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Dr Swamy PLAB Courses Ltd.

PLAB 1MOCK TEST: 5th MARCH 2017 TIME ALLOWED:3HRS

SINGLE BEST ANSWER

1. 19 year old boy complains of itching on the site of an insect bite. What is the SINGLE most
appropriate management?
A. Penicillin oral D. Oral Ciprofloxacin
B. Doxycycline oral E. Reassurance
C. Oral antihistamine

2. A child has come after overdosing on his grandmas pills. He has dilated pupils and extra systoles.
What is the most likely drug taken?
A. Digoxin
B. Amitriptyline
C. SSRI
D. Betablockers

3. A 37 years old lady strongly believes that a famous politician has been sending her flowers every
day and is in love with her. However, this is not the case. What is the most appropriate diagnosis?
A. Erotomania
B. Pyromania
C. Kleptomania
D. Trichotillomania
E. Grandiosity

4. A 34 years old alcoholic is found passed out in front of a local pub. The ambulance crew informs
you that he was sweating when they found him and there were cans of cider lying empty around him.
What is the initial stage of investigation?
A. Capillary blood sugar
B. CT head
C. Magnetic resonance imaging (MRI) head
D. ABG
E. MCV (Mean Corpuscular Volume)

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

6. A 60 year old man presents with dysphagia and pain on swallowing both solids and liquids. A
barium meal shows gross dilatation of the oesophagus with a smooth narrowing at the lower end of
the oesophagus. What is the SINGLE most likely cause of dysphagia from the given options?
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A. Achalasia
B. Myasthenia gravis
C. Oesophageal carcinoma
D. Oesophageal web
E. Systemic sclerosis
7. A 65 year old man presents with painless haematuria, Intravenous Urogram (IVU) is normal,
prostate is mildly enlarged with mild frequency. What is the most appropriate next step?
A. USG Abdomen
B. Flexible cystoscopy
C. Magnetic resonance imaging (MRI)
D. Nuclear Imaging
E. Prostate-Specific Antigen (PSA)

8. In the development of a 15 month old child which of the following would concern you the most?
A. Child walks independently, but does not run
B. Child builds a block of 2 cubes
C. Child scribbles with a pencil
D. Child has no pincer grasp
E. Child cannot draw a triangle

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

10. A patient operated for gastric carcinoma is on oral morphine for pain relief. He has adequate pain
relief but is experiencing side effects due to high dose of morphine required. What is the most
appropriate next step in his pain management?
A. Patient controlled analgesia
B. Oral oxycodone
C. IV morphine
D. Fentanyl patches

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

12. A 44 year old patient comes with right hemiparesis. On examination he has left sided ptosis and
his left pupil is dilated. Where is the lesion?
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A. Cerebral infarct
B. Cerebellar infarct
C. Medulla Oblongata
D. Pons
E. Midbrain

13. A 50 year old male with increased BMI. Has muscle wasting, difficulty climbing upstairs. Has
polyuria, polydipsia. What is the cause of muscle wasting and difficulty walking upstairs?
A. Amyotrophy
B. Peripheral neuropathy
C. Polyneuropathy
D. Autonomic neuropathy

14. A 29 year old gentleman was involved in an RTA. He presents with distended neck veins, clear
breath sounds and a trachea which is in the midline. His respiratory rate is 34 and blood pressure
60/0mmHg. What is the most likely diagnosis?

A. Simple pneumothorax
B. Tension pneumothorax
C. Cardiac tamponade
D. Pericarditis

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

16. A 37year old female working as a health care assistant in a nursing home, comes to the A&E with
complaints of severe itching all over her body. On asking she replies that she had applied cream on
the body of a resident in the nursing home who had similar itches. What is the mechanism of her itch?

A. Allergic reaction
B. Inflammation of keratinocytes
C. Allergic reaction developed due to use of topical steroid creams
D. Subcutaneous bleeding
E. None of the above

17. A 12 year old patient presents with copious diarrhoea. On examination his urine output is low,
mucous membranes are dry and skin turgor is low. What is the single most initial management?
A. Antibiotic
B. Antimotility
C. Anti-emetic
D. Fluid replacement
E. Reassure

18. A 45 year old heroin addict was involved in a car crash and is now paraplegic. During the first
week of his hospital stay he cried every day because he could not remember the accident.
What is the most likely diagnosis?
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A. PTSD
B. Severe depression
C. Organic brain injury

19. A 12 year old boy presents with painful swollen knee after a sudden fall. Which bursa is most
likely to be affected?

A. Semi-membranous bursa
B. Pre-patellar bursa
C. Pretibial bursa
D. Supra-patellar bursa

20. A 45 year old man, presented with a erythematous nodular rash on both his shins. He also
complained of dry cough for the last 3 weeks. What could be the most probable finding on his CXR?
A. Pleural effusion
B. Lung opacity in apical zone
C. A cavitating lesion
D. Bilateral hilar lymphadenopathy

21. A 30 year old female presents with complaints of weight loss, thinning hair, feeling cold all the
time, dryness of the skin, lethargy and constipation. What is the most likely diagnosis?
A. Hypothyroidism
B. Hyperthyroidism
C. Hypoparathyroidism
D. Hyperparathyroidism
E. Pseudopseudohypoparathyroidism

22.A man presents with medial deviation of his right eye. Which nerve is affected?
A. Left trochlear
B. Left oculomotor
C. Right trochlear
D. Right abducens
E. Right oculomotor

23. A woman with a spontaneous abortion at 14 and 23 weeks of gestational age presents at 8 weeks
gestational age with bleeding PV. What is the most appropriate intervention?
A. Bed rest
B. Aspirin
C. Reassurance
D. Trans-vaginal sonography (TVS)

24. A 22 year old college student presented with low grade fever and malaise for about a week. On
examination his tonsils were enlarged with a white membrane over them, also palpable, tender lymph
nodes in the neck and a macular rash. He went on a holiday a month ago to Thailand. What is the
diagnosis?
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A. Diphtheria
B. Glandular fever
C. Exudative pharyngitis
D. Acute tonsillitis

25. A patient on antihypertensive drugs presents to Accident and Emergency department complaining
of sudden loss of vision. On examination of the fundus, tortuous blood vessels and stormy sunset
appearance was seen. What is most likely diagnosis?
A. Papiloedema
B. CRAO
C. Anterior ischaemic optic neruropathy
D. CRVO
E. Retinal detachment

26.A middle age male after myocardial infarction is feeling unwell. The ECG has been performed and
shows a prolonged QRS complex and T wave is tented Sodium-136 mol/L
Potassium- 6.2mmol/L, Urea- 5.0 mmol/L What is the most appropriate management?
A. Calcium gluconate E. Calcium
B. Calcium resonium
C. Calcium with Vitamin D supplements
D. Vitamin D

27. A 28 year old woman at 39 weeks of gestation is in labour. She develops abdominal pain and heart
rate of 125 beats/min. blood pressure is 100/42mmHg, temperature 37.2oC and saturations 99% in air.
On examination, her lower abdomen is exquisitely tender. The CTG, which was previously normal,
now shows reduced variability, and late deceleration develops with slow recovery. She has had one
previous LSCS for a breech baby. Choose the most appropriate post C-Section complication for this
lady?
A. Endometriosis
B. Urinary tract infection
C. Urinary tract injury
D. Pleurisy
E. Uterine rupture

28. A 27 year old man presents with jaundice. On examination there is hepatosplenomegaly.
Peripheral blood film shows occasional spherocytes. What is the next appropriate investigation?
A. Direct Coombs test
B. Bone marrow test
C. Indirect Coombs test
D. RBC life span
E. Osmotic fragility test

29. A four years old boy with a febrile convulsion lasting eight minutes has been given intravenous
(IV) Lorazepam to control the convulsion. What is the SINGLE most likely serious side-effect?
A. Amnesia
B. Anaphylactic shock
C. Diabetes
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D. Bronchospasm
E. Cardiac arrhythmia

30. A 75 year old man was noticed to have increasing loss of memory of recent events. He is unable
to dress himself and has difficulty feeding himself. What is the main feature that will assist in the
diagnosis of this condition?

A. Progressive loss of function

B. Loss of control of bladder
C. Decreased visual acuity
D. Disinhibition
E. Visual hallucinations

31. A 57 year old female, who is suffering from hypertension, presented to the hospital with
complaints of recurrent falls when trying to get out of bed or get up from sitting. She is on some anti-
hypertensive therapy, with no other medical problems. What is the most likely cause of her fall?

A. Calcium channel blocker

B. Vertibrobasillar insufficiency
C. Bendrofluazide
D. Hypoglycemia
E. Infection

32. A 29 year old male patient presented with complaints of diarrhoea for the last 4 days. Biochemical
investigations were carried out. What is the key metabolic change that will be noticed?

A. Metabolic alkalosis
B. Hyperkalemia
C. Metabolic acidosis
D. Hypernatremia
E. Hypercalcaemia

33. A young woman has lost 6 kg in 2 weeks. The weight loss was deliberate as she exercises 5 hours
daily at the gym and is very concerned about her body. She admits to using laxatives and inducing
vomiting. Her BMI is 22. She also admits staying up until 3am cleaning her apartment, spending lots
of money on shopping and eating in very expensive restaurants. What is most probable diagnosis?

A. Anorexia nervosa
B. Bulimia nervosa
C. Eating disorder not otherwise classified
D. Depression
E. Seasonal affective disorder

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

A. Facial Nerve
B. Hypoglossal Nerve
C. Oculomotor nerve
D. Trigeminal Nerve
E. Glossopharyngeal Nerve
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35. A 28 year old female presents with a 3 months history of diarrhoea. She complains of abdominal
discomfort and passing stool 20 times a day. On examination she is febrile. Barium enema shows
cobble stone mucosa. What is the most likely diagnosis?
A. Amoeba
B. Colon Ca
C. Gastroenteritis
D. Crohns Disease
E. Ulcerative Colitis

36. A 36 year old lady complains of earache and fever. On examination her ear is severely tender and
there are vesicles within the ear canal. What is the most likely organism responsible for her condition?
A. Herpes zoster
B. Varicella zoster
C. Herpes simplex
D. HIV

37. A 28 year old pregnant woman with poly-hydramnios and shortness of breath comes for an
anomaly scan at 31 weeks. On ultrasound, there is absence of gastric bubble. What is the most likely
diagnosis?
A. Duodenal atresia
B. Oesophageal atresia
C. Gastroschisis
D. Exomphalos

38. A 55 year old lady was brought by her daughter who complained of deteriorating function and
inappropriate behaviour. Which lobe is affected?
A. Parietal lobe
B. Occipital lobe
C. Frontal lobe
D. Temporal lobe
E. All the lobes

39. A Schizophrenic patient not compliant on oral medication. What is the best long term
management?

A. Depot ( Risperidone)
B. Depot ( Haloperidol)
C. Quetiapine
D. Chorpromazine

40. A 22 years old man keeps having persistent and intrusive thoughts that he is a dirty thief. No
matter what he tries these thoughts keep coming to him. Any attempt to avoid these thoughts leads to
serious anxiety. What is the most likely diagnosis?
A. Schizophrenia
B. Obsessive Compulsive Disorder (OCD)
C. Post traumatic stress disorder (PTSD)
D. Mania
E. Psychotic Depression
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41. A young girl presented in Gynae assessment Unit with lower abdominal pain and per vaginal
bleeding after a history of hysteron-salpingo-graph as a part of her infertility treatment. On
observation her BP was 90/50mmHg and pulse was 120bpm and examination revealed rigid abdomen.
What is the most appropriate next investigation?
A. CT abdomen
B. X-ray abdomen in erect and supine
C. Ultrasound abdomen
D. Coagulation profile
E. X-ray chest

42. A pregnant woman with long-term history of osteoarthritis came to the antenatal clinic with
the complaints of restricted joint movement and severe pain in her affected joints. What is the choice
of drug?
A. Paracetamol
B. Steroid
C. NSAID
D. Paracetamol + Dihydrocodiene
E. Pethidine

43. A 9 year old child is diabetic and unhappy in school. What is your next step?
A. Refer to social worker
B. Clinical psychologist
C. Special school
D. Check child protection register
E. Give oral anti diabetics

44. An elderly gentleman who used to work in the shipyard industry presented with cough and
shortness of breath few weeks to months was given salbutamol nebulization and antibiotics and
admitted to the ward. He died 3 days later. His CT scan shows patchy infiltrates, pleural thickening
and pleural effusions. Why is this a Coroners case?
A. Patient got wrong diagnosis or wrong management
B. Patient died soon after admission
C. Death could be due to occupational illness

45. A 32 year old woman, para 3 of 39 weeks of gestation, reports having had spontaneous
rupture of membranes 4 days ago. She did not attend the delivery suite, as she knew that would
happen and had already decided on a home birth. Today she feels very hot and sweaty. She thought
that she was starting to have labour pains, but she describes the pain as more constant. On
examination, her uterus is tender throughout. Blood tests show a raised CRP and white cell count.
Select the most likely diagnosis from the following options:
A. Round ligament stretching
B. Chorioamnionitis
C. Uterine rupture
D. Labour
E. Disseminated intravascular coagulation
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46. A 56 year old woman with breast cancer and widespread lung metastases has non-productive
cough. She has been given codeine and the cough is not relieved. What is the next step in
management?
A. Oral antibiotics
B. Salbutamol/ Nebulizers
C. Oxygen
D. Nebulization with 0.9% NaCl
E. Anaesthetic nebulizer

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

48. A 35 year old man presents with a headache that worsens on bending his head forward. What
is the most likely diagnosis?
A. Chronic Sinusitis
B. Subarachnoid Haemorrhage
C. Migraine
D. Cluster Headache
E. Tension Headache

49. Patient had all signs of cerebello-pontine angle (CPA) tumour facial numbness, tinnitus and
vertigo. What is the best investigation?
A. CT scan
B. MRI Brain
C. MRI Head
D. X-ray head

50. A 53 year old woman presented with pain in the eye, blurry vision and clumsiness for 3 months.
She had a history of difficulty in swallowing and weakness in her right upper limb 2 years ago. What
is the investigation of choice?
A. CSF analysis D. MRI of the brain
B. Electroencephalography (EEG) E. Visuality Evoked Response test (VER)
C. Electromyography (EMG)

51. A 45 year old man diagnosed with Multiple Sclerosis is admitted after taking 100 Paracetamol
tablets. He seems well, is not vomiting and is alert. He is refusing all treatment. What should you do
next?
A. Gastric lavage
B. Activated charcoal
C. N-Acetyl cysteine
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D. Methionine
E. Evaluate his capacity to refuse treatment

52. A 23 year old female has repeated admissions to A& E department for self-harm. She denies
trying to commit suicide. What is the best treatment option for her?
A. Flooding
B. Desensitization
C. Token economy
D. Problem focused cognitive behavioural therapy
E. Thought stopping

53. A young woman was stabbed in the neck. On tongue protrusion, there was deviation to the right
side. Which nerve is involved?
A. Hypoglossal nerve injury
B. Accessory nerve
C. Vagus nerve
D. Glossopharyngeal nerve

54. A 60 year old lady has severe chest pain. ECG shows changes of inferior wall MI. ECG also
shows progressive prolongation of PR interval until a P wave is dropped. What is the most probable
diagnosis?
A. Atrial Fibrillation
B. Ventricular tachycardia
C. SupraVentricular tachycardia
D. Mobitz Type I Second Degree heart Block
E. Mobitz Type II Second Degree heart Block

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

56. A seven year old girl is brought by her mother with bright red staining of her underpants; she also
gives a history that her daughter recently started taking horse riding lessons. What is the single most
appropriate next action?

A. Local Examination
B. Examination under Anaesthesia
C. Continue Regular Child Care
D. Inform Child protection Services
E. Coagulation profile

57. A 4 year old boy is brought by his parents with complains of wetting his bed at night and
whenever he gets excited. What would be the most appropriate management for this child?
A. Desmopressin
B. Oxybutynin
C. Behavioural Therapy
D. Tamsulosin
E. Restrict fluid intake
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58. A 55 year old male patient had TIA which he recovered from. He has a history of stroke and upon
examination his heart rate was in sinus rhythm. He is already on aspirin 75mg and anti-hypertensive
drugs. What other action should be taken?

A. Add Clopidogrel only

B. Increase the doses of aspirin to 300mg
C. Add Warfarin
D. Add Clopidogrel and Statins
E. Add Statins only

59. A 2 year child is severely dehydrated and needs immediate fluid resuscitation. 4 attempts to gain
IV access have failed. Which of the following access routes should be considered next?
A. Subclavian artery
B. Radial artery
C. Intraosseous
D. Internal jugular vein
E. Saphenous cut

60. An 18 year old female has just received her A-Level exam results and she didnt get into the
University of her choice. She was brought into the A&E department after ingestion of 24 paracetamol
tablets. O/E: patient is slightly confused and tired. All initial management has been done.
Investigations done after 24 hours of admission showed normal FBC, ABG (pH 7.1), P.T (17
seconds), Bilirubin (4mol/L) and Creatinine (83mol/L). What is the next step in management?
A. Keep under observation for the next 24 hours.
B. Refer to Psychologist.
C. Give N-Acetylcysteine.
D. Discharge with referral to Psychiatrist.
E. Arrange for liver transplantation

61. What is first line management for an alcoholic presenting in delirium tremens?
A. IV CHLORDIAZEPOXIDE
B. IV DIAZEPAM
C. IV LORAZEPAM
D. IV MIDAZOLAM
E. IV ZOPICLONE

62. A man who wants to quit alcohol, but wants to avoid the unpleasant craving experiences.
What do you prescribe for him?
A. Acamprosate
B. Disulfiram
C. Methadone
D. Fluoxetine
E. Amitryptalline

63. A girl presents with signs of hyperventilation. What is the most likely arterial blood gas
(ABG) derangement?
A. pH increased pCo2 increased
B. pH decreased pCo2 increased
C. pH increased pCo2 decreased
D. pH decreased pCo2 decreased
 12

64. A 4 months old child diagnosed with a lower UTI was treated with Trimethoprim but was
unresponsive to this treatment after 48 hours. What should be the next appropriate step?
A. MSU for C/S
B. MCUG
C. Urgent DMSA scan
D. Ultrasound within six weeks time

65. A 62 year old female who had an episode of postmenopausal bleeding PV was sent for a TV
USG. Endometrial thickness was found to be 7mm. What is the next best step in management?
A. Total hysterectomy
B. Laparoscopy
C. Hysteroscopy and Endometrial biopsy
D. Pipelles endometrial sampling
E. MRI of pelvis

66. A 28 year old woman presents with foul smelling discharge with pH < 4.5. What is the single
most likely diagnosis?
A. Trichomoniasis
B. Candidiasis
C. Bacterial vaginosis
D. Chlamydia

67. A 6 year old child fell on his nose 2 days ago. His parents have now brought him with
difficulty in breathing. On examination he has a fever and his nasal bones are straight. What is the
single most likely diagnosis?
A. Nasal polyp
B. Septal hematoma
C. Septal abscess
D. Deviated nasal septum
E. Fractured nose

68. What is the best treatment for candidiasis in the throat?

A. Chlorhexidine mouthwash
B. Nystatin suspension
C. Oral Fluconazole
D. IV Metronidazole

69. A child was brought into Accident & Emergency with a non-blanching rash, high fever and
drowsiness. On examination, he is tachycardic, hypotensive and has neck stiffness. Blood has been
taken for cultures. What is the best treatment while awaiting culture results?
A. Cefotaxime
B. Benzylpenicillin
C. Co-Amoxiclav
D. Metronidazole
E. Vancomycin
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70. A 29 year old woman who was diagnosed to have migraine presents with severe onset of occipital
headache. She lost her consciousness. CT scan is normal. Neurological examination is normal. What
is the most appropriate management for this patient?
A. Repeat CT scan
B. Magnetic resonance imaging (MRI)
C. Lumbar puncture:
D. X-ray
E. No investigation required

71. An Afro-Caribbean boy presented with fever and arthralgia. FBC shows:
Hb : 6 g/dL
Reticulocyte count : 40%
Peripheral Smear : Target cells, Howell-Jolly bodies. What is the most appropriate diagnosis?

A. Haemophilia A
B. Thalassemia major
C. Sickle cell anaemia
D. Thalassemia minor
E. Acute lymphoblastic leukaemia

72. A man was brought to A&E department from a shopping mall after collapsing there. He is
conscious and answering questions now. His ECG shows irregular rhythm. Your choice of
investigation:
A. CT scan
B. Magnetic resonance imaging (MRI)
C. 24 hour ECG
D. Echo

73. A 48 year old woman is admitted to the Accident and Emergency Department with a productive
cough and moderate fever. She often has central chest pain and regurgitates undigested food most
times but does not suffer from acid reflux. These symptoms have been present for the last three and
half months which affects both food and drink. A chest x-ray shows an air-fluid level behind a
normal-sized heart. Which is the single most likely diagnosis?
A. Pharyngeal Pouch
B. Hiatus Hernia
C. Bulbar Palsy
D. Achalasia
E. Tuberculosis

74. A 48 year old presents with severe chest pain since the last 40 minutes. In the A/E he is given
oxygen, GTN and Morphine. ECG shows ST elevation. Bloods reveal increase in his troponin levels.
What is the next step of management?
A. B Blocker
B. Percutaneous angiography
C. Anticoagulant and heparin
D. Clopidogrel
E. Aspirin

75. A 4 weeks old baby develops yellowing of skin and sclera. He is thriving well on breast milk. On
presentation he is playing well and active. What is the most likely cause of jaundice in this child?
A. Breast milk Jaundice
B. Galactocaemia
C. ABO incompatibility
D. G6PD deficiency
E. CMV infection
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76. A woman with a previous history of pain at the left wrist following a fall 4months ago for which
she didnt seek any treatment now presented with pain in the same wrist below the thumb, and the
pain is aggravated whenever she holds her baby. What is the cause?
A. Fracture radial head
B. Scaphoid fracture
C. Carpel tunnel syndrome
D. Colles fracture
E. Ulnar fracture

77. A 15 years old boy who complains of pain in his legs. His pain has settled with aspirin. What is
the most probable diagnosis?
A. Leomyosarcoma
B. Liposarcoma
C. Painful Hip
D. Exostosis
E. OsteodOsteoma

78. A 4 year old child was diagnosed with epilepsy. His epilepsy is uncontrolled with sodium
valproate despite compliance to the medication. What should be the next best investigation?

A. MRI
B. EEG
C. ECG
D. Blood and urine biochemistry

79. A 58 year old lady presented with urinary incontinence. She looks anxious for her condition.
Urine culture is sterile. Her urodynamic study is normal. What is the next step
A. Antibiotics
B. Topical oestrogen
C. Systemic oestrogens
D. Duloxetine
E. Pelvic floor exercise

80. A 35 year old female attempts suicide 10 times. There is no history of psychiatric problem
and all neurological examinations are normal. What will be the best treatment?
A. Problem focussed treatment
B. Cognitive behaviour therapy (CBT)
C. Antipsychotic
D. Antidepressant
E. Electro convulsive therapy (ECT)

81. A 30 year old woman gets very anxious if she has to attend a party. She says she cannot eat in
font of anyone and refuses to attend social events. What is the most likely diagnosis?
A. Agoraphobia
B. Claustrophobia
C. Social phobia
D. Arachanophobia
E. Hydrophobia

82. A patient was admitted to A&E with prolonged hematemesis. Endoscopy revealed a bleeding
gastric ulcer which was then sutured. During the procedure, patient received 15 units of blood. The
next day, the drain contained 1 unit of blood. What is the next step in the management of this patient?
 15

A. Urgent USG
B. Urea breath test
C. H.Pylori serology
D. Manometry

83. A 27 year old female patient has been brought in with flight of ideas and attempted suicide.
She overdosed on 100 paracetamol tablets. She says there is nothing wrong with her. What should be
your next step?
A. Detain under Mental Health Act
B. Discharge
C. IV Haloperidol
D. Lithium
E. Fluoxetine

84. A 40 year old man came with fever and Urinary complaints. Urinalysis showed blood+ nitrites in
the urine. No history of discharge but groin is red, tender and swollen. What could be the most
probable cause of his symptoms?
A. E. Coli
B. Chlamydia
C. Neisseria gonorrhea
D. Mumps virus

85. A 34 year old woman complains of low mood predominantly in winter. She says she feels low
every year during winter and starts to feel better once spring arrives. What is the most likely
diagnosis?
A. Depression
B. Mania
C. Seasonal affective disorder
D. Cyclothymia
E. Dysthymia

86. A 64 years old diabetic has come for a routine eye check-up. Fundoscopy shows new vessels
all over the retina. What is the most appropriate management?
A. Strict Sugar Control
B. Regular eye check ups
C. Non urgent referral to a specialist
D. Laser photocoagulation
E. Insulin

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

88. A patient with cerebral metastasis has polyuria and polydypsia. What part of the brain would be
affected?
 16

A. Cerebral Cortrex
B. Cerebellum
C. Diencephelon
D. Pons
E. Medulla

89. A 32 year old woman has given birth 2 weeks ago to a healthy baby girl. She feels low in
mood and feels she cannot care for the baby. She says the world does not have enough food to feed
itself so she must not breastfeed her baby. She feels her husband is trying to poison the baby. What is
the most likely diagnosis?
A. Baby blues
B. Post partum depression
C. Post partum psychosis
D. Delirium
E. Mania

90. An otherwise healthy 13-year-old boy presents with recurrent episodes of facial and tongue
swelling and abdominal pain. His father has had similar episodes. What is the single most likely
diagnosis?
A. C1 esterase deficiency
B. HIV disease
C. Mumps
D. Sarcoidosis
E. Sjogrens syndrome

91. A 15 years old boy fell of his bicycle and hurt his abdomen. He presents with pain in abdomen, a
CT scan shows a small sub capsular spleen haematoma, his BP is 110/70mmHg and pulse is 80bpm.
What is the next step in his management?
A. Refer to surgeons for observation
B. Immediate Laparotomy
C. Immediate Laparoscopy
D. Discharge with advice
E. Blood transfusion

92. A patient presented to A & E with polyphonic wheeze. He was unable to complete sentence, pulse
was >110 bpm, RR > 25/min and PEFR 30-50% of predicted. What is the most likely diagnosis?
A. Mild asthma
B. Moderate asthma
C. Severe asthma
D. Life threatening asthma
E. Exercise induced

93. A child had three attacks of tonsillitis last year. What will be the most appropriate management for
this child?
A. Treat when ill
B. Surgery
C. Prophylactic Antibiotics
D. Refer to ENT
E. Do Nothing

94. A 25 year old woman is presenting with diarrhoea and abdominal bloating over the last 4
months. On examination she has blistering rash over her elbows. Biochemical investigation showed
 17

that she has low serum albumin, calcium and folate concentration. On jejunal biopsy there is
shortening of the villi and lymphocytosis. What is the most likely cause?
A. Coeliac disease E. Giardiasis
B. Whipple's disease F. Cystic fibrosis
C. Crohn's disease
D. Tropical Sprue

95. An 18 month old boy has been brought to the Emergency department because he has been
refusing to move his left arm and crying more than usual for the past 24 hours. He has recently been
looked after by his mothers new boyfriend while she attended college. Assessment shows multiple
bruises and a fracture of left humerus which is put in plaster. What is the SINGLE most appropriate
next step?

A. Admit under care of paediatrician

B. Discharge with painkiller
C. Follow up in fracture clinic
D. Follow up in paediatric outpatients
E. Follow up with general practitioner (GP)

96. A 60 year old man with IHD. He is on his heart medications. His daughter noticed some
abnormal behaviour including memory loss and cognitive impairment in a stepwise progression. What
is the most likely cause?
A. Lewy body dementia
B. Vascular dementia
C. Picks dementia
D. Parkinsons disease

97. How to check the function of Ulnar nerve ?

A. Adduction of fingers
B. Flex wrist towards radial side
C. Extend elbow
D. Extension at PIP

98. A 34 year old housemaid presents with headaches in the back of her head since several days. She
also complains of pain on flexing her neck. What is the most likely cause?
A. Subdural haemorrhage
B. Cervical spondylosis
C. Subarachanoid haemorrhage
D. Meningitis
E. Cluster headaches

99. A young child just diagnosed with chicken pox. Usually goes to day care. What is the most
appropriate advice?
A. Child should be admitted to hospital straight away
B. Isolate the child from parents and siblings at home
C. Advise him he can go back to nursery when the rash is crusted over

100. A 46 year old man complains of feeling low and inability to fall asleep. He is disinterested in
daily life and does not find any joy in his life. Due to this he has started to drink alcohol excessively.
What is the most likely diagnosis?
A. Delirium tremens
B. Wernickes encephalopathy
C. Korsakoffs syndrome
D. Schizophrenia
 18

E. Depression

101. A 45 year old male complains of tremors in hands. On examination these tremors are absent
at rest, but present when arms are held outstretched and persist on movement. What is the most
probable diagnosis?
A. Parkinsonism
B. Benign essential tremor
C. Cerebellar disease
D. Liver failure
E. Stroke

102. A 23 year old lady was prescribed with Azithromycin 1gm for her chlamydial pelvic
infection. She has got a new boyfriend for the last 2 months. She has recently started contraception to
avoid conception. Which of the following contraception method will be affected by Azithromycin?
A. Barrier
B. Intrauterine Contraceptive Device (IUCD)
C. Progestogen only pill (POP)
D. Combined Oral Contraceptive Pill (COCP)

103. A man had MI 4 months ago. He now complains of low mood, lack of appetite and problems
falling sleep. What is the best medication for him?
A. Amitryptalline
B. Fluoxetine
C. Venlafaxine
D. Sertaline
E. Moclobemide

104. A lady came in gynaecology assessment unit with a history of 8 weeks pregnancy and
bleeding per vagina for the last two days. On bimanual examination uterus is 8 week in size. On
speculum examination cervical os is closed. How do you confirm the viability of foetus?
A. Transvaginal USG Scan
B. Serum -HCG
C. Urinary B-HCG
D. Abdominal USG Scan
E. Per speculum examination

105. A 30 year old patient presents with heavy bleeding. She is in a stable relationship and is not
keen for conception. USG shows normal uterus. What would you advise her?
A. Mirena coil
B. Combined Oral Contraceptive Pill (COCP)
C. IUCD
D. Progesterone only pill
E. Tranexamic acid

106. A town has a population of 500,000. In a five year period there are 1250 cases of bladder
cancer diagnosed at the only hospital. During the same period the occupational health department
diagnosed a further 500 cases. What is the annual incidence per million of bladder cancer in this
population?
 19

A. 2100
B. 1750
C. 1400
D. 700
E. 350

107. A 6 year old girl has been brought to the hospital after being stung by a bee. She is
complaining of generalized itching, rashes, redness and has developed stridor. What is the most
appropriate treatment?

A. Oral Chlorpheniramine
B. IV Chlorpheniramine
C. IM Adrenaline
D. IV Adrenaline
E. Reassurance

108. An unconscious child is brought into Accident & Emergency. He is not breathing. What is
your initial management?

A. Capillary blood glucose

B. Secure airway
C. CT scan
D. IV 0.9% normal saline
E. 0.45% dextrose
109. A woman with sickle cell disease complains of heavy menstrual blood loss. What is the most
appropriate treatment for her?
A. Combined Oral Contraceptive Pill (COCP)
B. Mirena
C. Depot provera
D. Copper T insertion
E. Transdermal patch

110. A 38 years old lady presents with amenorrhea, she has very high Luteinizing hormone (LSH)
and Follicle-Stimulating hormone (FSH) levels, normal Prolactin and low Estradiol. Choose the single
most likely diagnosis?

A. Polycystic ovary syndrome (PCOS)

B. Premature ovarian failure
C. Hypothyroidism
D. Pregnancy
E. Menopause

111. A young man presented with fall on the hand. On examination, he is unable to oppose the thumb
and there is wasting of thenar muscles. Which is the most likely nerve that is damaged?
A. Ulnar nerve
B. Radial nerve
C. Both radial and median nerve
D. Median nerve

112. Patient with a history of alcoholism, ataxic gait, hallucinations and loss of memory. He is given
acamprosate. What other drug you can give with this?
 20

A. Chlordiazepoxide
B. Thiamine
C. Diazepam
D. Disulfiram
E. Haloperidol

113. A 28 years old man presents with a temperature of 38.7C and neck stiffness. There is no rash.
His GP calls, asking what should be done. How would you advise the GP?
A. Give the patient IV Benzyl penicillin
B. Give the patient IV Doxycycline
C. Give the patient IV Ceftriaxone
D. Send for a blood culture

114.A child was diagnosed with meningitis , who among the following options should be given
meningitis prophylaxis.?

A. Parents, siblings
B. Siblings plus doctors and nurses
C. All contacts plus doctors and nurses
D. Doctors and nurses

115. A 58 year old man presented with inability to close his left eye. Which nerve is involved?
A. Facial nerve
B. Oculomotor nerve
C. Trigeminal nerve
D. Abducent nerve

116. A 67 years old lady was found to have serum Calcium of 3.7 mmol/l. What is the most suitable
treatment option for her from the following?
A. Pamidronate
B. Calcitonin
C. Decrease calcium in diet
D. No intervention needed

117. A 37 years old lady has inflammatory cells on cervical smear. There is no dyskaryosis. One year
ago her smear was normal. On speculum examination the cervix was normal on appearance. What
will be the next step?
A. Repeat smear in 3 years
B. Repeat smear in 4 months
C. Repeat smear in 6 months
D. Colposcopy
E. Cervical biopsy

118. A 50-year-old woman presents following a fall. She reports of pain and weakness in her hands
for several months, stiff legs and swallowing difficulties and has bilateral wasting of the small
muscles of her hands. Reflexes in the upper limbs are absent. Tongue fasciculations are present and
both legs show increased tone, pyramidal weakness and hyper reflexia with extensor plantar response.
Pain and temperature sensation are impaired in the upper limbs. What is the most likely diagnosis?
A. Multiple Sclerosis
B. Motor Neuron Disease
C. Syringobulbia
D. Syringomyelia
E. Myasthenia Gravis
 21

119. A 55 year old male presents to the accident an emergency after an RTA with breathlessness,
engorged neck veins and a dull percussion note on the right side of his chest. On examination his
pulse is 140bpm and BP is 80/50mmHg, what is the most likely diagnosis?
A. Haemothorax
B. Haemopneumothorax
C. Tension pneumothorax
D. Simple pneumothorax

120. A child is brought in by her grandmother who is concerned about multiple bruises on the
childs back and buttocks. The bruises are of different sizes, shapes and colours. Some are blue
whereas others are yellow. The girl lives with her mother and mothers boyfriend. What is the most
likely diagnosis?
A. Accidental bruising
B. HSP
C. ITP
D. Non accidental injury
E. TTP

121. A 34 year old woman complains of low mood, loss of interest in everyday activities, loss of
appetite and weight. She also has trouble falling asleep and wakes up early in the morning. What is
the best treatment for her?
A. Fluoxetine
B. Minaprine
C. Moclobemide
D. Curcumine

122. A 65 year old alcoholic male is brought into hospital with aggression, confusion, diplopia and
ataxia. IV chlordiazepoxide has been started. Which other medication would you like to give?
A. Antibiotics
B. IV fluids
C. Acamprosate
D. Disulfiram
E. High dose B vitamins

123. A 30 years old woman has Pelvic inflammatory disease (PID), which was treated with
Metronidazole and Cephalosporin. It is getting worse. What is the next investigation?
A. Endocervical swab
B. Ultra sonography (USG)
C. Laparotomy
D. High vaginal swab

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

125. A 6 year old boy fell in the playground. He has not been using his forearm. He complains of
pain. On examination there is no sign of deformity or swelling. However, there is minimal tenderness
on examination. What is the most appropriate diagnosis?
A. Fracture of mid radius
B. Fracture of mid ulnar
C. Fracture of neck of humerus
D. Fracture of shaft of humerus
E. Green stick fracture of distal radius

126. A 70 year old man has been brought in by his wife. She says he has been losing his temper, is
aggressive and talks about their sex life with strangers. He does not agree with her and says he does
not know who she is. What test would you like to do?
A. EEG
B. ECG
C. MMSE
D. CT scan
E. MRI

127. A 30 years old female attends outpatient dept with c/o fever & dry cough. She says that she
had headache, myalgia & joint pain like one week ago. On examination Pulse: 100 b/min, Temp:
37.5C.Investigations: CXR: bilateral patchy consolidation. What is the single most likely causative
organism?
A. Pneumococcal Pneumonia
A. Legionella
B. Mycoplasma
C. Klebsiella
D. Chlamydia pneumonia

128. A girl has been brought to hospital by her mother. She has had no periods for 8 months but a
pregnancy test is negative .she exercises for 5 hours a day and eats only a little food. Her BMI is 16
kg/m2 . What is the management?
A. Refer to psychologist
B. Refer to eating disorder unit
C. Refer to dietician
D. Reassure
E. Refer to endocrinologist

129. A 45 year old lady came to family planning clinic for contraception advice. She is not keen to
be pregnant for the next 3 years. Her recent USG report showed multiple small submucosal fibroid.
What is the best method of contraception for here from the list below?
A. Etonogestrol
B. Combined OCP
C. IUS (intrauterine system)
D. Progestogen only pill
E. IUCD (intrauterine contraceptive device)
 23

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

131. A 62 years old lady presents with a pathological fracture of thoracic vertebra, this is found
to be associated with an underlying metastatic lesion, what is the most probable primary cancer
site?
A. Ovary
B. Lung
C. Breast
D. Cervix
E. Colon

132. A 35 year old lady at 36 weeks of gestation was diagnosed with pre eclampsia and was being
managed for it. She developed a fit while in the hospital. IV MgSO4 4 gram bolus was given and
MgSO4 infusion was started at 1g per hour. After 2 hours she developed another fit. What should be
the next step?

A. Give diazepam
B. Deliver the baby
C. Give MgSO4 bolus 2 gram
D. Give Lorazepam

133. A 4 year boy has cough and arthritis followed by rash on legs and trunk which are non-
blanching on glass test. No history of fever.
PT: 13
APTT : 31
Hb : 12
WBC: 6.5
Platelet: 300x10

Choose the most likely diagnosis?

A. Meningitis septicaemia
B. Haemophillia
C. Henoch-SchoenleinPupura
D. Idiopathic thrombocytopenic purpura
E. Thrombotic thrombocytopenic purpura

134. A lady is afraid to go out in crowded open places. She has extreme anxiety & has started
avoiding trains, supermarket & public places.
What is most likely diagnosis?
A. Claustrophobia
B. Agoraphobia
C. Social Phobia
D. Generalized anxiety
E. Obsessive compulsive disorder
 24

135. A patient 10 days post-op for rectal carcinoma presents with high grade fever and mass in pelvis.
What is the most probable diagnosis?
A. Pelvic Abscess
B. Recurrence of rectal carcinoma
C. Metastasis
D. Pneumonia secondary to aspiration
E. Septicemia

136. A 28 year old man on inhaled short acting bronchodilator and low dose corticosteroid complains
of disturbing cough and wheeze on exercise. He has good inhaler technique and no known allergens.
What is the best modification in his therapy?
A. Oral leukotriene antagonist
B. Inhaled regular long acting bronchodilator
C. Increase dose of inhaled corticosteroid
D. Sodium Chromoglycate
E. Oral corticosteroid

137. An 8 year old child presents with recurrent abdominal pains, occasional headaches but she
maintains a good appetite. Examination is normal. FBC, U&E and other investigations are normal.
What would you do for her next?
A. Ultrasound abdomen
B. CT head
C. Reassure
D. Analgesics

138. A 6 years old child was diagnosed with meningitis and treated successfully in the hospital. He is
being discharged now. What should be done prior to discharge?
A. Hearing test after the full treatment of meningitis
B. Echocardiography
C. Fundoscopy
D. MRI scan

139. A 56 year old lady presented with headache for the last one month. She also noticed weakness in
her left arm and leg. She says that headache is worst in the morning and accompanied by vomiting.
On examination Babinskis sign is positive with spastic paralysis of left upper and lower limb. What
is the most appropriate diagnosis from the following options?
A. Space occupying lesion
B. Giant Cell Arteritis
C. Stroke
D. TIA

140. A man diagnosed as a case of osteoarthritis. What is the management?

A. Paracetamol
B. Naproxen
C. Bisphosphonates
D. Codeine
E. Capsaicin

141. A 54 year old lady presents with sudden, severe pain in the left half of her skull. She also
complains of pain around her jaw. What is the most likely next step?
 25

A. CT scan
B. MRI
C. Fundoscopy
D. ESR
E. Temporal artery biopsy

142. A woman presents having overdosed on Imipramine. Which investigation should be done
immediately?
A. EEG
B. ECG
C. FBC
D. CT
E. MRI

143. A 23 year old female presented with a swelling of her neck that moved upwards on protrusion
of tongue. What is the next appropriate investigation?
A. FNAC
B. Punch biopsy
C. Core biopsy
D. MRI neck
E. Radioactive thyroid scan

144. What is the best long term management of panic disorder?

A. Lofepramine
B. Moclobemide
C. Fluoxetine
D. ECT
E. Diazepam

145. A 35 year old pregnant woman has been having tingling and numbness of her thumb, index
and middle fingers for a while. She has been treated with local steroids but it has not helped much,
and now she has been planned to undergo a surgical procedure. Which of the following structures
will be incised?
A. Flexordigitorumprofundus
B. Transverse carpel ligament
C. Palmar aponeurosis
D. Extensor retinaculum

146. Withdrawal from which of the following drugs can result in chills, pupil dilatation?
A. Cocaine
B. Heroine
C. Salicylates
D. Theophylline
E. Methanol

147. An elderly male who is immunocompromised has whitish plaques in the pharynx. He has
dementia, has stopped taking food due to the whitish plaques on the tongue. How will you treat this
elderly male?
 26

A. Fluconazole suspension E. IV Fluconazole

B. Nystatin suspension
C. Oral Miconazole
D. Oral Fluconazole

148. A 71 year old man presents with coarse tremor. He is on some medications. Which one can be
the reason for his tremors?
A. Lithium
B. Diazepam
C. Fluoxetine
D. Imipramine
E. Haloperidol

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

150.A 45 year old lady presented with weakness in left half of the body that resolved after two hours.
Ct scan showed area of reduced blood flow. What is the next best investigation?

A. Echo
B. Carotid Doppler plus angiography
C. Glucose
D. Lipids
E. ECG

151. A manual worker had a sudden feeling of giving away and pain in the elbow region during using
his screwdriver. There was tenderness and bluish discolouration just below the cubital fossa. The
tendon most likely to be ruptured is:

A. Biceps
B. Brachi-radialis
C. Triceps
D. Supraspinatus

152.A 65 year old man woke up with paralysis of his left half of the body. He is a known diabetic. Ct
scan shows non haemorrhagic stroke. What should be done next?
A. Thrombolysis
B. Aspirin 300mg
C. Carotid Doppler
D. Clopidogrel

153. How to perform CPR on a 5 month old child?

A. 15 chest Compressions with both hands
B. 30 chest compressions with single hand
C. 30 chest compressions with both thumbs
D. 15 chest Compressions with index and middle finger
E. 15 chest compressions with thumb and index finger
 27

154. A 78 year old woman presents with unilateral headache and pain on chewing. ESR is 70mm/hr.
She is on oral steroids. What is the appropriate additional therapy?
A. Bisphosphonates
B. Hormone replacement therapy (HRT)
C. ACE inhibitors
D. Interferons
E. IV steroids

155. A 16 year old girl presents with dehydration, dry mucus membranes, tachypnoea and abdominal
pain. She is drowsy. Blood glucose is 18mmol/L. What is the next step?
A. ABG
B. Check BP
C. Serum Alcohol Levels
D. Blood Sugar levels
E. CT Scan

156. A 65 year old man complains of sudden onset chest pain in the middle of his chest radiation to
his back. On examination he has an expansile mass in his abdomen. What is the next most appropriate
step?

A. USG D. Serum Lipase

B. PET Scan E. Doppler USG
C. Serum Amylase

157. A lady 76 years old had loss of consciousness but was fine after 10 minutes. She was taking
Aspirin, Bendroflumethiazide and Simvastatin. All examinations were normal. CT scan was done.
What is the most appropriate management?

A. Add aspirin 300

B. Clopidogrel
C. Dipyramidamole
D. Clopidogrel +Dipyramidamole

158. A child presents with history of two weeks of poor feeding, lethargy, facial swelling,
oliguria and proteinuria. What is the appropriate treatment for this child?
A. Prednisolone
B. Cyclosporin
C. Cyclophosphamide
D. Diurectics
E. No treatment needed

159.An 8 week pregnant lady is brought to the A and E due to severe vomiting. She was administered
IV fluids and oral anti-emetics. She still cannot tolerate anything orally. What is the next best
treatment for her?

A. Parenteral feeding
B. IV antiemetics
C. Termination of pregnancy
D. Proton Pump Inhibitor
E.IV Steroid

160. A 25 year old woman presents with a painful shallow ulcer on the vulva. What investigation
has to be done?
 28

A. HSV antibodies
B. Syphilis serology
C. Swab for Haemophilusducreyi
D. Urine culture
E. Blood culture

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

162. A 28 years old lady presents with dyspareunia and dysmenorrhoea. She is very obese. She
now wants reversible contraceptive method. Which of the following will be most suitable for her?
A. Mirena
B. Combined Oral Contraceptive Pill (COCP)
C. Progestogen only pill (POP)
D. Copper-T
E. Barrier method

163. A 64 year old man complains of increasing shortness of breath and cough for the past 18
months. He coughs up a tablespoon of mucopurulent sputum with occasional specks of blood. What is
the most likely underlying cause?
A. Acute bronchitis
B. Bronchiectasis
C. Chronic bronchitis
D. Lung cancer
E. Pneumonia

164. A man is brought to A&E after he was stabbed in the chest. Chest is clear bilaterally with
muffled heart sounds. Blood pressure is 60/40mmHg. Pulse is 120 bpm. JVP is raised. What is the
most probable diagnosis?
A. Pulmonary Embolism
B. Cardiac Tamponade
C. Pericardial Effusion
D. Hemothorax
E. Pneumothorax

165. A 32 years old woman has undergone a biopsy for a breast lump. The report says a well
circumscribed lump with clear margins and separated from the surrounding fatty tissue. What is the
most appropriate interpretation of this report?
A. Fibroadenosis
B. Carcinoma of the Breast
C. Mammary abscess
D. Fibroadenoma
E. Fat Necrosis
 29

166. Patient with widespread ovarian carcinoma had bowel obstruction and severe colic for 2 hrs
and was normal in between. What is the most appropriate management?
A. S/C morphine (PCA)
B. Spasmolytics
C. Palliative colostomy
D. Oral Morphine
E. Laxatives

167. A patient underwent liver biopsy. What is the most important investigation before the biopsy?
A. Viral screen
B. Coagulation profile
C. Serum electrolytes
D. Liver function tests
E. Abdominal US

168. A 32 year old man presented with painless haematuria. He is hypertensive but the rest of the
examination was fine. What is the most likely diagnosis?
A. Polycystic kidneys
B. Ca bladder
C. Ca prostate
D. Thrombotic thrombocytopenia purpura (TTP)
E. Hemolytic uremic syndrome (HUS)

169. A patient is on long standing indwelling catheter and now the catheter bag is turned purple.
Dipstick test shows nitrates ve, blood+. What investigation would you do next?
A. Urine culture and sensitivity
B. None
C. Urine porphobilinogen
D. USG abdomen

170. A mother comes with her 15 month old child. Which of the following will bother you?
A. Shies away from strangers
B. Can walk but cannot run
C. Vocabulary consists of only two meaningless words
D. She cant make a sentence
E. None

171. A 50 year old lady, with weak limbs, when examined was found to have burn marks on finger
tips, wasted and weak hands with diminished reflexes. She also has weak spastic legs and dissociated
sensory loss. What is the diagnosis?
A. Multiple sclerosis
B. Syringomyelia
C. Motor neuron disease
D. Guillian-barre syndrome
E. Freidriechs ataxia
 30

172. A 6 week old child presents with deep jaundice. He is breast feeding well but not gaining weight
and passes pale stools and dark urine. What is the most likely diagnosis?
A. Breast milk jaundice
B. Biliary atresia
C. Physiological jaundice
D. Galactosemia
E. congenital hypothyroidism

173. A man with a family history of panic disorder is brought to the hospital with palpitations, tremors
and sweating and muscle tightness on three occasions in the last six weeks. He does not complain of
headache and his blood pressure on each presentation is within normal limits. What is the single most
appropriate long term treatment for this patient?
A. Diazepam
B. Olanzapine
C. Haloperidol
D. Fluoxetine
E. Alprazolam

174. A 55 year old man returns for routine follow-up six weeks after a myocardial infarction. He gets
breathless when walking uphill. His ECG shows ST elevation in chest leads V1, V2, V3 and V4.
What is the single most likely explanation for the abnormal investigation?
A. Heart Block
B. Right Ventricular Strain
C. Atrial Thrombus
D. Left Ventricular Aneurysm
E. Dressler Syndrome

175.A 30 year old woman on oral contraceptives presents with dilated tortuous veins crossing her
abdomen to join the tributaries of superior vena-cava. What is the single most likely cause?
A. Intra-abdominal malignancy
B. Ovarian cyst
C. Fibroids
D. Ascites
E. Deep vein thrombosis (DVT)

176. Asthma not controlled on salbutamol and low dose Budesonide. Which is the next add on drug?
A. Salmetrol
B. Oral steroid
C. Aminophylline
D. High dose budesonide (inhaled)
E. Ipratropium Bromide

177. A 28 year old woman presents with pain and an ulcer on labia major. What is the lymphatic
drainage of labia major?
A. Superficial inguinal
B. Deep inguinal
C. Para aortic
D. Iliac
 31

178. A 35 year old woman had an uneventful laparoscopic cholecystectomy 18 hours ago. She has a
pulse rate of 108 beats/minute and a temperature of 37.8 C. There are signs of reduced air entry at the
right base but the chest X ray does not show any obvious abnormality. What is the most appropriate
management strategy?
A. Cefuroxime oral
B. Ceftriaxone I.V
C. Chlorpheniramine oral
D. Chest Physiotherapy
E. Reassure

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

180. You are the SHO in the hospital and the lab report of a patient shows glucose: 4mmol/L, K:
5.2mmol/l, Na129 mmol/l. What is the most appropriate management for this patient?
A. Normal Saline 0.9%
B. Normal saline 4.5%
C. Normal Saline 0.9% + insulin
D. Insulin
E. Dextrose

181. A 10 year old male child was brought by his mother complaining that her child watches TV at
very high volume, doesnt like to play out and instead has become more sincere with reading. She also
says that her son does not respond to her. What do you expect to see on otoscopy?
A. Flamingo pink Tympanic Membrane
B. Attic perforation
C. Bluish grey Tympanic membrane with air fluid levels
D. Inflamed tympanic membrane with cart wheel appearance of vessels
E. Red and inflamed tympanic membrane

182. A 2 year old boy has had fever, sore throat, runny nose and lethargy for the past few days.
Now he presents at A &E, is sitting in mothers lap with his body inclined forward with continuous
stridor and is drooling saliva. What is the most important next step in his management?
A. Call ENT specialist
B. High flow O2
C. Call Anaesthetist
D. Antibiotics IV
E. Immediate bronchoscopy
 32

183. A 50 years old man presents with low mood, poor concentration, anhedonia and insomnia. He
has had two episodes of increased activity, promiscuity and aggressive behaviour in the past. He was
arrested 8 months ago for trying to rob a bank, claiming it as his own. Which drug is most likely to
benefit him?
A. Haloperidol
B. Citalopram
C. Desipramine
D. Carbamazepine
E. Ethosuximide

184. A 25 years old woman with type one diabetes has delivered a baby weighing 4.5 kg. Her
uterus is well contracted. Choose the single most likely predisposing factor for developing postpartum
hemorrhage from the options?
A. Atonic uterus D. Large placental site
B. Cervical/vaginal trauma E. Rupture uterus
C. Retained product

185. A 27 year old lady came to the A &E department 10 days ago with fever, suprapubic
tenderness and vaginal discharge. Pelvic inflammatory disease was diagnosed. She has been on the
antibiotics for the last 10 days. She presents with lower abdominal pain. The temperature is 39.5C.
What is the most appropriate next management?
A. Vaginal swab
B. Endocervical swab
C. Ultra sound
D. Abdominal X-ray
E. Laparoscopy

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

187. A 2 year old boy was brought by his mother with a swelling in the right side of the neck
extending from the angle of the mouth to the middle one third of the sternocleidomastoid muscle. The
swelling was on the anterolateral side of the sternocleidomastoid and was brilliantly trans-illuminant.
What is the likely diagnosis?
A. Lymphangioma
B. Branchial cyst
C. Thyroglossal cyst
D. Ranula
E. Thyroid swelling

188. A young man presents complaining of seeing coloured halos when his eyes are closed. What
drug is most likely to be the cause of his symptoms?
 33

A. Heroin
B. Cocaine
C. Ecstasy
D. Lysergic acid diethylamide (LSD)

189. A 33 year old female complains of diplopia on upright gaze. On examination ptosis can be
seen. There are no other complains or any significant past medical history. What is the most
appropriate investigation for this patient?
A. Ophthalmoscopy
B. Visual field test
C. Thyroid function test
D. CT scan
E. Checking red reflex

190. A Middle aged hypertensive man presents with bleeding from the nose for half an hour. Bleeding
is not controlled with pressure. What is the most appropriate next step in management?
A. Refer to ENT surgeon
B. Anterior packing
C. Silver nitrate cautery
D. Posterior packing
E. Give antihypertensive

191. An 80 year old diabetic lady presents with redness and swelling over her right foot. It is tender to
touch, warm and glossy. Choose the most appropriate complications this patient might develop?
A. Meningitis
B. Sepsis
C. Ulcer
D. Gangrene

192.A 27 year old waitress has pelvic pain, dysmenorrhoea and increasingly heavy periods. She also
complains of dyspareunia. There is generalized pelvic tenderness without peritonium. Pelvic
ultrasound scan is reported as normal. What is the most likely diagnosis?
A. Endometriosis
B. Uterine Fibroid
C. Pelvic Congestion Syndrome
D. Pelvic Inflammatory Disease
E. Tubal Pregnancy

193.A 73 year old man who was a smoker has quit smoking for the past 3 years. He now presents with
hoarseness of voice and cough since past 3 weeks. On X-ray a mass is visible in the mediastinum.
What is the best investigation to confirm the diagnosis?
A. Bronchoscopy
B. Thoracoscopy
C. USG
D. CT Thorax
E. Lymph node biopsy

194. A Taxi driver complaints of recurrent flashbacks of an accident he had few months back. He also
finds it difficult to sleep and avoids the place where it had happened. His mood has become
increasingly low over the last few months since this accident. What is he suffering from?
 34

A. OCD
B. PTSD
C. Depression
D. Panic disorder

195. A child presents with fever and maculo-papular rash on the back as shown in the given picture.
What is the most probable diagnosis?
A. Chicken pox
B. Kawasaki disease
C. Measles
D. Rubella
E. Scarlet fever

196.A 7 year old child is being investigated for tuberculosis. His parents do not agree on taking a
broncho-alveolar lavage sample under general anaesthesia (GA).What other sample will show growth
of the organism?
A. Blood
B. Throat swab
C. Gastric washings
D. Mantoux
E. Cerebrospinal Fluid (CSF)

197. A 29 year old who is 38 weeks pregnant presents with a two hour history of constant abdominal
pain. She then passes 100ml of blood per vagina. On examination she has a rock hard uterus. What is
the next appropriate investigation?
A. Ultrasoundscan
B. Cardiotocograph
C. Clotting screen
D. Haemoglobin
E. Kleihauer-Betke test

198. A 67 year old man with dribbling of urine undergoes prostatic procedure. What serum osmolality
you would find in a patient after prostatic surgery?
A. Low Na
B. High K+
C. High Ca
D. High Na

199. A 14 year old boy presents with recurrent abdominal pains, malaise, and weight loss over 6
months. On examination a vague mass is felt in right iliac fossa. Colonoscopy shows transmural
inflammation and granulomata. What is the most appropriate management?
A. Sulfasalazine
B. Paracetamol
C. Metronidazole
D. Ibuprofen

200. 55 year old gentleman presented with palpitations and shortness of breath. He had the following
ECG finding. What is the most likely diagnosis?
 35

A. Atrial fibrillation D. Supraventriclar tachycardia

B. Atrial flutter
C. Ventricular tachycardia