March Recalls

Q1-Waldenstorm macroglobenemia patient came with rigors and

fever and right lower lobar pneumonia admitted and started
ampicillin and after 2days following papulo vesicular rash
developed. What is the most appropriate management?
1- prednisolone
2- immunoglobulin
3- stop ampicillin
4- Acyclovir

Q2-Parents concerning about their 8yr age child’s behaviour.

Child with Isolation not prefers to play with his peers just
playing with one of Peers ,difficult to control him in school,
tantrums language Normal.normal eye contact,but in his room
all dolls are parallel Locating making sudden screaming
occasionally in different times.
Asking diagnosis
1.ADHD
2Autusm spect disorder
3. Tourette synd.

Q3-A lady 10 years history of alcohol abuse has admitted in

hospital for surgery 3days after returns fearful shouting on staff
what additional finding confirms dx?
A. Voice telling she is God
B. seeing insects crawling on wall
C. strong believe spouse has affairs w someone
Q4-After administration of Cefazolin a young patint developed
allergic reaction in the skin (PIC of multiple red rash on the
back).Regarding management of this patient in future with
cephalosporin which is correct?
1.Cephalosporin other than cefazolin
2.No cephalosporin
3.neither penicillin and neither cephalosporin
4 doxycycline
5) ceftriaxone

Q5-16 year old girl came in for contraception. She has strong hx
of DVT in family. She is a carrier of factor Leiden V. Whats the
best contraception?
a Spermicidal gel
b Estrogen patch
c Low dose COCP
d POP

Q6-Nurse concerned about a Alzheimer's patient whose

communicatiog with the male Alzheimer's patient next step
Inform family
Separate them both
Inquire more about nurse concern

Q7-Women with genital herpes has been treated with

famciclovir for 2 weeks.now she is fine with almost
disappearing vesicles.she has come for followup. Now what u
will do ?
A) advise her to abstain sex for another 6 weeks
B ) check or treat her previous partners
C) tell her she might still be infectious for future partner
D) notify to health authorities

Q8-A 50 year old women had a mitral valve replacement

surgery after rheumatic infection. After 24 hours she starts
developing a swelling in the femoral region which is increasing
in size every hour, the swelling is pulsatile on palpation. What
would be your immediate next step?
A. Perform USG
B. Perform CT angio
C. Put pressure on the swelling
D. MRI
E. thrombin injection

Q9-A boy who visited India and after returning he developed

fever, abd pain , icterus . He is sexually promiscuous but always
uses condom and not a drug abuser . He took hepatitis A vaccine
before travelling. What’s the dx ?
1.Hep A
2.Hep B
3.Hep C
4.Hep D
5.Hep E
Q10-5-year-old boy with history of soiling. Mother complaint
that he soiled his pants every day for the past 2 months. Teacher
said he acts immaturely compared to other children. What's the
most likely diagnosis?
A. Constipation
B. Sexual abuse
C. Gross developmental delay
D. Autistic spectrum disorder

Q11-Female executive officer claims she just sleep 4 hours per

day during last 2 months. Lot of pressure about work
commitments, refuse to take any drugs. What is the best non
pharmacological management
1. Stress management
2. Sleep hygiene education
3. Psychotherapy
4. hot milk before sleeping

Q12-A pregnant in her last trimester presented w

MVA ,GSC8/15, she is spontaneously breathing sa 95 .bp 90/60,
PR 105, asking what to do first?
1.put on left lat position
2.IV fluid and warm colloid
3.urgent cross matching
4.CT
Q13-A 50yr male with right shoulder pain for days.. he
menthioned it always complaining from restriction of abduction
and pain in that shoulder ,partially get benefit from intraarticular
steroid injection before ,what to recommend for him as next ..
1. Arrange physiotherapy
2.intra artic steroid
3. Methotrex.
4.regular paracrtamo

Q14-A 28-year-old man is brought to the psychiatric clinic by

his family due to concerns about his recent behavior. The family
reports that over the past few weeks, the young man has
exhibited changes in his thinking, behavior, and emotions. He
has become increasingly paranoid, believing that his coworkers
are plotting against him and that his phone calls are being
monitored by government agencies. He has also started
experiencing auditory hallucinations, hearing voices
commenting on his actions and conspiring against him. In
addition, he has become socially withdrawn and spends most of
his time alone in his room. The symptoms have emerged
relatively abruptly and have significantly impaired his ability to
function at work and maintain relationships. What is the most
likely diagnosis for this patient?
A) Schizophreniform Disorder
B) Schizoaffective Disorder
C) Delusional Disorder
D) Brief Psychotic Disorder

Q15-Man with Abdominal pain ,bone pain and confusion.

calcium 3.9. RFT high. Already started on IV Fluids. What
next?
A. IV Furesemide
B. Calcitriol
C. Primdronate

Q16-Which of the following statement is incorrect regarding

Guillain-Barre syndrome?
a. Intravenous immunoglobulins are the treatment of choice
b. Plasma exchange is the first line treatment
c. Neuropathic pain is commonly seen during the illness
d . Steroids have no role in treatment
e. Neuropathic pain is responsive to tricyclic antidepressants

Q17-Agoraphobia need to start drug what should asked

1. Caffeine
2. Cannabis
3. Chocolate

Q18-Family moved to a place where tap water has no fluoride

added to it. What will u do for child ?
A)high fluoride toothpaste
B)low fluoride tooth paste
C)dental check at 2yrs

Q19-Young drug abuser presents with back pain and tenderness

at L3-L4, Temp 38.2.. Pain on raising legs. What's the most
important feature needed for futher investigations?

-DRUG USER
-temp
-pain on rising legs

Q20-Obs 36wk pregnant feeling reduced fetal movement, bmi

32 , on
examination fhr 142bpm ,mother bp 130/85 something pluse
normal mx?
Admit and observe
Iced cordial for stimulating movement
Refer to obs

Q21-Waldenstorm macroglobulaemia patient comes with fever

rigorous some respiratory symptoms Mx as R lower zone
pneumonia stared on him Ampicillin few movement developed
gen vesicular rash Mx
Predni
IVIG
Stop Ampicillin
Antiviral

Q22-17 year old male came to see the GP on account of lack of

secondary sexual characteristics. He wasn't doing well
academically. On examination, he had gynaecomastia, smooth
skin, small penis. Diagnosis
1- Fragile X syndrome
2- Klinefelter syndrome
3- Noonan's syndrome
Q23-14 year old female came to the hospital to inquire about
HPV vaccine. Her parents had signed against her taking it in
school. She was worried cos all her friends at school got the
vaccine, what to do.
1- Offer her the vaccination now
2- call her parents on the phone for consent
3- tell her to go and come back with her parents
4- tell her to go and return when she's sexually active.

Q24- 24 year old male just returned from Thailand ? 2 weeks

ago. Presented with fever, abdominal pain, nausea and vomiting,
jaundice. He had Hep A vaccine prior to travelling and had all
his childhood vaccinations. He is not sexually active.
Diagnosis
1- hepatitis A
2- hepatitis B.
3- hepatitis C.
4- hepatitis D.
5- 5- hepatitis E

Q26-Woman owner of a cat, lymphadenopathy of post cervical?

1.EBV
2.cat scratch
3.TB
Q27-Young baseball player presents with acute (or subacute not
sure) onset of right arm pain.
On exam, his right arm is tender, swollen, warm, discolored (I
think bluish or purplish). There is a tender point at the upper part
of his inner arm. There are also small non-tender (sure that they
are non-tender) axillary LN also present. He mentioned that his
cat is recently unwell. (did not mention about scratching or
biting from that cat). What is the diagnosis?
a. Cat scratch disease
b. Axillary vein thrombosis
c. TB

Q28-Pregnant woman, clinical findings TSH is high, what next?

1.free t4
2.sono of thyroid

Q29-Pregnant woman complaint of palpitation, lab result- TSH

↑, next investigation?
A. Repeat TSH
B. Thyroid antibody
C. Thyroid scan
D. Thyroid USG
E. Give thyroxine.
Q30-Left iliac fossa pain, tenderness, no rebound, warfarin user,
CT given
1.rectus sheet hematoma
2.retroperitoneal hematoma

Q31-Nurse, hep B, what next?

1.do nothing
2.tell her avoid contact procedure
3.informAPRAH

Q32-your friend and your colleague, want you to prescribe

mirtazapine, don’t want to see a GP himself, using 30 mg
codeine every day, what to do?
1.insist to see GP
2.inform APRAH

Q34-85 y Woman come with Local back pain after lifting up her
cat, 20 years ago surgery for colon cancer, dx?
1.compression fx
2.metastatis of vertebral body

Q35-Vit D def8ciency in patients of GP wants to study

Cohort
Case control

Q36-One question was abdominal perforation ,air under

diaphragm , patient comes with his wife, but patient is not
giving consent and he has mental capacity..
listen patient
listen wife

Q37-One was question a patient on medication of ADHD not

taking medication.
Talk to patient
Send nurse to school
Talk to parents

Q38-Cough sometimes dry sometime wet , nocturnal cough.

Not relieve by bronchodilator, diagnosis
GERD
Asthma

Q39-Man, chest pain, severe, no effect from nitrates. ECG

Norm. Flight 18h 2 weeks? Ago.
BP- 80/. Ps 100 Ome most appropriate inv
-CT and PA
-CT angio chest
-X-ray
-Trop?
-VQ

Q40- Elderly patient , urine test with 1+ protein, next step

Protein creat8nin ratio
24 hour urine protein
Repeat Urine dipstick after exercise

Q41-Two masses at p of lung. Xray done what to do next.

CT
Brochoscopy
Q42- Eosinophil esophagitis scenario with eczema asking next
step
Esophagoscopy
Barium sallow

Q43- Xray of Somalian female shows mild pleural effusion,

what to do next Minimal 3 kg w8 loss in 6 months , fever
Mantoux test
IGRA
CT
Brochoscopy

Q44-One was child with poor height and weight centiles, parents
are same, constipation in child, abdominal pain, diagnosis
Cealic disease
Thyroid problem

Q45-Picture of swelling around umblicus in child.swelling soft

no pain
Umbilical hernia
Hematoma
Lipoma
Epidermoid cyst
paraumbilical hernia

Q46- How to write insulin

12 unit subcut ,
s/c,
sc

Q47-Left iliac fossa pain , pulse irregular ,with ho of A fib ,

vitals were unstable.
bowel ischaemia

Q48-Swollen tongue, angioadenoma, history of ACEI was there

prindopril
ACEI
Q49-Pt on regular ACEI, Metformin, taking amoxicillin 2 days
ago, now with painful tongue and oedema especially on the right
side of tongue, on examination pt can’t talk much & point to his
tongue , asking what cause the symptom?
A. Amoxicillin
B. ACEI
C. Metformin

Q50-A man was brought by his wife who had complained of

sudden onset of tongue swelling. He is a known diabetic treated
with metformin and chlorpropramide, hypercholesterolemia
given simvastatin and hypertension for which he takes ramipril.
His GP prescribed him amoxicillin 2 days ago for a URTI. On
examination, tongue is swollen. He has difficulty speaking and
points to his tongue. Wheezing can be heard on auscultation.
Which of the following drugs is responsible for the patient’s
presentation?
A. Metformin
B. Chlorpropramide
C. Simvastatin
D. Amoxicillin
E. Ramipril
Q51-12 month amenorrhea. hirsutism. usg ,
FSH/LH/testosterone

Q52-Amenorrhea for 12 months, no sexual intercourse for 1.5

yr. What investigation to do
A)FSH and LH
B)Estrogen and progesterone
C)TSH
D)Urinary beta-hcg

Q53-Rt ovary complex mass , next ? ultrasound already done

MRI pelvic
laproscopy

Q54-With rt upper quadrant pain Pregnant female after PPH

settling. Loose 1500 ml of blood in 15 minutes with SOB.
I choose amniotic embolism

Q55- Pregnant female with MVA , Sat's on 10 liter with mask

was 97% , 90/60 BP , GCS was v low. What to do , GCS was
low
intubation
Fluid

Q56-CTG was given in exam.

I marked induce labour

Q57-CTG picture given

The pt is in 37 or 38 wks of preg, the PROM but the liquor has
meconium stained. On CTG there is 2 contraction decreased, to
80 from 140) . The pt pulse rate good. The cervix is only 3 cm
dilated, What is your next appropriate Mx?
A) Betamethasone inj
B) foetal scalp pH sampling
C) Vg Usg
D) CTG continuosly

Q58-a picture of finger lesion was given. Pt had injury due to

finger stuck in car door. A small pink lobulated lesion. Best
management.
Cautery,
Surgical excision
Cryotherapy
Q59-Lobar pneumonia in 3 y child, what is the germ?
1.staph
2.strept
3.H inf

Q60-36 wk pregnant woman, come with bleeding, 1000cc and

unstable, tenderness of uterus, what to do after resuscitation?
1.position patient to the left
2.cs
3.cyntocinone

Q61-After spontaneous rupture of membrane, CTG with 140-

160 heart rate, 2 deep decelerations ( i think it's variable
deceleration ) Os 5 cm, fully effaced, head just engaged. Most
appropriate next step
A. Tocolysis
B. Fetal Bld scalp sampling
C. LSCS
D. Continue CTG monitoring
E. Instrumental delivery

Q62-You are called to see a neonate recently born in a delivery

room. The mother is primagravida who just gave birth to a 3200
gr baby through and uneventful vaginal delivery except for
slightly meconium stained liquor. On examination the baby is
apneic and cyanotic has heart rate 40bpm and is severely
hypotonic... which of the following most appropriate immediate
management of this neonate...?
A. Intubation and ventilation
B. Ventilation by C-PAP
C. Bag and mask ventilation
D. Suction of the mouth and nose
E. Urgent peadiatric consult

Q63-34 year old primi came at term with rapture membranes

and meconium stained lecor , you did a CTG , in review of the
CTG wts the next best step ?
a. CS
b. Fetal scalp ph
c. Induce labour at once with cintocynon
d. Wait for normal delivary
e. High forceps

Q64-Young man who takes a lot of alcohol (think about 20

bottles per day) admitted for a humeral fracture which was
repaired. Next day he becomes aggressive and shouting at the
nurses. Which one of the symptoms would help with diagnosis.
1- voices telling him he's the Devil.
2- cursing frequently.

3- metallic taste in the mouth.

4- seeing insects crawling on the walls.

Q65-After TURP a man is unable to void.bladder containing 750

ml of urine.catheterization(size 12 may be) failed due to
swelling. Nurse tried the hot water bath.Bp is 160/70
mmHg.what to do?
A. give another 500 ml normal saline
B. supra pubic catheter
C. try large bore catheter
D. try small bore catheter

Q66-☆Ptsd scenario, pt had accidental hx

Q67-☆ pregnant lady having marks of domestic abuse. What to

do
Admit

Q68-☆ Male collegue having intoxication on duty.

Inform Aphra

Q69-☆female on biopsy having Hsil.

Colposcopy

Q70-☆ picture of male having breast enlargmemt, scenario was

about some drug.
Stop spirolactone

Q71-☆ Female picture having cellulitis of ant abd wall. On abx

Which abx should be given as cellulitus increased after starting
penicillin
May be debridment
Q72-☆ eldery female having hx of fall, osteoporotic some t
scores given. Best managment.
alendronate
Vit d
Calcium

Q73-Picture of a lady's neck with lower anterior neck swelling.

Said to move with swallowing. USS reveals multinodular
thyroid enlargement. Other examination findings and vitals
where all stable. What's next management
1- Review in some months
2- biopsy
3- partial thyroidectomy
4- total thyroidectomy

Q74-A 68-year-old male undergoes a transurethral resection of

the prostate (TURP) for benign prostatic hyperplasia.
Postoperatively, he develops confusion, nausea, and seizures.
His serum sodium level is found to be significantly decreased.
What is the most likely cause of his symptoms?
A. Acute urinary retention
B. Cerebral vascular accident
C. Transurethral resection syndrome (TURP syndrome)
D. Benign prostatic hyperplasia exacerbation
E. Prostate-specific antigen (PSA) rebound effect

Q75-☆ a picture of finger lesion was given. Pt had injury due to

finger stuck in car door. A small pink lobulated lesion.
Best managment.
Cautery,
Surgical excision
Cryotherapy

Q76-Pregnant lady at term in labour, 2nd pregnancy. 1st

pregnancy was through C/S for breech presentation.
Examination - 5cm dilated, Ceph presentation, station at +1.
After somse time, she starts bleeding a lot through the vagina.
Diagnosis
1- placenta preavia

2- Vasa preavia

3- Uterine rupture

4- amniotic fluid embolism

Q77-Picture of a mans lefthand, swollen and red index and
middle fingers which extended to the palm. It says the man had
gardened the previous day and development painful swollen left
hand. Had fever the previous night. Said to be painful with
movement of the hand. Management

1- administer colchicine.
2- joint aspirate for cytology
3- admit and administer antibiotics.

Q78-There was a graph for cardiovascular risk classification for

a 44 year old aboriginal male, known diabetic, smoker, systolic
BP was 142mmHg, total cholesterol 6.2mmol/l, HDL 1mmol/l.
Asked to use the graph to identify his 5-year cardiovascular risk
classification.

Q79-A wife came with ho husband erectile dysfunction and GP

is also his husband gp who knows he is on SSRI. Floxetine I
think so what does he do , option:
call husband to review his medication,
tell wife ,
call them both

Q80-An elderly female after MI nit walking enough in house to

avoid starin on heart , mot taking salt , came with SOB , anxious
etc , option :
relaxation therapy ,etc

Q82-Young woman on metformin,recurrent vaginal candidiasis,

want to loose weight, what next?
1.SGL2 inh
2.gliclazid
3.exenitide

Q83-Diabetic woman on 1 gr metformin, hba1c was 7.3. Cr

normal, no proteinuria,What to do?
1.increase dose of metformin
2.add glibenclamide
3.liraglutide
Q84-Woman with GTT: fasting normal, 1h normal, 2h little
derrange, what to do?
1.check in 2 weeks
2.self blood glusose check
3.insulin
4.check in a month again

Q85-60 y Woman with tenderness of one breast and no mass,

with family history of breast cancer in mother and sister, on
spironolacton,what to do next?
1. US
2. FNA
3. Discharge spironolacton
Carcinomatous Ascitis and pulmonary effusion Patient is
unstable What to do?
1. Paracenthesis
2. Furosemide
3. Albumin
Q86-A man with increased cr,fbs,alp, ggt, low hb,with hearing
loss, bowed tibia, dx?
1.paget
2.ckd
3.dm

Q87-Wakdenstrom after get ampicilin and azitro for pneumonia

come with vesicolupustular rash,not pruretic, in different
stages(picture is like VZV), what to do?
1.prednisolone
2.acyclovir
3.rituximab

Q88-Diabetic woman with multiple time of cellulitis, she has

tinea pedis, what is the etiology of her cellulitis?
1.dm
2.tinea pedis
3.microvascular injury