Dr. Swamy PLAB Courses Ltd

PLAB 1 MOCK TEST: MOCK 4 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. A 75-year-old woman who had a carcinoma of the distal rectum underwent an anterior resection.

The blood supply of the tumour arises from which of the following?

A. Coeliac artery

B. Ileocolic artery

C. Inferior mesenteric artery

D. Internal iliac artery

E. Superior mesenteric artery

2. A 34 year old patient presented with redness and pain in the eye. He is also suffering with back

pain that is worse in the morning. He is taking NSAIDs for back pain. What is the cause of red eye?

A. Ibuprofen

B. Steroids

C. Anterior Uveitis

D. Posterior Uveitis

E. Trauma

3. A 33 year old female with bipolar affective disorder had an acute depressive episode which was

controlled by antidepressants. Which drug will be best for prophylaxis in this patient?

A. Mood stabiliser

B. Selective serotonin reuptake inhibitors (SSRI)

C. Tricyclic Antidepressant (TCA)

D. Antipsychotic

4. A 15 year old boy presents with severe earache after having a swimming session. He does not allow

you to do an otoscopy and the ear is severely tender to touch. What is the most appropriate antibiotic

therapy for his condition? A. Amoxicillin

B. Ciprofloxacin

C. Flucloxacillin

D. Meropenem

5. A young woman on combined oral contraceptive pills has been prescribed Amoxicillin for sinusitis.

What should be the advice given to her? A. Increase dose of OCPS

B. Reduce dose of Amoxicillin

C. Use barrier methods for 2 weeks

D. No extra precautions needed

E. Barrier methods only if patient develops diarrhea

6. A middle aged man complains of a node which has been growing in his nose for several months.

Now it is firm with central depression. It’s 0.6cm in size. What is the SINGLE most likely diagnosis? A. Basal cell carcinoma F. Kerato acanthoma

B. Squamous cell carcinoma G.Molluscum Contagiosum

C. Lymph node

D. Melanoma

E. Kaposi’s Sarcoma

7. A 7 year old boy presents with her mother to the GP surgery. His mother describes he had

presented this since 3 weeks ago. He had not experienced any trauma. No other symptoms associated

with the condition. On examination the boy has non tender swollen ankles bilaterally. There is no rash

or lesion. He is otherwise well. Which single test would be the best as an initial assessment?

A. Plasma electrolytes.

B. Album

C. Total serum protein

D. Anti-streptolysin

8. A lady comes in 6 weeks after her normal vaginal delivery for contraceptive advice. She is breast

feeding her child and requests for reversible contraception. She is planning another pregnancy in 6

months time and is scared of injections. What is the best option for her? A. COCP

B. Cu IUCD (intrauterine contraceptive device)

C. Mirena coil

D. POP

E. Transdermal patch

9. A 68 year old man with diabetes and hypertension was noted to have a cholesterol level on

3.4mmol/l. He was also noted to have micro-albuminuria. What is the best drug to add to his regimen? A. Ace inhibitors

B. Statins

C. Amylodipine

D. Biguanides

10. A 65 year old man on dexamethasone underwent a surgery. During and after the surgery, his

blood glucose level was around 17 – 19 mmol/l. What will you give the patient? A. Insulin

B. Oral hypoglycaemics

C. Remove dexamethasone

D. IV saline

E. IV dextrose

11. 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.

12. 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

13. A 5 year old child was admitted with history of feeling tired and lethargic all the time, bleeding

gums and sore throat since the last 3 months. On examination he is found to have hepato-

splenomegaly. What is the most probable diagnosis?

A. Acute lymphoblastic leukemia (ALL)

B. Acute myeloid leukemia (AML)

C. Chronic myelogenous (or myeloid) leukemia (CML)

D. Chronic lymphocytic leukaemia (CLL)

E. Lymphoma

14. 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)

15. 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

16. A young child just diagnosed with chicken pox. Usually goes to day care. What is the most

appropriate advice?

A. Child should be admitted to hospital straight away

B. Isolate the child from parents and siblings at home

C. Advise him he can go back to nursery when the rash is crusted over

17. A lady presents with abdominal pain, dysuria, dyspareunia and vaginal discharge. What is your

next step? A. Laparoscopy E. Ultra sound

B. High vaginal swab

C. Hysteroscopy

D. Laparotomy

18. 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

19. 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

20. A 55 year old lady with swelling on the abdomen below the umbilicus on the right side. What is

the SINGLE most appropriate lymph node? A. External iliac lymph nodes F. Submental lymph nodes

B. Pre aortic lymph nodes G. Submandibular lymph nodes

C. Aortic lymph nodes H. Deep cervical lymph nodes

D. Inguinal lymph nodes

E. Iliac nodes

21. A 45 year old man presents to A&E with pain the chest and shortness of breath. He has no

recollection of what has happened to him. His breath smells of alcohol. What is the most probable

diagnosis looking at the given picture?

A. Shingles

B. Cellulitis

C. Blunt trauma

D. ITP

E. Hypersensitivity reaction

22. 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

23. 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

24. 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

25. 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

26. A 19 year old girl is brought into A & E after an argument with her boyfriend. She has multiple

superficial lacerations on her forearms and wrists which have been attended to by the medical team.

She has attended A&E many times in the past with similar episodes of self-harm and drug overdoses.

What is the most likely diagnosis?

A. Obsessive compulsive personality

B. Schizoid personality

C. Borderline personality

D. Dependent personality

27. A man with dementia has an ulcerative lesion on forehead. He wants it removed so ‘it can help

improve his memory’. Wife says he is not fit to give consent. What will you do?

A. Get letter signed from the GP

B. Get letter signed from wife

C. Get letter signed from patient

D. Refer to psychiatrist to assess the mental capacity to give consent

28. A young woman is brought to the hospital after consuming 17 tablets of paracetamol to the A&E.

On evaluation it is noted that she is clinically depressed and has not eaten anything for four days. She

has been brought to the hospital after 9 hours on consuming the tablets. What is the most important

next step? A. N acetyl cysteine

B. Paracetamol levels

C. Gastric Lavage

D. Activated Charcoal

E. Psychiatric Evaluation

29. 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

30. A child of 24 months can walk, run, can make a pyramid, speaks only two meaningful

words such as mama and dada. How will you manage this child? A. Reassure

B. Speech consultation

C. Physiotherapy

D. CT scan

E. Admit further assessment

31. A 65 year old man presented with hearing impairment and weight loss. He complains of hearing

buzzing sound and feeling dizziness that is becoming worse slowly. On examination facial numbness

has been noticed. What is the best investigation option for this problem? A. MRI acoustic meatus

B. CT Head

C. Blood culture

D. Audiometry

E. Tilt Test

32. 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

33. A 4 year boy has cough and arthritis followed by rash on legs and trunk which are non- blanching

on glass test. No history of fever. PT: 13

APTT : 31

Hb : 12

WBC: 6.5

Platelet: 300x10

Choose the most likely diagnosis?

A. Meningitis septicaemia

B. Haemophillia

C. Henoch-SchoenleinPupura

D. Idiopathic thrombocytopenic purpura

E. Thrombotic thrombocytopenic purpura

34. 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? A. Intra-abdominal malignancy

B. Ovarian cyst

C. Fibroids

D. Ascites

E. Deep vein thrombosis (DVT)

35. A 45 year old heroin addict was involved in a car crash and is now paraplegic. During the first

week of his hospital stay he cried everyday because he couldn’t remember the accident.

What is the most likely diagnosis? A. PTSD

B. Severe depression

C. Organic brain injury

36. 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

37. A 25 years old man presents with fever and pain in the right lower thigh of one month duration.

On examination the lower third of his thigh is red, hot and tender. The X-ray showed new bone

formation. What is the most probable diagnosis?

A. Osteosarcoma

B. Ewing’s Sarcoma

C. Tuberculus Arthritis

D. Exostosis

E. Fibrosarcoma

38. A 72 year old man had myocardial infarction a few weeks ago. Now he is on medication. He

comes to outpatient department and he complains of yellow colour in his vision. What can be the

cause of this? A. Digoxin

B. Amitriptyline

C. Atenolol

D. Ramipril

E. Bendroflumethiazide

39. In a laproscopic mesh repair for hernia, when the trochar is inserted at midpoint between

umbilicus and ischial spine, what structure will be pierced? A. Linea alba

B. Rectus muscle

C. Conjoint tendon

D. External and internal oblique muscles

E. Inguinal ligament

40. A 25 year old male had an injury to the knee while playing football. X ray reveals the condylar

fracture of tibia. What is the SINGLE most probable deformity? A. Dinner fork deformity

B. Gibbus

C. Cubitus valgus

D. Garden spade deformity

E. Genu valgus

41. A 37 year old patient presented with hearing loss and offensive discharge from the ear. Otoscopy

is performed and crusted tympanic membrane was noticed. A pearly white mass was seen on the attic

when crust was removed. Choose the correct diagnosis from following options A. Frunculosis

B. Basal cell carcinoma

C. Cholesteatoma

D. Acoustic Neuroma

E. Squamous cell carcinoma

42. A 62 years old lady presents with a pathological fracture of thoracic vertebra, this is found to

be associated with an underlying metastatic lesion, what is the most probable primary cancer

site? A. Ovary

B. Lung

C. Breast

D. Cervix

E. Colon

43. A man with a family history of panic disorder is brought to the hospital with palpitations, tremors

and sweating and muscle tightness on three occasions in the last six weeks. He does not complain of

headache and his blood pressure on each presentation is within normal limits. What is the single most

appropriate long term treatment for this patient?

A. Diazepam

B. Olanzapine

C. Haloperidol

D. Fluoxetine

E. Alprazolam

44. A 37year old female working as a health care assistant in a nursing home, comes to the A&E with

complaints of severe itching all over her body. On asking she replies that she had applied cream on

the body of a resident in the nursing home who had similar itches. What is the mechanism of her itch?

A. Allergic reaction

B. Inflammation of keratinocytes

C. Allergic reaction developed due to use of topical steroid creams

D. Subcutaneous bleeding

E. None of the above

45. A 55 year old male patient had TIA which he recovered from. He has a history of stroke and upon

examination his heart rate was in sinus rhythm. He is already on aspirin 75mg and anti-hypertensive

drugs. What other action should be taken? A. Add Clopidogrel only

B. Increase the doses of aspirin to 300mg

C. Add Warfarin

D. Add Clopidogrel and Statins

E. Add Statins only

46. 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

47. A middle age male after myocardial infarction is feeling unwell. The ECG has been performed

and shows a prolonged QRS complex and T wave is tented Sodium-136 mol/L

Potassium- 6.2mmol/L, Urea- 5.0 mmol/L

What is the most appropriate management? A. Calcium gluconate E. Calcium

B. Calcium resonium

C. Calcium with Vitamin D supplements

D. Vitamin D

48. A 57 year old man who had myocardial infarction a few months ago has been having low mood. A

diagnosis of moderate depression has been established. Which medication is the best treatment for

him? A. Selective serotonin re-uptake inhibitors (SSRI)

B. TACs

C. Monoamine oxidase inhibitor (MAOI)

D. Benzodiazepams

E. Mood stabilisers

49. A 64 year old man presents with ipsilateral vertigo, tinnitus and left side hearing loss. On

examination Rinne's test is positive and Weber’s test is lateralised to the right ear. What is the most

appropriate investigation? A. CT scan

B. Magnetic resonance imaging (MRI) of brain

C. X-ray

D. Audiometry

E. No investigation required

F. Caloric Testing

50. A 74 years old lady who has had a stroke in the past, had an indwelling catheter for 10 months.

She presents with bluish-purple discoloration of the catheter bag. What is the most likely explanation

for this change? A. Normal Change

B. Catheter Degradation

C. Acidic Urine

D. Alkaline Urine

E. Bacterial Colonisation of the Urinary Tract

51. 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

52. A four years old boy with a febrile convulsion lasting eight minutes has been given intravenous (IV)

Lorazepam to control the convulsion. What is the SINGLE most likely serious side-effect? A. Amnesia

B. Anaphylactic shock

C. Diabetes

D. Bronchospasm

E. Cardiac arrhythmia

53. 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

54. A 57 year old man, who is a known hypertensive, is on oral anti-hypertensives. However, he is

finding it difficult to mobilise as he feels dizzy whenever he tries to get up. What is the most

appropriate investigation for him? A. Ambulatory blood pressure

B. Electrocardiogram (ECG)

C. Magnetic resonance imaging (MRI)

D. Chest X ray

E. CT scan

55. 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.

56. A 72 years old woman has been taking loop diuretics for left ventricular failure. She now presents

with palpitations and muscle weakness. What is the SINGLE most likely serum electrolyte pattern to

be found? A. Sodium 130 mmol/L, potassium 2.5 mmol/L

B. Sodium 130 mmol/L, potassium 5.0 mmol/L

C. Sodium 140 mmol/L, potassium 4.5 mmol/L

D. Sodium 150 mmol/L, potassium 2.5 mmol/L

E. Sodium 150 mmol/L, potassium 3.5 mmol/L

57. What is the best treatment for candidiasis in the throat? A. Chlorhexidine mouthwash

B. Nystatin suspension

C. Oral Fluconazole

D. IV Metronidazole

58. A 45 year old man had recently started taking antihypertensive therapy. Six months later his

Random Blood Sugar was found to be 14.0 mmol/l. Which single drug is most likely to have caused

this? A. Amlodipine

B. Bendroflumethiazide

C. Doxazosin

D. Losartan

E. Ramipril

59. A 24 year old woman has severe depression three months after the birth of her first child. She is

breastfeeding but is otherwise unable to look after the baby and is convinced that her family is likely

to kill her. She has no interest in anything and keeps crying. What is the most appropriate treatment? A. Fluoxetine

B. Citalopram

C. Cognitive behavioural therapy

D. ECT

E. Haloperidol

60. A 31 years old woman presents 7-10 days following childbirth, with loss of feeling for the child,

loss of appetite, sleep disturbance and intrusive and unpleasant thoughts of harming the baby. What is

the best treatment for this patient? A. Fluoxetine

B. Haloperidol

C. Cognitive Behavioural Therapy

D. Reassurance

E. Electro Convulsive Therapy

61. 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

62. A 6 year old child fell on his nose 2 days ago. His parents have now brought him with difficulty in

breathing. On examination he has a fever and his nasal bones are straight. What is the single most

likely diagnosis? A. Nasal polyp

B. Septal hematoma

C. Septal abscess

D. Deviated nasal septum

E. Fractured nose

63. A 56 year old man with atrial fibrillation is prescribed digoxin. What side effect will you make the

patient aware of? A. Seeing visual haloes

B. Nausea

C. Vomiting

D. Diarrhoea

64. 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

65. A 54 year old lady presents with sudden, severe pain in the left half of her skull. She also

complains of pain around her jaw. What is the most likely next step?

A. CT scan

B. MRI

C. Fundoscopy

D. ESR

E. Temporal artery biopsy

66. A patient admitted due to repeated attacks of pancreatitis presents with dementia and loss of

proprioception in the legs. What is the most appropriate treatment?

A. Thiamine

B. Pyridoxine

C. Cobolamin

D. Lypase

E. Antibiotics

67. A 2 year old boy with 38.4°C fever had an episode of tonic clonic seizure at home that lasted for

15 minutes. In A&E patient is conscious and fit has stopped. When temperature was checked, it was

normal. What is most probable diagnosis?

A. Febrile convulsion

B. Infantile spasm

C. Absence seizure

D. Grandmal Epilepsy

E. Focal seizure

68. A 10 years old girl presents with pallor and features of renal failure. She has haematuria as well as

proteinuria. The serum urea and creatinine are elevated. These symptoms started after an episode of

bloody diarrhoea 4 days ago. What is the most probable diagnosis?

A. Thrombotic thrombocytopenia purpura (TTP)

B. Haemolytic-uremic syndrome (HUS)

C. Idiopathic thrombocytopenic purpura (ITP)

D. Henoch-Schonleinpurpura (HSP)

E. Acute renal failure (ARF)

69. 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?

A. Fibroadenosis

B. Carcinoma of the Breast

C. Mammary abscess

D. Fibroadenoma

E. Fat Necrosis

70. A West indian woman with anaemia and mild jaundice comes with limb pains and abdominal

pain. And the symptoms are precipitated by ongoing infections. On examination spleen is no more

palpable. What is your most probable diagnosis? A. G6PD deficiency

B. Sickle cell disease

C. Beta thalassemia major

D. Sideroblastic anaemia

E. Malaria

71. A 19 year old man presents for the first time with a firm and unshakable belief that he is being

followed by terrorists who are plotting against him. What is the single best term for this man’s

condition? A. Delusion of Persecution E. Delusion of Nihilism

B. Delusion of Grandeur

C. Delusion of Control

D. Delusion of Reference

72. A 29 year old young man complains of recurrent attacks of diarrhoea. He says his stools contain

blood and mucus. Sometimes she has low grade fever. What is the most appropriate investigation? A. Stool culture

B. Plain abdominal x-ray

C. Per rectal examination

D. Barium Enema

73. A boy with partial thickness, burn increased. What is the next step? A. Escharectomy

B. Dressing

C. Burst blisters

D. Local antibiotics

E. Refer to burn unit

74. A 64 years old diabetic has come for a routine eye check-up. Fundoscopy shows new vessels all

over the retina. What is the most appropriate management? A. Strict Sugar Control

B. Regular eye check ups

C. Non urgent referral to a specialist

D. Laser photocoagulation

E. Insulin

75. A 45 year old man underwent emergency splenectomy following a fall from his bicycle. He

smokes five cigarettes a day. Post -operatively despite mobile, he developed swinging pyrexia and a

swollen painful left calf. His chest x-ray shows lungs atelectasis and abdominal USG demonstrates a

small sub-phrenic collection.What is the SINGLE most likely risk factor for deep vein thrombosis in

the patient?

A. Immobility

B. Intraperitonealhaemorrhage

C. Smoking

D. Splenectomy

E. Sub-phrenic collection

76. A young woman was brought to the hospital. On examination she has low temperature and tremor.

She says when her eyes are closed she can see colour. What drug has been used? A. Methylenedioxymethamphetamine (MDA)

B. Lysergic acid diethylamide (LSD)

C. Cocaine

D. Heroine

E. Ecstasy

77. A mother brings her 1 week old baby to the clinic because she is concerned about a large mark on

his back. On examination there seems to be a large blue bruise like mark on the baby’s back. What is

the most likely diagnosis?

A. Non accidental injury

B. Mongolian spot

C. Accidental bruising

D. HSP

E. ITP

78. You are the SHO in the hospital and the lab report of a patient shows glucose: 4mmol/L, K:

5.2mmol/l, Na129 mmol/l. What is the most appropriate management for this patient?

A. Normal Saline 0.9%

B. Normal saline 4.5%

C. Normal Saline 0.9% + insulin

D. Insulin

E. Dextrose

79. A 10 year old male child was brought by his mother complaining that her child watches TV at

very high volume, doesn’t like to play out and instead has become more sincere with reading. She also

says that her son does not respond to her. What do you expect to see on otoscopy?

A. Flamingo pink Tympanic Membrane

B. Attic perforation

C. Bluish grey Tympanic membrane with air fluid levels

D. Inflamed tympanic membrane with cart wheel appearance of vessels

E. Red and inflamed tympanic membrane

80. 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

81. A 60 years old man brought to A&E department with fracture of hip; he is deaf and has bilateral

pedal oedema. What is the SINGLE most probable diagnosis?

A. Paget’s disease

B. Osteoporotic fracture vertebrae

C. Secondary

D. Multiple myeloma

E. Spondylosis

82. A 28 years old lady presents with dyspareunia and dysmenorrhoea. She is very obese. She now

wants reversible contraceptive method. Which of the following will be most suitable for her? A. Mirena

B. Combined Oral Contraceptive Pill (COCP)

C. Progestogen only pill (POP)

D. Copper-T

E. Barrier method

83. 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

84. An 80 year old man with prostatic cancer has confusion, thirst, abdominal pain and an abnormal

electrocardiogram (ECG). What is the most appropriate investigation? A. CT scan

B. Radionuclide bone scan

C. Skeletal Survey

D. Serum alkaline phosphatase iso-enzyme concentration

E. Serum calcium concentration

85. A 35 year old man presents with a headache that worsens on bending his head forward. What is

the most likely diagnosis? A. Chronic Sinusitis

B. Subarachnoid Haemorrhage

C. Migraine

D. Cluster Headache

E. Tension Headache

86. A 19 years old male presents with runny nose, cough and generalised rash. Blood MCS is positive

for coagulase positive cocci. What is the best management?

A. Amoxicillin

B. Rifampicin

C. Gentamycin

D. Flucloxacillin

E. Co-amoxiclav

87. An 82 year old man has woken up with incoherent speech and difficulty in finding the right

words. Examination is otherwise normal and his comprehension is good. Which anatomical site is

most likely to be affected? A. Broca’s Area

B. Wernicke’s Area

C. Midbrain

D. Parietal Cortex

E. Pons

88. 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

89. A10 year old girl presents with hoarseness of the voice. She is a known case of bronchial asthma

and has been on oral steroids for a while. What is the most likely cause of hoarseness of voice in this

case?

A. Candidial laryngitis

B. Tonsillitis

C. Chronic laryngitis

D. Laryngeal carcinoma

90. A 60 year old man presents with dysphagia and pain on swallowing both solids and liquids. A

barium meal shows gross dilatation of the oesophagus with a smooth narrowing at the lower end of

the oesophagus. What is the SINGLE most likely cause of dysphagia from the given options? A. Achalasia

B. Myasthenia gravis

C. Oesophageal carcinoma

D. Oesophageal web

E. Systemic sclerosis

91. A patient operated for gastric carcinoma is on oral morphine for pain relief. He has adequate pain

relief but is experiencing side effects due to high dose of morphine required. What is the most

appropriate next step in his pain management? A. Patient controlled analgesia

B. Oral oxycodone

C. IV morphine

D. Fentanyl patches

92. 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

93. A 27 year old woman had pre eclampsia and was delivered by c – section. She is now complaining

of right upper quadrant pain different from wound pain. What investigation will you do immediately?

A. Coagulation profile

B. Liver function tests

C. Ultrasound liver

D. MRCP

E. None

94. A 37 year old woman presents with more tiredness than usual, she is found to have angular

stomatitis, no koilonychia. Choose the single cell type you will find on blood film.

A. Macrocytes

B. Microcytes

C. Granulocyte without blast cells

D. Blast cells

95. A woman came with the complaint of pain in her right arm when she abducts it. She has recently

moved to a new house. There is no history of trauma. What is the likely cause of her pain?

A. Rupture of the long head of the biceps

B. Sprain of the acromio-clavicular ligament

C. Tendinitis of the abductor sheet

D. Supraspinatus tendinitis

E. Shoulder dislocation

96. A man presents to A& E with pins and needles in his arms and legs, decreased sensation and

reduced reflexes in lower limbs. Blood tests reveal a macrocytic anaemia. He sees things other people

can’t see and has a long history of alcoholism. When asked simple questions he makes up nonsensical

stories. What is the management? A. Diazepam

B. Chlordiazepoxide

C. Thiamine

D. Folic acid

97. A 56 years old patient, whose pain was relieved by oral Morphine, now presents with

progressively worsening pain relieved by increasing the dose of oral Morphine. However the patient

complains that the increased Morphine makes him drowsy and he is unable to carry out his daily

activities. What is the next step to manage this patient? A. Oral Oxycodone

B. Oral Tramadol

C. Patient Controlled Analgesia

D. I.V. Fentanyl

E. Diamorphine

98. A 20 years old young lady comes to her GP for advice regarding cervical cancer. She is worried as

her mother past away because of this disease. She would like to know what is the best method of

contraception in her case ?

A. Progestrogen only pill (POP)

B. Barrier method

C. Intrauterine Contraceptive Device (IUCD)

D. Combined Oral Contraceptive Pill (COCP)

E. Intruterine system

F. Osteoarthritis

99. A six year old girl has had two short episodes of cough and wheeze over the last 12 months. These

two acute episodes responded quickly to bronchodilator, she has no symptoms or abnormal physical

signs. She has slight eczema and her mother has asthma. What is the SINGLE most appropriate

investigation?

A. Chest x-ray

B. Peak flow rate diary

C. Pulse oximetry

D. Spirometry

E. Sweat test

100. A pregnant patient present with tingling, numbness, pain and loss of sensation on middle and

index finger of right hand. Tinel sign is negative. What is the most likely diagnosis?

A. Carpal tunnel syndrome

B. Hammer hypothenar syndrome

C. Ulnar nerve injury

D. Radial nerve injury

101. A 22 years old man keeps having persistent and intrusive thoughts that he is a dirty thief. No

matter what he tries these thoughts keep coming to him. Any attempt to avoid these thoughts leads to

serious anxiety. What is the most likely diagnosis?

A. Schizophrenia

B. Obsessive Compulsive Disorder (OCD)

C. Post traumatic stress disorder (PTSD)

D. Mania

E. Psychotic Depression

102. 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

103. Patient had all signs of cerebello-pontine angle (CPA) tumour facial numbness, tinnitus and

vertigo. What is the best investigation? A. CT scan

B. MRI Brain

C. MRI Head

D. X-ray head

104. A man has a habit of checking the locks of his house again and again. He tries to resist but he has

palpitations. What is the most appropriate treatment?

A. CBT + fluoxetine

B. CBT only

C. Fluoxetine only

D. ECT

105. A 70 year old lady presents with fever since 3 days and confusion. There is no significant past

history. What is most probable diagnosis? A. Delirium

B. Hypoglycemia

C. Alzheimer’s disease

D. Diabetic Ketoacidosis (DKA)

106. 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?

A. Oral Chlorpheniramine

B. IV Chlorpheniramine

C. IM Adrenaline

D. IV Adrenaline

E. Reassurance

107. A child who has type 1 diabetes is sad and unhappy at school. He has no friends and his

glycaemic control is poor. What would you do next? A. Refer to diabetologist

B. Refer to psychiatrist

C. Refer for developmental assessment

D. Increase insulin dose

108. A 27 year old man believes that the whole world is plotting to kill him. What is the best

treatment for him? A. Haloperidol

B. Chlorpromazine

C. Risperidone

D. Thioridazone

109. A 70 year old patient presents with cough and shortness of breath. He stopped smoking cigarettes

2 years ago but he has been smoking for about 50 years before quitting. CXR shows consolidation and

bilateral and bihilar lymphadenopathy. What is the best investigation for this patient? A. Lymphnode biopsy

B. Pleural fluid cytology

C. CT scan

D. Magnetic resonance imaging (MRI)

E. Ultrasound

110. A 12 year old boy with pain and swelling in multiple joints (small and large), has mild fever .

Which of the following change in his blood investigations will definitely be there? A. RA factor positive

B. Increase in ESR

C. ANA – positive

D. Rise in serum uric acid level

111. A 23 year old lady was prescribed with Azithromycin 1gm for her chlamydial pelvic infection.

She has got a new boyfriend for the last 2 months. She has recently started contraception to avoid

conception. Which of the following contraception method will be affected by Azithromycin? 23RD

NOVEMBER 2014 A. Barrier

B. Intrauterine Contraceptive Device (IUCD)

C. Progestogen only pill (POP)

D. Combined Oral Contraceptive Pill (COCP)

112. A 55 year old man presents with complaints of claudication pain in his right thigh and calf. On

examination the femoral and popliteal pulses are absent on the right leg. Localise the site of

occlusion. A. External Iliac Artery

B. Aorto-Iliac

C. Ilio-Femoral

D. Internal Iliac

E. Abdominal aorta

113. A child presents with projectile vomiting and is diagnosed with pyloric stenosis. What electrolyte

should be checked next?

A. Potassium

B. Calcium

C. Magnesium

D. Iron

114. A 27 year old man presents with chest pain and respiratory distress. On examination there is

tachycardia, hypotension and neck vein distension. Trachea is deviated to the left side, breathing

sound on the right side is absent and on the left side is diminished. What is the next appropriate

management?

A. A. Chest x-ray

B. B. Right side aspiration (16 G cannula)

C. C. Left side aspiration (16 G cannula)

D. D. Right side drainage with a small tube (12F)

E. E. Left side drainage with a small tube (12F)

115. A 45 year old woman has had severe epigastric and right hypochondrial pain for a few hours.

She has a normal full blood count; serum alkaline phosphatase is raised, normal transaminase. Three

months ago she had a cholecystectomy done. What is the most appropriate investigation?

A. Ultrasound of the Abdomen

B. Endoscopic Retgrograde Cholangiopancreatography

C. Magnetic Resonance Cholangiopancreatography

D. CT scan of the Abdomen

E. Upper GI Endoscopy

116. A 23 year old female presented with a swelling of her neck that moved upwards on protrusion of

tongue. What is the next appropriate investigation?

A. FNAC

B. Punch biopsy

C. Core biopsy

D. MRI neck

E. Radioactive thyroid scan

117. 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

118. Mother got infected with Hepatitis B during pregnancy. Her child is born. She is worried about

the risk of infection to the baby with Hepatitis B. What would you give to the baby? A. HepB Immunoglobulin only

B. HepB full vaccine and Ig

C. HepB vaccination only once

D. Nothing until immune status checked

E. HepB vaccine once and Ig

119. A 65 year old man with difficulty in swallowing presents with an aspiration pneumonia. He has a

bovine cough and a fasciculating tongue. Sometimes as he swallows food it comes back through his

nose. Choose the SINGLE most likely cause of dysphagia from the given options? A. Bulbar palsy

B. Oesophageal carcinoma

C. Pharyngeal pouch

D. Pseudobulbar palsy

E. Systemic sclerosis

120. Which one of the following is the major contributor to the development of physiological jaundice?

A. Breast feeding.

B. Immature liver

C. Low haemoglobin levels and longs life span

D. Immature gut flora

E. Entero-hepatic circulation

121. A 25 year old primigravida is found to have a blood pressure of 160/90mmHg and proteinuria of

+++. What is the most likely diagnosis? A. Eclampsia

B. Pre-eclampsia

C. HELLP

D. Normal finding

E. Renal failure

122. Among the risk factors given, which one will most likely enhance a woman’s chances of getting

ovarian cancer? A. Family history

B. Previous history of breast cancer

C. Environmental factor

D. Young age

E. Nulliparity

123. A 45 year old male complains of tremors in hands. On examination these tremors are absent at

rest, but present when arms are held outstretched and persist on movement. What is the most

probable diagnosis? A. Parkinsonism

B. Benign essential tremor

C. Cerebellar disease

D. Liver failure

E. Stroke

124. A 17 year old secondary school girl presents with complaint of prolonged irregular menstrual

periods and heavy blood losses. What is the most appropriate treatment for her?

A. Mefenamic Acid E. Intrauterine Contraceptive Device (IUCD)

B. Combined Oral Contraceptive Pill (COCP) F. Mirena

C. Progesterone only pill

D. Specific Antigen (PSA)

E. Midstream Specimen of Urine (MSU)

125. Patient with terminally ill cancer. He is on oral morphine. He cannot tolerate it. What is the next

mode of treatment? A. Intravenous

B. Subcutaneous

C. Change to other pain management

126. A 75 year old woman from a nursing home is brought to the A/E by her carer who says that she

has been confused for four days. She is on Warfarin for atrial fibrillation. Examination is

unremarkable except for multiple bruises on her body. Blood investigations reveal an INR of 7.3.

What is the most likely diagnosis? A. Alcohol intoxication

B. Urinary tract infection

C. Subdural haematoma

D. Dementia

127. A 50 years old man presents with low mood, poor concentration, anhedonia and insomnia. He

has had two episodes of increased activity, promiscuity and aggressive behaviour in the past. He was

arrested 8 months ago for trying to rob a bank, claiming it as his own. Which drug is most likely to

benefit him?

A. Haloperidol

B. Citalopram

C. Desipramine

D. Carbamazepine

E. Ethosuximide

128. 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? A. Lymphangioma

B. Branchial cyst

C. Thyroglossal cyst

D. Ranula

E. Thyroid swelling

129. A 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

130. A 2 year old boy has had fever, sore throat, runny nose and lethargy for the past few days. Now

he presents at A &E, is sitting in mother’s lap with his body inclined forward with continuous stridor

and is drooling saliva. What is the most important next step in his management?

A. Call ENT specialist

B. High flow O2

C. Call Anaesthetist

D. Antibiotics IV

E. Immediate bronchoscopy

131. 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

132. A 24 year old college student presents with nausea, vomiting, headache, neck stiffness and a

fever of 38.4˚C. What is the most appropriate empirical antibiotic to be started?

A. Cefotaxime

B. Penicillin

C. Gentamicin

D. Tazobactam

E. Meropenem

F. Rifampicin

133. A 3 year old girl was playing with her brother when she fell off her bicycle. She was about to cry

but fell unconscious without making any sound. She regained consciousness within 10 seconds and

was normal. The mother says similar episodes have happened in the past and she was afraid her

daughter as going to die. What is the appropriate investigation?

A. 24 hour EEG

B. CT scan

C. No investigation needed

D. MRI

E. Neuropsychological examination

134. A 23 year old female was involved in a house fire 3 months ago. She now complains of

nightmares and flashbacks about the incident. This is interfering with her daily life. Whenever she

hears a fire engine, she starts having palpitations and extreme anxiety and gets images of people being

burnt alive. What is the most likely diagnosis? A. Obsessive compulsive disorder

B. Adjustment disorder

C. Bipolar affective disorder

D. Eating disorder

E. Post traumatic stress disorder

135. A young man febrile with cough and sputum production with left lower lobe patchy

consolidation in CXR. Which is the best antibiotic therapy for this patient?

A. Ciprofloxacillin

B. Cotrimoxazole

C. Cefotaxime

D. Vancomycin

E. Amoxicillin

136. A child with inflammation in the orbit, fever, lid swelling and decreased eye mobility. Which is

the best investigation for his condition?

A. FBC

B. Blood cultures

C. CT scan of the orbits

D. Throat swab

E. Nasal Secretions

137. A 6 weeks old baby has blue mark near coccyx since birth. His mother is worried. What would

you do?

A. Reassure

B. Coagulation profile

C. Karyotyping

D. Skeletal survey

E. CT scan

138. Infection of which of the following areas in the face will lead to pre auricular lymph node

enlargement?

A. Mastoid area

B. Mandibular area

C. Pinna of the ear

D. Upper eyelid

139. A 9 year old girl presents with weekly abdominal pain and with occasional headaches but not

associated with vomiting and diarrhea. She has good appetite. Full blood count, urea and electrolytes

and other investigations are normal. On examination no abnormality was found and the abdomen was

soft and non-tender. What is the most likely next step?

A. Ultrasound scan of the abdomen

B. CT of thorax

C. Liver Function test

D. Reassure

E. Analgesia

140. An 8 year old girl presents with a large swelling on the side of her neck, there were associated

lymph nodes swellings in her neck and axilla. What is the most appropriate investigation?

A. Bone marrow biopsy

B. Lymph node biopsy

C. CT of the neck

D. MRI of the neck

E. Hb electropheresis

141. A 34 year old patient with small cell lung cancer of lung presents with Na: 119 and all other

values normal. Fluid restriction has failed to bring the Sodium up. What is the next most likely step?

A. Chemotherapy

B. Radiotherapy

C. Demeclocyclin

D. Somatostatin

E. Loop diuretics

142. A patient complains of shortness of breath, wheeze, cough and nocturnal waking. He has dry

scaly shin with rashes that are itchy. What is the single most likely diagnosis?

A. Scabies

B. Eczema

C. Rheumatitis

D. Dermatitis

E. Psoriasis

143. A woman has been prescribed long term steroids for polymyalgia rheumatic. What additional

drug should be added to prevent osteoporosis?

A. Calcium

B. Alendronate

C. Vit D

D. Calcium resonium

144. A young man who recently served in the Army, has been diagnosed with post traumatic stress

disorder. What is the best treatment for him? A. Narrative exposure therapy + paroxetine

B. Flooding + sertraline

C. Response prevention+ citalopram

D. Systematic desensitization + Fluoxetine

E. Play therapy

145. A 28 year old male is complying with her asthma treatment of low dose inhaled corticosteroids

and salbutamol as required. Her inhaler technique is rechecked. She has frequent night cough and

mild exercise induced wheeze. Most appropriate management A. Add leukotriene antagonist

B. Add oral theophylline

C. Add regular LABA

D. Increase dose of ICS

E. Short course of oral corticosteroid

146. A 24 years old woman is afraid to leave her house as whenever she goes out; she tends to have

shortness of breath and sweating. She has stopped going out except with her husband. What is the

most likely diagnosis?

A. Social Phobia D. Panic Disorder

B. Claustrophobia E. Agoraphobia

C. Depression

147. A 65 year old hypertensive man wakes up in the morning with slurred speech, weakness of the

left half of his body and drooling. Which part of his brain is affected?

A. Left parietal lobe

B. Right internal capsule

C. Right midbrain

D. Left frontal lobe

148. A known asthmatic adult on beta2 agonist inhaler, presents with worsening of breathlessness and

cough. What medication should be added further to the regime to control asthma symptoms?

A. Inhaled steroids

B. Oral steroids

C. Antibiotics

D. Increase beta2 agonist inhaler dose

E. Nebulized salbutamol

149. Patient was admitted with erectile dysfunction, reduced facial hair and galactorrhoea. What is

the most probable diagnosis?

A. Hyperprolactinemia

B. Cushing’s syndrome

C. Pheochromocytoma

D. Hyperthyroidism

E. Hypoparathyroidism

150. A 42 year old man presents with stroke, he is not able to walk straight and his speech is slurred.

What is the initial appropriate investigation?

A. CT scan brain

B. PET scan brain

C. MRI (brain)

D. Carotid angiography

E. Monitor for 24 hours

151. A 14 year old boy fell and hit his head in the playground school. He did not lose consciousness.

He has swelling and tenderness of the right cheek with a sub-conjunctival haemorrhage on his right

eye. What is the most appropriate initial investigation?

A. CT Brain

B. EEG

C. MRI

D. Skull X-Ray

E. Facial X-Ray

152. Diabetic man feels hot painful lump near the anal region. What is the most probable diagnosis?

A. Anal fissure

B. Abscess

C. Haematoma

D. Wart

E. External haemorrhoids

153. What is the most common post-operative complication following anterior resection of rectum?

A. Infection

B. Bleeding

C. Recurrence

D. Intestinal obstruction

E. Pain

154. A 43 year old woman is brought in by her husband to the A& E department. He says she has

been getting up repeatedly at night to wash her hands as she thinks they are dirty. She gets very

anxious if he tries to stop her. She admits washing her hands again and again but says she cannot

control her actions. What is the diagnosis? A. Schizophrenia

B. Obsessive compulsive disorder

C. Generalised anxiety disorder

D. Panic disorder

E. Depression

155. A 31 year old man is single and lives with his mother. He usually drives from his home to his

work place. He always thinks when the traffic lights change his mother is calling him, so he drives

back to his house. What is the diagnosis? A. Obsessive compulsive disorder

B. General anxiety disorder

C. Schizophrenia

D. Bipolar personality disorder

E. Cyclothymia

156. A 19 year old boy comes to A&E department. There is swelling, pain and tenderness 2cm distal

to Lister’s tubercle of radius. On examination proximal pressure on the extended thumb and index

finger is painful. The x-ray doesn’t show any fracture. What is the next appropriate management for

the patient?

A. Immobilization with a cast

B. Repeat the x-ray

C. Magnetic resonance imaging (MRI)

D. Surgery

E. No treatment required

157. A 35 year old female developed sudden severe chest pain with shortness of breath. She recently

underwent pelvic surgery. What is the most appropriate diagnostic investigation that should be done?

A. Serum D-dimer

B. Chest X-ray

C. ECG

D. CT pulmonary angiography

E. Arterial Blood Gas (ABG)

158. A 24 year old, male patient, presents with bizarre behavior. What single characteristic symptom

would confirm the diagnosis to be most likely to be schizophrenia?

A. Thought insertion

B. Visual hallucination

C. Aggressive, violent behavior

D. Low mood

E. Body dysmorphic image

159. A 36 years old man has been diagnosed with Diabetes Insipidus. What electrolyte picture is

expected to be seen?

A. High serum Na, low serum osmolarity, high urine osmolarity

B. Low serum Na, low serum osmolarity, high urine osmolarity

C. Low serum Na, high serum osmolarity, high urine osmolarity

D. High Serum Na, high serum osmolarity, low urine osmolarity

E. Normal Na, Normal serum osmolarity, normal urine osmolarity

160. A 79 year old man has a swelling of the right groin, which was clinically diagnosed to be indirect

inguinal hernia. What is the SINGLE feature of the hernia sac that would confirm the diagnosis?

A. Comes through femoral ring

B. Does not pass through deep inguinal ring

C. Lies below and lateral to pubic tubercle

D. Only passes through superficial ring

E. Passes through deep inguinal ring

161. A patient is admitted with fever, photophobia, and a non-blanching rash. His ABG values are as

follows: pH : 7.5

PaCO2 : 2.2 KPa

PaO2 : 9.0 KPa

What is the most likely diagnosis?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory alkalosis

D. Respiratory acidosis

162. A 34 year old man was walking along the country side when an insect bit him. After which he

started to complain of an annular rash spreading upwards. Which is the best treatment for this

patient? A. Penicillin oral

B. Doxycycline oral

C. Gentamicin oral

D. Flucloxacillin oral

163. A 24 years old woman has been complaining of amenorrhea for the last 12 weeks. She also has

diarrhoea and weight loss of 8 kg over the last 3 months. What is the most important next step?

A. Serum Prolactin

B. Thyroid Function Test

C. Thyroid Antibodies

D. 24 hours urinary VMA (Vanillylmandelic Acid)

E. Admit under the MHA (Mental Health Act)

164. A man brings his wife to see the doctor. He says she has been talking about their private life

openly and is throwing tantrums. Her mood changes quickly and she becomes aggressive. Physical

examination is normal. There is no history of trauma and she is not on any medications. What is the

most likely diagnosis? A. Huntington’s dementia

B. Lewy body dementia

C. Alzheimer’s dementia

D. Vascular dementia

E. Benign old age related dementia

165. How to keep a check on salbutamol's efficiency? A. PEFR

B. Spirometry

C. Vital capacity

D. FEV/ FEV1 ratio

E. Lung function test

166. A 30 year old alcoholic woman presents with low mood, anhedonia, lack of appetite and sleep.

What is the best treatment for her?

A. Amitryptiline

B. Fluoxetine

C. Venlafaxine

D. ECT

167. A pregnant woman had hit her chest 3 weeks ago. Now she is 24 weeks pregnant and presents

with left upper quadrant mass with dimpling. What is the most probable diagnosis? A. Breast Ca

B. Carcinoma

C. Fibroadenoma

D. Fibroadenosis

E. Fatty necrosis of breast

168. A lady who works at a nursing home presents with itching. On examination, she had linear tracks

in the wrists. She says that 2 days ago she had come in contact with a nursing home inmate with

similar symptoms. What is the mechanism of itching?

A. Infection

B. Destruction of keratinocytes

C. Allergic reaction

D. Immunosuppression

E. None

169. A 35 year old man presents with painless left testicular enlargement since past 6 months, which

is increasing in size. The swelling is 3 times larger than the right testis; there is no tenderness or

redness. What is the most likely diagnosis?

A. Testicular tumour D. Epididymo – orchitis

B. Hydrocele E. Reassure

C. Epididymal Cyst

170. A 50 year old woman complains of several months’ history of weakness and difficulty in

climbing stairs. O/E she has fissuring of the skin of her hands and her CXR shows pulmonary

fibrosis. What is the single most likely positive antibody? A. Anti Jo 1

B. Anti Scl 70

C. Anti Ro

D. Anti Ds DNA

E. Anti Centromere

171. A 65 year old lady with IDDM for the last 20 years comes with a tender lump near the anal

opening. She says she also has fever. What treatment should she get? A. Incision and drainage and antibiotics

B. IV antibiotics

C. Culture and sensitivity of aspirate from swelling

D. Painkillers

E. Cautery of the swelling

172. A 29-year-old woman presents to her GP with a history of weight loss, heat intolerance, poor

concentration and palpitations. Which of the following is most likely to be associated with a diagnosis

of thyroiditis associated with viral infection?

A. Bilateral exophthalmos

B. Diffuse, smooth goitre

C. Reduced uptake on thyroid isotope scan

D. Positive thyroid peroxidase antibodies

E. Pretibial myxoedema

173. A child was playing and suddenly developed breathlessness. What is the best investigation for

this child?

A. Nasal Endoscopy

B. Lateral neck X-Ray

C. CT scan

D. Pulse Oximetry

E. Spirometry

174. A 50 year old presented to the hospital with complain of chest tightness wheeze and chronic

cough. He has been smoking 20 cigarettes per day since last 35 years. A diagnosis of COPD was

made.What will be the picture of ABG for this patient?

A. Respiratory Acidosis

B. Respiratory alkalosis

C. Metabolic acidosis

D. Metabolic alkalosis

E. Normal pH

175. A known COPD patient presented to the hospital with complains of persistent cough, copious

sputum production and intermittent hemoptysis. On examination, finger clubbing and coarse

inspiratory crepitations were observed. What is the most probable diagnosis? A. Lung cancer

B. Cystic fibrosis

C. Bronchiectasis

D. Pulmonary edema

E. Lung abscess

176. A 64 years old man presents with a history of left sided hemi paresis and slurred speech. He was

absolutely fine 6 hours after the episode. What is the most appropriate prophylactic regimen?

A. Aspirin 300 mg for 2 weeks followed by Aspirin 75mg

B. Aspirin 300 mg for 2 weeks followed by Aspirin 75mg and Dipyridamole 200mg

C. Clopidogrel 75mg

D. Dipyridamole 200mg

E. Aspirin 300mg for 2 weeks

177. A 44 years old obese patient presents with lab findings of: Fasting blood sugar (FBS) 6mmol/L

Oral Glucose Tolerance Test (OGTT) 10mmol/L . What is the most likely diagnosis?

A. Impaired glucose tolerance

B. Diabetes Insipidus

C. Type 1 Diabetes Mellitus

D. Type 2 Diabetes Mellitus

E. Maturity Onset Diabetes of the Young (MODY)

178. A patient who does not eat regular meals presents with feeling faint and tired. Blood tests reveal

a deficiency of both iron and folic acid. What state best describes the reason for his anaemia? A. Nutritional deficiency

B. Malabsorption

C. Pernicious anaemia

D. Haemolytic anaemia

179. A 32 year old female with axillary freckles and cafe au lait spots wants to know the chances of

her child also having similar condition.

A. 1 in 2

B. 1 in 4

C. No genetic link

D. 1 in 16

E. Depends on the genetic make-up of the partner

180. A 45 year old man has been diagnosed with moderate depression. His past medical history is

significant for an anterior wall MI 6 months ago. What is most appropriate treatment for him?

A. Benzodiazepine

B. ECT

C. SSRI

D. MAO inhaler

E. TCA

181. A 65 year old man presents with progressively worsening breathlessness and productive cough.

He has a history of treated tuberculosis and rheumatoid arthritis, he smoked 20 cigarettes/day since 35

years. When he was given a trial of salbutamol nebuliser, FEV1/FEV changed from 1.7/2.0 to 1.8/2.1

(predicted 3.0/3.5). What is the most probable diagnosis?

A. Chronic bronchitis

B. Bronchiectasis

C. Bronchial carcinoma

D. Asthma

E. Pulmonary fibrosis

182. A 56 year old lady presents has a pathological fracture of her T11 vertebra. There is found to be

an underlying metastatic lesion. What is her most common primary cancer?

A. Lung

B. Breast

C. Uterine

D. Brain

183. A 61 year old man who had stroke 2 years ago is on aspirin. He has Rheumatoid arthritis but

suffers from the pain and cannot tolerate it. He is taking senna for constipation. What is the best

medication to relieve his pain?

A. Disease-modifying anti-rheumatic drugs (DMARDs)

B. Ibuprofen

C. Co-codamol

D. Paracetamol

184. A man presented to the hospital with complain of productive cough and chest pain. His

temperature was 38.5° C. Lobar Consolidation was seen on x-ray with pleurisy. What is the best

management? A. Clarithromycin

B. Amoxicillin

C. Tetracycline

D. Ciprofloxacilling

E. Imipenam

185. A man with a carcinoma and multiple metastasis presents with intractable nausea and vomiting.

He has become drowsy and confused. What is the most appropriate management?

A. Dexamethasone IM

B. Dexamethesone oral

C. Ondansetron IM

D. Ondansetron oral

E. Morphine oral

186. A 55 year old man is brought into A&E unconscious. He has a distended abdomen with caput

meduase and spider navi. He has a previous history of bleeding oesophageal varices. His Hb is 10

g/dL, MCV is 100 fL. His skin is pale and clammy. What is the reason for his loss of consciousness?

A. Alcoholic hypoglycaemia

B. Diabetic hypoglycaemia

C. Hepatic encephalopathy

D. Subdural haematoma

187. A 19 year old boy came with skin rash and decreased urine output. On investigations, he was

found to have raised urea and creatinine, and hematuria. There was history of bloody diarrhoea and

fever. What is the most likely diagnosis?

A. Thrombotic ThrombocytopoenicPurpura

B. Haemolytic Uraemic Syndrome

C. Post streptococcal glomerulonephritis

D. IgA Nephropathy

E. Minimal Change disease

188. During a basketball match, one of the players suddenly collapsed to the ground with coughing

and shortness of breath. What is the investigation of choice for this patient?

A. Chest x-ray

B. CT scan

C. Magnetic resonance imaging (MRI)

D. V/Q scan

E. CT pulmonary angiogram (CTPA)

189. A 63 year old woman came with uterine bleeding. Vaginal USG reveals uterine thickness 12mm.

What is the most probable diagnosis? A. Cervical Ca

B. Endometrial Ca

C. Ovarian Ca

D. Breast Ca

E. Vaginal carcinoma

190. A 48 years old male with history of chronic cough presents with increased breathlessness

copious sputum with streaks of blood, examination shows finger clubbing. What is the initial

investigation?

A. Chest x-ray

B. CT chest

C. Bronchoscopy

D. Blood culture

E. ECG

191. A man has been diagnosed with metastatic carcinoma of the middle 1/3rd of the oesophagus.

What is the best initial management? A. Chemotherapy

B. Celestin tube

C. Radiotherapy

D. Surgery

192. A man presents with inoperable carcinoma and back pain. His pain has been well controlled with

morphine, but he develops vomiting. Morphine was stopped and he was started on metoclopramide

and fentanyl patches. He then develops neck stiffness and fever. What is the cause of these

symptoms? A. Metoclopramide

B. Fentanyl

C. Morphine

D. Meningitis

E. Metastasis

193. A 72 year old presents with polyuria and polydipsia. The fasting blood sugar is 8 and 10 mmol/L.

The level of cholesterol is 5.7and blood pressure is 130/80mmHg. There is micro-albuminuria. What

is the most appropriate next management? A. ACE inhibitors and Sulfonylurea

B. Statin + biguanide

C. Statin + Glitazone

D. Insulin + ACEinhibitors

E. ACEinhibitors + Statin

194. A 56 year old male presents with intermittent vertigo, intermittent tinnitus and intermittent

hearing loss. What is the best drug treatment for this patient?

A. Buccal Prochlorperazine

B. Oral Flupenphenazine

C. Tricyclic antidepressants (TCA)

D. Gentamycin patch on the round window

E. No medical treatment available

195. A neonate’s chest X-ray shows double bubble sign. On examination the neonate has low set ears,

flat occiput. What is the most likely diagnosis?

A. Down’s Syndrome

B. Fragile X Syndrome

C. Turner’s Syndrome

D. Di George Syndrome

196. A patient having headache with sudden onset of loss of vision in one eye. What is the most

appropriate next step?

A. ESR

B. Temporal artery biopsy

C. Full blood count

197. A woman had widespread metastasis from a carcinoma. She presented with severe back pain.

Where do you expect the cancer to be?

A. Lungs

B. Cervix

C. Ovary

D. Uterus

E. Breast

198. A patient known to be HIV positive, has now got chicken pox in the maternity ward. What

precautions should be taken to prevent further spread of infection?

A. Vaccinate all the patients and staff in the ward

B. immunoglobulins to all the pregnant women in the ward

C. Immunoglobulins to all pregnant women who have negative serology

D. Start 7 days course of Acyclovir for all patients in the ward

E. No action required

199. An 18 year old female was brought into the A & E by her parents who are very concerned about

her. Her BMI is 15 kg/m2. She considers herself to be obese and has severely restricted her diet in

order to lose weight. She exercises 5-6 hours daily to further supplement her weight loss. She admits

to abusing laxatives and inducing vomiting. She has had no periods for 7 months but urine Beta HCG

is negative. She has fine lanugo hair covering her entire body and complains of being cold all the

time. What is the most likely diagnosis in her?

A. Bulimia nervosa

B. Anorexia nervosa

C. Hypothyroidism

D. Somatization disorder

E. Conversion disorder

200. A 34 year old male presents with history of headaches presents with ataxia, nystagmus and

vertigo. Where is the site of the lesion? A. Auditory canal

B. Eight nerve

C. Cerebellum

D. Cerebral hemisphere

E. Brain stem