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Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 7th MARCH 2017 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. A 40 year old teetotaller woman is recovering from a hysterectomy 2days ago. At night she
becomes agitated and complains of seeing animals and children walking around the ward. What is the
most likely diagnosis?
A. Delirium tremens
B. Toxic confusional state
C. Hysteria
D. Mania

2. A 14 year old girl suffers from hay fever which bothers her school attendance and performance.
What is the best treatment option?
A. Oral steroids
B. Topical steroids
C. Oral Antihistamines
D. Topical antihistamines
E. Adrenaline IM

3. An 18year old previously well student is in his 1st year at university. He has been brought to the
Emergency Room in an agitated, deluded and disoriented state. What is the most probable reason for
his condition from the following options?
A. Drug toxicity
B. Delirium tremens
C. Infection toxicity
D. Electrolyte imbalance
E. Head injury
4. A 65year old woman had an excision of colonic tumor 3years ago. Now she is losing weight and
feels lethargic. On examination she is pale but has no abdominal findings. What is the most
appropriate investigation?
A. CA 125
B. CA 153
C. CA 199
D. CEA
E. AFP
5. A 75 year old woman presents to the breast clinic having noticed that she has had a blood stained
discharge from the left nipple, together with dry skin over the left areola. Exam: blood stained
discharge with dry flaky skin noted on the left areola. The nipple was noted to be ulcerated. What is
the most appropriate investigation?

A. FNAC
B. MRI
C. Punch biopsy
D. Open biopsy
E. Stereotactic biopsy
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6. A 2 years old child who can run down steps, says mama and dada and understands what he says,
and also says one word. How is the development of this child?
A. Delayed motor milestones
B. Delayed speech
C. Normal
D. Global milestones delay
E. Delayed speech and motor milestones

7. 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

8. A 60 year old woman was found by her son. She was confused and had urinary incontinence. She
has recovered fully after 6 hours with no neurological complaints. What is the likely diagnosis?
A. Stroke E. Benign intracranial hypertension
B. Vestibular insufficiency
C. Transient ischaemic attack (TIA)
D. Intracranial haemorrhage

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

10. 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?
A. CT scan
B. Blood culture
C. ECG
D. Magnetic resonance imaging (MRI)
E. Radioactive thyroid scan

11. A 16 year old boy following a RTA was brought to the A&E with a swelling and deformity in his
right thigh. On examination airway is patent and he is found to have a pulse less leg. Which is the
most likely structure involved from the following options?
A. Femoral artery
B. Posterior tibial artery
C. Common peroneal nerve
D. Dorsali spedis
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12. A 34 year old female had pain in right knee joint. She now presents with red and tender left
metatarsal pharyngeal joint.
A. Joint aspiration for culture and sensitivity
B. Serum Uric Acid
C. Joint aspiration for crystals
D. Urine uric acid

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

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

15. A patient post surgery has severe pain and vomiting. What is the most appropriate painkiller to be
given in this case?
A. Paracetamol
B. Oral Morphine
C. I.V Morphine
D. Transdermal patch

16. 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

17. A 40 year old female who is on Sodium Valproate 5mg twice daily for epilepsy, has been getting
attacks more frequently than usual. On examination she has mild obesity. What is the most
appropriate management?
A. Increase the dose
B. Review the dose
C. Change the medications
D. Check serum drug level
 4

18. A 42 year old male with galactorrhea, pale in complexion with fine wrinkling of the skin, lack of
body hair. Breast examination reveals galactorrhea on expression. What is the visual field defect?
A. Left inferior quadrant anopia
B. Cortical blindness
C. Bitemporal hemianopia
D. Enlarged blindspot
E. Left homonymous hemianopia

19. A 46 year old man while in the gym had sudden onset of back pain. He presents at the A&E with
lower back pain. He has been given oral analgesia and now feels better. All examination is normal.
What is the most appropriate advice for him?
A. Bed rest
B. MRI spine
C. CT scan spine
D. Continue moving

20. A 30 year old lady taking COCP pills is on amoxicillin tablets for a week. What advice would you
give to the patient?
A. Stop COCP and continue amoxicillin
B. Use condom for a week
C. Use condom for 2 weeks
D. No precaution required

21. 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
B. Flail chest
C. Fracture of ribs
D. Ruptured esophagus
E. Tension pneumothorax
22. A 28 year old woman comes with sudden onset of vomiting and pain per abdomen. On
examination mobile swelling in the right iliac fossa was found. What is the most probable diagnosis?
A. Ectopic pregnancy
B. Tubo-ovarian abscess
C. Acute appendicitis
D. Ovarian torsion
E. Diverticulitis
23. Parents of a 4 year old child are worried since the child recently started wetting the bed at night
again despite being dry for the past 6 months. What advice from the following list of options would
you give them?
A. Reassure
B. Fluid restriction
C. Alarm Training
D. Desmopressin
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24. 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

25. A 56 years old lady presents with hot flushes. She had hysterectomy 2 years ago. She smokes
cigarettes. What will you give her for her symptoms?
A. Oestrogen and progesterone HRT
B. Oestrogen only HRT
C. Raloxifen
D. Bisphosphonates
E. Clonidine

26. A 27 year old lady after caesarean section, developed epigastric pain after 8 hours. What is the
appropriate investigation?
A. ABG
B. Coagulation profile
C. Liver enzyme
D. Liver biopsy

27. A 40 year old female had history of use of COCP for 5 years and condom for a few years. She is
obese and is a heavy smoker. Smokes 20 cigarette/day .Had repeated episodes of chlamydial
infections. Her family history showed that her aunt died of carcinoma of the ovary at 48 years of age.
What is the major risk factor for development of ovarian cancer in this patient?
A. OCOP
B. Condom
C. Obesity
D. Smoking
E. Family history

28. A 30 years old lady was blaming the medical staff that they did not give her adequate pain killer
post-operation, however after some time the pain subsided and she calmed down and she thanked the
team for treating her pain appropriately. What is the most appropriate cause for her behaviour?

A. Adjustment disorder
B. Post trauma
C. Personality disorder
D. Depression

29. A 34year old man after an RTA was brought to the A&E. He has BP 50/0mmHg and chest wall
with asymmetrical movement, RR 34bpm. What would be the initial action?
A. IV fluid infusion
B. Intubation and ventilation
C. CT chest
D. Transfer to ITU
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30. A 36 Weeks pregnant patient has been admitted with bleeding per vaginum and severe constant
pain in abdomen. A diagnosis of abruptio placentae has been made. What will be your immediate next
step?
A. Check Clotting profile
B. Ultrasound
C. CTG
D. Caesarian section
E. Check BP

31. A 22 year old woman was brought tothe emergency department by her friends for cutting her
wrists and overdosing on Paracetamol after she broke up with her boyfriend. She regrets her actions
which she says were on impulse but has been referred to Psychiatry for further management. What is
the most appropriate next best step?
A. Admit and keep under observation
B. Discharge and follow up
C. Start Antidepressants
D. ECT

32. A 18 month old girl who has a single urinary tract infection is seen in outpatients. She had fever
and vomiting but these improved with a course of trimethoprim. Urine culture became negative.
Subsequently a micturating cystogram showed bilateral vesico-ureteric reflux. What advice should
you give to the parents?
A. No treatment required
B. Oxybutinin
C. Ureteric Surgery
D. Give trimethoprim
E. Prophylactic antibiotics

33. This is the standard method for comparing distributions for example between the observed and
expected frequency of events. Choose the single term from the list of options given
A. Chi squared (X) test
B. Linear regression
C. Mean
D. Median
E. Mode

34. 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

35. Prenatal screening is recommended if ultrasound scan at 16 weeks confirms that the foetus is
male and the mother has had an affected son previously. Choose the single most likely condition from
the following list of options.
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A. Duchene muscular dystrophy

B. Cystic fibrosis
C. Spina bifida
D. Downs syndrome
E. Spinal muscular atrophy

36. A young man comes with back pain and occasional painless haematuria. What is the most likely
pathology?
A. Ca. Bladder
B. Ca. Prostate
C. Nephropathy
D. Uretric Calculi

37. A 45 year old man with chest pain has been given Aspirin and analgesia. ECG shows ST
depression in leads II, III and avF. What is the single most appropriate treatment?
A. Beta Blockers
B. GTN
C. Heparin
D. PCI
E. Furosemide

38. A 40year old manual worker presents with a swelling in the groin. Exam: mass is found to be just
above and lateral to the pubic tubercle. It is reducible. On applying pressure on the internal ring,
there is no cough impulse seen. What is the most probable diagnosis?
A. Direct inguinal hernia
B. Indirect inguinal hernia
C. Femoral hernia
D. Strangulated hernia
E. Femoral aneurysm

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

40. A patient in the post op ward develops persistent vomiting with a distended abdomen and no
bowel sounds. What is the primary electrolyte imbalance in this patient?
A. Hyponatremia
B. Hyperkalaemia
C. Hypernatremia
D. Hypokalaemia

41. A 20 year old lady developed post-influenza pneumonia. CXR shows bilateral cavitatory lesions.
What is the best treatment?
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A. Amoxicillin
B. Doxycycline
C. Flucloxacillin
D. Clarithromycin

42. 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?
A. Retained products of conception
B. Aspiration pneumonitis
C. Endometritis
D. Uterine rupture
E. Disseminated intravascular coagulation

43. An 18 years old lady in her 30th week of pregnancy is brought to the hospital in altered
sensorium. She is taking slow, shallow breaths and her breath has a fruity smell. An ABG analysis
shows a pH of 7.20. Urine shows the presence of ketones. What is the most probable diagnosis?
A. Hyperglycaemic Hyperosmolar Nonketotic Coma (HONK)
B. Diabetic Ketoacidosis (DKA)
C. HELLP syndrome (Hemolysis, elevated liver enzyme levels, and low platelet levels)
D. Pregnancy-Induced Hypertension (PIH)
E. Gestational Diabetes Mellitus

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

46. Which of the following is NOT a physiological change during pregnancy?

A. Tidal volume 500ml.
B. Red cell volume 1.64L.
C. Cardiac output 6.5L/min.
D. Uterus weight 1.1Kg.
E. ESR up by 4 folds

47.Child presents with severe pain in testis. On examination, one testis is higher than the other. What
is the most appropriate step you will do next?
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A. Refer to surgery for exploration

B. Antibiotics
C. Observation
D. Analgesia

48. A mother has a child with 17-hydroxylase deficiency. She is now pregnant for the second time.
What are the risks of her unborn child having congenital adrenal hyperplasia?

A. 1:1
B. 1:2
C. 1:4
D. 2:3
E. None

49. A 25 year old woman who is 11 weeks pregnant had central abdominal pain for 36 hours. The
pain is now colicky. There is no vaginal bleeding. She has vomited once and has had an episode of
loose motions. She looks ill, has a temperature of 37.8 C and there is rebound tenderness in the right
iliac fossa. What is the most probable diagnosis?
A. Salpingitis
B. Pelvic Inflammatory Disease
C. Appendicitis
D. Ovarian Torsion
E. Uterine Fibroid

50. A 46year old woman has offensive yellow discharge from one nipple. She had a history of breast
abscess 3years ago. What is the possible diagnosis?
A. Duct papilloma
B. Duct ectasia
C. Duct fistula
D. Breast cancer

51. A 32 year old man had a fracture of radius and plaster cast wasapplied.He returned with severe
pain in the arm. Arm is warm, both radial and brachial pulses are palpable. What will you do next?
A. Give stronger analgesics
B. Remove plaster cast
C. Reassure
D. Re- Xray the limb

52. A 23year old man feels anxious and agitated when faced with stress. He has an interview in 3days
and would like some help in relieving his symptoms. What is the most appropriate management?
A. SSRI
B. CBT
C. Propranolol
D. Diazepam

53. A 50 year old man presents with headache, fever, and neck stiffness. His heart rate is 50,
respiratory rate is 28 and Blood Pressure is 210/110mmHg. What is the single most appropriate
treatment?
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A. Dexamethasone
B. B-Blocker
C. Adrenaline
D. Mannitol
E. IV fluids

54. A random study on Pulmonary Embolism shows:

A. 100 patients out of 1000 died who did not get the treatment.
B. 5 patients out of 100 died who got proper treatment.
Choose the single most likely absolute risk for each of the above mentioned study.

A. Absolute risk 5%
B. Absolute risk 10%
C. Absolute risk 2%
D. Absolute risk 15%
E. Absolute risk 20%

55. A 1 year old boy has been bought to the accident and emergency department with diarrhoea and
vomiting for 5 days. For the past 24 hours he has been unable to tolerate and fluids. In the last hour he
has become drowsy, his skin turgor is reduced and his skin is mottled. His eyes are sunken. His heart
rate is 180 beats/minute and his capillary refill is prolonged. What is the single most appropriate
immediate treatment?
A. IV fluid bolus over 20 minutes
B. IV fluids over 24 hours
C. IV rehydration over 48 hours
D. Nasogastric rehydration over 24 hours
E. Oral rehydration solution over 48 hours

56. Young female, returning from USA to UK developed shortness of breath and productive cough
which initially contained blood, but now is dry. She is taking COCPs. What is the most likely
diagnosis?

A. Pneumonia
B. Pulmonary embolism
C. Pulmonary TB
D. PCP

57. A 14 year old girl is bought to the accident and emergency department after becoming
increasingly drowsy at home. She has recently lost weight and has complained of increasing thirst.
She is tachypnoeic and shocked. What is the single most appropriate diagnostic test?
A. Full Blood Count
B. Lumbar Puncture
C. Serum Glucose
D. Chest X-ray
E. Blood culture
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58. A 70 year old woman 3 days after a myocardial infarction presents with a pan systolic murmur.
What is the most likely cause?
A. Rupture of papillary muscle
B. Ventricular Aneurysm
C. Pericarditis
D. Pericardial Effusion
E. Atrial Septal Defect

59. 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

60. 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

61. A 51 years old Lady in A&E presents with severe chest pain following accident. On examination,
there are multiple rib fractures on both sides. How will you manage?
A. Stabilization of the ribs
B. Paracetamol (PCM) tablet
C. Oral morphine
D. TENS
E. NSAIDS

62. A 65 year old male, with past history of palpitations, now presents with narrow complex
tachycardia, BP 100/60mmHg, pulse 188 beats/min. What is the most appropriate management?
A. Adenosine
B. Atenolol
C. Amiodarone
D. DC-cardio version

63. 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 girls Height- 165cm. Weight- 33kg

A. Reassure parents
B. Detain under mental health Act
C. Eating disorder clinic
D. Psychodynamic Therapy
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64. A 57year old man with blood group A complains of symptoms of vomiting, tiredness, weight loss
and palpitations. On examination the patient has hepatomegaly, ascites, palpable left supraclavicular
mass. What is the most likely diagnosis?
A. Gastric carcinoma
B. Colorectal carcinoma
C. Peptic ulcer disease
D. Atrophic gastritic
E. Krukenburg tumor

65. A 32-year-old woman presents to the Emergency Department with headache and vomiting.
She was decorating her ceiling that morning when the headache began, felt mainly at the occiput with
neck pain. Some two hours later she felt nauseated, vomited and was unable to walk; she also noticed
that her voice had altered. She takes no regular medication and has no significant past history. On
examination, her acuity, fields and fundi are normal. She has upbeat nystagmus in all directions of
gaze, with normal facial muscles and tongue movements. Her uvula is deviated to the right and her
speech is slurred. Limb examination reveals left arm past- pointing and dysdiadochokinesis with
reduced pinprick sensation in her right arm and leg. Although power is normal, she cannot walk, as
she feels too unsteady. Where is the most likely site of her lesion?

A. Right medial medulla

B. Left medial pons
C. Left cerebellar hemisphere
D. Right lateral medulla
E. Left lateral medulla

66. A 65 year old man with recently diagnosed myocardial infarction developed atrial fibrillation. On
examination he had a pulse of 240 bpm and BP 90/60mmHg. What is the most appropriate next step?
A. DC Cardio version
B. IV Adenosine
C. IV Amiodarone
D. IV Digoxin

67. 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

68. A 45 years old woman diagnosed with Crohns disease. There was leaking faeces per vagina. A
diagnosis of fistula was made. From which part of the intestine is the faeces leaking from?
A. Caecum
B. Descending colon
C. Sigmoid colon
D. Jejunum
E. Duodenum
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69. A 3 years old boy presents with difficulty in walking and skin lesions. He has a rash on the
3rd day after the appearance of fever. What is the most likely causative agent?
A. Streptococcus pyogenes
B. Rubella virus
C. Parvovirus
D. Papova virus
E. Paramyxo virus

70. A young man is brought to the hospital with a history of fall and hitting his head on the pavement
after excessive drinking. His friends say he lost consciousness after the fall but did not have any other
symptoms. At the moment he appears completely fine, talkative and is determined to go home. What
is the next step in the management of this patient?
A. Reassure
B. CT and discharge
C. Check Blood glucose levels
D. Admit for observation

71. A 55 year old lady came to the A&E after a fall with loss of sensation of lower lip and chin.
Which nerve is involved?
A. Mental nerve
B. Lingual nerve
C. Facial nerve
D. Orbital nerve

72. 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

73. A woman with primary breast ca with metastasis to the brain is on Dexamethasone. However she
starts to develop symptoms of increased thirst and micturition after a while. What is the best course of
action to be taken?
A. Stop dexamethasone
B. Start oral hypoglycaemics
C. Start long acting insulin
D. Short acting before meals
E. Combination of long and short acting insulin

74. A 45 year old man with history of recurrent ascites which is exudative in nature. On abdominal
paracenthesis numerous neutrophils are found in ascites fluid. Choose the most likely cause of ascites.
A. Liver cirrhosis
B. Bacterial peritonitis
C. Congestive cardiac failure
D. TB peritonitis
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75. A woman with breast cancer is likely to be started on hormonal therapy. Which factor will affect
the prognosis of hormonal therapy?
A. ER receptor (estrogen receptor)
B. Lymph node involvement
C. Tumour grade
D. PR receptor (progesterone receptors)

76. What is the sign of life is threatening Asthma?

A. Deteriorating level of consciousness
B. Respiratory rate > 25
C. Hear rate > 100
D. Bilateral wheeze
E. PEFR is 50%

77. 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

78. A terminally ill lung cancer patient is in distress due to persistent dyspnoea as a result of
concomitant pleural effusion. He has a less than 4 weeks left to live. CXR shows moderate pleural
effusion. How would you manage this patient?
A. Analgesics
B. Thoracoscopy and Pleurodesis
C. Chest Drain
D. No treatment necessary

79. A patient has back pain at the level of iliac crest. What is the level of vertebrae?
A. L1
B. L2
C. L3
D. L4
E. L5

80. At the time that a condition is studied this is the number of patients in the whole population with
the condition. choose the single term from the list of options given
A Prevalence
B. Specificity
C. Sensitivity
D. Probability
E. Prevalence
 15

81. A 27 year old lady had an uncomplicated pregnancy so far. She came to the hospital 2 hours ago
after her water broke. The midwife is looking after her now. She has been having regular contractions.
P.V examination revealed cervix is 2cm dilated. Her vital signs are normal. What stage of labour is
this lady in now?
A. Second stage
B. First stage
C. Latent phase
D. Third stage
E. Active phase

82. A young woman complains of diarrhea, abdominal cramps and mouth ulcers. AXR shows
distended transverse colon with globet cell depletion on rectal biopsy. What is the most
probable diagnosis?
A. Coeliac Disease
B. Ulcerative colitis
C. Bowel Carcinoma
D. Bowel obstruction
E. IBS

83. A 14 year old girl presents with primary amenorrhoea. She also complains of cyclic monthly
abdominal pain and sensation of lump in the pelvis. Her hormone profile is normal. What is the
diagnosis?
A. Turners syndrome
B. Di George syndrome
C. Haematocolpos
D. Nephroblastoma

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

85. A woman had an emergency LSCS 7 days ago. She now presents with fever and excessive vaginal
bleeding. What is the single most likely diagnosis?
A. Endometriosis
B. Endometritis
C. Vaginal infection
D. Retained placenta

86. A 32 years old woman presents with history of lower abdominal pain and vaginal discharge .She
had her menses 4 weeks ago. She has a temperature of 38.6 C. What is the most suitable diagnosis?
A. Acute appendicitis
B. Acute pelvic inflammatory disease
C. Endometriosis
D. Ectopic pregnancy
E. Urinary tract infection
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87. A 28 year old woman who is 32 weeks pregnant, in her third pregnancy, is diagnosed as a case of
placental abruptio. After all the effective measures she is still bleeding. What is the underlying
pathology?
A. Clotting factors problem
B. Clausers syndrome
C. Platelets problem
D. Succenturiate lobe

88. 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

89. A 24 year old lady who is 37 weeks pregnant was brought to A&E Department. Her husband says
a few hours ago she complained of headache, visual disturbance and abdominal pain. On arrival to
A&E she had a fit. What is the next appropriate management for this patient?

A. 4mg MgSO4 in 100ml 0.9% Normal saline in 5 min.

B. 2mg MgSO4 IV as a bolus
C. 2mg MgSO4 in 500ml Normal saline in 1 hour
D. 4mg MgSO4 IV as a bolus
E. 10mg Diazepam in 500ml 0.9% Normal saline in 1 hour

90. A 30 year old lady who already has one child through a previous caesarean section demands a
reversible contraceptive. She presently experiences heavy and painful periods. What is the most
appropriate contraceptive you will recommend for her?
A. Combined Oral Contraceptive Pill
B. Progesterone only pill
C. Implanon
D. Danazol
E. Mirena coil
F. Intrauterine Contraceptive Device (IUCD)

91. 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

92. Patient in the post surgical ward develops calf pain and redness following open reduction and
internal fixation of fracture of the femur sustained after an RTA. What is the most likely cause of his
symptoms?
 17

A. Fat embolus
B. DVT
C. Cellulitis
D. Reaction to drugs

93. 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 (X) test
B. Linear regression
C. Mean
D. Median
E. Mode

94. A 50 year old woman comes with fever, jaundice and right hypochondrial pain. What is the most
appropriate investigation to be done next?
A. USG
B. Radiography
C. MRCP
D. ERCP

95. Prenatal amniocentesis for karyotype is offered if maternal blood tests at 16 weeks gestation
showed a high chorionic gonadotropin level and low alpha fetoprotein level. Choose the single most
likely condition from the following options.
A. Duchene muscular dystrophy
B. Cystic fibrosis
C. Spina bifida
D. Downs syndrome
E. Spinal muscular atrophy

96. A 50 year old woman is diagnosed with ovarian carcinoma. Staging of the disease is determined
by drainage to which of the primary lymph node groups first?
A. Inguinal nodes
B. Internal iliac
C. Para aortic
D. Obturator nodes

97. A patient developed macular rashes with target lesions, four days after using antibiotics. The rash
typically sparing the mouth. What is the most likely diagnosis?
A. Steven Johnson syndrome
B. Erythema nodosum
C. Erythema multiforme
D. Erythema infectiosum

98. A 63 year old woman who suffers from Osteoporosis now comes with complaints of backache.
What is the most appropriate investigation to be done in this case?
 18

A. X ray
B. MRI
C. Dexa scan
D. CT scan

99. A 35 year old pregnant lady presents with pain in wrist at night and on examination there is
numbness at the lateral 3 and half fingers and thinner eminence. Which level of the nerve is involved?
A. Ulnar nerve at wrist
B. Radial nerve at wrist
C. Medial nerve at wrist
D. Radial nerve at groove

100. A 45 year old woman who enjoys sunbathing comes with complaints of itching and
discolouration of a mole that has been present on her neck for many years. What is the most probable
diagnosis?
A. Squamous cell Carcinoma
B. Basal Cell Ca.
C. Malignant Melanoma
D. Kaposis Sarcoma

101. A patient presents 4 days after having myocardial infarction, complains of pain on inspiration
and unable to breathe with ease. What is the most likely diagnosis?
A. Pericarditis
B. Angina
C. Pancreatitis
D. Cholecystitis
E. Dresslers syndrome

102. A middle aged man complains of a node which has been growing on his nose for several months.
Now its firm with central depression. It is 0.6cm in size. What is the single most likely diagnosis?
A. Basal cell carcinoma
B. Squamous cell carcinoma
C. LN
D. Melanoma
E. Kaposis sarcoma

103. A 61 year male presented with worsening shortness of breath, pulseless, raised JVP bilaterally,
both upper limbs were swollen but lower limbs were normal. What is the investigation of choice?
A. CT contrast thorax
B. CXR- initial shows widened mediastinum
C. MRI Chest

104. A patient is to be put on lithium therapy. Her renal function and liver function tests are normal.
What is the most appropriate other test you need to do?
A. Urine for glucose
B. Thyroid function tests answer
C. EEG
D. ECG
 19

105. Patient presenting with oedema 5 days after thrombolysis. He was diagnosed with heart failure.
Which is the best investigation of choice?
A. ECG
B. ECHO
C. CT chest
D. Cardiac enzymes
E. Renal function test

106. 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. Kaposis sarcoma
C. Malignant melanoma
D. Squamous cell carcinoma
E. Kerathoacanthoma

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

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

109. 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

110. A young woman complains of diarrhea, abdominal cramps and mouth ulcers. Abdominal X-ray
shows a distended transverse colon. There is goblet cell depletion on rectal biopsy. What is the most
probable diagnosis?
A. Crohns disease
B. Ulcerative Colitis
C. Bowel Cancer
 20

111. A 22 year old boy as frequent fainting attacks since childhood. ECG shows normal PR interval
and QRS, however QT is prolonged. What is the cause of the faint?
A. Torsade de pointes
B. Complete heart block
C. Atrial Fibrillation
D. Sick sinus syndrome
E. Ventricular fibrillation

112. 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

113. A 48 year old man, two days after MI presents with palpitations and breathlessness. ECG shows
broad complex tachycardia, blood pressure is 90/60mmHg and heart rate is 154 beats/min. What is the
next best step in management?
A. IV amiodarone
B. DC Shock
C. Adenosine
D. Verapamil
E. Cardiac Pacing

114. A62 year old man is admitted for Surgery. He had a history of DVT and atrial fibrillation, is
taking warfarin. What is the next appropriate step?
A. Postpone operation
B. Stop Warfarin
C. Stop warfarin and start heparin
D. Add heparin

115. 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

116. A 23 year old woman unable to extend the fingers of her right hand at metacarpal phalgeal joint
and interphalageal joint following after accident. What is single most likely tandon damaged after
accident?
A. Extensor carpi radialis
B. Extensor carpi ulnaris
C. Extensor digitorium
D. Extensor in olces
 21

117. An old woman develops sudden pain in upper part of the arm after carrying heavy loads. Which
part of the arm is affected?
A. Biceps tear
B. Posterior capsulitis
C. Ruptured supraspinatus tendon
D. Bursitis

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

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

120. A 2 week old girl is found to have ambiguous genitalia, sodium is 128mmol/l and potassium in
5.7mmol/l. What is the most likely diagnosis?
A. Downs Syndrome
B. Turners Syndrome
C. Adrenal Hyperplasia
D. Adrenal Adenoma
E. Pituitary Tumor

121. An asymptomatic 35 year old lady with family history of ovarian carcinoma is concerned about
her risk. Her 2 sisters had Ovarian Cancer between the ages of 40 and 45. What is next step in plan of
management?
A. Pelvic ultrasound
B. CA 125
C. Genetic testing and counselling
D. Return if symptomatic
E. Reassurance

122. A 20 year old primigravida woman is in her 8th week of gestation. She presents with severe
repeated nausea and vomiting. What is the initial intravenous fluid to be used?
A. Normal saline 0.9%
B. Glucose water 5%
C. Saline 0.45%
D. Dextrose 5%
 22

123. A young man has been found in the park, drunk and brought to the A&E by ambulance. He
recently lost his job and got divorced. He thinks nurses are plotting against him. What is the
most likely diagnosis?
A. Schizoid personality
B. Borderline personality
C. Schizophrenia
D. Psychotic depression
E. Paranoid

124. A lady has been on contraception for a long time. She has regular periods and uterus also is
normal. She wants a contraception with least failure rate and side effects. Among the options given,
which one will you choose?
A. Depot Medroxyprogesterone Acetate( DMPA) injections
B. Cu intrauterine contraceptive device (IUCD)
C. Mirena coil
D. COCP
E. Female condom

125. 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

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

127. 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
 23

128. A 37 year old infertile lady with 5cm subserosal and 3 cm submucosal fibroid. She is trying to
get pregnant, management?
A. Clomifene therapy
B. IVF
C. Myomectomy
D. Hysterectomy
E. Intra uterine insemination

129. 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

130. 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

131. This is the measure of depression of a set of values. Choose the single term from the list of
options given.
A. Standard deviation( root mean square deviation)
B. Specificity
C. Sensitivity
D. Probability
E. Prevalence

132. A 32 years old lady delivered 3 days back. Today she developed sudden left leg pain and
swelling up to inguinal crease. She is advised to take antibiotic but she has a history of taking COCP
before she become pregnant. What is most definitive diagnosis for this lady?
A. Post-partum phlebitis Syndrome
B. Aorto iliac thrombosis
C. Rheumatoid arthritis
D. Septic arthritis

133. The risk of this foetal disease can be reduced by giving folic acid supplements for a few weeks
before conception and 6-8 weeks after conception. Choose the single most likely condition.
A. Downs syndrome
B. Duchene muscular dystrophy
C. Spinal muscular atrophy
D. Neurofibromatosis
E. Spina bifida

134. A 60 year old man was diagnosed with atrial fibrillation and is prescribed Warfarin.Target INR
should be?
 24

A. 2-3
B. 1.5 -2.5
C. 2.5- 3.5
D. 1-2

135. 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

136. A 25 years old young male complaining of back pain in the morning now complaining of red
eyes with photophobia and decreased vision and has with blood in the stools. What is the most
probable diagnosis?
A. Ankylosing Spondylitis
B. Gout
C. Rheumatoid arthritis
D. Reactive arthritis

137. A 15 years old female presents with right iliac fossa pain every 4-8 weeks which is very severe
in the recent weeks. What is the most likely diagnosis?
A. Miscarriage
B. Ectopic pregnancy
C. Ovarian cyst
D. Torsion of ovarian cyst
E. PID

138. A 20 year old young woman present with pain and swelling on the right side of the face. She said
her pain increases most often after taking meal. What is the most appropriate diagnosis for the
presenting complain?
A. Submandibular calculus
B. Parotid infection
C. Dental carries
D. Otitis media

139. A new born baby, born 3 hours ago, 48 hours after premature rupture of membranes at 36 weeks
gestation, has nasal flaring, normal temperature and intercostal recessions. What is the single most
likely investigation that should be done before commencing treatment?
A. Chest X-ray
B. Blood Glucose
C. Blood Culture
D. Echocardiogram
E. Electrocardiogram
 25

140. A 8 year old boy has had profuse diarrhoea and vomiting due to infective gastroenteritis for 2
days. Investigation results show the following:
Sodium 148mmol/l
Potassium 2.2mmol/l
Urea 20mmol/l
Glucose 4.3mmol/l

What is the most appropriate management?

A. IV normal saline and insulin
B.IV normal saline and potassium supplement
C. Plasma expanders
D. Dialysis
E. Oral potassium chloride

141. A 46 year old man who is a heavy drinker is brought to the A&E in a drowsy state. He is
responding vaguely to questions asked. On examination he has nystagmus and hyper-reflexia. His
MCV is 103fL.What is the most likely cause for his cognitive impairment?
A. B1 Deficiency
B. B12 Deficiency
C. Folate Deficiency
D. B6 deficiency
E. Alcohol withdrawal

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

143. A young boy presented in Out -Patient department 12 weeks after renal transplantation with
fever and pain in lower abdomen. Renal functions were deranged. Renal biopsy showed immune cell
infiltrate and tubular damage. What is the most probable diagnosis?
A. Pyelonephritis
B. Chronic graft rejection
C. Acute rejection
D. Drug toxicity
E. Graft host disease

144. A young man presents to Accident & Emergency Department with severe bloody diarrhoea,
abdominal pain and haematuria after eating meat at a barbecue party. FBC reveals schistocytes,
platelets, Hb. Clotting tests are normal. What is the most likely diagnosis?
A. Autoimmune haemolytic anemia
B. Paroxysmal cold haemoglobinuria
C. Paroxysmal nocturnal haemoglobinuria
D. Micro angiopathic haemolytic anemia
E. ITP
 26

145. A 22 year old girl is type I diabetic. She is prescribed long acting insulin in the morning and
short acting insulin before meals. She starts to become hypoglycaemic at about 4 pm. What should be
the next management for her?
A. Stop long acting insulin
B. Stop short acting insulin
C. Decrease dose of long acting insulin
D. Increase dose of short acting insulin
E. Decrease dose of short acting insulin

146. A 28 years old man returned from holiday presents with pain in the superior and posterior part
of the scrotum. Which is the best investigation to confirm the diagnosis?
A. MSU culture and sensitivity
B. USG of the scrotum
C. Semen analysis
D. Serology
E. CT scan of the pelvis

147. A man with a family history of panic disorder is brought to the hospital with palpitations,
tremors, sweating and muscles tightness on 3 occasions in the last 6 weeks. He doesnt complain of
headache and his BP is within normal limits. What is the single most appropriate long-term treatment
for him?
A. Diazepam
B. Olanzapine
C. Haloperidol
D. Fluoxetine
E. Alprazolam

148. A 70 year old man presented with muscle weakness and inability to climb the stairs.
Investigation shows Creatinine phospokinase (CPK) is very raised. ESR 15mm/hour. What is the most
likely diagnosis?
A. Polymyositis
B. Polymyalgia rheumatica
C. Reactive arthritis
D. Rheumatoid arthritis
E. Duchenne's muscular dystrophy

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

150. A thin 25 year old man who looks unwell has an ascitic fluid tap done for abdominal pain and
distension. Protein- 10g/l Lymphocytes- 70%. What is the most likely cause?

A. Liver Cirrhosis
B. Malignant ascites
C. TB Peritonitis
D. Sub acute bacterial Peritonitis
 27

151. A 30 year old man with complaints of left sided abdominal pain was diagnosed with gastric
ulcer. On USG incidental finding of gall bladder stone was noted. What is the most appropriate
management?
A. Lap Cholecystectomy
B. Statins
C. No treatment
D. Lithotripsy

152. A 30 year old lady suffering from arthritis of her wrist and ankle presents with pigmentation of
the skin and galactorrhea. She is a known diabetic. What is the most likely diagnosis?
A. Haemochromatosis
B. Haemosiderosis
C. Prolactinoma
D. Wilsons disease

153. A 56 year old man who has never smoked, presents with regurgitation of food when lying down.
He also has hoarseness of voice for few months. Where would you refer?
A. General Surgeon
B. Speech therapist
C. Voice therapist
D. ENT surgeon

154. 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

155. A 80 year old woman who is a known COPD, patient is on salbutamol inhalers, salmetrol
inhalers, steroid inhalers and oral steroids. She still gets shortness of breath at rest. What is the most
appropriate treatment of this patients symptoms.
A. Noninvasive ventilation
B. Longterm oxygen therapy
C. Mechanical ventilation
D. Continue current treatment
E. Short term oxygen therapy

156. A patient has injury to the right hand. He has lost triceps reflex. Which nerve is not affected?
A. C5
B. C6
C. C7
D. T1

157. A patient had closed tibial fracture. Cast was applied. Four days later, he presented to the clinic
with complaint of pain over fractured area. On examination limb is warm with good pulses. What will
you do next?
 28

A. Remove cast
B. Fasciotomy
C. X- ray
D. Increase analgesics
E. Reassure

158. 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

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

160. A 30 year old lady presents with difficulty in conceiving. She is having 32 day menstrual cycle.
What would be the best test for ovulation?
A. Day 21 progesterone
B. Day 28 progesterone
C. Day 25 progesterone
D. FSH and LH
E. Estrogen levels

161. You are FY2 working in the Orthopaedic department. An 80 year old lady with fracture neck of
femur has been admitted overnight and is on the trauma list today. She needs to be consented but she
is confused. Her daughter lives nearby and is on her way to the hospital. What is the most appropriate
action you will take?
A. Investigate the possible cause of confusion.
B. Phone the theatre to cancel the operation.
C. Inform the operating surgeon about the situation
D. Point to the signature line on the consent form and ask the patient to sign.

162. A 26 year old lady presents with high fever, lower abdominal pain and purulent vaginal
discharge. She looks very unwell. What is the most appropriate management for this patient?

A. Tetracycline 250mg 6 hourly

B. Doxycycline 100 mg 12 hourly po and Metronidazole 400mg 12 hourly
C. Ceftriaxone 2g 24 hourly I/V with Doxycycline 100mg po
D. Ceftriaxone 2g 24 hourly I/V with Doxycycline 500mg po
E. Ofloxacin 400mg 12 hourly po and Metronidazole 400 mg 12 hourly po
 29

163. A 7 year old child is on inhaled salbutamol. His symptoms are not controlled. What should be the
next step?
A. Add LABA
B. Increase the dose of salbutamol
C. Add a regular, low-dose inhaled steroids
D. Add leukotriene antagonists

164. You are called to see a 20 year old woman 2 hours post LSCS. She has not passed urine since
her operation. She denies any urinary symptoms preoperatively. On examination, she appears unwell,
with a temperature of 37.5oC, blood pressure 94/73mmHg, pulse 116 beats/min and saturations 97%
in air. Her abdomen id distended, with tenderness in the left flank and supra-pubic region. Bowel
sounds are not audible. Choose the most appropriate post C-Section complication for this lady?
A. Urinary tract infection D. Acute pyelonephritis
B. Urinary tract injury E. Paralytic ileus
C. Pleurisy

165. A 32 year old pregnant woman on prophylactic LMWH develops symptoms suggestive of
pulmonary embolism. What is the most appropriate management?
A. Continue same Rx
B. Switch to therapeutic dose of LMWH + CTPA or V/Q scan
C. Same dose of LMWH + CTPA
D. V/Q scan

166. An African woman 32 year old comes to the sexual clinic with a history of heavy menstrual
bleeding and dysmenorrhoea. What is the most likely cause?
A. Fibroid
B. Ectopic pregnancy
C. Endometriosis
D. PID
E. Adenomyosis

167.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 8109 Platelet count of
115109. What is your diagnosis?
A. Eclampsia
B. Preeclampsia
C. HELLP
D. Acute hepatitis

168. 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. Nesseria Gonorrhea

169.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?
 30

A. Lung cancer
B. Mesothelioma
C. Pneumonia
D. T.B

170. 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

171. A 20 year old woman is 17 weeks pregnant. She is worried about the possibility of her baby
with spina bifida as she did not take folic acid supplement before conception and in early pregnancy .
A. Pre-implantation genetic diagram
B. Aminocentesis
C. Chorionic villus sampling (CVS)
D. Fetalcordocentesis
E. Genotyping fetal cell in Maternal circulation
F. Ultrasound scan at 18-20 week gestation

172. A 40 year old man presents with unsteadiness, ringing in the ear and muffled hearing. What is
the most likely cause?
A. Menniers disease
B. Presbycusis
C. Noise induced
D. Benign positional vertigo
 31

173. A man had a strong blow to his face during fight. There is periorbital ecchymosis, enopthalmos
and diplopia on upward gaze. Which bone is likely to have fractured?
A. Frontal
B. Ethmoid
C. Sphenoid
D. Maxillary

174. A 40 year old man is having bilateral hilar lymphadenopathy on the CXR. She has rash on each
shin and his calcium is found to be high. Which of the following test is appropriate to perform in this
patient?
A. Lymphnode biopsy
B. U&Es
C. Angiotensin converting enzyme
D. Serum creatinine

175. A mother comes to you with her 12 year old child who has prominent protruding ears requesting
for a referral to private plastic surgeon for pinnoplasty. What will you do?
A. Refer to NHS plastic surgeon
B. Refer to private plastic surgeon
C. Contact social services
D. Child can't be referred without his consent

176. A post gastrectomy patient was on 60mg Morphine. Pain was well controlled with it but patient
is not able to swallow. What is the next appropriate step in management?
A. 60 mg per day SC Morphine
B. 100mg SC Morphine
C. 120mg SC Morphine
D. Fentanyl patch

177. An 8 month old child had a congenital heart murmur which disappeared at the age of one. What
is the most likely diagnosis?
A. Ventricular Septal Defect
B. Atrial Deptal Defect
C. Patent DuctusArteriosus
D. Innocent Murmur
E. Mitral Regurgitation

178. A middle aged man presents with bilateral pitting pedal edema and ascites, raised JVP. The
ascitic fluid is found to be transudate. Choose the most likely cause of ascities.
A. Liver cirrhosis
B. Bacterial peritonitis
C. Congestive cardiac failure
D. TB peritonitis

179. A 7 year old child is suspected to have a foramen oval. What is the most appropriate
investigation?
 32

A. Bubble Echocardiography
B. Transoesphageal Echocardiography
C. Transthoracic Echocardiography
D. ECG
E. CT chest

180. A 15 week pregnant lady is worried about congenital disease her baby might be having. What
test are you going to advise her?
A. Triple test
B. Fetal nuchal thickening
C. Amniocenthesis
D. Deformity scan

181. 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

182. A 68 year old diabetic, hypertensive with 45 pack years smoking history, has left sided chest
pain increased with breathing. Examination shows miosis on left side and wasting of small muscles of
left hand. What is the Single most appropriate diagnosis?
A. Costochondritis
B. Lung cancer
C. Good pastures syndrome
D. Motor neuron disease
E. Progressive massive fibrosis (PMF)

183. A 60 year old man presented with hemoptysis and weight loss for the past one month. He is a
chronic smoker. Bronchoscopy with biopsy was done. Histology: polygonal cells, intraepithelial
bridging. What is the most appropriate diagnosis?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Carcinoid tumor
D. Small cell lung cancer
 33

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

185. 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?
A. USG
B. FNAC
C. Excisional biopsy
D. Mammogram
E. Open biopsy

186. A 77 years old woman presents with vesicular rash on the left side of her face, vertigo,
deafness and Bells palsy. What is the most probable diagnosis?
A. Acoustic Neuroma
B. Trigeminal Neuralgia
C. Viral Labyrinthitis
D. Ramsay Hunt syndrome
E. Otitis Externa

187. A 20 years old pop star singer complains of inability to raise the pitch of her voice. She attributes
this to the thyroid surgery she underwent a few months back. What is the most probable diagnosis?
A. Thyroid Storm
B. Bilateral Recurrent Laryngeal Nerve Injury
C. Unilateral Recurrent Laryngeal Nerve Injury
D. External Laryngeal Nerve Injury
E. Thyroid cyst

188. 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

189. A 43 year old man was involved in an RTA. On examination, there was absent air entry on the
right side, tracheal deviation to the left and a dull percussion note on the right. BP is 80/60mmHg and
pulse is 120/beats per min. CXR shows a diffuse opacity on the right side obscuring the right costo-
phrenic angle. What should be the most appropriate immediate management?

A. Needle aspiration on the right side

B. needle decompression on the right side
C. insertion of chest drain on the right side
D. give 100% oxygen and fluid resuscitation with 2 large bore IV-lines
E.
 34

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

191. A 26year old man is referred for gastroscopy because of a history of several months of
dyspepsia. He has routine bloods checked and is found to have a serum calcium level=3.2mmol/l with
a venous bicarbonate level of 33mmol/l. Renal and LFT are both normal. CXR is normal. What is the
most likely cause of his hypercalcemia?
A. Melanoma
B. Metastatic malignancy
C. Milk alkali syndrome
D. Primary hyperparathyroidism
E. Sarcoidosis

192. A 72 year old man investigated for anaemia is booked for colonoscopy in 24hrs. What is the
single most appropriate management night before the procedure?
A. Bisacodyl tablet
B. Senna Tablet
C. Magnesium citrate orally
D. Lactulose syrup

193. A 50 year diabetic patient is going to undergo an endoscopy. He is on oral hypoglycemic

medications. What is the single most appropriate management plan?
A. Stop medications 1 week before
B. Stop medications in the morning of procedure
C. Stop medications one day before the procedure
D. Stop medications 3 days before the procedure

194. A 58 year old man presents with TIA, experiences loss of consciousness for 30 min. CT scan is
normal. And has AF on ECG. What is the risk assessment score used for this patient?
A. CHAD 2
B. ABCD2
C. FAST
D. MEWS
E. GCS

195. A 40 year old man presents with vertigo, nystagmus and weakness. He also has tingling
sensation in the right arm and diplopia. On examination there is loss of central vision, nystagmus and
ataxia. What is the most likely diagnosis?
A. Multiple sclerosis
B. Lateral medullary syndrome
C. Carotid artery disease
D. Vertebra basilar ischemia
 35

196. A 27 year old lady on Doxycycline for PID now complains of nausea, indigestion and abdominal
pain. What advice should you give to her?
A. Take DoxycYcline after meals
B. Take Doxycycline before meals
C. Reassure
D. Add antiemetic
E. Add antacid

197. A middle aged lady was lying the bed sheet when her index finger got stuck in between the bed
and mattress. She is unable to extend her proximal interphalangeal joint. What is the most appropriate
management?
A. Twin plaster the finger
B. Cast
C. Sling
D. Splint the finger

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

199. A 7 year old boy has clean wound on his foot. He has no past history of immunisation. His
parents are scared that he might get some disease. His wound has been cleaned and dressed. What is
the next step in management?
A. Reassure
B. Tetanus toxoid and immunoglobulin
C. Full course of DPT
D. Tetanus Immunoglobulin only

200. Which of the following histological finding is associated with Barret's esophagus
A. Columnar displasia
B. Squamous displasia
C. Squamous metaplasia
D. Columnar metaplasia