Diplomat Board of Family Medicine Exam 2023

A 6-month-old infant is brought in by his parents due to a rash on his cheeks, behind the ears, front of elbows and back of knee for the last three months of age. The rash is red, dry, and itchy. On examination, you notice erythematous papules and excoriations. The parents report that the infant's older sibling had a similar rash when they were at same age. What is the most likely diagnosis?

A 19-year-old patient presents with moderate-severe acne on the face and chest. Over-the-counter treatments have been ineffective. The patient is concerned about potential scarring. Which of the following is the most appropriate initial treatment?

A 38-year-old patient presents with an intensely pruritic rash on the wrists, waistband, and between the fingers. The patient recently returned from a camping trip. On examination, you notice linear, erythematous burrows and small vesicles. What is the most likely diagnosis?

A 50-year-old patient presents with a painless, slowly enlarging nodule on the right cheek. The lesion has been present for several months and has recently started to bleed occasionally. On examination, there is a well-defined, firm, dome-shaped, pearly nodule with telangiectasias and central ulceration. What is the most likely diagnosis?

A 5-year-old child presents with fever, cough, and maculopapular rash on the torso for 2 days. He is otherwise active and playful. On examination posterior and occipital cervical lymph nodes are palpable. What is the most appropriate management of this child?

A 20-year-old male genitor presents with a red, itchy rash in the groin for the last 4 weeks. He wears water proof uniform at work. On Examination, there is redness, shining skin, red margins and satellite lesions out side the margins of lesions. What is the most appropriate treatment for this condition?

An 8-year-old girl has been brought by mother because of itchy in scalp and scratching for the last 2 months. She has used many anti lice shampoos and lotions multiple times but without any rid from lice. What is the most suitable next step in management in this case?

A 7-year-old child presents with a pruritic rash on the arms and legs. The rash consists of round, erythematous, scaly patches with well-defined borders. The patient's mother reports that the child is otherwise healthy. What is the most likely diagnosis?

A 65-year-old, male, smoker for 30 years presents with a well-defined pruritic rash on the extensor surfaces of arms and legs. The rash responds to the over-the-counter corticosteroid creams. What is the most common complication of this condition over the years?

A 45-year-old patient presents with a raised, pigmented lesion on the upper back. The patient reports that the lesion has been slowly enlarging over the past few years. On examination, there is an irregularly bordered, asymmetric, pigmented lesion with variegated colors. What is the most appropriate next step?

A-39-year old female patient presents with snoring during sleep, day time somnolence, lethargy, lack of concentration. Her husband reports that she wakes up multiple times during sleep and sometimes falls asleep in bathroom. Her BP is 140/90 mmHg, weight is 104 KG. Rest of examination is unremarkable. What is the appropriate diagnostic test for this condition?

A 40-year-old woman presents with heartburn, regurgitation, indigestion for the last 3 months. Her symptoms are partially relieved with lifestyle modifications. What is the first-line pharmacological treatment in this patient?

A 60-year-old patient with a history of hypertension presents to your clinic with persistent elevated blood pressure despite lifestyle modifications. She is taking Allopurinol for her gout. What is the recommended first-line antihypertensive medication for this patient?

A 60-year-old obese patient with type 2 diabetes presents to your clinic with his labs showing his HbA1c 7.6 %. He is taking Metformin 2g daily along with lifestyle modifications. His BMI is 35 kg/m2. What is the recommended second-line add-on therapy for this patient according to NICE guidelines?

A 35-year-old female presents with recurrent acute episodes of headaches for the last 15 years. The headache lasts for 1-5 hours and recur thrice a week. During the episode of headache she feels nausea and irritability and is unable to carry her daily household activities. She gets relief after using Paracetamol and resting in a quiet and dark room. She has no comorbid conditions. What is the most appropriate prophylactic drug in this patient according to NICE guidelines?

A 55-year-old patient with newly diagnosed type 2 diabetes presents with an HbA1c level of 8.5%. He walks 45 minutes a day, follows strict dietary recommendations and has reduced 3 Kg weight in the last 3 months. What is the recommended initial pharmacological treatment for this patient?

A 65-year-old laborer with a history of hypertension presents with symptoms of progressive breathlessness and ankle swelling. On examination fine crackles are heard bilaterally on his back of chest. His blood pressure is 146/80 mmHg. His echocardiography shows with ejection fraction of 35%. He is taking tablet Furosemide 40 mg daily. What is the first-line treatment for heart failure in this patient?

A 30-year-old female banker presents with recurrent episodes of abdominal pain, bloating, and diarrhea for last 6 months. The pain is often relieved after bowel movements. She denies weight loss, fever, bleeding per rectum or palpitations. She has no known comorbid conditions. What is the most likely diagnosis in this condition?

A 55-year-old male smoker for the past 30 years presents with a persistent cough for two years and hemoptysis for one week. He also reports loss of weight and appetite for the last 2 months. What is the single most appropriate diagnosis in this case?

A 55-year-old female presents with persistent fatigue, unintentional weight loss, and night sweats. Physical examination reveals bilaterally enlarged cervical and axillary lymph nodes. The tip of the spleen is also palpable. What is the most appropriate diagnosis in this case?

A 35-year-old male presents with chronic joint pain, early morning stiffness, and swelling of the metacarpophalangeal joints since last 2 months. The pain gets better with daily activities. What is the most specific confirmatory test for this condition?

A 65-year-old male patient presents with progressive difficulty in swallowing solid foods since last 4 months. He has lost 3 Kg weight in the last 4 months. He denies heartburn or chest pain. What is the most definitive diagnostic test for evaluating this patient's symptoms?

A 30-year-old female presents with a gradual onset of fever, headache, nausea, vomiting, and photophobia since last one day. On physical examination, she has fever and neck stiffness. What is the most appropriate initial treatment?

A 50-year-old male presents with gradually worsening shortness of breath, chronic cough, and chest pain, weight loss and haemoptysis. He has a history of tobacco use. On physical examination, there are decreased breath sounds and dullness to percussion on the left side of the chest. What is the most appropriate diagnostic test for evaluating this patient's symptoms and assessing the possibility of pleural effusion or pleural malignancy?

A 40-year-old female presents with recurrent episodes of abdominal pain, bloating, and diarrhea for last 6 months. She also reports 5 Kg weight loss, 101o fever, bleeding per rectum and lower abdominal cramps. She has no other comorbid conditions. What is the most likely diagnosis in this condition?

A-42-year-old woman presents to GP clinic with 4 months history of lump in right breast. Lump is present in upper outer quadrant of right breast, hard in consistency, irregular margins and immobile. What is the most appropriate diagnosis?

A 36 years old female from far off village presents with swelling of left calf for last two days. On examination left calf is swollen, tender and red. Passive dorsiflexion of left foot causes pain in left calf. Rest of physical examination is unremarkable. What is the single most appropriate initial test?

A-64-year old man is referred to oncology clinic with increasing low back pain over the last 3 months. He also reports an 8-month history of weight loss. MRI lumbar spine confirms the suspicion of bone metastasis. What is the most likely primary tumour causing this back pain?

A 60-year-old male presents with pallor, shortness of breath, sore mouth and numbness of feet. He has undergone surgery of his stomach a few years back. Which one is the most appropriate drug for him?

A 30-year-old female presents with angular cheilitis, glossitis and dysphagia. Her nails are brittle and spoon shaped. Which is the most specific test to confirm the cause of anemia?

A 47-year-old female presented to your clinic with pain in right elbow since 3 days. She has spent the weekend painting her house. Examination reveals tenderness at radial side of elbow and pain on wrist extension against resistance. What is most likely diagnosis?

A 50-year-old man comes to you with sudden onset of swelling of right big toe since last one day. This is the first time he has had such pain. He has hypertension which is well controlled on Valsartan plus Hydrochlorothiazide tablet. On examination base of right big toe is red, swollen, tender and warm. What is the next most appropriate initial treatment at this stage of disease?

A 78-year-old male with prostate cancer presents to with lower back pain associated with shooting pains down the both legs to the knee. There is reduced sensation in the medial side of both thighs and perineum. He has not passed urine for past 12 hours. What is the most appropriate step in management?

A 24-year-old man presents to you clinic with back pain and stiffness since last one year. Stiffness is worse in the morning and after rest. He generally remains fine during rest of the day time. His X-ray of lumbo-sacral spine shows mild sclerosis of sacro-iliac joints bilaterally. Which of the following medications is the first line treatment for this condition in primary care?

A 50-year-old diabetic patient reports to your clinic with pain in right shoulder and stiffness for 1 month. Pain is worse at night affecting sleep. There is no history of trauma. Examination reveals limited active and passive movement particularly external rotation and abduction. What is most likely diagnosis?

A 68-year-old female presents to your clinic with pain in her hips for last 3 months. She had fracture of wrist due to minor trauma 2 years back. Her BMI is 16kg/m2. Her back looks stooped. She has been started on calcium 1200 mg and Vitamin D 600 IU on daily basis by her daughter. What is the most specific first line treatment for this condition?

A 50-year-old woman complains of widespread muscle pain all over body for last 10 months. She experiences fatigue, irritability in mood and difficulty in sleeping. Her neck, shoulders, elbows, back, hips have painful tender points to touch. What is the most likely diagnosis?

A 78-year-old man presents with severe throbbing headache on right side for 6 days with no trigger. She also reports malaise, pain in shoulders, and pain in jaw during chewing. Neurological examination is unremarkable. There is tenderness on right side of head. What is most appropriate first line treatment for this condition?

A 50 years old female comes with the reports showing Rheumatoid arthritis and you plan to start disease modifying drugs like methotrexate. What test will you perform before starting Methotrexate in this patient?

A 45-year-old woman presents with generalised body aches disturbed sleep and tingling in her hands. On examination she has multiple tender points on both sides of shoulder, back, neck, elbows and hips. What would be the most appropriate initial treatment in this patient?

A 52-year-old man had an acute myocardial infarction 2 months ago. He had good recovery after discharge. He moved from one city to the other and lot his prescription. He has come to you for his prescription. What will be the correct dose of Atorvastatin for him?

A 55 years old man present with central chest heaviness with sweating and shortness of breath on climbing 2 flight of stairs half an hour ago. It lasted for 5 minutes and settled on sitting. This has happened for the first time in his life. Since then he has not climbed stairs. What is the most appropriate diagnosis of this condition?

A 65-year-old female present to your clinic with mild palpitation. She denies chest pain, shortness of breath or dizziness. Her daily activities are not affected. She has no comorbids. Her physical examination is unremarkable except irregular pulse. Her ECG shows: What is the single most important step in preventing complications of this condition?

A 30-year-old male presents to your clinic for general health checkup. He is more concerned about heart disease because he has strong family history of IHD i.e., grandfather, father and paternal uncle all had IHD before the age of 50 years. He is otherwise functional class 1 and any known comorbids. Which screening test is recommended at this stage?

A 50-year-old hypertensive patient comes to you on a follow-up visit. You had prescribed Enalapril 10 mg for him one month ago. He complains of a persistent dry cough since the start of the medication. His blood pressure is now within normal limits. What is the most appropriate next step in treatment?

A 59-year-old male hypertensive patient comes for review. He takes 10mg of Enalapril once a day and Amlodipine 10mg once daily. His blood pressure remains uncontrolled, and you want to add a third agent. His Physical examination is unremarkable. His blood pressure today is 152/94 mmHg. Which drug should be added to the current regimen to control hypertension?

A 46-year-old man who is a known case of Metabolic Syndrome comes to your clinic for initiating treatment for his deranged blood reports. His blood pressure is 145/92 mmHg, Cholesterol 220 mg/dl, Triglycerides 310 mg/dl, ALT 23 IU/L and Fasting Blood sugar is 128 mg/dl. Apart from lifestyle changes, which of the following regime is the most suitable for the management of his condition? He has no drug allergies. What is the most appropriate lipid lowering drug for him?

A 70-year-old man known case of hypertension and diabetes presents with painful cramp in calf of both legs on walking which is relieved by rest. On examination legs are cold and skin shows with atrophic changes. The pulses of both feet are weak. What is most probable diagnosis?

A 70 years old lady presents with shoulder and hip muscle pains and stiffness for 3 months. Her symptoms are worst in the mornings and she has difficulty in getting out of bed. She reports mild fever, malaise and disturbed mood. She denies any headaches. Examination is unremarkable. What is the most likely diagnosis?

A 76 years old bed bound lady has been brought by family with complains of fever and bed wetting for the last 3 days. She is afebrile in your clinic. Her BP is 120/80 mm Hg on Tab Amlodipine 5 mg daily. What is the single most appropriate test at this stage?

A 55 year old goldsmith presents with tremor of both hands since last 5 years. His tremor gets worse at work and slows down his speed of work. His symptoms are better at rest. His father also suffered from same problem. His neurological examination is normal. There is no other significant medical, surgical or drug history? What is the most appropriate drug for this condition?

A 77 year old lady presents with complains of pain in her lower back since last one year. She is regularly taking Tab Calcium 1000 mg with vitamin D 400 IU daily since last one year. Her spinal x-ray is as follows: What is next most appropriate next step in management?

A 64 years old diabetic lady presents with burning feet for the last 6 months. Her symptoms are causing her severe distress and depression. Lately she also has been sleeping poorly and crying. Her diabetes management is currently optimal and all other investigations are also normal. Which one of the followings is the best treatment option?

A 28-year-old man, non-smoker presents with a dry cough, mild fever, abdominal pain, diarrhea for the last 3 days. His temperature is 1010 F and there are bilateral crepts in all lung fields. His oxygen saturation is 98%. What is the most likely diagnosis?

A 30-year-old woman with a history of asthma presents with a persistent night time cough and exertional wheeze for the last one month. She has been having such episodes since last 15 years. She is currently taking Salbutamol inhaler 100 mcg as needed, Beclomethasone inhaler 800mcg twice a day. What would be the most appropriate drug to be added in the management of this patient?

A 27-year-old painter presents complaining of episodic shortness of breath, cough and wheezing which are worse when he is at work. He feels better at home. His examination in your clinic is normal. What is the most likely diagnosis?

A 59-year-old man presented with productive cough & progressive shortness of breath for the last 3 months. He has been a smoker for last 35 years and smokes upto 2 packs a day. He has been taking different herbal medications for relief. What is the most appropriate step to confirm diagnosis in this case?

A 54-year-old obese woman presents with shortness of breath. She smokes 20 cigarettes per day. Chest examination reveals wheezing, decreased breath sounds, basal crepts and prolonged expiration. Spirometry shows an obstructive pattern with no reversibility to bronchodilators. What is the most likely diagnosis in this patient?

A 65-year-old male smoker who is known case of COPD presents with recurrent cough with excessive sputum and shortness of breath since last one month. His symptoms are worse on exertion. He denies chest pain and fever. Previously his symptoms are well controlled on an optimal dose of Salmeterol. What is the most appropriate drug to be added to his prescription?

A 45-year-old chronic smoker with COPD presents to your clinic for a routine checkup. His symptoms are normally well controlled on Salmeterol 25mcg twice daily and Salbutamol as required. Which one of the following vaccine is recommended in this condition?

A 53-year-old COPD patient presents with 3 day history of fever, cough, greenish sputum and shortness of breath. He is on maximum recommended doses of Salmeterol & fluticasone. What is the next step in his management according to WHO guidelines?

A 58-year-old man farmer presents with gradually increasing shortness of breath & dry cough over the last 1 year. He denies history of smoking, fever, hemoptysis, weight loss. He is vitally stable. There are fine inspiratory crackles on auscultation at lower and middle lung fields bilaterally. Chest X-ray shows fine honeycombing. Spirometry shows FVC reduced and FEV1/FVC ratio > 80%. What would be the most likely diagnosis in this patient?

A 25-year-old man presents with productive cough, fever & right sided chest pain for the last 5 days. His Temperature is 102° F, Pulse 100 bpm, B.P is 100/70 mmHg, RR 30/min. X-ray chest shows Right lobar consolidation. What would be the most appropriate treatment according to WHO guidelines?

You review a 57-year-old man who has recently been discharged following an ST- elevation myocardial infarction (STEMI) for which he was treated with a percutaneous coronary intervention (PCI). He wants to know when he can resume sexual activity. When can this patient resume sexual activity after MI?

A 46-year-old man who is a known case of Metabolic Syndrome comes to your clinic for initiating treatment for his deranged blood reports. His blood pressure is 145/92 mmHg, Cholesterol 220 mg/dl, Triglycerides 310 mg/dl, ALT 23 IU/L and Fasting Blood sugar is 128 mg/dl. He has no drug allergies. What is the most appropriate lipid lowering drug for him?

A 6-year-old boy attends your clinic with complains of pain and blurred vision in the left eye. He was playing football and was hit in the effected eye with a football two hours ago. His left eye shows small amount of blood in a crescent shape along the inferior aspect of his cornea. What is the most appropriate next step in his management?

A 75-year-old man presented with a watering and sore eye for the last one year. There is no change in his vision. What is the single most appropriate diagnosis?

A 22-year-old woman presents with a history of a painful red left eye with photophobia for the last 2 days. Fluorescein staining demonstrates a small, feathery area of abnormal uptake. What is the most appropriate management step?

A 26-year-old lady presents with a swelling and watering of right eye. She does not complain of any pain and tells you her vision is normal. What is the most likely diagnosis?

A 4-year-old girl is brought to the clinic due to poor control of asthma. She currently using Beclomethasone inhaler 600 mcg daily and a salbutamol inhaler as per need. She still has symptoms at night and day time. What is the next step in management?

An 8-year-old known asthmatic boy presents to your clinic. His current treatment is a salbutamol inhaler as per need and Beclomethasone inhaler 400 mcg BD. He very often requires salbutamol for day and night time symptoms. What is the most appropriate next step in management?

A 6-year-old girl is brought to the clinic by her mother. The mother complains that the child has not achieved night time dryness and passes urine at night. The child has never been dry. She denies fever and incontinence. What is the most appropriate initial step in management?

A 15-month-old child is due for his MMR vaccine. He is febrile due to acute otitis media. His temperature is 103o F. What is the single most appropriate action?

A distressed mother comes to your clinic with her 8-week-old daughter who has been crying for past 2 weeks. The baby cries for 3 or 4 hours continuously, mainly in the afternoons, clenching her fists and pulling her legs toward the abdomen. Mother denies diarrhoea and fever. Baby is breastfed and her weight is 4.5Kg and has no skin rash. What is the single most appropriate diagnosis?

A one year old child presented with complains of passage red currant jelly stool and vomiting. Mother also report episodes of pain during which the child screams, draws up his legs and becomes pale. Episodes have become more frequent with time. You feel a sausage-shaped mass in the right lower quadrant of the abdomen. What is the most likely diagnosis?

An 8-year-old girl has been bed wetting since last two weeks. She became dry at age of 5 years. Mother report she is unwell with lower abdomen pain after passing urine. What will be first investigation for this child?

A 3-year-old child has a history of diarrhoea for the last three years when weaning was started. The mother describes the stool as bulky, frothy, and difficult to flush. She also looks wasted with protuberant tummy. She has been given multiple antibiotics courses without improvement. Her weight is 10 Kg. What is the single most specific investigation to diagnosis this condition?

A 6-week-old child is brought to the clinic due to severe diarrhea for the past 5 days. On examination, he is very sick-looking and shows signs of severe dehydration. His labs reveal Na+=124, K+=2.8. Which fluid would you choose to resuscitate?

A 10-year-old girl comes to your office after her father noticed that her “skin turned yellow.” She reported weakness, loss of appetite, nausea, and abdominal pain for few days. On examination, her skin tone, conjunctivae, and mucous membranes are yellow-tinged. Her LFTs are Total bilirubin 5.6 mg/dl Conjugated bilirubin 2.4 mg/dl Unconjugated bilirubin 3.2 mg/dl ALT 1900 mg/dl ALP 600 mg/dl What is the single most likely diagnosis?

A 10-year-old boy is brought to your clinic patient comes to your clinic with the following lab report. He denies any symptoms HBsAg: Negative HBsAb: Positive IgM anti-HBc: Negative IgG anti-HBc: Negative Which of the following terms best describes his disease status?

A patient comes to your clinic with the following lab report. HBsAg: Positive HBsAb: Negative IgM anti-HBc: Positive IgG anti-HBc: Negative ALT: 35 mg/dl Which of the following terms best describes his disease status?

A 1-year-old girl is brought to the clinic by her mother. She has a diaper rash that began 2 days ago after the mother started using a new brand of diapers. You notice rash spares the creases. What will be initial treatment for this child?

A 12-year-old boy is brought to you with a history of hyper active behaviour and poor attention. He also interrupts others at school. You noticed he is shouts and easily distracted. Which of the following is the most likely diagnosis?

An 11-month-old infant has body weight below 5th centile on growth chart. Upon You notice baby is alert but irritable and has no oedema. Rest of examination is normal. Which of the following is the most likely diagnosis?

A 25-year-old man has left scrotal swelling for the last five years. The swelling appears on coughing, sneezing or lifting weights and disappears on lying supine. The swelling is oval, soft, smooth, and one cannot reach above the swelling. Both testes can be palpated separately. What is the most likely diagnosis?

A 17-year-old boy presents to your clinic with severe abdominal pain associated with nausea, which started two hours ago while he was playing football. He did not experience any trauma to the abdomen. On examination, abdomen is soft and non-tender. There is scrotal tenderness, erythema and edema. What is the most likely diagnosis?

A 17-year-old boy presents to your clinic with severe abdominal pain associated with nausea, which started two hours ago while he was playing cricket. He did not experience any trauma to the abdomen. On examination, abdomen is soft and non-tender. There is scrotal erythema and edema. The right hemi-scrotum is tender to palpation. What is the next best step in management of this patient?

A 55-year-old man presents to the clinic for a routine visit. His father died of colon cancer at the age of 60. What is the single most appropriate definitive screening test for him?

A 30-year-old man comes to the clinic after experiencing intermittent episodes of bright red blood in his stool over the past 2 months. He does not have anal or abdominal pain, nausea, and vomiting or weight loss. The patient has not noticed any recent changes in his bowel movements. On physical examination, the perianal skin shows no abnormalities. No mass is palpable on digital rectal examination and there is no tenderness. Proctoscopy reveals purplish mucosal bulges. What is the most likely diagnosis?

A 38-year-old woman comes to the clinic complaining of worsening anal pain for the past 2 days. Initially, the pain was only during defecation, but now the pain is constant and severe. She also has anal pruritus. The patient says she has had constipation from the past 10 years and frequently requires laxatives. On physical examination, her temperature is 39o C. On anal examination, there is an erythematous and tender 3-cm fluctuant mass near the anal orifice with induration of the overlaying skin. What is the single most likely diagnosis?

A 40-year-old man presents with progressive anal pain over the past two months. He also complains of drops of bright red blood occasionally dripping in the toilet after passing stool. On anal examination, an ulcerated lesion is seen protruding from the anal verge. He smokes 20 cigarettes per day. DRE shows irregular hard anal canal. What is the most likely diagnosis?

A 30-year-old female presents to the clinic with central abdominal pain which spread to right lower quadrant that started 8 hours ago. The pain is sharp and continuous. She did not have breakfast, has vomited once and has a mild fever. She is not sexually active. LMP was two weeks ago. O/E she has right-sided tenderness. What is the single most likely diagnosis?

A 42-year-old female presents to the clinic with pain in her right upper quadrant from the past two hours. She has also vomited twice. On examination, the patient holds her breath during inspiration while the examiner is palpating her right upper quadrant. What is the most likely diagnosis?

A 42-year-old male presents to the clinic with severe pain in the mid-epigastrium that radiates to the back. The pain is sharp and is relieved by bending forward. He has nausea and has vomited once. He admits to drinking regularly. There is epigastric tenderness on palpation of the abdomen but no rigidity. What is the most likely diagnosis?

A 34-year-old woman, para 1 and abortion 1, comes to the office for preconception counselling. The patient has no other chronic medical conditions. On examination, BP is 110/70 mmHg, BMI is 22 kg/m2. What is the most appropriate medicine for this patient at this stage?

A 33-year-old woman presented for the removal of her copper intrauterine device (IUCD). She is currently on day 4 of her regular 28-day menstrual cycle. After the IUCD removal, she start the combined oral contraceptive pill (COCP) on the same day. What is the most appropriate step regarding use of barrier methods in this case?

A 25-year-old woman presents to her GP with irregular periods. The patient describes infrequent menstrual cycle since menarche at age 13, with menstrual periods occurring approximately once every 8 weeks. The patient is undergoing laser treatment for excessive hair growth on her upper lip and chin. On examination, the patient has facial acne. The patient is booked for a blood test. What endocrine markers are most likely diagnosis?

A 27-year-old woman present to a GP clinic at 8 weeks of gestational amenorrhea. This is her second pregnancy. Her first child’s birthweight was recorded at 3.6 kg. She has no comorbids and no family history of diabetes. Her BMI is 31 kg/m². According to current NICE guidelines, which of the following investigations is most suitable to request between 24-28 weeks gestation?

A 26-year-old primigravida presented at gestational amenorrhea of 30 weeks, complaining of persistent itching. On examination, she looks jaundiced and there excoriation on the hands and body. No rash is visible. Which of the following is the most appropriate initial test regarding her itching?

A 37-year-old lady presents to you with a positive urine pregnancy test. She is taking Metformin, Amlodipine, Aspirin, Enalapril and Sertraline for her health issues. Her examination and recent routine blood test are within normal limits. Which of the following medicine you would like to stop?

A 32-year-old third gravida presented at 28 weeks of gestational amenorrhea. She has strong family history of Diabetes mellitus. Her fasting glucose was 136mg/dl with 2-hour glucose of 192mg/dl on OGTT. What is the most appropriate management option for this patient?

A 27-year-old lady comes to visit your clinic after one week of spontaneous vaginal delivery of her second child. During her pregnancy, she had developed gestational diabetes and discontinued insulin and metformin just after delivery. She denies any symptoms. What is the most appropriate time to exclude type 2 diabetes mellitus by checking blood sugar level?

A 27-year-old woman presents to the clinic complaining of vulvar pain since the past one week. She is married but reports occasional extramarital sexual contacts. On examination, there are vesicles with erythematous bases seen on her vulva. What is the most likely diagnosis?

A 19-year-old primigravida presents to your clinic. She is 10 weeks pregnant. She has no active complaints. She brings a CBC report with her from one week back which states that her Hb is 9.5 g/dl. What is the single most appropriate step in management?

A 16-year-old girl comes to the clinic because her periods have not yet started. The patient has never been sexually active. She has no headaches, visual changes, abdominal pain, or behavior changes. Physical examination shows normal breast development and normal external female genitalia. Her LH and FSH are within normal range. Which of the following is the next best step?

A 60-year-old woman presents to the clinic with an episode of vaginal bleeding. She has not had a menstrual period since the age of 52. She has a BMI of 22 and has no significant past medical or family history. What is the next best step?

A 21-year-old woman comes to the office due to pelvic pain lasting 1-2 days every other month. The pain is unilateral, tolerable and occurs mid-cycle. Her menstrual cycles are regular, last 28 days, and have normal flow. Physical examination is normal. What is the best next step?

A 27-year-old female presents to your clinic with fever, malaise and purulent vaginal discharge since the past 3 days. On further history-taking, she says that she had an IUD inserted 3 weeks ago. What is the most likely diagnosis?

A 27-year-old woman comes to the clinic. She has had foul-smelling vaginal discharge since the past 5 months. Her last menstrual period was 20 days ago. She has monogamous relationship with her husband. On physical examination, there is no vulvar or vaginal erythema. There is an off-white discharge with a fishy smell throughout the vaginal vault with no discharge from the cervical os. What is the single most appropriate treatment?

A 68 year old man is brought in by his wife. She reports that her husband’s mobility is affected. He is having difficulty in carrying out his daily routine activities. He is having resting tremors. On examination he has monotonous speech, pill rolling tremor, bradykinesia and cog wheel rigidity. What is the most likely diagnosis?

A 42 year old male presents with a sudden headache while watching TV. Pain is associated with nausea and vomiting and the patient says that it is the worst headache of his life.He is a chain smoker and had a sedentary life style. He on and off takes Lisinopril 5mg for his blood pressure and his father died of a myocardial infarction at the age of 55 years On examination pulse is 90 beats per minute and BP is 140/100 and with no focal neurological deficit. What is the most likely diagnosis?

A 53 year old male tailor presents with intermittent vertigo, numbness in both arms and hands for the last 2 months .His symptoms are worse after long working hours and he feels much better on his days off. Recently he has also developed some pain at the back of neck. His blood pressure is 140/90 mmHg and rest of the examination is normal. What is the most likely diagnosis?

A 21 year old female student presents with a throbbing headache around right eye and forehead. Pain usually comes once or twice a week for last 3 months. It is so severe that she takes a day off from her university and stays in a dark room. She has tried taking paracetamol 1000 mg but it doesn’t help. Her blood pressure is 130/85mmHg. There are no abnormal findings on examination. What is the most likely diagnosis?

A 62 year old man presents after a single episode of seizure. The seizure started at rest, his whole body went stiff and then starting jerking violently movements which last for 4 minutes and followed by loss of consciousness. He has never had a seizure before. There is no significant past medical history and the physical examination is also normal. What is the most appropriate next step in management?

A 78 year old man presents with a history of loss of vision in the right eye lasting 20 minutes. He previously had an episode of slurring of speech lasting for 2 hours. He is hypertensive and diabetic and takes amlodipine 5 mg OD and metformin 500 mg twice daily. Currently physical examination is unremarkable. What is the single most appropriate diagnostic test?

A 28 year old man with tuberculosis is taking anti tuberculosis therapy for the last 2 months. Recently he has developed some tingling sensation in his hands and feet. His sputum test is negative for tuberculosis. What medication would you like to prescribe him?

A 46 years old businessman has been having unilateral headache lasting for 30 minutes for the last 3 days. The pain is excruciating and throbbing in nature. Pain is associated with watery eyes and his nose feels congested. He had similar episodes of headache last year. While sitting in your clinic he starts to have another episode of unbearable headache. What is the most appropriate first line acute management of his headache?

A 60-year-old woman comes to you with pain on the right side of her head & face. She describes it as a sharp burning & electric shock like pain which lasts only for a few minutes mostly during laughing or eating. What would be the drug of choice for the treatment of this patient?

A 31-year-old man presents with episodic left sided headache with nausea & sometimes vomiting for the last 10 years. He has no other medical conditions or addictions. Last episode of the same nature was two hours ago. He has taken Paracetamol tablets already, but he is still in pain & wants a prompt relief. His physical examination is unremarkable. What would be the most appropriate pain controlling drug at this stage?

A 28-year-old uncircumcised male presents to your clinic with painful swelling of glans penis for three hours when he was engaged in homosexual activity. On examination the foreskin is retreated behind the glans and glans penis in swollen and tender. What is the most likely diagnosis?

A 24-year-old newly married man presents with ejaculation right at the start of sexual activity and is unable to satisfy his partner. He is very embarrassed because of this condition. What is the most appropriate drug for his condition?

A 22-year-old uncircumcised male presents with painful swelling of glans penis for three hours after masturbation. On examination the foreskin is adherent to glans and glans penis is tender and swollen. The foreskin cannot be retreated. What is the most likely diagnosis?

A 55-year-old man presents with erectile dysfunction since last one year. He is diabetic and hypertensive since last 10 years. Current BP is 130/90 mm Hg. What is the most appropriate initial treatment for his erectile dysfunction?

An 80-year-old patient of Benign Prostatic Hyperplasia on Doxazocin 4 mg daily comes presents with complains of hematuria. His post void residual urinary volume is 20 ml. What will be your next management plan?

24 year old pregnant presented came in contact with a child of chicken pox. She is not sure if she had the condition herself as child. What is the most appropriate action?

4 year old boy presents with 2 days history of high grade fever, cough, runny nose, watering eyes, maculo-papular rash on face which later on spread to entire body. There is no lymphadenopathy. What is the most common complication of this condition?

30 year old women presents with vaginal discharge with fishy smell. There is no associated itch or dyspareunia. She denies extra-mrital sexual contacts, fever or abdominal pain. Wet mount of vaginal fluid show epithelial cells covered by leuckocytes. Which one of the following organism is most likely cause?

34 year old man presented with dog bite on right hand. There is full thickness bite wounds on his hand. The dog is tied up at home and being observed. Which is most appropriate antibiotic therapy?

43 year old Asian presents with headache & neck stiffness. investigation Shows Serum Glucose 121 mg/dl CSF Glucose Normal CSF Protein Normal CSF WBC 75% Lymphocytes what is the most likely diagnosis?

23-year-old man presented dysuria & watery discharge from Uretheral meatus. He admits history of having a casual sexual contact with a commercial sex worker last week. What is most appropriate antibiotic combination for this patient?

A 43-year-old man is reviewed in clinic. He has recently started treatment for tuberculosis but is complaining of a deterioration in his vision. Which one of the following drugs is most likely to cause decreased visual acuity?

A 62-year-old patient with type 2 diabetes mellitus presents with a 'rash' on his left leg and is now a painful, hot, erythematous. He is systemically well. He is known case of penicillin allergy. What is the most appropriate antibiotic for his skin condition?

A 35-year-old male laborer in Middle East has come to you for advice after he has been deported on the basis of some blood tests done. He has not been given the reports and he is not aware of the tests. He feels well and can easily perform all his work. What would be the most appropriate screening test according to recent guidelines?

A 40-year-old man presents with 2 months history of fever, cough and weight loss. He had received complete course of ATT five years ago. Which one would be the right option for Anti-tuberculosis therapy in this patient?

A 26-year-old woman has been referred to you by a gynaecologist for the treatment of malaria. She is in her 3rd month of gestation & her blood film shows P. vivax. How would you manage her malaria?

A 27-year-old vitally stable pregnant woman comes to you for the treatment of malaria. She is in her 3rd month of gestation & her blood film shows P. Falciparum. How would you treat her malaria?

A 20-year-old boy comes to you with complains of fever, abdominal pain, diarrhoea, dry mouth & a skin rash for the last 1 week. What investigation you would choose to confirm the diagnosis of typhoid in this patient?

A35-year-old man comes to you with complains of fever, abdominal pain, diarrhoea, dry mouth & a skin rash for the last 1 week. His blood culture report shows S.typhi. What would be the most appropriate initial drug treatment for him?

A 35-year-old man comes to you with intermittent fever. He has taken Chloroquine for three days. His blood film shows Falciparum malaria. He is vitally stable. How would you treat this patient?

A 45-year-old marketing executive presented in your clinic with a preoccupied thought that he had colon cancer. He underwent repeated medical evaluations and workup which showed no evidence of illness. He frequently visits healthcare professionals to rule out colon cancer. What is the most likely diagnosis?

A 28-year-old software developer becomes extremely anxious in social situations, especially when speaking in public or interacting with strangers. She fears being scrutinized and avoids interacting with people. What is the most appropriate diagnosis?

A 20-year-old university student has been brought by his family to your clinic with complain of loss of consciousness. They deny injury, tongue bite and jerky movements. Her physical examination is un remarkable. She has been having these episodes since last 2 years and these symptoms got worsened before exams. What is the most like diagnosis?

A 30-year-old engineer experienced a traumatic event during a recent car accident. Since then, he has recurrent, distressing memories of the accident, nightmares, and avoids driving altogether. What is the most likely diagnosis?

A 27-year-old office worker intentionally exaggerates symptoms of illness to take extended sick leave from work. What is the appropriate management in this case?

A 28-year-old accountant, experiences intense fear and anxiety in social situations, especially when speaking in front of others. What is the most appropriate first line medication for his condition?

A 20-year-old university student has been brought by his family to your clinic with complain of loss of consciousness. They deny injury, tongue bite and jerky movements. Her physical examination is un remarkable. She has been having these episodes since last 2 years and these symptoms get worsened before exams. What is the most appropriate management in this case?

A 30-year-old graphic designer, has experienced episodes of intense sadness, followed by periods of high energy, insomnia, excessive talking and impulsivity. During her depressive episodes, she often feels hopeless and experiences sleep disturbances. What is the most likely diagnosis?

A 30-year-old graphic designer, has experienced episodes of intense sadness, followed by periods of high energy, insomnia, excessive talking and impulsivity. During her depressive episodes, she often feels hopeless and experiences sleep disturbances. What is the most appropriate initial management in this case?

A 14-year-old girl comes with her mother with complaint of passing more urine, & increased thirst. She eats well but is losing weight day by day. Her urine report shows ketone bodies. What is the most likely diagnosis?

A 42-year-old man brings his blood report showing fasting blood sugar 112mg/dl, 122 mg/dl and 116 mg/dl on three different occasions. He does not have any symptoms. What is the most appropriate diagnosis?

A 33-years old man comes to you for check-up. He was previously diagnosed with diabetes based on weight loss more than 15 kg in 3 months, polyuria, polydipsia & polyphagia. His Fasting blood sugar is 390 mg/dl & Random Blood sugar 480 mg/dl. What is the most likely diagnosis?

A 43-year-old male patient comes to you for review. He has been recently diagnosed with type 2 diabetes mellitus. He is on Metformin 500 mg twice a day and life style changes. What would be the target for HbA1c levels according to recent guidelines?

A 60-year-old man presents with frequent day time urination, headache & leg swelling. He is known type 2 diabetic first diagnosed about 15 years ago. His blood pressure is 168/100 mmHg with pulse of 84 beats/min. His BMI is 28 kg/m2. Rest of examination is unremarkable. His lab reports shows: 2+ protein on urinalysis, Blood urea nitrogen = 14 mg/dl Serum creatinine = 1.5 mg/dl Random blood glucose = 194 mg/dl What would be the most likely diagnosis in this case?

A 56-year-old diabetic man comes to you for review. He is on maximum dose of Metformin. You ordered an eGFR test to assess his renal function. Which eGFR level is suggestive for completely stopping metformin in this patient?

A 13-year old girl presented with gradual neck swelling for the last 3 weeks. She has no other complaints & apart from a painless, diffuse smoothly enlarged thyroid gland the rest of her physical examination is unremarkable. What is the most likely cause of goitre in this patient?

A 38-year-old woman comes to you with an enlarged thyroid nodule which is causing difficulty in swallowing & neck movements. She also complains of weight loss, tremors, insomnia & palpitations for the last 6 months. Her TSH is 0.02 mIU/L (0.4 --- 4.5 mu/L) and Free T4 35.7 pmol/l (9.0-----25 pmol/L) What would be the most appropriate step to evaluate thyroid nodule in this patient?

A 29-year-old female comes with complaints of low mood, lethargy, weight gain, constipation and irregular periods for the last 4 months. She is a house wife and her symptoms are affecting her ability to do daily household work. Physical examination shows an overweight lady with a BP of 135/98 mmHg, HR of 62/min and dry skin. Rest of the examination is unremarkable. What is the single most likely diagnosis?

A 57-year-old man presents with a 6-month history of lethargy, weakness, cold intolerance, constipation, and weight gain. On examination you noticed that her skin is dry with some hair loss from the scalp & she has a hoarse voice. What is the most appropriate initial investigation in this case?

A 55-year-old woman presents to the emergency department with a painful, deformed wrist after falling on an outstretched hand. She's unable to move her wrist properly. Based on the scenario and mechanism of injury, what is the likely diagnosis?

A 55-year-old woman presents to the emergency department with a painful, deformed wrist after falling on an outstretched hand. She's unable to move her wrist properly. What is the initial treatment approach for this condition in primary care set up?

A 40-year-old man, who is cook by profession, complains of pain on the outer edge of his elbow, which worsens with gripping and lifting objects. Based on the scenario and symptoms, what is the likely diagnosis?

A 2 months old child is brought to your clinic for general check-up. His examination is normal except a clicking sound in the hip joint during the Ortolani and Barlow tests. What is the most likely diagnosis?

A 40-year-old tennis payer presents with shoulder pain which occurs only in overhead movements and lifting objects. Rest of movements are normal. Based on the scenario and symptoms, what is the likely diagnosis?

A 28-year-old man presented with left knee pain which is more on the medial side during walking. The pain started right after he played a football match. On examination his joint line is warm & tender on the medial side. The pain is worse on twisting the knee. There is a clicking sound on flexion and extension of knee. What is the most likely diagnosis in this patient?

A 52-year-old man comes with complains of pain in both knees for the last 2 years. The pain is sometimes accompanied by noticeable swelling of knees. On examination you find out that there is crepitus & limitation of movement. What would be most likely diagnosis in this case?

A 47-year-old woman presents with pain in both knees for the last 2 years. Her x-ray findings are suggestive of osteoarthritis of knee. Which exercise will you recommend benefitting her knee arthritis? Which exercise will you recommend benefiting her knee arthritis?

A 50-year-old woman complains of pain in both knees & hip joints for the last 6 months. Her x-ray findings are suggestive of osteoarthritis of hips and knees. What would be the first line pain management option in this case?

A 42-year-old man comes to you with shoulder pain. There is no history of trauma. On examination you find out that he has limited active and passive movement of the right shoulder in all directions particularly external rotation is most affected. What is the most appropriate initial pharmacological management step in this case?

A 4-year-old boy was brought by her mother in clinic with foul smelling discharge from left nostril for 5 days. What is the most likely diagnosis?

A 32-year-old male, known asthmatic using Beclomethasone inhaler since 8 months. Presents complains of bad taste in mouth. In mouth there are slightly creamy white patches inside the mouth. What is the most likely Diagnosis?

A 30-year-old man presents with sore throat and fever for the last 5 days. Since last one day he reports worsening of fever, sore throat and he is unable to open his mouth or swallow. On examination his uvula is edematous and shifted to right side due to swelling of throat on left side. What is the most likely diagnosis of the current condition?

An 80-year-old male presented with complaint of difficulty in hearing particularly in noisy environment. He mentions that this issue has gradually worsened over the past few years and denies any tinnitus. There is no wax in both external auditory meatus. What is the most likely cause?

A 23-year-old male present in your clinic with sore throat, running nose, cough & fever for one day. On examination tonsil are slightly hyperemic with no exudates. Anterior cervical lymph nodes chains are palpable. Patient has to travel overseas in two days. What is the best treatment option?

A 68-year-old construction worker present with fullness of ears, mild hearing loss, vertigo and tinnitus since one day. He suffered for cough and cold three weeks ago. He denies any trauma. Vertigo is in all directions. What is correct treatment option for his vertigo?

A 2-year-old boy present with a fever of 102o F with severe pain in the left ear. On examination of his left ear there is redness and bulging of tympanic membrane with distorted light reflex. His father is a smoker. What is the first line treatment option for this child?

An 8-year-old boy presented with his mother with complain of snoring and mouth breathing from while asleep since 2 years. He has past history of recurrent ear problems. Mother report nasal tang in voice and is worried about his poor performance at school. What is definitive treatment for this child?

A 68-year-male singer presents with hoarseness of voice over 6 months. He has been chain smoker since 30 years and complains of decrease appetite and weight loss. His chest X-ray and TSH are normal. What is the single best treatment option for him?

A 25-year-old male presents with complains of vertigo on looking to the right side. He is distressed when he rises from bed or drives car. He denies hearing loss. What is the most appropriate treatment for this condition?

A 30-year-old male on his return from Thailand 5 days ago, presents with generalized abdominal cramps, high grade fever and bloody diarrhea since three days. There is mild tenderness all over abdomen but no guarding. BP is 120/80, pulse 102/min and temperature is 102o F. What will be most appropriate empirical first line antibiotic therapy?

A 50-year-old female presents with fever, diarrhea, abdominal pain, lethargy for 2 days after starting clindamycin for cellulitis 5 days back. What is the single most appropriate antibiotic for this condition in primary care setting?

A 40-year-old female presents with epigastric burning which is aggravated by taking meal since one year. She denies hematemesis, melena and weight loss. Her family history is negative for GI cancers. She has tried capsule omeprazole 40 mg OD and life style changes for 1 month but with no response. What should be next step in management according to NICE guidelines?

A 50-year-old female presents with severe continuous aching epigastric pain for 1 day. Pain radiates to back and worsen on laying flat. The pain is relieved by sitting and bending forward. BP is 120/80. Pulse is 106/min, Temperature is 101o F. She is tender at epigastric area. What is the single most appropriate laboratory test for this condition?

A 45-year-old female complain of intermittent bleeding per rectum since last 3 years. The blood is fresh and mixed with the stools. She also complains of joint pains, back pain, redness of eyes and mouth ulcers. Her conjunctiva is pale, lower legs have very tender red lesions. Which test can help in diagnosis before colonoscopy?

A 40-year-old obese woman presents with her Ultrasound scan report showing grade 2 fatty liver disease. She is otherwise healthy and has no known comorbids. You advised her on only life style changes at this stage. What is the most appropriate test to monitor disease progress in her case?

A mother brings 6 months old baby presents with a history a red mass coming down the anus with anal discharge for a few weeks. The mass is small pinkish, round and smooth. What is the most appropriate treatment?

40 years old male comes with diarrhoea for the last one and a half month. He has been to different doctors but of no use. You took history and found him to be a diabetic with poor control for the last ten years. What could be the most probable cause for his diarrhoea?

A 17 years old boy comes for hepatitis B vaccination. He had received his first dose of vaccine 7 years ago. What is the single most appropriate step?

A mother seeks advice for her 6 years old daughter for her diarrhea and abdominal distention since last 2 years. Her symptoms are better when she takes rice. She is pale and has angular stomatitis as well. What is the single most appropriate initial non-invasive test?

A 50-year-old female presents with dribbling of urine on coughing and exercise from last 6 years. She has 5 children. She has no known comorbids. Her BMI is 30. What is the single most appropriate initial treatment?

A 26-year-old married woman presents with burning micturition, frequency of urine and lower abdominal pain for 3 days. She denies high grade fever, hematuria and flank pain. There is no previous history of any renal disease. Urine analysis is positive for nitrites and shows increased leucocytes. What is the single most appropriate management approach in this case?

A 52-year-old male patient known case of CKD and HTN presented in your clinic 1 month ago with lab reports showing e-GFR 55ml/min. His BP was 150/94 mm Hg. You started enalapril 10 mg x OD. Now in follow up he came with Lab report showing e-GRF 38 ml/min. BP is 130 /80 mm Hg. What is the single most appropriate approach regarding antihypertensive medicine in this case?

A 25-year-old female presents with complaint of persistent headache and decrease urine output for 1 week. She had sore throat and fever 2 weeks ago. On examination her BP is 170/100 mm Hg with mild pitting edema. Urine analysis shows mild proteinuria, hematuria and RBC casts. What the most probable diagnosis?

28-year-old man presents with Left flank pain and high-grade fever since two days. His urine A exam shows; WBC > 20 HPF, Leukocyte Esterase + RBC Blood +> 20 HPF, What is the single most appropriate antibiotic according to WHO guidelines?

A 35-year-old accountant, presents with recurrent panic attacks and avoidance of public places for the past six months. She fears experiencing panic attacks in crowded areas. What is the most likely diagnosis for her?

A 35-year-old accountant, presents with recurrent panic attacks and avoidance of public places for the past six months. She fears experiencing panic attacks in crowded areas. What is first line management according to NICE Guideline?

A 28-year-old marketing manager has been experiencing low mood and difficulty in concentrating at his work for the past six months. He often feels agitated, hopeless and has disturbed sleep. He often cries easily and blames himself for hardships of his family. What is the most likely diagnosis?

A 28-year-old marketing manager has been experiencing low mood and difficulty in concentrating at his work for the past six months. He often feels agitated, hopeless and has disturbed sleep. He often cries easily and blames himself for hardships of his family. What is the most effective therapy for this patient?

A32-year-old pregnant woman presents with low mood and lack of interest since last 4 months. Her sleep, appetite and libido are reduced and she breaks into tears very easily. What is the most appropriate first-line pharmacological treatment?

A 30-year-old engineer, experiences recurrent episodes of palpitation, sweating, chest discomfort and dizziness. These episodes last for about ten minutes and often followed by concerns about having more attacks. His cardiac and thyroid workup is unremarkable. What is the most appropriate first line management to treat this condition?

A 20-year-old student presents with redness and irritation of both eyes since 2 days. His vision is normal. Few of his class mates also had similar redness in their eyes. What would be the most likely diagnosis?