13 july 2023 by zoom session

Please if you find any mistake then inform us.. thank you

Q1----A 18-year-old girl comes with father; with a with 10-week pregnancy, she don't want you to tell
this to her father. She has right arm fracture and not speaking in front of her father.What in history
suggest physical abuse by father?
A. Fracture of right arm.
B. Patient's mood and affect
C. The secret pregnancy
D. Hx of previous hospitalizations ????
Q2-----Which valvular disease is most commonly associated with the sudden death in younger patients?
a. Aortic stenosis… if asked valvular disease ???? but it is more common in older patients
b. Mitral stenosis
c. IHSS- Idiopathic Hypertrophic Subaortic Stenosis - HOCM. More common in young
d. Tetralogy of Fallot
e. Mitral valve prolapsed

So here asked valvular so answer is A

Q3---53yr male with DM has foot ulcer on sole of foot and is allergic to penicillin. What is the next best
management?
A. Amoxicillin
B. Co-amoxiclav
C. Clindamycin
D. X-ray…. After antibiotic…. First line investigation
E. MRI…. To exclude osteomyelitis….it is common in DM patient

In this question we confuse between treatment or investigation.

Investigation Xray first line and MRI best

Treatment antibiotics

This picture is from RACGP .. according to this first According to this

go with xray then treatment First line xray
Best is MRI
Q4---- Elderly man taking oxycodone/naloxone, added to amitriptyline he has been using for pain.Now
px presented with cramps of legs.What is the cause?
A. SS– SS: hyperreflexia mydriasis inc BS, Txciproheptidine-- Serotonin syndrome

B. NMS- SS hyporeflexia, N pupils Tx Iv benzo, dantrolene Na, bromocriptine-- neuroliptic malignant

syndrome..

C. TCA toxicity
 Q5---A patient came to your practice because of sore throat.The nurse informed you that she hasn't
paid for the last three consultations. What should you do?

a.Ask patient to go to public hospital…

b. Leave a prescription for amoxicillin… if
c. Book her for the next available appointment
d. See her after she paid the previous all
e. Refuse to see her

Q6---Lady travelled to Kenya, wt loss jaundice. Was taking doxycycline.increased liver enzymes,bilirubin.
What's the diagnosis

a. Malaria.. already took doxycycline

b. yellow fever.. patient did not take vaccination.
c. pancreatic cancer
d. Ross river fever
e. Choledocholithiasis

Malaria and TB common in Kenya

Patient is not vaccinated,, it may be yellow fever

Yellow fever can cause liver symptoms

Here weight loss is confusing.. check in exam weight loss is gradual or sudden

It may cause hepatitis, an inflammation (cellular damage) of the liver. Hepatitis can cause
jaundice, a yellow discoloration of the eyes and skin that led to the name "yellow fever."
This liver damage can also lead to disruption of the normal clotting of blood, resulting in
bleeding.
Q6---Temporal Lobe epilepsy.most appropriate initial mx.

A.sodium valproate… old

B.lamotrigene…new
C.Levitiracetam

Now guildline is changed. But JM 8th edition go with old guildline.. references shows both so go
with your answer… amedex qbank also go with new

Older antiepileptic drugs (AEDs) used for seizure control in temporal lobe epilepsy have some
long-term side effects and require lab monitoring:
Phenytoin
Carbamazepine
Valproate
Phenobarbital
Newer AEDs appear to be comparably effective but with fewer side effects and don't requre lab
monitoring for the most part:
Gabapentin
Pregabalin
Topiramate
Lamotrigine
Levetiracetam
Oxcarbazepine
Zonisamide
Lacosamide
Briviacetam
Clobazam
Rufinamide
Perampanel
Vigabatrin (for intractable)
Felbamate (for intractable)
Q7---Patient came for routine check-up. With result of 60% carotid stenosis. No symptoms. Looks well.
Management?
A. Give Unfractionated heparin - look for aspirin/antiplatelet for the option
B. Carotid endartectomy
C. Angiography
The gold standard treatment for symptomatic disease is carotid endarterectomy (CEA), the main goal of surgery
being to minimise the risk of recurrent stroke from an unstable plaque, with surgery having no impact on the outcome
of the initial stroke. RACGP

medical therapy alone is now considered by many to be increasingly comparable to surgical management for stroke
risk prevention in asymptomatic disease..

A reasonable approach from a general practice point of view is to refer asymptomatic patients with an ICA stenosis of
>80% for a non-urgent vascular surgical review for consideration of surgery. 16 The likely scenarios that could occur
would be either the decision for medical management only with ongoing surveillance or the decision for surgery after
careful consideration of the cumulative stroke reduction risk in that particular patient.

For asymptomatic patients with an ICA stenosis of <80%, referral is usually not required.

The commencement of best medical therapy (BMT) is the main principle of treatment for asymptomatic disease. This
includes antiplatelet therapy, statin therapy and cardiovascular risk modification. The antiplatelet of choice for
asymptomatic disease is generally aspirin monotherapy RACGP
Q8---Pt admit with stab injury to r.scapula . Bp.80/60.sob.after oxygen and iv fluid .next step.saturation
95%
a) removeknife.
b) cxr
c) ct scan
d) Intubation… it can worse BP

Tension pneumothorax

For unstable patient not go for CT

 In any patient presenting with chest trauma, airway, breathing, and circulation
should be assessed. Penetrating chest wounds must be covered with an airtight
occlusive bandage and clean plastic sheeting.
Positive pressure ventilation should be avoided initially, as it will increase the
tension pneumothorax's size. Patients can be placed on positive pressure
ventilation after a chest tube is placed
If the patient is hemodynamically unstable and clinical suspicion is high for
pneumothorax, immediate needle decompression must be performed without delay.
Needle decompression is done at the second intercostal space in the midclavicular
line above the rib with an angio-catheter. .
Following needle decompression, a CXR is done, and a chest tube is usually
placed.

Pneumothorax may result when blunt force (such as a motor vehicle crash
or fall) or a penetrating injury (such as a stab or gunshot wound) damages
the lungs and/or airways.
The damage allows air to leave the lung and collect between the lung and
the wall of the chest. Air from the pneumothorax may also leak into the
skin of the chest or neck. Many people also have blood in the pleural
space (hemopneumothorax).
Doctors usually diagnose a pneumothorax based on a chest x-ray.

Q9….A pxt with liver cirrhosis second to HCV, which vaccines, can he not take
A)HBV
B) influenza
C) Pneumococcal
D)BCG -live attenuated vaccine… it is contraindicated in immunocompromize patient
Q10--Cardiology A 75 years old, M, present to ED with CO worsening SOB; chest pain and fatigue for few
days. He has h/o HTN hyperlipidemia and aortic stenosis with systolic gradient of 45 mmhg and EF 35%.
What will be treatment?
A. Aortic valve replacement AVR
B. Percutaneous Aortic valvuloplastyor TAVI…. Transcathetor aortic valve implantation
C. CABG
D. Periodic monitoring with echo

EF 50 or above is normal, below 40 is abnormal

Diagnosis.. biventricular heart failure due to aortic stenosis

Q11---. Pregnant lady with systolic murmur at left upper sternal border, diastolic murmur at tricuspid
area, second heart sound split. Apex beat is palpable just outside the mid clavicular line. CXR shows
prominent pulmonary veins. Dx?

a. TS
b. ASD
c. VSD
d. PS -
e. MS
Q12---An old woman came to the ED with vulvar erythema and vaginal pain. She had some symptoms of
candidiasis which was confirmed by labs. How will you treat this woman?

a. Oral Nystatin
b. Oral Fluconazole. Because it is confirm case of candidiasis
c. HRT
d. Topical estrogen
e. Oral Clotrimazole

Q13--- female with recurrent candidiasis from 12 months.Rx

a. topical miconazole
b. topical nystatin
c. oral ketoconazole
d. oral fluconazole

according to RACGP oral first.. see in question other symtoms

Uncomplicated cases of vulvovaginal candidiasis respond to azole treatments at least 80% of the time.
Topical imidazole creams occasionally cause local side effects such as vaginal burning or irritation.
Fluconazole is an oral treatment available over-the-counter and is taken as a single statim dose. Nausea
and vomiting are infrequent side effects. Topical hydrocortisone cream may be used in addition for
symptomatic relief of vulval symptoms… RACGP

Recurrent vulvovaginal candidiasis It is recommended women with recurrent vulvovaginal candidiasis

are prescribed a longer course of azole therapy.

A suppressive course of treatment is then commenced. There are differing opinions on how aggressive
suppressive treatment should be – weekly or monthly treatments. weekly doses of oral fluconazole as
this will achieve therapeutic concentrations in the vagina for 3–5 days and reduce the attack rate by
more than 90%. Ketoconazole is another oral therapy used for suppressive treatment. Hepatotoxicity is
a known complication of both fluconazole and ketoconzole and this becomes more important with
prolonged treatment. Another option would be 500 mg of clotriamazole intravaginally weekly.2,4
Maintenance therapy needs to continue for at least 6 months. During this time, 90% of patients can
expect to be symptom free. On ceasing maintenance therapy, 60–70% of women will experience
recurrence of symptoms within 1–2 months. This can initially be treated as simple vulvovaginal
candidiasis with the usual treatment. However, if infections continue, the patient should again repeat
the treatment process.
Q14---. Female with recurrent candidiasis 4 times in last 6 months. Clotrimazole vaginal cream helped
controlling the symptoms last 3 times. What is the most appropriate next step?

b. Oral Nystatin
b. Oral Greisofulvin
c. Oral Ketoconazole
d. Oral Fluconazole…
e. Vaginal Nystatin
Q15---. 3 year old boy. Lump above the inguinal ligament. Tender. Non reducalble. Fever can't
remember.

a. reassure
b. USS
c. Review again in few weeks

Undescented testes

Q16…. old man with her wife.disoriented and confused.has diarrhoea for 24hr and H/O prostectome
1week ago, catheterised for it. IV fluid given yesterday and concious level improved. Now he comes with
urine output of 20ml/hr and his RFT is normal, What to do?

a. Give bolus of IV saline

b. IV furosemide
c. Encourage oral rehyd
d. Catheter flush

Q17---. 80yrs depressed started on sertraline 4 weeks later confused bloods- sodium low rest all normal
what to do next?
a) stop sertraline
b) normal saline

Sertraline can cause hyponatremia

Q18---. inferior wall MI given aspirin morphine and oxygen what next?
a) adrenaline
b) IV fluids
c) nitrates
d) PCI

We avoid nitrates in inferior wall MI… because inferior MI is present with hypotension
Q19---. 37yrs old patient Heavy menstrual bleeding abdominal examination normal transvaginal USG
normal with anemia what to do next?
a) OCpills
b) norethisterone
c) Mirena
d) depot injections
Q20--. G2P1 at 10weeks prev H/O VTE on 2nd postpartum day thrombophilia testing- heterozgous factor
V leiden mutation now comes to antenatal clinic what to do?
a) therapeutic LMWH now till 6 weeks postpartum….
b) Prophylactic LMWH now till 6 weeks postpartum….

c) compression stockings
d) LMWH only in postpartum period

Initial anticoagulant treatment of VTE in pregnancy In clinically suspected DVT or PE, treatment with
low-molecular-weight heparin (LMWH) should be commenced immediately until the diagnosis is
excluded by objective testing, unless treatment is strongly contraindicated. RACGP

Treatment with therapeutic doses of subcutaneous LMWH should be employed during the remainder of
the pregnancy and for at least 6 weeks postnatally and until at least 3 months of treatment has been
given in total.

Q21---. Intern during tetanus vaccination gets needle prick informs immediately to the training head the
patient is gone by that time not traceable what to do ?
a. HIV and hepatitis B postexposure prophylaxis
b. Ask police to trace the patient

Q22--. Athlete pain over the anterior tibia continues to run, tenderness over lower third of tibia X ray
normal what is the diagnosis?

a. osteochondritis
b. Stress fracture of tibia
Q24--. middle age man with frequent quarrels with colleagues had to attend court due to violence and
also had witness violence in family as a child what is the diagnosis?

a. Acute stress disorder

b. Prodromal shizophrenia
c. Bipolar disorder ?????

Q25. Treatment for bloating in pms.. premenstrual syndrom

1. Cocp
2. Pop

1--Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve aches, pains,

and dysmenorrhea.
2--Selective serotonin release inhibitors (SSRIs) have been shown in randomized
trials to improve mood and lessen physical symptoms such as breast tenderness and
changes in appetite. SSRIs are the medications of choice for relief of anxiety,
irritability, and other emotional symptoms, particularly if stress cannot be avoided.
include fluoxetine, sertraline and paroxetine.
3--Anxiolytics may help but are usually less desirable because dependence or
addiction is possible.
4--Buspirone, which may be given throughout the cycle or during the late luteal phase,
helps relieve symptoms of PMS and PMDD. Adverse effects include nausea,
headache, anxiety, and dizziness.
For some women, hormonal manipulation is effective. Options include
 Oral contraceptives COCP
 Progesterone by vaginal suppository (200 to 400 mg once a day)
 An oral progestogen (eg, micronized progesterone 100 mg at bedtime) for 10 to
12 days before mense
Q26... 5 months Baby constipation for 6 weeks. Switched to cow milk 3 months ago from breastfeeding.
Recently started on solids 1 week ago. Cause?

a. Cow protein allergy… it cause Diarrhea according to JM

b. Cow milk allergy…it is common cause of constipation according to JM
c. Dec fluid intake… because baby got constipation after 6 weeks of cow intake
Q27…. 17 years old boy left home 3 years ago, had sexual assault 18 months ago.history of multiple law
breaks, violations. Clue to make his diagnosis…
a. Flashbacks … if you find any previous history related to his disorder
b. Suicidal thoughts
c. Delusions
d. Family hx of antisocial personality

Etiology of Antisocial Personality Disorder

Both genetic and environmental factors (eg, abuse during childhood)
contribute to the development of antisocial personality disorder. A possible
mechanism is impulsive aggression, related to abnormal serotonin
transporter functioning. Disregard for the pain of others during early
childhood has been linked to antisocial behavior during late adolescence.
Antisocial personality disorder is more common among 1st-degree relatives
of patients with the disorder than among the general population. Risk of
developing this disorder is increased in both adopted and biologic children of
parents with the disorder.
If conduct disorder accompanied by attention-deficit/hyperactivity
disorder develops before age 10 years, risk of developing antisocial
personality disorder during adulthood is increased. Risk of conduct disorder
evolving into antisocial personality disorder may be increased when parents
abuse or neglect the child or are inconsistent in discipline or in parenting
style (eg, switching from warm and supportive to cold and critical).
Q28… 6 months brought pale sweating CRT >3 HR 200 BP unappreciated ECG SVT 280

a. Valsalva.. if patient is not in shock then initial valsalva

b. Adenosine
c. Metoprolol
d. DC 1j/kg … due to patient is in shock
Q29... Male with hematemesis known to alcoholic liver disease BP 100/70 HR 120 Then Bp suddenly
80/50 on sitting didn’t say repeat HR.Est loss

a. <10
b. 30
c. 40 ???
d. >45%
Q30. Surgery consultant asking his registrar to write him script for diazepam as he has panic attack and
work is too distressing

a. Write SSRI
b. Diazepam for 2 days
c. Report to Ahpra
d. Report to medical administrator

Self prescribing should be notified to Medical board

Panic attacks during surgery could be a problem

Ask him to consultant his gp

Notifiable conduct to AHPRA or medical board

 toxicated by alcohol or drugs while practicing

 sexual misconduct in connection with the practice
 practitioner"s impairment placed the public at risk
 practitioner constitute a significant departure from accepted professional standards

Above are the indication to go to Aphra

This scenario directly to medical administration or director

Q31. New patient in clinic from interstate with letter from GP known sponylolisthesis with CT result.
Asking for Oxycodone prescription old GP is not answering on phone

a. Give panadeine forte

b. Give Oxycodone for 5 days
c. Consult shopping pharamacy department
d. Do not write script

Q32. 10 week old baby with poor feeding , irritable , no weight gain, bibasal crepes and hepatomegaly
ask dx ?

a-Congestive heart failure….age???

incomplete question with options… may be it is cystic fibrosis

Q33... An obstetric USS at 18 week all normal hx mentioned smoker even in pregnancy now 26-28 week,
head circumferenc and abdominal circumference low. Femur length- within normal, Amniotic fluid index
low ask causes

a…placental insufficiency

Q34... Scenario of male taking quetiapine. Low libido and low testosterone level. Prolactin is 5400 mU/l
(Exactly the same prolactin level). no increased ICP symptoms. Asking for cause?

a. Prolactinoma… more then 5000 or 4000…. If less then drug induce

b. Antipsychotic

Q35…. A 91 year old, frail ,nursing home resident is found dead, and as the general practitioner you have
been asked to issue the death certificate. Two days before he was having urinary track symptoms and
confusion and fever. Yesterday morning, he was found unconscious on the floor with a laceration on the
scalp. What would be the cause of death?
A) sepsis
B) urinary track infection
C) death certificate can not be issued
D) head injury

Are there any specific rules regarding age as have read for newborns death when cause is unknown is
reported to colonel

Yes people have property issues also. You don’t know… So coroner confirms

If asked only cause then head injury

Q--36. alzimer patient. psychosis plus. DM Plus....bloodsugar high 8.5... Don't like to take insulin
1..resperidone.. it is contraindicated in DM
2...galantamine.. it is safe in DM
3...longterm insulin...
Diabetes can indeed cause psychosis, but this secondary form of psychosis comes and goes. Controlling
blood sugar so it stays within a healthy range can prevent psychotic episodes and improve quality of life.

Galantamine is an oral medication used for mild-to-moderate Alzheimer's disease. It belongs to a drug
class called acetylcholinesterase inhibitor

could be attributed partly to the enhancement of insulin and Wnt/β-catenin signaling

pathways. Galantamine can be strongly considered as a potential antidiabetic agent and as an add-on
therapy with other oral antidiabetics
Q--37. young lady took diazepam, paracetamol and metformin. Was in severe metabolic acidosis. pH 7.0
HCO3 12 What to do?

a. Activated charcoal
b. *Hemodialysis… because 7 is very low
c. Bicarbonate… 7.2

One of the indication of hemodylysis is metabolic acidosis

Q39... Testicular swelling on standing. Not on lying. No transillumination. Reason?

a. Hrdocele,,, it is tranilluminate
b. Varicocele,,, 2nd grade is on standing…

Q40... Xray of bowel obstruction.

Sl obstruction _central location,step ladder pattern,not much distended like large intestine,history of
past surgery,nausea and vimitting

LI obstruction:large dilated bowel loop,peripheral located,constipation, usually no nausea and vomiting

Central dilated loops in SBO and peripheral or inverted U shaped dilated loops in LBO

ray suggestive of bowel obstruction include dilated bowel loops with air-fluid level, distal collapsed
bowel, absence of gas in the abdomen or alternatively, "string of pearls" sign indicating trapped

Q41. Ct of liver abcess. Management?

Q42... Women with history of multiple compliants and labs normal. Now presented with abdominal pain
and some join pains. What to do

a. Reassure
b. Counsel that these are somatic
c. Investigate current issues

Q43... Similar scenario of multiple issues and no organic cause asking reason

a. Somatic disorder
b. Hypochondriasis
c. Factitious
Q44... Son complaint of mother giving gifts to nurse. Recently goven dinner set. What would you do

a. Talk to nurse
b. Told son to talk to nurse
c. Talk to patient

Son comes to your practise regarding his 82 year old mother saying that the nurse from your practise is
using his mother for financial purpose as she has been giving her expensive gifts and recently added her
to her will as a beneficiary. What will you do?

► - Ask son to speak to nurse

► - Arrange appointment with the mother,,, confirm from one GP

► - Raise issue with the nurse

► - Report her to APHRA

47. One long scenario of man alcoholic and 40 pack yr smoker found confused in home. Has lung opacity
labs had hyponatremia and low chloride Cause of confusion

a. Lung CA
b. Wernicke's encephalopathy
c. Congestive heart failure
48. 6 years old kid with slow language improvement.When the parents say something to him,he repeats
3 words from what the parents say.He doesn’t watch the same tv program for more than five
minutes.When the doctor talks to him,he repeats only 3 words from what the doctor said to him.
A.Autism
B.Asperger
C.ADHD
49. 24 wks pregnant pt with passage of 90ml blood. She also came a few weeks ago with 10ml blood
loss. USG showed grade 4 placenta previa. What to do?
a. Repeat usg
b. CTG
c. Haematological studies
d. Blood transfusion
e. crossmatch
50. 75 year old female patient,on a number of drugs including statin, presents with proximal muscle
weakness.On examination muscles of the shoulders are tender on palpation. Laboratory examination
shows raised ESR and CK is normal. What is your possible Diagnosis?
a)Drug induced myositis… ESR will be normal… CK increase
b)Dermatomyositis…. ESR will be increase… CK also increase
C)Polymyositis
D)polymyalgia rheumatic… ESR icrease… but CK normal
51. Son comes to your practise regarding his 82 year old mother saying that the nurse from your practise
is using his mother for financial purpose as she has been giving her expensive gifts and recently added
her to her will as a beneficiary. What will you do?

a. Ask son to speak to nurse

b. Arrange appointment with the mother,,, confirm from one GP
c. Raise issue with the nurse
d. Report her to APHRA

52. Aboriginal woman comes to you with 5 month history of insomnia, anxiety and depression. You want
to start her on escitalopram but she refuses. She wants to see a traditional healer within her community
instead.

a. involve indigenous officer

b. provide her leave to go see transitional healer
c. involuntarily detain her

53. most appropriate therapy for pulmonary embolism in a patient who suffered three broken ribs, a
fractured pelvis requiring operative intervention, and a subdural hematoma in a motor vehicle accident
is which of the following:
a. Unfractionated heparin
b. Low-molecular-weight heparin
c. Inferior vena cava filter …. THIS IS FOR PREVENTION NOT TREATMENT
d. Dabigatran
A 70-year-old woman presents with weight loss of 3kg, vague headaches, aching al over the body and
morning stiffness of the shoulder and hip girdles. These symptoms have been present for the past six
months. Physical examination is normal, except ofr sometenderness in the muscles of her
shoulder.Investigations show a normochromic normocytic. anaemia, erythrocyte sedimentation rate (ES)
of 65 mm/h (5-20) and raised C-reactive protein. Al other investigations, including muscle enzymes, are
normal. Which one of the following si the most likely diagnosis?
A. M u l t i p l e m y e l o m a .
B. Polymyalgia rheumatica.
C. Rheumatoid arthritis.

D. Occult malignancy.
.E Polymyositis.
54. mediastinal widening bilaterally but no apical lesions seen.Diagnosis?
1. Sarcoidosis…Biliteral hilar lympadenopathy
2. TB….consolidation… apical cavity…
3. Lymphoma….

55. 17 yrs old son..left home at the age of 15.sexually assaulted a girl 18 months back and
imprisonment..multiple previous self cut injuries in hands doesnt want to talk about it.multiple
substance abuse..what in the history is important to come to a diagnosi?
1. sleeping disturbance
2. family history of antisocial disorders and imprisonment
3. poorschool.performance
4. Childhood abuse

49 year old man who is a known case of HTN and DM on Captopril, Metformin,
Aspirin and sildenafil. Came with acute anterior MI, what will be your next step for
reducing his chest pain?

A. Naproxen
B. Morphine

C. Nitrates… it is contraindicated because of sildenafil

D. Paracetamol
E. Beta blocker
56. Patient with lung cancer, hyperkalemia, hypercalcemia, and rise creatinine, after iv hydration what
to do
1. Furosemide
2. Pamidronate
3. Dialysis

Sq cell May cause hypercalcemia bcz of ectopic pTH peptide

Hypercalcemia is damaging kidneys

Furosemide will Make HyperCalcemia worse and dialysis is done if potassium is too high which would
come with ECG changes

pamidronate will only lower the levels of calcium

57. Pregnant woman with vaginal bleeding and abd pain, what is the most significant agent to cause the
complication?
1. Alcohol
2. Smoking
3. Cocaine

Because smoking just stuns growth and alcohol cases not many with bleeding..less chances
So abruption as said...cocaine is
61. Boy fell from bike.tenderness in left upper quadrant. All vitals normal. What to do next?
A. usg
B. Cxr
C. Ct abdomen
62. Testicular firm swelling in 30 yrs old. Cause

a. Seminoma
b. Nonseminoma
c. Hydrocele.
63. Male patient develops pain in DIP joint, apart from psoriatic rashes in scalp. Physical examination is
normal, Diagnosis?
1) Psoriatic arthritis -
2) Reiters–

Skin lesions precede arthritis in psoriatic arthritis

What are the early signs of psoriatic arthritis?

A thick, red rash or scaly patches of silvery white skin.

Stiff, painful, swollen, warm joints (large joints like knees or small ones in your fingers)

Fatigue.

Inflammation in your eyes (causing redness and blurred vision)

64. An obstetric USS at 18 week all normal hx mentioned smoker even in pregnancy now, 36 week, HC
and AC low, FL - within normal. Amniotic fluid index low ask causes
A placental insufficiency …all parameters will be low accept HC.
B fetal anemia
C IUGR…asymetrical
D Congenital Abnormality
65. Patient presented with agitation and psychosis and accuses wife of having an affair. Doesn't want to
take his insulin. HBA1C 8.5. What to do next.
A. Risperidone
B. Gabapentin
C. 10 mg Acting Insulin

D… haloperidol…aripiprazole.. ziprasidone
67. Upper abdominal pain radiating to back for some days. Lipase, amylase, troponin are ordered. While
waiting, what will you do?
A. CT abdomen
B. USS
68. Patient difficulty in swallowing solid than liquid. Regurgitation +. What to do?
A. Oesophagoscopy
B. Barium meal follow through
C. Barium swallow …first investigation
D. Manometry…accurate investigation
69. Upper epigastric pain radiation to back, nausea and vomiting +. Non smoker and drink 5-6 alcohol
per day. Ex, tenderness and guarding on epigastrium. Vitals BP low side
A. Peptic Ulcer perforation
B. Acute appendicitis
C. Acute cholecystitis

70. Valgus injury. What to be tear (Which is most likely torn)?

A. Patellar tendon injury
B. Lateral miniscus tear
C. Lateral collateral tear
D.Medialcollatera ligament
71. After injury, pain in the middle calf. Cannot do extension. No pain on passive movements. What to
do?
A. mRI
B. USS
C. X ray

Achilles tendon???
73. Man standing in balcony and fisting clouds, saying something, he is untidy..What will help you to
diagnose?
A. Empty beer bottles in house

Alcohol may be cause hallucination.. auditory or visual

Diogenes syndrome is a behavioral-health condition characterized by poor personal hygiene, hoarding,

and unkempt living conditions. It is most common in older men and women, which is why it is also called
senile squalor syndrome

74. A. One question was vasectomy came after 3 months with motile sperms. What you are going to
advise?
1) Repeat next month
2) He can do sex now

75. 4 months after vasectomies, 20+ ejaculations already done. Still non motile sperms in semen.What
to do?
1- need more ejaculations
2- do USG for spermatocele
3- can safely have sex
4- Renal tract USG
91 year old, frail ,nursing home resident is found dead, and as the general practitioner you have

been asked to issue the death certificate. Two days before he was having urinary track symptoms and

confusion and fever. Yesterday morning, he was found unconscious on the floor with a laceration on the

scalp. What would be the cause of death?

A) sepsis

B) urinary track infection

C) death certificate can not be issued

D) head injury
77. One person got MI and had stent 5 days back and now he again came with severe shearing pain and
st elevation in ecg. Cause?
1) Stent thrombosis -
2) Coronary artery dissection
3) Pericarditis–

78. Indomethacin Given for gouty arthritis. Pt had hyponatremia and other renal derangement. Gout not
Subsided. What's Next
A. Prednisolone
B. Stop Indomethacin

79. 5 year old child recurrent upper respiratory tract disease w/ diarrhea(chronic not severe)
Hemoglobin decreased
A. Celiac
B. Cystic Fibrosis

80. Bloating, irritability, premenstrual. Most appropriate tx?

1) COCP
2) Pyridoxine ( vitamin B6)
3) Ginkgo Biloba

81. trimethoprim allergy, during operation, shocked. Cause?

1) Latex… it is more common to cause shock during operation
2) Plaster
3) Isoflurane… drug interaction

Latex contain sulfar..trimethoprim is also sulfar ????????

Child with some disease (cannot remember ) and urticaria , who was on trimethorim for recent
infection, developed bronchospasms and hypotension tension after GA for surgery asked the cause

1. Latex

2.Trimethoprime

3.isoflurane

Drug interection
82. area is having covid. patient is having fever. wife is a breast ca patient. Patient covid antigen
negative. all are vaccinated. What is the most appropriate action?
1. Isolate
2. covid PCR
3. rpt antigen
4. Nothing
84. young man coming with weight loss,cough and night sweats..bilateral cervical lymphadenopathy.cxr
given…. There is no apical opacity

TB

LYMPHOMA

sarcoidosis

Please if you find any mistake then inform us.. thank you