Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 5TH MARCH 2019 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. A 9 year old boy presented with complains of nocturnal cough and shortness of breath, chest tightness
plus wheeze after playing football. His father has eczema. What is the most appropriate investigation?
A. CXR D. Sweat test
B. Pulmonary function tests
C. High-Resolution Chest Tomography (HRCT)

2. A patient has been having influenza infection for the past 5 days and now presents with very painful
hemorrhagic blisters on the deep meatal skin. What is the most appropriate treatment?
A. Oral acyclovir
B. IV Acyclovir
C. Supportive treatment only
D. Gentamicin
E. Flucloxacillin

3. A 17 year old man history of easy bruising. On examination he is obese. Investigation reveals
potassium 2.3. What is the most likely diagnosis?
A. Conn Syndrome
B. Addison's disease
C. Cushing Syndrome
D. Pheochromocytoma

4. A 35 year old man with BP 140/80mmHg is having micro-albuminuria. He has never been diagnosed
with hypertension. Diabetes has been ruled out. What is the most appropriate next step?
A. Renal biopsy
B. Renal scan
C. Refer to renal unit
D. Start ACE inhibitor
E. IVU

5. A 6 months old infant has a breast milk jaundice. He is otherwise feeding well and is not dehydrated.
What would his liver function tests look like?
A. Total bilirubin: 40 , conjugated bilirubin < 5%
B. Total bilirubin: 300 , conjugated bilirubin 85%
C. Total bilirubin: 500 , conjugated bilirubin >85%
D. Total bilirubin: 400, conjugated bilirubin <85%
E. Total bilirubin: 500, conjugated bilirubin <70%

6. An old man presented with fever and weakness. On examination he was found to have rashes as shown
in the given picture. Choose the right option from the following options.
A. Plantar Petechiae
B. Lipoderma Sarcoma
C. Talengectasia
D. Cellulitis

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7. 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

8. A 27 year old man presents with chest pain and respiratory distress. On examination there is
tachycardia, hypotension and neck vein distension. Trachea is deviated to the left side, breathing sound on
the right side is absent and on the left side is diminished. What is the next appropriate management?
A. Chest x-ray
B. Right side aspiration (16 G cannula)
C. Left side aspiration (16 G cannula)
D. Right side drainage with a small tube (12F)
E. Left side drainage with a small tube (12F)

9. A 56 year old female has come to the fracture clinic with a fall on her outstretched hand. she complains
for pain and swelling in her right forearm and she is unable to bear weight. You suspect fracture of her
right upper forearm. What will be the best investigation to diagnose and to prevent recurrence?
A. Dexascan
B. CT scan
C. MRI
D. Full body xray

10. A 12 year old boy with pain and swelling in multiple joints (small and large), has mild fever. Which
of the following change in his blood investigations will definitely be there?
A. RA factor positive
B. Increase in ESR
C. ANA – positive
D. Rise in serum uric acid level

11. A woman presents with alternating episodes of low mood and happiness. When she feels happy she
goes on extravagant shopping sprees. What is the most likely diagnosis in this patient?
A. Depression
B. Bipolar affective disorder
C. Schizophrenia
D. Panic disorder

12. A 60 year old man presents to the ENT department with progressive hearing loss and ringing sound
on the right side. On examination external ear and tympanic membrane was normal. Hearing tests:
Rinne’s AC>BC in the right and left ears, Weber’s test lateralises to the left ear. What is the next best
investigation to diagnose the medical condition?
A. Audiometry
B. CT scan
C. MRI scan
D. CT angiography
E. Otoscopy

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13. A 72 year old man has been recently diagnosed with metastatic Ca Prostate, and he is symptomatic. A
team of doctors have discussed the best treatment option of radiotherapy and chemo with him, and their
possible side effects. He fully understands the best treatment options discussed with him but refuses the
treatment. What should you as the primary doctor do?
A. Override his wish.
B. Invite the psychiatry team to assess his capacity to refuse treatment.
C. Respect his wishes but counsel him on other treatment options available.
D. Accept his wish, and let him know that should he change his mind at any time, you are always
available
E. Involve his relatives about him not accepting the treatment option

14. An old man suffers from end stage prostatic cancer. He has pain, aneuria, bilateral hydronephrosis.
His son’s wedding is in 3 weeks. He is looking forward to enjoy the ceremony. What is the most
appropriate palliative treatment for him?
A. Palliative chemotherapy
B. Palliative radiotherapy
C. Bilateral nephrostomy
D. Catheterisation

15. A 26 year old man presents to the A&E with increasing shortness of breath in left side and chest pain.
He has been a heavy cigarette smoker for the past 4 years. He does not have any past medical history.
What is the most likely diagnosis?
A. Pulmonary Embolism
B. Myocardial Infarction
C. Asthma
D. Pleural effusion
E. Pneumothorax

16. A 3 years old child, who was wasted on examination, has a history of diarrhoea on and off. The
mother describes the stool as bulky, frothy and difficult to flush. What is the single investigation most
likely to lead to a diagnosis?
A. Sweat Chloride test
B. Anti Endomysial Antibodies
C. Liver Function tests
D. Ultrasound Abdomen
E. Thyroid Function Test

17. A 12 year old boy complains of acute development of purpura on the dependent areas of his body 2
weeks after an upper respiratory tract infection. The purpura does not blanch on pressure. tests reveal: Hb
12 g/dL, platelets 50 x 10*9/L, WCC 5 x 10*9/L. Bleeding time is 10 mins, APTT : 40 s, PT: 1.02. What
is the most likely diagnosis?
A. Idiopathic thrombocytopenic purpura (ITP)
B. Thrombotic thrombocytopenic purpura (TTP)
C. Von Willebrand's disease
D. Haemophilia A
E. Haemophilia B

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18. A 22 year old man presents with red hot swollen metatarsal phalangeal joint pain, sacro-ilitis and
onycholysis. What is the single most likely cause of this condition?
A. Gout
B. Psoriatic arthritis
C. Rheumatoid arthritis
D. Septic arthritis

19. 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

20. A 55 year old man is brought into A&E unconscious. He has a distended abdomen with caput
meduase and spider navi. He has a previous history of bleeding oesophageal varices. His Hb is 10 g/dL,
MCV is 100 fL. His skin is pale and clammy. What is the reason for his loss of consciousness?
A. Alcoholic hypoglycaemia
B. Diabetic hypoglycaemia
C. Hepatic encephalopathy
D. Subdural haematoma

21. A woman presents with butterfly rash on her face. What is the most likely diagnosis?
A. SLE
B. Herpes
C. Allergy
D. Reactive arthritis

22. A 28 year old woman comes with sudden onset of vomiting and pain per abdomen. On examination
mobile swelling in the right iliac fossa was found. What is the most probable diagnosis?
A. Ectopic pregnancy D. Ovarian torsion
B. Tubo-ovarian abscess E. Diverticulitis
C. Acute appendicitis

23. A 48 year old woman always socially withdrawn has stopped going out of the house. She is afraid to
socialize because she fears that people will criticize her. What is the most probable diagnosis?
A. Agoraphobia
B. Post Traumatic Stress Disorder
C. Social Anxiety
D. Obsessive Compulsive Disorder
E. Generalized Anxiety Disorder

24. A patient presented with atrophy of the thenar eminence, difficulty in abduction of the thumb and
paresthesia on the palmar aspect of the lateral three and half fingers. Which nerve is affected?
A. Radial nerve
B. Ulnar nerve
C. Median nerve
D. Axillary nerve
E. Posterior Interosseous Nerve

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25. 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?
A. Cerebral infarct
B. Cerebellar infarct
C. Medulla Oblongata
D. Pons
E. Midbrain

26. A patient with terminal cancer on morphine asks you to help him end his life by giving him lethal
dose of morphine.
A. Use lethal dose Morphine to end his life
B. Use some other medication to end his life
C. Suggest it some other way to end his life
D. Tell him this not possible but assure him that there are effective ways to deal with pain.

27. 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

28. A patient is admitted with fever, photophobia, and a non blanching rash. His ABG values are as
follows:
pH-7.5
PaCO2 – 2.2 KPa
PaO2 – 9.0 KPa
What is the most likely diagnosis?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis

29. A 27 year old female who had a Road Traffic accident 7 months ago now complains of attacks
of sudden onset rotational vertigo that occurs on sharp movements of her head and neck. Which of the
following would be most helpful?
A. Caloric testing
B. Hallpike manoeuvre
C. Gutenberger’s test
D. Meniere’s test
E. Otoscopy

30. An elderly man with dementia who has a lesion on his head and wants it removed because he believes
it'll improve his memory, wife disagrees. Choose the most appropriate management:
A. Asses patient’s capacity to give consent.
B. Refuse to do the surgery.
C. Do the surgery.
D. Get wife to sign consent form.
E. Talk to senior colleague.

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31. A 30year old lady complains of intermittent diarrhoea, chronic abdominal and pelvic pain and
tenesmus. Sometimes she notices blood in her stool. Select the most likely cause leading to her
symptoms?
A. Inflammatory bowel disease
B. Diverticulosis
C. Irritable bowel disease
D. Adenomyosis
E. UTI

32. A 45 year old lady presents with back pain to accident and emergency department. She had a lumbo-
sacral X-ray done which was normal. On examination she is found to have loss of 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

33. A 68 year old man with diabetes and hypertension was noted to have a cholesterol level on 3.4mmol/l.
He was also noted to have micro-albuminuria. What is the best drug to add to his regimen?
A. Ace inhibitors
B. Statins
C. Amylodipine
D. Biguanides

34. Patient comes with multiple painful ulcers over buccal mucosa and white striae on mouth and tongue.
What is the most likely diagnosis from the following list of options?
A. Candida
B. Oral Ca.
C. Aphthous ulcers
D. Lichen planus

35. A 24 year old woman complains of pain over the base of her right thumb. She finds that she cannot
extend her right thumb. The pain is worse when she is changing her son’s nappies and subsides with rest.
She noticed it for the first time a few months after the birth of her son. What is the most likely diagnosis?
A. Trigger finger
B. Mallet finger
C. Gamekeepers thumb
D. Mommy’s thumb

36. A 20 year old lady has got brother and sister and all of them have got adenomatous polyposis. Which
cancer are they most likely to develop?
A. Gastric carcinoma
B. Colorectal carcinoma
C. Lymphoma
D. Duodenal lymphoma

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?

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A. Subdural haematoma D. Epidural haematoma
B. Subarachanoid haemorrhage
C. Cerebral infarct

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 13year old boy with umbilical pain for the last 12h presents with anorexia, nausea and has not
passed a bowel motion for 24h. What is your diagnosis?
A. Acute appendicitis
B. IBD
C. IBS
D. Meckel’s diverticulum
E. Psoas hematoma

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44. A 62year old man has had ano-rectal pain aggravated by defecation for 3days. Rectal exam:
purple, tender lump at the anal verge. Flexible sigmoidoscopy: normal rectal mucosa and hard feces.
What is the best managementstrategy?
A. Analhematoma
B. Analfissure
C. Rectalca
D. Diverticulitis
E. Angio dysplasia

45. A 35 years old male presented with purulent nasal discharge from one side with headache and fever,
examination showed supra orbital and maxillary tenderness , what is the best diagnostic investigation?
A. CT Scan
B. MRI
C. X-ray
D. USG
E. Swab for culture

46. A 43 year old male presented to the ENT department with history of nausea and dizziness since 2
weeks. He noticed that these symptoms occur for a few seconds whenever he rolls over in his bed in the
mornings. On examination: external ear and tympanic membrane are normal, Rinne’s and Weber’s shows
no hearing loss, and his cranial nerves examination are normal. What is the most appropriate clinical test
to diagnose patient’s medical condition?
A. Head Impulse test
B. Dix-Hallpike test
C. Audiometry
D. Romberg’s test
E. Epley’s manoeuvre

47. 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

48. A 35 year old African woman presents with cyclical menorrhagia since last 8 month. She is
nulliparous and has been trying to conceive for some years now. What do you suspect from the history?
A. Dysfunctional Uterine Bleeding
B. Endometriosis
C. Endometrial polyp
D. Adenomyosis
E. Fibroids

49. 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. Pick’s dementia
D. Parkinson’s disease

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50. A 16 year old boy following a RTA was brought to the A&E with a swelling and deformity in his
right thigh. On examination airway is patent and he is found to have a pulse less leg. Which is the most
likely structure involved from the following options?
A. Femoral artery
B. Posterior tibial artery
C. Common peroneal nerve
D. Dorsalispedis

51. A 53 years old female presents with an acute painful hot knee joint. She is a known case of
rheumatoid arthritis. On examination, the knee is red, tender and swollen. The hamstring muscles are in
spasm. Her temperature is 38.5 ˚C and blood pressure is 120/80 mm Hg. What is the single best next
investigation?
A. Joint aspiration for cytology and culture and sensitivity
B. Join aspiration for positively birefrengent crystals
C. Joint aspiration for negatively birefringent crystals
D. Blood culture
E. Serum uric acid

52. A young woman was brought to the hospital. On examination she has low temperature and tremor.
She says when her eyes are closed she can see colour. What drug has been used?
A. Methylenedioxymethamphetamine (MDA)
B. Lysergic acid diethylamide (LSD)
C. Cocaine
D. Heroine
E. Ecstasy

53. A 33 years old male involved in street fight presents with bruises and deformity in the upper part of
his leg. X-ray shows fracture of the neck of fibula. What is the SINGLE most associated nerve injury?
A. Sciatic nerve.
B. Gluteal nerve.
C. Musculocutaneous nerve
D. Lateral peroneal nerve
E. Tibial nerve
F. Femoral nerve

54. A 34 year old woman presents with severe jaundice, fever and pruritus. What is the best initial
management to control the pruritus in her?
A. IV 0.9 % normal saline D. Cholestyramine
B. IV dextrose
C. Cimetidine

55. A 7 years old child presented with chronic cough and is also found to be jaundiced on examination.
What is the most likely diagnosis?
A. Congenital diaphragmatic hernia
B. Congenital cystic adenomatoid malformation
C. Bronchiolitis
D. Respiratory distress syndrome
E. Alpha 1 antitrypsin deficiency

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56. A retired shipyard worker has pleural effusion, diffuse shadow and is breathless. What is the single
management that can relive his symptoms?
A. Oxygen therapy
B. Salbutamol
C. Radiotherapy
D. Aspiration

57. A 7 year old boy presents with perioral blisters and a hot face. Some are weeping and some crusted.
What is the most likely diagnosis?
A. Impetigo
B. Shingles
C. Chicken pox
D. Acne
E. HSV 1

58. A 67 year old man with long standing constipation presents with sudden onset of confusion. What is
the treatment of choice?
A. Sodium picosulphate
B. Danthron
C. Phosphate enema
D. Methylcellulose
E. Bran

59. A 34 year old man with a white patch on the margin of the middle third of the tongue. Which is the
SINGLE most appropriate lymph node involved?
A. External iliac lymph nodes F. Submental lymph nodes
B. Pre aortic lymph nodes G. Submandibular lymph nodes
C. Aortic lymph nodes H. Deep cervical lymph nodes
D. Inguinal lymph nodes
E. Iliac nodes

60. A 10 years old girl presents with pallor and features of renal failure. She has haematuria as well as
proteinuria. The serum urea and creatinine are elevated. These symptoms started after an episode of
bloody diarrhoea 4 days ago. What is the most probable diagnosis?
A. Thrombotic thrombocytopenia purpura (TTP)
B. Haemolytic-uremic syndrome (HUS)
C. Idiopathic thrombocytopenic purpura (ITP)
D. Henoch-Schonleinpurpura (HSP)
E. Acute renal failure (ARF)

61. A 2 day baby started to have jaundice but is breast feeding well and gaining weight. She is passing
white stool 2-3 times per day. What is the single most likely cause of jaundice?
A. Biliary atresia
B. Haemolysis
C. Physiological
D. Congenital spherocytosis
E. Breast milk jaundice

62. A 28 years old man presents with sudden onset abdominal pain. He has no significant history apart
from an appendectomy when he was 12. His Abdominal X-ray finding is below.
What is the single most appropriate next step in the management?

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Options:
A. Urgent Laparotomy
B. Urgent Colonoscopy
C. Insert Nasogastric tube
D. High dose Laxatives
E. USG Abdomen

63. A young man presented with cough, high grade fever and chest pain. CXR shows bilateralcavitating
bronchopneumonia. He was diagnosed with influenza infection a week ago. What is the most probable
cause of his pneumonia?
A. Legionella
B. Mycoplasma
C. StaphylococcusAureus
D. Streptococcus pneumonia

64. A patient on insulin is booked in for a hernia operation. What is the most appropriate management of
insulin?
A. Give insulin and saline pre op
B. Stop insulin for the duration of the operation
C. Give intravenous insulin + dextrose + saline pre op
D. Give insulin as usual pre op
E. None

65. A 65 year old woman complaining of symptoms suggestive of Reynaud’s phenomena and difficulty in
swallowing. O/E she has painful lesions on her finger tips and facial telangiectasia. What is the single
most likely positive antibody?
A. Anti Jo 1
B. Anti Scl 70
C. Anti Ro
D. Anti Ds DNA

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66. A 55 year old man presented to the A and E with complains of calf muscle tendernes. On examination
the bulk of the muscle had decreased on the right side and also the foot was cold. Further examination
revealed no distal pulses palpable and also absent popliteal and femoral pulse. What is the level of the
occlusion?
A. Ext Illiac artery
B. Internal Illac artery
C. Inguinal artery
D. Abdominal Aorta
E. Common iliac artery

67. A 10 year old male child was brought by his mother complaining that her child watches TV at very
high volume, doesn’t 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

68. A 65 years old woman has being having tinnitus for more than 6 months. Each episode lasts more
than 30 seconds and occurs whenever she rotates in her bed. Choose the most appropriate investigation
that will assist you in making a diagnosis.
A. Caloric test
B. Hallpike test
C. Audiometry
D. CT head

69. A man undergoes a pneumonectomy, and after the surgery, investigations show hyponatremia. What
could be the cause of the biochemical changes?
A. Removal of hormonally active tumour
B. Excess dextrose
C. Excess colloid
D. Excessive Potassium
E. Hemo-dilution

70. A 55 year old man has been on long term steroids for rheumatoid arthritis. What other drug should he
begiven?
A. VitB12
B. VitD
C. Betablocker
D. Alendronate

71. A 2 year old was brought to the accident and emergency, with bruises on the right anterior thigh and
anterior leg. The left ankle was swollen and she refuses to move it. She was crying inconsolably. What is
the investigation of choice?
A. Blood culture
B. FBC
C. Bone marrow aspirate
D. Skeletal survey
E. Coagulation Screen

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72. An 80 year old woman with few month history of weight loss and dysphagia presented with sandwich
stuck in his throat. What is the most appropriate next step?
A. Barium meal
B. Barium swallow
C. Endoscopy foreign body removal and biopsy

73. A patient with severe pre eclampsia has just delivered a baby at 37 weeks gestation. 20min after
delivery she has her first fit. Her blood pressure is 160/90 mmHg. An IV line is established. What will
you administer?
A. MgSO4 drip
B. Hydralazine
C. Methyldopa
D. MgSO4 bolus dose
E. Calcium Gluconate

74. A man brings his wife to see the doctor. He says she has been talking about their private life openly
and is throwing tantrums. Her mood changes quickly and she becomes aggressive. Physical examination
is normal. There is no history of trauma and she is not on any medications. What is the most likely
diagnosis?
A. Huntington’s dementia
B. Lewy body dementia
C. Alzheimer’s dementia
D. Vascular dementia
E. Benign old age related dementia

75. Patient in the post surgical ward develops calf pain and redness following open reduction and internal
fixation of fracture of the femur sustained after an RTA. What is the most likely cause of his symptoms?
A. Fat embolus
B. DVT
C. Cellulitis
D. Reaction to drugs

76. A 70 years old patient has a large gall stone which was an incidental finding. What will be the
management?
A. Medical management
B. Endoscopic Retrograde Cholangio-. Pancreatography( ERCP)
C. Magnetic resonance cholangiopancreatography (MRCP)
D. Symptomatic management
E. Laparoscopic removal of gall stone
F. Laparotomy and removal of gall stone

77. A 7 year old boy is brought in by his mother. She is concerned that he does not have any friends at
school and is not doing well in his studies. He only likes to collect toy cars of which he has 2000. He does
not understand emotions and has poor interaction with his siblings. He gets angry and throws tantrums if
his daily routine is changed. What is the most likely diagnosis?
A. Schizophrenia
B. Depression
C. Autism spectrum disorder
D. Tourette’s syndrome
E. Alice in Wonderland syndrome

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78. Patient with myocardial infarction now presents with breathlessness, bi-basal crepitations. ECG is
normal. What is the most likely cause of his symptom?
A. Pulmonary embolism
B. Pulmonary oedema
C. Pneumothorax
D. Haemothorax
E. Mitral regurgitation

79. A 50 year old man with worsening dyspepsia, on PPI and previously treated for duodenal ulcer.
Endoscopy showing gastric, duodenal and oesophageal ulcers. What is the investigation of choice?
A. CT abdomen
B. Test for H pylori
C. Endoscopy with biopsy
D. Barium study
E. Serum gastrin levels

80. A 49 year old woman presents to the Out Patient Clinic. Her oral glucose test, after 2 hours of glucose
intake, versus plasma level in 2 different tests are 6mmol/L and 10mmol/L. This situation can be
categorized as :
A. Impaired glucose tolerance
B. Impaired fasting glucose
C. Diabetes Mellitus Type I
D. Diabetes Mellitus Type II
E. Metabolic syndrome

81. A mother brings her 12 year old son to you requesting surgery for his sticking out ears. The boy says
he does not want surgery. What do you do?
A. Refer to private practice
B. Schedule surgery
C. Contact social services and explore their concerns

82. 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?
A. Achalasia
B. Myasthenia gravis
C. Oesophageal carcinoma
D. Oesophageal web
E. Systemic sclerosis

83. A 62 year old man has had ano-rectal pain aggravated by defecation for 3days. Rectal exam: purple,
tender lump at the anal verge. Flexible sigmoidoscopy report shows normal rectal mucosa and hard
faeces. What is the best management strategy?
A. Anal hematoma
B. Anal fissure
C. Rectal ca
D. Diverticulitis
E. Angiodysplasia

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84. Patient with cardiac problem who takes 8units of alcohol in a week and 20 cigarette in a day. What is
the advice that can be given to the patient?
A. Alcohol group
B. Smoking ceasation group
C. Aspirin

85. 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

86. 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

87. A 40 year old woman requests post coital contraception. Her condom broke 36 hours ago. On 7th day
of regular 29th day of cycle this is her 2nd condom accident in 2 months. She has tried OC pills but
stopped it 6 months ago because of concerns about weight gain. She is undecided about future
contraceptive use. Her pregnancy test is -ve. Which is the most effective form of contraception for her?
A. OC pills
B. POP pills
C. IUS or Mirena coil
D. IUCD

88. A known COPD patient presented to the hospital with complains of persistent cough, copious sputum
production and intermittent hemoptysis. On examination, finger clubbing and coarse inspiratory
crepitations were observed. What is the most probable diagnosis?
A. Lung cancer
B. Cystic fibrosis
C. Bronchiectasis
D. Pulmonary edema
E. Lung abscess

89. A 30 year old pregnant lady presents with 175/90 mmHg. Has previous history of recurrent UTI.
Urine dipstick show proteinuria ++. She is 10 weeks pregnant. What is the most likely cause of
hypertension?
A. Pregnancy induced hypertension
B. Essential hypertension
C. Chronic pyelonephritis
D. Chronic glomerulonephritis

15
90. A patient comes with complaints of reflux and abdominal pain on and off for many months.
Endoscopy shows multiple ulcerations in gastric and duodenal muscosa with mucosal changes in the
oesophagus. What is the single most likely investigation to be done next?
A. Serum Gastrin
B. USG
C. Urea Breath test
D. Oesophageal pH monitoring

91. An alcoholic that was treated and is about to be discharged. Which of these would be used to make
the diagnosis that the person is dependent on alcohol?
A. Takes a drink immediately after waking up.
B. Driving under the influence of Alcohol.
C. 6 months detention due to alcohol abuse.
D. 70units of alcohol every month

92. A 65year old woman had an excision of colonic tumor 3years ago. Now she is losing weight and feels
lethargic. On examination she is pale but has no abdominal findings. What is the most appropriate
investigation?
A. CA 125
B. CA 153
C. CA 199
D. CEA
E. AFP

93. A patient was brought to the emergency department following an RTA. He was diagnosed with
fracture of femur and an ORIF was planned. During anaesthesia, vital signs began to deteriorate following
intubation. What is the most likely cause of this deterioration?
A. Fat embolism
B. Pulmonary embolism
C. Intra-abdominal bleeding
D. Cardiac tamponade
E. Tension pneumothorax

94. A 70 year old man presents with back pain, anaemia and raised calcium. What is the finding on the
marrow aspirate?
A. Increased T cell
B. Reduced plasma B cells
C. Increased Plasma B cells
D. Increase in neutrophils

95. A 2 year old boy with 38.4°C fever had an episode of tonic clonic seizure at home that lasted for 15
minutes. In A&E patient is conscious and fit has stopped. When temperature was checked, it was normal.
What is most probable diagnosis?
A. Febrile convulsion
B. Infantile spasm
C. Absence seizure
D. Grandmal Epilepsy
E. Focal seizure

16
96. Which is the correct statement regarding febrile seizures.
A. Most cases will resolve by the age of 6 years
B. All cases will progress to epilepsy
C. There is some learning difficulty later in life
D. A child can have a febrile fit only once

97. A middle aged plumber, who is a known case of COPD and has a history of smoking, presents with
breathlessness and chest pain on inspiration. CXR shows :
What is the most likely diagnosis?
A. Heart failure
B. Bronchiectasis
C. Pulmonary edema
D. Mesothelioma.

98. 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

99. What is the minimum age for consent ?

A. 14 years D. 18 years
B. 15 years
C. 16 years

17
100. A 31 year old woman who is 32 weeks pregnant attends antenatal clinic. Her blood result shows Hb
10.7 and MCV 91. What is the most appropriate management for this patient?
A. Folate supplement
B. Ferrous sulphate 200mg/24 Po
C. Iron dextran
D. No treatment required

101. A 34 year old man fell off a ladder and hit his head on the pavement. He now has blood coming out
of his ears and nose. Which bone has he fractured?
A. Maxilla
B. Base of skull
C. Mandible

102. A 6 months old child presents with cough and fever. What is most appropriate diagnosis?
A. Bronchiolitis
B. Asthma
C. Bronchitis

103. 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

104. 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

105. A 60 year old man was brought in by his wife complaining of ataxia, urinary incontinence and
erectile dysfunction. He also complains of rigidity and slowing of movement with a pill-rolling tremor of
the hands. What is the most likely diagnosis?
A. Parkinson's Disease D. Huntington's disease
B. Idiopathic Parkinson's Disease
C. Shy-Drager Syndrome

106. A 34 year old patient presented with redness and pain in the eye. He is also suffering with back pain
that is worse in the morning. He is taking NSAIDs for back pain. What is the cause of red eye?
A. Ibuprofen E. Trauma
B. Steroids
C. Anterior Uveitis
D. Posterior Uveitis

107. A 24 year old man presented to the A and E with swelling in his left scrotum. On examination he is
afebrile and he has a left swollen non tender testis that is firm and irregular. Some lymphadenopathy is
also appreciated. Which group of lymph nodes will be involved?

18
A. External iliac
B. Internal iliac
C. Inguinal
D. Para aortic
E. Pre aortic

108. A patient has amenorrhea for last 6 months. Previously she was taking COCP pills. Her LH : FSH
ratio is 1:1. What is the most probable diagnosis?
A. Post pill amenorrhea
B. PCOS
C. Hypothalamic amenorrhea
D. Premature ovarian failure

109. 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

110. A 45 year old man was trapped under a rock for 4 hours. He then presents with red urine and renal
failure. What is the most appropriate treatment?
A. Urgent dialysis
B. Fluid challenge
C. Glucose and insulin
D. Dobutamin
E. Antibiotics

111. A 26 year old man with history of hereditary haemorrhagic telegectasia. He is planning to start a
family. What is the mode of inheritance?
A. Autosomal dominant with incomplete penetrance
B. Autosomal recessive with incomplete penetrance
C. Autosomal dominant
D. Autosomal recessive

112. A patient is to be put on lithium therapy. Her renal function and liver function tests are normal. What
is the most appropriate other test you need to do?
A. Urine for glucose
B. Thyroid function tests answer
C. EEG
D. ECG

113. A 70 year old lady fell down and sustained neck of the femur fracture. Which artery is likely to bleed
from?
A. Femoral artery
B. Circumferential artery
C. Popliteal artery
D. Common iliac artery
E. External ilial artery

19
114. A 29 year old lady came to A & E with complaints of palpitations that have been there for the past
four days and also feeling warmer than usual. Upon examination her heart rate was 154 bpm and rhythm
was irregular. What is the treatment for her condition?
A. Amiadarone E. Flecainide
B. Beta blocker D. Verapamil
C. Adenosine

115. A 57 year old man, who is a known hypertensive, is on oral anti-hypertensives. However, he is
finding it difficult to mobilise as he feels dizzy whenever he tries to get up. What is the most appropriate
investigation for him?
A. Ambulatory blood pressure
B. Electrocardiogram (ECG)
C. Magnetic resonance imaging (MRI)
D. Chest X ray
E. CT scan

116. A 55year old woman with breast ca which has spread to lung, liver and bone now presents with
increasing constipation, weakness, thirst and anorexia for the past 3days. Her only medication is
haloperidol for hiccoughs. Today she is disorientated and has left sided weakness. What is the
most likely diagnosis?
A. Brain metastasis
B. Hypercalcemia
C. Liver failure

117. 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

118. Patient having pansystolic murmur at apex radiating to the axilla on the next day after MI with low
BP. What is the most likely cause?
        A. Ventricular aneurysm
        B. Papillary muscle rupture
        C. VSD
        D. Pericarditis
        E. Aortic stenosis

119. A 23 year old pregnant lady presents with tingling and numbness in her right hand. She has been
bothered by it but lately she has discovered that shaking her hand relieves the symptoms. The
neurosurgeon has offered her a surgical option. What structure would he want to cut ?
A. Common flexor sheath
B. Flexor retinaculum
C. Flexor carpi ulnaris
D. Flexor carpi radialis
E. Extensor retinaculum

120. A 40 year old man is having bilateral hilar lymphadenopathy on the CXR. She has rash on each shin
and his calcium is found to be high. Which of the following test is appropriate to perform in this patient?

20
A. Lymphnode biopsy
B. U&E
C. Angiotensin converting enzyme
D. Serum creatinine

121. A man after a fall presents to A &E .On examination his tibial and popliteal pulses are absent. Which
artery is most likely to be affected?
A. Femoropopliteal
B. External iliac
C. Aortoiliac
D. Dorsalispedis
E. Internal iliac

122. 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

123. 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

124. A 55 year old man has had severe pain in the right hypochondrium for 24 hours. The pain comes in
waves and is accompanied by nausea. Nothing seems to relieve the pain. He feels hot and sweaty but has
normal temperature. What is the most appropriate next investigation?
A. Ultrasound Abdomen
B. Endoscopic retrograde cholangiopancreatography (ERCP)
C. Magnetic resonance cholangiopancreatography (MRCP)
D. Serum Amylase
E. Upper gastro-intestinal Endoscopy

125. 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

126. A 28 years old male had an Accident and presented with head trauma. What choice of investigation
would you do to rule out haemorrhages?

21
A. CT scan
B. MRI
C. X ray skull
D. X ray spine
E. USG

127. A child presents with projectile vomiting and is diagnosed with pyloric stenosis. What electrolyte
should be checked next?
A. Potassium
B. Calcium
C. Magnesium
D. Iron

128. A 24year old lady has been low after the death of her husband and had stopped contacting her
family. She was started on SSRI treatment and started feeling better after a few months. On discontinuing
the medications she started feeling as though she has developed cancer just like her husband. What is the
most appropriate next step in this case?
A. Continue SSRI E. Antipsychotics
B. Add TCA
C. Neuropsychiatric analysis
D. CBT

129. A teacher brings in a child who she says fell down after hitting a table. On probing further, you
decided that it was most probably an absence seizure. What was it that led you to this diagnosis?
A. The child had not eaten since morning
B. The child suddenly went blank and there was upward rolling of eyes
C. The child started moving his fingers uncontrollably before he fell
D. The child’s body became rigid and then started to jerk

130. A 67 year old man with a 20 year history of osteoarthritis complains of sudden onset of sharp pain,
swelling and redness in his left calf muscles. He says he used to have a long standing swelling at the back
of his knee which is now no longer present. His reflexes are normal and peripheral pulses are palpable.
What is the single most likely condition affecting him?
A. Deep vein thrombosis
B. Burger’s disease
C. Ruptured Baker’s cyst
D. Ruptured muscle tendon

131. A 27 year old man believes that the whole world is plotting to kill him. What is the best treatment for
him?
A. Haloperidol
B. Chlorpromazine
C. Risperidone
D. Thioridazon

132. 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?

22
A. Flexordigitorumprofundus
B. Transverse carpel ligament
C. Palmar aponeurosis
D. Extensor retinaculum

133. 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

134. A 19 years old tall man presents with sudden onset of chest pain. His X ray is below. What is the
most probable diagnosis?

A. Pneumothorax
B. Pulmonary Embolism
C. Aortic Aneurysm
D. Aortic Dissection
E. Myocardial Infarction

135. 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. Ultrasound scan
B. Cardiotocograph
C. Clotting screen
D. Haemoglobin
E. Kleihauer-Betke test

136. A 37 year 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?

23
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

137. A 45 year old man underwent emergency splenectomy following a fall from his bicycle. He smokes
five cigarettes a day. Post -operatively despite mobile, he developed swinging pyrexia and a swollen
painful left calf. His chest x-ray shows lungs atelectasis and abdominal USG demonstrates a small sub-
phrenic collection. What is the SINGLE most likely risk factor for deep vein thrombosis in the patient?
A. Immobility
B. Intraperitoneal haemorrhage
C. Smoking
D. Splenectomy
E. Sub-phrenic collection

138. 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

139. A 34 year old man, from Congo, is admitted with abdominal pain to the A&E, and abdominal Xray
reveals bladder calcification. What is the most likely cause?
A. Schistosoma haematobium
B. Schistosoma mansoni
C. Sarcoidosis
D. Tuberculosis

140. A 69 year old woman had a stroke, her left upper and lower limbs are paralysed. She is having
difficulty in speaking. Which anatomical site is most likely affected?
A. Thalamus E. Internal Capsule
B. Brainstem
C. Cerebellum
D. Hippocampus

141. A 24 year old male is admitted with acute severe asthma. Treatment is initiated with 100% oxygen,
nebulised Salbutamol and Ipratropium Bromide nebulizers and IV hydrocortisone. Despite initial
treatment there is no improvement. Which is the next step in management?
A. IV Aminophylline
B. IV Magnesium Sulphate
C. IV Salbutamol
D. IM Adrenaline
E. IV Adrenaline

142. A 42year old woman reports to the surgeon that she is worried about a lump that she feels in her
right breast. The surgeon observes a 2 cm by 3 cm mass in the right lower quadrant of the breast. There
are no associated skin changes and the mass has limited mobility. There is no discharge from the nipple.
There is no axillary lymph node enlargement. Examination of the left breast and axilla was completely

24
normal. A mammogram report suggests the presence of micro-calcifications. Which is the most
appropriate next step in the management of this patient?
A. Observation for one year and repeat the mammography
B. A needle-guided biopsy of the breast
C. Excision biopsy of the breast
D. Partial mastectomy

143. A 23 year old woman has been having pain at the base of her thumb, the pain is reproduced when
lifting her 3 months old baby or changing diapers and also with forceful abduction of the thumb against
resistance . What is the most likely cause?
A. Avascular necrosis of the scaphoid
B. Trigger finger
C. De Quervain’s tenosynovitis
D. Mallet finger
E. Gamekeepers Thumb

144. A 74 year old woman with dizziness, nausea, and vomiting since 5 to 7 hours. The symptoms are
worse when she turns around in bed and are present most of the time. She is anxious and afraid of getting
out of bed. She is on antihypertensive and oral hypoglycaemic medications for her high blood pressure
and Diabetes. What is the most likely diagnosis?
A. Acoustic neuroma
B. BPPV
C. Cerebellar infraction.
D. Meniere’s Disease
E. Vestibular neuronitis

145. The daughter of an 83 year old man, who has been diagnosed with Alzheimer ’s disease, wants to
know about the possible outcome of his father. What would you tell her?
A. Progressive cognitive impairment
B. Will improve with time
C. Unpredictable
D. Condition will neither get better nor worse

146. A young man complains of fatigue and breathlessness. On evaluation he has spherocytes in his blood
film and reticulocytes 6%. What is the next appropriate test?
A. Coomb’s Test
B. White blood Cell Count
C. Platelet Count
D. Genetic Analysis
E. G6PD assay

147. A 20 year old pregnant, 32/40 weeks by date, presents to the antenatal clinic with a history of
painless per vaginal bleeding after intercourse. On examination: P/A – soft and relaxed, uterus = dates,
CTG is reactive. Choose the SINGLE most likely diagnosis.
A. Abruption of placenta secondary to pre- eclampsia
B. Ante partum haemorrhage
C. Placenta previa
D. Preterm labour
E. Placenta percreta

25
148. A patient with Hodgkins Lymphoma, who is under treatment, developed high fever. His blood
results show WBC less than 2000 and has chest infection. Choose the most likely treatment?
A. Co- Amoxiclav
B. Piperacillin +Tazobactam
C. Erythromycin
D. Piperacillin +Co-Amoxiclav
E. Penicillin +Tazobactam

149. A 49 year old obese patient presents with right hypochondriac pain. Investigations show a big gall
stone. What is the most appropriate management?
A. Laparoscopic Cholecystectomy
B. Reassure
C. Low fat diet
D. Ursodeoxycholic acid
E. Emergency Laparotomy

150. 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

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

152. 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

153. A patient comes with dyspepsia on H2 receptor blockers now comes with complaints of gradual
dysphagia. On oesophagoscopy, inflammation and mild narrowing of the lower 2/3rd of oesophagus is
seen. What is the most likely diagnosis?
A. Oesophageal Ca
B. Barrets Oesophagus
C. Achalasia Cardia
D. Oesophageal stricture

154. A 75 year old woman from a nursing home is brought to the A/E by her carer who says that she has
been confused for four days. She is on Warfarin for atrial fibrillation. Examination is unremarkable
except for multiple bruises on her body. Blood investigations reveal an INR of 7.3. What is the most
likely diagnosis?

26
A. Alcohol intoxication
B. Urinary tract infection
C. Subdural haematoma
D. Dementia

155. A 62 year old man with progressive SOB for 6months, now presenting with features of HF. Has
irregular pulse, systolic murmur radiating to the axilla. What is the likely cause of the heart failure?
A. Aortic stenosis
B. ASD
C. Mitral regurgitation
D. Mitral stenosis

156. A patient known to be HIV positive, has now got chicken pox in the maternity ward. What
precautions should be taken to prevent further spread of infection?
A. Vaccinate all the patients and staff in the ward
B. immunoglobulins to all the pregnant women in the ward
C. Immunoglobulins to all pregnant women who have negative serology
D. Start 7 days course of Acyclovir for all patients in the ward
E. No action required

157. 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

158. A pregnant patient present with tingling, numbness, pain and loss of sensation on middle and index
finger of right hand. Tinel sign is negative. What is the most likely diagnosis?
A. Carpal tunnel syndrome
B. Hammer hypothenar syndrome
C. Ulnar nerve injury
D. Radial nerve injury

159. A 8 weeks old baby with a fever of 38˚C. How will you manage this neonate?
A. Admit for infection screen and start IV antibiotic
B. Give antipyretic and ask to come later
C. Observe for 24hrs
D. Admit for infection screening
E. Reassure

160. A 64year old man believes a female newscaster is communicating directly with him when she turns a
page. What kind of delusions is he suffering from?
A. Persecutory
B. Control
C. Grandeur
D. Nihilistic
E. Reference

27
161. A 25 year old boy went to forest with his parents. He was stung by an insect and now presents with
rash which is increasing in size. What is the most likely diagnosis?
A. Brucellosis
B. Lyme disease
C. Dengue fever
D. Trypanosomiasis

162. 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

163. A young man presents to Accident & Emergency Department with severe bloody diarrhoea,
abdominal pain and haematuria after eating meat at a barbecue party. FBC reveals schistocytes,
↓platelets, ↓Hb. Clotting tests are normal. What is the most likely diagnosis?
A. Autoimmune haemolytic anemia
B. Paroxysmal cold haemoglobinuria
C. Paroxysmal nocturnal haemoglobinuria
D. Micro angiopathic haemolytic anemia
E. ITP

164. A patient is suffering from Post streptococcal GN which is the most appropriate management step
that will stop the progression of this condition?
A. Ace inhibitors
B. Cyclophosphamide
C. Steroids
D. Dialysis
E. Antibiotics

165. A 19 year old man presents for the first time with a firm and unshakable belief that he is being
followed by terrorists who are plotting against him. What is the single best term for this man’s condition?
A. Delusion of Persecution E. Delusion of Nihilism
B. Delusion of Grandeur
C. Delusion of Control
D. Delusion of Reference

166. A patient who came from India presents with cough, fever and enlarged cervical lymph node. On
examination there is caseating granulomata found in lymph node. What is the most appropriate diagnosis?
A. Lymphoma
B. TB adenitis
C. Thyroid Ca
D. Goitre
E. Thyroid cyst

28
167. A 34 year old man has been diagnosed with cellulitis. Culture confirms Staph Aureus, but the patient
is not improving with Flucloxacillin. What should be the next step?
A. Amoxicillin
B. Penicillin
C. Erythromycin
D. Vancomycin
E. Meropenem

168. A male patient presents with recurrent pain in feet and ankle joints. On X-Ray there were punched
out lesions, with erosions. What is the most probable diagnosis?
A. Pseudogout
B. Gout
C. Osteoarthritis
D. Rheumatoid arthritis

169. A patient with cerebral metastasis has polyuria and polydypsia. What part of the brain would be
affected?
A. Cerebral Cortrex E. Medulla
B. Cerebellum
C. Diencephelon
D. Pons

170. A patient with Parkinson’s disease has been on NG tube for the past ten days. He is still unable to
swallow. What would be the best management for him?
A. Gastrostomy
B. Colonostomy
C. Duodenostomy
D. Total parenteral nutrition
E. Ileostomy

171. A 40 year old woman with breast cancer has back pain which keep her awake at night. She blames
it on a gym session she had 2wks ago. She now has difficulty in climbing stairs. There is tenderness over
the right thoracic spine. She has diminished fine touch and temp sensation in her right foot. What is the
single most appropriate investigation?
A. Bone density scan
B. CT head
C. MRI spine
D. Nuclear bone scan
E. XR thoraco lumbar spine

172. A 34 year old man from Asia presented with 5 months history of productive cough, night sweats and
weight loss. His CXR reveals some shadowing in the left upper zone. What is the single most
discriminating investigation?
A. Acid fast bacilli test for sputum
B. CXR
C. CT scan
D. Thyroid function test
E. Ultrasound of the abdomen

29
173. A man presented with severe unilateral headache. After a while presented with diminished
consciousness. CT scan was normal. What is the next best step?
A. Lumbar puncture
B. No investigation
C. MRI

174. A 45 years old woman has been diagnosed with giant cell arteritis (GCA) and is being treated with
steroids. What is the other drug that can be added to this treatment?
A. ACE inhibitors
B. Beta blockers
C. Aspirin
D. Interferons
E. IV Ig

175. A mother comes to ask for contraception for her 12 year old daughter. What would you do?
A. Give COCP
B. Refuse
C. Call the police
D. Ask her to accompany her daughter

176. A 6 year old child has vomiting and diarrhoea for past 4 days. He is lethargic, has oliguria, dry
mucus membranes and decreased skin turgor. His brother had a similar illness a few days ago. What is the
most likely diagnosis?
A. Pyloric stenosis
B. Intestinal obstruction
C. Gastroenteritis
D. Gastro oesophageal reflux disease
E. Hirschsprungs

177. Patient with multiple fibroids which has distorted uterus, does not like pills because she is not
compliant and requires contraception for 3 years. What will you give?
A. Mirena
B. Implanon
C. POP
D. Depot provera

178. A 55 year old man diagnosed is with IHD, he has normal BMI. He is a smoker and smokes 20
cigarettes a day. He drinks 8 pints of beer. His clinical examination is normal and no systemic findings
were found. Where would you refer him to first?
A. To alcohol anonymous
B. Smoking cessation clinic
C. Dietician
D. No referral needed

179. 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

30
180. A 20 year old primigravida woman is in her 8th week of gestation. She presents with severe repeated
nausea and vomiting. What is the initial intravenous fluid to be used?
A. Normal saline 0.9%
B. Glucose water 5%
C. Saline 0.45%
D. Dextrose 5%

31