NOVEMBER 2011 RECALLS

1.A middle aged woman with calf pain from yesterday came to hospital; you did investigations and diagnosed deep vein thrombosis. Now she doesnt have any problem. What is next step in Mx? a. Inpatient management with compression socking and LMWH b. Inpatient management with leg elevation and LMWH c. Outpatient management with compression and LMWH d. Outpatient management with lag elevation and LMWH

2.A 55 year old worker of insulating factory for 30 years, came with breathlessness from several months ago and now with haemoptysis, (CXR was given; unilateral pleural effusion was obvious!) he has smoked from 20 years ago. Whats the diagnosis? a. Squamous cell Ca b. Small cell Ca c. Mesothelioma 3.A girl who visited SE Asia 6 months ago now has c/o diarrhoea, 3 kg wt loss, loss of appetite. Stool results: Blastocystis hominis and Giardia lamblia positive. What could be the cause for her presentation? (Feb 2011-Q 44) a) Blastocystis hominis b) Giardia lambliac c) Coeliac disease d) Rotavirus

4. A young lady with history of central chest pain and sweating for half an hour. In Ph/E everythings was NL, EKG, troponin, CXR and CTPA were NL. whats the next step? a. Check troponin in 8 hours b. Discharge the patient

5. 60y man comes with severe sudden chest pain, vomiting and sweating. ECG and Troponin level are normal. Whats the next management? a) Check troponin again in 8 h b) Admit patient to CCU c) Discharge pt with B Blocker and Aspirin.

d) Discharge pt without any drug

6. Patient with cluster headache. Treatment? a. Steroid b. Somatriptan c. Vigabatrin d. Na- valproate 7. z-score in bone densitometry for femoral neck was :-2.5 and for hip was:-1.5 what do you do? a. Reassre and do nothing b. Start immediately on biphosphonates c. Advise regular intake of calcium
nd

8. In 2 day after operation, patient suddenly became very agitated and anxious, apart from O2 which is very important to do? a. Starting anticoagulant therapy b. Brain CT c. hallopridole 9. Old patient felt pain in the buttock and thigh yesterday while walking, today he felt it again when he wanted to come to see you. In the examination there is slight tenderness in arm muscles. he is on treatment of HTN, hyperlipidemia and gout. He uses ACEi, atrovastatin Which one is the important next step to do? a. check creatinin and electrolytes b.EMG c. nerve conduction studies

10. Old lady stretches her back to open the window pf her house then suffered from back pain, MCV < 98, microcytic hypochromic anemia blood picture(huge presentation of full blood count) urea, creatinin and electrolytes). What is the most likely diagnosis?. a. Osteoporosis b. Multiple myeloma 11. Old lady case, presents with back pain. MCV <98, microcytic hypochromic anemia blood picture. What is the most appropriate investigation?. a. CT b. X Ray

c. Urine & serum electrophoresis d. ESR

15. An elderly patient, who developed agitation, confusion, after surgery. What is the most likely diagnosis?. a. Alcohol withdrawl b. Pulmonary embolism c. Hypoxia

16. Parents are screened for cysic fibrosis. One is found to be a carrier, what is the chance that their child will be affected by cystic fibrosis?. a. 0 b. 0.25 c. 0.5 d. all males will be affected.

17. Parents screened for haemophilia, mother is found to be a carrier. What is the chance of their children being affected?. a. 0.5 regardless of the sex b. all girls carriers c. all boys affected.

18. Old woman with carcinoma of caecum. what would be the most likely symptom? a) RIF mass b) Altered bowel habit c) Tiredness, fatigue d) Melena e) Bleeding

19. A young woman comes with first time seizure. She had history of sudden spasms and twitching of muscles in past few years. What is your advice about driving? a. no driving for 6 months b. no driving for 3 months c. no driving for 1 months d. can not drive any more

20. An old truck driver has 6/36 vision. He can see well with his glasses. After consulting with you, he goes to another GP and claims that he was given the ok to continue driving. What will you do?. a. Advise him not to drive b. Speak to the other GP c. Report to vic roads

21. A patient aged 35 yrs, comes for advise regarding screening for colon ca. His maternal aunt was diagnosed with HNPCC. What will you advise?. a. Sigmoidoscopy b. Genetic coulcelling c. Colonoscopy d. FOBT 22. How do you assess Pulmonary function in a patient with GBS?. a. C X Ray b. FVC c. EMG d. PEFR e. Spirometry 23. A 6 month old baby was born premature. Birth wt was 1.5 kgs, and is now 6 kgs at 6 months. What can you comment about the baby s weight?. a. underweight b. good weight c. over weight

24. Apart from Folate prescribing which one for a pregnant woman can reduce the risk of neurological problem in fetus? a. Iodine b. Iron c. Beta carotene d. Vitamin B 12 e. Vitamin B complex 25. a16-year old female comes to GP for OCP prescription, she conveyed her mother and sister were diagnosed with DVT. What is the next step in management? a. No OCPs use condoms b. Only progesterone pills c. OCPs can be prescribed d. Thrombophilia screening before prescription

26. A female patient 22yo who is 8 weeks pregnant. She was on OCP now complains of bleeding after intercourse. What is the most propable cause? a) cervical CA b) Ectropion c) Endocervical polyp d) atrophicvaginiti

27.A 20 yr old presents to the E.D for heaving bleeding after coitus. What is the most common cause? a.cervical polyp b.cervicalectropion c.fibroids

28. An elderly woman with urge incontinence, what will be the Mx? a. bladder re-education b. pelvic floor exercise

29. An elderly woman with uterus prolapse, what is the Mx? a. pelvic floor exercise b. b. pessary

30. USG abdome. Showing an ovarian cyst 4 cm. Young girl in your GP, with no particular complaints. What will you advise?. a. Immediate aspiration b. Re scan after 6 wks c. serum markers for ovarian ca

31. Picture of a finger and pt couldnt extend the finger actively; asked about the kind of pressure which leads to this problem: a. Hyper flexion while finger was extended b. Hyper extension while finger was flexed

32. Post-op. fever appears on 3rd day. Which is most likely.

a) actelectesis b) wounddehinscence c) wound infection d) abscess formation e) pneumonia

33. Case of male patient with Pelvic trauma. Patient fails to void urine. On examination blood is seen on urethral meatus. What is the next appropriate management? a) Suprapubic catheter b) urethral catheter c) urethrogram

34. A 60 yr old female, with a mass palpable in the right hypochondrium, which moves with respiration. She has a 2 wk h/o jaundice, dark urine and pale stools. She complains of vague pain in that area. No h/o alcohol intake, or any other medication. What is the most likely diagnosis?. a. Cholangitis b. Choledocholithiasis c. Ca Ampulla of Vater d. Cholecystitis

38. A patient suffering from chest pain and dyspnoes on the 5 th post op day. What test will help you establish a diagnosis?. a. Cardiac enzymes b. ECG c. CTPA d. oxygen saturation test 39. Picture similar to Q 3.025 in page 397 HMCQ (pt is trying to look at left) which nerve palsy? (this question was modified this time with further/different options and the picture was different person with same features) as: rd a. 3 Right nerve palsy /3rd left nerve palsy th b. 6 Right nerve palsy /6th left nerve palsy rd c. 3 Left nerve palsy /3rd right nerve palsy th d. 6 Left nerve palsy /3rd left nerve palsy

40. What symptoms and signs do you expect to find in a patient with caecum cancer? a. Anemia

b. Altered bowel habbits c. Bleeding PR d. pneumaturia in colo-vesical fistula

41. X-Ray of the wrist. Most common complication (assuming it s Colles #) a. Malunion b. Non union c. Stiffness of the joint.

42. Post thyroidectomy patient, c/o dyspnoea. What would you do?. a. Immediately remove the sutures b. transfer to surgery c. intubate and ventilate

44. 60 yr old Chinese Malaysian lady, no known co- morbidities, C/O passing non bloody diarrhoea for? (how long) Colonoscopy showed inflammation and stricture at the terminal ilium. What is the most likely diagnosis?. a. yersenia enterocolitis b. Pseudomembranous colitis c. (no Colon Ca, Chrons or Ulcerative colitis as options)

45. A woman who delivered her baby 6 weeks ago and no breast feeding came for advice for contraception. On her profile was written Do not prescribe OCP. You find out that her husband doesnt want her wife uses OCP. What would be your approach? a. Tell her that she has the right to use contraception b. Discuss with her husband and then advice OCP c. Do not prescribe contraceptive

46.a mother brought her child due to some problem, you diagnosed thet the child needs more investigation with CT, parents got divoce 3-4 month ago, you arrange CT scan for nearby hospital, but the day after that you noticed theyve never gone to hospital what would be your next step? a. call child care b. call to mother c. wait 14 days to come back then contact them 47. A new drug is discovered, which affects the progression of the disease, but not the mortality. Which is the most appropriate statement?.

a. increase incidence b. decrease incidence c. Increase prevalence d. decrease prevalence

48. One of your colleagues during the lunch time asks you to prescribe him some medication because he can not sleep appropriately recently. What will you do? a) Give him prescription b) Advise him drink hot milk before sleep c) Advise him relaxation and exercise d) Inform medical board e) Recommend him to visit a doctor 49.A young woman comes with first time seizure. She had history of sudden spasms and twitching of muscles in past few years. What is your advice about driving? a) no driving for 6 months b) no driving for 3 months c) no driving for 1 months d) can not drive any more

50. A 70 yr old Italian lady diagnosed to have Pancreatic ca. Her son rushes to your clinic, wishing to see you. He asks you not to tell his mother about the diagnosis, as she is sensitive and amy not be able to cope with the information. What do you do?. a. Tell the son that you can not respond to relatives requests. b. Tell him it is the right of the patient to be informed c. Seek advise from the medical board of advisors

52.Which of the following does NOT provide much information?. a. case control b. Cohort study c. Randomised control trial d. Case report there were many questions from population 53. you are a gp of small community and you have noticed high number of cases of Chlamydia in your clinic. In order to curb the infection what approace you are going to take. a) Ask all the community members to visit clinic and get checked for Chlamydia. b) Provide condoms in schools and colleges

c) Distribute public educational seminars and pamphlets about Chlamydia awareness and prevention d) Advise the community members to get checked for chalmydia yearly 54. You are conducting a randominzed controlled trials. In the result drug b has better affects that drug A. a) b) c) d) More trials are not required after this trial Proves that drug b should be prescribed and drug A not Both drug b and drug A can be prescribed Drug B seems to have better results Than Drug A, but both can be prescribed accordingly

55. What does the value of P less than 0.01 stands for? 56. What is 95% confidence interval This time too any questions from Randomized controlled trials. 57. A 80 year old man had already gone many surgical procedures and as a his doctor you believe that another surgical procedure can be very help ful for him. The mini mental status of old man was given has 26/30. his daughter approaches you and tells you that she has power of Attorney and requests you not to perform this procedure as he has already gone through lot of agony. What would be your approach? a) agree with daughters decision as she has power of attorney b) refuse the daughters advice and perform the S/p by your own decision as it would in the best interest of patient c) Ask the patient d) consult the health services council (or a body which takes decision on such matter)

58.Patient with known case of moderate renal failure and on warfarin for AF came with chest infection and sepsis. INR 2.2. in addition to IV antibiotics, what else would you give? a) LMW hep b) Unfrac hep c) Aspirin d) Clopidogrel e) Do nothing

59.Who is at the most risk if a patient is psychotic? a) Children b) Parents c) Neighbors d) Friends 60.Which past history is significant if the patient is violent? a) Crimes b) Cruelty to animals 61.Old patient sustained back pain while opening window. X ray compressed fracture at L4. Lab results : Hb low, K high, urea high, creat high. What is the next investigation? a) Bone scan b) Serum calcium c) Urine and serum electrophoresis 62.Patient came with post prandial abdominal pain a) PID b) Mesenteric adenitis c) Mesenteric ischaemia

63.Chest x ray with mediastinal lympadenopathy. Patient came with night sweats, fever, malaise, loss of weight, dry cough for a few months. a) TB b) Sarcoidosis c) Lymphaema d) 64.Chest xray: left sided pleural effusion. Patient working in a insulating industry for a 30 years. Also smoker. a) Ca of bronchus b) Asbestosis c) Silicosis d) Mesothelioma 65.Child with encoperesis

a) Laxatives 66.Old lady with incontinence a) Bladder re-education 67.Patient broke up with girlfriend and threaten to kill himself, associated violent behavior. Brought to hosp by police, tells he will suspend the police officer. Demands a super specialist to threat him. a) Borderline b) Histrionic 68.Baby with poor feeding, lethargy, increased temperature. Which is the most appropriate investigation? a) LP b) Urine culture c) FBC 69.Young lady with lump in breast. Lump was same consistency as the whole breast and soft. USG shows hypoechoiec lesion. a) Brest Ca b) Breast cyst c) Fibroadenoma 70.ECG of V-tac. Patient stable. What do you give? a) Verapamil b) Digoxin c) Amiodarone d) Cardioversion 71.Patient with sudden SOB and chest pain. Chest x ray given. ECG S1Q3T3. What is the appropriate investigation? a) D dimer b) CTPA 72.Patient with known case of gout on colchicines. Now came with knew swelling and pain. What will you give? a) Allopurinol b) Indomethacin

c) Steroids d) Continue colchine

77. Old woman needing urgent surgery is on warfarin and other many medicines Vit k FFP Stop warfarin and start heparin Platelet transfusion 78. Child with murmur heard in both systolic and diastolic. Venous hum Stills murmur PDA VSD 79. Correct sentence about long term naltrexone use for opiod addicts 80. Child with enuseris wants to go to camp next week . immediate treatment Alarm clocks with timed voiding Enuresis alarms Desmopressin spray Imipramine 81. Man with diplopia . isolated 3rd nerve palsy Berry aneurysm Diabetes mellitus Tumor 82. ill child with high fever .difficulty in breathing crowing cough next step iv antibioitic neb salbutomol 83. ct san of hepatocellullar carcinoma 84. xray of pleural effusion mesothilioma\ 85. stem of clinical pic of acute appendicitis RIF pain but blood picture showed obstructive type of jaundice and no option of choledocolitiasis (

not sure wwht that was ) acute appendicitis acute cholescytitis acute pancreatitis 86.man met with a mva ..had blood in meatus.. he wants to pass urine now ..what is the next step suprapubic catheter cystoscopy soft urinary catheter ct urogram 87.baby getting up in the middle of the night and crying only settles with a bottle of juice.next step change to cow milk change to water give antacid before sleeping 89.old woman comes with h/o of nausea dizziness and loss of movement in right arm ..which recovered ..had similar history a yr before. o/e arm muscle tone and reflex normal MS Conversion disorder 90.lady coming with 2 day bloody diaherra and abdo pain cause but no history of travel camplyobacteria jejuni toxic ecoli giardiasis

91. lady coming with vomiting and abdo pain culture shows salmonella..treatment Broad spectrum antibiotic like ampicillin Trimethoprim amd sulfa Vancomycin 92.Question about dawn and somogyi effect of DM 93.Women asking for medications history of insomniarecently diagnosed breast cancer 94.Man with hypertension and heamaturia bilateral kidney palpated RCC

Polycystic Kidney Disease 95.man with painless hematuria and ultrasound shows enlarged medial lobe of prostrate ..next step in management ct scan prostrate cystoscopy 96.how often to monitor lithium 3 months 6 months 9 months 97.treatmeant of sle 98..Kawasaki 99.Alcolhol withdrawal 100.Lewy body dementia 101.Women with cord prolapsed 102.Normal labour 103.Factitious disorder 104.Advance directives 105.Do diabetes well so many different questions 106.SCC picture 107.Breat discharge bloody nipple discharge and a 8mm small lump what is it? 108.Girl with no breast development only pubic hair..no menses..diagnoses?? 109. Stem of IM but monotest negative but blood pic show lympocytosis .. next step

110. You have diagnosed a 70 y/o Italian woman to have pancreatic cancer. Her son requests to urgently speak to you, and he asks you to please not to tell his mother of her disease. The most appropriate response should be? a. Tell the son that you cannot act on relatives consent b. Tell the son to have a family meeting to discuss the matter with the other relatives c. Contact your medical boards legal advise to enquire about this d. Consent and give your patient a false diagnosis e. Tell the nurse staff to deal with the situation 111.An 86 y/o female patient has come to you requesting euthanasia, as she was recently diagnosed with a terminal disease, having been a long-standing sufferer of multiple chronic illnesses. She lives with her daughter and grandson, and she does not wish to be a burden to her family. The most appropriate response should be? f. Proceed, as she has given you informed consent g. Discuss pros and cons of euthanasia h. Advise her that euthanasia is not legal in Australia i. Refer her to a psychiatrist j. Unwillingly admit her and start ECT on the basis of depression 112.A 22 y/o primigravida presents to the emergency department of a regional medical center at week 26 of gestational age. She has had a clear discharge per vagina. Speculum exam confirms active loss of a fluid, consistent with amniotic liquid, through cervix. Transfer to a tertiary hospital has been arranged, what else should you do next? k. Tocolysis l. Per vagina exam m. Steroids injection n. Induction of labor o. CTG (Neither swabs nor antibiotics were options) 113. a. b. c. d. e. What of the following is a contra indication for tocolysis? (one liner) Asthma Preeclampsia Congestive Heart Failure Antepartum hemorrhage Diabetes Mellitus

114. A 45 y/o female patient comes to you for advise on breast cancer prevention. Her mother died at 50 years of age from breast cancer and her sister was diagnosed with it at the age of 37 years. What is the best course of action for this patient? a. Breast screening should commence at 50 years of age b. Breast ultrasound now

c. Refer to genetic clinic for close surveillance d. Fine needle aspiration and cytology of the dominant nodule e. Yearly clinical review and 2 yearly mammography studies, commencing now 115. A 50 y/o men seek s advice on prostatic cancer prevention. He understands that there is a blood test that helps discovering the disease. He has a brother who was recently diagnosed with prostatic cancer. What is the best course of action for this patient? a. Digital rectal exam (DRE) b. Prostatic specific antigen (PSA) c. Ultrasound guided prostatic biopsy d. DRE + PSA e. Reassure 116. A 4 m/o boy, whose parent are from Sudan, is brought to you by his mother, who refers her baby has been feeding irregularly and generally looks unwell. Labs are as follows: i. Hb: 90 gr/L ii. WBC 5 x 109/L iii. Platelets 300 x 109/L iv. Bilirubin 240 mmol/L (<200 mmo/L) v. 25-hydroxylase (slightly elevated) Which of the results is most likely to reveal the cause of this boys symptoms? b. Hemoglobin c. WBC d. Platelets e. Bilirubin f. 25-hydroxylase 117. A 34 y/o patient in day 4 post laparoscopic cholecystectomy develops fever of 38.7 C. On examination he looks unwell and sweaty, HR 180 bpm, RR 24 bpm, BP 110/60 mmHg. Abdominal wall is tender, indurated and redden at the level of the umbilicus, the rest of the examination is unremarkable. What of the following is the most likely cause of the presentation: a. Meningitis b. Atelectasis c. Pelvic abscess d. Umbilical wound infection e. Vein catheter infection 118. A 10 y/o boy is brought,by his mother, to the emergency department. The boy explains that, while playing football he felt his heart racing. Physical examination HR 140 bpm, BP 90/60 mmHg. An ECG was performed and the result was the following:

Which of the following is the next step in management? a. Shock cardioversion b. Adenosine c. B-Blockers d. Valsalva maneuver e. Reassure the mother and discharge the boy 119. A 19 y/o man was seen in the emergency department 2 months ago after his first episode of tonic-clonic seizure. You medicated him and advised him that he must be on a 6 months seizure free period before he can drive again. In his control today you have learnt that he has been driving as part of his work as plumber. What is the most appropriate response? a. Report him to his employer b. Report him to the drivers licensing authority c. Recommend him to use his medication before driving d. Take no further action e. Retain him and call the police

MORE 2011 NOV RECALLS

treatment of convulsions after delivery in hypertensive pt sternomastoid tumour coeliac disease non dominant parietal lobe lesion painless rectal bleeding in elderly...divertiular disease pharyngeal pouch x ray x rays of samall intestine large intestine obstruction, sigmoid volvulus variceal bleeding pulmonary embolism ecg acute pericarditis IgA nephropathy Diabetic retinopathy fondoscopy 3rd nerve palsy but presrvation of pupilary reflex-DM 25yrs male with testicular swelling many psychiatry ethics risk factors of colonic carcinoma schizzzzzoophrenia too many questions hyaline membrane disease labrynthitis

food causing asthma- sulphite food allregy

most common hernia which undergoes strangulation- femoral

cystic fibrosis risk- 1 in 4

hemophilia- no girl n half the boys

pneumonia which doesnt causes abscess....--?

wof causes hepatoma- cirrhosis or hemochromatosis..

which of the following drug combinations shouldnt b used- in renal failure NSAID, ACEI n furesemide

an xray of sigmoid volvulus

an xray of small intestinal obstruction

ECG for hyperkalemia n the patient was on ACEIS--> i wrote stop aceis.(it was quite long question with many lab values n pt was on many drugs)

a child with features of ADHD__> talk to teacher

a post menopausal women started on HRT-- shez at risk of which cancer__> Both breast n endometrial cancers