NIDDM (564/1700)

A 45yo man with colon cancer now develops increased thirst, increased frequency in urination and weight loss. His fasting blood glucose=9mmol/L. what is the most appropriate management?
a. Oral hypoglycemic
b. Insulin long acting
c. Short acting insulin before meal
d. IV insulin
e. Subcutaneous insulin

ECG: wide QRS tachycardia (498/1700)

An ECG of an elderly lady who collapsed in the ED shows rapid ventricular rate of 220bpm,
QRS=140ms. What is the most probable dx?
a. Atrial fibrillation
b. VT
c. SVT
d. Mobitz type1 2nd degree heart block
e. Sinus tachycardia

ECG (439/1700)

A 72yo man is found to be not breathing in the CCU with the following rhythm. What is the most
likely dx?

a. SVT
b. VT
c. VF
d. Atrial fib
e. Atrial flutter

ECG (363/1700)

A 66yo man has the following ECG. What is the most appropriate next step in management?

a. Metoprolol
b. Digoxin
c. Carotid sinus massage
d. Adenosine
e. Amiodarone

Urinary Stone (931/1700)

A pt had passed a 4mm stone in his urine. He has a 3mm stone in the renal pelvis found on US.
What is the management?
a. ESWL
b. None
c. Dormier basket
d. Surgery
e. PCNL

Basketball Match, Player fell (936/1700)

During a basketball match, one of the players suddenly collapsed to the ground with coughing and SOB. What is the inv of choice?
a. CXR
b. CT
c. MRI
d. V/Q scan
e. CTPA

Progressive dyspnea, cough and mucopurulent sputum (903/1700)

A pt presents with progressive dyspnea. He complains of cough, wheeze and a table spoonful of
mucopurulent sputum for the last 18m. Spirometry has been done. FEV1/FVC=2.3/3.6. After taking salbutamol, the ratio=2.4/3.7. What is the most likely dx?

a. Chronic bronchitis
b. Asthma
c. Bronchiectasis
d. Lung fibrosis
e. Sarcoidosis

Fracture of femur, shock (899/1700)

A young male met with a RTA and is suspected to have a femur fx. His BP is 90/60mmHg. What is the next immediate action?

a. XR
b. IV fluids
c. Put leg splint
d. Send bloods for inv
e. US

Pain relief in a young asthmatic child (1496/1700)

A 4yo child comes with a sprain in his foot. Hx reveals that the child has had recurrent admissions to the hosp due to severe asthma. What is the most appropriate analgesic?

a. Diclofenac sodium
b. Ibuprofen
c. Paracetamol
d. Codeine

HUS vs TTP (1487/1700)

A middle aged lady presented with fever, altered sensorium, bleeding gums and jaundice. Labs: deranged renal function tests, normal PT/APTT, fragmented RBCs and low plts. What’s the most likely dx?

a. Cholesterol emboli
b. HUS
c. TTP
d. Hepatorenal syndrome
e. Sepsis

Hoarseness of Voice (1434/1700)

A 22yo man reports a 2d hx of hoarseness of voice. He denies any weight loss but he has been smoking for 4yrs. What is the single most appropriate inv?
a. None
b. Laryngoscopy
c. Bronchoscopy
d. BAL
e. CXR

Maxillary division of trigeminal (1312/1700)

A pt with vesicles in the maxillary divison of trigeminal nerve. Which area of mucus membrane will be involved?
a. Palate
b. Cheek
c. Cornea
d. Conjunctiva

Proptosis (1390/1700)

A 7yo boy presents with proptosis and periorbital edema. What is the immediate action that needs to be taken?
a. IV morphine and immediate ophthalmoscopy
b. IV morphine
c. Observation only

Pneumonia (1418/1700)

A 49yo man comes with hx of cough and SOB. His CD4 count is measured as 350. CXR shows lobar consolidation. What is the single most appropriate option?

a. Mycobacterium avium intercellular
b. CMV
c. Streptococcus
d. Toxoplasmosis
e. Pneumocystis jerovici

Acute Red Eye (807/1700)

A 52yo man has a painful, red, photophobic right eye with slightly blurred vision and watering
for 3days. He has had no such episodes in the past. On slit lamp examination there are cells and
flare in the ant chamber and pupil is sluggish to react. What is the single most appropriate
clinical dx?
a. Acute close-angle glaucoma
b. Acute conjunctivitis
c. Acute dacrocystitis
d. Acute iritis
e. Corneal foreign body

Cervical ectropion (1481/1700)

A 35yo woman who usually has 4 days mid-cycle bleeding, had her period 10d ago. She has now presented with spots of blood. Her smear was normal 6m ago. Exam: cervical ectropion which doesn’t bleed on touch. What would you do?

a. Cervical smear
b. Endocervical swab
c. US guided biopsy
d. Laparotomy
e. Transvaginal US
f. Punch biopsy
g. Serum estradiol
h. Colposcopy

Hepatitis B vertical transmission (1336/1700)

A mother got infected with Hep B during pregnancy. Her child is born and she is worried about
the risk of infection to the baby with Hep B. What would you give to the baby?
a. Hep B Ig only
b. Hep B full vaccine and Ig
c. Hep B vaccine only once
d. Nothing until immune status is checked
e. Hep B vaccine once and Ig

Ophthalmic anesthesia (1665/1700)

An elderly lady with COPD has chronic SOB. She is listed for cataract extraction. What is the anaesthetic of choice?
a. Facial nerve block
b. Bupivacaine infiltration of the peri-orbital skin
c. IV midazolam
d. Peribulbar acupuncture
e. Peribulbar lignocaine infiltration
f. Topical xylocaine
g. IV alfentanil
h. Epidural anesthesia
i. General anesthesia
j. Retrobulbar xylocaine Inj

Night sweats, lymphadenopathy, splenomegaly (1335/1700)

A 26yo man has returned from NY to the UK and noticed weight loss, night sweats, temp=37.5C and cervical lymphadenopathy. He also has splenomegaly. What is the dx?
a. TB
b. Lymphoma
c. Bronchial carcinoma
d. Bronchitis

Pansystolic murmur at sternal edge (1333/1700)

A new born bay is borught with pansystolic murmur at sternal border but the baby is not
cyanosed. What is the dx?

a. VSD
b. ASD
c. TOF
d. PDA