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Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 11TH MARCH 2017 TIME ALLOWED:3HRS

SINGLE BEST ANSWER

1. An 8 year old child, who is tall for his age and has a refractory error for which he wears glasses, has
presented with severe crushing chest pain. What is the most likely diagnosis?
A. Fragile X Syndrome
B. PraderWilli Syndrome
C. Di George Syndrome
D. Marfans Syndrome

2. 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

3. A 36 year old woman has been treated with dexamethasone for cerebral oedema for the last 3
months. She has now started having recurrent falls, especially in the morning. What is the most like
cause of her falls?
A. Drug side effects
B. Autonomic Neuropathy
C. Adrenal Insufficiency
D. Cushings syndrome
E. Addisons disease

4. A 35 year old man suffering from influenza 5 days ago now develops fever, cough and sputum.
Chest X-ray shows bullous appearance. What organism is causing the infection?
A. Haemophilus influenza
B. Staphylococcus aureus
C. Streptococcus pneumonia
D. Klebsiella

5. A six year old child with history of recurrent jaundice. Between the episodes he is totally fine.
Mother gives history of jaundice being brought about by on-going infections. What is the most likely
diagnosis?
A. Hereditary Spherocytosis
B. G6PD Deficiency
C. Thalassemia
D. Sickle Cell Disease
E. Congenital Storage Disorder
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6. A 68 year old lady complains of falls to the ground without any warning, maintains consciousness,
and no confusion. She says this has occurred number of times before. What is the diagnosis?
A. Stokes Adams attack
B. Hypoglycemia
C. Vasovagal syncope
D. Drop attacks
E. Epilepsy

7. A 50 year old man came to the hospital a few months after he had myocardial infarction. On
examination everything was normal, his S1 and S2 sounds were heard on auscultation, but there is a
new pan-systolic murmur. What is the most appropriate investigation of choice?
A. ECG
B. 24 hour ECG
C. Echocardiogram
D. CXR
E. CT scan

8. A 55year old male has been admitted for elective herniorraphy. Which among the following can be
the reason to delay his surgery?
A. Controlled asthma
B. Controlled atrial fibrillation
C. DVT two years back
D. Diastolic BP 90mmHg
E. Myocardial infarction two months back

9. A 7 years old boy is brought by his mother. There are multiple perioral and forehead vesicles. Some
vesicles are crusted and some are not. The face is hot. What is the most likely diagnosis?
A. Varecilla zoster
B. Herpez zoster
C. Fungal infection
D. Impetigo
E. Psoriasis

10. A 63-year-old male presents after having had a seizure. On examination he is alert and orientated.
Examination reveals some inattention on the left side and hyper-reflexia of the arm. What is the most
probable diagnosis?
A. Cerebral Tumour
B. Pituitary Adenoma
C. Cerebellar Abscess
D. Huntingtons chorea
E. Parkinsonism

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

12. 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. Burgers disease
C. Ruptured Bakers cyst
D. Ruptured muscle tendon

13. A 55 year female presented with complaining of chest pain, shortness of breath and palpitation.
On admission ECG showed SVT with HR of 220/min. No response to carotid massage. What is the
next step in management ?
A. DC shock
B. IV adenosine
C. Verapamil
D. PCI
E. Amiodrine

14. At birth a baby boy at 38 weeks gestation weighs 1.8 kg. He has hepato- splenomegaly and a
rash. Blood tests show raised level of bilirubin and liver enzymes. What is the most likely
diagnosis?
A. Galactosemia
B. Biliary Atresia
C. Glucose-6-phosphate dehydrogenase deficiency(G6PD)
D. Rhesus Incompatibility
E. Congenital Viral Infection

15. An old patient develops urinary retention on a coach journey. He is on Nifidipine and Atenolol for
hypertension and he has nocturnal frequency since last two years? What is the most likely diagnosis?
A. Prostatic Ca
B. BPH
C. Transitional cell carcinoma
D. Spinal cord compression
E. Trauma

16. A patient has the following blood test results. Ca (total) : 4 mmol/L
Na : 140 mmol/L
K : 4 mmol/L
Creatinine : 100 mol/L Uric acid : 8 mg/dL
ALT : 30 Iu/L
AST : 40 Iu/L
ALP : 100 Iu/L

What is the most appropriate initial treatment?

A. IV bisphosphonates
B. IV 0.9% normal saline
C. IV Cinacalcet
D. IV Furosemide
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17. A 32 years old man presented with slow progressive onset of dysphagia, there is a past history of
retro-sternal discomfort and he has been treated with prokinetics and H2 blockers. What is the most
probable diagnosis?
A. Foreign Body
B. Plummer Vinson Syndrome
C. Pharyngeal pouch
D. Peptic Stricture
E. Esophageal Carcinoma

18. A 29 year old man is found to have proteins and blood cells in urine. There is no history of any
renal disease and no other significant medical history, other than fever 4 weeks ago. What is the
most likely explanation for proteinuria and haematuria seen in this man?
A. ThromboticThrombocytopoenic Purpura
B. Haemolytic Uraemic Syndrome
C. Post streptococcal glomerulonephritis
D. IgA Nephropathy
E. Minimal Change disease

19. A 25 year old girl saw a tragic road traffic accident in which a young boy was killed. The night of
the event she could not sleep and the day after suddenly she lost her vision. She was previously fine
and there was no history of medical or psychological problems. What is the diagnosis?
A. Conversion
B. Somatisation
C. Post traumatic stress disorder
D. Dissociation
E. General anxiety disorder

20. Young boy with one sided facial swelling associated with pain tenderness and swelling
around eye. There is no proptosis and ophthalmoplegia. What is the most probable diagnosis?
A. Peri orbital cellulitis
B. Orbital cellulitis
C. Sinusitis
D. Conjunctivitis
E. Erysipelas

21. A 75 year old lady who had mitral valve replacement 13 years ago has developed recurrent
breathlessness. Her husband has noticed prominent pulsation in her neck. She complains of abdominal
pain and ankle swelling. What is the most probable diagnosis?
A. Aortic Regurgitation
B. Mitral Regurgitation
C. Mitral Stenosis
D. Tricuspid Regurgitation
E. Pulmonary Stenosis

22. A 75 year old man presents with Acute Renal Failure. He has been troubled by recurrent epistaxis
but over the last three weeks he reports to have coughed up blood too. What is the single most likely
positive antibody?
A. P ANCA
B. C ANCA
C. Anti Ro
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D. Anti Ds DNA
E. Anti Centromere

23. A 14 year old girl is clinically obese. She has not started her periods yet and has severe acne.
Among her investigations, a high insulin level is found. What is the most probable diagnosis?
A. Cushings Syndrome
B. Graves disease
C. Acquired Hypothyroidism
D. Polycystic ovarian syndrome
E. Addisons disease

24. 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

25. A boy came presents with plenty of transparent sticky liquid coming from both the eyes. The
mucosa of the lids and the conjunctiva was intact and calm. What will you give him?
A. Antibiotics
B. Steroids
C. Antibiotic and steroids

26. A 62 year old lady presents with right sided headache and loss of vision on the right side. What is
the single most next investigation?
A. Erythrocyte sedimentation rate (ESR)
B. Urea and electrolytes
C. CT scan head
D. X-ray orbit
E. Intra ocular pressure

27. A 34-year-old woman is referred to the Endocrine Clinic with a history of thyrotoxicosis. At her
first appointment she is found to have a smooth goitre, lid lag and bilateral exophthalmos with puffy
eyelids and conjunctival injection. She wants to discuss the treatment of her thyroid problem as she is
keen to become pregnant. What is the most likely treatment you would advise?
A. 18 months of carbimazole alone
B. 18 months of propyl thiouracil alone
C. A combination of anti-thyroid drugs and thyroxine
D. Radioactive iodine
E. Thyroidectomy

28. A 30 year old woman had a gradual decrease of visual acuity since the last 3 years. Now she has a
disability due to very low vision. What is the diagnosis?
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A. Glaucoma
B. Cataract
C. Macular degeneration
D. Retinitis Pigmentosa
E. Keratitis

29. A 14 years old boy has been diagnosed with Nephrotic Syndrome. Five days later he presents with
flank pain, hematuria and fluctuating urea levels. A diagnosis of renal vein thrombosis is made. What
is the most likely cause for renal vein thrombosis?
A. Protein C deficiency
B. Vasculitis
C. Loss of Antithrombin III
D. High estrogen levels
E. Stasis

30. A 44 year old singer was admitted for a partial thyroidectomy. Post surgery she has developed
hoarseness of voice which she is surprised to find. Which nerve has most likely been injured?
A. Phrenic Nerve
B. Obturator Nerve
C. Iliohypogastric Nerve
D. Recurrent laryngeal nerve

31. A 42 year old man presents with stroke, he is not able to walk straight and his speech is slurred.
What is the initial appropriate investigation?
A. CT scan brain
B. PET scan brain
C. MRI (brain)
D. Carotid angiography
E. Monitor for 24 hours

32. A 4 year old boy presents with a sharp metal injury. He never had any vaccination as his parents
were worried about the side effects. What should be the next step?
A. Tetanus toxoid + full course of DPT vaccine
B. TT Immunoglobulin
D. No treatment
C. A+B

33. A 48 years old male with history of chronic cough presents with increased breathlessness copious
sputum with streaks of blood, examination shows finger clubbing. What is the initial investigation?
A. Chest x-ray
B. CT chest
C. Bronchoscopy
D. Blood culture
E. ECG
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34. What is the mode of spread of chickenpox?

A. Airborne
B. Closecontact
C. Feco-Oral
D. Blood
E. Vectorborne

35. A patient diagnosed with DVT is taking warfarin. What is his cut off-international normalised
ratio (INR) limit?
A. <1
B. 1-2
C. 2-3
D. 3-4

36. A patient presents with hypernatremia, hypokalemia, hypocalcemia and hypertension. He is

30 years old and not on any medication. What hormone should be measured in him?
A. Aldosterone
B. Cortisol
C. Renin
D. Adrenocorticotropic hormone (ACTH)

37. A 9 year old girl presents with weekly abdominal pain and with occasional headaches but not
associated with vomiting and diarrhea. She has good appetite. Full blood count, urea and electrolytes
and other investigations are normal. On examination no abnormality was found and the abdomen was
soft and non-tender. What is the most likely next step?
A. Ultrasound scan of the abdomen
B. CT of thorax
C. Liver Function test
D. Reassure
E. Analgesia
38.A 25 year old female complains of intermittent pain in her fingers. She describes episodes of
numbness and burning of the fingers. She wears gloves whenever she leaves the house. What is the
most probablediagnosis?
A. Kawasaki Disease
B. Takayasu Arteritis
C. Buergers Disease
D. Embolism
E. Reynauds Phenomenon

39.A 65 year old man presents with a history of progressive difficulty in swallowing solid food for 6
months, he has also noticed unintentional weight loss and anorexia. What is the most likely diagnosis?
A. Achalasia cardia
B. Hiatus hernia
C. Gastroesophageal reflux disease
D. Carcinoma of the oesophagus
E. Oesophageal spasm

40. A child presents with eczema. She was given two creams by GP, one emollient and the other
steroid. What advice would you give her regarding application of the cream?
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A. Sparingly use both the cream.

B. First use emollient then steroids.
C. Apply steroids,then emollient
D. Mix emollient and steroids before use
E. Emollients at night with steroids

41. A 72 year old woman who had a repair of strangulated femoral hernia two days ago becomes
noisy, aggressive and confused. She is afebrile, her full blood count is normal apart from a raised
mean corpuscular volume (MCV). What is the most likely diagnosis?
A. Electrolyte imbalance
B. Delirium Tremens
C. Wernickes Encephalopathy
D. Infection toxicity
E. Hypoglycemia

42. A 65 year old woman, who is under a long term follow up after a lumpectomy and anti
oestrogen therapy for breast cancer, attends following a diagnosis of stress fracture in a metatarsal
bone. Choose the SINGLE most appropriate initial investigation?
A. Serum estradiol concentration
B. DEXA scan (Dual Energy X ray Absorptiometry)
C. Lumbar spine X- ray
D. X-ray of affected joint
E. Serum calcium levels

43. A 23 year old man has been stabbed in the back and has shortness of breath. The trachea is
deviated, he has engorged neck veins and absent breath sounds on the right. What is the most
appropriate diagnosis?
A. Tension pneumothorax
B. Cardiac tamponade
C. Simple pneumothorax
D. Haemothorax
E. Pleural effusion

44. What test will you do for a child with tuberculosis when the parents are not happy about general
anaesthesia?
A. Blood test
B. Heaf test
C. Widal test
D. Gastric washing
E. Mantoux

45. A 19 year old female is admitted with Paracetamol overdose after an argument with her boyfriend.
Her paracetamol levels are not dangerously high and she does not need medical treatment. She regrets
her actions and is very apologetic saying that she will never do this again. What is the next
management?
A. Discharge
B. Full psychiatric assessment
C. N acetylcysteine
D. Gastric lavage
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46. A 29 year old male is brought to A&E in unconscious state. There is no significant past history.
Which of the following should be done as the initial investigation?
A. CT Scan
B. Blood Glucose
C. Arterial blood gas
D. Magnetic resonance imaging (MRI)
E. Full blood count

47. A 65 year old man, scheduled for a hernia surgery, has been informed that his surgery has been
postponed. What is the most likely reason for cancelling the surgery?
A. Hb<10
B. SBP<90 (Systolic Blood Pressure)
C. Previous myocardial infarction
D. Diabetes Mellitus DM
E. Seizure disorder

48. A 74 years old man presents with sudden onset of weakness of the right side with slurred speech.
He also has loss of sensations over the right side of the body and visual field defects. CT Scan shows
an ischemic stroke. What is the most appropriate management for this patient?
A. Alteplase
B. Streptokinase
C. Nimodipine
D. Aspirin
E. Labetolol

49. A three years old boy has a sudden onset of fever, vomiting and bilateral face swelling. Few days
earlier general practitioner saw him for bilateral parotid pain and gave analgesics. What is the most
appropriate next step?
A. Analgesic E. Reassurance
B. Antibiotic
C. Biopsy
D. Immediate Surgery

50. A 48 year old man has continuous anterior chest pain, which is worse on inspiration, and has a
temperature of 37.5 C four weeks after a myocardial infarction. His erythrocyte sedimentation rate
(ESR) is 45 mm/hour. What is the single most likely explanation for the abnormal investigation?
A. Acute Pericarditis
B. Cardiac Tamponade
C. Atrial Thrombus
D. Left Ventricular Aneurysm
E. Dresslers Syndrome

51. A 68 year old man presents with muscle weakness. He is not able to climb the stairs. He also
complains of mild breathlessness. He says that he sometimes feels difficulty in swallowing food. The
lab report shows the following:
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Alkaline phosphatise (ALP) 216 U/L Aspartate aminotransferase (AST) 49 U/L Alanine
transaminase (ALT) 43 U/L
Creatine Kinase (CK) 417
Erythrocyte Sedimentation Rate (ESR) 16mm/h. What is the most likely diagnosis?
A. Polymyositis
B. Polymyalgia rheumatica
C. Muscular dystrophy
D. Esophageal carcinoma
E. Myasthenia Gravis

52. A lady comes in 6 weeks after her normal vaginal delivery for contraceptive advice. She is breast
feeding her child and requests for reversible contraception. She is planning another pregnancy in 6
months time and is scared of injections. What is the best option for her?
A. COCP
B. Cu IUCD (intrauterine contraceptive device)
C. Mirena coil
D. POP
E. Transdermal patch

53. A 29 year old female presents with intermittent episodes of unilateral headache. Headache is
always on right side. She also complains of associated watering of the eye and nasal congestion on the
same side. All these symptoms were worst particularly in the mornings. What is the most likely
diagnosis?
A. Sinusitis
B. Tension headache
C. Space occupying lesion
D. Cluster headache
E. Acute angle closure glaucoma

54. A 35 year old woman has had bruising and petechiae for one week. She has also had recent
menorrhagia but is otherwise well. A blood count shows:
Haemoglobin(Hb): 11.1g/dl
White blood cell (WBC): 6.3 X109L (normal
differential) Platelets : 14 X109L

What is SINGLE most likely diagnosis?

A. Acuteleukaemia
B. Aplasticanaemia
C. Human immunodeficiency (HIV)infection
D. Idiopathic thrombocytopenicpurpura
E. Systemic lupus erythematosus(SLE)

55. A 54 year old male builder has fallen off his ladder, hit his head and now presents with bruises
over his right mastoid region. He has no other injuries. There was no loss of consciousness and his
GCS is now 15. Which bone is affected in relation to the mastoid area bruising?
A. Parietal
B. Temporal
C. Mandible
D. Ethmoid
 11

E. Frontal

56. A mother brings her child saying that he is having problems at school. His teachers say that
he is naughty, difficult to control and he can never sit still. It is also difficult to make him concentrate
and he is unable to do tasks that need him to work on a particular thing for a long time. What is the
most appropriate diagnosis?
A. Attention deficit hyperactivity disorder (ADHD)
B. Autism
C. Schizophrenia
D. Conduct disorder

57. A 55 year old right handed school teacher complains of double vision when writing on the
blackboard. She mentions no history of trauma and the only recent visit to her GP was to review a
rash following a bite that she received when walking through a forest on a recent school trip. Which
cranial nerve is most likely to be effected?
A. Abducens
B. Trochlear
C. Oculomotor
D. Optic
E. Trigeminal

58. A 60 years old patient recovering from a surgery for toxic goitre is found to be hypotensive,
cyanosed in the recovery room. On examination her neck is tense. There is oozing of blood from the
drain. What is the most probable diagnosis?
A. Thyroid Storm
B. Reactionary Haemorrhage
C. Secondary Haemorrhage
D. Primary Haemorrhage
E. Tracheomalacia

59. A 46 year Afro Caribbean man is found to have blood pressure of 160/90mmHg on three
separate occasions. What is the best initial treatment?
A. ACE inhibitor
B. Beta-blocker
C. Angiotensin II receptor blocker
D. No treatment
E. Calcium channel blocker

60. A child presented with unilateral periorbital pain, swelling and proptosis, what is the initial
treatment?
A. Steroids
B. Antihistamine
C. Antibiotics
D. Analgesia
E. Pilocarpine

61. A child presents with clean wound, he has never been immunized as his parents were worried
about it. There is no contradiction to immunization, what is the best management?
A. Full course of diphtheria, tetanus, polio
B. 1 single injection DT
C. 1 single injection DTP
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D. Only immunoglobin
E. Antibiotic
62. A 73-year-old male presents with a 12 month history of falls. His relatives have also noticed rather
strange behaviour of late and more recently he has had episodes of enuresis. Examination reveals
disorientation in time and place and a broad based and rather clumsy gait. What is the most probable
diagnosis?
A. Dementia
B. Pituitary Adenoma
C. Cardiovascular disease
D. Syringomyelia
E. Normal Pressure Hydrocephalus

63. A 40 year old woman presents to the GP with low mood. Of note, she has an increased appetite
and has gone up to two dress sizes. She also complains that she cannot get out of bed until the
afternoon. What is the most likely diagnosis for this patient?
A. Pseudo Depression
B. Moderate Depression
C. Severe Depression
D. Dysthymia
E. Atypical Depression

64. 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

65. A 3 year old child with severe diarrhoea and vomiting, looks lethargic, has sunken eyes and a
feeble cry. What is the choice of fluids for this condition?
A. 0.9 % Saline
B. 0.9% Saline plus 5% Dextrose
C. 0.45% Saline plus 5% Dextrose
D. 0.45% Saline

66. A 26 years old man strongly believes that every elderly man he meets is his father. Although they
look different, he is sure it is his father wearing different disguises. What kind of delusions is this man
suffering from?
A. Delusion of Persecution
B. Erotomania
C. Delusion of Grandeur
D. Delusion of Doubles
E. Delusion of Reference

67. Where is the level of occlusion if popliteal, dorsalis pedis and posterior tibial pulses are not
palpable?
A. External iliac artery
B. Femoral artery
C. Internal iliac artery
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D. Sciatic artery

68. A 34 year old woman presents with severe pain in her right hypochondrium. She is diagnosed to
have cholelithiasis and her surgeon recommends her to undergo cholecystectomy. During the
laproscopic procedure, a trochar is inserted halfway between the umbilicus and the anterior superior
iliac spine. What are the structures most likely to be pierced?
A. Rectus sheath
B. Linea alba
C. External oblique aponeurosis
D. Internal oblique and transverse abdominal

69. A 30 year old man presents in Accident and Emergency department with difficulty in breathing.
He has returned from India. Recently examination of his throat revealed grey membranes on the
tonsils and uvula. He has mild pyrexia. What is the SINGLE most relevant diagnosis?
A. Diphtheria
B. Infectious mononucleosis
C. Acute follicular tonsillitis
D. Scarlet fever
E. Agranulocytosis

70. A 10 year old boy presents with irritability, sudden onset of pain and discharge from the right ear.
Which antibiotic would be the first line of treatment?
A. Amoxicillin
B. Ciprofloxacin
C. Flucloxacillin
D. Ceftazidime
E. Gentamicin

71. What is the maintenance fluid of choice in paediatric rehydration?

A. 0.9-5% Dextrose
B. 0.9 % normal saline
C. 0.18 % normal saline
D. 0.45 % normal saline
E. Hartmanns solution

72. An 83 year old man with long standing Chronic Obstructive Pulmonary Disease has become
progressively breathless over the last two years. He is on Salbutamol, Ipratropium, Salmetrol,
Beclomethasone and Theophilline. His FEV1 < 30%. What is the next appropriate management?
A. Lung transplant
B. Trial of continuous positive airway pressure ventilation
C. Trial of non invasive ventilation
D. Assessment for long term oxygen therapy
E. Short course of oxygen therapy

73.A 74 years old man, who has been a smoker since he was 20, has recently been diagnosed with
small cell carcinoma of the lung. What serum electrolyte picture will confirm the presence of
Syndrome of inappropriate anti-diuretic hormone secretion (SIADH)?
 14

A. High serum Na, low serum osmolarity, high urine osmolarity

B. Low serum Na, low serum osmolarity, high urine osmolarity
C. Low serum Na, high serum osmolarity, high urine osmolarity
D. High serum Na, low serum osmolarity, low urine osmolarity
E. High serum Na, high serum osmolarity, low urine osmolarity

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

75. A six years old girl child presents with bed wetting. She has never been incontinent before. What
is the best approach to treat this child?
A. Reassure
B. Sleep alarms
C. Desmopressin
D. Imipramine
E. Behavioural changes

76. A 2 year old child is brought by his mother. The mother had hearing impairment in her early
childhood and is now concerned about the child. What investigation would you do?
A. Audiometry
B. Distraction testing
C. Scratch test
D. Tuning fork

77. A 30 year old female presents with a lump in her left breast. She gives history of trauma to
her left breast 2 weeks back. What is the most probable diagnosis?
A. Fat Necrosis
B. Fibroadenoma
C. Breast abscess
D. Fibroadenosis
E. Carcinoma of breast

78.A Schizophrenic says: Life is unfair. I like fair. Fairs have food. It must be good. What term
describes this patients speech?
A. Neologism
B. Flight ofIdeas
C. BrocasAphasia
D. WernickesAphasia
E. Clang Association

79.A 60 year old lady who had stroke three years ago now reports having increased dyspnea on
exertion, she has atrial fibrillation. On the chest X- ray there is a straight left border on the cardiac
silhouette. What is the most probable diagnosis?
A. Aortic Regurgitation
B. Ischemic Mitral Regurgitation
C. Mitral Valve Prolapse
D. Pulmonary Stenosis
 15

E. Rheumatic Mitral Valve Stenosis

80. A baby boy when examined a few hours after birth, was found to have a machinery murmur.
On examination, he had heart rate of 160 bpm, he was not cyanosed and was asymptomatic. His
parents were told that the murmur will disappear on its own after a few weeks. What is the most likely
diagnosis?
A. Coarctation of the aorta
B. Tetralogy of Fallot
C. Patent ductusarteriosus
D. Atrial septal defect
E. Ventricular septal defect

81. A 23 year old male has a tonic clonic seizure whilst at college. His GCS is currently 12. His blood
pressure is 120/77mmHg and heart rate is 99 bpm . What is the most appropriate investigation for his
condition?
A. CT brain
B. MRI brain
C. Serum blood glucose
D. Serum drug levels

82. A 98 year old woman is found in her house unconscious. She is diagnosed with sepsis. In the
intensive care she starts to have epistaxis and haematuria. Her clotting profile is as follows:
Platelets 26
Fibrinogen 0.2 g/l
PT 18 seconds
BT 15 minutes
What is the most likely diagnosis?
A. Uraemia
B. Disseminated intravascular coagulation (DIC)
C. Von Willebrand disease
D. Liver failure

83. A 8 weeks old baby with a fever of 38C. 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

84. A 28 year old business man came to sexual clinic. He was worried that he has HIV infection.
Three HIV tests were done and all the results were negative. After a few months later he came back
again and claimed that he had HIV. What is the diagnosis?
A. Somatization
B. Hypochondriac
C. Mancheusens
D. Obsessive compulsive disorder
E. Schitzophrenia
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85. A 35 year old woman has butterfly rash on her face and she suffers symmetrical joint pains on
knee and elbow, ESR is raised. What is the most discriminative investigation for diagnosis?

A. Anti DNA antibodies

B. Anti Jo 1 antibodies
C. Anti nuclear antibodies
D. Anti centromere antibodies
E. Anti la antibody

86. A 4 year old girl presented with complaints of fever and rash, she was diagnosed with bacterial
meningitis. She is an only child living with both her parents. Doctors are concerned about her parents
and decided to give them prophylactic treatment. Which is the best prophylactic medicine for the
parents?
A. Ampicillin
B. Cefotaxime
C. Tetracycline
D. Rifampicin
E. Azythromycin

87. A patient after his house fire came with haematemesis with erosion of oesophagus and on
examination there is 55% burn and on endoscopy there is gastric erosion and soot on mouth. What is
the treatment?
A. Proton Pump Inhibitors oral
B. Proton Pump Inhibitors IV
C. Proton Pump Inhibitors &Antibiotics
D. Helicobacter pylori test
E. Tracheal intubation

88. A terminally ill patient with metastatic carcinoma presents with dysphagia and difficulty in
swallowing. What is the best possible treatment?
A. Nystatin suspension
B. Amphotericin B IV
C. Oral fluconazole
D. Cotrimazole
E. Analgesic

89. A 55 year old man presents with an ulcer of the scrotum. Which of the following lymph node is
involved?
A. External iliac lymph nodes F. Sub-mental 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

90. A 65 year old man complaints of episodes of vertigo, deafness and tinnitus only in the right ear,
all these symptoms are progressing slowly. Patient also complaints of right sided facial numbness.
Which of the following would help in the diagnosis?
A. Caloric test
 17

B. Electromagnetic Imaging of the vestibule

C. MRI Head
D. Gutenbergers test
E. Blood tests for tumour markers

91. A man presents with scrotal swelling, the swelling is cystic and is non tender, and it is located at
the upper pole of the posterior part of the testis. What is the most likely diagnosis?
A. Epididymal Cyst
B. Testicular cancer
C. Hydrocele
D. Teratoma
E. Testicular torsion

92. A 62 year old woman complains of unsteadiness when walking. On examination she has
pyramidal weakness of her left lower limb, and reduced pain and temperature sensation of her right
leg and right side of her trunk up to the level of the umbilicus. Joint position sense is impaired at her
left great toe but is normal elsewhere. She has a definite left extensor plantar response, and the right
plantar response is equivocal. Where is the most likely site of the lesion?

A. Left cervical cord E. Left lumbo-sacral plexus

B. Midline mid-thoracic cord
C. Right mid-thoracic cord
D. Left mid-thoracic cord

93. A 10 year old boy presents with nose bleed. What measure should be taken to stop the
bleeding? Choose the most appropriate measure.
A. Press base of the nose
B. Ice packs
C. Press soft parts of the nose
D. Start tranexemic acid
E. IV fluids

94. A 79 year old lady, who is otherwise well, recently started abdominal pain. She is a febrile and
complains that she passed air bubbles during urination. A urethral catheter passed showed faecal
leakage in the urinary bag. What is then likely pathology?
A. Diuretics
B. Crohns disease
C. Recto sigmoid tumour
D. Large bowel perforation
E. Ulcerative Colitis

95. A schizophrenic patient hears people only when he is about to fall asleep. What is the most likely
diagnosis?
A. Hypnopompic hallucination
B. Hypnogogic hallucination
C. Hippocampal hallucination
D. Delirious hallucination
E. Auditory hallucination
 18

96. A 53 years old man presents with a long standing history of a 1cm lesion on his arm. It has
started to bleed on touching. What is the most likely diagnosis?

A. Basal cell carcinoma E. Kerathoacanthoma

B. Kaposis sarcoma
C. Malignant melanoma
D. Squamous cell carcinoma

97. What is the most common post-operative complication following anterior resection of
rectum?
A. Infection
B. Bleeding
C. Recurrence
D. Intestinal obstruction
E. Pain
98. A 16 month old child presents with drooling. He has sore throat and loss of voice. He has fever
with a temp of 38.2C.What is your next step towards management?
A. Direct pharyngoscopy
B. Call ENT surgeon
C. Call anaesthetist
D. IV fluids
E. Start antibiotics

99. A 36 years old man walks into a bank and demands money claiming he owns the bank. On being
denied, he goes to the police station to report this. What kind of delusions is this man suffering from?
A. Delusion of Reference
B. Delusion of Control
C. Delusion of Guilt
D. Delusion of Persecution
E. Delusion of Grandeur

100. A 31 year old previously healthy gym instructor had a road traffic accident leading to intra-
capsular fracture of femur, for which he needed operation. After successful surgery he is now
recovering in post op ward. What is the most likely complication he can suffer from?

A. Avascular necrosis of femoral head.

B. Post op infection
C. Pulmonary embolism
D. Hypovolemic shock
E. Fat embolism

101. A 19 year old man with exercise induced asthma is on Salbutamol inhaler as-required and
Beclamethasone 400g twice a day. He complains that he has to wake up at night for his inhaler.
What is the most appropriate medication for this patient?
A. Salmeterol 50mcg twice a day
B. Beclomethasone 1000 g twice
C. Prednisolone 30mg per day
D. Sodium Cromoglycate
E. Monteleukast
 19

102. 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

103. A 48 year old woman who has been taking medications for asthma for a long time has now
presented with decreasing vision. What is the most probable cause for her decrease in vision?
A. Inhaled Salbutamol
B. Inhaled Steroids
C. Aminophylline
D. Beta blockers
E. Oral Steroids

104. An 83 year old elderly woman presented in the A&E with cough, fever and sneezing. Treatment
was given but she became confused and again presents with the cough, fever and sneezing. What is
the cause of her condition?
A. Aspiration pneumonia due to confusion
B. Alveolar damage due to drugs
C. Drugs toxicity
D. Pneumothorax

105. A patient was admitted to hospital with severe pyelonephnritis. He was given IV antibiotics. A
few days later he develops bloody diarrhoea. Stool cultures reveal Clostridium difficile. What is the
best treatment option for this patient?
A. Erythromycin
B. Gentamicin
C. Penicillin
D. Metronidazole

106. A 7 year old boy was involved in a fire. He has 15% partial thickness burns. What is the best
management for this patient?
A. Escharectomy
B. Dressing
C. Burst blisters
D. Local antibiotics
E. Refer to burn unit

107. A 6 year old boy is brought to the hospital for a third episode of sore throat in one month, he is
found to be bleeding from gums and nose has pale conjunctiva. What is the single cell type from
given options?
A. Clumped platelets
B. Microcytes
C. Granulocyte without blast cells
D. Blast cells
 20

E. Mature lymphocyte

108. A 45 year old lady presents with severe chest pain associated with difficulty in breathing. History
reveals that she has come from Australia few hours ago. What is the definitive investigation for her
condition?
A. CT pulmonary angiogram
B. VQ scan
C. Chest X-ray
D. D- dimer

109. A 10 year old boy is brought to A&E 10 hours after injury to the foot. It was punctured with a
metal spike that passed through his shoe. What is the next best step?
A. Immunoglobulin
B. Immunoglobulin and vaccine
C. Vaccine only
D. Clean the wound
E. Antibiotics

110. A previously healthy 23 year old man presented with a week history of bloody diarrhoea, crampy
abdominal pain and fever. On examination you find tenderness in lower abdomen. What is the most
appropriate diagnosis?
A. Coeliac disease D. Laxative abuse
B. Colorectal polyps E. Viral gastroenteritis
C. Ulcerative Colitis

111. A 18 year old man is rushed into A&E by his group of friends who left him immediately before
they can be interviewed by the medical staff. He is semiconscious, has a respiratory rate of 8/min, BP
of 120/70 mmHg and pulse 60 beats per minute. He is noted to have needle track marks on his arms
and his pupils are small. What is the single best initial treatment you would administer?
A. Insulin
B. Naloxone
C. Methadone
D. Gastric lavage

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

113. 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
 21

E. Pneumothorax

114. A 35 years old male is bitterly annoyed with people around him. He thinks that people are
putting ideas into his head. What is the single most likely diagnosis?
A. Thought block
B. Thought insertion
C. Thought broadcasting
D. Thought withdrawal
E. Reference

115. A 27 year old patient met with a road traffic accident comes to the A&E. While the nasogastric
tube is passing the bowel sounds are heard in the chest. On the chest x-ray nasogastric tube is seen
curled. What is the diagnosis?
A. Diaphragm rupture
B. Aortic rupture
C. Splenic rupture
D. Bowel rupture
E. Liver rupture

116. A 65 year old man on dexamethasone underwent a surgery. During and after the surgery, his
blood glucose level was around 17 19 mmol/l. What will you give the patient?
A. Insulin
B. Oral hypoglycaemics
C. Remove dexamethasone
D. IV saline
E. IV dextrose

117. A teacher had respiratory infection for which she was prescribed antibiotics. After her
antibiotic course, when she re-joined the school, she had lost her voice completely. What is the
SINGLE most appropriate diagnosis?
A. Recurrent Laryngeal nerve palsy
B. Angio edema
C. Laryngeal obstruction by the medications
D. Laryngitis
E. Functional dysphonia/vocal cord

118.A 28 year old female presented with one week history of jaundice and 2 days history of altered
sleep pattern and moods. She was diagnosed with hypothyroidism for which she is receiving
thyroxine. Thyroid function test showed TSH, prothrombin time (PT) was 70 seconds. What is the
most probable diagnosis?
A. Acute on chronic liver failure.
B. Hyper-acute liver failure.
C. Autoimmune hepatitis.
D. Acute liver failure.
E. Drug induced hepatitis

119.An 8 year old girl presents with a large swelling on the side of her neck, there were associated
lymph nodes swellings in her neck and axilla. What is the most appropriate investigation?
A. Bone marrow biopsy
B. Lymph node biopsy
C. CT of the neck
 22

D. MRI of the neck

E. Hb electrophoresis

120. A 45 years old known hypertensive man presents with haematuria, proteinuria and oedema. What
is the definitive diagnostic test for him?
A. Urine protein
B. Renal biopsy
C. Renal function tests
D. Urine microscopy
E. Serum protein

121. A 40 year old man complains of thirst and lethargy. His BP is 140/90mmHg and his calcium
which was corrected is 3.7mmol/l. What is the most appropriate management at this stage?
A. IV fluids
B. Prednisolone
C. IV hydrocortisone
D. Calcium preparation

122. 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 childs body became rigid and then started to jerk

123. A patient presented with a stab injury to his left groin, he keeps bleeding profusely. pressure has
been applied to stop bleeding , BP 80/60mmHg. What is the next appropriate action?
A. I/V fluid
B. Blood Transfusion
C. Oxygen
D. Elevate limb

124. A 63 years old female is noted to have left pupil irresponsive to light and is dilated. What is the
most probable diagnosis?
A. Pontine hemorrhage
B. Subdural hemorrhage
C. Cerebellar hemorrhage
D. Extradural hemorrhage
E. Sub arachnoid hemorrhage

125. A 6 year old came with full thickness burn. He is crying continuously. What is next step of
management?
A. Refer to burn unit
B. IV fluid start
C. Antibiotic
D. Analgesic
E. Dressing
 23

126. A 34 year old patient presents to the GP with painful sticky eyes, with inability to open his eyes.
On examination his conjunctiva appears congested. What is the most appropriate treatment?
A. Oral Antibiotics
B. Reassurance
C. IV antibiotics
D. Topical antibiotics
E. Pilocarpine

127. A known type 1 diabetic presents with drowsiness, vomiting, abdominal pain, fruity smell on his
breath and deep laboured breathing. His ABGs show metabolic acidosis. What is the best
rehydration regimen for him?
A. Insulin
B. Insulin + potassium
C. IV dextrose + insulin + potassium
D. IV 0.9% normal saline + insulin + potassium

128. A nurse comes to you saying that she has recently developed the habit of washing her hands after
every 15 to 20 minutes. She is unable to concentrate on her work and takes longer than before to
finish tasks as she must wash her hands constantly. What is the best management for this condition?
A. Cognitive behaviour therapy
B. Selective serotonin re-uptake inhibitors (SSRI)
C. Electroconvulsive therapy
D. Antipsychotics
E. Desensitization

129. A young man complains of bloody diarrhoea with mucus. He has colicky abdominal pain. What
is the most appropriate test for diagnosing his condition?
A. Barium enema
B. Stool culture
C. Lower GI endoscopy & biopsy
D. H.Pylori stool antigen test

130. A 40 year old male presented with chest pain and breathlessness following exercise, which was
relieved after taking rest. What is the best investigation to determine his condition?
A. Exercise ECG
B. 24 hour ECG
C. Cardiac enzymes
D. Echocardiography
E. Chest X-ray

131.A 26 years old male has been operated for abdominal trauma and splenectomy was done. On the
third post- operative day the patient developed acute abdominal pain and distension in the upper
abdominal area with hypotension. On insertion of ryles tube 2 litres of coffee ground fluid was
aspirated. What is the most probable diagnosis for the condition above?
A. Acute gastric dilatation.
B. Reactionary haemorrhage.
C. Sub-phrenic abscess.
D. Deep vein thrombosis.
 24

E. Left lower lobe atelectasis

132. A 62 year old man has been smoking about 15 cigarettes a day for 45 years. He started working
as a builder since he was 24 years old. He presents with chest pain, shortness of breath and weight
loss. Chest X-ray shows bilateral fibrosis and left side pleural effusion. What is the best investigation
that will lead to diagnosis?
A. Chest x-ray E. CT Scan
B. Pleural fluid aspiration of cytology
C. Magnetic resonance imaging (MRI)
D. Pleural biopsy

133. A 60 year old man presents with progressive claudication without diabetes or
hypercholesterolemia who is taking low dose Aspirin. What is the best next step of management?
A. Statin
B. ACE inhibitor
C. Angiography
D. Clostazol

134. A young girl complains of episodic headaches preceded by fortification spectra. Each
episode last for two to three days. During headache patient prefers quite darkroom.
What is the treatment of choice for acute stage?
A. Paracetamol
B. Aspirin
C. Sumatriptan
D. Gabapentin
E. Cafergot

135. A 45 year old female complaints of pain in the inner side of her right thigh. She was
diagnosed with a benign ovarian mass on the right side. Which nerve is responsible for this pain?
A. Femoral Nerve
B. Obturator Nerve
C. Ilio-hypogastric Nerve
D. Ovarian branch of splanchnic nerve
E. Pudendal nerve

136. A 57 year old man, who has history of MI, now presents with TIA after being on
anticoagulation. What is the best tool to calculate his risk of stroke?
A. NEWS
B. CHA2DS2-VASc
C. ROSIER Scale

137. A 77 year old male presents with history of enuresis and change in behaviour. On
examination he is found to have a waddling gait. What is the most likely diagnosis?
A. Subdural haemorrhage
B. Brain tumour
C. Normal pressure hydrocephalus
D. Psychotic depression
E. Extradural haemorrhage

138. A patient with sensori neural hearing loss and loss of corneal reflex on the left side. What is
the most definitive investigation?
 25

A. CT scan of internal auditory meatus

B. Nuclear imaging ofbrain
C. MRI of internal auditory meatus
D. Radio Isotope Scan
E. X-ray Skull

139. A 60 years old man has a pathological rib fracture. He also complains of recurrent infection.
Bone marrow aspiration is done. The lab report shows calcium is 3.9mmol/l and alkaline phosphatase
level is 160/l. What type of cell would be found in abundance in the marrow smear?
A. Plasma cells
B. Myeloid cells
C. Bence Jones protein
D. Megakaryocytes
E. Reticulocytes

140. A 32 years old married woman complains of feeling low and has had two episodes of drug
overdose. She has a family history of depressive disorders. She has reduced social contacts now.
Which risk factor greatly increases risk of suicide?
A. Lack of Social Support
B. Past history of overdose
C. Family history of depression
D. Married status
E. Female sex

141. A 40 year old woman, with breast cancer, has back pain which keeps her awake at night. She
blames it on a gym session she had two weeks ago. She now has difficulty in climbing the stairs.
There is tenderness over the right thoracic spine. She has diminished fine touch and temperature
sensation in her right foot. What is the SINGLE most appropriate investigation?
A. Bone density scan
B. Computed tomography (CT) scan of the head
C. Magnetic resonance Imaging (MRI) of the spine
D. Nuclear medicine (NM) bone scan
E. Plain X-ray of the thoraco-lumbar spine

142. A 50 years old woman who keeps bees has been stung many times. But the last time she was
stung, she developed large itchy swellings that lasted up to 72 hours. She now feels well and has no
other symptoms. What is the SINGLE most appropriate advice for her?
A. Carry subcutaneous adrenaline (epinephrine) injection
B. Take a Non-Steroidal Anti-Inflammatory Drug (NSAID) after a bee sting
C. Take oral steroid after a bee sting
D. Take regular anti-histamine tablets
E. Use anti-histamine cream after a bee sting

143. A woman presented with intermittent pain in her left breast radiating to her left arm. What is the
diagnosis?
A. Cyclical mastalgia
B. Fibroadenoma
C. Non cyclicalmastalgia
D. Duct Ectasia
E. Mondors disease
 26

144. A 20 years old fit man suddenly developed severe lower back pain as getting up from bed. What
is the SINGLE most probable diagnosis?
A. Pagets disease
B. Multiple myeloma
C. Prolapsed Intervertebral Disc
D. Ankylosing spondilitis
E. Spondylosis

145. The annual incidence of Down Syndrome is :

A. 7
B. 70
C. 700
D. 7000
E. 70000

146. A 24 years old woman complains of inability to stop thinking about saving water, and has to
keep checking the tap all the time. What is the diagnosis?
A. Schizophrenia
B. Obsessive compulsive disorder(OCD)
C. Obsessive Compulsive Personality
D. Posttraumatic stress disorder (PTSD)
E. Delusion of Grandeur

147. A one month old boy has been brought to the Emergency Department. He is conscious but with
cool peripheries and has heart rate of 22 beats/minute. He has been irritable and feeding poorly for
about 24 hours. His chest x-ray shows a borderline enlarged heart with clear lung fields and ECG
shows a regular narrow complex tachycardia. It is difficult to identify p wave on the tracing. What is
SINGLE most appropriate immediate treatment?
A. Administer fluid bolus
B. Administer oxygen
C. Oral beta blocker
D. Synchronised DC cardio-version
E. Unilateral carotid sinus massage

148. A 75 year old man presents with back pain, he looks pale and complains of heart racing. On
investigation there are many plasma cells in the peripheral smear. What is the most probable
diagnosis?
A. Multiple myeloma
B. Ankylosing spondylitis
C. Prolapsed disc
D. Leukemia
E. Bone degeneration

149. A 32 year old lady complains that she hears everyone saying that she is an evil person. What type
of hallucinations is she suffering from?
A. Second person auditory hallucinations D. D. Gedankenlautwerden
 27

B. Third person auditory hallucinations

C. Echo de la pense
150. A hypertensive patient who is on Bendroflumethiazide 2.5mg per day, has come for his routine
check-up. On examination his blood pressure is 145/85mmHg and lab report shows K=5.9 and
Na=137. What is the most appropriate management for this patient?
A. Stop medication
B. Continue the same dose
C. Increase the dose
D. Decrease the dose
E. Repeat the blood test

151. A 55 year old woman suffered from acute myocardial infarction 5 days ago, while in hospital the
patient developed features of pulmonary oedema and heart failure. What is the most probable cause of
her present condition?
A. Ventricular Septal Defect (VSD)
B. Rupture papillary muscle
C. Pericarditis
D. Atrial fibrillation
E. Re-infarction

152. A 32 year old woman presents with attacks of numbness in the right hand and fingers followed
by left side headache. What is the most probable diagnosis?
A. Cerebral tumour
B. Epilepsy
C. Migraine
D. Temporal arteritis
E. Cervical spondylosis

153. 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

154. A 60 year old man with a four year history of thirst, urinary frequency and weight loss presents
with a deep painless ulcer on the heel. What is the most appropriate investigation?
A. Arteriography
B. Venography
C. Blood Sugar
D. Biopsy for Malignant Melanoma
E. Biopsy for Pyoderma

155. A child is not breathing and failed to intubate. At what anatomy site the incision should be
made?
A. External iliac muscle
B. Cricoid cartilage
C. Linea alba
 28

D. Rectus sheath muscle

E. Duramater
156. A young female patient suffers from heartburn and abdominal discomfort and has taken four
weeks of Proton pump inhibitors (PPIs) without relief. H.pylori antigen test comes out negative. Stool
tested negative for antigens. What will be the next management for this patient?
A. Urea breath test
B. Endoscopy
C. 24 hour manometry
D. 24 hour pH measurement

157. A 57 year old shipyard worker has a 4 months history of cough and left sided chest pain. He has
a pleural effusion on the left side. What will you do to improve his symptoms?
A. Therapeutic thoracocenthesis
B. Chemotherapy
C. Pleural biopsy
D. Radiotherapy

158. A 23 year old man comes to the Emergency Department with a history of drug misuse. He
recognizes that he has a problem and is willing to see a psychiatrist. Which of the following terms
best describes this situation?
A. Judgement
B. Thought insertion
C. Thought block
D. Mood
E. Insight

159. A 17 year female present with a mobile swelling in the front of the neck which moves with the
protrusion of tongue. The most appropriate management
A. USG
B. Excision Biopsy
C. Tru-cut Biopsy
D. FNAC
E. Aspiration

160. A woman has electric pains in her face that starts with jaw and radiate towards her forehead.
Her corneal reflexes are normal. What is the most likely diagnosis?
A. Atypical face pain
B. Trigeminal neuralgia
C. Temporo-mandibular joint dysfunction
D. Giant Cell Arteritis (GCA)
E. Herpes Zoster

161. An ECG of an elderly female who collapsed in A&E shows rapid ventricular rate of 220 per
minute, QRS duration is 140 milli seconds. What is the most probable diagnosis?
A. Atrial Fibrillation
B. Ventricular tachycardia
C. Supra ventricular tachycardia
D. Mobitz Type I Second Degree heart Block
E. Sinus Tachycardia
 29

162. A 63 years old man presented with sudden onset of severe dyspnoea, orthopnoea, raised JVP and
bilateral basal crackles three days after an episode of myocardial infarction. A diagnosis of acute
congestive cardiac failure was made and intravenous furosemide was started for this patient. What
electrolyte abnormality is expected?
A. High Na, Low K
B. Low Na, High K
C. Low Na, low K
D. High Na, high K
E. Low Na, Normal K

163. 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

164. A 5 year old child came from Ghana 6 weeks ago. Two days ago he developed fever, vomiting
and neck stiffness. He had taken malaria prophylaxis, from until 4 weeks ago he had no rash. What is
the diagnosis?
A. Cerebral abscess F. Pneumonia
B. Cerebral malaria
C. Meningococcal meningitis
D. Subarachnoid hemorrhage
E. Cerebral tumor

165. A 5 year old boy is rescued from a burning building and is presented to the accident and
emergency. He had 5% partial thickness burns over the arms and legs and had soot in the mouth and
nose. His breathing has become noisy. What is the SINGLE most immediate management?
A. Nebulised Adrenaline
B. Nebulised Salmeterol and Oxygen
C. Needle Cricothyrodotomy
D. Oropharyngeal Airway
E. Intubation of Airway

166. A 56 year old woman has woken up five times in the last month with a feeling of thumping in
her chest. On sitting up for about two minutes and taking a few deep breaths, the sensation subsides
over a further minute. Her ECG shows sinus rhythm. What is the most appropriate investigation to be
done?
A. Cardiac Enzymes
B. Chest X Ray
C. 24 Hour ECG
D. Echocardiogram
E. Plasma Glucose
 30

167. A 22 years sexually active male came with 2 days history of fever with pain in scrotal area. On
examination scrotal skin is red, tender. What is the most appropriate diagnosis?
A. Torsion of testis
B. Orchitis
C. Inguinal Hernia
D. Epididymo- orchitis

168. After eating a cookie at a garden party, a child began to cough and went blue. The mother also
noticed that there were swollen patches on the skin. What is the initial management in this child?
A. Over the counter antihistamines
B. Oxygen
C. Bronchodilators
D. Epinephrine by injection
E. Nebulized epinephrine

169. A 55 year old woman with a persistent cough and history of smoking develops left sided chest
pain exacerbated by deep breathing with fever and localized crackles. What is the Single most
appropriate diagnosis?
A. Dissecting aneurysm
B. Pericarditis
C. Pneumonia
D. Pneumothorax
E. Pulmonary embolism

170. A 71 year old woman looks disheveled, unkempt and sad, with poor eye contact. She has
recently lost her husband. Which of the following describes her condition the best?
A. Anxiety
B. Hallucination
C. Mania
D. High Mood
E. Low Mood

171. A 65 year old woman presented with transient arm and leg weakness as well as a sudden loss of
vision in her left eye. Her symptoms resolved within the next couple of hours. What is the most
appropriate next investigation?
A. CT Brain
B. Echo
C. Doppler USG
D. Arteriography
E. 24 hour ECG

172. 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
B. Steroids
C. Anterior Uveitis
D. Posterior Uveitis
E. Trauma
 31

173. A woman presented with repeated candidiasis. She also has polyuria and polydipsia. What is the
most appropriate investigation that would confirm diabetes in this patient?
A. Urine dip stick + fasting blood sugar 6 E. FBS .7 and RBS >11
B. Random blood sugar 8+ fasting blood sugar 6.5
C. Random blood sugar >11+ fasting blood sugar>6
D. Random blood sugar>10

174. A 14 years old diabetic child does not follow his insulin regimen, misses his doses and eats
in between his meals. He is also not happy in the school. What is the next step in the
management?
A. Paediatrician
B. Psychologist
C. Dietician
D. Psychiatrist
E. Review insulin regimen
F. Refer to GP
G. Refer to socialservices
H. Change type ofinsulin

175. A 6 weeks old baby has blue mark near coccyx since birth. His mother is worried. What would
you do?
A. Reassure
B. Coagulation profile
C. Karyotyping
D. Skeletal survey
E. CT scan

176. A 6 year old child presents with swelling of face and feet and weight gain despite poor
feeding recently. What investigation should be carried out next?
A. Urinary albumin
B. Serum urea &creatinine
C. Full blood count
D. eGFR
E. Thyroid function tests

177. A 43 year old woman is brought in by her husband to the A& E department. He says she has
been getting up repeatedly at night to wash her hands as she thinks they are dirty. She gets very
anxious if he tries to stop her. She admits washing her hands again and again but says she cannot
control her actions. What is the diagnosis?
A. Schizophrenia
B. Obsessive compulsive disorder
C. Generalised anxiety disorder
D. Panic disorder
E. Depression

178. A young man has been diagnosed with seminoma of the right testis. Which group of
lymph nodes drain the right testis?
A. Superficial inguinal
B. Deep inguinal
C. Paraaortic
D. Femoral
 32

179. A84 year old man got surgical pain which is well controlled by oral Morphine 60mg bd.
However, now this patient is unable to swallow. What is the most appropriate next step?
A. Morphine 60mg stat
B. Morphine 60mg tds
C. Oxycodone 10mg od
D. Morphine 60mg IV for 24 hours
E. Fentanyl Patches

180. A woman who returned from abroad after three weeks of holiday complains of severe
diarrhoea of three weeks duration, she has also developed iron deficiency anaemia and folic acid
deficiency. What condition best describes her situation?
A. Jejunal villous atrophy D. Increased catabolism
B. Chronic diarrhoea secretions E. Increased secretions of acids
C. Malabsorption

181. 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
B. IV dextrose
C. Cimetidine
D. Cholestyramine

182. A 45 year old woman presents with rotational vertigo, nausea and vomiting, especially on
moving her head. She also had a similar episode 2 years back. These episodes typically followed an
event of runny nose, cold, cough and fever. What is the most probable diagnosis?
A. Acoustic neuroma
B. Meniere's disease
C. Labyrinthitis
D. Benign paroxysmal positional vertigo (BPPV)
E. Vestibular neuronitis

183. 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 sons 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. Mommys thumb

184. A 69 year old woman has had a stroke. Her left upper and lower limbs are paralyzed and she is
having difficulty in speaking. Which anatomical site is most likely to be affected?
A. Hippocampus E. Brain stem
B. Cerebellum
C. Internal Capsule
D. Thalamus
 33

185. A woman has been prescribed long term steroids for polymyalgia rheumatic. What additional
drug should be added to prevent osteoporosis?
A. Calcium
B. Alendronic acid
C. Vit D
D. Calcium resonium

186. A patient came to the A & E after he had banged his car quite a few times on reversing it. He was
complaining of seeing double while he tried to look back during the process of reversing the car, he
also complains of double vision on looking at an outward gaze. Which nerve is involved?
A. Abducent nerve
B. Trochlear nerve
C. Oculomotor nerve
D. Optic nerve
E. Trigeminal nerve

187. An eight year old boy with a body mass index (BMI ) of 28 kb/m2 was admitted to a surgical
ward following a motor vehicle accident. He was found to have glycosuria. When he recovered from
his injury the glycosuria resolved. What is SINGLE most appropriate follow-up investigation?
A. Fasting blood glucose concentration
B. Glycosylated hemoglobin (HbA1c)
C. Oral glucose tolerance test
D. Random blood glucose concentration
E. Serum cortisol concentration

188. A 40 year old chronic alcoholic who lives alone, brought into the A&E department having been
found confused at home after a fall. He complains of a headache and gradually worsening confusion.
What is the most likely diagnosis?
A. Head injury
B. Hypoglycemia
C. Extra Dural Hematoma
D. Sub Dural Hematoma
E. Delirium

189. A 2 year old girl presents with a 4-day history of fever. The illness started with a cough. Her
respiratory rate is 45/min, saturations 94% on air, temperature 38.9C and capillary refill time 1 sec.
There are crepitations at the left base on auscultation. Urine is negative on dipstick. What is the
single investigation most likely to lead to a diagnosis?
A. Blood for Culture and Sensitivity
B. ESR
C. Chest X Ray
D. Urine for Culture Sensitivity
E. CSF Analysis

190. A 12 years old boy with a history of fall on an outstretched hand was brought to A&E with
swelling and pain around the elbow. His radial nerve was affected. What type of fracture is it?
 34

A. Angulated fracture
B. Epiphyseal fracture
C. Compound fracture
D. Spiral fracture

191. 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

192. A 74 year old smoker presented to his GP with cough and shortness of breath. Examination
revealed pigmentation of the oral mucosa and also over the palms and soles. Tests show that he is
diabetic and hypokalaemic. What is the most probable diagnosis?
A. Pseudo Cushing syndrome
B. Conns Disease
C. Ectopic Adreno-corticotropic hormone (ACTH)
D. Cushings Disease
E. Hypothyroidism

193. A 36 years old man undergoes an elective hernia repair. 12 hour after the surgery he presents
with the following x-ray. What is the most likely diagnosis?

A. Pulmonary Effusion
B. Pneumothorax
C. Atelectasis
D. Pulmonary Edema
E. Pneumonia
 35

194. An 8 week old boy is brought by his mother due to projectile vomiting after every feed.
What will be most likely electrolyte abnormality seen in this patient?

A. Metabolicacidosis
B. Metabolicalkalosis
C. Respiratoryacidosis
D. Respiratoryalkalosis

195. A 36year old woman was recently admitted to a psychiatric ward. She believes that the staff
and other patients know exactly what she is thinking all the time. What is the most likely symptom
this patient is suffering from?
A. Thought Insertion
B. Thought Withdrawal
C. Thought Block
D. Thought Broadcasting
E. Hallucination

196. A young football player has collapsed during a game. During the initial evaluation his
respiratory rate is 14/min, pulse is 88/min and the blood pressure is 110/70 mmHg. He seems to be
sweating and muttering some incomprehensible words. What is the most important next step?
A. CT scan
B. Magnetic resonance imaging (MRI)
C. Blood Sugar
D. Check body temperature
E. IV fluids

197.An 18 year old female has blisters on tongue. Some of them are crusted, others secreting pinkish
fluid. What is the most likely diagnosis?
A. HSV1
B. Chicken pox
C. Rubella
D. Measles
E. Erythema Infectious

198. A 28 years old female had IDDM for 18 years. She has decreased acuity ( loss of
central vision). What is the anatomical structure that is most probably affected?
A. Lens
B. Retina
C. Iris
D. Anterior chamber
E. Posterior chamber

199. A diabetic lady present with inability to read small prints and decrease in visual acuity. Where is
the site of lesion?
A. Retina
B. Lens
C. Cornea
D. Macula
E. Iris
 36

200. A 33 year old female with bipolar affective disorder had an acute depressive episode which was
controlled by antidepressants. Which drug will be best for prophylaxis in this patient?
A. Mood stabiliser
B. Selective serotonin reuptake inhibitors (SSRI)
C. Tricyclic Antidepressant (TCA)
D. Antipsychotic