Doctor Abro:

Recalls

1.A patient with 3cm thyroid mass with follicles and the question was on mgt

2.The other one was a 1cm mass on thyroid with psammoma bodies . Q on definative
mgt
3.Mgt of prostate Ca Gleason 6 without metastasis

4.0.5 cm stone in renal pelvis? Uric acid was elevated

Options
A. Hydrochlorothiazide
B. Allopurinol
C.ESWL
https://www.racgp.org.au/afp/2017/september/urolithiasis

5.Pt with upper GI bleeding, resuscitated but minor bleeding from the ulcer but bleeding
arteries not located. H pylori positive.
Mgt
1.triple therapy
2.epinephrine
3.Banding

6. Elderly with painful knee, aspirate done. Temperature elevated.Next action

A.Ultrasound knee
B. X ray
C.Send to ED

7.pt presented with jaundice no abdominal pain and pale stools . Developed jaundice a
few days after taking amoxicillin and another drug. Ix high ALT , AST mildly elevated ,
ALP elevated, GGT elevated,
Cause of clinical picture?
A.Cholelithiasis
B.Drug induced cholestasis

8. Pt with a Hx of mouth and genital ulcers in a patient who has developed painful red
eye
Definative mgt
1.Prednisone eye drops
2.Oral prednisone
9. Nurses taking gifts from pt
A. Report to APHRA
B. Approach nurse and talk to her

10. Celebrity who had sugery done by plastic surgeon. Was not happy of the outcome.
Which features are suggestive of psychosis
A.Searching on internet on how to fix the nose herself

11.Pt with pneumonia had cough , chest pain fever, crackles , perihilar infiltrates
Tests for mycoplasma negative and something else
Which bacteria is the cause
Pneumococcal pneumonia

12. Similar question we did on Amedex pt coughing greenish sputum suggestive of

pseudomonas pneumonia with pseudomonas :
TTT: 1st : Tircacilin / clavulinate
Mgt- tircacillin/ clavulinate , coamoxiclav Bronchiectesis :
TTT: Coamoxiclav
13. Pregnant woman with acute SOB , recent long distance travel . ECG shoed sinus
tachycardia
Appropriate investigation
1.CT angiogram. 2. . D dimer
C. Doppler both legs

14.Impetigo- causative bacteria

15. MSM couple one was hbsAG positive and HCV, the other was negative
Best mgt
1.test hcv rna in negative partner in 3 months
2.Give hbv immunoglobulin
16.Pt with sudden onset severe headache. Normal BPs
Dx
1.SAH
2.migraine

Contro
Thromboembolism prophylaxis following surgery for complicated pud
A. Rivaroxiban
B Clexane for 10 days Clexane is LMWH
1.Child with scabies not responding to permethrin
A.Ivermectin

Look for Option Repeat Permethrin

2.19 yr old with jaundice after fasting. Which test is appropriate

Unconjugated bil
3.6 week old with jaundice. What’s the most important sign in history
I chose pale stool, don’t remember other options

4.Child with recurrent upper respiratory tract infections and microcytic anaemia. Had
other features
1.Coeliac 2. Cystics fibrosis

5. Baby with constipation for 6 days and episodes of passing frequent stools . From the
history baby was getting just breast milk
A. Give stool softeners ( forgot name) .
B.Advise mother to avoid milk products

Incomplete Scenario with options;

Woman on IUCD diagnosed with bacterial vaginosis

Got metronidazole. What else would you do
A.Contact tracing
B.Screen for chlamydia
C. Stop iucd

Sep day 3

8yr old boy presented with palpitations and light headechness stable bp normal
concious ecg svt
1..adenosine
2.Valsalvar manuar

Patient with rash on back

Look like a sebaric keratosis
Management
1.reasure
2.punch biopsy
3.surgical excision
3.cryotherapy

Pic given...look like bowens disease

Name conditions

1.bowens dx
2.metastatic melanoma

Patient presented with L Upper qurant pain and discolored PR bleeding next
investigation

Gastroscopy
Colonoscopy
Explorative laparotomy
Barium meal and follow throw

Patient presented dysuria he had a same episode 2moth ago

What is the ix find out cause for problem
Ct abdomen
Cystoscopy (Painless Hematuria)
Try to look for the Option: CTIVP/CT KUB

https://www1.racgp.org.au/ajgp/2021/april/recurrent-utis-and-cystitis-symptoms-in-
women

https://www1.racgp.org.au/getattachment/20a87144-551c-4d5d-a194-
66c52dfadc67/What-to-do-about-recurrent-urinary-tract-infection.aspx

Dx:Reccurent UTI
https://www1.racgp.org.au/ajgp/2021/april/recurrent-utis-and-cystitis-symptoms-in-
women

Patient with follen hx and pain on back ,no neurology what is next step of mx(
xray..Vertibral #...stable #)
Bed rest and analgesia
Mobilize ?
MRI

Child with a image (Impetigo) on back : Most commun organism

A. S Aureus
B. Epidermis
AAA grow more than 1cm in a yers (from 3.6-4.7) asymptomatic : next step
A. Follow up 24 months
B. Follow up 12 months
C. Semi urgent cx
D. Urgent surgery
⁃ Rash on face trunk and chest in a child of 6 days ( no symptoms no signs )
Pte with positive anal swab clamydia : treatment ?
Dicloxacilin 7 days anal swab ttt
https://sti.guidelines.org.au/sexually-transmissible-infections/chlamydia/

Pte with dysfagia and some signs of chest pain, abdomen normal. normal crx and
ECG. dx?
A. Cancer
B. Acalasia
C. esophagus spasm

22 months boy apparently healthy child with mass in left upper abdmon mom fund it
while she was bathing him.

A. Neuroblastoma
B. Wilson tumour
Pte on MVA with face fractures in maxillary and tongue bleeding what is the next step to
maintain airway:
1. Cricotyroidectomi
2. Oxygen
3. Traqueotomy
Doctor Abro:
. Colorectal cancer screening ( Cat I )
2. basket ball player - non tender lymph node + swelling of leg + dusky colour of arm ,
cat - has been recently ill Option 1. cat scrath disease, 2. Axillary vein thrombosis 3.
cellulitis
3. Flexor surface rash , no wheezing , history of taking montelukast option - 1. drug
reaction 2. Eczema 3. Urticaria
4. Statistics - case control ( same as previous - cancer and dental treatment case )
5.PCOS -irregular menstruation + mild hirsutism , most appropriate investigation Testosterone
6. -swelling at the upper pole of the testis, compressible , transillumination test –
negative-Varicocele
7. fetal demise due to abruption placenta - next management - option 1. amniotomy 2.
ultrasound 3. Prostaglandin
8. swelling above inguinal ligament - inguinal hernia - optimal period for surgery
9. multinodular goiter ( no retrosternal extension, less than 2 cm , ultrasound - benign ) -
Option - 1. review at 12 month 2. FNAC 3. radiotherapy 4. Total thyroidectomy 5.
Hemithyroidectomy

10. Brachial plexus injury

11. Inguinal hernia( reducible ), BMI 35 - Next Management - option 1. Herniorrhapy 2.
weight loss and review

12. Apical lung tumour investigation option 1. video assisted biopsy 2. bronchoscopy

13. Lower GI bleeding ( OGD scope - normal ) investigation option 1. colonoscopy after
gastric lavage 2. Angiogram

https://www.wacountry.health.wa.gov.au/~/media/WACHS/Documents/About-
us/Policies/Colonoscopy-Clinical-Practice-Standard.pdf?thn=0

successful businessman drug overdose recovered wife separated on restraining

order,telling wife is evil, demanding medical chief to come shuoting at staff
1Narci
2BPD
3Intermittent explosive disorder

Most dangerous job for individual. A chart with case fatality rate (per 100,000, and
actual fatality numbers)

Young female 18 years had uti , on culture E. coli was found, treated with antibiotics
and after 2
weeks she developed uti again and costovertebral angle tenderness was present.
Asking what will
help to find the cause of recurrence
Ct urography
VCUG
USG abdomen
Cystoscope

3cm lumb in the right upper quadrant of the right breast noticed after a tennis ball
trauma with right axial lymphadenopathy and at 37.5
fat necrosis
fibroadenoma
Fibrocystic change
Breast ca

Thyroid nodule right 2.5cm incidental finding on CT, biopsy done psammobodies. Best
intervention
Right thyroidectomy
Total thyroidectomy
RAI
repeat utz

Child jaundice for 6 weeks, most important in History to come up with dx

Stool color
Family history of liver

Sjogren, aside from eye treatment, other treatment (long term)

Lbm, urti 6 in 1 year, anemia, microcyric. Possible provisional dx

Coeliac
Cystic fibrosis

Doctor with depression, on venlaxafine. Called gp friend for olanzapine. because he

feels his hypomanic. What to advice
Stop venlaxafine
Take olanzapine
Give online prescription
Refer for psych assessment

DM 2 with hyper triglycerides with HBA1c skin lesion at shine asking for diagnosis
1 HPV2 Mollensum 2 hyertrigyezia
CRC screening 2 questions- 1st degree age 60yr cat 1 and
Age 50 yrs and second degree relatives

3. Women trying to conceive taking sodium valproate 15yrs

A. Cease Na valproate
B. stop valproate
C. Change another drug

4. Aortic aneurysms size 3.5 to 3.7 cm

A. Biennial
B ANNUIAL
C.urgent
D. Semiurgent

5. Aortic aneurysm size increase 1 cm per year

Semiurgent
6. 36yrs old women taking OC pills and vitamin supplements hearing of pop sound after
running. Can’t soft, not tender,
Asking investigation
A.USG
B. MRI
C. x-ray

Dx: Achilles Tendon Rupture

7. Psychi q relative to personality disorder

8. Chronic pancreatitis asking for treatment

9. SVT Child, pale and pulse readily papable

10.obgyn
Woman conceived naturally she also have 2 previous IVF which is insucessful
A. Midwife
B. OBGYN
C. At home

11. Asthma patient after trying salbutamol 2 time for acute attack
What to add before giving 3 rd times
A. Oral prednisone

Incomplete Scenario
https://www.rch.org.au/clinicalguide/guideline_index/asthma_acute/
12. Pregnant women spontaneous in labour 1 st os- 5cm, LOT
membrane spontaneous rupture, contraction 2 in 10 , 2 nd VE - same VE finding
A.oxytocin
B Emlscs
C.FBS
D. Instrumental delivery

14.MSM men, chilamydia positive no symptoms

A . Azithromycin
B. Doxycycline 100 mg BD for 7 days
https://sti.guidelines.org.au/sexually-transmissible-infections/chlamydia/

8 month child bowel output once per week after weaning.

-rectal suppo
-enema
-lactulose
-observation
https://www.rch.org.au/clinicalguide/guideline_index/Constipation/

melanoma in eyelid margin picture given. asking mx

-Excision
-Obseravation
-refer to plastic surgeon
symptoms of sjogren (gritty eyes) given and asking for long term treatment
-HCQ
-MXT
-Prenisolone

Young female present with uti , on culture E. coli was found, history of uti and treated
with antibiotics 2
weeks ago and well. Now she developed uti again and costovertebral angle tenderness
was present. Asking what will
help to find the cause of recurrence
-CTurography
-VCUG
-KUB xray
-Cystoscope
-Ct urograpgy

left lobe of thyroid, follicular cells +ve , dyspgaia symp (+)

what next?
-left lobectomy
-total thyrodectomy

she get injury and did ct scan. Accidently found left throid mass. No symptom.
psammo body found. asking mx
-left lobectomy
-total thyrodectomy

Seborrhoeic keratosis picture given. asking mx

-obersavation
-punch biopsy
-wide local excision

old lady with femoral neck fracture.after 3 days, developed dyspnoe, chest pain and
died from cardiac arrest. Primary cause of death?
femoral neck fracture
cardiac arrest
pulmonary embolism
5 month child, breast feeding to 3 months and gave cow milk formula. gave solid food 1
week ago
constipation for 6 week. cause?
-solid food
-cow milk formula
-cow milk protein allergy

Pt undergo thyroidectomy. 3hours later dyspnoea and stridor, Bp decrease. after

oxygen and fluid what to do next
-open wound
-intubation
-urgent OT

0.5 cm stone in renal pelvis and no symptom. Uric acid and calcium was elevated
Options
- Hydrochlorothiazide
- Allopurinol
- ESWL

man vomiting, abd distension, empty rectum, Xray show caecum 21cm. asking mx
-colostomy
-caecostomy
-sigmoidoscopy

Successful business man found overdose drug and alcohol, involuntary admission,
now get conscious and talk about his wife leave him, angry with her, asking who is
doctor admitted him involuntarily and will sue him
-borderline disorder
-grandiosity

Wife is HBsAG+ HBeAg-, husband is HBsAg-and Ab-. advise for husband

-No need vaccine because HBe-
-Need to check serology after intial vaccination
-after vaccinaton, need boaster in longterm

Most dangerous job for individual. A chart with case fatality rate
in chart, % rate in road transport is more than other and fatal people number in
agricuture is more than others
-Agricuture
-Transport
1-Stool Colour, 2-Aspiration
1-OverValued Idea, 2- Repeat DC-Shock
1-Normal behaviour, 2-
Part 3

- Higher individual mortality…. RCT, Acgriculture etc

- Patient with diabetes, HBA1c 8.1, hyperlipidemia, picture of xanthomatosis asking cause

- the patient with phobia for swalling food but the option we picked wasnt there…. So kindly
revisit question

- Patient with mandibular fracture, tongue split, already has endopharyngeal tube, next
management… crio, tracheo, etc

- Patient with 25mm thyroid tumour, follicular cells on histo, management…. Partial
thyroidectomy, complete thyroidectomy, CT, RT

- Patient with multinodular goiter, no sumptoms, multiple nodules on usg, asking

managenet Radio iodine, surgery, review in 6-12 months (not sure about duration)

https://australianprescriber.tg.org.au/articles/investigating-thyroid-nodules.html

- Lady for hpv screen has non hpv 16/18 and on LSICL management… repeat in 12 months,
colposcopy, repeat test now, colonoscopy

- Man 55, brother had colon cancer at 60, what to do… colonoscopy, Ifobt, ogt

Esophageal bleed, resolve, ulcer found, cand see bleeding vessel, H pylori positive,
management… triple therapy, adrelaline injection

- Burn question management… antibiotics, ivf

- 61 year old lady not opening bowels for 6 days

- 50 year old lady blooding LUQ pain and bleed (they used a weird term to describe bleed)
next….. colonoscopy, gastroscopy

- 19 year old girl want to do coeliac screen because 16 year brother has it. She is
asymptomatic and endomysial negative…… reasure, HLAQ, biospy, repeat TTG test
- Child 5 month old tarted on cow milk after three months, now has constipation 6 weeks (I
think), started eating cereal 1 week ago, cause…. Cow milk, cow milk protein, solid food
introduction
- Lady had cone biopsy, later deveoloped fever, low abdominal pain, started on co-
amoxiclav and metronidazole, asking for additional treatment- Doxycycline bd x 7 days,
gentamycin, cefriaxone, single dose azithromycin

https://sti.guidelines.org.au/syndromes/pelvic-inflammatory-diseases-pid/

- Guy travels to victoria for hiking and is single with multiple sexual partners, currently has
pain in joints and erythema on left seen with aspirate, asking diagnosis….

Chlamydia, ross river, australian tick

https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/c
onditions/infectious+diseases/ross+river+virus+infection/ross+river+virus+infection+-
+including+symptoms+treatment+and+prevention

https://www.healthdirect.gov.au/ross-river-virus

https://www.health.vic.gov.au/infectious-diseases/ross-river-virus-disease
https://www.racgp.org.au/getattachment/566dfc36-45e3-4ece-8e75-4f0794c54c94/Ross-
River-virus.aspx

- 50 year old lady with itching vagina, still mensturates but heavuer recently with periods
lasting 10 days, now how severly puritic vagina, picture given, management… topical
steroids, estrogen, anti fungal
- Doctor takes venlaflexin, now says he cant sleep and asks his gp friend to prescribe
olanzapine for him, what to do….

Report,

refer him to psychiatrist

- Patients hasband wants seperation, she lost her dad a year ago, her mum died when she
was 12 and she has been close to her dad since now cant sleep and had been moody
recently, management…

grief counceling, fluoxetine, olanzapine

Grief Tx

https://step2.medbullets.com/psychiatry/120624/grief
- Patient mild dementia mmse 23/30, moody aggitated, easly gets anrgy, diabetic on
insuline but doesnt want to take, first management

Risperisdone, Galantamine, long acting insulin

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274589/#:~:text=For%20moderate%20t
o%20severe%20symptoms,olanzapine,%20quetiapine,%20and%20aripiprazole

- 8 year old child with sore throat, weight in 80-95th percentile, parents also overweight,
initial advice….

Talking to child about weight will cause eating disorder in adulthood,

he will lose ythe weight in puberty,

he is okay cause parents are also overweight,

weight maintanace is initial management

https://www.rch.org.au/uploadedFiles/Main/Content/obesity-weight-
management/140785%20ALEXANDER%20Weight%20Management%20Service%20A5%20
LR%20web.pdf

- Psoriasis picture asking for management

- Child with Duchene muscular dystrophy, what advice to give mother….. child will not
need wheel chair in future, will develop ILD(Intellectual Disabilities), Will develop
incontince in adulthood
https://step2.medbullets.com/neurology/120316/duchenne-and-becker-muscular-
dystrophy

- Higher individual mortality…. RCT, Acgriculture etc

- Patient with diabetes, HBA1c 8.1, hyperlipidemia, picture of xanthomatosis asking cause

- the patient with phobia for swalling food but the option we picked wasnt there…. So kindly
revisit question
- Patient with mandibular fracture, tongue split, already has endopharyngeal tube, next
management… crio, tracheo, etc

- Patient with 25mm thyroid tumour, follicular cells on histo, management…. Partial
thyroidectomy, complete thyroidectomy, CT, RT

- Patient with multinodular goiter, no sumptoms, multiple nodules on usg, asking

managenet Radio iodine, surgery, review in 6-12 months (not sure about duration)

- Lady for hpv screen has non hpv 16/18 and on LSICL management… repeat in 12 months,
colposcopy, repeat test now, colonoscopy

- Man 55, brother had colon cancer at 60, what to do… colonoscopy, Ifobt, ogt

Esophageal bleed, resolve, ulcer found, cand see bleeding vessel, H pylori positive,
management… triple therapy, adrelaline injection

- Burn question management… antibiotics, ivf

- 61 year old lady not opening bowels for 6 days

- 50 year old lady blooding LUQ pain and bleed (they used a weird term to describe bleed)
next….. colonoscopy, gastroscopy

- 19 year old girl want to do coeliac screen because 16 year brother has it. She is
asymptomatic and endomysial negative…… reasure, HLAQ, biospy, repeat TTG test
- Child 5 month old tarted on cow milk after three months, now has constipation 6 weeks (I
think), started eating cereal 1 week ago, cause…. Cow milk, cow milk protein, solid food
introduction

- Lady had cone biopsy, later deveoloped fever, low abdominal pain, started on co-
amoxiclav and metronidazole, asking for additional treatment- Doxycycline bd x 7 days,
gentamycin, cefriaxone, single dose azithromycin

- Guy travels to victoria for hiking and is single with multiple sexual partners, currently has
pain in joints and erythema on left seen with aspirate, asking diagnosis…. Chlamydia, ross
river, australian tick

- 50 year old lady with itching vagina, still mensturates but heavuer recently with periods
lasting 10 days, now how severly puritic vagina, picture given, management… topical
steroids, estrogen, antifungal

- Doctor takes venlaflexin, now says he cant sleep and asks his gp friend to prescribe
olanzapine for him, what to do…. Report, refer him to psychiatrist

- Patients hasband wants seperation, she lost her dad a year ago, her mum died when she
was 12 and she has been close to her dad since now cant sleep and had been moody
recently, management… grief counceling, fluoxetine, olanzapine

- Patient mild dementia mmse 23/30, moody aggitated, easly gets anrgy, diabetic on
insuline but doesnt want to take, first management Risperisdone, Galantamine, long
acting insulin

- 8 year old child with sore throat, weight in 80-95th percentile, parents also overweight,
initial advice…. Talking to child about weight will cause eating disorder in adulthood, he
will lose ythe weight in puberty, he is okay cause parents are also overweight, weight
maintanace is initial management

- Child with Duchene muscular dystrophy, what advice to give mother….. child will not
need wheel chair in future, will develop ILD, Will develop incontince in adulthood
AHM Sep 12:

young religious boy masturbating once every day now for the last few months now
deperessd about it ok with friends studies ok .

1normal behavior

15 y boy abusing his mother tryied strangulate her what would u do

1.inform police 2. insist her to inform police 3.inform CPA

https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-
guidelines/view-all-racgp-guidelines/abuse-and-violence/domestic-or-intimate-partner-
abuse-violence/intimate-partner-abuse-safety

https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-
guidelines/view-all-racgp-guidelines/abuse-and-violence/specific-abuse-issues-for-
adults-and-older-people/abuse-of-older-people

medical student going through patients record u r the intern wheninquierd he says
pwtients mother in abroad wants to know about patients condtion what would u do

1. informAPRAHa 2. inform clinical director 3. tell the patient about it

1) seborrheic keratosis asking for management, it's was a picture of the back
. Punch biopsy

. Other option I forgot

Reassure

2) 18 years with menoragia.

It's her 2nd periods.. She the first one last 10 days this one 3 to 7 days and it too much

Asking for initial best management

. FBC

. Tsh

. Fsh

.Ultrasound
https://www.rch.org.au/clinicalguide/guideline_index/adolescent_gynaecology_menorrha
gia/

3)pregnant women with gallstones.

Asking what is true in statement. - oestrogen can cause decrease motility of gallbladder and it results with
gallstone.

4) picture of a girl who has some kind of rash around her genital parts, the during is
stinging, she has vomiting and abdominal if I recall well. She is sexualky active and have
one boyfriend

The asking most appropriate treatment.

. Azitromycine Ceftriaxon IV + Azitromycine IV + Metronidazole IV

. Trimethropine

https://www.racgp.org.au/

Dx:PID

incomplete

5) a homesexual lady who want to do screening, she has a girl friend, never have male
partners

What screening she can be doing on a regular basis

. Cervical cancer

. Mammography and ultrasound

6)case of fat necrosis, this was among the option, the stem was about a woman who hurt
her self while playing something like

They ask about what breast problem that can be. ( it a recall for day 1, 2 and 3)
7)an other women with lump one 1cm other women 2..she is now fine.. Asking for most
appropriate management or step

. Reassure

. Fna

8)a case of SVT in a boy asking initial for management

9) case on bercet disease asking for management

10)picture of impetigo asking germ

. Option :staph. Aureus

11)picture look like eczema

Asking for diagnosis

12)2 years old with a father who have a big head ( macro)

He can speak, walk

I don't know if I make sense.

They ask what can be the cause.

. Familial macrocephaly

Other option I don't recall

AHM Sep 12:

young girl 2nd mensus heavy bleeding 1st one 4 months ago lasted 10 days had to change
the pads every 3 hours what ix 1.FBC 2.TSH 3.fsh clotting profile

Doctor Abro:

Other topics I remember

1) seborrheic keratosis asking for management, it's was a picture of the back

. Punch biopsy

. Other option I forgot

2) 18 years with menoragia.

It's her 2nd periods.. She the first one last 10 days this one 3 to 7 days and it too much

Asking for initial best management

. FBC

. Tsh

. Fsh

.ultrasound

3)pregnant women with gallstones.

Asking what is true in statement.

4) picture of a girl who has some kind of rash around her genital parts, the during is
stinging, she has vomiting and abdominal if I recall well. She is sexualky active and have
one boyfriend

The asking most appropriate treatment.

. Azitromycine
. Trimethropine

The rest I don't recall

5) a homesexual lady who want to do screening, she has a girl friend, never have male
partners

What screening she can be doing on a regular basis

. Cervical cancer

. Mammography and ultrasound

The other options I don't recall

6)case of fat necrosis, this was among the option, the stem was about a woman who hurt
her self while playing something like

They ask about what breast problem that can be. ( it a recall for day 1, 2 and 3)

7)an other women with lump one 1cm other women 2..she is now find.. Asking for most
appropriate management or step

. Reassure

. Fna

8)a case of SVT in a boy asking initial for management

9) case on bercet disease asking for management

10)picture of impetigo asking germ

. Option :staph. Aureus

11)picture look like eczema

Asking for diagnosis

12)2 years old with a father who have a big head ( macro)

He can speak, walk

I don't know if I make sense.

They ask what can be the cause.

. Familial macrocephaly

Other option I don't recall

young religious boy masturbating once every day now for the last few months now
deperessd about it ok with friends studies ok .1normal behavior

15 y boy abusing his mother tryied strangulate her what would u do 1.imform police 2.
insist her to inform police 3.inform CPA

elderly man gedtiatrician diagnosed with Alzheimers,now he wants an advanced directive

against any painfull resuscitation or procedures MMSE 23/30 living with his wife what to do
1. send him back to geriatrician . faclitate him to get the advanced dierective

xrays given 52 y one was osteoporitic spine FBC RFT normal two bones DMD -1.7 and -2.5
reatments 1.alondronate 2.vit D Donusumab

CI of alendronate : eosphageal spasm or achalasia , severe renal failure , hypocalcemia

2nd xray osteoporortic spine with wedge # treatment 1. analagesisc and bed rest 2. mobilize no
options of braces
69-year-old man with DM presents with painful left leg. He had an episode of DVT 3
years ago. On examination leg appears erythematous, warm and tender. There is a
venous ulcer over his left ankle. There is sensory loss to fine touch and pain from soles
to knees bilaterally. Rest of the examination was normal. What is the most initial
investigation?
a. Doppler ultrasound
b. Blood culture
c. Full blood count

(Picture of a child with widespread rash all over the body and involving flexor surfaces
of elbows. Not exactly these pictures but similar)
History was of an 8-year-old child recently started on montelukast for asthma. Has
recurrent episodes of allergic rhinitis.
a. Drug reaction
b. Eczema
c. Urticaria

A doctor wants to evaluate the effect of mercury amalgam on developing dementia. So,
she goes and counts the number of amalgam fillings in the teeth of dementia patient.
What is the type of study?
a. Case control
b. Cohort
c. Cross sectional survey
d. Ecologic study
e. Randomised control trial

Woman wants to try to conceive. She wants to time intercourse so that she has the
best chance of conceiving. What is the most initial step (something weird like that)?
a. Tracking basal temperature
b. Diameter of follicles on day 14
c. Serum oestriol from day 8-13 (not sure)
d. Cervical mucous thickness

Old lady presented with femoral neck fracture. After 3 days, she developed dyspnoea
and died from a pulmonary embolism. What is the primary cause of death?
a. Femoral neck fracture
b. Cardiac arrest
c. Pulmonary embolism
0.5 cm stone in upper calyx and no symptom. Serum calcium, creatinine normal. Uric
acid and urinary calcium was elevated.
a. Hydrochlorothiazide
b. Allopurinol
c. ESWL
d. Ureterolithotomy

(Picture) Farmer coming with given lesions on his back. Management?

a. Observation
b. Punch biopsy
c. Wide local excision
d. Shave excision biopsy

Young female presented with (symptoms of UTI) and discovered to have E.coli in urine
culture. She has a history of urinary tract infection 2 weeks ago, where she was also
found to be positive for E.coli and treated with antibiotics. Now she has costovertebral
angle tenderness also. What investigation will help to find the cause of recurrence?
a. CT urography
b. VCUG
c. X-ray KUB
d. Cystoscopy

(Picture) Baby about to be discharged having this rash on face, chest and abdomen
developed one day before. Mother is concerned. What to do?
a. Observation
(Other options about different topical treatments)
Wife is HBsAg+ HBeAg-, husband is HBsAg-and HBsAb-. Advise for husband.
a. Vaccination is unnecessary because HBe-
b. Need to check serology after initial vaccination
c. After vaccination, will need booster doses.

https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-
diseases/hepatitis-b#vaccines-dosage-and-administration

A university lecturer is brought to the ED by security guards who say he was banging on
the dean’s door saying he wants to meet him. He claims that aliens have taken control
of the university and wants to influence the lecturers to bring about a ‘New World
Order’. He has worked flawlessly throughout his career and not taken leave for the past
years except few days for some illness. But staff and students consider him unfriendly
and odd (something like that). Most likely diagnosis?
a. Late onset schizophrenia
b. Delusion disorder
c. Depression

Schizotypal individuals have less likely hood occupational success (this statement is
from the AMC handbook)

Group of indigenous children were treated for scabies with permethrin. Many of them
had recurrences and were treated with permethrin again. There was one who recurred
despite this. What to do next for him?
a. Oral cotrimoxazole < 5 years : Permethrin + benzyl benzoat
b. Repeat permethrin < 1 month : crotametin
c. Oral ivermectin

Pregnant lady first pregnancy, religious beliefs against blood transfusions, Rh neg, 6
weeks, has had PV bleeding since 3 days, no Intrauterine GS, BHCG was 3630, on PV,
adnexal mass present, what's the best advice to give about Anti D
1. Check for partner's RH status
2. Check for feto maternal hhg
3. Counsel her about Anti D immunoglobulin not being a blood product
4. Counsel regarding the implications of Rh isoimmunisation
5. Reassure because Anti D is not needed
Middle aged man with Schizophrenia well controlled on Olanzapine. He presents with
increased day time sleepiness in workplace. Also, loud snoring and grunting in sleep,
and wife has to sleep in a separate room. Wife is threatening to leave him because of
his snoring, irritability etc. What intervention will most help with the sleep issues
1. Reduce Olanzapine
2. Weight loss program
3. Do nothing
4. Sleep hygiene
5. Sleep restriction

ECG – SVT, QT prolongation

Pt with chest pain. On antihypertensive perindopril. Pt has been given aspirin, nitrate
,oxygen and morphine but before you transport to tertiary hospital far away what else
can you give

1 subcut enoxaparin(Non-ST-Elevation)
2 iv tenectaplase…especially long trip(ST-Elevation)

PCI within 90 mins-otherwise Tenectap

After surgery, urologist prescribes antibiotics but the hospital protocol does not allow
for antibiotics to be prescribed to this pt
What do you do?

1 Discuss hospital protocol with urologist

2 Go ahead and prescribe medication.

Pt 13 yrs old woke up with hip pain but had become stable after a few hours.
Grandmother Mother has arthritis.
X-ray picture given

1Slipped hip
2Perthes
3Juvenile arthritis

Depend on the x-ray

Pt with missed pill one day yesterday , no intercouse. She usually take her pills at 11pm
but forgot. When should she take the pill.

1take the missed pill today now and today’s pill at the normal time
2 skip the pill and continue others
3 wait after 7 days then start a new line and use condom
Hairy Vulval pic, 55y:o woman with burning sensation on the vulva. Still seeing her
regular period except that it has been heavier recently. Other results are normal . What
should she do?

1clotrimazol cream
2 topical steroid
3 vulva Hygiene
4 estradiol pressary

Same questions on seborrheic dermatitis , hemagioma, eczema, maturbating man,

case control

Lots of questions on hepatology

One statistic question to calculate incidence of diarrhoea in a community with a table

 1. Patient has mouth and genital ulcer several time and now came for eye .pic given
fundoscop dome . Anterior uveitis ..asking Tx ...1.oral prenisolone 2. Topical
prenisolone 3.chramphnicol ..I choose topical prednisolone

2. Next ..eye pic given .. patient has trauma and fundoscopy done .no abnormalities.
No infection. pain. Not sudden onset No itchy. Already given topical antihistamine
asking appropriate 1. Timinol 2. Acetazolamide 3. Toprocapine.

3. Wafarin...patient symptoms PE due to dvt already given enoxaprin according to 1

u/kg plus Wafarin but patient git breathlessness plus inr 1.3 options 1 increase dose
enoxa 2. Stop enoxa and wafarin 3.increase dose warfarin and stop enoxa 4.
Change apixacan .

Try to look for option: Increase dose of Warfarin and continue the same dose Enox

https://www.health.qld.gov.au/__data/assets/pdf_file/0015/1152213/statewide-
anticoagulant-guideline.pdf

https://www.racgp.org.au/afp/2017/november/pulmonary-embolism
4. Patient smoking history 20 years ..hamotypsis weight loss night sweat ..no fever
immigrant 10 years ago from vitaneam chest crackle on both upper ....1.tb 2. Ca
lung 3. Pneumonia 4. Fibrosis..I choose 2

5. Patient has non hodgkin and chemotherapy given 1 years back. Now came to gp for
breathlessness .on examination crackle Chest x ray done ...hilar infiltration. No
chest ray given .and no sings of ca lung option and no fever or no flu signs or no
mention for pneumonia 1.pcp (Pneumocystis Pneumonia) ..

https://www1.racgp.org.au/ajgp/2023/june/immune-related-adverse-events-
secondary-to-immunot

6. One pic given....lipid deposation on leg ...not itchy no pain .yellowish deposition
that is already mentioning 50 years has hypertension hyperlipidaemia .no fever no
weight loss ask cause of this? options 1. Tb 2. Hyperlipidaemia. 3.scc 4.melanoma

7. Pharmacology is easy that I think ..one is patient already taken venaxaflxaxine for 2
years or 3 years with schiz complaints about he can't control his legs and symptoms
are controlled. 1. Propanolol 2. Stop vene 3.change Clozapine 4 .baclfecan 10 mg
5. Bromocriptine...

Contro
https://www1.racgp.org.au/ajgp/2023/september/restless-legs-syndrome

For Akathisia ( Leg sptm) : TTT :

1st : propanolol
2sd : lorazepam
3rd : benztropin
For Acute dystonia and Parkinsonism : TTT :
1st : Benztropin
https://www.racgp.org.au/afp/2017/may/beyond-anxiety-and-agitation-a-clinical-
approach-t
 8. One patient has cancer pain already taken oxycodone pcm analgesia...came to ER
drowsy gcs 13 parametric given naloxone .so2 98 vital signs stable What will you do
initial ? 1. Repeat naloxone 2. Pcm level 3.natrexone 4.oxygen

9. Patients came to ER fatigue BP 80/60 lab Na low k high cr Norma hco3 normal 1.
Pituitary deficiency.2. Hyperaldosteronism 3. Siadh
ACTH insuficiency

10. Patients taken indaparamide ecei bb blocker lab na 122 k 3.5 cr Normal hco3
normal cause of this? 1 acei 2.bb blocker 3.indaparamide Thiazide diuretic gives low Na and Low K
First I think it's Addison but not memtion details for primary cause so I choose it
..duration is progressive
Thiazide(Hypo Electrolytes-)- Indapamide(hypoNa)
 11. Next pharmacology patient taken acei bb blocker furosamide and got back pain so
recently taken naproxen lab given k high cr little high na low 120 ..causing 1 acei
2naproxene 3 bb blocker 4. Furosamide

https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/electrolytes/sodium-
hyponatraemia

https://derangedphysiology.com/main/cicm-primary-exam/renal-system/Chapter-
022/furosemide
https://www.health.qld.gov.au/__data/assets/pdf_file/0027/1006587/electrolyte-
prescribe-gline-adult.pdf

12. Patient got back pain from gardening x ray lumbar given normal no compression
fractures. Appropriate mx 1. Bed rest (Compression Fracture) 2. Mobile and
analgesic... 3. Mri

13. 50yr male patient got sudden on set back pain. Can't move limited movement.
Asking appropriate Mx 1MRI ..2.anagisia 3. Opiate
4 xray 5. physiothearphy
https://www1.racgp.org.au/ajgp/2020/november/non-radicular-low-back-
pain#:~:text=Low%20back%20pain%20(LBP)%20is%20a%20common
 14. Gyna 60 years vagina redness and pic given menopaused no bleeding per vagina no
itchy no dm ..treatment 1. Topical steroid. 2. Ketoconazole cream 3. Vg pessary
Go to according to Pic topical oestrogen
https://www.racgp.org.au/getattachment/8845e1a8-ccef-4cc2-b752-
2e1b277c62b4/Common-vulval-dermatoses.aspx

15. STD..chlamydia tx ....chlamydia positive and with symptoms. Options 1. Azithio

single I choose this 2. Cetriazone 3. Doxy for 7 days .
 17. 20 yrs old man came for bloating Dirrhoea sometimes constipation..brother and
sister got coliec disease . So he did coeliac serology and negative not advoiding
special food gluten.next investigation..1 iron studies. 2. Upper gi scope 3. Cp

https://www1.racgp.org.au/ajgp/2018/january-february/interpreting-tests-for-
coeliac-disease-1

https://australianprescriber.tg.org.au/articles/testing-for-coeliac-disease.html
 18. 15 years came to gp with menorragia ...last month and now menorrigia ..asking
initial test. 1. CBC 2. Coagulation profile 3. Haemophilia factors

19. 25 years old lady come to gp lower abdominal pain during menstrual peroid with
regular menstrual cycle .prevention of pain for lower abdominal pain
1.mefanamic 2.coc 3.progesrtone pill
Mefanamic : Nsaids
20. malenoma in eye 1. Refer plastic surgeon 2.excison .3. Punch biopsy ..I choose 1

21. A 42-year-old man comes to the emergency room with the chief complaint that "the
men are following me." He also complains of hearing a voice telling him to hurt
others. He tells the examiner that the news anchorman gives him special messages
about the state of the world every night through the TV.
Which of the following psychiatric findings best describes this last belief of the patient?
a. Grandiose delusion.
b. Illusion
c. Loose association
d. Idea of reference
e. Clouding of consciousness

It's old recalls I got it today I choose c ..little change Asian coming to the world
1. The answer is d. (Kaplan, pp 276, 278.) An idea of reference is the belief that an
object, event, or person in one's environment (commonly the television or radio)
has particular personal significance. A delusion is a fixed, false belief, and a
grandiose delusion has a theme that attributes special powers or talents to the
delusional person. An illusion is the misperception or misinterpretation of real
external sensory stimuli. A loose association describes a disturbance in the
continuity of thought in which ideas expressed do not seem to be logically related.
Clouding of consciousness refers to an overall reduced awareness of the
surrounding environment.

1.Seborrheic(means 'bening') Keratosis

(“liver spots”)
stuck on appearance and very common in older adults
treatment: cryotheraphy, surgery, laser for cosmetic reasons
2.Bowen disease
very early form of SCC (in situ SCC)
Slow growing, superficial(only epidermis)
3.svt treatment
usually hemodynamically stable (No p waves, QRS<100msec is normal or 'narrow')(based
on reentry around the av node)
1. Vagal maneuvers (carotid massage, valsalva, dive reflex, ice immersion)(both slow and
convert the SVT)
2. If no response: give Adenosine
3. if no response:give BBs, CCBs, or Digoxin
Radiofrequency Catheter Ablation is curable in many cases
4.acute pancreatitis treatment
NPO
IV hydration at very high volume
Analgesia
PPIs(to decrease pancreatic stimulation from acid entering duedonum)
if ct/mri show >30% necrosis add antibiotic (such as imipenem,meropenem) to decrease
mortality (for preventing necrotic or infected pancreatitis) and do Needle biopsy to
determine the Surgical Debridement (to prevent ARDS and death)
pseudocysts are drained with needle if they are enlarging or painful

5.impetigo bacteria?
Staphylococcus(not staph. Epidermidis, it is a part of normal skin flora)
and Streptococcus (skin infection with group A beta hemolytic Strep. can cause
Glomerulonephritis but NOT Rheuatic Fever)

6. Several colorectal cancer problems

Screening (simplified)
Category 1 (avarege or slightly increased)
No history OR 1 first-degree OR 1 first 1 second degree (not anyone early (<55y.o))
Do iFOBT every 2 years from 50 to 74
Category 2 (Moderately increased risk)
1first-degree early (<55y.o) OR 2 first degree OR 1 first 2 second degree
iFOBT every 2 years fro 40 to 49, Colonoscopy every 5 years from 50 to 74
Category 3 (high risk)(refer to family cancer clinic)
simlply more than category 2
do iFOBT every 2 years from 35 to 44, Colonoscopy every 5 years from 45 to 74
7. Infant Eczema(atopic dermatitis)
overactivity of mast cells and immune system, not allergic
generally onset is <5y.o (very rare >30y.o)
pruritis and scratching (most common presentation)
Superficial skin infection with Stahp.
Scally rough areas of thickened skin(“lichenified skin”) (face, neck and skin fold of
popliteal area)Treatment:
Skin care (moisturazers, avoid brush soap even hot water, cotton cloths)
Topical steroids (for flares)(oral for only most severe, acute flares)
Topical crisaborole (phosphodiesterase inhb.)(for mild)
Tacrolimus, pimecrolimus (topical T cell inhibiting agents) (for long term control)
Antihistamines (nonsedating(cetrizine,fexofenadine, loratadine) for mild;
hydroxyzine,diphenhydramine, doxepin (for severe)
Antibiotics(cephalexin, topical mupirocin, retapamulin) fro possible impetigo
UV light(phototherapy) or Cyclosporin for severe, recalcitrant disease
9.lower limb thrombosis treatment
DOAC(effective as lmwh+warfarin, effects onset in several hours,fewer complication)
LMWH followed by Warfarin(6months)
IVC when a contraindication for anticoagulant (melena, CNS bleed) or Reccurrent emboli
while on doac or warfarin (while INR 2-3)
for reversing effects of anticoagulants
heparin – protamine sulphat
warfarin- Prothrombin complex concantrate(PCC) (or FFP + Vit K)
Direct10a(Xa) inhb.(-xabans) -Andexanet alfa
Dabigatran(direct thrombin inhb.s) -Idarucizumab

10.neurofibromatosis
NF1: Neurofibromas: soft, flesh colored non tender skin lessions attached to the
peripheral nerves
CN8 tumors(bilateral deafness
Cafe au lait spots
Lisch nodules
meningioma and glioma
NF2:
(2 eyes) Juvenile cataracts
(2 ears) bilateral schwannomas
(2 brain tumors) Menegioma, ependymoma
Recalls on 9th September 9, 2024
1 23 years old woman came to gp and told that she is hassarment in
her laptop . one organization is tracing her files and they want to give
a danger to her . she also hears their voices from that organsations
telling about her for 6 months
1 delusional disorder
2. schisophrenia
3. shizoaffective 2 weeks
4 paranoid
5.delusion

2. mother brings her daughter 17 years old girl complining about her
daughter is afraid of her daughter of swalloing difficulty of food in the
throax. Her daughter is BMI 17 and no other point of other -no sucidal
thoughts, no self harm . no sexual abused in childhood ,no other
complaints—asking management for daughter

1.family theraphy
2 dilectal behavioural for borderline
3. progressive relaxation theraphy
4.Expose to solid food
Anxiety / psychological dysphagia ?
Anorexia nervosa

No CBT n here so I choose a

Im not sure for my answer
No borderline personality / No depressive symptoms

3 50 years old man with smoking history for 20 years. He changed

colour changes his fingers sometime .No telling about joint specificity .
no headache asking dx
1. deramtomoyositis – I choose 1
2. burger disease
3. RA
4 Polymyositis
5. polymyogia rhuematica

60 yo with shoulder pain and could’t get up for the share asking dg ?

PMR

Women struggling with her daughter, brought in by her husband

couldn’t get along with her daughter, irritable, very minor trauma, and
she’s worrying about her life what’s the most likely dg??
OCD
GAD Generalized anxiety disorder
 6 - 8 YO

Aggressive boy 6yo to 8yo when he’s being confront by his parents he
uses weapons, what’s the tx?
CBT modalities (Family Therapy)

Respiridone(Agrressive+Treat for Family)

Dx-Conduct Disorder 10 - 16 YO
https://www.ranzcp.org/clinical-guidelines-publications/clinical-
guidelines-publications-library/children-with-conduct-disorder
Pharmacotherapy and psychotherapy
While pharmacological approaches can be appropriate, it is stipulated that when
medications such as risperidone are used, they should be used carefully, for short
timeframes and starting at low doses.[8, 27] It is also demonstrated that psychological
therapies such as MST (Multisystemic therapy), CBT (cognitive behavioural therapy),
and DBT (dialectical behaviour therapy) have some proven efficiency.[28-30] Functional
Family Therapy (FFT) has shown to be an overarching psychosocial intervention that
has shown good overall effectiveness, including reducing recidivism in youth who have
been incarcerated.[12, 28, 29] [32] Research has also shown that treatments delivered
online for conduct disorder can be at least as effective as treatments delivered face to
face, making it an effective option for those in rural, regional and remote areas.[33]

Psychiatrists may consider the following in their practice:

● Taking approaches based on MST, CBT, DBT, or FFT for the treatment of children
with conduct disorder.
● Taking approaches that involve family and whanaunga to give them the tools and
support necessary to care for their child such as PMT.
● Taking steps to refer the family to social services organisations if appropriate.
● Taking steps to be responsive to the needs of children and young people with a
conduct disorder and their parents and carers.
● Taking an approach that investigates any potential comorbid
neurodevelopmental disorders and ensures the patient receives the appropriate
treatment as necessary.

https://www.racgp.org.au/getattachment/4e09c897-73ce-47d5-bd41-
f772ac6f5e46/attachment.aspx
Child in school isolated, line up his toys, no problem with speech he
screams things, no particular movements, not having friends, options?
Autism spectrum disorders
ODD
ADHD
2 scrotal questions
Midle 3x 4x aged man Unilateral left scrotal swelling, no risk factors for
cancers, no parotid gland enlargement, no ascites, nothing, On
examination discrete 4cm lump located on the upper pole of the testis,
kind of firm but you can squeeze it no transillumination, mild pain,
discomfort, DG ??
Non seminoma
Seminoma Most common ?
Hydrocele
Varicocele (mostly left upper pole of testis + squeeze)
Epidymal cyst ( +Transillumination)

Incidental finding on ct scan, presented with something else, found

5mm in calyces, no symptoms of renal Mx? No infection

Hydrochlorthiazide
ESWL
Ureterolithotomy
https://www.racgp.org.au/afp/2017/september/urolithiasis

No options of observation, Tamsolusine for distal stones : tamsolusine

4. The 39 years old man I found to have unconscious and treated in
ER and he regain consicouness and shouted and said that he will
gives lessons to his wife and abusive to wife. His wife ws applied
awaya from him and against him for domestic vilence and they have 2
children
Most apropirate mx call the public health
Inform police
Admit under medical tribual
Inform child protection service

One ldy came to gp and said that there is one drug is allergy to her
during hospitalization and she heard the nurse talking drug---
1. fIll incident form
2. complaint in proper channel

Because she doent tell about any complaints

16 years old boy doesn’t want to go school and locked himself in

room . no change in sleep and eating ,school grade is declding and
don’t talk to parents-
Points for dx
Loosening of association prodrome of schizophrenia
Don’t talk to parents
Asking about associations for using mecury and cancer

cross sectional-Prevalence

No randomized and no cohort study in options

Look for Case Control

Aboriginal guy, Smoking questions, demanding authorization of

smoking, insisting to smoke, angry, starting on nicotine replacement
therapy what to do?
Allow him to smoke 4 times a day with observer
Ask Advice for aboriginal liaison officer worker
we allow him to smoke
Sjoren with dry eyes and already given eye drop and asking long
term mx
Hydroxycholorquine
inferior MI with BP 80/90 asking initial mx
1 N/S infusion
2.dopamine
3. dobutamine
4. adrenaline

Pic of 3 days old boy without abnormalities with vagina, Mother has no
infection delivery...asking Mx .
1 reassure 2. Herpes 3. Streptococcal 4. Strep

2. 19 years old girl with bilirubin only increase..total ..other LFT

including GGT is normal. Histroy of jaundice after fasting to loose
weight.
Mother has no infection and I choose reassurance
:Look for Uncojucated bili
Dx:Gilbert’s Disease

2. 19 years old girl with bilirubin only increase..total ..other LFT

including GGT is normal. Histroy of judicie after fating to loose weight.
She go to party and drank alcohol and came to gp with slight
jaundice with LFT done
Mother has no infection and I choose reassurance
6weeks baby Total level of bilirubin elevated, conjugated very high 35 normal less than 10, ALT
AST elevated
Which syptoms of history important to make dg?

Family history of Liver disease

Pale stools
Enlarged liver

6weeks old baby, Presented with jaundice everything is ok, weight ok, which Ix?
Serum bilirubin
LFT
FBC

1.Seborrheic Keratosis Mx
Mx Punch biopsy
Observation
Surgical biopsy

2.Bowen disease SCC

3.svt treatment + ++
EKG took a lot of medications Olanzapine, haloperidol schizophrenic patients, he was not well,
ekg pic
Wide QRS complex Pulse: 75
Options:
AF
QRS prolongation
Heart block
QT prolongation

opiods overdose
Young guy took methadone, brought to the ED by his friends, agitated, uncooperative history of
opiods use, he was treated for something
Start naloxone
Flumazenil (Benzodiazepine) : ttt of overdose of all other ttt except opioids.

Addict to heroin, took methadone brought by ambulance to the ED, While going to the ED gave
him Naloxone, Upon arrival Pin point pupils, after the first dose, what to do ?
Give naloxone again
 Acute Pancreatitis :
IVX : next : US , Lipase X3 normal -> Pancreatitis
Best : CT after 48h
4.acute pancreatitis treatment - Fluids (Sodium lactate solution = Hartman solution)
+ Analgesics (IV morphine or fentanyl)
- Antiemitic therapy

4.impetigo bacteria? >> Staph aure

5. Several colorectal cancer problems.

6.
Child with Allergic rhinitis, asthmatic, started on Montelukast, 2months later itchy raches on
the extensor surfaces, red patches like atopic dermatitis, Most likely dg?
Drug induced allergy
Eczema (Firstly, scalp then by developmental age will appear in Extensor/flexor areas)
Urticaria

7.schizophrenia both parents, probability for children?

45-50(1/2 1/3)

8.lower limb thrombosis treatment

LADY come with acute left swollen and red ankle, no history of long flight, take COCP, US>>
Deep femoral vein with extension to popliteal >>
Rivaroxaban (DOACs)
Warfarin
IV heparin
Sc Enoxaparin
https://australianprescriber.tg.org.au/articles/venous-thromboembolism-current-
management.html

https://www.safetyandquality.gov.au/sites/default/files/2020-
01/venous_thromboembolism_prevention_clinical_care_standard_-_jan_2020_2.pdf

https://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0005/917807/DOAC-guidelines.pdf

9. Child mother came with complain of big head circumference a and hyperpigmented lesion
on the trunk several ones mother said that father had the same, OE Hyperpigmented sport on
the trunk, Cause ?
Neurofib disease
https://www.healthdirect.gov.au/amp/article/neurofibromatosis
https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-
racgp-guidelines/genomics-in-general-practice/disease-specific-topics/neurofibromatosis-type-
1#:~:text=NF1%20is%20a%20condition%20that,even%20within%20the%20same%20family
10. Man with lung cancer, treated surgically + RT repeated Cxr normal
Presented with wrist flexion impaired and numbness on palmar surface of the 5th finger treated
Cause?
Paraneoplastic mononeurapathy(Chest XR-Normal)-without Surgical treatment
Brachial plexus injury (Surgical Tx+)
Cervical spondylosis
Ulnar Entrapment

Contro!!!!
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8517070/

Median Nerve (Wrist Flexion impairment)-Ulnar nerve(5th Finger nerve impairment)

11.several questions on induce labour

a 33-year-old woman, has been using oral contraceptive
pills (OCPs) for two months. She presents to your GP
clinic today, concerned because she missed a pill and had
sexual intercourse 2 Weeks . evening clinic usually 11pm
took the pills, She has taken 7 pills from her current pack
and is worried about the risk of conception, as she is not
planning to have a baby at this time. What is the best
management to ensure that effective contraception
continues for Melissah? Late pill < 48H
Take the next pill as usual
Take the next pill and use condoms for the next 7days
No Correct Options Given
 > 48H

cohort
Increased incidence in children after wasting water in the river and increase of child cancers
Which one of the following will be a control group ?
Statistics

Different proffesion, a lot of number, which one of the following gorups are at increased risk of
death for the individual worker?
Agricultures
Miners
Truck divers
Mortality rates ?

INFERIOR WALL MI

- Dobutamine : will increase myocardiocyte O2 demand, worsen

ischemia.
- Adrenaline: will increase the afterload by total peripheral resistance,
straining the heart into further congestion
- Metoprolol: patients heart rate was already brady if I'm not mistaken,
due to right sided MI affecting heart's Dromotropy.
- S/L GTN: reduces afterload, but BP was contro.
- Iv fluid: increases afterload by blood volume (may worsen condition
BUT in the question there wasn't any lung congestion YET)

CT scans
Rectus sheet hematoma Mx

50 yo women just Intermittent Itchiness Vulva, she didn’t take any MHT, pic given nothing
pathological seen>> likely cause ?
Lichen planus >> 6P : Pruritus, Purple / Topical Btm
Oestrogen deficiency
Guy with shortness of breat after URTI, mild rhinorrhea, smoking history, bilateral wheezing,
how to establish diagnose ?
Spirometry with Bronchodilator
PEAK flow
Chest x ray

PE questions
A 50 yo women presented with SOB after long flight then presented to the ED Stable without
any other symptoms Chest xray normal ECG normal what to do ?
D dimer
CTPA
VQ scan
Doppler US

https://www.racgp.org.au/afp/2017/november/pulmonary-embolism

Psychiatry

Sportsman Injury, kicked in the belly, start having pain radiating to the back what to do Stable
patient initial ix
US
ERCP
CT
Xray abdomen
https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-
Guidelines/Abdominal-trauma

Waldenstrom macroglobulinemia and myelodysplastic disease treating

pneumonia. They started using ampicillin and azithro. Next day developed vesicular red rash over
the body (Macular reddish rash over the chest and abdomen image given). Asking the most
appropriate treatment
a. Acyclovir b. Immunoglobulin c. Amphotericin d. Prednisolone e. Stop ampicillin

Scenario of vomiting due to molar pregnancy, urine ketone positive, next step?
A. Serum electrolytes
B. Giving IV fluids
C. Ondansetron wafer

50 years old came with Melena . OGDS done .no bleeding vessels
H pyrili test positive, still bleeding ulcer no visible vessels around the ulcer and now stable
Asking appripirate mx
1 triple regeine (After Octreotide infusion-after bleeding settelled)
2. endoscopic ablation
3. adrenaline injection
4. Octreotide infusion
https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/gastroenterology/upper-gi-
bleeding#:~:text=Acute%20bleeding%20is%20typically%20managed,surgical%20shunting%20shoul
d%20be%20considered

Thyroid nodule 3 cm FNAC done – TSH is normal with left psamomma bodies foundand right side
is normal next . patient is discomforting and breathleness appropriate pan for this patient
Ridoiodine scan
Left thyroidectomy
Total thyroidcomy
Raidotheraphy
Patient is symptoms

https://www.mja.com.au/journal/2004/180/5/6-thyroid-nodules-and-thyroid-cancer

Lady nodule 4cm in the left lobe TSH normal US >> Solid mass
Left lobe thyroidectomy
Radioiodine ablation
Total thyroidectomy
Lobectomy
50 years old came with Malena . OGDS done .no bleeding vessels H
pyrili test positive and now stable
Asking appripirate mx
1 triple regeine
2. endoscopic ablation
3. aderanline injection
4. octride infusion

Thyroid nodule 3 cm FNAC done – TSH is normal with left Sonoma

bodies foundand right side is normal next . patient is discomforting
and breathleness appropriate pan for this patient
Ridoiodine scan
Left thyroidectomy
Total thyroidcomy
Raidotheraphy
Patient is symptoms
Patient is on post partum eclampsia 3 days and 2 times seizers
…already given IV midazolam
No underlying epilepsy and nothing about seizer
Now BP is 150/100
No telling about obstetric history of PE
Asking mx
1. labetalol pre eclampsia without seizers
2. MGSo4 Pre eclampsia with seizers , for the ttt of seizers
3. Nifidipine as tocolysis
4. Hydrolaxine
I choose 2

Primi gravida CTG given early acceralation uterine contraction is

same as 5hours vg length 3 cm
FHR is normal 140 . cerxi good effacement
Asking next step
1. Oxytocin
2. PG
3. CTG
continue CTG
Indications for LSCS
39 years old lady with labour pain
LOP position
Cx 1 cam
Meconium staning
Foetal scalp sampling acidosis –

Identical mcq old recalls

BP 80/50
PR 120
Asking Blood volume loss percentage
>45—I choose
>20
>40 –
30 and 40
Acutal PR >120 is better for choose for this

Identical old recall

After doing of needle aspiration of pneumothorax —the patient
becomes BP 80/60 and breathleness
Dullness on left side of the chest ..trachea shifted to the right
Asking apporpirate step
Needle aspiration
Chest x ray
USG
Thoracotomy and chest tube on affected side
Indication of Thoracotomy :
- 1500 ml of blood drainage in 24H
- 300 - 500 for 2 to 4 H
- Great vessel or chest wall injury
- Pericardial tamponade
- Persistant air leack
Preganycy 14 week came to check AN
Previous history of macrosomia and gestration DM and first pregnancy
has h/o of shoulder dyatocia . appropriate advice to make sure the
fetus not developing dystocia to the fetus,
OGT in early pregnancy
OGT in 28 week
Us at 36 weeks

Second pregnancy, DT first Pregnancy, shoulder dystocia

Patient has burn on abdomen and thigh .. for arm already given
analgesia – what additional want to give ?
Silver salphasazine
Airway patent
Normal saline

Middle age Guy presented with enlarged parotid glands with eating, painful while eating, no
neurological symptoms nothing, What’s the dg?

Sialadenitis
Cancer

1.Seborrheic(means 'bening') Keratosis

(“liver spots”)
stuck on appearance and very common in older adults
treatment: cryotheraphy, surgery, laser for cosmetic reasons
2.Bowen disease
very early form of SCC (in situ SCC)
Slow growing, superficial(only epidermis)
3.svt treatment
usually hemodynamically stable (No p waves, QRS<100msec is
normal or 'narrow')(based on reentry around the av node)
1. Vagal maneuvers (carotid massage, valsalva, dive reflex, ice
immersion)(both slow and convert the SVT)
2. If no response: give Adenosine
3. if no response:give BBs, CCBs, or Digoxin
Radiofrequency Catheter Ablation is curable in many cases

4.acute pancreatitis treatment

NPO
IV hydration at very high volume
Analgesia
PPIs(to decrease pancreatic stimulation from acid entering
duedonum)
if ct/mri show >30% necrosis add antibiotic (such as
imipenem,meropenem) to decrease mortality (for preventing necrotic
or infected pancreatitis) and do Needle biopsy to determine the
Surgical Debridement (to prevent ARDS and death)
pseudocysts are drained with needle if they are enlarging or painful

5.impetigo bacteria?
Staphylococcus(not staph. Epidermidis, it is a part of normal skin flora)
and Streptococcus (skin infection with group A beta hemolytic Strep.
can cause Glomerulonephritis but NOT Rheuatic Fever)

6. Several colorectal cancer problems

Screening (simplified)
Category 1 (avarege or slightly increased)
No history OR 1 first-degree OR 1 first 1 second degree (not anyone
early (<55y.o))
Do iFOBT every 2 years from 50 to 74
Category 2 (Moderately increased risk)
1first-degree early (<55y.o) OR 2 first degree OR 1 first 2 second
degree
iFOBT every 2 years fro 40 to 49, Colonoscopy every 5 years from 50
to 74
Category 3 (high risk)(refer to family cancer clinic)
simlply more than category 2
do iFOBT every 2 years from 35 to 44, Colonoscopy every 5 years
from 45 to 74
7. Infant Eczema(atopic dermatitis)
overactivity of mast cells and immune system, not allergic
generally onset is <5y.o (very rare >30y.o)
pruritis and scratching (most common presentation)
Superficial skin infection with Stahp.
Scally rough areas of thickened skin(“lichenified skin”) (face, neck and
skin fold of popliteal area)Treatment:

Skin care (moisturazers, avoid brush soap even hot water, cotton
cloths)
Topical steroids (for flares)(oral for only most severe, acute flares)
Topical crisaborole (phosphodiesterase inhb.)(for mild)
Tacrolimus, pimecrolimus (topical T cell inhibiting agents) (for long
term control)
Antihistamines (nonsedating(cetrizine,fexofenadine, loratadine) for
mild; hydroxyzine,diphenhydramine, doxepin (for severe)
Antibiotics(cephalexin, topical mupirocin, retapamulin) fro possible
impetigo
UV light(phototherapy) or Cyclosporin for severe, recalcitrant disease
9.lower limb thrombosis treatment

DOAC(effective as lmwh+warfarin, effects onset in several

hours,fewer complication)

LMWH followed by Warfarin(6months)

IVC when a contraindication for anticoagulant (melena, CNS bleed) or
Reccurrent emboli while on doac or warfarin (while INR 2-3)
for reversing effects of anticoagulants
heparin – protamine sulphat
warfarin- Prothrombin complex concantrate(PCC) (or FFP + Vit K)
Direct10a(Xa) inhb.(-xabans) -Andexanet alfa
Dabigatran(direct thrombin inhb.s) -Idarucizumab

10.neurofibromatosis
NF1: Neurofibromas: soft, flesh colored non tender skin lessions
attached to the peripheral nerves
CN8 tumors(bilateral deafness
Cafe au lait spots
Lisch nodules
meningioma and glioma
NF2:
(2 eyes) Juvenile cataracts
(2 ears) bilateral schwannomas
(2 brain tumors) Menegioma, ependymoma

Vomiting and headeaches in the morning ?

Group of indigenous children, treated many times with permethrin, kept recurring all of them
were healed after giving ivermectin just one who resist, what to do next?
Oral clotrimaxazole
Permethrin trial
Oral Ivermectin
Dx:Scabies 2sd : Bezelbenzoet
TIA Amaurosis fugaxis + Dropping of angle of mouth + loss of sensation in one part of body +
Aspirin Already bcs of previous MI, Carotid stenosis 60% next step?
Perform endarterectomy
Add clopi (at least 3 weeks within 24 hr)

Give Referral within 2 weeks for Sx.

https://www1.racgp.org.au/ajgp/2021/november/carotid-artery-stenosis

https://www.racgp.org.au/getattachment/5e79399f-5a97-4a3e-9837-
37b4d4ade553/Transient-ischaemic-attacks.aspx

3-
Patient diabetic on metformin 2g it didn’t help him, HBA1c 8-9% Post prandial BG : 12
preprandial same as fbg 7-10, he tried life style and diet also, what insulin regimen to add ?
Daily Long acting glargin
Long acting glargine + Short acting after meal
Metformin
No need for change

https://www.racgp.org.au/getattachment/41fee8dc-7f97-4f87-9d90-
b7af337af778/Management-of-type-2-diabetes-A-handbook-for-general-practice.aspx
Guy taking Amilsupiride for schizo then develops type 2 DT What do you need to check for him
Fasting lipids
LFTs
Prolactin level

CT scan erect, didn’t have history of travelling 38.7, RUQP, no jaundice nothing, Elevated LFTs

Iv AB
Drainage
Male patient who didn’t have any symptoms, which one of the following the most important
initial question for getting syphilis?
History of multiple partners
History of oral sex
Drug abuse ?

HMB
Lady with multiple sub serous fibroids with heavy bleeding, irregular bleeding BEST Mx for
heavy bleeding, not mentioning about the conception
Options

Hysteroscopic Fibroids
POP
Levonorgestrel IUD
Dilatation and Curetage

https://ranzcog.edu.au/wp-content/uploads/2022/06/Heavy-menstrual-bleeding.pdf

https://www1.racgp.org.au/ajgp/2024/july/contemporary-management-of-uterine-fibroids

Child Dx Duchene myopathy mother concerns about prognosis, what to tell her about his
Prognosis ??
Likely to preserve good Intelect
Unlikely Lung disease
Unlikey To develop cardiac disease
https://www.mda.org.au/duchenne

MMSE 22/30 what did

Intern was aked by his aunt to go to the system to got access to file of her husband?
Intern coordinator or supervisor
Contact

Ortho
Achiles tendonitis squeezing test negative, pain 3 cm above the heel considering the most likely
Dx what’s the tx? ttt : Rest , Nsaids, Heel padding , consider topical glyceryl trinitrates as
patches ,physiotherapy .
MOOn shaped
https://www.orthobullets.com/foot-and-ankle/7022/achilles-tendonitis

Swolen knee joint elderly man red swollen knee joints, no history of gout what to first fever

Aspiration

Similar scenario after obtaining synovial fluid what to next ?

Blood cultures
MRI
X ray of the knee

Try to see the CULTURE OF ASPIRATION FLUID, FOLLOWED BY X-RAY, US- Join EFUSSION.
https://www.racgp.org.au/afp/2015/april/septic-arthritis-in-children
https://www.sahealth.sa.gov.au/wps/wcm/connect/6b6ea17d-92cb-4375-aa03-
dae5a6d50ee9/Septic+Arthritis+Consumer+Health+Information+-
+Paediatrics+FMC.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-6b6ea17d-92cb-4375-
aa03-dae5a6d50ee9-ooKP-gF
Vertebral fracture she couldn’t bend X ray compression fracture, they
25mm nodule on left thyroid lobe psammoma bodies positive what is the managment?

patient on treament for mealonama with low Na high K BU Scr high asking for causes ACE inhibitors

young male took few bottles of whisky with friends develoed sever epigastric pain with
vomiting ex epugastric tenedernus + what is the initial mx 1. IVF 2. USS 3. NG tube

10 weeks old baby poor weight gain for last 1month reduced feeding with 2/6 left sternal
mumer RR 55 PR 160 1. congestive herat failure 2. pnemonia 3. tracheo eso fistula

Dx:Congenital Heart Disease- VSD

Campfire burn B/L LL + R forearm analgesia given next

1. Intubate

2. IV Hartman Ringer lactate

3. Tr to burn unit

4. Tropical silver D

1)4 months old baby fever reduced feeding for 48 hr supra pubic asp lots of lymphocytes
urine culture gram negative bacilli Ab? TTT : E.coli :
Cefalexim
1. Cefuroxime Benzyl penicillin + Gentamicine

2. Amox/cal

3. Amox+genta

pregnant 32 weeks 1strmester Uss completely normal O-ve mother now SFH 36 weeks Rh
titer 1:4 2 weeks back causes 1.hydrops 2 macrosomia 3. wrong dates 4. Polyhydro
1)4 months old baby fever reduced feeding for 48 hr supra pubic asp lots of lymphocytes
urine culture gram negative bacilli Ab?

1. Cefuroxime

2. Amox/cal

3. Amox+genta

17 y ear old girl swallowing dificulty brought by mother having lots of conflicts with mother
BMI 17 MX 1.graded slid food exposuer 2.family therapy 3. relaxation therapy

pregnant 32 weeks 1strmester Uss completely normal O-ve mother now SFH 36 weeks Rh
titer 1:4 2 weeks back causes 1.hydrops 2 macrosomia 3. wrong dates

Incomplete Scenario

image of eythema nodosum on shin, causes idiopathic , sarcoidosis , TB , ulceretiv colitis , crohn , behcet,
streptococcol infection , sulfanamides , penicillin , trimetoprim
-TB celfmetoxazel , gold penicilamin , OCP , malignancy.

middle aged man came C/O fever. Giving hx of brain tumour removal, abdominal sx (so
many major health conditions), but not in his medical records or no physical signs of it.

What is this? somatoforme syndrome

1)case of yellow discharge from eyes in a baby, asking for diagnosis

2)case of a boy after dental surgery, bleed a lot, he has history of nosebleed and his granny
and brother has that too

Platelets I don't remember if was normal or not. Have bruisers on his cheek.

Asking diagnosis +Spmt : Severe purulent discharge

IVX : discharge swab
A. Hemophilia VII gonococcal infection
TTT : IM Ceftriaxon
B. Hemophilia X something
+ Sptm : less severe discharge
C. ITP IVX : Swab PCR
Chlamydia
Look for the option Von Willebrand TTT : Azythromicin

H.B-3.263 + Spmt : mild red eye and mild discharge

for no specific organism
TTT : Chloramfinicol
3)cas of scabies in pregnant
TTT : permithrin
ivermectin is CI

4)25 years old, never have boyfriend or any sexual relationship asking if she can do the
cervical cancer screen

Option

1.not necessary

2. Necessary

3.i don't remember other options

5)Prevalence of diabete in community

Option:

. RCT

. Cross sectional

. Cohort

6) other recall amalgam and dementia which study

7)photo of a hand a Man gardening, was a case of amedex

Asking managent

Option:.

1.admit and iv

2.Antibiotic

Incomplete Scenario
8)case of Duchenne.. something on a boy, was like a genetic disease

Mother asking what will be the outcome or kind of how the child will be in future

Option:

1.he will be in wheel chair up to adolescent

2.will have a langue problem

9)a boy who have tummy ache when daddy go to work cause he work night shifts. When the
drop him at school he is fine

Asking cause

1.he is scared something will happen to his parent while at school

2.seen zombie and scarry thing while sleeping

3.bully at school
Seperation anxiety
TTT : CBT : Family therapy
10) Rosea infatum
high Fever for 3 D after it goes dawn we have the appearance of maculopapular rash

A lot of recalls from this month from day 1 and August

age (about 50- 60)aged lady with large bowel obstruction, cecum dilated most, stenosis at
sigmoid colon, hemodynamic stable

next mx?

colonoscopy

cecumstomy

sigmoidstomy

https://www.ogmagazine.org.au/15/3/ogilvies-syndrome/
https://aci.health.nsw.gov.au/networks/eci/clinical/clinical-tools/abdominal-
emergencies/bowel-obstruction

Elderly man with COPD on home oxygen therepy acute urinary retention prostatomegaly
biopsy gleson score 6 what is the managment 01.observation 2.erbt. 3.prostatectomy

https://www1.racgp.org.au/ajgp/2024/may/when-less-is-more
 Sept day 1-2024

1.Seborrheic Keratosis

2.bowen disease

3.svt treatment

4.acute pancreatitis treatment

4.impetigo bacteria?

5. Several colorectal cancer problems.

6. Infant eczema?

7.schizophrenia both parents, probability for children?

8.lower limb thrombosis treatment

9.neurofibroma disease?

10. Brachial plexus impairment after lung cancer radiology?

11.several questions on induce labour

Waldenstrom macroglobulinemia and myelodysplastic disease treating

pneumonia. They started using ampicillin and azithro. Next day developed vesicular
red rash over the body (Macular reddish rash over the chest and abdomen image
given). Asking the most appropriate treatment
a. Acyclovir b. Immunoglobulin c. Amphotericin d. Prednisolone e. Stop ampicillin
if vesicular: acyclovir

If maculopapular: drug reaction

Scenario of vomiting due to molar pregnancy, urine ketone positive, next step?
A. Serum electrolytes
B. Giving IV fluids
C. Ondansetron wafer
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.17739

1. Pic of 3 days old boy without abnormalities with vaginal delivery....asking mx ..

1 reassure 2. Herpes 3. Streptococcal 4. Strep

2. 19 years old girl with bilirubin only increase..total ..other LFT including GGT is normal.
Histroy of judicie after fasting to loose weight.
She go to party and drank alcohol and came to gp with slight jaundice with LFT done

Asking options are 1. USG 2 genetic 3..unconjugat bilirubin

Dx: Gilbert

Recalls on 9th September 9, 2024

1 23 years old woman came to gp and told that she is hassarment in her laptop . one
organization is tracing her files and they want to give a danger to her . she also hears
their voices from that organsations telling about her for 6 months

1 delusion

2. schizophrenia(Delusion, hallucination)
3. shixsoaffective

4 paranoid

5.delusion

2. mother brings her daughter 17 years old girl complaining about her daughter is afraid
of her daughter of swallowing difficulty of food in the throat. Her daughter is BMI 17 and
no other point of other -no suicidal thoughts, no self harm . no sexual abused in
childhood ,no other complaints—asking management for daughter

1.family therapy

2 dialectal

3. progressive relaxation therapy

4.Exposure to solid food

No borderline personality

No depressive symptoms
https://nedc.com.au/eating-
disorders/types/arfid#:~:text=Treatment%20may%20involve%20gradually%20exposing,
adolescents%20and%20adults%20(6)

3. pic of hand showing rash only ..no deformity of joint

3 50 years old man with smoking history for 20 years. He changed colour changes his
fingers sometime .No telling about joint specificity . no headache asking dx

1. deramtomoyositis

2. beurger disease

3. RA

4 Polymyositis

5. polymyogia rhuematica

https://www.mayoclinic.org/diseases-conditions/buergers-disease/symptoms-
causes/syc-20350658
 CCB : nifidipine

4. The 39 years old man I found to have unconscious and treated in ER and he regain
consicousness and shouted and said that he will gives lessons to his wife and abusive
to wife. His wife has applied away from him and against him for domestic violence and
they have 2 children. Most apropirate mx Health directive

a. Inform police

b. Admit under medical tribunal

c. Inform child protection service

One ldy came to gp and said that there is one drug is allergy to her during hospitalization
and she heard the nurse talking drug---

1. fill incident form

2. complaint in proper channel

16 years old boy doesn’t want to go school and locked himself in room . no change in
sleep and eating ,school grade is declining and don’t talk to parents-

Points for dx

a. Loosening of association
b. Don’t talk to parents

Asking about associations for using mecury and cancer

a. cross sectional

look for case control study-Retrospective

50 years old came with Malena . OGDS done .no bleeding vessels H pyrili test positive
and now stable

Asking appripirate mx

1 triple regeine

2. endoscopic ablation

3. aderanline injection

4. octride infusion

Thyroid nodule 3 cm FNAC done – TSH is normal with left psamomma bodies found
and right side is normal next . patient is discomforting and breathleness appropriate
plan for this patient

a. Ridoiodine scan
b. Left thyroidectomy—
c. Total thyroidcomy (Psamomma Body-Papillary Carcinoma)
d. Raidotheraphy
https://www.mja.com.au/journal/2004/180/5/6-thyroid-nodules-and-thyroid-cancer

https://www1.racgp.org.au/getattachment/7865e6bc-eb0f-424b-b0cf-
b18d29639888/Differentiated-thyroid-cancer.aspx
Patient is symptoms Sjoren de with eyes and already given eye drop and asking long
term mx

Hydroxycholorquine

inferior MI with BP 80/90 asking initial mx

1 N/S infusion

2.dopamine

3. dobutamine

4. adrenaline

Patient is on post partum 3 days and 2 times seizers …already given IV midazolam

No underlying epilepsy and nothing about seizer

Now BP is 150/100 , No telling about obstetric history of PE …nothing history of

pregnancy given

Asking mx

1. labetalol

2. MGSo4

3. Nifedipine

4. Hydralazine
Primi gravida CTG given early acceralation uterine contraction is same as 5hours vg
length 3 cm ,FHR is normal 140 . cerxi good effacement

Asking next step

1. Oxytocin

2. PG

3. CTG

If bishop score < 6: PG

If bishop score >6: oxytocin or amniotomy

https://www.sahealth.sa.gov.au/wps/wcm/connect/ac7d37804ee4a27985598dd150ce
4f37/Induction+and+Augmentation+of+Labour_PPG_V9_0.pdf?MOD=AJPERES&amp;C
ACHEID=ROOTWORKSPACE-ac7d37804ee4a27985598dd150ce4f37-p4bJc-V

Indications for LSCS

39 years old lady with labour pain

LOP position

Cx 1 cm

Meconium staning

Foetal scalp sampling acidosis

BP 80/50

PR 120

Asking Blood volume loss percentage

a. >45

b. >20 30%

c. >40 –

Acutal PR >120 is better for choose for this

Look for the options for: 30-40%

Depends upon other parameters/vitals

Question on estimating blood loss (ATLS classification)

HR was 124

BP was ok lying(~110/70)

BP sitting/standing low (MAP<65)

What would be the minimum amount of blood loss by patient?

- 10%

- 20%

- 30%

- 45%

- >45%
After doing of needle aspiration of pneumothorax —the patient becomes BP 80/60
and breathleness

Dullness on left side of the chest ..trachea shifted

Asking apporpirate step

a.Needle aspiration

b.Chest x ray

c.USG

d.Thoracotomy and chest tube on affected side

Preganycy 14 week came to check AN

Previous history of macrosomia and gestration DM and first pregnancy has h/o of
shoulder distocia . appropriate advice to patient

a.OGT in early pregnancy (High Risk)

b.OGT in 28 week

Normal Pregnancy(24-28 Weeks)

Patient has burn on abdomen and thigh .. for arm already given analgesia – what
additional want to give ?

a. Silver sulphasalazine
b. Airway patent
c. Normal saline

Look for hartmann solution

 Sept day 2 morning session Reference KM

Patient has mouth and genital ulcer several time and now came for eye .pic given fundoscop dome .
Anterior uveitis ..asking Tx ...1.oral prenisolone 2. Topical prenisolone 3.chramphnicol ..I choose
topical prenisolone
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095364/
Next ..eye pic given .. patient has trauma and fundoscopy done .no abnormalities. No infection. pain.
Not sudden onset No itchy. Already given topical antihistamine asking appropriate

1. Timinol 2. Acetazolamide 3. Toprocapine?.

one is female has ra taking hydroxychloc..and methiraxate

stop methiraxate and continue hydroy

Infertility mcq ..regular menstrual cycle 28 day cycle and need to check ovulation...

1..testeroaterone 2. Progesterone on day 21 .3. Estrogen on day 1 4 and...17..3.FSH and LH..I choose
2
https://sydney.communityhealthpathways.org/16204.htm

https://www.nice.org.uk/Guidance/CG156

NICE Guidelines – Fertility Problems: Assessment and Treatment

Sub-fertility

Clinical editor's note

A new rebate will be available for women undergoing assisted reproductive technologies (ART) for
services received from October 1, 2022. Applications for the rebate will open January 1, 2023.

Background

About sub-fertility

About sub-fertility

● Sub-fertility is defined as a failure to conceive after 6 months (female aged ≥ 35 years) or

12 months (female aged < 35 years) of regular unprotected intercourse.

● Approximately 80% of couples wanting to conceive will do so within a year.

● Sub-fertility affects 1 in 6 couples.

● It is due to female factors (40%), male factors (40%), or combined or idiopathic factors (20%).

● Age is the biggest factor affecting a woman's ability to conceive, both spontaneously and with
assisted reproductive technology.
 ● Female fertility (and to a lesser extent male fertility) declines from age 35 years and markedly
decreases after age 40 years.

● Causes of infertility:

● Female factors include ovulatory dysfunction, tubal or uterine abnormalities, peritoneal

or endometriosis, among others.

● Male causes include abnormalities with semen and sexual dysfunction, among others.

Assessment

1. Perform a pre-conception assessment.

2. Take a specific reproductive history:

● Couple-specific

Couple-specific history

● Previous pregnancies for either partner

● Length of time patient has been trying to conceive

● Frequency and timing of intercourse

● Lifestyle factors e.g., smoking, alcohol, drugs, caffeine, diet

● Female-specific

Female-specific history

● Age

● Menstrual history: age of menarche, cycle details, abnormal bleeding – pre-

menstrual spotting, intermenstrual bleeding, and post-coital bleeding

● Symptoms of endometriosis – dysmenorrhoea, dyspareunia, and dyschezia.

● Cervical screening test and HPV vaccine history

● Contraceptive history, including intrauterine devices (IUDs)

● Gynaecological history, including previous sexually transmitted infections (STI),

pelvic inflammatory disease (PID)

● Medical and surgical history

● Medications

● Family history of infertility or recurrent miscarriage, genetic, autoimmune, and

prothrombotic disorders.

● Male-specific

Male-specific history

● Age
 ● Timing of puberty and normal development

● History of mumps post puberty

● History of cryptorchidism, torsion, trauma, or surgery

● Sexual dysfunction – erectile or ejaculatory

● Androgen use or abuse

● Medical or surgical history

● Medications

● Genetic problem e.g., cystic fibrosis, Klinefelter syndrome

3. Examine the couple:

● Female-specific examination

Female-specific examination

● Look for signs of thyroid disease or PCOS.

● Body habitus e.g., Turner syndrome.

● Pelvic examination to assess for abnormal anatomy and deeply infiltrating

endometriosis.

● Male-specific examination

Male-specific examination

Body habitus e.g., Klinefelter syndrome, gynaecomastia, hair distribution.

If indicated by history, assess genitals:

● Penis, including position of meatus

● Scrotum:

● Testicular size, location, and consistency, including for presence of

masses

● Epididymis, including for presence of cyst

● Vas deferens

● Spermatic cord, including presence of varicocele

● Both – calculate BMI

Body mass index (BMI)

BMI kg/m2 Classification

(weight divided by height squared)

< 18.5 Underweight

18.5 to 24.9 Healthy weight range

25 to 29.9 Overweight

30 to 34.9 Obesity I

35 to 39.9 Obesity II

≥ 40 Obesity III

From NHMRC guidelines.

NSW Health – Body Mass Index (BMI) Calculator.

● Consider a lower BMI threshold (e.g., healthy BMI < 23 kg/m2) in:

● South Asian, Chinese, and Japanese population groups (proportionally

more body fat at lower weights).

● Aboriginal and/or Torres Strait Islander peoples (proportionally more

centrally deposited body fat).

● Consider a higher BMI threshold in:

● athletes and people with high muscle mass (lower proportion of body fat
to weight).

● Pacific Islander populations, including Torres Strait Islander and Māori

peoples (higher proportion of lean body mass).

● Elderly patients – consider sarcopenic obesity (central deposition of fat coupled

with decreased muscle mass), which may not result in a change in BMI over
time, but is associated with increased health risks.

4. Arrange investigations:

● Female-specific:

o Luteal phase progesterone to confirm ovulation

Luteal phase progesterone

● Test on day 21 of a 28 day cycle.

● Adjust for differing cycle lengths. Test 1 week prior to expected first day of
menses.

This has limited value if regular cycle.

o Hormone studies

Hormone studies

● If regular cycle – anti-mullerian hormone (AMH): $75.00 cost to patient

 ● If irregular cycle:

● AMH

● FSH, LH, and Estradiol

● TSH, FT4, FT3, and antibodies (TPO, Tg, and TRAB)

● Prolactin

● Androgens: Testosterone, SHBG, FAI, DHEAS, and 17-OHP

o STI screening

STI screening

● Either endocervical swab, self-collected vaginal swab, or first pass urine

(if unable to collect vaginal swab) for PCR testing for chlamydia and
gonorrhoea.

● High vaginal culture swab for microscopy, culture, and sensitivity (MCS).

● Other swabs if indicated e.g., herpes simplex virus PCR swab of visible
lesions.

o Pelvic ultrasound. Transvaginal ultrasound is preferred, ideally in follicular

phase of cycle.

o Consider HyCoSy or Hysterosalpinogram, especially if patient has risk factors

for tubal occlusion. If necessary, discuss with gynaecologist.

● Male-specific:

o Hepatitis B and C, HIV, and syphilis

o Seminal analysis

Seminal analysis

● Advise patient to contact pathology prior to presenting for collection

instructions.

● Usually collected 3 days after abstinence.

o Hormone studies

Hormone studies

If low male libido, abnormal clinical exam (e.g., small testes), oligospermia, or azoospermia:

● Follicle-stimulating hormone

● Luteinizing hormone

● Sex hormone-binding globulin

● Prolactin

● Testosterone levels (best collected in the morning)

 ● Thyroid-stimulating hormone

o Scrotal ultrasound, if concerns about varicocele or tumours, or if severe

oligospermia or azoospermia

Management

1. Discuss lifestyle advice for both partners to improve fertility and conception rates.

Lifestyle advice

● Smoking reduces fertility in both partners. See Smoking Cessation Advice pathway.

● BMI > 30 reduces fertility in both partners, and underweight BMI also negatively affects
hypothalamic-pituitary-ovarian axis.

● Excessive alcohol intake is detrimental to semen quality.

● Excessive caffeine intake may affect fertility.

● A healthy, balanced diet is strongly recommended.

● Elevated scrotal temperature is known to reduce semen quantity, but it is uncertain if

changing underwear helps.

Consider referring to the Get Healthy program.

2. Provide routine pre-conception care, including folic acid supplementation.

3. Educate couple about optimal frequency and timing of intercourse.

Optimal frequency and timing of intercourse

● Ovulation occurs between day 11 to 16 (approximately day 14) of a 28 day cycle. If the
cycle is an unusual length, ovulation will occur around 11 to 16 days before the first day
of menses.

● The lifespan of sperm is usually less than 3 days, whereas the egg only lasts
12 to 24 hours. Sexual intercourse should occur every 2 days during the "fertile window"
i.e., the 5 to 6 days before and including the anticipated ovulation date.

● Consider giving advice on natural family planning.

4. Request fertility specialised assessment if:

● primary infertility and failure to achieve pregnancy after 12 months or more.

● secondary infertility and failure to achieve pregnancy after 6 months.

● female partner is aged > 35 years and has failed to achieve pregnancy after 6 months.

● male and female sub-fertility factors identified e.g., PCOS, endometriosis,

azoospermia, premature ovarian failure.

Ensure both names are on the referral form.

5. If fertility difficulties impacting on patient's psychological well-being, consider requesting

counselling via a psychologist or counsellor.
One mcq is thrombocypenia plt 5 . With bleeding ..asking mx

1. Immiguglobulin .. 2. Plt transfusion 3. Steroid ..4 blood transfusion

https://litfl.com/thrombocytopaenia/

https://www.uptodate.com/contents/diagnostic-approach-to-thrombocytopenia-in-
adults?search=thrombocytopenia&source=search_result&selectedTitle=1%7E150&usage_type=defa
ult&display_rank=1#H20171687

One patient came abdominal pain ..after taking alcohol.. and vomiting after giving analgesic and
doing USG..normal ..what is the mx of initial..1.NG . 2. IV normal saline 3.antibioctis

Child psycho...identical mcq 4 years old boy don't talk ...playing alone ..arranged toys
........development is normally asking dx ..choose 1. aperger .2 ODD 3. ADH

Dx:ASD
One patient after accident..came to ER..tongue is bleeding..maxill and mandibles fracture on both
side and can't open mouth and alreasy orophygreal tube inserted but still breathlessness So 92 and
appropriate mx ? 1 endotrache incubation 2.naso incubation 3.tracheostimy 4. Cicroth 5.
Percutaneou treostomy with oxygen
https://litfl.com/facial-trauma/
Adult text book of emergency medicine
Patient 17 years old boy collapse and history of cardiac death in father ...after this good and normal.
Initial test is 1.ecg I choose ..2 echo 3.chest x ray

9 years old child with svt given BP stable ..initial mx? 1.Vasoval men..I choose this 2.adenosine 3.
Amidraone 4. Metoprolol

Please read ..initial..next ..most appropriate...that are too many...like this

Colon Cancer screening for 2 problems. Identical mcq 2024. One is 52 years old man history of colon
screening with ny symptoms. His brother has ca colon at 60 years. I choose 1 ...1fobt. Now 2
colonoscopy now 4. 5 yearly colon scope..

Next screening is 39 years old and history of fa colon in her father 49 and his aunty 60 years. Options
1.colonosovpy 39 years . 2. Colonoscpy now 3. Fobt 5.5 years colonoscopy
Colonscopy Now in 5 yearly
Aortic aneurysm 3.5 cm to 4.9 cm within 1 years...male patient...5 ..I choose 1semiurgent 2 urgently
3 yearly USG 4 6 monthly USG

I got neurofibrosis same problem ezema pic ..same

Will tumour..mother noticed 3 years old child that mass on left side of abdomen while bathing

Ich ct pictures. Patient has weakness may be stroke .ct given ..options are infract haemorrhage EDH
SAH ..it's ich
Headache ..frontal but before headache flickering light on eyes. Not responsible to pcm
..sensationike migration..bank type chractracter. I choose migraine because no option on tension or
rebound headache in options
https://www1.racgp.org.au/ajgp/2021/december/the-state-of-migrain
3 month old baby picture on abdomen given...maybe haemangioma...three portions..propanolol
given 3 days after birth. Mother does not want to give anymore. Appropriate mx..1
Review 6 months. 2.surgery 3. Topical b blocker. ..I'm.not sure for my answers. I choose surgery..no
other complications

Cardiac failure patients has EF only 30 with maximising medication. Acei bb furosamide statin given..
options 1 icd .. 2. Increase frosamide 3.. pacemaker
CHF : Implantebla Cardiac Defibrilation
Less than ef 35 so I choose it Acute HF : Digoxin

https://australianprescriber.tg.org.au/articles/chronic-heart-failure.html
Patient has TIA .aspirin given .total Cholesterol 5.6 . Carotid stenosis 30 on right 1. Dipyrimole 2
cloudlet 3. Enenrectoy 4. Rosuva .
Clopidogrel

Pregnancy 14 weeks. ...shortness of Brest. Chest pain ...sudden onset 3 days ago ..others fine. No
history of travelling. Ecg sinus tacy vital signs normal claf soft no pain 1.ctpa 2. USG dropller 3.Chest x
ray 4 d dimers

https://www.racgp.org.au/afp/2017/november/pulmonary-
embolism#:~:text=Imaging%20considerations%20in%20pregnancy,a%20significantly%20higher%20
maternal%20risk.&text=Radiation%20risk%20to%20the%20fetus,CTPA%20and%20V%2FQ%20scan
ning.
https://sydney.communityhealthpathways.org/32106.htm

Carotid Artery Stenosis

See also:

● Transient Ischaemic Attack (TIA)

● Stroke

Clinical editor's note

Dipyridamole is not currently available. Supply may recommence (Diasp only) late in 2021.

Background

About carotid artery stenosis

About carotid artery stenosis

 ● Up to 85% of all strokes are due to ischaemia. Approximately 20% of these will affect the
vertebrobasilar territory and 80% will affect the carotid territory, of which approximately half
will be due to extra-cranial disease i.e., carotid artery disease.

● Carotid-related ischaemic stroke are the most amenable to treatment to prevent further major
strokes and death.

● Carotid endarterectomy trials have demonstrated that symptomatic patients with carotid
artery stenosis ≥ 70% benefit from carotid endarterectomy (CEA). 1

● Treatment of asymptomatic carotid artery stenosis is controversial and still being researched.

● Stroke risk in patients with asymptomatic carotid artery stenosis is 0.5% to 1% annually.

● Carotid artery bruits are a poor predictor of carotid artery stenosis or stroke risk. 2

Assessment

Practice point

Consider carotid endarterectomy

Consider carotid endarterectomy (CEA) in all patients with a carotid TIA or minor stroke. Follow
the Transient Ischaemic Attack (TIA) pathway.

1. Determine whether the patient is symptomatic or asymptomatic:

● Symptomatic carotid artery stenosis may present with carotid artery symptoms.
Follow the Transient Ischaemic Attack (TIA) or Stroke pathways. Some stroke patients
(excluding those with large stroke, stroke haemorrhage, cerebral or intra-cranial
oedema, large clinical deficit) benefit from carotid intervention.

Carotid artery symptoms

● Monocular blindness – usually a transient visual loss (amaurosis fugax) and can
be the only symptom of carotid artery disease. Usually rapid onset, brief
duration (less than 10 minutes).

● Dysphasia

● Unilateral motor and/or sensory symptoms affecting face and limbs

Vertebrobasilar artery symptoms (carotid ultrasound/CTA is not indicated):

● Cortical blindness

● Diplopia

● Isolated homonymous hemianopia or quadrantanopia

● Bilateral motor and/or sensory symptoms affecting face and/or limbs

● Ataxia

● Asymptomatic carotid artery stenosis may be discovered via carotid artery bruit on
cardiovascular examination, or incidental finding on imaging.
Carotid artery bruit 2

Carotid artery bruits:

● are a poor predictor of carotid artery stenosis or stroke risk.

● indicate generalised cardiovascular (CV) risk i.e., both cardiovascular and

cerebrovascular disease. CV risk reduction is indicated.

2. If the patient had a vascular event > 48 hours ago, arrange urgent carotid duplex ultrasound:

● Some nursing home patients may be inappropriate to investigate due to co-morbidities

and low life expectancy.

● Imaging and surgery need to be performed as early as possible to reduce the risk of
early stroke (from a few days to 2 weeks).

3. Consider whether the patient is suitable for carotid endarterectomy (CEA). Consider
exclusion criteria for surgery.

Exclusion criteria

● Life expectancy < 3 years

● Carotid occlusion or trickle flow on ultrasound

● Multiple co-morbidities

Patient's suitability for carotid endarterectomy (CEA)

● The patient must have > 3 years' life expectancy, and be on optimal medical therapy to
control risk factors.

● Typically important features include:

● focal neurological symptoms in diseases of carotid artery narrowing which fit

with an amaurosis fugax, TIA, or stroke with good recovery within last 6 months.

● 50 to 99% stenosis of relevant common carotid artery.

● other medical problems that suggest suitable for surgical treatment.

● If in any doubt about suitability, discuss with the on-call vascular

surgeon or neurologist.

Management

Symptomatic carotid artery stenosis

1. Arrange transfer to the emergency department by ambulance for immediate vascular surgery
assessment or admission if:

● transient ischaemic attack in the last 48 hours.

● acute stroke.

● multiple or recurrent transient ischaemic attack episodes in the last 7 days.

 ● amaurosis fugax in the last 48 hours.

2. If carotid stenosis > 70% is detected on the symptomatic side on ultrasound and the
patient is suitable for carotid endarterectomy (CEA), request urgent vascular surgery
assessment as soon as possible for surgery to occur in 2 weeks.

3. If carotid stenosis 50 to 70 % on ultrasound, request non-urgent vascular surgery

assessment for suitable patients, noting exclusion criteria.

4. Reduce all cardiovascular risk factors to reduce the risk of stroke and add antiplatelet
therapy.

Antiplatelet therapy

● First-line options:

● Aspirin 100 mg per day

● Aspirin plus dipyridamole, modified release 25 mg + 200 mg twice a day.

o PBS – prevention of recurrence of ischaemic stroke or transient cerebral

ischaemic events.

o Advise that headache is a common side-effect in 10% of patients, and

can be relieved by paracetamol and 3 coffees a day.

o Start at night while maintaining morning aspirin dose for a week to reduce
headaches.

o Marginally more effective than aspirin alone.

● Second-line option:

● Clopidogrel 75 mg per day.

PBS – prevention of recurrence of ischaemic stroke or transient cerebral ischaemic events in patients
who cannot tolerate or are allergic to aspirin, or who have had a stroke or TIA while taking aspirin.

● The combination of clopidogrel and aspirin is used in some patients (e.g., high-risk TIA,
mild stroke or carotid stents), and generally short-term (< 1 month).

Reduce all cardiovascular risk factors

● Statin therapy

● Blood pressure control

● Lifestyle modification:

● Smoking cessation

● Reduced alcohol consumption

● Weight control

● Regular aerobic physical activity

● Mediterranean diet
 ● Optimise diabetes management

Asymptomatic carotid artery stenosis

1. Refer all patients with a carotid stenosis > 70% to a vascular surgeon for surveillance.

● Carotid endarterectomy may be beneficial if > 80% stenosis.

● Other considerations include:

o age and sex, men do better than women.

o low surgical risk (< 3% risk of major stroke or death).

o medical fitness with > 5 years life expectancy.

o pre-occlusive disease (95 to 99% stenosis) which has a high stroke risk.

2. Reduce all cardiovascular risk factors to reduce the risk of stroke and consider
antiplatelet therapy.

Request

● Arrange transfer to the emergency department by ambulance for immediate vascular surgery
assessment or admission if:

● transient ischaemic attack in the last 48 hours.

● acute stroke.

● multiple or recurrent transient ischaemic attack episodes in the last 7 days.

● amaurosis fugax in the last 48 hours.

● Request urgent vascular surgery assessment for non-acute symptomatic patients with carotid
stenosis > 70%.

● Request non-urgent vascular surgery assessment if the patient presents with:

● carotid artery stenosis 50 to 70% on imaging and non-acute symptoms.

● asymptomatic carotid artery stenosis > 70% on imaging.

Information

For health professionals

Further information

● Australian Family Physician – Acute Stroke Patients: Early Hospital Management

● Choosing Wisely Australia – Recommendations: Australian and New Zealand Association of

Neurologists: Don't Routinely Recommend Surgery for a Narrowed Carotid Artery (> 50%
Stenosis) that has not Caused Symptoms

For patients

● Agency for Clinical Innovation – Stroke: Chronic Care for Aboriginal People
 ● Patient – Transient Ischaemic Attack

● Royal Australian College of General Practitioners (RACGP) – Mediterranean Diet: Reducing

Cardiovascular Disease Risk

● Stroke Foundation Australia:

● Home Page

● What is a Transient Ischaemic Attack (TIA)?

SEND FEEDBACK
Sept day 2 morning session
Patient has mouth and genital ulcer several time and now came for eye .pic given
fundoscop dome . Anterior uveitis ..asking Tx ...1.oral prenisolone 2. Topical
prenisolone 3.chramphnicol

Next ..eye pic given .. patient has trauma and fundoscopy done .no abnormalities. No
infection. pain. Not sudden onset No itchy. Already given topical antihistamine asking
appropriate 1. Timinol 2. Acetazolamide 3. Toprocapine?

Incomplete Scenario

https://www1.racgp.org.au/ajgp/2022/july/eye-injuries

Female has RA taking hydroxychloc..and methiraxate.., Tx in Pregnancy.

stop methiraxate and continue hydroy

Infertility regular menstrual cycle 28 day cycle and need to check

ovulation...1..testeroaterone 2. Progesterone on day 21 .3. Estrogen on day 1 4
and.17.3.FSH and LH.
https://www1.racgp.org.au/ajgp/2020/june/female-fertility-in-general-practice-setting

thrombocypenia plt 5 . With bleeding ..asking mx 1. Immiguglobulin(Severe and amount

of blood lost) .2. Plt transfusion 3. Steroid..4 blood transfusion

https://www.rch.org.au/clinicalguide/guideline_index/Immune_thrombocytopenic_pur
pura/

One patient came abdominal pain ..after taking alcohol.. and vomiting after giving
analgesic and doing USG..normal ..what is the mx of initial..1.NG ...2. IV normal saline
3. antibioctis

4 years old boy don't talk ...playing alone ..arranged toys ........development is
normally asking dx ..choose 1. aperger .2 ODD 3. ADH

Dx:ASD
One patient after accident..came to ER..tongue is bleeding..maxill and mandibles
fracture on both side and can't open mouth and alreasy orophygreal tube inserted but
still breathlessness So 92 and appropriate mx ?

1 endotrache incubation 2.naso incubation 3.tracheostimy 4. Cicroth 5. Percutaneou

treostomy with oxygen

Patient 17 years old boy collapse and history of cardiac death in father ...after this good
and normal. Initial test is 1.ecg 2 echo 3.chest x ray

9 years old child with svt given BP stable ..initial mx?

1.Vasoval men. 2.adenosine 3. Amidraone 4. Metoprolol

Please read ..initial..next ..most appropriate...that are too many...like this

Colon Cancer screening for 2 problems. One is 52 years old man history of colon
screening with ny symptoms. His brother has ca colon at 60 years.

1fobt. Now 2 colonoscopy now 4. 5 yearly colon scope..

Next screening is 39 years old and history of fa colon in her father 49 and his aunty 60
years. Options 1.colonosovpy 39 years .. 2. Colonoscpy now 3. Fobt 5.5 years
colonoscopy
-Colonscopy now and 5 yearly

Aortic aneurysm 3.5 cm to 4.9 cm within 1 years...male patient... 1semiurgent 2

urgently 3 yearly USG 4 6 monthly USG

neurofibrosis same problem ezema pic ..same

Will tumour..mother noticed 3 years old child that mass on left side of abdomen while
bathing

ICH ct pictures. Patient has weakness may be stroke .ct given ..options are infract
haemorrhage EDH SAH ..
Headache ..frontal but before headache flickering light on eyes. Not responsible to pcm
..sensationike migration..band type chractracter. migraine (with aura )because no
option on tension or rebound headache (Medication Used Headache more than 15
days/ months)

3 month old baby picture on abdomen given...maybe haemangioma...three

portions..propanolol given 3 days after birth. Mother does not want to give anymore.
Appropriate mx..1
Review 6 months. 2.surgery 3. Topical b blocker. .. surgery..no other complications

Cardiac failure patients has EF only 30 with maximising medication. Acei bb furosamide
statin given.. options 1 ICD.. 2. Increase frosamide 3.. pacemaker
Less than EF 35

Patient has TIA .aspirin given .total Cholesterol 5.6 . Carotid stenosis 30 on right 1.
Dipyrimole (recurrent TIA-Clopi) 2 cloudlet 3. Enenrectoy 4. Rosuva ..
Clopidogrel

https://australianprescriber.tg.org.au/articles/drugs-in-secondary-stroke-
prevention.html
Pregnancy 14 weeks. ...shortness of Brest. Chest pain ...sudden onset 3 days ago
..others fine. No history of travelling. Ecg sinus tacy vital signs normal claf soft no pain
1.ctpa 2. USG dropller 3.chest x ray 4 d dimers
1.Hemothorax, treatment?
2.Becet disease, long term treatment
3.Seb Keratosis-> whats management?
4.New born bay with erythematous parches on body, what to do? (It seems just normal
variation i guess)
5.Picture of eczema, asking diagnosis
6. PR 120, whats minimum volume of blood loss? -> 30%
7. Maybe ARDS question?(wheezing all over the chest, opaque patches all over the lung
in CXR), which antibiotics? There were amoxicillin/clavulante, ceftriaxone, TMPSMX

8.
Registrar takes drugs from cupboard, as an intern what's next do?
c. Report to coordinator of intern trainning
D. Talk to registrar to consult his problem with his senior

9.A man was transferred from ICU due to overdose of drug. He's renowned self made
man. Recently divorced by wife because she felt emotional abuse. He assessed her as
ungrateful, and suspicious of her purpose. Now he is finding medical chief who treated
him, and registrar to sue them. What's his problem? No self-harm

C. Borderline disorder
E. Narccistic disorder

10. Chronic pancreatitis pt, whats initial investigation?

Contrast-CT Scan

11. Foreign body sensation in the eye, no visible foreign body, but corneal scratch on
slit lamp. Whats management?
1.chlroramphenicol
5. Tropicamide
Patient with bipolar disease, what will necessitate involountar admission?
1. Reckless spending, 2. /increasing libido 3. using drugs

One patient after accident..came to ER..tongue is bleeding..maxill and mandibles

fracture on both side and can't open mouth and alreasy orophygreal tube inserted but
still breathlessness So 92 and appropriate mx ? 1 endotrache incubation 2.naso
incubation 3.tracheostimy 4. Cicroth 5. Percutaneou treostomy with oxygen

Mellory Wiess tear, patient is having recurrent vomit, next best management? 1.
Gastroscopy, 2.PPI, 3 PPI followed by endoscopy. 4. ondansetron

https://www.ncbi.nlm.nih.gov/books/NBK538190/
https://www.msdmanuals.com/en-au/professional/gastrointestinal-
disorders/esophageal-and-swallowing-disorders/mallory-weiss-syndrome

3 month old baby picture on abdomen given...maybe haemangioma...three

portions..propanolol given 3 days after birth. Mother does not want to give anymore.
Appropriate mx..1
Review 6 months. 2.surgery 3. Topical b blocker.

A case with genital ulcer with h/o multipartner and signs of meningitis.on CSF raised
glucose,polymorph nuclear cells predomonantly. which organism responsible for?

1.HSV-rbc
2.HIV????
3.pneumococcus
4.meningococcus
5.treponema pallidum

These are some of the recall I can remember

Most were from yesterday's recalls as well

2 red lesions on baby's abdomen mother refused to cont propranolol

Management
Observe
Surgery

Ct scan pic given

Girl c/o RIF pain and tender +fever
1 Rectus sheath hematoma
2 Appendix abscess
3 Right ovarian cyst

Patient has mouth and genital ulcer several time and now came for eye .pic given
fundoscop dome . Anterior uveitis ..asking Tx ...1.oral prenisolone 2. Topical
prenisolone 3.chramphnicol

Facial trauma with maxillary and mandibular fracture tongue l/w pt sob most
appropriate management
Tracheostomy
Crico

Back of neck of child pic impetigo asking organism cause

Staph epidermidis
Staph aureus

Child very ill looking

Reduced ae right lung Spo2 93
What abx to give
Iv flucloxacillin
Iv benzylpenicillin for severe pneumonia : IV flucloxacilin + C3G

regular menstrual cycle 28 day to 31 cycle and need to check

ovulation...1..testeroaterone 2. Progesterone on day 21 .3. Estrogen on day 1 4
and...17..3.FSH and LH

Pic of ecg af
Patient took overdose Digoxin ramipril..
Subsequently collapsed

Pic of partogram primid 36 weeks mild aph

Os 3cm
Next step
Oxytocin
Ctg monitoring
Pg
Cs
Fetal scalp monitoring