DFM FINAL EXAM: 7th BATCH

Paediatrics
1. A 4 year old child has a 48 hour history of ‘barking’ cough with stridor and intercostal chest recession. Looks lethargic. No fever
noted. CVS and lungs are normal. WCC normal. What is the diagnosis?
a. Acute epiglottitis
b. Croup (x)
c. Pertussis
d. Acute tonsillitis
e. Asthma

2. A 12 year old boycomplains of abdominal pain for 2 days and fever for 1 day. On examination: temperature 38.5C, throat injected,
tenderness at umbilical region.
a. Give symptomatic treatment and review after 24 hours (x) (mesenteric adenitis?)
b. Refer hospital for further evaluation
c. Do an ultrasound abdomen
d. Do an FBC, if normal, review after 24 hours kiv
e. Give antibiotics

3. A 7 year old complains of fever, abdominal pain and vomiting x 1/7. On examination: dry oral mucosa, abdomen: generalized
tenderness but not distended. No fever documented. What is the likely diagnosis?
a. Intusussception ??
b. Acute appendicitis
c. Intestinal obstruction
d. Urinary tract infection (x)

4. A 3 year old child was found by his mother to be playing with her iron tablets. She is unsure whether her son ingested any of the
tablets or not. On examination, the child looks well. What should you do?
a. Give activated charcoal
b. Reassure the mother since the child looks well and discharge
c. Refer to hospital (x)
d. Gastric lavage
e. IV fluid

5. A 2 year old child came to see you forfever, sore throat and poor oral intake. There are vesicles at thebuccal mucosa and rash at
palms and feet. What is the most likely causative agent for the child's condition?
a. Coxsackie virus (x)
b. Varicella zoster
c. ?EBV
d. Kawasaki

6. An 8 year old child has been havingfrequent episodes of constipation for the past one year. There is frequent soiling, especially at
school. On examination, abdomen is soft and on PR, there is hard impacted stool. What will you do?
a. Evacuate stool and prescribe oral lactulose (x)
b. Regular oral Bisacodyl daily
c. Increase dietary fibre intake /?
d. Thyroid function test

7. A 10 year old girl complains of recurrent non specific abdominal pain for the past 6 months. However the pain does not wake her up
at night. She is able to eat well. Weight and height are normal. Her mother hada history of similar abdominal pain when she was a
child. What will you do next?
a. Ultrasound
b. Ask psychosocial history (x)
c. Abdominal x ray

8. A 10 year old girl complains of right ear pain for the past 2 weeks. On examination, there aresigns of middle ear inflammation and
fluid in the middle ear with conductive deafness. What is your diagnosis?
a. Acute otitis media
b. Acute otitis media with effusion (x)

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 c. Chronic otitis media
d. External otitis
e. Foreign body

9. A child was jumping on the bed, thenhad sudden severe headache, vomiting and neck stiffness.What is the most likely cause?
a. Encephalitis
b. Meningitis
c. Subdural haemorrhage
d. Subarachnoid haemorrhage (x)
e. Brain tumor

10. A4 year old girl presents with a UTI. She has a past history of 3 episodes of UTI in the past 6/12. Urinalysis shows nitrites &
leucocytes. What is the most appropriate step?
a. Urine culture, treat with antibiotics & refer to Paeds (x)
b. Urine culture & treat only if culture is positive
c. Treat empirically with antibiotics after urine C&S
d. No antibiotics are required

11. A 15 year old girl has not yet had menarche. Her sister and mother had menarche at the age of 13. On examination,there is no
breast development and no pubic hair. Her height and weight are at< 5th centile. She also has anosmia.What is the diagnosis?
A. Noonan syndrome > girl webbing ASD
B. Kallman's syndrome (x) 20 character x
C. Turner syndrome > boy tall gynecomastea
D. Constitutional delayed puberty

12. You are about to undertake an investigation to look for lead poisoning among students at a school. What is the most important
thing to look for?

a. Poor school performance (x) ? memory loss, fatige, sleep disturb

b. A history of staying for prolonged periods in old houses

c. ?Vaccination

Cardiovascular

13. A 45 year old patient is noted on several different occasionsto have an average BP of 162/98mmHg. Otherwise, there are no other
medical illnesses or risk factors. What is your management?
a. Repeat BP 3 months later
b. Start single antiHTN therapy
c. Dual antiHTN therapy (x)
d. Lifestyle modification

14. A 20+ year old man complains of recent onset irregular heart beat. He is otherwise well. On examination he is normotensive. What
does his ECG show?

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a. Mobitz type 1 second degree heart block
b. Mobitz type 2 second degree heart block
c. Ventricular bigeminy (x)
d. 3rd degree heart block

15. A 20+ year old man comes to your clinic for a preemployment medical check up. He is physically well. His ECG is shown below. What
will you do?

a. Refer to cardiologist
b. Refer for pacemaker
c. Reassure him and no need follow up (x)
d. Send for ECHO

16. A 78 year old frail lady with hypertension has defaulted treatment and follow up. She comes to see you with the complaint of
headache and giddinesson and off. Her average BP is 194/119mmHg. She lives in a high rise building and has to take care of her
disabled husband. ECG is normal.What is your management?
a. Admit medical ward(x)
b. Oral nifedipine 10mg stat
c. Continue monitoring
d. Refer to medical outpatient
e. Double antiHTN therapy

17. A 60+ year old came for URTI symptoms. Noted BP 158/89. This is his ECG:

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 What is your management?
a. Start losartan 50mg od
b. Start amlodipine 10mg od
c. Give combination of losartan 50mg od and hctz 12.5 mg od (x)
d. No need meds, rpt BP in 1/12
e. Check for albuminuria

18. A 52 year old man complains of reduced effort tolerance for the past 2 weeks. No orthopnoea/chest pain/leg swelling. Systemic
examination was normal.JVP 3cm. What investigation will you order?
a. ECHO
b. Angiogram
c. CXR
d. Stress test (x)
e. BNP

19. An 18 year old girl presents withdyspnoea. On examination, there is an apical heave, apical systolic thrill, systolic murmur and
rumbling mid-diastolic murmur (region not specified). What is the most likely diagnosis?

a. Mitral regurgitation ??

b. Aortic stenosis (x)

c. Tricuspid regurgitation

d. VSD ??

e. ?other non valvular lesion

Respiratory
20. A 30 year old man complains of exacerbations of cough and shortness of breath 2-3x per week for past 2/12 and night cough 1-
2x/week. He has a history of similar symptoms during childhood. His SOB is aggravated by cold weather and exercise. What is your
plan of management?
a. Daily high dose inhaled corticosteroid+ b2 agonist when needed
b. Daily high dose inhaled corticosteroid+ oral steroid prn + b2 agonist prn
c. Daily low dose inhaled corticosteroid+ b2 agonist when needed (x)
d. B2 agonist when needed
e. ? LABA only
f. ?Daily oral steroid

21. A 60 year old ex-smoker presents with breathlessness for ?duration. Chest x-ray shows hyperinflated lungs. The following treatment
may be suitable for him EXCEPT:
a. Steroid inhaler

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 b. Tiotropium inhaler
c. Erythromycin (x)
d. Stop smoking
e. B2 agonist

22. A young man complains of URTI symptoms for 8 days with hoarseness of voice. On examination he is afebrile and throat was
normal. What is your diagnosis?
a. Acute pharyngitis
b. Acute laryngitis (x)
c. Acute tonsillitis
d. Viral fever
e. Acute sinusitis

23. A 20 year old student complains of sore throatand fever x 2-3/7. No cough/RN. His temperature is 38.5C, with tender anterior
cervical lymph nodes. Pharynx and tonsils are injected but there are no exudates. He wishes to get well fast in view of a major
examination in two weeks time. The best course of action is to:
a. Prescribe oral penicillin V for 10 days(x)
b. Reassure him that it is viral in origin and give symptomatic treatment
c. Check FBC: if there is leucocytosis, give azithromycin for three days
d. Prescribe analgesics, do a throat swab and review in three days
e. ?Oralcloxacillin for 7 days
f. ?Throatswab and azithromycin for 3 days

24. A 20+ year old man complains of chronic cough with itchy throat, worse at night for the past 1 month. Throat is mildly injected. No
other significant finding. What medication will you prescribe?
a. Pseudoephedrine
b. Ranitidine (x)
c. Prednisolone
d. MDI Salbultamol

25. An elderly man stopped smoking some time ago due to increasing shortness of breath and cough. He was noted to have altered
behavior over the past few months. He is forgetful, and he has started to talk ‘dirty’ to their old maid at home and started to grab at
her. Even the maid thinks that he is getting strange as he used to be a perfect gentleman. He also has history of a fall previously. On
examination, he is noted to have clubbing. What investigation will you do next?
a. CXR (x)
b. Lung function test
c. Skull x-ray
d. Mantoux test

GI system
26. A 30+ year old man sees you 1/52 after returning from his trip to ?country where he ate half cooked clams. He complains of
fever,abd pain with vomiting. On examination, he is jaundiced, with a tender right hypochodriumand hepatomegaly. What blood
test will you do?
a. Hepatitis A antibody (x)
b. HbsAg
c. Serum amylase
d. Anti HCV
e. ?LFT

27. A 42 year old man who is a hepatitis B carrier comes to see you. His father died of colorectal cancer. He is worried about cancer and
requests screening. Which is the most appropriate test?
a. Alpha feto protein (x)
b. CEA Colon Rectum
c. B-HCG
d. CA 19.9 CA125 ovary
e. PSA

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28. A 60+ year old man complains of abdominal distension with reduced appetite. He has a history of H.pylori infection. He is pale and
jaundiced with ?abd mass. What will you do?
a. LFT
b. Colonoscopy
c. Upper endoscopy (x)
d. Serum amylase

29. An old man presents with PR bleeding, incomplete defecation and constipation. On examination:haemorrhoids noted. What is the
next step?
a. Colonoscopy (x)
b. Encourage high fibre diet
c. Start Daflon

Renal

30. A 60+ year old man has a backgroundhistory LUTS symptoms. Noted sudden onset of oliguria over the past 3 days. His bladder is
distended. Blood Ix:
Urea/ creatinine: raised
Hyperkalemia
PSA:6
What is your diagnosis?
a. Renal cell carcinoma
b. Renal cyst
c. Renal stone
d. BPH (x)

31. A man complains of sandy urine and ?dysuria. What investigationwill youorder to prevent recurrences?
a. Urinary calcium excretion
b. Ultrasound
c. Stone analysis (x)
d. Serum uric acid
e. Serum calcium

32. A patient was given an antibiotic, and subsequently developed hearing loss and acute renal failure. Whichdrug was the most likely
culprit?
a. Tetracycline
b. Ciprofloxacin
c. Gentamicin (x)
d. ?Antimalarial

33. A pregnant ladypresents with a UTI. She has G6PD deficiency. Which antibiotic will you give?
a. Co-trimoxazole
b. ?Cefuroxime/Cephalexin (x)
c. Ciprofloxacin
d. Moxifloxacin
e. Nitrofurantoin

34. A 30+ year old marathon runner who has been training hard was noted to have dark urine. Urine dipstick: Blood 3+. Urine
microscopy: no blood

What is the diagnosis?

a. Rhabdomyolysis (x)
b. UTI
c. Stones

35. An elderly man was noted to have microscopic hematuria. On examination, thereis a mass palpable per abdomen. What is your
diagnosis?
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 a. Renal cancer (x)

b. Polycystic kidney disease

Neurology

36. A man who was recently diagnosed with Parkinson's disease is started on a cholinesterase inhibitor. What is the most likely side
effect you anticipate during the first few weeks?
a. Blurring of vision
b. Diarrhea (x)
c. Postural hypotension
d. Giddiness
e. Headache
f. Rhinorrhea

37. A 60 year old man complains of sudden onset of incontinence and left lower limb weakness. No slurred speech. On examination,
noted left lower limb weakness but sensation is intact. BP was 160/90mmHg. What is your diagnosis?
a. Brain tumour (x)
b. Brown-Sequard syndrome
c. CVA
d. Spinal cord compression ??
e. GBS
f. ?Parkinson disease

38. A 21 year old man walks into your clinic with his head tilted sideways, his eyes rolled up and his tongue sticking out. He speaks with
difficulty but gives the message that he has been in this position for a few hours after taking a new medicine for his ‘nerves’. What
medication has he most likely taken?
a. Benztropine
b. Diazepam
c. Chlorpromazine
d. Phenytoin
e. Haloperidol (x)
f. ?Maxalon

39. A 70+ year old manwas noted to have memory lossover the past 1 year. Lately he complainsof seeing wild animals in the house. He
has a shuffling gait
a. Alzheimer disease
b. Lewy body dementia (x)
c. Fronto-temporal dementia
d. Parkinson disease
e. Creutzfeldt-Jacob disease mad cow dz: speec impair myoclonus depress

40. A girl has severe unilateral headaches which usually begins premenstrually and resolves after her menses. What medication can be
given to reduce the frequency of this headache?( ? menstrual migraine)
a. Propranolol
b. Mefanamic acid
c. Ergotamine
d. Paracetamol
e. Sumatriptan (x)

41. An elderly man is noted to have hallucinations, shuffling gait and stiffness of limbs. Which is the most likely cause?

a. Dementia of Lewy Bodies (x)

b. Parkinson’s Disease
c. Alzhemier’s disease

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 Endocrine

42. A45 year old overweight lady was recently diagnosed with diabetes. Her HbA1Cis 12 and FBS 15despite diet and exercise. What is
the most appropriate course of management?
a. Start MTF
b. Start insulin
c. Start MTF + insulin (x)
d. Start MTF + SU
e. Start MTF + SU + Acarbose

43. A gentleman came for a check up. His capillary blood glucose is 5.8. What should you do?
A Repeat DXT in 1 year
B HbA1c
C FBS (x)
D OGTT

44. A 38 year old obese woman who has a family history of diabetes came for diabetes screening. Noted RBS was 5.6mmol/L. What will
you do next?
a. Order fasting plasma glucose
b. OGTT ??
c. No need to check (x)
d. Another random blood sugar

45. A 30+ yearold man who was previously well was noted to have high BP with 3 episodes of hypokalemia. He has a normal BMI. There
is no radiofemoral delay. What is your diagnosis?
a. Conn's syndrome (x)
b. Cushing's syndrome
c. Renal artery stenosis
d. Coarctation of the aorta

46. A patient presents with hyperpigmented oral mucosa & low serum potassium level. What is the most likely cause?
a. Conn’s disease
b. Addisons (x)

47. A 20+ year oldlady is sitting for her exams soon. She presents with diarrhea, palpitation, tremors and anxiety. Her mother has a
history of anxiety disorder. Father has diabetes. On examination, noted tachycardia, tremor, proptosis and a smooth, diffusely
enlarged goitre. What is the most likely diagnosis?
a. Hashimoto’s thyroiditis
b. Thyrotoxicosis
c. Anxiety disorder
d. Grave’s disease (x)
e. DM

Derm/STD

48. A 40+ year old man complains of a (?painless) ulcer at the genitalia. Noted bilateral inguinal lymph node swelling across the inguinal
ligament.

What is your diagnosis?

a. Lymphogranulomavenereum (x)

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 b. Syphilis
c. Chancroid

49. A 30+ year old man recently visited a sex worker. He now complains of a painful ulcer at the penis which ulcerates. (picture
given).There is yellowish-grey slough at the ulcer and Gram stain shows a ‘school of fish’ pattern. What is the cause for his
condition?
a. Hemophilusducreyi (x)
b. Chlamydia
c. ?Donovanosis
d. Gonorrhea
e. ?Syphilis

50. A young lady complains of an itchy rash at the neck which worsens when she is exposed to the sun and when she is angry, eats spicy
food or exercises. What is your diagnosis?

a. Heat urticarial rash

b. Solar urticarial rash
c. Contact urticaria
d. Chronic Idiopathic urticaria
e. Cholinergic urticarial (x)

51. A young man complains of anon-pruritic rash at the groin. He was treated with a steroid cream. Initially the symptoms improved but
now the rashis spreading. What is the diagnosis?
(pic given showing a rash at the groin with an annular pattern, +satellite lesions)
a. Lichen planus
b. Tineacruris
c. Tinea incognito (x)
d. Intertrigo
e. Eczema

52. .Psoriasis can be exacerbated by

a. Β-blockers
b. Antimalarials
c. Aspirin
d. Ibuprofen
e. All of the above (x)

Travel medicine
53. A backpacker tourist returning from his trip to Bangladesh comes to see you with the complaint of fever, chills and diarrhea. What
test will you do?
a. BFMP (x)
b. Widal Weil Felix
c. Dengue serology

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54. A businessman recently came back from the UK. He presents 3/7 after his trip with headache, insomnia, loss of appetite, feeling
feverish and irritable. What is the most likely cause?
a. Jetlag (x)
b. Hepatitis
c. Dengue
d. Malaria
e. Gastritis

Emergency Med
55. A 40+ year old man sustains a fall from a height. He comes to your clinic complaining of chest pain.No external bleeding noted. On
examination, chest spring is positive, there is crepitus at the chest and paradoxical movement on the right lower chest region. What
is your diagnosis?
a. Tension pneumothorax
b. Open pneumothorax
c. Flail chest (x)
d. Haemothorax
e. Cardiac tamponade

56. A young man sustained a traumatic injury to the right medial thigh (?penetrating wound). There was a lot of bleeding,which has now
stopped. There is a large hematoma which is increasing in size over the thigh. The distal part of the limb is noted to be pale, cold
with weak pulses and numbness. What is your management?
a. Evacuate blood clot and suture the wound
b. Arrange for immediate emergency exploration and repair
c. Fasciotomy (x)
d. Angiogram

57. A patient involved in an MVA who sustains intraabdominal injury is most like to injure which organ?
a. Liver
b. Spleen (x)
c. Kidney
d. Pancreas
e. Intestine

58. A 22 year old lady was found by her parents in her room. She had ingested 10 tablets of PCM 1 hour ago. She was brought to the
casualty. What will you do?
a. Give activated charcoal (x)
b. Start N-acetylcysteine now
c. Give intravenous drip
d. Check her PCM level first
e. Give Ipecac syrup

59. A man in involved in an MVA, and isbrought in unconscious to your clinic. What is your first step?
a. Assess airway (x)
b. Head tilt chin lift
c. Take BP
d. Secure IV access
e. Full examination from head to toe

Orthopedics/Rheumatology

60. A 40 year old lady fell down the steps and now complains of left ankle pain and mild swelling. She is able tobear weight and walk
with a limp. On examination, there is mild swelling on her foot but no bruising. What will you do?
a. X-ray
b. Figure-of-8 bandage (x)
c. NSAIDS
d. Bed rest for 3 days
e. Hot pack

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61. An 18 year old boy was playing football, when he wastripped by an opponent and fell onto his outstretched right hand. What is the
most likely fracture that he will have?
a. Coles fracture (x)
b. Smith fracture
c. Supracondylar fracture
d. Mid-shaft humerus fracture
e. Clavicle fracture

62. An 18 year old man complains of lower back pain and stiffness x 2 years, worse in the morning. Pain is aggravated by bending at the
waist to touch his toes, and is improved by activity. No dysuria. What is the most likely diagnosis?
a. Ankylosing spondylitis (x)
b. Rheumatoid arthritis

63. A 20+ year old man is training for a marathon. He complains of pain at the posterior part ofhis left calf especially in the morning. On
examination, there is tenderness at the junction between the lower one third and middle third of the calf. No bruises. What is your
diagnosis?
a. Soleus muscle tear (x)
b. Achilles tendonitis
c. Stress # of fibula

64. A 22 year old girl is noted to have rash and arthritis. Her investigations show:
FBC: pancytopenia
ESR: 60
dsDNA positive
ANA positive
UFEME: proteinuria and hematuria
What is your diagnosis?
a. Systemic sclerosis
b. Systemic lupus sclerosis (x)
c. Mixed connective tissue disease
d. Ankylosing spondylitis
e. Rheumatoid arthritis

Ob/Gyn
65. A 48 year old lady has been having irregular heavy menses for the past 2 years. Otherwise she is well. On examination: abdomen
normal. Uterus is normal, anteverted. ?Ultrasound normal. What is your most likely diagnosis?
a. Dysfunctional uterine building (x)
b. Endometrial carcinoma
c. Uterine fibroids

66. A 40+ year old Para 4 (all SVD) has heavy menses &dysmenorrhoea. What is the treatment of choice?

a. Mefenemic acid (x)

b. Tranexamic acid

c. COCP

d. Norethisterone only

e. Estrogen only

67. A 30 year old lady had a Pap smear. Results showed atypical cells of undetermined significance (ASCUS). Her previous last 2 Pap
smears were normal. What should you do?
a. Repeat pap smear in 6 months
b. Repeat pap smear in 9 months
c. Repeat pap smear in 12 months (x)
d. Repeat pap smear in 2 years
e. Refer for colposcopy

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 f. Refer for cone biopsy

68. A primigravida at 28 weeks had an MGTT done and result are as follows:
FBS: <5.6mmol/L
2HPP: 9.6mmol/L
What will you do?
a. Blood sugar profile (x)
b. Start insulin
c. Do HbA1c
d. Diet control
e. Rpt MGTT

69. A 35 year old woman has a strong family history of breast cancer. She is worried that she may have breast cancer, and wants to
have screening. What is the most appropriate screening tool for her?
a. Mammogram
b. Ultrasound(x)
c. Mammogram and ultrasound
d. Breast MRI

70. A 30 year oldlady has just gotten married. She wantsa foolproof method of contraception as she does not want to get pregnant, and
wants a method which is not troublesome, as she works full time.She insists on having an IUCD inserted. What contraception would
you give her?
a. Copper IUCD
b. OCP
c. None above is suitable for her (x)
d. Condom

71. A 29 year old unmarried lady complains of hirsutismand amenorrhea for 7 months. She has a BMI of 34. What is the most likely
diagnosis?
A Pregnancy
B PCOS (x)

Ophthalmology
72. A boy presents with pain, redness and watering of the eye x 2/7. No blurring of vision. This is the picture of the eye:

a. Scleritis
b. Episcleritis (x)
c. Pterygium
d. Keratitis

73. A construction worker complains of right eye pain after cement splashed into his eyes while working. What is the next course of
action?
a. Refer ophthalmologist for treatment
b. Irrigate eye with copious water stat and refer ophthal stat (x)
c. Irrigate eye with copious water stat and TCA in a few days
d. Apply anaestheticeyedrops
e. Irrigate copiously and try to get cement out of fornices

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74. A young man presents with a 2 day history of redness of the eyes and watery discharge. This is the picture of his eyelid upon
eversion. What is your diagnosis?

a. Vernal conjunctivitis (x)

b. Viral conjunctivitis
c. Keratoconjuctivitis
d. Bacterial conjunctivitis

75. A 78 yearold ?diabeticwoman was noted to have microaneurysms in her fundus. What should you do?
a. Repeat fundus examination in 6/12
b. Repeat fundus examination in 9/12 (x)
c. Repeat fundus examination in a year
d. Refer eye immediately
e. Refer eye as outpatient

Psychiatry
76. Which of the following statements is correct about medically unexplained symptoms?
a. Depression is not common
b. 20 % of patients that come for consultation have this condition (x)
c. Somatization disorder needs to be considered if symptoms persist for> 1 month

77. Somatization disorder:

a. Is the same as conversion disorder
b. Is the same as chronic fatigue syndrome
c. Requires multiple somatic complaints for at least 1 year ??
d. 20% of patients seeing GPs have somatization disorder (x)

78. When a patient is started on atypical antipsychotic, what should you monitor?
a. Do LFT every 6/12
b. Do FLP every 2 years (x)
c. Do FBS every 2 years
d. Monitor level of the drug given

79. The main difference between delirium and dementiais:

a. Clouding of consciousness (x)
b. Thought disorder
c. Impaired memory
d. Hallucinations
e. ?Psychosis/aggression
f. ?Anxiety

80. A 23-year-old man is charged with assault with a weapon and resisting arrest. He claims to have total amnesia. His memories are
vague, patchy and often not in accordance with the overall picture/goes against the physical evidence. The most likely diagnosis is:
a. Malingering
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 b. Brief psychosis
c. Dysthymic disorder
d. Alcohol/drug intoxication (x)
e. Conversion reaction.

81. A young man withsymptoms of depression has suicidal thoughts. What should you do?
a. Admit to hospital (x)
b. Start antidepressants
c. Counsel not to have such thoughts
d. Start treatment and review the next day

Palliative care

82. An elderly man who is terminally ill is noted to have dyspnoea. What treatment you can offer to relieved his symptoms?

a. High flow oxygen with mask

b. Low-dose S/C morphine (x)

c. Frusemide

d. Suction

e. Benzodiazepine

Geriatrics

83. You are called to attend to an 80+ year old man post CVA who has pulled out his Ryle's tube. On assessment, patient is alert,
coherent and understands what is going on around him. He refuses to have the Ryle's tube inserted. What should you do?
a. Re-insert the Ryle's tube and restrain the patient
b. Re-insert the Ryle's tube but do not restrain the patient
c. Restart feeding orally
d. Refer for gastrostomy
e. Send for swallowing assessment (x)

84. A 78 year old woman complained of incontinence when she coughs or laughs.She is a known hypertensive on diuretics. Her HbA1c is
7.1%, BP 122/88mmHg. BMI 34. What would youadvise her?
a. Increase her OHA
b. Increase her antiHTN
c. Teach her pelvic floor exercises
d. Ask her to reduce weight
e. Stop diuretics and change to another antihypertensive (x)

Occupational Med
85. A factory manager noted that the factory's facilities are deteriorating and that workers do not get decent working conditions. His
workers are unhappy and many of them complain of headache and are taking sick leave. What should be done to improve the
working environment?
a. Hire a counselor to counsel the workers on productivity
b. Have incentive bonuses for high performers
c. Send workers for a course to teach them how to improve their working skills
d. Hire a consultant to upgrade the facility
e. Comply with minimum standards set by the government (x)

Prepared by:

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~ Harnie~ Juhaida ~ Lavanya ~ Rafidah ~ Sri Dewi ~
~ SzeLeng~Usha ~ Wong Sher Yee~
~ Samantha ~

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