1.Most favourable prognostic factor foe Schiz A. (+) of neurological signs B. acute onset with ppting factor C.

presence of (-)ve symptoms D the patient is not married 2.The ultimate aim of crisis intervention is A. to support the patient B. to restore precrisis functional level of patient C. to use the opportunity to treat the patient TNS: I DONT KNOW 3. ***A 19 year old gal failed the first semester exam. She did well throughout the final year exam and allowed to continue advanced course. She tried hard but cannot scrap through later. She said that she failed the exam because the examiners discriminate her for being female. And other students r planning to spoil her by text messaging her and telling lies about her. She admits cannabis abuse . This year, she broke up with her boyfriend who she started a relationship not long ago. Dx is A. adjustment disorder with depressed mood B. cannabis abuse C. SCH D. Schizophrenifonn 4. ***An old woman in early sixty lives alone as hee husband died exactly 5 years ago. Her daughter who was not visited her for 2 mths was very surprised to see her mother with poor memory and hygiene. Her neighbour say she was found to be normal looking 6 weeks ago. O/E she was agitated, confused and has poor memory. Lab invs were normal.Dx is A.dementia B.delirium C.depression 5. A young man with persistent anxiety and was very shy and afraid of being rejected wants to be like others and socialize with them and take part in social activities. How will you treat A. propanolol B. alprazolam C. fluoxetin

6. ***A 70 year old man was transferred to the care area. A few days later, he was found to be agitated, making her carers difficult to deal. She is sleeping poorly. She was prescribed haloperidol pm, amitryptiline daily, dozepil 2mg daily and lorazepam pm. The most likely Dx is A. toxic reaction to haloperidol B. paradoxical reaction to lorazepam C. reaction to dozepil D. reaction to amitryptiline 7. A patient is found to have unilateral tremor in left hand at rest, stiffness and drooling of saliva. The posture is still normal . (early parkison). Mx A expectant observation 3 mthly B Levodopa_mg and carvidopa-mg C. amantidine D seligiline E. another drug used in parkison ds in exact doses 8. Treatment of refractory SCH A. amitryptiline B.haloperido C. Sertratine D. CPZ E. clozapine

9. A 19 years old man is suffering fr Sch and his mother wants to know whether his son can commit suicide or not. His son has no suicidal thought. You will tell her A. there is no chance of suicidal attack B. there is increased risk of suicide C. there is no relation bet sch and suicide attack. 10.***A child with ADHD and comorbid oppositional defiant behaviour His parents want to know whether their child will recover as he mature. The _/s most likely to recover as he mature is A. inattention B.impul siveness C. hyperactivity D. oppositional behaviour E.Antisocialbehaviour

11. Concerning elderly abuse,

A elderly women r more likely to be abused than man counterparts B. elderly with physical ds r less likely to be abused C. they usually don't know the person who abuse them D. the abusive person is mentally ill E. the abusive person is not related to the elderly 12. Domestic violence A more likely to occur during pregnancy 13. A pregnant with domestic violence. Your advice A. encourage her to have marital counseling with his husband B. Confront her husband C. inform. the police D. supports the patient and inform about the shelter and social ser-vices available 14. Indication for thrombolysis in acute MI, A. the presence of pathological Q wave B. ST depression C. T inversion D. New RBBB E. New LBBB

15. ****A old man with history of MI came to u with palpitation. EC6 shows AF. He said another doctor has tried propanolol, quinidine and digoxin 0. 125mg which he still is taking . Which is the most important next step in preventing the long term sequale of his condition? A increase the dose of digoxin if it is below therapeutic level B Initiate 24 hour ECG monitoring C. Start long term coagulation SHOULD B ANTICOAGULATION

16. An old man with MI present with depression. He is Taking nitrolycerin patches. Which of the following is suitable for her?

A. phenetzine B. amitryptiline C. sertraline D clonidine E. 17 . A woman with pain and numbness of forearm esp at night.Tinel sign is positive. Which investigation will u order? A XR of wrist joint B. arteriography of upper extremities C.venography D.. Duplex scan E. 18. The cut off point of screening test is increased. A. both sen and sp will increased B Sen increased, Sp decreased C.Sen decreased, SP increased D no effect 18. The researcher wants to study and compare the effect of a drug on mean arterial BP with another drug. He measure MBP b4 and after the drug. He should use which of the following test? A. chi square B. calculation of mean C. t test

19. A researcher wants to calculate the approximate effectiveness of measle vaccines in vaccinated children under 1 year after studying an outbreak. of measte, Vaceine status Unvac'cinated Vaccinated <1 year Vaccinated > 1 year A. 18 % Measle (+) Can't remember Measle (-) Attack rate 36.8 17.9

8
C.22 or 29 D.49

B. 10 %

20. Direct estimation of risk can be achieved by A both cohort and case control

B. cohort only C. case control only D. cross sectional study 21. A researcher wants to study the relationship bet ALL and magnetic radiation, He collected Children with ALL and those without ds and folIQiv t'hoir history of exposure to radiation. It was found that there was increased occurrence of ALL in those with h/o exposure. In this study, which of the following makes the finding of researcher wrong? A. sample selection B. recall bias C. lack of statistical significance 22. A researcher who wants to study neonatal Jaundice collects neonates with jaundice and those without it, and follow the record of their family, antenatal and delivery history of all these neonates. The study design he is using A. cohort B. case control C cross- sectional

23****An infant presents with an apparently life threatening attack. 0/E there is wide suture, full fontanels, bruise
on chest and retinal hges A. near missed SID B. shaken baby syndrome C. meningitis 24. A picture of fundoscopy of an infant. A. retinopathy of prematurity B. Retinal hge of NAI C. Toxocara infection D. cherry red spot of tay sach ds

25. An 18 mth old accompained by the father presents with a scald burn on anterior chest wall which the father say the child get it when coffe is spiiled as the child pull ? table cloth the pattern of burn agrees with the mechanism of injury). The child is sitling and crying on father's lap. The next appropriate important step after h/o and p/e is A. administration of IV fluids B. Antibiotics C. adequate pain control D. inform child protective service E. Occlusive dressing 26.****A child with known history of sickle disease presents with pain crisis. Apart from adequate pain control and hydration, which is the most important appropriate next step? A. administration of IV antibiotics 27*****A post splenoctomised child presents with fever of 38.6 . C. Next important step, A. Oral acetaminophen B. oral acetaminophen and cefaclor C. IV antibiotics and admit hospital 28.**** A 72 year old post appendectomy patient on day ten presents with fever of 38.8 degree C. He is ill and USG shows an abscess in posterior aspect of right lobe of liver. Your next step is A. give him analgesics and antibiotics and send him home B Admit him for IV antibiotics and immediate surgical drainage C. Admit him, give IV antibiotics and prepare for percutaneous drainage 29****An elderly patient who was trated for pnia with amoxillin for 3 or 4 days presents with increasing fever and cough without recovering. CXR show increasing consolidation in left lower lobe Ur Mx A change to azithromycin B. change to iv fluclox C. IV ceftriazone 43 Which of the following is the most common cardiovascular side effect of tricyclic antidepressants in therapeutic dose? A. prolonged PR interval B.orthostatic hypotension C.widening of QRS

44. A case of a schizophrenic patient on neuroleptic presents with stiffness, tremor of hands at rest, slowing of movements. Dx

A. drug induced parkison B. acute dystonia 45. A patient on both neuroleptic and antiparkison medication develops stiffness, abnormal movement, smacking the lips and A. increase both neuroleptic and antiparkisonism medication B. increase neuroleptic and decrease antparkisonism C. decrease neuroleptic D. decrease both neuroleptic and antiparkison

E. increase antiparkison 46. A child accompanied by his mother presents with frequent frontal headache, 'Thee mother says he recover after a big sleep. She also suffered similar headache when she was young. Dx is A. meningitis B. posterior cranial tumour C. migraine 47. A child presents with early morning headache and vorniting for 2 months. There is no visual symptoms. A. migraine B.. chronic meningitis C. posterior cranial tumour

48. Dx of neuroleptic malignant syndrome. 49. 50 % of patients with schizophrenic patients has comorbid substance abuse. Which of the following drug is mostly associated with sch.? A. cocaine B. metamphetamine C. MDMA (ecstasy) D.cannabis E. dz 50. Which of the following fresh sample you would ask to investigate substance abuse.?

A. blood

B. urine

C. breath

51. A child presents with fever and lethargy. He looks ill and source of infection cannot be localized. Culture from specimen of urine bag grow mixture of bacteria with predominant E. coli of 10 -5 organism per ? ml. How will u interprect? A. infection proven B. infection cannot be proved C. equivocal 52. An 8month old child presents with a painless mass in left flank. USG shows a mass pushing down the left kidney (the exact word in exam).Dx A. pheochromocytorna B. neuroblastorna C. nephroblastoma D. polycystic kidney 53.A child with hydronephrosis. USG shows dilation of pevicalces and proximal ureters the child is asymptomatic and has normal urine output.Dx A posterior urethral valve B. vesicourethral reflux C. PU junction obstruction D. UTI E. polycystic kidney

54. A man ask about the risk of hiv in hirn. Which of the following is the lowest risk for him if he is A. hemophiliacs B had a history of blood transfusion after universal screening program C. frequently deals with prostitutes D. homosexual

55. the best way to diagnose to hepatitis A infection is A. Anti A Ig G

B. anti A lg M C HAV antigen

56. A 16 years old pregnant girl came for therapeutic abortion which u r personally opposed of. A. ask her to find another doctor B. refer her to a colleague to manage her case C. do the abortion D. tell her you cannot do the abortion 57.**** A woman is being prepared for minor preparation. While lignocaine is being infiltrated without adrenalin , the woman feels circumoral and facial numbness and starts myoolonal jerks. Next step, A. IV hydrocortisone and 02 B. IV DZ and 02 inhalation C IV phonobarbital D. IV phenytoin E. IV carbamazepine( there is no option given as IM adrenalin) 58.***Similar story as above. While lidocaine was being infiltrated \vithout adrenalin, the woman felt cicumoral numbness, urticaria and lose consciousness and she is shock. The most appropriate next step would be A. IV fluids B. SC adrenalin (not iv no im) C. IV phenytoin D. IV DZ

59 ****A 8 week primigravida present with abdominal pain and bleeding pv. On examination, os 3cm 50% effaced. USG shows viable fetus at 7 weeks . Dx A threatened abortion B. missed C. inevitable D. ruptured ectopic

60****A 10 weeks pregnant lady present with abdominal pain and bleeding pv, she has already passed the tissue but still bleeding. A evacuation is necessary even though the placenta seems complete. B she should be placed under observation

61.****A lady present with iliac fossa pain, bleeding and profound shock. LMP 6 weeks ago and urine beta hcg is positive. The most important appropriate next step should be A arrange USG scan B. serum hcg C. arrange laprotomy or laproscopy 62. A semen analysis of a man after 3 days of abstinence show amount 2 ml, sperm count 90000 per ml, motillty < 40%, morphology less than 20. A. Infertility would likely to benefit from clomiphene B. He should receive pulse gonadotrophin therapy. C Intracytoplasmin injection of sperm has a role. 63. A young man presents with inguinoscrotal swelling that disappear completely with lying supine position. Dx
A

hydrocoele

B direct ingulinal hernia C. varicocele D. encysted hydrocoele of the cord. 64. ****The mother of a child is concerned about the swelling that appears in his goin frequently. O/E there is no palpable mass and hernia orifices are intact but there is thickening of spermatic cord. Most appropriate next step A reassurance B reassurance after 3 months C . arrange surgery (ANS: rfer to Sx Department)

65***A 1 year old child accompanied by mother presents with undescended testis. Management of undescended testis ( this Q confuses candidates because we r not sure about asking about undescended testis in general or this 1 year old child with undes testis. No options that say observation, orchidopexy or milking as usual ).the options are all wrong but as far as 1 can recall

A. waiting upto 3 years can ensure spermarogenic function B. recommend orchidectomy to prevent malignant transformation C. Treatment with gonatrophin is likely to be successful D. And E too stupid and completely impossible 66. A man presents with frequent attack of nausea, sweating and dyspnoea. During attack his BP is increased. The next investigation u order is A. dexamethasone suppression test B. urinary 5 HIAA C. 24 hour urinary cortisol D. 24 hour urinary VMA level

61. A middle aged man with hypercalcemia on check up. His brother died of cancer of thyroid. The most appropriate next step is
A. usg neck B. scrum PTH assay C. CT abdomen 68. Dx of pheochromocytoma 69. Inv of pheochromocytorna 70. A case of hypercalcemic woman with metastasis 71. A 52 year old man is concerned as his father died of cancer of prostste, Regarding screening of prostate. A. should be advised every 5 years since 52 B. annual screening of high risk patient C. yearly screening after 45

72. A 25 years old woman complaints of irregular periods. She said that the menses come only every 2 to 6 month. BMI is 24. She is likely to develop A. morbid obesity C. infertility B. hyperprolactinernia. D. diabetes

73. A 22 year old marathon runner present with amenorrhoea of 2 year duration. Her BMI is 22. The cause of her amenorrhoea is A. hypothalamic cause B. pituitary cause C. obesity 74.**A woman with congenital heart disease request you for prophylaxis for SBE as she wants to have orodental procedur. The choice of antibiotic depends on A. type of dental procedure B. history of rheumatic fever

C. type of valvular disease

D. type of congenital disease 75. An old woman under broad spectrum antibiotic develops bloody diarrhea. Colonoscopy reveals pseudomembrane. You will giver her A. loperamide B oral vancomycin (TNS: oral metro may also given but prefer in yg patient, for old age: I use vanco pls chk) .C. oral metro D. IV metro E IV vancomycin 76. A 5 month old child present with cough, fever, and conjuntival hge. The mother says he vomits after coughing. He missed second dose of DPT. Which of the following is true? A. give her dpt dose immediately B. she is likely to develop cough for another 4 weeks (as whooping cough) C she has to be isolated

76 A mother bring her child for immunization.

You gave measle, rubella and polio iv by mistake. You contact local public

health centre and they say it is safe. A. you don't need to tell the mother as it is harmless B You tell the mother ur mistake and reassure her that it is harmless 77. A mother come for MMR vaccination of the child and tells his son has egg allergy. Your next step

A. you tell her that there is no relation between egg allergy and MMR vaccine B tell the mother that the child cannot be vaccinated. C. give oral route of vaccine D. give test dose of mmr vaccine and if there is no reaction follow full dose E. withhold MMR vaccine 78. which of the following child cannot receive measle vaccination? A. a child with fever B. a child with hemophilia C a child on prednisolone for nephrotic syndrome D. a child with history of milk intolerance 79. A 7 week primigravida who has not immunized mmr say she had exposed to a child with rubella. Your next step A. suggest her therapeutic abortion B Measure rubella antibody C. give her mmr vaccine 80. A 6 week old primigravida wants.to go South Africa to care for her ill mother. Which of the following is true? A. CQ cannot be given during pregnancy for prophylaxis B.she has to be given bcg vaccine C. she should be given oral cholera vaccine (TNS: I dont know ans) 81. You want to decrease the incidence of food poisoning . Which of the following is the most effective

way.
A Efficient water sanitation B regular Screening of food handlers

82 You noticed that many students from a secondary school fequently come to you for gastroenteritis. Your next step is A. inform the school head B. arrange a trip to the school C inform local public health center D. inforrn the police

83. A 2 year old child presents with fever and coriza for 3 days. 0/E theris bilateral wheezing, and basal crackes in both lungflelds. This is the third time in this year. Dx A. pnia B. bronchi la asthma C. bronchiolitis D. ALTB E. heart failure

84.****A neighbour of you ask for help as her 18 month daughter is choking while having dinner, Your initial mx is A. immediately sweep the mouth blindly with your hand B. give 2 to 3 thrust to the epigastrium with the child's face down C. give 2 to 3 thrust to the back bet the two scapula with head(face) down 85. the parents of a 3 year old child is concerned as their child only say mama and dada only. Which of the following would u consider as normal if the child can A. feed herself with spoon B. unbottom herself C. parallel play D.build a tower of 10 E. name a colour 86. 8 year old girl in kindergarden was accompanied by her mother who said the child is having difficulty in adding more than one digit numbers, poor school performance. When u assess her the child has difficulty in understanding the tasks but once she understands, she follow your commands happily. A. developmental delay B Specific learning disorder C childhood depression

87. A 6 child old child was brought by the mother for enuresis. Which of the following in history is likely to reveal the cause? A history of uti B. family history C. arrival of new sibling 88. the fact that helps to differentiate Hirshsprung disease from simple constipation is 89. A child who has not passed meconium (Dx Hirshsprung)

90 ***.A 22 year man arrives A n E in coma, there are needle marks in forearms, pupil are pinpoint react to light, respiration shallow, cold water into ear turns head to same side, He responds to pain, withdraw from pain symmetrically, planter reflex are upgoing bilaterally and symmetrically, there is a bruise in the parietal region. Which of the following is true? A. diffuse neuronal injury due to hypoxia B. there is a supratentorial leision C. injury to the pons 91. A woman 3 months after delivery was accompanied by her husband who is concerned that she has been frequently cleaning the carpets and frequently checking the child for the rash since 2 mths ago, during the interview, you noticed that she is frequently checking her purse. Most likely Dx. A. post natal depression B. postpartum psychosis C. OCD D. substance abuse 92. Which of the following is mostly associated with global amnesia after prolonged persistent abuse? a. cocaine b. MDMA c. Metamphetamine (ecstasy) d.canabis e. LSD

93.A pregnant lady comes with condylomata accurninata at her genital area.Mx A.Imiquirnod B.Podophyllin CL C.Trichloroacetic acid

94.A 16year old girl comes with anovulatory cycles menorrhaoia , Hb-Norrnal, Menarche 14 year old,Mx A OCP B. Reassure 95.An old man suffered from carcinoma prostate and multiple secondaries in bone.Mx

A.Hormonal Ablation

B.Chemotherapy

96.Typical presentation of anorexia nervosa A.Sialorica B.Bradycardia 97.You refer a patient to your college . A few days later that patient come back and tell u that u are an imcompetent doctor and your colleague is a good doctor Which type of defense mechanism is she using? A.Spliting 98 . A postpartum mother go and look her child several times while she is talking with you she frequently opens her purse to check her money.she is suffering from A.0bsessive rumination B.Post parturn psychosis C.Post parturn depression 99. A college student who break up with her boyfriend comes to u because she thinks other people are taking ideas out of her mind.She has history of cocaine abuse.She passed first year exam but in the second year,she passed the exam with difficulties Dx A-Shcizotypal B.Schizophrenia C.Cocaine Abuse
100. A drug which can cause amnesia after taking is A-Diazeparn B.Alprazolarn 101. History of trasient ischemic attack, CT -Normal Hypertension (+) A. Aspirin B. Wafarin C Heparin

101. A patient present with Diabetes Keto Acetosis Na -165, Tx; A. IV N/S 103. Pictures Fundoscope of an infanct: finding of retinal haemorrhage A-Non Accidental Injury B Tinea cruris 104. An ulcer of an lower lip of a farmer Dx. A. SCC B. BCC C. Keratoacanthoma

105.The same scenario of white patch on lower lip for 2 months Wx: A.Biopsy

106.1f.a cut-off point of a test is increased, A.Sensitivity reduded and specificity increased B.Cannot be interpreted from the data given 107.The best pain killer for a child with burn A.Paracetamol B.NSAID C.Morphine D.Codeine E.Local anesthetics 108.You are a psychiatrist After you have closed ur clinic one of your patient( who has dependent personality disorder) is waiting for you because she doesn't know how to return her own place Which of the following. is likely to create potential professional misconduct; A.Blame her B.Tell her that it is out of your boundry C.Offer her to call a taxi for her D Offer her to give a lift to her home E.Call a police 109.Which test is the best to compare two mean? A. T Test B.Chi Square 110.Which of the following is clinically most significant about true sucide A Females attempt more suicide than males B In clinical depression, asking sucidial tendency should always be discussed 111.When doctor patient sexual relationship should start? A. When the doctor stop treating the patient B. If she is old patient C. once a patient,she is always your patient and it is unethical to start sexual relationship

112.A patient wants to know his cancer risk because his father died from CA prostate and one of his relatives has CA colon The screening test for him should be A Colonoscopy B. Serum PSA 113.A patient come with melanoma 8 mm surgery was done. Biopsy reveals malignant melanoma and clearance margin is 0. 1 mm.Further management. A.Margin is clear and no more treatment is required B.Excise further 2 cm from the margin C.Isolated limb chemo perfusion 114.A patient with pseudomembranous colitis :Clostrium difficile toxin positive in stool,Mariagenet ? A IV Metro B.Oral Metro

C.Oral Vancomycin 115. Treatment for overwhelming post splenectomy infection A IV Penicillin B. Antipyretics 116.Most common complication of vaginal hysterectomy A. common peroneal nerve palsy B. DVT 117. A mother was exposed to varicella infection during 2 nd trimester. What will you do? A Check Ab against varicella zoster for mother 118. A pap smear shows atypical cells of unknown origin inflarnmatory cells. MX A Refer to do colposcopy B Reprat pap smear 2 years later C Repeat pap smear within 3-6 weeks

119.After taking a pap smear u should A.Fix the specimen after drying B.Dry the specimen after fixation 120. Mother take her child who has egg allergy to take MMR vaccine, What will u do? A,Vaccine can be given under observation B.Give the vaccine after skin testing C.MMR is Cl in child with egg allergy D.Rubella vaccine can be civen

121. 45 year old man suffered from LIF pain and collapsed. while he was walking BP 110/70 mm Hg.most likely Dx, A Aortic Rupture B Volvulus 122. A girl known DM, collapsed suddenly when playing Mx A Insulin + Glucose B. Fluid Replacement C. Glucose 50% stat 123. A patient came with pneumonia He was treated with amoxyllin and gentamycin But get worse. CXR. shows shadow on the left lower lobe. A.Cloxacillin B.Azithromycin C.Cefazolin 124. During the 2nd stage of labour spontaneous bleeding from IV line and nose Dx

A.Amniotic fluid embolism B.Unrecognize coagulation defect

125. A pregnant girl wants u to do abortion U can't do it for personal matter What is your
response ? A. Persuade her not to do abortion B. Blame her C. Refer her to the abortionist D. Refer her to your colleague who do abortion E. Arrange next appointment 126. the most common occupational injury is A.Back Strain B.Fracture C.Comeal abration D.Head injuries

127. 14 month old baby brought to ER by her father with 2 % BSA of bums over anterior trunk and father said that it was due to splash of hot water on he kitchen table What is the Dx. A.Non Accidental Injury 128.The most common side effect of lithium A.tremors

129.The schizophrenic patient 21 years old and he mother said her son got this disease since 17 and would to know his sucidal tendency? 130. What is the most appropriate action in psychiatric treatment? A. To assess /ask every depressed patient about sucidial tendency 131.What is the most important factor to diagnose active stage of labour? A.Cervical dilation 132. How to differentiate Hirschpsung and Acquired megacolon A.Since Birth 131***A brestfed infant has passed motion only once in 4 days and apart from that baby is well A.Normal variant 134. 31 year old pregnant lady with 13 weeks ;Hb level lower limit of normal, O Neaative what is the most appropriate management?

A. Start to take folic acid now B. To have iron supplement C. To have Rh immunoglobulin D. To have Rubella immunization 135. A pregnant lady now 37 weeks, during 32 weeks she had genital herpes CS will be done in A on 4Oth week B If she had herpes lesion during active stage of labour C. If she has antibody for herpes D. She must have urgent CS 136. If measles was eradicated, which of the following will be achieved; A. Surveillence of measles reduced B.Vaccination reduced C Hospital attendance due to measles complication 137. You accidentally injected injected SC instead od IM; you have contact the local public health authority and they said that u don't need to inject another one which of their following correct; A.Tell the patient that u have consulted with local public health authority and reassure the patient

B Another dose to inject C. Reasure 138. The most common complication after varicella infection A.Bacterial skin infection B.Pneumonia
C.Encephalopathy

139. 51 year old man is afraid of having HIV which of the following, is the lease likely to be infected with HIV; A. hornosexual for the last 10 year B. Heterosexual for for a few times with prostitutes C. Blood transfusion once after universal precaution D IVDU 140. A lady comes with her husband for prepregnant couselling which of the following is the most appropriate genetic history; A.Down $ in relative B.Her sister has spina bifida C Having Duchenne muscular atrophy in maternal uncle and maternal side relative 141.***45 year old lady who has bloody nipple discharge for 2 months with the history of CA breast in mother and sister,what is the likely Dx. A.Intraductal papilloma B.CA in situ of ductal C.Invasive ductal carcinoma breast D.Paget disease of nipple 142. 24 months child can do A. Button himself B. Build a tower of 3 or 4

C.Climb the stair on alternate foot 143. A patient had appendicetomy 7 days ago for burst appendicitis and now complaints of having diarrhoea and fever;what is the cause A pelvic abscess 144. A new born baby 2 days old has vomiting, lab results are Na -very high ;K low, what is the cause A.Congenital adrenal hyperplasia B.Pyloric stenosis C.Duodenal atresia
I 45 . Fluid replacement for post colectomy patient after 24 hour, input 2 L, urinary output 2 L, NG aspiration 700 mI , wound drainage 500 ml, electrolytes Na+ -- 130, K+ -3, Cl - 80,Tx

A. 1 L of NaCI + 2 L of Dextrose + 50 K B. 3 L of NaCI + 2 L dextrose + 1 OOK

146. A patient lab results return as: Na+ -156, K+- 4, etc what is the most appropriate Management A 5 % DW B. O.9 % NS C. 3% NS D. Half strenath saline (if dehydrated, 0.9%NS, IF NOT ALSO CAN USE 5%DW)

147. 3 year old patient is having headache and vomiting. He has family history of migraine and on examination there is no signs of increased ICP or meningoeal irritation But he has ataxic gait A. Posterior fossa tumor B. Migraine C. Meninaitis 148. Full term pregnant lady is having regular contraction 3 times each lasting 20 minutes over 10 minutes. On VE Cervix is 4 cm dilated, 60 effaced, station 0, membranes intact, what will be the management ? A. serial VE B. rupture of membrane C.Oxytocin infusion D.Urgent CS 149. The pregnant lady wants to know about the most accurate and least threat to abortion to detect Down$ A Amniocenthesis 150. A 32 year pregnant lady comes to you and on examination you find bruises and suspect domestic violence which of the following is correct A. It is more common during preginancy

B. It is mostly due to absuser's alcohol intake C. It is provoked by the women

In a study the mean systolic BP of the patients under the study was 115mmHg,the standard deviation was 15.This mean that 95% of the patient under the study had a BP between a)100-130

b)85-145
c)90-100 A lady presented with secondary ovarian CA.Which investigatoin will u do first to rule out primary Ca?

a)CT scan abdomen

b)USG abdomen c)mammography d)colonoscopy I have found that CA stomach is the most common primary AMC sample questions: given by AMC MCQ boa rd...so A is correct answer???

The pathological report following a therapeutic abortion shows decidualization.The most appropriate next step in management of this patient would be?

a)repeat a pegnancy test

b)laparoscopy c)reassure the patient d)prescribe oral contraceptive e)repeat the D and C

75 years old man engineer,taking metoprolol,thiazides,Oral Hypoglycemic agents and nurse omes in 2wks.What is the highest risk to fall?

a)He lives alone

b)He walks everyday c)Nurse comes less often d)He takes 3 drugs e)He lives far from hospital

20 yr old uni student on routine medical check up, CXR shows inactive pulmonary TB, Mantoux test positivem appropriate next step Mx? A. review after 3 months

B.

get 6 sputum samples for AFB

C. give INH prophylaxis for 6 months and recheck X-ray after that D. recheck X-ray after 6 months

when u are talking with pt wtih thought disorder,what is the greatest difficulty? a)you can't uderstand his thoughts,b/c of flight of idea b)u feel like there is a glass between u and the pt c)He stops talking in the mmiddle of his talk

d)u do not understand him

A drug addict,prostitute,on antidepressent and not compliant with treatment, sucidal tendency+ce,wants help from u,your advice? a)stop prostitution b)stop drugs

c)give medication
d)give benzodiazepine e)I won't be able to help u if u follow the same life stye 6wk pregnant lady c/o abdo pain in the RIF,which increases with sneezing cughing getting up from chair.No other signs and symptoms. a)rectus hematoma b)uterosacral pelvic ligament strain

c)ectopic pregnancy
d)acute appendicitis when a patient comes with sorethroat how will u detect that it is of viral origin? a)H/O tonsillectomy b)tonsillar exudate c)lymphadenopathy d)high fever

e)laryngitis

75yrs old man with denture for 15 yrs,now became ill fitted recently,has an ulcer in the lower gingiva near premolar,Dx? not mention friable or not this time.... a)traumatic ulcer b)aphthous ulcer c)adenocarcinoma

d)SCC
25yrs,obese lady,who drinks,smokes,famiy h/o of Breast Ca.How can she modify the risk of getting Ca.what will u advice? a)mammography b)stop smoking c)low dose oestrogen

d)reduce weight
e)yearly self examination a man presenting with hematuria,proteinuria,hypertension after 2weeks of viral respiratory infection,what investigation will u do to confirm diagnosis? a)Ig A b)ASO titre c)Blood culture d)Urine culture

ANS: Renal Biosy

this man's problem is proliferative GN?????I am not sure what type of GN this man has got.....To get the diagnosis,biopsy is the most suitable one ????? Older lady presented with stress incontinence with cough,laughing.she wears pads and feels disturbed.Initial investigation? a)IVP

b)bladder pressure cytometry

c)cystoscopy d)MCU micturation cystourethrography e)CT

even after micturition( overflow incontinence).she has palpable bladder.US residual urine present..Mx?
a)IVP b)blaadder pressure cystometry

8yrs old girl,has incontinence

c)cystoscopy to see obstruction and for removal of cause

d)MCU micturation cystourethrography e)CT

An old man patient 2 days after colorectal surgery develops pain in the lower leg with red tender line which was palpable on the middle side of calf,Tx?

a)start heparinisation
b)bed rest and elevation c)mobilise th e patient d)compression bandage e)antibiotics compression bandage is for venous ulcer??? creep bandage can be ussed for superficial thrombophlebitis....but creep bandage and compression bandage are

the same or not....????

A patient coming with a lump in the forearm .what would help u to dx malignaancy? a)progressively increasing in size

b)lump in axilla
c)fever an elderly woman,from nursing home with history of prolonged constipation now present with acute signs of bowel obstruction ,hadn't passed stool or flatus today,diagnosis? a)carcinoma sigmoid b)pseudobstruction

c)volvulus sigmoid
d)intussusception on Ba enema,core apple appearance ,why is colonoscopy done?

a)for tissue bx
b)check for synchronous tumours A boy came after 40tabs of iron,what is expected except: a)shock within 6hours b)shock within 24 hours c)liver damage

d)asymptomatic in the first hours

2days old infant baby poor feeding,and cold,inactive,LP done: cloudy,increased WBC, decreased glucose,no organism on g ram stain,what could b e the cause?

a)E coli
b)GbS c)Herpes simplex d)staph site in the brain where affect is managed: a)amygdala b)putamen c)hypothalamus d)thalamus

e)cerebral
a patient presented with glove and stocking anaesthesia and romberg's test +ve and position sense disturbed. Investigation?

a)serum B12
b)Myelogram c)CT d)nerve conduction study e)serum glucose estimation a patient after renal transplant a year ago,meningitis symptoms+ce,CSF analysis given:elevated protein,sugar reduced,WBC+++

a)cryptococcal antigen assay

b)Zeil Nelson stain c)gram stain d)blood culture Which of the following doesn't cause lung abscess?

a)mycoplasma pneumonia
b)pneumocystis carinii c)staph aureus d)strep

an obese alcoholic and heavy smoker coming with h/o reflux,what initial Mx?

a)stop alcohol,smoking and lose wt

b)stop alco,lose wt c)stop smoking and lose wt d)omeprazole e)lose wt which is the least likely mode of transmission of hepatitis C infection? a)materno fetal

b)homosexual
c)drug users d)dialysis 70yrs old driver g ave history of stroke and hemiparesis one month back.Now he is normal except for left homonymous hemianopia.He likes to drive esp at night.what will u adivce? a)don't drive at night

b)don't drive at all

c)consult with an occupational therapist a patient presents with history of bloody diarrhoea,colonoscopy revealed inflammatory lesions involving 10cm of the colon.What would be the initial management?

a)sulfasalazine
b)oral steroid c)steroid enema 14 yrs old girl ask u for abortion.Her bf is 21yrs old and left her. a)call the police b)call her mother

c)call the adolescent or child protection centre

d)do the abortion 18yr old girl with psychiatric problem needs contraception.what would u do a)prescribe OCP b)refer to gynaecologist for IUCD

c)let gynaecologist decide about her contraception

40yrs old lady,all the following may be the cause of menorrhagia except a)horonal response to uterus

b)subserous fibroid
c)intermural fibroid d)adenomyosis e)endometriosis 70years old man taking aldomet for hypertension for 10yrs starts to isolate himself and is suffering from deafness. He feels that people are talking about him.What is most likey diagnosis a)symptoms of aldomet

b)reaction to deafness
c)atherosclerotic dementia d)senile dementia e)senile paraphrenia

8yrs old boy is brought by his mum b/c she is concerned he is entering puberty aleady. O/E, beginning of facial hair,axillary hair and tanner stage 2 external genitalia.Choose the set of investigaition u initially want to do> a)CBC,lytes,testosterone,bone age ,CT head b)FSH,LH, testosterone,electrolytes ,bone age,DHEA.S

c)FSH,LH,testosterone,cortisol,DHEA.S,11OH progesterone,bone age

d)lytes,testosterone,DHEA.S,17hydroxyprogesterone,cortisol,bone

RECALL MCQs Aug 2008 (Pls to be informed that Qs are not the exact word as in the exam, just an overall idea, so pls study on topic.) 1. A. B. C. D. In which of the following condition has no role in treatment with topical corticosteroids? atopic dermatitis discoid eczema psoriasis perioral dermatitis***

E.

SLE. Systemic steroid

2. A lady was recently diagnosed with high grade CA breast after mastectomy and axillary clearance. This morning, she was already informed about this in the presence of her daughter & discharged from hospital. She also said that her marriage life is problematic. Now, her husband come to u and ask about the severity of the d/s. You should A. tell him about her d/s condition B. contact her & ask her permission

C.

tell him to ask her directly***

3. The most characteristic feature of chronic ischemic pain is A. relieve pain by resting the leg on the pillow

B.

pain felt in the muscle of the foot***

C. leg shows dependent rubor D. reduce pain by walking E. ankle brachial pressure index >1

4. An overweight man BMI 28, smoking 20/day, drinking 2 glasses of win/d. With C/F of GORD & endoscopy shows oesophagitis, initial Tx

A.
B. C. D. E.

stop smoking, drinking, & reduce wt

stop smoking & reduce wt*** stop smoking & drinking IV omeprazole Triple therapy

5. How do you reduce dental caries in school children? A. adding fluoride in drinking water***

B.

adding fluoride in toothpaste

6. Pic CXRs 7. Pic CT( brain) with large whit area in left cerebral hemisphere, C/F given as sudden onset, loss of conciousness , right sided stroke

A.

cerebral haemorrhage**

B. cerebral infarct C. SAH D. Brain tumour

8.Pic CT (brain) with no apparent lesion, C/F also given as above but less dramatic onset A. B. cerebral hge C.SAH

ischemic stroke***

9. Pic scabies hand from antho , 38 yr old homeless woman come to ED with these lesion. WOF is the most likely cause? A. self-neglect

B.

mite infestation***

10. Pic of left thigh with erythematous area on lateral aspect,C/F farmer got scratch injury with seaweed mower & 2 days later, this lesion appear, most likely organism? A. staph. Aureus

B.

strep. Pyogenes**** Dx cellulitis

C. pseudomonas pseudomallei

11. ECG showing RBBB, ST elevation in inf leads, C/F 38 year old with severe chest pain A.

acute MI

12. Pic of pigmented lesion on right cheek of elderly woman A

. Hutchison melanotic freckle malignant melanoma

13. Pic of foot with pigmented irregular lesion between little and 4th toe, C/F young lady with itchy lesion A.

14. 20 yr old uni student on routine medical check up, CXR shows inactive pulmonary TB, Mantoux test positivem appropriate next step Mx?Inactive may be scar . A. review after 3 months

B. get 6 sputum samples for AFB . since CXR dose not show normal , should check sputum.
C. give INH prophylaxis for 6 months and recheck X-ray after that*** D. recheck X-ray after 6 months

15. 35 yr old primi gravida with 8 week gestation, wants to know about tests on Downs $. WOF tests is safest (i.e. least likely to cause pregnancy loss & most likely to be diagnostic)? A. nuchal translucency at 8 wk B. triple marker screening at 12 wk

C.

amniocentesis at 18 wk***

D. CVS at 9 wk

16. stastic Q on null hypothesis 17. Sample of TURP shows <5% cancer cells, next step

A.

Observation****

B. total prostectomy C. orchidectomy D. radiotherapy

18. Pic of ulcerated lesion at natal cleft pilonidal sinus 19. Q on human bite, some blood enters biters mouth, already tested HIV but now biters doctor also wants to test Hep C, but the victim repeatedly refuse to be tested, how to procede? A. ask advice from medical board B. do test despite her refusal

C.

ask them to find other way to get her permission****

D. tell the biters dr to give the prophylaxis as if the victims has the d/s

20. ?????A lady with C/F of multiple sclerosis, she wants to know the chance of getting another neurological event in the next 10 years A. 10% B. 20%

C.
D. 70% E. 90%

50%

21. 22. 23. 24. 25. 26.

Q on % of detecting Dukes A diagnosed by fecal occult blood testing many Qs in h/o injury and DPT immunization many Qs on C/F of renal and ureteric colic, next IVG? Pic of plain X ray abd of young girl??? Q on laproscopy many Qs on breast lump Dx

approx: 60 %

27. Q on pyromanic 28. Serological marker of Hepatitis carrier after 6 months infection HBs Ag 29. Elderly woman got injury to the wrist after single vehicle accident, on examination, peripheral vision loss and lens opacity is detected, most app next step A. review driving license

for psychological satisfication

B.

check eye pressure

C. refer for cataract surgery 30. Q on GCS

2008 AUG 6 (WED) OFF- SHORE 1. A patient come to ed after falling from6m high, blood at the external urinary meatus, which is the most appropriate Mx? A. cystoscopy B. urethroscopy C. IVP D. Spc catheter

E.

Urethrography****

2. 17 preg female has a/c RIF pain, what is the least likely cause of the pain?

A.
B. C. D. E.

pyelonephritis

ectopic preg**** a/c appendicitis degeneration of fibroid ovarian cyst torsion

3. * 30 yr old presented at 33 week preg, found to have BP 140/90 mmHg , proteinuria ++, what is the most app Mx? A. immediate delivery B. full bed rest Mg SO4 R: both are not suitable.

best rest and BP monitioring

4. 70 yr c/o sore wrist which happened a/f an accident . On exam, peri vision loss and small left side pupil, opacity of lens . What will u do most appropriate? A. review driving licence B. check IOP C. refer for cataract surgery

D.

CT****

E. Retinal exam

5. 40 yr old male present with 4 wk h/o fatigue , lethargy, wt loss , night sweat on admission she had 37.6C what will u do to get Dx? A. ANA B. CRP C. Anti RNP D.

Sputum culture ****????i am not sure..

u think IE

E. Blood culture if

6. Which of the following is associated with childhood undescended testes?

A.

indirect hernia****

B. direct hernia C. malignancy

7. Zygomatic bone fracture ask Dx?Tripod #

8. 48 yr lady presented with frequent 5-6 syncopal attack of 6 wk. Pulse rate 44/min, B.P= 180/110, and ESM in the aortic region. Dx? A. arrythmia B. vasovagal attack C. complete ht block not

usually ass o with ESM

D.
E. AF

AS****????

9. A preg with CIN 2 on pap smear, what will u do next/

A.

Colposcopy*** and biopsy

B. Cone Bx C. Reassess D. Wait

10. Screening about Ca colon( fecal ( mammography)

occult blood test and colonoscopy) and Ca breast

11. Patient with failed defibrillation A. HCO3 IV 10MINLY B. CPR

C.

Adrenalin

D. ECG The correct answer should be amiodarone????

12. 80 kg man burn injury with 15% body surface area, the most appropriate fluid replacement? A. Blood

B.

3L Hartmann + 2L 5% glu****

13. A patient with parkinsonism for 2 years on long term Rx, now comes with tongue protruding out. What is your management?

A.

decrease levo+ carbidova****

B. increase levo+ carbi C. stop levo + carbi dova D. add benzhexol

14. Pain with swelling around the knee, aspirated fluid contains yellowish fluid and numerous neutrophils, no organism or crystal. A. gout B. pseudogout

C.

septic arthritis ****

D. Reiters

E. RA

15. A drug which decrease BP and HR is

A.
B. ACEI

CCB****

16. What is the percentage of detection of Duke stage A of ca colon after screening with FOBT? A. less than 5% B. about 15 %??? C. about 25%????

D.

about 50%approx: 50-60%

E. about 75%

17. Photo of Dupuytrens contracture, which is true?

A.

due to thicking of palmar aponeurosis

18. Drugs that causes nephrotoxicity

A.

Aminoglycoside

19. Which of the following will resolve spontaneously in 30 % of new borns

A.
B. C. D. E. F.

small VSD in 1 year old****

PDA COA ASD Heart block

20. An elderly lady with h/o prolong constipation, now presents with intestinal obstruction, dx? A. volvulus sigmoid

B. ca sigmoid***both are possible but ca is more important.

21. Q regarding child with injury , no immunization 22. .yr, .wk preg, spontaneous labour (the Q I hate the most), similar 3 Qs are asked.

23. Insulinoma

A.

increased insulin, increased C peptide

24. In anxious hyperventilation A. PO2 106

,reduced PCO2, increased pH 7.48

25. A 2 yr old can do A B. hop on one leg C. point to one color D. draw a part of man E. count 1 to5

. 2-3 blocks***

25. 5yr old presented with painful arm, support with other hand not allowing to exam A. Humerus fracture B. Ulna fracture

C.

Radial head subluxation***

26. 5 month present with funny turns, forward flexion , EEG- hysarrythmia, treatment?

A.
B. C. D. E.

sodium val is preferred

ethosuxamide vagbactrin*** carbamazapine not ACTH

27. Regarding laproscopy except, A. can present with shoulder tip pain B. can injure viscera

C. can injure aorta .least possible coz aorta is retroperitoneal.

all can be possible>>>>right?

28. A 6 week infant with undescended testis, what will u do? A. immediate orchidopexy B. milk down

C.

review after 6 month***

D. wait until 4 yr E. reassess

29. about 10 photos which show neck swelling, CXR, melanoma, pilonidal sinus, scabies 30. A man with 3 point restraint, met with MVA, brought to emergency department, X-ray reveals gas under diaphragm

A.

intestinal perforation*** pneumatosis intestinalis is specific for NEC)

B. diaphragm rupture C. spleen rupture D. bladder rupture E. P.intestinalis(

31. Site in the brain where affect is managed A. putamen B. thalamus C. amygdale**** D. cerebral?????? E. Cerebellum

32. You are at conference with parents which would be the most suspicious Q from parents?

A.

3 month not smiling at mom.****

B. ? C. ? D. 10 month no teeth

33. A child with febrile fit, his bro has h/o epilepsy

A.

can get repeated fit with high fever***

B. more chance to get epilepsy C. benzodiazepine

34. A boy with haematuria, proteinuria after 2 days, after viral infection A. APSGN

B.

IGA***

35. 3 weeks old child or duration 3 weeks with purulent eye d/c

A.

blocked duct

B. gono C. chlymdia

36. An 18 month old child with breast development, no menarche

A.

isolated thelarche

37. Loss of plantar flexion and inversion, loss of ankle jerk A. S1 B. L4 C. L5

D.

Tibial N****

E. Sciatic N

38. A p/t on warfarin, undergone urgent Sx, INR 1.2 A. Vit K B. C. stop War and heparin

stop Warfarin ****

38. C/F of GBS

A.
B. C. D. E. CT MRI LP EEG

CSF****

39. ECG inferior MI

40. A man CXR inactive TB, skin test +, next step Mx? A. INH 6 months****

B.

Sputum culture

C. Repeat CXR

41. Regarding Sjogrens , all of the following are true except. A. Anti Rho, Anti La B. Dry mouth C. Dry eye

D.

Always give steroid****

E. Associated with lymphoma

42. septic arthritis, most common cause of organism is

A.

staph aureus

43. A neonate with hepatomegaly, jaundice and there is reducing sugar A. glycogen storage d/s

B.

galactocemia

44. A preg with tissue at os, with B/P 90/60, PR 110, Mx?

A.

IV line .. first

B. Remove t/s at ED****. next

C. Remove at theatre