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PLAB
1
MOCK
1
DATE:
1st
JUNE
2013
1. A
56year
old
nulliparous
woman
with
a
BMI
of
37
has
a
four-month
history
of
blood
stained
discharge.
She
is
otherwise
normal.
What
is
the
single
most
likely
diagnosis?
a. Atrophic
Vaginitis
b. Bacterial
Vaginosis
c. Endometrial
Carcinoma
d. Candidiasis
e. Chlamydia
2. A
23year
old
woman
has
been
taking
the
combined
oral
contraceptive
pill
for
4
years.
She
has
a
troublesome
clear,
sticky
discharge
with
no
odour
or
itching.
What
is
the
single
most
likely
diagnosis?
a. Cervical
cancer
b. HIV
Infection
c. Ectropion
d. Gonorrhea
e. Chlamydia
3. A
25year
old
pregnant
woman
has
a
slight
increase
in
vaginal
discharge
with
vulval
itching.
Her
partner
has
recent
balanitis.
What
is
the
single
most
likely
diagnosis?
a. Ectropion
b. Cervical
polyp
c. Cervical
carcinoma
d. Candidiasis
e. Atrophic
Vaginitis
4.
5.
6.
7.
8.
A
76year
old
woman
has
vaginal
soreness
and
an
intermittent
pink
staining
on
her
underwear.
She
is
not
on
any
medication.
What
is
the
single
most
likely
diagnosis?
a. Atrophic
vaginitis
b. Bacterial
vaginistis
c. Endometrial
carcinoma
d. Candidiasis
e. Chlamydia
A
19-year-old
woman
in
a
new
sexual
relationship
has
a
vaginal
discharge
of
sudden
onset.
There
is
intense
itching
at
the
introitus
and
examination
reveals
a
frothy
discharge
with
redness
of
her
vulva.
What
is
the
single
most
likely
diagnosis?
a. Syphilis
b. HIV
Infection
c. HPV
d. Trichomonas
Infection
e. Gonorrhea
A
62year
old
woman
has
right-sided
headaches
with
malaise,
weight
loss
and
depression.
What
is
the
single
most
appropriate
investigation?
a. Temporal
artery
biopsy
b. ESR
c. Skull
X-Ray
d. Nerve
conduction
studies
e. MRI
imaging
of
brain.
A
56year
old
man
has
sudden
severe
occipital
headaches,
drowsiness
and
vomiting.
What
is
the
single
most
initial
appropriate
investigation?
a. CT
Scan
of
brain
b. No
investigation
required
c. Carotid
arteriograph
d. Lumbar
puncture
e. Temporal
artery
biopsy
A
45year
old
woman
has
right-sided
headaches,
nausea
and
visual
disturbance.
This
lasted
for
24
hours
and
she
is
fine.
She
was
recently
started
on
hormone
replace
therapy.
What
is
the
single
most
initial
appropriate
investigation?
a. Temporal
artery
biopsy
b. ESR
c. No
investigation
d. Nerve
conduction
studies
13.
A
38-year-old
woman
has
low
mood,
early
morning
awakening
and
poor
appetite
for
six
weeks.
She
had
a
similar
episode
12
years
ago
and
a
further
admission
with
over
activity,
irritability
and
grandiose.
What
is
the
single
most
likely
diagnosis?
a. Post
partum
blues
b. Post
partum
depression
c. Bipolar
affective
disorder
d. Recurrent
depressive
disorder
e. Schizo-affective
disorder
14.
A
47-year-old
man
has
diurnal
mood
variation,
early
morning
awakening
and
loss
of
interest
and
negative
thoughts
for
four
weeks.
He
has
had
no
such
previous
episodes,
he
has
been
made
redundant
recently
and
as
a
result
his
house
has
been
repossessed.
What
is
the
single
most
likely
diagnosis?
a. Anxiety
depressive
disorder
b. Bipolar
affective
disorder
c. Major
depressive
disorder
d. Depression
with
personality
disorder
e. Depression
with
psychotic
symptoms
15.
A
32-year-old
woman
has
poor
concentration
and
forgetfulness
for
four
weeks.
She
feels
sad
and
tired
with
insomnia
and
poor
appetite.
What
is
the
single
most
likely
diagnosis?
a. Post
partum
blues
b. Post
partum
depression
c. Post
partum
psychosis
d. Recurrent
depressive
disorder
e. Depressive
pseudo-dementia
16.
A
29-year-old
woman
has
had
delusions
of
poverty
and
guilty
ideas
for
some
time.
He
has
not
had
any
such
previous
episodes.
He
is
convinced
that
spies
are
after
him
and
trying
to
kill
him.
He
also
admits
to
feeling
lethargic.
What
is
the
single
most
likely
diagnosis?
a. Anxiety
depressive
disorder
b. Bipolar
affective
disorder
c. Depressive
personality
disorder
d. Post
partum
blues
17.
A
30-year-old
lady
has
developed
breast
abscess
2
days
after
delivery
of
her
second
baby.
What
is
the
single
most
likely
causative
organism?
a. E.
Coli
b. Group
B
beta
haemolytic
streptococcus
c. Staphylococcus
albus
d. Staphylococcus
faecalis
e. Staphylococcus
aureus
18.
A
28-year-old
lady
developed
her
baby
after
10
days
feels
that
she
is
not
good
enough
to
take
care
of
the
baby
and
has
a
low
mood,
not
eating
well,
exhaustion,
inability
to
enjoy
things
that
she
previously
enjoyed
and
sleep
disturbance.
a. Post
partum
depression
b. Post
partum
psychosis
c. Major
depressive
disorder
d. Depressive
personality
disorder
e. Depression
with
psychotic
symptoms
19. A
57-year-old
man
recently
underwent
prostatectomy.
Seven
days
later
he
develops
pain
and
swelling
of
his
left
leg.
This
was
later
confirmed
as
deep
venous
thrombosis
and
he
has
to
be
started
on
warfarin.
What
is
the
optimal
INR
for
this
patient?
a. <
1
b. 1-2
c. 2-3
d. 3-5
e. >5
20. A
2-year-old
boy
has
been
unable
to
bear
weight
since
the
fall
from
a
chair
the
previous
night.
He
is
tender
in
the
mid-tibia
but
there
is
no
obvious
deformity.
What
is
the
single
most
likely
radiographic
appearance?
a. Angulated
fracture
b. Compound
fracture
c. Epiphyseal
fracture
d. No
trauma
likely
e. Spiral
fracture
21. An
8-year-old
girl
had
recurrent
central
abdominal
pains
since
6
months.
She
also
has
occasional
headaches.
She
maintains
a
normal
appetite.
There
are
no
abnormal
signs.
FBC,
Urinalysis
and
stool
microscopy
are
normal.
What
is
the
single
most
appropriate
management?
a. Proton
pump
inhibitor
b. Pyeloplasty
(+/-
percutaneous
nephrostomy)
c. Triple
therapy
d. Reassurance
e. Sulphasalazine
22.
An
8-year-old
boy
has
symptoms
of
right-sided
abdominal
pain.
He
has
had
symptoms
of
UTI
in
the
past.
Abdominal
Ultrasound
shows
right-sided
hydronephrosis
and
excretory
isotope
scan
conforms
PUJ
obstruction.
What
is
the
single
most
appropriate
management?
a. Pancreatic
enzymes
b. Metoclopramide
c. Pyeloplasty
(+/-
percutaneous
nephrostomy)
d. Enema
and
laxative
e. Aspirin
23. A
14
year
old
boy
has
had
recurrent
abdominal
pains,
malaise
and
weight
loss
over
6
months.
He
has
had
a
vague
mass
in
the
right
iliac
fossa.
Colonoscopy
and
biopsy
of
the
caecal
area
shows
transmural
inflammation
and
granulomata.
What
is
the
single
most
appropriate
management?
a. Sulphalazine
b. Appendicectomy
c. Aspirin
d. Enema
and
Laxatives
e. Gluten
free
diet
24.
An
8
year
old
has
had
recurrent
abdominal
pain
for
2
months.
His
appetite
is
reduced
and
he
has
faecal
soiling.
There
are
pitting
masses
throughout
the
abdomen.
He
has
a
dilated
rectum.
What
is
the
single
most
appropriate
management?
a. Proton
pump
inhibitor
b. Pyeloplasty
(+/-
percutaneous
nephrostomy)
c. Enema
and
laxative
d. Aspirin
e. Triple
therapy
25.
A
12
year
old
has
recurrent
abdominal
pain
which
is
worse
when
he
is
hungry.
The
pain
is
relieved
by
food
or
meal.
He
is
tender
in
the
epigastrium.
Test
has
revealed
H.
pylori
infection.
What
is
the
single
most
appropriate
management?
a. Proton
pump
inhibitor
b. Enema
and
laxative
c. Aspirin
d. Gluten
free
diet
e. Metoclopramide
26.
A
26-year-old
man
presents
to
the
A
&
E
department
with
shortness
of
breath
of
3
days
duration.
He
has
been
coughing
during
the
night
and
using
his
salbutamol
inhaler
more
frequently.
What
is
the
single
most
appropriate
investigation?
a. Arterial
blood
gases
b. Chest
X-ray
c. Electrocardiogram
(ECG)
d. Haemoglobin
e. Magnetic
resonance
Imaging
Scan
(MRI)
of
the
chest
27. A
22-year-old
man
presents
to
the
A
&
E
with
sudden
onset
of
sharp
right-sided
chest
pain
and
shortness
of
breath.
There
is
reduced
air
entry
in
the
right
side
of
the
chest.
What
is
the
single
most
appropriate
investigation?
a. Peak
Expiratory
Flow
b. Pulse
Oximetry
c. Spiral
Computed
Tomography
Scan
of
the
chest
d. Chest
X-ray
e. Arterial
blood
gases
28. A
78-year-old
woman
is
brought
by
her
family
to
the
A
&
E
department
with
shortness
of
breath
and
occasional
cough
over
the
previous
72
hours.
There
is
a
coarse
crepitation
present
at
the
right
lung
base.
What
is
the
single
most
appropriate
investigation?
a. Arterial
blood
gases
b. Chest
X-ray
c. Electrocardiogram
(ECG)
d. Haemoglobin
e. Magnetic
resonance
Imaging
Scan
(MRI)
of
the
chest
29. A
26
year
old
woman
how
has
returned
from
a
holiday
in
America
develops
sudden
left
sided
chest
pain
and
breathlessness.
Her
chest
is
clear.
What
is
the
single
most
appropriate
investigation?
a. Peak
expiratory
flow
b. Pulse
Oximetry
c. Spiral
Computed
Tomography
(CT)
Scan
pulmonary
angiogram
of
the
chest
d. Chest
X-ray
e. Arterial
blood
gases
30.
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
28mmmol/l.
What
is
the
single
most
appropriate
investigation?
a. Chest
X-ray
b. Arterial
blood
gases
c. Electrocardiogram
(ECG)
d. Haemoglobin
(Hb)
e. Magnetic
Resonance
Imaging
(MRI)
Scan
of
the
chest
31.
A
55-year-old
man
has
weight
loss,
dyspnea
and
syncope.
He
smokes
20
cigarettes
a
day.
Investigation
confirms
squamous
cell
carcinoma
in
the
left
bronchus.
What
is
the
single
most
important
likely
biochemical
abnormality
to
be
associated
with
the
condition?
a. Hyperkalaemia
b. Hypercalcaemia
c. Hypernatremia
d. Hypocalcemia
e. Hypomagnesemia
32. A
21-year-old
woman
in
her
first
pregnancy
has
been
admitted
at
39
weeks
gestation
with
breech
presentation.
She
has
had
an
eclamptic
fit
at
home.
She
is
conscious
and
observations
are
stable.
What
is
the
single
most
appropriate
IV
therapy
to
prevent
further
fits?
a. Clomethiazole
b. Diazepam
c. Labetalol
d. Magnesium
Sulphate
e. Phenytoin
33. A
14-year-old
girl
developed
an
itchy,
scaly
patch
on
her
scalp.
She
has
a
similar
patch
that
cleared
spontaneously
2
years
ago.
Her
aunt
had
similar
undiagnosed
rash
on
the
extensor
aspects
of
her
elbows
and
knees.
What
is
the
single
most
likely
diagnosis?
a. Eczema
b. Fungal
Infection
c. Impetigo
d. Lichen
Sclerosis
e. Psoriasis
34. A
58-year-old
man
suddenly
becomes
shocked
several
days
after
suffering
an
acute
myocardial
infarction.
His
chest
X-ray
shows
a
large
globular
shaped
heart
and
clear
lung
fields.
What
is
the
single
most
likely
diagnosis?
a. Acute
pericarditis
b. Atrial
thombus
c. Cardiac
tamponade
d. Heart
block
e. Left
Ventricular
Aneurysm
35.
A
63-year-old
man
continues
to
experience
chest
pain
and
has
mild
pyrexia
two
days
after
an
acute
myocardial
infarction.
His
ECG
shows
widespread
ST
elevation
and
upward
concavity.
What
is
the
single
most
likely
diagnosis?
a. Left
Ventricular
endocardial
thrombus
b. Post
Myocardial
Infarction
(Dresslers
Syndrome)
c. Acute
Pericarditis
d. Ruptured
Intraventricular
Septum
e. Ruptured
Papillary
muscle
36. A
48-year-old
man
has
continuous
anterior
chest
pain,
worse
on
inspiration
and
pyrexia
four
weeks
after
a
myocardial
infarction.
His
ESR
is
raised.
What
is
the
single
most
likely
diagnosis?
a. Left
Ventricular
endocardial
thrombus
b. Post
Myocardial
Infarction
(Dresslers
Syndrome)
c. Acute
Pericarditis
d. Ruptured
Intraventricular
Septum
e. Ruptured
Papillary
muscle
37. A
60-year-old
woman
suddenly
develops
severe
left
ventricular
failure
following
a
myocardial
infarction.
Her
echocardiogram
demonstrates
mild
regurgitation.
What
is
the
single
most
likely
diagnosis?
a. Left
Ventricular
endocardial
thrombus
b. Post
Myocardial
Infarction
(Dresslers
Syndrome)
c. Acute
Pericarditis
d. Ruptured
Intraventricular
Septum
e. Ruptured
Papillary
muscle
38.
Aar
55
year
old
man
returns
for
routine
follow
up
6
weeks
after
myocardial
infarction.
He
gets
breathless
when
walking
uphill.
His
ECG
shows
ST
elevation
in
the
anterior
chest
leads.
What
is
the
single
most
likely
complication?
a. Left
Ventricular
endocardial
thrombus
b. Post
Myocardial
Infarction
(Dresslers
Syndrome)
c. Acute
Pericarditis
d. Ruptured
Intraventricular
Septum
e. Left
Ventricular
Aneurysm
39. A
70-year-old
man
is
brought
to
the
A
&
E
department
by
her
daughter
following
an
overdose
of
10
paracetamol
tablets.
His
wife
died
2
weeks
ago.
His
only
relevant
past
medical
history
was
treatment
for
depression
10
years
ago.
His
paracetamol
level
is
below
the
treatment
level.
What
is
the
most
appropriate
initial
management?
a. Referral
for
Social
worker
b. Discharge
home
with
advice
c. Refer
for
urgent
psychiatric
opinion
d. Refer
for
clinical
psychiatric
opinion
40. A
24-year-old
woman
fell
and
injured
her
right
knee.
The
knee
is
swollen
and
tender
to
valgus
stressing.
Which
of
the
following
ligament
is
the
most
likely
to
have
been
damaged?
a. Anterior
Cruciate
b. Lateral
Collateral
c. Medical
Collateral
d. Oblique
Popliteal
e. Posterior
41. A
22-year-old
man
has
had
acute
painful,
red
eye
with
blurring
of
vision
for
one
day.
He
had
similar
episodes
1
year
ago
and
has
had
back
pain
and
stiffness
relieved
by
exercise
and
diclofenac
for
years.
What
is
the
single
most
likely
cause
of
the
red
eye?
a. Retinitis
b. Conjuctivitis
c. Iritis
d. Scleritis
e. Glaucoma
42.
A
70-year-old
man
has
back
pain,
anaemia
and
weight
loss
of
gradual
onset.
In
addition
to
renal
failure,
he
has
hypercalcaemia.
What
is
the
most
appropriate
investigation?
a. ANCA
b. Bone
marrow
aspirate
c. Creatinine
clearance
d. Culture
of
MSU
specimen
e. Cystoscopy
43. A
55-year-old
man
has
leg
swelling.
He
has
heavy
proteinuria
and
his
serum
creatinine
concentration
is
185mmol/l.
What
is
the
single
most
appropriate
investigation?
a. IVU
b. Nuclear
scan
c. Renal
biopsy
d. Renal
Ultrasound
e. Serum
cholesterol
concentration
44. A
75-year-old
man
has
had
a
frequency
of
micturition,
poor
urinary
stream
and
some
incontinence
for
2
years.
His
serum
creatinine
concentration
is
350mmol/l.
What
is
the
single
most
appropriate
investigation?
a. ANCA
b. Bone
marrow
aspirate
c. Creatinine
clearance
d. Culture
of
MSU
specimen
e. Cystoscopy
f. Ultrasound
of
the
Kidneys
45. A
65-year-old
woman
has
urinary
frequency,
weight
loss,
hematuria
and
blood
clots.
An
abdominal
ultrasound
is
inconclusive.
What
is
the
single
most
appropriate
investigation?
a. IVU
b. Nuclear
scan
c. Renal
Ultrasound
d. Serum
cholesterol
concentration
e. Cystoscopy
46. A
20-year-old
woman
with
multiple
sclerosis
presents
with
blurring
of
vision
and
pain
in
the
eye
on
movement.
Where
is
the
lesion?
a. Cerebellum
b. Optic
Discs
c. Optic
nerve
d. Occipital
e. Retina
47. A
65-year-old
man
after
an
open
cholecystectomy
experiences
numbness
around
the
umbilicus.
Which
nerve
is
damaged?
a. Diaphragmatic
nerve
b. T4
nerve
c. Intercostal
nerve
d. L1-L2
nerve
root
e. T10
nerve
root
48. A
30-year-old
lady
presents
with
sudden
onset
of
right-sided
iliac
fossa
pain.
She
also
experiences
shoulder
tip
pain.
What
is
the
single
most
likely
nerve
damage?
a. Phrenic
nerve
b. T12
nerve
root
c. T5
nerve
root
d. T10
nerve
root
e. Intercostal
nerve
49. A
25-year-old
woman
is
8
weeks
pregnant.
She
has
experienced
a
degree
of
vaginal
bleeding
and
severe
left
sided
abdominal
pain.
Her
pulse
rate
is
100beats/
minute
and
her
BP
is
110/75mmHg.
There
is
marked
cervical
excitation
on
vaginal
examination.
What
is
the
single
most
appropriate
management?
a. Administration
of
anti-D
b. Bimanual
vaginal
examination
c. Blood
transfusion
d. Coloscopy
e. Culdocentensis
50. An
18-year-old
woman
who
is
13
weeks
pregnant
has
a
single
episode
of
painless
post
coital
bleeding.
The
fetal
heart
is
audible
during
the
Doppler
scan.
What
is
the
single
most
appropriate
management?
a. Evacuation
of
retained
products
b. Group
and
save
serum
c. Laparoscopy
d. Monitor
e. Oral
stilbesterol
51. A
28-year-old
woman
who
is
10
weeks
pregnant
has
had
vaginal
bleeding
and
period
like
pain
for
5
days.
Over
the
next
48
hours
the
symptoms
have
decreased.
Examination
is
inconclusive.
Beta
HCG
is
very
low
and
US
Scan
reveals
minimal
uterine
contents.
What
is
the
single
most
appropriate
management?
a. Speculum
examination
b. Ultrasound
scan
c. Blood
transfusion
d. Colposcopy
e. Evacuate
products
of
conception
52. A
28-year-old
woman
who
is
9
weeks
pregnant
has
a
small
amount
of
spontaneous
vaginal
bleeding.
She
has
a
mild
vague
lower
abdominal
pain.
Her
uterus
is
non-tender
and
equivalent
for
dates.
What
is
the
single
most
appropriate
management?
a. Administration
of
Anti-D
b. Bi-manual
vaginal
examination
c. Blood
transfusion
d. Culdocentensis
e. Transvaginal
USS
53. A
woman
who
is
10
weeks
pregnant
has
heavy
vaginal
bleeding
with
marked
uterine
pain.
Her
pulse
rate
is
110
beats/min
and
BP
is
110/75mmHg.
Vaginal
examination
confirms
that
the
blood
is
uterine
and
her
cervix
has
begun
to
dilate.
a. Evacuation
of
retained
products
b. Group
and
save
serum
c. Laparoscopy
d. Monitor
e. Oral
stilbesterol
54. A
23-year-old
lady
with
multiple
sclerosis
presents
with
ataxia,
dysarthria
and
nystagmus.
Which
of
the
following
is
the
most
likely
location
of
the
lesion?
a. Spinal
cord
b. Brain
stem
c. Cerebellum
d. Cerebral
cortex
e. Medulla
oblongata
55. A
45-year-old
man
presents
with
headache
and
vomiting.
He
is
diagnosed
with
meningitis
and
a
decision
to
perform
a
lumbar
puncture
has
been
made.
Which
of
the
following
structure
will
be
pierced
just
before
reaching
the
desired
space?
a. Dura
mater
b. Pia
mater
c. Skin
d. Longitudinal
muscles
e. Arachnoid
mater
56. A
40-year-old
man
presents
with
headache,
vomiting
and
fever.
He
has
been
diagnosed
with
meningitis.
Which
of
the
following
is
a
correct
landmark
to
perform
a
lumbar
puncture?
a. L4
b. Iliac
crest
c. Superior
anterior
iliac
spine
d. Cox
cocedeus
e. L5
veterbrae
57. A
man
was
involved
in
a
fight
and
sustained
a
blow
to
his
mastoid
bone.
Which
one
is
fractured?
a. Sphenoid
bone
b. Mandibular
bone
c. Temporal
bone
d. Parietal
bone
e. Occipital
bone
58. A
35-year-old
man
is
being
investigated
for
infertility.
Which
of
the
following
tests
would
prove
that
he
has
complete
azoospermia?
a. Prolactin
b. Oestrogen
level
c. Testosterone
d. Gonadotrophin
e. Follicular
stimulating
hormone
59. A
70-year-old
lady
brings
her
husband
who
is
83
years
of
age.
Which
of
the
following
additional
factor
will
confirm
the
diagnosis?
a. Progressive
functional
disorder
b. Fluctuating
functional
disorder
c. Incontinence
of
urine
d. Suicidal
intention
e. Stepwise
deterioration
60. A
5-year-old
firl
has
had
an
upper
respiratory
tract
infection
(URTI)
for
3
days
and
has
been
treated
with
paracetamol
by
her
mother.
The
last
12
hours,
she
has
been
hot
and
irritable
with
severe
pain
in
the
right
ear.
a. Acoustic
neuroma
b. Chronic
serous
otitis
media
(glue
ear)
c. Otitis
media
d. Foreign
body
e. Herpes
zoster
infection
61. A
38-year-old
woman
has
just
returned
from
a
holiday
where
he
went
swimming
every
day.
For
the
last
few
days
he
has
had
irritation
in
both
ears.
Now
his
right
ear
is
hot,
red,
swollen
and
acutely
painful.
What
is
the
most
likely
diagnosis?
a. Impacted
wax
b. Mumps
c. Otitis
media
d. Otitis
externa
e. Perforation
of
eardrum
62. A
45-year-old
man
has
a
smooth,
tender
swelling
extending
from
the
ear
to
the
angle
of
the
jaw
of
sudden
onset.
He
has
a
temperature
of
38.5
C.
What
is
the
single
most
likely
diagnosis?
a. Presbycusis
b. Temporomandibular
joint
pain
c. Trigeminal
neuralgia
d. Mumps
e. Otitis
media
63. An
18-year-old
man
has
a
smooth,
tender
swelling
from
the
ear
to
the
angle
of
the
jaw
of
sudden
onset.
He
has
a
temperature
of
38.5
C.
What
is
the
single
most
likely
diagnosis?
a. Presbycusis
b. Temporomandibular
joint
pain
c. Trigeminal
neuralgia
d. Mumps
e. Otitis
media
64. A
75-year-old
woman
has
weakness
of
the
left
side
of
her
face.
She
has
had
a
painful
ear
for
48
hours.
There
are
pustules
in
the
left
ear
canal
and
on
the
eardrum.
What
is
the
single
most
likely
diagnosis?
a. Impacted
earwax
b. Mumps
c. Otitis
externa
d. Otitis
media
e. Perforation
of
the
eardrum
f. Ramsay
Hunt
syndrome
65. A
45-year-old
woman
has
her
left
ear
syringed
48
hours
ago.
During
this
procedure,
she
dad
acute
pain.
Now
she
has
discharge
and
deafness.
Which
vein
is
likely
to
be
involved?
a. Perforated
ear
drum
b. Azygous
vein
c. Brachiocephalic
vein
d. Cephalic
vein
e. External
iliac
vein
66. A
43
year
old
has
pain
and
stiffness
to
her
leg.
The
limb
is
swollen
and
cyanosed
from
the
upper
thigh
to
her
ankle.
A
large
uterine
mass
is
palpable.
Which
vein
is
likely
to
be
involved?
a. Inferior
vena
cava
b. Internal
iliac
vein
c. External
iliac
vein
d. Long
saphenous
vein
e. Median
cubital
vein
67. A
41-year-old
woman
has
varicose
vein
on
the
lateral
side
of
her
right
lower
leg.
The
vein
is
tortuous
and
dilated.
Which
vein
is
likely
to
be
involved?
a. Popliteal
vein
b. Profunda
femoris
vein
c. Renal
vein
d. Short
saphenous
vein
e. Axillary
vein
68. A
25-year-old
man
has
a
varicosity
on
his
lower
abdominal
wall.
There
is
a
small
testicular
mass,
which
is
subsequently
found
to
be
malignant.
Which
vein
is
likely
to
be
involved?
a.
Axillary
vein
b.
Azygous
vein
c. Brachiocephalic
vein
d.
Renal
vein
e.
External
iliac
vein
69. A
63
year
old
has
pain
and
stiffness
of
his
left
leg.
His
calf
is
swollen
and
feels
hard.
Which
vein
is
likely
to
be
involved?
a.
Inferior
vena
cava
b.
Internal
iliac
vein
c.
Internal
jugular
vein
d.
Long
saphenous
vein
e.
Popliteal
vein
70. A
28
year
old
man
who
has
spent
his
weekend
decorating
his
house
has
swelling
and
discomfort
in
his
right
arm
of
sudden
onset.
The
upper
limb
is
swollen,
congested
and
cyanosed.
Which
vein
is
involved?
a. Popliteal
vein
b. Profunda
femoris
vein
c. Renal
vein
d. Short
saphenous
vein
e. Axillary
vein
71. A
30-year-old
lady
presents
with
foul
smelling
discharge.
Endocervical
swab
shows
trichomonas.
Which
of
the
following
is
the
most
appropriate
treatment?
a. Amoxicillin
b.
c.
d.
e.
Metronidazole
Co-trimoxazole
Tetracycline
Ceftriaxone
72. A
69year
old
man
with
heart
failure
develops
gout.
He
has
recently
been
started
on
treatment
and
his
heart
failure
worsens.
Which
of
the
following
is
the
most
likely
cause?
a. NSAIDS
b. B-blockers
c. Bendroflumethiazide
d. Calcium
channel
blocker
e. Allopurinol
73. A
7-year-old
7
days
post
tonsillectomy
presents
with
nose
bleed.
He
is
currently
not
bleeding.
What
is
the
most
appropriate
treatment?
a. Apply
pressure
on
the
soft
part
b. Antibiotics
c. Reassure
d. Surgical
exploration
e. Local
adrenaline
74. A
3-year-old
boy
has
a
sudden
onset
of
cough,
shortness
of
breath
and
noisy
breathing.
His
mother
reports
that
this
is
followed
by
a
choking
episode
while
he
was
playing.
a. Cystic
fibrosis
b. Epiglottitis
c. Immunodeficiency
d. Inhaled
foreign
body
e. Recurrent
aspiration
75. A
2-year-old
boy
has
repeated
chest
infections,
offensive
loose
stools
and
recurrent
rectal
prolapsed.
a. Tracheomalacia
b. Tuberculosis
c. Asthma
d. Cystic
fibrosis
e. Bronchiolitis
76. A
4-year-old
girl
who
has
had
a
runny
nose
for
12
hours
has
woken
up
2
oclock
in
the
morning
with
difficulty
in
breathing
a
barking
cough.
What
is
the
single
most
likely
diagnosis?
a.
b.
c.
d.
e.
Asthma
Bronchiectasis
Bronchiolitis
Bronchopulmonary
dysplasia
Croup
77. A
4-year-old
girl
whose
parents
have
refused
to
allow
immunisations
has
a
fever,
difficulty
in
breathing,
stridor,
drooling
and
central
cyanosis.
What
is
the
single
most
likely
diagnosis?
a. Cystic
fibrosis
b. Epiglottitis
c. Immunodeficiency
d. Inhaled
foreign
body
e. Recurrent
aspiration
78. A
16-year-old
footballer
presents
with
sudden
onset
testicular
pain,
which
started
an
hour
ago.
What
is
the
most
likely
diagnosis?
a. Trauma
b. Testicular
torsion
c. Epididymo-orchitis
d. Varicocele
e. Hernia
79. A
70-year-old
man
who
is
on
bendroflumethiazide
develops
an
acute
swelling
of
his
right
knee.
What
is
the
single
most
appropriate
diagnostic
investigation?
a. Serum
uric
acid
b. Reactive
protein
c. D-dimer
d. Blood
culture
e. Plain
x-ray
of
the
knee
80. A
45-year-old
man
with
diabetes
mellitus
has
a
high
ferritin.
What
type
of
cancer
is
he
most
likely
to
develop?
a. Liver
cancer
b. Lung
cancer
c. Renal
cancer
d. Colonic
cancer
e. Gastric
cancer
81. A
70-year-old
man
had
a
painful
swelling
of
his
right
testis
for
36
hours.
He
has
a
history
of
dysuria
and
frequency
of
micturition
and
has
a
temperature
of
38.C
a.
b.
c.
d.
e.
Epididymal
cyst
Epididymo-orchitis
Hydrocele
Inguinal
hernia
Scrotal
abscess
82. A
25-year-old
man
has
had
a
painless
enlargement
of
his
left
testes
for
3
months.
The
left
testes
are
3
months
the
size
of
the
right
testes
and
is
non-tender.
What
is
the
single
most
likely
diagnosis?
a. Sebaceous
cyst
of
the
scrotum
b. Testicular
hematoma
c. Testicular
neoplasm
d. Hydrocele
e. Epididymal
cyst
83. A
17-year-old
lady
presents
to
the
A&E
department
after
taking
45
tablets
of
paracetamol
following
an
argument
with
her
boyfriend.
The
incident
happened
10
hours
ago.
What
is
the
single
most
appropriate
next
action?
a. Activated
charcoal
b. Check
paracetamol
levels
c. N-acetylcysteine
d. Observe
e. Do
blood
tests
after
4
hours
84. A
56-year-old
man
with
known
HIV
presents
with
chronic
diarrhoea.
What
is
the
most
likely
cause?
a. Cryptococcus
infection
b. Toxoplasmosis
c. Pneumocystic
carinii
d. Cryptosporidium
e. Herpes
zoster
85. A
65
year
old
man
who
is
an
intravenous
drug
abuser
presents
with
weight
loss
and
macopapular
rash.
What
is
the
single
most
likely
cause?
a. Cryptococcus
infection
b. HHV
8
c. Pneumocystic
carinii
d. Human
papilloma
virus
e. Cryptosporidium
86. A
42-year-old
woman
has
not
had
a
period
for
10
months.
She
feels
well
but
she
has
hot
flushes.
Her
mother
also
had
an
early
menopause.
a. Cervical
smear
b. Chest
ray
c. DEXA
scan
(Dual
Energy
X-Ray
Absorptiometry)
d. FSH/LH
87. A
60-year-old
woman
under
long-term
follow-up
after
a
lumpectomy
and
therapy
for
breast
cancer
at
the
age
of
50
comes
to
discuss
her
bone
health
following
a
stress
fracture
to
her
metartarsal
bone.
a. Lumbar
spine
X-ray
b. Dexa
scan
c. Mid
stream
urine
(MSU)
culture
d. No
investigation
e. Serum
calcium
concentration
88. A
36-year-old
lady
who
is
an
intravenous
drug
user
has
had
weight
loss
for
the
past
4
months.
He
now
presents
with
drowsiness
and
increasing
confusion.
What
is
the
single
most
likely
cause?
a. Cryptococcus
infection
b. Toxoplasmosis
c. Pneumocystic
carinii
d. Cryptosporidium
e. Herpes
zoster
89.
A
36-year-old
woman
is
complaining
of
mood
swings,
palpitations
and
irregular
menses.
a. Transvaginal
USS
b. FSH
c. Chest
x-ray
d. DEXA
scan
(Dual
Energy
X-Ray
Absorptiometry)
e. ECG
90. A
20year
old
mother
brings
her
2
year
old
child
and
she
is
worried
that
her
child
be
deaf
as
she
is
deaf
herself.
What
is
the
single
most
appropriate
investigation?
a. Audiometry
b. Turning
fork
c. Audiometry
brain
stimulating
d. Reassure
e. Distraction
test
95. A
49
year
old
man
has
returned
home
6
times
daily
from
work
for
the
past
many
years
worried
that
he
has
left
the
taps
running.
His
employers
are
concerned
about
his
poor
work
productivity.
a. Adjustment
disorder
b. Agoraphobia
c. Anorexia
nervosa
d. Obsessive
compulsive
disorder
e. Generalised
anxiety
disorder
96. A
40-year-old
woman
has
acute
symptoms
of
palpitations,
sweating,
difficulty
in
breathing
and
feeling
unsteady
on
her
feet.
She
has
noticed
her
symptoms
occur
only
in
crowded
public
places.
a. Major
depressive
disorder
b. Obsessive
compulsive
disorder
c. Agoraphobia
d. Post
traumatic
stress
disorder
e. Social
anxiety
disorder
97. A
75-year-old
man
has
an
episode
of
syncope
while
working
in
his
garden.
When
visited
by
his
doctor
30
minutes
later,
he
is
in
sinus
rhythm;
his
pulse
rate
is
74-beats/
minute.
His
blood
pressure
is
110/60mmhg
and
he
has
a
systolic
murmur.
What
is
the
single
investigation
most
likely
to
provide
the
definite
diagnosis?
a. Coronary
angiogram
b. Echocardiogram
c. Electrocardiogram
d. 24
hour
ambulatory
blood
pressure
e. 24
hour
taped
ECG
98. An
83-year-old
woman
who
is
resident
in
a
nursing
home
is
admitted
to
hospital
with
a
four-day
history
of
diarrhoea.
She
has
had
no
weight
loss
or
change
in
appetite.
She
has
been
on
analgesics
for
3
weeks
for
her
back
pain.
She
is
in
obvious
discomfort.
On
rectal
examination,
she
is
found
to
have
faecal
impaction,
what
is
the
single
most
appropriate
immediate
management?
a. Codeine
phosphate
for
pain
relief
b. High
fibre
diet
c. Oral
laxative
d. Phosphate
enema
e. Urinary
catheterization
99. A
65-year-old
man
has
a
productive
cough
and
fever.
He
has
influenza
and
his
temperature
is
38.5C.
There
is
reduced
air
entry
and
crepitations
bilaterally.
What
is
the
single
most
likely
cause
of
the
pneumonia?
a. Haemophilus
influenza
b. Klebsiella
pneumonia
c. Mycoplasma
pneumonia
d. Staphylococcus
aureus
e. Streptococcus
pneumonia
100. A
67-year-old
lady
has
lung
cancer
and
she
suffers
from
heartburn,
which
increases
at
night.
She
has
tooth
carries
and
has
offensive
moth
odour.
She
cannot
cope
with
it.
What
is
the
single
most
appropriate
treatment
for
her?
a. Erythromycin
b. Vancomycin
c. Metronidazole
d. Proton
pump
inhibitor
e. Ant
H.
pylori
treatment
101. A
20-year-old
man
has
a
head
on
collision
in
a
car.
He
is
not
breathless
and
has
chest
pain
as
he
fractured
his
5-7th
ribs.
Chest
x-ray
confirms
this
fracture.
What
is
the
most
appropriate
initial
action?
a. Antibiotics
b. Analgesia
c. Oxygen
mask
d. Physiotherapy
e. Refer
to
surgeon
102. A
54-year-old
man
comes
with
a
sudden
onset
of
palpitation
and
breathlessness.
His
heart
rate
is
164beats/minute.
What
is
the
single
most
appropriate
treatment
in
the
acute
phase?
a. Adenosine
b. Metaprolol
c. Verapamil
d. Amiodarone
103. A
young
adult
presents
to
the
A&E
after
a
motorcycle
crash.
The
patient
has
bruises
around
his
left
orbital
area.
His
GCS
is
13
on
examination
and
a
strong
alcoholic
breath
is
noticed.
Shortly
afterwards,
his
GCS
drops
to
7.
What
is
the
single
most
important
initial
assessment?
a. MRI
brain
b. CT
brain
c. Chest
X-ray
d. CT
angiogram
brain
104. A
27-year-old
woman
at
34
weeks
gestation
in
her
first
pregnancy
attends
ANC.
Her
blood
results
showed
Hb:
10.6,
MCV:
95,
MCHC:
350.
What
should
you
do
for
her?
a. Folate
b. Dextran
c. Ferrous
sulphate
d. None
105. A
60
years
old
man
is
on
treatment
for
Ischemic
Heart
Disease
and
hypertension
and
hyperlipidemia.
During
the
night,
he
complains
of
wheezing
and
shortness
of
breath.
Which
of
the
following
medication
is
responsible
for
his
symptoms?
a. Amlodipine
b. Atenolol
c. Ramipril
d. Simvastatin
e. Bendroflumethiazide
106. A
30-year-old
man
complains
of
pain
in
the
loin
with
a
blood
pressure
of
140/90mmHg.
He
is
found
to
have
proteinuria
and
hematuria.
What
is
the
investigation
would
you
do
to
confirm
the
diagnosis?
a. Ultrasound
of
abdomen
b. ANCA
c. ANA
d. Urine
miscroscopy
and
culture
e. Stool
culture
107. A
4-year-old
girl
is
taken
by
her
mother
to
the
A&E
with
feeling
of
being
unwell,
urinary
urgency
and
39.C
temperature.
What
is
the
single
next
best
investigation?
a. Catheter
catch
of
urine
b. Clean
catch
of
urine
c. Ultrasound
d. Intravenous
Urography
(IVU)
e. Suprapubic
catch
of
urine
108. A
35-year-old
lady
comes
with
a
5-year-old
child
who
has
nystagmus,
tinnitus
and
deafness.
The
boy
is
found
to
have
tumour
in
the
cerebello-pontine
angle.
On
examination,
the
boy
is
found
to
have
numerous
cafe-au-lait
spots
seen
on
the
back.
What
is
the
inheritance
ratio
of
this
condition?
a.
b.
c.
d.
e.
100%
1:2
1:4
1:8
None
109. A
70
year
old
man
with
cerebral
metastases
develops
cerebral
edema
and
is
being
given
dexamethasone
and
antihypertensive
drugs.
His
blood
glucose
rises
to
17-
18mmol/l.
What
is
the
appropriate
management?
a. Low
dose
insulin
b. Optimal
dose
of
insulin
c. Glibenclamide
d. Stop
dexamethasone
110. A
53
years
old
female
presents
with
an
acute
painful
hot
knee
joint.
She
is
a
known
case
of
rheumatoid
arthritis.
On
examination,
the
skin
is
red,
tender
and
swollen.
The
hamstring
muscles
are
in
spasm.
Her
temperature
is
38.5.C
and
blood
pressure
is
120/80mmHg.
What
is
the
single
best
next
investigation?
a. Joint
aspiration
for
cytology,
culture
and
sensitivity
b. Joint
aspiration
for
positively
birefringent
crystals
c. Joint
aspiration
for
negatively
birefringent
crystals
d. Blood
culture
e. Serum
uric
acid
111. A
75
year
old
man
complaining
of
dripping
incontinence
and
has
an
ammonia
smell.
On
examination,
he
has
a
furred
tongue
and
a
painless
abdominal
mass
with
extension
to
the
umbilical
level.
Urine
analysis
shows
proteins++
and
nitrates+
with
no
growth.
What
is
the
most
appropriate
management
for
this
patient?
a. Suprapubic
catheterization
b. Trimethoprim
c. Intraurethral
catheterisation
d. Laparatomy
e. Condom
catheter
112. What
is
the
most
appropriate
antibiotic
to
treat
uncomplicated
Chlamydia
infection
in
a
21-year-old
female
who
is
not
pregnant?
a. Erythromycin
b. Ciprofloxacin
c. Metronidazole
d. Cefixime
e. Doxycycline
113. A
child
complains
of
right
iliac
fossaa
pain
and
diarrhoea.
On
colonoscopy,
granular
transmural
ulcers
are
seen
near
the
ileocaecal
junction.
a. Sulfalazine
b. Paracetamol
c. Ibuprofen
d. Metronidazole
e. Steroid.
114. A
42
year
old
man
has
been
tired
and
sleepy
for
the
last
few
weeks
in
the
morning.
His
work
has
started
being
affected
as
he
feels
sleepy
in
the
meeting.
His
BMI
is
36kg/m2.
What
is
the
single
most
likely
diagnosis?
a. Idiopathic
narcolepsy
b. Narcolepsy
c. Chest
hyperventilation
syndrome
d. Obstructive
sleep
apnoea
syndrome
e. REM
related
sleep
disorder
115. A
47
year
old
man
with
a
history
of
ischemic
heart
disease
complains
of
chest
pain
with
shortness
of
breath
on
exertion
over
the
past
few
days.
ECG
is
normal
and
echocardiography
shows
decreased
ejection
fraction
and
decreased
septal
wall
thickening.
What
is
the
single
most
likely
diagnosis?
a. Dilated
cardiomyopathy
b. Constructive
pericarditis
c. Amyloidosis
d. Subacute
endocarditis
116. A
76
year
old
woman
on
paroxetine
has
increasingly
become
confused
and
weak.
What
is
the
single
most
likely
reason
for
her
confusion?
a. Hypercalcemia
b. Hypernatremia
c. Hypocalcemia
d. Hypoglycemia
e. Hyponatremia
117. A
46
year
old
man
is
being
investigated
fro
indigestion,
jejuna
biopsy
shows
deposition
of
macrophages
containing
PAS
positive
granules.
What
is
the
most
likely
diagnosis?
a. Bacterial
overgrowth
b. Celiac
disease
c. Tropical
sprue
d. Whipples
disease
e. Small
bowel
lymphoma
118. A
30
year
old
woman
has
IUCD
inserted
8-9
months
ago.
Now
on
routine
follow-up,
the
thread
is
missing.
Uterine
ultrasound
shows
no
IUCD
in
the
uterus.
What
is
the
best
management?
a. Laparoscopy
b. Pelvic
CT
Scan
c. Laparotomy
d. Pelvic
X-ray
e. MRI
119. A
man
with
dementia
has
an
ulverative
lesion
on
this
forehead.
He
wants
it
to
be
removed
so
that
it
can
improve
his
memory.
The
wife
says
he
is
not
fit
to
give
consent.
What
will
you
do?
a. Get
the
GP
to
sign
the
consent
b. Get
the
wife
to
sign
the
consent
c. Get
the
patient
to
sign
the
consent
d. Refer
to
psychiatrist
to
assess
the
mental
capacity
to
give
consent
120. A
6
year
old
boy
is
brought
to
the
A&E
with
pain
in
his
left
arm
following
a
fall
from
a
tree
on
his
outstretched
hand.
There
is
a
swelling
around
his
left
elbow
and
a
reduced
radial
pulse.
What
is
the
most
likely
diagnosis?
a. Angulated
fracture
b. Compound
fracture
c. Epiphyseal
fracture
d. No
fracture
e. Spiral
fracture
121. A
young
woman
fainted
in
the
street
and
was
brought
to
the
A&E.
she
weighs
33kg.
She
is
alert
and
well
in
the
A&E
and
states
she
is
on
a
diet
and
admits
to
not
eating
or
drinking
anything
for
48
hours.
She
is
annoyed
that
she
has
been
brought
to
the
hospital
and
adamantly
states
that
she
wants
to
leave.
What
is
the
most
appropriate
next
step?
a. Detain
her
under
the
Mental
Health
Act
b. Refer
to
the
dietician
c. Allow
her
to
be
discharged
d. Refer
her
to
the
GP
122. A
woman
with
mild
ulcerative
colitis
is
not
on
any
treatment.
She
develops
diarrhoea
and
mucus
in
the
last
3
months.
All
other
examinations
are
normal.
Her
Hb
is
9.6gm/dl.
What
is
the
single
best
treatment?
a. Magnesium
sulphate
b. Ferrous
sulphate
c. Mesalazine
d. Endoscopy
e. Colonoscopy
123. A
smoker
with
several
ulcers
in
the
mouth
and
lower
surface
of
the
tongue
and
also
with
white
striae
on
the
mouth.
a. Apthous
ulcer
b. Lichen
planus
c. Kaposi
sarcoma
d. Cancer
of
the
mouth
124. A
middle
aged
man
complains
of
a
node
which
has
been
growing
for
several
months.
Now
it
is
firm
and
centrally
depressed.
What
is
the
most
likely
diagnosis?
a. Basal
cell
carcinoma
b. Squamous
cell
carcinoma
c. Pyoderma
gangrenosum
d. Melanoma
e. Necrobiosis
lipoidica
125. A
76
year
old
man
presents
with
loss
of
sensation
on
the
middle
part
of
the
chin
and
lower
lip.
Which
nerve
is
involved?
a. Lingual
b. Inferior
alveolar
c. Auricular
d. Submental
e. Buccal
nerve
126. A
37-year-old
man
had
hemicolectomy.
Immediately
after
the
operation,
he
becomes
aggressive
not
allowing
doctors
to
give
him
analgesia.
2
days
later
the
thanked
the
doctor.
a. Delirium
b. Acute
stress
reaction
c. Depression
d. Adjustment
disorder
e. Alcohol
withdrawal
127. A
60-year-old
lady
has
had
breast
surgery
done
for
breast
cancer.
Which
one
of
the
following
will
increase
the
chance
of
recurrence?
a. Sensitivity
to
oestrogen
receptors
b. Lymph
node
involvement
c. Presence
of
BRA
1
and
2
gene
d. Family
history
e. Age
128. A
24-year-old
schizophrenic
man
has
recently
been
depressed.
He
is
on
treatment
for
schizophrenia
and
depression.
Which
one
of
the
following
increases
his
risk
for
suicide?
a. Alcohol
b. Fluoxetine
c. Haloperidol
d. Carbamazepine
e. Olanzepine
129. A
man
has
been
diagnosed
with
indirect
inguinal
hernia.
Which
is
the
single
feature
of
the
hernia
sac
would
confirm
the
diagnosis?
a. Comes
though
the
femoral
ring
b. Passes
through
the
deep
inguinal
ring
c. Lies
below
the
lateral
pubic
tubercle
d. Does
not
pass
through
the
deep
inguinal
ring
130. A
22
year
old
man
presents
with
chronic
diarrhoea
for
months.
Sigmoidoscopy
shows
ulcerative
strictures.
What
will
be
the
skin
manifestation?
a. Pyoderma
gangrenosum
b. Erythema
multiforme
c. Necrobiosis
lipoidica
d. Erythema
chronicum
migrans
131. Each
year
950,000
people
develop
MI
in
a
population
of
250,000
million.
Out
of
these,
215,000
die
and
112,500
in
the
first
hour.
What
is
the
incidence
of
MI?
a. 112,500
in
215,000
million
b. 112,500
in
250,000
million
c. 215,000
in
950,000
million
d. 215,000
in
250,000
million
e. 950,000
in
250,000
million
132. A
70-year-old
man
with
metastatic
cancer
is
on
steroid
therapy.
His
U&E
shows
Sodium
131,
Potassium
5.5
and
Urea
12.
What
is
the
most
likely
underlying
condition?
a.
b.
c.
d.
e.
Adrenal
insufficiency
SIADH
Hyponatremia
Hyponatremia
Hyperkalemia
133. An
8
year
old
swallowed
12
tablets
of
paracetamol
4
hours
ago.
Serum
paracetamol
levels
when
tested
were
at
critical
level.
What
is
the
single
most
likely
management?
a. Activated
charcoal
b. IV
N-acetyl
systeine
c. Gastric
lavage
d. Observation
only
134. A
79-year-old
active
man
comes
to
you
with
complaints
of
swelling
and
pain
on
dorsiflexion
of
the
leg.
On
examination,
there
is
oedema
and
a
3
cm
increase
in
diameter
of
the
right
calf
on
comparison
with
the
left
calf.
What
is
the
likely
cause?
a. Popliteal
artery
aneurysm
b. Deep
Venous
Thrombosis
c. Popliteal
cyst
d. Lymph
oedema
e. DMD
135. A
pregnant
patient
whos
Rh
negative
and
has
not
has
been
previously
sensitized
delivers
her
first
baby
without
complications.
What
would
be
the
latest
time
to
administer
anti-sensitization?
a. 6hours
post
partum
b. 24
hours
post
partum
c. 48
hours
post
partum
d. 72
hours
post
partum
e. 5
days
post
partum
136. A
64-year-old
man
complains
of
increasing
shortness
of
breath
and
cough
for
the
past
18
months.
He
coughs
up
a
tablespoon
of
muco-purulent
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
137. A
28-year-old
man
believes
that
each
time
the
traffic
lights
change,
it
means
that
his
mother
needs
to
see
him
urgently
and
he
needs
to
return
home.
He
has
only
slept
for
2
hours
in
the
last
2
days
and
eats
very
little.
He
believes
that
his
thoughts
are
being
taken
out
of
his
head
and
are
being
made
available
for
the
people
around
him.
What
is
the
single
most
likely
diagnosis?
a. Depression
b. GAD
c. Mania
d. Obsessive
compulsive
disorder
e. Schizophrenia
138. A
7-year-old
girl
comes
with
dysuria
and
fever
of
37.8
C.
What
is
the
most
appropriate
investigation?
a. Clean
catch
of
urine
b. Full
blood
count
c. Renal
Ultrasound
d. Supra
pubic
aspirate
139. A
28-year-old
woman
who
is
breastfeeding
has
pain
in
her
left
breast.
The
outer
upper
quadrant
of
the
breast
is
red,
swollen
and
tender.
a. Staphylococcus
aureus
b. Staphylococcus
epidermidis
c. Streptococcus
faecalis
d. Streptococcus
pyogens
e. Streptococcus
viridians
140. A
70-year-old
man
present
with
sudden
onset
of
severe
pain
in
the
lower
part
of
his
abdomen.
He
is
unable
to
pass
water
and
is
distressed.
On
examination,
the
abdomen
is
distended,
tender
and
dull
on
percussion.
What
is
the
single
most
appropriate
initial
management?
a. Arranging
abdominal
X-ray
b. Giving
morphine
c. Inserting
a
urinary
catheter
d. Sending
blood
for
amylase
e. Starting
IV
fluids
141. A
28-year-old
woman
suddenly
develops
a
red
rash
all
over
the
body
following
a
wasp
sting.
Her
pulse
is
100beats/minute,
BP
120/70mmHg,
RR-
24c/m.
What
is
the
single
most
important
clinical
feature
indicative
of
adrenaline?
a. IM
Adrenaline
0.5ml
in
100
b.
c.
d.
e.
a.
b.
c.
d.
e.
Atlanto-occipital
Cricoaryteniod
Cricothyroid
Costochondral
Sternoclavicular
151. A
68-year-old
woman
has
otalgia
and
dysphagia.
She
ahs
angula
cheilitis
and
pale
conjunctivitis.
Her
oropharyngeal
examination
is
normal.
In
which
single
anatomical
site
is
this
patient
likely
to
have
a
tumour?
a. Lower
oesophagus
b. Nasopharyngeal
c. Post
cricoids
d. Thyroid
e. Tonsil
152. A
4
year
old
boy
with
Downs
syndrome
has
proven
middle
ear
effusion
bilaterally
that
has
been
present
for
6
months.
Which
is
the
single
most
appropriate
management?
a. Adenoidectomy
b. Bilateral
mastoidectomy
c. Bilateral
grommet
ventilation
d. Cochlear
implantation
e. Watch
and
wait
for
3
months
153. A
20-year-old
man
has
a
chronic
facial
palsy
and
rinorrhoea.
He
has
multiple
courses
of
antibiotics
with
little
improvement
in
his
symptoms.
A
CT
scan
shows
a
round
opacity
with
mixed
density
within
the
right
maxillary
sinus.
What
is
the
most
likely
diagnosis?
a. Allergic
b. Angifibroma
c. Antrochoanal
d. Fungal
ball
e. Foreign
body
within
the
sinus
154. A
78-year-old
man
has
sudden
onset
of
hoarseness
of
voice.
He
has
a
weak
cough
and
he
coughs
when
eating.
He
has
been
a
smoker
since
18
years
ago.
He
has
right-
sided
vocal
cord
palsy.
Which
is
the
single
most
likely
anatomical
site
of
his
primary
tumour?
a. Bronchus
b. Larynx
c. Oesophagus
d. Oral
cavity
e. Parotid
155. A
22
year
old
woman
says
she
has
taken
about
40
tablets
of
paracetamol
3
hours
ago.
Her
heart
rate
is
110beats/minute,
BP
110/80mmHg
and
RR
22c/m.
Which
is
the
single
most
appropriate
initial
management?
a. Give
activated
charcoal
b. Give
N-acetylcysteine
c. Induce
vomiting
d. Perform
gastric
lavage
e. Wait
for
the
4
hour
paracetamol
level
156. A
30-year-old
woman
says
she
has
taken
about
34
tablets
of
paracetamol
about
12hours
ago.
She
is
now
unwell.
Her
heart
rate
is
120beats/minute,
BP
112/78mmHg
and
RR
20c/m.,
which
is
the
single
most
important
management?
a. Discuss
with
the
liver
transplant
unit
b. Give
N-acetylcysteine
immediately
c. Give
activated
charcoal
immediately
d. Refer
for
psychiatric
assessment
e. Wait
for
the
paracetamol
level
157. A
20-year-old
woman
says
she
has
taken
40
tablets
of
paracetamol
over
the
past
3
days.
She
is
not
unwell
and
has
vomited
a
few
times.
Her
heart
rate
is
22breaths/min.
The
blood
tests
are
as
follows;
Sodium
146mmol/l
Potassium
3.5mmol/l
Urea
5.6mmol/l
Creatinine
115umol/l
Albumin
32g/l
Bilirubin
52umol/l
ALT
2,560IU/l
Alkaline
phosphatise
230IU/l
Gamma
transpeptidase
230IU/l
Ph
7.3
INR
4.0
Lactate
4.2mmol/l
Paracetamol
190mg/l
Which
is
the
single
most
likely
chemical
compound
responsible
for
this
findings?
a. NAPQI
b. N
para-acetyl
aminophenol
c. N
para-acetyl
aminophenol
glucuronate
d. Para-acetyl
aminophenol
sulphate
e. Para-amino
phenol
158. A
36-year-old
woman
has
taken
about
28
tablets
of
paracetamol
6hours
ago.
She
has
been
drinking
a
bottle
of
vodka
and
a
couple
pints
of
lager
everyday
for
the
last
few
years.
She
feels
nauseous
and
has
vomited
a
few
times.
Sodium
144mmol/l
Potassium
3.8mmol/l
Urea
5.6mmol/l
Creatinine
86umol/l
B.
C.
D.
E.
Ulcerative
disease
Coaeliac
disease=increased
lymphocytes
Helicobacter
pylori
Gastric
cancer
167. A
34
year
has
been
drinking
for
4
days,
now
he
comes
saying
that
he
can
feel
insects
walking
on
the
skin
and
nasal
redness.
What
is
the
single
most
likely
drug
abuse.
A. Alcohol
(answer)
B. Cocaine
C. LSD
D. Heroin
E. Cannabis
168. A
40
year
old
man
presents
with
abdominal
distention4
days
after
an
open
cholecystectomy.
On
examination
there
were
no
bowels
sound.
What
is
the
diagnosis?
A. intestinal
obstruction
B. Paralytic
ileus
(answer)
C.
Internal
bleeding
D. anastamotic
leak
E. abdominal
aneurysm.
169. A
57
year
old
man
with
known
diabetes
has
cholesterol
5.7.
Which
of
the
following
is
the
correct
combination
of
medication
for
his
management?
A. Angiotensin
converting
enzymes
and
statin
B. Angiotensin
converting
enzymes
and
metformin
C. Angiotensin
converting
enzymes
and
Glibenclamide
D. Angiotensin
converting
enzyme
inhibitor
and
Gliclazide
E. Glibenclamid
and
statin
170.
A
45
year
old
man
presents
to
accident
and
emergency
department
with
headache.
He
is
then
found
to
have
high
blood
reassure
of
210/110.
His
blood
results
are
as
follows:
Potassium
is
2.7,
urea
4.5,
creatinine
124,
sodium
136.
What
is
the
is
the
single
most
appropriate
investigation?
A. Cortisol
B. Aldesterone
C. Adrenaline
D. Renin
E. Growth
hormone.
171. An
18
year
old
man
presents
with
sudden
nset
of
testicular
pain.
He
has
history
multiple
sexual
partner..
temperature
37.4,
Blood
pressure
120/80.
Thee
is
no
urethral
discharge.
What
is
the
single
most
likely
diagnosis?
A. Testicular
torsion
B. Epidydimo-orchitis
C. Testicular
tumour
D. Epidydimal
cysts
E. Hydrocele
172. A.
45
year
old
man
presents
with
ascites
and
epigastric
pain.
He
had
peritoneal
lavage
done
which
shows
protein
less
25.
What
is
the
single
most
likely
cause
of
ascites?
A. Tuberculous
B. Cirrhosis
C. Bid
chiari
syndrome
D. Alcoholic
liver
disease
E. Carcinomatosis
173. A
65
year
old
man
pesents
with
ascites
.
After
peritoneal
lavage
he
is
found
to
have
low
glucose
and
red
cells.
What
is
the
single
most
likely
cause?
A. Gastric
cancer
B. Tuberculosis
C. Baud
chiari
syndrome
D. Liver
cirrhosis
E. Hear
failure
174. A
30
year
old
was
put
on
a
theatre
table
having
an
operation
with
his
had
extended.
After
the
operation
he
is
unable
to
extend
his
wrist
and
he
also
has
loss
of
sensation
on
the
first
dorsal
area
between
of
the
thumb
and
index
finger.
Which
nerve
is
most
likely
to
be
affected?
A. Radial
nerve
B. Medial
nerve
C. Axillary
nerve
D. Musculocutaneous
175. A
51
year
old
man
was
sitting
for
few
hours
with
his
legs
crossed.
Later
he
could
not
dorsiflex
or
invert
his
foot
.
He
also
has
got
loss
of
sensation
on
the
dorsum
of
his
foot.
Which
nerve
is
most
likely
to
be
damaged?
A. peroneal
nerve
B. Sciatic
nerve
C. Sura
nerve
D. Femoral
nerve
E. Tibial
nerve.
176. A
mother
brings
her
2
days
old
baby
worried
she
could
be
be
deaf.
The
mother
is
deaf
herself
and
thee
is
family
history
of
deafness
as
well.
What
is
the
singl
single
most
appropriate
investigation?
A. Brainstem
evolked
response
B. Distraction
C. Tuning
folk
tests
D. Startle
reflex.
E. Audiogram
177. A
45
year
old
lady
presents
with
back
pain
to
accident
and
emergency
department.
She
had
an
lumbo-sacral
X-ray
done
which
was
normal.
On
examination
she
is
found
to
have
loss
f
sensation
of
the
lower
legs
on
pin
prick
.
What
is
the
most
appropriate
investigation?
A. Bone
nuclear
scan
B. MRI
scan
C. Skeletal
survey
D. CT
scan
spine
E. No
investigation
178. A
50
year
old
lady
with
history
of
breast
cancer
treated
with
chemotherapy
and
surgery.
Now
she
has
come
back
with
pelvic
pain.
What
is
the
most
appropriate
management?
A. DEXA
B. Radiotherapy
C. Additional
chemotherapy
D. Biphosphanates
E. Mamography
179. A
2
year
old
child
was
found
to
have
meningitis.
The
child
recovered
well.
He
was
not
resuscitated.
What
would
be
the
expected
outcome
of
the
child?
A. Goes
back
to
normal
status
like
before
the
illness.
B. Hearing
loss
C. Visual
loss
D. Mental
state
retaration
E. Hemiparesis
180. A
35
year
old
man
presents
with
headache
and
rash.
On
examination
the
rash
does
not
branch.
What
is
the
single
most
appropriate
antibiotics?
A. Cefotaxime
B. Amoxicillin
C. Ciprofloxacin
D. Vancomycin
Clarithromycin
181. A
45
year
old
man
presents
with
fever,
rash
and
headache.
His
Glascow
coma
scale
is
10/15.
What
is
the
single
most
appropriate
immediate
management?
A. Intravenous
antibiotics
and
Ct
scan
brain
B. Lumbar
puncture
and
Iv
antibiotics
C. CT
scan
of
the
brain
and
intravenous
fluids
D. Lumbar
puncture
and
antibiotics
E. Blood
culture
and
Lumbar
puncture
182. A
47
ear
old
man
presents
with
fever,
headache
,
neck
stiffness
and
photophobia.
He
is
also
vomiting.
What
is
the
single
most
diagnostic
investigation?
A. Blood
culture
B. CT
scan
brain
C. Blood
culture
D. Lumbar
puncture
E. MRI
brain.
183. A
40
year
old
man
presents
to
accident
and
emergency
department
with
confusion,
ataxia
and
ophthalmoplegia.
He
lost
his
job
recently
and
he
is
smelling
of
sweet
breath.
Alcohol
breath
test
is
negative.
What
is
the
single
most
appropriate
immediate
management?
A.
B.
C.
D.
E.
Glucose
Intravenous
fluids
Intravenous
thiamine
Potassium
chloride
Chlordiazepoxide
184. A
40
year
old
man
lost
his
job
1
year
ago.
The
police
picked
him
from
the
street.
He
has
a
sweet
smell.
Alcohol
breath
test
was
negative.
What
si
the
most
likely
diagnosis?
A. Alcohol
intoxication
B. Alcohol
withdrawal
C. Delirium
tremens
D. Wernickes
encephalopathy
E. Acute
psychosis
185. An
18
year
old
lady
was
found
to
have
BMI
of
22.
She
had
lost
8kg
of
weight
in
6
months.
She
has
low
mood,
she
sad
all
the
time.
She
then
started
to
buy
expensive
clothes
and
eating
in
expensive
restaurant.
What
is
the
single
most
appropriate
diagnosis?
A. Anorexia
nervosa
B. Bulaemia
nervosa
C. Bipolar
affective
disorder
D. Schizophrenia
E. Depression
186. A
3
year
old
girl
fell
down
while
riding
her
bicycle.
She
then
went
pale,
and
then
rigid.
2
minutes
later
she
recovered
fully
but
she
was
still
pale.
After
1
hour
she
well
and
playing
around.
What
is
the
most
appropriate
management?
A. No
investigations
B. Electrocardiogram
C. Full
blood
count
D. Electroencephalogram
E. CT
scan
of
the
brain
187. A
19
year
old
man
dos
not
talk
to
anyone.
He
has
collected
2000
toy
cars.
He
is
indifferent
to
his
mum.
What
is
the
single
most
appropriate
investigation?
A. Autistic
spectrum
disorder
B. Psychosis
C. Borderline
personality
disorder
D. Dissociative
disorder
E. Schizotypal
disorder
188. A
30
year
old
lady
every
time
she
leaves
the
house
experiences
palpitation
and
difficulty
in
breathing.
She
has
to
rush
back
into
her
house
to
to
allay
her
anxiety
with
a
drink.
What
si
the
single
most
likely
diagnosis?
A. social
phobia
B. Agarophobia
C. Panick
attack
D. Hysteria
E. Arachnophobia
189. A
40
year
old
lady
was
biten
by
a
bee
on
her
right
hand
3
weeks
ago.
She
has
past
history
of
past
medical
history
breast
cancer
for
which
she
had
Radiotherapy
and
surgery
with
axillary
clearance
.
She
presents
to
accident
and
emergency
department
with
swelling
of
the
right
hand.
What
is
the
single
most
likely
diagnosis?
A. Anaphylaxis
B. Delayed
allergic
reaction
C. Cellulitis
D. Lymphoedema
E. Superior
vena
cava
obstruction
190. A
60
year
old
lady
who
had
anterior
resection
of
his
bowel
5
days
ago
presents
with
selling
on
her
wound..
There
is
4
cm
swelling
is
around
the
colostomy
which
tender
and
it
fluctuating.
She
is
not
systemically
unwell.
What
is
the
single
most
appropriate
action?
A. Laparotomy
B. Local
anaesthesia
C. Laparotomy
with
wound
repair.
D. Exploration
of
the
wound
E. Abdominal
X-ray.
191. A
25
year
old
lady
presents
to
out
patient
department
requesting
contraception.
She
has
irregular
and
painful
periods.
She
smokes
20
cigarrets
a
day.
Otherwise
she
fit
and
well.
Which
is
the
single
most
appropriate
type
of
contraception?
A. Combined
oral
contraception
B. Progesterone
only
contraception
C. Trenexemic
acid
D. Levenoestrel
E. Levanogestrel
IUCD
192. A
16
year
old
girl
presents
with
heavy
regular
periods.
What
is
the
single
most
appropriate
treatment?
A. Combined
oral
contraception
B. Progesterone
only
pill
C. Trenexemic
acid
D. Mefenemic
acid
E. Levenogrel
intrauterine
system
193. A
30
year
old
lady
with
past
medical
history
pulmonary
embolism
presents
to
out
patient
clinic
requesting
contraception,
She
has
irregular
and
painful
periods.
What
is
the
single
most
appropriate
contraception?
A. Intra
uterine
contraceptive
device
B. Combined
pill
contraception
C. Progesterone
only
pill
D. Mefenemic
acid
E. Trenexemic
acid
194.
A
34
year
old
man
had
a
4
mm
ureteric
stone
which
he
passed
with
urine.
This
time
he
presents
with
3
cm
stone
in
a
right
kidney.
What
is
the
single
most
appropriate
treatment?
A. No
treatment
B. Lithotripsy-shock
wave
C. Laparotomy
D. Operative
stone
removal
E. Observe
195. A
35
year
old
man
returned
from
Egypt
where
she
was
working
in
out
door.
She
was
found
to
have
a
5cm
stone
which
was
removed
operative.
She
is
now
planning
to
go
back
to
Egypt.
What
advice
would
you
give
her?
A. Increase
fluid
intake
B. Better
not
to
go
to
Egypt
again
C. Reduce
fluid
intake
D. Regular
hospital
admission
for
intravenous
fluids
E. Return
to
UK
regularly
196. A
28
year
old
man
with
a
known
psychiatric
disease
thinks
that
he
is
the
professor
of
medicine
and
he
says
later
he
will
become
God.
What
is
the
single
most
likely
diagnosis?
A. Delusion
of
grandiose
B. Idea
of
reference
C. Identity
disorder
D. Paranoid
delusion
E. Delusion
of
reference
197. A
30
year
of
lady
with
past
history
of
1
episode
of
mania
presents
with
depression.
She
has
been
treated
successfully
this
time
but
she
needs
prophylaxis
for
her
condition.
What
is
the
most
appropriate
medication?
A. Mood
stabilizer
B. Benzodiaxepines
C. Anti-depressant
D. Anti-psychotic
E. Anti-epileptic
198.
A 35 year old diabetic pattient was on long acting anti diabetic in
the morning and short acting in the evening. after lunch patient gets
hypoglycaemia . How will manage this patient
A) provide more food at lunch
B) decrease long acting in the morning (answer)
C) decrease short acting in the afternoon
D) decrease both dose
E) reassurance
199.
A
70
year
old
man
with
lung
cancer
presents
with
a
cough.
He
is
already
on
codeine,
steroid
and
salbutamol
inhalers.
What
is
the
single
most
appropriate
management?
A. Nebilised
adrenaline
B. 0.9%
saline
nebulized
C. Oral
morphine
D. Antibiotics
E. Benzodiazepine
200.A
65
year
old
man
presented
with
shortness
of
breath.
He
was
a
shipyard
worker.
He
was
admitted
treated
with
antibiotics
and
inhalers.
What
would
be
the
reason
to
inform
the
coroner/
A. Industrial
disease
B. Inappropriate
treatment
C. Because
he
died
during
admission
D. To
satisfy
the
relatives
E. It
should
be
done
as
a
routine.
GOOD
LUCK
FROM
DR
SAMSON