Genetics

1) Pattern of inheritence of cystic fibrosis… 1 in 4

2) Patient has dificulty in climbing stairs… diminished reflexes, muscles wasted… Duchene muscular
dystrophy or GBS

Derma
1) Oral sores on the tongue with whitish plaques on ventral surface… Lichen Planus
2) Annular rash… lyme antibodies
3) Patient 4 days after taking antibiotic develops rash.. erythemia multiforme
4) Allergic reaction - none of the indications of adrenaline were given… Oral chlorpheniramine
5) Allergic reactiion… patient had SOB… IM adrenaline 5ml 1in1000
6) Macule that bleeds on touch... SCC
7) Cellulitis... choice of antibiotic? Flucloxacilin + benzylpenicilin

CVS
1) Scenario of infective endocarditis (mention of prosthetic heart valve)... initial inv?
2) Post MI… dyspnea on climbing mountain… left vent aneurysm
3) Post MI… patient became unconscious… VF
4) Post MI… basal crackles… asked the CAUSE for this condition? pulmonary oedema/embolus
5) ECG 1... Atrial fibrillation
6) ECG 2... Atrial Fibrillation
7) ECG 3… SVT
8) Patient with HF, treatment done… develops hot swollen joint in foot… drug side effect ( thiazide)
9) Lady living alone, recurrent falls… cardiac arrhythmia
10) Scenario of MI, NSTEMI… immediate tx? aspirin + LMWH
11) Scenario of angina... inv? Stress ecg
12) Suspicion of cardiac temponade asked about beck’s triad of muffled heart sounds, raised JVP
13) Women on haloperidol and bendro? Drug side effects

Psychiatery
1) Suicide attempt after bf left her, she regrets it? Admission
2) A case of MS, takes paracetamol OD now refusing tx… assess patient’s ability to refuse tx
3) Gradual loss of memory, recently not able to recognize family, frnds, gets lost when goes out…
alzheimers
4) Patient saw and accident, presented 1 day later with visual loss… conversion disorder
5) HIV positive - Typical presentation of hypochrondiasis
6) Scenario of schizophrenia...tx: olanzapine
7) A girl having issues with boyfriend… Borderline personality
8) Post op patient… becomes agitated, insects crawling in bed… Delirium
9) Patient with severe depression (low mood, loss of interest, insomnia, asking frnds to help him
end his life) ... ECT
10) Anorexia nervosa… height 165cm, weight 33kg… Detain under mental health act
 11) Child does not interact with friends, has repitiive behavior… Autisim
12) Patient with moderate depression and hx of heart disease… Citalopram
13) Another one with SSRIs
14) Symptoms of Parkinsonism… drug group responsible? Antipsychotics
15) Patient was afraid to go out of her home, only went out with her husband... agoraphobia
16) Patient after rectal Ca surgery had pain, was angry, shouting and blaming the surgeon. Later on
he thanked the surgeon… ans: adjustment disorder?
17) History of depression and self harm, family history of suicides, no social support…. which one
among them is the most dangerous risk?
18) Patient attempted suicide, symptoms of tinnitus, hyperthermia, sweating………. Paracetamol
19) Patient alcoholic admitted has symptoms of delirium... chlordiazepoxide
20) Another one had ophthalmoplegia, ataxia, confusion... IV thiamine
21) Guilty with persecutions? Olanzapine
22) Anxious girl? CBT or Relaxing therapy

CNS
1) Loss of shrugging of shoulders… accesory nerve damage
2) Tongue deviation, hx of injury to neck… hypoglossal nerve injury
3) Typical scenario of Stroke – slurred speech and arm involvement
4) Patient with SNHL, past pointing, ataxia… investigation: MRI brain
5) Scenario of MS… MRI brain
6) Typical scenario of migraine
7) Patient with abdominal pain...all examinations and investigations normal… abdominal migraine
8) Child with meningitis was treated… outcome? full recovery
9) Scenario of spinal cord compression… MRI
10) Ulnar claw hand... how to check? Adduction of fingers
11) Scenario of median nerve injury... unable to oppose the thumb, thenar wasting
12) Pt unable to close eye lid... facial nerve

Eye
1) Cervical spondylosis patient with red eye… iridocyclitis

Oncology
1) CA breast with mets to spine… pain not controlled by med… give radiotherapy
2) Patient with CA breast… labs given… calcium was raised… IV fluids
3) Patient after breast CA… bee sting, develops swelling of the arm… lymphedema
4) Patient on steroids, develops hyperglycemia... short acting insulin at every meal or long acting
OD
5) Features of horner syndrome... cause? Ipsilateral cervical trunk compression

Respo
1) Purulent sputum, post Influenza, pneumonia… Staphylococus
 2) Hostel student - Pneumonia + rash… mycoplasma
3) Meningitis… on CSF gram + diplococci were found… strept pneumonia
4) Patient with obstructive lung disease… not improving with oxygen… ABGs were given which
showed type 2 resp failure… ans was non invasive pressure ventilation
5) Basket ball player… SOB, reduced breath sounds on one side, trachea central… Inv? CXR
6) Scenario of sarcoidosis… shin lesion given… CXR finding? Bilateral hilar lymphadenopathy
7) Lung CA… histology: polygonal cells, intraepithelial bridging… SCC
8) Asthmatic already on SABA + ICS...what to add? LABA
9) Woman painting her bathroom got unconscious... check CO levels

GIT
1) Patient with vomiting, constipation, no bowel sounds… bioneuro abnormality? Low potassium
2) Scenario of haemochromatosis… patient is at risk of which CA? Liver
3) 80 years old, sudden acute dysphagia… Achlasia… investigation was asked: manometry or
endoscopy
4) Patient with confusion, lethargy taking diuretics… abnormality? Hyponatermia
5) Patient with left hypochondrium pain, large stone on USG… lap cholecystectomy
6) Barret esophagus... histological appearance? Columnar metaplasia
7) Painless jaundice... pancreatic CA
8) Mother Hep B carrier delivers a baby... give vaccine to the baby
9) Coeliac disease scenario (villus atrophy, crypt hyperplasia)... anti TTG
10) Diarrhea with mucus etc... IBS
11) Hx of travel to malaysia presents with abd pain, jaundice, vomiting... hepatitis screen
12) Scenario of gilbert syndrome... Inv? Unconjugated bilirubin
13) Patient with drowsy/LOC + sweating some more features... hypoglycemia
14) AST, ALP values with Bilirubin levels?
15) Alpha-1 antitrypsin - HCC

Peads
1) No gastric bubble… oesophegial atresia
2) 2 months child dehydrated… what is the indication to start IV therapy? Sternal capillary refill
>4sec??
3) Severely Dehydrated child… mx? IV NaCl in 20 mins
4) Asthma child with ankle sprain... analgesic? Paracetamol
5) Mother brings her 2 weeks baby with blue swelling at the coccyx region since birth... reassure
6) Child given lorazepam for seixures... side effect? Apnea
7) Croup natural course?

Renal
1) Back pain… ESR 97, anaemia… Multiple myeloma
 2) Hx of urinary retention… painless mass palpable up to umbilicus… catheterization
3) Patient with BP 145/100, proteinuria… inv? USG abdomen??
4) Child with scenario of minimal change disease… mx? Steroids
5) Peripheral edema, proteinuria... membranous GN
6) Purple urine... Urine culture and sensitivity
7) Elderly man with UTI, came back with confusion, what would u do?

Endo
1) Patient with DM and proteinuria… ACEi
2) Diabetes scenario… OGTT was done and 2hr value given… IGT. DM I, DM II
3) Patient with HTN, hypokalaemia... Conns syndrome
4) Cushing`s syndrome?
5) Type 2 DM patient pain in anal region… tx? Incision and drainage
6) There was a pt with some symptoms pointing towards DM, with fungal balanitis... inv? FBS
7) Woman with blurred vision, tachypnea, wt loss... TFTs
8) Patient with increased Urea & creat... low albumin... what to give first? IV NS? Or Albumin
9) Patient during surgery had glucosuria… after surgery was normal… inv? FBS, cortisol
10) Another one about fasting blood sugar? Cant remember the scanario

Anatomy
1) Illiac crest landmark… L4
2) Patient with loss of tricep reflex, loss of extension at arm, loss of sensation at index and middle
fingers… C7

Toxicology
1) Child with paracetamol OD 2 hrs ago… when to do paracetamol levels: in 2 hrs
2) Paracetamol OD… levels below tx line… urgent referral to psych

Trauma
1) Widened mediastinum...Ruptured thoracic
2) Woman who had an RTA… abdominal distention… most appropriate investigation? CT abdomen
3) RTA - Call the anesthetist?
4) BP 50/30 – secure airway or IV fluids?

Surgery
1) Lady on gliclazide comes for review before gastroscopy… what to do? stop on day of procedure
2) Chest drain inserted in 4th intercostal space… structure damaged most likely? Intercostal artey.
3) Acute pain in testis while playing football… testicular torsion...immediate surgical exploration
4) Acute pain in testis, hx of multiple sexual partners, fever… Epididiymytis
5) Male patient with swelling in the groin, on & off cough, smoker… Hx of appendectomy -
inguinal??
 6) Child with humerus fx, parents say it happened coz of falling off from bed + some previous fx…
NAI
7) Old age patient with haematuria plus proteinura… cystoscopy or Renal biopsy?
8) Motor vehicle accident...Had to follow ATLS… secure airway and cervical spine care
9) Swelling at the back of the knee, fluctuant… baker’s cyst
10) Loss of dorsiflexion, loss of sensation over dorsum of the foot… common peroneal nerve injury
11) Patient after trauma, valgus test positive… medial collateral ligament rupture
12) Patient admitted for surgery… he had DVT and had AF and was taking warfarin… stop warfarin
and start heparin
13) Hx of trauma to chest… fat necrosis
14) Hx of femur fx… develops SOB… fat embolism
15) Blood discharge from breast… duct papilloma
16) Smooth discrete lump in breast… fibroadenoma
17) 30 yr old girl with a lump in breast… inv? USG
18) Breast CA... hypercalcaemia... IV pamidronate (IV fluids was not in the options in this one
19) A woman with ovarian ca had 5 cycles of chemotherapy. Each one of them have been
associated with vomiting and poor oral intake. She develops tingling and numbness in her
fingertips. There is also decreased sensation to touch. No other neurological deficits. Most
likely cause?
20) Hx of trauma... tenderness at tibia... not visible on xray... spiral fx
21) Tenderness at anatomical snuff box... scaphoid cast for 2 weeks
22) Sudden pain in calf, swollen, tenderness at upper medial aspects? options: DVT? ruptured
baker’s cyst?
23) Patient had cement powder fall on him, he has severe pain, erythema, blister, next action?
options: IV NS? Irrigation? Burn dressing?

Obs & Gyne

1) Woman after delivery has fits… IV MgSo4
2) Woman 21 weeks pregnant has proteinuria, BP 145/100… ADMIT
3) Patient requiring contraception,hx of DVT, fibroids distorting uterus... no other option fitted...
except depot provera
4) 36wks pregnant... bleeding PV, tender abdomen... placental abruption
5) Inflammation on cervical smear... endocervical swab
6) Infertility... 32 days regular cycle... inv? Day 25 progesterone level
7) 16 wks pregnant... look for chromosomal abnormality... Amniocentesis
8) Incontinence, passing urine without pain... Urine test negative... urodynamic studies
9) Hx of repeated UTI, post menopausal...Atrophic vaginits... topical estrogen
10) Patient with heavy bleeding, COCP was contraindicated...mx? Tranexamic acid was not given...
ans was MIRENA
11) Urinary pregnancy test...
12) Lady taking depot provera ... she's worried she's not having bleeding from 6 months ...
13) Risk factor for ectopic... IUCD
 14) Patient has mild dyskariosis on cervical smear she was smoker, taking COCP etc… what advice
can be given to dec the risk of CA? stop smokin
15) Lower abd pain, discharge, fever… PID
16) A young lady with a cervical ectropion, most appropriate? CIN or Variant?

ENT
1) Patient with hoarsness and some other symptoms… refer to ENT
2) A boy with nose bleed could not be stopped with pressure for 2 hours… he was taking warfarin…
give vitamin k or cautery??
3) Ulcer on tonsil… tonsillar CA
4) Boy with orbital swelling some other features... looked like sinusitis... xray sinuses or ct orbit?
5) Hoarseness, coughing blood, swelling and anterior triangle of neck? options: carotid body
tumor? branchial cyst? parotid swelling? Lymph-something?
6) There was a bead in ear in a 2yr old child, irritated... remove under GA
7) Insect in a woman’s ear... 70 alcohol ear drops
8) Conductive hearing loss + mastoid involvment... bone fx? Temporal
9) Vocal cord infection in stroke patient? Due to NG feeding?
10) Nasal endoscopy

Infectious diseases
1) Scenario of chicken pox, asked about mode of transmission… airborne
2) Scenario fo chicken pox… when can the child return to school? once the rash has crusted
3) Patient with clean wound... 2yrs of age no prev immunization... Give full course of DPT

Blood
1) Scenario of hereditry spherocytosis… inv? Direct coombs test
2) Patient with recent onset easy bruising... Platelets were low... APTT and other labs normal... ITP
3) Patient with vitiligo... Dec Hb, high MCV... pernicious anaemia
4) Erythropoitin
5) Vitamin B 12

Epidemology
1) Prostate CA cases 1250 in a population of 500,000 in 5yrs… incidence per million per year? 500
2) 10kg Child taking some drug 50mg/5ml at 4mg/10 BD… 4ml BD