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Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 24TH OCTOBER 2017 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. A 23 year old woman unable to extend the fingers of her right hand at metacarpal phalangeal
joint and interphalangeal joint following after accident. What is single most likely tendon damaged
after accident?
A. Extensor carpi radialis
B. Extensor carpi ulnaris
C. Extensor digitorium
D. Extensor pollicis

2. 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

3. An old woman develops sudden pain in upper part of the arm after carrying heavy loads. Which
part of the arm is affected?
A. Biceps tear
B. Posterior capsulitis
C. Ruptured supraspinatus tendon
D. Bursitis

4. A 24 year old, male patient, presents with bizarre behaviour. What single characteristic symptom
would confirm the diagnosis to be most likely to be schizophrenia?
A. Thought insertion
B. Visual hallucination
C. Aggressive, violent behaviour
D. Low mood
E. Body dysmorphic image

5. A 2 year old was brought to the accident and emergency, with bruises on the right anterior thigh
and anterior leg. The left ankle was swollen and she refuses to move it. She was crying inconsolably.
What is the investigation of choice?
A. Blood culture
B. FBC
C. Bone marrow aspirate
D. Skeletal survey
E. Coagulation Screen

6. A 17 year old man history of easy bruising. On examination he is obese. Investigation reveals
potassium 2.3. What is the most likely diagnosis?
A. Conn Syndrome
B. Addison's disease
C. Cushing Syndrome
D. Pheochromocytoma
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7. A 70 year old lady fell down and sustained neck of the femur fracture. Which artery is likely to
bleed from?
A. Femoral artery
B. Circumferential artery
C. Popliteal artery
D. Common iliac artery
E. External iliac artery

8. A patient, who suffered from an acute myocardial infarction a day ago, suddenly developed rapid
pounding and fast breathing. What is the most probable cause of this?
A. Ventricular ectopics
B. Atrial fibrillation
C. Ventricular tachycardia
D. Complete heart block
E. Acute pericarditis

9. A 22 year old boy as frequent fainting attacks since childhood. ECG shows normal PR interval and
QRS, however QT is prolonged. What is the cause of the faint?
A. Torsade de pointes
B. Complete heart block
C. Atrial Fibrillation
D. Sick sinus syndrome
E. Ventricular fibrillation

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

11. 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

12. A 25 years old young male complaining of back pain in the morning now complaining of red eyes
with photophobia and decreased vision and has with blood in the stools. What is the most probable
diagnosis?
A. Ankylosing Spondylitis
B. Gout
C. Rheumatoid arthritis
D. Reactive arthritis

13. A 77 year old man is admitted to hospital for investigation of an irregular heart beat. The
conducting system of the heart includes which one of the following anatomical structures?
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A. Atrioventricular node
B. Chordae tendineae
C. Fibrous skeleton of the heart
D. Interatrial septum
E. Phrenic nerve

14. Patient comes with multiple painful ulcers over buccal mucosa and white striae on mouth and
tongue. What is the most likely diagnosis from the following list of options?
A. Candida
B. Oral Ca.
C. Aphthous ulcers
D. Lichen planus

15. A man is being admitted for an open fracture of the femur following RTA. During the induction of
anaesthesia the BP drops to 60/40 and HR is 130 bpm. The likely explanation is
A. Fat embolism
B. Severe bleeding
C. Reaction to anaesthesia
D. Pulmonary Embolism

16. A 26 year old man with history of hereditary haemorrhagic telangiectasia. He is planning to start a
family. What is the mode of inheritance?
A. Autosomal dominant with incomplete penetrance
B. Autosomal recessive with incomplete penetrance
C. Autosomal dominant
D. Autosomal recessive

17. A patient who came from India presents with cough, fever and enlarged cervical lymph node.
On examination there is caseating granulomas found in lymph node. What is the most appropriate
diagnosis?
A. Lymphoma
B. TB adenitis
C. Thyroid Ca
D. Goitre
E. Thyroid cyst

18. A patient post surgery has severe pain and vomiting. What is the most appropriate painkiller to be
given in this case?
A. Paracetamol
B. Oral Morphine
C. I.V Morphine
D. Transdermal patch

19. A 13-year-old girl complains of a 2-day history of hoarseness of voice associated with dry cough.
She feels feverish. On direct laryngoscopy her vocal cords are grossly oedematous. What is the single
most appropriate investigation?
A. No investigation required. D. Bronchoscopy
B. Sputum for acid fast bacilli. E. Cervical spine X-ray.
C. Laryngoscopy.
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20. A 53 year old woman was found to have an enlarged spleen which is palpable up to the umbilicus.
Blood tests show HB 8.7g/dl, WBC 100 and Platelets 72. What is the single most likely diagnosis?
A. Chronic myeloid leukemia
B. Chronic lymphoid leukemia
C. Acute myeloid leukemia
D. Lymphoma
E. Splenic carcinoma

21. For a patient presenting with Parkinson’s disease, which one of the following drugs is most
useful in the management of tremor?
A. Apomorphine
B. Cabergoline
C. Selegiline
D. Amantadine
E. Benzhexol

22. A 53year old man presents with a longstanding history of a 1cm lesion on his arm. It has
started bleeding on touch. What is the most likely diagnosis?
A. Basal cell carcinoma
B. Kaposi’s sarcoma
C. Malignant melanoma
D. Squamous cell carcinoma
E. Kerathoacanthoma

23. A 19 years old male presents with runny nose, cough and generalised rash. Blood,
Microscopy, culture and sensitivity is positive for coagulase positive cocci. What is the best
management?
A. Amoxicillin
B. Rifampicin
C. Gentamycin
D. Flucloxacillin
E. Co-Amoxiclav

24. A 64year old man believes a female newscaster is communicating directly with him when she
turns a page. What kind of delusions is he suffering from?
A. Persecutory
B. Control
C. Grandeur
D. Nihilistic
E. Reference

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

26. A 7 year old boy presents with perioral blisters and a hot face. Some are weeping and some
crusted. What is the most likely diagnosis?
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A. Impetigo
B. Shingles
C. Chicken pox
D. Acne
E. HSV 1

27. A 6 months old infant has breast milk jaundice. He is otherwise feeding well and is not
dehydrated. What would his liver function tests look like?
A. Total bilirubin: 40 , conjugated bilirubin < 5%
B. Total bilirubin: 300 , conjugated bilirubin 85%
C. Total bilirubin: 500 , conjugated bilirubin >85%
D. Total bilirubin: 400, conjugated bilirubin <85%
E. Total bilirubin: 500, conjugated bilirubin <70%

28. A 26 year old man presented with abdominal distension and pain. His stool was mucoid and
sometimes blood stained. What is the most appropriate investigation?
A. Stool culture and sensitivity
B. Colonoscopy and Biopsy
C. IgA against tissue transglutaminase
D. Barium meal
E. Jejunal biopsy

29. 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

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

31. 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

32. A 14 year old girl suffers from hay fever which bothers her school attendance and performance.
What is the best treatment option?
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A. Oral steroids
B. Topical steroids
C. Oral Antihistamines
D. Topical antihistamines
E. Adrenaline IM

33. 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

34. An 18year old previously well student is in his 1st year at university. He has been brought to the
Emergency Room in an agitated, deluded and disoriented state. What is the most probable reason for
his condition from the following options?
A. Drug toxicity
B. Delirium tremens
C. Infection toxicity
D. Electrolyte imbalance
E. Head injury

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

36. A 65year old woman had an excision of colonic tumor 3years ago. Now she is losing weight and
feels lethargic. On examination she is pale but has no abdominal findings. What is the most
appropriate investigation?
A. CA 125
B. CA 153
C. CA 199
D. CEA
E. AFP

37. A 34 year old man with a white patch on the margin of the middle third of the tongue. Which is
the SINGLE most appropriate lymph node involved?
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
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38. A 75 year old woman presents to the breast clinic having noticed that she has had a blood stained
discharge from the left nipple, together with dry skin over the left areola. Exam: blood stained
discharge with dry flaky skin noted on the left areola. The nipple was noted to be ulcerated. What is
the most appropriate investigation?
A. FNAC
B. MRI
C. Punch biopsy
D. Open biopsy
E. Stereotactic biopsy

39. An 18 year old girl has started college 4 months ago. For the past 3 months she is eating very little
and has poor sleep. She wakes up early in the mornings and says she feels very sad all the time. She
stopped going to piano lessons which she used to enjoy earlier. What is the most likely diagnosis?
A. Dysthymia
B. Cyclothymia
C. Depression

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

41. A 65 year old man has haematamesis , endoscopy shows duodenal ulcer which was injected. He
had a further haematemesis and his BP dropped to 100/60mmHg. His haemoglobin is 6, MCH is
25pg, MCH conc. is 35g/dl, MCV is 85. What is the most appropriate initial management?
A. Defer operation and investigate
B. Fresh frozen plasma (FFP)
C. Vit K injections
D. Proceed with planned surgery
E. Immediate blood transfusion, stabilise and proceed to surgery

42.. A 20 year old pregnant, 32/40 weeks by date, presents to the antenatal clinic with a history of
painless per vaginal bleeding after intercourse. On examination: P/A – soft and relaxed, uterus =
dates, CTG is reactive. Choose the SINGLE most likely diagnosis.
A. Abruption of placenta secondary to pre- eclampsia
B. Ante partum haemorrhage
C. Placenta previa
D. Preterm labour
E. Placenta percreta

43. A 17 year old girl took 14 tablets of PCM. After 4 hrs the PCM levels in are above the treatment
level curve. What will you do for her management?

A. Observe and give basic care

B. Nalaxone
C. Refer to Psychiatrist
D. N. Acetylcystine
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44. A 22year old man says that he can hear the voice of his deceased uncle telling him that he is being
spied on. The patient is distressed by this and is becoming low in mood and anxious and has not left
the house for 2weeks. He is starting to drink increasing quantities of alcohol. He is noticed to have
thought-block and passivity phenomena. What is the single most suitable medication to treat his
symptom?
A. Diazepam
B. Disulfiram
C. Fluoxetine
D. Lithium
E. Olanzapine

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

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

47. 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

48. A pregnant lady on her 28 weeks pregnancy presents with BP 160/100mmHg and proteinuria of
0.2 gm/ day. What is your most probable diagnosis?
A. Gestational hypertension
B. Pre eclampsia
C. Eclampsia
D. Chronic hypertension

49. 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
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50. An asymptomatic 35 year old lady with family history of ovarian carcinoma is concerned about
her risk. Her 2 sisters had Ovarian Cancer between the ages of 40 and 45. What is the next step in plan
of management?
A. Pelvic ultrasound
B. CA 125
C. Genetic testing and counselling
D. Return if symptomatic
E. Reassurance

51. A 49 year old obese patient presents with right hypochondriac pain. Investigations show a big gall
stone. What is the most appropriate management?
A. Laparoscopic Cholecystectomy
B. Reassure
C. Low fat diet
D. Ursodeoxycholic acid
E. Emergency Laparotomy

52. A 28 year old woman comes with sudden onset of vomiting and pain per abdomen. On
examination mobile swelling in the right iliac fossa was found. What is the most probable diagnosis?
A. Ectopic pregnancy
B. Tubo-ovarian abscess
C. Acute appendicitis
D. Ovarian torsion
E. Diverticulitis

53. A 78 years old lady has been on Tamoxifen for 3 years. Now she presents with a heavy vaginal
bleeding but clinical examination shows no obvious abnormality. What is the most definitive
investigation for this lady?
A. Transvaginal scan
B. Pap smear
C. Endometrial sampling
D. Colposcopy
E. Hysteroscopy and biopsy

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

55. A 55 year old man has taken an overdose of his antidepressant medication. He presents with dry
mouth, blurred vision, urinary retention and constipation. What is the most appropriate investigation
to be done?
A. Thyroid function tests
B. EEG
C. Creatinine clearance
D. ECG
E. CT
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56. A 30 year old professional athlete presents with amenorhea of 7 months duration. What is the
Single most likely cause from the following options? FSH 8, LH 6, Oestradiol 80, Prolactin 600.
A. Premature ovarian failure
B. Hypothalamic failure
C. PCOS
D. Prolactinoma

57. 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

58. A 56 years old lady presents with hot flushes. She had hysterectomy 2 years ago. She smokes
cigarettes. What will you give her for her symptoms?
A. Oestrogen and progesterone HRT
B. Oestrogen only HRT
C. Raloxifen
D. Bisphosphonates
E. Clonidine

59. A couple are expecting their second baby. They have one son who has haemophilia A. What is the
likelihood of their second child also being born with haemophilia?
A. 25%
B. 50%
C. 75%
D. 100%
E. No likelihood

60. 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

61. A patient presented with atrophy of the thenar eminence, difficulty in abduction of the thumb and
paresthesia on the palmar aspect of the lateral three and half fingers. Which nerve is affected?
A. Radial nerve
B. Ulnar nerve
C. Median nerve
D. Axillary nerve
E. Posterior Interosseous Nerve

62. A 27 year old lady on Doxycycline for PID now complains of nausea, indigestion and abdominal
pain. What advice should you give to her?
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A. Take Doxycycline after meals

B. Take Doxycycline before meals
C. Reassure
D. Add antiemetic
E. Add antacid

63. A man had a soft mass on his mandible. Mass is freely mobile and has started growing
progressively over the past six months. The mass still moves freely. What is the best investigation for
this patient?
A. Fine-needle aspiration cytology (FNAC)
B. CT scan
C. X ray
D. Magnetic resonance imaging (MRI)
E. Erythrocyte sedimentation rate (ESR)

64. DA middle aged lady was lying the bed sheet when her index finger got stuck in between the bed
and mattress. She is unable to extend her proximal interphalangeal joint. What is the most appropriate
management?
A. Twin plaster the finger
B. Cast
C. Sling
D. Splint the finger

65. A 67 year old man with long standing constipation presents with sudden onset of confusion. What
is the treatment of choice?
A. Sodium picosulpahte
B. Danthron
C. Phosphate enema
D. Methylcellulose
E. Bran

66. A 20 year old young woman present with pain and swelling on the right side of the face. She said
her pain increases most often after taking meal. What is the most appropriate diagnosis for the
presenting complain?
A. Submandibular calculus
B. Parotid infection
C. Dental carries
D. Otitis media

67. 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

68. 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?
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A. Reassure
B. Tetanus toxoid and immunoglobulin
C. Full course of DPT
D. Tetanus Immunoglobulin only

69. A 24 year old man presents to Accident & Emergency after his friends noticed his sclera turning
yellow. This happened after he had been taking paracetamol for a few days for an upper respiratory
tract infection. What is the single best cause for jaundice in him?
A. Gilbert’s syndrome
B. Criggler-Najjar syndrome
C. Glucose 6 phosphate dehydrogenase deficiency
D. Hereditary Spherocytosis
E. Hereditary Elliptocytosis

70. 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

71. A young male met with a RTA and is suspected to have a femur fracture. His BP is 90/60mmHg.
What is the next best immediate action?
A. X ray
B. IV fluids
C. Put leg splint
D. Send bloods for investigation
E. US

72. Patient in the post surgical ward develops calf pain and redness following open reduction and
internal fixation of fracture of the femur sustained after an RTA. What is the most likely cause of his
symptoms?
A. Fat embolus
B. DVT
C. Cellulitis
D. Reaction to drugs

73. A lady developed breast abscess after delivery. What is the most likely organism?
A. Staph aureus
B. Staph albus
C. Group B streptococcus
D. Strep pyogenes
E. Strep faecalis

74. Half of a group of observations lies above this level and it is particularly important if the
distributions non normal. Choose the single term from the list of options given.
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A. Chi squared (X²) test

B. Linear regression
C. Mean
D. Median
E. Mode

75. A 50 year old man presented with acute onset of severe breathlessness and cough with pink, frothy
sputum. He is a known case of IHD. What should be the first step?
A. Give IV Furosamide
B. Give supplemental Oxygen
C. Give nitrates
D. Give opiates

76. 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

77. A 60 year old smoker presents with cramp-like pain in the calves relieved by rest and non-healing
ulcers. On examination cold extremities with lack of hair around the ankles, absent distal pulses is
found. What is the most probable diagnosis?
A. Intermittent claudication
B. Chronic ischemia of the limbs
C. Buerger’s disease
D. Deep venous thrombosis
E. Diabetes Mellitus

78. 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

79. A 50 year old woman is diagnosed with ovarian carcinoma. Staging of the disease is
determined by drainage to which of the primary lymph node groups first?
A. Inguinal nodes
B. Internal iliac
C. Para aortic
D. Obturator nodes

80. A 60 year old diabetic complains of pain in thigh and gluteal region on walking up the stairs for
the last 6 months. She is a heavy smoker and has ischemic heart disease. What is the most appropriate
diagnosis?
 14

A. ThromboangitisObliterans
B. Sciatica
C. DVT
D. Atherosclerosis
E. Embolus

81. A 70 year old man presents with a punched out ulcer between his toes. He is a heavy drinker and
smoker. On examination ulcer is yellow and the foot turns red when dangling off the bed. What is the
single most likely diagnosis?
A. Arterial ischemia ulcer
B. Malignancy
C. Neuropathic ulcer
D. Pressure ulcer
E. Venous stasis ulcer

82. A 15 years old female presents with right iliac fossa pain every 4-8 weeks which is very severe in
the recent weeks. What is the most likely diagnosis?
A. Miscarriage
B. Ectopic pregnancy
C. Ovarian cyst
D. Torsion of ovarian cyst
E. Pelvic Inflammatory disease

83. A 24 years old schizophrenic has been under antipsychotic treatment for the last 1 year and now
complains of erectile dysfunction. Which drug is most likely to have caused this effect?
A. Fluoxetine
B. Citalopram
C. Clozapine
D. Haloperidol
E. Risperidone

84. A 70 year old man presented with muscle weakness and inability to climb the stairs. Investigation
shows Creatinine phospokinase (CPK) is very raised. ESR 15mm/hour. What is the most likely
diagnosis?
A. Polymyositis
B. Polymyalgia rheumatica
C. Reactive arthritis
D. Rheumatoid arthritis
E. Duchenne's muscular dystrophy

85. 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

86. A new born baby, born 3 hours ago, 48 hours after premature rupture of membranes at 36 weeks
gestation, has nasal flaring, normal temperature and intercostal recessions. What is the single most
likely investigation that should be done before commencing treatment?
 15

A. Chest X-ray
B. Blood Glucose
C. Blood Culture
D. Echocardiogram
E. Electrocardiogram

87. A 25 year old man has been suffering from breathlessness and wheeze for 3 months. He has been
taking salbutamol 2 puffs –as- required. In the last 2 weeks his symptoms have worsened, and he has
to take salbutamol more frequently during the day time. He also complains of excessive dyspnoea at
night. What drugs or regimen would you like to add?
A. Prednisolone (oral)
B. Fluticasone + Salbutamol (inhaled)
C. Beclometasone (inhaled)
D. Montelukast (oral)
E. Salmetrol (oral

88. This is the measure of depression of a set of values. Choose the single term from the list of options
given.
A. Standard deviation ( root mean square deviation)
B. Specificity
C. Sensitivity
D. Probability
E. Prevalence

89. A 14 year old girl with short stature and no secondary sexual characteristics developed. What is
your most probable diagnosis?
A. Turners
B. Constitutional delay
C. Klinefilters syndrome
D. Testicular feminisation syndrome

90. A 18 month old girl who has a single urinary tract infection is seen in outpatients. She had fever
and vomiting but these improved with a course of trimethoprim. Urine culture became negative.
Subsequently a micturatingcystogram showed bilateral vesico-ureteric reflux. What advice should you
give to the parents?
A. No treatment required
B. Oxybutinin
C. Ureteric Surgery
D. Give trimethoprim
E. Prophylactic antibiotics

91. A 2year old child aspirated a foreign object which was removed at the hospital. The parents are
now asking how to remove it if that ever happens at home.
A. Hemlich manoeuvre D. CPR
B. Bring back to the hospital. E. Remove manually by fingers
C. Turn the child on his back and give thumps

92. 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
 16

A. Chi squared (X²) test

B. Linear regression
C. Mean
D. Median
E. Mode

93. A 28 year old shipyard worker was admitted for pain in calf while at work which has been
increasing over last 3 months. There is no history of hypertension or diabetes but he is a smoker. On
examination, he has loss of posterior tibial and dorsalispedis pulsations along with a non-healing ulcer
at the base of right 1st MCP joint. What is the most probable diagnosis?
A. ThromboangitisObliterans
B. Sciatica
C. Deep Vein Thrombosis
D. Baker’s cyst
E. Embolus

94. A 34year old man was involved in a RTA and whilst in the ambulance his GCS deteriorated and
RR increased from 30-48bpmin. What is the most appropriate management for this patient?
A. IV fluid
B. Needle thoracocenthesis
C. 100% oxygen
D. Portable XR

95. A 60 year old man was brought in by his wife complaining of ataxia, urinary incontinence and
erectile dysfunction. He also complains of rigidity and slowing of movement with a pill-rolling tremor
of the hands. What is the most likely diagnosis?
A. Parkinson's Disease D. Huntington's disease
B. Idiopathic Parkinson's Disease
C. Shy-Drager Syndrome

96. Prenatal screening is recommended if ultrasound scan at 16 weeks confirms that the foetus is male
and the mother has had an affected son previously. Choose the single most likely condition from the
following list of options.
A. Duchene muscular dystrophy
B. Cystic fibrosis
C. Spina bifida
D. Down’s syndrome
E. Spinal muscular atrophy

97. 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

98. A young man comes with back pain and occasional painless haematuria. What is the most
likely pathology?
 17

A. Ca. Bladder
B. Ca. Prostate
C. Nephropathy
D. Uretric Calculi

99. 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

100. A 28 years old man returned from holiday presents with pain in the superior and posterior part
of the scrotum. Which is the best investigation to confirm the diagnosis?
A. MSU culture and sensitivity
B. USG of the scrotum
C. Semen analysis
D. Serology
E. CT scan of the pelvis

101. A pregnant patient with RH negative who hasn’t been previously sensitized delivers her first
baby without any problems. What would be the latest time to administer anti sensitization?
A. 6 hours post partum
B. 24 hours post partum
C. 48 hours post partum
D. 72 hours post partum
E. 5 days post partum

102. A man with a family history of panic disorder is brought to the hospital with palpitations,
tremors, sweating and muscles tightness on 3 occasions in the last 6 weeks. He doesn’t complain of
headache and his BP is within normal limits. What is the single most appropriate long-term treatment
for him?
A. Diazepam
B. Olanzapine
C. Haloperidol
D. Fluoxetine
E. Alprazolam

103. 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

104. A 85 year old man fell down and hit his head. 5 days later he came back with confusion. Which
is the most likely site of bleeding?
 18

A. Middle meningeal artery

B. Internal cerebral artery
C. Cerebral vein plexus
D. Berry aneurysm

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

106. A 7 years old child presented with chronic cough and is also found to be jaundiced on
examination. What is the most likely diagnosis?
A. Congenital diaphragmatic hernia
B. Congenital cystic adenomatoid malformation
C. Bronchiolitis
D. Respiratory distress syndrome
E. Alpha 1 antitrypsin deficiency

107. A male patient presents with recurrent pain in feet and ankle joints. On X-Ray there were
punched out lesions, with erosions. What is the most probable diagnosis?
A. Pseudogout
B. Gout
C. Osteoarthritis
D. Rheumatoid arthritis

108. A 46 year old man who is a heavy drinker is brought to the A&E in a drowsy state. He is
responding vaguely to questions asked. On examination he has nystagmus and hyper-reflexia. His
MCV is 103fL.What is the most likely cause for his cognitive impairment?
A. B1 Deficiency
B. B12 Deficiency
C. Folate Deficiency
D. B6 deficiency
E. Alcohol withdrawal

109. A 70 years old male presents with balance difficulties, vomiting and nausea. Which of the
following is the best investigation?
A. MRI of Cerebellum
B. CT Scan of cerebellum
C. Skull X-RAY
D. Lumbar puncture
E. Blood Culture

110. A 25 year old had an LSCS 24 hours ago for foetal distress. She now complains of
intermittent vaginal bleeding. Observations include saturations 98% in air, blood pressure 124/82
mmHg, pulse 84 beats/min and temperature 37.8oC. The midwife tells you that she had a retained
placenta, which required manual removal in the operating theatre. Choose the most appropriate post
C-Section complication in this case?
 19

A. Retained products of conception

B. Aspiration pneumonitis
C. Endometritis
D. Uterine rupture
E. Disseminated intravascular coagulation

111. 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

112. An 18 years old lady in her 30th week of pregnancy is brought to the hospital in altered
sensorium. She is taking slow, shallow breaths and her breath has a fruity smell. An ABG analysis
shows a pH of 7.20. Urine shows the presence of ketones. What is the most probable diagnosis?
A. Hyperglycaemic Hyperosmolar Nonketotic Coma (HONK)
B. Diabetic Ketoacidosis (DKA)
C. HELLP syndrome (Hemolysis, elevated liver enzyme levels, and low platelet levels)
D. Pregnancy-Induced Hypertension (PIH)
E. Gestational Diabetes Mellitus

113. A 23 year old woman has been having pain at the base of her thumb, the pain is reproduced when
lifting her 3 months old baby or changing diapers and also with forceful abduction of the thumb
against resistance . What is the most likely cause?
A. Avascular necrosis of the scaphoid
B. Trigger finger
C. De Quervain’s tenosynovitis
D. Mallet finger
E. Gamekeepers Thumb

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

115. A 24 year old college student presents with nausea, vomiting, headache, neck stiffness and a
fever of 38.4˚C. What is the most appropriate empirical antibiotic to be started?
A. Cefotaxime
B. Penicillin
C. Gentamicin
D. Tazobactam
E. Meropenem
F. Rifampicin
 20

116. A 9 year old boy presented with complains of nocturnal cough and shortness of breath, chest
tightness plus wheeze after playing football. His father has eczema. What is the most appropriate
investigation?
A. CXR
B. Pulmonary function tests
C. High-Resolution Chest Tomography (HRCT)
D. Sweat test

117. A 2 year old boy with 38.4°C fever had an episode of tonic clonic seizure at home that lasted for
15 minutes. In A&E patient is conscious and fit has stopped. When temperature was checked, it was
normal. What is most probable diagnosis?
A. Febrile convulsion
B. Infantile spasm
C. Absence seizure
D. Grandmal Epilepsy
E. Focal seizure

118. Which of the following is NOT a physiological change during pregnancy

A. Tidal volume 500ml.
B. Red cell volume 1.64L.
C. Cardiac output 6.5L/min.
D. Uterus weight 1.1Kg.
E. ESR up by 4 folds

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

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

121. 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

122. A patient had closed tibial fracture. Cast was applied. Four days later, he presented to the clinic
with complaint of pain over fractured area. On examination limb is warm with good pulses. What will
you do next?
 21

A. Remove cast
B. Fasciotomy
C. X- ray
D. Increase analgesics
E. Reassure

123. A 37 years old woman believes that her neighbours have been using her shower while she is
away from home. Her 42 years old partner is convinced about this and calls the police. What term best
describes this situation?
A. Capgras Syndrome
B. Cotard Syndrome
C. Delusion of Persecution
D. Folie a Deux
E. Munchausen Syndrome

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

125. 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

126. A patient comes with complaints of reflux and abdominal pain on and off for many months.
Endoscopy shows multiple ulcerations in gastric and duodenal muscosa with mucosal changes in the
oesophagus. What is the single most likely investigation to be done next?
A. Serum Gastrin
B. USG
C. Urea Breath test
D. Oesophageal pH monitoring

127. 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

128. A woman had an emergency LSCS 7 days ago. She now presents with fever and excessive
vaginal bleeding. What is the single most likely diagnosis?
 22

A. Endometriosis
B. Endometritis
C. Vaginal infection
D. Retained placenta

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

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

131. A 24 year old woman has eight weeks amenorrhoea, right sided pelvic pain and vaginal bleeding.
She is apyrexial. Peritonism is elicited in the right iliac fossa. Vaginal examination reveals right-sided
cervical excitation. What is the most probable diagnosis?
A. Ectopic Pregnancy
B. Salpingitis
C. Endometriosis
D. Ovarian Torsion
E. Ovarian tumor

132. 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
B. Acute pelvic inflammatory disease
C. Endometriosis
D. Ectopic pregnancy
E. Urinary tract infection

133. A lady comes with severe liver disease and hematemesis. Her INR is more than 10. What should
she be given?
A. Fresh Frozen Plasma
B. Steroids
C. Whole blood
D. IV Fluids
E. Vitamin K
 23

134. A 40 year old woman requests post coital contraception. Her condom broke 36 hours ago. On 7th
day of regular 29th day of cycle this is her 2nd condom accident in 2 months. She has tried OC pills
but stopped it 6 months ago because of concerns about weight gain. She is undecided about future
contraceptive use. Her pregnancy test is -ve. Which is the most effective form of contraception for
her?
A. OC pills
B. POP pills
C. IUS or Mirena coil
D. IUCD

135. A 20 year old lady has got brother and sister and all of them have got adenomatous polyposis.
Which cancer are they most likely to develop?
A. Gastric carcinoma
B. Colorectal carcinoma
C. Lymphoma
D. Duodenal lymphoma

136. 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

137. A 30 year old man with complaints of left sided abdominal pain was diagnosed with gastric
ulcer. On USG incidental finding of gall bladder stone was noted. What is the most appropriate
management?
A. Lap Cholecystectomy
B. Statins
C. No treatment
D. Lithotripsy

138. A 36 year old gravida 1 woman with gestational age of 30 weeks was brought to A&E as she
started to have bleeding from vagina. The bleeding was fresh and painless and was not preceded by
trauma. On examination her abdomen was not tender, BP was 90/60mmHg, pulse rate was 130/min,
US shows low lying placenta, CTG shows normal fetal heart sounds. How will you best manage this
patient
A. IV fluids → Blood trandfusion → delivery
B. IV fluids → blood transfusion→ investigations → delivery
C. Investigations→ IV fluids→ blood transfusion→ delivery
D. Deliver baby immediately

139. A 23year old man feels anxious and agitated when faced with stress. He has an interview in
3days and would like some help in relieving his symptoms. What is the most appropriate
management?
A. SSRI
B. CBT
C. Propranolol
D. Diazepam
 24

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

141. A 50 year old man presents with headache, fever, and neck stiffness. His heart rate is 50,
respiratory rate is 28 and Blood Pressure is 210/110mmHg. What is the single most appropriate
treatment?

A. Dexamethasone
B. B-Blocker
C. Adrenaline
D. Mannitol
E. IV fluids

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

143. A random study on Pulmonary Embolism shows:

A. 10 patients out of 1000 died who did not get the treatment.
B. 5 patients out of 100 died who got proper treatment.
Choose the single most likely absolute risk for each of the above mentioned study.
A. Absolute risk 5%
B. Absolute risk 10%
C. Absolute risk 2%
D. Absolute risk 15%
E. Absolute risk 20%

144. Infection of which of the following areas in the face will lead to pre auricular lymph node
enlargement?
A. Mastoid area
B. Mandibular area
C. Pinna of the ear
D. Upper eyelid

145. A 1 year old boy has been bought to the accident and emergency department with diarrhoea
and vomiting for 5 days. For the past 24 hours he has been unable to tolerate and fluids. In the last
hour he has become drowsy, his skin turgor is reduced and his skin is mottled. His eyes are sunken.
His heart rate is 180 beats/minute and his capillary refill is prolonged. What is the single most
appropriate immediate treatment?
 25

A. IV fluid bolus over 20 minutes

B. IV fluids over 24 hours
C. IV rehydration over 48 hours
D. Nasogastric rehydration over 24 hours
E. Oral rehydration solution over 48 hours

146. A 50 year old man presents with decreased body mass, mixed iron and folic acid deficiency, and
diarrhoea after recent travelling abroad to Barbados. He is also stating that his stools are smelly and
difficult to flush away. What is most discriminative investigation?
A. Blood cultures
B. Thyroid function tests (TFTs)
C. Serum calcium
D. CT scan
E. Jejunal biopsy

147. Young female, returning from USA to UK developed shortness of breath and productive cough
which initially contained blood, but now is dry. She is taking COCPs. What is the most likely
diagnosis?
A. Pneumonia
B. Pulmonary embolism
C. Pulmonary TB
D. PCP

148. 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

149. An African woman 32 year old comes to the sexual clinic with a history of heavy menstrual
bleeding and dysmenorrhoea. What is the most likely cause?
A. Fibroid
B. Ectopic pregnancy
C. Endometriosis
D. PID
E. Adenomyosis

150. A man has been brought into Accident & Emergency for alternating episodes of over activity and
depression. What is the most likely diagnosis?
A. Dysthymia
B. Bipolar affective disorder
C. Cyclothymia
D. Mania
E. Phobia

151. A 25 year old woman , 38 weeks pregnant , presents with blood pressure of 160/100 and +++
proteinuria . Her AST was 35 and ALT of 40. HB =12.7 g/dl. WBC count of 8×109 Platelet count of
115×109. What is your diagnosis?
 26

A. Eclampsia
B. Preeclampsia
C. HELLP
D. Acute hepatitis

152. 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

153. A middle aged man presents with bilateral pitting pedal edema and ascites, raised JVP. The
ascitic fluid is found to be transudate. Choose the most likely cause of ascities.
A. Liver cirrhosis
B. Bacterial peritonitis
C. Congestive cardiac failure
D. TB peritonitis

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

155. A 58 year old man presented with chest pain, breathlessness and weight loss. He is a non-
smoker and is a shipyard worker. CXR is shown below. What is the most probable diagnosis?
 27

A. Lung cancer
B. Mesothelioma
C. Pneumonia
D. T.B

156. A 65 year old female patient was given Tamoxifen, which of the following side effect caused by
it will concern you?
A. Fluid retention
B. Vaginal bleeding
C. Loss of appetite
D. Headache and dizziness

157. 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.

158. A 27 year old presents with abdominal pain, bleeding, vomiting and diarrohea. Her last
menstrual period was 7 weeks ago. On examination abdomen is tender and BP is 90/60mmHg. What
is the next appropriate management?
A. Immediate laparotomy
B. Laparoscopy
C. Salpingotomy
D. Salpingectomy
E. Metotrexate

159. 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

160. 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
B. Hypernatremia
C. Hyponatremia
D. Hypokalemia
E. Hypercalcemia

161. A 16 year old girl is brought to the hospital by her parents as they are worried about her poor
appetite and her rigorous exercise regimen. And she does not think there is anything wrong with her
eating habits. She says she is overweight which is why she follows such a strict diet and exercise
regimen. What is your next line of management? The girl’s Height- 165cm. Weight- 33kg
 28

A. Reassure parents
B. Detain under mental health Act
C. Eating disorder clinic
D. Psychodynamic Therapy

162. A patient with severe pre eclampsia has just delivered a baby at 37 weeks gestation. 20min after
delivery she has her first fit. Her blood pressure is 160/90 mmHg. An IV line is established. What will
you administer?
A. MgSO4 drip
B. Hydralazine
C. Methyldopa
D. MgSO4 bolus dose
E. Calcium Gluconate

163. A 57year old man with blood group A complains of symptoms of vomiting, tiredness, weight
loss and palpitations. On examination the patient has hepatomegaly, ascites, palpable left
supraclavicular mass. What is the most likely diagnosis?
A. Gastric carcinoma
B. Colorectal carcinoma
C. Peptic ulcer disease
D. Atrophic gastritic
E. Krukenburgtumor

164. A 60 years old man brought to A&E department with fracture of hip; he is deaf and has
bilateral pedal oedema. What is the SINGLE most probable diagnosis?
A. Paget’s disease
B. Osteoporotic fracture vertebrae
C. Secondary
D. Multiple myeloma
E. Spondylosis

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

166. 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?
 29

A. Haemophilia
B. Von willibrand disease
C. ITP
D. Vit K deficiency

167. 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
B. IV Adenosine
C. IV Amiodarone
D. IV Digoxin

168. A female with type1 diabetes would like to know about any deficiency of vitamins in pregnancy
that can be harmful. A deficiency of which vitamin can lead to teratogenic effects in the child?
A. Folic acid
B. Vit B12
C. Thiamine
D. Riboflavin
E. Pyridoxine

169. A post gastrectomy patient was on 60mg Morphine. Pain was well controlled with it but
patient is not able to swallow. What is the next appropriate step in management?
A. 60 mg per day SC Morphine
B. 100mg SC Morphine
C. 120mg SC Morphine
D. Fentanyl patch

170. A 30 year old woman has been feeling low and having difficulty in concentrating since her
mother passed away 2 months ago. She feels lethargic and tends to have breathlessness and tremors
from time to time. What is the most likely diagnosis?
A. Adjustment Disorder
B. Post-traumatic stress disorder (PTSD)
C. Panic Disorder
D. Generalized anxiety disorder (GAD).
E. Bereavement

171. An 8 month old child had a congenital heart murmur which disappeared at the age of one. What
is the most likely diagnosis?
A. Ventricular Septal Defect
B. Atrial Deptal Defect
C. Patent DuctusArteriosus
D. Innocent Murmur
E. Mitral Regurgitation

172. A 24year old lady has been low after the death of her husband and had stopped contacting her
family. She was started on SSRI treatment and started feeling better after a few months. On
discontinuing the medications she started feeling as though she has developed cancer just like her
husband. What is the most appropriate next step in this case?
 30

A. Continue SSRI
B. Add TCA
C. Neuropsychiatric analysis
D. CBT
E. Antipsychotics

173. A lady underwent debulking surgery for ovarian carcinoma. Soon after the surgery she presents
with signs of intestinal obstruction. What is the Single most appropriate investigation?
A. Pelvic CT
B. CA 125
C. Laparotomy
D. Laparoscopy
E. Abdominal USG

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

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

176. 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.

177. A 20 year old woman is 17 weeks pregnant. She is worried about the possibility of her baby with
spina bifida as she did not take folic acid supplement before conception and in early pregnancy .
A. Pre-implantation genetic diagram
B. Aminocentesis
C. Chorionic villus sampling (CVS)
D. Fetalcordocentesis
E. Genotyping fetal cell in Maternal circulation
F. Ultrasound scan at 18-20 week gestation

178. A patient with hepato-cellular carcinoma has raised levels of the ferritin. What is themost
probable cause?
 31

A. Haemochromatosis
B. A1 antitrypsin deficiency
C. Cystic fibrosis
D. Wilsons
E. Primary Biliary Cirrhosis

179. An 80 year old woman who is on MR Morphine 60mg had to increase it to 120mg twice a day
and again with extra 10mg oral Morphine6 times a day. What is the best form of management?
A. Subcutaneous Morphine infusion
B. Fentanyl patches
C. Change to Oxycodone
D. Increase to 200 mg bd orally
E. 90mg MR Morphine plus 30mg every 4 hours

180. A family with a baby who has a cousin who died from cot death recently, mother asks for advice.
What advice will you give the mother?
A. Child should sleep on the back with legs towards the end of the cot
B. Child should sleep on the front with the legs towards the end of the cot
C. Child should sleep on the back with the head towards the end of the cot
D. Child should sleep on the front with head towards the end of the cot
E. Reassure

181. A woman with primary breast ca with metastasis to the brain is on Dexamethasone. However she
starts to develop symptoms of increased thirst and micturition after a while. What is the best course of
action to be taken?
A. Stop dexamethasone
B. Start oral hypoglycaemics
C. Start long acting insulin
D. Short acting before meals
E. Combination of long and short acting insulin

182. A child has hypothyroidism. What feature is associated with it?

A. Microglossia
B. Prolonged neonatal jaundice
C. Un-descended testis
D. Anal tag
E. Cleft soft palate

183. A 45 year old man with history of recurrent ascites which is exudative in nature. On abdominal
paracenthesis numerous neutrophils are found in ascites fluid. Choose the most likely cause of ascites.
A. Liver cirrhosis
B. Bacterial peritonitis
C. Congestive cardiac failure
D. TB peritonitis

184. A 32 year old woman has severe right sided abdominal pain radiating into the groin which has
lasted for 3hrs. She is writhing in pain. She has no abdominal signs. What is the most likely cause of
her abdominal pain?
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A. Appendicitis
B. Ruptured ectopic pregnancy
C. Salpingitis
D. Ureteric colic
E. Strangulated hernia

185. A woman with breast cancer is likely to be started on hormonal therapy. Which factor will affect
the prognosis of hormonal therapy?
A. ER receptor (estrogen receptor)
B. Lymph node involvement
C. Tumour grade
D. PR receptor (progesterone receptors)

186. A 50 year old man with pain in the right leg and bowing of tibia. Alkaline phosphatase is
1000u/L. Calcium levels are normal. Imaging showed trabecular pattern of the bone. What is the most
likely diagnosis?
A. Paget’s disease of bone
B. Osteosarcoma
C. Metastatic disease
D. Multiple Myeloma

187. What is the sign of life is threatening Asthma?

A. Deteriorating level of consciousness
B. Respiratory rate > 25
C. Hear rate > 100
D. Bilateral wheeze
E. PEFR is 50%

188. A 3 years old child had a high temperature for four days and he had not seen a doctor. Then
mother notices rashes on buccal mucosa and some around the mouth. What is the most appropriate
diagnosis?
A. Measles
B. RoseolaInfantum
C. Rubella
D. Chicken Pox
E. Impetigo

189. A 77 years old woman presents with vesicular rash on the left side of her face, vertigo, deafness
and Bell’s palsy. What is the most probable diagnosis?
A. Acoustic Neuroma
B. Trigeminal Neuralgia
C. Viral Labyrinthitis
D. Ramsay Hunt syndrome
E. Otitis Externa

190. An 80 year old lady who was lying on the floor is brought to the A&E by her daughter, she is
confused, has palpitations and she is known epileptic. On enquiry daughter says she is on medication
which she is not aware of. What is the underlying cause?
A. TCA D. Carbamezepine
B. MAOI E. Diazepam
C. SSRI
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191. A 20 years old pop star singer complains of inability to raise the pitch of her voice. She attributes
this to the thyroid surgery she underwent a few months back. What is the most probable diagnosis?
A. Thyroid Storm
B. Bilateral Recurrent Laryngeal Nerve Injury
C. Unilateral Recurrent Laryngeal Nerve Injury
D. External Laryngeal Nerve Injury
E. Thyroid cyst

192. 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 hoip, 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 ANS
E. Prolapsed inter-vertebral disc at L2-L3

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

194. A 22 year old man presents with red hot swollen metatarsal phalangeal joint pain, sacroilitis and
onycholysis. What is the single most likely cause of this condition?
A. Gout
B. Psoriatic arthritis
C. Rheumatoid arthritis
D. Septic arthritis

195. A 4 year old boy presents with bleeding from nose, bleeding time is increased. What is the
most likely diagnosis?
A. ITP
B. Haemophilia
C. HSP
D. Von-willbrand disease

196. A 43 year old man was involved in an RTA. On examination, there was absent air entry on the
right side, tracheal deviation to the left and a dull percussion note on the right. BP is 80/60mmHg and
pulse is 120/beats per min. CXR shows a diffuse opacity on the right side obscuring the right costo-
phrenic angle. What should be the most appropriate immediate management?
A. Needle aspiration on the right side
B. needle decompression on the right side
C. insertion of chest drain on the right side
D. Give 100% oxygen and fluid resuscitation with 2 large bore IV-lines
 34

197. A 70 year old woman has been diagnosed with Type 2 Diabetes. Her body mass index is
22kg/meter square. Random plasma glucose concentrations are 8mmol/l and 10mmol/l. Her BP is
130/80mmHg and her fasting cholesterol is 5.7mmol/l. She is currently symptom free but has micro
albuminuria. What is the single most appropriate drug management?
A. Ace inhibitor and metformin
B. Ace inhibitor and glibenclamide
C. Statin and Ace inhibitor
D. Statin and Metformin

198. A 62 year old man has multiple liver metastases due to adenocarcinoma with an unknown
primary. He is deeply jaundiced and has ascites, with oedema of his legs up to the buttocks. He is now
drowsy and his family are worried that he is not drinking enough. His medication includes:
Haloperidol 1.5 mg and Lactulose 10 ml. Blood taken three days ago showed:
Normal electrolytes Urea 6.5 mmol/L
Creatinine 89mmol/L
Calcium 2.04mmol/L
Albumin 17g/L Total bilirubin 189 mmol/L
What is the SINGLE most appropriate management of his fluid intake?
A. Albumin infusion
B. Crystalloid fluids (continuous intravenous)
C. Crystalloid fluids (intermittent subcutaneous)
D. Fluids Via nasogastric tube
E. Oral fluids

199. 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 tachyarrhythmias 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

200. 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