A 35-years-old man who is on anti-tuberculous therapy presents to you with difficulty to differentiate between different colours for the last 1 week. Which drug in his treatment is most likely responsible for this problem?

A 30-year-old man comes to your clinic & complains of severe recurrent right sided headache mostly around the eye for the last 3 weeks. The pain disturbs his sleep & affects daily routine. Apart from smoking he has no other addictions or medical conditions. On examination you noticed that his right eye is red & watery; his eyelid appears to be lower than the other. What would be the most appropriate management of acute attack for this patient?

A 30-year-old man came to show you his radiographs. He complains of backache and stiffness for the last 4 months. His symptoms are more in the morning. Flexion of back is restricted, thoracic curvature is more convex & there is loss of lumber lordosis. What sign will you look for in his radiographs in this case?

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?

A 55-year-old man presents to the clinic for a routine visit. He has well-controlled diabetes and hypertension from the past 10 years. Blood pressure is 120/80 and his HbA1C from 1 month back is 6.7%. He tells you that his mother died of stroke at the age of 65 and his father died of colon cancer at the age of 60. What is the single most appropriate step?

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?

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. On examination, it is noted that the rash spares the creases. What is the treatment of choice for this child? What is the treatment of choice for this child?

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 19-year-old university student believes that he deserves a top position in the university and that he is going to solve problems associated with providing limitless free energy to the whole world. He has the best brain in the world and is directly in communication with God. He sleeps very little talks very loud. What is the most appropriate explanation of his condition?

A 4-year-old girl is brought to the clinic due to poor control of asthma. She currently takes a regular steroid inhaler and a salbutamol inhaler as required. What is the next step in management?

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 32-year-old woman presents with painful area in the middle of left heel pad. Pain is worst when taking the first few steps. She is being treated with diclofenac, heel padding & exercises but her symptoms persist. What is the next definitive management step in this case?

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 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 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? What would be the most appropriate initial treatment in this patient?

A 30-year-old man came to show to you, his radiographs. He complains of backache and morning stiffness for the last 4 months. His symptoms are more in the morning. Flexion of back is restricted, thoracic curvature is more convex & there is loss of lumber lordosis. What sign will you look for in his radiographs to diagnose this case?

A 62-year-old man with a history of recurrent lower respiratory tract infections is diagnosed as having bilateral bronchiectasis following a high-resolution CT scan. Which one of the following is most important in controlling his symptoms?

What advice would you give to a 60-year-old man who has undergone PCI (Percutaneous Coronary Intervention) for Acute Coronary Syndrome, regarding his lipid therapy? Blood Pressure: 142/82 mmHg Triglycerides: 275 mg/dl. What is the right dose of Atorvastatin for him?

An 80-year-old patient of B.P.H. on Doxazocin 4 mg OD comes with hematuria. His post void residual urinary volume is 30 ml. What will be your next management plan?

A distressed mother comes to your clinic for the first time and states that her 5-week-old daughter has been crying for 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. The child is not suffering from diarrhoea, and she passes flatus when she cries. You observe an adequate weight gain on the growth chart. She is on breastfeed. What is the single most appropriate diagnosis?

A 20 years old patient presents with blood report showing Hep B s Ag Negative Hep B s Ab Positive Hep B c Ig G Negative Hep B e Ag Negative...What is her current state?

A 66-year-old man presents with troublesome tremors in both hands for about 10 years. They occur during work and improve during rest. He is taking Losartan 50 mg, Methycobolamine 500 mcg daily. His neurological examination is normal. What is the most likely diagnosis?

A 37 yrs. old male presents with redness on body for 4 days. It was initially patchy, then become generalized. Skin is hot, red, itchy, dry and thickened involving more than 90% of body surface area. He has started taking some pills for ankle joint swelling. What is most likely treatment option?

A 9-years-old boy presents to your clinic with fever, throat pain, drooling and restlessness. There is an audible husky inspiratory sound. How would you manage this patient?How would you manage this patient?

A 56-year-old woman presents with facial asymmetry. Whilst brushing her teeth this morning she noted that the right hand corner of her mouth was drooping. She is generally well but noted some pain behind her right ear yesterday and says her right eye is becoming dry. On examination she has a complete paralysis of the facial nerve on the right side, extending from the forehead to the mouth. Ear, nose and throat examinations are normal. Clinical examination of other nerves is normal.What is the most likely diagnosis in this case?

A 47-year-old man comes to you with history of fever, headache, myalgia, cough, rhinorrhoea, sore throat, and malaise. He says that all of his family members & many residents in the neighbourhood have similar symptoms. He has received no vaccinations in the previous 5 years. On examination, the patient appears acutely ill with fever 39.4 °C (102.92 °F), tachypnoea, and tachycardia. The patient also has prominent pharyngeal erythema. What would be the most likely diagnosis in this case?

A 48-year-old office worker presents with sudden onset of painful swollen big right toe for last 2 days. He is fond of meat and bar-B-Q foods. He is having fever of 101o F. What would be the most definite test to diagnose this condition?

A 20-years-old boy presents with pain & swelling of right elbow and left knee joint for last 1 week. Three weeks ago, he had diarrhoea which has now settled. He denies eye or urethral symptoms. What would be the most likely diagnosis in this case?

A 50-year-old hypertensive woman is seen in the clinic for pain and swelling in her right toe from the past 2 weeks when a drug was added to her previous regimen for hypertension. Addition of which of the following drugs could have caused her condition?

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 35-year-old woman is concerned about her weight. Her body mass index is 34 kg/m2. Which one of the following best describes her weight?

A 35-year-old man presents with tremors, confusion, palpitation and restless. He feels as if spiders are crawling all over his body. He also has vomiting, flickering of eye lids and excessive sweating. His wife tells you that he was using some addictive drug and he has suddenly stopped it. She does not know the name of drug. What is the single most likely drug that has caused these withdrawal symptoms?

A 4-week-old baby has weeping eyes, but these are not red. The discharge is mucoid and conjunctiva are white. The problem started two weeks after birth. What is the single most appropriate management step at this stage?

A 32-year old woman presents to the clinic complaining of vaginal pruritis and increasing vaginal discharge for the past one week. She has no fever or dysuria. On examination, there is a frothy, green discharge in the vaginal vault. What is the most likely diagnosis? What is the most likely diagnosis?

A 20-year-old boy presents to you for the third time with recurrent P. vivax infection. He has been treated previously with combination therapies & Chloroquine. He is taking Chloroquine currently. What would be the single best drug of choice for him at this stage?

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 22 years old man has left scrotal swelling for the last five years. 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? What is the most likely diagnosis?

A 19 yrs. male patient presents with spots on face. There are frequent papules, pustules, nodular abscesses and wide spread scarring. He applied topical treatment and took oral antibiotics for 8 weeks. Acne relapses after discontinuing treatment. What is single best treatment option?

A 19-year-old university student believes that he deserves a top position in the university and that he is going to solve problems associated with providing limitless free energy to the whole world. He has the best brain in the world and is directly in communication with God. He sleeps very little talks very loud. What is the most appropriate treatment option?

A mother comes to your clinic with her infant. Her baby is 6 weeks of age and has been “spitting up” her formula milk “since birth.”. The baby weighs 4.5 Kg while her birth weight was 3 kg. What is the single most appropriate step in management?

A 29-year-old medical student presents with redness and irritation of both eyes for two days. On examination both conjunctivae are red and congested and there are pre-auricular lymph nodes present. What is the single most appropriate preventive measure in this case?

A 54-year-old obese woman presents with shortness of breath. She currently uses HRT (Hormone Replacement Therapy) and smokes 20 cigarettes per day. Chest auscultation is unremarkable. Spirometry shows an obstructive pattern with no reversibility to bronchodilators. What would be the most likely diagnosis in this patient?

A 60-year-old woman with a known history of seizures was brought by her son for assessment. He says that he witnessed her seizure which began by affecting her right hand before spreading to her arm & progressing to loss of consciousness with her whole body shaking. What would be the most likely type of seizure in this patient?

A 10-year-old boy is passing blood in his urine. His B.P. is 140/92 mm Hg. His urine report shows Proteins +, RBC +++, WBC 4-6 HPF. Two weeks back he had an acute infection in his ear. What is the most likely diagnosis?

An 8-year-old boy known asthmatic presents to your clinic. His current treatment is a salbutamol inhaler as required and beclomethasone inhaler 200 mcg BD. Despite this, he regularly requires salbutamol for exacerbations and suffers with a night time cough. What is the most appropriate next step in management?

A 75-year-old man comes to your clinic with complaints of hearing loss for the last 3 years. Patient has no other complaints and is vitally stable. You perform Rinne and Weber test to determine the cause of the hearing loss with the following results: Left side Rinne : air conduction > bone conduction Right side Rinne : air conduction > bone conduction Weber: lateralizes to right ear. What is the diagnosis for this patient?

A 62-year-old man comes to the clinic due to sudden onset of severe epigastric pain that began two hours ago, accompanied by nausea and an episode of vomiting. On examination, there is marked upper abdominal tenderness with guarding and rigidity. ECG is normal. An urgent chest x-ray is ordered which shows; What is the most likely diagnosis?

A 55-year-old man presents with erectile dysfunction since last one year. He has diabetes and hypertension since last 10 years. He is talking Sitagliptin and Valsartan. His fasting blood sugar is 102 mg/dl, random sugar is 150 mg/dl, BP is 130/90 mm Hg. What is the single most appropriate initial step for his erectile dysfunction?

A 16-year-old girl is brought to your clinic after ingestion of 40 tablets of Lorazepam. She is nonresponsive, her BP is 100/60 mm Hg, pulse is 100 per minute, respiratory rate is 8 per minute. What is the single most appropriate drug for her condition?

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 investigation in a GP clinic to the associated disease with this condition?

A 58-year-old woman presents with malaise, low mood, pain and stiffness of neck, shoulder & hip for last 3 months with morning stiffness. Her ESR is 55 mm/hr. What would be the appropriate initial drug therapy for this patient? What would be the appropriate initial drug therapy for this patient?

You review a 35-year-old woman with recurrent hand dermatitis. You find out that this happened because she frequently washes her hands and she finds this upsetting and unpleasant. She tried to resist hand washing in the past but was unable to stop. What is the most first line treatment?

A 25-year-old primigravid presents to your clinic for her first antenatal visit at 10 weeks gestation. She has no active complaints. Her blood pressure readings are 122/78 and 124/80 mm Hg. How often will you check her blood pressure during her antenatal period? How often will you check her blood pressure during her antenatal period?

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

A 25-year-old Primigravida at 34 weeks of gestation met a minor road accident. Her pulse is 105 BPM, BP is 80/50 mmHg and respiratory rate is 14/min. She complains of weakness and shortness of breath. There is no obvious wound What is the most appropriate first step in management of this patient?

A 44-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 39 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 most likely diagnosis? What is the single most likely diagnosis?

A 25-year-old man presents to you with a history of recurrent headaches at least four times a week for the last 4 months. He describes it as a tight band encircling his head. There is no history of nausea, vomiting & malaise. His sleep is disturbed due to workload & stress at his job place. His examination is unremarkable. What would be the most likely diagnosis of headache in this patient?

A 30-year-old male teacher comes to you for annual health check-up. He was BCG immunized previously & has good health but one of his friends has pulmonary TB. His chest x-ray is normal. You ordered Tuberculin skin test for assessment of his TB status. At which level would you call his Tuberculin test strongly positive for latent TB infection?

A 36 yrs. old female presents with fever and painful nodules on legs for 3 weeks. There is tender erythematous nodules1-5 cm in diameter on shins. what is most likely associated condition?

A 35-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 52-year-old woman presents to the clinic with the complaints of hot flashes, night sweats and sleep disturbances which are causing her a lot of distress. She has a past history of a myocardial infarction 3 years ago and history of DVT. She has been trying lifestyle modifications to relieve her complaints but they have not been useful. What is the most appropriate drug for her symptoms? What is the most appropriate drug for her symptoms?

A 60-year-old man who is investigated for exertional chest pain is diagnosed as having angina pectoris. Which one of the following drugs is most likely to improve his long-term prognosis?

A 9-year-old boy brought by parents saying that he does not listen to teachers in school and does whatever pleases him. He draws strange lines and describes them as different objects. During the consultation, the boy was busy writing with a pen on the table making bizarre circles. What is the single most appropriate diagnosis?

A 50-year-old chronic smoker presents with productive cough for the last 10 years. His chest x-ray shows hyperinflated lungs and lung function test shows obstructive pattern. Which one of the following interventions is most likely to increase survival in this patient?

A 70-year-old man presents with recurrent urinary tract infections because of benign prostatic hyperplasia. His urine culture report shows proteus species. What type of stones is he likely to develop?

A 20-year-old woman comes to the office due to abdominal bloating, headache, fatigue, weight gain, mood swings, and decreased libido. She says, "The symptoms last about a week and then seem to subside, but they always come back again." The episodes have been occurring for years. She takes no medications and physical examination is normal. Which of the following is the most appropriate next step for confirming diagnosis in this patient? Which of the following is the most appropriate next step for confirming diagnosis in this patient?

A 60-year-old man is complaining of difficulty in swallowing and hoariness of voice, which has been getting slowly worse over the past 3 months. He has lost around two KG weight. He has no pain when swallowing and has no regurgitation of food. What is the most likely diagnosis?

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.What is the most appropriate next step in treatment?

A 7-year-old boy is brought to your clinic with complaints that he is unable to sit still and keeps moving all the time. He can’t sit calmly for studies, taking meals, or travelling in a car. He looks here and there during the consultation. What is the most likely diagnosis?

A 16-year-old girl presents with two days history of mild headache and facial rash. She also has mild fever, malaise and joint pains. She denies any neck stiffness, nausea or vomiting. On examination there is maculopapular rash on her chest and there are enlarged posterior cervical & suboccipital lymph nodes. Neurological exam is fine. What would be the most likely diagnosis in this case?

A 23-year-old man comes to you with a 5 days history of white cloudy urethral discharge, burning micturition & mild scrotal pain. His culture report shows Chlamydia trachomatis infection. What would be the appropriate first line treatment for this patient?

A 23-year-old woman comes to the clinic due to a bump on her vaginal introitus for the past three days. The bump causes discomfort when she walks. On examination, there is a 3-cm, mobile, soft, cystic mass on her vulva. What is the most likely diagnosis?

Mother of atopic child comes for advice about his clothing. The child doesn’t have any current lesions. She wants to be careful for the future. What is the best option?

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?

An 11-year-old boy presents with sudden reduction in urine output within last 14-16 hours. He had acute tonsillitis 2 weeks ago. His lab results show acute rise in creatinine, blood urea and eosinophil count. His urine report shows hematuria and +1 proteinuria. What is the cause for his acute renal failure?

You review a 35-year-old woman with recurrent hand dermatitis. You find out that this happened because she frequently washes her hands and she finds this upsetting and unpleasant. She tried to resist hand washing in the past but was unable to stop. What is the most likely underlying diagnosis?

A 69-year-old man is admitted to the emergency department with left hemiplegia which started about 5 hours ago. He has no other complaints; his blood pressure is 140/90 mmHg. You ordered an urgent CT scan suspecting it to be a stroke & the results show no intracranial haemorrhages. What would be the most appropriate management for him at primary care level?

A 43-year-old diabetic patient comes for follow up after 2 years. He HbA1 c is 8.5%. What is the single most appropriate screening test for early diabetic nephropathy?

A patient of unstable angina starts bleeding from her nose and gums. Her current medicines are Nitrates, Heparin, Atenolol, Aspirin and Simvastatin. Her latest APTT is four times raised. Which therapeutic agent can reverse the effect?

A school nurse called you to see a 6-year-old boy with school refusal. He cries and screams after his parents leave and refuses to stay in the classroom. The school nurse informed you that she tried her best during the last 4 weeks to help the child settle at school, and she met with the parents frequently. The parents have tried to calmly send the child to school and reward him for each completed day. Which of the following is the next best step in management?

A 38-year-old female comes to you with bilateral painful hands. Her X-ray shows soft tissue swelling but bones and joints appear normal. Pain is more in the morning and gets better as the day passes by. The joints are swollen, tender, soft and boggy. What definitive investigation you’ll order to confirm the diagnosis in this patient? What definitive investigation you’ll order to confirm the diagnosis?

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 32-year-old woman on Antituberculous treatment for 1 month got pregnant. She came to you for advice as she is concerned about her foetus What would be the most appropriate management step for her at this stage?

A 54-year-old woman presents systemically unwell. She has recently started Carbimazole for hyperthyroidism. What is the most important blood test to perform during treatment with Carbimazole?

A 30-year-old woman feels tired all the time. She feels sad and tearful and has been sleeping poorly for the past 6 months. She has lost interest in life and blames herself for all the miseries on her family. She had her second child 8 months ago. She does not take care of her children well. What is the most likely diagnosis?

A 30-year-old man presents with low mood, lack of interest, insomnia, crying, lack of energy and social withdrawal. You have made the diagnosis of depression and have started him on Fluoxetine and have called him for 2 weekly follow up. You plan to increase dose on each visit till patient goes into complete remission of depression. What is the most important aspect to look for in each follow up visit?

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 most likely diagnosis?

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 25-year-old man presents with burning urination and a milky urethral discharge for 3 days. He had unprotected sexual contact 5 days prior to the onset of these symptoms. A smear of the urethral discharge demonstrates gram-negative diplococci in neutrophilic granulocytes. The patient has no history of allergies or drug abuse. Which of the following would be the most appropriate treatment?

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 mother brings her 4-year-old son to the clinic with complaints of severe right ear pain and fever of 39.5 C for the last three days. The child has been irritable and has not been able to go to school either. There is no discharge from the ear. On an Otoscopic examination, the tympanic membrane appears inflamed and dull. The child was previously sick with the flu, which resolved spontaneously a week ago. What is the diagnosis?

A 68-year-old man comes to you with complaints of sudden weakness in his right arm & leg since morning. He has been on treatment for diabetes & hypertension for the last 10 years. On examination power & tone is reduced on the right side of the body. Blood pressure is 170/105 mmHg. You also noticed drooping of his facial muscles on the right side but wrinkles on his forehead are produced bilaterally. Rest of examination is unremarkable. What would be the most likely diagnosis in this patient?

A 40-year-old man has Triglyceride level of 1200 mg/dl and Total Cholesterol level of 240 mg/dl. He does not have risk factors for coronary artery disease.What is the initial first line drug of choice for him at this stage?

An 18-year-old cocaine addict has been brought by relatives in an agitated state. He snorted cocaine 12 hours ago. He is abusive and violent. Which drug would you prescribe to sedate him? Which drug would you prescribe to sedate him?

An 11-month-old alert infant has body weight for age less than 3 standard deviations of the mean. His length is on 25th centile for age. Upon physical examination, the baby is alert but irritable and has no oedema. Rest of examination is normal. Which of the following is the most likely diagnosis?

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 5-week-old breast fed baby whose birth weight was 3.5 kg and is now 4.5 kg is thriving well but is deeply jaundiced. What is the most likely diagnosis?

A 63-year-old man Ex-smoker comes to you for review with complaints of chest pain & breathlessness even when going out of the house. He is a known COPD patient & is on regular Formoterol, Tiotropium bromide & Beclomethasone therapy. You noticed some degree of cyanosis & peripheral oedema during his physical examination. Pulse oximetry shows oxygen saturation 92% & pulse 84 beats per minute. Which of the following features would you not consider for the need of oxygen therapy in this patient?

A 35-year-old woman comes to your clinic with complaints of nausea and dizziness every time she moves towards the left side. This also usually happens when she gets up from the bed in the morning or turns around rapidly. There is no hearing loss. Her physical exam is within normal limits, but she has a nystagmus when Dix-Hallpike maneuver is performed.What is the treatment for this patient?

A 24-month-old child has failure to thrive and an unusual gait. She has bowed legs, thick wrists and dental caries. Her weight (8kg) and height (72.5 cm) are below the 3rd percentiles for her age. Which of the following is most likely nutrient deficiency in this child?

17-year-old male presents with rash on body for the last few days. There are multiple oval pink lesions having delicate collarets of scales preceded by single large oval lesion 2-5 cm diameter several days ago. What is the single most likely diagnosis?

A 32-year-old woman continues to be distressed by recurrent dreams and intrusive thoughts two years after she was saved from a burning house. She has purchased a new home away from the previous area and often avoids any conversation regarding the incident; but still is unable to rid herself of these thoughts. What is the single most appropriate treatment option?

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 55-year-old male presents with weight loss, passage of small stones in urine, weakness, joint pains and abdominal pain. His spleen is massively enlarged. WBC is 70 x 109/L, Hb is 8.5 gm/dl with few myeloid precursor cells. How will you prevent further stone formation in this patient?

A 23-year-old female student is reluctantly brought to you by her concerned parents. She has been behaving oddly, keeps quiet and seems withdrawn. She is no more interested in studies and cries without reason. Her baseline laboratory tests are normal. What is the single most appropriate question in her history?

A 20-year-old woman comes to the clinic. She says she has had vaginal discharge intermittently for the past few months. She is sexually inactive. Her last menstrual period was two weeks ago. On examination, there is no redness of the external genitalia. On external examination, there is scanty white, mucoid, odorless vaginal discharge. Microscopic examination shows only squamous cells. What is the most likely 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 37-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 is nauseous and has vomited once. He admits to drinking regularly. There is epigastric tenderness on palpation of the abdomen but no rigidity. An ECG is performed which is normal. What is the most likely diagnosis? What is the most likely diagnosis?

A middle-aged female is having erythema and pustules on the face for the last five months. Earliest symptom was flushing. There is erythema, telangiectasia, papules, pustules and lymphoedema affecting cheeks, nose, forehead and chin. Lesions exacerbate by sun light and topical steroids. What is most likely diagnosis?

A child is brought to your clinic with a history of paroxysms of pain during which the child draws up his legs and often screams due to pain and becomes pale. Episodes usually are 10–15 min apart and last 2–3min but have become more frequent with time. The pain is accompanied by vomiting, passage of blood (‘red currant jelly stool’). Examination reveals a sausage-shaped mass in the right lower quadrant of the abdomen. What is the most likely diagnosis?

A 30-year-old man presents with a 2-days history of malaise, fever, muffled voice, severe throat pain, painful swallowing and inability to open mouth. There is a bulge in the left side of the pharynx shifting uvula to the right side. What is the most appropriate treatment option for this patient?

A 39-year-old man presents with pain in his lateral side of wrist joint for the last 10 days. It started while he was gardening. Pain is worse in the morning. hat clinical test will you perform to reach the diagnosis of this case?

A 33-year-old woman, para 2, comes to the clinic due to 2 days of left breast pain. She has fever, chills, muscle aches, and fatigue. The patient had a spontaneous vaginal delivery 8 weeks ago and has been breastfeeding her infant. Temperature is 38.8 C. Breast examination shows a 6-cm area of erythema, warmth, and tenderness at the upper outer quadrant of the left breast. What is the best next step in management of this patient?

A 35-year-old male presents with an acute onset of right sided pleuritic chest pain and dyspnoea. He is in distress and is not able to speak. There is reduced air entry on the right side. Right chest is resonant. What emergency measure would be life saving for this patient in a family medicine clinic?

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? Which fluid would you choose to resuscitate?

A 31 yrs. old male presents with fever, arthralgia, myalgia, conjunctivitis and skin lesions. There are vesicles on buccal mucosa, genital area and conjunctiva. There are target lesions on palms. He was taking septran tabs few days ago. What is likely diagnosis?

A 12-year-old boy is brought to you with a history of extreme talkativeness, poor attention to detail and organization of tasks. He appears not to listen when given a task and is forgetful and easily distracted. Further history reveals he shouts out answers to questions and at times he is unable to take turns or wait in a queue. He also interrupts others at school and at home. Which of the following is the most likely diagnosis?

A 50-year-old office worker presents with painful swollen big right toe for last 1 week. He is known hypertensive & is using Metformin, Atenolol, Hydrochlorothiazide, Omeprazole & Acetaminophen. Which of his medication may have contributed to development of his symptoms?

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 30-year-old patient has been referred to you with a 3-year history of multiple vague health and cognitive complaints including pain, nausea, memory and concentration difficulties, and fatigue. Despite an exhaustive battery of tests, no medical basis has been found for the patient's symptoms. She does appear genuinely and significantly distressed by her reported issues but otherwise denies depressive symptoms. She desires to get rid of her symptoms and has no idea about the cause of her symptoms. What is single most likely diagnosis?

A 4-year-old girl has been non-specifically unwell since last two weeks. She has been complaining of a tummy ache. She has been wetting the bed again, having been dry at night since the age of one year. What will be the appropriate investigation of this child?

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 20 years old boy presents with recurrent mild jaundice since his childhood usually after intercurrent infections and during fasting. His total bilirubin is 6 mg/ dl and unconjugated bilirubin is 5.1 mg/dl. All other liver function tests are normal. What is most appropriate diagnosis?

A 42-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 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? What is the most likely diagnosis?

A 60-year-old businessman presents with 3 days history of progressive dry cough, fever, coryza & shortness of breath. He has recently returned from a business trip to China. On examination he is febrile & tachypneic. You are considering a diagnosis of covid-19 infection. What would be the test of choice to confirm the diagnosis of covid-19 at this stage in this patient?

A 33-year-old woman is brought to your clinic by her husband. He is worried that his wife seems to be increasingly worried about things and repeats things including cleaning, making visitors leave their shoes outside, not eating from outside her own kitchen. Most recently, she has started getting up at 5am to clean the house. Which of the following is the most appropriate initial treatment for her?

A 30-year-old woman with a history of asthma presents for review. She has recently been discharged from hospital following an acute exacerbation of asthma and reports generally poor control with a persistent night time cough and exertional wheeze. She is currently on salbutamol inhaler 100mcg prn, beclomethasone dipropionate inhaler 800mcg bd & salmeterol 50mcg bd. What would be the most appropriate drug to add in the management of this patient?

A 22-year-old woman presents to your clinic. She has been sexually active with her husband since the past one year. She has no active complaints and no comorbid conditions. What is the most appropriate recommendation for initial pap smear in this patient?

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 54-year-old woman with a long history of rheumatoid arthritis and treated with Methotrexate is reviewed in clinic complaining of shortness of breath. Oxygen saturations are 90% on room air with spirometry showing a restrictive pattern. What is the single most appropriate step in management of shortness of breath?

A 72-year-old woman presents with a vesicular rash around her left eye. The left eye is red and there is a degree of photophobia. What is the most appropriate treatment?

A 50-year-old lady complains of epigastric burning pains due to stress. She finally undergoes gastroscopy which shows gastro-oesophageal reflux. Which medication is the most effective for her condition to control her symptoms?

An 11-year-old girl was brought to you by her mother stating that for the last 3 months her child is not performing well in the school & spends most of her time staring into space. Sometimes there are twitching movements in her limbs. Her physical & neurological examination are unremarkable. What would be the most likely diagnosis in this patient?

A 20-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. Urine dipstick is positive for leukocytes but no bacteria. What is the single most likely diagnosis? What is the single most likely diagnosis?

A 31-year-old man comes to you for review. He was previously diagnosed with migraine & medications for acute treatment were advised. He complains that his migraine attacks are becoming more frequent. Last month he had seven attacks. You want to start migraine prophylaxis. What would be the most appropriate treatment as prophylaxis for migraine in this patient?

A 40-year-old female comes with the pain, swelling and stiffness of hands, feet and knees since 4 weeks. Her proximal interphalangeal joints, wrists are swollen and boggy. Her reports show ESR 45 mm/Hr Uric acid 6.0 mg/dl RA factor Negative Anti CCP Positive What is the most appropriate next step in management?

A patient, who suffers from irritable bowel syndrome (IBS) with loose stools, has had an unsatisfactory response to Loperamide and antispasmodics. Which class of medication does NICE suggest as second line treatment for IBS?

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 wets herself up to 3 times/week. What is the most appropriate management?

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 40-year-old man comes after a minor road traffic accident which happened because he fell asleep during driving. He also falls asleep during meetings and social gatherings. His concentration is poor, and his sexual drive is decreased. What is the most appropriate management step?

A patient of Nephrotic syndrome comes with complains of fever and productive cough for 5 days. There are crepts on right middle lung zone. X-ray show pneumonic patch at right middle lobe. What is the single most appropriate drug for him?

A 65-year-old woman came to your office with a severe left-sided headache with pain around left temple & jaw during chewing for the past 3 days. She reports pain even combing her hair. She also feels unwell, feverish and feels pain and stiffness in shoulders. On examination there is moderate tenderness around the left temple. Her blood pressure is 135/95 mmHg. Rest of the examination is unremarkable. What would be the most likely diagnosis in this patient?

A 55-year-old obese diabetic man was admitted in the emergency department with marked breathlessness, wheezes & productive cough. He is a known COPD patient & strictly complies with treatment. His current condition is similar to his previous 3 episodes during this year. You are considering oral prophylactic antibiotic therapy. Which of the following can be used as criteria for initiating oral prophylactic antibiotics in this patient?

A 10-year-old boy presents with redness and irritation of both eyes since last four days. His vision is normal. On examination there is diffuse erythema under both eye lids and white purulent discharge is present in medial part of palpebral space. What is the single most appropriate specific treatment option in primary care?

A 25-year-old man presents to you with fever, headache, joint pains & rash all over his body. He came to show you his lab reports which affirms positive Dengue-specific IgM & low platelets confirming the diagnosis of dengue. What is the most appropriate treatment for this patient?

A 29-year-old obese woman comes to the clinic complaining of severe vaginal pruritis and vaginal discharge. Her last menstrual period was 2 weeks ago. On pelvic examination, there is vulvar and vaginal erythema and a small amount of white curdy vaginal discharge with a cottage-cheese appearance. She has just recovered from Bell’s palsy and was on oral Prednisolone for one week What is the single most appropriate treatment

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?

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 3-year-old child has a history of diarrhoea on and off for the past 6 months. The mother describes the stool as bulky, frothy, and difficult to flush. She also looks wasted on examination and her abdomen is protuberant. She has used multiple antibiotics for diarrhoea but to no avail. What is the single most specific investigation to diagnosis this condition?

A 53-year-old man comes to you on a follow up visit who was previously diagnosed with COPD. His current treatment includes Salmeterol & Fluticasone. He still has day-to-day symptoms which continue to adversely impact his life. What would be the most appropriate treatment to add in the regime for this patient?

A 30-year old multigravida woman presents to your clinic for her first antenatal visit at 10 weeks gestation. She has no active complaints. She smokes half a pack of cigarettes a day. She wants to continue smoking during her pregnancy. What advice will you give her with regards to smoking? What advice will you give her with regards to smoking?

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 25-year-old man presents with productive cough, fever & right sided chest pain for the last 5 days. He has a history of Intravenous drug abuse. His Temperature is 102° F, Pulse 100 bpm, B.P is 100/70 mmHg, RR 30/min. CXR Shows Right lobar consolidation. What would be the most appropriate treatment in this patient?

A 45-year-old man presented to you with a productive cough, breathlessness & wheeze during exercise for the last 1 year. He smokes 20 packs-a-year for the last 15 years. His lung function tests are suggestive of COPD. Which of the following treatments you would AVOID in this patient?

A 56-year-old man came to you for review. He is admitted with a non-ST elevation myocardial infarction (NSTEMI) in the emergency department. He is treated with Clopidogrel, Aspirin & Simvastatin. For how long he should take Clopidogrel?

A 52-year-old woman is diagnosed with fatty liver following an ultrasound. What is the single most important step to help prevent the progression of her disease?

A 35-year-old man with a history of depression and gastro-oesophageal reflux disease presents to the clinic due to a milky discharge from his nipples. The following blood results are obtained: Serum Prolactin 700 mu/l (High). Which one of his medications is most likely to be responsible for nipple discharge?

A 45-year-old businessman who is H.I V Positive comes to you for assessment of his TB status. On screening his tuberculosis skin test is 6 mm. His chest x-ray is normal. What is the most appropriate advice regarding his treatment?

A 53-year-old man presents with right sided nasal blockage for two months. He has a long history of runny nose, post nasal drip and disturbance in smell and taste. There is visible pink mass in right nasal cavity which is mobile on touching. What is the single most appropriate initial step in management?

A 40-year-old man presents with weakness of his right arm. He cannot move the arm at all. Weakness came on suddenly and started 9 days ago. He saw a neurologist, but no neurological cause could be found, including normal examination, MRI and EMG and nerve conduction studies. Past medical history is insignificant and has not missed a day off work for 2 years.What is the most likely diagnosis?

A 58-year-old man who is known diabetic and hypertensive presents with muscle aches and pains after his previous doctor changed his medications recently. He is currently taking the following medications: Enalapril, Metformin, Sitagliptin, Simvastatin, and Aspirin. Which of these medicines is mostly responsible for muscle aches and pains?

A 45 years old woman presents with abdominal pain and chronic diarrhoea. Her symptoms increase during the days of stress. Her lab workup is normal. Which of the following favours her diagnosis of IBS?

A 32-year-old man has come to you complaining of a lack of confidence. He says he has difficulty talking to people, especially when he confronts a stranger. He is shy of moving around in the office because there are many women working there, and he tries to avoid them. He is now worried because he is going to get married in four months and he has no experience in talking to women. What is the single most appropriate diagnosis?

A 28-year-old man presents with a persistent productive cough and wheezing. His symptoms get worse in the winter season. Which one of the following is the correct diagnosis for this patient?

A 35-year-old female who has recently been diagnosed with Grave's disease presents for review 3 months after starting carbimazole. She is concerned about developing thyroid eye disease. What is the most appropriate step in reducing her risk of developing thyroid eye disease?

A 55-year-old woman presents to your clinic. She has no active complaints. She has had well-controlled diabetes since the past 15 years. Her most recent HbA1C was 6%. She says that a friend of hers was recently diagnosed with endometrial cancer. Her own family history is unremarkable for ovarian or breast cancer. Her routine pap smear is normal. What is the most appropriate next step for this patient? What is the most appropriate next step for this patient?

A 9-year-old girl presents with a small midline swelling in the neck since birth. It is painless and is not growing in size. Which single clinical test would be most useful in this case? Which single clinical test would be most useful in this case?

A 37-year-old woman comes to the clinic after discovering a lump in her left breast. She has no pain in the area. Her last menstrual period ended 4 days ago. Breast examination shows a 2-cm firm, round mass in the upper outer quadrant of the left breast. There is no axillary lymphadenopathy. Which of the following is the most appropriate next step in management of this patient? Which of the following is the most appropriate next step in management of this patient?

An 18-month-old girl has been having an intermittent sneezing and runny nose for the past 6 weeks. On physical examination, there is clear nasal discharge and nasal mucosa is mildly congested. The toddler appears healthy otherwise. What would be the most appropriate treatment option for her at this stage?

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 59-year-old man presented with productive cough & progressive shortness of breath for the last 3 months. He is a chronic smoker & has been taking different medications for relief. You suspect him as a case of chronic obstructive pulmonary disease & ordered spirometry to confirm the diagnosis. According to NICE guidelines, which type of spirometry would you recommend in this patient?

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 34-year-old steel worker presents complaining of episodic shortness of breath. This is particularly noted whilst at work where he describes feeling wheezy and having a tendency to cough. A diagnosis of occupational asthma is suspected. Which one test would NOT be appropriate for the diagnosis of asthma in this patient?

A 29-year-old obese woman comes to the clinic complaining of severe vaginal pruritis and vaginal discharge. Her last menstrual period was 2 weeks ago. On pelvic examination, there is vulvar and vaginal erythema and a small amount of white curdy vaginal discharge with a cottage-cheese appearance. She has just recovered from Bell’s palsy and was on oral Prednisolone for one week. What is the most likely diagnosis?

A 21 years old woman has been brought by her family members after having ingested 20 tablets of Acetaminophen. Which of the following is the most appropriate antidote?

A 24-year-old pregnant female presents with intense itching all over the body for 1 week. There are multiple papules with excoriations on sides of fingers, wrists, and ankles. Other family members also have same problem.What is the single best treatment option for this patient?

A 23-year-old student is investigated following an anaphylactic reaction suspected to be secondary to a wasp sting. Which one of the following is the most appropriate first-line test to identify the allergen?

A 4-year-old child who was born at term with no congenital anomalies is brought to your clinic. She looks severely underweight. On examination, she shows dependent oedema of the lower extremities as well as an enlarged abdomen with palpable fluid wave. Her desquamating skin shows irregular areas of depigmentation, and hyperpigmentation. Which of the following nutritional problems is most likely present in this child

A 58-year-old man with chronic hypertension and chronic heart failure presents to your clinic. Which of the following will you prescribe to improve mortality from chronic heart failure in this case?

A 5-year-old child presents with fever, cough, runny nose, redness of eyes for 5 days & skin rash for1 day. There are tiny white spots on bright red background on the inside of buccal mucosa of cheeks and florid maculopapular rash over the body. What would be the most likely diagnosis in this case?

A 31-year-old-woman is found to have high blood pressure on first antenatal visit at 4 weeks of gestation. Her BP is 150/90 mm Hg on three occasions. Her work up for hypertension is unremarkable.What is the most appropriate drug to control her BP according to NICE guidelines?

A 30-year-old man presented with headache, fever, vomiting & lethargy for 2 days. On examination his pulse is 110 BPM; blood pressure is 100/65 mmHg & temperature is 103˚ F. Skin has a non-blanching rash on chest & back & he seems restless on examination. What would be the most likely diagnosis in this patient?

A 28 yrs. old lady presents with excessive growth of hair on face and trunk for many months. She is using some drug. No other cause has been found.Which is the most likely causative drug ?

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

A 45-year-old male presents with mild pain in his ring finger. The finger is flexed & locked to the palm & he has to open it with the other hand. His fist closes easily without any problem. What is the most effective pharmacological treatment at this stage? What is the most effective pharmacological treatment at this stage?

A 29-year-old clerk presents with headache, lethargy, low mood and weight gain since last three months. He has difficulty concentrating in his work and in the bad books of his boss. He has been given a warning letter. He has a big family to support. His RBS is 140 mg/dl and TSH is 2.4 IU (Normal 0.4 to 4.0 IU). What is the single best step in management?

A 39-year-old woman comes to your clinic due to worsening pelvic pressure over the last three years. She has no abnormal uterine bleeding. On examination, there is an enlarged pelvic mass extending to the umbilicus. There is no tenderness to palpation. Urine pregnancy test is negative. Which of the following is the most likely diagnosis in this patient? Which of the following is the most likely diagnosis in this patient?

A 4-year-old boy was brought to your clinic with pain in the left arm. The pain started when his father lifted the child by one hand. On examination you noticed that the child is holding the arm pronated in extended position. what is the most appropriate treatment at this stage?

A 56-year-old man presents with complaints of new onset swelling over his feet. He is known hypertensive and is using Valsartan, Amlodipine, Bisoprolol, Aspirin, Methylcobolamine. His blood pressure is 130/80mmHg and his pulse is 74 bpm.Which medication might have caused swelling in feet in this patient?

A 35 years old man comes with pain in his lower abdomen with constipation and bloating. His pain is relieved after defecation. Which laxative will make his bloating worse?

A patient comes to your clinic with the following lab report. HBsAg: Positive HBsAb: Negative IgM anti-HBc: Negative IgG anti-HBc: Positive ALT: 120 mg/dl Which of the following terms best describes his disease status?

A 25 years old female presents with hair loss, urticaria & rash on the face, nose and forehead and also pain in wrists and elbow joints for last 1 month. Lab tests show; Haemoglobin 9.0 g/dl, platelets 120,000 & protein ++ in urine. What would be the most likely diagnosis in this case?

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? Which of the following is the next best step?

A 7-year-old girl is brought by her mother after recovery from a recent sore throat for which she was given antibiotics for 1 week. She has missed school five times in the last three years. Her weight is 28 kg. Her tonsils are enlarged bilaterally. She is currently afebrile. What is the most appropriate next step in management of this patient?

A 42-year-old male clerk complains of difficulty in walking because of pain and swelling of right knee joint which started when he jumped out of a running bus. He cannot make his knee straight. His knee gets locked during bending. What is the most appropriate first line investigation for this condition?

A 6-year-old girl presented by her mother with generalized vesicular eruption and fever for the last 4 days. Her mother states that some of her rash has changed from vesicles to dry scabs over the past 1 day. Examination reveals vesicles on erythematous base scattered all over the body particularly severe on face and trunk. What would be the most appropriate management in this patient?

A 40-year-old patient has been brought to your clinic after having ingested a large amount of methylated spirit in a wedding party. The patient complains of nausea, vomiting and abdominal pain. Which one of the following agents will you use as antidote?

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 24-year-old navy officer presents with itching and skin rash in groins for 2 weeks. There is reddened moist glazed area in inguinal regions.What is single most appropriate treatment?