Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 19TH JUNE 2019 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. Baby with congenital adrenal hyperplasia, found unconscious in the ward. What would be the finding
in the baby?
A. Genital hyperpigmentation
B. Hypotension
C. Hypernatremic dehydration
D. Hyperkalemia

2. A 30 year old woman has US which shows 8 weeks pregnant 9 days ago and the fetus was viable. She
is now presenting with vaginal spotting. What is the most appropriate management?
A. Reassure
B. Clotting screen
C. Repeat USG scan
D. Beta HCG

3. 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?
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

4. A 37 year old lady stopped taking COCP 18 months ago and she had amenorrhea for 12 months
duration. What is the most appropriate cause? FSH : 8, LH: 7 and Prolactin is 400 and Estradiol : 500.
A. Hypothalamic amenorrhea
B. Polycystic ovary syndrome (PCOS)
C. Prolactinoma
D. Post pill amenorrhea
E. Premature ovarian failure

5. 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

6. A woman with breast carcinoma developed supra ventricular tachycardia following MI. Now she
suffers from right side arm pain, which comes like electric pain. Pain was controlled by fentanyl patches
but she suffers from prolong sedation. What is the drug you can add to control her arm pain?

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A. Amytriptaline
B. Morphine
C. Gabapentine
D. Codeine
E. Carbamezepine

7. A man with heart failure recently was started on medication for Gout. His gout improved however the
medication worsened his heart failure. Can you state the causative drug?
A. Prednisolone
B. Paracetamol
C. NSAID
D. Colchicine
E. B-blockers

8. A lady underwent debulking surgery for ovarian carcinoma. Soon after the surgery she presents with
signs of intestinal obstruction. What is the Single most appropriate investigation?
A. Pelvic CT
B. CA 125
C. Laparotomy
D. Laparoscopy
E. Abdominal USG

9. A 74year old lady called an ambulance for an acute chest pain. She has a history of DM and HTN, and
is a heavy smoker. Paramedics mentioned that she was overweight and recently has been immobile
because of a hip pain. She collapsed and died in the ambulance. What is the most likely cause of her
death?
A. Pulmonary embolism
B. MI
C. Stroke
D. Cardiac arrhythmia
E. Cardiac failure

10. You are the foundation year doctor in the emergency department when a mother brings her 2- year-
old son to you with a one hour history of noisy breathing. She states that although he had a mild coryza
over the last week, he was improving and so they had gone to a children's picnic with nursery friends.
Another parent had found him coughing and spluttering, and ever since the breathing has remained noisy.
Though he appears well in the department, his current observations demonstrate a raised respiratory rate
and saturations of 91% on air. What is the most likely diagnosis?
A. Anaphylaxis E. Tonsillitis
B. Croup
C. Foreign body aspiration
D. Epiglottitis

11. A child suffering from cystic fibrosis developed pneumonia. Which organism is responsible for this
pneumonia?
A. Haemophilius influenza
B. Klebsiella
C. Staphylococcus aureus
D. Streptococcus pneumonia
E. Pseudomonas

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12. A 64 years old man presents with sudden onset of severe chest pain and sweating for 45 minutes. The
x ray is given below. What is the most probable diagnosis?

A. Pneumothroax
B. Aortic Dissection
C. Heart Failure
D. MI
E. Pneumonia

13. A 64 years old diabetic has come for a routine eye check-up. Fundoscopy shows new vessels all over
the retina. What is the most appropriate management?
A. Strict Sugar Control E. Insulin
B. Regular eye check ups
C. Non urgent referral to a specialist
D. Laser photocoagulation

14. A 53year old man presents with a longstanding history of a 1cm lesion on his arm. It has started
bleeding on touch. What is the most likely diagnosis?
A. Basal cell carcinoma
B. Kaposi’s sarcoma
C. Malignant melanoma
D. Squamous cell carcinoma
E. Kerathoacanthoma

15. A man had MI 4 months ago. He now complains of low mood, lack of appetite and problems falling
sleep. What is the best medication for him?
A. Amitryptalline
B. Fluoxetine
C. Venlafaxine
D. Sertaline
E. Moclobemide

16. A 50 year old man presents with decreased body mass, mixed iron and folic acid deficiency, and
diarrhoea after recent travelling abroad to Barbados. He is also stating that his stools are smelly and
difficult to flush away. What is most discriminative investigation?
A. Blood cultures
B. Thyroid function tests (TFTs)
C. Serum calcium
D. CT scan
E. Jejunal biopsy

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17. A 56 year old lady presented with sudden weakness in the left upper and lower limbs. On examination
the plantars are up going and there is hypertonia. She is hypertensive on anti HTN medications. What is
the most appropriate cause of her symptoms?
A. Space occupying lesion
B. Multiple Sclerosis
C. Stroke
D. Giant Cell Arteritis

18. Patient with abdominal pain of sudden onset dies. Autopsy reveals ruptured abdominal aneurysm,
what is the pathophysiology resulting in this?
A. Atheroma
B. Aortic coarctation
C. Dissecting aneurysm

19. 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

20. A patient with migraine and photophobia, she has uterine fibroids distorting the uterine cavity. She is
the mother of 2 children, needs contraception.
A. Mirena coil
B. Copper IUCD
C. COCP
D. Depo progesterone
E. Endometrolibilation

21. A 29-year-old woman presents to her GP with a history of weight loss, heat intolerance, poor
concentration and palpitations. Which of the following is most likely to be associated with a diagnosis of
thyroiditis associated with viral infection?
A. Bilateral exophthalmos
B. Diffuse, smooth goitre
C. Reduced uptake on thyroid isotope scan
D. Positive thyroid peroxidase antibodies
E. Pretibial myxoedema

22. A housebound 78 year old man with severe chronic obstructive pulmonary disease has had a gradual
deterioration over recent months and is now breathless at rest. He is on maximal inhaled therapy. Results
show the following:
Ph: 7.36 PaCO2: 5.9kPa PaO2: 6.9kPa
What is the single most appropriate additional treatment?
A. Aminophylline (oral)
B. Angiotensin converting enzyme (ACE) inhibitor (oral)
C. Antibiotic (oral)
D. Oxygen
E. Steroid (oral)

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23. A 7 months old baby is irritable and fails to gain weight. His stools are pale, frothy and bulky. What
will be the most diagnostic test to confirm the condition?
A. Sweat Test D. Stool Culture
B. Jejunal Biopsy E. Liver biopsy
C. Endomysial Antibodies

24. 3A 55 year old man has taken an overdose of his antidepressant medication. He presents with dry
mouth, blurred vision, urinary retention and constipation. What is the most appropriate investigation to be
done?
A. Thyroid function tests
B. EEG
C. Creatinine clearance
D. ECG
E. CT

25. A 32 year old patient presents with cervical lymphadenopathy and splenomegaly. What is the
SINGLE most appropriate option?
A. Streptokinase
B. Haemophilus
C. Streptococcus
D. Toxoplamosis
E. Non Hodgkins Lymphoma
F. Pneumocystis jerovici

26. 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
E. Bisphosphonates

27. A woman was brought in unconscious with an empty bottle of medications (PCM or others, not sure)
beside her. It is assumed she tried to commit suicide. What will you do?
A. Go to court for warrant to treat her
B. Start treating in her best interest and collect collateral info
C. Wait for her to wake up and seek consent from her
D. Ask her relatives for consent to treat her

28. How to perform CPR on a 5 month old child?

A. 15 chest Compressions with both hands
B. 30 chest compressions with single hand
C. 30 chest compressions with both thumbs
D. 15 chest Compressions with index and middle finger
E. 15 chest compressions with thumb and index finger

29. A 62 year old male comes to the GP complaining of double vision while climbing downstairs.
Which of the following nerve is most probably involved?

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A. Abducens nerve
B. Trochlear nerve
C. Oculomotor
D. Optic nerve
E. Trigeminal

30. A 27 year old waitress has pelvic pain, dysmenorrhoea and increasingly heavy periods. She also
complains of dyspareunia. There is generalized pelvic tenderness without peritonium. Pelvic ultrasound
scan is reported as normal. What is the most likely diagnosis?
A. Endometriosis
B. Uterine Fibroid
C. Pelvic Congestion Syndrome
D. Pelvic Inflammatory Disease
E. Tubal Pregnancy

31. An 18 year old girl comes with complaints of fresh painless bleeding while passing stools. No other
symptoms. What is the most likely diagnosis?
A. Bowel Ca
B. IBDs
C. Anal stricture
D. Haemorrhoids

32. A 10 year old child presents with severe vomiting and lethargy. She feels dizzy and thirsty. She has
had urinary incontinence for the past 2 weeks. Which investigation would you wish to perform
immediately?
A. Urine glucose
B. Urine culture & sensitivity
C. FBC
D. Blood culture
E. CT scan

33. A patient with dysmenorrhea and dysfunctional uterine bleeding presents to you for contraceptive
advice. Uterus is normal. There is no past medical history. What is the best management for her?
A. Give COCP
B. Mirena Coil
C. IUCD
D. POP (Progestogen only pill)
E. Depo provera

34. An 81 year old man complains of general malaise and chronic backache. He has a history of mild
concussion with episodes of blurring of vision. An X-ray report show pepper-pot skull. What is single
most appropriate next best test?
A. Full blood count
B. ECG
C. Serum electrophoresis
D. Blood glucose

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35. A 22 year old lady comes complaining of painful sexual intercourse and abdominal pain 4 days after
moving in with her boyfriend a week ago. Since the last 2 days she also noticed increased frequency of
micturition. A vaginal examination showed foul- smelling cervical discharge which was collected and
sent for culture and sensitivity. She denies any itching and does not appear to be very ill. What would be
the appropriate initial treatment in this case?
A. Ceftriaxone with metronidazole
B. Meropenem and Paracetamol
C. Ofloxacin with metronidazole
D. Vaginal oestrogen cream

36. A 62 year old man has multiple liver metastases due to adenocarcinoma with an unknown primary. He
is deeply jaundiced and has ascites, with oedema of his legs up to the buttocks. He is now drowsy and his
family are worried that he is not drinking enough. His medication includes: Haloperidol 1.5 mg and
Lactulose 10 ml. Blood taken three days ago showed:

Normal electrolytes Urea 6.5 mmol/L

Creatinine 89mmol/L
Calcium 2.04mmol/L
Albumin 17g/L Total bilirubin 189 mmol/L
What is the SINGLE most appropriate management of his fluid intake?
A. Albumin infusion
B. Crystalloid fluids (continuous intravenous)
C. Crystalloid fluids (intermittent subcutaneous)
D. Fluids Via nasogastric tube
E. Oral fluids

37. A 29 year old lady, who is a Bank Manager, is referred by the GP to the medical Out-Patient Clinic
due to a long history of tiredness and pain in the joints. An autoimmune screen result showed smooth
muscle antibodies positive. What is the most appropriate next investigation?
A. ECG
B. Thyroid FunctionTest
C. Liver FunctionTest
D. Serum glucose
E. Jejunal biopsy

38. Half of a group of observations lies above this level and it is particularly important if the distributions
non normal. Choose the single term from the list of options given
A. Chi squared (X²) test E. Mode
B. Linear regression
C. Mean
D. Median

39. A 60 years old female presents with acute onset of bone and back pain following a rough journey in
car. On examination she has tenderness at mid-thoracic vertebrae with spasm, she feels better once she
bend forward. What is the SINGLE most probable diagnosis?
A. Osteoporotic fracture vertebrae
B. Myofascial pain.
C. Whiplash injury
D. Myocardial Infarction
E. Pancreatitis

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40. A patient presents with ectopic pregnancy. Which is the most important risk factor for it?
A. Polycystic ovary syndrome (PCOS)
B. PID with chlamydia,
C. Depo-provera
D. Instrumentation

41. A lady 76 years old had loss of consciousness but was fine after 10 minutes. She was taking Aspirin,
Bendroflumethiazide and Simvastatin. All examinations were normal. CT scan was done. What is the
most appropriate management?
A. Add aspirin 300
B. Clopidogrel
C. Dipyramidamole
D. Clopidogrel +Dipyramidamole

42. A man is being admitted for an open fracture of the femur following RTA. During the induction of
anaesthesia the BP drops to 60/40 and HR is 130 bpm. The likely explanation is :
A. Fat embolism
B. Severe bleeding
C. Reaction to anaesthesia
D. Pulmonary Embolism

43. A 16 year old boy presents with acute pain in the right ear and little bleeding from the same ear. He
had been in a boxing match and had sustained a blow to the ear. There is little amount of blood in the
auditory canal and a small perforation of the eardrum. What is the most appropriate management?
A. Admission for parental antibiotics
B. Nasal de-congestant
C. Oral Amoxicillin
D. Outpatient clinic review
E. Packing of the ear

44. An 18 month old boy has been brought to the Emergency department because he has been refusing to
move his left arm and crying more than usual for the past 24 hours. He has recently been looked after by
his mother’s new boyfriend while she attended college. Assessment shows multiple bruises and a fracture
of left humerus which is put in plaster. What is the SINGLE most appropriate next step?
A. Admit under care of paediatrician
B. Discharge with painkiller
C. Follow up in fracture clinic
D. Follow up in paediatric outpatients
E. Follow up with general practitioner (GP)

45. A pregnant pt with Rh –ve who hasn’t been previously sensitized delivers her first baby at home
without any problem. What would be the
latest time to administer anti-sensitization?
A. 6h PP
B. 24h PP
C. 48h PP
D. 72h PP
E. 5d PP

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46. A 16 year old girl is brought to the hospital by her parents as they are worried about her poor appetite
and her rigorous exercise regimen. And she does not think there is anything wrong with her eating habits.
She says she is overweight which is why she follows such a strict diet and exercise regimen. What is your
next line of management? The girl’s Height- 165cm. Weight- 33kg
A. Reassure parents
B. Detain under mental health Act
C. Eating disorder clinic
D. Psychodynamic Therapy

47. Patient immunized against hep B. What do you expect to find on investigation?
A. HbsAg negative, Anti HBc positive, Anti HBe negative
B. HbsAg negative, Anti HBc negative, Anti HBs positive /Anti HBe positive
C. HBsAg positive, Anti HBc negative, Anti HBe negative
D. HBsAg positive, AntiHBs, HBeAg, Anti HBe, Anti HBc.

48. A couple are expecting their second baby. They have one son who has haemophilia A. What is the
likelihood of their second child also being born with haemophilia?
A. 25%
B. 50%
C. 75%
D. 100%
E. No likelihood

49. A 30 year old lady has blood film shows with picture of anaemia with spherocytes. What will you do?
A. Direct Coomb Test
B. Indirect Coomb Test
C. Bone marrow examination
D. Serum ferritin

50. A 5 year old child was found to have vesico-ureteric reflux. What is true about this condition?
A. Requires prophylactic antibiotics
B. Most will require surgery
C. In most kidney will be scarred by five years
D. No further action is required
E. It is usually asymptomatic

51. A 30 year old professional athlete presents with amenorhea of 7 months duration. What is the Single
most likely cause from the following options? FSH 8, LH 6, Oestradiol 80, Prolactin 600.
A. Premature ovarian failure
B. Hypothalamic failure
C. PCOS
D. Prolactinoma

52. A man brought his wife who left consuming alcohol for a few days. She now presents with agitation
and hallucinations. His husband informs that she hadn't taken alcohol for last three days. What is
appropriate management?
A. Benzodiazepines E. Acomprosate
B. Thiamine
C. Vit B complex
D. Disulfiram

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53. A 50 year old female presents to the medical department with complaints of dizziness since few days.
She is a teacher by profession, and she describes her class room moving around her whenever she turns
her head to look at the door. She also feels nauseous in these few seconds. She has no other complaints.
What is the likely diagnosis?
A. Meniere’s Disease
B. BPPV
C. Vestibular Neuronitis
D. Acoustic neuroma
E. Cholesteatoma

54. A 53 year old woman was found to have an enlarged spleen which is palpable up to the umbilicus.
Blood tests show HB 8.7g/dl, WBC 100 and Platelets 72. What is the single most likely diagnosis?
A. Chronic myeloid leukemia
B. Chronic lymphoid leukemia
C. Acute myeloid leukemia
D. Lymphoma
E. Splenic carcinoma

55. A 56 year old woman with history of breast cancer 10 years ago when radical mastectomy and
axillary lymph node removal were done for her now complains of swollen upper limb 3 weeks after an
insect bite. The bite site is better but gross oedema still present. What is the most likely cause?
A. Lymphoedema
B. Breast Ca
C. Allergy
D. Filariasis
E. Infection

56. Which statement best describes the planes of the abdomen?

A. The transpyloric plane lies halfway between the xiphoid and the symphysis pubis.
B. The transpyloric plane passes through the hilar of the kidneys.
C. The subcostal plane is at the level of the body of L2.
D. The iliac crests lie at the level of L5.
E. The umbilicus usually lies at the level of the L4/L5 disc.

57. A two year old boy fell off his tricycle, hurting his arm. He got up and started to cry but before there
was any sound he went pale, unconscious and rigid. He recovered after 1-2 minutes but remained pale.
After an hour he was back to normal. His mother says she was afraid he was going to die and that he had
a similar episode three months previously after he fell down some steps. What SINGLE investigation is
indicated?
A. Computed tomography (CT) scan of the head
B. Electroencephalogram (EEG)
C. Full blood count `
D. None
E. Skeletal survey

58. A man with prosthetic heart valve underwent hemicolectomy and after some days complains of left
hypochondriac pain, fever and has a systolic murmur. What is the next investigation to ascertain the cause
of heart failure?

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A. CT scan
B. Blood culture
C. ECG
D. Magnetic resonance imaging (MRI)
E. Radioactive thyroid scan

59. A 3 year old boy has 3 episodes of limb jerking. His teacher has noticed that at times he does not
concentrate in class. What is the single most appropriate investigation?
A. CT scan of Brain
B. Echocardiogram
C. ECG
D. EEG
E. LFT

60. A 60 year old man was diagnosed with atrial fibrillation and is prescribed Warfarin.Target INR should
be?
A. 2-3
B. 1.5 -2.5
C. 2.5- 3.5
D. 1-2

61. A 45 year old lady came to family planning clinic for contraception advice. She is not keen to be
pregnant for the next 3 years. Her recent USG report showed multiple small submucosal fibroid. What is
the best method of contraception for here from the list below?
A. Etonogestrol
B. Combined OCP
C. IUS (intrauterine system)
D. Progestogen only pill
E. IUCD (intrauterine contraceptive device)

62. A 27 year old woman presented with amenorrhoea of 10 months duration. FSH – 28, LH – Normal,
Testosterone – 1.8, Estradiol – 80. What is the most probable diagnosis?
A. Hypothalamic
B. Polycystic ovary syndrome (PCOS)
C. Premature ovarian failure
D. Hyper androgenism

63. A 54 years old patient 7 days after a total hip replacement presents with acute onset breathlessness
and a raised JVP. Which of the following investigations will be most helpful in leading to a diagnosis?
A. CXR
B. CTPA
C. V/Q Scan
D. D Dimers
E. Doppler USG of legs

64. A man complains of loss of sensation in little and ring finger. Which nerve is most likely to be
involved?
A. Median Nerve
B. Ulnar Nerve
C. Radial Nerve
D. Long Thoracic Nerve

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E. Axillary Nerve

65. 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. Marfan’s Syndrome

66. A 14 year old girl who asks for oral contraception. Her boyfriend is a school teacher.
A. Tell her that you can’t prescribe because she is child
B. Call her parents and tell them
C. Report to police
D. Report to local safe guards

67. A 7 year old boy who is up to date with all his immunization has come to you 7 hrs after a metal spike
has injured his hand, wound is 0.5 cm deep. What is the most appropriate action?
A. Tetanus Ig + tetanus vaccine + antibiotics
B. Tetanus Ig + antibiotics
C. Tetanus Ig + tetanus vaccine
D. Tetanus vaccine + antibiotics
E. Antibiotics

68. A pregnant lady on her 28 weeks pregnancy presents with BP 160/100mmHg and proteinuria of
0.2 gm/ day. What is your most probable diagnosis?
A. Gestational hypertension
B. Pre eclampsia
C. Eclampsia
D. Chronic hypertension

69. A 40year old divorced man with bipolar affective disorder attends hospital following an overdose of
30 TCA tablets. His new partner has left him and he has stopped taking his medicine and begun drinking
heavily. He appears depressed, feels hopeless and is ambivalent about being alive. He is now fit for
discharge from the medical ward and acknowledges the benefits of previous treatment. What is the
SINGLE most appropriate next management?

A. Admission to the psychiatry ward

B. Arrange psychiatric outpatient follow-up
C. Discharge to the care of the general practitioner
D. Referral to local alcohol treatment team
E. Referral to clinical psychologist

70. A 4year old child weighing 10kg with UTI on trimethoprim 50mg/5mls.

Prescribed 4mg/kg twice daily, what is the dosage?

A. 4mls twice daily
B. 2ml twice daily
C. 8mls twice daily
D. 12mls daily

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71. A 15 years old boy fell of his bicycle and hurt his abdomen. He presents with pain in abdomen, a CT
scan shows a small sub capsular spleen haematoma, his BP is 110/70mmHg and pulse is 80bpm. What is
the next step in his management?
A. Refer to surgeons for observation
B. Immediate Laparotomy
C. Immediate Laparoscopy
D. Discharge with advice
E. Blood transfusion

72. A 24 year old man presents to Accident & Emergency after his friends noticed his sclera turning
yellow. This happened after he had been taking paracetamol for a few days for an upper respiratory tract
infection. What is the single best cause for jaundice in him?

A. Gilbert’s syndrome
B. Criggler-Najjar syndrome
C. Glucose 6 phosphate dehydrogenase deficiency
D. Hereditary Spherocytosis
E. Hereditary Elliptocytosis

73. 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

74. 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. Cushing’s Syndrome
B. Grave’s disease
C. Acquired Hypothyroidism
D. Polycystic ovarian syndrome
E. Addison’s disease

75. A patient with proteinuria ++. What medication in this patient will prevent the progression of this
disease?
A. ACE inhibitors
B. Calcium channel blockers
C. Thiazide
D. Beta blockers
E. Alpha blockers

76. A 25 year old had an LSCS 24 hours ago for foetal distress. She now complains of intermittent
vaginal bleeding. Observations include saturations 98% in air, blood pressure 124/82 mmHg, pulse 84
beats/min and temperature 37.8oC. The midwife tells you that she had a retained placenta, which required
manual removal in the operating theatre. Choose the most appropriate post C-Section complication in this
case?

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A. Retained products of conception
B. Aspiration pneumonitis
C. Endometritis
D. Uterine rupture
E. Disseminated intravascular coagulation

77. 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)?
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

78. Woman presented with blood pressure 220/110mmHg. Not on any medication. Potassium 2.2mmol/l.
What is the most likely diagnosis?
A. Hypopitutarism
B. Cushings Syndrome
C. Primary Hyperaldosteronism
D. Secondary Hyperalsosteronism

79. A 7 month old child presents with seizures and jerking of limbs. What is the most likely diagnosis?
A. Infantile spasms
B. Space occupying lesion
C. Absence seizure
D. Breath holding spell

80. A 60 year old man with anuria had left nephrectomy for left renal Ca. Ultrasound shows dilatation of
the right upper renal tract with a stone impacted at the pelvic-ureteric junction. Bp 80/40mmHg. What is
the appropriate management?
A. Urethral catheterization
B. Lithotripsy
C. Percutaneous right nephrostomy
D. Dormier basket
E. Mid streamurine for culture and sensitivity.

81. A 54 year woman was found to have glycosuria at a routine medical examination. She has a body
mass index (BMI) of 32kg/m2. Her fasting blood sugar is 6mmol/l.
After a glucose tolerance test 2 hours later, her plasma glucose is 9mmol/l. What is the single most likely
diagnosis?
A. Cushing’s syndrome
B. Fanconi’s syndrome
C. Impaired glucose tolerance
D. Type 1 diabetes
E. Type 2 diabetes

82. A 30 years old female presented with a 1.5cm discrete lump in the upper outer quadrant of her right
breast, which was tender. What is the initial investigation?

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A. USG
B. FNAC
C. Excisional biopsy
D. Mammogram
E. Open biopsy

83. A lady developed breast abscess after delivery. What is the most likely organism?
A. Staph aureus
B. Staph albus
C. Group B streptococcus
D. Strep pyogenes
E. Strep faecalis

84. A 14 year old boy presents with recurrent abdominal pains, malaise, and weight loss over 6 months.
On examination a vague mass is felt in right iliac fossa. Colonoscopy shows transmural inflammation and
granulomata. What is the most appropriate management?
A. Sulfasalazine
B. Paracetamol
C. Metronidazole
D. Ibuprofen

85. An 80 year old woman who is on MR Morphine 60mg had to increase it to 120mg twice a day and
again with extra 10mg oral Morphine6 times a day. What is the best form of management?
A. Subcutaneous Morphine infusion
B. Fentanyl patches
C. Change to Oxycodone

D. Increase to 200 mg bd orally 90mg MR Morphine plus 30mg every 4 hours

86. A patient with hepatocellular carcinoma has raised levels of ferritin. What is the most probable cause?
A. Hemochromatosis
B. Wilsons disease
C. Alpha 1 antitrypsin deficiency
D. Carcinomatosis

87. A woman with a spontaneous abortion at 14 and 23 weeks of gestational age presents at 8 weeks
gestational age with bleeding PV. What is the most appropriate intervention?
A. Bed rest
B. Aspirin
C. Reassurance
D. Trans-vaginal sonography (TVS)

88. 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. full course of DPT vaccine

B. TT Immunoglobulin
D. No treatment
C. A+B

15
89. A 51 year old man was sitting for few hours with his legs crossed. Later he could not dorsiflex or
invert his foot . He also has got loss of sensation on the dorsum of his foot. Which nerve is most likely to
be damaged?
A. peroneal nerve
B. Sciatic nerve
C. Sura nerve
D. Femoral nerve
E. Tibial nerve.

90. A 45year old woman comes with red, swollen and exudating ulcer on the nipple and areola of right
breast with palpable lump under the ulcer. What do you think is causing this skin condition?
A. Inflammatory cells releasing cytokines
B. Infiltration of the lymphatics by the carcinomatous cells
C. Infiltration of the malignant skin cells to the breast tissue

91. A 46 year old man is being treated for a pleural effusion. A chest drain has been sited just below the
fourth rib in the mid-axillary line on his right side. What SINGLE structure is at particular risk of injury?
A. Azygos vein
B. Diaphragm
C. Intercostal artery
D. Internal thoracic artery
E. Liver

92. A 45 year old woman who is taking Lithium for Bipolar affective disorder for past 14 years presents
with coarse tremor. What investigation should be done?
A. Thyroid function test E. Reassure
B. Creatinine clearance
C. Urea and electrolytes
D. Serum lithium levels

93. What is the most appropriate antibiotic to treat uncomplicated Chlamydia infection in a 21 year old
female who is not pregnant?
A. Erythromycin
B. Ciprofloxacin
C. Metronidazole
D. Cefixime
E. Doxycycline

94. A 36 year old man had hematemesis and was found at endoscopy to have a duodenal ulcer. He was
treated with H.pylori eradication therapy. Some months later, he returns with epigastric pain.
What single investigation is most likely to review eradication of H.pylori?
A. Barium meal
B. C13 urea breath test
C. H.pylori serology
D. Repeat endoscopy

95. A 24 year old, male patient, presents with bizarre behavior. What single characteristic symptom
would confirm the diagnosis to be most likely to be schizophrenia?

16
A. Thought insertion
B. Visual hallucination
C. Aggressive, violent behavior
D. Low mood
E. Body dysmorphic image

96. A 37year old woman presents with heavy bleeding. Investigations show sub-serosal fibroid measuring
4cm and intramural fibroid of 6cm.What is the most appropriate treatment for her?
A. Uterine artery embolization
B. Abdominal Hysterectomy
C. Hysteroscopic myomectomy
D. Vaginal Hysterectomy
E. Abdominal myomectomy

97. A 34year old man was involved in a RTA and whilst in the ambulance his GCS deteriorated and RR
increased from 30-48bpmin. What is the most appropriate management for this patient?
A. IV fluid
B. Needle thoracocenthesis
C. 100% oxygen
D. Portable XR

98. A 67 years old lady was found to have serum Calcium of 3.7 mmol/l. What is the most suitable
treatment option for her from the following?
A. Pamidronate
B. Calcitonin
C. Decrease calcium in diet
D. No intervention needed

99. A 26 year old man presented with abdominal distension and pain. His stool was mucoid and
sometimes blood stained. What is the most appropriate investigation?
A. Stool culture and sensitivity
B. Colonoscopy and Biopsy
C. IgA against tissue transglutaminase
D. Barium meal
E. Jejunal biopsy

100. A 7 years old boy presents with epistaxis of two hours duration. The bleeding has been controlled.
His investigations are as follows:
Platelets 210,000
PT 13 seconds
APTT 42 seconds
Bleeding time: Normal
Which one of the following is the most likely diagnosis?
A. Hemophilia
B. Von-Willebrand disease
C. Idiopathic thrombocytopenic purpura
D. Vitamin K deficiency
E. Liver disease
F. Anatomical defect

17
101. Patient with widespread ovarian carcinoma had bowel obstruction and severe colic for 2 hrs and was
normal in between. What is the most appropriate management?
A. S/C morphine (PCA)
B. Spasmolytics
C. Palliative colostomy
D. Oral Morphine
E. Laxatives

102. A patient, from Africa, comes with nodular patch on the shin. It has a reddish brown colour. What is
the most probable diagnosis?
A. Lupus vulgaris
B. Erythema nodosum
C. Pyodermagangrenosum
D. Erythema marginatum
E. Solar Keratosis

103. A 24 year old woman has eight weeks amenorrhoea, right sided pelvic pain and vaginal bleeding.
She is apyrexial. Peritonism is elicited in the right iliac fossa. Vaginal examination reveals right-sided
cervical excitation. What is the most probable diagnosis?
A. Ectopic Pregnancy
B. Salpingitis
C. Endometriosis
D. Ovarian Torsion
E. Ovarian tumor

104. A 27 year old presents with abdominal pain, bleeding, vomiting and diarrohea. Her last menstrual
period was 7 weeks ago. On examination abdomen is tender and BP is 90/60mmHg. What is the next
appropriate management?
A. Immediate laparotomy
B. Laparoscopy
C. Salpingotomy
D. Salpingectomy
E. Metotrexate

105. A 55 year old alcoholic man complains of severe abdominal pain radiating to his back. He also
passes lose stool, pale stools and has weight loss. What is the most likely diagnosis?
A. Acute pancreatitis
B. Chronic pancreatitis
C. Esophagitis
D. Pancreatic carcinoma

106. A 30 year old gentle man is brought to hospital and is found to have increased blood pressure and
low serum potassium levels on examination. Which hormone should be tested?
A. Aldosterone
B. Cortisol
C. Adrenaline
D. Glucagon
E. Growth hormone

18
107. A 50 year old patient has been prescribed propranolol for a cardiac condition, but his GP now wants
to stop this drug. Which of the following is the most important reason for this decision?
A. Familial tremor
B. Partial AV heart block
C. Mild hypertension
D. Angina pectoris
E. Supraventricular tachycardias

108. A young woman was stabbed in the neck. On tongue protrusion, there was deviation to the right side.
Which nerve is involved?
A. Hypoglossal nerve injury
B. Accessory nerve
C. Vagus nerve
D. Glossopharyngeal nerve

109. A 20 year old male smoker is noted to have intense rubor of the feet and absent foot pulse. On
examination he was found to have amputated right 2nd toe. What is the most probable diagnosis?
A. Intermittent claudication
B. Cardiovascular syphilis
C. Buerger’s disease
D. Embolism
E. Acute limb ischemia

110. An elderly male who is immunocompromised has whitish plaques in the pharynx. He has dementia,
has stopped taking food due to the whitish plaques on the tongue. How will you treat this elderly male?
A. Fluconazole suspension E. IV Fluconazole
B. Nystatin suspension
C. Oral Miconazole
D. Oral Fluconazole

111. 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

112. A child living with his step father brought by the mother with multiple bruise, fever, fractures. What
do you suspect?
A. Non accidental injury
B. Malnutrition
C. Thrombocytopenia
D. HIV
E. Type 1diabetes

113. A 34 year old woman complains of low mood, loss of interest in everyday activities, loss of appetite
and weight. She also has trouble falling asleep and wakes up early in the morning. What is the best
treatment for her?

19
A. Fluoxetine—antidepressant--SSRI
B. Minaprine—antidepressant-MAOI
C. Moclobemide – antidepressant--Reversible selective MAOI
D. Curcumine chemical curcuminoid –turmeric

114. 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

115. A 25 year old woman , 38 weeks pregnant , presents with blood pressure of 160/100 and +++
proteinuria . Her AST was 35 and ALT of 40. HB =12.7 g/dl. WBC count of 8×109 Platelet count of
115×109. What is your diagnosis?
A. Eclampsia
B. Preeclampsia
C. HELLP
D. Acute hepatitis

116. A 45 year old lady is found to have CIN 2 on routine test. What is the most appropriate next step?
A. Cervical biopsy
B. Smear
C. Colposcopy
D. Transvaginal ultra sonography

117. A 25 year old man presents with multiple silver scaly lesions over the extensor surfaces of his elbow
and knees. He also has nail pitting and arthropathy and is worried that it might spread to his colleagues at
work. What is the most appropriate option?
A. Admit and isolate
B. Reassure not contagious
C. Inform infection control team
D. Antibiotics

118. 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. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis

119. A 73 year old woman has lymphadenopathy and splenomegaly. She feels well but has had recurrent
chest infections recently. Choose the SlNGLE most likely blood film finding?
A. Atypical lymphocytes E. Numerous blast cells
B. Excess of mature lymphocytes
C. Plasma cells
D. Multiple immature granulocytes without blast cells

20
120. A 33 year old man is hit by a car. He loses consciousness but is found to be fine by the paramedics.
When awaiting doctor’s review in the A&E he suddenly becomes comatose. What is the most likely
diagnosis?
A. Subarachanoid haemorrhage
B. Subdural haemorrhage
C. Intracerebral haemorrhage
D. Extradural haemorrhage

121. A 34 year old woman complains of low mood predominantly in winter. She says she feels low every
year during winter and starts to feel better once spring arrives. What is the most likely diagnosis?
A. Depression
B. Mania
C. Seasonal affective disorder
D. Cyclothymia
E. Dysthymia

122. During a basketball match, one of the players suddenly collapsed to the ground with coughing and
shortness of breath. What is the investigation of choice for this patient?
A. Chest x-ray
B. CT scan
C. Magnetic resonance imaging (MRI)
D. V/Q scan
E. CT pulmonary angiogram (CTPA)

123. A 27 year old man presents with jaundice. On examination there is hepatosplenomegaly. Peripheral
blood film shows occasional spherocytes. What is the next appropriate investigation?
A. Direct Coomb’s test
B. Bone marrow test
C. Indirect Coomb’s test
D. RBC life span
E. Osmotic fragility test

124. 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

125. A 19 year old boy comes to A&E department. There is swelling, pain and tenderness 2cm distal to
Lister’s tubercle of radius. On examination proximal pressure on the extended thumb and index finger is
painful. The x- ray doesn’t show any fracture. What is the next appropriate management for the patient?

A. Immobilization with a cast

B. Repeat the x-ray
C. Magnetic resonance imaging (MRI)
D. Surgery
E. No treatment required

21
126. A 40 year old Man fell from 8ft high scaffolding . On Xray there was a fracture of the foot. Which
bone will be most likely fractured?
A. Calcaneus
B. Metatarsals
C. Phalanges
D. Tibia
E. Femur

127. A 23 year old woman has white discharge from her vagina. She had a 7 day course of broad
spectrum antibiotics before her dental procedure. What is the causative microorganism?
A. Chlamydia
B. Candida
C. Trichomonas
D. Gardnerella
E. NesseriaGonorrhea

128. A 48 year old man with renal cancer had radiotherapy for metastatic spinal cord compression at the
11th thoracic vertebrae 4 weeks ago. he had reduced sensation but is unable to stand. He has pain in the
band around the lower trunk which is controlled by regular oral Morphine. He is distressed by
increasingly frequent episodes of painful muscle spasms in his right leg. What is the most appropriate
treatment?
A. Amitriptyline
B. Gabapentin
C. Increased Morphine dose
D. Baclofen

129. A young child just diagnosed with chicken pox. Usually goes to day care. What is the most
appropriate advice?
A. Child should be admitted to hospital straight away
B. Isolate the child from parents and siblings at home
C. Advise him he can go back to nursery when the rash is crusted over

130. Patient with pain and swelling in left leg and thigh up to the level of inguinal ligament. Where is the
level of occlusion?
A. Femoro-popliteal artery
B. External iliac artery
C. Aortoiliac artery
D. Femoral artery

131. Infection of which of the following areas in the face will lead to pre auricular lymph node
enlargement?
A. Mastoid area
B. Mandibular area
C. Pinna of the ear
D. Upper eyelid

132. A 1 week old baby presents with projectile vomiting. On examination there is an olive shaped mass
in his abdomen. What investigation would you do for him initially?
A. Ultrasound abdomen D. CT abdomen
B. Check serum potassium
C. Laparoscopy

22
133. A 45 year old woman comes with complaints of bloody discharge from the nipple. No other
symptoms. What is the most likely diagnosis?
A. Pagets disease
B. Duct ectasia
C. Duct papilloma
D. Ductal Ca. in situ

134. A 50 years old man presents with low mood, poor concentration, anhedonia and insomnia. He has
had two episodes of increased activity, promiscuity and aggressive behaviour in the past. He was arrested
8 months ago for trying to rob a bank, claiming it as his own. Which drug is most likely to benefit him?
A. Haloperidol E. Ethosuximide
B. Citalopram
C. Desipramine
D. Carbamazepine

135. A 30 year old woman has injured her left lower chest in a RTA. She has BP 80/50mmHg, pulse
120bpm. Auscultation of chest and bowel sounds present. What is the single most likely diagnosis?
A. Diaphragmatic rupture E. Tension pneumothorax
B. Flail chest
C. Fracture of ribs
D. Ruptured oesophagus

136. A 65 year old alcoholic male is brought into hospital with aggression, confusion, diplopia and ataxia.
IV chlordiazepoxide has been started. Which other medication would you like to give?
A. Antibiotics
B. IV fluids
C. Acamprosate
D. Disulfiram
E. High dose B vitamins

137. Patient with a history of alcoholism, ataxic gait, hallucinations and loss of memory. He is given
acamprosate. What other drug you can give with this?
A. Chlordiazepoxde
B. Thiamine
C. Diazepam
D. Disulfiram
E. Haloperidol

138. A lady comes with severe liver disease and hematemesis. Her INR is more than 10. What should she
be given?
A. Fresh Frozen Plasma
B. Steroids
C. Whole blood
D. IV Fluids
E. Vitamin K

139. 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?

23
A. Jejunal villous atrophy D. Increased catabolism
B. Chronic diarrhoea secretions E. Increased secretions of acids
C. Malabsorption

140. A 33 year old male came to the hospital with complaints of occasional left sided chest pain that lasts
less than 30 minutes, following exercise, which relieves upon taking rest. What is the most probable
diagnosis?
A. Unstable angina D. Coronary spasm
B. Decubitus angina E. Myocardial infarction
C. Stable angina

141. Lady with 10 months amenorrhea, hypokalaemia, BMI- 32. What is the most probable cause?
A. PCOS
B. Cushings
C. Primary hyperaldosteronism
D. Pheochromocytoma

142. A 64 year old man who has urinary frequency for past 2 years now complains of anuria. He is taking
nifedipine and propranolol. What is the mechanism of his anuria?
A. Drug induced
B. Diabetes
C. Enlarged prostate gland
D. High blood pressure
E. Cancer of the bladder

143. 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. Wernicke’s Encephalopathy
D. Infection toxicity
E. Hypoglycemia

144. What is the mode of spread of chickenpox? Chose from the following options :
A. Airborne
B. Close contact
C. Feco-Oral
D. Blood
E. Vector borne

145. A boy with a history of recurrent swollen tender joints on both knees and elbows and not able to
participate in sports. What is the investigation of choice to diagnose his case?
A. Rheumatic factor/ASO titre
B. Clotting factor
C. ESR
D. Xray

24
146. A 58 year old man presented with chest pain, breathlessness and weight loss. He is a non-smoker
and is a shipyard worker. CXR is shown below. What is the most probable diagnosis?
A. Lung cancer
B. Mesothelioma
C. Pneumonia
D. T.B

147. A 35 year old woman came for a routine cervical smear examination. . Inflammatory changes were
seen. her past cervical smears have been negative. She does not complain of any discharge or any other
symptom. What will you do next?
A. Repeat cervical smear in 3yrs
B. Repeat smear in 6months
C. Colposcopy
D. Cauterization
E. Take swab

148. A 62 years old man has slow palpitations and the following ECG. What is the most likely diagnosis?

A. Sinus Bradycardia
B. First Degree Heart Block
C. Mobitz Type I Block
D. Mobitz Type II Block
E. Complete Heart Block

149. A 40 year old lady was bitten by a bee on her right hand 3 weeks ago. She has past history of past
medical history breast cancer for which she had Radiotherapy and surgery with axillary clearance She
presents to accident and emergency department with swelling of the right hand. What is the single most
likely diagnosis?
A. Anaphylaxis
B. Delayed allergic reaction
C. Cellulitis
D. Lymphoedema
E. Superior vena cava obstruction

150. A 75 year old alcoholic presents with a mass up to the umbilicus, urinary dribbling, incontinence,
and clothes smelling of ammonia. What is the next step in management?
A. Urethral catheter
B. Suprapubic catheter
C. Antibiotics

25
D. Condom catheter
E. Nephrostomy

151. A 15 year old boy presents with generalized oedema. His urinalysis reveals +++ proteins. His eGFR
is 110. Which one of the following is the most likely diagnosis?
A. IGA nephropathy
B. Membranous nephropathy
C. Minimal change disease
D. Post streptococcal glomerulonephritis
E. Lupus nephritis

152. A 7 year old child is being investigated for tuberculosis. His parents do not agree on taking a
broncho-alveolar lavage sample under general anaesthesia (GA).What other sample will show growth of
the organism?
A. Blood
B. Throat swab
C. Gastric washings
D. Mantoux
E. Cerebrospinal Fluid (CSF)

153. A 36 year old gravida 1 woman with gestational age of 30 weeks was brought to A&E as she started
to have bleeding from vagina. The bleeding was fresh and painless and was not preceded by trauma. On
examination her abdomen was not tender, BP was 90/60mmHg, pulse rate was 130/min, US shows low
lying placenta, CTG shows normal fetal heart sounds. How will you best manage this patient?
A. IV fluids → Blood trandfusion → delivery
B. IV fluids → blood transfusion→ investigations → delivery
C. Investigations→ IV fluids→ blood transfusion→ delivery
D. Deliver baby immediately

154. A 45 years old female looking pale, has bluish discoloration of hands whenever she goes out in cold.
She has also noticed some reddish spots on her body. She has symmetrical peripheral arthropathy for last
1-2 years. What is the most probable diagnosis?
A. Rheumatoid Arthritis
B. Osteosarcoma
C. Limited Systemic Sclerosis
D. Diffuse Systemic Sclerosis
E. Chondrosarcoma

155. A 22year old man says that he can hear the voice of his deceased uncle telling him that he is being
spied on. The patient is distressed by this and is becoming low in mood and anxious and has not left the
house for 2weeks. He is starting to drink increasing quantities of alcohol. He is noticed to have thought-
block and passivity phenomena. What is the single most suitable medication to treat his symptom?
A. Diazepam
B. Disulfiram
C. Fluoxetine
D. Lithium
E. Olanzapine

156. A 74year old woman. Presents with recurrent collapse and falls. She lives a quiet life and has a
mark/scar on side of head. What is the diagnosis?

26
A. Hypoglycemia
B. Subdural hematoma
C. Aortic stenosis
D. Vasovagal syncope
E. carotid sinus syncope

157. A man has a BP of 160/90mmHg, proteinuria ++. On ultrasound kidneys are equally reduced in size
with smooth borders and normal pelvicalyceal system. What is the cause of hypertension in this man?
A. Chronic glomerulonephritis
B. Chronic Pyelonephritis
C. Bilateral Renal Artery Stenosis
D. Essential HTN
E. Polycystic Kidney

158. A 37 years old lady strongly believes that a famous politician has been sending her flowers every
day and is in love with her. However, this is not the case. What is the most appropriate diagnosis?
A. Erotomania
B. Pyromania
C. Kleptomania
D. Trichotillomania
E. Grandiosity

159. Pregnant woman at 34 weeks gestation presents with tingling and numbness with altered sensation of
her right middle and index finger. Tinel’s sign is negative. What is the most likely diagnosis?
A. Carpal Tunnel
B. Radial nerve entrapment
C. Blackberry’s thumb
D. Mallet finger

160. A middle aged man who has history of chronic sinusitis, nasal obstruction, blood stained nasal
discharge. He now presents with cheek swelling, epiphora, ptosis, diplopia and maxillary pain. What is
the single most likely diagnosis?
A. Nasopharyngeal cancer
B. Pharyngeal cancer
C. Sinus squamous cell cancer

161. A 70 year old lady who has been treated on Carbamazepine for epilepsy, she now presents with
shortness of breath and light headedness. Blood results show MCV 70, Hb 8.5g/dl, WBC 2, Neutrophils 1
and Platelets 50.
A. Aplastic anaemia
B. Hereditary spherocytosis
C. Pernicious anaemia
D. Folate deficiency anaemia
E. Haemorrhagic anaemia

162. 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

27
163. Which of the following electrolyte abnormalities is most likely to be seen in SIADH?
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, high serum osmolarity, low urine osmolarity
E. Normal Na, normal serum osmolarity, normal urine osmolarity

164. A 76 years old man presents with cough and haemoptysis. What is the most probable diagnosis
based on the Xray?

A. Lung Cancer
B. Bronchiectasis
C. COPD
D. Goodpasture’s Disease
E. Wegener’s Granulomatosus

165. A 50 year old lady who had fallen in a shopping centre was brought to the accident and emergency
department. She reported to have an attack of palpitations for 30 seconds before collapsing. An ECG was
done and shows atrial fibrillation. What is the single most appropriate treatment?
A. Digoxin
B. Warfarin
C. Amiodarone
D. Metoprolol
E. Flecanide

166. A 46 year old man is being investigated for indigestion. Jejunal biopsy shows deposition of
macrophages containing Periodic acid–Schiff (PAS) – positive granules with clumps. What is the most
likely diagnosis?
A. Bacterial overgrowth
B. Coeliac disease
C. Tropical sprue
D. Whipple’s disease
E. Small bowel lymphoma

167. A new mother has been feeling tired, tearful and overwhelmed for the past 2 weeks after the birth of
her baby. She feels like she cannot cope and is unfit to take care of the child. What is your most likely
diagnosis?

28
A. Postpartum Blues
B. Postpartum Depression
C. Postpartum Psychosis
D. Psychotic Depression

168. A girl with history of allergies visited a friend’s farm. She got stridor, wheeze and erythematous
rash. What is the most appropriate treatment?
A. 0.25ml IM adrenaline
B. 0.25ml PO adrenaline
C. 0.25ml IV adrenaline
D. IV chlorpheniramine

169. A man had a soft mass on his mandible. Mass is freely mobile and has started growing progressively
over the past six months. The mass still moves freely. What is the best investigation for this patient?
A. Fine-needle aspiration cytology (FNAC)
B. CT scan
C. X ray
D. Magnetic resonance imaging (MRI)
E. Erythrocyte sedimentation rate (ESR)

170. A 28 year old lady with a family history of cystic fibrosis comes for genetic counselling and wants
the earliest possible diagnostic test for cystic fibrosis for the baby she is planning. She is not in favour of
termination. What would you recommend for her?
A. Chorionic villous sampling
B. Amniocentesis
C. Pre implantation genetic diagnosis
D. Chromosomal karyotyping
E. Maternal serum test
F. Reassure

171. A woman presents with hematuria and her blood tests reveal ANA positive. What is the most likely
condition she is suffering from?
A. Good pasture's syndrome
B. Nephrotic syndrome
C. Urinary tract infection
D. SLE
E. Urinary tract trauma

172. A 85 year old man fell down and hit his head. 5 days later he came back with confusion. Which is
the most likely site of bleeding?
A. Middle meningeal artery
B. Internal cerebral artery
C. Cerebral vein plexus
D. Berry aneurysm

173. A 30 year old lady with two months history of abdominal cramps, bloating, blood, mucus in stool.
Most appropriate initial investigation :
A. Colonoscopy
B. Fecal occult blood
C. Stool culture and sensitivity
D. Fecal calprotectin

29
174. A 25 years old woman presents with single lump in the breast and axilla. The lump is mobile and
hard in consistency. The ultrasound, mammogram and fine needle aspiration turned out to be normal.
What is the most appropriate investigation to confirm the diagnosis?
A. Fine Needle Aspiration Cytology (FNAC)
B. Magnetic resonance imaging (MRI)
C. Punch biopsy
D. Genetic testing and counselling
E. Core biopsy

175. A 6 year old sick looking child presents with high fever, drooling of saliva and breathing difficulty.
X ray of the neck shows thumb sign. What is the INITIAL step of management?
A. Adrenaline inhalation
B. Oxygen inhalation
C. Intubation
D. I.V Hydrocortisone
E. I.M MgSO4

176. A 25 year old woman was brought to the A&E by her boyfriend. She has many superficial
lacerations. On examination there are many scars of old cut in her forearm. She is so distressed and
constantly says her boyfriend is going to end the relationship. She denies trying to end her life. What is
the most likely diagnosis?
A. Acute psychosis
B. Severe depression
C. Psychotic depression
D. Border line personality disorder
E. Schitzophrenia

177. 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. Conn’s Disease
C. Ectopic Adreno-corticotropic hormone (ACTH)
D. Cushing’s Disease
E. Hypothyroidism

178. 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

179. A 57 year old man who had myocardial infarction a few months ago has been having low mood. A
diagnosis of moderate depression has been established. Which medication is the best treatment for him?

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A. Selective serotonin re-uptake inhibitors (SSRI)
B. TACs
C. Monoamine oxidase inhibitor (MAOI)
D. Benzodiazepams
E. Mood stabilisers

180. A 50-year-old woman presents following a fall. She reports of pain and weakness in her hands for
several months, stiff legs and swallowing difficulties and has bilateral wasting of the small muscles of her
hands. Reflexes in the upper limbs are absent. Tongue fasciculations are present and both legs show
increased tone, pyramidal weakness and hyper reflexia with extensor plantar response. Pain and
temperature sensation are impaired in the upper limbs. What is the most likely diagnosis?
A. Multiple Sclerosis
B. Motor Neuron Disease
C. Syringobulbia
D. Syringomyelia
E. Myasthenia Gravis

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