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Theme-1: Non Accidental injuries

A- Child physical abuse
B- Normal
C- Accidental injury
D- Malnutrition
E- Sexual abuse
F- Elderly abuse
G- Henoch Schönlein purpura
H- Idiopathic thrombocytopenic purpura

1.A few days old child has multiple dark bluish patches on the buttocks. The maternal grandparent is worried. The child's mother is white & the father black.
2.A 10 yr. girl is confused and has repeated fresh bloody staining of her panties. She is also reported to have incontinence of urine. Her parents think it could be due to her recently joining horse riding lessons.
3. A girl is unable to move her leg, which is swollen on examination X-ray reveals a spiral # femur, with no callus formation.
4. A 8 yr old ran into a door & hit his forehead & there is no loss of consciousnesses. He develops a swelling & pain on the head.
5. A 7 yr old is brought to the A & E with repeated bruises on his hand & wrists. Parents are having some bleeding disorder. On doing a venepuncture for taking blood, the kid develops a big bruise at the site.
6. An old man living with his daughter comes for the third time with bruises on his forearm & face





Theme-2: Investigations of Hoarseness

A-No investigations
B-Laryngoscopy
C-Lateral neck x-ray
D-Fiberoptic Laryngoscopy
E-Chest radiograph
F-Bronchoscopy
G-
7. A singer is having hoarseness of voice since the past 6 moths. What investigation will you do next..
8. A man reports to the A & E with hoarseness of voice. He had been to a football match the previous night. Next investigation..
9. A 60 yr chronic smoker complains of hoarseness of voice, shortness of breath, cough. Laryngoscopy is normal. Next investigation.





Theme-3: Bites Initial management

A- Tourniquet
B- Anti-rabies
C- Wash with soap & water
D- Anti-histamines
E- Adrenaline




10. Bite by weaver fish - ?
11. Bite by a bee to a woman who has severe reaction previously, now in stridor
12. Pt with dog bites.
13. An 8 yr old bites his elder brother.




Theme-4 : Stroke Prevention

A- Blood pressure control
B- Cholesterol reduction
C- Carotid end arterectomy
D- Warfarin
E-Manage in Stroke rehabilitation unit
F-Aspirin
G-Heparin
H-Weight Control

14. A patient having hemorrhagic shock. Now you want to decrease the further morbidity –
15. A pt. with stroke, which would help improve in life from morbidity.
16. A pt. has TIA., CAD & ___. Which measure will help reduce mortality.
17. In a pt. with Atrial fibrillation & h/o TIA, which measure helps in decreasing mortality.
18. A pt. with 80% carotid artery stenosis. He will have improved survival if…


Theme- 5: PPH - Initial most appropriate step

A- Ergometrine iv
B- Syntocinon Infusion
C- Inspection of placenta
D- Give fluids
E- Give blood
F- Genital tract examination under GA
G- USG Pelvis
H- Syntometrine iv.
I- Ergometrine IM
J- Intramyometrial prostaglandin
K- Oxytocin

20. PPH after forceps delivery, Uterus is fully contracted & placenta complete -
21. A 34 yr female has had postpartum hemorrhage during the last two deliveries. Now what will you do after the delivery of the baby in the present pregnancy.
22. A 28 yr female pt. bleeds 600-ml after delivery of the placenta. Next step.
23. A lady with fever & discharge after 10 days of delivery -


Theme-6 : Thyroid management

A- FNAC
B- Carbimazole
C- Thyroxine
D- Observation
E- Explore immediately
F-Propranolol
G-Thyroidectomy

24. 70-year lady with TSH 4 times normal
25. A woman with signs of graves disease & asthma
26. Lady with goiter, no symptoms & the tests are also inconclusive
27. A man with a 2 cm discrete nodule in the right thyroid
28. Pt having 2-cm swelling in the neck moves with swallowing. What investigation do you do to be sure it is not malignancy.
29. A pt. with loss of wt. despite appetite, increased sweating, diarrhoea is an asthmatic. TSH decreased but increased T3, T4, on investigation. Next step in treatment is. ______?
30. A pt. with a simple goiter. No signs of hyper or hypothyroidism. No antibodies to thyroid. TSH, T3, & T4 are normal.



Theme-7: Eye management & steps taken to stop further eye problems

A-Eye surgery
B-No management
C-Oral steroids
D-Beta blockers
E-Laser photocoagulation
F-Observation

31. Lady with headache & vision loss
32. 80 year old man with vision loss
33. Man with haloes around light
34. Woman suffering from SLE, & lens opacity
35. Diabetic with Proliferative Retinopathy



Theme-8 Psychiatry

A-Multi infarct dementia
B- Pseudo dementia
C-Alzheimer's dementia
D-Delirium
E- Frontal dementia syndrome
F-Schizophrenia
G- Depression
H-

37. A 80 yr. female is healthy & being taken care by her neighbours. They say that she is trying to go shopping at 4 am in the morning. They think that she is otherwise normal, except that her memory is not as good as before, & they think it may all be do to her old age.
38. A man living alone collapses, is brought to the hospital. After 3 days he starts talking to people whom others cannot see. He is not oriented in time & place.
39. A 45 yr man develops a viral infection. He has cough & fever since 2 days. His wife tells that he is confused & has decreased concentration & has no orientation about the place or time. She says he was alright one day before.
40. An elderly pt. with recurrent faints, with deteriorating mental functions.
41. A 40 yr female brings her husband to the A & E He talks about their sex life, but does not care about the problems at home which his wife tells about..
42. A 70 yr man says that his life is not worth living & asks others not to talk about him as it was a waste of their energy & time & he is not worth it too. He does all his work very slowly & has lost 5 kgs of wt.







Theme 9: Psychiatric epidemiology

A-Multi infarct dementia
B- Pseudo dementia
C-Alzheimer's dementia
D-Delirium
E- Frontal dementia syndrome
F-Lewy body dementia
G- Depression
H-

44. Most common dementia in UK
45. This dementia is characterized by neurofibrillary tangles & senile plaques.
46. A pt. is depressed & dementiated & responds a little to antidepressants.
47. Dementia with hypertension
48. Dementia with Parkinsonism like signs -




Theme-10: Causative agent

A-Streptococcus pneumoniae
B-Mycoplasma pneumoniae
C-Staphylococcus Aureus
D-Streptococcus pyogenes
E-Clostridium difficile

50. A 8 yr boy has cellulitis in his both hands with well-demarcated edges, pyrexia & increased WBC
51. A 24 yr old with dry cough, skin manifestations & bone, muscle aches. C X-ray shows patchy shadows.
52. A 60 yr male has pyrexia & an axillary abscess.
53. A patient in hospital is given a 3rd generation cephalosporin & it results in diarrhoea & other symptoms due to it. Most probable



Theme-11: Side effects of anti-psychotics

A- Lithium
B- Amitriptyline
C- Chlorpromazine
D- Imipramine
E- Phenelzine
F-Fluoxetine.
G-Clozapine
H-
55. A Schizophrenia pt. develops decreased WBC count, sore throat & increased sedation after being on a drug.
56. A pt. of mania is on a drug to prevent it as prophylaxis. she develops polyuria & other symptoms. Decreased TSH Increased T3 & altered T4.
57. Drug which causes Malignant hyperpyrexia
58. Drug which has anticholinergic side-effects
59. A schizophrenic female is on some drug, she develops discharge from breast & loss of libido.
60. A pt. of depression on a drug develops tremor, Blurred vision, dryness of mouth, eyes, tachycardia.
61. A Schizophrenic is on a drug, she develops tremors, Increased temperature, increased muscle Creatine kinase, Increased WBC.


Theme-12: Side effects of drugs

A- Rash
B-Reye's syndrome
C-Bronchoconstriction
D- Liver demage
E-Dry mouth

63. Tricyclics
64. When aspirin is taken by 6 year old child
65. Ibuprofen
66. Chlorpromazine
67. A 30 yr female swallows 12 gm of Paracetamol tablets, after a heated argument with her husband.


Theme-13: Mechanism behind

A-Drugs
B-Cilliary immobility
C-Decreased immunity
D-_____ Channel blockade
E-Nasal polyps
F-Eczema

68. Mechanism behind Cystic fibrosis. .
69. Broncholitis in children Mechanism.
70. Asthma in infants. Mechanism.


67-D, 68-? 69-? 70-

Theme-14: Skin conditions

A-Lentigo maligna
B-Solar keratosis
C-Malignant melanoma
D-Kaposi's sarcoma
71. A 16 yr girl has many multiple coloured moles of various sizes on the back of her trunk.
72. Farmer with skin problems
73. Man with a brown patch on forehead skin which grows slowly
74. HIV with?

71-A/C, 72-B, 73-A, 74-D

Theme-15 : Joint problems

A-Psoriatic arthropathy
B-Degenerative Osteoarthritis
C-Chondromalacia patella
D-Septic arthritis
75. An old patient has knee pain for 10 yrs but knee is not hot & swollen - ?
76. A patient on steroid, has hot & swollen knee -]
77. A man with 10 years pain in joints -
78. Pitting of the nails with arthropathy of distal interphallangeal joints



Theme-16: Myocardial infarction

A-Atropine
B-Pacemaker
C-Streptokinase
D-Altepase
E-Valve replacement
F-Nitrates
G-Angiography
H- Pacemaker replacement
I- Naproxen
J-Steroids
79. Myocardial infarction but no chest pain
80. Myocardial infarction with Heart block
81. Myocardial infarction with murmur
82. A pt. with chest pain, ECG showed T wave depression in L III, aVF & L II has pain & nausea for 2 hrs & it subsidies completely. Now he presents in the A & E after one hour. What do you give next.
83. A pt. develops chest pain, which subsides. He has an ejection systolic murmur, BP 110 /60-mmHg, low volume pulse. The Next step.
84. A pt. recovering from MI, collapses & O/E has a pulse of 36 / min. Next step.
85. A pt. develops pyrexia & pleural effusion one week after inferior Myocardial infarction.


Theme-17: Blood

A- Pernicious anemia
B- Aplastic Anemia
C- B12 deficiency
D- B12 malabsorption
E-
86. A 40 yr vegetarian presents with Macrocytosis, plasma folate levels are normal.
87. A known pt. with antibodies to intrinsic factor shows R B C of large size.
88. A pt. on treatment with Cyclophosphamide has anemia with decreased WBC count & decreased platelets.



Theme-18: Vaginal bleeding Investigation of choice

A- Cervical inspection
B- Cervical smear
C- Endometrial sampling
D- Hysteroscopy
E- Pregnancy test
F- USG
G- Gonadotrophin levels
H- Endometrial swab


89. A woman with irregular vaginal bleeding for 3 months, cervical smear 6 months ago was normal. what is the investigation of choice)
90. A Ca. Breast pt. is on tamoxifen & has vaginal discharge. Next step.
91. A 49 yr old presents with a 9 month history of prolonged slightly irregular periods. On clinical examination. normal sized uterus with no adnexal masses. Next investigation.
92. A 52 yr woman presents with a history of offensive vaginal discharge & intermittent vaginal bleeding over the past 3 months. her last cervical smear was taken 4 years back. Next step.
93. A 26 yr old with a 6 wk history of amenorrhoea presents in the A & E with vaginal bleeding. U S G has an empty uterus.
94. A 24 yr female is on OCP for 6 months without any problems. She changes her partner 2 wks back. She develops inter-menses bleeding & discharge. Investigation.


Theme- 19: CA breast management

A-Radiotherapy /
B-TENS
C-Bisphosphonates
D-


96. A 35 yr woman on 1-yr treatment for breast cancer with 12/20 lymph nodes positive, presents with a history of increasing confusion. She is drowsy & disoriented. Her husband reports of her complaining of severe thirst for the past week.
97. A 50 yr female pt. with Ca. Breast has metastases in the lumbar spine & has back pain.


Theme- 20: Renal area involvement

A- Renal interstitium
B- Renal cortex
C- Renal medulla
D- Renal papilla
E- Bladder
F- Urethral
G-Prostate
H-Ureteric


98. In sickle cell anemia which part of the kidney is involved.
99. A pt. with chronic hypertension, which part of the kidney is involved.
100. A pt. has dilated calyces & renal pelvis (hydronephrosis). Urinary bladder is full. He has incontinence. Cause is.
101. A female pt. presents with edema & proteinuria. Defect lies at
102. A 70 yr old man has difficulty in passing urine, nocturia & dribbling. The site of the defect is.


Theme-21 : Trauma next step

A-# reduction
B-. Immediate removal of plaster
C- Tapping out Blood
D- Angiography
E- Rapid I V fluid bolus
F- Splint the femoral #

104. Patient with RTA. has a # in the tibia. A POP cast is applied. He develops severe pain & loss of pulse below the cast. Next step.
105. A pt. has # at the head of fibula. P O P cast is applied & he is put under observation. After 8 hrs he develops foot drop. Next step.
106. A motorcyclist arrives in the A & E after a R T A. Airway is patent. He has deformed thigh on the Lt side. Next step.
107. A 23 yr old has a RTA. He is confused & smells alcohol.
108. A sportsman injures his knee. At the hospital, it is noted to be very painful to movement, & is swollen & has haemarthrosis. Rx. Tapping out Blood.


Theme-:

A-Metabolic acidosis
B-Hypokalaemia
C-Metabolic alkalosis
D-
110. A pt. with villous adenoma has profuse diarrhoea & is dehydrated.
111. A 45 yr man with pyloric stenosis has profuse vomiting & shows increased plasma HCO3 levels with hypokalaemia.



Theme-22: ENT (vertigo-hearing loss, tinnitus)

A- Anxiety
B- Vestibular Neuronitis
C- Migraine
D- Acoustic Neuroma
E- Meniere's disease.
F-

112. A 35 yr female develops vertigo every day, just before she has to leave to office..
113. A 40 yr pt. has hearing loss & vertigo, but as days pass hearing loss becomes more prominent than vertigo..
114. A pt. develops URTI following which she develops vertigo.
115. A 40 yr old presents with recurrent episodes of deafness & tinnitus..




Theme-23 : Head Injury

A- Brain stem injury
B- Cerebral hemorrhage
C- Depressed # skull
D- Extradural haematoma
E- Intracerebral haematoma
F- Acute Subdural haematoma
G- Chronic Subdural haematoma
H-Extradural hemorrhage.
I-.
117. A pt. is hit on the head by a hammer & has vomiting...
118. A young man fell over & there is an injury over his temple. He is alert & conscious.
119.A pt. with GCS-3, Bilaterally dilated pupils is on ventilator after RTA. Pulse 58/min, B P 110 / 80.
120. A 40 yr man sustains a head injury & becomes unconscious. Then he recovers to go home where after 3 hrs his wife finds him unconscious.


Theme-24: Post-operative complications

A-Chest X ray
B-VQ scan
C-Surgical exploration
D-Observation
E-


121. A patient already on steroids now having shock postoperatively?
122. pt. undergoes caesarean section for the delivery of a child. After 10 days she presents with bleeding. On USG, there is hemoperitoneum. Next step.
123. A 65 yr man after 10 days post hip replacement surgery presents with sudden breathlessness & collapses. On examination pleural rub, increased JVP, swollen right leg are seen. Next investigation.
124. A 70 yr gardner collapses while doing garden work. Afterwards O/E he is noted to be in profound confusion.
125. A man with hydrocele undergoes tapping. After one day he is pyrexial & the swelling has re appeared.


Theme- 25: acute abdomen

A-Abdominal X-ray
B-Barium enema
C-Small bowel enema
D-Mesenteric Angiogram
E-Chest X-ray
126. A 1 yr boy presents with vomiting, central abdominal pain with distention. He has blood & mucus per rectum.
127. a pt. has intermittent Abdominal pain, 30 min after meals. He also has a history of pain in the abdomen radiating to the back, O/E there is an abdominal bruit. The pt. also has intermittent claudication.
128. A 45 yr woman complains of abdominal pain. She has been having altered bowel habits recently. On examination the thickened sigmoid colon is palpable.


Theme: Mixed

130. A 5-year-old child comes with vomiting & confusion with 2 rashes behind his neck (Investigation)
131. A person is admitted in an I T U for being comatose. He has recently been on a holiday trip to Ghana. Next investigation.
132. A premature baby develops diarrhoea with blood in stools, after she is fed on formula feeds on the 4th day.
133. A 48 yr female is an IDDM pt., has been on treatment for 20 yrs. She has recurrent 3 episodes of hypoglycemia. She is on the same dose of insulin. Diagnosis.
134. A 67 yr diabetic on Metformin C/O severe epigastric pain, drowsiness & confusion. Diagnosis.
135. A 60-yr female pt. suddenly collapses while shopping in a supermarket. Her daughter says that her face was pale just before collapse. What could be the likely cause.
136. A 44 yr female undergoes hystrectomy under General Anesthesia after the surgery she complains of breathlessness & increased JVP. Diagnosis.
137. A pt. with irregular pulse, radial pulse rate is 90 / min. Next step..
138. A 22 yr old is involved in a R T A & is brought to the A&E. He appears stable, but while sitting up & talking he becomes progressively breathless. Reduced air entry on the Lt side. Next step.
139. A 24 yr woman who is taking O C pills for 5 months presents with palpitations & On examination he has a diastolic murmur & a thrill. Next step.
140.A 32 yr woman on OC pills for 9 months develops swelling of legs, pain in the calf, bilateral pedal edema. Investigation.
141. A 20 yr old has been taking OCPs since the last 5 months. She comes with a history of cough producing green sputum & fever over the last 2 - 3 days. Next investigation.


142. A pt. is confused & drowsy, he has flapping tremor & asterexis. What do you investigate for..
143. A pt. has a pan-systolic murmur, increased JVP, liver is palpable 3 cm below the rib margin.
144. A 4-month child develops dribbling of saliva from the mouth. He has severe abdominal pain & is pyrexial & refuses to eat or drink...

Theme-: Kidney investigation

A-Plasma Urea
B-Electrolytes
C-Serum Creatinine
D-Plasma glucose levels
E-IVU
F- Cystoscopy
G-Mid stream urine culture
H-Urethral swab

151.A pt. who has been normal has glucosuria & mild ketonuria..
152. pt. who has never been to the hospital has a RBS 17.5 m mol / l . She has mild proteinuria & on ophthalmoscopy there is non Proliferative retinopathy...
153. A female child presents with frequency & dysuria. It's the 3rd such episode. On culture of urine E.coli are seen...
154. A man has pyrexia, dysuria & pus at the external urethral meatus. Both testes are swollen & tender.


Theme- : Urinary Retention

A-Spinal cord compression
B-Renal Failure
C-BPH
D-CA Prostate
155. A 50 yr female pt. with mild jaundice is not able to pass urine, she is confused, tired & has hiccups.
156. A pt. with malignancy develops weakness of both legs with difficulty in walking. There is urinary retention.
157. A pt. with hesitancy during micturition, nocturia has a large amount of alcohol & presents with retention of urine.

ANSWERS

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1- B/A,
2- E,
3- D,
4- C/B,
5- H,
6-F
7-B/A
8- A
9- E/F
10-
11- E it may be life saving as anaphylaxis
12- B/C
13- C
14- E
15-E
16-A/B/H
17- D/F/G
18- B/A/C
20- F,
21- J/I,
22-A/I/J,
23-G (endometritis)
24-C,
25-B,
26-D,
27-A,
28-A,
29-F/B,
30-D/G/A
31- C,
32- B,
33- D,
34- A,
35-E
37-C,
38-D,
39- D,
40- A,
41 E,
42- G
44-C,
45- C,
46-B,
47-A,
48-F
50-Erysiplelas by D,
51-B/A,
52-C,
53-E
55-g
56-a
57-c
58-b
59-c
60-b/e/f
61-c
63-e,
64-b,
65-c,
66-a,
67-d
75-C,
76- D Septic arthritis [As steroid leads to increased susceptibility to infections
77-B,
78-A
79-C
80-A/H
81-E
82-?
83-E/G
84-?
86-c
87-c/a
88-b
89-c
90-?
91-g
92-a
93-e
94-?
96-c
97-?
98-d
99-?
100-e/f
101-?
102-g
104-b
105-?
106-?
107-
108-c
110-b
111-c
112-c/a
113-d
114-b
115-e
116-e
117-d/c
118-a/b
119-?
120-
121-?
122-c
123-b
124-
125-c
126-e/a
127-d
128-b/c
129-
130-
130- Blood culture
131 Thick & Thin Blood Smear.
132.?
133. Possible infection.
134.. Lactic acidosis.
135. Cardiac rhythm disturbance / T I A / Postural hypotension.
136.. Fluid overload.
137. Digoxin / Heparin / Warfarin.
138.. Chest drain after needle thoracocentesis
139. Next step. Echocardiography.
140.. Duplex ultrasound scanning.
141. C X-ray.
142. Liver function tests / Liver ultrasonogram.
143.. Investigation/RX
144. Gingivostomatitis / Intestinal obstruction.
145-
146-
147-
148-
149-
150-
151-D
152-A/B/C
153-E/F
154-B
155-A
156-C