Many had their exam postponed due to recent surge in Covid-19 cases. However, some still managed to sit for their 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 for you. You may get them from here.
Australian Medical Council (AMC) MCQ Recalls SEPTEMBER 2021 compilation
- Middle aged woman with painless lump in breast. P/E well circumscribed, round, 3 cm mass. On USG hypoechoic. Dx?
A) Fibroadenoma
B) Ca
C) Breast Cyst
D) Cystosarcoma Phylloids - Pt k/c/o CHF. MI 2 years ago… 3 DES 3 months ago.. So many labs given but I remember 127 Na+, 3 K+, Creat clearance 70(Normal >90), FBS 5.7(Normal 5.1). Pt on multiple drugs(atorvas,perindopril,indapamide,aspirin,clopid, etc) what next?
A) Continue current rx
B) Add metformin
C) halves the dose of atorvas
D) Change atorvas to rosuvastatin
E) Change perindopril/Indapamide to perindopril/amlodipine - Pt with epigastric pain, no radiation. Abdominal fullness following meal and eventually anorexia. H/o cholecystectomy due to gallstone induced pancreatitis 2 months ago. Next inv?
A) ERCP
B) Ct abdo
C) Endoscopic Ultrasound
D) Angiography - Pt with profuse rectal bleeding. Low BP, Tachycardia. After resuscitation, Uper GI endoscopy done which reveals nothing. Next?
A) Abdo Angiography
B) Rbc nuclear scintigraphy
C) Colonoscopy following colonic lavage - Pt with 4mm pupil dia in lt eye. 5mm in rt eye. Direct light reflex absent in rt eye. Present in lt eye. Inv?
A)CT head
B) MRI brain
C) Cerebral angiogram
D) ESR - 24-yr-old woman in a motor vehicle collision is infused 1 L of crystalloid. B/P 80/50, pulse 138 & respirations 24. Chest x-ray reveals a right hemothorax. A right chest tube is placed & 1.5 L of blood is returned. Next step?
a) Administer an additional liter of crystalloid
b) Administer a vasopressor
c) Transfuse group O, Rh D-negative packed red blood cells - 7-mth-old boy is brought with persistent bilious vomiting for the past 6 hours. His last bowel movement was 24 hours ago. The child moans on soft palpation of the abdomen, which is distended & hypertympanic. Cause?
A) Acute appendicitis
B) Intestinal malrotation - 23-yr-old man was unresponsive after a motor vehicle collision. B/P 72/54 & pulse 120. Neck veins are distended. Multiple bruises involving the anterior chest & upper abdomen. Chest x-ray reveals a small, left-sided pleural effusion & normal cardiac contours. Diagnosis?
A) Aortic rupture
B) Bronchial rupture
C) Cardiac tamponade - 70-yr-old man comes for a follow-up for gout. No joint pain since he started taking allopurinol 6 mths ago. B/P 148/92. ECG indicates left ventricular hypertrophy. Next step?
A) Discontinue allopurinol and recheck blood pressure in 4 weeks
B) Order exercise stress testing
C) Start losartan - 74-yr-old woman complains of right ear pain. Currently taking trimethoprim-sulfamethoxazole for an uncomplicated urinary tract infection. Several erythematous vesicles in the right external auditory canal with no drainage. There is mild right-sided facial droop. Cause?
A) Borrelia burgdorferi
B) Herpes simplex virus type 1
C) Varicella zoster virus - Sudden throbbing headache with eye red,tearing since 6 hours. No h/o same. No family h/o. Next mx?
A) High dose steroid
B) Sumatriptan
C) Metoclopromide
D) Ondansetron - Ct given. H/o Reux en y. POD4 Sudden epigrastric pain, vomiting. Dx?
A) Afferent loop occlusion - Mid-trimester pregnancy for antenatal checkup. All screening test normal. BMI 41. What next?
A) Random Blood glucose
B) Iodine supplement - Child living with grandmother. Decreased concentration in school. Grandma says child is hyperactive, inobedient, pacing around. Dx?
A) Autism spectrum disorder
B) ODD - Pt came in ED with knife in left infrascapular region in posterior part. Low bp, tachycardia. After resuscitation, what will do as immediate next mx?
A)Endotracheal Intubation
B) remove knife
C) CXr
D) Ct chest - Sexual abuse with girl 3 weeks ago. Since then, she is irritating, decreased sleep, concentration, alone and some more symptoms. Dx?
A) ptsd
B) acute stress reaction
C) mdd - 5-yr-old boy is evaluated for “clumsiness. Begun drinking large amounts of water & urinating “all the time.” Exam shows dry mucous membranes & loss of peripheral visual fields. Diagnosis?
A) Craniopharyngioma
B) Medulloblastoma - 64-yr-old woman with fever, chills, flank pain & lethargy has right costovertebral angle tenderness. Leukocytes are 16,000/mm3 & urinalysis shows pyuria, many bacteria & positive nitrites. ECG shows sinus tachycardia. A triple lumen catheter is placed into the left subclavian vein. Next step?
A) Antibiotic through the catheter
B) Bedside echocardiography
C) Portable chest radiograph - 38-yr-old woman complains of abdominal bloating, excessive flatulence & diarrhea over the past 3 mths. Has 4 or 5 nonbloody, loose stools a day. Lost 30 kg after undergoing Roux-en-Y gastric bypass surgery 3 yrs ago. BMI is 28. Cause?
A) Bacterial overgrowth
B) Clostridioides difficile infection - 72-yr-old man comes with fatigue & 3+ edema in lower extremities. Has hypertension. Underwent permanent pacemaker implantation for sick sinus syndrome 6 mths ago. A 3/6 holosystolic murmur is heard over the left lower sternal border. Diagnosis?
A) Mitral chordal rupture
B) Pulmonic valve stenosis
C) Tricuspid regurgitation - 56-yr-old man comes with a year long history of skin lesions on the cheeks, forehead & scalp. Medical history includes androgenic alopecia & poorly controlled type 2 diabetes mellitus. Diagnosis?
A) Actinic keratosis
B) Psoriasis - 50-yr-old man sustained full-thickness burns to the left pretibial and ankle areas 10 yrs ago that required skin autografting. It developed into 3-cm, irregularly shaped ulcer on the left lower leg just proximal to the medial malleolus. Bleeds easily when touched. Diagnosis?
A) Basal cell carcinoma
B) Cutaneous T-cell lymphoma
C) Squamous cell carcinoma - Painless bleeding PR. On PR, haemorrhoids beyond anal verge. What will be your next initial mx?
A) sitz,dietary change
B) sclerotherapy
C) haemorrhoidectomy
D) band ligation - Adhd rx?
A) Atomoxetine
B)Methyphenidate
C)Guanfenasin - Pt with MRI of prolactinoma(macroadenoma). Rx started with bromocriptine since 6 months. Before 1375 level nd now 1125 level. Next?
A) trans-sphenoidalSx
B) stereotactic sx
C) Mri Brain - 18 yr old girl came to ED by ambulance after sudden collapsed and loss of consciousness. She is now alert with GCS 15/15. She admits self inducing vomit 2-3 times per day. BMI 24.5 Reason for this attack?
A) serum K
B) Blood glucose
C) EEG
D) ECG
E) CT head - Pt with acute epigastric pain after binge drinking 18 hours ago. Bp Normal, Pulse normal, Temp normal. No radiation of pain. Lipase high. After analgesia, what will u do next?
A) IV fluid
B) Ct abdo
C) Usg Abdo
D)xray abdo - Pregnant lady with ROM. Pulsating cord visible ahead of baby head. Rest everything normal. Baby Heart rate normal. Next?
A) pt in lithotomy
B) inhaled salbutamol
C) Fill Bladder - Pt with COPD exacerbation. Given o2(Fio2 27%) (not written by which device- mask, ventury, ventilator, NRBM) now after 30 mins Abg is ph-7.37, pao2-67, paco2-61. Respi rate 24. Next?
A) increase o2
B) decrease o2
C) intubate
D) No NIPV - Pt with recurrent h/o agitation. Assylum official came with complain that pt is Now wandering around in hot sun and asking for breakfast in evening. Not sleeping and talking to himself since few days. Mx?
A) Olanzapine
B) Lithium
C) Mirtazapine - 72-yr-old man comes after a syncopal episode. Lost consciousness an hour ago while getting dressed. History of poorly controlled hypertension. Has type 2 diabetes mellitus & hyperlipidemia. Ankle reflexes are absent bilaterally. Cause?
A) Baroreceptor hypersensitivity
B) Damaged autonomic nerves - 15-yr-old girl is brought with sharp pain in the left lower quadrant that radiates to the lower back. Associated with nausea and vomiting. Pelvic ultrasound shows a 5-cm left ovarian mass with normal ovarian arterial & venous blood flow. Next step?
A) CT scan of the abdomen and pelvis
B) Diagnostic laparoscopy - 28-yr-old nulliparous woman complains of a malodorous, tan vaginal discharge with intermittent, crampy abdominal pain. There’s a patch of erythema on the posterior vaginal wall. A sinus with purulent drainage is also present in the perianal skin. Cause?
A) Blockage of the Bartholin gland duct
B) Chronic occlusion and inflammation of hair follicles
C) Transmural inflammation of the bowel - 32-yr-old woman has persistent tiredness, lack of motivation, memory impairment & loss of libido. Has anorexia, weight loss of 15kg, BMI is 19.8. There is decreased axillary and pubic hair. Diagnosis?
A) Cosyntropin stimulation testing
B) CT scan of the chest, abdomen, and pelvis - 15-mth-old full-term boy is brought for a well-child exam. At age 6 mths, he had a generalized seizure lasting 2 min within hours of receiving the diphtheria–tetanus–acellular pertussis vaccine. His uncle has a history of childhood-onset epilepsy. Due for the fourth dose of vaccine. Next step?
A) Administer the diphtheria and tetanus toxoids; avoid the pertussis component
B) Administer the diphtheria–tetanus–acellular pertussis vaccine as scheduled - 46-yr-old man is brought after a suicide attempt. Urine drug screening is positive for cocaine & opiates. Becomes restless, anxious & reports feeling nauseous. Appears flushed & diaphoretic. ECG demonstrates sinus tachycardia. Next step?
A) Administer metoprolol
B) Obtain blood cultures
C) Prescribe clonidine - 28-year-old woman, gravida 1 para 1, comes for follow-up 10 days after cesarean delivery. Exam reveals moderate tenderness over the lumbar region & weakness of left quadriceps & decreased left knee reflex. Sensation to light touch is decreased over bilateral dorsa of the feet. Most appropriate?
A) Advise nonsteroidal anti-inflammatory drugs and physical activity as tolerated
B) Evaluate for labor-associated peripheral nerve injury
C) Obtain urgent MR imaging of the lumbosacral spine - Pt with acute pulmo edema. Iv furosemide given. Normal Bp, HR, Temp. O2 given by 6L/min hudson mask. Next?
A) Iv morphine
B) High flow Nrbm
C) GTN transfusion - 7 month baby. Waking up in night since birth. But increased intensity since 2 weeks. Normal wt gain. 2 stool pass per day. Sometimes regurgitate. Arching back and pulling nipple while breastfeeding. (NO SNORING mentioned like in other recalls). 5 months, exclusive breastfeeding weaned off. At 6 months age, URTI and rx with Abx. Dx?
A) Normal variant of growth
B) GERD
C) Pyloric stenosis - PAN case. Left foot drop. Renal protien ++, blood ++. Inv?
A) sural biopsy
B) renal biopsy - Hereditary angioedema recall… C1 defi
- Alzheimer dis male nd female kissing recall….. organise conference with female pt, family and staff
- 25 yo female with 2 spotting episode following intercourse. She is taking ocp. Otherwise well. Normal temp. No cx motion tenderness. Dx?
A) HSIL
B) Cervical Ca
C) Chlamydia
D) vaginal laceration - Pregnant with painless 1000ml blood loss. P/e uterus contraction present. Baby longitudinal. Baby spine on maternal left. Baby floating per abdominally. FHR normal. Mother vitals normal. What in h/o will you guide for dx?
A) FHR
B) mother vitals
C) Fetal engagement
D) mother temp - Ecg pericarditis. Mx? Indomethacine
- Renal graft. 10 years. Low grade fever, wt loss. Crept on left mid zone. CT given showing upper zone mass. Inv?
A) Tuberculin test
B) fungal swab
C) lymphnode biopsy - Pt with no urinary symptoms. Temp normal. Urine rme rbc 10 power n(some value), wbc 10 power 5 per ml. Nil organism, nil epithelial cells. Nil cast. Urine cytology normal. Ct kub done was normal. Next?
A) renal biopsy
B) Abx Iv
C) cystoscopy - Hookworm prevention recall… avoid walking barefoot.
- SSRI clinical dx? …. hyperreflexia
- Drug in party. Yellow oozing from skin, tachy and mydriasis…… LSD, cocaine, amphetamine
- 18 yo with gtcs on carbamazepine.. most appt advice?
A) condom+ocp
B) ocp
C) abstain - 10 mg morphine dose needed. 2mg given by nurse. You gave corrected morphine and nurse head informed. Whom to inform is essential….. patient
- Clinical trial. Before mmse was normal. Now mmse 18. Who will decide to discontinue with this pt?
A) yourself
B) pt
C) pt son
D) ethics committee
E) pharma company - Mother needs resuscitation. One daughter say she has advance directive stating no resuscitation. Other daughter disagree and says mother would wish to live. No documentation available. What will u do?
A) resuscitation
B) ethics committee
C) guardianship appoint - Domestic violence. What next?
A) photo of bruises for documentation
B) inform about shelter and counselling resources
C) inform police - Pregnant with systolic palpation at lt 2nd ICS with systolic murmur. Diastolic murmur at triscupid region. 2nd heart sound widely split during inspi and expiration. On cxr mild cardiomegaly and prominent pulmo vessels. Dx?
A) Asd
B) vsd
C) pds
D) ps
E) tricuspid incompetence - 6-yr-old boy is brought for eyelid swelling due to mosquito bite below his left lower eyelid. Temp is 38.3 C. The left lower eyelid is erythematous, edematous & tender to palpation. There is limited left eye adduction. Most concerning?
A) Eyelid edema
B) Eyelid erythema
C) Ophthalmoplegia - 25-yr-old woman, gravida 1 para 0, at 24 weeks gestation comes due to diarrhea. The abdomen is minimally tender to palpation in the bilateral lower quadrants without rebound or guarding. There is trace pitting edema in the bilateral lower extremities. Cause?
A) Diverticulosis
B) Endometriosis
C) Irritable bowel syndrome - 25-yr-old man comes with dry cough, wheezing & congestion. Medical history includes well-controlled asthma. In addition to an inhaled corticosteroid & a beta agonist, medications to include?
Inhaled ipratropium
A) No additional medication
B) Oral prednisone - 21-yr-old man with a prior history of seizures is brought during a tonic-clonic seizure. Has not been compliant with his medications. Given IV lorazepam, thiamine & glucose en route but continued seizing. Unresponsive & cyanotic. Highest risk?
A) Cerebellar atrophy
B) Cortical necrosis - 35-yr-old man complains of persistent fatigue & insomnia. Was fired from his job. No difficulty falling asleep but awakens at 4 AM most nights. Feels pressured to look for new job but is so unfocused that he has not been able to complete any applications. Likely findings?
A) Decreased REM sleep latency
B) Increased periodic limb movements during sleep - 31-yr-old woman, gravida 2 para 1, at 10 weeks gestation comes for an initial prenatal visit. US shows 2 viable intrauterine gestations, a single fundal placenta & a thin intertwin membrane that meets the placenta at a 90-degree angle. Highest risk?
A) Conjoined twins
B) Cord entanglement - 37-yr-old woman comes with abdominal pain, nausea & vomiting. A wk ago underwent a laparoscopic hysterectomy for severe endometriosis. Watery vaginal discharge & the vaginal cuff appears closed. US reveals a large amount of intraabdominal fluid with no internal echoes. Diagnosis?
A) Hemoperitoneum
B) Intraabdominal abscess
C) Unilateral ureteral laceration - 1-day-old boy was born at 34 weeks gestation to a 25-year-old-primigravida, delivery was complicated by placental abruption & a forceps-assisted vaginal delivery was performed. A firm, well-demarcated swelling on the right parietal scalp with no discoloration or apparent tenderness. Cause?
A) Caput succedaneum
B) Cephalohematoma - 40-yr-old man is prescribed niacin for severe hypertriglyceridemia. Has hypertension controlled with hydrochlorothiazide & asymptomatic gallstones. His father had a nonfatal myocardial infarction at age 47. He returns 1 week later due to intense, generalized pruritus & flushing. Cause?
A) Hypersensitivity reaction
B) Prostaglandin-related reaction - Obese on metformin BD. Hba1c 8. What to add?
A) gliclazide
B) rosiglitazone
C) insulin
D) gliptins
E) something glinide - Pcos a/w what? ……. a)diabetes,b) Osteoporosis, c)HTN
- Abx in endometritis.?? ….. penicillin, metro
and genta… - Young child with headache and increasing nausea. Ct midline mass in post fossa. Temp 37.7 she keeps neck tilted. Dx?
A) cerebral abscess
B) medulloblastoma - Exposure of varicella in pregnant.. next? Check serology
- Mother with hep B and Hep C positive. What to decrease vertical transmission?
A) elective cs at 39 wks
B) avoid artifical rupture memb in labour - ARF symptoms and asking for definitive dx? ASO titre
- (BLACK LEG IMAGE)Haemosiderin(NOWHERE WRITTEN IN QUE, BUT AS USUAL RECALL KNOWN AS HAEMOSIDERIN DEPOSIT) deposit august recall…
- 48-yr-old woman complains of progressive loss of visual acuity. Has chronic HIV infection, well controlled with a multidrug antiretroviral regimen. Exam shows opacification of the lenses bilaterally. Next step?
A) Antioxidant supplement
B) Cytomegalovirus IgG antibody assay
C) Surgical removal of the lens - A couple wants to know the health implications of neonatal circumcision. Appropriate response?
A) “It decreases his risk of urinary tract infections as an infant.”
B) “It is essential for maintaining good hygiene.” - 45-yr-old woman comes with colicky pain in the right upper quadrant. Had cholecystectomy 2 yrs ago due to symptomatic cholelithiasis. Problems include hyperlipidemia, obesity & tachycardia. A mildly dilated common bile duct but no stones. Receives morphine but the pain worsens. Diagnosis?
A) Bile reflux gastritis
B) Choledocholithiasis
C) Sphincter of Oddi dysfunction - 58-yr-old man with a history of extensive alcohol use is admitted with the diagnosis of decompensated liver cirrhosis & ascites. Which of the following best explains the acid-base status change in this patient?
A) Acute kidney injury
B) Bowel ischemia
C) Loop diuretic therapy - 8-yr-old boy is brought with bilateral leg back pain. Notable for sickle cell disease, had 5 prior hospitalizations for similar pain episodes. Has conjunctival pallor. Present on patient’s peripheral smear?
A) Basophilic stippling
B) Bite cells
C) Howell-Jolly bodies - A study evaluated the relationship between the common cold the number of cigarettes smoked per day. Which of the following factors would most likely invalidate the findings of this study?
A) Admission rate bias
B) Lead-time bias
C) Response bias - 54-yr-old man complains of blood in the stool. Family history includes colon cancer in his paternal uncle. Flexible sigmoidoscopy confirms a fungating mass in the upper rectum; biopsy is consistent with adenocarcinoma. Next step before surgical treatment?
A) Adenomatous Polyposis Coli gene testing
B) Colonoscopy of the entire colon - 56-yr-old smoker comes with exertional dyspnea. Has palpitations, dry cough & lower extremity swelling. Was hospitalized 4 mths ago for MI. Has hypertension, type 2 diabetes mellitus, hyperlipidemia, asthma & gout. His father died of heart disease at age 55. BMI is 32. Diagnosis?
A) Large pericardial effusion
B) Left ventricular aneurysm - Woman, gravida 3 para 2, at 35 weeks gestation comes with frequent, painful uterine contractions. Tocodynamometer shows contractions every 6 min. No evidence of membrane rupture. Cervix is 4 cm dilated & 90% effaced with the fetus at −3 station. Next step?
A) 17-Hydroxyprogesterone
B) Emergency cervical cerclage
C) Expectant management - 56-yr-old man complains of epigastric pain & dizziness. Has a history of hypertension, hyperlipidemia & GERD. B/P 85/52, pulse 55. Patient is diaphoretic. ECG reveals sinus bradycardia with symmetric T-wave inversion in leads II, III & aVF. Next step?
A) CT pulmonary angiography
B) Intravenous furosemide
C) Right-sided precordial ECG - 24-yr-old man is brought with bizarre behavior. Has abdominal pain, constipation & a tingling sensation in his fingertips. Medical history includes major depression & GERD. His father also suffered from unexplained psychiatric episodes. Diagnosis?
A) Acute intermittent porphyria
B) Lyme disease - 32-yr-old woman, gravida 2 para 1, at 28 weeks gestation has been unable to work at her job due to increasing fatigue & dizziness on standing. Light brown, irregularly shaped macules are arranged in a bilaterally symmetric fashion on the patient’s cheeks & nasal bridge. Next step?
A) 3-hour glucose tolerance test
B) Antinuclear antibody test
C) No further evaluation indicated - 28-yr-old woman complains of right lower abdominal pain associated with nausea & vomiting. Pain does not radiate. There is tenderness to palpation over the right lower quadrant with no rebound or guarding. Additional information?
A) Associated urinary symptoms
B) Family history of malignancy
C) History of ovarian cysts - One que on dx of Fibroadenoma.
- Lady with h/o breast Ca. Now with back pain. Ct of whole spine showed solitary metastatic deposit. Rx?
A) raloxifene
B) tamoxifene
C) chemo
D) radiotherapy - Acute bladder obstruction. Prostate enlarged and tender on DRE. Temp high. Fluid given, no urine output. What next?
A) indwelling urethral catheter
B) prostatic aspiration
C) suprapubic aspiration- A man comes to clinic for painless swelling in front of the ear. He noticed this 2 weeks ago. He had operation for SCC of head and neck ( i dn’t remember the Dx) 2 yrs ago. He had URTI 1 month ago. On examination, firm, mobile, non tender 2cm swelling over the angle of mandible. Dx?
A. Warthim tu
B. Pleomorphic adenoma
C. Reactive lymphadenopathy
D. Metastatic tu
E. Lymphoma
- A man comes to clinic for painless swelling in front of the ear. He noticed this 2 weeks ago. He had operation for SCC of head and neck ( i dn’t remember the Dx) 2 yrs ago. He had URTI 1 month ago. On examination, firm, mobile, non tender 2cm swelling over the angle of mandible. Dx?
- Young boy after neck trauma become confused, cyanosed, stridor, swelling at the neck. After o2 mask and IV fluid, what next?
A. Suxamethonium and intubate
B. Cricothyroidotomy
C. Tracheostomy
D. Urgent lateral soft tissue X ray - 8. A receptionist comes to GP clinic that she feels tired and complaint about her specialist that she has to work extra time without pay and he demands to finish the job in time. The specialist is the GP’s friend. Most appropriate action?
A. Declare the conflict interest.
B. Tell the specialist confidentially
C. Tell the specialist on behalf of her.
D. Tell the receptionist that this is normal to work like this becoz of austalia work load
E. Refer to other GP - A young man with generalised headache for years. He remembers the onset of headache starting without trauma. Neuro exam is normal. He can work despite he suffers from headache. No aura. No nausea, vomitting. Most likely Dx?
A. Tension headache
B. Migraine - 26 yr old lady with lower abdominal pain. Regular cycle every 4-6 week, normal amount. LMP last 6 weeks ago. She usually suffers from dysmenorrhoea at the start of her period but not as severe as this time. Temp – normal. Abd – soft, no adnexal mass, no cervical motion tenderness, dx?
A. Endometriosis
B. Corpus leuteal cyst complication
C. Early PID
D. Dysmenorrhoea - Restless leg syndrome Ix?
A. Magnesium level
B. Serum ferritin - Chlymydia screening in 58 yr old women. Prevalance is 1%. Screening test has 98 specificity and 97% sensiticity.
A. The test has high sensitivity.
B. The prevalence is not high enough to screen those population - 70 yrs old man comes for varicella zoaster vaccination. He had RA and took methotraxte and infliximab several years ago. But not taking it now and in remission. He suffered from shingles when he took infliximab. No only on celecoxib. What would u advise?
A. Vaccination is contraindicated
B. Give high dose VZV vaccine
C. Give immunoglobulin
D. Test serology for susceptibility - Preterm labour with a baby weighed ~00 gram, cyanosed, RR 40, floppy, immediate next step.
A. Send to NICU
B. cardiac message
C. Intubate - (VARIATION IN RECALL)
boy tells his gf he need to protect world from allines. He realised this from watching TV advertisement of OMEGA WATCH. He said OMEGA indicates world is going to end soon. Dx?
A) nihilistic delusion
B) delusional perception
C) delusion of reference - 6 weeks amenorrhoea. UCG (+) next step?
A. Serum beta HCG
B. TVS
C. Transabdominal USG - AAA scenario. He’s taking regular surveillence 3.8 cm 2 yrs ago. 4.3 cm now. Appropriate Mx?
A. Screen annually
B. Sx
C. Continue his surveillance - 7 mm mid ureteric stone. Mild hydronephrosis. No fever
A. Laser lithotripsy
B. Percutaneous drainage
C. Hydration, analgesic, antibiotics - CT brain haemorrhage. Taking warfarin. INR 4.5. After stopping warfarin, most appropriate
Mx?
A. Daily INR monitoring
B. Oral vit K
C. IV vit K
D. 2 units of FFP
E. prothrombinus VF - Same que with different types of bleedings… one time hematoma, one time cerebral haemorrhage… Ans same… PCC
- A middle aged lady with tiredness, weight gain, headaches. Loss of interest and not enjoy watching TV. She is taking lithium for bipolar disorder. Most likely dx?
A. Lithium induced hypothyroidism
B. Depression - CO poisoning
A. 6L/min Oxygen by hudson mask
B. Bileaflet mask (??)
C. High oxygen flow with non rebreathable mask - Temporal lobe epilepsy. Most appropriate initial Mx?
A. Sod valproate
B. Lamotrigene
C. Levitiracetam - Aboriginal boy with urine protein 2+ RBC 4+, BP 130/90, mild oedema. Sore thorat 2 weeks ago. Most likely Dx?
A. IgA neohropathy
B. APSGN - BIZARRE QUE. pt with B/l symmetrical edema of LL. Non pitting from foot upto groin. No any significant history. No heart history, no liver, renal, or any sx. No tm history. What will you do?
A) duplex of LL
B) Usg of abdo and pelvic
C) Ct abdo and pelvis
D) Angiography - head injury GCS 4, already intubate, only X ray is available is this hospital. nearest hospital 3 hr. Next Mx?
A. Mannitol
B. Burhole
C. Urgent transfer
D. Skull X ray - Amiodarone phototoxicity rash.
- Elderly woman who is living alone with diagnosed with hypothyroidsm and prescribed with thyroxine and dose titrated with 75 microgram/. In this follow up, TFT results are given. TSH – increase, T4 – decreased. Most appropriate Mx?
A. Increase thyroxine dose
B. Ensure drug compliance
C. Continue this dose - Tics scenario very old recall. Child hand goes upward and then down. Not going school bcz other teases. Cant stop movt despite willing to do so. Mx.
A. Habit reversal
B. Interpersonal therapy
C. Family therapy
D. Exposure nd response prevention - Vertigo scenario with head impulse nystagmus something test positive. Rx?
A. Prochoperazine
B. Betahistine
C. Scopolamine
D. Metoclopromide
E. Ondansetron - -Elderly lady, drowsiness and constipation, with hypercalcaemia- 55mmol management?
A. 2 litres normal saline
B. Prednisolone
C. Oral fluids
D. Pamidronate
E. IV furosemide - patient with history of seizures, used anticonvulsants in the past, stopped since 12 months, advised to take medications, pt not ready to take anticonvulsants.what do you do?
A. change the anticonvulsant
B. Refer to a neurologist
C. Get EEG done
D. Do nothing - Best test to determine Anti-D level?
A Feto-maternal hemorrhage test
B Anti-D immunoglobulin level - 6-yo boy has symptoms of transient synovitis. Best management?
a/ Oral ibuprofen
b/ Oral steroid
c/ Hip splint to immobilise joint
d/ Crutches - Itching n burning in vulvar region. Specially before onset of menstruation. On exam, vulva normal. Otherwise healthy. Dx?
A) candida
B) chlamydia
C) gonorrhea
D) e.coli - Pt came for other rx. Incidentally 1cm stone on upper pole of kidney found. No urinary symptoms. Serum Urate mild high, urine calcium excretion mild high. Next?
A) eswl
B) pcnl
C) allopurinol - Alt, ast raised. Ggt raised. Alp raised. Total bilirubin raised. Severe epigrastric pain n tenderness. Cause?
A) acute cholecystitis
B) stone in CBD
C) viral hepatitis - Girl with lft lower abd pain. Generally pain before nd at onset of menstruation. This time severe than usual. 6 weeks ago LMP. No cx motion tenderness, no adnexal mass on exam everything normal. Dx?
A) corpus leuteal cyst compli
B) ectopic
C) dysmenorrhea
D) Endometriosis - Pregnant 28 wks. At 10 wks dating scan done. 19 wks anomaly scan done, normal. Now 32 cm height. Cause?
A) full bladder
B) polyhydramnios - Ocp taking for 10yrs.. risk of ca?
A) cervix
B) breast
C) colon
D) ovarian
E) endometrial - Breast ca screening… ans was… start regular screening from 50 yrs old
- Wide based gait, forgetfulness. mother n brother has same history. Other wilson symptoms. Inv to dx?
A) genetic test
B) serum cu and ceruloplasmin
C) liver biopsy - 40 yrs old Lady with history of sx for Endometriosis. Rx of genital Chlamydia 2 months ago. Family h/o early menopause. Which will affect future fertility?
A) family h/o
B) age
C) surgery
D) chlamydia
E) smoking - Graves dis. Asking for establishing dx?
A) anti-tsh receptor ab
B) anti tpo
C) anti thyroglobulin
D) tsh - Aged care pneumonia. Organism?
Strep. Pneumonia - Pt with factor 5 leiden deficiency. Best Contraception?
A)Mirena - Lawyer came for pt medical record. Pt not competent due to depression. When will u give info?
A) ask for court order
B) pt consent needed - Young lady reluctant to go to college bcz breathless while giving answer in lecture. Dx?
A) GAD
B) Social anxiety
C) agoraphobia - X-ray showed fracture of C2-C3 (?), pt has respiratory distress. Best management?
a/ Endotracheal intubation
b/ Tracheostomy
c/ Cricothyroidotomy - Pt with pulmonary edema, SpO2 90% with 6L of Hudson mask. Next management?
a/ Non-rebreathe mask
b/ BIPAP
c/ Glyceryl trinitrate
d/ Intubation - You ordered 10mg Morphine, but nurse only injected 2 mg. You recognized and injected more Morphine. What to do next?
a/ Raise the problem with nurse at tea break
b/ Report to nurse unit manager - Best test to determine Anti-D level?
a/ Feto-maternal hemorrhage test
b/ Anti-D immunoglobulin level - Agitated man, said” If you don’t admit me to hospital, I’ll jump out of the car”. Best inv.?
a/ Magnesium level
b/ Alcohol level
138/ Woman has vaginal bleeding at 5 days postpartum. During delivery has tear not requiring suture, confirmed complete placental removal, no fever. Diagnosis?
a/ Retained products of conception
b/ Endometritis
c/ Vaginal laceration
d/ Cervical laceration
139/ Sheep farmer. CT showed?. Diagnosis?
a/ Hydatid cyst
b/ HCC
c/ Hemangioma
140/ 15-yo girl has symptoms of MDD. Best drug?
a/ Fluoxetine
141/ Carpal tunnel syndrome. Best inv.?
a/ Nerve conduction study
b/ US
c/ X-ray
142/ 6-yo boy has symptoms of transient synovitis. Best management?
a/ Oral ibuprofen
b/ Oral steroid
c/ Bed rest
d/ Crutches
143/ Child, has systolic murmur at left 2nd intercostal space, diastolic murmur. Diagnosis?
a/ ASD
b/ VSD
c/ PDA
d/ Pulmonary stenosis
144/ Child, systolic murmur at left upper sternal border, no diastolic murmur. Dx?
a/ ASD
b/ VSD
c/ PDA
d/ Pulmonary stenosis
145/ Pt has dysphagia to certain foods. Endoscopy showed mid-esophageal ring. Best management?
a/ Esomeprazole
b/ Ranitidine
c/ Budesonide
d/ Esomeprazole + metronidazole
146/ Wife continuously clean the floor, seduce husband’s friend. If they refuse, she becomes agitated and abusive. Dx?
a/ Hypomania
b/ OCD
c/ Schizophrenia
147/ Pt with prolactinoma using bromocriptine. Now check prolactin still high 750. CT show 0.9 cm tumor. Next management?
a/ Carbegoline
b/ … surgery
c/ … surgery
Thanks for great effort
It will be better if sharing the answers of questions also
Thanks again.