Q1. Agitation in Alzheimer's Disease An 82-year-old woman with moderate Alzheimer's disease is becoming increasingly agitated and aggressive despite non-pharmacological interventions. Medication is being considered. Which of the following is the most appropriate first-line antipsychotic? A. Aripiprazole B. Clozapine C. Olanzapine D. Quetiapine E. Risperidone Q2. Persistent Parotid Swelling A 60-year-old man presents with a unilateral parotid swelling for 2 months associated with drooling of saliva. Examination confirms a firm parotid mass. What is the most appropriate initial investigation? A. Chest X-ray B. CT head C. Fine-needle aspiration cytology (FNAC) D. MRI neck E. Ultrasound Answer: C. FNAC Q3. Progressive Visual Loss A patient presents with progressive visual deterioration. Fundoscopy shows a pale optic disc in one eye and a pink optic disc in the other. Which investigation is most useful to assess visual field defects? A. CT brain B. MRI brain C. Perimetry D. Tonometry E. Visual evoked potentials Answer: C. Perimetry Q4. Excluding Malaria A traveller returns from overseas with daily fever and rash. Malaria is suspected. Which investigation is required to exclude malaria? A. Blood culture B. Malaria rapid antigen test only C. Peripheral blood film repeated over several days D. Stool culture E. Ultrasound abdomen Answer: C. Peripheral blood film repeated over several days Q5. Generalised Itching A woman presents with intense itching and scratch marks over her body. There are no visible primary skin lesions. What is the most appropriate initial treatment? A. Loratadine B. Oral prednisolone C. Permethrin cream D. Topical steroid cream E. UV phototherapy Answer: A. Loratadine Q6. Alzheimer's Disease and Refusal of Treatment An elderly woman with Alzheimer's disease wishes to return home. Her family believes she does not need medication. What is the most appropriate management? A. Arrange daily nursing supervision B. Deny discharge home C. Tell her she must take medication before discharge D. Encourage her son to ensure medications are taken at home E. Transfer to residential care Answer: D. Encourage her son to ensure medications are taken at home Q7. Adolescent Requesting Contraception A 13-year-old girl requests contraception and asks that her parents not be informed. What is the most appropriate next step? A. Assess her competence and understanding B. Deny contraception C. Inform her parents D. Require parental consent E. Refer to child protection immediately Answer: A. Assess her competence and understanding Q8. Collection of Insulin by Partner A woman attends to collect insulin prescribed for her boyfriend who is busy at work. What is the most appropriate action? A. Call the patient to confirm consent and then provide it B. Deny the request immediately C. Give the insulin without question D. Refer her to another pharmacy E. Require written consent only Answer: A. Call the patient to confirm consent and then provide it Q9. Epidural in Labour A woman in labour is 9 cm dilated and requests an epidural. Her husband states they had previously agreed not to have one. What is the most appropriate management? A. Arrange epidural after confirming the woman's wishes B. Deny epidural because of previous agreement C. Follow the husband's wishes D. Wait until delivery is imminent E. Obtain husband's written consent Answer: A. Arrange epidural after confirming the woman's wishes Q10. HIV Prevention Advice A man recently diagnosed with HIV attends with his husband seeking advice. What is the most appropriate recommendation? A. Abstain from all oral sex B. Avoid all sexual activity C. No prevention is necessary D. Use condoms consistently E. Separate sleeping arrangements Answer: D. Use condoms consistently Q11. Social Anxiety Disorder A university student is extremely shy, blushes frequently, struggles to make friends and repeatedly drops out of social activities. What is the most appropriate treatment? A. Cognitive behavioural therapy (CBT) B. Interpersonal therapy
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