1
Q
Post-op patient on PCA fentanyl, feels nauseated but no pain, next step?
A
Reduce dose
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2
Q
Labour progressing normally, multiparous, pulsating cord felt in vagin* at full dilation, station +2, next step?
A
Commence active pushing
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3
Q
Informed consent taken for laparoscopic removal of gallstones, surgery done by consultant, next step?
A
Proceed with surgery as planned
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4
Q
Woman tearful a week after 2-year anniversary of mother’s death, sees mother in dreams, diagnosis?
A
Bereavement
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5
Q
Patient with blunt trauma to eye, severe pain, hyphema present, next step while waiting for ophthalmology?
A
Eye patch
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6
Q
22-year-old man with dysphagia worse with solids than liquids, regurgitation at night, history of eczema?
A
Esophagoscopy
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7
Q
Patient in ED after home destroyed by fire, calms down after 2 hours, can’t remember past few hours, diagnosis?
A
Transient global amnesia
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8
Q
Best study design to assess drug efficacy by intern?
A
Randomized Controlled Trial (RCT)
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9
Q
Obese female with cellulitis on abdomen, best antibiotics?
A
Ampicillin + Clavulanate
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10
Q
Right mastitis, advises feeding every 4-6 hours, next step?
A
Increase frequency of feeding
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11
Q
Patient on oxycodone for back pain, using heroin for better pain control, next step?
A
Tail off oxycodone, prescribe benzodiazepines, and perform urine drug test
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12
Q
Aboriginal girl with recurrent sore throats and hematuria, next investigation?
A
ASO titre
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13
Q
8-week pregnant woman with severe vomiting, dehydration, ketones +++, treatment?
A
IV fluids and antiemetics; consider steroids
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14
Q
Medical student caught taking pictures of patient records, you are an intern, next step?
A
Confront the student and report the incident
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15
Q
25-year-old female post-laparotomy for appendicular mass, started TPN, low magnesium and phosphate, cause?
A
Refeeding syndrome
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16
Q
Patient with rhinorrhea, sneezing, allergic to carpet mites, treatment?
A
Fluticasone nasal spray
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17
Q
U/S shows small kidneys, indicating chronic kidney disease, what confirms chronicity?
A
Ultrasound finding
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18
Q
72-year-old woman with bilateral knee pain and effusion, controlled on PCM, appropriate management?
A
Progressive resistance training
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19
Q
10-year-old girl with dysphagia for chicken nuggets, complaint for 7 months, diagnosis?
A
Psychological feeling
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20
Q
Elderly patient with bowing of legs, diagnosis?
A
Paget’s disease
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21
Q
6-month-old baby with 1 cm umbilical hernia, color changes, next step?
A
Refer to emergency
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22
Q
Chronic HCV positive mother at 20 weeks POA, asking about breastfeeding?
A
It is safe to breastfeed
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23
Q
Soccer player with head impact, brief LOC, wants to play again, next step?
A
Need observation for 24 hours
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24
Q
18-year-old girl with recurrent UTIs, last culture E. coli, best step before treatment?
A
Partner penile swab
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25
Q
Woman with psychosis, refuses ECT, believes intestines disappear, what to do?
A
Seek husband’s consent and tribunal permission for ECT
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26
Q
16-month-old with vomiting, diarrhea, seizure, Na 119, Cl 79, next investigation?
A
Urine osmolality and Na
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27
Q
DM patient on metformin 2g, BMI 30, poor control, HbA1c 8.3, wants to lose weight, frequent UTIs?
A
Exenatide
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28
Q
HIV patient started ART, husband present, best safety option for husband?
A
Start on HIV prophylaxis
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29
Q
Chinese mother with English-speaking son, memory loss, MMSE 22/30, next step?
A
Chinese MMSE
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30
Q
24-year-old healthy male with hemoptysis, mild SOB, no travel, normal exam, next step?
A
D-dimer
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31
Q
35-year-old male with flank pain, macroscopic hematuria, 2cm radiolucent stone, no hydronephrosis, next step?
A
Extracorporeal shock wave lithotripsy (ECSW)
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32
Q
58-year-old woman with perimenopausal symptoms on HRT for 8 years, no symptoms now, next step?
A
Cease HRT
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33
Q
Woman with occipital headache, nausea, vomiting for 3 months, positive pass pointing test, next investigation?
A
CT brain
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34
Q
Elderly woman with COPD, acute confusion post-party, fever, basal crackles, cause?
A
UTI
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35
Q
Hemorrhoid with bluish anal verge, pain post 48 hours, treatment?
A
GTN surgery
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36
Q
Man in CHF, initial management?
A
ACE inhibitor
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37
Q
Man with claudication pain only in calf, absent pulses, affected artery?
A
Popliteal artery
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38
Q
Intern assessing diet in arthritis patients, strongest study design?
A
Meta-analysis
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39
Q
18-year-old female with PMS, irritability, insomnia, most appropriate treatment?
A
Fluoxetine
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40
Q
Impetigo case, when to report to school?
A
After initiating treatment
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41
Q
Young girl with bee sting, urticaria rash, severe itchiness, treatment?
A
Oral promethazine
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42
Q
Male working in animal center with fever, chills, discharge from axillary lump, diagnosis?
A
Hidradenitis suppurativa
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43
Q
Treatment of pancreatic pseudocyst, 3mm thin wall, presents with abdominal discomfort?
A
Observe
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44
Q
Woman in labor, how to determine if labor is established?
A
More frequent contractions and cervical dilation
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45
Q
Ankle sprain in pregnancy, treatment?
A
Ice
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46
Q
Postpartum woman with depression, constantly checking baby, previous depression history, needs management?
A
Previous history of depression
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47
Q
16-year-old girl with Factor V Leiden heterozygous, best contraceptive apart from condom?
A
Progestin-only pill (POP)
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48
Q
Man concerned about prostate cancer, father diagnosed at old age, next step?
A
PSA test
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49
Q
40-year-old male with C4-5 injury, MDD, on opioids, flushed face, sweating, BP 170/95, PR 50, cause?
A
Autonomic dysreflexia
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50
Q
64-year-old male with lung cancer post-radiation, SOB, inflammatory shadow on CXR, next treatment?
A
Prednisolone
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51
Q
32-year-old obese female, stopped previous drug due to nausea, BMI 32, already has dietician, next step?
A
Liraglutide
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52
Q
16-year-old girl starting sodium valproate, likely side effect to stop treatment?
A
Weight gain
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53
Q
Schizophrenia patient on risperidone, bilateral breast galactorrhea, prolactin 1120, cause?
A
Risperidone
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54
Q
Radiation exposure comparison, X-ray to CT?
A
20%
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55
Q
Feeling disturbed in mall, needs to start drug, what to ask in history?
A
Cannabis use
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56
Q
Teen girl with ataxia, sensory loss, upward plantar reflexes, diagnosis?
A
Friedreich’s ataxia
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57
Q
Truck driver with sleep apnea, day somnolence, financial problems, wants to drive, next step?
A
Drive after sleep specialist consultation
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58
Q
68-year-old man with right-left confusion, apraxia, can’t write or do math, likely lesion?
A
Left parietal glioblastoma
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59
Q
Elderly man with hearing loss, audiogram shows decreased hearing at high frequencies, cause?
A
Age-related hearing loss
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60
Q
Post-menopausal woman on denosumab with T-score -2.5 (sacral) and -3 (femoral), next step?
A
Alendronate
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61
Q
ECG shows digoxin toxicity, no cardiac arrest, next step?
A
stop digoxin Administer digibind (digoxin-specific antibody)
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62
Q
- MVA, 31yr female, USS 2.2 cm splenic artery aneurysm, other parameters ok, other injuries excluded
A
Splenic artery embolization
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63
Q
- Boy, 7 years old, bitten by a bat. Management?
A
Post-exposure rabies vaccine
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64
Q
- Girl comes to collect prescription for Risperidone for her boyfriend with schizophrenia, unable to visit due to work
A
Provide the prescription after obtaining verbal consent from him via a phone call
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65
Q
- 6-week baby, cough while feeding and mild increased work of breathing when breastfeeding. Next?
A
Referral to cardiology
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66
Q
- Crescendo-decrescendo murmur - cause?
A
Aortic stenosis
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67
Q
- 50-year-old lady, no significant medical history, not on HRT, breast lump 2 cm, mammogram shows dense breast tissue, USG shows cystic lesion. Management?
A
FNAC
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68
Q
- Action if a doctor wants to enter a relationship with a current patient?
A
Unethical
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69
Q
- URTI not responding to antibiotics, bronchoscopy shows Masson body. Treatment?
A
Steroid
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70
Q
- 16-year-old girl with depressive symptoms, self-injury behavior, denies suicidal thoughts, multiple antidepressant use, asks not to inform parents
A
Voluntary admission
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71
Q
- Elderly with AF, ECG HR 88, multiple comorbidities, asymptomatic, BP 145/90, eGFR 35, on aspirin, atorvastatin, and metformin
A
Rivaroxaban
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72
Q
- 50-year-old lady admitted for uncomplicated Colles fracture, after 3 days of admission, agitated, sweaty, confused with visual hallucinations. Cause?
A
Alcohol withdrawal
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73
Q
- Substance used in pregnancy associated with decreased risk of congenital birth defects?
A
Iodine
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74
Q
- Patient with gambling issue, initial treatment?
A
CBT
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75
Q
- 32-year-old female considering Mirena, currently using condoms, no medical history, heavy menses, prefers Mirena over pills due to forgetfulness
A
Pregnancy rate is less than 0.1%
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76
Q
- Depuytren contracture of hand, next investigation needed to diagnose?
A
No investigation
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77
Q
- 18-month-old child, URTI with clear nasal discharge, red enlarged tonsils, multiple cervical lymph nodes enlarged. Cause of infection?
A
Normal childhood URTI
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78
Q
- Newly diagnosed HIV patient, CD4 150, management?
A
TMP-SMX prophylaxis
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79
Q
- Patient with RA on MTX develops pneumonia and rash, COVID negative, precaution type?
A
Droplet
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80
Q
- 14-year-old female with MDD on fluoxetine, mother concerned about SSRI addiction
A
Reassure the mother about fluoxetine safety for long-term use
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81
Q
- Elderly female, confusion after learning about a fire, later improves but can’t remember event details, aware of husband, date, and day but not time
A
Transient global amnesia
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82
Q
- Elderly female, urine exam shows 20 WBC, culture E. coli, no symptoms
A
No treatment
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83
Q
- 50-year-old male with right shoulder pain, restriction of abduction, partial benefit from intraarticular steroid, next recommendation?
A
Arrange physiotherapy
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84
Q
- Child with swelling, pain in left eye, high fever, cannot open eye
A
IV flucloxacillin
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85
Q
- Child with URTI, symptoms of rheumatic heart disease, arthritis, murmur, fever, confirmation test?
A
ASO titre
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86
Q
- Manager with work delay, study postponement, organizational difficulties, poor concentration, symptoms after an event 3 months ago, diagnosis support?
A
Anxious and fidgeting appearance
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87
Q
- Elderly female with colicky abdominal pain, distension, now constant pain, vitals stable
A
Sigmoid volvulus
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88
Q
- Elderly female with persecutory delusions towards neighbors
A
Persecutory delusions
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89
Q
- Somalian patient, cough, hemoptysis, SOB for 3 months, heavy smoker, weight loss, X-ray shows right upper lobe haziness, sputum culture and AFB sent
A
Mantoux test
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90
Q
- Postpartum mother, anorexia, not feeding baby much, lack of sleep, baby sleeping 6 hours at a time
A
Postpartum depression
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91
Q
- 22-year-old man with strange behavior, speech, isolation, aggression, failure in school, shouts at family
A
Schizophrenia
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92
Q
- Photo of eye with matted lashes, discharge, normal cornea, no hyphema, management?
A
Cleaning and antibiotics
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93
Q
- 4-year-old boy with nocturnal enuresis, no constipation, eats well, next step?
A
Fasting blood sugar and urinalysis
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94
Q
- 45-year-old man with bilateral tender breast swelling, alcoholic, on Ranitidine, bilateral parotid swelling, leukoplakia, scrotal swelling
A
Alcoholic liver disease
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95
Q
- Elderly patient with dizziness, multiple drugs (metoprolol, ramipril, indapamide), HR 56, BP 90/60, cause?
A
Metoprolol
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96
Q
- Elderly female with type 1 DM, recent hypoglycemic attack, advice on driving?
A
Don’t drive for 6 weeks
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97
Q
- 18-week period of amenorrhea, tremor, palpitations, high TSH, next step?
A
Check thyroxin level
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98
Q
- Patient with vomiting, abnormal behavior, staring at ceiling, dystonia
A
Benztropine
99
Q
- Aged patient in residential care, post-menopausal bleeding, dislikes vagin*l examination
A
Abdominal ultrasound
100
Q
- Post-menopausal female on HRT for 8 years, no complaints, initially started for hot flushes
A
Cease HRT
101
Q
- P3C2 mother in 3rd pregnancy, 12 weeks, previous large babies, all uncomplicated, next check?
A
Glucose tolerance test
102
Q
- Female, routine antenatal visit, Hb 9, MCV 70, not vegetarian, next step?
A
Hb electrophoresis
103
Q
- Waldenstrom macroglobulinemia with myelodysplastic syndrome, develops rash on ampicillin for pneumonia
A
Stop ampicillin
104
Q
- 33-week pregnant lady with vagin*l bleeding, abdominal pain, BP 145/90, urine dipstick +prot, +RBC, previous preterm labor due to preeclampsia, preclude tocolysis?
A
vagin*l bleeding
105
Q
- Skin mass excised with clear margins, biopsy shows melanoma 0.6mm thickness, next step?
A
Further excision
106
Q
- Child with fever, irritability, cough, dyspnea, crepitations, CXR with 2 lesions showing fluid level
A
Clindamycin + Ceftriaxone
107
Q
- 55-year-old DM female with recurrent cellulitis in left leg, healed now, varicosities, tinea infections between toes, major factor causing problem?
A
DM
108
Q
- RTA patient with GCS 6/15, heavy beard, BP 100/75, RR 9, SaO2 88, initial step?
A
Shaving the beard to ensure mask ventilation
109
Q
- Patient with BP 90/60, PR 105, next step?
A
Put on left lateral position
110
Q
- Midline neck mass 1cm, important step for diagnosis?
A
Tongue extrusion
111
Q
- Patient with cellulitis treated with cefazolin, develops macular drug reaction, future avoidance?
A
All penicillins and cephalosporins
112
Q
- 8-year-old child with isolation, tantrums, normal language, good eye contact, aligns dolls, screams occasionally
A
Autism spectrum disorder
113
Q
- Female with gradual loss of superior quadrants of visual fields
A
Temporal lobe tumor
114
Q
- 4-month-old baby not gaining weight, dusky mouth, systolic murmur
A
TOF
115
Q
- 24-year-old post-laparoscopic cholecystectomy, severe shoulder tip pain
A
Ultrasound abdomen
116
Q
- Female in labor, slow progression, oxytocin started, deceleration on CTG, 6cm dilation with caput and molding, baby’s part 1cm above pelvic rim
A
Stop oxytocin
117
Q
- Labor case with ROM, meconium stained, no deceleration on CTG, +1 station, good contraction and effacement, 7cm dilation
A
Continue CTG
118
Q
- Crusty hyperpigmented lesion over earlobe
A
SCC
119
Q
- 10-year-old aboriginal boy, ear discharge, tympanic membrane dull and retracted, greenish nasal discharge
A
Cholesteatoma
120
Q
- Patient on oxycodone for back pain, recently started heroin for uncontrolled pain
A
Check urine drug level
121
Q
- Boy worried about body image, thinks shoulders are too narrow, joined gym, still dissatisfied
A
Body dysmorphic disorder
122
Q
- 12-year-old girl with head lice, visible eggs, permethrin given but still lice present
A
Use lice comb, repeat permethrin
123
Q
- Chronic schizophrenic patient not listening to questions
A
IM haloperidol
124
Q
- 12-year-old child, shortest in class, height at 3rd percentile, weight at 10th percentile, TSH elevated, low FT4
A
Thyroxine
125
Q
- Child with vomiting and diarrhea, treated for UTI 3 months ago, weight 10th percentile, vitals stable, most likely diagnosis?
A
UTI
126
Q
- Patient on OCP, newly diagnosed with RA, suitable drug for RA treatment?
A
Sulfasalazine
127
Q
- Elderly with nausea and vomiting, visual hallucination, multiple medications including digoxin
A
Digoxin toxicity
128
Q
- Patient with exertional breathlessness, pulse rate 100, BP 150/90, eGFR 35, Hb 105, next step?
A
Blood transfusion
129
Q
- Elderly female with pain in breast after menopause, skin biopsy shows orange pigment around dermal blood vessels, dense lymphocytic infiltrate, next step?
A
Treatment with steroids
130
Q
- 3-week baby with jaundice, weight loss 8% after birth, HR 150, BP 60/40, jaundice not cleared after phototherapy, next step?
A
Review breastfeeding technique
131
Q
- 3-year-old child with high fever, rash after 3 days, red eyes, no coryza, conjunctivitis, red tongue
A
Kawasaki disease
132
Q
- Elderly male with advanced pancreatic cancer, requires pain control, best management?
A
Oral morphine
133
Q
- Asthma patient with multiple inhaler use, no control, next step?
A
Check adherence
134
Q
- Elderly patient with bilateral eye inflammation, treated for multiple allergic conditions, no improvement, on prednisolone 10 mg, multiple anti-histamines
A
Biopsy
135
Q
- Teenage girl with vagin*l bleeding, one episode of heavy bleeding, no other bleeding disorder
A
Oral contraceptive pill
136
Q
- Pregnant lady in 3rd trimester with painful rash over upper chest, no vesicles
A
Pemphigoid gestationis
137
Q
- Man with difficulty seeing road signs at night, low vitamin A
A
Night blindness
138
Q
- Postmenopausal woman with endometrial thickness 3mm, high prolactin, galactorrhea
A
MRI brain
139
Q
- Elderly male with hip pain, right foot 4cm shorter, traumatic injury, no other significant history
A
Open reduction and internal fixation
140
Q
- Boy with swelling and fever, history of trauma
A
Osteomyelitis
141
Q
- Girl with irritability, constipation, abdominal pain, PICA, family member with similar symptoms
A
Lead poisoning
142
Q
- Patient in ICU with history of hemorrhagic stroke, develops sudden collapse
A
Subarachnoid hemorrhage
143
Q
- Patient with left-side weakness, anosognosia, constructional apraxia, preserved comprehension
A
Right MCA stroke
144
Q
- Elderly patient with colonoscopy showing adenocarcinoma, CT shows no metastasis, next step?
A
Surgery
145
Q
- Female with dizziness, difficulty walking, headache, vomiting, diplopia, vertical nystagmus, next step?
A
MRI brain
146
Q
- Elderly patient with aortic stenosis, significant pressure gradient, next step?
A
Valve replacement
147
Q
- Patient with chronic back pain, opioid dependence, next step?
A
Buprenorphine
148
Q
- Patient with COPD, worsening breathlessness, increased sputum, SaO2 88, PaO2 60, next step?
A
Low-dose oxygen therapy
149
Q
- Male with difficult-to-treat psoriasis, long-term alcohol use, new lesions on legs
A
Liver function test
150
Q
- Female patient with cough, dyspnea, high-pitched inspiratory noise, no fever, normal oxygen saturation
A
Vocal cord dysfunction
151
Q
- Patient with chronic kidney disease, recent increase in serum creatinine, new antihypertensive started
A
Stop antihypertensive
152
Q
- Teenage girl with abdominal pain, tender palpable mass in the right lower quadrant, fever, next step?
A
Laparoscopy
153
Q
- Elderly male with DVT, on warfarin, INR 4.5, no bleeding, next step?
A
Stop warfarin for 2 days
154
Q
- Pregnant lady with fever, rash, myalgia, conjunctivitis, lymphadenopathy, confirmed Zika infection
A
Ultrasound and amniocentesis
155
Q
- Elderly patient with T2DM, GFR 35, HbA1c 8%, on metformin, next step?
A
Add DPP-4 inhibitor
156
Q
- Young male with epigastric pain, radiating to back, elevated lipase, history of binge drinking
A
Pancreatitis
157
Q
- Young female with chronic fatigue, arthralgia, low-grade fever, positive ANA, next step?
A
Anti-dsDNA and C3/C4
158
Q
- Elderly male with progressive memory loss, urinary incontinence, gait disturbance
A
Normal pressure hydrocephalus
159
Q
- Middle-aged female with recurrent UTI, next step?
A
Postcoital voiding
160
Q
- Young female with recurrent vulvovagin*l candidiasis, no diabetes, normal immune status
A
Antifungal therapy
161
Q
- Elderly male with chronic heart failure, ejection fraction 25%, not responding to medications, next step?
A
Cardiac resynchronization therapy
162
Q
- Middle-aged male with severe acne, failed multiple treatments, isotretinoin considered, next step?
A
LFT and lipid profile
163
Q
- Pregnant lady with history of venous thromboembolism, next step?
A
Low molecular weight heparin
164
Q
- Elderly female with frequent falls, dizziness, orthostatic hypotension, on multiple medications including antihypertensives
A
Review medication list
165
Q
- Middle-aged male with hypercalcemia, low PTH, history of lung mass, next step?
A
PTHrP assay
166
Q
- Female with headache, visual disturbances, elevated prolactin
A
MRI brain
167
Q
- Young male with sore throat, fever, splenomegaly, atypical lymphocytosis
A
EBV serology
168
Q
- Elderly patient with hypertension, hyperlipidemia, diabetes, low ankle-brachial index
A
Peripheral artery disease
169
Q
- Middle-aged male with new onset AF, stable vitals, next step?
A
Anticoagulation therapy
170
Q
- Young female with shortness of breath, pleuritic chest pain, D-dimer elevated
A
CT pulmonary angiography
171
Q
- Elderly male with dysphagia, weight loss, barium swallow shows filling defect
A
Esophagogastroduodenoscopy
172
Q
- Middle-aged female with pruritus, jaundice, elevated bilirubin, ALP, GGT
A
MRCP
173
Q
- 48-year-old man drinks 12 standard drinks daily after work, denies withdrawal symptoms. What are you going to do?
A
Motivational psychotherapy
174
Q
- Patient from Vietnam 72 hours ago now has fever, dyspnea, chest pain. Diagnosis?
A
Bacterial pneumonia
175
Q
- 40-year-old male with sudden severe chest pain radiating to back after 18-hour flight, normal ECG. Next step?
A
D-dimer
176
Q
- Woman post-pregnancy developed psychosis, started on SSRI, planning next pregnancy. Advice?
A
Continue the same dose
177
Q
- 35-year-old female with TAH+BSO, DEXA results -2.5 spine and -1.5 femoral BMD. Treatment?
A
Risedronate
178
Q
- 18-year-old female with multiple bruises, living with paternal uncle. Whom to call next?
A
Inform child protection services
179
Q
- Elderly man with swelling over submandibular region. What to examine next?
A
Salivary gland
180
Q
- 10-year-old child started on stimulants for ADHD, not complying, problems in school. Next step?
A
Talk to boy about advantages and disadvantages of the drug
181
Q
- 56-year-old truck driver had a minor stroke, now has left hom*onymous hemianopia, reluctant to stop driving. Advice?
A
After occupational therapist assessment
182
Q
- Old man post hip/knee surgery, feels dizzy, BP 80/60, HR 110, DTX 4mmol. Cause of dizziness?
A
Orthostatic hypotension
183
Q
- Postpartum hemorrhage, 1500ml blood loss, continuous fresh blood. Most likely cause?
A
Atonic uterus
184
Q
- 18-year-old female with PMS, irritability, insomnia. Most appropriate treatment?
A
Fluoxetine
185
Q
- 72-year-old lady with vulval itching, on clotrimazole cream, not settled. Examination shows adhesion of labia, shrunk skin, narrowed introitus. Management?
A
Oestriol cream
186
Q
- Serum creatinine high, eGFR low, ultrasound showed small kidney. Feature indicating chronic disease?
A
Ultrasound finding
187
Q
- Knee injury. Best method for examination findings?
A
Anterior drawer test positive, Posterior drawer test positive
188
Q
- BRCA 1 positive. Correct screening method?
A
(Answer not provided in prompt)
189
Q
- Na low, sugar high. Diagnosis?
A
Hyperosmolar hyperglycemic state
190
Q
- On clozapine, symptoms improved, weight gain up to 15 kg. Next step?
A
Dietitian referral
191
Q
- Perimenopausal woman on estrogen patch, now menopausal. Advice?
A
Continue same
192
Q
- Best study type for GP to see incidence of cancer among patients?
A
Cohort
193
Q
- Hepatitis A epidemic in school. Management?
A
Exclude children for 14 days
194
Q
- Patient on corticosteroids for polymyalgia rheumatica, now tapering dose, patient lethargic. Cause?
A
Addison crisis
195
Q
- Woman in 20s with progressing occipital headache, nausea, vomiting for 3 months. Next step?
A
CT
196
Q
- Elderly lady with COPD, acute onset confusion after party, had fever, normal RR, tachycardia, normal O2 sats. Possible cause?
A
Pneumonia
197
Q
- Commercial driver 4 months post-stroke, decreased vision. Advice?
A
After occupational review
198
Q
- External hemorrhoid with hematoma. Treatment?
A
Surgery
199
Q
- Man with back pain, raised ESR, normocytic anemia. Investigation to establish diagnosis?
A
Hb electrophoresis
200
Q
- Man in chronic renal failure, anemia, hypertension, scarring kidneys. Most indicator for chronic disease?
A
Ultrasound findings
201
Q
- Man with CHF, stable. Initial management?
A
ACE inhibitors
202
Q
- Mastitis case. Advice?
A
Frequent feeds
203
Q
- Man with claudication symptoms, weak femoral pulse, absent distal pulses. Possible diagnosis?
A
Superficial femoral artery disease
204
Q
- Intern wants to assess diet in arthritis patients. Strongest evidence study design?
A
Meta-analysis
205
Q
- Intern administered wrong drug, not harmful, stopped. Next step?
A
Apologize to patient
206
Q
- 18-year-old female with PMS, irritability, insomnia. Most appropriate treatment?
A
Fluoxetine
207
Q
- AF with ECG, renal failure, GFR 24, not 35.
A
(Incomplete prompt)
208
Q
- Impetigo case. When to report to school?
A
After initiating treatment
209
Q
- Young girl stung by bees, urticaria rash, severe itchiness. Treatment?
A
Oral promethazine
210
Q
- Girl collecting Risperidone for boyfriend with schizophrenia, unable to visit due to work. Most appropriate action?
A
Provide the prescription after obtaining verbal consent via phone call
211
Q
- First cousins planning to start a family, history of genetic problems and miscarriages. Advice?
A
Recommend genetic counseling
212
Q
- Man concerned about infertility, wife has child from previous marriage. Potential reason for infertility?
A
Past infection with mumps
213
Q
- Pregnant nurse changing job to work with children, last diphtheria vaccine 8 years ago. Advice?
A
Vaccinate at 20 weeks
214
Q
- Research evaluating new drug effectiveness. Characteristic ensuring reliability?
A
Double-blindness
215
Q
- Elderly Chinese man with forgetfulness, MMSE score 22. Next action?
A
Perform MMSE in Chinese
216
Q
- 12-year-old child, shortest in class, height 3rd percentile, weight 10th percentile, otherwise well. Next step?
A
Ask about parents’ heights
217
Q
- Man working in garden, thorn cut, red and swollen hand. Most appropriate management?
A
Antibiotics
218
Q
- Carpenter with shoulder pain, partially relieved by steroid injections. Most appropriate management?
A
Physiotherapy
219
Q
- Labour progressing normally, then at 5cm dilation, station +1, fetal HR 115, pulsating cord felt in vagin*. Management?
A
Reduce the cord and progress with labour
220
Q
- 6-year-old child with hereditary spherocytosis, anemia, jaundice, Hb 80-90, reticulocytes <0.1%. Management?
A
Folic acid
221
Q
- Family migrated to Australia 1 year ago, daughter depressed now doing well on fluoxetine, mother concerned about addiction. Management?
A
Reassure mother
222
Q
- Junior doctor in tertiary hospital, colleague disheveled and drunk. Next step?
A
Keep record of how many times colleague came in drunk
223
Q
- Couple, wife pregnant, man has chlamydia, doesn’t want to tell wife but wants her tested. Management?
A
Encourage him to tell wife
224
Q
- Woman tearful a week after 2-year anniversary of mother’s death, sees mother in dreams, saw mother standing in doorway. Diagnosis?
A
Bereavement
225
Q
- Eye trauma, hyphema. What to do while waiting for ophthalmology referral?
A
Eye pad and bed rest
226
Q
- End-stage small cell lung cancer, on oxycodone for pain, increased thirst, dry mucous membranes. Diagnosis?
A
Hypercalcemia
227
Q
- Recurrent DVT. Which cancer is likely?
A
Lung cancer
228
Q
- Clinical features of lateral epicondylitis. Investigation?
A
No need to do anything
229
Q
- 8-year-old child with scrotal pain, testes non-tender, redness extending to perineum and groin. Most likely diagnosis?
A
Scrotal edema
230
Q
- Patient with recent MI and DM, optimize medications, BMI 26, HbA1c 7. Treatment?
A
Empagliflozin
231
Q
- Waldenstrom macroglobulinemia with myelodysplastic syndrome, left lower lobe pneumonia, rash on ampicillin. Next step?
A
Stop ampicillin
232
Q
- Patient with family history of breast cancer, unilateral painful gynecomastia, on spironolactone. Next step?
A
Ultrasound breast
233
Q
- Female, healthy, routine antenatal visit, Hb 9, MCV 70. Next step?
A
Hb electrophoresis
234
Q
- Young male with scrotal lump, testes separately palpable, no other symptoms. Next step?
A
Testicular tumor markers
235
Q
- Female admitted for fracture, given morphine, weird behavior after 12 hours, claims can’t control eye movement. Treatment?
A
Benztropine
236
Q
- Female with swollen lymph nodes, 2 months tiredness, lives with cats, right posterior cervical lymph node FNAC shows reactive cells, no malignancy. Diagnosis?
A
Cat scratch disease
237
Q
- Orthopedic surgery patient on multiple medications. What to change on morning of surgery?
A
Withhold aspirin
238
Q
- Patient with ST elevation anterior wall MI, alcohol use, smoker, T2DM. Risk factor to address?
A
Smoking
239
Q
- Ear pain, submandibular gland swelling, dull TM. What organ to examine?
A
Tongue
240
Q
- Postpartum hemorrhage, 1500ml blood loss, shortness of breath. Diagnosis?
A
Amniotic fluid embolus
241
Q
- 18-month-old child with recurrent respiratory infections, multiple ear infections, enlarged tonsils, clear nasal discharge, normal development.
A
(Incomplete prompt)
242
Q
- Schizophrenic patient agitated in ED, holding knife, refuses call to psychiatrist. What to do?
A
Overrule refusal and call psychiatrist
243
Q
- 18-year-old male with sleep difficulties, sad, declining grades, not suicidal. Treatment?
A
Mirtazapine
244
Q
- Patient came in for testosterone injection, noticed tampered. What to do?
A
Prescribe and reschedule appointment
