1. A skin lesion was suspected to be melanoma 2.7mm depth. Excised. A pathology report says that margins of 2.6 mm width are clear. What is the best next step in management? a. Wider Excision b. radiation therapy of the scar c. 3monthly follow up. 2. A 52 year old menopausal woman came is bleeding per vagina for 24 hours. Her last menses were 1 year ago. Yesterday she had intercourse after 2 years of sexual rest. Her last PAP smear 2 years ago was normal. What’s the most probable diagnosis ?? a. Endometrial cancer b. Cervical cancer c. Vaginal atrophy d. Menses e. Endometrial hyperplasia 3. A lady has been feeling depressed for the last 4 years, she was in an abusive relationship for 6 years her alcoholic husband left her one year ago. She was a victim of bullying and was raped at school in high school. She complains of feeling insomnia sometimes, increased appetite and depression. (Sounded like she was abused all her life by whoever she meets). As soon as she started to live with her mother who supports her, she feels better. a. Post traumatic stress disorder b. Borderline personality c. Dependent personality disorder 4. Picture of slapped cheek disease. There are lot of pregnant moms in the school where this child is studying. What to do? a. No exclusion required b. Call to school and notice them c. Exclusion for 7 days until all the rash disappears. 5. Picture of chickenpox or molluscum contagiousum (1 element was with central dimpling). School exclusion? Cannot understand “no” 7. biopsy of the lesion c. When all rash disappears. WOF will signify developmental delay? a. the pain and stiffness makes him stays in the bed for at least 30 min. Pregnant lady at term. What is the most likely reason? a. but couples of them are pustules. cervical incompetence d. 1 year old child. The next day he develops rash. When the lesions scab over.a. UTI suspected. A 35 year old man came with severe back pain over years that is worse when he wakes up in the morning . Clean catch d. Catheter 8. occipito-posterior view 10. bone marrow biopsy d. He has a history of glandular fever infection and varicella infection in childhood. 6. swab from the lesion b. Mom brings her 12 month old child. What would you do to determine the cause of rash? a. placenta praevia c. drug allergy test 9. what’s the best initial treatment for him ? (Xray of “bamboo spine”) . fetal head 4/5 per abdominally. no height of history given. Patient with known Waldenström's macroglobulinemia is admitted with fever. it is getting worse now . Urine bad e. He is given ampicillin and azythromycin. Not required b. Then he gets better somehow along the day . Suprapubic aspiration c. It doesn’t look like erythema multiforme at all. Picture: rash is on the abdomen and chest. c. contracted pelvis b. MSU b. macrosomia e. How will you collect the urine for analysis? a. Most of the elements are raised papules. o. Start B-blocker d. Random blood glucose every 3 years d. Just clean and dress the wound 12. An 8 year old boy with enuresis going to a camp with school. his knee fat is appearing out of the wound and it is contaminated with soil. What is the treatment? a. Start nifedipine 14. what is the best treatment ? a. Surgical intervention b.How would you screen the woman after gestational diabetes? a. TT b. Walking program c. OGTT every 2 years c. Methotrexate 11. but limbs are well perfused and warm on examination. What would you give him now? a.a. although he has no dorsalis pedis pulse. 25 y. A smoker man with bilateral leg pain when walking for 100 m. Aspirin d. Fasting blood glucose every year 15. he had TT 5 months ago for a similar injury. Azathioprine c. A farmer had an injury while working in the farm. woman with PAP smear showing LSIL. Naproxen b. Prednisolon e. ABI is not given. Fasting blood glucose every 3 years b. What is the next management? . Nasal desmopressin 13. double-dose TT and Igs d. distance. TT and Igs c. Antibiotics e. He doesn’t recall having any other vaccination. pulse 115. ascitis. On auscultation . 20. Maxillary sinusitis b. resuscitation started. she has lost 1000 ml already. LLETZ 16. IgA nephropathy c. 17 y. just gave birth per vaginum for the second child. Mentally retarded girl with menorrhagia and non-complience of OCP.atony . Endometrial ablation 17. On CXR – bilateral infiltrates. Ovarian dysgenesis c. Implanon b.inversion b. she doesn’t look at you.o. Dx? a. What do you think the reason for this behavior? a. An aboriginal woman comes with her 12 month old baby for appointment. colposcopy d. repeat PAP smear in 1 year b. BP 100/60. Woman is still bleeding. Depo-provera c. O/e no palpable masses in the abdomen. Cluster headache d. There some redness over the area of the projection of the maxillary sinus. poststrep GN d. Cultural issues 18. A 25 yo man with dyspnea. polyarteritis nodosa e. Mellerian dysgenesis b.rupture c. Pitutary tumor d. anti-glomerular basement dx. girl with primary amenorrhea. vaginal examination is not performed. G2. Nothing said about nasal symptoms. Dx? a. protein +++. Management? a. although she has axillary and pubic hair of adult type. She is short (like 140 cm?). SLE b. 5 minutes before this delivery FHT dropprd to 70 per min.P1 who had previous child delivered by CS. What is the cause? a. Herpes simplex infection 19. a. A middle-aged woman complaining of burning pain in the maxillary region during last 24 hours. Varicella infection e. repeat PAP smear in 2 years c. newborn was not well. In urine blood +++. although heart shape is normal. Mirena e. PCO 21. Breast development is Tanner 2. IUCD (Cu) d. Despite normal separation of placenta. coming out without saying anything.a. ankle oedema. Trigeminal neuralgia c.bilateral crackles. 45 yo woman with painful. What is the most likely dx? a. case. 28.22. sexual abuse c. Non-melanotic skin cancer c. What vaccination would you recommend? a. She is very picky with food and eats only particular dishes. non-Hodgkin lymphoma 27. nasopharyngeal cancer c. 40 yo alcoholic and smoker complains of a 2 cm painless lump on the left tonsil. body/aneurism on the carotid artery d. Squamous cell carcinoma b. Hemophilus influenzae vaccine c. It is a good time for what screening? a. cohort c. How would you establish correlation between a large number of naevi in population and development of melanoma? a. lipoma c. substance abuse b. A child with small VSD goes for tonsillectomy. Pneumococcal vaccine 23. mts from some place e. No option of “no prophylaxis”. MMR is grown not on the eggs b. No allergy. A mother brings her child for MMR and is worrying that her son is allergic to eggs. A 13 year child was removed from biological parents for some reason. Now she is with foster family. No other signs and symptoms described. RCT d. DM 25. cyst . amoxicillin Other options are antibiotics. BP d. A 25 yo man comes for routine for some reason. carcinoma b. firm 2 cm lump in the breast. fibroadenoma d. What is the most likely dx? a. At this moment she is at risk of developing what? a. She doen’t talk a lot. round. Testicular tumor b. anorexia nervosa 26. She is playing most of the day with her imaginary friend. hospitalize her son and administer vaccine in parts under supervision c. What is prophylaxis? a. DTPa b. Cancel vaccination 24.control b. A 68 yo comes for a routine visit and says her daughter is pregnant. case study e. cross-sectional 29. What is your advise? a. On DRE prostate is normal. oral nitrofurantoin b.cyanotic heart disease b. O2 requirement increased from 40% to 85% during last hours. glucose 3. What is the management? a. PSA is 3. continue surveillance b. urgency occasional urine incontinence (nothing sid aboud dysuria). keep in R arm. Dx? a.2 mmol/L. 4 options of antibiotics b. advance it with the R leg stepping forward d. no treatment required 34. and it’s written like this) c. Direct inguinal hernia 36. Urinalysis – no WBS. advance it with the R leg stepping forward b. Urine microscopy and culture b. 65 y.pneumothorax c. ciprofloxacin d. What is the most likely cause? a. b. keep in R arm. A 25 yo man with inguinoscrotal swelling that disappears almost completely when he is supine. CSF analysis of mom shows 15*10^6 mononuclears. lady has frequency. Neonate with hyaline membrane disease. Patient with coxarthrosis. a. Management? a.0) On 12direction USG-guided biopsy 1 locus pathology showed adenocarcinoma of Gensel (?) 4 stage. WOF most likely will determine the cause? a. Blood glucose 37. slight neck stiffness. Dyspnoea after birth. radical prostatectomy d. Today his mom is feeling unwell.0 (n<4. Varicocoele.coli 10^5. Management? a.30. Culture gave pure growth of E.o girl with intermittent abdominal pain. keep in L arm. 65 y. no treatment required 35.coli growth 10^6. Urine analysis shows 10 WBC (N<20). keep in R arm. woman with occasional urine incontinence. culture – E. radiotherapy e. A child has fever and purpuric rash a few days ago. A 60 yo man with no complaints (?). brachitherapy . Viral meningitis 32. Pneumococcal memingitis c. 13 y. advance it with the L leg stepping forward 31.o. advance it with the L leg stepping forward c. nitrofurantoin cefaclor (I have red few times. protein 0. What is your advice about walking stick? a. fever. Nothing said about cyanosis.o.45 g/L. Meningococcal meningitis b. transurethral prostatectomy c. urodynamic studies c. hyperviscocity syndrome 33. then the pain goes away spontaneously.o. In few hours complains of shoulder pain and BP starts dropping like 100/60. If I am not mistaken.35-7. Non-dominant parietal lobe 39. What part of brain do you test on MMSE with overlapping pentagons? a.38. Some non-specific symptoms described. Stable. A lady sees “ocean waves coming towards her” and then stares blankly. tachycardia.0) Different forms of neutrophils from metamyelocytes to mature forms. CT abdomen 42. Bas. ECG d. Barium meal and follow through 43. multiple myeloma 41. In what part of brain MRI is most likely to find pathology? a. a 60 y. On the 4th POD the develops chest pain and dyspnea. Oxygen by Hudson mask b. Erect and supine X-ray of abdomen c. Athlete had a blow out trauma of abdomen. To tell you the truth. Today he is also complaining of the left flank pain. CTPA c. Lymph. boy comes with intermittent abdominal pain. CT abdomen b. USG abdomen during the episode d. A 4 y. patient after knee replacement.o. Frontal lobe e. Temporal lobe 40. patient complains of fatigue and tiredness.32 (N 7. Eo. Micturition cystogram e. because there was huge blood analysis: Hb low RBC low PLT low WBC 5. Pain in LUQ. Usually it lasts for 12 hours. Dominant temporal lobe d.o. Dx? a.0-10. Non-dominant temporal lobe c. Posterior occipital lobe b. ABG: pO2 90 (N 95-100 mm) p CO2 31 (N 35-45) HCO3 21 (N 22-28) pH 7. sometimes he is vomiting during this time. I do not remember the stem. Chronic aleukemic leukemia b.45) What is the next step in management? a.CXR 44. A 50 y. USG abdomen b. WOF will help you in dx? a. Mon – normal. Patient presents with a red eye and photophobia.0 (N 4. Dx? . in this question they mentioned rouleux cells formation after blood count. WOF is the next step in management? a. O/e no abnormalities mentioned. Take consent from husband b. She doesn’t dive you consent. "Please.a. What is your next step? a. Take consent from Mental Health Tribunal c. You have to do ECT.o. What is the management? a.o. tell her test result b. Patients ate chicken and a small bone stuck in his throat and he feels somewhere on the neck. In urinalysis – protein or blood +.o. Creatinine. Management? a. Renal biopsy b. bring your daughter for another appointment" 48. kidney disease 47. On X-ray – fracture of one of the anterior pubic rami. 50. ask your daughter to call for results" d. A 4 y. Brachial plexus 51. What to do? a. A 65 y. Repeat analysis when she gets better. Indirect laryngoscopy 46. A 4 y. Site of lesion? a. Mobilize as tolerated d. In the morning – it doesn’t move properly and hurts. You see the girl privately and she requested a test for chlamydia which you did. Bed rest for 2 weeks b. Mobilize with brace c. What could it signify? a. Sling 53. At that moment urinalysis showed proteinuria +. insert a nasogastral tube and feed her through this 49. Close reduction b. urea. hidden pathology of urinary tract c.o. complains of pain in the anterior aspect of the pelvis after the fall. A young lady with depression refuses to eat and drink. Hormonal profile: Estrogene – low FSH – high . a reaction of the body to trauma b. c. Picture of anterior glenohumeral dislocation. girl presents with URTI. In few days mom call to your clinic as her daughter asked to organise follow up on appointment (?). What would you say? a . Treatment? a. Paracetamol c.Keratitis 45. no need of consent as it is life-saving procedure d. A man slept on his arm all night in the chair. Mom brings her 16 yo daughter for an appointment about knee pain. that disappeared in 1 week. lady complains of hot flushes. Surgical fixation 52."I cannot discuss anything about your daugher results with you" (There was no “please”). electrolytes c. The test came back positive. A 35 y. girl fell out from the tree. "Please. Nitrates. (And I had an impression that it is not a primary urogenital pathology). football player presents with gynaecomastia. atrial flutter with variable block c. Coronary angiography 58. Oxygen. Treatment? a. When you perform a table test (?) – after head tilt for few minutes her pulse drops to 50 and BP to 70/40. A lady in her 20s with lightheadedness (and ECG given – heart block 1st degree. TFT c. What is the management? a. other hormones (TSH. sunis arrhythmia (not SVT.o. A 17 y. What is the next step? a. ACEI. AVL and V5. Start verapamil 59. tPA b. and P wave is present before every QRS) b. woman with intermittent hot flushes that do not disturb her a lot. man develops lightheadedness and palpitations. What of the following will determine the dx? a. ECG is given – clearly showed AFib. What is the cause of his gynaecomastia? a. Vaginal USG b. I think). What ECG would you expect? (5 ECG strips given) a. VTach d. anabolic 56.o. Aspirin given. FSH.o. Pacemaker b. Morphine. What is the next management? a. A 30 yo lady complains of proximal shoulder girdle pain bilaterally. He is on inhaled steroids for asthma. diuretic. LH. Cease thyroxine b. Atropine c. A patient presents with chest pain of 2 hours onset in the metropolitan hospital. normal adolescence b. b-blocker . Prolactin) are either borderline low-normal or low. Start b-blocker d. He has hx of thyroid disease and wellcontrolled heart failure. MRI of the head all the option were related to OB&G. as different RR intervals. Pacemaker b. He is on thyroxine. Start digoxine c. A 60 y.V6. AFib e. 1st degree heart block 57.Other hormones i did not even look at. HRT 54. Menses are regular. What is the next step? a. A young athlete presents with palpitations after marathon. steroids c. ECG of 1st degree heart block given and bradycardia around 50-60. Atropine 60. Her hormonal profile shown and all E is low. ECG showing lateral STEMI in I. no option of TFT or smth like that 55. A 35 y. An ECG strip from one lead given. She also admits of cutting herself. . advise him that compulsions are the form of anxiety reduction behaviour no option of exposure-control therapy or smth similar. What is the offensive drug combination? I tried to figure out what combination could cause either brady or hyperkalaemia. Patient is on numerous medications: aspirin. it seems that bradycardia is present. Patient would like to try some non-medicament therapy. I just picked one randomly. I even will not provide you any options because I do not remember them. amiodarone. Olanzapine was prescribed and she develops DM. 62. I have seen this ECG when pericarditis was described – “smiley face” ST elevation. partial response.61. amlodipine. Organise regular follow up 65. Fasting lipids b. Anyway. what is the management? a. Olanzapine 63. OCD case. doesn’t want to do anything or socialize. But none of them was suitable. He also has a very stressful job that drives he’s fed up with. ST elevation or tall T-wave (although it was not peaked T wave of hyperkalaemia). nitrites. refer him for long-term insight-oriented psychotherapy b. SSRI prescribed. she is tearful. woman complains of loss of interest in life. Contact local mental health crisis team c. TFT 2 other incomprehensible options 64. Also. What is the management? a.o. After treating caring her wounds on the wrist. (You cannot clearly understand if she is suicidal or not). advise to change the job 66. discuss benefits and risks of antidepressants b. 67. Stem clearly describing autism with language delay. It is going on for 6 weeks after his girlfriend broke up with him after 3 months of dating. A middle-aged lady had psychosis for 12 months. What is you advice? a. I didn’t get what pathology they want me to see: bradycardia. WOF will you check? a. repetitive acts and social isolation in a toddler. In the conversation she mentions that life is not worth living. A young man sleeps all day long. Urea&creatinine c. A 50 y. Involuntary admission d. A young guy with schizophrenia. advise him that his feeling are quite normal and understandable c. Start sertraline b. What is the best option to start the Tx? a. What do you suspect here? No option of splitting. What would you recommend? a. PLT count is normal. Pt with fever. steroids b. Management? a. Management? a. Chest auscultation: crepitations in the base of the right lung. breathlessness. DRE+PSA b.amoxiclav . Where could be the primary malignancy in 60 yo woman assessed for anemia? a. A lady is admitted to hospital and she is very demanding. proceed to surgery b. some well-sounding form of psychotherapy 69. A 9 month old with fever. Immediate surgery c. Treatment? a. oxygen and IV fluids given. although easy bruising. A 40 yo man asks for prostate cancer screening. Passive-aggressive d. Stop clopidogrel. Xray – right lobar pneumonia . then proceed to surgery 71. Narcissistic personality disorder b. stop clopidogrel 7 days prior to surgery. A patient with recently placed stent and started on clopidogrel presenting for varicose vein surgery. defer the surgery for 12 months. They live in the mining city. dry cough. proceed to surgery 70. Lead in blood twice higher than normal. Management? a. verbal behaviour. Discuss pros and cons of screening 75. antibiotics d. continue clopidogrel. PLT transfusion. Some mental illness 72. Admitted. Tells you “I am sure you as a doctor understand me and will be able to organise me a private ward. scheduled pleasures therapy b. Caecum 74. Borderline personality disorder c. PLT transfusion. Refer to chelation 73. proceed to surgery c. wheezes. unhappy about the ward. Move the family from the city b. continue clopidogrel and then stop it 2 weeks prior the surgery b. A young man has depression. Dissociation e. What is your next step? a. these nurses do not understand”.68. a. Your advice? a. stop clopidogrel. cough. nebulised adrenaline c. observation 76. Stop clopidogrel for 7 days and then proceed to surgery b. grunting. Mom brings her girl with lead poisoning. Elderly patient on clopidogrel (not mentioned for what reason) is admitted with neck of femur fracture. Partial response to SSRI but he still complains of anhedonia. inform sexual assault agency 79. A patient with vision 6/24. Acne and weight gain. He went to another doctor who permitted him to drive. A young girl collapsed after exercise.azithromycin 77. Admits that she was raped. Observe for 4 hours and let him go home 81. What is next Ix? a. Admit him for 24 h observation b. MCV 70. Call to police b. What is the cause? a. CT head c. Agitated patient with alcohol withdrawal to the point when the security is struggling to keep him. On presentation he is ok. 13 yo girl living alone comes for abortion. Report the case to Road and Traffic department d. Hx of father’s death at 28. procaine penicillin d. Cause? a. Chloroquine 2 options I do not remember as I picked one randomly. What is your management? a.refer to pregnancy termination b. What is next? a.doxycycline c. no neurological signs. fell of the tree. Now he comes to you again and asks you to change your conclusion. Aspirin b. Patient is on risperidone and lithium. ECHO . Blood count shown – Hb low. What is the cause? a.o. Patient is on multiple medications.b. Diclofenac c. No LOC. You prohibited him to drive. IV diazepam b. IM haloperidol 78. Lithium and risperidone d. Discharge him as no pathological sings found d. Vomited on the spot. Ask him to drive only is someone else is in the car 80. 84. Risperidone c.inform police c. Drug interaction 82. Diabetes insipidus 83. Patient is on sertraline and nifedipine. A 4 y. What is the next step? a. Lithium b. IV thiamine c. Call to this doctor to discuss the issue c. Your management? a. When he stands up – tachycardia. Sialography b. Ask the patient if he is happy with intern witnessing his will . Immunoglobulin and vaccine c. Also he developed dry eyes and poliarthritis 2 years ago.antihypertensive b. CT head d. Nothing. Colonoscopy 88. MRI face c.frusemide 90. Biopsy of the swelling 86. Elderly man with difficulty initiating urination and dribbling at the end. What would you give give? a. Contact dialysis team b. Result of student: HbSAg positive. Vaccine d. Afrer MVA patient is short of breath. Lamivudine e. You are intern. You patient is not improving despite the treatment. BP 90/60. just swelling. Patient wishes you to witness her will in the presence of lawyer. pulse 110. Sometimes it hurts when he eats. but refer to counseling 89. Patient on dialysis is well during dialysis but between the sessions hast HTN. BPH 93. What is your next step? a. blow out trauma to the chest. What is the management? a. Management? a. Ask surgical registrar if he can do it d. Refuse to witness c. Witness will b. In blood ALP& GTT high. Immunoglobulin b.needle thoracocentesis b. 78 y. Patient presents with preauricular swelling. No night frequency. Blood culture c. On auscultation breath sound diminished. Dx? a. Few days later authorities announced Salmonella outburst. Give 100 mg frusemide 91. a. resident suddenly developed diarrhea of 4 days duration. nothing specific. What would you do initially? a. Stool culture b.85. Patient comes from some trip with fever and chills. Stool culture is negative. What is ne next step? a. A medical student sustained needle-stick injury. What is the next Ix? a. ERCP 87.chest tube under-water seal drainage 92. FNAC – inflammatory cells. Blood from patient and student is taken. Patient on dialysis presents with dyspnea.o. USG done – no specific findings. jaundice and RUQ pain. dullness (not hyperresonant) on percussion. makes her to lose her temper. but now is worse again. “Smth is about to happen”. not putting a baby to the breast to eat long enough 98. He talks in words. What is the reason? a. not putting a baby to the breast to eat frequently enough b. idea of reference c.e. What will you do? a. give another 12 puffs of salbutamol . Mother bring her child for consultation because he behaves and doesn’t listen to her. He improved. give steroids orally b. Next management? a. report to child protection agency b. What of the following drugs have the highest potential of fetal anomaly? a. 97. send her for good parenting programme c.diazepam c. Mom has given 6 puffs of salbutamol for him. marijuana 96. She beats him with the stick as a punishment and locks his door for hours. What is the most common reason of not having enough milk for breastfeeding in a new mom? a. 6 yo child presents with asthma attack. A 20 yo patient is complaining that “smth funny is going on around him”. depression 95. seek legal advice 94. schizophrenia prodromal b. give inhaled steroids d. but he doesn’t understand exactly what. methadone b. ask further what could be the cause of child’s misconduct. give ipratropium puffer c. methamphetamine d.