Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 7TH MARCH 2019 TIME ALLOWED: 3HRS

1. Parents of a 4 year old child are worried since the child recently started wetting the bed at night again
despite being dry for the past 6 months. What advice from the following list of options would you give
them?
A. Reassure
B. Fluid restriction
C. Alarm Training
D. Desmopressin

2. A sick child presents with drooling of saliva and fever. What is the most probable diagnosis?
A. Acute asthma
B. Bronchiolitis
C. Croup
D. Epiglottitis
E. Tonsilitis
F. URTI
G. Pharyngitis

3. 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

4. A 55 year female presented with complaining of chest pain, shortness of breath and palpitation. On
admission ECG showed SVT with HR of 220/min. No response to carotid massage. What is the next step
in management?
A. DC shock
B. IV adenosine
C. Verapamil
D. PCI
E. Amiodarone

5. A 50 year old man presented with acute onset of severe breathlessness and cough with pink, frothy
sputum. He is a known case of IHD. What should be the first step?

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A. Give IVFurosamide
B. Give supplemental Oxygen
C. Give nitrates
D. Give opiates

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

7. What is the ideal method of providing nutrition to a terminally ill bedridden stroke patient?
A. Parenteral
B.Percutaneous Gastrostomy
C.Jejunostomy
D. Nasogastric

8. A 65 year old man presents with painless haematuria, Intravenous Urogram (IVU) is normal,
prostate is mildly enlarged with mild frequency. What is the most appropriate next step?
A. USG Abdomen
B. Flexible cystoscopy
C. Magnetic resonance imaging (MRI)
D. Nuclear Imaging
E. Prostate-Specific Antigen (PSA)

9. 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

10. A woman has numerous painful ulcers on her vulva. What is the cause?
A. Chlamydia
B. Trichomonas
C. Gardenella
D. Herpes Simplex Virus (HSV)
E. Epstein–Barr virus (EBV)

11. A young male is brought to the Accident and Emergency after an RTA. His GCS on initial evaluation
is 6. What is the most appropriate next step?

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A. CT scan
B. Magnetic resonance imaging (MRI)
C. IV Fluids
D. Skull X ray
E. Secure Airway

12. A 6 year old patient comes with easy bruising in different places when she falls. Her FBC results are:
WBC 25 * 10 9, Hb: 10.9, platelet 45* 10 9. Her Paul Bunnel test is positive. What is the single most
likely diagnosis?
A. Glandular fever
B. Idiopathic thrombocytopenia purpura (ITP)
C. Trauma
D. Non accidental injury (NAI)
E. Septicaemia

13. 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

14. A first year college student is brought into A&E unconscious with constricted pupils, redness around
the nasal alae, inflamed and swollen nasal mucosa and high fever. Toxicity with what substance is
suspected?
A. Cocaine E. Marijuana
B. Heroin
C. Ecstasy
D. LSD

15. A 29 year old lady complains that she hears everyone saying that she is an evil person. What type of
hallucination is she suffering from?
A. Second person auditory hallucination
B. Third person auditory hallucination
C. Echo de la pensne
D. Gerdemankessane

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

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17. A middle aged hypertensive man presents with bleeding from the nose for half an hour. Bleeding is
not controlled with pressure. What is the most appropriate next step in management?
A. Refer to ENT surgeon
B. Anterior packing
C. Silver nitrate cautery
D. Posterior packing
E. Give antihypertensive

18. A 40 year old female had history of use of COCP for 5 years and condom for a few years. She is obese
and is a heavy smoker. Smokes 20 cigarette/day .Had repeated episodes of chlamydial infections. Her
family history showed that her aunt died of carcinoma of the ovary at 48 years of age. What is the major
risk factor for development of ovarian cancer in this patient?
A. OCOP
B. Condom
C. Obesity
D. Smoking
E. Family history

19. A pregnant woman is concerned about her unborn baby. Her previous baby died because of severe
jaundice. She is worried that the same may happen this time. She has blood group O negative and the
baby’s father is A positive. What test can be done to determine if her baby could be at risk of sever
jaundice?
A. Osmotic fragility test
B. Kleihauer-Betke test
C. FBC
D. Direct Coomb’s test
E. Indirect Coomb’s test

20. Prenatal amniocentesis for karyotype is offered if maternal blood tests at 16 weeks gestation showed a
high chorionic gonadotropin level and low alpha fetoprotein level. Choose the single most likely
condition from the following options.
A. Duchene muscular dystrophy
B. Cystic fibrosis
C. Spina bifida
D. Down’s syndrome
E. Spinal muscular atrophy

21. Man who took a bunch of over the counter drugs presented with jaundice. What is the most probable
cause of his Jaundice?
A. Hemochromatosis
B. Cholelithiasis
C. Gilbert's syndrome
D. Portal hypertension
E. Hepatitis

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22. A 2 years old child who can run down steps, says mama and dada and understands what he says, and
also says one word. How is the development of this child?
A. Delayed motor milestones
B. Delayed speech
C. Normal
D. Global milestones delay
E. Delayed speech and motor milestones

23. A 72 year old man investigated for anaemia is booked for colonoscopy in 24hrs. What is the single
most appropriate management night before the procedure?
A. Bisacodyl tablet
B. Senna Tablet
C. Magnesium citrate orally
D. Lactulose syrup

24. 78 year old man with past history of ischemic heart disease presents with yellow haloes, nausea and
vomiting. ECG reveals arrhythmia. Which of the following medication is most likely responsible for his
symptoms?
A. Amlodipine
B. Digoxin
C. Aminophyline
D. Propanolol
E. Diltiazem

25. A 2 year old child is very naughty. His teacher complains that he is easily getting distracted. His
parents say that he can’t do a particular task for a long time. He sometimes hurts himself and breaks many
things. This causes many troubles in his family life. What is the diagnosis?
A. Autism spectrum disorder
B. Dyslexia
C. Attention deficient hyperactive disorder
D. Antisocial personality disorder
E. Oppositional defiant

26. A 71 year old woman looks disheveled, unkempt and sad, with poor eye contact. She has recently lost
her husband. Which of the following describes her condition the best?
A. Anxiety
B. Hallucination
C. Mania
D. High Mood
E. Low Mood

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27. 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

28. A 45 year old Afro-Caribbean female was recently diagnosed with hypertension. For this her GP
prescribed her an antihypertensive medication. After some time she developed swelling around her
ankles. What is the most probable cause of her swelling?
A. ACE inhibitors
B. Diuretics
C. Calcium channel blockers
D. Beta blocker
E. Alpha blocker

29. A young college student is found in his dorm unconscious. He has a tachy-arrhythmia and is having
high fever. He also seems to be bleeding from his nose, which on examination shows a perforated nasal
septum. What is the most likely diagnosis?
A. Marijuana Overdose
B. Cocaine Overdose
C. Heroin Overdose
D. Alcohol Overdose
E. Carbon Monoxide poisoning

30. A man, who was drunk, left a pan on the hob and dozed off causing fire in his house. He was drowsy.
His house caught fire. He was eventually brought to the A &E with laryngeal oedema and hoarse voice.
What is the next best step?
A. Anaesthetics for help
B. I/V fluids
C. CT scan
D. MRI
E. X-RAY

31. A homeless lady presents with cough and fever. She complains of night sweats and weight loss. Chest
X-ray has been done and shows opacity. What is the next appropriate management?
A. Acid fast bacilli
B. Mantoux test
C. Interferon gamma testing
D. Bronchoscopy
E. CT scan.

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32. 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

33. A 30 year old lady every time she leaves the house experiences palpitation and difficulty in breathing.
She has to rush back into her house to allay her anxiety with a drink. What is the single most likely
diagnosis?
A. Social phobia
B. Agarophobia
C. Panick attack
D. Hysteria
E. Arachnophobia

34. A 7 year old boy is brought by his mother who says that he was well at birth but has been suffering
from repeated chest and gastro intestinal infections since then. She also says that he is not growing well
for his age. What is the likely condition in this child?
A. Cystic fibrosis
B. Severe combined immunodeficiency (SCID)
C. Primary T cell immunodeficiency
D. Primary B cell immunodeficiency
E. Malabsorption

35. A 50 year old man has been laid off work because he is unreliable and is now homeless. He was
bought to the accident and emergency department by police in a very agitated state who found him
wandering about and muttering to himself about a plot to kill him. He is confused, unkempt and smells of
stale sweat. What is the single most important initial management?
A. IV antipsychotics
B. IV benzodiazepines
C. IV glucose
D. IV antibiotics

36. A 72 year old man presented with joint pains on both sides. He also complained of weakness and
stiffness in his shoulders which made it difficult for him to stand up from the chair after sitting for a
while. His ESR was raised and CPK was normal. What would be the appropriate treatment for him?
A. Physiotherapy
B. Methotrexate
C. Prednisolone
D. Allopurinol
E. Bed rest

37. A middle aged lady was lying the bed sheet when her index finger got stuck in between the bed and
mattress. She is unable to extend her proximal interphalangeal joint. What is the most appropriate
management?

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A. Twin plaster the finger
B. Cast
C. Sling
D. Splint the finger

38. 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

39. A 60 year old man describes detailed Lilliputian visual hallucinations. He has memory loss and cannot
recall his name. What is the most likely diagnosis?
A. Alzheimer’s
B. Vascular dementia
C. Pick’s disease
D. Lewy body dementia
E. Huntington’s disease

40. All of the following drugs do cause broncho-dilatation except:

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

42. A 1 year old boy has been bought to the accident and emergency department with diarrhoea and
vomiting for 5 days. For the past 24 hours he has been unable to tolerate and fluids. In the last hour he has
become drowsy, his skin turgor is reduced and his skin is mottled. His eyes are sunken. His heart rate is
180 beats/minute and his capillary refill is prolonged. What is the single most appropriate immediate
treatment?
A. IV fluid bolus over 20 minutes E. Oral rehydration solution over 48 hours
B. IV fluids over 24 hours
C. IV rehydration over 48 hours
D. Nasogastric rehydration over 24 hours

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43. A man on road trip with son was hit while on the passenger’s side of the car by another vehicle. He
now presents with left sided abdominal pain and blue patch on the left side. What structure was most
likely damaged?
A. Aorta
B. Liver
C. Stomach
D. Kidney
E. Spleen

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

45. A 25 year old female complains of intermittent pain in her fingers. She describes episodes of
numbness and burning of the fingers. She wears gloves whenever she leaves the house. What is the most
probable diagnosis?
A. KawasakiDisease
B. TakayasuArteritis
C. Buerger’sDisease
D. Embolism
E. Reynaud’s Phenomenon

46. A child comes with recurrent joint pain, multiple bruise, swollen ankle and unable to move his legs.
What is the investigation of choice?
A. Erythrocyte sedimentation rate (ESR)
B. Rheumatoid factor
C. Clotting factor

47. A 29 year old man is found to have proteins and blood cells in urine. There is no history of any renal
disease and no other significant medical history, other than fever 4 weeks ago. What is the most likely
explanation for proteinuria and haematuria seen in this man?
A. Thrombotic ThrombocytopoenicPurpura
B. Haemolytic Uraemic Syndrome
C. Post streptococcal glomerulonephritis
D. IgA Nephropathy
E. Minimal Change disease

48. A 70 year old hypertensive white British man on thiazide diuretics needs a second drug to control his
blood pressure. Which one of the following is the best choice for him?
A. Amlodipine (CCB) D. Increase dose of diuretic
B. Enalapril (ACE inhibitor) E. Prazocin (Alpha blocker)
C. Propanolol (B blocker)

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49. A footballer has been struck in the groin by a kick and presents with severe pain and mild swelling
in the scrotum. What is the most appropriate next step?
A. USG D. IV fluids
B. Doppler E. Antibiotics
C. Exploratory Surgery

50. A man with previous TIA drinks 8 units per week, smokes 20 cigarettes per day, BMI was 25kg/m2.
Where will you refer him to ?
A. Alcohol cessation services
B. Smoking cessation services
C. Dietary intake
D. Refer to dietician
E. Send home

51. A 70 year old man with hoarseness of voice for 3 months presented with breathing difficulties. On
chest x- ray there was a unilateral opacity in hilum. There is no history of smoking. What is most
probable diagnosis?
A. Bronchial carcinoma
B. Laryngeal carcinoma
C. Oesophageal carcinoma
D. Nasopharyngeal carcinoma
E. Sarcoidosis

52. A previously healthy 23 year old man presented with a week history of bloody diarrhoea, crampy
abdominal pain and fever. On examination you find tenderness in lower abdomen. What is the most
appropriate diagnosis?
A. Coeliac disease D. Laxative abuse
B. Colorectal polyps E. Viral gastroenteritis
C. Ulcerative Colitis

53. Which of the following increases the risks of a young woman having an ectopic pregnancy?
A. Nulliparous
B.PID
C. Maternal age above 25
D. UTI
E. Sexually transmitted infections

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

55. A 38 years old female returns from a holiday in Greece. Now has dry cough, bilateral consolidated
areas in the chest X-ray. What is the best antibiotic you would prescribe?

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A. Clarithromycin
B. Ciprofloxacin
C. Amoxycillin
D. Cephalexin
E. Gentamycin

56. A 23year old man feels anxious and agitated when faced with stress. He has an interview in 3days and
would like some help in relieving his symptoms. What is the most appropriate management?
A. SSRI
B. CBT
C. Propranolol
D. Diazepam

57. A patient was having proteinuria of 3.4g/day and slight edema of his feet. Renal biopsy was done and
it showed presence of a thin basement membrane. What is the most appropriate step to stop the
progression of this?
A. Steroid
B. immune suppressants
C. ACEI
D. Cyclophosphamide
E. No treatment needed

58. A middle aged man complains of a node which has been growing on his nose for several months. Now
it’s firm with central depression. It is 0.6cm in size. What is the single most likely diagnosis?
A. Basal cell carcinoma
B. Squamous cell carcinoma
C. LN
D. Melanoma
E. Kaposi’s sarcoma

59. A patient has injury to the right hand. He has lost triceps reflex. Which nerve is not affected?
A. C5
B. C6
C. C7
D. T1

60. A 24 year old unconscious man was brought by his friends from a party where he was said to have
drank vodka. While he was being attended to by the doctor in the emergency department, he became
conscious and said the green tie the attending doctor was wearing was talking to him. What substance
could this patient have taken?
A. Cocaine E. LSD
B. Alcohol
C. Heroin
D. Cannabis

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61. Baby with congenital adrenal hyperplasia, found unconscious in the ward. What would be the finding
in the baby?
A. Genital hyperpigmentation.
B. Hypotension.
C. Hypernatremic dehydration.
D. Hyperkalemia

62. A six year old child with history of recurrent jaundice. Between the episodes he is totally fine. Mother
gives history of jaundice being brought about by on-going infections. What is the most likely diagnosis?
A. Hereditary Spherocytosis
B. G6PD Deficiency
C. Thalassemia
D. Sickle Cell Disease

63. A 29 year old lady, who is a Bank Manager, is referred by the GP to the medical Out-Patient Clinic
due to a long history of tiredness and pain in the joints. An autoimmune screen result showed smooth
muscle antibodies positive. What is the most appropriate next investigation?
A. ECG
B. Thyroid FunctionTest
C. Liver FunctionTest
D. Serum glucose
E. Jejunal biopsy

64. A 56 year old woman with history of breast cancer 10 years ago when radical mastectomy and axillary
lymph node removal were done for her now complains of swollen upper limb 3 weeks after an insect bite.
The bite site is better but gross oedema still present. What is the most likely cause?
A. Lymphoedema
B. Breast Ca
C. Allergy
D. Filariasis
E. Infection

65. Young boy with one sided facial swelling associated with pain tenderness and swelling around eye.
There is no proptosis and ophthalmoplegia. What is the most probable diagnosis?
A. Peri-orbital cellulitis
B. Orbital cellulitis
C. Sinusitis
D. Conjunctivitis
E. Erysipelas

66. A 46 year old man is being treated for a pleural effusion. A chest drain has been sited just below the
fourth rib in the mid-axillary line on his right side. What SINGLE structure is at particular risk of injury?
A. Azygos vein D. Internal thoracic artery
B. Diaphragm E. Liver
C. Intercostal artery

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67. A 20 year old male smoker is noted to have intense rubor of the feet and absent foot pulse. On
examination he was found to have amputated right 2nd toe. What is the most probable diagnosis?
A. Intermittent claudication
B. Cardiovascular syphilis
C. Buerger’s disease
D. Embolism
E. Acute limb ischemia

68. A boy with a history of recurrent swollen tender joints on both knees and elbows and not able to
participate in sports. What is the investigation of choice to diagnose his case?
A. Rheumatic factor/ASO titre
B. Clotting factor
C. ESR
D. Xray

69. Which of the following electrolyte abnormalities is most likely to be seen in SIADH?
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

70. A 23 year old woman has white discharge from her vagina. She had a 7 day course of broad spectrum
antibiotics before her dental procedure. What is the causative microorganism?
A. Chlamydia
B. Candida
C. Trichomonas
D. Gardnerella
E. NesseriaGonorrhea

71. A 30 year old woman has US which shows 8 weeks pregnant 9 days ago and the fetus was viable. She
is now presenting with vaginal spotting. What is the most appropriate management?
A. Reassure
B. Clotting screen
C. Repeat USG scan
D. Beta HCG

72. A patient with migraine and photophobia, she has uterine fibroids distorting the uterine cavity. She is
the mother of 2 children, needs contraception.
A. Mirena coil
B. Copper IUCD
C. COCP
D. Depo progesterone
E. Endometrolibilation

73. Half of a group of observations lies above this level and it is particularly important if the distributions
non normal. Choose the single term from the list of options given

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A. Chi squared (X²) test E. Mode
B. Linear regression
C. Mean
D. Median

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

75. A 14 year old girl is clinically obese. She has not started her periods yet and has severe acne. Among
her investigations, a high insulin level is found. What is the most probable diagnosis?
A. Cushing’s Syndrome
B. Grave’s disease
C. Acquired Hypothyroidism
D. Polycystic ovarian syndrome
E. Addison’s disease

76. A 45 year old woman who is taking Lithium for Bipolar affective disorder for past 14 years presents
with coarse tremor. What investigation should be done?
A. Thyroid function test E. Reassure
B. Creatinine clearance
C. Urea and electrolytes
D. Serum lithium levels

77. 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

78. A 58 year old man presented with chest pain, breathlessness and weight loss. He is a non-smoker
and is a shipyard worker. CXR is shown below. What is the most probable diagnosis?
A. Lung cancer
B. Mesothelioma
C. Pneumonia
D. T.B

79. A 76 years old man presents with cough and haemoptysis. What is the most probable diagnosis based
on the Xray?

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 A. Lung Cancer
B. Bronchiectasis
C. COPD
D. Goodpasture’s Disease
E. Wegener’s Granulomatosus

80. A 48 year old man with renal cancer had radiotherapy for metastatic spinal cord compression at the
11th thoracic vertebrae 4 weeks ago. he had reduced sensation but is unable to stand. He has pain in the
band around the lower trunk which is controlled by regular oral Morphine. He is distressed by
increasingly frequent episodes of painful muscle spasms in his right leg. What is the most appropriate
treatment?
A. Amitriptyline
B. Gabapentin
C. Increased Morphine dose
D. Baclofen

81. A child presents with eczema. She was given two creams by GP, one emollient and the other steroid.
What advice would you give her regarding application of the cream?
A. Sparingly use both the cream.
B. First use emollient then steroids.
C. Apply steroids, then emollient
D. Mix emollient and steroids before use
E. Emollients at night with steroids

82. 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

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83. A 60 years old female presents with acute onset of bone and back pain following a rough journey in
car. On examination she has tenderness at mid-thoracic vertebrae with spasm, she feels better once she
bend forward. What is the SINGLE most probable diagnosis?
A. Osteoporotic fracture vertebrae
B. Myofascial pain.
C. Whiplash injury
D. Myocardial Infarction
E. Pancreatitis

84. A two year old boy fell off his tricycle, hurting his arm. He got up and started to cry but before there
was any sound he went pale, unconscious and rigid. He recovered after 1-2 minutes but remained pale.
After an hour he was back to normal. His mother says she was afraid he was going to die and that he had
a similar episode three months previously after he fell down some steps. What SINGLE investigation is
indicated?
A. Computed tomography (CT) scan of the head
B. Electroencephalogram (EEG)
C. Full blood count `
D. None
E. Skeletal survey

85. A patient with proteinuria ++. What medication in this patient will prevent the progression of this
disease?
A. ACE inhibitors
B. Calcium channel blockers
C. Thiazide
D. Beta blockers
E. Alpha blockers

86. What is the most appropriate antibiotic to treat uncomplicated Chlamydia infection in a 21 year old
female who is not pregnant?
A. Erythromycin
B. Ciprofloxacin
C. Metronidazole
D. Cefixime
E. Doxycycline

87. A 36 years old man undergoes an elective hernia repair. 12 hour after the surgery he presents with the
following x-ray. What is the most likely diagnosis?
A. Pulmonary Effusion
B. Pneumothorax
C. Atelectasis
D. Pulmonary Edema
E. Pneumonia

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88. A 35 year old woman came for a routine cervical smear examination. . Inflammatory changes were
seen. Her past cervical smears have been negative. She does not complain of any discharge or any other
symptom. What will you do next?
A. Repeat cervical smear in 3yrs
B. Repeat smear in 6months
C. Colposcopy
D. Cauterization
E. Take swab

89. A 50 year old lady who had fallen in a shopping centre was brought to the accident and emergency
department. She reported to have an attack of palpitations for 30 seconds before collapsing. An ECG was
done and shows atrial fibrillation. What is the single most appropriate treatment?
A. Digoxin
B. Warfarin
C. Amiodarone
D. Metoprolol
E. Flecanide

90. 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

91. A 37 year old lady stopped taking COCP 18 months ago and she had amenorrhea for 12 months
duration. What is the most appropriate cause? FSH : 8, LH: 7 and Prolactin is 400 and Estradiol : 500.
A. Hypothalamic amenorrhea
B. Polycystic ovary syndrome (PCOS)
C. Prolactinoma
D. Post pill amenorrhea
E. Premature ovarian failure

92. A housebound 78 year old man with severe chronic obstructive pulmonary disease has had a gradual
deterioration over recent months and is now breathless at rest. He is on maximal inhaled therapy. Results
show the following:
Ph: 7.36
PaCO2: 5.9kPa PaO2: 6.9kPa
What is the single most appropriate additional treatment?
A. Aminophylline (oral)
B. Angiotensin converting enzyme (ACE) inhibitor (oral)
C. Antibiotic (oral)
D. Oxygen
E. Steroid (oral)

93. A 53 year old woman was found to have an enlarged spleen which is palpable up to the umbilicus.
Blood tests show HB 8.7g/dl, WBC 100 and Platelets 72. What is the single most likely diagnosis?

17
A. Chronic myeloid leukemia
B. Chronic lymphoid leukemia
C. Acute myeloid leukemia
D. Lymphoma
E. Splenic carcinoma

94. A man with prosthetic heart valve underwent hemicolectomy and after some days complains of left
hypochondriac pain, fever and has a systolic murmur. What is the next investigation to ascertain the cause
of heart failure?
A. CT scan
B. Blood culture
C. ECG
D. Magnetic resonance imaging (MRI)
E. Radioactive thyroid scan

95. A 25 year old had an LSCS 24 hours ago for foetal distress. She now complains of intermittent vaginal
bleeding. Observations include saturations 98% in air, blood pressure 124/82 mmHg, pulse 84 beats/min
and temperature 37.8oC. The midwife tells you that she had a retained placenta, which required manual
removal in the operating theatre. Choose the most appropriate post C-Section complication in this case?
A. Retained products of conception
B. Aspiration pneumonitis
C. Endometritis
D. Uterine rupture
E. Disseminated intravascular coagulation

96. A 36 year old man had hematemesis and was found at endoscopy to have a duodenal ulcer. He was
treated with H.pylori eradication therapy. Some months later, he returns with epigastric pain.
What single investigation is most likely to review eradication of H.pylori?
A. Barium meal
B. C13 urea breath test
C. H.pylori serology
D. Repeat endoscopy

97. A child living with his step father brought by the mother with multiple bruise, fever, fractures. What
do you suspect?
A. Non accidental injury
B. Malnutrition
C. Thrombocytopenia
D. HIV
E. Type 1diabetes

18
98. A 62 years old man has slow palpitations and the following ECG. What is the most likely diagnosis?

A. Sinus Bradycardia

B. First Degree Heart Block

C. Mobitz Type I Block

D. Mobitz Type II Block

E. Complete Heart Block

99. A 46 year old man is being investigated for indigestion. Jejunal biopsy shows deposition of
macrophages containing Periodic acid–Schiff (PAS) – positive granules with clumps. What is the most
likely diagnosis?
A. Bacterial overgrowth
B. Coeliac disease
C. Tropical sprue
D. Whipple’s disease
E. Small bowel lymphoma

100. Patient with pain and swelling in left leg and thigh up to the level of inguinal ligament. Where is the
level of occlusion? B 21ST JUNE 2017
A. Femoro-popliteal artery
B. External iliac artery
C. Aortoiliac artery
D. Femoral artery

101. A 25 year old girl saw a tragic road traffic accident in which a young boy was killed. The night of the
event she could not sleep and the day after suddenly she lost her vision. She was previously fine and there
was no history of medical or psychological problems. What is the diagnosis?

19
A. Conversion
B. Somatisation
C. Post-traumatic stress disorder
D. Dissociation
E. General anxiety disorder

102. A 7 months old baby is irritable and fails to gain weight. His stools are pale, frothy and bulky. What
will be the most diagnostic test to confirm the condition?
A. Sweat Test D. Stool Culture
B. Jejunal Biopsy E. Liver biopsy
C. Endomysial Antibodies

103. A patient presents with ectopic pregnancy. Which is the most important risk factor for it?
A. Polycystic ovary syndrome (PCOS)
B. PID with chlamydia,
C. Depo-provera
D. Instrumentation

104. A 3 year old boy has 3 episodes of limb jerking. His teacher has noticed that at times he does not
concentrate in class. What is the single most appropriate investigation?
A. CT scan of Brain
B. Echocardiogram
C. ECG
D. EEG
E. LFT

105. A 74 years old man, who has been a smoker since he was 20, has recently been diagnosed with small
cell carcinoma of the lung. What serum electrolyte picture will confirm the presence of Syndrome of
inappropriate anti-diuretic hormone secretion (SIADH)?
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, low serum osmolarity, low urine osmolarity
E. High serum Na, high serum osmolarity, low urine osmolarity

106. 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

107. A 34 year old woman complains of low mood, loss of interest in everyday activities, loss of appetite
and weight. She also has trouble falling asleep and wakes up early in the morning. What is the best
treatment for her?

20
A. Fluoxetine—antidepressant--SSRI
B. Minaprine—antidepressant-MAOI
C. Moclobemide – antidepressant--Reversible selective MAOI
D. Curcumine ?chemical curcuminoid -turmeric

108. A 40 year old lady was bitten by a bee on her right hand 3 weeks ago. She has past history of past
medical history breast cancer for which she had Radiotherapy and surgery with axillary clearance She
presents to accident and emergency department with swelling of the right hand. What is the single most
likely diagnosis?
A. Anaphylaxis
B. Delayed allergic reaction
C. Cellulitis
D. Lymphoedema
E. Superior vena cava obstruction

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

110. 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

111. A woman with breast carcinoma developed supra ventricular tachycardia following MI. Now she
suffers from right side arm pain, which comes like electric pain. Pain was controlled by fentanyl patches
but she suffers from prolong sedation. What is the drug you can add to control her arm pain?
A. Amytriptaline
B. Morphine
C. Gabapentine
D. Codeine
E. Carbamezepine

112. 3A 55 year old man has taken an overdose of his antidepressant medication. He presents with dry
mouth, blurred vision, urinary retention and constipation. What is the most appropriate investigation to be
done?
A. Thyroid function tests E. CT
B. EEG
C. Creatinine clearance

21
D. ECG
113. A lady 76 years old had loss of consciousness but was fine after 10 minutes. She was taking Aspirin,
Bendroflumethiazide and Simvastatin. All examinations were normal. CT scan was done. What is the
most appropriate management?
A. Add aspirin 300
B. Clopidogrel
C. Dipyramidamole
D. Clopidogrel +Dipyramidamole

114. A 60 year old man was diagnosed with atrial fibrillation and is prescribed Warfarin.Target INR
should be?
A. 2-3
B. 1.5 -2.5
C. 2.5- 3.5
D. 1-2

115. Woman presented with blood pressure 220/110mmHg. Not on any medication. Potassium 2.2mmol/l.
What is the most likely diagnosis?
A. Hypopitutarism
B. Cushings Syndrome
C. Primary Hyperaldosteronism
D. Secondary Hyperalsosteronism

116. A 37year old woman presents with heavy bleeding. Investigations show sub-serosal fibroid
measuring 4cm and intramural fibroid of 6cm.What is the most appropriate treatment for her?
A. Uterine artery embolization
B. Abdominal Hysterectomy
C. Hysteroscopic myomectomy
D. Vaginal Hysterectomy
E. Abdominal myomectomy

117. A 65 year old man presents with a history of progressive difficulty in swallowing solid food for 6
months, he has also noticed unintentional weight loss and anorexia. What is the most likely diagnosis?
A. Achalasia cardia
B. Hiatus hernia
C. Gastroesophageal reflux disease
D. Carcinoma of the oesophagus
E. Oesophageal spasm

118. A 75 year old alcoholic presents with a mass up to the umbilicus, urinary dribbling, incontinence, and
clothes smelling of ammonia. What is the next step in management?
A. Urethral catheter E. Nephrostomy
B. Suprapubic catheter
C. Antibiotics

22
D. Condom catheter
119. A girl with history of allergies visited a friend’s farm. She got stridor, wheeze and erythematous rash.
What is the most appropriate treatment?
A. 0.25ml IM adrenaline
B. 0.25ml PO adrenaline
C. 0.25ml IV adrenaline
D. IV chlorpheniramine

120. A 1 week old baby presents with projectile vomiting. On examination there is an olive shaped mass
in his abdomen. What investigation would you do for him initially?
A. Ultrasound abdomen
B. Check serum potassium
C. Laparoscopy
D. CT abdomen

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

122. A Taxi driver complaints of recurrent flashbacks of an accident he had few months back. He also
finds it difficult to sleep and avoids the place where it had happened. His mood has become increasingly
low over the last few months since this accident. What is he suffering from?
A. OCD
B. PTSD
C. Depression
D. Panic disorder

123. A patient complains that he can hear voices upon waking up in the morning. Chose the most
appropriate diagnosis.
A. First person hallucination
B. Delirium
C. Hypnopompic hallucination
D. Hypnogogic hallucination
E. Depression

124. A 65 year old woman presented with transient arm and leg weakness as well as a sudden loss of
vision in her left eye. Her symptoms resolved within the next couple of hours. What is the most
appropriate next investigation?
A. CT Brain
B. Echo
C. Doppler USG
D. Arteriography
E. 24 hour ECG

23
125. A woman in her 36 weeks of gestation comes with pain and vaginal bleeding. On examination he
abdomen is tender and uterus is rigid and hard. What is the diagnosis?
A. Placenta previa
B. Abruptio placenta
C. Miscarriage
D. Clotting problem
E. Labour

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

127. A 39 year old woman will undergo tubal sterilization and she wants to know the failure rate of this
type of sterilization.
A. 1:50
B. 1:200
C. 1:500
D. 1:1000
E. 1:5000

128. A 45 year old woman with a history of rheumatoid arthritis presents to the A&E department with a 2
day history of hot, painful and swollen right elbow joint. What is the most appropriate management? A.
Joint aspiration
B. Start infliximab
C. Oral high dose
D. Short course of methotrexate
E. Dexamethasone injection

129. A 70 year old man admits to asbestos exposure 20 years ago and has attempted to quit smoking. He
has noted weight loss and hoarseness of voice. Choose the single most likely type of cancer associated
with the risk factors presented.
A. Basal cell Carcinoma
B. Bronchial Carcinoma
C. Oesophageal Carcinoma
D. Nasopharyngeal Carcinoma
E. Oral carcinoma

130. A 32 years old lady delivered 3 days back. Today she developed sudden left leg pain and swelling up
to inguinal crease. She is advised to take antibiotic but she has a history of taking COCP before she
become pregnant. What is most definitive diagnosis for this lady?

24
A. Post-partum phlebitis Syndrome
B. Aorto iliac thrombosis
C. Rheumatoid arthritis
D. Septic arthritis

131. A 79 year old anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency
and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 1.9 and he is
anaemic. His blood pressure is 165/95mmHg. What is the most probable diagnosis?
A. Benign prostatic hypertrophy
B. Prostate carcinoma
C. Chronic pyelonephritis
D. Benign nephro sclerosis

132. The patient developed falls, pill rolling tremor and masked like face after start of a new treatment.
What could be the treated disease?
A. Depression
B. Schizophrenia
C. Obesity
D. Gord
E. Prostate gland enlargement

133. A 3 year old child with severe diarrhoea and vomiting, looks lethargic, has sunken eyes and a feeble
cry. What is the choice of fluids for this condition?
A. 0.45% - 5 % Saline
B. 0.9% Saline plus 5% Dextrose
C. 0.45% Saline plus 5% Dextrose
D. 0.45% Saline

134. A patient with FBS-6mmol/L and RBS-9mmol/L 2 hours after a meal. What is the most likely
diagnosis?
A. Impaired glucose tolerance
B. DM 1
C. DM 2

135. A four week old girl has been diagnosed of having breast- milk jaundice. She is otherwise well. What
is the SINGLE most appropriate management?
A. Continue breastfeeding
B. Exchange transfusion
C. Increase fluid intake
D. Phototherapy
E. Stop breastfeeding

136. A 22 year old man has a reduced conscious level and a fixed dilated pupil after being involved in a
motor vehicle collision. What is the SINGLE most appropriate option?

25
A. Facial nerve
B. Oculomotor nerve
C. Olfactory nerve
D. Optic nerve
E. Trigeminal nerve

137. A 49 year old man complains of fullness in the left ear, recurrent vomiting and tinnitus. What is the
most appropriate medication for this condition?
A. BuccalProchlorperazine
B. Oral Chlorpheniramine
C. Oral Fluphenazine
D. Buccal Midazolam
E. IV Ranitidine

138. A 29 year old male is brought to A&E in unconscious state. There is no significant past history.
Which of the following should be done as the initial investigation?
A. CT Scan
B. Blood Glucose
C. Arterial blood gas
D. Magnetic resonance imaging (MRI)
E. Full blood count

139. A 65 year old man presented with shortness of breath. He was a shipyard worker. He was admitted
treated with antibiotics and inhalers. What would be the reason to inform the coroner?
A. Industrial disease
B. Inappropriate treatment
C. Because he died during admission
D. To satisfy the relatives
E. It should be done as a routine.

140. A 30 year old man has diarrhoea for the 4 days. What metabolic changes will you see in the blood?
A. pH increased, bicarbonate decreased
B. Increased bicarbonate, increased pH
C. Decreased pH, decreased bicarbonate
D. Normal pH, normal bicarbonate

141. A woman presented with repeated candidiasis. She also has polyuria and polydipsia. What is the
most appropriate investigation that would confirm diabetes in this patient?
A. Urine dip stick + fasting blood sugar 6 E. FBS .7 and RBS >11
B. Random blood sugar 8+ fasting blood sugar 6.5
C. Random blood sugar >11+ fasting blood sugar>6
D. Random blood sugar>10

142. 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?

26
A. Cefotaxime
B. Penicillin
C. Gentamicin
D. Tazobactam
E. Meropenem
F. Rifampicin

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

144. A 35 year old diabetic pattient was on long acting anti diabetic in the morning and short acting in the
evening. after lunch patient gets hypoglycaemia . How will manage this patient?
A. Provide more food at lunch
B. Decrease long acting in the morning
C. Decrease short acting in the afternoon
D. Decrease both dose
E. Reassurance

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

146. A 31 year male HIV patient presents with Oral candidiasis and white patches in pharynx and
complains of mild pain in the mouth and on swallowing. What is the most appropriate management?
A. Oral fluconazole
B. IV amphotericin
C. Amoxycillin
D. Nystatin suspension
E. Oral morphine

147. A young girl presented in Gynae assessment Unit with lower abdominal pain and per vaginal
bleeding after a history of hystero-salpingo-graph as a part of her infertility treatment. On observation her
BP was 90/50mmHg and pulse was 120bpm and examination revealed rigid abdomen. What is the most
appropriate next investigation?

A. CT abdomen
B. X-ray abdomen in erect and supine

27
C. Ultrasound abdomen
D. Coagulation profile
E. X-ray chest

148. A 32-year-old woman presents to the Emergency Department with headache and vomiting. She was
decorating her ceiling that morning when the headache began, felt mainly at the occiput with neck pain.
Some two hours later she felt nauseated, vomited and was unable to walk; she also noticed that her voice
had altered. She takes no regular medication and has no significant past history. On examination, her
acuity, fields and fundi are normal. She has upbeat nystagmus in all directions of gaze, with normal facial
muscles and tongue movements. Her uvula is deviated to the right and her speech is slurred. Limb
examination reveals left arm past- pointing and dysdiadochokinesis with reduced pinprick sensation in her
right arm and leg. Although power is normal, she cannot walk, as she feels too unsteady. Where is the
most likely site of her lesion?
A. Right medial medulla
B. Left medial pons
C. Left cerebellar hemisphere
D. Right lateral medulla
E. Left lateral medulla

149. A 70 year old man has sudden severe painful medial side of left calf on walking uphill. He has no
ankle swelling and he can extend his foot easily. What is the single most likely diagnosis?
A. Popliteal cyst
B. DVT
C. Tendon Achilles rupture
D. Fracture
E. Acute limb ischemia

150. A 7 year old child is suspected to have a foramen oval. What is the most appropriate investigation?
A. Bubble Echocardiography
B. Transoesphageal Echocardiography
C. Transthoracic Echocardiography
D. ECG
E. CT chest

151. A 12 year old patient presents with copious diarrhoea. On examination his urine output is low,
mucous membranes are dry and skin turgor is low. What is the single most initial management?
A. Antibiotic
B. Antimotility
C. Anti-emetic
D. Fluid replacement
E. Reassure

152. A 24 year old woman presents with deep dyspareunia and severe pain in every cycle. What is the
initial investigation?

28
A. Laparoscopy
B. Pelvic ultrasound
C. Hystroscopy
D. Vaginal swab

153. A 49 year old man lost his job and now he is homeless. He was found wandering in the park. He is
muttering that some people are after him. Alcohol was tested and it was negative. What will your next
step be?
A. Thiamine
B. Neuropsychiatric analysis
C. Mini mental state
D. CT head
E. MRI head

154. A patient has the following blood test results. Ca (total) : 4 mmol/L
Na : 140 mmol/L
K : 4 mmol/L
Creatinine : 100 µmol/L Uric acid : 8 mg/dL
ALT : 30 Iu/L
AST : 40 Iu/L
ALP : 100 Iu/L
What is the most appropriate initial treatment?
A. IV bisphosphonates
B. IV 0.9% normal saline
C. IV Cinacalcet
D. IV Furosemide

155. A 28 year old man with complains of headaches and nose bleeds, also has pain in the lower limbs on
exertion. Examination shows radio femoral delay. He also has cold legs with weak pulses and mid systolic
murmur with normally audible S1 and S2. What is the most probable diagnosis?
A. Tetralogy of Fallot D. Patent ductusarteriosus (PDA)
B. Atrial septal defect (ASD) E. Coarctation of Aorta

156. A 52 year old woman speaks rapidly without any pause and ignores interruptions. She doesn’t even
pause to take enough breaths. What term best describes this kind of speech?
A. Flight of Ideas
B. Broca’s Aphasia
C. Wernicke’s Aphasia
D. Pressure of Speech
E. Verbal dysphasia

157. A woman has low mood, anhedonia, and refuses to eat or drink because she says she does not want
to live any more. What is the most appropriate treatment?
A. ECT
B. Dosulpine

29
C. Fluoxetine
D. Moclobemide
E. Diazepam

158. 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

159. A term baby born to a 30 year old woman of blood group A –ve develops severe jaundice within the
first 24 hours of birth. What is the most likely diagnosis?
A. Hereditary Spherocytosis
B. Glucose-6-phosphate dehydrogenase deficiency (G6PD)
C. ABO Incompatibility
D. Rh Incompatibility
E. Physiological Jaundice

160. A 54 year old woman presents complaining of nausea, vomiting, diarrhoea, abdominal pain, feeling
faint and dizzy and hyperpigmentation. She takes steroid for rheumatoid arthritis for past 10 years. What
is the most likely diagnosis?
A. Primary adrenal insufficiency
B. Ectopic ACTH producing tumour
C. Secondary adrenal insufficiency
D. Congenital adrenal hyperplasia

161. A 25 year old lady presents to outpatient department requesting contraception. She has irregular and
painful periods. She smokes 20 cigarettes a day. Otherwise she fit and well. Which is the single most
appropriate type of contraception?
A. Combined oral contraception
B. Progesterone only contraception
C. Trenexemic acid
D. Levenoestrel
E. Levanogestrel IUCD

162. A 28 year old female presents with a 3 months history of diarrhoea. She complains of abdominal
discomfort and passing stool 20 times a day. On examination she is febrile. Barium enema shows cobble
stone mucosa. What is the most likely diagnosis?
A. Amoeba E. Ulcerative Colitis
B. Colon Ca
C. Gastroenteritis
D. Crohn’s Disease
163. A 70 years old male presents with balance difficulties, vomiting and nausea. Which of the following
is the best investigation?
A. MRI of Cerebellum
B. CT Scan of cerebellum

30
C. Skull X-RAY
D. Lumbar puncture
E. Blood Culture

164. A 4 year old boy presents with a febrile convulsion lasting 8 minutes and has been given intravenous
lorazepam to control the convulsion.
What is the single most likely serious side effect?
A. Amnesia
B. Anaphylactic shock
C. Bronchospasm
D. Cardiac arrhythmia
E. Apnoea

165. A patient presents 4 days after having myocardial infarction, complains of pain on inspiration and
unable to breathe with ease. What is the most likely diagnosis?
A. Pericarditis
B. Angina
C. Pancreatitis
D. Cholecystitis
E. Dressler’s syndrome

166. A patient in the post op ward develops persistent vomiting with a distended abdomen and no bowel
sounds. What is the primary electrolyte imbalance in this patient?
A. Hyponatremia
B. Hyperkalaemia
C. Hypernatremia
D. Hypokalaemia

167. A 65 year old man presents with a 3rd degree haemorrhoid, what will be the single most appropriate
action?
A. Rubber band ligation
B. Sclerotherapy
C. Do nothing
D. Haemorroidectomy
E. Cryotherapy

168. An HIV drug abuser and alcoholic was found to have markedly raised creatinine levels, proteinuria
of 3.7g/day and hyperlipidemia. What is the most definitive investigation?

A. HIV serology
B. STI screening
C. Renal function tests
D. Renal biopsy

31
E. U/S

169. A 35 year old man was found to have hematuria, after 3 days of having sore throat, running nose,
burning and increased lacrimation of eyes and headache. Which of the following would explain best the
reason for hematuria?
A. Thrombotic ThrombocytopoenicPurpura
B. Haemolytic Uraemic Syndrome
C. Post streptococcal glomerulonephritis
D. Berger’s disease
E. Minimal Change disease

170. A 40 years old man fell onto grass from the second floor. In the A and E he complained of shortness
of breath and chest pain. What is the most probable diagnosis?

A. Cardiac Tamponade
B. Tension Pneumothorax
C. Simple Pneumothorax
D. Flail Chest
E. Atelectasis

171. A woman complains of bloody diarrhoea, vomiting and abdominal cramps 1 week after a holiday in
France. What is the single best investigation?
A. Stool test for reducing sugars
B. Endoscopy
C. Barium enema
D. Stool microscopy and culture
E. Sigmoidoscopy

172. A 32 years old man presented with slow progressive onset of dysphagia, there is a past history of
retro-sternal discomfort and he has been treated with prokinetics and H2 blockers. What is the most
probable diagnosis?
A. Foreign Body

32
B. Plummer Vinson Syndrome
C. Pharyngeal pouch
D. Peptic Stricture
E. Oesophageal Carcinoma

173. A 45 year old man who has undergone a recent subtotal gastrectomy for peptic ulcer disease has now
developed anaemia with haemoglobin 6.8, tiredness, fatigue and loss of vibration sensation in legs. What
is the underlying cause of his symptoms?
A. B12 deficiency
B. Iron deficiency
C. Folate deficiency
D. Vit C deficiency
E. Metastases

174. A 48 year old man has continuous anterior chest pain, which is worse on inspiration, and has a
temperature of 37.5° C four weeks after a myocardial infarction. His erythrocyte sedimentation rate
(ESR) is 45 mm/hour. What is the single most likely explanation for the abnormal investigation?
A. Acute Pericarditis
B. Cardiac Tamponade
C. Atrial Thrombus
D. Left Ventricular Aneurysm
E. Dressler’s Syndrome

175. An 80 year old diabetic lady presents with redness and swelling over her right foot. It is tender to
touch, warm and glossy. Choose the most appropriate complications this patient might develop?
A. Meningitis
B. Sepsis
C. Ulcer
D. Gangrene

176. A 2 year old child was found to have meningitis. The child recovered well. He was not resuscitated.
What would be the expected outcome of the child?
A. Goes back to normal status like before the illness.
B. Hearing loss
C. Visual loss
D. Mental state retardation
E. Hemiparesis

177. A 8 year old boy has a fever for 5 days and a generalised maculopapular rash with peeling of skin on
hands and feet. Oral lesions are also present. the child also has red eyes. What is the single most likely
diagnosis?

A. Kawasaki Disease
B. Hand foot-mouth disease
C. Roseolainfantum
D. Measles

33
E. Chicken pox

178. A 14 year old girl presents with primary amenorrhoea. She also complains of cyclic monthly
abdominal pain and sensation of lump in the pelvis. Her hormone profile is normal. What is the
diagnosis?
A. Turner’s syndrome
B. Di George syndrome
C. Haematocolpos
D. Nephroblastoma

179. A 21 years old college student came to ER with needle marks on his hand and hypotension,
tachycardic, pinpoint pupils. Which drug is involved?
A. LSD
B. Ectasy
C. Cocaine
D. Heroine

180. 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  femoral hernia
B. Does not pass through deep inguinal ring  direct
C. Lies below and lateral to pubic tubercle  femoral
D. Only passes through superficial ring  direct
E. Passes through deep inguinal ring

34