Clinical Model Exam

1. A 20 yrs old male patient comes to you at medical opd with complaint of fever and
headache of 2days duration. Blood film was done and showed trophozoite stage
plasmodium falciparem and vivax. How do you treat this patient?
A. Quarteum
B. Quartem + Quinine
C. Quartem + Chloroquine
D. Chloroquine
2. A 60yrs old diabetic patient presents with cough, shortness of breath and fever of 5 days
duration. CBC showed WBC of 25,000/uL with Neutrophil of 85%. What is next step to
diagnose this patient condition?
A. Sputum AFB
B. Sputum culture
C. Chest X-ray
D. Echocardiography
3. A newly diagnosed RVI female patient was sent to you for evaluation. She has no
complaint. When do you initiate ART drugs?
A. When she develops AIDS defining opportunistic infection.
B. When her CD4 count drops below 200.
C. When her CD4 count drops to 50.
D. Right now
4. A 30 yrs old male patient comes with complaint of headache, fever, neck stiffness and
photophobia of 5days duration. What is the commonest organism responsible for patient
condition?
A. Streptococcal pneumonia
B. Homophiles influenza
C. Neisseria meningitides
D. E. coli
5. How do you treat the above mentioned patient?
A. Ceftriaxone for 10 days
B. Ceftriaxone + metronidazole for 10days
 C. Ceftriaxone + vancomycin for 10days
D. Vancomycine for 10days
6. A 25 yrs old patient admitted to medical ward with diagnosis of NYHA Class IV Stage
C CHF due to chronic rheumatic valvular heart disease with sever mitral stenosis. She
developed acute rheumatic fever at age of 10 and was treated. Which preventive measure
will benefit her not to develop her current condition?
A. Aspirin
B. Prednisolone
C. Monthly B. penicillin
D. NSAIDs like diclofenac
7. What is the definitive management for the above mentioned patient after discharge?
A. Furosemide(Lasix)
B. Metoprolol
C. Enalapril
D. Cardiac surgery
8. A known asthmatic patient come with acute severs exacerbation at your duty time.
Which one is best management step for this patient?
A. Inhalational corticosteroid
B. O2, salbutamol puff, systemic steroid
C. Only O2
D. Epinephrine
9. A known chronic liver disease adult patient comes to you with abdominal swelling, pain,
fever, and tender abdomen. Which organism is the commonest cause of current patient
condition?
A. E. coli
B. Streptococcus
C. Staphylococcus
D. Homophiles
10. A known dyspepsia patient stool examination showed positive for H. Pylori antigen.
How do you proceed to treat this patient?
A. Omeprazole
 B. Omeprazole + Anti acid syrup
C. Omeprazole + clarithromycin + Amoxicillin
D. Cimetidine
11. A 20 yrs old known diabetic patient on NPH 20/10 comes to you in the morning with
loss of consciousness. He is adherent but his mother report he missed his yesterday
dinner. You are in health center with no laboratory to measure his blood glucose. What
do you do for this patient?
A. To refer to hospital.
B. To give him IV NS fluid
C. To give him his morning insulin
D. To give him 40% dextrose
12. A patient with recent history of acute tonsillopharyngitis present to you with reddish
discolaration of urine, body swelling and decreased urine amount. What is the likely
diagnosis of this patient?
A. Nephrotic syndrome
B. Nephritic syndrome
C. CHF
D. Protein losing entropathy
13. What is the likely microorganism responsible for above patient?
A. Streptococcal pneumonia
B. Staphylococcal aures
C. Streptococcal pyogens
D. Streptococcal agalactia
14. Which of the following is not feature of nephrotic syndrome?
A. Body swelling
B. Proteinuria
C. Hyperlipidaemia
D. RBC casts
15. The most common site for extrapulmonary TB is the
A. Lymph node
B. CNS
 C. Pericardium
D. Liver
16. First-line drugs used in the treatment of drug-susceptible TB include
A. rifabutin and streptomycin.
B. ethionamide and ethambutol.
C. isoniazid and rifampin.
D. rifapentine and capreomycin.
17. An elderly male patient produced only 25 mL of urine in the past 24 hours. you discover
that prostatic hypertrophy is the cause. Which one of the following best describes this
patient's acute renal failure?
A. Pre renal AKI
B. Intrinsic AKI
C. Post renal oliguric AKI
D. Post renal anuric AKI
18. A 25 yrs old male who has multiple sexual partner come to you with urethral discharge
of 01 week duration. What is the commonest microorganism responsible for this patient
condition?
A. T. pallidum
B. N.gonorrhoea
C. H. ducrie
D. C. trachomatis
19. How do you treat the above patient?
A. B. Penicillin
B. Ceftriaxone IM stat
C. Ceftriaxone IM stat + Azithromycin po stat
D. Doxycycline
20. Which of the following approaches to heart failure management should be attempted
last?
A. Diuretics
B. BP control
C. Anti-remodelling drugs
 D. Implantation of permanent device
21. A70 yrs old diabetic and hypertensive patient present to your health center with sudden
onset of right body weakness of 04 hrs duration. What is your next best step?
A. Stabilizing patient and refer to nearby hospital.
B. Controlling BP and sending to home
C. Keeping and giving IV fluid.
D. Giving insulin and Discharge to home.
22. What is the preferred investigation of choice to confirm the above patient condition?
A. Blood glucose
B. Electrocardiography
C. Brain CT scan
D. MRI of brain
23. Which of the following is not the component of CURB-65 pneumonia prognostic
criteria?
A. Convulsion
B. Age >65
C. Renal failure
D. BP <90/60mmhg
24. In management of chronic Asthma, the treatment of choice for mild intermittent asthma
is:
A. Oral corticosteroid with long acting B2 agonist
B. Low dose inhaled corticosteroid
C. Low dose inhaled corticosteroid with long acting B2 agonist
D. Short acting B2 agonist as required for symptomatic relief
25. Which of the following is non-modifiable risk factor for coronary heart disease?
A. DM
B. Age
C. Dyslipidaemia
D. Smoking
26. Which of the following has protective effect against formation of PUD
A. Pepsin
 B. H. Pylori
C. NSAID
D. Bicarbonate
27. Which of the following is complication of PUD
A. GI Bleeding
B. Perforation
C. Obstruction
D. All
28. A 60 years old female patient presented with new onset of epigastric pain, recent
significant weight loss and anaemia. What diagnostic test should this patient undergo?
A. Urea-breath test
B. H. Pylori antibody test
C. Upper GI Endoscopy
D. Stool antigen test for H. pylori
29. One of the following is not cause of GOO in Patients with PUD
A. Mucosal edema
B. Spasm
C. scarring
D. None of the above
30. All of the following are associated with increased risk of gastric cancer, Except
A. Atrophic Gastritis
B. Adenomatous Polyp
C. Remnant gastric ulcer
D. Multiple endocrine neoplasia 1
31. Which one of the following is true about Gastric Lymphomas?
A. stomach is the most common site of primary GI lymphoma
B. Most of them are Non-Hodgkin’s Lymphomas
C. Most of the patients require surgical resection
D. A & B
32. Metabolic complications of subtotal gastrectomy includes
A. Anemia
 B. Reactive Hypoglycemia
C. Metabolic bone disease
D. None
33. A 20 years old female patient presented with difficulty of swallowing of 04 months,
mainly for liquid, barium swallow was done and showed dilated esophagus with
tapering at lower end, with rat tail appearance. What is the most likely diagnosis for this
lady?
A. Esophageal Cancer
B. Eosinophilic Esophagitis
C. Esophageal Achalasia
D. RefluxEsophagitis
34. A 35 years old male patient presented after he sustained RTA 30 minutes prior to his
presentation to EOPD, up on evaluating airway is intact, but the patient is desaturating,
air entry over the right side of chest is absent, percussion note over similar side is hyper-
resonant, and trachea is shifted to the left side, what should be the first management of
this patient
A. Send X-ray and intervene based on the finding
B. Draw blood for cross match
C. Intubate the patient
D. Insert large bore needle on the 2nd ICS at MCL
35. What is the most common type of shock in patients with trauma?
A. Septic Shock
B. Neurogenic Shock
C. obstructive Shock
D. Hemorrhagic Shock
36. One of the following has similar feature with osteomyelitis
A. Ewing sarcoma
B. Osteosarcoma
C. chondrosarcoma
D. All
37. Which of the following imaging can be used for diagnosing a bone tumour
 A. MRI
B. X-ray
C. CT-scan
D. All
38. A 30yrs old male patient present to ED with acute onset of scrotal pain, associated with
low grade fever, on physical examination V/S bp normal PR 120bpm RR 20 T 36.8 Lt
scrotam High-riding testis with a transverse lie, Prehn’s test negative .what is the most
likely diagnosis
A. Acute Epididymitis
B. Acute orchitis
C. Testicular torsion
D. All
39. The following is/are cause of hyperparathyroidism.
A. Graves disease
B. Pulmmers disease
C. Hashimotos disease
D. A & B
40. The most reliable diagnosis of hyperthyroidism.
A. T4
B. T3
C. TSH
D. A&B
41. One is not symptom of hyperthyroidism
A. Palpitation
B. Inability to sleep
C. Increase in bowel movement
D. Increase in weight
42. The following are feature of hypothyroidism except
A. Constipation
B. Heat intolerance
C. weight gain despite poor appetite
 D. Menses irregularity
43. A 25years old male patient with the diagnoses of testicular torsion present within the
first 4hrs. The salvage rate is-------------?
A. 100%
B. 60%
C. 20%
D. None
44. One of the following is contraindication for conservative Management of Extra
peritoneal Rupture of the bladder
A. Bone fragment projecting into the rupture
B. open pelvic fracture
C. Rectal Perforation
D. All
45. One is not feature of urethral injury
A. Blood at the meatus
B. Difficulty to pass a urethral catheter
C. high-riding’ prostate
D. Frequency
46. Which parameter is not the component of Alvarado score in a patient with acute
appendicitis
A. Fever
B. Migratory left lower quadrant tenderness
C. Anorexia
D. Nausea
47. Which one of the following is not one of the cardinal manifestations of small bowel
obstruction
A. Abdominal pain
B. Vomiting
C. Diarrhea
D. Failure to pass faeces and flatus
48. Which of the following hernias has the highest probability to strangulate
 A. Direct inguinal hernia
B. Femoral hernia
C. Indirect inguinal hernia
D. None
49. In assessing a trauma patients which should come first
A. Alertness
B. breathing
C. circulation
D. Airway
50. What is the best imaging diagnostic modality to evaluate masses arising from the liver
A. Erect abdominal x-ray
B. Triphasic CT scan
C. Ultrasound of the liver
D. None
51. The most frequent type of anemia in pregnancy is:
A. Iron deficiency anemia.
B. Folate deficiency anemia
C. Sickle cell anemia
D. Vitamin B2 deficiency anemia
52. What is the station where the presenting part is at the level of the ischial spines
A. -2
B. -1
C. 0
D. +1
53. The relationship of the long axis of the fetus to the long axis of the mother is called
A. Lie
B. Presentation
C. Position
D. Attitude
54. The maximum amount of oocytes in a female's ovaries occurs at what point in her life?
A. 8 weeks gestation
 B. 20 weeks gestation
C. At birth
D. At puberty
55. A 27 year old G6p5 (6 alive) mother whose LNMP was 10/8/11 E.C come you with the
complaint of pushing down pain of 5hr duration. Otherwise no danger signs. P/E G/A-
ASL in Labor pain V/S-PR=60 RR-20 T-36.7 BP-100/70
ABD-term sized gravid uterus, FHB-144 Ux-3/10/20-25 GUS=Cx-5cm dilated, fully
effaced. What is the diagnosis of the above patient?
A. Third trimester abortion
B. AFSOL
C. LFSOL
D. second stage of labor
56. True about above patient?
A. She has possibly have twin delivery
B. EDD will be 14/4/12
C. Start augmentation as the uterine contraction is inadequate
D. Elective C/S is required
57. For the patient at Q3, GUS is the same after 4 hour of evaluation, one of the ff is true?
A. Prolongation of Active first stage of labor
B. Cause for the abnormal labor is likely passenger
C. Protraction of cervix
D. None
58. Earliest sign of scar dehiscence/uterine rupture in patient who is laboring and opted for
VBAC is
A. NRFHS
B. Vital sign derangement like hypotension
C. Infection
D. All
59. W/ro x is 30 yr old lady who comes with complaint of failure to control urine
2month.when you interview her she told you that after sensation of voiding she fail to
control and even it leaks at the bed before she went to toilet. What is your Dx?
 A. Stress incontinence
B. Urge incontinence
C. Bypass incontinence
D. UTI
60. What could be the cause of the above complaint?
A. Detrusor over activity
B. Fistula
C. Infection
D. All
61. Weak support to pelvic organ
A. Upper tier
B. Middle tier
C. Lower tier
D. Pelvic diaphragm and perineal body
62. A 19-year-old woman comes to the emergency room and reports that she fainted at work
earlier in the day. She has mild vaginal bleeding. Her abdomen is diffusely tender and
distended. In addition, she complains of shoulder and abdominal pain. Her temperature
is 36.8 0C, pulse rate is 120/min, and blood pressure is 96/50 mmHg. To confirm the
diagnosis suggested by the available clinical data, the best diagnostic procedure is
A. Pregnancy test
B. Posterior colpotomy
C. Dilation and curettage
D. Laparoscopy
63. A primipara is in labor and an episiotomy is about to be cut. Compared with a midline
episiotomy, an advantage of mediolateral episiotomy is
A. Ease of repair
B. Fewer breakdowns
C. Less blood loss
D. Less dyspareunia
64. During the delivery, it is necessary to cut an episiotomy. The tear extends through the
sphincter of the rectum, but the rectal mucosa is intact. How would you classify this type
of episiotomy?
A. First-degree
B. Second-degree
C. Third-degree
D. Fourth-degree
65. If blood must be given without adequate cross matching, the best to use is
A. AB RH Positive
B. AB RH negative
C. O RH positive
D. O RH negative
66. A 35 yrs old G7P6 presented with a pushing down pain of 1 hour duration. At
presentation the cervix was 4 cm and station was -2. After 1 hour of evaluation the
mother gave birth to an alive baby. What kind of labor abnormality did she have?
A. arrest of cervical dilation
B. b)protracted cervical dilation
C. precipitated labor
D. prolonged latent phase of labor
67. Uterine bleeding at 12 weeks gestation accompanied by cervical dilation without passage
of tissue
A. Complete abortion
B. Incomplete abortion
C. Threatened abortion
D. Inevitable abortion
68. Passage of some but not all placental tissue through the cervix at 9 weeks gestation
A. Complete abortion
B. Incomplete abortion
C. Threatened abortion
D. Missed abortion
69. Fetal death at 15 weeks gestation without expulsion of any fetal or maternal tissue for at
least 8 weeks
A. Complete abortion
B. Incomplete abortion
C. Threatened abortion
D. Missed abortion
70. Uterine bleeding at 7 weeks gestation without any cervical dilation
A. Complete abortion
B. Incomplete abortion
C. Threatened abortion
D. Missed abortion
71. Expulsion of all fetal and placental tissue from the uterine cavity at 10 weeks gestation
A. Complete abortion
B. Incomplete abortion
C. Threatened abortion
D. Missed abortion
72. Nausea and vomiting are common in pregnancy. Hyperemesis gravidarum, however, is a
much more serious and potentially fatal problem. Findings that should alert the physician
to the diagnosis of hyperemesis gravidarum early in its course include
A. Electrocardiographic evidence of hypokalemia
B. Metabolic acidosis
C. Jaundice
D. Ketonuria
73. A 27 year old G2P1 mother presented with leakage of liquor of 24 hours duration. She
claims amenorrhea of 7 months and it is 26 weeks from early (9 th week) ultrasound. The
leakage was confirmed to be amniotic fluid. What is your diagnosis for this case?
A. Preterm prolonged PROM
B. Inevitable abortion
C. Preterm labor
D. Chorioaminonitis
74. All of the following are scenarios in which it would have been appropriate to administer
Anti-D immunoglobulin to RH negative mother, except
A. After a spontaneous first-trimester abortion
B. After treatment for ectopic pregnancy
C. Within 3 days of delivering an Rh− fetus
D. At the time of amniocentesis
75. 25 years old male patient who is sexually active presented with genital sore of 2 weeks
duration, objectively he is well looking well with stable vital sign. On GUS there is
kissing ulcer whi is painfull. What is the most likely diagnosis
A. Herpes
B. Syphilis
C. Chancroid
D. All
76. A 9 month old female infant was brought to ETAT with watery diarrhea and vomiting of
02 days. Has sunken eyeballs, is unable to drink. On physical examination the skin pinch
goes back slowly and is sleepy. What is the severity of her dehydration (DHN)(she is
Well-nourished)
A. No DHN
B. Some DHN
C. Severe DHN
D. Very Severe DHN
77. What is the most appropriate fluid Management of the above Patient? She weighs 10kg
A. 750ml of ORS via NGT over 4 hours
B. 750ml RL IV over 4 hours
C. 300ml RL IV over 30 minutes then 700ml RL over 2 hours and 30 minutes
D. 300ml RL IV over 1 hour and 700ml RL over 5 hours
78. Of the following one is not Signs of improving hydration status in SAM patients
A. Less thirsty
B. Less lethargic
C. Slowing of rapid respiratory and pulse rates
D. Gaining weight without clinical improvement
79. Which one of the following is TRUE
A. M. tuberculosis and M. bovis are equally most important causes of TB disease in
humans
B. The hallmark of all mycobacteria is being Gram positives
C. M.Tuberculosis is found in the body in both LTBI and Active TB disease
D. Patients with LTBI are symptomatic
80. Which one is the most likely presentation of foreign body in the nose
A. Cough
B. Chocking
C. Unilateral foul smelling discharge
D. Wheeze
81. Which one of the following is not a sign of upper air way obstruction?
A. Stridor
B. Wheeze
C. Hoarseness
D. Respiratory distress
82. Commonest ethology of croup is
A. Influenza virus
B. Adenovirus virus
C. Para influenza virus
D. RSV
83. A 3 years old male patient came to you with a complaint of rash which began at forehead
then spread down the torso, fever and cough of 2 days duration. On P/E Temperature
38.5, injected conjunctiva and maculopapular rash all over the skin. The most likely
diagnosis is----------
A. Rubella
B. Measles
C. German measles
D. Herpes zoster
84. The most common symptom/s of pertussis for under 3 months infants is/are-------------
A. Apnoea
 B. Cough
C. Vomiting
D. B and C
85. What is a neonate?
A. birth-28 days
B. birth-2 months
C. birth-3months
D. birth -1month
86. Rh incompatibility occurs in
A. mother Rh –ve and fetus Rh +ve
B. mother Rh +ve and fetus Rh +ve
C. mother Rh –ve and fetus Rh –ve
D. mother Rh +ve and fetus Rh –ve
87. Which of the following is a cyanotic congenital heart disease?
A. ASD
B. PDA
C. TOF
D. VSD
88. The brief statement of primary problem that caused family to seek medical attention is
called
A. Identification
B. Chief complaint
C. Diagnosis
D. History of present illness
89. Which one of the following is not a major Criterion of Acute rheumatic fever?
A. Arthritis
B. Chorea
C. Hematuria
D. Carditis
90. Which one of the following complications of S. tonsilopharyngitis cannot be prevented
by appropriate Antibiotics ?
 A. ARF
B. PSGN
C. Peritonsillar Abscess
D. All can be prevented
91. Which one of the following is most important to Diagnose Dehydration in patients with
SAM?
A. Sunken eye balls
B. Slow skin pinch
C. Recent fluid loss
D. Irritability
92. Which of the following is risk factor for pneumonia?
A. Malnutrition
B. Immunosuppression
C. Unvaccination
D. All of the above
93. A 7 month old female infant presented to emergency with fast breathing, cough and high
grade intermittent fever. Up on presentation she was grunting, PR: 168, RR: 64, To:
39.4.On respiratory system, she has subcostal and intercostal retraction with coarse
crackles and wheezing on the posterior lower third of lung field. Which of the following
should be the first measure to be taken?
A. IV antibiotics
B. Oxygen
C. Salbutamol puff
D. Send for chest x-ray
94. Which of the following vaccines is given for newborn at birth?
A. BCG and OPV 0
B. BCG and measles
C. DPT 1 and BCG
D. DPT 1 and OPV 0
95. Which one of the following is not a risk factor for neonatal sepsis?
A. prolonged rupture of membranes
B. maternal chorioamnionitis
C. post term new-born
D. frequent vaginal examination
96. What is the Diagnostic modality for Relapsing Fever?
A. blood culture
B. U/A
C. B/F
D. CBC
97. The route of transmission for polio virus is by---------
A. Skin to skin contact
B. Respiratory droplets
C. Transplacental
D. Faeco-oral
98. An 8year old male child present with mild fever, cough, decreased sense of smell,
periorbital edema and facial pain. What is your top diagnosis?
A. common cold
B. conjunctivitis
C. sinusitis
D. periorbital cellulitis
99. A 9 month old infant with SAM came with shock. What is the appropriate Fluid
management?
A. 20ml/kg RL over 1hr
B. 15ml/kg RL/NS with 5% dextrose fast
C. 15ml/kg RL/NS with 5% dextrose over 1hr
D. 15ml/kg RESOMAL over 1hr
100. One of the following is not admission criteria for SAM patient
A. WFL less than < -3Z score and failed appetite
B. Presence of pitting edema of both feet for age <6 months
C. Visible wasting
D. MUAC <11.5cm and Measles