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Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 10TH MARCH 2017 TIME ALLOWED : 3HRS

SINGLE BEST ANSWER

1. A 6 week old child is brought in with vomiting, constipation and decreased serum Potassium. What
is the most probable diagnosis?
A. Pyloric stenosis: hypokalemic hypochloremic metabolic alkalosis
B. Duodenal atresia
C. Hirschprung disease
D. Achalasia cardia
E. Tracheo-esophageal fistula

2. A mother presents with her 6-month-old son who is vocalizing. She has noticed that he does not
respond to loud noises. His motor milestones are normal. What is the best management strategy?
A. Arrange Hearing test
B. Assess Developmental Milestones
C. Reassure
D. Refer to a Speech Therapist
E. MRI Brain

3. A 2 month old child with diarrhoea and vomiting for 6 days is brought in looking lethargic. What is
the investigation to get done immediately?
A. Urea and electrolytes
B. Random blood sugar
C. FBC
D. CXR

4. A 14 year old girl has been brought by her school teacher as the teacher is concerned about the
girl’s health. She has a BMI of 14.2 and has been having bouts of dizziness recently. What is the most
appropriate next step?
A. Psychiatric routine referral
B. Admission to psychiatric ward
C. Admission to medical ward
D. CBT
E. Diet plan

5. A 25 year old woman has been feeling anxious and nervous for the last few months. She also
complains of palpitations and tremors. Her symptoms last for a few minutes and are very hard to
control. She tells you that taking alcohol initially helped relieve her symptoms but now this effect is
wearing off and she has her symptoms even after drinking alcohol. What is the most likely diagnosis?
A. Panic disorder
B. Depression
C. Obsessive compulsive disorder
D. Alcohol addiction
E. Generalized anxiety disorder
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6. A patient who is a known case of tuberculous abscess with the history of previous abscess drainage
presented with fever and tenderness between L2 L3 vertebra. Which is the best investigation for this
patient?
A. X-ray
B. CT
C. USG
D. MRI
E. Blood culture

7. Patient was admitted with erectile dysfunction, reduced facial hair and galactorrhoea. What is the
most probable diagnosis?
A. Hyper prolactinemia
B. Cushing’s syndrome
C. Pheochromocytoma
D. Hyperthyroidism
E. Hypoparathyroidism

8. A 75 year old man was undergoing treatment of pneumonia during which he developed stroke, for
which thrombolysis was administered. Following this he developed bloody diarrhoea with passage of
clots. Colonoscopy revealed multiple ulcers in transverse colon which were inflamed. What could be
the possible cause of bleeding?
A. Crohn’s disease
B. Complication of thrombolysis
C. Ulcerative Colitis
D. Bowel ischaemia
E. Pseudo membraneous colitis

9. Chest X-ray shows bilateral fibrosis and left sided pleural effusion. What is the best investigation
that will lead to diagnosis?
A. Chest x-ray
B. Pleural fluid aspiration of cytology
C. Magnetic resonance imaging (MRI)
D. Pleural biopsy
E. CT Scan

10. A 28 year old pregnant lady presents with severe lower abdominal pain with excessive per vaginal
bleeding at her 34 weeks of pregnancy. What should be the initial investigation of choice?
A. Coagulation profile
B. US scan of abdomen
C. CT pelvis
D. D-dimer
E. Kleiuher Test

11. A 45 year old obese man, who is a smoker and a chronic alcoholic, has hoarseness of voice for 6
weeks. A biopsy of the larynx is taken and histology shows non-invasive dysplasia. What advice
would you give to this patient?
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A. Stop smoking
B. Reduce weight
C. Voice therapy
D. Reduce alcohol intake

12.A 60 year old woman is admitted to hospital after a fall. She is noted to have poor eye contact.
When asked how she is feeling, she admits to feeling low in mood and losing enjoyment in all her
usual hobbies. She has also found it difficult to concentrate, feels that she is not good at anything,
feels guilty over minor issues and feels very negative about the future. What is the most likely
diagnosis?
A. Mild Depression
B. Moderate Depression
C. Severe Depression
D. Psychosis
E. Seasonal depression

13. A 20 year old female presented with complaints of diarrhoea with blood and mucus in it. She
was diagnosed with Crohn’s disease. Which part of the gut is most commonly affected by this
disease?
A. Duodenum
B. Jejunum
C. Ileum
D. Sigmoid colon
E. Caecum

14. A 53 year old man with previous history of COPD presents with breathlessness and purulent
sputum. Oxygen saturation is 85% on air. ABG shows Pa O2 = 7.6, Pa CO2 = 7. What is the
appropriate management for hiscondition?

A. 24% Oxygen
B. Mechanical ventilation
C. 100% oxygen
D. Nebulised salbutamol
E. Nebulised ipratropium

15. A 14 year old boy fell and hit his head in the playground school. He did not lose consciousness.
He has swelling and tenderness of the right cheek with a sub-conjunctival haemorrhage on his right
eye. What is the most appropriate initial investigation?
A. CT Brain
B. EEG
C. MRI
D. Skull X-Ray
E. Facial X-Ray

16. A 49 year old man lost his job and now he is homeless. He was found wandering in the park. He
is muttering that some people are after him. Alcohol was tested and it was negative. What will your
next step be?
A. Thiamine
B. Neuro psychiatric analysis
C. Mini mental state
D. CT head
E. MRI head
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17. A woman has numerous painful ulcers on her vulva. What is the cause?
A. Chlamydia
B. Trichomonas
C. Gardenella
D. Herpes Simplex Virus(HSV)
E. Epstein–Barr virus(EBV)

18. A child comes with recurrent joint pain, multiple bruise, swollen ankle and unable to move
his legs. What is the investigation of choice?
A. Erythrocyte sedimentation rate(ESR)
B. Rheumatoid factor
C. Clotting factor

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

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

21. 2 year old child was brought into A& E with coarse jerking movements of her limbs which lasted
for about 10 seconds followed by unconsciousness. She regained consciousness soon after and was
disoriented but afebrile with no signs of meningeal irritation. What is the single best investigation in
this child?
A. 24 hour ECG
B. 24 hour EEG
C. No investigation needed
D. CT scan
E. MRI scan

22. 70 year old man presents with fever, chest pain and seating. ECG confirmed an acute myocardial
infarction. What is the single most important route of administration of pain relieve?
A. Intravenous
B. Oral
C. Subcutaneous
D. Transcutaneous
E. Transmucosal

23. Patient with puffiness of face and rash showing cotton wool spots on fundoscopy. What is the
single most likely diagnosis?
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A. Macular Degeneration
B. Hypertensive retinopathy
C. Diabetic background
D. Proliferative Diabetic retinopathy
E. Systemic Lupus Erythematosus (SLE)

24. A 35 year female presents with complains of intermittent palpitations lasting few hours every
day. Which is the most appropriate intervention?
A. 24 hr ECG
B. ECHO
C. Reassure
D. Atenolol
E. Flucainide

25. A 35 year old, intra-venous drug abuser on Penicillin and Flucloxacillin for cellulitis, now
presents with jaundice, pale stools and dark urine. What is the single most likely diagnosis?
A. Hepatitis A
B. Cholestatic jaundice
C. Chronic active hepatitis
D. Primary billiary cirrhosis
E. Hepatitis B

26.A 50 year old man with a past history of hypertension presents to A & E with motor weakness of
right side of the body. He complains of forgetfulness and falls. What is the most probable diagnosis?
A. Multi-infarct dementia
B. Lewy body dementia
C. Frontal lobe dementia
D. Shy-drager syndrome
E. Alzheimer’s

27. A 63 year old woman came with uterine bleeding. Vaginal USG reveals uterine thickness 12mm.
What is the most probable diagnosis?
A. Cervical Ca
B. Endometrial Ca
C. Ovarian Ca
D. Breast Ca
E. Vaginal carcinoma

28.A 28 year old sexually active female presents with a red raw bleeding 4cm ulcer presenting on the
labia minora. Which set of lymph nodes will this lesion drain to?
A. Superficial inguinal
B. Para-aortical
C. Popliteal
D. Iliac
E. Femoral
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29.A man has reducible bulge below the pubic turbercle, and on occlusion of the deep inguinal ring,
cough impulse is present. What is the most likely diagnosis?
A. Direct Inguinal Hernia
B. Indirect Inguinal Hernia
C. Femoral Hernia
D. Spigelian Hernia
E. Lumbar Hernia

30. 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. What is the best management strategy?
A. Arrange Hearing test
B. Assess Developmental Milestones
C. Refer to an ENT Surgeon
D. Refer to a Speech Therapist
E. Refer to sleep lab

31. Tip of the ninth costal cartilage. What is the Single most appropriate landmark?
A. Fundus of the gallbladder
B. Deep inguinal ring
C. Termination of the spinal cord
D. Transpyloricplane
E. Vena cava opening in to the diaphragm

32. A 79 year old man has poor urine stream. He has fever, burning sensation during micturition and
lower abdominal pain. . He also has severe back pain. What is the first line investigation of choice?
A. Blood culture
B. MSU for culture and sensitivity
C. X-ray KUB
D. CT scan
E. Full blood count

33. A man presented to the hospital with complain of productive cough and chest pain. His
temperature was 38.5° C. Lobar Consolidation was seen on x-ray with pleurisy. What is the best
management?
A. Clarithromycin
B. Amoxicillin
C. Tetracycline
D. Ciprofloxacilling
E. Imipenam

34. A 28 year old male is complying with her asthma treatment of low dose inhaled
corticosteroids and salbutamol as required. Her inhaler technique is rechecked. She has frequent night
cough and mild exercise induced wheeze. Which is the most appropriate management from the given
options?
A. Add leukotriene antagonist
B. Add oral theophylline
C. Add regular LABA
D. Increase dose of ICS
E. Short course of oral corticosteroid
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35. A patient diagnosed with HIV has received no treatment for HIV. He now presents with dry cough
and shortness of breath. Chest x-ray showed bilateral perihilar opacity. Pneumocystitiscarini was
indicated. What is the appropriate treatment?
A. Amphotericin B IV
B. Trimethoprim
C. Sulfadiazine
D. Gancyclovir
E. Dexamethasone
F. Pentamidine Isetionate

36. A 79 year old man has a swelling of the right groin, which was clinically diagnosed to be
indirect inguinal hernia. What is the SINGLE feature of the hernia sac that would confirm the
diagnosis?
A. Comes through femoral ring
B. Does not pass through deep inguinal ring
C. Lies below and lateral to pubic tubercle
D. Only passes through superficial ring
E. Passes through deep inguinal ring

37. Two hours after an appendicectomy, a patient complains of a rapid heart rate and fever. He
says there is also abdominal pain and pain in the shoulder area. What is happening to this patient?
A. Intra-abdominal bleeding
B. Anastomotic leak
C. Sepsis
D. Intestinal obstruction

38. What is the best investigation to diagnose pyloric stenosis?

A. Xray
B. MRI
C. CT SCAN
D. Ultrasound

39. A 42 year old man presents with longstanding foul smelling ear discharge and progressive
hearing loss. Otoscopy showed perforation of the pars flacida and a mass in the upper part of the
middle ear. What is the most likely diagnosis?
A. Acute Suppurative Otitis Media
B. Chronic Suppurative Otitis Media
C. Acquired Cholesteatoma
D. Congenital Cholesteatoma
E. Barotrauma

40. A 40 year old man has pain, redness and swelling over the nasal end of his right lower eyelid.
The eye is watery with some purulent discharge. The redness extends on to the nasal peri-orbital area
and mucoid discharge can be expressed from the lacrimal punctum. What is the SINGLE most
appropriate clinical diagnosis?

A. Acute conjunctivitis
B. Acute dacryocystitis
C. Acute iritis
D. Retrobulbar neuritis
E. Scleritis
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41. A 35 years old man who has served in the army presents with lack of interest in enjoyable
activities and feeling low. He doesn’t feel like reading the news or watching movies as he believes
there is violence everywhere. What is the most appropriate first line therapy?
A. Citalopram
B. Lofepramine
C. Cognitive Behavioural Therapy
D. Chlordiazepoxide
E. Desensitization

42. A child with inflammation in the orbit, fever, lid swelling and decreased eye mobility. Which
is the best investigation for his condition?
A. FBC
B. Blood cultures
C. CT scan of the orbits
D. Throat swab
E. Nasal Secretions

43. A 30 year old woman presents with intermittent breast pain. On examination a tender smooth
mobile lump measuring approximately 4cm by 3cm is found, which is not attached or fixed to deep
tissues. What is the best method for diagnosis?
A. Mammogram
B. Ultrasound
C. CT scan
D. Fine Needle Aspiration
E. Core Biopsy

44. With prolonged use in epilepsy, which of the following drugs can cause coarsening of facial
features, hirsutism, gingival hyperplasia and osteomalacia?
A. Valproic acid
B. Carbamazepine
C. Ethosuximide
D. Phenytoin
E. Gabapentin

45. A 27 year old woman had hit her neck in RTA but no complains of tingling or motor loss.
What is the most appropriate investigation?
A. MRI Scan
B. Plain X-ray
C. CT Cervical
D. Diagonal X-ray

46. A 49 year old man complains of fullness in the left ear, recurrent vomiting and tinnitus. What
is the most appropriate medication for this condition?
A. Buccal Prochlorperazine
B. Oral Chlorpheniramine
C. Oral Fluphenazine
D. Buccal Midazolam
E. IV Ranitidine
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47. A 45 year old man who has undergone a recent subtotal gastrectomy for peptic ulcer disease
has now developed anaemia with haemoglobin 6.8 , tiredness, fatigue and loss of vibration sensation
in legs. What is the underlying cause of his symptoms?
A. B12 deficiency
B. Iron deficiency
C. Folate deficiency
D. Vit C deficiency
E. Metastases

48. A man, who was drunk, left a pan on the hob and dozed off causing fire in his house. He was
drowsy. His house caught fire. He was eventually brought to the A &E with laryngeal oedema and
hoarse voice. What is the next best step?
A. Anaesthetics for help
B. I/V fluids
C. CT scan
D. MRI
E. X-RAY

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

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

51.A 45 years old chronic smoker attends outpatient department with complaints of persistent cough
and copious amount of purulent sputum. He had history of measles in the past. On examination he
has got finger clubbing and inspiratory crepitations on auscultation. What is the single most likely
diagnosis?
A. Interstitial lung disease
B. Bronchiectasis
C. Asthma
D. Chronic obstructive pulmonary disease
E. Sarcoidosis

52. A 48 years old woman presents with left sided severe headache. She also has a red, watering eye
and complains of seeing coloured haloes in her vision. What is the most appropriate next step?
A. Measure Intraocular pressure D. CT Scan
B. Relieve pain with aspirin E. Relieve pain with Sumatriptan
C. 100% oxygen
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53.A patient is admitted with fever, photophobia, and a non-blanching rash. His ABG values are as
follows: pH :7.5 , PaCO2 : 2.2 KPa , PaO2 : 9.0 KPa
What is the most likely diagnosis?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory alkalosis
D. Respiratory acidosis

54. A man is brought into A&E claiming to be a professor of medicine. His family say he left school
at the age of 16 and has never studied anything after that. He also claims that he is soon going to be
God. What is the most likely diagnosis in this patient?
A. Delirium
B. Mania
C. Depression
D. Delusion
E. Schizophrenia

55. A man was stabbed in the upper left chest. He has shortness of breath and unequal chest
movements on the left side. Which nerve is most likely to be damaged?
A. Left phrenic nerve
B. Right phrenic nerve
C. Right vagus nerve
D. Left vagus nerve
E. Thoraco-dorsal nerve

56. A 5 month old child can't speak but makes sounds. She can hold things with palm not fingers.
She can't sit independently but can hold her head and sit when propped up against pillows. How is
the child’s development?
A. Normal development
B. Delayed speech
C. Delayed sitting up
D. Delayed motor development

57. A 56 year old lady presents has a pathological fracture of her T11 vertebra. There is found to be
an underlying metastatic lesion. What is her most common primary cancer?
A. Lung
B. Breast
C. Uterine
D. Brain

58.A man was involved in a motor bike accident. Paramedics found that he was unable to dorsiflex
his right leg and had no sensation between the 1st and 2nd toes in the right leg. Which nerve is
most likely to be injured?
A. Femoral nerve
B. Tibial nerve
C. Superficial peroneal nerve
D. Deep peroneal nerve
59. A young girl returns from holidays in Spain. She complains of discharge from her ear and
complains of tragal tenderness. On examination tympanic membrane is normal. Aural toilet has been
done. What is the next appropriate medication for this patient?

A. Oral antibiotic
B. Drop antibiotic
C. Oral steroid
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D. Drop steroid
E. Drop antibiotic with steroid
60. Which of the following formula is used for calculating fluids for burns patients?

A. 4 x Weight(lbs) x area of Burns = ml of fluids

B. 4 x Weight(kgs)x Area of Burns = l of fluids
C. 4 x Weight(kgs)x Area of Burns = ml of fluids
D. 4x Weight(lbs) x Area of Burns = l of fluids
E. 4.5x Weight(kgs)x Area of Burns = dl of fluids

61. A resident of nursing home presented with rashes in his finger webs and also on his abdomen,
with complaints of itching which is severe at night. He was diagnosed with scabies. What is the best
treatment for this condition?
A. 0.5 % Permethrin
B. Doxycycline
C. 5% Permethrin
D. Reassure
E. Acyclovir

62. A 66 year old male presents with painful swallowing. What is the most likely diagnosis/
organism?
A. Neisseria meningitides
B. Cryptococcus neoformans
C. Candida albicans
D. Isospora belli
E. Mycobacterium avium-intra-cellular

63. A 30 year old patient who is not taking any medications presents with blood pressure 200/100
mmHg, sodium 140 mmol/L, potassium -2.2mmol/L, calcium 2.0 mmol/L. What is the most likely
diagnosis in this patient?
A. Primary hyperaldosteronism ( Conn’s disease)
B. Primary adrenal insufficiency (Addison’s disease)
C. Cushing syndrome
D. Cushing’s disease
E. Hypopituitarism

64. In chronic renal failure main cause of Vit D deficiency is the failure of :
A. Vit D absorption in intestines E. Availability of Vit D precursors
B. 25 alpha hydroxylation of Vit D
C. Excess Vit D loss in urine
D. 1 Alpha hydroxylation of Vit D

65.After surgery, a patient’s left leg has become swollen and tender. The diameter of the calf has
increased and passive movements cause pain. What is the most probable diagnosis in this patient?
A. Deep venous thrombosis (DVT)
B. Lymphoedema
C. Peripheral vascular disease
D. Haematoma
E. Superficial thrombo-phlebitis
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66.A 30 year old man presents with a 5 cm swelling in the neck anterior to the sternocleido-mastoid
muscle on the left side in its upper third. He states that the swelling has been treated with antibiotics
for infection in the past. Choose the single most likely cause from the given options.
A. Branchial cyst
B. Parotitis
C. Pharyngeal pouch
D. Thyroglossal cyst
E. Thyroid swelling

67.A 44 year old woman has lost weight over 12 months. She has also noticed episodes where her
heart beats rapidly and strongly. She has a regular pulse rate of 90 beats/minute. Her ECG shows
sinus rhythm. What is the most appropriate investigation to be done?
A. Thyroid Antibodies
B. Thyroid Function Tests
C. ECG
D. Echocardiogram
E. Plasma Glucose

68.A 24 years old hiker has been rescued after being trapped under rocks for almost 12 hours. He
complains of reddish brown urine. His creatinine is 350µmol/L and his urea is 15mmol/L. What is the
most important next step in the management of this patient?
A. Dialysis
B. IV normal saline
C. IV dextrose
D. IV KCL
E. Pain relief

69.A man post-cholecystectomy presented with jaundice, fever and dark urine. What is the single
most diagnostic investigation?
A. Endoscopic retrograde cholangio pancreatography (ERCP)
B. USG Abdomen
C. CT scan
D. Magnetic resonance cholangio pancreatography (MRCP)
E. Magnetic resonance imaging (MRI)

70.A 12 year old man presents with chest pain. On examination there is tachycardia and hypotension.
Neck vein is distended and trachea is not centrally placed. What is the next appropriate management?
A. Portable X-ray
B. Needle thoracocenthesis
C. Chest drainage
D. Arterial blood gas
E. CTPA

71. A 56 year old male presents with intermittent vertigo, intermittent tinnitus and intermittent
hearing loss. What is the best drug treatment for this patient?
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A. Buccal Prochlorperazine
B. Oral Flupenphenazine
C. Tricyclic antidepressants (TCA)
D. Gentamycin patch on the round window
E. No medical treatment available

72. A fifteen month old child is due for his measles, mumps and rubella (MMR) vaccines. There
is a family history of egg allergy. He is febrile, with acute otitis media. What is the single most
appropriate action?
A. Defer immunization for two weeks
B. Do not give vaccine
C. Give half dose of vaccine
D. Give paracetamol with future doses of the same vaccine
E. Proceed with standard immunization schedule

73. A 50 year old patient presents with squamous cell carcinoma of bronchus. What is electrolyte
imbalance?
A. Hypocalcemia
B. Hyperkalemia
C. Hypercalcemia
D. Hypokalemia
E. Hypermagnesemia

74. A 31 year old man is single and lives with his mother. He usually drives from his home to his
work place. He always thinks when the traffic lights change his mother is calling him, so he drives
back to his house. What is the diagnosis?
A. Obsessive compulsive disorder
B. General anxiety disorder
C. Schizophrenia
D. Bipolar personality disorder
E. Cyclothymia

75. A 36 years old man has been diagnosed with Diabetes Insipidus. What electrolyte picture is
expected to be seen?

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

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

76. A 79 year old man stumbled and sustained a minor head injury two weeks ago. He has
become increasingly confused, drowsy and unsteady on his feet. He has a GCS (Glasgow coma scale)
score of 13. He takes Warfarin for atrial fibrillation. What is the most probable diagnosis?

A. Extradural Hemorrhage
B. Cerebellar Hemorrhage
C. Epidural Hemorrhage
D. Subdural Hemorrhage
E. Subarachnoid Hemorrhage

77. A 25 year old man presented with history of breathlessness. A transthoracic echo revealed a
patent foramen ovale. What diagnostic investigation would you do for a patent foramen ovale?
 14

A. Trans oesophageal echo

B. Bubble echo
C. Trans thoracic echo
D. ECG

78. An elderly man presents with fever of 38°C and very severe headache. His BP is 85/50 mm
Hg. Neck rigidity is present and he has photophobia also. What is the most appropriate management?
A. Intravenous fluid
B. CT head
C. Lumbar puncture
D. IV fluid and CT head
E. CT head and Lumbar puncture
79. A 39 year old woman complains of thirst, frequency and confusion. Her BP is 140/90 mmHg,
Na is 142, K is 4 and Ca is 3.7. What is the most effective management of this condition?
A. IV Dextrose
B. Alandronate
C. Tamoxifen
D. Calcitonin
E. Vitamin D

80. A 7 year old boy presents with her mother to the GP surgery. His mother describes he had
presented this since 3 weeks ago. He had not experienced any trauma. No other symptoms associated
with the condition. On examination the boy has non tender swollen ankles bilaterally. There is no rash
or lesion. He is otherwise well. Which single test would be the best as an initial assessment?
A. Plasma electrolytes.
B. Album
C. Total serum protein
D. Anti-streptolysin

81.A 53 year female on Ramipril, aspirin, thiazide complains of fall. Her BP standing was
140/80mmHg and lying was 120/80. What is the best step in management?
A. Review her anti-hypertensive medication
B. Advise on posture
C. Encourage to drink plenty of water
D. CT brain

82. A 65 year old hypertensive man wakes up in the morning with slurred speech, weakness of
the left half of his body and drooling. Which part of his brain is affected?
A. Left parietal lobe
B. Right internal capsule
C. Right midbrain
D. Left frontal lob

83.An alcoholic patient presented to hospital with complains of palpitation and fast thumping few
hours. On examination observations are stable bloods are normal and 24 hr ECG is normal. What is
the next step in management?
A. Reassure and life Style modification
B. ECHO
C. Heparin& Cardioversion
D. Beta Blockers
E. Digoxin
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84. A lady presents with itching around breast, a greenish foul smelling discharge is seen from a
nipple. She had a similar episode before. What is the diagnosis?
A. Duct papilloma
B. Duct ectasia
C. Breast abscess
D. Periductal mastitis
E. Mammary duct fistula

85.75 year female comes for check-up. She is healthy except that her 3 BP readings come under stage
2 HTN (SBP= 160-175). She is not on any other medication and has no history of previous surgical
illness. What would you prescribe?
A. ACE inhibitors
B. Salt free Diet
C. Beta Blockers
D. Amlodipine
E. Exercise

86. A 24 years old woman is afraid to leave her house as whenever she goes out; she tends to
have shortness of breath and sweating. She has stopped going out except with her husband. What is
the most likely diagnosis?
A. Social Phobia D. Panic Disorder
B. Claustrophobia E. Agoraphobia
C. Depression

87. A 72 year male with previous history of ischemic heart disease presents to the A&E with
increasing shortness of breath and decreasing exercise tolerance. Which drug is the most likely drug
responsible?
A. Diclofenac Sodium
B. Ibuprofen
C. Paracetamol
D. Atenolol
E. Codeine

88. A 16 year old girl presents with heavy and painful vaginal bleeding. Choose the most
appropriate initial investigation from the following options.
A. Endometrial sampling
B. Trans vaginal ultra sound scan
C. Hysteroscopy
D. Pelvic ultrasound
E. Examination under anesthesia

89. A 30 year old male got up after sitting on the floor crossed leg, complained of tingling sensation
on lateral part of leg and difficulty in flexing foot.
A. Common peroneal nerve injury E. Sciatic nerve
B. Anterior tibial nerve
C. Obturator nerve
D. Femoral nerve
 16

90. A 19 year old boy was brought in by his mother with complaint of lack of interest and no
social interactions. He has no friends, he doesn’t talk much, he has interest only in collecting
cars/vehicles, he has around 2,000 toy cars. What is the most appropriate diagnosis?
A. Borderline personality disorder
B. Depression
C. Schizoaffective disorder
D. Autistic spectrum behaviour disorder

91. A 10 year old boy, who 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. What is the SINGLE most appropriate investigation?
A. Chestx-ray
B. No investigation needed
C. Peak flow rate diary
D. Pulse oximetry
E. Spirometry

92. A 32 year old man on psychiatric medications complains of inability to ejaculate. Which drug is
most likely to cause these symptoms?
A. Lithium
B. Haloperidol
C. Chlorpromazine
D. Fluoxetine
E. Clozapine

93. A 65 year old lady with IDDM for the last 20 years comes with a tender lump near the anal
opening. She says she also has fever. What treatment should she get?
A. Incision and drainage and antibiotics
B. IV antibiotics
C. Culture and sensitivity of aspirate from swelling
D. Painkillers
E. Cautery of the swelling
94. A 45 year old lady has 10 month history of shortness of breath. She is found to have irregularly
irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left 2nd intercostal
space. What is the most probable diagnosis?
A. Tetralogy of Fallot
B. Atrial septal defect(ASD)
C. Ventricular septal defect(VSD)
D. Patent ductus-arteriosus(PDA)
E. Coarctation of Aorta

95. An elderly 80 year old woman lives in a residential home presents with agitation, confusion and
abdominal pain. She has been diagnosed to have faecal impaction. What will be the first step in your
management?
A. High fibre diet
B. Phosphate enema
C. Sodium picosulphate
D. Senna
E. Bran
 17

96.A patient complains of shortness of breath, wheeze, cough and nocturnal waking. He has dry
scaly shin with rashes that are itchy. What is the single most likely diagnosis?
A. Scabies
B. Eczema
C. Rheumatitis
D. Dermatitis
E. Psoriasis
97. A man presents with inoperable carcinoma and back pain. His pain has been well controlled with
morphine, but he develops vomiting. Morphine was stopped and he was started on metoclopramide
and fentanyl patches. He then develops neck stiffness and fever. What is the cause of these
symptoms?
A. Metoclopramide
B. Fentanyl
C. Morphine
D. Meningitis
E. Metastasis
98. Patient had breast Ca. She had chemotherapy and now has severe pain. She was given morphine
and yet pain is not relieved. What will you prescribe?
A. Amitryptiline
B. Gabapentine
C. Paracetamol
D. Other pain adjuvant
E. Carbamazepin
99.A 32 year old man with HIV and under treatment with antiretroviral medications presents with
dry cough, increasing breathlessness on excretion. What is the best treatment?
A. Amoxicillin E. Doxycycline
B. Co-amoxiclav F. Cotrimoxazole
C. Ceftriaxone
100. A man has symptoms of sleep apnoea and daytime headaches and somnolence. Spirometry
shows a decreased tidal volume and vital capacity. What is the Single most appropriate
diagnosis?
A. Ankylosing spondylitis
B. Churg-Strauss syndrome
C. Good pasture’s syndrome
D. Motor neuron disease
E. Progressive massive fibrosis(PMF)
F. Spinal Cord Compression

101. In a man, who is neglected and is alcohol dependent, with high suicidal risk, which factor can
increase this risk further?
A. Alcohol dependence
B. Selective serotonin re-uptake inhibitors (SSRI)
C. Smoking
D. Agoraphobia
E. Court involvement

102. A man brings his wife to see the doctor. He says she has been talking about their private life
openly and is throwing tantrums. Her mood changes quickly and she becomes aggressive. Physical
examination is normal. There is no history of trauma and she is not on any medications. What is the
most likely diagnosis?
 18

A. Huntington’s dementia
B. Lewy body dementia
C. Alzheimer’s dementia
D. Vascular dementia
E. Benign old age related dementia

103. A patient on insulin is booked in for a hernia operation. What is the most appropriate
management of insulin?
A. Give insulin and saline pre op
B. Stop insulin for the duration of the operation
C. Give intravenous insulin + dextrose + saline pre op
D. Give insulin as usual pre op
E. None

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

105. A 64 years old man has recently suffered from a myocardial infarction and is on Aspirin,
Atorvastatin and Ramipril. He has been having trouble sleeping and has been losing weight for the
last 4 months. He doesn’t feel like doing anything he used to enjoy and has stopped socializing. He
says he gets tired easily and cannot concentrate on anything. What is the most appropriate treatment?
A. Lofepramine
B. Dosulepin
C. Citalopram
D. Fluoxetine
E. Phenelzine

106. A 52 year old man presents with hyponatremia, hyperkalemia, hypercalcemia and
hyperpigmentation. What hormone should be measured in him?
A. Aldosterone
B. Cortisol
C. Renin
D. ACTH
E. Testosterone

107. A 5 year old child presents with fever. He looks pale. His parents say he always feels tired. On
examination there is also orchidomegaly and splenomegaly. The lab report shows WBC= 1.7 X
104/L, Hb=7.1 g/dL and platelets= 44 X 10 4g/dL. What is the most likely diagnosis?
A. Acute lymphoblastic leukaemia
B. Chronic lymphoblastic leukaemia
C. Acute myloid leukemia
D. Chronic myloid leukemia
E. Hodgkin’s lymphoma
 19

108. A 35 year old female developed sudden severe chest pain with shortness of breath. She
recently underwent pelvic surgery. What is the most appropriate diagnostic investigation that should
be done?
A. Serum D-dimer
B. Chest X-ray
C. ECG
D. CT pulmonary angiography
E. Arterial Blood Gas (ABG)

109. A 50 year old patient admitted to the hospital for elective herniorraphy. Which of the following
option will lead to his postponement of the operation?
A. Systolic BP less than 90mmHg
B. Myocardial infarction two months ago
C. Hb 12g/dl
D. Pain around the hernia
E. Abdominal distension

110. A 50 year old patient was complaining of pain within 6 hours after his appendectomy for
gangrenous appendix. What medication is the best option for his pain relief?
A. I/V morphine
B. Diclofenac per rectally
C. Patient control analgesic
D. Tramadol
E. Paracetamol

111. passing six to eight loose stools. Temperature is 38.8°C. He is tender in the right lower quadrant
and has an anal fistula. Choose the single most likely cause of abdominal pain.
A. Inflammatory bowel disease (IBD)
B. Irritable bowel syndrome (IBS)
C. Pyelonephritis
D. Uretric calculus
E. Gastroenteritis

112. A young man complains of fatigue and breathlessness. On evaluation he has spherocytes in
his blood film and reticulocytes 6%. What is the next appropriate test?
A. Coomb’s Test
B. White blood Cell Count
C. Platelet Count
D. Genetic Analysis
E. G6PD assay

113. A 33 year old male came to the hospital with complaints of occasional left sided chest pain
that lasts less than 30 minutes, following exercise, which relieves upon taking rest. What is the most
probable diagnosis?
A. Unstable angina
B. Decubitus angina
C. Stable angina
D. Coronary spasm
E. Myocardial infarction
 20

114. How to keep a check on salbutamol's efficiency?

A. PEFR
B. Spirometry
C. Vital capacity
D. FEV/ FEV1 ratio
E. Lung function test

115. A 59 years old patient has been diagnosed with hypertension. His blood pressure has been
above 160/90 mmHg on three separate occasions. His biochemical profile is as follows:
Na: 145mmol/L
K: 6.2 mmol/L
Creatinine: 112 µmol/L
Urea: 5.7 mmol/L
Which antihypertensive will you choose for him?

A. Diuretic
B. ACE Inhibitors
C. Hydralazine
D. Angiotensin receptor blocker

116. A young male is brought to the Accident and Emergency after an RTA. His GCS on initial
evaluation is 6. What is the most appropriate next step?
A. CT scan
B. Magnetic resonance imaging (MRI)
C. IV Fluids
D. Skull X ray
E. Secure Airway

117. A young college student is found in his dorm unconscious. He has a tachy-arrhythmia and is
having high fever. He also seems to be bleeding from his nose, which on examination shows a
perforated nasal septum. What is the most likely diagnosis?
A. Marijuana Overdose
B. Cocaine Overdose
C. Heroin Overdose
D. Alcohol Overdose
E. Carbon Monoxide poisoning

118. A 63 year old woman underwent knee surgery and was kept on low molecular weight heparin
postoperatively. On the 6th post-operative day she developed sudden severe chest pain with
breathlessness. Her ECG and chest x-ray were normal. What is your next action?
A. Stop low molecular weight heparin and start Warfarin
B. Keep on low molecular weight heparin and do CT. pulmonary angiography.
C. Increase the dose of low molecular weight heparin and do CT. pulmonary angiography.
D. Keep on low molecular weight heparin, add warfarin and do CT. pulmonary angiography.
E. Change to unfractionated heparin and do CT. pulmonary angiography.

119. A girl with history of allergies visited a friend’s farm. She got stridor, wheeze and erythematous
rash. What is the most appropriate treatment?
A. 0.25ml IM adrenaline
B. 0.25ml PO adrenaline
 21

C. 0.25ml IV adrenaline
D. IV chlorpheniramine

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

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

122. A child was playing and suddenly developed breathlessness. What is the best investigation for
this child?
A. Nasal Endoscopy
B. Lateral neck X-Ray
C. CT scan
D. Pulse Oximetry
E. Spirometry

123. A 55 year old man has had severe pain in the right hypochondrium for 24 hours. The pain comes
in waves and is accompanied by nausea. Nothing seems to relieve the pain. He feels hot and sweaty
but has normal temperature. What is the most appropriate next investigation?

A. Ultrasound Abdomen
B. Endoscopic retrograde cholangiopancreatography (ERCP)
C. Magnetic resonance cholangiopancreatography (MRCP)
D. Serum Amylase
E. Upper gastro-intestinal Endoscopy

124. A 54 years old patient 7 days after a total hip replacement presents with acute onset
breathlessness and a raised JVP. Which of the following investigations will be most helpful in leading
to a diagnosis?
A. CXR
B. CTPA
C. V/Q Scan
D. D Dimers
E. Doppler USG of legs
 22

125. A 65 year old hypertensive man presents with haematuria, lower abdominal pain and back pain.
An expansive abdominal mass is palpated lateral and superior to the umbilicus. What is the single
most discrimination investigation from the given options?
A. Laparoscopy
B. KUB X-ray
C. Pelvic ultrasound
D. Rectal examination
E. Ultrasound abdomen

126. A 35 years old man presented with severe painful episodes on one side of the face with nasal
congestion and drooping of eyelid on same side and frequent attacks of epistaxis. What is the most
probable diagnosis?
A. Maxillary sinus carcinoma
B. Maxillary sinusitis
C. Bell’s palsy
D. Horner’s syndrome
E. Herpetic neuralgia

127. A 65 year old man has incurable bronchial cancer. He is unable to cough up his secretions. This
is leading to a distressing cough. Which of the following drugs is most likely to help him?
A. Scopalamine
B. Xanomeline
C. Aceclidine
D. Pilocarpine
E. Cevimiline

128. A pregnant woman had hit her chest 3 weeks ago. Now she is 24 weeks pregnant and presents
with left upper quadrant mass with dimpling. What is the most probable diagnosis?
A. Breast Ca
B. Carcinoma
C. Fibroadenoma
D. Fibroadenosis
E. Fatty necrosis of breast

129. The widespread diarrhoea in a town was controlled by closing down of a local butcher's shop.
What is the causative organism?
A. Bacillus cereus
B. E.coli
C. Clostridium difficile
D. Listeria Monocytogenes
E. Staphylococcus Aureus

130. A 55 years old lady who is 3 years menopausal, presents with a second episode of fracture.
Bone densitometry shows 70% of predicted value. What will be the appropriate management for her?
A. Estrogen only HRT E. Weight bearing exercise
B. Raloxifen {selective estrogen receptor modulator (SERM)}
C. Bisphosphonates
D. Ca and Vit D
 23

131. A 67 year old woman is brought to the Emergency department having fallen on her left arm.
There is an obvious clinical deformity and X-ray demonstrates a mid-shaft fracture of the humerus.
She has lost the ability to extend the left wrist joint. Which nerve has most likely been damaged
with the fracture?
A. The axillary nerve
B. The median nerve
C. The musculo cutaneous nerve
D. The radial nerve
E. The ulnar nerve

132. A 17 year old male complains of fever and generally feeling unwell. On examination
widespread lesions on trunk were noticed. Lesions did not look the same everywhere, they were in
various stages, some of them were scabbed. What is the most likely diagnosis?
A. Herpes zoster
B. Varicella zoster
C. Impetigo
D. Psoriasis
E. None of the above
133. A 65 year old man presents with progressively worsening breathlessness and productive cough.
He has a history of treated tuberculosis and rheumatoid arthritis, he smoked 20 cigarettes/day since
35 years. When he was given a trial of salbutamol nebuliser, FEV1/FEV changed from 1.7/2.0 to
1.8/2.1 (predicted 3.0/3.5). What is the most probable diagnosis?
A. Chronic bronchitis
B. Bronchiectasis
C. Bronchial carcinoma
D. Asthma
E. Pulmonary fibrosis
134. A 75 year old man is on digoxin and develops weakness in the right upper and lower limbs
which resolves within a few hours. What is the most definitive investigation for this condition?
A. Carotid Doppler
B. Angiography
C. CT head
D. Digoxin level
E. MRI

135. A 35 years old woman undergoing treatment for Tuberculosis presents with a malar rash,
photosensitivity and haematuria. What is the single most likely positive antibody?
A. Anti Ds DNA
B. Anti Sm
C. Anti Histone
D. Anti La
E. Anti Centromere
136. Diabetic man feels hot painful lump near the anal region. What is the most probable diagnosis?
A. Anal fissure
B. Abscess
C. Haematoma
D. Wart
E. External haemorrhoids
 24

137.A 20 year old man presents to the A/E following motorcycle accident, where his foot was
stuck under the motorcycle. On examination he had tenderness of the foot, loss of sensation in the
space between the big and 2nd meta tarsal. His dorsalis pedis was not felt. What is the most likely
diagnosis?
A. Compartment syndrome
B. Arterial rupture
C. Arterial embolus
D. DVT

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

139.A four week old girl has been diagnosed of having breast- milk jaundice. She is otherwise well.
What is the SINGLE most appropriate management?
A. Continue breast feeding
B. Exchange transfusion
C. Increase fluid intake
D. Phototherapy
E. Stop breast feeding

140. A 46 year old man is being investigated for indigestion. Jejunal biopsy shows deposition
of macrophages containing Periodic acid–Schiff (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

141. A 25 years old woman complains of dizziness, nausea, vomiting, visual disturbances and
anxiety, which keeps coming from time to time. Most of the attacks are associated with sudden
change in posture. What is the most likely diagnosis?
A. Panic Disorder
B. Carotid Sinus Syncope
C. Benign Positional Paroxysmal Vertigo
D. Vertebro basilar Insufficiency
E. Postural Hypotension

142. A 54 years old woman has presented with episodes of abdominal ache, vomiting and postural
hypotension. She also has a dark pigmentation of her skin. A diagnosis of Addison’s disease was
made. What is the most likely electrolyte abnormality expected in this patient?
A. High Na, low K
B. Low Na, high K
C. Low Na, low K
D. High Na, high K
E. Low Na, normal K
 25

143. A 28 year old drug user presents to the A&E with collapse and anuria. His serum potassium
concentration is 7.5mmol/L. His chest x-ray shows early pulmonary edema. What is the next
appropriate management for this patient?
A. Urgent haemo-dialysis
B. IV calcium gluconate
C. IV insulin +dextrose
D. Furosemide
E. IV Normal Saline 0.9%

144. A 65 year old male patient presents with dysphagia, weight loss and is thought to have
oesophageal cancer. What will be the best diagnostic investigation for this patient?
A. Barium swallow
B. Endoscopy and Biopsy
C. CT chest
D. CXR
E. Serum Tumour Markers

145. A 30 year old male presents with a left sided scrotal swelling and scrotal discomfort which
increases toward the end of the day and after long standing. What is the most appropriate diagnosis?
A. Inguinal hernia
B. Testicular tumors
C. Hydrocele
D. Varicocele
E. Testicular torsion

146. A 44 years old obese patient presents with lab findings of: Fasting blood sugar (FBS)
6mmol/L
Oral Glucose Tolerance Test (OGTT) 10mmol/L. What is the most likely diagnosis?
A. Impaired glucose tolerance
B. Diabetes Insipidus
C. Type 1 Diabetes Mellitus
D. Type 2 Diabetes Mellitus
E. Maturity Onset Diabetes of the Young (MODY)

147. A 52 year old woman speaks rapidly without any pause and ignores interruptions. She doesn’t
even pause to take enough breaths. What term best describes this kind of speech?
A. Flight of Ideas
B. Broca’s Aphasia
C. Wernicke’s Aphasia
D. Pressure of Speech
E. Verbal dysphasia

148. A 56 years old lady with lung cancer presents with urinary retention, postural hypotension,
diminished reflexes and a sluggish papillary reaction. What is the most likely explanation for her
symptoms?
A. Paraneoplastic syndrome
B. Progression of lung cancer
C. Brain Metastasis
 26

D. Hyponatremia
E. Spinal Cord Compression

149. A 24 year old man is suffering from Generalized Anxiety Disorder. Which drug may be
preferred in the short term to treat this patient from the following options?
A. Zolpidem
B. Buspiron
C. Midazolam
D. Triazolam
E. Phenobarbital

150. A 40 year old male with slow growing mass at the angle of mandible. The mass is smooth,
firm and mobile. What is the most likely diagnosis?
A. Submandibular bone tumour
B. Pleomorphic adenoma of parotid
C. Parotid carcinoma
D. Lipoma
E. Submandibular lymph node

151. A woman has pernicious anemia. She has been prescribed parenteral vitamin B12 treatment
but she is needle phobic. Why is oral treatment not preferred for this patient?
A. IM B12 is absorbed more
B. Intrinsic factor deficiency affects oral B12 utilization
C. IM B12 acts faster
D. IM B12 needs lower dosage
E. Pernicious anemia has swallowing difficulties

152. A 19 years old man presents with weight loss, increasing thirst and increased frequency of going
to the washroom. His father, grandfather and two sisters have been diagnosed with Diabetes Mellitus.
What is the most likely type of diabetes this patient is suffering from?
A. Insulin-dependent diabetes mellitus (IDDM)
B. Noninsulin-dependent diabetes mellitus (NIDDM)
C. Latent autoimmune diabetes of adults(LADA)
D. Maturity Onset Diabetes of the Young(MODY)
E. Diabetic ketoacidosis (DKA)

153. 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. On examination
there was a 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. Fine-needle aspiration biopsy (FNAC)
B. MRI scan
C. Punch Biopsy
D. Open Biopsy
E. Stereotactic Biopsy

154. A known COPD patient presented to the hospital with complains of persistent cough, copious
sputum production and intermittent hemoptysis. On examination, finger clubbing and coarse
inspiratory crepitations were observed. What is the most probable diagnosis?
A. Lung cancer
B. Cystic fibrosis
C. Bronchiectasis
 27

D. Pulmonary edema
E. Lung abscess

155. A 54 year old man after a CVA (cerebral vascular accident) presents with ataxia, intention
tremors and slurred speech. Which part of the brain has been affected by the stroke?
A. Inner Ear
B. Brain Stem
C. Diencephalon
D. Cerebrum
E. Cerebellum

156. Young boy presenting a soft swelling between the thyroid cartilage and the tongue. It moves
on protrusion of tongue. What is the diagnosis?
A. Thyroglossal cyst
B. Thyroglossal fistula
C. Trache-oesophageal fistula
D. Goiter
E. Aberrant thyroid

157. An elderly lady who lives in a care home complains of abdominal discomfort and
constipation. Rectal examination reveals faecal impaction. What is the treatment of choice?
A. Senna
B. High fibre diet
C. Ispaghula husk
D. Liquid paraffin

158. A middle aged man complains of a node which has been growing in his nose for several months.
Now it is firm with central depression. It’s 0.6cm in size. What is the SINGLE most likely diagnosis?
A. Basal cell carcinoma F. Kerato acanthoma
B. Squamous cell carcinoma G. Molluscum Contagiosum
C. Lymph node
D. Melanoma
E. Kaposi’s Sarcoma

159. A 47year old male comes to the GP with a swelling in his left groin which disappears on lying
down. The swelling was bluish in colour and felt like a bag of worms. He also complains of a mass in
the left loin along with haematuria occasionally. What could be the possible diagnosis?
A. Left sided renal cell carcinoma E. Inferior Vena Cava obstruction
B. Varicosity secondary to liver disease
C. Testicular tumor
D. Urinary tract infection

160. A woman who has cystic fibrosis is planning a pregnancy. She wants to know the chances of
her children being affected by the disease.
A. 25%
B. Depends on genetic makeup of partner
C. 50 %
D. 75%
E. 100%

161. A 28 year old woman complains of hearing strange voices in her bedroom as she is falling asleep
in the night. She says there is no one in the room except her. On evaluation she has no other problems.
What is she suffering from?
 28

A. Delusion of persecution
B. Cotard Syndrome
C. Hypnogogic Hallucinations
D. Lilliputian Hallucinations
E. Schizophrenia

162. A 55 year old male presents with a gradually increasing right sided scrotal swelling over 3
months. On examination, the swelling transilluminates and it is possible to palpate above it. What is
the most appropriate diagnosis?
A. Testicular tumour
B. Indirect inguinal hernia
C. Direct inguinal hernia
D. Hydrocele
E. Varicocele

163. A 34 year old man from Asia presented with 5 months history of productive cough, night sweats
and weight loss. His CXR reveals some shadowing in the left upper zone. What is the single most
discriminating investigation?
A. Acid fast bacilli test for sputum
B. CXR
C. CT scan
D. Thyroid function test
E. Ultrasound of the abdomen

164. A 19 year old boy came with skin rash and decreased urine output. On investigations, he was
found to have raised urea and creatinine, and hematuria. There was history of bloody diarrhoea and
fever. What is the most likely diagnosis?
A. Thrombotic ThrombocytopoenicPurpura
B. Haemolytic Uraemic Syndrome
C. Post streptococcal glomerulonephritis
D. IgA Nephropathy
E. Minimal Change disease

165.A 33 year old man presents with an itchy scaly annular rash on his thigh after a walk in the park.
Which of the following drugs will treat his condition?
A. Erythromycin
B. Doxycycline
C. Penicillin
D. Amoxicillin

166. A 2 years old girl has frequency, urgency and burning micturition. She has some supra pubic
tenderness. Which one of the following is the most appropriate initial investigation for this patient?
A. Supra pubic aspiration of urine for Culture and Sensitivity
B. Clean catch of urine for Culture and Sensitivity
C. USG D.IVU
E. Micturating cysto-urethrogram
 29

167. A 3 years old child has been brought with facial lacerations. On examination he has some cuts
over his right cheek and under the eye. The GCS on initial evaluation is 15. What is the most
appropriate next investigation?
A. Skull X Ray
B. Facial X ray
C. CT Scan
D. Magnetic resonance imaging (MRI)
E. Observation

168. A 55 year old man was involved in a fight near his pub on Saturday night. He is bleeding
from his ear. He complains of ringing in his ear and deafness. What is the most important
investigation for his condition?
A. CT head
B. X-ray skull
C. Otoscopy
D. Do nothing
E. MRI Inner Ear

169.A young boy presents with non-blanching rash on extensor surfaces, proteinuria, haematuria,
diarrhoea and abdominal pain after an upper respiratory tract illness 2 weeks ago. His platelet counts
and clotting factors are normal. What is the single best diagnosis?
A. ITP (Idiopathic thrombocytopenic purpura)
B. TTP (Idiopathic thrombotic thrombocytopenic purpura)
C. Haemophilia
D. HSP (Henoch-Schönleinpurpura)
E. Vitamin K deficiency

170. During a laparoscopic procedure, a trochar is inserted halfway between the umbilicus and the
anterior superior iliac spine. What are the structures most likely to be pierced?
A. Rectus sheath
B. Linea alba
C. External oblique aponeurosis
D. Internal oblique and transverse abdominal
E. Both C and D

171.A 5 year old girl had ear ache and some yellowish foul smelling discharge, perforation at the
attic and conductive hearing loss. She has no past history any ear infections. What is the
diagnosis?
A. Acute otitis Media
B. Otitis media with effusion
C. Acquired cholesteatoma
D. Congenital cholesteatoma
E. Otitis externa

172. A 34 year old patient with small cell lung cancer of lung presents with Na: 119 and all other
values normal. Fluid restriction has failed to bring the Sodium up. What is the next most likely
step?
 30

A. Chemotherapy
B. Radiotherapy
C. Demeclocyclin
D. Somatostatin
E. Loop diuretics

173.A man has been diagnosed with metastatic carcinoma of the middle 1/3rdof the
oesophagus. What is the best initial management?
A. Chemotherapy
B. Celestintube
C. Radiotherapy
D. Surgery
174. 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 he was not cyanosed. He has
reduced breath sounds on the right side. His oxygen saturation is 94% on air. What is the SINGLE
most appropriate investigation?
A. Capillary blood gases
B. Chest x-ray
C. CT scan of the chest
D. Exercise challenge
E. MRI of the chest

175.A 31 year old man has epistaxis following 10 days after Polypectomy. What is the most
likely diagnosis?
A. Nasal infection
B. Coagulation disorder
C. Carcinoma

176. A 34 year old man was walking along the country side when an insect bit him. After which
he started to complain of an annular rash spreading upwards. Which is the best treatment for this
patient?
A. Penicillin oral
B. Doxycycline oral
C. Gentamicin oral
D. Flucloxacillin oral

177.A patient underwent laparoscopic cholecystectomy in which the trocar was inserted on the
right side between the midline and the anterior axillary line below the umbilicus. What structure is
most likely to be pierced?
A. Rectus abdominis
B. Lineaalba
C. External oblique
D. Internal oblique
178. A 37 years old female had a fall with out-stretched hand, presented with dinner folk
deformity and tenderness over the right arm. What is the SINGLE most associated nerve injury?
A. Axillary nerve E. Ulnar nerve
B. Radial nerve
C. Musculo-cutaneous nerve
D. Median nerve
 31

179.A 50 year old man has had anterior resection of the rectum for carcinoma. He expressed
concerns about control of post-operative pain in discussions with the anaesthetist before surgery.
What is the best management strategy?
A. Oral Diclofenac
B. Oral Codeine
C. IM Morphine
D. IM Dihydrocodeine
E. Ondansetron oral

180. Young girl who is known to have type 1 diabetes presented with drowsiness, deep breathing.
Her sugar level is 20. Her blood pressure is 120/80mmHg. Her mucous membrane is dry. What
would be the next appropriate step?
A. Serum urea
B. Blood culture
C. CT scan
D. HbA1c
E. Arterial blood gas

181.A 54 year old woman presents complaining of nausea, vomiting, diarrhoea, abdominal pain,
feeling faint and dizzy and hyper pigmentation. She takes steroid for rheumatoid arthritis for past 10
years. What is the most likely diagnosis?
A. Primary adrenal insufficiency
B. Ectopic ACTH producing tumour
C. Secondary adrenal insufficiency
D. Congenital adrenal hyperplasia
182. A 47 year old man met with a road traffic accident. He has multiple injuries. Pelvic fracture
has been confirmed. He has not passed any urine during the last four hours. What is the next
appropriate management for this patient?
A. Urethral catheter
B. Suprapubic catheter
C. IV fluid
D. IV Furosemide
E. Insulin

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

184. A 50 year old patient has been prescribed propranolol for a cardiac condition, but his GP now
wants to stop this drug. Which of the following is the most important reason for this decision?
 32

A. Familial tremor
B. Partial AV heart block
C. Mild hypertension
D. Angina pectoris
E. Supraventricular tachycardias

185.A patient was lying down on an operation table during surgery in a position with his arm hanging
down for 3 hours. Soon after he woke up, he complains of numbness and weakness in that hand and
has limited wrist movement / wrist drop and sensory loss over dorsum of that hand, weakness of
extension of the fingers and loss of sensation at the web of the thumb. What structure is likely to be
damaged?
A. Radial nerve D. Axillary nerve
B. Median nerve E. Supra-scapular nerve
C. Ulnar nerve
186. Which of the following drugs produces respiratory depression and maybe reversed by the
administration of flumazenil?
A. Fentanyl E. Enflurane
B. Propofol
C. Ketamine
D. Midazolam
187.A 52 year old man with a history of anterior MI 3 weeks ago developed sudden onset of
dyspnoea. On examination: BP 100/60mmHg, PR 100/min, SaO2: 88%
Chest: bilateral crackles.
Which investigation would you do to find the underlying cause?
A. Chest x-ray
B. ECHO
C. D-DIMERS
D. Radio-nucleotide lung scan
E. Troponin

188. A 46 year old man was found outside a pub. He was confused, had ataxia and ophthalmo
plegia. What is the most likely condition the patient is suffering from?
A. Delirium tremens
B. Wernicke’s encephalopathy
C. Korsakoff’s syndrome
D. Hepatic encephalopathy
E. Meningitis

189.A 82 years old lady, who has atrial fibrillation is well maintained on digoxin, has now developed
diarrhoea and vomiting for last 3 days. She is also dehydrated. Her Abbreviated Mental score is 4 out
of 10 and she is experiencing yellow-green visual halos. What is the most important investigation to
give the likely cause of the vomiting?
A. Gastroscopy
B. Stool Culture
C. Calcium Level
D. Digoxin Level
E. Blood culture
 33

190. An 11 year old boy is being checked by the diabetic specialist nurse. His HBA1C was high
and he has been skipping meals recently. He has been unhappy at school. Which single member of
clinical team would you refer him to next?
A. Refer to GP
B. Refer to paediatrician
C. Refer to dietician
D. Refer to clinical psychologist
E. Refer to school nurse

191. A male patient who is terminally ill with metastasis has developed bilateral hydro-nephrosis.
His Urea, Creatinine (380) was high. He wants to attend his daughter’s wedding in two weeks. What
would you do?
A. Haemodialysis
B. Nephrostomy
C. Peritoneal dialysis
D. Suprapubic catheter
E. Urethral Catherisation

192. A 50 year old presented to the hospital with complain of chest tightness wheeze and chronic
cough. He has been smoking 20 cigarettes per day since last 35 years. A diagnosis of COPD was
made. What will be the picture of ABG for this patient?
A. Respiratory Acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
E. Normal pH

193. A young man febrile with cough and sputum production with left lower lobe patchy
consolidation in CXR. Which is the best antibiotic therapy for this patient?
A. Ciprofloxacillin
B. Cotrimoxazole
C. Cefotaxime
D. Vancomycin
E. Amoxicillin

194. A mother has come to the GP. She has 2 daughters, one of whom has cystic fibrosis. The
other daughter is normal. She would like to know what is the chance her other daughter will be a
carrier.
A. 1 in 4
B. 2 in 4
C. 1 in 2
D. 2 in 2
E. 1 in 3

195. A 70 year old man with hoarseness of voice for 3 months presented with breathing
difficulties. On chest x- ray there was a unilateral opacity in hilum. There is no history of smoking.
What is most probable diagnosis?
A. Bronchial carcinoma
B. Laryngeal carcinoma
C. Oesophageal carcinoma
D. Nasopharyngeal carcinoma
E. Sarcoidosis
 34

196. A man with a carcinoma and multiple metastasis presents with intractable nausea and
vomiting. He has become drowsy and confused. What is the most appropriate management?

A. Dexamethasone IM
B. Dexamethesone oral
C. Ondansetron IM
D. Ondansetron oral
E. Morphine oral

197. A 40 years old man collapsed at home and died. The GP’s report says he suffered from type 2
DM and his BMI was 35. What is the most likely cause of death?
A. Myocardial infarction
B. Diabetes Mellitus
C. Heart Failure
D. Pulmonary Embolism
E. Renal Failure

198. A 35 year old man with a history of schizophrenia is brought to the Emergency Department
by his worried friends due to drowsiness. On examination he is generally rigid. A diagnosis of
neuroleptic malignant syndrome is suggested. Each one of the following is a feature of neuroleptic
malignant syndrome, except:
A. Renal failure
B. Pyrexia
C. Elevated creatinine kinase
D. Usually occurs after prolonged treatment
E. Tachycardia

199. A 9 year old boy has been brought by his mother to the GP. She says he is a loner and does
not like to play with other children of his age. He has collected 200 toy airplane models and spends all
his time with them. He has never been good academically and his teachers complain that he does not
participate in classroom activities, and seems not to be making any effort to learn. What is the most
likely diagnosis in this boy?
A. Phenylketon uria
B. Autism
C. Down’s syndrome
D. Tourette’s syndrome

200. A 40 year old manual worker presents with a swelling in the groin. On examination the mass is
found to be just above and lateral to pubic tubercle. There is no cough impulse and it is reducible. On
applying the 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
35