1. What is the specific test used for diagnosis of Latent Tuberculosis?

a. Mantoux test
b. Acid fast bacilli on ziel nelseen staining
c. Peritoneal Tapping
d. Incubate cultures on Lowenstein Jensen Medium
e. Lumbar puncture
2. Which of the following anti-Tb treatment can cause orange-red
discolouration in urine?
a. Isoniazid
b. Pyrazinamide
c. Rifampicin
d. Streptomycin
e. Ethambutol
3. The following is the treatment that can be given for patients with
chronic peptic ulcer disease except
a. Antacid
b. H2 receptor agonist
c. Proton pump inhibitor
d. Mucosal protective agents
e. Prostaglandin analogue

Questions 4 and 5 refer to the following case.

4. A 25-year-old man presents to the neurologist for follow-up evaluation
of epilepsy that started in his teens. The patient averages approximately 3
to 4 seizures per month. His seizures are preceded by a warning of dj vu
and a rising abdominal sensation, followed by lip smacking and speech
arrest for 1 to 2 minutes and then postictal disorientation and amnesia.
What is this patients most likely diagnosis?
a. Atypical absence seizures
b. Gelastic seizures
c. Myoclonic absence seizures
d. Partial seizures originating in the frontal lobe
e. Partial seizures originating in the temporal lobe
5. Previous medications have included carbamazepine, valproate sodium,
and topiramate, alone and in combination, but the patient continues to
have frequent seizures. Two years prior, magnetic resonance imaging
(MRI) of the brain showed a discrete lesion that was compatible with
mesial temporal sclerosis. What is the most appropriate next step in this
patients treatment?
a. Administer a different antiepileptic
b. Insert a vagal nerve stimulator
c. Obtain an EEG
d. Refer to the neurosurgeon.
e. Repeat MRI of the brain

6. A 21-year-old woman presents to the ED after experiencing a first-time

convulsive seizure. A friend observed the patient suddenly falling at home
and convulsing for 45 seconds. Afterwards, the patient was lethargic for
15 minutes but then recovered completely without residual neurologic
deficit. She sustained a tongue bite during the seizure and was
incontinent of urine. What is the most appropriate next step in the
management of this patient?
a. Initiate an antiepileptic drug
b. Obtain an EEG and a neuroimaging study
c. Obtain a serum neuron-specific enolase level
d. Perform a lumbar puncture for CSF analysis
e. Obtain ECG recording
7. A 49-year-old obese man presented with a nighttime attack of swelling,
tenderness, redness, and sharp pain in the big toe for the last 2 days. He
also complained of having pain at the ankle.
Which of the following drug cannot be given and is contraindicated in this
patient?
a. Ibuprofen
b. Morphine
c. Aspirin
d. Diclofenac
e. Indometacin
8. An blood investigation carried out to a man who came with joint
stiffness in the morning revealed a positive test result of anti cycliccitrullinated peptide (CCP).
Which of the following is the diagnosis ?
a. Septic arthritis
b. Transverse myelitis
c. Rheumatoid arthritis
d. Osteomyelitis
e. Hypertrophic pulmonary osteoarthropathy

9. In a patient with a diet high in meat and seafood, high in beverages

sweetened with fruit sugar (fructose) and untreated high blood pressure,
diabetes, heart and kidney diseases.
What is the most likely condition which can occur?
a. Diabetic Ketoacidosis
b. Gout
c. Osteoporosis
d. Liver cirrhosis
e. Portal hypertension
10. Which of the following is NOT a common clinical symptom of
hypothyroidism?
a. Cold intolerance
b. Depression
c. Diarrhea
d. Muscle cramps
e. Weight gain
11. Hashimoto's disease is:
a. Chronic inflammation of the thyroid gland
b. Diagnosed most frequently in Asian-Americans and Pacific Islanders
c. A form of hyperthyroidism
d. A rare form of hypothyroidism
e. Chronic infection of the thyroid gland
12. GERD is a risk factor for the development of:
a. Celiac disease
b. Biliary Atresia
c. Barrett's Esophagus
d. Inguinal Hernia
e. colon cancer

13. Which of the following measures does not help to prevent chronic
diabetes complications?
a. controlling blood glucose
b. controlling blood pressure
c. eliminating all carbohydrates from the diet
d. regular foot care
e. regular eye examination
14. Clinical manifestations associated with a diagnosis of type 1 DM
include all of the following except:
a. hypoglycaemia
b. Hyponatremia
c. Hematuria
d. Polyphagia
e. hyperkalemia
15. Which of the following condition is the most commonly associated with
acute glomerulonephritis?
a. A congenital condition leading to renal dysfunction
b. Prior infection with group A Streptococcus within the past
10-14 days
c. Viral infection of the glomeruli
d. Nephrotic syndrome
e. Complication of Diabetes Mellitus

16. A 68-year-old man with chronic kidney disease presents with

weakness and progressively worsening shortness of breath. Laboratory
findings show a potassium level of 7.2 mmol/L; an electrocardiogram
reveals tall peaked T waves and widening of the QRS complex. Which one
of the following is NOT indicated in the treatment of this patient?
a. Calcium gluconate
b. Intravenous glucose and insulin
c. Beta blockers
d. Exchange resins (Kayexalate)
e. Dialysis
17. Indications to consider dialysis for a patient with acute kidney injury
except
a. Severe pulmonary oedema
b. Hyperkalemia with significant ECG changes refractory to medical
treatment
c. Arterial blood pH of 7.25
d. Uraemic encephalopathy
e. pleural rub
18. Patients with progressive chronic renal failure typically develop:
a. Hemolytic anemia
b. Aplastic anemia
c. Hypochromic, microcytic anemia
d. Normochromic normocytic anemia
e. Macrocytic anemia
19. The following is known feature of infective endocarditis.
a. Spider naevi
b. Osler nodes
c. Jaundice
d. Past history of pulmonary TB.
e. Duputyren contracture

20. Which one of the following is a recognized manifestation of Crohns

disease.
a. Retinitis pigmentosa
b. Erythema multiforme
c. Discoid lupus erythematosus
d. Dermatitis herpetiformis
e. Uveitis
21. Which one of the following would favour the diagnosis of ulcerative
colitis rather than Crohns disease.
a. Non caseating granulomata
b. Crypt abscesses
c. Enterovesical fistula formation
d. Oral ulceration
e. Failure to respond to oral methotrexate
22. Which ONE of the following is NOT true in thalassemia intermedia?
a.

It may be due to homozygous thalassemia

b.

It is associated with extramedullary haemopoiesis

c.

It is usually associated with splenomegaly

d.

It may cause iron overload

e.

It is associated with ineffective erythropoiesis

23. Which ONE of these statements is TRUE about thalassemia major?

a. It presents at birth
b. It is caused by a defect in globin synthesis
c. It is associated with splenomegaly
d. It is associated with an increased risk of bone infarction
e. Iron overload does not normally occur

24. You are called to see a 67 year old dyspnoiec patient in the ED. The
patient has a respiratory rate of 32/min. He has become confused, systolic
blood pressure is 100 mmHg and a Urea nitrogen of 8 mmol/L. Using the
CURB-65 score, the patient has a score of:
a. 2 points and the patient should be discharged from the hospital with
a prescription for antibiotics
b. 2 points and the patient should be moved to an ICU for treatment
c. 4 points and the patient should be moved to an ICU for
treatment
d. 4 points and the patient should be monitored a day or two in the ED
e. 3 points and the patient needs to be moved to the ICU for treatment
25. Liver cirrhosis is pathologically defined as a diffuse liver abnormality
characterized by massive fibrosis and abnormal regenerating nodules. The
main etiology of liver cirrhosis in Malaysia is
a. Alcohol abuse
b. Portal hypertension
c. Hepatitis B virus infection
d. Ascites
e. Crohns disease
26. A 44-year-old man presents to the casualty with a history of six
months of frequent central chest pain in the early morning or during the
night. He had no chest pain on exertion.For the present episode, the had
been particularly severe , lasting over 20 minutes . His pulse rate is 84
beats/min in sinus rhythm and blood pressure is 134/86 mmHg. The ECG
shows anterior ST-segment elevation in leads V1 to V4, but troponin levels
do not rise. Subsequent coronary angiography is normal. What is the most
likely diagnosis?
a. Myocardial infarction
b. Stable angina
c. Unstable angina
d. Anxiety

e. Variant angina
27. Liver cirrhosis may be entirely asymptomatic or may be found
incidentally at surgery or may be associated with minimal features such
as isolated hepatomegaly. The sign of hepatomegaly in liver cirrhosis is
uncommon in
a. Viral hepatitis
b. Alcoholic liver disease
c. Autoimmune liver disease
d. Non-alcoholic fatty liver disease
e. Primary sclerosing cholangitis
28. The most common risk factor for chronic obstructive pulmonary
disease is
a. air pollution
b. exercise
c. bat dropping
d. infection
e. tobacco smoke.
29. A young girl complains of nocturnal cough and shortness of breath
which disturbs her sleep. A diagnosis of bronchial asthma is made. The
most important investigation to confirm diagnosis is
a. chest X-ray
b. eosinophil count
c. lung function test
d. serum Ig G LEVEL
e. sputum examination
30. A 50 year old smoker presents with history of productive cough with
mucoid sputum in every winter for last 3 years . the most likely diagnosis
is
a. bronchial asthma

b. bronchiectasis
c. bronchogenic carcinoma
d. chronic bronchitis
e. pulmonary tuberculosis