A 32 yo woman suffers an episode of severe occipital headache with vomiting and loss of consciousness. She is brought to the hospital where she is found to be conscious and completely alert. Exam: normal pulse & BP. No abnormal neurological signs. What is the next step in management?

Admission for observation

CT brain

MRI head

Reassurance and discharge

XR skull

A 25 yo woman was brought to the ED by her boyfriend. She has many superficial lacerations on her forearm. She is so distressed and constantly says her boyfriend is going to end the relationship. She denies trying to end her life. What is the most likely dx?

Acute psychosis

Severe depression

Psychotic depression

Borderline personality disorder


A young woman was brought to the hospital. On exam she has low temperature and tremor. She says when she closes her eyes, she can see colors. What drug has been used?






A lady comes in severe liver disease and hematemesis. Her INR is >10. What should she be given?



Whole blood

IV fluids

Vit K


After eating a cookie at a garden party, a child began to cough and went blue. The mother also noticed that there were swollen patches on the skin. What is the initial management?

OTC antihistamine



Epinephrine IM

Nebulized epinephrine

A 63 yo female is noted to have left pupil irresponsive to light and is dilated. What is the most probably dx?

Pontine hemorrhage

Subdural hemorrhage

Cerebellar hemorrhage

Extradural hemorrhage

Subarachnoid hemorrhage

A 28yo business exec presents at the GP asking for some help because she has been arguing with her boyfriend frequently. She is worried about her weight, and she thinks she may be fat. She has been on a diet and lost 7 kgs in the last 2 months on purpose. She is eating less. She used to do a lot of exercise. Now she says she’s feeling down, has some insomnia and feels tired and without energy. She has not showed up at work. She is worried because recently she got a loan to buy a luxury car. She can’t be fired. She complains about her low mood. She thinks this is weird because she used to be extremely productive. She used to work showing an excellent performance at the office. She even received compliments from her boss. How, she says her boyfriend is angry because her apartment is a chaos. Usually she spends a lot of time cleaning it, even upto 3 AM. She liked it to be perfect, but not it’s a mess. On exam: BMI=23, no other signs. What is the most probably dx?

Anorexia nervosa

Bipolar disease

Binge eating disorder



A woman brought her husband saying she wants the ‘thing’ on his forehead removed. The husband is refusing tx saying it improves his thinking. What is the next most appropriate next step?

Assess his mental capacity to refuse tx

Remove lesion

Refer to ED

Mini-mental state exam

Refuse surgery and send pt back

A 37 yo man who has many convictions and has been imprisoned many times has a hx of many unsuccessful relationships. He has 2 boys but doesn’t contact them. What is the most probable dx?

Borderline personality disorder


Avoidant personality disorder

Histrionic personality disorder

Antisocial behavior disorder

A 60 yo man has a pathological rib fx. He also complains of recurrent infection. BMA is done. Labs: Ca2+ = 3.9mmol/L and ALP = 127u/L. what type of cell would be found in abdundance in the marrow smear?

Plasma cell

Myeloid cell

Bence-jones protein



A child presents with blue marks on the sclera, short stature and heart murmur. What is the dx?

Osteogenesis imperfect





A 5month child can’t speak but makes sounds. She can hold things with palm, not fingers. Can’t sit independently but can hold her hand and sit when propped up against pillows. How’s the childs development?


Delayed speech

Delayed sitting

Delayed motor development

A 27 yo woman has hit her neck in an RTA without complains of tingling or motor loss. What is the next most appropriate inv?



CT cervical

Diagonal XR

A young female who has many superficial lacerations was brought into the ED by her boyfriend for superficially lashing her upper arm. She is adamant and screaming that she is not suicidal but scared her boyfriend wants to leave her. What is the dx?


Acute psychosis

Severe depression



Borderline personality



A 22yo woman was brought by her boyfriend with multiple superficial lacerations. There are scars of old cuts on her forearms. She is distressed because he wants to end the relationship. She denies suicide. What is the most likely dx?

Acute psychosis

Borderline personality disorder

Severe depression

Schizoid personality

Psychotic depression

A 31yo single man lives with his mother. He usually drives to work. He always thinks when the traffic lights change, his mother is calling him, so he drives back home. What is the dx?






A 56yo woman is known case of pernicious anemia. She refuses to take hydroxycobalamin IM as she is needle shy. She asks for oral medication. Why will oral meds be not effective?

Intrinsic factor def


Irritated gastric mucosa

Lack of gastric acidity

An 11m baby had an apnea event. The parents are worried that if something like this happens in the future, how they are to deal. Advise them about infant CPR.

Index and middle finger compression

Compression with palm of one hand

Compression with palm of two hands

Compression with rescue breaths 30:2

Compression with rescue breaths 15:2

A teacher brings in a child who says she fell down after hitting a table. On probing further, you decide that it was most probably an absence seizure. What led you to this dx?

The child had not eaten since morning

The child suddenly went blank and there was up-rolling of eyes

The child started moving his fingers uncontrollably before he fell

The child’s body became rigid and then started to jerk

A man has discharge from his left ear after a fight. Where is the discharge coming from?


Inner ear

Outer ear


A 40 yo manic depressive is noted to have high serum levels of lithium and profound hypokalemia. His GP had started him on anti-HTNs. Choose the single most likely cause?






A 74yo man presents with weakness in his arm and leg from which he recovered within a few days and short term memory loss. He has an exterior plantar response. He has similar episodes 2 years ago and became unable to identify objects and to make proper judgment. What is the most appropriate dx?

Alcoholic dementia

Pick’s dementia

Huntington’s disease

Alzheimer’s disease

Vascular dementia

A nurse comes to you saying that she has recently developed the habit of washing her hands after every 15-20 mins. She is unable to conc on her work and takes longer than before to finish tasks as she must constantly was her hands. What is the most appropriate management?






A 61yo man underwent a surgery in which ileal resection had been done. He complains of fatigue, headache, and heart racing. Labs: MCV=108fL, Hgb=8.9g/dL. What is the most likely dx?

Vit B12 def

Iron def

Folate def

Hemolytic anemia

Anemia of chronic disease

A 7yo is brought by his mother who says that he was well at birth but has been suffering from repeated chest and GI infections since then. She also says that he is not growing well for this age. What is the likely condition of this child?



Primary Tcell immunodeficiency

Primary Bcell immunodeficiency



A 3yo child has a high temp for 4 days and he had not seen a doctor. Then mother notices rashes on buccal mucosa and some around the mouth. What is the most appropriate dx?


Roseola infectiosum


Chicken pox


A 70yo lady presents with fever for 3d and confusion. There is no significant PMH. What is the most probable dx?





An obese mother suffers from OSAS. Which of the following inv is best for her?

The case is diagnosed as OSAS, so no need for PSG again.
Pulse oximetry is used for monitoring.


Overnight pulse-oximetry



A 28yo business man came to the sexual clinic. He was worried that he has HIV infection. 3 HIV tests were done and all the results are negative. After a few months, he comes back again and claims that he has HIV. What is the dx?






A 6wk child presents with progressive cyanosis, poor feeding, tachypnea over the first 2 wks of life and holosystolic murmur. What is the most appropriate condition?



Tricuspid atresia



A 29yo woman who was dx to have migraine presents with severe onset of occipital headache. She lost her consciousness. CT=normal. Neurological exam=normal. What is the most appropriate management?

Repeat CT




No inv required

A 19yo man has been happier and more positive than usual, with more energy than he has ever felt before for no particular reason. He has been getting more work done at the office today and has been socializing with his friends as usual. What is the most likely dx?

Atypical depression

Marked depression

Bipolar syndrome



A 35yo female attempts suicide 10x. There is no hx of psychiatric problems and all neurological exams are normal. What is the best tx?

Problem focused tx





A 57yo man presents with weight loss, tiredness, fever and abdominal discomfort. Exam: spleen palpable up to the umbilicus. Labs: WBC=127, Hgb=8.7, Plt=138. What is the most likely dx?







A baby born at 34 weeks with a heart murmur is kept in the incubator for almost 4 weeks. There is no murmur at discharge. What is the likely cause of this murmur?



Aneurysm of sinus of Valsalva

Aorto-pulmonary septal defect


A 6yo girl who has previously been well presented with a hx of tonic-clonic seizures lasting 4mins. Her mother brought her to the hospital and she appeared well. She is afebrile and didn’t lose consciousness during the episode of seizure. She has no neurologic deficit. What is the most appropriate inv for her?


Serum electrolytes


Blood glucose

A 60yo woman was found by her son. She was confused and had urinary incontinence. She has recovered fully after 6h with no neurological complaints. What is the most likely dx?


Vestibular insufficiency


Intracranial hemorrhage

A 34yo woman presents 3 weeks after childbirth. She has had very low mood and has been suffering from lack of sleep. She also has thought of harming her little baby. What is the most appropriate management for this pt?



IV haloperidol



A 65yo woman presents with headache. She also complains of dizziness and tinnitus. He has recently realized she has visual problems. There is hx of burning sensation in fingers and toes. On exam: splenomegaly, itchy after hot bath. Labs: RBC=87, Hgb=31.9, Plt=796. What is the dx?



Polycythemia vera



A 29yo male brought to ED in conscious state. There is no significant past hx. Which of the following should be done as the initial inv?


Blood glucose




A 45yo woman comes with red, swollen and exudating ulcer on the nipple and areola of right breast with palpable lump under the ulcer. What do you think is causing this skin condition?

Inflammatory cells releasing cytokines

Infiltration of the lymphatics by the carcinomatous cells

Infiltration of the malignant skin cells to the breast tissue

A 20yo young lady comes to the GP for advice regarding cervical ca. she is worried as her mother past away because of this. She would like to know what is the best method of contraception in her case?


Barrier method




A 66yo man, an hour after hemicolectomy has an urine output of 40ml. However, an hour after that, no urine seemed to be draining from the catheter. What is the most appropriate next step?

IV fluids

Blood transfusion


IV furosemide

Check catheter

A 24yo pt presented with anaphylactic shock. What would be the dose of adrenaline?

0.5ml of 1:1000

0.5ml of 1:10000

1ml of 1:500

5ml of 1:1000

0.05ml of 1:100

A 44yo woman complains of heavy bleeding per vagina. Transvaginal US was done and normal. Which of the following would be the most appropriate inv for her?


Endometrial biopsy


High vaginal swab

Coagulation profile

A 60yo woman presented to OPD with dysphagia. No hx of weight loss of heartburn. No change in bowel habits. While doing endoscopy there is some difficulty passing through the LES, but no other abnormality is noted. What is the single most useful inv?


 Manometry would show increased LES pressure.



Esophageal biopsy

Esophageal manometry

Abdominal XR

A 24yo woman presents with deep dyspareunia and severe pain in every cycle. What is the initial inv?


Pelvic US


Vaginal Swab

A 38yo woman, 10d postpartum presents to the GP with hx of passing blood clots per vagina since yesterday. Exam: BP=90/40mmhg, pulse=110bpm, temp=38C, uterus tender on palpation and fundus 2cm above umbilicus, blood clots +++. Choose the single most likely dx/

Abruption of placenta 2nd to pre-eclampsia

Concealed hemorrhage

Primary PPH

Secondary PPH

Retained placenta


A 32yo female with 3 prv 1st trimester miscarriages is dx with antiphospholipid syndrome. Anti-cardiolipin antibodies +ve. She is now 18wks pregnant. What would be the most appropriate management?


Aspirin & warfarin

Aspirin & heparin

Heparin only

Warfarin only

A 23yo presents with vomiting, nausea and dizziness. She says her menstrual period has been delayed 4 weeks as she was stressed recently. There are no symptoms present. What is the next appropriate management?

Refer to OP psychiatry

Refer to OP ENT

CT brain

Dipstick for B-hCG

MRI brain


A 16yo girl came to the sexual clinic. She complains of painful and heavy bleeding. She says she doesn’t a regular cycle. What is the most appropriate management?

Mini pill

Combined pill




A 36yo man walks into a bank and demands money claiming he owns the bank. On being denied, he goes to the police station to report this. What kind of delusions is he suffering from?

Delusion of reference

Delusion of control

Delusion of guilt

Delusion of persecution

Delusion of grandeur

Which method of contraception can cause the risk of ectopic pregnancy?





A woman has pernicious anemia. She has been prescribed parenteral vitamin B12 tx but she is needle phobic. Why is oral tx not preferred for this pt?

IM B12 is absorbed more

Intrinsic factor deficiency affects oral B12 utilization

IM B12 acts faster

IM B12 needs lower dosage

Pernicious anemia has swallowing difficulties

An old man comes to the doctor complaining that a part of this body is rotten and he wants it removed. What is the most likely dx?





Capras syndrome

A 31yo woman who is 32weeks pregnant attends the antenatal clinic. Labs: Hgb=10.7, MCV=91. What is the most appropriate management for this pt?

Folate supplement

Ferrous sulphate 200mg/d PO

Iron dextran

No tx req

A 47yo man who is a chronic alcoholic with established liver damage, has been brought to the hospital after an episode of heavy drinking. His is not able to walk straight and is complaining of double vision and is shouting obscenities and expletives. What is the most likely dx?

Korsakoff psychosis

Delirium tremens

Wernickes encephalopathy

Tourettes syndrome

Alcohol dependence

A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with sudden onset of epigastric pain a/w nausea and vomiting. Temp 36.7C. Exam: RUQ tenderness. Bloods: mild anemia, low plts, elevated LFT and hemolysis. What is the most likely dx?

Acute fatty liver of pregnancy

Acute pyelonephritis


HELLP syndrome

Acute hepatitis

A 57yo woman presents with dysuria, frequency and urinary incontinence. She complains of dyspareunia. Urine culture has been done and is sterile. What is the most appropriate step?

Oral antibiotics

Topical antibiotics

Topical estrogen

Oral estrogen

Oral antibiotics and topical estrogen

A pt came to the ED with severe lower abdominal pain. Vitals: BP=125/85mmHg, Temp=38.9C. Exam: abdomen rigid, very uncomfortable during par vaginal. She gave a past hx of PID 3 years ago which was successfully treated with antibiotics. What is the appropriate inv?


Abdomen XR


High vaginal

Endocervical swab

A pregnant woman with longterm hx of osteoarthritis came to the antenatal clinic with complaints of restricted joint movement and severe pain in her affected joints. What is the choice of drug?






A 24yo 18wk pregnant lady presents with pain in her lower abdomen for the last 24h. She had painless vaginal bleeding. Exam: abdomen is tender, os is closed. What is the most probable dx?

Threatened miscarriage

Inevitable miscarriage

Incomplete miscarriage

Missed miscarriage

Spontaneous miscarriage

A 2yo child playing in the garden had a clean cut. She didn’t have any vaccinations. Also, there is no contraindication to vaccinations. Parents were worried about the vaccine side effects. What will you give?

Clean the wound and dress it

Give TT only

Give DPT only

Give DPT and tetanus Ig

Give complete DPT vaccine course


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