Dr.

Swamy PLAB Courses Ltd

PLAB 1 MOCK TEST:

MOCK 4

TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. A 75-year-old woman who had a carcinoma of the distal rectum underwent an anterior resection.
The blood supply of the tumour arises from which of the following?
A. Coeliac artery
B. Ileocolic artery
C. Inferior mesenteric artery
D. Internal iliac artery
E. Superior mesenteric artery
2. A 34 year old patient presented with redness and pain in the eye. He is also suffering with back
pain that is worse in the morning. He is taking NSAIDs for back pain. What is the cause of red eye?
A. Ibuprofen
B. Steroids
C. Anterior Uveitis
D. Posterior Uveitis
E. Trauma
3. A 33 year old female with bipolar affective disorder had an acute depressive episode which was
controlled by antidepressants. Which drug will be best for prophylaxis in this patient?
A. Mood stabiliser
B. Selective serotonin reuptake inhibitors (SSRI)
C. Tricyclic Antidepressant (TCA)
D. Antipsychotic
4. A 15 year old boy presents with severe earache after having a swimming session. He does not allow
you to do an otoscopy and the ear is severely tender to touch. What is the most appropriate antibiotic
therapy for his condition?
A. Amoxicillin
B. Ciprofloxacin
C. Flucloxacillin
D. Meropenem
5. A young woman on combined oral contraceptive pills has been prescribed Amoxicillin for sinusitis.
What should be the advice given to her?
A. Increase dose of OCPS
B. Reduce dose of Amoxicillin
C. Use barrier methods for 2 weeks
D. No extra precautions needed
E. Barrier methods only if patient develops diarrhea
6. A middle aged man complains of a node which has been growing in his nose for several months.
Now it is firm with central depression. Its 0.6cm in size. What is the SINGLE most likely diagnosis?
A. Basal cell carcinoma
F. Kerato acanthoma
B. Squamous cell carcinoma
G.Molluscum Contagiosum
C. Lymph node

D. Melanoma
E. Kaposis Sarcoma
7. A 7 year old boy presents with her mother to the GP surgery. His mother describes he had
presented this since 3 weeks ago. He had not experienced any trauma. No other symptoms associated
with the condition. On examination the boy has non tender swollen ankles bilaterally. There is no rash
or lesion. He is otherwise well. Which single test would be the best as an initial assessment?
A.
B.
C.
D.

Plasma electrolytes.
Album
Total serum protein
Anti-streptolysin

8. A lady comes in 6 weeks after her normal vaginal delivery for contraceptive advice. She is breast
feeding her child and requests for reversible contraception. She is planning another pregnancy in 6
months time and is scared of injections. What is the best option for her?
A. COCP
B. Cu IUCD (intrauterine contraceptive device)
C. Mirena coil
D. POP
E. Transdermal patch
9. A 68 year old man with diabetes and hypertension was noted to have a cholesterol level on
3.4mmol/l. He was also noted to have micro-albuminuria. What is the best drug to add to his regimen?
A. Ace inhibitors
B. Statins
C. Amylodipine
D. Biguanides
10. A 65 year old man on dexamethasone underwent a surgery. During and after the surgery, his
blood glucose level was around 17 19 mmol/l. What will you give the patient?
A. Insulin
B. Oral hypoglycaemics
C. Remove dexamethasone
D. IV saline
E. IV dextrose
11. Which statement best describes the planes of the abdomen?
A.
B.
C.
D.
E.

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

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

E. Cyclothymia
13. A 5 year old child was admitted with history of feeling tired and lethargic all the time, bleeding
gums and sore throat since the last 3 months. On examination he is found to have hepatosplenomegaly. What is the most probable diagnosis?
A. Acute lymphoblastic leukemia (ALL)
B. Acute myeloid leukemia (AML)
C. Chronic myelogenous (or myeloid) leukemia (CML)
D. Chronic lymphocytic leukaemia (CLL)
E. Lymphoma
14. An 18 month old boy has been brought to the Emergency department because he has been
refusing to move his left arm and crying more than usual for the past 24 hours. He has recently been
looked after by his mothers new boyfriend while she attended college. Assessment shows multiple
bruises and a fracture of left humerus which is put in plaster. What is the SINGLE most appropriate
next step?
A. Admit under care of paediatrician
B. Discharge with painkiller
C. Follow up in fracture clinic
D. Follow up in paediatric outpatients
E. Follow up with general practitioner (GP)
15. An 8 year old child presents with recurrent abdominal pains, occasional headaches but she
maintains a good appetite. Examination is normal. FBC, U&E and other investigations are normal.
What would you do for her next?
A. Ultrasound abdomen
B. CT head
C. Reassure
D. Analgesics
16. A young child just diagnosed with chicken pox. Usually goes to day care. What is the most
appropriate advice?
A. Child should be admitted to hospital straight away
B. Isolate the child from parents and siblings at home
C. Advise him he can go back to nursery when the rash is crusted over
17. A lady presents with abdominal pain, dysuria, dyspareunia and vaginal discharge. What is your
next step?
A. Laparoscopy
E. Ultra sound
B. High vaginal swab
C. Hysteroscopy
D. Laparotomy
18. A primiparous woman with no previous infection with Herpes zoster is 18 weeks pregnant. She
had a recent contact-history with a young patient, aged 21, having widespread chicken pox. What is
the most suitable management for the pregnant lady?
A. Acyclovir orally
B. IV Acyclovir +IV Immunoglobulin
C. IV Acyclovir

D. Reassure
E. IV Immunoglobulin
19. A three- month old baby was miserable and cried for two hours following his first routine
immunization with diphtheria, tetanus, polio, Haemophilus influenza- B (HiB) and meningitis. What
is the single most appropriate action?
A. Defer immunization for two weeks
B. Do not give vaccine
C. Give half dose of vaccine
D. Give Paracetamol with future doses of the same vaccine
E. Proceed with standard immunization schedule
20. A 55 year old lady with swelling on the abdomen below the umbilicus on the right side. What is
the SINGLE most appropriate lymph node?
A. External iliac lymph nodes
F. Submental lymph nodes
B. Pre aortic lymph nodes

G. Submandibular lymph nodes

C. Aortic lymph nodes

H. Deep cervical lymph nodes

D. Inguinal lymph nodes

E. Iliac nodes
21. A 45 year old man presents to A&E with pain the chest and shortness of breath. He has no
recollection of what has happened to him. His breath smells of alcohol. What is the most probable
diagnosis looking at the given picture?
A. Shingles
B. Cellulitis
C. Blunt trauma
D. ITP
E. Hypersensitivity reaction
22. A 45 year old man diagnosed with Multiple Sclerosis is admitted after taking 100 Paracetamol
tablets. He seems well, is not vomiting and is alert. He is refusing all treatment. What should you do
next?
A.
B.
C.
D.
E.

Gastric lavage
Activated charcoal
N-Acetyl cysteine
Methionine
Evaluate his capacity to refuse treatment

23. A child had three attacks of tonsillitis last year. What will be the most appropriate management for
this child?
A.
B.
C.
D.
E.

Treat when ill

Surgery
Prophylactic Antibiotics
Refer to ENT
Do Nothing

24. A patient 10 days post-op for rectal carcinoma presents with high grade fever and mass in pelvis.
What is the most probable diagnosis?
A. Pelvic Abscess
B. Recurrence of rectal carcinoma
C. Metastasis
D. Pneumonia secondary to aspiration
E. Septicemia
25. A 28 year old woman presents with pain and an ulcer on labia major. What is the lymphatic
drainage of labia major?
A. Superficial inguinal
B. Deep inguinal
C. Para aortic
D. Iliac
26. A 19 year old girl is brought into A & E after an argument with her boyfriend. She has multiple
superficial lacerations on her forearms and wrists which have been attended to by the medical team.
She has attended A&E many times in the past with similar episodes of self-harm and drug overdoses.
What is the most likely diagnosis?
A. Obsessive compulsive personality
B. Schizoid personality
C. Borderline personality
D. Dependent personality
27. A man with dementia has an ulcerative lesion on forehead. He wants it removed so it can help
improve his memory. Wife says he is not fit to give consent. What will you do?
A. Get letter signed from the GP
B. Get letter signed from wife
C. Get letter signed from patient
D. Refer to psychiatrist to assess the mental capacity to give consent
28. A young woman is brought to the hospital after consuming 17 tablets of paracetamol to the A&E.
On evaluation it is noted that she is clinically depressed and has not eaten anything for four days. She
has been brought to the hospital after 9 hours on consuming the tablets. What is the most important
next step?
A. N acetyl cysteine
B. Paracetamol levels
C. Gastric Lavage
D. Activated Charcoal
E. Psychiatric Evaluation
29. A 6 year old child presented with drooling of saliva, and a severe stridor. He is febrile and sick
looking. X ray of the neck in extension shows a thumb sign. Choose the single most likely diagnosis
from the list of options given below.
A. Croup

B. Upper respiratory tract infection (URTI)

C. Diphtheria
D. Acute epiglottitis
30. A child of 24 months can walk, run, can make a pyramid, speaks only two meaningful
words such as mama and dada. How will you manage this child?
A. Reassure
B. Speech consultation
C. Physiotherapy
D. CT scan
E. Admit further assessment
31. A 65 year old man presented with hearing impairment and weight loss. He complains of hearing
buzzing sound and feeling dizziness that is becoming worse slowly. On examination facial numbness
has been noticed. What is the best investigation option for this problem?
A. MRI acoustic meatus
B. CT Head
C. Blood culture
D. Audiometry
E. Tilt Test
32. A 15 years old boy fell of his bicycle and hurt his abdomen. He presents with pain in abdomen, a
CT scan shows a small sub capsular spleen haematoma, his BP is 110/70mmHg and pulse is 80bpm.
What is the next step in his management?
A. Refer to surgeons for observation
B. Immediate Laparotomy
C. Immediate Laparoscopy
D. Discharge with advice
E. Blood transfusion
33. A 4 year boy has cough and arthritis followed by rash on legs and trunk which are non- blanching
on glass test. No history of fever.
PT: 13
APTT : 31
Hb : 12
WBC: 6.5
Platelet: 300x10
Choose the most likely diagnosis?
A. Meningitis septicaemia
B. Haemophillia
C. Henoch-SchoenleinPupura
D. Idiopathic thrombocytopenic purpura
E. Thrombotic thrombocytopenic purpura
34. A 30 year old woman on oral contraceptives presents with dilated tortuous veins crossing her
abdomen to join the tributaries of superior vena-cava. What is the single most likely cause?
A. Intra-abdominal malignancy
B. Ovarian cyst
C. Fibroids
D. Ascites

E. Deep vein thrombosis (DVT)

35. A 45 year old heroin addict was involved in a car crash and is now paraplegic. During the first
week of his hospital stay he cried everyday because he couldnt remember the accident.
What is the most likely diagnosis?
A. PTSD
B. Severe depression
C. Organic brain injury
36. A 15 year old boy presents with testicular pain for 2 days. There is no history of trauma. On
examination he has a temperature of 38.5C and there is tenderness of the right hemi-scrotum. What is
the single most appropriate management?
A. Give antibiotics
B. Give analgesia
C. Reassure
D. USG of scrotum
E. Exploratory surgery
37. A 25 years old man presents with fever and pain in the right lower thigh of one month duration.
On examination the lower third of his thigh is red, hot and tender. The X-ray showed new bone
formation. What is the most probable diagnosis?
A. Osteosarcoma
B. Ewings Sarcoma
C. Tuberculus Arthritis
D. Exostosis
E. Fibrosarcoma
38. A 72 year old man had myocardial infarction a few weeks ago. Now he is on medication. He
comes to outpatient department and he complains of yellow colour in his vision. What can be the
cause of this?
A. Digoxin
B. Amitriptyline
C. Atenolol
D. Ramipril
E. Bendroflumethiazide
39. In a laproscopic mesh repair for hernia, when the trochar is inserted at midpoint between
umbilicus and ischial spine, what structure will be pierced?
A. Linea alba
B. Rectus muscle
C. Conjoint tendon
D. External and internal oblique muscles
E. Inguinal ligament
40. A 25 year old male had an injury to the knee while playing football. X ray reveals the condylar
fracture of tibia. What is the SINGLE most probable deformity?
A. Dinner fork deformity
B. Gibbus
C. Cubitus valgus
D. Garden spade deformity

E. Genu valgus
41. A 37 year old patient presented with hearing loss and offensive discharge from the ear. Otoscopy
is performed and crusted tympanic membrane was noticed. A pearly white mass was seen on the attic
when crust was removed. Choose the correct diagnosis from following options
A. Frunculosis
B. Basal cell carcinoma
C. Cholesteatoma
D. Acoustic Neuroma
E. Squamous cell carcinoma
42. A 62 years old lady presents with a pathological fracture of thoracic vertebra, this is found to
be associated with an underlying metastatic lesion, what is the most probable primary cancer
site?
A. Ovary
B. Lung
C. Breast
D. Cervix
E. Colon
43. A man with a family history of panic disorder is brought to the hospital with palpitations, tremors
and sweating and muscle tightness on three occasions in the last six weeks. He does not complain of
headache and his blood pressure on each presentation is within normal limits. What is the single most
appropriate long term treatment for this patient?
A. Diazepam
B. Olanzapine
C. Haloperidol
D. Fluoxetine
E. Alprazolam
44. A 37year old female working as a health care assistant in a nursing home, comes to the A&E with
complaints of severe itching all over her body. On asking she replies that she had applied cream on
the body of a resident in the nursing home who had similar itches. What is the mechanism of her itch?

A.
B.
C.
D.
E.

Allergic reaction
Inflammation of keratinocytes
Allergic reaction developed due to use of topical steroid creams
Subcutaneous bleeding
None of the above

45. A 55 year old male patient had TIA which he recovered from. He has a history of stroke and upon
examination his heart rate was in sinus rhythm. He is already on aspirin 75mg and anti-hypertensive
drugs. What other action should be taken?
A. Add Clopidogrel only
B. Increase the doses of aspirin to 300mg
C. Add Warfarin
D. Add Clopidogrel and Statins
E. Add Statins only

46. A man presents with medial deviation of his right eye. Which nerve is affected?
A. Left trochlear
B. Left oculomotor
C. Right trochlear
D. Right abducens
E. Right oculomotor
47. A middle age male after myocardial infarction is feeling unwell. The ECG has been performed
and shows a prolonged QRS complex and T wave is tented Sodium-136 mol/L
Potassium- 6.2mmol/L,
Urea- 5.0 mmol/L
What is the most appropriate management?
A. Calcium gluconate
E. Calcium
B. Calcium resonium
C. Calcium with Vitamin D supplements
D. Vitamin D
48. A 57 year old man who had myocardial infarction a few months ago has been having low mood. A
diagnosis of moderate depression has been established. Which medication is the best treatment for
him?
A. Selective serotonin re-uptake inhibitors (SSRI)
B. TACs
C. Monoamine oxidase inhibitor (MAOI)
D. Benzodiazepams
E. Mood stabilisers
49. A 64 year old man presents with ipsilateral vertigo, tinnitus and left side hearing loss. On
examination Rinne's test is positive and Webers test is lateralised to the right ear. What is the most
appropriate investigation?
A. CT scan
B. Magnetic resonance imaging (MRI) of brain
C. X-ray
D. Audiometry
E. No investigation required
F. Caloric Testing
50. A 74 years old lady who has had a stroke in the past, had an indwelling catheter for 10 months.
She presents with bluish-purple discoloration of the catheter bag. What is the most likely explanation
for this change?
A. Normal Change
B. Catheter Degradation
C. Acidic Urine
D. Alkaline Urine
E. Bacterial Colonisation of the Urinary Tract
51. A patient on antihypertensive drugs presents to Accident and Emergency department complaining
of sudden loss of vision. On examination of the fundus, tortuous blood vessels and stormy sunset
appearance was seen. What is most likely diagnosis?
A. Papiloedema
B. CRAO
C. Anterior ischaemic optic neruropathy
D. CRVO

E. Retinal detachment
52. A four years old boy with a febrile convulsion lasting eight minutes has been given intravenous (IV)
Lorazepam to control the convulsion. What is the SINGLE most likely serious side-effect?
A. Amnesia
B. Anaphylactic shock
C. Diabetes
D. Bronchospasm
E. Cardiac arrhythmia
53. A 33 year old female complains of diplopia on upright gaze. On examination ptosis can be seen.
There are no other complains or any significant past medical history. What is the most appropriate
investigation for this patient?
A. Ophthalmoscopy
B. Visual field test
C.Thyroid function test
D. CT scan
E. Checking red reflex
54. A 57 year old man, who is a known hypertensive, is on oral anti-hypertensives. However, he is
finding it difficult to mobilise as he feels dizzy whenever he tries to get up. What is the most
appropriate investigation for him?
A. Ambulatory blood pressure
B. Electrocardiogram (ECG)
C. Magnetic resonance imaging (MRI)
D. Chest X ray
E. CT scan
55. A 6 year old boy fell in the playground. He has not been using his forearm. He complains of pain.
On examination there is no sign of deformity or swelling. However, there is minimal tenderness on
examination. What is the most appropriate diagnosis?
A. Fracture of mid radius
B. Fracture of mid ulnar
C. Fracture of neck of humerus
D. Fracture of shaft of humerus
E. Green stick fracture of distal radius.
56. A 72 years old woman has been taking loop diuretics for left ventricular failure. She now presents
with palpitations and muscle weakness. What is the SINGLE most likely serum electrolyte pattern to
be found?
A. Sodium 130 mmol/L, potassium 2.5 mmol/L
B. Sodium 130 mmol/L, potassium 5.0 mmol/L
C. Sodium 140 mmol/L, potassium 4.5 mmol/L
D. Sodium 150 mmol/L, potassium 2.5 mmol/L
E. Sodium 150 mmol/L, potassium 3.5 mmol/L
57. What is the best treatment for candidiasis in the throat?
A. Chlorhexidine mouthwash
B. Nystatin suspension
C. Oral Fluconazole
D. IV Metronidazole

58. A 45 year old man had recently started taking antihypertensive therapy. Six months later his
Random Blood Sugar was found to be 14.0 mmol/l. Which single drug is most likely to have caused
this?
A. Amlodipine
B. Bendroflumethiazide
C. Doxazosin
D. Losartan
E. Ramipril
59. A 24 year old woman has severe depression three months after the birth of her first child. She is
breastfeeding but is otherwise unable to look after the baby and is convinced that her family is likely
to kill her. She has no interest in anything and keeps crying. What is the most appropriate treatment?
A. Fluoxetine
B. Citalopram
C. Cognitive behavioural therapy
D. ECT
E. Haloperidol
60. A 31 years old woman presents 7-10 days following childbirth, with loss of feeling for the child,
loss of appetite, sleep disturbance and intrusive and unpleasant thoughts of harming the baby. What is
the best treatment for this patient?
A.
Fluoxetine
B.
Haloperidol
C.
Cognitive Behavioural Therapy
D.
Reassurance
E.
Electro Convulsive Therapy
61. A girl presents with signs of hyperventilation. What is the most likely arterial blood gas (ABG)
derangement?
A. pH increased pCo2 increased
B. pH decreased pCo2 increased
C. pH increased pCo2 decreased
D. pH decreased pCo2 decreased
62. A 6 year old child fell on his nose 2 days ago. His parents have now brought him with difficulty in
breathing. On examination he has a fever and his nasal bones are straight. What is the single most
likely diagnosis?
A. Nasal polyp
B. Septal hematoma
C. Septal abscess
D. Deviated nasal septum
E. Fractured nose
63. A 56 year old man with atrial fibrillation is prescribed digoxin. What side effect will you make the
patient aware of?
A. Seeing visual haloes
B. Nausea
C. Vomiting
D. Diarrhoea

64. A pregnant woman with long-term history of osteoarthritis came to the antenatal clinic with the
complaints of restricted joint movement and severe pain in her affected joints. What is the choice of
drug?
A. Paracetamol
B. Steroid
C. NSAID
D. Paracetamol + Dihydrocodiene
E. Pethidine
65. A 54 year old lady presents with sudden, severe pain in the left half of her skull. She also
complains of pain around her jaw. What is the most likely next step?
A. CT scan
B. MRI
C. Fundoscopy
D. ESR
E. Temporal artery biopsy
66. A patient admitted due to repeated attacks of pancreatitis presents with dementia and loss of
proprioception in the legs. What is the most appropriate treatment?
A. Thiamine
B. Pyridoxine
C. Cobolamin
D. Lypase
E. Antibiotics
67. A 2 year old boy with 38.4C fever had an episode of tonic clonic seizure at home that lasted for
15 minutes. In A&E patient is conscious and fit has stopped. When temperature was checked, it was
normal. What is most probable diagnosis?
A. Febrile convulsion
B. Infantile spasm
C. Absence seizure
D. Grandmal Epilepsy
E. Focal seizure
68. A 10 years old girl presents with pallor and features of renal failure. She has haematuria as well as
proteinuria. The serum urea and creatinine are elevated. These symptoms started after an episode of
bloody diarrhoea 4 days ago. What is the most probable diagnosis?
A.
B.
C.
D.
E.

Thrombotic thrombocytopenia purpura (TTP)

Haemolytic-uremic syndrome (HUS)
Idiopathic thrombocytopenic purpura (ITP)
Henoch-Schonleinpurpura (HSP)
Acute renal failure (ARF)

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

A. Fibroadenosis
B. Carcinoma of the Breast
C. Mammary abscess
D. Fibroadenoma
E. Fat Necrosis
70. A West indian woman with anaemia and mild jaundice comes with limb pains and abdominal
pain. And the symptoms are precipitated by ongoing infections. On examination spleen is no more
palpable. What is your most probable diagnosis?
A. G6PD deficiency
B. Sickle cell disease
C. Beta thalassemia major
D. Sideroblastic anaemia
E. Malaria
71. A 19 year old man presents for the first time with a firm and unshakable belief that he is being
followed by terrorists who are plotting against him. What is the single best term for this mans
condition?
A. Delusion of Persecution
E. Delusion of Nihilism
B. Delusion of Grandeur
C. Delusion of Control
D. Delusion of Reference
72. A 29 year old young man complains of recurrent attacks of diarrhoea. He says his stools contain
blood and mucus. Sometimes she has low grade fever. What is the most appropriate investigation?
A. Stool culture
B. Plain abdominal x-ray
C. Per rectal examination
D. Barium Enema
73. A boy with partial thickness, burn increased. What is the next step?
A. Escharectomy
B. Dressing
C. Burst blisters
D. Local antibiotics
E. Refer to burn unit
74. A 64 years old diabetic has come for a routine eye check-up. Fundoscopy shows new vessels all
over the retina. What is the most appropriate management?
A. Strict Sugar Control
B. Regular eye check ups
C. Non urgent referral to a specialist
D. Laser photocoagulation
E. Insulin

75. A 45 year old man underwent emergency splenectomy following a fall from his bicycle. He
smokes five cigarettes a day. Post -operatively despite mobile, he developed swinging pyrexia and a
swollen painful left calf. His chest x-ray shows lungs atelectasis and abdominal USG demonstrates a
small sub-phrenic collection.What is the SINGLE most likely risk factor for deep vein thrombosis in
the patient?

A. Immobility
B. Intraperitonealhaemorrhage
C. Smoking
D. Splenectomy
E. Sub-phrenic collection
76. A young woman was brought to the hospital. On examination she has low temperature and tremor.
She says when her eyes are closed she can see colour. What drug has been used?
A. Methylenedioxymethamphetamine (MDA)
B. Lysergic acid diethylamide (LSD)
C. Cocaine
D. Heroine
E. Ecstasy
77. A mother brings her 1 week old baby to the clinic because she is concerned about a large mark on
his back. On examination there seems to be a large blue bruise like mark on the babys back. What is
the most likely diagnosis?
A. Non accidental injury
B. Mongolian spot
C. Accidental bruising
D. HSP
E. ITP
78. You are the SHO in the hospital and the lab report of a patient shows glucose: 4mmol/L, K:
5.2mmol/l, Na129 mmol/l. What is the most appropriate management for this patient?
A.
B.
C.
D.
E.

Normal Saline 0.9%

Normal saline 4.5%
Normal Saline 0.9% + insulin
Insulin
Dextrose

79. A 10 year old male child was brought by his mother complaining that her child watches TV at
very high volume, doesnt like to play out and instead has become more sincere with reading. She also
says that her son does not respond to her. What do you expect to see on otoscopy?
A. Flamingo pink Tympanic Membrane
B. Attic perforation
C. Bluish grey Tympanic membrane with air fluid levels
D. Inflamed tympanic membrane with cart wheel appearance of vessels
E. Red and inflamed tympanic membrane
80. A patient is on long standing indwelling catheter and now the catheter bag is turned purple.
Dipstick test shows nitrates ve, blood+. What investigation would you do next?

A.
B.
C.
D.

Urine culture and sensitivity

None
Urine porphobilinogen
USG abdomen

81. A 60 years old man brought to A&E department with fracture of hip; he is deaf and has bilateral
pedal oedema. What is the SINGLE most probable diagnosis?
A.
B.
C.
D.
E.

Pagets disease
Osteoporotic fracture vertebrae
Secondary
Multiple myeloma
Spondylosis

82. A 28 years old lady presents with dyspareunia and dysmenorrhoea. She is very obese. She now
wants reversible contraceptive method. Which of the following will be most suitable for her?
A. Mirena
B. Combined Oral Contraceptive Pill (COCP)
C. Progestogen only pill (POP)
D. Copper-T
E. Barrier method
83. Patient with widespread ovarian carcinoma had bowel obstruction and severe colic for 2 hrs and
was normal in between. What is the most appropriate management?
A. S/C morphine (PCA)
B. Spasmolytics
C. Palliative colostomy
D. Oral Morphine
E. Laxatives
84. An 80 year old man with prostatic cancer has confusion, thirst, abdominal pain and an abnormal
electrocardiogram (ECG). What is the most appropriate investigation?
A. CT scan
B. Radionuclide bone scan
C. Skeletal Survey
D. Serum alkaline phosphatase iso-enzyme concentration
E. Serum calcium concentration
85. A 35 year old man presents with a headache that worsens on bending his head forward. What is
the most likely diagnosis?
A. Chronic Sinusitis
B. Subarachnoid Haemorrhage
C. Migraine
D. Cluster Headache
E. Tension Headache

86. A 19 years old male presents with runny nose, cough and generalised rash. Blood MCS is positive
for coagulase positive cocci. What is the best management?

A. Amoxicillin
B. Rifampicin
C. Gentamycin
D. Flucloxacillin
E. Co-amoxiclav
87. An 82 year old man has woken up with incoherent speech and difficulty in finding the right
words. Examination is otherwise normal and his comprehension is good. Which anatomical site is
most likely to be affected?
A. Brocas Area
B. Wernickes Area
C. Midbrain
D. Parietal Cortex
E. Pons
88. A 9 year old child is diabetic and unhappy in school. What is your next step?
A. Refer to social worker
B. Clinical psychologist
C. Special school
D. Check child protection register
E. Give oral anti diabetics
89. A10 year old girl presents with hoarseness of the voice. She is a known case of bronchial asthma
and has been on oral steroids for a while. What is the most likely cause of hoarseness of voice in this
case?
A. Candidial laryngitis
B. Tonsillitis
C. Chronic laryngitis
D. Laryngeal carcinoma
90. A 60 year old man presents with dysphagia and pain on swallowing both solids and liquids. A
barium meal shows gross dilatation of the oesophagus with a smooth narrowing at the lower end of
the oesophagus. What is the SINGLE most likely cause of dysphagia from the given options?
A. Achalasia
B. Myasthenia gravis
C. Oesophageal carcinoma
D. Oesophageal web
E. Systemic sclerosis
91. A patient operated for gastric carcinoma is on oral morphine for pain relief. He has adequate pain
relief but is experiencing side effects due to high dose of morphine required. What is the most
appropriate next step in his pain management?
A.
Patient controlled analgesia
B.
Oral oxycodone
C.
IV morphine
D.
Fentanyl patches

92. A 50 year old man with a known history of stroke. He cannot remember anything about his life.
What is the single most likely defect?

A.
B.
C.
D.
E.

Homonymous hemianopia
Homonymous upper quadrantanopia
Bitemporal hemianopia
Binasal hemianopia
Homonymous lower quadrantanopia

93. A 27 year old woman had pre eclampsia and was delivered by c section. She is now complaining
of right upper quadrant pain different from wound pain. What investigation will you do immediately?
A.
B.
C.
D.
E.

Coagulation profile
Liver function tests
Ultrasound liver
MRCP
None

94. A 37 year old woman presents with more tiredness than usual, she is found to have angular
stomatitis, no koilonychia. Choose the single cell type you will find on blood film.
A.
B.
C.
D.

Macrocytes
Microcytes
Granulocyte without blast cells
Blast cells

95. A woman came with the complaint of pain in her right arm when she abducts it. She has recently
moved to a new house. There is no history of trauma. What is the likely cause of her pain?

A.
B.
C.
D.
E.

Rupture of the long head of the biceps

Sprain of the acromio-clavicular ligament
Tendinitis of the abductor sheet
Supraspinatus tendinitis
Shoulder dislocation

96. A man presents to A& E with pins and needles in his arms and legs, decreased sensation and
reduced reflexes in lower limbs. Blood tests reveal a macrocytic anaemia. He sees things other people
cant see and has a long history of alcoholism. When asked simple questions he makes up nonsensical
stories. What is the management?
A.
Diazepam
B.
Chlordiazepoxide
C.
Thiamine
D.
Folic acid
97. A 56 years old patient, whose pain was relieved by oral Morphine, now presents with
progressively worsening pain relieved by increasing the dose of oral Morphine. However the patient
complains that the increased Morphine makes him drowsy and he is unable to carry out his daily
activities. What is the next step to manage this patient?
A. Oral Oxycodone
B. Oral Tramadol
C. Patient Controlled Analgesia
D. I.V. Fentanyl
E. Diamorphine

98. A 20 years old young lady comes to her GP for advice regarding cervical cancer. She is worried as
her mother past away because of this disease. She would like to know what is the best method of
contraception in her case ?
A. Progestrogen only pill (POP)
B. Barrier method
C. Intrauterine Contraceptive Device (IUCD)
D. Combined Oral Contraceptive Pill (COCP)
E. Intruterine system
F. Osteoarthritis
99. A six year old girl has had two short episodes of cough and wheeze over the last 12 months. These
two acute episodes responded quickly to bronchodilator, she has no symptoms or abnormal physical
signs. She has slight eczema and her mother has asthma. What is the SINGLE most appropriate
investigation?
A. Chest x-ray
B. Peak flow rate diary
C. Pulse oximetry
D. Spirometry
E. Sweat test
100. A pregnant patient present with tingling, numbness, pain and loss of sensation on middle and
index finger of right hand. Tinel sign is negative. What is the most likely diagnosis?
A. Carpal tunnel syndrome
B. Hammer hypothenar syndrome
C. Ulnar nerve injury
D. Radial nerve injury
101. A 22 years old man keeps having persistent and intrusive thoughts that he is a dirty thief. No
matter what he tries these thoughts keep coming to him. Any attempt to avoid these thoughts leads to
serious anxiety. What is the most likely diagnosis?
A.
B.
C.
D.
E.

Schizophrenia
Obsessive Compulsive Disorder (OCD)
Post traumatic stress disorder (PTSD)
Mania
Psychotic Depression

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

Round ligament stretching

Chorioamnionitis
Uterine rupture
Labour
Disseminated intravascular coagulation

103. Patient had all signs of cerebello-pontine angle (CPA) tumour facial numbness, tinnitus and
vertigo. What is the best investigation?
A. CT scan
B. MRI Brain
C. MRI Head
D. X-ray head
104. A man has a habit of checking the locks of his house again and again. He tries to resist but he has
palpitations. What is the most appropriate treatment?
A.
B.
C.
D.

CBT + fluoxetine
CBT only
Fluoxetine only
ECT

105. A 70 year old lady presents with fever since 3 days and confusion. There is no significant past
history. What is most probable diagnosis?
A. Delirium
B. Hypoglycemia
C. Alzheimers disease
D. Diabetic Ketoacidosis (DKA)
106. A 6 year old girl has been brought to the hospital after being stung by a bee. She is complaining
of generalized itching, rashes, redness and has developed stridor. What is the most appropriate
treatment?
A. Oral Chlorpheniramine
B. IV Chlorpheniramine
C. IM Adrenaline
D. IV Adrenaline
E. Reassurance
107. A child who has type 1 diabetes is sad and unhappy at school. He has no friends and his
glycaemic control is poor. What would you do next?
A.
Refer to diabetologist
B.
Refer to psychiatrist
C.
Refer for developmental assessment
D.
Increase insulin dose
108. A 27 year old man believes that the whole world is plotting to kill him. What is the best
treatment for him?
A. Haloperidol
B. Chlorpromazine
C. Risperidone
D. Thioridazone
109. A 70 year old patient presents with cough and shortness of breath. He stopped smoking cigarettes
2 years ago but he has been smoking for about 50 years before quitting. CXR shows consolidation and
bilateral and bihilar lymphadenopathy. What is the best investigation for this patient?
A. Lymphnode biopsy
B. Pleural fluid cytology
C. CT scan
D. Magnetic resonance imaging (MRI)
E. Ultrasound

110. A 12 year old boy with pain and swelling in multiple joints (small and large), has mild fever .
Which of the following change in his blood investigations will definitely be there?
A. RA factor positive
B. Increase in ESR
C. ANA positive
D. Rise in serum uric acid level
111. A 23 year old lady was prescribed with Azithromycin 1gm for her chlamydial pelvic infection.
She has got a new boyfriend for the last 2 months. She has recently started contraception to avoid
conception. Which of the following contraception method will be affected by Azithromycin? 23RD

NOVEMBER 2014
A.
B.
C.
D.

Barrier
Intrauterine Contraceptive Device (IUCD)
Progestogen only pill (POP)
Combined Oral Contraceptive Pill (COCP)

112. A 55 year old man presents with complaints of claudication pain in his right thigh and calf. On
examination the femoral and popliteal pulses are absent on the right leg. Localise the site of
occlusion.
A. External Iliac Artery
B. Aorto-Iliac
C. Ilio-Femoral
D. Internal Iliac
E. Abdominal aorta
113. A child presents with projectile vomiting and is diagnosed with pyloric stenosis. What electrolyte
should be checked next?
A.
Potassium
B.
Calcium
C.
Magnesium
D.
Iron
114. A 27 year old man presents with chest pain and respiratory distress. On examination there is
tachycardia, hypotension and neck vein distension. Trachea is deviated to the left side, breathing
sound on the right side is absent and on the left side is diminished. What is the next appropriate
management?
A.
B.
C.
D.
E.

A. Chest x-ray
B. Right side aspiration (16 G cannula)
C. Left side aspiration (16 G cannula)
D. Right side drainage with a small tube (12F)
E. Left side drainage with a small tube (12F)

115. A 45 year old woman has had severe epigastric and right hypochondrial pain for a few hours.
She has a normal full blood count; serum alkaline phosphatase is raised, normal transaminase. Three
months ago she had a cholecystectomy done. What is the most appropriate investigation?
A.
B.
C.
D.
E.

Ultrasound of the Abdomen

Endoscopic Retgrograde Cholangiopancreatography
Magnetic Resonance Cholangiopancreatography
CT scan of the Abdomen
Upper GI Endoscopy

116. A 23 year old female presented with a swelling of her neck that moved upwards on protrusion of
tongue. What is the next appropriate investigation?
A. FNAC
B. Punch biopsy
C. Core biopsy
D. MRI neck
E. Radioactive thyroid scan
117. An elderly male who is immunocompromised has whitish plaques in the pharynx. He has
dementia, has stopped taking food due to the whitish plaques on the tongue. How will you treat this
elderly male?
A. Fluconazole suspension
E. IV Fluconazole
B. Nystatin suspension
C. Oral Miconazole
D. Oral Fluconazole

118. Mother got infected with Hepatitis B during pregnancy. Her child is born. She is worried about
the risk of infection to the baby with Hepatitis B. What would you give to the baby?
A. HepB Immunoglobulin only
B. HepB full vaccine and Ig
C. HepB vaccination only once
D. Nothing until immune status checked
E. HepB vaccine once and Ig
119. A 65 year old man with difficulty in swallowing presents with an aspiration pneumonia. He has a
bovine cough and a fasciculating tongue. Sometimes as he swallows food it comes back through his
nose. Choose the SINGLE most likely cause of dysphagia from the given options?
A. Bulbar palsy
B. Oesophageal carcinoma
C. Pharyngeal pouch
D. Pseudobulbar palsy
E. Systemic sclerosis
120. Which one of the following is the major contributor to the development of physiological jaundice?
A. Breast feeding.
B. Immature liver
C. Low haemoglobin levels and longs life span
D. Immature gut flora
E. Entero-hepatic circulation
121. A 25 year old primigravida is found to have a blood pressure of 160/90mmHg and proteinuria of
+++. What is the most likely diagnosis?
A. Eclampsia
B. Pre-eclampsia
C. HELLP
D. Normal finding
E. Renal failure

122. Among the risk factors given, which one will most likely enhance a womans chances of getting
ovarian cancer?
A. Family history
B. Previous history of breast cancer
C. Environmental factor
D. Young age
E. Nulliparity
123. A 45 year old male complains of tremors in hands. On examination these tremors are absent at
rest, but present when arms are held outstretched and persist on movement. What is the most
probable diagnosis?
A. Parkinsonism
B. Benign essential tremor
C. Cerebellar disease
D. Liver failure
E. Stroke
124. A 17 year old secondary school girl presents with complaint of prolonged irregular menstrual
periods and heavy blood losses. What is the most appropriate treatment for her?
A.
B.
C.
D.
E.

Mefenamic Acid
E. Intrauterine Contraceptive Device (IUCD)
Combined Oral Contraceptive Pill (COCP) F. Mirena
Progesterone only pill
Specific Antigen (PSA)
Midstream Specimen of Urine (MSU)

125. Patient with terminally ill cancer. He is on oral morphine. He cannot tolerate it. What is the next
mode of treatment?
A. Intravenous
B. Subcutaneous
C. Change to other pain management
126. A 75 year old woman from a nursing home is brought to the A/E by her carer who says that she
has been confused for four days. She is on Warfarin for atrial fibrillation. Examination is
unremarkable except for multiple bruises on her body. Blood investigations reveal an INR of 7.3.
What is the most likely diagnosis?
A. Alcohol intoxication
B. Urinary tract infection
C. Subdural haematoma
D. Dementia
127. A 50 years old man presents with low mood, poor concentration, anhedonia and insomnia. He
has had two episodes of increased activity, promiscuity and aggressive behaviour in the past. He was
arrested 8 months ago for trying to rob a bank, claiming it as his own. Which drug is most likely to
benefit him?
A.
B.
C.
D.
E.

Haloperidol
Citalopram
Desipramine
Carbamazepine
Ethosuximide

128. A 2 year old boy was brought by his mother with a swelling in the right side of the neck
extending from the angle of the mouth to the middle one third of the sternocleidomastoid muscle. The
swelling was on the anterolateral side of the sternocleidomastoid and was brilliantly trans-illuminant.
What is the likely diagnosis?
A. Lymphangioma
B. Branchial cyst
C. Thyroglossal cyst
D. Ranula
E. Thyroid swelling
129. A 19 year old boy complains of itching on the site of an insect bite. What is the SINGLE most
appropriate management?
A.
B.
C.

Penicillin oral
Doxycycline oral
Oral antihistamine

D. Oral Ciprofloxacin
E. Reassurance

130. A 2 year old boy has had fever, sore throat, runny nose and lethargy for the past few days. Now
he presents at A &E, is sitting in mothers lap with his body inclined forward with continuous stridor
and is drooling saliva. What is the most important next step in his management?
A. Call ENT specialist
B. High flow O2
C. Call Anaesthetist
D. Antibiotics IV
E. Immediate bronchoscopy

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

132. A 24 year old college student presents with nausea, vomiting, headache, neck stiffness and a
fever of 38.4C. What is the most appropriate empirical antibiotic to be started?
A.
B.
C.
D.
E.
F.

Cefotaxime
Penicillin
Gentamicin
Tazobactam
Meropenem
Rifampicin

133. A 3 year old girl was playing with her brother when she fell off her bicycle. She was about to cry
but fell unconscious without making any sound. She regained consciousness within 10 seconds and
was normal. The mother says similar episodes have happened in the past and she was afraid her
daughter as going to die. What is the appropriate investigation?
A. 24 hour EEG
B. CT scan
C. No investigation needed
D. MRI
E. Neuropsychological examination
134. A 23 year old female was involved in a house fire 3 months ago. She now complains of
nightmares and flashbacks about the incident. This is interfering with her daily life. Whenever she
hears a fire engine, she starts having palpitations and extreme anxiety and gets images of people being
burnt alive. What is the most likely diagnosis?
A. Obsessive compulsive disorder
B. Adjustment disorder
C. Bipolar affective disorder
D. Eating disorder
E. Post traumatic stress disorder
135. A young man febrile with cough and sputum production with left lower lobe patchy
consolidation in CXR. Which is the best antibiotic therapy for this patient?
A. Ciprofloxacillin
B. Cotrimoxazole
C. Cefotaxime
D. Vancomycin
E. Amoxicillin
136. A child with inflammation in the orbit, fever, lid swelling and decreased eye mobility. Which is
the best investigation for his condition?
A.
B.
C.
D.
E.

FBC
Blood cultures
CT scan of the orbits
Throat swab
Nasal Secretions

137. A 6 weeks old baby has blue mark near coccyx since birth. His mother is worried. What would
you do?
A.
B.
C.
D.
E.

Reassure
Coagulation profile
Karyotyping
Skeletal survey
CT scan

138. Infection of which of the following areas in the face will lead to pre auricular lymph node
enlargement?
A.
B.
C.
D.

Mastoid area
Mandibular area
Pinna of the ear
Upper eyelid

139. A 9 year old girl presents with weekly abdominal pain and with occasional headaches but not
associated with vomiting and diarrhea. She has good appetite. Full blood count, urea and electrolytes
and other investigations are normal. On examination no abnormality was found and the abdomen was
soft and non-tender. What is the most likely next step?
A. Ultrasound scan of the abdomen
B. CT of thorax
C. Liver Function test
D. Reassure
E. Analgesia
140. An 8 year old girl presents with a large swelling on the side of her neck, there were associated
lymph nodes swellings in her neck and axilla. What is the most appropriate investigation?
A.
B.
C.
D.
E.

Bone marrow biopsy

Lymph node biopsy
CT of the neck
MRI of the neck
Hb electropheresis

141. A 34 year old patient with small cell lung cancer of lung presents with Na: 119 and all other
values normal. Fluid restriction has failed to bring the Sodium up. What is the next most likely step?
A. Chemotherapy
B. Radiotherapy
C. Demeclocyclin
D. Somatostatin
E. Loop diuretics
142. A patient complains of shortness of breath, wheeze, cough and nocturnal waking. He has dry
scaly shin with rashes that are itchy. What is the single most likely diagnosis?
A.
B.
C.
D.
E.

Scabies
Eczema
Rheumatitis
Dermatitis
Psoriasis

143. A woman has been prescribed long term steroids for polymyalgia rheumatic. What additional
drug should be added to prevent osteoporosis?
A.
B.
C.
D.

Calcium
Alendronate
Vit D
Calcium resonium

144. A young man who recently served in the Army, has been diagnosed with post traumatic stress
disorder. What is the best treatment for him?
A. Narrative exposure therapy + paroxetine
B. Flooding + sertraline
C. Response prevention+ citalopram
D. Systematic desensitization + Fluoxetine
E. Play therapy

145. A 28 year old male is complying with her asthma treatment of low dose inhaled corticosteroids
and salbutamol as required. Her inhaler technique is rechecked. She has frequent night cough and
mild exercise induced wheeze. Most appropriate management
A. Add leukotriene antagonist
B. Add oral theophylline
C. Add regular LABA
D. Increase dose of ICS
E. Short course of oral corticosteroid
146. A 24 years old woman is afraid to leave her house as whenever she goes out; she tends to have
shortness of breath and sweating. She has stopped going out except with her husband. What is the
most likely diagnosis?
A. Social Phobia
B. Claustrophobia
C. Depression

D. Panic Disorder
E. Agoraphobia

147. A 65 year old hypertensive man wakes up in the morning with slurred speech, weakness of the
left half of his body and drooling. Which part of his brain is affected?
A.
B.
C.
D.

Left parietal lobe

Right internal capsule
Right midbrain
Left frontal lobe

148. A known asthmatic adult on beta2 agonist inhaler, presents with worsening of breathlessness and
cough. What medication should be added further to the regime to control asthma symptoms?
A. Inhaled steroids
B. Oral steroids
C. Antibiotics
D. Increase beta2 agonist inhaler dose
E. Nebulized salbutamol
149. Patient was admitted with erectile dysfunction, reduced facial hair and galactorrhoea. What is
the most probable diagnosis?
A.
B.
C.
D.
E.

Hyperprolactinemia
Cushings syndrome
Pheochromocytoma
Hyperthyroidism
Hypoparathyroidism

150. A 42 year old man presents with stroke, he is not able to walk straight and his speech is slurred.
What is the initial appropriate investigation?
A.
B.
C.
D.
E.

CT scan brain
PET scan brain
MRI (brain)
Carotid angiography
Monitor for 24 hours

151. A 14 year old boy fell and hit his head in the playground school. He did not lose consciousness.
He has swelling and tenderness of the right cheek with a sub-conjunctival haemorrhage on his right
eye. What is the most appropriate initial investigation?
A. CT Brain
B. EEG
C. MRI
D. Skull X-Ray
E. Facial X-Ray
152. Diabetic man feels hot painful lump near the anal region. What is the most probable diagnosis?
A.
B.
C.
D.
E.

Anal fissure
Abscess
Haematoma
Wart
External haemorrhoids

153. What is the most common post-operative complication following anterior resection of rectum?
A. Infection
B. Bleeding
C. Recurrence
D. Intestinal obstruction
E. Pain
154. A 43 year old woman is brought in by her husband to the A& E department. He says she has
been getting up repeatedly at night to wash her hands as she thinks they are dirty. She gets very
anxious if he tries to stop her. She admits washing her hands again and again but says she cannot
control her actions. What is the diagnosis?
A. Schizophrenia
B. Obsessive compulsive disorder
C. Generalised anxiety disorder
D. Panic disorder
E. Depression
155. A 31 year old man is single and lives with his mother. He usually drives from his home to his
work place. He always thinks when the traffic lights change his mother is calling him, so he drives
back to his house. What is the diagnosis?
A. Obsessive compulsive disorder
B. General anxiety disorder
C. Schizophrenia
D. Bipolar personality disorder
E. Cyclothymia

156. A 19 year old boy comes to A&E department. There is swelling, pain and tenderness 2cm distal
to Listers tubercle of radius. On examination proximal pressure on the extended thumb and index
finger is painful. The x-ray doesnt show any fracture. What is the next appropriate management for
the patient?
A. Immobilization with a cast
B. Repeat the x-ray
C. Magnetic resonance imaging (MRI)
D. Surgery
E. No treatment required
157. A 35 year old female developed sudden severe chest pain with shortness of breath. She recently
underwent pelvic surgery. What is the most appropriate diagnostic investigation that should be done?
A.
B.
C.
D.
E.

Serum D-dimer
Chest X-ray
ECG
CT pulmonary angiography
Arterial Blood Gas (ABG)

158. A 24 year old, male patient, presents with bizarre behavior. What single characteristic symptom
would confirm the diagnosis to be most likely to be schizophrenia?
A.
B.
C.
D.
E.

Thought insertion
Visual hallucination
Aggressive, violent behavior
Low mood
Body dysmorphic image

159. A 36 years old man has been diagnosed with Diabetes Insipidus. What electrolyte picture is
expected to be seen?
A.
B.
C.
D.
E.

High serum Na, low serum osmolarity, high urine osmolarity

Low serum Na, low serum osmolarity, high urine osmolarity
Low serum Na, high serum osmolarity, high urine osmolarity
High Serum Na, high serum osmolarity, low urine osmolarity
Normal Na, Normal serum osmolarity, normal urine osmolarity

160. A 79 year old man has a swelling of the right groin, which was clinically diagnosed to be indirect
inguinal hernia. What is the SINGLE feature of the hernia sac that would confirm the diagnosis?
A. Comes through femoral ring
B. Does not pass through deep inguinal ring
C. Lies below and lateral to pubic tubercle
D. Only passes through superficial ring
E. Passes through deep inguinal ring
161. A patient is admitted with fever, photophobia, and a non-blanching rash. His ABG values are as
follows:
pH
: 7.5
PaCO2 : 2.2 KPa
PaO2 : 9.0 KPa
What is the most likely diagnosis?

A.
B.
C.
D.

Metabolic acidosis
Metabolic alkalosis
Respiratory alkalosis
Respiratory acidosis

162. A 34 year old man was walking along the country side when an insect bit him. After which he
started to complain of an annular rash spreading upwards. Which is the best treatment for this
patient?
A. Penicillin oral
B. Doxycycline oral
C. Gentamicin oral
D. Flucloxacillin oral
163. A 24 years old woman has been complaining of amenorrhea for the last 12 weeks. She also has
diarrhoea and weight loss of 8 kg over the last 3 months. What is the most important next step?
A. Serum Prolactin
B. Thyroid Function Test
C. Thyroid Antibodies
D. 24 hours urinary VMA (Vanillylmandelic Acid)
E. Admit under the MHA (Mental Health Act)
164. A man brings his wife to see the doctor. He says she has been talking about their private life
openly and is throwing tantrums. Her mood changes quickly and she becomes aggressive. Physical
examination is normal. There is no history of trauma and she is not on any medications. What is the
most likely diagnosis?
A. Huntingtons dementia
B. Lewy body dementia
C. Alzheimers dementia
D. Vascular dementia
E. Benign old age related dementia
165. How to keep a check on salbutamol's efficiency?
A. PEFR
B. Spirometry
C. Vital capacity
D. FEV/ FEV1 ratio
E. Lung function test
166. A 30 year old alcoholic woman presents with low mood, anhedonia, lack of appetite and sleep.
What is the best treatment for her?
A.
B.
C.
D.

Amitryptiline
Fluoxetine
Venlafaxine
ECT

167. A pregnant woman had hit her chest 3 weeks ago. Now she is 24 weeks pregnant and presents
with left upper quadrant mass with dimpling. What is the most probable diagnosis?
A. Breast Ca
B. Carcinoma
C. Fibroadenoma
D. Fibroadenosis

E. Fatty necrosis of breast

168. A lady who works at a nursing home presents with itching. On examination, she had linear tracks
in the wrists. She says that 2 days ago she had come in contact with a nursing home inmate with
similar symptoms. What is the mechanism of itching?
A.
B.
C.
D.
E.

Infection
Destruction of keratinocytes
Allergic reaction
Immunosuppression
None

169. A 35 year old man presents with painless left testicular enlargement since past 6 months, which
is increasing in size. The swelling is 3 times larger than the right testis; there is no tenderness or
redness. What is the most likely diagnosis?
A. Testicular tumour
B. Hydrocele
C. Epididymal Cyst

D. Epididymo orchitis
E. Reassure

170. A 50 year old woman complains of several months history of weakness and difficulty in
climbing stairs. O/E she has fissuring of the skin of her hands and her CXR shows pulmonary
fibrosis. What is the single most likely positive antibody?
A. Anti Jo 1
B. Anti Scl 70
C. Anti Ro
D. Anti Ds DNA
E. Anti Centromere
171. A 65 year old lady with IDDM for the last 20 years comes with a tender lump near the anal
opening. She says she also has fever. What treatment should she get?
A. Incision and drainage and antibiotics
B. IV antibiotics
C. Culture and sensitivity of aspirate from swelling
D. Painkillers
E. Cautery of the swelling
172. A 29-year-old woman presents to her GP with a history of weight loss, heat intolerance, poor
concentration and palpitations. Which of the following is most likely to be associated with a diagnosis
of thyroiditis associated with viral infection?
A. Bilateral exophthalmos
B. Diffuse, smooth goitre
C. Reduced uptake on thyroid isotope scan
D. Positive thyroid peroxidase antibodies
E. Pretibial myxoedema
173. A child was playing and suddenly developed breathlessness. What is the best investigation for
this child?
A.
B.
C.
D.
E.

Nasal Endoscopy
Lateral neck X-Ray
CT scan
Pulse Oximetry
Spirometry

174. A 50 year old presented to the hospital with complain of chest tightness wheeze and chronic
cough. He has been smoking 20 cigarettes per day since last 35 years. A diagnosis of COPD was
made.What will be the picture of ABG for this patient?
A. Respiratory Acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
E. Normal pH
175. A known COPD patient presented to the hospital with complains of persistent cough, copious
sputum production and intermittent hemoptysis. On examination, finger clubbing and coarse
inspiratory crepitations were observed. What is the most probable diagnosis?
A. Lung cancer
B. Cystic fibrosis
C. Bronchiectasis
D. Pulmonary edema
E. Lung abscess
176. A 64 years old man presents with a history of left sided hemi paresis and slurred speech. He was
absolutely fine 6 hours after the episode. What is the most appropriate prophylactic regimen?
A. Aspirin 300 mg for 2 weeks followed by Aspirin 75mg
B. Aspirin 300 mg for 2 weeks followed by Aspirin 75mg and Dipyridamole 200mg
C. Clopidogrel 75mg
D. Dipyridamole 200mg
E. Aspirin 300mg for 2 weeks
177. A 44 years old obese patient presents with lab findings of:
Fasting blood sugar (FBS) 6mmol/L
Oral Glucose Tolerance Test (OGTT) 10mmol/L . What is the most likely diagnosis?
A.
B.
C.
D.
E.

Impaired glucose tolerance

Diabetes Insipidus
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Maturity Onset Diabetes of the Young (MODY)

178. A patient who does not eat regular meals presents with feeling faint and tired. Blood tests reveal
a deficiency of both iron and folic acid. What state best describes the reason for his anaemia?
A. Nutritional deficiency
B. Malabsorption
C. Pernicious anaemia
D. Haemolytic anaemia
179. A 32 year old female with axillary freckles and cafe au lait spots wants to know the chances of
her child also having similar condition.
A.
B.
C.
D.

1 in 2
1 in 4
No genetic link
1 in 16

E.
Depends on the genetic make-up of the partner
180. A 45 year old man has been diagnosed with moderate depression. His past medical history is
significant for an anterior wall MI 6 months ago. What is most appropriate treatment for him?
A.
B.
C.
D.
E.

Benzodiazepine
ECT
SSRI
MAO inhaler
TCA

181. A 65 year old man presents with progressively worsening breathlessness and productive cough.
He has a history of treated tuberculosis and rheumatoid arthritis, he smoked 20 cigarettes/day since 35
years. When he was given a trial of salbutamol nebuliser, FEV1/FEV changed from 1.7/2.0 to 1.8/2.1
(predicted 3.0/3.5). What is the most probable diagnosis?
A. Chronic bronchitis
B. Bronchiectasis
C. Bronchial carcinoma
D. Asthma
E. Pulmonary fibrosis
182. A 56 year old lady presents has a pathological fracture of her T11 vertebra. There is found to be
an underlying metastatic lesion. What is her most common primary cancer?
A. Lung
B. Breast
C. Uterine
D. Brain
183. A 61 year old man who had stroke 2 years ago is on aspirin. He has Rheumatoid arthritis but
suffers from the pain and cannot tolerate it. He is taking senna for constipation. What is the best
medication to relieve his pain?
A.
B.
C.
D.

Disease-modifying anti-rheumatic drugs (DMARDs)

Ibuprofen
Co-codamol
Paracetamol

184. A man presented to the hospital with complain of productive cough and chest pain. His
temperature was 38.5 C. Lobar Consolidation was seen on x-ray with pleurisy. What is the best
management?
A. Clarithromycin
B. Amoxicillin
C. Tetracycline
D. Ciprofloxacilling
E. Imipenam
185. A man with a carcinoma and multiple metastasis presents with intractable nausea and vomiting.
He has become drowsy and confused. What is the most appropriate management?
A.
B.
C.
D.

Dexamethasone IM
Dexamethesone oral
Ondansetron IM
Ondansetron oral

E. Morphine oral
186. A 55 year old man is brought into A&E unconscious. He has a distended abdomen with caput
meduase and spider navi. He has a previous history of bleeding oesophageal varices. His Hb is 10
g/dL, MCV is 100 fL. His skin is pale and clammy. What is the reason for his loss of consciousness?
A.
B.
C.
D.

Alcoholic hypoglycaemia
Diabetic hypoglycaemia
Hepatic encephalopathy
Subdural haematoma

187. A 19 year old boy came with skin rash and decreased urine output. On investigations, he was
found to have raised urea and creatinine, and hematuria. There was history of bloody diarrhoea and
fever. What is the most likely diagnosis?
A.
B.
C.
D.
E.

Thrombotic ThrombocytopoenicPurpura
Haemolytic Uraemic Syndrome
Post streptococcal glomerulonephritis
IgA Nephropathy
Minimal Change disease

188. During a basketball match, one of the players suddenly collapsed to the ground with coughing
and shortness of breath. What is the investigation of choice for this patient?
A. Chest x-ray
B. CT scan
C. Magnetic resonance imaging (MRI)
D. V/Q scan
E. CT pulmonary angiogram (CTPA)
189. A 63 year old woman came with uterine bleeding. Vaginal USG reveals uterine thickness 12mm.
What is the most probable diagnosis?
A. Cervical Ca
B. Endometrial Ca
C. Ovarian Ca
D. Breast Ca
E. Vaginal carcinoma
190. A 48 years old male with history of chronic cough presents with increased breathlessness
copious sputum with streaks of blood, examination shows finger clubbing. What is the initial
investigation?
A. Chest x-ray
B. CT chest
C. Bronchoscopy
D. Blood culture
E. ECG

191. A man has been diagnosed with metastatic carcinoma of the middle 1/3rd of the oesophagus.
What is the best initial management?
A. Chemotherapy
B. Celestin tube
C. Radiotherapy
D. Surgery

192. A man presents with inoperable carcinoma and back pain. His pain has been well controlled with
morphine, but he develops vomiting. Morphine was stopped and he was started on metoclopramide
and fentanyl patches. He then develops neck stiffness and fever. What is the cause of these
symptoms?
A. Metoclopramide
B. Fentanyl
C. Morphine
D. Meningitis
E. Metastasis
193. A 72 year old presents with polyuria and polydipsia. The fasting blood sugar is 8 and 10 mmol/L.
The level of cholesterol is 5.7and blood pressure is 130/80mmHg. There is micro-albuminuria. What
is the most appropriate next management?
A. ACE inhibitors and Sulfonylurea
B. Statin + biguanide
C. Statin + Glitazone
D. Insulin + ACEinhibitors
E. ACEinhibitors + Statin
194. A 56 year old male presents with intermittent vertigo, intermittent tinnitus and intermittent
hearing loss. What is the best drug treatment for this patient?
A.
B.
C.
D.
E.

Buccal Prochlorperazine
Oral Flupenphenazine
Tricyclic antidepressants (TCA)
Gentamycin patch on the round window
No medical treatment available

195. A neonates chest X-ray shows double bubble sign. On examination the neonate has low set ears,
flat occiput. What is the most likely diagnosis?
A.
B.
C.
D.

Downs Syndrome
Fragile X Syndrome
Turners Syndrome
Di George Syndrome

196. A patient having headache with sudden onset of loss of vision in one eye. What is the most
appropriate next step?
A. ESR
B. Temporal artery biopsy
C. Full blood count
197. A woman had widespread metastasis from a carcinoma. She presented with severe back pain.
Where do you expect the cancer to be?
A. Lungs
B. Cervix
C. Ovary
D. Uterus
E. Breast

198. A patient known to be HIV positive, has now got chicken pox in the maternity ward. What
precautions should be taken to prevent further spread of infection?
A. Vaccinate all the patients and staff in the ward
B. immunoglobulins to all the pregnant women in the ward
C. Immunoglobulins to all pregnant women who have negative serology
D. Start 7 days course of Acyclovir for all patients in the ward
E. No action required
199. An 18 year old female was brought into the A & E by her parents who are very concerned about
her. Her BMI is 15 kg/m2. She considers herself to be obese and has severely restricted her diet in
order to lose weight. She exercises 5-6 hours daily to further supplement her weight loss. She admits
to abusing laxatives and inducing vomiting. She has had no periods for 7 months but urine Beta HCG
is negative. She has fine lanugo hair covering her entire body and complains of being cold all the
time. What is the most likely diagnosis in her?
A.
B.
C.
D.
E.

Bulimia nervosa
Anorexia nervosa
Hypothyroidism
Somatization disorder
Conversion disorder

200. A 34 year old male presents with history of headaches presents with ataxia, nystagmus and
vertigo. Where is the site of the lesion?
A. Auditory canal
B. Eight nerve
C. Cerebellum
D. Cerebral hemisphere
E. Brain stem