- A 29yo teacher is involved in a tragic RTA. After that incident, he has been suffering from
nightmares and avoided driving on the motorway. He has been dx with PTSD. What is the most
appropriate management?
a. CBT
b. Diazepam
c. Citalopram
d. Dosalepin
e. Olanzepin - A 5yo child resents with fever. He looks pale. His parents say he always feels tired. On exam:
orchidomegaly & splenomegaly. Labs: WBC=1.7, Hgb=7.1, Plt=44. What is the dx?
a. ALL
b. CLL
c. AML
d. CML
e. Hodgkins - A 6wk child is brought in with vomiting, constipation and decreased serum K+. What is the dx?
a. Pyloric stenosis
b. Duodenal atresia
c. Hirschsprung disease
d. Achalasia cardia
e. Tracheo-esophageal fistula - A 17 yo girl had an episode of seizure. Contraction of muscles started from around the
interphalangeal joints, which spread to the muscles of wrist and elbow. Choose possible type of
seizure?
a. Grand mal
b. Tonic clonic
c. Myoclonic
d. Absent - A 46yo man, known case of chronic GN presents to OPD. He feels well. BP = 140/90mmHg. Urine
dipstick: protein ++, blood ++ and serum creatinine=106mmol/L. Which medication can prevent
the progression of this dx?
a. ACEi
b. Diuretics
c. Cytotoxic meds
d. Longterm antibiotics
e. Steroids - A 23 yo girl presented with perioral paresthesia and carpopedal spasm 20 mins after a huge
argument with her boyfriend. What is the next step for this pt?
a. SSRI
b. Diazepam
c. Rebreath into a paper bag
d. Propranolol
e. Alprazolam - A 25 yo woman has been feeling anxious and nervous for the last few months. She also
complains of palpitations and tremors. Her symptoms last for a few minutes and are very hard
to control. She tells you that taking alcohol initially helped her relieve her symptoms but now
this effect is wearing off and she has her symptoms even after drinking alcohol. What is the dx?
a. Panic disorder
b. Depression
c. OCD
d. Alcohol addiction
e. GAD - A 2yo child is very naughty. His teacher complains that he is easily distracted. His parents say
that he ĐaŶ͛t do a particular task for a long time. He sometimes hurts himself and breaks many
things. This causes many troubles at home. What is the dx?
a. ASD
b. Dyslexia
c. ADHD
d. Antisocial personality disorder
e. Oppositional defiant - A 79 yo lady who is otherwise well recently started abdominal pain. She is afebrile and
complains that she passed air bubbles during urination. A urethral catheter showed fecal
leakage in the urinary bag. What is the likely pathology?
a. Diuretics
b. CD
c. Rectosigmoid tumor
d. Large bowel perforation
e. UC - A 2 month child with diarrhea and vomiting for 6 days is brought in looking lethargic. What is the
appropriate initial inv?
a. BUE
b. Random blood sugar
c. CBC
d. CXR
e. AXR - A 72 yo man fell while shopping and hurt his knee. His vitals are fine. He speaks in a low voice
and is very slow to give answers. What is the most probable dx?
a. Alzheimers
b. Vascular demetia
c. TIA
d. Pseudo-dementia
e. Picks dementia - A 47 yo man met with a RTA. He has multiple injuries. Pelvic fx is confirmed. He has not passed
urine in the last 4 hrs. What is the next appropriate management for this pt?
a. Urethral catheter
b. Suprapubic catheter
c. IV fluids
d. IV furosemide
e. Insulin - A 49 yo pt presents with right hypochondriac pain. Inv show a big gallstone. What is the most
appropriate management?
a. Lap Cholecystectomy
b. Reassure
c. Low fat diet
d. Ursodeoxycholic acid
e. Emergency laparotomy - In a man who is neglected and alcohol dependent, which high suicidal risk, which factor can
increase this risk further?
a. Alcohol dependence
b. SSRI
c. Smoking
d. Agoraphobia
e. Court involvement - A 71 yo man presents with coarse tremor. He is on some meds. Which one can be the reason for
the tremor?
a. Lithium
b. Diazepam
c. Fluoxetine
d. Imipramine
e. Haloperidol - A young woman complains of diarrhea, abdominal cramps and mouth ulcers. AXR shows
distended transverse colon with globet cell depletion on rectal biopsy. What is the most
probable dx?
a. CD
b. UC
c. Bowel Ca
d. Bowel obstruction
e. IBS - After eating a cookie at a garden party, a child began to cough and went blue. The mother also
noticed that there were swollen patches on the skin. What is the dx?
a. Allergic reaction
b. Aspiration of food
c. Cyanotic heart disease
d. Trachea-esophageal fistula
e. Achalasia cardia - A 70 yo man presents with balance difficulties, vomiting and nausea. Which of the following is
the best inv?
a. MRI cerebellum
b. CT cerebellum
c. Skull XR
d. LP
e. Blood culture - A 2 yo pt presents with colicky pain which radiates from loin to groin. He complains of similar
episodes in the past. Inv has been done and 7mm stone was found in the ureter. What is the
most appropriate management?
a. Percutaneous nephrolithiotomy
b. Open surgery
c. Ureterscopy or laser
d. Conservative tx
e. ESWL - A footballer has been struck in the groin by a kick and a presents with severe pain and mild
swelling in the scrotum. What is the most appropriate next step?
a. USG
b. Doppler
c. Exploratory surgery
d. IV fluids
e. Antibiotics - A 47 yo ex-soldieƌ suffeƌs fƌoŵ loǁ ŵood aŶd aŶdžietLJ. He ĐaŶ͛t foƌget the iŵages he faĐes
before and has always had flashbacks. He is not able to watch the news because there are
usually some reports about war. What is he suffering from?
a. Depression
b. PTSD
c. Panic attack
d. Agoraphobia
e. GAD - A 36 yo woman has recently spent a lot of money on buying clothes. She goes out almost every
night with her friends. She believes that she knows better than her friends, so she should choose
the ƌestauƌaŶt foƌ eatiŶg out. She gaǀe hdž of haǀiŶg loǁ ŵood at ϭϮ LJo. What͛s the ddž?
a. Mania
b. Depression
c. Bipolar affective disorder
d. Borderline personality disorder
e. Dysthymia - A 28 yo female presents with a 3m hx of diarrhea. She complains of abdominal discomfort and
passing stool 20x/day. Exam=febrile. Barium enema shows cobblestone mucosa. What is the
most likely dx?
a. Ameoba
b. Colon Ca
c. GE
d. CD
e. UC - A child is brought in with high grade fever, runny nose and bark-like cough. He is also drooling.
What is the most appropriate tx for this child?
a. Corticosteroids
b. Paracetamol
c. Adrenaline nebulizer
d. IV antibiotics
e. Intubation under GA - A 78yo lady on warfarin for atrial fibrillation lives in a care home. She presents with hx of
progressive confusion for three days. She was also noticed to have bruises on her arms. INR = 7.
What is the most probable dx?
a. Alzheimers
b. Delirium
c. Subdural hemorrhage
d. Vascular dementia
e. PiĐk͛s deŵeŶtia - A 28 yo drug user presents to the ED with collapse and anuria. His serum K+ = 7.5mmol/L. CXR =
early pulmonary edema. What is the next appropriate management?
a. Urgent hemodialysis
b. IV calcium gluconate
c. IV insulin + dextrose
d. Furosemide
e. IV NS 0.9% - A 32 yo woman suffers an episode of severe occipital headache with vomiting and loss of
consciousness. She is brought to the hospital where she is found to be conscious and completely
alert. Exam: normal pulse & BP. No abnormal neurological signs. What is the next step in
management?
a. Admission for observation
b. CT brain
c. MRI head
d. Reassurance and discharge
e. XR skull - A 25 yo woman was brought to the ED by her boyfriend. She has many superficial lacerations on
her forearm. She is so distressed and constantly says her boyfriend is going to end the
relationship. She denies trying to end her life. What is the most likely dx?
a. Acute psychosis
b. Severe depression
c. Psychotic depression
d. Borderline personality disorder
e. Schizophrenia - A young woman was brought to the hospital. On exam she has low temperature and tremor.
She says when she closes her eyes, she can see colors. What drug has been used?
a. Amphetamines
b. LSD
c. Cocaine
d. Heroine
e. Ecstasy - A lady comes in severe liver disease and hematemesis. Her INR is >10. What should she be given?
a. FFP
b. Steroids
c. Whole blood
d. IV fluids
e. Vit K - After eating a cookie at a garden party, a child began to cough and went blue. The mother also
noticed that there were swollen patches on the skin. What is the initial management?
a. OTC antihistamine
b. Oxygen
c. Bronchodilators
d. Epinephrine IM
e. Nebulized epinephrine - A 63 yo female is noted to have left pupil irresponsive to light and is dilated. What is the most
probably dx?
a. Pontine hemorrhage
b. Subdural hemorrhage
c. Cerebellar hemorrhage
d. Extradural hemorrhage
e. Subarachnoid hemorrhage - A 28yo business exec presents at the GP asking for some help because she has been arguing
with her boyfriend frequently. She is worried about her weight, and she thinks she may be fat.
She has been on a diet and lost 7 kgs in the last 2 months on purpose. She is eating less. She
used to do a lot of edžeƌĐise. Noǁ she saLJs she͛s feeliŶg doǁŶ, has soŵe iŶsoŵŶia aŶd feels tiƌed
and without energy. She has not showed up at work. She is worried because recently she got a
loan to buy a luxury car. She can͛t ďe fiƌed. She ĐoŵplaiŶs aďout heƌ loǁ ŵood. She thiŶks this is
weird because she used to be extremely productive. She used to work showing an excellent
performance at the office. She even received compliments from her boss. How, she says her
boyfriend is angry because her apartment is a chaos. Usually she spends a lot of time cleaning it,
eǀeŶ upto ϯ AM. She liked it to ďe peƌfeĐt, ďut Ŷot it͛s a ŵess. OŶ edžaŵ: BMI=Ϯϯ, Ŷo otheƌ sigŶs.
What is the most probably dx?
a. Anorexia nervosa
b. Bipolar disease
c. Binge eating disorder
d. Hyperthyroidism
e. Schizophrenia
Ϯϯϰ. A ǁoŵaŶ ďƌought heƌ husďaŶd saLJiŶg she ǁaŶts the ͚thiŶg͛ oŶ his foƌehead ƌeŵoǀed. The
husband is refusing tx saying it improves his thinking. What is the next most appropriate next
step?
a. Assess his mental capacity to refuse tx
b. Remove lesion
c. Refer to ED
d. Mini-mental state exam
e. Refuse surgery and send pt back - A 37 yo man who has many convictions and has been imprisoned many times has a hx of many
unsuccessful relatioŶships. He has Ϯ ďoLJs ďut doesŶ͛t ĐoŶtaĐt theŵ. What is the ŵost pƌoďaďle
dx?
a. Borderline personality disorder
b. Schizophrenia
c. Avoidant personality disorder
d. Histrionic personality disorder
e. Antisocial behavior disorder - A 60 yo man has a pathological rib fx. He also complains of recurrent infection. BMA is done.
Labs: Ca2+ = 3.9mmol/L and ALP = 127u/L. what type of cell would be found in abdundance in
the marrow smear?
a. Plasma cell
b. Myeloid cell
c. Bence-jones protein
d. Megakaryocytes
e. Reticulocytes - A child presents with blue marks on the sclera, short stature and heart murmur. What is the dx?
a. Osteogenesis imperfect
b. Hypopituitarism
c. VSD
d. Achondrogenesis
e. Dwarfism
Ϯϯϴ. A ϱŵoŶth Đhild ĐaŶ͛t speak ďut ŵakes souŶds. She ĐaŶ hold thiŶgs ǁith palŵ, Ŷot fiŶgeƌs. CaŶ͛t
sit iŶdepeŶdeŶtlLJ ďut ĐaŶ hold heƌ haŶd aŶd sit ǁheŶ pƌopped up agaiŶst pilloǁs. Hoǁ͛s the
childs development?
a. Normal
b. Delayed speech
c. Delayed sitting
d. Delayed motor development - A 27 yo woman has hit her neck in an RTA without complains of tingling or motor loss. What is
the next most appropriate inv?
a. MRI
b. XR
c. CT cervical
d. Diagonal XR - A young female who has many superficial lacerations was brought into the ED by her boyfriend
for superficially lashing her upper arm. She is adamant and screaming that she is not suicidal but
scared her boyfriend wants to leave her. What is the dx?
a. Acute psychosis
b. Severe depression
c. Obsessive
d. Bipolar
e. Borderline personality
f. Schizophrenia - A 22yo woman was brought by her boyfriend with multiple superficial lacerations. There are
scars of old cuts on her forearms. She is distressed because he wants to end the relationship.
She denies suicide. What is the most likely dx?
a. Acute psychosis
b. Borderline personality disorder
c. Severe depression
d. Schizoid personality
e. Psychotic depression - A 31yo single man lives with his mother. He usually drives to work. He always thinks when the
traffic lights change, his mother is calling him, so he drives back home. What is the dx?
a. OCD
b. GAD
c. Schizophrenia
d. Bipolar
e. Cyclothymia - A 56yo woman is known case of pernicious anemia. She refuses to take hydroxycobalamin IM as
she is needle shy. She asks for oral medication. Why will oral meds be not effective?
a. Intrinsic factor def
b. Malabsorption
c. Irritated gastric mucosa
d. Lack of gastric acidity - An 11m baby had an apnea event. The parents are worried that if something like this happens in
the future, how they are to deal. Advise them about infant CPR.
a. Index and middle finger compression
b. Compression with palm of one hand
c. Compression with palm of two hands
d. Compression with rescue breaths 30:2
e. Compression with rescue breaths 15:2 - A teacher brings in a child who says she fell down after hitting a table. On probing further, you
decide that it was most probably an absence seizure. What led you to this dx?
a. The child had not eaten since morning
b. The child suddenly went blank and there was up-rolling of eyes
c. The child started moving his fingers uncontrollably before he fell
d. The Đhild͛s ďodLJ ďeĐaŵe ƌigid aŶd theŶ staƌted to jeƌk - A man has discharge from his left ear after a fight. Where is the discharge coming from?
a. CSF
b. Inner ear
c. Outer ear
d. Brain - A 40 yo manic depressive is noted to have high serum levels of lithium and profound
hypokalemia. His GP had started him on anti-HTNs. Choose the single most likely cause?
a. Verapamil
b. Amiodarone
c. Ranitidine
d. Lithium
e. Thiazide - A 74yo man presents with weakness in his arm and leg from which he recovered within a few
days and short term memory loss. He has an exterior plantar response. He has similar episodes 2
years ago and became unable to identify objects and to make proper judgment. What is the
most appropriate dx?
a. Alcoholic dementia
ď. PiĐk͛s deŵeŶtia
Đ. HuŶtiŶgtoŶ͛s disease
d. Alzheiŵeƌ͛s disease
e. Vascular dementia - A nurse comes to you saying that she has recently developed the habit of washing her hands
after every 15-20 mins. She is unable to conc on her work and takes longer than before to finish
tasks as she must constantly was her hands. What is the most appropriate management?
a. CBT
b. SSRI
c. ECT
d. Antipsychotics
e. Desensitization - A 61yo man underwent a surgery in which ileal resection had been done. He complains of
fatigue, headache, and heart racing. Labs: MCV=108fL, Hgb=8.9g/dL. What is the most likely dx?
a. Vit B12 def
b. Iron def
c. Folate def
d. Hemolytic anemia
e. Anemia of chronic disease