- A 2yo boy fell off his tricycle and hurt his arm. He got up to start crying, but before there was
any sound, he went pale, unconscious and rigid. He recovered after 1-2 mins but remained pale.
After an hour he was back to normal. His mother says she was afraid he was going to die, and
that he had a similar episode 3 months prior after falling down some steps. What single inv is
indicated?
a. CT head
b. EEG
c. CBC
d. None
e. Skeletal survey - A 29yo woman had just delivered a still born vaginally, following a major placental abruption.
Choose the single most likely predisposing factor for developing PPH in this lady?
a. Retained product
b. DIC
c. Fibroid uterus
d. Uterine infection
e. Large placental site - A 28yo woman has delivered with rotational forceps after an 8h labor and 3h second stage.
Choose the single most likely predisposing factor for PPH for this pt?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Retained product
d. Preterm labor
e. Uterine infection - A 50yo man has had anterior resection of the rectum for carcinoma. He expressed concerns
about control of post-op pain in discussions with the anaesthetist before surgery. What is the
best management strategy?
a. Oral diclofenac
b. Oral codeine
c. IM morphine
d. IM dihydrocodeine
e. Ondansetron oral - A 73yo male presents with enlarged cervical nodes. He has had recurrent infections over the last
year. His conjunctiva is pale. Choose the single cell type you will find on the blood film.
a. Granulocyte without blast cells
b. Myelofibroblasts
c. Plasma cells
d. Mature lymphocytes - A 45yo lady has 10m hx of SOB. She is found to have irregularly irregular pulse and loud P2 with
fixed splitting and ejection systolic murmur in left 2nd ICS. What is the probable dx?
a. TOF
b. ASD
c. VSD
d. PDA
e. CoA - A 5m baby present with recurrent vomiting. Mother noticed some of the vomitus is blood
stained. Choose the single most likely inv?
a. Upper GI endoscopy
b. Barium meal
c. US
d. Colonoscopy
e. CT abdomen - A 76yo is treated with HTN. He suffers from pain and redness at the MTP joint of his right big toe.
Which of the following anti-HTN cause this symptoms?
a. Losartan
b. Bendroflumethiazide
c. Ramipril
d. Bisoprolol
e. Verapamil - A 33yo male involved in a street fight presents with bruises and deformity in the upper part of
his leg. XR shows fx of the neck of fibula. What is the single most associated nerve injury?
a. Sciatic nerve
b. Gluteal nerve
c. Musculocutaneous nerve
d. Lateral peroneal nerve
e. Tibial nerve
f. Femoral nerve - A 35yo man presents with hx of dyspepsia. H.Pylori antibodies are negative. No improvement is
seen after 1m of tx. What is the next step?
a. Urea breath test
b. Gastroscopy
c. CT
d. MRI - A 15yo male has bilateral ankle edema. His BP=110/70mmHg and urinalysis shows protein++++.
What is the most likely dx?
a. HUS
b. IgA nephropathy
c. Membranous GN
d. Minimal change GN
e. Nephrotic syndrome - A 28yo man has developed a red, raised rash on trunk after playing football. His PMH shows he
had childhood asthma. The rash is becoming increasingly itchy. What is the most appropriate tx?
a. Oral chlorpheneraime
b. Oral amoxicillin
c. IM adrenaline
d. Nebulized salbutamol
e. Histamine - A 72yo man has been advised to have antibiotic prophylaxis for some years now before dental tx.
He has never experienced chest pain. Three weeks ago, he noticed breathlessness on exertion
and for one week he had orthopnea. His pulse is normal. What is the most probable dx?
a. Aortic regurgitation
b. Ischemic mitral regurgitation
c. Mitral valve prolapse
d. Pulmonary stenosis
e. Mitral valve stenosis - A 37yo woman presents with fatigue. Exam: angular stomatitis, no koilonychea. Choose the
single cell type you will find on the blood film.
a. Macrocytes
b. Microcytes
c. Granulocytes wthout blast cells
d. Blast cells - A 4yo boy with a febrile convulsion lasting eight minutes has been given IV lorazepam to control
them. What is the single most likely serious side effect?
a. Amnesia
b. Anaphylactic shock
c. Apnea
d. Bronchospasm
e. Cardiac arrhythmia - A 4wk girl has been dx of having breast milk jaundice. She is otherwise well. What is the single
most appropriate management?
a. Continue breastfeeding
b. Exchange transfusion
c. Increase fluid intake
d. Phototherapy
e. Stop breastfeeding - A 12yo girl when playing in the garden accidentally stepped on a hive and was bitten several
times. She has numerous wheals on her body and complains of severe itching. What is the single
most appropriate management?
a. Oral antihistamine
b. IV antihistamine
c. IM adrenaline
d. Oral ciprofloxacin
e. Reassurance - A term baby born to a 30yo woman of blood group A-ve develops severe jaundice within the
first 24h of birth. What is the most likely dx?
a. Hereditary spherocytosis
b. G6PD
c. ABO incompatibility
d. Rh incompatibility
e. Physiological jaundice - A 4yo girl is found to have bounding pulse and continuous machinery murmur. What is the most
probable dx?
a. TOF
b. ASD
c. VSD
d. PDA
e. CoA - A 12yo child with episodes of sudden bluish discoloration and brief loss of consciousness. Exam:
clubbing, central cyanosis, systolic thrill with systolic ejection murmur in 2nd left ICS. What is the
most probable dx?
a. TOF
b. ASD
c. VSD
d. PDA
e. CoA - An 8yo child who is tall for his age and has a refractory error for which he wears glasses has
presented with severe crushing chest pain. What is the most likely dx?
a. Fragile X syndrome
b. Prader-willi syndrome
c. DiGeorge syndrome
d. Marfans syndrome - A 4yo child presents with pain of spontaneous onset in his knee of 2 days duration. He has
developed mild fever in the 2nd day. He can walk but has a limp. Exam: painful restriction in the
right hip. What is the most probable dx?
a. Osteosarcoma
b. Septic arthritis
c. TB arthritis
d. Exostosis
e. Osteomyelitis - A man with anterior resection and end to end anastomosis done complains of severe pain in the
chest and abdominal distension. What is the most appropriate inv likely to review the cause this
deterioration?
a. XR abdomen
b. Exploratory laparoscopy
c. CT
d. US
e. Laparotomy - Pt with hx of alcoholism, ataxic gait, hallucinations and loss of memory. He is given acamprosate.
What other drug can you give with this?
a. Chlordiazepoxide
b. Thiamine
c. Diazepam
d. Disulfiram
e. Haloperidol - A 35yo male builder presented with sudden onset of severe abdominal pain. He was previously
fit and well other than taking ibuprofen for a long term knee injury. On examination he is in
severe pain, pulse=110bpm, BP=110/70mmHg and has a rigid abdomen. What is the most likely
dx?
a. Biliary peritonitis
b. Ischemic colon
c. Pancreatic necrosis
d. Perforated diverticulum
e. Perforated peptic ulcer - A woman 5 days post-op for bilateral salphingo-oopherectomy and abdominal hysterectomy has
developed abdominal pain and vomiting a/w abdominal disteŶsioŶ aŶd ĐaŶ͛t pass gas. No ďoǁel
sounds heard, although well hydrated. What is the most appropriate next step?
a. XR abdomen
b. Exploratory laparoscopy
c. CT
d. USG
e. Barium enema - A 30yo man complains of hoarseness of voice. Exam: unilateral immobile vocal cord. What is the
most probable dx?
a. Graves disease
b. Hematoma
c. Unilateral recurrent laryngeal nerve injury
d. External laryngeal nerve injury
e. Tracheomalacia - A 38yo woman has delivered after an induced labor which lasted 26h. choose the single most
likely predisposing factor for postpartum hemorrhage?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Rupture uterus
d. Fibroid uterus
e. Age of mother - A 32yo woman in tears describing constant irritability with her 2 small children and inability to
relax. She describes herself as easily startled with poor sleep and disturbed nightmares following
a house fire a year ago, while the family slept. What is the single best tx?
a. Rassurance
b. Relaxation therapy
c. Quetiapine
d. Lofepramine
e. Fluoxetine - A 22yo woman with longstanding constipation has severe ano-rectal pain on defecation. Rectal
exam: impossible due to pain and spasm. What is the most probable dx?
a. Anal hematoma
b. Anal fissure
c. Anal abscess
d. Protalgia fugax
e. Hemorrhoids - A 20yo student attends the OPD with complaint of breathlessness on and off, cough and sputum.
His sleep is disturbed and skin is very dry in flexural areas of the body. Exam: tachypnea,
hyperresonant percussion and wheezing on auscultation. What is the most likely dx?
a. Extrinsic allergic alveolitis
b. Asthma
Đ. WegeŶeƌ͛s gƌaŶuloŵatosis
d. COPD
e. Cystic fibrosis - A pt with thought disorder washes hands 6x each time he uses the toilet. What is the best
management?
a. Psychodynamic therapy
b. CBT
c. Antipsychotics
d. Refer to dermatology
e. Reassure - A 25yo woman presented to her GP on a routine check up. Upon vaginal exam, she was fine
except for finding of cervical ectropion which was painless but mild contact bleeding on touch.
What is the next management?
a. Endometrial ablation
b. Cervical smear (2nd line)
c. Colposcopy
d. Antibiotics (1st line)
e. Vaginal US
f. Pack with gauze and leave to dry - A 32yo had a normal vaginal delivery 10 days ago. Her uterus has involuted normally. Choose
the single most likely predisposing factor for PPH?
a. Retained product
b. DIC
c. Uterine infection
d. Von Willebrand disease
e. Primary PPH - A 37yo man slipped while he was walking home and fell on his out stretched hand. He complains
of pain in the right arm. XR showed fx of the head of radius. What is the single most associated
nerve injury?
a. Radial nerve
b. Musculocutaneous nerve
c. Median nerve
d. Ulnar nerve - A butcher stabbed accidently his groin. He bled so much that the towel was soaked in blood and
BP=80/50mmHg, pulse=130bpm. What % of circulatory blood did he lose?
a. <15%
b. 15-30%
c. 30-40%
d. 40-50%
e. >50% - A 67yo man presents with palpitations. ECG shows an irregular rhythm and HR=140bpm. He is
otherwise stable, BP=124/80mmHg. What is the most appropriate management?
a. Bisoprolol
b. ACEi
c. Ramipril
d. Digoxin - A 78yo man is depƌessed afteƌ his ǁife͛s death. He has ďeeŶ ŶegleĐtiŶg hiŵself. His soŶ fouŶd
hiŵ iŶ a ŵiseƌaďle state ǁheŶ he ǁeŶt to ǀisit. The soŶ ĐaŶ͛t deal ǁith his fatheƌ. What is the
appropriate management?
a. Voluntary admission to psychiatry ward
b. Hand over to social worker
c. Request son to move in with father
d. Send pt to care home - An old alcoholic presents with cough, fever, bilateral cavitating consolidation. What is the most
probable cause?
a. Gram +ve diplococcic
b. Coagulase +ve cocci
c. Gram –ve cocci
d. AFB
e. Coagulase –ve cocci - A 67yo man had successful thrombolysis for an inf MI 1 month ago and was discharged after
5days. He is now readmitted with pulmonary edema. What is the most probable dx?
a. Aortic regurgitation
b. Ischemic mitral regurgitation
c. Mitral valve prolapse
d. Pulmonary stenosis
e. Rheumatic mitral valve stenosis - A 60yo lady who had stroke 3 years ago now reports having increased dyspnea on exertion and
atrial fibrillation. CXR: straight left border on the cardiac silhouette. What is the most probable
dx?
a. Aortic regurgitation
b. Ischemic mitral regurgitation
c. Mitral valve prolapse
d. Pulmonary stenosis
e. Rheumatic mitral valve stenosis - A 60yo diabetic complains of pain in thigh and gluteal region on walking up the stairs for the last
6 months. She is a heavy smoker and has ischemic heart disease. What is the most appropriate
dx?
a. Thromboangitis Obliterans
b. Sciatica
c. DVT
d. Atherosclerosis
e. Embolus - A 3yo child who looks wasted on examination has a hx of diarrhea on and off. The mother
describes the stool as bulky, frothy and difficult to flush. What is the single inv most likely to
lead to dx?
a. Sweat chloride test
b. Anti-endomysial antibodies
c. LFT
d. US abdomen
e. TFT - A 45yo woman has had severe epigastric and right hypochondrial pain for a few hours. She has a
normal CBC, serum ALP is raised, normal transaminase. 3 months ago she had a
cholecystectomy done. What is the most appropriate inv?
a. US abdomen
b. ERCP
c. MRCP
d. CT abdomen
e. Upper GI endoscopy - A 53yo woman presented with pain in the eye, blurry vision and clumsiness for 3 months. She
has a hx of difficulty in swallowing and weakness in her right upper limb 2y ago. What is the inv
of choice?
a. CSF analysis
b. EEG
c. EMG
d. MRI brain
e. Visual evoked response test - A 55yo male presents with malaise and tiredness. Exam: spleen approaching RIF, no
lymphadenopathy. Choose the single cell type?
a. Helmet shaped cell
b. Sickle cell
c. Granulocyte without blast cells
d. Blast cells - A 6yo pt comes with easy bruising in different places when she falls. CBC: WBC=25, Hgb=10.9,
Plt=45. Her paul brunnel test +ve. What is the most likely dx?
a. Glandular fever
b. ITP
c. Trauma
d. NAI
e. Septicemia - A 41yo woman who has completed her family, has suffered from extremely heavy periods for
many years. No medical tx has worked. She admits that she would rather avoid open surgery.
After discussion, you collectively decide on a pƌoĐeduƌe that ǁouldŶ͛t ƌeƋuiƌe opeŶ suƌgeƌLJ oƌ
GA. Select the most appropriate management for this case.
a. Endometrial ablation
b. Hysterectomy
c. Fibroid resection
d. Myomectomy
e. Uterine artery embolization - A girl with hx of allergies visited a fƌieŶd͛s faƌŵ. She got stƌidoƌ, ǁheeze aŶd eƌLJtheŵatous ƌash.
What is the most appropriate tx?
a. 0.25ml IM adrenaline
b. 0.25ml PO adrenaline
c. 0.25ml IM adrenaline
d. IV chlorphearamine - A 5yo boy is referred to the hospital and seen with his father who is worried that he has been
listless. He is not sure why his GP suggested he should come to the ED and is keen to get some
tablets and go home. Exam: tired and irritable, swelling around eyes. Renal biopsy: remarkable
for podocyte fusion on EM. What is the most probable dx?
a. NAI
b. Myelodysplastic disease
c. HSP
d. Membranous GN
e. Minimal change GN