Веб-сайт Ассоциации LRC

Theme No. 1 : Types of bias in clinical trials

A. Recall bias
B. Chronologic Bias
C. Lead-time bias
D. Publication bias
E. Selection bias
F. P-value bias
G. Randomisation bias
H. Commercial bias
I. Confounding bias
J. Observational bias

1. A study was performed examining stroke rates when comparing people at work with people on long term sickness leave. Working people were found to have a lower stroke rate. It was concluded that work reduces your risk for stroke. This study most clearly shows

2. A study aims to evaluate the impact of screening for colorectal cancer by means of faecal occult blood testing. It is found that patients detected by this method tend to survive longer than patients presenting with a complication of the tumour. It is concluded that faecal occult blood testing improves the chances of survival. This study demonstrates

3. Controversy surrounds the surgical treatment of Ebstein's anomaly. An author studies a population group undergoing surgery in early adulthood. He compares the results with those of a study performed twenty years previously in which surgery was performed in infancy.
This study is likely to result in

4. A study was performed in order to evaluate whether the age of first
menstruation influenced the age of developing breast cancer. Patients first diagnosed with breast cancer were asked for the age of their first menstruation. This study is likely to result in a

5. A new type of antibiotic is gaining press attention. A certain journal informs authors that it would give preference to articles that are centered around this new antibiotic. Articles in the next edition of this journal are likely to suffer from

Theme No. 2 : Treatment of intestinal obstruction

A. Anterior resection
B. Sigmoid colectomy
C. Subtotal colectmy and ileorectal anastomosis
D. Transverse colectomy
E. Right hemicolectomy
F. Exploratory laparotomy and Hartman’s procedure
G. Abdomio-perineal resection with end colostomy
H. Urgent hernioraphy

6. An 86 yr old man opresents with abdominal distension and pain . sigmoidoscopy and barium enema confirm a obstructinf CA of rectosigmoid.

7. A 60 year old male presents with abdominal pain ion RIF with distension. Xray shows a dilated loop of bowel 12 cm in dia with convexity \towards left hemi diaphragm

8. An elderly male with high grade fever vomiting and intense pain in RIF o/e hard rigid distended mass seen on abdomen with rebound tenderness on the left., X ray shows free air under the diaphragm

9. An 46 year old man presents with bowel obstruction and pain in rectum. Rectal examination and X-rays confirm obstruction and carcinoma rectum.

10. Middle aged man c/o constantt groin pain a/w N + V o/e he had +ve cough impulse. A tender lump is also palpated which is not reducible.

Theme No. 3 : Abnormalities of water and electrolyte balance
A. Addisons
B. Conn’s syndrome
C. Diabetes insipidus
D. RTA
E. Salmonella enteritis

Na K HCO3
11 136 2.8 18
12 149 2.6 30
13 128 5.6 22
14 130 2.5 8
15 160 5.6 18

Theme No. 4 : Association of systemic diseases and skin lesions

A. Erythema chronicum migrans
B. Erythema multiforme
C. Pretibial myxedema
D. Dermatitis herpetiformis
E. Livedo reticularis
F. Dermatomyositis
G. Bazin’s disease
H. Dermatitis artefacta
I. Alopecia areata
J. Mycosis fungoides
K. Bowen’s disease
L. Paget’s disease
M. Rodent ulcer
N. Cafй-au-lait spots

16. Addison’s disease
17. Cutaneous T-cell lymphoma
18. Celiac disease
19. Hyperthyroidism
20. Tuberculosis
21. Polyarteritis nodosa
22. Mycoplasma pneumoniae
23. Lyme disease
24. Von-Recklinghausen disease
25. Bronchial carcinoma

Theme No. 5 : Overdosage management

A. Acetylcysteine
B. Desferrioxamine
C. Dimercaprol
D. Ethanol
E. Flumazenil
F. Glucagon
G. Naloxone
H. Observation
I. Pralidoxime
J. Penicillamine
K. Sodium nitrite

26. A 50 year old female is admitted unconscious after taking an overdose of an unknown substance. The only history is from her husband who states that she has been depressed and anxious of late and has been prescribed some medication by the GP. Examination reveals a Galsgow Coma Scale of 10/15 and she responds and opens her eyes to pain. She has a pulse of 62 beats per minute regular, a blood pressure of 130/80 mmHg and a respiratory rate of 20/minute with a saturation of 96 per cent. The pupils are of normal size.

27. A 70 year old farmer is admitted acutely after ingesting an unknown overdose. Examination reveals a particularly anxious male who is sweaty and salivating. His temperature is 40°C and he has a blood pressure of 90/60 mmHg with a pulse of 65 beats per minute.

28. A 6 year old child is admitted after consuming her mothers ferrous sulphate tablets. She has had one haemetemesis and the iron concentration is excessive.

29. A 52 year old vagrant attends casualty with hyperventilation and vomiting. He confesses to having drunk methanol.

30. A 16 year old girl is admitted after taking a paracetamol overdose with alcohol 4 hours previously. Her plasma paracetamol concentration is just below the nonagram concentration that would suggest treatment. Her plasma alcohol concentration is 120 mg/l.

Theme No. 6 : Differential diagnosis of chest pain in children

A. Mitral insufficiency
B. Aortic stenosis
C. Pericarditis
D. Tricuspid incompetence
E. Costochondritic pain
F. Hiatus hernia
G. Perciardial tamponade
H. Reflux esophagitis
I. Aortic insufficiency
J. Pleuritis

31. A 4-year-old boy wakes up frequently saying, 'It hurts here' while pointing to his chest. He was born prematurely but has done well otherwise. On examination he has a 2/6 ejection systolic murmur between the left sternal border and the apex that radiates to the base and is accompanied by an apical S3.

32. A 7yr old girl who had chickenpox 4 weeks ago complains of shortness of breath and a squeezing tightness in her midchest. She is anxious and refuses to lie down. Her heart rate is 110 beats per minute and blood pressure 110/80. Her neck veins are distended.

33. A 14-year-old boy scout complains of exercise-induced sharp chest pain at the left lower sternal border that diminishes with resting and does not awaken him. He has never had anything like this before. Palpation along the sternal edge replicates the symptoms.

34. A 17-year-old develops a tightening sensation in his mid sternum during exercise. On examination the pulse rate is 180/minute, the respiratory rate is 38/minute, and the blood pressure is 120/90 mm Hg. You hear a suprasternal notch thrill, an apical click, and a 3/6 ejection murmur at the right upper sternal border.

35. An 18-year-old girl has dull retrosternal pain and shortness of breath. On examination she has a heaving apical pulse, an apical systolic thrill and a short mid-diastolic rumbling murmur.

Theme No. 7 : Localisation of neurological disorder

A. Non-dominant frontal lobe

B. Dominant frontal lobe

C. Non-dominant temporal lobe

D. Dominant temporal lobe

E. Non-dominant parietal lobe

F. Dominant parietal lobe

G. Occipital lobes

H. Temporal-occipital-parietal junction

36. A 45-year old stroke patient clearly can understand what someone says to him but he is unable to respond verbally to that person

37. Although he can repeat phrases, the speech of a 52-year old stroke patient is impaired and has difficulty understanding what someone says to him.

38. A well-educated stroke patient cannot add a column of four single digit numbers.

39. A 58-year-old stroke patient is unable to copy completely; a simple drawing of a clock face.

Theme No. 8 : Investigations in substance abuse

A. Dexamethasone suppression test
B. Electrocardiogram
C. Electroencephalogram
D. Full blood count
E. Gamma-glutamyl transpeptidase
F. Genetic analysis
G. MRI brain
H. Serum toxicology screen
I. Thyroid function tests
J. Treponema pallidum haemagglutination assay
K. Urine drug screen

40. A 32-year-old woman with bipolar affective disorder is brought to A & E department comatose. She is apyrexial and has no focal neurological deficit.
41. A 45-year-old man presents with low mood and tremor, worse first thing in the morning.
42. A 25 yr old nurse with a history of alcoholism partner says that after an argument she took some medication after which she is behaving strangely, very agitated , profusely sweating , and with tremors and episodes of diarrhoea.
43. A 50 yr old patient says that he had brief spells of dizziness and palpitations since he has started his new medication . He also vomited twice and had trouble coming to the A & E because his vision is compunded with colored haloes.
44. A 65-year-old man presents with progressive dementia, spastic paraparesis and seizures. He also has small irregular pupils that accommodate but do not react to light.

Theme No. 9 : Diagnosis of Infections
A. Lyme disease
B. Brucellosis
C. Infective endocarditis
D. Listeriosis
E. Psittacosis
F. Typhoid fever
G. Infectious mononucleosis
H. Legionnaire's disease
I. Tularemia
J. Tuberculosis
45. A 34 year old man gets bitten on his hand by a rat. A few days later he develops enlarged and tender localized cervical and axillary lymphadenopathy on the same side as the bite. The bite becomes rapidly red and painful and undergoes necrosis. He also complains of generalised fever, headache and fatigue.
46. A 22 year old male has a gradual onset of cough, night sweats, vomiting and weight loss. On his chest X-Ray there is a density which enlarges the left hilum. It occupies the site of the apico-posterior segment of the left upper lobe. There is a lobulated left para-tracheal density.
47. Five days after a working journey in France a 42 year old male smoker begins to feel ill with malaise, general aches, a headache, and a dry cough. He rapidly develops diffuse bruising and acute renal failure. Investigations reveal a thrombocytopenia.
48. A mother notes that her eight year old son has mild weight loss and a prolonged low grade fever over about two weeks. On examination he is found to have cervical lymphadenopathy and splenomegaly.
49. While working with a missions organisation in Africa a doctor is asked to see a 28 year old male with fresh bleeding per rectum. The man gives a history of increasing fever, headache and constipation. On inspection he is noted to have a relatively slow pulse rate and pinkish spots are seen on his abdomen.
50. A pregnant woman and her husband develop fever, muscle aches and severe diarrhoea about three weeks after eating a soft cheese given to them as a present from a guest. Her baby is later born at term with septicemia and becomes acutely unwell.

Theme No. 10 : Clotting disorders
A. Desmopressin
B. Factor VIII concentrate
C. Factor X
D. Fresh frozen plasma
E. Folic acid
F. Gelofusin
G. Heparin
H. Steroids
I. Vitamin K
J. Wafarin

51. A 23 year old lady, 10 weeks pregnant, is diagnosed with a pulmonary embolism. She is allergic to wafarin
52. A 65 year old alcoholic man is admitted with bleeding oesophageal varices. He has received 6 units of blood and has a prolonged prothrombin time
53. A 70 year old man with prosthetic mitral valves is admitted to hospital with a 2 day history of bleeding per rectum and a INR of 6. He had been commenced on ciprofloxacin 3 days previously, to treat a urinary tract infection by his GP.
54. A 5 day old baby girl whose mother is taking anticonvulsants is admitted with unexplained bruising. Clotting profile reveals both her prothrombin and partial thromboplastin times are elevated
55. A 7 year old boy is admitted with haemarthrosis of his left knee. This has been a recurrent since his early years. His Activated partial thromboplastin time is significantly prolonged but bleeding time is normal.

Theme No. 11 : Investigations of paediatric endocrinological and metabolic disorders

A. FBC
B. Serum electrolytes
C. Serum ADH
D. Serum GH
E. Phenylketones in urine
F. Thyroid function tests
G. Galactose in urine
H. Serum ACTH
I. High serum blood glucose
J.Low blood glucose
K. Cystine in urine
L. Plasma cortisol

56. 1 month baby with poor feeding and lethargy. O/E umbilical hernia and enlarged tongue

57. Newborn female with enlarged clitoris and fused labia.

58. 13 yr obese girl with asthma and eczema and amennorrhoea, BP 130 /80.

59. 1 month baby with vomiting jaundice and hepatomegaly. Baby is worse
after feeding

60. 8 year old boy with short stature c/o thirst and passes huge volume of
colorless urine.

Theme No. 12 : Differential Diagnosis of Neuromuscular Disease

A. Cerebrovascular Accident
B. Guillain-Barre' Syndrome
C. Amyotrophic lateral sclerosis(ALS)
D. Neurosyphilis
E. Duchenne Muscular Dystrophy
F. Friedreich's ataxia
G. Myasthenia gravis
H. Tranverse myelitis
I. Motor neurone Disease
J. Syringomyelia

61. A 39 year-old man white man presents to his GP because of progressive muscle weakness of 1 week's duration. His medical history is unremarkable, although he reports having had an influenza-like episode 2 weeks ago. GP notes a marked decrease in reflexes and loss of light touch and vibration sensation in the distal extremities.

62. A 6 year-old black boy is brought to GP by his mother. She is concerned that he can no longer keep up with his friends, and she notes that he is using his hands to pull himself up from the floor. GP notes that the boy's calf muscles appear enlarged and his muscle strength is extremely impaired.

63. A 55 year-old man with no previous medical problems visits his GP because his arms have become progressively weaker over the past 2 months. The weakness and fatigue began first in one arm and developed later in the other. GP notices hyperreflexia,as well as generalized muscle weakness,in all four extremities. The man has no sensory dysfunction,and his gait is normal.

64. A 34 year-old woman presents with muscular weakness of 3 month's duration and says that she tires easily when she's trying to work.After she rests for a while,some of her strength returns. GP notices bilateral fascial weakness and asymmetric distribution of proximal limb weakness. Tendon reflexes are normal.

Theme 13 : Tumour risk factors

A. Pernicious anaemia
B. Dye and printing chemicals
C. Asbestos
D. Ulcerative colitis
E. Epstein-Barr virus
F. Nickel
G. Smoking
H. CMV
I. Excessive sunlight and UV exposure
J. Human Papilloma Virus

65. Burkitt's lymphoma
66. Bladder ca
67. Gastric ca
68. Colorectal ca
69. Lung ca
70. Nasopharyngeal ca

Theme No. 14 : Diagnosis
A. Rubella
B. Landau Barre Syndrome
C. Landau Kleffner Syndrome
D. Cystinuria
E. Homocystinuria
F. Phenylketonuria
G. Hirschsprung Disease
H. Celiac disease
I. Fifth Disease
J. Measles
K. Infectious Mononucleosis
L. Hypothyroidism
J. Cri-du-chat syndrome

71. A chinese woman of 34 yr presents to you with her 5 yr old son.She says that her child was speaking normally till about 3 yr,thereafter he has been increasingly aloof and does not talk.o/e the child is mute.Auditory evoked response is normal b/l.The baby has mongloid features.There has been two episodes of generalised convulsions in the past not associated with fever.What is the most likely diagnosis?

72. A child presents to you with h/o convulsions.o/e white opacity is found in the eyes.The hair is thin and breaks easily.The urine biochemistry shows an abnormaility for proteins.

73. A cild presents with alternating diarrhea and constipation.o/e abdominal distension is present.The child is in the 70 th percentile of his weight for age.

74. A young adult man presents with flushed cheeks and rashes on his forearms.He c/o intermittent joint pain for the past 2 weeks.Cervical lymphadenopathy present.The monospot test is positive.

75. An infant is brought to you with poor feeding.o/e the muscle tone is decreased.The baby has a peculiar cry.He is a full term baby delivered p/v.The mother is healthy and antenatal history is uneventful.

Theme No. 15 : Investigations of the unconscious patient
A. Blood cultures
B. Blood gases
C. Brain stem death tests
D. Carboxyhaemoglobin level
E. Computed tomography of head
F. Cardiac monitoring
G. Lumbar puncture
H. Serum glucose
I. Thyroid function tests
J. Toxicology screen
K. Urea and electrolytes

76. A 47 year old woman is found collapsed in her home. Examination reveals meningism and bilateral upgoing plantars.
77. A 67 year old man with severe chronic obstructive pulmonary disease was brought to Casualty Department by ambulance. His breathing and conscious level seems much worse with oxygen during the ambulance journey, although his oxygen saturation on pulse oximetry is 90%.
78. A middle-aged couple is found comatosed in their caravan by their teenaged son, who woke up in the middle of the night with nausea and vomiting. All three of them had been well before they went to sleep.
79. A 45 year old man collapses in the ward. Examination reveals cardiorespiratory arrest.
80. A 56 year old diabetic is found unresponsive at home by her neighbour. She is presently being treated for a urinary tract infection. There is no focal neurological deficit on examination.

Theme No. 16 : Side-effects of Drugs used in Tuberculosis

A. Ciprofloxacin
B. Clarithromycin
C. Cycloserine
D. Dexamethasone
E. Ethambutol
F. Isoniazid
G. Prothionamide
H. Pyridoxime
I. Pyrazinamide
J. Rifampicin
K. Streptomycin

81. Colour blindness
82. Peripheral neuropathy
83. Ototoxicity
84. Hepatic enzyme induction
85. Vertigo

Theme No. 17 ; Milestones

A.3mths
B.6mths
C.9mths
D.12mths
E.18mths
F.2yr
G.3yrs
H.4yrs
I.5yrs
J.6yrs
K.7yrs

86. A child can copy a square and triangle but not a diamond

87. Mother concerned that baby not walking yet. the baby can sit unsupported, bables, holds pencil in scissor grasp, can transfer it to his mouth and between his hands

88. A child can only copy a circle , climbs stairs one foot per step, builds tower of nine cubes

89. A child can only copy a circle and cross, stand on 1 foot for 5 sec and climbs up and down stairs one foot per step

90. Mother concerned that baby not talking yet, he can walk around furniture, can stand alone for few sec,holds objects in pincer grasp

Theme 18 : Investigations in Rheumatology

A.Full blood count
B.Kveim test
C.ANCA
D.ESR
E.Antibodies to double-stranded DNA
F.Skin biopsy
G.Skin biopsy for Ziehl Neelsen staining for acid-fast bacilli.
H.Fasting cholesterol and triglyceride levels.
I.Anti-Ro antibodies
J.Serum pancreatic glucagon
K.Muscle biopsy.
L.Serum glucose
M. Anti-La antibodies
91.A 38 yr old man presents with malaise and arthralgia.He is noted to have various skin lesions,including a purple bulbous nose and tender red raised nodules on his anterior shin.

92.A 70 yr old woman presents with a mid-facial disfigurement.The nose appears to have been gnawed off by a condition. The cutaneous lesion shows granulomas with central caseations.

93.A 50 yr old woman presents with fleshy coloured papules over her right distal interphalangeal joint of her thumb and with a brown waxy plaque over her right shin.

94.A 50 yr old woman presents with weakness in her upper arms. She has difficulty combing her hair.On examination,she is noted to have ragged cuticles and nail fold capillary dilatation.

95.A 60 yr old woman presents with crops of yellow papules on her elbows and knees. Her serum glucose is normal.

Theme No. 19 : Causative organisms in infection
A. Bacillus anthracis
B. Clostridium difficile
C. Campylobacter jejuni
D. Clostridium perfringes
E. Clostridium welchii
F. Haemophilus influenzae
G. Mycobacterium kansasii
H. Neisseria gonorrhoea
I. Neisseria meningitidis
J. Treponema pallidum

96. A 10 year old boy rushed to hospital with a days' history of fever, a blotchy rash and confusion.
97. A 14 day old neonate presenting with a purulent eye discharge.
98. A 37 year old man, previously fit and well, presenting with a 2 day history of bloody diarrhoea, abdominal pain and vomiting.
99. A 3 year old boy who has gone of his food, presenting with fever and left ear pain.
100. An 80 year old nursing home resident admitted to hospital with profuse diarrhoea, one week after completing a course of Augmentin for a Urinary Tract Infection.

Theme No. 20 : Management of Ankle injuries

A. Elastic bandage and physiotherapy
B. External fixation
C. External fixation and wound debridement
D. MUA [ manipulation under anesthesia ] and POP
E. ORIF (open reduction and external fixation)
F. POP immobilization
G. Suture repair

101. 26 year old man c/o sudden pain at the back of the heel and his calf wehile playing sqaush . he has calf tenderness and unnable to stand on his toes XR are normal

102. 54 year old woman sustains injury on her left ankle whilst stepping dnt the kitchen ladder.she has swelling and tenderness over the lateral aspect opf her an ankle . Xray shw undisplaced # fibula distal.

103. 23 year old motor cyclist involved in a RTA has a compound open # of the left tibia and extending into the ankle.
104. 31 year old foot baller sustains an injuiry over her right ankle ina tackle swelling and tenderness over the medial and the lateral aspect of the ankle are +. Xray show displaced # distal fibula with evidence of talar shift.

105. 43 year old cleaner falls off the ladder injurying his left heel. X ray confirm extra articular # calcaneum.

Theme No. 21 : Management of Ischaemic Limb

A Stop smoking, exercise
B Amputation
C Angiography
D Duplex scan
E IA vasodilator
F Chemical sympathectomy
G Angioplasty
H Ca ch. Blockers
I Antibiotics
106. 40 yr woman, h/o angina; c/o sudden pain, pale, pulseless, lower limb; can
hardly move her foot
107. 45yr man has been suffering from intermittent claudication and it is
getting worse now

108. 53 yr man h/o femoral-popliteal reconstraction on the left leg; o/e
progressive cellulitis , ulcers on the shin no dorsalis pedis pulses

109. 45 yr smoker c/o pain in calf walking up hill 400 yrds ;o/e absent dorsalis
pedis other Ps are normal

110. 25 yr guy after RTA with fructure of tibia/fibula ; appears to be no pulse in
the foot.

Theme No. 22 : Prevention and treatment of DVT

A. Systemic heparin 30,000 units per day
B. Systemic heparin 5000 units BD
C. Compression stockiungs
D. Systemic fibrinolysis
E. Use caval filters
F. Cardiopulmonary bypass
G. LMW heparin
H. No Rx
I. Oral anti coagulants
J. LMW dextran

111. 56 year old obese man undergoing surgery for total hip rplacement
112. 45 year old man with precv h/o peptic ulcer undergoes surgery for soft tissue sarcoma of the thigh.
113. 45 yr old female undergoes surgery for a # shaft femur . develops tender swelling in the calf. An I 131 fibrinogen uptake scan shows increased uptake .
114. 36 year old 45 kg demale uundergoes surgery for fibroadenoma
115. 45 year old female in [3] develops repeated episodes of cough and dyspnoea and hempotysis inspite adequete medical rx. VQ scan shows perfusion defects.

Theme No. 23 : Diagnosis of Breast lumps

A. Carcinoma
B. Fibroadenoma
C. Cyst
D. Cyclical mastalgia
E. Breast abscess
F. Pagets disease
G. Cystosarcoma Phyllodes

116. 72 yo lady, with a complaint of unilateral mass, in the right upper quadrant with axillary nodes enlarged and fixed.
117. 21 yo lady with a firm mass in the lower quadrant. the mass is mobile no axillary nodes are palpable.
118. 58 yo lady comes with excoriation of skin on the nipple, with bloody discharge.
119. 52 yo patient comes with a history of a bloody discharge from the nipple on squeezing.
120. Post partum patient with a unilateral localised swelling , accompanied by tenderness and rise in temperature.

Theme No. 24 : Investigations in Upper GI Bleeding

A. Barium swallow
B. Blood alchohol concentration
C. Blood glucose concentration
D. CVP monitoring and blood replacement
E. Coagulation screen
F. Diagnostic gastroscopy and biopsy
G. Full blood count the following morning
H. Immediate FBC
I. LFTs
J. Serum auto-antibodies
K. Serum urea and electrolytes
L. Viral hepatic serology

121. A 30 yo man with known duodenal ulcer dis. with profuse haemotemesis and maelena. He has sinus tachycardia of 150 and blood pres of 50/0 mm Hg.
122. A 50 yo man with a history of alchoholism, cirrosis and tense ascites with haemotmesis and sudden onset of coma.
123. A 20 yo male student drunk 10 pints of beer earlier in the evening now with a small fresh haemotomesis. His initial HB is 15 g/dl.
124. A70 yo with a 3 month history of epigastric pain anorexia adn 15 kg weight loss presents with a small heamotomesis.His HB is 8g/dl.Blood film suggests iron deficiency.
125. A 70 yo woman with atrial fibrilation on digoxin and warfarin, presents with haematamesis. The initial HB is 11 g/dl.

Theme No. 25 : Decision making in terminal care
A. Administer enema
B. Gastric intubation
C. High fibre diet
D. Increase opiate analgesia
E. IV fluids
F. Nutritional supplements
G. Palliative radiotherapy
H. Prescribe a cotricosteroid
I. Laxative
J. Amytriptyline
K. ABGs
L. Biphosphonate
M. Methotrimeprasin
N. Reduce opiate analgesia
O. Set up syringe driver

126. An 80 yo man with metastatic carcinoma becomes confused wiht abdominal distention and faecal incontinence. He is on high doses opiates.
127. A 55 yo woman wiht known spinal metastases from breast cancer becames nauseted and confused. Serum creatinine is 120 umol/l, blood gluc is 5.4 mmol/l serum calcium 3.2, she is receiving IV fluids.
128. A 45 yo man is dying of AIDS. he is in considerable pain, despite morphine sulfate, slow release, 20 mg daily, amt 100 mg at night and naproxen 500 mg twice a day.
129. A 65 yo man with prostate CA has extensive pelvic spread of disease with pain not adequately controlled by full dosage of analgesia.
130. An 82 yo man with bronchial CA are known cerebral metastases develops weakness of his right arm but is in no pain.

Theme No. 26 : Investigations of Hypertension
A. 24-hour ambulatory BP
B. 24-hour ambulatory ECG
C. Abdominal ultrasound scan
D. Carotid ultrasound scan
E. CT scan of thorax and abdomen
F. Echocardiogram
G. Magnetic resonance imaging of abdomen
H. Pulmonary arteriogram
I. Renal biopsy
J. Urine catecholamines
K. Urine free cortisol measurement

131. A 58-year-old woman with a 6-year history of essential hypertension presents after a sudden loss of vision in the left eye. This resolved after 30 minutes.
132. A 77-year-old man comes to the Emergency Department because he is feeling unwell, 2 weeks after starting treatment for systolic hypertension and headaches. He does not know the name of the drug which his GP prescribed, but his blood pressure was checked by the practice nurse for several hours after the first dose.

133. A 78-year-old woman underwent hysterectomy 10 days ago. She now presents with breathlessness on minimal exertion. Her chest x-ray shows interstitial pulmonary oedema.

134. A 33-year-old man with no family history of hypertension is seen in out-patient clinic. His blood pressure is 162/76 mmHg and the pulse 98 beats/min; after 5 minutes of rest the BP is 148/80 mmHg and his pulse 72 beats/min

135. A 62-year-old man has poorly controlled hypertension despite 4 antihypertensive drugs. His renal function (urea, creatinine) is normal but he has proteinuria

Theme No. 27 : Diagnosis of Eye diseases

A. Acute Glaucoma
B. Acute Iritis
C. Amaurosis Fugax
D. Cataracts
E. Pituitary Tumour
F. Retinitis pigmentosa
G. Subconjunctival Haemorrhage
H. Temporal Arteritis
I. Thyroid associated opthalmopathy
J. Viral conjunctivitis
K. Behcet’s disease
L. Cavernous sinus thrombosis
M. Graves’ disease
N. Multiple Sclerosis
O. Ophthalmic herpes zoster
P. Pancoast tumour
Q. Reiter’s syndrome
R. Sjogren’s syndrome
S. Syphilis
T. Wegener’s granulomatosis

136. A 27 year old girl presents with unilateral proptosis, weight loss, palpitations and increased appetite.

137. A 75 year old lady complains of a temporary loss of vision 'like a curtain coming down'.

138. A 60 year old man presents with pain and blurring of vision in his right eye. His right pupil is fixed and dilated.

139. A 15 month old child diagnosed with whooping cough presents with a red eye.

140. A 50 year old man presents with early morning headaches and visual field defects

141. A 60 year old diabetic presents with gradual deterioration of vision and dazzling of view in well light places

142. A 65 year old woman presents with tiredness, headache, blurring of vision in the left eye and is unable to comb her hair.

143. A 50 year old male presents with general lethargy, weight loss, eye discomfort and nasal stuffiness. Examination reveals a pulse of 70 beats per minute, mild proptosis of the left eye with diplopia on left lateral gaze and a tenderness over the nasal bridge.

144. A 72 year old female presents with severe pain in the face and right eye. Examination reveals a temperature of 36.7°C and two small red eruptions on the right lower forehead which are exquisitely tender

145. A 24 year old male presents acutely with pain in the left eye. Examination reveals a temperature of 39°C, redness and swelling of a completely closed left eye. On raising the eye ocular movements are universally impaired.

Theme No. 28 : Teratogenicity

A. Betamethasone
B. Norethisterone
C. Salbutamol
D. Ergometrine
E. Oxytocin
F. Prostaglandin F2 alpha
G. Indomethacin
H. Oxytetracycline
I. Amoxycillin
J. Alcohol
K. Isotretinoin
L. Lithium
M. Valproic acid
N. Dilantin
O. Streptomycin
P. Thalidomide

146. Ebstein’s anomaly.
147. Congenital deafness, CNS and Heart defects.
148. Short palpebral fissure, long philtrum and midfacial hypoplasia.
149. Oligohydraminos.
150. Pulmonary Edema.
151. Virilization of a female fetus.
152. Premature closure of ductus arteriosus
153. Defective dentition of the fetus after 4th month.
154. Fetal hydantoin syndrome.
155. Neural tube defects.

Theme No. 29 : Amputations in Orthopaedic practice

A. Below knee amputation
B. Transmetatarsal amputation
C. Syme's amputation
D. Ray amputation with "racket incision"
E. Supracondylar amputation
F. Tarsal amputation
G. Hindquarter amputation
H. Chopart's amputation
I. Above knee amputation

156. A 85 year old man with pain and deformity of the left knee due to congenital malformation. He was able to walk up to the last 5 years when the pain became unbearable.

157. Ischaemic gangrene of the lower leg with ulceration over the medial malleolus and spreading infection proximally

158. A 90 year old lady who is immobile due to severe osteoartritis in the hips and knees. She has developed marked arterial ulceration in the right lower limb. She is requires full nursing care.

159. A gangrenous toe due to peripheral vascular disease with superimposed infection in a 70 year old diabetic.

160. A 64 year old man with a tumour of the upper femur.

Theme No. 30 : Pathologic features of bowel disease

A. Ulcerative colitis

B. Crohn's disease

C. Whipple's disease

D. Hirschprung's disease

E. Coeliac disease

F. Cystic fibrosis

G. Diverticulosis

H. Colorectal carcinoma

I. Primary biliary cirrhosis

J. Colonic polyposis

161. Segmental lesions

162. Fistulae

163. Periodic acid-Schiff(PAS)-positive macrophages in the lamina propria

164. Megacolon

165.Crypt abscesses

166. Granulomas

167. Superficial ulceration

168. Transmural inflammation

169. Pseudo-polyps of regenerating mucosa

170. Bronchiectasis

Theme No. 31: Features of pericardial pathology

A. Postpericardiotomy Syndrome
B. Pneumopericardium
C. Uremic Pericarditis
D. Constrictive pericarditis
E. Mesothelioma
F. Cardiac tamponade
G. Congenital Pericardial Defects
H. Acute viral Pericarditis
I. Pericardial Cysts
J. Bronchogenic carcinoma

171. The commonest pericardial manifestation of the Coxsackie infective agent.

172. A patient with retrosternal pain is found to have an elevated jugular venous pressure that increases with inspiration.

173. A young male is brought to casualty in a confused state. He is found to have a fall in systemic arterial pressure of greater than 20 mm. Hg with inspiration.

174. Malignant pericardial involvement is most likely to be secondary to

175. An 18 year old has a chest X-Ray as part of his pre-employment examination before joining the army. A density is seen in the cardiophrenic sulcus.

Theme No. 32 : The Diagnosis of Infertility

A Polycystic ovary disease

B Endometriosis

C Adenomyosis

D Chronic salpingitis

E Diabetes mellitus

F Hyperprolactinaemia

G Hypopituitarism

H Hyperthyroidism

I Hypothyroidism

J Pulmonary tuberculosis

K Possible Malignancy

176. A 42 year old woman complains of being unable to conceive for 2 years despite have regular unprotected sex. She complains of excessive sweating,frequent stools and says this explains her loss in weight over recent weeks.She denied starving herself and says she a very good appetite. Glycosylated Hb (Hb1c) = 5 %.

177. A 28 year old woman complains of infertility and is otherwise well. She had been on haloperidol to treat a schizophreniform illness she had for six years. She has a healthy 3 year old daughter.

178. A 26 year old woman complains if infertility for 3 years. She has a low libido, and has put on a lot of weight over the last couple of years. Her breasts were found to be discharging on examination.

179. A 31 year old woman complains of abdominal pain which seems to increase during her periods.Over the last year,she has noticed difficulty in breathing and chest pain associated with occasional haemoptysis,following her periods.She has been unable to conceive. On examination she is found to have an enlarged and tender uterus. Her BMI = 20.

Theme No. 33 : Ethical Practice of medicine in the United Kingdom

A Reversal of the circumcision.

B Reversal of circumcision for catheter to be inserted and re-circumcising her.

C Trial of Labour

D Termination

E Refusal of termination since it’s illegal after 24 weeks for social reasons.

F Give her contraception

G Withhold contraception

H Call Police and then Give her the contraception

I Inform Mother and Police immediately.

J Inform the General practitioner (GP)

180. A 22 year Somalian primigravida who doesn’t speak English presents in labour. On vaginal examination you notice a very small introintus, barely enough to admit your little finger. A CTG is done and is shows a baseline rate of 100beats/min. Your team decides, she needs an emergency caesarean section but because of the small introitus you are unable to pass the catheter to proceed to theatre.

181. A 13-year-old girl demands the morning after pill. She says the condom she used with her 13-year-old boyfriend split in two, while having intercourse.

182. A tearful 19 year-old girl at 27 weeks of pregnancy requests a termination, saying her boyfriend has just left her and that she wouldn’t want the baby to remind her of him. The boyfriend who is now in Jail is reported to have assaulted her during their stormy 2-year relationship.

Theme No. 34 : Investigation of Hoarseness

A No investigation

B Computed tomography ( CT ) scan of the neck

C Sputum for Acid fast bacilli

D Cervical spine x-ray

E Laryngoscopy

F Bronchoscopy

G Bronchoalveolar lavage

H Chest X-ray

I Lymph node biopsy

J Treponemal Haemagglutination assay

183. A 25-year-old man complains of a two-day history of hoarseness of the voice. He denies any history of weight but admits to 4-year history of smoking.

184. A 13-year-old girl complains of a 2-day history of hoarseness of the voice associated with a dry cough. She feels feverish and on direct laryngoscopy her vocal cords are grossly oedematous.

185. A 34-year-old woman had a partial thyroidectomy 3 hours ago complains of mild hoarseness of the voice. She had no history of phonation problems prior to surgery.

186. A 67-year-old man with a history of weight loss complains of hoarseness of the voice Computed tomography scan reveals an opacity in the right upper mediastinum. He denied any history of difficulty in breathing.

187. A 34-year-old IV drug user complains of history of a 4-month history of a productive cough. He has lost 10 kg in weight.

Theme No. 35 : Investigations and Treatment in G & O

A. Ethinyl estradiol + levonorgestrol
B. Smear after 6 months
C. Sacrohysterpexy
D. Total hysterectomy with bilateral salpingo oophrectomy
E. Marsupialization
F. Sacrocolpoplexy
G. IUCD
H. Manchester operation
I. Pessary
J. Colposcopy
K. Antibiotics
L. Cord compression
M. Uterine rupture
N. Rubella
O. Chloroquine
P. Mendelsons syndrome
Q. Placenta praevia
R. Mefloquine
S. Threatened abortion
T. Toxoplasmosis
U. Pneumonia
V. Anencephaly

188. A 54 yrs obese lady presents with vaginal discharge and scanty bleeding. Her periods stopped 2 yrs back and she has been on tamoxifen for last 5 yrs. The speculum examination is normal.

189. A 26 yrs lady comes to you 4 days after unprotected sex. She says that she does not wants a pregnancy at this stage of her career. What method of emergency contraception will you choose?

190. A 73 yrs lady comes with complains of something coming down her vagina along with frequency and slight passage of urine when she coughs. She has a h/o chronic bronchitis

191. A 43 yr old smoker presents with vaginal discharge and post coital bleeding. On smear examination borderline nuclear abnormality is seen. What will be the next step
192. A 37 yrs lady with h/o gonorrhoea in past now presents with the complaints of such a severe pain that she cannot even sit down. On examination hugely swollen and red labia is seen. How will you treat this?

193. A lady with 34 weeks of gestation comes for her routine checkup. The foetal heart rate is noted to be around 100bpm. What can be the possible causative factor?

194. A pregnant lady presents in a state of shock with severe bleeding pv. The uterus is not tender and the foetal heart rate is within normal limits. What do you suspect is the cause?

195. A pregnant lady had fever, rash and eosinophilia. She was started on spiramycin for it. What did she suffered from?

Theme No. 36 : Diagnosis of thyroid disorders

A. Thyroglossal cyst
B. De Quervain’s dis
C. Hypothyroidism
D. MEN type 1
E. Simple goitre
F. Hashimoto’s thyroiditis
G. Graves Disease
H. Men type1
I. Papillary Carcinoma
J. Lymphoma
K. Follicular Carcinoma
L. MEN Type II B

196. A 26 YEAR OLD man presents with hypertension, bone pains, prominent mucosal neuromas involving lips, tongue, and inner aspect of the eyelids. His uncle had the same problems.

197. 43 yr old woman presents with wt loss despite good appetite, constipation, frontal headaches and metrorrhagia. Also complains of recurrent dyspepsia and peptic ulcers. Her abdominal radiography shows renal stones.

198. 30 yr old woman presents with wt gain, constipation, lethargy, flaky rash. She prefers to stay indoors even in warm weather.

199. 19 yr old student presents with a neck swelling. On exam swelling moves up with swallowing and protrusion of the tongue.

200. 49 yr old woman presents with goitre. On exam thyroid is firm & rubbery. Thyroid microsomal antibodies are positive in high titre.