Feb Part 2 2024 Flashcards
1
Q
Post-op patient on PCA fentanyl, feels nauseated but no pain, next step?
A
Reduce dose
2
Q
Labour progressing normally, multiparous, pulsating cord felt in vagina at full dilation, station +2, next step?
A
Commence active pushing
3
Q
Informed consent taken for laparoscopic removal of gallstones, surgery done by consultant, next step?
A
Proceed with surgery as planned
4
Q
Woman tearful a week after 2-year anniversary of mother’s death, sees mother in dreams, diagnosis?
A
Bereavement
5
Q
Patient with blunt trauma to eye, severe pain, hyphema present, next step while waiting for ophthalmology?
A
Eye patch
6
Q
22-year-old man with dysphagia worse with solids than liquids, regurgitation at night, history of eczema?
A
Esophagoscopy
7
Q
Patient in ED after home destroyed by fire, calms down after 2 hours, can’t remember past few hours, diagnosis?
A
Transient global amnesia
8
Q
Best study design to assess drug efficacy by intern?
A
Randomized Controlled Trial (RCT)
9
Q
Obese female with cellulitis on abdomen, best antibiotics?
A
Ampicillin + Clavulanate
10
Q
Right mastitis, advises feeding every 4-6 hours, next step?
A
Increase frequency of feeding
11
Q
Patient on oxycodone for back pain, using heroin for better pain control, next step?
A
Tail off oxycodone, prescribe benzodiazepines, and perform urine drug test
12
Q
Aboriginal girl with recurrent sore throats and hematuria, next investigation?
A
ASO titre
13
Q
8-week pregnant woman with severe vomiting, dehydration, ketones +++, treatment?
A
IV fluids and antiemetics; consider steroids
14
Q
Medical student caught taking pictures of patient records, you are an intern, next step?
A
Confront the student and report the incident
15
Q
25-year-old female post-laparotomy for appendicular mass, started TPN, low magnesium and phosphate, cause?
A
Refeeding syndrome
16
Q
Patient with rhinorrhea, sneezing, allergic to carpet mites, treatment?
A
Fluticasone nasal spray
17
Q
U/S shows small kidneys, indicating chronic kidney disease, what confirms chronicity?
A
Ultrasound finding
18
Q
72-year-old woman with bilateral knee pain and effusion, controlled on PCM, appropriate management?
A
Progressive resistance training
19
Q
10-year-old girl with dysphagia for chicken nuggets, complaint for 7 months, diagnosis?
A
Psychological feeling
20
Q
Elderly patient with bowing of legs, diagnosis?
A
Paget’s disease
21
Q
6-month-old baby with 1 cm umbilical hernia, color changes, next step?
A
Refer to emergency
22
Q
Chronic HCV positive mother at 20 weeks POA, asking about breastfeeding?
A
It is safe to breastfeed
23
Q
Soccer player with head impact, brief LOC, wants to play again, next step?
A
Need observation for 24 hours
24
Q
18-year-old girl with recurrent UTIs, last culture E. coli, best step before treatment?
A
Partner penile swab
25
Woman with psychosis, refuses ECT, believes intestines disappear, what to do?
Seek husband's consent and tribunal permission for ECT
26
16-month-old with vomiting, diarrhea, seizure, Na 119, Cl 79, next investigation?
Urine osmolality and Na
27
DM patient on metformin 2g, BMI 30, poor control, HbA1c 8.3, wants to lose weight, frequent UTIs?
Exenatide
28
HIV patient started ART, husband present, best safety option for husband?
Start on HIV prophylaxis
29
Chinese mother with English-speaking son, memory loss, MMSE 22/30, next step?
Chinese MMSE
30
24-year-old healthy male with hemoptysis, mild SOB, no travel, normal exam, next step?
D-dimer
31
35-year-old male with flank pain, macroscopic hematuria, 2cm radiolucent stone, no hydronephrosis, next step?
Extracorporeal shock wave lithotripsy (ECSW)
32
58-year-old woman with perimenopausal symptoms on HRT for 8 years, no symptoms now, next step?
Cease HRT
33
Woman with occipital headache, nausea, vomiting for 3 months, positive pass pointing test, next investigation?
CT brain
34
Elderly woman with COPD, acute confusion post-party, fever, basal crackles, cause?
UTI
35
Hemorrhoid with bluish anal verge, pain post 48 hours, treatment?
GTN surgery
36
Man in CHF, initial management?
ACE inhibitor
37
Man with claudication pain only in calf, absent pulses, affected artery?
Popliteal artery
38
Intern assessing diet in arthritis patients, strongest study design?
Meta-analysis
39
18-year-old female with PMS, irritability, insomnia, most appropriate treatment?
Fluoxetine
40
Impetigo case, when to report to school?
After initiating treatment
41
Young girl with bee sting, urticaria rash, severe itchiness, treatment?
Oral promethazine
42
Male working in animal center with fever, chills, discharge from axillary lump, diagnosis?
Hidradenitis suppurativa
43
Treatment of pancreatic pseudocyst, 3mm thin wall, presents with abdominal discomfort?
Observe
44
Woman in labor, how to determine if labor is established?
More frequent contractions and cervical dilation
45
Ankle sprain in pregnancy, treatment?
Ice
46
Postpartum woman with depression, constantly checking baby, previous depression history, needs management?
Previous history of depression
47
16-year-old girl with Factor V Leiden heterozygous, best contraceptive apart from condom?
Progestin-only pill (POP)
48
Man concerned about prostate cancer, father diagnosed at old age, next step?
PSA test
49
40-year-old male with C4-5 injury, MDD, on opioids, flushed face, sweating, BP 170/95, PR 50, cause?
Autonomic dysreflexia
50
64-year-old male with lung cancer post-radiation, SOB, inflammatory shadow on CXR, next treatment?
Prednisolone
51
32-year-old obese female, stopped previous drug due to nausea, BMI 32, already has dietician, next step?
Liraglutide
52
16-year-old girl starting sodium valproate, likely side effect to stop treatment?
Weight gain
53
Schizophrenia patient on risperidone, bilateral breast galactorrhea, prolactin 1120, cause?
Risperidone
54
Radiation exposure comparison, X-ray to CT?
20%
55
Feeling disturbed in mall, needs to start drug, what to ask in history?
Cannabis use
56
Teen girl with ataxia, sensory loss, upward plantar reflexes, diagnosis?
Friedreich's ataxia
57
Truck driver with sleep apnea, day somnolence, financial problems, wants to drive, next step?
Drive after sleep specialist consultation
58
68-year-old man with right-left confusion, apraxia, can't write or do math, likely lesion?
Left parietal glioblastoma
59
Elderly man with hearing loss, audiogram shows decreased hearing at high frequencies, cause?
Age-related hearing loss
60
Post-menopausal woman on denosumab with T-score -2.5 (sacral) and -3 (femoral), next step?
Alendronate
61
ECG shows digoxin toxicity, no cardiac arrest, next step?
stop digoxin Administer digibind (digoxin-specific antibody)
62
64. MVA, 31yr female, USS 2.2 cm splenic artery aneurysm, other parameters ok, other injuries excluded
Splenic artery embolization
63
65. Boy, 7 years old, bitten by a bat. Management?
Post-exposure rabies vaccine
64
66. Girl comes to collect prescription for Risperidone for her boyfriend with schizophrenia, unable to visit due to work
Provide the prescription after obtaining verbal consent from him via a phone call
65
68. 6-week baby, cough while feeding and mild increased work of breathing when breastfeeding. Next?
Referral to cardiology
66
69. Crescendo-decrescendo murmur - cause?
Aortic stenosis
67
70. 50-year-old lady, no significant medical history, not on HRT, breast lump 2 cm, mammogram shows dense breast tissue, USG shows cystic lesion. Management?
FNAC
68
71. Action if a doctor wants to enter a relationship with a current patient?
Unethical
69
72. URTI not responding to antibiotics, bronchoscopy shows Masson body. Treatment?
Steroid
70
73. 16-year-old girl with depressive symptoms, self-injury behavior, denies suicidal thoughts, multiple antidepressant use, asks not to inform parents
Voluntary admission
71
74. Elderly with AF, ECG HR 88, multiple comorbidities, asymptomatic, BP 145/90, eGFR 35, on aspirin, atorvastatin, and metformin
Rivaroxaban
72
75. 50-year-old lady admitted for uncomplicated Colles fracture, after 3 days of admission, agitated, sweaty, confused with visual hallucinations. Cause?
Alcohol withdrawal
73
76. Substance used in pregnancy associated with decreased risk of congenital birth defects?
Iodine
74
77. Patient with gambling issue, initial treatment?
CBT
75
78. 32-year-old female considering Mirena, currently using condoms, no medical history, heavy menses, prefers Mirena over pills due to forgetfulness
Pregnancy rate is less than 0.1%
76
79. Depuytren contracture of hand, next investigation needed to diagnose?
No investigation
77
80. 18-month-old child, URTI with clear nasal discharge, red enlarged tonsils, multiple cervical lymph nodes enlarged. Cause of infection?
Normal childhood URTI
78
81. Newly diagnosed HIV patient, CD4 150, management?
TMP-SMX prophylaxis
79
82. Patient with RA on MTX develops pneumonia and rash, COVID negative, precaution type?
Droplet
80
83. 14-year-old female with MDD on fluoxetine, mother concerned about SSRI addiction
Reassure the mother about fluoxetine safety for long-term use
81
84. Elderly female, confusion after learning about a fire, later improves but can't remember event details, aware of husband, date, and day but not time
Transient global amnesia
82
85. Elderly female, urine exam shows 20 WBC, culture E. coli, no symptoms
No treatment
83
86. 50-year-old male with right shoulder pain, restriction of abduction, partial benefit from intraarticular steroid, next recommendation?
Arrange physiotherapy
84
87. Child with swelling, pain in left eye, high fever, cannot open eye
IV flucloxacillin
85
88. Child with URTI, symptoms of rheumatic heart disease, arthritis, murmur, fever, confirmation test?
ASO titre
86
89. Manager with work delay, study postponement, organizational difficulties, poor concentration, symptoms after an event 3 months ago, diagnosis support?
Anxious and fidgeting appearance
87
90. Elderly female with colicky abdominal pain, distension, now constant pain, vitals stable
Sigmoid volvulus
88
91. Elderly female with persecutory delusions towards neighbors
Persecutory delusions
89
92. Somalian patient, cough, hemoptysis, SOB for 3 months, heavy smoker, weight loss, X-ray shows right upper lobe haziness, sputum culture and AFB sent
Mantoux test
90
93. Postpartum mother, anorexia, not feeding baby much, lack of sleep, baby sleeping 6 hours at a time
Postpartum depression
91
94. 22-year-old man with strange behavior, speech, isolation, aggression, failure in school, shouts at family
Schizophrenia
92
95. Photo of eye with matted lashes, discharge, normal cornea, no hyphema, management?
Cleaning and antibiotics
93
96. 4-year-old boy with nocturnal enuresis, no constipation, eats well, next step?
Fasting blood sugar and urinalysis
94
97. 45-year-old man with bilateral tender breast swelling, alcoholic, on Ranitidine, bilateral parotid swelling, leukoplakia, scrotal swelling
Alcoholic liver disease
95
98. Elderly patient with dizziness, multiple drugs (metoprolol, ramipril, indapamide), HR 56, BP 90/60, cause?
Metoprolol
96
99. Elderly female with type 1 DM, recent hypoglycemic attack, advice on driving?
Don't drive for 6 weeks
97
100. 18-week period of amenorrhea, tremor, palpitations, high TSH, next step?
Check thyroxin level
98
101. Patient with vomiting, abnormal behavior, staring at ceiling, dystonia
Benztropine
99
102. Aged patient in residential care, post-menopausal bleeding, dislikes vaginal examination
Abdominal ultrasound
100
103. Post-menopausal female on HRT for 8 years, no complaints, initially started for hot flushes
Cease HRT
101
104. P3C2 mother in 3rd pregnancy, 12 weeks, previous large babies, all uncomplicated, next check?
Glucose tolerance test
102
105. Female, routine antenatal visit, Hb 9, MCV 70, not vegetarian, next step?
Hb electrophoresis
103
106. Waldenstrom macroglobulinemia with myelodysplastic syndrome, develops rash on ampicillin for pneumonia
Stop ampicillin
104
107. 33-week pregnant lady with vaginal bleeding, abdominal pain, BP 145/90, urine dipstick +prot, +RBC, previous preterm labor due to preeclampsia, preclude tocolysis?
Vaginal bleeding
105
108. Skin mass excised with clear margins, biopsy shows melanoma 0.6mm thickness, next step?
Further excision
106
109. Child with fever, irritability, cough, dyspnea, crepitations, CXR with 2 lesions showing fluid level
Clindamycin + Ceftriaxone
107
110. 55-year-old DM female with recurrent cellulitis in left leg, healed now, varicosities, tinea infections between toes, major factor causing problem?
DM
108
111. RTA patient with GCS 6/15, heavy beard, BP 100/75, RR 9, SaO2 88, initial step?
Shaving the beard to ensure mask ventilation
109
112. Patient with BP 90/60, PR 105, next step?
Put on left lateral position
110
113. Midline neck mass 1cm, important step for diagnosis?
Tongue extrusion
111
114. Patient with cellulitis treated with cefazolin, develops macular drug reaction, future avoidance?
All penicillins and cephalosporins
112
115. 8-year-old child with isolation, tantrums, normal language, good eye contact, aligns dolls, screams occasionally
Autism spectrum disorder
113
116. Female with gradual loss of superior quadrants of visual fields
Temporal lobe tumor
114
117. 4-month-old baby not gaining weight, dusky mouth, systolic murmur
TOF
115
118. 24-year-old post-laparoscopic cholecystectomy, severe shoulder tip pain
Ultrasound abdomen
116
119. Female in labor, slow progression, oxytocin started, deceleration on CTG, 6cm dilation with caput and molding, baby's part 1cm above pelvic rim
Stop oxytocin
117
120. Labor case with ROM, meconium stained, no deceleration on CTG, +1 station, good contraction and effacement, 7cm dilation
Continue CTG
118
121. Crusty hyperpigmented lesion over earlobe
SCC
119
122. 10-year-old aboriginal boy, ear discharge, tympanic membrane dull and retracted, greenish nasal discharge
Cholesteatoma
120
123. Patient on oxycodone for back pain, recently started heroin for uncontrolled pain
Check urine drug level
121
124. Boy worried about body image, thinks shoulders are too narrow, joined gym, still dissatisfied
Body dysmorphic disorder
122
125. 12-year-old girl with head lice, visible eggs, permethrin given but still lice present
Use lice comb, repeat permethrin
123
126. Chronic schizophrenic patient not listening to questions
IM haloperidol
124
127. 12-year-old child, shortest in class, height at 3rd percentile, weight at 10th percentile, TSH elevated, low FT4
Thyroxine
125
128. Child with vomiting and diarrhea, treated for UTI 3 months ago, weight 10th percentile, vitals stable, most likely diagnosis?
UTI
126
129. Patient on OCP, newly diagnosed with RA, suitable drug for RA treatment?
Sulfasalazine
127
130. Elderly with nausea and vomiting, visual hallucination, multiple medications including digoxin
Digoxin toxicity
128
131. Patient with exertional breathlessness, pulse rate 100, BP 150/90, eGFR 35, Hb 105, next step?
Blood transfusion
129
132. Elderly female with pain in breast after menopause, skin biopsy shows orange pigment around dermal blood vessels, dense lymphocytic infiltrate, next step?
Treatment with steroids
130
133. 3-week baby with jaundice, weight loss 8% after birth, HR 150, BP 60/40, jaundice not cleared after phototherapy, next step?
Review breastfeeding technique
131
134. 3-year-old child with high fever, rash after 3 days, red eyes, no coryza, conjunctivitis, red tongue
Kawasaki disease
132
135. Elderly male with advanced pancreatic cancer, requires pain control, best management?
Oral morphine
133
136. Asthma patient with multiple inhaler use, no control, next step?
Check adherence
134
137. Elderly patient with bilateral eye inflammation, treated for multiple allergic conditions, no improvement, on prednisolone 10 mg, multiple anti-histamines
Biopsy
135
138. Teenage girl with vaginal bleeding, one episode of heavy bleeding, no other bleeding disorder
Oral contraceptive pill
136
139. Pregnant lady in 3rd trimester with painful rash over upper chest, no vesicles
Pemphigoid gestationis
137
140. Man with difficulty seeing road signs at night, low vitamin A
Night blindness
138
141. Postmenopausal woman with endometrial thickness 3mm, high prolactin, galactorrhea
MRI brain
139
142. Elderly male with hip pain, right foot 4cm shorter, traumatic injury, no other significant history
Open reduction and internal fixation
140
143. Boy with swelling and fever, history of trauma
Osteomyelitis
141
144. Girl with irritability, constipation, abdominal pain, PICA, family member with similar symptoms
Lead poisoning
142
145. Patient in ICU with history of hemorrhagic stroke, develops sudden collapse
Subarachnoid hemorrhage
143
146. Patient with left-side weakness, anosognosia, constructional apraxia, preserved comprehension
Right MCA stroke
144
147. Elderly patient with colonoscopy showing adenocarcinoma, CT shows no metastasis, next step?
Surgery
145
148. Female with dizziness, difficulty walking, headache, vomiting, diplopia, vertical nystagmus, next step?
MRI brain
146
149. Elderly patient with aortic stenosis, significant pressure gradient, next step?
Valve replacement
147
150. Patient with chronic back pain, opioid dependence, next step?
Buprenorphine
148
151. Patient with COPD, worsening breathlessness, increased sputum, SaO2 88, PaO2 60, next step?
Low-dose oxygen therapy
149
152. Male with difficult-to-treat psoriasis, long-term alcohol use, new lesions on legs
Liver function test
150
153. Female patient with cough, dyspnea, high-pitched inspiratory noise, no fever, normal oxygen saturation
Vocal cord dysfunction
151
154. Patient with chronic kidney disease, recent increase in serum creatinine, new antihypertensive started
Stop antihypertensive
152
155. Teenage girl with abdominal pain, tender palpable mass in the right lower quadrant, fever, next step?
Laparoscopy
153
156. Elderly male with DVT, on warfarin, INR 4.5, no bleeding, next step?
Stop warfarin for 2 days
154
157. Pregnant lady with fever, rash, myalgia, conjunctivitis, lymphadenopathy, confirmed Zika infection
Ultrasound and amniocentesis
155
158. Elderly patient with T2DM, GFR 35, HbA1c 8%, on metformin, next step?
Add DPP-4 inhibitor
156
159. Young male with epigastric pain, radiating to back, elevated lipase, history of binge drinking
Pancreatitis
157
160. Young female with chronic fatigue, arthralgia, low-grade fever, positive ANA, next step?
Anti-dsDNA and C3/C4
158
161. Elderly male with progressive memory loss, urinary incontinence, gait disturbance
Normal pressure hydrocephalus
159
162. Middle-aged female with recurrent UTI, next step?
Postcoital voiding
160
163. Young female with recurrent vulvovaginal candidiasis, no diabetes, normal immune status
Antifungal therapy
161
164. Elderly male with chronic heart failure, ejection fraction 25%, not responding to medications, next step?
Cardiac resynchronization therapy
162
165. Middle-aged male with severe acne, failed multiple treatments, isotretinoin considered, next step?
LFT and lipid profile
163
166. Pregnant lady with history of venous thromboembolism, next step?
Low molecular weight heparin
164
167. Elderly female with frequent falls, dizziness, orthostatic hypotension, on multiple medications including antihypertensives
Review medication list
165
168. Middle-aged male with hypercalcemia, low PTH, history of lung mass, next step?
PTHrP assay
166
169. Female with headache, visual disturbances, elevated prolactin
MRI brain
167
170. Young male with sore throat, fever, splenomegaly, atypical lymphocytosis
EBV serology
168
171. Elderly patient with hypertension, hyperlipidemia, diabetes, low ankle-brachial index
Peripheral artery disease
169
172. Middle-aged male with new onset AF, stable vitals, next step?
Anticoagulation therapy
170
173. Young female with shortness of breath, pleuritic chest pain, D-dimer elevated
CT pulmonary angiography
171
174. Elderly male with dysphagia, weight loss, barium swallow shows filling defect
Esophagogastroduodenoscopy
172
175. Middle-aged female with pruritus, jaundice, elevated bilirubin, ALP, GGT
MRCP
173
138. 48-year-old man drinks 12 standard drinks daily after work, denies withdrawal symptoms. What are you going to do?
Motivational psychotherapy
174
139. Patient from Vietnam 72 hours ago now has fever, dyspnea, chest pain. Diagnosis?
Bacterial pneumonia
175
140. 40-year-old male with sudden severe chest pain radiating to back after 18-hour flight, normal ECG. Next step?
D-dimer
176
141. Woman post-pregnancy developed psychosis, started on SSRI, planning next pregnancy. Advice?
Continue the same dose
177
142. 35-year-old female with TAH+BSO, DEXA results -2.5 spine and -1.5 femoral BMD. Treatment?
Risedronate
178
143. 18-year-old female with multiple bruises, living with paternal uncle. Whom to call next?
Inform child protection services
179
144. Elderly man with swelling over submandibular region. What to examine next?
Salivary gland
180
145. 10-year-old child started on stimulants for ADHD, not complying, problems in school. Next step?
Talk to boy about advantages and disadvantages of the drug
181
146. 56-year-old truck driver had a minor stroke, now has left homonymous hemianopia, reluctant to stop driving. Advice?
After occupational therapist assessment
182
147. Old man post hip/knee surgery, feels dizzy, BP 80/60, HR 110, DTX 4mmol. Cause of dizziness?
Orthostatic hypotension
183
148. Postpartum hemorrhage, 1500ml blood loss, continuous fresh blood. Most likely cause?
Atonic uterus
184
149. 18-year-old female with PMS, irritability, insomnia. Most appropriate treatment?
Fluoxetine
185
150. 72-year-old lady with vulval itching, on clotrimazole cream, not settled. Examination shows adhesion of labia, shrunk skin, narrowed introitus. Management?
Oestriol cream
186
151. Serum creatinine high, eGFR low, ultrasound showed small kidney. Feature indicating chronic disease?
Ultrasound finding
187
152. Knee injury. Best method for examination findings?
Anterior drawer test positive, Posterior drawer test positive
188
153. BRCA 1 positive. Correct screening method?
(Answer not provided in prompt)
189
154. Na low, sugar high. Diagnosis?
Hyperosmolar hyperglycemic state
190
155. On clozapine, symptoms improved, weight gain up to 15 kg. Next step?
Dietitian referral
191
156. Perimenopausal woman on estrogen patch, now menopausal. Advice?
Continue same
192
157. Best study type for GP to see incidence of cancer among patients?
Cohort
193
158. Hepatitis A epidemic in school. Management?
Exclude children for 14 days
194
159. Patient on corticosteroids for polymyalgia rheumatica, now tapering dose, patient lethargic. Cause?
Addison crisis
195
160. Woman in 20s with progressing occipital headache, nausea, vomiting for 3 months. Next step?
CT
196
161. Elderly lady with COPD, acute onset confusion after party, had fever, normal RR, tachycardia, normal O2 sats. Possible cause?
Pneumonia
197
162. Commercial driver 4 months post-stroke, decreased vision. Advice?
After occupational review
198
163. External hemorrhoid with hematoma. Treatment?
Surgery
199
164. Man with back pain, raised ESR, normocytic anemia. Investigation to establish diagnosis?
Hb electrophoresis
200
165. Man in chronic renal failure, anemia, hypertension, scarring kidneys. Most indicator for chronic disease?
Ultrasound findings
201
166. Man with CHF, stable. Initial management?
ACE inhibitors
202
167. Mastitis case. Advice?
Frequent feeds
203
168. Man with claudication symptoms, weak femoral pulse, absent distal pulses. Possible diagnosis?
Superficial femoral artery disease
204
169. Intern wants to assess diet in arthritis patients. Strongest evidence study design?
Meta-analysis
205
170. Intern administered wrong drug, not harmful, stopped. Next step?
Apologize to patient
206
171. 18-year-old female with PMS, irritability, insomnia. Most appropriate treatment?
Fluoxetine
207
172. AF with ECG, renal failure, GFR 24, not 35.
(Incomplete prompt)
208
173. Impetigo case. When to report to school?
After initiating treatment
209
174. Young girl stung by bees, urticaria rash, severe itchiness. Treatment?
Oral promethazine
210
175. Girl collecting Risperidone for boyfriend with schizophrenia, unable to visit due to work. Most appropriate action?
Provide the prescription after obtaining verbal consent via phone call
211
176. First cousins planning to start a family, history of genetic problems and miscarriages. Advice?
Recommend genetic counseling
212
177. Man concerned about infertility, wife has child from previous marriage. Potential reason for infertility?
Past infection with mumps
213
178. Pregnant nurse changing job to work with children, last diphtheria vaccine 8 years ago. Advice?
Vaccinate at 20 weeks
214
179. Research evaluating new drug effectiveness. Characteristic ensuring reliability?
Double-blindness
215
180. Elderly Chinese man with forgetfulness, MMSE score 22. Next action?
Perform MMSE in Chinese
216
181. 12-year-old child, shortest in class, height 3rd percentile, weight 10th percentile, otherwise well. Next step?
Ask about parents' heights
217
182. Man working in garden, thorn cut, red and swollen hand. Most appropriate management?
Antibiotics
218
183. Carpenter with shoulder pain, partially relieved by steroid injections. Most appropriate management?
Physiotherapy
219
184. Labour progressing normally, then at 5cm dilation, station +1, fetal HR 115, pulsating cord felt in vagina. Management?
Reduce the cord and progress with labour
220
185. 6-year-old child with hereditary spherocytosis, anemia, jaundice, Hb 80-90, reticulocytes <0.1%. Management?
Folic acid
221
186. Family migrated to Australia 1 year ago, daughter depressed now doing well on fluoxetine, mother concerned about addiction. Management?
Reassure mother
222
187. Junior doctor in tertiary hospital, colleague disheveled and drunk. Next step?
Keep record of how many times colleague came in drunk
223
188. Couple, wife pregnant, man has chlamydia, doesn't want to tell wife but wants her tested. Management?
Encourage him to tell wife
224
189. Woman tearful a week after 2-year anniversary of mother's death, sees mother in dreams, saw mother standing in doorway. Diagnosis?
Bereavement
225
190. Eye trauma, hyphema. What to do while waiting for ophthalmology referral?
Eye pad and bed rest
226
191. End-stage small cell lung cancer, on oxycodone for pain, increased thirst, dry mucous membranes. Diagnosis?
Hypercalcemia
227
192. Recurrent DVT. Which cancer is likely?
Lung cancer
228
193. Clinical features of lateral epicondylitis. Investigation?
No need to do anything
229
194. 8-year-old child with scrotal pain, testes non-tender, redness extending to perineum and groin. Most likely diagnosis?
Scrotal edema
230
195. Patient with recent MI and DM, optimize medications, BMI 26, HbA1c 7. Treatment?
Empagliflozin
231
196. Waldenstrom macroglobulinemia with myelodysplastic syndrome, left lower lobe pneumonia, rash on ampicillin. Next step?
Stop ampicillin
232
197. Patient with family history of breast cancer, unilateral painful gynecomastia, on spironolactone. Next step?
Ultrasound breast
233
198. Female, healthy, routine antenatal visit, Hb 9, MCV 70. Next step?
Hb electrophoresis
234
199. Young male with scrotal lump, testes separately palpable, no other symptoms. Next step?
Testicular tumor markers
235
200. Female admitted for fracture, given morphine, weird behavior after 12 hours, claims can't control eye movement. Treatment?
Benztropine
236
201. Female with swollen lymph nodes, 2 months tiredness, lives with cats, right posterior cervical lymph node FNAC shows reactive cells, no malignancy. Diagnosis?
Cat scratch disease
237
202. Orthopedic surgery patient on multiple medications. What to change on morning of surgery?
Withhold aspirin
238
203. Patient with ST elevation anterior wall MI, alcohol use, smoker, T2DM. Risk factor to address?
Smoking
239
204. Ear pain, submandibular gland swelling, dull TM. What organ to examine?
Tongue
240
205. Postpartum hemorrhage, 1500ml blood loss, shortness of breath. Diagnosis?
Amniotic fluid embolus
241
206. 18-month-old child with recurrent respiratory infections, multiple ear infections, enlarged tonsils, clear nasal discharge, normal development.
(Incomplete prompt)
242
207. Schizophrenic patient agitated in ED, holding knife, refuses call to psychiatrist. What to do?
Overrule refusal and call psychiatrist
243
208. 18-year-old male with sleep difficulties, sad, declining grades, not suicidal. Treatment?
Mirtazapine
244
209. Patient came in for testosterone injection, noticed tampered. What to do?
Prescribe and reschedule appointment
