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Anatomy-June 2020 1. Short term memory loss? A.Frontal lobe B. Parietal C. Temporal D. Limbic system 2. A patient who has pain and loss of sensation on the shoulder and upper arm following dislocation of the glenohumeral joint. Which nerve is involved? A. Axillary B. Long thoracic nerve C. Radial nerve D. Median nerve E. Ulnar nerve 3. A patient had pain on the shoulder and upper arm, can’t lift shoulder upwards, which nerve is damaged A) Accessory nerve B) Radial nerve 4. A man had RTA with fracture of mid femoral shaft, pulses are not felt on leg and foot. Which vessel is damaged? a. femoro-Popliteal b. Internal iliac c. External iliac d. Dorsalis pedis e. Posterior tibial

1.Frontal Lobe

2. Axillary nerve

3. Accessary nerve

4. Femoro-popliteal

Cardiology-June 2020 1. A transgender pt. presented with high potassium. What is the next step? a. ECG b. calcium gluconate c. Low potassium diet d. Echocardiography

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2. A patient who presented 1 hr ago in A&E with retrosternal chest pain of 3 hours. Had similar episode 12 hours ago. Pt was given aspirin and GTN and pain was relieved. BP normal. PR 45bpm. Diagnostic investigations A. CXR B. ECG. C. Troponin D. ECHO 3. Patient with Atrial fibrillation, on warfarin, developed intracranial bleed. Vit K has been given. What else will you give? A. PCC B Iv fluid C. Fresh frozen plasma 4. A chest X-ray of a pt with difficulty in breathing on mild exertion, recently returned from Gambia, (Picture-the X-ray actually showed sharp straight left heart border). There is a mid diastolic murmur at apex) A) mitral stenosis B) Aortic regurgitation C) tricuspid regurgitation D) dilated cardiomyopathy 5. A patient with chest pain which is worse lying flat and relieved on learning forward. What is expected on ECG. A. Prolonged QT interval. B. Saddle shaped ST elevation C. Wide ST depression 6. A pt c/o racing heart. ECG is normal with HR=150/m, No SOB, BP=140/95 mmgh. What is the most appropriate treatment to give, pt is diabetic and hypertensive. A) Give IV adenosine B) Verapamil 7. A pt with features of heart failure and on frusemide, bisoprolol, clopidogrel, what drugs to add? a. lisinipril b. CCB c. thiazides d. BB

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8. A pt has a cardiac risk 14 % for 10 year, what prophylaxis you will give? Statin 9. An elderly pt on amlodepine, on his next visit hi BP is elevated. What would be the next drug on routine follow up? a. lisinipril (ACE inhibitor) b. CCB c. thiazides d. BB

1.ECG 2.ECG

3.PCC 4.Mitral Stenosis

5. Saddle shaped ST elevation 6.Adenosine

7.Lisinopril 8.Statin

9.Lisinopril

Dermatology-June 2020 1. Pt with melanoma, what determines prognosis. A. depth B. Horizontal height C, colour D, tumour size 2. Pt on emollients has exacerbated eczema, there were mouth ulcers as well, next step? Steroids Antiviral Antiboitics 3. Question with picture. A 2 year old child that had painful lesions around the naso-labial area, and all over the body. Skin is being peeled off by slight pressure.. What was dx of the child in the picture??? Impetigo i chose scalded skin synd?? It was staphylococcal scalded skin syndrome 4. Pregnant Female with vesicular rash on genitalia, pain while micturition...

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Genital herpes Syphilis Eczema 5. 4 year old boy with painful and crusted rash on face and neck is brought by her to GP. Rashes are with fluid filled blisters and are not responding to self-medication, Dx? Acute pemphigoid Bullous impetigo Viral hemmorhagic fever Non- Bullous impetigo A picture of a child with impetigo, treatment A) Antibacterial B) Antifungal C) Reassurance D) Anelgesia and bed rest

1.Depth

2. Steroid

3. staphylococcal scalded skin syndrome

4. Genital Herpes

5. Bullous impetigo Impetigo-Rx, if non bolous-Flouclaxciline. If bulous-1st line Hydrgen peroxide 1%, 2nd line Fucidic acid 2% or Mupirocin

Emergency-June 2020

1. A patient who was on antidepressant and took an overdose. Presented with dilated pupils, dry mouth....What is the drug involved. A. Sertraline B. Amitriptyline C. Aspirin D. Paracetamol 2. A patient on warfarin presenting with bleeding ( I can't remember where the bleeding was). What is the most appropriate fluid to give? A. Vit k. B. PPC. C. FFP D. Normal Saline

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Repeat---- A patient with major bleed and INR 6, has been give vit k what next? A. Plasma concentrate B. Fresh frozen plasma C. Protamine 3. A type 1 diabetic patient who has epigastric pain. RBS was 36. Most appropriate initial fluid to give. A. Insulin B. O.9% N/ S C. 0.4% N/ S. D. Hartman solution 4. A 22 yr old man who went to eat at a party and developed wheeze and itchy rash. Which medication to give A. O.5 in 1000 IM of adrenaline B. O.5 in 1000 IV C. 10 in 1000 1M D. 10 in 1000 IV. E. 10 in 1000 subcutaneous 5. An hour following an uncomplicated laparoscopic cholecystectomy, a patient presented with SOB and fever 40 degree. BP was ?97/ 70mmhg. PR 120bpm. He was given GA. Diagnosis. A. RDS B. Cardiogenic shock C. Hypovolemic shock. D. Neurogenic shock. E. Septic shock Repeaed--------A post op pt presented with fever=38.8C and breathlessness. His pulse rate was 110/m and BP=90/60mmgh. BP remained low after giving I/V fluids. Options were A.ARDS, B. septic shock, C. neurogenic, D. cardiogenic or E. hypovolemic shock Incomplete question-6. A patient who is feeling unwell with mild Diarrhea and sever vomiting...K+ high=6.3mmol/l, Na low. All other investigations are normal. Most appropriate investigation to do. A. ABG.

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B. CXR C. ECG D. serum drug level 7. A pt with massive upper GI bleed, had a BP of 70/ 50, has been on NSAIDS for Rheumatoid Arthritis, pt is not hypertensive or diabetic, what is the most appropriate next step A) Endoscopic band ligation B) Sengs staken B) lakemore tube C) IV fluids D) Terlipresin E) IV Proton pump inhibitor 8. A pt who was recently managed for intracerebral Hemorrhage 6 weeks ago. He developed DVT. Most appropriate step will be, a. Direct thrombin inhibitor b. Warfarin c. DOAC d. I/V Thrombolysis e. Compression socks Repeated--- Patient who had haemorrhagic stroke/ intracerebral hemorrhage, 3 days ago, still in the ward, then develop DVT. How will you manage? A.heparin B warfarin C. DOAC D. IVC filter E. percutaneous thrombolectomy

1. Amitriptyline 2. Vit K then PCC

3. O.9% N/ S 4. O.5 in 1000 IM of adrenaline

5. Septic Shock 6. ECG

7. I/V Fluids 8. DOAC

9.

Endocrinology-June 2020

1. A case of Addison’s dx, hyperkalemia, brownish coloration of skin, and salt craving, what test to do?

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A) Dexamethasone suppression test B) Short synacten test 2. A patient with polyuria and polydipsia. Sodium was high. K+ normal, glucose was 5.5 mmol/l. Most appropriate investigation. A. Short synathen test. B. Growth hormone C. OGTT D. Water deprivation E. Glucagon test 3. A pt with features of Addison’s, what’s the commonest cause in the Uk A) autoimmune B) infection C) malnutrition 4. A 36 year old lady who was diagnosed with DM 6 months ago. What investigation to use and differentiate the types of DM (DM1 from DM2). A. C peptide B. Anti GAD antibodies. C. Glucose tolerance test. D. Growth hormone 5. A patient who has diabetes. Glysolated Hb was 58. BMI 32kg/ m2. On metformin 1g twice a day. Next appropriate action A. Continue lifestyle changes. B. Sulphonylureas. C. SGLT2 inhibitor. D. Insulin. E. GLP. Repeat----A pt that is diabetic on metformin HbA1C is 58 the cut off given was <53, eGFR was normal, what will you do A) add sulphonylurea B) advise on life style modification C) add Gliptins 6. A patient who has weight loss despite good appetite and 6 months history of amenorrhea. Dxs. A. PCOS. B. Hyperthyroidism. C. Hypothyroidism

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D. Premature ovarian failure. E. Prolactinoma Repeated--------Pt on metformin, still hbA1c 58. How to manage? Life style modification Gliptins cause weight loss, pt was a lorry driver BMI =32 so no insulin, and no sulphonylyureas....answer gliptins Target was given on bracket 53 Patient with hypernatremia, and hypokalemia, normal BP. Past history of meningitis. desmopressine?? question was about the test? so after water deprivation w give desmopressin and test various osmolarities Water deprivation test then?? Pt with secondary amenorrhea and wt loss? wt loss despite increased appetite hyperthyroidism? prolactinoma hypothyroidism 7. Pt has multiple episodes of sweating tremors chest pain anxiety Panic attacks? Pheocromocytome?? 24 hr urine catecholamines Metanephrines 5 HIAA. 8. Pt sclera visible between cornea and lid something like that-Diplopia when looking upward and delay in the eyelid, dx TSH Ab?? tensilon test

1. Short synacten test 2. Water deprivation

3. Autoimmune 4. Anti GAD antibodies

5. GLP? 6. Hyperthyroidism

7. Metanephrine

ENT-June 2020

1. After a fight. A boy presented with nasal bleeding which lasted for 3 hrs. Bleeding has stopped now. Nasal septum is deviated. What investigation to do.

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A. X ray of paranasal sinus B. X ray of the nose. C. Examination of the septum. 2. A patient on warfarin who presented with epistaxis for 3 hours that has not been stopped after soft tissue pinch. It’s lasted for 30 min. Conservative measures also failed to stop the bleeding. What is the most appropriate next step? A. Vit K. B. anterior nasal packing C. PPC. D. FFP E. Silver nitrite 3. A man who has hoarseness of voice and smoking history and alcohol history. He is obese. Examination of the vocal cords, it was swollen with epithelial dysplasia. Most appropriate management A. Stop smoking. B. Refer to alcohol group C. Advice to decrease weight. D. Chemotherapy E. Radiotherapy 4. A 2 days old child who mother has hearing impairment. She is worried about her child having a hearing problem. What investigation to do. A. Auditory brainstem test. B. Distraction test. C. Speech discrimination D. Pure tone audiometry 5. A 33 year old man presented with vertigo after URTI. What medication will you prescribe for him? A.Prochlorperazine B. Metachlorpromide C. Haloperidol D. Promethazine

1. Examination of the septum

2. Nasal packing

3. Stop smoking

4. Auditory brainstem test

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5. Prochlorperazine

Ethics-June 2020

1. A man who has dementia and has and accident. He was driving the car and hit a pole and couldn't remember the events of the accident. What is the most appropriate action? A. Stop driving and encourage to tell DVLA. B. Continue driving. C. Report to police. D. Drive only accompanied. E. Drive on familiar road 2. A patient with dementia who presented to the clinic with his son. His son is worried that he recently sent a large amount of money to an unknown account. What is the most appropriate action? A. Advice son to report to police B. Call safeguarding C. Call the bank. D. Advice son to get power of attorney E. Refer to memory clinic for capacity assessment 3. A man with seizure 3 years ago, seen driving. Appropriate next step A. Report to DVLA B. Find out from clinic if he has had recent seizures C. Report to the police D. Report to safeguarding authority 4. A colleague in a practice that posted personal and confidential clinical information about a child under their care which is causing some controversies online. What is the next action to take? A. Tell him not to post patients info online next time B. Inform GMC C. Inform his consultant. D. Inform medical union 5. A 15yr old girl that was placed on contraceptive, has mental capacity, the mother discovered few weeks later and visits the GP angry about the decision of the Doctor placing her on contraceptive pills, what will you do. A) Tell the mother to come with the daughter and withdraw drugs B) Explain to her the daughter was given drugs because she showed mental capacity

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C) Tell her she has no right stopping her daughter from receiving the drugs D) Assure mom that daughter got proper treatment E) Don’t disclose to mother coz she is 15 yr old

1. Stop driving and encourage to tell DVLA

2. Refer to memory clinic to ass the mental capacity

3. Find out from clinic if he has had recent seizures

4. Inform the Consultant in-charge for proper action

5. Explain to her the daughter was given drugs because she showed mental capacity

Genetics-June 2020 1. A patient has a child who had hemolytic disease of the newborn. Currently pregnant and asking for the chance of his unborn child having the same dxs A. O% B. 25% C. 50% D. 75% E. 100% 2. A man who has cystic fibrosis. One child already has it. What is the possibility of the son having the disease? A. 1:2 B 1:3 C. 1:4 D. 2:3 E. 3:4 3. A patient who came to her GP worried about the possibility of her having Alzheimer as her mother had Alzheimer’s at an early age. Gene involved. A. Apo E4 B. BRCA1 C. COH 4. A man who has Becker's muscular dystrophy/ Duchene’s Muscular Dystrophy which is x lined recessive. How will it affect his children? A. All girls will be affected and all boys will be carriers.

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B. All girls will be carriers and all boys will be unaffected. C. All girls will be carriers and 50%of the boys will be unaffected. D. All the boys will be unaffected and 50%of the girls will be carriers. E. 50% of boys will be affected and 50% of girls will be carriers Child with recurrent URTI – Cystic fibrosis Risk of CF in brother with family tree A.0% B. 1:2 C. 1:4 D. 100%

1.0%

2. 1:2 as sons only

3. Apo E4

4. All the boys will be unaffected and 50%of the girls will be carriers.

Geriatric-June 2020 1. An elderly woman diagnosed with dementia, who brought to the GP by her daughter complaining and she shouts at people at night and neighbors are complaining. At other times she converses well. She recently became forgetful. Diagnosis. A. Delirium B. Psychotic depression. C. Mania. D. Schizophrenia E. Bipolar Repeat- A question on a woman screaming at night, saying someone is reading into her house A. Parkinson B. Delirium 2. A patient who has dementia and has been treated 3 times in the last 6 weeks with bruises on the arm and face. Possible diagnosis A. Accidental injury B. Warfarin

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C. Non Accidental Injury

1.Delerium

2. Non Accident Injury

GIT-June 2020

1. An elderly patient who has jaundice, no abdominal pain. Weight loss and hyperglycemia. Possible diagnosis. A. Cholangiocarcinoma B. Cancer of head of pancreas. C. Cholangitis D. Biliary atresia. 2. A patient with passage of bulky stool which is difficult to flush. Also has jaundice. Most appropriate investigation A. Serum chymotrypsin. B. fecal elastase. C. USS. D. Serum calproctein E. CT abdomen 3. A patient with Dysphagia to solid food, most appropriate investigation to do A) Upper GI Endoscopy B) Barium swallow 4. A woman presents with malaise, nausea and vomiting. Has jaundice, fever and right sided abdominal pain. No history of recent travel HAV Ig G positive and HBC antibody negative. What is the next appropriate investigation to establish diagnosis? A. HBV Ig G. B. HAV Ig M C. HCV Ig G D. HBsAng E. HBV surface antigen 5. A patient with left iliac Fossa pain, very severe, with fever of 38 degrees and pt is unwell, what is the diagnosis A) Diverticular abscess B) sigmoid CA

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6. A 40 year old patient who has abdominal pain and 2 episodes of bloody diarrhea in the past? 2 month. Has mouth ulcers, wt loss of 8kg. Possible diagnosis. A. Cystic fibrosis B. Coeliac disease. C. Colon CA D. Ulcerative colitis E. Chron's disease 7. A pt with esophageal cancer and liver metastasis developed dysphagia. Most appropriated immediate Rx. A. Chemotherapy B. Stent. C. Radiotherapy D. NG tube E. Gastrostomy Repeat------8. Man with floating stools and weight loss but no travel history, Stool difficult to flush and had jaundice. A. Pancreas cancer. B. Achalasia cardiac. C. Pharyngeal pouch. D. Pancreas Cancer E. Ch. Pancreatitis....I think the answer was Pancreas Cancer 9. A pt with Dysphagia, hemoptysis and weight loss. Investigation of choice? A. Endoscopy

1.Ca pancreases 6. CD

2. fecal elastase 7. Stent

3. Endoscopy

4. HAV Ig M

5. Diverticulitis

G. Surgery-June 2020

1. A pt to do an elective herniorrapphy. Has HBA1c 68, BP 170/ 90mmhg, MI 6 weeks ago. What is the absolute contraindication for surgery? A. Uncontrolled blood sugar.

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B. Uncontrolled BP. C. Recent hx of MI 2. A patient billed for elective herniorraphy. HB.8.7. MCV low and MCHC is low. What is the most appropriate action? A. Defer surgery and do further investigation. B. Give iron and continue with surgery. C. Continue with surgery. D. Transfuse and continue with surgery. E. Transfuse and defer surgery 3. Pt on warfarin day before surgery what should be done? Stop warfarin start LMWH 4. A pt came to GP for adv; regarding her cyclical mastalgia management? paracetamol primose oil Supporting bra? Repeated----A patient who has breast pain and tenderness during his period and shortly before his period starts. She is on COCP. Most appropriate management. A. Primrose B. Paracetamol C. Supporting br

1. Recent hx of MI

2. Defer surgery and do further investigation

3. stop warfarin start LMWH

4.Suppot bra

Gyane & Obs-June 2020 1. A 22 year old woman who had abortion 6 days ago presenting with vaginal bleeding and abdominal pain. Diagnosis. A. PID. B. Endometritis C. Uterine rupture

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Repeated----------------- A woman who has evacuation at 8 wks GA, developed abd pain and vaginal bleeding after 6 days. Diagnosis A. Uterine perforation B. Endometritis C. Ovarian rupture D. Appendicitis 2. A 38 year old patient who stopped taking contraceptives 6 months ago and has amenorrhea of 7 months. FSH 25, LH 15, prolactin 550. BMI 24.9kg/ m2. Diagnosis. A. PCOS. B. Premature ovarian failure. C. Post pill amenorrhea D. Hypothalamic amenorrhea 3. Best contraception for woman with irregular, bulky uterus with history of DVT A. Depot provera B IUCD C. IUS D. COCP E POP 4. 70yr old woman with lower abd. pain and left iliac mass, has fever, A) diverticula abscess B) tubo-ovarian abscess 5. A woman who is rehsus negative gave birth to a rhesus positive child. She has not received any anti D Ig prophylaxis. What is the maximum time for anti D Ig prophylaxis to be given. A. 12 hours after delivery. B. 24 hrs C. 72 hrs. D. 36 hrs. E. 1 hr 6. A 28 year old pregnant female who presented at 12 weeks GA with nausea and vomiting. Also has vaginal bleeding. On examination GA was 16 weeks size. USS was normal and Os was closed. Possible diagnosis. A. Ectopic pregnancy B. Threatened miscarriage C. Molar pregnancy D. Twin gestation

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E. Wrong date? ------The molar pregnancy is the same one in Plabable Person was 12 weeks pregnant but FSH was 16 was 7. Best contraception for woman who wants Long contraception but reversible much later. Which one do you give? A. Depot provera B IUCD C. IUS D. COCP 8. A patient who delivered 6 weeks ago presenting with breast pain, tenderness, fever and a mass. Which organisms is mostly implicated. A. Stap aureus. B. Strep pyogene. C. Strep pneumonia D. Pseudomonas

1. Endometritis

2. POF

3. Depo provera

4. tubo-ovarian abscess

5. 72 hours

6. Molar pregnancy

7. Marina-IUS

8. Staph aureus

Haematology-June 2020 1. A patient presenting with tiredness, ?easy fatigability and mild jaundice Pale. Blood film showed polymicrosia, sphereocytes, Hb low and MCV high. LDH high. Bilirubin high. Investigation to do.. A. Ferritin study. B. Direct coomb test. C. Vit B12. D. Folate. 2. A patient with tiredness, blah blah blah...WBC normal, HB low, platelet low, LFT was normal. MCV was high Investigation that will lead to diagnosis. A. FBC/ ?iron study

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B. Bone marrow aspiration C. DAT. D. folate level. E. Vit B12 level 3. A Pt. on warfarin, bleeding, given vitamin K next important thing to give? prothrombin concentrate complex. FFP Platelets I/V fluids Blood 4. Question with lupus anticoagulant +ve, on aspirin??? I marked for stop aspirin and start apixaban Stop aspirin and start LMWH

1. Direct coomb test

2.Vit B 12 level

3. prothrombin concentrate complex

4. stop aspirin and start apixaban

Infectious diseases-June 2020 1. A pt with vesicular rashes on the trunk and face, had fever for some days, later rashes had purulent discharge with erythematous edges, what will you give A) Antifungal B) Antibacterial C) no treatment D) Antiviral E) steroid (Case of infected chicken pox) 2. A man who travelled to Gambia 5months ago, presents with vesicular rash, fever and delirium, what’s the diagnosis A) Chicken pox B) Pemphigoid C) Measles D) Malaria Repeaed-----------A patient with vesicular rash on the trunk with history of travel to Africa 5 months ago. Presenting with fever, delirium. Diagnosis

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A. Pephemigoid. B. Shingles. C. Measles. D. Malaria E. Chicken pox

3. A child who had chicken pox. Mother is asking when she can return to school. A. Never. B. Isolate the child. C. When rash has crusted D. After antibiotics. Congenital CMV early symptoms??? 4. A man who recently returned from central America where he worked in a farm. Developed night sweat and fever. Has enlarged spleen. Diagnosis A. Tb B. Lymphoma C. Brucellosis D. CML. There was this question with history of travel and work on farm ...brucellosis? Yes central America return Not sure about exact question………………………..Blisters on torso only, with fever, malaise, and pain in local area? Shingles cellulistis Chicken pox? Chicken pox is generalized, while shingles present in single dermatomes. Another question was patient with foot ulcer then developed myelitis, what is the organism 1. Streptococcus 2. Staphylococcus I thought it's spinal abscess and it was needed the definite diagnosis staph. It's a GMC website question from MRCP PACES sample scenario

1.Anti Bacterial

2. Chicken pox

3. When rash has crusted

4. Brucellosis

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Nephrology-June 2020 1. An elderly man who has hypertension, DM and chronic glomerulonephritis. BP was? 180/ 100. Proteinuria and hematuria. What medication will slow the disease process? A. ACEI. B. CCB. C. Steroid. D. Frusemide E. Beta blockers 2. A patient who has hypertension, DM with proteinuria+, hematuria +++. Which investigation is the most diagnostic? A. Urinalysis. B. USG. C. Renal biopsy. D. CT KUB E. cystoscopy 3. A man who suddenly collapsed while jogging. Has a history of episodic palpitations and ??. Has hypertension. Most appropriate diagnostic investigation A. 24 hr urine cortisol B. 24 hr urine catecholamines C. Urine 5HTT D. Dexa suppression test. E. Aldosterone/ renin ratio 4. Pt with diarrhea vomiting features of acute kidney injury what should be stopped? co-cadamol ramipril because I chose co-cadamol some NSAID I chose ramipril because you can't give diuretics, acid and arbs, metformin and Nsaids in dehydration U can give acei until gf is less than 30

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DAMN drugs not given in dehydration. Co-comadol is codeine and paracetamol, where is the NSAID?

1.ACEi

2. Renal biopsy

3. 24 hr urine catecholamines

4. ??

Neurology-June 2020

1. A patient with non blanching rash, limited lateral neck flexion, photophobia, headache and fever. Possible diagnosis. A. ITP. B. TPP. C. meningitis D. SAH 2. 50 yr old man who is in a nursing home and developed confusion. He was recently incontinent. Has AF and was placed on warfarin. ECG: irregular rhythm, one sided sensory loss and bruises on the arm and face. What is the possible cause of his confusion? A. Stroke B. Meningitis C. Subdural hematoma. D. UTI E. SAH 3. A patient who has one sided headache with nausea, vomiting and photophobia. Which medication can be used to reduce the frequency of symptoms? A. Propanolol B. Verapamil. C. Sumatriptan. D. Topiramate 4. An elderly man who had TIA 3 years ago. Has not been on any medication for 2 years. Presented to ur GP. Which medication will u give to prevent future stroke. A. Apixaban and clopidogrel. B. Aspirin and dipyridamol. C. Aspirin and atovastatin D. Clopidogrel and atovastatin

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E. Warfarin 5. A man who cannot draw circle, do arithmetic etc. Which lobe is affected? A. Frontal. B. Parietal C. Temporal. D. Occipital E. Subcortical 6. A girl with viral infection/diarrhea prior to onset of bilateral lower limb paralysis and inability to use both lower limbs A. Nerve conduction test B. CT head C. MRI brain D. Full blood count E. Nerve/muscle evoke response 7. 13 yr old female with symptoms of meningitis without rashes CSF is thick/prulent in consistency. What is the likely causative organism? A) neisseria meningitidis B) streptoccoci pneumonia C) Listeria D) viral E) TB 8. A 14 year old with fever, headache, photophobia and generalized non blanching skin rash. What is the diagnosis? A. Staph aureus B. H. Influenza. C. Strep pneumonia D. N. Meningitis E. Klebsiella? 9. A patient with headache. She had a history of brain cancer and was treated. Brain CT showed enhanced lesions with surrounding edema. Most appropriate management of symptoms. A. Mannitol. B. Dexamethasone. C. Radiotherapy D. Chemotherapy

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I am not sure about this question-------------10. A pt with fever, photophobia, No neck stiffness, fundoscopy revealed papillooedema, CT normal? Next invx? I put LP LP contraindicated in papillooedema Benign intracranial hypertension. LP improves the symptoms is there fever and photophobia in ICP ? Can't this be a cerebral abcess ? We would get and incresed ICP and fever and photophobia, no? Was there a CT scan in the options? No fever, and no photophobia in stem, female pt, common in females CT done normal I think it was subarachnoid hemorrhage and CT done which was normal so we request lumber puncture for xanthochromia ... It wasn't encephalitis then Elderly 3 days has visual hallucinations was normal before dilirium Lewy body dementia case IVC filter?

1.Meningistis

2. Subdural hematoma

3. Propranolol

4. Clopidogrel and atorvastatin

5. Parietal

6. Nerve condution test

7. streptoccoci pneumonia

8. N. Meningitidis

9. Dexamethason

Ophthalmology-June 2020 1. A patient who presented with sudden onset of painful reduction in vision, nausea and vomiting. Cornea was hazy. Flourescin test was negative Possible diagnosis A. Acute uveitis B. Acute glaucoma. C. Corneal ulceration. D. Episcleritis/ scleritis. E. Conjuctivitis

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2. A patient with sudden onsent of painless visual loss. Fundoscopy showed flame shaped hemorrhages. He is hypertensive. BP was 170/ 100. Possible diagnosis A. CRAO B. CRVO. C. retinal detachment D. Vitreous hemorrhage Repeated---------Flame shaped haemorrhages on fundoscopy, vitreous hemorrohage RVO CRVO central retinal vein occlusion 3. Pt with right eye adduction problem what is next step? MRI? carotid doppler

1. Acute glaucoma

2. CRVO

3. MRI

Orthopedics-June 2020

1. Knee pain on flexion, investigation. Question about positive mc murray test and Apply test positive, MRI or USG Added the question with medial meniscus: MRI 2. A question about young boy moving house, having back ache for a week but he had red flags. What was next step? it like which disc is affected?? No it was next step i chose urgent refereal to surgery since he had lost sensations in the perianal area But i am not sure what the other options were yes he had cauda equina

1.MRI

2. urgent referral to surgery

Paeds-June2020

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1. A mother presents with his son who is asymptomatic for CMV. She is asking the long term complication of CMV. A. Blindness B. Deafness. C. Learning disabilities 2. A 1 yr child who has been admitted severally for cough and wheeze. Temp 36. 7. Wt @ 3rd centile and Ht at 75th percentile. What is Diagnosis? A. Asthma B. Cystic fibrosis. C. Bronchitis. D. Bronchiolitis 3. A child who had a temp of 39.1 for 2 days presenting with vesicular lesions and blisters esp on her flexures, crusted lesions on the month, eyes and nose. Diagnosis. A. Kawasaki B. Impetigo C. Staphylococcus scalded syndrome. D. Eczema PS: there was a pix of the child. I wish I can reproduce it too 4. A child who has blisters and vesicles. Some are crusted and some are weeping with redness around the lesion. Fever of ?38. Appropriate treatment. A. Antibiotics. B. Antifungal C. Antiviral D. Steroid 5. 7months old patient with abdominal pain and chest knee position . sausage shaped mass palpated in the abdomen. what is thediagostic test A) USS B) CT C) gastrograffin D) X-ray abdomen 6. A child with pruritus vesicule which appear as crops on the trunk. What is the mode of transmission. A. Air droplet B. Contact C. Blood born D. Hematogenous

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7. A 4 weeks old child with cough and wheezing, had fever with decreased SPO2, what is the diagnosis A) Asthma B) brochiolitis C) pneumonia 8. A 4 months old baby vomiting since birth after every feed irrespective of the amount given. He is gaining weight and well. Most appropriate Rx. A. Gaviscon B. PPI C. avoid mother feed ----- Infant with recurrent vomiting immediately after feed, normal weight gain , ? Reflux what were the options. tx surgery Wasnt the treatment gavison? This was a GMC question twisted round. So is it, is it not reflux? 9. Child not completing school work keep things organized. Collecting cars and arranging them in row again and again. No eye to eye interaction. Learning difficulties-autistic?? OCD LD i ve given learning because of poor academic performance 10. child with day wetting --- bladder training enuresis alarm? Refer to urologist it is day wetting Was there oxubutin among the options of this question?? Enuresis alarm 1st line incontinence management in kids less than 7 y not for daytime symptoms was there desompressin in the options of this q? Blue lips of child?? Child with cough coryzal symptoms something like that don’t remember the question what next CXR

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blood culture etc what is the diagnosis? Was nasopharyngeal aspirate among the answers given for this question....I remember I chose that as an answer to a question i thought it was pertussis, if I remember correctly there was something in the stem about not being vaccinated. Diagnosis by per-nasal swab 11. A mother worried about her 2 months old child and brought him for hearing test? audiologic brainstem yes and for 6 days old child

1.Deafness 9. Autism

2. CF? 10. refer to urologist

3. Impetigo 11. audiologic brainstem

4. Antibiotics

5. USG

6. Air born

7. Bronchiolitis

8. Gaviscon-GOR

Palliative-June 2020 1. An unresponsive female patient with an advanced directive of DNR. He doesn't want to be managed in the hospital. He started deteriorating and daughter wants him to be managed in the hospital. Most appropriate action. A. Tell her that DNR can be revoked. B. Tell her to get a court order?? C. Explain what DNR means to her. D. Respect the daughter's wishes E. 2. An elderly man in a nursing home for palliative care, in respiratory distress, with rattling noisy breathing what do you give A) Anti muscarinic B) Nebulized Normal saline C) Midazol 3. A patient with intractable hiccup. Management? A. Chlorpromazine. B. Metoclopramide

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C. Hyocine butylbromide 4. A patient who is on palliative care for metastatic lung CA. Started vomiting blood. She was scared and agitated What is the most appropriate action? A. FFP. B. Vit K. C. Midalozam. D. IVF A man who is on palliative care for liver metastatic and? Colon cancer. He was managed at home. Developed noisy breathing. She has difficulty in swallowing oral medications. Appropriate step. A. Nebulized adrenaline B. Nebulize n/ s. C. Oral .... D. Subcut hyoscin butylbromide Pt in end days of life with vomiting can’t tolerate oral fluids not passed stool next step? hyocine butylbromide With vomiting it clear secretions I think Not passed stool, you now give hyocine butylbromide that stops or suspends gastric motility? Was it the same question that had the option of IV antiemetic, and the patient was already taking something IV infusion?? So why not put the option of IV antiemetic in this question, as the patient is already was taking IV Rx? I assumed because it’s hard to administer because the patient is receiving home based care Pt with liver mets has severe blood in vomiting most important next step midazolam I thought it was esophageal varices so chose terlipressen It was varices i guess. But since he was on end of lifw care .. so we'll give him midazolam s/c midazolam one hiccup Q was due to peripheral cause (liver metastasis or something) = metoclopramide.

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The other was probably central (unknown cause) = chlorpromazine. If I’m not mistaken

1. Explain what DNR means to her

2. Anti muscarinic

3. Metoclopramide

4. Vit K

Pharama-June 2020 1. Dose and route of adrenaline 2. A man who had COPD, HTN and IHD. On, lisinopril, aspirin, beclomethsone, salbutamol etc. Developed diarrhea and vomiting with deranged RFT. Which medication to stop. A. Metformin B. Beclomethsone. C. Aspirin D. Lisinopril 3. A patient with status epilepticus who is on phenytoin. He weighs 80kg. Maximum dose of phenytoin is 50mg/ min. He is to receive 20mg/ kg. What is maximum time for phenytoin to be administered. A. 25 mins. B. 30 mins C. 12 mins D. 32 mins E. 50 mins 4. A 22 year old woman with epileptic seizure who is on sodium valproate. What advice will give her? A. Do RFT every 6 months. B. Do ECG every month. D. advice on contraceptive use 5. An autistic pt came with carer. Pt is not getting proper treatment. What could be reason? A. carer is not able to explain medication to the pt B. pt is autistic

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Another calculation I put 175 twice but don’t know Yeah I think 175 There was a question in which we have to increase the dose of something by 1/3 I guess.

1.0.5ml 1:1000 dilution-IM

2. Metformin

3. 32mins

4. Advise on contraceptive use-teratogenicity

5. Career is not able to explain the medication

Psychiatry-June 2020

1. A young boy presenting with crying, rhinorrhea, sever pain. Takes alcohol and illicit drug. Possible drug of abuse. A. Cocaine. B. Amphetamines C. LSD. D. Heroin E. Cannabis Repeated-------------A child who cannot finish his assignment. Collects cars and arranges repeatedly and when disrupted, he gets angry. Possible diagnosis. A. ADHD. B. Learning disabilities C. OCD D 2. A patient who has low mood, lack of energy and loss of interest. Finds it difficult to get out of bed in the morning. Still hears her husband who died 3 years talking to her. A. Grief adjustment disorder. B. Bipolar disorder. C. Psychotic depression. D. Schizophrenia E. Mania 3. A patient who checks his door multiple times and washes hands severally. He goes to work late. Diagnosis A. Mania. B. Schizophrenia.

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C. OCD. D. Depression. E. Mania 4. A known diabetic and hypertensive man on medication/CCB. Recently started on sertraline for depression. Now developed erectile dysfunction. Possible cause. A. Autonomic neuropathy B. Sertraline C. CCB. 5. a patient 6weeks post natal ,not feeding baby, thinks baby has evil eye. what's the diagnosis A) post natal depression B) postnatal psychosis C) baby blues 6. Patient presents with side effect of antipsychotic where he paces room the house A. Chorea B. Dystonia C. Tardative dyskinesia D. Akathisia E. Hemiballimus 7. A woman who has anxiety, palpitations, breathlessness and feeling of dying. She is scared of going outside as she may develop the symptoms. What is the diagnosis A. Agoraphobia B. Panic attack C. GAD D. OCD 8. A pt that is eating excessively, adding weight, low mood and suicidal thought, what’s the diagnosis A) psychotic depression B)schizo affective disorder C) seasonal affective disorder There was no atypical depression in the options 9. A patient who presented to the hospital claiming he has HIV. The test was conducted and it was negative. He was told the result and discharge home. He

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presented again complaining of having HIV. He has had one episode of unprotected sexual intercourse before his 1st disease. What is the diagnosis. A. Somatization B. Hypochondriasis. C. Malingering D. Conversion disorder. E. Munchausen syndrome 10. An 18 year girl boy who took 40 tabs of ibuprofen. He also left a suicide note stating he doesn't want to be treated and wishes to die. She was subsequently treated in the hospital. She and now well and fit for discharge. What is most appropriate step. A. Discharge home B. Give an outpxt follow up to psychiatry. C. Refer to her GP. D. Refer to psychiatry liaison E.... 11. An alcoholic who wants to stop drinking. Which medication can be given to him to reduce his symptoms gradually. A. Disulfiram B. Chlordiazepoxide. C. Lorazepam. 12. A child who complains of abdominal pain and doesn't want to go to school. His mother is being managed for depression. What is the most appropriate action. A. Do abd USS. B. Do CT scan. C. Admit and treat. D. Collect collateral information from friends and teachers Child not doing good in school mother has depression assess home and school something something I chose family systemic something collateral information from family and school I did the same as mother diagnosed with cancer Wht abt collection of collateral info/refer to systemic family therapy. Key was collect collateral info or refer family therapy? 13. An alcoholic having visual hallucinations, agitation, severe tremors, most appropriate drug to give A)lorazepam

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B) haloperidol A pt having delusion of guilt, not sleeping properly, suicidal intent, what’s the diagnosis A) depression with psychosis B) delusional disorder C. Schizophrenia D. Schizoaffective disorder. E. Mania F. Bipolar disorder Woman with panic attack want a letter to get leave from job occupational health i think but not sure I chose advice her that she doesn’t need them anymore as she is already on CBT but she still having symptoms 14. rigidity, high temp, increased sweating after receiving metoclopramide, Dx Neuroleptic malignant syndrome EPSe There was question about agitation and hallucinations after alcohol stoppage .there was no lorazepam in the options .. I chooses carbamezapine chlordiazepoxide was in option too So, that's mean you considered the question as Delirium tremenus, not acute alcohol withdrawal??

1.Herion

2. Psychotic Depression

3. OCD

4. Sertraline

5. Postnatal Psychosis

6. Akathsesia

7. Agoraphobia

8. SAD

9. Hypochondriasis

10. refer to Psychiatry liaison

11. Chlordiazepxide

12. Collect information from family and teacher

13. Lorazepam

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depression with psychosis

14. EPSe-side effect of metachlorpromide

Respiratory-June 2020

1. Following a laparoscopic cholecystectomy, a pt developed shortness of breath and chest pain. ECG normal, CXR normal. Most appropriate diagnostic investigations. A. CTPA B. Echo C. Doppler USS. D. VQ scan

2. An asthmatic child on SABA and steroid inhaler. Still having symptoms. Appropriate next step.. A. Increase steroid. B. LABA. C. LTRA D. Theophylline 3. A patient already on warfarin and Satatin, came with fever, cough and sputum production. Has a left lower lobe crackle and allergic to penicillin. Treatment. A. Amoxicillin B clarithromycin C. Penicillin D. Ciprofloxacin E. Doxycycline Asthma pt on salbutamol and ICS still has symptoms increase ICs dose? i did laba LTRA it was agonist so laba New guidelines state LTRA before LABA. PLAB 1 KEYS changed that, I don't know if PLABABLE did. are you sure it was agonist? so it was not written in aconyms (LABA), LTRA etc. ? I cant remember. Leukotriene receptor agonist was written I also chose LABA and was worried when checked the guideline COPD palliative care mx? Prednisilone

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salbutamol inhaler morpine Diaphramatic hernia sx complication mx Chest drain? I think it was ABC .. I choosed intubation or IV fluids. Something like that Chose intubation too. Chest drain is a painful procedure and requires sedation but you can’t sedate someone who’s already unstable

1.CTPA

2. LABA

3. Doxycyline

Rheumatology-June 2020

1. Pt has metastatic cancer incontinence and perianal numbness ... what is the most appropriate investigation DEXA Scan MRI Urine dipstick Radio Isotope Study 2. A patient presenting with features of hypercalcemia. Takes 4 tabs of multivite every day. PTH is normal. Ca is high. ALP is high. Diagnosis A. Vit D excess. B. Sarcoidosis C. Metastatic Cancer D. primary hyperparathyroidism E. M. Meyloma Raised alkaline po4 , raised calcium, normal parathyroid levels. What was the question metastasis? Mets , parathyroid will reduce, I wrote primary hyperparathyroidism, where PTH stay normal. primary hyperparathyroidism because of normal PTH in the context of hypercalcemia it was mets high ALP was there too M.myloma was probably the right answer

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3. A patient that had mastectomy for breast CA, and later develops severe bone pain, what is the most appropriate treatment A) Radiotherapy B) Alendronate C) IV normal saline D) Calcium supplements 4. An 80 year old patient who has wrist fracture. Xray wrist shows Cole's fracture. Dexa scan showed - 2.3. What is most appropriate management. A. Bisphosphonate- Alendronate B. Vit D and calcium supplements. C. Discharge and check dexa in 3 years Dexa -2.3 next step ca and vit D as bisphophonates are given after -2.5 alendronic acid osteoporosis happens when dexa is -2.5 Patient was 80 so high risk. Alendronate 5. A patient who has metastatic prostate Ca. presents with back pain. Was given morphine. What is the next appropriate management to help with her symptoms? A. Bisphosphonate B. Calcuim C. Chemotherapy D. Radiotherapy Cancer pt bone pain next step was radiotherapy don’t remember the exact question radiotherapy..? 6. Pt had fracture what test to determine future risk of fracture A.DEXA B.S. ca C.S. phosphate D.????

1.MRI

2. primary hyperparathyroidism

3. Radiotherapy

4. Bisphonates

5. Radiotherapy

6. DEXA

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Statics-June 2020

1. 10, 000 women screened for a test, 1000 who were Positive had a further screen and 10 actually had disease, what term is the 9000 who did go for the second rounds. A. True positive B. True negative C. False positive D. False negative E. Test positive 2. Calculate Pancreatic CA incidence in a population with 500, 000 people, cases 250, over 5 year period in one million A. 1000 B. 250 C. 100 D. 25 E. 50 Pancreatic Ca epidimiology qs Answer 100?

1. False negative

2. 100

Urology-June 2020

1. A 78 year old man, who has family history of cancer and worked in a factory. Has a high smoking and alcohol history. Was diagnosed to have bladder Ca. What is the most important risk factor for bladder CA. A. Alcohol B. Smoking. C. Family history. D. Occupational hx E. Age 2. A 19 year old boy who developed sudden onset of testicular pain while playing football. Had similar episode in the past. Most appropriate action. A. Surgical exploration B. Antiboitics. C. USS of the scrotom D. Not action

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3. A man with a left testicular swelling that disappears on lying flat. Scrotal swelling is on left side. Diagnosis A. Varicocele. B. Hydrocele. C. Testicular Ca. D. Seminoma. E. Epidymal cyst 4. A 6 yrs old child with enuresis for the past 6 months, exam and investigations are in normal. What is the least appropriate management? A. Enuresis alarm B. Bladder training C. Desmopressin D. Fluid restriction 5. 68yr old woman with urinary urgency n frequency with 18months history. URE normal. What’s the next appropriate management? - Antibiotics - refer to urology - adv; bladder training - oxybutin painful ,swollen testis post traumatic....answer? USG or aspirate surgery here too posttraumatic torsion need urgent surgery to save testicle 6. Swollen painful testis, recurrent , sexually active 21 year man. Investigate?? USG surgical exploration antiboitics repeated-----------19 yrs old boy presented with testicular pain of 3 hour and had similar pain in the past. He is sexually active. What is most appropriate action Me too, as the senario was going with Epididmoorchitis, … scenario was chronic pain with superadded acute onset pain that lasted 3 hours. I think the correct answer was still surgery because you can still get torsion even if you’ve had long-standing orchitis. The key was probably the acute change in intensity… 7. Prostate ca investigation in initial presentation?

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Biopsy PSA

1.Smoking

2. Surgical exploration

3. Varicocele

4. Fluid Restriction

5. Bladder training

6. Surgical exploration????

7. 19.5 marker????

Vascular-June 2020

1. An elderly man with renal carcinoma. Has oedema upto the thigh with lower abdominal oedema. What is the cause of swelling? Obstruction of IVC Common iliac V obstruction Great Saphenous V obstruction

1. Obstruction of IVC

Osteomyelitis one why not white cell labelled nuclear med scan for osteomylistis? I mean the other question with foot ulcer , developed fever, ..back pain #There’s one with essential tremor as part of the option that’s where the option hemiballimus comes in -case with nystagmus ( investigation of choice) Eye difficult to abduct???