Australia’s fourth Covid wave is likely to peak before Christmas as the rate of hospitalisations and infections begin to slow down. Although cases still continues to rise nationwide for the sixth consecutive weeks, it is now at a slower rate. This suggests to reach a plateau in cases by the first week of December and probably a decreasing rate just before Christmas.
New South Wales recorded 31,531 new Covid cases in the weekly reporting period, a 13% increase from last week’s 27,869.
Victoria recorded 22,281 new cases in the latest weekly reporting period, a 9% increase on the previous week’s 20,398.
Previously, cases in NSW and Victoria were doubling in just a fortnight, driven by a “soup” of Omicron subvariants.
On the side note, a huge thank you to those who had contributed in providing us with these recalls. Now let us do our part by solving these for you. You may get them from here.
Australian Medical Council (AMC) MCQ Recalls NOVEMBER 2022 compilation
45yo man sudden onset skin rash, oral lesion with fever. Not able to eat. Conjunctivae inflamed. Erosion at oral mucosa. Rash at trunk and thigh. Prescribed TMTSFX 5 days ago. Dx?
a/ Staphylococcal scalded skin syndrome
b/ Stevens-Johnson syndrome
1month boy poor feeding. Breathing hard and fast during feed. 4/6 holosystolic murmur at left sternal border with thrill. Lungs rales bibasal. Liver palpable. Cause?
a/ Increased left ventricular afterload
b/ Increased pulmonary blood flow
34yo lady fatigue become tired easily after walking short distance. Difficulty combing hair. Father die of stroke. Mother dm. she has tachycardia. Awkward drop into chair when ask to sit. Decreased shoulder muscle mass. Cause?
a/ Cerebellar dysfunction
b/ Neuromuscular junction disorder
c/ Thyroid disease
Around 40 y, conjunctiva pale, alcohol h/o Can’t remember . cld features but no pedal edema, all the LFT markers bilirubin, albu, glob, ggt, alt, ast elevated.. Dx?
1. Cld
2.metastatis from colon,
Other can’t remember
17 yrs female, Recurrent resp infection, fatigue, alb, glob both decrease..
1. Coeliac dis
2. SLe
Child with headache, vomiting , small palpable cervical lymph node on rt side . Head also tilt towards the same side.
Mom has h/o recurrent headache..
Investigation?
1. Usg
2. Ct
3.biopsy
4. Mri
Boy who failed in exam and now threatened to kill his teacher. Thinks that he deserve great marks. I got that ques. But ask about which features if present will help to dx ?
A. Rapid speech
B. Poor concentration
C. Ptsd
Cannot remember all options
A lady with h/o dental procedure few days back. Now c/o 4hrs stridor, with rt sided neck swelling, there is red swelling from from preauricular area to ramus. Ask mx ?
young woman. Panic attack. Severe anxiety. Trembling sweating chest tightness SOB when giving presentation. Concern lose job resulting poor asleep. Avoids eye contact. Dx?
a/ Generalized anxiety disorder
b/ Social anxiety disorder
4month girl. Fussiness and persistent fever 2 days. 1 episode of vomiting. Not finishing breastmilk. Still wet diapers but urine no smell or blood. Exam shows tired baby. Next step?
a/ Abdominal ultrasound
b/ Urinalysis and urine culture
snake bite + no fangs marks + linear scar. What to do next?
Take swab and pressure bandage/
anti venom kit/
transfer to hospital/
serve antivenom
PCV (polycythemia rubra vera) what is the physical examination finding: splenomegaly/cardiomegaly
After delivery of baby, bleeding and not clotting?
a/AFE
b/retained placenta
the same question: Pt gravida 2, 1 previous scar for breech under GA. This time at 39w, placenta previa and undergo planned caesarean section under GA. Otherwise, antenatal no other problem. IMMEDIATE upon delivery of baby, patient BP drop to 60/40mmHg, profuse bleeding, not clotting
A. Anaphylaxis to anaesthesiological medication
B. Amniotic fluid embolism
C. Retained placenta
D. Uterine inversion
E. Extended year to the uterosacral ligament
Pregnant after rubella vaccination post 2 weeks? What’s the next step?
Don’t do anything
rubella serology
terminate pregnancy
Diplopia + athralgia + hematuria + hemoptysis + HT, what’s the diagnosis ?
SLE
Wegener granumolatosis
Goodpasture disease
Floater increasing, Fundoscopy: white band ring? Diagnosis?
idiopathic floaters/
retinal detachment/
vitreous hemorrhage
ASTHMA: given three puff of salbutamol, what’s next to give?
Jptrapium bromide
hydrocortisone inhalation/
oral Prednisolone
8Ankylosing spondylitis 1st line = NSAID ankylosing spondylitis. Pt was having stomach problem, 57 yrs and mild pain from 20yreas. What you choose:
a. Parracetamol
b.Naproxen
c Methotrexate
d.sulfosalazine
e.Infliximab
Ankylosing spondylitis xray asking for best treatment. Patient already on Paracetamol and codiene but no relief
Sulphasalazine
Methotrexate
Indomethacin
infliximab
Pediatrics: nephrotic syndrome, immunisation,
5mth old, full-term boy is brought due to fever, runny nose & intermittent coughing. His 3yrold brother had an upper respiratory tract infection last wk. Takes vitamin D. Exam shows crusted rhinorrhea at the nares. Marked on chest radiograph
a/ Right upper lobe atelectasis
b/ Right upper lobe infiltrate
25 yo woman comes due to chest pain that began 2 days ago. Unable to sleep prone because of pain. Last menstrual period was 3 wks ago. Takes a daily folic acid supplement. Palpation demonstrates bilateral, nonfocal chest tenderness & diffusely nodular, dense breasts. Diagnosis?
a/ Fibroadenoma
b/ Fibrocystic changes
teenage girl is brought for a preparticipation sports physical. She is planning to play lacrosse, which she had played the previous school yr. Posture seemed abnormal. Physical exam shows a right-sided lumbar prominence during forward bend test. Next step?
a/ MRI of the spine
b/ Surgical fixation
c/ X-ray of the spine
43yr old woman comes with abdominal pain & dark urine. Physical exam shows right upper-quadrant tenderness without guarding or rebound. Further workup, including MRI of the abdomen, shows hepatic vein thrombosis. Diagnosis?
a/ Acute intermittent porphyria
b/ Paroxysmal nocturnal hemoglobinuria
elderly woman is brought for lethargy & drowsiness. Medical history is significant for hypertension, chronic kidney disease, chronic low back pain & frequent constipation. Strength in the upper & lower extremities is 2/5 & deep tendon reflexes are absent. Serum creatinine 200. Diagnosis?
a/ Cerebellar infarction
b/ Hypermagnesemia
21yrold man being stepped on the chest by a bull approx 30 min ago. BP 75/50. Bilateral chest tubes with 1.5 L of blood is returned from each side; Vital signs do not improve. 4 units of packed red blood cells are prepared for transfusion. Blood products to be administered?
a/ 4 units of cryoprecipitate only
b/ 4 units of fresh frozen plasma and 4 units of platelets
c/ 4 units of platelets only
Psy Qs
Delusional disorder: is a type of mental health condition in which a person can’t tell what’s real from what’s imagined. There are many types, including persecutory, jealous and grandiose types. It’s treatable with psychotherapy and medication.
Hypochondriasis: Illness anxiety disorder, sometimes called hypochondriasis or health anxiety, is worrying excessively that you are or may become seriously ill. You may have no physical symptoms.
dementia
Parkinson
Patient under clozapine treatment for resistant schizophrenia, bmi 42, what is the best opción to treat obesity
Aripiprazole
Acromioclavicular dislocation picture given
intestinal obstruction
positive predictive value in a depression scale, data given. PPV = TP/TP+FP
Lichen sclerosis treatment
Local potent steroids (clobetasol)
Screening for Prostate cancer
not recommended, but if patient wants, PSA
breast brown discharge
duct ectasia breast
Preg 6weeks with intense itching next?
Diplopia + arthralgia + hematuria + hemoptysis + hypertension. What’s the diagnosis?
Wegener granumolatosis
Qs about duct ectasia breast
Qs about atelectasis
Qs about shoulder dislocation
Qs about diabetic foot ulcer rx?
Qs about african pt with esinophilia and next do
stool cult (Schistosomiasis)
Qs about One was boy with repeated swollen knee painful… treatment
A mother came to your office with complaints of her son having urti from past 3 days and asking for med certificate for past 3 days as she had to take care of him On examination only mild symptoms.of urti present
A) give med certificate (better give certificate like a carer)
B) give med certificate for the present day
C) call her supervisor to tell about the condition
Another question Greenish discharge from 3 spots of one breast Cause?
Duct ectasia
Intraductal papilloma
Invasive CA
Paed-6 yr old with dark urrine UE – protein 2+ RBC 4+ Urea and creatinine elevated Albumin and globulin normal Cause?
IgA
psgn
6 weeks return from Thailand, complain of fever, fatigue. Physical examination normal. What’s the next investigation?
HIV (because the time 6 weeks after the travel)
Malaria
dengue
56yold man comes due to an episode of transient right eye blindness that lasted an hr. Smoked a pack of cigarettes daily for 30 yrs. BP 160/94. BMI 32. Facial plethora is present. Abdominal exam reveals splenomegaly. Best therapy?
a/ Anticoagulation
b/ Phlebotomy
middle age car mechanic comes due to a 4-wk history of right elbow pain. Tenderness on palpation around the lateral distal humerus. Pain is reproduced when testing grip strength & with resisted wrist extension. Next step?
a/ Elbow counterforce brace
b/ Elbow x-ray
Meningococcal meningitis: antibiotic of choice for 5 years old
Ceftriaxone
Ampicillin
Gentamicin
Metronidazole
basilar skull fracture; raccoon eyes, CSF leaking, what to do next?
IV DEXA
oral gastric tube
NG tube
abx
FERTILITY: sulfasalazine and MTX (recalls)
Hoarding: what to look for?
Substance abuse/
social anxiety/
mood/
alcohol abuse
Paramedic placed a ET tube in ambulance after coming to ER you have following Caphnography (etCO2). What is the reason.
Tube leakage
Chyne strokes
Proper placement
Synchronised breathing
Asynchrnised breathing
old man with severe difficulty speaking, right visual field defect & severe right lower facial droop. Weakness & sensory loss in right arm & leg. Has transient ischemic episode with 30% stenosis in carotid arteries. Has hypertension, hyperlipidemia, type 2 diabetes mellitus & ADPKD. Cause?
a/ Cardiogenic emboli
b/ Carotid artery atherosclerosis
man with intermittent right knee pain for the last few mths. Has type 2 diabetes mellitus. BMI 36. Right knee has bony enlargement & a small effusion. Synovial fluid shows a leukocyte count of 1,800/mm3 with no crystals. Medication for relief?
a/ Colchicine
b/ Diclofenac
middle age man hx of travelling cruise to Indonesia. Presented to you now with fever, nonproductive cough & shortness of breath for the past 2 days. Also has headache, abdominal pain & diarrhea. History of type 2 diabetes mellitus & smoked a pack of cigarettes/day for 20 yrs. Lung crackles bilaterally; interstitial infiltrates. Sodium 128. Antibiotics? Legionella infection.
a/ Ceftriaxone
b/ Clindamycin
c/ Levofloxacin
26yo woman comes due to pulsatile headaches associated with nausea over the past 6 wks. Has transient episodes of blindness lasting 2-3 secs. 16-kg weight gain over the past yr. BMI 43. Funduscopy shows bilateral papilledema. Feels better after the lumbar puncture. Treatment?
a/ Acetazolamide
b/ Cerebral venous sinus stenting
c/ Corticosteroids
20 yo woman comes due to hearing loss. Trouble with balancing poses during yoga. Her mother also developed hearing loss in her 20s. Standing on 1 foot is difficult, especially with closed eyes. Audiogram shows bilateral sensorineural hearing loss. Cause?
a/ Multiple sclerosis
b/ Neurofibromatosis
51 yo old man comes due to frequent itching, especially after bathing. Occasional headaches & dizziness. His sister has bipolar disorder. BMI 30. Face has a ruddy cyanotic appearance. Spleen is palpable 4 cm below the left lower ribs. Likely seen on further workup?
a/ Low resting arterial oxygen saturation
b/ Low serum erythropoietin level
75 yo man in end-stage multiple myeloma. Severe pain due to pathologic vertebral compression fractures & osteolytic rib lesions. Continuous IV morphine infusion; infusion rate has been increased several times. Pulse oximetry 89%. Patient is drowsy but constantly moans in pain. Next step?
a/ Continue morphine at the same dosage and reevaluate in 48 hours
b/ Increase morphine until adequate pain control is achieved
young woman with sudden-onset blurry vision, numbness & tingling in the legs. Stressed at school & worried about her mother’s health. 2 episodes of urinary incontinence. MRI shows multifocal, white matter, hyperintense T2 lesions in corpus callosum & periventricular area. Likely to develop?
a/ Dementia
b/ Depression
c/ Psychosis
A 30 year old woman, pregnant , 36 week gestation, SFH 32 weeks. Fetal parts palpable.Everything normal, regular follow up, cause of discrepancy
1. IUGR
2. Constitutional small baby
3. Renal agencies
4.Wrong dates
Lady 33 year, have body pain, and many point tenderness. Every test is normal. ANA, CRP, ESR etc. What is the best treatment.
1. Sertraline
2. Amitriptyline
3. Lorazepam
18 months old boy is brought due to developmental concerns. Does not walk independently. His older brother began walking at age 12 mths. Speaks in 2- to 3-word sentences & follow simple commands. Height, weight & head circumference track at the 20th percentile. Next step?
a/ Brain imaging
b/ Creatine kinase level
38-Old man, 70. With on and off constipation for 6 months. Now obstipation for 3 days. On xray, bowel is dilated, no gas in rectum, DRE normal. Cut off point at sigmoid. Diagnosis
1. Sigmoid cancer
2. Sigmoid volvulus
75 y old female. Post op day 5. Painless distension of abdomen. Rectal examination unremarkable. X- ray given. Looks like small bowel distention. Next management
1. NG tube and decompression
2. Rectal tube and decompression
3. Colonoscopy
Women 24. 2 children. 4 y and 8 months. Husband 26 y. comes asking for tubal ligation as she doesn’t want anymore kids. What’s the best advice
1. Husband should do vasectomy.
2. Tell her about other contraceptive methods.
3. Do tubal ligation
4. Tell her she should not do that
5. Tell her that its irreversible.
Trucker comes with bloating, diarrhoea and nausea. Had a similar episode 1 year back. Colonoscopy and other investigation at that time was all normal. What to do next.
1. Colonoscopy
2. FiOBT
3. Dietary advices
4. Stool for ova , parasite
Women comes with suddn onset chest pain. Left side lower chest dullness+. History of vomiting. BP 90/60. HR 100. What to do next
1. Gastrograffin
2. ECG
3. Echo
4. CXR
A man came, asking about prostate disease. He had symptoms of urgency and urinary obstruction. DRE was done. Moderately enlarged prostate was found. Next most appropriate
1. Tell him about pros and cons of test
2. Do psa (if he is >40YO and family with prostate CA)
3. Usg (if he is <40YO or without family with Prostate CA)
4. Ct scan abdomen
A 35 year old man, came from india, had joint pain, tenosynovitis, swollen joints. Have vesicular eruptions in arms. Diagnosis
1. Reactive arthritis
2. Gonococcal arthritis
A boy, 13 year. Knee pain. All examination normal. Tenderness over tibial tuberosity, range of movement normal. Diagnosis
1. Traction apophysitis (Osgood-Schlatter disease)
2. Pre patellar bursitis
3. Patellar tendonitis
Man comes for refuge camp health screen. He has taken one dose of albendazole before coming. Has eosinophilia. No other abnormality. Hasn’t mentioned about bowel symptoms. What next
-check for ova in stool (Schistosomiasis)
53yo man comes due to persistent fatigue. Started a therapeutic dose of fluoxetine 2 mths ago after being diagnosed with major depressive disorder. Medical history includes hypertension treated with enalapril. 4-kg weight gain over the past 2 mths. Appears depressed & speaks softly. Next step?
a/ Continue fluoxetine and add methylphenidate
b/ Discontinue fluoxetine and begin bupropion
34yo woman with worsening difficulty hearing, especially in the left ear. When environment is noisy, she can understand speech better than when in a quiet room. Hears ringing. Her mother had surgery for hearing loss in her 40s. A slight reddish hue behind the left tympanic membrane. Cause?
a/ Bony overgrowth of the ossicles
b/ Degeneration of neuronal cell bodies
30+ yo man comes due to lack of sexual desire & erectile dysfunction for 3 mths. Medical history is significant for opioid use disorder, for which he has been taking methadone for 2 yrs. Gained 4.5 kg over the past 6 mths. BMI is 24.5 kg/m2. Testes are small & soft. Cause?
a/ Klinefelter syndrome
b/ Medication adverse effect
teenage girl of short stature with height <3rd percentile & weight at 20th percentile. Not yet undergone menarche. A 2/6 systolic ejection murmur heard loudest in left infraclavicular area. Breast development is Tanner stage 1 & pubic hair development is Tanner stage 4. Present?
a/ High estrogen
b/ High FSH
c/ High inhibin A
middle age woman slipped & fell backward down half a flight of stairs. Has right-sided back & chest pain. X-ray reveals a minimally displaced, posterior fracture of the right sixth rib & bilateral basilar atelectasis. Essential for preventing pulmonary complications?
a/ Adequate analgesia
b/ Continuous positive airway pressure
middle woman is evaluated for fatigue & exertional dyspnea. Difficulty walking for more than 1 or 2 blocks without becoming short of breath. Significant for hyperlipidemia, hypertension & type 2 diabetes mellitus. BMI 55 . There is trace bilateral lower-extremity edema. Cause of dyspnea?
a/ Airway inflammation and bronchospasm
b/ Alveolar hypoventilation
4-yr-old boy is brought due to concerns about his vision. Born at 34 wks gestation & takes no daily medications. Visual acuity is 20/30 in the right eye. In the left eye, the patient is unable to see the visual acuity chart & is able to count fingers only at a close distance. Cause?
a/ Retinopathy of prematurity
b/ Uncorrected refractive error
middle age woman comes due to bloating, flatulence, abdominal cramps & explosive watery diarrhea. These symptoms occur after ingesting dairy products. Physical exam shows abdominal distention & borborygmi. Further investigation test results observed?
a/ Decreased stool osmotic gap
b/ Positive hydrogen breath test
man with history 6 mths ago, diagnosed with papillary thyroid cancer & underwent total thyroidectomy, followed by radioactive iodine treatment. Since then, takes levothyroxine. Significantly elevated serum thyroglobulin concentration compared with the previous level 6 mths ago. Explaination?
a/ Excessive thyroid hormone replacement
b/ Recurrence of the thyroid malignancy
5-mth-old girl is brought due to abnormal body movements started a mth ago.During exam, the patient suddenly flexes at the hips & elbows for approx 2 secs. Skin exam shows several hypopigmented, elliptical macules on the chest. The mother has similar lesions. Cause?
a/ Acoustic schwannoma
b/ Subependymal giant cell tumor
39-yr-old woman with worsening urinary symptoms. Diagnosed with multiple sclerosis 3 yrs ago. Has hypertension & glucocorticoid-induced hyperglycemia. Hyperreflexia of lower extremities & mild intention tremor. Scan reveals a contracted, small bladder. Cause?
a/ Obstruction of bladder outlet
b/ Overactivity of detrusor muscle
25-yr-old homeless man with a history of schizophrenia, destroyed a television set at a local electronics store & then became extremely agitated & violent. Given haloperidol, which calms him down. Physical exam shows a sustained contraction of his neck to the right side. Next step?
a/ Dantrolene
b/ Diphenhydramine
52-hr-old girl with abdominal distension. Loops of small bowel with paucity of air in large intestine & rectum. Left lateral decubitus view shows free air above liver & emergency laparotomy is performed. Thick, sticky stool evacuated from ileum & colon appears diffusely narrow. Risk?
a/ Bicuspid aortic valve
b/ Chronic rhinosinusitis
47-R/ hand thumb and index finger weakness. Improved when raising arm above head. Thenar muscle wasteing. Brachioradialis jerk normal. Diagnosis
1. Cervical radiculopathy
2. Carpal tunnel syndrome
3. Thoracic outlet obstruction
48-pt on atorvastatin, have myositis , ck and cr normal. Stop atrva. After repeat lipid profile TG rising. What drug to be start
a. No option of re start atovasta
b. Gemfibrozil
c. nicotinic acid,
d. eczematide,
e. pravastatin
49-Pt with erectile dysfuntion, depression, emphysema, HTN, MI, hevy smoking > 40, alcoholic. Most appropriate of mx
a. Sildenafil
b. Cease smoking
c. Cease alcohol
d. Increase dose of htn drug
50-A university student present for sick certificate that he missed exam yesterday due to muscle aches, headaches and fever starting last three days and he is now well. what will you do?
A. Decline the request as his illness is not confirmed
B. Decline the request as he is not present during the exam day
C. Confirm his illness from third party
D. Dating the certificate with today date
E. Dating the certificate with the exam date
51-Lady took olanzapine and stable with that, complain about wt gain what to give BMI 42
1.risperidone
2. Clozapine
3. Aripiprazole
4. Other antidepressants .
1 Refer to dietitian
2. Refer to endocrinologist
3. Advice exercise
52-Ptn coming with intense photophobia , painful red eye but pupils reacting normally.. diagnosis
Keratitis
53-. Mother brings her son who is not doing well in his studies.. he threatens her to harm her, going out of house, herd he talking to himself
Schizophrenia
24yo adult developing flu like symptoms and rashes over face neck trunk. Diagnosis ?
1. Measles
2. Rubella
3. Scarlet
Carotid stenosis 70% …carotid endartrectomy
*Baby 6 hs jaundice
Hemolytic anemia
Biliary atresia
*Pnt on parkinsonism medication levodopa still has eye glising and lip licking..
Increase dose of levodopa
Decrease dose of levodopa
>>better to decrease or stop anti-psychotic like haloperoild
Female failure to breastfeed
Pit necrosis
Asherman syndrome
Child on chart hight fall to 10% but wt is on 95%
Growth hormone ass
Pnt presented with jaundice with normal exam
Gilbert
Enlarge epididimis
E coli (if Young)
Chlamydia
Pnt diabetic has painless foot ulcer
Neuropathy
Infection
aaaa
Pnt pneumonia 10d medication still has symptoms
Un treated pneumonia
Pneumothorax 15%
aspiration
Nurse in rural area develop cough sweat xray upper rt consolidation
TB
Doctor infected with pnt not know his state Dr took all vaccination
counselling
Female wants to travel to see her mum but there is stress because of pandemic illness counselling her about hazards of travelling this days
Your collage asked for a tazepam to sleep will
Advice him to see his gp
6y came with headache…
Mri to ro malignancy
Which will be ..medulloblastoma
Difficulty of swallowing soil and then fluids
achasicia
Sigh of orbital floor fr
diplopia
Leg pain while walking
angiography
Pnt bhcg returned to normal after evacuating the mole noe came with amenorrhoea and bhcg is 600 …
Recurrent mole
New pregnancy
Snake bit kid no compression done 2 hours later he feels pian at site ..
No further investigation
Cbc
Pnt on antipsychotic develop restlessness can’t set in his place ..
Reduce the medication dose
Nurse didn’t give correct medication
incident form
Pain in buttocks
common iliac artery
Female has brusis and lip injury avoid eye contact ..what to examine
musculoskeletal
Pict of Duptrine contracture..ask for cause
alcohol
Spherocytpsis
parovirus
A 30 year old woman, pregnant , 36 week gestation, SFH 32 weeks. Fetal parts
palpable.Everything normal, regular follow up, cause of discrepancy
1. IUGR
2. Constitutional small baby
3. Renal agencies
4.Wrong dates
Ptn come with Schizophrenia, has a history of same treated by consultant
psychiatrist, but no documents. Upon repeated request of reports he is not
replying, what to do next..
Ask the patient to bring ask for the reports
40 year complaint of persistant chest pain for 24 hour medial to left nipple area.
otherwise all normal, ECG normal. Next
A. Exercise ECG
B. Repeat ECG and troponin
C. Ask him to go to GP if pain recurs
Patient treated with amoxicillin-clavulanate for bone? Severe? Infection for 14
days. After 3 day patient developed fever, maculopapular rash. What will you dx?
a- idiosyncriatic drug reaction
b- amoxicillin drug reaction
c- Ig E serology
Man previously well came in due to intermittent cough with chest tightness and
wheezing
This started when he Began to work in a horse camp.What is the most
appropriate initial diagnostic
A. Blood IgE level
B. Spirometry with bronchodilator
C. Skin allergy testing
Got an xray with coffee bean shaped colonic expansion.Stem talks about colonic
obstruction. Asking for definite management
A. Ng tube
B. Rectal tube
C. Colonoscopy
Agitated man confused , took by police, always keeping a knife with him
because he is believing that someone will kill him. He also took the knieve to
ED but he put it down in a safe place when the doctor request. He didnt not
give any history of his previous psychiatric or medical illness. What is the best
way to obtain collateral history for this patient?
Ask the police records
Ask about his illness for relatives
Wait for the patient until he stable
Ask for Guardianship board
Old man taking Temazapam , He came to GP for prescription of temazema.
He has to take 3 tabets of temazapam to fall asleep well. When he reduced the
dose , he can’t sleep well. What would you give him?
Give temazapam as he requested
Give Oxycodone
Sleep hygiene and relaxation
Reduce Tempazepam dose
Change to Diazepam and Wean slowly
3 yr old child, came for upper respiratory tract infection. duting physical
examination grade 2-3/6 Ejection Systolic murmur in left sternal border+.
What is your next action?
Refer for paediatric cardiologist
Review 2 weeks later
give amoxcillin
2.5 year boy can do which of the following?
A. Button his shirt
B. Kick a ball
C. Make a sentence with 4to 5 words
D. Copy n draw a ladder
64-yr-old woman with a neck lump. Significant for obesity, type 2 diabetes mellitus & nonalcoholic fatty liver disease. 2-cm, hard, nontender cervical lymph node close to the right submandibular gland. Mild hepatomegaly. Fine-needle aspiration reveals squamous cell carcinoma. Most helpful?
a/ Abdominal CT scan
b/ Colonoscopy
c/ Laryngopharyngoscopy
middle age presented to the ER, with complaint of seizure. diagnosed as a case of generalized tonic clonic seizures. He has a history of stroke and hypertension and takes warfarin and other drugs. What will be your best drug of choice for him?
a/ amiodarnone
b/ sodium valproate
c/ carbamazepine
d/ phenytoin
e/ topiramate
Plain radiography is the most common first-line radiological investigation for underlying osteomyelitis
Magnetic resonance imaging is the best imaging modality to diagnose osteomyelitis
Boy with hereditary spherocytosis. What are the chances of his siblings to get
the disease.
1. 25% of sibling will have the disease
2. 50% of the siblings will have the disease
woman of some age with sudden buttock pain , radiation to foot. What clinical
symptoms do u expect?
-Weakness extension of knee
-Loss of sensation of lateral thigh
-Loss of sensation medial aspect of thigh
-loss of ankle reflex
-loss of knee reflex
old lady came with persistent pain at back of left eye and headache. Apart from
proptosis, ESR -65, no loss of vision was seen. Dx?
-retrobulbar tumor
-temporal arteritis
snakebite , adult male from rural area . Big black? Brown? Snake, even though
they search couldn’t find . No bite marks,but lateral thigh laceration , pt stable.
Management?
a) antivenom
b) swab from wound
c) send home
d)reassure
female 1st trimester. Trying to stop smoking. How will you help
Nicotine patch
Bupripione
elderly-old man is agitated & confused after surgery for a right hip fracture. History of mild cognitive impairment, hypertension, gout & benign prostatic hyperplasia. Faint mid-systolic murmur heard over the left sternal border. Lower abdomen is tender & palpation exacerbates the agitation. Next step?
a/ Abdominal x-rays
b/ Bladder ultrasound
boy is brought due to right knee swelling after a fall. Last wk he fell & developed a large bruise to his left hip. Pain with knee movement & limited range of motion. Scattered ecchymoses to the anterior shins. Radiograph of the right knee shows a large effusion. Next step?
a/ Bone marrow evaluation
b/ Coagulation studies
Woman came for leision on her vulva ( i am not sure she is pregnant or not) ,
then you took viral swab tests and syphilis serology. Then the patient loss
follow up for 1 month. Then she came back again and there are no more
vulval leision, Her sypyllis Ab you previously done show RPR -1:64, What is
your next action
IM Benzythinepenicillin now
Inform health authority
Trace her pervious partner
Reassure
6 year old child, concerned by the teacher that she is not cooperating well in
class and not talking with other friends, eat lunch in recess alone. But her
school records in school grades are Okay. She has some anxiety when she have
to go for school. She is normal at home and talk with relatives normally too.
Asked for Dx?
Separation Anxiety Disorder
Selective Mutism
woman has done chorionic villus sampling at 12 weeks for which the USG
show nuchal translusancy, the results show 46XY. What is your next action?
Termination of Preg
Amniocentesis at 16 weeks
USG again at tertiary hospital with special (maternal care or sth?) unit
Continue Normal Antenatal Care
14-foot ulcer in a diabetic patient, picture given, what’s the next step in management
after antibiotics started
swab and send for culture
Boy with hereditary spherocytosis. What are the chances of his siblings to get
the disease.
1. 25% of sibling will have the disease
2. 50% of the siblings will have the disease
xray
other
19yo gravida 2 para 1, at 38 wks gestation comes due to severe abdominal pain & vaginal bleeding. Prior pregnancy is cesarean delivery at 24 wks gestation for placental abruption. Uses cocaine multiple times a wk. FHT shows multiple prolonged decelerations to 100/min. Risk factors?
a/ Maternal age
b/ Prior uterine surgery
Antipsychotic with lower metabolic profile
Smoking cessation treatment option in first trimester
Middle aged lady presented with headache 10 days after covid 19 vaccine. Normal neurological findings. Investigation of choice?
Management for primary spontaneous pneumothorax of 15%. Patient is otherwise clinically stable.