FACEBOOK MCQS

Question 1

Patient returned travel overseas was taking tetracyclin proohylaxis for malaria;2-3 days after return bloody diarrhea 2 days.O/E slight tenderness left lower abdomen T 37.5 other all normal.Blood culture,stool normal.cause?

a. pseudomembranous colitis
b. giardia
c. E H
d. Sigella

Answer 1

a. pseudomembranous colitis

Question 2

presents Abd cramps, bloody diarrhoea. recently returned from Nepal trip, was taking doxycycline for malaria prophylaxis.dx?
pseudomembranous colitis
ulcerative colitis
infective colitis
ischaemic colitis
giardiasis

Answer 2

pseudomembranous colitis

Question 3

14 yr old 3 month history loose stools abdominal pain.anal excoriations.No anaemia/blood in stools. pin worm infestation at age of 3 for which she was treated.Her ESR 70.most likely diagnosis is?

a. Crohn’s disease
b. Giardiasis
c. Campylobacter
d. Clostridium perfringens
e. Pseudomembranous

Answer 3

a. Crohn’s disease

Question 4

woman 20s abd cramps, bloody diarrhoea. recently returned from nepal trip,was taking doxycycline for malaria prophylaxis .dx? 
Pseudo membranous colitis, 
ulcerative colitis, 
infective colitis, 
ischaemic colitis, 
giardiasis

Answer 4

Pseudo membranous colitis

Question 5

3 yr child complaining colicky abd pain anorexia 7 days, 2 days diarrhea now tenderness all over  abdomen guarding,temp 39.most likely diagnosis?
A-perforated appendicitis 
B-mesenteric adenitis   
C-norovirus gastroenteritis
D-giardiasis 
E-campylobacter gastroenteritis

Answer 5

perforated appendicitis

Question 6

30 people eat banquet after that 10 people become sick. Hx of abd pain nausea no vomiting.cause?
A Salmonella food poisoning 
B Bacillus 
C giardiasis 
D campylobacter jejuni food poisoning
E. Strep

Answer 6

B Bacillus

Question 7

Young man pain lower abd bloody diarrhoea mucous 2 week wt loss.had similar episode in past.just came back from Somalia..likely diagnosis?

1. amoebiasis ( incubation period 2-4 wks)
2. giardiasis
3. infective colitis
4. ulcerative colitis

Answer 7

4.ulcerative colitis

trip to Somalia is just a trap

Question 8

Pt abd pain blood in stool & mucus. Travelled to Vietnam.had previous same attacks on 6 month back. Wt loss 10 kg

1. Amoebic colitis
2. Giardiasis
3. Ulcerative colitis
4. Corynibacteria

Answer 8

3. Ulcerative colitis

Question 9

Middle yr man recently arrived from Africa with complaint of haematuria and splenomegaly Hb 8 tested malaria negative 3 days before he left from Africa .
A) recheck malaria immunoassay (black water fever)
schistosomiasis
C) giardiasis

Answer 9

Schistosoma haematobium

Africa endemic for schistosomiasis

Question 10

3yr old complain anorexia diarrhoea past 2days fever.Temp 39,tenderness guarding in Left iliac fossa.diagnosis?
Mesenteric adenitis
Appendicitis
Giardiasis
Amoebic dysentery

Answer 10

A-perforated appendicitis

Question 11

12 yrs boy diarrhoea not responding to routine antidiarrhoeal.Jejunal biopsy showed partial villous atrophy with many pas positive macrophages.Most likely diagnosis?
A.Carcinoid tumour
B.Coeliac disease
C.Giardiases
D.Immunoproliferative disease
E.Whipples disease

Answer 11

E.Whipples disease
villous atrophy in celiac disease
And pas positive macrophages in whipple
Confusion

Question 12

A woman went on holiday to Indonesia. She has now returned and has been complaining of diarrhoea and bright red bloody stool. What is the causative agent 
A) Shigella
b) E.coli
C) norovirus
D) giardia 
E) cryptococcus

Answer 12

A( red bloody stool)A) Shigella

E.coli is the common cause of traveller diarrhoea but never come with blood

Question 13

a lady of 28 years, G2P1, in labor since 36hrs.CTG was done for
30mins and was normal. after birth, the child has an APGAR score of 5 in 1
min and 7 in 5 mins. blood index of the child was showing met. acidosis. what
is it the most likely diagnosis?
a) cong. diaphragmatic hernia
b) chest infection
c) hypoglycemia

Answer 13

c) hypoglycemia

C - Possible causes of neonatal hypoglycemia

Question 14

preterm labour,baby cyanosed,RR 40,floppy.
next?
a)intubation
b)cardiac massage

Answer 14

a)intubation

Question 15

A 26 year old Primiparous was admitted to labour ward in labour. Findings confirmed 38 cm SFHT, cephalic, 3/5, station -2, and no membrane felt. Contractions were 2:10 and moderate intensity. 4 hours later, VE findings were the same. Management Plan is as follows:
A. 15 units Syntocinon should be started
B. 10 units Syntocinon should be started
C. Encourage to ambulate for next 3 hours then
D. Start a hydration drip and give 1g Ampicillin

Answer 15

B. 10 units Syntocinon should be started

Question 16

A 25-year-old nulliparous woman in spontaneous labour at term has shown no progress during a six-hour period, despite having her membranes ruptured, syntocinon infused and epidural anaesthesia employed. The cervix has failed to dilate beyond 4cm, the fetal head is at the level of the ischial spines (IS) and she has been diagnosed to have obstructed labour. Which one of the features listed below is most consistent with this diagnosis?
A. Lack of moulding but caput formation of the fetal head. B. Oedema of the cervix.
C. A progressive increase in the fetal heart rate to a level now of 168/min. D. The bony head is at the level of the ischial spines.
E. There is 4cm of head palpable abdominally.

Answer 16

E. There is 4cm of head palpable abdominally.

Question 17

A pregnant of 37weeks gestation comes with complains of reduced fetal movements for the last 24hrs.CTG done. it was normal and pt was sent home with reassurance…she now comes again after 3days that she is not feeling any movements .what’s the most appropriate next step?
a-immediate CTG
b-obstetric USG (as patient is not in labour)
c- reassure that its normal at this gestation
d-Amniotomy
e-induction with prostaglandins

Answer 17

b-obstetric USG (as patient is not in labour)

Where the fetal movements are still not being felt 24 hours after a normal cardiotocograph (CTG), induction of labour should be performed, especially if the pregnancy is at or near term and the cervix is favourable

Question 18

A pregnant lady, 37 weeks, came to the hospital with an abdomen without bleeding. What will be the indication of labor
A Rupture of the membrane
B frequency of contraction
C cervical dilation

Answer 18

C cervical dilation

Question 19

The most common cause of cesarean section delivery in Australia?

a. failed progress of labour
b. fetal distress
c. cephalopelvic disproportion
d. previous c section
e. cord prolapse

Answer 19

d. previous c section

Question 20

Woman, gravida 2 para 2, underwent a prolonged induction of labor for gestational diabetes mellitus complicated by an intraamniotic infection. Discharged but came back later with active bleeding from the cervical os with passage of large clots. Diagnosis?
Cervical laceration
Normal lochia
Retained products of conception

Answer 20

Retained products of conception

Most common cause of secondary PPH

Question 21

woman 3hrs into labour, everything ok,starts bleeding, bp drops,baby pulse drops.reason

a. Placenta praevia
b. amniotic embolism
c. coagulation
d. placenta accreta

Answer 21

a. Placenta praevia

(amniotic embolism causes cardiopulmonary collapse and bleeding)

Question 22

A 31-year-old G1P0 woman with a history of hypertension presents to the emergency department because she believes that she is in labor. She is in her 38th week of pregnancy and her course has thus far been uncomplicated. This morning, she began feeling painful contractions and noted vaginal bleeding after she fell off her bike while riding to work. She is experiencing lower abdominal and pelvic pain between contractions as well. Her temperature is 97.6°F (36.4°C), blood pressure is 180/100 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 98% on room air. Physical exam is notable for a gravid and hypertonic uterus and moderate blood in the vaginal vault. Ultrasound reveals no abnormalities. Which of the following is the most likely diagnosis?
A) Abruptio placentae
B) Normal labor
C) Placenta previa
D) Uterine rupture
E) Vasa previa

Answer 22

A) Abruptio placentae
, as here uterus is hypertonic and also supposed to be tender on palpation due to concealed bleeding and P/V bleeding is not much significant

Question 23

A 33 year-old multiparous woman has come in labour. Her cervix is fully dilated. The foetus is with occipito-anterior position. The head is at 2 cm from ischial spine. On a repeat examination after two hours, the head is at 3 cm from ischial spine and there is mild caput and moulding.
What would you do next?
A. Oxytocin
B. Vacuum
C. Non rotational forceps
D. Rotational forceps
E. CS

Answer 23

E. CS

Question 24

A lady 39 weeks pregnant now comes with contractions. Asking for indication for start of labour.
A) cervical dilatation
B)frequency of contractions
C) Rupture of membranes

Answer 24

A) cervical dilatation

Question 25

some ECV Scenario 28 yrs old woman at 39 weeks pregnancy is found to have a transverse lie.she is not in labour, there is no other abnormalities, next step?

1. immediate us
2. external cephalic version
3. LSCS
4. Tell her to come to see u in 2 weeks

Question 26

38 wks lady in labour. O/E everything normal. CTG shows fetal heart rate 140. After amniotomy, frank meconium staining .. what to do? a. Continuous CTG monitoring

b. Start Oxitocin
c. Give antibiotic
d. CS

Answer 26

d. CS

Question 27

A 30 years male went to Thailand. Had sex with many prostitutes.. Now develops fever, sore throat, arthralgia. On examination generalized lymphadenopathy, spleenomegaly and mild pharyngeal erythema.
Labs- Lymphocytosis
Monospot- Negative
Diag?
a. EBV
b. HIV
c. Malaria
d. Toxoplasma

Answer 27

a. EBV
The clinical picture of malaise, pharyngitis, fever, a maculopapular rash. lymphadenopathy and splenomegaly accompanied by lymphocytosis is very suggestive of infectious mononucleosis

Question 28

A young boy with the history of tonsillitis now developed involuntary movements with subcutaneous nodules and proteinurea ++.What is most likely diagnosis?
A.Infective endocarditis
B.Infectious mononucleosis
C.Rheumatic fever 
D.Acute glomerulonephritis 
E.Wilsons disease

Answer 28

C.Rheumatic fever

Question 29

A old man present with new onset of diarrhoea for 3 months and weight loss. Complains for difficulty in getting up from chair and walking up the start.

• –campylobacter jejuni infection
• –coeliac disease
• –polymyositis
• –thyroxicosis

Answer 29

Final answer is D .thyroxicosis
Thank you all
DX : Thyrotoxicosis
Key words - diarrhoea + wt loss for 3 months + proximal muscle myopathy
Check difference chart from Davidson medicine hypo Vs hyperthyroidism system chart .

Question 30

Man came from another country with H/o bloody diarrhoea for 3 years with some other symptoms. Now comes with abdominal distension,pain,fever,vomiting and bloody diarrhoea. Dx ?

a. Infectious Colitis
b. Toxic megacolon
c. Large bowel disorder
d. Infective enteritis
e. Pseudo obstruction

Answer 30

b. Toxic megacolon

Question 31

a 34 year old woman presents with a painful lump in the right upper eyelid. the lump has developed over a course of 3 days. on examination, there is a 1X1.5 cm warm tender lump in the upper eyelid of the right eye. the visual acuity is intact. the eye movements are normal in all directions. the patient appears healthy otherwise and afebrile. which one of the following would be the next best step of management for this patient?

a. CT scan of orbit
b. Flucloxacillin and ceftriaxone IV
c. topical chloramphenicol
d. application of heat and gentle massage
e. incision and curettage of lesion under local anesthesia

Answer 31

d. application of heat and gentle massage

D heat compress is the initial mx

Question 32

A young man presented with low grade fever for the last 3 months .On examination ,nasal bridge was distorted and cervical lymph nodes were palpable .Histology of these lymph nodes revealed non caseative granuloma and positive AFB Stain .The most ;ikely diagnosis is 
A.CAT sCRATCH DISEASE
b.Leprosy 
C.Sarcoidosis
D.Syphilis
E.Tuberculosis

Answer 32

b.Leprosy

Question 33

Child with hereditary spherocytosis is pale and has multiple bruises. Blood test: HGB 7.8/ WC 2000/ platelets 70000. What’s the cause?

a) Pneumococus
b) Cytomegalovirus
c) RSV
d) Norwalk virus
e) Parvovirus

Answer 33

e) Parvovirus

Pancytopenia as a result of infection with Parvovirus B19 in patients with hereditary spherocytosis.

Question 34

Q.young man with milky white discharge for urethra for 2 days. Neisseria diagnosed. Treated with ceftriaxone 1 gm IM. But he comes back with the same symptoms. Urine analysis diplococci. Reason? shahriaramc

a) coli infection
b) chlamydia infection
c) Neisseria reinfection
d) drug resistance
e) inadequate dosage

Answer 34

e) inadequate dosage
Current aus guidelines says to give ceftriaxone 500 mg IM WITH Azithromycin 1 gm PO single dose. check out the image Dr. he was only given ceftriaxone, so inadequate dose.

Question 35

Which of the following is the most common mode of transmission of hepatitis B in Australia?
A. Sexual Transmission 
B. Breast feeding
C. Intravenous drug abuse
D. Vertical transmission 
E. Blood Transfusion

Answer 35

C. Intravenous drug abuse

Question 36

Immediate management of shortness of breath after carotid endarterectomy
A 65-year-old man underwent an uneventful right carotid endarterectomy 4 days ago. Today, he presents with shortness of breath which is progressively becoming worse. Which one of the following would be the best immediate step in management?
A Intubation.
B Tracheostomy.
C Opening all the wound layers in the Emergency Department.
D Supplemental oxygen via face mask.
E Opening all the wound layers in the operating theater.

Answer 36

C Opening all the wound layers in the Emergency Department.

Question 37

A 32-year-old man is brought to the emergency department of a local hospital after he was
recovered from a fire in a building. He was working in his office in that building when the fire started
and was barricaded in the room for approximately 20 minutes before firemen were able to break
into the room surrounded by fire and full of smoke. Which one of the following is the correct method of giving him oxygen?
A 2L/min via nasal cannula.
B 6L/min via Venturi mask.
C 5-10L/min via simple face mask.
D 10-15L/min via non-rebreathing mask.
E Transferring him

Answer 37

D 10-15L/min via non-rebreathing mask.

Question 38

A 35-year-old man presents to the emergency department after he sustained a bite by a drunk woman in a pub.The woman was a stranger who walked away after the incident.On history, he is fully immunized against tetanus with the last dose being 3 years ago. He is unaware of his hepatitis
B immunization. On physical examination, there is a 2-cm bite wound 5mm deep in the right arm that is actively bleeding and teeth marks around the wound. Which one of the following is the most appropriate next step in management of this patient?
A Tetanus immunization.
B Start him on zidovudine for HIV prophylaxis.
C Give him hepatitis B vaccine and immunoglobulin.
D Start him on a 5-day course of prophylactic azithromycin.
E Suture the wound and review in 24-hours.

Answer 38

C Give him hepatitis B vaccine and immunoglobulin.

Question 39

During your night shift in a rural hospital in Northern Territory, you receive a 27-year-old man 30 minutes after being bitten by a brown snake in the left ankle. Upon arrival, he has no symptoms. On examination, you notice scratches over the left ankle, but no fang marks are present. The nearest tertiary hospital is 150 km away. Which one of the following is the most appropriate next step in management of this patient?
A Discharge him home because he is asymptomatic and there is no fang mark
indicating a bite.
B Air-transfer him to the tertiary hospital.
C Give him a vial of antivenom now and another if symptoms develop.
D Application of a tourniquet above the bite site.
E Give him a vial of antivenom once he starts developing the symptoms.

Answer 39

B Air-transfer him to the tertiary hospital.

Question 40

A 46-year-old man undergoes laparoscopic cholecystectomy due to recurrent episodes of cholecystitis in the setting of gallstones. After 12 hours of the surgery, he develops chest pain. In addition to a complete focused history and physical examination, which one of the following would you consider first for this patient?
A Chest physiotherapy.
B CTPA.
C ECG.
Echocardiography.
E Chest X-ray.

Answer 40

C ECG.

Question 41

An 11-year-old boy is recovered from a beach in Northern Queensland and brought to the emergency department of the local hospital. Upon arrival he has severe pain in the right foot and leg. Jellyfish tentacles are noted stuck in the skin of the right sole on a whip-like manner and there is surrounding erythema and slight swelling. Which one of the following options would be the most
important step in management?
A Intramuscular morphine.
B Pour vinegar on the foot and tentacles.
C Immerse the foot in hot water.
D Administer antivenom.
E Start intravenous antibiotics.

Answer 41

B Pour vinegar on the foot and tentacles.

Question 42

Joan is 60-year old woman who is suffering migraine. The pain has been crushing and disabling despite medical therapy with maximum dose of paracetamol. Seven hours ago in a desperate attempt she took 20 500mg paracetamol tablets to make the pain go away. She is now in the emergency department of the tertiary hospital you work in with complaints of right upper quadrant abdominal pain, nausea, and vomiting. She weighs 65 kilograms. Which one of the following is the next best step in management?
A Give her intravenous N-acetyl cysteine immediately.
B Obtain a serum paracetamol level and give her N-acetyl cysteine.
C Do immediate gastric lavage and give her activated charcoal.
0 Check liver function tests prior to decision making on giving N-acetyl cysteine.
E Refer the patient to toxicology registrar.

Answer 42

B Obtain a serum paracetamol level and give her N-acetyl cysteine.

Question 43

A few hours after insertion of a permanent pacemaker for a 55-year-old man, he develops shortness of breath and pleuritic chest pain. On examination, he has a blood pressure ofV80/50mmHg, heart rate of 110 bpm and respiratory rate of 25 cycles/min. He has an 02 saturation of 96% on room air and a jugular venous pressure (JVP) of 6cm (normal<3cm). On auscultation,lungs are clear but heart sound are distant and muffled.Which one of the following is the
investigation of choice to consider as the next best in management?
A Serum troponin level.
B ECG.
C Chest X-ray.
D Echocardiography.
E CTPA.

Answer 43

D Echocardiography.

Question 44

A 57-year-old farmer presents to the emergency department after he accidentally steps on a rake in the farm and injures his left foot. On examination there are 3 puncture wounds on his left sole
which are not actively bleeding but the edges of the entry wounds are contaminated with soil. He has had a full course of tetanus vaccination including several boosters, with the last one being 6
years ago. After disinfecting the wounds and putting non-adherent bandage over them, which one of the following would be the best action regarding post-exposure prophylaxis of tetanus in this patient?
A Another tetanus booster with DTPa.
B No tetanus immunization is required.
C Another tetanus booster with dT.
D Tetanus toxoid in form of dT and tetanus immune globulin (TIG).
E TIG and a course of oral penicillin.

Answer 44

C Another tetanus booster with dT.

Question 45

A 50-year-old man presents to the emergency department with a laceration in his left lower leg caused by pickax while farming. The wound is 1.5cm deep and is contaminated with soil. You debride the wound, disinfect it and put a non-adherent bandage on it. On enquiry about tetanus
vaccination, you realize that he had his tetanus vaccination completed. He also had a hand cut 5 weeks ago, for which he received a single dose of dT. Which one of the following is the appropriate action for management of this patient?
A Start him on a 5-day course of oral penicillin for wound infection prophylaxis.
B Give him250 IU of human tetanus immune globulin (TIG).
C Give him one dose of tetanus toxoid (TT).
D Arrange for follow-up to check the need for antibiotics and discharge home.
E Give him one dose of dT.

Answer 45

D Arrange for follow-up to check the need for antibiotics and discharge home.

Question 46

While working in a factory, a 26-year-old machinist sustains a hand injury with a cutting machine.The wound is deep with bone exposure and crushed surrounding tissue.The wound is irrigated with copious amounts of normal saline and dressed appropriately. The patient is arranged to have his wound repaired in the operating room.The surgeon advises that the patient receive intravenous antibiotics for prophylaxis, and be managed for tetanus prevention. You enquire about his vaccination history and realize that he had a full course of tetanus vaccination as a child and also has received a booster dose 3 years ago. Which one of the following is the most appropriate option for him regarding tetanus prophylaxis?
A Human tetanus immune globulin (TIG), 250 III, via intramuscular injection.
B A single dose of dT (diphtheria/ tetanus vaccine).
C Tetanus prophylaxis is not indicated for this patient.
D dTpa plus 250 IU of TIG.
E A single dose of DTPa.

Answer 46

C Tetanus prophylaxis is not indicated for this patient.

Question 47

John, 15 years of age, is a patient of yours since he was born. Today, his mother has brought him
to your office after his left hand was bitten by his dog. The bite happened when John accidentally
stepped on the dog’s tail and provokes the animal. On examination, there is a puncture wound
which slightly bleeds when you remove the bandage the mother put on it at home. No associated
bone or tendon injury is found. You check his file to check his immunization status and you learn
that his primary and booster vaccines (a total of 5 doses) has been given with the last booster at
the age of 4 years. You debride the wound, disinfect it, and put a non-adherent absorbent plaster
as covering. You also prescribe a 5-day course of co-amoxiclave for prevention of infections based
on clinical grounds. Since it is a deep bite wound, you decide to also be on the safe side and give
him prophylaxis against tetanus. Which one of the following would be the best course of action for
tetanus prophylaxis for him?
A booster dose with DTPa (child formulation of diphtheria, tetanus and acellular
pertussis).
B Tetanus toxoid (TT).
c Adult diphtheria and tetanus toxoids (dT).
D TT + tetanus immune globulin (TIG).
A dose of combination vaccine of diphtheria toxoid plus tetanus toxoid plus whole cell

Answer 47

c Adult diphtheria and tetanus toxoids (dT).

Question 48

John, 5 years of age, falls from a swing and inures his right leg. Accompanied by his parents, he is
now in the emergency department. He has a 2mm deep laceration in a 2x3 abrasion on his right
leg. The wound is contaminated with soil. You disinfect the wound and ask his parents about his
tetanus vaccination status. He has received two doses of DTpa at 2 and 4 months of age, but not
the third dose at 6 months or thereafter. Which one of the following is the appropriate management
plan for him regarding tetanus vaccination?
One dose of DTPa now and a booster dose after 2 months.
B One dose of DTPa plus tetanus immunoglobulin (TIG) now.
C One dose of dT plus TIG now.
D One dose of DTPa now plus a 5-day course of topical antibiotic cream.
E One dose of DTPa nowplus a 5-day course of oral penicillin.

Answer 48

B One dose of DTPa plus tetanus immunoglobulin (TIG) now.

Question 49

A nurse from the surgery ward calls you to visit a 65-year-old inward patient for agitation.
When you arrive at the ward you are informed that she underwent cholecystectomy 48 hours
ago. Her file shows that she received prophylactic amoxicillin prior to the surgery. On
examination, she is confused and delirious, has a blood pressure of 135/87mmHg, heart rate
of 110 and temperature of 38.4°C. She is agitated and difficult to deal with. Which one of the
following is the most appropriate next step in management?
A Start her on ceftriaxone.
B Give her haloperidol.
C Intravenous fluids.
D Chest X-ray.
E ABG

Answer 49

B Give her haloperidol.