AMC RECALL EXAM OCTOBER 2000
MEDICINE
1. Hepatitis C in Australia mainly spread by
1. heterosexual
2. homosexual
3. intravenous drug users
4.blood products
5.
2. Anterior uveities most commonly seen in
1. Rheumatoid Arthritis
2. SLE
3. Ankylosing spondilitis
4. .
3. Women presented with bleeding. She has a family history of bleeding (brother, father).
1. Haemophylia
2. Deficiency XII
3. Von Willebrand’s disease
4. .
5. .Christmas disease
4. Patient – pulmonary embolism
1. cyanosis
2. tachycardia
3. hypotension
4. haemoptysis
5.
5. Granuloma Anulare
1. premalignant
2. itch
3. irregular raised edge
4. oral antifungal treatment
5.
6. HLA typing most useful in
1. Renal Transplantations
2. Cardiac transplantataions
3. .
4. .
5. .
6. For organ donation how to diagnose brain death
1. No EEG recording
2.
3.
4.
5.
7. Myelofibrosis
1. tear drop cells
2. .
3. .
4. .
5. .
8.Young man – Ferritin slightly elevated,
1. Acute blood loss
2. Heamoglobinopathy
3. .
4. .
5. .
9.Which does not transmit HIV
1. Cryopresipitate
2. .
3. .
4. .
5. .
10. Woman taking progesteron complaines of a headache in the afternoon. Paracetamol did not help.
1. stop progesterone
2. start ergotamine
3. Relaxation method
4. .
5. .
11. Numbness of mouth . which nerve leision
1. VII
2. V
3. II
4. .
5. .
12.
12. Woman (old) , history of tremor- increase when reach for an object. Treatment
1. propranolol
2. levedopa and carbidopa
3. .
4. .
5. .
13. Parkinsonism
1. loss of postural reflexes
2. .
3. .
4. .
5. .
14. women present with
1. cervical spondilosis
2. .
3. .
4. .
5. .
15. Which arthritis heals completely
1. Rheumatic fever
2. Rheumatiod arthritis
3. .
4. .
5. .
16. What type of renal calculi seen if urine is acidic
1. oxalate
2. uric acid
3. .
4. .
5. .
17. How to confirm gout
1. check synovial fluid for crystals
2. .
3. .
4. .
5. .
18. Asthmatic patient – which is not a proper management
1. taking prednisolone for every attack
2.
3.
4.
5.
19. Red painful eye dilated pupil
1. Glucoma
2. .
3. .
4. .
5. .
20. bulging eardrum –what is true
1. spontaneous rupture relives pain.
2. .
3. .
4. .
5. .
21. Spont. Pneumothorax
1. needle aspiration
2. .
3. .
4. .
5. .
22. Patient had a fall from a roof. BP –reduced, RR- increased
1.
2.
3.
4.
5.
23. In duodenal ulcer – not seen
1. Anorexia
2. .
3. .
4. .
5. .
24. cellulitis
1. group A streptococci
2. .
3. .
4. .
5. .
25. SLE
1. > 90% patients has DNA antibodies
2. > 50% has renal involvement
3. .
4. .
5. .
26. Patient with Rheumatic fever developed a new murmur- lower end of the sternum
1. Aortic regurgitation
2. Pulmonary regurgitation
3. Rupture of
4.
5.
27. Patient with a carotid stenosis > 80%
1. with out surgery her chances of having a stroke in next 3 months is more
2. .
3. .
4. .
5. .
28. Phenytoin and warrfarin
1. if serum level –half of the needed therapeutic dose then double the dose
2. .
3. .
4. .
5. .
29. Hypercalcemia occurs ecxept
1. chronic pancreatitis
2. .
3. .
4. .
5. .
30. In Australia –why women live longer than men
1. genetics and biological reasons
2. use of more medicare
3. men are more violent
4. .
5. .
31. In Digoxin toxicity seen ecxept
1. nodular rytham
2. ventricular trachacycardia
3. Atrial tachycardia
4. .
5. .
32. woman with R haemiparesis and loss of vision in the L eye
1.left anterior
2.left middle
4. middle cerebral
4.
5.
33. 70 years old woman -with 3 week history of confusion. Increased Phosphate, increased calcium.
1.paget disease
2. renal failure
3. .
4. .
5. .
34. Pituitary tumor
1. Bitemporal hemianopia
2. .
3. .
4. .
5. .
35. Emphysema – not true
1.
2.
3.
4.
5.
36. ITP
1. Extensor surfases
2. Splenomegaly
3. Rash
4. Haemorrage –fundoscopy
5. .
37. Mycoplasma Pneumonia
1. wrong antibiotic
2. .
3. .
4. .
5. .
38. Pressure gradient more than 50
1. you do surgery
2. .
3. .
4. .
5. .
39. Obstructive cardiomyopathy . RX
1.
2.
3.
4.
5.
40. All causing hypoglycemia ecxept
1. Prolactin inducing tumour
2. .
3. .
4. .
5. .
41. Meningitis complication except
1. Cephalohematoma
2. .
3. .
4. .
5. .
42. 34 year old women got 4-5 patches on the head
1. scraping under KOH
2. .
3. .
4. .
5. .
43. Pleural effusion in TB
1. lymphocytosis
2. redused sugar
3. transudate
4. .
5. .
44. man developed a rash on palms and the soles . Anal ------
1. second syphylis
2. yaws
3. .
4. .
5. .
45. Atopic eczema except
1. use soap and water
2. .
3. .
4. .
5. .
46. Pulmonary Embolism
1. Tachypnoea
2. Cyanosis
3. Hypotension
4. .
5. .
47. In gross Acites
1. cannot palpate liver
2. .
3. .
4. .
5. .
48. In kernicteros
1. Increased in total bilirubin
2. Inreased in uncongugated bilirubin
3. Increased in congugated biluribin
4. .
5. ,
49. Obstructive cardiomyopathy RX
1.
2.
3.
4.
5.
50. All causing hypoglycemia ecxept
1. prolacting inducing tumour
2. .
3. .
4. .
5. .
51. Meningitis complication except
1. cephalohaematoma
2. .
3. .
4. .
5. .
52. L5 L4 affected
1.absent knee jerk
2. absent ankle jerk
3.
4.
5.
53. Acromegaly Ix
1. Oral and GH
2. .
3. .
4. .
5. .
54. All the following anomalies are corrected surgically except
1. fallots tetralogy
2. patent ductus
3. VSD
4. Transposition of great vessels
5. .
55. Man present with a ureteric colic and brought a sample of urine which contained blood and asks for pethidine. On examination NAD. Urine sample containes blood.
Rx.
1. take a another urine sample for blood
2. give him pethidine
3. .
4. .
5. .
56. patient presents with (night time) paresthesia and waisting of thenar muscles
1. carpal tunnel syndrome
2. ulnar nerve
3. .
4. .
5. .
57. to reduce staph. Infections
1. Rx all the carries
2. .
3. .
4. .
5. .
58. ACE inhibitors
1.increase afterload
2. increase preload
4. decrease afterload
5. decrease preload
5.
59. WOF cross the blood brain barrier
1. lipid soluble
2. low molecules
3. .
4. .
5. .
60. Patient Rx with warfarin now present with loss of consciousness.
1. extradural haematoma
2. subdural haematoma
3. .
4. .
5. .
61. Vascular dementia
1.
2.
3.
4.
5.
62. Diabetic patient taking morning and evening doses. He wakes up at night with sweating
1. reduce evening dose
2. .
3. .
4. .
5. .
63. woman with ulcerative colitis
1.SCLEROSING CHOLANGITIS
2.
3.
4.
5.
6. Women presented with bleeding. She has a family history of bleeding (brother, father).
6. Haemophylia
7. Deficiency XII
8. Von Willbird
9. .
10. .Christmas disease
64. same pt.going for surgery give
1. give factor VIII
2.
3.
4.
5.
65. “De ja vu” experience in
1.
2.
3.
4.
5.
Paediatrics
66. (overweight )Boy aged 12 years presents with a limp.
1. Perths disease
2. Slipped upper femoral epiphysis
3. .
4. .
5. .
67. Most common cause of bleeding in childhood
1. anal fissure
2. hemorroids
3. .
4. .
5. .
68. Child present with moring vomiting . She also have headaches.
1. Migraine
2. Medulloblastoma
3. .
4. .
5. .
69. Iron deficiency anaemia in a 4 year old most common cause
1. diet mainly milk
2. increased consumption of fruit juices
3. .
4. .
5. .
70. Child (7 years) presents with a high temparature and with a sore throat. He cannot swallow.
1. Intubation
2. Antibiotics
3. .
4. .
71.What age a child can talk with short sentences and follow simple commands.
1. 18 months
2. 2 years
3. 3 years
4. .
5. .
72. Increased HBS2 found in
1. Iron deficiency anaemia
2. B thalassemia
3. Sickle cell
4. .
5. .
73. Febrile convulsions
1. last less than 15 min
2. 30% family history
3. .
4. .
5. .
74. 7 year old boy refused to go to school
1. separation anxiety
2. sign of mental retardation
3. .
4. .
5. .
75. Speech delay after a period normal speech ,. Other aspects of development were normal.
1. deafness
2. mental retardation
3. autistic
4. .
5. .
76. Child with a swollen eye lid. Eye movements are ok.
1. B heam.strep. A
2. B heam.strep. B
3. .
4. .
5. .
77. what is dangerous
1.rash on buttocks
2.bruise on the cheek
3.
4.
5.
78. cerebral palsy
1.
2.
3.
4.
5.
79. Pain in the knee
1. acute osteomyelitis
2. .
3. .
4. .
5. .
80. 3 months old baby with purulent discharge from eye. Increased neutrophils.
1.gonococcal
2.duct stenosis
3.chlamydia
4.
5.
81. In a 12 month old which spontaneously closures
1.VSD
2.ASD
3.
4.
82. 2 year old child marked failure to thrive and history of dyspnoea and cough and wheeze.
1. sweat chloride
2. antigliadin antibodies
3. .
4. .
5. .
83. Lymphoadenopathy and fever
1. Infectious mononucleosis
2. .
3. .
4. .
5. .
84. Haemophilia
1.
2.
3.
4.
5.
85. Pain , pallor, screeming
1. Intussuception
2. .
3. .
4. .
5. .
86. 11 year old with torsion of the testes
1. surgical exploration
2.
3.
4.
5.
87. child with a foreign body in her nose
1.removal under GA
2.
3.
4.
5.
88. History of vomiting
1. pyloric stenosis
2. .
3. .
4. .
5. .
89. When mother comes girl was watching the TV
1. panic attack
2. .
3. .
4. .
5. .
90. ---month old don’t babble
1. Audiogramme
2. .
3. .
4. .
5. .
91. Lactating women eating a well balanced diet. What is the defficient
1.Vit c
2.Vit K
3. Vit D
4.
5.
93. Most common cause of loss of consciousness except
1. petit mal
2.
3.
4.
5.
94.Child with 20% of burn –Rx. Except
1. skin graft
2. .
3. .
4. .
5. .
94. Serous otitis media
1.
2.
3.
4.
5.
SURGERY
1.After appendectomy. There is a swelling. Rx.
1. Remove the sutures
2. .
3. .
4. .
5. .
2. Picture varicocele
3. Picture Pyloric obstruction-(Xray). Hx of vomiting. Initial Rx.
1. .9% Nacl
2. Hartman Solutuion
3. 5% dextrose
4. 5% dextrose and N.saline
5. Same patient (Q. 3) how much K+ need for the next 24 h
1.less than 50 mmol
2. more than 50 mmol
3. 50 mmol
4. .
5. .
6. Picture Xray of the hand- Rx scaphoid fracture
1.
2.
3.
4.
5.
7. Complication of colles fracture
1. non union
2. mal union
3. .
4. .
5. .
8. Picture –leg- blue black –discoloration
1. Venous hypertention
2. Clostridium Welchii
3. .
4. .
5. .
9.Pt. admitted with a crush injury to his lower abdomen and pelvis. On examination he has fresh blood at the external ureathal meatus.
1. Pass a catherter
2. Excretion urethrogram
3. Arrange urethroscopy
4. Urethrography
5. .
9. Picture with a mammogram and aultrasound of the breast.
1. cyst
2. .
3. .
4. .
5. .
10. which one of the following associated with a family history
1. Follicular carcinoma
2. Medullary carcinoma
3. Thyroiditis
4. .
5. .
11. Patient presents with severe vomiting – with emphysema. Cause
1. eosophagal rupture
2. .
3. .
4. .
5. .
12. Picture- woman with a red patch on her face
1. haemangioma
2. teleangiectasis
3. .
4. .
5. .
13. extra orbital cellulitis.
1. flucloxacillin
2. .
3. .
4. .
5. .
14. Hx. Of a snake bite. On examination a scratch mark only. No other symtomps. Rx.
1. Observe
2. .
3. .
4. .
5. .
15. Gas Gangreen
1.
2.
3.
4.
5.
16. hemiplegic man with incontinence Rx.
1. insert a permanent catheter.
2. .
3. .
4. .
5. .
17. A man with uncomplicated first degree haemorrhoids
1. High fiber diet
2. Emergency surgery
GYN/OBS
1. Pregnant women – how to diagnose that she will have a premature delivery after another 4 weeks.
1. cervix mesure 3.8 cm long
2. external os one finger open but internal os closed
3. cervix firm and 5 cm long
4. .
5. .
2. Twin pregnancy
1.
2.
3.
4.
5.
3. Pregnant woman aborting at 17 weeks. Least likely
1. ectopic pregnancy
2. .
3. .
4. .
5. .
4. woman –36 weeks preg. Complains of abdominal pain. Pulse rate increased. What is not seen
1. BP increased
2. .
3. .
4. .
5. .
6. FH rate –CTG
1. less than 5 variation
2. .
3. .
4. .
5. .
6. 16 yr old girl . with breast budding sparse axillary, pubic hair. Which investigation is least likely
1. CT-head
2. Pelvic ultrasound
3. FSH
4. LH
5. Prolactin level
7. Ovarian stimulating is least likely
1. Human menopausal hormone
2. HCG
3. Clomephene
4. GH analogue
5. GnRh analogue
8. Couple want to get pregnanant. Best way for them to find the time of ovulation
1. progest
2. LH urine level every day
3. Basal temperature
4. .
5. .
9. What is the best way to prevent cervical cancer in Australia
1. increase colposcopic clinic and Rx CIN I
2. cervical smear more available
3. develop a vaccine against human papilloma virus
4. .
5. .
10.Puperal psychosis
1. >50% get
2. .
3. .
4. .
5. .
11. Endometrial ablation. Except
1. Eostrogen alone therapy not enough
2. .
3. .
4. .
5. .
12. PV bleeding for 2 days started OC pills.
1. continue oc
2. .
3. .
4. .
5. .
13. Girl -high prolactin level. TSH normal. Found pituitary adenoma size 1.8 cm 3 cm extending to chiazma. What is your first initial management
1. bromocriptine
2. .
3. .
4. .
5. .
14. 68 yr. Woman recently started on warfarin and Pv bleeding. All true except
1. bleeding because cervical cancer
2. .
3. .
4. .
5. .
15. Twin pregnancy- should not do
1. External cephalic version
2. .
3. .
4. .
5. .
16. In a older women malodour discharge- all true except
1. foreign body
2. .
3. .
4. .
5. .
17. not true-
1. ACE should not give in pregnancy
2. .
3. .
4. .
5. .
18. 34/52 preg. All Rx true except
1. Corticosteroid should be given
2. .
3. .
4. .
5. .
19. Breast feeding and OCP
1.
2.
3.
4.
5.
20. Woman with Cystic fibrosis want to get pregnant what advise can be given
1. can deliver
2. should not encourage to get pregnant
3.
4.
5.
21. Recurrent Candidiasis. Which drug is not useful.
1. Metronidazole
2. .
3. .
4. .
5. .
22. In which case IVF useful – all true except
1.
2.
3.
4.
5.
23. OCP –which effect is seen with progesterone only pill as compaired with eostrogen
1. low density lipid ……..
2. .
3. .
4. .
24. woman pregnant with her 2nd child . 1st pregnancy baby bw 4.5 kg and during the birh fractured the clavicle. Ix.
1. 3hr glucose tolerance test
2. test urine for glucose. Ketone
3. .
4. .
5. .
25. Painless dilatation of bladder
1. chronic retention
2. pregnancy
3. .
4. .
5. .
26. pregnant woman eating a balanced diet- what supplement need
1. Zn
2. Ca
3. Vit c
4. .
5. None of the above
27. In Ectopic pregnancy rupture at 14/52 likely in located in
1. .isthmus
2. .cervix
3. .abdomen
28. Mammography screening program-
1. detect small cancers early
2. .
3. .
4. .
5. .
29. Hypertensive patient well controlled with ACE. She wanted to get pregnant. What advise you would give
1. Continue ACE
2. Rx with methyldopa and diuretics
3. .
4. .
5. .
30. What is the contraceptive pill for a woman who takes phenytoin
1.Microgynon 30
2. Microgynon 50
3. Diane
4.
5.
Psychiatry
1. What is “TESTAMENTARY CAPACITY”
1. ABLE TO MAKE A WILL
2. Able to give evidence in a court
3. .
4. .
5. .
2. Couple wants to get pregnant. But concerned because grandmother has bipolar disorder. What advise
1. not to get pregnant
2. Refer to genetic study
3. <10%
4. .
5. .
3. Dejavu seen in temporal lobe epilepsy
1.
2.
3.
4.
5.
4.Obssesive conpulsive disorder associated with
1. hypochondrasis
2. paranoid
3. dementia
4. .
5. .
5. Social phobia
1.
2.
3.
4.
5.
6. Serotonin Syndrome
1.
2.
3.
4.
5.
7. man wears womaen’s cloths
1. transsexualism
2. .
3. .
4. .
5. .
8. Man presents with impotence what is least likely to given as a initial treatment
1. Viagra
2. .
3. .
4. .
5. .
9. Negative symptoms in sciczophrenia
1. blunted effect
2. catatonia
3. delusion
4. .
5. .
10. Canabis
1. increasesd with ingestion
2. less likely to have withdrawal symptoms
3. .
4. .
5. .
11. HIV Dementia
1. toxoplasmosis
2. .lymphomaa
3. .
4. .
5. .
12. Woman acting and appearance – seductive
1. histrionic personality
2. hypomania
3. .
4. .
5. .
13. Vascular Dementia
1.
2.
3.
4.
14. Bulimia nervosa
1.
2.
3.
4.
5.
15 ADHD –cause
1. not known
2.
15. Maternal blue
1. > 50%
16. For new antidepression drug trial what is required
1. permission and ethical clerance
2. .
17. difference between psychosis
1. sensory loss
2. .
MCQ Recall Paper October 2000
MEDICINE
1. All of the following are true about duodenal ulcer, EXCEPT:
a) Hunger pain
b) Loss of appetite
c) Weight gain
d) Relapse and remissions
e) Reversed by antacids
2. A patient presents with a history of 2 episodes of Left eye blindness, Right hemiplegia, and transient speech difficulty, which lasted 20 minutes each. Which is the most possible site of obstruction?
a) Left middle cerebral artery
b) Right middle cerebral artery
c) Left anterior cerebral artery
d) Right anterior cerebral artery
e) Posterior cerebral artery
3. In which disease is anterior uveitis most commonly associated?
a) Reiter’s disease
b) Ankylosing spondylitis
c) Syphilis
d) Gout
e) Rheumatoid arthritis
4. Which is the most common mode of transmission in Hepatitis C infection?
a) IV drug users
b) Homosexual active males
c) Heterosexual
d) Vertical Transmission
e) ?
5. Mycoplasma pneumoniae infection has which of the following characteristics, EXCEPT:
a) Cough is unusual
b) Pleural effusion is a characteristic feature
c) ESR is always high
d) Very severe headache
e) Responds to tetracycline treatment
6. A patient present with Haematuria. About 24 hours ago he had a sore throat. Which is the most likely diagnosis?
a) IgA nephropathy
b) Post-streptococcal glomerulonephritis
c) Membranous glomerulonephritis
d) Nephrotic syndrome
e) Acute pyelonephritis
f) Acute pyelonephritis
7. Which of the following is true about Tuberculous Pleural Effusion ?
a) Blood stained always
b) Acid-fast bacilli are always found
c) Most likely cells are lymphocytes
d) It is transudate
e) Glucose is normal or decreased
8. Acute attacks of asthma can best be treated with:
a) Inhaled Salbutamol
b) Oral steroids
c) Inhaled steroids
d) Oral theophylline
e) PEFR measured at home
9. A young man present with Pleuritic chest pain and cough. On percussion there is dullness over the right base. There are no breath sounds in the right lower zone, but bronchial breathing is noted in the right middle zone. Which is the most likely diagnosis?
a) Right lower lobe consolidation
b) Right lower lobe collapse
c) Pleural effusion
d) Right pneumothorax
e) Left tension pneumothorax
10. All of the following are true about Emphysema, EXCEPT:
a) Clubbing is present
b) Distant heart sounds
c) Diffusion capacity is decreased
d) Total lung capacity is increased
e) Hyperinflation of the lungs
11. Photosensitivity is present in:
a) Amiodarone treatment
b) SLE
c) Niacin deficiency
d) Thiamine deficiency
e) ?
12. In a patient with massive ascites, all are possible findings except:
a) Hepatomegaly
b) Shifting dullness
c) Eversion of umbilicus
d) Dullness to percussion
e) ?
13. Which of the following drugs can give Nephrotoxicity?
a) Gentamycin
b) Gold
c) Digoxin
d) Sulphonamides
e) Mefanamic acid
14. A 65 year old woman became confused. Laboratory findings were; Calcium 4.8, increased Calciuria, decreased Phosphate. Which is the most likely diagnosis?
a) Malignancy (osteolytic metastases)
b) Primary hyperthyroidism
c) Idiopathic hypercalcaemia/hypercalciuria
d) Paget’s disease
e) Multiple myeloma
15. Papillary necrosis is caused mostly by;
a) Diabetes
b) Alcohol
c) Analgesic nephropathy
d) Medullary sponge kidney
e) Sickle cell crisis
16. In a patient with acidic urine, which are the most commonly found stones?
a) Uric acid
b) Cystine
c) Calcium oxalates
d) Calcium carbonate
e) Xanthine
17. In patients with chronic renal failure:
a) Most patients develop osteoporosis
b) Bone dystrophy is present
c) ?
d) ?
e) ?
18. In rheumatic fever arthritis, which is the most typical finding?
a) Heals without deformities
b) Affects small joints equally as large ones
c) Is confined to one joint
d) ?
e) ?
19. Which of the following drugs most commonly cause prolonged QT interval?
a) Digoxin
b) Procainamide
c) Quinidine
d) Propranolol
e) ?
20. A woman presents with dark colour urine, pruritus and jaundice. Blood examination shows a mild increase in alkaline phosphatase, high AST and ALT. Which is the most likely diagnosis?
a) Viral hepatitis
b) Acute fatty liver
c) Cholangitis
d) Biliary obstruction with cholestasis
e) Cholecystitis
21. Which of the following is true regarding Phenytoin?
a) Should be given three times daily
b) It will decrease the effect of Warfarin
c) It will increase the effect of OCP
d) If given in combination with other drugs, the therapeutic dose should be halved
e) ?
22. Statistically women live longer than men. Which is the reason for this?
a) Females have a genetic advantage
b) Women use the medical system more often than men
c) Men have more stressful jobs than women
d) Men drive more aggressively
e) Women have less accidents
23. Treatment of hypertension is a proven factor in preventing:
a) TIA
b) Ischaemic stroke
c) Coronary artery disease
d) Congestive cardiac failure
e) Atherosclerosis
24. A patient with CRF and hypertension was dialysed. His BP improved after dialysis but he still had 2 episodes of high blood pressure. Which is now the initial step in your management?
a) Decrease protein in his diet
b) Ideal weight should be reached
c) Give Frusemide
d) Give anti-hypertensive therapy prior to dialysis
e) Give anxiolytics prior to dialysis
25. Hepatitis BV has never been found in which of the following blood products:
a) Fresh frozen plasma
b) Cryoprecipitate
c) Whole blood
d) Erythrocytes
e) White blood cells
26. In a woman with splenomegaly, WCC 33,000 and tear drop poikilocytes, which is the most likely diagnosis?
a) CML
b) CLL
c) Hodgkin’s disease
d) Acute lymphoma
e) Myelofibrosis
27. A woman, whose father and brother are haemophilic, has bleeding tendency. She has a history of haemarthrosis and prolonged bleeding associated with dental procedures. Which is the most likely diagnosis?
a) Haemophilia
b) Christmas disease
c) Von Willebrandt’s disease
d) Factor XII deficiency
e) Factor IX deficiency
28. Which of the following are true regarding Atopic Eczema?
a) Soap and water are helpful
b) It is a contraindication for immunization
c) Flexure surfaces are commonly involved
d) Positive family history of asthma and hay fever
e) Moisturizing agents are helpful
29. Which of the following is a feature of Parkinson’s disease?
a) Loss of postural reflexes
b) Hyperreflexia
c) Atactic gait
d) Resting tremor
e) Muscle weakness
30. A diabetic patient is taking insulin twice a day. Before breakfast a combination of L/A and S/A and in the evening one dose of L/A. He complains of sweating in the morning. What alteration in insulin doses needs to be done?
a) Reduce dose of L/A in the morning
b) Reduce dose of S/A in the morning
c) Reduce dose of L/A in the evening
d) Increase dose of L/A in the evening
e) Increase dose of L/A in the morning
31. Which is the most specific antibody in SLE?
a) dsDNA
b) ANA
c) Anti Ro
d) Anti La
e) Anti LKM
32. A 24 year old student complains of 12 days of fever, malaise and sore throat. On examination he has white tonsillar exudates, generalized lymphadenopathy, maculopapular rash on palms and soles and excoriating lesions around the anus. Which is the most likely diagnosis?
a) Glandular fever
b) Syphilis
c) Pemphigus
d) Stevens Johnson syndrome
e) ?
33. Which of the following is true regarding granuloma annulare?
a) Irregular raised margins
b) Is pre-malignant
c) Caused by sun exposure
d) Is autosomal recessive
e) ?
34. A school teacher presents with patches of hair loss on scalp. Skin of the affected area is shiny. All of the following are possible treatment except:
a) Nystatin ointment
b) Metronidazole
c) Ketoconazole
d) Griseofulvin
e) Nystatin cream
35. Which is the most important finding for the diagnosis of gout?
a) Finding birefringent crystals
b) Increased neutrophil count
c) Increased serum uric acid
d) Increased urinary acid
e) ?
36. In a patient with T8 pain and spastic paresis of lower limbs, which is the most likely diagnosis:
a) Herpes zoster
b) Spinal cord compression
c) Syringomyelia
d) Multiple sclerosis
e) ?
37. Digoxin is indicated in all of the following except:
a) Atrial fibrillation
b) Atrial flutter
c) Atrial tachycardia
d) Nodal rhythm
e) SVT dye to AV nodal recovery
38. In a 30 year old patient with iron deficiency but no history f bleeding and whose ferritin level is elevated, which is the next investigation?
a) Gastroscopy
b) Colonoscopy
c) Bone Marrow aspiration
d) Sigmoidoscopy
e) Haemoglobin electrophoresis
39. An overweight patient has had an episode of bulk diarrhoea with steatorrhoea. He has a history of drinking alcohol for many years. Which of the following is the most useful investigation?
a) IV pancreatography
b) Endoscopic pancreatography
c) Abdominal X-ray
d) Ultrasound
e) Faecal fat analysis
40. A young woman who takes oral contraceptive pills, complains of headaches over the last 3 weeks. The frequency of headaches is five days per week. The headaches improve in the afternoon and during the weekend. Which is the most appropriate management?
a) Stop OCP
b) Relaxation techniques
c) Ergotamine
d) Methysergide
e) Sumatriptan
41. Which of the following is the commonest organism that gives cellulitis?
a) Group A streptococcus
b) Group B streptococcus
c) Staphylococcus aureus
d) E Coli
e) ?
42. All of the following can cause glucose intolerance, except:
a) Pituitary tumour
b) Thyrotoxicosis
c) Acromegaly
d) Phaeochromocytoma
e) Pancreatitis
43. Which of the following is the most common complication of Infectious Endocarditis?
a) Mitral stenosis
b) Rupture of chordae tendineae
c) Aortic stenosis
d) Tricuspid stenosis
e) Aortic regurgitation
44. A woman present with tremor of the hands. Which of the following is correct?
a) Disappears when she looks at her hands
b) Treatment of choice is Propranolol
c) Is present when she is on the phone
d) Disappears when she sleeps
e) Benztropine is helpful
45. A 35 year old policeman suffers from ulcerative colitis, and is treated with Sulfasalazine. He drinks 60g of alcohol per day. Laboratory investigations show: serum bilirubin 18mmol/l; increased alkaline phosphatase, GGT and SGOT. The most likely diagnosis is:
a) Fatty liver
b) Alcoholic cirrhosis
c) Biliary stones
d) Sclerosing cholangitis
e) Cholestasis
46. Demential symptoms in an HIV positive patient can be due to all of the following EXCEPT:
a) AZT side effects
b) Interferon side effects
c) Toxoplasmosis infection
d) AIDS dementia
e) Non-Hodgkin lymphoma
47. A patient with rheumatoid arthritis on long-term treatment with naproxen, came complaining of fatigability over the past week. Lab analysis shows decreased Hb, Normal MCV, raised TIBC and ferritin. Which is the most appropriate diagnosis?
a) Anaemic due to blood loss from GIT
b) Anaemia of the chronic disease
c) Iron deficiency anaemia
d) B12 deficiency
e) ?
48. A lesion of spinal cord at L4/L5 level produces:
a) Loss of foot dorsiflexion
b) Absent ankle jerk
c) Loss of sensation of the medial aspect of calf and thigh
d) Absent knee jerk
e) Absence of sensation on the sole of foot
49. The most common cause of neck stiffness is:
a) Meningitis
b) Botulism
c) Phenothiazine toxicity
d) Tetanus
e) Pneumonia
50. A patient present with headache and neck stiffness over a 4 week period. All of the following are possible except:
a) Extradural haematoma
b) Subdural haematoma
c) Lumbar puncture should be done
d) Urgent CT scan should be done
e) ?
51. Which of the following will decrease the gradient in hypertrophic cardiomyopathy?
a) Digoxin
b) Verapamil
c) ACE inhibitors
d) Prazosin
e) Propranolol
52. Which of the following is true regarding aortic stenosis?
a) Sudden death is possible
b) Gradient of over 50% requires surgery
c) Angina suggest coexistent coronary artery disease
d) Doppler ultrasound is not accurate in diagnosis
e) Echocardiography may be used for diagnosis
53. A patient present with headache, prominent supra orbital ridges, prognathism, wide teeth spacing, thick spade like hands and seborrhoeic, coarse, oily skin. Which of the following is the best investigation to establish a diagnosis?
a) Insulin + glucose test
b) X-ray of the pituitary fossa
c) Cranial CT scan or MRI scan
d) Serum T4 + PRL + growth hormone test
e) Oral glucose tolerance test + GH
54. A pregnant lady present with a widely split S2, cardiomegaly, systolic murmur best heard at pulmonary area and a diastolic murmur in tricuspid area. Which is the most likely diagnosis?
a) Atrial septal defect
b) PDA
c) VSD
d) Pulmonary stenosis
e) Aortic stenosis
55. A 45 year old woman about to undergo cholecystectomy, has a history of bleeding tendency, increased bleeding time, but a normal platelet count. Which of the following are indicated prior to surgery?
a) Vitamin K
b) Factor VIII concentrate
c) Fibrinogen
d) Fresh frozen plasma
e) ?
56. Which type of bilirubin can cross the blood brain barrier?
a) Unconjugated
b) Conjugated
c) Biliary salts
d) ?
e) ?
57. A 28 year old female presented with a history of hypertension. Which of the following tests is best for assessing the structure and function of her kidneys?
a) IV pyelogram
b) Renal ultrasound (Doppler)
c) Renal X-ray
d) CT scan
e) MRI
58. In a paraplegic patient suffering from overflow incontinence, which is the best management?
a) Continuous catheterisation
b) Suprapubic catheterisation
c) Intermittent self-catheterisation
d) Permanent cystostomy
59. A patient present with bilateral temporal hemianopia. Where is the lesion?
a) Pituitary fossa
b) Optic chiasm
c) Parietal lobe
d) Temporal lobe
e) Optic nerve
SURGERY
1. Picture: A young female with a bright red area of rash on her right cheek measuring approx. 5cm x 2cm. Which of the following is the most likely diagnosis?
a) Angiosarcoma
b) Hutchinson melanotic freckle
c) Cellulitis
d) Strawberry haemangioma
e) Solar keratosis
2. Picture 1: A mammograph showing a radio-opaque mass with round, clear margins, and approximately 4cm in diameter.
Picture 2: An ultrasonograph showing the same mass as radiolucent and with a size of 5cm x 5cm.
The diagnosis is:
a) fibroadenoma
b) cyst
c) Fat necrosis
d) Lipoma
e) Carcinoma of the breast
3. Picture: A patient with a given history of a fall on his outstretched hand) lesion is shown on X-Ray (scaphoid fracture). Which is the most appropriate management:
a) Open reduction and internal fixation
b) Plaster including wrist and distal interphalangeal thumb for at least 6 months
c) Plaster including wrist and distal interphalangeal thumb joints for at least 3 weeks.
d) Plaster including wrist and elbow joints for at least 6 weeks
e) Plaster including wrist and elbow joints for at least 3 weeks.
4. Picture: left testis with tortuous swelling above and behind. Which of the following is the diagnosis:
a) Teratoma
b) Varicocele
c) Seminoma
d) Epididymal cyst
e) Hydrocele
5. Picture: Barium meal showing obstructed stomach outlet (most probably diagnosis to be interpreted as ‘Pyloric Stenosis”). This patient presented with severe vomiting. Which of the following fluids should be given:
a) Normal saline
b) Dextrose 5%
c) Hartman’s solution
d) Plasma expanders
e) Ringer’s lactate
6. Picture: Same case as in Qs. 5 above (no new picture was given). How much K+ should be given:
a) 5mmol KCl
b) 25mmol KCl
c) 50mmol KCl
d) More than 50mmol KCl
e) Does not need K+
7. Picture: The picture shown is the same as Figure 45 on Page 262 of the AMCQ Book, 1997 Edition (this picture is given in the explanatory commentary to Surgery Qu No 130 and the commentary on page 262 is titled SU-C130). What is the condition?
a) Chronic deep venous insufficiency
b) Arterial ulcer
c) Raynaud’s phenomenon
d) Raynaud’s disease
e) ?
8. A 35 year old female came with complaint of waking up during the night with pain in her hands accompanied by a burning sensation (pins and needles). Examination of her Right hand shows thenar wasting. Which of the following is the diagnosis?
a) Carpal tunnel syndrome
b) Cervical spondylosis
c) Cervical rib
d) Apical tumor of the lung
e) Brachial plexus injury
9. A young female patient after bouts of vomiting presents with suprasternal emphysema, severe epigastric pain and epigastric guarding and mild dyspnoea. Which of the following is the most probable diagnosis?
a) Rupture of the s tomach
b) Rupture of the oesophagus
c) Rupture of the diaphragm
d) Ruptured mediastinum
e) Ruptured pleura
10. A 35 year old man came with an acute painful eye with conjunctival injection. Examination shows a hazy cornea with fixed dilated pupil. Which is the most probable diagnosis?
a) Iritis
b) Glaucoma
c) Foreign body
d) Trachoma
e) Conjunctivitis
11. In a patient who has wasting of the small muscles of the hand with thenar sparing, which nerve is injured?
a) Median
b) Radial
c) Ulnar
d) Lower branch of the brachial plexus
e) T1
12. The commonest complication of Colles fracture is:
a) Malunion
b) Non-union
c) Sympathetic dystrophy
d) Compartment syndrome
e) Carpal tunnel syndrome
13. In a 32 year old man with 1st degree haemorrhoids, which bleeds occasionally, which is the most appropriate treatment?
a) Band ligation
b) High fibre diet
c) Sclerosing therapy
d) Anal dilatation (Lord’s procedure)
e) Sphincterotomy
14. In a patient presenting with a perforated peptic ulcer, all of the following are correct, except:
a) Patient remembers exactly the moment of rupture
b) Back pain
c) Vomiting
d) Board-like abdominal rigidity
e) Guarding
15. Regarding pancreatic pseudocyst, which is the most correct statement:
a) It is lined with squamous epithelium
b) It can resolve spontaneously
c) It arises in the first 24 hours after an episode of acute pancreatitis
d) It has a connection with the pancreatic duct
e) It drains in the stomach
16. After falling from 6m high scaffolding, a patient presents with pelvic injuries and blood at the external urinary meatus. Which is the most appropriate management?
a) Cystoscopy
b) Urethroscopy
c) IVP
d) Suprapubic catheterisation
e) Urethrography
17. A 35 year old woman has a painless bladder up to the level of her umbilicus. Which is the correct diagnosis?
a) Acute urinary retention
b) Chronic urinary retention
c) Pregnancy
d) Neurogenic bladder with incontinence
e) ?
18. A middle aged man present with severe shock (BP 80/60, HR 120/min), back pain and slight abdominal guarding. Which of the following is the most likely diagnosis?
a) Acute pancreatitis
b) Acute myocardial infarction
c) Leaking aortic aneurysm
d) Perforated peptic ulcer
e) Acute cholecystitis
19. A seamstress which working pierced the proximal interphalangeal crease of her left index finger with a needle. On examination the whole finger was swollen and she experiences pain upon extending the finger. Which of the following is the most likely diagnosis?
a) Cellulitis
b) Tenosynovitis
c) Palmar fascial abscess
d) Osteomyelitis
e) Carpal tunnel syndrome
20. HLA is done for transplantation in Australia. For which of the following is HLA assessment most commonly and widely used?
a) Kidney transplant
b) Liver transplant
c) Brain transplant
d) Heart transplant
e) Lung transplant
21. A patient presents one week after appendicectomy which high fever and a red fluctuating swelling on the medial aspect of the wound. Which is the most appropriate management?
a) Release suture to prevent sinus formation
b) Drain the abscess
c) Give broad spectrum antibiotics
d) Abdominal CT
e) Abdominal X-ray
22. A patient wakes up during the night with sever bilateral calf pain. He has to get out of bed and walks around for a while to relieve the pain. The most likely diagnosis is:
a) Ischaemic pain
b) Rest pain
c) Muscle cramps
d) Intermittent claudication
e) Sciatic pain
23. Which of the following symptoms in a patients’ limb is an unequivocal indication for urgent intervention?
a) Pain
b) Pallor
c) Paraesthesia
d) Temperature
e) Loss of sensation
24. In a lesion between L4 and L5, which of the following will occur?
a) Loss of ankle reflex
b) Loss of knee reflex
c) Impossible dorsiflexion
d) Loss of sensation along the medial aspect of the calf
e) Loss of sensation along the lateral aspect of the calf
25. In case of an emergency, you can safely give a blood transfusion with:
a) Blood group O Rh negative
b) Blood group O Rh positive
c) Blood group AB Rh +ve
d) Blood group AB Rh –ve
e) Blood group A Rh +ve
26. A young male walks into your surgery complaining of severe ureteric colic. Apparently a sample of urine that he has brought with him is blood stained. He requests a shot of pethidine to relieve his pain. What is your next step?
a) Give him 50mg pethidine IV to relieve his pain
b) Give him 100 mg IM to relieve his pain
c) Ask for a fresh urine sample
d) Send him an urgent IVP
e) Arrange hospital admission
27. A 40 year old male present with an acute onset of pain and swelling of the left testicle over the last 2 days. Which of the following is the most likely diagnosis?
a) Varicocoele
b) Acute epididymitis
c) Testicular torsion
d) Teratoma
e) Spermatocoele
28. A patient is brought with a flail chest and haemothorax. His BP is 90/40 mmHg and HR is 140/min. What is your initial management?
a) Endotracheal intubation
b) Nasogastric tube
c) IV fluids
d) Wide bore chest drain
e) Immediate thoracostomy
29. For a 65 year old female with TIA, who was diagnosed as having 85% stenosis of the carotid artery, which is the most correct statement?
a) Aspirin is the best treatment
b) Endarterectomy will decrease by more than 50% the chance of stroke
c) Endarterectomy is contraindicated 9there is a 70% chance of death within 30 days)
d) Do nothing as she is going to die anyway
e) ?
30. A young woman present with a solitary nodule in the anterior triangle of the neck. Histological examination reveals normal thyroid cells. Which if the following is the most likely diagnosis?
a) Aberrant thyroid tissue
b) Thyroid malignancy
c) Normal lymph node
d) Hashimoto’s thyroiditis
e) ?
31. Which of the following is hereditary?
a) Papillary carcinoma of thyroid
b) Follicular carcinoma of thyroid
c) Medullary carcinoma of thyroid
d) Anaplastic carcinoma of thyroid
e) Grave’s disease
32. In a young person with a left sucking wound of the chest, which is the most appropriate management after managing the airway, pulse and circulation?
a) Debridement and closure of the wound
b) Pressure bandage
c) Lage bore drainage tube
d) Needle thoracotomy
e) Open thoracotomy
33. Ischaemic pain is suggested by all the following except;
a) Pain in the thigh on walking
b) Pain in the calf on walking
c) Localized ankle pain
d) Pain on walking relieved by rest
e) Rest pain
34. A 65 year old man present with fever of 40C and chills 6 hours after urethral instrumentation. Which if the following is the most likely cause?
a) Acute pyelonephritis
b) Suppurative urethritis
c) Gram negative bacteraemia
d) Ruptured bladder
e) Cystitis
35. In a patient with splenectomy and spherocytosis which will be the most probable finding?
a) Leucocytosis
b) Increased number of platelets
c) Hepatomegaly
d) Number of spherocytes is below normal
e) Fragility test remains positive
36. All of the following symptoms are present in an extradural haemorrhage except:
a) Bradycardia
b) Hypotension
c) Focal neurological signs
d) Dilated pupil
e) ?
37. What would be the best reason to make a screening program more available to the public?
a) Possibility of early diagnosis
b) It is required for research purposes
c) It improves the treatment’s prognosis
d) Specialised treatment is available
e) It can lower the death rate from the disease
38. Hypercalcaemia will be present with all the following findings except;
a) Lytic bone lesions
b) Hypercalcinosis
c) Diarrhoea
d) Depression
e) Hypercalciuria
39. Which of the following electrolytes is lost after ileostomy:
a) Na
b) Cl
c) HCO3
d) K
e) Ca
40. Which is the best indicator for the depth of a burn:
a) Anaesthesia of the wound
b) Increased blistering
c) Oozing is seen in deep burns
d) Scalds are prone to deeper burning
e) ?
41. A woman present with an ulcer on the loser third of the medial side of her left leg. All of the following are appropriate treatments except:
a) Compression stockings
b) Bed rest with the elevation of the leg
c) Local antibiotics
d) ?
e) ?
42. Regarding clostridial myonecrosis:
a) Gas is always present on X-ray
b) Surgical excision is a part of the treatment
c) Hyperbolic oxygen will invariably reduce the need for surgery
d) ?
e) ?
43. Best management of a major trauma would be:
a) Debridement of the necrotic tissue
b) Proper apposition of the sutured skin flaps
c) Use of antibiotics
d) Use of proper surgical techniques
e) ?
44. All of the following can be done to reduce nosocomial infections except:
a) Staff with active infection should not be allowed to deal directly with the patients
b) Staff members who are carriers of Staphylococcus aureus in their noses should not be allowed to work with the patients
c) Staff members should wash their hands between dressing
d) Staff members should have prophylactic antibiotics policy
e) ?
OBSTETRICS AND GYNECOLOGY
1. A 17 year old girl was commenced on OCP (microgynon 30). She had two periods in the first month, one lasted 2 days and the other one lasted 4 days. What would you advise her?
a) Change over to Microgynong 50
b) Continue on Microgynon 30 for another 2 months
c) Stop OCP and use some other form of contraception
d) Use POP (Progesterone only Pill)
e) ?
2. A 25 year old female present with galactorrhoea and amenorrhoea. On CT scan there was a pituitary adenoma that was 3mm from the optic chiasm, but there was no visual disturbance. Prolactin level was 1000. Which will be the most appropriate management?
a) Trans-frontal surgery
b) Trans-nasal surgery
c) Bromocriptine
d) Clomiphene
e) Oestrogen 85 micrograms
3. The most appropriate OCP for a 24 year old woman on Phenytoin is:
a) Microgynon 30
b) Microgynon 50
c) Diane 35
d) Clomiphene
e) Oestrogen 85 micrograms
4. A woman gave birth to a baby 2 months ago. She has decided to breast feed the baby and is asking for a contraceptive method with a failure rate less than 2%. She wants to have another baby after 12 months. You will advise her all of the following except:
a) POP
b) Depo Provera
c) Combined OCP
d) IUCD (intro-uterine device)
e) Breastfeeding will provide the best contraception and thus she doesn’t need another contraceptive method.
5. For the treatment of infertility, to induce ovulation, you will give all of the following except:
a) Beta-hCG
b) Human menopausal gonadotrophin
c) Clomiphene Citrate
d) GnRH agonist + hCG
e) Gonadotrophin releasing hormone
6. A pregnant woman is 34 weeks of gestation present with ante-partum haemorrhage (about 100 ml). She is in shock. You diagnose abruptio placentae. All of the following findings are possible except:
a) Tender uterus
b) Shock out of proportion with the bleeding
c) BP 180/110 mmHg
d) Head high in the pelvis (not engaged)
e) Dead foetus
7. A woman present 3 days after she gave birth to a baby complaining of irritability and tearfulness. Which of the following is correct?
a) Postpartum blues predisposed to postpartum psychosis
b) More than 50% pf women suffer from postpartum blues
c) She requires anti-psychotic medication
d) She requires ECT
e) Postpartum blues last for at least 3 months
8. A 30 year old woman is in labour for 8 hours. Despite rupture of the membranes the cervix is still dilated at 4cm. Obstructed labour is diagnosed. All of the following are true EXCEPT:
a) Oedema of the anterior lip of the cervix
b) Face presentation (mento-anterior)
c) Foetal head is palpable 1cm above the ischial spine
d) Foetal head is palpable 4cm in abdomen, vertex is 1cm below the ischial spine
e) Foetal tachycardia (168/min)
9. In twin pregnancy, after delivery of the first twin you will do all of the following EXCEPT:
a) Vaginal examination
b) External version is the second twin is breech
c) Oxytocin infusion if contractions don’t start
d) Check foetal heart rate
e) Check position of the second twin
10. A pregnant female came to see you for her first antenatal check. She has a good balanced diet. What would you recommend for her as dietary supplements?
a) Calcium
b) Vitamin B12
c) Phosphorus
d) Iron
e) None of the above
11. A 13 year old girl is brought to you by her mother. The girl has slightly developed breast, sparse axillary hair, but she has never menstruated. She is shy and does not allow you to examine her genitalia. All of the following tests are appropriate, EXCEPT:
a) Chromosomal analysis
b) Prolactin levels
c) CT scan
d) Pelvic ultrasound
e) FSH levels
12. A couple came to you for IVF. She is 22 years old and he is 26 years old. All of the following are indications for IVF, EXCEPT:
a) Husband is azoospermic
b) She has anovulatory cycles with normal levels of FSH, LH and prolactin
c) They have not been able to conceive for two years
d) Bilateral obstructed tubes
e) Endometriosis diagnosed a few months ago
13. A couple comes to you for advice. The husband’s mother has bipolar disorder. They want to know what are the chances for their baby to inherit the disorder. What would be your advice?
a) Less than 10%
b) They should not conceive because the chance is too high for the aby to have the same disorder
c) They should have chromosomal analysis done to determine if they carry the gene
d) Amniocentesis should be done at Wk 16 of pregnancy to determine to see if the foetus is affected
e) ?
14. Which is the most reliable test to determine the time of ovulation:
a) Progesterone levels from the 21st day (in a 28 day cycle)
b) Serial urinary LH levels
c) Self assessment of cervical mucus changes
d) Body temperature charting
e) Estimation of FSH levels
15. A woman came to you 2 years after her menopause asking for something to relieve her postmenopausal symptoms. You decide to give her combined HRT: Oestrogen for 28 days and progesterone for the last 12 days of the cycle to oppose the action of oestrogen. You are going to explain to her the effects of progesterone, which are all of the following, except:
a) She will have pre-menstrual like symptoms
b) She will have withdrawal bleeding every month
c) Progesterone will oppose the action of oestrogen on the endometrium
d) Progesterone will potentiate the action of oestrogen in increasing HDL levels
e) Progesterone will augment the action of oestrogen for prevention of osteoporosis
16. A 16 weeks pregnant female comes to see you for her first antenatal check up. She tells you that she had previously given birth to a baby, who was 4.8kg at birth; she had a difficult labour, the baby was forceps delivered and had a broken clavicle, and she suffered multiple vaginal lacerations. How would you manage her in this pregnancy?
a) Urine examination for glucose, ketones and proteins
b) 2 hours serum glucose test
c) Glucose tolerance test
d) Ultrasound pelvimetry
e) Abdominal X-ray in the last trimester
17. A 26 weeks pregnant female came to see you, complaining of slight vaginal bleeding and uterine contractions. Which of the following is an indication of pre-term labour?
a) Raised AFP (alpha-feto proteins) levels
b) Ruptured membranes, with closed cervix
c) Cervix of normal length, internal os closed, external os admits one finger
d) Foetal fibronectin at the cervix
e) ?
18. A 17 weeks pregnant female has acute right iliac fossa pain. Which is the least likely cause of this pain?
a) Pyelonephritis
b) Red degeneration of a fibroid
c) Ectopic pregnancy
d) Acute appendicitis
e) Torsion of an ovarian cyst
19. Which of the following CTG patterns indicate foetal distress?
a) Accelerations with foetal movements
b) Early decelerations with uterine contractions
c) A beat to beat variability < 5 beats/min
d) Decelerations when the foetus is sleeping
e) Accelerations on sound stimulation
20. Regarding endometrial ablation, all of the following are true EXCEPT:
a) 30-60% of women will be amenorrhoeic
b) Oestrogen alone can be given safely as HRT
c) 15% of women will need to repeat the procedure or have an hysterectomy
d) The basal layer of endometrium is destroyed
e) It is one of the treatments for dysfunctional uterine bleeding
21. A young obese female, with hirsutism, oligomenorrhea and irregular periods was found to have endometrial hyperplasia (benign) on curettage. All of the following are appropriate treatments, EXCEPT:
a) Progesterone from 14th to 21st day of each cycle
b) Diane35
c) Clomiphene citrate on the 4th and 9th days of the menstrual cycle
d) Progesterone + oestrogen (OCP)
e) Oestrogen alone
22. A 65 year old female was prescribed Warfarin recently for atrial fibrillation. Now she present after a brief period of vaginal bleeding. Which is the least likely cause for this?
a) Endometrial carcinoma
b) Cervical carcinoma
c) Atrophic vaginitis
d) Anticoagulant therapy
23. Which of the following measures would have the most dramatic impact on preventing and reducing the mortality from cervical carcinoma?
a) Usage of condom in cases of extramarital intercourse
b) Papilloma virus vaccine
c) Improving pap smears
d) Improving screening methods for early detection
e) Making colposcopy more available
24. In a pregnant female with multiple pregnancy you will advise all of the following EXCEPT:
a) More frequent antenatal checking
b) Iron and folic acid supplements
c) More frequent Ultrasonograms
d) Give a corticosteroid injection at 34 weeks of pregnancy, as she has an increased chance of pre-term labour
e) Induced delivery before term
25. A 26 weeks pregnant female had a BP of 140/90mmHg on her first antenatal visit. Four weeks later the blood pressure was 140/100. Which of the following is contraindicated:
a) ACE inhibitors
b) Methyldopa
c) Labetolol
d) ?
e) ?
PAEDIATRICS
1. A 6 week old baby presents with unilateral eye discharge since birth. A pathology result shows polymorphonuclear cells. Which is the most likely diagnosis:
a) Gonococcal infection
b) Chlamydial infection
c) Syphilitic infection
d) Imperforated lacrimal duct
e) Herpetic infection
2. Which of the following will resolve spontaneously in 30% of newborns?
a) Small VSD in a year old
b) PDA in a 3 year old
c) Coarctation of aorta in a pre-term baby
d) ASD in an 8 month old baby
e) Congenital heat block
3. A 5 year old girl has headaches and morning vomiting for 3 weeks. She is well otherwise. Which is the most likely cause:
a) Migraine
b) Medulloblastoma
c) Sinusitis
d) Hydrocephalus
e) Wilson’s disease
4. All of the following are correct about atopic eczema in children, EXCEPT:
a) It is very itchy
b) Usually involves flexor surfaces
c) Topical steroids are helpful
d) First episode in early childhood
e) It is a contraindication for DTP vaccination
5. A 2 years old boy has purulent unilateral nasal discharge and occasional bleeding, for 2 weeks. He has had a course of antibiotics with no improvement. On examination he is very irritable and doesn’t allow you to examine his nostrils. What is your further management?
a) Repeat course of antibiotics
b) Topical antibiotics
c) Carefully examine is nose under general anaesthesia
d) Refer him to an ENT specialist
e) Change the antibiotics
6. Which is the most common cause of death in a child with beta-thalassemia:
a) Cardiac failure
b) Renal failure
c) Hepatic failure
d) Infection
e) Haemorrhage
7. All of the following are false regarding cerebral palsy, EXCEPT:
a) 90% progress to severe mental retardation
b) 80%of the children have an IQ of 70
c) Is frequently associated with Down Syndrome
d) 70% will have moderate handicap
e) 10% will improve
8. A 2 year old boy is brought to you by his parents. He doesn’t speak as he should for his age, but his hearing is adequate. When he was 1 year old he could babble a few words. Which of the following is your further management?
a) Arrange audiometry
b) Check the hearing system
c) Check his development
d) ?
e) ?
9. Regarding febrile convulsions, which of the following is true:
a) There is always a family history
b) Commonly occur between 3-5 years
c) Focal seizures are present
d) Usually last less than 15 minutes
e) Most will develop epilepsy later in life
10. A 3 year old girl presents with 3cm x 3cm erythematous area on the upper eyelid, the oedema, congestion of conjunctiva and normal eye movement. Which is the correct treatment:
a) IV flucloxacillin and cephalosporin
b) Topical chloramphenicol
c) Topical steroids
d) Surgical intervention
e) Topical gentamycin
11. The most common cause of iron deficiency in Australian children is:
a) GIT bleeding
b) Lack of fresh fruit and vegetables
c) Malabsorption
d) Recurrent infections
e) Cow’s milk diet
12. Which of the following is the cause of kernicterus in children:
a) total bilirubin
b) Conjugated bilirubin
c) Haptoglobin
d) Cholestasis
e) ?
13. A 3 year old boy present with fever (380C), difficulty in breathing and difficulty in swallowing fluids. Which is the most appropriate management?
a) Prepare for intubation or tracheostomy
b) Treatment with oral penicillin
c) Nebulised Salbutamol
d) Reassure mother and send her home
e) Examine throat
14. A 7 years old boy fell from a tree. After 7 days he present with pain and swelling of one knee, and fever of 38C. Which is the most likely diagnosis?
a) Acute leukaemia
b) Osteomyelitis
c) Osteogenic sarcoma
d) Perthe’s disease
e) Still’s disease
15. A fully breast-fed baby, from a mother on a healthy balanced diet, can suffer from which vitamin deficiency?
a) Vit A
b) Vit B complex
c) Vit C
d) Vit D
e) ?
16. A 5 year old child present with extremely painful ears. The eardrums are red and protruding. Which of the following is correct?
a) tetracycline is the treatment of choice
b) Broad spectrum antibiotics should be administered as ear drops
c) If the eardrums ruptured spontaneously, it will provide immediate pain relief
d) Tympanotomy will lead to life lone ear discharge
e) Antihistamines can improve the drainage of the middle ear
17. At what age can a normally developed child speak simple phrases and understand simple verbal commands?
a) 1 year
b) 2 years
c) 3 year
d) 4 years
e) 5 years
18. The most common cause of rectal bleeding in a child is:
a) Intussusception
b) Gastroenteritis
c) Fissure in ano
d) Meckel’s diverticulum
e) Haemorrhoids
19. A mother brought her 12 year old child with hip pain and limping. He is in the 19th percentile of weight. Which is the most likely diagnosis?
a) Hip arthroses
b) Perthe’s disease
c) Transient synovitis
d) Slipped upper femoral epiphysis
e) Tuberculosis
20. In a boy weighing 4 kg, who suffered 20% burns, you will do all of the following, EXCEPT:
a) Skin graft
b) Fluid replacement of 1500ml over the first 24 hours
c) Assessment of depth by examining for pain sensation
d) IV narcotics for pain relief
e) Urinary catheterisation
21. A previously well 12 year old girl, while she was watching TV, had a sudden attack of difficult breathing. All the examinations were normal and she was not dyspnoeic anymore. Which would be the most probable diagnosis?
a) Asthma
b) Panic attack
c) Pneumothorax
d) Epilepsy
e) Ketoacidosis
22. A 12 year old boy presents to the emergency department with a 4 hour history of severe Right testicular pain, with an acute onset. On examination the scrotum is swollen and extremely tender. Which is the most appropriate management?
a) Surgical exploration of the scrotum
b) Confine him on antibiotics and scrotal support (elevation)
c) Do a urine ward examination
d) No treatment, only observe
e) Reassure and send him home
23. Which is the most common form of epilepsy that occurs between 4-10 years old?
a) Infantile spasm
b) Myoclonic attacks
c) Breath-holding attacks
d) Petit mal seizures
e) ACTH dependent seizures
24. A 3 year old presents with persistent cough. On examination he has rhonchi and crepitations. He also has diarrhoea and has lost weight. Which would be the most correct management?
a) Treat empirically with antibiotics
b) Do a sweat X-ray
c) Abdominal ultrasound
d) Full blood examination
e) ?
25. A child present with scattered bruises all over his body. He is well otherwise. Which of the following is the most correct management?
a) Admit the patient to the ward, contact social work department and other authorities
b) Give IV antibiotics
c) Reassure the parents and send the child home
d) Do a full blood examination
e) Do a clotting profile
26. A child is brought to you after being bitten by a snake two hours ago. The child is well except a small scratch on the lateral aspect of his Right leg. Which is the most appropriate next step?
a) Observe him for 24 hours
b) Admit him and give polyvalent anti-snake venom immediately
c) Reassure and send him home
d) Clear the wound with antiseptic and start antibiotics
e) Do clothing profile and give anti-snake venom
27. All of the following are complications of meningitis except:
a) Hydrocephalus
b) Cerebral abscess
c) Subdural haematoma
d) Subarachnoid haematoma
e) Subdural effusion
PSYCHIATRY
1. All of the following can be a cause of psychosis in a HIV positive patient except:
a) Toxoplasma infection
b) Zidovudine therapy
c) Non-Hodgkin lymphoma
d) AIDS itself
e) Interferon therapy
2. Which of the following is correct regarding “Baby Blues”?
a) Is present in more than 50% of women
b) Is associated with breastfeeding
c) Predisposes to post-partum psychosis
d) ?
e) ?
3. Which of the following is correct regarding OCD (Obsessive Compulsive Disorder)?
a) It is associated with borderline personality disorder
b) It is associated with acute myocardial infarction
c) It is associated with substance abuse
d) It is associated with epilepsy
e) It is associated with dementia
4. Which of the following is most commonly associated with bulimia nervosa?
a) Morbid obesity
b) Hyperkalaemia
c) Depression
d) Female gender
e) Improvement with dietary advice
5. Which of the following are well known causes of ADHD (Attention Deficit Hyperactivity Disorder)?
a) Fragile X syndrome
b) ?
c) ?
d) ?
e) ?
6. Which of the following is a negative symptom of schizophrenia?
a) Auditory hallucinations and delusions
b) Blunt affect
c) Visual hallucinations
d) Catatonia
e) Thought disorder
7. A 16y old female is brought to you after attempted suicide. She is reluctant to take any drug, as are her legal guardians. What would you do?
a) Admit her to hospital (involuntary admission)
b) ?
c) ?
d) ?
e) ?
8. Testamentary capacity means
a) Fitness to plead in court
b) Capacity to make a valid will
c) No mental disorder is present
d) Capacity to swear an oath on the Bible
e) Not responsible for criminal actions in the past
9. In a patient who comes to you complaining of impotence, you advise all of the following except:
a) Trial of Viagra
b) Take a good history of his sexual behaviour
c) Explain to him that this happens to a certain percentage of the male population
d) Find out whether he has any cardiac or endocrine conditions
e) Find out whether he is taking any drugs which can cause the problem
10. If you want to do a trial of a new drug, which of the following is essential?
a) Use a placebo group as control
b) Ask the Helsinki Human Rights Commission for permission to test it on humans
c) Ensure the patients are financially compensated for loss of time due to trial procedures
d) Obtain permission from the Medical Ethics Committee
e) ?
11. All of the following can cause serotonin syndrome except:
a) Haloperidol
b) L tryptophan
c) Clonazepam
d) Moclobemide
e) Dextromorphan
12. In which of the following conditions will you find “déjà vu” ?
a) Occipital lobe tumour
b) Temporal lobe tumour
c) Korsakoff’s syndrome
d) Raised intracranial pressure
e) Frontal lobe tumour
13. A lady came to you looking for counselling after her second marriage break-up. She was severely depressed and anxious but very seductive during the interview. She was very suggestive when she was talking about her previous sexual relationships. Her behaviour is most probably due to:
a) Borderline personality
b) Histrionic personality
c) Antisocial personality
d) Dependent personality
e) Substance abuse
14. All of the following psychoses are fully reversible except:
a) Mania
b) Factitious disorder
c) Severe sensory deprivation
d) Amphetamine abuse
e) ?
15. Panic disorder without agoraphobia:
a) Is more frequent in men
b) Is more frequent in women
c) Is equally frequent in men and women
d) Starts in the 20s
e) Patients should avoid trigger factors[code][quote]
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