How the bank works
Contents — Internal Medicine & Emergency · Obstetrics & Gynaecology · Paediatrics · Surgery, Ortho & Trauma · Family Medicine, Ethics & Safety · Psychiatry · Public Health & Biostatistics.
Attempt each stem closed-book and click a letter, or press its key. Green holds your pick; red shows you the right letter and nothing else until you read the teaching point. Flag anything shaky — flags and wrong answers become your weak-list.
Internal Medicine & Emergency
24 questions · 20% of the paper · cardiology, respiratory, endocrine, renal, haematology, rheumatology, infection, emergency, dermatology
0 / 24 correct
45-year-old man has sudden crushing retrosternal pain radiating to left arm, sweaty, ECG shows ST elevation in V2–V4. Onset 90 min ago. Most appropriate next step?
Answer: C. Anterior STEMI <12h: primary PCI is standard if available; give dual antiplatelet + heparin en route. Time is muscle.
68-year-old with progressive dyspnoea, orthopnoea, bilateral crackles, S3 gallop, ankle oedema. Echo EF 32%. First-line long-term therapy that improves mortality?
Answer: B. HFrEF guideline therapy: ACEi/ARNI + beta-blocker (bisoprolol/carvedilol/metoprolol succinate) + MRA + SGLT2i. Diuretics relieve congestion only.
72-year-old has irregularly irregular pulse, no P waves, variable QRS. CHA2DS2-VASc 4. Management?
Answer: B. Atrial fibrillation with high stroke risk needs rate/rhythm control plus anticoagulation (DOAC/warfarin), not aspirin alone.
Man develops an itchy, well-demarcated scaly rash confined to the skin under his belt buckle. No vesicles elsewhere, no fever. Most likely diagnosis?
Answer: B. Recall: rash limited to the contact site (belt buckle → nickel) = allergic contact dermatitis. Confirm with patch testing; avoid the allergen + topical steroid/emollient.
64-year-old smoker with barrel chest, chronic productive cough, FEV1/FVC 0.58, FEV1 45% predicted. Exacerbation with increased sputum purulence. Best initial approach?
Answer: B. COPD exacerbation: bronchodilators, steroids, antibiotics if purulent change, controlled oxygen 88–92% to avoid CO2 retention.
70-year-old man, day 10 post-op, first mobilisation: sudden unilateral pleuritic chest pain, dyspnoea, diaphoresis, afebrile, self-resolved. Most likely?
Answer: B. Classic recall pattern: post-op immobilisation + pleuritic pain + dyspnoea = PE until proven otherwise. Needs CT pulmonary angiography + heparin.
Woman has chronic scaly plaques on legs and axillae covering ~10% of body surface; new lesions appear at scratch sites (Koebner phenomenon). No joint pain. Best initial treatment?
Answer: B. Recall: moderate plaque psoriasis (~10% BSA) + Koebner → topical steroid + vitamin D analogue first-line; phototherapy if extensive. Reserve systemic agents for severe/refractory disease; avoid systemic steroids alone (rebound).
30-year-old with 3-week night sweats, weight loss, upper-lobe cavitary lesion. Next step?
Answer: B. Upper-lobe cavitation + chronic B symptoms = TB. Confirm microbiologically, isolate, RIPE regimen per guidelines.
19-year-old diabetic with polyuria, vomiting, Kussmaul breathing, glucose 28 mmol/L, ketones strongly positive, pH 7.18. First management?
Answer: B. DKA: fluids, insulin, correct K+, treat precipitant (infection). Never oral agents alone.
Patient on sulfonylurea, dose increased, lost 4 kg, lifestyle improved, but HbA1c still 9%. Best next step?
Answer: B. Recall pattern: SU failure with HbA1c ≥9% + symptoms/weight loss despite adherence = insulin needed. Don't endlessly up-titrate SU.
Obese type 2 diabetic wants to lose weight and control glucose. Which class most helps weight loss?
Answer: C. Recall: GLP-1 RAs reduce weight + HbA1c. SU/insulin/TZDs tend to increase weight.
Pregnant woman with Hashimoto on levothyroxine 100 mcg, now TSH high, free T4 normal with hypothyroid symptoms. Next step?
Answer: B. Pregnancy increases thyroxine needs. High TSH = under-replaced; increase dose. Radioiodine/FNA not indicated here.
28-year-old woman with tremor, weight loss, heat intolerance, exophthalmos, diffuse goitre. Best initial treatment?
Answer: B. Graves hyperthyroidism: antithyroid (carbimazole/methimazole or PTU in 1st trimester) + propranolol for adrenergic symptoms.
65-year-old dehydrated after NSAID + diarrhoea: creatinine doubled, K+ 5.8, low urine output. Most likely and first action?
Answer: A. AKI from hypovolaemia + NSAID: stop precipitant, volume resuscitate, monitor UO/electrolytes. Dialysis only for refractory indications.
ECG shows tall peaked T waves, K+ 6.8 mmol/L. First stabilising drug?
Answer: B. Hyperkalaemia with ECG changes: calcium stabilises myocardium, then insulin-glucose + bicarbonate/salbutamol + binders/dialysis as needed.
Young woman fatigue, pallor, koilonychia, ferritin 6 ng/mL, microcytic anaemia. Best treatment + workup?
Answer: A. Iron deficiency: replace iron + find cause (menorrhagia, GI loss, parasites, diet). Hookworm is classic EMREE-linked cause.
22-year-old with sickle-cell disease: severe limb/back pain, no fever, chest clear. Management of vaso-occlusive crisis?
Answer: A. VOC: hydration, stepwise analgesia, oxygen, rest, incentive spirometry, screen for ACS/infection.
70-year-old sudden right hemiparesis + aphasia, onset 2 h ago, CT shows no bleed. Best next step?
Answer: B. Acute ischaemic stroke <4.5h without bleed: thrombolysis if eligible, plus stroke-unit care, statins, workup. Time-critical.
Generalised tonic-clonic seizure lasting 6 min in ED. First drug?
Answer: B. Status protocol: benzodiazepine first (lorazepam), then levetiracetam/phenytoin if persists, ABCs + glucose + cause search.
Fever, neck stiffness, photophobia, Kernig positive. After blood cultures, best immediate action?
Answer: B. Suspected bacterial meningitis: don't delay antibiotics for LP/CT. Cultures → immediate empirical antibiotics.
Hypotensive, tachycardic, lactate 4.5, suspected sepsis. Best initial bundle?
Answer: A. Sepsis-induced hypoperfusion: early antibiotics + aggressive fluids + reassess, then vasopressors if MAP <65.
24-year-old woman malar rash, arthralgia, oral ulcers, ANA positive, low C3. Most likely and steroid-sparing drug?
Answer: A. SLE young woman + malar rash + ANA: hydroxychloroquine for all unless contraindicated; add steroids/immunosuppression for organ disease.
45-year-old symmetric small-joint polyarthritis, morning stiffness >1 h, anti-CCP positive. First DMARD?
Answer: A. RA: early methotrexate + short steroids bridge, then escalate to biologics if target not met.
Acute hot swollen first MTP joint, hyperuricaemia, needle crystals negatively birefringent. Acute treatment?
Answer: B. Gout flare: anti-inflammatory now; don't start allopurinol alone acutely. Start ULT after flare settles with prophylaxis.
Obstetrics & Gynaecology
18 questions · 15% of the paper · ectopic, torsion, praevia, preeclampsia, PPH, PPROM, fibroid, endometriosis, screening
0 / 18 correct
24-year-old, 8 weeks amenorrhoea, RIF pain + vaginal spotting, pyrexial, cervical excitation on bimanual. Most likely?
Answer: B. Demo recall: pain + bleeding + amenorrhoea + peritonism/cervical excitation = ectopic until proven otherwise. Resuscitate, beta-hCG, TVUS, surgery (laparoscopy/laparotomy by stability).
33-year-old sudden severe colicky RIF pain radiating to back/pelvis, vomiting, tender mobile RIF mass. Most likely emergency?
Answer: B. Sudden unilateral severe pain + vomiting + adnexal mass = torsion. Doppler US, urgent gynaecology – detorsion/oophoropexy, ovary often salvageable early.
32-year-old multigravida, 32 weeks, sudden painless pool of blood at night, now stopped, transverse lie, maternal pulse 120, BP 110/70, FH 145. Most likely?
Answer: B. Painless third-trimester bleeding + malpresentation = praevia. No PV exam; resuscitate, Rh status, steroids if preterm, US placenta location, C-section if major.
26 weeks: BP 165/110, proteinuria 2+, headache, hyperreflexia. Diagnosis and seizure prophylaxis?
Answer: B. Preeclampsia: HTN + proteinuria/end-organ after 20w. MgSO4 prevents eclampsia; delivery is definitive. Control BP urgently.
Preeclamptic woman seizes. First drug?
Answer: B. Eclampsia: MgSO4 is drug of choice; secure airway, control BP, deliver when stable.
Multiparous woman just delivered: boggy uterus, heavy vaginal bleeding. First steps?
Answer: A. Atonic PPH: call for help, massage, oxytocin, empty bladder, check placenta/trauma, tranexamic acid early, transfuse if needed.
28 weeks PPROM: pooling, ferning positive. Afebrile, fetus cephalic, no labour. Management?
Answer: B. PPROM preterm: prolong latency if no infection/distress – steroids for lungs, antibiotics, surveillance. Avoid digital exams.
28-year-old heavy prolonged periods, pelvic pressure, enlarged uterus with firm mass. Most likely?
Answer: A. Menorrhagia + bulk symptoms + firm uterine mass = fibroid. US confirms; manage by symptoms/fertility (tranexamic, hormonal, myomectomy/hysterectomy).
22-year-old severe dysmenorrhoea, dyspareunia, chocolate cyst on US. Most likely?
Answer: B. Cyclic pain + infertility + endometrioma = endometriosis. Laparoscopy gold standard; COCP/progestin/GnRH + surgery per severity.
24-year-old oligomenorrhoea, hirsutism, acne, BMI 32, polycystic ovaries. First-line?
Answer: B. PCOS: lifestyle is foundation; COCP regulates cycles/androgens; manage fertility with letrozole/clomiphene when desired.
Healthy 30-year-old: cervical screening advice?
Answer: B. HPV testing is primary screen in most UAE-aligned guidelines; follow abnormal with colposcopy/biopsy.
35-year-old smoker, migraine with aura, wants contraception. Safest?
Answer: B. Migraine with aura + smoking >35 = oestrogen contraindicated (stroke). Copper IUD highly effective, no hormones.
Middle-aged woman post ovarian cancer: menarche 17, COCP 5 years, multiparous. What increases endometrial cancer risk?
Answer: B. Recall: COCP, late menarche and multiparity protect; smoking is never advised. Unopposed oestrogen (obesity, theca-cell tumour, tamoxifen) raises risk.
58-year-old postmenopausal vaginal bleeding. Next step?
Answer: B. Postmenopausal bleeding = endometrial cancer until proven otherwise. Biopsy + imaging promptly.
New immigrant delivers baby with cataracts, deafness, microcephaly, hepatosplenomegaly. No drugs. Prevention for next pregnancy?
Answer: B. Congenital rubella triad. Prevent by pre-conception MMR/rubella immunity check; vaccinate when not pregnant.
Couple worried about Down syndrome. Definitive test and timing?
Answer: A. Recall: amnio 15–16w definitive; CVS earlier. Screening (NT + biochemistry/NIPT) is not diagnostic.
38 weeks: diazepam, indomethacin, MgSO4, pethidine given. FHR 190→150 reactive. Which drug least likely to drop FHR?
Answer: B. Recall logic: opioids, benzodiazepines and MgSO4 all blunt variability and rate; indomethacin has the least direct fetal cardiac effect here. NSAIDs still need ductus and fluid monitoring.
Pregnant woman with diarrhoea, Giardia confirmed. Safe treatment?
Answer: B. Recall: paromomycin is luminal, minimally absorbed – preferred for giardia in pregnancy per many sources. Avoid teratogens; consult OB/ID.
Paediatrics
18 questions · 15% of the paper · pyloric, Hirschsprung, Rh HDN, sepsis, seizures, asthma, vaccines, growth
0 / 18 correct
6-week-old persistent non-bilious vomiting, hungry, wants to feed, K+ 3.1, olive mass. Diagnosis?
Answer: B. Non-bilious projectile vomiting 3–8w + hungry + olive + hypochloraemic alkalosis = pyloric stenosis. US confirms; correct electrolytes then pyloromyotomy.
Term neonate day 3: abdominal distension, delayed meconium day 3, no stool after, dilated loops on X-ray. Diagnosis?
Answer: C. Delayed meconium >48h + distension + dilated loops = Hirschsprung. Biopsy (aganglionosis); contrast enema transition zone.
Mother A-negative, no anti-D last pregnancy, husband unknown. Term boy severe jaundice within hours. Most likely?
Answer: B. Hours-after-birth severe jaundice + Rh-negative mother without prophylaxis = Rh HDN. Check DAT, bilirubin, Hb; phototherapy/exchange + IVIG per severity.
Macrosomic infant of diabetic mother, glucose 3.2 mmol/L, vigorous. Management?
Answer: B. Asymptomatic 3.2 (>2.5) vigorous term: feed early + monitor. IV dextrose if <2.0–2.5, symptomatic, or persistent low.
3-day breastfed term: lethargic, poor feeding, new jaundice, T 35.4, liver 2 cm. Most likely?
Answer: D. Hypothermia + lethargy + poor feeding + jaundice = sepsis until proven otherwise. Cultures, antibiotics, glucose, bilirubin workup urgently.
18-month febrile seizure <5 min, generalised, quick recovery. Advice?
Answer: B. Simple febrile seizure 6mo–5y: brief, generalised, once/24h, full recovery. Exclude meningitis by age/clues; educate, no chronic AED.
8-month winter wheeze, crackles, rhinorrhoea, RSV positive, mild distress. Best care?
Answer: B. Bronchiolitis is viral supportive care. Antibiotics/steroids not routine unless bacterial superinfection.
7-year-old recurrent wheeze responsive to salbutamol, atopy. Best controller?
Answer: A. Childhood asthma: ICS backbone, step-up per control, spacer technique, trigger avoidance.
2-year-old watery diarrhoea, some dehydration, no blood. First therapy?
Answer: B. Viral gastroenteritis: ORS is life-saving; zinc reduces duration; continue feeds; antibiotics only for cholera/shigella/amoeba per protocol.
5-year-old periorbital + leg oedema, heavy proteinuria, albumin low, cholesterol high. Diagnosis and first-line drug?
Answer: B. Nephrotic triad + hyperlipidaemia: minimal-change commonest; steroids first-line; monitor relapse, vaccinate, salt management.
Girl iron-deficiency anaemia. Which parasite classically causes it?
Answer: C. Hookworm sucks blood → IDA. Fish tapeworm → B12 deficiency. Pinworm → perianal itch.
Mode of inheritance of beta-thalassaemia major?
Answer: B. Beta-thal major needs two mutated HBB alleles – AR. Counselling + premarital screening crucial in region.
Child with VP shunt since age 3 now febrile. Best temperature method + concern?
Answer: B. Fever + VP shunt = shunt infection until excluded. Use non-invasive thermometry; cultures, bloods, neurosurgery review – don't delay.
14-month boy born 8 weeks preterm: says baba/mama, walks unassisted, can't turn pages. Action?
Answer: B. Correct age = 12 months: walking + 2 words is on track. Preterms need corrected-age assessment + hearing/vision screen + follow-up.
4-year-old fever, ear pain, rhinorrhoea, cervical nodes, mobile eardrum. Management if mild?
Answer: B. Mild AOM/viral URI with mobile drum: symptomatic first; antibiotics if bulging, otorrhoea, <2y bilateral, or no improvement.
Parents of a child with diabetes insipidus ask what labs to expect. Which pattern fits DI?
Answer: B. DI: dilute polyuria → concentrated serum. Teach parents thirst, dehydration signs, desmopressin (central) vs thiazide/low salt (nephrogenic).
A 12-month-old is due vaccines. When is MMR given?
Answer: B. MMR 12–15mo + 4–6y. Check UAE schedule; catch-up if missed; contraindicated in pregnancy/severe immunocompromise.
Newborn hyperbilirubinaemia + anaemia + hypoproteinaemia day 1, O-negative mother antiglobulin positive, no antenatal care. Baby blood type likely?
Answer: B. Rh-positive fetus in sensitised Rh-negative mother → haemolysis. Type baby, DAT, bilirubin, treat aggressively to prevent kernicterus.
Surgery, Ortho & Trauma
18 questions · 15% of the paper · appendicitis, cholecystitis, obstruction, hernia, burns, compartments, torsion, ATLS
0 / 18 correct
What is the first symptom of acute appendicitis classically?
Answer: B. Visceral → somatic: vague periumbilical pain → localises to McBurney after 6–12h + anorexia/nausea/fever. Alvarado + US/CT.
35-year-old RUQ pain after fatty meal, Murphy positive, fever. Best test and definitive treatment?
Answer: B. Cholecystitis: US wall thickening/pericholecystic fluid + Murphy. Antibiotics, fluids, early lap chole; ERCP only if CBD stone/cholangitis.
Elderly distension, vomiting, no flatus/stool, air-fluid levels. First steps?
Answer: B. Bowel obstruction: decompress, resuscitate, find cause (adhesions/hernia/tumour/volvulus). Red flags: pain + tachycardia + peritonism.
Groin bulge that enlarges on coughing/straining, reducible. Management?
Answer: B. Inguinal hernia: elective repair; strangulation = emergency surgery. Counsel smoking/constipation/prostate.
30-year-old breast lump: firm, mobile. Best approach?
Answer: B. Triple assessment for any discrete lump. Red flags: hard, fixed, skin change, nipple discharge, axillary nodes.
Thyroid nodule: euthyroid, 2 cm solid. Next step?
Answer: B. Nodule workup: US (TIRADS) + FNA. Surgery for malignant/suspicious/compressive/toxic. Don't miss anaplastic/red flags.
40% burns adult. Initial fluid formula?
Answer: A. Burns: ATLS ABCs, stop burning, Parkland, urine output 0.5–1 mL/kg/h, warm, tetanus, refer to burns centre.
Tibial fracture with severe pain out of proportion, tense compartments, paraesthesia. Action?
Answer: B. Compartment syndrome is surgical emergency. Remove constriction, measure pressures, fasciotomy <6h to save limb.
16-year-old sudden severe scrotal pain, absent cremasteric, high-riding testis. Best next step?
Answer: B. Torsion: time = testis. Don't delay for imaging if classic; Doppler if equivocal but go to theatre fast.
In polytrauma, what is the correct assessment order?
Answer: B. ATLS: treat greatest threat to life first. Airway wins. Pelvic binder, TXA <3h, massive transfusion if bleeding.
Elderly subcapital femoral neck fracture, stable with rib fracture + splenic contusion managed conservatively. Hip plan?
Answer: B. Recall: displaced subcapital → high AVN risk; fix urgently once resuscitated/optimised, VTE prophylaxis, ortho-geriatrics.
60-year-old medial malleolar ulcer, varicose veins, hyperpigmentation, mild non-tender calf swelling. Next step?
Answer: B. Venous ulcer: compression is cornerstone if ABPI normal. Check arterial, rule out DVT if swelling/tender, dressings, refer vascular.
Claudication 100 m, absent pedal pulses, ABI 0.6. Diagnosis + first advice?
Answer: B. PAD: ABI <0.9 diagnostic. Supervised exercise, risk-factor control, cilostazol where suitable, revascularise if critical/limiting.
Epigastric pain radiating to back, vomiting, lipase 8× normal after alcohol/gallstone. Management?
Answer: B. Pancreatitis: aggressive fluids, nutrition, no routine antibiotics; ERCP if cholangitis/obstruction; cholecystectomy after gallstone episode.
Sudden severe epigastric pain, rigid abdomen, free air under diaphragm. Likely cause and best initial test?
Answer: A. Perforation: resuscitate, NGT, broad antibiotics, laparotomy/laparoscopic repair + washout. Don't miss Boerhaave/ectopic.
Painful defecation with bright-red bleeding + anal fissure vs haemorrhoids. First care?
Answer: B. Most anal pain + bleeding benign: exclude cancer/IBD red flags, conservative first, refer if thrombosed/prolapse/anaemia.
Post-op fever day 5, wound erythema, pus. Action?
Answer: B. Surgical-site infection: examine, probe, culture, debride/necrotising check, antibiotics, glycaemic control.
Diabetic foot ulcer with numbness, pulses present. Key step?
Answer: B. Neuropathic ulcer: offload (total-contact cast), daily care, probe-to-bone/osteomyelitis check, MDT foot clinic.
Family Medicine, Ethics & Safety
18 questions · 15% of the paper · consent, confidentiality, safety, breaking bad news, orthostasis, back pain
0 / 18 correct
Cancer patient asks doctor not to tell family. Doctor respects her wishes. Which principle is applied?
Answer: B. Recall: confidentiality/autonomy – competent adult controls disclosure. Breach only for serious harm/public safety per law.
Child critically ill, parents refuse life-saving treatment, want religious healer only. Best?
Answer: B. Paediatric emergency: best interests override refusal. Culturally sensitive engagement + ethics/legal + document. Life-threatening = court order if needed.
Radiologist almost filed report for wrong patient but caught before submitting. Event type?
Answer: B. Near miss: error intercepted. Report to patient-safety system, disclose per policy, fix ID checks/barcoding.
Doctor dismissed serious rash as normal despite nurse concern; patient discharged, returned and died. Error type?
Answer: B. Ignoring red flags + hierarchy failure → harm. Classic negligence: duty, breach, causation, damages. Needs disclosure + review.
Valid informed consent requires?
Answer: B. Consent is a process, not a form. Document discussion, use interpreter, assess capacity, allow refusal.
Breaking bad news: best framework?
Answer: B. SPIKES + privacy + empathy + clear plan + support person + written summary.
Elderly independent woman falls, no injury. Most useful next step?
Answer: B. Recall: meds review first (sedatives, antihypertensives). Then gait, vision, footwear, home safety, vitamin D/calcium, physio.
Hypertensive on nitrates + alpha-blocker, recurrent syncope, normal ECG, no chest pain/palpitations/SOB. Most likely cause?
Answer: B. Recall: drug-induced orthostasis. Check lying/standing BP, review meds, hydrate, compression, deprescribe.
Asymptomatic, prior chest pain/syncope, exam normal. Best cardiac test?
Answer: B. Recall: exertional syncope/chest pain history → stress testing/echo workup even if now well. Refer cardiology.
70-year-old HTN, EF 65% on old echo, for elective non-cardiac surgery, asymptomatic. Pre-op?
Answer: B. Normal EF on prior echo + currently asymptomatic with good functional capacity → no repeat echo. Follow ACC/AHA algorithm.
Runner with pinpoint greater-trochanter pain, no trauma. Management?
Answer: B. Greater-trochanteric pain syndrome: conservative first. Inject only if persistent; rule out hip OA/fracture if atypical.
Woman lifting heavy: low-back pain radiating posterior leg, no red flags, neuro intact. Next?
Answer: B. Acute sciatica without red flags: conservative 6 weeks. MRI if cauda equina, progressive deficit, cancer/infection suspicion.
Known ankylosing spondylitis, sacroiliac pain, acute flare. Effective biologic class if NSAID fails?
Answer: B. Axial AS: NSAIDs + exercise first; TNF/IL-17 inhibitors for high activity. Methotrexate helps peripheral, not axial.
Third-trimester bleeding: what most reduces mortality?
Answer: B. Never PV with suspected praevia – can provoke catastrophic bleed. Locate placenta abdominally, cross-match, steroids, C-section plan.
Tingling lateral forearm + reduced brachioradialis reflex. Which nerve root?
Answer: B. C6: thumb/index, lateral forearm, biceps/brachioradialis. Know dermatomes/myotomes for EMREE.
Healthy runner requests full-body MRI + antibiotics for viral cold. Best?
Answer: B. Professionalism: avoid low-value testing/antibiotics, explain harms (incidentalomas, resistance), offer alternatives.
Inter-professional conflict: nurse flags deterioration, junior dismisses. Best?
Answer: B. Patient safety: graded assertiveness, SBAR, rapid response. Hierarchy never overrides safety.
Suspected child/spouse/elder abuse with inconsistent story. Duty?
Answer: B. Abuse: separate interview, body map, photos, report to authorities, admit if unsafe. Confidentiality yields to protection.
Psychiatry
12 questions · 10% of the paper · depression, eating disorders, anxiety, OCD, PTSD, ADHD, lithium, NPH
0 / 12 correct
32-year-old low mood, anhedonia, weight loss, insomnia, guilt 3 weeks + somatic aches. First-line?
Answer: B. Moderate-severe depression: SSRI + psychotherapy, safety plan, monitor activation/suicide early. Treat somatic pain within depression.
18-year-old binge-eats then vomits, feels overweight, BMI 16.5. Diagnosis?
Answer: B. Recall: BMI <18.5 + body-image distortion = anorexia even with binge/purge. Bulimia usually normal/overweight. Needs MDT refeeding + psych.
Panic attacks, palpitations, catastrophic thoughts, avoids malls. Best long-term?
Answer: B. Panic/GAD: CBT + SSRI first-line. Benzos only short crisis due to dependence.
Intrusive contamination fears + 2-hour washing rituals, knows excessive. Diagnosis and best therapy?
Answer: B. OCD: obsessions + compulsions + insight. ERP + SSRI/clomipramine; augment if resistant.
Nightmares, flashbacks after crash, hyperarousal, avoidance 2 months. Best next step?
Answer: B. PTSD >1 month: trauma-focused therapy first; meds adjunct. Early support, not single debrief.
22-year-old deliberate self-harm, says will repeat. Best immediate action?
Answer: B. Self-harm: empathic risk stratification, protective factors, means restriction, follow-up <48h, involve family with consent unless imminent risk.
8-year-old inattentive, hyperactive, impairing school/home >6 mo. First-line after behavioural?
Answer: B. ADHD: confirm pervasiveness, exclude vision/hearing/thyroid/sleep; stimulants effective with monitoring.
Chronic insomnia, daytime benzodiazepine request. Best?
Answer: B. Insomnia: CBT-I beats pills. Taper benzos (dependence/rebound), treat apnea/depression/RLS.
Patient on lithium: what to monitor regularly?
Answer: B. Recall: lithium renally cleared, narrow index → nephrogenic DI, hypothyroidism, toxicity with dehydration/NSAIDs. Check levels 12h post-dose.
Triad incontinence + dementia + gait apraxia, ventriculomegaly + periventricular hyperintensity. Diagnosis?
Answer: B. NPH: wet-wobbly-wacky. Tap test predicts shunt response. Rule out obstructive/vascular.
2 years isolated, poor hygiene, flat affect, no friends, no positive psychosis. Most likely personality pattern?
Answer: B. Recall: persistent social detachment + restricted affect without psychosis = schizoid pattern; monitor for schizophrenia prodrome, support ADLs.
Elevated mood, reduced sleep, grandiosity, overspending 1 week, impaired function. Best acute?
Answer: B. Mania: stop pro-manic agents, stabilise, protect finances/safety, psychoeducation + lithium/valproate maintenance.
Public Health & Biostatistics
12 questions · 10% of the paper · cohort, sensitivity, bias, attack rate, herd immunity, screening
0 / 12 correct
Two groups: one previously used omega-3 (exposed), one never, followed forward for events. Study type?
Answer: B. Exposed vs non-exposed followed forward = cohort. Remember: cohort = exposure → outcome; case-control = outcome → exposure.
Depression test: TP 75, FN 25. Sensitivity?
Answer: B. Sensitivity = TP/(TP+FN) = 75/100 = 75%. Specificity = TN/(TN+FP).
Regression intercept for gestation = 37.9 weeks. Meaning?
Answer: B. Intercept = predicted Y when all predictors zero. Check centring – may be non-physiological, just model anchor.
Test detects disease earlier but death age unchanged. Bias?
Answer: A. Screening survival illusion: earlier diagnosis without delayed death = lead-time. Length-time is slow-growing cases over-represented.
Correlation between dose and weight gain (continuous). Measure?
Answer: B. Two continuous → Pearson r / linear regression. OR/RR for binary outcomes; chi-square for categorical.
Outbreak: 40 ill of 200 exposed. Attack rate?
Answer: B. Attack rate = ill/exposed during outbreak. Guide control + source search.
Herd immunity threshold for measles (~95%) rationale?
Answer: A. High coverage stops transmission, shielding infants/immunocompromised. Measles needs ~95% due to R0 12–18.
Child up-to-date except MMR at 14 months in endemic area. Advice?
Answer: B. MMR ≥12 mo (maternal antibodies wane). Give now + second at 4–6y. Early dose (<12 mo) during outbreak doesn't count.
What is the best first-line smoking-cessation help?
Answer: B. Combine behavioural + pharmacotherapy doubles quit rates. Screen, advise, assess, assist, arrange.
How often should diabetic retinopathy screening occur?
Answer: B. Recall-linked: dot-blot + gradual blur with clear vitreous/normal IOP → diabetic maculopathy. Annual screen prevents blindness.
Confounding example: coffee–MI confounded by smoking. How to handle it at the design stage?
Answer: A. Design: randomise/match/restrict; Analysis: stratify/adjust. Confounder linked to exposure + outcome, not on pathway.
Travel medicine: traveller’s diarrhoea prevention?
Answer: B. Food/water precautions + vaccines + ORS plan. Prophylactic antibiotics not routine except special groups.