Recall June11
Content
JUNE 2011
A middle aged woman with calf pain from yesterday came to hospital; you did investigations and diagnosed deep vein thrombosis. Now she doesn’t have any problem. What is next step in Mx? a. Inpatient management with compression socking and LMWH b. Inpatient management with leg elevation and LMWH c. Outpatient management with compression and LMWH d. Outpatient management with lag elevation and LMWH
A 55 year old worker of insulating factory for 30 years, came with breathlessness from several months ago and now with haemoptysis, (CXR was given; unilateral pleural effusion was obvious!) he has smoked from 20 years ago. What’s the diagnosis? a. Squamous cell Ca b. Small cell Ca c. Mesothelioma A girl who visited SE Asia 6 months ago now has c/o diarrhoea, 3 kg wt loss, loss of appetite. Stool results: Blastocystis hominis and Giardia lamblia positive. What could be the cause for her presentation? (Feb 2011-Q 44) a) Blastocystis hominis b) Giardia lambliac c) Coeliac disease d) Rotavirus A young lady with history of central chest pain and sweating for half an hour. In Ph/E everythings was NL, EKG, troponin, CXR and CTPA were NL. what’s the next step? a. Check troponin in 8 hours b. Discharge the patient 60y man comes with severe sudden chest pain, vomiting and sweating. ECG and Troponin level are normal. What’s the next management? a) Check troponin again in 8 h b) Admit patient to CCU c) Discharge pt with B Blocker and Aspirin. d) Discharge pt without any drug
Patient with cluster headache. Treatment? a. Steroid b. Somatriptan c. Vigabatrin d. Na- valproate z-score in bone densitometry for femoral neck was :-2.5 and for hip was:-1.5 what do you do? a. Reassre and do nothing b. Start immediately on biphosphonates c. Advise regular intake of calcium
In 2 day after operation, patient suddenly became very agitated and anxious, apart from O which is very important to do? a. Starting anticoagulant therapy b. Brain CT c. hallopridole
nd 2
Old patient felt pain in the buttock and thigh yesterday while walking, today he felt it again when he wanted to come to see you. In the examination there is slight tenderness in arm muscles. he is on treatment of HTN, hyperlipidemia and gout. He uses ACEi, atrovastatin… Which one is the important next step to do? a. check creatinin and electrolytes b.EMG c. nerve conduction studies
Old lady stretches her back to open the window pf her house then suffered from back pain, MCV < 98, microcytic hypochromic anemia blood picture(huge presentation of full blood count) urea, creatinin and electrolytes). What is the most likely diagnosis?. a. Osteoporosis b. Multiple myeloma
. Old lady case, presents with back pain. MCV <98, microcytic hypochromic anemia blood picture. What
is the most appropriate investigation?. a. CT b. X Ray c. Urine & serum electrophoresis d. ESR An elderly patient, who developed agitation, confusion, after surgery. What is the most likely diagnosis?. a. Alcohol withdrawl b. Pulmonary embolism c. Hypoxia Parents are screened for cysic fibrosis. One is found to be a carrier, what is the chance that their child will be affected by cystic fibrosis?. a. 0 b. 0.25 c. 0.5 d. all males will be affected.
Parents screened for haemophilia, mother is found to be a carrier. What is the chance of their children being affected?. a. 0.5 regardless of the sex b. all girls carriers c. all boys affected.
Old woman with carcinoma of caecum. what would be the most likely symptom? a) RIF mass b) Altered bowel habit c) Tiredness, fatigue d) Melena e) Bleeding
A young woman comes with first time seizure. She had history of sudden spasms and twitching of muscles in past few years. What is your advice about driving? a. no driving for 6 months b. no driving for 3 months c. no driving for 1 months d. can not drive any more
An old truck driver has 6/36 vision. He can see well with his glasses. After consulting with you, he goes to another GP and claims that he was given the ok to continue driving. What will you do?. a. Advise him not to drive b. Speak to the other GP c. Report to vic roads A patient aged 35 yrs, comes for advise regarding screening for colon ca. His maternal aunt was diagnosed with HNPCC. What will you advise?. a. Sigmoidoscopy b. Genetic coulcelling c. Colonoscopy d. FOBT How do you assess Pulmonary function in a patient with GBS?. a. C X Ray b. FVC c. EMG d. PEFR e. Spirometry A 6 month old baby was born premature. Birth wt was 1.5 kgs, and is now 6 kgs at 6 months. What can you comment about the baby s weight?. a. underweight b. good weight c. over weight Apart from Folate prescribing which one for a pregnant woman can reduce the risk of neurological problem in fetus? a. Iodine b. Iron c. Beta carotene
d. Vitamin B 12 e. Vitamin B complex
a16-year old female comes to GP for OCP prescription, she conveyed her mother and sister were diagnosed with DVT. What is the next step in management? a. No OCPs use condoms b. Only progesterone pills c. OCPs can be prescribed d. Thrombophilia screening before prescription A female patient 22yo who is 8 weeks pregnant. She was on OCP now complains of bleeding after intercourse. What is the most propable cause? a) cervical CA b) Ectropion c) Endocervical polyp d) atrophicvaginiti A 20 yr old presents to the E.D for heaving bleeding after coitus. What is the most common cause? a.cervical polyp b.cervicalectropion c.fibroids
An elderly woman with urge incontinence, what will be the Mx? a. bladder re-education b. pelvic floor exercise An elderly woman with uterus prolapse, what is the Mx? a. pelvic floor exercise b. b. pessary USG abdome. Showing an ovarian cyst 4 cm. Young girl in your GP, with no particular complaints. What will you advise?. a. Immediate aspiration b. Re scan after 6 wks c. serum markers for ovarian ca
Picture of a finger and pt couldn’t extend the finger actively; asked about the kind of pressure which leads to this problem: a. Hyper flexion while finger was extended b. Hyper extension while finger was flexed 8. Post-op. fever appears on 3rd day. Which is most likely. a) actelectesis
b) wounddehinscence c) wound infection d) abscess formation e) pneumonia Case of male patient with Pelvic trauma. Patient fails to void urine. On examination blood is seen on urethral meatus. What is the next appropriate management? a) Suprapubic catheter b) urethral catheter c) urethrogram A 60 yr old female, with a mass palpable in the right hypochondrium, which moves with respiration. She has a 2 wk h/o jaundice, dark urine and pale stools. She complains of vague pain in that area. No h/o alcohol intake, or any other medication. What is the most likely diagnosis?. a. Cholangitis b. Choledocholithiasis c. Ca Ampulla of Vater d. Cholecystitis A patient suffering from chest pain and dyspnoes on the 5 th post op day. What test will help you establish a diagnosis?. a. Cardiac enzymes b. ECG c. CTPA d. oxygen saturation test Picture similar to Q 3.025 in page 397 HMCQ (pt is trying to look at left) which nerve palsy? (this question was modified this time with further/different options and the picture was different person with same features) as: a. 3 Right nerve palsy /3rd left nerve palsy b. 6 Right nerve palsy /6th left nerve palsy c. 3 Left nerve palsy /3rd right nerve palsy d. 6 Left nerve palsy /3rd left nerve palsy
rd th rd th
What symptoms and signs do you expect to find in a patient with caecum cancer? a. Anemia b. Altered bowel habbits c. Bleeding PR d. pneumaturia in colo-vesical fistula X-Ray of the wrist. Most common complication (assuming it s Colles #) a. Malunion b. Non union c. Stiffness of the joint. Post thyroidectomy patient, c/o dyspnoea. What would you do?.
a. Immediately remove the sutures b. transfer to surgery c. intubate and ventilate 60 yr old Chinese Malaysian lady, no known co- morbidities, C/O passing non – bloody diarrhoea for…? (how long) Colonoscopy showed inflammation and stricture at the terminal ilium. What is the most likely diagnosis?. a. yersenia enterocolitis b. Pseudomembranous colitis c. (no Colon Ca, Chrons or Ulcerative colitis as options)
A woman who delivered her baby 6 weeks ago and no breast feeding came for advice for contraception. On her profile was written “Do not prescribe OCP”. You find out that her husband doesn’t want her wife uses OCP. What would be your approach? a. Tell her that she has the right to use contraception c. Do not prescribe contraceptive a mother brought her child due to some problem, you diagnosed thet the child needs more investigation with CT, parents got divoce 3-4 month ago, you arrange CT scan for nearby hospital, but the day after that you noticed they’ve never gone to hospital what would be your next step? a. call child care b. call to mother c. wait 14 days to come back then contact them A new drug is discovered, which affects the progression of the disease, but not the mortality. Which is the most appropriate statement?. a. increase incidence b. decrease incidence c. Increase prevalence d. decrease prevalence
One of your colleagues during the lunch time asks you to prescribe him some medication because he can not sleep appropriately recently. What will you do? a) Give him prescription b) Advise him drink hot milk before sleep c) Advise him relaxation and exercise d) Inform medical board e) Recommend him to visit a doctor
A young woman comes with first time seizure. She had history of sudden spasms and twitching of muscles in past few years. What is your advice about driving? a) no driving for 6 months b) no driving for 3 months c) no driving for 1 months d) can not drive any more
A 70 yr old Italian lady diagnosed to have Pancreatic ca. Her son rushes to your clinic, wishing to see you. He asks you not to tell his mother about the diagnosis, as she is sensitive and amy not be able to cope with the information. What do you do?. a. Tell the son that you can not respond to relatives requests. b. Tell him it is the right of the patient to be informed c. Seek advise from the medical board of advisors Which of the following does NOT provide much information?. a. case control b. Cohort study c. Randomised control trial d. Case report there were many questions from population you are a gp of small community and you have noticed high number of cases of Chlamydia in your clinic. In order to curb the infection what approace you are going to take. a) b) c) d) Ask all the community members to visit clinic and get checked for Chlamydia. Provide condoms in schools and colleges Distribute public educational seminars and pamphlets about Chlamydia awareness and prevention Advise the community members to get checked for chalmydia yearly
You are conducting a randominzed controlled trials. In the result drug b has better affects that drug A. a) b) c) d) More trials are not required after this trial Proves that drug b should be prescribed and drug A not Both drug b and drug A can be prescribed Drug B seems to have better results Than Drug A, but both can be prescribed accordingly
What does the value of P less than 0.01 stands for? What is 95% confidence interval This time too any questions from Randomized controlled trials. A 80 year old man had already gone many surgical procedures and as a his doctor you believe that another surgical procedure can be very help ful for him. The mini mental status of old man was given has 26/30. his daughter approaches you and tells you that she has power of Attorney and requests you not to perform this procedure as he has already gone through lot of agony. What would be your approach? a) agree with daughter’s decision as she has power of attorney b) refuse the daughter’s advice and perform the S/p by your own decision as it would in the best interest of patient c) Ask the patient d) consult the health services council (or a body which takes decision on such matter)
A middle aged woman with calf pain from yesterday came to hospital; you did investigations and diagnosed deep vein thrombosis. Now she doesn’t have any problem. What is next step in Mx? a. Inpatient management with compression socking and LMWH b. Inpatient management with leg elevation and LMWH c. Outpatient management with compression and LMWH d. Outpatient management with lag elevation and LMWH
A 55 year old worker of insulating factory for 30 years, came with breathlessness from several months ago and now with haemoptysis, (CXR was given; unilateral pleural effusion was obvious!) he has smoked from 20 years ago. What’s the diagnosis? a. Squamous cell Ca b. Small cell Ca c. Mesothelioma A girl who visited SE Asia 6 months ago now has c/o diarrhoea, 3 kg wt loss, loss of appetite. Stool results: Blastocystis hominis and Giardia lamblia positive. What could be the cause for her presentation? (Feb 2011-Q 44) a) Blastocystis hominis b) Giardia lambliac c) Coeliac disease d) Rotavirus A young lady with history of central chest pain and sweating for half an hour. In Ph/E everythings was NL, EKG, troponin, CXR and CTPA were NL. what’s the next step? a. Check troponin in 8 hours b. Discharge the patient 60y man comes with severe sudden chest pain, vomiting and sweating. ECG and Troponin level are normal. What’s the next management? a) Check troponin again in 8 h b) Admit patient to CCU c) Discharge pt with B Blocker and Aspirin. d) Discharge pt without any drug
Patient with cluster headache. Treatment? a. Steroid b. Somatriptan c. Vigabatrin d. Na- valproate z-score in bone densitometry for femoral neck was :-2.5 and for hip was:-1.5 what do you do? a. Reassre and do nothing b. Start immediately on biphosphonates c. Advise regular intake of calcium
In 2 day after operation, patient suddenly became very agitated and anxious, apart from O which is very important to do? a. Starting anticoagulant therapy b. Brain CT c. hallopridole
nd 2
Old patient felt pain in the buttock and thigh yesterday while walking, today he felt it again when he wanted to come to see you. In the examination there is slight tenderness in arm muscles. he is on treatment of HTN, hyperlipidemia and gout. He uses ACEi, atrovastatin… Which one is the important next step to do? a. check creatinin and electrolytes b.EMG c. nerve conduction studies
Old lady stretches her back to open the window pf her house then suffered from back pain, MCV < 98, microcytic hypochromic anemia blood picture(huge presentation of full blood count) urea, creatinin and electrolytes). What is the most likely diagnosis?. a. Osteoporosis b. Multiple myeloma
. Old lady case, presents with back pain. MCV <98, microcytic hypochromic anemia blood picture. What
is the most appropriate investigation?. a. CT b. X Ray c. Urine & serum electrophoresis d. ESR An elderly patient, who developed agitation, confusion, after surgery. What is the most likely diagnosis?. a. Alcohol withdrawl b. Pulmonary embolism c. Hypoxia Parents are screened for cysic fibrosis. One is found to be a carrier, what is the chance that their child will be affected by cystic fibrosis?. a. 0 b. 0.25 c. 0.5 d. all males will be affected.
Parents screened for haemophilia, mother is found to be a carrier. What is the chance of their children being affected?. a. 0.5 regardless of the sex b. all girls carriers c. all boys affected.
Old woman with carcinoma of caecum. what would be the most likely symptom? a) RIF mass b) Altered bowel habit c) Tiredness, fatigue d) Melena e) Bleeding
A young woman comes with first time seizure. She had history of sudden spasms and twitching of muscles in past few years. What is your advice about driving? a. no driving for 6 months b. no driving for 3 months c. no driving for 1 months d. can not drive any more
An old truck driver has 6/36 vision. He can see well with his glasses. After consulting with you, he goes to another GP and claims that he was given the ok to continue driving. What will you do?. a. Advise him not to drive b. Speak to the other GP c. Report to vic roads A patient aged 35 yrs, comes for advise regarding screening for colon ca. His maternal aunt was diagnosed with HNPCC. What will you advise?. a. Sigmoidoscopy b. Genetic coulcelling c. Colonoscopy d. FOBT How do you assess Pulmonary function in a patient with GBS?. a. C X Ray b. FVC c. EMG d. PEFR e. Spirometry A 6 month old baby was born premature. Birth wt was 1.5 kgs, and is now 6 kgs at 6 months. What can you comment about the baby s weight?. a. underweight b. good weight c. over weight Apart from Folate prescribing which one for a pregnant woman can reduce the risk of neurological problem in fetus? a. Iodine b. Iron c. Beta carotene
d. Vitamin B 12 e. Vitamin B complex
a16-year old female comes to GP for OCP prescription, she conveyed her mother and sister were diagnosed with DVT. What is the next step in management? a. No OCPs use condoms b. Only progesterone pills c. OCPs can be prescribed d. Thrombophilia screening before prescription A female patient 22yo who is 8 weeks pregnant. She was on OCP now complains of bleeding after intercourse. What is the most propable cause? a) cervical CA b) Ectropion c) Endocervical polyp d) atrophicvaginiti A 20 yr old presents to the E.D for heaving bleeding after coitus. What is the most common cause? a.cervical polyp b.cervicalectropion c.fibroids
An elderly woman with urge incontinence, what will be the Mx? a. bladder re-education b. pelvic floor exercise An elderly woman with uterus prolapse, what is the Mx? a. pelvic floor exercise b. b. pessary USG abdome. Showing an ovarian cyst 4 cm. Young girl in your GP, with no particular complaints. What will you advise?. a. Immediate aspiration b. Re scan after 6 wks c. serum markers for ovarian ca
Picture of a finger and pt couldn’t extend the finger actively; asked about the kind of pressure which leads to this problem: a. Hyper flexion while finger was extended b. Hyper extension while finger was flexed 8. Post-op. fever appears on 3rd day. Which is most likely. a) actelectesis
b) wounddehinscence c) wound infection d) abscess formation e) pneumonia Case of male patient with Pelvic trauma. Patient fails to void urine. On examination blood is seen on urethral meatus. What is the next appropriate management? a) Suprapubic catheter b) urethral catheter c) urethrogram A 60 yr old female, with a mass palpable in the right hypochondrium, which moves with respiration. She has a 2 wk h/o jaundice, dark urine and pale stools. She complains of vague pain in that area. No h/o alcohol intake, or any other medication. What is the most likely diagnosis?. a. Cholangitis b. Choledocholithiasis c. Ca Ampulla of Vater d. Cholecystitis A patient suffering from chest pain and dyspnoes on the 5 th post op day. What test will help you establish a diagnosis?. a. Cardiac enzymes b. ECG c. CTPA d. oxygen saturation test Picture similar to Q 3.025 in page 397 HMCQ (pt is trying to look at left) which nerve palsy? (this question was modified this time with further/different options and the picture was different person with same features) as: a. 3 Right nerve palsy /3rd left nerve palsy b. 6 Right nerve palsy /6th left nerve palsy c. 3 Left nerve palsy /3rd right nerve palsy d. 6 Left nerve palsy /3rd left nerve palsy
rd th rd th
What symptoms and signs do you expect to find in a patient with caecum cancer? a. Anemia b. Altered bowel habbits c. Bleeding PR d. pneumaturia in colo-vesical fistula X-Ray of the wrist. Most common complication (assuming it s Colles #) a. Malunion b. Non union c. Stiffness of the joint. Post thyroidectomy patient, c/o dyspnoea. What would you do?.
a. Immediately remove the sutures b. transfer to surgery c. intubate and ventilate 60 yr old Chinese Malaysian lady, no known co- morbidities, C/O passing non – bloody diarrhoea for…? (how long) Colonoscopy showed inflammation and stricture at the terminal ilium. What is the most likely diagnosis?. a. yersenia enterocolitis b. Pseudomembranous colitis c. (no Colon Ca, Chrons or Ulcerative colitis as options)
A woman who delivered her baby 6 weeks ago and no breast feeding came for advice for contraception. On her profile was written “Do not prescribe OCP”. You find out that her husband doesn’t want her wife uses OCP. What would be your approach? a. Tell her that she has the right to use contraception c. Do not prescribe contraceptive a mother brought her child due to some problem, you diagnosed thet the child needs more investigation with CT, parents got divoce 3-4 month ago, you arrange CT scan for nearby hospital, but the day after that you noticed they’ve never gone to hospital what would be your next step? a. call child care b. call to mother c. wait 14 days to come back then contact them A new drug is discovered, which affects the progression of the disease, but not the mortality. Which is the most appropriate statement?. a. increase incidence b. decrease incidence c. Increase prevalence d. decrease prevalence
One of your colleagues during the lunch time asks you to prescribe him some medication because he can not sleep appropriately recently. What will you do? a) Give him prescription b) Advise him drink hot milk before sleep c) Advise him relaxation and exercise d) Inform medical board e) Recommend him to visit a doctor
A young woman comes with first time seizure. She had history of sudden spasms and twitching of muscles in past few years. What is your advice about driving? a) no driving for 6 months b) no driving for 3 months c) no driving for 1 months d) can not drive any more
A 70 yr old Italian lady diagnosed to have Pancreatic ca. Her son rushes to your clinic, wishing to see you. He asks you not to tell his mother about the diagnosis, as she is sensitive and amy not be able to cope with the information. What do you do?. a. Tell the son that you can not respond to relatives requests. b. Tell him it is the right of the patient to be informed c. Seek advise from the medical board of advisors Which of the following does NOT provide much information?. a. case control b. Cohort study c. Randomised control trial d. Case report there were many questions from population you are a gp of small community and you have noticed high number of cases of Chlamydia in your clinic. In order to curb the infection what approace you are going to take. a) b) c) d) Ask all the community members to visit clinic and get checked for Chlamydia. Provide condoms in schools and colleges Distribute public educational seminars and pamphlets about Chlamydia awareness and prevention Advise the community members to get checked for chalmydia yearly
You are conducting a randominzed controlled trials. In the result drug b has better affects that drug A. a) b) c) d) More trials are not required after this trial Proves that drug b should be prescribed and drug A not Both drug b and drug A can be prescribed Drug B seems to have better results Than Drug A, but both can be prescribed accordingly
What does the value of P less than 0.01 stands for? What is 95% confidence interval This time too any questions from Randomized controlled trials. A 80 year old man had already gone many surgical procedures and as a his doctor you believe that another surgical procedure can be very help ful for him. The mini mental status of old man was given has 26/30. his daughter approaches you and tells you that she has power of Attorney and requests you not to perform this procedure as he has already gone through lot of agony. What would be your approach? a) agree with daughter’s decision as she has power of attorney b) refuse the daughter’s advice and perform the S/p by your own decision as it would in the best interest of patient c) Ask the patient d) consult the health services council (or a body which takes decision on such matter)
