Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 29TH OCTOBER 2017 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. A 58 year old man presented with inability to close his left eye. Which nerve is involved?
A. Facial nerve
B. Oculomotor nerve
C. Trigeminal nerve
D. Abducent nerve

2. A 13year old boy with umbilical pain for the last 12h presents with anorexia, nausea and has not
passed a bowel motion for 24h. What is your diagnosis?
A. Acute appendicitis
B. IBD
C. IBS
D. Meckel’s diverticulum
E. Psoas hematoma

3. A 67 years old lady was found to have serum Calcium of 3.7 mmol/l. What is the most suitable
treatment option for her from the following?
A. Pamidronate
B. Calcitonin
C. Decrease calcium in diet
D. No intervention needed

4. A 40 year old man who had sore throat for 2 months now presents with mild pedal edema. BP is
190/100mmHg and has haematuria and proteinuria. What is the most probable diagnosis?
A. IgA Nephropathy
B. Buerger’s disease
C. Membranous nephropathy
D. Post streptococcal nephropathy

5. A 37 years old lady has inflammatory cells on cervical smear. There is no dyskaryosis. One year
ago her smear was normal. On speculum examination the cervix was normal on appearance. What
will be the next step?
A. Repeat smear in 3 years
B. Repeat smear in 4 months
C. Repeat smear in 6 months
D. Colposcopy
E. Cervical biopsy

6. Post mortem examination of a patient who died of massive GIT bleed shows a small nodular liver.
What is the most likely cause of bleed?
A. Perforated GIT ulcer
B. Portal hypertension
C. Liver abcess
D. Hepatocellular carcinoma

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7. A 50-year-old woman presents following a fall. She reports of pain and weakness in her hands for
several months, stiff legs and swallowing difficulties and has bilateral wasting of the small muscles of
her hands. Reflexes in the upper limbs are absent. Tongue fasciculations are present and both legs
show increased tone, pyramidal weakness and hyper reflexia with extensor plantar response. Pain and
temperature sensation are impaired in the upper limbs. What is the most likely diagnosis?
A. Multiple Sclerosis
B. Motor Neuron Disease
C. Syringobulbia
D. Syringomyelia
E. Myasthenia Gravis

8. A 64year old man has recently suffered from an myocardial infarction and is on Aspirin,
Atorvastatin and Ramipril. He has been having trouble sleeping and has been losing weight for the
past 4 months. He doesn’t feel like doing anything he used to enjoy and has stopped socializing. He
says he gets tired easily and can’t concentrate on anything. What is the most appropriate treatment?
A. Lofepramine
B. Dosulepin
C. Citalopram
D. Fluoxetine
E. Phenelzine

9. A 55 year old male presents to the accident an emergency after an RTA with breathlessness,
engorged neck veins and a dull percussion note on the right side of his chest. On examination his
pulse is 140bpm and BP is 80/50mmHg, what is the most likely diagnosis?
A. Haemothorax
B. Haemopneumothorax
C. Tension pneumothorax
D. Simple pneumothorax

10. A 5 year old boy presents to the outpatient clinic. He has learning difficulties, a large head and
large testicles. He has quite a characteristic facial appearance, with a prominent forehead and large
ears , select the most likely karyotype
A. 47XY(18) B. 47XY(13) C. 47XY(21)
D. 69XXY
E. Fragile X syndrome

11. A 5 year old boy was diagnosed with urinary tract infection, which was later found to be due
to E.Coli. What is the most appropriate treatment?
A. Trimethoprim
B. Nitrofurantoin
C. Amoxicillin
D. Cefalexin
E. Metronidazole

12. A 44 year old patient comes with right hemiparesis. On examination he has left sided ptosis
and his left pupil is dilated. Where is the lesion?
A. Cerebral infarct
B. Cerebellar infarct
C. Medulla Oblongata
D. Pons
E. Midbrain

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13. A 20 year old man received multiple fractures and crash injuries in motor vehicle collision. 4 days
later he has enuria with pulmonary edema. Investigation shows Na 150mmol/l, K 7.2mmol/l, Urea 60,
Glucose 4.2. What is the single most appropriate management?
A. Dialysis
B. Fluid challenge
C. Plasma expanders
D. IV normal saline and hydrocortisone

14. A 55 year old man is brought in the A& E department for acute abdominal pain. He is found
to have a strangulated hernia for which he undergoes emergency surgery. 3 days post op, he is in a
very agitated state claiming to see spiders on the wall and crawling over his body. He is sweaty, has
palpitations and is confused. What is the most likely diagnosis?
A. Delirium tremens
B. Wernicke’s encephalopathy
C. Korsakoff’s syndrome
D. Dysthymia
E. Cyclothymia

15. A man undergoes a pneumonectomy. After surgery, investigations show hyponatraemia.

What could be the cause of the biochemical change?
A. Removal of hormonally active tumor
B. Excess dextrose
C. Excess colloid
D. Excessive K+
E. Hemodilution

16. A 50 year old male with increased BMI. Has muscle wasting, difficulty climbing upstairs.
Has polyuria, polydipsia. What is the cause of muscle wasting and difficulty walking upstairs?
A. Amyotrophy
B. Peripheral neuropathy
C. Polyneuropathy
D. Autonomic neuropathy

17. A 54 year old man presented with a sudden, unilateral, brief, stabbing, recurrent pain on the
right side of his face. This occurred 5-10 times in a day. What is the diagnosis?
A. Ramsay Hunt Syndrome
B. Trigeminal neuralgia
C. Temporomandibular joint dysfunction
D. Post herpetic neuralgia

18. A 29 year old gentleman was involved in an RTA. He presents with distended neck veins, clear
breath sounds and a trachea which is in the midline. His respiratory rate is 34 and blood pressure
60/0mmHg. What is the most likely diagnosis?
A. Simple pneumothorax
B. Tension pneumothorax
C. Cardiac tamponade
D. Pericarditis

19. What is the most common route of colonic metastasis to the liver?

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A. Hematogenous
B. Lymphatic
C. Local invasion
D. Peritoneal seeding

20. A patient comes to the A&E with chest pain within 1 hour of onset. He was given aspirin and
nitrates and he is fine now. Myocardial infarction was confirmed in ECG. What is your next
management?
A. Streptokinase and thrombolytics
B. Morphine
C. Percutaneous coronary intervention (PCI)
D. Oxygen

21. A 30 year old patient presents with heavy bleeding. She is in a stable relationship and is not keen
for conception. USG shows normal uterus. What would you advise her?
A. Mirena coil
B. Combined Oral Contraceptive Pill (COCP)
C. IUCD
D. Progesterone only pill
E. Tranexamic acid

22. A 45 years old man comes to A and E accompanied by his wife. She says that he starts to act
strangely sometimes during the last 8 months. He doesn't drink alcohol. He doesn't have any injuries
on his body. He had transient hemiparesis which resolved. What could be the cause?
A. Dementia
B. Arrhythmia
C. Delirium Tremens
D. Seizures
E. Transients ischemic attack

23. A town has a population of 500,000. In a five year period there are 1250 cases of bladder cancer
diagnosed at the only hospital. During the same period the occupational health department diagnosed
a further 500 cases. What is the annual incidence per million of bladder cancer in this population?
A. 2100
B. 1750
C. 1400
D. 700
E. 350

24. Patient in terminal stage of cancer, who is on morphine, presents with rattling breath sounds. What
medication will you administer?
A. Anti-Muscarinic
B. Oxygen
C. Steroid
D. Naloxone
E. Methadone

25. A 6 year old girl has been brought to the hospital after being stung by a bee. She is complaining of
generalized itching, rashes, redness and has developed stridor. What is the most appropriate
treatment?

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A. Oral Chlorpheniramine
B. IV Chlorpheniramine
C. IM Adrenaline
D. IV Adrenaline
E. Reassurance

26. A 30 year old woman has experienced restlessness, muscle tension and sleep disturbance on most
days over the last six months. She worries excessively about a number of every day events and
activities, and is unable to control these feelings which are impairing her ability to hold down her job.
What is the most likely diagnosis?
A. Panic Disorder
B. Generalized Anxiety Disorder
C. Pheochromocytoma
D. Acute Stress Disorder
E. Social Phobia

27. An unconscious child is brought into Accident & Emergency. He is not breathing. What is your
initial management?
A. Capillary blood glucose
B. Secure airway
C. CT scan
D. IV 0.9% normal saline
E. 0.45% dextrose

28. A 63 year old female with a history of osteoporosis suddenly fall on her outstretched hand while
shopping. X ray shows there is fracture at the distal radius with backward shift of the distal fragment.
What is the SINGLE most probable deformity?
A. Dinner fork deformity.
B. Coxavara.
C. Mallet finger
D. Cubitus valgus
E. Garden spade deformity

29. A woman with sickle cell disease complains of heavy menstrual blood loss. What is the most
appropriate treatment for her?
A. Combined Oral Contraceptive Pill (COCP)
B. Mirena
C. Depot provera
D. Copper T insertion
E. Transdermal patch

30. A young man presents with chest pain, palpitations, shortness of breath and perioral tingling
sensation after an argument with his girlfriend. ECG is normal. What is the best management for his
shortness of breath?
A. Amitriptyline
B. Diazepam
C. Rebreathe into a paper bag
D. Propanolol

31. A 27 year old woman presented with amenorrhoea of 10 months duration. FSH – 28, LH –
Normal, Testosterone – 1.8, Estradiol – 80. What is the most probable diagnosis?

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A. Hypothalamic
B. Polycystic ovary syndrome (PCOS)
C. Premature ovarian failure
D. Hyper androgenism

32. A child has come after overdosing on his grandma’s pills. He has dilated pupils and extra systoles.
What is the most likely drug taken?
A. Digoxin
B. Amitriptyline
C. SSRI
D. Betablockers

33. A 15 year old male has bilateral ankle oedema. His blood pressure is 110/70mmHg and urinalysis
shows protein ++++. What is the most likely diagnosis?
A. Haemolytic uraemic syndrome
B. IgA nephropathy
C. Membranous glomerulonephritis
D. Minimal change glomerulonephritis
E. Nephrotic syndrome

34. 19 year old boy complains of itching on the site of an insect bite. What is the SINGLE most
appropriate management?
A. Penicillin oral D. Oral Ciprofloxacin
B. Doxycycline oral E. Reassurance
C. Oral antihistamine

35. A 35 years old male presented with purulent nasal discharge from one side with headache and
fever, examination showed supra orbital and maxillary tenderness , what is the best diagnostic
investigation?
A. CT Scan
B. MRI
C. X-ray
D. USG
E. Swab for culture

36. A 37 years old lady strongly believes that a famous politician has been sending her flowers every
day and is in love with her. However, this is not the case. What is the most appropriate diagnosis?
A. Erotomania
B. Pyromania
C. Kleptomania
D. Trichotillomania
E. Grandiosity

37. A young female presents with sweating and confusion. Her vitals are stable, ABG shows
metabolic acidosis. What investigation should be done for her next?
A. Capillary blood glucose
B. Dexamethasone suppression test
C. Oral Glucose Tolerance Test (OGTT)
D. Head CT

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38. A 34 years old alcoholic is found passed out in front of a local pub. The ambulance crew
informs you that he was sweating when they found him and there were cans of cider lying empty
around him. What is the initial stage of investigation?
A. Capillary blood sugar
B. CT head
C. Magnetic resonance imaging (MRI) head
D. ABG
E. MCV (Mean Corpuscular Volume)

39. A three- month old baby was miserable and cried for two hours following his first routine
immunization with diphtheria, tetanus, polio, Haemophilus influenza- B (HiB) and meningitis. What
is the single most appropriate action?
A. Defer immunization for two weeks
B. Do not give vaccine
C. Give half dose of vaccine
D. Give Paracetamol with future doses of the same vaccine
E. Proceed with standard immunization schedule

40. A 50 year old man with a known history of stroke. He cannot remember anything about his
life. What is the single most likely defect?
A. Homonymous hemianopia
B. Homonymous upper quadrantanopia
C. Bitemporal hemianopia
D. Binasal hemianopia
E. Homonymous lower quadrantanopia

41. A child presents with fever and maculo-papular rash on the back as shown in the given picture.
What is the most probable diagnosis?
A. Chicken pox
B. Kawasaki disease
C. Measles
D. Rubella
E. Scarlet fever

42. A 30year old lady complains of intermittent diarrhoea, chronic abdominal and pelvic pain and
tenesmus. Sometimes she notices blood in her stool. Select the most likely cause leading to her
symptoms?
A. Inflammatory bowel disease
B. Diverticulosis
C. Irritable bowel disease
D. Adenomyosis
E. UTI

43. A 7 year old child is being investigated for tuberculosis. His parents do not agree on taking a
broncho-alveolar lavage sample under general anaesthesia (GA).What other sample will show growth
of the organism?
A. Blood
B. Throat swab
C. Gastric washings
D. Mantoux
E. Cerebrospinal Fluid (CSF)

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44. An 84 year old woman with drusen and yellow spots in the centre of retina. What is the single
most likely diagnosis?
A. Proliferative diabetic retinopathy
B. Hypertensive retinopathy
C. Multiple sclerosis
D. Macular degeneration

45. A 29 year old who is 38 weeks pregnant presents with a two hour history of constant abdominal
pain. She then passes 100ml of blood per vagina. On examination she has a rock hard uterus. What is
the next appropriate investigation?
A. Ultrasoundscan
B. Cardiotocograph
C. Clotting screen
D. Haemoglobin
E. Kleihauer-Betke test

46. A 59-year-old man has shown a change in his mood and personality over a 9-month period. He
has subsequently developed difficulty with memory and concentration, and then progressive fidgety
movements of his limbs and facial musculature. By the time of medical assessment he has frank
choreiform movements and a Mini-Mental State Examination of 21/30. Other examination is normal.
He was adopted and therefore no information on his family history is available. He has three adult
children (aged 27, 30 and 33 years) of whom the two youngest are asymptomatic. However, the oldest
son has recently been investigated by the Neurology Department for slightly erratic behaviour and
fidgety restless movements of both legs. Based on the likely clinical diagnosis, which one of the
following genetic patterns of this condition is most likely?
A. Autosomal-dominant inheritance with anticipation E. Mitochondrial disorder
B. Autosomal-dominant with variable penetrance
C. Autosomal-recessive inheritance
D. X-linked inheritance

47. A 67 year old man with dribbling of urine undergoes prostatic procedure. What serum osmolality
you would find in a patient after prostatic surgery?
A. Low Na
B. High K+
C. High Ca
D. High Na

48. A 68 year old man gets repeated attacks of loss of consciousness and TIA. What is the most likely
cause for this?
A. Carotid artery stenosis
B. Aortic stenosis
C. Mitral stenosis
D. Tricuspid stenosis

49. A 14 year old boy presents with recurrent abdominal pains, malaise, and weight loss over 6
months. On examination a vague mass is felt in right iliac fossa. Colonoscopy shows transmural
inflammation and granulomata. What is the most appropriate management?
A. Sulfasalazine
B. Paracetamol
C. Metronidazole
D. Ibuprofen

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50. A 5 year old boy is noted to have clumsy gait and mild scoliosis. When he gets off the floor
he uses his hands to climb up the stairs. What is the single most likely diagnosis?
A. Motor neuron disease
B. Polio myelitis
C. Hunter's Syndrome
D. Gullian Barre Syndrome
E. Duchne muscular dystrophy

51. A patient presented to A & E with polyphonic wheeze. He was unable to complete sentence, pulse
was >110 bpm, RR > 25/min and PEFR 30-50% of predicted. What is the most likely diagnosis? A.
Mild asthma
B. Moderate asthma
C. Severe asthma
D. Life threatening asthma
E. Exercise induced

52. A 30 year old pregnant lady presents with 175/90 mmHg. Has previous history of recurrent UTI.
Urine dipstick show proteinuria ++. She is 10 weeks pregnant. What is the most likely cause of
hypertension?
A. Pregnancy induced hypertension
B. Essential hypertension
C. Chronic pyelonephritis
D. Chronic glomerulonephritis

53. A 15 years old boy fell of his bicycle and hurt his abdomen. He presents with pain in
abdomen, a CT scan shows a small sub capsular spleen haematoma, his BP is 110/70mmHg and pulse
is 80bpm. What is the next step in his management?
A. Refer to surgeons for observation
B. Immediate Laparotomy
C. Immediate Laparoscopy
D. Discharge with advice
E. Blood transfusion

54. A 60 year old patient with single tumor in brain is on dexamethasone now presents with hyper
glycemia. With fasting blood sugar 12mmol/L. What is the next immediate step?
A. Long acting insulin in the morning
B. Short acting insulin with every meal
C. Stop dexamethasone
D. Oral hypoglycemic drugs

55. A child had three attacks of tonsillitis last year. What will be the most appropriate management for
this child?
A. Treat when ill
B. Surgery
C. Prophylactic Antibiotics
D. Refer to ENT
E. Do Nothing

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56. A 34 year old lady presented with complains of vertigo for the last 4 days. It started suddenly and
was like a feeling of room rotating. It was aggravated by head movement. On examination there was
spontaneous, unidirectional, horizontal nystagmus. Romberg’s test was positive. What is the most
likely diagnosis?
A. BPV (Benign positional vertigo )
B. Vestibular neuronitis
C. Menniere’s disease
D. MS

57. A 25 year old woman is presenting with diarrhoea and abdominal bloating over the last 4
months. On examination she has blistering rash over her elbows. Biochemical investigation showed
that she has low serum albumin, calcium and folate concentration. On jejunal biopsy there is
shortening of the villi and lymphocytosis. What is the most likely cause?
A. Coeliac disease E. Giardiasis
B. Whipple's disease F. Cystic fibrosis
C. Crohn's disease
D. Tropical Sprue

58. An old man suffers from end stage prostatic cancer. He has pain, aneuria, bilateralhydronephrosis.
His son’s wedding is in 3 weeks. He is looking forward to enjoy the ceremony. What is the most
appropriate palliative treatment for him?
A. Palliative chemotherapy
B. Palliative radiotherapy
C. Bilateral nephrostomy
D. Catheterisation

59. An 18 month old boy has been brought to the Emergency department because he has been
refusing to move his left arm and crying more than usual for the past 24 hours. He has recently been
looked after by his mother’s new boyfriend while she attended college. Assessment shows multiple
bruises and a fracture of left humerus which is put in plaster. What is the SINGLE most appropriate
next step?
A. Admit under care of paediatrician
B. Discharge with painkiller
C. Follow up in fracture clinic
D. Follow up in paediatric outpatients
E. Follow up with general practitioner (GP)

60. A butcher was stabbed in the groin and bled so much that the towel was soaked in blood. His BP
is 80/50mmHg and pulse 130bpm. What percent of circulatory blood did he lose?
A. Less than 15% D. 40-50%
B. 15-30% E. Above 50%
C. 20-40%

61. A 6 year old boy fell in the playground. He has not been using his forearm. He complains of pain.
On examination there is no sign of deformity or swelling. However, there is minimal tenderness on
examination. What is the most appropriate diagnosis?
A. Fracture of mid radius
B. Fracture of mid ulnar
C. Fracture of neck of humerus
D. Fracture of shaft of humerus
E. Green stick fracture of distal radius

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62. An 8 year old boy is clinically obese. As a baby, he was floppy and difficult to feed. He now has
learning difficulties, and is constantly eating despite measures by his parents to hide food out of reach.
What is the most probable diagnosis?
A. Cushing’s Syndrome
B. Congenital Hypothyroidism
C. Prader Willi Syndrome
D. Lawrence Moon Biedel Syndrome
E. Down’s syndrome

63. A 70 year old man has been brought in by his wife. She says he has been losing his temper, is
aggressive and talks about their sex life with strangers. He does not agree with her and says he does
not know who she is. What test would you like to do?
A. EEG
B. ECG
C. MMSE
D. CT scan
E. MRI

64. A 46 year old woman is brought to A&E after falling in bathroom while painting. She is drowsy
and gives history of sudden severe headache at the back of the head prior to the fall. What
investigation would be best choice in this case?
A. Carboxy haemoglobin
B. MRI head
C. CT Head
D. Lumbar puncture
E. Skull X-ray

65. A 30 years old female attends outpatient dept with c/o fever & dry cough. She says that she had
headache, myalgia & joint pain like one week ago. On examination Pulse: 100 b/min, Temp:
37.5ºC.Investigations: CXR: bilateral patchy consolidation. What is the single most likely causative
organism?
A. Pneumococcal Pneumonia
A. Legionella
B. Mycoplasma
C. Klebsiella
D. Chlamydia pneumonia

66. A 3 years old child, who was wasted on examination, has a history of diarrhoea on and off. The
mother describes the stool as bulky, frothy and difficult to flush. What is the single investigation most
likely to lead to a diagnosis?
A. Sweat Chloride test
B. Anti Endomysial Antibodies
C. Liver Function tests
D. Ultrasound Abdomen
E. Thyroid Function Test

67. A girl has been brought to hospital by her mother. She has had no periods for 8 months but a
pregnancy test is negative .she exercises for 5 hours a day and eats only a little food. Her BMI is 16
kg/m2 . What is the management?

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A. Refer to psychologist
B. Refer to eating disorder unit
C. Refer to dietician
D. Reassure
E. Refer to endocrinologist

68. A 60 year old diabetic patient on antidiabetic medication developed diarrhoea. What is the most
likely cause for his diarrhoea?
A. Autonomic neuropathy
B. Infective
C. Celiac disease
D. Crohn’s disease

69. A 45 year old lady came to family planning clinic for contraception advice. She is not keen to be
pregnant for the next 3 years. Her recent USG report showed multiple small submucosal fibroid. What
is the best method of contraception for here from the list below?
A. Etonogestrol
B. Combined OCP
C. IUS (intrauterine system)
D. Progestogen only pill
E. IUCD (intrauterine contraceptive device)

70. A 30 years old female presents with severe intermittent pain in the upper outer quadrant of her left
breast, which is radiating to the axilla. On examination there is no palpable lump. What is the most
probable diagnosis?
A .Cyclicalmastalgia B.Fibroadenoma
C .Noncyclicalmastalgia
D. Duct Ectasia
E. Mondor’s disease

71. A 38 year old female gravida 4 gestational age 32 weeks, presented with thick white marks on the
inside of her mouth for 3 weeks. Her mouth including her tongue appeared inflamed on examination.
She smokes 20 cigarettes per day despite advice to quit. She attends her ANC regularly. What is the
most probable diagnosis?
A. Lichen Planus D. Candidiasis
B. Aphthous ulcer E. Leukoplakia
C. Smoking

72. A man presents with medial deviation of his right eye. Which nerve is affected?
A. Left trochlear
B. Left oculomotor
C. Right trochlear
D. Right abducens
E. Right oculomotor

73. A lady presents with abdominal pain, dysuria, dyspareunia and vaginal discharge. What is the
most appropriate best next step?
A. Laparoscopy D. Laparotomy
B. High vaginal swab E. Ultra sound
C. Hysteroscopy

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74. A 30 year old female presents with complaints of weight loss, thinning hair, feeling cold all the
time, dryness of the skin, lethargy and constipation. What is the most likely diagnosis?
A. Hypothyroidism
B. Hyperthyroidism
C. Hypoparathyroidism
D. Hyperparathyroidism
E. Pseudopseudohypoparathyroidism

75. A 15 year old girl was admitted with anemia, chest infection and thrombo-cytopenia. She was
treated and her symptoms regressed. She was brought again with fever and the same symptoms a few
days later. She also seems to have features of meningitis. What is the most likely diagnosis?
A. Acute Myeloid Leukaemia(AML)
B. Acute lymphoblastic leukemia (ALL)
C. Aplastic Anemia
D. Chronic myeloid leukaemia (CML)
E. Chronic lymphocytic leukaemia (CLL)

76. A woman with a spontaneous abortion at 14 and 23 weeks of gestational age presents at 8
weeks gestational age with bleeding PV. What is the most appropriate intervention?
A. Bed rest
B. Aspirin
C. Reassurance
D. Trans-vaginal sonography (TVS)

77. An elderly man with atrial fibrillation is on digoxin. He has recurrent nausea, vomiting, dizziness
and palpitation. Best next step of management?
A. Serum electrolytes E. ECG
B. Serum drug level
C. Serum glucose level
D. Echo

78. A 22 year old college student presented with low grade fever and malaise for about a week. On
examination his tonsils were enlarged with a white membrane over them, also palpable, tender lymph
nodes in the neck and a macular rash. He went on a holiday a month ago to Thailand. What is the
diagnosis?
A. Diphtheria
B. Glandular fever
C. Exudative pharyngitis
D. Acute tonsillitis

79. A lady has complains of lower abdominal pain, low grade fever and vaginal discharge
suggestive of pelvic inflammatory disease (PID). She is not toxic. What is the appropriate empirical
treatment for Pelvic inflammatory disease?
A. Ceftriaxone
B. Metronidazole
C. Doxycycline
D. Erythromycin
E. Ciprofloxacin

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80. A patient on antihypertensive drugs presents to Accident and Emergency department
complaining of sudden loss of vision. On examination of the fundus, tortuous blood vessels and
stormy sunset appearance was seen. What is most likely diagnosis?
A. Papiloedema
B. CRAO
C. Anterior ischaemic optic neruropathy
D. CRVO
E. Retinal detachment

81. A patient 10 days post-op for rectal carcinoma presents with high grade fever and mass in pelvis.
What is the most probable diagnosis?
A. Pelvic Abscess
B. Recurrence of rectal carcinoma
C. Metastasis
D. Pneumonia secondary to aspiration
E. Septicemia

82. A 60year old man presents with mass in the groin. Exam: mass lies below the midpoint of the
inguinal ligament and is pulsatile. What is the most probable diagnosis?
A. Direct inguinal hernia
B. Saphenavarix
C. Femoral hernia
D. Irreducible hernia
E. Femoral aneurysm

83. A 28 year old man on inhaled short acting bronchodilator and low dose corticosteroid complains
of disturbing cough and wheeze on exercise. He has good inhaler technique and no known allergens.
What is the best modification in his therapy?
A. Oral leukotriene antagonist
B. Inhaled regular long acting bronchodilator
C. Increase dose of inhaled corticosteroid
D. Sodium Chromoglycate
E. Oral corticosteroid

84. A patient on Warfarin due to past history of DVT is now scheduled for a surgery. What is the
most appropriate step to be taken next?
A. Stop Warfarin D. Increase Warfarin
B. Continue Warfarin add heparin
C. Stop Warfarin and start heparin

85. An 8 year old child presents with recurrent abdominal pains, occasional headaches but she
maintains a good appetite. Examination is normal. FBC, U&E and other investigations are normal.
What would you do for her next?
A. Ultrasound abdomen
B. CT head
C. Reassure
D. Analgesics

86. A 55 year old man comes with complaints of backache. Urine analysis shows proteinuria. What is
the most likely diagnosis?

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A. Pagets disease of the bone
B. Prostatic mets
C. BPH
D. Multiple myeloma

87. A 6 years old child was diagnosed with meningitis and treated successfully in the hospital. He is
being discharged now. What should be done prior to discharge?
A. Hearing test after the full treatment of meningitis
B. Echocardiography
C. Fundoscopy
D. MRI scan

88. A 36 year old woman presents with swelling in the groin. Exam: swelling is diffuse and soft and
lies below the inguinal ligament. It empties with minimal pressure and refills with release. There is a
cough impulse and it disappears on lying down. On the calf of the same leg there are varicosities on
the medial aspect. What is the most likely diagnosis?
A. Varicose vein
B. Varicocele
C. Saphenavarix
D. Femoral hernia
E. Inguinal hernia

89. A 56 year old lady presented with headache for the last one month. She also noticed weakness in
her left arm and leg. She says that headache is worst in the morning and accompanied by vomiting.
On examination Babinski’s sign is positive with spastic paralysis of left upper and lower limb. What
is the most appropriate diagnosis from the following options?
A. Space occupying lesion
B. Giant Cell Arteritis
C. Stroke
D. TIA

90. A 4year old boy complains of pain around his right eye. He is unwell, febrile and also suffers from
pain on the right side of his face. What is the most probable diagnosis?
A. Allergic reaction
B. Furuncle
C. Folliculitis
D. Foreign body
E. Periorbital cellulitis

91. A 34 year old man, from Congo, is admitted with abdominal pain to the A&E, and abdominal
Xray reveals bladder calcification. What is the most likely cause?
A. Schistosoma haematobium
B. Schistosomamansoni
C. Sarcoidosis
D. Tuberculosis

92. A 29 year old male patient presented with complaints of diarrhoea for the last 4 days. Biochemical
investigations were carried out. What is the key metabolic change that will be noticed?

15
A. Metabolic alkalosis
B. Hyperkalemia
C. Metabolic acidosis
D. Hypernatremia
E. Hypercalcaemia

93. A 50 year old man has been admitted for investigations for breathlessness and weight loss. He has
been taking thiazide diuretics for hypertension for 2 years. His BP is 150/100mmHg. Investigation
shows Na: 138, K: 2.9, Urea 5.8, Glucose 5.7. What is the single most appropriate management?
A. IV normal saline and insulin
B. IV normal saline and K supplements
C. Plasma expanders
D. Dialysis
E. Oral KCL

94. A 57 year old female, who is suffering from hypertension, presented to the hospital with
complaints of recurrent falls when trying to get out of bed or get up from sitting. She is on some anti-
hypertensive therapy, with no other medical problems. What is the most likely cause of her fall?
A. Calcium channel blocker
B. Vertibrobasillar insufficiency
C. Bendrofluazide
D. Hypoglycemia
E. Infection

95. You are asked to see a 1 hour old baby. He is dysmorphic, with a small chin and low-set ears. He
also has a small head and rocker- bottom feet. , select the most likely karyotype:
A. 45XO
B. 47XXX
C. 47XXY D. 47XY(13) E. 47XY(18)

96. A young woman has lost 6 kg in 2 weeks. The weight loss was deliberate as she exercises 5 hours
daily at the gym and is very concerned about her body. She admits to using laxatives and inducing
vomiting. Her BMI is 22. She also admits staying up until 3am cleaning her apartment, spending lots
of money on shopping and eating in very expensive restaurants. What is most probable diagnosis?
A. Anorexia nervosa
B. Bulimia nervosa
C. Eating disorder not otherwise classified
D. Depression
E. Seasonal affective disorder

97. A 60 year old man with rheumatoid arthritis is noted to have low FEV1. The value shows no
improvement after Salbutamol. What is the most likely cause?
A. Asthma
B. Chronic bronchitis
C. Pulmonary fibrosis
D. Sarcoidosis

98. A 62 year old man who has recently had flu- like illness has woken to find his speech altered.
Movement of his eyelids and lips are weak on the right side. Examination is otherwise normal. Which
anatomical site is most likely to be affected?

16
A. Facial Nerve
B. Hypoglossal Nerve
C. Oculomotor nerve
D. Trigeminal Nerve
E. Glossopharyngeal Nerve

99. A 45 year old man with retrosternal chest pain radiating to the throat for 2 hours. What is the
single most diagnostic investigation?
A. Electrocardiogram
B. Troponin levels
C. Angiography
D. Oesophago-duodenoscopy
E. Echocardiogram

100. A 28 year old female presents with a 3 months history of diarrhoea. She complains of abdominal
discomfort and passing stool 20 times a day. On examination she is febrile. Barium enema shows
cobble stone mucosa. What is the most likely diagnosis?
A. Amoeba
B. Colon Ca
C. Gastroenteritis
D. Crohn’s Disease
E. Ulcerative Colitis

101. A 35 year old pregnant woman has been having tingling and numbness of her thumb, index and
middle fingers for a while. She has been treated with local steroids but it has not helped much, and
now she has been planned to undergo a surgical procedure. Which of the following structures will be
incised?
A. Flexordigitorumprofundus
B. Transverse carpel ligament
C. Palmar aponeurosis
D. Extensor retinaculum

102. A 44 year old lady who has polycystic kidney disease is concerned because her 38 year old
brother has just died of an intracranial insult. She knows he was not hypertensive. What was the most
likely cause of her brother’s death?
A. Subdural haematoma D. Epidural haematoma
B. Subarachanoid haemorrhage
C. Cerebral infarct

103. Withdrawal from which of the following drugs can result in chills, pupil dilatation?
A. Cocaine
B. Heroine
C. Salicylates
D. Theophylline
E. Methanol

104. A 16 year old teenager was brought into A & E after being stabbed on the upper right side of his
back. Erect Chest X ray revealed homogenous opacity on the lower right lung, trachea was centrally
placed. What is the most probable explanation for the X-ray findings?

17
A. Pneumothorax
B. Haemothorax
C. Pneumonia
D. Tension pneumothorax
E. Empyema

105. An elderly male who is immunocompromised has whitish plaques in the pharynx. He has
dementia, has stopped taking food due to the whitish plaques on the tongue. How will you treat this
elderly male?
A. Fluconazole suspension E. IV Fluconazole
B. Nystatin suspension
C. Oral Miconazole
D. Oral Fluconazole

106. A 55 year old man diagnosed is with IHD, he has normal BMI. He is a smoker and smokes 20
cigarettes a day. He drinks 8 pints of beer. His clinical examination is normal and no systemic
findings were found. Where would you refer him to first?
A. To alcohol anonymous
B. Smoking cessation clinic
C. Dietician
D. No referral needed

107. A 71 year old man presents with coarse tremor. He is on some medications. Which one can be
the reason for his tremors?
A. Lithium D. Imipramine
B. Diazepam E. Haloperidol
C. Fluoxetine

108. A 55 year old alcoholic man complains of severe abdominal pain radiating to his back. He also
passes lose stool, pale stools and has weight loss. What is the most likely diagnosis?
A. Acute pancreatitis
B. Chronic pancreatitis
C. Esophagitis
D. Pancreatic carcinoma

109. A patient presents with facial oedema, raised JVP, shortness of breath and cough. A chest X ray
shows superior vena cave obstruction. What is the immediate management?
A. Furosemide
B. Dexamethasone
C. Radiotherapy
D. Stenting

110. A 20 year old lady is suffering from fever and loss of appetite. She has been diagnosed with
Toxoplasmosis. What is the treatment for Toxoplasmosis?
A. Pyrimethamine
B. Pyrimethamine plus Sulfadiazine.
C. Clindamycin
D. Spiramycin
E. Trimethoprim and Sulfamethoxazole
D. Chest xray

18
111. A 7 year old boy is brought in by his mother. She is concerned that he does not have any
friends at school and is not doing well in his studies. He only likes to collect toy cars of which he has
2000. He does not understand emotions and has poor interaction with his siblings. He gets angry and
throws tantrums if his daily routine is changed. What is the most likely diagnosis?
A. Schizophrenia
B. Depression
C. Autism spectrum disorder
D. Tourette’s syndrome
E. Alice in Wonderland syndrome

112. A pregnant woman with long-term history of osteoarthritis came to the antenatal clinic with
the complaints of restricted joint movement and severe pain in her affected joints. What is the choice
of drug?
A. Paracetamol
B. Steroid
C. NSAID
D. Paracetamol + Dihydrocodiene
E. Pethidine

113. A 40 year old gentleman with a fistula which discharging on the anal midline posterior to anus.
What is the single most appropriate treatment?
A. Lay open fistula
B. Oral antibiotics
C. Local anaesthetics
D. Observe
E. GTN cream

114. A young girl presented in Gynae assessment Unit with lower abdominal pain and per vaginal
bleeding after a history of hysteron-salpingo-graph as a part of her infertility treatment. On
observation her BP was 90/50mmHg and pulse was 120bpm and examination revealed rigid abdomen.
What is the most appropriate next investigation?
A. CT abdomen
B. X-ray abdomen in erect and supine
C. Ultrasound abdomen
D. Coagulation profile
E. X-ray chest

115. A Young female with epilepsy. She is on Sodium valproate. Seizures are not controlled on
valproate. What is the next investigation you will do?
A. Check drug levels
B. CT brain
C. MR Brain
D. EEG

116. A 9 year old child is diabetic and unhappy in school. What is your next step?
A. Refer to social worker
B. Clinical psychologist
C. Special school
D. Check child protection register
E. Give oral anti diabetics

19
117. A 53 year old man felt jerking in his left hand which spread to the rest of the body. A few
minutes later he developed a generalized seizure with loss of consciousness. What is the Investigation
of choice here?
A. CT head
B. EEG
C. ECG
D. Carotid USG
E. 24 hrs EEG

118. An elderly gentleman who used to work in the shipyard industry presented with cough and
shortness of breath few weeks to months was given salbutamol nebulization and antibiotics and
admitted to the ward. He died 3 days later. His CT scan shows patchy infiltrates, pleural thickening
and pleural effusions. Why is this a Coroner’s case?
A. Patient got wrong diagnosis or wrong management
B. Patient died soon after admission
C. Death could be due to occupational illness

119. A 6 year old child presented with drooling of saliva, and a severe stridor. He is febrile and sick
looking. X ray of the neck in extension shows a thumb sign. Choose the single most likely diagnosis
from the list of options given below.
A. Croup
B. Upper respiratory tract infection (URTI)
C. Diphtheria
D. Acute epiglottitis

120. A 32 year old woman, para 3 of 39 weeks of gestation, reports having had spontaneous rupture of
membranes 4 days ago. She did not attend the delivery suite, as she knew that would happen and had
already decided on a home birth. Today she feels very hot and sweaty. She thought that she was
starting to have labour pains, but she describes the pain as more constant. On examination, her uterus
is tender throughout. Blood tests show a raised CRP and white cell count. Select the most likely
diagnosis from the following options:
A. Round ligament stretching
B. Chorioamnionitis
C. Uterine rupture
D. Labour
E. Disseminated intravascular coagulation

121. A 16 year old girl presents with dehydration, dry mucus membranes, tachypnoea and abdominal
pain. She is drowsy. Blood glucose is 18mmol/L. What is the next step?
A. ABG
B. Check BP
C. Serum Alcohol Levels
D. Blood Sugar levels
E. CT Scan

122. An 80 year old woman with few month history of weight loss and dysphagia presented with
sandwich stuck in his throat. What is the most appropriate next step?
A. Barium meal
B. Barium swallow
C. Endoscopy foreign body removal and biopsy

20
123. A 65 year old man complains of sudden onset chest pain in the middle of his chest radiation to
his back. On examination he has an expansile mass in his abdomen. What is the next most appropriate
step?
A. USG D. Serum Lipase
B. PET Scan E. Doppler USG
C. Serum Amylase

124. A new mother has been feeling tired, tearful and overwhelmed for the past 2 weeks after the birth
of her baby. She feels like she cannot cope and is unfit to take care of the child. What is your most
likely diagnosis?
A. Postpartum Blues
B. Postpartum Depression
C. Postpartum Psychosis
D. Psychotic Depression

125. A lady 76 years old had loss of consciousness but was fine after 10 minutes. She was taking
Aspirin, Bendroflumethiazide and Simvastatin. All examinations were normal. CT scan was done.
What is the most appropriate management?
A. Add aspirin 300
B. Clopidogrel
C. Dipyramidamole
D. Clopidogrel +Dipyramidamole

126. A 7 month old child presents with seizures and jerking of limbs. What is the most likely
diagnosis?
A. Infantile spasms
B. SOL
C. Absence seizure
D. Breath holding spell

127. A child presents with history of two weeks of poor feeding, lethargy, facial swelling, oliguria and
proteinuria. What is the appropriate treatment for this child?
A. Prednisolone
B. Cyclosporin
C. Cyclophosphamide
D. Diurectics
E. No treatment needed

128. This is the likelihood of a test reporting positive when the condition is being tested in actually
present. Choose the single term from the list of options given
A. Standard deviation( root mean square deviation)
B. Specificity
C. Sensitivity
D. Probability
E. Prevalence

129. An 8 week pregnant lady is brought to the A and E due to severe vomiting. She was administered
IV fluids and oral anti-emetics. She still cannot tolerate anything orally. What is the next best
treatment for her?

21
A. Parenteral feeding
B. IV antiemetics
C. Termination of pregnancy
D. Proton Pump Inhibitor
E. IV Steroid

130. A previously fit 30 year old man presents to the hospital with fever and shortness of breath after
returning from holiday in Spain. The girlfriend is concerned that he is confused. Which of the
following is the most likely CXR finding?
A. Cavitation
B. Bilateral cavitation
C. Patchy consolidation
D. Bilateral interstitial shadowing
E. Upper lobe consolidation

131. A 3 week old girl has been brought to the emergency department. She is lethargic, unwell and
not feeding well. Her temperature is 38.5°C, HR 90bpm and RR 20breaths/min. Her skin, chest,
abdomen, ear and throat examinations are normal. What is the single most appropriate management?
A. Admit for full infection screening
B. Admit for full infection screening and start broad spectrum antibiotics
C. Admit for serial examination and observation
D. Discharge with broad spectrum antibiotic
E. Discharge with oral antipyretic

132. A 23 year old female has repeated admissions to A& E department for self-harm. She denies
trying to commit suicide. What is the best treatment option for her?
A. Flooding
B. Desensitization
C. Token economy
D. Problem focused cognitive behavioural therapy
E. Thought stopping

133. A 45 year old woman comes with complaints of bloody discharge from the nipple. No other
symptoms. What is the most likely diagnosis?
A. Pagets disease
B. Duct ectasia
C. Duct papilloma
D. Ductal Ca. in situ

134. A 45 year old man diagnosed with Multiple Sclerosis is admitted after taking 100 Paracetamol
tablets. He seems well, is not vomiting and is alert. He is refusing all treatment. What should you do
next?
A. Gastric lavage
B. Activated charcoal
C. N-Acetyl cysteine
D. Methionine
E. Evaluate his capacity to refuse treatment

135. A 70 year old man has sudden severe painful medial side of left calf on walking uphill. He has
no ankle swelling and he can extend his foot easily. What is the single most likely diagnosis?

22
A. Popliteal cyst
B. DVT
C. Tendon Achilles rupture
D. Fracture
E. Acute limb ischemia

136. A young woman was stabbed in the neck. On tongue protrusion, there was deviation to the right
side. Which nerve is involved?
A. Hypoglossal nerve injury
B. Accessory nerve
C. Vagus nerve
D. Glossopharyngeal nerve

137. A 32 year old woman has had three episodes of slurred speech and two episodes of transient
weakness of both legs in the past five years. Each episode has resolved within three months. What is
the SINGLE most likely diagnosis?
A. Meningioma
B. Migraine
C. Multiple sclerosis
D. Stroke
E. Transient ischaemic attack

138. A 60 year old lady has severe chest pain. ECG shows changes of inferior wall MI. ECG also
shows progressive prolongation of PR interval until a P wave is dropped. What is the most probable
diagnosis?
A. Atrial Fibrillation
B. Ventricular tachycardia
C. SupraVentricular tachycardia
D. Mobitz Type I Second Degree heart Block
E. Mobitz Type II Second Degree heart Block

139. A 42 year old man 72 hours after an operation for acute cholecystitis develops vomiting and
abdominal distension. He has no abdominal tenderness. What is the single most likely diagnosis?
A. Paralytic ileus
B. Mechanical obstruction
C. Anastomotic leak
D. Wound adhesions

140. Man who has motor neuron disease and is wheelchair bound, finds it difficult to swallow food-
both liquids and solids. What would be the best option to provide nutrition?
A. Gastrostomy
B. Fine bore NG tube
C. Parenteral nutrition
D. Give steroids and continue oral nutrition

141. A 32 years old woman has undergone a biopsy for a breast lump. The report says “a well
circumscribed lump with clear margins and separated from the surrounding fatty tissue”. What is the
most appropriate interpretation of this report?

23
A. Fibroadenosis
B. Carcinoma of the Breast
C. Mammary abscess
D. Fibroadenoma
E. Fat Necrosis

142. The daughter of an 83 year old man, who has been diagnosed with Alzheimer ’s disease, wants to
know about the possible outcome of his father. What would you tell her?
A. Progressive cognitive impairment
B. Will improve with time
C. Unpredictable
D. Condition will neither get better nor worse

143. Patient with widespread ovarian carcinoma had bowel obstruction and severe colic for 2 hrs and
was normal in between. What is the most appropriate management?
A. S/C morphine (PCA)
B. Spasmolytics
C. Palliative colostomy
D. Oral Morphine
E. Laxatives

144. Which statement best describes the planes of the abdomen?

A. The transpyloric plane lies halfway between the xiphoid and the symphysis pubis.
B. The transpyloric plane passes through the hilar of the kidneys.
C. The subcostal plane is at the level of the body of L2.
D. The iliac crests lie at the level of L5.
E. The umbilicus usually lies at the level of the L4/L5 disc.

145. A patient underwent liver biopsy. What is the most important investigation before the biopsy?
A. Viral screen
B. Coagulation profile
C. Serum electrolytes
D. Liver function tests
E. Abdominal US

146. MRI spine of a patient shows L3/ L4 spine compression. She complains of bladder control loss
and also has some eye problem. She has breast carcinoma in the past. What explains her symptoms
the best?
A. Metastasis in brain
B. Metastasis in spine
C. Sciatica
D. Disc prolapse

147. A 32 year old man presented with painless haematuria. He is hypertensive but the rest of the
examination was fine. What is the most likely diagnosis?
A. Polycystic kidneys
B. Ca bladder
C. Ca prostate
D. Thrombotic thrombocytopenia purpura (TTP)
E. Hemolytic uremic syndrome (HUS)

24
148. A mother brings her baby to the hospital complaining that the baby has stridor only upon breast-
feeding. On examination, omega shaped cartilage was seen in the neck. What is the most probable
diagnosis?
A. Laryngomalacia
B. Bronchiolitis
C. Croup
D. Epiglotitis
E. Tracheo oesophageal fistula

149. A patient is on long standing indwelling catheter and now the catheter bag is turned purple.
Dipstick test shows nitrates –ve, blood+. What investigation would you do next?
A. Urine culture and sensitivity
B. None
C. Urine porphobilinogen
D. USG abdomen

150. A child presented with right sided hearing loss. Tuning fork test was done and showed Air
conduction > Bone conduction. Weber test localised to left ear. What is the most appropriate
diagnosis?
A. Acute Otitis Media
B. Acute Otitis externa
C. Serous Otitis Media with effusion (glue ear)
D. Otosclerosis
E. Acoustic neuroma

151. A 72 year old presents with ipsilateral ptosis and contralateral hemiparesis. Which of the
following structure is affected?
A. Medulla D. Cerebellum
B. Cortex E. Pons
C. Midbrain

152. A man who wants to quit alcohol, but wants to avoid the unpleasant craving experiences.
What do you prescribe for him?
A. Acamprosate
B. Disulfiram
C. Methadone
D. Fluoxetine
E. Amitryptalline

153. A 50 year old man presented with Left SNHL. On examination he showed finger past
pointing, absent left corneal reflex and ataxia. What is the investigation of choice?
A. CT scan brain
B. CSF analysis
C. MRI brain
D. ESR

154. What is first line management for an alcoholic presenting in delirium tremens?
A. IV Chlordiazepoxide E. IV Zopiclone
B. IV Diazepam
C. IV Lorezepam
D. IV Midazolam

25
155. A 32 year old man presents with lateral deviation of his right eye. Which nerve is affected?
A. Left trochlear
B. Left oculomotor
C. Right trochlear
D. Right abducens
E. Right oculomotor

156. A girl presents with signs of hyperventilation. What is the most likely arterial blood gas (ABG)
derangement?
A. pH increased pCo2 increased
B. pH decreased pCo2 increased
C. pH increased pCo2 decreased
D. pH decreased pCo2 decreased

57. A 20 year old man has a head on collision in a car. On presentation he is breathless and has chest
pain as he has fractured his 5 to 7 ribs. Chest x-ray shows fracture of 5th to 7th ribs. What is the most
appropriate initial action in this patient?
A. Antibiotics
B. Analgesia
C. Oxygen by mask
D. Physiotherapy
E. Refer to surgeon

158. A 4 months old child diagnosed with a lower UTI was treated with Trimethoprim but was
unresponsive to this treatment after 48 hours. What should be the next appropriate step?
A. MSU for C/S
B. MCUG
C. Urgent DMSA scan
D. Ultrasound within six weeks time

159. A 75 year old man comes in complaining of difficulty in passing urine, poor stream and dribbling
at the end of voiding urine and anorexia. Ultra sonography (USG) shows bilateral hydro-nephrosis.
What is the cause for these findings?
A. Benign prostatic hyperplasia (BPH)
B. Renal stones
C. Bladder stones
D. Prostatic cancer
E. Urinary tract infection

160. A 62 year old female who had an episode of postmenopausal bleeding PV was sent for a TV
USG. Endometrial thickness was found to be 7mm. What is the next best step in management?
A. Total hysterectomy
B. Laparoscopy
C. Hysteroscopy and Endometrial biopsy
D. Pipelle’s endometrial sampling
E. MRI of pelvis

161. A 30 year old woman on oral contraceptives presents with dilated tortuous veins crossing her
abdomen to join the tributaries of superior vena-cava. What is the single most likely cause?

26
A. Intra-abdominal malignancy
B. Ovarian cyst
C. Fibroids
D. Ascites
E. Deep vein thrombosis (DVT)

162. A 12 year old boy leaks urine all the time. He has history of spina bifida. What is the appropriate
management?
A. Intermittent catheterisation
B. Desmopressin
C. Condom catheter
D. Urinary incontinence pad

163. Asthma not controlled on salbutamol and low dose Budesonide. Which is the next add on drug?
A. Salmetrol
B. Oral steroid
C. Aminophylline
D. High dose budesonide (inhaled)
E. Ipratropium Bromide

164. Patient with unilateral tonsil redness and enlargement presents with fever. He tookAmoxicilline
for 5 days, but there is still oozing from the tonsil .What is the most likely diagnosis?
A. Peritonsillar abscess
B. Tonsillar carcinoma
C. Squamous cell carcinoma
D. Tonsillitis
E. IMN

165. A 28 year old woman presents with pain and an ulcer on labia major. What is the lymphatic
drainage of labia major?
A. Superficial inguinal
B. Deep inguinal
C. Para aortic
D. Iliac

166. A 45 year old Schizophrenic patient is smashing down windows after being admitted ion the
psychiatric ward. What is the most immediate management?
A. Haloperidol IM
B. Diazepam
C. Olanzepine
D. Risperidone

167. A 35 year old woman had an uneventful laparoscopic cholecystectomy 18 hours ago. She has a
pulse rate of 108 beats/minute and a temperature of 37.8° C. There are signs of reduced air entry at the
right base but the chest X ray does not show any obvious abnormality. What is the most appropriate
management strategy?
A. Cefuroxime oral
B. Ceftriaxone I.V
C. Chlorpheniramine oral
D. Chest Physiotherapy
E. Reassure

27
168. A patient diagnosed with gastric ulcers has continuous symptoms despite 8 weeks of PPI therapy.
Symptoms are aggravated post meals. What is the next step in the management?
A. Surgery
B. Urea breath test
C. Switch to H2 receptor blockers
D. Endoscopic evaluation

169. A 15 year old boy presents with testicular pain for 2 days. There is no history of trauma. On
examination he has a temperature of 38.5˚C and there is tenderness of the right hemi-scrotum. What is
the single most appropriate management?
A. Give antibiotics
B. Give analgesia
C. Reassure
D. USG of scrotum
E. Exploratory surgery

170. A 22 year old lady has multiple fibroid with distorted uterus. She also has menorrhagia, she is
forgetful and as a result she does not take pills. What is the most appropriate contraception pill for
her?
A. IUCD
B. Diaphragm
C. COCP
D. Implant

171. A 50 year old man presented with stroke. Onset was 1 hour ago. CT scan showed a non
haemorrhagic stroke. What is the most appropriate next best step?
A. Aspirin
B. Carotid Doppler
C. tPA thrombolysis
D. Clopidogrel

172. A man was brought to A&E department from a shopping mall after collapsing there. He is
conscious and answering questions now. His ECG shows irregular rhythm. Your choice of
investigation:
A. CT scan
B. Magnetic resonance imaging (MRI)
C. 24 hour ECG
D. Echo

173. A 56 year old woman has woken up 5 times in the last month with a feeling of thumping in her
chest. On sitting up for about 2 minutes and taking a few deep breaths, the sensation subsides over a
further minute. Her ECG shows sinus rhythm. What is the single most appropriate investigation?
A. Cardiac Enzymes
B. 24 hour Ambulatory Electrocardiogram
C. Echocardiography
D. Serum urea and electrolytes
E. Cardiac Enzymes

174. An Afro-Caribbean boy presented with fever and arthralgia. FBC shows: Hb : 6 g/dL
Reticulocyte count : 40%
Peripheral Smear : Target cells, Howell-Jolly bodies. What is the most appropriate diagnosis?

28
A. Haemophilia A
B. Thalassemia major
C. Sickle cell anaemia
D. Thalassemia minor
E. Acute lymphoblastic leukaemia

175. A maid complains of pain in anterior inferior part of the knee. What is the most likely bursa
involved?
A. Supra patella
B. Pre patella
C. Inferior patella
D. Medial patella

176. A 48 year old woman is admitted to the Accident and Emergency Department with a productive
cough and moderate fever. She often has central chest pain and regurgitates undigested food most
times but does not suffer from acid reflux. These symptoms have been present for the last three and
half months which affects both food and drink. A chest x-ray shows an air-fluid level behind a
normal-sized heart. Which is the single most likely diagnosis?
A. Pharyngeal Pouch
B. Hiatus Hernia
C. Bulbar Palsy
D. Achalasia
E. Tuberculosis

177. A 30 year old lady suffering from arthritis of her wrist and ankle presents with pigmentation
of the skin and galactorrhea. She is a known diabetic. What is the most likely diagnosis?
A. Haemochromatosis
B. Haemosiderosis
C. Prolactinoma
D. Wilson’s disease

178. A 48 year old presents with severe chest pain since the last 40 minutes. In the A/E he is given
oxygen, GTN and Morphine. ECG shows ST elevation. Bloods reveal increase in his troponin levels.
What is the next step of management?
A. B Blocker
B. Percutaneous angiography
C. Anticoagulant and heparin
D. Clopidogrel
E. Aspirin

179. A 7 year old girl with allergy became acutely unwell while visiting a friend’s house and has been
bought immediately to the emergency department. She is fully conscious but has stridor, wheeze and
generalised erythematous rash. She is receiving oxygen. What is the single immediate management?
A. Check airway patency and prepare intubation
B. Give 0.3ml in 1000 adrenaline by IM injection
C. Give 10mg chlorepheniramine by IM injection
D. Give 50ml hydrocortisone by IM injection
E. Give 0.5ml in 1000 adrenaline by IM injection

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180. A 4 weeks old baby develops yellowing of skin and sclera. He is thriving well on breast milk.
On presentation he is playing well and active. What is the most likely cause of jaundice in this child?
A. Breast milk Jaundice
B. Galactocaemia
C. ABO incompatibility
D. G6PD deficiency
E. CMV infection

181. A 27 year old lady came to the A &E department 10 days ago with fever, suprapubic tenderness
and vaginal discharge. Pelvic inflammatory disease was diagnosed. She has been on the antibiotics for
the last 10 days. She presents with lower abdominal pain. The temperature is 39.5˚C. What is the most
appropriate next management?
A. Vaginal swab
B. Endocervical swab
C. Ultra sound
D. Abdominal X-ray
E. Laparoscopy

182. A 55 year old woman was found collapsed at home, paramedics revived her but in the ambulance
she had a cardiac arrest and could not be revived. The paramedic’s report tells that the woman was
immobile lately due to hip pain and that they found ulcers on the medial side of ankle. She was a
diabetic and was on anti-diabetics. What is the cause of her death?
A. Acute myocardial infarction
B. Diabetic ketoacidosis
C. Pulmonary embolus
D. Acute pericarditis
E. Cardiac tamponade

183. A young patient, 10 days after a tonsillectomy, presents with pain and profuse bleeding from the
operative site. What is the most important intervention to take care of the underlying problem?
A. Pack the tonsillar area
B. Cryotherapy
C. Antibiotics
D. Laser cautery
E. Surgical closure

184. A 45 years old woman has been extensively investigated for a lump she believes to be cancer.
She does not think doctors take her seriously and demands another referral. What term best describes
her condition?
A. Munchausen Syndrome
B. Munchausen’s by Proxy
C. Hypochondriasis
D. Malingering
E. Phobia

185. A 2 year old boy was brought by his mother with a swelling in the right side of the neck
extending from the angle of the mouth to the middle one third of the sternocleidomastoid muscle. The
swelling was on the anterolateral side of the sternocleidomastoid and was brilliantly trans-illuminant.
What is the likely diagnosis?

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A. Lymphangioma
B. Branchial cyst
C. Thyroglossal cyst
D. Ranula
E. Thyroid swelling

186. A 25 year old woman was brought to the A&E by her boyfriend. She has many superficial
lacerations. On examination there are many scars of old cut in her forearm. She is so distressed and
constantly says her boyfriend is going to end the relationship. She denies trying to end her life. What
is the most likely diagnosis?
A. Acute psychosis
B. Severe depression
C. Psychotic depression
D. Border line personality disorder
E. Schitzophrenia

187. A young man presents complaining of seeing coloured halos when his eyes are closed. What
drug is most likely to be the cause of his symptoms?
A. Heroin
B. Cocaine
C. Ecstasy
D. Lysergic acid diethylamide (LSD)

188. A 20 year old man presents with syphilis ulcers. What is the single most appropriate
investigation?
A. PCR for Treponema
B. Swab from lesion
C. Antibody for Treponemapallidium
D. Syphilis Antigen

189. A 33 year old female complains of diplopia on upright gaze. On examination ptosis can be seen.
There are no other complains or any significant past medical history. What is the most appropriate
investigation for this patient?
A. Ophthalmoscopy
B. Visual field test
C. Thyroid function test
D. CT scan
E. Checking red reflex

190. A 35 year old factory machine operator has been diagnosed with depression and prescribed
fluoxetine. What is the most important precaution to take?
A. Take it after meals
B. Take it empty stomach
C. Take it in the night
D. Take it in the morning
E. Not to combine it with analgesics

191. When prescribing an SSRI, what will you warn the patient about its time of action?

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A. It will work within few days
B. It will within 1 week
C. It will work by 2-3 weeks
D. It will work by 2-3 months
E. It will work by 1 year

192. A patient was admitted to A&E with prolonged hematemesis. Endoscopy revealed a bleeding
gastric ulcer which was then sutured. During the procedure, patient received 15 units of blood. The
next day, the drain contained 1 unit of blood. What is the next step in the management of this patient?
A. Urgent USG
B. Urea breath test
C. H.Pylori serology
D. Manometry

193. A 4 years old girl has had a temperature of 38.5 degree Celsius for the last two days
and refused to eat her food. Yesterday she developed sore throat and a small painful ulcer inside her
mouth. Today she has small blisters on the palms of her hands and soles of her feet which are painful
but not itchy. What is the single most likely underlying cause?
A. Coxsackie virus
B. Herpes Simplex virus
C. Staphylococcus aureus
D. Streptococcus pneumonia
E. Varicella zoster virus

194. A 30 year old woman gets very anxious if she has to attend a party. She says she cannot eat in
font of anyone and refuses to attend social events. What is the most likely diagnosis?
A. Agoraphobia
B. Claustrophobia
C. Social phobia
D. Arachnophobia
E. Hydrophobia

195. A primiparous woman with no previous infection with Herpes zoster is 18 weeks pregnant.
She had a recent contact-history with a young patient, aged 21, having widespread chicken pox. What
is the most suitable management for the pregnant lady?
A. Acyclovir orally
B. IV Acyclovir +IV Immunoglobulin
C. IV Acyclovir
D. Reassure
E. IV Immunoglobulin

196. A 27 year old female patient has been brought in with flight of ideas and attempted suicide. She
overdosed on 100 paracetamol tablets. She says there is nothing wrong with her. What should be your
next step?
A. Detain under Mental Health Act
B. Discharge
C. IV Haloperidol
D. Lithium
E. Fluoxetine

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197. A patient, from Africa, comes with nodular patch on the shin. It has a reddish brown colour.
What is the most probable diagnosis?
A. Lupus vulgaris
B. Erythema nodosum
C. Pyoderma gangrenosum
D. Erythema marginatum
E. Solar Keratosis

198. A 40 year old man came with fever and Urinary complaints. Urinalysis showed blood+ nitrites in
the urine. No history of discharge but groin is red, tender and swollen. What could be the most
probable cause of his symptoms?
A. E. Coli
B. Chlamydia
C. Neisseria gonorrhea
D. Mumps virus

199. A 7 year old child with meningitis is being treated. What is the usual outcome?
A. Learning difficulty
B. Full recovery
C. Speech problem
D. Hearing deficit

200. A 34 year old woman complains of low mood predominantly in winter. She says she feels low
every year during winter and starts to feel better once spring arrives. What is the most likely
diagnosis?
A. Depression
B. Mania
C. Seasonal affective disorder
D. Cyclothymia
E. Dysthymia

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