32. A 71 year old woman looks disheveled, unkempt and sad, with poor eye contact.

She has recently

lost her husband. Which of the following describes her condition the best?
A. Anxiety
B. Hallucination
C. Mania
D. High Mood
E. Low Mood

33. A 9 year old girl presents with weekly abdominal pain and with occasional headaches but not
associated with vomiting and diarrhea. She has good appetite. Full blood count, urea and electrolytes
and other investigations are normal. On examination no abnormality was found and the abdomen was
soft and non-tender. What is the most likely next step?
A. Ultrasound scan of the abdomen
B. CT of thorax
C. Liver Function test
D. Reassure
E. Analgesia

34. A 45 year old Afro-Caribbean female was recently diagnosed with hypertension. For this her GP
prescribed her an antihypertensive medication. After some time she developed swelling around her
ankles. What is the most probable cause of her swelling?
A. ACE inhibitors
B. Diuretics
C. Calcium channel blockers
D. Beta blocker
E. Alpha blocker

35. A young college student is found in his dorm unconscious. He has a tachy-arrhythmia and is
having high fever. He also seems to be bleeding from his nose, which on examination shows a
perforated nasal septum. What is the most likely diagnosis?
A. Marijuana Overdose
B. Cocaine Overdose
C. Heroin Overdose
D. Alcohol Overdose
E. Carbon Monoxide poisoning

36. A man, who was drunk, left a pan on the hob and dozed off causing fire in his house. He was
drowsy. His house caught fire. He was eventually brought to the A &E with laryngeal oedema and
hoarse voice. What is the next best step?
A. Anaesthetics for help
B. I/V fluids
C. CT scan
D. MRI
E. X-RAY

37. A 44 year old lady who has polycystic kidney disease is concerned because her 38 year old
brother has just died of an intracranial insult. She knows he was not hypertensive. What was the most
likely cause of her brother’s death?
A. Subdural haematoma D. Epidural haematoma
B. Subarachanoid haemorrhage
C. Cerebral infarct

6
38. A 24 year old woman has severe depression three months after the birth of her first child. She is
breastfeeding but is otherwise unable to look after the baby and is convinced that her family is likely
to kill her. She has no interest in anything and keeps crying. What is the most appropriate treatment?
A. Fluoxetine
B. Citalopram
C. Cognitive behavioural therapy
D. ECT
E. Haloperidol

39. An 80 year old man presented with bone pain and urinary retention. What do you suspect in this
patient?
A. Benign prostatic hyperplasia (BPH)
B. Prostatic cancer
C. Urinary Tract Infection (UTI)
D. Prostatitis

40. A 27 year old lady on Doxycycline for PID now complains of nausea, indigestion and abdominal
pain. What advice should you give to her?
A. Take Doxycycline after meals
B. Take Doxycycline before meals
C. Reassure
D. Add antiemetic
E. Add antacid

41. A 24 year old alcoholic patient was admitted for fracture femur surgery in an emergency. Post
operatively he developed delirium tremens for which he received chlordiazepoxide. He has now
settled. Which other drug would you add to his regime?
A. Thiamine
B. Cyanocobalamine
C. Niacin
D. Pyridoxine

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

43. 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

7
44. A woman had widespread metastasis from a carcinoma. She presented with severe back pain.
Where do you expect the cancer to be?
A. Lungs
B. Cervix
C. Ovary
D. Uterus
E. Breast

45. A 17 year old girl took 14 tablets of PCM. After 4 hrs the PCM levels in are above the treatment
level curve. What will you do for her management?
A. Observe and give basic care
B. Nalaxone
C. Refer to Psychiatrist
D. N. Acetylcystine

46. An 8 year old girl fell down and fainted at school assembly. She went pale and light headed. What
is the most likely diagnosis?
A. Decreased blood sugar E. Heat stroke
B. Vasaovagal syncope
C. Anxiety
D. Arrythmia

47. A 45 years old woman diagnosed with Crohn’s disease. There was leaking faeces per vagina. A
diagnosis of fistula was made. From which part of the intestine is the faeces leaking from?
A. Caecum
B. Descending colon
C. Sigmoid colon
D. Jejunum
E. Duodenum

48. A 15 year old male has bilateral ankle oedema. His blood pressure is 110/70mmHg and urinalysis
shows protein ++++. What is the most likely diagnosis?
A. Haemolytic uraemic syndrome
B. IgA nephropathy
C. Membranous glomerulonephritis
D. Minimal change glomerulonephritis
E. Nephrotic syndrome

49. A man on road trip with son was hit while on the passenger’s side of the car by another vehicle.
He now presents with left sided abdominal pain and blue patch on the left side. What structure was
most likely damaged?
A. Aorta
B. Liver
C. Stomach
D. Kidney
E. Spleen