DURBAN 2016 MAY

1. A 3 year old child was brought to the eye clinic by her mother who complained that
for the last month, the child’s eyes turned inward when reading a book, what do you
suggest?

a. Alternate patching of the eye may completely correct this problem

b. surgery may correct the problem
c. muscle strengthening may correct completely the problem
d. This child problem may be completely corrected with glasses

2. In cases of trauma to the ear which of the following indicates ossicular chain
discontinuity?

a. Blood on the external auditory canal

b. Conductive hearing loss › 40 decibel
c. Conductive hearing loss ‹ 20 decibel
d. Irregular perforation of tympanic membrane

6. Patient with joint pains, rash on the chest, taking anti TB treatment. Which of the
following drugs of TB medication is responsible?

a. pyrazinamide
b. ethambutol
c. rifampicin
d. isoniazid

7. The anterior fontanelle can be palpated in a woman in labour with 7 cm dilatation.

What is the presenting AP diameter given normal positioning of the child?

a. submental bregmatic
b. suboccipitobregmatic
c. occipitofrontal
d. occipito mental

8. A 30 weeks pregnant woman presents with bleeding PV and 20 weeks ultrasound

shows that the placenta was at a low insertion in the uterus. Which of the following is
the correct management?

a. admit the woman to hospital. Put her on IV access fluid and observe for 72 hours
b. give steroids if bleeding is excessive
c. send her back home
9. How long after starting antifungal therapy do you start an HIV positive patient with
fungal meningitis on ART?

a. 4 weeks
b. 2 weeks
c. 6 weeks
d. 8 weeks

10. A 55 years old man is diagnosed with an uncomplicated diverticulitis. What is the
management?

a. colosigmoidectomy
b. antibiotic therapy
c. diverticulectomy
d. diverticulostomy

12. Patient falls, is unresponsive, no pulse, not breathing. What is the first instruction
you give to the nursing assistant in resuscitation management?

a. chest compressions
b. bag mask ventilation
c. call for help
d. defibrillate

15. A postpartum woman experiences foul smelling discharge and fever. What is the
appropriate treatment?

a. cefuroxime
b. clindamycin
c. metronidazole
d. penicillin

18.The management of carpal tunnel sydrome is:

a. surgery
b. steroids
c. splint

19. A patient with swollen and painful big toe. What is the most specific investigation
should you request?

a. test uric acid

b. check synovial fluid aspirate for crystals
21. A diabetic patient with haematuria and bacteriuria is likely suffering from?

a. nephritic syndrome
b. diabetic nephropathy
c. renal cell carcinoma

22. A 17-year old asthmatic patient is seen by you in OPD. She currently takes
salbutamol inhaler 10 times per day despite being on an inhaled corticosteroids
(budesonide) twice daily. What is the next management step?

a. give her a short course of oral prednisolone

b. Add a leukotriene antagonist
c. check inhaler technique
d. check spirometry

24. Inpatient with symptoms indicative of renal calculi and blood revealed by the urine
dipstick. The following investigation is the best choice to confirm your initial diagnosis
of calculi:

a. CT scan
b. X- ray
c. Ultrasound
d. IVU

25. A 16 year old with unilateral nasal obstruction, recurrent and sometimes severe
epistaxis presents to you. What is the most important diagnosis to exclude?

a. Haematoma
b. Haemophilia
c. Nasopharyngeal angiofibromatosis
d. bleeding from little’s area

30. Patient collapses with a history of consuming a large amount of alcohol, what is the
appropriate management?

a. thiamine infusion
b. naloxone
c. benzodiazepine

31. The best method to determine whether the episode of epistaxis is anterior or
posterior in origin is:

a. Look up the nose with a good light source for the source of bleeding
b. Look for blood flowing down the posterior pharyngeal wall, using the good source
of light
c. Ask the patient to extend the neck for 10 to 12 minutes, check for resolution
 d. Pinch the nose close for 10 to 12 minutes and check for resolution

32. Dermatome of big toe and medial internal face of leg.

a. L4
b. L4-L5
c. L5-S1

33. A pregnant woman with RPR 1:16 which of the following is:

a. recheck RPR at 32 weeks

b. give benzathine benzyl penicillin one dose
c. give benzathine benzyl penicillin 3 doses

34. An unconscious bleeding patient is being set up for monitoring What to do in

primary survey?

a. give oxygen
b. control vital signs

35. The best course of treatment of a patient with clean, traumatic eardrum perforation
is:

a. ears drops
b. prophylactic oral antibiotics..
c. Reassurance as the usually heal spontaneously
d. tympanoplasty

36. A 45 years old patient presents to Phoenix clinic with deafness of left ear. You
perform a rinne test as part of your assessment which indicates a conductive hearing
loss. You perform the weber test to confirm the conductive hearing loss, the sound
should be:

a. not be heard at all

b. Be heard best on the left ear
c. Be heard best on the right ear
d. Be heard equally in both ears

37. A 55 years old woman presents to the breast clinic with a short history of a lump in
the left breast. After the clinical assessment and imaging, core needle biopsy is
scheduled. Which of the following is the most appropriate concerning core needle
biopsy?

a. This procedure is the best done in the PHC setting so that the results are available
when the patient presents to the surgeon
b. This procedure should be performed with the smallest possible needle gauge to
reduce risk of tissue damage
c. This procedure has a diagnostic accuracy similar to FNAC
 d. The sensitivity of this procedure is increased if performed under imaging guidance
and multiple cores are taken

38.A 79 year old man consulted with you 3 months ago. An incidental finding was a BP
of 182/ 92. You checked his BP again last month where you recorded his BP as 180/ 86.
His BP today is 180/90. His ECG and CXR are normal. What course of action would
you recommend in addition to life style changes?

a. Take no further action since CXR is normal.

b. Start the patient on a thiazide diuretic like Hydrochlorthiazide.
c. Start the patient on an ACE Inhibitor like Enalapril.
d. Continue to monitor his BP and only take action if he develops symptoms.

40. A 5 year old girl presents with a painful right ear. An examination reveals a
hyperaemic tympanic membrane. You make the diagnosis of acute otitis media. The
most common organism responsible is:

a. Haemophilus influenza
b. streptococcus pyogenes
c. Group B haemolytic streptococcus
d. Staphylococcus

49. A patient presents with an inflamed knee, which is swollen, warmth and painful to
the touch. He has a history of a long treatment with corticosteroids, what the diagnosis?

a. bursitis
b. septic arthritis

50. Patient describe fall on the outstretched hand during sport activity. Multiple
radiographic views show no distinct fracture. His hand is tender to palpation in the
anatomical snuffbox. X-rays show no fracture, how do you manage?

a. Apply a short arm cast to include the thumb

b. apply a full arm cast
c. give analgesics

51. Which of the following drugs have the side effect of atrial fibrillation?

a.Diltiazem
b.Digoxine
c.Verapamil
d.Amiodarone

53. A non-traumatic new-born presents with an increasing cranial circumference. The

most probably diagnosis is:

a. hydrocephalus
b. subdural haematoma
 c. subdural oedema
d. intracranial haemorrhage

54. Which of the following contraceptive methods is reversible and safe?

a. depot IM
b. IUD copper
c. implants
d. Hysterectomy

55. Patient hearing voice talking to him is:

a. visual hallucination
b. auditory hallucinations

56. Picture of Herpes Zoster Ophthalmicus. Which of the following is NOT true
concerning HZO?

a. loss of corneal sensation

b. uveitis

c. early warning sign of AIDS

58. An HIV+ patient with cough, AFB negative with gene Xpert negative. What is the
immediate action you should take?

a. send for microscopic culture

b. give her antibiotics

60. A 30 year old woman presents, complaining of breast lump. 1 cm in diameter,

mobile, firm and non-tender. You make the diagnosis of probable fibroadenoma, your
next course of action is:

a. arrange for follow up in 3 months to assess any changes in the mass

b. Arrange for ultrasound and FNA to confirm the diagnosis
c. Arrange for excision of the breast lump
d. Teach the patient self-examination and ask her to return if she mention any changes
in the lump

61. a 3rd year medical student with alcohol binging after exams… cant remember the
exact question.

63. Patient with white spot in the eye, HIV positive. What the most appropriate
diagnosis?

a. cytomegalovirus
b. tuberculosis
64. Patient with sharp pain on the chest and vomiting. What is the diagnosis?

a. aortic dissection
b. oesophagus rupture

68. Examination of the nose in patient with allergic rhinitis reveal:

a. Pink, shrunken turbinates

b. Pale oedematous turbinates
c. Pink, oedematous turbinates
d. Pale, shrunken turbinates

70. Treatment of choice of acute otitis media is:

a. Penicillin ear drops, nasal decongestants, analgesia

b. Oral penicillin, dry mopping, analgesia
c. Oral penicillin, nasal decongestant, analgesia
d. Penicillin ears drops, dry mopping, analgesia

An HIV positive patient develops retinitis. What is the most likely cause of the retinitis?

CMV

21 year old male comes in for routine checkup. Mass is 121kg, height is 163cm. All
bloods normal except for abnormally high creatinine.

a. Normal for him

b. Due to renal failure
c. Due to liver pathology

Most specific test for acute pancreatitis?

a. Serum amylase
b. Serum lipase
c. ERCP
d. CT scan

Glaucoma picture. Sudden, severe pain and sight loss.

OTHER TOPICS COVERED IN 2016 EXAMINATIONS:

Diverticulitis

CCF

Hypertension

CPR

TURP
Syphillis (UTI + Preg)

DM – sliding scale, DKA, HONKC

HIV – PEP, IPT, Rx

Reiters syndrome

Conjunctivitis

Ethics

Patient with chronic renal failure, are state hospitals allowed to withhold dialysis if it is
futile?

a. With court order

b. If he develops edema of his feet

Patient is HIV positive and doesn’t tell partner. You give him 2 weeks to tell partner, he
doesn’t. What should you do?

a. Respect confidentiality
b. Tell the partner after informing patient