ERMP 2021, Part II

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1. A 22 year old patient presented with red macules and papules on the trunk and extremities symmetrically of
5 days duration. She was taking non-specific oral medication for an infection.
What is the drug responsible for such reaction?
A) Azithromycin
B) Ciprofloxacin
C) Tetracycline
D) Co-trimoxazole

2. A 59 year old male patient presented with a skin lesion of 1 year duration. He also has weight loss and
anorexia. On examination, he has a darkly pigmented plaque with central fungating ulcer on the left plantar
area. He also has bilateral palpable inguinal lymph nodes. Skin biopsy showed oval to round cells that
shows atypia and have darkly pigmented cytoplasm.
What is the most likely diagnosis?
A) Pigmented basal cell carcinoma
B) Acral lentiginous melanoma
C) Squamous cell carcinoma
D) Merkel cell carcinoma

3. A 34 year old a known asthmatic patient on regular follow up presented with a newly erupting skin lesions
over the arms and the legs of two weeks duration. On evaluation at the dermatology clinic, erythematous
and edematous plaques topped with vesicles and erosions was observed over antecubital and popliteal
fossae bilaterally.
What is the most likely diagnosis?
A) Allergic contact dermatitis
B) Irritant contact dermatitis
C) Atopic dermatitis
D) Steven Johnson syndrome

4. A 28 year old patient presented with an abrupt generalized skin rash of 5 days duration, along with fever,
myalgia and arthralgia. He is known RVI patient on HAART. On examination, he is acutely sick , Temp=
38.8 degrees Celsius. There are multiple vesicles, erosions and crusts over his face and trunk. Tzanck smear
from the vesicles revealed the presence of multinucleated giant cells.
What is the most likely etiology for the lesions?
A) Measles
B) Varicella
C) Syphilis
D) Tuberculosis

5. A 25 year old known HIV-AIDS patient was referred to the dermatologic clinic for evaluation of mildly
itchy skin lesions of 2 weeks duration. On examination, there are multiple annular plaques with central
clearing and peripheral erythematous papules and tiny pustules.
What is the most appropriate diagnostic test?
A) Skin biopsy
B) VDRL
C) Microscopy with 5 percent KOH
D) Microscopy with modified Zheil Nelson staining
6. A 27 year old female patient with hypothyroidism came with a compliant of asymptomatic whitening of the
finger tips. On examination, there are depigmented macules and patches over the finger tips and lower lip.
What is the most likely cause of the depigmentation?
A) Decrease in size of melanosomes
B) Decrease in functions of melanocytes
C) Absence of melanosomes
D) Absence of melanocytes

7. A 24 year old male patient presented with a painless genital ulcer of 1 week duration. He has history of
unprotected sex a month back with. He has a non-tender, indurated ulcer with a clean base over the shaft of
the penis and a contralateral inguinal lymphadenopathy with a rubbery consistency. VDRL serology is non-
reactive.
What is the next appropriate investigation?
A) FNA from the lymph node
B) Rapid plasma reagin test
C) Urine microscopy
D) Treponemal hemagglutination assay

8. A 6 year old female child presented to ER with worsening of shortness of breath of 3 weeks duration. On
examination, she has stridor, BP=100/70 mmHg, PR=119bpm, RR=32bpm and oxygen saturation at room
air= 86%. On fiberoptic examination, there was globular, smooth, vallecular mass pushing the epiglottis
posteriorly and obscuring laryngeal inlet. Oro-tracheal intubation was tried but failed.
What is the best next step for securing airway in this patient?
A) Submental intubation
B) Needle cricothyrotomy
C) Open cricothyrotomy
D) Tracheostomy

9. A 40 year old female patient presented with swelling behind right ear of 3 years duration. Over the past 6
months the swelling is growing fast. On examination, there is firm, mobile 6X5cm anterior pre-auricular
mass.
What is the best next step in the management of this patient?
A) FNA cytology
B) Neck Ultrasound
C) Neck CT with contrast
D) Excisional biopsy

10. A 6 year old child presented with ear pain of a day duration. The pain initially was throbbing and waking
him from sleep and later became dull aching associated with high grade intermittent fever. He is fully
vaccinated. On otoscopic examination, there is bulged, vascular injected tympanic membrane with air fluid
level.
What is the most likely etiologic agent?
A) Parainfluenza virus
B) Hemophilus influenza type B
C) Streptococcus pneumonia
D) Staphylococcus aureus

11. A 16 year old female patient presented with scanty left side foul smelling ear discharge since childhood
which was initially white and odorless. Otoscope examination shows subtotal tympanic perforation with
whitish flaks in middle ear; rhine-negative and weber lateralization on the right ear.
What is the most likely diagnosis?
A) Cholesteatoma
B) Chronic mastoiditis
C) Chronic supportive otitis media
D) Tympanosclerosis
12. A 40 year old male patient presented with vertigo of 3 days duration which often follows body position
change and stays for about 30sec with no associated hearing loss or tinnitus.
What is the most likely diagnosis in this patient?
A) Benign paroxysmal positional vertigo
B) Acute Serious labyrinthitis
C) Meniere disease
D) Acute Viral vestibulitis

13. A 4 year old male child was brought to ER after he inserted peanut to his right ear 6 hours back. On
otoscopic examination, the peanut is visible at right external auditory canal at level of the isthmus.
What is the best tool to remove the peanut?
A) Magills forceps
B) Ear loop
C) Crocodile forceps
D) Ear hook

14. A 14 year old male child presented with mild intermittent right side nasal bleeding, usually following
episode of common cold during dry season, with no other pertinent positive history.
What is the most likely site of the bleeding?
A) Roof of ethymoid
B) Sphenopalatine area
C) Anterio-inferior septum
D) Inferior turbinate

15. A physician mistakenly ordered wrong medication which is contraindicated for the patient. The patient later
developed serious adverse events. On recovery, the patient asks his physician why he became so ill.
What should be the physician's most appropriate response?
A) Explicitly deny the error and its consequences
B) Explain to the patient as such event can happen in few patients
C) Explain to him as it happened following wrong routes of administration
D) Explicitly acknowledge and explain the error and its consequences

16. A 70 year old woman was diagnosed with terminal illness. The patient, her children and health care
providers have different views about the subsequent management.
What is the first best step in resolving their differences?
A) Consult ethics committee
B) Consult a legal expert
C) Make evidence-based decision
D) Discuss with the patient, family, and health care team

17. In a public hospital support group for substance abuse, religion comes up as a topic. One patient says, "God
takes care of us all." Another patient says, "There is no God." The members of the group are not aware that the
group facilitator is devoutly religious, with a deep faith in God.
What is facilitator's best course of action?
A) Explain to the group that this topic is inappropriate for the discussion
B) Quickly change topics without explanation
C) Attempt to persuade them on your belief
D) Facilitate continuation discussion holding neutrality

18. A 46 year old patient whom you operated for removal of large intracranial hemorrhage remained in coma
and transferred to ICU. On the third day of his ICU stay, while you were making round in ICU the patient
arrested and died. As you exit the ICU, you met the patient's wife.
How should the bad news be disclosed?
A) Inform her to gather her family
B) Let the ICU staff tell her
C) Escort her to a private room and disclose
D) Inform her husband's death on the spot
19. A colleague regularly talks about her personal problems at workplace. She mentions the details of her
impending divorce even to patients.
What is the most appropriate measure?
A) Inform to her supervisor to help her find counseling service
B) Ignore her as her problems aren't yours
C) Advise her to talk to someone who cares to listen
D) Tell her to get help from a counselor

20. A 62 year-old man who had tumor biopsy of the thalamus diagnosed to have Glioblastoma. As you went out
of the OR his son begged you not to tell the diagnosis to his father because the knowledge would kill him even
faster. A family gathering to discuss the prognosis is already scheduled for later that afternoon.
What is the best way to handle this situation as a doctor?
A) Honor the request of the son who is protecting his beloved father from the bad news
B) Withhold informing the patient until the family gathering happened
C) Ask the patient how he wants to be informed about his disease
D) Discuss with the rest of the family member on how to handle the information

21. A fully conscious and oriented adult patient with advanced renal cancer, gave his written wish not to receive
chemotherapy or resuscitation preferring to die in peace. Few days later, he lost consciousness and the family
requested to start chemotherapy.
What is the appropriate next measure?
A) Honor the family's request
B) Seek for another physician's opinion
C) Honor the patient's wish
D) Seek for legal advice

22. A 45 year old man was found dead in his home. He was brought to the forensic medicine unit for autopsy. A
cornea-donor card from the eye bank was found in his wallet indicating his desire to donate. The eye bank was
contacted to harvest the cornea. But, the family members threatened to sue the team if they take the cornea.
What should be done?
A) Honor the wishes of the family
B) Honor the wishes of the man
C) Seek court order to overrule the family
D) Consult with a legal person

23. A primigravida woman at 30 weeks of gestation was diagnosed with advanced esophageal cancer with very
low survival rate. She refused to start chemotherapy not to jeopardize the safety of the fetus. After assessing the
NICU capabilities, she decided to undergo cesarean section and deliver the baby before she dies so that her
generation continues and her husband gets comfort from this. She was counseled on the possibility of losing her
life and the risk associated with prematurity. Despite all these, she signed a written consent. The husband
disagrees with her decision.
What is the appropriate course of action to take?
A) Get a legal advice to obtain a court order
B) Honor her wishes and do the cesarean section
C) Delay the cesarean section till the husband and wife agree
D) Seek advice from a medical board and decide accordingly

24. When you are passing by a ward where you are not on duty, you noticed that a patient seems to be in a
respiratory distress. The only resident on duty in that ward is attending another patient.
What is the right action to follow?
A) Attend the patient
B) Inform the resident on duty
C) Call the senior on duty
D) Call the nurse
25. A new resident and asked to follow-up an immediate post-operative patient. The senior urged to make sure
the patient takes the antibiotics he prescribed overnight. After the senior left, it is noticed that the order-sheet
was missing from the patient's chart. The senior was not reachable. The hospital doesn't have a specific protocol
for this kind of situation.
What course of action should be taken?
A) Use a protocol from another hospital as a reference
B) Consult another senior physician or resident on duty
C) Inquire the ward nurse on what the senior usually prescribes
D) Refer resources to find out the appropriate antibiotics

26. A 30 year old man who was found roadside with head injury was brought to ER by a policeman. On arrival,
he was unconscious with GCS of 9/15 and was having frequent episodes of vomiting and seizure. He was put on
oxygen, secured IV line and loaded with phenytoin. CT scan showed right side acute subdural hematoma.
Emergency craniotomy was planned.
How do you proceed with obtaining consent for the surgery?
A) Ask the police man to sign the consent
B) Treating physician can sign on the patient's behalf
C) A team of three physicians sign the consent
D) Wait for family members to sign the consent

27. While working in the ICU, a senior physician informed you to reserve a bed for Patient A who is 68 year-old
with chronic COPD in acute respiratory distress with a 20% survival rate. You have only one ICU bed
unoccupied. While processing the admission process for this patient, you received another call from the
emergency department to reserve a bed for patient B who is a 35-year-old with polytrauma with an estimated
survival rate of 50%.
What is the most appropriate decision you should take?
A) Let families make an appeal for priority
B) Admit Patient B
C) Admit Patient A
D) Decide with lottery method

28. You are working as a director at a COVID-19 treatment center overwhelmed with patients requiring
ventilation and you are running out of ventilators and oxygen. The emergency response team is on its way
bringing in more patients.
What is the most appropriate response in this situation?
A) Tell the them that you have run out of supplies and can't admit patients
B) Check with your logistics team for an inventory of consumables before you respond
C) Prepare to assess incoming patients and communicate with nearby facilities for possible transfer
D) Advice the team to send patients back to their families for home-based care

29. An 18 year-old pregnant lady at 31 weeks of gestation came to terminate her pregnancy stating that she was
raped.
What is the next best action to handle her request?
A) Counsel on the risks and if she gives written consent, perform the procedure
B) Inform her, contact social service to address her concerns and facilitate term delivery
C) Find and consult a more experienced senior to perform the procedure
D) Report to the police and ascertain if it was rape before deciding to perform the procedure

30. A 72 year-old patient who is suffering from metastatic cancer needs to undergo a surgical treatment. His
family requested to withhold disclosing the state of his terminal illness, for fear of declining consent.
What is the appropriate approach to proceed with the management?
A) Discuss with the family and proceed with the surgery
B) Respect the family's request and proceed the surgery
C) Counsel the patient and respect his decision
D) Advise him and proceed with the surgery
31. A 45 year old woman presented with bruises and ecchymoses on multiple sites. The physician suspected
physical abuse. The woman admitted that it was inflicted by her husband. As he is the bread winner, she pleads
not to report the incident.
How should the doctor handle such a matter?
A) Counsel her to resolve their conflict
B) Manage only her medical condition
C) Report the abuse to police
D) Advise her to report to police

32. You and a colleague were attending a major round. You forgot to collect the lab results before the round is
commenced. While discussing the patient who is under the care of your colleague, the senior asked for the renal
function test values. Your friend responded as the patient's creatinine is 8mg/dl, but you know he has not seen
the result. A decision was about to made on the patient's management.
What immediate appropriate measure would you take on the spot?
A) Tell the senior that the results are not yet collected
B) Discuss with your colleague after the round is completed
C) Report the issue to the chief resident
D) Report the issue to the hospital ethics committee

33. A seriously ill patient who has received care for months at a hospital brought cakes and flowers to the health
care team in appreciation for their help.
What is the most appropriate response to such gift?
A) Accept the cake as a gesture of gratitude.
B) Accept the cake but only after thoroughly discussing the meaning of the gift.
C) Decline the cake as it is ethical breach to accept gift from a patient.
D) Consult with ethics committee at the hospital before making decision.

34. You evaluated and ordered lab tests for an 18 year old university student who came alone to you. Next day,
the father of the patient comes to inquire about test results for his son. The patient didn't inform you or signed a
consent that family members could collect the test results.
How do you proceed?
A) Give him the copy of the test results
B) Give him the original test results once you prove he is a true guardian
C) Give him the result if you have permission from the patient
D) Inform him the copy is only given to the patient

35. An 11 year old presented with cheesy white-yellow vaginal discharge. She complains of severe itching and
burning sensation in the vaginal area.What is the management of this patient?
A) Sitz bath
B) Metronidazole
C) Nystatin
D) Cleaning the perineum

36. A 2 month old baby was brought with a complaint of sudden stopping of breathing of 30 minutes duration.
The neonate was relatively ok before the event. He was on exclusive breast feeding with normal anthropometric
measurements. Postmortem examination revealed nothing as to the cause of the death in this infant.
What possible risk factor might be associated with the death of this infant?
A) Arrhythmia
B) Unnoticed aspiration
C) No specific cause
D) Asphyxiation

37. Hand hygiene is one of the most effective methods to prevent hospital-acquired infections. It can be
performed either by using alcohol-based hand rub or washing with soap and water. Keeping hand hygiene is a
requirement in between examination of patients.
Which disease condition warrants mandatory hand washing even after use of alcohol-based hand rub?
A) COIVD 19
B) Staphylococcal sepsis
C) Pseudo-membranous colitis
D) Acute watery diarrhe
38. A 3 month old infant is brought with complaints of cough, shortness of breath and feeding difficulty of three
days duration. He had repeated respiratory tract infections. On examination: he has profuse sweating and dusky
appearance, PR= 140bpm and RR=60bpm; accentuated P2 and soft blowing holosystolic murmur.
What is the most likely cause of the child's presentation?
A) Ventricular Septal Defect
B) Pulmonary Hypertension
C) Tetralogy of Fallot
D) Patent ductus arteriosus

39. A 7 year old child who was on follow up in cardiac clinic missed his two regular visits. Up on lost-to-
follow up call, family reported his sudden death. The physician reviewed his chart to find out the boy had
elongated facies, droopy lids and mild kypho-Scoliosis. Ophthalmologic evaluation also showed severe myopia,
flat cornea, hypoplastic iris and features of cataract.
What is the most common cause of death?
A) Aortic dissection
B) Long QT syndromes
C) Complete AV block
D) Aortic stenosis

40. A 6 month old infant is brought to the ER with complaints of shortness of breath, body swelling and high
grade fever. The family gives history of preceding upper respiratory tract infection. On examination, his vitals
are; RR =60bpm, PR =140bpm and Temp=36.2 degree Celsius. He has bilateral crepitation on posterior chest
with palpable liver of 5cm and palmar pallor. What is the most important management in this infant?
A) Furosemide 1mg/kg/day IV
B) Digoxin 0.125 mg PO
C) Ceftriaxone 75mg/kg/day IV
D) Salbutamol puffs

41. A 3 year old child comes with history of vomiting of ingested matter, fast breathing and fatiguability. On
further enquiry, the parents stated she has had bed wetting in the past couple of months and weight loss. Vitals:
RR=40bpm, PR=120bpm and has dry buccal mucosa. Urinalysis: albumin +, glucose +++, ketone + and WBC
5-7/HPF. Arterial blood gas shows PH 7.32, PCO2 20, and HCO3 19.
What investigation result can confirm the diagnosis in this child?
A) Hemoglobin A1c greater than or equal to 6 percent
B) Random plasma glucose greater than or equal to 200 mg/dL
C) Fasting (at least 8 hr) plasma glucose greater than or equal to 120 mg/dL
D) 2 hr plasma glucose during OGTT greater than or equal to 180 mg/dL

42. A 10 month old infant is admitted to the ER with complaints of acute onset of watery diarrhea and vomiting
of ingested matter of 2 days duration. The mother had replaced the loss with water at home as the infant refused
to take ORS. On examination: PR =140bpm-full in volume, RR =34bpm and Weight 9 Kgs.
What is the expected hemodynamic state of the infant?
A) Hyponatremic dehydration
B) Hypernatremic dehydration
C) Isotonic dehydration
D) Hypovolemic shock

43. A 1 year old child comes with generalized body swelling of 1 week with new onset of watery diarrhea. He is
lethargic with PR of 145 bpm and cool extremities. The mother noted his eyes are recently appearing sunken.
What is the appropriate rehydration fluid choice for the child?
A) Hypotonic solution with added potassium
B) Isotonic solution with added potassium
C) Isotonic solution with added bicarbonate, glucose and potassium
D) Hypotonic solution with added bicarbonate, glucose and potassium
44. An infant is able to sit with support only in a bed.
What is the estimated age of the child?
A) 10
B) 8
C) 6
D) 4

45. Routine physical examination of a female new-born revealed epicanthal folds, high arched palate, low set
ears and systolic murmur at the left sternal border.
What is the most likely diagnosis?
A) Turner Syndrome
B) Patau syndrome
C) Down syndrome
D) Edward's syndrome

46. A 12 year old male known cirrhosis patient with portal hypertension presented to GI clinic with progressive
abdominal distension and fever of 2days duration. On examination, temperature was 38.6 degree Celsius,
positive shifting dullness, fluid thrill and abdominal tenderness. You did a peritoneal tap and the color was
cloudy. You sent it for analysis and culture.
What will be the commonest etiologic agent you expect from the culture?
A) Pseudomonas
B) Escherchia coli
C) Staphylococcus aureus
D) Pneumococcus

47. A 5 week old infant came to high risk infant clinic for non-projectile non-bilious vomiting soon after breast
feeding since 3weeks of life. Examination revealed a swelling over epigastric area. Contrast ultrasonography
showed "string sign" and "double tract sign".
What is the most likely diagnosis?
A) Pyloric duplication
B) Pyloric stenosis
C) Duodenal stenosis
D) Pyloric web

48. A mother brought her 13 months old male infant to OPD due to poor weight gain. He wasn't exclusively
breast fed, was taking goat's milk since birth. Physical examination showed some palmar pallor. Peripheral
morphology shows large RBCs and hypersegmented neutrophils.
What's the most likely diagnosis for the underlying cause?
A) Iron deficiency anemia
B) Folate deficiency anemia
C) Vit B-12 deficiency anemia
D) Aplastic anemia

49. A 16 year-old girl presented with progressive numbness, tingling, and pain in both feet of one week
duration. Over the next 10 days, her lower extremities became weaker. She had a diarrheal illness 12 days
before the onset of her symptoms. On examination, Temp=37 degree Celsius, power of 2/5 over lower
extremities and absent reflexes bilaterally in both upper and lower extremities. CSF analyses: WBC= 5/HPF,
protein = 63 mg/dL, and glucose = 60 mg/dL.
What is the most likely etiology for her condition?
A) Escherichia coli
B) Salmonella typhimurium
C) Campylobacter jejuni
D) Yersinia enterocolitica
50. A 2 year old male child who presented with low grade fever, irritability and drowsiness had also neck
stiffness. The CSF study showed leukocyte count of 500 cells/mL (70% lymphocyte), low glucose and the
protein is markedly elevated. No organism detected on the gram stain.
What is the most likely diagnosis?
A) Viral meningitis
B) Bacterial meningitis
C) Tuberculous meningitis
D) Cryptococcal meningitis

51. A 10 year old child with a diagnosis of ALL on chemotherapy presented with fever. The child has stable
vital sign except his temperature. What will be your next step in the management of this patient?
A) Vancomycin should be started as soon as possible
B) Chemotherapy should be stopped for the time being till the fever subsides
C) Start empirical antibiotic/s like cefepime
D) Delay any antibiotics till you take all appropriate investigation

52. A 3 year old child admitted to the hospital two days ago for hypospadia repair. He started to have fever with
no other symptoms. On examination: T=38.2 degree Celsius, other vital sign are all normal.
What is the initial step in managing this patient?
A) Give antipyretics and proceed with the surgery
B) Discharge and reschedule
C) Investigate for hospital associated infection
D) Start broad spectrum antibiotics

53. A 3-year-old boy presents with ongoing wheezing with intermittent fevers of 6 weeks. The child is from a
poor neighborhood. On examination, there is scattered wheeze over the chest. CBC reveals marked eosinophilia,
ESR=40 in the first hour. Chest X-ray has no abnormality.
What is the best treatment for this child?
A) Salbutamol
B) Diphenhydramine
C) Albendazole
D) Praziquantel

54. The parents of a healthy 4 year-old girl who weighs 22 kg are planning to travel to Arba-Minch (an area
with chloroquine-resistant Plasmodium falciparum) and want to get malaria prophylaxis prior to the journey.
What is the most appropriate drug?
A) Doxycycline
B) Sulfadoxine/Pyridoxine
C) Mefloquine
D) Atovaquone/proguanil

55. A 2 year old male child presented with cough and fast breathing of 3hrs duration after he drunk from a can
where the parents use to store kerosene. On physical examination RR is 52, saturation was 85 percent with room
air and chest was clear. CXR was sent right away.
What abnormality do you expect to see on CXR?
A) Coalescing nodular opacities
B) Normal CXR finding
C) Pneumatoceles
D) Costophrenic angle obliteration

56. A 14 year old female is brought to the ER after she took unknown substance and developed loss of
consciousness of 1 hour duration. Parents noticed increased urination. On examination, she is confused, has
increased secretions from nose and mouth, chest has transmitted sounds, reactive and dilated pupil and GCS is
12/15.
What is the most likely agent she has ingested?
A) Lead
B) Opioids
C) Organophosphate
D) Anticonvulsant drug
57. A mother brought her 2 days old neonate after noticing abnormality on the hand and arm. She had a forceps
delivery at health center. On examination, the neonate had internally rotated adducted left shoulder, extended
elbow and flexed hands at the wrist. Moro reflex was absent on left side.
What is the most likely diagnosis?
A) Klumpke's paralysis
B) Left shoulder dislocation
C) Left humeral fracture
D) Erb's palsy

58. A 48 hour old male neonate delivered via assisted vaginal delivery is admitted to NICU for a compliant of
swelling over his head of a day duration. On examination: RR =70bpm, PR =166bpm, firm localized swelling
over right parieto-occipital area and warm extremities. Lab results showed a Hgb of 9mg/dL. You gave oxygen
via nasal prong.
What is the next step in the management of this neonate?
A) Transfuse with 10ml/kg of PRBC over 3hours
B) Give 10ml/kg of normal saline as fast as possible
C) Supplement with iron
D) Administer IV antibiotics

59. An intern from neonatal ward came to you for consultation about a neonate being managed for
neurosyphilis.
What measure could have prevented such condition?
A) Prevent acquisition of syphilis in a women of child bearing age
B) Prompt diagnosis and treatment of both parents
C) Prompt diagnosis and treatment of the mother
D) Prompt diagnosis and follow with treponemal tests

60.A 7 year old female child comes to OPD with fatigue, tinnitus and palpitation. On examination, she has
failure to thrive and severe pallor. Her height is 125cm and weight is 25kg. Her lab result shows serum
creatinine of 1mg/dl.
What is her estimated glomerular filtration rate?
A) 51
B) 61
C) 55
D) 65

61. A mother brought her 3 year old male child to OPD for difficulty of climbing stairs. She reported he was
previously having a toe walking. On examination, you noted a prominent tongue, hypertrophied calf muscles
and a waddling gait.
What's the most likely mode of inheritance for the underlying cause?
A) Autosomal dominant
B) Autosomal recessive
C) X-linked recessive
D) X-linked dominant

62. A newborn weighing 3500gm is admitted for treatment of sepsis is on nasogastric tube feeding. You want to
provide 120Kcal/Kg/Day to be fed every 3 hours.
How much breast milk is required per feed?
A) 80 mL
B) 60 mL
C) 50 mL
D) 70 mL

63. A mother brought her 6 month old infant o the vaccination center. The baby was born preterm.
What infant feeding practice is advised?
A) Introduce low calorie diet.
B) Discourage phytate diet.
C) Give cow's milk no more than 200 ml/day.
D) Continue exclusive breast feeding.
64. A 5 week old female infant was brought to OPD with a compliant of audible breathing sound since birth.
Mother reported that she is gaining weight and feeds well but frequently spits up. Examination shows subcostal
retraction and stridor.
What is the most likely diagnosis ?
A) Laryngomalacia
B) Subglottic hemangioma
C) Tracheomalacia
D) Vascular ring

65. A 4 year old male child was brought to the ER with difficulty swallowing, drooling of saliva and fever of a
day duration. On examination, he is sitting upright in a tripod position lifting his chin up, Temp= 39 degree
Celsius.
What is the initial step in the management of this child?
A) IV antibiotics
B) IM Dexamethasone
C) Oral suction in the OR
D) Direct laryngoscopy in the OR

66. A 1 year old female child presented with cough and fever of 2 days duration. The father reported that she
had frequent treatment with antibiotics at a health center due to recurrent cough. You noticed she isn't
vaccinated at all. The importance of vaccination was discussed with the father.
What vaccine should be provided as a catch up strategy?
A) OPV0, DPT1, HIB1, Hep1, PCV1, Rota1 and measles vaccine
B) OPV1, DPT1, HIB1, Hep1, PCV1, Rota1 and measles vaccine
C) BCG, OPV0, DPT1, HIB1, Hep1, PCV1, Rota1 and measles vaccine
D) BCG, OPV1, DPT1, HIB1, Hep1, PCV1, Rota1 and measles vaccine

67. A 3 year-old male child is brought by his mother to pediatric ER after he swallowed 1 Birr coin.
Where is the most likely area the cent will be stacked?
A) The lower third esophagus
B) The upper third esophagus
C) Abdominal esophagus
D) The mid esophagus

68. A 36 year old known RVI patient for whom incision and drainage was done for perianal abscess 6 months
ago presented to OPD for follow up. The wound has healed well except at the center of the scar where there is a
1x2cm persistent opening that discharges small amount of offensive fluid. He has no pain at the site.
What is the best diagnostic test for this patient's condition?
A) Fistulography
B) Transrectal ultrasound
C) Pelvic CT scan
D) Pelvic MRI

69. A 46 year old female patient presented with swelling in the upper part of the thigh near the groin noted since
the past one year. Physical examination, she had reducible and non-tender mass lateral and inferior to the
symphysis pubis.
What is the most likely diagnosis?
A) Direct inguinal hernia
B) Indirect inguinal hernia
C) Obturator hernia
D) Femoral hernia
70. A 39 year old farmer had on and off type groin swelling since 2 years. Since 2 days the swelling became
painful and non-reducible. He has also associated crampy abdominal pain and 2 episodes of vomiting. He is
passing faces and flatus. On physical examination, vital signs are stable, has soft abdomen and tender groin
mass.
What is the best management for this patient?
A) Admit for close observation
B) Manual reduction of the mass with analgesics
C) Emergency surgery
D) Re-assure him

71. An adult male who is fasting presented with severe sharp epigastric pain that gradually involved the whole
abdomen of 6 hours duration. On examination, vital signs were within the normal range but he has diffused
abdominal tenderness with board like rigidity.
What is the next best step in management of this patient?
A) Start broad spectrum antibiotics
B) Resuscitate with crystalloids
C) Send for chest X-ray
D) Send for ultrasound

72. A 23 year old male patient who is scheduled for emergency surgery under general anesthesia for acute
appendicitis after being symptomatic for 36 hours. He has taken solid food an hour back.
What is the appropriate alternative to minimize complication?
A) Rapid sequence induction of anesthetic agents
B) Bag ventilation before giving muscle relaxant
C) Keep him NPO for the next six hours
D) Use un-cuffed endotracheal tube

73. An apparently healthy young man to undergo fistulectomy. Fifteen minutes after spinal anesthesia, he
developed hypotension. What is the best initial management for this patient?
A) Fluid Administration
B) Initiating vasopressor
C) Putting the patient in Trendelenburg position
D) Cardiologist consultation

74. A 60 year old male patient presented to OPD with vomiting of ingested matter of two months duration that
worsened in the last two weeks. Investigation: Hct= 27%, upper GI endoscopy showed pyloric thickening and
difficult to pass the scope. Serum electrolyte was sent.
What is the expected electrolyte imbalance?
A) Hypochloremic and hyperkalemic metabolic alkalosis
B) Hypochloremic and hyperkalemic metabolic acidosis
C) Hypochloremic and hypokalemic metabolic alkalosis
D) Hypochloremic and hypokalemic metabolic acidosis

75. A 65 year old male patient diagnosed with gangrenous small bowel primary volvulus. He was operated and
distal ileal resection and ileostomy was done. On his 7th post-operative day he starts to have constipation,
weakness and fatigue. On physical examination, he has diminished tendon reflexes.
What is the most likely cause for the patient complaint?
A) Hypocalcaemia
B) Hypochloromia
C) Hypokalemia
D) Hypomagnesaemia

76. A 50 year old male patient presented to the ER with failure to pass feces and flatus of two days duration. On
examination, abdomen is grossly distended and tympanitic. Plain abdominal X-ray showed distended bowel
loops with multiple peripheral air fluid level. Surgery was planned.
When should prophylactic antibiotic be administered for this patient?
A) 30 minutes before induction
B) 60 minutes before induction
C) 30 minutes before incision
D) 60 minutes before incision
77. A 30 year old male patient was operated for perforated appendicitis. He has been taking IV antibiotics. On
5th postoperative day, he started to have wound site pussy discharge. WBC =13000 cells/mL and abdominal US
was unremarkable.
What will be the next step in the management of the patient?
A) Relaparatomy and lavage
B) Change the antibiotics
C) Open and wash the wound
D) Continue with the antibiotics for five more days

78. A 25 year old male patient came to the ER after he sustained RTA of 12 hours. His BP = 80/50 mmHg, PR=
100 bpm and his GCS = 14/15. He has soft tissue injuries at multiple sites. He is suspected to have closed
femoral fracture and lung contusion.
What is the best measure of the outcome of the management?
A) Urine out put
B) Blood pressure
C) Oxygen saturation
D) Pulse rate

79. A 30 year old female patient come to the surgical OPD with the compliant of serosanguinous nipple
discharge from her right breast. On examination, her vital signs were normal; has nipple discharge but no
palpable mass. Ultrasound was non-revealing. Mammography with contrast injected to the duct revealed filling
defect and ectasia in the nipples.
What is the most likely diagnosis in this patient?
A) Intra ductal stone
B) Intraductal papilloma
C) Lobar mass
D) Nipple mass

80. A 35 year old female patient came to the OPD with painful anterior neck swelling of 4 weeks duration. She
had history of upper respiratory tract infection. Her vital signs were stable and examination of the neck revealed
tender, firm and mildly enlarged goiter. CBC and thyroid function test are normal.
What is the best initial treatment for this patient?
A) Glucocorticoid
B) Amoxicillin
C) Asprin
D) Acyclovir

81. A 63 year old women presented with rectal bleeding of 2 months duration. Colonoscopy revealed a 7cm
fungating mass at the anal verge and subsequent biopsy showed adenocarcinoma.
What is the best investigation for local staging in this patient?
A) Pelvic MRI
B) Pelvic CT scan
C) Transvaginal ultrasound
D) PET Scan

82. A mother bought her 1 month old infant to the OPD after she noticed bilateral feet deformity since birth. She
had ANC follow up and had vaginal delivery with breech presentation. On examination, the infant's feet were in
varus, equinus and supinated position. Infant had no back problem.
What is the next appropriate step?
A) Hip examination for DDH
B) Knee examination for congenital knee dislocation
C) Hip US for DDH
D) Knee US for congenital knee dislocation
83. A 45 year old man was admitted to orthopedic ward for right femoral shaft fracture fixation ten days back.
He suddenly started to have shortness of breath and palpitation. On examination, RR = 35 bpm, PR = 100 bpm
and oxygen saturation was 85%. He is restless and chest has right side crepitation. His right lower limb was on
skeletal traction.
What is the most likely diagnosis?
A) Pulmonary thrombo-embolism
B) Fat embolism syndrome
C) Hospital acquired infection
D) Pulmonary edema

84. A 40 year old computer engineer came with a complaint of left wrist swelling of 3 weeks duration. The
swelling gradually increased in size and attained the current size. On examination the swelling is cystic and
trans-illuminates. Image of the swelling is shown below.
What is the most likely diagnosis?
A) Epidermal cyst
B) Ganglion cyst
C) Giant cell tumor of tendon sheath
D) Anomalous extensor tendon

85. A 29 year old accountant sustained road traffic injury one day prior to presentation. He injured his left lower
limb. On examination the left thigh is swollen and is shorter than the contralateral limb. X-ray of the thigh is
shown below.
What is the appropriate definitive management?
A) Intramedullary fixation
B) Hemi-arthroplasty
C) Plate and screw
D) External fixation

86. A 85 year old female patient presented with right side groin pain of 5 months duration. She is taking non-
steroidal anti-inflammatory drug and usually ambulatory using cane. She has no history of trauma. Her physical
examination was non-revealing. Pelvic X-ray was taken and is shown below.
What is the next appropriate step?
A) Bed rest
B) Steroid injection
C) Vitamin D supplementation
D) Calcium supplementation

87. A 5 year old male child is brought with complaint of right side severe scrotal pain of 5 hours duration. He
has no history of trauma. On examination, there is tenderness in the right scrotum, horizontally positioned testis
and absent crimasteric reflex.
What is the most appropriate next step in the management?
A) Doppler ultrasound
B) Scrotal exploration
C) Antibiotics and analgesics
D) Reduction of the mass

88. A 11 month old male infant was brought to OPD with complaint of abdominal distention and subsequently
vomiting of offensive fecal matter. On PR examination, blast sign was positive. Plain abdominal X-ray showed
both small bowel and large bowel dilation.
What complication is most likely to happen in this infant?
A) Bowel perforation
B) Necrotizing Enterocolitis
C) Ischemic colitis
D) Secondary peritonitis
89. A 5 month old male infant was brought with complaint of vomiting of ingested matter and eager to suck
breast milk since the age of 3 weeks. On examination, he is wasted with sunken eyes and skin pinch returns in 3
seconds. On palpation there is typical "olive" in the right upper quadrant with the presence of visible gastric
waves on the abdomen.
What is the fluid of choice to prepare this patient for surgery?
A) 10 % DNS with added potassium of 2-4 mEq/kg
B) 5 % DNS with added potassium of 2-4 mEq/kg
C) 10 % DNS with added bicarbonate of 2-4 mEq/kg
D) 5 % DNS with added bicarbonate of 2-4 mEq/kg

90. A 10 month old male infant is scheduled for orchidoplexy for undescended testis. The mother is concerned
about the risk if the child doesn't undergo the surgery.
What risks would you tell the mother?
A) Testicular torsion
B) Testicular cancer
C) Testicular infection
D) Testicular rupture

91. A 50 year old male patient has a pigmented skin lesion on the scalp that has recently changed in color and
has become itchy and started to bleed. There are few small black spots irregularly scattered around the
lesion.What is the most likely diagnosis?
A) Bowen’s disease
B) Extra mammary Paget’s disease
C) Malignant melanoma
D) Basal cell carcinoma

92. A 54 year old female patient has sustained scald burn in her left arm two years ago. She treated the wound
by homemade remedies. The wound had formed unstable scar and frequently ulcerates. In the past three months
the recurrent ulcer persisted.
Which skin cancer is the patient most likely to develop?
A) Squamous cell carcinoma
B) Basal cell carcinoma
C) Melanoma
D) Merkel cell carcinoma

93. A 56 year old female patient was cut by a knife at her distal forearm. Since the accident she has loss of
sensation over her thumb and the two adjacent fingers.
What is the most likely cause?
A) Ulnar nerve injury
B) Median nerve injury
C) Radial nerve injury
D) Lateral cutaneous nerve injury

94. A 34 year old male patient has sustained electric burn while maintaining a high voltage line. Upon
evaluation, he is communicative with stable vital signs. He has 3X4 cm wound on his right hand and 4X6 cm
wound on his left leg.
What is the next most appropriate management?
A) Admit and start digoxin
B) Admit for wound care
C) Discharge after wound care
D) Admit and follow urine output

95. A 20 year old female patient sustained blunt abdominal injury from a road traffic accident. Emergency
laparotomy and splenectomy was done.
For which organisms do you want to vaccinate this patient?
A) Streptococcus pneumoniae
B) Staphylococcus aureus
C) Pseudomonas aeroginosa
D) Escherichia Coli
96. A 23 year old male patient came to ER 2 hours after falling from a 3 meters height. On neurologic
evaluation he speaks inappropriate words, has flexion withdrawal from pain and opens his eyes to pain.
What is his Glasgow coma scale?
A) 9
B) 8
C) 7
D) 10

97. A 30 year old male patient sustained fall down accident from 4 meter high tree presented to surgical
emergency department. At presentation he was complaining of chest paint. On examination BP = 130/90mmHg,
PR =88bpm, RR= 20bpm and oxygen saturation was 95% at atmospheric air. Chest was clear with multiple
segment rib fractures. After 6 hours of stay in the ER, he developed frothy cough, tachypnea and shortness of
breath.
What is the most likely diagnosis i?
A) Flail chest
B) Hemopneumothorax
C) Pulmonary contusion
D) Tension pneumothorax

98. A 40 year old male patient was involved in a motor bicycle accident presented to the ER with decreased
mentation and unable to move his lower extremities. On examination: BP = 70/40 mmHg, PR = 80bpm, RR
=20bpm and with warm extremities. The sensory level was at the level of T4 and per rectal examination
revealed loose perianal tone.
What is the most appropriate next step in the management?
A) Secure central IV access
B) Pulse Methylprednisolone
C) Applying spinal brace
D) Vasopressor

99. A 12 year old boy is evaluated for recurrent nephrolithiasis. He spontaneously passed three stones in the last
4 years and has recently undergone shockwave lithotripsy twice without success. He has been treated in the past
with an unknown medication but was discontinued because the parents believed it was of no benefit. Urinalysis
demonstrates hexagonal crystals.
What is the most likely metabolic condition?
A) Hypocitraturia
B) Hyperoxaluria
C) Hyperuricosuria
D) Cystinuria

100. A 20 year old male patient came with a complaint of difficulty of urination, dribbling, hesitancy and
nocturia. He has history of trauma while he was riding bicycle 3 months ago.
What is the best diagnostic test for this patient?
A) IVP
B) Contrast Urography
C) Urodynamic study
D) CT urography