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Wednesday, November 4, 2009

MCQS WITH ANSWERS


PSYCHIATRY
1.A lady with a previous divorce now comes to
you with a seductive behaviour
a. Narcistic
b. Histrionic
c. Borderline
2.In Australia bush fire are common either
accidentally or some people lighting fire
deliberately.
Which is true regarding pyromaniacs?
a. Done for notoriety or publicity
b. To hide their acts
c. As they like to play with fire
d. Set fire and get panic attacks
e. For satisfaction
3.Depersonalization may occur in
a. Schizophrenia
b. Ecstatic religious experience
c. Depression
d. Post traumatic disorder
e. All of the above
4.A middle aged lady present to you with nausea
dyspepsia abdominal distention. She had a past
history of going to many doctors and being
treated for many disorders. she has been treated
by a rheumatologist for aches and pains,
cardiologist for her palpitations and gave her
propanolol without improvement , a neurologist
for her epilepsy. On examination you find a
tense anxious woman in spite of her daily dose
of benzodiazepine. There are scar from
appendectomy and hysterectomy operations.
What is the most appropriate diagnosis?
a. Munchausen syndrome
b. Conversion disorder
c. Hypochondriasis
d. factitious disorder,
e. Neurotic anxiety
5.Many psychopharmacologic substance are
lipophilic the advantage is
a. better absorbed with meals
b. promptly binds with free fatty acids
c. more resistant to be metabolized by thae liver
d. the pass rapidly to the brain and to the blood
e. a drug which has a long life and needs to be
given once a day daily
6. Lithium:
a. loses it effectiveness over the time
b. is non addictive
c. works better in women than men
d. interaction with NSAIDS
7. morbid jealousy
a. alcoholism
b. schizophrenia
c. depression
d. obsessive compulsive
e. mania
8. A 40 yr old male school teacher who has
recently separated from his wife was;
prescribed imipramine 25 mg for his
depression. He had a road accident in which he
hurt his child. He was admitted to hospital for
taking an overdose of imipramine with alcohol.
He does not give consent to go for psychiatric
counselling or to be admitted hospital for
further treatment. Your next step in the
management of this patient is:
a. Ask him to go to alcoholics anonymous
b. Increase the dose of Amitriptyline to 125 mg and
send him home
c. Change to another drug
d. Retain him in the hospital against his using he
Mental health act
e. Contact his wife and try to persuade her to return
to him
f. Alcohol counselling
9.A 46 year old widow consults you for advice
on management of insomnia, indifferent
appetite; recent weight loss of 5 kg., headaches
and tearfulness. 4 weeks ago her only son died
after subarachnoid haemorrhage. Since then she
had experienced auditory hallucination, of her
son's voice calling out her name and had felt his
presence in their living room. Your initial
management of this woman would involve:
a. Grief counselling and a brief course of
benzodiazepine
b. Grief counselling and a brief course of TCA
c. Grief counselling and a brief course of
phenothiazines
d. Referral to psychiatrist
e. Referral for hospitalisation and treatment
10.Depersonalization may occur in:
a. schizophrenia
b. ecstatic religious experience
c. depression
d post traumatic disorder
e.A11 of the above
11. A 36 yr old engineer is due to give an speech
soon and is reluctant to be exposed to people. At
the same time, he does not want to sign cheques
or write anything in public. He also thinks his,
boas is controlling what he is doing although he
knows that there is no motive for that because
he is a very good worker. He realizes there is no
reason to act this way, Lately he has been
avoiding to go to the canteen with his mates and
takes alcohol to cope with the situation. What he
is suffering from?
a. Social phobia
b. agoraphobia
d. antisocial personality disorder
e. panic disorder
f. paranoid disorder
12. Deinstitutionalisation means:
a. Transferring a patient from a psychiatric hospital
to a community based facility.-
b . Put him in prison hospital
c. discharge the patient to a nursing home
d. Put patient in a psychiatric hospital
e. psychiatric patients are not permitted to vote
13.Lithium:
a. loses its effectiveness over the time
b. Is non-addictive
c. works better in women than men
d. Interaction with NSAIDS causes increase in
lithium levels
e. Lithium toxicity
14.Cognitive therapy has good results in:
a. depression
b- chronic pain
c. social phobia
d. bulimia
e. all of the above
15. Many psychopharmacologic substance are
lipophilic. The advantage is:
a. better absorbed with meals
b. promptly bind to free fatty acids
c. more resistant to be metabolised by the liver they
pass rapidly to the blood and to the brain
e. a drug has a long life and needs to be given once
a day only
16. Psychiatric treatment in women is more
commonly found in:
a. first trimester of pregnancy
b. second trimester
c. third trimester
d. puerperium
e.6 weeks after the first control
17.Regarding depression, what is true?
a. onset in winter, disappear in summer
b. -onset in autumn, disappear in summer
c. onset in summer; disappear in winter
d. onset in summer, disappear in autumn
e. onset in spring, disappear in winter
18. Despite obvious to the contrary, a 16 w old
female with anorexia nervosa, thinks she is
overweight. This is an example of :
a. delusion
b. obsession
c. over valued idea
d. rumination
e. hallucination
19. A 35 year old female secretary, unmarried,
complains of feeling of mass or lump on her
neck:
a. psychological (Globus Hystericus)
b. inflamed tonsils
c. lingual thyroid
d. hyperthyroidism
e. goitre
20.In generalized anxiety disorder, what Will
develop in the next follow :
a. Schizophrenia
b. bipolar manic depression.
depressive illness
mania
phobia.
21. Using the WHO criteria, what is the most
common symptoms of schizophrenia?
a. Flat affect
b. Auditory Hallucination
c. Visual hallucination
d. Lack of insight
e. Suicidal ideation
22. Exposure to stimuli and response prevention
is the treatment of
a. Obsessive-compulsive disorder
b. Agoraphobia
c. Depression
d. Bipolar manic depression
e. Schizophrenia
23.Morbid jealousy, associated with:
a. alcoholism
b. schizophrenia
c. depression
d. obsessive compulsive
e. mania
24.WOF may be treated with ECT
a. puerperal depression
b. catatonic schizophrenia
c. mania
d. acute schizophrenia
e. all of the above
25.A 1 yr old child of normal intelligence
becomes withdrawn and shows deterioration in
his school
work. What is most likely:
a. schizophrenia
b. response to stress *in the family
c. normal variance of adolescence
d. Migraine
26. Anorexia nervosa is characterized by all of
the following except.
1. 90% of those affected are females
2. raised FSH is pathognomonic
3. not eating or recognizing hunger
27. Fluoxetine is a new antidepressant unrelated
to TC.A but with similar pharmacologic action.
What is its mechanism of action?
a. inhibits uptake of dopamine
b. inhibits uptake of norepephrine
c. inhibits uptake of serotonin
d. inhibit uptake of epinephrine
28.Apatient maintained on lithium carbonate
was given an NSAIDS and developed then Most
likely explanation for this :
- lithium toxicity
- toxicity to NSAIDs
29. In married couple, the most likely cause of
inhibited sexual excitement is?
a. fear of pregnancy
b. marital discord
c. empty nest syndrome
d. organic disorder
30.A Malaysian university student who is
working as a waiter, whose girlfriend went
home to attend her father's funeral became
irritable, restless and unable to sleep. He
complains that his companions are talking
behind his back and plotting against him what
is your diagnosis?
a. reactive psychosis
b. grief reaction
c. onset schizophrenia
d. suspicious cannabis
e. panic psychosis
31. A 45 yr old salesman comes to you with
complaints of difficulty of getting to sleep,
waking up
with nightmares & loss of weight. What is your
diagnosis'?
- anxiety
- depression
32. The most common cause of vaginismus :
-- Phobia
- schizophrenia
33. In borderline personality. What is correct?
a. antisocial with difficulty in establishing a
relationship
b. histrionic personality
c. social withdrawal
d. identification problem
e. tendency to self harm
34. What is correct of obsessive rumination?
a. compulsive hand washing
b. repetitive, persistent sexual fantasy c.
35. A 35 yr old man maintained on lithium was
admitted for an infection. HIV test taken and
done without his consent turned up positive.
What is correct in this case?
a. stop lithium and start AZT
b. Tell the patient he has AIDS and extract a
history of his sexual contacts/partners
c. It is unlawful to do the test without consent and
pre treatment counselling
d. Inform the staff of the patient condition
36. A 65 yr old Greek lady living in Australia
since 34 yrs ago has been living alone. She now
seems to answer voices and does strange things.
The most likely
a. paranoid delusions
b. migrant psychosis
c. Capgras syndrome
d. Paraphilia
e. Frigoli
37. A 23 yr old male unemployed is complaining
about his nose. He says that he can't get a good
job because of his nose. He also said he can't get
a girl friend , and is demanding about a
reduction of his nose. The doctors an opinion is
that the nose looks normal. What is your
management?
a. refer to p1'astic surgeon
b. refer to psychiatry
d. try a short course of...
e. explain him very gently that his nose looks
normal and try to find out what social causes and
difficulties about his work.
38. What is delusion?
a. False Belief
b. False thought
c. Sexual Fantasy
39. Most appropriate re :post partum psychosis
is:-
a. family counselling
b. ask mother to stop breastfeeding
c. admit to hospital
d. psychiatric treatment to the mother
e. treat and send home
40. A 85 YO old man with progressive loss of
memory for recent events, unable to do any
calculations is disoriented for time, WOF is
correct?
1. frontal lobe tumour
2. Alzheimers
3. Multi infarct Dementia
4. Due to old age
41. A young girl with running nose; diarrhoea.
sweating; lacrimation, and abdominal pain.
WOF is
the cause'?
a. heroin withdrawal
b. cocaine
c. LSD
d. marijuana
e. amphetamine
42. Endogenous depression. WOF is true?
a. Early morning waking
b. Difficulty in initial sleep
c. Dreams with content involving death patient
d. Somnolence in the early part of day
e. None of Above
43. Basis of Dopamine theory of Scz:
a. Phenothiazine can cause Parkinson like
syndrome
b. Amphetamine can cause schizophrenia
c. Anticholinergic drug can cause delirium.
c. Tricyclic Antidepressants have anticholinergic
effects.
d. Imipramine helps in obsessive neurosis.
44 Acute alcoholic hallucination can be
differentiated from delirium tremens by the fact
that:
A. It occurs following ingestion of small amount of
ethanol whereas DT is a withdrawal syndrome.
c. Unilateral tinnitus is pathognomic of alcohol
hallucination.
d. Unilateral auditory hallucination is path gnomic
of alcoholic, hallucination.
e. The sensorial remain clear despite the presence
of terrifying auditory hallucination.
f. The hallucination of alcoholic is visual and
unpleasant.
45. WOF is characteristic of schizophrenia'?
a auditory hallucination
b. Depersonalisation
d. antisocial behaviour
e. flight of ideas
f. all of the above
46 A 70 yr old male taking Aldomet for
hypertension for the last 10 Years starts to
isolate himself and is suffering from deafness:
He feels that people are speaking about him.
What is most likely diagnosis:
a. Symptoms of Aldomet
b. reaction to deafness
c. atherosclerotic dementia
d. senile dementia
e. senile paraphrenia

MEDICINE
1. In dislocation of shoulder, which nerve is
liable to be injured?
a. Radial
b. Axillary
c. Musculocutaneous
d. Ulnar
e. Brachial plexus
2. Which of the following is likely to damage an
artery?
a. Anterior Dislocation shoulder
b. Posterior dislocation shoulder
c. Anterior dislocation hip
d. Posterior dislocation hip
e. Posterior dislocation knee
3. In Colles Fracture, the distal segment is
displaced:
a. Backwards and ulnarwards
b. Backwards and radially
c. Forwards and ulnarwards
d. Forwards and radially
e. Minimally displaced
4. An 18-month-old is brought to you by the
mother for breast enlargement. Tanner 3. No
pubic hair or axillary hair is seen. No other
abnormality is seen. What is your diagnosis?
a. Precocious puberty
b. Idiopathic thelarche
c. Congenital adrenal hyperplasia
d. Breast tumour
e. Mastitis
5. A 21-year-old child is brought to you for
having loose motions for 3 days. The stool
contains undigested food material. No vomiting.
Thriving well. What is he suffering from?
a. Cystic fibrosis
b. Coeliac disease
c. Gastroenteritis
d. Toddlers diarrhoea
e. IBS
6. A large man presents with big face broad
hands thick and oily skin and hoarse voice.
What is the initial investigation of choice?
a. GTT + GH
b. Insulin challenge test + GH
c. GH+ cortisol
d. GH
e. GTT
7. Regarding heparin induced
thrombocytopenia, what is true?
a. Purpura
b. Joint bleeding
c. Ecchymosis
d. Thrombosis
e. Hematuria
8. Regarding ADHD, what is correct?
a. Age 5-7 years
b. Reading difficulties
c. Social withdrawal
d. Females affected more than Males
e. Prevalence is 15%
9. All the following can cause dysphagia except:
a. Oesophageal cancer
b. Achalasia
c. Oesophageal varices
d. Barretts oesophagus
e. Hiatus hernia
10.A 6 week old is brought to you for not having
passed motion for last 4 days. He has been
feeding well, and is gaining weight. Otherwise
well and active. What is the most probable
explanation?
a. Hirsprungs disease
b. Normal variant
c. Hypothyroidism
d. Acquired constipation
e. Foreign body
11. A man returns after a trip to India. Now has
3 days diarrhoea with blood in stools. Looks run
out and dehydrated. Noted to have fever. What
is most correct?
a. Giardia infection
b. Amoebiasis
c. E. coli gastroenteritis
d. Viral diarrhoea
e. Cholera
12. In a 40 years old lady, all the following may
be the cause of menorrhagia except:
a. Hormonal response to uterus
b. Subserous fibroid
c. Intermural fibroid
d. Adenomyosis
e. Endometriosis
13. 3 month old comes with unilateral eye
discharge. What is the most possible cause:
a. Chlamydia infection
b. Gonococcus
c. Ophthalmia neonatorum
d. Blocked nasolacrimal duct
e. Normal variant
*14. A 6-month-old presents with SOB. There
was a birthday party at home yesterday. On
examination, child is wheezing. What is most
initial investigation?
a. Sweat test
b. Bronchogram
c. CXR
d. Inspiratory and Expiratory Rontogram
e. PEFR measurement
15. A mother brings her 3-year-old baby girl
with unilateral nasal discharge off and on for
last 3 months. Secretion is foul smelling and at
times copious. Baby is uncooperative. What is
the initial investigation of choice?
a. CXR
b. indirect laryngoscopy
c. Examination under GA
16. A 6-year-old girl wakes up at night c/o sever
pain in her calves. Mother rubs her calves and
she feel fine, goes to sleep. This has been
happening for a number of days now. At
daytime she is active and playing. All of the
following are true except:
a. Ca and CK will be abnormal
b. No investigations are needed
c. Family Hx will be positive
d. Reassurance is the treatment.
17. Which vaccination should not be given to a
child who is under remission on chemotherapy
for CLL?
a. Polio
b. MMR
c. HiB
d. DPT
18.Solitary mobile carcinoma breast lump. No
axillary lymphadenopathy. Which of the
following is a prognostic marker?
a. Age > 45
b. Neu2 / HER oncogene status
c. Oestrogen level
19. All can occur with chronic limb ischemia
except:
a. Great Toe gangrene
b. Pallor
c. Ulcer on medial side of leg above malleolus
d. Rest pain
e. Intermittent claudication
*22. 40 year old with acute painful testis:*
a. Varicocele
b. Hydrocele
c. Epididymoorchitis
d. Torsion
e. Tumour
23. WOF is true regarding a 2cm kidney stone
in the pelvis seen in KUB examination.:
a. Expectant treatment is right
b. It is a urate stone
c. Lithotripsy
d. Open surgery
24. Patient cant dorsiflex or evert his foot.
What is wrong?
a. L4
b. L5
c. Tibial nerve
d. Peroneal nerve
e. Sciatic nerve
25. Body dysmorphia is seen in AOF except:
a. Anorexia nervosa
b. Acromegaly
c. Non dominant parietal lobe lesion
d. Dominant parietal lobe lesion
e. Narcissistic personality disorder
26. 6 year old child comes to you with up rolling
if eyes, neck stiffness, protruded tongue, rigid
body and face tilted to one side. Had vomiting
and was being treated by the GP. What is the
cause?
a. Huntingtons chorea
b. Epilepsy
c. Reaction to metoclopramide
d. Gastritis
27. Lung cancer associated with non-smokers:
a. Sq. cell Ca.
b. Adenocarcinoma
c. Small cell Ca.
d. Oat cell Ca.
e. Large cell Ca.
28. All of the following cause gynecomastia
except :
a. spironolactone
b. cimetidine
c. digoxin
d. alpha methyldopa
e. labetolol
29.A young female presents with 24 hour h/o
sore throat. Later she develops proteinuria and
some hematuria. What is the most probable
cause?
a. Glomerulonephritis
b. IgA Nephropathy
c. Nephrotic syndrome
d. HTN
30.What is the most important step in
psychotherapy?
a. Detailed history
b. Isolation
c. History from friends and relatives.
d. Developing relationship
e. Investigations
31. When do we use Psychodynamic
Psychotherapy?
a. Obsessive Compulsive Disorder
b. Bipolar Disorder
c. Schizophrenia
d. Depression
e. Anorexia Nervosa
32. You are asked to examine a person. He is cut
off from the world since he was teen. Lives alone
and wants to be alone. No friends. Family wants
to support but he refuses to get any help. He
doesnt have any thought disorder or
perceptional symptoms, but his affect is blunt.
What would be the most probable diagnosis?
a. Chronic schizophrenia
b. Major depression
c. Narcissistic Personality
d. Bipolar disorder
33.Regarding Billings method of contraception,
AOF are true except:
a. Cervical mucus has to be palpated
b. Unsafe sex, if it becomes more
c. Safe sex after 2-3 days of becoming more
d. Since it considers the cervical mucus, it is same
contraception in regular, irregular and
lactational menstrual periods.
34.Regarding Levonorgestral containing IUCD,
AOF are true except:
a. Light periods
b. Amenorrhoea
c. Decreased risk of cervical carcinoma
d. Decreased risk of sexually transmitted diseases
e. Decreased risk of ectopic pregnancy
35.Spleenectomy in spherocytosis will do all the
following except:
a. Normalize anaemia
b. Normalize spherocytosis
36. An 8-year-old child presents to the ED with
bilateral tonsillitis with greyish white exudates.
He has cervical lymphadenopathy, fever and
hepatosplenomegaly. What is the probable
cause?
a. EBV
b. CMV
c. Diphtheria
d. Bacterial
37. A young child with 2-week h/o dry cough
with whop, and some times vomits. What is true
about this patient?
a. Will have cough for the next 4 weeks
b. Amoxicillin should be started
c. D & T vaccine should be given immediately
38. A patient with pyloric stenosis, vomiting for
4 days now presents to ED with mother. He is
dull lethargic, skin turgor is lost, and BP is
90/50. What is the most initial choice of fluid in
this patient?
a. Normal saline
b. Hartmans solution
c. Ringers lactate solution
d. Dextrose 5% and Normal saline
39.Regarding diffuse fibrosing alveolitis what is
true?
a. Decreased FEV1 / FEV
b. Decreased TLC
c. Decreased Expansion
d. Decreased O2 tension
e. Hypercarbia
40.Psychiatric side effect of corticosteroids?
Withdrawal causes delirium
41. A patient is suffering from cyclical
mastalgia. Routine treatment fails. What is your
next
management?
a. NSAID
b. Bromocriptine
c. Danazol
d. Progesterone
e. Lasix
42.Regarding CPR, WOF statement is most
correct?
a. Adrenaline should be given every 10 minutes
b. Bicarbonate is mandatory
c. ECM only pumps of the cardiac output in one
stroke
d. ECG is necessary before cardio-version.
43. Patient with grandiose character. Doesnt
care about others. Feels himself to be unique:
a. Histrionic personality
b. Schizoid
c. Narsistic
d. Delusional
e. Borderline
44.Picture of CT Scan showing two white spots
just lateral to the midline. A patient 59 year old
presents with sudden onset of left hand
weakness. What could be the possible cause?
a. SDH
b. SAH
c. Intra cerebral haemorrhage
d. Cerebral infarct
45. WOF has the least risk of having congenital
malformation at birth.
a. Chromosomal abnormality AD, AR, Sex linked
recessive
b. Rubella at 18 weeks
46. What is the most likely cause of post coital
bleeding?
a. Endometrial Carcinoma
b. Vaginal candidiasis
c. Cervical polyp
d. Fibroid
47. Regarding thyroid cancer, all are true
except:
a. Enlarged thyroid
b. Solitary nodule
c. Hot nodule
d. Change in voice
e. Tracheal compression
48. Patient presents with fever, tachycardia
(Pulse 110/mt), Tremors, and palpable & tender
thyroid. On investigation, there is no radioactive
iodine uptake. What is the possible treatment?
a. Carbimazole
b. I131
c. Beta-Blocker + Paracetamol
d. Thyroxine
49. A women has bilateral suppurative
inflammatory lesion on the axilla and groin.
What is true?
a. Actinomycosis
b. Fungal infection Mycosis Fungoides
c. Suppurative Hidradenitis
d. Multiple lymphadenopathy with abscess
e. Pilonidal sinus
50. An old man who was operated for aortic
aneurysm 3 weeks ago, presents to the ED with
irregular pulse, restlessness, abdominal
distension and not having passed flatus and
motions for last 2 days. WOF is the most
possible cause?
a. Rupture of suture site
b. Mesenteric artery embolism
c. Urinary retention
d. Diverticulosis
51 Why do we do an ultra sound in a patient
with sign symptoms of biliary disease?
a. To visualize stones in the GB or CBD
b. To visualize pancreatic cancer
c. To see the dilation of bile tree
d. To locate the hepatic cancer
e. To visualize the GB pathology
52. A seventy-year lady who is alcoholic and
smokes > 20 cigarettes a day, presents to you
with tiredness and fatigue. She also complains of
weakness in limbs. Her Hb was 98, MCV 110,
and platelets were decreased. What is the most
possible cause?
a. AoCD
b. IDA
c. Alcoholism
d. Pernicious Anaemia
e. Auto immune Haemolytic Anaemia
53. A young female on oral contraceptive misses
one tablet while in the mid cycle. Had coitus the
same day, and takes the missed tablet 12 hours
later. Then continues with rest of her tablets.
She has spotting on the third day of coitus.
What will be your advice?
a. Continue with the OCP.
b. Change to different contraceptive drug.
54. AOF are the features of basal ganglion
except:
a. Ataxia
b. Tremor
c. Bradykinesia
d. Chorea
e. Rigidity
55.Most common cause of bowel obstruction in
Australia assuming that he as not undergone
any abdominal surgery, is:
a. Volvulus
b. Intersuseption
c. Groin hernia
d. Internal hernia
e. Tumours
56. A patient presents with wasting of small
muscles of hand with thenar sparing. What is
the most probable diagnosis?
a. Ulnar N
b. Median N
c. Axillary N
d. Musculocutaneous N
57. Picture on Page 206 of AMC. Picture of
scalp showing white scaly lesion.
a. Psoriasis
b. Alopecia Areata
c. Pediculosis
d. Tinea Capitis
58. A young couple wants to adopt abstinence as
contraception. Assuming the female is having a
regular monthly cycle of 28 days, you would
advice them to avoid sex on AOF days except:
a. Day 4 17
b. Day 8 17
c. Day 10 19
d. Day 12 19
e. Day 17 - 21
59. Most common cause of cholecystitis in
Australia
a. Gall stone at out flow
b. Gall stone in CBD
c. Pancreatitis
d. Tumour
e. Hepatitis
60.WOF is expected to happen after
splenectomy for spherocytosis?
a. RBC life span improves
b. Leukopenia
c. Reduction in anaemia
d. Reduction of spherocytes
e. Reduction in fragility of RBCs.
61.What is the cause of majority of HbsAg
patients in Chinese population?
a. Blood product
b. IVDU
c. Child birth
d. Sexual spread
e. Haemophilia
62. A 60 years old female patient of RA takes
5mg of Prednisolone tabs BD for last 10 years.
Now she comes to you complaining sudden onset
of pain and swelling of her right knee, which is
warm and tender. Your management would be:
a. Increase dose of NSAID
b. Decrease dose of NSAID
c. IV Antibiotics & hospitalisation
d. Knee X Ray for unrecognised trauma
e. Knee aspiration for cytology.
63. A 12 year old is having pain in his hip. His
mother noticed a limp. He is afebrile, and the
general examination is normal. What is the most
probable cause of his symptoms?
a. Slipped upper femoral epiphysis
b. Perthes disease
c. Non specific synovitis
d. Osteomyelitis
64. Photo of viral wart on the eyelid of a young
female.
a. Wart
b. Molluscum contagiosum
c. Herpes simplex
d. Skin tag
65. AOF cause gynecomastia, except:
a. Spironolactone
b. Digoxin
c. Methyldopa
d. Labetolol
66. A 41 week primi comes to you complaining
of no fetal movements for last 24 hrs. FHS is
140/mt, CTG is normal, and rest of the
examination is normal. You send her home.
Next day she
rings you stating that there is again no fetal
movement for the last 24 hrs. What will be you
next
step of management?
a. Tell her that all her examinations are fine, & she
should not worry
b. Ask her to wait for another 24 hrs.
c. Admit labour ward and induce labour.
d. Immediate LSCS
67. Picture of supracondylar fracture (AMC
Book): A young girl fall on her out stretched
hand. What
will be your management?
a. Neurological study to check the Median Nerve
involvement
b. Fasciotomy
c. # Reduction and assessment of circulation
d. Back slab and review in 24 hours
68. Many people attended a dinner party on a
week end. 10% had diarrhoea. Most of them
recovered spontaneously, but few needed
hospitalisation for severe dehydration. What is
the most
probable cause?
a. Giardia
b. Salmonella
c. Clostridium
d. Shigella
69.Complication of # of epiphyseal plate
a. Retardation of longitudinal growth
b. Joint stiffness
c. Malunion
d. Non-union
e. Avascular necrosis
70.4 day old full term baby normal at birth.
Suddenly collapse at cot. O/E baby is
peripherally
cyanosed , no pulse and respiratory distress.
Diagnosis?
a. Pulmonary Hypertension
b. Fallots Tetralogy
c. PDA
d. CHD
e. Lt Heart hyperplasia.
f. Transposition of great vessels

MEDICINE, SURGERY , OBSTETRICS AND
PSYCHIATRY
1. An elderly woman can read the newspaper,
but has halos in bright sunlight.
A. Cataract
B. Glaucoma
C. Presbyopia
D. Macular Degeneration
2. Which of the following drugs decrease renin:
A. Beta Blockers
B. ACE Inhibitors
C. Spironolactone
D. Hydralazine
E. Centrally acting antihypertensives.
3. Newborn with respiratory distress , faint
breath sounds on the left and with a scaphoid
abdomen
A. Meconium aspiration syndrome
B. Situs inversus
C. Diaphragmatic hernia
4. Which nerve gives the sensation of taste to the
anterior 2/3rd of tongue.
A. Trigeminal nerve
B. Facial nerve
C. Hypoglossal nerve
D. Glossopharyngeal nerve
5. A Patient who underwent a cholecystectomy,
now comes with jaundice .what is the
investigation
of choice.
A. Oral cholecystogram
B. CT scan
C. Ultrasound
D. Sr. Creatinine
E. Upper GI Studies
6. Regarding pseudobulbar palsy AOF is true
except
A. Wasting and fasciculation of tongue
B. Jaw jerk decreased
C. Loss of sphincter control
D. Gag reflex present
7. Regarding ACE Inhibitors, which is not true :
A. Used in the treatment of heart failure
B. Used as first line in the treatment of
Hypertension
C. Used in Diabetics
D. Cannot be used in the treatment of Aortic
stenosis.
8. Regarding CRF and Calcium metabolism
A. Ca is decreased
B. Ca is increased
C. There is no relation between CRF and Ca
D. Causes Osteomalacia.
9. Most significant complication of massive
blood transfusion. ( *)
A. Pulmonary oedema
B. Change in acid base balance
C. DIC and coagulation defect
D. Increased CVP
10. Regarding CRF and Potassium all of the
following reduce potassium except (treatment of
hyperkalemia) *
A. Calcium Carbonate
B. Glucose and Insulin
C. Dialysis
D. Resonium
E. Sodium Bicarbonate
11. 55year old patient with dysphagia for solids
with a previous history of reflux
A. Carcinoma oesophagus
B. Stricture
C. Scleroderma
D. Achalasia \
E. Raynauds syndrome
12. An infant came with pneumonia , X ray
showed consolidation of a lobe with round
translucencies and a small pleural effusion.
What is the treatment of choice?
A. Crystalline penicillin
B. Flucloxicillin
C. Amoxicillin / clavulanic acid
D. Tetracycline
13. A new born was peripherally cyanosed and
crying lustily ..the axillary temperature
recorded was 37.2degrees what would be the
next step( *)
A. Take an x ray
B. reassure
C. oxygen
D. urine culture
14. 34 year old lady on phenytoin wants to take
OCPS what can be prescribed
A. Microgynon 30
B. Microgynon 50
C. Triphasic
D. Oetradiol patches
E. Progesterone only pill
15. 6 months old boy brought by his mother
with a temperature of 38.9degrees with bilateral
wheezing .his resp. rate was 36/min .other
members in the family had a h/o similar illness.
There is family h/o asthma. What is the
diagnosis?
A. Asthma
B. Foreign body
C. Bronchiolitis
D. Pneumonia
16. 16 weeks p regnant lady came for a check up
,for the diagnosis of foetal anencephaly all are
true except
A. increased alpha feto protein
B. increased beta HCG
C. nuchal thickness
D. decreased alpha fetoprotein
17. Regarding tubal pregnancy most suggestive
is (*)
A. ve beta HCG
B. ultrasound showing empty uterus
C. ultrasound showing tubal mass
D. CT scan
18. 10 weeks old child with persistent unilateral
eye discharge responding to antibiotics but
recurring
A. nasolacrimal duct obstruction
B. gonococcus
C. Chlamydia
19. unilateral foul smelling ,bloodstained
discharge from nose
A. foreign body
B. nasal polyps
C. Atopy
D. Rhinitis
20. 10 year old came to your surgery with
scrotal pain .on examination both testis are in
the scrotum , next management :
A. do an ultrasound
B. arrange surgery
C. write some analgesic and send him home
D. do nothing it will go away
E. tell his mother to review back again when the
pain recurs
21. 19 year old girl had a binge of drinking the
previous night with lower abdominal tenderness
and
all investigations and testis are normal (*)
A. treat as gastroenteritis
B. tell her it is due to alcohol
C. not sure of diagnosis ;come back for review
D. Give analgesic and antiemetic and send her
home.
22. Reversal of non depolarising skeletal muscle
blockade
A. Pyridostigmine
B. Neostigmine
C. Atropine
D. Benzhexol
23. differentiation between schizophrenia and
shcizophreniform disorders is by (*)
A. affective symptoms
B. duration of symptoms
C. lack of insight
D. female and male ratio
24. A lady with a previous divorce now comes to
you with a seductive behaviour
A. Narcicistic
B. Histrionic
C. Borderline
25. In Australia bush fires are common either
accidentally or due to some people lighting fire
deliberately, which is true regarding pyromaniacs.
A. Done for notoriety and publicity
B. To hide their acts
C. As they like to play with fire
D. Set fire and get panic attacks
E. For satisfaction.
26. People living near airport have(*)
A. Explosive personality
B. Insomnia
C. Agitated
D. Depression
27. Regarding panic attacks all are true except
(*)
A. 20% have had at least one attack in their
lifetime.
B. With out agoraphobia it is equal in male and
female
C. Always avoid precipitating factors
D. Usually occurs in the twenties
28. Regarding treatment of chronic duodenal
ulcer
A. eradication of H pylori
B. H2 blockers
C. PPI
D. Selective vagotomy
29. 4 year old boy with fever and malaise ,
lymphocyte count normal, platelets decreased
,Hb decreased
A. ALL
B. Infectious mononucleosis
C. Hodgkins disease
30. Pregnant lady with Group B strep infection,
what is true.
A. Penicillin to be given as prophylaxis
B. Bolus dose of penicillin before labour
C. Take a swab and if B strep present then treat.
31. Regarding MI , maximum deaths occur in
(*)
A. with in 1st 2 hrs
B. 2 to 12hrs
C. 12 to 24hrs
D. 2 to 7days
E. after discharge
32. A case of stable angina with chest pain. On
examination enzymes, ECG are normal but as
you were examining him he belches and says he
feels better - what would you do (*)
A. Admit to coronary care Unit and do ECG
monitoring.
B. send him home with appointment to cardiologist
C. refer to gastroenterologist
D. if enzymes normal then probably no cardiac
33. With regard to primary health care all are
true except(*)
A. 1/3rd of population come to a GP with
psychiatric symptoms.
B. Most patients are psychotic
C. Only few are referred to psychiatrists
D. Alcoholics and drug abuse frequently
overlooked by GPs
34. A patient with known Parkinsons disease
for 2 yrs on long term treatment now comes
with tongue protruding out. What would you do
?
A. Decrease levodopa +carbidopa
B. Increase levodopa + carbidopa
C. Stop levodopa +carbidopa
D. Treat with chlorpromazine
35. In a case of twin pregnancy all are true
except
A. asymmetrical growth retardation
B. anaemia in pregnancy
C. premature labour
D. acute polyhydramnios
E. 2nd twin foetal malformation.
36. 60 yr old female with diarrhoea and profuse
mucous discharge .what could be the cause
A. Crons disease
B. ulcerative colitis
C. villous adenoma
D. rectal Ca
E. acute mesenteric ischaemia
37. How do you differentiate between anorectal
and colorectal cause of bleeding(*)
A. Blood mixed with stools
B. Fresh bright bleeding
C. Mucoid discharge
D. Pain during defecation
38. most common cause of severe chest pain in
pericarditis
A. viral pericarditis
B. tuberculosis
C. Mycoplasma
D. Uraemia
E. MI
39. all of the following are causes of
supraclavicular mass except (*)
A. stomach Ca
B. cervical rib
C. breast Ca
D. subclavian thrombosis
E. subclavian artery aneurysm
40. which of the following has worst prognosis
A. advanced breast Ca
B. choriocarcinoma
C. Hodgkins lymphoma
D. Non-Hodgkin lymphoma
E. Prostate carcinoma
41. Which of the following does not metastasise
to brain
A. Malignant melanoma
B. Prostatic Ca
C. Lung Ca
D. Breast Ca
42. 40 yr old lady with a 2 cm palpable breast
lump on the right side .What is the next step.(*)
A. FNAC
B. Ultrasound
C. Lumpectomy
D. Mammography
E. Radical mastectomy
43. A lady with a palpable breast lump, FNAC
showed few malignant cells regarding
conservative
surgery what is true? (*)
A. Assess for oestrogen receptors
B. Bone marrow biopsy
C. Axillary lymph node sampling
D. Mammography
44. A lady with a breast cancer on left side
operated 2yrs ago now detects a small lump on
the right side .how do you explain the lump
A. Cancer arising de novo
B. Fibroadenoma
C. Metastasis from the previous one
45. facial nerve palsy can be associated with all
of the following except
A. chronic parotitis
B. Ca parotid
C. Acoustic neuroma
D. # base of the skull
46. A middle aged woman with deafness and
loss of corneal reflex but with no tinnitus
A. vestibular neuronitis
B. Menieres disease
C. Acoustic neuroma
D. Multiple sclerosis
47. Ptosis ,dysphagia ,ataxia ,on the same side
and spinothalamic loss on the opposite side:
A. vertebral artery occlusion
B. basilar artery occlusion
C. MS midbrain
D. Posterior communicating artery syndrome
(PICA)
48. 22yr old lady with diplopia. On closing the
right eye ,the medial side of the image is lost ( i.e
diplopia on looking laterally ) what is the
diagnosis
A. left 6th nerve palsy
B. left 3rd nerve palsy
C. right 6th nerve palsy
D. posterior cranial fossa tumour
49. Regarding a patient with hepatoma , which
of the following is least likely
A. Hepatitis B
B. Hepatitis C
C. Hemochromatosis
D. CMV
E. Alcoholic cirrhosis
50. In which of the following cell mediated
immunity is lost first followed by loss of
humoral immunity (*)
A. CLL
B. HIV
C. RA
51. which of the following is not a carcinogen (*)
A. EBV
B. CMV
C. Hep C
D. HIV
52. Picture of a lesion at the lateral angle of the
eye what is the treatment ( its a BCC) :
A. Surgical removal
B. Excision and radiation
C. Cryotherapy
D. Chemotherapy
E. Local steroids
53. Picture of swelling at the outer angle of the
eye .it is described as being hard and present
since birth:
A. Osteoma
B. Sebaceous cyst
C. Lipoma
54. picture of a large swelling on the back near
the left scapula
A. lipoma
B. sebaceous cyst
C. 2ndary breast
55. Picture of the face with a non itchy rash like
lesion on the cheeks, forehead.
A. SLE
B. Seborrheic dermatitis
C. Acne rosacea
D. Dermatomyositis
56. post operative specimen ( testicle with
epididymis )
A. TB
B. Epididymoorchitis
C. Teratoma
D. Torsion of testis
E. seminoma
57. A chest x ray of a child showing
consolidation > neutrophils increased. What
could be the cause
A. Klebsiella pneumonia
B. Group B streptococcus
C. Staphylococcus
D. Mycoplasma pneumonia
58. A lesion (looks like an ulcer) diagnosis?
A. Amelanotic melanoma
B. Implantation dermoid
C. Basal cell carcinoma
59. ECG- patient is a diabetic and he is
dyspnoeic .diagnosis(*)
A. Inferior wall MI
B. Anterior wall MI
C. Pericarditis
D. WPW syndrome
E. Pulmonary embolism
60. ECG patient has palpitations, otherwise
normal (*)
A. Atrial fibrillation
B. Atrial flutter with variable block
C. WPW syndrome with accelerated beats
61. ECG patient comes with sweating ,
palpitations
A. Ventricular ectopic
B. Ventricular tachycardia
C. Atrial fibrillation
D. RBBB
62. How do you treat WPW in a patient with a
previous history of collapse?
A. Beta blockers
B. Cardioversion
C. Radiofrequency ablation abnormal tract
D. Surgical ablation
D. Long term verapamil
63. 40 yr old man with SVT 160/min ..Patient
not arousable , Treatment is
A. cardioversion
B. adenosine
C. procainamide
D. verapamil
E. take an ECG
64. A child with heart rate of 220/min otherwise
normal , how do you manage
A. cold stimulus
B. Valsalva
C. Verapamil
D. DC shock
65. All of the following are side effects of depot
medroxyprogesterone , except(*)
A. Amenorrhoea
B. Weight gain
C. Depression
D. Used with oestrogen causes stratification and
cornification of vagina
E. hypotension
66. 20yr old man came with pain referring from
groin to loin to tip of penis brought a sample of
urine mixed with blood and asks for a shot of
pethidine to relieve his pain. What is the next step
A. give him an injection of pethidine to relieve his
pain
B. KUB
C. Ultrasound abdomen
D. Examine fresh urine sample
67. 12yr old boy with bee sting with wheeze
,with swollen lips ,tachycardia , restless,
immediate treatment(*)
A. adrenaline IM
B. hydrocortisone IV
C. oxygen
D. antihistamine
E. give NSAID and send him home
68. Young man with tachycardia, BP
90/70,Pulse 140 difficulty in breathing (*)
A. start two IV line to Hartmann
B. wide bore needle
C. tube drainage
69. RTA respiratory distress mediastinal shift to
opposite side with emphysema in the neck .what
is
the diagnosis
A. Tension pneumothorax
B. Hemothorax
C. Cardiac tamponade
D. Bronchial tear
70. Newborn male with normal genitalia , which
is true
A. 47xxy
B. 46xy with androgen insensitivity
C. mother treatment with cyproterone from 8
weeks
71. 16yr old girl came with her mother with no
menstrual , breast development is normal
(testicular feminisation)
A. 45xo
B. 46xy
C. Turner syndrome
72. After MVA a patient is dyspnoeic BP 100/70,
HR 110/min, Breath sounds decreased on left
side, heart sounds normal, JVP raised, next step
in management (*)
A. IV fluids
B. Wide bore thoracostomy
C. Tube thoracostomy
73. A patient with excruciating chest pain and a
diastolic murmur .what does the X-ray show (*)
A. widening of mediastinum
B. increased left ventricular size
C. trachea shifted to left
74. A child with fever malaise, sore throat
white papillae on the tongue and later a
sandpapery rash...what is the diagnosis
A. measles
B. rubella
C. scarlet fever
75. A child with fever of 3 days duration and a
rash develops when fever subsides
A. Rubella
B. Roseola
C. Erythema multiforme
76. An unconscious man (a known COPD case)
was brought to the emergency, on examination
there was a bruise on the parietal area and
needle mark in the cubital fossa. His ABG was
as follows (PH: 7.26, PCO2: 60, PO2: 50) His
previous ABG showed (PH: 7.35, PCO2: 30,
PO2: 60) .what is the diagnosis? (*)
A. Narcotic
B. Subdural haemorrhage
C. Subarachnoid haemorrhage
77. 16 weeks pregnant woman with proteinuria
3 +, hematuria, and hypertension (*)
A. PIH
B. Pre-existing renal disease
C. Essential hypertension
D. Pregnancy will continue until term
78. Which of the following is familial
A. papillary carcinoma
B. medullary carcinoma
C. follicular Ca
D. anaplastic
E. secondary Ca of thyroid
79. A patient with HIV and cough (respiratory
symptoms) has a Mantoux 5mm +ve , what is
the next step
A. INH prophylaxis
B. Zidovudine
C. Interferon
80. Patient with HIV +ve status ..what is true (*)
A. Life long infectivity
B. He has AIDS
C. Can transmit through saliva
D. He should avoid sexual intercourse
81. Tremor can be present in all of the following
except
A. hyperthyroidism
B. hypothyroidism
C. benign essential tremor
D. Parkinsonism
E. chronic liver disease
82. A lady with tremor on lifting the phone and
disappears when she looks at her hand with
mild
rigidity of the hand but no cogwheel rigidity. What
is the treatment?
A. Propranolol
B. Benzhexol
C. Levodopa
83. Complication of # of epiphyseal plate
A. retardation of longitudinal growth
B. joint stiffness
C. malunion
D. non-union
E. avascular necrosis
84. which of the following does not have any
interaction
A. warfarin & Isosorbitrate
B. verapamil & metoprolol
C. erythromycin & terfenadine
D. digoxin & amiodarone
85. 12yr old child weight 90th percentile with a
limp
A. Perthess disease
B. slipped capital femoral epiphyses
C. tibial synovitis
86. 13yr old child which would be the
appropriate bone age for a normal adult height
A. 9yr old
B. 13yr old
C. 18yr old
87. Regarding mammography, what is true?
A. It is painless
B. Can diagnose breast Ca earlier than self-
examination
C. More diagnostic for 70yr old
D. Definitive diagnosis of Ca breast
88. 10 days old boy with vomiting, serum
potassium is 7.7; serum Na is 118.what is the
diagnosis.
A. Pyloric stenosis
B. congenital adrenal hyperplasia
C. SIADH
D. Posterior cranial fossa tumour
89. A young boy has fever and limp. There is
tenderness at one point in the tibia; all
movements are full except flexion which is
restricted to 30degrees. what is the diagnosis?
A. Septic arthritis
B. Osteomyelitis
C. Perthes disease
90. 6 hours after difficult catheterisation, a
patient developed fever with chills
A. suppurative urethritis
B. gram negative septicaemia (bacteremia)
C. haemorrhage
91. Regarding hemochromatosis , diagnostic
investigation is
A. Sr. ferritin
B. Transferrin
C. Sr .Iron
D. Liver biopsy
92. In Australia the common cause of iron
deficiency is
A. Nutritional deficiency
B. Malabsorption
C. Diarrhoea
93. most common cause of bleeding P/R in
children
A. fistula in ano
B. fissure in ano
C. haemorrhoid
94. Patient with depression is treated with
antidepressants; following a course of treatment
she now wants to stop the drug .What do you
advice?
A. Follow up every week
B. Follow up every month
C. Admission to hospital
95. Child with abdominal mass and with
metastasis to skull
A. neuroblastoma
B. Willms tumour
C. retinoblastoma
96. A child babbles , sits for sometime
unsupported ,stands with support and holds an
object by the palm .what is the age (*)
A. 5 months
B. 7 months
C. 1year
D. 18 mon.
97. A patient with dysthymia for 2years
..treatment is (*)
A. SSRI + SSRI+ benzodiazepine
B. SSRI cognitive + behaviour therapy
C. SSRI
D. Antipsychotics +SSRI
98. A young patient vomits 1Litre of blood and
has 2 times malaena. what is next appropriate
step
A. Gastroscopy
B. Immediate surgery
C. Barium meal
99. old lady with knee swelling and has weekly
positive birefringent crystals ,the crystals
contain
A. calcium pyrophosphate dihydrate
B. calcium hydroxyapatite
C. urate
100. A patient is worried about the (sexual
dysfunction and depression) side effects of
sertraline. What would be the advice regarding
the same to the patient?
A. It is only side effect of antidepressant
B. both these side effects are not related to
sertraline
101. Young man after a RTA was found
unconscious only responds to painful stimuli
and eye cold stimuli what is the GCS score
A. GCS >3
B. 3 to 6
C. 6 to 9
102. child with fever and blisters in the palm
and sole and mouth ,there is lymphadenopathy
A. Coxsackies
B. Kawasaki
C. Herpes
103. All of the following are scaly lesions except
A. Keratoacanthoma
B. Squamous cell Ca
C. Pityriasis rosea
D. Psoriasis
104. Rash similar to syphilis except
A. Infectious mononucleosis
B. Atopic eczema
C. Discoid eczema
D. Tinea corporis
105. Pregnant lady with carpel tunnel syndrome
.what is true?
A. Surgical intervention is rarely needed
B. Splinting in hyperextension
C. Surgical correction
106. what is typical feature of carpal tunnel
syndrome
A. severe pain awakening the patient at night
B. pain in the ring and little finger
C. paresthesia restricted to median nerve
D. history of myxedema
107. 3rd day blues what is correct? (*)
A. Occurs at least in 50% after delivery
B. More common following C section
C. Always lead to psychosis
D. Results in more premature malformed children
108. regarding child abuse
A. more common in deformed ,premature and
LBW children
B. toddlers are more commonly affected
C. majority patients would have a psychiatric
disorder
D. other children in the family wont get affected
109. confidentiality can be broken in which of
the following situations
A. child abuse
B. when the police comes to ask
C. insurance matters
110. all are hepatotoxic except
A. paracetamol
B. OCPS
C. Halothane
D. INH
111. carcinomatous change can occur in all
except
A. Sjogrens syndrome
B. thyrotoxicosis
C. coeliac disease
112. 2yr old child with chronic respiratory
infection, what would you do?
A. Sweat chloride test
B. X ray chest
C. Barium meal
113. Child with chronic cough and rectal
prolapse, diagnosis?
A. Congenital megacolon
B. Cystic fibrosis
C. Whooping cough
114. 6 weeks old child on breast feeding with 4
days constipation and thriving well diagnosis?
(*)
A. Hirschsprungs disease
B. normal variant
C. hypothyroidism
D. acquired constipation
115. Which of the following is not associated
with brain metastasis?
A. Small cell Ca
B. Breast Ca
C. Renal Ca
D. Lung Ca
116. An elderly patient ,known case of Ca
rectum , on morphine has chronic constipation
and was treated with lactulose but was not
responding .what is the next step
A. Arrange a surgical consultation
B. Enema
C. P/R examination
D. Modify diet
117. All of the following are associated with
Raynauds except
A. RA
B. SLE
C. Scleroderma
D. Dermatomyositis
E. Ankylosing spondylitis
118. cause of diarrhoea in an old bed ridden
patient
A. faecal impaction
B. Carcinoma
C. Constipation
119. Haemolytic anaemia all are true except
A. Increased urobilinogen
B. Icterus and clear urine
C. MCV decreased
120. A child ingested washing powder half an
hour ago next management(*)
A. Admit to hospital and possible endoscopy
B. Charcoal
C. Sent him home
D. Syrup of ipecacuanha
E. Observe
121. Mother of an 18 month child was
concerned as it was not babbling .audiological
assessment was done when he was 10 months
old .what is the next step
A. Arrange audiometry
B. Repeat hearing test
C. Reassure the mother
122. 71/2 yr old girl attained menarche; her
mother noticed the breast growth and axillary
hair growth 6 months ago.
A. premature puberty
B. undiagnosed congenital adrenal hyperplasia
C. turner syndrome
123. In a young female patient what is the most
common cause of subarachnoid haemorrhage?
A. Ruptured aneurysms
B. Av malformations
C. Mycotic aneurysms
D. trauma
124. A neonate few hours after birth developed
cyanosis which was not responding to oxygen.
NO murmer is there. Diagnosis? (*)
A. Transposition of great vessels
B. Tetralogy of fallots
C. VSD
D. ASD
125. Lung Carcinoma seen in non smokers
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell ca.
D. Basal cell ca.
126. A child has facial movements and it is
increased on watching TV (question on tics).
They are present even during examination.
A. Myoclonic epilepsy
B. Tics
C. Partial complex epilepsy
D. Panic attack
127. In TNM staging which has a better
prognosis
A. T1 N0 M0
B. T1 N1 M0
C. T1 NI MI
128. 60 yr old female patient had repeated
bilateral thrombophlebitis and DVT cause
A. pancreatic Cancer
B. ovarian cancer
C. protein c deficiency
129. Most common cause of central cyanosis
A. Left to right shunt
B. Right to left shunt
C. CO poisoning
130. Regarding immunology what is correct?
A. Ig G associated with atopic eczema
B. Delayed hypersensitivity is T cell mediated
131. Why is it difficult to differentiate beta
HCG and LH
A. FSH high
B. LH high
C. Prolactin high
D. Progesterone low
132. Young hypertensive male with proteinuria,
hematuria and upper respiratory infection for 2
days .Diagnosis?
A. Ig A nephropathy
B. Glomerulonephritis
C. Nephrotic syndrome
D. Acute pyelonephritis
E. Membrane nephropathy
133. All of these can cause gynecomastia except
A. Spironolactone
B. Cimetidine
C. Labetolol
D. Digoxin
E. methyldopa
134. which of the following is least likely
associated with primary hypothyroidism
A. 72y/o with multinodular goitre
B. 28 y/o with menorrhagia
C. 9y/o with retarded bone age
D. 16y/o with anovulatory cycles
135. which of the following is incorrect :
A. alcohol reduces triglycerides
B. olive oil decreases HDL
C. increased LDL/HDL ratio is good
D. Taking 300 gms of fish daily does not reduce
cholesterol
136. Point prevalence in schizophrenia means
the
A. Current cases at that time
B. Cases in one year
C. The total number of cases
137. Regarding Diabetes mellitus what is true?
(*)
A. At least take 100gms of carbohydrate everyday
to prevent ketonuria.
B. If one parent has diabetes there is 1:8 chance of
getting affected.
C. You cant give insulin until level comes to
normal.
138. Regarding diabetic foot ,all are true ,except
(*)
A. 50% mortality following amputation
B. If the pulse is present patient is unlikely to have
it.
C. To have diabetic foot controlling glucose level
can help
139. Regarding 80% carotid artery stenosis.
What is true? (*)
A. The incidence of stroke will be halved
B. 40% stroke with out treatment
C. 50% incidence of stroke after endarterectomy
D. 40% death will occur within 30days
140. Spiral # of humerus which nerve damaged
A. Radial
B. Ulnar
C. Median
D. Volkmanns ischemia contracture
141. 50 yr old patient wakes up at night due to
pain in the calf which is relieved by walking.
What is the cause?
A. Ischemic pain
B. Raynauds phenomenon
C. Muscular cramps
D. DVT
E. Intermittent claudication
142. A patient with pain in the calf worsened by
elevation of feet
A. Ischemia
B. Nocturnal cramps
C. DVT
143. Which of the following feature is unlikely
to be due to arterial ischemia
A. Pain along the buttock and thigh after exertion
B. Weakness of the buttock and thigh
C. Shooting pain from buttock and thigh
D. Leg paralysis
144. Most common feature of rectal carcinoma
A. Tenesmus
B. Bleeding
C. Incomplete defecation
D. rectal prolapse
145. A patient after MVA sustained a pelvic #
and has blood in the external meatus ,initial
investigation of choice is (*)
A. Urethrogram
B. CT scan
C. Cystoscopy
D. Catherisation
E. IVU
146. Regarding uncomplicated haemorrhoids all
are true except
A. Pain
B. Pruritus
C. Bleeding
D. Prolapse
E. Mucus discharge
147. Regarding PMS what is true?
A. 5% have very severe symptoms
B. 40% have PMS
C. all patients with PMS always have
dysmenorrhoea
148. Patient mechanic with penetrating hand
injury. What is true? (*)
A. Drainage should be done from extensor surface
B. It indicates that there is extension of the palmar
abscess into extensor aspect
C. The swelling is due to oedema
D. It indicates the involvement of extensor tendons
149. Apathetic and dull are the negative
symptoms of schizophrenia. Which is the other
negative symptom (*)
A. Catatonia
B. Blunted affect
C. Cataplexy
150. A patient who is aware about his own
problems during treatment .what is it ? (*)
A. Instinct
B. Insight
C. Pseudo altruism
D. Intellectualisation
151. In chronic liver failure (obstructive
jaundice) whats true
A. Vitamin K absorption is reduced
B. Prothrombin cannot be converted to thrombin
C. Chronic hepatitis
152. In hemochromatosis after venesection all
are true except
A. Skin pigmentation becomes normal
B. Cardiac siderosis is reversible
C. Hepatoma can be cured
153. In hemochromatosis
A. size of the liver is decreased following
treatment
154. A patient with perforated peptic ulcer all
are correct except
A. Patient remembers exactly the moment of
rupture
B. Back pain
C. Vomiting
D. Board like rigidity
E. Guarding
155. Concerning cluster headache all are correct
except
A. vomiting
B. treat with methysergide
C. occurs after 3-4 hrs of falling asleep
D. occurs at the same time of the day
156. A young man with throat infection in child
hood and was treated with penicillin ..He now
comes with a fear of developing a rash due to
penicillin as he was influenced by his friends
words.
What does he have?
A. Induced delusion
B. Hypochondriasis
157. young man with needle marks and pin
point pupils ,gag reflexes are normal ,no
extensor plantar reflexes(*)
A. opiate ingestion
B. temporoparietal #
158. A young man with left sucking wound in
the chest .After initial airway resuscitation and
circulation management what is the next step(*) C.
A. Debridement and closure
B. Pressure bandage
C. IV fluids
159. Which infection is least likely during
childbirth?
A. Syphilis
B. Gonorrhoea
C. Streptococcal
D. HIV
E. Herpes
160. Appropriate Estimation of the foetal
gestational age is by (*)
A. Transvaginal ultrasound at 8 weeks
B. Bimanual examinations at 8 weeks
C. Ultrasound at 18 weeks
D. Transvaginal ultrasound at 18 weeks
161. Regarding OCP what is the absolute
contraindication?
A. Focal migrainous hemiplegia
B. Hypertension
C. Diabetes
162. Regarding OCP what is correct? (*)
A. All the progesterones except cyproterone have
derived from testosterone
B. Derive from oestrogen
C. Derive from progesterone
163. Young man with severe joint pain and
profuse bleeding from venipuncture site.
Diagnosis? (*)
A. DIC
B. Thrombophlebitis
C. Clotting defect
164. All are true regarding DIC except (*)
A. Fibrin decreased
B. FDP decreased
C. PTT increased
165. intermittent claudication commonest site
A. profunda femoris
B. superficial femoral artery
C. posterior tibial artery
D. bifurcation of abdominal aorta
E. external iliac artery
166. Which defence mechanism is mature?
A. Denial
B. Projection
C. Introjection
D. Humour
167. Undescended testis is most commonly
associated with (*)
A. Torsion of testis
B. Spermatogenesis will be perfect if the operation
is done before 3 years
C. Development delay of the child
D. Acute epididymitis
E. Hernia
168. G3P0 pregnant lady came to you at 16
weeks pregnancy .She had two spontaneous
abortions
at 17 and 18 weeks in the previous pregnancies
.how do you treat?
A. Chromosomal analysis
B. Cervical stitch
C. Complete bed rest
169. Regarding Mullerian agenesis all of the
following is true except
A. Short vagina
B. Normal breast development
C. X linked recessive
170. What would be the most likely cause for
bloody discharge from the nipple in a 50 year old
lady?
A. Intraductal papilloma
B. Intraductal carcinoma
C. Pagets disease
D. Fibrocystic disease
171. The relative marker in Hepatocellular
carcinoma is
A. PSA
B. CA125
C. CEA
D. CA153
E. AFP
172. Treatment of seminoma stage 2 with
metastasis to the para-aortic lymph nodes
A. Radio therapy to testis and nodes
B. Surgery and radiation to Para aortic nodes
C. Chemotherapy
D. Surgery
173. 70 year old woman with vaginal prolapse
with ring pessary what is the complication (*)
A. atrophic vaginitis
B. cervical carcinoma
C. decubitus ulcer
D. carcinoma of vagina
174. After splenectomy you expect all of the
following except (*)
A. Life long increased risk of infection
B. Transient increased platelets to predispose to
thrombosis
C. Persistent decrease of RBC life span
D. Decrease in anaemia
175. Diabetic mother after prolonged labour
delivered a jittery baby which responds to
oxygen
..what is the diagnosis
A. Hyperglycaemia
B. Hypoglycaemia
C. Meconium aspiration
D. Hyperbilirubinemia
176. Splenectomy is most beneficial in which of
the following
A. Haemophilia
B. Chronic ITP
C. Myelofibrosis
177. A middle aged man unable to fall asleep
has night mares and remembers his daily
activities diagnosis?
A. Anxiety disorder
B. Depression
C. OCD
D. Insomnia
178. Alcoholism is associated with all of the
following except
A. Substance abuse (benzodiazepine)
B. Depression
C. OCD
179. Proteinuria is seen in all of the following
except
A. congenital nephritis
B. RPGN
C. UTI
D. RA
E. Horseshoe kidney
180. Tourette syndrome ; all are correct except
A. Motor and vocal tics are seen
B. 2 or more bouts per day
C. the person is not distressed with vocal tics
D. coprolalia is less than 10%
E. onset always less than 18 years of age
181. A 35 year old lady has a grey greenish
vaginal discharge, microscopy shows clue cells,
and she responded well to metronidazole
.diagnosis (*)
A. Chlamydia
B. Bacterial vaginosis
C. Trichomoniasis
D. Moniliasis
182. Regarding stammering which is correct
A. spontaneous resolution at 16years
B. resolution after 2 year.
C. No resolution in life
D. Operative measure
183. Still birth after a normal delivery. all of the
following tests are done except
A. Kleihaur test
B. Chromosomal analysis
C. Foetal parts
D. Maternal antibodies
E. Foetal post-mortem
184. Polyhydramnios all are true except
A. Rh incompatibility
B. Oesophageal atresia
C. bladder neck obstruction
D. Anencephaly
185. Polyhydramnios see in all except
A. Diabetes
B. Multiple pregnancy
C. Cardiac anomalies
D. Hydrops fetalis
186. Child with greyish tonsillar exudate and
atypical lymphocytes
A. Infectious mononucleosis
B. CMV
C. ALL
187. Urge incontinence all are true except (*)
A. Colposuspension
B. Taping the vagina
C. Pelvic exercise
D. Weighted vaginal cones
188. (Regarding Rubella and pregnancy) a
kindergarten teacher 6 weeks pregnant had one
of her student with rubella .all are true except
A. immunoglobulins
B. IgG is increased initially then IgM
C. Antibody measure and repeat SRH after 10 days
D. If mother infected early then child can have
microcephaly, seizures and cataracts
189. A patient with pyloric stenosis vomiting a
lot and vomitus contains undigested food
material
taken 2 days back. What is the initial management?
A. Normal saline
B. Hartmanns
C. Ringer lactate
190. daily requirement of potassium
A. 50mmol
B. 1gm
C. 30mmol
191. In pyloric stenosis vomiting is
A. Intermittent
B. Occurs 1hour after food
C. 2 days after food
192. A man with abdominal pain x ray showed
multiple fluid levels .what is the management
A. 2 litres RL
B. 2 litres Hartmanns before surgery
C. 2 litres Hartmanns after surgery
D. 2 litres Hartmanns after surgery
193. regarding antibiotic prophylaxis what is
true
A. single dose is sufficient when compared to
multidose
B. urologic surgery needs a culture for the specific
antibiotic
194. 4 year old child constipated ,rectum empty
and sphincter tone lax ,mass at the apex of
rectum
A. Hirschsprungs
B. acquired megacolon
C. hypothyroidism
195. hypercalcemia seen in all except
A. hyperparathyroidism
B. pancreatitis
C. RTA
196. 3 year old girl with periorbital oedema
,protein 3+, all are true except
A. prednisolone will impr

answers..psychiatry
1...b
2...e
The diagnostic criteria for pyromania are:
deliberate and purposeful firesetting on more than
one occasion;
tension or emotional arousal before the act;
intense interest, curiosity or fascination about fire
(which can include fire equipment and the
consequences of fire);
pleasure, gratification or relief when setting or
witnessing fires and their aftermath;
the firesetting is not done for another motive such
as financial gain, anger or revenge, to gain
recognition or to relieve boredom, and is not done
in response to a delusion or hallucination or due
to impaired judgment (such as through
intoxication); and
the firesetting is not better accounted for by
conduct disorder, antisocial personality disorder or
a
manic episode.
3...c
4...a
5...d
6...b
7...b
8...d
9...a
10...c
11...f
12...a
13...b
14...e
15...e
16...e 6 weeks post partum
17...b...not sure ,this is what happens in seasonal
dysthymic disorder
18...a Delusion
A delusion is commonly defined as a fixed false
belief and is used in everyday language to describe
a belief that is either false, fanciful or derived from
deception.
19...
20...e
21...d
22...a
23...b...also in alcoholism and cocaine addiction
24...e
25...b
26...b
27...c
28...developed what
29...a????
32....fear is a common cause
33...a
35...c
37...b
38...a
39...d
41...a
43...a
44...a
45...a
46...b

MEDICINE
1...b....in ant.dislocations
3...c
4...c
5...d
6...a
7...d
8...a
9...c
10...b
11...c
12...b
13...d
14...d
15...c
16...b
17...b
18...c
19...c
22...c
23...c
24...d
26...c
27...e...
28...e
29...a
30...d
31...e....not sure
32...b.......not sure
34...d
35...b
36...c
37...a
38...d
39...c
41...c
43...c
44...c
46...c
47...c
48...c
49...c
50...b
51...c
52...d...????
53...advice to stop taking pills from the this pack
that will initiate bleeding and start another .
54...a
55...c
56...a
57...d
58...c
59...a???
60...c
61...???
62...e
63...a
65...d
66...c ....its 41 weeks!
67...c..b/c volkmann contractures r common in this
injury
68...b
69...a though all epiphyseal # dont cause growth
retardation..it depends on severity of injury,
invovement of growth plate
70...e....if it is "hypoplasia
MEDICINE, SURGERY , OBSTETRICS AND
PSYCHIATRY
1...b
2...a
3...c
4...b
5...c...US ?????
6...all r false except d
7...d...afterload reducers r not used in AS.
8...d
9...b
10...a
11...a
12...c caused in this age group by S. pnemoniae,
H.influenzae and staphlococcus.
13...b...excessive crying causes cyanosis
14...b
15...c????
16...c
17...c???
18...a
19...a
20...b...b/c the most common cause of scrotal pain
in infants and children is torsion f testes
22...b ...
23...b
24...b
25...c
26...b
28...d????
30...b
31...a
32...c ????? anyone??
33...b
34...c
35...e
37...b
38...e
39...d
40...a
41...b
42...a
43...c
44...a
45...a
46...d ...c can also be true b/c sometimes acoustic
neuroma patients dont complain of tinnitis.
47...D
PICA =posterior inf cerebellar artery .
Lateral medullary syndrome (also called
Wallenberg's syndrome and posterior inferior
cerebellar
artery syndrome) is a disease in which the patient
has difficulty with swallowing or speaking or
both owing to one or more patches of dead tissue
(known as an infarct) caused by interrupted
blood supply to parts of the brain.
This syndrome is characterized by sensory deficits
affecting the trunk and extremities on the
opposite side of the infarct and sensory and motor
deficits affecting the face and cranial nerves on
the same side with the infarct. Other clinical
symptoms and findings are ataxia, facial pain,
vertigo,
nystagmus, Horner's syndrome, diplopia and
dysphagia. The cause of this syndrome is usually
the
occlusion of the posterior inferior cerebellar artery
(PICA) at its origin.
The affected persons have difficulty in swallowing
(dysphagia) resulting from involvement of the
nucleus ambiguus, and slurred speech (dysphonia,
dysarthria). Damage to the spinal trigeminal
nucleus causes absence of pain on the ipsilateral
side of the face, as well as an absent corneal
reflex.
The spinothalamic tract is damaged, resulting in
loss of pain and temperature sensation to the
opposite side of the body. The damage to the
cerebellum or the inferior cerebellar peduncle can
cause ataxia.
48...c
49..d
50...b
51...b
52...a
54...a
57...d???
62...c
63...a
65...e
66...d
67...O2 then adrenaline
69...a
74...c
75...b
76...a
77...b
78...b
79...a
80...a
81...b
82...a
83...a
84...a
86...b
87...b
88...b
89...b
90...b
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Posted by BANDA at 10:09 AM
Labels: MCQs, Study Material
Tuesday, October 6, 2009
HIV AND "SKIN"
Fungal/yeast

1 Candida (oral or oesophageal)
2 Tinea infections (corporis,
cruris, pedis, interdigitale etc)
3 Pityriasis versicolor
4 Seborrhoeic dermatitis
(especially when severe or
recalcitrant)
5 Pityrosporum folliculitis

Viral

1 Herpes zoster
2 Herpes simplex
3 Viral wart infections
4 Molluscum contagiosum
Bacterial
5 Staphylococcus aureusimpetigo,
chronic folliculitis
Mycobacterial
6 M tuberculosis
Infestations
7 Scabies (especially Norwegian
scabies)

Other

1 Psoriasis
2 Kaposis sarcoma
3 Acne

All of these skin conditions can
occur without HIV, but consider
HIV particularly if they are
recalcitrant, recurrent or atypical.
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Posted by BANDA at 10:52 AM
HIV Presentation
Acute HIV-related conditions that may present
in the emergency
department



1. Community acquired bacterial pneumonia.
People with HIV, regardless of their level of
immunosuppression, are more at risk of bacterial
pneumonia. They have similar signs
and symptoms to the non-HIV-infected population,
eg fever, cough, dyspnoea,
increased respiratory rate and sputum production.

2. TB presents with malaise, weight loss, night
sweats, fever, cough, sputum production
(may be blood-stained), and lymphadenopathy.
3. Pneumocystis pneumonia (PCP) presents with
exertional dyspnoea, fever, dry cough,
normal auscultation. X-ray typically shows
perihilar shadowing (ground glass haze),
but may be normal.
4. Cryptococcal meningitis. This presents with
headache, with or without classical signs
of meningism. Occasionally rapid progression
occurs, and the patient may present in
coma.
5. Cerebral toxoplasmosis. This may present with
headache, fever, lethargy and
confusion, progressing to fits and coma.
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Posted by BANDA at 10:43 AM
Thursday, September 24, 2009
EPILEPSY MANAGEMENT
Treatment of status epilepticus in hospital.


1.Immediate measures Secure airway

Give oxygen
Assess cardiac and respiratory function
Secure iv access
Give lorazepam 4 mg iv or diazepam
10 mg iv
Repeat after 10 mins if no response

2.In hospital


Take blood for electrolytes, LFT, calcium,
glucose, clotting, AED levels and storage
for later analysis
Measure blood gases
Establish aetiology
Give thiamine or 50% glucose solution if
indicated
Within 30 minutes In patients with established
epilepsy:
give usual AED orally, NG or iv

3.In patients with new-onset epilepsy or if
seizures continue:

fosphenytoin (18 mg/kg phenytoin
equivalent), up to 150 mg/min with ECG
monitoring or phenytoin 18mg/kg,
50 mg/min with ECG or phenobarbital
15 mg/kg iv, 100 mg/min
Longer than ITU may be necessary
minutes Anaesthetise with EEG monitoring
Midazolam, phenobarbital, propofol, or
thiopentone most commonly used
Non-convulsive status Augment or reinstate usual
AEDs
Consider lorazepam or diazepam iv
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Posted by BANDA at 10:12 PM
PNEUMONIA INFECTIOUS AGENTS
1.Haemophilus influenza -Smokers, COPD
2.Mycoplasma --------Young, otherwise healthy
patients
3.Legionella --------Epidemic infection in older
smokers, particularly when located near infected
water sources, such as air-conditioning systems

4.Pneumocystis jiroveci (formerly carinii)
pneumonia HIV-positive persons with <200 CD4
cells not on prophylaxis.
5.Coxiella burnetti (Q-fever) Exposure to animals,
particularly at the time they are giving birth
6.Klebsiella Alcoholics
7.Staphylococcus aureus Following viral
syndromes or viral bronchitis, especially influenza
8.Coccidioidomycosis Exposure to the deserts of
the American Southwest, particularly Arizona
9.Chlamydia psittaci Exposure to birds
10.Histoplasma capsulatum Exposure to bat or bird
droppings, spelunking (recreational cave
exploration)
11.Bordetella pertussis Cough with whoop and
post-tussive vomiting
12.Francisella tularensis Hunters, or exposure to
rabbits
SARS, Avian injluenza Travel to Southeast Asia
13.Bacillus anthracis, Yersinia pestis, and
Francisella tularensis Bioterrorism
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Posted by BANDA at 10:06 PM
Labels: MCQs, Medical Exams, Study Material
Sunday, August 16, 2009
ANDROGEN DEFICIENCY IN MALE
Symptoms and signs suggestive of
androgen deficiency in men

Incomplete sexual development, eunuchoidism,
aspermia
Reduced sexual desire (libido) and activity
Decreased spontaneous erections
Breast discomfort, gynecomastia
Loss of body (axillary and pubic) hair, reduced
shaving
Very small or shrinking testes (especially < 5
mL)
Inability to father children, low or zero sperm
counts
Height loss, low-trauma fracture, low bone
mineral
density
Reduced muscle bulk and strength
Hot flushes, sweats
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Posted by BANDA at 11:10 PM
Labels: MCQs
Wednesday, August 12, 2009
AUTOSOMAL DOMINENT
CONDITIONS
Autosomal dominant inheritance is seen in:


Achondroplasia, Acute intermittent porphyria,
Adult polycystic kidney disease, Ehlers-Danlos
syndrome, Familial adenomatous polyposis,
Gilbert's syndrome, Hereditary sensory and motor
neuropathy, Hereditary spherocytosis, Huntington's
disease, Hyperlipidaemia type II, Malignant
hyperthermia, Marfan's syndrome, Myotonia
congenita, Myotonic dystrophy,
Neurofibromatosis, Osteogenesis imperfecta type
1, Noonan's syndrome, Polyposis coli, Rotor
syndrome, Retinoblastoma, Tuberose sclerosis,
Von Hippel-Lindau disease, von Willebrand's
disease
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Posted by BANDA at 9:47 AM
Saturday, June 6, 2009
ISOTRETINOIN IN ACNE
Features of oral isotretinoin treatment
For patients with severe acne
For patients unresponsive to conventional therapy
For acne patients experiencing psychological
distress
Extremely effective, as it targets all causes of
acne
Duration of treatment and daily dose are
individualised
Low starting dose is used that may be gradually
increased, as
tolerated
Side effects are usually manageable
Warn of mood changes and the potential risk of
depression
Warn about contraception and teratogenicity
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Posted by BANDA at 5:19 PM
ISOTRETINOIN IN ACNE
Features of oral isotretinoin treatment
For patients with severe acne
For patients unresponsive to conventional therapy
For acne patients experiencing psychological
distress
Extremely effective, as it targets all causes of
acne
Duration of treatment and daily dose are
individualised
Low starting dose is used that may be gradually
increased, as
tolerated
Side effects are usually manageable
Warn of mood changes and the potential risk of
depression
Warn about contraception and teratogenicity
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Posted by BANDA at 5:19 PM
ACNE TREATMENT
Tips for antibiotic
therapy

Do not use topical and
oral antibiotics at the
same time
Use oral antibiotics for a
6-12-week course
If a longer course of oral
antibiotics is required, use
benzoyl peroxide for a
week between courses
Warn of side effects of
antibiotic therapy,
particularly
photosensitivity with
doxycycline
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Posted by BANDA at 5:16 PM
ACNE MANAGEMENT
IMPORTANT POINTS HISTORY AND
EXAMINATION


History

How long have you had
pimples for?
Are there any triggers?
Is there a family history?
What treatments have you
had? How long did you
follow each treatment?
What was the most
effective treatment? Why
did you stop it?
How do you feel about
your skin? Does it stop
you from doing anything?

Examination

Assess the severity and
whether there is any
scarring.
Determine any
psychological impact.
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Posted by BANDA at 5:05 PM
Saturday, May 30, 2009
Lethal In Low Doses
Box 1: Nine ingestants that can be
lethal in toddlers in low doses
Calcium channel blockers
Camphor
Imidazolines (eg, clonidine)
Cyclic antidepressants
Lomotil
Opiates
Salicylates
Sulphonylureas
Toxic alcohols
Note: Not in order of lethality
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Posted by BANDA at 11:45 PM
Friday, May 1, 2009
Preventing Recurrent DVT
A patient with successfully treated
DVT remains at increased risk of
DVT or PE for life and will need prophylaxis
at times. Prophylaxis (with,
for example, enoxaparin 40mg daily)
should begin 12 hours before elective
surgery.
In orthopaedic surgery, it should
be continued at this dose for three
weeks after discharge from hospital2.
Early remobilisation and compression
stockings should be used routinely
for all surgery. Intra-operative
calf compression machines are often
used in prolonged elective surgery.
High-risk medical patients (eg,
those likely to be inpatients for more
than five days) should receive routine
prophylaxis whether or not they
have had a prior DVT.
Seek advice if the patient has renal
impairment because LMW heparins
accumulate quickly in patients with
moderate to severe renal failure.
All women with previous DVT or
artificial heart valves should receive
daily heparin prophylaxis during
pregnancy. Haematological review is
recommended in those with diagnosed
thrombophilia (deficiency of
anti-thrombin III, protein C or S,
mutations of factor V or prothrombin
genes), as more intense prophylaxis
may be needed in some.
Patients with a past history of
DVT who are planning air travel for
more than four hours should be
given recommendations in writing:
Self-inject 40mg enoxaparin before
each separate flight (not including
refuelling stops)
Ask for a seat with good leg room
Accept every non-alcoholic
beverage offered
Minimise alcohol consumption
Perform in-seat exercises recommended
by the airline.
National guidelines do not recommend
frequent walking around the
cabin because of the risk of turbulence.
Aspirin does more harm than
good in air travellers.
References
Current Diagnosis of Venous Thromboembolism
in Primary Care: A Clinical Practice Guideline,
American Academy of Family Physicians and
the American College of Physicians.
Annals of Internal Medicine: p57- 62: Vol 5:
No 1: January/February 2007
1. Palareti G., Cosmi B., Legnani C., et al. DDimer
Testing to Determine the Duration of
Anticoagulation Therapy. N Engl J Med 2006;
355:1780-1789, Oct 26, 2006.
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Posted by BANDA at 7:02 AM
Preventing Recurrent DVT
A patient with successfully treated
DVT remains at increased risk of
DVT or PE for life and will need prophylaxis
at times. Prophylaxis (with,
for example, enoxaparin 40mg daily)
should begin 12 hours before elective
surgery.
In orthopaedic surgery, it should
be continued at this dose for three
weeks after discharge from hospital2.
Early remobilisation and compression
stockings should be used routinely
for all surgery. Intra-operative
calf compression machines are often
used in prolonged elective surgery.
High-risk medical patients (eg,
those likely to be inpatients for more
than five days) should receive routine
prophylaxis whether or not they
have had a prior DVT.
Seek advice if the patient has renal
impairment because LMW heparins
accumulate quickly in patients with
moderate to severe renal failure.
All women with previous DVT or
artificial heart valves should receive
daily heparin prophylaxis during
pregnancy. Haematological review is
recommended in those with diagnosed
thrombophilia (deficiency of
anti-thrombin III, protein C or S,
mutations of factor V or prothrombin
genes), as more intense prophylaxis
may be needed in some.
Patients with a past history of
DVT who are planning air travel for
more than four hours should be
given recommendations in writing:
Self-inject 40mg enoxaparin before
each separate flight (not including
refuelling stops)
Ask for a seat with good leg room
Accept every non-alcoholic
beverage offered
Minimise alcohol consumption
Perform in-seat exercises recommended
by the airline.
National guidelines do not recommend
frequent walking around the
cabin because of the risk of turbulence.
Aspirin does more harm than
good in air travellers.
References
Current Diagnosis of Venous Thromboembolism
in Primary Care: A Clinical Practice Guideline,
American Academy of Family Physicians and
the American College of Physicians.
Annals of Internal Medicine: p57- 62: Vol 5:
No 1: January/February 2007
1. Palareti G., Cosmi B., Legnani C., et al. DDimer
Testing to Determine the Duration of
Anticoagulation Therapy. N Engl J Med 2006;
355:1780-1789, Oct 26, 2006.
2. TGA-approved product information for
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Posted by BANDA at 7:02 AM
DVT FACTS
1. The surgical or sick medical
patient is the classic high-risk
person for DVT.
2.High clinical suspicion and a
positive D-dimer mandate further
investigation.
3.If suspicion is high, treatment for
DVT or PE should be started as
soon as the diagnosis is
suspected, not delayed for
confirmatory imaging studies.
Many DVTs are unprovoked,
especially in males.
4.Testing INR too often wastes
resources and leaves you making
frequent dose changes to chase
your tail.
5.Electing to continue warfarin for
12 months delays recurrence of
VTE but does not eliminate it.
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Posted by BANDA at 6:52 AM
Friday, April 17, 2009
INVESTIGATIONS OF INFECTIVE
SYMPTOMS IN PREGNANCY
Clinical presentation Possible diagnosis
Investigations

Maculopapular rash Rubella IgM and IgG*
Parvovirus IgM and IgG*
Enterovirus Throat or faecal culture


Vesicular rash Varicella Rash IgM and IgG* if
uncertain
Enterovirus Throat or faecal culture


Flu-like symptoms CMV IgM and IgG*
(fever, myalgia, malaise, LFTs, FBC
+/- lymphadenopathy) Toxoplasmosis IgM and
IgG*
Listeriosis Blood and faecal culture
Other viral infections Serology or culture as
required


*In parallel with previous
antenatal serum and 2-4 weeks later if required
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Posted by BANDA at 5:44 AM
PREPREGNANCY COUNSELLING.
GPs should encourage couples who are planning
to conceive to have counselling and
testing before conception.
Tests for infection should include:
rubella IgG
syphilis serology TPHA or RPR
hepatitis B serology hepatitis B
surface antigen
hepatitis C serology hepatitis C antibody
HIV
varicella IgG
CMV IgG (in high-risk patients)
Women who have negative rubella serology
should be offered MMR vaccine and
retested for rubella seroconversion eight
weeks later. About 5% will need revaccination.
A very small number of women will
remain rubella seronegative despite two successive
MMR vaccinations.
It is unlikely that further vaccination will
lead to seroconversion. In these cases it is
best to counsel the woman to avoid rubella
contact in her subsequent pregnancy.
Women found negative to varicella IgG
should be offered varicella vaccine with two
doses, eight weeks apart. Pregnancy should
be delayed until eight weeks after vaccination
for rubella or varicella.
In those at high risk of CMV infection
(carers of young children), CMV IgG should
also be measured.
Seronegative women should be counselled
to practise thorough hygiene when in
contact with secretions of newborn infants
and toddlers.
A pre-pregnancy session will also allow
the GP to provide nutritional advice and
instructions on ways to minimise risks of
infection with toxoplasmosis, listeria and
other infections.
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Posted by BANDA at 5:35 AM
Monday, April 13, 2009
SIGNS OF A PERFORATED EYE
an irregular or peaked pupil
a shallow anterior chamber
compared to the other eye
absent or diminished red
reflex
a boggy haemorrhagic
swelling over the sclera
uveal tissue, which is dark,
lying external to the globe
Note: not all these signs need
be present.
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Posted by BANDA at 6:40 AM
EYE EXAMINATIO TOOLS
a vision chart
a light source with a cobalt
blue filter
a means of magnification such
as loupes (or a pair of +3.0
chemists glasses)
amethocaine drops to
anaesthetise the ocular surface
fluorescein drops to stain any
epithelial defects
cycloplegic drops to dilate the
pupil
an ophthalmoscope to visualise
the red reflex and/or posterior
segment of the eye
cotton buds to wipe up any
secretions and help evert the
upper lid.
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Posted by BANDA at 6:33 AM
Sunday, April 5, 2009
Diagnosis of metabolic Syndrome
The size of the waistline is the key
to selecting patients to investigate.
People who are genetically predisposed
and who take in an excessive
amount of calories are most
likely to develop this condition.
The lean man with a pot belly, a
shape seen commonly in general
practice, could be considered the
most toxic shape of all.
Objective assessment of known
risk factors (cholesterol, fasting
lipids, blood glucose level, blood
pressure, smoking, obesity and
sedentariness) is also necessary.
Risk factors for metabolic syndrome
often cluster together and have
a multiplicative rather than an additive
effect. In women, it is the level
of fasting triglycerides, rather than
cholesterol, that predicts subsequent
cardiovascular disease and death.
Waist target parameters have
tightened over time and vary according
to genetic polymorphism (see
table below).
If BMI is >30kg/m2, central
obesity can be assumed and waist
circumference does not need to be
measured. Abnormal blood glucose
should be investigated with a
glucose tolerance test.
About a third of patients with diabetes
will be picked up by the
glucose tolerance test compared with
just focusing on the fasting glucose.
Obesity and central adiposity
seem to co-segregate, not only with
cardiovascular and diabetes risk, but
also with an increased risk of certain
types of malignancy, such as breast
and endometrial cancer.
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Posted by BANDA at 7:14 PM
METABOLIC SYNDROME
the International
Diabetes Federation published a consensus
worldwide definition of metabolic syndrome.
It is defined as central obesity in
concurrence with any two of the following
factors: raised triglycerides, reduced HDL
cholesterol, raised blood pressure or raised
fasting plasma glucose
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Posted by BANDA at 7:06 PM
METABOLIC SYNDROME
the International
Diabetes Federation published a consensus
worldwide definition of metabolic syndrome.
It is defined as central obesity in
concurrence with any two of the following
factors: raised triglycerides, reduced HDL
cholesterol, raised blood pressure or raised
fasting plasma glucose
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Posted by BANDA at 7:06 PM
METABOLIC SYNDROME
the International
Diabetes Federation published a consensus
worldwide definition of metabolic syndrome.
It is defined as central obesity in
concurrence with any two of the following
factors: raised triglycerides, reduced HDL
cholesterol, raised blood pressure or raised fasting
plasma glucose
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Posted by BANDA at 7:06 PM
Friday, April 3, 2009
CASE STUDY
CASE ONE

A mother brings her six-year-old
son to your emergency department.
He was practising his Power
Ranger moves in the familys
split-level living room and leapt
from the upper to the lower level,
landing heavily on his feet. He
complains of neck pain but no
other symptoms.
What features are present on
inspection?
He has a torticollis, and is in some
degree of pain.
What immobilisation is
indicated?
This child would not fit into a collar.
Forcing the issue would create further
pain and distress and may exacerbate
an injury. He should be allowed to
adopt a position of comfort, with
padded support if necessary, and
given simple analgesia as required.
What imaging is indicated?
X-rays are indicated as an initial investigation,
but should be interpreted
with care, with recognition that in
this age-group plain X-rays are
known to be poorly sensitive.
What is the injury?
X-rays showed an anterior subluxation
of C2 on C3. In this particular
case, injury was missed on two presentations,
as the treating doctor interpreted
the X-rays as normal and
assumed a muscular strain. Relying
on negative X-rays in this age
group is a classical error the
history and examination (inspection)
give the diagnosis.
Neck pain after play mishap
X-rays are indicated for the boy but
should be interpreted with care.
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Posted by BANDA at 8:05 AM
CERVICAL SPINE CLEARING
1. The awake, alert patient, with no other
significant injuries.
Bony and ligamentous
injury to the cervical spine and its supporting
structures is intrinsically painful and also
causes pain because of secondary muscle
spasm. Patients in this category can tell you
where it hurts, and are able to respond adequately
to examination.
If these features are present, the neck can
be cleared clinically:
No midline cervical tenderness
No focal neurological deficit
Normal alertness
No intoxication
No painful distracting injury
50% or greater active range of movement
in all planes.
If any of the first five features are present,
standard plain three-view X-rays are indicated.
These three views should include a
lateral view (to include all seven cervical
vertebrae and enough of the first dorsal vertebra
to demonstrate alignment), an anterior-
posterior projection, and an openmouth
odontoid view.

2. The mentally obtunded patient.

Thisgroup is the most difficult to assess accurately.
They may be affected by intoxicants,
head injury, hypoxia, shock or pain, or by a
combination of these factors. They need careful
clinical assessment and imaging, and are
at high risk of having a spinal injury and it
may be masked.
X-rays are often of sub-standard quality
in this group for several reasons, including
poor co-operation leading to difficulty visualising
C7-T1 junction and difficulty
getting the open mouth peg view. Plain
X-rays of good quality, which include the
C7/T1 junction and the odontoid peg/C1/occipital
junctions, are needed to clear the neck
for most patients and swimmers views
and/or obliques may be needed.
Those patients with a significant head
injury, requiring CT scanning of the brain,
should also have CT scanning of the craniocervical
junction and often the rest of the
neck as well. Patients with other significant
injuries, whether spinal, chest, abdomen or
pelvic, often require CT scanning, and clearance
of the cervical spine using CT should
be done then.
3. The patient who clearly has a spinal
injury.

This is the easiest group for decisionmaking!
They may have evidence of a spinal
cord injury, or displaced fracture on plain
X-rays, or other myelopathic or radiculopathic
symptoms or signs that will require
specialist consultation. They need transfer
for detailed imaging such as CT and/or MRI,
as well as treatment.
4. The patient with other injuries requiring
transfer to a higher-level facility. Plain Xrays
should be performed and the need for
continued immobilisation discussed with
the referral centre.
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Posted by BANDA at 7:45 AM
Thursday, April 2, 2009
Non-ulcer dyspepsia

Functional or non-ulcer dyspepsia is defined as at
least three
months of dyspepsia in which no definite
biochemical or
structural cause can be found to explain symptoms.
There
is no confirmatory test and the diagnosis can only
be made
after exclusion of the aforementioned structural
causes.
A diagnosis of non-NSAID, non-H pylori ulcer
should
only be entertained after:
exclusion of surreptitious NSAID use
careful exclusion of H pylori infection by several
biopsies
use of more than one H pylori diagnostic test
exclusion of confounders that would alter the
sensitivity
of these tests, such as concurrent proton pump
inhibitor
(PPI) use, recent antibiotic therapy or
gastrointestinal
bleed.
Management involves 4-8 weeks of PPI therapy.
Although rare, exclusion of gastric carcinoma and
other
upper gastrointestinal malignancies is important in
those
with alarm symptoms, which the American
Gastroenterological
Association guidelines summarise as:
age older than 55 years with new-onset
dyspepsia
family history of upper gastrointestinal cancer
unintended weight loss
gastrointestinal bleeding
progressive dysphagia
odynophagia
unexplained iron-deficiency anemia
persistent vomiting
palpable lymphadenopathy
jaundice.
However, the presence of alarm symptoms has
been
found to have poor predictive value for malignancy
rather
they alert the practitioner to the need for early
endoscopy
to avoid the risk of missing a neoplastic process.
Functional dyspepsia can be difficult to manage.
There
is evidence showing a small benefit with H pylori
eradication
and PPI therapy. Although impaired gastric
emptying
is noted in 25-40% of patients with functional
dyspepsia,
there is inadequate evidence for the efficacy of
prokinetic therapy.
Despite its similarities to irritable bowel syndrome
in
pathophysiology, there is also inadequate evidence
to support
routine use of anti-depressants and psychological
therapies, although these should be considered as
alternatives
for refractory patients. Counselling and reassurance
is essential.
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Posted by BANDA at 5:37 AM
Monday, March 30, 2009
EPIGASTRIC PAIN
peptic ulcer disease
(5-15%)
gastro-oesophageal reflux
disease (5-15%)
gastric or oesophageal
cancer (<2%)
gallstones/biliary pain
chronic pancreatitis/
pancreatic cancer
coeliac disease
lactose intolerance
medications digoxin,
theophylline, erythromycin,
potassium supplements,
corticosteroids and NSAIDs
infiltrative diseases of
the stomach eosinophillic
gastritis, Crohns disease,
sarcoidosis
metabolic causes
hypothyroidism,
hypercalcaemia,
hyperkaelemia, heavy
metals
hepatoma and
steatohepatitis
intestinal angina
abdominal wall pain
Zollinger-Ellison syndrome
diabetic radiculopathy
Functional dyspepsia
(up to 60%)
caffeine, alcohol and
smoking can exacerbate
symptoms
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Posted by BANDA at 8:06 PM
PERINATAL DEPRESIION
Women often dont recognise
themselves as being depressed
they hide their symptoms or
present as the baby having the
problem.
When symptoms (anxiety,
lowered mood, tearfulness,
fears of not being able to cope
or being a bad mother) are
recurrent, severe or continue for
more than two weeks, the diagnosis
of depression or anxiety
disorder must be considered.
In PND many anxieties arise
from the lack a balanced
perspective. Cognitive behavioural
therapy is well suited to
address these issues.
Maternal depression is associated
with poor developmental
outcomes for children with
implications for the childs
education and the potential for
mental illness as adults.
Mothers groups can be
beneficial if they are specifically
for women with PND but general
mothers groups can alienate
women if they feel different to
the other coping mothers.
Early detection and treatment
of PND may lead to remission
of symptoms and improvement
for mother, child and family
members, but it does not
guarantee a good outcome.
For some women, mother-infant
or long-term therapy is needed
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Posted by BANDA at 7:59 PM
Saturday, March 28, 2009
Dermatology
Skin care advice for patients with lymphoedema


Keep the skin supple using a non-perfumed
moisturising cream such as sorbolene.
Avoid drying out your skin and consider using a
soap-free alternative.
Clean any scratches, grazes or cuts immediately
using an antiseptic solution,
use an antibacterial cream and cover the area with
a clean, dry plaster.
Use an electric razor for shaving instead of a wet
razor.
Avoid tattoos and body piercing.
Consider ways to protect the skin, such as
wearing gloves while washing dishes,
gardening or handling pets.
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Posted by BANDA at 6:37 PM
Administration of Anti -D
At the first pregnancy consultation the mother's
blood
group should be determined and blood taken for
detection/
measurement of blood group antibodies. For
complete and incomplete miscarriages all Rh(D)
negative
women who have not actively formed their own
anti-D should be given 250IU of anti-D.
There is insufficient evidence to suggest that a
threatened
miscarriage before 12 weeks gestation necessitates
use of anti-D, but meta-analyses indicate that
antenatal
administration of anti-D (for all indications
including miscarriage) can result in a 78%
reduction
in allo-immunisation.
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Posted by BANDA at 6:24 PM
Labels: AMC, Basics, Clinicals
Wednesday, March 25, 2009
CLINICAL DEFINITION OF
MISCARRIAGE
Complete miscarriage No intrauterine
gestational sac
No ovarian/fallopian mass
Products of conception passed
No evidence of POC in uterus
Endometrial thickness <15mm in
longitudinal section


Incomplete
No intrauterine gestational sac
miscarriage No ovarian/fallopian mass
POC passed
More POC seen in uterus

Missed miscarriage

Intact intrauterine gestational sac
Fetal pole seen
No fetal heartbeat
CRL >6mm
OR
Intact intrauterine gestational sac
measuring >20mm
Fetal pole not seen
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Posted by BANDA at 8:52 AM
HOW TO TREAT MISCARRIAGE
INITIAL MANAGEMENT

When a woman describes
bleeding in early pregnancy
the treating doctor must first
determine whether she has
heavy bleeding and/or severe
pain. Saturation of pads
and/or passing clots larger
than a 20 cent piece implies
heavy bleeding. If either is
present this scenario must betreated as a clinical
emergency.
The possibility of cervical
shock should always be considered.
A speculum examination
should be performed,
and any products of conception
(POC) should be removed
from the cervix . This is the
only way to reverse shock associated
with this condition.
Basic life support principles
apply. It is important to:
Ensure that the woman has
a clear airway and adequate
breathing before the speculum
examination is performed.
Gain IV access with a cannula
of at least 16G diameter
and start IV crystalline
fluids at a rate that maintains
adequate blood pressure
(>100/60) and pulse
rate (<100 beats per minute).
As the IV is inserted, take
blood for blood group typing
and FBC, and arrange
cross-match of four units of
packed cells.
If analgesia is required, small
bolus doses of IV morphine
2mg titrated to pain at 5-
minute intervals gives quick
relief but should be accompanied
by metoclopramide 10mg
IV as an anti-emetic.
If shock cannot be controlled
despite adequate IV fluids
and removal of POC, the
woman must be prepared for
emergency D&C. Surgery
should not be delayed due to
haemodynamic instability; it
should be performed before
blood and fluid losses have
been replaced. Sometimes surgical
evacuation of the uterus
is needed to resolve shock.
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Posted by BANDA at 8:41 AM
Monday, March 16, 2009
Differential Diagnosis of snake bites
DIFFERENTIAL DIAGNOSIS OF VENOMOUS
SNAKEBITE
non-venomous snakebite
bite or sting by other venomous creature
(arthropod, including spider, octopus, jellyfish)
CVA
ascending neuropathy, eg Guillain-Barre
syndrome
AMI
allergic reaction
hypoglycaemia/hyperglycaemia
drug overdose
closed head injury
The combination of neurological disturbance and
evidence of defibrination in a patient with an
appropriate history is strongly suggestive of severe
envenomation.
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Posted by BANDA at 5:04 AM
Labels: Snake Bites, Study Material
Snake Bites Australia How to investigate
In managing the patient with suspected
snakebite, it is necessary to
establish whether significant envenomation
has occurred and to attempt
to identify the type of snake
involved. A significant proportion of
venomous snakebites dont result in
envenomation. The use of antivenom
should be reserved for those cases
with clinical or pathologic evidence
of envenomation.

1.Snake venom Detection Kit

2.Clotting Studies

3.Creatinine Kinase-Indicating Myolysis

4.Urinalysis-Haemoglobin,Myoglobin

5.Renal Function-May be impaired secondary to
Myoglobinuria or other mechanism.
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Posted by BANDA at 4:57 AM
Labels: Snake Bites
Austrlian Snake Bites Overview
Effects of Australian snake bite venom are
usually
species specific, but in general include:

neurotoxins
procoagulants
anti-coagulants
rhabdomyolysins
haemolysins (weak).

Presentation



Symptoms and signs of
envenomation may include:
EARLY (within 30 minutes)
- headache, nausea/vomiting,
abdominal pain
- coagulopathy
LATE (within several hours)
- cranial nerve palsies
(ptosis, ophthalmoplegia,
dysarthria, dysphonia,
dysphagia)
- limb and truncal weakness
- respiratory failure
- haemorrhage
VERY LATE (delayed
presentation,
wrong/inadequate treatment)
- prolonged paralysis
- renal failure
- uncontrollable haemorrhage
Features suggestive of snakebite
Identification of snakes is often
unreliable: polyvalent antivenom
should be used if the
type of snake cannot be identified
in all areas of Australia
apart from Tasmania, where
both tiger snake and copperhead
bite may be successfully
treated with tiger snake
antivenom, and Victoria, where
bites should be treated with
combined tiger/brown snake
antivenom


How to treat

Identification of snakes is often
unreliable: polyvalent antivenom
should be used if the
type of snake cannot be identified
in all areas of Australia
apart from Tasmania, where
both tiger snake and copperhead
bite may be successfully
treated with tiger snake
antivenom, and Victoria, where
bites should be treated with
combined tiger/brown snake
antivenom.



Important to remember

Correct diagnosis of snakebite
may be delayed because the
bite may not be dramatic or
painful, and snake venom
generally causes little local
pain or tissue destruction.
Identification of snakes is often
unreliable: polyvalent
antivenom should be used if
the type of snake cannot be
identified in all areas of
Australia apart from Tasmania,
where both tiger snake and
copperhead bite may be
successfully treated with tiger
snake antivenom.
Children are more likely to
sustain multiple bites and may
be more quickly and severely
affected by snakebite than
adults because of their lower
body weight.
The combination of
neurological disturbance and
evidence of defibrination in a
patient with an appropriate
history is strongly suggestive of
Severe envenomation
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Posted by BANDA at 4:36 AM
Labels: Snake Bites
Saturday, February 14, 2009
BRONCHOSCOPY
The therapeutic indications for bronchoscopy
include:


removal of secretions and mucus plugs:
often used in ITU
pneumonic lobar collapse
allergic bronchopulmonary aspergillosis

removal of foreign bodies

stent insertion in benign airways disease:
for example in relapsing polychondritis
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Posted by BANDA at 10:51 PM
BRONCHOSCOPY
Diagnostic role of flexible bronchoscopy






lung cancer:
the type and operability of lung tumours can be
assessed

pneumonia:
good for identifying infecting organism

interstitial lung disease:
permits histoloy and analysis of bronchoalveolar
lavage

causes of haemoptysis, cough and recurrent
pneumonia
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Posted by BANDA at 10:47 PM
BROCHODILATORS
bronchodilators






Bronchodilation is a phenomenon of sympathetic
stimulation. Thus drugs which attempt to achieve it
include:

1.sympathomimetics

salbutamol } beta-2 adrenoceptor
terbutaline } agonists
fenoterol }
rimiterol }
salmeterol }
adrenaline
isoprenaline


2.antimuscarinics

Anticholinergics are drugs which antagonise
cholinergic receptors.





3.xanthinesTypes of sympathomimetic include:
Xanthines are compounds which inhibit
phosphodiesterase and thus are able to produce
bronchodilatation.




theophylline
aminophylline
caffeine, theophylline and tannin
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Posted by BANDA at 10:33 PM
Wednesday, February 11, 2009
LONG TERM SIDE EFFECTS OF
TREATMENT OF BREAST CANCER
Lymphoedema after axillary dissection and/or
radiotherapy. It can arise at any time, even many
years after treatment.
Cardiovascular toxicity after radiotherapy, and
increased cardiovascular risk after premature
menopause. Treat with appropriate medical and
risk-reduction strategies.
Congestive heart failure associated with
anthracyclines
and trastuzumab. Monitor (mandatory with
trastuzumab) and manage medically if present.
DVT, stroke (tamoxifen). Treat as usual if
present.
Hot flushes after premature menopause,
tamoxifen
or aromatase inhibitors (less so). SSRIs, SNRIs and
gabapentin may be useful. Alternatives such as
black cohosh have also been suggested.
Vaginal dryness and dyspareunia. Non-hormonal
moisturisers and lubricants; use local oestrogen
with caution as there may be systemic absorption.
Loss of libido resulting from altered body image,
radiotherapy, chemotherapy, depression or
dyspareunia. Counselling may be helpful, as well
as
appropriate medical treatment.
Arthralgia and musculoskeletal symptoms, from
aromatase inhibitors and sometimes tamoxifen.
Conservative treatment such as paracetamol or
NSAIDs if needed.
Depression and anxiety following the diagnosis,
loss of body image, concern about morbidity and
mortality, and the direct effects of some
treatment. Treat as usual, including supportive
counselling and antidepressants if needed.
Fatigue, associated with the diagnosis and
treatment. Provide support, encourage activity,
and rule out psychiatric or biological causes
(depression, anaemia, hypothyroidism).
Weight gain, which can occur with
chemotherapy
and possibly with tamoxifen and aromatase
inhibitors. Manage as usual with diet and
exercise.
Osteopenia or osteoporosis, associated with
treatment-induced menopause and aromatase
inhibitors. Monitor bone mineral density and treat
as usual, including bisphosphonates if needed.
NEJM 2007; 356:2505-13.
Drug class
Anthracycline
Alkylating agent
Anti-metabolite - Folic acid analogue
- Uracil analogue
- Taxane
Selective oestrogen receptor modulator
Nonsteroidal aromatase inhibitors
Steroidal aromatase inactivator
Luteinising hormone releasing hormone agonist
Monoclonal antibody
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Posted by BANDA at 4:48 AM
RISK FACTORS FOR BREAST
CANCER
Relative risk

Advanced age >10
Genes, family history, personal history
BRCA1/2 mutation 5-10
Breast cancer in first-degree relative 2
Previous atypical hyperplasia 4-5
Previous breast cancer >4
Breastfeeding for 12 months 0.96
One birth 0.93
Two births 0.84

Menstrual/reproductive history
Menarche before 11 years 3
Menopause after 54 years 2
First child after 30 1.2-1.4
First child after age 40 3
Current use of HRT 1.3-1.6
Current use of oral contraceptive 1.2

OtherLiving in a developed country (?oestrogen
exposure) 5
High breast density on mammogram (?oestrogen
exposure) >5
Abnormal exposure to ionising radiation 3
Lifestyle
High socioeconomic status 2
High postmenopausal BMI 2
High premenopausal BMI <1
One alcoholic drink daily 1.07
Lancet 2005; 265: 1727-1741. Cancer 2004;
101:353-62.
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Posted by BANDA at 4:33 AM
Sunday, February 1, 2009
THE MANAGEMENT OF VARIZELLA
ZOSTER VIRUS EXPOSURE AND
INFECTION IN PREGNANCY AND
NEW BORN PERIOD
GOOD DAY

1.Zoster immunoglobulin (ZIG) should be offered
to pregnant, varicella-seronegative women with
significant exposure to varicella-zoster virus
(VZV) (chickenpox) infection.

2.Oral aciclovir prophylaxis should be considered
for susceptible pregnant women exposed to VZV
who did not receive ZIG or have risk factors for
severe disease.

3.Intravenous aciclovir should be given to pregnant
women who develop complicated varicella at any
stage of pregnancy.

4.Counselling on the risk of congenital varicella
syndrome is recommended for pregnant women
who develop chickenpox.

5.ZIG should be given to a baby whose mother
develops chickenpox up to 7 days before delivery
or up to 28 days after delivery.

6.Intravenous aciclovir should be given to babies
presenting unwell with chickenpox, whether or not
they received ZIG.

7.Breastfeeding of babies infected with or exposed
to VZV is encouraged.

8.A mother with chickenpox or zoster does not
need to be isolated from her own baby.

9.If siblings at home have chickenpox, a newborn
baby should be given ZIG if its mother is
seronegative.

10.The newborn baby does not need to be isolated
from its siblings with chickenpox, whether or not
the baby was given ZIG.

11.After significant nursery exposure to VZV, ZIG
should be given to seronegative babies and to all
babies born before 28 weeks' gestation.
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Posted by BANDA at 12:11 PM
Labels: AMC, Clinicals, education, MCQs,
Medical Exams, Study Material, travel and places
Saturday, January 31, 2009
Asthma Management of Exacerbations
GOOD DAY !

ASTHMA

Managing exacerbations

SUMMARY OF PRACTICE POINTS
LEVEL OF EVIDENCE
Management of exacerbations in adults

A short (7-10 days) course of oral corticosteroids is
the current standard treatment for adults with
moderate-to-severe asthma exacerbations.
I
When administering a SABA via MDI during an
exacerbation, use a spacer. []
In adults with acute exacerbations not considered
severe enough for admission to hospital, high-dose
ICS may be effective. II
Merely doubling the maintenance ICS dose is not
effective in managing exacerbations. II
Management of exacerbations in children

A short (up to 5 days) course of oral corticosteroids
(prednisolone 1 mg/kg up to 60 mg daily) is the
current standard treatment for severe
exacerbations. Closely monitor response to
treatment. I
Children who are taking regular preventive
medication should continue taking the same dose
during an exacerbation. II
When administering a SABA via MDI during an
exacerbation, use a spacer. III-1
Merely doubling the maintenance ICS dose is not
effective in managing exacerbations in children. II
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Posted by BANDA at 3:35 AM
Labels: AMC, MCQs, Study Material
Understanding Cervical Pathology
GOOD DAY
Cervical pathology ! Hot topic in AMC
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Posted by BANDA at 3:28 AM
Labels: AMC, MCQs, Study Material
ASTHMA KEY POINTS
GOOD DAY !

ACUTE ASTHMA
SUMMARY OF PRACTICE POINTS
LEVEL OF EVIDENCE
Managing acute asthma in adults

If the patient is acutely distressed, give oxygen and
SABA immediately after taking a brief history and
physical examination.
[]
Assess response to treatment using spirometry,
oxygen saturation, heart rate, respiratory rate and
pulsus paradoxus status.
[]
Wheeze is an unreliable indicator of the severity of
an asthma attack and may be absent in severe
asthma.
[]
Ensure every patient receives adequate follow-up
after an acute asthma episode, including review of
medications, triggers and asthma action plan.
[]
Managing acute asthma in children

If the patient is acutely distressed, give oxygen and
SABA immediately after taking a brief history and
physical examination.
[]
Emergency management of acute asthma in a child
is based on initial administration of salbutamol 4-6
puffs (< 6 years) or 8-12 puffs (6 years) via MDI.
I
Load the spacer with one puff at a time and give
each puff separately.
III-1
If treatment with an oral corticosteroid (e.g.
prednisolone 1 mg/kg up to 60 mg as a single daily
dose) has been initiated for a moderate-to-severe
acute episode, continue for up to 5 days.
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Posted by BANDA at 3:16 AM
Labels: AMC, Clinicals, MCQs, Study Material
Friday, January 30, 2009
By The Way--ELCTRICAL BANDAGE ?
GOOD DAY !
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Posted by BANDA at 5:09 AM
Labels: Advances In Medicine
Thursday, January 29, 2009
Are You Ready
GOOD DAY !
I need some feed back from you guys come
on.....take it easy.
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Posted by BANDA at 1:10 PM
Labels: AMC, Basics, Medical Exams
MCQs
GOOD DAY !

Hi next to come is MCQ discussion............please
mind that you needs to know what exactly is
"ASKING".......this will help to select what is the
answer.....!!!
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Posted by BANDA at 9:25 AM
Labels: AMC, Australia migration, Doctors,
MCQs, Medical Exams
Wednesday, January 28, 2009
DOCTOR LOCUMS
GOOD DAY !
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Posted by BANDA at 7:08 AM
Labels: AMC, Clinicals
AMC EXAM TRAINING
GOOD DAY !
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Posted by BANDA at 7:04 AM
Labels: AMC, Clinicals
Sunday, January 25, 2009
Important notice from AMC
GOOD DAY !
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Posted by BANDA at 8:26 PM
Labels: AMC, Clinicals
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Blog Archive
2009 (52)
o November (1)
MCQS WITH ANSWERS
o October (2)
HIV AND "SKIN"
HIV Presentation
o September (2)
EPILEPSY
MANAGEMENT
PNEUMONIA
INFECTIOUS AGENTS
o August (2)
ANDROGEN
DEFICIENCY IN MALE
AUTOSOMAL
DOMINENT
CONDITIONS
o June (4)
ISOTRETINOIN IN ACNE
ISOTRETINOIN IN ACNE
ACNE TREATMENT
ACNE MANAGEMENT
o May (4)
Lethal In Low Doses
Preventing Recurrent DVT
Preventing Recurrent DVT
DVT FACTS
o April (11)
INVESTIGATIONS OF
INFECTIVE SYMPTOMS
IN PREGNANCY
PREPREGNANCY
COUNSELLING.
SIGNS OF A
PERFORATED EYE
EYE EXAMINATIO
TOOLS
Diagnosis of metabolic
Syndrome
METABOLIC
SYNDROME
METABOLIC
SYNDROME
METABOLIC
SYNDROME
CASE STUDY
CERVICAL SPINE
CLEARING
Non-ulcer dyspepsia
Functional or non-ulcer
dyspe...
o March (9)
EPIGASTRIC PAIN
PERINATAL DEPRESIION
Dermatology
Administration of Anti -D
CLINICAL DEFINITION
OF MISCARRIAGE
HOW TO TREAT
MISCARRIAGE
Differential Diagnosis of
snake bites
Snake Bites Australia How
to investigate
Austrlian Snake Bites
Overview
o February (6)
BRONCHOSCOPY
BRONCHOSCOPY
BROCHODILATORS
LONG TERM SIDE
EFFECTS OF
TREATMENT OF BREAST
CANC...
RISK FACTORS FOR
BREAST CANCER
THE MANAGEMENT OF
VARIZELLA ZOSTER
VIRUS EXPOSURE ...
o January (11)
Asthma Management of
Exacerbations
Understanding Cervical
Pathology
ASTHMA KEY POINTS
By The Way--ELCTRICAL
BANDAGE ?
Are You Ready
MCQs
DOCTOR LOCUMS
AMC EXAM TRAINING
Important notice from AMC

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