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SAMSONPLAB

ACADEMY LIMITED
BOW BUSINESS CENTRE
BOW ROAD 153-159
E3 2SE
LONDON.
EMAIL: info@samsonplab.co.uk
TELEPHONE: +44 02089800039: MOBILE: +447940433068
PLAB 1 MOCK 1 DATE: 1st JUNE 2013

1. A 56year old nulliparous woman with a BMI of 37 has a four-month history of blood
stained discharge. She is otherwise normal. What is the single most likely diagnosis?
a. Atrophic Vaginitis
b. Bacterial Vaginosis
c. Endometrial Carcinoma
d. Candidiasis
e. Chlamydia

2. A 23year old woman has been taking the combined oral contraceptive pill for 4 years.
She has a troublesome clear, sticky discharge with no odour or itching. What is the
single most likely diagnosis?
a. Cervical cancer
b. HIV Infection
c. Ectropion
d. Gonorrhea
e. Chlamydia

3. A 25year old pregnant woman has a slight increase in vaginal discharge with vulval
itching. Her partner has recent balanitis. What is the single most likely diagnosis?
a. Ectropion
b. Cervical polyp
c. Cervical carcinoma
d. Candidiasis
e. Atrophic Vaginitis

4.

5.

6.

7.

8.


A 76year old woman has vaginal soreness and an intermittent pink staining on her
underwear. She is not on any medication. What is the single most likely diagnosis?
a. Atrophic vaginitis
b. Bacterial vaginistis
c. Endometrial carcinoma
d. Candidiasis
e. Chlamydia

A 19-year-old woman in a new sexual relationship has a vaginal discharge of sudden
onset. There is intense itching at the introitus and examination reveals a frothy
discharge with redness of her vulva. What is the single most likely diagnosis?
a. Syphilis
b. HIV Infection
c. HPV
d. Trichomonas Infection
e. Gonorrhea

A 62year old woman has right-sided headaches with malaise, weight loss and
depression. What is the single most appropriate investigation?
a. Temporal artery biopsy
b. ESR
c. Skull X-Ray
d. Nerve conduction studies
e. MRI imaging of brain.

A 56year old man has sudden severe occipital headaches, drowsiness and vomiting.
What is the single most initial appropriate investigation?
a. CT Scan of brain
b. No investigation required
c. Carotid arteriograph
d. Lumbar puncture
e. Temporal artery biopsy

A 45year old woman has right-sided headaches, nausea and visual disturbance. This
lasted for 24 hours and she is fine. She was recently started on hormone replace
therapy. What is the single most initial appropriate investigation?
a. Temporal artery biopsy
b. ESR
c. No investigation
d. Nerve conduction studies

e. MRI imaging if brain



9. A 46year old man has a headache and confusion three days after slipping in the garden.
What is the single most appropriate investigation?
a. CT Scan of the brain
b. No investigation required
c. Carotid arteriogram
d. Lumbar puncture
e. Temporal artery biopsy

10. A 58year old man presents with chest pain, which is aggravated by exercise but
relieved with GTN spray. He has recurrent episodes of pain. Examination is normal and
ECG shows new T depression in lead II, III and a VF. What is the single most initial
combination to administer?
a. Antiplatelet drugs and low molecular weight heparin
b. Anti-platelet drugs and pravastin
c. Anti-platelet drugs and streptokinase
d. Low molecular weight heparin and warfarin
e. Low molecular weight heparin and pravastin

11. A 60year old woman has increasing frequency and urgency leading to occasional
incontinence for 3 months. Abdominal and renal examination is normal. What is the
most appropriate initial investigation?
a. Flexible cystoscopy
b. Retrograde cystourethrography
c. Ultrasound scan of the kidneys
d. Urinalysis for nitrates and leucocytes
e. Urodynamic studies

12. A 30year old man has developed a red raised lesion on his trunk and limbs after playing
football one hour ago. He is feeling unwell with a slight cough. He had asthma, as a child
but is otherwise well. The rash is becoming increasingly itchy. What is the most initial
appropriate treatment?
a. Intravenous adrenaline
b. Intravenous dexamethasone
c. Oral prednisolone
d. Oral Chlorpheniramine
e. Intravenous penicillin

13. A 38-year-old woman has low mood, early morning awakening and poor appetite for six
weeks. She had a similar episode 12 years ago and a further admission with over
activity, irritability and grandiose. What is the single most likely diagnosis?
a. Post partum blues
b. Post partum depression
c. Bipolar affective disorder
d. Recurrent depressive disorder
e. Schizo-affective disorder

14. A 47-year-old man has diurnal mood variation, early morning awakening and loss of
interest and negative thoughts for four weeks. He has had no such previous episodes,
he has been made redundant recently and as a result his house has been repossessed.
What is the single most likely diagnosis?
a. Anxiety depressive disorder
b. Bipolar affective disorder
c. Major depressive disorder
d. Depression with personality disorder
e. Depression with psychotic symptoms

15. A 32-year-old woman has poor concentration and forgetfulness for four weeks. She
feels sad and tired with insomnia and poor appetite. What is the single most likely
diagnosis?
a. Post partum blues
b. Post partum depression
c. Post partum psychosis
d. Recurrent depressive disorder
e. Depressive pseudo-dementia

16. A 29-year-old woman has had delusions of poverty and guilty ideas for some time. He
has not had any such previous episodes. He is convinced that spies are after him and
trying to kill him. He also admits to feeling lethargic. What is the single most likely
diagnosis?
a. Anxiety depressive disorder
b. Bipolar affective disorder
c. Depressive personality disorder
d. Post partum blues

17. A 30-year-old lady has developed breast abscess 2 days after delivery of her second
baby. What is the single most likely causative organism?
a. E. Coli
b. Group B beta haemolytic streptococcus

c. Staphylococcus albus
d. Staphylococcus faecalis
e. Staphylococcus aureus

18. A 28-year-old lady developed her baby after 10 days feels that she is not good enough
to take care of the baby and has a low mood, not eating well, exhaustion, inability to
enjoy things that she previously enjoyed and sleep disturbance.
a. Post partum depression
b. Post partum psychosis
c. Major depressive disorder
d. Depressive personality disorder
e. Depression with psychotic symptoms

19. A 57-year-old man recently underwent prostatectomy. Seven days later he develops
pain and swelling of his left leg. This was later confirmed as deep venous thrombosis
and he has to be started on warfarin. What is the optimal INR for this patient?
a. < 1
b. 1-2
c. 2-3
d. 3-5
e. >5
20. A 2-year-old boy has been unable to bear weight since the fall from a chair the previous
night. He is tender in the mid-tibia but there is no obvious deformity. What is the single
most likely radiographic appearance?
a. Angulated fracture
b. Compound fracture
c. Epiphyseal fracture
d. No trauma likely
e. Spiral fracture

21. An 8-year-old girl had recurrent central abdominal pains since 6 months. She also has
occasional headaches. She maintains a normal appetite. There are no abnormal signs.
FBC, Urinalysis and stool microscopy are normal. What is the single most appropriate
management?
a. Proton pump inhibitor
b. Pyeloplasty (+/- percutaneous nephrostomy)
c. Triple therapy
d. Reassurance
e. Sulphasalazine

22. An 8-year-old boy has symptoms of right-sided abdominal pain. He has had symptoms
of UTI in the past. Abdominal Ultrasound shows right-sided hydronephrosis and
excretory isotope scan conforms PUJ obstruction. What is the single most appropriate
management?
a. Pancreatic enzymes
b. Metoclopramide
c. Pyeloplasty (+/- percutaneous nephrostomy)
d. Enema and laxative
e. Aspirin

23. A 14 year old boy has had recurrent abdominal pains, malaise and weight loss over 6
months. He has had a vague mass in the right iliac fossa. Colonoscopy and biopsy of the
caecal area shows transmural inflammation and granulomata. What is the single most
appropriate management?
a. Sulphalazine
b. Appendicectomy
c. Aspirin
d. Enema and Laxatives
e. Gluten free diet


24. An 8 year old has had recurrent abdominal pain for 2 months. His appetite is reduced
and he has faecal soiling. There are pitting masses throughout the abdomen. He has a
dilated rectum. What is the single most appropriate management?
a. Proton pump inhibitor
b. Pyeloplasty (+/- percutaneous nephrostomy)
c. Enema and laxative
d. Aspirin
e. Triple therapy

25. A 12 year old has recurrent abdominal pain which is worse when he is hungry. The pain
is relieved by food or meal. He is tender in the epigastrium. Test has revealed H. pylori
infection. What is the single most appropriate management?
a. Proton pump inhibitor
b. Enema and laxative
c. Aspirin
d. Gluten free diet
e. Metoclopramide

26. A 26-year-old man presents to the A & E department with shortness of breath of 3 days
duration. He has been coughing during the night and using his salbutamol inhaler more
frequently. What is the single most appropriate investigation?
a. Arterial blood gases
b. Chest X-ray
c. Electrocardiogram (ECG)
d. Haemoglobin
e. Magnetic resonance Imaging Scan (MRI) of the chest

27. A 22-year-old man presents to the A & E with sudden onset of sharp right-sided chest
pain and shortness of breath. There is reduced air entry in the right side of the chest.
What is the single most appropriate investigation?
a. Peak Expiratory Flow
b. Pulse Oximetry
c. Spiral Computed Tomography Scan of the chest
d. Chest X-ray
e. Arterial blood gases

28. A 78-year-old woman is brought by her family to the A & E department with shortness
of breath and occasional cough over the previous 72 hours. There is a coarse crepitation
present at the right lung base. What is the single most appropriate investigation?
a. Arterial blood gases
b. Chest X-ray
c. Electrocardiogram (ECG)
d. Haemoglobin
e. Magnetic resonance Imaging Scan (MRI) of the chest

29. A 26 year old woman how has returned from a holiday in America develops sudden left
sided chest pain and breathlessness. Her chest is clear. What is the single most
appropriate investigation?
a. Peak expiratory flow
b. Pulse Oximetry
c. Spiral Computed Tomography (CT) Scan pulmonary angiogram of the chest
d. Chest X-ray
e. Arterial blood gases

30. A 23-year-old man with type 1 diabetes presents with 48 hours of increasing confusion
and breathlessness. His chest is clear and his blood glucose concentration is
28mmmol/l. What is the single most appropriate investigation?
a. Chest X-ray
b. Arterial blood gases

c. Electrocardiogram (ECG)
d. Haemoglobin (Hb)
e. Magnetic Resonance Imaging (MRI) Scan of the chest

31. A 55-year-old man has weight loss, dyspnea and syncope. He smokes 20 cigarettes a
day. Investigation confirms squamous cell carcinoma in the left bronchus. What is the
single most important likely biochemical abnormality to be associated with the
condition?
a. Hyperkalaemia
b. Hypercalcaemia
c. Hypernatremia
d. Hypocalcemia
e. Hypomagnesemia

32. A 21-year-old woman in her first pregnancy has been admitted at 39 weeks gestation
with breech presentation. She has had an eclamptic fit at home. She is conscious and
observations are stable. What is the single most appropriate IV therapy to prevent
further fits?
a. Clomethiazole
b. Diazepam
c. Labetalol
d. Magnesium Sulphate
e. Phenytoin

33. A 14-year-old girl developed an itchy, scaly patch on her scalp. She has a similar patch
that cleared spontaneously 2 years ago. Her aunt had similar undiagnosed rash on the
extensor aspects of her elbows and knees. What is the single most likely diagnosis?
a. Eczema
b. Fungal Infection
c. Impetigo
d. Lichen Sclerosis
e. Psoriasis

34. A 58-year-old man suddenly becomes shocked several days after suffering an acute
myocardial infarction. His chest X-ray shows a large globular shaped heart and clear lung
fields. What is the single most likely diagnosis?
a. Acute pericarditis
b. Atrial thombus
c. Cardiac tamponade
d. Heart block
e. Left Ventricular Aneurysm


35. A 63-year-old man continues to experience chest pain and has mild pyrexia two days
after an acute myocardial infarction. His ECG shows widespread ST elevation and
upward concavity. What is the single most likely diagnosis?
a. Left Ventricular endocardial thrombus
b. Post Myocardial Infarction (Dresslers Syndrome)
c. Acute Pericarditis
d. Ruptured Intraventricular Septum
e. Ruptured Papillary muscle

36. A 48-year-old man has continuous anterior chest pain, worse on inspiration and pyrexia
four weeks after a myocardial infarction. His ESR is raised. What is the single most likely
diagnosis?
a. Left Ventricular endocardial thrombus
b. Post Myocardial Infarction (Dresslers Syndrome)
c. Acute Pericarditis
d. Ruptured Intraventricular Septum
e. Ruptured Papillary muscle

37. A 60-year-old woman suddenly develops severe left ventricular failure following a
myocardial infarction. Her echocardiogram demonstrates mild regurgitation. What is
the single most likely diagnosis?
a. Left Ventricular endocardial thrombus
b. Post Myocardial Infarction (Dresslers Syndrome)
c. Acute Pericarditis
d. Ruptured Intraventricular Septum
e. Ruptured Papillary muscle

38. Aar 55 year old man returns for routine follow up 6 weeks after myocardial infarction.
He gets breathless when walking uphill. His ECG shows ST elevation in the anterior chest
leads. What is the single most likely complication?
a. Left Ventricular endocardial thrombus
b. Post Myocardial Infarction (Dresslers Syndrome)
c. Acute Pericarditis
d. Ruptured Intraventricular Septum
e. Left Ventricular Aneurysm


39. A 70-year-old man is brought to the A & E department by her daughter following an
overdose of 10 paracetamol tablets. His wife died 2 weeks ago. His only relevant past

medical history was treatment for depression 10 years ago. His paracetamol level is
below the treatment level. What is the most appropriate initial management?
a. Referral for Social worker
b. Discharge home with advice
c. Refer for urgent psychiatric opinion
d. Refer for clinical psychiatric opinion

40. A 24-year-old woman fell and injured her right knee. The knee is swollen and tender to
valgus stressing. Which of the following ligament is the most likely to have been
damaged?
a. Anterior Cruciate
b. Lateral Collateral
c. Medical Collateral
d. Oblique Popliteal
e. Posterior

41. A 22-year-old man has had acute painful, red eye with blurring of vision for one day. He
had similar episodes 1 year ago and has had back pain and stiffness relieved by exercise
and diclofenac for years. What is the single most likely cause of the red eye?
a. Retinitis
b. Conjuctivitis
c. Iritis
d. Scleritis
e. Glaucoma

42. A 70-year-old man has back pain, anaemia and weight loss of gradual onset. In addition
to renal failure, he has hypercalcaemia. What is the most appropriate investigation?
a. ANCA
b. Bone marrow aspirate
c. Creatinine clearance
d. Culture of MSU specimen
e. Cystoscopy

43. A 55-year-old man has leg swelling. He has heavy proteinuria and his serum creatinine
concentration is 185mmol/l. What is the single most appropriate investigation?
a. IVU
b. Nuclear scan
c. Renal biopsy
d. Renal Ultrasound
e. Serum cholesterol concentration

44. A 75-year-old man has had a frequency of micturition, poor urinary stream and some
incontinence for 2 years. His serum creatinine concentration is 350mmol/l. What is the
single most appropriate investigation?
a. ANCA
b. Bone marrow aspirate
c. Creatinine clearance
d. Culture of MSU specimen
e. Cystoscopy
f. Ultrasound of the Kidneys

45. A 65-year-old woman has urinary frequency, weight loss, hematuria and blood clots. An
abdominal ultrasound is inconclusive. What is the single most appropriate
investigation?
a. IVU
b. Nuclear scan
c. Renal Ultrasound
d. Serum cholesterol concentration
e. Cystoscopy

46. A 20-year-old woman with multiple sclerosis presents with blurring of vision and pain in
the eye on movement. Where is the lesion?
a. Cerebellum
b. Optic Discs
c. Optic nerve
d. Occipital
e. Retina

47. A 65-year-old man after an open cholecystectomy experiences numbness around the
umbilicus. Which nerve is damaged?
a. Diaphragmatic nerve
b. T4 nerve
c. Intercostal nerve
d. L1-L2 nerve root
e. T10 nerve root

48. A 30-year-old lady presents with sudden onset of right-sided iliac fossa pain. She also
experiences shoulder tip pain. What is the single most likely nerve damage?
a. Phrenic nerve
b. T12 nerve root
c. T5 nerve root
d. T10 nerve root

e. Intercostal nerve

49. A 25-year-old woman is 8 weeks pregnant. She has experienced a degree of vaginal
bleeding and severe left sided abdominal pain. Her pulse rate is 100beats/ minute and
her BP is 110/75mmHg. There is marked cervical excitation on vaginal examination.
What is the single most appropriate management?
a. Administration of anti-D
b. Bimanual vaginal examination
c. Blood transfusion
d. Coloscopy
e. Culdocentensis

50. An 18-year-old woman who is 13 weeks pregnant has a single episode of painless post
coital bleeding. The fetal heart is audible during the Doppler scan. What is the single
most appropriate management?
a. Evacuation of retained products
b. Group and save serum
c. Laparoscopy
d. Monitor
e. Oral stilbesterol

51. A 28-year-old woman who is 10 weeks pregnant has had vaginal bleeding and period
like pain for 5 days. Over the next 48 hours the symptoms have decreased. Examination
is inconclusive. Beta HCG is very low and US Scan reveals minimal uterine contents.
What is the single most appropriate management?
a. Speculum examination
b. Ultrasound scan
c. Blood transfusion
d. Colposcopy
e. Evacuate products of conception

52. A 28-year-old woman who is 9 weeks pregnant has a small amount of spontaneous
vaginal bleeding. She has a mild vague lower abdominal pain. Her uterus is non-tender
and equivalent for dates. What is the single most appropriate management?
a. Administration of Anti-D
b. Bi-manual vaginal examination
c. Blood transfusion
d. Culdocentensis
e. Transvaginal USS

53. A woman who is 10 weeks pregnant has heavy vaginal bleeding with marked uterine
pain. Her pulse rate is 110 beats/min and BP is 110/75mmHg. Vaginal examination
confirms that the blood is uterine and her cervix has begun to dilate.
a. Evacuation of retained products
b. Group and save serum
c. Laparoscopy
d. Monitor
e. Oral stilbesterol

54. A 23-year-old lady with multiple sclerosis presents with ataxia, dysarthria and
nystagmus. Which of the following is the most likely location of the lesion?
a. Spinal cord
b. Brain stem
c. Cerebellum
d. Cerebral cortex
e. Medulla oblongata

55. A 45-year-old man presents with headache and vomiting. He is diagnosed with
meningitis and a decision to perform a lumbar puncture has been made. Which of the
following structure will be pierced just before reaching the desired space?
a. Dura mater
b. Pia mater
c. Skin
d. Longitudinal muscles
e. Arachnoid mater

56. A 40-year-old man presents with headache, vomiting and fever. He has been diagnosed
with meningitis. Which of the following is a correct landmark to perform a lumbar
puncture?
a. L4
b. Iliac crest
c. Superior anterior iliac spine
d. Cox cocedeus
e. L5 veterbrae

57. A man was involved in a fight and sustained a blow to his mastoid bone. Which one is
fractured?
a. Sphenoid bone
b. Mandibular bone
c. Temporal bone
d. Parietal bone

e. Occipital bone

58. A 35-year-old man is being investigated for infertility. Which of the following tests
would prove that he has complete azoospermia?
a. Prolactin
b. Oestrogen level
c. Testosterone
d. Gonadotrophin
e. Follicular stimulating hormone

59. A 70-year-old lady brings her husband who is 83 years of age. Which of the following
additional factor will confirm the diagnosis?
a. Progressive functional disorder
b. Fluctuating functional disorder
c. Incontinence of urine
d. Suicidal intention
e. Stepwise deterioration

60. A 5-year-old firl has had an upper respiratory tract infection (URTI) for 3 days and has
been treated with paracetamol by her mother. The last 12 hours, she has been hot and
irritable with severe pain in the right ear.
a. Acoustic neuroma
b. Chronic serous otitis media (glue ear)
c. Otitis media
d. Foreign body
e. Herpes zoster infection

61. A 38-year-old woman has just returned from a holiday where he went swimming every
day. For the last few days he has had irritation in both ears. Now his right ear is hot, red,
swollen and acutely painful. What is the most likely diagnosis?
a. Impacted wax
b. Mumps
c. Otitis media
d. Otitis externa
e. Perforation of eardrum

62. A 45-year-old man has a smooth, tender swelling extending from the ear to the angle of
the jaw of sudden onset. He has a temperature of 38.5 C. What is the single most likely
diagnosis?
a. Presbycusis
b. Temporomandibular joint pain

c. Trigeminal neuralgia
d. Mumps
e. Otitis media

63. An 18-year-old man has a smooth, tender swelling from the ear to the angle of the jaw
of sudden onset. He has a temperature of 38.5 C. What is the single most likely
diagnosis?
a. Presbycusis
b. Temporomandibular joint pain
c. Trigeminal neuralgia
d. Mumps
e. Otitis media

64. A 75-year-old woman has weakness of the left side of her face. She has had a painful ear
for 48 hours. There are pustules in the left ear canal and on the eardrum. What is the
single most likely diagnosis?
a. Impacted earwax
b. Mumps
c. Otitis externa
d. Otitis media
e. Perforation of the eardrum
f. Ramsay Hunt syndrome

65. A 45-year-old woman has her left ear syringed 48 hours ago. During this procedure, she
dad acute pain. Now she has discharge and deafness. Which vein is likely to be
involved?
a. Perforated ear drum
b. Azygous vein
c. Brachiocephalic vein
d. Cephalic vein
e. External iliac vein

66. A 43 year old has pain and stiffness to her leg. The limb is swollen and cyanosed from
the upper thigh to her ankle. A large uterine mass is palpable. Which vein is likely to be
involved?

a. Inferior vena cava
b. Internal iliac vein
c. External iliac vein
d. Long saphenous vein
e. Median cubital vein


67. A 41-year-old woman has varicose vein on the lateral side of her right lower leg. The
vein is tortuous and dilated. Which vein is likely to be involved?

a. Popliteal vein
b. Profunda femoris vein
c. Renal vein
d. Short saphenous vein
e. Axillary vein

68. A 25-year-old man has a varicosity on his lower abdominal wall. There is a small
testicular mass, which is subsequently found to be malignant. Which vein is likely to be
involved?

a. Axillary vein
b. Azygous vein
c. Brachiocephalic vein
d. Renal vein
e. External iliac vein

69. A 63 year old has pain and stiffness of his left leg. His calf is swollen and feels hard.
Which vein is likely to be involved?

a. Inferior vena cava
b. Internal iliac vein
c. Internal jugular vein
d. Long saphenous vein
e. Popliteal vein

70. A 28 year old man who has spent his weekend decorating his house has swelling and
discomfort in his right arm of sudden onset. The upper limb is swollen, congested and
cyanosed. Which vein is involved?
a. Popliteal vein
b. Profunda femoris vein
c. Renal vein
d. Short saphenous vein
e. Axillary vein

71. A 30-year-old lady presents with foul smelling discharge. Endocervical swab shows
trichomonas. Which of the following is the most appropriate treatment?
a. Amoxicillin

b.
c.
d.
e.

Metronidazole
Co-trimoxazole
Tetracycline
Ceftriaxone

72. A 69year old man with heart failure develops gout. He has recently been started on
treatment and his heart failure worsens. Which of the following is the most likely cause?
a. NSAIDS
b. B-blockers
c. Bendroflumethiazide
d. Calcium channel blocker
e. Allopurinol

73. A 7-year-old 7 days post tonsillectomy presents with nose bleed. He is currently not
bleeding. What is the most appropriate treatment?
a. Apply pressure on the soft part
b. Antibiotics
c. Reassure
d. Surgical exploration
e. Local adrenaline


74. A 3-year-old boy has a sudden onset of cough, shortness of breath and noisy breathing.
His mother reports that this is followed by a choking episode while he was playing.
a. Cystic fibrosis
b. Epiglottitis
c. Immunodeficiency
d. Inhaled foreign body
e. Recurrent aspiration

75. A 2-year-old boy has repeated chest infections, offensive loose stools and recurrent
rectal prolapsed.
a. Tracheomalacia
b. Tuberculosis
c. Asthma
d. Cystic fibrosis
e. Bronchiolitis

76. A 4-year-old girl who has had a runny nose for 12 hours has woken up 2 oclock in the
morning with difficulty in breathing a barking cough. What is the single most likely
diagnosis?

a.
b.
c.
d.
e.

Asthma
Bronchiectasis
Bronchiolitis
Bronchopulmonary dysplasia
Croup

77. A 4-year-old girl whose parents have refused to allow immunisations has a fever,
difficulty in breathing, stridor, drooling and central cyanosis. What is the single most
likely diagnosis?
a. Cystic fibrosis
b. Epiglottitis
c. Immunodeficiency
d. Inhaled foreign body
e. Recurrent aspiration

78. A 16-year-old footballer presents with sudden onset testicular pain, which started an
hour ago. What is the most likely diagnosis?
a. Trauma
b. Testicular torsion
c. Epididymo-orchitis
d. Varicocele
e. Hernia

79. A 70-year-old man who is on bendroflumethiazide develops an acute swelling of his
right knee. What is the single most appropriate diagnostic investigation?
a. Serum uric acid
b. Reactive protein
c. D-dimer
d. Blood culture
e. Plain x-ray of the knee

80. A 45-year-old man with diabetes mellitus has a high ferritin. What type of cancer is he
most likely to develop?
a. Liver cancer
b. Lung cancer
c. Renal cancer
d. Colonic cancer
e. Gastric cancer

81. A 70-year-old man had a painful swelling of his right testis for 36 hours. He has a history
of dysuria and frequency of micturition and has a temperature of 38.C

a.
b.
c.
d.
e.

Epididymal cyst
Epididymo-orchitis
Hydrocele
Inguinal hernia
Scrotal abscess

82. A 25-year-old man has had a painless enlargement of his left testes for 3 months. The
left testes are 3 months the size of the right testes and is non-tender. What is the single
most likely diagnosis?
a. Sebaceous cyst of the scrotum
b. Testicular hematoma
c. Testicular neoplasm
d. Hydrocele
e. Epididymal cyst

83. A 17-year-old lady presents to the A&E department after taking 45 tablets of
paracetamol following an argument with her boyfriend. The incident happened 10
hours ago. What is the single most appropriate next action?
a. Activated charcoal
b. Check paracetamol levels
c. N-acetylcysteine
d. Observe
e. Do blood tests after 4 hours

84. A 56-year-old man with known HIV presents with chronic diarrhoea. What is the most
likely cause?
a. Cryptococcus infection
b. Toxoplasmosis
c. Pneumocystic carinii
d. Cryptosporidium
e. Herpes zoster

85. A 65 year old man who is an intravenous drug abuser presents with weight loss and
macopapular rash. What is the single most likely cause?
a. Cryptococcus infection
b. HHV 8
c. Pneumocystic carinii
d. Human papilloma virus
e. Cryptosporidium

86. A 42-year-old woman has not had a period for 10 months. She feels well but she has hot
flushes. Her mother also had an early menopause.
a. Cervical smear
b. Chest ray
c. DEXA scan (Dual Energy X-Ray Absorptiometry)
d. FSH/LH

87. A 60-year-old woman under long-term follow-up after a lumpectomy and therapy for
breast cancer at the age of 50 comes to discuss her bone health following a stress
fracture to her metartarsal bone.
a. Lumbar spine X-ray
b. Dexa scan
c. Mid stream urine (MSU) culture
d. No investigation
e. Serum calcium concentration

88. A 36-year-old lady who is an intravenous drug user has had weight loss for the past 4
months. He now presents with drowsiness and increasing confusion. What is the single
most likely cause?
a. Cryptococcus infection
b. Toxoplasmosis
c. Pneumocystic carinii
d. Cryptosporidium
e. Herpes zoster

89. A 36-year-old woman is complaining of mood swings, palpitations and irregular
menses.
a. Transvaginal USS
b. FSH
c. Chest x-ray
d. DEXA scan (Dual Energy X-Ray Absorptiometry)
e. ECG

90. A 20year old mother brings her 2 year old child and she is worried that her child be
deaf as she is deaf herself. What is the single most appropriate investigation?
a. Audiometry
b. Turning fork
c. Audiometry brain stimulating
d. Reassure
e. Distraction test

91. A 75-year-old man is having a laparoscopic cholecystectomy. 2 ports on the lateral


abdomen have been inserted. When placing the 3rd port, which structure will be
damaged?
a. Linea alba
b. Latissimus dorsi
c. Pectoralis major
d. Skin
e. Intercostals muscle

92. A 21-year-old student has several episodes of palpitations, sweating, nausea and
overwhelming fear of sudden onset. On one occasion, she was woken from sleep in this
state and fears she is going insane. There is no previous history of any psychiatric
disorder. What is the single most likely diagnosis?
a. Adjustment disorder
b. Agoraphobia
c. Anorexia nervosa
d. Bipolar disorder
e. Panic attack

93. A 40-year-old businessman is worried that his alcohol consumption has reached
dangerous levels. He has recently changed jobs, which involve travelling and corporate
hospitality. He finds it increasingly difficult to give presentations to new business
associates and finds that alcohol helps him to function.
a. Major depressive episode
b. Obsessive compulsive disorder
c. Panic disorder
d. Post traumatic stress disorder
e. Social anxiety disorder

94. A 32-year-old mother is in tears, complaining of constant irritability with her 2 small
children and inability to relax. She describes herself as easily startled with poor sleep,
disturbed by nightmares, following a serious house fire one year ago while the family
slept.
a. Post traumatic stress disorder
b. Adjustment disorder
c. Agoraphobia
d. Anorexia nervosa
e. Bipolar disorder

95. A 49 year old man has returned home 6 times daily from work for the past many years
worried that he has left the taps running. His employers are concerned about his poor
work productivity.
a. Adjustment disorder
b. Agoraphobia
c. Anorexia nervosa
d. Obsessive compulsive disorder
e. Generalised anxiety disorder

96. A 40-year-old woman has acute symptoms of palpitations, sweating, difficulty in
breathing and feeling unsteady on her feet. She has noticed her symptoms occur only in
crowded public places.
a. Major depressive disorder
b. Obsessive compulsive disorder
c. Agoraphobia
d. Post traumatic stress disorder
e. Social anxiety disorder

97. A 75-year-old man has an episode of syncope while working in his garden. When visited
by his doctor 30 minutes later, he is in sinus rhythm; his pulse rate is 74-beats/ minute.
His blood pressure is 110/60mmhg and he has a systolic murmur. What is the single
investigation most likely to provide the definite diagnosis?
a. Coronary angiogram
b. Echocardiogram
c. Electrocardiogram
d. 24 hour ambulatory blood pressure
e. 24 hour taped ECG

98. An 83-year-old woman who is resident in a nursing home is admitted to hospital with a
four-day history of diarrhoea. She has had no weight loss or change in appetite. She has
been on analgesics for 3 weeks for her back pain. She is in obvious discomfort. On rectal
examination, she is found to have faecal impaction, what is the single most appropriate
immediate management?
a. Codeine phosphate for pain relief
b. High fibre diet
c. Oral laxative
d. Phosphate enema
e. Urinary catheterization

99. A 65-year-old man has a productive cough and fever. He has influenza and his
temperature is 38.5C. There is reduced air entry and crepitations bilaterally. What is the
single most likely cause of the pneumonia?
a. Haemophilus influenza
b. Klebsiella pneumonia
c. Mycoplasma pneumonia
d. Staphylococcus aureus
e. Streptococcus pneumonia

100. A 67-year-old lady has lung cancer and she suffers from heartburn, which increases
at night. She has tooth carries and has offensive moth odour. She cannot cope with it.
What is the single most appropriate treatment for her?
a. Erythromycin
b. Vancomycin
c. Metronidazole
d. Proton pump inhibitor
e. Ant H. pylori treatment

101. A 20-year-old man has a head on collision in a car. He is not breathless and has chest
pain as he fractured his 5-7th ribs. Chest x-ray confirms this fracture. What is the most
appropriate initial action?
a. Antibiotics
b. Analgesia
c. Oxygen mask
d. Physiotherapy
e. Refer to surgeon

102. A 54-year-old man comes with a sudden onset of palpitation and breathlessness. His
heart rate is 164beats/minute. What is the single most appropriate treatment in the
acute phase?
a. Adenosine
b. Metaprolol
c. Verapamil
d. Amiodarone

103. A young adult presents to the A&E after a motorcycle crash. The patient has bruises
around his left orbital area. His GCS is 13 on examination and a strong alcoholic breath
is noticed. Shortly afterwards, his GCS drops to 7. What is the single most important
initial assessment?
a. MRI brain
b. CT brain

c. Chest X-ray
d. CT angiogram brain

104. A 27-year-old woman at 34 weeks gestation in her first pregnancy attends ANC. Her
blood results showed Hb: 10.6, MCV: 95, MCHC: 350.
What should you do for her?
a. Folate
b. Dextran
c. Ferrous sulphate
d. None

105. A 60 years old man is on treatment for Ischemic Heart Disease and hypertension and
hyperlipidemia. During the night, he complains of wheezing and shortness of breath.
Which of the following medication is responsible for his symptoms?
a. Amlodipine
b. Atenolol
c. Ramipril
d. Simvastatin
e. Bendroflumethiazide

106. A 30-year-old man complains of pain in the loin with a blood pressure of
140/90mmHg. He is found to have proteinuria and hematuria. What is the investigation
would you do to confirm the diagnosis?
a. Ultrasound of abdomen
b. ANCA
c. ANA
d. Urine miscroscopy and culture
e. Stool culture

107. A 4-year-old girl is taken by her mother to the A&E with feeling of being unwell,
urinary urgency and 39.C temperature. What is the single next best investigation?
a. Catheter catch of urine
b. Clean catch of urine
c. Ultrasound
d. Intravenous Urography (IVU)
e. Suprapubic catch of urine

108. A 35-year-old lady comes with a 5-year-old child who has nystagmus, tinnitus and
deafness. The boy is found to have tumour in the cerebello-pontine angle. On
examination, the boy is found to have numerous cafe-au-lait spots seen on the back.
What is the inheritance ratio of this condition?

a.
b.
c.
d.
e.

100%
1:2
1:4
1:8
None

109. A 70 year old man with cerebral metastases develops cerebral edema and is being
given dexamethasone and antihypertensive drugs. His blood glucose rises to 17-
18mmol/l. What is the appropriate management?
a. Low dose insulin
b. Optimal dose of insulin
c. Glibenclamide
d. Stop dexamethasone

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


111. A 75 year old man complaining of dripping incontinence and has an ammonia smell.
On examination, he has a furred tongue and a painless abdominal mass with extension
to the umbilical level. Urine analysis shows proteins++ and nitrates+ with no growth.
What is the most appropriate management for this patient?
a. Suprapubic catheterization
b. Trimethoprim
c. Intraurethral catheterisation
d. Laparatomy
e. Condom catheter

112. What is the most appropriate antibiotic to treat uncomplicated Chlamydia infection
in a 21-year-old female who is not pregnant?
a. Erythromycin
b. Ciprofloxacin
c. Metronidazole
d. Cefixime

e. Doxycycline

113. A child complains of right iliac fossaa pain and diarrhoea. On colonoscopy, granular
transmural ulcers are seen near the ileocaecal junction.
a. Sulfalazine
b. Paracetamol
c. Ibuprofen
d. Metronidazole
e. Steroid.

114. A 42 year old man has been tired and sleepy for the last few weeks in the morning.
His work has started being affected as he feels sleepy in the meeting. His BMI is
36kg/m2. What is the single most likely diagnosis?
a. Idiopathic narcolepsy
b. Narcolepsy
c. Chest hyperventilation syndrome
d. Obstructive sleep apnoea syndrome
e. REM related sleep disorder

115. A 47 year old man with a history of ischemic heart disease complains of chest pain
with shortness of breath on exertion over the past few days. ECG is normal and
echocardiography shows decreased ejection fraction and decreased septal wall
thickening. What is the single most likely diagnosis?
a. Dilated cardiomyopathy
b. Constructive pericarditis
c. Amyloidosis
d. Subacute endocarditis

116. A 76 year old woman on paroxetine has increasingly become confused and weak.
What is the single most likely reason for her confusion?
a. Hypercalcemia
b. Hypernatremia
c. Hypocalcemia
d. Hypoglycemia
e. Hyponatremia

117. A 46 year old man is being investigated fro indigestion, jejuna biopsy shows
deposition of macrophages containing PAS positive granules. What is the most likely
diagnosis?
a. Bacterial overgrowth
b. Celiac disease

c. Tropical sprue
d. Whipples disease
e. Small bowel lymphoma

118. A 30 year old woman has IUCD inserted 8-9 months ago. Now on routine follow-up,
the thread is missing. Uterine ultrasound shows no IUCD in the uterus. What is the best
management?
a. Laparoscopy
b. Pelvic CT Scan
c. Laparotomy
d. Pelvic X-ray
e. MRI

119. A man with dementia has an ulverative lesion on this forehead. He wants it to be
removed so that it can improve his memory. The wife says he is not fit to give
consent. What will you do?
a. Get the GP to sign the consent
b. Get the wife to sign the consent
c. Get the patient to sign the consent
d. Refer to psychiatrist to assess the mental capacity to give consent

120. A 6 year old boy is brought to the A&E with pain in his left arm following a fall from a
tree on his outstretched hand. There is a swelling around his left elbow and a reduced
radial pulse. What is the most likely diagnosis?
a. Angulated fracture
b. Compound fracture
c. Epiphyseal fracture
d. No fracture
e. Spiral fracture

121. A young woman fainted in the street and was brought to the A&E. she weighs 33kg.
She is alert and well in the A&E and states she is on a diet and admits to not eating or
drinking anything for 48 hours. She is annoyed that she has been brought to the hospital
and adamantly states that she wants to leave. What is the most appropriate next step?
a. Detain her under the Mental Health Act
b. Refer to the dietician
c. Allow her to be discharged
d. Refer her to the GP

122. A woman with mild ulcerative colitis is not on any treatment. She develops diarrhoea
and mucus in the last 3 months. All other examinations are normal. Her Hb is 9.6gm/dl.
What is the single best treatment?
a. Magnesium sulphate
b. Ferrous sulphate
c. Mesalazine
d. Endoscopy
e. Colonoscopy

123. A smoker with several ulcers in the mouth and lower surface of the tongue and also
with white striae on the mouth.
a. Apthous ulcer
b. Lichen planus
c. Kaposi sarcoma
d. Cancer of the mouth

124. A middle aged man complains of a node which has been growing for several months.
Now it is firm and centrally depressed. What is the most likely diagnosis?
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Pyoderma gangrenosum
d. Melanoma
e. Necrobiosis lipoidica

125. A 76 year old man presents with loss of sensation on the middle part of the chin and
lower lip. Which nerve is involved?
a. Lingual
b. Inferior alveolar
c. Auricular
d. Submental
e. Buccal nerve

126. A 37-year-old man had hemicolectomy. Immediately after the operation, he
becomes aggressive not allowing doctors to give him analgesia. 2 days later the thanked
the doctor.
a. Delirium
b. Acute stress reaction
c. Depression
d. Adjustment disorder
e. Alcohol withdrawal

127. A 60-year-old lady has had breast surgery done for breast cancer. Which one of the
following will increase the chance of recurrence?
a. Sensitivity to oestrogen receptors
b. Lymph node involvement
c. Presence of BRA 1 and 2 gene
d. Family history
e. Age

128. A 24-year-old schizophrenic man has recently been depressed. He is on treatment
for schizophrenia and depression. Which one of the following increases his risk for
suicide?
a. Alcohol
b. Fluoxetine
c. Haloperidol
d. Carbamazepine
e. Olanzepine

129. A man has been diagnosed with indirect inguinal hernia. Which is the single feature
of the hernia sac would confirm the diagnosis?
a. Comes though the femoral ring
b. Passes through the deep inguinal ring
c. Lies below the lateral pubic tubercle
d. Does not pass through the deep inguinal ring

130. A 22 year old man presents with chronic diarrhoea for months. Sigmoidoscopy
shows ulcerative strictures. What will be the skin manifestation?
a. Pyoderma gangrenosum
b. Erythema multiforme
c. Necrobiosis lipoidica
d. Erythema chronicum migrans

131. Each year 950,000 people develop MI in a population of 250,000 million. Out of
these, 215,000 die and 112,500 in the first hour. What is the incidence of MI?
a. 112,500 in 215,000 million
b. 112,500 in 250,000 million
c. 215,000 in 950,000 million
d. 215,000 in 250,000 million
e. 950,000 in 250,000 million

132. A 70-year-old man with metastatic cancer is on steroid therapy. His U&E shows
Sodium 131, Potassium 5.5 and Urea 12. What is the most likely underlying condition?

a.
b.
c.
d.
e.

Adrenal insufficiency
SIADH
Hyponatremia
Hyponatremia
Hyperkalemia

133. An 8 year old swallowed 12 tablets of paracetamol 4 hours ago. Serum paracetamol
levels when tested were at critical level. What is the single most likely management?
a. Activated charcoal
b. IV N-acetyl systeine
c. Gastric lavage
d. Observation only

134. A 79-year-old active man comes to you with complaints of swelling and pain on
dorsiflexion of the leg. On examination, there is oedema and a 3 cm increase in
diameter of the right calf on comparison with the left calf. What is the likely cause?
a. Popliteal artery aneurysm
b. Deep Venous Thrombosis
c. Popliteal cyst
d. Lymph oedema
e. DMD

135. A pregnant patient whos Rh negative and has not has been previously sensitized
delivers her first baby without complications. What would be the latest time to
administer anti-sensitization?
a. 6hours post partum
b. 24 hours post partum
c. 48 hours post partum
d. 72 hours post partum
e. 5 days post partum

136. A 64-year-old man complains of increasing shortness of breath and cough for the
past 18 months. He coughs up a tablespoon of muco-purulent sputum with occasional
specks of blood. What is the most likely underlying cause?
a. Acute bronchitis
b. Bronchiectasis
c. Chronic bronchitis
d. Lung cancer
e. Pneumonia

137. A 28-year-old man believes that each time the traffic lights change, it means that his
mother needs to see him urgently and he needs to return home. He has only slept for 2
hours in the last 2 days and eats very little. He believes that his thoughts are being taken
out of his head and are being made available for the people around him.
What is the single most likely diagnosis?
a. Depression
b. GAD
c. Mania
d. Obsessive compulsive disorder
e. Schizophrenia

138. A 7-year-old girl comes with dysuria and fever of 37.8 C. What is the most
appropriate investigation?
a. Clean catch of urine
b. Full blood count
c. Renal Ultrasound
d. Supra pubic aspirate

139. A 28-year-old woman who is breastfeeding has pain in her left breast. The outer
upper quadrant of the breast is red, swollen and tender.
a. Staphylococcus aureus
b. Staphylococcus epidermidis
c. Streptococcus faecalis
d. Streptococcus pyogens
e. Streptococcus viridians

140. A 70-year-old man present with sudden onset of severe pain in the lower part of his
abdomen. He is unable to pass water and is distressed. On examination, the abdomen is
distended, tender and dull on percussion. What is the single most appropriate initial
management?
a. Arranging abdominal X-ray
b. Giving morphine
c. Inserting a urinary catheter
d. Sending blood for amylase
e. Starting IV fluids


141. A 28-year-old woman suddenly develops a red rash all over the body following a
wasp sting. Her pulse is 100beats/minute, BP 120/70mmHg, RR- 24c/m.
What is the single most important clinical feature indicative of adrenaline?
a. IM Adrenaline 0.5ml in 100

b.
c.
d.
e.

IM Adrenaline 0.5ml in 1,000


IM Adrenaline 0.5ml in 10,000
IM Adrenaline 0.5ml in 100,000
IM Adrenaline 0.5ml in 1,000,000


142. A 72-year-old man has had cough and fever for the past 1-week and now has
suddenly become short of breath and coughed up a cup full of fresh blood. His
temperature is 38.6 C, HR 126 beats/minute, saturations 96% on 10L, BP 150/ 85mmHg;
RR 43c/m. IV cannulation has been done. Which is the most appropriate next step?
a. Antibiotics
b. Arterial blood gas
c. Blood culture
d. Chest X-ray
e. ECG

143. A 20 year old lost control of her car and hit a tree while driving at a speed of 60mph.
She has a large laceration on the parietal scalp and some bruises on the right chest. Her
GCS is 14/15 and she is speaking in sentences. She has been given high flow oxygen via
facemask. Which is the most immediate management?
a. Cervical spine immobilisation
b. Chest tube insertion
c. CT brain scan
d. Endotracheal intubation
e. IV access

144. A 35-year-old man skidded on a wet road while riding his motorbike at a speed of
70mph. He has a large hematoma on the temporal scalp, some bruises on the chest wall
and abdomen and a deformed thigh. His GCS is 11/15. He has been given high flow
oxygen via facemask. Which is the single most immediate radiological investigation
required during the initial resuscitation phase?
a. CT abdomen
b. CT brain
c. X-ray of the chest
d. X-ray of the abdomen
e. X-ray of the femur
145. A 20-year-old mans house caught fire. He has blisters and peeling of his skin. He is
coughing black sputum. What is the single most appropriate immediate management?
a. Arrange chest X-ray
b. Applying dressing on the face
c. IM analgesia

d. Transfer to burns unit


e. Establish a definitive airway


146. A 50-year-old man present with central crushing chest pain radiating to the left arm.
ECG is shown below. What is the next step in management?
a. Warfarin
b. Low molecular weight heparin
c. Percutaneous coronary intervention
d. Aspirin
e. Clopidrogel

147. A 60-year-old woman presents with post coital bleeding for the past 1 week. What is
the most appropriate investigation?
a. Cervical smear
b. Cervical biopsy
c. Colposcopy
d. Endometrial sampling
e. Transvaginal Ultrasound


148. A 2year old boy has a temperature of 39.C and purulent otorrhea. His pinna is
laterally and inferiorly displaced. Which is single most appropriate management?
a. Admit for analgesia
b. Admit for intravenous antibiotics
c. Emergency grommet insertion
d. Antibiotic ear drops
e. Oral antibiotics


149. A 32-year-old woman is having intermittent episodes of vertigo. Each episode lasts
up to 12hours and is associated with tinnitus and hearing loss. Which is the single
medication that may help in reducing the frequency of the vertigo episodes?
a. Amitryptilline
b. Paroxetine
c. Cyclizine
d. Betahistine
e. Prochlorperazine

150. A 72-year-old woman with rheumatoid arthritis has hoarseness of voice. There is left
vocal cord palsy. Which is the joint likely to be involved?

a.
b.
c.
d.
e.

Atlanto-occipital
Cricoaryteniod
Cricothyroid
Costochondral
Sternoclavicular


151. A 68-year-old woman has otalgia and dysphagia. She ahs angula cheilitis and pale
conjunctivitis. Her oropharyngeal examination is normal. In which single anatomical site
is this patient likely to have a tumour?
a. Lower oesophagus
b. Nasopharyngeal
c. Post cricoids
d. Thyroid
e. Tonsil

152. A 4 year old boy with Downs syndrome has proven middle ear effusion bilaterally
that has been present for 6 months. Which is the single most appropriate management?
a. Adenoidectomy
b. Bilateral mastoidectomy
c. Bilateral grommet ventilation
d. Cochlear implantation
e. Watch and wait for 3 months

153. A 20-year-old man has a chronic facial palsy and rinorrhoea. He has multiple courses
of antibiotics with little improvement in his symptoms. A CT scan shows a round opacity
with mixed density within the right maxillary sinus. What is the most likely diagnosis?
a. Allergic
b. Angifibroma
c. Antrochoanal
d. Fungal ball
e. Foreign body within the sinus

154. A 78-year-old man has sudden onset of hoarseness of voice. He has a weak cough
and he coughs when eating. He has been a smoker since 18 years ago. He has right-
sided vocal cord palsy. Which is the single most likely anatomical site of his primary
tumour?
a. Bronchus
b. Larynx
c. Oesophagus
d. Oral cavity

e. Parotid

155. A 22 year old woman says she has taken about 40 tablets of paracetamol 3 hours
ago. Her heart rate is 110beats/minute, BP 110/80mmHg and RR 22c/m. Which is the
single most appropriate initial management?
a. Give activated charcoal
b. Give N-acetylcysteine
c. Induce vomiting
d. Perform gastric lavage
e. Wait for the 4 hour paracetamol level

156. A 30-year-old woman says she has taken about 34 tablets of paracetamol about
12hours ago. She is now unwell. Her heart rate is 120beats/minute, BP 112/78mmHg
and RR 20c/m., which is the single most important management?
a. Discuss with the liver transplant unit
b. Give N-acetylcysteine immediately
c. Give activated charcoal immediately
d. Refer for psychiatric assessment
e. Wait for the paracetamol level

157. A 20-year-old woman says she has taken 40 tablets of paracetamol over the past 3
days. She is not unwell and has vomited a few times. Her heart rate is 22breaths/min.
The blood tests are as follows;
Sodium 146mmol/l Potassium 3.5mmol/l
Urea 5.6mmol/l Creatinine 115umol/l
Albumin 32g/l Bilirubin 52umol/l
ALT 2,560IU/l Alkaline phosphatise 230IU/l
Gamma transpeptidase 230IU/l Ph 7.3
INR 4.0 Lactate 4.2mmol/l Paracetamol 190mg/l
Which is the single most likely chemical compound responsible for this findings?
a. NAPQI
b. N para-acetyl aminophenol
c. N para-acetyl aminophenol glucuronate
d. Para-acetyl aminophenol sulphate
e. Para-amino phenol

158. A 36-year-old woman has taken about 28 tablets of paracetamol 6hours ago. She has
been drinking a bottle of vodka and a couple pints of lager everyday for the last few
years. She feels nauseous and has vomited a few times.
Sodium 144mmol/l Potassium 3.8mmol/l
Urea 5.6mmol/l Creatinine 86umol/l

Albumin 30g/l Bilirubin 15umol/l


ALT 30IU/l AST 32IU/l Alkaline phosphatise 230IU/l
Gamma glutammyl-transpeptidase 1,261IU/l Paracetamol 80mg/l
Which is the single most appropriate immediate management?
a. Discussing with liver transplant unit
b. Give acetylcysteine
c. Give fresh frozen plasma
d. Give Vitamin K injection
e. Repeat the blood tests


159. A 40-year-old man with chroic AF presents with palpitations.
What is the most appropriate treatment?
a. Metoprolol
b. Digoxin
c. Verapamil
d. Atenolol
e. Amlodipine

160. A 67-year-old man presents with shortness of breath. On examination, he has a
harsh pansystolic murmur at the apex which radiates to the axilla. What is the cause?
a. Ventricular Septal Defect (VSD)
b. Mitral stenosis
c. Triscuspid regurgitation
d. Mitral stenosis
e. Aortic regurgitation

161. A healthy baby boy is born at term to a woman who was unwell with confirmed
acute hepatitis B during pregnancy. The mother is very concerned that she may have
infected the baby with hepatitis B. What is single preventive measure should be given to
the baby?
a. Full course of hepatitis B vaccine
b. Hepatitis B immunoglobin alone
c. Hepatitis B status testing
d. Hepatitis B vaccine and hepatitis B immunoglobin
e. Hepatitis vaccine as single dose

162. An 18 months girl who has had a single urinary tract infection is seen in the
outpatients department. She has fever and vomiting but these improved with a course
of trimethoprim. Urine culture became negative. Subsequently a micturating systogram
showed bilateral vesico-ureteric reflux.

What is the single most appropriate management?


a. No treatment
b. Oxybutinin (anti-cholinergic)
c. Potassium citrate (urinary alkanisation)
d. Prophylactic antibiotic
e. Ureteric surgery

163. A 6-year-old boy presents with a fever and is unable to swallow his saliva. He has a
temperature of 39.C, pulse rate of 130beats/minute and RR of 40c/m. What is the single
most appropriate initial management?
a. Emergency help from anaesthetist or ENT surgeon
b. Establish intravenous (IV) access and give IV penicillin
c. Examine the throat using a tongue depressor
d. Lay the patient flat and give high flow oxygen
e. Obtain lateral soft tissue neck X-ray

164. A 78-year-old man presents to the A&E department with an upper gastrointestinal
haemorrhage. According to his wife, he is taking tablets for osteoporosis to build his
bones and voltarol for pain relief. The following are causes of gastric or lower
oesophageal ulceration except:
a. Crohns disease
b. Celecoxib
c. Alendronate
d. Misoprostol
e. Chronic renal failure

165. A town has a population of 500,000. In a 5-year period, 100 people present with
cancer Y. During the same period, 1,250 cases of cancer Y were registered by death
certification. And also it was found that in the same city 500 people were found to have
cancer Y from the community hospital. The 1-year survival rate is 0%. What is the
annual prevalence of cancer Y per million in this population?
a. 200
b. 400
c. 500
d. 700
e. 1250



166. A 40 year old patient with malabsorption had biopsy done. On biopsy she was found to
large amount of biopsy of lymphocytes. What is the single most likely diagnosis?
A. whipples disese= Crohns disease


B.
C.
D.
E.

Ulcerative disease
Coaeliac disease=increased lymphocytes
Helicobacter pylori
Gastric cancer


167. A 34 year has been drinking for 4 days, now he comes saying that he can feel insects walking
on the skin and nasal redness. What is the single most likely drug abuse.
A. Alcohol (answer)
B. Cocaine
C. LSD
D. Heroin
E. Cannabis

168. A 40 year old man presents with abdominal distention4 days after an open cholecystectomy.
On examination there were no bowels sound. What is the diagnosis?
A. intestinal obstruction
B. Paralytic ileus (answer)
C. Internal bleeding
D. anastamotic leak
E. abdominal aneurysm.

169. A 57 year old man with known diabetes has cholesterol 5.7. Which of
the following is the correct combination of medication for his
management?
A. Angiotensin converting enzymes and statin
B. Angiotensin converting enzymes and metformin
C. Angiotensin converting enzymes and Glibenclamide
D. Angiotensin converting enzyme inhibitor and Gliclazide
E. Glibenclamid and statin

170. A 45 year old man presents to accident and emergency department
with headache. He is then found to have high blood reassure of 210/110.
His blood results are as follows: Potassium is 2.7, urea 4.5, creatinine 124,
sodium 136.
What is the is the single most appropriate investigation?
A. Cortisol
B. Aldesterone
C. Adrenaline
D. Renin
E. Growth hormone.

171. An 18 year old man presents with sudden nset of testicular pain. He has
history multiple sexual partner.. temperature 37.4, Blood pressure 120/80.
Thee is no urethral discharge. What is the single most likely diagnosis?
A. Testicular torsion
B. Epidydimo-orchitis
C. Testicular tumour
D. Epidydimal cysts
E. Hydrocele

172. A. 45 year old man presents with ascites and epigastric pain. He had
peritoneal lavage done which shows protein less 25. What is the single
most likely cause of ascites?
A. Tuberculous
B. Cirrhosis
C. Bid chiari syndrome
D. Alcoholic liver disease
E. Carcinomatosis

173. A 65 year old man pesents with ascites . After peritoneal lavage he is
found to have low glucose and red cells. What is the single most likely
cause?
A. Gastric cancer
B. Tuberculosis
C. Baud chiari syndrome
D. Liver cirrhosis
E. Hear failure

174. A 30 year old was put on a theatre table having an operation with his
had extended. After the operation he is unable to extend his wrist and he
also has loss of sensation on the first dorsal area between of the thumb
and index finger. Which nerve is most likely to be affected?
A. Radial nerve
B. Medial nerve
C. Axillary nerve
D. Musculocutaneous

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

176. A mother brings her 2 days old baby worried she could be be deaf. The
mother is deaf herself and thee is family history of deafness as well. What
is the singl single most appropriate investigation?
A. Brainstem evolked response
B. Distraction
C. Tuning folk tests
D. Startle reflex.
E. Audiogram

177. A 45 year old lady presents with back pain to accident and emergency
department. She had an lumbo-sacral X-ray done which was normal. On
examination she is found to have loss f sensation of the lower legs on pin
prick . What is the most appropriate investigation?
A. Bone nuclear scan
B. MRI scan
C. Skeletal survey
D. CT scan spine
E. No investigation

178. A 50 year old lady with history of breast cancer treated with
chemotherapy and surgery. Now she has come back with pelvic pain. What
is the most appropriate management?
A. DEXA
B. Radiotherapy
C. Additional chemotherapy
D. Biphosphanates
E. Mamography

179. A 2 year old child was found to have meningitis. The child recovered
well. He was not resuscitated. What would be the expected outcome of the
child?
A. Goes back to normal status like before the illness.
B. Hearing loss
C. Visual loss
D. Mental state retaration
E. Hemiparesis

180. A 35 year old man presents with headache and rash. On examination the
rash does not branch. What is the single most appropriate antibiotics?
A. Cefotaxime
B. Amoxicillin
C. Ciprofloxacin
D. Vancomycin
Clarithromycin

181. A 45 year old man presents with fever, rash and headache. His Glascow
coma scale is 10/15. What is the single most appropriate immediate
management?
A. Intravenous antibiotics and Ct scan brain
B. Lumbar puncture and Iv antibiotics
C. CT scan of the brain and intravenous fluids
D. Lumbar puncture and antibiotics
E. Blood culture and Lumbar puncture
182. A 47 ear old man presents with fever, headache , neck stiffness and
photophobia. He is also vomiting. What is the single most diagnostic
investigation?
A. Blood culture
B. CT scan brain
C. Blood culture
D. Lumbar puncture
E. MRI brain.

183. A 40 year old man presents to accident and emergency department
with confusion, ataxia and ophthalmoplegia. He lost his job recently and he
is smelling of sweet breath. Alcohol breath test is negative. What is the
single most appropriate immediate management?

A.
B.
C.
D.
E.

Glucose
Intravenous fluids
Intravenous thiamine
Potassium chloride
Chlordiazepoxide

184. A 40 year old man lost his job 1 year ago. The police picked him from the
street. He has a sweet smell. Alcohol breath test was negative. What si the
most likely diagnosis?
A. Alcohol intoxication
B. Alcohol withdrawal
C. Delirium tremens
D. Wernickes encephalopathy
E. Acute psychosis

185. An 18 year old lady was found to have BMI of 22. She had lost 8kg of
weight in 6 months. She has low mood, she sad all the time. She then
started to buy expensive clothes and eating in expensive restaurant. What
is the single most appropriate diagnosis?
A. Anorexia nervosa
B. Bulaemia nervosa
C. Bipolar affective disorder
D. Schizophrenia
E. Depression

186. A 3 year old girl fell down while riding her bicycle. She then went pale,
and then rigid. 2 minutes later she recovered fully but she was still pale.
After 1 hour she well and playing around. What is the most appropriate
management?
A. No investigations
B. Electrocardiogram
C. Full blood count
D. Electroencephalogram
E. CT scan of the brain

187. A 19 year old man dos not talk to anyone. He has collected 2000 toy
cars. He is indifferent to his mum. What is the single most appropriate
investigation?
A. Autistic spectrum disorder
B. Psychosis
C. Borderline personality disorder
D. Dissociative disorder
E. Schizotypal disorder

188. A 30 year old lady every time she leaves the house experiences
palpitation and difficulty in breathing. She has to rush back into her house
to to allay her anxiety with a drink. What si the single most likely diagnosis?
A. social phobia
B. Agarophobia
C. Panick attack
D. Hysteria
E. Arachnophobia

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

190. A 60 year old lady who had anterior resection of his bowel 5 days ago
presents with selling on her wound.. There is 4 cm swelling is around the
colostomy which tender and it fluctuating. She is not systemically unwell.
What is the single most appropriate action?
A. Laparotomy
B. Local anaesthesia
C. Laparotomy with wound repair.
D. Exploration of the wound
E. Abdominal X-ray.


191. A 25 year old lady presents to out patient department requesting
contraception. She has irregular and painful periods. She smokes 20
cigarrets a day. Otherwise she fit and well. Which is the single most
appropriate type of contraception?

A. Combined oral contraception
B. Progesterone only contraception
C. Trenexemic acid
D. Levenoestrel
E. Levanogestrel IUCD

192. A 16 year old girl presents with heavy regular periods. What is the single
most appropriate treatment?
A. Combined oral contraception
B. Progesterone only pill
C. Trenexemic acid
D. Mefenemic acid
E. Levenogrel intrauterine system

193. A 30 year old lady with past medical history pulmonary embolism
presents to out patient clinic requesting contraception, She has irregular
and painful periods. What is the single most appropriate contraception?
A. Intra uterine contraceptive device
B. Combined pill contraception
C. Progesterone only pill
D. Mefenemic acid
E. Trenexemic acid
194. A 34 year old man had a 4 mm ureteric stone which he passed with
urine. This time he presents with 3 cm stone in a right kidney. What is the
single most appropriate treatment?
A. No treatment
B. Lithotripsy-shock wave
C. Laparotomy
D. Operative stone removal
E. Observe

195. A 35 year old man returned from Egypt where she was working in out
door. She was found to have a 5cm stone which was removed operative.
She is now planning to go back to Egypt. What advice would you give her?
A. Increase fluid intake
B. Better not to go to Egypt again
C. Reduce fluid intake
D. Regular hospital admission for intravenous fluids
E. Return to UK regularly

196. A 28 year old man with a known psychiatric disease thinks that he is the
professor of medicine and he says later he will become God. What is the
single most likely diagnosis?
A. Delusion of grandiose
B. Idea of reference
C. Identity disorder
D. Paranoid delusion
E. Delusion of reference

197. A 30 year of lady with past history of 1 episode of mania presents with
depression. She has been treated successfully this time but she needs
prophylaxis for her condition. What is the most appropriate medication?
A. Mood stabilizer
B. Benzodiaxepines
C. Anti-depressant
D. Anti-psychotic
E. Anti-epileptic

198. A 35 year old diabetic pattient was on long acting anti diabetic in
the morning and short acting in the evening. after lunch patient gets
hypoglycaemia . How will manage this patient
A) provide more food at lunch
B) decrease long acting in the morning (answer)
C) decrease short acting in the afternoon
D) decrease both dose
E) reassurance


199. A 70 year old man with lung cancer presents with a cough. He is
already on codeine, steroid and salbutamol inhalers. What is the single
most appropriate management?
A. Nebilised adrenaline
B. 0.9% saline nebulized
C. Oral morphine
D. Antibiotics
E. Benzodiazepine
200.A 65 year old man presented with shortness of breath. He was a
shipyard worker. He was admitted treated with antibiotics and
inhalers. What would be the reason to inform the coroner/
A. Industrial disease
B. Inappropriate treatment
C. Because he died during admission
D. To satisfy the relatives
E. It should be done as a routine.








GOOD LUCK FROM DR SAMSON