Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 10TH MARCH 2019 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

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

2. A 23 year old woman unable to extend the fingers of her right hand at metacarpal phalangeal joint and
inter-phalangeal joint following after accident. What is single most likely tendon damaged after accident?
A. Extensor carpi radialis
B. Extensor carpi ulnaris
C. Extensor digitorum
D. Extensor in olces

3. A 15 year old boy presents with a limb and pain in the knee. On examination, the leg is externally
rotated and 2 cm shorter. There is limitation of flexion, abduction, and medial rotation. As the hip is
flexed external rotation is increased. Choose the single most likely diagnosis.
A. Juvenile rheumatoid arthritis
B. Osgood Schlatter disease
C. Reactive arthritis
D. Slipped femoral epyphisis
E. Transient synovitis of the hip

4. A 3 year old girl fell down while riding her bicycle. She then went pale, and then rigid. 2 minutes later
she recovered fully but she was still pale. After 1 hour she well and playing around. What is the most
appropriate management?
A. No investigations
B. Electrocardiogram
C. Full blood count
D. Electroencephalogram
E. CT scan of the brain

5. A 35 year old man presents with progressive breathlessness. He gave a history of polyarthralgia with
painful lesion on shin. Chest x-ray shows bilateral hilar- lymphadenopathy .What is the most likely
diagnosis?
A. Bronchial Asthma
B. Cystic fibrosis
C. Sarcoidosis
D. Bronchiectasis
E. Pneumonia

6. A 68 year old man gets repeated attacks of loss of consciousness and TIA. What is the most likely
cause for this?

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A. Carotid artery stenosis
B. Aortic stenosis
C. Mitral stenosis
D. Tricuspid stenosis

7. A 67 year old woman is brought to the Emergency department having fallen on her left arm. There is an
obvious clinical deformity and X-ray demonstrates a mid-shaft fracture of the humerus. She has lost the
ability to extend the left wrist joint. Which nerve has most likely been damaged with the fracture?
A. The axillary nerve
B. The median nerve
C. The musculocutaneous nerve
D. The radial nerve
E. The ulnar nerve

8. A 80 year old woman who is a known COPD, patient is on salbutamol inhalers, salmetrol inhalers,
steroid inhalers and oral steroids. She still gets shortness of breath at rest. What is the most appropriate
treatment of this patients’ symptoms.
A. Noninvasive ventilation
B. Longterm oxygen therapy
C. Mechanical ventilation
D. Continue current treatment
E. Short term oxygen therapy

9. A university student is brought in by his friend after collapsing at a party. His pupils are dilated and he
has high grade fever. ECG reveals tachyarrythmias and BP is 170/90 mmHg. Urine analysis reveals
myoglobinuria. Toxicity with which substance is likely in this scenario?
A. Heroin
B. Ecstasy
C. LSD
D. Alcohol
E. Cocaine

10. A 54 year old woman with breast ca which has spread to lung, liver and bone now presents with
increasing constipation, weakness, thirst and anorexia for the past 3d. Her only medication is haloperidol
for hiccoughs. Today she is disorientated and has left sided weakness. What is the most likely diagnosis?
A. Hyperglycemia
B. HypercalcemicHypoglycemia
C. Brain metastases
D. Liver failure

11. A 12 year old boy was brought to A & E after a road traffic accident in which he was the passenger in
a car. He has fracture of left femur. The left posterior tibial and dorsalis pedis artery are not palpable.
Which vessel is most likely to be injured?
A. Femoral artery
B. Sciatic artery
C. Popliteal artery
D. Femoral vein
E. Iliac artery

12. A 15 year old girl is brought into hospital after taking 50 paracetamol tablets 10 hours ago. What is the
most appropriate management?

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A. Wait 4 hours for serum paracetamol levels
B. Wait 2 hours for serum paracetamol levels
C. Start N-Acetylcysteine
D. Activated charcoal
E. Gastric lavage

13. A 60 year old woman was found by her son. She was confused and had urinary incontinence. She has
recovered fully after 6 hours with no neurological complaints. What is the likely diagnosis?
A. Stroke E. Benign intracranial hypertension
B. Vestibular insufficiency
C. Transient ischaemic attack (TIA)
D. Intracranial haemorrhage

14. A 32 year old woman had progressive decrease in vision over 3 years. She is now diagnosed as almost
blind. What would be the mechanism?
A. Cataract
B. Glaucoma
C. Retinopathy
D. Uveitis
E. Keratitis

15. A man was noticed to have consumed alcohol on both occasions when he visited the GP clinic for
regular check-ups. What is the most definitive test to check for alcohol dependency?
A. Blood alcohol levels
B. GGT levels
C. Asking if he needs to drink alcohol the first thing in the morning
D. Total number of units of alcohol he consumes weekly
E. ALT and AST levels

16. A man was resuscitated by the medical team in the ambulance but the patient died of a cardiac arrest
on the way. The man weighed 122kg due to which he had very restricted mobility. He was also a smoker.
Choose the most likely cause of his death.
A. Myocardial Infarction
B. Pulmonary Embolism
C. Chronic cardiac failure

17. A 20 years old fit man suddenly developed severe lower back pain as getting up from bed. What is the
SINGLE most probable diagnosis?
A. Paget’s disease
B. Multiple myeloma
C. Prolapsed Intervertebral Disc
D. Ankylosing spondilitis
E. Spondylosis

18. A patient has been diagnosed with end stage oesophageal Ca. What is the best method to manage
progressive dysphagia?
A. Stenting
B. Chemotherapy
C. Radiotherapy
D. Laser therapy

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19. 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

20. An obese mother is thought to be suffering from obstructive sleep apnoea syndrome. Which of the
following investigation is the best for her?
A. Arterial blood gas analysis
B. Overnight pulse-oximetry
C. Polysomnography
D. EEG
E. CT scan

21. A 65 year old hypertensive man presents with haematuria, lower abdominal pain and back pain. An
expansive abdominal mass is palpated lateral and superior to the umbilicus. What is the single most
discrimination investigation from the given options?
A. Laparoscopy
B. KUB X-ray
C. Pelvic ultrasound
D. Rectal examination
E. Ultrasound abdomen

22. A 46 year old man has tried to kill himself by jumping off a bridge. He was rescued and brought to
hospital where he is refusing all treatment. What should be your next step?
A. Discharge
B. Assess mental capacity
C. Refer to community mental health team
D. Outpatient referral to psychologist
E. Routine referral to GP

23. A 45 year old man was involved in a fight and sustained injury to his right ear. He has bleeding with
ringing and deafness in his right ear.
What is the most appropriate investigation?
A. CT head
B. Otoscopy

C. X‐ray

D. MRI scan
E. Refer to outpatient clinic

24. A baby vomits after every feed and becomes lethargic. On examination, eyes are sunken, lips
are cracked, fontanelle is depressed and skin pinch is slow. Which is the INITIAL investigation of choice?
A. Renal function tests
B. Serum Electrolytes

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C. Liver function tests
D. FBC
E. ABGS

25. A 55yr old man who is 1 day post total knee replacement. Presenting with fever 38.5, tachycardia 130,
BP normal. Chest is clear. What investigation would you do initially?
A. Chest X-ray.
B. CT of Chest (not CTPA).
C. Echocardiogram.
D. ECG

26. A young woman complains of diarrhea, abdominal cramps and mouth ulcers. AXR shows distended
transverse colon with globet cell depletion on rectal biopsy. What is the most probable diagnosis?
A. Coeliac Disease
B. Ulcerative colitis
C. Bowel Carcinoma
D. Bowel obstruction
E. IBS

27. A 22-year woman developed right lower abdominal pain, fever of 38.9, anorexia, lethargic, what
could be the diagnosis?
A. Appendicular mass
B. Torsion ovarian cyst
C. Ectopic pregnancy
D. Rapture ovarian cyst

28. 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)

29. 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

30. A 49 year old patient with obstructive lung disease presented with acute severe shortness of breath.
ABGs were done which showed type 2 respiratory failure (hypercapnia and hypoxia). He was started on
24% oxygen via Venturi mask. His symptoms were still not improving. Repeat ABGs showed a rise in
pCO2 levels. NIPPV (Non-invasive Positive Pressure Ventilation)
also failed. What is the next best appropriate step?
A. Intubate and ventilate
B. 100% oxygen
C. Continue Non-invasive positive pressure ventilation
D. 35-60% oxygen via face mask

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31. A patient diagnosed with DVT is taking warfarin. What is his cut –off-international normalised ratio
(INR) limit?
A. <1
B. 1-2
C. 2-3
D. 3-4

32. What is the most common route of colonic metastasis to the liver?
A. Hematogenous
B. Lymphatic
C. Local invasion
D. Peritoneal seeding

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

34. A 27 year old woman had pre eclampsia and was delivered by c – section. She is now complaining of
right upper quadrant pain different from wound pain. What investigation will you do immediately?
A. Coagulation profile
B. Liver function tests
C. Ultrasound liver
D. MRCP
E. None

35. An old lady who is a nursing-home resident presents with itchy rash, white linear lesions on wrists
and elbows. What is the best treatment?
A. Permetrin E. Steroids
B. Antibiotics
C. Antifungals
D. Emollients

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

37. A 60 year old man with diagnosed COPD 6 years ago. He was started on medications for the same. He
was presented to the A and E with complaints of deteriorating vision on both eyes. He said that the
complains had begun 1 month back. What is the most likely cause of the vision deterioration?
A. Corticosteriod
B. Oxygen
C. Salbutamol

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D. Long-acting beta agonists (LABA)
E. LeukoTriene Receptor Antagonist (LTRA)

38. 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

39. A 45 year old gardener was injured by a nail on the garden fence. The wound was washed and
bandaged. He has previously received 3 doses of Tetanus Toxoid with 2 booster doses. What is the
appropriate treatment in this case?
A. Antibiotics
B. TT vaccination
C. Ig
D. Ig plus vaccination
E. No treatment needed

40. A 32year old woman has recurrent breast abscess, the latest one was six weeks ago. There was an area
of induration between the junction on areola which is discharging puss. What is the single most likely
diagnosis?
A. Mastitis
B. Breast abscess
C. Ductectasia
D. Mammary duct fistula

41. A 73 year old woman with skeletal and brain metastasis from breast cancer has worsening low back
pain and blurring of vision. She had weakness of her legs and minimal knee and absent ankle tendon
reflexes and a palpable bladder. Her power is 2/5 at the hip, 3/5 at the knee and ankle with tenderness
over 2nd lumbar vertebrae. there is reduced sensation in the perineum. She was started on Dexamethasone
16mg daily. What is the single most likely cause of her weakness?
A. Paraneoplastic neuropathy
B. Progression of brain tumor
C. Steroid induced myopathy
D. Spinal cord compression
E. Prolapsed inter-vertebral disc at L2-L3

42. How will you check the function of the Ulnar nerve?
A. Adduction of fingers
B. Flex wrist towards radial side
C. Extend elbow
D. Extension at PIP

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

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D. Tonsillitis
E. IMN

44. A 17-year-old boy who went playing football, suddenly develops unilateral swelling of the RT
hemiscrotum, non-tender on raising it. What is the next appropriate management?
A. Reassure
B. Urgent surgical exploration
C. IV antibiotics
D. US of the scrotum

45. A 27 year old lady after caesarean section, developed epigastric pain after 8 hours. What is the
appropriate investigation?
A. ABG
B. Coagulation profile
C. Liver enzyme
D. Liver biopsy

46. An 85 year old woman with Alzheimer’s dementia wants to change her will. What do you do?
A. Refer for assessment of capacity
B. Allow her to change her will
C. Refuse the change
D. Consult her family

47. A 63 years old woman underwent knee surgery and was kept on low molecular weight heparin
postoperatively. On the 6th post-operative day she developed sudden sever chest pain with breathlessness.
Her ECG and chest x-ray were normal. What is your next action?
A. Stop low molecular weight heparin and start Warfarin
B. Keep on low molecular weight heparin and do CT. pulmonary angiography.
C. Increase the dose of low molecular weight heparin and do CT. pulmonary angiography.
D. Keep on low molecular weight heparin, add warfarin and do CT. pulmonary angiography.
E. Change to unfractionated heparin and do CT. pulmonary angiography.

48. After a prolonged labour, a 34 year old patient underwent a caesarean section. After 2 hours, her left
thigh became blue, mottled and cold to touch up to the inguinal crease. Her right leg is normal. What is
the most probable diagnosis?
A. Left common iliac vein thrombosis
B. Femoral artery embolus
C. Popliteal artery embolus
D. Popliteal vein thrombosis

49. The risk of this foetal disease can be reduced by giving folic acid supplements for a few weeks before
conception and 6-8 weeks after conception. Choose the single most likely condition.
A. Down’s syndrome
B. Duchene muscular dystrophy
C. Spinal muscular atrophy
D. Neurofibromatosis
E. Spina bifida

50. A 30 year old pregnant lady presents to the hospital with constipation. High fibre diet is not effective.
What is the single most appropriate treatment?

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A. Reassure
B. Advice to walk around
C. Increase water intake
D. Laxatives
51. A 26 year old female has multiple painless genital ulcers. She is on combined oral contraceptive pill.
What is her diagnosis?
A. Chlamydia trichromatis
B. HPV
C. HSV
D. Bacterial vaginosis
E. Hemophillus ducreyi

52. A 59 years old patient has been diagnosed with hypertension. His blood pressure has been above
160/90 mmHg on three separate occasions. His biochemical profile is as follows:
Na: 145mmol/L
K: 6.2 mmol/L
Creatinine: 112 µmol/L
Urea: 5.7 mmol/L
Which antihypertensive will you choose for him?
A. Diuretic
B. ACE Inhibitors
C. Hydralazine
D. Angiotensin receptor blocker

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

54. A 64 year old man has had a recent onset of cough, fever and weight loss. A chest X-ray shows upper
lobe cavitation. Tuberculosis is a possible diagnosis. He is sufficiently unwell to require hospital
admission while further investigations are arranged. What is the single most important immediate step to
take in order to reduce the risk of tuberculosis spreading among hospital patients and staff?
A. Adopt universal precautions
B. Arrange immediate bronchoscopy to establish the diagnosis
C. Commence anti-tuberculous treatment without delay
D. Ensure staff have received Bacillus Calmette-Guerin (BCG) immunization
E. Isolate patient in a negative pressure room

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

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56. A 26 years old woman being treated for a carcinoma of the bronchus with steroids presents with
vomiting, abdominal pain and sudden falls in the morning. What is the most specific cause for her
symptoms?

A. Steroid side effect

B. Postural Hypotension
C. Adrenal insufficiency
D. Conn's disease
E. Cushing's disease

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

58. 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

59. A 58 year old man has been prescribed ibuprofen for the management of rheumatoid arthritis for the
past 15 years. His symptoms have been under control ever since. He has been suffering from recurrent
episodes of breathlessness and palpitations which have started making his life miserable. On examination
he seemed to have pallor and koilonychia was noticed. Cardiovascular examination was normal. What
would be the expected finding on peripheral blood smear?
A. Fragmented RBCs
B. Microcytes
C. Blast cells
D. Mature lymphocytes

60. A 50 year old man with epilepsy took overdose of his medication 45 minutes ago. He has dry mouth
and dilated pupils but is not drowsy. What is the most appropriate management?
A. Haemodyalisis
B. Activated charcoal
C. Gastric lavage
D. Forced emesis

61. A patient presents with right sided hemiplegia and aphasia. Symptoms resolved in 6 hours. What is the
best scoring method to assess his risk for future stroke?
A. Well’s score
B. CHADS score
C. ABCD2 score
D. CURB 65

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62. You are FY2 working in the Orthopaedic department. An 80 year old lady with fracture neck of femur
has been admitted overnight and is on the trauma list today. She needs to be consented but she is
confused. Her daughter lives nearby and is on her way to the hospital. What is the most appropriate action
you will take?

A. Investigate the possible cause of confusion.

B. Phone the theatre to cancel the operation.
C. Inform the operating surgeon about the situation
D. Point to the signature line on the consent form and ask the patient to sign.

63. A 26 year old lady presents with high fever, lower abdominal pain and purulent vaginal discharge. She
looks very unwell. What is the most appropriate management for this patient?
A. Tetracycline 250mg 6 hourly
B. Doxycycline 100 mg 12 hourly po and Metronidazole 400mg 12 hourly
C. Ceftriaxone 2g 24 hourly I/V with Doxycycline 100mg po
D. Ceftriaxone 2g 24 hourly I/V with Doxycycline 500mg po
E. Ofloxacin 400mg 12 hourly po and Metronidazole 400 mg 12 hourly po

64. A 42 year old man presents with stroke, he is not able to walk straight and his speech is slurred. What
is the initial appropriate investigation?
A. CT scan brain
B. PET scan brain
C. MRI (brain)
D. Carotid angiography
E. Monitor for 24 hours

65. A 37 year old infertile lady with 5cm subserosal and 3 cm submucosal fibroid. She is trying to get
pregnant, management?
A. Clomifene therapy E. Intra uterine insemination
B. IVF
C. Myomectomy
D. Hysterectomy

66. A 56 year old man presents with progressive dysphagia to solids, weight loss, and anaemia. Which is
the most diagnostic investigation?
A. Oesophageal manometry
B. Barium meal
C. Gastroscopy
D. CT scan

67. A 17 year old man has acute pain and earache on the right side of his face. He has a temperature of
38.4˚C and has extensive pre- auricular swelling on the right, tender on palpation bilaterally. What is the
single most likely diagnosis?
A. Acute mastoiditis
B. Acute otitis externa
C. Acute otitis media
D. Mumps

68. 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?

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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
69. 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

70. A 40 years old lady complains of 10 months amenorrhoea. She presents with hot flush, mood swings,
irritability and insomnia. What will be the single most effective diagnostic test for this lady?
A. Serum FSH and LH E. Serum cortisol
B. Serum FSH
C. Serum Progesterone
D. Serum estradiol

71. A 62 year old man presents with cough, breathlessness and wheeze. 24% oxygen, Salbutamol and
hydrocortisone were given. The symptoms have not improved and so nebulised bronchodilator was
repeated and IV Aminophylline was given. ABG showed pH: 7.31 and respiratory rate is 32. What is the
next appropriate management?
A. Nasal intermittent positive pressure ventilation
B. Intubation and ventilation
C. Long acting beta agonist
D. Toxapram
E. Amoxicillin oral

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

73. A 34 year old man had a 4 mm ureteric stone which he passed with urine. This time he presents with 3
cm stone in a right kidney. What is the single most appropriate treatment?
A. No treatment

B. Lithotripsy-‐shock wave

C. Laparotomy
D. Operative stone removal
E. Observe

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74. A boy who was in boarding school, he has cough and fever and rash all over his body. His leukocytes
are not increased. What is the most probable organism for pneumonia?
A. Legionella
B. Mycoplasma
C. Pneumocystis
D. Chlamydia

75. A 58 year old man is scheduled to have anterior resection of rectal Ca. What is the most appropriate
preoperative antibiotic management?
A. Give IV antibiotics 24hr prior to surgery
B. Give broad spectrum antibiotics a dose before induction of anaesthesia.
C. Perioperative rectal therapy
D. No treatment needed

76. A 14 year old boy with asthma suddenly developed chest pain and increasing breathlessness during a
game of football. When seen in the Emergency Department he was not cyanosed. He has reduced breath
sounds on the right side. His oxygen saturation is 94% on air. What is the SINGLE most appropriate
investigation?
A. Capillary blood gases
B. Chest x-ray
C. CT scan of the chest
D. Exercise challenge
E. MRI of the chest

77. A 67 year old man presents to the A&E with pain in his left groin. He suddenly collapses and he is not
able to move or lift his leg. He is on Alendronate. What is the diagnosis?
A. Fracture of neck of femur D. Pelvic base fracture
B. Posterior hip dislocation E. Peripheral vascular disease
C. Fracture of shaft of femur

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

79. A 23 year old man has been stabbed in the back and has shortness of breath. The trachea is deviated,
he has engorged neck veins and absent breath sounds on the right. What is the most appropriate
diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
C. Simple pneumothorax
D. Haemothorax
E. Pleural effusion

80. An 8year old boy with a BMI=28 was admitted to a surgical ward following a Motor Vehicle
Accident. He was found to have glycosuria. When he recovered from his injury the glycosuria resolved.
What is the single most appropriate follow-up investigation?

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A. Fasting blood glucose conc
B. Glycosylated hemoglobin - HbA1c
C. OGTT (oral glucose tolerance test)
D. Random blood glucose conc
E. Serum cortisol conc

81. A man was brought to A&E department from a shopping mall after collapsing there. He is conscious
and answering questions now. His ECG shows irregular rhythm. Your choice of investigation:

A. CT scan
B. Magnetic resonance imaging (MRI)
C. 24 hour ECG
D. Echo

82. A 7 year old child is on inhaled salbutamol. His symptoms are not controlled. What should be the next
step?
A. Add LABA (long-acting beta2 agonist)
B. Increase the dose of salbutamol
C. Add a regular, low-dose inhaled steroids
D. Add leukotriene antagonists

83. A 35 year old patient is complaining of severe pain along the right side of the jaw and face. What is
the best choice for this neuralgic pain?
A. Methadone
B. Ibuprofen
C. Carbamazepine
D. Lorazepam
E. Amphetamine

84. A lady with depression has a bag full of medicines. She now presents with coarse tremors. Which drug
caused her symptom?
A. Lithium
B. Thyroxine
C. Amitriptyline
D. Sodium valproate
E. Tetrabenazine

85. A 50 year diabetic patient is going to undergo an endoscopy. He is 25TH June 2018
A. Stop medications 1 week before
B. Stop medications in the morning of procedure
C. Stop medications one day before the procedure
D. Stop medications 3 days before the procedure

86. A 4 year old boy is brought by his parents with complains of wetting his bed at night and whenever he
gets excited. What would be the most appropriate management for this child?
A. Desmopressin
B. Oxybutynin
C. Behavioural Therapy
D. Tamsulosin
E. Restrict fluid intake

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87. A 40 year old woman presents to the GP with low mood. Of note, she has an increased appetite and
has gone up to two dress sizes. She also complains that she cannot get out of bed until the afternoon.
What is the most likely diagnosis for this patient?
A. Pseudo Depression
B. Moderate Depression
C. Severe Depression
D. Dysthymia
E. Atypical Depression

88. A 63 years old female is noted to have left pupil irresponsive to light and is dilated. What is the most
probable diagnosis?
A. Pontine hemorrhage
B. Subdural hemorrhage
C. Cerebellar hemorrhage
D. Extradural hemorrhage
E. Sub arachnoid hemorrhage

89. A 30 year old lady taking COCP pills is on amoxicillin tablets for a week. What advice would you
give to the patient?
A. Stop COCP and continue amoxicillin
B. Use condom for a week
C. Use condom for 2 weeks
D. No precaution required

90. A child comes to the A&E with severe asthma, has vomited several times and is not responding to
salbutamol nebulizer.What is the most appropriate management?
A. Salmetrol
B. Montelukast
C. Prednisolone
D. Budesonide inhaler
E. Oxygen
F. IV Salbutamol

91. A middle aged man develops constipation with overflow diarrhoea and bright red bleeding per rectum.
Barium enema reveals ulcerative stricture in sigmoid colon. What is the most likely diagnosis?
A. Diverticular disease
B. Ulcerative colitis
C. Crohn's disease
D. Sigmoid carcinoma

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

93. A 6 week child is very sick -looking. Blood results show Na :124mmol/l, K: 2.8mmol/l. He is also
dehydrated. What would you chose to resuscitate?

15
A. 0.18% Normal Saline + 4% Dextrose + 20mmol KCl
B. 0.9% Normal Saline
C. 0.45% Normal Saline + 5% Dextrose
D. 0.45% Normal Saline + 5% Dextrose + 20mmol KCl

94. A 54 year old male builder has fallen off his ladder, hit his head and now presents with bruises over
his right mastoid region. He has no other injuries. There was no loss of consciousness and his GCS is now
15. Which bone is affected in relation to the mastoid area bruising?

A. Parietal
B. Temporal
C. Mandible
D. Ethmoid
E. Frontal

95. A drug addict has bitten a police officer. What would you advise the police officer?
A. HIV serology
B. Hepatitis & HIV serology
C. No test required at this stage
D. Tetanus toxoid

96. A 45 year old patient was bought to the A and E with complaints of breathlessness. He was diagnosed
with Asthma and was on medications. He was given salbutamol inhaler and steroid along with 100%
oxygen. What is the next step of management?
A. Continue asthma
B. Salmetrol
C. Beclometasone
D. IV Aminophylline
E. IV MgSo4

97. A patient has back pain at the level of iliac crest. What is the level of vertebrae?
A. L1
B. L2
C. L3
D. L4
E. L5

98. A 7 year old boy has clean wound on his foot. He has no past history of immunisation. His parents are
scared that he might get some disease. His wound has been cleaned and dressed. What is the next step in
management?
A. Reassure
B. Tetanus toxoid and immunoglobulin
C. Full course of DPT
D. Tetanus Immunoglobulin only

99. A 12 year old girl when playing in the garden accidentally stepped on a hive and was bitten several
times. She has numerous wheals on her body and complains of severe itching. What is the SINGLE most
appropriate management?
A. Oral antihistamine
B. IV antihistamine
C. IM adrenaline

16
D. Oral Ciprofloxacin
E. Reassurance

100. Patient with jaundice who had test showing IgG Hep A is positive. Which other test will be
appropriate to do?
A. Hep A IgM
B. Hep B surface antigen
C. Hep B core antibody
D. Hep C testing
101. A man is admitted in a ward and develops varicella zoster after two days. Which of the following
group below should get immunoglobulin only?
A. All staff in contact with the patient
B. All pregnant women who are tested negative for antibodies.
C. All family members
D. None
E. All children

102. 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

103. A 75 year old man complains of prostatism and anorexia. Ultra sound shows bilateral
hydronephrosis. What is the cause of this finding?
A. Prostate carcinoma
B. Benign prostatic hyperplasia (BPH)
C. Hypertension

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

105. A young man has been brought to the hospital after being hit on the head by a metal rod. On
evaluation his GCS is 7. What is the best next step?
A. CT scan
B. MRI
C. PET scan
D. Call anaesthetist
E. Refer to a neurosurgeon

106. Among the risk factors given, which one will most likely enhance a woman’s chances of getting
ovarian cancer?
A. Family history
B. Previous history of breast cancer
C. Environmental factor

17
D. Young age
E. Nulliparity

107. A 45 year old lady presented with weakness in left half of the body that resolved after two hours. CT
scan showed area of reduced blood flow. What is the next best investigation?
A. Echo E. ECG
B. Carotid Doppler plus angiography
C. Glucose
D. Lipids
108. A 62 year old female who had an episode of postmenopausal bleeding PV was sent for a TV USG.
Endometrial thickness was found to be 7mm. What is the next best step in management?
A. Total hysterectomy
B. Laparoscopy
C. Hysteroscopy and Endometrial biopsy
D. Pipelle’s endometrial sampling
E. MRI of pelvis

109. A 31 year old primigravida who is into her 36th week of pregnancy was diagnosed with pregnancy
induced hypertension during her 16th week of gestation. She was brought with complaints of headache
and severe epigastric pain following which she threw a fit in the labor room. Once her fit was controlled
after administration of 4 gms of MgSO4, she was started on a maintenance dose when she threw another
fit .From the given options, choose your next line of management?
A. Deliver the baby
B. Another infusion of MgSO4 4gms
C. Continue Labetalol with IV MgSO4 2 gms bolus
D. Start her on sodium valproate.

110. 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

111. Which of the following group of drugs will be treatment of choice for Trigeminal neuralgia?
A. Anti epileptics
B. Anti depressant
C. Opioids
D. Benzodiazepens
E. NSAIDS

112. A young man has been found in the park, drunk and brought to the A&E by ambulance. He recently
lost his job and got divorced. He thinks nurses are plotting against him. What is the most likely diagnosis?
A. Schizoid personality D. Psychotic depression
B. Borderline personality E. Paranoid
C. Schizophrenia

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

18
A. Facial Nerve
B. Hypoglossal Nerve
C. Oculomotor nerve
D. Trigeminal Nerve
E. Glossopharyngeal Nerve

114. A 40 year old woman with breast cancer and metastasis to brain, CT scan shows localised metastasis
with cerebellar edema. What is the next step in management?

A. Mannitol
B. Dexamethasone
C. Radiotherapy
D. Surgery

115. A 2week old girl presents with E-coli which is confirmed by urine culture. What is the most
appropriate next investigation?
A. US
B. Intravenous Urography
C. CT kidney
D. X ray KUB
E. MCUG

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

117. Patient with history of recurrent breast abscess for 2 years. Now presents with a swelling and
purulent discharge from the breast with induration, located between the nipple and areola. What do you
think the patient is suffering from?
A. Breast abscess
B. Mammary duct Fistula
C. Duct ectasia
D. Duct papilloma

118. A 65 year old man with recently diagnosed myocardial infarction developed atrial fibrillation. On
examination he had a pulse of 240 bpm and BP 90/60mmHg. What is the most appropriate next step?
A. DC Cardio version D. IV Digoxin
B. IV Adenosine
C. IV Amiodarone

119. A young man is brought to the hospital with a history of fall and hitting his head on the pavement
after excessive drinking. His friends say he lost consciousness after the fall but did not have any other
symptoms. At the moment he appears completely fine, talkative and is determined to go home. What is
the next step in the management of this patient?
A. Reassure
B. CT and discharge
C. Check Blood glucose levels
D. Admit for observation

19
120. A 65 year old man has haematemesis. Endoscopy shows duodenal ulcer which was infected. He has
a further haematemesis and his BP drops to 100/60mmHg. His Hb 6g/dl, MCH is 25pg, MCH
concentration is 33g/dl, MCV is 85 ft. What is the most appropriate initial management?
A. Defer operation and investigate
B. Vit K injection
C. Proceed with planned surgery
D. Immediate blood transfusion stabilization and proceed to surgery

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

122. A 12 year old boy presents with painful swollen knee after a sudden fall. Which bursa is most likely
to be affected?
A. Semi-membranous bursa
B. Pre-patellar bursa
C. Pretibial bursa
D. Supra-patellar bursa

123. A 27 year old patient met with a RTA. While the NGT is passing, bowel sounds are heard in the
chest. CXR shows NGT curled. What is the diagnosis?
A. Diaphragm rupture
B. Aortic rupture
C. Splenic rupture
D. Bowel rupture
E. Liver rupture

124. A 5 year old girl had ear ache and some yellowish foul smelling discharge, perforation at the attic
and conductive hearing loss. She has no past history any ear infections. What is the diagnosis?
A. Acute otitis Media
B. Otitis media with effusion
C. Acquired cholesteatoma
D. Congenital cholesteatoma
E. Otitis externa

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

20
126. A 12 year old boy with type 1 diabetes has poor long-term control. He is unconscious, hyper-
ventilating and dehydrated. His blood glucose is 28 mmol/L. What is the SINGLE most important initial
treatment?
A. Albumin (IV)
B. Bicarbonate (IV)
C. Insulin (IV)
D. Insulin (subcutaneous)
E. Saline 0.9% (IV)

127. A 65 year old patient who had MI a year back now comes to the A&E complaining that his neighbor
is conspiring against him. When his son is asked, he denies it and also narrates that sometimes his father
says that everybody in his office is always talking about him which is not the case.What is the most
appropriate medication for this patient?
A. Tricyclic antidepressants
B. Clozapine
C. Olanzapine
D. Lorazepam

128. A 50 years old chronic smoker came to outpatient department with complains of chronic productive
cough, shortness of breath and wheeze. Investigations results are: FBC: Increase in PCV CXR: >6 ribs
anterior ribs seen above diaphragm in mid clavicular line. ABG: pO2 is decreased. What is the single
most likely diagnosis?
A. Interstitial lung disease
B. Wegener’s granulomatosis
C. Ca bronchi
D. Chronic obstructive pulmonary disease
E. Amyloidosis

129. A child was brought into Accident & Emergency with a non-blanching rash, high fever and
drowsiness. On examination, he is tachycardic, hypotensive and has neck stiffness. Blood has been taken
for cultures. What is the best treatment while awaiting culture results?
A. Cefotaxime
B. Benzylpenicillin
C. Co-Amoxiclav
D. Metronidazole
E. Vancomycin

130. A 34 year old female had pain in right knee joint. She now presents with red and tender left
metatarsal pharyngeal joint.
A. Joint aspiration for culture and sensitivity
B. Serum Uric Acid
C. Joint aspiration for crystals
D. Urine uric acid

131. A 34 year old marathon runner presents with secondary amenorrhea. On investigation, she had a
normal LH, FSH and estradiol values. Her prolactin levels were 6000.What is the most likely diagnosis?
A. Hypothalamic amenorrhoea
B. Pregnancy
C. Polycystic ovary syndrome (PCOS)
D. Prolactinoma

21
132. A 7 year old boy presents with epistaxis, bleeding is not being controlled. Investigations are as
follows:
Platelets : 210,000 PT : 13 sec
APTT : 42 sec Bleeding : normal.
Which one of the following is the most likely diagnosis?
A. Haemophilia
B. Von willibrand disease
C. ITP
D. Vit K deficiency
133. A 32 year old pregnant woman on prophylactic LMWH develops symptoms suggestive of pulmonary
embolism. What is the most appropriate management?
A. Continue same Rx
B. Switch to therapeutic dose of LMWH + CTPA or V/Q scan
C. Same dose of LMWH + CTPA
D. V/Q scan

134. A 28 year old woman presents with 18 weeks of amenorrhoea. A scan was done and it revealed an
ovarian mass on the right side with solid and cystic areas, with a bright nodular structure suggestive of
tooth. What is your most likely diagnosis?
A. Ovarian cancer
B. Endometriosis
C. Tubo-ovarian abscess
D. Dermoid cyst

135. A woman has pernicious anemia. She has been prescribed parenteral vitamin B12 treatment but she
is needle phobic. Why is oral treatment not preferred for this patient?
A. IM B12 is absorbed more
B. Intrinsic factor deficiency affects oral B12 utilization
C. IM B12 acts faster
D. IM B12 needs lower dosage
E. Pernicious anemia has swallowing difficulties

136. A 30 year old man has facial flushing and warm upper limbs. There is pallor seen with cold
peripheries on both lower limbs. There is a murmur on auscultation of chest. What is the most appropriate
test to diagnose the condition?
A. Echo cardiography D. MRI scan
B. CXR
C. CT scan

137. A 65 year old male, with past history of palpitations, now presents with narrow complex tachycardia,
BP 100/60mmHg, pulse 188 beats/min. What is the most appropriate management?
A. Adenosine
B. Atenolol
C. Amiodarone
D. DC-cardio version

138. A 32 year old woman of 39 weeks of gestation attends the antenatal day unit feeling very unwell
with sudden onset of epigastric pain associated with nausea and vomiting. Her temperature is 36.7˚C. On
examination, she is found to be tender over the right upper quadrant. Her blood results show mild
anaemia, low platelets, elevated liver enzymes and haemolysis. Select the most likely diagnosis?

22
A. Acute fatty liver of pregnancy
B. Acute pyelonephritis
C. Cholecystitis
D. HELLP syndrome
E. Acute hepatitis

139. A 59 year old man has sleep disturbance, loss of interest and weight loss of 2 months duration
complicated by myocardial infarction. He has a feeling of worthlessness but nil suicidal ideation.
What is the single most appropriate treatment?

A. Diazepam
B. Electroconvulsive therapy
C. Fluoxetine
D. Imipramine
E. Lithium

140. A 36 year old woman has been treated with dexamethasone for cerebral oedema for the last 3
months. She has now started having recurrent falls, especially in the morning. What is the most like cause
of her falls?
A. Drug side effects
B. Autonomic Neuropathy
C. Adrenal Insufficiency
D. Cushing’s syndrome
E. Addison’s disease

141. A 35 years old woman undergoing treatment for Tuberculosis presents with a malar rash,
photosensitivity and haematuria. What is the single most likely positive antibody?
A. Anti Ds DNA
B. Anti Sm
C. Anti Histone
D. Anti La
E. Anti Centromere

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

143. A 41 year old man who is addicted to using heroin wants to quit using it. What is the most
appropriate option for him?
A. N- Acetyl Cysteine
B. Needle exchange program
C. Naloxone
D. Bupropion
E. Methadone

144. A 32 years old woman presents with history of lower abdominal pain and vaginal discharge .She had
her menses 4 weeks ago. She has a temperature of 38.6 ˚C. What is the most suitable diagnosis?
A. Acute appendicitis

23
B. Acute pelvic inflammatory disease
C. Endometriosis
D. Ectopic pregnancy
E. Urinary tract infection

145. A 63 year old woman who suffers from Osteoporosis now comes with complaints of backache. What
is the most appropriate investigation to be done in this case?
A. X ray D. CT scan
B. MRI
C. Dexa scan

146. A patient was lying down on an operation table during surgery in a position with his arm hanging
down for 3 hours. Soon after he woke up, he complains of numbness and weakness in that hand and has
limited wrist movement / wrist drop and sensory loss over dorsum of that hand, weakness of extension of
the fingers and loss of sensation at the web of the thumb. What structure is likely to be damaged?
A. Radial nerve D. Axillary nerve
B. Median nerve E. Supra-scapular nerve
C. Ulnar nerve

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

148. 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 D. Somatostatin
B. Radiotherapy E. Loop diuretics
C. Demeclocyclin

149. An 83 year old elderly woman presented in the A&E with cough, fever and sneezing. Treatment was
given but she became confused and again presents with the cough, fever and sneezing. What is the cause
of her condition?
A. Aspiration pneumonia due to confusion
B. Alveolar damage due to drugs
C. Drugs toxicity
D. Pneumothorax

150. A 15 year old girl is brought by her mother. She has not started menstruation yet, has no axillary or
pubic hair and has webbed neck. What is the most likely diagnosis?
A. Turner’s syndrome
B. Klinefelter’s syndrome
C. Fragile X syndrome
D. Edwards’s syndrome
E. Patau syndrome

24
151. A patient with hepato-cellular carcinoma has raised levels of the ferritin. What is the most probable
cause?
A. Haemochromatosis
B. A1 antitrypsin deficiency
C. Cystic fibrosis
D. Wilsons
E. Primary Biliary Cirrhosis

152. A 65 year old woman, who is under a long term follow up after a lumpectomy and anti – oestrogen
therapy for breast cancer, attends following a diagnosis of stress fracture in a metatarsal bone. Choose the
SINGLE most appropriate initial investigation?
A. Serum estradiol concentration
B. DEXA scan (Dual Energy X ray Absorptiometry)
C. Lumbar spine X- ray
D. X-ray of affected joint
E. Serum calcium levels

153. A young boy presented in Out -Patient department 12 weeks after renal transplantation with fever
and pain in lower abdomen. Renal functions were deranged. Renal biopsy showed immune cell infiltrate
and tubular damage. What is the most probable diagnosis?
A. Pyelonephritis
B. Chronic graft rejection
C. Acute rejection
D. Drug toxicity
E. Graft host disease

154. A 64 years old patient has been having frequent episodes of secretory diarrhea, which is extremely
watery, with large amounts of mucus. A diagnosis of villous adenoma was made after endoscopy. What
electrolyte abnormality is most likely in this patient?
A. Hyperkalemia E. Hypercalcemia
B. Hypernatremia
C. Hyponatremia
D. Hypokalemia

155. A patient is recovering after an operation, he is on 100% face mask oxygen. He developed
breathlessness. His ABG is as follows :
PH:7.54
paO2: 8
paCO2:3.8
What is the best next step in management?
A. Reduce oxygen to 24%
B. Physiotherapy
C. Intubate and ventilate
D. Increase morphine

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

25
E. Transdermal patch

157. A patient is on long standing indwelling catheter and now the catheter bag is turned purple. Dipstick
test shows nitrates –ve, blood+. What investigation would you do next?
A. Urine culture and sensitivity
B. None
C. Urine porphobilinogen
D. USG abdomen
158. A 5 year old boy presents to the outpatient clinic. He has learning difficulties, a large head and large
testicles. He has quite a characteristic facial appearance, with a prominent forehead and large ears, select
the most likely karyotype
A. 47XY(18) B. 47XY(13) C. 47XY(21)
D. 69XXY
E. Fragile X syndrome

159. A 34 years old African-Caribbean man, with a history of Sarcoidosis, has presented with bilateral
kidney stones. What is the most likely cause for this patient’s stones?
A. Hyper calcemia
B. Hyper uricemia
C. Diet
D. Recurrent UTIs
E. Hyperparathyroidism

160. A 25 year old woman presents with a painful shallow ulcer on the vulva. What investigation has to
be done?
A. HSV antibodies
B. Syphilis serology
C. Swab for Haemophilusducreyi
D. Urine culture
E. Blood culture

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

162. This is the standard method for comparing distributions for example between the observed and
expected frequency of events. Choose the single term from the list of options given
A. Chi squared (X²) test
B. Linear regression
C. Mean
D. Median
E. Mode

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

26
D. Oral hypoglycemic drugs

164. A 62 year old man is admitted for Surgery. He had a history of DVT and atrial fibrillation, is taking
warfarin. What is the next appropriate step?
A. Postpone operation
B. Stop Warfarin
C. Stop warfarin and start heparin
D. Add heparin
165. A 35 year old woman has butterfly rash on her face and she suffers symmetrical joint pains on knee
and elbow, ESR is raised. What is the most discriminative investigation for diagnosis?
A. Anti DNA antibodies
B. Anti Jo 1 antibodies
C. Anti nuclear antibodies
D. Anti centromere antibodies
E. Anti la antibody

166. A 44 year old woman with breast cancer had an extensive removal and lymph node clearance. She
needs an adjunctive treatment. Her mother had cancer when she was 65 years of age. Which of the
following factors will be against the treatment?
A. Family history
B. Tumour grading
C. Lymph node involvement
D. Her age

167. An elderly man presents with frequent fractures and with poor diet. What could be the underlying
cause for fractures?
A. Multiple myeloma
B. Paget’s disease
C. Osteomalacia
D. Osteoarthritis

168. A 50 year old woman comes with fever, jaundice and right hypochondrial pain. What is the most
appropriate investigation to be done next?
A. USG
B. Radiography
C. MRCP
D. ERCP

169. A 2 months old baby who has ambiguous genitalia presents to the A and E with vomiting. Lab tests
are as follows.
Na: 125mmol/L
K: 6 mmol/L
What is the most likely diagnosis?
A. Fragile X Syndrome
B. Turner’s Syndrome
C. Noonan Syndrome
D. Congenital Adrenal Hyperplasia

170. A thin 25 year old man who looks unwell has an ascitic fluid tap done for abdominal pain and
distension. Protein- 10g/l Lymphocytes- 70%. What is the most likely cause?
A. Liver Cirrhosis

27
B. Malignant ascites
C. TB Peritonitis
D. Sub acute bacterial Peritonitis

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

172. A 23 year old woman with painless vaginal bleeding in 36 weeks of pregnancy otherwise seems to be
normal. What should be done next?
A. Vaginal U/S
B. Abdominal U/S
C. Vaginal examination
D. Reassurance

173. A 26year old man is referred for gastroscopy because of a history of several months of dyspepsia. He
has routine bloods checked and is found to have a serum calcium level=3.2mmol/l with a venous
bicarbonate level of 33mmol/l. Renal and LFT are both normal. CXR is normal. What is the most likely
cause of his hypercalcemia?
A. Melanoma
B. Metastatic malignancy
C. Milk alkali syndrome
D. Primary hyperparathyroidism
E. Sarcoidosis

174. A 14 year old girl has collapsed and has been brought to hospital. She has lanugo hair and has had
amenorrhea for past 7 consecutive months. What test should be done immediately?
A. Urea & Electrolytes
B. FBC
C. Urine analysis
D. CT scan
E. No test needed

175. A middle aged lady presented with fever, altered sensorium, bleeding gums and jaundice. Laboratory
results show deranged LFT’s, normal PT/APTT, fragmented RBC’s and low platelets. What is the likely
diagnosis?
A. Cholesterol emboli
B. Hemolytic uremic syndrome
C. Thrombotic thrombocytopenic purpura
D. Hepatorenal syndrome
E. Sepsis

176. A healthy parents have two children, a child with cystic fibrosis and a healthy child. They want to
have another child. What are the chances of that child being a carrier?
A. 1:4

28
B. 1:2
C. 2:3
D. 1:8
E. 1:16

177. A young girl complains of episodic headaches preceded by fortification spectra. Each episode last for
two to three days. During headache patient prefers quite darkroom.
What is the treatment of choice for acute stage?
A. Paracetamol
B. Aspirin
C. Sumatriptan
D. Gabapentin
E. Cafergot

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

179. An expectant mother is planning a water birth at home but would like any injections in the hospital
setup. Her blood group is O negative and the baby's father is of blood group B positive. She would like to
know when does she have to come to the hospital if she needs a Rhesus antiD?
A. Not necessary
B. Within 24 hrs
C. Within 72 hrs
D. Within 48hrs
E. After 24 hours

180. A 45 year old man has been diagnosed with moderate depression. His past medical history is
significant for an anterior wall MI 6 months ago. What is most appropriate treatment for him?
A. Benzodiazepine
B. ECT
C. SSRI
D. MAO inhaler
E. TCA

29