Theme 13 Drug Abuse
a. Inform Police
b. Advise Self-help group
c. Advice how to decrease harm
d. Inform Narcotics and Drug abuse Center
e. Psychiatric Referral
f. Start on Naloxone
g. Wait and Watch
54. A 25 year old Female, who was addicted to heroin, has now left the habit, but her male
partner is forcing her to use the same.
55. A 23 year old Female on heroin, is now pregnant. Concerned about the effects on her
56. 23 year old married female has left the heroin habit, Husband also wants to leave the drug
abuse but not immediately, The wife has come to you for advise.
57. A 24 year old male patient comes to you with some minor complaint, you notice injection
marks on his forearm. What do you do.?
Theme 14 Treatment of Suicidal Tendencies
a. N Acetyl Cysteine
b. Urgent Psychiatric Admission
c. Referral to Psychiatric OPD
d. Contact GP
e. Give ECT
58. Female patient with history of consumption of about 40 tablets of Paracetamol, has now
come to the A&E after 12 hrs of consumption
59. 25 year old Female patient comes to the A&E saying that she is an addict and says that
she has counsumed tablets prescribed by her GP. The moment you go to call the Registrar
she has disappeared
60. A 23 year old Female patient is seen in the A&E with cuts on her hand, says that she had
an argument with her boyfriend.
61. An elderly male comes to the A&E with thoughts of suicide, and feels that his wife and
children would be better off without him.
60-B?? IT CAN BE AN ASSAULT AS WELL ,I THINK POLICE HAS TO BE INFORMED?
61-C,IF NOT SAY WHY YOU CHOOSE B
Theme 15 Diffrential diagnosis of Abdominal Pain.
a. Ectopic Pregnancy
b. Chronic Pancreatitis
c. Ac. Pancreatitis
d. Ac. Cholecystitis
e. Duodenal Ulcer
f. Ca. Pancreas
g. Ruptured Spleen
62. A 62 year old male alcoholic, comes with complaints of weight loss, pale stools, and of
abdominal pain radiating to the back.
63. A 35 year old male patient, presents with abdominal pain more in the epigastric region,
On history taking he mentions hunger pains at night.
64. 22 year old Female, has presented to the A&E with severe pain in the left iliac fossa,
accompanied by nausea and vomiting
65. 35 year male patient is brought to the A&E with a history of a blow to the abdomen,
following which he has developed pain abdomen. On examination his BP has fallen and he is
Theme 16 Investigative modalities in Acute Abdomen.
a. Emergency Laparotomy
b. Laparascopy with Biopsy
c. Urgent Fluids/Blood
d. CT Scan
e. MRI Scan
f. Peritoneal Dialysis
h. Full Blood Count
66. A 60 year old male patient, with a previous history of pain in calves and decreased pulses
in the leg, has suddenly developed pain the back and BP decreased with Increased pulse rate
67. 24 year male, has recently finished his exams, and had been partying with friends, now
presents with complaints of vomitting blood and malena.
68. 66 year old male, gives history of chronic blood loss PR, and decreased weight, he
complains of increased acidity.
66-A, EVEN IF ULTRASOUND WAS A CHOICE ,I DON’T THINK HIS CONDITION PERMITS
ANY DELAY,,WHAT DO YOU THINK ??
67-C,is treatment , investigation here shoild include endoscopy!!
68-D ??IS IT CANCER OR WHAT!!
Theme 17 Endocrine Abnormalities.
e. T4 levels
f. TRH estimation
69. 32 year old Female, has presented to the OPD, she has a moon face and striae marks on
70. A 42 year old Male, has come with complaints of palpitations and sweating. On
examination he is found to be hypertensive.
71. A 22 year old female patient was seen, with a history of polyuria and a feeling of
increased thirst, however no glycosuria was seen and blood glucose levels were normal.
72. A 32 year old female, with complaints of palpitations, increased sweating, and cannot
tolerate warmth. Her BP is found to be normal.
Theme 18 DD of Falls (loss of consciousness)
a. Blood glucose
b. CT Scan
c. MRI scan skull
d. Blood Cortisol levels
e. BP test
f. Tilt test
g. Caloric Test
h. Standing and Supine BP
73. Elderly female patient found unconscious. Has a bag containing Gliclazide, Metformin and
74. A 43 year old female patient, was brought unconscious. On pupillary examination the right
pupil appears dilated and fixed
75. A 55 year old lady complains of increased dizziness on getting up from bed. She also falls
down especially in the early morning hours
76. A 50 year old male, comes with complaints of giddiness and vertigo. He says that the
surrondings are spinning around him. On examination nystagmus is seen.
77. A 35 year old Female, patient complains of giddiness manifesting on moving her head.
Theme 19 Treament of Confusion
a. Discuss with GP
c. CT scan
d. MRI scan
e. Neurology referral
f. Blood Glucose
78. Man found wandering aimlessly, brought to the A&E by neighbours, who inform that his
GP had called on him yesterday.
79. A 57 year old male comes to the A&E with his daughter, in a confused state. The
daughter said that her father was started on some medication by his GP, but he still suffers
from the same symptoms
79-A OR F?
Theme 20 Drug Therapy in Ear Pain
a. Amoxicillin Oral
b. Amoxicillin I.V
c. Cefotaxime I.V
e. Gentamicin I.V
f. Supportive Tx only
80. A 24 hour old female infant, is brought to the A&E with incessant crying. On Examination
an inflamed ear drum is noted.
81. A 12 year old boy, complains of ear pain, following an air journey. On examination the
drum is not inflamed, but fluid is noted in the middle ear
82. 3 year old boy is brought to the A&E with a history of tugging at his ear, A red inflamed
drum with fluid is noted
83. A 3 year old girl, who appears very toxic, with a history of nausea and vomitting.
Typmanic membrane appears red and inflamed with fluid behind it.
80-C ,WHAT IS THE ORGANISM HERE??haemophilus !!
Theme 22 Care of terminally ill
a. Decrease Opiods
b. Increase Opiods
c. Use syringe driver
d. Palliative Radiotherapy
g. Start O2 therapy
84. A 72 year old male patient suffering from terminal multiple myeloma, is being treated for
bone pain with high doses of opiods, now complains of increasing constipation
85. A 75 year old patient was started on low dose opiod therapy with naloxone for control of
pain. The patient still feels that the pain is unbearable.
86. A 66 year old female patient with Ca Breast having multiple metastases, is on palliative
care. She develops severe nausea and vomitting. Lab tests ordered show an increased
Serum Calcium level
87. A 80 year old male patient, under treatment for Ca prostrate, is noted to have increasing
pelvic infiltration. And he now complains of pain.
88. A 70 year old male patient, under treatment is noted to have breathlessness. He is noted
to have compromised respiratory function.
Theme 22 Differential Diagnosis of Dementia
a. Chronic Alcoholic Dementia
b. Alzheimers Disease
c. Senile Dementia
d. Multi infarct Dementia
e. AIDS dementia
f. Huntington’s disease
g. Lewy Body Dementia
h. Picks disease
i. Wernicke’s encephalopathy
89. A 50 year old Male patinet, suffering from Dementia , with a family history of Dementia
proceeding to early death
90. A progressive dementia leading onto death within 10 years
91. Dementia developed all of a sudden with quick progression and death resulting in less
than 5 years
92. Dementia with loss of recent memory, but old memory is preserved with remembrance of
I think this last theme ,and the one about Mx of earache ,deserve a detailed discussion ,because they are commonly repeated in a confusing way …
please do contribute if anybody has more ...