The Delta variant of Covid-19 — which first appeared in India — has started spreading rapidly in the United Kingdom and was also recently detected in Australia. Both countries have registered a sharp increase in new infections over the past week.
The B.1.617 variant of the virus, which has in part been blamed for India’s explosive outbreak, has been dubbed a triple mutant variant since it is split into three lineages: B.1.617.1, B.1.617.2 and B.1.617.3. Of these, B.1.617.2 has been identified as a variant of concern (VoC) by the World Health Organization (WHO) and was recently renamed as the Delta variant. It is said to be highly transmissible.
Meanwhile, B.1.617.1, or Kappa variant, has been identified as a Variant of Interest (VoI). The B.1.617.3 strain has not been classified as either VoC or VoI since there have been very few reports of people being infected by the strain.
Due to this surge of second wave, many of our candidates got their exam postponed to a later date. However, there are still minority of them who managed to sit for the exam. A big thank you to those who had contributed in providing us with these recalls. Now let us do our part by solving these recalls for you. You may get them from here.
Australian Medical Council (AMC) MCQ Recalls JUNE 2021 compilation
- A 58-year-old woman has breast cancer and has been vomiting for the past 2 days. She has abdominal pain and is disoriented in time and place. She is afebrile. She is on prochloperazine only. Urinalysis is normal. What is the single most likely cause of her symptoms?
A. Acute intestinal obstruction
B. Hypercalcemia
C. Hyperglycemia
D. Liver failure
E. Hepatitis - Several hours after a vaginal delivery assisted by forceps, patient developed pain in the perineal area. Exam showed normal uterus size and no pain. Pic with huge purple haematoma blocking the normal perineal anatomy. Asking for next step.
A reassure
B cross match blood type - 10-year old boy with autism showed violent behaviour towards younger sister and pet. School cannot tolerate him. What to prescribe?
A olanzapine
B respiradone
C clozapine - 2 yrs old boy always bangs his head against crib after being put to bed to sleep. So loud that the next door could hear it. Symptoms appeared six months ago. What to do next?
A reassure
B Polysomnography
C EEG
D MRI brain - young couple with infertility for 2 years. The lady aged 27 had normal and regular period. The man aged 22 showed little pubic hair and small testies. What to examine in the man could confirm diagnosis?
A karyotype
B DNA
C LH and FSH
D testosterone - Man with painless progressive visual loss in the right eye came for treatment. MRI reveals 2 small, cystic, enhancing nodules in the cerebellum. Renal US reveals multiple cysts in both kidneys. Diagnosis?
A Autosomal dominant polycystic kidney disease
B Autosomal recessive polycystic kidney disease
C Von Hippel-Lindau disease - Investigators studying relationship between a particular 5-lipoxygenase genotype & atherosclerosis. Blood samples for leukocyte genotyping are obtained, and ultrasonography to assess carotid intima-media thickness (CIMT), a marker of atherosclerosis, is performed. Results show that the particular 5-lipoxygenase genotype is associated with abnormally increased CIMT, a predisposition to atherosclerosis. Which of the following best describes this study design?
A Case-control study
B Cross-sectional study - 35-yr-old man training for marathon complains of right ankle pain. Pain worsens with walking or running & improves slightly with rest. Tenderness at the right Achilles tendon 4 cm proximal to its insertion. Therapy?
A. Eccentric calf-strengthening exercises
B. Local corticosteroid injection
C. Couldnt rmb other option - young man with well controlled Schizophrenia by clozapine for some years developed lightheadedness. Asking for diagnosis
A clozapine caused hypotension
B Cannot remember other options - young pregnant lady in first trimester had a first degree cousin who delivered a baby with Cri du chat syndrome. She is eager to test her baby. What is the best method?
A ultrasound at 19 weeks
B amniocentesis at 16 weeks
C Chrionic villous sampling at 12 weeks - An old demented lady with shoulder pain difficult to explain symptoms. Exam showed all movement restricted and bilateral shoulder muscle atrophy. What to examine next?
A MRI shoulder
B X ray - 5 yrs old girl with severe headache and nausea in the morning for some months. No vomiting. Exam showed bilateral papilledema. Rest of the eye was difficult to exam. Mother had similar headache history. What to investigate?
A lumber puncture
B MRI brain
no option for CT brain - Primigravida at 18 weeks gestation has a cephalic singleton fetus measuring at <10th percentile consistent with severe growth restriction. There are bilateral choroid plexus cysts, clenched fists & a large ventricular septal defect. Most appropriate statement?
A “Could I speak to you in private about my concerns with your US finding?”
B “Im sorry to tell you this, but your ultrasound findings are suggestive of a genetic anomaly.”
C “There are some things about your ultrasound that I need to discuss with you; is it okay to do that now?” - 72-yr-old man diagnosed with 4.2-cm adenocarcinoma of the cecum. Underwent right hemicolectomy. Significant for hypertension & obesity. Recommend?
A Abdominal CT scan in 1 year
B Annual fecal occult blood testing
C Colonoscopy in 1 year - An old man with Parkinson’s disease developed paranoia and delusion. He refused any anti-psychotics and denied his conditions. He now is demanding his medical record because he thinks his family lied to the doctors and planed some conspiracy against him. What to do?
A give him the medical record
B contact hospital management
C refuse to give him because he is not competent
D remove the family statement in the medical record - in a remote town with population of 200, the numbers of HBV are
2009 2010
HBV surface antigen positive 5 7
HBV surface antigen and core antibody positive 10 12
HBV core antibody positive 50 60
Asking the incidence of HBV infection per 1000 people in 2010 in this town.
A 25
B 50
C 75
D 300
- Young boy with increasing difficulty climbing stairs. Physical exams totally normal. CK normal.
A Duchenne muscular dystrophy
Cannot remember other options - Woman with severe burns to 30% of her body. Undergone staged excision & grafting. Necrosis & sloughing of skin grafts to the chest, with erythema of the surrounding skin. Therapy?
A. Amphotericin B
B. Azithromycin and ceftriaxone
C. Meropenem and vancomycin - 17-yr-old boy with progressive facial puffiness, fatigue & decreased appetite shows periorbital & pretibial edema. Albumin 2.2 mg/dl, proteinuria 4+, diffuse, granular lgG & C3 along capillary loops. Additional studies?
A. Antistreptolysin O titers
B. Audiology evaluation
C. Hepatitis B serologies - 68 yrs lady with malaise. CCB and iron study showed low Hb, low MCV, low ferritin, low Transferrin saturation. Ask what to investigate next
A iFOBT
B gastro endoscopy and colonoscopy - 6 mths old exclusive breast feeding baby now showed increased night hunger. Mom was willing to add solid supplement. Which is the best to add first?
A formula
B rice and cereal
C egg
D toast soaked in formula
E minced family meal - 25-yr-old female complains of exertional dyspnea & fatigue. Has pale conjunctiva. Hemoglobin 7.5g/dl, MCV 70fl. MCH 29. Next step?
A. Bone marrow sampling
B. Iron studies - 3-yr-old boy with progressive, bilateral lower leg pain shows bilateral calf enlargement & thin, atrophied thighs. Has a waddling gait, high creatine kinase level, replacement of muscle by fat & connective tissue. Additional tests?
A. Abdominal ultrasound
B. Antinuclear antibody
C. Echocardiogram - 26-yr-old woman, gravida 2 para 1, at 35 weeks gestation. Cervix on admission is 7 cm dilated & 100% effaced with the fetal head at +2 station. Rupture of membranes results in bright-red amniotic fluid. Cause of fetal heart rate tracing?
A. Fetal blood loss
B. Intraamniotic infection - 30+ yrs old man with pneumonia. Treatment with antibiotics had no improvement. CT lung revealed multiple small round opacity and biopsy demonstrated Masson inclusion body. Asking for treatment
A some antibiotic
B anti viral
C caspofungin - 30+ lady BMI 32. trying different ways to lose weight but has little effect. Generally healthy and takes no medication. Next step?
A refer to dietitian
B refer to bariatric surgery
C regular exercise
D Bupropion - Pregnant lady with G3P2 third trimester had itchy skin. No rash no icteric. No results of bilirubin. She had similar symptoms for previous two pregnancies. Which one is correct?
A pregnancy is contraindicated
B future use of combined contraception pill is contraindicated
C future risk of hepatocellular carcinoma is increased - Young lady 3 days after surgical abortion wished to get contraception now. Which is the most suitable
A progesterone only pill
B COCP
C progesterone depot
D mirena
E condom - 25-yr-old female complains of exertional dyspnea & fatigue. Has pale conjunctiva. Hemoglobin 7.5g/dl, MCV 70fl. MCH 29. Next step?
A. Bone marrow sampling
B. Iron studies - 3-yr-old boy with progressive, bilateral lower leg pain shows bilateral calf enlargement & thin, atrophied thighs. Has a waddling gait, high creatine kinase level, replacement of muscle by fat & connective tissue. Additional tests?
A Abdominal ultrasound
B Antinuclear antibody
C Echocardiogram - 26-yr-old woman, gravida 2 para 1, at 35 weeks gestation. Cervix on admission is 7 cm dilated & 100% effaced with the fetal head at +2 station. Rupture of membranes results in bright-red amniotic fluid. Cause of fetal heart rate tracing?
A Fetal blood loss
B Intraamniotic infection - 38-yr-old nulliparous woman complains of chronic constipation, cramping with menses & menses with no bleeding. Her mother had breast cancer & grandmother ovarian cancer. Has an enlarged uterus with a prominent posterior mass. Next step?
A BRCA1 and BRCA2 genetic testing
B CT scan of the abdomen and pelvis
C Pelvic ultrasound - old lady with right lower abdominal pain. Now the pain is constant. No fever. Physical exam showed pain in the lower right. No rebound. CT picture. No mass no haemorrhage that I can see. Asking for diagnosis
A rectal sheath haemorrhage
B mesenteric adenitis
C pelvic abscess
No option for appendicitis or colitis or caecum vulvus - erysipelas situation. Red line extending in the inner side of shin. Asking for management. No option for antibiotics
A heparin
B bed rest and elevation of the leg
C warfarin - Woman comes with severe, left-sided flank pain. Has associated nausea, vomiting & hematuria.
CT scan reveals a 5-mm stone in the left midureter. Indication for an urgent urologic consultation?
a Fever and chills
b Macroscopic hematuria - Woman, gravida 1 para 1, complains of bilateral nipple soreness with breastfeeding. Developed bloody nipple discharge. Breasts diffusely engorged & mildly tender to palpation, but there are no palpable masses or lymphadenopathy. Cause?
a Bacterial overgrowth of stagnant milk in blocked ducts
b Candida infection spread from infant oral flora
c Poor infant positioning and latch-on technique - 31-year-old woman, gravida 3 para 3, diagnosed with antiphospholipid antibody syndrome & was informed that she is at increased risk for another miscarriage. Best contraceptive option?
a Combined hormonal patch
b Combined oral contraceptive pills
c Copper intrauterine device - 48-yr-old woman comes with sudden-onset right flank pain. Imaging reveals a 3-mm stone in the right upper ureter & a few gallstones in the gallbladder. Analgesics & intravenous fluids given; in a few hours she passes the ureteral stone in the urine with complete pain relief. Next step?
a Laparoscopic cholecystectomy
b Lithotripsy
c No treatment at this time - 36-yr-old woman complains of left hand clumsiness. Had an episode of vertigo & a history of bipolar disorder. Couldn’t hold her stretched out left arms for long; will involuntarily drift downward. Cause?
a Basal ganglia dysfunction
b Cerebellar dysfunction
c Pyramidal tract lesion - first trimester Down’s syndrome screening showed PAPPA decreased and increased neck thickness by ultrasound. CVS showed karyotype 46 XY. What to do next?
A no need for further test
B second trimester screening - patient had a business trip to Vietnam returned 3 days ago had high fever and cough. He told you other 3 colleagues also had similar symptoms. What to do?
A ask him to isolate at home
B inform public health
C admit to hospital - 32-yr-old woman, gravida 1 para 1, complains of left breast pain during breastfeeding. Erythema extending from the areola to the lateral edge of the left breast & surrounding a well-circumscribed, 4-cm area of fluctuance. Axillary lymphadenopathy is present. Next step?
a Breast binding and acetaminophen
b Core needle and skin punch biopsies
c Needle aspiration and antibiotics - 62-yr-old woman complains of insomnia & depressed mood after her husband unexpectedly announced divorce. Though tearful, patient brightens when asked about her grandchildren. Diagnosis?
a Acute stress disorder
b Adjustment disorder - 2-yr-old girl vomited & become irritable & lethargic. Has a ventriculoperitoneal shunt placed after birth due to intraventricular hemorrhage. The anterior fontanelle is enlarged & tense. Next step?
a Abdominal ultrasound
b Brain imaging - Woman, gravida 2 para 2, underwent a prolonged induction of labor for gestational diabetes mellitus complicated by an intraamniotic infection. Discharged but came back later with active bleeding from the cervical os with passage of large clots. Diagnosis?
a Cervical laceration
b Normal lochia
c Retained products of conception - 86-yr-old woman with progressive confusion & lethargy. Has a history of Alzheimer dementia, hypertension & osteoarthritis. Withdraws from painful stimuli applied to her right side but not to her left. Cause?
a Amyloid angiopathy
b Arteriovenous malformation rupture - domestic violence question. In the outpatient clinic, woman is now revealing violence from her husband and fears for her life. Her husband is now in the waiting area. What to do
A call police
B admit her to hospital (maybe not)
C ask her to exit from the other door
No option for counselling or providing shelter - 45-year-old man complains of poor sleep, worried about losing his job. Patient appears nervous & restless. Treatment?
a Alprazolam and supportive psychotherapy
b Buspirone and psychodynamic psychotherapy
c Escitalopram and cognitive-behavioral therapy - Woman complains of recurrent headaches. Family history is significant for hypertension & diabetes. B/P 175/100 mm Hg. A systolic bruit is heard under the right ear. Cause of hypertension?
a Coarctation of the aorta
b Fibromuscular dysplasia - 17-yr-old boy comes with progressive papular rash involving the trunk, neck, upper arms & genital area. Is notable for mild intermittent asthma & childhood eczema. Cause?
a Cellular immunodeficiency
b Circulating autoantibodies - 3 hx of major depressive episodes and suicidal attempt. Duration of treatment?
- Gastric perforation mcq (ask for ix)
- sciatica question (ask bout what sensory area)
- large bowel obstruction cxr ask for investigation
- intestinal ischaemia what can you get from history?
- fever reduced breath sound + pleuritic chest pain = dx?
- Precocious puberty may be associated with all of the following except?
A. Hepatoma
B. Adrenal tumor
C. McCune-Albright’s Syndrome
D. Ovarian tumor
E. Klinefelter’s syndrome… - COPD and investigation (PEEF and spirometry)
- hydatid cyst (image) dx?
- BCC of the eye mx?
- 17 wt loss, recurrent infection, mucus and bloody stool dx? CF
- lateral epicondyltitis pain treatment
- angina with normal ECG mx?
- CTG variable cervix 9c,. cord prolapse next? stop oxytocin
- low MCV ix? irons study
- paraesthesia MCV 120 B12
- agitated and came to hospital and want to kill his children. first mx?
- proteinuria on chance, repeat test with protein then 24h +ve, morning present and on night present? mx?
- bells palsy = mx?
steroid
steroid with acyclovir
acyclovir
reassurance - breast ca with skeletal involvement and abd, mx?
- scabies given twice 2 weeks, next mx?
- abscess on the uvula, shift, next?
- osteoporosis treatment.
- COCP what is important not to give
- chronic limb ischemia API 0.25 and no rest pain manamagement?
- cri du chat syndrome at pregnancy = diagnositic test
- Man has surgical removal of shrapnel to left eye. Patient reports blurry vision in his right eye, normal 2 mths ago. Bilateral conjunctival erythema. ??sympathetic opthalmia?? Pathogenesis of ocular condition?
a Hematogenous fungal spread
b IgE-mediated hypersensitivity
c T-cell sensitization to self-antigens - 65-yr-old man complains of progressively decreased vision in both eyes. Has diabetes ten yrs ago, medications are metformin & glyburide. Ophthalmoscopy reveals microaneurysms, dot & blot hemorrhages, hard exudates & macular edema. Diagnosis?
a Central retinal vein occlusion
b Diabetic retinopathy - Construction worker complains of pain, watering & redness in his left eye for the past 2 days. Left eye reveals vesicles & dendritic ulcers in the cornea. Diagnosis?
a Bacterial keratitis
b Herpes simplex keratitis - 6-mth-old girl unable to sit & roll; is hypotonic with hepatosplenomegaly & a protuberant abdomen. Has a bright red macula along with cervical lymphadenopathy. All deep-tendon reflexes are diminished. Cause? niemann pick disease???? This is really difficult.
a β-hexosaminidase A deficiency
b Galactocerebrosidase deficiency
c Sphingomyelinase deficiency - Woman suffers abnormal uterine bleeding with passage of large clots. Menarche was at age 16. Had a cervical conization at age 29. BMI is 39 kg/m2. Biopsy shows endometrial adenocarcinoma. Most significant risk?
a Age at menarche
b Body mass index - Lady with 150 ml cervical bleed, ex – mild suprapubic tenderness but soft abdomen
A. Cervical pregnancy
B. adnexal pregnancy
C. Placenta previa
D. vasa previa
E. Appendicitis - Trauma scenario with paradoxical movement in Flial chest, he is otherwise stable
A – IV fluids
B – PPD
C – Analgesia
84.Child with watery diarrhoea and fever and abdominal pain, no PR bleeding, cause
A. Campylobacter jejuni
B. EColi
C. salmonella
- A man came from Turkey, s/s of ???
- Person feel Fatigued and on drugs – statins, indapimine, CCB, Furosemide, digoxin
- Drugs responsible
A statins, indapamide
B CCB, Furosemide
C Digoxin and statin - Lady, 8 week pregnant, was on antiepileptic’s (name not mentioned) for last 6 years and now asymptomatics, what to do
A Hold antiepileptics
B Start different epilepics - Type 1 D/M – driving condition
A Check sugar before driving and every 2 hourly
B Check sugar levels before and after the driving
C serial blood sugar tests
D No restrictions - ECG – Afeb – lady with H/o of light headiness, normal CVS exam, what is the next investigation
A VQ scan – no CT given
B CXR
C ECG - ECG – A lady with SOB, and chest pain for 2 hours and now pain settling, ECG ST elevation (V1-V4), LBB, best appropriate management
A Trop
B PCI
C CXR
D Echo - A child with posterior triangle Lymph node – mobile, non tender, what to do for diagnosis
A CXR
B CBC
C Lymph node biopsy
D FNAC - Man with lung nodule – 2 cm on CXR, what to do
A Ct guided biopsy
B bronchoscopy
C Calcium - Lady is telling she had 10 sexual partner, important question you need to ask to find if she is not in risk
A How many times she had relations in last 12 months
B use condom - A lady with Rubella exposure when she was expecting periods and suddenly found she is pregnant, what to do
A Terminate pregnancy
B Check antibodies first - A lady exposure to chicken pox, she hasn’t received vaccine prior to pregnancy, what to do
A check Antibodies levels first
B terminate pregnancy
C Give baby vaccine after delivery - A 50-year lady needs emergency surgery, refused to consent, siblings want’s procedure, what to do?
A access her competency level
B refuse surgery
C proceed with surgery
D Involve court - A lady after molar pregnancy, B HCG levels come to normal in 4 months, elevated suddenly , reason
A. Recurrence
B. Invasive mole
C. Lab error - A wife and husband had swabs came – husband swan positive for HIV, wife normal, husband refused you not to tell to his wife, what to do?
A agree
B tell to wife
C encourage him to inform his wife - PHotos- Cheek soft mass for 3 weeks, asymptomatic, diagnosis
A SCC
B BCC
C epidermoid cyst - Ct with hydatid cyst
- SBO – management after resuscitation – next step
A IV fluids
B NG
C Abx - AXR – Distended abdomen with dilated small bowel postop, bowel sounds sluggish, next step
A IV fluids
B Ng tube
C Rectal tube - AXR of a patient with UC and megacolon, next step in management
A. NG
B. IV fluid
C. rectal tube
D. IV abx - A woman with H/o 1st trimester abortions, what to check first
A. US for cervical length
B. fibronectin
C. Us abdomen - A lady with antenatal US at prominent nuchal, CVS at 12 week showed 47 XY, what to do?
A 2nd trimester screening
B amniocentesis
C Routine screening - 50-year man with dysphagia of liquid and solid feeds for 4 months and weight loss of 5 kg, rest of examination is normal, diagnosis
A. Achalasia
B. Oesophageal CA
C. GERD
106.A man with diagnosed H pylori and Penicillin allergy, Rx
A. PPI, clarithromycin and Penicillin
B. PPI, clarithromycin and Tetracycline
C. PPI
D. Clarithromycin
- Old man with active bleeding ulcers find on colonoscopy, treatment
A Injection simultaneously
B PPI
C octreotide - 50-year male with dark stool, upper and lower GI – normal, what to do, what o do
A. PPI
B. blood
C. capsule endoscopy - A lady with Hb – low normal but with Low MCV and normal MCHC, diagnostic test
A Iron deficiency workup
B Electrophoresis - 4-year child with difficulty to stand from floor – seems Grover sign is positive, normal CK levels – diagnosis
A DMD
B Lateral sclerosis - A lady with bilateral Greenish discharge
A ductal ectasia
B DCIS
C LCIS - A 30-year lady with two kids wants Tubal ligation, what to do?
A tell her it is irreversible
B Discuss her other options of contraception’s
C refer her to obstetricians - Infertile couple for 2 years, Husband came as azoospermia, wife normal what next investigation
A Testosterone
B karyotype
C FSH
D Thyroid
E prolactin - A pregnant lady with HTN, model of care
A GP led care
B Obs referral - A 70-year lady with women with urge incontinence small cystocele, best treatment
A vaginal pessary
B Bladder neck repair
C alpha blocker - A middle age male bent his back to to take matchbox experienced sveere back pain from left buttock, thigh till sole, what will be s/s
A cant feel back of thigh
B No sensation lateral thigh
C no sensation medial thigh
D No knee reflex
E no Ankle reflex - Scenario of an old man who is chronic alcoholic for 40 years, LFTS, all deranged – AST > ALT and raised ALK Pho, diagnosis
A Portal HTN
B Chronic liver disease
C Wilson disease - child calm and quiet in class but enjoys in sports and plays with friends normally. Also good at home and in front of relatives.
A Selective mutism
B Separation anxiety
C Autism spectrum disorder - Patient on clozapine well controlled. Now having involuntary movement of legs and annoyed with this. What to do
A Propranolol
B Benztropine
C Decrease clozapine dose
D Change to other antipsychotic - Child with URTI and protein urea, diagnosis
A WG
B PSGN
C MCD - Child with proteinuria and low C3
A PSGN
B MCD - LN palpable in groin, source of malignancy
A testis
B rectum
C bladder - Middle age man, fall on elbow, later developed decrease thumb flexion, investigation
A X-ray
B CT
C NCT - the Fingers and toes and weakness and unsteadiness of the legs with glove and stocking
sensory loss to all modalities and absent knee jerk while ankle reflex was preserved. He was
statins 5mg for 8yr.which one of the following is most likely diagnosis?
A. Diabetic peripheral neuropathy
B. Diabetic amyotrophy
C. lumbar radioculopathy
D. Statins induced myopathy
E. polymyositis - Premature urge to push baby and you found cord in front of baby – options
A knee chest position
B C section
C left lateral - Lady came with her son. Her son is complaining she is forgetting often. She denies those
clams and says her son is exaggerating. Mmse 21/30. Management
A Ask son to leave and repeat mmse
B Refer to psychiatry
C Discuss with both - 70 year male, known HTN and Dyslipidaemia had TIA of right, US Doppler suggest r) 60% stenosis, L) 50% stenosis – current BP – 180/90, Risk factors which creates max impacts in health improvement
A R) endarterectomy
B control BP
C Manage Dyslipidaemia - man came to ED after fight with stranger saying he is in bad relations with wife and going to kill her – options
A admit
B haloperidol
C discharge - Child with rash and frequent bleed, commonest reason
A Fact 8 def
B WWF def
C ITP - Male on thyroxine, presented with lethargy and low BP, what to check first
A TSH
B BP
C Ct head - Scenario of complex bipolar depression, hypertensive, cardiac failure, patient on lithium, ACEI, diuretics, SSRI developed agitation, tremor and agitation
cause:
A NM syndrome
B serotonin syndrome - a lady with fever and dysuria – UTI, nitrates positive in urine, treatment
A Nitrofurantoin
B Ampicillin
C TMP - 55 year lady worries about her mother died at 50 years with Huntington chorea asking for help, what to say
A genetic counselling
B no need to do as she is already 55 year - 4-year child in ED with mid femoral # what to suspect
A Decrease Calcium
B decrease Vit D
C non accidental injury - old lady came to new GP after 8 month, supposed to be seen by old GP in 2 month, asking for prescription for Anti HTN med – current BP is 155/80
A confirm with old GP first
B call pharmacist
C give prescription - A 45-year-old woman who presented with severe headache and vomiting for 24 hours, mild neck stiffness. Previously well. Diagnosis?
A Meningeal meningitis
B Cryptococcus meningitis
C Subarachnoid haemorrhage - A boy has schizophrenia ,taking clozapine, his symptom is improves but some symptoms
present, But excessive sleepiness, what next
A Increase Clozapine dose
B Decrease clozapine’
C Add risperidone - 70 year male, chain smoker for 40 year, c/o dizziness
- Labs – low Na, Low K, Low HCo3, normal Abgs – diagnosis
A Lung CA
B Cushing
C Conn - 40-year male with prolong h/o obesity, not responding to exercise and diet control, BMI is 32, what to do
A Diet rehabilitation programme
B bariatric surgery
C Continue exercise - A 39yo man came with history of obesity for as long as he could remember
A Life style modifications
B Refer to dietician
C Refer to bariatric surgery
D Refer to endocrinologist - Young man, pre-employment found proteinuria, on further work up – no Pt in morning sample and only evening sample – protein – all haematology normal, what to do
A reassure
B Refer to nephrologist
C repeat sample in 2 weeks - scabies no response after given treatment (permethrin) twice, what next
A steroid
B repeat same treatment
C replace with oral permethrin - boy with fever, rash and neck pain
A Roseola
B HSV
C meningitis - ABI – 0.25, next investigation
A Ct angio
B US Doppler - History of premature ejaculation
A sildenafil
B SSRI - post cholecystectomy – no aspirin due to allergy, options
A compression stocking till mobilised
B LMWH till 5 days
C LMWH – 10 days
D no prevention - an obese lady with hirsutism and infertility, most reliable investigation
A US
B Testosterone
C Gonadotrophins - 38-yr-old nulligravid woman complains of intermenstrual spotting & bleeding that have occurred at varying intervals & last 3-7 days. BMI is 29 kg/m2. Next step?
a Coagulation studies
b Endometrial ablation
c Endometrial biopsy - 19-yr-old woman complains of 6-mth history of amenorrhea. Menarche occurred at age 11 & her menstrual cycles were regular until 9 mths ago. BMI is 20 kg/m2. No menstrual bleeding occurred after a 10-day challenge with medroxyprogesterone acetate. Risk?
a Decreased bone mineral density
b Ectopic pregnancy - 15-mth-old boy is brought for chronic constipation since early infancy. Stool occult blood testing is positive. Next step?
a Begin scheduled polyethylene glycol only
b Obtain contrast enema - 22-yr-old woman is diagnosed with schizophrenia. Her declining grades in school upsets her father. She quits the part-time job she enjoyed believing that she has been spied on. Apart from risperidone, which would be most helpful?
a Encourage the patient to resume employment
b Encourage the patient to return to school immediately
c Recommend family therapy - 65-yr-old man complains of progressive cough & shortness of breath. Noninvasive ventilation is begun, as are inhaled bronchodilators, systemic glucocorticoids & empiric antibiotics. Respiratory status significantly improves. Next step?
a Additional history regarding alcohol use
b Arterial blood gas analysis - A 48-yr-old woman comes for evaluation of elevated blood pressure. Family history is significant for hypertension in her father. BMI is 28.6 kg/m2 Additional evaluation?
a Assessment of left ventricular function
b Home sleep apnea testing
c Screening for diabetes mellitus - 45-yr-old man met with a motor vehicle collision. Bruising around the scrotum & perineum & blood is seen at the urethral meatus. Digital rectal exam reveals a high-riding prostate. Next step?
a Foley catheterization
b Immediate surgical repair of the urethra
c Retrograde urethrography - 6-mth-old boy is brought for a routine well-child check. The family is concerned about introducing highly allergenic foods because the patient’s cousin was hospitalized after developing a severe allergic reaction to eggs. Best approach?
a Begin small amounts of highly allergenic foods at home
b Delay introduction of eggs and other high-risk foods until 2 years of age - 34-yr-old woman sustained multiple bony fractures & approx 50% total body burns. The patient is intubated, sedated & mechanically ventilated. Urine output has progressively decreased & has been difficult to ventilate. Next step?
a Bilateral chest tubes
b Intravenous mannitol
c Measurement of bladder pressure - Man complains of exertional dyspnea & fatigue. Has end-stage renal disease due to glomerulonephritis. B/P 160/60 mm Hg. Scattered rales are heard at the lung bases. The extremities are warm & there is trace peripheral edema. Cause?
a Decreased cardiac output
b Flail mitral leaflet
c Increased cardiac preload - Woman comes with eye problems. Frequent blinking of the eyes is noted & shining light in the eyes to assess pupillary response causes involuntary tonic closure of the eyelids bilaterally. Diagnosis?
a Acute uveitis
b Focal dystonia - Man brought with gunshot wound to the abdomen. Because of hypotension, paramedics administered 1 L of normal saline. His extremities are cool & clammy. Exam shows free fluid in the abdomen. Continuation of saline fluid boluses would likely result in?
a Decreased risk for acute respiratory distress syndrome
b Decreased risk for hypothermia
c Increased risk for coagulopathy - There is a surgeon always shouting to the staff or others.It’s happened several times.The staffs get upset and some crying until left the operation room during operation.You are intern,what you should do:
- Talk to surgeon
- talk to anesthestist
- raise problem at intern meeting
- report to director of clinical training
- Wpw with af treatment?
1 Adenosine
2 Verapamil
3 Lignocaine
4 Digoxin - one senerio of women taking cabermizapine for optic neuritis and trimethoprim for uti, thyroxine ,ramipril of ht, lab given only Na reduced and urea high ask for Tx
A fluid restriction
B cease trimethoprim and give saline
C cease cabemizapine and saline
D hypertonic fluid - 18 month? Kid otherwise well but sometimes five stools a day which are large smelly…wtt to do
A Gluten free diet
B Start Soy formula
C Lactose free
D Continue same diet - child with abdominal pain irritability fever ?may be cxr was given with opacity in left lower lobe looked like pl effusion asking which ix is dxtic
A Blood culture
B Fbe
C Pleural aspirate
D Pneumococcal pcr - A case of 1 month old child for check-up due to bilateral eye discharges since day 1. No other associated symptoms. Choices
A gonorrhea,
B chlamydia,
C adenovirus,
D nasal blockage (naso-lacrimal duct obstruction) - 30 month of child brought in by her mother, what can she do?
A) wash his hands and mouth
b) speak a 4-5 word sentence
c) dress/undress
d) kick a ball - Pt has auditory hallucinations asking him to harm the neighbor and to persecute him. He says the voice us telling him to kill the neighbor. He is on forrbight Inj zuclopenthixol, last 2 days ago. Most app immediate step?
A. Increase dose to weekly inj
B. Administer another dose of inj now
C. Add clozapine
D. Add lithium
E. Inform neighbor - 23-year-old woman whose last menstrual period was 14 weeks ago presents with a history of intermittent acute right iliac fossa pain accompanied by vomiting. She has not had any vaginal bleeding. Her uterus is of normal size. What is the single most appropriate diagnosis.
A. Torsion of the ovarian cyst (if the uterus correspond to the size of the gestation)
B. Tubo-ovarian abscess
C. Ruptured ovarian cyst
D. Hemorrhage into ovarian cyst
E. Ectopic pregnancy (if uterus is less than the size of gestation) - Lady with SOB, pregnant and left leg swelling, pain in calf asking what to do next:
a. CTPA
b. VAQ
c. Doppler
d. LMWH - Lady with MDD on SSRI, with many depression crisis including suicide attempt in the past. Asking how many years will you treat her medically:
a. 1
b. 2
c. 5
d. Life long - Tia scenario Bp 160/98. Carotid calcified Ventricles enlarged Asprin commenced. What to give with aspirin
A Ramipril
B Clopidogrel
C Statin - Old lady comes to you because she wants more oxycodone prescription since she has finished it due to intense metastatic pain
You check her files and find out that she finished her medicine 2 months earlier this time. What will you do?
A) telephone the pharmacist and ask if they refilled her drug box recently
B. Refer to drug specialist sector - 12 year boy brought by his mother complaining that everyone in school called him fat , his weight is at 90th percentile and height 50th percentile. She said its happening when he was six years old. What is ur next investigation of choice
a. chromosomal analysis
b. early morning serum cortisol
c. plasma growth hormone
d. thyroid stimulating hormone
e. IGF 1 level - child with history of prolonged cough was diagnosed as pertussis and started treatment. His young sister, 5 months has no immunization history. After giving erythromycin for all family members, what also will be done?
A- Giving another antibiotic to all family(can not remember its name)
B- Give booster dose of DTAP to all family members
C- Give booster dose of DTAP to his 5-month sister only
D- Do nothing - Man going for CRC surgery. What wil you give?
A Heparin from now til discharge
B Heparin from now til 30 days
C Heparin from now til 6 months
hey when will you post the answers
Hi, could you please share the answers ??
Kindly updates 2021 whole year and 2022feb past recall with answerd.