MARCH 2018 PLAB 1 RECALL

1. A 26 year old woman in her first pregnancy with heavy vaginal bleeding at 40 weeks GA . Uterus was
hard and tender . What is the most likely diagnosis

A. Cervical ectropion

B. Vasa previa

C. Placental abruption

D. Placenta previa

2. A 14 year old girl was weighed by the school nurse and BMI was 15 kg/m2. She was raised in a strict
vegan family.

Hb 80mg/ dl

MCV 108

What is the most appropriate treatment

A. Ferrous Sulphate

B. Blood transfusion

C. Hydroxocobalamine + folic acid

D. Vit C

E. Pyridoxine

3. A 13 year old girl is short for her age. What is the most likely finding in Turner's syndrome

A. Asplenia

B. Hydrocephalus
C. Ovarian failure

D. Epicanthal fold

E. Polydactyly

4. Woman who had pneumonia was admitted. RBS during admission was elevated. 6 weeks after repeat
FBS and OGTT were normal. 6mmol/ L and 7.1 mmol/ l. What is responsible for the initial elevated sugar
when she had pneumonia.

A. Fanconi's syndrome

B. Impaired glucose tolerance

C. Stress hyperglycaemia

D. Type 1DM

E. Type 2DM

5. A man on warfarin now wants to go for surgery. What's the best preoperative management.

A. Continue warfarin

B. Continue warfarin and start LMWH

C. Stop warfarin and start LMWH

6. A woman who is normotensive before delivery, other parameters normal, uneventful labour;
suddenly convulses 6 hours after delivery. What is the diagnosis?

A. Pre eclampsia

B. Amniotic fluid embolism

C. Pulmonary embolism

D. Eclampsia

7. A man who is a painter of houses has pain in the elbow, lateral epicondyle, worse with lifting heavy
weights. What group of muscles are affected?
A. Forearm flexors

B. Forearm extensors

C. Wrist flexors

D. Wrist extensors

8. Elderly woman brought by her relatives with complaints of 3 day history of shouting and disturbing
neighbours, visual hallucinations, impaired recent memory, confusion. What is the most likely diagnosis

A. Delirium

B. Dementia

C. Schizophrenia

D. Mania

9 . A patient with worsening tiredness, mild jaundice for 2weeks .PR normal, BP normal, HB reduced,
MCV increased, wbc within normal range, bilirubin increased, AST 27,

most appropriate diagnostic investigation

A. Bone marrow aspiration

B. Antiglobulin

C. Fecal occult blood

D. Serum ANA

10. A child with duchenne muscular dystrophy, inability to climb stairs, thickened calf muscles. Which of
the following anatomical sites will be affected

A. Striated muscle

B. Ventral horn

C. Myelin sheath

D. Motor end plate

11. 66 year old man with advanced COPD who had to sit up in bed or a chair at night due to dyspnoea.
He also experienced panic attacks and had to take deep breaths.He is on 100% Oxygen but still
dyspneic.What other management will help improve his dyspnoea.

A. Antibiotics(Intravenous)

B. Prednisolone

C. Promethazine

D . 0.9% Normal Saline (Nebulise)

12. A woman complains of urinary incontinence worse when she coughs and sneezes she has 4 children
all between 21 to 27 yrs. She can't go out due to the incontinence. What is the most appropriate initial
management?

A. Pelvic floor exercises

B. Rings

C. Pass urethral catheter

D. Duloxetine

13. A young woman trying to conceive has a regular 35 day cycle. Did hormone profile on day 15.
Results stated FSH, LH, Estradiol normal. Progesterone 10nmol.hat is the problem

A. Did progesterone on the wrong day

B. PCOS

C. Hypothalamic problem

14 A man who had total gastrectomy now present with features of vit B 12 deficiency what is the
mechanism.

A. Folate deficiency

B. Malabsorption

C. Rapid transit time

D. Deficiency of intrinsic factor

15. A young man was trapped under a shelve of some rumbles. He now presents with features of anuria
and myoglobinuria. What is likely to predict the cause of anuria.

A. Acetylcholine

B. Creatine kinase

C lactose dehydrogenase

D Troponin

16. A 65 year old woman has been increasingly distressed and crying, she forgets to lock her doors and
turn off the stove. Her mini mental state exam is 26 out of 30. What is the most likely diagnosis.

A. Alzheimers disease

B. Bipolar affective disorder.

C. Pseudodementia

D. Mania

E. Schizophrenia

17. A 2 year old boy developed a rash after 2 days of being unwell, he also experiences exacerbation of
his eczema, what is the most appropriate management.

A. Antibiotics (systemic)

B. Antifungal (systemic)

C. Corticosteroids

D. No treatment required

E. Antiviral

18. 10000 women underwent cervical smear screen. 1000 of them had repeat smear and were
confirmed to have premalignant changes, 100 of these underwent treatment for the cervical changes,
10 of the women who were comfirmed to have no premalignant cervical changes developed cervical
cancer within 6 to 12 months, what is the term to describe the women confirmed to have premalignant
cervical changes.

A.False negative

B.False positive

C. Incident group

D. True negative

E. True positive

19. A 35 year old woman with sensitivity to cold in her hands, with swelling in the fingers. Has ulcers in
the mouth and rashes on the cheeks and nose. What is the most likely positive auto antibody

A. Anti CCP

B. Anticardiolipin ab

C. Anti DS DNA

D. Antismooth muscle ab

E. Anti neutrophil cytoplasmic ab.

20. A 45 year old man following abdominal surgery had his pain controlled on oral morphine 60mg twice
daily. However recently he's been unable to take his oral medication. What is the most appropriate
management

A. Oxycodone elixir 40mg 4 hrly

B. Commence morphine 60mg per 24 hrs by continuous subcutaneous infusion.

C. Commence oral oxycodone 10 mg 4 hrly

D. Oral morphine elixir 20mg 4 hrly

E. Morphine 240mg per 24 hrs by continuous subcutaneous infusion.

21. 75yr old with previous history of renal calculi now have increasing dizziness and confusion. 350mls of
urine drained. Cr is 750 and K is 5.9mmol/l.
What is most appropriate investigation?

A. Abd USS

B. Auto Antibody Test

C. Estimated GFR

D. Renal Angiography

E. Urine m/c/s

22. Patient has polyuria and polydipsia, has history of treated lung cancer.

Urea value is high

Creatinine is also high

Serum corrected calcium is 3.0mmol/l

What is next most appropriate biochemical investigation

A. 24hr Urinary calcium

B. Serum Alkaline phosphatase

C. Serum magnesium

D. Serum PTH

E. Serum Phosphate

23. 23yr with sudden onset of diarrhea for 6 episodes per day over 5days ,with associated abdominal
cramp and nausea. Abdomen is not tender and soft.

Most appropriate investigation

A. Stool fat test

B. Fecal occult blood

C. Stool sugar reducing test

D. Stool m/c/s
24. A 3yr old with fever, rash, conjunctivitis, cattarh with a lesion in the mouth.

Diagnosis?

A. Erythema multiforme

B. Roseola

C. Measles

D. Rubella

25. A man with moderate depression and 6 months history of previous MI.

What the most appropriate treatment.

A. Mood stabilizers

B. Antipsychotics

C. SSRIs

D. ECT

E. TCAs

26 . A 54 year old man with Type 2 DM being treated with diet alone for the past 3 months,BMI-
33kg/m2, FBS-12.4mmol/l,glycosuria,eGFR-29ml/min,creatinine 220mmol/l. Treatment

A Advice a sugar free diet

B Prescribe alpha glucoronidase

C Prescribe biguanide

D Prescribe a DPP-IV inhibitor

E Prescribe sulfanylurea

27. A 22yr old with recurrent fainting spells since childhood.. ECG parameters were given but the only
abnormality was prolonged QT. What is the most likely diagnosis

A. Ventricular tachyarrthymias
B. Asystole

C. Atrial fibrillation

D. Sick sinus syndrome

28. An elderly man with HR 34 and Ecg showed ventricular rate of 64 and p wave of 40. What is the
most likely diagnosis

A. Complete block

B. 1st degree

C. 2nd degree

29. A patient had MI. Ecg showed St depression. What is the next appropriate management

A. Factor Xa inhibitor and anti platelet

B factor Xa inhibitor and statin

C. Statin and anti-platelet

30. A patient with flaccid paralysis of lower limbs. Now spread to upper limbs. What's the mechanism of
the paralysis...

A. Blockade of the end plate

B. Antibodies against myelin sheath

C. Degeneration of axons

31. A 26 year of female presented to the clinic with 3 episodes of tonic clonic convulsions, there were
no drooling of saliva, frothing or incontinence. Every seizure episode has happened in front of an
observer. What's the most appropriate investigation.

A. EEG

B. CT

C. MRI
D. Blood Glucose

E. Video electroencephalogram.

32. A woman that overdosed on PCM was unconscious and rushed to the A&E by her relatives, 4hr PCM
level was above N-acetylcystiene level. What is the best management

A. Wait for consent from relatives

B. Start treatment and obtain collateral information

C. Consult hospital legal department

D. Observe

33. A 22 year old footballer was brought to the A and E with a locked right leg and inability to extend the
knee at 30 degrees. It happened when he tried catching the ball and he landed with the leg twisted.
What is the likely diagnosis

A. Torn medial meniscus

B. Stretched anterior collateral ligament

C. Fractured patella

D. Fractured medial femoral condyle

34. A 35 year old woman with a breast mass . Histology shows a well defined mass , separated from the
surrounding fatty tissue . What is the most likely diagnosis?

A. Fibroadenoma

B. Fibrocystic breast disease

C. Breast Ca

35. An 18 year old was bought to the A and E confused and drowsy. He has been anxious and depressed.
He is suspected to have overdosed.
ABG shows

PCO2 4kpa

PO2 17kpa

HCO3 18mmol/l

PH 7.3

what is the most likely drug overdosed?

A. Propranolol

B. Amytriptylline

C. Aspirin

D. Daizepam

E. Paracetamol

36. 52 yr old brought to the ED with 1 hr hx of central crushing chest pain….(ECG pix attached). Which
part of the heart had MI?

A. Anterolateral wall of the left ventricle

B. Anteroseptal wall of the left ventricle

C. Posterior wall of the left ventricle

D. Right ventricle

E. Ventricular septum

37. 32 yr old man presenting with severe pain and swelling in scrotum for 48hrs; feels unwell;
associated pain on passing urine; what is the most likely diagnosis?
A. Acute epididymoorchitis

B. Epididymal cyst rupture

C. Renal calculi

D. Torsion of cyst of morgagni

E. Urinary tract infection

38. 56 yr old woman found with glycosuria at routine medical examination. FBS is 6mmol/L; OGTT after
2 hrs- 9mmol/L. Diagnosis?

A. Cushing”s syndrome

B. Fanconi’s syndrome

C. IGT

D. T1DM

E. T2DM

39. A woman with back pain and other symptoms of secondaries to the back. Where's the likely source
of the cancer

A. Cervix

B. Ovary

C. Breast

D. Pancrease

40. Woman who had mastectomy 4yrs ago,on treatment for depression with fluoxetine, presents with
hx of thirst and confusion. What was the cause of the symptoms

A Hyponatraemia

B Hypercalcemia

C. Cerebral Oedema
41. A 31 year old lady with disseminated renal CA presents with bilateral leg swelling up to the groin
with associated dilated lower abdominal veins. What's the cause

A. Lymphedema

B. Portal vein occlusion

C. Right heart failure

D. IVC occlusion

E. Hypoalbuminemia

42. A pt who has been on 5% Glucose has become drowsy and had clinical features and lab investigation
suggestive of hyponatremia. what's the pathologic mechanisms

A. Cerebral oedema

B. Osmotic dymelination

C. Osmotic shrinkage

D. Complex partial status epilepticus

43. 75yr old presents 6times in a 3week period for bruised face and forearm. What's his diagnosis

A Occult malignancy

B. Scurvy

C. NAI

D Bleeding disorder

E Vasculitis

44. 72yr old man on 4th course chemotherapy 8days ago for small cell Ca with cough and sputum.
Exam- coarse crep in right base Temp 37.6, PR 92bpm. Samples sent to lab

Hb- 125g/L, wbc- 1.1 x 10^9/L, plt- 89x10^9/L. What would u do

A. Broad spectrum antibiotics( oral)

B. Broad spectrum ab( IV)

C Granulocyte-colony stimulating factor

D. Wait for lab results

E. Reassure and send home

45. Patient who had endoscopy and treated for peptic ulcer. How to confirm he is H. Pylori free

A. Urea breath test

B. Endoscopy

C. H. Pylori serology

46. A girl who fought with her boyfriend , was brought to ED after harming herself. What is the most
likely diagnosis

A. Bipolar disorder

B. Borderline personality

C. Mania

47. 40 year old man has difficulty walking. Has left foot drop with weak external rotation. reflexes are
intact but diminished pin prick sensation. What is the most appropriate option

A. Common peroneal

B. Saphanous

C. Femoral

D. Sural

48. A 71 year old lady with hematemesis with stable vital signs. She has a history of chronic NSAIDS use
for osteoarthritis. How would you manage?

A. Antibiotics IV

B. Antacids oral
C. Antiemetics oral

D. PPI I.V

49. A 39 yr old woman presented with yellowness of sclera.

Hb low, bilirubin increased, other liver enzymes normal.

Blood film showed polychromasia and a few spherocytes but no target cell.

What is the diagnostic inv

A. Antiglobulin test

B. Auto antibody test

C. Bone marrow aspiration

50. A man with MI, took some drugs OD. ABG showed low pH, low HCO3, high PC02. What is the most
likely drug overdosed

A. aspirin

B. Amitriptylline

C. Digoxin

51. A 35 year woman presented with severe pain in the right breast, Intermittent, radiating to the axilla.
Tenderness in the outer aspect of breast, no palpable mass

What's the most likely diagnosis

A. Cyclical Mastalgia

B. Ductal Carcinoma in situ

C. Fibrocystic disease
D. Mondor disease

E. Non-cyclical Mastalgia

52. A woman who had 12hrs history of sudden onset persistent headache. All neurological
examinations we're normal. She was given 1.V opiods and she is better. What is the next appropriate
step ?

A. LP

B. Subcut sumatriptan

C. CT brain

53 .A 73 year old woman who stays alone after the death of her husband 4 months ago. For 3 months,
she is becoming forgetful, more socially withdrawn, contacts her children less frequently, late in
response to her bills. Recent memory is impaired, tends to memorise things but blames impairment on
tiredness.

What's the most likely diagnosis

A. Alzheimzer's dementia

B. Frontal Dementia

C Normal Grief Response

D Pseudodementia

E Vascular dementia

54. A 67 year old with metastasis from CA of bronchus with increasing weakness and drowsiness,
nausea. She is now confused and has fallen twice

Sodium (Normal)

Potassium (Normal)

Urea (Normal)
Creatinine (Increased)

Calcium (Increased)

What's the most appropriate initial treatment

A. Bishosphate

B. Calcitonin

C. Calcium Gluconate

D. Dexamethasone

E. 0..9% N/S

55. A man with repeated chest infections during childhood presenting with fever, mucopurulent sputum.
Antibiotics have been given.

What is the definitive management

A. Physiotherapy

B. Oxygen

C. Antibiotics

D. Corticosteroids

56. 58yr old man has major depressive illness following wife's death 4 mth ago. He is on mgt for MI and
arrythmia. Most appropriate medication

A. Venlafaxine

B. Amytrptilline
C. Moboclomide

D. Phenelzine

E. Sertralline

57. A 45 yr woman,3mth hx of dizziness, nausea, vertigo, postural hypotension .Na reduced , K and urea
elevated, normal Creatinine . What is the commonest mechanism for these condition in the UK?

A. Amyloid infiltration

B. Metastasis

C. Autoimmune

D. Medication

58. Parents don't have CF, one child has CF, risk for future children having Cystic Fibrosis

A. 1:2

B. 1:4

C.1:3

59. 45yr old man with herpes zoster on dermatome of maxillary branch of trimeminal nerve . Which
mucous membrane is involved

A. Conjunctiva

B. Cheek

C. Lips

D. Eyelids

60. A 28 year old woman attends ANC. She is concerned about fetal anomaly in her unborn child . Which
of the following will you prescribe for her

A. Bit C

B. Folic acid
C. Ferrous sulphate

61. A woman presently on Depoprovera but has menorrhagia with a history of PID wants to know the
most import risk factor for ectopic pregnancy

A. Menorrhagia

B. PID

C Depot provera

62. A man with cough and shortness of breath. Also smokes about 15 cigarettes dlaily .Chest Xray
showed hilar opacities, history revealed polygonal cell, dark and Keratin-producing . Choose the most
appropriate option

A.Small cell Ca

B. Large cell Ca

C. Squamous cell Ca

63. A woman who now has atrial fibrillation, with history of left hemiparesis four days ago, has flaccid
paralysis, BP is 150/90mmhg, CT scan shows cortical infarct. What's appropriate prophylaxis

A. Aspirin 300mg

B. Aspirin 75mg

C. TPA

D. Warfarin

64. A woman with lower abdominal pain, vaginal discharge, temp 38.2, four weeks of amenorrhea.
What's the most likely diagnosis

A. Appendicitis

B. PID
C. Ectopic pregnancy

D. Ovarian torsion

65. A 25 year old male with sub sternal pain worse on inspiration, smokes 20 sticks of cigarette daily,
drinks 50 units of alcohol weekly, chest is clear, temperature 38, abdomen is soft RR-18, BP
110/70mmhg. Most likely diagnosis

A. MI

B. Pericarditis

C. PE

D. Pneumonia

66. A case of esophageal Ca and a history of dysphagia.

What is the next line of management?

A. Radiotherapy

B. Chemotherapy

C. Stenting

67. A 72 year old man who was treated for liver disease. His liver enzymes are now normal. What's the
most appropriate investigation to do next?

A. ERCP

B. MRCP

C.LFT

D. Repeat US
68. A child presents with pain around the right eye, he is febrile; temperature 38.5 and there is redness
and swelling around the eye. What is the likely diagnosis

A. Allergic

B. Foreign body

C.Conjunctivitis

D. Periorbital cellulitis

69. A 28 year old man at a traffic, sees the amber turn green and says his mother is calling him, turns
back and goes home. He has 4 months history of hallucinations. What is the most likely diagnosis

A. Schizophrenia

B. Bipolar disorder

C. Depression

70. A 25 yr old woman had a seizure 6hours post delivery, prenatal and post delivery blood pressure was
normal. What is the diagnosis

A. Amniotic fluid embolism

B. Cardiac arrhythmias

C. Eclampsia

D. PE

E.SAH

71. A 32 year old man that carried a heavy load, now complains of back pain that radiates down his left
leg. What is the diagnosis..

A. Prolapsed intervertebral disc

B. Sacroiliitis

C. Lumbar spondylosis
72. A retired army officer with features of PTSD, what is the first-line of management?

A. CBT

B. Fluxetine

C. Olanzepine

D. Benzodiazepine

E. Quietapine

73. A man with features of hypovolemic shock, sweating . Had RTA with bruises on the abdomen. What
mechanism explains the manifested symptoms

A. Increased sympathetic activities

B. Increased Aldosterone

C. Increased ADH

D. Reduced blood sugar

74. A 60year old man has had a major abdominal surgery. He is not a known smoker and has not been
on any medications. His pain is being effectively controlled with epidural analgesia. Ten hours post-
operatively, he's noticed to have made only 30mls of urine. Patient is otherwise alert and well. BP is
90/60. Pulse is 90bpm.

What is the most appropriate initial management.

A. Stop Epidural Analgesia

B. IV Fluids

C. Flush urethral catheter

D. Bladder Ultrasound Scan

75. A child with rashes on her back that has spread to her legs, temperature was 38 degrees, and she is
unwell(picture attached). Choose the most appropriate option
A. Chicken pox

B. Kawasaki

C. Measles

76. A woman with 2 siblings diagnosed with ovarian cancer. She is worried about having the same
diagnosis. Her pelvic ultrasound is normal. What is the appropriate management

A. Bilateral oophorectomy

B. Bimanual pelvic examination

C. Ca 125

D. Measure FSH /LH level

E. Send for genetic counselling

77.56 year old woman with diplopia on looking to the right. She is in good health. No history of head
trauma. Which nerve is affected.

A. Left abducent

B. Right abducent

C. Left trochlear

D. Right trochlear

E. Left oculomotor

78. Man with squamous cell carcinoma of the lung has shoulder pain. Responding to oral morphine but
was changed to Fentanyl patch because of vomiting. He was placed on metoclopramide. Now has neck
stiffness. What is the course of the symptom?

A. Metastasis

B. Fentanyl patch

C. Hypercalcemia

D. Metastatic meningitis
E. Metoclopramide

79. 6 weeks old baby with abdominal protrusion. History of vomiting which is non bilous. What is the
appropriate diagnostic investigation?

A. Barium meal

B. Abdominal X ray

C. abdominal US

80. A patient with high fever, normal pulse and BP. Patient is photophobic and with neck stiffness. CT
has been ordered. What drug will you give immediately.

A. Gentamicin

B. Ceftriaxone

C. Vancomycin

81. Patient presents with severe exacerbation of COPD,was on nebulized salbutamol and 100% oxygen .

Blood;ph 7.2

PCO2- 12.0

PO2 -11.0

Most appropriate treatment.

A. Physiotherapy

B. 24% oxygen

C. Increase dose of salbutamol

82. Post rectal carcinoma surgery, 5days after patient presents with temperature 36.8, lower abdominal
tenderness.

A Pellvic hematoma

B Pelvic abscess
C. Anastomotic leak

83.Patient with type2 diabetes mellitus. BMI 28

Normal urine function

Treatment?

A .Insulin

B. Metformin

C. Sulphonylurea

84. Patient with asthma, on nebulised salbutamol and beclomethasone, allways wakes up at night to
take inhaled salbutamol

Treatment?

A. LABA

B. IV salbutamol

C. Magnesium sulphate

D. Increase dose of salbutamol

85. Patient had carotid angiogram, two carotid stents were placed. Trocar on femoral artery was
removed. Patient appeared weak BP 95/60

Next management?

A. Press the thigh

B. IV fluids

C. Doppler scan

86. A 36yr old man has persistent bloody and mucoid discharge from an orifice 2cm posterior to the anal
verge. There is no involvement of the anal sphincter. Whats d appropriate mgt?

A. Botox injection
B. Anal dilatation

C. Defunctional colostomy

D. Anal sphincterectomy

E. Laying fistula bare

87. A 40 yr old man with long-standing nervousness. He describes each episode as feeling very anxious,
choking and has fear of death.

What is d best long term management?

A. Benzodiazepines

B. Beta blockers

C. Mood stabilizers

D. Neuroleptic

E. SSRI

88. 28 yr old having left sided colicky loin pain radiating to the groin with associated nausea and
intermittent vomiting. He is writhing in pain. Urinalysis done: blood 4+

What is the most sensitive investigation in making diagnosis?

A. Intravenous urography

B. MR urography

C. Non- contrast CT urography

D. Plain abdominal X-ray

E. US of the urogenital system

89. A 35 yr old with diarrhoea, MCV-106, blood film is dimorphic, histology of small intestine was done.
What is the likely pathology seen.

A. Villous atrophy

B. Lymphocytic infiltration of submucosa

C. Intraepithelial macrophages

90. A man with supraclavicular mass and loss of appetite and weight loss. What is the most likely
diagnosis

A. Gastric Can

B. Esophageal Can

C. Tuberculosis

91. 30 yr old male with sudden collapse. GCS 6, headache, vomiting x2 days. Next appropriate action

A. CT scan

B. lumbar puncture

C Secure airway

D Observe

92. A patient passes bloody stool 8times and had been on oral mesalazine. What is the next appropriate
management

A. I V Hydrocortisone

B. Oral mesalazine and sterods

C. Oral Prednisolone

93. 66yr female. 12hrs headache and nausea. CT scan normal. Morphine already given for her pain. Next
action

A Observe for 48hrs

B MRI

C Do Lumbar puncture

D Repeat CT scan
94. 56yr old with arthritis in the index finger, Shoulder, hip , knee joints for 2yrs. Patient is diabetic and
has gynecomastia.

Likely diagnosis

A. Hypercalcemia

B. Hyperprolactinemia

C. Haemochromatosis

D. Hypothyroidism

95. A 35yr old man with Rt iliac fossa pain, mouth ulcers and diarrhea for the past year

A .Ulcerative colitis

B. Celiac disease

C. Crohn disease

D. Bacteria superinfection

96. A man who was successfully treated for bronchial CA 2 yrs ago, now presents with polyuria,
polydipsia and serum corrected calcium was high. What other biochemical test is needed for diagnosis

A. 24 hour urine calcium

B. Serum parathyroid hormone

C. Serum phosphate

97. A 38 year old woman with axillary freckles and cafe au lait spots. What is the risk passing this
condition to the offspring

A. 1:2

B. 1:4

C. 3:4
98. A 71yo man with vascular dementia presents with some rt sided weakness and swallowing difficulty.
He previously had good appetite but no longer eats. However still takes medications. O/e: white patches
on buccal cavity and pharynx. What is the appropriate tx for px

A. Amphotericin I.V

B. Chorhexidine oral

C. Flucloxacillin oral

D. fluconazole suspension

99.A 21yo lady presents with weight loss, excessive sweating and tremor. O/e: temp:36.9 PR:90 with
slightly tender enlarged anterior neck mass. FBC: normal.

TSH: low

T4: high

TSH receptor Ab: neg

TPO Ab: neg

What is the most likely diagnosis

A. Hashimoto

B. Graves

C. Subacute thyroiditis

D. Thyroid adenoma

100. 8yo boy presents with 3days, 3wks hx of rt ear pain and hearing loss. O/e: febrile: 39, moderately
enlarged tonsils, rt ear: dull tympanic membrane, Lt: normal with enlarged rt cervical lymph nodes.

What is responsible for this childs rt ear ache

A. AOM

B. AOE

C. Secretory otitis media

D. Tonsillitis

E. Acute mastoiditis

101. You suspect that your colleague is involved in substance abuse . You confronted him and he denied.
What is your next action ?

A. Inform the police

B. No further action

C. Tell nurses to help gather info

D. Tell consultant in charge

102. A 38yr old painter developed burning pain on his left elbow that radiated to his forearm. It was
worsened by lifting heavy objects and firm hand gripping. There was tenderness on his lateral
epicondyle. Which muscle group is affected here?

A. Elbow flexors

B. Elbow extensors

C. Wrist flexors

D. Wrist extensors

E. Wrist pronators

103. A 26yr old man presents with epigastric pain and hematemesis. There's an associated 4day hx of
ingestion of a drug which he cannot remember as he was drunk.

Serum Creatinine, total bilirubin, aspartate transaminase and prothrombin time were all raised.

Which drug was most likely ingested?

A. Amitriptyline
B. Aspirin

C. Paracetamol

D. Venlafaxine

104. A 34yr old woman presents with a 4 week history of itchy rash. She's a taxi driver and doesn't want
a medication that would affect her on her job.

Which drug is most appropriate?

A. Cetirizine tablet

B. Chlopheniramine tablet

C. Hydrocortisone ointment

D.. Prednisolone tablet

105. A 48yr old man with continuous anterior chest pain worse on inspiration. She had an MI about
4weeks ago. Temp. = 36.5 C and ESR = 40mm/hr.

What's the most likely diagnosis?

A. Acute pericarditis

B. Post MI (dressler) syndrome

C. Left ventricular failure

D. Ventricular aneurysm

E. Papillary muscle rupture

106. Patient with sudden loss of vision. Flame-shaped hemorrhage, dot and blot hemorrhage with
swollen optical disc and swollen macula.

What is the most likely diagnosis?

A.Branch retinal artery occlusion

B. Branch retinal vein occlusion

C. Central retinal artery occlusion

D. Central retinal vein occlusion

107. Man with pneumonia and low urinary output.

Elevated urea and creatinine.

Next best step.

A. Furosemide infusion

B. Hemodialysis

C. Saline infusion

D. Dopamine infusion

108. A woman was diagnosed with community acquired pneumonia and started on IV Co-amoxiclav.Ten
minutes later ,she complained of breathlessness and sever itching . On examination, there is a skin rash
and bilateral coarse crepitation.PR is 138bpm. What is the most appropriate management.

A. IM epinephrine
B. IV amiodarone

C. IV chlorpheniramine

D. IV corticosteroids.

E. Nebulized salbutamol

109 An 80 year old woman with breast cancer is increasingly drowsy and has two episodes of
generalized seizures .CT scan revealed multiple cerebral metastasis. Relatives are taking care of her at
home and seizures are well controlled with benzodiazepines. What is the best route of administration of
benzodiazepines.

A.intravenous

B.Oral

C.Rectal.

D.subcutaneous .

E.transdermal.

110. A 50 year old man has persistent cough and increasing shortness of breath. He smokes 20
cigarettes/day .

Haemoglobin 19.8g / dl

Platelets 250.

WBC 9.8.

Hematocrit 58 %

What is the hormone implicated in the blood picture.

A. Erythropoietin

B. Cortisol.

C. Renin.

D.Thyroxine
E. insulin

111. 16yr old sickle cell lady with painful menstruation and crisis during periods. What is the
approximate mgt option

A. COCP

B. Depot Provera

C. Tranxanemic Acid

D. POP

112 A man with 8weeks hoarseness,BMI 32kg/m2, hiatus hernia. Drinks 21units per week. Who to refer
to?

A. ENT

B. Gastroenerologist

C. Dietician

113. A 45 year old woman has a hx of recurrent right breast abscess in the past 3 years. Last episode was
6month ago. On examination a swelling is noticed at the junction of the areola and skin of the right
breast discharging pus. What's the likely diagnosis

A. Breast abscess

B. Duct ectasia

C. Mammary duct fistula

D. CA breast

114. A 43yr old woman presents with a history of 12weeks amenorrhea. Home PT positive. She has a
history of bleeding pv and hyperemesis. She has 2 previous hx of normal vaginal delivery. On
examination uterine size 16wks. What's the diagnosis

A. Ectopic pregnancy

B. Uterine fibroids
C. Incorrect LMP

D. Molar gestation

E. Ovarian tumor

115. A 54 yr old man had a cardiac arrest, he is managed in the ICU and on ventilator. Pr 120bpm, BP
100/50mmhg

Ph decreased

Pco2 increased

Hco3 19

Po2 12

What the appropriate next step in mgt

A IVF

B Bicarbonate

C Inotrope

D Increase ventilation

E Increase FiO2

116 . A 65 year old man that presents with painless hematuria. What is the most appropraite
investigation

A . Flexible cystoscopy

B. Renal scan

C. Abdominal USS

117. A 36 year old woman who presents with complaints of heavy regular menstral flow. What is the
best contraceptive to give her?.

A. COCP

B. IUCD
C. POP

D. Depot Provra

E. Levonogestral IUS ( minera).

118. A young girl was brought to the ED following a drug overdose. She attempted to commit suicide.
What is the next best step

A. Admit in hospital

B. Reassure patient

C. Discharge for follow up

119. An elderly lady with Alzheimer's came to see the GP with her daughter. She wants to change her
will. What will you do as the GP?

A. Go ahead and change the will

B. Refer her to the psychiatrist for assessment of her mental capacity

C. Find out if there is any prior arrangement as regarding the change of will

D. Contact the hospital solicitor

120. A 50 year old patient presented with shooting pain which start from the jaw and radiates. Corneal
reflexes are intact . What is the most likely diagnosis

A. Temporomandibular joint dysfunction

B. Trigeminal neuralgia

C. Dental carries

121. Two trial drugs administered, orally and intravenously,were plotted on a Plasma concentration
curve (AUR) . Why is the oral drug under the curve ?

A. Hepatic first pass metabolism

B. Increased excretion of the oral drug

122. Weakness, lethargy,pain in right hypochondrium.Hepatomegaly with histology of
adenocarcinoma,immunohistochemistry shows TTP-1 which indicates a primary pulmonary tumor.
What’s the route of spread ?

A. Hematogenous

B. Lymphatic

C.Direct spread

D. Transcoelomic

123.Young boy with swollen feet and increase in weight.What investigation would you do ?

A. Albumin

B. Hemoglobin

C.Creatinine Kinase

D. Urea

124. An old woman on warfarin for atrial fibrillation presents with headache and confusion.

What is the most likely dx ?

A. Subdural hemorrhage

B. Alzheimer's dementia

C. Vascular dementia

D. Pick's dementia

E. Dementia

125. A women avoids going in crowded places. She tends to have shortness of breath and sweating
when she goes out. What is the most likely dx ?
A. Social phobia

B Claustrophobia

C. Agoraphobia

D. Panic disorder

E. Depression

126. A 65yr old woman post left hemicolectomy. 3hrs later, bp-60/40 and urine 20ml/litre. What is your
initial management?

A. IVF

B. Blood transfusion

C. IV antibiotics

127. A 26yr old woman has had amenorrhea for 6months. She is fit and athletic. LH: low , FSH: low ,
Estradiol: low. Prolactin 600. What's the most likely diagnosis.

A. Hypothalamic amenorrhea

B. PCOS

C. POF

128. A woman that has uncontrolled type 1 DM. She has drooping left eyelid. Her pupil does not react
to light and accommodation and is deviated downward and laterally. What is the nerve involved.

A. Occulomotor

B. Abducent

C. Optic

D. Trochlear

129. A man was brought by his wife with loss of consciousness. He is now conscious but confused what
is the initial step
A. CT scan of the brain

B. Heparin

C. Streptokinase

130. A 21year man who has pain on urination. There are tender ulcers on the penile shaft. What is the
most appropriate diagnosis

A. Herpes simplex

B. Chlamydia infection

C. Gonorrhea infection

131. A 22 year old man presented with acute shortness of breath and left sided chest pain for 2 hours.
He smoked 20 cigarettes per day for the last 7 years.

What is the most likely diagnosis?

A Acute Exacerbation of COPD

B Asthma

C Myocardial Infarction

D Pneumothorax

E Pulmonary Embolism

132. A 35 year old woman presents with heavy menstrual bleeding, dyspareunia and dysmenorrhea.
What investigation is most definitive for the underlying cause?

A. Pelvic ultrasound

B. Lapascopy

C. Endocervical swab

D. High vaginal swab

133. The remaining dose of 0.5% Lidocaine for an 80kg man who had received 20ml previously. Allowed
maximum safe dose is 3mg/kg.

A. 4ml

B. 18ml

C. 56ml

134. Man who lost his job because he was unreliable. He found wandering. No alcohol. Brought to ED.
What is the most appropriate treatment

A. IV Benzodiazepine

B. IV Thiamine

C. IV Antipsychotics

135. A child without fever, has stridor and RR 28cpm. He got slightly better following nebulization but
worsened soon after. RR = 60c/min. Initial management step.

Options

A. Secure Airway

B. Anaesthetic support

C. I.M Adrenaline

136. A 75year old woman with odd behavior, says people come into her room but her daughter says it's
not true. Her neighbor hears her banging the room. She is on medication for hypertension.

A. Diagnosis.

B. Dementia

C. Delirium

D. Schizophrenia

E. Delusion
137. A woman that was painting and had nausea and fainting. GCS 15. What should be done

A. Check carboxyhemoglobin level

B. CT scan

C. MRI brain

138. A middle aged woman with pruritis and intermittent jaundice . Choose the most likely option

A. Ca head of Pancreas

B. Choleric hoping I as is

C. Hepatitis

139. A young man with hematuria and hypertension. He is otherwise healthy . What is the most
diagnostic test ?

A. Renal ultrasound

B. 24 hour urine protein

C. Abdominal Xray

140. A 25 year old man had productive cough, intermittent fever, and 4 episodes of hemoptysis. He has
apical crackles. What is the most initial diagnostic microbiological test?

A. Bllood for CMV

B. Sputum for AFB

C. Sputum for PCP

141. A man was brought to you after 36 hours of weakness of the lower limbs and it has affected the
upper limb, there is flaccid paralysis, loss of reflex and mild impairment of sensation. He was previously
well

What is the cause of this disorder

A. Neuromascular blockage

B. Demyelination of neurons

C. Infltration of the neuron by amyloid

D. Degeneration of pyramid tract

142. A man who had myocardial infarction with heart failure . When he was being taken to the ward, he
developed hot swelling in the big toe. What drug could precipitate it

A. Aspirin

B. Ramipril

C. Dimorphine

D. Frusemide

143. A man with previous history of myocardial infarction developed right sided hemiplegia with sensory
loss associated with dilated pupil, ptosis and the eyeball turning down and laterally

Which part of the brain was affected

A. Cerebrum

B. Cerebellum

C. Midbrain

D. Pons

E. Medulla

144. A man with history of psychiatric illness says he hears someone call his name when he wakes up in
the morning.

What type of hallucination is this?

A. Hypnogogic

B.Hypnopompic

C. Lilupitian
145. A 2 year old girl develops fever, vesicular rash in the trunk spreading to the limbs

What is the management

A. IV acyclovir

B. Oral acyclovir

C. No treatment needed

D. Steroid

146. A young man sustained multiple injuries from RTA. His bp is 70/40mmhg, pulse rate 130bpm. A
FAST assessment revealed large collection of free fluid in peritoneal cavity. His family said he is a
Jehovah witness and states that he won't have blood transfused. They have no written declaration
concerning that.

What is the next appropriate action

A. Talk to the hospital's solicitor

B. Let the relatives sign a disclaimer

C. Contact Jehovah witness council

D. Initiate a blood transfusion

147. A 51 year old woman has irregular heavy vaginal bleeding for 6 months. She has hot flushes and
night sweats.

What is the initial investigation for the symptom?

A. Hysteroscopy and endometrial biopsy

B. Serum estradiol

C. Serum FSH
D. Transvaginal scan

E. Laparoscopy

148. A woman has a thick whitish vaginal discharge since being on antibiotics prescribed by her dentist
for dental abscess.

what is the diagnosis?

A. Candidiasis

B. Gardnerella

C. Neisseria

D. Chlamydia

E. Herpes simplex

149. A man with dyspnea and weight loss. Bp is very low

ABG:

Ph 7.15

PCO2 2.2kpa

PO2 12kpa

Urea 15

What is the most likely acid base disturbance?

A. Compensated respiratory acidosis

B. Compensated resp alkalosis

C. Respiratory acidosis

D. Metabolic acidosis

E. Resp alkalosis

150. A young boy with swollen ankles . He has also gained weight. What is the most diagnostic
investigation?

A. Albumin

B. 24-hr urine protein

C. Renal ultrasound

D. Renal biopsy

151. A woman with nausea, vomiting, headache, hazy cornea not stained with fluoresceine dye. What is
the most likely diagnosis

A. Acute glaucoma

B. Conjunctivitis

C. Retinal detachment

152.. A woman has an anaphylactic reaction. What is the route of administration of Adrenaline

A IM

B IV

C Subcutaneous

D Intradermal

153 A 4yr old boy has an anterior midline neck swelling, size is 1.5cm, round and which moves with
swallowing and tongue protrusion

A Branchial cyst
B Thyroid carcinoma

C Thyroglossal cyst

D Lympadenopathy

154. The mother of a 14 year old girl comes to you requesting contraception for her daughter.

What is the most appropriate action?

A. Advice mother and daughter to attend a joint appointment together.

B. Contact daughter to discuss mother's request

C. Confirm girl is sexually active before offering advice

D. prescribe contraceptive to the daughter

E. refer to family planning clinic

155. A 16 year old boy has been having deteriorating academic performance. He arranges his table in a
particular manner and counts to 20 before he starts work. He finds it difficult to complete his homework
in time. Any deviation from his routine causes him anxiety and irritability. Diagnosis?

A Generalised anxiety disorder

B major depressive disorder

C Learning disability

D Obsessive compulsory disorder

E Bipolar

156. 2 year old girl, crying and listless, pulling her ears. On exam, bead seen in ear. What is the most
appropriate management?

A. Alcohol

B. Removal under GA

C.Remove with hook.

157. 60years old man, complains of dry cough and increasing SOB. He is hypertensive, on ramipril. Bp is
145/85, . finger clubbing and fine inspiratory crackles on both lung bases. He has worked in a warehouse,
no history of asbestosis exposure. FEV1 60% predicted,, FEV1/FVC ratio >90% predicted, O2 saturation
89%. What is the most likely option

A. Asthma

B. Bronchietasis

C.pulmonary edema

D. Pulmonary fibrosis.

158. A patient presebts a valuable gift to you. What do you do?

A. Ask pxt to donate the gift to the ward

B. Receive gift from patient

C. Explain to patient that doctors can't receive expensive gifts

159. 40yr old man, idiopathic epilepsy, generalized tonic clonic seizures for 40mins, noisy breathing and
cyanosis. Next best appropriate mgt?

A.Oxygen by facemask

B. IV paraldehyde

C Rectal diazepam

D. Secure airway.

160. 50yrs old man, 5days post hemicolectomy, develops abdominal distension and vomiting, no bowel
sound, hasn't opened bowel since after surgery, most appropriate management???

A. Laparotomy

B. Ng tube and iv fluids

C. Enema
161. A young lady developed jaundice with associated abdominal pain. What is the most appropriate
initial step?

A. HCV antigen

B. HCV antibody

C. Liver enzymes

162. A young man said he will soon become God. He dropped out of school at 16. What do you describe
this phenomenon as?

A. Delusion

B. Hallucination

C. Schizophrenia

163. A 75yr old with previous history of renal calculi now have increasing dizziness and confusion.
350mls of urine drained in the past 24 hours. Cr is 750 and K+ is 5.9mmol/l.

What is the most appropriate investigation?

A. Abdominal USS

B. Auto Antibody Test

C. Estimated GFR

D. Renal Angiography

E. Urine M/C/S

164. 32 year old man presenting with severe pain and swelling in scrotum for 48hrs; feels unwell;
associated pain on passing urine; what is the most likely diagnosis?

A. Acute epididymoorchitis

B. Epididymal cyst rupture

C. Renal calculi
D. Torsion of cyst of Morgagni

E. Urinary tract infection

165.. 60 year old with palpitation for 4 hours. Has Hypertension, angina and type 2 DM. BP was 130/80.
ECG done showed SVT. Most appropriate management

A. IV adenosine

B. IV amiodarone

C. IV digoxin

D. IV verapamil

166. A 32 year old woman with lid lag, diplopia. Investigation to determine cause of eye symptoms?

A. TFT

B. Tensilon test

C. Visual field test

167. A man's hand was caught in a machine, came out with swelling of hand and fingers. No fracture or
bone involvements on X-ray. What is the best management?

A. Elevate in arm sling for 2-3days

B. Plaster cast

C. High arm sling

168. Young man with sore throat 2weeks ago. Now has ankle swelling. Creatinine was deranged,
hematuria and Proteinuria. Choose the most appropriate diagnosis

A. IgA nephropathy

B. Post streptococcal glomerulonephritis

C. Minimal change disease

169. A 48yr old woman with left shoulder pain. Had breast cancer 3years ago. X-ray shoulder showed
bone degeneration. Diagnostic investigation for cause of bone pain?

A. Dexa scan

B. CT

C. Serum calcium

D. Radionuclide bone scan

170. 60yr old with occasional bright red stool. Sigmoid colonoscopy is normal. Dad has colon cancer, he
smokes 5 sticks daily, travels a lot for work, on Ramipril for hypertension.

Most useful risk factor for colon cancer?

A. Smoking

B Family history

C. Occupation

D. Travel

E. Medication

171. A student was brought to the ED following a drug OD. He occasionally commenrs that the color of
the doctor's shirt was too bright. What is the most likely cause for this ?

A. Cocaine

B. Ecstasy

C. Heroine

172. A case of scrotal discomfort exacerbated by prolonged standing and exercise

A. Varicocoele

B Hydrocoele

C. Inguinal hernia
173. A woman who was delivered with Ventouse to shorten 2nd stage, 3rd stage was uneventful
However, she developed fits, what would you give?

A. Dexamethasone

B. Diazepam,

C. Paraldehyde

D. Hydrallazine

E. Mgso4

174. A woman with maladorous vaginal discharge, on exam, vulvovaginitis, ph > 4.5. Choose the most
appropriate option

A. Candida

B. Chlamydia

C. Gonorrhoea

D. Gardnerella

E. Trachomatis

175. A patient who had ileostomy reversal 5 days ago came with bloody diarrhoea, was not on any
antibiotics, but he was given 1g Ceftriazone before surgery. Culture yeilded Clostridium difficile. What is
the most appropriate treatment?

A. Clindamycin

B. Ciprofloxacin

C. Metronidazole

D. Repeat Ceftriazone

176. A woman had isolated tonic-clonic seizure. She has regained consciousness.. Examination showed
no neurological deficits. In the past, she had a mastectomy for breast ca and received adjuvant
chemotherapy. What is the most appropriate management..

A. CT brain scan
B. Dexamethasone IV

C. Diazepam

177. A woman with lower abdominal pain, vaginal discharge, temp 38.2, four weeks of amenorrhea.
What's the most likely diagnosis?

A. Acute Appendicitis

B. Acute PID

C. Ectopic pregnancy

D. Ovarian torsion

178. A woman on lithium for 10years, travelled to Asia. Husband says she was fine throughout the trip.
She too diclofenac for neck pains. Now having coarse tremors. Investigations to do?

A. Serum lithium levels

B. ECG

C. Chest Xray

179. Patient with type2 diabetes mellitus. BMI 28

Normal renal function

Treatment?

A) Insulin

B) Metformin

C) Sulphonylurea
180. A girl was brought into the emergency department by her parents She is involved in social
activities.Her BMI is 15kg/m2. She was found with laxatives, diuretics, and multivitamins. What is the
diagnosis?

A. Anorexia nervosa

B. Bipolar disorder

C. Depression

181. A 35yr old man with Right iliac fossa pain, mouth ulcers and diarrhea for the past year. Diagnosis?

A. Ulcerative colitis

B. Celiac disease

C. Crohn disease

D. Bacterial superinfection

182. A 36 year old woman who presents with complain of heavy regular menstrual flow. What is the
best contraceptive to give her?

A. COCP

B. IUCD

C. POP

D. Depot provera

E. Levonogestral IUS (mirena).

183. A 65 year old distressed lady is leaving the cooker on and the doors open. Mental state exam is 24.
What’s the diagnosis?

A. Alzheimer

B. Depressive illness

C. Bipolar disorder
184. A mother complains that her 3month old child has been vomitting after feeding since birth and she
is now worried her child is allergic to cow milk.

What advise would you give

A . Change cow milk to elemental (hypo allergenic)

B Check for cow milks igE antibody

C Skin prick test for antibody

D Change cow milk to soya milk.

185. An old woman found unconscious by her neigbours with history of previous fainting.

But ECG showed q waves in lead III

What is the diagnosis

A. Atrial fibrillation

B. Acute MI

C. Angina

186. 38 year old man with drainage of blood and pus close to the anal verge.

What is the most appropriate treatment

A. Layinng open fistula

B. BOTOX

C. Anal dilatation

187. A man who has had repeated episodes of anxiety and feeling like he would die.

Most appropriate long term treatment

A. Benznzodiazepines
B. Mood stabilizers

C. Propranolol

D. SSRI

C. CBT

188. A man with previous history of myocardial infarction developed right sided hemiplegia with sensory
loss associated with dilated pupil, ptosis and the eyeball turning down and laterally

Which part of the brain was affected?

A. Cerebrum

B. Cerebellum

C. Midbrain

D. Pons

E. Medulla

189. A 39 year old woman presented with yellowness of sclera.

Hb low, bilirubin increased, other liver enzymes normal.

Blood film showed polychromasia and a few spherocytes but no target cell.

What is the diagnostic investigation?

A. Antiglobulin test

B. Auto antibody test

C. Bone marrow aspiration

190. A middle aged man who is depressed following his MI 6months ago. He has no previous psychotic
symptoms. What is the best treatment?

A. TCA

B. Monoamine oxidase inhibitor

C. SSRI

D. ECT

E. Benzodiazepines

191. A 65yr old woman post left hemi colectomy. 3hrs later, BP -60/40 and urine 20ml/hr. What is your
initial management?

A. IVF

B. Blood transfusion

C. Inotrope

192. 35 years old female came for medical check up. Protein + was found on urinalysis. No medical
history . Her 2 pregnancies were uneventful. What is the next most appropriate step

A. Refer to renal clinic

B. Start ACE

C. Renal abdominal scan

D. Advise to reduce protein in diet

E. Repeat test

193 .56 years old with disseminated renal carcinoma complains of progresssive leg swelling of 2 weeks
duration.There is pitting oedema up to the groin.Tortous veins on the lower abdomen . What is the
cause of the swelling of the legs.

A. Lymphatic occlusion.

B. Portal vein occlusion

C. Right heart failure

D. Inferior vene cava obstruction

194.
195.

196.

197.

198.

199.

200. A man presents with pains in his ring finger in the mornings and hears a click on straightening it.
Choose the most likely option

A. Trigger finger

B. Mallet finger

C. De Quervain's tenosinovitis