January 2024 Medical Examination Papers PDF

January 2024 1. EMQ: (100% endocrine) a) MRI brain. b) Karyotyping. c) Testosterone. d) LH and FSH. e) Urinary catecholamine. f) 17 hydroxy progesterone. What investigations to reach diagnosis? A. 7yr. child Neurofibromatosis1 had testicular volume 12 ml and Pubic...

January 2024 1. EMQ: (100% endocrine) a) MRI brain. b) Karyotyping. c) Testosterone. d) LH and FSH. e) Urinary catecholamine. f) 17 hydroxy progesterone. What investigations to reach diagnosis? A. 7yr. child Neurofibromatosis1 had testicular volume 12 ml and Pubic hair. MRI Brain B. 5yr. tall child with testicular volume 3 ml, Na 122, k 6 and pubic hair. 17 hydroxyprogesterone C. 5yr. tall child with testes 6ml, excluded from school with moderate gynecomastia. Karyotyping 2. EMQ: (Neuro 100%, Neonate 100%) a) Myotonic dystrophy. b) SMA. c) Non ketotic hyperglycaemia. d) Myasthenia gravis. e) Duchene muscle dystrophy. f) Hyperglycinaemia. A. Baby has poor feeding; mother has recent onset of diplopia. Myasthenia gravis B. Baby with birth wt. 2.2 kg has poor feeding and inverted V shape mouth. Myotonic dystrophy C. Baby with poor feeding, hiccups, and myoclonic convulsions. Hyperglycinaemia January 2024 3. EMQ: (Endocrine 100%, Neonate 100%) a) Cow milk protein allergy. b) IDM. c) IUGR. d) Inborn error of metabolism. e) Hyperinsulinemia. f) Birth asphyxia. g) Sepsis. h) Poor intake. A. Term baby, wt. 1.9 kg + hypoglycaemia. IUGR B. Term baby, wt. 4.3, plethoric, hypoglycaemia. IDM C. Term baby, wt. 3.4, 1st day feeding well, 2 days after delivery vomiting related to feeds, started formula, drowsy, did not wake up for feeding, hypoglycaemia. Sepsis 4. EMQ: (No 100% oncology) a) Acute lymphoblastic lymphoma. b) Non-Hodgkin’s lymphoma. c) Wilms tumour. d) Retinoblastoma. e) Astrocytoma. f) Rhabdomyosarcoma. g) Osteosarcoma. h) Hepatoblastoma i) Orbital cellulitis. A. Child aged 6 years with unilateral proptosis and limited adduction of eye. Retinoblastoma ‫خلف‬ B. Male infant with aniridia with abdominal distention. Wilms January 2024 C. 18-month boy with cough and noisy breathing for 2 weeks no improvement on antibiotics with bilateral wheeze chest x ray show wide mediastinum, eczema, injected conjunctiva. Acute lymphoblastic lymphoma ‫خلف‬ 5. EMQ: Seizure (Neurology 100%, neurodevelopment 100%) a) Reflex anoxic seizure. b) QT prolongation. c) Night terrors. d) Centro temporal epilepsy. A. 12 years boy came to emergency with his father and told he has abnormal symptoms happened yesterday and he came out the room screaming, drooling, afraid with abnormal sound, and he can’t talk with face muscles rigidity and numbness, Can recall on the morning. Centrotemporal epilepsy B. 15 years girl has 2 attacks occur in school after drama class and one during physical class sudden drowsy then blackout and fall loss of consciousness for minutes. Teachers noticed being pale and unresponsive. She has uncle died suddenly with unknown cause. Long QT C. Baby on the beach with his mother doing castle building and then go near the sea and put his leg in cold water become pale and his mother call the ambulance. Before the ambulance arrived, he returned normal. Reflex anoxic seizure January 2024 6. EMQ: ( Endocrine 100%) a) Hypoaldosteronism. b) pseudo hypoaldosteronism c) 21hydroxylase deficiency. A) 10 days old poor feeding, wt. decreased 12 % Investigations: Na 128, K 5.8 ,17HO progesterone 2.1 (n> Assessment >> Recommendations. 61) What is the indication for Botulinum toxin in CP patients? (100% neuro, neurodevelopment) a) Generalized spasticity. b) Focal limb spasticity. c) Fixed Muscle contracture. d) Spasticity with bone deformity. 62) Male patient aged 14 years wt. 85 kg with screening for nocturnal enuresis OGTT was fasting 6.3 post 75-gram glucose was 8.7 mmol, Hb A1C 44. What is diagnosis? (100% diabetes, endocrine) a) Type 1 DM. b) Monogenic diabetes. c) Type 2 DM. d) Impaired glucose tolerance. e) Diabetes insipidus. January 2024 63) 8 years old female presented with headache 3 month ago, photophobia, seizure, confusion, BP 230/140, puiy eyelid and increase urea and create. Proteinuria + haematuria ++++ peri-orbital oedema. (100% pharma) a) IV furosemide. b) IV Na nitroprusside. c) Oral nifidipine. d) Mannitol. 64) 3 years old, going for adenotonsillectomy, discovered to have PDA, how to manage? (Neonate 100%) a) Transcutaneous catheter occlusion. b) Ibuprofen. c) Ligation. d) Wait for spontaneous closure. 65) 13 years girl from Somalia you have doubt she will go to Somalia with relative in next holiday and there is no immediate risk now. What is your action? (100% ethics, safeguarding, patient safety) a) Call police. b) Court order. c) Inform doctor of safeguarding in hospital. d) Discuss with parents. e) Talk to FGM team. f) Discuss with social service in local area. January 2024 66) CP patient feeding through NG tube didn't undergo fundoplication before recurrent attacks of aspiration, family refused to consent for end-of-life plan. But legal order approved to receive nutrition and treatment only for treatable conditions not including CPR or intubation. Now palliative multidisciplinary team decided to do nasojejunal feeding. But parents asking for fundoplication and gastrostomy. What is your decision? (100% ethics,100% safeguarding, 100% patient safety,100% palliative) a) Insert nasojejunostomy as its best interest. b) Court order to insert nasojejunal tube. c) Respond to parent wish. d) discuss with parents to reach consensus. e) Use gastrostomy and treat aspiration. 67) X-ray for a child with chronic cough 3 weeks (100% respiratory) (Cavitation in X-ray) Pulmonary TB January 2024 68) 4 months old boy was previously well presenting with increasing abdominal distention for 3 weeks. No GIT symptoms no vomiting. Urine negative for protein, normal bowel habit. On examination abdomen is distended, no organomegaly. Mild shifting dullness CBC normal except: Lymphocyte 0.7 (1.5-8) ESR 22 ALT 40 (0-28) Albumin 24 (normal >30) Immunoglobulins normal Urea and electrolytes normal US: thickening intestinal wall & dilated intestinal loop free fluid What is the best diet to prescribe? (100% metabolic, nutrition) a) Medium chain triglyceride formula. b) 50%:50% long chain, medium chain triglyceride formula. c) Extensively hydrolysed formula. d) Lactose free formula. 69) 3month baby with nystagmus, smile to mother. (100% neurology, neurodevelopment, ophthalmic) a) Physiological nystagmus. b) Idiopathic sensory nystagmus. c) Idiopathic motor nystagmus. 70) Child with headache and decrease vision on examination the child found having ptosis, absent pupillary reflex, eye turned inferolateral. (100% neuro, ophth) a) 3rd cranial nerve palsy. b) 6th cranial nerve palsy. c) 4th cranial nerve palsy. d) Dowen syndrome. January 2024 71) Scenario about SUFE with picture and they ask about immediate management. Need two answers. (100% MSK, palliative) a) Analgesics. b) Admission & Urgent referral to orthopaedics c) Thyroid function. d) Refer to orthopaedics clinic. 72) 4 months old infant developed facial eczema from 2 months and received topical steroid and emollient regime which showed little improvement then deteriorated again and developed loose stool and weight become less than 2nd centile. Baby is on bottle feeding. What will you do? (100% nutrition) a) Hydrolysed formula. b) Soy milk. c) Tacrolimus. d) Oral high dose prednisolone. 73) 7 years old child with decreased school performance for which EEG was done. What is the best description for EEG appearance? (100% neuro) a) 3 spike and waves. b) Hypsarrhythmia. c) Temporal lope epilepsy. d) Centro temporal. January 2024 74) X- Ray of 18 months with cough and soft bilateral lower wheeze. (100% Respiratory, oncology, safeguarding) a) Wide upper mediastinum. b) Hilar lymphadenopathy. c) Interstitial infiltration. d) Post rib fracture. 75) Child with absence seizure, developed GTC, myoclonic seizure. What is the best treatment? (100% pharma, neuro) a) Na valproate. b) Euthosuximide. 76) Girl with type DM1 went to ER hypoglycaemic 2.9 she was drowsy, disoriented but respond to voice. What is your immediate action? (100% Emergency, diabetes) a) Rub gucogel in oral mucosa. b) IM glucagon. c) 3 ml/kg D10. d) Continues infusion IV dextrose. e) Oral high glucose drink. 77) Child was found beside drugs of her father and mother (pain killers, antidepressants, hypothyroid drugs) presented with hypotension, cold extremities sinus tachycardia. Best management? (100% emergency, pharma) a) Flumazenil. b) Nahco3. c) Naloxone. January 2024 d) Activated charcoal. 78) Child with sickle cell anaemia admitted on painful crisis after eating lunch devolved widespread rash. All vitals were normal, but he was distressed what will you give? (No 100 hematology,100% emergency, 100% pharma,100%allergy & immunology) a) Oral cetirizine. b) Naloxone. c) Oral prednisolone. d) IV hydrocortisone. e) IV chlorpheniramine. 79) Neonate passed 1st day screening, 1st day feeding normal, 2nd day lethargic, poor perfusion BP Rt arm 95/66, ABG respiratory acidosis. (LONG SCENARIO) (100% metabolic) a) Serum ammonia. b) ECHO. 80) Girl 15 years with vaginal discharge and dysuria, she was sexually active two years ago diagnosed with chlamydia what is the best management: (100% infection) a) 7 days oral doxycycline. b) IV ceftriaxone. c) IV floxacillin. d) 7 days metronidazole. e) Erythromycin. January 2024 81) 14 years old girl presented with an attack of pallor then collapse and then started to shake all her body with extended limbs with eyes rolling up (with white sclera only as parents’ description) during this she was unresponsive, she started to regain conscious then after few minutes the same shaking happens again, after which she was unresponsive for 30 minutes, before the episode she was helping her brother in the garden and he hurt himself in his hand, there was history of uncle have seizures, Diagnosis? (100% emergency, neuro) a) Vasovagal attack. b) Generalized tonic colonic seizures. c) Juvenile Myoclonic epilepsy. 82) Male child aged 8 years diagnosed as GTC started on anti-epileptic levetiracetam 3 months ago, and controlled on it, since diagnosis becomes withdrawn and stays a lot in his room and occasionally absent from school what is the cause of his behaviour? (100% neuro, 100% pharma) a) S/E from levetiracetam. b) Seizures. c) Afraid from seizures in front of friends. d) Illness anxiety disorder. e) Autistic co exciting with epilepsy. 83) Scenario about preterm baby 23+1 weeks and history of PROM 36 hours with fever and rigors. Ask about consent for resuscitation? (100% ethics) a) Entirely up to parents. b) As parent wish after telling them complications. c) NICU consultant.  January 2024 84) 10 months old infant have 24 lesions like this picture, what will you do? (Neonate 100%) a) Liver US. b) Renal US. c) Brain imaging. 85) 14 years old with polyuria and polydipsia for 4 months, passes 6 L of urine per day, all labs normal serum Na, K and osmolality 275, RBS 7.4 (normal till 6) urine osmolality 180, What is the diagnosis? (Endocrine 100%, Renal 100%) a) Impulsive water intake b) DM. c) Central DI. d) CKD. e) Nephrogenic diabetes insipidus. 86) Mother with low platelets, baby pale has soft swelling over his vertex, cord blood platelets of 35, what is the Next step? (Neonate 100%) a) Repeat FBC of venous blood of baby. b) Father and mother platelet antigen. c) Cross matching and direct ant globulin test. d) Cranial u/s. e) Repeat coagulation profile of baby.  January 2024 87) A case of male 4 years with headache, pain in the calf muscle with normal neurological and cardiac examination, no rash and family was changing house as the previous one is old And the brother has similar condition, what will you do next?? ‫خلﻓﻲ‬ a) CK. b) Ct brain. c) Bone marrow. d) ABG e) Serum lead level. 88) 16 years old boy, c/o attacks of lethargy, inability to sleep for 12 months during which he has attack of nausea but no vomiting, all labs normal including the FBC except high unconjugated bilirubin in 2 occasions between the attacks there is no history of passing dark urine. What is Diagnosis? (hepatology 100%) a) Gilbert syndrome. b) Cigler’s-Naggar syndrome. c) Autoimmune hepatitis. d) Alpha 1 antitrypsin. e) Chronic fatigue syndrome. 89) Child known CF presented with vomiting labs showed Na 108, K 2.3, Bicarb 37. What is the cause of these lab abnormalities? (Endocrine 100%, Renal 100%) a) Pseudo barter syndrome. b) Nephrogenic DI. c) Pyloric stenosis. d) CAH. e) Barter syndrome.  January 2024 90) 12-year girl has oedema and swelling of both ankles extend in lower limbs to mid shaft and eye puiiness with headache, high Bp, ECG show LVH. Labs showed: low albumin proteinuria +++ haematuria ++ PANCA -ve C ANCA -ve Complement normal. Immunoglobins normal. What is the most probable diagnosis? (100% renal) a) IgA nephropathy. b) FSGNs. c) PSCGN. d) Minimal change glomerulonephritis. e) Membranoproliferative GN. 91) X-ray chest baby 18 month has been well presented with sudden onset of cough, wheeze and decrease air entry in RT side. What is your best action? (Respiratory 100%, Emergency 100%) a) Ct chest. b) Chest US. c) Urgent referral for bronchoscopy. d) Insert chest drain on the RT side.  January 2024 92) Girl drowned in pond arrested, ECG showed VF, RECTAL temp was low 26, resuscitation was started for 40 min but no response even on DC shock 3 times, IO amiodarone, adrenaline was given 3 times, with no improvement. What is the next step in management? (Emergency 100%) a) Give warm IV fluid, gastric and bladder lavage by warm saline. b) Stop resuscitation. c) Give IV NAHCO3. d) IV bolus. e) Increase dose of adrenaline. 93) Newborn Day1, antenatal scan at 20 and 32 wk showing bilateral dysplastic kidney and oligohydramnios what is the next step in management? (Neonate 100%) a) Urea and electrolytes. b) Urgent postnatal us. c) Follow urine stream. d) Refer to urology. e) Insert catheter. 94) 12 years old boy had a road traffic accident presented groaning severely distressed with tachypnea RR 40, Oxygen saturation was 80, and Pulse rate 140, BP 110/65. Para medics insert intravenous line at antecubital fossa. On examination there is decreased air entry in the left side with resonate percussion bilaterally and the saturation decline to 75%. What is the next immediate step? (2 answers needed) (Emergency100%) a) Insert another large bore cannula. b) Bag and mask ventilation. c) Endotracheal tube insertion and ventilation. d) Insert left sided drain. e) Needle aspiration of the left side.  January 2024 95) Scenario regarding child with pallor, history of travel to France, recurrent non bloody diarrhoea, elevated RFT, thrombocytopenia, drowsiness, asking about investigation to confirm diagnosis? (100% haematology, 100% infection) a) Blood film for fragmented RBCS. b) Bone marrow aspiration. c) Renal US. d) Stool culture. 96) 2 years child, blood pressure 90/50, HR 200, ABC was done, and despite of normal saline boluses HR remains 210/min, BP 80/50, RR 80/min and on Nasal Cannula still same SPO2 88%, low Hg normal platelets, WBCS. What to do? Choose Two Options (Emergency100%) a. Intubate and ventilate. b. Inotropes. c. Blood transfusion. d. Platelet transfusion. e. Sodium bicarbonate. f. Granulocytes transfusion. 97) A boy presented with right limping and knee stiiness after a fall and was treated only as mechanical injury 6 week ago then discharged with ibuprofen and now limping improved but came with dilated left pupil, what is the important action? (100% MSK, Ophthalmology) a. Urgent MRI brain. b. Schedule MRI. c. urgent neurosurgical opinion. d. MRI knee. e. Urgent ophthalmology referral.  January 2024 98) Case of girl with visual and auditory hallucination, came with grandmother, she was well except she has irritable bowel syndrome and given antihistamine and hyoscine for abdominal pain. What is cause? (pharma 100%) a. drug interaction. b. drug abuse. c. conversion reaction. 99) Girl presented with history of URTI 3 weeks ago, then developed lower limb weakness and absent reflexes. Which investigation will lead to diagnosis? Need TWO options (neuro 100%) a. CSF analysis. b. nerve conduction. c. EMG. d. MRI spine. 100) Statist 1. Feather pillow in asthma 101) Statistics 2. Developmental delay in mothers less than 18 yrs 102) Statistics 3. vit K IM Exam was108 Qs (6 Qs could not recall) Best of Luck Jan 2024 group