MD (UKM) Class of 2010: Contoh Soalan Peperiksaan Ikhtisas M.D. (Ukm) Sesi 2009/10

MD (UKM) Class of 2010
CONTOH SOALAN PEPERIKSAAN IKHTISAS M.D. (UKM) SESI 2009/10
With compliments from;
the MD (UKM) Class of 2010 : The Pioneers of The PPD & New Integrated Curriculum
Disclaimer:Every question was memorized by the members of Class of 2010. No written information
was brought out from the examination hall. Efforts have been made to ensure the accuracy of the
information supplied in these pages. Therefore, we are conscious that there may be unintentional
errors or omissions. The information in these pages is provided on the basis that the reader will not
rely on it as the sole basis for any action or decision. Readers are advised to discuss the questions
and their answers. Neither the Universiti Kebangsaan Malaysia (UKM) nor the Faculty of Medicine
UKM assumes liability for errors or omissions. The pages are prepared for the eyes of UKM
medical students ONLY.
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For the eyes of UKM Medical Students only.
OBA 1
Q9 & Q 10
65 years old gentleman, a known case of DM and hypertension on medication, came to A&E
complaining of severe epigastric pain for 2 hours associated with profuse sweating and dizziness. On
examination, his BP is 90/60 mmHg, heart rate is 40 bpm, respiratory rate is 24/min and
temperature is 37.5 °C. CVS reveal DRNM and lung is clear.
Q9:
What is the immediate investigation that you want to do to get the diagnosis?
A. OGDS
B. Renal profile and electrolytes
C. FBC
D. Echocardiogram
E. ECG
Q10:
What is the best immediate & definitive management for this patient?
A. Intravenous morphine
B. Intravenous recombinant tissue plasminogen inhibitor
C. Oral aspirin
D. Oral clopidogrel
E. Sublingual glyceryl trinitrate
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Q11
A 34- year-old gentleman came to the psychiatrist for his problem – “panic attack when in large
crowd”. He also experienced intermittent sensation of blood rushing up his face. These symptoms
have been present for the past 2 years. On examination, he had a blood pressure of 170/100 mmHg
and pulse rate of 120 beats/ min. Cardiovascular examination revealed apex beat at the 6th
intercostal space, 5 cm lateral to mid clavicular line. There was no murmur heard. Other systems
were normal.
What is most likely diagnosis?
A) Anxiety Disorder
B) Carcinoid Syndrome
C) Phaechromocytoma
D) Conn Syndrome
E) Thyrotoxicosis
Q12
60 years old patient was on warfarin for atrial fibrillation since 3 years ago. During his last visit in the
clinic, the INR level was 9.0. He refused admission. One day, while he was having his meal, he
vomited out large amount of blood. His family members brought him to A&E.
What is your IMMEDIATE step to control his bleeding?
A.Cryopreciptate
B. Fresh Frozen Plasma
C.Factor VIII Concentrate
D. Intravenous Vitamin K
E. Platelet
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Q13
30 years old gravida 5 para 0+4 presented with calf swelling. She also had shortness of breath and on
examination; she was pale but not jaundiced or cyanosed. On palpation, the calf was tender. Blood
investigations were done
hb: 12.8
wcc: 2.4
plt: 120
So, what is the most appropriate investigation to make a diagnosis?

a. anticardiolipin antibody
b. antinuclear antibody
c. ESR
d.
e.
Q14 (Q13 scenario)

What is your immediate management ?
a. aspirin
b. clopidogrel
c. s/c heparin
d.
e.
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Q18
A 65 year old retired army officer on multiple medications for diabetic nephopathy, hypertension
and cardiac failure was rushed to emergency department with increasing shortness of breath for one
day associated with nausea and vomiting. On examination, he was sallow and had ankle edema. His
blood pressure was 170/100 mmHg and pulse rate was 100 beats/minute. Other Physical
Examination findings were unremarkable.
His ABG result were :
pH : 7.1
pO2 : 120 mmHg
pCO2 : 15 mmHg
Std HCO3 : 12 mmol/L
Base excess : -20
The most like likely medication associated with this condition :
A) Aspirin
B) Glicazide
C) Losartan
D) Metformin
E) Metoprolol
Q27
A 36-year old lady took 30 PCM and 56 escitalopram 3 hours before presented to A&E with restless,
PR: 98/min RR: 12/min and sp02: 98%
What would your immediate management be?
a) iv flumazenil
b) oral sedative
c) 02 mask
d)gastric washout
e)send blood for toxicology
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Q32
An 18-mth old Indonesian baby girl was brought to the clinic for persisting cough. He was previously
well until the age of 6 months when he was ventilated for 1 month for severe pneumonia. Since
then, he was on antibiotic every 1-2. On PE: finger clubbing, bilateral Harrison's sulcus, auscultation
revealed bilateral coarse crepitation.
What is your most likely diagnosis?

A. Bronchial asthma
B. Bronchiectasis
C.GERD
D. HIV infection
E.
Q40
There is a pandemic of H1N1. Passanger Y just came back from USA and she had high grade fever
and flu like symptoms.
What is the first step as a health authority at the airport?

a. give prophylactic to all passengers
b. isolate passenger y and admit ward
c. notify MOH
d. Quarantine all passenger in the flight
e. treat patient with tamiflu
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Q 42
Pn Sarinah, a G3P2, at 36 weeks gestation came to Tg Karang Health Centre for routine antenatal
check-up. She wanted to deliver her baby at home. Your health team did a home visit on the next
day. What is the most important factor suitable for home delivery?
A. Electricity
B. Clean water supply
C. Good home sanitation
D. Having helper at home
E. Distance from home is not more than 5 km to the health clinic
Q?&Q?
34 years old female teacher presented with multiple joint involving metacapophalengeal joints for
the past 3 months. It was associated with morning stiffness for more than 1 hour. BP:120/80. PR:90
PE: multiple joint swellings, tenderness over wrist, shoulder, knee, ankle
1. What is the result that is consistent with the most likely diagnosis
A raised CRP
B raised ESR
C (can’t remember)
D joint erosion in x ray
E positive rheumatoid factor
2. What is the medication that is most appropriate for her at this moment
A Methotrexate with indomethacin
B Methotrexate with sulfasalazine
C Prednisolone with indomethacin
D Prednisolone with sulfasalazine
E Prednisolone with tramadol
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Q?
A one year old baby was diagnosed to have Kawasaki and treated with immunoglobulin. She was due
for her MMR. When should you give her MMR?
a. defer 2 weeks
b. defer 8 months
c. give after discharge
d. give after fever subside.
e. omit immediately
Q?
Middle- aged female kindergarten teacher fears to go to work as she has the desire to strangulate
the children. She also has insomnia and poor concentration. What is the diagnosis?
a. GAD
b. OCD
c. MDD
d.personality disorder
Q?
A patient with hypertension and DM presented with MI. He was not compliant to medications,
smokes, eats fast food and works until late night.
What is the most important advice to adhere for the first month after discharge?
a. compliance
b. jogging.
c. stop smoking.
d.
e.
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Q?
60 y/o man, chronic smoker, presented with fever, cough and pleuritic chest pain (SIADH Case)
Renal profile:
Na- low
K- low
Urea- normal
creatinie- normal
serum osmolality- low
urine osmolality- high
What is the suitable fluid to be used?

a. Dextrose 10% infusion
b. Hypertonic saline infusion
c. Normal saline infusion
d. Potassium replacement
e. Fluid restriction
EMI: Congenital Infection
a- GBS
b- toxo
c- treponema pallidum
d- herpes simplex
e- CMV
f- varicella zoster
An unbooked teenager came in with active phase of labour at 32 weeks, delivered a baby with Apgar
score 7 in 1 mint and 8 in 5mint, presented with pale , peeling of skin of the palms and soles ,
hepatosplenomegaly.. ix- Hb - low , plt- low and hematocrit - low
Other EMI questions are not available. Sorry for the inconvenience.
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OBA 2
Q5
A 15 y/o boy came to A&E with a complaint of sudden right scrotal pain while playing football. There
is no history of trauma, no urinary symptoms such as dysuria, frequency or fever. On examination,
the scrotum swells and tender. The left scrotum is normal. Abdominal examination is soft and has
active bowel sound.
What is the most likely diagnosis?
a) orchitis
b) epididymitis
c) scrotal haematoma
d) strangulated inguinal hernia
e) testicular torsion
Q7 & Q8
43 years old malay lady presented with 2 days history of fever and right upper abdominal pain. On
examination, she was found to have yellowish discolouration of the sclera and tender right
hypochondric region. Investigations showed bilirubin as 300 and directed bilirubin as 200. LDH 600.
AST 200. ALP 342. HB 11. WCC 16x10^9 and platelet 350x10^9.
7. What the most likely diagnosis?
A.Asecending cholangitis
B.Actue Cholescystitis
C.Acute Hepatis
D.liver Abscess
E.Mirrizi's syndrome
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8. What the investigation to assist your diagnosis?
A.Abdominal Radiography
B.Abdominal ultrasound
C.Endoscopic Retrograde cholangiopancreatography
D.HIDA scan
E.Magnetic resonance cholangiopancreatogrphy
Q10
A 39-year old woman with long history of migraine presented with severe headache associated with
intermittent nausea and vomiting for 3 weeks. The headache was initially mild but became worst
after 3 weeks. However, she can still performed her daily chores. She was on anti migraine
medication. She had history of mastectomy with axillary clearance 3 years ago, chemotherapy and
radiotherapy for breast carcinoma. On examination, she was alert and conscious without any
neurological abnormalities. Her vital signs: BP - 120/70, PR - 70 bpm. Other physical examinations
were unremarkable.
What is next most appropriate initial management for her?
A. IV pethidine
B. Optimised her anti migraine medications
C. Perform a CT brain
D. IV dexamethasone.
E. IV fluid normal saline
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Q12
A 75 year old man with a background history of DM & HPT, presented with right loin pain radiating
to the right groin for 1 year. He occasionally had blood in his urine and pain on micturition. On
examination, the abdomen was not tender, no palpable abdominal mass, renal punch was -ve. Urine
Blood: 3+, Leucocyte: trace, Nitrite: -ve. Urea 19.7, Sodium- normal, Pottasium normal, Creatinine
200.
What is the appropriate investigation help to confirm the diagnosis?
A. CT Urogram
B. DTPA
C. DMSA
D. IVU
E. MRI
Q17
20 yo. Skidded & fall on right arm. In severe pain, unable to move right arm. Swelling + ecchomosis
right arm. There were lacerations 5x7 cm on right arm lateral aspect. He was not able to extend
wrist. Radiograph showed comminuted fracture at his mid shaft of humerus.
a) paraaesthesia palmar aspect little finger + medial side finger

b) positive froment sign
c)
d) no sensation at rt anatomical snuff box
e) wasting extensor aspect of arm
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Q18
A 17-year old boy complained of right knee pain for 6 months. The pain was gradually increasing in
nature, frequency and intensity. Radiograph of right knee revealed sunburst appearance on the
distal right femur and non-homogenous surrounding structures due to nearby infiltration. CT done
showed no metastatic changes. Biopsy of lesion done showed anaplastic and pleomorphic changes.
What is the best option of treatment you would like to offer to this patient?
A. chemotherapy + radiotherapy
B. chemo + surgery
C. chemo + physiotherapy
D. radiotherapy + analgesic
E. radiotherapy + surgery
Q27
24 years old primigravida came in labour. You are called to attend her after 18 hours in labour
augmented with oxytocin. A vacuum-assisted delivery was done due to maternal exhaustion.
Subsequently, a healthy male infant weighing 4.2 kg was delivered. After 30 min, you were informed
by the staff nurse in-charge that the patient is bleeding. You attended stat and her BP at that
moment was 80/50 mmHg. The bed linen was soaked in blood.
Which below is likely the cause for her BP finding?
A. Cervical laceration
B. DIVC
C. Uterine atony
D. Uterine rupture
E. Vulval hematoma
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Q30
45 years old lady, G8P7 at 34 weeks POA by LMP which she is unsure of, came for her first antenatal
visit. No dating scan was done earlier. She didn't complaint of any bleeding, abdominal pain or
decrease in fetal movement. Examination revealed clinical fundal height of 30 weeks with
symphysio-fundal height of 31 cm. By CTG, the FHR is 150 bpm.
Which is the likely cause for the above findings?
A. Unsure date
B. Fetal anomaly
C. IUGR
D. Oligohydramnios
E. Leaking liquor
Q42
23 year old lady compalining of irregular menses. She had menses every 3 to 4 months. She denied
any dysmenorrhea. On examination, she was obese and had hirsuitism. Transabdominal US was
done and found that there was pearl - necklace appearance in her ovary.
What is the best medication to treat her condition?
A. Cyclical provera
B. Diane 35
C. Loette
D. Enorgestrel implant
E. MIRENA
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Q44
A 58 year old man came with acute intestinal obstruction. He was planned for exploratory
laparotomy. Which of the following is the most appropriate airway device for him intraoperatively?
a. cuffed oral endotracheal tube

b.cuffed oral double lumen tube
c.cuffed nasotracheal tube
d.face mask and oropharyngeal airway
e.Proseal laryngeal mask airway
Q48
A 20-year old man man was brought to A & E from MVA ( from a burn car) scene.
At A & E, he was having stridor and grunting. His shirt was burned and there was a swelling at his
maxillary area. GCS 7/15. PR 28 bpm, spo2 79 %, bp 106/68, reduced breath sound bilaterally.
what is the appropriate immediate specific management for this patient?
a. urgent Ct scan
b. O2
c. endotracheal intubation
d. infusion
e.
Q53
62 years old man, diabetes mellitus and hypertension for 15 years, brought in by wife complaining of
sudden onset of severe headache and left sided weakness. On examination, GCS 11/15; there is
weakness of the left upper and lower limbs. What will be your investigation for this patient?
a)
b) CT of brain
c) Lumbar puncture
d) Blood culture
e) MRI of the brain
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Q?
A 24 years old woman G2P1 succesfully delivered fetal head. Despite adequate maternal effort and
uterine contraction the labour failed to progress.
What is the best appropiate step you would like to do?
A) Give oxygen via facemask

B) Mc Robert Manouvre
C) Deliver Posterior Shoulder
D) Apply pressure to suprapubic area
E) Episiotomy
Q?
A 17 years old footballer had an injury during the game. He had knee pain but after that, he
continued playing. 5 months later, he developed locking knee. On examination, it was tender around
his medial joint line. What the most likely diagnosis?
a) ACL injury
b) pcl injury
c) collateral ligament injury
d) medial meniscus injury
e) lateral meniscus injury
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EMQ
Q1: Defence mechanism
A) Acting out
B) Projection
C) Denial
D) Reaction formation
E) Sublimitation
F) Identification
G) displacement
1. A lady was treated for dysthymia for 2 years . She referred her conversation with her husband to
the doctor as, “I shouted to my husband last week when I came back home and found that his radio
was loud. I had a bad day and he should understand me better.”
2) A 23 years old man, angry to his supervisor. He enrolled to a karate class after office hour. He did
it several time and happier at work.
Q 2: Congenital Heart Disease
A. aortic stenosis- mild

B. aortic stenosis - severe
C. coarctation of aorta
D. Ventricular septal defect with Eisenmenger syndrome
E. PDA small
F. PDA large
G. Small ventricular septal defect
H. Tetralogy of Fallot
J. Transposition of great arteries
1. A 4-month old baby, presented with bluish discoloration on crying for 2 weeks. He was well in
between episode. No chest deformity. No thrills or parasternal heave. Apex beat at 4th intercostal
space, midclavicular line. First heart sound normal, second heart sound soft. There was ejection
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systolic murmur best heard on left sternal edge.
2. Baby have pan systolic murmur, grade 3/5, best heard at left sternal edge
Q3: Viral Exanthem
a. cytomegalovirus
b. human herpes virus
c. human immunodefeciency virus
d. treponema pallidum
e. parvovirus 19
1. A mother had rash and vulva lesion. She delivered a baby who had respiratory problem. On the
baby’s chest x-ray- there is "white out" lesion.
2. Unbooked, single, not married, sexually active college student came in labor at 36 wk POA.
delivered baby- had rash at palm n soles with peeling of skin; hepatosplenomegaly; anaemia
Q4: Psycotherapy intervention
a. non BDZ
b. clonazepam
c. CBT
d. breathing exercise.
e. exposure and response prevention
f.
g.
h.
j. muscular relaxation
1. Patient panic attack and hyperventilate
2. Patient was afraid going out to crowded places such as supermarket. Then, decide to stay at home
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Q5: Psychopathology
a. persecutory delusion
b. delusion of refernce
c. thought broadcasting
d.thought insertion
e. thought wthdrawal
1. Patient feel that people on TV was talking about him.
2. She believes that her family wanted to poison her.
Q6: Muscle weakness
a. myasthenia gravis
b. gullein bare.
c. periodic hypokalemic paralysis
d. spinal cord compression
e. stroke.
f. tranverse myelitis
g.
h.
1. patient had grave’s disease. weakness during party night. sensation intact. hypotonia.
2. patient had low back pain..hyperreflexia..up going plantar.
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Q7: Itchy and rash
a.psoriasis.
b. infected scabies.
c. photosensitivity rash
d.
e.
1. patient had rash hand and foot. all friends at hostel have the same lesion.
2. rash pinna, cheek, forehead
Q8: Nephro investigation
a. IVU
b. MCUG
c. ultrasound
d.UPCI
e.
1. a boy with periorbital swelling and oedema
2. congenital spina bifida
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Q9: Gynaecology investigations
A. Cervical biopsy
B. Cervical cauterization
C. Colposcopy
D. LLETZ
E. Pipelle sampling
F. Hysterosalpingogram
G. Beta-HCG
H. Alpha-fetoprotein
I. Ca-125
What is the most appropriate investigation?

1. A 65 y/o lady, post- menopause for 10 years and had been married for 35 years complaint of
spotting per vaginal bleeding. Her BMI was 37 kg/m2.Cervix was atrophic.
Q10:
A. AFP
B. beta HCG
C. CA 125
1. 21 years old with ovarian cancer stage 1A. right salphingoopherectomy was done, HPE found
endodermal sinus tumor. she come next month to monitor for recurrence.
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KFQ A
Q1
34 y/o Malay lady complained of 3 days history of gum bleeding. On examination she was afebrile
and vital signs were normal. She was not jaudice. Oral examination showed blood clots at her gum
and petechiea at hard palate and legs.
Result of FBC as follow :
Hb = 11
TWBC = 5.1
Platelet = 3
1. List 2 symptoms u would ask from the history (2 marks)
2. Interprete the result (2 marks)
3. Give 2 Differential Diagnosis (4 marks)
4. State 2 relevant blood investigations and expected findings (4 marks)
Q4
65 y/o man, dx as DM since 5 years ago (memang xde on waht medication) presented to A&E with
shortness of breath and lower lomb swelling (xde duration). On examination, he is tachypnoeic, BP
160/100 mmHg, afebrile, respi rate 28/min. There is pitting oedema of lower limb with bibasal
crepitation. Other systems were unremarkable. Investigation results were as follows:
FBC:
Hb 9.0
WCC 6.0
Plt 150
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RP:
K 6.0
Urea 15.0
Creatinine 400
Ca: 1.95
Phosphate: 2.95
Urine dipstick: ALbumin 3+
1. List 3 problems this patient is facing currently (3 marks)
2. Give 2 classes of medication that you would give to the patient and its main side effect (2 marks)
Unfortunately, during admission, he deteriorated and was referred to the nephrology team for
further management
3. Give 3 indications for dialysis in this patient (3 marks)
After 1 week of the above treatment, he improved and was discharged well.
4. Give 2 non-pharmacological advices that you would give to him on discharge (2 marks)
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KFQ B
7y/o girl,referred for persistent cough for one month. Cough was dry and occur throughout the day.
She also had low grade fever, malaise, LOA and LOW of 1 kg. She had received several course of
antibiotic with no improvement. Her grandmother who lived in the same house had a history of
chronic cough 3 months ago and has been on medication for 2 months. Other family member are
well. No medical history.
Clinically,s he was thin with weight on 3rd centile.BCG scar present. Temperature 37.8,resp rate
36,mild intercostal recession, O2 sat 95% under room air. Trachea centrally located, bronchial breath
sounds at right upper zone anteriorly. Percussion on same site- dull. Abdominal examination normal
1) The most likely diagnosis?
2)2 investigations and expected finding?
3) What medications you would start and state the duration of treatment
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KFQ C
Q1
Ms Sweet, a 25 year old lady with irregular menses for 1 year. She was having menses for every 3-4
months. Every menses was associated with heavy vaginal and clots. She having menses for the past 2
days presented with lethargy.
She attained menarche at the age of 13 with regular menses. No family history of malignancy,
hypertension or diabetes mellitus. She has no other medical problem. She is not sexually active and
the only child in the family.
P/E
BMI 29, severe facial hair with upper lip hair. Vital signs were stable, No abdominal tenderness or
mass palpable. Per-rectal was normal.
1. Give your full diagnosis. (2 marks)
2. Give 4 relevant investigations with expected findings. (4 marks)
3. What is the principle management at this point of time? (4 marks)
Q2
Madam S, G2P1, currently at 31 week of POA, coming today for antenatal check up. She had history
of vacuum delivery due to fetal distress with baby weighed 3.7kg. Otherwise there was no other
complication. On examination, her uterus was palpable at 36 weeks of gestation; there is singleton,
transverse lie, fetal part difficult to felt. Her BP was normal. Other systems were normal as well.
Her blood results show MGTT high

BSP high
Full blood count (x ingat)
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1. list 4 problems in this patient (2 marks)
2. plan for her antenatal management (4marks)
3. when do u want to deliver the baby and why? ( 2 marks)
4. Give 3 postnatal advices (4 marks)
Q3
- 42 years old lady - primigravida - coming for antenatal check up - LMNP: (it was a uterine-larger-
than-date case) - both parents passed away because HPT & DM - her BMI= 27
Her antenatal blood investigation results: (within acceptable range)

Her BP was also acceptable
1. List the problems in this patient (they asked for 5 problems)
2. From the problem list, name the complications that may occur during her pregnancy (give 3
problems from no. 1 & write down its complications to her pregnancy)
3. What other investigations that you would like to do & the indications for each, besides the usual
antenatal blood investigations (Give 3)
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Q4
60 years old para 4, 9 years post meopausal complaint of vaginal bleed for 4 month. married at 16
years old. married with man who has married 3x. 1st child at 17 years old. last child is already 30
year old. Husband died & then she remain widowed. EUA revealed ................... (explanation of
cervical ca FIGO IIB)
-what is your diagnosis (1 mark)
- list 4 risk factors in that woman (4 marks)
- what 2 other ix to stage (2 marks)
- what is mx for FIGO IIB (1 mark)
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KFQ D
Q1
A 38 year-old man presented to the emergency department complaining of acute epigastric pain. He
never had that kind of pain before. He was also jaundiced, hypotensive and had reduced urine
output.
1) Give 3 further history you would like to elicit from this patient (3m)
2) Give your provisional diagnosis and one differential diagnosis (2m)
3) What complication has occurred in this patient? (2m)
4) List all the relevant investigations done.
5) Outline the principle of your immediate management of this patient. (3m)
Q2
40 years old man; history of anterior neck swelling for past 5 years; recently complaint of palpitation
and feeling anxious. On examination – the swelling was a firm nodule 3x2cm; moves on swallowing.
His pulse was irregular at 120 beats/ min. He had fine tremor of his hands.
1) Provisional diagnosis?
2) One initial lab investigation to confirm the diagnosis and your expected result?
3)3 other relevant investigations and give a reason for each.
4)How would you treat this patient?
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Q3
Madam X, 55 year old lady, presented with history of breast lump for the past 2 years. The lump
measures 5x5cm, located at retroareolar area. Associated with peau d'orange, satellite nodules. Also
have palpable lymph node at the axilla and supraclavicular. Investigation showed presence of
multiple lung nodules.
- Give your diagnosis
- TNM staging for Madam X
- How to obtain tissue for histological diagnosis? List 2 methods.
- List two choices of treatment for the patient.
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KFQ E
Q1
Madam K, 67 years old lady, complaining of left knee pain since 5 years ago. The pain increases in
severity. There was no history of trauma before. On examination, there were varus deformity of the
knee with crepitus and limited joint movement. Her height is 1.5m and her weight is 78kg
1) List 3 differential diagnoses (3 marks)
2) On Radiological examination, joint space reduced and osteophytes were present. List 3 principles
of management for this patient? (3 marks)
3) What type of surgical intervention that you would offer her? (2 marks)
4) list 2 early post-operative complications
Q2
Female - pain and tenderness at dorsalradial side of dominan hand - when moving thumb, pain over
the thumb and radial side forearm
1. Provisional Diagnosis
2. Differential diagnoses. List two
3. Name the provocative test to confirm diagnosis
4. List the structures involve
5. 2 non-surgical management for the diagnosis
6. Name 2 complications of the surgical release.
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KFQ F
Q1
A woman complained of insomnia and interrupted sleep since 1 year ago when she was promoted to
become Assistant of principal. She has over worries about everyday matters like financial, death,
friends’ problem for the past 6 months. She found it is unreasonable but she cannot stop of thinking
about it. No other psychopathology except poor concentration and tired . No history o previous
medical or surgical problem. She has no history of substance abuse.
MSE : anxious women with tremor. Others are normal
1. What is your provisional diagnosis (2m)
2. 3 reason for your provisional diagnosis (3m)
3. 3 other differential diagnoses (3m)
4. 2 types of intervention that can be offered to her (2m)
Q2
A 20y/o man was brought to the clinic by his wife with complain of talking to himself and seeing
elephant playing footballs. At the same time he believed that his wife is trying to poison him. There
was no past pyschiatric hx except amphetamine abuse.
1. What is your provisional diagnosis?
2. What is your differential diagnosis?
3. List 4 psychopathologies
4. Outline your management
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UNMANNED OSCE
Q1
Ecg of 3 year old boy
Calculate :
a) Heart rate (2marks)
b) PR interval (2marks)
c) QRS axis (1mark)
Q2
Different types of solution (drip). You have to choose appropriate drip for different situations.
Q3
Miss PE, presented to A&E with h/o 7 weeks of amenorrhoea and right iliac fossa pain. UPT test was
positive and emergency laparoscopic was done.
Picture: Laparoscopic finding (ectopic pregnancy)
1. Describe the intra-op findings. (2marks)
2. What is your diagnosis? (1mark)
3. What are 2 risk factors of the above condition?(2marks)
4. What is the immediate management would you do on her? (1mark)
32 | P a g e
Q4
Picture of ERCP
56 year old man complaint of jaundice, fever and RHC pain for 2 days duration.
1.what is the procedure performed?
2. State 2 findings
3. What is the diagnosis?
4. What is the complication other than bleeding?
Q5
Picture of baby (anencephaly)
1. What is the abnormality shown? (1 mark)
2. Give 3 ANTENATAL complications (3 marks)
3. What medication can be given to mother to prevent this? (1 mark)
Q6
65 years old man complaining of intermittent claudication and gangrene of left 2nd toe with
surrounding cellulitis for 1 week duration.
1. What is your diagnosis?
2. List one diagnostic investigation.
3. What is your initial management?
4. What is the therapeutic procedure for the patient?
33 | P a g e
Q7
80-year-old gentleman presented with progressive visual loss for past 5 months; no history of red
eye or painful eye; right eye down to light perception only visual acuity on the left eye was 6/60.
Given a funduscopy picture and Humphrey's visual field.
1) 2 abnormalities in the funduscopy (2 marks)
2) type of visual abnormality from the graft (1 mark)
3) diagnosis (2 marks)
Q8
A&E. Instrument shown (cervical collar)
1. What is this?(1 mark)
2. What are the indications? (2 marks)
3. What are the adverse effects? (2marks)
34 | P a g e
Q9
A note was found beside an 18-year old high school dropout. He had history of being treated for
depression.He was found unconcious in his locked room.
'Dear mum and dad,

When you find this note I will be far away, in a better place
Dad, you can relax now,
After 17 years of hitting, belting me, and telling everyone that I am the most useless, worthless son
compared to your other 4 university graduate children, u can rest now.
I know I will succeed this time after multiple times failing before this. I looked up the dosage of the
tablets that will make me not coming back to this world.'
1. What type of note is that? (1mark)
2. Based on the information given, what do you think points towards the seriousness of this patient's
intention of taking his life? (2marks)
3. How would you describe the relationship between the patient and his father? (2marks)
Q10
Picture shown: A machine
1. What is this? (Patient-controlled analgesia)( 1 mark)
2. arrow = button controller (1 mark)
3. common drug used= (1 mark)
4. pt's parameter ( four) ( 2 marks)
35 | P a g e
Q11
PIC A- single round wound at right hypochoncdriac region(gun shot wound)
PIC B- postmortem pic, intrabdominal bleeding
1. Describe lesion in Pic A (2marks)
2. What are the cause of death?( 2 marks)
3. What is the weapon being used?(1mark)
4. What is the manner of death? (1mark)
Q 12
30 years old man, national service camp instructor with fever and chills. Peripheral blood film given.
(malaria)
*picture shown was not clear. Unsure which species.
1. Describe the abnormality. (1 mark)
2. What is the diagnosis? (2 marks)
3. What is the treatment? (2 marks)
Q13
Picture of hand (Scleroderma)
1. Describe the abnormality (3 marks)
2. What is your diagnosis (1 mark)
3. State the serological investigation. (1 mark)
36 | P a g e
Q 14
34 year old man, sudden onset of right chest pain and SOB. No history of trauma.
X-Ray shown.
1. what is the diagnosis?
2. What is the most likely cause?
3. What is immediate therapeutic intervention? What landmark?
Q15
This question is not available. Sorry for the inconvenience.
Q16
A 70-year old woman presented with right hip pain after trivial fall.
Radiographic Xray of Pelvis-Showing Fracture of Right Neck of Femur
1.Describe the Xray Finding (2 marks)
2.Classification used for this fracture? (1 mark)
3.Other Investigation to know the causes of the fracture? (1 mark)
4. How do you manage? (1 mark)
37 | P a g e
Q17
Given a picture of common equipment used in orthopaedic surgery.
(Tourniquet)
1. Name the device (1 mark)
2. Give TWO reasons using this equipment (2 marks)
3. What is the maximum pressure to apply if the systolic of the upper limb is 150mmHg (1 mark)
4. Give one complication of this procedure (1 mark)
Q 18
(Sorry)
Q 19
A picture of an ambulance with a man standing inside
(1) what are the possible hazards seen in the picture shown (2 marks)
(2) how is the hierarchy of control of the occupational safety and health hazards? (2 marks)
(3) what is the legislation control? (1 mark)
Q 20
A table from a Cohort Study was shown.
1. % obese with DM (1 mark)
2. % non-obese with DM (1 mark)
3. is the result significant? (1 mark)
4. count relative risk (2 marks)
38 | P a g e

MD (UKM) Class of 2010: Contoh Soalan Peperiksaan Ikhtisas M.D. (Ukm) Sesi 2009/10

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MD (UKM) Class of 2010: Contoh Soalan Peperiksaan Ikhtisas M.D. (Ukm) Sesi 2009/10

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MD (UKM) Class of 2010

CONTOH SOALAN PEPERIKSAAN IKHTISAS M.D. (UKM) SESI 2009/10

With compliments from;

What is most likely diagnosis?

What is your IMMEDIATE step to control his bleeding?

So, what is the most appropriate investigation to make a diagnosis?

Q14 (Q13 scenario)

His ABG result were :

The most like likely medication associated with this condition :

What would your immediate management be?

What is your most likely diagnosis?

What is the first step as a health authority at the airport?

What is the suitable fluid to be used?

EMI: Congenital Infection

What is the most likely diagnosis?

7. What the most likely diagnosis?

8. What the investigation to assist your diagnosis?

What is next most appropriate initial management for her?

a) paraaesthesia palmar aspect little finger + medial side finger

What is the best medication to treat her condition?

a. cuffed oral endotracheal tube

What is the best appropiate step you would like to do?

A) Give oxygen via facemask

Q 2: Congenital Heart Disease

A. aortic stenosis- mild

systolic murmur best heard on left sternal edge.

Q3: Viral Exanthem

Q4: Psycotherapy intervention

1. Patient panic attack and hyperventilate

1. Patient feel that people on TV was talking about him.

2. She believes that her family wanted to poison her.

Q6: Muscle weakness

2. patient had low back pain..hyperreflexia..up going plantar.

Q7: Itchy and rash

2. rash pinna, cheek, forehead

Q8: Nephro investigation

1. a boy with periorbital swelling and oedema

2. congenital spina bifida

Q9: Gynaecology investigations

What is the most appropriate investigation?

Result of FBC as follow :

1. List 2 symptoms u would ask from the history (2 marks)

2. Interprete the result (2 marks)

3. Give 2 Differential Diagnosis (4 marks)

4. State 2 relevant blood investigations and expected findings (4 marks)

Urine dipstick: ALbumin 3+

1. List 3 problems this patient is facing currently (3 marks)

3. Give 3 indications for dialysis in this patient (3 marks)

1) The most likely diagnosis?

2)2 investigations and expected finding?

1. Give your full diagnosis. (2 marks)

2. Give 4 relevant investigations with expected findings. (4 marks)

3. What is the principle management at this point of time? (4 marks)

Her blood results show MGTT high

1. list 4 problems in this patient (2 marks)

2. plan for her antenatal management (4marks)

3. when do u want to deliver the baby and why? ( 2 marks)

4. Give 3 postnatal advices (4 marks)

Her antenatal blood investigation results: (within acceptable range)

1. List the problems in this patient (they asked for 5 problems)

-what is your diagnosis (1 mark)

- list 4 risk factors in that woman (4 marks)

- what 2 other ix to stage (2 marks)