Mock 3

SAMSONPLAB ACADEMY LIMITED

BOW BUSSINESS CENTRE
BOW ROAD 153-‐159
E3 2SE, LONDON
EMAIL: info@samsonplab.co.uk
Mobile: 07940433068

SAMSONPLAB MOCK MARCH 2013

1. A 25-‐year-‐old man fell onto outstretched hand and sustained injury to his hand
on examination there is tenderness just distal to the radius. X-‐rays are normal.
What is the most appropriate management?
a. Analgesia
b. Scaphoid cast
c. Below elbow cast
d. Follow up in clinic
e. Bandage

2. A 20-‐year-‐old man sustained angular fracture of femur. Which artery is artery
involved?
a. circumferential
b. Femoral
c. Popliteal
d. Internal iliac
e. Dorsalis pedis

3. A child 5 year with febrile convulsions what reassurance you will give to
mother.
a. Occur after head injury

b. Occur after 7 year age

c. Family history of febrile convulsions
d. Can lead to epilepsy
e. Its cause is benign

4. A. 45 year old man travel to Thailand. 2 days after returning he develops rash,
cervical lymphadenopathy, splenomegaly with sore throat. What the most
likely diagnosis?
a. Eistein bar virus
b. Cytomegalo virus
c. Parainfluenzae
d. Herpes simplex
e. Streptococcus

5. A 50-‐year-‐old man believes that his intestines are blocked and obstructed. He
refuses to eat or drink. What’s the most likely diagnosis?
a. Nihilistic
b. Hypochondriasis
c. Guilty
d. Paranoid delusion
e. Passivity phenomenon

6. A 60-‐year-‐old lady is refusing to eat and drinks. She says this is because there
is wide famine. What’s the most likely diagnosis?
a. Anxiety
b. Delusion of grandiose
c. Generalised anxiety disorder
d. Depression
e. Schizophrenia

7. A 23-‐year-‐old man claims that when he reads newspaper he can communicate
with the author
a. Depression
b. Paranoid delusion
c. Hypochondrial
d. Delusion of grandiose
e. Delusion of reference

8. A 60-‐year-‐old lady believes that she has got cancer of her bowels despite have
all investigations normal. What’s the most likely diagnosis?
a. Nihilistic
b. Hypochondrial
c. Depression
d. Generalised anxiety
e. Munchensen syndrome

9. A man swings his hands to strangers. He claims that help people to do what
they are doing. What is the most likely diagnosis?
a. Delusion of grandiose
b. Delusion of control
c. Paranoid delusion
d. Delusion of reference
e. Passivity phenomenon

10. A 50-‐year-‐old man develops lower back pain and which radiated all the way
down to the right toes after heavy lifting. What’s the most appropriate
diagnosis?
a. Disc prolapse
b. Spinal cord compression
c. Vertebral collapse
d. Sciatica
e. Muscle spasm

11.A 34-‐year-‐old lady presents with seizures 6 hours after delivery. What is the
most likely diagnosis?
a. Eclampsia
b. Pre-‐Eclampsia
c. Epilepsy
d. Hypovolaemia
e. Septic shock

12.A 10 months old child is brought by her mother, as she is worried that her child
could have cystic fibrosis. What is the most appropriate investigation?
a. Sweat test
b. Heel prick test
c. Breath test
d. Lung biopsy
e. Genetic testing

13.A 6-‐month-‐old infant with s/s of mild dehydration only dry mucous
membranes but good skin turgor. What is the most appropriate management?
a. ORS 90 Na mEq/l
b. ORS 60 Na mEq/l
c. IV fluids
d. No action required
e. Water by mouth

14.An infant with dry membranes drowsiness and prolonged capillary refill of 6sec,
decreased skin tugor.
a. NaCI 0.9% IV fluid bolus over 20 minutes
b. NaCI 9% IV fluids in 2 hours
c. ORS 60Na
d. ORS 90
e. Water by mouth

15.A 2-‐year-‐old baby girl has got diarrhoea 10 days ago, now presents with his
mother who is concerned about his status. Baby has moist mucus membrane
and is playing actively. What is the most appropriate management?
a. Reassure
b. IV 5% dextrose
c. IV fluids NaCI 0.9%
d. Admit
e. Refer to GP

16.A 25-‐year-‐old lady is found have pelvic inflammatory disease. What’s is the
most appropriate treatment?

a. Ofloxacin & metronidazole.

b. Metronidazole
c. Doxycylline
d. Cefuroxime
e. Metronidazole

17.34 year old woman who is 16 weeks pregnant, ultrasound scan of shows semi
solid cystic mass. What is the most likely diagnosis?
a. Fibroid
b. Ovarian cyst
c. Gravida uterus
d. Adenomyosis
e. Dermoid cyst

18.A 60-‐year-‐old lady who had stage 3-‐breast cancer has had an operation with
3/10 lymph nodes involved. What is the most appropriate next step in
management?
a. Radiotherapy
b. Chemotherapy
c. No action required
d. Analgesia
e. Follow up in clinic

19.A 29-‐year-‐old lady had FNAC done after being found to have a lump in the
breast. FNAC turned out to be normal. What’s the most appropriate
management?
a. Reassure
b. Mammography
c. USS
d. Core biopsy
e. Open biopsy

20.A 35-‐year-‐old lady on oral contraception has inter-‐menstrual breed. Cervical
smear 1 year back was normal.
a. Cervical smear
b. Endocervical swab

c. Colposcopy
d. Pelvic CT
e. Endometrial carcinoma

21.A 30-‐year-‐old lady with history of severe headache and photophobia and
presents with painful and irregular periods. She wants reversible contraception.
a. Mirena
b. Depo provera
c. Progesterone only pill
d. Implant
e. Combined oral contraception

22.A child was brought by her mother after having a fit. On fundoscopy she has
got retinal haemorrhages. What’s the most appropriate investigation?
a. CT head
b. Skeletal survey
c. FBC
d. X-‐ray
e. Reassure

23.A 2-‐year-‐old child presents with bruises of different shapes and ages. What is
the most appropriate investigation?
a. Coagulation screen
b. Skeletal survey
c. FBC
d. No investigation required
e. Autoantibodies

24.A 40-‐year-‐old man fell onto outstretched hand. X-‐ray confirms scaphoid
fracture. What’s
the most appropriate management?
a. Follow p in clinic in 6 weeks
b. Analgesia and follow in clinic
c. Broad arm sling
d. Above elbow cast

e. Cast for 6 weeks and review

25.A G3 P2 patient with a past history of smoking presents at 30 weeks gestation
with sudden, severe, diffuse abdominal pain. Examination reveals bleeding per
vagina and a rigid abdomen.
a. Ectropion
b. Trauma
c. Vasa praevia
d. Abruptio placentae
e. Uterine rupture

26.A patient with a history of 3 previous caesarean section presents in labour with
bleeding per vagina. On examination, there is abdominal tenderness and some
drainage from the abdominal scar.
a. Ectropion
b. Trauma
c. Cervical carcinoma
d. Uterine rupture
e. Vasa praevia

27.A 52 year old man has had left-‐sided chest pain for one day. It is severe,
constant and worse on respiration. He is also short of breath, nausea and reels
unwell. He has a body mass index of 27kg/m2 and smokes 15 cigarettes per
day. His chest x-‐ray is normal and he has had a tachycardia on ECG. What is
the single most likely diagnosis?
a. Acute coronary syndrome
b. Costo-‐chondritis
c. Gastro-‐oesophageal reflux disease (GORD)
d. Pericarditis
e. Pulmonary embolism

28.A 58-‐year-‐old man has dyspnoea, syncope and has lost weight. He is breathless
at rest. His blood pressure is 110/60mmHG on standing and 140/80mmHg on
lying. He smokes 30 cigarettes a day. What is the single most appropriate
initial investigation in establishing a diagnosis?

a. Chest x-‐ray
b. Echocardiogram
c. ECG
d. Pulmonary oedema
e. 24-‐hour ECG
29.A 22 year old woman is a non-‐smoker and sexually active with a regular
partner.
a. Tubal ligation
b. Withdrawal technique
c. Combined oestrogen/progesterone
d. Condom (male)
e. Vaginal condom

30.A 22-‐year-‐old non-‐smoking, nulli-‐parous woman has a strong family history of
deep vein thrombosis and pulmonary embolism. She has irregular periods,
which concern her. She has a regular partner and is very anxious not to
become pregnant.
a. Cap or diaphragm (barrier method)
b. Progesterone only pill
c. Injection of depot progesterone
d. Vasectomy
e. Rhythm method (billings)

31.A 30 year old woman’s, who has learning difficulties, lives in the community
and has recently been diagnosed as HIV positive
a. Intrauterine contraceptive device
b. Injection of depot progesterone
c. Condom male
d. Rhythm method (billings)
e. Withdrawal technique

32. A study was carried over a 5 year period in two hospital A & B for
treatment of women with breast cancer. Follow up in country A showed
more people were better than in hospital B. What type of study is this?
A. Prospertive cohort
B. Retrospective cohort
C. Case control

D. Obervation study
E. Retrospective and prospective study

33. A 14 year old boy who is a known diabetic has stopped taking his
medication and he has stopped going to school as well. He is not eating
and drinking and is not happy at school. What would be the most
appropriate management?
A. Refer to clinical psychiatrist
B. Refer to paediatrician
C. Refer to social worker
D. Refer to community health team
E. Admit to medical team

34. a 45 year old man wpresents with vertigo and dizziness. On
examination he has nystagmus but no hearing loss and tympanic
membrane is normal. What is the single most likely diagnosis?
A. Acoustic neuroma
B. Cerebellar infarction
C. Meneires disease
D. MODA syndrome
E. Vestibular neuritis

35. A 24 year old man after playing rugby he complains of eae pain but he
has normal tympanic membrane? What is the single most appropriate
management?
A. analgesia
B. Intravenous analgesia
C. Topical antibiotics
D. Oral antibiotics
E. No action required.

36. A 32 year old women presents with hypertension. She has loin discomfort and
bilaterally
palpable kidneys. Choose the single investigation most likely to indicate a
cause for

hypertension.
a. 24 hour urinary free cortisol concentration
b. 24 hour urinary metanephrines concentration
c. Autoantibody screen
d. Ultrasound scan of the abdomen
e. Plasma aldosterone concentration

37. A 45-‐year-‐old woman presents with weight gain 7 kg over nine months. She
has developed
acne and is bruising more easily. She is obese, hypertensive and plethoric.
Choose the single
investigation most likely to indicate a cause for hypertension.
a. 24 hour urinary free cortisol concentration
b. Radionuclide renogram
c. Serum calcium concentration
d. Serum Cortisol concentration
e. Serum growth hormone concentration

38. A 55-‐year-‐old man is referred following a visit to the optician. He has blood
pressure of
210/110 mmHg with hypertensive retinopathy but no other abnormalities. His
serum
Potassium is 2.9 mmol/l. He is on no medication.
a. Ultrasound scan of the kidneys
b. 24 hour urinary free cortisol concentration
c. Plasma aldosterone concentration
d. Autoantibody screen
e. Radionuclide renogram

39. A man who works in the shipyard and smokes is admitted with shortness of
breath. He was treated with antibiotics by his GP but it didn’t help and he
died later. Pleural thickness was found. Why will you report the death to a
coroner?
a. Death is due to an industrial cause.
b. Death is due to wrong treatment by GP

c. Wrong treatment for the cause

d. In order to satisfy relatives
e. to find the cause
40. A man with known renal failure is to undergo a surgical procedure which
require contrast medium. Which of the following will you give to protect the
kidney from further damage from the contrast?
a. Mannitol
b. Furosemide
c. Dopamine
d. Normal saline

41. A woman is in her 9th week of pregnancy and lupus anticoagulant antibodies
are found to be positive. What will you give her?
a. Aspirin only
b. Aspirin and heparin
c. Heparin only
d. Reassure
42. A child presents to the Accident and Emergency Department with headache,
vomiting, neck stiffness and a rash is present. What treatment would you
give?
a. Cefotaxime
b. Amoxicillin
c. Cotrimoxazole
d. Flucloxacillin
43. A group of patients with a common disease characteristics are followed

forward over a period of time to investigate the outcome according to
exposure to different factors. It started with two groups free of disease and
followed forward for a period of time. Which kind of study design is this?
a. Prospective cohort study
b. Randomized controlled trial
c. Case control study
d. Case control retrospective study
e. Prevalence
44. A man presents with ascites and jaundice. Ascitic tap showed low albumin
and protein (<25g/d). What is the diagnosis?
a. Cirrhosis
b. Budd-Chiari syndrome
c. Tuberculosis

d. Heart failure
45. A man presents with breathlessness and ascites. His ascetic tap showed low
glucose and low protein (<25g/d). What is the diagnosis?
a. Heart Failure
b. Cirrhosis
c. Tuberculosis
d. Budd-Chiari syndrome
46. A post-menopausal woman has hot flushes. His family history is

unremarkable. What is the best management?
a. Oestrogen/progesterone
b. Raloxifene
c. Surgery
d. Norethisterone

47. A 27-‐year-‐old woman with anxiety and weight loss has a tachycardia; tremor
and mud
proptosis. What single mechanism accounts for her weight loss?
a. Deficiency of thyroid hormone
b. Increased levels of calcitonin
c. Increased metabolic rate
d. Insulin resistance
e. Reduced calorie intake

48. A four-‐year-‐old boy is about to start nursery school. He wets the bed every
night and also
wets himself about once a week when he gets excited. What is the single
most appropriate?
Management?
a. Amitriptyline
b. Behavioural modification treatment
c. Blood sugar
d. Desmopressin
e. Reassurance

49. A 2-‐year-‐old child presents with fever of 39 degrees and is unable to swallow
saliva. What
is the single most appropriate initial investigation?
a. Call anesthetist
b. Barium swallow
c. Oesohago-‐gastroduodenoscopy
d. Intravenous antibiotics
e. Nebulised salbutamol and adrenaline.

50. A child is presents with loose stool and failure to thrive. What is your next
investigation to lead to a diagnosis?
a. Antiendomysial antibodies
b. Sweat test
c. Alpha 1 antitrypsin
d. Antimitochondrial antibodies
e. Echocardiogram
51. A child took his grandmothers pills. The ECG of the child shows tachycardia
and arrhythmias. Which of the following medications was likely taken?
a. Tricyclic antidepressants
b. Beta blocker
c. Calcium channel blocker
d. Lithium
e. Diuretics

52. A 2-‐year-‐old child presents with a bead in the ear. What is the single most
appropriate
management?
a. Remove under GA
b. Remove with forceps
c. Remove with hook
d. Remove with fingers
e. Remove with oil

53. A 40-‐year-‐old man has been brought to hospital by his because he has been
repeatedly

washing hands and locking the doors. What is the most appropriate
management?
a. Cognitive behaviour therapy
b. Behavior therapy
c. Reassure
d. Electroconvulsive therapy
e. Anti-‐depressants

54. Which of the following presentations of an 18-‐month-‐old baby deserves to be
worried about
concerning the development of the baby?
a. Social smile but no eye-‐to-‐eye contact
b. Can’t make meaningful sentences
c. Can’t throw ball overhead
d. Can’t make a tower of 4 cubes
e. Can’t kick ball forward

55. A woman who already has 2 kids has had amenorrhea for 8wks now. Her
pregnancy test is
positive but it shows 16wks of pregnancy. Her cervical os is closed but there
are signs of
bleeding. She has severe morning sickness this time compared to previous 2
pregnancies.
What is the diagnosis?
a. Molar Pregnancy
b. Ectopic pregnancy
c. Placenta praevia
d. Inevitable abortion
e. Threatened abortion

56. A 3 months old boy has developed honey colored crusts around his mouth.
There are some
blisters with erythematous base, some of which are discharging. The boy is
apyrexial.
What is the most likely diagnosis?
a. Herpes simplex
b. Bullous impetigo

c. Phemphigoid
d. Erysipelas
e. Cellulites

57. An 80 year old lady with previous history of breast cancer treated with surgery
and
chemotherapy presents with confusion, thirst and abdominal pain. What is
the single most
appropriate investigation?
a. Serum calcium concentration
b. Serum potassium
c. Serum urea and phosphates
d. Serum sodium
e. MRI scan of the chest

58. A 36-‐year-‐old lady presents with headache and can’t look at a bright light.
What is the single
a. Migraine
b. Sinusitis
c. Giant cell arteritis
d. TIA
e. CRAO

59. A 60 yr old woman suddenly develop severe left ventricular failure following a
myocardial
infarction and she is found to have systolic murmur on examination.
a. VSD
b. Papillary muscle rupture
c. Aortic stenosis
d. PDA

e. ASD
60. A 2 month old breast milk fed baby presents with jaundice and white stool.
What is the
single most likely diagnosis?
a. Breast milk jaundice
b. Biliary atresia
c. Physiological jaundice
d. Celiac disease

61. 79 yr old man who is active comes to you with complaint of swelling and pain
of dorsiflexion
of the leg. On examination there is oedema + 3cm increase in diameter of
right calf
comparing to the other side. What is the cause?
a. Popliteal artery aneurysm
b. DVT
c. Popliteal cyst
d. Pulmonary embolism
e. Gout

62. A 54-‐year-‐old patient presents with a lump in the neck, which moves on
swallowing. What
Investigation will you do to establish diagnosis?
a. Ultrasound
b. FNAC
c. CT
d. MRI scan
e. X-‐ray neck

63. A 35-‐year-‐old lady presents with several episodes of panic attack. What long
term treatment can be given to her?
a. Beta blocker
b. CBT
c. Behavior therapy
d. Re-‐breathing bag

e. Benzodiazepine

64. A 6 year old with weekly abdominal pain with headache not associated with
vomiting and
diarrhea and no abnormal findings on examination. What investigation would
you carry out
for her?
a. No investigations required
b. Abdominal X-‐ray
c. Ultrasound scan abdomen
d. CT abdomen
e. MRI scan abdomen

65. A 54-‐year-‐old man presents with some raised lesions on the shin. He comes
with cough and
Shortness of breath. Chest X-‐ray shows bilateral hilar lymphadenopathy. What
is the most
likely diagnosis?
a. Sarcoidosis
b. Mesothelioma
c. Interstitial lung disease
d. Extrinsic allergic aveolitis
e. Tuberculosis

66. Which medicine to be given in the treatment of meningitis at the hospital?
a. Ampicillin
b. Cefotaxime
c. Tetracycline
d. Benzylpenicillin
e. Rifampicin

67. Which of the following drugs can cause vision impairment?
a. Steroids
b. Salbutamol

c. Beta blockers

d. Biphosphanates
e. Non steroid anti-‐inflammatory drugs

68. An 80-‐year-‐old man presents with ulcer on the tonsils. What is the most likely
diagnosis?
a. Tonsilar carcinoma
b. Laryngeal cancer
c. Lymphoma
d. Acute Lymphoblastic Leukemia
e. Herpes Simplex

69. A 57-‐year-‐old man with pernicious anemia prefers injection for her medication
because oral medication doesn’t work. Why oral medication won't work?
a. Intrinsic factor deficiency
b. Iron deficiency
c. Folate deficiency
d. Coaeliac disease
e. Phenytoin medication

70. A 70-‐year-‐old patient presents with cancer metastasis to the bone. Which is
the likely
primary cancer site?
a. Breast
b. Cervix
c. Ovary
d. Lung cancer
e. Gastric carcinoma

71. An 85-‐year-‐old lady who lives in the nursing home presents with severe
itching in her hands
and she is found to have scabies. What is the mechanism for itching?

a. Allergy to toxins realized by mites

b. Inflammation reaction
c. Autoimmune inflammation reaction
d. Normal phenomenon
e. Infection

72. What advice will you give the parents of a child with repeated UTI?
a. Surgery needed
b. Prophylactic antibiotics
c. Intermittent self catheterization needed
d. Foley catheter needed

73. What test will you do for TB for the child when the parents are not happy
about doing
bronchoalveolar lavage under general anesthesia?
a. Blood test
b. Chest X-‐ray
c. Bronchoscopy
d. None
e. Skin test

74. Baby has blue mark near coccyx since birth. What is the most appropriate
treatment?
a. Reassure
b. Resection by surgery
c. Clothing screen and biopsy
d. Biopsy
e. Chromosomal analysis

75. A 60 year old man who is an ex military serviceman with post traumatic stress
disorder.

What is the most appropriate initial treatment?

a. CBT
b. Benzodiazepines
c. Electroconvulsive therapy
d. Supportive therapy
e. Behaviour therapy

76. A 30-‐year mother with café-‐au-‐lait spot is asking what the chance is that her
child will
acquire the disease?
a. 1:2
b. 1:4
c. 1:8
d. 0%
e. 1:16

77. A 45-‐year-‐old man presents with central crushing chest pain radiating to left
arm with
nausea and analgesia. Morphine has been to him for the pain. Which
medication should be
used to reduce nausea and vomiting?
a. Metochlopromide
b. Cyclizine
c. Prochlorperazine
d. Cimetidine
e. Betahistine

78. A patient has diplopia on looking downward. On examination he is found to
have dilated pupils. What nerve is affected?
a. Trochlear nerve
b. Occulomotor nerve
c. Abducens nerve
d. Trigeminal nerve

e. Hypoglossal nerve

79. A 47-‐year-‐old man presents to accident and emergency department with full
thickness
burns calculating up to 10% of his lower limbs from steam pipe. Analgesia has
been given.
What is the most appropriate immediate management?
a. Escharotomy
b. Intravenous fluids
c. Refer to burns to unit
d. Admit to general ward
e. Discharge home with analgesia and follow up in clinic

80. An 18 year old male is rushed into the emergency department by a group of
friends who
leave before they can be interviewed by medical staff. He is semiconscious,
has a
respiratory rate of 8/min, a BP of 120/70mmhg and a pulse of 60bpm. He is
noted to have
needle track marks on his arms and his pupils are small. What single initial
treatment
would you administer?
a. Naloxone
b. Morphine
c. Adrenaline
d. Atropine

81. A 45-‐year-‐old nurse who works in the nursing home five days after looking
after the patient
in the nursing home experiences excessive itching in between the fingers and
toes. What is
the mechanism of severe itching?
a. Allergic to medication she was handling

b. Keratinosis
c. Secondary infection
d. Blood vessel rapture
e. Allergic reaction

82. An 80-‐year-‐old lady with an ulcer on the labia major, which is found to be
carcinoma. Which
group of lymph nodes will be initially involved?
a. Superficial inguinal lymph nodes
b. Deep inguinal lymph nodes
c. Para-‐aortic lymph nodes
d. Common iliac lymph nodes
e. Internal iliac lymph nodes

83. A 50-‐year-‐old lay presents with post-‐coital bleeding for the past 3 months.
What is the
most appropriate investigation?
a. cervical smear
b. Colposcopy
c. Trans-‐vaginal ultrasound scan
d. Endometrial sampling
e. Hysteroscopy

85. A 70-‐year-‐old man presents to outpatient clinic complaining of swelling of the
ankles
month after being started on anti-‐hypertensive medication. Which of the
following is the
a. Angiotensin converting enzymes inhibitor
b. Bendroflumethiazide
c. Amlodipine
d. Furosemide
e. Beta-‐blocker

86. A 70-‐year-‐old man with small cell carcinoma of the lungs presents with thirst
and polyuria.
Which of the following is the most likely location?
a. Medulla
b. Pons
c. Cerebellar
d. Midbrain
e. Brainstem

87. A 5-‐year-‐old boy is found to have syndrome of inappropriate anti-‐diuretic
syndrome after
suffering from meningitis. Which of the following is the most likely
abnormality?
a. Hypernatraemia
b. Hyponatrmia
c. Hypokalaemia
d. Hyperkalaemia
e. Hypocalcaemia

88. A 65 year old lady on tamoxifen for breast cancer which was treated with
mastectomy and
radiotherapy. She is also on on senna. She is complaining of thirst and
polyuria. What is the
single most appropriate initial investigation?
a. Mammography
b. Ultrasound scan
c. MRI scan chest

d. Serum blood glucose

e. Serum calcium

89. A 12 year old boy presents with weight loss, night sweats and chronic cough
for the past 3
months. His father has tuberculosis. You decide to do broncho-‐alveolar
lavage under
general anesthesia but the family refuses. What investigation will you do to
confirm the
diagnosis of tuberculosis?
a. urine antigen for TB
b. Gastric washing
c. Sputum culture
d. Blood culture
e. Heef (skin prick) test

90. A 40-‐year-‐old mother who is a carrier of hepatitis B has just delivered a baby.
What is the
most appropriate management?
a. hepatitis vaccination of the baby
b. Give immunoglobulin to the child
c. Advice the mother not to breast feed
d. Test the baby for hepatitis
e. Take the blood from the lab for hepatitis serology

91. A 23-‐year-‐old woman who is 18 weeks pregnant has just had exposure to a
child who has
chicken pox. Her varicella antibodies are negative. What is the most
appropriate
management?

a. Vaccination
b. Give oral acyclovir
c. Give immunoglobulin
d. Isolation
e. Quarantine

92. An 80 year old lady with history of breast cancer and now on tamoxifen and
senna. IN
The last couple of weeks she has been complaining of thirst and polyuria.
What is the single
most likely electrolyte abnormality to be found?
a. Hyponatraemia
b. Hypokalaemia
c. Hypernatraemia
d. Hypercalcaemia
e. Hpocalcaemia

93. A 65-‐year-‐old lady with hypertension on treatment with bendroflumethiazide
present with
confusion. His Electrocardiogram is normal. What is the most likely cause of
his symptoms?
a. Hyperkalaemia
b. Hypokalaemia
c. Hpercalcaemia
d. Hyponatraemia
e. Hypernatraemia

94. A 71year old presents with weakness on her left side and dysphagia. By the
time she is seen
accident and emergency department al her symptoms have resolved. She is
on aspirin 75
mg, Paracetamol 2 tablets a day and Temazepam. What is the single most
appropriate

management?
a. Aspirin 75mg and dipridamole
b. Clopidogrel and dipyridamole
c. Give statin
d. Aspirin 300mg for 2 weeks
e. Aspirin 300mg

95. A 50-‐year-‐old man has had progressive difficult in walking for the past 2 years.
He has
memory loss and history of recurrent falls. He also has tremors. What is the
single most
likely diagnosis?
a. Subdural haematoma
b. Alzheimer’s disease
c. Multi-‐infarct dementia
d. Pick’s disease
e. Lewy body dementia
96. An obese 55-‐year-‐old man with a 2-‐year history of palpitations is brought to
the accident
and emergency department unconscious. He is pulseless and his respiration is
progressively
becoming shallower. The ECG shows disorganized complexes. Choose the
SINGLE most likely
diagnosis.
a. Complete heart block
b. Ventricular fibrillation
c. Phaeochromocytoma
d. Wolf Parkinson white syndrome
e. Wenckebach phenomenon

97. A 45-‐year-‐old man with a history of palpitations complains of difficulty in
breathing

associated with chest pain. His ECG tracing shows a tachycardia of 100
beast/minute and a
wide QRS complex, which begins with a ‘slur’. Choose the SINGLE most likely
diagnosis.
a. Wenckebach phenomenon
b. Torsade de points
c. Wolf Parkinson white syndrome
d. Diabetic neuropathy
e. Ventricular ectopics

98. A woman brings her asthmatic child who is breathing heavily to the A&E.
Oxygen, nebulized salbutamol, ipratropim bromide and oral prednisolone
has already been given at the A&E. She is flaring with subcostal and
intercostals recession. What will you give next?
a. Magnesium sulphate IV
b. Aminophylline IV
c. Hydrocortisone IV
d. Inhaled steroid
e. IV hydrocortisone
99. A patient is found to have a pansystolic murmur radiating to the axilla.
a. Mitral regurgitation
b. Mitral stenosis
c. Tricuspid regurgitation
d. Aortic stenosis
100. A child is found to have a harsh pansystolic murmur. He is not

cyanosed. What is the diagnosis?
a. VSD
b. ASD
c. PDA
d. Transposition of the great vessels
e. Tetrad fallot
101. A 30 year old man is diagnosed with Chlamydia. If he is left

untreated, what is the most likely complication to develop?
a. Balanitis
b. Cystitis
c. Epididymorchitis

d. Cancer

102. A 49 year old man with suspected heart failure has a blood pressure of
90/60mmHg and
Pulse rate of 110 beats/minute. Chest X-‐ray shows a huge globular heart.
Choose the
SINGLE most appropriate management strategy.
a. Pericardiocentesis
b. ACE inhibitors
c. Heart transplant
d. Aortic valve replacement
e. Thiazide diuretic
103. A 25 year old man has passed a 4mm stone in urine. He says he drinks
water often. He is found to have another 3mm stone. What management
will you suggest?
a. Lithotripsy
b. Ask patient to continue to drink more water
c. Reassure patient
d. Open surgery.
e. Endoscopic removal

104. A 42-‐year-‐old man with cardiac failure is found to have a palpable thrill in the
right second
intercostal space, which radiates to the neck. Choose the SINGLE most
appropriate
management strategy.
a. ACE inhibitors
b. Heart transplant
c. Thiazide diuretics
d. Aortic valve replacement
e. Thiazide diuretics

105. A woman who uses COCP often undergoes a speculum examination
which shows an ectropion. Her last cervical smear was 2 years ago.
What will you do next?
a. Cervical smear

b. Endoscopy
c. Colposcopy
d. Surgery

106. A 50-‐year-‐old man has had vomiting for the past 2 weeks. He has been
vomiting steal
substances and he also regurgitates. What is the most likely electrolyte
abnormality?
a. Hyponatraemia
b. Hyponatraemia
c. Hypercalcaemia
d. Hyperkalaemia
e. Hypocaemia

107. A 40-‐year-‐old lady presents with hot flushes and sweating. Her mother had
early
menopause. What is the most appropriate investigation?
a. Testesterone
b. Serum oestrogen levels
c. Serum Follicular stimulating hormone
d. Corticosteroid levels
e. Trans-‐vaginal ultrasound scan

108. A 40-‐year-‐old lady presents to out patient clinic because she is worried of
ovarian
carcinoma because her mum had ovarian cancer. What is the most
appropriate test?

a. CA 19
b. CA 125
c. CEA
d. Alpha fetal protein
e. Prostate specific antigen
109. A post menopausal woman presents with symptoms of osteoporosis. What

investigation will you do?
a. Bone density
b. Nuclear medicine scan
c. CT scan
d. MRI

110. A 20-‐year-‐old man present to accident and emergency after being involved in
road traffic
accident. Ultrasound scan of the abdomen shows there is a small hematoma
in the
spleen. What is the most appropriate management of this patient?
a. Discharge home and review in outpatient clinic
b. Refer to general surgeons for admission for a period of observation.
c. Refer to general surgeon for an operation
d. Immediate blood transfusion
e. Discharge home no treatment required

112. A mother comes to paediatric outpatient clinic with an 18-‐month-‐old child
for assessment
of her development. Which of the following would cause concern in the 18-‐
month-‐old child?
a. He smiles but no eye contact
b. Speaks 2 words but words do make sense
c. No hand dominance
d. Not able to throw the ball overhead
e. Cannot stand on 1 leg.

113. A 28-‐year-‐old lady presents with a lump in the right breast. She had biopsy
of the lump
done which showed low columnar lined with clear duct with fibrosis tissue
in between.
The lump is well defined. What is the single most appropriate diagnosis?
a. Breast carcinoma
b. Begnin breast disease
c. Fibroadenoma
d. Ductectasia
e. Breast cyst

114. A 57 year old with bipolar affective disorder is on treatment with lithium
1200mg. He
develops tremors and agitation. What is the single most likely cause?
a. Lithium toxicity
b. Renal failure
c. Acute flare of bipolar disorder
d. Anxiety
e. Autoimmune hyperthyroidism

115. A 40-‐year-‐old man with asthma is treatment with maximum does of inhaled
medication
but he still gets breathless. What is the single most appropriate
management?
a. Oxygen
b. Oral steroid
c. Oral aminophylline
d. Antibiotics
e. Continue same treatment

116. A 53 year old woman with wide spread metastatic breast cancer develops
rattling noise

from the throat. Suction does not help. What is the single most appropriate
management?
a. Normal saline 0.9 % nebulisers
b. Hyoscine injection intramuscular
c. Anti-‐muscarinic
d. Antibiotics
e. Reassure

117. A 19-‐year-‐old girl who is a dancer by profession was brought to hospital by
her family with
a BMI of 12. Blood test show potassium of 3.2. The girl is ok now. At the
home the girl is
always fighting with everyone. What is the single most appropriate
management?
a. Out patient depart family therapy
b. Out patient psychiatrist referral
c. Out patient cognitive behavior therapy
d. Inpatient monitored feeding
e. Discharge home with outpatient follow up.

118. A 16-‐year-‐old girl took 10 tablets of paracetamol. She is now fine and her
paracetamol
levels are below the treatment levels. She is still drunk but she is clinically
fine. What is
a. Admit to general ward and referral to psychiatrist the following morning.
b. Psychoanalysis
c. Refer to social worker
d. Refer to the psychiatrist
e. Out-‐patient psychiatrist referral

119. A woman with haemoglobin of 8.4g/dl is to undergo an elective surgery.

What decision will you take?
a. Defer and investigate
b. Proceed with surgery
c. Transfuse blood and proceed with surgery
d. Reassure patient and proceed with surgery

120. A 20-‐year-‐old woman feels guilty that she got traffic tickets. She now feels
that she need
to be punished. What is the single most likely diagnosis?
a. Schizophrenia
b. Bipolar affective disorder
c. Paranoid delusion
d. Dementia
e. Nihilistic disorder

121. A 20-‐year-‐old lady who is 6 weeks after birth of her child thinks that her baby
has evil eyes.
What is the single most likely diagnosis?
a. Baby blues
b. Post natal psychosis
c. Post natal depression
d. Anxiety
e. Schizophrenia
122. An 18-‐month-‐old child who was properly gaining weight initially up to 11
months. At 11
months he was 11kg. He is eating and drinking well. Now he is 18 months he
is 10kg. What
is the most appropriate investigation?
a. Stool culture
b. Ant-‐mitochondrial antibodies
c. Anti-‐endomysial antibodies
d. Echo cardiogram

e. Sweat test
123. A 54 year old woman, who works in a pet shop and previously been well,
presents with
breathlessness and a dry cough. What is the single most likely diagnosis?
a. Tuberculosis
b. Brucellosis
c. Chlamydia psittacci
d. Legionella
e. Pneumocysti Jiroveci

124. A 43 year old man presents with generally feeling unwell. On examination
he is found to
have raised jugular venous pressure and swelling of the upper limb
bilaterally. Lower
limbs are normal and he has no pulse. Which of the following is the most
appropriate?
investigation?
a. CT scan chest
b. MRI scan chest
c. Electrocardiogram
d. Echocardiogram
e. Standing and lying blood pressure

125. A 65 year old man presents with headache and loss of vision in one eye.
Blood test shows
increased ESR and found to have giant cell arthritis. She is put on
appropriate treatment.
Which of the following medication would be required in her further
management?
a. Proton pump inhibitor
b. Aspirin
c. Paracetamol
d. Beguinide

e. Anti-‐depressant

126. A 40 year old man 24 hours after an operation of total hip replacement
present with
temperature of 37.7C and shortness of breath. What is the single most
appropriate
investigation?
a. DEXA scan
b. CT scan chest
c. MRI scan chest
d. Nuclear bone scan
e. Chest X-‐ray

127. A 67 year old man with type 1 diabetes mellitus is unable to walk up the
stairs and on
examination he has wasting of the upper limbs and quadriceps. What is the
single most
likely diagnosis?
a. Myotrophy
b. Peripheral neuropathy
c. Mononeuropathy
d. Autonomic neuropathy
e. Dermatomyositis

128. A 60 year old man who is in intensive therapy unit suddenly develops
palpitation and a
systolic murmur. What is the most appropriate investigation?
a. ECG
b. Echocardiogram
c. CT scan chest
d. MRI scan chest
e. Blood culture

129. An 18 months old baby has hypothyroidism. What is the single most likely
characteristic?
Of hypothyroidism?
a. Prolonged jaundice
b. Can cause jaundice
c. Jaundice will persist into adult life
d. jaundice will resolve on its own
e. Needs exchange of blood

130. A 22 year old Irish man presents to accident and emergency department
with
hyperventilation and palpitation and shortness of breath. What would be on
his arterial
blood gas?
a. Ph 7.55, PaCO2 2.1
b. Ph 7.55, PaCO2 7.7
c. Ph 7.30, HCO3 35
d. Ph 7.35 HCO3 35
e. Ph 7.55, CO2 5.0

131. A 10 year old girl has hay fever and he has a problem with school
performance. What is
the single most appropriate management?
a. Oral antihistamine
b. Intramuscular adrenaline
c. Oral antihistamine and IM adrenaline
d. Desensitization
e. Reassure

132. A 65 year old man present to emergency department with palpitations. ECG
shows atrial
fibrillation. Which of the following scores will you use to assess the risk of
this patient?
a. CHADS 2 score
b. ABCD 2 score
c. MEWS score
d. FAST
e. GRACE

133. An 80 year old man presents with right sided weakness and dysphasia by the
time you see
her in accident and emergency department all the symptoms had
disappeared. Which of
the following scores will you use?
a. CHADS2 score
b. ABCD 2 score
c. FAST score
d. Well’score
e. Rockall score

134. A 6 year old boy was hit in the scrotum at school. He has severe pain and
acute
tenderness. What is the most appropriate investigation?
a. Early surgical exploration
b. Ultrasound scan
c. Reassure
d. Mid stream urine
e. CT scan scrotum

135. A 20 year old lady who is a marathon runner on routine examination she is
found to have
normal FSH and LH levels. Her prolactin level is 600. What is the single most
likely cause?
a. Hypothalamic amenorrhea
b. Prolactinoma
c. Menopause
d. Congenital anomaly
e. Turner’s Syndrome

136. A 34 year old woman who is 18 months after delivery of her baby has had no
periods since
the birth of her child. She has been feeding her baby intermittently.
Prolactin is 600mg.
What s the single most likely cause?
a. Prolactinoma
b. Physiological amenorrhoea after birth
c. Menopause
d. Hypothalamic amenorrhoea
e. Pregnancy

137. An 18 year old university students came back home yesterday due to
headache. She
presents to accident and emergency department with headache , nausea
and vomiting.
On examination she has a temperature 38 degrees, pulse is 80, BP 120/70
and she has
neck stiffness. What is the single most appropriate treatment?
A. Co-‐amoxiclav

B. Ceftriaxone
C. Amoxicillin
D. Rifampicin
E. Benzylpenicillin

138. A 60 year old lady was admitted with sepsis 48 hours ago. She was started
on
benzyl penicillin and tazobactam but still the high temperature persists.
What is the
most appropriate next step in management?
a. Change to ceftriaxone
b. Penicillin plus tazobactam plusanti-‐fungal
c. Anti-‐fungal medication intravenous
d. Add steroids orally
e. Continue the same medication for 2 weeks.

139. A patient is severely sick, He came with rash that does not blanch,
photophobia, headache, papilloedema and neck stiffness, what is the next
line of immediate action?
a. IV antibiotic and CT scan
b. IV antibiotics
c. CT scan
d. Lumber puncture

140. A new born baby 3 weeks old has had jaundice from 48 hrs of age. The baby
is now 3
weeks and still jaundice. He is growing well and breast feeding. What is the
single most
likely diagnosis?

a. Physiological jaundice
b. Breast milk jaundice
c. Galactassaemia
d. Hypothyroidism
e. Urinary tract infection

141. A 70 year old woman presents with shortness of breath. On examination has
unilateral
basal crepitations. She had pleural tap, which showed Protein of 42g/l from
the pleural.
She is otherwise fit and well. She is a non smoker. What is the single most
likely diagnosis?
a. Benign ovarian tumour
b. Bronchial carcinoma
c. Congestive heart failure
d. Hepatic cirrhosis
e. Renal failure

142. A 70 year old man is found to have colonic cancer. Which of the following is
the risk factor?
a. Smoking
b. Family history
c. Poor diet
d. Coal
e. Analine dye

143. A 76 year old man with proteinuria and blood pressure of 160/100. An
ultrasound scan
shows both kidneys to be small but smooth outlined and he has fibro-‐
nephrosis. What is
the most likely cause?

a. Obstructive uropathy
b. Unilateral renal artery stenosis
c. Chronic glomerulonephritis
d. Chronic pyelonephritis
e. Bilateral renal artery stenosis

144. A mother comes in with her 8 month old child who has been fed with
artificial milk. The
mother is worried that the child could have lactulose intolerance. What is
the most
appropriate management?
a. Change to hypo-‐allergic milk
b. Change to soya milk
c. Continue with milk and reassure
d. Do immunoglobulin
e. Never use any type of milk.

145. A 45 year old man who is a known alcoholic present with vomiting and
haematemesis.
The blood pressure is 90/60 and pulse is 120. ECG has been done. What is
the most likely
finding on the ECG?
a. Atrial fibrillation
b. Sinus tachycardia
c. Ventricular tachycardia
d. Ventricular ectopics
e. Ventricular fibrillation

146. A 50 year old man who is a know alcoholic presents with vomiting and
haematemesis. He
has a blood pressure of 90/60 and pulse 120. Which of the following scores
will you use?
a. Rockall score
b. ABCD2 score
c. CHADS 2 score
d. CURB 65.
e. FAST

147. A 68 year old presents with fever and cough. Chest X-‐ray shows
consolidation. Which of
the followings scores will you use to assist in the further management of the
patient?
a. CURB 65
b. Well’s score
c. ABCD 2 score
d. ABCDS 2 score
e. GRACE score

148. A 40 year old man has been to West Indies for holiday. Now he presents
with pain in both
ears. What is the single most appropriate management?
a. Amoxicillin
b. Gentamicin eye drops
c. Flucloxacillin
d. Urgent referral to ENT
e. Cefuroxime drops

149. A 75 year old man presents with facial numbness and pain in the right ear.
On
examination he has blister in the external auditory canal. What is the most
appropriate

treatment?
a. Steroid
b. Oral acyclovir
c. Referral to the ophthalmologist
d. Antibiotics
e. No treatment required

150. A 67 year old man with known HIV infection presents with temperature of
38.5 and basal
crepitations on both sides of the lung fields. What is the single most likely
cause?
a. Cryptococcus
b. Toxoplasmosis gondii
c. Pneumocysti jiroveci
d. Human papilloma virus
e. Herpes zoster infection

151. A 27 year old lady who is 10 weeks pregnant presents with per vaginal
bleeding. On
examination she has products of conception at the cervical os and she has
lower
abdominal tenderness. What is the single most appropriate management?
a. Admit and observe
b. Blood transfusion
c. Discharge home
d. Intravenous fluids
e. Evacuation of the content.

152. A 34 year old man presents with neck pain after the road traffic accident. At
what level
should the cervical X-‐ray de done?
a. C5-‐C6
b. C6-‐C7

c. C7-‐T1
d. C8-‐T1
e. T1-‐T2.

153. A 45 year old man who is a known alcoholic come to outpatient clinic for
follow up and he is found to have loss of vibration and touch and position up to
his knees bilaterally. What is
the single most likely diagnosis
a. Autonomic neuropathy
b. Peripheral neuropathy
c. Intermittent claudication
d. Venous insufficiency
e. Mononeuropathy

154. A 29-‐year-‐old man with human immunodeficiency virus (H/Y), who is taking
antiretroviral
drugs and has falling T cell count, presents with a two day history or herpes
zooster rash
over the C8 dermatome. What is the single most appropriate management
plan?
a. Acyclovir (intravenous)
b. Acyclovir (oral)
c. Urgent referral to ophthalmologist
d. Prednisolone (oral)
e. Co-‐amoxiclav (oral)

155. A 19-‐year-‐old woman presents with a herpes zoster rash of the L4
dermatome. The rash is
itchy but not painful. What is the single most appropriate management plan?
a. Amitryptilline (oral)
b. Paracetamol (oral)

c. Dihydrocodeine (oral)
d. Symptomatic treatment
e. Inoxuridline paint

156. A 59-‐year-‐old man presents with a herpes zoster rash affecting all three
divisions of the
trigeminal nerve. He has severe conjunctivitis and cannot close his eye. What
is the single
most appropriate management plan?
a. Symptomatic treatment
b. Prednisolone (oral)
c. Co-‐amoxiclav (oral)
d. Acyclovir (intravenous)
e. Urgent referral to ophthalmologist

157. An 80 year old woman presents with a painful herpes zoster rash which
appeared
yesterday on her trunk. What is the single most appropriate management
plan?
a. Acyclovir (intravenous)
b. Co-‐amoxiclav (oral)
c. Paracetamol (oral)
d. Dihydrocodeine (oral)
e. Prednisolone (oral)

158. A 55 year old woman present with severe post herpetic neuralgia following
an episode of
ophthalmic herpes which occurred six months ago. Co-‐codamol tablets are
not relieving
the pain. She is desperate for something to control the pain at night. What is
the single
most appropriate management plan?
a. Acyclovir (oral)
b. Dihydrocodeine
c. Inoxuridine paint
d. Paracetamol (oral)
e. Co-‐amoxiclav (oral)

159. A 30-‐year-‐old lady who already has one child through a previous caesarean
section
demands a reversible contraceptive. She presently experiences heavy and
painful periods.
What is the most appropriate contraceptive you will recommend for her?
a. Combined oral contraceptive pill
c. Danazol
d. Mirena coil
e. IUCD

160. A wife is convinced that her neighbour was using her shower when nobody
was at home.
Her husband believed her and called the police.
a. Folie a trios
b. Folie a deux
c. Folie a quatre
d. Faute de fait

161. A seven-‐year-‐old girl with allergy became acutely unwell while visiting a
friend’s house
and has been brought immediately to the emergency department. She is
fully conscious
but has stridor, wheeze and generalized erythematosus rash. She is
receiving oxygen.
What is the single immediate management?
a. Check airway patency and prepare intubation
b. Give 0.25ml in 1000 epinephrine (adrenaline) intramuscular injection
c. Give 50ml hydrocortisone by intramuscular injection
d. Give 1.0mg chlorphenaramine by intramuscular injection
e. Obtain secure intravenous access

162. A 14-‐year-‐old girl attends a family planning clinic. She has become sexually
active with her
boy-‐friend of two months. What is the single most appropriate prescription
treatment?

a. Female sterilization
c. Oral contraception and condom
d. Combined oral contraception
e. Rhythm method (safe period)

163. A 38-‐year-‐old woman who smokes 30 cigarettes a day comes for a six week
postnatal
check up after delivery of her third child. She is keen not to become
pregnant again but
does not wish to be sterilized. She does not wish to gain weight. What is the
single most
appropriate prescription treatment.
a. Medroxy-‐progesterone acetate (Depo-‐Provera)
b. Mirena (Levongestrel) intra-‐uterine system
c. Post-‐coital oral contraception
d. IUCD
e. Progesterone only contraception pills

164. A 26 year old woman has one child and wishes to gain advice about a
reliable method of
contraception. She does not wish to have any chemicals in her body. She has
heavy period
with dysmenorrhoea. Her husband refuses etc use a condom. What is the
single most
appropriate prescription/treatment?
a. Intra-‐uterine contraceptive device (IUCD)
b. Diaphragm
c. Male sterilization

d. Abstinence
e. Mirena coil

165. A 19 year old female college student who has taken the combined oral
contraceptive pill
for two years now requires rifampicin prophylaxis as she has shared a room
with a girl
who has been diagnosed as having meningococcal septicaemia. What is the
single most
appropriate prescription/treatment?
a. Medroxy-‐progesterone acetate (Depo-‐Provera)
b. Progesterone only contraceptive pills
c. Combined oral contraception with condom
d. Condom
e. Rhythm method (safe period)

166. A 15-‐year-‐old college residential student, with severe learning difficulties
and a
development age of six, is physical mature and shows signs of being sexually
attracted to
some of the male students. Her parents and staff are anxious to ensure that
she does not
become pregnant. What is the single most appropriate
prescription/treatment
a. Oral contraception and condom
b. Male sterilization
c. Depot provera
d. Female sterilization
e. Abstinence

167. A 23 year old woman who is 12 weeks pregnant has been admitted with
nausea and
vomiting. What is the single most useful blood test in the immediate
management?
a. Plasma estradiol
b. Serum beta human gondatropine (BHCG)
c. Serum free thyroxine

d. Serum human placental lactogen (HPL)

e. Serum urea and electrolytes

168. A 30 year old woman comes to the A&E complaining of pain in right side of
the abdomen, she is seven weeks amenorrhea. Her pregnancy test is positive and
US scan shows an empty uterus.
What is the next step?
a. Laparoscopy
b. HCG measurements
c. USG
d. Laparotomy
e. Culdocentesis

169. Prenatal screening is recommended if ultrasound scan at 16 weeks confirms
that the fetus
is male and the mother has had an affected son previously. What is the
single most likely
condition?
a. Cystic fibrosis
b. Epilepsy
c. Spina bifida
d. Turners syndrome
e. Down’s syndrome
170. A Patient 12 hours post-op is having pin-point pupils, respiratory
depression, reduced consciousness and hypotension. What will be given as
treatment?
a. Naloxone.
b. Flumezenil
c. Pralidoxime
d. Atropine
e. Dicobalt edetate
171. A patient has a lung Cancer. His serum sodium is 122mmol. What is the
treatment for it?
a. Restrict fluids
b. Vasopressin
c. Demeclocyclin
d. Reassure

172. A 60 year old man is referred to out-‐patient with frequent episodes of
breathlessness and
chest pain associated with an irregular heartbeat. He has a regular pulse
rate of 60 beats/
minute. His EGC shows sinus rhythm. Choose the SINGLE most appropriate
management
strategy.
a. 24 hour ambulatory taped electrocardiogram
b. Blood glucose concentration
c. Cardiac enzymes
d. Chest x ray
e. Echocardiogram

173. A child presents with nose bleeding. What will be your immediate action?
a. Pinch the soft part of the nose
b. Anterior packing
c. Posterior packing
d. Bipolar cautery
174. Testis drains into which of the following lymph nodes?
a. Pararectal
b. Paraaortic
c. External iliac
d. Superficial inguinal lymph nodes
e. Inferior mesenteric lymph nodes
175. A patient presented with ataxia, nystamus and vertigo. Where is the likely
location for the lesion in the brain?
a. Brain stem
b. Cerebellum
c. Medulla oblongata
d. Cerebellopontine angle

176. A 60 year old man is found to have an irregularly irregular pulse, with a rate
of 110
beats/minute. Choose the SINGLE most likely diagnosis.

a. Wenckebach’s phenomenon
b. Atrial flutter
c. Atrial fibrillation
d. Ventricular tachycardia
e. Sinus bradycardia

177. A woman had a surgery for removal of a stone 110 hours ago with
MRCP procedure. His post endoscopy status was good and normal and
she now presents with jaundice and a fever. What is responsible for her
jaundice?
a. Infection
b. Cirrhosis
c. Retained stone
d. Peritonitis
e. Panceatitis
178. A patient has been properly treated for CIN, she is on COCP, smokes
20 sticks of cigarette in a day. She went to the hospital to be examined
for an ovarian cancer because her aunty has been diagnosed of ovarian
cancer. Which of these is the risk factor for developing cervical cancer?
a. Family history
b. Smoking history
c. Use of COCP
d. None
e. CIN

179. Which one of the following is the most useful function of adrenaline when it
is used with a
local anesthetic?
a. Increases the potency of anesthetic
b. Prolongs effect of the anesthetic
c. Minimizes complications
d. Prevents infection
e. Decreases the potency of anesthetist

180. A 22 year old man complains that he can hear the voice of his deceased
uncle telling him

that he is being spied on. The patient is distresses by this, becoming low in
mood and
anxious, and has not left the house for two weeks. He is starting to drink
alcohol to excess.
He is noted to have thought block and passivity phenomena. What is the
single most
suitable medication to treat his symptoms from the list of options below?
a. Amitryptiline
b. Diazepam
c. Disulfiram
d. Haloperidol
e. Lithium

181. A 60 year old man presents with a six month history of poor sleep loss of
interest,
episodes of anxiety and forgetfulness. He shows psychomotor retardation
and tends to
answer most questions with “I don’t know”. What is the single most likely
diagnosis from
the list of options below?
a. Bipolar disorder
b. Dementia
c. Depressive illness
d. Normal aging process
e. Panic disorde

183. A 30 year old man with schizophrenia heard voices telling him to kill himself
by drinking
bleach. He is bought to the accident and emergency department. What is
the single most
likely management plan from the list of options below?
a. Admit to medical ward
b. Admit to psychiatric ward
c. Give amitrytilline
d. admit to pediatric ward
e. Sedative medication

184. A 40 year old man is admitted to a surgical ward following a car accident in
which he
sustained a minor head injury and leg fracture. After ten days is it is
apparent he is
monosyllabic his injuries are healing well. There were no witnesses to the
accident. What
is the single most likely management plan from the list of options below?
a. Admit to general medical ward
b. Admit to general psychiatric ward
c. refer for psychiatric opinion
d. Psychotherapy
e. Family therapy

185. A 40 year old woman who is admitted in the psychiatric ward feels that the
staff knows
what she is thinking. What is the single most likely diagnosis?
a. Delusion
b. Thought withdrawal
c. Thought insertion
d. thought broadcasting
e. Hallucinations

186. A 25 year old man keeps on talking and he jumps from one topic to another
even before
he finishes one stream of thought. What is the single most likely diagnosis
form the list of
options below?
a. Insight
b. Flight of ideas
c. Depression
d. Mania
e. Hypomania
187. A 20 year old man presents to the addiction clinic and wishes to give up his
habit of

drinking. He does not want to get relapse and he is fried of relapses as he
had tried t stop
on his own. What is the single most appropriate management?
a. Acamprosate
b. Disulfiram
c. Naloxone
d. Naltrexone
e. Refer to self help group

188. A 30 year old heroin addict clinically depressed and comes for treatment.
What is the
single most appropriate management?
a. Refer to self help group
b. Fluoxetine
c. Naltrexone
d. Methadone
e. Benzodiazepine

189. A woman on lorazepam, wishes to withdraw from it. What is the single most
likely
diagnosis form the list of options below?
a. Long acting benzodiazepine
b. Methadone
c. Short acting benzodiazepine
d. Amitryptilline
e. Citalopram

190. A 68 year old lady comes to the hospital with her husband. She says her
husband has
become increasingly forgetful recently. What is the most appropriate
investigation?
a. Mini-‐mental state examination
b. Psychoanalysis
c. CT head
d. Urea and electrolytes
e. Chest X-‐ray

191. A 26 year old woman who has returned from a holiday in America develops
a sudden left-‐
sited chest pain and breathlessness. Her chest is clear. What is the single
most useful
diagnostic test?
a. Cardiac Enzymes
b. Electrocardiogram
c. Chest X-‐ray
d. Ventilation Perfusion scan
e. Echocardiogram

192. A 23 year old man with type 1 diabetes presents with 48 hours of increasing
confusion and
breathlessness. His chest is clear and his blood glucose concentration is 28
mmol/l. What is
the single most useful diagnostic test?
a. CT head
b. Blood Glucose
c. Urine dipstix
d. CTPA
e. CXR

193. A young female has dysmenorrhea and irregular periods. She has never
had children. Which of the following can be given?
a. COCP
b. levonorgestral IUCD
c. copper IUCD
d. tranexamic acid
194. A 50 year old woman can't leave her house. As soon as she gets out, she
has to rush back in. She will only go out if accompanied by her husband.
a. Agoraphobia
b. Depression
c. Obsessive compulsive disorder
d. Paranoid

195. A 26 year old man was stabbed in the chest. His Respiratory Rate is
30/min. Breath sounds are audible on both sides. Percussion note is
resonant. Neck veins are engorged and he is breathing with his accessory
muscles.
What is the most likely diagnosis?
a. Ruptured oesophagus
b. Cardiac tamponade
c. Haemopneumothorax
d. Simple pnemothorax
e. Tension pneuothorax

196. A 54 year old homeless man, who has a history of alcoholism and smokes
heavily,
presents with a worsening cough and blood stained sputum. The chest x-‐ray
shows a
cavitating lesion. What is the single most appropriate investigation?
a. CT chest
b. CXR
c. Sputum culture
d. PEFR
e. Blood culture

196. A 35 year old man with known alcohol dependence presents to the
emergency department with opthalmoplegia , ataxia and confusion. What is
a. IV glucose
b. IV dextrose
c. Bolus of thiamine
d. Vit B 12
e. Lorazepam

197. An 85 year old lady presents with clear discharge from her
presents which was fund to be from the single duct. What is the single
A. Fibroedenoma
B. Breast cancer
C. Duct papilloma
D. Intraduct papilloma
E. Duct ectasia

198. A 34 year od lady presents with yellow thick discharge from
multiple ducts. What is the single most appropriate diagnosis?
A. Duct ectasia
B. Duct papilloma
C. Intraduct papilloma
D. Galactorrhoea
E. Breast cancer

199. A 24 year old lady presents with galactorrhoea and 6 month
history of amenorrhoea. Which is the most important hormone to
measure?
A. Prolactin
B. Follicuar stimulating hormone
C. Oestrogen
D. TSH
E. Testesterone

200. A 30 year old man is found to have complete azospermia. Which
of the following tests is diagnostic ?
A. Follicular stimulating hormone
B. Testesterone
C. Luteunising hormone
D. Oestrogen
E. Androgens

GOOD LUCK FROM DR SAMSON.

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SAMSONPLAB ACADEMY LIMITED

SAMSONPLAB MOCK MARCH 2013

b. Occur after 7 year age

a. Ofloxacin & metronidazole.

e. Cast for 6 weeks and review

c. Wrong treatment for the cause

43. A group of patients with a common disease characteristics are followed

46. A post-menopausal woman has hot flushes. His family history is

c. Beta blockers

a. Allergy to toxins realized by mites

What is the most appropriate initial treatment?

d. Serum blood glucose

100. A child is found to have a harsh pansystolic murmur. He is not

101. A 30 year old man is diagnosed with Chlamydia. If he is left

109. A post menopausal woman presents with symptoms of osteoporosis. What

119. A woman with haemoglobin of 8.4g/dl is to undergo an elective surgery.

d. Serum human placental lactogen (HPL)

GOOD LUCK FROM DR SAMSON.

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