J

P L A B
PLAB-l MOCK-TEST: 3

T R A I N E R

)c(o5[lO(l

T I M E A L L O W E D : 3HRS

S I N G L E B E S T ANSWER:
1. A boy is brought to the A&E. He has felt unwell for a few days and is now vomiting. His
pulse rate is 100 beats/minute and his capillary refill is 3 seconds. He is confused and his
arterial blood gas results are:
pH

: 7.25 t-. tx-^o-isu

PaC0
Pa0

(Aj)
B.
C.
D.
E.

:3.2kpa I
:20kpa 'T

h|

a <\,

V u5,-vWM'
v

u u 4s y

(c ^u^^
c

(tux.i t c ^ - v i,U<-

Metabolic acidosis
Metabolic alkalosis
Normal
Respiratory disorder
Respiratory alkalosis

S I N G L E B E S T ANSWER:
2. A mother has brought her three year old son to the Emergency department two hours after
he has taken an unknown quantity of paracetamol suspension. He appears well and is playing
normally. .
What is the SINGLE most appropriate time to measure his serum paracetamol levels?
A^
\Bj
C.
D.
E.

Immediately
In 2 hours
In 4 hours
In 8 hours
In 24 hours

Theme: Neck swellings

Options:
A.
B.
C.
D.
E.
F.
G.
H.

Ultrasound
FNAC
CT
Excision Biopsy
X-ray
Contrast X-ray
Doppler ultrasound
Aspiration with cytology and microscopy

Instruction: For each presentation below choose the Single most likely investigation from
the above list of options. Each option may be used once, more than once or not at all.
/^3. 18 year old man presents with a painless swelling in the midline of the neck, just in front of
the trachea. The swelling moves on swallowing and protrusion of the tongue. ) Wtffzfj^&A l\
LJL
^T ,

A 4. A 14 year old girl presents with a painless swelling in the upper part of the right of the
^ neck. On examination it is a fluctuant swelling felt beneath the upper third sterno-mastoid.

^ . ^ ^ j '

txc

5. A 75 year old man presents with dysphagia, regurgitation of food and chronic cough. On
examination, a 7cm soft, smooth, non- tender and compressible swelling behind the mastoid
and inferior to the thyroid cartilage is noted, p ftcf-fflfA jM/c-h
fiUuj
ft*

S I N G L E B E S T ANSWER:
6. A 52 year old woman has pruritus, jaundice and general malaise. She describes abdominal
discomfort, dark urine and pale offensive stools. She takes thyroxine. On examination, she
is mildly icteric with scratch marks and splenomegaly. Blood tests are: HblO.Og/dl, WBC
3.5*10 /L, Pits 110* 10 L, INR1.7, bilibrubin 140 umol/1, ALP 800 iu/1, ALT 150iu/l,
Alb30g/1. o Oi [r>Jtk)til j <Ci1#-6.
k i p ^ i o ^ ^ l - ' - x : >L--i-G.w ^
9

Which of the following is the most appropriated investigation?

0 L i v e r biopsy fc-~ t W , "

| l

^ f

B. Abdominal ultrasound
C. Anti-smooth muscle antibody
D. Anti-mitochondrial antibody - 5
E. Viral serology.

^
,

7-fP
f l
s

^ "

-H*!^'^

/-.-)

S I N G L E B E S T ANSWER:
7. A 55 year old man has weight loss, dyspnoea and syncope. He smokes 20 cigarettes a day.
Investigation confirms a squamous cell carcinoma in the left bronchus.
What is the SINGLE most likely biochemical abnormality to be associated with the
condition?

B.
C.
D.
E.

Hyperkalaemia
Hypermatraemia
Hypocalcaemia
Hypomagnesaemia

Theme : Diagnosis of anxiety

Options:
A.
B.
C.
D.
E.
F.
G.

Acute stress syndrome

Agoraphobia
Alcohol withdrawal
Generalized anxiety disorder
Obsessive compulsive disorder(OCD
Panic disorder
Phaeochromocytoma

H.
I.
J.
K.
L.

Post traumatic stress disorder(PTSD)

Psychotic disorder
Social phobia
Substance abuse
Thyrotoxicosis.

Instruction: For each patient described below, choose the most likely diagnosis from the
above list of options. Each option may be used once, more than once or not at all.
8. A 30 year old woman has experienced restlessness, muscle tension and sleep disturbance
on most days over the last six months. She worries excessively about a number of every day
events and activities, and is unable to control these feelings which are impairing her ability to
hold down her j ob.
9. A 26-year old political refugee has sought asylum in the UK and complains of poor
concentration. He keeps getting thoughts of his family whom he saw killed in a political
coup. He is unable to sleep and feels hopeless about his survival. Because of this he is afraid
to go out.
10. A 30-year-old man is becoming concerned about safety of his family. He has been
checking the locks of the door every hour during the night. He becomes very anxious i f his
wife tries to stop him.
11. A 48 year old woman always socially with-drawn has stopped going out of the house.
She is afraid to socialize because she fears that people will criticize her.

Theme: Treatment of Septicaemia

Options:
A. Ceftazidim
B. Cefuroxime
C. Ceftriaxone
D. Gentamicin
E. Cefalexin

F. Co- Amoxiclave
G. Piperacillin+ Tazobactam
1^ , -. , .......
_
.."
'
"^^ '
v

v v
v

L <

v ,

Instruction: For each patient described below, choose the most likely diagnosis from the
above list of options. Each option may be used once, more than once or not at all.
H 12. An old lady had UTI treated with antibiotics then developed diarrhoea. ^A/donviwkt^ciX
cJJas
_L 13. A patient with penicillin allergy.
j 14. A patient has Hodgkin Lymphoma under treatment developed high fever and WBC less
than 2000 and chest infection. e^micvfuiXhl ^^a^
- W ^ l c fic^uU^x^
t 74?e,fca cfr^

Theme : Side effects of Antipsychotic Medications

Options:
A.
B.
C.
D.
E.

Lithium carbonate
Phenelzine
Diazepam
Haloperidol
Thioridazine

G. Fluoxetine
H. Valproate
I . Clozapine
J. Chlorpromazine
K. Amphetamines

Instruction: For each patient described below, choose the SINGLE most relevant option
from the above list of options. Each option may be used once, more than once or not at all.
jS- 15. Dosages above the recommended upper limit can lead to retinitis pigmentosa.
|I

16. Inhibition of ejaculation is a characteristic side effect.

P5, 17. Sudden development of severe throbbing headache signals a possible medical emergency.
A" 18. Gastro intestinal distress and fine tremor of the hands indicate toxicity.
3) 19. In low dosages, its relative lack of autonomic side effects makes it a drug of choice in the
treatment of agitation in elderly individual.

Theme : Speech disorder in children

Options:
A.
B.
C.
D.
E.
F.
G.
H.
I.

Arrange hearing test

Arrange magnetic resonance imaging(MRI) brain scan
Broad spectrum antibiotic
Reassure
Refer for developmental assessment
Refer to department of child psychiatry
Refer to ear, nose and throat ENT surgeon
Refer to social services
Refer to speech therapist

Instruction: For each child described below, choose the single most appropriate management
strategy from the above list of option. Each option may be used once, more than once, or not
at all.
20. A mother is concerned that her 18-month-son has vocabulary of ten words but cannot
form a sentence.
P[ 21. A mother presents with her 6-month-old son who is vocalizing. She has also noticed that
he does not respond to loud noises. His motor milestones are normal.
1

22. A mother presents with her 12-month-old daughter. The child has no meaningful words,
is unable to sit unaided and cannot play with her toys. She does not laugh and has poor
interaction with her siblings.
23. A mother presents with her 3-year-old son who has indistinct nasal speech. He snores at
night and has restless sleep. He is tired by day.

S I N G L E B E S T ANSWER:
24. A 60 year old man has had spontaneous painful swelling of his right knee for three days.
Five days previously he had an inguinal hernia repaired as a day case. He takes
, ,j, ^ J
bendroflumethiazide 2.5 mg daily. He is apyrexial.
(>oof
t^f^it ^ ^ ^ ^
c

What is the SINGLE most appropriate diagnostic investigation?

A. Blood cultures
B. C -reactive protein
C. D- dimer
D. Plain x-ray of the knee
(^E?) Serum uric acid

j&Jl

S I N G L E B E S T ANSWER:
25. A man presents with knee injury while skiing. On examination there is pain on valgus
stressing. What is the most likely affected ligament?
Medial collateral ligament
B. Lateral collateral ligament ^Y^UVS
C. Anterior cruciate ligament
D. Posterior cruciate ligament

Theme: Treatment of vision loss

Options
A.
B.
C.
D.
E.
Y.J

Pan retinal photo coagulation

B complex vitamins
Pilocarpine eye drops
Corticosteroids
Peripheral iridectomy
Scleral buckling

G. Physiotherapy
H. Spectacles
I . Analgesics alone
J. Surgical extraction of lens
K. Pressure over eyeball

Instruction: For each of the patient described below choose the single most appropriate
treatment from the above list of options. Each may be used once, more than once or not at
all.
~\ 26. A 38 year old female presents with sudden loss of vision but fundoscopy is normal. She
had a similar episode about 1 year back, which resolved completely within 3 months. On
('(V
examination, she has mild weakness of right upper limb and the reflexes are exaggerated.

27. A 54 year old myopic develop[s flashes of light and then sudden loss of vision. rerc/W
^

28. A 65 year old female presents with head ache and loss of vision. Her ESR is markedly
elevated. 6cA
29. A 55 year old hypertensive suddenly lost his vision. The retina is pale and fovea appears
as a bright cherry red spot.
^

30. A 55 year old man presents with mild headache. He has changed his spectacles thrice in
one year. There is mild cupping present in the disc and sickle shaped scotoma present in both
eyes.
(Wyaic.
^i&rr&

Theme: Pain in pregnancy

Options:
A. Acute fatty liver of pregnancy

H. Obstretic cholestasis

B. Acute pyelonephritis

I . Placental abruption

C. Braxton hicks contractions

J. Round ligament stretching

D .Cholecystitis

K. Symphysis pubis dysfunction

E. Chorioamnionitis

L. Urinary tract infection

F. HELLP syndrome

M . Uterine rupture

G. Labour
Instruction: Each of the following scenario, select the most likely diagnosis. Each option
may be used once, more that once or not at all.
_T 31. A 32 year old woman of 39 weeks of gestation attends the antenatal day unit feeling very
^
unwell with sudden onset epigastric pain associated with nausea and vomiting. Her
temperature is 36.7C. On examination, she is found to be tender over the right upper
quadrant. Her blood results show mild anaemia, low platelets, elevated liver enzymes and
haemolysis.
/v 32. A 32 year old woman of 38 weeks of gestation complains of felling unwell with fever,
Is, rigors and abdominal pains. The pain was initially located abdomen and was associated with
urinary frequency and dysuria. The pain has now become more generalized specifically
radiating to her right loin. She says that she has felt occasional 'uterine tightening'. A CTG is
.reassuring.

&

33. A 32 year old woman para 3 of 39 weeks of gestation reports having had spontaneous
ruptureof membranes 4 days, ago. She did not attend the delivery suite, as she knew that
would happen and had already decided on a home birth. Today, she feels very hot and
sweaty. She thought that she was starting to have labour pains, but she describes the pain as
more constant. On examination, her uterus is tender throughout. Blood tests show a raised
CRP and white cell count.
34. A 32 year old woman of 40 weeks gestation attends the antenatal day unit with sudden
onset epigastric pain with nausea and vomiting. She is clinically jaundiced. Her biochemistry
ivfruniH
results show a raised bilirubin, abnormal liver enzyme, high uric acid and hypoglycaemia. t^~ipd- iSl ^

^ 35. A 32 year old woman of 38 weeks gestation attends the antenatal day unit with pain in
the supra-pubic area that radiates to the upper thighs and perineum. It is worse on walking.
Her urine dipstick showed a trace of protein but in white cells, nitrates or blood.

nf

^{j^, /

Theme: Haematuria

Option:
A.
B.
C.
D.
E.
F.

Benign prostatic hypertrophy

Carcinoma of the bladder
Cystitis
Hypernephroma
Polycystic kidney disease
Renal calculus

G.
H.
I.
J.
K.

Schistosomiasis
Trauma to the kidney
Tuberculosis of the kidney
Ureteric calculus
Wilm's tumour

Instruction : For each of the following presentations, choose the single most likely cause
from the above list of options. Each option may be used once, more than once or not at all.
36. A 60 year old man presents with frank haematuria. He has lived for many years in the
Middle East company reveals pseudo-tubercles and sandy patches.
37. A 25 year old woman presents with urinary frequency dysuria and fever. Urine
microscopy shows 20-50 red blood cells and 10-20 leucocytes in each field.
38. A 70 year old man presents with severe, right sided colicky loin pain radiating towards
the inguinal region. Urine microscopy shows 50-100 red blood cells in each field.
39. A 40 year old man presents with haematuria. On examination both his kidneys are easily
palpable and non tender and his blood pressure is 190/1 lOmmHg. His father had the same
symptoms and died at the age of 55 years.
40. A 65 year old man complains of haematuria frequency, hesitancy and nocturia. He
reports that one certain occasion he finds it difficult to control the urge to pass urine. Urine
microscopy confirms the presence of blood but shown no other features.

S I N G L E B E S T ANSWER:
41. A 19 year old man has had fever, neck pain and generalized rash for 12 hours. He is not
on any medication. He has a temperature of 39.5C. He has limitation of neck flexion and no
lymphadenopathy. The rash is sparse and mainly on the trunk and looks slightly hemorrhagic,
non-blanching on pressure.
What is the SINGLE most likely diagnosis?
A. Henoch-Schonlein purpura
B. Measles
C. Idiopathic thrombocytopenic purpura (ITP)
LyMeningitis
E. Chickenpox

> LI u

ini^XlV^M'l
frtto^CCoJ^"***

~9

Theme: Treatment of dysphagia

Options:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.

Antifungal therapy
Incision and drainage
Endoscopic diverticulectomy
External excision of pharyngeal pouch
Reassurance
Nasogastric intubation
Intravenous antibiotic and analgesia
Antispasmodics
Dilatation of the lower oesophageal sphincter
H2- receptor antagonists

Instruction : For each case below, choose the SINGLE most appropriate treatment from the
above list of options. Each option may be used once, more than once or not at all.
T

42. A 50 year old man complains of dysphagia after eating bread. Barium swallow reveals a
lower oesophageal ring, ^fihabzfcf axy
A 43. A 40 year old woman on chemotherapy for metastatic breast carcinoma now presents
with painful swallowing. On examination she has white plaques on top of friable mucosa in
her mouth and more seen on oesophagoscopy. c^mAjc&'-t^
44. A 20 year old man presents with painful swallowing. On examination he has trismus and
unilateral enlargement of his tonsils. The peri-tonsilar region is red, inflamed and swollen. Q vi^^\

. ^ 45. A 40 year old woman presents with dysphagia. On examination she is febrile with neck ' ^ tf7x> 1
^ erythema and a middle neck swelling. J> j^oa S&xp^&igaJ
--j-

46. A 40 year old woman complains of dysphagia for both solids and liquids. She sometimes
suffers from severe retrosternal chest pain; Bariums swallow reveals a dilated oesophagus
which tapers to a fine distal end.
^id^tfu^

S I N G L E B E S T ANSWER:
47. A 46 year old man is being investigated for indigestion. Jejunal biopsy shows deposition
of macrophages containing PAS - positive granules. What is the most likely diagnosis?
A. Bacterial overgrowth
B. Coeliac disease
C. Tropical sprue
D/Whipple's disease
E. Small bowel lymphoma

$y\cvtfobL

i^ch^l

S I N G L E BEST ANSWER:
48. A 42 years 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 body mass index (BMI)
is 36kg/m
What is the SINGLE most likely diagnosis?
A. Idiopathic hypersomnia
B. Narcolepsy
Chest hyperventilation syndrome
Obstructive sleep apnoea syndrome
E. REM- related sleep disorder

Theme : Disease of the ear

Options:
A.
B.
C.
D.
E.
F.
G.

Acute mastoiditis
Acute otitis externa
Acute otitis media
Cholesteatoma
Dental abscess
Ear wax
Foreign body

H. Herpes zoster infection

I . Mumps
J. Oro- pharyngeal malignancy
K. Otitis media with infusion
L. Perforated tympanic membrane
M . Tosilitis

Instruction: For each child described below, choose the SINGLE most likely diagnosis from
the above list of options. Each option may be used once, more than once or not at all.
49. A four years old boy, who previously had normal hearing, has mild earache relieved by
paracetamol. He has been noticed to turn up the volume on the television. He has bilateral
dull tympanic membranes. His pre-school hearing test shows symmetrical loss at 40 db. t] U/t
50. A 17 year old man has acute pain and earache on the right side of his face. He has a
temperature of 38.4 C and has extensive pre- auricular swelling on the right, tender on
palpation bilaterally.
51. A 68 year old woman has a sudden onset of pain in her left ear, loss of hearing on the left
ear and unsteadiness when walking. There are small lesions visible on her palate and left
external auditory meatus.
Qs&JV-m K v ^ .
o-\
52. A 75 year old man has left- sided earache and discomfort when he swallows. There is
ulceration at the back of his tongue and he has a palpable non- tender cervical mass.

Theme : Genetic disorders

Options:
A.
B.
C.
D.
E.
F.
G.
H.

45X0
47XXX
47XXYkl^jeU^r'i
47XY(13) fda^ '
47XY(18) ( f i o r d ' s
47XY(21)
69XXY
Fragile X syndrome

Instrcutions: For each of the following scenarios, select the most likely karyotype. Each
option may be used once, more than once or not at all.
53. You are performing the postnatal check on a 3 day old girl. She has swollen hands and
feet, and you find it difficult to palpate her femoral pulses.
54. You are asked to see a 1 hour old baby. He is dysmorphic, with a small chin and low-set
ears. He also has a small head and rocket- bottom feet.
55. A 15 year old boy presents to the general pediatrics clinic. He and his family are
concerned as he has not entered puberty yet. He is tall for his age and has small, firm tests.
He is a shy boy and has some behavioural problems at school.
ffivcO

56. You are asked to see a 1 hour-old baby. He is dysmorphic with a round face. On
examination you notice that he is very floppy.
57. A 5 year old boy presents to the outpatient clinic. He has learning difficulties, a large
head and large testiclg.s. He has quite a characteristic facial appearance, with a prominent
forehead and large ears .
U - ^ ^fiXx)
1

S I N G L E B E S T ANSWER:
58. A retired ship worker has pleural effusion and pleural thickening on right side with
bilateral lung shadowing. What would you do to improve his symptoms?
A.
(By
. C.
C.

Aspiration.
Chest drain
Chemotherapy
Diuretic

S I N G L E B E S T ANSWER:
59. Which single drug is unlikely to cause depression as a side effect?
^ A: Amoxicillin
B. Digoxin
C. Haloperidol
D. Indomethacin
E. Prednisolone

S I N G L E B E S T ANSWER:
60. A 76 year old woman on paroxetine has increasingly become weak and confused. What
the single most likely reason for her confusion?
A. Hypercalcaemia
B. H>"pematraemia
C. Hypocalcaemia
D. Hypoglycaemia
E. Hyponatraemia

SINGLE B E S T ANSWER:
61. An 83 year old woman who is resident in a nursing home is admitted to hospital with a
four history of diarrhoea. She has had no weight loss or change in appetite. She has been on
analgesics for three weeks for her back pain. She is in obvious discomfort. On rectal
examination, she is found to have fecal impaction.
What is the SINGLE most appropriate irnmediate management?
A. Codeine phosphate for pain relief
B. High fibre diet
C. Oral laxative
E. Urinary catheterization

SINGLE BEST ANSWER:

62. A 35 year old woman has had brusing and petechiae for one week. She has also had
recent menorrhagia but is otherwise well. A blood count shows:
Haemoglobin (Hb) 11. lg/dl ^

White blood cell (WBC) 6.3 X10 L (normal differential)

9

.-,

UOUWWJK

Platelets 14 X 10 L j
9

What is SINGLE most likely diagnosis?

A.
B.
C.
(D)
E.

Actue leukaemia
Aplastic anaemia
Human immunodeficiency (HIV) infection
Idiopathic thrombocytopaenic purpura
Systemic lupus erythematosus(SLE)

Theme: Diagnosis of sore throat

Options:
A.
B.
C.
D.
E.
F.
G.

Diphtheria
Infectious mononucleosis
Acute follicular tonsillitis
Scarlet fever
HIV
Agranulocytosis
Acute otitis media

Instruction: For each patient described below, choose the S I N G L E most relevant diagnosis
from the above list of options. Each option may be used once, more than once or not at all.
63. A 5 year old child complains of sore throat and earache. He is pyrexial. On examination
tonsils are enlarged and hyperemic exude pus pressed upon.
64 A 25 year old man presents with severe malaise and sore throat. He has red tonsils with
yellow membranes and enlarged lymph nodes on the neck.
65. A 30 year old man presents in Accident and Emergency department with difficulty in
breathing. He has returned from India. Recently examination of his throat revealed grey
membranes on the tonsils and uvula. He has mild pyrexia.
66. A 7 years old girl presents to her GP with sore throat, a punctuate erythematosus rash and
circum-oral pallor.

SINGLE B E S T ANSWER:
67. A child recovered from meningitis. What investigation will you do before discharge?
A. CT scan.
B. EEG.
C. Blood culture.
D. Repeat lumbar puncture.
(jB^Ffearing test 10 cM ctf ^..<

<

SINGLE B E S T ANSWER:
68. A 75 years old man complaining of dripping incontinence and has an ammonia smell. On
examination he has furred tongue & has a painless abdominal mass which extends to the
umbilical level. Urine analysis shows proteins ++ & nitrates + & no growth.
What is the most appropriate management for this patient?
A.
B.
(c)
D.
E.

Suprapubic catheterization ^ ifl f^X

fm&*L

/ jcUi * i>W~: '

r b

Trimethoprim
Intraurethral catheterization
Condom catheter
Laparotomy

Theme: Pelvic pain

Options:
A.
B.
C.
D.
E.
F.
G.
H.
I.

Pelvic inflammatory disease

Endometriosis
Ectopic pregnancy
Miscarriage
Inflammatory bowel disease
Diverticulosis
Irritable bowel disease
Pelvic congestion syndrome
Adenomyosis

Instruction: For each presentation described below choose the Single most likely diagnosis
from the above list of options. Each option may be used once, more than once or not at all.
>

69. A 28 year old woman complains of chronic cyclic_pelvic pain. On taking history it is
revealed that she has been trying to conceive since she was 17 and her periods are heavy.

f\. A 25 year old lady complains of chronic pelvic pain and infertility. She has changed three
sexualpartners in one year.

71. A 30 year old lady complains of irrtermittent diarrhoea, chronic abdominal pain and
jtenesmus.jSometimes she notices^loo^inher stools?

Ij 72. A 45 year old waitress complains of pelvic pain which WOT^enspre-inensfaTaally and on
standing and walking. She also complains of post -coital ache, b c * ^ wf U'-W feh/jfC V'eor - KA-J
73. A 35 year old lady who has been using IUCD for one year now complains of pelvic pain
andheavyjainMperiods.
~ U , j ^ , ,uM ^
^
^ ^
^
f

p l i h j t

Diagnostic tests for headache relating to eye problem

Options:
A.
B.
C.
D.
E.
F.
G.
H.
I.

Colour vision test

Computed tomography (CT) scan of the brain
Electroencephalogram (EEG)
Erythrocyte sedimentation rate (ESR)
Full blood count
Intra- ocular pressure measurement
Serum urea and electrolyte concentration
Visual acuity assessment
Visual field mapping

Instructions: For each patient described below, choose the S I N G L E most appropriate
initial test from the above list of options. Each option may be used once, more than once or
not at all.
74. A 76 year old woman presents with symptoms of feeling generally unwell and anorexia
with weight loss. She complains of sudden loss of vision in her left eye. On the left side the
papillary light reaction is sluggish. Qc A
C^f-ui
|^ 75. A 40 year old woman presents with sudden onset of severe occipital headache,
photophobia and vomiting.
f\\\
j - ^ 76. A 22 year old woman complains of afternoon headache which have progressively
worsened. She works as a visual display and (VDU)j)perator. < > JYUch^v) tQfp&T
.L7 77. A 72 year old woman presents with tunnel and severe headache, nausea and vomiting of
recent onset. She has noticed coloured haloes for six months. cX^ic-taP'
p

78. A 27 year old woman presents with severe morning headache for two months. Full
neurological examination is normal apart from bilateral papilledema. Her blood pressure is
120/70 mmHg. B
i^U mc^f^j
U&M
'
79. A two year old boy has been unable to bear weight since a fall from a chair the previous
night. He is tender over the mid-tibia but there is no obvious limb deformity.

-f^h^J

^ x .

What is SINGLE most likely radiographic appearance?

A.
B.
C.
D.
^R)

Angulated fracture
Compound fracture
Epiphyseal fracture
No fracture likely
Spiral fracture

Theme: Diagnosis of jaundice in childhood

Options:
A. Alpha 1 - antitrypsin deficiency
deficiency
B.
C.
D.
E.
F.

Biliary atresia
Breast milk jaundice
Congenital sphercytosis
Congenital viral infection
Galactosaemia

G. Glucose-6-phosphate dehydrogenase
(G6PD)
H. Hepatitis A infection
I . Hypothyroidism
J. Physiological jaundice
K. Rhesus hemolytic disease
L. Urinary tract infection

Instructions: For each patient described below, choose the Single most likely diagnosis
from the above list of options, each option may be used once, more than once, or not at all.
80. A previously well 10 year old girl presents with a two day history of nausea, anorexia,
low grade fever and loose stools. She has yellow sclera and is tender in the right upper
quadrant on abdominal palpation.
81. At birth a baby boy at 38 weeks gestation weighs 1.8 kg. He has hepato-splenomegaly
and a rash. Blood tests show raised level of bilirubin and liver enzymes.
82. A baby girl on the post natal ward becomes progressively more jaundiced and pale. A
cord blood tested at birth shows Coomb's test positive. V\^ toU^j
83. A six week old formula fed baby_boy is found at child health surveillance to be deeply
jaundiced. His weight gain is poor and his stools are pale. Yj&s*nj (XMZK-^
84. A n eight week old baby boy is noted to be jaundiced. He is breastfeeding well and has
gained 3OOg from birth. His stools are yellow and his urine is pale straw coloured.
^f ^
M

S I N G L E B E S T ANSWER:
85. A 57 year old man presents with pain in his right knee. An X-ray shows Osteoarthritis. He
has no past medical history of note. What is the most suitable treatment option for the
management of his pain?
A. Diclofenac with Omeprazole
B. Co-codamol (30/500)
C. Diclofenac
D. Ibuprofen
Paracetamol 1

toc&ti&

S I N G L E B E S T ANSWER:
86. What is the most appropriate antibiotic to treat uncomplicated Chlamydia infection in a
21 year old female who is not pregnant?
A Erythromycin

c u w ^ ' l U / ! *~

'if W

ff^^LM

B. Ciprofloxacin
C. Metronidazole
D. Cefixime
^EyDoxycycline

S I N G L E B E S T ANSWER:
87. For patient with Parkinson's disease, which one of following drugs is most useful in the
management of tremor?
A. Apomorphine
B. Cabergoline
C. Selegiline
D. Amantadine
^E\Benzhexol

S I N G L E B E S T ANSWER:
88. A 60 year old man presents with increasing forgetfulness poor sleep, loss of interest. He
shows psychomotor retardation and answers every question with T don't know'
What single diagnosis explains his condition?
[A/
B.
C.
D.
E.

Depression
Dementia
Bipolar affective disorder
Normal aging process
Panic disorder

Theme: Investigations for Pulmonary Conditions in Children

Options
A. Barium swallow
B. Bronchial lavage
C. Capillary blood gases
D. Chest x-ray
E. CT scan of the chest
F. Exercise challenge
G. MRI of the chest
H. Mantoux test

I.
J.
K.
L.
M.
N.
O.

No investigation needed
Peak flow rate diary
Per nasal swab
Pulse oximetry
Spirometry
Sputum culture
Sweat test

Instruction: For each child described below, choose the SINGLE mojtap^opnate
investigation from the above list of options. Each option may be used once, more than once
or not at all.
89. A n eight year old boy has longstanding asthma. He has been admitted with a severe
episode and is tired and drowsy. He has not improved on Oxygen, inhaled Beta 2 Agonists
and Intravenous (IV) Hydrocortisone. A chest x-ray shows bilateral hyperinflation. He is too
breathless to use a peak flow meter and his oxygen saturation is below 90% on Oxygen. , \ ^ ' \
90. A 10 year old boy takes regular high dose inhaled steroids for his longstanding asthma
has been advised to use bronchodilators to control acute attacks. His parents are unsure when
should he use his bronchodilator inhaler.
j
;
utfydiT
v x W

91. A six year old girl has had two short episodes of cough and wheeze over the last 12
months. These two acute episodes responded quickly to bronchodilator, she has no symptoms
or abnormal physical signs. She has slight eczema and her mother has asthma. (<i rftk.^
^
92. A 14 year old boy with asthma suddenly developed chest pain and increasing
breathlessness during a game of football. When seen in the Emergency Department not
cyanosed. He has reduced breath sounds on the right side. His oxygen saturation is 94% on
air.

M ^

S I N G L E B E S T ANSWER:
93. A child complains of right iliac fossa, pain and diarrhoea. On colonoscopy, granular
transmural ulcers are seen near ilecoecal junction. What should be the management? v
Sulfasalazine
B. Paracetamol
C. Ibuprofen
D. Metronidazole

Diagnosis of scrotal swelling

Options
A.
B.
C.
D.
E.
F.
G.
H.
I.

Epididymal cyst
Epididymo-orchitis
Hydrocele
Inguinal hernia
Scrotal abscess
Sebaceous cyst of scrotum
Testicular hematoma
Testicular neoplasm
Torsion of testis

Instruction : From each patient described below, choose the SINGLE most likely diagnosis
from the above list of options. Each option may be used once, more than once or not at all.
^

94. A 70 year old man has had a painful swelling of his right testis for 36 hours. He has a
history of dysuria and frequency of micturation and has a of temperature of38C.

95. A 25 year old man has had painless enlargement of his left testis for three months. The
left testis is three times the size of the right testis and in non-taider.^ ^ ^
'
w

U S i

96. A 39 year old man had a painless_soft 1 cm swelling near the upper pole of his right testis
for six months.
97. A 4 year old boy has had one hour of severe right testicular pain of sudden onsets

Theme : Overdose

Options
A.
B.
C.
D.

Amphetamines
Aspirin
Cannabis
Carbon monoxide

E.
F.
G.
H.

Cocaine
Organophosphate insecticides
Theophyline
Tricyclic antidepressants

Instruction : For each patient described below, choose the single most likely agent from the
above list of options. Each option may be used once, more than once or not at all.
98. A 26 year old man changed his job from a labourer to a paint ^tWpppr About two months
to his job he went to his GP complaining of recurrent bouts of headache and mild exertional
dyspnoea. The GP diagnosed a viral illness. However, his condition did not improve and
during the next two months his symptoms gradually became worse. He was brought to the
hospital with generalized tonic- clonic convulsion which was followed by cardio respiratory
arrest.
99. A 66 year old man with known asthma was brought to the hospital with nausea and
vomiting and a single episode of haematemesis. He also complained of central abdominal
pain and diarrhoea. His ECG shows supra-ventricular tachycardia at 150 beats per minute.
Blood tests show hypokalaemia and acidosis.
100. A 56 year old farmer was brought in to the hospital with nausea, vomiting, abdominal
colic and diarrhoea. He also complained of chest tightness. Examination of the eyes showed
miosis. A diagnosis has been confirmed be measuring erythrocyte acetycholinesterase
activity.
101. A 26^y^ar_okTw^man presented with hyperventilation, sweating, nausea, vomiting and
abdominal pain. Blood gas analysis shows mixed acid base disturbances with respiratory
alkalosis and metabolic acidosis.

Acute trauma life support:

Options
A.
B.
C.
D.
E.

Chest drain insertion

ECG
Guedel airway
Intubation
Needle thoracocenthesis

F.
G.
H.
I.
J.

Pericardio-centhesis
Secondary survey
Thomas splint
Trauma X-ray series
Two wide bore cannulas and IV fluids

Instruction : For each patient described below, choose the S I N G L E most appropriate
management from the above list of options. Each option may be used once, more than once
or not at all.
102. A 20 year old woman has been brought to the resuscitation room after being involved in
high speed RTA. Her airways and her breathing are clear. She raised JVP, hypotension and
muffled heart sounds.
103. A 57 year old man fell from his roof while installing an antenna and landed on his head.
His GCS score is 7.
104. A 17 year old boy is brought to the A&E after a motor bike accident in which he injured
his right tibia. His airways and breathing are clear and his observations are stable.
105. A 34 year old man presents A & E following RTA. His breathing is laboured and you can
hear a moaning sound, even after chin lift and jaw thrust.
'
106. A 54 year old man presents with cyanosis and breathlessness following a RTA. Chest
percussion in hyper resonant.

Theme: Anatomical land marks

Options:
A.
B.
C.
D.
E.
F.

Apex beat
Chest-drain insertion
Femoral artery pulse is felt
Fundus of the fall bladder
McBurney's point
Stellate ganglion

G.
H.
I.
J.

-Superficial- inguinal ring

Termination of the spinal cord
Transpyloric plane
Vena caval opening in to the diaphragm

Instructions: For each of locations described below choose the Single most appropriate land
mark form the list of options above. Each option maybe used once, more than once or not at
all.
107. L I level. -

'

'

108. Midpoint between the supra-sternal notch and pubic symphysis. <
109. Tip of the ninth costal cartilage. '<.
110. Just above the mid-inguinal point.
111. Fifth intercostal space in the anterior axillary line, A-v

uv

S I N G L E B E S T ANSWER:
112. A 62 year old man who was admitted for minor surgery three days ago suddenly
recedes conf jsed. His attention span is reduced. He is restless and physically aggressive and
ricks ar Ms bed sheets.
Wzs: SINGLE aspect of the patient's history recovered in his notes is most likely to aid in
-<r-? a diagnosis?
Ay
B.
C.
D.
E.

Alcohol consumption
*
Head trauma
History of anxiety
Prescribed medication
Obvious cognitive impairment
1

S I N G L E B E S T ANSWER:
113. A 34 year old man with multiple sclerosis has taken an overdose of 100 tablets of
paracetamol with intent to end his life. He has been brought to the Emergency department of
treatment but is refusing all interventions.
A. Assessment of suicide
(JS)Evaluate patient's capacity to refuse treatment
C. Establish i f patient has a previous mental illness

S I N G L E B E S T ANSWER:
114. A 45 year old man underwent emergency splenectomy following a fall from his bicycle.
He smokes five cigarettes a day. Post -operatively despite mobile, he developed swinging
pyrexia and a swollen painful left calf. His chest x-ray shows lungs atelectasis and
abdominal ultra-sonography demonstrates a small sub-phrenic collection.
What is the SINGLE most likely risk factor for deep vein thrombosis in the patient?
.*
;

A. Immobility
B. Intraperitoneal hemorrhage
C. Smoking
(_L\ Splenoctomy
E. Sub-phrenic collection

\
,

,
.,

j Theme: Skin lesion

(
Options :
A. Psoriasis
B. Basal cell Ca
C. Lichen planus

ft'--

D. Venous Ulcer
E. Bed Sore
F. Bullous Phemphigoid
Instructions: For each of locations described below choose the Single most appropriate land
mark form the list of options above. Each option maybe used once, more than once or not at
all.
C- 115. Flexor papules and white thread in the mouth
- ' ' ,
+~116. A n old man has itching and tense blisters
f 117. A young lady has a scaly rash on her head and her extensors, her aunt has the same rash.
% 118. A 60 year old man has a lesion with pearly edge on his face.
119. A ulcer on medial maleolus with loss of hair & shiny skin on lower limps.

Theme : Obesity
Options:
H.
A. Acquired hypothyroidism
I.
B. Addision's disease
J.
C. Bulimia nervosa
K.
D . Congenital hypothyroidism
L.
E. Cushing's disease
M
.
F. Cushing's syndrome
G .Hyper-insulinaemia secondary to diabetes

Lawrence-moon-biedl syndrome
Obesity secondary to behavioural disorder
Ploycystic ovarian syndrome
Prader-willi syndrome
Primary obesity
Tricyclic antidepressant use

Instruction : For each of the following patients who are clinically obese, select the most
likely
diagnosis. Each option may be used once, more than once or not at all.
k

120. A n 8 year old boy is clinically obese. As a baby, he was floppy and difficult to feed. He
now has learning difficulties, and is constantly eating despite measures by his parents to hide
food out of reach.
V
'
' '; ', , -' ' V'.', ^ ' . ^ ' j f , / ' '^.p^'r^.,.-.
121. A 6 year old boy is clinically obese; his body mass index is above the 95th centile. He
has no other medical problems and an examination is unremarkable. His mother says that she
has tried everything to help him lose weight. ; ' , f

et

122. A 10 years old boy is clinically obese and the shortest in his class. He had a renal
transplant last year and his mother is worried that he is being bullied.

123.A 17 year old girl is clinically obese. She has put a lot of weight on over the last year.
She says that she is always tired and is becoming more constipated, jJ.1

^
^

124. A 14 year old girl is clinically obese. She has not started her periods yet and has severe
acne. Among her investigations, a high insulin level is found.
Theme : Hearing difficulty
Options:
A. Encephalopathy
B. Chronic perforation of tympanic
membrane
C> Chronic secretory otitis media'';
\yith effusion
...
y
D. Congenital sensori neural deficit
E. Cytomegalo virus (CMV) infection
F. Functional hearing loss

G. Tympano-sclerosis
H. Otosclerosis
I . Post meningococcal
neural deficit
J. Presbycusis
K. Syndromic deafness

Instructions: For each hearing assessment described below, choose the most likely diagnosis
from the above list of options. Each option may be used once, more than once, or not at all.
| 125. A 26 year old woman has become aware of increasing right - sided hearing deficiency
' since her recent pregnancy. Her eardrums are normal. Her hearing tests show:
Bone conduction normal
Weber test lateralizes to the right ear.
^

126. A 32 year old man cannot hear in his left ear following recovery from a motor vehicle
collision in which he sustained a left parietal fracture and whiplash associated disorder. Her
hearing tests shows air conduction and bone conduction thresholds symmetrically reduced
greater than 90%
* ,
Weber test lateralizes to the right ear.
>''
1
~
'
|A;

; :

127. A 10 year old girl has been referred for assessment of hearing as she difficulty hearing
her teacher in class. Her hearing tests show:
/:_., .
,
Bone conduction normal
' *
Symmetrical air conduction thresholds reduced bilaterally
_
Weber test shows no lateralization.
c

128. A 59 year old man has had increasing conversational difficulties because of background
noise. His eardrums are normal in appearance. His hearing tests show:
Bone conduction and air conduction thresholds equally reduced in both ears.
Weber test shows no lateralization.

Theme : Antenatal diagnosis of children with potential congenital abnormalities

Options:
A. Aminocenthesis
B. Chorionic villus sampling (CVS)
C. Chorionic and DNA studies of
both parents
D. Fetal cordo-centhesis
protein S (PAPP-A)
E. Genotyping fetal cell in
maternal circulation
F. Maternal serum alpha-fetoprotien

G. Pre-implantation genetic screening

H. Serum anti - D titers
I . Serum creatinine kinase.(CK)
J. Serum pregnancy associated plasma
K. Ultra sound scan at 12 weeks
gestation
L. Ultrasound scan at 18-20 week
gestation

Instruction: For each disorder described below, choose the SINGLE most useful test from
the above list of options. Each option may be used once, more than once or not at all.
129. A 27 year old woman who is eight week pregnant asks for a test on her unborn baby
possible skeletal dysplasia. Her first baby died shortly after birth with short-limb dwarfism.
130. A couple attend to discuss risks of cystic fibrosis (CF) in their future pregnancy because
of family history of CF on the maternal side.
131. The mother of a child with Duchene muscular dystrophy plans to become pregnant in
the near future. She enquires about the earliest test to identify i f the fetus of a future
pregnancy would be affected.
132. 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.
133. A 29 year old woman reports that her partner's father has recently been diagnosed as
Huntington chorea. She wants to know what diagnostic test would be certain to avoid
problem in a future child.

Theme : Diagnostic tests for patients presenting with chest pain

Options:
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
K.

Abdominal ultrasound
Blood culture
Bronchoscopy
Cardiac enzymes
CXR
CT scan
ECG
FBC
LP
Oesophago-gastro-duodenoscopy (OGD)
V/Qscan

Instruction: For each patient described below, choose the single next most appropriate
test from the above list of options. Each option may be used once, more than once or not at
all.
134. A 68 year old man has had malaise for five days and fever for two days. He has cough
and there is dullness to percussion at the left lung base. . . .
135. A 50 year old woman returned by air to the U K from Australia. Three days later she p/w
sharp chest pain and breathlessness. Her CXR and ECG are normal.
136. A tall, thin, young man has sudden pain in the chest and becomes breathless while
crying.
137. A 45 year old manual worker p/w a two hour h/o chest pain radiating into his left arm.
His ECG is normal.
<
*
138. A 52 year old obese man has been having episodic anterior chest pain particularly at
night for three weeks.

S I N G L E B E S T ANSWER:
139. A middle aged man presents with splenomegaly, hepatomegaly, bleeding and more
prone to infections. He has a very high leukocyte count (mainly neutrophils).
What is the most likely diagnosis?
A. A M L
B. A L L
C. Aplastic anaemia
(rx)CML
E. CLL

'

~~

, "

Theme: Later complications of H I V infections

Options:
A.
B.
C.
D.
E.

Kaposi's sarcoma
Molluscum contagiosum
''
Hairy leukoplakia
f'^ ,Tuberculosis
" ' > * ' '
Cryptosporidium po^HrT^wi ^V^ji-

F. CMV infection

G. Candida infection
H. Pneumocystiscarinii infection
I . Cryptociccal infection ^/^I'wkHtflfe
J. Toxoplasma abscess
^.vf""^
K. AIDS dementia
^

^^

Instruction: For each patient described below, choose the S I N G L E most likely diagnosis
from the above list of options. Each option may be used once, more than once or not at all.
140. A patient presents with progressive visual deterioration. On examination there are large,
multiplefcottonwools spots)in both eyes,.
141. A patient presents with gradual onset of headache, neck stiffness, photophobia and
fluctuating level of consciousness. CSF shows a lymphocytosis but no organisms on gram
stain. CT brain is normal.
<-,. , >. <
142. A patient presents with purple popular lesions on his face and upper trunk measuring
one to two centimetres across. They are not painful or itchy.
^ 143. A patient presents with dysphagia and pain on swallowing. He has a sore mouth and
soreness in the corners of the mouth.
\. A patient presents with fever, dry cough and breathlessness. He is tachypnoeic but chest
is clear on examination. Oxygen saturation is normal at rest but drops on exercise.

Theme : Initial Investigations In Women's Health

Options:
A. Cervical smear
B. DEXA scan(dual energy x ray)
absorptiometry)
C. High vaginal swab (HVS)
J.

H.
Serum estradiol concentration
I.
Serum follicle stimulating
hormone/Leuteninsing hormones
Serum haemoglobin (Hb) concentration

D. Lumbar spine x- ray

E. Mammogram
F. No investigation

Serum progesterone concentration

Thyroid function tests
Transvaginal ultrasound scan

K.
L.
M.

Instructions: For each patient described below, choose the SINGLE most appropriate initial
investigation from the above list of options. Each option may be used once, more than once
or not at all.
145. A 39 year old woman has not had a period for 10 months. She feels well but is anxious
as her mother had an early menopause.
146. A 65 year old woman under long term follow up after a lumpectomy and anti oestrogen therapy for breast cancer attends following a diagnosis of stress fracture in a
metatarsal bone.
147. A 64 year old woman has been on hormone replacement therapy (HRT) for nine years.
She had regular withdrawal bleeds until three years ago and since then has been taking a no
bleed preparation. Recently she noticed a brown vaginal discharge.
148. A 48 year old nulliparous woman feels tiered all the time. Her periods are regular but
have always lasted for at least 10 days, :v> : '

Theme : Acute Abdomen

Option:
A.
B.
C.
D.
E.
F.
G.
H.

Ovarian cancer
Appendicitis
Cervicitis
Crohn's disease
Diverticular disease
Endometriosis
Genital herpes infection
Irritable bowel syndrome

J.
K.
L.
M.
N.
0.
P.

Ovarian torsion
Pelvic congestion syndrome
Pelvic inflammatory disease
Tubal(ectopic) pregnancy
Uterine fibroid
Utero-vaginal prolapse
Vaginal moniliasis (thrush)

Instruction: For each patient described below, choose the single most appropriate conditions
from the above list of options. Each option may be used once, more than once or not at all.
M

XJ~

149. A 24 year old woman has eight weeks amenorrhoea, right sided pelvic pain and vaginal
bleeding. She is apyrexial. Peritonism is elicited in the right iliac fossa. Vaginal examination
reveals right-sided cervical excitation.
150. A 28 year old nulliparous woman has had secondary dymenorrhoea and deep dysparunia
for 10 months. There is restricted mobility of her uterus with some tender nodules in the
utero-sacral ligaments.

x \. A 25 year old woman has had generalized pelvic discomfort from the last years,
' * particularly after sexual intercourse. She has some intermittent loose motion. Examination
and ultrasound scan show normal pelvic organs.

152. A 27 year old woman has pelvic pain, dysmenorrhea and increasingly heavy periods.
She has a six year history of involuntary infertility in three partnerships. Her current partner

, ^ y ^^
^
v

has three young children. There is generalized pelvic tenderness without peritonism. Pelvic^'T^ \y^u{ 'l
v

ultrasound scan is reported as normal.

^ [j^uil

fzkii

iKjwf

^ > <Shdfv { # W <

f

153. 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 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.

^ S I N G L E B E S T ANSWER:

-^Xt^AS

154. Which one of the following is not a degenerative corneal disease?

A. Band Keratopathy
B. Marginal Dystropathy
C. Fatty or lipoid degeneration
D)MooreH'5 Ulcer - ^ ) ^

E. Keratconus

S I N G L E B E S T ANSWER:
155. A n 18 month old boy has been brought of the Emergency department because he has
been refusing to move his left arm and crying more than usual for the past 24 hours. He has
recently been looked after by his mother's new boy friend while she attends college.
Assessment shows multiple bruises and a fracture of left humerus, which is put in plaster.
What is the SINGLE most appropriate next step?
Admit under care of pediatrician -j b^

B.
C.
D.
E.

Discharge with painkiller

Follow up in fracture clinic
Follow up in paediatric outpatients
Follow up with general practitioner (GP)

^ '

^^ *^ ^

)X

"^^fe^tt?

Theme : Immunization in children

Options:
A.
B.
C.
D.
E.
F.
G.
H.
I.

Defer immunization for two weeks

Do not give vaccine
Give half dose of vaccine
Give paracetamol with future doses of the same vaccine
Give simultaneous gamma globulin
Give vaccine as separate Components
Give vaccine in hospital
Immunize other household members
Proceed with standard immunization schedule

Instruction: For each child described below, choose the S I N G L E most appropriate
actionfrom the above list of options. Each options may be used once, more than once or not
at all.
"f

156. A three- month old baby was miserable and cried for two hours following his first
routine immunization with diphtheria, tetanus, polio, Haemophilus influenza- B (HiB) and
meningitis.

A 157. A fifteen month old child is due his measles, mumps and rubella (MMR) vaccine. There
is a family history of egg allergy. He is febrile, with acute otits media.
^

158. A two - month child is due to have her first immunization with diphtheria. Polio,
tetanus, Homophelies influenza - B (HiB) and meningitis. There is a family history of
epilepsy.

pL

159. A twelve- month old child with acquired immunodeficiency syndrome (AIDS) is due for
his measles, mumps, and rubella (MMR) vaccination.^
Wtru/x.

S I N G L E B E S T ANSWER:
160. A 72 year old woman is reviewed following course of oral flucloxacillin for right lower
limb cellulitis. The local protocol suggests oral Clindamycin should be used next line.
i i ,
Which one of the following side effects is it most important to warn her about?

A. Heart burn or indigestion

B. Jaundice
C. Sore throat, bruising or lethargy
D. Avoid any food or drink containing alcohol

l . ' A*,-/
u

.J

E. Diarrhoea

S I N G L E B E S T ANSWER:
161. A 67 year old man has deteriorating vision in his left eyes. He has longstanding chronic
obstructive pulmonary disease (COPD) and is on multiple drug therapy, r,^ ^ , ^
_
What SINGLE medication is most likely to be responsible for his visual deterioration?
A.
(a.
TJ.
D.
E.

'

Beta2 agonist
Corticosteroid
Diuretic
Oxygen
Theophyline

S I N G L E B E S T ANSWER:
162. A 22 year old man has rushed into A & E asking for help. He describes recurrent
episodes of fearfulness, palpitations, faintness, hyperventilation, dryness of the mouth with
peri-oral tingling & cramping of the hands. His symptoms last 5 to 10 mins & have worsened
since their onset 3 months ago. He is worried he may be having heart attack. An ECG shows
sinus tachycardia (lOObeats/ min)
'
What is the SINGLE appropriate immediate intervention?
A.
B.
(Cy>
D.
E.

High flow oxygen

Intravenous (IV) sedation
Re-breathe into a paper bag
Refer for anxiety management course
Refer for urgent cardiology opinion

S I N G L E B E S T ANSWER:
163. A 28 year old man believes that each time the traffic lights changes from amber to red
means that his mother needs to see his urgently, and return home. He has slept for two hours
in the last two days and eats very little. He believes that his thought are being taken out of
his head and made available to people n vicinity.
What is the SINGLE most likely diagnosis?
A. Depressive disorder
B. Generalized anxiety disorder
C. Manic disorder

D. Obsessive compulsive neurosis

\E.y Schizophrenia

Theme : Diagnosis of central chest pain

Options:
A.
B.
C.
D.
E.
F.
G.
H.

Achalasia
Angina
Anxiety
Contochonditis( Tietz's disease)
Dissecting aneurysm
Gall stone colic
Hiatus hernia
Myocardial infraction

I.
J.
K.
L.
M.

Pericarditis
Pneumonia
Pneumothorax
Pulmonary embolism
Rib fracture

Instructions: For each patient described below, choose the single most likely diagnosis from
the above list of option, each option may be used once, more than once, or not at all.
.. / 164. A tall 35 year old man suddenly develops acute localized left sided anterior chest pain
* with breathlessness whilst walking along the street.
165. A 55 year old woman with a persistent cough and history of smoking develops left
sided chest pain exacerbated by deep breathing with fever and localized crackles.
166. A 50 year old man with diabetes suddenly develops persistent crushing central chest
pain radiating to the neck.
167. A 35 year old woman taking the combined oral contraceptive pill has a sudden onset of
central chest pain and presents to the A & E department hypotensive and cyanosed with a
raised jugular venous pressure(JVP).
168. A 48 year old man develops central chest pain over two or three days which is affected
by posture and associated with a pericardial friction run and inverted T waves widely spread
through the electrocardiogram (ECG).

S I N G L E B E S T ANSWER:
169. A 45 year old woman with a history of rheumatoid arthritis presents to the Accident and
Emergency department with a two day history of a hot, painful, swollen right elbow joint.
What is the most appropriate management?
^ ) Joint aspiration ^s^dr^j

e^VMf^ '

B. Start infliximab
C. Oral high dose
D. Short course of methotrexate
E. Depomederone injection

Theme : Neck lump

Options
A.
B.
C.
D.
E.
F.

X4-

Carcinoma of larynx ^
Carcinoma of lungs
Carcinoma of the left main bronchus
Carcinoma of the right main bronchus
Carcinoma of the thyroid
Functional dysphonia

G.
H.
I.
J.
K.

Pan coast tumor

Myxoedema
Mycobacterium tuberculosis
Thyrotoxocosis
Vocal card nodular

Instruction: For each patient described below, choose the SINGLE most likely diagnosis
from the above list of options. Each option may be used once, more than once or not at all.
170. A 52 year old woman has had a swelling in the neck, hoarseness and stridor, both
inspiratory and expiratory, for two months.
171. A 50 year old man has had hoarseness and dropping eyelid for two months. A mass is
palpable in the right supra-clavicular fossa. He smokes 20 cigarettes a day.
172. A 25 year old woman has a recent cough, hoarseness and swelling in the neck. There
are several non-tender swellings on both sides of her neck. She has lost 13 kg in weight. She
takes recreational drugs.

S I N G L E B E S T ANSWER:
173. A man has brought to A & E department from a shopping mall after collapsing there. He
is consious and answering questions. His ECG shows irregular rhythm. _____
ferry
Choice of investigation :
A. CT scan
B. MRI
' c l 24 hr ECG
*^
^
D. Echo
.-.
j .|/ncti^) Afrd^r*-'-

Theme: Post-Partum Hemorrhage - Causes

Options
A.
B.
C.
D.
E.

Atonic uterus
Cervical/vaginal trauma
DIC
Fibroid uterus
Large placental site

F.
G.
H.
I.
J.

Placenta praeiva
Retained product
Rupture uterus
Uterine infection
Von willebrand's disease

Instruction: For each woman with postpartum hemorrhage (PPH) described below, choose
the single most likely predisposing factor from the above list of options. Each option may be
used once, more than once or not at all.
174. A 38 years old woman has delivered after an induced labour which lasted 26 hours.
175. A 28 years old woman has delivered with rotational forceps after an eight hours labours
and a three hours second stage.
176. A 32 years old woman had normal vaginal delivery 10 days ago. Her uterus has
involuted normally.^ l o ^ ' c K ^ l fs [Y-GNT coom^
V pfZ-l
177. A 29 years old woman has just delivered still born infant vaginally, following a major
placental abruption.
178. A 25 years old woman with type one diabetes has delivered a baby weighting 4.5 kg.
Her uterus is well contracted.

Theme : Asthma

Options
A.
B.
C.
D.
E.
F.
G.

Barium swallow
Bronchial lavage
Capillary blood gases
Chest x-ray
CT scan of the chest
Exercise challenge
Mantoux test

1.
J.
K.
L.
M.
N.
0.

No investigation needed
Peak flow rate diary
Per nasal swab
Pulse oximetry
Spirometry
Sputum culture
Sweat test

Insturction: For each child described below, choose the SINGLE most appropriate
investigation from the above list of options. Each option may be used once, more than once
or not at all.
179. An eight year old boy has longstanding asthma. He has been admitted with a severe
episode and is tired and drowsy. He has not improved on oxygen, inhaled beta 2 agonists and
intravenous(IV) hydro-coristone. A chest x- ray shows bilateral hyperinflation. He is too
breathless to use a peak flow meter and his oxygen saturation is below 90% on oxygen.
180. A 10 year old boy takes regular high dose inhaled steroids for his longstanding asthma
has been advised to use bronchodilators to control acute attacks. His parents are unsure when
should used his bronchodilator inhaler.
181. A six year old girl has had two short episodes of cough and wheeze over the last 12
months. These two acute episodes responded quickly to bronchodilators she has no
symptoms or abnormal physical signs. She has slight eczema and her mother has asthma.
182. A 14 year old boy with asthma suddenly developed chest pain and increasing
breathlessness during a game of foot ball. When seen in the Emergency department not
cyanosed. He has reduced breath sound on the right. His oxygen saturation is 94% in air.

S I N G L E B E S T ANSWER:
183. A man who is a heavy smoker presents with a long history of breathlessness on exertion
and productive cough. His blood gas results are:
P0 :
2

7.0kPa

PC0 :
2

6.5KPa

pH : 7.30

...w^iA *

What is the single most appropriate treatment?

A. Aminophyline infusion
.
B. Invasive ventilation ? kecCff If ' i US. ^
C. Non invasive ventilation
24% OXYGEN
E. 100% O X Y G E N .
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h l

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Theme : Scientific basis of speech disorder

Options
A. Brocca's area (Frontal cortex) ?
B.
C.
D.
E.
F.
G.
H.
I.
J.

c~p<^'

Facial nerve
Glossopharyngeal nerve
Hypoglossal nerve
Internal capsules
Phrenic nerve
Recurrent laryngeal nerve
Spinal root of accessory nerve
Thalamus
Wernicke's area" (temporo-parietal cortex) - >>M,^kc^' <^!"U_n>

Instruction: For each patient described below, choose the SINGLE most likely anatomical
site to be affected from the above list of options. Each option may be used once, more than
once or not at all.
Jy 184. A n 82 year old man has woken up with incoherent speech. Examination is otherwise
normal and his comprehension is food.
185. A 52 year old man who became hoarse following thyroid surgery one week ago shows
X no improvement.
186. A 23 year old man is having difficulty speaking following a stab wound to the right of
his neck. On being asked to protrude his tongue, it is noticed that the tip deviates to the right.
187. A 62 year old man who has recently has flu- like illness has woken to find his speech
v altered. Movement of his eyelids and lips are weak on the right side. Examination is
otherwise normal.
p ^ f r
"^
^ cc~\im^a Cm,* * j M

w C

188. A 69 year old woman has had a stroke. Her left upper and lower limbs are paralyzed and
she is having difficulty speaking."^ hju>wpl^fu<.

S I N G L E B E S T ANSWER:
189. A 52 year old man has had left -sided chest pain for one day. It is severe, constant and
worse on respiration. He is also short of breath, nausea and feels unwell. He has a body mass
index of 27kg/m2 and smokes 15 cigarettes per day. His chest x-ray is normal and he has had
a tachycardia on ECG.
What is the SINGLE most likely diagnosis? \
A. Acute Coronary syndrome
B. Costochondritis

"

^-

^$njm*.

C 6 ci-^j
'^(^v!

C. Gastro- oesophageal reflux disease (GORD)

'Pericarditis
Pulmonary embolism
, .

( v ,C

r6C&

Car) be. fytX^db

i/} rt>

S I N G L E B E S T ANSWER:
190. A 58 year old man has dyspnoea, syncope and has lost weight. He is breathless at rest.
His blood pressure is 110/60mmHG on standing and 140/80mrnHg on lying. He smokes 30
cigarettes a day.
CA
What is the SfNGLE most appropriate initial investigation in establishing a diagnosis?
A)
.
C.
D.
E.

Chest x-ray
Echocardiogram
ECG
Pulmonary oedema
24-hour ECG

"' ~^

'""

"-^Y'J

^' (" J
AJ

S I N G L E B E S T ANSWER:
191. A 34 year old man from Zimbabwe is admitted with abdominal pain to the Emergency
Department. An abdominal x-ray reveals bladder calcification. What is the most likely
cause?
A. Schistosomamansoni

'

^'

B. Sarcoidosis
C. Leishmaniasis
D. Tuberculosis
E. /Schistosoma haematobium

S I N G L E B E S T ANSWER:
192. A 74 year old female presents with headache and neck stiffness to the Emergency
Department. Following a lumbar puncture the patient was stated on IV Ceftriaxone. CSF
culture grows listeria monocytogenes. What is most appropriate treatment?
A. Add IV Amoxicillin
B. Change to I V amoxicillin + gentamicin
C. Add IV Ciprofloxacin
D. Add IV co Amoxicalv
(

E. Continue IV Ceftriaxone as mono-therapy

S I N G L E B E S T ANSWER:
193. A woman gives a vaginal birth to a boy at term. She has Hepatitis B and is concerned
about the risk of transmitting it to her baby.
What is the most appropriate management?
A.
B.
(Tj
D.
E.

Give hepatitis B vaccine

Hepatitis B anti-body test.
Hepatitis B vaccine + Hepatitis B Ig
Hepatitis B Ig only
Do nothing

Theme: Oral and parotid swellings

Options:
A.
B.
C.
D.
E.
F.

ACE inhibitor therapy

Beta blocker therapy
Bulimia nervosa
CI esterase deficiency
Chronic alcohol use
Crohn's disease

G.
H.
I.
J.
K.
L.

Dietary allergy
HIV disease
Mumps
Nifedipine therapy
Sarcoidosis
Sjogren's syndrome

Instruction: For each of the following scenarios, choose the most likely diagnosis from the
above list of options. Each option may be used once, more than once or not at all.
J ~ 194. A 65- year- old man with hypertension develops gingival hyperplasia.
J)

pnint^xu?

195. A n otherwise healthy 13-year-old boy presents with recurrent episodes of facial and
tongue swelling and abdominal and abdominal pain. His father has had similar episodes.

196. A 70-year -old woman presents with recurrent episodes of parotid swelling. She
complains of difficulty talking and speaking and her eyes feel gritty on waking in the
morning.
Q

197. A thin 18 -year-old girl has bilateral parotid swelling with thickened calluses on the
dorsum of her hand.
198. A 40-year old man with marked weight loss over the preceding 6 months has bilateral
white, vertically corrugated lesion on the lateral, surfaces of the tongue.

^GUrt-j CO) l x i M ^

S I N G L E B E S T ANSWER:
199. A 70 years old man with few months history of loss of weight and dysphagia
presented with sandwich stuck in throat. What is the most appropriate step of the following?

A. Barium meal
B. Barium swallow
('CT. Endoscopy (oesophagoscopy) foreign body removal and biopsy

VUSG
E. Chest X-ray

S I N G L E B E S T ANSWER:
200. A 50 year old lady with weak limbs when examined was found to have burn marks on
linger tips, wasted and weak hands with diminished reflexes. She also has weak spastic legs
and dissociated sensory loss.
What is the diagnosis?
A. Multiple sclerosis
( B.jSyringomyelia f-k/d
C. Motor neuron disease
D. Guillian barre syndrome
E. Freidriechs ataxia.

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