AMC MCQ Recalls OCTOBER 2021

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With the COVID-19 vaccination rollout in late February, 2021, we have finally achieved up to >50% of Australian population from being fully vaccinate. We sincerely hope that all candidates have already completed their Covid vaccination. Being fully vaccinated against Covid protects you from getting severe disease, yes, but it doesn’t completely protect you from getting Covid.

A big 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 OCTOBER 2021 compilation

1) Malaysian student,uni student ,his gf went back to attend dad’s funeral now this guy become restless ,irritable and cant sleep and complains that his gf talking behind his back
A/ Suspicious cannabis (amphetamines would be best)
B/ Grief reaction
C/ Panic psychosis
D/ Reactive psychosis
E/ Onset of schizo…

2) Breast carcinoma stage Q, nipple discharge, orange peel? ….. T1, T2, T3,T4?

3) Pt C/O diplopia, headache, pic with red eyes, Rt looking straight & normal , Lt eye looking down to the nasal. What is the affected nerve? …… Rt CN3?

4) 60 yrs pt C/O IO Sx, vomiting, constipation, very tender abdo, chest x-ray was given (looks normal..?) Dx? ……..

5) 16 yrs old girl comes with here mum. Her mum against vaccination, what to do?…… talk to the girl about vaccination

6) A nurse not given the right dose to the pt (she gave the pt 3 doses instead of 5 doses). What to do?
A/ Talke to the nurse
B/ Report to hospital
C/ Report to APPRA

7) Pt on SSRI C/O tiredness, irritability, u gave the pt tramadol, pt come back with hyperreflexia, hypertension. Dx? …… serotonin syndrome

8) Lithium cut off pont?…….. 2.5

9) 20 yr old pt with bipolar, on lithium, C/O core tremor, agitation, Dx? …. Lithium toxicity

10) 30 yrs old female, come regularly to u C/O iredness, fatigability, blurring of vision, vision dropped in one of her eye from last visit?
A/ Multiple sclerosis
B/ Myasthenia gravis

11) 28-yr old woman complains of a yr-long history of fatigue & leg pain, unrelated to exertion. During college, she received supportive counseling for 2 mths after being raped. She drinks 1 or 2 glasses of wine or smokes marijuana most evenings. Family history is significant for bipolar disorder. Cause?
a/ Family history of bipolar disorder
b/ History of alcohol and drug use
c/ History of sexual trauma

12) A Dr want to do screening about the cause of increase blindness in his area. What should he screen?
a/ glaucoma
b/ DM
c/ Trichomoniasis

13) 57-yr-old woman complains of vaginal pruritus, pain with urination & increased urinary frequency. Suffers some pain with intercourse. Has poorly controlled type 2 diabetes mellitus. Vagina appears pale, dry & has multiple areas of petechiae. Next step?
a/ Oral metronidazole
b/ Oral nitrofurantoin
c/ Vaginal estrogen cream

14) 26 yrs girl C/O weakness & burning sensation in bilateral arm, examination of lower limps are normal, Dx? …… syringomyelia

15) Ct of brain shows black colour lesion, pt C/O headache, tingling in half of his face & weakness in half of his body, for 3 hrs. Tx?
a/ Asprin
b/ warfarin
c/ TPA ……black lesion = ischemic Stroke

16) 27-yr-old woman complains of palpitations & dyspnea on exertion. A 3/6 ejection-type systolic murmur is heard along the left sternal border & decreases in intensity when the patient moves from a standing to a squatting position. Additional info required?
a/ Family history
b/ Intravenous substance use

17) 37-yr-old woman has severe abdominal pain that started several hrs ago. Sexually active with her boyfriend. Lower abdominal quadrants tender on palpation with mild guarding. Bowel sounds are diminished. Next step?
a/ Abdominal CT scan
b/ Diagnostic peritoneal lavage
c/ Pregnancy test

18) 65-yr-old man comes due to recurrent falls. Has type 2 diabetes mellitus & hypertension. Drinks 1 or 2 beers daily. Exam shows decreased proprioception & vibration sense in the feet. Ankle jerk reflexes are absent. Bilateral hammer toe deformities are present. Cause?
a/ Axonopathy of large nerve fibers
b/ Axonopathy of small nerve fibers

19) Pt C/O light heandness, dozznis, ECG pic? ….. AF ( irregular puls, narrow QRS)
Ipsilateral vision loss for few sec, headache, cheek numbness, initial Ix?
a/ Brain CT
b/ ESR

20) Pt come to ER, lab shows… Na = 121, K = 6.5, gluscose = 20 mmol. Tx? ….. DKA Q …IV fluid (N.S)

21) Pt com from indonisa, C/O abdo pain, has ictris (juandce), liver enzymes are very high +++, bilirubin very high = 85, Dx?
a/ Malaria
b/ HAV
c/ HBV

22) The parents of a 16-yr-old boy concerned about their son’s behavior. Has been more distant & grades have dropped over the past 2 mths. The parents ask if the physician can order a urine drug test without their son’s knowledge. Response?
a/ U should try to have an open conversation with your son before requesting a drug test.
b/ Im concerned your son may be depressed; do you think he would be open to meeting with a chanselor?”
c/ Substance use issues can often be uncovered through conversation alone; can you tell me more about the changes you’ve noticed?

23) A new screening test was devised to detect pancreatic cancer at early stages using a serum marker (CA19-9) of the disease. Test showed that its use prolongs the survival of patients with pancreatic cancer by several mths. Potential problem?
a/ Observer’s bias
b/ Measurement bias
c/ Lead-time bias

24) Pt with past H/O cough, headache, u ordered CXR & given a pic with his leg shows large raised red nodule around 5 cm on the shaft of his leg/ ankle. Most imp appropriate nex step to reach Dx?
a/ Chest CT
b/ Brain MRI
c/ Skin biopsy

  • b – I think it is sarcoidosis…… skin biopsy to look for caseating granuloma)

25) Prostate Q, pt C/O dysuria, frequency, regency & his Sxs are not improving with Tx. He come back to u as his friend told him he can do surgery, what is the complication of the surgery?
a/ Necrosis
b/ Urethral stenosis
c/ Meatal retrograde …..

26) 4 yr kid, has asthma on SABA, prednisolone for long time, 2 X-ray was given one with straight legs, sec with open leg, no pain, what do u see?
a/ Necrosis of bone
b/ Osteomalasia
c/ Sign of short leg

27) Pt come from overseas, C/O fever 38.2 c, headac, malaise, runny nose, lab with normal liver enzyms, bilirubin increased, Alkaline phosphatase (ALP) increased.

28) 29-yr-old woman comes with mild fatigue & nausea. She has no chronic medical conditions, and her only medications are a daily probiotic and prenatal vitamin. She exercises daily, alternating between running & weight training. Drinks decaffeinated coffee with breakfast has ginger tea throughout the day to help relieve nausea. She prefers a diet rich in vegetables & fish. US shows a 7-wk intrauterine fetal pole with cardiac motion. Which of the following part of this patient’s history requires further evaluation?
a/ Caffeine intake
b/ Exercise routine
c/ Fish intake
d/ Ginger intake
e/ Probiotic regime

29) A prospective cohort study revealed a strong positive association between smoking & liver cirrhosis. Cohort then divided into 2 groups: alcohol consumers & non-consumers. Result: no association between smoking & liver cirrhosis with either group. Scenario above is an example of?
a/ Selection bias
b/ Observer’s bias
c/ Confounding

30) 17-yr-old girl is thinking about having sex for the first time. In a relationship for 6 months. Has fantasies often about having sex with her boyfriend & masturbates 4 or 5 times a wk. Response?
a/ We should talk about ways to protect yourself from STI
b/ Having sex is big decision, have you discuss with your parents?
c/ Wondering about when to have sex is very normal; what questions do you have about sex and your body?

31) Autopsy is performed on an 11-wk-old girl found unresponsive in her bassinet after a nap. Received vaccinations 3 wks ago including DTPa. Recently had congestion, rhinorrhea & fever for 3 days but had no symptoms for the past week. Autopsy is inconclusive. Possible cause?
a/ Position of the infant while sleeping
b/ Reaction to vaccinations

32) 14 yr old boy trouble maker, steal objects from school, has thin lips, smooth philtrum, his mother drink alcolo sinse she was 15 yrs, Dx?
a/ Alcohol syndrome
b/ conduct disorder

33) 38 male alcoholic, drik 3 cups/ day, health is good, come for checup for insurance. what in the Hx indicates that drinking alcohol has affected him? ….. memory gap in his talking (confabulation)

34) 24-yr-old primigravida comes for her first prenatal visit. Has a history of intravenous heroin use but stopped when diagnosed with HIV infection last year. Started combination antiretroviral therapy last year but stopped taking her medications 2 wks ago when she found out she was pregnant. Next step?
a/ Combination antiretroviral therapy starting immediately
b/ Combination antiretroviral therapy starting in the third trimester

35) 16-yr-old girl comes for emergency contraception after unprotected sexual intercourse last night. Urine pregnancy test is negative. She asks for a pill option & that her parents not be notified about this visit. Next step?
a/ Obtain parental consent prior to providing emergency contraception
b/ Prescribe misoprostol pills
c/ Provide levonorgestrel pill

36) They ve asked about jellyfish in qweensland. Don’t know the stem? (similar question seen in mplus)
a/ hot water immersion
b/ wash with vinegar

37) Pt C/O diplopia, headache, pic with red eyes, Rt eye looking straight & normal but the Lt eye looking down to the nasal, ptosis. What is the affected nerve?
a/ Rt CN3
b/ Lt CN3
c/ Rt CN6
d/ Lt CN6
ans d? CN3 will look Out gaze..???

38) Biostatistic for wound infection
Anti biotic not given
4%. 96%
Antibiotic given
2%. 98%
Asking abt reduction rate?
a/ 1%
b/ 2%
c/ 50%
ARR…. 4 -2 = 2%……???

39) Biostatistic for wound infection
Anti biotic not given
4%. 96%
Antibiotic given
2%. 98%
Asking about number needed to treat (NNT)?
a/ 1
b/ 2
c/ 50
d/ 25
…. RR = 2 NNT= 1/ARR NNT = 100/2 = 50 ….???

40) Young pt come for cheek up, have icteric, increase bilirubin, not symptomatic, Dx? ………. gilbert syndrome

41) Pt with IO Sx, given x ray showing omega shape, Dx? …… sigmoid volvus

42) Pt has HTN, DM, gout, on Furosemide 20 mg, ACEI 20 mg, amlodipine?
a/ Furosemide 80 mg
b/ ACEI 40 mg
c/ Tinolol
c — beta blocker

43) Pt with cough for long time, not improving, CXR shows white circle surrounded with black color, Dx? ……. Lung abscess

44) Pt with dupuytren contracture, initial Tx?
a/ Physiotherapy
b/ Cortison
c/ Surgery

45) Child with bilateral basal crackles, SOB, fever 40 C, Dx?
a/ Pneumonia
b/ Croup
c/ Epilogititis

46) Runner, heavy exercise, now C/O pain at the lateral aspect of the thigh, what is the cause? ….. iliotibial ligament pain
47) Pt fall from high place, tender foot, X-ray normal, Dx? ….. stress #

48) 63 yrs pt, nodule &deformities of the hand, H/O chronic renal disease. What drug should not be given to him?
a/ Hydroxychlo
b/ Methotrexate

49) 70-yr-old woman is brought due to 2 days of fever, cough & a day of excessive somnolence. Has a history of hypertension & osteoarthritis. X-ray reveals a right lower lobe infiltrate. Cause?
a/ Anaerobic bacteria
b/ Haemophilus influenzae
c/ Streptococcus pneumoniae

50) 24-yr-old primigravida comes for her first prenatal visit. Has a history of intravenous heroin use but stopped when diagnosed with HIV infection last year. Started combination antiretroviral therapy last year but stopped taking her medications 2 wks ago when she found out she was pregnant. Next step?
a/ Combination antiretroviral therapy starting immediately
b/ Combination antiretroviral therapy starting in the third trimester

51) 16-yr-old girl comes for emergency contraception after unprotected sexual intercourse last night. Urine pregnancy test is negative. She asks for a pill option & that her parents not be notified about this visit. Next step?
a/ Obtain parental consent prior to providing emergency contraception
b/ Prescribe misoprostol pills
c/ Provide levonorgestrel pill

52) 84-yr-old man is brought due to severe left-sided flank pain & nausea. Has hypertension, dyslipidemia, sigmoid diverticulosis & a transient ischemic attack 5 yrs ago. Peripheral pulses are decreased. Diagnosis?
a/ Abdominal aortic aneurysm rupture
b/ Acute pyelonephritis

53) 23-yr-old woman comes with fever & dysuria. Has a pruritic, erythematous vulvar rash. Sexually active with one partner. Several tender, ulcerated lesions with circular borders on the inside of the left labia minora. Left inguinal lymph nodes are enlarged & tender. Diagnosis?
a/ Gram stain and culture of lesion for Haemophilus ducreyi
b/ KOH wet mount microscopy for Candida albicans
c/ Viral culture of lesion for herpes simplex virus

54) 73-yr-old man comes with right anterior thigh pain that is worse with walking. Has stable angina, hypertension, hypercholesterolemia & COPD. Smokes 2 packs a day. A small pulsatile mass in the right groin area. Diagnosis?
a/ Femoral vein aneurysm
b/ Femoral artery aneurysm

55) 45-yr-old man was diagnosed with diabetes mellitus 5 years ago & has maintained good control most of that time. 6 mths ago has a hypoglycemic seizure. Glucose readings over 200 mg/dL frequently since. Has chronic pancreatitis related to excessive alcohol use. Appropriate statement?
a/ Heavy alcohol use can cause high blood glucose. I am concerned that you might be drinking excessively again.
b/ It is normal for diabetes to worsen over time. Increasing insulin dose should get your blood sugar back to normal.
c/ Some people who have experienced frighteningly low blood glucose often reduce their insulin dose. Do you think this is happening with you?

56) 45y healthy male, awaiting Laparoscopic fundoplication for chronic gastritis. Past hx of DVT in teens. Already on mechanical thromboprophylaxis. Additional measures
a/ No more actions needed
b/ LMWH before surgery until discharge
c/ LMWH after surgery until discharge
d/ Dagibatran for 14 days

58) Picture of molluscum contagiosum, other options given HSV, Varicella

59) Patient received 1st dose of Covid vaccine (wildtype) 1 week ago and had mild fever that night, which later settled. Now presenting with fever headache cough shortness of breath, SpO2 93% bilateral crackles. Diagnosis?
a/ SARS-COV2 (wildtype) infection
b/ SARS-COV2 (variant) infection
c/ Delayed hypersensitivity

60) Patient on warfarin, complaining of RIF pain, CECT Abd given, looks like a rectus sheath harmatoma. Management

61) COVID viral pandemic in 3 countires. Cummulative case graph is given. Country A fail to implement appropriate measure early. What does country B graph show?
a/ graph A has highest case, B in middle then C last
b/ more death rate than C
c/ delay in social distance
d/ new viral strain
e/ group B was not wearing masks

62) A man got vaccination for SARS cov2, 2 weeks ago, first dose, now in his town there are cases with SARS cov2. Now he has fever, headache, dry cough and crackles bilateral of 3 days of evolution.
a/ side effects of SARS cov2 vaccination
b/ infection for SARS cov2 (actual genotype in community)
c/ community-acquired pneumonia
d/ aspergillosis

63) Patient on aspirin, ramipril, atorvastatin for long term management of chronic conditions, started on Amoxocillin 2 days ago, coming with tongue swelling and bronchospasm. Most likely inciting agent?
a/ Ramipril
b/ Amoxicillin
c/ Aspirin
d/ Atorvastatin

64) CXR abdomen given. Old lady who had undergone appendicextomy long back, now having a history of constipation coming with features of bowel obstruction. Diagnosis
Fecal impaction

65) Old man having constipation for a week, now absolute constipation for 2 days and abdominal pain and distension. DRE rectum empty. Xray shows dilatation of ascending transverse and descending colon, and collapsed rectum. Diagnosis
?sigmoid CA

66) ECG of Atrial fibrillation, to diagnose

67) Lady with atypical chest pain for 2 days, Now settled. CXR Trop in 12 hours all normal.
ECG given – no abnormalities.

68) 16 year old soccer player, with a history if asthma on fluticasone since childhood, having a right sided tender gynaecomastia. Most probable cause
a/ Anabolic steroid
b/ Fluticasone
c/ physiological

69) Lichen sclerosis management

70) Man with haematuria and recurrent loin pain, hypercalcaemia, CXR bilateral hilar shadows. Investigation?
a/ ACE levels
b/ CT chest

71) Obese child with bronchial asthma on long term steroids. Complaining of bilateral hip pain. Afebrile. Xray hip given in frog leg view and AP, most significant complication
a/ Avascular necrosis of femur head
b/ Limb shortening
c/ Osteomyelitis

72) Old lady with a history of polymyalgia rheumatica was treated with prednisolone for 12 months some time back. DEXA before that was normal. Has back pain and tenderness over lumbar vertebrae, Xray shows #. Already on high calcium diet, Vit D levels are normal. most appt management
a/ Alendronate
b/ Calcium supplements
c/ Vit D supplements

73) Registrar asks junior doctor to draw additional blood from patients admitted to a ward to increase sample size. Response
a/ Refuse
b/ Discuss with ethics committee
c/ Discuss with consultant
d/ Get consent from patient before drawing blood

74) Bladder CA, muscle invasion present but no mets, management

75) Most appropriate contraception for a woman with Factor V Leiden deficiency

76) Returned traveller from Thailand, abdominal pain, blood and mucus diarrhoea, most likely cause
b/ Shigella
c/ Entamoeba histolytica

77) Tetanus – no history of vaccination, dirty wound, Managemrnt

78) Patient with malignant melanoma, having multiple brain mets, nausea and vomiting, management
a/ Ondansetron
b/ Metoclopramide
c/ Dexamethasone

79) NCCT brain of an infarction, onset 3 hours ago, most appropriate management

80) 56-yr-old man was admitted with descending aortic dissection at the left subclavian artery takeoff & extending to the iliac arteries. B/P 240/130. IV labetalol & nitroprusside are initiated. Unable to sense touch, pain or move the lower extremities, but vibration sensation is intact. Cause?
a/ Carotid artery occlusion
b/ Global cerebral hypoperfusion
c/ Thoracic spinal cord ischemia

81) 5-hr-old girl was born at 40 weeks gestation by vacuum-assisted vaginal delivery. A small area of scalp edema shows. Palpation of the left clavicular bone reveals crepitus. Passive movement of the left upper extremity elicits crying. Moro reflex is decreased on the left. Next step?
a/ Administer aspirin for analgesia
b/ Closed reduction using traction
c/ Reassurance and gentle handling

82) 3-yr-old boy is brought for fever, cough & worsening shortness of breath. Just recovered from prolonged diarrhea due to Giardia infection. Has recurrent ear infections & lobar pneumonia. Small tonsils & crackles in the lower lobe of the right lung. Weight is at the 40th percentile. Cause? Something about x-linked agammaglobulinemia (small tonsil & recurrent infection)
a/ Abnormal B-lymphocyte maturation
b/ Adenosine deaminase deficiency

83) 28-yr-old 4th-year medical student is brought by 3 security officers after causing a disturbance in the medical director’s office for not taking his “medical discovery” seriously. Has “endless energy”, difficulty focusing & becomes irritable & hostile. Significant for depression at age 19. Medication?
a/ Bupropion
b/ Haloperidol
c/ Valproate

84) 34-yr-old woman was in a motor vehicle collision last week. CT scan showed a markedly enlarged uterus with multiple intramural & pedunculated leiomyomata that did not compress the ureters or surrounding bowel. Next step?
a/ Combination oral contraceptive pills
b/ GnRH agonist therapy
c/ Observation and reassurance only

85) 55-yr-old man comes for follow-up of hypertension. Diagnosed with hypertension 3 mths ago. His current medications include aspirin, lisinopril & low-dose hydrochlorothiazide. Cardiac exam shows a 4th heart sound on auscultation. Diagnosis?
a/ Malignant hypertension
b/ Primary hyperaldosteronism

86) 22-yr-old primigravida at 34 wks gestation is brought due to sudden loss of consciousness followed by generalized shaking. Paramedics initiated an IV magnesium sulfate bolus. Has blurry vision, headache, muscle pain & sore joints & unable to move her right arm. Urinalysis 3+ protein. Cause?
a/ Anterior shoulder dislocation
b/ Magnesium toxicity
c/ Posterior shoulder dislocation

87) 17-yr-old boy went through a change in behavior after his girlfriend ended their relationship. He spends most of his time in his room & has trouble falling asleep. Has suicidal thoughts about hanging himself. Action?
a/ Encourage the patient to inform his parents and refer them for family therapy to facilitate the discussion
b/ Explain the need for breaking confidentiality and hospitalize the patient if his parents give consent
c/ Inform the parents about the patient’s suicidal thoughts and hospitalize him immediately with or without parental consent

88) 39-yr-old woman has persistent right-sided breast pain for the past 2 mths. Her last menstrual period was 2 wks ago. Paternal cousin has breast cancer at age 58. There is dense breast tissue bilaterally. The right breast has localized tenderness. Next step?
a/ BRCA testing
b/ Breast imaging

89) Breast CA mets to bone management?

90) SCAFE complication

91) CV line complication

92) H/O DnC 12 months back, now amenorrhoea for 8 months, inv?
A. Fsh, LH
B. Usg
C. B hcg

93) Rh mother 2nd PG, anti D in blood, cause? fetomaternal mix
Previous blood transfusion

94) Occipital headache, renal bruit, Cause?ADPKD?

95) 3 month ear pain, DM pt, Polyp like growth in external ear, Next inv?
a/ Ct temporal bone
b/ Ear swab

96) 2 Yr baby, URTI, his, 2 weeks after a Swelling over thyroid. Inv
a/ usg
b/ ct scan of neck
c/ fnac

97) Middle age pt wid and pain and gradual distension for 7 days. H/O appendicectomy 10 years back. Rectum empty. 2 days absolute constipation. Dx
a/ CA caecum
b/ Adhesion

98) 70 Yr, 90 kg, upper abd Swelling while coughing or straining. Diagnosis? a/ Rectal diverication
b/ Epigastric hernia

99) Child with abd pain when father not at home…
a/ Anxiety disorder
b/ Seperation anxiety

100) 2 ques on OCD and OCPD

101) Senerio of Internet gaming disorder

102) Hiking, multiple sexual partner, multiple joint swelling and knee effusion.
a/ Chlamydia PCR
b/ RA
c/ can’t remember

103) Bladder CA management

104) Ramsey hunt Syndrome management

105) Cervical ectropion, last pap 18 months ago what to do next.
a/ Colposcopy
b/ HPV test
c/ Co test.

106) 35-yr-old woman rescued from inside a burning building by firefighters. Had a brief tonic-clonic seizure en route to hospital. She is confused & mildly agitated. There are symmetric breath sounds bilaterally with scattered end-expiratory wheezes. Treatment?
a/ 50% dextrose with thiamine
b/ 100% oxygen with facemask

107) 46-yr-old man with HIV 10 has episodes of pneumocystis pneumonia, cryptococcal meningitis & oropharyngeal candidiasis. Treated with several different antiretroviral combinations. Loss of sensation to touch, pain & temp over the distal legs & feet bilaterally. CD4 count is 180. Treatment?
a/ Acetaminophen-hydrocodone
b/ Gabapentin

108) 21-yr-old man complains of a rash, more noticeable over the summer. Works as a lifeguard at a hotel swimming pool & has had “5 or 6” sexual partners in the last yr. Exam shows scattered macules across the shoulders, chest & upper back. Treatment?
a/ Corticosteroid ointment
b/ Intramuscular penicillin G
c/ Selenium sulfide lotion

109) 23-yr-old woman has skin concerns over her nose. Applies concealer & touches up her makeup throughout the day. Skin exam shows pores of minimal size; no acne or scarring is visible. Most appropriate statement?
a/ Forget the exact sentence… something like telling about nasal skin can be a problem for lots of people; has anything u’ve tried in the past been helpful for ur skin?”
b/ You have concerns about how your nose appears; if we were to ask other people about your nose, what would they say? – exact same wordings (I think this is the correct answer)

110) 29-yr-old woman comes with chest pain & dyspnea for 10 days. Has a normal spontaneous vaginal delivery 3 mths ago, after which she has had frequent episodes of dark, bloody vaginal discharge. Chest x-rays reveal multiple bilateral infiltrates of various shapes. Next step?
a/ CT scan of the chest
b/ Echocardiogram
c/ Quantitative β-hCG test (TRO chorio CA)

111) 4-mth-old girl is brought after a seizure. Limited prenatal care & polysubstance use disorder. Ht & wt at 25th percentile & head at 97th percentile. Acute & chronic retinal inflammation. Abdomen is soft with moderate hepatosplenomegaly. Cause?
a/ Child abuse
b/ Intracranial tumor
c/ Intrauterine infection

112) 17-yr-old girl comes due to worsening acne. Has scattered papules & pustules with mild-to-moderate redness on the cheeks. Using topical tazarotene & benzoyl peroxide for 2 mths without improvement. Sexually active. Next step?
a/ Add oral spironolactone
b/ Add topical clindamycin

113) 3-wk-old neonate is brought with a facial rash. 3 days ago, the rash started as small bumps on the forehead, spreading to entire face. Unbothered by the rash & has continued to take 3 ounces of formula every 2-3 hrs. Patient is awake & alert. Given picture. Next step?
a/ Daily cleansing with soap and water
b/ Frequent application of emollient

114) A study was conducted to assess the association between hormone replacement therapy (HRT) in post-menopausal women & the level of serum C-reactive protein (CRP), categorized as “high” or “normal” based on predefined values. Method to assess association between HRT & CRP levels?
CRP high CRP normal Total
HRT 32 41 73 (random numbers given by me, but sth like this)
No HRT 28 49 77
Total 60 90 150

a/ Correlation analysis
b/ Two-sample t-test
c/ Chi-square test (think this is the answer) – comparing the proportions of a categorized outcome with a qualitative independent variable and a qualitative dependent variable.

115) 19-yr-old nulligravid woman is concerned about having gained 4.5 kg over the last yr & believes it is related to her oral contraceptive pills. Her partner use condoms inconsistently. BMI 27. Advice?
a/ Discontinue oral contraceptive pills (OCPs) and start nonsteroidal anti-inflammatory drugs
b/ Reassure that the weight gain is not related to combined OCPs

116) 26-yr-old primigravid woman at 25 weeks gestation comes due to preterm labor. On sterile speculum exam, the cervix is visibly 2 cm dilated. Contractions occur every 2-3 min on tocodynamometry. Patient is administered indomethacin for tocolysis. Intervention increases risk for?
a/ Gestational diabetes mellitus
b/ Intraamniotic infection
c/ Oligohydramnios

117) 40 weeks of pregnancy,come to labor,her labor was progressed,had cervical dilation ,amniotic sac perforated,there is a problem occured , decide to do emergent C/s ,Why this decision was made ?
a/ cervical dilation
b/ partogram
c/ CTG

118) 6 year old boy after urti presents with hematuria 1+,after 2 weeks UA nl (no rbc,no nitrite),what’s the cause?
a/ UTI
b/ igA nephropathy
c/ Nl reaction to urti

119) 45y lady trauma to perinea in bath tub . Very large vulvar hematoma . what is next step?( sure cross match is not in options )
a/ FBC
b/ Perineal sono
c/ Pelvic CT
d/ Retrograde uretrogram

120) Blunt Chest trauma ,young man( long scenario ), hemopneumothorax,after insertion chest tube 1800cc blood drain ,1 lit NS received,Bp:120,next step?
a/ transfusion 2 Unit O negative blood
b/ thoracotomy
(No option cross match)

121) An old woman about 10 years after menopause,presents with cc itching vulve,never get HRT,there is erythema in vulva,lab data including bs are Nl, diagnosis?
a/ atrophic vaginitis
b/ lichen sclerosis
c/ atopic dermatitis

122) 65 years old woman ,her menupose 10 years ago,presents with dysuria , frequency,never get HRT,in her phex ant labias had fusion ,UA:nl,Tx?
a/ HRt
b/ hydrocortisone cream
c/ estrogen cream

123) A 75 y/o woman came with cc of a pain in groin area from 6 month ago,this pain wake her up in middle of the night, increased after 200 m walking ,in phex there is a mass located under inguinal canal and medial to femoral artery, it’s not tender and gets visible only during walking. On p/e : extremely decreased range of motion in internal rotation of hip and painful flexion of hip.What’s the cause of her pain?
a/ indirect ingulinal hernia
b/ direct ingulinal hernia
c/ femoral hernia
d/ OA of hip

124) You are treating a person who had minor trauma in the emergency department and the person
you are treating is a celebrity. One of visitors of another patient took a picture of that
celebrity in his smartphone. What is the correct response by you?
a/ Talk to celebrity patient and do as instructed.
b/ Talk to visitor and demand to delete pic.
c/ Take advice from emergency department head.
d/ Take help from hospital security
e/ Inform police

125) 2-yr-old boy’s parents concerned he is not as talkative as his twin sister. When the physician approaches, he runs to hide behind his father & initially refuses to cooperate or make eye contact. When mother helps him onto the exam table, he pushes her away & says, “Me do.” Diagnosis?
a/ Autism spectrum disorder
b/ Cognitive delay
c/ Normal development

126) 38-yr-old woman complains of pain & tingling in her hands. Works as a telemarketer & having difficulty holding the phone. BMI is 32. Numbness in the thumb, index & middle fingers of both hands. The skin appears doughy & dry at both elbows. Mild edema in both ankles. Cause?
a/ Amyloid accumulation
b/ Calcium phosphate deposits
c/ Mucinous infiltration

127) A lady who doesn’t speak English is diagnosed with cancer, son requests not to disclose the diagnosis to the mother. What would you do
a/ Explore patient’s wishes
b/ Tell the son diagnosis cannot be withheld
c/ Tell the patient in front of her son
d/ Agree to son’s wishes

128) Image of Dacrocytitis, management
a/ IV Flucloxacillin
b/ Warm compresses
c/ Incision and drainage
d/ Aspiration
e/ Excision

129) Homeless man, brought in drowsy with fever, cough. CXR shows a right apical lesion with air fluid levels. Management

130) History suggestive of bronchiectasis, coming with purulent cough and fever, most appropriate antibiotic
Ticarcillin Clavulanate

Other topics:
Nenonatal jaundice
Essential thrombocythaemia
Cervical ectropion
Asherman syndrome

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