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1. Which condition which live vaccine is contraindicated?

A.hay fever
B. Asthma
C. Sickle cell anemia
D. Chronic Lung and heart disease
E. Pregnancy

2. A patient with Polycystic kidney disease presents with severe headache.

What is the most likely cause?
A. Hypoglycemia
B. Trauma
C. Rupture brain cyst
D. Rupture aneurysms
E. Stroke

3. 2 years old boy, 2×2cm lump at right superficial ring. O/E cystic and transilluminant.
Moves downward, into scrotum when traction applied to testis. Most likely diagnosis?

A. Congenital hydrocele
B. Encysted hydrocele
C. Hydrocele-en-bissac
D. Infantile hydrocele
E. Spermatocele

4. 30 years old hairdresser presented with left lower limb swelling after pelvic surgery . On
examination , the the leg is swelling up to the thigh and painful at the calf area. All of the
pulses are palpable . What is the immediate management ?

A) Aspirin
B ) Heparin
C) Warfarin
D) Tramadol
E) Cephalosporine

5. A 70 year old man presented with Prostatomegaly and serum psa 35ng/ml.
what is the most appropriate investigation?
a. ultrasound abdomen
b. X ray KUB
c. IV urethrogram
d. cystoscopic biopsy
e. transrectal biopy

6. What's the initial management in acute asthma attack?

Answer: to stimulate B2 adrenergic receptor
7. 65 yo male left inguinoscrotal swelling. Left scrotum appears lower than right. The left
cord feel like bag of worms. The cause is left sided
A. Lymphangioma cord
B. Funiculitis
C. Irreducible inguinal hernia
D. Renal ca
E. Lipoma cord

8. Pt come with unilateral headache, claudication of jaw, constitutional symptoms. Dx?

A. Migraine
B. Meningitis
C.subarachnoid hemorrhage
D.temporal arteritis
E. Brain tumor

9. Old man with severe COPD ,came with bilateral pedal edema.O/E increase JVP and
signs of right ventricle overload.ABG at room air show pH 7.29, PCO2 55 , PaO2 60.
What is the most appropriate treatment for a better prognosis ?
C.long term oxygen therapy
D. Forgot

10. All of the following is TRUE regarding warfarin EXCEPT :

A. Proximal DVT should be given warfarin for 6 months
B. Patients with a. Fib and structurally defect heart should be given prophylaxis
C. Biological heart valve should be given long term warfarin (im not sure)
D. Thromboembolic stroke due to a.fib should be given anticoagulant
E. Bleeding due to warfarin is corrected by vitamin K

11. Reason for weight loss a few days post burn

Ans: negative nitrogen balance

12. Inferior vena caval filter is used to prevent:

B. Pre-operative air embolism
C. Portal hypertension
D. Pulmonary embolism
E. Thrombophlebitis

13. Chronic Diabetic and hypertensive patient came with proteinuria. He also has left
ventricular hypertrophy . Management?
A. B- blocker
B. ACE inhibitor
14. "Bag of worms" feel on palpation is a feature of:
A. Enterocele
B. Omentocele
C. Epididymdal cyst
D. Varicocele
E. Hydrocele

15. 28 y/o, sustained pelvic fracture after mva, unable to pass urine, palpable distended
urinary bladder, blood in external utethral meatus. Diagnosis?

A) intraperitoneal bladder rupture

B) extraperitoneal bladder rupture
C) membrane urethral rupture
D) bulbar urethral rupture
E) penile urethral rupture

16. Following are the features of stagnant hypoxia.

B) cardiogenic shock
C) cyanide poisoning
D) Carbon monoxide poisoning
E) pul. TB

17. which of the following features help differentiate between CKD and AKI ?
A. Hypophosphatemia
B. Hypocalcemia
C. Hyperkalemia
D. Hyponatremia
E. Metabolic acidosis

18. Regarding hiatus hernia which is true:

A) causes lung infection
B) diagnose by ogds
C) dysphagia is more common is rolling
D) surgery is required
E) rolling more common then sliding

19. In an average man, how much g/dl of hemoglobin increases with 1 unit of blood
A) 0.5 g/dl
B) 1.0 g/dl
C) 1.5 g/dl
D) 2.0 g/dl
E) 2.5 g/dl
20. 56y/o admitted for anemic symptom has been diagnosed with decompensated liver
cirrhosis due to hepatitis c. Full blood picture shows anemia, thrombocytopenia, mcv
67fL. Which one of following investigation n respective treatment would you consider?
A. Renal profile to look for heaptorenal syndrome, hemodialysis
B. OGDS to look for esophageal varices; ligation
C. Colonoscopy for colorectal ca; colestomy
D. Proctoscopy for hemorrhoid; ligation

21. Which is the most common complication of fundoplication due to reflux?

A. Dysphagia - answer
B. Esophageal erosion
C. Esophagitis
D. Injury to spleen
E. Diaphragmatic hernia

22. most aggressive type of malignant melanoma


23. Aspiration of gastric content into tracheobronchial tree should be managed immediately
A. Tracheal intubation and suctioning
B. Proton pump inhibitor
C. Salbutamol nebulizer
D. Cricothyroidotomy
E. Positive pressure ventilation

24. A 19 yo female with right upper quadrant of abdominal pain with fever, jaundice and
palpable mass on upper abdomen ? What is the most likely diagnosis?

A) Cholecystitis
B) Acute Choledochal cyst
C) Mucocele of gallbladder
D) Mirrizzi’s syndrome
E) Carcinoma of gallbladder

25. All the following is true EXCEPT:

A. Vsd- pansystolic murmur
B. Aortic stenosis- ejection systolic
D. Pulmonary stenosis- early diastolic
E. PDA - continuous machinery mumur

26. Young lady, having symptoms of tachycardia, palpitations ...

Have swelling on anterior neck
What is the expected finding
B. Decreased cardiac output
D.paroxysmal atrial fibrillation

27. Man on blood transfusion complaint of sudden fever with rigor, back pain, anxiety and
red coloured urine
What is the immediate management after stopping boood transfusion

A) antibiotics
B) antihistamine
C) diuretic
D) epinephrine
E) steroid

28. 54 y/o male with type 2 Dm, HTN, (one more I forgot) was diagnosed with lower
esophageal Ca. ASV classification?

29. Most common cause of metastasis to bone is carcinoma of

A. Prostate
B. Pancreas
C. Rectum
D. Testis
E. Bronchus

30. Which of the following is Autosomal Dominant

A. Beta thalassemia
B. Wilson disease
C. Marfan syndrome

31. Pt came w fever, dry mouth, palpitations, bottle of meds "take one as necessary for
stomach pain. Xigt sgt

2 more x igt

32. Which infection has the shortest incubation period?

C.Hepatitis A

33. One of the family member has been tested positive for Diphtheria.
What prophylaxis will you administer to the rest of the family?

34. 67 y/o man has 10-years history of GERD. Currently present with dysphagia. On
endoscopic examination, an obstructive lesion was seen at the lower esophagus ,
suspected to be Ca of esophagus .what is the most likely Histological finding of the
A) squamous cell Ca
B) Normal squamous epithelium
C) Adenocarcinoma
D) Leiomyoma
E) Metaplastic Columnar epithelium

35. Pantoprazole acts by

A. Direct cytoprotective
B. Inhibit hydrogen potassium ATPase
C. Inhibit gastrin and acid production
D. Block something...
E. Buffer PH

36. What is the pathological feature of Crohn's disease. except

A. present of fistula
B. proximal colitis with rectal sparing
C. Lymphoid aggregates and microgranuloma
D. Ulceration within small bowel
E. Inflammation limited to mucosa (UC)

37. What's the most appropriate drug to treat diabetes insipidus?

A frusemide
B desmopressin
C vasopressin
D amiloride
E hydrocortisone

38. Which one of the following is not the causes of nephrotic syndrome?
A. Malaria
B. Syphilis
C. Hepatitis B
D. Rheumatic fever
E. Penicillamide
39. Which of these are examples of clean wound? IDK

A. Debridement of Laceration Wound

B. Drainage of Abscess
C. Emergency Appendicitis
D. Laparoscopic Cholecystectomy
E. Radical Mastectomy

40. Cause for Secondary Parkinsonism

a Methyldopa
b Levodopa
c Topiramate
d Pyridostignmine
e Celecoxib

41. 60yo, bloody diarrhea & lower abdominal pain, stool exam. Normal. Sigmoidoscopy
done shows typical ulcerative coliti. There severe features, except?
A) bowel output >10times
B) stool >200g/24h
C) fever 38°c in 2 consecutives
D) pulse rate 110bpm
E) ESR 80ml/h

42. A 45 year old man presented with epitaxis and progressively worsening dypsnea and
cough, 2 months. He also had few episodes of hemotypsis. He had rhinitis recent few
years. Chest X Ray on admission shows pulmonary infiltrates. Blood investigation
consistent with chronic renal impairment. cANCA is positive. What is the most likely
A) wegener's granulomatosis
b) systemic sclerosis
C) membranous nephropathy
D) IgA nepropathy

43. Which drug causes Retroperitoneal Fibrosis?

A. Lithium
B. Methotrexate
C. Methysergide
D. Mephenemic Acid
E. Norfloxacin

44. 50 years old with sudden right sided chest pain along with tachycardia, tachypnoea, and
reduced PaO2 after 4th-day postoperative gastric surgery. Next step investigation. a.
ECG b. chest X-ray c. Echo d. cardiac enzyme e. ventilation perfusion ratio
45. 60 years old man, chronic smoker, partial ptosis of right eye with constricted pupils.
Numbness & weakness of the right shoulder & arm
A. Stroke ?
B. Venous sinus thrombosis
C. Pancoast tumour
D. Retro pharyngeal growth
E. Peripheral neuropathy

46. Normal levels of CRP, elevated ESR seen in which of the following?
A) rheumatoid arthritis
C) Sjogren
D) scleroderma
E) polymyalgia rheumatic

47. Following these are live attenuated vaccine, except?

B) rabies
C) mumps
D) varicella
E) measles

48. 65 years old with underlying copd fall and got 7,8,9 rib fracture. Chest xray normal.
Appropriate management?

A. Immobilise with sand bag

B. Strap with strong adhesion
C. Tube thoracostomy
D. Analgesic and bed rest
E. Surgical approach

49. What's the most common carcinoma of a chronic varicose ulcer ?

A. Angiosarcoma
E.malignant melanoma

50. 36 years old man, with body weight 60kg sustained burn 40% of total body surface area.
How much fluid should be given in 1st 8 hours base on parkland criteria?

51. acute renal transplant rejection is:a) with 1-3 days of transplantation b) after 3 weeks
of transplantation c) within one month of transplantation d) within 2nd week of
transplantation d) within few hours of transplantation (Hyperacute)

52. 39 y/o present with history of 6 weeks intermittent pain & swelling of submandibular
gland. Pain more after eating and resolves after few hour.The gland is enlarged & mildly
tender. No lympadenopathy. What is most likely diagnosis?

53. Patient post op cholecectomy come with sob

ABG done
PH 7.5
PCo2 30mmHg
P02 80 mmHg
Bicarbonate 26mmol/L
BE: 3.2
A.metabolic acidosis
b.metabolic alkalosis
C.respiratory alkalosis
D.respiratory acidosis
E. Metabolic acidosis with respiratory alkalosis

54. 57yo man schduled laparoscopic cholecystectomy, on warfarin for chronic atrial
fibrillation. How many days prior to operation he need to stop taking warfarin?
A. 1-3 days
B. 4-7
C. 8-10
D. 11-15
E. 16-30
55. n splenectomy:
A. Post-operative anti-immune prophylaxis within 24 hours of surgery.
B. Life long antibiotics.
C. Post-operative platelet transfusion.
D. Post-operative antibiotics.
E. Fresh frozen Plasma infusion.

56. A 26 years old lady come to do ultrasound for her 24 weeks of gestation pregnancy. The
fetus was confirm to be male. Her husband is positive Hemophilia A. Otherwise she was
negative for hemophilia screening.
What is the probability of the baby to get hemophilia?
A. 100%
B. 75%
C. 50%
D. 25%
E. 0% Pls check

57. Total parental nutrition is mandatory for preoperative management of

A. Acute intestinal obstruction
B. Burn
C. High output intestinal fistula
D. Obstructive jaundice
E. Upper GI malignancy (check)
58. unable to close right eye . corneal reflex absent right eye and reactive left eye.

A cp angle tumor
B pontine glioma
C lmn facial palsy
D trigeminal
E hemifacial spasm

59. screening test for scleroderma.

A) Antinuclear antibody
B) anti LKM antibody
C) anti SSB antibody
D) anti topioramase antibody
E) anti rubionuclease antibody

60. A 40 years old lady presented with thyroid nodule. FNAC was done and confirmed to be
papillary carcinoma of thyroid. What is the treatment?
A.local excision
B.near total thyroidectomy
C.hemi thyroidectomy
D.lobectomy thyroidectomy

61. A 34 years old man presented with left scrotal swelling for 1 year duration. Can get
above swelling. Soft, fluctuant, non- trans illuminating.testis can be felt separately. What
is the diagnosis ?

A.cyst of epididymis
D.vaginal hydrocele

62. 72yo man with pathological fracture of tibia. No lytic lesion on xray ribs. Serum calcium
more than 3. Usg show Large central abdominal mass withsome mesenteric
lymphadenopathy. What is the cause:
A) multiple myeloma
B)disseminated high grade non hodgkin lymphoma
C) disseminated Hodgkin lymphoma
D) plasmacytosis of tibia
E) Osteosarcoma of tibia

63. 55 year old man came to ED with severe upper abdominal pain. On examination his
abdomen was rigid and there was obliteration of liver dullness on percussion. the best
examination is A) abdomen ultrasound B) barium meal C) contrast CT D) ERCP E)
erect chest X ray
64. 70 year old man presented with arthritis in PIP and DIP joints and also carpometacarpal
joint of thumb. MCP joints and wrist joints are spared. What is the most likely
A. Psoriatic arthritis
C. Rheumaroid arthritis
D. Gout
E. Pseudogouty arthritis

65. The dance sign associated with

A. Duodenal atresia
B. Hirschsprung disease
C. Intussusception
D. Jejunal atresia
E. Meconium ileus

66. A 60 year old lady presented with rapid emergency hypertension, by 210/105 without
any symptoms. Managed accordingly..
Which sign can be found by fundoscopy .
A )retinitis obliterant
B ) cotton wool
C) optic atrophy
D) retina detachment

67. what is the drug use as medical adrenalectomy for cushing sydrome:
A. Fluconazole
B. Metyrapone
C. Aminoglycoside
D. Labetolol
E. Amlodipine

68. 25 year old male came with a stab wound at the RIF. He is conscious, BP 110/55
mmHg, PR 110 bpm. Abdominal examination shows that there is a 5cm length
penetrating wound, generalised tenderness, guarding and rigidity. What is the next
appropriate step?
A. Observation
B. FAST scan
C. Diagnostic peritoneal lavage
D. Abdominal CT scan ?
E. Laparotomy

69. 34 y/o man with Burkitt's lymphoma receive chemotherapy (cyclophosphamide,

vincristine, methotrexate, prednisolone) 24 hrs later he's confused, muscle cramps in the
legs. What is the likely cause?
A. Prednisolone induced psychosis
B. Hypercalcemia
C. Methotrexate pneumonitis leading to hypoxia
D. Hemorrhagic cystitis leading to acute renal failure
E. Tumor lysis

70. when inserting central venous line..

A. Sildenger technique contraindicated
B. Head down tilt will reduce risk of air embolism
C. Post CT chest is necessary
D. Needle directed to contralateral nipple
E. Subclavian vein is found deep to artery

71. What is the Rx for Class III and IV lupus nephritis?

A. IV Cyclophosphamide
B. Oral prednisolone
C. Plasmapheresis
D and E?

72. 40 y/o patient developed cardiac failure, has history of 2 previous blood transfusions,
underwent splenectomy for enlarged spleen. Has multiple ulcers on leg.

A. B thalassemia minor
B. B thalassemia intermedia
C. B thalassemia trait
D. A thalassemia minor
E. A thalassemia major

73. Drug contraindicated in pregnancy.

-tetracycline ?

74. A 70 years old man presented with features of gastric outlet obstruction. Investigations
shows an antral carcinoma of the stomach with liver metastasis. What is the most
appropriate management?
A. Total gastrectomy
B. Chemotherapy
C. Radiotherapy
D. Endoscopic ballon dilatation
E. Pyloric stent

75. 39 years old had transfusion reaction during resuscitation for upper GI bleed. Which of
the following is the appropriate management ?
A. Removal of foreign body irritants, such as Foley catheter
B. Steroids
C. Inotropic agents
D. Fluid restriction
E. Fluid, mannitol infusion

76. which of the drug have the least direct bronchodilating effect
A theophylline
B ipratropium
C beclamethasone
D montelukast
E salbutamol

77. Screening test for scleroderma

B. Anti U1- ribonuclease Ab
C. Anti LKM Ab
D. Anti topoisomerse ab
E. Anti Ssb (La) ab

78. All the following conditions cause joint erosions except

A. Rheumatoid arthritis
B. Psoriatic arthritis
C. Multicentric reticulohistiocyte
E. Gouty arthritis
79. 40. Which of the following tumour has specific tumour marker?
A. Seminoma
B. Prostate cancer
C. Cholangiocarcinoma
E. Malignant Melanoma