The Palaszczuk Government has announced today that all Queenslanders will be offered a free flu vaccination, amid a spike in influenza cases across the state.
Free influenza vaccinations will be available from 22 July to 31 August at GPs and pharmacies across Queensland.
The Palaszczuk Government will cover the cost, which is estimated to cost between $5 – 10 million, for providing the vaccination to all Queenslanders, many of whom do not fall within the federally funded national immunisation program.
Influenza cases this year have reached more than 51,426 cases, compared to last year where 44,438 cases were record for the entire year.
Influenza B is causing severe disease in some children. Since 1 July, 78 children aged 6 months to four years old were hospitalised with flu – 50 with the B strain, and only 1 of these children were vaccinated.
The Health Minister today met with professional pharmacy and medical bodies to ensure all bodies could work together to help roll out the free program.
There are no changes for people already eligible under the National Immunisation program. People eligible under the National Immunisation Program should continue to access influenza vaccine from their usual vaccination providers.
Anyone who has their vaccination booked before Saturday will also receive it for free.
We would like to extend a huge thank you to those who have provided us with these recalls. It is now our turn to do our part and help solve them for you. You can obtain them from here.
Australian Medical Council (AMC) MCQ Recalls JULY 2023 compilation
Teenage boy presented with declining grades and sad mood. Feel depressed, hopeless, little interest, difficulty concentrating. Quit soccer and now isolate at home. No suicidal intention. Family history of depression? MDD diagnosed and treatment is discussed. The patient is willing to take medication, but his mother is concerned that antidepressants can cause people to become suicidal. What to reply to mother?
a/ There is no association between antidepressants and an increased risk of suicidal thoughts in adolescents.
b/ The slightly increased risk of suicidal thoughts with antidepressants in this age group needs to be weighed against the risk of completed suicide in untreated depression.
63yo with vague abd pain, increased fatigability. Smokes, drinks alcohol. Mother died of stroke, father died of MI. Mildly distended, soft abdomen. Positive fecal occult blood test. cause?
a/ Alcoholic cirrhosis
b/ Metastatic disease
21-day-old girl constipation, breastfeeding going well. Urinates frequently, but BM every 2-3 days. No routine prenatal care. Soft abdomen, nontender. Jaundice from head to abdomen. Ix?
a/ Thyroid function studies
b/ Rectal suction biopsy
c/ Sweat chloride test
4yo boy presented with hyperactivity, impulsivity, disruptive behavior. Mother struggling with his behavior, affects job performance. Abrasions on knees, bruise on right shin. intervention?
a/ Begin low-dose diphenhydramine at bedtime
b/ Recommend parent-child behavioral therapy
37 yo male hemoptysis, fever, pleuritic chest pain, cough w brown sputum.??Allogenic stem cell transplantation 6 wks ago. Right-sided crackles, dense infiltrate in right upper lobe on x-ray. diagnosis?
a/ CMV
b/ Invasive aspergillosis
Woman 34 yo w/ 2 kids from different fathers. Is on a new relationship e don’t want to get pregnant. Wish to esterilize.
1 agree with her
2 offer her partner to do vasectomy
3 consult with gynecologist
4 offer combined oral pills
Man submitted 4m ago to vasectomy, >20 ejaculations, spermogram w/ non motile sperm. Conduct?
1 – repeat after 50 ejaculations
2 – USG for spermatocele
3 – repeat next month
4 – can have sex without worry for pregnancy
5 – Renal USG
Man 34yo, urinary dribbling, straining and post void micturition. Physical exam normal, include RDE. What’s next?
1- urethoscopy
2 – renal USG
3 – USG rectal biopsy
elderly man presents with malena. endoscopy and colonoscopy does not reveal any bleeding. His vitals are stable at the moment but he requires 2 units of blood daily to maintain a HBat 90. what is the best management
A. capsule endoscopy
B.catheter angio
C.CT angio
D. 55 technetium scan
Old lady, asymptomatic, for check up. DM2, crônica arterial disease.
Urine culture + E. coli >100.000 ufc/ml
Cefalexin S
Amoxicillin Clav S
Sulfa R
Cipro S
Conduct?
Reassure
Cefalexin
Sulfa
Cipro
Old lady, menopause, urinary symptoms with LUTS emptying.
Physical exam: labia major United until urethral meatus
Conduct?
1 topic oestregen
2 separate labia major
A 18-year-old girl comes with father; with a with 10-week pregnancy, she don’t want you to tell this to her father. She has right arm fracture and not speaking in front of her father.What in history suggest physical abuse by father?
A. Fracture of right arm.
B. Patient’s mood and affect
C. The secret pregnancy
D. Hx of previous hospitalizations
Which valvular disease is most commonly associated with the sudden death in younger patients?
a. Aortic stenosis
b. Mitral stenosis
c. IHSS- Idiopathic Hypertrophic Subaortic Stenosis – old name of HOCM
d. Tetralogy of Fallot
e. Mitral valve prolapse
34lady with amenorrhea, regular menses since age 12. Suction curettage for missed abortion, followed by IUD placement. Initial irregular and heavy bleeding. No menstrual period in 6 months. diagnosis?
a/ Intrauterine adhesions
b/ Primary ovarian insufficiency
42male ankylosing spondylitis, fell on back, severe pain. History of duodenal ulcer. Vital signs normal w/ mild tachycardia. Midline tenderness over upper lumbar region, restricted spinal range of motion. cause?
a/ Disc herniation
b/ Vertebral fracture
26 lady presented with thigh skin lesion appeared 3 wks ago. No similar lesions in past. Mild pruritus, no fever, chills, or pain. Sexually active.
a/ Liquid nitrogen
b/ Punch biopsy
c/ Topical acyclovir
38 female with chronic aching pain, stiffness in neck, shoulders, lower back, and hips. Pain worsens w/ exertion. Sleep difficulties, morning fatigue. Tender spots at muscle insertions, normal strength and reflexes. therapy?
a/ Amitriptyline
b/ Colchicine
28male with 6mo extreme nervousness, irritability, restlessness, muscle tension, insomnia. 2 beers on weekends. Reluctant for psychotherapy. medication?
a/ Bupropion
b/ Venlafaxine
34 female with progressive dyspnea, drowsiness. Difficulty swallowing, choking episode. Recent ciprofloxacin treatment. Reduced work hours, difficulty lifting books. absent Babinski reflex. diagnosis?
a/ Foodborne botulism
b/ Myasthenic crisis
c/ Polymyositis
53yr male with DM has foot ulcer on sole of foot and is allergic to penicillin. What is the next best management?
A. Amoxicillin
B. Co-amoxiclav
C. Clindamycin
D. X-ray
E. MRI
Elderly man taking oxycodone/naloxone, added to amitriptyline he has been using for pain.Now px presented with cramps of legs.What is the cause?
A. SS – SS: hyperreflexia mydriasis inc BS, Tx ciproheptidine
B. NMS – SS hyporeflexia, N pupils Tx Iv benzo, dantrolene Na, bromocriptine
C. TCA toxicity
A patient came to your practice because of sore throat.The nurse informed yo that she hasn’t paid for the last three consultations. What should you do?
a.Ask patient to go to public hospital
b. Leave a prescription for amoxicillin
c. Book her for the next available appointment
d. See her after she paid the previous all
e. Refuse to see her
Lady travelled to Kenya, wt loss jaundice. Was taking doxycycline.increased liver enzymes,bilirubin. What’s the diagnosis
A Malaria
B yellow fever
C pancreatic cancer
D Ross river fever
E choledocholithiasis
75 gentleman severe back pain x3wks, worse past 12h. Difficulty walking, urinating. Hx of prostate cancer w/ radiation therapy. Tenderness over midline spine near T10-T11. initial?
a/ Intravenous glucocorticoids
b/ Radiation to the spine
c/ Skeletal survey
6-day-old boy, routine visit after birth. Exclusive breastfeeding, adequate voiding/stooling. Full term, spontaneous vaginal delivery. Normal temp, BP, pulse, resp. Clear lungs. 2/6 holosystolic murmur at LLSB. Normal cardiac impulse, pulses, skin.
a/ Obtain arterial blood gas
b/ Perform echocardiography
35 female w/ 2 months of productive cough, fever, weight loss. 1-2 beers daily. Cervical lymphadenopathy, crackles at L upper posterior thorax. Gram stain/acid-fast staining negative, culture pending. Next step?
a/ Isoniazid and rifampin empiric therapy
b/ Isoniazid, rifampin, pyrazinamide, and ethambutol empiric therapy
patient w HTN, obesity, osteoarthritis. Missed last 2 appts. Reports low energy, pain in knees/back/hands. Weight gain, decreased ROM. Difficulty dieting. response?
a/ “I can understand why your wife is worried about your health.”
b/ “It can be difficult to keep up with diet, exercise, and medication on a daily basis.”
26 female with worsening PCOS symptoms: abnormal uterine bleeding, lip/chin hair. Velvety, pigmented plaques on neck/axilla. Small comedones on forehead. tumor?
a/ Body hair pattern
b/ Changes in voice
c/ Menstrual bleeding cycle
27Female f/u for fibromyalgia, previously had musculoskeletal pain and fatigue. intermittent dizziness. Worsened lethargy, dry mouth. Meds: amitriptyline, acetaminophen, polyethylene glycol. cause?
a/ Carotid sinus massage
b/ Orthostatic blood pressure measurements
55Male with wound, laparotomy, bowel resection, left nephrectomy. Postop day 4: fever, tachypnea, SOB, lethargy. Crackles on lung auscultation, well-healing abdominal wound. Next?
a/ Hemodialysis
b/ Intravenous lactated Ringer
c/ Intravenous dopamine
34M w/ severe diarrhea, light-headedness. Diarrhea for 14 days, malaise. Fever, hypotension, tachycardia, dry mucous membranes. Brown stool, negative occult blood. organism?
a/ Cryptosporidium parvum
b/ Cytomegalovirus
67 female come for knee pain. Gradually increasing pain in L knee, worse w/ prolonged walking/stairs. Brief morning stiffness. Reduced flexion at L knee. Next?
a/ Hyaluronic acid injection
b/ Quadriceps strengthening exercises
58F w advanced breast cancer, bone metastases. Routine follow-up. Mild, vague bone pain relieved by acetaminophen. Moist mucous membranes.
a/ Bisphosphonate therapy
b/ Loop diuretics
65F brought to office after fall 3 mos ago. Decr activity since. Med hx: HTN, T2DM, peripheral neuropathy. Meds: lisinopril, insulin, canagliflozin, metoclopramide. Peripheral pulses 1+.
a/ Discontinue canagliflozin
b/ Discontinue metoclopramide
65F w concerns about osteoporotic fractures. Sister has osteoporosis. 10-pack-yr smoking hx, quit at 40. Drinks 2-3 glasses of wine/wk. Besides Ca+ and vit D, treatment?
a/ Nasal calcitonin
b/ Oral alendronate
Temporal Lobe epilepsy.most appropriate initial mx.
A sodium valproate
B lamotrigene
C Levitiracetam
Patient came for routine check-up. With result of 60% carotid stenosis. No symptoms. Looks well. Management?
A. Give Unfractionated heparin – look for aspirin/antiplatelet for the option
B. Carotid endartectomy
C. Angiography
Pt admit with stab injury to r.scapula . Bp.80/60.sob.after oxygen and iv fluid .next step.saturation 95%
a) removeknife.
b) cxr
c) ct scan
d) Intubation
A pxt with liver cirrhosis second to HCV, which vaccines, can he not take
A)HBV
B) influenza
C) Pneumococcal
D)BCG -live attenuated vaccine
Cardiology A 75 years old, M, present to ED with CO worsening SOB; chest pain and fatigue for few days. He has h/o HTN hyperlipidemia and aortic stenosis with systolic gradient of 45 mmhg and EF 35%. What will be treatment?
A. Aortic valve replacement
B. Percutaneous Aortic valvuloplasty or TAVI
C. CABG
D. Periodic monitoring with echo
Pregnant lady with systolic murmur at left upper sternal border, diastolic murmur at tricuspid area, second heart sound split. Apex beat is palpable just outside the mid clavicular line. CXR shows prominent pulmonary veins. Dx?
A TS
B ASD
C VSD
D PS –
E MS
36F, G2P1, 9 wks gestation, prenatal care initiation. Previous pregnancy: vaginal delivery, induced at 37 wks for preeclampsia w/o severe features. Healthy, prenatal vitamin only. finding?
a/ Decreased leukocyte count
b/ Decreased serum creatinine
c/ Decreased urine protein
45F w/ reflux, nausea, vomiting x3 wks. Daily heartburn, regurgitation, sour taste. Severe nocturnal reflux, recumbent chair sleep. Postprandial nonbloody, nonbilious emesis. Morbid obesity, T2DM, HTN. Next?
a/ Esophagogastroduodenoscopy
b/ Gastric emptying scan
48F w/ sister for preventive visit. Sister w/ stage I breast cancer. Patient skeptical of doctors, no health issues/meds. Fixated gaze, constricted affect. Explanation?
a/ Avoidant personality disorder
b/ Paranoid personality disorder
c/ Schizoid personality disorder
64F w/ bitemporal headache, worsened over wk. Dizziness, blurry vision, tingling, numbness of feet. Hx: HTN on lisinopril. PE: Moist mucous membranes, normal tympanic membranes. diagnostic?
a/ Hemoglobin A1c level
b/ Serum protein electrophoresis
45M w/ intermittent pain, numbness in R hand for months. Primarily at night, relieved by shaking or dependent position. Decreased pinprick sensation in thumb, index finger. diagnosis?
a/ MRI of the cervical spine
b/ Nerve conduction studies
c/ X-ray of the hands
55M w/ abrupt-onset excruciating rectal pain. No fevers, abd pain, hematochezia, weight loss. Hx of chronic constipation. Exquisitely tender, purplish bulge below dentate line.
a/ Hemorrhoidectomy under local anesthesia
b/ Rubber band ligation
31F, G3P2, 40wks gest. Normal prenatal course. Prior uncomplicated vaginal delivery and emergent C-section for non-reassuring fetal heart rate. Epidural anesthesia. Mild pelvic pressure. cause?
a/ Fetal head compression
b/ Placental abruption
c/ Uterine rupture
65M w COPD, hospitalized for worsening SOB, cough, wheezing. Severe respiratory distress w/ bilateral wheezing. Bronchodilators, glucocorticoids, antibiotics given. 45 mins later, progressive hypoxemia, elevated pressures. cause?
a/ ARDS
b/ Pneumothorax
34M w intermittent dizziness past 3 months. Triggers: lifting weights, riding elevator. Trouble hearing R ear. Provoked nystagmus, Valsalva maneuver. diagnosis?
a/ Benign paroxysmal positional vertigo
b/ Perilymphatic fistula
16F w vomiting, abdominal pain, watery diarrhea. Attended school cookout, friends have similar symptoms. Tender abdomen, no masses/hepatosplenomegaly. etiology?
a/ Norovirus
b/ Rotavirus
c/ Bacillus cereus
21F w severe RLQ pain. Pain started 3 wks ago, became constant/severe in the last 4 hrs. Nausea/vomiting. RLQ tenderness w/ rebound/guarding. cause?
a/ Cystic teratoma
b/ Endometrioma
1mo boy w/ blood-streaked stools. Born full term, breastfed exclusively. Stools turned loose w/ blood/mucus past 3 days. Nurses every 2-3 hrs, spits up small amount of breast milk. cause?
a/ Clostridioides difficile colitis
b/ Food protein–induced allergic proctocolitis
2yo boy, new house. Well-child check, parents want child-proofing guidance. Single-story house built in ’85, in-ground pool. Electric water heater, central AC, grounded outlets. recommendation?
a/ Install a 4-sided fence around the pool
b/ Remove power outlets within the toddler’s reach
20yo hockey player, headfirst into rink boards, unable to move arms/legs. Cervical collar, backboard transport. C5 burst fracture, spinal cord impingement.
a/ Administration of oral prednisone
b/ Bladder catheterization
c/ Femoral line placement
74yo man, worsening lethargy, abdominal pain/distension. Fever, hypotension, tachycardia. Dry mucous membranes, distended/tender abdomen. Leukocytosis, hypokalemia. cause?
a/ Microbial toxin–induced colonic inflammation
b/ Sudden decrease in colonic perfusion pressure
73yo woman w/ change in behavior, increasing forgetfulness. Irritable, insomnia, forgetful tasks. Drowsy, word-finding difficulties past year. Fever, hypertension, tachycardia. diagnosis?
a/ Alzheimer disease
b/ Brief psychotic disorder
c/ Delirium
67M w/ 2wks intermittent hematuria, no pain/urgency. History of CAD, HTN, hyperlipidemia, heavy smoking. Normal abdominal exam, enlarged prostate. evaluation?
a/ Abdominal ultrasound
b/ Cystoscopy
An old woman came to the ED with vulvar erythema and vaginal pain. She had some symptoms of candidiasis which was confirmed by labs. How will you treat this woman?
A Oral Nystatin
B Oral Fluconazole.
C HRT
D Topical estrogen
E Oral Clotrimazole
Female with recurrent candidiasis from 12 months.Rx
a topical miconazole
b topical nystatin
c oral ketoconazole
e oral fluconazole
Female with recurrent candidiasis 4 times in last 6 months. Clotrimazole vaginal cream helped controlling the symptoms last 3 times. What is the most appropriate next step?
A Oral Nystatin
b Oral Greisofulvin
c Oral Ketoconazole
d Oral Fluconazole
e Vaginal Nystatin
3 year old boy. Lump above the inguinal ligament. Tender. Non reducalble. Fever can’t remember.
A reassure
B USS
C Review again in few weeks
old man with her wife.disoriented and confused.has diarrhoea for 24hr and H/O prostectome 1week ago, catheterised for it. IV fluid given yester and concious level improved. Now he comes with urine output of 20ml/hr and his RFT is normal, What to do?
A Give bolus of IV saline
B IV furosemide
C Encourage oral rehyd
D Catheter flush
80yrs depressed started on sertraline 4 weeks later confused bloods- sodium low rest all normal what to do next?
a) stop sertraline
b) normal saline
inferior wall MI given aspirin morphine and oxygen what next?
a) adrenaline
b) IV fluids
c) nitrates
d) PCI
37yrs Heavy menstrual bleeding abdominal examination normal transvaginal USG normal with anemia what to do next?
a) OCpills
b) norethisterone
c) Mirena
d) depot injections
G2P1 at 10weeks prev H/O VTE on 2nd postpartum day thrombophilia testing- heterozgous factor V leiden mutation now comes to antenatal clinic what to do?
a) therapeutic LMWN now till 6 weeks postpartum
b) Prophylactic LMWH now till 6 weeks postpartum
c) compression stockings
d) LMWH only in postpartum period
Intern during tetanus vaccination gets needle prick informs immediately to the training head the patient is gone by that time not traceable what to do ?
a. HIV and hepatitis B postexposure prophylaxis
b. Ask police to trace the patient
Athlete pain over the anterior tibia continues to run, tenderness over lower third of tibia X ray normal what is the diagnosis?
A osteochondritis
B Stress fracture of tibia
middle age man with frequent quarrels with colleagues had to attend court due to violence and also had witness violence in family as a child what is the diagnosis?
A Acute stress disorder
B Prodromal shizophrenia
C Bipolar disorder
Treatment for bloating in pms
1. Cocp
2. Pop
5 months Baby constipation for 6 weeks. Switched to cow milk 3 months ago from breastfeeding. Recently started on solids 1 week ago. Cause?
A Cow protein allergy
B Cow milk allergy
C Dec fluid intake
17 years old boy left home 3 years ago, had sexual assault 18 months ago.history of multiple law breaks, violations. Clue to make his diagnosis
a. Flashbacks
b. Suicidal thoughts
c. Delusions
d. Family hx of antisocial personality
6months brought pale sweating CRT >3 HR 200 BP unappreciated ECG SVT 280
A Valsalva
B Adenosine
C Metoprolol
D DC 1j/kg
Male with hematemesis known to alcoholic liver disease BP 100/70 HR 120 Then Bp suddenly 80/50 on sitting didn’t say repeat HR. Est loss
A <10
B 30
C 40
D >45%
Surgery consultant asking his registrar to write him script for diazepam as he has panic attack and work is too distressing
A Write SSRI
B Diazepam for 2 days
C Report to Ahpra
D Report to medical administrator
New patient in clinic from interstate with letter from GP known sponylolisthesis with CT result. Asking for Oxycodone prescription old GP is not answering on phone
A Give panadeine forte
B Give Oxycodone for 5 days
C Consult shopping pharamacy department
D Do not write script
10 week old baby with poor feeding , irritable , no weight gain, bibasal crepes and hepatomegaly ask dx ? Ans. Congestive heart failure
An obstetric USS at 18 week all normal hx mentioned smoker even in pregnancy now 26-28 week, HC and AC low. FL – within normal, Amniotic fluid index low ask causes
A I put placental insufficiency
B Sorry forgot other options
Scenario of male taking quetiapine. Low libido and low testosterone level. Prolactin is 5400 mU/l (Exactly the same prolactin level). no increased ICP symptoms. Asking for cause?
A Prolactinoma
B Antipsychotic
A 91 year old, frail ,nursing home resident is found dead, and as the general practitioner you have been asked to issue the death certificate. Two days before he was having urinary track symptoms and confusion and fever. Yesterday morning, he was found unconscious on the floor with a laceration on the scalp. What would be the cause of death?
A) sepsis
B) urinary track infection
C) death certificate can not be issued
D) head injury
alzimer patient. psychosis plus. DM Plus….bloodsugar high 8.5… Don’t like to take insulin
1..resperidone
2…galantamine
3…longterm insulin…
young lady took diazepam, paracetamol and metformin. Was in severe metabolic acidosis. pH 7.0 HCO3 12 What to do?
A Activated charcoal
B *Hemodialysis
C Bicarbonate
Testicular firm swelling in 30 yrs old. Cause
A Seminoma
B Nonseminoma
C Hydrocele
Testicular swelling on standing. Not on lying. No transillumination. Reason?
A Hrdocele
B Varicocele
Xray of bowel obstruction.
Ct of liver abcess. Management?
6months old BP unrecorded pulse 220 SVT
a DC shock
b Adenosine
c Valsalva
Women with PMS bloating Mx
CoCP
POP
Pyridoxine
Some herbs name was there
Women with history of multiple compliants and labs normal. Now presented with abdominal pain and some join pains. What to do
Reassure
Counsel that these are somatic
Investigate current issues
Similar scenario of multiple issues and no organic cause asking reason
Somatic disorder
Hypochondriasis
Factitious
Son complaint of mother giving gifts to nurse. Recently goven dinner set. What would you do
Talk to nurse
Told son to talk to nurse
Talk to patient
One long scenario of man alcoholic and 40 pack yr smoker found confused in home. Has lung opacity labs had hyponatremia and low chloride Cause of confusion
Lung CA
Wernicke’s encephalopathy
Congestive heart failure
6 years old kid with slow language improvement. When the parents say something to him,he repeats 3 words from what the parents say.He doesn’t watch the same tv program for more than five minutes. When the doctor talks to him,he repeats only 3 words from what the doctor said to him.
A.Autism
B.Asperger
C.ADHD
24 wks pregnant pt with passage of 90ml blood. She also came a few weeks ago with 10ml blood loss. USG showed grade 4 placenta previa. What to do?
a. Repeat usg
b. CTG
c. Haematological studies
d. Blood transfusion
e. crossmatch
75 year old female patient,on a number of drugs including statin, presents with proximal muscle weakness. On examination muscles of the shoulders are tender on palpation. Laboratory examination shows raised ESR and CK is normal. What is your possible Diagnosis?
a)Drug induced myositis
b)Dermatomyositis
C)Polymyositis
D)polymyalgia rheumatic
Son comes to your practise regarding his 82 year old mother saying that the nurse from your practise is using his mother for financial purpose as she has been giving her expensive gifts and recently added her to her will as a beneficiary. What will you do?
Ask son to speak to nurse
Arrange appointment with the mother
Raise issue with the nurse
Report her to APHRA
Aboriginal woman comes to you with 5 month history of insomnia, anxiety and depression. You want to start her on escitalopram but she refuses. She wants to see a traditional healer within her community instead.
involve indigenous officer
provide her leave to go see transitional healer
involuntarily detain her
most appropriate therapy for pulmonary embolism in a patient who suffered three broken ribs, a fractured pelvis requiring operative intervention, and a subdural hematoma in a motor vehicle accident is which of the following:
a. Unfractionated heparin
b. Low-molecular-weight heparin
c. Inferior vena cava filter
d. Dabigatran
mediastinal widening bilaterally but no apical lesions seen.Diagnosis?
1. sarcoidosis
2. TB
3. Lymphoma
17 yrs old son..left home at the age of 15.sexually assaulted a girl 18 months back and imprisonment..multiple previous self cut injuries in hands doesnt want to talk about it.multiple substance abuse..what in the history is important to come to a diagnosi?
1. sleeping disturbance
2. family history of antisocial disorders and imprisonment
3. poor school.performance
4. Childhood abuse
Man with septic arthritis scenario, local gp. What to do after joint aspiration and analgesia
Blood culture
Refer to the ED
no option for antibiotics or culture of aspirate
Xray of old woman with gallstone ileus
Picture of hand, foot and mouth disease(rash looked dry, no blisters) , 5 days duration. Asking for school exclusion
Go to school now
After blisters dry
After resolution of rash
Impetigo, started antibiotics but couldn’t cover blisters. Asking school exclusion
No exclusion
Exclude until blisters dry
Go to school after 24hrs
Patient with lung cancer, hyperkalemia, hypercalcemia, and rise creatinine, after iv hydration what to do
1. Furosemide
2. Pamidronate
3. Dialysis
Pregnant woman with vaginal bleeding and abd pain, what is the most significant agent to cause the complication?
1. Alcohol
2. Smoking
3. Cocaine
Different scenarios of SVT in children asked next management
HC and AC low, FL – within normal, Amniotic fluid index low. Asking for causes?
A. placental insufficiency
Gallstone illeus xray
Boy fell from bike.tenderness in left upper quadrant. All vitals normal. What to do next?
A. usg
B. Cxr
C. Ct abdomen
Testicular firm swelling in 30 yrs old. Cause
Seminoma
Nonseminoma
Hydrocele.
Male patient develops pain in DIP joint, apart from psoriatic rashes in scalp. Physical examination is normal, Diagnosis?
1) Psoriatic arthritis –
2) Reiters–
An obstetric USS at 18 week all normal hx mentioned smoker even in pregnancy now, 36 week, HC and AC low, FL – within normal. Amniotic fluid index low ask causes
A placental insufficiency—> all parameter are low,head sparing
B fetal anemia—> Hydrops Edema
C IUGR—> symmetrical
D Congenital Abnormality
Patient presented with agitation and psychosis and accuses wife of having an affair. Doesn’t want to take his insulin. HBA1C 8.5. What to do next.
A. Risperidone
B. Gabapentin
C. 10 mg Acting Insulin
Old woman gives the nurse dinner set, son complaints
A. Tell patient to have a talk with nurse
B. Talk to nurse to give back the dinner set
C. Discuss with nurse it is not appropriate
Upper abdominal pain radiating to back for some days. Lipase, amylase, troponin are ordered. While waiting, what will you do?
A. CT abdomen
B. USS
Patient difficulty in swallowing solid than liquid. Regurgitation +. What to do?
A. Oesophagoscopy
B. Barium meal follow through
C. Barium enema (lower GI)
D. Manometry
Upper epigastric pain radiation to back, nausea and vomiting +. Non smoker and drink 5-6 alcohol per day. Ex, tenderness and guarding on epigastrium. Vitals BP low side
A. Peptic Ulcer perforation
B. Acute appendicitis
C. Acute cholecystitis
Valgus injury. What to be tear (Which is most likely torn)?
A. Patellar tendon injury
B. Lateral miniscus tear
C. Lateral collateral tear
D.Medial collatera ligament
After injury, pain in the middle calf. Cannot do extension. No pain on passive movements. What to do?
A. mRI
B. USS
C. X ray
For obesity control, what to do?
A. Measure height and weight
B. Control screen time
C. Exercise program
Man standing in balcony and fisting clouds, saying something, he is untidy.. What will help you to diagnose?
A. Empty beer bottles in house
Man with high BP , chest pain came to you after doing duplex left carotid artery 60% n rt carotid artery 30% stenosis. Most appropriate initial things to do?
Carotid endarectomy
Aspirin
Angiography
Male pt experienced some violence and unstable relationships with his male partner?
Refer to support group
Call the police
Relationship council
Pregnant Women comes with vomiting 2 times, afebrile slight tenderness in pelvic region. Mild gaurding no rigidity, urine examination normal. What is the cause?
A.Ovarian torsion
B.Round ligament pain
C.Red degeneration
D.Appendicitis
8yr old girl , not using school toilet to fear of getting ill, soon after reaching home she washed thoroughly for long time . Her mother also had the sane problem during childhood, what is most appropriate initial step?
A.Low dose fluvoxamine
B.Address her with contamination fear
C.Behavioural Therapy
One question was vasectomy came after 3 months with motile sperms. What you are going to advise?
1) Repeat next month
2) He can do sex now
Another today‘s similar Q by 4 months after vasectomies, 20+ ejaculations already done. Still non motile sperms in semen.What to do?
1- need more ejaculations
2- do USG for spermatocele
3- can safely have sex
4- Renal tract USG
Man with jaundice dark urine pale color stool , smoker ,drinks alcohol 3/4times weekly. what is the diagnosis?
A.ALP,ALT,GGT,Bilirubin-high
B.Protein,albumin-normal
C.Alcoholic hepatitis
D.Choledocolithiasis
E.Liver abscess
Pt suddenly develop some problem while talking, he can understand everything but having difficulty while talking,( something like that but no SOB, chest pain no cardiac issues) what is most appropriate things to do?
A.TTE
B.CTPA
C.IV nitroprucide
D.Beta blocker
An old person had UTI then he fell and people found him conscious on the floor with scalp laceration. Then next day he was found dead in the bed. Cause of death?
1) Sepsis
One person got MI and had stent 5 days back and now he again came with severe shearing pain and st elevation in ecg. Cause?
1) Stent thrombosis –
2) Coronary artery dissection
3) Pericarditis
Indomethacin Given for gouty arthritis. Pt had hyponatremia and other renal derangement. Gout not Subsided. What’s Next
A. Prednisolone
B. Stop Indomethacin
5 year old child recurrent upper respiratory tract disease w/ diarrhea(chronic not severe) Hemoglobin decreased
A. Celiac
B. Cystic Fibrosis
Bloating, irritability, premenstrual. Most appropriate tx?
1) COCP
2) Pyridoxine ( vitamin B6)
3) Ginkgo Biloba
trimethoprim allergy, during operation, shocked. Cause?
1) Latex
2) Plaster
3) Isoflurane
area is having covid. patient is having fever. wife is a breast ca patient. patient covid antigen negative. all are vaccinated. what is the most appropriate action?
1. Isolate
2. covid PCR
3. rpt antigen
4. Nothing
Patient coming with typical features of obstructive jaundice..consume alcoho 4-5 drinks on weekends only.no fever..received a course amoxicillin and pcm 3g for upper respiratory tract infection..liver palpable 2cm below the costal margin.ix given(AST/ALT/ALP/GGT all high) possible cause?
1. alcoholic liver disease
2. drug induced
3. viral hepatitis
4. Choledocholithiasis
young man coming with weight loss,cough and night sweats..bilateral cervical lymphadenopathy.cxr given.
Woman 34 yo w/ 2 kids from different fathers. Is on a new relationship e don’t want to get pregnant. Wish to sterilize.
1 agree with her
2 offer her partner to do vasectomy
3 consult with gynecologist
4 offer combined oral pills
Man submitted 4m ago to vasectomy, >20 ejaculations, spermogram w/ non motile sperm. Conduct?
1 – repeat after 50 ejaculations
2 – USG for spermatocele
3 – repeat next month
4 – can have sex without worry for pregnancy
5 – Renal USG
Man 34yo, urinary dribbling, straining and post void micturition. Physical exam normal, include RDE. What’s next?
1- urethoscopy
2 – renal USG
3 – USG rectal biopsy
elderly man presents with malena. endoscopy and colonoscopy does not reveal any bleeding. His vitals are stable at the moment but he requires 2 units of blood daily to maintain a HBat 90. what is the best management
A. capsule endoscopy
B.catheter angio
C.CT angio
D. 55 technetium scan
Old lady, asymptomatic, for check up. DM2, crônica arterial disease. Urine culture + E. coli >100.000 ufc/ml
Cefalexin S
Amoxicillin Clav S
Sulfa R
Cipro S
-Conduct?
Reassure
Cefalexin
Sulfa
Cipro
Old lady, menopause, urinary symptoms with LUTS emptying. Physical exam: labia major United until urethral meatus
1 topic oestregen
2 separate labia major
Female washed her home today morning with bleaching powder, in evening while she go for walking had nasal congestion, wheeze, past h/0 adult onset asthma,asking reason for exacerbation?. She said she had no symptoms when using bleach
A.Chlorine
B.URTI
C.Allergic bronchopulmonary aspergillosis
D.Hypersensitivity pneumonia
E. Asthma
Pms with irritability bloating and less sleep/annorexia
Flouxetine
Pyridoxine
Herbal tea
Mefanemic acid
Obesity screening in community, as stroke is increasing in population so doctor worries an wants to reduce risk factors for it. What is best to do?
H8 w8 of children
Reduce screen time
Include exercise in their routine.
Awareness program
New drug that reduces stroke risk. Wat will u do b4 starting?
Check how many pt it has been tried on
Check its common side effects
Check this pt’s risk of stroke
Check how long the trial duration was
Intern, Needle prick while giving tt vaccine to a pt wd lacerated wound. Hep b negetive of pt. When intern came back after informing management, Pt had left. Now wat to do?
PEP against HIV
PEP againts HIV and hep c
No PEP
Middle age female with right side mandibular swelling anterior to tragus of ear which increases when she chewing food. Temprature normal. Lump~2cm, non fluctuant. Diagnosis?
A. Salivary duct stone
B. Parotid carcinoma
C. Pleomorphic adenoma
D. Salivary duct sialoadenitis
Postpartum pt had total 500ml blood loss. Vitals okay. Has not passed urine since delivery. Don’t remember how many hours had passed. Abdomen distended till umblicus.
Pass cathter (this made more sense during question)
Give iv (i think they were already giving iv in stem)
OB patient, with 2 previous IVF, no lw concieved naturally, where will you ask patient to follow up
1.Midwife
2.OB staff
3.Medicine Staff
4.Doula
6 mon brought pale sweating CRT >3 HR 200 BP unappreciated ECG SVT 280
Valsalva
Adenosine
Metoprolol
DC 1j/kg
A 91 year old, frail ,nursing home resident is found dead, and as the general practitioner you have been asked to issue the death certificate. Two days before he was having urinary track symptoms and confusion and fever. Yesterday morning, he was found unconscious on the floor with a laceration on the scalp. What would be the cause of death?
A) sepsis
B) urinary track infection
C) death certificate can not be issued
D) head injury
30 yr male, firm lump in right scrotum. No illumination. It is present on standing and supine as well
Seminoma
Varicocele
Hydrocele
Non seminoma
Aged male with heaviness in scrotum. Prominent on standing, no illumination, non tender. Testis can be felt.
Hydrocele
Varicocele
Male wd scrotal lump. Cough impulse positive. Non tender. No illumination
Hernia
Hydrocele
Varicocele
Pt with 6 weeks postpartum. Teary, tired, doesnot want to take care of baby, feels like she is failing as amother. Insomnia, anorexia, doesn’t take care of herself
a. Ppd
b. Pp psychosis
c. Pp blues
scenario of Infabtile spasm
same recall of bloody mucousy diarrhea for weeks with positive travel history.
a.Chr ameobiasis
same recall of working with Shearing and pul symptoms.
– brucelosis
-Hyadatid cyst
xray with b/l hilar lymph node prominent. Dry cough, w8 loss
Sarcoidosis
16 yr male football player, asthmatic mod on salbutamol and fluticasone. Tender mass in chest . Cause
Normal? ( I realted it to q.2.135 handbook)
Fluticasone
Steroids
Valgus injury to knee, popping and give away as well. Can’t flex or walk properly. ACL Inj. What else will you see in him?
MCL
Lat meniscal
Patellar tendon rupture
Heamarthrosis
Young female gave birth to a child at home and was still birth, ask what’s next?
A. Inform coroner
B. Bring the baby to hospital
C. Autopsy
Man with high BP , chest pain came to you after doing duplex left carotid artery 60% n rt carotid artery 30% stenosis. Most appropriate initial things to do?
1.Carotid endarectomy
2.Aspirin
3.Angiography
Sick child. Uti
Amoxcilin and gentamicin
Cephalexin
Ceftriaxone
old age pt with herpes rash for weeks. Came for pain.
Amytriptiline
Prednisolone
Acyclovir
paracetamol