Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 27TH OCTOBER 2018 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. A 35 year old man presents with a headache that worsens on bending his head forward. What is the
most likely diagnosis?
A. Chronic Sinusitis
B. Subarachnoid Haemorrhage
C. Migraine
D. Cluster Headache
E. Tension Headache

2. A 27 year old man presents with chest pain and respiratory distress. On examination there is
tachycardia, hypotension and neck vein distension. Trachea is deviated to the left side, breathing
sound on the right side is absent and on the left side is diminished. What is the next appropriate
management?
A. A. Chest x-ray
B. B. Right side aspiration (16 G cannula)
C. C. Left side aspiration (16 G cannula)
D. D. Right side drainage with a small tube (12F)
E. E. Left side drainage with a small tube (12F)

3. A 56 year old female has come to the fracture clinic with a fall on her outstretched hand. she
complains for pain and swelling in her right forearm and she is unable to bear weight. You suspect
fracture of her right upper forearm. What will be the best investigation to diagnose and to prevent
recurrence?
A. Dexascan
B. CT scan
C. MRI
D. Full body xray

4. A 12 year old boy with pain and swelling in multiple joints (small and large), has mild fever.
Which of the following change in his blood investigations will definitely be there?
A. RA factor positive
B. Increase in ESR
C. ANA – positive
D. Rise in serum uric acid level

5. A woman presents with alternating episodes of low mood and happiness. When she feels happy she
goes on extravagant shopping sprees. What is the most likely diagnosis in this patient?
A. Depression
B. Bipolar affective disorder
C. Schizophrenia
D. Panic disorder

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6. A 60 year old man presents to the ENT department with progressive hearing loss and ringing sound
on the right side. On examination external ear and tympanic membrane was normal. Hearing tests:
Rinne’s AC>BC in the right and left ears, Weber’s test lateralises to the left ear. What is the next best
investigation to diagnose the medical condition?
A. Audiometry
B. CT scan
C. MRI scan
D. CT angiography
E. Otoscopy

7. A 35 year old man suffering from influenza 5 days ago now develops fever, cough and sputum.
Chest X-ray shows bullous appearance. What organism is causing the infection?
A. Haemophilus influenza
B. Staphylococcus aureus
C. Streptococcus pneumonia
D. Klebsiella

8. A 80 year old man diabetic and hypertensive presents with acute onset of vomiting and vertigo with
a tendency to fall to the right. He also had difficulty in swallowing. Examination shows right sided
partial ptosis, constricted pupils and exolphthalmus. There is also right sided soft palate palsy and
sensory loss of the face on the right side and left half of the lower body.
A. Weber Syndrome
B. Left middle cerebral artery infarct
C. Right posterior cerebral artery infarct
D. Lateral medullary syndrome

9. A 65 year old man who has been self medicating for chronic knee pain, presents in the Accident
and Emergency with pain in the abdomen. His chest x-ray is given below.
What is the most definitive treatment?

Options:
A. Antibiotics
B. Chest Physiotherapy
C. Urgent Laparotomy
D. Planned Laparatomy
E. Analgesics and Fluids

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10. A 63 year old female with a history of osteoporosis suddenly fall on her outstretched hand while
shopping. X ray shows there is fracture at the distal radius with backward shift of the distal fragment.
What is the SINGLE most probable deformity?
A. Dinner fork deformity.
B. Coxavara.
C. Mallet finger
D. Cubitus valgus
E. Garden spade deformity

11. A mother brings her baby to the hospital complaining that the baby has stridor only upon breast-
feeding. On examination, omega shaped cartilage was seen in the neck. What is the most probable
diagnosis?
A. Laryngomalacia
B. Bronchiolitis
C. Croup
D. Epiglotitis
E. Tracheo oesophageal fistula

12. A 55 year old male presents to the accident an emergency after an RTA with breathlessness,
engorged neck veins and a dull percussion note on the right side of his chest. On examination his
pulse is 140bpm and BP is 80/50mmHg, what is the most likely diagnosis?
A. Haemothorax
B. Haemopneumothorax
C. Tension pneumothorax
D. Simple pneumothorax

13. A patient diagnosed with DVT is taking warfarin. What is his cut –off-international normalised
ratio (INR) limit?
A. <1
B. 1-2
C. 2-3
D. 3-4

14. What is the most common route of colonic metastasis to the liver?
A. Hematogenous
B. Lymphatic
C. Local invasion
D. Peritoneal seeding

15. A 15 year old boy presents with testicular pain for 2 days. There is no history of trauma. On
examination he has a temperature of 38.5˚C and there is tenderness of the right hemi-scrotum. What is
the single most appropriate management?
A. Give antibiotics
B. Give analgesia
C. Reassure
D. USG of scrotum
E. Exploratory surgery

16. A 27 year old woman had pre eclampsia and was delivered by c – section. She is now complaining
of right upper quadrant pain different from wound pain. What investigation will you do immediately?

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A. Coagulation profile
B. Liver function tests
C. Ultrasound liver
D. MRCP
E. None

17. An old lady who is a nursing-home resident presents with itchy rash, white linear lesions on wrists
and elbows. What is the best treatment?
A. Permetrin E. Steroids
B. Antibiotics
C. Antifungals
D. Emollients

18. Man who has motor neuron disease and is wheelchair bound, finds it difficult to swallow food-
both liquids and solids. What would be the best option to provide nutrition?
A. Gastrostomy
B. Fine bore NG tube
C. Parenteral nutrition
D. Give steroids and continue oral nutrition

19. A 44 year old patient comes with right hemiparesis. On examination he has left sided ptosis
and his left pupil is dilated. Where is the lesion?
A. Cerebral infarct
B. Cerebellar infarct
C. Medulla Oblongata
D. Pons
E. Midbrain

20. A patient with terminal cancer on morphine asks you to help him end his life by giving him lethal
dose of morphine.
A. Use lethal dose Morphine to end his life
B. Use some other medication to end his life
C. Suggest it some other way to end his life
D. Tell him this not possible but assure him that there are effective ways to deal with pain.

21. A middle age male after myocardial infarction is feeling unwell. The ECG has been performed
and shows a prolonged QRS complex and T wave is tented Sodium-136 mol/L
Potassium- 6.2mmol/L, Urea- 5.0 mmol/L What is the most appropriate management?
A. Calcium gluconate E. Calcium
B. Calcium resonium
C. Calcium with Vitamin D supplements
D. Vitamin D

22. 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?

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

23. A 27 year old female who had a Road Traffic accident 7 months ago now complains of
attacks of sudden onset rotational vertigo that occurs on sharp movements of her head and neck.
Which of the following would be most helpful?
A. Caloric testing
B. Hallpike manoeuvre
C. Gutenberger’s test
D. Meniere’s test
E. Otoscopy

24. An elderly man with dementia who has a lesion on his head and wants it removed because he
believes it'll improve his memory, wife disagrees. Choose the most appropriate management:
A. Asses patient’s capacity to give consent.
B. Refuse to do the surgery.
C. Do the surgery.
D. Get wife to sign consent form.
E. Talk to senior colleague.

25. A 58 year old man presented with inability to close his left eye. Which nerve is involved?
A. Facial nerve
B. Oculomotor nerve
C. Trigeminal nerve
D. Abducent nerve

26. A 55 year old man presents with history of weight loss and tenesmus. He is diagnosed with rectal
carcinoma. Which risk factors help to develop rectal carcinoma except following?
A. Smoking
B. Family history
C. High fibre diet
D. Previous Carcinoma
E. High fat diet
F. Polyp

27. A child presents with fever and maculo-papular rash on the back as shown in the given picture.
What is the most probable diagnosis?
A. Chicken pox
B. Kawasaki disease
C. Measles
D. Rubella
E. Scarlet fever

28. A 25 year old male had an injury to the knee while playing football. X ray reveals the condylar
fracture of tibia. What is the SINGLE most probable deformity?
A. Dinner fork deformity E. Genu valgus
B. Gibbus
C. Cubitus valgus
D. Garden spade deformity

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29. A 20 year old woman has had abdominal pain in the left iliac fossa of 6 weeks duration. Over the
past 48 hours, she had had severe abdominal pain and fever of 39.C. Pelvic ultrasound shows a
complex cystic 7cm mass in the left iliac fossa. What is the most likely diagnosis?
A. Endometriosis
B. Dermoid cyst
C. Ovarian carcinoma
D. Tubo-ovarian abscess
E. Ectopic pregnancy

30. A man presents with scrotal swelling, the swelling is cystic and is non tender, and it is located at
the upper pole of the posterior part of the testis. What is the most likely diagnosis?
A. Epididymal Cyst
B. Testicular cancer
C. Hydrocele
D. Teratoma
E. Testicular torsion

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

32. A 32 year old woman had progressive decrease in vision over 3 years. She is now diagnosed as
almost blind. What would be the mechanism?
A. Cataract
B. Glaucoma
C. Retinopathy
D. Uveitis
E. Keratitis

33. A man was noticed to have consumed alcohol on both occasions when he visited the GP clinic for
regular check-ups. What is the most definitive test to check for alcohol dependency?
A. Blood alcohol levels
B. GGT levels
C. Asking if he needs to drink alcohol the first thing in the morning
D. Total number of units of alcohol he consumes weekly
E. ALT and AST levels

34. A man was resuscitated by the medical team in the ambulance but the patient died of a cardiac
arrest on the way. The man weighed 122kg due to which he had very restricted mobility. He was also
a smoker. Choose the most likely cause of his death.
A. Myocardial Infarction
B. Pulmonary Embolism
C. Chronic cardiac failure

35. A 20 years old fit man suddenly developed severe lower back pain as getting up from bed. What is
the SINGLE most probable diagnosis?

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A. Paget’s disease
B. Multiple myeloma
C. Prolapsed Intervertebral Disc
D. Ankylosing spondilitis
E. Spondylosis

36. A patient has been diagnosed with end stage oesophageal Ca. What is the best method to manage
progressive dysphagia?
A. Stenting
B. Chemotherapy
C. Radiotherapy
D. Laser therapy

37. A 13year old boy with umbilical pain for the last 12h presents with anorexia, nausea and has not
passed a bowel motion for 24h. What is your diagnosis?
A. Acute appendicitis
B. IBD
C. IBS
D. Meckel’s diverticulum
E. Psoas hematoma

38. A 62year old man has had ano-rectal pain aggravated by defecation for 3days. Rectal exam:
purple, tender lump at the anal verge. Flexible sigmoidoscopy: normal rectal mucosa and hard
feces. What is the best managementstrategy?
A. Analhematoma
B. Analfissure
C. Rectalca
D. Diverticulitis
E. Angio dysplasia

39. A 35 years old male presented with purulent nasal discharge from one side with headache and
fever, examination showed supra orbital and maxillary tenderness , what is the best diagnostic
investigation?
A. CT Scan
B. MRI
C. X-ray
D. USG
E. Swab for culture

40. A 43 year old male presented to the ENT department with history of nausea and dizziness since 2
weeks. He noticed that these symptoms occur for a few seconds whenever he rolls over in his bed in
the mornings. On examination: external ear and tympanic membrane are normal, Rinne’s and Weber’s
shows no hearing loss, and his cranial nerves examination are normal. What is the most appropriate
clinical test to diagnose patient’s medical condition?
A. Head Impulse test
B. Dix-Hallpike test
C. Audiometry
D. Romberg’s test
E. Epley’s manoeuvre

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41. A 36 year old lady complains of earache and fever. On examination her ear is severely tender and
there are vesicles within the ear canal. What is the most likely organism responsible for her condition?
A. Herpes zoster
B. Varicella zoster
C. Herpes simplex
D. HIV

42. A 35 year old African woman presents with cyclical menorrhagia since last 8 month. She is
nulliparous and has been trying to conceive for some years now. What do you suspect from the
history?
A. Dysfunctional Uterine Bleeding
B. Endometriosis
C. Endometrial polyp
D. Adenomyosis
E. Fibroids

43. A boy presents to the A&E department. He was playing with his pencil in the class. He scratched
his ear with the pencil and when he took out his pencil, he found that the eraser at the pencil tip was
missing. Choose the single most appropriate method of removal of foreign body for this person.
A. Removal with a hook
B. Syringing
C. Removal under GA
D. Putting oil
E. Putting alcohol

44. A 30 year old patient presents with heavy bleeding. She is in a stable relationship and is not keen
for conception. USG shows normal uterus. What would you advise her?
A. Mirena coil
B. Combined Oral Contraceptive Pill (COCP)
C. IUCD
D. Progesterone only pill
E. Tranexamic acid

45. A man with dementia has a nodule on his scalp. He wants to remove it to improve memory and his
daughter refuses surgery.
A. Refer patient to psychiatry to asses capability to consent
B. Refuse to do the surgery
C. Agree with the daughter because she is the one who has to decide for her mother.

46. A 61 year old male who was recently diagnosed to have stable angina is waiting to have contrast
coronary angiography. Which of the following should be done before the procedure?
A. Buccal Nitrates
B. IV 0.9% Saline
C. IV Dextrose
D. ECG
E. Echo

47. An 18 year old woman says that she can’t walk around as she is very big for that room. What is
the most likely hallucination?

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A. Extra-campine visual hallucinations
B. Lilliputian visual hallucinations
C. Alice in wonderland syndrome
D. Hypnagogic hallucinations

48. A 55 year old woman suffered from acute myocardial infarction 5 days ago, while in hospital the
patient developed features of pulmonary oedema and heart failure. What is the most probable cause of
her present condition?
A. Ventricular Septal Defect (VSD)
B. Rupture papillary muscle
C. Pericarditis
D. Atrial fibrillation
E. Re-infarction

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

50. A 30 year old pregnant lady presents to the hospital with constipation. High fibre diet is not
effective. What is the single most appropriate treatment?
A. Reassure
B. Advice to walk around
C. Increase water intake
D. Laxatives

51. A 26 year old female has multiple painless genital ulcers. She is on combined oral contraceptive
pill. What is her diagnosis?
A. Chlamydia trichromatis
B. HPV
C. HSV
D. Bacterial vaginosis
E. Hemophillus ducreyi

52. 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

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53. A young man presents with chest pain, palpitations, shortness of breath and perioral tingling
sensation after an argument with his girlfriend. ECG is normal. What is the best management for his
shortness of breath?
A. Amitriptyline
B. Diazepam
C. Rebreathe into a paper bag
D. Propanolol

54. A 64 year old man has had a recent onset of cough, fever and weight loss. A chest X-‐ray shows
upper lobe cavitation. Tuberculosis is a possible diagnosis. He is sufficiently unwell to require
hospital admission while further investigations are arranged. What is the single most important
immediate step to take in order to reduce the risk of tuberculosis spreading among hospital patients
and staff?
A. Adopt universal precautions
B. Arrange immediate bronchoscopy to establish the diagnosis
C. Commence anti-tuberculous treatment without delay
D. Ensure staff have received Bacillus Calmette-Guerin (BCG) immunization
E. Isolate patient in a negative pressure room

55. A 2 day baby started to have jaundice but is breast feeding well and gaining weight. She is passing
white stool 2-3 times per day. What is the single most likely cause of jaundice?
A. Biliary atresia
B. Haemolysis
C. Physiological
D. Congenital spherocytosis
E. Breast milk jaundice

56. A 28 years old man presents with sudden onset abdominal pain. He has no significant history apart
from an appendectomy when he was 12. His Abdominal X-ray finding is below.
What is the single most appropriate next step in the management?

Options:
A. Urgent Laparotomy
B. Urgent Colonoscopy

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 C. Insert Nasogastric tube
D. High dose Laxatives
E. USG Abdomen

57. A patient has amenorrhea for last 6 months. Previously she was taking COCP pills. Her LH : FSH
ratio is 1:1. What is the most probable diagnosis?
A. Post pill amenorrhea
B. PCOS
C. Hypothalamic amenorrhea
D. Premature ovarian failure

58. A young man presented with cough, high grade fever and chest pain. CXR shows
bilateralcavitating bronchopneumonia. He was diagnosed with influenza infection a week ago. What
is the most probable cause of his pneumonia?
A. Legionella
B. Mycoplasma
C. StaphylococcusAureus
D. Streptococcus pneumonia

59. 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

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

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

62. 8 month old child chocked on food, parents are worried as to what to do if it happens again. What
is the most appropriate advice you would give the parents?
A. Heimlich manoeuvre
B. Back blows with child on lap
C. Chest Compression with child on lap
D. Induced Vomiting
E. Back blows on back with child standing

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

64. A child was diagnosed with meningitis, who among the following options should be given
meningitis prophylaxis?
A. Parents, siblings
B. Siblings plus doctors and nurses
C. All contacts plus doctors and nurses
D. Doctors and nurses

65. A 4 months old child diagnosed with a lower UTI was treated with Trimethoprim but was
unresponsive to this treatment after 48 hours. What should be the next appropriate step?
A. MSU for C/S
B. MCUG
C. Urgent DMSA scan
D. Ultrasound within six weeks time

66. A patient with rheumatoid arthritis has swelling of calf with joint effusion, dorsiflexion and
plantar flexion of foot are normal, fluctuating swelling at the back of knee.
A. Popliteal cyst rupture
B. Popliteal artery aneurysm
C. DVT
D. Tendinitis

67. 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. What
is the single most likely diagnosis?
A. Acute mastoiditis
B. Acute otitis externa
C. Acute otitis media
D. Mumps

68. 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. 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

69. A 33 year old female complains of diplopia on upright gaze. On examination ptosis can be seen.
There are no other complains or any significant past medical history. What is the most appropriate
investigation for this patient?

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A. Ophthalmoscopy
B. Visual field test
C. Thyroid function test
D. CT scan
E. Checking red reflex

70. A 40 years old lady complains of 10 months amenorrhoea. She presents with hot flush, mood
swings, irritability and insomnia. What will be the single most effective diagnostic test for this lady?
A. Serum FSH and LH E. Serum cortisol
B. Serum FSH
C. Serum Progesterone
D. Serum estradiol

71. A 62 year old man presents with cough, breathlessness and wheeze. 24% oxygen, Salbutamol and
hydrocortisone were given. The symptoms have not improved and so nebulised bronchodilator was
repeated and IV Aminophylline was given. ABG showed pH: 7.31 and respiratory rate is 32. What is
the next appropriate management?
A. Nasal intermittent positive pressure ventilation
B. Intubation and ventilation
C. Long acting beta agonist
D. Toxapram
E. Amoxicillin oral

72. A child presented with right sided hearing loss. Tuning fork test was done and showed Air
conduction > Bone conduction. Weber test localised to left ear. What is the most appropriate
diagnosis?
A. Acute Otitis Media
B. Acute Otitis externa
C. Serous Otitis Media with effusion (glue ear)
D. Otosclerosis
E. Acoustic neuroma

73. Patient with myocardial infarction now presents with breathlessness, bi-basal crepitations. ECG
is normal. What is the most likely cause of his symptom?
A. Pulmonary embolism
B. Pulmonary oedema
C. Pneumothorax
D. Haemothorax
E. Mitral regurgitation

74. A 50 year old man with worsening dyspepsia, on PPI and previously treated for duodenal ulcer.
Endoscopy showing gastric, duodenal and oesophageal ulcers. What is the investigation of choice?
A. CT abdomen
B. Test for H pylori
C. Endoscopy with biopsy
D. Barium study
E. Serum gastrin levels

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75. A 49 year old woman presents to the Out Patient Clinic. Her oral glucose test, after 2 hours of
glucose intake, versus plasma level in 2 different tests are 6mmol/L and 10mmol/L. This situation can
be categorized as :
A. Impaired glucose tolerance
B. Impaired fasting glucose
C. Diabetes Mellitus Type I
D. Diabetes Mellitus Type II
E. Metabolic syndrome

76. A mother brings her 12 year old son to you requesting surgery for his sticking out ears. The boy
says he does not want surgery. What do you do?
A. Refer to private practice
B. Schedule surgery
C. Contact social services and explore their concerns

77. A 60 year old man presents with dysphagia and pain on swallowing both solids and liquids. A
barium meal shows gross dilatation of the oesophagus with a smooth narrowing at the lower end of
the oesophagus. What is the SINGLE most likely cause of dysphagia from the given options?
A. Achalasia
B. Myasthenia gravis
C. Oesophageal carcinoma
D. Oesophageal web
E. Systemic sclerosis

78. A 62 year old man has had ano-rectal pain aggravated by defecation for 3days. Rectal exam:
purple, tender lump at the anal verge. Flexible sigmoidoscopy report shows normal rectal mucosa and
hard faeces. What is the best management strategy?
A. Anal hematoma
B. Anal fissure
C. Rectal ca
D. Diverticulitis
E. Angiodysplasia

79. A 28 year old woman who is 32 weeks pregnant, in her third pregnancy, is diagnosed as a case of
placental abruptio. After all the effective measures she is still bleeding. What is the underlying
pathology?
A. Clotting factors problem
B. Clauser’s syndrome
C. Platelets problem
D. Succenturiate lobe

80. A 5 year old boy was diagnosed with urinary tract infection, which was later found to be due to
E.Coli. What is the most appropriate treatment?
A. Trimethoprim
B. Nitrofurantoin
C. Amoxicillin
D. Cefalexin
E. Metronidazole

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81. A mother is worried about cot death and asks about precautions to prevent it.
A. Lie the baby prone with feet at feet end ofcot
B. Lie the baby prone with feet at head end ofcot
C. Lie the baby supine with feet at head end ofcot
D. Lie the baby supine with feet at feet end ofcot
E. Lie the baby supine in the middle of thecot

82. A woman presents having overdosed on Imipramine. Which investigation should be done
immediately?
A. EEG
B. ECG
C. FBC
D. CT
E. MRI

83. A 37 year old female who complains of feeling nervous over her daily routine or trivial chores.
She states her work and quality of life is being affected. What would be the best option for long term
treatment of this condition?
A. Fluoxetine
B. Haloperidol
C. Lithium
D. Ecstasy
E. Diazepam

84. Patient with multiple painful vaginal ulcers. What is the appropriate investigation?
A. Anti HSV1
B. Dark ground microscopy
C. PCR for treponema pallidum
D. Swab for H. ducreyi

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

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

86. A 4 year old boy is brought by his parents with complains of wetting his bed at night and
whenever he gets excited. What would be the most appropriate management for this child?
A. Desmopressin
B. Oxybutynin
C. Behavioural Therapy
D. Tamsulosin
E. Restrict fluid intake

87. A 40 year old woman presents to the GP with low mood. Of note, she has an increased appetite
and has gone up to two dress sizes. She also complains that she cannot get out of bed until the
afternoon. What is the most likely diagnosis for this patient?

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A. Pseudo Depression
B. Moderate Depression
C. Severe Depression
D. Dysthymia
E. Atypical Depression

88. A 63 years old female is noted to have left pupil irresponsive to light and is dilated. What is the
most probable diagnosis?
A. Pontine hemorrhage
B. Subdural hemorrhage
C. Cerebellar hemorrhage
D. Extradural hemorrhage
E. Sub arachnoid hemorrhage

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

90. A child comes to the A&E with severe asthma, has vomited several times and is not responding to
salbutamol nebulizer. What is the most appropriate management?
A. Salmetrol
B. Montelukast
C. Prednisolone
D. Budesonide inhaler
E. Oxygen
F. IV Salbutamol

91. Which is the correct statement regarding febrile seizures.

A. Most cases will resolve by the age of 6 years
B. All cases will progress to epilepsy
C. There is some learning difficulty later in life
D. A child can have a febrile fit only once

92. A middle aged plumber, who is a known case of COPD and has a history of smoking, presents
with breathlessness and chest pain on inspiration. CXR shows :
What is the most likely diagnosis?
A. Heart failure
B. Bronchiectasis
C. Pulmonary edema
D. Mesothelioma.

16
93. A 32 year old woman has given birth 2 weeks ago to a healthy baby girl. She feels low in mood
and feels she cannot care for the baby. She says the world does not have enough food to feed itself so
she must not breastfeed her baby. She feels her husband is trying to poison the baby. What is the most
likely diagnosis?
A. Baby blues
B. Post partum depression
C. Post partum psychosis
D. Delirium
E. Mania

94. What is the minimum age for consent ?

A. 14 years
B. 15 years
C. 16 years
D. 18 years

95. A 31 year old woman who is 32 weeks pregnant attends antenatal clinic. Her blood result shows
Hb 10.7 and MCV 91. What is the most appropriate management for this patient?
A. Folate supplement
B. Ferrous sulphate 200mg/24 Po
C. Iron dextran
D. No treatment required

96. A 34 year old man fell off a ladder and hit his head on the pavement. He now has blood coming
out of his ears and nose. Which bone has he fractured?
A. Maxilla
B. Base of skull
C. Mandible

17
97. A 32-year-old man presents with confusion, ataxia and ophthalmoplegia. What is the most
probable diagnosis?
A. Wernicke’s Korsakoff
B. Meningitis
C. Stroke
D. TIA

98. A 23 year old female presented with a swelling of her neck that moved upwards on protrusion of
tongue. What is the next appropriate investigation?
A. FNAC
B. Punch biopsy
C. Core biopsy
D. MRI neck
E. Radioactive thyroid scan

99. An elderly woman who used to be always happy, spends money and hyperactive presents with
forgetfullness for the past 5 years and is found wandering. It has become worse after her husband's
death 2 years back. She is neglecting herself, has low mood and is not on any treatment. What is the
most appropriate diagnosis?
A. Bipolar disorder
B. Depression
C. Dementia
D. Delusional disorder

100. A 29 year old gentleman was involved in an RTA. He presents with distended neck veins, clear
breath sounds and a trachea which is in the midline. His respiratory rate is 34 and blood pressure
60/0mmHg. What is the most likely diagnosis?
A. Simple pneumothorax
B. Tension pneumothorax
C. Cardiac tamponade
D. Pericarditis

101. A patient diagnosed with gastric ulcers has continuous symptoms despite 8 weeks of PPI
therapy. Symptoms are aggravated post meals. What is the next step in the management?
A. Surgery
B. Urea breath test
C. Switch to H2 receptor blockers
D. Endoscopic evaluation

102. A 25 year old man complains of bouts of alternating intermittent diarrhoea and constipation for
past one month. He describes a sensation of incomplete evacuation and bloating. Symptoms are
relieved by defecation. Sigmoidoscopy is normal. What is the single most likely diagnosis?
A. Diverticulitis
B. Gastroenteritis
C. Irritable bowel syndrome
D. Pseudomembranous colitis
E. Ulcerative colitis

103. A 75 year old man complains of prostatism and anorexia. Ultra sound shows bilateral
hydronephrosis. What is the cause of this finding?
A. Prostate carcinoma
B. Benign prostatic hyperplasia (BPH)

18
C. Hypertension

104. A 42 year old man 72 hours after an operation for acute cholecystitis develops vomiting and
abdominal distension. He has no abdominal tenderness. What is the single most likely diagnosis?
A. Paralytic ileus
B. Mechanical obstruction
C. Anastomotic leak
D. Wound adhesions

105. A young man has been brought to the hospital after being hit on the head by a metal rod. On
evaluation his GCS is 7. What is the best next step?
A. CT scan
B. MRI
C. PET scan
D. Call anaesthetist
E. Refer to a neurosurgeon

106. Among the risk factors given, which one will most likely enhance a woman’s chances of getting
ovarian cancer?
A. Family history
B. Previous history of breast cancer
C. Environmental factor
D. Young age
E. Nulliparity

107. A 45 year old lady presented with weakness in left half of the body that resolved after two hours.
Ct scan showed area of reduced blood flow. What is the next best investigation?
A. Echo
B. Carotid Doppler plus angiography
C. Glucose
D. Lipids
E. ECG

108. A 62 year old female who had an episode of postmenopausal bleeding PV was sent for a TV
USG. Endometrial thickness was found to be 7mm. What is the next best step in management?
A. Total hysterectomy
B. Laparoscopy
C. Hysteroscopy and Endometrial biopsy
D. Pipelle’s endometrial sampling
E. MRI of pelvis

109. A 29 year old male patient presented with complaints of diarrhoea for the last 4 days.
Biochemical investigations were carried out. What is the key metabolic change that will be noticed?
A. Metabolic alkalosis
B. Hyperkalemia
C. Metabolic acidosis
D. Hypernatremia
E. Hypercalcaemia

110. A 19 years old tall man presents with sudden onset of chest pain. His X ray is below. What is the
most probable diagnosis?

19
 A. Pneumothorax
B. Pulmonary Embolism
C. Aortic Aneurysm
D. Aortic Dissection
E. Myocardial Infarction

111. A 29 year old who is 38 weeks pregnant presents with a two hour history of constant abdominal
pain. She then passes 100ml of blood per vagina. On examination she has a rock hard uterus. What is
the next appropriate investigation?
A. Ultrasound scan
B. Cardiotocograph
C. Clotting screen
D. Haemoglobin
E. Kleihauer-Betke test

112. A 37 year old female working as a health care assistant in a nursing home, comes to the A&E
with complaints of severe itching all over her body. On asking she replies that she had applied cream
on the body of a resident in the nursing home who had similar itches. What is the mechanism of her
itch?
A. Allergic reaction
B. Inflammation of keratinocytes
C. Allergic reaction developed due to use of topical steroid creams
D. Subcutaneous bleeding
E. None of the above

113. 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 USG 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 haemorrhage
C. Smoking
D. Splenectomy
E. Sub-phrenic collection

20
114. A young man presented with fall on the hand. On examination, he is unable to oppose the thumb
and there is wasting of thenar muscles. Which is the most likely nerve that is damaged?
A. Ulnar nerve
B. Radial nerve
C. Both radial and median nerve
D. Median nerve

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

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

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

118. Recurrent UTI in a postmenopausal woman treatment, Urine mcs sterile. Appropriate
management?
A. Bladder retraining
B. Oral oestrogen
C. Vaginal oestrogen
D. Oestrogen pessaries

119. A 31 year old female had inflammatory changes on cervical smear, she did not complain of any
pain or discharge and she was otherwise feeling well. What would be the most appropriate step?
A. Repeat smear
B. Repeat smear in 6 months
C. Colposcopy.
D. Repeat smear in 3 months
E. Cervical biopsy

120. A child presents with clean wound, he has never been immunized as his parents were worried
about it. There is no contradiction to immunization, what is the best management?
A. Full course of diphtheria, tetanus, polio
B. 1 single injection DT

21
C. 1 single injection DTP
D. Only immunoglobin
E. Antibiotic

121. A 32 year old woman of 39 weeks of gestation attends the antenatal day unit feeling very unwell
with sudden onset of epigastric pain associated with nausea and vomiting. Her temperature is 36.7˚C.
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. Select the most likely diagnosis?
A. Acute fatty liver of pregnancy
B. Acute pyelonephritis
C. Cholecystitis
D. HELLP syndrome
E. Acute hepatitis

122. A 59 year old man has sleep disturbance, loss of interest and weight loss of 2 months duration
complicated by myocardial infarction. He has a feeling of worthlessness but nil suicidal ideation.
What is the single most appropriate treatment?
A. Diazepam
B. Electroconvulsive therapy
C. Fluoxetine
D. Imipramine
E. Lithium

123. A 36 year old woman has been treated with dexamethasone for cerebral oedema for the last 3
months. She has now started having recurrent falls, especially in the morning. What is the most like
cause of her falls?
A. Drug side effects
B. Autonomic Neuropathy
C. Adrenal Insufficiency
D. Cushing’s syndrome
E. Addison’s disease

124. 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

125. A patient comes to the A&E with chest pain within 1 hour of onset. He was given aspirin and
nitrates and he is fine now. Myocardial infarction was confirmed in ECG. What is your next
management?
A. Streptokinase and thrombolytics
B. Morphine
C. Percutaneous coronary intervention (PCI)
D. Oxygen

126. A 41 year old man who is addicted to using heroin wants to quit using it. What is the most
appropriate option for him?

22
A. N- Acetyl Cysteine
B. Needle exchange program
C. Naloxone
D. Bupropion
E. Methadone

127. A patient with cerebral metastasis has polyuria and polydypsia. What part of the brain would be
affected?
A. Cerebral Cortrex E. Medulla
B. Cerebellum
C. Diencephelon
D. Pons

128. A patient with Parkinson’s disease has been on NG tube for the past ten days. He is still unable
to swallow. What would be the best management for him?
A. Gastrostomy
B. Colonostomy
C. Duodenostomy
D. Total parenteral nutrition
E. Ileostomy

129. A 40 year old woman with breast cancer has back pain which keep her awake at night. She
blames it on a gym session she had 2wks ago. She now has difficulty in climbing stairs. There is
tenderness over the right thoracic spine. She has diminished fine touch and temp sensation in her
right foot. What is the single most appropriate investigation?

A. Bone density scan

B. CT head
C. MRI spine
D. Nuclear bone scan
E. XR thoraco lumbar spine

130. 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

131. A man presented with severe unilateral headache. After a while presented with diminished
consciousness. CT scan was normal. What is the next best step?
A. Lumbar puncture
B. No investigation
C. MRI

132. A 45 years old woman has been diagnosed with giant cell arteritis (GCA) and is being treated
with steroids. What is the other drug that can be added to this treatment?
A. ACE inhibitors
B. Beta blockers
C. Aspirin

23
D. Interferons
E. IV Ig

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

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

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

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

136. A 34 years old alcoholic is found passed out in front of a local pub. The ambulance crew informs
you that he was sweating when they found him and there were cans of cider lying empty around him.
What is the initial stage of investigation?

A. Capillary blood sugar

B. CT head
C. Magnetic resonance imaging (MRI) head
D. ABG
E. MCV (Mean Corpuscular Volume)

137. A 20 year old man presents with syphilis ulcers. What is the single most appropriate
investigation?
A. PCR for Treponema
B. Swab from lesion
C. Antibody for Treponema pallidium
D. Syphilis Antigen

24
138. An old patient develops urinary retention on a coach journey. He is on Nifidipine and Atenolol
for hypertension and he has nocturnal frequency since last two years? What is the most likely
diagnosis?
A. Prostatic Ca
B. BPH
C. Transitional cell carcinoma
D. Spinal cord compression
E. Trauma

139. A woman with sickle cell disease complains of heavy menstrual blood loss. What is the most
appropriate treatment for her?
A. Combined Oral Contraceptive Pill (COCP)
B. Mirena
C. Depot provera
D. Copper T insertion
E. Transdermal patch

140. A patient is on long standing indwelling catheter and now the catheter bag is turned purple.
Dipstick test shows nitrates –ve, blood+. What investigation would you do next?
A. Urine culture and sensitivity
B. None
C. Urine porphobilinogen
D. USG abdomen

141. A 5 year old boy presents to the outpatient clinic. He has learning difficulties, a large head and
large testicles. He has quite a characteristic facial appearance, with a prominent forehead and large
ears , select the most likely karyotype
A. 47XY(18) B. 47XY(13) C. 47XY(21)
D. 69XXY
E. Fragile X syndrome

142. A 34 years old African-Caribbean man, with a history of Sarcoidosis, has presented with bilateral
kidney stones. What is the most likely cause for this patient’s stones?
A. Hyper calcemia
B. Hyper uricemia
C. Diet
D. Recurrent UTIs
E. Hyperparathyroidism

143. A 25 year old woman presents with a painful shallow ulcer on the vulva. What investigation has
to be done?
A. HSV antibodies
B. Syphilis serology
C. Swab for Haemophilus ducreyi
D. Urine culture
E. Blood culture

144. A 22 year old lady has multiple fibroid with distorted uterus. She also has menorrhagia, she is
forgetful and as a result she does not take pills. What is the most appropriate contraception pill for
her?

25
A. IUCD
B. Diaphragm
C. COCP
D. Implant

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

146. Patient having pansystolic murmur at apex radiating to the axilla on the next day after MI with
low BP. What is the most likely cause?
        A. Ventricular aneurysm
        B. Papillary muscle rupture
        C. VSD
        D. Pericarditis
        E. Aortic stenosis

147. A 23 year old pregnant lady presents with tingling and numbness in her right hand. She has been
bothered by it but lately she has discovered that shaking her hand relieves the symptoms. The
neurosurgeon has offered her a surgical option. What structure would he want to cut ?
A. Common flexor sheath
B. Flexor retinaculum
C. Flexor carpi ulnaris
D. Flexor carpi radialis
E. Extensor retinaculum

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

149. A man after a fall presents to A &E .On examination his tibial and popliteal pulses are absent.
Which artery is most likely to be affected?
A. Femoropopliteal
B. External iliac
C. Aortoiliac
D. Dorsalispedis
E. Internal iliac

150. A 64 year old female presents to the emergency department with sudden loss of vision in her
right eye. There is no history of headache or eye pain. Patient is on anti-hypertensive medications. On
examination the right eye shows no signs of congestion. Visual acuity is 20/200. Red reflex is present.
Ophthalmoscopy shows hyperaemia with numerous flame shaped haemorrhages and increased
tortuosity of the retinal blood vessels. What is the likely diagnosis?

26
A. CRAO
B. Retinal detachment
C. GCA
D. BRAO
E. CRVO

151. A 63 year old man has vague persistent upper abdominal pain. Endoscopy shows columnar
epithelium dipping into muscularis. What is the most probable diagnosis?
A. Adenocarcinoma
B. Peptic ulcer
C. H.Pylori ulcer
D. Gastrinoma

152. A12 year old child is ill. Doctor prescribed treatment. Mother agreed but the child did not agree.
What will you do?
A. Agree with the child
B. Agree with the parent since she is thinking in best interest of the child
C. Send the child for counseling

153. A 60 year old lady has severe chest pain. ECG shows changes of inferior wall MI. ECG also
shows progressive prolongation of PR interval until a P wave is dropped. What is the most probable
diagnosis?
A. Atrial Fibrillation
B. Ventricular tachycardia
C. SupraVentricular tachycardia
D. Mobitz Type I Second Degree heart Block
E. Mobitz Type II Second Degree heart Block

154. A lady came in gynaecology assessment unit with a history of 8 weeks pregnancy and bleeding
per vagina for the last two days. On bimanual examination uterus is 8 week in size. On speculum
examination cervical os is closed. How do you confirm the viability of foetus?
A. Transvaginal USG Scan
B. Serum Β-HCG
C. Urinary B-HCG
D. Abdominal USG Scan
E. Per speculum examination

155. A 50 years old heavy smoker presented with complaints of sudden lower back pain after lifting a
heavy weight; the pain moves down the back of his leg. What is the appropriate treatment for his
condition?
A. Bed rest for 2 weeks
B. Analgesia
C. Immediate surgery
D. Steroids–injections

156. A 65 year old man has haematemesis. Endoscopy shows duodenal ulcer which was infected. He
has a further haematemesis and his BP drops to 100/60mmHg. His Hb 6g/dl, MCH is 25pg, MCH
concentration is 33g/dl, MCV is 85 ft. What is the most appropriate initial management?

27
A. Defer operation and investigate
B. Vit K injection
C. Proceed with planned surgery
D. Immediate blood transfusion stabilization and proceed to surgery

157. A 75 year old man comes in complaining of difficulty in passing urine, poor stream and
dribbling at the end of voiding urine and anorexia. Ultra sonography (USG) shows bilateral hydro-
nephrosis. What is the cause for these findings?
A. Benign prostatic hyperplasia (BPH)
B. Renal stones
C. Bladder stones
D. Prostatic cancer
E. Urinary tract infection

158. A 12 year old boy presents with painful swollen knee after a sudden fall. Which bursa is most
likely to be affected?
A. Semi-membranous bursa
B. Pre-patellar bursa
C. Pretibial bursa
D. Supra-patellar bursa

159. A 27 year old patient met with a RTA. While the NGT is passing, bowel sounds are heard in the
chest. CXR shows NGT curled. What is the diagnosis?
A. Diaphragm rupture
B. Aortic rupture
C. Splenic rupture
D. Bowel rupture
E. Liver rupture

160. 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

161. A 35 year old factory machine operator has been diagnosed with depression and prescribed
fluoxetine. What is the most important precaution to take?
A. Take it after meals
B. Take it empty stomach
C. Take it in the night
D. Take it in the morning
E. Not to combine it with analgesics

162. A child has come after overdosing on his grandma’s pills. He has dilated pupils and extra
systoles. What is the most likely drug taken?
A. Digoxin D. Betablockers
B. Amitriptyline
C. SSRI

28
163. A 6 year old girl has been brought to the hospital after being stung by a bee. She is complaining
of generalized itching, rashes, redness and has developed stridor. What is the most appropriate
treatment?
A. Oral Chlorpheniramine
B. IV Chlorpheniramine
C. IM Adrenaline
D. IV Adrenaline
E. Reassurance

164. Patient had all signs of cerebello-pontine angle (CPA) tumour facial numbness, tinnitus and
vertigo. What is the best investigation?
A. CT scan
B. MRI Brain
C. MRI Head
D. X-ray head

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

166. A patient comes with dyspepsia on H2 receptor blockers now comes with complaints of gradual
dysphagia. On oesophagoscopy, inflammation and mild narrowing of the lower 2/3rd of oesophagus is
seen. What is the most likely diagnosis?
A. Oesophageal Ca
B. Barrets Oesophagus
C. Achalasia Cardia
D. Oesophageal stricture

167. A 75 year old woman from a nursing home is brought to the A/E by her carer who says that
she has been confused for four days. She is on Warfarin for atrial fibrillation. Examination is
unremarkable except for multiple bruises on her body. Blood investigations reveal an INR of 7.3.
What is the most likely diagnosis?
A. Alcohol intoxication
B. Urinary tract infection
C. Subdural haematoma
D. Dementia

168. A 62 year old man with progressive SOB for 6months, now presenting with features of HF. Has
irregular pulse, systolic murmur radiating to the axilla. What is the likely cause of the heart failure?
A. Aortic stenosis
B. ASD
C. Mitral regurgitation
D. Mitral stenosis

169. A 30 year old lady with two months history of abdominal cramps, bloating, blood, mucus in
stool. Most appropriate initial investigation :

29
A. Colonoscopy
B. Fecal occult blood
C. Stool culture and sensitivity
D. Fecal calprotectin

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

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

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

172. A 76 year old man presents with right hemiparesis. CT scan shows an ischaemic stroke and
aspirin 300 mg is commenced. In terms of further management in the acute phase which of the
following values should not be corrected?
A. O2 saturation 94%
B. BP 210/10mmHg
C. Blood glucose 9.4 mmol/L
D. Temp 38.5 C

173. 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?
A. Delusion of persecution
B. Cotard Syndrome
C. Hypnogogic Hallucinations
D. Lilliputian Hallucinations
E. Schizophrenia

30
174. A 61 year male presented with worsening shortness of breath, pulseless, raised JVP bilaterally,
both upper limbs were swollen but lower limbs were normal. What is the investigation of choice?
A. CT contrast thorax
B. CXR- initial shows widened mediastinum
C. MRI Chest

175. A 14 year old girl has collapsed and has been brought to hospital. She has lanugo hair and has
had amenorrhea for past 7 consecutive months. What test should be done immediately?
A. Urea & Electrolytes
B. FBC
C. Urine analysis
D. CT scan
E. No test needed

176. A middle aged lady presented with fever, altered sensorium, bleeding gums and jaundice.
Laboratory results show deranged LFT’s, normal PT/APTT, fragmented RBC’s and low platelets.
What is the likely diagnosis?
A. Cholesterol emboli
B. Hemolytic uremic syndrome
C. Thrombotic thrombocytopenic purpura
D. Hepatorenal syndrome
E. Sepsis

177. A healthy parents have two children, a child with cystic fibrosis and a healthy child. They want
to have another child. What are the chances of that child being a carrier?
A. 1:4
B. 1:2
C. 2:3
D. 1:8
E. 1:16

178. A young girl complains of episodic headaches preceded by fortification spectra. Each episode
last for two to three days. During headache patient prefers quite darkroom.
What is the treatment of choice for acute stage?
A. Paracetamol
B. Aspirin
C. Sumatriptan
D. Gabapentin
E. Cafergot

179. A 50 year old man with a known history of stroke. He cannot remember anything about his life.
What is the single most likely defect?
A. Homonymous hemianopia
B. Homonymous upper quadrantanopia
C. Bitemporal hemianopia
D. Binasal hemianopia
E. Homonymous lower quadrantanopia

180. An expectant mother is planning a water birth at home but would like any injections in the
hospital setup. Her blood group is O negative and the baby's father is of blood group B positive. She
would like to know when does she have to come to the hospital if she needs an Rhesus antiD?

31
A. Not necessary
B. Within 24 hrs
C. Within 72 hrs
D. Within 48hrs
E. After 24 hours

32