain.fischtest. is brought to the A&E in a state of collapse.

uk Theme: Antibiotic prophylaxis of surgical patients Options A Angiography B Bronchoscopy C Colles' fracture D Dental treatment of a cardiac patient E Dislocated shoulder F Emergency appendicectomy G Heart valve replacement H Sigmoid colectomy I Spleenectomy J Thyroidectomy Instructions For each prophylactic regimen given below.fischtest. 325 Three days of intravenous broad-spectrum antibiotics beginning with induction of anesthesia. more than once or not at all. 326 Clear fluids by mouth & two sachets of Na+ picosulphate on the day before the operation plus broad-spectrum intravenous antibiotics at induction.www. . Each option may be used once.co. 324 3-gm sachet of Amoxycillin one hour before the procedure. 328 One dose of Metronidazole at induction of anesthesia. 327 Long-term oral penicillin & immunization against pneumococcal infection. Answers. choose the single most likely indication from the above list of Options.

lasting only a few seconds in the face. 331 A 59-year-old man. choose the single most likely diagnosis from the above list of Options. Each option may be used once. 332 A 38-year-old woman suffers paroxysms of intense stabbing pain. 329 A 42-year-old businessman has a H/O headaches associated with photophobia & phonophobia. presents with sudden onset of severe occipital headache & vomiting.co. . Answers.uk Theme Diagnosis of headache Options A Carotid artery stenosis B Cerebellar haemorrhage C Temporal neuralgia D Cerebral vasculitis E Migraine F. 330 A deaf 56-year-old woman C/O a chronic headache. He now presents with slowly increasing drowsiness & headache.www. J Temporal arteritis K Paget’s disease L Cluster headache Instructions For each patient described. Her only physical sign on examination is a stiff neck. previously in good health. Subarachnoid haemorrhage G Chronic Subdural haematoma H Polymyalgia rheumatica I Vertebro basilar TIA .fischtest. 333 A 34-year chronic alcoholic had a fall two weeks ago. The headaches always follow a flight from Edinburgh were he has business interests. more than once or not at all. It's precipitated by talking. She is found to have sabre tibiae.

fischtest. 335 A 37-year-old alcoholic is found wandering in a park. 338 A 45-year-old is brought to the A&E by her husband who reports that she collapsed in the bathroom. He has an abrasion over his left temple & puncture marks on his left. His partner says he has had a number of falls recently & in the A&E the patient is confused. Each option may be used once.uk Theme: The management of patients in a coma Options A Alcohol level B Angiography C Arterial blood gases D Blood cultures E Blood sugar F Computed tomography (CT) G Naloxone H Paracetamol screen I Plasma osmolality J Toxicology K Urea & electrolytes Instructions For each patient described below.co. Upon Examination. 334 A 25-year-old found deeply unconscious is brought to the Accident & Emergence Department. . choose the single most appropriate intervention from the Options above. She has a purpuric rash & a fever. Her blood sugar level is normal. more than once. she is unconscious with bilateral up going plantar responses. forearm. sweaty & unconscious. Her companion says she was well 30 minutes ago. The next morning she is found unconscious at home. Answers. 337 A 23-year-old known diabetic arrives in the A&E. but suddenly became confused & then could not be aroused.www. or not at all. The blood sugar level is normal. She is pale. 336 A 19-year-old university student went home from class because of a headache.

fischtest. Each option may be used once. particularly for the first two hours of each day. burning retrosternal chest pain associated with acid regurgitation & increased oral flatulence. 343 A 67-year-old woman reports severe paroxysms of knife -like or electric shock-like pain. 340 A 70-year-old man with inoperable gastric cancer causing obstruction. She continues to C/O joint pain & stiffness.www. retrosternal chest pain & sweating.uk Theme: Prescribing for pain relief Options A A bolus of intravenous opiate B A subcutaneous opiate infusion H Oral non-steroidal antiinflammatory drugs (NSAIDs) C Acupuncture I Oral opiates D Carbamazepine J Proton pump inhibitors (e. 342 A 50-year-old obese man with a known hiatus hernia. Answers. & multiple liver metastases. choose the single most appropriate method of pain relief from the above list of Options. Omeprazole) E Corticosteroid F Hypnotherapy G Intramuscular non-steroidal anti-inflammatory drugs (NSAIDs) K Selective serotonin re-uptake inhibitor e. more than once or not at all. worse in the morning. Despite this. in the lower part of the right side of her face. . fluoxetine L Simple analgesics M Transcutaneous electrical nerve stimulation (TENS) machine N Tricyclic antidepressant Instructions For each patient described below. & one episode of uveitis. severe. lasting seconds.g. 341 A 25-year-old woman has just been diagnosed having rheumatoid arthritis & her rheumatologist has begun giving her gold injections. his pain is currently unrelieved.co.g. 344 A 27-year-old man presents with an 8 year H/O back pain. An ECG shows an acute infero-lateral myocardial infarction. presents with recurrent. 339 A 65-year-old man presents with severe. is taking a large dose of oral analgesia.

His two siblings have a similar problem. Answers. There was no pain & the vision was unaffected.fischtest. Areas of the cornea are stained yellow. 349 A 35-year-old rugby player sustained facial injuries. 348 A 24-year-old man has a history of recurrent attacks of blurring of vision associated with redness. Twelve months later he presented with a painful swelling at the left medial canthus. more than once. associated with red eye & purulent discharge.co. or not at all. 346 A 72-year-old patient complains of severe pain in his right eye with severe deterioration of vision. pain & photophobia. 347 A seven-year-old North African boy gave a history of two years of discomfort.uk Theme: The diagnosis of a red eye Options A Acute glaucoma B Conjunctivitis C Dacryocystitis D Dacryoadenitis E Endopthalmitis F Foreign body G Scleritis H Spontaneous Subconjunctival haemorrhage I Trachoma J Trauma K Uveitis L Episcleritis M Herpes zoster ulcer N Dendritic ulcer O Ulcerative keratitis Instructions For each patient described below. . Both eyes have been affected in the past. His older brother is currently being investigated for severe backache. redness & mucopurulent discharge affecting both eyes. 345 A 60-year-old patient presented to his GP with sudden onset of redness in the left eye.www. Steroid eye drops are given & massive ulceration & blindness results. He had noticed haloes around streetlights for a few days before the onset of pain. Each option may be used once. choose the single most appropriate diagnosis from the above list of Options. 350 A 24-year-old man with a painful red eye has his eye stained with fluorescein drops.

fischtest. . presents with a painless. She is generally well. fetal heart monitoring) B Cord blood flow studies (Doppler) C Central venous pressure D Coagulation profile E Cardiotocography F Electronic maternal cardiovascular monitoring (ECG G Placental localization (USG) Ultrasound scan H Haemoglobin I Kleihauer test J Pulse oximetry K Rhesus status L Speculum examination M Urinalysis Instructions For each patient described below.www. . Answers. investigation shows the fetus to be small for dates at 32 weeks. whose previous pregnancy was complicated by isoimmunization. more than once or not at all. She is 22 weeks pregnant & had similar complaints 2 years ago when she was on the pill.co. 353 Following recurrent Antepartum haemorrhage. 352 A 25-year-old nulliparous presents at 26 weeks gestation with slight postcoital bleeding. 355 A 31-year-old woman is anxious about slight per l bleeding.g.. Each option may be used once. 351 A 24-year-old gravida 4 para 3. has l spotting at 36 weeks in an otherwise normal pregnancy. A 19-week fetal anomaly ultrasound scan confirmed normal placental localization. but worried. 354 A woman.uk Theme: Antepartum haemorrhage-the selection & interpretation of Options A Biophysical profile (e. Conservative management is preferred. choose the single most appropriate investigation from the above list of Options. unprovoked l bleed of approximately 50-ml at 32 weeks.

357 An armed robber is injured during an exchange of gunfire with the police & comes to the A&E. H Tell partner of the patients' illness. 356 A 13-year-old girl is pregnant & requires a termination of the pregnancy.co. . C Ask the girl to come with parent/guardian. & naturally requests your silence. as procedure can't be carried out without their approval D Talk to girl about importance of telling parents but just go on & carry out procedure if she refuses to tell parents. He is against condom use and. The police call you & request that you tell them what medicine you prescribed the man. Answers. more than once or not at . 358 A 13-year-old girl is having unprotected sex with her 17-year-old boyfriend & asks that she be given the oral contraceptive pill. 359 A 32-year-old man is found to be HIV positive.fischtest. F Offer contraception if risks are discussed. Instructions For each of the scenarios described below. She tells you "emphatically that at no point should you consider informing her parents. Each option may be used once. A breath test proves negative & the patient says its probably the medication you prescribed that is to blame. 360 A 30-year-Old man is pulled over while driving for suspected drink driving. choose the most appropriate action to be taken.uk Theme: Ethical practice of medicine in the UK Options A Tell the police B Don’t tell the police. after a lengthy talk with him refuses to accept the need to tell his wife. The man then calls you & asks that you don’t tell the police. even without parental consent. I Don’t tell partner since the patient is against this.www. G Consult with senior managers of the NHS trust. J Consult with social services E Offer the contraception only with parental consent only.all.

She is now seeing ants crawling over her & is becoming disturbed & restless.www. She has been injecting heroin intermittently for the last six months. He is already taking vitamin supplements. 365 A 46-year-old woman has been admitted to the medical ward with jaundice & a past history of alcohol abuse. more than once or not at all. Her partner is not a drug user & is very supportive. He shows global amnesia on testing & there is no impairment of consciousness. 363 A 27-year-old woman wants help in coming off heroin. .uk Theme: Prescribing for alcohol & drug abuse Options A Acamprosate B Admit & give benzodiazepines C Benzodiazepines D Disulfiram E Electroconvulsive therapy (ECT) F Haematinics G Heroin H High potency vitamins I Insulin coma therapy J Lithium K Liver extract L Methadone M Multivitamins N Naltrexone O Refer to substance misuse team P Vitamin K Instructions For each patient described below.co. which started after he woke up following a 36 hour binge of alcohol at a party. He gives a history of alcohol abuse & has been hearing voices. Answers. She attends the Accident and Emergency Department. 364 A 46-year filmmaker presents with making up stories to fill the memory gaps. 362 A 34-year-old unemployed man has been in hospital for a period of detoxification due to alcohol. choose the single appropriate treatment from the above list of Options. He is ready for discharge but wants to remain abstinent after discharge. Each option may be used once. 361 A 46-year-old man presents to the clinic with a history of shakes for 12 hours.fischtest.

or not at all. amitriptyline 100-mg at night & Naproxen 500-mg twice a day. blood sugar is 5.co.2-mmol/L .www. 369 An 80-year-old man with metastatic carcinoma becomes confused with abdominal distension & faecal incontinence.fischtest. 368 A 70-year-old woman with metastatic bowel carcinoma is distressed by severe pleural pain. calcium 3. Creatinine is 120-mmol/L. He is on high doses of opiates. He is in considerable pain. more than once. He is depressed & anorexic.She is receiving intravenous fluids. 373 An 82-year-old man with bronchial carcinoma is distressed by breathlessness. despite the morphine sulphate. She is already on 80 mg /12h PO of diamorphine. but in no pain. 367 A 70-year-old woman with terminal breast carcinoma gets recurrent pleural effusions. 366 A 70-year-old woman with terminal Endometrial carcinoma is distressed by a very foul l discharge. 371 A 45-year-old man is dying of pain of AIDS (Acquired Immunodeficiency Syndrome). 370 A 55-year-old woman with known spinal metastases from breast cancer becomes nauseated & confused. slow release 20 mg daily. Answers. choose the single most appropriate action from the above list of Options.4-mmol/L. . 372 A 65-year-old man with prostate cancer has extensive pelvic spread of disease with pain not adequately controlled by full analgesic cover.uk Theme: Decision making in terminal care Options A Add amitriptyline or similar drugs B Add Midazolam / methotrimeprazine C Antibiotics D Administer enema E Gastric intubation F High fiber diet G Increase opiate analgesia H Intravenous fluids I Nutritional supplements J Palliative deep x-ray therapy K Prescribe bisphosphates' L Prescribe laxative M Reduce opiate analgesia N Set up syringe driver O Start steroids P Pleurodesis Q Intercostal nerve block R Betadine gel S High dose frusemide Instructions For each patient described below. Each option may be used once.

On examination. 376 A 30-year-old woman has severe colic & upper abdominal pain radiating to her right scapula & is vomiting.www. . 379 A 31-year-old woman presents with acute. Answers. Her BP is IOO/60-mmHg & no abdominal signs are found. worse on coughing. severe abdominal pain. more than once or not at all. Hematological investigations show a moderate leucocytosis. F Ectopic pregnancy G Mesenteric thrombosis H Perforated peptic ulcer I Renal colic J Salpingitis K Spontaneous abortion L Strangulated hernia M Torsion ovarian cyst N Ulcerative colitis O Urinary tract infection (UTI) Instructions For each patient described below.co. She has pain radiating to the left shoulder. Each option may be used once. her abdomen is found to be distended with no rebound & a tender lump in the right groin. choose the single most likely diagnosis from the above list of Options. 377 A 12-year-old girl has central abdominal pain & is vomiting. Hemoglobin level is 17-g/dl & the plasma amylase is only mildly raised. followed by the right iliac fossa pain. 378 A 31-year-old woman has severe colic & upper abdominal pain.uk Theme: Diagnosis of acute abdominal pain in younger women Options A Acute gastroenteritis B Acute pancreatitis C Appendicitis D Biliary colic E Cholecystitis. She is febrile & vomiting.fischtest. 374 A 20-year-old married woman presents in the Accident and Emergency Department with the onset of acute lower abdominal pain. She has fever & rebound in the right iliac fossa. Her last menstrual period was six weeks previously. 375 A: 15-year-old girl presents with a 24-hour history of central abdominal pain.

or not at all. . choose the single most likely diagnosis from the above list of Options. She also C/O hot flushes.co.fischtest. 380 An 18-year-old dancer presents with secondary amenorrhoea. Her BMI is 32. more than once. She has a BMI of 16 is concerned that she is fat & goes to the gym 4 times a day. 381 A 34-year-old woman presents with an eight-month history of secondary amenorrhoea.uk The Diagnosis of menstrual disorders (amenorrhoea) Options A Anorexia B Complete androgen insensitivity C Hyperthyroidism D Hypogonadal hypogonoadism.www. 384 A 17 year .old girl with secondary amenorrhoea. night sweats & mood swings. On examination. is reported to be binge eating. With an eight-month history of secondary amenorrhoea Prior to this her periods have been irregular since the menarche at the age of 12. on all days of the week. 382 A 19-year-old woman presents. H Polycystic ovarian syndrome I Pregnancy J Premature ovarian failure L Prolactinoma M Turner's syndrome N Bulimia Instructions For each patient described below. Answers. 383 A 33-year-old woman presents with a seven-month H/O amenorrhoea. On direct questioning she admits to a weight loss of 6-kg despite having a good appetite. E Hypothyroidism F Intra-uterine synaechia G Menopause. Each option may be used once. she is 1 m 68 cm tall & weighs 46 kg.

Pulse rate is 110-beats/min. While sitting up talking. There is reduced air entry on the left side of his chest. 386 A 22-year-old motorist arrives in the Accident and Emergency after an accident. His airway is patent. . He has a deformed left thigh. more than once more than once not at all.co. choose the single most likely immediate action from the above list Options. appears to be stable after an accident. Each option may be used once. 387 A 22-year-old motorist is being resuscitated after an accident. Answers. His airway is secure. He is noted to have external injuries on the left side & a deformed left thigh. 385 A 22-year-old motorcyclist. BP-100/50-mmHg.www. GCS-9. in the Accident and Emergency resuscitation room.fischtest.uk Theme: Immediate management of an injured patient Options A Abdominal ultrasound B Assess airway C Cervical spine immobilization D Chest auscultation E Chest drain after needle thoracocentesis F CT brain scan G ECG H Endotracheal intubation I Immediate blood transfusion J Rapid (20-min) fluid bolus (1 liter) K Splint femoral fracture L Transfer to operating theatre M X-ray femur Instructions For each patient described below. he becomes progressively breathless.

fischtest. red. scaly. The consultant dermatologist confirms it's Bowen’s disease. 392 A 56-year-old man presents with a shallow ulcerative lesion on the right cheek. 389 A retired 55-year-old man who worked in an arsenic factory presents with a flat. There is no H/O progression. Answers. choose the single most appropriate answer from the list of Options above. Each option may be used once. more than once or not at all. 390 A 45-year-old woman presents with multiple marked brown lesions on the fore head & limbs. 391 A 36-year-old woman presents with multiple scaly lesions on the upper trunk & back. 393 A 65-year-old uncircumcised man is found to a red scaly lesion on his penis. 388 A 56-year-old man who works in Australia for most of the year presents with cutaneous scaling on his & forehead. indurations & no obvious ulceration is seen O/E.co.www. He says its progressively increased in size. It has pearly rounded margins. crusted plaque on his right hand. .uk Theme: Pre-malignant Malignant Disease Options A Erythoplasia of Querat B Marjolins Ulcer C Malignant melanoma D Pytrias versicolor E Dermatofibroma F Lentigo maligna G Basal cell carcinoma f'_ H Porokeratosis I Squamous cell carcinoma J Solar keratosis K Pyogenic Granuloma L Lupus vulgaris M Psoriasis N Seborrhoiec keratosis O Bowen’s disease Instructions For each of the patients described below. which seem to disappear & recur.

394 When would you use acetylcysteine as an antidote?' 395 When would you use methionine as an antidote? 396 What can cause heart block? 397 Na+ nititrite followed by Na+ thiosulphate would be useful. choose the single most appropriate action to take.uk Theme: Mechanism of poisoning Options A Aspirin B Ipratopium C Paracetamol D Cyanide E Steroids F Quinine G Carbon monoxide H. 400 Methadone is useful for those who are addicted. Answers. Oxygen I Morphine J K Warfarin M Heparin N Cocaine O Amphetamine P Glue Instructions For each of the conditions below.www. Each option may be used once. more than once or not at all.co. . 398 Protamine sulphate is used in overdosage with it.fischtest. 399 Dicobalt edetate is a useful antidote.

more than once or not at all.co. In addition he has had a myocardial infarction & intermittent claudication.uk Theme: Investigation of Aortic aneurysms Options A CT B Ultrasound of abdomen C ECG D Echocardiography E Ankle-femoral index F Coronary angiography G Doppler ultrasound H Intravenous pyelography I Spiral CT J Immediate surgery K Iv normal saline L O negative blood transfusion M Chest X-ray Instructions For each of the patients described below. from the list of Options above. You are assessing for renal involvement. Answers. 404 A 68-year-old man with an abdominal aortic aneurysm presents with calf tenderness & a positive Homan's sign. 403 A 68-year-old man presents with a pulsatile mass in the abdomen. 402 A 68-year-old woman with an aortic aneurysm is being considered for surgery. .www. choose the single most appropriate investigation. Each option may be used once. 405 A 68-year-old man with an abdominal aortic aneurysm presents with sudden onset epigastric pain. 401 A 68-year-old man with an aortic aneurysm is being considered for surgery. His BP is 60/40-mmHg & pulse rate is 200-beats/min.fischtest.

www.fischtest.co.uk

Theme:

Diagnosis of dysphagia
Options
A Achalasia
B Benign stricture
C Pharyngeal pouch
D Carcinoma of the oesophagus
E Oesophagitis
F Peptic stricture
G Myasthenia gravis
H Plummer-Wilson syndrome
I Globus hystericus
J Diffuse esophageal spasm
K Esophageal candidiasis
L Mallory-Weiss syndrome
M Schatzki ring

Instructions
For each of the patients below, choose the single most likely diagnosis from the list of
Options above. Each option may be used once, more than once or not at all.

406 A 43-year-old woman C/O difficulty in swallowing both liquids & solids. He is
found to have a red tongue & angular stomatitis.
407 A 45-year-old man had a renal transplant 6 months ago. He now C/O painful
swallowing.
408 A 34-year-old man presents with a H/O intermittent dysphagia of both liquids
& solids. He gets' temporary relief on eating large quantities of food. There is
a further history nocturnal retrosternal chest pain but he denies any loss in
weight.
409 A 59-year-old man C/O progressive difficulty swallowing solids. In the last 2
days he has noticed a difficulty in swallowing liquids & says anorexia has
made him lose weight.
410 An obese 45-year-old man C/O difficulty in swallowing. In addition he C/O
retrosternal chest pain especially following heavy meals. He smokes about
25 cigarettes a day.

Answers.

www.fischtest.co.uk

Theme:

Developmental milestones
Options
A 2-3 months,
B 0-2 months
C 2-5 months
D 7-10 months
E 6-10 months
F 10-13 months
G 4-7 months
H 15-18 months
I 2-3 months
J 11-14 months
K 2-4 months
L 6-8 months

Instructions
From each of the milestones below, choose the single most likely answer from the list
of options above. Each option mat be used once, more than once or not at all.

411 Smiles spontaneously
412 Listen to bells
413 Squeals
414 Says 'Dada & Mama’.
415 Sits alone.
416 Finger thumb grasp.
417 Drinks from cup.
418 Walks alone. ;
419 Pulls self to stand.
420 Walks around furniture.

Answers.

www.fischtest.co.uk

Theme:

Antibiotic prophylaxis of surgical patients
Options
A Angiography
B Bronchoscopy
C Colles' fracture
D Dental treatment of a cardiac patient
E Dislocated shoulder
F Emergency appendicectomy
G Heart valve replacement
H Sigmoid colectomy
I Spleenectomy
J Thyroidectomy

Instructions
For each prophylactic regimen given below, choose the single most likely indication
from the above list of Options. Each option may be used once, more than once or not at
all.

421 3-g sachet of amoxycillin one hour before procedure.
422 Three days of intravenous broad-spectrum antibiotics beginning with
induction of anesthesia.
423 Clear fluids by mouth & two sachets of Na+ picosulphate on the day before
the operation plus broad spectrum intravenous antibiotics at induction. .
424 Long-term oral penicillin & immunization against pneumococcal infection.
425 One dose of Metronidazole at induction of anesthesia.

Answers.

Each option may be used once.uk Theme: Interpretation of hematology results Options A Alcoholism B Beta thalassemia major C Chronic blood loss D Cytotoxic drugs E Dietary deficiency F Haemolysis G Hypothyroidism H Pernicious anaemia I Rheumatoid arthritis J Untreated hyperthyroidism Instructions For each set of results bellow.000.000.co.fischtest.1g/dl 73-fL 31-g/dl .000..000/L Platelets 523 x l.000/L 62 x l. choose the single most likely cause from the above list of options. WBC 9. or not at all.000.000. MCHC WBC Platelets Retics ESR' Blood film 10.000/L 283 X l.000.000. 426 Hb 7. more than once.000.000/L <1 % 6-min/hr Normal .000.8g/dL 84-fL Hb MCV.000.000.6g/dL MCV 83 fL MCHC 32g/dL. 3.000/L Retics <1% ESR 6 min/hr Blood film Normal 429 Hb MCV MCHC 32g/dL WBC Platelets Retics ESR Blood film 9.1 X l.000/L <1 % 8 min/hr Target cells 428 Hb 5.000.000/L 9% 15 min/hr Small irregular shaped RBC.0 x l.000.000/L 223 x l.000.000/L Platelets 62 x l.0 x 1.000. WBC 1.1 X l.9g/dl MCV 57-fL MCHC 21-g/dl.www.000/L Retics 6% ESR 14 min/hr 427 Hb MCV MCHC 37g/dL WEC Platelets Retics ESR Blood film 10.000. 6.9g/dL 10-6fL 8.000.000.3 x l. anisocytosis 430 Answers.000.000.

431 A 68-year-old man has had malaise for five days & fever for two days . 434 A 45-year-old manual worker presents with a two-hour H/O chest pain radiating into the left arm.He has a cough & you find dullness to percussion at the left lung base. Chest x-ray & ECG are normal. for three weeks. His ECG is normal. or not at all. young man has a sudden pain in the chest & left shoulder & breathlessness while cycling. . 435 A 52-year-old obese man has had episodic anterior chest pain.co. particularly at night. Answers.www. 433 A tall. Her chest x-ray & ECG are normal. Three days later she presents with sharp chest pain & breathlessness.fischtest. 432 A 50-year-old woman returned by air to the UK from Australia.uk Theme: Diagnostic test for patients presenting with chest pain Options A Abdominal ultrasound' B Blood culture C Bronchoscopy D Cardiac enzymes E Chest x -ray F CT G ECG H Full blood count (FBC) I Lumbar puncture J Oesophago-gastro-duodenoscopy K Ventilation / Perfusion scan Instructions For each patient described below. thin. more than once. Each option may be used once. choose the single next most appropriate test from the above list of Options.

She describe the incidence like a Curtin coming down. more than once. choose the single most likely risk factor from the above list of Options. A 57-year-old man complains of sudden loss of vision in his right eye. 437. or not at all. 436 A 38-year-old man suddenly notices markedly reduced vision in his right eye. 439. The fundus looks red and intensely hyperaemic. A 59-year-old man says he is always running into objects. .fischtest.uk Theme: Risk factors of opthalmic pathology Options A Myopia B Hypermetropia C Astigmatism D Hereditary in 30% E Hypocalcaemia F Polycythaemia rubra vera G Immunosuppression H Candidiasis I Myxodema J Sjogren’s syndrome Instructions For each patient described below with ophthalmic disease. Each option may be used once.co. He cannot read the visual acuity chart and can only count fingers. His vision is blurred and also complains of dazzling in bright light. A Schirmers test is performed and is found to be positive. A 39-year-old woman complains of gritty feeling in her eyes.www. Answers. 438.

co. headache & weight loss.uk Theme: The immediate management of meningitis. Options A Acyclovir B Antipyretics C Cranial CT-scan D High dose steroids E 20% dextrose iv F Plasma expansion iv G Sodium bicarbonate iv H Lumbar puncture I Nasogastric tube insertion J Thick & thin blood film K Treat immediate contacts L Urinary catheter Instructions For each patient described below. 440 A four-year-old girl. rigor & stiff neck and shoulders. O/E he has excoriated urticarial' lesions of his ankles arid jaundice. headache. . he has sudden fever. has been treated with Ampicillin for otitis media. His college doctor has given him intramuscular penicillin. A previously well college student aged 18. neck stiffness but no alteration in I consciousness. O/E she is confused & has papilloedema & bradycardia. is found unconscious by his friend. 24-hours after returning home. more than once. choose the single most urgent first step from the above list of Options. 441.fischtest. photophobia. Her fundi & BP are normal. he has a tachycardia. 444 A 40-year-old journalist visited Western Africa at short notice for three days. On arrival at the A&E. He has a petechial rash & antibiotics were started for suspected meningococcal infection. 443 A six-week-old boy developed fever. Each option may be used once. After five days she is more unwell with fever. 442 A 23-year-old unemployed woman who is known to have AIDS has a threeweek H/O increasing vomiting. who has never been immunized. or not at all.www. Answers. neck stiffness & photophobia on the morning after his birthday. weak pulse & a rapidly spreading purpuric rash. He is now stable & receiving all necessary immediate treatment.

She has no will & her lawyer requests that you tell him whether her condition is terminal so he can convince her to sign the will Informing her. about her worsening condition has caused significant deterioration in her condition before. health authority. . The secretary asks for the patients' medical records so that she can type the letter. C Wait for relatives before you can begin resuscitation D Transfuse with blood E Don’t transfuse with blood. Her husband objects saying they are devout Jehovars' witnesses & are against blood transfusion.uk Theme: Ethical practice of medicine Options A Resuscitate without consent & do cervical smear since this may be only opportunity. over who inherits her estate & her enormous wealth. 448 A 50-year-old wealthy widow has terminal breast cancer & has \ only days to live. don’t inform. B Resuscitate even without consent. more than once or not at all. She has confided in you before that her daughters are threatening to kill each other.She is in shock & you decide she needs an immediate blood transfusion. even if patients' life is at risk F Inform relevant health authority G Respect the patient's confidentiality. Each option may be used once. 447 A 32-year-old woman. Her condition is not improving & you want your medical secretary to type a referral letter. following a road traffic accident . 449 You are treating a 56-year-old woman who had an acute myocardial infarction. 446 You are treating a surgeon for Hepatitis-B you ask him to inform to inform the NHS trust where he is working & he refuses.fischtest. is brought into the A&E by her husband drifting in & out consciousness. following a road traffic accident. Her condition is deteriorating. H Respect the patient's confidentiality & don’t tell lawyer I Tell lawyer about her condition without her consent J Ask for consent again K No need to ask for consent again Instructions For each of the scenarios below choose the most appropriate action to take from the above list of Options.www.co. 445 A 17-year-old boy is brought into the A&E unconscious. Answers.

more than once. She has urinary frequency. Urine is now sterile. 453 An eight-year-old girl presents with a 12-hour H/O nausea & central abdominal pain now radiating to the right iliac fossa. A proteus urinary tract infection (UTI) has been confirmed on culture.uk Theme: Investigation of urinary tract infection (UTI) Options A Abdominal x-ray B Intravenous urogram C Isotope renal scan ' D Laparotomy E Lumbo-sacral spine x-ray F Micturating cysto-urethrogram G Mid stream specimen of urine H Serum creatinine I Supra pubic aspiration of urine for culture J Urinary glucose test. 454 A 14-year-old girl has had a pseudomonas urinary tract infection & her BP is 149/9)-mmHg persistently. . 451 A one-year-old boy had a severe urine infection complicated by E. choose the single most helpful next investigation from the above list of Options.www. Abdominal examination is normal. Answers. K Urodynamics Instructions For each child described below. Abdominal examination is normal. A bag urine specimen showed red & white cells & a culture of mixed organisms. Each option may be used once.fischtest. 450 A 10-day-old girl has developed fever & jaundice & is not feeding as well as normal. He is on prophylactic antibiotics. or not at all. coli septicemia one month ago. 452 A five-year-old boy has a persistent H/O diurnal & nocturnal. enuresis & soiling. He has had a series of orthopaedic operations for talipes equino varus. She has a past H/O recurrent urinary tract infections & an abdominal ultrasound at the age of two was normal.co. Ultrasound examination of the abdomen during the acute' infection was normal.

www. which affects males more than females. It may recover even without treatment. Answers. 455 A condition. which is only present between 4_ & 160 degrees of abduction. Each option may be used once. 458 intermittent acute attacks of severe asymmetrical mono arthritis over a period of several years with symptom free intervals. symmetrical. which starts with inflammatory joint symptoms in late teens or early twenties. There is a gradual improvement in symptoms in later life. .uk Theme: The natural H/O joint disease Options A Ankylosing spondylitis B Gout C Osteoarthritis of the hip D Prolapsed intervertebral disc E Painful arc syndrome F Rheumatoid arthritis G Rotator cuff tear H Sjogren's syndrome I Systemic lupus erythromatosus J Tennis elbow K Tendinitis of long head of biceps L Psoriatic arthritis Instructions For each description below.fischtest. more than once or not at all. 459 Shoulder pain. 456 A progressive. choose the single most likely condition from the above list of Options. . 460 Pain is felt in the anterior shoulder & is characteristically worse on forced contraction of the biceps. 457 An acute presentation of back pain radiating down the leg with resolution in the majority of cases over a six-week period.co. inflammatory arthritis with a relapsing & remitting course over several years resulting in significant destruction of several joints.

Her last period was when she started tamoxifen two years ago. Her mother & father died of carcinoma colon. .www. choose the single most likely diagnosis from the Options listed above. 462 A 31-year-old nulliparous woman with a H/O cyclical pelvic pain. Answers. slightly irregular periods. Each option may be used once. She is nulliparous. 464 A 46-year-old woman who has breast cancer & is on tamoxifen has had two episodes of bright red bleeding.fischtest. Clinical examination shows a normal size uterus with no adnexal masses. more than once or not at all. 463 A 53-year-old woman has had a H/O offensive l discharge & intermittent l bleeding over the past three months. 461 A 50-year-old woman presents with a nine month H/O prolonged. C/O heavy & frequent periods. Her husband died of carcinoma of the penis.uk Theme: The diagnosis of l bleeding Options A Cervical carcinoma B Vulval carcinoma C Cervical ectropion D Endometrial carcinoma E Endometriosis F Ectopic pregnancy G Ovarian carcinoma H Menopause I Hyperthyroidism J Rhesus incompatibility K Von Willebrand’s disease L Pelvic inflammatory disease M Pelvic adhesions Instructions -For each patient described below. An ultrasound scan reports "an empty uterus.co. On l examination a fixed retroverted uterus is found. 465 A 22-year-old woman with a six-week H/O amenorrhoea presents to the A&E with l bleeding." 466 An obese 55-year-old woman presents with per l bleeding associated with a watery non-foul smelling discharge.

or not at all.co. Each option may be used once. more than once.fischtest. Answers. 471 Blocking these can cause worsening of asthma.uk Theme: The disease process of asthma Options A 5% reversibility in FEV I K IgG B 10% reversibility in FEV I L IgM C 15% reversibility in FEVI M Leukotrienes D Alpha-receptors N Mast cells E Beta 2 receptors 0 Neutrophils F Eosinophils G Forced vital capacity P Peak expiratory flow rate (PEFR) H Histamine Q Positive pollen skin test I IgA R Raised eosinophil count J IgE S T cells T Vital capacity Instructions For each of the statements below. 467 A criterion for the diagnosis of asthma. choose the single most likely connecting treatment from the above list of Options.www. 469 This parameter of respiratory function is usually unaffected by asthma. ' 468 The substance is released by mast cell activation & causes bronchospasm. . 470 Found commonly in the sputum of patients with asthma.

474 At antenatal clinic visit at 38 weeks gestation. . She was mildly hypertensive in both of her previous pregnancies. On dipstick she is found to have 3+ proteinuria. At her first visit at 12 weeks the BP was 145/90-mmHg. a 22-year-old primigravida is found to have a BP of 145/1 OOmmHg. Each option may be used once. She is then admitted as an emergency with epigastric pain.co. or not at all. Two weeks later at the hospital ante-natal clinic. 476 At 34 weeks. 'There is hyper-reflexia & her BP is 150/100-mmHg.the above list of Options. Answers. an 85 kg woman C/O persistent headaches & 'flashing lights. but she is found to have oedema to her knees. 473 A 24-year-old Nigerian woman has an uneventful first pregnancy to 30 weeks. Urinalysis is negative but she has finger oedema. The fetal cardiogram (CTG) is normal.uk Theme: Clinical management of hypertension in pregnancy Options A 24-hour urinary protein B A period of observation for BP C Complete neurological examination D Fetal ultrasound E Immediate Caesarean section F Induction of labour G Intravenous anti-hypertensives H Intravenous benzodiazepines I Low dose aspirin J Magnesium hydroxide K Oral antihypertensive L Oral diuretic M Recheck BP in seven days N Renal function tests O Retinosopy Instructions For each patient described below. Her BP is 150/100-mmHg.fischtest. She has no proteinuria. 475 At 32 weeks. choose the single most appropriate action from . her BP is 150/9-mmHg. She has no proteinuria. a 36-year-old multiparous woman has a BP of 140/90-mmHg. 472 A patient in her third pregnancy presents to her GP at 12 weeks gestation. During the first 2 hours her BP rises from 150/105-mmHg to 170/120-mmHg. more than once.www. but-she is found to have oedema to her knees.

. 481 A 20-year-old man with severe renal failure (serum creatinine concentration 700-umol/l presents with proximal myopathy. choose the single most appropriate drug to prescribe from the above list of Options.co. or not at all. 477 A 30-year-old man with diabetes mellitus & severe renal failure (serum creatinine 700 umol/l . more than once. 480 A 62-year-old man with chronic renal failure (serum creatinine concentration 800-umol/l . Answers.x 7 normal) has a blood glucose concentration of 24 mmol/l (x3 normal).www.x 8 normal) & known renal calculi presents with left sided renal colic.uk Theme: Prescribing & renal failure Options A Aluminium hydroxide J Insulin -increased dosage B Aspirin K Insulin-reduced dosage C Bendrofluazide L Magnesium D Calcitriol M Mefenamic acid E Calcium N Metoprolol F Captopril O Metformin G Diamorphine Paracetamol H Enalapril Q Spironolactone I Frusemide Instructions For each patient described below. 478 A 43-year-old woman with severe renal failure (serum creatinine concentration 750 umol/l.fischtest.x 6 normal) has a BP of 220/142-mmHg. Each option may be used once. 479 A 21-year-old man with a failing renal transplant (serum creatinine concentration 600 umol/l.x 7.5 normal) presents with markedly swollen ankles.

She is found to have spider naevi on her chest. . salt & fluid restriction.co.www. 482 A 32-year-old chronic alcoholic is in liver failure. He now develops liver cirrhosis. 485 A 30-year-old woman presents with a mildly distended abdomen. yellowing of the mucous membranes. 484 A 32-year-old man has had hepatitis-B for the last one year & now presents with a grossly distended abdomen & other stigmata of liver disease.uk Theme: Prescribing & liver failure Options A Spironolactone 100-mg/24-hr PO B Frusemide I00-mg/24-hr PO C Paracentesis D Paracentesis with Albumin infusion E Ciprofloxacin 250-mg PO F Flucloxacillin 500-mg/24-hr PO G Chlorpheniramine 75-mg PO H Cholestyramine 4g/8h PO I Tetracycline 250-mg/8h PO J Stop Warfarin K Warfarin-increased dosage L Warfarin-reduced dosage M Bed rest. Instructions For each patient described below choose the most appropriate drug/action from the above list of Options. Answers.fischtest. 483 A 30-year-old chronic alcoholic is on warfarin following an acute myocardial infarction he suffered 3 months ago. He has severe pruritis. You are worried he may develop spontaneous bacterial peritonitis.

He is found to have colorectal carcinoma confined to the bowel wall' 487 A 79-year-old man with a H/O weight loss & per rectal bleeding is found to large bowel carcinoma with para-aortic lymph node involvement. which has not involved any lymph nodes but has penetrated the bowel wall. . Answers. Each option may be used once. She is found to have stage I cancer of the cervix. .co. 489 A 55-year-old woman with a foul smelling found to have stage II cervical carcinoma.uk Theme: Staging & prognosis Options A 90% B 65% C30% D20% E70% F 80% G 5% H 10% I 100% Instructions For each of the patients with cancer described below. more than once or not at all.fischtest. l discharge & post coital is 490 A 40-year-old woman presents with a 3 month H/O postal coital bleeding.www. match the appropriate stage with the expected 5-year survival treatment if adequate treatment is given. 486 A 59-year-old man presents with bleeding per rectum. 488 A 71_9f old woman with tenesmus & bleeding per rectum has bowel carcinoma.

P Café-au-lait spots Instructions For each.www. more than once or not at all. 491 Addison's disease 492 Cutaneous T-cell lymphoma 493 Coeliac disease 494 Hyperthyroidism 495 Tuberculosis 496 Polyarteritis nodosa 497 Mycoplasma pneumoniae 498 Lyme disease 499 Von Recklinghausen disease 500 Bronchial carcinoma {. choose the most likely matching skin pathology from the list of Options above. Answers. Each option may be used once.uk Theme: Association of systemic disease & skin lesions Options.fischtest.co. of the diseases named below. . A Erythema chronicum migrans B Erythema multiforme C Pretibial myxodema D Dermatitis herpetiformis E Livedo (a cutaneous vasculitis) F Dermatomyositis G Bazins disease H Dermatitis artefacta I Alopecia areata L Mycosis Fungoides M Bowen's disease N Paget's disease O Rodent ulcer.

You find bilateral papilloedema. She says she has. He is recovering from a bilateral parotitis.fischtest. 506 A 34-year-old known my positive South African man presents with a generalised headache. more than once or not at all. 504 A 13-year-old boy presents with drowsiness & generalized headache. been generally unwell for a few months with aching muscles.uk Theme: Headache : selection of diagnostic tests Options A Carotid arteriography B CT . His fundi look pale. 501 A 30-year-old woman has a generalised headache. Each option may be used once. 502 A 54-year-old man has a severe headache. worse on lying. choose the single most appropriate investigation from the above list of Options. CT is done & shows ring enhancing lesions. She has difficulty in sleeping & has lost weight recently. 503 A 68-year-old woman has a right-sided headache aggravated by bruising her hair. 505 A 30-year-old man presents with headache.scan of the brain C EEG D Erythrocyte sedimentation rate (ESR) E Fundoscopy F Intraocular pressure G Lumbar puncture H MRI of cervical spine I Mental state examination J Nasendoscopy K Skull X-ray L Temporal artery biopsy M Toxoplasma serology N Visual fields Instructions For each patient described below.co. . .www. unrelieved by paracetamol. Answers. photophobia & sudden reduction in visual acuity. described as a tight band. His CT-scan is normal.

more than once or not at all. Creutzfeld Jacob disease Answers. Each option may be used once. Hepatitis-A 513. Cholera 514. Chicken pox 509. Rubella 510. Mumps 511.fischtest.www. 507. .co. Hepatitis-B 512. Syphilis 515.uk Theme: Incubation periods for common diseases Options A I5-50 days B 50-180 days C 10-20 years D 7-21 days E 3 hours .5 days F 9-90 days G 14-21 days H 20-40 years I 3 days J 60 days K 5 hours L 7-8 days M 11-21 days Instructions For each of the disease conditions listed below choose the most appropriate incubation period from the list of Options above. Measles 508.

Aspiration of the joint has revealed uric acid crystals.www. Examination of the hands reveals heberden's nodes. She has swinging pyrexia.uk Theme: The management of chronic joint pain Options A Allopurinol B Antidepressant C Cognitive Behavioural therapy D Colchicine E Gold F Joint replacement G Methotrexate H Oral NSAIDs I Oral NSAIDs with gastric protection J Joint aspiration & blood culture K Paracetamol L Sulphasalazine Instructions For each patient described below. neck. 516 A 50-year-old obese asthmatic businessman who.co. or not at all. presents with fifth episode of a . .fischtest. swollen. 517 A healthy 70-year-old independent woman C/O increasing pain in her left knee & episodes of the joint 'giving way’. O/E. inflamed right knee. more than once. choose the single most likely initial management from the above list of Options. Answers. She is' no longer able to climb her stairs. drinks 40 units of alcohol a week. she is found to have a marked valgus deformity with obvious instability. 519 A 20-year-old bricklayer with Ankylosing spondylitis has increasing early morning back pain & stiffness. 520 An elderly man with severe ischaemic heart disease C/O stiff. knees & feet. 518 A 43-year-old woman with long-standing rheumatoid arthritis presents with a red. He is on no medication at present.ankle. painful hands. Each option may be used once.

Answers. 'attack disorder F Paranoid personality disorder G Obsessive-compulsive personality disorder H Avoidant personality disorder I Antisocial personality disorder J Dependent personality disorder Instructions For each patient described below choose the single most likely diagnosis from the list of Options above. wash him & put him to sleep. He spends hours watching his neighbor through pair of binocular lens. more than once or not at all. . Each option may be used once.www. 525 A 32-year-old man always gives in to his wife over any decision even when he knows this isn't right He insists on having his wife prepare his every meal.uk Theme: Diagnosis of personality disorders Options A Histrionic personality disorder B Borderline personality disorder C SchizotypaI personality disorder D Schizoid personality disorder E Panic. 524 A 16-year-old girl in high school always comes late to class wearing strong perfume in a vain attempt to attract attention. .fischtest. hoping to catch in the act 523 A 16-year-old girl is described as ' ' by his mates. He was a high achiever in high school. She is unfriendly & has no close friends despite numerous attempts by boys in her college. He cries whenever his wife's away. many of her mates don't find particularly hilarious. 521 A 20-year-old man keeps cleaning his hands every time he shakes his partner's hands. She lacks empathy & is largely introspective. She laughs loudly at jokes.co. 522 A 56-year-old farmer believes his 34-year-old neighbor is killing his farm animals despite the local veterinary's advice that the death is due to an outbreak of anthrax.

choose the single most likely initial management from the above list of Options.uk Theme: The management of joint pain Options A Allopurinol B Carbimazole C Hypnosis D Colchicine E Penicillamine F Prosthesis consideration G Methotrexate H Ibuprofen I Naproxen with gastric protection J Joint aspiration & blood culture K Paracetamol L Sulphasalazine M Acupuncture N Drain & await culture results O Drain & start on 250-mg Flucloxacillin 6-hrly Instructions For each patient described below. tender & warm. She is pyrexial. He is on no medication at present. neck. He dislikes surgery. She is found to have a marked valgus deformity with obvious instability & muscle wasting. 528 A 30-year-old woman with long-standing rheumatoid arthritis presents with a red. which is swollen. Each option may be used once. 529 A 19-year student with Ankylosing spondylitis has increasing early morning back pain & stiffness. 527 A healthy 80-year-old independent woman C/O increasing pain in her left knee & episodes of the joint 'giving way’. knees & feet. 531 A 6-year-old girl is unwilling to her right hand. He has been given loads of medication & requests alternative treatment. 1 530 An elderly woman with multiple sclerosis C/O stiff. . associated with rigors. inflamed right knee. painful hands. Examination reveals bouchards' nodes on the hands. She swinging pyrexia. swollen. more than once or not at all. Answers.www.co. 526 A 43-year-old man has had a chronic knee joint pain for 3 years. as his brother died during an appendicectomy. She is no longer able to walk her dog.fischtest.

www. He has lost several kgs in weight.co. choose the single most appropriate treatment from the list of option. Each option may be used once. mother presents a week after delivering with episodes of crying & feeling alone. He is threatening to drown himself. She wants to be a model. She feels life is not worth living. 535 A 20-year-old first time.uk Theme: Treatment of Depression Options A Electroconvulsive therapy B Flupenthixol C Psychodynamic psychotherapy D Cognitive therapy E Behavioural therapy F Marital therapy G Lithium H Imipramine I No action J Psychosurgery K Hypnotherapy L Abreaction M Counseling Instructions For each patient of the patients below. . more than once or not at all. Her husband says prior to this she was markedly withdrawn & blamed herself for their daughter's death due leukemia. 536 A 40-year-old man has been treated for depression for 5 months. 533 A 20-year-old woman presents with inability to sleep & aggressiveness & increased libido. & is getting suicidal thoughts.fischtest. She is not on the pill & her pregnancy test is negative. Answers. 534 A 14-year-old boy refuses to go to school because of constant failure to score grade-A. 532 A 15-year-old girl with a BMI of 16 C/O a 6-week H/O amenorrhoea.

redness & mucopurulent discharge affecting both eyes. pain & photophobia. Each option may be used once more than once or not at all. 541 A 23-year-old man has a H/O recurrent attacks of blurring of vision associated with redness. His two siblings have a similar problem.fischtest.5% Prednisolone drops 2-hrly & cyclopentolate drops G 3% Pilocarpine drops & Acetazolamide H 500-mg Acetazolamide I Acyclovir drops J Total iridectomy K/I 5% Flourescein drops Instructions For each patient described below. Answers. 542 A 25-year cricket player sustained facial injuries. 539 A mother brings her 2-year-old child with a squint. .uk Theme: The management of red eye Options A No treatment B Check BP & do coagulation studies C Immediate antibiotic therapy D Enucleation E 0. choose the single most appropriate mode of management from the above list of Options.5% Prednisolone drops 4-hourly F 0.co. O/E a leucokoric right pupil is seen with an absent red reflex. 537 A 69-year-old patient presented to his GP with sudden onset of redness in the right eye. He had noticed haloes around streetlights at night for a few days before the onset of the pain. 538 A 60-year-old patient C/O severe pain in his left eye with severe deterioration of vision.www. 540 A 12-year-old Libyan boy gave a two-week H/O discomfort. 10 months later he presented with a painful swelling at the left medial canthus. His older is currently being investigated for bowel disease & a severe backache. Both eyes have been affected in the past. There was no pain & vision was unaffected. associated with red eye & purulent discharge.

543 A 50-year-old man with no previous history is brought to the Accident. poor concentration & inability to recognize household objects. . He C/O chronic cough & forgetfulness.in both hands. Answers.He had a similar episode two years ago & became unable to identify objects & to make proper judgments.fischtest. 544 A 74 year old. There is a strong family H/O similar complaint.www. He is on Pneumocystis carinii treatment. He is unable to speak properly. 547 A 69-year-old patient with chronic schizophrenia presents with a mask like face & involuntary pill rolling movement . 545 A 30-year-old sickler from Nigeria who received several blood transfusions a few years ago presents with irritability & increasing memory deficit. & Emergency Department by his wife who says that he has become progressively more forgetful. tends to lose his temper & is emotionally labile. man presents with weakness in his arm & leg (from which he recovered within a few days) & short-term memory loss. He has an extensor plantar response . O/E she has right-handed involuntary writhing movement. choose the single most likely diagnosis from the above list of options. 546. Each option may be used once more than once or not at all. There is no H/O infectious disease or trauma.A 39-year-old woman presents with memory loss.co.uk Theme: Diagnosis of dementia Options A Alcoholic dementia B Alzheimer's dementia C Creutz-feldt-Jakob's disease D Head trauma E Human immunodeficiency virus (HIV) F Huntington’s chorea G Parkinsonism H Pick's disease I Repeated trauma J Space occupying lesions K Substance induced dementia L Toxin dementia M Vascular dementia Instructions For each patient described below.

.uk Theme: Management of thromboembolic disease Options A Phlegm microscopy.549 A 31-year-old woman is being treated for a thrombophilic tendency. culture & sensitivity. B Echocardiography C Blood culture D Blood transfusion E Duplex scan F IV bolus of Warfarin G 20-mg Aspirin 12-hourly H Coronary angiography I Counseling J Streptokinase K Protamine sulphate L Diathermy M Positron Emission Tomography (PET) N Cervical smear O Abdominal ultrasound P/K Dilatation & curettage Instructions For each patient described below. . 550 A 26-year-old obese woman. Each option may be used once. Her BP is low & has a loud P2 on auscultation. presents with complaints of bleeding every month in her pill free days. presents with palpitations. choose the single most important first management step from the above list of Options. 551 A 25-year-old woman. who has been taking the pill for six months. O/E she is febrile & has nail bed fluctuance.fischtest. who has. who has been taking the combined oral contraceptive pill for 2 months. 548 A 30-year-old woman.co. The nurse administers dose of subcutaneous Heparin & she begins to bleed from the nose & other injection sites. He had previously presented with a diastolic murmur of Mitral stenosis. Her partner died or road traffic accident. or not at all. ' Answers.www. is brought to the A&E in a state of collapse. Her mother died of cervical carcinoma. 'presents with a 3 month H/O cough with sputum. been taking the combined oral contraceptive pill for 9 months. more than once. 552 A 16-year-old woman. fever & night sweats.

more than once or not at all 553 Ultrasound shows intra-abdominal free fluid. 554 BP is 80/60-mmHg & pulse rate is 11-beats/min. JVP is raised & the P2 is . raised bilirubin. . normal albumin & normal hepatocellular enzymes. H Posterior myocardial infarction I Splenic rupture J Deep vein thrombosis K Wound dehiscence L Incisional hernia M Antero-lateral myocardial infarction N Inferior myocardial infarction Instructions For each patient below. 558 days following bowel resection a 45-year-old man presented with chest pain on inspiration & haemoptysis.loud on auscultation.www.fischtest. choose the single most likely complication of abdominal surgery from the above list of Options.co. 555 ECG shows Q-waves & ST-elevation in leads III & aVF 556 Liver function tests show raised alkaline phosphates. 557 5 days following cholecystectomy. incision wound is noted to have a serous discharge.uk Theme: Diagnosis of complications Of Abdominal Surgery Options A Mesenteric adenitis B Pulmonary embolism C Biliary peritonitis D Acute mesenteric thrombosis E Sub-phrenic abscess F Cholestasis G Small bowel obstruction. Answers. Each option may be used once.

559 Pneumocystis carinii pneumonia 560 Tuberculosis 561 Bronchial carcinoma 562 Bronchiectasis 563 Bronchial carcinoid 564 Pulmonary embolism Answers. or not at all. single most definitive investigation from the above list of Options. choose the. Each option may be used once.uk Theme: investigations of patient with a productive cough Options A CT-scan B Ziehl Nielsen (ZN) staining C Echocardiography D Ventilation perfusion scan E Broncho-pulmonary lavage F Sputum cytology G Mediastinoscopy H Mediastinostomy I Pulmonary angiography J Thoracoscopy K L Selective arteriogram M MRI scan N O Fiberoptic Bronchoscopy Instructions For each suspected diagnosis below.co.fischtest. more than once.www. .

or not at all. he becomes progressively dyspnoeic. appears to be stable after an accident. Each option may be used once. She has a deformed left thigh. 568 A 29-year-old motorist.co. . He had a herniorrhaphy two weeks ago. There is reduced air entry on the left side of his chest. 570 A 22-year-old motorist is being resuscitated after an accident. She C/O neck pain. Answers. in the A&E resuscitation room. He C/O an acute abdominal pain & is vomiting. pupil is fixed & dilated & GCS is now 7. The neurosurgeon is 30 minutes away. 565 A 43-year-old man is brought to the A&E delirious. 567 A 30-year-old man is involved in a fight.-year-old motorist arrives in the A&E after an accident.fischtest. 566 A 22. GCS is 13. Initial resuscitation has been done. He is noted to have external injuries on the right side & a deformed right hand.uk Theme: Immediate management of a trauma patient Options A Plain abdominal X-ray B Asses airway & stabilize spine C CT-scan of abdomen D Transfer to operating theatre E Call ambulance only after full recovery F Chest drain after needle thoracentesis G ECG H Immediate blood transfusion I Cervical spine immobilization J Bolus of 50% dextrose followed by a saline infusion K CT brain scan L Normal saline infusion M Burr hole(s) should drilled N Lumbar puncture O Call neurosurgeon immediately P Splint limb Instructions For each patient described below choose the single most likely immediate action from the above Options.www. While standing up. his right. He is conscious & fundoscopy hasn't been done. O/E. He has a bruise on the cheek.Her airway is secure. He is noted to have a splinted right leg. more than once. His airway is patent. Her pulse rate is 100-beats/min & BP is 110/70mmHg. following and injury at a rugby match. His GCS at the scene of injury is 13. 569 An 18-year-old girl is being resuscitated after an accident . .

a 23-year-old student presented with onset of fever. high fever. 573 A 26-year-old woman 'has had influenza for the last 2 weeks.www. Over the last three weeks he has noticed a dry cough with increasing breathlessness. has felt unwell with fever & a dry cough for two weeks despite treatment with IV broadspectrum antibiotics. The student health service gave him amoxycillin. Chest X-ray shows cavities in both upper zones. he had presented with per rectal bleeding. abdominal pain. She is coughing up copious amounts of purulent sputum. He has lost considerable weight & has recently developed haemoptysis. malaise an dry cough. 574 A 70-year-old man. After a week he felt no better & his chest X-ray showed patchy bilateral consolidation. Answers. diarrhoea & vomiting. 571 A 34-year-old male patient has just returned from Thailand. She is not improving & has a swinging fever. more than once or not at all. The chest X -ray shows bilateral interstial infiltrates. 575 A 34-year-old haemophiliac. During induction of general anesthesia. Clinically De improves with antibiotics. In the Out patient clinic 5 weeks later. Chest X -ray shows left lower lobe consolidation. ahs felt generally unwell for two months with some weight loss. mid zone consolidation. she throws up. headaches. right sided. currently on steroid treatment for ulcerative colitis. 576 On return to university. choose the single most likely underlying cause from the above list of Options. 577 A 60-year-old man with chronic obstructive pulmonary disease presents with pneumonia.fischtest. the consolidation on his chest X-ray has not resolved. 572 A 30-year-old man presents with a 3 month H/O a productive cough.uk Theme: Causes of pneumonia Options A Legionella pneumophila B Tuberculosis C Fungal D Haemophilus influenzae E Bronchial carcinoma F Mycoplasma pneumoniae G Pneumocystis carinii H Staphylococcus Aureus I Viral pneumonia J Streptococcus pneumoniae L Bronchiectasis M Klebsiella N Aspiration pneumonia Instructions For each patient described below.co. Each piton may be used once. 578 A 32-year-old woman is rushed to theatre for an emergency appendectomy. Two courses of antibiotics from his GP have produced no improvement. He presents with a mild flu like illness. The chest X -ray shows an enlarging. . Prior to this.

. a mother notices her baby is crying excessively & has passed blood & mucus per rectal.fischtest. 585 8 days after a premature birth. Abdominal x-ray demonstrated a "double bubble". Urine microscopy shows no haematuria. The mother says her baby has passed reddish stool. He is now lethargic. 581 An eight-year-old girl shows signs of moderate dehydration.uk Theme: Diagnosis of acute abdominal pain & vomiting in children Options A Hirschsprung’s disease B Pyloric stenosis C Acute cholecystitis D Duodenal atresia' G Mesenteric thrombosis E Intussusception F Wilma's Nephroblastoma G Mesenteric thrombosis H Gastro-esophageal reflux I Meningitis J Meconium ileus K Cyclical vomiting L Necrotizing enterocolitis M Psychogenic vomiting N Urinary tract infection O Acute pancreatitis P Gastroenteritis Instructions For each child described below. 584 A 6-year-old febrile girl is drowsy & vomiting.co. She is being treated for otitis media by her GP. or not at all. An abdominal mass is found O/E. She has vomited all fluids for 24 hours & the vomit is not bile stained. Answers. choose the single most likely' diagnosis from the above list of Options. Her abdomen is now soft & non -tender. 580 A 12-year-old girl presents with fever. Each option may be used once. dehydrated & tachypnoeic. 583 A one day old breast fed infant is vomiting after each feed. following a 2 hour H/O abdominal pain associated with drawing up of legs. more than once. She has had two similar episodes in the past year. 582 A Six-week-old breast-fed girl had projectile vomiting after every feed for the past two weeks. The infant is still in the special care baby unit (SCBU) 586 A 15-year-old boy who is thriving has a mild abdominal pain & is passing "rice water" stools he had been at a mates' birthday party the / night before. flank pain.www. 579 A 5-month-old baby presents with vomiting.

Each option may be used once. choose the single most important side effect from the list of Options above. or not at all. 587 Cimetidine 588 Cyclophosphamide 589 Diamorphine 590 Amoxycillin 591 Oral contraceptive pill 592 Aspirin 593 Ethambutol 594 Tamoxifen 595 Methysergide Answers. more than once.uk Theme: Important Side effects of common Drugs Options A Impotence B Wasting C Deep vein thrombosis D Bronchospasm E Pseudo-membranous colitis F Hemorrhagic cystitis G Constipation H Retrobulbar neuritis I Endometrial Carcinoma J Steven-Johnson syndrome K Retroperitoneal fibrosis Instructions For each of the drugs below.co. .www.fischtest.

co.www. Answers. 600 Minutes after upper GI endoscopy a 56-year-old man develops chest pain. 599 A 68-year-old man develops crushing chest pain in the chest associated with nausea & profuse sweating radiating to the neck By the time he gets to hospital quarter of-an hour later the pain is gone. 597 A tall young man developed sharp Chest pain on his right. or not at all. Each option may be used once. 596 A 23-year-old man develops pain an acute pain in her right chest radiating to her right shoulder associated with a fever. When you examine him. . he has a crackling feeling under the skin around his upper chest & neck. She is vomiting and has mild yellowing of her skin.uk Theme: Diagnosis of acute chest pain Options A Acute pancreatitis B Angina pectoris C Aortic dissection D Trigeminal neuralgia E Herpes Zoster F Lobar pneumonia G Ruptured oesophagus H Herpes simplex I Acute myocardial infarction J Spontaneous pneumothorax K Acute cholecystitis L Bornholm disease M Tietze's syndrome N Esophageal spasm O Fracture fib Instructions For each patient below. more than once.On palpation. choose the single most likely diagnosis from the above list of Options. A chest x-ray shows her lungs are not injured. this area is tender. following a I road traffic accident . 598 A 23-year-old male prostitute develops severe chest pain: The area of chest pain corresponds to an area with an erythematous rash.fischtest.

but is (now afraid to look at bright light & has refuses to eat. O/E. A 34-year-old man has lost 4 kg over the past 3 months. A 30-year-old man who has just returned from Africa. C/O joint pains & fever associated with chills & rigors.fischtest. A mother brings her 2-year-old son to the A&E.uk Theme: Diagnosis of common infectious diseases Options A Measles B Tuberculosis C Meningitis D Sickle cell trait E Hepatitis-A F Hepatitis-B G Malaria H AIDS I Influenzae J Glandular fever K Chickenpox L Scarlet fever M Mumps N Rubella Instructions For each of the patients described below. choose the single most likely diagnosis from the list of Options above. 602. Answers. A 5-year-old girl was given antibiotics for an ear infection 6-hrs ago.www. koplik spots were found with a generalised maculo-papular rash. & C/O a 4 month H/O a productive cough.co. Each option may be used once more than once or not at all. . 601. who is drowsy & vomiting. A blood smear shows numerous 'ring' trophozoites. A 23-year-old male icterus.. 603. 605. C/O joint pains associated with malaise & mild 604.

He is now stable & receiving all necessary immediate treatment. 606 A six-year-old girl. Each option may be used once. O/E he has excoriated urticarial lesions of his ankles & mild jaundice. 607 A previously well college student aged 19.fischtest. he has a sudden fever. who has never been immunized.www. he has a tachycardia. choose the single most urgent first step from the above list of Options. headache & weight loss. Her fundi & BP are normal. O/E. headache. 610 A 43-year-old journalist visited Sierra Leone in West Africa to cover the on going war for 5 days. . Answers. rigors & stiff neck & shoulders. photophobia. His college doctor has given him intramuscular penicillin. He has a petechial rash & antibiotics were started for suspected meningococcal infection. On arrival at the A&E. 609 A seven-year-old boy developed fever. After five days. neck stiffness & photophobia on the morning after a schoolmates' birthday party. is found unconscious by his friend. weak pulse & a rapidly spreading purpuric rash. she is confused & has papilloedema & pulse rate of 60-beats/min. neck stiffness but no alteration in consciousness. 608 A 32-year-old known AIDS patient has a three-week H/O increasing vomiting.uk Theme: The immediate management of meningitis Options A Acyclovir B Antipyretics C Cranial CT-scan D High dose steroids E Intravenous 20% dextrose F Intravenous plasma expansion G Intravenous Na+ HCO3 H Lumbar puncture I Nasogastric tube insertion J Thick & thin blood film K Treat immediate contacts L Urinary catheter Instructions For each patient described below. more than once or not at all.co. has been treated with amoxycillin for otitis media. she is more unwell with fever. A day after returning at home in Islington.

uk Theme: Decision making in the injured patient Options A 10 units of soluble insulin (IV) B Secure airway & stabilize cervical spine C Dexamethasone i/v D 2 mg Glucagon (IM) E Discharge patient after a period of counseling F 0.9% Saline (iv) G Splint limb H Asses airway I Aspirin J Morphine K Naproxen L 50-ml of 50% dextrose i/v M Finger prick glucose measurement N Cut down should be performed. You find 19-year-old man unconscious smelling of alcohol. more than once or not at all. 612 You arrive at the scene of major accident & find a 32-year-old man unconscious. Each option may be used once. 613 A 34-year-old known diabetic is brought to the A&E unconscious following a road traffic accident Initial resuscitation has been done by the paramedics. Instructions For each of the scenarios below choose the single most appropriate first step from the above list of Options. Answers. He now C/O severe excruciating pain in his right big toe.fischtest. He had complained of a similar pain last year .co. Several attempts at getting intravenous (iv) access have failed. His airway & cervical spine are secured by your team. 611 An obese 56-year-old man is involved in a road traffic accident & sustains multiple bruises. 615 After a heavy bout of drinking a 17-year-old is to the A&E unconscious. 614 As part of the ambulance team you arrive at the scene of a major accident. He smells of alcohol. .www. The airway & cervical spine are secure.

There is a gradual worsening of symptoms in later life.fischtest. symmetrical. 616 A condition which affects males more than females. It may recover even without treatment. Each option may be used once more than once. . Answers. 620 Shoulder pain. inflammatory arthritis with a relapsing & remitting course over several years resulting in significant destruction of several joints.co. several years with symptom free intervals. or not at all. / 617 A progressive. which starts with inflammatory symptoms in late teens or early twenties.uk Theme: The natural H/O joint disease Options A Ankylosing spondylitis B Gout C Osteoarthritis of the hip D Prolapsed intervertebral disc E Psoriatic arthritis F Rheumatoid arthritis G Sjogren's syndrome H Systemic lupus erythromatosus I Tennis elbow J Painful arc syndrome Instructions For each patient described below. choose the single most likely condition from the above list of Options. which is present between 45 & 160 degrees of abduction. 618 An acute presentation of back pain radiating down the leg with resolution in the majority of cases over a six-week period. 619 Intermittent acute attacks of a severe asymmetrical monoarthritis over a period of.www.

fischtest. Each option may be used once.uk Theme: Prescription & Disease Options A Vancomycin B Benzyl penicillin C Erythromycin D Actinomycin E Metronidazole F Amoxycillin G Glyceryl trinitrate (GTN) H Co-trimoxazole I Zidovudine (AZT) J Ondansetron K Fluconazole L Imidazole M Verapamil N Immunoglobuins i/v (under senior guidance) O Piperacillin P Trimethoprim Instructions For each of the disease conditions mentioned below.www. . choose the drug of choice from the above list of possible Options. 627 Sinusitis in-patient allergic to penicillin 628 Acute otitis media 629 Acute streptococcal sore throat ( patient allergic to penicillin) 630 Pneumocystis Carinii Answers. 621 Meningococcal meningitis 622 Tetanus 623 Trichomonas lis 624 Vincent's angina 625 Uncomplicated urinary tract infection (UTI) 626 Pseudo-membranous colitis (Patient allergic to Vancomycin) .co. more than once or not at all.

637 A 53-year-old who has a family H/O breast cancer has been experiencing mild discomfort for a few hours following for the last month.fischtest. Answers. 634' An obese 40-year-old woman presents with a two H/O post coital bleeding associated with a foul smelling l discharge. Each option may be used once. D Oestrogen pessaries E Thyroid function tests F l lubricant G Regular exercise H Prophylactic HRT I Endometrial sampling J Cervical inspection K Cervical smear M High protein diet Instructions For each scenario below. She wants relief from her symptoms. choose the single most appropriate treatment from the above list of Options. 635 An obese 50-year-old pre-menopausal woman presents with menorrhagia. which is becoming more frequent.co. 'She had a fracture neck of femur which is being treated.uk Theme: The management of menopausal symptoms Options A TransdermaI Oestrogen patch B Raloxifene C Oestrogen implants. She had previously been on tamoxifen. She is worried about using hormones. She C/O constipation & says. She denied a H/O hot flushes she has a family H/O breast & Endometrial carcinoma. 636 A 56. more than once or not at all.www. .-year-old woman C/O night sweats & mood swings. she cant stand cold weather. 632 A 34-year-old woman is worried about the menopause & wants advice on how best to reduce the incidence of osteoporosis 633 An obese 59-year post-menopausal woman presents with a two week H/O per l bleeding.

choose the single most likely diagnosis from the above list of Options. has experienced monthly l bleeding. l discharge & abdominal pain. 640 A 17-year-old woman presents with a sudden onset of severe left iliac fossa pain. 643 A 32-year-old who conscientiously uses the oral contraceptive pill.and is otherwise healthy. O/E. She C/O a watery brown. Appendicitis J Acute pancreatitis K Ectopic pregnancy L Septic abortion M Break-through bleeding N Inevitable miscarriage O Missed abortion P Bowel carcinoma Instructions For each patient described below. L 638 A 3.fischtest. 639 A 31-year-old man reports a 7-week H/O gradual onset rectal bleeding associated with constipation.www. 641 A 22-year-old has just had an Intra uterine device fitted. Answers. She has not seen her period for 8 weeks & had a positive home pregnancy test yesterday. His brother had similar bowel symptoms & back pain. 2-cm echogenic masses are seen in the broad ligament She says this pain seems to come on every month. the uterus is tender & bulky. On l ultrasound examination.5-year-old woman C/O abdominal discomfort relieved by passing flatus or defecation. 642 A 19-year-old woman presents as an emergency with a 3 hour H/O lower abdominal pain & bleeding per vaginum. but denied she had lost weight Her mother i died of bowel carcinoma. O/E he is found to have red eyes & skin lesions on both his shins. On abdominal examination she is uncomfortable. Her temperature is 37 C . . Over the last 6 month she has had episodes 'of diarrhoea & constipation.uk Theme: Differential diagnosis of abdominal pain in a woman Options A Uterine rupture B Ulcerative colitis C Twisted ovarian mass D Threatened miscarriage E Irritable Bowel Syndrome' F Pelvic inflammatory disease G Renal colic H Endometriosis I.co. The cervical Os is closed.

S Vital capacity H Histamine T Leukotrienes I IgA U Meter does inhaler J IgB V Syringe driver K IgG W positive pollen skin test L Spacer M Mast cells X Aspirin 644. Important for the home monitoring of asthma control Answers. . Immunoglobuins predominantly involved in atopic disease. which aids the delivery of asthma medication in infants & young children.www. 651.co.uk Theme: The disease process of asthma Options A 5% reversibility in FEV-1 N Neutrophils B I0% reversibility in FEVI C 15% reversibility in FEV-1 O Peak expiratory now rate (PEFR) D Alpha-receptors P Captopril E Beta-2 receptors Q Raised eosinophil count F Eosinophils R T Cells G Forced vital capacity. A criterion for the diagnosis of asthma. 647. The substance is released on deregulation of mast cells & causes bronchospasm. This parameter of respiratory function is usually affected by asthma 652. 645. Propranolol activation of these is hazardous in Asthma. This parameter of respiratory function is usually unaffected by asthma 653.fischtest. Found commonly in the sputum of patients with asthma. 646. A device. 649. Medication contraindicated in asthmatics 650.

On dipstick she is found to have 3+ proteinuria. She has no proteinuria and is otherwise well. Her BP is 150/100-mmHg. A 22-year-old Nigerian woman has an uneventful first pregnancy to 30weeks.fischtest. choose the single most appropriate action from the above list of Options. 656 At an antenatal clinic visit at 38 weeks gestation.uk Theme: Clinical management of hypertension in pregnancy Options A Low dose aspirin B A period of observation for BP C 24-hour urinary protein D Fetal ultrasound E Retinosopy F Induction of labour G Renal function tests H Intravenous antihypertensive I Intravenous benzodiazepines J Magnesium hydroxide K Oral anti hypertensive L Oral diuretic M Recheck BP in seven days N Complete neurological exam O Immediate Caesarean section Instructions For each patient described below. She has no proteinuria. a 22-year-old primigravida is found to have a BP of 145/100mmHg. During the first 2 hours her BP rises from 150/1 05 to 170/120. Urinalysis is negative but she has finger oedema. . a 86 kg woman C/O persistent headaches & flashing lights There is no hyper-reflexia & her BP is 150/100. 654 A patient in her third pregnancy presents to her OP at 12 weeks gestation. more than once or not at all. She was mildly hypertensive in both of her previous pregnancies. She is then admitted as an emergency with epigastric. a 36-year-old multiparous woman has a BP of 140/90-mmHg. At 32 weeks. Each option may be used once. The fetal cardiotocogram (CTG) is normal. but she is found to have oedema on her knees. 658 At 34 weeks.www. Answers.co. Two weeks later at the hospital antenatal clinic her BP is 150/95-mmHg 655. 657.

Answers. 660.uk Theme: Headache: selection of diagnosis tests Options A Carotid arteriography I Mental state examination B CT-scan J Nasendoscopy C EEG K Skull x -ray D ESR L Temporal artery biopsy E fundoscopy M Toxoplasma serology F Intraocular pressure N Visual fields G Lumbar puncture O Psychiatric History H MRI Instructions For each patient described below. A 54-year-old man is brought to the A&E with a 6-month H/O headache. photophobia & sudden reduction in visual acuity . 666. described as a tight band. You find bilateral papilloedema. which he has had for the past 5 months. 664. She has difficulty sleeping & says she has lost weight recently. A 34-year old man with blurred vision complains of a severe headache of 1-hour duration. A 23-year old man c/o headache of 3-week duration. Each option may be used once. A CT-scan is done & shows multiple ‘ring’ enhancing lesions.His fundi look pale. A 51-year-old man has a severe headache. A 34-year-old woman has a generalised headache. A 55-year-old man with blurred vision C/O headache. unrelieved by paracetamol. His CT-scan is normal. more than once. . worse on lying. A 71-year-old woman has a severe headache aggravated by brushing her hair. 659. or not at all. choose the single most appropriate investigation from the above list of Options. 663. 661. A 14-year-old boy presents with drowsiness & generalized headache. He is recovering from a bilateral parotitis. A 32-year-old man presents with headache. His wife sys that he has also become progressively more forgetful tends to lose his temper & is emotionally labile. 667. He also complains of pain on chewing. 668.fischtest.www. In obese 31-year-old woman is brought to the A&E with a sever occipital headache of 2-hr duration she is unable to move her left hand & leg. 662. She says she has been generally unwell for a few months with aching muscles. There is no H/O loss of weight: in factious disease or trauma.co. 665. Coughing & sneezing seem to worsen the headache.

674 The treatment of ulcerative colitis. . more than once or not at ail. Each option may be used once. choose the single most appropriate drug from the above list of Options. 673 A 32-year-old man has been treated for morphine dependence. He is withdrawn & has a bleak view of the future. I Naltrexone N Propranolol J Vigabatrin T Fluoxetine Instructions For each patient described below. O/E they are found to be swollen & tender. The pain is still present when he arrives in hospital an hour later. 676 A 45-year-old man C/O morning stiffness of both his knees. more than once or not at all.www. 670 A 32 year old] 3-week pregnant woman C/O heat intolerance. 677 A 32-year-old man has lost weight since the death of his wife 3 months. He wants to stay off the drug. He has lost weight. She has lost weight despite a good appetite. 675 The treatment of crohn's disease. 672 A 13-year-old known asthmatic is brought to the A&E breathless.co. Answers. 671 A 45-year-old man develops a crushing chest pain associated with nausea & profuse sweating. Each option may be used once. No wheezing is heard. 669 A 65-year-old man with no previous history is brought to the A&E by his wife who says that he has become progressively incontinent & forgetful & tends to have mood swings.fischtest.uk Theme: Drugs of choice Options A Diamorphine (iv) K Sulphasalazine B Diamorphine (IM) L Carbimazole C Salbutamol nebulised in oxygen M Carbamazepine D Nebulised Steroids O Radioiodine E Protamine Sulphate P Ipratopium bromide F Carbamazepine Q Diazepam G Donepezil R Paracetamol H Methadone S Oxygen if needed & advice on risk factors. Her pulse rate is 56-beats/min.

679 A one-year-old boy had a severe urine infection complicated by E. He has a serious of orthopaedic operations for talipes equino varus. or. Ultrasound examination of the abdomen during the acute infection was normal. not at all. Abdominal examination is normal. 681 in eight-year-old girl presents with a 12' hour H/O nausea and central abdominal pain now radiating to the right iliac fossa. A proteus urinary tract infection has been confirmed on culture. coli septicemia one month ago. Abdominal examination is normal. Answers.www. She has urinary frequency. She has a past H/O recurrent urinary tract infections & an abdominal ultrasound at the age of two was normal. A bag of urine specimen showed red & white cells & a culture of mixed organisms. He is on prophylactic antibiotics. choose the single most helpful next investigation from the above list of Options. 682 A 14-year-old girl has had a pseudomonas urinary tract infection & her BP is 140/95-mmHg persistently. more than once. Each option may be used once. . 680 A five-year-old boy has persistent H/O diurnal & nocturnal enuresis and soiling. 678 A 10-day-old girl has developed fever & jaundice & is not feeding as well as normal.fischtest. Urine is now sterile.co.uk Theme: Investigation of urinary tract infection ( UTI) Options A Abdominal x-ray B Intravenous urogram C Isotope renal scan D Laparotomy E Lumbo-sacral spine x-ray F Micturating cysto-urethrogram G Mid --stream specimen of urine H Serum creatinine I Supra pubic aspiration of urine for culture J Urinary glucose test K Urodynamics Instructions For each child described below.

684 A 34-year-old woman wants to have a sterilization . L Get partners written & informed consent before carrying out sterilization F Carry out operation to save at least one baby M Inform Health Minister. J Give her pills & then phone the mother & tell her about the pills. this means certain death for both babies.co. Your consultant is having a relationship with a widow he's been treating for depression. G Respect parents decision & let nature take it's course. What should be done? 686 A 12-year-old girl wants oral contraceptive pills. even if N Seek a judicial review Instructions For each of the scenarios described below choose the most appropriate action from the above group of options.uk Theme: Ethical Practice of Medicine in the United Kingdom Options A Report him to trust managers.www. They are married. 683 You are the SHO on the Psychiatry ward. . I Tell her you cant give her the pills without mothers' consent C Call police & inform them at once. Answers. B Don't do anything . 687 A 9-year-old girl wants to have a termination of pregnancy. She is 14 weeks pregnant. She doesn't want her mother informed about the termination. H Carry out the sterilization. Since having the operation means certain death of one the babies. and as such without an operation to save the one with the major organs they will both perish. K Tell the parents & only carry out termination. 685 A mother has Siamese twins. as situation is complicated. D Give her the pills after explaining risks to her & disregard her mother completely. with their consent E Carry out the termination even without the parents' knowledge.Her last born child I has Cerebral palsy & her partner strongly objects to the procedure. The lady is getting better & is awaiting discharge next week. The procedure to terminate is not without complications. One of the twins has no heart & liver & depends on the other for survival. She doesn't want her parents to know about this.fischtest.since the actions of your consultant don't seem to be affecting the progress of patient's condition. the parents who are staunch Christians oppose the operation.

Prior to starting the tablets he was losing weight & complaining of thirst. or not at all.his BP was 80/65-mmHg & his pulse was regular at 50/min. 690 A previously well 70-year-old man has been noticed by her daughter to be increasingly slow & forgetful over several months. confusion & drowsiness.uk Theme: Investigation of confusion Options A Thyroid function tests B Blood glucose C Mid -stream specimen D CT-scan of head E ECG F Full blood count (FBC) G Urea & electrolytes. Over the past few days she has become increasingly confused & feacally incontinent.even in hot weather. O/E she has' a left hemiplegia. 691 An 80-year-old woman presents with poor mobility & a recent H/O fails. When seen in the A&E . 689 A 79-year-old man in a nursing home has been constipated for a week. 688 A 67-year-old man has recently been started on tablets by his GP . Answers. Each option may be used once.He is brought to the A&E by his wife with sudden onset of aggressive behaviour.fischtest. .co. H Stool culture I Blood cultures J Ultrasound abdomen K Chest x-ray Instructions For each presentation below.www. more than once. choose the single most discriminating investigation from the above list of Options.-She has gained weight & tends to stay indoors with the heating on . She has deteriorated generally' over the past two weeks with fluctuating confusion. 692 A 70-year-old man with known multiple sclerosis became suddenly more confused yesterday.

www. ectopic. .uk Theme: Causes of Maternal "Mortality In The United Kingdom Options A First (commonest) B Second commonest C Third commonest D Fourth commonest E Fifth commonest F Six commonest G Seventh commonest H Eighth commonest Instructions For each of the conditions mentioned below match them with their corresponding answer .co.from the list of Options above. 697 Thromboembolism. 693 Acute fatty liver of pregnancy. 694 Hypertensive disease of pregnancy. 699 Hemorrhage. 696 Amniotic fluid embolism.. 695 Early pregnancy problems e.g.fischtest. 698 Genital tract sepsis. Answers. 700 Uterine rupture.

from the list above.uk Theme: Causes of Peri-natal mortality in the United Kingdom Options A First (commonest) B Second commonest C Third commonest D Fourth commonest E Fifth commonest Instructions For each of the conditions below. 701 Maternal conditions & toxemia 702 Unclassified hypoxia 703 Congenital abnormalities 704 Placental conditions 705 Cord problems Answers. match them with their corresponding positions.www.co.fischtest. .

. more than once or not at au.co. 706 A voidance of smoking. Answers.uk Theme: Prevention/health promotion of Fever Options A Tuberculosis B Infectious mononucleosis C Malaria D Gastroenteritis E Meningitis F Hepatitis-A G Hepatitis-B H Hepatitis-C I Cytomegalo-virus infection J Herpes simplex infection K Toxoplasmosis L Bronchial carcinoma M Staphylococcal Pneumonia N Diphtheria O Bladder carcinoma P Schistosomiasis Instructions For each strategy for prevention choose the single most LIKELY disease to be prevented from the above list of options. 707 A voidance of work in Dye factories. Each option may be used once. 708 Counseling for sexually active 23-year-old male.fischtest.www. 711 Immunization of paramedics with body fluids. 709 Prophylaxis with proguanil before travel to Asia 710 Avoidance of swimming in rivers.

.co.fischtest. below. choose the single most likely risk factor from the list of Options above. & affects women twice as much as men H Chronic headache I Bartender J Klinefelter's syndrome K Strokes L Childhood meningitis M Childhood asphyxia' N Ingestion of aniline dyes O Tainted meat P Lewy bodies Q Normal pressure hydocephalus R Work alcoholics Instructions For each of the conditions listed.www.uk Theme: Risk factors for the development of dementia Options A Postpartum haemorrhage B Phenothiazines C Decreased CD4 count D Familial inheritance E Edwards’s syndrome F Downs’s syndrome G Damage to frontal lobe. more than once or not at all. 712 Aids related dementia 713 Alzheimer’s disease 714 Multi infarct dementia' 715 Parkinson's disease 716 Huntingdon's chorea 717 Diffuse Lewy body disease 718 Hypothyroidism 719 Hypothyroidism 720 Alcoholic dementia 721 Creutzfeldt-Jakob's disease Answers. Each option may be used once.

Answers.www. He has a tinge of jaundice. Days later she C/O abdominal pain & passing bloody watery stools.uk Theme: Diagnosis of anaemia Options A Sickle cell anaemia B Sickle cell trait C Sideroblastic anaemia D Nutritional anaemia E Macrocytic anaemia F Microcytosis G Iron deficiency anaemia H Normochromic normocytic anaemia I Aplastic anaemia Instructions For each of the patients listed below. 722 A young Jamaican boy is brought to the A&E complaining of episodic chest pain associated with pallor. more than once or not at all.fischtest. choose the single most appropriate diagnosis from the list of Options above.co. Each option may be used once. 10 years ago. 725 A 24-year-old woman C/O easy fatigability. Her menses last 7 days & she uses multiple sanitary towels. He has regular meals but spends most of his time in the 'Old Vic' a. 724 An elderly man lost his wife. . She is found to be unkempt with pallor of the mucous membranes. 723 An elderly woman who stays alone is examined by the nurse. local pub is found to have mild pallor of the mucous membranes. 726 A 23-year university student travels to Thailand.

' Answers. The pain is absent on resting.co. 729 A 55-year-old man C/O intermittent pain in his toe on walking. . 730 A 46-year-old woman is brought to the A&E breathless & complaining of chest pain. He says that in addition it looks 'white'. He has a two-month H/O leg pain.uk Theme: Investigation of an Ischaemic limb Options A Ventilation perfusion (V/Q) scan B ECG C Ultrasound D Femoral duplex scan E Femoral arteriography G Venography H Ankle-Brachial index measurement I Digital Subtraction.www. 727 A 36-year-old man C/O pain at rest in his calves. angiography J Coagulation profile K None of the above Instructions For each of the patients below choose the single most definitive investigation from the list of Options above.fischtest. Each option may be used once more than once or not at all. . 728 A 34-year-old man C/O pain in the calves on walking.

Answers.fischtest. 731 A man presents with abdominal pain radiating to the back He is found to have a pulsatile mass in the abdominal pain.co. Each option may be used once more than once or not at all. . 34-year-old man C/O retrosternal pain associated with water brash. wants to know about the extension of the aneurysm to the renal artery. He is haemodynamically stable 732 A 67-year-old man is being prepared for the repair of. an aortic aneurysm. 733 This patient is due for repair of aneurysm of aorta.uk Theme: Investigation of Aortic aneurysm Options A Abdominal Ultrasound B Chest X -ray C Barium meal D Transoesophageal echocardiography E Endoscopic studies F Barium swallow G CT-scan of head H Echocardiography I Spiral CT J Lower limb angiography K Coronary angiography L Plain abdominal x-ray Instructions For each of the patients described below. 734 An obese. choose the single most appropriate investigation from the list of Options above. There is claudication in the legs. Exercise ECG reveals ischemia.www.

He is found to have a BP of 100/60-mmHg.fischtest. 737 A 23-year-old man is brought into the A&E from the local park. he presents with warm extremities & a BP of 90/60-mmHg. Answers. Each option may be used once. 735 A 64-year-old patient on the surgical ward has been operated on for a hernia.www.co. from the list of Options above. more than once or not at all. choose the single most appropriate diagnosis. . with a red swollen arm. 736 A woman had a caesarean done in the morning presented with a BP of 80/65-mmHg & pulse rate of 120-beats/min.uk Theme: Diagnosis of shock Options A Anaphylactic shock B Neurogenic shock C Septic shock D Hypovolumic shock E Disseminated intravascular coagulation Instructions For each of the patients below.

has become progressively forgetful. was diagnosed 5-7 years ago with dementia.fischtest. Answers. .www. 738 A 57-year-old woman. 741 A 76-year-old woman is normal at her home.co. more than once or not at all. He is put on dopaminergic drugs by his OP but shows no response. all the episodes lasting about 12 hours. She C/O slight blurring of vision. whose son mentioned that he was becoming progressively for getting the names of things & chores. now dies 739 An elderly woman has a H/O episodic weakness of her right. arm. 740 A 45-year-old man presents with difficulty in initiating movement & general slowness in doing anything. but falls downs at her son's home.uk Theme: Prognosis of Dementia Options A Alzheimer's disease B Cardiovascular accident C Lewy body dementia D Cataract E Parkinsonism F Huntingdon's chorea G H Pick's disease I Creutzfeld Jakob's disease Instructions For each of the patients described below choose the single most appropriate diagnosis from the list of Options above. is brought by her daughter who says the former. She cannot remember what time of the day she was born. Each option may be used once.

co. 744.A seen at the moment of injury. Superficial bums of the right hand.uk Theme: The Treatment of Burns Options A Admit B Irrigation with cold water C Application of vaseline D Tetanus toxoid. E Antibiotics F Escharotomy G Constructive observation combined with debridement. They are painful. 743. Answers.fischtest. Bums on the anterior chest. H Don’t admit Instructions For each of the scenarios described below. or not at all. A baby with bums.S. Each option may be used once. less than 9% of the B. 742. 745. choose the most appropriate action from the list of Options above.www.A. Full thickness bums on the genital area. over the chest & back about 7% B. . more than once.S.

choose the single most appropriate diagnosis from the list of Options above. 747 An obese 45-year-old man C/O recurring chest pain. 746 An obese 34-year-old man C/O epigastric pain.co. more than once or not at all. It coincides with his weekly executive board meetings. 748 An obese 29-year-old woman C/O with a cough of two weeks C/O right upper quadrant pain. O/E there was no abdominal tenderness Answers. which seems to exacerbated by eating his favorite meal. which radiates to his neck lasting 20 minutes.fischtest.www. Each option may be used once. He get temporary relief when hungry. fish & chips. She is mildly febrile. .uk Theme: Differential diagnosis of angina Options A Unstable angina B Stable angina C Syndrome X D Myocardial infarction E Pericarditis F Peptic ulcer disease G Arrhythmia H Spontaneous pneumothorax I Acute cholecystitis J Chronic cholecystitis K Pneumonia Instructions For each of the patients below.

palpitations & headache. 753 A 34-year-old woman presents with intermittent flushing. His BP is found to be 145/l00mmHg. 752 A 34-year-old man presents with haematuria. 749 An obese 34-year-old woman presents with excessive facial hair.fischtest. He is otherwise well. more than once or not at all. His father died from chronic renal failure. a BP of 150/95-mmHg & abdominal striae. He is found to have femoral delay. .www. G Coarctation of the aorta Instructions For each of the patients below.uk Theme: Diagnosis of Hypertension Options A Cushing’s syndrome B Conn's syndrome C Pheochrornocytoma D Essential hypertension E Renal artery stenosis F Polycystic kidney disease. Answers. 754 A 45 year known hypertensive is found to have a bruit in the abdomen.co. Each option may be used once. choose the most likely diagnosis from the list of Options above. 751 An elderly man has three readings of BP of 160/100-mmHg. His BP is 145/90mmHg. 750 A 23-year-old man presents with a chronic headache.

Each option may be used once. Her pregnancy test is positive.uk Theme: Diagnosis of Pelvic inflammatory disease Options A Endometriosis B Acute Chlamydial infection C Ectopic pregnancy D Gonococcal infection E Acute on chronic pelvic inflammatory pelvic disease F Chronic pelvic inflammatory disease G Abruptio placenta H Septic miscarriage Instructions For each of the patients below. 756 A 25-year-old woman who had an Intra-uterine-contraceptive device fitted 2 years ago presents with heavy per l bleeding. choose the single most appropriate diagnosis from the list of Options above. She now presents with acute abdominal pain.www. .fischtest. Her periods are regular & her two previous cervical smears were normal. Her BP is 90/60mmHg. 755 A 24-year-old university student had a con finned Chlamydial infection 2 years ago.co. 757 A 24-year-old woman C/O deep dyspareunia. Answers. more than once or not at all.

fischtest. Answers. choose the single most appropriate diagnosis from the list of Options above. 759 An elderly woman reports a H/O loss of consciousness on five occasions.uk Theme: Investigation of loss of consciousness Options A Electroencephalography B Ambulatory ECG C Exercise ECG D Carotid arteriography E CT F Echocardiography G Do nothing Instructions For each of the patients described below.www.co. Each option may be used once. 761 A 12-year-old girl has a H/O falling with jerky movements of the body on several occasions. 758 A 12-year-old girl loses consciousness after a period of prolonged standing: She becomes pale but regains consciousness within a few seconds. more than once or not at all. Each time she regains consciousness after a few minutes. 760 A 34-year-old man has a H/O falling with jerky movements of the hands and the feet associated with urinary incontinence. . She bites her tongue during the falls.

www. Abdominal ultra sound showed a dilated calyx. J Percutnaeous drainage Instructions For each of the patients described below.uk Theme: Management of Septicemia Options' A Intravenous catecholamines B Intravenous dopamine C Intravenous corticosteroid D Intravenous dobutamine E Oxygen by mask F Oral cefuroxamine G Stenting H Laparotomy & removal of dead tissue. She scratches herself excessively and develops a blue discoloration on the abdomen. more than once or not at all.co. She has a H/O not passing urine in the last 24 hours.fischtest. has a H/O recurrent Urinary tract infections. Answers. 762 A 28-year-old woman after cholecystectomy following a perforated gall bladder has a raised right diaphragm with a temperature of 38C & a pulse of 120 beats per minute. She continues to scratch herself & the discoloration increases in size. . 763 A febrile 39-year-old woman with hypertension. Each option may be used once. choose the most appropriate management from the list of Options above. 764 A 32-year-old woman has chickenpox. I Wide excision of soft tissues.

weakness & polyuria . Answers.co. blurring of vision in his right eye. I 769 A 55-year-old woman treated for breast cancer with chemotherapy and radiotherapy presented with a H/O confusion. Each option may be used once.On examination no neurological deficits were found. He then suffers a drop attack. 767 A 32-year-old known hypertensive presents to you with a right hemiparesis. which resolves with no neurological deficits. tiredness. 766 A 33-year-old man reports a H/O walking while swinging to one side. 765 An elderly man wakes up in the morning with numbness of his right hand. more than once or not at all.uk Theme: Diagnosis of Neurological abnormalities Options A Vertebro-basilar infarction B Cerebral infarct C Subarachnoid haemorrhage D Cerebral haemorrhage E Hypoglycemia F Cerebello-pontine haemorrhage G Hypercalcaemia H Multiple sclerosis I Polymyalgia rheumatica Instructions For each of the patients described below choose the single most likely cause of their symptoms & signs from the list of Options above. 768 A 34-year-old woman has a 6-month H/O on & off hemiparesis.fischtest. .www.

more than once or not at all.He denied they were blood stained & barium studies show a filling defect in the ascending colon. Barium enema reveals an ulcerated stricture of the sigmoid colon. MCV 67 fl. Investigation shows granular inflammation in the distal 12 cm of the sigmoid colon.co.uk Theme: Diagnosis of Lower Gastrointestinal Bleeding Options A Ulcerative colitis B Amoebic dysentery C Crohn's disease D Carcinoma of the rectum E Carcinoma of the sigmoid F Diverticular disease G Diverticulosis H Ulcerative pancolitis I Trauma J Tuberculous enteritis K HIV enteropathy Instructions For each of the patients described below. choose the single most likely cause of lower GIT bleeding from the list of Options above.fischtest. 773 A 45-year-old man presents with abdominal pain frequent stools (about 5 episodes a day) . Colonoscopy revealed ulcers in the transverse colon. bleeding per rectum.www. 770 A young man presents with abdominal pain. His Hb was 8g/dl. . Each option may be used once. 771 A young man presents with per rectal bleeding. Answers. 772 A young woman with per rectal bleeding is found to have ulcers in the anal area & vulva. The proximal area is normal.

776 A 25-year-old man presents to the A&E with pain in the right eye associated with backache. 778 An elderly man who is an in-patient (for hypertension) wakes in the morning notes that he can't see his breakfast He has no other' complaints.fischtest.co. 775 A 55-year-old known diabetic & hypertensive wakes up in the morning with diminished vision. 774 A 35-year-old man presents with pain in the right eye. more than once or not at all. choose the single most likely cause of visual loss from the list of Options above. Answers. Each option may be used once. 777 An elderly woman presents with a H/O visual loss & Scalp soreness. . vomiting & loss of vision. He has a carotid bruit.uk Theme: Diagnosis of Visual loss Options A Acute glaucoma B Central retinal vein occlusion I C Central retinal artery occlusion D Cranial arteritis E Uveitis F Occipital lobal infarct G Direct trauma H Retrobulbar neuritis I Retinal detachment Instructions For each of the patients described below.www.

780 A 60-year-old woman presents with pain in her right hip. She also C/O stiffness in the hands & feet.uk Theme: Investigation of Chronic Joint pain Options A Joint aspiration & culture B X-ray of the joint C Aspirate for monourate crystals D ESR E Rheumatoid factor F Weakly positive birefringent crystals G Urinalysis H CT-scan I Fine needle aspiration cytology Instructions For each of the patients described below. more than once or not at all. most marked at rest & at the end of the day associated with mild stiffness & joint instability. swollen & hot right wrist He has a fever & general malaise. - . 779 A 53-year-old woman presents with on & off left knee pain.fischtest. 781 A 73-year-old fit farmer presents with a painful. Each option may be used once. choose the single most appropriateinvestigation from the list of Options above.www.co. especially in the morning. O/E it is found to be swollen. 782 an elderly woman started on diuretics 3-week ago now presents with a swollen metetarsophalangeal joint. Answers.

choose the single most. 785 A 54-year-old man presented with varicose veins which developed lowing a compound fracture of the left lower limb a couple of weeks ago & have persisted. appropriate answer from the list of Options above.uk Theme: Management of Varicose veins Option A Graduated compression stockings B Crepe bandage C X-ray D Skin graft D Doppler Ultrasound E Elevation of the leg F Sclerosant G Lose weight Instructions For each of the patients described below. No treatment has been attempted.fischtest. Answers.co. . Her BMI is 30 & she is found to have Lipodermosclerosis around her shins. more than once or not at all. He comes to you for advice. His father died of embolism. 784 An obese woman has bilateral leg varicose veins. Each option may be used once. He is scared of surgical operations. 783 A middle-aged man with bilateral leg varicose veins is to fly to New York for a business meeting.www. 786 A 45-year-old woman with a BMI of 33 presents with bilateral varicose veins.

Examination reveals a mild splenomegaly.fischtest.www. Mature lymphoblasts are seen on the blood film. 787 A 34-year-old woman with increased granulocyte series & a raised platelet count. 790 A 38-year-old woman presents with cervical lymphadenopathy. Each option may be used once. Blood film shows a marked Lymphocytosis.co.uk Theme: Complications Of Blood Dyscrasia Options A Generalized Lymphadenopathy B Meningitis C Massive Splenomegaly D Purpura E Bone pain F Gum hyperplasia G Thrormbophilia Instructions For each of the patients described below. . choose the single most likely complication from the list above. 789 A 3-year-old boy presents with neck stiffness. He is on Phenytoin for epilepsy Answers. more than once or not at all. photophobia & headache. 788 A young boy with cervical lymphadenopathy & a raised white cell blood cell count.

choose the single most likely diagnosis from the list of Options above. worsened by stress.co. more than once or not at all. 793 An Elderly man on chemotherapy for Colonic cancer develops pain in the right ear.uk Theme: Diagnosis of Earache Options A Otitis Media B Otitis externa C Herpes Zoster D Temporal mandibular joint disease E Acoustic neuroma F Perforation of the Eardrum G Mumps H Glue ear I Mastoiditis J Dental caries Instruction For each of the patients described below. He later develops weakness on the right side of the body.www. . On opening her mouth 'noises' are heard. there is a swelling extending from the ear to the angle of the jaw. Her husband says she tends to grind her teeth at night. 792 A 12-year-old boy presents with earache. Each option may be used once. O/E. 795 A 15-year-old boy with a H/O right earache now presents with a right ear discharge. 794 A 56-year-old woman C/O earache. 791 A 23-year-old avid swimmer develops an ear discharge and inflammation on the pinna. the right ear is found to have vesicles.fischtest. The pain has abated. Answers. O/E.

Blood sugar is 27 mmol/l. Answers.fischtest. She is found to have a 'moon' face. deep sighing respiration. more than once or not at all. Each option may be used once. 799 An obese woman presents with polyuria & polydipsia. truncal obesity & is easily bruised. polydipsia. She has chronic pancreatitis. . 797 A 29-year-old woman presents with polyuria & polydipsia. 796 A known diabetic presents with dehydration. Blood sugar is 15 mmol/l 798 A 40-year-old woman presents with dehydration.www. sweet smelling breath & altered consciousness. but is otherwise well.uk Theme: Investigation of Diabetes Options A Random blood sugar B Glucose tolerance test C Urea & Electrolytes D 24-hour urinary free cortisol E Dexamethasone suppression test F Serum Amylase G Synacthen test H Ultrasound of the abdomen I X -ray abdomen J Abdominal CT-scan Instructions For each of the patients described below. choose the most appropriate test from the list of Options above. Blood glucose is 7 mmol/l.co. She has a H/O polyuria.

800 A fanner who keeps pigeons develops breathlessness. which progressively worsens & later resolves on its own. 801 A Coal miner develops. Answers. now presents with a productive cough associated with occasional haemoptysis. more than once or not at all.uk Theme: Diagnosis Of Breathlessness Options A Fibrosing alveolitis B Occupational Lung disease C Extrinsic allergic alveolitis D Allergic Bronchopulmonary aspergillosis E Asthma' F Pneumonia G Bronchiectasis H Pulmonary tuberculosis Instructions For each of the patients described below. Each option may be used once. 803 A 7-year-old boy had measles 2 years ago. He is getting worse despite treatment & the parents are getting concerned.fischtest. chose the single most likely diagnosis from the list of Options above. Spirometry shows a restrictive pattern.co. progressive breathlessness. .www. 802 A young boy is diagnosed with asthma & is started on inhaled bronchodilators. Serum IgE is raised.

brought on by exercise & relieved by rest. . Answers. 806 A 67-year-old woman presents with a 2-hour H/O chest pain radiating to the left shoulder. more than once or not at all. He is sweating & feels sick. 807 A tall young man presents with a H/O sudden chest pain radiating to the back & interscapular area. 804 A 30-year-old obese man complains--of retrosternal chest pain. 805 A 34-year-old man presents with a H/O chest pain radiating to the jaw. choose the single most likely diagnosis from the list of Options above.uk Theme: Diagnosis of Chest Pain Options' A Chest x-ray B Exercise ECG C Echocardiography D Gastroscopy E Oesophagoscopy F CT-scan G ECG H Pulmonary -angiography I Cardiac catheterization J Indirect Laryngoscopy Instructions For each of the patients described below.co. Each option may be used once. worse at night & after meals.fischtest.www.

810 A Boy with a vesicular rash & fever goes to his GP. from the list of Options above.www. His sister has just been discharged following a renal transplant. more than once or not at all.fischtest.uk Theme: Management of a Rash. The young woman is otherwise well. Each option may be used once. . 808 A distressed mother rings you.co. Options A Isolation / Quarantine B Reassure C Acyclovir D Hydrocortisone cream E PUVA F A half-day course of Rifampicin G Immunize against measles H Check anti cardiolipin antibodies Instructions For each of the patients described below. Answers. choose the single most appropriate option. which disappears. She's found out that one of the children at her daughter’s school has meningitis: 809 A pregnant woman gets a transient rash.

813 A man involved in a mining accident presents with oliguria & passing dark brown urine. pulse rate of 120-beats/min & BP-70/50-mmHg. He is otherwise well. . Each option may be used once more than once or not at an. Answers.fischtest.www. a 67-year-old man is unable to pass urine.uk Theme: Trauma & Oliguria Options A Percutnaeous nephrostomy B Suprapubic cystostomy C Urethral catheterization D Blood transfusion E Fluid challenge F 500-ml of IV mannitol G Walk around Instructions For each of the patients below. 811 Following an elective herniorrhaphy. when a nurse hands him a small bottle for microscopic studies. choose the most appropriate option from the list of Options above. 812 A 34-year-old woman presents with right-sided loin pain & oliguria. O/E he has abdominal tenderness & fullness & blood on the urethral meatus. 815 A 23-year-old man who sustained a pelvic fracture is unable to pass urine.co. An intravenous urogram shows right-sided dilated calyces and hydroureter. 814 A 45-year-old man sustained a pelvic fracture & now presents with oliguria.

from the list of Options above. 817 A 25-year-old pregnant sickler wants to know whether her baby will have the haemoglobinopathy.co.www. more than once or not at all. 819 A 33-year-old rhesus negative woman had isoimmunization in her last pregnancy. She wants to know weather her child actually has the syndrome. Answers. She has a 75% a chance of getting a baby with Down’s syndrome. but with no physical abnormality. . A biophysical profile shows an edematous fetus.uk Theme: Prenatal diagnosis Options A Cordocentesis B Rhesus status C Kleihauer test D Chorionic villus sampling E Abdominal ultrasound F Biophysical profile G Amniocentesis Instructions For each of the patients described below. choose the single most appropriate option. 818 A 30-week pregnant woman had an episode of Antepartum haemorrhage during the current pregnancy. 816 A 23-year-old primigravida at 13th weeks is told after screening. A detailed ultrasound shows a grossly retarded fetus. Each option may be used once.fischtest.

Her baby is in occipito-posterior position. pain free. 821 A 39-year gravida 3 para 2 + 0. Each option may be used once. Answers.co. more than once or not at all.31-year-old woman has a retained placenta.uk Theme: Management of Pain in Labour Options A Spinal anesthesia B Epidural anesthesia C Pudendal nerve block D General anesthesia E Pethidine injection F Nitrous oxide G Local anesthesia Instructions For each of the patients described below. . 820 A 20-year-old primigravida at 40 th-weeks is 6-cm dilated & she requests pain relief She dislikes injections.fischtest. 824 A. following a spontaneous delivery. from the list of Options above.www. l . presents at 39 th weeks . She stills C/O pain. 823 A Gravida 4 para 2 + 1 has been in labour for 4 hours. She is 3-cm dilated & has already received 2 injections of Pethidine. 822 A 28-year-old woman wants to be able to move around during labour. choose the most appropriate option.Her cervix is 8-cm dilated but she C/O severe pain.

co. She now presents with fever (38 oC) & a foul smelling l discharge & a BP of 100/65-mmHg. . 829 A 33-year woman with a H/O pelvic inflammatory disease now presents with lower abdominal pain & fever (38oC). 828 A 32-year-old woman with an Intra-uterine device C/O right iliac fossa pain. most appropriate answer from the list of Options above.fischtest. 825 A 24-year-old woman is in her periods. more than once or not at all.www. Each option may be used once. Answers. 827 A 34-year-old woman with a H/O pelvic inflammatory disease now presents with deep dyspaerunia & pain in the lower abdomen. amenorrhoea for the 6 weeks.uk Theme: Pelvic Inflammatory disease Options A Acute PID B Acute on chronic PID C Gonorrhea D Bacterial Vaginosis E Lymphogranuloma venerum F Ectopic pregnancy G Threatened miscarriage H Toxic shock syndrome I Syphilis J Chronic PID Instructions Each of the patients described below choose the single. 826 A 24-year woman presents with a foul smelling l discharge.

832 Found commonly in the sputum of patients with asthma. Each option may be used once.uk Theme: The disease process of Asthma Options A 5% reversibility in FEV I B 10% reversibility in FEV I C 15% reversibility in FEV I D Alpha-receptors E Beta 2 receptors F Eosinophils. choose the single most likely connecting statement from the above list of options. G Forced vital capacity N Mast cells H Histamine I IgA J IgE K IgG L IgM M Leukotrienes Q Neutrophils P Peak expiratory flow rate (PEFR) Q Positive pollen test R Raised eosinophil count S T cells T Vital capacity Instructions For each of the statements below. 833 Blocking of these can cause worsening of asthma. 831 The substance is released by mast cell activation & causes bronchospasm. .co.www. more than once or not at all. 830 A criterion for the diagnosis of asthma. Answers.fischtest.

uk Theme: Diagnosis of Hip pain Options A Fracture neck of femur B Perthe’s disease C Slipped femoral epiphysis D Osteoarthritis E Septic arthritis F Congenital dislocation of the hip G Transient synovitis H Osteogenesis imperfecta Instructions For each of the patients described below. 837 A child presents with right hip pain. choose the single most likely diagnosis from the list of Options above. O/E it's difficult to abduct the thighs. O/E the hip is flexed abducted & externally rotated. 836 A 10-year-old girl is febrile. 834 A 7-year boy presents with a H/O acute onset of pain in the knee. abducted. O/E the left lower limb is flexed. Answers.www. 835 A 67-year-old woman C/O right hip pain. Each option may be used once.co. O/E the right hip is adducted.fischtest. more than once or not at all. externally rotated & flexed. . internally rotated.

choose the single most likely diagnosis from the list of Options above. Answers. 839 A 40-year-old man with a H/O high BP presents with central chest pain radiating to the interscapular area. he has white granular lesions on the buccal mucosa. more than once or not at all. .www. 840 A young man C/O central chest pain.co. 841 A 20-year-old man with a H/O drug abuse presents with sudden onset central chest pain associated with passage of maelena stool. which is red. O/E of his mouth. Each option may be used once. 842 A 60-year-old woman with a H/O calf pain following an anterior resection of the rectum presents with sudden onset central chest pain.fischtest.uk Theme: Diagnosis of Central Chest pain Options A Myocardial infarction B Esophageal candidiasis C CMV Oesophagitis D Reflux Oesophagitis E Tietze's syndrome F Acute cholecystitis G Peptic ulcer disease H Constrictive pericarditis I Pulmonary embolism J Angina pectoris K Dissecting aortic aneurysm Instructions For each of the patients described below. 838 A thin 60-year-old man presents with a 2 hour H/O a crushing central chest pain.

He has had previous. 849 A 45-year-old man presents with dyspnoea and-chest pain. 844 A 55-year-old man C/O chest pain.His pulse is irregularly irregular 845 A 55-year-old man presents with dyspnoea & chest pain. . if done in synchrony with the QRS complex.www.uk Theme: Treatment of Arrhythmias Options A Fleicanide B Amiodarone C Chloroquine D Digoxin E Temporary pacing F Permanent pacing G DC cardioversion H Lignocaine I Reassurance J Nifedipine K Glyceryl trinitrate L Warfarin M 5 ml of a 1: 1000 solution of Adrenaline N Atropine Instructions For each of the options below choose the single most appropriate intervention from the list of Options above.fischtest. more than once or not at all. Each option may be used once. 1 847 A 69-year-old man is C/O chest pain. 846 A 68-year-old man found to have a pulse rate of 60-beats/min & C/O chest pain & breathlessness. His BP is 145/92-mmHg . Drug treatment is no help. He is found to have a broad complex tachycardia on ECG. 848 Useful for the conversion a Supraventricular tachycardia to sinus rhythm. which begins with a 'slurred' upstroke (delta wave) Answers. The ECG shows a short PR interval & wide QRS.co. I episodes of severe bradycardia. and" Supraventricular tachycardia alternating with asystole. 843 A 20-year-old officer worker gets palpitations whenever he walks a flight of several stairs to work. cardiac arrest.

Answers. Otoscopy shows waxy material in the canal.fischtest. . The left eardrum looks gray. Otoscopy reveals a right perforated eardrum with a purulent discharge. Examination reveals a bulging hyperaemic right eardrum.uk Theme: Treatment of Ear Infections Options A Chloramphenicol eardrops B Amoxycillin C Amoxycillin & Clavulanic acid D Penicillin E Cefuroxime F Ear wash out G Syringing H Removal with forceps Instructions For each of the patients described below. 852 A 14-year girl C/O diminished hearing in the right ear.co. Each option may be used once. 851 A 7-year-old girl C/O right earache.www. 854 A 24-year-old woman has a purulent lesion in her right canal. more than once or not at all. 850 A 13-year-old boy complains or a headache. She has a fever & doesn't C/O hearing loss. choose the single most appropriate answer from the list of Options above. 853 A 4-year-old boy with a fever is found to have a bead in his left ear.

frequency & vomiting. more than once or not all.uk Theme: Treatment of UTI in children Options A Trimethoprim 1-2 mg/kg/single dose B Trimethoprim 3 mg/kg/BD C Amoxycillin D Amoxycillin 500 mg/8-hr E Gentamycin 10 mg/kg/day F Nitrafurantoin 12 mg/kg/day G Ciprofloxacillin 500 mg stat H Metronidazole 500 mg/kg/day I Co-amoxiclav 20-45 mg/kg/day J Nalidixic acid 50 mg/kg/day Instructions For each of the patients listed below.co. Answers. Abdominal ultrasound shows no abnormalities. choose the single most appropriate treatment from the list of Options above.dysuria shown to have vesico-ureteric reflux.www. .coli infections are now unresponsive to this. 856 A 6-year-old girl presents with a fever. 857 A 5-year-old boy presents with dysuria. Each option may be used once. frequency dysuria & abdominal pain. fever. 858 Almost 50% of all E. He is treated for the acute infection & you want him to stay healthy until surgical intervention. 855 A 2-year-old boy is with frequency & .fischtest.

Each option may be used once.fischtest. What is the possible etiological agent? 861 A 24-year-old took an overdose of pills & now C/O right upper quadrant pain.co. He is found to be hypoglycemic. . 860 Patient presents within urinary retention.uk Theme: Poisoning Options A Aspirin B Atropine C Paracetamol D Iron E Morphine F Warfarin G Carbon monoxide H Oxygen I Quinine' J Corticosteroid Instructions For each of the scenarios below. choose the most appropriate intervention/etiology. 859 Desferoxamine is used in poisoning. Answers.www. more than once or not at all. dry mouth & sedation.

co. more than once or not at all.fischtest. l discharge. There is 864 A 5-year-old girl who is in foster care is noted to have a foul smelling discharge. l 865 A 12-year-old girl who under went a renal transplant 4 months ago presents with a white curdly l discharge.uk Theme: Diagnosis of l discharge in Children Options A Foreign body B Candidiasis C Physiological D Bacterial Vaginosis E Trichomonas lis F Sexual abuse G Urinary tract infection H Gonorrhea I Threadworm infection K Juvenile Cervical carcinoma Instructions For each of the patients below. 863 A 6-year-old girl is brought with a fouling smelling no H/O sexual abuse. Answers. . 862 A sexually active 13-year-old girl presents with a mild non-fouling smelling l discharge.www. Each option may be used once. She is under-weight. choose the single most likely diagnosis from the list of Options above.

Answers. Each option may be used once. 866 A. There is no H/O infectious disease or trauma. 868 A 67-year-old man presents with increased forgetfulness.uk Theme: Management of Dementia Options A Benzhexol B levodopa C Dopamine D Mannitol E Dexamethasone F 50-ml of 50% glucose G Immunoglobuin H Donezepil I Try shunting J Multi-vitamins Instructions For each of the patients described below. .co.www. more than once or not at all.fischtest. 867 A 43-year-old woman presents with memory loss. He has become increasingly forgetful & emotionally labile. choose the single most appropriate treatment from the list of Options above. Investigations reveal normal CSF pressure & constituents with enlarged cerebral ventricles & no cortical atrophy. She has drooling & a mask-like face. poor concentration & inability to recognize household objects. 869 A 67-year-old man has been a bartender for 30 years.59 year old man with no previous history brought by his wife who says he has become progressively more forgetful tends to lose his temper and emotionally labile. urinary incontinence.

THEME: Pain Relief In Children OPTIONS A Paracetamol B Sweets & feed C Carbamizipine D Transcutaneous electrical nerve stimulation (TENS) E IV Opiates F 1M Opiates G Non steroidal anti-inflammatory drugs Theme: investigation of miscarriage Theme: investigation of testicular swelling Theme: differential diagnosis of hip pain Options A Perthe’s disease B Chrondosarcoma C Osteosarcoma D Osteoarthritis E Fracture neck of femur F Slipped femoral epiphysis Theme: Investigation Of Hoarseness A No investigation B CT neck C Sputum for Acid Fast bacilli D Cervical spine X-ray E Laryngoscopy F Bronchoscopy G Throat swab Theme. THEME: MECHANISM OF POISONING OPTIONS A Paracetamol B Barbiturates C Ferrous sulphate D Warfarin E Methanol F Ethanol G Carbon monoxide H Tricyclic antidepressant I Amphotericin J Morphine Theme: Differential Diagnosis Of Palpitations options A Ventricular tachycardia B Ventricular fibrillation C Atrial fibrillation D Ventricular ectopic E Complete heart block F Wolf Parkinson white syndrome Theme: Investigation Of Urethral Disease options A Syphilis serology B Urine culture C Urine cytology D Urine cytology E High l swab F Chlamydial swab Theme: diagnosis of dysphagia Options A Carcinoma of the oesophagus B Achalasia cardia C Pharyngeal pouch D Benign stricture E Esophageal spasm F Thoracic aortic aneurysm G Esophageal web H Oesophagitis Theme: Management of suicide Options.. builds a tower of cubes.fischtest. Theme: differential diagnoses of .uk INCOMPLETE QUESTIONS Theme: Management of earache Theme: Milestones in Development Options A I week B 6 weeks C 6 months D 9 months E I year F 2 years G 4 years H 5 years Read about motor & Behavioural milestones.CT abdomen F Serum amylase G Coeliac angiography H Sigmoidoscopy I Water soluble Barium enema Answers.www. transfers objects between hands. etc call peter on 020 7 281 for notes or read any standard pediatrics text book.co. starts walking. When baby smiles.. Epigastric pain Altered bowel habit Haematuria l discharge in children . eg . A Antidepressant B Cognitive therapy C Coagulation profile D Dentention under mental health act E Antipsychotic F Anxio/ytics G Admit & observe H Intensive psychiatric care.. sits. Management of multiple fracture Theme: Investigation of Post-op Complications Options A Chest x-ray B Abdominal ultrasound C Echocardiography D ECG E.

G 90.H 23.fischtest. 38.C 134.C 7.G 111.E 68.A 98.I 94.G 11.A 87.H 19.A 55.H 106.A 33.I 119.I 122.N 10.A 72.I 144.' Answers.C 45.G 81.F / 145.E 78.F 129_D 121.G 3.C 116.H 131.F 129.N 95.A 60.G 41.co.E 103.G 2.E 46.G 105.L 110.E 84.D 127.A 85.C 17.A 76.D 48.M 9.A 56.G 77.C 139.B 14.J 44.H 65.D 114.F 79.M 35.C 24.E 26.C 59.I 22.A 70.I 34.G 42.D 67.D 143.F 58.B 74.D 43.I 62.D 73.E 146.I 137.E 51.H 37.C 6.J 18.F 104.B 117.M 100.C 5.D lO9.I/ 86.E 115.D 30.C 25.F .J 130.G 128.B 101.F 61.D 50.B 133.A 69.C 54.D 2l.J 4.H 148.B 124-.A 80.C 64.I 99.B 28.D 29.B 27.J 83.K 107.H 75.A 118.I 66.M 91.L 16.G 132.E 138.J A 136.E 82.H 126.B 88.K 123.G 8._ 47.A 49.A 40.A 53.A 135.G 52.K 140141.www.D 36.C lO8.C 71.F 147.M 102.A 15.M 20.C 39.G 32.A 13.A 125.E 89.K 93.E 92.A 63.G 97.D 96.D 113._ 57.A 142.D 31.uk As given at the end of the book but not complete so another list from u&f is also there at the end 1.E 112.D 12.

C 258.L 270.M 177.C 152.A/ 164.F 272.D 244.www.J ` 241.B 243.A 185. 242.B 251.uk l49.J 239.H 246.C l72.G 249 A 250.D 253.E 216.D 225.C 252.A .A l75.C 162.H 1 97.A 228.E/ 195.H 169 .fischtest.D l76.H 153.J 219.D 233.H 190.H 220.B 208. l81.E 179{F l80.D 231.E 266.A 158.G 264.D 202.E 168.J 271.F.co.K 189.J 256.C 194.A 178.A 261.C 212.B l51.K 187.D 217.C 248.C 156.C 25 . 211.B 255.I l7l.H 269.D 268.G 199.G 262.G 237.E l82.D 183.F 267.H 209.I 170.B l74.I 167.E 221.K l50.G 230.E 204.G 240.B 201.A 260.H 205..I 263.A 234.F 186.C 247.A 206.I 245.C 161.F 2l0-.F 254.C 265.I 200.B 222.G 163.B .B 193.C 229.E l65.F 155.I 227.F 232.C 223.K 166.N 236.D 238.I Answers.J 198.D 259.B 226.H 154.K 191.G 188. 159.J 192.G 215.F 207.F 235.C 218.F 213.B 184.K 157.H 214.» 203.F 196.A l73.C 160.L 224.

C 108. A 142. H 154. I 94.uk List From U&F 1. H 205. D 231. C 172. B 226. P. I 167. B 222. G 240. A 282. I 22. H 383. G 90. F 155.C 229.. F 129. 10.J 271. K 371. D 357. D 31.< J( 355. r fie). H 345. D 21. H 1nO. C 212. F 211.8 184. N 236.8 201. F 335. M 315. F 186. E 138.K 191. A 40. H 63. K 349. L 378. F 149.8 124. F 329.C 134. I 170. E 76.0 277. H 220.E 179. A 13. F 272. . A 178.co. C 139. E 115. C 39. F 314. C 156. B 8. B 88.1 348. K 150. A 74.9_. E 50. H 291. A 173. E 307.J 322. F 47. A 175. H 23. E 82. A 261. G 51. I 263. G 132. 8 72.8 174. A 14. D 36. H 19. E 221. K 320.fischtest.. G 81. D 176. C 252. C 257. A 58. G 352. " 181. G 97. F 207. G 313. E 6. D 325. ole. E 338. B 341. C 350. D 96. C 265. J 18. F 375.8 117. I 119. E 168. E 195.B 85. K 11J9. D 109.11111. E 103.J 192. D 183.J 130. J 198. E 77.1. G 326. H 312. M 9.J 239. D 127. .0 225. G 308. C 116. E . P 360. K 157. E 112.L 110.177. A 374. E 278. F 302.J 298. D 336. I 284. A 185. D 318. H 342. B 78. A 164. J<A 354. S'A 84. I 99. N. F 232.S. I 227. C 223.1[. A 135. 305. H 209. I 328. G 42. B 141. A 87. K 296. F 180. D 244. II . L 353. F 3. C 7._ 300. C 162. L 270.L 356. G 215. D 217. B 366. B 46. A 158.6. C 218. G 334. F 38. A 54. A 118. K 83. D 233.J 256. I 171. J 373.. I 144. A 228. D 259. D 113.J 219. H 197. C 290. G 111. oj 3. D 202. G 262.8 160.E 165. A 67. G 264. E 301. B 297. G 41. D 253. H 169. A 260. Q 369. A 52. D 337. A 234. F 196.1 2B\). I 86. D 65.H 317.G 128. M 100.B' F 133. I 60. I 122. C 382. I 137. A 49. E 204. C 45. A 273. G 62. F 79. F 275. C 152. A 381. A 61. B 377. D 238. E 146.J 136. I 200. C 362.www. G 11. J . G 249. G 75. M 20. H 292. J 4. N 351. C 161. E276. F Answer should read Abdominal paracentensis NOT Amniocentesis 47. J 343. M 102. F 145. 1 55. C 258.274. M 303. J 310. C 89. jIti I" IK. L 370. I 34. D 71. 93.}if I. H 153. H 246. D 43. B 361. E 324. F 213. H 327. H 214. K 166.. C 53. C 25. A 288. C 57. H 131./ 92. B 319. B 251. A 98. D 143. A 33. L 286.8 159. F 2. D 344. K 107. E 182. H 283. A 80. G 254. M 365. A 358.0 121. L 299. F 295. K 123. C 248.8 151. H 126. A 70. .. E 216. F 332. A 68. G 230. N 95. M 35. . J 44. B 27. F ' \ 339. D 300.K 309. E 281. H 73. D 242. B 340. D 29. B 28. K 140. C 6.8 208. L 16. H 148. C 5. J 367. C 17. F _04. H 360. A 287. G 294. E 293. E 59. C 247. A 306. D 30. K 187. F 2. F 267.8 101. A 15. G 16. D 48. 0 91. A 250. B 285.C 333. L 224. F 120. E 203. E 330. G 199.G 237. H 346. G 105. G 188.8 193.8 255. C 24. H 106. G 316. C 311. F 210.1 321. K 331.E 266.0 2!i1l. C 69.J 241.8 243. L 364. A 363. C 194. G 32. 12. G 372.1 245. F 359. I _4. C 376. H 37. D 114. A 347.0 279. 0 379. H 323. A 206.8 280.A 125. E 26.

G 423. D 398. I 429. B 427. D 400.co. E' 432. K 387. D 392.fischtest. A 404. I 449.D 410. G 405. K'3"" 388. C 412. E 4411. B 411.K 408. C 395. E 420.J 445. A 385. E 439. J 436. F 426.J 406. H 424. E 434. H 441.J 418. F 447.www. D 421. G 393.C 443. H 403. I 425. A 438. B 413. D 422. F 442. J 391. J 440.J 419. E 386. K 444. F 437.J 409. G 416. D 417. A 420. A 394.J 389.uk 384. D 435.A 402. M 399.0 390. E 415. B 446. K . F 397. C 430.1 401. E 431. C 414. H 407. K 433. C 396.

8 767.J 647. M 509. M 566. F. D 643. K 612. Jl E 699.8 490. A 525. E 472.8 561. D 822. J 529. A -746. N 556.C 710. D 568.8 459.8 640. E 702.C 838. F 557. A 464. . F 753. A 738. C 516. B 583. H 846.1 734. A 672. I 844.8 667. K 749. F 523. 582.H 685. A 664. F 618. D 845. G 510.818. F 743.0 654.8 802. L 645. F 649. H 729. A 800.0 709. D 752. C 592. I 595.1 776.K 730.rF 700. P 570.0 807.C 797.F 796. H 613. A.0 701. K(vascular dementia not in question) 740. F 764. P 500.8 489. F 457. E 463. A 762. P 711.K 477.J 591. A 784. H 641.8 625. F 471. A 499. K 550. A 719.8 695.J 621. M 658. K 596.1 502. B 657. G 590. H 674. F 518. K 461. M 644.1 451.0 727. J 763.www.0 722.E 725. A 588. E 460. D 817.N 579.0 798. _ 812.0 759.A 720. A 766.C 831.C 697.8 824. C 541. E 580. C 455.H 469. C 783. D 795. L 484. E 646.8 661. D 517. E 837. E 777. A 617.8 1120. I -"_01fG . E 639.C 789. H 651.8 503. F 452. I 843. F 547. M 486. G 539.0 770.0 670. L 567. P 571. A 771.1 530. C 773.0 652./1. U 508. A 744.0 760. C 772. K 677.E 578. E 599. E 632. J 526.1 470. C 827. H 483.8 841. F 577.A 811. I 520. F 714.0 633. C 609.8 790.F 466. D 692.C 794. D 687.0 .S 653. G 576. A 487.0 708.0 562. A 552. L 493. I 679. C 757. D 619. K 597'. K 521.C 648. L 662. 601. 537. T 678.8 492. F 829.F 848. Anti-D 820.C 788. E 834. G 496. A 530. D 815. B 623. H 769. I .8 637. F 779.8 745. A 723. L 707. F 569. E 514.0 663.J 574.8 830.8 681. L 615.C 630. E 535.C 801. H 631. N 616. po 11 696. H 832.8 666. K 675. A 704. K 659. tF 814. C 754. H 826. I 634. K 715. F 528.8 498. G 505. M 6G6.fischtest. F 6RO.uk 450. F 629.D 742. A 684.K 478.J 611.G 481.0 598. K 676. F 515.0 785. 665. E 497. D 778. I 721. M 545. H 462. K 473. K 728.co. A 731.H 480.1 479. E 627. K 558. C 575.C 823.j!JA 775.0 803. I 765. E 482. E 485.0 712. D 494. H 607. " 587.E 847. P 718. C 554. P 626. A 739. F 774.8 544. E 693. A lion.C 495. C 705. D 706. A 761. A 750.. F 809.C 628.8 512. B 622.1 553. F 808. A 839.8 799. E 755.C 736. D 682.C 543. K 610.8 810.8 475.A 782.8 835. G 548.8 602. D 540.8 806. C 468. M 476. D 732.8 748. K 733.0 751. F 491.8 689.D 454. G 511.0 660. A 691. N 686. A 563. M 507. A 564. K 840. A 836.C 741. A 456. D 467. E 735. H 474. F 604. H 594. A 572.1 555.C 683. F 549. F 608.8 716. M 614. F 642.0 726.F 791.8 703.0 787.A 792. K 655.8 781.C 673. F 581. D 524.J 828. C 713.C 551.C 606. M 533. M 536. D 724.C 819. A 758. E 624.A 513. F 747. D 584.J 532.]it'f 833. D 465. D 593. A 605. D 825. K 531. 786. L 669. E 546.E 688.0 804. F 821.I!SA 698. E 805. D 565.J 635. X 650.8 816. D 458. C 488. C 842.. L 504. 542. F 638.C 768. D 737. E 780.J 519.C 756.C 690. I rmrbllli. G 603. D 717. F 501. M 527. E 560. K . G 522. B 453.8 559. F 589.H 656. H 534. H 694. E 636.1 793.8 573. A 813. L 671.

F 865.8 866. C 863. I 858. C 862.8 856. H 854.www.co.1 869.fischtest. C 859. B 868.8 850. H 867. C 852. B 855.0 853. C 851.J . D 860. E 861. I 857.uk 849. A 864.