Mock 2

SAMSONPLAB ACADEMY LIMITED

BOW BUSINESS CENTRE
BOW ROAD 153-‐159
E3 2SE
LONDON
EMAIL: info@samsonplab.co.uk
TELEPHONE: 02089800039 : MOBILE: 07940433068
PLAB 1 MOCK 2 2nd JUNE 2013
1. A 38-‐year-‐old man with type 1 diabetes has been vomiting for 8 hours.
He is clinically dehydrated with a blood pressure of 90/60mmHg. His
capillary blood glucose is 18.5mmol/l. What is the single most relevant
initial investigation?
a. Arterial blood gases
b. Full blood count
c. Haemoglobin A/C
d. Liver function tests
e. Serum urea concentration

2. A 25-‐year-‐old woman has been told that her cervical smear shows mild
dyskaryosis (CIN 1). She wants to know what she can do to reduce the
risk of cervical cancer. She takes the oral contraceptive pill, smokes 20
cigarettes a day and drinks an average of 10 units of alcohol per week.
She is slightly overweight but is normotensive. What is the single most
important advice to give this woman?
a. Avoid tampon use
b. Discontinue the oral contraceptive pill
c. Loser weight
d. Reduce alcohol intake
e. Stop smoking

3. A 62-‐year-‐old man who was admitted for minor surgery 3 days ago
suddenly becomes confused. His attention span is reduced. He is restless
and physically aggressive and picks at his bed sheets. What single aspect
of the patient’s history received in his notes is most likely to aid in
making a diagnosis?
a. Alcohol consumption
b. Head trauma
c. History of anxiety
d. Prescribed medication
e. Obvious cognitive impairment

4. A 5-‐year-‐old girl who suffered from extensive burns has returned to the
general ward after 2 weeks in the intensive care unit (ICU). She has a
large haematemesis. Full blood count and coagulation screen are
normal.
a. Coagulation screening
b. Computed tomography scan (CT) scan
c. Barium study of upper GI tract
d. Discriminate between fetal and maternal blood cells (APT test)
e. Endoscopy

5. A 7-‐year-‐old boy has coffee ground vomit and previous unexplained nose
bleeds. He is systemically well with no abdominal tenderness. His full
blood count is normal.
a. Full blood count
b. Coagulation screen/clotting screen
c. Liver function tests
d. Ultrasound scan of the abdomen
e. X-‐ray of the abdomen

6. A 2-‐week-‐old boy born with caesarean section because of placental
abruption vomits altered blood. He is well hydrated and systemically
well.

e. Endoscopy

7. A 4-‐week-‐old boy born at home has blood stained vomiting for the first
time.
He is breast-‐fed and his stools are dark. He is jaundiced and there is
blood oozing from his umbilical cord.
a. Full blood count
b. Clotting screen
d. Ultrasound of the abdomen
e. X-‐ray of the abdomen

8. A 1-‐year-‐old boy has had intermittent vomiting since 3 months of age. He
is thriving and his vomit occasionally contains blood.
e. Endoscopy

9. A 30-‐year-‐old woman has a painless lump in the outer aspect of her
breast. She has had a previous breast lump. Her grandmother had breast
cancer at 70 years of age. She has a 1cm x 1cm smooth, firm, discrete,
mobile lump in the outer quadrant region of her left breast. What is the
single most likely diagnosis?
a. Breast abscess
b. Breast carcinoma
c. Breast cyst
d. Fibroadenoma
e. Sebaceous cyst

10.A 38-‐year-‐old woman in her 1st pregnancy at 16 weeks gestation is very
anxious about the possibility of chromosomal abnormalities in her baby.
What is the single best test to give a definitive diagnosis?
a. Amniocentensis
b. Chorionic Villous Sampling
c. Maternal alpha feto protein
d. Nuchal fold thickness
e. Parental karyotype

11.A 1-‐year-‐old boy has been brought to the emergency department with
diarrhoea and vomiting for 5 days. For the past 24 hours he has been
unable to tolerate any 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 180beats/minute and his capillary refill is prolonged. What
is the single most appropriate immediate treatment?
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

12.A 25-‐year-‐old woman has developed lassitude, breathlessness, purulent
sputum and palpitations over a 24-‐hour period. She has a pulse rate of
88beats/minute. Her electrocardiogram (ECG) shows sinus rhythm.
a. Cardiac enzymes
b. Chest X-‐ray
c. Echocardiogram
d. Plasma glucose concentration
e. Serum urea and electrolytes concentration

13.A 44-‐year-‐old woman has lost weight over 12 months. She has also had
episodes where her heart beats rapidly and strongly. Her family has
noticed that she loses her temper easily. She has a regular pulse rate of
90beats/minute. Her ECG shows sinus rhythm.
a. Thyroid auto antibodies

b. Thyroid function tests

c. 24 hour ambulatory taped electrocardiogram (ECG)
d. Cardiac enzymes
e. Chest X-‐ray

14.A 61-‐year-‐old man has been referred to the outpatients department with
frequent episodes of breathlessness and chest pain associated with an
irregular heartbeat. He has a regular pulse rate of 60beats/minute. His
ECG shows sinus rhythm.
a. Cardiac enzymes
b. Electrocardiogram
c. Echocardiogram
d. 24 hours ambulatory taped electrocardiogram

15.A 56-‐year-‐old woman has woken up 5 times in the last month with a
feeling of thumping in her chest. On sitting up for about 2 minutes and
taking a few deep breaths, the sensation subsides over a further minute.
Her ECG shows sinus rhythm.
a. Cardiac enzymes
b. Electrocardiogram
c. Echocardiogram
d. 24 hours ambulatory taped electrocardiogram

16.An 80-‐year-‐old woman has malignant ulcer under 1cm in diameter on
the anterolateral aspect of the left labium major 3cm from the midline. A
biopsy shows penetration of the tumour to 1.5mm. What is the most
likely site for the lymph node metastases?
a. Deep inguinal nodes
b. Ilieocolic nodes
c. Iliac nodes
d. Para-‐aortic nodes
e. Superficial inguinal nodes

17.A 32-‐year-‐old woman has had a febrile illness and swelling of the small
joints of her hands, feet, wrists and knees for 2 days. She has a
maculopapular rash and a few palpable small cervical lymph nodes. She
was preciously well. There is no history of relevant travel overseas. She
has 2 young children. What is the most likely diagnosis?
a. Psoriasis
b. Reactive arthritis
c. Sarcoidosis
d. Systemic Lupus Erythmatosis (SLE)
e. Viral arthritis

18.A 34-‐year-‐old man with multiple sclerosis has taken an overdose of 100
tablets of paracetamol with intent to end his life. He has been brought to
the emergency department for treatment but is refusing all
interventions. What is the single most appropriate next step in the
management?
a. Assessment of suicide intent
b. Commence treatment without consent
c. Establish if patient has a history of mental illness
d. Evaluate patient’s capacity to refuse treatment
e. Evaluate the severity of depression

19.A 56-‐year-‐old man who has been admitted following his 1st seizure denies
a history of weight loss and haemoptysis.
a. Computer tomography (CT) scan of the brain.
b. Echocardiogram
c. Electrocardiogram (ECG)
d. Electroencephalogram (EEG)
e. Liver function tests

20.A 3-‐year-‐old boy has 3 episodes of limb jerking. His teacher has noticed
that at times he does not concentrate in class.
b. Echocardiogram


21.A 45-‐year-‐old man travelling alone has been admitted from the airport to
the emergency department. He is unconscious following a seizure. There
are needles and a syringe in his hand luggage.
a. Lumbar puncture
b. Midstream urine (MSU) for microscopy, culture and sensitivity
c. Plasma glucose concentration
d. Serum electrolytes concentration
e. Skull X-‐ray

22.A 50-‐year-‐old woman has developed jerking in her left hand, which
spread to the rest of his body. A few minutes later, she has a generalised
seizure with loss of consciousness.
b. Echocardiogram

23.A 46-‐year-‐old woman with type 2 diabetes has proteinuria +++,
creatinine concentration of 250mmol/l and a serum haemoglobin (Hb)
concentration of 16g/UL. She has a mild ankle oedema and a blood
pressure of 145/100mmHg. Her abdominal ultrasound examination
shows normal sized kidneys. Urine culture is normal. What is the single
most appropriate drug to include in her long-‐term management?
a. Angiotensin converting enzyme (ACE) inhibitor
b. Beta blocker
c. Calcium channel blocker
d. Loop diuretic
e. Potassium sparing diuretic

24.A 35 year old man has had acute pain and swelling below the mandible
on the left side for 6 hours. The swelling occurred after eating a large
meal. What is the most likely diagnosis?
a. Laryngocele
b. Mumps
c. Neck abscess
d. Parotid abscess
e. Submandibular calculus

25. A 40-‐year-‐old man presents with jaundice. He became ill with a
headache and myalgia 5 days after a fishing trip. He has now noticed red
spots on his skin. His wife says his eyes have been red before they turned
yellow. What is the most useful diagnostic test?
a. Blood and urine cultures
b. Conjugated/Unconjugated bilirubin
c. Cytomegalovirus serology
d. Hepatitis B serology
e. Paul-‐Bunnel test

26.A 30-‐year-‐old woman presents for the first time with a history of heavy
menstrual loss lasting 4 days and associated with flooding and passage
of clots. What is the initial treatment?
a. Combined oral contraceptive
b. Tranexamic acid
c. Gonadotropin releasing hormone (GnRH) analogues
d. Levogestrel releasing intrauterine system
e. Mefenamic acid
27.A 29-‐year-‐old woman is very concerned because she has had very light
and infrequent periods for 6 months. Her body mass index (BMI) is
35kg/msq. She has a raised serum luteinising hormone (LH)
concentration. What is the initial treatment?
a. Norethisterone
b. Progesterone suppositories
c. Tranexamic acid
d. Danazol

e. Combined oral contraceptive pill

28.A 12-‐year-‐old girl has primary dysmenorrhea, which prevents her from
attending school during her period.
a. Combined oral contraceptive
b. Danazol
c. Gonadotropin releasing hormone (GnRH) analogues
d. Levogestrel releasing intrauterine system
e. Mefenamic acid

29.A 55-‐year-‐old man has weight loss, dyspnoea and syncope. He smokes 30
cigarettes a day. He is thin and breathless at rest. His blood pressure on
standing is 110/60mmhg and on lying is 140/80mmHg. What is the most
appropriate initial investigation in establishing a diagnosis?
a. Chest X-‐ray
b. Echocardiogram
d. Pulmonary function tests
e. 24 hours taped ECG

30.A 19-‐year-‐old man has had fever, neck pain and generalised rash for 12
hours. He is not on any medication. He has a temperature of 39.5 C. He
has limitation of neck flexion and no lymphadenopathy. The rash is
sparse and mainly on the trunk and looks slightly hemorrhagic and non-‐
blanching on pressure. What is the most likely diagnosis?
a. Henoch-‐Schonlein Purpura
b. Measles
c. Idiopathic Thrombocytopenic Purpura (ITP)
d. Meningitis
e. Chicken pox

31.A 20-‐year-‐old woman has nausea, vomiting, fainting and weight loss. She
is hypotensive. Investigation results show the following;
Sodium 129mmol/l
Potassium 5.2mmol/l

Urea 12mmol/l
Glucose 4mmol/l
What is the most appropriate management?
a. Dialysis
b. Fluid restriction
c. Insulin only
d. IV 5% glucose
e. IV normal saline and hydrocortisone

32.A 6-‐year-‐old boy has thirst, weight loss and urinary frequency for a few
weeks. investigations results show;
Sodium 148mmol/l
Potassium 5.1mmol/l
Urea 14mmol/l
Glucose 30mmol/l
What is the single most appropriate management?
a. IV Normal saline and insulin
b. IV Normal saline and potassium supplement
c. Plasma expanders
d. Dialysis
e. Oral potassium chloride

33.A 20year old man received multiple fractures and crash injuries in motor
vehicle collision. 4 days later, he has anuria with pulmonary enema.
Investigation results show;
Sodium 150mmol/l
Potassium 7.2mmol/l
Urea 60mmol/l
Glucose 4.2mmol/l
a. Dialysis
b. Fluid restriction
c. Plasma expanders
d. IV 5% glucose
e. IV Normal saline and hydrocortisone

34.A 50-‐year-‐old man has been admitted for investigations for
breathlessness and weight loss. He has been taking thiazide diuretic for
hypertension for 2 years. His blood pressure is 160/100mmHg and
investigation results show;
Sodium 138mmol/l
Potassium 2.9mmol/l
Urea 5.8mmol/l
Glucose 5.7mmol/l
c. Plasma expanders
d. Dialysis

35.An 8-‐year-‐old boy has had profuse diarrhoea and vomiting due to
infective gastroenteritis for 2 days. Investigation results show the
following;
Sodium 148mmol/l
Potassium 2.2mmol/l
Urea 20mmol/l
Glucose 4.3mmol/l
c. Plasma expanders
d. Dialysis

36.An 82-‐year-‐old man has woken up with incoherent speech. Examination
is otherwise normal and his comprehension is good. Where is the lesion
located?
a. Boca’s area (frontal cortex)
b. Facial nerve

c. Glossopharyngeal nerve
d. Hypoglossal nerve
e. Internal capsule
37.An 18-‐year-‐old man with type 1 diabetes mellitus has been vomiting for
the past 8 hours. He is clinically dehydrated with a blood pressure of
90/60mmHg. His capillary blood glucose is 18.5mmol/l. What is the
single most relevant initial investigation?
a. Arterial blood gas
b. Full blood count
d. Haemoglobin
e. Serum urea concentration

38.A 52-‐year-‐old man who had hoarseness of voice following thyroid
surgery 1 week ago shows no improvement. What is the single most
likely diagnosis?
a. Recurrent laryngeal nerve site
b. Hypoglossal nerve
c. Brocas aphasia
d. Laryngitis
e. Cerebellum

39.A 23-‐year-‐old man is having difficulty to speak following a stab wound to
the right of his neck. On being asked to protrude his tongue, it is
deviating to the right. What is the single most important diagnosis?
a. Glossopharngeal nerve
b. Facial nerve
c. Recurrent laryngeal nerve
d. Hypoglossal nerve
e. Phrenic nerve

40.A 62-‐year-‐old man has recently had a flu like illness and woke up to find
his speech altered. Movement of his eyelids and lips are weak on the
right. Examination is otherwise normal. What is the single most likely
anatomical site?

a. Internal capsule
b. Facial nerve
c. Thalamus
d. Spinal cord root accessory nerve
e. Wernicke’s area

41.A 69-‐year-‐old man has had stroke. Her left upper and lower limbs are
paralysed and she is having difficulty speaking. What is the single most
likely diagnosis?
a. Thalamus
b. Wernicke’s area
c. Internal capsule
d. Facial nerve
e. Broca’s area

42.A 47-‐year-‐old man has a temperature of 39.1 C with delirium. He has
developed blisters mainly on his trunk, which appeared a few hours ago.
He is well and not on any medication. He travelled 5 months ago to Italy.
What is the single most likely diagnosis?
a. Acute pemphigoid
b. Acute viral haemorrhagic fever
c. Chicken pox
d. Lyme disease
e. Shingles

43.A 19-‐year-‐old man has exercise-‐induced asthma. This has previously
been controlled by using a salbutamol inhaler as required but now he
gets attacks with exercise. What is the single most appropriate
management?
a. Regular salbutamol
b. Regular salbutamol and budesonide
c. Sodium cromoglycate
d. Oral steroid
e. Inhaled steroid

44.A 32-‐year-‐old man previously healthy and fit has developed pain and
swelling of both knees and ankles with nodular rash over his shins. As
part of investigation, a chest X-‐ray has been performed. What is the
single most likely chest X-‐ray appearance?
a. Apical granuloma
b. Bilateral hilar lymphadenopathy
c. Lobar consolidation
d. Pleural effusion
e. Reticular shadow in the bases

45.A 35-‐year-‐old woman has had bruises and petechiae for 1 week. She has
also had recent menorrhagia but is otherwise normal. Full blood count
shows;
Hb 11.1, WBC 6.3, Platelets 14.
a. Acute leukemia
b. Aplastic anaemia
c. HIV
d. Idiopathic Thrombocytopenic Purpura (ITP)
e. SLE

46.A 4-‐week-‐old boy has been diagnosed as having breast milk jaundice.
a. Continue breast feeding
b. Exchange transfusion
c. Increase fluid intake
d. Stop breastfeeding
e. Phototherapy

47.A 19-‐year-‐old woman has had progressive bilateral iliac fossa pain and
dyspareunia for 3 days. She has offensive vaginal discharge and feels
unwell and feverish. The temperature is 39.C. What is the single most
appropriate initial investigation?
a. C-‐reactive protein
b. Endocervical swab

c. ESR
d. Full blood count
e. High vaginal swab

48.A 58-‐year-‐old woman has breast cancer and has been vomiting for the
past 2 days. She has abdominal pain and is disoriented in time and place.
She is afebrile. She is on prochlorperazine only. Urinalysis is normal.
What is the single most likely cause of her symptoms?
a. Acute intestinal obstruction
b. Hypercalcemia
c. Hyperglycemia
d. Liver failure
e. Hepatitis

49.A 6-‐week-‐old baby girl is found to have a high fever and has white blood
cells in a suprapubic aspirate of urine, culture of which has shown pure
growth of E.coli. What is the single most appropriate initial
investigation?
a. Intravenous urogram
b. Micturating cystogram
c. No investigation required
d. Nuclear medicine renogram
e. Ultrasound scan of kidneys

50.A 72-‐year-‐old white man has a lump on the left side of his nose. It has
grown gradually over several months and now is a firm pearly white
nodule with a central depression 0.8cm in diameter. What is the single
most likely diagnosis?
a. Basal cell carcinoma
b. Intradermal naevus
c. Malignant melanoma
d. Molluscum contagiosum
e. Squamous cell carcinoma

51.A 50-‐year-‐old man who has been stung by bees many times but the last
time she was stung she developed large itchy swelling that lasted up to
72hours. She now feels well in herself and has no other symptoms. What
is the single most appropriate advis?
a. Carry subcutaneous adrenaline
b. Take NSAIDS after bee sting
c. Take steroid after bee sting
d. Take regular anti-‐histamine tablets
e. Use anti-‐histamine cream after bee sting

52.A 64-‐year-‐old man has been brought to the A&E department after being
found wandering in the park unsteadily. He is confused and ataxic, has
dry mucous membrane and bilateral opthalmoplegia. He has a history of
long standing alcohol abuse. He has a blood pressure of 115/65mmHg,
PR 64beats/ minute, temperature of 36.8C and a capillary blood glucose
of 3.5mmol/l. What is the most urgent treatment?
a. Bolus of 50% glucose solution
b. Bolus of lorazepam
c. Bolus thiamine
d. Infusion of 0.9% saline
e. Infusion of 5% dextrose solution

53.A 35-‐year-‐old man has fallen 10 metres from a ladder and has been
brought to the emergency department. He is drowsy and has a swelling
on the right parietal area. His GCS score is initially 13 but falls to 9 within
an hour. What is the single most appropriate initial step?
a. CT scan of the head
b. IV Mannitol
c. MRI scan of the brain
d. Skull X-‐ray
e. Observation

54.A 59-‐year-‐old man has been admitted for the right hemicolectomy for
the carcinoma of the caecum. 6 months prior to admission he developed
a deep venous thrombosis in the left leg. This was complicated by

pulmonary embolism and he has been on warfarin since then. What is
the single most appropriate pre-‐operative management?
a. Reduce warfarin
b. Increase warfarin
c. Replace warfarin with heparin
d. Stop warfarin

55.A 65-‐year-‐old man who smokes has a long-‐standing history of
breathlessness on exertion and productive cough. He has increasing
breathlessness, wheeze and fever for 3 days. Arterial blood gas shows;
PO2 7.0
PaCO2 6.5
Ph 7.3
What is the single most appropriate initial management for this
respiratory failure?
a. Aminophylline
b. Invasive ventilation
c. Non-‐invasive ventilation
d. 24% oxygen
e. 60% oxygen

56.A 28-‐year-‐old Caribbean man has pain and redness over his shin over the
anterior surface of his leg. He smokes cigarettes and recently suffered
red eyes. Chest X-‐ray shows enlarged mediastinal lymph nodes and clear
fields. What is the most likely diagnosis?
a. Phemphigoid
b. Phemphigus
c. Erythema nodosum
d. Rash
e. Scabies

57.A healthy 2 year old is brought to the A&E with a cut to his hand while
playing in the garden. He has a 2cm clean laceration. He has not received
any routine immunisations as his parents are concerned about possible
side effects. There are no contraindications to immunisations.

What is the single most appropriate follow up investigation?

a. Course of diphtheria, pertussis and tetanus vaccine
b. Course of diphtheria and tetanus
c. Single injection of diphtheria, pertussis and tetanus
d. Single injection of diphtheria and tetanus
e. Single injection of tetanus immunoglobulin

58.A 67-‐year-‐old man has deteriorating vision in his left eyes. He has
longstanding chronic obstructive disease and is on multiple drug therapy.
What is the single most likely medication responsible?
a. Beta agonist
b. Corticosteroid
c. Diuretic
d. Oxygen
e. Theophylline

59.A 25-‐year-‐old woman has had blurred vision, intermittent paraesthesia
and clumsiness of her left arm for the past 3 months. The reflexes are
brisk in her arm and her optic discs are pale. The single most useful test
to confirm the diagnosis?
a. Cerebrospinal fluid
b. EEG
c. Electromyogram (EMG)
d. MRI of the brain
e. Visual evoked responses

60.An 83-‐year-‐old woman who is a resident in a nursing home is admitted to
hospital with a 4-‐day history of diarrhoea. She has had no weight loss or
change in bowel appetite. She has been on analgesics for the past 3
weeks for her back pain. She is in obvious discomfort. On rectal
examination, she is found to have faecal impaction. What is the single
most appropriate management?
a. Codeine phosphate for the pain
b. High fibre diet
c. Oral laxatives

d. Phosphate enema
e. Urinary catheterization

61.A 65-‐year-‐old man has a productive cough and fever. He has influenza
and is temperature is 38.5C. There is reduced air entry and crepitations
bilaterally. What is the single most appropriate cause of the pneumonia?
a. Haemophilus influenza
b. Klebsiella
c. Mycoplasma
d. Staphylococcus aureaus
e. Streptococcal pneumonia

62.A 25-‐year-‐old woman whose last menstrual period was 12 weeks ago
presents with vomiting and increasing right iliac fossa pain of 24 hours
duration. Her temperature is 38.C and she is acutely tender in the right
iliac lower quadrant. The uterus is just palpable abdominally. What is the
a. Ectopic pregnancy
b. Acute appendicitis
c. Ruptured ovarian cyst
d. Spontaneous abortion
e. Haemorrhage into the ovarian cyst

63.A 23-‐year-‐old woman whose last menstrual period was 14 weeks ago
presents with a history of intermittent acute right iliac fossa pain
accompanied by vomiting. She has not had any vaginal bleeding. Her
uterus is of normal size. What is the single most appropriate diagnosis?
a. Torsion of the ovarian cyst
b. Tubo-‐ovarian abscess
c. Ruptured ovarian cyst
d. Haemorrhage into ovarian cyst
e. Ectopic pregnancy

64.An 84-‐year-‐old man has been breathless at rest for several months. His
current medication is furosemide, isosorbide nitrate and digoxin. He is in

sinus rythmwith a heart rate of 78b/m and blood pressure of
145/85mmHg. His serum electrolytes and urea are normal. What is the
single most appropriate drug to use at this stage?
a. Bendroflumethiazide
b. Nifedipine
c. Ramipril
d. Donazol
e. Nifedipine

65.A 30-‐year-‐old woman has had intense itching of the perineum and
between the fingers of her right hand side for 2 weeks. The pruritus is
more pronounced in the night after a hot shower. Occasional
papulovesicular lesions with excoriation are visible on the perineum. A
pelvic examination is normal. What is the single most likely organism to
account for this presentation?
a. Enterobius vermicularis
b. Herpes simplex
c. Pthius pubis
d. Sarcoptes scabei
e. Trichomonas vaginalis

66.A 25-‐year-‐old lady with 8 weeks amenorrhoea presents with 3 days
history of right iliac fossa pain and a heavy dark vaginal discharge. On
vaginal examination, the uterus is bulky and non-‐tender. She is acutely
tender in the right adnexus. What is the single most likely diagnosis?
a. Ruptured ovarian cyst
b. Ectopic pregnancy
c. Spontaneous abortion
d. Torsion of ovarian cyst
e. Appendicitis

67.A 24-‐year-‐old woman with 8 weeks amenorrhoea presents with 7 days
history of intermittent right iliac fossa pain and scanty vaginal bleeding.
An ultrasound scan shows an empty uterus, no visible adnexal masses

but excess fluid in the pouch of Douglas. What is the single most likely
diagnosis?
a. Ruptured ovarian cyst
b. Ectopic pregnancy
c. Spontaneous abortion
d. Torsion of ovarian cyst
e. Bleeding into a corpus luteum

68.A 25-‐year-‐old woman with 10 weeks history of amenorrhea presents
with lower abdominal pain and vaginal bleeding. She is tender across the
lower abdomen but otherwise well. On vaginal examination the uterus is
bulky and slightly tender. What is the single most likely diagnosis?
a. Spontaneous abortion
b. Torsion of ovarian cyst
c. Ruptured cyst
d. Ectopic pregnancy
e. Ruptured ovarian cyst

69.A 24-‐year-‐old woman presents with offensive bloody vaginal discharge.
On examination the cervix appears to be ulcerated. What is the single
most appropriate investigation?
a. Colposcopy
b. Cervical smear and biopsy
c. Cervical smear
d. Cystoscopy
e. CT scan

70.A 24-‐year-‐old woman presents with post coital bleeding. An abdominal
X-‐ray is normal. Speculum examination is also normal apart from ectopy.
a. Colposcopy
b. Cervical smear and biopsy
c. Cystoscopy
d. Cervical smear
e. CT scan

71.A 64-‐year-‐old man with long standing alcohol dependence has been
brought to the A&E department after being found wandering in the park
unsteadily. He is confused and ataxic, has dry mucous membrane and
bilateral opthalmoplegia. He has a history of long standing alcohol
abuse. He has a blood pressure of 115/85mmHg, PR 64beats/ minute,
temperature of 36.8C and a capillary blood glucose of 3.5mmol/l. What
is the most urgent treatment?
a. Bolus of 50% glucose solution
b. Bolus of lorazepam
c. Bolus thiamine
d. Infusion of 0.9% saline
e. Infusion of 5% dextrose solution

72.A 4-‐year-‐old boy has been brought to the A&E department by
ambulance. He has been unwell with a sore throat for 8 hours. He is
sitting on his mother’s knee and is tolerating an oxygen mask but looks
unwell. He has constant noisy breathing and is dribbling saliva. His
temperature is 39.C. What is the single most appropriate action?
a. Administer IV penicillin
b. Call an anaesthetist
c. Examine the tonsils with a tongue depressor
d. Listen to the chest
e. Take blood culture

73.A 44-‐year-‐old man presents with painful erection with curving of the
penis. What is this condition?
a. Balanitis
b. Phimphosis
c. Priapism
d. Peyrionne disease
e. Paraphimosis

74.A 60-‐year-‐old man who has been treated for carcinoma of the cervix is
admitted because of confusion. The GP has done blood test, which shows

a high urea of 20mmol/l and a normal full blood count. What is the
single most appropriate investigation?
a. IVU
b. Cystoscopy
c. Ultrasound scan
d. MRI pelvis
e. CT Scan pelvis

75.A 36-‐year-‐old lady has been found to have mild dyskaryosis on
ultrasound scan. What is the single most appropriate investigation?
a. Repeat smear in 6 months
b. Colposcopy
c. Cervical biopsy
d. Reassure
e. Speculum examination

76.A 36-‐year-‐old lady has been found to have mild dyskaryosis on
ultrasound scan. What is the single most appropriate investigation?
a. Repeat smear in 6 months
b. Colposcopy
c. Cervical biopsy
d. Reassure
e. Speculum examination

77.A 45-‐year-‐old man presents after being hit on the superior part of the
knee. What is the single most likely diagnosis?
a. Obturator fossa
b. Prepatellar
c. Infrapatellar
d. Suprapatellar

78.A 60-‐year-‐old lady fell down and cannot rotate her arm externally. Which
joint is affected?
a. Humeroscapular joint
b. Acromioclavicular joint

c. Humeroclaviuclar joint
d. Sternoclavicular joint
e. Glomeruloclavicular joint

79.A 60-‐year-‐old lady underwent mastectomy with axillary lymph node
clearance. She develops paraesthesiae of the inner 3rd of the arm. Which
nerve is affected?
a. Axillary
b. Radial
c. Brachial
d. Ulnar
e. Median

80.A 34-‐year-‐old man from Zimbabwe is admitted with abdominal pain to
the emergency department. An abdominal X-‐ray reveals bladder
calcification. What is the most likely cause?
a. Schistosomiasis
b. Sarcoidosis
c. Leishmaniasis
d. Tuberculosis
e. Schistosomiasis haematobium

81.A 74-‐year-‐old female presents with headache and neck stiffness to the
emergency department. Following a lumbar puncture, the patient was
started on IV Ceftriaxone. CSF culture shows Listeria monocytogens.
What is the most appropriate treatment?
a. Add IV Amoxicillin
b. Change to IV Amoxycillin + Gentamicin
c. Add IV Ciprofloxacin
d. Add IV Amoxiclav

82.A 30-‐year-‐old woman presents with 6 months history of palpitations. Her
ECG shows shortened PR interval and delta waves. Holter monitoring
shows paroxysmal SVT. What is the single most appropriate
management?

a. Carotid massage
b. Verapamil
c. Sotalol
d. Adenosine
e. Amiodarone

83.A 50-‐year-‐old man was admitted with an acute myocardial infarction
earlier in the day 2hours after thrombolysis with tPA. He suddenly
complains of feeling faint. His PR is 140b/m and BP is 90/40mmHg.
Cardiac monitoring shows long run of SVT. What is the single most
appropriate treatment?
a. Carotid massage
b. Emergency DC shock
c. Amiodarone
d. Verapamil
e. Elective cardioversion

84.A 24-‐year-‐old woman presents to the A&E with dizziness. His ECG shows
re-‐entrant tachycardia. She had a similar episode in the past, which
stopped simultaneously. She is not on any medication. What is the single
most appropriate management?
a. Carotid massage
b. Adenosine
c. Accessory pathway ablation
d. Verapamil
e. Amiodarone

85.A 4-‐year-‐old boy was diagnosed with UTI, which was later found to be
due to E.coli. What is the most appropriate treatment?
a. Trimethoprim
b. Nitrofurantoin
c. Amoxicillin
d. Cefalexin

86.A 28-‐year-‐old lady complains that she hears everyone saying that she is
an evil person. What type of hallucinations is she suffering from?
a. Second person auditory hallucinations
b. Third person auditory hallucinations
c. Echo de la pense
d. Gerdemankessane

87.A 3-‐week-‐old girl has been brought to the emergency department. She is
lethargic, unwell and not feeding. Her temperature is 38.5C, PR 90b/m
and RR 20c/m. Her skin, chest, abdominal, ear and throat examinations
are normal. What is the single most appropriate management?
a. Admit for full infection screening
b. Admit for full infection screening and start broad-‐spectrum antibiotic
c. Admit for serial examination and observation
d. Discharge with broad spectrum antibiotic
e. Discharge with oral antipyretic

88.A 9-‐year-‐old boy has had neck pain and generalised rash for 12 hours. He
is not on any medication and has a temperature of 39.5C. He has
limitation of neck flexion and no lymphadenopathy. The rash is sparse,
mainly on the trunk, looks slightly hemorrhagic and is non-‐blanching on
pressure. What is the single most likely diagnosis?
a. Henoch-‐Schonlein Purpura
b. Measles
c. Meningococcal infection
d. Parvovirus B infection
e. Rubella

89.A 4-‐year-‐old boy has been bedwetting his bed and the parents are asking
for the most appropriate action.
a. Behavioural therapy
b. Restrict fluid 2-‐3 hours before sleep
c. Desmopressin
d. Incontinent pants
e. No action required

90.A 30-‐year-‐old lady who works in a pet shop presents with shortness of
breath and fever of 38.C. What is the most appropriate management?
a. Penicillin
b. Amoxicillin
c. Clarithromycin
d. Erythromycin
e. Tetracycline

91.A 40-‐year-‐old man is found to have bronchiectasis. What is the most
appropriate investigation?
a. Spiral CT
b. High resolution CT
c. Chest X-‐ray
d. MRI chest
e. Echocardiography

92.A 20-‐year-‐old man with fever and running nose presents with hoarseness
of breath. What is the most appropriate investigation?
a. Laryngoscope
b. CT chest
c. TSH
d. MRI chest
e. No investigation required

93.A 70-‐year-‐old man who has been smoking for 50 years presents with
weight loss and haemoptysis. What is the most appropriate
investigation?
a. CT chest
b. MRI chest
c. Bronchoscopy and biopsy
d. Chest X-‐ray
e. No investigation required

94.A 40-‐year-‐old man has undergone detoxification programme. He wants

some medication to help him reduce cravings.
a. Disulfuram
b. Chlordiaxepoxide
c. Diazepam
d. Thiamine
e. Acamprosate

95.A couple have undergone detoxification programme. They want a
medication to help them serve as a deterrent when they take alcohol.
a. Disulfuram
b. Chlordiaxepoxide
c. Naltrexone
d. Thiamine
e. Acamprosate

96.A 45-‐year-‐old man has been drinking for the past 48 hours. He presents
to the emergency department with aggressive behaviour, shaking,
tremors and agitation. What is the most appropriate management?
a. Disulfuram
b. Chlordiaxepoxide
c. Naltrexone
d. Thiamine
e. Acamprosate

97.A 40-‐year-‐old man presents with confusion and constipation. Calcium is
3.4mmol/l. What is the most appropriate treatment?
a. IV sodium chloride
b. Pamidronate
c. Calcitonin
d. Calcium resonium
e. Potassium chloride

98.A 40-‐year-‐old man with a history of COPD and a shipyard worker present
with pleural effusion. How would you diagnose this fluid?

a. Pleural aspiration
b. CT chest
c. MRI chest
d. Chest tube insertion
e. Tumour markers
99.A 30-‐year-‐old man put his hand accidentally in a machine. There is no
fracture. What is the most appropriate management?
a. Splint
b. High arm sling and rest for 2-‐3 days
c. Scaphoid cast
d. Plaster cast
e. Analgesia only

100. A 5-‐year-‐old child was found to have vesico-‐ureteric reflux. What is
true about this condition?
a. Requires prophylactic antibiotic
b. Most will require surgery
c. In most kidney will be scarred by 5 years
d. No further action is required.
e. It is usually asymptomatic

101. A 59-‐year-‐old man presents with shortness of breath. Chest X-‐ray
shows opacities of the whole left hemi-‐thorax. What is the most
a. CT chest
b. Bronchoscopy
c. Diagnostic thoracocentensis
d. MRI chest
e. Sputum culture

102. A 30-‐year-‐old lady stopped OCP 18 months ago. She has
amenorrhea for the past 9months. Pregnancy test is negative. Prolactin
is 600. What is the most likely diagnosis?
a. Hypothalamic amenorrhea
b. Prolactinoma

c. PCOS
d. Endometriosis
e. PID

103. A 70-‐year-‐old lady presents with palpitation for the past 7 days.
Which of the following is the first line drug of choice?
a. Atenolol
b. Adenosine
c. Amlodipine
d. Digoxin
e. Flecanide

104. A 57-‐year-‐old man presents with dizziness after an acute upper
respiratory tract infection. What is the most likely cause?
a. Meniere’s disease
b. Vestibular neuritis
c. Benign positional vertigo
d. TIA
e. Drug induced

105. A 40-‐year-‐old housewife who has five children complains of

increasing breathlessness in climbing the stairs. Her periods lasts 8-‐ 10
days and she loses clots. She smokes 5-‐ 7 cigarettes a day. What is the
single most appropriate initial investigation?
a. Colposcopy
b. FBC
c. Clotting screen
d. Cervical smear
e. MRI pelvis

106. A 70 year old man with temperature of 39° C and cough. What
would he check x-‐ray for?
a. Pneumothorax
b. Lung cancer
c. Mesothelioma

d. Normal
e. Free gas in the mediastinum

107. A 45 year old man 30 year history of smoking presents with
shortness of
breath. His Oxygen is 8, PaCO2 is 7. How much oxygen will you give?
a. 100%
b. 85%
c. 28%
d. 24%
e. 40%
108. 45-‐year-‐old man who returned from holiday from Spain presents
with dry cough and shortness of breath. Hat is the most appropriate
treatment?
a. Clarithromycin
a. Erythromycin
b. Amoxicillin
c. Benzylpenicillin
d. Tetracycline

109. A 45-‐year-‐old man from Africa presents with weight loss, dry
cough and shortness of breath. What is the most appropriate treatment?
a. Co-‐trimoxazole
b. Tetracycline
c. Ant-‐tuberculous drugs
d. Clarithromycin
e. Amoxicillin

110. A 45-‐year-‐old man believes that his neighbour is using his shower
despite the fact that there is no one at home. What is the most likely
diagnosis?
a. Nihilistic
b. Folie a deux
c. Hypochondrial
d. Paranoid delusion

e. Delusion of grandiose

111. A 30-‐year-‐old lady is infertile. What test should you do to prove
ovulation?
a. Mid-‐cycle progesterone
b. FSH
c. Leutenising hormone
d. Ultrasound scan
e. Testosterone

112. A 30-‐year-‐old lady 2 hours into her labour develops fits. Despite
treatment with Magnesium Sulphate she develops another seizure. What
is the most appropriate treatment?
a. IV Bolus magnesium
b. IV Hydralazine
c. IV Labetalol
d. IV Methyldopa
e. Caesarean section

113. A 60-‐year-‐old woman presents with a 1cm ulcer on his hand, which
bleeds easily on touch. What is the most appropriate diagnosis?
a. Basal cell carcinoma
b. Eczema
c. Squamous cell carcinoma
d. Melanoma
e. Benign mole

114. A 50-‐year-‐old man presents with dizziness, which is worse on lying
in bed. What is the most appropriate investigation?
a. Tilt test
b. Weber’s test
c. Rinnes test
d. Dix Hallpike manoeuvre
e. CT head

115. A 40-‐year-‐old lady presents with clear discharge from a single

duct. What is the most appropriate diagnosis?
a. Duct papilloma
b. Duct ectasia
c. Intraduct papilloma
d. Paget’s disease
e. Breast cancer

116. A 16-‐year-‐old girl who has been to the forest remembers being
bitten by an insect and presents with a lesion on her leg. What is the
most appropriate treatment?
a. Doxycycline
b. Metronidazole
c. Penicillin
d. Tetracycline
e. Ciprofloxacin

117. A 12-‐year-‐old boy present with soiling and he has got a palpable
mass in the right lower quadrant. What is the most appropriate
management?
a. Enema and laxative
b. Laxatives
c. Enema only
d. High fibre diet
e. Increase water intake
118. A 24-‐year-‐old man present with epigastric pain. H.pylori is positive.
a. Endoscope
b. Urea breath test
c. Triple therapy
d. Serology for H.pylori
e. Ultrasound scan

119. A 40-‐year-‐old man has had epigastric pain. H.pylori was negative.
He received omeprazole but still no improvement. What is the most
appropriate management?
a. Triple therapy
b. Endoscopy
c. Urea breath test
d. Serology for H.pylori
e. Ultrasound scan

120. A 40-‐year-‐old man presents with swelling of the leg. Urine
examination shows protein+++. What is the most appropriate
investigation?
a. Ultrasound of the kidneys
b. Renal biopsy
c. IVU
d. Full Blood Count
e. Immunocomplex

121. A 6-‐year-‐old child had fractured fibula. He was applied a plaster
cast. Later in the night, he develops pain. On examination, the pulses are
normal. There is no sensory loss and the limbs are well perfused. What is
the most appropriate management?
a. Remove cast
b. Split cast
c. Fasciotomy
d. Increase analgesia
e. Repeat X-‐ray

122. A 35-‐year-‐old lady who has a family history of ovarian cancer is
anxious about getting the cancer. What initial investigation will you do
to assure her?
a. Colposcopy
b. Transvaginal Ultrasound Scan
c. CA 125

d. CA 19.9
e. MRI Pelvis

123. A 56-‐year-‐old man was involved in a road traffic accident. His
initial GCS was 15/15. 3 hours later his GCS is 8/15. What is the most
a. IV mannitol
b. CT head
c. MRI brain
d. Dexamethasone
e. X-‐ray skull

124. A 56-‐year-‐old man who is a known diabetic present with
microalbuminuria. The BP is 128/85mmHg. What is the most appropriate
treatment?
a. Atenolol
b. ACE Inhibitors
c. Calcium channel blockers
d. Diuretics
e. Metoprolol

125. A 3-‐year-‐old child has been treated for meningitis successfully. The
child is about to be discharged from the hospital home. What is the most
appropriate test to do?
a. Audiometry
b. CT brain scan
c. Lumbar puncture
d. Blood culture
e. EEG

126. A 20-‐year-‐old tall basketball player present with sudden chest
pain. The trachea is central. He has reduced air entry on the right lung
base? What is the most appropriate investigation?
a. ECG
b. Chest X-‐ray

c. CT Scan
d. MRI chest
e. Endoscope

127. An 18-‐year-‐old woman is bought into the accident and emergency
department unconscious. Her respiratory is deep and sighing at a rate of
24-‐breaths/ minute. Her temperature is 38.5°C. Her chest is clear. What
a. Pneumonia
b. UTI
c. Pulmonary embolism
d. Diabetic ketoacidosis
e. Pericarditis

128. A 35-‐year-‐old woman presents severely breathless to the accident
and emergency department. She has signed eyebrows and soot in her
mouth and stridor. What single most likely diagnosis?
a. Pneumonia
b. Anaphylaxis
c. Laryngeal edema
d. Epiglotitis
e. Laryngeal carcinoma

129. A 29-‐year-‐old woman presents with right-‐ sided chest pain and
shortness of breath. Her chest examination is normal apart from a
pleural rub in the right mid-‐zone. Her temperature is 39°C. What single
a. Pulmonary embolism
b. Pneumonia
c. Pnemothorax
d. Pulmonary oedema
e. Pericarditis
130. A couple’s 3 months old baby died after collapsing and no cause
was found. They would like to know how to resuscitate the baby in case
of a future occurrence as a preventive measure?

a. Index finger and middle finger

b. Thumb and middle finger
c. Thumb and index finger
d. One hand
e. 2 hands

131. A 60-‐year-‐old woman was recently diagnosed with breast cancer
and presents with thirst, polyuria and constipation. What is the most
likely diagnosis?
a. Cerebral metastasis
b. Diabetes
c. Hypercalcemia
d. Rhabdomyolysis
e. Spinal cord compression

132. A 64-‐year-‐old man present with bloating and abdominal pain.
Which of the following is the most appropriate investigation?
a. FBC
b. TFT’s
c. Endomysial antibodies
d. LFT
e. Faecal blood test

133. A 45-‐year-‐old lady present after his foot was stuck under the
motorbike to the emergency department with swelling of the leg.
Dorsalis pedia is not felt. He has loss of sensation between the second
and big toes. What is the most likely diagnosis?
a. Compartment syndrome
b. Arterial rupture
c. Arterial embolus
d. Fracture of the foot
e. Soft tissue injury

134. A 70-‐year-‐old man who is on Amlodipine and Bedroflumethiazide
for hypertension present with heart rate of 30b/m and BP of
140/80mmHg. What is the most appropriate investigation?
a. Ambulatory ECG
b. ECG
c. Ambulatory BP

d. Echocardiography
e. Serum drug level

135. A 60-‐year-‐old man present with ankle swelling after being started
on new antihypertensives. Which of the following medication is the most
likely cause?
a. Amlodipine
b. Bendroflumethiazide
c. Bisoprolol
d. Tazosin
e. Lisinopril

136. A 50-‐year-‐old man 3 hours after cholecystectomy has a BP of
60/40mmHg and heart rate of 110b/m. What is the most appropriate
immediate treatment?
a. Blood transfusion
b. Diuretics
c. IV fluids
d. Echocardiography
e. Furosemide

137. A 70-‐year-‐old man presents with right-‐sided weakness and left
sided visual loss. Which artery is occluded?
a. Anterior cerebral artery
b. Carotid artery
c. Posterior inferior cerebellar artery
d. Middle cerebral artery
e. Posterior cerebral artery

138. A 50-‐year-‐old alcoholic man presents with bilateral cavitations and
haemoptysis. What is the most appropriate investigation?
a. CT chest
b. Acid fast bacilli
c. Bronchoscopy
d. Blood culture
e. Sputum culture

139. A 7-‐year-‐old child is suspected to have a foramen ovale. What is
the most appropriate investigation?

a. Bubble echocardiography
b. Transoesophageal echocardiogram
c. Transthoracic echocardiography
d. ECG
e. CT chest

140. A 20-‐year-‐old lady who is not a smoker has been using condom as
a means of contraception but would like to change the contraception
now. What is the most appropriate contraception?
a. COCP
b. POP
c. Danazol
d. Progesterone
e. IUCD

141. A 30-‐year-‐old woman presents with shortness breath itching and
urticarial after playing in the grass in the garden. On examination she
has red patches all over her body? Which of the following is the
indication of adrenaline?
a. Cough
b. Urticaria
c. Hoarseness of voice
d. Itching
e. Vomiting

142. A previously fit 25-‐year-‐old man presents with sudden onset of
right – sided pleuritic chest pain and fever. His girlfriend is concerned
that he has also become confused. What is the single most likely
causative organism?
a. Chlamydia psitacci
b. Mycoplasma
c. Legionella
d. Pneumocysti jiroveci
e. H. influenza

143. A 19-‐year-‐old woman with cystic fibrosis has been well until 24
hours ago when she developed fever, lethargy and breathlessness. What
is the single most likely causative organism?

a. Haemophilus influenza
b. Streptococcus
c. Staphylococcus
d. Tuberculosis
e. Mycoplasma

144. A 50-‐year-‐old man presents with a persistent cough for 3 months.
He has low-‐grade pyrexia. He has also lost 5kg in weight and has noticed
streaks of blood in his sputum. What is the single most likely causative
organism?
a. Tuberculosis
b. Legionella
c. Pneumocysti jiroveci
d. Mycoplasma
e. Staphylococcus

145. A 75-‐year-‐old lady underwent total hip replacement. She had
severe blood loss during the surgery and also post surgery. She has also
developed hyponatremia. Which one of the following IV fluid is
responsible for this?
a. Platelets
b. Albumin
c. Crystalloids
d. Colloids
e. Blood

146. A 30-‐year-‐old lady with history of bee stings presents with bee
sting on her hand with swelling, itching and shortness of breath. She is a
farmer and has been treated successfully. What would you suggest for
future management?
a. Adrenaline patch
b. Corticosteroids
c. Anti-‐fungals
d. Topical steroids
e. IM Adrenaline

147. An 81-‐year-‐old woman is brought to the accident and emergency
department confused. Over the past three months, she has been
complaining of excessive passing of water and weight loss. What is single
most appropriate investigation?
a. Serum and urine electrophoresis
b. Chest X-‐ray
c. Blood glucose
d. Urea and electrolytes
e. Calcium and phosphate level.

148. An 81-‐year-‐old man complains of general malaise and a chronic
backache. He has a history of mild confusion with episodes of marked
blurring of vision. An x-‐ ray report shows a pepper pot skull. What is
single most appropriate investigation?
a. Full blood count
b. ECG
c. Serum electrophoresis
d. Thyroid function tests
e. Blood glucose

149. What is the test for wobble teeth?
a. DEXA scan
b. Nuclear bone medicine
c. Skeletal survey
d. X-‐ray
e. Serum calcium

150. A 40-‐year-‐old man is diagnosed with rectal cancer. Which lymph
node drainage will it spread to?
a. Para-‐aortic
b. Superficial inguinal
c. Common iliac
d. Deep inguinal

e. Internal iliac

151. A 40-‐year-‐old man is diagnosed with ulcer on his scrotum. Which
lymph node will it drain to?
a. Deep inguinal
b. Common iliac
c. Internal iliac
d. Superficial inguinal
e. Para-‐aortic

152. A 40-‐year-‐old lady who just lost her husband has lost interest in
everything. She has low mood and cannot get along with her son. What
is the most appropriate management?
a. Detain under mental act
b. Voluntary admission in psychiatry ward
c. ECT
d. Admit to general ward
e. Send to counselling sessions.

153. A 1-‐year-‐old child presents with shortness of breath and coryza
symptoms. He has barking cough. What is the most likely natural history
of this condition?
a. Natural resolution
b. Persist into adult life
c. Unknown
d. Abscess
e. 10% chance that it would persist to adult life

154. An 8-‐year-‐old boy with longstanding eczema has an intense o flare
up of this eczema. There is erythema, excoriation and exudates in the
flexure. The weeping lesions have no responded to topical
betamethasone. A skin swab has been taken.
a. Prolonged high dose oral steroid
b. Ski sensitivity testing

c. Oral antihistamine
d. Emollient and a short course of 0.1% hydrocortisone (topical)
e. Oral flucloxacillin

155. A 50-‐year-‐old woman has seborrhoeic eczema affecting the scalp
margin and naso-‐labial folds. Hydrocortisome cream 1% that she
purchased from the pharmacy has failed to help.
a. Acyclovir (Oral)
b. Emollient
c. Fusidic acid cream
d. Betamethansone 0.1% ointment
e. Ketoconazole cream

156. A patient presents with skin lesion at the nasolzbial fold. It is noted
to have rolled edges.
a. Bowens disease
b. Basal cell carcinoma
c. Lipoma
d. Malignant melanoma
e. Kaposi sarcoma

157. A pregnant lady presents with pain in the wrist at night and
numbness at the thenar eminence and lateral 3 and half fingers. Which
nerve is involved and at what level?
a. Median nerve at wrist
b. Median nerve at elbow
c. Radial nerve at elbow
d. Radial nerve at wrist
e. Ulnar nerve at wrist

158. A pregnant lady presents with UTI. On microscopic urine analysis,
E.coli was detected. What drug should be prescribed to her?
a. Trimethoprim
b. Amoxicillin
c. Ciprofloxacin
d. Mefenamic acid
e. Tetracycline

159. A couple have not been able to conceive despite having regular sex
for 2 years. The lady’s menstrual cycles are regular and of 28days. 21
days progesterone test shows low level. What is the best treatment for
this scenario?
a. Bromocriptine
b. Clomiphene
c. IVF
d. Testosterone

160. A man comes with pain and swelling in front of the knee. Which
bursa might have been involved?
a. Prepatellar bursa
b. Suprapatellar bursa
c. Infrapatellar bursa
d. Semi membranous bursa

161. A 41-‐year-‐old woman presents with a rapidly enlarging mass in
the neck. She has recently developed stridor and dysphagia. On
palpation, the mass is hard and tethered to the skin. What is the single
a. Thyroid adenoma
b. Follicular carcinoma
c. Anaplastic carcinoma
d. Hyperthyroidism
e. Viral thyroiditis

162. A 25-‐year-‐old woman presents with intolerance to heat and
sweating of the hands, she has a smooth, soft thyroid swelling with a
bruit. What is the most likely diagnosis?
a. Graves disease
b. Drug induced
c. Viral thyroiditis
d. Thyroid cancer
e. Iodine deficiency

163. A 55-‐year-‐old woman presents with increasing obesity. On
examination, she has central obesity with a round moon face. She is
hypertensive and has glycosuria. An ultrasound of her abdomen reveals
an enlarged right adrenal gland. The left adrenal gland is normal. What
is the single most likely diagnosis?

a. Addison’s disease
b. Cushing’s disease
c. Phaechromocytoma
d. Conn’s disease
e. Cushing’s syndrome

164. Patient has just had a transurethral prostatic biopsy. What
electrolyte imbalance can he develop?
a. Hyperkalemia
b. Hyponatremia
c. Hypocalcemia
d. Hypernatremia
e. Hypercalcemia

165. A man was brought to the A&E department from a shopping mall
after collapsing there. He is unconscious and answering questions. His
ECG shows irregular rythm. What is the choice of investigation?
a. CT scan
b. MRI
c. 24 hour Echocardiogram
d. Echocardiography

166. A 60-‐year-‐old man is being treated with cyclophosphomide for
fibrosing alveolitis. His haemoglobin (HB) level is 6.2g/dl with normal red
cell parameters, a platelet count of 25 c 10 9/1 and white cell count of
2.0. What is the single most likely diagnosis?
a. Anaemia of chronic disease
b. Aplastic anaemia
c. Acute leukaemia
d. Pernicious anaemia
e. Blood transfusion

167. A young boy has a painless soft swelling in the right scrotum. It is
blue in colour and compressible. What is the best management?
a. Surgical exploration
b. CT abdomen
c. Herniotomy
d. Reassurance
e. Antibiotics

168. A 47-‐year-‐old man, known to be belligerent heavy drinker,
becomes increasingly drowsy over a period of several days. He has
previously been well he is rousable but mental state examination reveals
considerable cognitive impairment. What is the single most like
diagnosis?
a. Motor neurone disease
b. Huntington’s disease
c. Creutzfeldt-‐Jacob disease (CJD)
d. Subdural haematoma
e. Benign intracranial disease
169. A 49-‐year-‐old man first presented with increasing difficulty in

swallowing several months later he developed weakness in his right foot.
Now he can no longer feed himself, chokes on food and has become
confined to a wheelchair. What is the single most like diagnosis?
a. Multi-‐infarct dementia
b. Alzheimer’s disease
c. Benign intracranial hypertension
d. Normal pressure hydrocephalus
e. Motor neurone disease
170. A man has been on treatment forfor 20 years for type 1 diabetes
mellitus and now complains of blurring of vision and frequent change of
his reading glasses. Where could be the location of his eye lesion?
a. Retina
b. Choroid
c. Lens
d. Iris
e. Cornea

171. An adolescent boy comes with a transverse fracture of the tibia
and is managed conservatively by putting a plaster. Analgesic is already
given to him before putting on the plaster. Sometime after putting the
plaster, he complains of pain in the fractured limb. On examination,
pulse, temperature and sensations are normal. What is the most
appropriate thing to do next?
a. Cut open the plaster

b. Cut open the plaster and reapply after adding more cotton
c. Do an X-‐ray of the limb
d. Give more analgesics
e. Do open reduction of the fracture

172. A woman had a motorcar accident and comes to the A&E with
pain and rigidity of the abdomen. Her condition is settled now. What
investigation should be done next?
a. CT scan of the abdomen
b. USG
c. MRI
d. Abdominal X-‐ray
e. 0.9% saline
f. Percutaneous lavage

173. An 82-‐year-‐old woman is brought to the A&E after a fall at home.
ECG and physical examinations are normal. She takes spironolactone for
mild oedema, glibenclamide (500mg daily) for type 2 diabetes and uses
Ibuprofen get for a painful shoulder. What is the single most appropriate
management?
a. Medication (sleeping tablets)
b. Review psychotropic
c. Review diabetic medication
d. Review antihypertensive medication
e. Prescribe biphosphonate

174. A 82-‐year-‐old man presents with unilateral headache,
photophobia and sudden reduction in visual acuity. He has a pale fundus.
a. Mental state examination
b. Magnetic resonance imaging (MRI) of the brain
c. Temporal artery biopsy

d. Intraocular pressure
e. Fundoscopy

175. A 64-‐year-‐old woman has increased generalised headache,
unrelieved by paracetamol. She has difficulty sleeping and says she has
lost weight recently. What is the single most diagnostic investigation?
a. ESR
b. CT Head
c. Temporal artery biopsy
d. MRI scan of the head
e. Visual fields

176. A 53-‐year-‐old man has severe headaches, worse on lying. You find
bilateral papilloedema. What is the single most appropriate
investigation?
a. Erythrocyte Sedimentation Rate (ESR)
b. Electroencephalogram
c. CT Brain
d. Carotid arteriography
e. Skull X-‐Ray

177. A 6-‐year-‐old boy has eczema. He has been prescribed emollients and
corticosteroid. What advice would you give to this patient?
A. Apply both together
B. Apply after shower
C. Apply after shower wait for seconds to dry and dry and apply both
D. Apply corticosteroid
E. Apply both twice a day

178. An 8-‐year-‐old boy has viral infection. . He took a lot of over the counter
drugs. His friends noticed that he has yellow sclera. AST, ALT, Alkaline

phosphatase are all normal. Bilirubin is 31. What is the single most likely
diagnosis?
A. Viral hepatitis
B. Gallstones
C. Gilbertsyndrome
D. Drug toxicity
E. Alcoholicliver

179. A 30-‐year-‐old man is having headaches, fever, neck stiffness and
vomiting. What is the single most appropriate antibiotics to give this patient?
A. ceftriaxone
B. Co-‐-‐amoxiclav
C. Amoxicillin
D. Ciprofloxacin E. Gentamicin

180. An 18-‐year-‐old lady with several tiny nodules for 2 days, she has
cervical lymphadenopathy and rash on the shin. She has 2 small children.
What is the most likely diagnosis?
A. sarcoidosis
B. Reactive arthritis
C. Rheumatpoidarthritis
D. SLE
E. Rreiter‘ssyndrome

181. A 60-‐year-‐old woman presents with vaginal bleeding. Her last cervical
smear was 3 years was normal. What is the single most appropriate
investigation?
A. Endometrial sampling
B. Cervical smear
C. Endometrial sampling
D. Colposcopy
E. CT scan

181. A 60-‐year-‐old lady who is chronic atrial fibrillation and is on warfarin,

beta blocker, digoxin and bendroflumethiazide presents with yellow sclerae.

What is the single most likely cause?
A. Digoxin
B. Bendroflumethiazide
C. Warfarin
D. Beta blocker
E. Aspririn

182. A 45 year old man who is working an engineering plant. He complains
that his hearing is not good due to noise. What type deafness is he most likely
to have?
A. Unilateral sensory hearing loss
B. Bilateral sensory neural
C. Unilateral conductive deafness
D. Bilateral conductive deafness
E. Mixed conductive and sensory neural deafness bilaterally.

183. A 30-‐year-‐old man died after complaining of sudden onset of severe
headache. What is the single most likely location of bleeding?
A. intracerebral
B. Extradural
C. Epidural
D. Subarachnoid
E. Intracerebellar

184. A 30-‐year-‐old lady presents to out patient clinic
complaing of palpitations , feeling of thumpoing in the chest and a feeling of
impending doom. The symptoms are so disably that she cannot cope with it.
What is the single most appropriate medication?
A. No medication
B. SSRI
C. Benzodiazepines
D. Anti-‐-‐psychotics
E. Mood stabiliseers

185. An 80-‐year-‐old lady had stroke and she was put on aspirin 75 mg
once a day. She presents with another TIA. She has been treated
successfully and she is now ok. What is the single most appropriate next
action?
A. aspirin and dipiridamole
B. Clopidogrel
C. Warfarin
D. Warfarin and aspirin

186. A 45-‐year-‐old man presents with a swelling in the testes. On
examination the swelling is smooth and fluctuates. It is located at the
posterior upper pole of the left testis. What is the single most appropriate
initial investigation?
A. CT scan testes
B. MRI scan of the testes
C. USSscanofthetestes
D. Mid stream urine
E. Urethralswab

187. A 30 year old lady presents to accident and emergency department with
shortness of breath, generalised chest pain and feeling as if she will dies. You
decide to do arterial blood gas. What abnormality will you find in the ABG?
A. High PH, Low CO2
B. High PH, normal CO2
C. HighO2andLowPH
D. High PH, and high O2
E. LowPh,LowCO2

188. In a population of 500 000, 100 people present with cancer Y. there
1250 cases of cancer Y is registered by deaf certificate in the last 5 years. The
one year survival rate for cancer Y is 0%. What’s the annual incident rate per
million?
A. 700
B. 400

C. 200
D. 500
E. 600

189. 76 year old lady suddenly develops confusion. What’s the initial
investigation?
A. Blood glucose
B. Blood culture
C. CT head
D. MRI
E. Urine culture

190. 24 year old man postoperative develops shortness of breath and fever.
What’s the most appropriate investigation?
A. CT thorax
B. Chest X ray
C. V/Q scan
D. Echo
E. ECG

191. A 60-‐year-‐old man with back pain. Creatinine 350, urea 18, PSA 14.7
The most likely
diagnosis?
A. BPH
B. Prostate carcinoma
C. Bladder carcinoma
D. Multiple myeloma
E. Renal carcinoma

192. A 60 year old man with back pain. Blood test show creatinine 350, urea
18, PSA 4.5. The most likely diagnosis?
A.BPH
B. Prostate carcinoma
C. Bladder carcinoma
D. Multiple myeloma

E. Renal carcinoma
193. A 5-‐year boy presents with a bluish mark on his buttocks. Mother wants
to know if anything can be done?
A. Clotting screen
B. Full blood count
C. Reassure
D. LFT
E. No investigation required
194. A 10-‐year-‐old boy presents with purple plaques. He also has proteinuria.
What is the most likely cause?
A. Infection
B. Clotting abnormality
C. Vasculitis
D. Malignancy
E. Autoimune disease

195. There were 1000 members selected for a double blind placebo
controlled study. 503 were taking the placebo and 479 were in the active
group. After few weeks 25% of those taking the placebo withdrew compared
to 2% of active ones. What is the interpretation of the given data?
A. Chance event
B. Breakdown in the double blind placebo study C. Not possible to interpret
the given data
D. Failure of the active drug
E. Initial randomisation error

196. A 45-‐year-‐old man develops ankle oedema, headaches, engorged neck
veins. The most likely diagnosis?
A. Pericarditis
B. Pneumonia
C. MI
D. COPD

E. VSD

197. A 74 year old man is found to have bladder cancer.
He smoked for several years but stopped smoking 5 years ago. Otherwise he is
fit and well.
What is the most likely risk factor which could have contributed to him
developing bladder cancer?
A. smoking
B. stones
C. family history
D. drugs
E. aniline dye

198. A housewife develops pain on the anterior inferior part of the knee.
What’s the most likely bursa is involved?
A. prepatella
B. suprapatella
C. inferior patella
D. lateral patella
E. medial patella

199. A 45 year old man is undergoing laparoscopic apendicectomy. A port
for the camera was inserted half way between the line connecting the
umbilicus and anterior superior iliac spine. Which structure was pierced?
A. Linea Alba
B. Rectus abdominis
C. Aponeurosis of external oblique and internal oblique
D. Internal muscles and external muscles

200. A woman collapsed and was taken to the hospital. While in the
ambulance she complains of pain in the pelvis and on the malleoli. She is
diabetic, her weight 122kg, and height 162 cm. She dies in the ambulance.
What could have been the cause for her death?
A. PE
B. MI
C. Sepsis
D. Abdominal aneurysm

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SAMSONPLAB ACADEMY LIMITED

BOW ROAD 153-‐159

TELEPHONE: 02089800039 : MOBILE: 07940433068

PLAB 1 MOCK 2 2nd JUNE 2013

b. Thyroid function tests

e. Combined oral contraceptive pill

What is the single most appropriate follow up investigation?

94.A 40-‐year-‐old man has undergone detoxification programme. He wants

105. A 40-‐year-‐old housewife who has five children complains of

e. Delusion of grandiose

115. A 40-‐year-‐old lady presents with clear discharge from a single

a. Index finger and middle finger

169. A 49-‐year-‐old man first presented with increasing difficulty in

beta blocker, digoxin and bendroflumethiazide presents with yellow sclerae.

You might also like

Mock 2

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Mock 2

Uploaded by

Copyright:

Available Formats

SAMSONPLAB ACADEMY LIMITED

BOW ROAD 153-­‐159

TELEPHONE: 02089800039 : MOBILE: 07940433068

PLAB 1 MOCK 2 2nd JUNE 2013

b. Thyroid function tests

e. Combined oral contraceptive pill

What is the single most appropriate follow up investigation?

94.A 40-­‐year-­‐old man has undergone detoxification programme. He wants

105. A 40-­‐year-­‐old housewife who has five children complains of

e. Delusion of grandiose

115. A 40-­‐year-­‐old lady presents with clear discharge from a single

a. Index finger and middle finger

169. A 49-­‐year-­‐old man first presented with increasing difficulty in

beta blocker, digoxin and bendroflumethiazide presents with yellow sclerae.

You might also like

BOW ROAD 153-‐159

94.A 40-‐year-‐old man has undergone detoxification programme. He wants

105. A 40-‐year-‐old housewife who has five children complains of

115. A 40-‐year-‐old lady presents with clear discharge from a single

169. A 49-‐year-‐old man first presented with increasing difficulty in