1.

88-year-old woman presents with sudden onset weakness of the left arm and leg, right sided
facial weakness ( involve upper and lower part of the face) and right lateral rectus palsy. She
is diagnosed with a stroke. Where is the lesion?
A. Medial midbrain
B. Ventral pons
C. Lateral medulla
D. D. right internal capsule

2. 74-yearold lady presents acutely SOB. She mention increasingly dyspnoeic over the past
week but breathing worsened significantly over the past 24hours. Denies any associated
chest pain but slightly productive cough. Smoker for 40 years. She could not pick up her
repeat prescription for her inhalers as she wastoo short of breath and has been without
them for 5 days. On examination, respiration rate 18/min and auscultation reveals
widespread wheeze with some crepitations heard in the left upper zone and a loud split P2
in pulmonary area. MOSTLY diagnosis is
A. Pneumothorax
B. Exacerbation of COPD
C. Pulmonary embolus
D. Congestive cardiac failure

3. 82 year old lady attends outpatient clinic with her son. She lives independently, but her son
has noticed that she has become increasingly forgetful over the past 9months. Neurological
examination is normal. Which of the following additional features would MOST likely to
support diagnosis of EARLY Alzheimer disease?
A. Drowsiness
B. Slow, shuffling gait
C. Confusion about the location of familiar places
D. Mutism

4. 20 y/o malebrought to outpatient department with difficulty in movement and coordination.

Has ataxic gait and slurred speech. Psychiatric symptoms such as personality changes and
odd behaviour for which he is started on some sedative drugs. On clinical examination, he
was found to have scleral icterus, Kayser-fleischer rings in the cornea on slit lamp
examination. Other lab investigations reveals that he has low ceruloplasmin level and high
24-hour urinary copper level. MOST likely diagnosis with above given features?
A. Huntington’s disease
B. Drug induced extra pyramidal syndrome
C. Sydenham’s chorea
D. Wilson’s disease
5. 41 year old lady admitted with a fever, cough, yellowish sputum, dyspnoea and right sided
chest pain. She is diagnosed with pneumonia.
Which of the following is MOST likely causative organism for her condition?
A. Haemophilus influenzae
B. Legionella pneumophilla
C. Streptococcus pneumoniae
D. Staphylococcus aureus

6. 40 year old female says feels tired all the time. On exam, she is pale and her heart rate is 110
beats/min. No history of any long standing medical illness which is known to her.
Complete blood count shows:
Haemoglobin 10 g/dl (12-16)
MCV 75 (80-100)
Her reticulocyte count is not increased

MOST likely?
A. Anaemia of chronic disease
B. Iron-deficiency anaemia
C. Megaloblastic anemia, probability due to B12 deficiency
D. Hemolytic anemia

7. 26 year old male present to GP complain of malaise, LOA, & mild abdominal pain. He has
noticed his urine is darker than ususal. Looks mildly jaundice.
Blood investigation:
Serum total bilirubin 78 umol/L (1-22)
Serum alanine aminotransferase 1780 U/L (5-35)
Serum alkaline phosphatase 198 U/L (45-105)
Serum urea 6.5 mmol/L (2.5-7.5)
Serum sodium 138 mmol/L ( 137-144)
Serum potassium 5.4 mmol/L (3.5-4.9)
Haemoglobin 14.5 g/dl (13-18)
WBC 8.6 x 10^9 /L (150-400)
Prothrombin time 15 s (11.5-15.5)
MOST likely diagnosis

A. Acute cholangitis
B. Hepatitis A
C. Leptospirosis
D. Malaria

8. 55 year old woman complaint left sided abdominal pain. Blood pressure 120/70 mmHg,
pulse 90 bpm temperature 37ᵒC. respirations 12 breath/min. She sits up then lays down,
then move on one side, then the other She periodically moans with increased pain then
seems relieved. Indicates pain radiates from the left flank pain to her groin. Inspection
 reveals non-distended abdomen that moves with respiration. Auscultation reveals active
bowel sounds. Percussion note was normal throughout with no tenderness. Palpation
reveals soft abdomen without any rigidity. MOST likely diagnosis?
A. Ureteric colic
B. Sigmoid volvulus
C. Renal cell carcinoma
D. Splenic infarct

9. 50 year old hypertensive patient presented with tearing retrosternal chest pain radiating to
the neck with examination revealed unequal pulses in the limbs. ECG showed sinus
tachycardia with T inversionin some leads. Cardiac enzymes were normal and transthoracic
echocardiography did not show any dilated chambers but regional wall motion abnormality
and intimal flap were seen.
Which one is MOST useful investigation to confirm the diagnosis?
A. CT scan of the chest
B. Cardiac enzymes
C. Stress ECG
D. Ventilation-perfusion scan

10. 30 y/o man with no previous medical illness presents with history of palpitations.. On
examination, pulse 100bpm and BP 110/70 mmHg. Examination of precordium – a thrusting
hyperactive left ventricular apex and auscultation – a soft blowing pan-systolic murmur is
heard with a diminished first heart sound in the apex.
A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid regurgitation
D. Ventricular septal defect

11. 73 y/o gentleman presents to ED with fever, chills, cough with sputum and SON. Right sided
stabbing chest pain. Pain and SOB exacerbated by deep respiratory effect but ameliorated
by shallow breathing. Had history of severe Parkinson’s disease and is cared for by his wife.
Takes levodopa and carbidopa but no other medications. On examination he has reduced
lung movements, increased vocal resonance and inspiratory creptations at the right base.
Which of the following is the MOST likely cause for his symptoms?
A. Aspiration pneumonia
B. Atypical pneumonia
C. Levodopa toxicity
D. Parkinson’s disease associated with heart failure

12. 40y/o woman diagnosed HIV positive presentd to hospital with a 3-day history of headache,
nausea and lack of appetite. She has been otherwise fit and healthy and describes the
headache of not related to any particular time of the day but associated with pain on looking
bright lights. CT-Brain shows multiple hypodense regions predominantly in the basal ganglia.
 And at the cortico-medullary junction and following administration of contrast there is
nodular or ring enhancement. MOST likely cause?
A. Candidiasis
B. Cryptosporidum infection
C. Cryprtococcal infection
D. Toxoplasmosis

13. 66 y/o Type 2 diabetic patient developed end stage renal failure.
Which one of the following factors if present in him is an absolute contraindication to renal
transplant?
A. His age > 65 years
B. HIV infection which he developed during haemodialysis
C. Past history of skin cancer excised 10 years ago
D. Type 2 diabetes mellitus

14. 67 y/o chronic smoker presents with cough and breathlessness. On examination – chest is
hyper-inflated, respiratory rate of 24 breath/minute. His pulmonary function tests show:
FVC: 70% predicted
FEV1: 25 % predicted
FEV1/FVC ratio: 55%

These abnormalities were partially reversed by inhaled salbutamol where the percentage
change in reversibility of FEV1 is less than 15%
What is the MOST likely diagnosis?

A. Acute bronchial asthma

B. Bronchogenic carcinoma
C. COPD
D. Congestive cardiac failure

15. Patient with chronic kidney disease on conservative management presents with severe
retrosternal chest pain for the past 2 days. Pain is worse on inspiration and a friction rub is
heard on auscultation. ECG shows diffuse ST elevation with concavity upwards in most of the
chest leads. Cardiac enzymes are normal, and echocardiography shows mild pericardial
effusion.
Which is the following is the MOST appropriate intervention?
A. Haemodialysis
B. I.V. hydrocortisone
C. Pericardial tapping
D. Thrombolysis
16. A patient with upper motor neuron weakness and loss of dorsal column sensation (vibration
and joint position) on the left side and loss of spinothalamic sensation (pain, temperature
and light touch) on the right side of the trunk and lower limbs is MOST likely to have:
A. Spinal cord transection
B. Spinal cord compression
C. Left sided hemisection
D. Right sided hemisection

17. 76 y/o – recent history of stroke with hemiplegia is admitted with – a cough worsening
breathlessness and right pleuritic chest pain. He is also mildly febrile. His ventilation-
perfusion scan reveals several area of ventilation/perfusion mismathches.
MOST likely diagnosis?
A. Acute myocardial infarction
B. Acute dissection
C. Acute pericarditis
D. Pulmonary embolism

18. 25-year-old medical student agrees to have 75mL of blood drawn for a scientific study.
While attempting to draw the blood, the medical officer encounters difficulty and begins
manipulating the needle and probing. The medical student becomes pale, cold, and clammy.
A few seconds later, he slumps over in the chair and has several brief jerking movements of
the arms and legs. He is helped down to the floor and promptly regains consciousness. After
a few brief moments of confusion, he appears normal and his face become flushed.
What is MOST likely diagnosis?
A. Carotid sinus syncope
B. Orthostatic hypotension
C. Seizure
D. Vasovagal syncope

19. 35 y/o man – progressive dyspnoea and swelling of face & legs for the past 6-8weeks. Past
history of subarachnoid haemorrhage. Strong family history of kidney failure in his father
and brother. On examination – BP 180/100 mmHg. Investigations – blood urea 45 mmol/L
and serum creatinine - 650µmol/L. MOST likely diagnosis?
A. Good pasture’s syndrome
B. Nephrolithiasis
C. Polycystic kidney disease
D. Reflux nephropathy

20. 25 y/o patient history of asthma and ulcerative colitis comes to physician – an itch red rash
in the right and left popliteal regions. This is 2nd time had a popliteal rash and rash over the
antecubital fossae. Physical examination – popliteal areas are erythematous with slight
oedema and weeping. Some overlying vesicles and papules. MOST likely diagnosis?
A. Atopic eczema
 B. Lichen planus
C. Psoriasis
D. Seborrhoeic dermatitis

21. 30y/o footballer – acute left sided anterior chest pain while playing football. Then become
breathlessness and presented to A&E department. As an attending doctor you would prefer
to do all the following investigations immediately. EXCEPT
A. Blood for cardiac enzymes
B. Blood gas analysis studies
C. Electrocardiogram
D. Plain chest radiograph

22. 25y/o lady – palpitations, proptosis and fine tremors of outstretched hands.
All the following are in favour of Graves’ disease, EXCEPT
A. Diffuse thyroid enlargement
B. Presence of thyroid nodules
C. Presence of proximal myopathy
D. Presence of pretibial myxedema

23. 64y/o gentlemen 4 days following primary PCI for an LAD infarct. He becomes short of
breath and hypotensive. On examination – loud pan-systolic murmur at the lower sternal
border and apex. Echocardiogram reveals turbulent flow in the region of the septum on
para-sternal long-axis view. MOST likely diagnosis?
A. Aortic stenosis
B. Mitral regurgitation
C. Tricuspid regurgitation
D. Ventricular septal defect

24. 72 y/o man – lethargy and palpitations. Examination – pulse 120bpm irregularly irregular in
rhythm, BP 118/70 mmHg and his chest is clear. ECG confirms features of atrial fibrillation.
No signs of bi-basal crackles on chest auscultation.
Which one of the following is the MOST appropriate drug to control his heart rate?
A. Amiodarone
B. Amlodipine
C. Atenolol
D. Digoxin

25. 50 y/o man with type 2 diabetes undergoes a prosthetic aortic valve replacement after
suffering from congestive heart failure due to native valve endocarditis. Following the
operation, he presents with fever, janeway lesions, splinter haemorrhages and night sweats.
MOST definitive investigation for prosthetic valve endocarditis?
A. Chest x-ray
 B. Electrocardiogram
C. Transthoracic echocardiography
D. Trans-oesophageal echocardiography

26. 42 y/o man presents to A&E with a 3 week history of retrosternal discomfort after
swallowing. He mentions that he has been unable to keep any food down at all. Has been
HIV positive for 10 years. He is admitted and endoscopy shows area of curdy white patches
throughout esophagus.
MOST likely causative organism?
A. Staphylococcus aureus
B. Cryptosporidium parvus
C. Candida albicans
D. Pneumocystis jivorecii

27. 26 y/o lady presents – 2 days history of progressive left-sided facial drooping and dribbling
from left corner of her mouth when she eats and drinks. Examination – unable to elevate her
left eyebrow. There was loss of left nasolabial fold, and there was weakness of eyelid closure
and lip closure on the left side. She also describes altered taste sensation. Sensory
examination of the face was normal.
Which of the following explains the clinical findings?
A. Left upper motor neuron facial palsy
B. Right upper motor neuron facial palsy
C. Left lower motor neuron facial palsy
D. Right lower motor neuron facial palsy.

28. 58y/o comes to a physician after experiencing repeated episodes of chest pain upon walking
several blocks. Describes chest pain as pressure sensation that last for around 5 minutess,
gradual in onset, is brought on by walking and relieved by rest. Has shortness of breath,
nausea and diaphoresis. He has a history of hypertension and dyslipidemia. His resting ECG is
normal. Patient is referred for a cardiac stress test in the coming week.
Which of the following medications will most likely reduce the risk of chest pain in above
mentioned patient?
A. Metoprolol
B. Nifedipine
C. Nitroglycerine
D. Ramipril

29. 60 y/o male attend the physician with symptoms of breathlessness of NYHA class IV, nausea
and sweating. History of hypertension, diabetes and dyslipidemia for which he is not
compliant to treatment and follow-up. He was not admitted with the similar complaints
before and this is his first hospitalization. On examination , vital signs are HR: 110 /min; BP
102/60 mmHg, Sao2 90% and has reduced urinary output. Has raised JVP, shift of cardiac
apex to 6th intercostal space, S3 in apex and fine crepitations heard all over the chest.
 Which of the following drugs is NOT INDICATED while treating this patient’s acute condition
as described above?
A. Dobutamine
B. Furosemide
C. Morphine
D. Spironolactone

30. 65 y/o man comes to physician with silvery scaly rashes on the back of his forearms and over
his knees. He was diagnosed to have psoriasis. He has many other medical problems as well.
So now the physician thinks that some of the drugs, if started for treating his other medical
problems, may aggravate his psoriasis.
Which of the following drugs is SAFE to be prescribed in this patient, bearing in mind his
problem of psoriasis?
A. Aspirin
B. Beta-blockers
C. Chloroquine
D. Lithium

1. B
2. B
3. C
4. D
5. C
6. B
7.
8. A
9. A
10. B
11. A
12. D
13. B
14. C
15. B
16. C
17. D
18. D
19. C
20. A
21.
22. B
23.
24. B
25. D
26. C
27. C
28. C
29. C
30. D