Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 22ND OCTOBER 2017 TIME ALLOWED:

1. A young man was knocked down during a fight in the waiting room in A & E department. He is
unconscious and unresponsive. What is the first /initial management?
A. Put him in the left lateral/recovery position
B. Put airway
C. Endo-tracheal intubation
D. Assess GCS
E. Start CPR

2. A 45 year old female complaints of pain in the inner side of her right thigh. She was
diagnosed with a benign ovarian mass on the right side. Which nerve is responsible for this pain?
A. Femoral Nerve
B. Obturator Nerve
C. Ilio-hypogastric Nerve
D. Ovarian branch of splanchnic nerve
E. Pudendal nerve

3. A 6 month old baby was started on formula feed. He develops vomiting and severe cry after each
feed. His mother is concerned whether the baby will develop allergy to cow’s milk. She wants to be
assured before switching to cow’s milk. What is the most appropriate advice for her?
A. Tell mother to start cow’s milk and monitor symptoms
B. Tell her it is highly unlikely and continue with formula feed
C. Offer RAST test to determine possible allergy to cow’s milk
D. Reassure

4. A 57 year old man, who has history of MI, now presents with TIA after being on anticoagulation.
What is the best tool to calculate his risk of stroke?
A. NEWS
B. CHA2DS2-VASc
C. ROSIER Scale

5. A 14 year old girl has not developed secondary sexual characteristics. She hasn’t achieved
menarche yet. She is of normal height and weight. What is the most likely diagnosis?
A. Turner’s Syndrome
B. Sheehan’s Syndrome
C. Constitutional Delay
D. Cystic Fibrosis
E. Hypothyroidism

6.A 77 year old male presents with history of enuresis and change in behaviour. On examination he is
found to have a waddling gait. What is the most likely diagnosis?
A. Subdural haemorrhage E. Extradural haemorrhage
B. Brain tumour
C. Normal pressure hydrocephalus
D. Psychotic depression

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7. A 24 year old patient has come 4 times to the hospital. She lives alone, has no relationships and
always comes to the hospital in loud clothes, demanding for the same doctor. Her behaviour is quite
inappropriate, always giving the doctor compliments and praising him. What is the most likely
diagnosis?
A. Schizophrenia
B. Mania
C. Histrionic Personality
D. Borderline personality
E. Munchausen’s

8. A 23 year old man comes to the Emergency Department with a history of drug misuse. He
recognizes that he has a problem and is willing to see a psychiatrist. Which of the following terms
best describes thissituation?
A. Judgement
B. Thoughtinsertion
C. Thoughtblock
D. Mood
E. Insight

9. A 23 year old lady presents with headache. On examination she is found to have photophobia and a
generalised rash that does not blanch on pressure. What must be done immediately?
A. Give IV benzyl penicillin
B. Isolate patient
C. Gown and mask
D. Blood cultures

10. A young man complains of bloody diarrhoea with mucus. He has colicky abdominal pain. What is
the most appropriate test for diagnosing his condition?
A. Barium enema
B. Stool culture
C. Lower GI endoscopy & biopsy
D. H.Pylori stool antigen test

11. A 60 year old woman is admitted to hospital after a fall. She is noted to have poor eye contact.
When asked how she is feeling, she admits to feeling low in mood and losing enjoyment in all her
usual hobbies. She has also found it difficult to concentrate, feels that she is not good at anything,
feels guilty over minor issues and feels very negative about the future. What is the most likely
diagnosis?
A. Mild Depression
B. Moderate Depression
C. Severe Depression
D. Psychosis
E. Seasonal depression

12. A 50 year old woman complains of several months’history of weakness and difficulty in climbing
stairs. On examination 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 E. Anti Centromere
B. Anti Scl 70
C. Anti Ro
D. Anti Ds DNA

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13. 2 year old child was brought into A& E with coarse jerking movements of her limbs which lasted
for about 10 seconds followed by unconsciousness. She regained consciousness soon after and was
disoriented but afebrile with no signs of meningeal irritation. What is the single best investigation in
this child?
A. 24 hour ECG
B. 24 hour EEG
C. No investigation needed
D. CT scan
E. MRI scan

14. A 45 year old lady complains of expressable galactorrhea, decreased libido and amenorrhea,
weight gain and easy fatigue. Her serum prolactin levels are 11000mu/l. What is the likely cause of
hyper-prolactinemia?
A. Hypothyroidism D. Prolactin secreting pituitary tumour
B. Stress E. Polycystic ovarian syndrome
C. Pregnancy

15. Patient with puffiness of face and rash showing cotton wool spots on fundoscopy. What is the
single most likely diagnosis?
A. Macular Degeneration
B. Hypertensive retinopathy
C. Diabetic background
D. Proliferative Diabetic retinopathy
E. Systemic Lupus Erythematosus (SLE)

16. A 36 year old male diagnosed with a glioblastoma since last 5 months, has cerebral oedema and is
on dexamethasone. He has diarrhoea and vomiting for the last 3 days. He has been suffering from
repeated falls today. What could be the possible cause for his falls?
A. Adrenal insufficiency
B. Dehydration
C. Dexamethasone therapy
D. Raised intracranial pressure

17. A 35 year female presents with complains of intermittent palpitations lasting few hours every day.
Which is the most appropriate intervention?
A. 24 hr ECG
B. ECHO
C. Reassure
D. Atenolol
E. Flucainide

18. A child playing with toys suddenly develops breathlessness and stridor. Which investigation will
lead to the diagnosis?
A. Laryngoscopy
B. Chest x ray
C. Peak flow meter
D. Arterial blood gas

19. A 35 year old, intra-venous drug abuser on Penicillin and Flucloxacillin for cellulitis, now
presents with jaundice, pale stools and dark urine. What is the single most likely diagnosis?

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A. Hepatitis A
B. Cholestatic jaundice
C. Chronic active hepatitis
D. Primary billiary cirrhosis
E. Hepatitis B

20. A 34 year old woman presents 3 weeks after child birth. She has had very low mood and has been
suffering from lack of sleep. She also has thoughts of harming her little baby. What is the most
appropriate management for this patient?
A. Electro convulsive therapy (EC T) E. Amitryptiline
B. Cognitive behaviour therapy (CBT)
C. IV Haloperidol

21. 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

22.The annual incidence of Down Syndrome is :

23. A 58 year old man has a headache and confusion three days after slipping and hitting his head in
the garden. What is the most appropriate initial investigation?
A. X ray Skull
B. X ray Face
C. CT Brain
D. MRI Brain
E. EEG

24. A 24 years old woman complains of inability to stop thinking about saving water, and has to keep
checking the tap all the time. What is the diagnosis?
A. Schizophrenia
B. Obsessive compulsive disorder(OCD)
C. Obsessive Compulsive Personality
D. Posttraumatic stress disorder (PTSD)
E. Delusion of Grandeur

25. A 54 year old man with alcohol dependence has tremor and sweating three days into a
hospital admission for a fractured femur. He is apprehensive and fearful. What is the SINGLE most
appropriate treatment?
A. Acamprosate E. Procyclidine
B. Chlordiazepoxide
C. Lorazepam
D. Lofexidine

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26. A one month old boy has been brought to the Emergency Department. He is conscious but with
cool peripheries and has heart rate of 222 beats/minute. He has been irritable and feeding poorly for
about 24 hours. His chest x-ray shows a borderline enlarged heart with clear lung fields and ECG
shows a regular narrow complex tachycardia. It is difficult to identify p wave on the tracing. What is
SINGLE most appropriate immediate treatment?
A. Administer fluid bolus
B. Administer oxygen
C. Oral beta blocker
D. Synchronised DC cardio-version
E. Unilateral carotid sinus massage

27. A 30 year old male has been caught in a house fire and presents with a 55% burns over his trunk,
back and arms .He has had an episode of 300 ml hematemesis and following an endoscopy several
ulcers were found in stomach. What is the best treatment option for this patient?
A. Oral PPI
B. IV PPI
C. Triple therapy for H.pylori
D. Oral cimetidine
E. Oral antacids

28. After eating a cookie at a garden party, a child began to cough and went blue. The mother also
noticed that there were swollen patches on the skin. What is the initial management in this child?
A. Over the counter antihistamines
B. Oxygen
C. Bronchodilators
D. Epinephrine by injection
E. Nebulized epinephrine

29. A 68 year old woman diagnosed with Diabetes Type II and BMI is 33. Lab report shows GFR
is 29, urea :13, creatinine: 390mmol/L. What is the next appropriate management?
A. Biguanide
B. Sulfonylurea
C. Insulin
D. Glitazone
E. Sulfonylurea receptor binder

30. A 60 years old man has a pathological rib fracture. He also complains of recurrent infection. Bone
marrow aspiration is done. The lab report shows calcium is 3.9mmol/l and alkaline phosphatase level
is 160µ/l. What type of cell would be found in abundance in the marrow smear?
A. Plasma cells
B. Myeloid cells
C. Bence Jones protein
D. Megakaryocytes
E. Reticulocytes

31. 70 year old man presents with fever, chest pain and seating. ECG confirmed an acute myocardial
infarction. What is the single most important route of administration of pain relieve?
A. Intravenous E. Transmucosal
B. Oral
C. Subcutaneous
D. Transcutaneous

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32. A five year old girl has had an upper respiratory tract infection (URTI) for three days and has been
treated with paracetamol by her mother. For the last 12 hours she has been hot and irritable with
severe pain in her right ear. What is the single most likely diagnosis?
A. Herpes zoster infection D. Otitis media
B. Impacted earwax E. Perforation of eardrum

33. Tip of the ninth costal cartilage. What is the Single most appropriate landmark?
A. Fundus of the gallbladder
B. Deep inguinal ring
C. Termination of the spinal cord
D. Transpyloric plane
E. Vena cava opening in to the diaphragm

34. A 75 year old man with adenocarcinoma of the prostate which has spread outside the capsule of
the gland has acute renal failure. What is the most appropriate next investigation?
A. Magnetic resonance imaging (MRI) of the spine
B. Radionuclide bone scan
C. Trans Rectal USG
D. USG Pelvis
E. USGKUB

35. 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

36. 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

37. 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. Which is the most appropriate management from the given
options?
A. Add leukotriene antagonist
B. Add oral theophylline
C. Add regular LABA
D. Increase dose of ICS
E. Short course of oral corticosteroid

38. A 6 hours old child born at 34 weeks of gestation presents with tachypnoea, nasal flaring and
grunting. His chest x-ray is below. What is the most probable diagnosis?

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A. Transient Tachypnoea of Newborn
B. Meconium Aspiration
C. Bronchiolitis
D. Streptococcal Pneumonia
E. Respiratory Distress Syndrome

39. A patient diagnosed with HIV has received no treatment for HIV. He now presents with dry cough
and shortness of breath. Chest x-ray showed bilateral perihilar opacity. Pneumocystitiscarini was
indicated. What is the appropriate treatment?
A. Amphotericin B IV
B. Trimethoprim
C. Sulfadiazine
D. Gancyclovir
E. Dexamethasone
F. PentamidineIsetionate

40. A 30 year old gentleman presents with deep penetrating knife wound. He said he
hadTetanusToxoid (TT) when he left school. What will you do for him?
A. Human immunoglobulin only
B. Human immunoglobulin and tetanus toxoid
C. Full course of tetanus vaccine only
D. Human immunoglobulin and full course of tetanus vaccine
E. Antibiotic

41. A 50 year old lady has severe profuse diarrhea two days after the stoma reversal. She did not take
any oral antibiotics however, before surgery she was treated with IV ciprofloxacin. Stool culture
showed a positive result for clostridium difficile and no other micro-organism. She is currently
haemodynamically stable.What would be the initial treatment for her?
A. Vancomycin
B. Amoxycillin
C. Metronidazole
D. Benzylpenicillin

42. A 6 year old came with full thickness burn (covers 3%). He is crying continuously. What is next
step of management?
A. Refer to burn unit E. Dressing
B. IV fluid start
C. Antibiotic
D. Analgesic

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43. A 5 week old breast fed baby whose birth weight was 3.5 kg and is now 4.5kg is thriving well but
is deeply jaundiced. What is the most likely diagnosis?
A. Galactosemia
B. Breast Milk Jaundice
C. Thalassemia
D. Sickle Cell Disease
E. Congenital Storage Disorder

44. A 34 year old patient presents to the GP with painful sticky eyes, with inability to open his eyes.
On examination his conjunctiva appears congested. What is the most appropriate treatment?
A. Oral Antibiotics
B. Reassurance
C. IV antibiotics
D. Topical antibiotics
E. Pilocarpine

45. A 15 year old boy has a soft painless swelling in the left scrotum, blue in colour and can be
compressed. What is the most appropriate next step?
A. Analgesic
B. Antibiotic
C. Biopsy
D. Immediate Surgery
E. Reassurance

46. A known type 1 diabetic presents with drowsiness, vomiting, abdominal pain, fruity smell on his
breath and deep laboured breathing. His ABG’s show metabolic acidosis. What is the best
rehydration regimen for him?
A. Insulin
B. Insulin + potassium
C. IV dextrose + insulin + potassium
D. IV 0.9% normal saline + insulin + potassium

47. 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
E. Gentamycin

48. A 75 year old man presents with back pain, he looks pale and complains of heart racing. On
investigation there are many plasma cells in the peripheral smear. What is the most probable
diagnosis?
A. Multiple myeloma
B. Ankylosing spondylitis
C. Prolapsed disc
D. Leukemia
E. Bone degeneration

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49. A type 2 diabetic patient is undergoing a gastric surgery. What is the most appropriate pre-op
management?
A. Start him on I.V insulin with glucose and potassium just before surgery
B. Stop his oral hypo-glycaemics on the day of the procedure
C. Continue regular oral hypo-glycaemics
D. Stop oral hypo-glycaemics the previous night and start IV insulin with glucose and potassium
before surgery
E. Change to short-acting oral hypo-glycemics

50. 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 electrophoresis

51. A mother presents with her 6-month-old son who is vocalizing. She has noticed that he does not
respond to loud noises. His motor milestones are normal. What is the best management strategy?
A. Arrange Hearing test
B. Assess Developmental Milestones
C. Reassure
D. Refer to a Speech Therapist
E. MRI Brain

52.A 34 year old man with multiple sclerosis has taken an overdose of 100 tablets of Paracetamol with
intent to end his life. He has been brought to the Emergency department for treatment but is refusing
all interventions.
A. Assessment of suicide
B. Evaluate patient’s capacity to refuse treatment
C. Establish if patient has a previous mental illness

53. A 45 year old obese man, who is a smoker and a chronic alcoholic, has hoarseness of voice for 6
weeks. A biopsy of the larynx is taken and histology shows non-invasive dysplasia. What advice
would you give to this patient?
A. Stop smoking
B. Reduce weight
C. Voice therapy
D. Reduce alcohol intake

54. A 7 year old child is brought to the emergency department with a 1 day history of being listless.
On examination you find the child to be drowsy with an extensive non blanching rash. What advice
would you give to his parents?
A. All members of the family need antibiotic therapy
B. Only the mother should be given Rifampicin prophylaxis
C. All members of the family need isolation
D. All members of the family should be given Ciprofloxacin prophylaxis

55. A 20 year old female presented with complaints of diarrhoea with blood and mucus in it. She was
diagnosed with Crohn’s disease. Which part of the gut is most commonly affected by this disease?

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A. Duodenum
B. Jejunum
C. Ileum
D. Sigmoidcolon
E. Caecum

56. A 47 year old man has a temperature 39°C and he is delirious. He has developed blisters mainly
on his trunk, which appeared a few hours ago. He is well and not on any medication. He last travelled
five months ago to Italy. Which one of the following is the most likely diagnosis?
A. Shingles
B. Chicken pox
C. Pemphigoid
D. Bullous pemphigus

57. A 53 year old man with previous history of COPD presents with breathlessness and purulent
sputum. Oxygen saturation is 85% on air. ABG shows Pa O2 = 7.6, Pa CO2 = 7. What is the
appropriate management for hiscondition?
A. 24%Oxygen
B. Mechanicalventilation
C. 100%oxygen
D. Nebulisedsalbutamol
E. Nebulisedipratropium

58. A 32 years old female has a history of shortness of breath and fever. Pre-broncho-dilatation test
was done and it was 2/3.5 and post bronchodilator was 3/3.7.The patient was diagnosed of eczema
and tuberculosis (TB).What is the possible diagnosis?
A. Chronic obstructive pulmonary disease (COPD)
B. Asthma
C. Pneumonia
D. Bronchiectasis
E. Pulmonary Embolus

59. 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. CTBrain
B. EEG
C. MRI
D. SkullX-Ray
E. FacialX-Ray

60. A patient has reduced central vision. Fundoscopy shows normal retina & optic disc. Which drug is
responsible for the problem faced by the patient?
A. Corticosteroids
B. Ethambutol
C. Antihistamines
D. Quinine
E. Penicillamine

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61. The body of a 65 year old man, who was treated for TB and bronchitis, was seen at autopsy.
His legs were swollen and his liver showed signs of a transudate fluid. What was the cause of the
transudate?
A. Liver Cirrhosis
B. Alcoholic Liver disease
C. Cardiac failure
D. Budd-Chiari syndrome
E. Tuberculosis

62. A child is not breathing and failed to intubate. At what anatomy site the incision should be
made?
A. External iliac muscle
B. Cricoid cartilage
C. Linea alba
D. Rectus sheath muscle
E. Duramater

63. A 28 year old man presents with a maculo-papular rash over his trunk and palms. He also has
numerous mouth ulcers. He had penile ulcer which healed 2 weeks ago. What will you do to confirm
diagnosis?
A. Serology for treponema and non-treponemal antibodies
B. Dark ground microscopy from mouth ulcer
C. Blood culture for treponema
D. Dengue Fever

64. A young female patient suffers from heartburn and abdominal discomfort and has taken four
weeks of Proton pump inhibitors (PPIs) without relief. H.pylori antigen test comes out negative. Stool
tested negative for antigens. What will be the next management for this patient?
A. Urea breath test
B. Endoscopy
C. 24 hour manometry
D. 24 hour pH measurement

65. A 6 year old girl, who has previously been well, presented with a history of tonic-clonic seizure
lasting 4 minutes. Her mother brought her to the hospital and she appeared well. She is afebrile and
did not lose consciousness during the episode of seizure. She has no neurological deficit. What is the
best investigation for her?
A. Arterial Blood Gas
B. Serum electrolytes
C. ECG
D. Blood capillary glucose

66. A 57 year old shipyard worker has a 4 months history of cough and left sided chest pain. He has a
pleural effusion on the left side. What will you do to improve his symptoms?
A. Therapeutic thoracocenthesis
B. Chemotherapy
C. Pleural biopsy
D. Radiotherapy

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67. A 40 year old woman notices increasing lower abdominal distension with little or no pain. On
examination of the abdomen, a lobulated cystic mass is felt and it seems to be arising from the pelvis.
What is the most appropriate investigation?
A. CA 125
B. CA 153
C. CA 199
D. Carcino-embryonic antigens (CEA)
E. Alpha Fetoprotein (AFP)

68. A young man has been diagnosed with seminoma of the right testis. Which group oflymph nodes
drain the righttestis?
A. Superficialinguinal
B. Deepinguinal
C. Paraaortic
D. Femoral

69. A 72 year old man has been advised for some year to have antibiotic prophylaxis before
dental treatment. He has never experienced chest pain. Three weeks ago he noticed breathlessness on
exertion and for one week. He had orthopnea. His pulse character is normal. What is the most
probable diagnosis?
A. Aortic Regurgitation
B. Ischemic Mitral Regurgitation
C. Mitral Valve Prolapse
D. Pulmonary Stenosis
E. Rheumatic Mitral Valve Stenosis

70. A 32 year old lady complains that she hears everyone saying that she is an evil person. What type
of hallucinations is she suffering from?
A. Second person auditory hallucinations D. Gedankenlautwerden
B. Third person auditory hallucinations
C. Echo de la pense
71. A 79 year old man has poor urine stream. He has fever, burning sensation during micturition and
lower abdominal pain. . He also has severe back pain. What is the first line investigation of choice?
A. Blood culture
B. MSU for culture and sensitivity
C. X-ray KUB
D. CT scan
E. Full blood count

72. A man presents with anaemia and profuse watery diarrhoea. He is found to be deficient in iron and
Vit B12. What is the possible reason for his anaemia?
A. IBD
B. Villous atrophy
C. IBS
D. Alcohol
E. Bacterial Infection

73. A 35 years old man who has served in the army presents with lack of interest in enjoyable
activities and feeling low. He doesn’t feel like reading the news or watching movies as he believes
there is violence everywhere. What is the most appropriate first line therapy?

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A. Citalopram
B. Lofepramine
C. Cognitive Behavioural Therapy
D. Chlordiazepoxide
E. Desensitization

74. A 22 year old man is being investigated for steatorrhea and flatulence. On jejunal biopsy there is
shortening of the villi and lymphocytosis. What is the most likely cause?
A. Coeliac disease
B. Whipple's disease
C. Crohn's disease
D. Irritable bowel syndrome

75. A 30 year old woman presents with intermittent breast pain. On examination a tender smooth
mobile lump measuring approximately 4cm by 3cm is found, which is not attached or fixed to deep
tissues. What is the best method for diagnosis?
A. Mammogram
B. Ultrasound
C. CT scan
D. Fine Needle Aspiration
E. Core Biopsy

76. A 36 year old woman has recently spent a lot of money on buying clothings. She goes out almost
every night with her friends. She believes that she knows better than her friends, so she should choose
the restaurant for eating out with her friends. She gave history of having low mood at 12 years of age.
What is the most probable diagnosis?
A. Mania
B. Depression
C. Bipolar affective disorder
D. Borderline personality disorder
E. Dysthymia.

77. With prolonged use in epilepsy, which of the following drugs can cause coarsening of facial
features, hirsutism, gingival hyperplasia and osteomalacia?
A. Valproic acid
B. Carbamazepine
C. Ethosuximide
D. Phenytoin
E. Gabapentin

78. A 79 year old man who is being treated with gonadotropin releasing hormone (GnRH) antagonist
for proven adenocarcinoma of the prostate attends for a follow up session. What is the most
appropriate investigation?
A. Serum AFP (Alpha-fetoprotein)
B. Serum PSA (prostate-specific antigen)
C. Serum acid phosphates concentration
D. Serum alkaline phosphatase iso-enzyme concentration
E. Trans Rectal US

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79. A 27 year old woman had hit her neck in RTA but no complains of tingling or motor loss. What is
the most appropriate investigation?
A. MRI Scan
B. Plain X-ray
C. CT Cervical
D. Diagonal X-ray

80. A 45 years old woman has recently been diagnosed with multiple sclerosis and has been started on
oral steroids. She is brought to the hospital after having ingested 100 Paracetamol tablets 4 hours ago.
She is refusing all medical treatment. What is the next best step for this patient?
A. Observe
B. Refer to a psychiatrist to assess patient’s ability to refuse
C. Gastric Lavage
D. Activated charcoal
E. Refer to a social worker

81. A 50 year old man has a stab wound to his left anterior chest at the level of the 4thintercostal
space. He has a blood pressure of 80mmHg. Systolic and pulse rate of 130 beats / minute. His neck
veins are dilated and his heart sounds are faint. His trachea is central. What is the SINGLE most likely
diagnosis?
A. Cardiac tamponade
B. Diaphragmatic rupture
C. Fractured ribs
D. Tension pneumothorax
E. Traumatic rupture of aorta

82. A 5 year old boy is rescued from a burning building and is presented to the accident and
emergency. He had 5% partial thickness burns over the arms and legs and had soot in the mouth and
nose. His breathing has become noisy. IV fluids have been given already. What is the SINGLE most
immediate management?
A. Nebulised Adrenaline
B. Nebulised Salmeterol and Oxygen
C. Needle Cricothyrodotomy
D. Oropharyngeal Airway
E. Intubation of Airway

83. A 45 year old man keeps having intrusive thoughts about having dirt under the bed. He cannot
keep himself from thinking these thoughts. If he tries to resist, he starts having palpitations. What is
the most likely diagnosis?
A. Obsessive Compulsive Personality
B. Obsessive Compulsive Disorder
C. Schizophrenia
D. Panic Disorder
E. Phobia

84. A 56 year old woman has woken up five times in the last month with a feeling of thumping in her
chest. On sitting up for about two minutes and taking a few deep breaths, the sensation subsides over a
further minute. Her ECG shows sinus rhythm. What is the most appropriate investigation to be done?

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A. Cardiac Enzymes
B. Chest X Ray
C. 24 Hour ECG
D. Echocardiogram
E. Plasma Glucose

85. A 64 year old woman has difficulty moving her right shoulder on recovering from surgery of the
posterior triangle of her neck. What is the SINGLE most appropriate option?
A. Accessory nerve
B. Glosso pharyngeal nerve
C. Hypoglossal nerve
D. Vagus nerve
E. Vestibulocochlear nerve

86. A 22 years sexually active male came with 2 days history of fever with pain in scrotal area. On
examination scrotal skin is red, tender. What is the most appropriate diagnosis?
A. Torsion of testis
B. Orchitis
C. Inguinal Hernia
D. Epididymo- orchitis

87. 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

88. A 40 year old chronic alcoholic who lives alone, brought into the A&E department having been
found confused at home after a fall. He complains of a headache and gradually worsening confusion.
What is the most likely diagnosis?
A. Head injury
B. Hypoglycemia
C. Extra Dural Hematoma
D. Sub Dural Hematoma
E. Delirium

89. A 5 year old boy is referred to hospital and seen with his father who is worried that he has been
restless. He is not sure why his GP suggested he should come to accident and emergency and is keen
to get some tablets and go home. On examination the child is tired and irritable and has some swelling
around his eyes. Carefully considered renal biopsy is remarkable only for some podocyte fusion on
electron microscopy. What is the most probable diagnosis?
A. Non Accidental Injury
B. Myelo dysplastic disease
C. Henoch Schonlein Purpura
D. Membranous glomerulonephritis
E. Minimal Change Disease

90. A 17 year female present with a mobile swelling in the front of the neck which moves with the
protrusion of tongue. The most appropriate management-

15
A. USG
B. Excision Biopsy
C. Tru-cut Biopsy
D. FNAC
E. Aspiration

91. 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

92. A child had a patchy rash following treatment for sore throat and cervical lymph node
enlargement .What is the antibiotic that caused this rash?
A. Ampicillin
B. Erythromycin
C. Cefuroxime
D. Metronidazole
E. Tetracycline

93. 45 years old chronic smoker attends outpatient department with complaints of persistent cough
and copious amount of purulent sputum. He had history of measles in the past. On examination he has
got finger clubbing and inspiratory crepitations on auscultation. What is the single most likely
diagnosis?
A. Interstitial lungdisease
B. Bronchiectasis
C. Asthma
D. Chronic obstructive pulmonarydisease
E. Sarcoidosis

94. A 3 month old infant has presented with recurrent infections, he has abnormal facies and chest X-
ray shows absent thymic shadow. What is the most likely diagnosis?
A. Down’s Syndrome
B. Fragile X Syndrome
C. Di George Syndrome
D. Marfan’s Syndrome

95. 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

96. A patient has been diagnosed with Obsessive Compulsive Disorder. What is the best treatment for
him?

16
A. Tricyclic Antidepressant (TCA)
B. Selective serotonin reuptake inhibitors (SSRI) and CBD
C. MAO- inhibitor
D. Selective Norepinephrine Reuptake Inhibitor(SNRI)

97. A man is brought into A&E claiming to be a professor of medicine. His family say he left school
at the age of 16 and has never studied anything after that. He also claims that he is soon going to be
God. What delusion is this man suffering from?
A. Delirium
B. Mania
C. Depression
D. Delusion
E. Schizophrenia

98. A 52 year old man underwent hemicolectomy. After a few days he complains of left ventricular
pain and fever. Echocardiogram has been done and shows a systolic murmur. What is the next
appropriate investigation?
A. CT scan D. Blood culture
B. Ultrasound E. Liver function test
C. Chest x-ray

99. A man was stabbed in the upper left chest. He has shortness of breath and unequal chest
movements on the left side. Which nerve is most likely to bedamaged?
A. Left phrenicnerve
B. Right phrenicnerve
C. Right vagus nerve
D. Left vagus nerve
E. Thoraco-dorsal nerve

100. A 4 year old boy ingested his grandmother’s medicine and has developed dilated pupil. What is
the cause?
A. Amitryptyline
B. Paracetamol
C. Iron
D. Digoxin

101. A 27 year old patient met with a road traffic accident comes to the A&E. While the nasogastric
tube is passing the bowel sounds are heard in the chest. On the chest x-ray nasogastric tube is seen
curled. What is the diagnosis?
A. Diaphragm rupture
B. Aortic rupture
C. Splenic rupture
D. Bowel rupture
E. Liver rupture

102. A 45 years old I/V drug abuser is brought into A/E with complains of fever, shivering,
malaise, shortness of breath and productive cough. On examination Temp: 39ºC, Pulse: 110 b/min and
BP: 100/70 mmHg. Investigations: CXR: bilateral cavitating bronchopneumonia. What is the single
most likely causative organism?

17
A. Mycoplasma
B. Staphylococcus
C. Chlamydia pneumonia
D. Pseudomonas
E. Pneumocystis pneumonia(PCP)

103. 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

104. A 64 year old anemic man presents with constipation. Barium enema demonstrates a stricture on
the right side, close to the appendix. What is the most likely diagnosis?
A. Ulcerative Colitis
B. CaecalCa
C. Rectal Ca
D. Sigmoid Ca

105. A teacher had respiratory infection for which she was prescribed antibiotics. After her
antibiotic course, when she re-joined the school, she had lost her voice completely. What is the
SINGLE most appropriate diagnosis?
A. Recurrent Laryngeal nerve palsy
B. Angioedema
C. Laryngeal obstruction by the medications
D. Laryngitis
E. Functional dysphonia/vocal cord

106. A 60 years old man presents with a six month history of poor sleep and loss of interest. He
has become forgetful recently and answers most of the questions with “I don’t Know”. What is the
most likely diagnosis?
A. Bipolar affective disorder
B. Depression
C. Normal Ageing Process
D. Dementia
E. Dyslexia

107. A patient with sensorineural hearing loss and loss of corneal reflex on the left side. What is the
most definitiveinvestigation?
A. CT scan of internal auditorymeatus
B. Nuclear imaging ofbrain
C. MRI of internal auditorymeatus
D. Radio IsotopeScan
E. X-raySkull

108. A 20 year old male smoker is noted to have intense rubor of the feet and absent foot pulse. On
examination he has an amputated right second toe. What is the most probable diagnosis?

18
A. Intermittent Claudication
B. Cardiovascular Syphilis
C. Buerger’s Disease
D. Embolism
E. Acute Limb Ischemia

109. A 10 year old boy is brought to A&E 10 hours after injury to the foot. It was punctured with a
metal spike that passed through his shoe. What is the next best step?
A. Immunoglobulin
B. Immunoglobulin and vaccine
C. Vaccine only
D. Clean the wound
E. Antibiotics

110. A 14 years old diabetic child does not follow his insulin regimen, misses his doses and eats in
between his meals. He is also not happy in the school. What is the next step in the management?
A. Paediatrician
B. Psychologist
C. Dietician
D. Psychiatrist
E. Review insulinregimen
F. Refer to GP
G. Refer to socialservices
H. Change type ofinsulin

111. A 32 year old man on psychiatric medications complains of inability to ejaculate. Which drug is
most likely to cause thesesymptoms?
A. Lithium
B. Haloperidol
C. Chlorpromazine
D. Fluoxetine
E. Clozapine

112. A 65 year old woman is undergoing coronary angiography. What measure will protect her
kidneys from contrast?
A. Furosemide
B. Dextrose
C. 45% saline
D. 0.9% saline

113. A 44 year old man comes with history of early morning headaches and vomiting. CT brain shows
ring enhancing lesions. What is the SINGLE most appropriate option?
A. Cytomegalovirus
B. Streptokinase
C. Toxoplamosis
D. Non Hodgkins Lymphoma
E. Pneumocystis jerovici

114. A 2 month old child with diarrhoea and vomiting for 6 days is brought in looking lethargic. What
is the investigation to get done immediately?

19
A. Urea and electrolytes
B. Random blood sugar
C. FBC
D. CXR

115. A 26 year old female presented at A&E with complaints of palpitations. Upon examination her
heart rate was 200bpm with no other abnormalities. What is the best initial management for this
patient?
A. DC cardioversion E. Verapamil
B. Carotid massage
C. Adenosine
D. Amiadarone

116. A 14 year old girl has been brought by her school teacher as the teacher is concerned about the
girl’s health. She has a BMI of 14.2 and has been having bouts of dizziness recently. What is the most
appropriate next step?
A. Psychiatric routine referral
B. Admission to psychiatric ward
C. Admission to medical ward
D. CBT
E. Diet plan

117. A 24 year old man has been complaining of difficulty in hearing his lectures. He also has been
feeling dizzy and now presents with a ringing sensation in her ears. What is the best treatment for this
patient?
A. Cyclizine
B. Metoclopramide
C. Hearing aids
D. Domperidone
E. Aspirin

118. A 25 year old woman has been feeling anxious and nervous for the last few months. She also
complains of palpitations and tremors. Her symptoms last for a few minutes and are very hard to
control. She tells you that taking alcohol initially helped relieve her symptoms but now this effect is
wearing off and she has her symptoms even after drinking alcohol. What is the most likely diagnosis?
A. Panic disorder
B. Depression
C. Obsessive compulsive disorder
D. Alcohol addiction
E. Generalized anxiety disorder

119. A 4 year old child is brought to the GP by his mother. She informs the GP that his father is
suffering from tuberculosis. She has a strong suspicion that her child will also suffer from it but the
family doesn’t want any procedure done under GA for obtaining bronchial samples. Where else can
this grow in the body to obtain samples?
A. Urine
B. Blood
C. Cerebrospinal fluid (CSF)
D. Gastric washings

20
120. A patient who is a known case of tuberculous abscess with the history of previous abscess
drainage presented with fever and tenderness between L2 L3 vertebra. Which is the best investigation
for this patient?
A. X-ray
B. CT scan
C. USG
D. MRI
E. Blood culture

121. A 75 year old man presents with Bell’s palsy. His past medical history is significant for late onset
asthma and heart failure. He also reports to have consulted his GP for a generalized rash sometime
back. His CXR shows multiple soft shadows and Full Blood Count shows eosinophilia. What is the
single most likely positive antibody?
A. P ANCA
B. C ANCA
C. Anti Ro
D. Anti Ds DNA
E. Anti Centromere

122. 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

123. A 43 year old lady is admitted with pyrexia, arthropathy, breathlessness and syncope. She was
recently diagnosed as having Pulmonary Emboli. There is early diastolic sound and a mid -diastolic
rumble. Her jugular venous pressure (JVP) is elevated with prominent a waves. What is the most
likely cause from below options?
A. Mitral regurgitation
B. Ventricular ectopics
C. Pulmonary regurgitation
D. Atrial Myxoma
E. Complete heart block

124. A 6 year old child presents with swelling of face and feet and weight gain despite poor
feeding recently. What investigation should be carried out next?
A. Urinary albumin
B. Serum urea &creatinine
C. Full blood count
D. eGFR
E. Thyroid function tests

125. Few weeks old child presents with profuse projectile vomiting. What is the most appropriate
initial action in this child?
A. USG E. IV fluids
B. Check serum K level
C. ABG
D. Nasogastric tube

21
126. 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

127. A schizophrenic patient is non-compliant with his medication. He also complains of tardive
dyskinesia. What is the best management for him?
A. Oral Haloperidol
B. IM Fluphenazinedecanoate
C. IV Chlorpromazine
D. IM Risperidone
E. Tetrabenazine

128. A 28 years old female had IDDM for 18 years. She has decreased acuity ( loss of central vision).
What is the anatomical structure that is most probably affected?
A. Lens
B. Retina
C. Iris
D. Anteriorchamber
E. Posteriorchamber

129. A 67 year old man had successful thrombolysis for an inferior myocardial infarction one month
ago, and he was discharged after 5 days. He is now readmitted having pulmonary oedema. What is the
most probable diagnosis?
A. Aortic Regurgitation
B. Ischemic Mitral Regurgitation
C. Mitral Valve Prolapse
D. Pulmonary Stenosis
E. Rheumatic Mitral Valve Stenosis

130. A 55 year old woman with a persistent cough and history of smoking develops left sided chest
pain exacerbated by deep breathing with fever and localized crackles. What is the Single most
appropriate diagnosis?
A. Dissecting aneurysm
B. Pericarditis
C. Pneumonia
D. Pneumothorax
E. Pulmonary embolism

131. A 48 years old woman presents with left sided severe headache. She also has a red, watering eye
and complains of seeing coloured haloes in her vision. What is the most appropriate next step?
A. Measure Intraocularpressure D. CT Scan
B. Relieve painwithaspirin E. Relieve pain with Sumatriptan
C. 100%oxygen

22
132. A 30 year old man is suffering from fever, rash and photophobia. Doctors are suspecting he is
suffering from meningitis. Which is the best medication for this condition?
A. Ampicillin
B. Cefotaxime
C. Tetracycline
D. Acyclovir
E. Dexamethasone

133. A resident of nursing home presented with rashes in his finger webs and also on his abdomen,
with complaints of itching which is severe at night. He was diagnosed with scabies. What is the best
treatment for this condition?
A. 0.5 % Permethrin
B. Doxycycline
C. 5% Permethrin
D. Reassure
E. Acyclovir

134. A 44 years patient has sudden onset of breathlessness and stridor few minutes after extubation
for thyroidectomy. The patient had long standing goitre for which he had the surgery. What is the
most probable diagnosis?
A. Thyroid Storm
B. Hematoma
C. Unilateral Recurrent Laryngeal Nerve Injury
D. External Laryngeal Nerve Injury
E. Tracheo-malacia

135. A 30 year old patient who is not taking any medications presents with blood pressure 200/100
mmHg, sodium 140 mmol/L, potassium -2.2mmol/L, calcium 2.0 mmol/L. What is the most likely
diagnosis in this patient?
A. Primary hyperaldosteronism( Conn’s disease)
B. Primary adrenal insufficiency (Addison’s disease)
C. Cushing syndrome
D. Cushing’s disease
E. Hypopituitarism

136. A 56 years old man complains of increasing sputum production with streaks of blood in it and
chest pain for the last 6 months. He has been smoking for the last 12 years. What is the most likely
diagnosis?
A. Bronchiectasis
B. Chronic Bronchitis
C. Lung Cancer
D. Emphysema
E. Asthma

137. In chronic renal failure main cause of Vit D deficiency is the failure of :
A. Vit D absorption in intestines E. Availability of Vit D precursors
B. 25 alpha hydroxylation of Vit D
C. Excess Vit D loss in urine
D. 1 Alpha hydroxylation of Vit D

23
138. A 7 year old boy complains of vague aches and pains. His mother says he has been looking pale
and has been bruising easily lately. He also seems very tired and had 3 upper respiratory tract
infections in the last 1 month. Platelet counts and clotting factors are normal. His Hb is low and WCC
is 40 x10*9/L. What is the single best diagnosis?
A. ALL
B. ITP
C. TTP
D. Haemophilia

139. A 25 year old woman has a recent cough, hoarseness and swelling in the neck. There are several
non-tender swellings on both sides of her neck. She has lost 13 kg in weight. She takes recreational
drugs. What is the most probable diagnosis?
A. Thyrotoxicosis
B. Hyperthyroidism
C. Vocal Chord Nodules
D. Carcinoma Bronchus
E. Tuberculosis

140. A 62 year old man who was admitted for minor surgery three days ago suddenly becomes
confused. His attention span is reduced. He is restless and physically aggressive and picks at his bed
sheets. What SINGLE aspect of the patient’s history recovered in his notes is most likely to aid in
making a diagnosis?
A. Alcohol consumption
B. Head trauma
C. History of anxiety
D. Prescribed medication
E. Obvious cognitive impairment

141. A woman has been prescribed long term steroids for polymyalgia rheumatic. What additional
drug should be added to prevent osteoporosis?
A. Calcium
B. Alendronic acid
C. Vit D
D. Calcium resonium

142. A 62 year old man diagnosed with Diabetes Type II. BMI is 33. Lifestyle modification has been
done but it failed to control blood sugar. Lab report shows urea 3.6mmol/L and creatinine
89mmol/L.What is the next appropriate management?
A. Biguanide
B. Sulfonylurea
C. Insulin
D. Glitazone
E. Sulfonylurea receptor binder
F. ACEIs

143. A patient came to the A & E after he had banged his car quite a few times on reversing it. He was
complaining of seeing double while he tried to look back during the process of reversing the car, he
also complains of double vision on looking at an outward gaze.

Which nerve is involved?

24
A. Abducent nerve
B. Trochlear nerve
C. Oculomotor nerve
D. Optic nerve
E. Trigeminal nerve

144. A 12 year old child with episode of sudden bluish discoloration and brief loss of consciousness.
Examination reveals clubbing, central cyanosis and systolic thrill with systolic ejection murmur in 2nd
left inter costal space. What is the most probable diagnosis?
A. Tetralogy of Fallot ` D. PDA (Patent ductus arteriosus)
B. Atrial septal defect (ASD) E. Coarctation of Aorta
C. Ventricular septal defect (VSD)

145. An eight year old boy with a body mass index (BMI ) of 28 kb/m2 was admitted to a surgical
ward following a motor vehicle accident. He was found to have glycosuria. When he recovered from
his injury the glycosuria resolved. What is SINGLE most appropriate follow-up investigation?
A. Fasting blood glucose concentration
B. Glycosylated hemoglobin (HbA1c)
C. Oral glucose tolerance test
D. Random blood glucose concentration
E. Serum cortisol concentration

146. A 66 years old woman has been brought to the hospital on a number of occasions with a history
of loss of memory. Her past history is significant for a MI six years ago. It is noted that she has a step
wise worsening of her cognitive functions. What is the most likely diagnosis?
A. Alzhemier’s Disease E. Lewy Body Dementia
B. Vascular Dementia
C. Pick’s Dementia
D. Huntington’s Disease

147. A 22 year old man has rushed into A& E asking for help. He describes recurrent episodes of
fearfulness, palpitations, faintness, hyperventilation, dryness of the mouth with peri-oral tingling and
cramping of the hands. His symptoms last 5 to 10 minutes and have worsened since their onset 3
months ago. He is worried he may be having a heart attack. An ECG shows sinus tachycardia
(100beats/ min).
What is the SINGLE appropriate immediate intervention?
A. High flow oxygen
B. Intravenous (IV) sedation
C. Re-breathe into a paper bag
D. Refer for anxiety management course
E. Refer for urgent cardiology opinion

148. A 55 year old man has a chronic cough and sputum, night sweats and weight loss. What is the
SINGLE most likely causative organism?
A. Coagulase positive cocci insputum
B. Gram negative diplococci insputum
C. Gram positive diplococci insputum
D. Pneumocystis cariniiinsputum
E. Sputum staining for Mycobacterium tuberculosis

25
149. A84 year old man got surgical pain which is well controlled by oral Morphine 60mg bd.
However, now this patient is unable to swallow. What is the most appropriate next step?
A. Morphine 60mg stat
B. Morphine 60mg tds
C. Oxycodone 10mg od
D. Morphine 60mg IV for 24 hours
E. Fentanyl Patches

150. A 66 year old male presents with painful swallowing. What is the most likely diagnosis/
organism?
A. Neisseria meningitides
B. Cryptococcus neoformans
C. Candida albicans
D. Isospora belli
E. Mycobacterium avium-intra-cellular

151. 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

152. A boy was rushed to the Emergency unconscious after he had taken methadone belonging to the
sister. He was given naloxone and he regained consciousness. After a while he started getting drowsy
again. What is responsible for his present drop in level of consciousness?
A. Naloxone is absorbed faster than methadone
B. Methadone is absorbed faster than Naloxone
C. He has also taken another substance apart from methadone
D. The methadone had already caused some brain damage.
E. Naloxone is eliminated faster than methadone

153. A 50 year old patient presents with squamous cell carcinoma of bronchus. What is electrolyte
imbalance?
A. Hypocalcemia
B. Hyperkalemia
C. Hypercalcemia
D. Hypokalemia
E. Hypermagnesemia

154. A 34 year old male presents with headache, vomiting and intermittent fever. Examination reveals
a temperature of 38.5°C, neck stiffness, a discharge from the left ear and right sided hyper-reflexia
with an extensor plantar response. What is the most likely diagnosis?
A. Cerebral Tumor
B. Meningitis
C. Cerebellar Tumor
D. Cerebral Abscess
E. Normal Pressure Hydrocephalus

26
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 58 year old type 1 diabetic, on antihypertensive therapy for 13 years, while driving developed
central chest pain of 45 minutes duration accompanied by cold sweating and dyspnoea. What is the
Single most appropriate diagnosis?
A. Myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Costo-chondritis
E. Pneumothorax

157. 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

158. A 70 years old patient with right hemicolectomy done some days ago, now develops vomiting
and has distended abdomen. He has not opened bowel since surgery, he has fever. What is the next
best management?
A. NG tube + IV fluids
B. Laparotomy
C. IVA ntibiotics
D. Laparoscopy
E. Analgesics

159. A 32 year old lady presents with history of palpitations. They had the following ECG finding.
What is the most likely diagnosis?
A. Ventricular fibrillation
B. Supraventricular tachycardia
C. Myocardial infarction
D. Atrial fibrillation
E. Sinus Tachycardia

160. A 36year old woman was recently admitted to a psychiatric ward. She believes that the staff
and other patients know exactly what she is thinking all the time. What is the most likely symptom
this patient is suffering from?
A. Thought Insertion
B. Thought Withdrawal
C. Thought Block
D. Thought Broadcasting
E. Hallucination

27
161. A 24 years old lady had been low after the death of her husband and had stopped contacting
her family. She was started treatment on SSRIs and felt better after a few months. On discontinuing
the medications she starts feeling that she has developed cancer, just like her husband. What is the
most appropriate next step?
A. Continue SSRIs
B. Add TCAs
C. Neuropsychiatric analysis
D. Cognitive behavioural therapy (CBT)
E. Antipsychotics

162. A young football player has collapsed during a game. During the initial evaluation his respiratory
rate is 14/min, pulse is 88/min and the blood pressure is 110/70 mmHg. He seems to be sweating and
muttering some incomprehensible words. What is the most important next step?
A. CT scan
B. Magnetic resonance imaging (MRI)
C. Blood Sugar
D. Check body temperature
E. IV fluids

163. A woman presented with blurred vision and intermittent clumsiness for 3 months. On
examination reflexes are brisk in her arm and her optic discs are pale. What is the single most
appropriate test to confirm diagnosis?
A. Cerebrospinal fluid (CSF) Analysis
B. CT Scan
C. MRI
D. Electromyography (EMG)
E. EEG

164. An 18 year old female has blisters on tongue. Some of them are crusted, others secreting pinkish
fluid. What is the most likely diagnosis?
A. HSV1
B. Chicken pox
C. Rubella
D. Measles
E. Erythema Infectious

165. A 28 year old female presented with one week history of jaundice and 2 days history of altered
sleep pattern and moods. She was diagnosed with hypothyroidism for which she is receiving
thyroxine. Thyroid function test showed TSH, prothrombin time (PT) was 70 seconds. What is the
most probablediagnosis?
A. Acute on chronic liverfailure.
B. Hyper-acute liverfailure.
C. Autoimmunehepatitis.
D. Acute liverfailure.
E. Drug inducedhepatitis

166. A teenager presented to A and E with shortness of breath and chest pain. On examination his
chest was hyper resonant on one side. He is the tallest guy in his class.

28
A. Simple Pneumothorax
B. Open pneumothorax
C. Close Pneumothorax
D. Tension pneumothorax
E. Refractory pneumothorax

167. A 29 years old motorcyclist, presents to the A&E following a road traffic accident with
breathlessness and severe chest pain worsened by breathing movements. Percussion of his chest
reveals stony dullness note on the right side. What is the most appropriate management?
A. Needle thoracocentesis
B. ECG
C. Chest drain
D. Bronchoscopy
E. Endotracheal tube

168. A 2 year old girl presents with a 4-day history of fever. The illness started with a cough. Her
respiratory rate is 45/min, saturations 94% on air, temperature 38.9°C and capillary refill time 1 sec.
There are crepitations at the left base on auscultation. Urine is negative on dipstick. What is the single
investigation most likely to lead to a diagnosis?
A. Blood for Culture and Sensitivity
B. ESR
C. Chest X Ray
D. Urine for Culture Sensitivity
E. CSF Analysis

169. A fifteen month old child is due for his measles, mumps and rubella (MMR) vaccines. There is a
family history of egg allergy. He is febrile, with acute otitis media. 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

170. A 26 year old man presented with history of passing loose stools for the past 2 months. Stools are
mixed with blood and mucus and is associated with abdominal pain. He undergoes a colonoscopy
after which he was started on treatment. What is the treatment of choice for his condition?
A. Mesalazine
B. Corticosteroids
C. Infliximab
D. Cyclosporin
E. Azothiaprine

171. A 53 year female on Ramipril, aspirin, thiazide complains of fall. Her BP standing was
140/80mmHg and lying was 120/80. What is the best step in management?
A. Review her anti-hypertensive medication
B. Advise on posture
C. Encourage to drink plenty of water
D. CT brain

29
172. A 32 years old woman presents with obesity, easy bruising and striae on the abdomen. The low
dose Dexamethasone suppression test shows no suppression of cortisol levels, but with higher doses
of Dexamethasone there is suppression of the serum cortisol. What is the most likely diagnosis?
A. Pseudo-cushing's D. Adrenal Adenoma
B. Pituitary Adenoma E. Exogenous Steroid
C. Ectopic Adrenocorticotropic Hormone (ACTH) source

173. An alcoholic patient presented to hospital with complains of palpitation and fast thumping few
hours. On examination observations are stable bloods are normal and 24 hr ECG is normal. What is
the next step in management?
A. Reassure and life Style modification
B. ECHO
C. Heparin&Cardioversion
D. Beta Blockers
E. Digoxin

174. A 77 year old woman woke up in the morning and shortly after developed right sided weakness
which resolved after 30 minutes. She is on Aspirin, Simvastatin, Bendroflumethiazide and
Amlodipine. Her examination is unremarkable. Her CT brain is normal. ECG shows sinus rhythm.
What other action should be taken?
A. Add Clopidogrel
B. Start Aspirin 300 mg for 2 weeks
C. Add Warfarin
D. Stop Amlodipine
E. Clopidogrel + Dipyramidamole

175. A lady presents with itching around breast, a greenish foul smelling discharge is seen from a
nipple. She had a similar episode before. What is the diagnosis?
A. Duct papilloma
B. Duct ectasia
C. Breast abscess
D. Periductal mastitis
E. Mammary duct fistula

176. A young male whose sclera was noted to be yellow by his colleague. He has history of taking the
drug over the counter for some pain. Tests showed raised bilirubin, ALT in normal range, and AST in
normal range. The provocation test with intravenous nicotinic acid is positive and produces a further
rise in the serum bilirubin levels. What is the most probable diagnosis?
A. Acute hepatitis
B. Drug hypersenstivity
C. Gilberts syndrome
D. Acute Pancreatitis

177. 75 year female comes for check-up. She is healthy except that her 3 BP readings come under
stage 2 HTN (SBP= 160-175). She is not on any other medication and has no history of previous
surgical illness. What would you prescribe?
A. ACE inhibitors
B. Salt free Diet
C. Beta Blockers
D. Amlodipine
E. Exercise

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178. An 89 year old patient has lung cancer. His sodium is 122mmol/l. What is the initial management
for it?
A. Demeclocycline
B. Vasopressin
C. Restrict fluids
D. Reassure

179. A patient was admitted to hospital with severe pyelonephnritis. He was given IV antibiotics. A
few days later he develops bloody diarrhoea. Stool cultures reveal Clostridium difficile. What is the
best treatment option for this patient?
A. Erythromycin
B. Gentamicin
C. Penicillin
D. Metronidazole

180. A young woman, who is a chronic alcoholic, presents with a massive hematemesis. She
continues to have episodes of hematemesis despite initial measures. What is the most important next
step?
A. Emergency banding
B. Sclerotherapy
C. Terlipressin
D. Octreotide
E. IV fluids

181. A 7 year old boy was involved in a fire. He has 15% partial thickness burns, IV fluids already
given. What is the best management for this patient?
A. Escharectomy
B. Dressing
C. Burst blisters
D. Local antibiotics
E. Refer to burn unit

182. A 73 year old male, presents with enlarged cervical nodes, he has recurrent infections over
the last one year, his conjunctiva is pale. Choose the single cell type you will find on blood film.
A. Granulocyte without blast cells
B. Myelofibro-blasts
C. Plasma cells
D. Mature lymphocyte

183. A 6 year old boy is brought to the hospital for a third episode of sore throat in one month, he is
found to be bleeding from gums and nose has pale conjunctiva. What is the single cell type from
given options?
A. Clumped platelets
B. Microcytes
C. Granulocyte without blast cells
D. Blast cells
E. Mature lymphocyte

184. A 35 year old man presented with painful vesicles around the right ear with facial palsy on
examination of the ear there are vesicles in external ear extending to the tympanic membrane. The
patient also complains of hearing difficulty. What is the most probable diagnosis?

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A. Ramsay-Hunt syndrome
B. Herpes simplex
C. Otitis externa
D. Acute otitis media
E. Parotitis

185. A nurse comes to you saying that she has recently developed the habit of washing her hands after
every 15 to 20 minutes. She is unable to concentrate on her work and takes longer than before to
finish tasks as she must wash her hands constantly. What is the best management for this condition?
A. Cognitive behaviour therapy
B. Selective serotonin re-uptake inhibitors (SSRI)
C. Electroconvulsive therapy
D. Antipsychotics
E. Desensitization

186. Which nerve is most likely to be injured in a mid-shaft femoral fracture?

187. A 45 year old lady presents with severe chest pain associated with difficulty in breathing. History
reveals that she has come from Australia few hours ago. What is the definitive investigation for her
condition?
A. CT pulmonary angiogram
B. VQ scan
C. Chest X-ray
D. D- dimer

188. A diabetic lady present with inability to read small prints and decrease in visual acuity. Where is
the site of lesion?
A. Retina
B. Lens
C. Cornea
D. Macula
E. Iris

189. 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 lob

190. A 6 month old baby had loss of consciousness after which he had jerky movement of hands and
feet. What is the most probable diagnosis?
A. Infantile spasm E. Partial complex
B. Absence
C. Partial seizure simple
D. Atonic seizure

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191. A 45 year old manual worker presented with a two hour history of chest pain radiating into his
left arm. His ECG is normal. What is the SINGLE most appropriate investigation?
A. Cardiac enzymes
B. Chest x-ray
C. CT scan
D. ECG
E. V/Q scan

192. A 10 year old boy, who takes regular high dose inhaled-steroids for his longstanding asthma, has
been advised to use bronchodilators to control acute attacks. His parents are unsure when should he
use his bronchodilator inhaler. What is the SINGLE most appropriateinvestigation?
A. Chestx-ray
B. No investigationneeded
C. Peak flow ratediary
D. Pulse oximetry
E. Spirometry

193. A 19 year old man has exercise-induced asthma. This has previously been controlled using a
salbutamol inhaler as required, but he now gets attacks with exercise. What is the SINGLE most
appropriate treatment?
A. Regular salbutamol D. Oral steroid
B. Regular salbutamol and Budesonide E. Inhaled steroid
C. Sodium cromoglycate D.

194. 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

195. A patient presents with widespread ovarian carcinoma. She had bowel obstruction and severe
colic for 2 hours and was normal for few hours in between severe pain. What is the management?
A. S/C morphine, pain controlled analgesia (PCA)
B. Spasmolytics
C.Palliative colostomy
D. Oral Morphine
E. Laxatives

196. A 45 year old lady has 10 month history of shortness of breath. She is found to have irregularly
irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left 2nd intercostal
space. What is the most probable diagnosis?
A. Tetralogy ofFallot
B. Atrial septal defect(ASD)
C. Ventricular septal defect(VSD)
D. Patent ductus-arteriosus(PDA)
E. CoarctationofAorta

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197. A 12 year old boy presented with itching in his hands. On examination the skin is dry and red.
His mother is asthmatic and his older brother has hay fever. What is the single most likely causative
factor?
A.Dermatitis Herpitiformis
B. Scabies
C. Eczema
D. Uraemia
E. Drug induced

198. After surgery, a patient’s left leg has become swollen and tender. The diameter of the calf has
increased and passive movements cause pain. What is the most probable diagnosis in this patient?
A. Deep venous thrombosis (DVT)
B. Lymphoedema
C. Peripheral vascular disease
D. Haematoma
E. Superficial thrombo-phlebitis

199. An elderly 80 year old woman lives in a residential home presents with agitation, confusion and
abdominal pain. She has been diagnosed to have faecal impaction. What will be the first step in your
management?
A. High fibrediet
B. Phosphateenema
C. Sodiumpicosulphate
D. Senna
E. Bran

200. A 44 year old female was brought into A& E after a suicide attempt. She had overdosed on
paracetamol. She demands to be discharged saying she wants to go home and try to kill herself again.
She refuses all treatment. What is the most appropriate action for her?
A. Discharge
B. Call police
C. Call social services
D. Detain under Mental Health Act

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