PHC

MCQs

1. A 6 years old male diagnosed with rheumatic fever. What is the appropriate
management for this patient?
A. Steroids + aspirin + I/V pencillin
B. Aspirin + I/V pencillin + H2-blocker
2. A patient had hepatitis 2 months back. Now, his serology reveals that he is
positive for surface antigen and IgM core antibody. What is the correct
interpretation?
A. Active hepatitis
B. Chronic carrier
3. Recently married female with 1st UTI: what is the appropriate management?
A. Cotrimoxazole for 7 days
B. Nitrofurantoin for 3 days
C. Amoxicillin for 5 days
D. Naldixic acid for 5 days
4. A patient with pain in flank radiating to groin: which is the appropriate
investigation?
A. IVP
B. U/S-KUB
5. All of the following will be advised to obese man EXCEPT:
A. 1000-1200 calorie diet
B. Carbohydrates 50%
C. Fat < 30%
D. Protein 30%
6. A patient with uncomplicated MI is on β-blocker with a pulse rate of 54/min.
What is the most appropriate management?
A. Lower the dose of β-blocker
B. Order ECG
C. Refer to cardiologist
D. Switch to ACE inhibitors
7. A young male with ulcerative gingivitis, stomatitis and lymphadenopathy.
Investigation likely to reveal the diagnosis is:
A. WBC with differential count
B. Paul-Bunnell test [for infectious mononucleosis]
8. Typhoid: patient has taken amoxicillin for 3 days and chloramphenicol for 2
days; which investigation will best confirm the diagnosis now?
A. Blood C/S
B. Bone marrow C/S
9. Recently married female with raw albumin-like discharge without any itching:
what is the most likely cause?
A. Candidiasis
B. Trichomoniasis
C. Physiologic
10. Female with pain in hands, wrist and knee with no response to ibuprofen.
What is the treatment now?
A. Methotrexate
B. Increase dose of ibuprofen
C. Cyclophosphamide
D. Gold
11. 35 years old female with 3 cm x 3 cm lump in breast. What will be the most
appropriate investigation?
A. FNA
B. Mammogram
12. A 40 years old female with a positive family history of breast CA in mother.
What is the appropriate next step?
A. Mammogram now
13. A patient with allergic rhinitis: what is the appropriate treatment?
A. Antibiotics, nasal steroids and decongestants for 3 weeks
B. Antibiotics when needed, nasal decongestants for 3 days and nasal
steroids for 3 months
14. A 50 years old male smoker presents with hoarseness and cough: what is the
first step of management?
A. Laryngoscopy
B. Chest X-ray
C. Quit smoking
D. Refer to pulmonology
15. A patient comes with 6 hour history of pain in left arm. JVP is 4 cm and final
basal crepts are heard at both lung bases. What is the first thing to do?
A. Refer
B. Angacid
C. IV furosemide
D. β-blocker
16. A child with non-bloody diarrhea, no mucus and fever of 39oC. What is the
most appropriate treatment?
A. ORS + antibiotics
B. ORS + anti-pyretic
C. ORS + anti-emetics
D. ORS + anti-diarrheal
17. A child with diarrhea, fever with WBCs and RBCs in stool. The most likely
diagnosis is:
A. Shigella
B. Salmonella
C. Rotavirus
D. Escherichia coli
18. A 24 years old male with bilateral watery discharge from eyes with red
conjunctiva. A friend has same problem. What is the appropriate
management?
A. Refer
B. Chloramphenicol ointment and drops
 C. Chloramphenicol with steroids
D. Tetracycline drops
E. Strict hygiene
19. A patient has chronic cough: presents with acute shortness of breath and
tracheal shift; the most likely cause is:
A. Pneumothorax
20. A patient with history of anorexia with cough productive of white sputum.
What is the first investigation before treatment is started?
A. Mantoux test
B. AFB smear
C. Sputum C/S for AFB
D. Chest X-ray
21. A person on pre-employment checkup has asymptomatic bilateral hilar
lymphadenopathy on chest X-ray. What is the most likely cause?
A. Tuberculosis
B. Sarcoidosis
C. AIDS
D. Lymphoma
22. A 10 years old child with mild hepatosplenomegaly, low-grade fever and
lymphadenopathy. What is the investigation of choice?
A. Lymph node biopsy
23. Hyperthyroid picture: which investigation to order?
A. TSH
B. FT4
C. T4,T3
D. Antibodies
24. A mother with TB delivers a baby: what is the appropriate management now?
A. Isoniazid + breastfeeding
25. p-value of a test is set at 0.025. You will reject the null hypothesis:
A. At level of 3% significance
B. At level of 2% significance
C. At level of 1% significance
D. At level of 5% significance

Match the following:

26. Psoriasis Pitted nails
27. Lichen planus Purple (violet)
28. Tinea Ring lesion
29. Impetigo Crusted lesion
30. Erythema marginatum Target lesion

31. Pale child from a poor family: you will advise him to eat:
A. Citrus fruits
B. Spinach
C. Apple
D. Eggs
32. Male with NIDDM, weight 80 kg, height 170 cm: what is the appropriate
management?
A. Biguanides
B. Sulfonylureas
C. Acarbose
D. Insulin
33. Mirpur has a population of 20,000, but, only 20 patients are seen every day.
The reason is:
A. Inclination towards traditional medicine
B. Facility underutilized / underserved population
C. Focus on curative care
D. Universal health
34. 6 years old child with recurrent sore throats; a diastolic murmur grade 3/6 on
auscultation with an irregularly irregular pulse; what is the most likely cause?
A. Sinus arrhythmia
B. Atrial fibrillation
C. AV block
D. Premature birth
35. A known case of asthma with gradually worsening dyspnea for the past 2 days
using 2.5 mg TID salbutamol. What is the most appropriate management?
A. Salbutamol nebulizer
B. Ipratropium bromide
C. IV hydrocortisone
D. Oral prednisolone
36. A female with polymenorrhea for the past 6 months with pallor on
examination. What is the treatment?
A. Iron + folic acid
B. Iron + transamin
C. Iron + OC
37. A patient with signs and symptoms of bacterial vaginosis. The drug of choice
for this patient is:
A. Vibramycin
B. Flagyl
38. A 55 years old female on HRT has vaginal bleeding: what is the most
appropriate management?
A. Refer for endometrial biopsy
39. A patient with a history of rheumatic fever is undergoing an abdominal
surgery. What antibiotic prophylaxis should be given before the procedure?
A. Augmentin
B. Ampicillin + gentamycin
C. Septran
40. A patient presents with left-sided ptosis, headache and anisocoria. He has a
history of long-standing diabetes mellitus. The patient is afebrile. Which of
the following is an unlikely cause?
A. Meningitis
B. Space occupying lesion
 C. Myasthenia gravis
D. Diabetic neuropathy
E. Carotid aneurysm
41. A medical student with one week history of dry barking cough, headache,
myalgia, fever and few rales at left lung base. What is the most likely cause?
A. Mycoplasma pneumonia
B. Viral pneumonia
42. A case history of mother with history of Sheehan syndrome. All labs show
hypopituitarism. The lesion is most likely at which site?
A. Hypothalamus
B. Pituitary gland
C. Cerebellum
D. Adrenal
43. In the above patient, what will be expected levels of anti-diuretic hormone in
the blood?
A. Increased
B. Decreased
C. Normal
D. Undetectable
44. In the above patient, what will be the cause of lactation failure?
A. Decreased prolactin
45. In the above patient, what will you give first?
A. Thyroxine
B. Cortisol
C. Minerals
D. LH
46. Which one of the following will cause a shift of hemoglobin dissociation
curve to the left?
A. Persistent vomiting
B. DKA
C. Septicemia
D. Hyperventilation
47. A hypertensive patient presents with sudden dorsal back pain referred to jaw
and both arms. What is the most likely diagnosis?
A. Myocardial infarction
B. Pancreatitis
C. Aortic dissection
48. An arterial blood gas analysis shows a pH of 7.45, pCO2 of 65 mm Hg and
pO2 of 60 mm Hg without mentioning bicarbonate. What is the most likely
cause?
A. Mixed disorder
B. Metabolic alkalosis
C. Metabolic acidosis
D. Respiratory alkalosis
E. Respiratory acidosis
49. A patient in septicemic shock has passed no urine in the past 2 hours. Which
of the following describes the most appropriate course of action?
A. Give dobutamine to increase cardiac output
B. Give dopamine to increase mean arterial pressure
C. Give dopamine to increase splanchnic blood flow leading to increased
kidney perfusion
50. A patient with hepatitis B: which of the following will lead to fulminant
hepatic failure?
A. Infection with hepatitis A
B. Infection with hepatitis C
C. Infection with hepatitis D
D. Infection with hepatitis G
51. A patient with a dry persistent cough for 1 month and subconjunctival
hemorrhages. What is the most appropriate treatment?
A. Erythromycin for 10 days
B. Septran for 10 days
C. Throat culture
52. A patient has pneumonia and massive effusion due to infection. Gram staining
of the fluid shows gram positive diplococci. What is the urgent management?
A. IV antibiotic
B. Chest tube
C. Ventilation
53. A diabetic patient with peripheral vascular disease underwent TKR. On 10th
post-operative day, he develops a pulurent discharge with swollen knee joint.
The pathophysiology of this disease includes all of the following EXCEPT:
A. Colonization of nasopharynx by causative agent
B. Defective neutrophil function
C. Ischemia due to peripheral vascular disease
D. Polyneuropathy causing sensory loss
54. A woman with abdominal pain, fever and weight loss. A barium follow-
through shows thickened terminal ileum with ulcers. What is the
pathophysiology of this condition?
A. Caseating granulomas
55. In the above patient, what will you do to confirm your diagnosis?
A. Colonoscopy, ileoscopy + biopsy
B. Tuberculin test
C. Proctoscopy
56. The most appropriate management of the above patient is:
A. Anti-tuberculous therapy
B. Steroids
57. A nurse with HBsAg positive, HBcAb IgG positive and HBeAg negative.
What is the most likely diagnosis?
A. Chronic active hepatitis
B. Carrier state
C. Treated patient
D. Vaccinated patient
58. What should the above nurse do?
A. Practice universal precaution
B. Not touch patients
C. Get vaccinated
D. Start treatment
E. Change job
59. A 19 year old primigravida has contracted mumps infection. What is the
appropriate management?
A. Vaccination
B. Termination of pregnancy
C. Analgesia and bed rest
D. Administration of gamma globulin
E. Antibiotics
60. Most common intrapartum evidence of complete rupture of LSCS scar is:
A. Fetal distress
B. Suprapubic pain
C. Vaginal bleeding
D. Maternal hypotension
E. Maternal tachycardia
61. A patient with syncope has a systolic murmur at the base of the heart. On
examination, you are likely to find:
A. Decreased upstroke of carotid pulse
B. Carotid bruits
C. Normal ECG
62. The investigation of choice in the above patient is:
A. Echocardiography
B. Electrocardiography
C. Coronary angiography
63. A hypertensive patient has stroke due to atheromatous plaque. The best
management is to give:
A. Anti-platelet drugs
B. Warfarin
64. A diabetic patient with CRF has pneumonia. You administer antibiotics, but,
the patient develops oliguria with increasing BUN and K+ 7.5. What step will
you take next?
A. Call for consult
B. Give insulin + 10% dextran
65. A young girl presents with history of joint pains. On examination, a rash is
noted on the face and arms. The best investigation in this case is:
A. ANA
66. The most common cause of death in the above patient is:
A. Infection
B. Renal failure
67. In the above patient, the test used for confirmation is:
A. Anti-dsDNA antibodies
68. The best treatment for the above patient is:
 A. Methotrexate
B. Prednisolone
C. Remicade
69. 18 years old female with episodes of ghabrahat, inability to sleep and
palpitations. On examination, she has a pulse of 100 bpm, fine tremors with
moist cold hands. The thyroid is enlarged with a diffusely palpable goiter.
What is the most likely diagnosis?
A. Panic attack
B. Generalixed anxiety disorder
C. Iodine deficiency
70. Most common morbidity associated with twin pregnancy is:
A. Prematurity and SGA
71. In a depressed lady, it is very important to know about:
A. Psychosis
B. Mania
C. Suicide ideation
72. An 8 months old child has exposure to measles and is not vaccinated. You
should:
A. Administer vaccine and immunoglobulin
73. The child’s 2 years older sibling is also not vaccinated. You should:
A. OPV, BCG, DT
74. A 3 years old child with red bulging ear drum. Septran (drug of choice) being
given but not responding. What should be done in this case?
A. Give Augmentin
[No mention of myringotomy.]
75. A man went to tropical region and now has come back with high fevers, dark-
coloured urine and abdominal pain. What is the most likely diagnosis?
A. Typhoid
B. Malaria
76. A child who has never been vaccinated presents at two and a half years of age
with cough, cold and mild fever. Which of the following should be
administered?
A. OPV and DPT
B. BCG, OPV, DT
C. BCG and DPT
D. BCG and OPV
77. A man presents with sudden loss of vision. On examination, there is a pale
optic disc with cherry red spot and vision limited to perception of light. What
is the most likely diagnosis?
A. Age-related macular degeneration
B. Central retinal artery occlusion
C. Central retinal vein occlusion
D. Cataract
78. Eighteen years old male with matted lymph nodes in neck. The most
appropriate treatment is:
A. Chest X-ray
 B. Mantoux test
C. Anti-tuberculous therapy
D. Aspiration of lymph nodes
79. A person with 7 days history of continuous fever. What investigation will be
most appropriate?
A. CBC
B. Stool C/S
C. Blood C/S
D. Urine C/S
80. A lady with 7 days history of fever, unresponsive to chloroquine and 200 mg
TID of Augmentin. What is the most appropriate management?
A. Increase the dose of Augmentin
B. Start chloramphenicol 1g
C. Start ofloxacin 500 mg TID
D. Start ofloxacin 400 mg BID
81. A child with bloody stools for 7 days. The most likely cause is:
A. Shigella
B. Salmonella
C. Rotavirus
82. A 16 years old patient with painful menses for 2 days with pain shooting
down to legs and to the back. The treatment is:
A. Pelvic examination
B. Analgesia
C. OCPs
83. A man with a pterygium which has crossed the limbus to encroach on the
pupil. What is the best management?
A. Surgery
B. Refer to ophthalmology
C. Retinoic acid for 6 weeks
84. A 46 years old male with productive cough for 2 months. Now, he has
developed progressively worsening dyspnea. On examination, bilateral
rhonchi are heard with increased anteroposterior diameter of chest noted.
What is the most likely diagnosis?
A. Lung cancer
B. Chronic bronchitis
85. A man with a history of jaundice for 2 months. His current hepatitis B profile
reveals that he is positive for surface antigen and IgM core antibody. The best
explanation is:
A. Chronic carrier
B. Active hepatitis
C. Vaccination
D. Infection in the past
86. A male middle-aged with periorbital puffiness and 3+ proteinuria. The next
appropriate step is:
A. 24-hour urinary protein
B. Urinanalysis
87. A 36 years old unmarried male with complaints of somnolence, loss of
concentration and decreased appetite. What is the drug of choice for this
patient?
A. Amitryptaline
B. Benzodiazepine
C. Imipramine
88. A 40 years old male patient with complaints of insomnia and depression.
Which of the following drugs will you prescribe to this patient?
A. Amitryptaline
B. Benzodiazepine
C. Imipramine
89. An obese diabetic with RBS > 260 mg/dl. What is the most appropriate
management?
A. Diet and exercise
B. Diet, exercise and biguanides
C. Diet, exercise and sulfonylureas
D. Diet, exercise and prevention
90. A 35 years old pregnant female at 16 weeks gestation has a blood pressure of
160/100 mm Hg. One week later, her blood pressure is 159/98 mm Hg. What
is the most likely diagnosis?
A. Labile hypertension
B. Essential hypertension
C. Pre-eclampsia
91. Obese man presents with hypertension: the most relevant dietary intervention
that will reduce blood pressure would be:
A. Decrease fat
B. Decrease sodium
C. Exercise
D. Lose weight

Match the following:

92. Classic sore throat Pencillin V
93. Pneumonia with pencillin allergy Erythromycin
94. Young girl with acne Tetracycline

95. A drowsy 11 months old baby with sunken fontanelle: what is the most
appropriate management for this patient?
A. Oral rehydration and observe
B. Oral rehydration and refer
C. I/V hydration and observe
D. I/V hydration and refer
96. A 46 years old male with history of hemoptysis, weight loss, hard swollen
supraclavicular lymph nodes. The next best test to order in this patient is:
A. Chest X-ray
B. Cytology
C. Lymph node biopsy
97. Which of the following drugs is NOT used in the management of acute
exacerbation of asthma?
A. β-blockers
B. β-agonists
C. Ipratropium
D. Aminophylline
98. In a 18 months old child, what is the best way to assess dehydration?
A. Urine output
B. Altered mental status
C. Sunken fontanelle
D. Sunken eyes
E. Skin turgor
99. A 24 years old male with first-time culture-proven urinary tract infection.
What is the most appropriate management?
A. Drug therapy and IVP
B. Drug therapy
C. Investigate on second infection
100. A male with bilateral hilar lymphadenopathy on chest X-ray. He has been
treated with ATT for 7 months with no improvement. He has no history of
weight loss, but, has progressive dyspnea. What is the best management?
A. Refer to pulmonology
B. Order serum ACE levels
101. A female treated in the past with ATT for 9 months. Four years later, she has
apical findings on auscultation. What is the appropriate next step?
A. Start ATT
B. Chest X-ray & ATT
C. Chest X-ray & sputum smear
102. A drowsy dehydrated child with 18-20 motions per day. What is the best
management?
A. I/V rehydration and refer to hospital

Match the following:

103. Depression with suicide Lithium
104. Depression without suicide TCA
105. Depression with heart disease Prozac
106. GAD Benzodiazepines
107. Panic Phenothiazine

108. Unusual presentation Case report

109. Drug efficacy Cohort
110. Prevalence Cross-sectional
111. New drug Experimental
112. Epidemic Cross-sectional

113. Migratory polyarthritis Salicylates

114. Rheumatoid arthritis Systemic steroids
115. Gout Colchicine
116. Hemarthrosis Aspirate and transfuse
117. Swollen knee with effusion Aspirate and bed rest

118. The ideal contraceptive for a P1+1 breastfeeding woman is:

A. Medroxyprogesterone acetate
B. OCPs
C. IUCD
D. Condoms
119. An 18 years old female with complaint of pain starting 2 days before periods
and lasting for first 2 days of menses. What is the most appropriate
management?
A. Order CBC and lytes
B. Reassure and prescribe NSAIDs
C. Ultrasound
D. Pelvic examination
120. A kid has scabies and tells you that his elder brother also has similar
complaints. What is the best management in this case?
A. Treat the kid
B. Treat the kid and the brother
C. Treat the whole family
D. Treat the kid and rest of the members if symptomatic
121. Which of the following drugs is most appropriate for the management of a
pregnant woman with hyperthyroidism?
A. Propylthiouracil
B. Carbimazole
122. A female with signs and symptoms of hyperthyroidism. What is the best
investigation to order?
A. TSH
B. T3, T4
123. A 55 years old male smoker with productive cough for 10 years. The most
important initial step in management is:
A. Stop smoking
124. An old male smoker with drug cough and hoarseness. What is the best way to
manage this patient?
A. Refer to ENT
B. Laryngoscopy*
C. Chest X-ray
125. A child with diarrhea has 10 RBCs and many WBCs on stool D/R. What is the
most likely cause?
A. Shigella
B. Entamoeba histolytica
C. Rotavirus
D. Salmonella
126. A child with Hymenolepis nana infestation. What is the drug of choice for this
patient?
 A. Niclosamide
B. Mebendazole
C. Pyrantel pamoate
D. Metronidazole
E. Levamisole
127. A child with Ascaris lumbricoides infestation. What is the drug of choice for
this patient?
A. Niclosamide
B. Mebendazole
C. Pyrantel pamoate
D. Metronidazole
E. Levamisole
128. A child with chickenpox should be isolated for a duration of:
A. 7 days
B. 14 days
C. 10 days
D. 5 days
129. A female mother lost her 18 year old son 3 months back. Now, she has been
depressed for 2 months. What is the appropriate management?
A. Counselling
B. Benzodiazepines
C. TCA
130. A married female has anxiety while her husband is abroad. What is the
appropriate treatment?
A. Counselling
B. Benzodiazepines
C. TCA
131. A child with joint swelling, raised ESR and an audible murmur. He has a
history of sore throat 1 week back. What is the most likely diagnosis?
A. Glomerulonephritis
B. Henöch-Schonlein purpura
C. Rheumatic fever
132. A business man is suspected to have typhoid fever. What is the best
investigation?
A. Typhi-dot
B. Widal test
C. Stool culture
D. Blood culture
133. A 2 year child with weight between the 50th to 75th percentiles. Parents
complain that the child does not eats “nothing”. What is the best
management?
A. Reassure
134. A male smoker presents with a history of recurrent lip ulcer. The ulcer bleeds
on touching. What is the most likely diagnosis?
A. Squamous cell carcinoma
135. Which drug would you NOT give for malaria?
 A. Primaquine
B. Quinine
C. Chloroquine
D. Mefloquine
136. A female at 30 weeks gestation with Hb of 8 g/dl. She complains of nausea &
vomiting and says that she cannot tolerate iron supplements. What is the most
appropriate management?
A. Discontinue iron supplementation
B. Give I/M iron
137. Which of the following is an absolute contraindication to IUCD?
A. Grand multiparity
B. Vaginal discharge
C. Uterine anomaly
D. Prevous C-section
138. A female presents with symptoms of anemia. She is a mother of 3 kids. What
is the most appropriate investigation to order?
A. Hb/Hct
B. Ferritin
C. Electrophoresis
D. Peripheral smear
139. A female with IUCD in place. On examination, the string cannot be found.
What is the next best step?
A. Order ultrasound
140. A child with a single palpable lymph node in the anterior triangle. What is the
best management?
A. FNA
B. Excisional biopsy
C. Start ATT
D. Refer for surgery
E. Observe
141. A baby is born to a mother on anti-tuberculous therapy. What is the best way
to manage the baby?
A. Brest-feeding and isoniazid
142. If you raise the serum cholesterol level from 200 mg/dl to 250 mg/dl, which of
the following happens?
A. ↑ false-negative
B. ↓ false-positive
143. A person with a dog bite has been administered the rabies vaccine. All of the
following are part of management EXCEPT:
A. Observe for a day
B. Give antibiotics
C. Check tetanus
D. Reassure
E. Wound toilet
144. Which of the following would you use to determine association between diet
and obesity?
 A. Odds ratio
B. Relative risk
C. Chi-square test
145. A male with mucopurulent eye discharge. What is the best way to manage this
patient?
A. Give antibiotics
146. A child has been given BCG after birth. He has a 2 cm x 2 cm palpable lymph
node in the axilla. What step would you take to manage this patient?
A. Call back in 2 weeks
B. Start isoniazid
147. A child got measles vaccine at the age of 9 months. The vaccine quality is out
of question. The child later on develops measles at the age of 1 year. What is
the most likely explanation?
A. Malnutrition
B. Maternal antibody interference
C. Vaccine was given subcutaneously
D. Child was too young
148. A patient with diabetes mellitus has 2+ pedal edema and significant
proteinuria. Which of the following tests will predict renal function in this
patient?
A. Creatinine clearance
149. A patient with uncomplicated diabetes mellitus. Which of the following tests
would you order along with RBS on regular visits?
A. HbA1c
B. Urinanalysis
150. A patient with active hepatitis B has negative HBsAg and HBsAb, but, IgM
HBcAb is positive (“window period”). What is the most likely explanation?
A. Surface antigen is cleared by antibody
151. You will administer all of the following to a patient with hepatitis B
EXCEPT:
A. Steroids
152. In which of the following conditions, emergent referral is required?
A. Acute angle-closure glaucoma
153. Recurrent diarrhea: you will do all of the following EXCEPT:
A. Disinfect with bleach
B. Wash vegetables with KMnO4 solution
154. Which of the following is appropriate for prophylaxis of malaria?
A. Chloroquine 200 mg for 1 week
B. Mefloquine 100 mg for 1 week
155. A person staying in an Afghan refugee camp. Which of the following is he
least likely to contract?
A. Malaria
B. Tuberculosis
C. Typhoid
D. Leishmaniasis
156. An 8 months child with history of exposure to measles. Which of the
following is the most appropriate management?
A. Administer vaccine
B. Give immunoglobulin
C. Reassure
157. In the above question, if the child was 2 months old, what would be the
appropriate management?
A. Administer vaccine
B. Give immunoglobulin
C. Reassure
158. A male smoker presents with complaints of hemoptysis and fever. What is the
most appropriate next step?
A. Chest X-ray
159. Migratory polyarthritis is a feature of which of the following diseases?
A. Gout
B. Rheumatoid arthritis
[No mention of rheumatic fever.]
160. Which of the following is the best management for threatened abortion?
A. D&C
B. Ultrasound
C. Bed rest
D. β-hCG
161. A person had history of gonorrhea which was treated recently. Now, the
person’s wife comes with gonorrhea. What is the most appropriate
management?
A. Treat wife
B. Treat wife and husband
162. A child who has never been vaccinated presents with convulsions. Which of
the following should be administered?
A. BCG, OPV, DT
163. A 68 years old male with nocturia, frequency, hesitancy and dribbling. On
DRE, a smooth enlarged firm prostate is felt. What is the most likely
diagnosis?
A. Benign prostatic hyperplasia
B. Adenocarcinoma of prostate
164. What is the most appropriate step on the first visit of the above patient?
A. Order serum PSA levels
B. Refer to a urologist
C. Order ultrasound of prostate
D. Prostate massage for secretions
E. Urine culture
165. Developing countries have seen improvement in health in the past 50 years
due to:
A. Improved socioeconomic system
B. Gap between pregnancies
C. Industrialization
 D. Better investment in health sector
E. Doctor-to-patient ratio has improved
166. A Rh D-negative patient delivered an infant whose umbilical cord tested
blood D positive, direct Coomb’s negative. A review one week postpartum
reveals that the mother did not receive D-immune globulin. Which of the
following describes the correct administration of D-immune globulin at this
time?
A. No longer useful
B. 300 μg I/M
C. 300 μg I/V
D. 600 μg I/M
E. 600 μg I/V
167. A 29 years old patient conceives 2 weeks after receiving rubella vaccine. She
is concerned about fetal risk. What should be done now?
A. Serial U/S should be initiated in the midtrimester
B. The vaccine is a killed vaccine and is of no consequence
C. Two rubella titers should be obtained 2-3 weeks apart
D. The risk of congenital infection is negligible
E. Induced pregnancy termination is recommended
168. A 35 years old P3+0 is on oral contraceptive pills since past 2 years. Since the
last few months, she is experiencing marked diminution of withdrawal flow in
the pill free interval. Now she has come with complaint of bleeding P/V for
the last 10 days while on medication. What will be your next step?
A. Stop the pill and change to another method of contraception
B. Double the dose of OCP
C. Change to high dose estrogen (50 μg) OCP
D. Add estrogen for a week in addition to the use of OCP
E. Complete the pack of OCP and estrogen together
169. A 55-year old woman last menstruated at age 51. Nine months back, she
began taking 0.625 mg of conjugated equine estrogen and 2.5 mg of
medroxyprogesterone acetate daily. About 3 months after starting the
regimen, she spotted lightly for 2 days. Six months later, she is having
bleeding that requires one to two sanitary pads daily. Recommended
management of this patient is to:
A. Discontinue estrogen until bleeding ceases and then resume the combined
regimen after a month free of bleeding
B. Double the estrogen dose until a week after bleeding ceases then resume
the original regimen
C. Discontinue estrogen-progesterone therapy
D. Sample the endometrium
170. A 25 years old woman P2+0 with an IUCD for the past 12 weeks. She comes in
with the complaint of vaginal discharge which is frothy, greenish white in
color and has a fishy smell, especially, after intercourse. There is no vaginal
irritation. What is the most appropriate management?
A. Give a course of Flagyl 400 mg BID for 7 days
B. Remove the IUCD and prescribe antibiotic
 C. Canestan vaginal pesseries 500 mg HS for 6 nights
D. Use condoms during sexual intercourse
171. A 28-year old infertility patient conceives and presents for U/S examination of
her pregnancy. Her LMP was 6 weeks ago. A TVS shows an 8 mm sac but no
identifiable fetal pole or heart beat. The next step in this patient’s management
is:
A. Suction curettage
B. Methotrexate therapy
C. CVS
D. Measurement of serum progesterone
E. Measurement of β-hCG
172. A 35-year old patient G4P3+0 underwent an uncomplicated elective abortion 8
weeks after her LMP. Three days later, she reports cramping pelvic pain and
vaginal bleeding that requires two pads every hour. Examination reveals that
the uterus is at 8 weeks size and softened. What is the next step in the
management of this patient?
A. Perform suction curettage
B. Prescribe oral doxycycline
C. Obtain an upright X-ray abdomen
D. Hospitalize for hydration and observation
E. Determine serum β-hCG
173. A 21-year old para 1+0 presents with a unilateral mobile moderately painful
ovarian cyst measuring 7 cm. U/S examination confirms the presence of cyst
and there is no ascites. The next step in the management of this patient is:
A. Laparotomy
B. Laparoscopy
C. Oral contraceptives
D. Observation
E. CT scan
174. A 32-year old patient G2P2 is seen for a follow-up visit 6 weeks after
insertion of a Copper T-380A IUCD. She is concerned that she has never been
able to feel the IUCD string. A speculum examination does not reveal the
string. A bimanual examination is unremarkable and a pregnancy test is
negative. What is your next step?
A. Perform HSG
B. Schedule AP and lateral X-rays
C. Schedule an ultrasound of the pelvis
D. Reassure the patient and schedule a follow-up visit at 3 months
175. Teenager girl has dysmenorrheal, diagnosed double cervix and double vagina;
Probe passes easily through each canal into a uterine cavity; what is the
management?
A. Hysterectomy
B. Uterine unification
C. Excision of vaginal septum
D. Medical management of dysmenorrhea
E. Cervical unification and excision of vaginal septum
176. Two hours after delivering a 3.8 kg infant, a 30 years old patient has profuse
vaginal bleeding. Labor was augmented with oxytocin and lasted for 16 hours.
Delivery was by low forceps with spontaneous delivery of placenta. What is
the most likely cause of this patient’s bleeding?
A. Uterine atony
B. Uterine rupture
C. Uterine inversion
D. Retained placental fragments
E. Lower genital tract laceration
177. A surgeon who is at 16 weeks gestation is accidentally punctured by a needle
while drawing blood from a patient with chronic active hepatitis B. The
surgeon tests negative for hepatitis B. Immediate management should include:
A. Administration of hepatitis B immunoglobulin and hepatitis B
vaccine, followed by two more vaccines over the next 6 months
B. Administration of gamma globulin and hepatitis B vaccine, followed by
two more vaccines after delivery
C. Administration of gamma globulin only, followed by vaccination after
delivery
D. Hepatitis B vaccine only
178. A 35 years old woman reports episodic bloating, breast tenderness,
dyspareunia, irritability and depression, which have her feeling good only one
week a month. She is currently using condoms and spermicidal foam for birth
control because she did not feel well when she was taking oral contraceptives.
Pelvic examination is normal. Your best diagnostic course is:
A. Instruct her to keep a prospective diary documenting her symptoms
for the next 2 months
B. Perform a transvaginal ultrasound
C. Measure serum progesterone during the last half of her menstrual cycle
D. Measure serum estrogen during the first half of her menstrual cycle
E. Begin basal body temperature recording
179. What is the major benefit of HRT in postmenopausal women?
A. Improvement in vasomotor symptoms
B. Protection against cardiovascular disease
C. Reduction in bone aches and pains
D. Psychological benefit
E. Protection against bone fractures
180. Continuous combined HRT increases the risk of:
A. Breast cancer
B. Ovarian cancer
C. Endometrial cancer
D. Cervical cancer
E. Liver cancer
181. Contraindication to HRT is:
A. Fibroids
B. History of venous thromboembolism
C. History of endometrial cancer
 D. Diabetes
182. A 40-year old woman had undergone TAHBSO as a treatment for
endometriosis. At 6 weeks follow-up visit, she is concerned about her having
premature, iatrogenic menopause and wishes to start hormone replacement
therapy. After baseline screening, you would advise her to start on:
A. Combined estrogen-progesterone therapy immediately
B. Estrogen alone immediately
C. Combined estrogen-progesterone therapy after six months
D. Hormone replacement therapy is not recommended
183. A 60-year old woman menopausal for the past 10 years has been brought to
you by her daughter, who is a final year medical student. Her mother was
suffering from osteoporosis and was under treatment. She wishes to start her
on hormone replacement therapy. The patient had no other co-morbidity
except for a history of stroke last year, from which she had completely
recovered. You would advise that:
A. Hormone replacement therapy will be of no benefit now
B. Hormone replacement therapy is contraindicated in her case
C. Start her on combined estrogen-progesterone therapy
D. Start her on estrogen alone
E. Giver her calcium supplements and bisphosphonates
184. A 17-year old girl is brought to you for evaluation of primary amenorrhea. On
examination, she is sexually infantile and on investigations, she is diagnosed
to have Turner’s syndrome. You counseled her to start on HRT. What regime
would you follow?
A. Estrogen 0.625 mg daily and medroxyprogesterone 10 mg for the first 12
calender days each month
B. Estrogen 0.625 mg and medroxyprogesterone 10 mg daily
C. Estrogen 0.3 mg for 6 months to 1 year followed by estrogen 0.625 mg
daily and medroxyprogesterone 10 mg for the first 12 calendar days each
month
D. Medroxyprogesterone cyclical for 6 months to 1 year followed by estrogen
0.625 mg daily and medroxyprogesterone 10 mg for the first 12 calendar
days each month
E. Medroxyprogesterone 10 mg for the first 12 calendar days each month
185. A 44-year old woman has come to you for advice. She is on combined oral
contraceptive pills for the past 8 years. Her sister had menopause at the age of
45 years. She is concerned regarding her menopausal status and when to stop
taking oral contraceptive pills. What would you advise?
A. Stop the contraceptive pills and start with hormone replacement therapy.
She is unlikely to become pregnant
B. Continue with the oral contraceptive pills till there is no withdrawal
bleeding and then switch to hormone replacement therapy
C. Continue on oral contraceptive pills and check for FSH and LH level
during menses yearly
D. Stop the oral contraceptive pills and then check for FSH and LH
levels
 E. Use another method of contraception
186. A 46-year old woman has come to you with complaints of vasomotor
symptoms, irritability and depression. Her last menstrual period was 8 months
ago. You have diagnosed her to have perimenopausal symptoms. What
treatment regimen would be best for her?
A. Continuous combined estrogen-progestrone therapy
B. Sequential estrogen and progesterone therapy
C. Tibilone (estrogen, progesterone and androgen)
D. Raloxifen (selective estrogen receptor modulator)
E. Anti-depressant therapy
187. What is the most common cause of infant mortality?
A. Septicemia
B. Low birth weight
C. Asphyxia
[No mention of diarrhea.]
188. Effectiveness of an intervention for the eradication of a disease is judged best
by:
A. Prevalence
B. Incidence
C. Absolute risk
D. Relative risk
E. Odds ratio
189. Child after giving DPT vaccine cries for 3 hours and then stops. What is the
most likely reason?
A. Reaction to diphtheria
B. Reaction to pertussis
C. Hematoma formation
D. Pain at injection site
190. A pregnant woman on average should gain how much weight in pregnancy?
A. 7 kg
B. 10 kg
C. 12 kg
D. 14 kg
191. All the following are useful tests in the diagnosis of jaundice EXCEPT:
A. Endoscopic retrograde cholangiopancreatoduodenography
B. Ultrasound
C. Intravenous cholangiogram
D. Biliary excretion (HIDA) scan
192. All of the following are causes of prolonged jaundice in a neonate EXCEPT:
A. Tracheoesophageal fistula
B. Untreated UTI
193. A 16 years old girl with amenorrhea. Her breast development according to
Tanner stages is stage II. Her FSH and LH are slightly reduced with a
prolactin of 50. What is the next best step?
A. Karyotyping
B. TSH
 C. Bone X-ray
194. If appendectomy is performed due to RLQ pain but the appendix is found to
be normal intra-operatively, what could be the other most likely cause?
A. Mesenteric lymphadenitis
B. Meckel’s diverticulum
195. Fistula-in-ano can be caused by all of the following EXCEPT:
A. Ulcerative colitis
B. Cancer
C. Trauma
D. Polyps
196. An old alcoholic man with a painful ulcer at the base of tongue. What is the
most likely diagnosis?
A. Squamous cell carcinoma
B. Basal cell carcinoma
C. Blastomycosis
197. A 4 months old baby with noisy breathing since birth. Dyspnea is relieved by
placing the baby in prone position. Now, the baby has runny nose and cough.
What is the most likely diagnosis?
A. Laryngomalacia
198. A young male for last 4 days has pain in chest which is relieved by sitting
forward. What is the most likely cause?
A. Rheumatic fever
B. Viral pericarditis
199. Which of the following antibiotics has the best penetration into prostatic
fluids?
A. Sulfamethoxsazole-trimethoprim
B. Ciprofloxacin
200. A young female underwent a two-stage esophagectomy for esophageal
carcinoma. She is currently on total parenteral nutrition. On 3rd day, she
develops excessive lethargy, drowsiness and increased urination. What is the
next best step?
A. Check blood glucose levels
B. Check serum electrolytes
201. A baby born to a diabetic mother will suffer from all of the following
EXCEPT:
A. Hypocalcemia
B. Hyperinsulinemia
C. SGA
D. Hypomagnesemia
E. Polycythaemia
202. Portal hypertension is caused by all of the following EXCEPT:
A. Alcoholic cirrhosis
B. Post-necrotic cirrhosis
C. Budd-Chiari syndrome
D. Portal venous thrombosis
E. Amebic abscess
203. Hypercapnia is most likely seen in which of the following conditions?
A. Obesity (Pickwickian syndrome)
B. Asthma
C. Chronic obstructive pulmonary disease
204. A patient who has developed DVT: which of the following statements is
wrong?
A. Start heparin immediately and monitor aPTT
B. Start warfarin after 1 week and monitor PT
C. Selected patients can have thrombolytics to prevent post-
thrombophlebitis syndrome
205. A man presents with history of fever with chills. On further investigations, he
is found to have deranged ALT. He started on empirical ceftriaxone. What is
the next best step?
A. Order ultrasound
206. On ultrasound, a 4 cm x 8 cm hypoechoic mass is seen. What is the next best
step?
A. Start ceftriaxone and Flagyl
B. Continue ceftriaxone, start Flagyl and do U/S-guided biopsy
(aspiration)
C. Continue ceftriaxone, start Flagyl and do CT-guided biopsy
207. A man with backache and pain radiating down to legs with numbness in sole
of feet. What is the most likely diagnosis?
A. Disc prolapse at L5
B. Disc prolapse at S2
C. Disc prolapse at S1
208. ABGs of a patient show pCO2 of 28 mm Hg, pO2 of 85 mm Hg and pH of
7.32 (without any mention of HCO3-). What is the most likely disorder?
A. Metabolic acidosis
B. Respiratory acidosis
C. Compensated metabolic acidosis
D. Hypoxemia
E. Compensated respiratory alkalosis
209. A man was hit on his leg from behind. Now, his foot is pulseless and leg is
angulated. What is the next best step?
A. Gently realign the leg and reassess
B. Generate a vascular surgery consult
210. A child has nappy pustules with erythematous base. He has fever, but, does
not look very ill. On culture, growth of which organism is most likely?
A. Viral
B. Group B streptococci
C. Staphylococcus aureus
211. The most important factor for developing preterm labor is:
A. Hypertension
B. Previous history
C. Diabetes mellitus
D. Polyhydraminos
 E. Urinary tract infection
212. A 9 kg child has diminished skin turgor and appears moderately dehydrated.
His fluid deficit is:
A. 1500 mL
B. 900 mL
C. 720 mL
D. 200 mL
213. In a patient with acute abdomen, you suspect the cause to be a perforated
duodenal ulcer. What is the next best step in the management of this patient?
A. X-ray standing and sitting
214. A psychotic man who is taking his medications regularly develops fever,
rigidity and altered mental status. What is the most likely cause?
A. Neuroleptic malignant syndrome
215. A patient with resected colonic carcinoma. How do you follow-up this patient
for liver metastases?
A. Ultrasound
B. CEA
C. CT scan
216. The most important factor in predicting the development of carcinoma in
ulcerative colitis is:
A. Duration of disease
B. Chronic course with multiple remission
C. Total length of colon involved
217. Which of the following is a finding of heat stroke?
A. Heart is not affected
B. Core temperature remains normal
C. Skin is dry and hot
D. Diaphoresis is a prominent feature
218. Which of the following thyroid conditions do NOT respond to TSH?
A. Papillary carcinoma
B. Medullary carcinoma
C. Hashimoto’s thyroiditis
D. Grave’s disease
219. The most common presentation of GERD in children is:
A. Regurgitation
B. Apnea
C. Heartburn
220. All of the following are true about ischemic ulcers EXCEPT:
A. Redness
B. Pain
C. Thickened skin
221. The most important prognostic factor in cases of hemorrhagic pancreatitis is:
A. Serum amylase > 1000 IU/mL
B. Serum calcium < 8 mg/dl
C. History of pancreatitis in past one month
222. The best test to diagnose infective endocarditis is (serial blood cultures)
223. In cases of colon carcinoma, a large portion of gut is removed. The main
reason for this practice is (good end-to-end anastamosis)
224. A man with numbness in thenar eminence at night: (carpal tunnel syndrome)
225. Breast abscess is most commonly associated with (lactation)
226. Metabolic alkalosis is mostly associated with (hypokalemia)
227. A lady with drowsiness; you suspect meningitis, but, an LP cannot be
performed. What is the next best step? (send blood C/S and start antibiotics)
228. A lady with insomnia, sweating and irritability alongwith irregular periods.
What is the most likely cause? (perimenopausal)
229. A patient with head injury: first thing to do is (secure airway)
230. The most common cause of airway obstruction is (tongue falling back)
231. A child with unilateral wheeze and CXR shows air-trapping: (foreign body)
232. The classical presentation of ileocecal intussusception in children is:
(sausage-shaped RUQ mass, currant-jelly stools and Dance sign on AXR)
233. Best investigation for abdominal mass: (CT scan)
234. A boy took phenytoin and developed maculopapular rash with face
downwards and eosinophilia in blood: (drug allergy)
235. UTI in pregnancy on urine D/R: (give Augmentin)
236. A grand-multipara augmented with augmented labor has become hypotensive:
(uterine rupture)
237. Which of the following can be diagnosed on wet mount? (Trichomonas)
238. Which of the following is contraindicated in pregnancy? (tetracycline)
239. Which of the following is contraindicated in young children? (tetracycline)
240. The most common cause of malnutrition is (inorganic cause)
241. The best indicator of progress of labour is (cervical dilatation)
242. Peripheral smear picture shown: (nucleated RBCs)
243. A patient with bone pains; peripheral smear will show (sickle cells)
244. A patient with spiking fevers with chills and rigors. A peripheral smear
picture was shown: (Plasmodium falciparum, Plasmodium vivax)
245. A patient with pancytopenia; bone marrow trephine biopsy was shown. The
most likely diagnosis is: (aplastic anemia)
246. A patient with decreased hemoglobin and normal MCV has: (aplastic
anemia)
247. A patient has a 3 month history of tremors, which are present in certain
positions only with no resting tremors. What is it? (benign essential tremors)
248. A 46 years old patient with incontinence, memory deficits and ataxia:
(normal pressure hydrocephalus)
249. A patient with MI: what will you give to manage pain? (morphine +
nitroglycerin)
250. Female patient with symptoms of anxiety, husband away, which drug to give?
(benzodiazpines)
251. A 2 months old baby had OPV and DPT. 8 hours later presented with fever of
104oF and persistent crying: (do not give pertussis in future)
252. Treatment of malaria—dosing of chloroquine: (4 tablets stat, then 2 tablets
after 6 hrs, then 1 tablet BID for 2 days)
253. At 6 weeks postpartum, you will not investigate further EXCEPT in case of
(vaginal bleeding)
254. The first investigation in case of primary infertility is (semen analysis)
255. A patient with left-sided retro-orbital pain, red eye and decreasing visual
acuity. The treatment of choice is: (IV mannitol + topical pilocarpine +
acetazolamide)
256. A medical student with 6 month history of 3-4 stools in day and no stools at
night. On stool D/R, no WBCs or RBCs are seen. What is the most likely
diagnosis? (Irritable Bowel Syndrome)
257. A person had laceration due to fall in severage water; his vaccination history
is unknown. Which of the following will you administer? (TT + Ig)
258. A young girl had 3 attacks of sudden fall. Last one was after seeing her
neighbour shot dead. What is the most likely cause? (vasovagal syncope)
259. A patient with signs and symptoms consistent with tuberculous pericarditis.
Increased JVP is due to (reduced ventricular filling)
260. Most common cause of PPH is (uterine atony)
261. Above patient comes for urgent management: (pericardiocentesis)
262. Odds ratio calculation by a 2x2 table: (ad/bc)
263. Which of the following drugs is contraindicated in asthma patients? (β-
blockers)
264. A volunteer worker with intermittent fever and dark-colored urine: (malaria)
265. A dialysis worker should NOT get which vaccine? (typhoid)
266. The most common complication of multiple gestation? (preterm labor)
267. A patient with fever, diarrhea and mucus in stool: (give naldixic acid)
268. A patient with essential HTN at 16 weeks gestation: (methyldopa)
269. Pregnant lady with negative Rubella IgG: (MMR after delivery)
270. A female with a minor laceration. Her immune status is unknown. What will
you administer? (Pencillin + TT + Ig)
271. A pregnant female with vaginal bleeding. What would be the next step? (P/V
examination)
272. Pre and post-industrialization health transition because of (better primary
care)
273. Which drug given for prophylaxis of malaria in Pakistan? (mefloquine)
274. Drug of choice for rheumatoid arthritis: (DMARDs, methotrexate,
cyclophosphamide, gold salts)
275. Investigation or intervention of choice for a woman with threatened abortion
at 8 weeks gestation: (ultrasound)
276. 3 hours of crying / day for 3 days or weeks in a 2-6 months old baby during
the evening: (COLDC)
277. Earliest onset primary post-partum hemorrhage: most common cause is
(uterine atony)
278. Hypothyroidism in pregnancy: all can be administered EXCEPT (radio-
iodine)
279. All of the following are good sources of iron EXCEPT (apples)
280. Child given DPT starts insolable crying and screaming: what is the immediate
management? (do not give DPT again, Panadol*)
281. HRT is protective against: (endometrial CA)
282. Which contraception protects against STDs? (condoms)
283. PCOS patient: what to prescribe? (combined OCPs)
284. Innocent murmur of pregnancy: (ejection systolic murmur)
285. A child with streptococcal sore throat has elevated ASO titers. Now, he has
developed edema with 2 RBCs in urine and +1 protein. What is the most
likely cause? (post-streptococcal glomerulonephritis)
286. A 65 years old man has bleeding P/R for 2 yrs. Now, he has developed early
morning diarrhea. What is the most likely cause? (IBD)
287. The most common cause of abortion/miscarriage is (triploidy)
288. The most common anemia in pregnancy is (iron deficiency anemia)
289. Most important cause of polyhydraminos: (GIT malformations)
290. A lady presents with bleeding P/V. Her LMP was 8 weeks ago. She has no
other symptoms. On examination, her cervix is not dilated. What is the most
likely diagnosis? (threatened abortion)
291. Recurrent tetanic contractions occurring in a lady. She is on low-dose
oxytocin in labor. What to do? (stop oxytocin infusion)
292. The most likely cause of symmetric IUGR is (essential HTN, PIH, GDM,
congenital problems)
293. Down’s syndrome increases the risk of (duodenal atresia)
294. A school-going child with watery diarrhea: (rotavirus)
295. A patient with a third degree burn. What is the best way to avoid infection?
(prophylactic antibiotics)
296. Which of the following is NEVER used as first-line antihypertensive?
(clonidine)
297. Which of the following investigations is best for monitoring glycemic control
in patients with diabetes mellitus? (glycosylated HbA1c)
298. 4 years old child with bloody diarrhea and decreased urine output: (hemolytic
uremic syndrome)
299. Hypotension in a post-op patient: how do we assess for cardiogenic shock in
this patient? (PCWP)
300. A lady with IUCD in place has become pregnant. What to do now? (remove
and counsel)
301. All of the following abnormalities are NOT visible on chest X-ray EXCEPT:
(tension pneumothorax)
302. A 3 years old child with a mass in superior mediastinum on chest X-ray and
ipsilateral Horner’s syndrome: (neuroblastoma)

303. A 7 yrs old child bare-footed  injures foot: (find immunization status and
manage accordingly)
304. A 9 yrs old child with no immunization injures foot while bare-footed: (give
Ig & TT)
305. A 3 years old child complains of low-grade fever and cough. He is febrile
with a temperature of 38oC and his respiratory rate is 25. What to do?
(symptomatic treatment and follow up in 48 hours)
306. HBsAg positive mother gives birth to a child. The baby should get (HBIG +
vaccine within 12 hrs)
307. A 7 years old child with high-grade fever, anemia and hepatomegaly. The
diagnosis is (dengue)
308. Danger signs of severe pneumonia according to IMCI are (chest indrawing
and RR > 58)
309. A 2 months old child with pertussis had 1 dose of DPT + Hep B @ 6 wks;
what to do now? (continue EPI schedule)
310. A 4 day child with severe jaundice; active and alert on examination; bilirubin
pending; appropriate advice would be (continue breast-feeding)
311. A 4 day child with pneumonia: the antibiotic of choice would be (amoxicillin)
312. A 1.5 yrs old child with history of diarrhea and fever for 3 weeks. He has been
given four antibiotics. Now, on bovine & breast milk + ORS. He is passing 7-
8 watery stools per day; no fever or vomiting. What should be done? (stop
cow milk, continue breast milk, give KYB)
313. Child with diarrhea since 4 weeks; foul-smelling stools + flatulence +
abdominal cramps; stool culture is negative; infective organism is (Giardia)
314. Newborn full-term jaundiced at 24 hours; O/E alert & oriented; serum
bilirubin is 13; mother is O+. What to do? (blood group)
315. Child on exclusive breastfeeding needs supplementation of (vitamin D, iron)
316. Child > 6 mo; exclusive breastfeeding; Hb at 8 g/dl; management should be
(iron therapy + weaning)
317. Child with rhinorrhea, severe cough + post-tussive emesis; diagnosis is
(pertussis)
318. Peak age for rubella infection is (adolescence + adults)
319. Child with diarrhea; O/E irritable, slow skin pinch & sunken eyes;
management should be (ORS over 4 hours)  Plan B
320. Child infected with Enterobius vermicularis; management should be (hygiene
+ medicine)
321. Child with diarrhea brought to ER; to assess hydration status: (skin turgor,
eyes, ability to drink)
322. Molarity of different ions in 1 L of water when making ORS should be: (Na+
75 mmol, Cl- 65 mmol, K+ 20 mmol, Citrate 10 mmol, Glucose 75 mmol)
323. By 2 yrs, baby should be able to (make 3 word sentences)
324. 6 month old child can (roll when lying supine, sit with support)
325. Anterior fontanelle at (junction of coronal and sagittal sutures)
326. 2 day old boy with mottling of skin, lethargy and poor feeding. The diagnosis
is (sepsis neonatorum)
327. Common organism of neonatal sepsis: (E. Coli)
328. Mild diarrhea: most inappropriate advice is (stop breastfeeding)
329. Commonest cause of watery diarrhea: (rotavirus)
330. Child told to avoid egg/milk/wheat; now stunted: what was the reason?
(decreased caloric intake)
331. Which of the following is NOT true for measles? (mortality is 1:3000)
332. A 9 month old baby with Na+ of 185 mmol; want to give ORS; what is most
relevant? (contraindicated if gut sounds absent)
333. A child for DPT; elder brother had convulsions after it; what would be the
appropriate counseling? (only 1% of children suffer from this effect)
334. Runny nose, hyperemia with no fever; management is (reassure mother +
fluid intake)
335. A 4 months old child had one injection and one drops; what to do now? (give
DPT+OPV+HBV)
336. When to follow up above child? (after 4 weeks)
337. Goat milk can cause (megaloblastic anemia due to folate deficiency)
338. Pregnant nursing female; best advice would be: (continue feeding till you
can)
339. Child on fortified cereals; advice should be: (continue ascorbic acid)
340. Child on breast milk; most important advice to mother would be (suckling to
increase milk production)
341. Child from Sukkur; fever for 3 days with hepatomegaly; diagnosis is (dengue)
342. Child from Sukkur with splenomegaly; diagnosis is (Falciparum malaria)
343. NOT true for hepatitis A: (chronic carrier state)
344. Child has total bilirubin 2.5, direct 2.0, indirect 0.5, SGPT 280; treatment
should be (reassure + symptomatic treatment)
345. Vitamin D deficiency leads to (costochondral angle widening)
346. Vitamin B6 deficiency leads to (neuropathy + seizures)
347. Vitamin B12 deficiency leads to (megaloblastic anemia)
348. Vitamin A deficiency leads to (conjunctival xerosis)
349. Niacin deficiency causes (diarrhea, dementia, dermatitis and death)
350. Child smiles socially at the age of (2 months)
351. Parachute reflex disappears by (8 months)
352. Stuttering is normal at (3 years)
353. A child can skip; what is the age? (4 yrs)
354. Gaze follows objections: (upto midline  1 month; past midline  2 months;
in circle  3 months)
355. Seborrheic dermatitis: (selenium sulphide)
356. Scabies: (5% permethrin ointment)
357. Irritant dermatitis: (steroids)
358. Ringworm: (miconazole)
359. Candida dermatitis: (zinc oxide)
360. Difference between breast milk and cow milk: (iron in cow milk, but,
absorption more in breast milk)
361. Exclusively on cow milk causes (iron deficiency anemia)
362. Child was 10th percentile at birth; now weight is at 5th percentile at 1 yr; the
reason is (decreased caloric intake)
363. Children on breast milk have less diarrhea than those on cow milk; most likely
reason is (sterile)
364. Child with acute otitis media; treatment is (amoxicillin for 10 days)
365. Mother with 6 months old child; wants to wean; advice: (continue
breastfeeding and start solid diet starting with cereals)
366. Characteristic features of kwashiorkor is (hair depigmentation)
367. Not true about marasmus: (child not hungry)
368. Neonatal sepsis; treatment is (ampicillin + gentamycin)
369. 8 months old child with cough, wheezing, tachypnea and low-grade fever; the
diagnosis is (bronchiolitis)
370. Contraindication of Abs in pertussis: (persistent insolable crying for >4 hrs)
371. Why 2 doses of measles not in EPI? (EPI for 1 year)
372. Child sits unsupported and transfers objects from hand to hand: (6-7 months)
373. 11 months old child with open anterior fontanelle; advice would be (normally
closes at 18-24 months)
374. Dysentry: what to give? (ORS + ciprofloxacin)
375. Child with anorexia, malaise, hepatomegaly; history of outside food;
diagnosis is (hepatitis A)
376. Incubation period of chickenpox is (10-21 days) avg: 14-15 days.
377. Neonate with pertussis: biopsy shows (eosinophils)
378. Mother came with child; grandmother had TB; management should include
(PPD + CXR)
379. 7 months old child; fever for 4 days; fever settles and then maculopapular
erythematous rash appears; treatment is (symptomatic) [child has rubella]
380. Baby with purulent ear discharge and perforated tympanic membrane. The
management of this patient includes (ear drops)
381. A patient with a 0.4 cm renal stone on CT scan: what to do? (conservative
management)
382. A person with episodic vertigo, fluctuating SHL and tinnitus: (Meniere’s
disease)
383. A patient with genital herpes: treatment is (acyclovir)

384. Treatment of Meniere’s disease  Serc

385. Angina  Angicid under tongue
386. BCG  live attenuated
387. Measles  live attenuated
388. OPV  live attenuated
389. Tetanus  toxoid
390. Whole cell pertussis  killed
391. HUS  EHEC O157:H7 strain
392. < 20 wks  symmetrical IUGR
393. > 20 wks  asymmetrical IUGR
394. Shoulder dystocia  Erb’s palsy
395. Post-thyroidectomy tingling  calcium gluconate
396. Feature of febrile seizures  <5 months age
397. Confidence interval from 95% to 99%  width ↑
398. Calculating sample size  80%
399. Lactose intolerance  ↓ milk intake
400. Calcium oxalate stones  ↑ water intake
401. Increased hematocrit  smoking
402. Impetigo: honey-crusted lesions on face  cloxacillin
403. Child with epiglottitis  refer to ER
404. Child with bulging ear drum  amoxicillin
405. A grand multipara has hypotension postpartum  uterine atony
406. Intestinal obstruction  common causes are hernias, adhesions, malignancy
407. Child has nappy rash without satellite lesions  give zinc oxide
408. 16 years old girl with vaginal discharge  physiological
409. A child with hepatitis A  don’t restrict diet
410. Frothy vaginal discharge  metronidazole
411. Hyperthyroidism  Grave’s disease
412. Serum progesterone  second half of cycle
413. Serum estrogen  first half of cycle
414. Scabies  treat all family members
415. Papilledema  NOT in DM
416. Osteoarthritis  simple effusion
417. Premenstrual syndrome  reassure
418. Candida vaginitis  pessaries
419. β-blocker  labetalol
420. Hirsutism  PCOS
421. Hemarthrosis  hemophilia
422. Shingles  give analgesics
423. Menopause  HRT
424. Infant most commonly  LBW
425. Repeated D&C  cervical stenosis
426. PCOS  LH:FSH atleast ≥ 2:1
427. Anemia screening  booking visit and 28 wks
428. Absolute contraindication to OCPs  prosthetic heart valve
429. 2 yrs old child with inability to speak  ask about deafness
430. COPD + white sputum + fever for 2 months  TB
431. Stool occult blood positive  positive predictive value
432. Prevention of colon cancer  ↓ intake of fat
433. Alcoholic cirrhosis  do cohort study
434. BMI with sex  Chi-square test
435. Measles  maternal antibody protective
436. Perceived lactation failure  infrequent suckling
437. Sample size  power = 80%
438. ↑ BP on one occasion  recheck BP on 3 different occasions
439. IHD with elevated cholesterol  target LDL < 100 mg/dl
440. Depression + insomnia  amitryptaline
441. Depression + ↑ sleep  imipramine
442. Depression + phobia  clomipramine
443. Depression + anxiety  dothiepide
444. Pregnancy  physiologic drop in Hb
445. Pseudomonas aeuriginosa  gram negative rod
446. Fever on 5th post-operative day  wound site infection
447. Inguinal lymph node suppuration forming an abscess  refer
448. Lichen planus
449. Paired t-test
450. APGAR scoring
451. Tanner staging
452. Composition of breast milk
453. Kwashiorkor vs. marasmus
454. Odds ratio vs. relative risk
455. Classic causes of menorrhagia: uterine fibroid, adenomyosis

NOTES:
456. SCABIES: 25% benzyl benzoate 3 applications at 24 hrs each, infants 1:3,
children < 5 yrs 2:1, children > 5 yrs do not use, apply on whole body except
face, Lotrix 5%, Phenergan 0.5 mg/kg in 3 divided doses
457. FEBRILE SEIZURES: Panadol, Phenobarbital 15 mg/kg
458. FUNGAL INFECTION: Tab Terbenafine 250 mg QD for 3 months, Tab
Griseofulvin 500 mg QD (10 mg/kg in children) for 3 months if scalp, 6
months if fingernails, > 1 yr if toenails
459. PYODERMA GANGRENOSUM: association with ulcerative colitis
460. SPONGY GUMS: scurvy, ulcerative gingivitis, phenytoin use
461. ALOPECIA ARREATA
462. PITYRIASIS VERSICOLOR: teardrop pattern on cheeks, neck and upper
limbs, differential includes vitiligo, 2.5% selenium oxide solution, apply at
night, wash off in morning
463. PITYRIASIS ROSEA: herald patch, “christmas tree” distribution (face, neck,
trunk, arms), no treatment
464. HYPERTENSION WORKUP: baseline labs include U/A, BUN/Cr, lytes,
FBS, repeat baseline labs in 6 months, prescribe CCBs to asthmatics
465. CONTRACEPTION: condom failure rate 5-10%, protection against STIs in
latex condoms only, spermicides failure rate 5-25%, vaginal sponges failure
rate 5-10%, vaginal diaphragm failure rate 5-10%, IUCD failure rate 2-3%
466. FAILURE RATES: <1% COC injections, 2% IUCDs, 12% basal body
temperature charting, 15% withdrawal
467. MORNING AFTER-PILLS: Levonorgesterl 250 mg, Nerdette for regulating
periods, Lesermine for contraception, Nova for contraception
468. TUBERCULOSIS: avoid INH+RIF+PZA in liver disease, prescribe
streptomycin and ethambutol in such case, PZA is less toxic than INH and
RIF, vitamin B6 1 tab OD for patient >10 yrs, ethambutol should be stopped of
all the drugs as it is less bacteriostatic and causes optic neuritis, steroids given
in tuberculous meningitis and genitourinary TB, 12 months treatment for TB
meningitis, bone & joint TB and HIV patients, do not give ethionamide &
streptomycin & rifampin to pregnant patients, use INH + ethambutol in such
patients
469. HEPATITIS: refer if coagulopathies, altered mental status, chronic hepatitis,
poor food intake
470. NEONATAL HYPERBILIRUBINEMIA:
 INDIRECT DIRECT
Sepsis Sepsis
ABO incompatibility TORCHeS infections
Hepatitis Biliary atresia
Drugs Choledochal cyst
Increased hematocrit Galactossemia
RBC defect Cystic fibrosis
G6PD deficiency AAT deficiency
Hypoxia
Breast milk
Gilbert’s syndrome
Hypthyroidism
Physiologic (onset > 3 days, peaks 5th day, resolves by 10th day)

471. DRUG FEVER: resolves in 1 week, caused by RIF, not caused by (“I Don’T
Cause fever”) Insulin, Digoxin, Tetracycline, Chloramphenicol
472. BRADYCARDIAC FEVER: typhoid, hepatitis, Lyme’s disease, raised ICP
473. TACHYCARDIAC FEVER: TB, diphtheria, malaria
474. MEASLES: vitamin A 600,000 IU I/M stat, Calpol, hydration, nutritional
counseling
475. RICKETS: vitamin D 600,000 IU I/M stat, maintainence 400 IU PO
476. PRESCRIPTION WRITING: name, age, date, drug ‘X’ mg tab 1+1+1 with or
without meals for ‘n’ days, signature
477. ENTERIC FEVER: amoxicillin 100 mg/kg/d for 2 wks, chloramphenicol 75
mg/kg/d, Septran DS BID
478. HONEY-MOON CYSTITIS: Nitrofurantoin 100 mg QID for 3 days, Septran
DS BID for 3 days
479. RVF: sx: tender hepatomegaly, jugulovenous distension, peripheral cyanosis,
edema, abdominal distension, wasting; Mx: treat underlying cause, ↓ salt
intake, ↓ alcohol, ↓ smoking, ↓ weight, balanced diet, exercise, fluid
restriction < 1.5 L/day, Na+ restriction < 2 g/day, O2 to improve dyspnea,
avoid NSAIDs as they can cause fluid retention, diuretics (thiazide),
vasodilators like nitrates (↓ preload), ACE inhibitors (↓ afterload), inotropes
480. PCOS: investigations include fasting insulin, FBS, FSH/LH, TVS, prolactin;
weight loss and Glucophage 500 mg TID for 3 weeks; regular OCPs or
progesterone 3 monthly; fertility issues (Clomid); Dian for hirsutism, surgical
treatment includes wedge resection and ovarian drilling; long-term
complications include DM, HTN, hyperlipiedmia, endometrial hyperplasia,
endometrial carcinoma, breast carcinoma
481. FIBROIDS: obese and multiparous patients, menorrhagia, urinary frequency,
myomectomy, hysterectomy
482. ADENOMYOSIS: multiparous woman of older age group; sx: menorrhagia,
secondary dysmenorrheal, infertility; examination: large bulky uterus;
treatment: hysterectomy
483. ENDOMETRIOSIS: nulliparous woman of younger age group; sx:
dysmenorrhea, dyspareunia, dyschezia, infertility; examination: nodules &
 tender adnexal mass; treatment: progesterone, OCPs, danazol, GnRH analogs,
surgery
484. RUBELLA VACCINE DURING PREGNANCY:
CDC & ACIP 2001 RECOMMENDATIONS & ACOG 2002
RECOMMENDATIONS
- No cases of CRS identified among infants born to females who were
vaccinated inadvertently against Rubella within 3 months or early in
pregnancy
- Recommended period to avoid pregnancy shortened to 28 days after
receiving Rubella vaccine
- Overall “theoretical” risk is 0.5%. Maximum theoretical risk to infants
born to susceptible mothers vaccinated 1-2 weeks before to 4-6 wks after
conception is 1.3%. This is substantially less than the >20% risk for CRS
associated with maternal infection during the first 20 weeks pregnancy
- If a pregnant woman is not immunized, she should receive the vaccine
immediately after delivery, since, it is safe for breast-feeding women

485. RhoGAM RCOG 2002 GUIDELINES:

- I/M anti-D Ig 300 µg (1500 IU) given into deltoid is ideal, though, I/V
preparations are also available
- Anti-D Ig should be given as soon as possible after the delivery or
sensitizing event within 72 hours
- If it is not given before 72 hours, every effort should be made to
administer anti-D Ig as a dose given within 9-10 days may provide some
protection against maternal isoimmunization and consequent hemolytic
disease in subsequent D+ offspring (Grade B recommendation based on
experimental and observational studies)
- Women who are already sensitized should not be given anti-D Ig

486. SECONDARY SEX CHARACTERISTICS:

9-10 yrs Thelarche
10-11 yrs Adrenarche
11-12 yrs Growth spurt
12-13 yrs Menarche
13-14 yrs Pubic hair

487. NEONATAL MORTALITY:

Most common cause Septicemia
Second most common LBW
Third most common Asphyxia
 SAQs

1. A 6 months old child with a temperature of 40oC suffers a generalized tonic-

clonic seizure.
a. What is the most important step in management? (ABCs)
b. After the child stops seizing, what medication would you give? (anti-
pyretics)
c. How would you counsel the parents? (reassure, 0.02% risk of epilepsy,
recurrence rate is 30-35%)

2. A retrospective study on development of DVT. Odds ratio given and asked about
interpretation of odds ratio.

Odds ratio = ad/bc, describes strength of association.

3. A 38 years old gardener with history of lower backache (disc prolapse). Now, he
has developed sudden onset lower back pain.
a. What are the important points in history?
b. What is important in examination? (SLR)
c. What non-pharmacological modalities would you prefer?
4. Management of patient in anaphylactic shock.

5. 40 yrs P1+0 COPDer develops right lower lobar pneumonia 3 days back. Now, she
has developed painful swelling of right knee.
a. Differentials gout,septic arthritis, RA, TB effusion.
b. Investigations CBC, ESR, RF, joint fluid analysis, BLCS, joint
fluid gram stain and CS, CXR
c. Management warm compresses, joint aspiration, IV antibiotics,
analgesia

6. A study comparing mean Hb levels of two different communities.

a. Write null and alternate hypotheses null: mean Hb level of community A
is greater than or equal to the mean hb level of community B.
b. What would be the appropriate statistical test? T-test
c. What would be the appropriate study design? Descriptive study
d. What type of sampling method would be used? Randomized.

7. An otherwise healthy child with jaundice on 3rd day of life.

a. Important points in history
b. Three differentials
c. Modalities to confirm diagnosis
d. Management

8. A diabetic hypertensive on oral hypoglycemics presents for a follow-up visit.

a. Which three organ systems would you also check?
b. Atleast six lab tests that you would order
9. A 43 years old P4+0 comes at the PHC clinic with the complaints of painless,
heavy menstrual cycles for the past 2 years. On examination, her pulse is 90/min,
blood pressure is 140/80 mm Hg. Per abdominal examination is unremarkable and
on vaginal examination, uterus is bulky with no adnexal masses or tenderness.
a. Elaborate the history.
i. Regularity, clots, number of pads, inter-menstrual or post-coital
bleeding
ii. Contraception: history of insertion of IUCD
iii. Past history: DM, HTN, CLD
iv. Family history: ovarian/uterine cancer
b. What is your differential diagnosis? (fibroids, adenomyosis, DUB,
endometrial hyperplasia, hypothyroid)
c. What relevant investigations would you like to order? (CBC, PT/aPTT,
LFTs, U/S, endometrial biopsy, PAP smear)
d. What medical treatment options might you offer her? (Ponstan,
Transamin, estrogen 21 day & progesterone 10 day, danazol, LNG-IUS)
e. If medical treatment fails, what other options might you offer her?
(endometrial ablation, myomectomy, hysterectomy)

10. A 6 years old boy presents to you with complaints of 3 episodes of wheezing and
chest pain over the past 1 month. He has been afebrile throughout. He is
asymptomatic between attacks.
a. What is the diagnosis?
b. How would you manage this patient?

11. A 9 years old girl presents to you with complaints of difficulty in expiration
during the last 3 months. She says that she has these episodes almost every week
and usually after playing.
a. What is the diagnosis?
b. How would you manage this patient?

12. A 7 years old boy is brought to you with complaints of breathlessness, wheezing
and chest tightness. His respiratory rate is 22/min and his pulse is 98/min. He
prefers to sit and seems to be using accessory muscles of respiration. He becomes
breathless on talking but is able to complete sentences.
a. What is the diagnosis?
b. How would you manage this patient in your clinic?
13. A 12 years old boy comes with complaints of episodes of breathlessness, chest
tightness and cough which have been occurring on a daily basis for the past one
month. Earlier they would occur less frequently. These days he is taking inhaled
corticosteroids and Ventolin inhaler on a daily basis.
a. What is the diagnosis?
b. How would you manage it?

14. A 7 years old boy has been taking inhaled steroids (100 mg/day) for the past 6
months. Since then he has not had a single episode of chest tightness,
breathlessness, cough or wheezing. He has come for a follow-up visit.
a. What is the diagnosis?
b. How would you manage this patient?

15. A study about relation of scalp skin carcinoma with hair dye use.
a. Write the null hypothesis.
b. Write the alternate hypothesis.
c. Three inclusion criteria.

16. 2.5 months old infant with 7 weeks history of mucoid diarrhea and weight loss.
What can be the causes with their appropriate reasons?
a. Bacterial diarrhea: unclean feeding practices
b. Amebic infection: unclean water being fed
c. Tuberculosis: weight loss and prevalence of disease in Pakistan
d. Cystic fibrosis: mucoid nature of diarrhea
e. Chronic giardiasis: malabsorption

17. 2 years history of knee pain: now bilateral swelling of knees and epigastric
tenderness alongwith retrosternal burning.
a. List three differentials: IBD, psoariatic arthritis, PUD secondary to
NSAID use, osteoarthritis.
b. Non-pharmacological management: lifestyle changes (stop smoking and
alcohol), exercise + physiotherapy, warm compresses for knee swelling
c. Pharmacological options: PPI, COX-2 selective NSAID
 OSCE

I
1. History of DM, headache, migraine, sciatica
2. Prescription writing for a patient with TB or UTI
3. Counselling of patient with TB for TB medications or diabetes mellitus
4. Nutrition
5. Nutrition
6. Examination of a patient with prolonged HTN, CHF
7. X-ray: dextrocardia, TB, COPD
8. Slide: Tinea corporis or scabies plus prescription writing
9. Prescription writing for a patient with dysentery
10. Contraception during breast-feeding

II
1. Diagnosis of TB patient and prescription writing
2. Diabetes mellitus: medications and complications
3. A patient with renal or hepatic failure: nutrition advice
4. Slide of herpes simplex: diagnosis and prescription
5. A patient with anemia: treatment plan
6. A patient presents for contraception advice: side effects, rule out risk factors,
contraindications
7. Acute URTI
8. Order labs for a patient with amenorrhea
9. Measles / impetigo
10. Asthma

III
1. Chest X-ray (pleural effusion) and prescription writing (TB)
2. Examination of patient with diabetic foot
3. PCOS: investigations and management
4. Counselling for hypertension
5. Nutrition
6. Asthma
7. Rheumatic fever with dose of aspirin
8. History of syncope
a. CAUSES OF SYNCOPE:
i. CVS: vasovagal [non-cardiogenic] syncope (most common, can be
situational, micturition or cough syncope), orthostatic hypotension
(prolonged bed rest, drug induced, hypovolemia, autonomic
dysfunction in GBS/DM), arrhythmias (sick sinus syndrome,
Stokes-Adams syndrome, SVT, VT), MI, cardiac outflow
obstruction (HOCMP), carotid sinus syndrome, pulmonary
embolism
ii. CNS: seizure, hysterical syncope
 iii. Metabolic: hypoxia, hypoglycemia
b. HISTORY OF SYNCOPE:
i. Vasovagal: factors (fear, emotions, prolonged standing), associated
findings (nausea, weakness, blurred vision)
ii. Orthostatic hypotension: factors (prolonged bed rest, drugs, history
of diarrhea or blood loss, history of DM, rule out GBS)
iii. Cardiac: factors (exertion in AS or HOCMP, tight collar in carotid
sinus syndrome)
iv. Metabolic factors (ask about breakfast for hypoglycemia esp. in
IDDM, hypoxia)
c. EXAMINATION:
i. Appearance: pale with cold clammy extremities in syncope
ii. Blood pressure: check for orthostatic hypotension
iii. Pulse: bradycardia in vasovagal syncope, asystole in Stokes-Adam
syndrome, alternating bradycardia & tachycardia in sick sinus
syndrome, tachycardia in shock/SVT/VT
iv. Pressure on carotid sinus: syncope in carotid sinus syndrome
v. Precordium: ejection systolic murmur in AS, bisferiens pulse in
HOCMP
d. LABS
i. Reflo STAT
ii. CBC
iii. BUN
iv. Lytes
9. History of sciatica / lower backache
a. HISTORY
i. Onset: insidious or specific trauma
ii. Location of symptoms: percentage of lower back or leg
iii. Duration: acute (<6 wks), chronic (>6 wks)
iv. Character: mechanical, radicular, claudication, non-specific
v. Nature of limitation posed by the condition
vi. CNS: distribution, bowel/bladder symptoms, weakness, saddle
numbness
vii. Constitutional symptoms: fever, weight loss, night sweats
viii. Previous spinal surgery with persistent pain
ix. History of drug seeking behavior or I/V drug abuse
x. Smoking history
xi. Past medical and surgical history
xii. History of immunosuppression: steroids, cancer, HIV
xiii. Nature of physical demands of work
xiv. Stiffness: sudden and complete (disc prolapse), central and more in
morning (ankylosing spondylitis)
b. EXAMINATION
i. Inspection: posture, body habitus, stance, gait
ii. Regional back examination and range of motion of spine: flexion,
extension, lateral bending, rotation
 iii.Straight leg raising
iv.Crossed SLR
v.Dorsiflexion—strength of ankle and great toe (L5)
vi.Plantarflexion—strength of ankle (S1)
vii.Ankle reflexes—check S1 dermatome
viii.Light touch sensation on medial (L4), dorsal (L5) and lateral
aspects (S1)
ix. A medical history suggestive of non-spinal pathology; back
examination may warrant examination of pulses, pelvis and other
examinations

IV
1. History of rheumatic heart disease
a. Dose of aspirin
2. History of facial nerve palsy
a. D/d include stroke, TIA, LMN disease
b. Physical examination includes neurological, carotid pulse and bruits,
cranial nerves, parotid examination, corneal reflex
3. History of vertigo/syncope
a. Relevant examination includes cerebellum, tuning fork tests, nystagmus,
anemia, otoscopy
4. History of sciatica
a. Must do SLR
5. Diabetic foot
6. Chest X-ray
a. History gives a clue to the diagnosis
b. Prescription writing for a 50 kg patient
7. Prescription writing for malaria
a. Chloroquine: 4 tablets STAT, 2 tablets 6 hrs later, 1 tablet BID for 2 days
b. Anti-emetic: Maxilon 10 mg 1+1+1
c. Anti-pyretic: Panadol 500 mg 2+2+2+2
8. A patient with TB
a. Prescription
b. Counselling
i. Cover mouth while coughing
ii. No spitting
iii. No smoking
iv. Test close contacts for TB
9. Slide: tinea pedis
a. Prescription writing
10. A patient with terminal illness—breaking bad news (communication skills)
11. EPI
12. Complications of measles
13. Management of diarrhea
14. History of amenorrhea/infertility
 a. Investigations (semen analysis, serum progesterone day 21, TSH,
prolactin, HSG, etc.)
b. Treatment (Clomid 50 mg given day 2 to 7, assess follicle size, maximum
dose is 150-200 mg)
15. History of dysmenorrheal and treatment
16. History of irregular menses (PCOS)
17. Counselling for weaning
18. Non-pharmacological management of hypertension
19. Caloric values of oxalate & cholesterol, calcium content of various foods

V
1. CXR  TB (tracheal deviation)
2. History and management of patient with gastric CA
3. Scabies  diagnosis and treatment
4. Menorrhagia  4 differentials
5. Hyperthyroidism: drugs for a female in the reproductive age group
6. History of dying patient: bed sores, constipation, medications, catheter
7. 6 yrs old boy with malnutrition: causes? What would you give him?
8. Calcium requirements of a lactating female
9. Prescription writing for a pregnant female with UTI
10. Iron deficiency anemia: history, labs, management
11. Picture of herpes zoster
12. Post-partum 6-week visit: options available for contraception
13. Prolactinoma: bromocriptine 5 mg/d
14. History taking of vaginal discharge/42ysmenorrheal

Class of 2002 (A)

1. Physical examination: a patient with diplopia on looking towards right side;
history of nausea and vomiting; perform a quick neurological assessment of eye
movements as it is a very busy clinic; do not test the corneal reflex
a. List your findings
b. Which nerve palsy can give rise to this condition?
c. What further clinical examination would you do to rule out a space-
occupying lesion?
d. What specialty would you refer this patient to?
2. A 15 months old child coming from interior Sindh to your PHC clinic for
vaccination. Vaccination history: he has had 2 doses of some oral drops and
injections 4 weeks apart in the first few months of his life. Medical history:
history of unexplained seizure at the age of 1 year. Allergies: develops a rash
upon ingestion of eggs.
a. List the vaccinations and the routes of administration for this patient
3. 60 years old man with history of chronic cough since last 4 years and dyspnea
since last 4 months. He has a history of smoking since 20 years. On examination,
there are expiratory rales with jugulovenous distension.
a. Most likely diagnosis
b. Two other important differential diagnoses
 c. Treatment
i. Non-pharmacologic measures
ii. Pharmacologic measures
4. A pregnant lady in the first trimester with pre-pregnancy history of passage of
calcium oxalate stones. Her height is 5’12” and she weighs 100 lbs. She is fond of
tea and green leafy vegetables.
a. What are her caloric requirements?
b. What percentage of her total caloric intake is provided by the lunch?
c. What is the amount of proteins (in grams) provided by her lunch?
d. In order to stop development of kidney stones, what should she stop?
e. Which food contains most amounts of iron AND vitamin A?
5. Sudden onset of vertigo in the morning; recent history of respiratory infection; no
deafness or tinnitus; no exacerbating or relieving factors; unremarkable
examination; no nystagmus:
a. What is the most likely diagnosis? (vestibular neuronitis)
b. What are the two important differential diagnoses? (cervical spondylosis,
orthostatic hypotension)
c. What symptomatic treatment would you give?
6. Slide showing erythematous, well-circumscribed lesions on buttocks:
a. Describe two clinical features of the lesion you can see on this slide.
b. What is the diagnosis?
c. How would you treat this condition?
7. 25 years old P0+0 6 weeks postpartum, currently breastfeeding her child.
Examination is unremarkable. Pulse of 88/min and BP of 120/80 mm Hg.
a. What questions would you further ask in the history before advising about
a particular form of contraception?
b. What are the two best forms of contraception for this person?
c. If the patient agrees to use the coil, what prerequisites must be met for
insertion of coil?
d. What advice would you give regarding follow-up in the above patient if
she decides to use the coil?
8. Chest X-ray: a 40 years old man who is married and lives with his family of 6 in a
house of two rooms. History of weight loss and sweating especially at night.
History of smoking 20 cigarettes a day for the last 20 years.
a. List two important findings visible on this chest X-ray.
b. What are the two important differential diagnoses?
c. Besides prescribing for the condition, what other 2 preventive measures
would you advice to your patient?
9. A mother of 3 year old child has brought her child to you who has a history of
chronic persistent cough since 6 months. Please take a revelant history to evaluate
this child. [History of dry cough, continuous, exacerbations every few weeks;
history of fever—temperature around 99oF, measured once or twice, but, child is
warm all the time; no runny nose; no relation with dust exposure; no pets; family
history is positive for TB, grandfather, untreated; nutrition; vaccination;
development history]
a. What are the two important differential diagnoses?
 b. What are three investigations will you order to reach a conclusion?
10. Physical examination of a 55 year old diabetic (diagnosed a year ago) on oral
hypoglycemics. History of numbness, weakness in legs and difficulty in seeing in
the dark. Do a relevant clinical examination as it is a busy clinic and you don’t
have much time.
a. List two important findings.
b. What advice would you give to this patient regarding this condition?

Class of 2004 (B)

1. Young married female with acute abdomen:
a. Most likely cause
b. Investigations
2. Sexually active female with burning micturition:
a. Prescription writing
b. Counseling
3. Malnourished and anemic child had piercing in her right ear that is now swollen:
a. What additional history would you take?
b. TT vaccine
c. Dietary counseling
d. Diagnosis and management
4. Scabies
a. Management and counseling
5. CXR of a chronic smoker with cough:
a. Differentials
b. What would you tell the family?
c. Counseling of patient
6. Dietary record of an athlete who is feeling weak:
a. Calculate caloric requirements
b. Counsel for nutrition
7. History taking of patient with headache:
a. Diagnosis
b. Prescription writing
8. Diabetic foot:
a. Examination
b. Counseling
9. History taking of a patient with asthma:
a. Assess severity
b. Counseling on how to use inhaler

Class of 2004 (C)

1. Picture of zoster on back:
a. Describe the lesion
b. Most likely diagnosis
c. Why this particular distribution?
2. Chest X-ray:
a. List three abnormalities
 b. Most likely cause (COPD)
c. Counseling
3. History taking of sciatica
a. At what level, is the lesion present?
b. Management
4. Slide of kerion:
a. Organism: Trichophyton
b. Treatment: Griseofulvin 10 mg/kg/d PO
c. Prevention: avoid contact with cattle and other domestic animals
5. Picture of nappy rash
6. Facial nerve palsy secondary to TIA
a. History taking
b. Examination
c. Diagnosis
d. Management
7. Nutritional counseling of diabetic patient
8. Calculation of caloric requirements for an athlete
9. Counseling for recurrent miscarriages