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A 65yo man presents w/ painless hematuria, IVU is normal, prostate is mildly enlarged with mild
frequency. What is the most appropriate next step?
a. US Abdomen
b. Flexible cystoscopy
c. MRI
d. Nuclear imaging
e. PSA
A 74yo smoker presented to his GP with cough and SOB. Exam revealed pigmentation of the oral
mucosa and also over the palms and soles. Tests show that he is diabetic and hypokalemic.
What is the most probable dx?
a. Pseudocushing syndrome
b. Conns disease
c. Ectopic ACTH
d. Cushings disease
e. Hypothyroidism
A 44yo 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 90bpm. Her ECG shows sinus rhythm.
What is the most appropriate inv to be done?
a. Thyroid antibodies
b. TFT
c. ECG
d. Echocardiogram
e. Plasma glucose
A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency
and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 1.9 and he is
anemic. His BP is 165/95 mmHg. What is the most probable dx?
a. BPH
b. Prostate carcinoma
c. Chronic pyelonephritis
d. Benign nephrosclerosis
A 64yo man has recently suffered from a MI and is on aspirin, atorvastatin and ramipril. He has
been having trouble sleeping and has been losing weight for the past 4 months. He doesn’t feel
like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and
can’t concentrate on anything. What is the most appropriate tx?
a. Lofepramine
b. Dosulepin
c. Citalopram
d. Fluoxetine
e. Phenelzine
A 67yo man after a stroke, presents with left sided prosis and constricted pupil. He also has loss
of pain and temp on the right side of his body and left side of his face. Which part of the brain is
most likely affected?
a. Frontal cortex
b. Cerebellum
c. Pons
d. Medulla
e. Parietal cortex

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A 60yo man presents with dysphagia and pain on swallowing both solids and liquids. A barium
meal shows gross dilatation of the esophagus with a smooth narrowing at the lower end of the
esophagus. What is the SINGLE most likely cause of dysphagia?
a. Achalasia
b. Myasthenia gravis
c. Esophageal carcinoma
d. Esophageal web
e. Systemic sclerosis
A man undergoes a pneumonectomy. After surgery, invs show hyponatremia. What could be the
cause of the biochemical change?
a. Removal of hormonally active tumor
b. Excess dextrose
c. Excess colloid
d. Excessive K+
e. Hemodilution
A pregnant lady came with pain in her calf muscle with local rise in temp to the antenatal clinic.
What tx should be started?
a. Aspirin
b. LMWH
c. Paracetamol
d. Cocodamol
e. Aspirin and heparin
A 53yo female presents with an acute painful hot knee joint. She is a known case of RA. On
examination, the knee is red, tender and swollen. The hamstring muscles are in spasm. Her
temp is 38.5C and BP is 120/80mmHg. What is the SINGLE best next inv?
a. Joint aspiration for cytology and culture and sensitivity
b. Joint aspiration for positive birefrengent crystals
c. Joint aspiration for negative birefrengent crystals
d. Blood culture
e. Serum uric acid
An 80yo man presented with pain in his lower back and hip. He also complains of wakin g up in
the night to go to the washroom and has urgency as well as dribbling. What is the most likely dx?
a. BPH
b. Prostatitis
c. UTI
d. Prostate carcinoma
e. Bladder carcinoma
An 18yo female has peri-orbital blisters. Some of them are crusted, others secreting pinkish fluid.
What is the most likely dx?
a. Shingles
b. Chicken pox
c. Varicella
d. Rubella
e. Measles
A 29yo lady who is a bank manager is referred by the GP to the medical OPC due to a long hx of
tiredness and pain in the joints. An autoimmune screen result showed smooth mu scle
antibodies positive. What is the most appropriate next inv?
a. ECG

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b. TFT
c. LFT
d. Serum glucose
e. Jejunal biopsy
A 5yo with recurrent chest pain, finger clubbing with offensive stool. Choose the single most
likely inv?
a. Endomyseal/Alpha glidin antibody
b. Sweat test
c. Barium meal
d. ECG
e. Glucose tolerance test
A clinical picture of breast cancer originated from the mammary duct. Biopsy was done ad there
were neoplastic cells found. Choose the histological picture of the cancer.
a. Neoplastic cells are arranged in small clusters occupying a space between collagen
bundles (Seirrhous carcinoma)
b. Spindle cell neoplasms with margins, which infiltrate adjacent structure, fat invaded
(Breast sarcoma)
c. Small cells with round nucleus and scant indistinct cytoplasm (Lobular carcinoma)
A 22yo man has a reduced conscious level and a fixed dilated pupil after being involved in a MVC.
Choose the single most appropriate option?
a. Facial nerve
b. Oculomotor nerve
c. Olfactory nerve
d. Optic nerve
e. Trigeminal nerve
A man with suspected active TB wants to be treated at home. What should be done to prevent
the spread of disease?
a. Immediate start of the tx with Anti-TB drugs
b. All family members should be immediately vaccinated with BCG vaccine
c. Patient should be isolated in a negative pressure chamber in his house
d. Universal prevention application protocol
A 7yo child is brought to the ED with a 1 day hx of being listless. On examination, the child is
drowsy with an extensive non-blanching rash. What advice would you give the parents?
a. All family members need antibiotic therapy
b. Only the mother should be given rifampicin prophylaxis
c. All family members need isolation
d. All family members should be given rifampicin prophylaxis
A 47yo man has a temp of 39C and is delirious. He has developed blisters mainly on his trunk,
which appeared a few hours ago. He is well and not on any medications. He last travelled 5
months ago to Italy. Which of the following is the most likely dx?
a. Shingles
b. Chicken pox
c. Pemphigoid
d. Bullous pemphigus
A 64yo pt has been having freq episodes of secretory diarrhea, which is extremely watery, with
large amts of mucus. A dx of villous adenoma was made after endoscopy. What electrolyte
abnormality is most likely in this pt?
a. Hyperkalemia

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b. Hypernatremia
c. Hyponatremia
d. Hypokalemia
e. Hypercalcemia
A pt with an acute gout attack came to the ED. What drug should be given to relieve symptoms?
a. NSAIDs
b. Allopurinol
c. Ibuprofen
A pt was lying down on the operating table in a position with his arms 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
b. Median nerve
c. Ulnar nerve
d. Axillary nerve
e. Suprascapular nerve
A pt who was previously on 120mg slow release oral morphine has had his dose increased to
200mg. He is still in significant pain. He complains of drowsiness and constipation. What is the
next step in the management?
a. Increase slow release morphine dose
b. Fentanyl patch
c. Replace morphine with oral hydromorphone
d. Replace morphine with oxycodone
e. Subcutaneous morphine
A 40yo woman notices increasing lower abdominal distention with little/no pain. On
examination, a lobulated cystic mass is felt and it seems to be arising from the pelvis. What is
the most appropriate inv?
a. CA 125
b. CA 153
c. CA 199
d. CEA
e. AFP
A resident of a 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 dx with scabies. What the best tx for
his condition?
a. 0.5% permethrin
b. Doxycycline
c. 5% permethrin
d. Reassure
e. Acyclovir
A 34yo 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 inv?
a. Capillary blood sugar
b. CT head
c. MRI head

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d. ABG
e. MCV
A young boy fell on his outstretched hand and has presented with pain around the elbow. He
has absent radial pulse on the affected hand. What is the most likely dx?
a. Dislocated elbow
b. Angulated supracondylar fx
c. Undisplaced fx of radial head
d. Posterior dislocation of shoulder
A 65yo woman presented with transient arm and leg weakness as well as a sudden loss of vision
in the left eye. Her symptoms resolved within the next couple of hours. What is the most
appropriate next inv?
a. CT brain
b. Echo
c. Doppler USG
d. Arteriography
e. 24h ECG
A man complains of loss of sensation in his 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
A young man complains of double vision on seeing to the right. Which nerve is most likely to be
involved?
a. Left abducens
b. Right abducens
c. Left trochlear
d. Right trochlear
e. Right oculomotor
A 45yo man keeps having intrusive thoughts about having dirt under the bed. He can’t keep
himself from thinking about these thoughts. If he tries to resist, he starts having palpitations.
What is the most likely dx?
a. OC personality
b. OCD
c. Schizophrenia
d. Panic disorder
e. Phobia
A 33yo 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
A pt with cerebral mets has polyuria and polydipsia. What part of the brain would be affected?
a. Cerebral cortex
b. Cerebellum
c. Diencephalon

Mammary duct fistula A young male whose sclera was noted to be yellow by his coll eagues has a hx of taking OTC drugs for some pain. What is the most likely dx? a. Skull XR b. The GCS on initial evaluation is 15. HUS A 45yo female complains of pain in the inner side of her right thigh.34. Erotomania b. Iliohypogastric nerve d. The provocation test . Trichotillomania e. Tests showed raised bilirubin. d. Facial XR c. Which nerve is responsible for this pain? a. 35. She feels well but has had recurrent chest infections recently. 40. 39. Medulla A 32yo man presented with painless hematuria. Numerous blast cells A lady presents with itching around the breast and greenish foul smelling discharge from the nipple. MRI e. Duct papilloma b. Periductal mastitis e. 37. Obturator nerve c. Ca bladder c. Femoral nerve b. Pudendal nerve A 37yo lady strongly believes that a famous politician has been sending her flowers every day and is in love with her. Polycystic kidneys b. 36. Atypical lymphocytes b. Multiple immature granulocytes with blast cells e. Grandiosity A 3yo child has been brought with facial lacerations. Observation A 73yo woman has lymphadenopathy and splenomegaly. What is the most likely dx? a. What is the most likely dx? a. 38. What is the appropriate next inv? a. Pyromania c. Pons e. this is not the case. Plasma cells d. She had a similar episode before. ALT and AST normal. CT scan d. Excess of mature lymphocytes c. Duct ectasia c. He is hypertensive but the rest of the exam is unremarkable. Choose the single most likely blood film findings? a. She was dx with benign ovarian mass on the right. On examination he has some cuts over his right cheek and under the eye. TTP e. Breast abscess d. Kleptomania d. Ca prostate d. However. Ovarian branch of splanchic nerve e.

Pneumothorax A 50yo pt is admitted for elective herniorraphy. Chest is bilaterally clear with muffled heart sounds. Hemothorax e. Superficial inguinal LN . elevated liver enzymes and hemolysis. Acute fatty liver of pregnancy b. Cholecystitis d. High serum Na. Acute pyelonephritis c. IV dextrose d. low urine osmolarity e. high urine osmolarity b. HELLP syndrome e. What is the most likely dx? a. Drug hypersensitivity c. His creatinine is 350umol/L and his urea is 15mmol/L. Abdominal distention A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with sudden onset of epigastric pain associated with nausea and vomiting. low serum osmolarity. 46. IV KCl e. 44. low platelets. High serum Na. high serum osmolarity. Pericardial effusion d. Hgb 12g/dl d. What is the most likely dx? a. What is the most likely dx? a. Her blood results show mild anemia. What is the most imp step in the management of this patient? a. Pain relief A 74yo man who has been a smoker since he was 20 has recently been dx with SCLC. Low serum Na. Pain around hernia e. MI 2 months ago c. What is the lymphatic drainage of this area? a. Cardiac tamponade c. with IV nicotinic acid is positive and produces further rise in the serum bilirubin levels. Pulmonary embolism b. high urine osmolarity d. 43. Acute hepatitis A woman comes with an ulcerated lesion 3 cm in the labia majorum. low serum osmolarity. low urine osmolarity A man brought into the ED after being stabbed in the chest. What serum electrolyte picture will confirm the presence of SIADH? a. Acute pancreatitis A 24yo biker has been rescued after being trapped under rocks for almost 12h. External iliac b. low serum osmolarity.7C. Acute hepatitis b. Low serum Na. High serum Na. Which of the following options will lead to a postponement of the operation? a. 42. Pulse is 120bpm. He complains of reddish brown urine. Dialysis b. JVP raised. high serum osmolarity. SBP <90mmHg b. 45. high urine osmolarity c. BP is 60/nil.41. Gilberts syndrome d. Her temp is 36. IV NS c. Exam: she is found to have RUQ tenderness.

MRI A 79yo stumbled and sustained a minor head injury 2 weeks ago. What is the most probable dx? a. Chicken pox d. He has a GCS of 13. 52. Embolism e. Cellulitis A 5yo girl had earache and some yellowish foul smelling discharge. USG Abdomen c. Para-aortic d. Subarachnoid hemorrhage A 25yo female complains of intermittent pain in her fingers. She wears gloves whenever she leaves the house. A deficiency of which vitamin can lead to teratogenic effects in the child? a. Herpes zoster c. What is the most diagnostic inv? a. Epidural hemorrhage d. 49. Buerger’s disease d. c. perforation at the attic and conductive hearing loss. Folic acid b. 48. Extradural hemorrhage b. She came to the hospital with complaints of fever and painful vesicles in her left hear. He has become increasingly confused. ERCP b. Congenital cholesteatoma e. Takayasu arteritis c. Subdural hemorrhage e. He takes warfarin for Afib. 51. What is the most appropriate dx? a. fever and dark urine. Iliac e. Insect bite e. drowsy and unsteady. CT Scan d. MRCP e. OM with effusion c. Acquired cholesteatoma d. Vit B12 c. Cerebellar hemorrhage c. Raynaud’s phenomenon A 22yo lady has been unwell for some time. Acute OM b. Kawasaki disease b. Aortic A man post-cholecystectomy presented with jaundice. What is the most probable dx? a. Pyridoxine . She has no past hx of any ear infections. Otitis externa A female with T1DM would like to know about an deficiency of vitamins in pregnancy that can be harmful. Thiamine d. She describes episodes of numbness and burning of the fingers. Riboflavin e. What is the most likely dx? a. 50.47. Acne b.

What is your next step towards management? a.2C. Methadone e. Joint position sense is impaired at her left great toe but is normal elsewhere. Start antibiotics A 62yo woman complains of unsteadiness when walking. Disulfiram A 16m child presents with drooling. De Quervain’s tenosynovitis A 6m child presents with fever and cough. What is the likely cause? a. 24h BP monitoring e. Tachycardia A 33yo drug addict wants to quit. Direct pharynoscopy b. 55. His mother has rushed him to the ED asking for help. Midline mid-thoracic cord . On examination she has pyramidal weakness of her left lower limb and reduced pain and temp sensation on right leg and right side of trunk up to the umbilicus. 58. ECG b. He has fever with a temp of 38. Usually occurs after prolonged tx e. She has a definite left extensor plantar response and the right plantar response is equivocal. Call ENT surgeon c. Benzodiazepines b. Prv CIN A 35yo man with a hx of schizophrenia is brought to the ER by his friends due to drowsiness. Echo c. Dx? a. His activities have been reduced lately which he attributes to old age. She says she is ready to stop the drug abuse. A 23yo woman has been having pain at the base of her thumb. 24h ECG monitoring d. 54. Call anesthesiologist d. Pyrexia c. He has a systolic murmur on examination. 59. Asthma c. Diazipoxide c. Elevated creatinine kinase d. What drug tx would you give her? a. She is supported by her friends and family.53. What is the definitive diagnostic inv that will assist you with his condition? a. He recovered fully within 30 mins with BP 110/80 mmHg and regular pulse of 70bpm. Bronchitis A 75yo man collapsed while walking in his garden. A dx of neuroleptic malignant syndrome except: a. IV fuilds e. 56. 57. Where is the lesion? a. Left cervical cord b. Exam: temp=39C and the child is feeding poorly. On examination he is generally rigid. the pain is reproduced when lifting her 3 month old baby or changing diapers and also with forceful abduction of the thumb against resistance. sore throat and loss of voice. Lithium d. Avascular necrosis of scaphoid b. Bronchiolitis b. Trigger finger c. Renal failure b.

There is past hx of retro-sternal discomfort and he has been treated with prokinetics and H2 blockers. the pt complains that the increased morphine makes him drowsy and his is unable to carry out his daily activities. Mid meningeal artery c. What is the likely dx? a. What is the most likely dx? a. Right mid-thoracic cord d. What is the next step in his management? . MI c. Left mid-thoracic cord e. Mid cerebral artery d. Pneumothorax A pt with hepatocellular ca has raised levels of ferritin. Herpes zoster A 32yo man presented with slow progressive dysphagia. What is the most probable cause? a. A1 antitrypsin def c. Ant cerebral artery f. Esophageal Ca A 56yo man comes with hx of right sided weakness & left sided visual loss. He doesn’t have any past med hx. 64. Ant meningeal artery b. 61. which on examination shows a perforated nasal septum. Pulmonary embolism b. Pleural effusion e. Ant communicating artery A young college student is found in his dorm unconscious. CO poisoning A 56yo pt whose pain was relieved by oral Morphine. now presents with progressively worsening pain relieved by increasing the dose of oral morphine. Peptic stricture e. Marijuana OD b. c. Cystic fibrosis A woman has electric pains in her face that start with the jaw and move upwards. 65. GCA e.60. Pharyngeal puch d. What is the probably dx? a. However. Where is the occlusion? a. Asthma d. Left lumbo-sacral plexus A 26yo man present to ED with increasing SOB on left side and chest pain. Atypical face pain b. 63. Cocaine OD c. He also seems to be bleeding from his nose. Plummer vinson syndrome c. 66. Tempero-mandibular joint dysfunction d. Foreign body b. Hemochromatosis b. Carotid artery e. What is the most likely dx? a. He has tachyarrhythmia and high fever. He has been a heavy smoker for the past 4 years. Alcohol OD e. Heroin OD d. 62. Trigeminal neuralgia c. Her corneal reflexes are normal.

Exam: confused and tired. The man is tall. Thyroid swelling An 18yo man is rushed into the ER by his friends who left him immediately before they could be interviewed by staff.67. Nephrostomy In CRF. Suprapubic catheter c. Liver transplantation A 75yo alcoholic presents with a mass up to umbilicus. 25 alpha hydroxylation of Vit D . Urethral catheter b. Parotitis c. firm testes. CT of pituitary b. Examination of the testes reveals bilateral small. IV Fentanyl e. Bilirubin=4umol/L. Refer to psychologist c. a. He is noted to have needle track marks on his arms and his pupils are small. Inv after 24h: normal CBC. incontinence. Condom catheter e. and clothes smelling of ammonia. He states that the swelling has been treated with antibiotics for infection in the past. Chromosomal analysis c. Observation for another 24h b. 71. Diamorphine A 30yo man presents with a 5cm neck mass anterior to the sternocleido-mastoid muscle on the left side in its upper third.1. Oral oxycodone b. PT=17s. has bilateral gynecomastia. 68. ABG = pH7. RR=8/min. Branchial cyst b. She was brought into the ED after ingestion of 24 paracetamol tablets. Oral tramadol c. What is the next step in management? a. main cause of Vit D deficiency is the failure of: a. Semen analysis An 18yo female just received her A-Level results and she didn’t get into the university of her choice. PCA d. pulse=60bpm. What is the next step in manageme nt? a. 72. Which of the following inv is most helpful in dx? a. Discharge with psychiatry referral e. urinary dribbling. Give N-Acetylcysteine d. Antibiotics d. BP=120/70mmHg. creatinine=83umol/L. Initial management has been done. He is semiconscious. Vit D absorption in intestines b. What is the single best initial tx? a. Measure of serum testosterone e. Naloxone c. Pharyngeal pouch d. Measure of serum gonadotropins d. Gastric lavage A 30yo man and wife present to the reproductive endocrine clinic because of infertility. 70. What’s the most likely cause? a. Thyroglossal cyst e. 69. Methadone d. Insulin b.

Corticosteroid c. Sarcoidosis d. 1 single injection DTP d. Proliferative diabetic retinopathy e. 1 alpha hydroxylation of Vit D e. US Abdomen b. Only Ig e. Full course of DTP b. Rectal exam e. Bronchial asthma b. He gave a hx of polyarthralgia with painful lesions on the shin. Pelvic US d. 77. but he has never been immunized as his parents were worried about it. Chronic diarrhea secretions . Hypertensive retinopathy c. Availability of Vit D precursors Pt with puffiness of face and rash showing cotton wool spots on fundoscopy. Cystic fibrosis c. He feels hot and sweaty but has normal temp. What’s the most likely dx? a. Serum amylase e. 78.73. Antibiotic A 65yo HTN man presents with lower abdominal pain and back pain. What single medication is likely to cause this visual deterioration? a. CXR: bilateral hilar lymphadenopathy. Excess Vit D loss in urine d. Diabetic background d. Theophylline A woman who returned from abroad after 3 weeks of holiday complains of severe diarrhea of 3 weeks. Macular degeneration b. 74. Laparascopy b. There is no contraindication to immunization. KUB XR c. ERCP c. 79. what is the best management? a. What is the most appropriate next inv? a. c. What’s the dx? a. B2 agonist b. What is the single most discriminating inv? a. Abdominal US A 55yo man has had severe pain in the right hypochondrium for 24h. The pain comes in waves and is accompanied by nausea. She also developed IDA and folic acid def. Pneumonia A child presents with clean wound. Jejunal villous atrophy b. 76. Bronchiectasis e. SLE A 35yo man presents with progressive breathlessness. What condition best describes her situation? a. MRCP d. UGI endoscopy A 67yo man has deteriorating vision in his left eye. Diuretic d. He has longstanding COPD and is on multiple drug therapy. 1 single injection DT c. 75. An expansive abdominal mass is palpated lateral and superior to the umbilicus. Nothing seems to relieve the pain.

81. Ceftriaxone e. Hypersensitivity reaction d. What other medication do you want to add? a. What is the most likely cause of hoarseness? a. 84. What is the single most likely dx? a. What is the most appropriate empirical antibiotic to be started? a. What is the drug of choice for him? a. 85.80. Thought withdrawal e. Lymphedema b. 86. Laryngeal candidiasis b. 82. She develops arm swelling after being stung by a bee. Fluid retention A 34yo pt presents with 50% partial thickness burns. Cellulitis c. Citalopram b. neck stiffness and a fever of 38. Vancomycin b. Reference A 10yo girl presents with hoarseness of the voice. c. Laryngeal edema d.4C. IV dextrose stat e. Diazepam A man presented with cellulitis and swelling. Thought insertion c. Increased catabolism e. ECT d. Ludwigs angina A lady with breast cancer has undergone axillary LN clearance. She is a known case of bronchial asthma and has been on oral steroids for a while. IV fluids calculated from the time of hospital arrival b. IV fluids calculated from the time of burn c. What is the most likely mechanism responsible for the swelling? a. Lofepramine c. Allergic drug reaction e. Metronidazole d. headache. He has hx of MI and is suffering from insomnia. DVT e. Infective tonsillitis c. Burns ointment A 54yo man has recently been dx with moderate depression. Haloperidol e. Penicillin c. Malabsorption d. He was started on flucloxacillin. Amoxicillin A 24yo college student presents with nausea. He thinks that people are putting ideas into his head. Thought broadcasting d. What should be the most appropriate management? a. Ceftriaxone . 83. Increased secretions of acid A 35yo male is bitterly annoyed with people around him. Thought block b. No IVF d. vomiting.

What will be the most likely location of the collection? a. Pediatrician c. Citalopram b. Pelvic cavity e. MRI e. His HbA1c was high and he has been skipping meals recently. Blood culture c. Penicillin c. He has been unhappy at school. Which single member of the clinical team would you refer him to next? a. Desensitization A man has reducible bulge below the pubic tubercle. Which of the following contraception method will be affected by azithromycin? a. US shows a collection in the peritoneum. Radioactive thyroid scan A 45yo man with posterior gastric ulcer presented with severe excruciating pain which subsided after conservative treatment. 10 days later he developed swinging pyrexia. Spigelian . Barrier b. What is the next inv to ascertain the cause of HF? a. CT b.87. Hepatorenal puch b. 90. 92. She has recently started contraception to avoid conception. He doesn’t feel like reading the news or watching movies as he believes there is violence everywhere. 88. Dietician d. What is the most appropriate first line therapy? a. and on occlusion of the deep inguinal ring. IUCD c. She has got a new boyfriend for the last 2 months. What is the most likely dx? a. Meropenem A man with prosthetic heart valve underwent hemicolectomy and after some days complains of left hypochondriac pain. Direct inguinal b. CBT d. fever and has a systolic murmur. Indirect inguinal c. COCP An 11yo boy is being checked by the diabetic specialist nurse. Gentamicin d. Lofepramine c. Subphrenic d. 89. Left paracolic gutter c. POP d. 91. cough impulse is present. Chlordiazepoxide e. b. Femoral d. ECG d. Lesser sac A 23yo lady was prescribed with azithromycin 1gm for her chlamydial pelvic infection. Tazobactam e. GP b. Clinical psychologist A 35yo man who has served in the army presents with lack of interest in enjoyable activities and feeling low.

93. Lumbar A 48yo woman is admitted to ED with a productive cough and moderate fever. Renal biopsy e. CT b. IVU b. 97. Urine analysis A young man is brought to the ED after a RTA. What is the most diagnostic inv? a.5 months which affects both food and drink. SAH b. She feels nauseated. What is the most appropriate next step that will lead to the dx? a. Hiatus hernia c. What is the most likely dx? a. CT d. Hyperkalemia d. US Abdomen c. These symptoms have been present for the last 3. Bulbar palsy d. Cystoscopy b. Cystoscopy d. Secure airway A 65yo man presented with frank hematuria. What is the most likely dx? a. MRI c. Cluster headache e. A dx of BPH was made after a transrectal US guided biopsy and the pt was prepared for a TURP. 94. Achalasia e. A CXR shows an air-fluid level behind a normal sized heart. What electrolyte abnormality is highly likely due to this surgery? a. IV fluids d. USG c. Transrectal US . but doesn’t vomit. His GCS on initial evaluation is 6. Skull XR e. She has often central chest pain and regurgitation of undigested food most times but doesn’t suffer from acid reflux. Hypernatremia A 56yo lady has developed severe right sided headache which worsens whenever she comes to bright light since the last 4 days. Migraine d. He also had difficulty in initiating micturition and complains of dribbling. 98. What ist he most appropriate next step? a. TB A 64yo man has been waking up in the middle of the night to go to the bathroom. Subdural headache A 35yo man presented with hematuria. Hypocalcemia c. abdominal swelling and has a BP of 190/140. e. Pharyngeal pouch b. Hypokalemia b. Hyponatremia e. 96. 95. Brain tumor c. Mid-stream urine for culture e. He has no other urinary symptoms.

A 30yo woman had a gradual decrease of visual acuity since the last 3 years. 101. 104. His mother says she was afraid he was going to die. She came to the hospital 2h ago after her water broke. Uterine infection A 50yo man has had anterior resection of the rectum for carcinoma. Third stage e. Ondansetron oral . Retained product d. P. and that he had a similar episode 3 months prior after falling down some steps. unconscious and rigid. What stage of labour is she in? a. She has regular contractions. Choose the single most likely predisposing factor for PPH for this pt? a.99. Latent stage d. None e. First stage c. IM morphine d. He expressed concerns about control of post-op pain in discussions with the anaesthetist before surgery. The midwife is looking at her now. Oral diclofenac b.V exam revealed 2cm dilated cervix. Active phase A 2yo boy fell off his tricycle and hurt his arm. What is the best management strategy? a. Glaucoma b. Retained product b. Cervical/vaginal trauma c. Fibroid uterus d. CBC d. What’s the dx? a. he went pale. Vital signs are normal. Skeletal survey A 29yo woman had just delivered a still born vaginally. Second stage b. 102. but before there was any sound. 103. EEG c. 100. After an hour he was back to normal. IM dihydrocodeine e. Atonic uterus b. DIC c. He recovered after 1-2 mins but remained pale. Preterm labor e. Cataract c. Choose the single most likely predisposing factor for developing PPH in this lady? a. He got up to start crying. Macular degeneration d. Large placental site A 28yo woman has delivered with rotational forceps after an 8h labor and 3h second stage. Oral codeine c. What single inv is indicated? a. Keratitis A 27yo lady has had an uncomplicated pregnancy so far. Retinitis pigmentosa e. Uterine infection e. Now she has a disability due to very low vision. following a major placental abruption. CT head b.

He has had recurrent infections over the last year. TOF b. Upper GI endoscopy b. HUS b. Mature lymphocytes 106. Membranous GN d. Gastroscopy c. Choose the single most likely inv? a. Granulocyte without blast cells b. US d. CT abdomen 108. What is the probable dx? a. Sciatic nerve b. What is the most likely dx? a. Plasma cells d. CoA 107. MRI 111. Losartan b. VSD d. Bisoprolol e. Minimal change GN e.Pylori antibodies are negative. Urea breath test b. Which of the following anti-HTN cause this symptoms? a. No improvement is seen after 1m of tx. A 33yo male involved in a street fight presents with bruises and deformity in the upper part of his leg. Myelofibroblasts c. A 73yo male presents with enlarged cervical nodes. A 15yo male has bilateral ankle edema. She is found to have irregularly irregular pulse and loud P2 with fixed splitting and ejection systolic murmur in left 2nd ICS. Gluteal nerve c. Choose the single cell type you will find on the blood fi lm. Barium meal c. Femoral nerve 110. His conjunctiva is pale. Bendroflumethiazide c. Colonoscopy e. Mother noticed some of the vomitus is blood stained. Nephrotic syndrome . a. Tibial nerve f.105. ASD c. A 5m baby present with recurrent vomiting. XR shows fx of the neck of fibula. PDA e. He suffers from pain and redness at the MTP joint of his right big toe. His BP=110/70mmHg and urinalysis shows protein++++. What is the next step? a. Musculocutaneous nerve d. IgA nephropathy c. A 45yo lady has 10m hx of SOB. H. CT d. A 35yo man presents with hx of dyspepsia. A 76yo is treated with HTN. Verapamil 109. Lateral peroneal nerve e. Ramipril d. What is the single most associated nerve injury? a.

ABO incompatibility . Histamine 113. IV antihistamine c. Mitral valve stenosis 114. Cardiac arrhythmia 116. What is the most likely dx? a. Pulmonary stenosis e. Mitral valve prolapse d. Ischemic mitral regurgitation c. A 72yo man has been advised to have antibiotic prophylaxis for some years now before dental tx. Oral antihistamine b.112. She is otherwise well. A 4wk girl has been dx of having breast milk jaundice. Macrocytes b. His PMH shows he had childhood asthma. The rash is becoming increasingly itchy. What is the most appropriate tx? a. Granulocytes wthout blast cells d. He has never experienced chest pain. Exam: angular stomatitis. IM adrenaline d. Increase fluid intake d. What is the single most appropriate management? a. G6PD c. raised rash on trunk after playing football. Bronchospasm e. Blast cells 115. Phototherapy e. A 37yo woman presents with fatigue. Stop breastfeeding 117. Aortic regurgitation b. Continue breastfeeding b. A 12yo girl when playing in the garden accidentally stepped on a hive and was bitten several times. Oral ciprofloxacin e. What is the most probable dx? a. Oral amoxicillin c. Anaphylactic shock c. She has numerous wheals on her body and complains of severe itching. Hereditary spherocytosis b. Amnesia b. Apnea d. What is the single most likely serious side effect? a. a. What is the single most appropriate management? a. Three weeks ago. A 4yo boy with a febrile convulsion lasting eight minutes has been given IV lorazepam to control them. Oral chlorpheneraime b. he noticed breathlessness on exertion and for one week he had orthopnea. Microcytes c. no koilonychea. A term baby born to a 30yo woman of blood group A-ve develops severe jaundice within the first 24h of birth. Choose the single cell type you will find on the blood film. A 28yo man has developed a red. Nebulized salbutamol e. IM adrenaline d. Exchange transfusion c. His pulse is normal. Reassurance 118.

What is the most probable dx? a. 120. VSD d. Fragile X syndrome b. TOF b. Prader-willi syndrome c. Haloperidol A 35yo male builder presented with sudden onset of severe abdominal pain. ASD c. What is the most appropriate inv likely to review the cause this deterioration? a. Chlordiazepoxide b. Osteosarcoma b. US e. Septic arthritis c. d. 123. Exam: clubbing. TOF b. central cyanosis. He can walk but has a limp. He has developed mild fever in the 2nd day. XR abdomen b. CoA An 8yo child who is tall for his age and has a refractory error for which he wears glasses has presented with severe crushing chest pain. What is the most probable dx? a. 121. What is the most likely dx? a. 125. Disulfiram e. 124. systolic thrill with systolic ejection murmur in 2 nd left ICS. Physiological jaundice A 4yo girl is found to have bounding pulse and continuous machinery murmur. What is the most probable dx? a. ataxic gait.119. CT d. He is given acamprosate. PDA e. Exploratory laparoscopy c. hallucinations and loss of memory. Diazepam d. What other drug can you give with this? a. 122. DiGeorge syndrome d. Osteomyelitis A man with anterior resection and end to end anastomosis done complains of severe pain in the chest and abdominal distension. PDA e. He was previously fit and well other than taking ibuprofen for a long term knee injury. CoA A 12yo child with episodes of sudden bluish discoloration and brief loss of consciousness. Laparotomy Pt with hx of alcoholism. Rh incompatibility e. On examination he is in . VSD d. Marfans syndrome A 4yo child presents with pain of spontaneous onset in his knee of 2 days duration. ASD c. Thiamine c. Exam: painful restriction in the right hip. Exostosis e. TB arthritis d.

Anal hematoma b. Fibroid uterus e. choose the single most likely predisposing factor for postpartum hemorrhage? a. Anal abscess d. Rassurance b. Quetiapine d. External laryngeal nerve injury e.126. Perforated peptic ulcer A woman 5 days post-op for bilateral salphingo-oopherectomy and abdominal hysterectomy has developed abdominal pain and vomiting a/w abdominal distension and can’t pass gas. Relaxation therapy c. although well hydrated. What is the most appropriate next step? a. XR abdomen b. What is the most likely dx? a. Protalgia fugax e. Extrinsic allergic alveolitis . Barium enema A 30yo man complains of hoarseness of voice. Hemorrhoids A 20yo student attends the OPD with complaint of breathlessness on and off. Anal fissure c. 130. severe pain. Atonic uterus b. USG e. No bowel sounds heard. while the family slept. Pancreatic necrosis d. What is the most likely dx? a. Fluoxetine A 22yo woman with longstanding constipation has severe ano-rectal pain on defecation. 128. CT d. Rectal exam: impossible due to pain and spasm. Rupture uterus d. What is the most probable dx? a. Hematoma c. Exam: tachypnea. hyperresonant percussion and wheezing on auscultation. 131. pulse=110bpm. Ischemic colon c. Exam: unilateral immobile vocal cord. His sleep is disturbed and skin is very dry in flexural areas of the body. Tracheomalacia A 38yo woman has delivered after an induced labor which lasted 26h. BP=110/70mmHg and has a rigid abdomen. Unilateral recurrent laryngeal nerve injury d. What is the single best tx? a. 129. Cervical/vaginal trauma c. Exploratory laparoscopy c. Age of mother A 32yo woman in tears describing constant irritability with her 2 small children and inability to relax. What is the most probable dx? a. Biliary peritonitis b. Perforated diverticulum e. 127. Lofepramine e. Graves disease b. cough and sputum. She describes herself as easily startled with poor sleep and disturbed nightmares following a house fire a year ago.

Choose the single most likely predisposing factor for PPH? a. ECG shows an irregular rhythm and HR=140bpm. XR showed fx of the head of radius. Cervical smear (2nd line) c. Musculocutaneous nerve c. Median nerve d. 134. What is the single most associated nerve injury? a. ACEi c. >50% A 67yo man presents with palpitations. Vaginal US f. 40-50% e. Antibiotics (1st line) e. 137. Psychodynamic therapy b. Upon vaginal exam. Radial nerve b. Refer to dermatology e.132. Primary PPH A 37yo man slipped while he was walking home and fell on his out stretched hand. 133. COPD e. Uterine infection d. pulse=130bpm. 135. He complains of pain in the right arm. Colposcopy d. she was fine except for finding of cervical ectropion which was painless but mild contact bleeding on touch. Endometrial ablation b. 136. Digoxin . Pack with gauze and leave to dry A 32yo had a normal vaginal delivery 10 days ago. Reassure A 25yo woman presented to her GP on a routine check up. What % of circulatory blood did he lose? a. He bled so much that the towel was soaked in blood and BP=80/50mmHg. DIC c. b. <15% b. He is otherwise stable. BP=124/80mmHg. Von Willebrand disease e. What is the best management? a. Retained product b. What is the next management? a. Wegener’s granulomatosis d. Ramipril d. 15-30% c. Asthma c. Antipsychotics d. Ulnar nerve A butcher stabbed accidently his groin. CBT c. Her uterus has involuted normally. What is the most appropriate management? a. Bisoprolol b. 30-40% d. Cystic fibrosis A pt with thought disorder washes hands 6x each time he uses the toilet.

Coagulase –ve cocci 140. He has been neglecting himself. fever. Gram +ve diplococcic b. His son found him in a miserable state when he went to visit. Coagulase +ve cocci c. Anti-endomysial antibodies c. What is the most probable dx? a. LFT d. What is the appropriate management? a. frothy and difficult to flush. Rheumatic mitral valve stenosis 141. Thromboangitis Obliterans b. Ischemic mitral regurgitation c. Embolus 143. Mitral valve prolapse d. What is the most probable cause? a. A 78yo man is depressed after his wife’s death. Rheumatic mitral valve stenosis 142. What is the most probable dx? a. Pulmonary stenosis e. normal transaminase. Atherosclerosis e. Aortic regurgitation b. Sweat chloride test b. An old alcoholic presents with cough. She has a normal CBC. A 3yo child who looks wasted on examination has a hx of diarrhea on and off. The son can’t deal with his father. The mother describes the stool as bulky. bilateral cavitating consolidation. A 60yo lady who had stroke 3 years ago now reports having increased dyspnea on exertion and atrial fibrillation. A 67yo man had successful thrombolysis for an inf MI 1 month ago and was discharged after 5days. Send pt to care home 139. He is now readmitted with pulmonary edema. Sciatica c. US abdomen e. What is the single inv most likely to lead to dx? a. AFB e. What is the most appropriate inv? . A 60yo diabetic complains of pain in thigh and gluteal region on walking up the stairs for the last 6 months. Hand over to social worker c. serum ALP is raised. Aortic regurgitation b. CXR: straight left border on the cardiac silhouette. What is the most appropriate dx? a. She is a heavy smoker and has ischemic heart disease. A 45yo woman has had severe epigastric and right hypochondrial pain for a few hours. Ischemic mitral regurgitation c. Voluntary admission to psychiatry ward b. DVT d. Gram –ve cocci d. Request son to move in with father d. 3 months ago she had a cholecystectomy done. Pulmonary stenosis e. Mitral valve prolapse d. TFT 144.138.

25ml PO adrenaline c. Upper GI endoscopy A 53yo woman presented with pain in the eye. 149.9. MRI brain e. NAI b. ITP c. She got stridor. 150. you collectively decide on a procedure that wouldn’t require open surgery or GA. He is not sure why his GP suggested he should come to the ED and is keen to get some tablets and go home. Renal biopsy: remarkable for podocyte fusion on EM. 146. a. 0. blurry vision and clumsiness for 3 months. Hysterectomy c. Exam: spleen approaching RIF. What is the most likely dx? a. swelling around eyes. Choose the single cell type? a. What is the most probable dx? a. ERCP c. wheeze and erythematous rash. Visual evoked response test A 55yo male presents with malaise and tiredness. CSF analysis b. EEG c. Septicemia A 41yo woman who has completed her family. CBC: WBC=25. Myelodysplastic disease c.25ml IM adrenaline d. Endometrial ablation b. 0. Her paul brunnel test +ve. Fibroid resection d. After discussion. Sickle cell c. No medical tx has worked. Trauma d. a. CT abdomen e. no lymphadenopathy. Plt=45. HSP .25ml IM adrenaline b.145. US abdomen b. Uterine artery embolization A girl with hx of allergies visited a friend’s farm. Granulocyte without blast cells d. Select the most appropriate management for this case. 147. Blast cells A 6yo pt comes with easy bruising in different places when she falls. 0. What is the most appropriate tx? a. IV chlorphearamine A 5yo boy is referred to the hospital and seen with his father who is worried that he has been listless. MRCP d. Helmet shaped cell b. Hgb=10. EMG d. Myomectomy e. She has a hx of difficulty in swallowing and weakness in her right upper limb 2y ago. has suffered from extremely heavy periods for many years. What is the inv of choice? a. NAI e. 148. Exam: tired and irritable. She admits that she would rather avoid open surgery. Glandular fever b.

156. What is the most appropriate next step? a. What is the most probable dx? . blue in color and can be compressed. What’s the single cell type? a. 155. Cerebellar infarct c. Pons e. Exam: cold extremities with lack of hair around the ankles. Anti-emetic d. Hemothorax e. His neck veins are dilated and his heart sounds are faint. Reassurance A 12yo pt presents with copious diarrhea. What is the most appropriate dx? a. Fluid replacement e. 154. 153.151. Pleural effusion A 44yo pt comes with right hemiparesis. Analgesia b. Minimal change GN A 6yo boy is brought to the hospital for a 3rd episode of sore throat in 1 month. skin turgor=low. Midbrain A 50yo man has a stab wound to his left anterior chest at the level of the 4 th ICS. Antibiotic c. His trachea is central. d. Diaphragmatic rupture c. Medulla oblongata d. Mature lymphocytes A 23yo man has been stabbed in the back and has SOB. Microcytes c. he has engorged neck veins and absent breath sounds on the right. Blast cells e. mucous membrane=dry. Exam: left sided ptosis and left dilated pupil. Cardiac tamponade b. Immediate surgery e. He is found bleeding from gums and nose and has pale conjunctiva. What is the most appropriate initial management? a. 152. Granulocyte without blast cells d. Tension pneumothorax e. Clumped platelets b. Traumatic rupture of aorta A 15yo boy has a soft painless swelling in the left scrotum. Reassurance A 60yo smoker presents with cramp-like pain in the calves relived by rest and non-healing ulcers. Where is the lesion? a. Cerebral infarct b. Antibiotic b. The trache a is not deviated. Biopsy d. 157. Membranous GN e. Tension pneumothorax b. absent distal pulses. Antimotility c. Exam: urine output=low. He has a BP 80mmHg. Cardiac tamponade c. Simple pneumothorax d. Fractured ribs d. pulse=130bpm. What is the most appropriate dx? a.

161. Tibial nerve e. On presentation his is breathless. What is the most appropriate initial action in this pt? a. Rectal examination and flexible sigmoidoscopy are normal. Sjogren’s syndrome A 25yo had an LSCS 24h ago for fetal distress. which required manual removal in the OT. Rectal carcinoma d. C1 esterase deficiency b. XR=fx of femur neck. Aspiration pneumonitis c. Intermittent claudication b. DVT e. Analgesia c. 160. 162. The midwife tells you that she had a retained placenta. Endometritis d. Observations: O2 sat=98% in air. Antibiotics b. Exam: radio-femoral delay. Sciatic nerve b. HIV c. O2 by mask d. Mumps d. Buerger’s disease d. What is the most likely dx? a. cold legs with weak pulse and mild systolic murmur with normal S1S2. Piles A 78yo male. 159. Chronic ischemia of the limbs c. DM and HTN. a.8C. Retained POC b. Lateral peroneal nerve d. What is the most probable dx? a. temp=37. has chest pain and fx of 5-7th rib. TOF b. pulse=84bpm. Choose the most appropriate C-Section complication in this case? a. Anal hematoma b. DIC A 30yo woman has brief episodes of severe shooting pain in the rectum. She now complains of intermittent vaginal bleeding. Gluteal nerve c. had a fall and since then is unable to walk. CXR confirms this. Physiotherapy e. ASD . What is the most probable dx? a. 163. Femoral nerve A 20yo man has a head on collision in a car. DM An otherwise healthy 13yo boy presents with recurrent episodes of facial and tongue swelling and abdominal pain. BP=124/82mmHg. Proctalgia fugax e. Uterine rupture e. Sarcoidosis e. What is the single most associated nerve injury? a. Anal fissure c. He presents with deformity and tenderness over the right hip area. His father has had similar episodes. Refer to surgeon A 28yo man with complains of headache and nose bleeds also has pain in the lower limbs on exertion.158.

166. Non-urgent referral to ophthalmologist e. Urticaria c. Nothing can be done A 2m baby who has ambiguous genitalia presents to the ED with vomiting. 170. Laser therapy d. HR=99bpm. Uremia b. His GCS is 12. Mitral regurgitation c. Fragile X syndrome b. resp stridor and involuntary spasm of the upper extremities. PE e. MI b. Labs: Na+=125mmol/L. What is the most appropriate inv for his condition? a. Tricuspid regurgitation e. Primary biliary cirrhosis A 75yo lady who had mitral valve replacement 13 yrs ago has developed recurrent breathlessness. 169. paraesthesia. 168. CoA A 23yo male has a tonic clonic seizure whilst at college. BP=120/77mmHg. What is the next step in management? a. Aortic regurgitation b. Atopic eczema e. What is the most probable dx? a. The GPs report says he suffered from T2DM and BMI=35. CT b. PDA e. Renal failure A 38yo pt presented with tingling. HF d. Ophthalmoscopy showed dot and blot hemorrhage + hard exudate and multiple cotton wool spots. Reassurance and annual screening only b. Thes e can last up to an hour. Pulmonary stenosis A 45yo T1DM had an annual check up. What is the most likely dx? a. 167. MRI c. 165. VSD d. K+=6mmol/L. Congenital adrenal hyperplasia A 40yo man collapsed at home and died. c. She complains of abdominal pain and ankle swelling. Serum blood glucose d. Mitral stenosis d. What is the most probable dx? a. What is the most likely dx? . numbness. There are numerous wheals of all sizes on his skin particularly after he has scratched it. What is the most likely cause of death? a. DM c. Turners syndrome c.164. Her husband has noticed prominent pulsation in her neck. Urgent referral to ophthalmologist c. Serum drug levels A 20yo man complains of recent onset of itching which followed a viral infection. Noonan syndrome d. Psychogenic itching d. She has undergone surgery for thyroid carcinoma a week ago.

Hematoma c. What is the most likely dx? a. What is the most appropriate management? a. Choose the single most likely predisposing factor for PPH from the options? a. 174. CBC: Hgb=12. What is the most likely dx? a. CXR >6ribs seen above the diaphragm in midclavicular line. Unilateral recurrent laryngeal nerve injury d. His urinalysis reveals protein +++. Wegener’s granulomatosis c. Neutrophils=0. HR=92bpm. Labs: CBC=increase in PCV.1. Interstitial lung disease b. IgA nephropathy b. PSGN e. Sputum. 172. Broad spectrum antibiotics PO c. WBC=1. Isolate pt . Retained POC d. What is the most likely dx? a. Hyperparathyroidism c. ABG=pO2 decreased. Ca bronchi d. External laryngeal nerve injury e. Cervical/vaginal trauma c. Hypocalcemia A 50yo chronic smoker came to OPD with complaint of chronic productive cough. Unilateral recurrent laryngeal nerve injury d. Temp=37. Plt=89. IV benzylpenicillin b. SOB and wheeze. eGFR =110. Reassure and send home A 25yo woman with T1DM has delivered a baby weighing 4. Broad spectrum antibiotics IV b.171. GCSF d. 175. Chest exam = few coarse crepitations in the right base.5kg. 176. He has a cough with some green sputum but feels well. COPD e. 173. Her uterus is well contracted. Membranous nephropathy c. Thyroid storm b. The pat had longstanding goiter for which he had the surgery. Rupture uterus A 23yo lady presents with headache. Atonic uterus b.6. urine and blood culture sent to microbiology. Minimal change disease d. Lupus nephritis A 72yo man is receiving chemotherapy for SCLC.5g/dL. Large placental site e. He has his 4th tx 8 days ago. Amyloidosis A 44yo pt has sudden onset of breathlessness and stridor few minutes after extubation for thyroidectomy. What must be done immediately? a. Exam: photophobia and generalized rash that doesn’t blanch on pressure. a. Thyroid storm b. Postpone tx until bacteriology results available e. External laryngeal nerve injury e. Tracheomalacia A 15yo boy presents with generalized edema.6C.

She has a pulse=108bpm. Partial complex seizure A middle aged Asian presents with episodes of fever with rigors and chills for last 1y. Fragile X syndrome c. 180. Blood film: ring form plasmodium with schaffners dots in RBCs. temp 37. Ceftriaxone IV c. Absence seizures c. Uterine rupture An 8m infant presented with FTT and constipation. Unilateral recurrent laryngeal nerve injury d. 181. Congenital hypothyroidism . Quinine e. Choose the most appropriate CS complication for this lady? a. She has had 1 prv LSCS for a breech baby. 179. What is the drug to eradicate this infection? a. What is the most likely dx? a.8C. Exam: lower abdomen is exquisitely tender. Praderwilli syndrome d. 182. Chest physiotherapy e. Gown and mask d. DiGeorge syndrome e. BP=100/42mmHg. UTI c. Urinary tract injury d. Doxycycline b. Blood culture A 4yo baby has generalized tonic-clonic seizure and fever of 39C. 178. External laryngeal nerve injury e. Mefloquine c. Cefuroxime PO b. She attributes this to the thyroid surgery she underwent a few months back. Chlorpheniramine PO d. Reassure A 20yo pop star singer complains of inability to raise the pitch of her voice. Endometritis b. Exam: large tongue and fam hx of prolonged neonatal jaundice. What is the most likely dx? a. Bilateral recurrent laryngeal nerve injury c. now showing reduced variability and late deceleration develops with slow recovery. Proguanil d. There are signs of reduced air entry at the right base but the CXR doesn’t show an obvious abnormality. temp=37. What is the most likely dx? a. Downs syndrome b. Epilepsy d.177. Febrile convulsion b. his mother informs you that this has happened 3-4x before. CTG=prv normal.2C and saturation=99%. Pleurisy e. c. What is the most appropriate management strategy? a. Artesonate A 35yo woman had an uneventful lap chole 18h ago. Thyroid cyst A 28yo woman at 39wk gestation is in labor. Thyroid storm b. She develops abdominal pain and HR=125bpm.

As part of the inv a CXR has been performed. He seems to be sweating and muttering some incomprehensible words. What is the most imp next step? a.183. pulse=88bpm. CT b. Apical granuloma b. A 3m infant has presented with recurrent infections. MRI c. Human Ig only b. Marfans syndrome 184. He has abnormal facies and CXR shows absent thymic shadow. flat occiput. Doxycycline oral c. A 32yo previously healthy woman has developed pain and swelling of both knees and ankles with nodular rash over her shins. Bilateral hilar lymphadenopathy c. What is the single most appropriate management? a. A man presents with scrotal swelling. A young footballer has collapsed during a game. What will you do for him now? a. Full course of tetanus vaccine only d. What is the most likely dx? a. DiGeorge syndrome d. Human Ig and TT c. Body temp . During initial evaluation: RR=14/min. Turner’s syndrome d. Blood sugar d. A 30yo man presents with deep penetrating knife wound. the swelling is cystic and is non-tender. What is the most likely dx? a. Penicillin oral b. What is the most likely dx? a. Oral antihistamine d. Reticular shadowing in the bases 186. BP=110/70mmHg. Exam: low set ears. Teratoma e. What is the single most likely CXR appearance? a. He said he had TT when he left school. Downs syndrome b. DiGeorge syndrome 187. Fragile X syndrome c. Reassurance 188. Testicular ca c. Fragile X syndrome c. Human Ig and full course of tetanus vaccine e. It is located in the upper pole of the posterior part of the testis. Antibiotic 185. A neonate’s CXR shows double bubble sign. Lobar consolidation d. Epididymal cyst b. Testicular torsion 189. Oral ciprofloxacin e. Pleural effusion e. Downs syndrome b. Hydrocele d. A 19yo boy complains of itching on the site of insect bite.

A 37yo female had a fall with outstretched hand. What is the single most associated nerve injury? a. T-cells b. She also complains of post-coital ache. Choose the single most appropriate initial inv? a. N-acetylcystine d. Ulnar nerve 192. The dx cells of Hodgkin disease are: a. A 16yo girl is admitted after taking a paracetamol OD 4 h ago. Median nerve e. Serum plasma paracetamol e. Cervical smear b. PID b. What should be the tx option for her? a. PID b. Axillary nerve b. Fibroids e. Refer to medical ward c. High vaginal swab . IV fluids 190.e. Select the most likely cause leading to her symptoms? a. Vocabulary consists of only 2 meaningless words d. R-S cells c. Radial nerve c. She has consumed lare amounts of alcohol. Recently she noticed a brown vaginal discharge. Endometritiosis c. B-cells d. Her plasma paracetamol conc is just below the conc that would suggest tx. A 45yo waitress complains of pelvic pain which worsens pre -menstrually and on standing and walking. Adenomyosis d. Select the most likely cause leading to her symptoms? a. Asherman syndrome 194. A 35yo lady who has been using IUCD for one year now complains of pelvic pain and heavy painful periods. Shies away from strangers b. Musculocutaneous nerve d. Adenomyosis e. Refer to psychiatry ward b. Pelvic congestion syndrome d. Auer rods 195. Endometriosis c. She had regular withdrawal bleeds until 3 yrs ago and since then has been taking a no bleed prep. Premature ovarian failure 191. None 193. Macrophages e. Can walk but not run c. A mother comes with her 15m child. A 64yo woman has been on HRT for 9yrs. She can’t make a sentence e. presented with dinner fork deformity and tenderness over the right arm. Which of the following will bother you? a. No further investigation 196.

Tracheomalacia A 33yo man is hit by a car. dark room. Thyroid storm b. Olanzepin A 5yo child resents with fever. SAH b. There is blood oozing from the drain. ALL b. Hgb=7. Exam: waddling gait. CLL c. CML e. constipation and decreased serum K+. He has been dx with PTSD.7. What is the most likely dx? a. Transvaginal US e. AML d. Gabapentin e. 201. What is the dx? a. 198. he has been suffering from nightmares and avoided driving on the motorway. He loses consciousness but is found to be fine by the paramedics. 202. Aspirin c. 199. cyanosed in the the RR. Paracetamol b. Each episode last for 2-3 days. Dosalepin e. Subdural hemorrhage c. On exam: orchidomegaly & splenomegaly. 203. Intracerebral hemorrhage d. Diazepam c.1. Primary hemorrhage e. What is the dx? a. Sumatriptan d. He looks pale. 200. Labs: WBC=1. Reactionary hemorrhage c. Extradural hemorrhage A 77yo male presents with hx of enuresis and change in behavior. CBT b. Pyloric stenosis . TFT d. Normal pressure hydrocephalus d. Plt=44. His parents say he always feels tired. Endometrial sampling A young girl complains of episodic headaches preceded by fortification spectra. c. Brain tumor c. Cafergot A 60yo pt recovering from a surgery for toxic goiter is found to be hypotensive. When awaiting doctors review in the ED he suddenly becomes comatose. Subdural hemorrhage b. During headache pt prefers quiet. What is the most likely dx? a. What is the most likely dx? a. Exam: tense neck. What is the tx of choice for acute stage? a. Psychotic depression A 29yo teacher is involved in a tragic RTA.197. What is the most appropriate management? a. Hodgkins A 6wk child is brought in with vomiting. Secondary hemorrhage d. Citalopram d. After that incident.

205. He feels well. She tells you that taking alcohol initially helped her relieve her symptoms but now this effect is wearing off and she has her symptoms even after drinking alcohol. ADHD d. OCD d. BP = 140/90mmHg. His parents say that he can’t do a particular task for a long time. 207. blood ++ and serum creatinine=106mmol/L. Diuretics b. which spread to the muscles of wrist and elbow. Her symptoms last for a few minutes and are very hard to control. Urine dipstick: protein ++. Rebreath into a paper bag d. Achalasia cardia e. This causes many troubles at home. b. Panic disorder b. Tracheo-esophageal fistula A 17 yo girl had an episode of seizure. What is the likely pathology? a. Alcohol addiction e. Propranolol e. CD . Dyslexia c. Diazepam c. Antisocial personality disorder e. He sometimes hurts himself and breaks many things. A urethral catheter showed f ecal leakage in the urinary bag. Contraction of muscles started from around the interphalangeal joints. Choose possible type of seizure? a. ACEi b. ASD b. Steroids A 23 yo girl presented with perioral paresthesia and carpopedal spasm 20 mins after a huge argument with her boyfriend. Absent A 46yo man. She also complains of palpitations and tremors. Longterm antibiotics e. Hirschsprung disease d. Tonic clonic c. Duodenal atresia c. Depression c. She is afebrile and complains that she passed air bubbles during urination. GAD A 2yo child is very naughty.204. What is the next step for this pt? a. 206. Myoclonic d. Oppositional defiant A 79 yo lady who is otherwise well recently started abdominal pain. Which medication can prevent the progression of this dx? a. Cytotoxic meds d. 208. SSRI b. Diuretics c. Grand mal b. 209. Alprazolam A 25 yo woman has been feeling anxious and nervous for the last few months. What is the dx? a. His teacher complains that he is easily distracted. known case of chronic GN presents to OPD. What is the dx? a.

UC A 2 month child with diarrhea and vomiting for 6 days is brought in looking lethargic. which factor can increase this risk further? a. CXR e. Alcohol dependence b. CBC d. Agoraphobia e. Pseudo-dementia e.210. Which one can be the reason for the tremor? a. 214. Smoking d. Lithium b. Lap Cholecystectomy b. Court involvement A 71 yo man presents with coarse tremor. AXR A 72 yo man fell while shopping and hurt his knee. 211. which high suicidal risk. Pelvic fx is confirmed. TIA d. SSRI c. What is the most probable dx? . abdominal cramps and mouth ulcers. What is the most probable dx? a. Haloperidol A young woman complains of diarrhea. Large bowel perforation e. What is the most appropriate management? a. Diazepam c. 215. Random blood sugar c. Rectosigmoid tumor d. 212. Imipramine e. IV furosemide e. BUE b. Vascular demetia c. Low fat diet d. 216. IV fluids d. He has multiple injuries. He has not passed urine in the last 4 hrs. Emergency laparotomy In a man who is neglected and alcohol dependent. He speaks in a low voice and is very slow to give answers. Inv show a big gallstone. Ursodeoxycholic acid e. What is the next appropriate management for this pt? a. c. Reassure c. AXR shows distended transverse colon with globet cell depletion on rectal biopsy. His vitals are fine. Picks dementia A 47 yo man met with a RTA. He is on some meds. Insulin A 49 yo pt presents with right hypochondriac pain. Fluoxetine d. Urethral catheter b. Suprapubic catheter c. 213. Alzheimers b. What is the appropriate initial inv? a.

What’s the dx? a. Trachea-esophageal fistula e. PTSD c. 219. What is he suffering from? a. Mania b. Bowel obstruction e. 220. Inv has been done and 7mm stone was found in the ureter. What is the most appropriate next step? a. Depression b. 221. a. Depression c. Skull XR d. Blood culture A 2 yo pt presents with colicky pain which radiates from loin to groin. Exploratory surgery d. Antibiotics A 47 yo ex-soldier suffers from low mood and anxiety. ESWL A footballer has been struck in the groin by a kick and a presents with severe pain and mild swelling in the scrotum. LP e. He complains of similar episodes in the past. vomiting and nausea. Ureterscopy or laser d. She goes out almost every night with her friends. She believes that she knows better than her friends.217. a child began to cough and went blue. Percutaneous nephrolithiotomy b. Bowel Ca d. Open surgery c. Achalasia cardia A 70 yo man presents with balance difficulties. so she should choose the restaurant for eating out. Panic attack d. Agoraphobia e. He can’t forget the images he faces before and has always had flashbacks. 218. He is not able to watch the news because there are usually some reports about war. CD b. Bipolar affective disorder . IV fluids e. GAD A 36 yo woman has recently spent a lot of money on buying cl othes. What is the most appropriate management? a. She gave hx of having low mood at 12 yo. What is the dx? a. Conservative tx e. The mother also noticed that there were swollen patches on the skin. Cyanotic heart disease d. USG b. UC c. CT cerebellum c. Doppler c. Aspiration of food c. IBS After eating a cookie at a garden party. MRI cerebellum b. 222. Allergic reaction b. Which of the following is the best inv? a.

She is so distressed and constantly says her boyfriend is going to end the relationship. GE d. Corticosteroids b. 224. What is the most likely dx? a. d. Ameoba b. She was also noticed to have bruises on her arms. Borderline personality disorder . Colon Ca c. His serum K+ = 7. IV calcium gluconate c. Alzheimers b. IV insulin + dextrose d. She complains of abdominal discomfort and passing stool 20x/day. Urgent hemodialysis b. runny nose and bark-like cough. What is the next step in management? a. MRI head d. She denies trying to end her life. 227. XR skull A 25 yo woman was brought to the ED by her boyfriend. CT brain c. Exam=febrile. Delirium c. Admission for observation b. Intubation under GA A 78yo lady on warfarin for atrial fibrillation lives in a care home. 226. No abnormal neurological signs. IV NS 0. What is the most appropriate tx for this child? a. Psychotic depression d. 225. Exam: normal pulse & BP. Furosemide e. Acute psychosis b. Pick’s dementia A 28 yo drug user presents to the ED with collapse and anuria. CD e. CXR = early pulmonary edema. Subdural hemorrhage d. IV antibiotics e. She is brought to the hospital where she is found to be conscious and completely alert. Borderline personality disorder e. INR = 7. Severe depression c.223. Adrenaline nebulizer d. UC A child is brought in with high grade fever. Barium enema shows cobblestone mucosa. She has many superficial lacerations on her forearm.9% A 32 yo woman suffers an episode of severe occipital headache with vomiting and loss of consciousness. What is the next appropriate management? a. Dysthymia A 28 yo female presents with a 3m hx of diarrhea. Reassurance and discharge e. What is the most likely dx? a. 228. What is the most probable dx? a. Vascular dementia e. He is also drooling.5mmol/L. She presents with hx of progressive confusion for three days. Paracetamol c.

She has not showed up at work. The mother also noticed that there were swollen patches on the skin.e. Pontine hemorrhage b. Subarachnoid hemorrhage 233. A woman brought her husband saying she wants the ‘thing’ on his forehead removed. FFP b. What should she be given? a. Nebulized epinephrine 232. no other signs. A 63 yo female is noted to have left pupil irresponsive to light and is dilated. Usually she spends a lot of time cleaning it. She used to work showing an excellent performance at the office. has some insomnia and feels tired and without energy. Whole blood d. Now she says she’s feeling down. She is worried about her weight. but not it’s a mess. She says when she closes her eyes. What is the most probably dx? a. and she thinks she may be fat. Binge eating disorder d. What is the most probably dx? a. What drug has been used? a. she says her boyfriend is angry because her apartment is a chaos. Steroids c. A lady comes in severe liver disease and hematemesis. She has been on a diet and lost 7 kgs in the last 2 months on purpose. Anorexia nervosa b. Vit K 231. On exam: BMI=23. She even received compliments from her boss. LSD c. She liked it to be perfect. Assess his mental capacity to refuse tx . A 28yo business exec presents at the GP asking for some help because she has been arguing with her boyfriend frequently. A young woman was brought to the hospital. OTC antihistamine b. She thinks this is weird because she used to be extremely productive. Subdural hemorrhage c. How. Bipolar disease c. Schizophrenia 234. What is the next most appropriate next step? a. She complains about her low mood. she can see colors. even upto 3 AM. Hyperthyroidism e. What is the initial management? a. She is eating less. Bronchodilators d. Cocaine d. a child began to cough and went blue. The husband is refusing tx saying it improves his thinking. After eating a cookie at a garden party. Heroine e. Her INR is >10. On exam she has low temperature and tremor. She can’t be fired. Epinephrine IM e. Oxygen c. Schizophrenia 229. Cerebellar hemorrhage d. Extradural hemorrhage e. IV fluids e. Amphetamines b. Ecstasy 230. She is worried because recently she got a loan to buy a luxury car. She used to do a lot of exercise.

Can’t sit independently but can hold her hand and sit when propped up against pillows. 239. What is the most probable dx? a. Delayed speech c. Achondrogenesis e. What is the next most appropriate inv? a. Delayed motor development A 27 yo woman has hit her neck in an RTA without complains of tingling or motor loss. Borderline personality disorder b. what type of cell would be found in abdundance in the marrow smear? a. What is the most likely dx? . Mini-mental state exam e.9mmol/L and ALP = 127u/L. He has 2 boys but doesn’t contact them. What is the dx? a. 236. Schizophrenia c. short stature and heart murmur. 241. 240.235. BMA is done. b. XR c. Bence-jones protein d. Megakaryocytes e. Antisocial behavior disorder A 60 yo man has a pathological rib fx. She denies suicide. Dwarfism A 5month child can’t speak but makes sounds. She can hold things with palm. Delayed sitting d. Histrionic personality disorder e. Severe depression e. Diagonal XR A young female who has many superficial lacerations was brought into the ED by her boyfriend for superficially lashing her upper arm. CT cervical d. Schizophrenia A 22yo woman was brought by her boyfriend with multiple superficial lacerations. Hypopituitarism c. 237. Obsessive f. Labs: Ca2+ = 3. Myeloid cell c. not fingers. There are scars of old cuts on her forearms. Refer to ED d. Borderline personality c. MRI b. Osteogenesis imperfect b. 238. Reticulocytes A child presents with blue marks on the sclera. Refuse surgery and send pt back A 37 yo man who has many convictions and has been imprisoned many times has a hx of many unsuccessful relationships. She is distressed because he wants to end the relationship. Normal b. He also complains of recurrent infection. How’s the childs development? a. Plasma cell b. Bipolar b. Avoidant personality disorder d. VSD d. Acute psychosis d. What is the dx? a. She is adamant and screaming that she is not suicidal but scared her boyfriend wants to leave her. Remove lesion c.

245. Compression with palm of one hand c. 243. On probing further. Cyclothymia A 56yo woman is known case of pernicious anemia. a. Index and middle finger compression b. Where is the discharge coming from? a. CSF b. Schizophrenia d. The child had not eaten since morning b. OCD b. Advise them about infant CPR. Alcoholic dementia . Inner ear c. Severe depression d. He usually drives to work. 247. The child’s body became rigid and then started to jerk A man has discharge from his left ear after a fight. GAD c. He always thinks when the traffic lights change. Outer ear d. Compression with rescue breaths 30:2 e. Psychotic depression A 31yo single man lives with his mother. She asks for oral medication. you decide that it was most probably an absence seizure. Schizoid personality e. The child started moving his fingers uncontrollably before he fell d. The parents are worried that if something like this happens in the future. What is the dx? a. What led you to this dx? a. The child suddenly went blank and there was up-rolling of eyes c. Amiodarone c. Thiazide A 74yo man presents with weakness in his arm and leg from which he recovered within a few days and short term memory loss. his mother is calling him. Lithium e. how they are to deal. Bipolar e. Intrinsic factor def b. Why will oral meds be not effective? a. Choose the single most likely cause? a. He has an exterior plantar response. Compression with rescue breaths 15:2 A teacher brings in a child who says she fell down after hitting a table. so he drives back home. Lack of gastric acidity An 11m baby had an apnea event. Verapamil b. Ranitidine d. His GP had started him on anti-HTNs. Acute psychosis b. 248. Irritated gastric mucosa d. What is the most appropriate dx? a. 244. a. Compression with palm of two hands d. He has similar episodes 2 years ago and became unable to identify objects and to make proper judgment. Malabsorption c.242. Borderline personality disorder c. Brain A 40 yo manic depressive is noted to have high serum levels of lithium and profound hypokalemia. She refuses to take hydroxycobalamin IM as she is needle shy. 246.

250. Measles b. Primary Tcell immunodeficiency d. SSRI c. She is unable to conc on her work and takes longer than before to finish tasks as she must constantly was her hands. Iron def c. headache. What is the likely condition of this child? a. What is the most appropriate management? a. What is the most likely dx? a. 254. Pick’s dementia c. Labs: MCV=108fL. He was worried that he has HIV infection. After a few months. Alzheimer’s disease e. Roseola infectiosum c. What is the dx? . He complains of fatigue. What is the most probable dx? a. b. 3 HIV tests were done and all the results are negative. 252. Folate def d. ABG b. DKA An obese mother suffers from OSAS. Polysomnography d. Malabsorption A 3yo child has a high temp for 4 days and he had not seen a doctor. 255. She also says that he is not growing well for this age. Rubella d. Anemia of chronic disease A 7yo is brought by his mother who says that he was well at birth but has been suffering from repeated chest and GI infections since then. Hemolytic anemia e. There is no significant PMH. Delirium b. Vascular dementia A nurse comes to you saying that she has recently developed the habit of washing her hands after every 15-20 mins. Overnight pulse-oximetry c. he comes back again and claims that he has HIV. Alzheimers d. SCID c. and heart racing.249. Desensitization A 61yo man underwent a surgery in which ileal resection had been done. Hgb=8. Antipsychotics e. Impetigo A 70yo lady presents with fever for 3d and confusion. CF b. 253. Then mother notices rashes on buccal mucosa and some around the mouth. ECT d.9g/dL. Primary Bcell immunodeficiency e. Hypoglycemia c. EEG A 28yo business man came to the sexual clinic. 251. Which of the following inv is best for her? a. Huntington’s disease d. CBT b. What is the most appropriate dx? a. Chicken pox e. Vit B12 def b.

Mancheusens d. tiredness. TOF A 29yo woman who was dx to have migraine presents with severe onset of occipital headache. What is the most likely dx? a. LP d.256. AML c. ECT A 57yo man presents with weight loss. MRI c. Schizophrenia A 6wk child presents with progressive cyanosis. 257. 258. a. CML b. Somatization b. There is no murmur at discharge. What is the most appropriate condition? a. Antidepressant e. ASD b. Hypomania A 35yo female attempts suicide 10x. CLL d. What is the most likely dx? a. Hypochondriac c. 259. What is the most appropriate management? a. Marked depression c. She lost her consciousness. Polycythemia A baby born at 34 weeks with a heart murmur is kept in the incubator for almost 4 weeks. AML e. What is the likely cause of this murmur? a. PDA b. Exam: spleen palpable up to the umbilicus. VSD c. No inv required A 19yo man has been happier and more positive than usual. tachypnea over the first 2 wks of life and holosystolic murmur. CT=normal. poor feeding. OCD e.7. Labs: WBC=127. Hgb=8. Plt=138. XR e. CBT c. Bipolar syndrome d. Antipsychotic d. 261. with more energy than he has ever felt before for no particular reason. Repeat CT b. He has been getting more work done at the office today and has been socializing with his friends as usual. TOF c. Tricuspid atresia d. What is the best tx? a. Problem focused tx b. Aorto-pulmonary septal defect . fever and abdominal discomfort. 260. Atypical depression b. Aneurysm of sinus of Valsalva d. Psychosis e. PDA e. There is no hx of psychiatric problems and all neurological exams are normal. Neurological exam=normal.

e. AVM
262. A 6yo girl who has previously been well presented with a hx of tonic-clonic seizures lasting
4mins. Her mother brought her to the hospital and she appeared well. She is afebrile and didn’t
lose consciousness during the episode of seizure. She has no neurologic deficit. What is the most
appropriate inv for her?
a. ABG
b. Serum electrolytes
c. ECG
d. Blood glucose
263. A 60yo woman was found by her son. She was confused and had urinary incontinence. She has
recovered fully after 6h with no neurological complaints. What is the most likely dx?
a. Stroke
b. Vestibular insufficiency
c. TIA
d. Intracranial hemorrhage
264. A 34yo woman presents 3 weeks after childbirth. She has had very low mood and has been
suffering from lack of sleep. She also has thought of harming her little baby. What is the most
appropriate management for this pt?
a. ECT
b. CBT
c. IV haloperidol
d. Paroxethine
e. Amitryptiline
265. A 65yo woman presents with headache. She also complains of dizziness and tinnitus. He has
recently realized she has visual problems. There is hx of burning sensation in fingers and toes.
On exam: splenomegaly, itchy after hot bath. Labs: RBC=87, Hgb=31.9, Plt=796. What is the dx?
a. CML
b. CLL
c. Polycythemia vera
d. Myelofibrosis
e. NHL
266.
A 29yo male brought to ED in conscious state. There is no significant past hx. Which of the
following should be done as the initial inv?
a. CT
b. Blood glucose
c. ABG
d. MRI
e. CBC
267.
A 45yo woman comes with red, swollen and exudating ulcer on the nipple and areola of right
breast with palpable lump under the ulcer. What do you think is causing this skin condition?
a. Inflammatory cells releasing cytokines
b. Infiltration of the lymphatics by the carcinomatous cells
c. Infiltration of the malignant skin cells to the breast tissue
268. A 20yo young lady comes to the GP for advice regarding cervical ca. she is worried as her mother
past away because of this. She would like to know what is the best method of contraception in
her case?
a. POP
b. Barrier method

269.

270.

271.

272.

273.

274.

c. IUCD
d. COCP
e. IUS
A 66yo man, an hour after hemicolectomy has an urine output of 40ml. However, an hour after
that, no urine seemed to be draining from the catheter. What is the most appropriate next step?
a. IV fluids
b. Blood transfusion
c. Dialysis
d. IV furosemide
e. Check catheter
A 24yo pt presented with anaphylactic shock. What would be the dose of adrenaline?
a. 0.5ml of 1:1000
b. 0.5ml of 1:10000
c. 1ml of 1:500
d. 5ml of 1:1000
e. 0.05ml of 1:100
A 44yo woman complains of heavy bleeding per vagina. Transvaginal US was done and normal.
Which of the following would be the most appropriate inv for her?
a. Hysterectomy
b. Endometrial biopsy
c. CBC
d. High vaginal swab
e. Coagulation profile
A 60yo woman presented to OPD with dysphagia. No hx of weight loss of heartburn. No change
in bowel habits. While doing endoscopy there is some difficulty passing through the LES, but no
other abnormality is noted. What is the single most useful inv?
a. CXR
b. MRI
c. Esophageal biopsy
d. Esophageal manometry
e. Abdominal XR
A 24yo woman presents with deep dyspareunia and severe pain in every cycle. What is the
initial inv?
a. Laparoscopy
b. Pelvic US
c. Hysteroscopy
d. Vaginal Swab
A 38yo woman, 10d postpartum presents to the GP with hx of passing blood clots per vagina
since yesterday. Exam: BP=90/40mmhg, pulse=110bpm, temp=38C, uterus tender on palpation
and fundus 2cm above umbilicus, blood clots +++. Choose the single most likely dx/
a. Abruption of placenta 2nd to pre-eclampsia
b. Concealed hemorrhage
c. Primary PPH
d. Secondary PPH
e. Retained placenta
f. Scabies

275. A 32yo female with 3 prv 1st trimester miscarriages is dx with antiphospholipid syndrome. Anticardiolipin antibodies +ve. She is now 18wks pregnant. What would be the most appropriate
management?
a. Aspirin
b. Aspirin & warfarin
c. Aspirin & heparin
d. Heparin only
e. Warfarin only
276. A 23yo presents with vomiting, nausea and dizziness. She says her menstrual period has been
delayed 4 weeks as she was stressed recently. There are no symptoms present. What is the next
appropriate management?
a. Refer to OP psychiatry
b. Refer to OP ENT
c. CT brain
d. Dipstick for B-hCG
e. MRI brain
277. A 16yo girl came to the sexual clinic. She complains of painful and heavy bleeding. She says she
doesn’t a regular cycle. What is the most appropriate management?
a. Mini pill
b. Combined pill
c. IUS
d. Anti-prostoglandins
e. Anti-fibrinolytics
278. A 36yo man walks into a bank and demands money claiming he owns the bank. On being denied,
he goes to the police station to report this. What kind of delusions is he suffering from?
a. Delusion of reference
b. Delusion of control
c. Delusion of guilt
d. Delusion of persecution
e. Delusion of grandeur
279. Which method of contraception can cause the risk of ectopic pregnancy?
a. COCP
b. IUCD
c. Mirena
d. POP
280. A woman has pernicious anemia. She has been prescribed parenteral vitamin B12 tx but she is
needle phobic. Why is oral tx not preferred for this pt?
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
281. An old man comes to the doctor complaining that a part of this body is rotten and he wants it
removed. What is the most likely dx?
a. Guilt
b. Hypochondriasis
c. Munchausen’s
d. Nihilism

e. Capras syndrome
282. A 31yo woman who is 32weeks pregnant attends the antenatal clinic. Labs: Hgb=10.7, MCV=91.
What is the most appropriate management for this pt?
a. Folate supplement
b. Ferrous sulphate 200mg/d PO
c. Iron dextran
d. No tx req
283. A 47yo man who is a chronic alcoholic with established liver damage, has been brought to the
hospital after an episode of heavy drinking. His is not able to walk straight and is complaining of
double vision and is shouting obscenities and expletives. What is the most likely dx?
a. Korsakoff psychosis
b. Delirium tremens
c. Wernickes encephalopathy
d. Tourettes syndrome
e. Alcohol dependence
284. A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with
sudden onset of epigastric pain a/w nausea and vomiting. Temp 36.7C. Exam: RUQ tenderness.
Bloods: mild anemia, low plts, elevated LFT and hemolysis. What is the most likely dx?
a. Acute fatty liver of pregnancy
b. Acute pyelonephritis
c. Cholecystitis
d. HELLP syndrome
e. Acute hepatitis
285. A 57yo woman presents with dysuria, frequency and urinary incontinence. She complains of
dyspareunia. Urine culture has been done and is sterile. What is the most appropriate step?
a. Oral antibiotics
b. Topical antibiotics
c. Topical estrogen
d. Oral estrogen
e. Oral antibiotics and topical estrogen
286. A pt came to the ED with severe lower abdominal pain. Vitals: BP=125/85mmHg, Temp=38.9C.
Exam: abdomen rigid, very uncomfortable during par vaginal. She gave a past hx of PID 3 years
ago which was successfully treated with antibiotics. What is the appropriate inv?
a. US
b. Abdomen XR
c. CT
d. High vaginal
e. Endocervical swab
287. A pregnant woman with longterm hx of osteoarthritis came to the antenatal clinic with
complaints of restricted joint movement and severe pain in her affected joints. What is the
choice of drug?
a. Paracetamol
b. Steroid
c. NSAID
d. Paracetamol+dihydrocoiene
e. Pethadine
288. A 24yo 18wk pregnant lady presents with pain in her lower abdomen for the last 24h. She had
painless vaginal bleeding. Exam: abdomen is tender, os is closed. What is the most probable dx?

289.

290.

291.

292.

293.

294.

a. Threatened miscarriage
b. Inevitable miscarriage
c. Incomplete miscarriage
d. Missed miscarriage
e. Spontaneous miscarriage
A 2yo child playing in the garden had a clean cut. She didn’t have any vaccinations. Also, there is
no contraindication to vaccinations. Parents were worried about the vaccine side effects. What
will you give?
a. Clean the wound and dress it
b. Give TT only
c. Give DPT only
d. Give DPT and tetanus Ig
e. Give complete DPT vaccine course
A 32yo female who has had 3 prv miscarriages in the 1st trimester now comes with vaginal
bleeding at 8wks. US reveals a viable fetus. What would be the most appropriate definitive
management?
a. Admit
b. Aspirin
c. Bed rest 2 weeks
d. Cervical cerclage
e. No tx
A 6yo girl started wetting herself up to 6x/day. What is the most appropriate tx?
a. Sleep alarms
b. Desmopressin
c. Reassure
d. Behavior training
e. Imipramine
A 27yo 34wk pregnant lady presents with headache, epigastric pain and vomiting. Exam:
pulse=115, BP=145/95mmHg, proteinuria ++. She complains of visual disturbance. What is the
best medication for the tx of the BP?
a. 4g MgSO4 in 100ml 0.9%NS in 5mins
b. 2g MgSO4 IV bolus
c. 5mg hydralazine IV
d. Methyldopa 500mg/8h PO
e. No tx
A 24yo lady who is 37wk pregnant was brought to the ED. Her husband says a few hours ago she
complained of headache, visual disturbance and abdominal pain. On arrival at the ED she has a
fit. What is the next appropriate management for this pt?
a. 4g MgSO4 in 100ml 0.9%NS in 5mins
b. 2g MgSO4 IV bolus
c. 2g MgSO4 in 500ml NS in 1h
d. 4g MgSO4 IV bolus
e. 10mg diazepam in 500ml 0.9%NS in 1h
What is the pathological change in Barret’s esophagitis?
a. Squamous to columnar epithelium
b. Columnar to squamous epithelium
c. Dysplasia
d. Metaplasia

5C. What is the most appropriate test to confirm dx? a. PDA e. Where is the site of the lesion? a. Laparoscopy 298. Hyperplasia 295. Salpingotomy . CXR e. Abdominal XR e. She presents again with lower abdominal pain. She can use COCP if anticonvulsant is changed to carbamezapin. Vaginal swab b. LP d. A young girl presenting with fever. 8th CN c. US d. Right midbrain d. She can’t use COCP b. Auditory canal b. ASD c. What is the most probable dx? a. She is on sodium valproate. Blood glucose c. Laparoscopy c. bleeding. neck stiffness and photophobia. a. what is the most appropriate next management? a. Brain stem 296. She can use COCP with extra precaution c. he has left parasternal heave and systolic thrill with a harsh pan-systolic murmur at left parasternal edge. CT 300. VSD d. Right internal capsule c.e. Her LMP was 7wks ago. Exam: abdominal tenderness. Left frontal lobe 301. nystagmus and vertigo. Blood culture b. d. weakness of the left half of his body and drooling. She can use COCP with estrogen 50ug and progesterone higher dose e. She has been on the antibiotics for the last 10days. PID was dx. Which part of the brain is affected? a. A 65yo HTN man wakes up in the morning with slurred speech. Immediate laparotomy b. vomiting. She has no rashes. A 27yo presents with abdominal pain. Endocervical swab c. What is the next appropriate management? a. A 34yo male presents with hx of headache presents with ataxia. TOF b. She can use COCP 297. vomiting and diarrhea. A 24yo girl comes to the woman sexual clinic and seeks advice for contraception. An 18yo man complains of fatigue and dyspnea. Temp=39. Cerebellum d. A 27yo lady came to the ED 10 days ago with fever. suprapubic tenderness and vaginal discharge. Left parietal lobe b. Cerebral hemisphere e. TGA 299. headache. BP=90/60mmHg.

Somatization c. Liver What advice would you give for the parents of a child with repeated UTI? a. Laxatives A pt presents with complete anuria following prolonged hypotension and shock in a pt who bled profusely from a placental abruption. MTX A woman presents with complains of abdominal pain. 306.5L/min d. Ice packs c. 309. A chest drain has been sited just below the 4th rib in the mid-axillary line on his right side. All inv are normal. Uterus weight 1. Salpingectomy e. Hyperuricemia c. 308. Hyperparathyroidism Which of the following is NOT a physiological change during pregnancy? a. What single structure is at particular risk of injury? a. Intercostal artery d. Internal thoracic artery e. Cardiac output 6. IV fluids An MI pt who is already on aspirin no longer smokes and his cholesterol.1kg e. Prophylactic antibiotics c. Recurrent UTIs e. echo and BP are normal. What measure should be taken to stop the bleeding? a. Manchausen b. Surgery b. ESR up by 4x A 10yo boy presents with nose bleed. Choose the best option for him: a. Give statin+warfarin c. What is the most probable dx? . 307. Press soft parts of the nose d. Bipolar A 34yo African-caribbean man with a hx of sarcoidosis has presented with bilateral kidney stones. 304. Statin+ACEi A 46yo man is being treated for a pleural effusion. Diet d. Arzygos vein b. Low cholesterol diet d. Toilet training e. RBC vol 1. numbness of lower limb and palpitations. Increase fluids d. Give statin b. What is the dx? a. d.302. 303. 305. Diaphragm c. Hypercalcemia b.64L c. unsteadiness. ECG. What is the most likely cause for this pt’s stones? a. Press base of the nose b. Tidal volume 500ml b. Hypochondriac d. Start tranexemic acid e.

POP e. 313. 311. What is the next step? a. then steroid c. Alcoholic hepatitis b. First use emollient. 315. Salbutamol c. Etonogestrol b. Ipratropium bromide e. Neoplasm A 15yo boy presents with testicular pain for 2days.310. HUS e. Antibiotics b. She is not keen to be pregnant for the next 3yrs. Decompensated cirrhosis c. What is the single most appropriate management? a. 314. Reassure d. Topical estrogen c. Emollient at night with steroid All the following drugs do not cause bronchoconstriction except? a. Give analgesia c. What is the best method of contraception for her? a. Give antibiotics b. Post viral infection b. US scrotum e. right hemi-scrotum tenderness. What advice would you give her regarding application of the cream? a.5C. Acute papillary necrosis c. Renal vein thrombosis An alcoholic 56yo man had ascetic fluid analysis done which was found to be yellow color. Sparingly use both the cream b. Exam: temp=38. Pelvic floor exercise A 45yo lady came to family planning clinic for contraception advice. Salmetrol d. Atenolol b. She looks anxious for her condition. Her urodynamic study is normal. TB peritonitis d. a. Pyogenic peritonitis e. Exploratory surgery A 58yo lady presented with urinary incontinence. Cocaine . IUCD A child presents with eczema. Apply steroid then emollient d. COCP c. What is the most appropriate cause? a. She was given to creams by the GP – emollient and steroid. 312. Her recent US showed multiple small submucosal fibroid. IUS d. There is no hx of trauma. Systemic estrogen d. Duloxetine e. Mix emollient & steroid before use e. Urine culture is sterile. Acute cortical necrosis d.

Na+=140mmol/L. Lymphoma 319. Epitrochlear LN b. Duct ectasia e. Serum B12 increased. Psychotic depression 317. Glomerulonephropathy c. Fibroadenosis b. A 67yo female who had undergone a radical mastectomy now comes with the complaint of swelling and redness in her right upper limb. A 28yo female who delivered 6wks ago feels sad and has no interest in feeding the baby. Subclavian artery d.5g/dL. CLL c. A 53yo man presents complaining of weight loss. What is the most likely dx? a. lethargy. Postpartum depression c. irregular. Exam: spleen palpated 5cm below left costal margin. urea=7mmol/L. Fat necrosis c. IgA nephropathy f. 10 died that wasn’t treated while 5 died in the tx group. no fluid wave. Axillary group of LN . She also says that the baby has evil eyes. WBC=200 – 85% neutrophils. Absolute risk =10 b. She has a bruise on the surface and there is no discharge. What would be the most likely dx? a. Renal biopsy results are awaited. In a group of cancer pts. AML d. A 67yo woman has presented with hard. Membranous glomerulonephropathy d. Involvement of which of the following structures explain these symptoms? a. A 44yo man presents with periorbital and pedal edema. Relative risk =10 c. poorly defined 5cm lump in her right breast. Cephalic vein c. Which statement is correct? a. What is the most likely dx? a. Philadelphia chromosome +ve. plts=100. She feels weak throughout the day and has stopped taking the baby out of the house.316. ALL e. Mesangiocapillary 318. What is the most likely dx? a. Relative risk =5 d. Minimal change disease b. FSGS e. K+ 4mmol/L. Postpartum psychosis d. Relative risk=2 320. Absolute risk=5 e. Postpartum blues b. 24h urine shows 8g of protein/d and serum cholesterol=7mmol/L. She has been eating poorly and having difficulty sleeping. increasing abdominal discomfort and gout for the pat yr. Schizophrenia e. Ca breast 321. CBC: Hgb=10. CML b. Fibroadenoma d. create=151umol/L.

ESR e. Varicosity 2nd to liver disease c. Left ant descending artery b. Temporal artery biopsy 327. What is the most likely dx? a. Acoustic neuroma c. Left sided RCC b. Acute labyrinthytis d. Fundoscopy d.e. The swelling was bluish in color and felt like a bag of worms. Long thoracic nerve 322. Return to work to relieve her anger 328. What is the single most appropriate option? a. He also complains of double vision when looking to the right. In 85% of the population this artery is dominant. Otosclerosis 325. Testicular tumor d. A 6yo fell on outstretched hand while playing. Green stick fx c. She took 10 tablets of paracetamol in front of his mother after taking alcohol. Pulled elbow . Counselling c. Refer to psychiatry b. What should you do? a. IVC obstruction 324. A teenage girl who was ‘fine’ until her boyfriend said he didn’t want the relationship anymore. Compound fx d. What is your next step in management? a. What could be the possible dx? a. Supracondylar fx e. He feels tender at the elbow but otherwise well. A 50yo smoker and heavy drinker presents with complaints of racing heart. Meningioma e. severe pain in the left half of her skull. post descending artery e. Left main stem. What is the next likely step? a. Stress test 323. A 54 yo lady presents with sudden. What is the most appropriate dx? a. Meniere’s disease b. CT b. He also complains of a mass in the left loin along with hematuria occasionally. ECHO b. Spiral fx b. A man presents with muffled hearing and feeling of pressure in ear with tinnitus and vertigo. UTI e. Reassure c. A 47yo man comes to the GP with a swelling in his left groin which disappears on lying down. GP to sort out family issues d. Right coronary artery 326. She also complains of pain around her jaw. Circumflex artery d. Coronary sinus c. MRI c. A 24h ECG comes out normal.

Chest CT c. ECG shows ST elevation. Polycystic kidney 330. Emboli 334. CXR f. What is the most probably dx? a. A lady presents with abdominal pain. Atrial fib e. Inhaled steroids c. Left trochlear b. Generalized tonic-clonic b. CXR: loss of margin at costo-vertebral angle. US 331. Laryngoscopy e. KUB US are equally reduced in size with smooth borders and normal pelvic calyceal system. An old lady 72yo staying at a nursing home for a few years. EEG abnormality in temporal lobe. Chronic pyelonephritis c. What si your next step? a. Endoscopy with biopsy 332. Laparoscopy b. Right abducens e. What would be your next step? a. A man has a BP of 160/90mmHg. dysuria. Cardiac tamponade b. Which nerve is affected? a. What is the most probable cause for her decrease in vision? a.329. LOC. What is the single most likely cause? a. A man presents with outward deviation of his right eye and diplopia. Essential HTN e. Febrile convulsion 335. Aminophylline . Chronic glomerulonephritis b. Hysteroscopy d. The girl had a rapid recovery. Right trochlear d. A 48yo woman who has been taking medications for asthma for a long time has now presented with decreasing vision. Dressler’s syndrome d. no residual sign and no post-ictal phase. Atonic seizure e. Ba swallow b. A 12yo girl presented with tics. Right oculomotor 333. A 60yo pt who has had a MI a week back presents with dyspnea and pericardial rub. High vaginal swab c. Laparotomy e. Myoclonic c. Bilateral renal artery stenosis d. Mitral regurge c. Inhaled salbutamol b. What is the cause of HTN in the pt? a. dyspareunia and vaginal discharge. Left oculomotor c. Partialgeneralized seizure d. Endoscopy d. a known HTN on reg tx presented with sudden dysphagia while eating with drooling of saliva and req urgent inv. proteinuria++.

Antipsychotics A 40yo male with pre-existing glumerulonephritis having proteinuria and hematuria suddenly deteriorates and presents with oliguria and serum K+=7. Hemodialysis urgent 34yo man was brought to the ED after a RTA. Dermatitis e. Normal K+ An 8yo returned from Spain with severe pain in one ear. BP=50/0mmHg and chest wall not moving symmetrically. High Na+. Psoriasis A 54yo woman has presented with episodes of abdominal ache. MRI d. Low Na+. The best management would be? a. What medication needed to be continued so he can stay well? a. She also has a dark pigmentation of her skin. Scabies b. Mood stabilizers c. A dx of Addison’s disease was made. Low K+ d. His GCS has fallen from 13 to 7. vomiting and postural hypotension. 10units insulin with 50% dextrose d. urea=13mmol/L. 337. Burr hole c. Low K+ b.8mmol/L. GFR=19mL/h. Anxiolytics b. creat=342mmol/L. Antidepressants d. Transfer to ITU A pt complains of SOB. Exam: pus in auditory canal. Eczema c. d. CT b. What would be initial action? a. tempanic membrane looks normal. High Na+. Low Na+. High K+ e. Intubation e. High K+ c. What is the most likely electrolyte abnormality expected in this pt? a. What is the most appropriate next step? a. What is the tx option? a. 342. Intubation and ventilation c. 339. He has dry scaly shin with rashes that are itchy. What is the single most likely dx? a. wheeze. 338. 340. 10ml of 10% calcium gluconate f. IV fluids A pt with alternating swings or episodes from elation and depression had underwent tx and gotten better. cough and nocturnal waking. Oral steroids A 34yo man after a car crash is in the ED and deteriorating. Rheumatism d.336. RR=34bpm. Calcium supplement b. Nebulized salbutamol e. Calcium resonate enema 30g c. CT chest d. Gentamicin topical . 341. Beta-blockers e. IV fluid infusion b. Low Na+.

Refer to neuro-surgeon b. Amoxicillin IV A 6wk child is very sick-looking. 0. hearing impairment and some in-coordination of her movements. Cerebrum c. What is the management? a.9% NS c. Carotid artery stenosis Pt presented with hemoptysis 7d post-tonsillectomy. Oral antibiotics + discharge c. What is the next step? a. What is the cause of her fall? a. Pleomorphic adenoma .45% NS d. She is on some anti -HTN therapy with no other med prbs. Packing b. Exam: firm in consistency. Then during the night the noticed GCS reduced to 13. 0. Admit + IV antibiotics d. What would you choose to resuscitate? a. What is the most likely cause for this? a. Optic nerve A 68yo male presented with swelling in the lower pole of the parotid gland for the last 10yrs.343. Spinal cord d. 346. 348. 349. CT brain e. She also has loss of sensation over her face. 344. HOCM e. Vestibrobasiliar insufficiency c. Bloods: Na+=124. Return to theatre and explore e.45% NS + 5% dextrose + 20 mmol KCl A 68yo man gets repeated attacks of LOC and TIA. presented to the hospital with complaints of recurrent falls when trying to get out of bed or getting up from sitting. K+=2. Skull XR A 57yo woman who is suffering from HTN. What’s the most probable dx? a. 345. 0. Oxygen d. Cerebellum b. CCB b. Atrial fib b. Thiazide d. 347. IV fluids c. 0. Brain stem e. b. Aortic stenosis d. Mitral stenosis c. Infection A 56yo woman with MS presents with drooping of the left side of her lips.8. Ice cream and cold fluids A child was admitted following a RTA with initial GCS=15. Analgesia d. Amoxicillin PO c. Dehydrated. What is the most likely anatomical site affected? a. Hypoglycemia e. 0.18% NS + 4% dextrose + 20mmol KCl b.45% NS + 5% dextrose e.

Baker’s cyst e. Basal cell carcinoma b. Frey’s syndrome A 28yo shipyard worker was admitted for pain in calf while at work which has been increasing over the last 3m. Fasting blood sugar e. 354. Thromboangitis obliterans b. Parotiditis e. Gastrochiasis d. what is the appropriate inv which will lead to the dx? a. ECG normal. What is the most likely dx? a. Rapid plasma regain test e. Malignant melanoma d. DVT d. Treponema palladium antibody test d. Amyloidosis d. VDRL A 53yo man presents with a longstanding hx of a 1cm lesion on his arm. Exam: loss of posterior tibial and dorsalis pedis pulsation along with a non-healing ulcer at the base of the right 1st MCP joint. Echo= increased EF and decreased septal wall thickness. What is the most likely dx? a. Constrictive pericarditis c. Subacute endocarditis An elderly pt who is known to have DM presents to the hospital with drowsiness. Kaposi’s sarcoma c. 353. Blood sugar b. 355. What is the most likely dx? a. Esophageal atresia c. b. Anti-HSV antibodies b. It has started bleeding on touch. Dark ground microscopy of the ulcer c. 351. CT A 28yo pregnant woman with polyhydramnios and SOB comes for an anomaly scan at 31 wks. What inv should be done to help in further management? a. Sciatica c.350. Kerathoacanthoma A 47yo man with hx of IHD complains of chest pain with SOB on exertion over the past few days. 352. What is the most probably dx? a. Dilated CM b. Adenolymphoma c. Mikulicz’s disease d. Duodenal atresia b. Embolus A 35yo lady presents with painful ulcers on her vulva. Diaphragmatic hernia . Exomphalos e. ECG c. There is no hx of HTN or DM but he is a smoker. Standing and lying BP d. US= absence of gastric bubble. Squamous cell carcinoma e. tremors and confusion.

What is the cause? a. EBV 360. DVT 2yrs ago d. He has been irritable and feeding poorly for 24h. He also has basal consolidation in the left lung. PPI IV b. MI 2 months ago 362. Alendronate c. What is the single most appropriate immediate tx? a. What is the most likely dx? a. RDS e. What is the most important complication that we should be careful with? a. Gardenella d. Which among the following can be the reason to delay his surgery? a. Chlamydia b. conscious but with cool peripheries and has HR=222bpm. Limb ischemia e. What is the next appropriate step? a. Passes through the superficial inguinal ring only b. Trichomonas c. Synchronized DC cardio-version e. ECG=regular narrow complex tachycardia. Controlled asthma b. Which statement below best describes it? a. Osteoporosis c. Diarrhea 361. Congenital cystic adenematoid malformation c. Congenital diaphragmatic hernia b.356. A 7yo child presented with chronic cough and is also found to be jaundiced on examination. with difficulty identifying p wave. Alpha 1 antitrypsin deficiency 358. A 65yo known case of liver ca and metastasis presents with gastric reflux and bloatedness. Headache b. HSV e. Diastolic BP 90mmHg e. Passes through the deep inguinal ring 359. Administer fluid bolus b. CXR=borderline enlarged heart with clear lung fields. Does not pass through the superficial inguinal ring d. Ear infection d. A 35yo construction worker is dx with indirect inguinal hernia. Lies above and lateral to the pubic tubercle c. IV antibiotics . Unilateral carotid sinus massage 357. A woman has numerous painful ulcers on her vulva. On bone exam there is osteoporosis. Controlled atrial fib c. Administer oxygen c. A 72 yo man has been on warfarin for 2yrs because of past TIA and stroke. A 55yo man has been admitted for elective herniorraphy. Bronchiolitis d. A 1m boy has been brought to the ED. Oral beta-blockers d.

She is writhering in pain. 367.d. Continue with warfarin and add heparin c. Exam: scrotal skin is red and tender. What is the most likely cause of her abdominal pain? a. Epididymo-orchitis A man on warfarin posted for hemicolectomy. PPI PO 363. What other drug would you like to prescribe? a. Appendicitis b. Torsion of testis b. What is the most appropriate next step in management? 364. aggressiveness and ophthalmoplegia. Adenosine e. Inguinal hernia d. Vit B complex A 32yo woman has severe right sided abdominal pain radiating into the groin which has lasted for 3h. What is the most appropriate dx? a. IV fluids d. Salpingitis d. Metoprolol b. drinks and has a fam hx of bladder cancer is suffering from BPH. Strangulated hernia A 39yo coal miner who smokes. What option is the best for him? a. Stop warfarin and add heparin e. Digoxin c. Carotid sinus massage d. 366. Orchitis c. The most important risk factor for his bladder carcinoma is? . Ureteric colic e. Stop warfarin A 65yo known alcoholic is brought into hospital with confusion. He is treated with diazepoxide. Disulfiram e. Ruptured ectopic pregnancy c. Continue with warfarin b. a. Stop warfarin and add aspirin d. She has no abdominal signs. Analgesic e. As the pt is about to undergo surgery. Antibiotics b. 365. Glucose c. Amiodarone A 22yo sexually active male came with 2d hx of fever with pain in scrotal area. A 66yo man has the following ECG. 368.

Malnutrition c. dilation of esophagus with tapering end is noted. HTN retinopathy b. Syringing c. By instilling olive oil A pt presents with longstanding gastric reflux. Radioactive iodine e. 370. Fam hx b. What is the cause of this pts unilateral blindness? a. The right eye is normal. A combo od anti-thyroid drug and thyroxine d. dysphagia and chest pain. Fundus exam: flame shaped hemorrhages. The carer confirms this. NAI b.369. He had progressive dysphagia to solids and then liquids. 18m of carbimazole alone b. CRV thrombosis d. GERD . CRA thrombosis c. Achalasia b. Give 100% oxygen e. What is the single most appropriate dx? a. lid lag and bilateral exophthalmos with puffy eyelids and conjunctival injection. What is the most appropriate single best approach to remove this object? a. Under GA d. He was found with Barrett’s esophagus. 372. What is the 1st thing you would do? a. a. Smoking c. Thrombocytopenia d. fever and fractures. BPH A 34yo woman is referred to the endocrine clinic with a hx of thyrotoxicosis. What is the most likely tx you would advise? a. Esophageal spasm c. The eye shows hand movement and a light shined in the eye is seen as a faint light. By magnet b. Clear airway c. 371. Background retinopathy e. Intubate and ventilate A HTN male loses vision in his left eye. 374. She wants to discuss the tx of her thyroid prb as she is keen to become pregnant. 18m of PTU alone c. Thyroidectomy A child living with this stepfather is brought by the mother with multiple bruises. Exposure to coal mine d. He is now cyanosed and unresponsive. HIV A young man who was held by the police was punched while in custody. On barium enema. Otoscopy shows a green colored object in the ear canal. What do you suspect/ a. By hook e. 373. IV fluids b. Turn pt and put in recovery position d. At her 1st appointment she is found to have a smooth goiter. Retinal detachment A mentally retarded child puts a green pea in his ear while eating.

Keratitis A child during operation and immediately after showed glycosuria. Choose the most probable dx. Adenolymphoma c. ventricular rate=150/min and regular R-R interval. Laxatives A 70yo man admits to asbestos exposure 20yrs ago and has attempted to quit smoking. Paget’s disease of the breast b. Oral carcinoma A 32yo woman had progressive decrease in vision over 3yrs. Basal cell carcinoma b. Mikulicz’s disease d. What would be the mechanism? a. redness. Breast abscess d. Oral morphine e. 377. Atrial fib . Chronic recurrent sialadenitis b. He has noted weight loss and hoarseness of voice. What is the most likely dx? a. Spasmolytics c.375. Retinopathy d. What is the most appropriate management? a. d. Palliative colostomy d. which became more prominent and painful on chewing. Fibrocystic dysplasia c. Esophageal carcinoma A 48yo lady presents with itching. Cataract b. 380. Duct papilloma e. Adenoid cystic carcinoma e. PCA (morphine) b. She is no dx as almost blind. Sub-mandibular abscess ECG of an 80yo pt of ICH shows saw-tooth like waves. bloody discharge and ulceration around her nipple. Nasopharyngeal carcinoma e. the area is tender on palpation. a. Normal finding c. Barrett’s esophagus e. Glaucoma c. He also gave hx of sour taste in the mouth. Pre-diabetic state b. but later his urine sugar was normal. 376. 378. QRS complex of 80ms duration. Uveitis e. 379.w risk factors present. What is the most porbable dx? a. Low renal tubular threshold d. excoriations. Choose the most probable dx? a. a. Bronchial carcinoma c. DM A pt presented with hx of swelling in the region of the sub-mandibular region. Choose the single most likely type of cancer a. 381. Eczema Pt with widespread ovarian carcinoma has bowel obstruction and severe colic for 2h and was normal in between severe pain for a few hours. Esophageal carcinoma d.

382. Positive thyroid peroxidase antibodies e. Anorgasm A 39yo man with acute renal failure presents with palpitations. She has become drowsy now. heat intolerance. 388. His ECG shows tall tented T waves and wide QRS complex. 384. What is the most likely metabolic abnormality? a. IV calcium chloride c. Fluid retention b. CTPA c. D-Dimer e. Nebulized salbutamol A 54yo pt 7 days after a total hip replacement presents with acute onset breathlessness and raised JVP. 385. smooth goiter c. Loss of apetite d. Doppler US of legs A 7yo girl has been treated with penicillin after sore throat. Pretibial myxedema A lady. Hypoglycemia d. What is the management option for her? a. b. Mobitz type1 second degree heart block e. Dialysis b. 387. CXR b. Exploratory laparotomy c. Bilateral exophthalmos b. Hypocalcemia A 29yo woman presents to her GP with a hx of weight loss. poor conc and palpitations. Reassure A 65yo female pt was given tamoxifen. Then she develops skin rash and itching. fever and cough. Diffuse. 386. Hyperkalemia c. Sinus tachycardia A 50 yo woman who was treated for breast cancer 3 yrs ago now presents with increase thirst and confusion. Which of the following is most likely to be a/w dx of thyroiditis a/w viral infection? a. Hypercalcemia b. V/Q scan d. What is the next best step? a. What is the most probable dx? a. SVT d. 383. IV insulin w/ dextrose d. post-colostomy closure after 4days comes with fluctuating small swelling in the stoma. Erythema nodosum . Atrial flutter c. Vaginal bleeding c. Which of the following inv will be most helpful in leading to a dx? a. Local exploration b. which of the following side effect caused by it will concern you? a. Reduced uptake on thyroid isotope scan d. Headache and dizziness e. Calcium resonium e. Hyperglycemia e. Open laparotomy d.

CT shows no hemorrhage. Erythema multiforme c. tiredness. 394. Stomach carcinoma c. Warfarin b. Heparin c. SJS d. TFT d. ECG shows atrial fib. Atrophic gastritic e. LSD e. Bronchial carcinoma d. agitated. Gastric carcinoma b. What prophylactic regimen is best for him? a. Heroin c. What can be the substance misuse here? a. Ecstasy A child presents with increasing jaundice and pale stools. Cerebellum A 57yo man with blood group A complains of symptoms of vomiting. Aspirin d. LFT e. Alcohol b. weight loss and palpitations. His appetite is decreased and he has lost 5kg recently. 392.389. malnourished and nervous came to the hospital asking for painkillers for her abdominal pain. Choose the most appropriate test? a. 391. Brain stem c. Laryngeal carcinoma A 64yo man has presented to the ED with a stroke. Cocaine d. shivering and complains of j oint pain. Endomyseal antibodies . Cerebrum e. Krukenburg tumor A 21yo girl looking unkempt. Beta blockers A 54yo man after a CVA presents with ataxia. palpable left supraclavicular mass. b. Exam: hepatomegaly. Thyroid carcinoma b. Erythema marginatum e. Statins e. intention tremors and slurred speech. US abdomen b. 393. Sweat test c. Diencephalon d. Colorectal carcinoma c. Mesothelioma e. What is the most probably dx? a. Which part of the brain has been affected by the stroke? a. Erythema gangernosum A 60yo man presented with a lump in the left supraclavicular region. He has been thrombolysed and he’s awaiting discharge. 390. ascites. She is sweating. Peptic ulcer disease d. What is the most likely dx? a. Inner ear b.

Analgesia b. Diffuse wheeze c. She has normal pupil and cornea.395. Audiometry b. Which bursa is most likely to be affected? a. Semimembranous bursa b. A pt comes with sudden loss of vision. Intercostal recession b. Exam: tenderness on palpation and only one testis was normal in size and position. MRI d. Antibiotics c. GCA 398. An old woman having decreased vision can’t see properly at night. Glaucoma c. What is the underlying pathology? a. On fundoscopy the optic disc is normal. He also complains of tinnitus. Vitreous chamber d. Iritis b. Spinal cord compression 397. drooling saliva on to the mother’s lap. A 12yo boy presents with painful swollen knew after a sudden fall. Tympanometry e. postural hypotension. Discharge with analgesics 400. Hyponatremia e. Paraneoplastic syndrome b. Iritis e. What is the most appropriate inv for his condition? a. Retinal detachment 399. diminished reflexes and sluggish papillary reaction. Reassurance e. Refer urgently to a surgeon d. Retinal detachment d. Weber’s test 396. and taking oxygen by mask. What sign will indicate that he is deteriorating? a. Drowsiness 401. She has changed her glasses quite a few times but to no effect. Progression of lung cancer c. A child suffering from asthma presents with Temp 39C. Glaucoma c. Prepatellar bursa c. Suprapatetaller bursa . vertigo and numbness on same half of his face. A 56 yo lady with lung cancer presents with urinary retention. What is the most likely explanation for her symptoms? a. A 32yo man presents with hearing loss. Brain metastasis d. AC>BC in the right ear after Rhine test. What is the most likely dx? a. What would be your next step? a. A child was woken up from sleep with severe pain in the testis. Pretibial bursa d. Cataract b. CT c.

Continue current management e. Erythema marginatum . Acid fast urine test e. Compulsory admission under MHA c. urine culture = negative for nitrates. CXR c. Cerebral cortex 404. creat and electrolytes c. Lupus vulgaris b. Urea. Streptokinase c. Alternate housing e. None 407. What is the most probable dx? a. Erythema nodosum c. He sees no point in living now that his wife is not around and apologises for his existence. ECG shows ST elevation in leads I. Cardiac enzymes b. PSA b. Voluntary admission to psychiatry ward b. She was breathless and is put on oxygen mask and GTN. What is the most likely dx? a. What is the most appropriate next step? a. What is the next dx inv? a. which part of the brain is the metastasis spread to? a. A woman dx with Ca Breast presents now with urinary freq. MSU culture and sensitivity d. A 61yo man has been referred to the OPD with frequent episodes of breathlessness and chest pain a/w palpitations. III. Pons c. Medulla d. ECG=sinus rhythm. A 31yo man has epistaxis 10 days following polypectomy. ECG d. A 67yo male presents with polyuria and nocturia. Echo e. What is the most appropriate inv to be done? a. Refer to social services d. He has a regular pulse rate=60bpm. Her HR=40bpm. ECT 405. Coagulation disorder c. The son can’t deal with the father any more. Blood sugar 408. His BMI=33. What is your next step? a. A woman had an MI. Carcinoma 406. A pt from Africa comes with nodular patch on the shin which is reddish brown. her chest pain has improved. His son has brought him to the ED. LMWH b. A man is very depressed and miserable after his wife’s death. Nasal infection b.402. II. 24h ECG 403. He refuses any help offered. Brain stem b. Pyoderma gangrenosum d. Diencephalon e. Angiography d.

He is now completely well but his parents are anxious as his cousin died of SIDS at a similar age. Start him in IV insulin and glucose and K+ just before surgery b. Progressive massive fibrosis 413. Autistic spectrum disorder 412.3C. What is the single most appropriate next management? a. A 6m boy has been brought to ED following an apneic episode at home. What is the most appropriate dx? a.e. Stop his oral hypoglycemic on the day of the procesure c. Temp=37. Beta blockers c. Heel of both hand e. There are no bowel sounds. MI b. Exam: HR=154bpm. Antibiotic therapy IV b. Stop oral hypoglycemic the prv night and start IV insulin with glucose and K+ before surgery e. A 19yo boy is brought by his mother with complaint of lack of interest and no social interactions. All fingers of one hand c. Verapamil e. Good pastures syndrome e. Pain is sharp. TPN . irregular rhythm. He now has abdominal distension and recurrent vomiting. What is the single most appropriate dx? a. Pericarditis c. What is the single most recommended technique for cardiac compressions? a. A 45yo man who is diabetic and HTN but poorly compliant has chronic SOB. Borderline personality disorder b. Heel of one hand d. increased by breathing and relieved by sitting forward. A T2DM is undergoing a gastric surgery. What is the tx for her condition? a. He has no friends. WBC=9. Adenosine d. Depression c. He has not opened his bowels since surgery. NG tube suction and IV fluids e. Flecainide 410. develops severe SOB and chest pain. Glycerine suppository c. All fingers of both hands b. he doesn’t talk much. Change to short acting oral hypoglycemic 411. Lung cancer d. What is the most appropriate pre -op management? a. Laparotomy d. The parents ask for guidance on BLS for a baby of his age. Solar keratosis 409. Continue regular oral hypoglycemic d. Amiadarone b. his only interest is in collecting cars/vehicles having around 2000 toy cars. A 29yo lady came to the ED with complaints of palpitations that have been there for the past 4 days and also feeling warmer than usual. A 70yo man had a right hemicolectomy for ceacal carcinoma 6days ago. Schizoaffective disorder d. Index and middle fingertips of one hand 414.

Lorazepam . Peripheral iridectomy c. urinary freq and weight loss presents with a deep painless ulcer on the heel. brought in the ED having been found confused at home after a fall. Venography c. Exam: cold peripheries and paraparesis. Surgical extraction of lens 420. Scleral buckling d. Ateriography b. Subdural hematoma e. HSP 417. Biopsy for pyoderma 416. Biopsy for malignant melanoma e. What is the most probable dx? a. Pre-aortic LN f. A 60yo man with a 4y hx of thirst. What is the most appropriate inv? a. MI b. Motor neuron disease 419. A 54yo myopic develops flashes of light and then sudden loss of vision. Blood sugar d. Inguinal LN h. What is the single most appropriate dx? a. Spectacles e. He complains of a headache and gradually worsening confusion. Submental LN c. Acamprossate b. Head injury b. What is the single most appropriate tx? a. Which is the single most appropriate LN involved? a. ITP e. A 50yo lady presents to ED with sudden severe chest pain radiating to both shoulder and accompanying SOB. Chlordiazepoxide c. Deep cervical LN 418. Hypoglycemia c. A 34yo man with a white patch on the margin of the mid-third of the tongue. Measles b. Good pastures syndrome e. Delirium 421. External iliac LN e. Iliac LN b. What is the most likely dx? a. Pan retinal photo coagulation b. Bullous-pemphigoig c.415. Aortic dissection c. Aortic LN g. Pulmonary embolism d. That is the single most appropriate tx? a. Submandibular LN d. A 16yo boy presents with rash on his buttocks and extensor surface following a sore throat. A 54yo man with alcohol dependence has tremor and sweating 3days into a hosp admission for a fx femur. Rubella d. Extradural hematoma d. A 40yo chronic alcoholic who lives alone. He is apprehensive and fearful.

Procyclidine A 5yo child complains of sore throat and earache. Acute OM A man with a fam hx of panic disorder is brought to the hosp with palpitations. He is dx with rectal carcinoma. Acute follicular tonsillitis c. tremors. sweating and muscles tightness on 3 occasions in the last 6 wks. Diazepam b. Long saphenous vein c. Aspirin 300mg for 2 weeks A 63yo lady with a BMI=32 comes to the ED with complaints of pigmentation on her legs. He is completely conscious throughout. The ECG was taken (SVT). Lidocaine d. 424. CBT b. Adenosine c. What is the 1st med to be used to manage this condition? a. 423. Continue amitryptaline c. Deep venous system d. Verapamil e. Popliteal veins e.422. Aspirin 300mg for 2 weeks followed by aspirin 75mg and dipyridamole 200mg c. Short saphenous vein b. Exam: dilated veins could be seen on the lateral side of her ankle. He is pyrexial. What is the single most relevant dx? a. 427. Lofexidine e. Which risk factors help to develop rectal carcinoma except following? . Clopidogrel 75mg d. Her sleep has improved and she now wants to stop medication but she still speaks about her husband. How would you manage her? a. IM b. What is the single most appropriate long-term tx for him? a. Metoprolol A 56yo woman who is depressed after her husband died of cancer 3m ago was given amitryptaline. 428. 425. Olanzapine c. He was absolutely fine 6h after the episode. Which of the following is involved? a. Fluoxetine e. Alprazolam A 28yo man presents with rapid pounding in the chest. Saphano-femoral junction A 55yo man presents with hx of weight loss and tenesmus. Haloperidol d. He doesn’t complain of headache and his BP is WNL. Aspirin 300mg for 2 weeks followed by aspirin 75mg b. Dipyridamole 200mg e. Amiodarone b. Agranulocytosis e. 426. Antipsychotic A 64yo man presents with a hx of left sided hemiparesis and slurred speech. d. Bereavement counselling e. What is the most appropriate prophylactic regimen? a. Psychoanalysis d. Exam: tonsils enlarged and hyperemic. Scarlet fever d. exudes pus when pressed upon.

High fibre diet A pt presents with a painful. sticky red eye with a congested conjunctiva. 431. Serum calcium e. Korsakoff’s psychosis d. Smoking b. Systemic sclerosis c. Increase dose of aspirin to 300mg . What is the most appropriate next step? a. 430. Coagulation profile c.429. Acute leukemia b. a. Steroid drops e. Prv carcinoma e. Add clopidogrel only b. High fat diet f. Delirium tremens b. Globus hystericus A 3yo child brought to the ED with a swelling over the left arm. SLE d. Plt=14. He is already on aspirin 75mg and anti-HTN drugs. DEXA scan A 35yo woman has had bruising and petechiae for a week. It seems to be in the middle of ther esophagus but she can’t localize exactly where it sticks. Polyp d. HIV infection d. She has also had recent menorrhagia but is otherwise well. 432. Pharyngeal carcinoma e. Aplastic anemia c. Choose the single most likely cause of dysphagia from the options? a.3. 433. Alcohol hallucinosis e. Exam: bruises on childs back. When she is eating. IBS A 45yo woman complains of pain in her hands precipitated by exposure to the cold weather.1. she can feel food suddenly sticking to the gullet. Check child protection register b. Wernicke’s encephalopathy c. Family hx c. WBC=6. SLE A 30yo man complains of episodes of hearing music and sometimes threatening voices within a couple of hours of heavy drinking. What is the most suitable tx? a. What is the most likely dx? a. Temporal lobe dysfunction A pt had TIA which he recovered from. Antihistamine PO c. Skeletal survey d. Esophageal carcinoma b. Antibiotic drops d. ITP e. XR shows multiple callus formation in the ribs. It is usually relieved with a drink of water. What is the single most likely dx? a. She is breathlessness on walking. Blood: Hgb=11. What other action should be taken? a. Antibiotic PO b. He has a hx of stroke and exam shows HR in sinus rhythm. 434.

TB adenitis c. Pneumocystis jerovii A 72yo man is found to be not breathing in the CCU with the following rhythm. Streptococcus c. What is the most likely dx? a. Subarachnoid b. Exam: caseating granulomata found in LN. 437. c. Lymphoma b. Add warfarin d. 436. Subparietal e. Add clopidogrel and statin e. Extradural d. Goiter e. c. Hippocampal hallucinations d. Subdural c. Brain ventricles A schizophrenic pt hears people only when he is about to fall asleep. SVT VT VF Atrial fib Atrial flutter . In which space did the bleeding occur? a. CT brain shows ring enhancing lesions. b. Hypnopompic hallucinations b. Add statin only A 40yo woman suddenly collapsed and died. What is the most appropriate dx? a. Thyroid carcinoma d. e. NHL e. Hyponogogic hallucinations c. fever and enlarged cervical LN. it was found that there a bleed from a berry aneurysm from the circle of Willis. Toxoplasmosis d. CMV b.435. What is the single most appropriate option? a. 438. d. Auditory hallucinations A pt who came from India presents with cough. Delirious hallucinations e. At the post-mortem autopsy. Thyroid cyst A 44yo man comes with hx of early morning headaches and vomiting. 439. What is the most likely dx? a.

Pseudobulbar palsy e. Bulbar palsy b. Vestibule-cochlear nerve . As the hip is flexed external rotation is increased. Surgical extraction of lens 444. A 38yo female presents with sudden loss of vision but fundoscopy is normal. What is the single most likely dysphagia? a. What is the single most appropriate option? a. The food suddenly sticks in the middle of the chest. He has a bovine cough and fasciculating tongue. A 16yo teenager was brought to the ED after being stabbed on the upper right side of his back.440. Peripheral iridectomy e. Corticosteroids d. There is limitation of flexion. Pilocarpine eye drops c. Slipped femoral epiphysis e. Reactive arthritis d. A barium meal shows a ‘corkscrew esophagus’. Pharyngeal pouch d. A 15yo boy presents with a limp and pain in the knee. but she can clear it with a drink of water and then finish the meal without any further problem. Choose the single most likely cause of dysphagia from the given option? a. Hemothorax c. Glossopharyngeal nerve c. What is the single most appropriate tx? a. Esophageal carcinoma c. Osgood-schlatter disease c. Erect CXR revealed homogenous opacity on the lower right lung. A 65yo man with difficulty in swallowing presents with an aspiration pneumonia. Accessory nerve b. trachea was centrally placed. A 55yo woman complains of retrosternal chest pain and dysphagia which is intermittent and unpredictable. Pneumonia d. Hypoglossal nerve d. What is the most probable explanation for the XR findings? a. She a similar episode about 1 y ago which resolved completely within 3m. Pharyngeal pouch e. Empyema 442. Exam: mild weakness of right upper limb and exaggerated reflexes. Plummer-vinson syndrome 443. Esophageal spasm d. abduction and medial rotation. Transient synovitis of the hip 445. Pneumothorax b. Exam: leg is externally rotated and 2cm shorter. A 64yo woman has difficulty moving her right shoulder on recovering from surge ry of the posterior triangle of her neck. Sometimes as he swallows food it comes back through his nose. Pan retinal photo coagulation b. Tension pneumothorax e. Esophageal carcinoma c. Vagus nerve e. Esophageal candidiasis b. Juvenile rheumatoid arthritis b. Choose the most likely dx? a. Systemic sclerosis 441.

Goiter e. When she is outdoors. A 76yo woman has become tired and confused following an influenza like illness. Aortic LN g. Pre-aortic LN f. Pain and temp sensation are impaired in the upper limbs. swallowing difficulties. Inguinal LN h. CT 450. Hypoglycemia e. What is the most likely dx? a. He has a lump in front of his neck which moves on swallowing. Hysteria e. SSRI c. MAO inhibitors e. He also complains of palpitations. MS b. she hears people say that she is evil and needs to be punished. A 65yo woman says she died 3m ago and is very distressed that nobody has buried her. Psychotic depression d. Lymphoma b. Iliac LN b. A 32yo man has OCD. What is the best tx? a. A 50yo woman presents following a fall. Which of the following LN is involved? a. External iliac LN e. She is also breathless with signs of consolidation of the left lung base. Reassure c. Reassure 451. Head roll test b. Submandibular LN d.446. Electrolyte imbalance 449. What is the most likely dx? a. Advice on posture d. Infection toxicity d. TB adenitis c. A pt presents with weight loss of 5kgs despite good appetite. sweating and diarrhea. What would be the most appropriate next step? a. Drug toxicity b. TCA d. Thyroid Ca d. Mania c. and has bilateral wasting of the small muscles of her hands. Toxic confusional state 452. Thyroid cyst 448. Tongue fasciculations are present and both legs show increased tone. Submental LN c. MND . stiff legs. CBT b. A 37yo man with an ulcer on the medial malleolus. She reports pain and weakness in her hands for several months. What is the most likely explanation for her symptoms? a. What is the most appropriate dx? a. pyramidal weakness and hyper-reflexia with extensor plantars. Reflexes in the upper limbs are absent. Schizophrenia b. A young pt is complaining of vertigo whenever she moves sideways on the bed while lying supine. Deep cervical LN 447. Delirium tremens c. Carotid Doppler e.

Pernicious anemia c. What is the single most likely tx? a. She is febrile. Spirometry shows a decreased tidal volume and vital capacity. What is the most likely dx? a. 459. CBC normal apart from raised MCV. Churg-strauss syndrome c. What is the most probably dx? a. diarrhea and her skin i s lemon yellow in color. 4 x weight(lbs) x area of burn = ml of fluids b. Leukemia d. Lymphoma A 72yo woman who had a repair of strangulated femoral hernia 2 days ago becomes noisy. What is the single most appropriate dx? a. 4 x weight(kgs) x area of burn = ml of fluids d. Syringomyelia e. 4. BP=120/80mmHg. Syringobulbia d. Myasthenia gravis Which of the following formulas is used for calculating fluids for burn pts? a. 458. Carotid massage has been done as first instance. Vancomycin A 56yo man has symptoms of sleep apnea and daytime headaches and somnolence.453. Exam: pulse=170bpm. Piperacillin + tazobactam c. His CXR shows fluffy nodular shadowing and there is PMN leukocytosis. Also complaint severe weight loss. ITP e. Co-amoxiclav b. Hypoglycemia An old lady had UTI and was treated with antibiotics. She then developed diarrhea. What is the single most appropriate dx? . c. weight loss. malaise. Cryptogenic organizing d. 4 x weight(kgs) x area of burn = L of fluids c. Exam: tachypnea. Extrinsic allergic alveolitis e.5 x weight(kgs) x area of burn = dL of fluids A 65yo male presents with dyspnea and palpitations. cough and SOB. Amilodipine c. 454. Progressive massive fibrosis A 35yo lady is admitted with pyrexia. DC cardioversion d. Wernicke’s encephalopathy d. cyanosis. Delirium tremens c. 457. Ceftriaxone d. Infection toxicity e. 456. Adenosine b. 455. Electrolyte imbalance b. 4 x weight(lbs) x area of burn = L of fluids e. CBC = high MCV. Beta blocker A 48yo farmer presented with fever. Lidocaine e. aggressive and confused. Ankylosing spondylitis b. What is the next step of the management? a. Aplastic anemia b. coarse end inspiratory crackles and wheeze throughout.

He has changed his spectacles thrice in 1 yr. What is the single most appropriate tx? a. Corticosteroids d. Acute MI b. Celiac disease c. deluded and disoriented state. Progressive massive fibrosis c. She says that she had headache. Ankylosing spondylitis d. What is the cause of her death? a. Delirium tremens c. What is the most probable reason for his condition? a. Motor neuron disease b. a. GCS=13.460. CXR d. Acute pericarditis e. Analgesics alone A 55yo woman was found collapsed at home. Pneumococcal pneumonia b. 465. myalgia and joint pain like one week ago. Cardiac tamponade An 18yo previously well student is in his 1st year at uni. 462. Klebsiella e. DKA c. Head injury A young adult presents to the ED after a motorcycle crash. Good pasture syndrome f. Scleral buckling e. examination notes alcoholic breath. Drug toxicity b. Head XR A 30yo female attends OPD with a fever and dry cough. Shortly afterwards. Pilocarpine eye drops c. Tropical sprue . He has been brought to the ED in an agitated. What is the single most important initial assessment test? a. 464. MRI brain b. CXR: bilateral patchy consolidation. Legionella c. temp=37. the re is mild cupping present in the disc and sickle shaped scotoma present in both eyes. Churg-strauss syndrome e. 463. Electrolyte imbalance e. Spinal cord compression A 55yo man presents with mild headache. What is the single most likely causative organism? a. Mycoplasma d. 461. Bacterial overgrowth b. The paramedic’s report tells that the woman was immobile lately due to hip pain and that they found ulcers on the medial side of ankle. She had DM and was on anti-diabetics. The pt has bruises around the left orbital area. Infection toxicity d. Jejunal biopsy shows deposition of macrophages containing PAS (Periodic acid-schiff) +ve granules. Exam: pulse=100bpm. his GCS drops to 7. paramedics revived her but in the ambulance she had a cardiac arrest and couldn’t be saved. CT brain c. Pulmonary embolism d. CT angio brain e. What is the most likely dx? a. Chlamydia pneumonia A 46yo man is being investigated for indigestion. Pan retinal photo coagulation b.5C.

Small bowel lymphoma A 32yo woman of 38wks gestation complains of feeling unwell with fever. 467. Streptococcus c. TFT A 45yo IV drug abuser is brought into the ED with complaint of fever. Head trauma c. CT brain c. shivering. HUS c. Toxoplasmosis d. Whipple’s disease e. Chlamydia pneumonia . These symptoms started after an episode of bloody diarrhea 4days ago. TTP b. rigors and abdominal pains. 471. 470. She is in a loving relationship and has no probs at work or home. NHL e. Inv: CXR=bilateral cavitating bronchopneumonia. The pain was initially located in the abdomen and was a/w urinary freq and dysuria. Mycoplasma b. Each episode usually resolves after a few hours. Hemophilus b. d. Pneumocystis jerovcii A 62yo man who was admitted for surgery 3days ago suddenly becomes confused. dizziness and anxiety for 4months. Obvious cognitive impairment A 10yo girl presents with pallor and features of renal failure. What is the single most likely causative organism? a. Collateral info b. She says that she has felt occasional uterine tightening. She has hematuria as well as proteinuria. Acute fatty liver of pregnancy b. Alcohol consumption b. Hx of anxiety d. 469. LFT e. malaise. What is the ne xt step in her management? a. Exam: temp=39C. ARF A 40yo woman has had intermittent tension. HSP e. Acute pyelonephritis c. The serum urea and creat are elevated. His attn span is reduced. Cholecystitis e. BP=100/70mmHg. pulse=110bpm. She said she takes alcohol to make her calm. What single aspect of the pt’s hx recovered in his notes is most likely to aid in making the dx? a. He is restless and physically aggressive and picks at his bed sheets. Staphylococcus c. What is the most probable dx? a. 468. CTG is reassuring. SOB and productive cough. CBC d.466. UTI A 32yo pt presents with cervical lymphadenopathy and splenomegaly. Select the most likely dx? a. What is the single most appropriate option? a. The pain has now become more generalized specifically radiating to the right loin. Prescribed med e. Roung ligament stretching d. ITP d.

Mcburney’s point b. Gram -ve diplococci in sputum c. Gram +ve diplococci in sputum . Mania d. unkempt and sad with poor eye contact. Exam: acuity. She has recently lost her husband. Trochlear nerve c. She was dx with hypothyroidism for which she is receiving thyroxine. Abducens nerve b. Oculomotor nerve d. She takes no reg meds and has no significant PMH. d. Although power is normal. Anxiety b. night sweats and weight loss. Acute liver failure e. 475. field and fundi are normal. TFT showed increased TSH. Some 2hs later she felt nauseated. Left cerebellar hemisphere d. Stellate ganglion c. 477. Transpyloric plane A 32yo woman presents to the ED with headache and vomiting. Pseudomonas e.472. Right medial medulla b. Which of the following nerve is most likely involved? a. vomited and was unable to walk. PCP A 71yo woman looks disheveled. What is the single most likely causative organism? a. What is the most probable dx? a. Optic nerve e. Left lateral medulla A 28yo female presents with 1 wk hx of jaundice and 2d hx of altered sleep pattern and moods. Drug induced hepatitis A 55yo man has a chronic cough and sputum. She was decorating her ceiling that morning when the headache began. Acute on chronic liver failure b. Coagulase +ve cocci in sputum b. She also noticed that her voice had altered. PT=70s. felt mainly occipital with neck pain. Her uvulas deviated to the right and her speech is slurred. She has upbeat nystagmus in all directions of gaze with normal facial muscles and tongue movements. Termination of the spinal cord e. Left medial pons c. she can’t walk as she feels too unsteady. Deep inguinal ring d. 474. Which of the following describes her condition? a. Right lateral medulla e. Where is the most likely site of lesion? a. High mood e. Trigeminal nerve L1 level. Hyper-acute liver failure c. 473. Low mood A 62yo male comes to the GP complaining of double vision while climbing downstairs. 476. Autoimmune hepatitis d. Hallucination c. Limb exam: left arm past-pointing and dysdiadochokinesis with reduced pin prick sensation in her right arm and leg. what is the most appropriate landmark? a.

Placenta percreta A 30yo man presents to the ED with difficulty breathing. Bladder calculi e. CTG=reactive. He has returned from India. Choose the single most likely dx? a. 482. IM c. he develops swinging pyrexia and a swollen painful . Endometrial ca c. What is the most probably dx? a. Mood e. Judgement b. He smokes 5 cigarettes/day.478. Kidney trauma c. Urine microscopy shows 20-50 RBC and 10-20 WBC in each field. Cervical ca b. Placenta previa d. Thought insertion c. uterus=dates. Thought block d. Insight A pt with hodgkins lymphoma who is under tx develops high fever. She complains of bleeding after sex. Penicillin+tazobactam A 25yo woman presents with urinary freq. Schistosmiasis b. Cystitis A 65yo presents with dyspareunia after sex. 484. His blood results show WBC <2800 and has a chest infection. Scarlet fever e. Ovarian ca d. Post-op. She in menopause. What is the most probable dx? a. Agranulocytosis A 23yo man comes to the ED with a hx of drug misuse. What is the single most relevant dx? a. 483. Exam: P/A – soft and relaxed. Vaginal ca A 45yo man underwent an emergency splenectomy following a fall from his bicycle. Sputum staining for mycobacterium tuberculosis A 20yo pregnant 32wks by date presents to the antenatal clinic with hx of painless vagin al bleeding after intercourse. He has mild pyrexia. Acute follicular tonsillitis d. Pneumocystis carinii in sputum e. Co-amoxiclav b. Exam: throat reveals grey membranes on the tonsils and uvula. Abruption of placenta 2nd to pre-eclampsia b. despite mobile. Piperacillin+Co-amoxiclav e. Diphtheria b. dysuria and fever. d. 481. Erythromycin d. Piperacillin+tazobactam c. Choose the most likely tx? a. 480. Ureteric calculus d. He recognizes that he has a prb and is willing to see a psychiatrist. Which of the following terms best describes this situation? a. Antepartum hemorrhage c. Preterm labor e. Breast ca e. 479.

Smoking d. He was admitted to the psychiatry ward last year following an episode of overspending. Seasonal affective disorder A 42yo female who is obese comes with severe upper abdominal pain with a temp=37. Placenta previa d. He says that feels down. Biliary colic e. Blood culture . Infantile spasm b.8C. Atonic seizure e. Choose the single most likely dx? a. Bipolar affective disorder d. What is the most probable dx? a. Immobility b. Cyclothymia c. Hepatitis d. What is the most probable dx? a. CT head d. Absence c. Antepartum hemorrhage c. 488. Splenectomy e.485. XR orbit e. Abdominal exam: irritable uterus. Vasa previa e. His CXR shows lung atelectasis and abdominal U demonstrates a small sub-[hrenic collection. left calf. What is the single most inv? a. CTG=reactive. Intraperitoneal hemorrhage c. IOP A 24yo man asks his GP for a sick note from work. 486. EEG c. BUE c. CT scan b. Abruption of placenta 2nd to pre-eclampsia b. Ovarian torsion c. ESR b. Cholecystitis A child has just recovered from meningitis. She has 5 children. What inv will you do before discharge? a. 490. Partial simple seizure d. Sub-phrenic collection A 6m baby had LOC after which he had jerky movement of hands and feet. What is the most probable dx? a. promiscuity and distractibility. Partial complex A 24yo primigravida who is 30wk pregnant presents to the labor ward with a hx of constant abdominal pain for the last few hours. Psychosis b. She also gives a hx of having lost a cupful of fresh blood per vagina before the pain started. 489. is lethargic and has stopped enjoying playing the piccolo (his main hobby). Revealed hemorrhage A 62yo lady presents with right sided headache and loss of vision. What is the single most likely risk factor for DVT in this pt? a. Ectopic pregnancy b. 487.

491. Trimethoprim + sulfamethoxazole A 68yo woman has a sudden onset of pain and loss of hearing in her left ear and unsteadiness when walking. Severe depression d. Interferons e. She had recent contact with a young 21yo pt having widespread chicken pox. Oropharyngeal malignancy e. Cholesteatoma c. There are small lesions visible on her palate and left external auditory meatus. OM with infusion A 45yo woman has been dx with GCA and is being treated with steroids. 493. 495. Acyclovir IV +IVIG c. What is the tx? a. Pyrimethamine + sulfadiazine c. IVIG A 40yo woman presents to the GP with low mood. Moderate depression c. ACEi b. What is the other drug that can be added to this? a. d. Prader Willi syndrome d. Dysthymia e. Of note. Beta blockers c. She also complains that she can’t get out of bed until the afternoon. Pseudo depression b. 492. Atypical depression An 8yo boy is clinically obese. Clindamycin d. Acyclovir IV d. She has been dx with toxoplasmosis. Reassure e. she has an increased appetite and has gone up 2 dress sizes. Repeat LP e. What is the most suitable management for the pregnant lady? a. Spiramycin e. What is the single most likely dx? a. As a baby he was floppy and difficult to feed. Lawrence moon biedel syndrome e. 496. Aspirin d. 494. Hearing test A primiparous woman with no prv infection with herpes zoster is 18wk pregnant. Acute mastoiditis b. What is the most probable dx? a. What is the most likely dx? a. Acyclovir PO b. Pyrimethamine b. Down’s syndrome A 20yo lady is suffering from fever and loss of appetite. He now has learning difficulties and is constantly eating despite measures by his parents to hide food out of reach. IVIG . Congenital hypothyroidism c. Cushing’s syndrome b. Herpes zoster infection d.

Sinus tachycardia 499. A pt presents with purple papular lesions on his face and upper trunk measuring 1-2 cm across. What is the single most likely dx? a. QRS=140ms. Benzhexol 503. A 17yo man has acute pain and earache on the right side of his face. Hairy leukoplakia c. Kaposi’s sarcoma b. An ECG of an elderly lady who collapsed in the ED shows rapid ventricular rate of 220bpm. Primary obesity 501. Exam: perforated nasal septum. Weber test lateralizes to the right ear.497. Which of the fol lowing is the most likely to be responsible for his symptoms? a. Selegiline d. A 20yo boy is brought by his parents suspecting that he has taken some drug. Cocaine c. What is the single most likely dx? . Acute OM d. Apomorphine b. Cabergoline c. He has no other medical prbs. Mumps e. Congenital hypothyroidism c. Her eardrums are normal. CMV infection e. Down’s syndrome d. Temp=38. irritated and can’t sleep. What is the most probable dx? a. Cryptosporidium d. Opioids 502. Alcohol e. Heroine b. Acute mastoiditis b. What is the most probable dx? a. For a pt presenting with Parkinson’s disease which of the following drugs is most useful in the management of the tremor? a. tender on palpation bilaterally. What is the single most likely dx? a. Mobitz type1 2nd degree heart block e. Her hearing tests show: BC-normal. Amantadine e. Cryptococcal infection 500. A 6yo boy is clinically obese. his BMI >95th centile. He is agitated. examination is unremarkable. Ecstasy/MDMA/amphetamine d. Atrial fibrillation b. A 26yo woman has become aware of increasing right sided hearing deficiency since her recent pregnancy. Lawrence moon biedel syndrome e. Cushing’s syndrome b. OM with effusion 498. Acute otitis externa c. They aren’t painful or itchy. SVT d. His mother says that she has tried everything to help him lose weight. VT c.4C and has extensive pre-auricular swelling on the right.

Ciprofloxacin c. 24h ECG d. BP=90/70mmHg. Metronidazole d. 508. CT abdomen b. CT b. Costochondritis e. Pericarditis c. 507. What is the single most appropriate dx? a. Cushing’s syndrome b. MRI b. What inv would be the best option? a. Encephalopathy b. 505.5C. US abdomen e. Pulmonary embolism d. Endoscopy A 50yo man presents to the ED with acute back pain radiating down to his legs. Echo A 10yo boy is clinically obese and the shortest in his class. Pneumothorax A man was brought to the ED from a shopping mall after collapsing there. He has a hx of longstanding heartburn. He is conscious and answering questions now. Congenital hypothyroidism c. pulse=120bpm. His ECG shows irregular rhythm. XR abdomen c. Serum paraprotein electrophoresis What is the most appropriate antibiotic to treat uncomplicated chlamydial infection in a 21yo female who isn’t pregnant? a. He had a renal transplant last year and his mother is worried that he is being bullied. He now comes with rigid abdomen which is tender. What is the next step of the inv? a. Doxycycline . Erythromycin b. Sensorineural deafness A 58yo T1DM on anti-HTN therapy for 13yrs developed central chest pain for 45 mins while driving a/w cold sweating and dyspnea. Cefixime e. XR spine d. 506. Lawrence moon biedel syndrome e. Down’s syndrome A 45yo man had cancer of head of pancreas which has been removed. temp 37. Tympano-sclerosis d. MI b. Your choice of inv: a. Dual energy XR abruptiometry e. 509. Pseudocushing’s syndrome d. Pain which is usually relieved by lying down and exacerbated by long walks and prolong sitting. What is the most probable dx? a. Functional hearing loss c. MRI abdomen d. CT spine c. Otosclerosis e. MRI c. a.504.

Deep inguinal ring c. A 45yo manual worker presented with a 2h hx of chest pain radiating to his left arm. Candida infection e. Switch to sodium valproate 512. Anatomical e. A child complains of RIF pain and diarrhea. Oaracetamol c. What is the single most appropriate advice? a. Fundus of the gallbladder b.510. A 30yo lady has epistaxis for 30mins. Continue lithium at the same dose and stop when pregnancy is confirmed b. On colonoscopy. Transpyloric plane 515. Midpoint between the suprasternal notch and pubic symphysis. Termination of the spinal cord d. What is the single most appropriate landmark? a. Sepsis d. PT/APTT/Bleeding time are normal. CMV infection d. MCV normal. CT d. Deep inguinal ring e. Metronidazole . His ECG is normal. ECG e. Ibuprofen d. CXR c. Molluscum contagiosum c. Fundus of the gallbladder b. RBC 514. What is the single most appropriate landmark? a. Toxoplasma abscess 513. WBC normal. She is symptom free for the past 4 years. A pt presents with dysphagia and pain on swallowing. What is the single most appropriate inv? a. Continue lithium during pregnancy and stop when breast feeding c. Reduce lithium dosage but continue throughout pregnancy d. Mcburney’s point c. Sulfasalazine b. Cardiac enzymes b. Vena cava opening in the diaphragm 516. Stellate ganglion d. She is now planning her pregnancy and wants to know whether she should continue taking lithium. What should be the management? a. Transpyloric plane e. A 26yo woman had bipolar disorder for 10yrs and is on Lithium for it. Tip of the 9th costal cartilage. Her Hgb is normal. Reduce lithium gradually and stop when pregnancy is confirmed e. Plts b. V/Q scan 511. Coagulation factor c. granular transmural ulcers are seen near the ileo-cecal junction. He has sore mouth and soreness in the corners of the mouth. Where is the defect? a. What is the single most likely dx/ a. Kaposi’s sarcoma b.

Sjogrens syndrome 519. CT chest d. Angina b. She feels well but is anxious as her mother had an early menopause. Pulse oximetry . d. MI e. inhaled B2 agonist and IV hydrocortisone. He is too breathless to use a peakflow meter and i s O2 sat <90%. What is the single most appropriate inv? a. Mumps d. He is worried he may be having a heart attack. CXR c. Serum FSH/LH c. she feels better once she bends forward. Refer for anxiety management course e. He has admitted with a severe episode and is tired and drowsy. He has not improved on oxygen. A 39yo woman has not had her period for 10months. Refer for urgent cardiology opinion 522. Myofacial pain c. Pulmonary embolism 521. Exam: tenderness at mid-thoracic vertebra with spasm. Whiplash injury d.517. dryness of the mouth with peri-oral tingling and cramping of the hands. Osteoporotic fx verterbra b. b. She complains of difficulty in talking and speaking and her eyes feel gritty on waking in the morning. Dissecting aneurysm d. Serum estradiol conc. Pancreatitis 518. MI e. Crohns disease c. faintness. Rebreathe into a paper bag d. None e. A 50yo man with DM suddenly develops persistent crushing central chest pain radiating to the neck. An 8yo boy has longstanding asthma. His symptoms last 5-10 mins and have worsened since their onset 3months ago. What is the single most appropriate dx? a. A 70yo woman presents with recurrent episodes of parotid swelling. IV sedation c. A 22yo man has rushed into the ED asking for help. Transvaginal US 520. hyperventilation. C1 esterase deficiency b. What is the single most probable dx? a. CBG b. What is the single most likely dx? a. High flow oxygen b. Costochondritis (tietz’s disease) c. Sarcoidosis e. Choose the single most appropriate initial inv? a. An ECG shows sinus tachycardia. palpitations. A 60yo woman presents with acute onset of bone and back pain following a rough journey in a car. CXR shows bilateral hyperinflation. He describes recurrent episodes of fearfulness. What is the single most appropriate immediate intervention? a. Serum progesterone conc.

He has cough and there is dullness to percussion at the left lung base. Asthma d. Acute pyelonephritis b. A 45yo chronic smoker attends the OPD with complaints of persistent cough and copious amount of purulent sputum. Vaginal exam d. Interstitial lung disease b. He had hx of measles in the past. A man was operated for colorectal ca. Reassurance 528. What is the single most appropriate landmark? a. a. Just above the mid-inguinal point. Deep inguinal ring e. His pain is relieved with morphine 60mg bd PO but now he can’t swallow medications. Fentanyl patch c. A 34yo man with MS has taken an OD of 100 tablets of paracetamol with intent to end his life. Abdominal US c.e. UTI d. Sarcoidosis 530. Evaluate pt’s capacity to refuse tx c. Apex beat b. Stellate ganglion d. 5 ICS in the ant axillary line. What is the most probable dx? a. Vena cava opening into the diaphragm 526. Bronchiectasis c. COPD e. Femoral artery pulse felt b. What should be done next? a. Transpyloric plane e. Oxycodone b. Chronic pyelonephritis c. CXR . What is the single most appropriate inv? a. Establish if pt has a prv mental illness 527. What will be the next regimen of analgesic administration? a. Spirometry 523. Mcburney’s point c. Morphine 60mg IV/d d. Bronchoscopy b. He has been brought to the ED for tx but is refusing all intervention. Transpyloric plane th 525. A 68yo man has had malaise for 5 days and fever for 2 days. Assessment b. What is the single most appropriate landmark? a. Bladder stone 529. A 29yo lady admitted with hx of repeated UTI now developed hematuria with loin pain. What is the single most likely dx/ a. Morphine 240mg IV/d 524. A 23yo woman with painless vaginal bleeding at 36wks pregnancy otherwise seems to be normal. Chest drain insertion c. Exam: finger clubbing and inspiratory crepitations on auscultation. Stellate ganglion d. Vaginal US b.

534. MRI e. Endometriosis d. Phosphate binders A 26yo woman with regular menses and her 28yo partner comes to the GP surge ry complaining of primary infertility for 2yrs. V/Q scan A 5yo child was admitted with hx of feeling tired and lethargic all the time. CXR b. What is the most probable dx? a. AML c. None c. What is the single most likely dx? a. ESR=25. What other drug should be added to her tx regime? a. Vaginal exam reveals right sided cervical excitation. Bisphosphonates b. 535. 532. CML d. ALL b. Peritonism is elicited in the RIF. ALL b. Endometrial biopsy A 10yo boy who takes regular high dose inhaled steroids for his longstanding asthma has been advised to use bronchodilators to control his acute attacks. Ovarian torsion e. c. Calcium c.9. CT d. bleeding gums and sore throat since the last 3months. Day21 progesterone e. Hgb=10. What is the single most appropriate inv? a. Lymphoma A 24yo woman has 8wk amenorrhea. Peak flow rate diary d. Lymphoma A 65yo man presents with back pain. What would be the single best investigation to see whether she is ovulating or not? a. Plt=100. Basal body temp estimation b. Exam: hepatosplenomegaly. Ectopic pregnancy b. 533. Exam: splenomegaly and anemia. What is the most probable dx? a. Cervical smear c. Ovarian tumor A 64 yo woman has been treated for breast cancer with tamoxifen. 536. Vit D d. Day2 LH and FSH d. Pulse oximetry . She is apyrexial. right sided pelvic pain and vaginal bleeding. His parents are unsure when should he use his bronchodilator. CML d. He has been found to have Philadelphia chromosome. Calcitonin e. CLL e. AML c. Salpingitis c. CLL e. Blood: WBC=22.531.

CSF analysis b. Select the most likely cause leading to her symptoms? a. Nasopharyngeal cancer b. MS b. Reflexes are brisk in her arm and optic disc is pale. EMG 538. Transvaginal US . Huntingtons chorea e. EEG e. A woman presented with blurred vision and intermittent clumsiness for 3m. She also has weak spastic legs and dissociated sensory loss. Sometimes she notices blood in her stool. The histology has shown changes consistent with a hydatidiform mole. Sinus squamous cell carcinoma d. CT c. A 30yo lady complains of intermittent diarrhea. Spirometry 537. Squamous cell laryngeal cancer e. What is the single most appropriate inv in this case? a. Syringomyelia c. orientated. MRI d. Diverticulosis c. wasted and weak hands with diminished felexes. Parkinsonism 539. Exam: alert. What is the dx? a. Adenomyosis e. What is the most probable dx? a. He mentioned that he used to be a regular cannabis user. inattention on the left side and hyperreflexia of the arm. What is the single most likely dx? a. Pharyngeal carcinoma c. MND d. A 40yo man with a 25y hx of smoking presents with progressive hoarseness of voice. Pituitary adenoma c. Serum B-HCG e. Guillian-barre e. UTI 541. difficulty swallowing and episodes of hemoptysis. Freidriech’s ataxia 542. What is the single most appropriate test to confirm dx? a. Hypopharyngeal tumor 540. chronic abdominal and pelvic pain and tenesmus. Paternal blood group d. Cerebral tumor b. A 50yo lady with weak limbs when examined was found to have burn marks on finger tips. Irritable bowel disease d. Cerebellar abscess d. Inflammatory bowel disease b. A 23yo woman is being followed up 6wks after a surgical procedure to evacuate the uterus following a miscarriage. A 63yo man presents after having a seizure.e. Abdominal US b. Maternal karyotype c.

nausea and overwhelming fear. Bilateral external laryngeal nerve e. Laryngoscopy b. ECG e. A 75yo nursing home resident complains of headache. Barium swallow 544. Her CXR and ECG are normal. Syringomyelia e. clumsy gait. She has multiple bruises on her head. Vocal cords 545. Bronchoalevolar lavage e. Subdural hematoma d. Hypoglycemia e. His relatives have also noticed rather strange behavior of late and more recently he has had episodes of enuresis. There is no prv psychiatric disorder. What is the most probable dx? a. 3days later she presented with charp chest pain and breathlessness. Pituitary adenoma c. A 73yo male presents with a 12m hx of falls. Alcohol intoxication b. MRI 548. sweating. A tall thin young man has sudden pain in the chest and becomes breathless while crying. Unilateral external laryngeal nerve d. CVD d. confusion and impaired vision for 4days. Infection c.543. Which anatomical site is most likely affected? a. Pulse oximetry b. Cardiac enzymes b. LN biopsy d. A 67yo man with hx of weight loss complains of hoarseness of voice. Bronchoscopy c. CT reveals opacity in the right upper mediastinum. CT g. What is the most likely cause of confusion in this pt/ a. What is the single most appropriate inv? a. He denied any hx of difficulty breathing. A 50yo woman returned by air to the UK from Australia. CTPA d. Hyponatremia 547. Exam: disorientation to time and place. Unilateral recurrent laryngeal nerve c. What is the most probable dx? a. CT d. Normal pressure hydrocephalus 546. CXR c. Bilateral recurrent laryngeal nerve b. Dementia b. A 52yo man whose voice became hoarse following thyroid surgery 1 wk ago shows no improvement. What is the single most appropriate inv? a. On one occasion she was woken from sleep and feared she was going insane. Pheochromocytoma . V/Q scan c. V/Q scan 549. Cardiac enzymes f. What is the single most appropriate inv? a. broad-based. A 21yo woman has had several sudden onset episodes of palpitations. Bronchoscopy e.

Pneumothorax e. She sometimes suffers from severe retrosternal chest pain. Candidiasis e. What is the single most likely dx? a. scaly patch on her scalp. 552. Barium swallow reveals a dilated esophagus which tapers to a fine distal end. Lichen planus b. Antispasmodics c. Which anatomical site is most likely affected? a. Brain stem A 72yo man brought to the ED with onset of paraplegia following a trivial fall. Pulmonary embolism A 40yo woman complains of dysphagia for both solids and liquids. 554. Dissecting aneurysm b. Phobia e. 551. She attends her ANC regularly. Panic disorder c. What is the best management strategy? a. What is the single most appropriate dx? a. Cerebellum c. He was treated for prostatic malignancy in the past. Paget’s disease b. Thalamus e. Pneumonia d. Secondary d. Acute stress disorder A 55yo woman with a persistent cough and hx of smoking develops left sided chest pain exacerbated by deep breathing with fever and localized crackles. GAD d. Her left upper and lower limbs are paralyzed and she is having difficulty in speaking. 555. Her aunt has a similar undiagnosed rash on the extensor aspects of her elbows and knees. Spondylosis A 14yo girl has developed an itchy.550. Her mouth including her tongue appeared inflamed on examination. Internal capsule d. Eczema b. Smoking d. Aphthous ulcer c. Osteoporotic fx of vertebre c. What is the most probable dx? a. 553. Barium swallow A 38yo female G4 at 32wks of pregnancy presented with thick white marks on the inside of her mouth for 3wks. She smokes 20 cigarettes/day despite advice to quit. Fungal infection . b. Leukoplakia A 69yo woman has had a stroke. Reassurance b. What is the single most probable dx? a. Endoscopic diverticulectomy e. Hippocampus b. Dilatation of the LES d. She had a similar patch that cleared spontaneously 2yrs ago. Multiple myeloma e. Pericarditis c.

She is now complaining of RUQ pain different from wound pain. Clopidogrel e. Hypercalcemia A 28yo woman has been admitted at 38wks gestation. MRCP e. Coagulation profile b. In the ED he is given oxygen. Percutaneous angiography c. morphine. Congenital sensorineural deficit d. Her hearing tests show: BC normal. Lichen planus e. 558. Diazepam IV b. Chronic secretory OM with effusion c. 557. What inv will you do immediately? a. C1 esterase deficiency c. Immediate delivery e. Hydralazine IV d. Crohn’s disease d. 559. symmetrical AC threshold reduced bilaterally. None A 10yo girl has been referred for assessment of hearing as she is finding difficulty in hearing her teacher in the class. Psoriasis A pt after transurethral prostatic biopsy. Her BP=190/120mmHg and proteinuria +++. Hypocalcemia d. ECG=ST elevation. Anticoagulant & heparin d. What is the single most likely dx? a. 561. Liver US d. Beta blockers b. c. weber test shows no lateralization. What is the next step of management? a. 560. Chronic perforation of tympanic membrane b. Otosclerosis e. Sarcoidosis A 48yo presents with severe chest pain since the last 40mins. LFT c. Hyperkalemia b. Immediately following admission she has a grand-mal seizure. GTN. Aspirin .556. Bulimia nervosa b. What is the single most likely dx? a. Impetigo d. What is the single most appropriate initial management? a. Magnesium sulphate IV A 27yo woman had pre-eclampsia and was delivered by C-section. Hyponatremia c. Hypernatremia e. Fetal CTG c. Presbycusis A thin 18yo girl has bilateral parotid swelling with thickened calluses on the dorsum of her hand. What electrolyte imbalance can he develop? a. Bloods=increased troponin levels. Mumps e.

increased frequency in urination and weight loss. A 34yo man from Zimbabwe is admitted with abdominal pain to the ED. A 34yo female presents with a foul smelling discharge. Exam: white linear lesions are seen on the wrists and elbows and red papules are present on the penis. gonorrhea. Gardenella only 563. gardenella c. A 45yo man with colon cancer now develops increased thirst. IV insulin e. what is the most appropriate management? a. An AXR reveals bladder calcification. A 78yo nursing home resident is revived due to the development of an intensely itchy rash. Galactosemia b. Topical betnovate d. Topical ketoconazole e. Rh incompatibility e. gardenella e. Chlamydia. IV fluid stat c. Dressing 567. He is crying continuously. Subcutaneous insulin 565. What is the most appropriate management? a. TB e. Refer to burn unit b. Otitis externa . Now it’s noticed that he increases the TV volume. Insulin long acting c. His weight pain is poor and his stools are pale. What is the next step of management? a. Schistosoma mansoni b. His fasting blood glucose=9mmol/L. Chlamydia. A 4yo has earache and fever. G6PD deficiency d. Short acting insulin before meal d. gardenella d. His preschool hearing test shows symmetric loss of 40db. Chlamydia. Oral hypoglycemic b. Congenital viral infection 564. OM with effusion b. What is the most likely dx? a. Has taken paracetamol several times. Antibiotic d.562. What is the most likely dx? a. A 6wk formula fed baby boy is found at the child health surveillance to be deeply jaundiced. Topical selenium sulphidehyosine 568. Analgesia e. What set of organisms are we looking for to be treated here? a. What is the most likely cause? a. gonorrhea b. Topical permetrin b. Referral to GUM clinic c. Leishmaniasis d. Sarcoidosis c. A 6yo came with full thickness burn. Biliary atresia c. Schistosoma hematobium 566. Gonorrhea.

Follow up in pediatric OPD e. c. Facial XR A 15m child is due for his MMR vaccine. Hairy leukoplakia b. Change to IV amoxicillin + gentamicin c. photophobia and fluctuating LOC. Defer immunization for 2wks b. Assessment shows multiple bruises and a fx of the left humerus which is put in plaster. Add IV co-amoxiclav e. dry cough and breathlessness. Cryptococcal infection An 18m boy has been brought to the ED because he has been refusing to move his left arm and crying more than usual for the past 24h. What is the single most appropriate action? a. What is the most appropriate initial inv? a. CT brain is normal. He is febrile with acute OM. 573. Toxoplasma abscess A 14yo boy fell and hit his head in the playground school. MRI d. 574. Continue IV ceftriaxone as mono-therapy A pt presents with fever. Follow up in fx clinic d. CSF shows lymphocytosis but no organism on gram stain. Add IV ciprofloxacin d. Candida infection e. CMV infection d. Cryptococcal infection e. Give half dose of vaccine d. Candida infection c. He has swelling and tenderness of the right cheek with a subconjuctival hemorrhage on his right eye. 570. Following a LP the pt was started on IV ceftriaxone. Oxygen saturation is normal at rest but drops on exercise. Skull XR e. What is the single most appropriate next step? a. TB c. EEG c. Don’t give vaccine c. Admit under care of pediatrician b. He is tachypneic but chest is clear. 571. Cholesteatoma d. He has recently been looked after by his mother’s new bf while she attended college. Tonsillitis A pt presents with gradual onset of headache. 572. What is the single most likely dx? a. Give paracetamol with future doses of the same vaccine . Pneumocystis carinii infection d. CSF culture = listeria monocytogenes. neck stiffness. Follow up with GP A 74yo female presents with headache and neck stiffness to the ED. CT brain b.569. He didn’t lose consciousness. There is a fam hx of egg allergy. CSOM e. Discharge with painkillers c. What is the single most likely dx? a. CMV infection b. Add IV amoxicillin b. What is the appropriate tx? a.

Blood was taken for test. ACEi b. Postural hypotension . Oral laxative d. What will you do next? a. Urinary catheterization 581. What measure will protect her kidneys from contrast? a. C1 esterase deficiency b. A 40yo man with marked weight loss over the preceding 6m has bilateral white. HIV disease d. She has been on analgesics for 3wks for her back pain. Proceed with standard immunization schedule 578. Dextrose c. Beta blockers c. A 65yo woman is undergoing coronary angiography. What is the most specific cause for her symptoms? a. Give paracetamol with future doses of the same vaccine e. A 3m baby was miserable and cried for 2h following his 1st routine immunization with DTP. Furosemide b. left sided abdominal pain and lymphadenitis. What is the single most likely dx? a. What is the single most appropriate action? a. 0.9% saline 580. Sjogren’s syndrome 577. A 65yo man with HTN develops gingival hyperplasia. 0. Start broad spectrum IV antibiotics c. Nifedipine e. Crohns disease c. She is in obvious discomfort. Steroid side effects b. Sarcoidosis e. abdominal pain and sudden falls in the morning. Phosphate enema e. A 33yo lady with Hodgkin’s lymphoma presents with temp=40C. HiB and meningitis. On rectal exam: fecal impaction.e. High fiber diet c. Defer immunization for 2wks b. Don’t give vaccine c.45% saline d. Monitor pyrexia 576. Oral antibiotics d. An 83yo woman who is a resident in a nursing home is admitted to hospital with a 4d hx of diarrhea. Crohns disease d. What is the single most likely dx? a. Sarcoidosis 579. Codeine phosphate for pain relief b. Proceed with standard immunization schedule 575. CBC e. A 26yo woman being treated for a carcinoma of the bronchus with steroids presents with vomiting. Wait for blood test b. What is the single most appropriate immediate management? a. vertically corrugated lesion on the lateral surfaces of the tongue. She has had no weight loss or change in appetite. Give half dose of vaccine d.

She is on oral steroids. ALL c. Tetracycline d. IV steroids A 30yo man is suffering from fever. Aplastic anemia d. 583. Plasma osmolality of 335mosmol/kg and urine osmolality of 700mosmol/kg d.582. rash and photophobia. CML e. CT head b. Which is the best medication for this condition? a. Plasma sodium of 126mmol/l b. Which of the following results would be the most useful in confirming the dx of diabetes insipidus after a water deprivation test (without additional desmopressin)? a. Acute OM c. What is the single most likely dx? a. He has been noticed to turn up the vol on the TV. ACEi d. Foreign body e. What investigation should be done? a. 585. Adrenal insufficiency d. Acyclovir e. IFN e. When examined on arrival his GCS=15 and then at night his GCS deteriorated to 12. Plasma sodium of 150mmol/l c. His pre school hearing test shows symmetrical loss of 40dB. She also seems to have features of meningitis. AML b. Cushing’s disease A 78yo woman presents with unilateral headache and pain on chewing. 587. ESR=70mm/hr. chest infection and thrombocytopenia. HRT c. Ampicilling b. XR skull c. Doctors are suspecting he is suffering from meningitis. 586. He has bilateral dull tympanic membranes. Dexamethasone A 15yo girl was admitted with anemia. What is the most likely dx? a. What is the appropriate additional tx? a. IV mannitol d. has a mild earache relieved by paracetamol . Cefotaxime c. Shift to OR A 4yo boy who prv had normal hearing. Drill a burr hole e. Bisphosphonates b. Acute otitis externa b. Conn’s disease e. Plasma osmolality of 280mosmol/kg and urine osmolality of 700mosmol/kg . He is referred to the local endocrine clinic. Some 6m ago he had a significant head injury as the result of a RTA. CLL A pt was admitted to the ED after a head injury. She was brought again with fever and the same symptoms a few days later. c. OM with effusion An 18yo man presents to his GP with thirst and polyuria. She was treated and her symptoms had regressed. 584. Ear wax d.

Which of the following structures will be incised? a. Idiopathic hypersomnia b. Chest hyperventilation syndrome d. Reassurance d. Oropharyngeal malignancy e. Transverse carpel ligament c. index and middle fingers for a while. Hyperkalemia c. A 58yo pt presents with altered bowel habits and bleeding per rectum. Hypercalcemia b. A 55yo man has weight loss. Extensor retinaculum 591. Assess developmental milestones c. A 35yo pregnant woman has been having tingling and numbness of her thumb. Exam and sigmoidoscopy showed an ulcer. MRI brain 593. Colorectal carcinoma b. Tonsillitis 589. A 75yo man has left-sided earache and discomfort when he swallows. Refer to speech therapist e. What is the single most likely biochemical abnormality to be a/w the condition? a. A 42yo man has been tired and sleepy for the last few weeks in the morning. Plasma osmolality of 335mosmol/kg and urine osmolality of 200mosmol/kg 588. Herpes zoster infection d. UC e. His work has starte getting affected as he feels sleepy in the meetings. There is ulceration at the back of his tongue and he has a palpable non-tender cervical mass. Hypocalcemia e. What is the single most likely dx? a. Flexor digitorum profundus b. What is the single most likely dx? a. His BMI=36. Narcolepsy c.e. A mother is concerned that her 18m son has a vocabulary of ten words but can’t form a sentence. Arrange hearing test b. Acute mastoiditis b. Crohns disease d. IBS 592. Inv confirms squamous cell carcinoma in the left bronchus. He smokes 20 cigarettes/day. Hypoernatremia d. She has been treated with local steroids but it hasn’t helped her much and now she has planned to undergo a surgical procedure. dyspnea and syncope. Dental abscess c. OSAS e. What is the best management strategy? a. Hypomagnesium . Celiac disease c. Palmar aponeurosis d. What is the single most likely dx? a. REM-related sleep disorder 590.

Korsakoffs psychosis d. K+ 5. Exam: both testicles are palpable in the scrotum. Pharyngeal pouch e. A 37yo woman was admitted for femur fx repair after a RTA. Celiac disease b. Esophageal spasm d. Benign structure b. IBS 598. Systemic sclerosis 595. A 36yo pt came with diarrhea. Elective herniotomy d. K+ 3.5mmol/l c. What is the most appropriate management strategy? a. Autonomic neuropathy b. What is the most likely dx? a. Wernickes encephalopathy c. bleeding. K+ 4. A 60yo diabetic pt on anti-diabetic medication developed diarrhea. Na+ 130mmol/l. Sometimes he wakes up at night with a feeling of suffocation.594. Septal branches d. A 72yo man presents with intermittent difficulty in swallowing with regurgitation of stale food materials. Emergency herniotomy + orchidopexy e. None 599. Right coronary artery .5mmol/l d. Which artery runs in the anterior inter-ventricular groove? a. Reassurance b. Crohns disease 600. What is the single most likely dx? a. On the 4th post-op day she became confused and starts picking on her bed sheets and complains of seeing spiders all over. Emergency herniotomy c. What is the electrolyte imbalance found? a. K+ 2. Circumflex artery e. UC d. A 72yo woman who is taking look diuretics is suffering from palpitations and muscle weakness. Infective c. Choose the single most likely cause of dysphagia? a. Na+ 140mmol/l.5mmol/l b. Left ant descending artery c. Psychotic depression 597. Na+ 150mmol/l. Acute marginal branch b. Celiac disease d. Elective herniotomy + orchidopexy 596.5mmol/l e. weight loss and fistula. Na+ 130mmol/l. Esophageal carcinoma c. What is the most likely cause for his diarrhea? a. Delirium tremens b. A 9m child is brought to the ED with an irreducible firm swelling which descended into the left groin when the child has been crying. Crohns disease c.

The child has no meaningful words. Infection e. What is the most appropriate inv? a. Compound fx d. CA 153 c. What is the single most likely dx? a. 2nd person auditory hallucinations b. Regeneration d. Neoplastic 604. What is the best management strategy? a. ACEi b. high temp of 39C. She doesn’t laugh and has poor interaction with her siblings. A 65yo woman had an excision of colonic tumor 3yrs ago. Reassure d. A 32yo lady complains that she hears everyone saying that she is an e vil person. multiple cotton wool spots in both eyes. Epiphyseal fx c. is unable to sit unaided and can’t play with her toys. 3rd person auditory hallucinations c. CA 199 d. What is the single most likely dx? a. None e. ARBs d. A 46yo African-Caribbean man is found to have BP=160/90mmHg on 3 separate occasions. AFP 607. Exam: large. Gedankenlautwerden 606. Now she is losing weight and fe els lethargic. A 53yo had a dental extraction after which he recently had a mitral valve prolapse. MRI brain 602. Refer to speech therapist e. CA 125 b.601. CCB . Spiral fx 605. cardiac failure and new cardiac murmur. His radial nerve was affected. Arrange hearing test b. Exam: pale but no abdominal findings. Pneumocystis carinii infection e. What is the best initial tx? a. A mother presents with her 12m daughter. A pt presents with progressive visual deterioration. Beta-blockers c. Kaposi’s sarcoma b. Cryptosporidium c. What type of hallucinations is she suffering from? a. CEA e. Echo de la pense d. A 12yo boy with a hx of fall on an outstretched hand was brough to the ED with swelling and pain around the elbow. Angulated fx b. Atheroma b. Cryptococcal infection 603. Assess developmental milestones c. Congenital c. What is the type of fx? a. CMV infection d.

Hypoglycemia c. What is the dx? a. Extensor carpi ulnaris b. Dementia b. 1:500 d. 1:5000 609. Which of the following reflexes and innervating spinal nerves are correctly paired? a. Extensor pollicis brevis e. He has poor concentration and impaired short-term memory. 4h later on examination showed that the cervix was still 3cm dilated. A 39yo woman will undergo tubal sterilization and she wants to know the failure rate of this type of sterilization. A pt with prv hx of HTN. Ankle jerk – L5 c.608. Extensor pollicis longus 611. She says this has occurred at number of times. What is the single most likely tendon to have been damaged? a. Biceps jerk – C7 & C8 d. What is the single most appropriate management for her labor? a. the MCP joint of the thumb remained flex. maintains consciousness and no confusion. Anal reflex – S1 b. Wernicke’s encephalopathy d. What is the single most appropriate inv? a. Vasovagal syncope d. He admits to drinking large amounts of alcohol for the last 20yrs. a. Extensor indicis d. He subsequently found that although he could extend the interphalangeal joint of his right thumb. Schizophrenia e. She has slight eczema and her mother has asthma. she has no symptoms or abnormal physical signs. A 62yo man with rheumatoid arthritis struck his hand against a door. Korsakoff psychosis 613. 1:1000 e. Extensor digitorum c. Stokes Adams attack b. External rotation e. A 50yo man complains of being pursued by the police for a crime he denies committing. These 2 acute episodes responded quickly to bronchodilator. 1:50 b. IV syntocin drip 614. Epilepsy 612. Repeat vaginal examination in 4h b. the membranes have ruptured and the cervix is 3cm dilated. Knee jerk – L3 & L4 e. A 68yo lady complains of falls to the ground without any warning. CXR . Hallucination c. Triceps jerk – T1 610. Drop attacks e. What is the most probable dx? a. C-section d. A 6yo girl has had 2 short episodes of cough and wheeze over the last 12m. 1:200 c. CTG c.

620. Grave’s disease c. b. Capillary blood gases b. Spirometry e. She has not started her periods yet and has severe acne. What is the single most appropriate inv? a. PCOS e. Ramipril A 27yo waitress has pelvic pain. Exercise challenge e.615. Exam: lower abdominal mass is felt. dysmenorrhea and increasingly heavy periods. Peak flow rate diary c. She also complains of dyspareunia. Uterine fibroid c. 617. There is generalized pelvic tenderness without peritonism. Which single drug is most likely to have caused this? a. What is the most probable dx? a. CXR c. Sweat test A 45yo man had recently started taking anti-HTN therapy. What is the most likely symptom this pt is suffering from? a. Amlodipine b. Cushing’s syndrome b. Renal carcinoma A 14yo boy with asthma suddenly developed chest pain and increasing breathlessness during a game of football. He has reduced breath sounds on the right side. Pulse oximetry d. When seen in the ED he was not cyanosed. Pelvic congestion syndrome d. Bendroflumethiazide c. 619. Acquired hypothyroidism d. Lorsartan e. a high insulin level is found. Biliary colic e. Doxazosin d. What is the most probable dx? a. Pelvic US is normal. 616. 6m later his RBS=14mmol/l. CT chest d. Ovarian carcinoma c. Thought block d. Ectopic pregnancy b. Thought insertion b. Thought withdrawal c. What is the most likely dx? a. Tubal pregnancy A 14yo girl is clinically obese. His oxygen saturation is 94% on air. PID e. Among her inv. Though broadcasting . 618. She believes that the staff and other pts know exactly what she is thinking all the time. MRI chest A 36yo woman was recently admitted to a psychiatric ward. Endometriosis b. Hematometrium d. Addison’s disease An 18yo girl with primary amenorrhea complains of severe abdominal pain every 4-8weeks which is now getting worse.

What is the single best term for this man’s condition? a. Femoral nerve b. Delusion of control d. Permethrin 623. Biochemistry: low serum albumin. A 16yo boy following a RTA was brought to the ED with a swelling and deformity in his right thigh. A 60yo woman is admitted to the hospital after a fall. He also has sensory loss on the same side of the foot after 2h. What is the most likely dx? a. Seasonal depression 622. Tropical sprue e. Sural nerve c. Whipple’s disease c. feels guilty over minor issues and feels very negative about the future. Chlorphenaramine c. Peroneal nerve d. Sciatic nerve 625. After this he was unable to dorsiflex his left foot and had loss of sensation in the web space between the big toe and the 2 nd toe. A 19yo man presents for the 1st time with a firm and unshakable belief that he is being followed by terrorists who are plotting against him. Crohn’s disease d. Hallucination 621. On jejunal biopsy. She is noted to have poor eye contact. A 25yo woman is presenting with diarrhea and abdominal bloating over the last 4m.e. Psychosis e. Delusion of grandeur c. A 70yo woman lives in a nursing home following a stroke has developed reddish scaly rash on her trunk. What is the most likely dx? a. Delusion of reference . Coal tar d. Common peroneal nerve d. Mild depression b. She has also found it difficult to concentrate. Exam: she has blistering rash over her elbows. 1% hydrocortisone ointment e. Aqueous cream b. Severe depression d. she admits to feeling low in mood and losing enjoyment in all her usual hobbies. She has many scratch marks on her limbs and trunk with scaling lesions on her hands and feet. there is shortening of the villi and lymphocytosis. Which structure is involved in this fx? a. Which of the following was affected? a. feels that she is not good at anything. Moderate depression c. When asked how she is feeling. Femoral artery b. A man sat cross-legged for about 30mins. Delusion of persecution b. Dorsalis pedis 624. Exam: airway is patent and is found to have a pulseless leg. Cystic fibrosis 626. Celiac disease b. Posterior tibial artery c. What is the single most appropriate initial tx? a. Giardiasis f. calcium and folate conc.

A teacher had a respiratory infection for which she was prescribed antibiotics. A 19yo female is brought in by her parents. Laryngitis e. Complete heart block 631. Medical admission 628. Psychiatric referral for admission b. Atrial myxoma e. she lost her voice completely. Allergic reaction d. What will you do to confirm the dx? a. Auto antibodies d. Dark ground microscopy from mouth ulcer c. Functional dysphonia/vocal cords 630. Immunosuppression e. Pulmonary regurgitation d. After the antibiotic course when she rejoined school. A 43yo lady is admitted with pyrexia. PMH is remarkable for childhood eczema. What is the mechanism of itching? a. Recurrent laryngeal nerve palsy b. Exam: linear tracks on the wrist. Delusion of nihilism 627. Which inv is most likely to lead to a dx? a. Start antidepo e. She is satisfied with it. arthropathy. She says that 2d ago she had come in contact with a nursing home inmate with similar symptoms. Destruction of keratinocytes c. Angioedema c. There is an early diastolic sound and a mid-diastolic rumble. Dengue fever 632. Infection b. None 629. Family counselling c. abdominal pain and vomiting. breathlessness and syncope. A lady who works at a nursing home presents with itching. A 28yo man presents with a maculopapular rash over his trunk and palms. Ventricular ectopics c. He had a penile ulcer which healed 2wks ago. He also has numerous mouth ulcers. Mitral regurgitation b. A 34yo man complains of arthralgia. What is the most likely cause? a. US KUB b. PCR for treponemal and non-treponemal antibiodies b. Urea and creatinine are slightly elevated with urinalysis demonstrating red cell casts. She was recently dx with pulmonary emboli. Blood culture for treponema d. They are concerned about her BMI which is 12. Laryngeal obstruction by medication d. IVU e. What is the single most appropriate dx? a. a facial rash that is worse in the summer and hematuria. Renal biopsy . What is the next step? a. Her JVP is elevated with prominent a-waves. Social service d. Joint aspiration c.e.

A 52yo woman speaks rapidly without any pause and ignores interruptions. Broca’s aphasia c. Bereavement . Scleritis 636. ECG also shows progressive prolongation of PR interval until a QRS complex is dropped. Wernicke’s aphasia d. Acute dacrocystitis c. A 40yo man has pain. The redness extends on to the nasal peri-orbital area and mucoid discharge can be expressed from the lacrimal punctum. PTSD c. What is the most likely dx? a. Mobitz type II 2nd degree heart block 637. redness and swelling over the nasal end of his right lower eyelid. GAD e. CT abdomen 634. Pressure of speech e. 2yrs ago. VT c. She appears to be tachycardic and in shock. 1:16 e. What term best describes this kind of speech? a. a. Flight of ideas b. Mobitz type I 2nd degree heart block e. A 30yo woman has been feeling low and having difficulty in concentrating since her mother passed away 2m ago. A 56yo woman has had severe abdominal pain for 24h radiating to her back and is accompanied by nausea and vomiting. Retrobulbar neuritis e. No genetic link d. Acute conjunctivitis b. Depends on the genetic make up of the partner 635. The eye is watery with some purulent discharge. What is the most probable dx? a. What is the most likely inv to confirm dx? a. A 32yo female with axillary freckles and café au lait spots wants to know the cahnces of her child also having similar condition. Acut iritis d. A 60yo lady has severe chest pain. She was found to have gallstones. US abdomen b. What is the single most appropriate clinical dx? a. Serum lipase d. Angiography e. 1:2 b. Verbal dysphasia 638. LFT c. SVT d. Adjustment disorder b. Atrial fibrillation b. ECG shows changes of inferior wall MI. She feels lethargic and tends to have breathlessness and tremors from time to time. 1:4 c. She doesn’t even pause to take enough breaths.633. Panic disorder d.

Plenty of fluids c. A 25yo woman complains of dizziness. What is the most likely dx? a. He was arrest 8m ago for trying to rob a bank claiming it as his own. What would be the most appropriate management for this child? a. visual disturbances and anxiety which keep coming from time to time. vomiting. Haloperidol b. Desipramine d. Postural hypotension . Wht is the most appropriate inv? a. A 75yo woman presents to the breast clinic having noticed that she has had a blood stained discharge from the left nipple. Citalopram c. Punch biopsy d. Stereotactic biopsy 643. Vertebrobasilar insufficiency e. Fluoxetine e. Tamsulosin e. A 50yo man presents with low mood. Behavioural therapy d. anhedonia and insomnia. Which drug is most likely to benefit him? a. poor concentration. Restrict fluid intake 641. ACEi e. He has had 2 episodes of increased activity. MRI c. Carbamazepine e. Panic disorder b. Haloperidol c. IV dextrose 642. Lithium b. FNAC b. Most of the attacks are a/w sudden change in posture. Reduce contrast dye b. A 4yo boy is brought by his parents with complains of wetting his bed at night and whenever he gets excited. nausea. BPPV d. promiscuity and aggressive behavior in the past.639. A 34yo DM pt is undergoing contrast radiography. Clozapine 640. Which drug is most likely to cause these symptoms? a. Exam: blood stained discharge with dry flaky skin noted on the left areola. A 32yo man on psychiatric medications complains of inability to ejaculate. What measure should be taken to prevent renal damage with contrast dye? a. Oxybutanin c. The nipple was noted to be ulcerated. Chlorpromazine d. together with dry skin over the left areola. Desmopressin b. NSAIDS d. Open biopsy e. Carotid sinus syncope c. Ethosuximide 644.

A lady with fam hx of ovarian carcinoma has a pelvis US that fails to reveal any abnormality. What is the possible dx? a.645. MRI head d. What is the single most appropriate inv? a. Pelvic CT b. Duct papilloma b. CA 153 d. Creat=112. US b. Laparoscopy . A 55yo woman who attends the clinic has recently been dx with a depressive episode. photosensitivity and hematuria. Skull XR b. What is the single most likely positive antibody? a. Exam: normal. She feels that her mood is worse at the beginning of the day. Anti Ds DNA b. She complains of unintentionally waking early in the morning. Reassure 651. losing 5kg weight in the last month. Urea=11. Anti Histone d. Anti centromere 648. Check serum K+ level c. What is the most likely dx for this pt? a. Atenolol e. IV fluids 649. Severe depression d. Duct ectasia c. CA 125 c. a recent disinterest in sex and a loss of appetite. CT head c. ABG d. Breast cancer 647. A 56yo man was recently put on anti-HTN meds and recent biochemistry on 2 occasions showed: Na+=132. What is the first thing you will do? a. Doxazosin d. Mild depression b. K+=7. Low mood e. An employer sent his worker to the ED after having hit his head on a machine. What is the single most likely inv you would do? a. Pseudo depression 650. Moderate depression c. She had a hx of breast abscess 3yrs ago. Anti La e. Ramipril 646. Anti Sm c.6. Amlodipine b. Duct fistula d. Bendroflumethiazide c. Which of the following drugs is responsible for this result? a. NG tube e.3. A 6wk child with profuse projectile vomiting. A 46yo woman has offensive yellow discharge from one nipple. A 35yo woman undergoing tx for TB presents with malar rash.

A 52yo male presents with sudden complete loss of vision from right eye. Optic nerve e. Ekbom syndrome e. Trigeminal nerve . What is the best drug tx for this pt? a. Reassurance e. She also has a red. loss of appetite.e. Accessory nerve b. Buccal prochlorperazine b. He attends a special school due to inappropriate behavior and during the interview with his parents the boy barks at infrequent episodes and shouts expletives. What is the most likely dx? a. A 56yo male pt presents with intermittent vertigo. An 82yo woman has developed painful rash on one side of her forehead and ant scalp. Asperger syndrome b. Facial nerve c. Gentamicin patch on the round window e. Lesions have also affected her cornea. CT e. Fluoxetine b. sleep disturbance and intrusive and unpleasant thoughts of harming the baby. Cotard syndrome c. the retina was pale and a cherry red spot could be seen in the macular region. Branch RVO e. ECT 656. What caused this vision loss? a. Olfactory nerve d. Oral flupenphenazine c. 100% oxygen d. tinnitus and hearing loss. Relieve pain with aspirin c. TCA d. Haloperidol c. Rett syndrome d. CBT d. Tourette’s syndrome 653. What is the single most appropriate option? a. On fundoscopy. with loss of feeling for the child. Measure IOP b. CRVO c. What is the best tx for this pt? a. Branch RAO d. He also had been complaining of right sided headaches which would come up more on chewing. watering eye and complains of seeing colored haloes in her vision. What is the most appropriate next step? a. CRAO b. A 48yo woman presents with left-sided severe headache. MRI 652. No med tx available 657. Circumciliary vein occlusion 654. A 31yo woman presents with 7-10days following childbirth. Relieve pain with sumatriptan 655. A 10yo boy is taken to his GP by his parents with behavioural prbs.

What is the inv of choice? a. She thought that she was starting to have labour pains but she describes the pain as more constant. Anti centromere antibodies e. What is the most discriminative inv for dx? a. What is the best management strategy for this pt? a. MRI vestibule e. Anti DNA antibodies b. exams and after arguments. Buspirone e. Dressler syndrome 661. Rebreathe in a paper bag c. Aortic LN g. Submandibular LN d. Hep A . Select the most likely dx? a. Deep cervical LN 662. Left ventricular aneurysm e. Anti Jo1 antibodies c. What is the single most likely explanation for the abnormal inv? a. A 32yo woman P3 of 39wks gestation reports having spontaneous ROM 4days ago. Cardiac tamponade c. Iliac LN b.658. Propranolol 659. Chorioamnionitis c. Anti la antibodies 663.8C 2 days after an acute MI. Inguinal LN h. External iliac LN e. A 35yo woman has butterfly rash on her face and she suffers symmetrical joint pains on knee and elbow. Submental LN c. Labor e. CT b. A 35yo IVDA on penicillin and flucloxacillin for cellulitis now presents with jaundice. Coagulation study 664. A 55yo man presents with an ulcer of the scrotum. Anti nuclear antibodies d. His ECG shows widespread ST elevation with upward concavity. Atrial thrombus d. Acute pericarditis b. Uterine rupture d. She didn’t attend the delivery suite as she knew that would happen and had already decided on a home birth. What is the single most likely dx? a. A 63yo man continues to experience chest pain and has a temp of 37. Today she feels very hot and sweaty. Blood tests show raised CRP and WBC. Exam: uterus is tender throughout. Round ligament stretching b. Pt had a fight following which he developed bleeding. Otoscopy d. Desensitization d. A 24yo woman presents with episodes of peri-oral tingling and carpo pedal spasms every time she has to give a public talk. This also happens to her before interviews. Diazepam b. pale stools and dark urine. Which of the following LN is involved? a. XR skull c. ESR is raised. DIC 660. Pre-aortic LN f. ringing and hearing loss from one ear.

Vascular dementia c. Statin and ACEi d. What is the best management strategy? a. 670. b. Her BP=130/80mmHg. Hep B A 79yo woman has been dx with T2DM. Flexor digitorum profundus e.7mmol/l. He gave a hx of smoking 20 cigarettes/d for the last 10 years. Pick’s dementia d. Chronic active hepatitis d. Abductor pollicis longus b. sputum and dyspnea. What is the most likely dx? a. Statin and glibenclamide e. Pt was given oxygen in ambulance but he is not improving. 666. V3 and V4. Cholestatic jaundice c. Prednisolone b. What is the single most appropriate drug management? a. V2. 667. Alzhemiers b. ACEi and metformin c. Refer to speech therapist e. What is the single most likely tendon to be damaged? a. Lewy body dementia A 55yo man returns for routine follow up 6wks after a MI. Her fasting cholesterol=5. 669. Primary biliary cirrhosis e. RBS are 8 and 10mmol/l. Statin and metformin A 68yo woman is unable to extend the IP joint of her right thumb 7wks following a fx of the right radius. Other finger and thumb movements are normal. Arrange hearing test b.665. Check ABG d. Heart block b. What is the next step? a. His motor milestones are normal. CXR e. Reassure d. She is currently symptom-free but has microalbuminuria. Huntington’s disease e. Assess development milestones c. It is noted that she has a step wise decline of her cognitive functions. ECG A 66yo woman has been brought to the hospital on a number of occasions with a hx of loss of memory. Salbutamol c. Flexor pollicis longus A mother presents her 6m son who is vocalizing. Extensor pollicis longus d. He gets breathless when walking uphill. MRI brain A 39yo man presents to the ED with persistent cough. ACEi and glibenclamide b. Extensor pollicis brevis c. Her BMI=22. Right ventricular strain . 668. Her PMH is significant for a MI 6yrs ago. His ECG shows ST elevation in leads V1. What is the single most like ly explanation for the abnormal investigation? a. She has noticed that he doesn’t respond to loud noises.

Cystic medial necrosis c. Flamingo pink tympanic membrane b. She also says that her son doesn’t respond to her. Atheroma b. A scan reveals a normal uterus. Hep B d. 672. MI A 42yo overweight smoker comes with heavy periods. Spherocytosis A 76yo man suddenly collapsed and died. Her parents have been unable to seek medical care. Stable angina d. At post mortem exam. Syphilis A 33yo male came to the hospital with complaint of occasional left sided chest pain that lasts <30mins. Decubitus angina c. Attic perforation c. Select the best management for her menorrhagia? a. Left ventricular aneurysm e. c. which relieves upon taking rest. Red and inflamed tympanic membrane A lady underwent debulking surgery for ovarian carcinoma. Dressler’s syndrome A 4m girl has severe FTT and increasing jaundice which was 1st noticed at 1wk of age. 675. 676. CA 125 c. 674. Atrial thrombus d. 673. Dissecting aneurysm d. IU/systemic progesterone d. What is the single most appropriate inv? a. Laparotomy . Coronary spasm e. What is the most probable dx? a. Biliary atresia b. G6PD deficiency c. Pelvic CT b. Inflamed tympanic membrane with cart wheel appearance of vessels e. a retroperitoneal hematoma due to ruptured aortic aneurysm was noted. She is unsure whether she would like more children. Copper containing IUCD A 10yo male child was brought by his mother complaining that her child watches TV at very high volumes. NSAIDs e. What is the most likely underlying cause of the aortic aneurysm? a. She would like a long term tx with minimal side effects that would offer tx for the menorrhagia and provide contraception. Soon after the surgery she presents with signs of intestinal obstruction. COCP b. She is adamant that she doesn’t want surgery as she is terrified of the prospect. What do you expect to see on otoscopy? a. Bluish grey tympanic membrane with air fluid levels d. following exercise.671. Unstable angina b. Polyarteritis nodosa e. She has an enlarged liver and scratches on her skin. What is the most likely dx? a. doesn’t like to play outside and instead has become more sincere with reading. GrH analogues c.

What is the first inv? a. 682. Pneumocystis carinii in sputum e. d. Exam: normal. For the last 12h she has been hot and irritable with severe pain in her right ear. easy fatigabiliy and lack of energy. Sulfasalazine A 62yo man who has recently had flu-like illness has woken to find his speech altered. Exam: fixed.677. Methotrexate e. 678. Herpes zoster infection b. Applanation tonometry An 82yo male suddenly becomes unconscious and fell down. Gram +ve diplococci in sputum d. Hypoglossal nerve c. OM e. What is the best inv you to to dx the case? a. CT . Blood glucose level d. Perforation of eardrum A 35yo man has a temp=39C. 679. Glossopharyngeal nerve A 5yo girl has had an URTI for 3 days and has been treated with paracetamol by her mother. She complains of sudden severe pain in the eye followed by vomiting and also was seeing colored halos. Abdominal US A 45yo woman undergoing tx for RA for the last 5yrs presents with dizziness. CT head b. Laparoscopy e. Coagulase +ve cocci in sputum b. Trigeminal nerve e. He recovered completely within minutes. Facial nerve b. A blood film shows MCV 106. Toxicology screen e. Serology for legionella A 27yo female was brought to the ED by her friend from a movie theatre. 681. Gram -ve diplococci in sputum c. NSAIDs d. cough with purulent sputum and right sided chest pain on inspiration. EEG c. MRI orbits c. Blood culture and sensitivity d. Mumps d. 680. Impacted ear wax c. Steroids b. Chronic disease c. He has herpes labialis. What could be the most probable reason for her anemia? a. Oculomotor nerve d. Movement of his eyelids and lips are weak on the right side. Which anatomical site is most likely to be affected? a. She gives a past hx of recurrent headaches which used to resolve spontaneously. ECG b. What is the most likely dx? a. What is the single most likely causative organism? a. dilated ovoid pupil seen.

Lateral MI d. he has hx of HTN and exam: pulse=120bpm. PT=13. Broca’s aphasia d. Hgb=11. Dopamine inj 687. What is the most likely dx? a. APTT=71. He is restless and in shock. Urgent abdominal CT b. A 5yo boy has cough and swelling at the knee after falling on the ground with rashes on the buttocks which are non-blanching. Urgent abdominal US c. NSTEMI 685. What term describes this pt’s speech? a. Posterior MI e. Polymyalgia rheumatic 684. The following ECG was taken. CXR 683. Dermatomyositis e. WBC=8. NAI b. Choose the most likely dx? a. Neologism b. Duchenne’s MD b. A child admitted with progressive muscle weakness and frequent falls.9% NS crystalloids to bring SBP to 120mmHg e.e. IV fluids 0. Clang association 686. Inferior MI c. HSP . A schizophrenic says: life is unfair. Becker’s MD c. Fairs have food. It must be good. Plt=200. Polymyositis d. What is the most probable dx? a. Wernicke’s aphasia e.9% NS crystalloids to bring SBP to 90mmHg d. What emergency management should be done on priority basis? a. A 56yo man presents to the ED with chest pain. A man comes to the ED with hx of pulsatile swelling in the abdomen. BP=70/40mmHg. Flight of ideas c. Anterior MI b. IV fluids 0. I like fairs. Hemophilia c.

Von-Willebrand disease A 45yo woman presents with discharge from the left nipple. This has been present for 4days and included swollen ankles and puffiness of the face. proteinuria 10g/24h. Duct papilloma b. What is the tx for this pt? a. Ondansetron A 16yo girl has been unwell for 5days with malaise. IgA nephropathy b. Gram +ve diplococcic in sputum d. Buccal prochlorperazine (2nd line) b. Mammary duct fistula e. Choose the appropriate test: a. 690. HSP c. 689. 692. Osler weber reindu syndrome e. What is the single most likely dx? a. temp=37. headache and dry cough. Duct ectasia d. Endomyseal antibodies b. Cyclazine (1st line) d. Cotrimazole e. Wilson’s disease e. 694. Cardiac failure A 28yo man complains of vertigo. What is the single most likely causative organism? a. She denied any urinary symptoms preoperatively. It started a few days after he had a mild cold with runny nose. Serology for legionella e. Extensor digitorum d. US A 73yo woman with RA is unable to extend the fingers of her right hand at the MCP joint and IP joints following a fall. . Her CXR shows patchy consolidation in the lower lobes. Extensor carpi radialis b. 693. Sweat test c. Flexor digitorum profundum You are called to see a 20yo woman 2h post-LSCS. d. Metachlorpromide c. Breast abscess A 10yo boy presents with generalized swelling. Cold agglutinins b. 691.688. TFT d. LFT e. His only PMH was eczema.5C. Sputum staining for mycobacterium TB A child with increasing jaundice and pale stools. She has a few crackles in her chest. She has not passed urine since her operation. creat 60umol/l and albumin=15g/l. What is the single most likely tendon to have been damaged? a. nausea and vomiting for more than 30 mins and tinnitus. Gram –ve diplococci in sputum c. Minimal change nephropathy d. Exam: appears unwell. hearing loss in the left ear. The discharge is brownish-green and foul smelling. Extensor indicis e. Intra-ductal papilloma c. Extensor carpi ulnaris c. Urine analysis: hematuria. What is the most likely dx? a.

Hemophilia c. Metronidazole b. Pleurisy d. Hgb=12. XR face c.5. APTT=31. Lateral MI d. A 58yo man has a headache and confusion of 3 days after slipping and hitting his head in the garden. NSTEMI 698. Posterior MI e. EEG 696. UTI b. Urinary tract injury c. No hx of fever. CT brain d. loss of weight and flatulence for 3 days. Meningitis septicemia b. pulse=116bpm. PT=13. A young man has diarrhea. Anterior MI b. A 4yo boy has a cough and arthritis followed by rash on legs which are non-blanching on glass test. Inferior MI c.BP=94/73mmHg. What is the most imp tx? a. ITP e. WBC=6. Bowel sounds are not audible. Paralytic ileus 695. Fluconazole . Her abdomen is distended with tenderness in the left flank and suprapubic region. What’s the most likely dx? a. The following ECG was taken What is the most likely dx? a. Plt=300. Choose the most appropriate post Csection complication for this lady? a. Acute pyelonephritis e. XR skull b. A 72yo man presents to the ED with chest pain. What is the most appropriate initial inv? a. sat=97%. MRI brain e. HSP d. TTP 697.

Few days earlier the GP saw him for bilateral parotid pain and gave analgesics. Fentanyl patches A 19yo man has exercise induced asthma. He is febrile and sick looking. Howe ver. Needle aspiration of scrotum b. Diphtheria d. c. Carcinoma thyroid c. 701. Oral steroid e. Inhaled steroid A 3yo boy has a sudden onset of fever. This has prv been controlled using a salbutamol inhaler as req. Oxycodone 10mg OD d. 704. 705. 702. Assess development milestones c. URTI c. He is tired by day. XR Neck in extension shows a thumb sign. Choose the single most likely dx. Pancoast tumor An 84yo man got surgical pain which is well controlled by oral morphine 60mg BD. Morphine 60mg TDS c. Refer to speech therapist e. Amoxicillin A 6yo child presented with drooling of saliva and severe stridor. He snores at night and has restless sleep. Vancomycin d. Regular salbutamol and budesonide c. Carcinoma right bronchus d.699. Sodium cromoglycate d. He smokes 20 cigarettes/day for the last 30yrs. What is the best manageme nt strategy? a. a mass is palpable in the right supraclavicular fossa. vomiting and bilate ral face swelling. now this pt is unable to swallow. Croup b. but he now gets attacks with exercise. What is the most appropriate next step? a. What inv is the most appropriate to dx? a. MRI brain A 17yo boy while playing football got a kick and now he is complaining of severe pain and swelling of the left side of his scrotum. What is the most likely dx? a. Urine test for hematuria A 50yo man has had hoarseness of voice and drooping eyelid for 2m. Analgesic . Mesothelioma e. Acute epiglottitis A mother presents with her 3yo son who has indistinct nasal speech. Morphine 60mg IV e. Morphine 60mg state b. Surgical exploration of scrotum e. Regular salbutamol b. Carcinoma larynx b. What is the single most appropriate tx? a. 700. Arrange hearing test b. MSU d. US scrotum c. Refer to ENT surgeon d. What is the most appropriate next step? a. a. 703.

What is the single most likely dx? a. Radionuclide bone scan c. What is the most likely dx? a. 711.706. 15-20ml of reddish brown urine was obtained. Cushing’s syndrome d. 709. US KUB A 57yo male presents with sudden onset severe abdominal pain and rigidity against a 4d background of LIF pain and pyrexia. US pelvis e. b. Immediate surgery e. Reassurance A 32yo miner is rescued after being trapped under a fallwn rock for 4h. Acamprosate d. 708. Trans rectal US d. Immediate surgery e. Hypothyroidism b. After applying a bladder catether. What is the most appropriate next inv? a. Perforated diverticulum e. What is the most appropriate tx? a. What would be the next appropriate step? a. Perforated meckel’s diverticulum A 46yo woman has weight gain. Disulfiram e. 710. Furosemide IV d. Pheochromocytoma An alcoholic who has completely given up drinking hears voices. CT abdomen c. MRI spine b. Fluid challenge c. pulse=50bpm. Biopsy d. Antibiotics . Addison’s disease e. Herniotomy b. SBP=100mmHg. Sigmoid volvulus d. Antibiotic c. He has no PM/SHx of note and isn’t on any meds. Biopsy d. 20% Mannitol IV e. Dopamine IV b. Haloperidol A 6yo boy has completed an induction course of chemo for ALL. sensitivity to cold. Hyperthyroidism c. He has an enlarged left scrotum. HR=120bpm. Olanzapine b. Ischemic colon c. 707. Reassurance A 75yo man with adenocarcinoma of the prostate which has spread outside the capsule of the gland has ARF. What is the most appropriate next step? a. Intussusception b. heart is enlarged with murmur. Diazepam c.

He is apyrexial. DKA 716. he denies any problem with memory. Deficiency in thyroid hormone b. Blood culture b. CT brain c. Reduced caloric intake 714. Morphine oral 715. A man with carcinoma and multiple metastasis presents with intractable nausea and vomiting. What single mechanism accounts for her weight loss? a. What is the most appropriate management? a. Renal artery Doppler e. grandfather and 2 sisters have been dx with DM. Dexamethasone IM b. CRP c. IVU d. NIDDM c. His father. A 42yo woman with a PMH of severe headache treated in the ED presents with signs and symptoms of renal failure. MODY e. Pelvic cavity c. Serum uric acid 713. where will the fluid accumulate in the peritoneal cavity? a. He has become drowsy and confused. US KUB b. Ondansetron IM d. 5days prv he had an inguinal hernia repaired as a day case. Right paracolic gutter 718. On questioning. A 60yo man has had spontaneous painful swelling of his right knee for 3days. She has been seen by her GP for HTN and abdominal pain with OP inv pending. What is the most likely type of DM this pt suffers from? a. A 62yo male is brought to the ED by his daughter because of his persistent lying. LADA d. Which inv is most likely to lead to a dx? a. XR knee e. Under the diaphragm e. D-dimer d. Ondansetron PO e. He knows his name and address and states that was at the betting shop . Increased level of calcitonin c. He takes bendroflumethiazide 2. Dexamethasone PO c. IDDM b. A 19yo man presents with weight loss. Left paracolic gutter b.5mg daily. increasing thirst and increasing frequency of going to the washroom. A 27yo woman with anxiety and weight loss has tachycardia. Renal biopsy 717. What is the single most appropriate diagnostic inv? a. Lesser sac d. Insulin resistance e.712. Increased metabolic rate d. tremor and mild proptosis. In perforation of a post gastric ulcer. He is a known alcoholic and has been admitted recently with delirium tremens.

720. She has stopped going out except with her husband. Headache b. Reactive arthritis d. IV fluids d. but his daughter interjects calling him a liar explaining that he was at her home. RS e. Ramipril b. What is the most imp complication the pt should be careful with? a. 722. Depression d. Korsakoff psychosis e. Agoraphobia A pt on HTN drugs develops hyperkalemia. this morning. Thiazide d. Antibiotics b. Wernicke’s encephalopathy d. ESR 15. Clang association A 72yo man has been on warfarin for 2yrs because of past TIAs and strokes. Social phobia b. Panic disorder e. Polymyositis b. Incongruent affect e. What other drug would you like to prescribe? a. Cotard syndrome c. Alcohol withdrawal A 70yo man presented with muscle weakness and inability to climb the stairs. Glucose c. 721. What is the most likely dx? a. Claustrophobia c. she tends to have SOB and sweating. Osteoporosis c. 724. Which term best describes his condition? a. Ganser syndrome b. Duchenne’s MD A 65yo known alcoholic is brought into the hospital with confusion. What is the most likely dx? a. Vit B complex A pt suffering from schizophrenia laughs while talking about his father’s death.719. He is treated with diazepoxide. Depression b. Which anti-HTN is likely to cause it? a. Disulfiram e. Furosemide . Polymyalgia rheumatic c. Inv: CPK raised. What is the most likely dx? a. 723. Lorsartan c. Emotional liability d. Nifedipine e. Ear infection d. Limb ischemia e. Diarrhea A 24yo woman is afraid to leave her house as whenever she goes out. Flat affect c. aggressiveness and ophthalmoplegia.

He also reports itching after a hot bath and burning sensation in finger and toes. Exam: greysish white linear rash can be seen on the wrist and periumbilical area. A 55yo man presents with HTN. Inv: Hgb=20g/dl. CD b. A young man develops itching worse at night and following bathing. Polycythemia rubra vera c. IBD 729. What is the likely dx? a. Lose weight 728. A 60yo DM lady presents with severe peri-anal pain and swelling. Polycythemia c. His face is flushed red. EPO normal. Urticarial d. Colonscopy reveals transmural granulomatous inflammation involving ileocecal junction. He was dx with what? a. CML e. He complains of headache and visual disturbances. Erythropoietin d. Where is the first site of cancer? a. Stop smoking b. What is the next step? a. Return to OT and explore e. What hormone should you check? a. Testes b.725. Essential thrombocythemia d. WBC=20. T4 e. Cortisol c. abdominal pain and weight loss for few months. CLL 731. Oral antibiotics and discharge c. Liver d. He has swollen vocal cords. Adrenal c. Atopic eczema e. His BMI=32 and he smokes 20-25 cigarettes/day. Aldosterone b. heart failure and having high ferritin (hemochromatosis) level is refusing tx. A 25yo man presents with hoarseness of voice. Exam: clubbing. Pancreas 732. Gastric cancer e. Admit and IV antibiotics d. PE: mild splenomegaly. Myelofibrosis b. Packing b. What is the dx? a. A 64yo male was admitted to the medical ward with complaint of diarrhea. Scabies b. Ice cream and cold fluids 730. What would you advise him? a. What’s the cause? . A 40yo lady who has been a smoker since she was a teenager has the following blood result: Hgb=19. plt=500. TSH 727. perianal skin tags and abdominal tenderness. Lichen planus 726. A pt presents with hemoptysis 7d after tonsillectomy. An old man having T2DM with increased skin tanning. Bowel cancer d. UC c.

Platelet problem d. She has normal pupils and cornea. What is the underlying pathology? a. Mental health team d. High potent vitamins e. 737. now comes for help and she is concerned about her problem. Drug induced personality disorder A woman with a hx of drug abuse and increased alcohol intake. What is the most likely dx? a. Anal carcinoma b. Diazepam d. ataxic gait and some visual problems. Chlordiazepoxide c. 734. Anal fissure c.733. Hemorrhoid d. OCD b. Glaucoma c. She has changed her glasses quite a few times but with no effect. Iritis e. 738. Psychiatry voluntary admission A 28yo woman who is 32 wks pregnant in her 3rd pregnancy is diagnosed as a case of placental abruption. Cataract b. Grieving d. Clotting factor problem b. Mania e. 736. Severe depression A 40yo teetotaler woman is recovering from a hysterectomy 2days ago. Disulfiram . 735. What is the most likely dx? a. Psychotic depression c. fatigues and she is eating more and also has sleeping disturbance and hears the voice of her husband who died 3yrs ago. 3 days after admission he developed alternating state of consciousness. Retinal detachment d. What is the dx? a. What is the most appropriate management of this pt? a. she is still bleeding. Villamentous insertion of placenta An old woman having decreased vision can’t see properly at night. a. What is the most appropriate management option? a. Anal abscess A woman is sad. Voluntary admission b. Clauser’s syndrome c. Hysteria d. After all the effective measures. Delirium tremens b. At night she becomes agitated and complains of seeing animals and children walking around the ward. Succiturate lobe e. Toxic confusional state c. GCA A 53yo man was admitted to the hospital for inv of hemoptysis. Psychiatry team c. Acamprosate b.

He was given naloxone and he regained consciousness. MI c. Amitryptilline c. 24h help line c. LABA b. Oral prednisolone e. What is responsible for his present drop in level of consciousness? a. Fluoxetine b. Fat embolism e. Olanzapine 742. A 25yo woman with a hx of several episodes of depression is brought to the ED after she was found with several empty bottles of her meds.739. The methadone had already caused some brain damage e. Which of the following drugs is likely to have caused her symptoms? a. He has also taken another substance apart from methadone d. None 740. A 23yo man feels anxious and agitated when faced with stress. Tension pneumothorax d. What is the next appropriate management? a. Later he presents with SOB and chest pain. CBT c. Naloxone is eliminated faster than methadone . Insight into problem 745. Methadone is absorbed faster than naloxone c. What is the dx? a. he wakes up at night due to his symptoms. ECG 741. Diazepam 743. Bubble echo c. Propranolol d. However. She complains of coarse tremor. What is the most appropriate management? a. Phenelzine e. Naloxone is absorbed faster than methadone b. Pulmonary embolism b. High dose steroid c. After a while he started getting drowsy again. SSRI b. An 8yo boy dx with asthma is on salbutamol and beclomethasone. A boy was rushed to the ED unconscious after he had taken methadone belonging to the sister. Anti-depressants e. Aminophylline d. A pt underwent hip surgery. He has an interview in 3days and would like some help in relieving his symptoms. Open access to ED b. Transthoracic echo d. A woman presents with a hx of poisoning 10x with different substances. nausea and vomiting. CBT d. There are no obvious signs of depression or suicidal behavior. A transthoracic echo reveals a patent foramen ovale. A 25yo man presents with hx of breathlessness. What is the best preventive step? a. Lithium d. What diagnostic inv would you do for a patent foramen ovale? a. Transesophageal echo b. Sodium cromoglycate 744.

A 24yo male on remand in prison for murder is referred by the prison doctor. K+=3. A 17yo lady presents with a worm in her ear. Cardiac failure d. sleeps less and bought a house and 2 new cars. Capgras syndrome b. Budd-chiari syndrome e. Ekbom syndrome e. Remove under GA b. Na+=120mmol/L. His legs were swollen and his liver showed signs of a transudate fluid. A 60yo woman has tiredness. What was the cause of the transudate? a. Hypomania d. K+=5. What is the most likely dx? a. On questioning he provides inappropriate but approximate answers to all questions stating that Bill Clinton is the prime minister of England. Schizotypal d. A guy who has several convictions and has been imprisoned several times. What is the single most likely electrolyte pattern to be found? a. She has noticed that her skin looks permenantly tanned and she describes dizziness on standing up. He has a prv hx of IV drug abuse. What is the next step? a. What type of personality disorder is this? a. Schizoid e. Na+=150mmol/L. A 32yo lady has recently become more active. Cotard syndrome c. K+=2. Ganser syndrome d. What is the prisoner suffering from? a. breaks up with his family and doesn’t contact his children. Na+=140mmol/L. A 20yo girl with amenorrhea and BMI of 14 still thinks she has to lose weight. Criminal 752. Suction .746.5mmol/L e. What is the most likely dx? a. Mania c.5mmol/L d. Bipolar disorder b. Liver cirrhosis b. Bulimia nervosa c. Schizophrenia 748. She is very agitated and anxious.9mmol/L c.9mmol/L b. Body dysmorphic disorder 751.9mmol/L 750. OCD d. Borderline b. K+=4. Tourette’s syndrome 747. K+=5. Anorexia nervosa b. He is noted to be behaving oddly whilst in prison and complains of seeing things. Na+=125mmol/L. Alcoholic liver disease c. Na+=150mmol/L. Depression e. Antisocial c. The body of a 65yo man who was treated for TB and bronchitis was seen at autopsy. TB 749.

APTT=40s. 754. Cardiovascular syphilis c. Cushing’s syndrome b. CPR e. plts=50. Hyperparathyroidism d. tests reveal: Hgb=12. Remove manually by fingers . Clotting screen b. Embolism e. Omeprazole A 12yo boy complains of acute development of purpura on the dependent areas of his body 2wks after a URTI. abdominal pain. bendroflumethiazide and amlodipine. CT head A 43yo woman has been feeling lethargic and tired. Buerger’s disease d. Von Willebrand’s disease d. 24h BP monitoring c. she still continues to bleed with pulse=130bpm and BP=85/58mmHg. Endoscopy e. Intermittent claudication b. What is the most probable dx? a. 758. ECG d. K+=3. 756. the parents are now asking how to remove it if that ever happens at home. Her BP=160/90mmHg. Bleeding time=10mins. What inv is needed? a. c. PT=1. TTP c. Exam: amputated right 2nd toe. What is the most likely dx? a. The purpura doesn’t blanch on pressure. vomiting blood with cool peripheries. Bloods: Na+=140mmol/L. Forceps A 20yo male smoker is noted to have intense rubor of the feet and absent foot pulse. Hemlich maneuver b.753. oxygen and fluids. Renal disease e. Turn the child on his back and give thumps d. Bring to the hospital c. 24h ECG b. Hemophilia B A woman presents with hx of falls. Hemophilia A e. Acute limb ischemia A young lady after a heavy bout of drinking last night comes to the ED with dizziness. What is the most likely dx? a. What would be your next best management? a. She is hypertensive and takes atenolol. US c. Pheochromocytoma A 2yo child aspirated a foreign object which was removed at the hosp. ITP b. 757.1mmol/L. 755.02. What do you advise? a. Alcohol drops d. WBC=5. Echo e. becomes pale and clumsy. Conn’s syndrome c. After initial resuscitation. CT d.

Hemangioma c. You are a FY doctor in the ED when a mother brings her 2yo son to you with a 1h hx of noisy breathing. A 27yo man presents to the ED after a RTA where his foot was stuck under a truck for several hours. Tetrabenazine 762. DVT e. looks lethargic. has sunken eyes and a feeble cry. Which drug caused her symptoms? a. What is the most likely dx? a. Foreign body aspiration d. Croup c. A 38yo man has had a liver biopsy as part of inv for abnormal LFTs. She state that although he had mild coryza over the last week. She now presents with coarse tremors. Arterial embolus d. Hemochromatosis d. Kleiuber test 760. Though he appears well in the ED. Exam: foot tenderness. Hemosiderosis e.9%NS + 5%Dextrose c. Anaplyaxis b. his current observations demonstrate a raised RR and sat=91% on air. What is the most likely dx? a. CT pelvis d. Epiglottitis . Another parent had found him coughing and spluttering. 0. A lady with depression has a bag full of meds. Amitriptyline d. Arterial rupture c.9%NS b. Sodium valproate e. Coagulation profile b. He now has swelling on the foot. Thyroxine c.45%NS 761. The pathologist report states: special stains demonstrate the presence of a very large amount of iron pigment within the hepatocytes. 0. What single condition is identified by the pathologists report? a. Fibular fx 764. he was improving and so they had gone to a children’s picnic with nursery friends. 0. Compartment syndrome b. What should be the initial inv of choice? a. loss of sense in the space between the 3rd metatarsal and big toe and his dorsalis pedis is not felt. What is the choice of fluids? a. Wilson’s disease 763. and ever since his breathing has remained noisy. D-dimer e.759. 0. US abdomen c. A 28yo pregnant lady presents with severe lower abdominal pain with excessive per vaginal bleeding at 34wks gestation. Alpha 1 antitrypsin deficiency b. Lithium b. A 3yo child with severe diarrhea and vomiting.45%NS + 5%Dextrose d.

Take it after meals b.6cm in size. MRI head 768. He was found wandering in the park. MRI of internal auditory meatus d. XR skull 769. What is the most definitive inv? a. pulse=100bpm. Echo c. It is 0. Radio isotope scan e. A pt with SNHL and loss of corneal reflex on the left side. Mini mental state d. BPPV e. chest=bilateral crackles. Nuclear imaging of brain c. D-dimer d. SaO2=88%. Thiamine b. Alcohol was tested and it was negative. Labyrinthitis d. Melanoma 770. She also had a similar episode 2yrs back. What is the most immediate management? a. CT of internal auditory meatus b. especially on moving her head. Kaposi’s sarcoma b. CXR b. CT head e. Exam: BP=100/60mmHg. Molluscum contagiosum d. Take it before meals c. What is the single most likely dx? a. Take antiemetic 766. Meniere’s disease c. LN g. Troponin 767. Radiotherapy c. Take antiacids e. What will your next step be? a. What is the most probable dx? a. A 45yo woman presents with rotational vertigo. Squamous cell carcinoma f. A middle aged man complains of a node which has been growing on his nose for several months. Vestibular neuronitis 771. What will you advise? a. A 49yo man lost his job and now is homeless. He is muttering that some people are after him. Stop the drug d. Radionucleotide lung scan e. indigestion. Neuropsycho analysis c. Basal cell carcinoma e. Which inv would you do to find the underlying cause? a.765. abdominal pain and vomiting. Now it’s firm with central depression. cold. Stenting . A 65yo man with cancer of middle 1/3 of the esophagus presents with dysphagia. Keratoacanthoma c. A 52yo man with hx of ant MI 3 wks ago developed sudden onset of dyspnea. nausea and vomiting. A pt taking doxycycline complains of nausea. Acoustic neuroma b. cough and fever. Chemotherapy b. These episodes typically follow an event of runny nose.

15 compression: 2 breaths with nose pinched d. Calcium resonium c. The right hand is not swollen and there is tenderness under the root of the thumb. Discharge with advice c. Amylodipine d. Na+=136mmol/l. Repeat XR d. Refer to surgeon b. Raise had for 2d c. Arm sling for 1 wk b. he was also noted to have microalbuminuria. d. A mobile mass is felt on examination. What is the most likely dx? a. Constipation A middle aged male is feeling unwell after a recent MI. 776. What is the best drug to add to his regimen? a. 773.4mmol/l. Antibiotic A 30yo lady was playing volleyball when her hand got injured with the ball. 775. ABG Anxious parents ask you for resus technique for their 3yo. What is the most appropriate management? a. 15 compression: 2 breaths without nose pinched e. Calcium with vit D supplement d. Calcium gluconate b. 5 compression: 2 breaths c. The recent ECG shows prolonged QRS complex and tented T wave. Statin c. He woke up in the middle of the night crying severely. Which inv will lead to the dx? a. ACEi b. Calcium A 68yo man with DM and HTN was noted to have cholesterol level of 3. Analgesia d. K+=6. What initial measure should be taken for this child? a. CXR c.772. urea=5mmol/l. Ovarian torsion d. Appendicitis c. XR is normal.2mmol/l. 778. Full arm cast A 33yo female presents with sudden severe colicky abdominal pain in her RIF. Vit D e. 5 compression: 1 breath b. What do you tell them? a. 777. Laryngoscopy b. Gastrostomy e. TPN A 1yo child is brought to ED. What is the most appropriate next management? a. 774. PID b. Biguanides A child playing with toys suddenly develops breathlessness and stridor. Peak flow meter d. 30 breaths: 2 compressions .

He reported it being painful. What is the possible dx? a. Asthma c. Pulmonary TB 780. Exam: red and tender pinna. A 50yo newly dx with HTN complains of urinary freq and dysuria. Fam hx b. A 2yo girl prv well presents with a hx of vomiting and diarrhea for 4hrs. Exam: clubbing. Bronchiectasis d. Thyroglossal cyst d. Choose the single most appropriate tx? a. Lymphangioma b. Pre-broncho-dilation test was done and it was 2/3. Ranula e. Increased RR d. Which of the following factors will be against the tx? a. No further intervention needed 784. A 2yo male pt was brought by his mother with a swelling in the right side of his neck extending from the angle of the mouth to the middle 1/3 of the sternocleidomastoid muscle. Bronchiectasis 781. Vaginal estrogen d. COPD b. What is the likely dx? a.7. A 44yo woman with breast cancer had an extensive removal and LN clearance. Imipramine b. Pulmonary thrombosis b. Stool >10x/d e. What would be the next appropriate step? a. A 32yo female has a hx of SOB and fever. Pneumonia d. Adjust diuretics c. What is the cause of blood in his sputum? a. The pt was dx of eczema and TB. The swelling was on the anterolateral side of the sternocleidomastoid and was brilliantly transilluminant. A boy injured his ear during a rugby match. Tympanic membrane was normal. Tumor grading c. The urinalysis reveals presence of white cells and protein.779. Bronchial carcinoma c. Her mother had cancer when she was 65. Refer to ENT specialist e. Thyroid swelling 782. IV flucloxacillin d. Topical gentamicin b. Capillary refill time >4s b. Weight of child = 10kgs 785. Trimethoprim 783.5 and post-bronchodilator was 3/3. Oral flucloxacillin c. Her age . What is the most suitable indication for IV fluid administration? a. LN involvement d. She needs an adjunctive tx. HR >90bpm c. Branchial cyst c. He h as a hx of DVT. A 56yo man complains of increased vol of sputum with specks of blood and chest pain.

What is the most likely cause of death? a. Stroke d. A female pt with HTN and serum K+=2. and is a heavy smoker. What is the single most appropriate inv? a. His chest is clear. PaCO2 =2. Otoscopy 787. Sigmoidoscopy 791. Colonoscopy c. Pulmonary embolism b. Paramedics mentioned that she was overweight and recently immobile because of a hip pain. Cardiac failure 788. PaCO2 =1. pulse=100bpm. BP=140/80mmHg. MSU b. Exam: weber test lateralizes to the left. US abdomen c. What is the most appropriate inv? a. Call radiology b. MRI brain c. Aldosterone b. A 60yo man presents with weight loss and Hgb=6. Angiogram d.8 789. PaCO2 =8 b. Renin e. She collapsed and died in the ambulance. A 25yo male with a hx of frequent binge drinking presents 4h after having had a take away meal following a nights heavy drinking.4. He complains of nausea and has vomited on several occasions. PaCO2 =2. A 74yo lady called an ambulance for an acute chest pain. Hx reveals that he has abdominal pain and diarrhea for the past 6m. vomiting. She was treated with an epidural for analgesia.786.5 c. Barium enema b. She has a hx of DM and HTN. CT b. What is your dx? a.7mmol/l. On admission. A man presents with abdominal pain.4. After the last vomiting episode. A 35yo primigravida post C-section complains of inability to void. Urgent admission to ITU 790. Testosterone 793. What is the next best inv? a.6 d. Cortisol c. pH =7. pH =7. he vomited approximately a cupful of blood. which hormone would you be looking for? a. He has some tenderness in the epigastrium. A 77yo woman suffered diarrhea 4d ago. What is the immediate management? a. She denies dysuria but complains of fullness. What would be her blood gas result? a. MI c. pulse=120bpm. A 45yo man presents with hearing loss and tinnitus in the right ear. US KUB d.4. Cardiac arrhythmia e. Gastric carcinoma . Audiometry: AC > BC in both ears.2. BP=90/60mmHg and a rigid abdomen. Serum calcium 792. Thyrotoxin d. pH =7. pH =7. he smells of alcohol. Admit to medical ward c.

She knows he was not hypertensive. Subdural hematoma b. Peptic ulceration A young boy presented with bilateral periorbital edema. Portable XR A 44yo lady who has PCKD is concerned because her 38yo brother has just died of an intracranial insult. CT head . Nephrotic syndrome c. What was the most likely cause of her brother’s death? a. Cerebral infarct d. Mechanical ventilation c. 798. What is the most appropriate management for this pt? a. 799.6. 795. He has been suffering from repeated falls today. BUE. What is the appropriate management for his condition? a. What is the most likely dx? a. Tuning fork An 8yo child presents with recurrent abdominal pain. Acute heart failure e. Mallory-weiss tear c. 796.794. Needle thoracocentesis c. ankle swelling and increase in body weight. Esophageal varices e. Esophageal varices f. 100% oxygen d. What inv would you do? a. What would you do for her next? a. US abdomen b. Dexamethasone therapy d. Renal failure d. Subarachnoid hemorrhage c. 24% oxygen b. Adrenal insufficiency b. Epidural hematoma A 36yo male dx with glioblastoma since last 5m has cerebral edema and is on dexamethasone. Raised ICP A 2yo child is brought by his mother. Nebulized salbutamol A 34yo man was involved in a RTA and whilst in the ambulance his GCS deteriorated and RR increased from 30-48. ABG: PaO2=7. Esophageal carcinoma d. Distraction testing c. Glomerulonephritis A 53yo man with prv hx of COPD presents with breathlessness and purulent sputum. IV fluid b. Chronic heart failure b. What could be the possible cause for his falls? a. 797. Exam: normal. Dehydration c. He has diarrhea and vomiting for the last 3days. 800. Audiometry b. PaCOS=7. Scratch test d. CBC. The mother had hearing impairment in her early childhood and is now concerned about the child. 100% oxygen d. etc are normal. b. O2 stat=85% on air. occasional headaches but maintains a good appetite.

Cerebellar hemorrhage d. 807. Migraine e. Reassure d. CT head d. Umbilical hernia A woman prv in good health presents with sudden onset of severe occipital headache and vomiting. Subarachnoid hemorrhage d. What is the most likely cause? a. Cervical spondylosis c. Prednisolone c. His BP=140/90mmHg. Choose the most likely dx. a. Subdural hemorrhage b. 804. What is the most definitive inv? a. Acute dacrocystitis d. c. What is the most definitive inv for this condition? a. 803. IV hydrocortisone d. Acute conjunctivitis c. On slit lamp examination there are cells and flare in the ant chamber and pupil is sluggish to react. red. His HR=120bpm. CT scan of internal auditory meatus b. Cerebral embolus A 34yo housemaid presents with headaches in the back of her head for several days and pain on flexing her neck. Corneal foreign body . Cluster headache A 40yo man complains of thirst and lethargy. MRI of internal auditory meatus d. What is the most appropriate dx? a. Subarachnoid hemorrhage b. SNHL and loss of coreneal reflex on the left side. corrected Ca2+=3. Exam: pulsatile mass in abdomen. Calcium prep A 75yo man on digoxin develops weakness in the right upper and lower limbs which resolves within a few hours. Acute close-angle glaucoma b. photophobic right eye with slightly blurred vision and watering for 3days. Angiography c. What is the single most appropriate clinical dx? a. He has had no such episodes in the past. Meningitis e. 806. Digoxin level A 35yo man presents with balance problems. Nuclear imagine of the brain c.801. 802. Acute iritis e. Mesenteric cyst c. Her only physical sign on exam is a stiff neck. headache. 805. BP=70/40mmHg. MRI brain A 52yo man has a painful. IV fluids b. What is the most appropriate management at this stage? a. Analgesics A 78yo gentleman suddenly collapsed. Aortic aneurysm b.7mmol/l. Subdural hematoma c. Carotid Doppler b.

what is the likely cause of hyperprolactinemia? a. Iliac LN b. Pregnancy d. A child born at 36wks developed difficulty in breathing with intercoastal recession and nasal flaring. His temp is normal but his mother had PROM 48h ago. Isospora belli e. Hypothyroidism b. Lay on the back with feet towards feet end c. CXR c.808. Deep cervical LN 809. Prolactin secreting pituitary tumor e. It was there for a very long time before someone was able to remove it. weight gain and easy fatigue. Submandibular LN d. Sputum culture 814. Cryptococcus neoformans c. What is the most likely dx? a. SAH b. External iliac LN e. A 24yo male was trying to move his wardrobe but it fell on his thigh. Mycobacterium avium 810. When he was seen in ED he had casts in his urine . What advice would you give? a. Video-fluoroscopy 815. Stress c. What is the single most appropriate lymph node? a. Meningitis d. A 42yo female had sudden severe headache and vomiting. CT chest d. Endoscopy and biopsy e. A 68yo man has had increasing dysphagia for solid food for 3m and has lost 5kgs in weight. Anaphylaxis 812. What is the most likely inv that will lead to tx? a. Lay on the back with feet towards head end b. Submental LN c. Lay on side d. What is the most likely dx? a. Aortic LN g. Barium swallow b. A 66yo male presents with painful swallowing. Nesseria meningitides b. PCOS 811. What single inv is most likely to lead to a def dx? a. Stool culture d. A 45yo lady complains of expressable galactorrhea. Pre-aortic LN f. Lay on stomach 813. Parents of a 3m baby are worried about cot death. Viral encephalitis c. Blood culture b. Her serum prolactin levels are 1100um/l. Candida albicans d. CXR c. A 55yo lady with swelling on the abdomen below the umbilicus on the right side. decreased libido and amenorrhea. Inguinal LN h. She took paracetamol and then collapsed.

HIV d. 1-2 c. What is the most appropriate dx of underlying cause? a. What is the single most appropriate anatomical structure? a. PEFR . weight loss and night sweats. Conjoined tendon e.5C since 4wks after a MI. Rectus sheath muscle h. 817. Linea alba g. Activated charcoal b. Malaria b. Left ventricular aneurysm e. a. Intercostal muscles A 29yo man presents with hx of cough.816. Cricoid cartilage f. What is the most diagnostic inv? a. What is the cause for his renal failure? a. <1 b. Exam: pansystolic murmur. Conjoined tendon d. 818. Duramater b. Myoglobin c. 822. Myotroponin d. External iliac muscle b. His ESR=45mm/h. 1st tracheal cartilage c. Cardiac tamponade c. Dressler syndrome An 8yo child swallowed 12 tablets of paracetamol 4h ago. Dengue fever A 15yo boy presents with recurrent breathlessness and wheeze especially after exercise. 821. Atrial thrombus d. Observation only A pt dx with DVT is taking warfarin. HSP c. What would you do next? a. External iliac muscle e. What is the single most likely e xplanation for the abnormal inv? a. Intercostal muscles A 48yo man has continuous ant chest pain which is worse on inspiration and has temp of 37. Serum paracetamol levels when tested were at critical level. Other inv showed hypocalcemia and high serum creatinine. CXR b. but no RBCs. Acute pericarditis b. Lung function test c. What is his cut off INR limit? a. Acetyl acetate Anatomical structure to be pierced during surgery midline port during gallstone removal. 3-4 Inserting a drain in the mid-axillary line. Rectus sheath muscle d. 2-3 d. Acetylcholine b. 819. Linea alba c. 820. Gastric lavage d. IV N-acetylcysteine c.

Parkinson’s disease b. He also complains of rigidity and slowing of movement with a pill rolling tremor of the hands. A 10yo child who presented with fx of the radius which was treated with a plaster cast. CT d. Conjoined tendon d. Duramater b. Rectus sheath muscle c. Duramater d. Continue IV antibiotics and add oral antifungals b. Antihistamine PO m. CT scan 823. Idiopathic parkinson’s disease c. HbA1c e. Serum urea b. Stop antibiotics d. Antihistamine IV 824. which single most appropriate anatomical structure will be pierced? a. A young girl who is known to have T1DM presented with drowsiness and deep breathing. What would be the next appropriate step? a. pulses are present. Cricoid cartilage b. A 60yo man was brought in by his wife complaining of ataxia.d. WBC=<0. After which he started to complain of an annular rash spreading upwards. He has also recently commenced on Meropenem but on the 3rd day his temp still remains >39C. Penicillin PO h. Plt=15. He has been commenced on Ticacillin. Her sugar level=20. Corticosteroid IV b. Adrenaline IV e. What should you do next? . 2 blood tests and urine cultures show no organism. Doxycycline PO i. Exam: limb is swollen but warm and well perfused. Linea alba g. Removal of a glioma. Tazobactam and Gentamicin. Adrenaline IM d.5. A 67yo man being managed for a malignancy develops neutropenic fever. Cricoid cartilage f. Inv: Hgb=104g/dl. A child is not breathing and intubation failed. Shy-drager syndrome d. Blood culture c. Continue only present antibiotics 826. A 34yo man was walking along the country side when an insect bit him. External iliac muscle e. complains of pain. Intercostal muscles 829. a. Conjoined tendon e. Reassurance g. Continue antibiotics and add IV antifungals c. Corticosteroid IM c. Intercostal muscles 828. ABG 827. Rectus sheath muscle h. Flucloxacillin PO j. Her BP=120/80mmHg and her mucous membranes are dry. Gentamicin PO k. What is the likely dx? a. Ciprofloxacin PO l. Huntington’s disease 825. What will you do next? a. 1st tracheal cartilage c. Atropine IV f. At what anatomical site should the incision be made? a. urinary incontinence and erectile dysfunction.

835. What is the most likely dx? a. NHL e. Upper GI endoscopy c. Colonscopy f. Fundoscopy reveals retinal hemorrhages. HIV b. What is the most likely dx? a. VT d. 833. What is the single most appropriate option? a. A-fib . Schistosomiasis A 32yo homosexual comes with hx of weight loss. Sclera A 70yo woman with longstanding anxiety is seen in the OPD.830. EBV c. 834. Cornea d. Exam: hepatomegaly. What is the most likely rhythm disturbance? a. This particularly occurs when she is trying to get to sleep. 831. Malaria b. What is the single most discriminatory inv? a. Minimal change GN d. Remove cast c. RPGN An 80yo woman suffering from RA presents with severe epigastric pain and vomiting. She complains of her heart skipping a beat quite often. PSGN b. Typhoid d. He now presents with red urine and fever. Erect CXR A 44yo man went on holiday to Sudan 5wks ago. SVT b. Membranous GN c. Sigmoidoscopy e. No hematuria. Send for repeat XR b. Barium meal b. Mycobacterium avium b. Replace cast with more padding d. She also complains of shoulder tip pain. VF c. Iris b. 836. Conjunctivitis e. a. US Abdomen d. Hemophilus influenze d. Pneumocystic jerovici A 30yo man comes with hx of early morning back pain and stiffness. Give analgesic A 32yo man has been to Thailand and returned with cervical lymphadenopathy and fever. Brucellosis c. Ciliary body c. Exam: red eyes. 832. V-ectopics e. Leptospirosis d. CMV c. What is the single most appropriate option? a. What is he most likely suffering from? a. The palpitations are never sustained. Measles A 6yo child presents with edema and mild proteinuria.

837. A 17yo has acute pain around his right eye, pain on one side of his face and ear ache too. What
is the single most dx?
a. Ear wax
b. Ear foreign body
c. Dental abscess
d. Cellulitis
e. Herpes zoster
838. A 12yo boy presented with itching in his hands. Exam: skin is dry and red. His mother is
asthmatic and older brother has hay fever. What is the single most likely causative factor?
a. Dermatitis herpitiformis
b. Scabies
c. Eczema
d. Uremia
e. Drug induced
839. A 45yo man presented with pruritic purple papules on the flexor surface of his wrist and some
white lacy markings on his buccal mucosa. What is the single most likely causative factor?
a. ALL
b. Lymphoma
c. Polycythemia
d. IDA
e. Lichen planus
840. A known DM was admitted with sudden LOC. What is the initial inv?
a. CT scan
b. RBS
c. MRI
d. ECG
e. ABG
841. A 36yo lady comes with hx of early morning stiffness of her small joints and with red and painful
eye. What is the single most appropriate option?
a. Iris
d. Conjunctivitis
b. Ciliary body
e. Sclera
c. Cornea
f. Lichen planus
842. A 23yo man comes with 2d hx of sticky greenish discharge from the eyes with redness. What is
the single most appropriate option?
a. Iris
b. Ciliary body
c. Cornea
d. Conjunctivitis
e. Sclera
843. A pt was admitted with erectile dysfunction, reduced facial hair and galactorrhea. What is the
most probable dx?
a. Hyperprolactinemia
b. Cushing’s syndrome
c. Pheochromocytoma
d. Hyperthyroidism
e. Hypoparathyroidism

844. A 32yo man has been repeatedly admitted to hospital for what was described as anxiety or
panic attacks and palpitations. On occasions he is found to be tremulous and hypertensive. A
persistent weight loss is noted. What is the most probable dx?
a. Hyperthyroidism
b. Panic attacks
c. Pheochromocytoma
d. Cushing’s disease
e. GAD
845. A 35yo man with T1DM is dehydrated with BP of 90/50mmHg. What is the single most
appropriate initial inv?
a. ABG
b. CBC
c. HbA1c
d. LFT
e. Serum Urea
846. In OGTT what is the glucose venous plasma level 2h after glucose intake which indicates
impaired glucose tolerance?
a. >11.1mmol/l
b. Between 7.8-11.0mmol/l
c. Between 8.0-10.9mmol/l
d. Between 10.0-11.0mmol/l
e. Between 7.1-11.0mmol/l
847. A young man who has no PMH presented with jaundice, low Hgb, retics 8% and other indices
WNL but occasional spherocytes were seen on blood film. What is the single most appropriate
inv?
a. G6PD enzyme assay
b. Direct coombs test
c. Repeat blood film
d. Indirect coombs test
e. BMA
848. A 22yo man came to the hosp after an injury in his hand while playing basketball. Exam: avulsion
of extensor tendon from the distal phalanx. What is the single most probable deformity?
a. Dinner fork deformity
b. Game keeper thumb
c. Mallet finger
d. Gun-stock deformity
e. Garden spade deformity
849. A 28yo man is inv for recurrent lower back pain. A dx of AS is suspected. Which of the following
inv is most useful?
a. ESR
b. XR sacro-iliac joints
c. HLA B27
d. XR thoracic spine
e. CT lumbar spine
850. A 4yo girl is taken by her mother to the ED and complains of feeling unwell, urinary urgency and
temp=39C. What is the single next best inv?
a. Catheter catch of urine
b. Clean catch of urine

851.

852.

853.

854.

855.

856.

c. US
d. IVU
e. Suprapubic catch of urine
A 2yo girl presents with a 4d hx of fever that started with a cough. Her RR=45bpm, sat=94%,
temp=38.9C, capillary refill time=1s. There are crepitations at the left base on auscultation.
Urine shows negative dipstick. What is the single inv most likely to lead to dx?
a. Blood for C&S
b. ESR
c. CXR
d. Urine for C&S
e. CSF analysis
A 3yo girl presents with fever for 2d. She is drowsy and had a seizure causing twitching of the
right side of the body for 4mins. Her RR=30bpm, sat=90%, temp=38.9C, capillary refill time=2s.
Urine negative on dipstick. What is the single inv most likely to lead to dx?
a. Blood for C&S
b. ESR
c. CXR
d. Urine for C&S
e. CSF analysis
A 6m boy is admitted with persistent irritability. He is lethargic and is not feeding as well as
usual. His RR=30bpm, sat=97%, temp=38.0C, capillary refill time=2s. Urine reveals leucocytes on
dipstick. What is the single inv most likely to lead to dx?
a. Blood for C&S
b. ESR
c. CXR
d. Urine for C&S
e. CSF analysis
A 3yo boy presents with a 1d hx of being unwell. He appears shocked and has 3h old rash made
up of urticarial and purpural spots. His RR=30bpm, sat=94%, temp=39C, capillary refill time=1s.
Urine is clean on dipstick. What is the single inv most likely to lead to dx?
a. Blood for C&S
b. ESR
c. CXR
d. Urine for C&S
e. CSF analysis
A child is dx with VUR. What would you tell his parents?
a. Requires antibiotic prophylaxis
b. Most will require surgery
c. Most will have kidney scarring by 5yo
d. Nothing can be done
e. Reassure
A 2yo child presents with severe vomiting. Exam: mass felt in abdomen. What inv is most
appropriate?
a. US
b. XR
c. CT
d. CBC

857. A 13yo girl complains of a 2d hx of hoarseness of voice a/w dry cough. She feels feverish. On
direct laryngoscopy, her vocal cords are grossly edematous. What is the single most appropriate
inv?
a. None req
b. Sputum for AFB
c. Laryngoscopy
d. Bronchoscopy
e. XR cervical spine
858. A 7yo girl is brought by her mother with bright red staining of her underpants. She also gives a
hx that her daughter recently started taking horse riding lessons. What is the single most
appropriate next action?
a. Local exam
b. Exam under GA
c. Continue regular child care
d. Inform child protection services
e. Coag profile
859. A 7d baby whose birth weight was 3.5kg and now is 3kg. What is the most appropriate next step?
a. Check child protection register
b. Nutritional assessment
c. Skeletal survey
d. Continue regular child care
e. Inform police
860. A 6yo child fell on his nose 2d ago. His parents have now brought him with difficulty in breathing.
Exam: fever, nasal bones are straight. What is the single most likely dx?
a. Nasal polyp
b. Septal hematoma
c. Septal abscess
d. Deviated nasal septum
e. Fx nose
861. A 12yo pt came to the OPD with complains of fever, malaise, weight loss, anorexia and
productive cough. Exam: temp=39C, pulse=100bpm. His mother says that he has a hx of
recurrent chest infections and he is not thriving well. What is the single most likely causative
organism?
a. Pneumococcal pneumonia
b. Staphylococcus
c. Mycobacterium TB
d. Pseudomonas
e. PCP
862. A 3yo child brought by his mother. Exam: bruises on the buttocks. Mother al so gives hx of runny
nose 2wks ago. What is the single most appropriate next action?
a. Check child protection register
b. Coag profile
c. Skeletal survey
d. Continue regular child care
e. Inform police
863. A 4yo is brought to the ED by ambulance. His mother reports that he has been unwell with a
sore throat for 8h. He is sitting on his mother’s knee and is tolerating an oxygen mask but looks

864.

865.

866.

867.

868.

869.

unwell. He has constant noisy breathing and he is drooling saliva. His temp=39C. What is the
most imp dx?
a. Acute asthma
b. Bronchiolitis
c. Croup
d. Epiglottitis
e. Tonsillitis
A pt with terminal cancer is being treated with chemo develops tingling and numbness of the
fingertips of both arms. What is the single most likely cause of the symptoms?
a. Bone mets to cervical vertebrae
b. Post-chemo neuropathy
c. Hyponatremia
d. Hypocalcemia
An 80yo man has a permanent catheter. Catheter specimen urine found lots of e -coli. What is
the single most appropriate management as he wants to attend his daughter’s wedding next
week?
a. Change the catheter
b. Prolonged antibiotics
c. Bladder wash
d. Repeat MSU after wedding
e. Reassure
A 35yo male typist who suffered a scaphoid fx was treated with a scaphoid cast. After 2wks
when the cast was removed for a review XR, it was found that he had problems in moving the
thumb, index and middle fingers. What would you suggest as the management for the recent
prb?
a. Release of flexor retinaculum
b. Release of common flexor sheath
c. Release of palmar sheath
d. Ulnar nerve release
e. Fasciotomy
A pt 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 op
c. Give IV insulin + dextrose + saline pre-op
d. Give insulin as usual pre-op
e. None
A 35yo male who recently had an appendicectomy has got severe pain in his right big toe. Joint
is red and swollen. He consumes 30 units of alcohol/week. What is the most probable dx?
a. Rhabdomyosarcoma
b. Osteoarthritis
c. Gout
d. Pseudogout
e. Arthritis
A 25yo male who recently noticed change in his shoe size, he is also constipated, has a
preference to hot weather, his skin is dry, has severe pain in wrist joint. Joint is red and swollen.
What is the most probable dx?
a. Chondro-sarcoma

Nasopharyngeal ca b. Sinus squamous cell ca d. Anal fissure e. Cornea A 75yo man who has DM and HTN experiences acute monocular blindness which resolves after 1h. What is the single most likely dx? a. Squamous cell laryngeal ca e. Optic neuritis c. Pharyngeal ca c. CD d. He now presents with cheek swelling. What is the single most likely dx? a. PR exam: very painful. Ant chamber d. Epididymo-orchitis e. Epididymal cyst d. Constipation A 35yo man with painless left testicular enlargement for the past 6m which is increasing in size and 3x larger than the right side. Hydrocele c. Pseudogout e. What is the single most likely dx? a. Lacunar infarct d. Hypopharyngeal tumor . epiphora. Post chamber e. Ciliary body c. Squamous cell laryngeal ca e.870. What is the most likely dx? a. blood on side of stool and very painful defecation. GCA b. Lipo-sarcoma c. otalgia and conductive deafness. diplopia. b. Hypopharyngeal tumor A 60yo man with a long hx of smoking and alcohol presents with nasal obstruction. Nasopharyngeal ca b. Testicular tumor b. maxillary pain. 871. Ankylosing spondylitis A 45yo woman had her visual acuity checked at her local optician. 875. 12h later she presents to the ED with severe pain and redness in her eye. What is the most likely dx? a. 873. Pharyngeal ca c. 874. nasal obstruction and blood stained nasal discharge. There is no tenderness or redness. 872. Iris b. diplopia. Pontine hemorrhage e. ptosis. Reassure A middle aged man who has had a hx of chronic sinusitis. Sinus squamous cell ca d. Ca Colon b. Amaurosis fugax A 26yo presents with prolonged constipation. What is the single most appropriate option? a. UC c. epistaxis. Gout d.

Lung cancer c. Osteoporotic fx vertebra c. Osteod osteoma 878. Septal hematoma d.876. Herpes zoster b. A 34yo man had a cold 2d back. Bone degeneration d. Costochondritis b. PID d. Leomyosarcoma b. What is the single most probable dx? a. Painful hip d. He now presents with right sided facial pain. Which of the following meds is responsible for that? a. Costochondritis c. Bendroflumethiazide 877. During the night he complains of wheeze and SOB. A 60yo man brought to the ED with fx hip. Simvastatin e. Atenolol c. he is deaf and has bilateral pedal edema. What is the most probable dx? a. It is non-tender on examination. HTN and hyperlipidemia. Ramipril d. has left sided chest pain increased with breathing. What is the single most probable dx? a. Multiple myeloma c. AS e. A 20yo fit man suddenly developed severe lower back pain as getting up from bed. Multiple myeloma e. Septal abscess . A 15yo boy who complains of pain in his leg which has settled with aspirin. A 60yo is on tx for IHD. Spondylosis 879. What is the single most appropriate dx? a. Spondylosis 880. HTN with a 45pack/year smoking hx. An 80yo lady presents wih pain on left 6th rib for a week. Good pasture’s syndrome d. A 68yo DM. Liposarcoma c. Progressive massive fibrosis 882. What is your most likely dx? a. Maxillary sinus b. What is the single most likely dx? a. Ethmoid sinus c. Paget’s disease b. MND e. Thoracic vertebra compression 881. Exam: myosis on left side and wasting of small muscles of left hand. Amlodipine b. Paget’s disease b. Exostosis e. Secondary d.

Colonoscopy d. Mallet finger d. Septal hematoma c. Thiamine e. Coxavara c. A 29yo man with hx of asthma comes with post nasal discharge and bilateral painless nasal blockage. Glucose 885. Dinner fork deformity b. Laproscopy 888. and complains of seeing snakes on the hosp wall. A 23yo female presents with back pain and early morning stiffness. sweating. Septal abscess d. Disulfiram d. What is the single most discrimatory inv? a. A woman with a prv hx of pain at the left wrist following a fall 4m ago for which she didn’t seek any tx now presented with pain in the same wrist below the thumb and the pain is aggravated whenever she holds her baby. What is the most appropriate next step? a. What is the cause? . What is the single most probable dx? a. His pupils are constricted. Naltrexone d. Cubitus valgus e. What is the single most probable deformity? a.e. What is the single most likely dx? a. Naloxone c. Garden spade deformity 887. Nasal polyp b. Chlordiazepoxide has been started for this pt. Diazepam b. A 60yo man presents with severe colicky pain from his right flank radiating to his groin. Allergic rhinitis 884. Spondylosis 886. Paget’s disease b. Upper GI endoscopy e. Methadone b. A 63yo female with a hx of osteoporosis suddenly falls on her outstretched hand while shopping. US abdomen b. Methadone 889. A 45yo man has been admitted for an elective hernia surgery. aggressiveness. Allergic rhinitis 883. Myofacial pain d. What is the best tx? a. Atopic rhinitis e. XR KUB c. XR shows fx at distal radius with backward shift of the distal fragment. also complaining of eye problem and her sister has a similar condition. AS e. PID c. Acamprosate c. 3d later he presents with agitation. Thiamine e. A 24yo man has been found unconscious in an alleyway with a RR=6bpm and HR=60bpm. His urinalysis reveals trace blood cells.

What is the single most appropriate dx? a. 893. Left lower lobe atelectasis A 50yo man presented with increased breathlessness at rest. Cardiac tamponade d. Fx radial head b. He is currently on furosemide. What is the most likely dx? a. Ulnar c. IDA b. Ramipril b. Carpal tunnel syndrome d. Median d. Exam: loss of proprioception and vibration sense. 894. What drug is going to help him? a. Diverticular disease A 55yo male after gastrectomy developed anemia. Folate def c. Anal fissure c. Tension pneumothorax c. 891. Diltiazem A 31yo man underwent an operation where his hand was hanging outside the table. Axillary e. Subphrenic abscess d. Simple pneumothorax b. Which nerve was injured? a. Atenolol d. DVT e. Pericarditis An elderly woman is found anemia. 892. Acute gastric dilatation b. His MCV=106fl. Bendroflumethiazide c. Sigmoid volvulus b. Amlodipine e. Ulnar fx A 29yo man was involved in an RTA. she had a barium enema which reveals a mass lesion in the ascending colon. On insertion of ryles tubes. Radial b. BP=60/0mmHg. What is the most probable dx? a. His RR=34bpm. Vit B12 def d. a. digoxin and isosorbide mononitrate. What is the most likely dx? a. Anemia of chronic disease A 26yo male has been operated for abdominal trauma and splenectomy was done. On the 3 rd post-op day the pt developed acute abdominal pain and distention in the upper abdominal area with hypotension. clear breath sounds and a trachea which is in the midline. After the operation he had wrist drop and sensory loss over the dorsum of his hand. 895. As part of her exam. He presents with distended neck veins. Brachial . Cecal carcinoma e. Reactionary hemorrhage c.890. 2L of coffee ground fluid was aspirated. Sigmoid carcinoma d. Scaphoid fx c. Colles fx e.

Aortic rupture c. Bowel rupture e. He stopped smoking cigarettes 2yrs ago but has a 50yr smoking hx before quitting. creatinine=89mmol/l. What is the dx? a. US 900. XR b. A 64yo man presents with ipsilateral vertigo. What is the most appropriate inv? a. Vector 897. CXR shows NGT curled. Sulfonylurea c. Audiometry e. Insulin . Fx of neck of femur b. Put leg splint d. His BP is 90/60mmHg. Caloric testing 898. What is the best inv for this pt? a. Labs: urea=3. what is the next appropriate management? a. Peripheral vascular disease 899. CT d. Biguanide b. A 70yo pt presents with cough and SOB. Fecal-oral d. Send bloods for inv e. A young male met with a RTA and is suspected to have a femur fx. Blood e. US 901. Liver rupture 902. He suddenly col lapses and his is not able to move or lift his leg. What is the dx? a. CXR=consolidation and bilateral bihilar lymphadenopathy. MRI brain c. None f. A 27yo pt met with a RTA. MRI e. Post hip dislocation c. IV fluids c. Pelvic base fx e. Splenic rupture d. Exam: Renne test +ve and Weber’s lateralizes to the right ear. What is the mode of spread of chicken pox? a. XR d. Airborne b. A 67yo man presents to the ED with pain in his left groin. While the NGT is passing.6mmol/l. tinnitus and left side hearing loss. What is the next immediate action? a. Diaphragm rupture b. Pleural fluid cytology c. He is on alendronate. CT b. Lifestyle modifications have failed to control blood sugar. bowel sounds are heard in the chest. Fx of shaft of femur d.896. A 62yo man dx with T2DM with BMI=33. Close contact c. LN biopsy b.

908. Sarcoidosis A 62yo man presents with cough. Endotracheal intubation d. Antibiotic drop with steroid A 23yo man sprained his right ankle 6wks ago while playing football. the ratio=2. What is the most likely cause of the foot drop? a. Put airway c. Exam: tympanic membance normal. What is the 1st thing you would do? a.31. Compression of the S1 nerve root d. Assess GCS e. Toxapram e. Steroid drop e. 905. Chronic bronchitis b. The ankle jerk is present and plantar reflex is flexor. Steroid PO d. 904. Antibiotic IV c. Nasal IPPV b. Bronchiectasis d. 24% O2. RR=32. On removal of the cast. He has weakness of extensors of the ankle and toes and diminished pin prick sensation over the d orsum of the foot. She complains of discharge from her ear and complains of tragal tenderness. ABG: pH=7. d. He was tx with a below knew walking cast. Turn pt and put in recovery position b. Intubation and ventilation c. He complains of cough. What is the next appropriate inv? a. Start CPR A 52yo man underwent a hemicolectomy. What is the most likely dx? a. ECHO has been done and shows a systolic murmur. The symptoms haven’t improved and so nebulized bronchodilator was repeated and IV aminophylline was given. 907.903. Aural toilet has been done. Amoxicillin PO A young girl returns from holidays in Spain. What is the next appropriate management? a. Compression of common peroneal nerve b. wheeze and a table spoonful of mucopurulent sputum for the last 18m. Sulfonylurea receptor binder A pt presents with progressive dyspnea. breathlessness and wheeze. After a few days he complains of left ventricular pain and fever.7.3/3. FEV1/FVC=2. What is the next appropriate med? a. 906. Tx of the medial collateral lig of the ankle A young man was knocked down during a fight in the waiting room of the ED. Compression of the tibial nerve c. Antibiotic PO b. US . After taking salbutamol. Rupture of Achilles tendom e.4/3. Glitazone e. CT b. salbutamol and hydrocortisone were given. He is now unconscious and unresponsive. Lung fibrosis e.6. Asthma c. LABA d. Spirometry has been done. the pt noted to have right foot drop.

urea=13. CXR d. Oat cell ca A 27yo man presents with chest pain and respiratory distress. hypotension and neck vein distension. Beclo b. what is the next appropriate management? a. Adenocarcinoma d. Oral acyclovir c. Ig c. What is the most likely dx? a. breathing sounds on right side are absent and diminished on left side. Sulfonylurea c. Oral antibiotics d. What is the most appropriate management? a. She was tested –ve for varicella antibody. Regular salbutamol and budesonide c. Right side drain with a small tube (12F) e. CXR b. 911. Inhaled steroid Pt with a long hx of smoking is now suffering from bronchial ca. What is the next most imp step in management? a. Left side aspiration (16G) d. What is the next appropriate management? a. What is the single most appropriate tx? a. Sulfonylurea receptor binder A 5yo boy was brought to GP with high temp and many vesicles on his back. Left side drain with a small tube (12F) A 16wk pregnant pt who was exposed to a child with chicken pox came to GP for help. LFT A 19yo man has exercised induced asthma and is using a salbutamol inhaler as req and beclamethasone 400ug BD. Large cell ca e. histology reveals there are sheets of large polygonal or giant MNC. creatinine=390mmol/L. Ig + vaccine d. None . Lab: GFR=29. Trachea is deviated to the left side. Right side aspiration (16G) c.909. Sodium cromoglycate d. 910. c. Reassurance b. Blood culture e. Topic acyclovir b. Vaccine only e. Small cell ca c. Acyclovir A 68yo woman dx with T2DM and BMI=33. 912. Exam: tachycardia. Biguanide b. Glitazone e. 914. He complains that he has to wake up at night for his inhaler. 913. Oral steroid e. Insulin d. Squamous cell ca b. Topical steroids e.

VT b. ESR 919. What is the next appropriate management? a. IV rantidine 918. recurrent vomiting and tinnitus. A 49yo man complains of fullness in his left ear. Buccal prochlorperazine b. What is the most likely dx? a. MRI e. Assessment for long term O2 therapy e. His FEV1<30%. Lung transplant b. Sprain of the acromio-clavicular ligament c. A-fib . FNAC b. His ECG is below. XR d. What is the most appropriate med? a. Trial of non-invasive ventilation d. A woman came with the complaint of pain in her right arm when she abducts it. salmetarol. ipratropium. A man had a soft mass on his mandible. An 83yo man with longstanding COPD has become progressively breathless over the last 2yrs. Rupture of the long head of biceps b.915. The mass still moves freely. Trial of CPAP c. Supraspinatus tendinitis e. Buccal midazolam e. Shoulder dislocation 916. beclomethasone and theophylline. Oral chlorpheniramine c. Mass is freely mobile and has started growing progressively over the past 6m. Oral flupenphenazine d. He is on salbutamol. Tendinitis of the abductor sheat d. Wht is the likely cause of her pain? a. She has recently moved to a new house. What is the best inv for this pt? a. CT c. There is no hx of trauma. A 63yo man has been brought to the hosp after collapsing during a wedding. Short course of O2 therapy 917.

however. Bendroflumethiazide d. Ramipril c. A-flutter e. XR showed no fx but arm is very swoll en. XR: no fx. Irradiation A 19yo boy comes to the ED with pain. AFB e. c. Surgery e. 923. He also has anorexia and weight loss. TURP c. Hypernatremia e. Wide splint with upward position c. None A 71yo man with a hx of 50yrs of smoking presents with cough. SVT A 75yo war veteran complains of loss of appetite and says he has lost weight over the past few months. Immobilization with cast b.5ng/ml. Furosemide A 33yo man has a temp=38. Radical prostatectomy b. What is the best tx? a. Which drug can cause this? a. MRI d. dyspnea and chest pain. Atenolol b. Brachytherapy e. hemoptysis. He also has purulent sputum. Gram +ve diplococcic b. Gram –ve diplococci A young man’s arm was caught in a machine. Plaster cast b. Coagulase +ve cocci c. 922. cough and chest pain on the right side on inspiration. What is the next appropriate management for the pt? a. Hyponatremia d. 921.5C. Hypocalcemia c. 2days later he developed wheezing. A recent report shows that PSA >5. Antibiotics e. PCP cold agglutinins d. 925. Analgesics d. Cryosurgery d. Tetanus prophylaxis . 924. VF d. how will you manage this pt? a. The dx of lung cancer has been stabilized. Which electrolyte abnormality can be seen? a.920. Hypomagnesemia A 56yo man who is hypertensive recently underwent a change in meds. He says that he has passed come blood in his urine. he had no pain. swelling and tenderness 2cm distal to Lister’s tubercle of radius. Hyperkalemia b. Verapamil e. What is the most likely organism to cause pneumonia in this pt? a. Exam: proximal pressure on the extended thumb and index finger is painful. Repeat XR c.

A 5yo child came from Ghana 6wks ago. None 931. vomiting and neck stiffness. Pancoast tumor b. ESWL b. What is the most appropriate management for this pt? a.926. He had 3 episodes last yr. What is the most appropriate management for this pt? a. A child was brought in to ED by his parents for taking his grand-dad’s meds. A pt had passed a 4mm stone in his urine. Bendroflumethiazide 927. Increase the dose d. What is the management? a. He also has mod tonsillitis. SOB and chest pain. Cerebral abscess b. Digoxin b. sore throat and lymphadenopathy. Meningococcal meningitis d. drooping of left eyelid. Cervical rib d. Exam: tympanic membrane bulging. OE b. Surgery e. Exam: BP=145/85mmHg.9. SAH e. Tonsillectomy b. Dormier basket d. Pneumonia e. Atenolol d.5mg/d has come for his routine checkup. Bronchogenic ca 930. Amitryptiline c. Decrease the dose e. A 65yo man presents with significant weight loss and complains of cough. A 4yo boy presents with fever. Oral penicillin V d. Repeat the blood test 929. severe ear ache. PCNL 932. Continue same dose c. Na+=137. A 4yo boy presents with fever. The dx of tonsillitis has been made. Ramipril e. What is the dx? a. Paracetamol/ibuprofen c. There is an extra systole in the ECG. What is the most likely dx? a. None c. Thoracic outlet syndrome c. vomiting and anorexia. What is the most appropriate dx? a. Which drug was taken? a. Pneumonia 928. A HTN pt on bendroflumethiazide 2. He had taken malaria prophylaxis and had no rash. Acute OM . Cerebral malaria c. Exam: left pupil constricted. Cerebral tumor f. Stop meds b. 2d ago he developed fever. He has a 3mm stone in the renal pelvis found on US. He came to the GP a few days ago and was dx with URTI. Lab: K+=5. IV penicillin e.

MRI d. and has been working as a builder since he was 24yo. 935. SAH b. CTPA A 57yo man having HTN on oral anti-HTN. ECG c. there is minimal tenderness on exam. Visual field test c. Serous otitis d. TFT d. Stroke d. Chronic suppurative OM e. Fx neck of humerus d. CXR b. SOB. Subdural hemorrhage A 6yo boy fell in the playground and has been holding his forearm complaining of pain. CT A 33yo female complains of diplopia on upright gaze. 936. He presents with chest pain. Mastoiditis A 3yo girl presents with complains of sudden right facial weakness and numbness and pain around her ear. Fx shaft of humerus e. However. CXR shows bilateral fibrosis and left side pleural effusion. 934. 938. Green stick fx of distal radius A 62yo man has been smoking about 15 cigarettes/day for 45yrs. Exam: no sign of deformity or swelling. Ambulatory BP b. What is the best inv that will lead to dx? a. Bell’s palsy c. Fx mid ulnar c. CT c. There are no symptoms. V/Q scan e. 937. Fx mid radius b.933. Exam: ptosis can be seen. Checking red reflex . CXR e. What is the most appropriate inv for him? a. one of the players suddenly collapsed to the ground with coughing and SOB. There are no other complains or any significant PMH. However. Pleural fluid aspiration of cytology c. he is finding it difficult to mobilize as he feels dizzy whenever he tries to get up. c. What is the most appropriate dx? a. CT During a basketball match. TIA e. MRI d. What is the most appropriate inv for him? a. MRI d. Pleural biopsy e. What is the dx? a. Ophthalmoscopy b. CXR b. weight loss. What is the inv of choice? a. CT e.

Post cruciate e. Urine C&S c. Hematoma . You have been called to look at him. Insert a needle in the 2nd ICS in the mid-clavicular line b. What is happening to this pt? a. Urgent hemodialysis b. Sepsis d. a pt complains of a rapid HR and fever. Medial collateral c. US e.939. His serum K+=7. US shows bilateral hydronephrosis. Lateral collateral d. IV insulin + dextrose d. What is the most probable dx? a. DM man feels hot. Some unusual cells have been seen in urine on routine exam. Anal fissure b. CXR shows early pulmonary edema. how will you manage him? a. What is the cause of these findings? a. What ligament was most probably injured? a. A 50yo man presents with the complaints of recurrent UTI and occasional blood in the urine. He says there is also abdominal pain and pain in the shoulder area. A tall rugby player was hit in the chest by a player of the opponent team. Anastomotic leak c. Prostatic ca e. IV calcium gluconate c.5mmol/l. Intubate the pt d. Give oxygen 940. Furosemide e. Intestinal obstruction 943. Insert a needle in the 5th ICS in the mid-axillary line c. Renal stones c. A 28yo drug user presents to ED collapsed and anuria. painful lump near the anal region. Cystoscopy b. Intra-abdominal bleeding b. Bladder stones d. IV 0. Meniscus 941. UTI 942. poor stream and dribbling at the end of voiding and anorexia. What is the next appropriate management for this pt? a.9% NS 945. Exam: valgus test +ve. A young woman fell and hit her knee. XR KUB d. CBC 944. Ant cruciate b. 2h after an appendectomy. Start CPR e. BPH b. A 75yo man comes in complaining of difficulty in passing urine. Which os the following inv would you like to carry out now? a. He developed breathlessness and his face went blue and purple. Abscess c.

He says that he sometimes feels difficulty in swallowing food. Labs: CRP=12. Maintain IV access and give IV fluids b. The diameter of the calk has increased and passive movements cause pain. Cautery of swelling An 80yo DM lady presents with redness and swelling over her right foot. warm and glossy. 952. 948. What is the first step in the management? a. I&D + antibiotics b. Intra articular steroid e. Insert NGT for intestinal decompression d. Basal cell b. Start IV antibiotics c. a pt complains of a rapid HR and fever. Polymyalgia rheumatic c. What tx should she get? a. What are the complications this pt might develop? a. 951. C&S of aspirate from swelling d. She says she also has a fever. DVT b. Meningitis b. Labs: ALP=216. What is the 1 st line med? a. ALT=43. AST=49. ESR=16. Polymyosis b. NSAIDs c. CK=417. What is the most likely dx? a. Oral steroid d. Muscular dystrophy d. Superficial thrombophlebitis 2h after an appendectomy. Gangrene After surgery a pt’s left leg has become swollen and tender. Painkillers e. Esophageal carcinoma e. 947. What is the most probable dx? a. Ulcer d. Cross match blood e. Emergency exploratory laparotomy A pregnant woman presents with knee pain on movements. Paracetamol b.946. Peripheral vascular disease d. The pain becomes worse at the end of the day. Radiology shows decreased joint space. What is the dx? a. d. Wart e. Osteoarthritis A 67yo builder presents with a persistent nodular lesion on upper part of pinna with some telangiectasia around the lesion. Lymphedema c. He says there is also abdominal pain and pain in the shoulder area. IV antibiotics c. It is tender to touch. 950. Squamous cell . DMARDs A 68yo man presents with muscle weakness. External hemorrhoids A 65yo lady with T1DM for the last 20y comes with a tender lump near the anal opening. He also complains of mild breathlessness. Sepsis c. Hematoma e. 949. He is not able to climb stairs.

What is the single most appropriate option? a. Acute metabolic acidosis A 65yo man on dexamethasone underwent surgery. He has slurred speech. Aspirin b. IV Saline e. 956. He is taking senna for constipation. PCO2=2. What is the best med to relieve his pain? a. DMARDs b. 957. What is the most appropriate tx? a. Keratocanthoma d. What is the most probable dx? a.2kPa. Oral hypoglycemic c. Insulin b.953. c. Bicarb=20. PO2=11kPa.52. What is the most likely condition? a. 954. Exam: tympanic membrane was dull greyish and no shadow of handle of malleus. Acute OM c. Ibuprofen c. Actinic keratosis e. Remove dexamethasone d. Accessory nerve b. Warfarin d. the tip deviated to the left. Cholesteatoma . Acute metabolic alkalosis b. Vagus nerve A 24yo woman known to be suffering from panic disorder presents to the hospital with tingling and numbness in her fingers. 955. Facial nerve c. IX dextrose A 61yo man who had stroke 2y ago is on aspirin. Dipyridamole A 73yo man who is recovering from surgery on the left carotid artery in his neck. Compensated metabolic acidosis e. During and after the surgery. Clopidogrel e. Chronic OM b. Co-codamol d. his blood glucose was around 17-19mmol/l. Glossopharyngeal nerve d. Hypoglossal nerve e. What will you give the pt? a. 958. Compensated resp alkalosis d. Paracetamol A young child was brought by his mother to the OPD complaining that he raised the vol of the TV and didn’t respond to her when she called him. Otitis externa e. On protusion of his tongue. He has RA but suffers from pain and can’t tolerate it. Acute resp alkalosis c. ABG: pH=7. Secretory OM d. CT shows cerebral infarct. Bowens disease A 68yo pt wakes up with slurred speech and right sided weakness. Alteplase c.

959. A 48yo woman always socially withdrawn has stopped going out of the house. She is afraid to
socialize because she fears that people will criticize her. What is the most probable dx?
a. Agoraphobia
b. PTSD
c. Social anxiety
d. OCD
e. GAD
960. Post gastric ulcer got perforated leading to bleeding involving the gastro-duodenal artery.
Where would fluid accumulate in the cavity?
a. Left paracolic gutter
b. Pelvic cavity
c. First part of duodenum
d. Under the diaphragm
e. Retroperitoneal
961. A 4yo boy presents with recurrent episodes of self limiting spontaneous bleeding. Coag test: PT
normal, bleeding time normal, APTT prolonged, Factor VIII decreased. His father and uncl e
suffer from a similar illness. What is the most likely dx?
a. Hemophilia A
b. Hemophilia B
c. Von willebrand’s disease
d. ITP
e. TTP
962. A 53yo lady presents with hot flash and night sweats. Her LMP was last year. She had MI
recently. What is the most appropriate management for her?
a. Reloxifene
b. Estrogen
c. COCP
d. Evening primrose
e. Clonidine
963. A 73yo man who was a smoker has quit smoking for the past 3yrs. He now presents with
hoarseness of voice and cough since past 3wks. XR: mass is visible in the mediastinum. What is
the best inv to confirm the dx?
a. Bronchoscopy
b. Thoracoscopy
c. US
d. CT thorax
e. LN biopsy
964. A 52yo man known DM presents to ED with sudden onset of pain in the left loin and hematuria.
Inv: 8mm stone in left lower ureter. Nifedipine with steroids was prescribed as initial tx with
supportive therapy. He returned complaining of worsening pain, vomiting with passing of 2
stones. Renal function tests indicate impending ARF. How will you manage this pt?
a. Continue same tx
b. Start alpha blocker
c. ESWL
d. Percutaneous nephrolithotomy
e. Percutaneous nephrostomy
f. Open surgery

965. A lady who is alcohol dependent wants to quit but wants someone to encourage her. What
would you do?
a. Medication
b. Refer to social services
c. Refer to psychology
d. CBT
966. A young girl presented to OBGYN assessment unit with lower abdominal pain and per vaginal
bleeding after a hx of hysterosalpingograph as a part of her infertility tx. Observation:
BP=90/50mmHg, pulse=120bpm, exam revealed rigid abdomen. What is the most appropriate
next inv?
a. CT
b. XR erect and supine
c. US abdomen
d. Coag profile
e. CXR
967. A 21yo woman who is on COCP had to take azithromycin. What should be advised for her
contraception?
a. Using 7d condoms after antibiotics and avoid pill free break
b. Using 14d condoms after antibiotics and avoid pill free break
c. Using 7d condoms after antibiotics
d. No extra precaution
e. Using 14d condoms after antibiotics
968. A 60yo woman presented with radial fx and had a colle’s fx and supracondylar fx in the past.
What inv is req to detect her possibility of having the same prb later?
a. Dexa scan
b. MRI
c. Nuclear bone scan
d. CT
e. Bone biopsy
969. A 43yo woman presents with low mood, loss of libido, sleep disturbance, tiredness, palpitation,
chest discomfort, irritability and recurrent worries. What is the most likely dx?
a. Seasonal Affective Disorder
b. Mod depression
c. Dysthymia
d. GAD
e. Bipolar disorder
970. Which of the following is true for tamoxifen?
a. Increased incidence of endometrial carcinoma
b. Increased risk of breast ca
c. Increased risk of osteoporosis
d. Increased risk of ovarian ca
971. A 45yo male complains of tremors in hands. Exam: tremors are absent at rest but present when
arms are held outstretched and persist on movement. What is the most probable dx?
a. Parkinsonism
b. Benign essential tremor
c. Cerebellar disease
d. Liver failure
e. Stroke

972. Pregnant lady had her antenatal screening for HIV and Hep B. what more antenatal inf should
she be screened for?
a. Rubella and syphilis
b. Toxoplasma and rubella
c. Syphilis toxoplasma
d. Hep C & E
e. Hep A & C
973. A young man has been found in the park, drunk and brought to the ED by ambulance. He
recently lost his job and got divorced. He thinks nurses are plotting against him. What is the
most likely dx?
a. Schizoid personality
b. Borderline personality
c. Schizophrenia
d. Psychotic depression
e. Paranoid personality
974. An elderly man who used to work in the shipyard industry presented with cough and SOB few
weeks to months. He was given salbutamol nebulization and antibiotics and admitted to the
ward. He died 3d later. CT: patchy infiltrates, pleural thickening and pleural effusion. Why is this
a coroner’s case?
a. Pt got wrong dx or management
b. Pt died soon after admission
c. Death could be due to occupational illness
975. A 26yo lady came with abdominal pain, vaginal discharge and low grade fever. What is the most
likely dx?
a. HELLP syndrome
b. Acute PID
c. Ectopic pregnancy
d. Appendicitis
976. A new screening test has been devised to detect early stages of prostate ca. However, the test
tends to dx a lot of ppl with no cancer, although they do have cancer as dx by other standard
tests. What is this flaw called?
a. False +ve
b. True +ve
c. False –ve
d. True –ve
e. Poor specificity
977. A 26yo political refugee has sought asylum in the UK and complains of poor conc. He keeps
getting thoughts of his family whom he saw killed in a political coup. He is unable to sleep and
feels hopeless about his survival. Because of this he is afraid to go out. What is the most likely dx?
a. Acute stress disorder
b. PTSD
c. Social phobia
d. OCD
e. GAD
978. A 2yo boy presented with gradual swelling of feet and poor feeding. He has gained weight and
has dark urine. What is the single most appropriate inv?
a. Serum albumin (2nd)
b. 24h urinary protein (1st)

979.

980.

981.

982.

983.

984.

c. Serum calcium
d. BUE
e. Serum glucose
A 26yo lady presents with high fever, lower abdominal pain and purulent vaginal discharge. She
looks very unwell. What is the most appropriate management?
a. Tetracycline 250mg QD
b. Doxycycline 100mg BD and metronidazole 400mg BD
c. IV Ceftriaxone 2g with doxycycline 100mg
d. IV ceftriaxone 2g with doxycycline 500mg
e. Ofloxacin 400mg BD and metronidazole 400mg BD
A 39wk pregnanct woman came to labor suite 3d after an obstructed labour presents with pain
and swelling of one leg. Exam: leg has blue mottline and is cold. What is the dx?
a. DVT
b. Post phlebitis syndrome
c. Embolus
d. Varicose vein
e. Herpes gladiatorum
An 8yo boy has his tonsils and adenoids removed. On the 7th post-op day, he comes back to the
ED with hemoptysis and fever. What is the most appropriate management?
a. Admit for IV antibiotics
b. Prescribe oral antibiotics and discharge
c. Packing
d. Surgery
e. Reassurance
A 50yo female had swelling in her ankles. She is a known alcoholic. Now she presented with
breathlessness and palpitations. What is the most likely cause of her condition?
a. VT
b. SVT
c. A-flutter
d. A-fib
e. V-ectopics
A young boy has acute scrotal pain for a few hours. Exam: one testis is very painful to touch. He
had this kind of pain before but it was mild and resolved itself within 30mins. What would you
do next?
a. Urgent exploration
b. US
c. Antibiotics
d. IV fluids
e. Doppler US
An 8wk pregnant woman presents with persistent vomiting and weight loss. Exam: HR=110bpm.
Dehydration was corrected with NS infusion and K+. The condition didn’t improve so IM cyclizine
was given. She is still vomiting. What is the next appropriate management?
a. IV fluids
b. IV antiemetics
c. IV steroids
d. Terminate pregnancy
e. Thiamine

985. A 28yo lady presents with dyspareunia and dysmenorrhea. She is very obese. She now wants
reversible contraceptive method. Which of the following will be most suitable for her?
a. Minera
b. COCP
c. POP
d. Copper T
e. Barrier method
986. A young lady who is 28wks pregnant presents with vaginal bleeding. She has lost about 200ml of
blood. Exam: uterus is tender. Resuscitation has been done. What is the most omp inv to
establish the dx?
a. US
b. CT
c. D-dimer
d. Clotting profile
e. None
987. A 14yo girl presents with primary amenorrhea and a short stature. What is the most likely dx?
a. Down’s syndrome
b. Klinefeltner’s syndrome
c. Turner’s syndrome
d. Fragile X syndrome
e. Normal finding
988. A 32yo woman wants reversible form of contraception. She has one child delivered by
emergency C-section. She also suffers from migraine and heavy periods. What is the most
suitable form of contraception for this lady?
a. COCP
b. Mini pill
c. IUCD
d. Barrier method
e. Abstinence
989. A 45yo known hypertensive man presents with hematuria, proteinuria and edema. What is the
definitive dx test for him?
a. Urine protein
b. Renal biopsy
c. Renal function test
d. Urine microscopy
e. Serum protein
990. A 47yo man presents with proteinuria+, BP=160/95mmHg, small kidneys that have smooth renal
pelvis. What is the most probable dx?
a. GN
b. Chronic pyelonephritis
c. Unilateral renal artery stenosis
d. Multiple myeloma
e. ARF
991. You are the HO in the hospital and the lab report of a pt shows glucose=4mmol/l, K+=5.2mmol/l,
Na+129mmol/l. what is the most appropriate management?
a. NS 0.9%
b. NS 0.45%
c. NS 0.9% and insulin

What is the most likely underlying cause? a. Give paracetamol with future doses of the same vaccine e. 997. Chronic bronchitis d. Exam: BP=160/105mmHg. Axillary nerve b. 996. Corticosteroids c. CT d. He is refusing any oral meds. He says his urine is dark. Fluphenazine . What is the single most appropriate tx? a. Radial nerve c. Hematocele c. 995. Ulnar nerve A 64yo man complains of increasing SOB and cough for the past 18m. Pan retinal photocoagulation b. Don’t give vaccine c. Median nerve d. 993. The retina is pale and fovea appears as a bright cherry red spot. Bronchiectasis c. Varicocele b. Acute bronchitis b. Proceed with standard immunization schedule A young man presents with sudden. Scleral buckling d. What is the single most associated nerve injury? a. 994. Urine protein e. Testicular tumor d.992. Insulin e. US b. What is the single most appropriate action? a. Testicular torsion A 24yo male involved in RTA with XR: fx neck of humerus. Renal biopsy c. What is the single most appropriate injection? a. Pneumonia A 55yo man who is hypertensive suddenly lost his vision. He coughs up a Tbsp of mucopurulent sputum with occasional specks of blood. d. Surgical extraction of lens e. Flupenthixol b. What is the most probable dx? a. Give half dose of vaccine d. Exam: one testis seems higher than the other. severe pain and swelling in the scrotum. Epidiymo-orchitis e. Lung cancer e. What is the most appropriate inv? a. Dextrose A 27yo man presents with abdominal pain. Defer immunization for 2wks b. 998. Urine microscopy A 12m child with AIDS is due for his MMR vaccination. Pressure over eyeball A 32yo man with schizophrenia and a hx of violence and distressing auditory hallucinations was admitted to the ward with aggressive behavior and has already smashed his room.

There are several non tender swellings on both sides of her neck. Prostatic ca d. What is the most probable dx? a. She complains of seeing halos especially at night. Femoral hernia d. Midbrain d. Tunnel vision d. hesistancy and nocturia. BPH b. Urine microscopy confirms the presence of blood but no other features. Exam: otherwise normal. 1003. Femoral aneurysm An 82yo man has woken up with incoherent speech and difficulty in finding the right words. What is the most probable dx? a. Chronic sinusitis b.999. Risperidone A 65yo man complains of hematuria. She has lost 13kgs. Prostatitis A 60yo man presents with mass in the groin. Saphenavarix c. Mono-ocular field loss c. What is the single most likely defect? a. Haloperidol d. Vocal cord nodules d. SAH c. Parietal cortex e. Bladder ca c. She takes recreational drugs. Hyperthyroidism c. Central scotoma e. TB A 30yo woman presents with acute headache. What is the most likely dx? a. good comprehension. Wernicke’s area c. frequency. Thyrotoxicosis b. Irreducible hernia e. Carcinoma bronchus e. Which anatomical site is most likely to be affected? a. He reports that on certain occasions he finds it difficult to control the urge to pass urine. Migraine d. 1000. Cortical blindness A 35yo man presents with a headache that worsens on bending his head forward. Paraldehyde e. 1002. Broca’s area b. Cluster headache e. Pons A 25yo woman has a recent cough. 1004. 1001. Pyelonephritis e. hoarseness and swelling in the neck. Paracentral scotoma b. c. Tension headache . Exam: mass lies below the midpoint of the inguinal ligament and is pulsatile. What is the most porbable dx? a. Direct inguinal hernia b.

Anti DS DNA e. Indirect inguinal hernia c. Exam: trismus and unilateral enlargement of his tonsils. discharge from left ear and right sided hyper-reflexia with an extensor plantar response. Cerebellar tumor d. A 50yo man complains of visual prbs and dull pain in the left eye. Homonymous lower quadrantanopia . A 34yo male presents with headache and vomiting. IV antibiotics and analgesics c. Homonymous upper quadrantanopia d. Central scotoma e. A 40yo manual worker presents with a swelling in the groin. Anti centromere 1010. A 20yo man presents with painful swallowing. There is no consensual light reflex of the right eye. It is reducible. Direct inguinal hernia b. What is the single most likely positive antibody? a. Analgesics with antipyretics e. CXR: multiple soft shadows and CBC: eosinophilia. Exam: nystagmus. What is the most likely dx? a. Mono-ocular field loss c.5C. He also reports to have consulted his GP for generalized rash prv.1005. Exam: temp=38. Paracentral scotoma b. What is the most probable dx? a. Cerebrum e. Cerebral tumor b. I&D with antibiotics d. Pons c. C ANCA c. Vestibule cochlear nerve 1009. Femoral hernia d. Cerebral abscess e. inflamed and swollen. He was dx with MS 2yrs ago. Exam: mass is found to be just above and lateral to the pubic tubercle. What is the single most likely defect? a. Normal pressure hydrocephalus 1008. On applying pressure on the internal ring there is no cough impulse seen. The peritonsilar region is red. neck stiffness. P ANCA b. His PMH is significant for late onset asthma and heart failure. Strangulated hernia e. Oral antibiotics b. A 26yo male presents with speech difficulties. Fundoscopy reveals papilloedema. Which anatomical site is most likely to be affected? a. Meningitis c. Anti Ro d. Tonsillectomy 1006. A 75yo man presents with Bell’s palsy. Femoral aneurysm 1007. What is the most appropriate tx? a. Midbrain b. Cerebellum d.

Ovarian torsion e. CBT d. Restrict fluids d. She looks ill.8C and there is rebound tenderness in the RIF. Dipyridamole e. What is the single most likely dx? a. The pain is now colicky. Haloperidol 1017. A 54yo pt wakes up with right sided weakness. What is the most appropriate tx? a. What is the most appropriate tx? a. CT shows left cerebral infarct. He is not able to walk straight and his speech is slurred. Appendicitis d. Aspirin c. A 25yo woman who is 11wks pregnant had central abdominal pain for 36h. An 89yo pt has lung cancer. PET brain c. Simvastatin 1012. What would you advice the GP? a. Fluoxetine b. Chondromalasia b. His Na+=122mmol/l. Pulse=92bpm. There is no vaginal bleeding. A 20yo woman with no prv hx of ear complains. A 33yo man presented to the GP with hx of headaches and photophobia. Alteplase b. His current medication is bendroflumethiazide for HTN. Start IV benzylpenicillin c. Furuncle c. What is the initial appropriate inv? a. Send pt home b. BP=160/90mmHg. Clopidogrel d. She is breastfeeding but is otherwise unable to look after the baby and is convinced that her family is likely to kill her. Conduct LP d. temp=37. She has no interest in anything and keeps crying. Myringitis . A 42yo man presents with stroke. Demeclocycline b. A 24yo woman has severe depression 3m after the birth of her first child. Reassure 1014. presents with 1d hx of severe pain in the right ear which is extremely tender to examine. The GP examines him and finds a rash and is now ringing you at the hospital for advice.1011. MRI brain d. CT brain b. Uterine fibroid 1015. Monitor for 24h 1016. Salpingitis b. She has vomited once and has had an episode of loose motion. What is the tx for this? a. Citalopram c. ECT e. Vasopressin c. Start IV ceftriaxone 1013. PID c. Carotid angiography e. What is the most probable dx? a.

Coxiella burnetti d. Disulfiram b. Acamprosate c. Optic disc c. Serum ALP concentration e. Ophthalmoscopy shows papilloedema. DEXA scan d. Diazepam A 48yo pt after surgical removal of mandibular ca presents with perioral paresthesia and severe pain which is not relieved by oral morphine. d. Werniecke’s encephalopathy c.1018. 1019. spider angioma. Optic nerve b.3C and productive cough. Dosulepin e. Occulomotor nerve e. CBT d. Streptococcus pneumonia b. What tx would be most effective for this pt? a. Radionuclide bone scan c. MRI spine b. Optic chiasma A 75yo man has been attending the clinic for lower urinary tract symptoms. What drug is the appropriate choice? a. His mood is very low and he says he feels unhappy. Vitamin supplement d. liver firm with 8cm span. He has been dx with moderate depression. 1024. Optic radiation d. Hepatoma e. 1023. What is the most likely organism? a. anxious and unable to sleep. no ascites. 1021. Which anatomical site is most likely to be affected? a. Naloxone e. Hepatic vein thrombosis A 39yo male presents with visual symptoms. Mycoplasma pneumonia A 70yo man with prostatic cancer has had severe acute back pain waking him up at night for 6wks. What is the most appropriate inv? a. S3 gallop. cardiomegaly. 1020. Sputum is rusty colored after 2 days. Temp=39. What is the next step in treating this pt? . CXR shows right lower lobe consolidation. Citalopram c. OE e. Naltrexone A 68yo woman presents to the ED with confusion. Serum calcium concentration An asymptomatic 56yo man who has never consumed alcohol came for a routine checkup. OM A couple has just finished their detox regime and wants a drug with a pharmacological action to serve as a deterrent when they take alcohol. Exam: increased skin pigmentation. 1022. Renal failure d. Staphylococcus aureus c. Cerebellar degeneration b. Amitriptyline b. He is in the risk of which condition? a.

deafness and ringing in his ears. Fentanyl patch c. Liver biopsy A 35yo woman presents with visual problems. What is the most likely dx? a. What is the single most likely defect? a. Homonymous hemianopia b. PCA f. Lyme antibodies d. Skin swab for bacteria A 80yo man with prostatic cancer has confusion. Homonymous upper quadrantopia c. Homonymous lower quadrantopia A 45yo heroin addict was involved in a car crash and is now paraplegic. Gabapentine (1st line) A 34yo man was slapped over his right ear in a fight. 1028. The rash has been spreading over the last 3wks. abdominal pain and an abnormal ECG. thirst. ABG b. Liver enzyme d. DEXA scan d. Serum calcium concentration A 27yo lady after C-section developed epigastric pain after 8h. Skin scrap for mycology e. MRI spine b. Serum ALP concentration e.1025. What is the appropriate inv? a. Cortical blindness e. IV morphine b. Hypertensive retinopathy . There is blood coming from his external auditory canal and he has pain. a. Otoscopy d. Oral oxycodone e. Coag profile c. Organic brain damage A pt with T1DM has a fundus showing micro-aneurysm and hard exudate. What is the most appropriate inv? a. What is the most appropriate initial inv? a. CT b. 1030. Bitemporal hemianopia d. PTSD b. 1029. What is the single most useful investigation? a. 1026. Macular degeneration b. CT brain reveals pituitary tumor. Radionuclide bone scan c. He has some general aches and pains. 1031. Oral amitryptiline (2nd line) d. Biopsy lesion c. During the 1st week of hospital stay he cried everyday because he couldn’t remember the accident. Facial XR A 45yo man has developed an annular rash with a scaly edge on his thigh. What is the single most likely dx? a. ANA b. 1027. Skull XR e. Severe depression c. MRI c.

1032. Surgery e. MRI shows 15mm tumor in the pituitary fossa. He is deeply jaundiced and has ascites with edema upto the buttocks. What will you do? a.03mmol/l. What is the single most appropriate management of his fluid intake? a. albumin=17g/L.5mg. c. Fluids PO A 2yo with atrophy of the buttocks. Crystalloids IV c. He is now drowsy and his family are worried that he is not drinking enough. Diabetic background e.5mmol/l. Endoscopic diverticulectomy e. urea=6. lactulose 10ml. 1037. calcium=2. Bloods taken 3d ago: electrolytes normal. and lack of energy. Mental state exam A 40yo woman presents with dysphagia. What is the best management strategy? a. What is the tx of choice? a. 1035. Stool culture A 78yo woman is brought to the hospital complaining of back pain and is referred to the surgeon. She has been saying that her mother is due to visit her today and that somebody must have broken her lower back as she is in agony. MS d. Albumin infusion b. calcium=3. Choose the single most likely inv? a. total bilirubin=189mmol/l. Which inv is most likely to lead to a dx? a. creatinine=89mmol/l. IVU d. 1036. Proliferative DM retinopathy A 62yo man has multiple liver mets due to adenocarcinoma with an unknown primary. Colonscopy e. Get letter signed from the wife . distended abdomen with frequent offensive smelly stool. visual disturbance. Upper GI endoscopy b. 1034. XR Spine c. Exam: febrile with erythema and middle neck swelling. He wants it removed so ‘it can help improve his memory’. Get letter signed from the GP b. Octreotide c. Crystalloids SC d. 1033. Labs: creatinine=295mmol/l. Sweat test d. Fluids via NGT e. I&D A young lady presents with gradually worsening headaches. XR neck d. Antipyretics c. US KUB b. His meds include: haloperidol 1. IV antibiotics and drainage b. Chemotherapy A man with dementia has an ulcerative lesion on his forehead. Reassurance and f/u after 6m d. Endomyseal/alpha glidin antibody c. Bence-Jones Protein e.04mmol/l. Radiotherapy b. Wife says he is not fit to give consent.

Refer to psychiatrist to assess the mental capacity to give consent A pt with flame shaped hemorrhage on long term tx with nifedipine. Co-codamol c. C8/T1 c. Serum AFP b. Proliferative DM retinopathy c. Binasal hemianopia e. 1040. CT abdomen e.1038. c. He can’t remember anything about his life. 1044.5. DM background b. Serum ALP isoenzyme conc e. HTN retinopathy e. SLE A pt whose pain is not relieved by oral codeine. US d. What is the most appropriate inv? a. Choose the single most likely inv? a. Homonymous hemianopia b. Refer to acute medical team d. MS f. C5/C6 d. PCA d. Refer to eating disorder clinic b. Barium meal c. Homonymous lower quadrantanopia An 18yo girl has been dx with anorexia nervosa and has mild depressive symptoms. 1043. Serum acid phosphates conc d. Bitemporal hemianopia d. Barium enema A 79yo man who is being treated with GnRH antagonist for proven adenocarcinoma of the prostate attends a follow up session. Oral morphine A 6wk baby with vomiting. Which vertebra will be the lowest to be included on cervical XR to dx the injury? a. Prescribe antidepressant . 1041. Upper GI endoscopy b. 1039. Her BMI=15. Trans rectal US A middle aged woman has some weakness of hand after an injury. IV morphine e. What is the single most likely dx? a. 1042. What is the single most likely defect? a. Refer to psychodynamic therapy c. She has cut down her food intake for the last 18m and exercises 2h everyday. Oral oxycodone b. Macular degeneration d. Homonymous upper quadrantanopia c. irritability and palpable mass in the abdomen on feeding. Serum PSA c. C6/C7 A 50yo man with a known hx of stroke. What would be the single most appropriate management? a. What is the best management? a. BP=90/60mmHg. Get letter signed from the pt d. C7/T1 b.

Staph aureus b. What is the most likely organism? a. An 8wk baby boy is noted to be jaundiced. Presbycusis 1047. He is breast-feeting well and has gained 300g since birth. His stools are yellow and his urine is pale straw colored. CCB d. Dormier basket e. A 32yo man suffering from MS presents with blurring of vision. Ophthalmoscopy shows pallor of the optic disc. Optic nerve b. What is the single most likely dx? a. Galactosemia b. An IVU confirms a stone in the ureter which is 8mm in size. Impacted earwax d. Chronic serous OM b. Herpes zoster infection c. He is rolling about on the floor. A 36yo woman has an injury to the right external laryngeal nerve during a thyroid surgery. She has had a painful ear for 48h. Optic radiation d. Congenital viral infection 1048. Cotard syndrome c. Her 42yo partner is convinced about this and calls the police. GBS d. Which tx modality will be most effective? a. G6PD deficiency d. ESWL c. There are pustules in the left ear canal and on the eardrum. Stridor b. PCNL 1051. A lady developed breast abscess after delivery. Dysphonia e. Which anatomical site is most likely to be affected? a. Optic disc c. What is the most likely dx? a. Aphonia d. A 23yo man presents with severe pain in the right flank radiating to his groin. Hoarseness c. What symptom would be expected in this pt? a. Breast milk jaundice e. Aphasia 1046.1045. Capgras syndrome b. Strep pyogenes e. Fluids and alpha blockers b. A 75yo woman has weakness of the left side of her face. Staph albus c. Trigeminal e. Oculomotor nerve 1050. Perforation of eardrum e. A 37yo woman believes that her neighbours have been using her shower while she is away from home. Delusion of persecution . What term best describes this situ? a. Biliary atresia c. Strep faecalis 1049.

d. What is the most probable dx? a. Trigeminal nerve c. Keratoconus A 30yo man presents to hosp complaining that his urine has been very dark recently. She worries excessively about a number of everyday events and activities and is unable to control these feelings which are impairing her ability to hold down her job. Which anatomical site is most likely to be affected? a. Oculomotor nerve d. 1054. 1057. Ischemic mitral regurgitation c. Brain stem e. Dental caries b. Aortic stenosis d. Trigeminal neuralgia A 42yo lady had corrective surgery for cyanotic congenital heart disease at the age of 3y. SLE . Basal ganglia A 30yo woman has experienced restlessness.1052. OM d. Cerebral cortex b. Pulmonary regurgitation A 45yo lady presents with hx of double vision and facial numbness. 1055. 1056. Chewing is uncomfortable and her husband has noticed that she grinds her teeth during sleep. Mooren’s ulcer e. Temporomandibular joint pain e. There is a parasternal impulse and an early diastolic murmur. Fatty/lipid degeneration d. Acute stress disorder e. Folie a deux e. muscle tension and sleep disturbance on most days over the last 6m. Panic disorder b. Marginal dystropathy c. Social phobia Which of the following is not a degenerative corneal disease? a. Pulmonary stenosis e. Mumps c. Membranous glomerulonephropathy b. What is the most likely dx? a. resembling coffee at worst. There is no discharge. He has been under the weather 2wks back and had taken a few days off w ork with a sore throat and coryzal symptoms. He is admitted for supportive management and is scheduled for a renal biopsy. Munchausen syndrome A 45yo woman has dull pain in her right ear which has been present for several weeks. which shows mesangial proliferation with a positive immune-flurescence pattern. Pheochromocytoma d. Urine dipstick in hosp returns highly positive for blood and protein. What is the most probable dx? a. after a palliative operation during infancy. What is the single most likely dx? a. Band keratopathy b. GAD c. The eardrum appears normal. Aortic regurgitation b. 1053.

Cryptogenic organizing c. Aspirin d. Oral b. Which is the most appropriate vessel affected? a. His CXR shows round fibrotic tissue demonstrating a mixed restrictive and obstructive ventilator defect with irreversible airflow limitation and reduced gas transfer. In the ED. Molluscum A pt was complaining of pain within 6h after his appendectomy for gangrenous appendix. PCA d. IV c. Per rectal e. NAI b. Basiliary artery b. HSP d. She has been prescribed diazepam 2. Churg-strauss syndrome b. Altepase c. What med is the best option for his pain relief? a. Post – strep GN e. Clopidogrel b. IM d. Wegener’s granulomatosis d. IgA nephropathy A 65yo lady presents with a 6h hx of facial droop and weakness in the left sied of her body. What single agent will she be prescribed for her whole life? a. Social services had been notified on arrive to hospital. Good pasture’s syndrome e.1058. 1063. 1059. SC A nonsmoker who has worked in coal mines for 20yrs presents with gradually increasing SOB. limited exercise tolerance and a dry cough. c. ITP c. Vertebral artery d. 1061. 1060. 1062. ALL e. HUS A man with hx of fall had confusion and laceration mark on the head. Diclofenac per rectal c. he is accompanied by his mother and stepfather. Labetalol A 10yo boy is brought to the hosp with a rash over his buttocks a/w abdominal pain and vomiting. What is the most probably dx? a. Progressive massive fibrosis f. Diploic vein A 72yo lady is drowsy and her relatives want to take her home.5mg. Extrinsic allergic alveolitis d. What is the single most appropriate dx? a. IV morphine b. Tramadol . Middle meningeal artery c. What is the best delivery route? a. His mother had left him for the weekend with the stepfather and was called to come back from holiday as he started to have some hematuria with the rash.

Impaired glucose tolerance b.1064. stridor and unable to swallow saliva. Basal cell b. She is brought to the hosp after having ingested 100 paracetamol tablets 4h ago. A 44yo obese pt with findings: FBS=6mmol/l. Sinus Tachycardia d. T1DM d. A 62yo farmer presents with a persistent firm irregular lesion on upper part of pinna which grew over the last few months. Fluoxetine b. What is the most appropriate dx? a. MODY 1069. Clozapine d. Risperidone 1066. Refer to social worker 1068. VT c. What is the initial step that needs to be taken? a. Which drug is most likely to have caused this? a. Examine throat . She is refusing all med tx. Gastric lavage d. What is the next best step? a. Observe b. Refer to psychiatrist to assess pts ability to refuse tx c. T2DM e. A child distressed with fever. Activated charcoal e. His RR=40bpm. WPW syndrome e. Diabetes insipidus c. A 24yo schizophrenic has been under antipsychotic tx for the last 1 yr and now complains of ED. What is the most likely dx? a. A 45yo woman has recently been dx with MS and has been started on oral steroids. Keratocanthoma 1065. OGTT=10mmol/l. Normal b. Squamous cell c. Citalopram c. A-fib 1067. What is the most likely dx based on this ECG? a. Haloperidol e.

CT h. IV penicillin A pt presents with hemoptysis 7d after tonsillectomy and adenoidectomy. Benign parotid b. IVU g. Myeloma A 54yo lady presents with sudden severe pain in the left half of her skull. He has been worried about his loss of weight and reduced general activity. 1074. Mandible tumor c. 1076. She was administered IV fluids and oral anti-emetics. What is the most probable dx? a. comes to the hospital with complaints of painless hematuria. Ice cream and cold fluid A 55yo man presents with swelling at the angle of the mandible which is progressively increasing in size and it’s mobile for 6m. Which inv would be diagnostic of his condition? a. Temporal artery biopsy A 7yo school boy has been dx with meningococcal meningitis. Oral antibiotics and discharge d. KUB b. MRI c.1070. urgency and dysuria. IV steroid A 48yo man presents with bone pain. She still can’t tolderate anything orally. Urine microscopy f. What is the most likely next step? a. Rifampicin for the whole class and family b. IV feeding b. Termination of pregnancy d. Mid stream urine for culture d. 1072. What is the most likely dx? a. Explore again b. Admit and IV antibiotics e. ESR e. Osteoporosis b. known smoker. Fundoscopy d. IV antiemetics c. 1073. Tonsillar carcinoma A 61yo man. Cystoscopy with biopsy c. What is the next step of management? a. phosphate=normal. Pack it c. 1071. She also complains of pain around her jaw. What is the advice for schoolmates and staff? a. CT b. b. Trans rectal US e. Keep him laid flat d. Fx e. Osteomalacia c. What is the next best tx? a. Rifampicin for the whole school and family . Secure airway c. Paget’s disease d. PPI e. Cystoscopy i. Labs: ALP=high. US abdomen An 8wk pregnant lady is brough to the ED due to severe vomiting. 1075.

On bimanual exam. IV fluids d.1077. IV bisphosphonates e. Na+=149mmol/l and PCV=55%. None f. IV calcium gluconate c. Transvaginal US b. Where is the level of occlusion? a. VSD A 64yo man with multiple myeloma has been vomiting since the past 2days. Femoral artery e. Cervical smear shows abnormal cells. Femoro-popliteal artery b. On speculum exam. Abdominal US . 1079. Oral bisphosphonates A 30yo man from Australia returned from a business trip to Indonesia 6d ago presenting with complaints of fever. Benzylpenicillin e. What is the most likely dx? a. joint and muscle ache and headache. cervical os is closed. c. Colposcopy b. On auscultation he has a pansystolic murmur at the apex radiating to the axilla. Chicken pox c. Profound femoral artery A 65yo man presents with dyspnea 3d after an MI. She is a heavy smoker and alcoholic. How do you confirm the viability of the fetus? a. 1082. IV insulin b. Ventricular aneurysm c. Cone biopsy Pt with pain and swelling in left leg and thigh up to the level of inguinal ligament. Serum BHCG c. 1081. Labs: Ca2+=3. TB d. IV cefotaxime A pt came with dyskaryosis to the OPD. 1080. Pericardial effusion e. What is the best advice for her? a. Aortoiliac artery d. Dengue A lady came for OBGYN assessment unit with hx of 8wk pregnancy and bleeding per vagina for last 2 days. uterus =8wks in size. Ruptured papillary muscle b. Repeat after 4m e. in particular behind the eye for the past 2 days. What is the most appropriate next step? a. Meningococcal vaccine for the family d. What is the most probable dx? a. Urinary BHCG d. Pericarditis d. Endocervical sample d. Biopsy c. Lyme’s disease e. 1078. Left common iliac artery c.2mmol/l. Malaria b. K+=5mmol/l.

Continue SSRI b. Increase dose of diuretic e. What is the mos t appropriate next step? a. She was started on SSRI tx and starts feeling better after a few months. Low Na+. A dx of acute congestive cardiac failure was made and IV furosemide was started for this pt. What is the most likely dx? a. Orchitis b. Add TCA c. A 70yo hypertensive white british man on thiazide diuretics needs a 2nd drug to control his BP. Low Na+. Per speculum exam 1083. High K+ c. Agoraphobia b. Prazocin (Alpha blocker) 1088. Acute abdomen 1085. Which one of the following is the best choice for him? a. Adjustment disorder e. A 24yo male who is sexually active with other males with hx of discharge per urethra. raised JVP and bilateral basal crackles 3d after an episode of MI. Epididymo-orchitis d. A 63yo man presented with sudden onset of severe dyspnea. Alkaline urine e.e. Enapril (ACEi) c. Dx of chlamydia has been made. A 62yo man has slow palpitations and the following ECG. orthopnea. High Na+. He finds it difficult to associate with his peers in a restaurant or under social settings. A person doesn’t go outside the home because he thinks that people will look at him and talk about him. She presents with bluish-purple discoloration of the catheter bag. Acidic urine d. Neuropsychiatric analysis d. Bacterial colonization of the urinary tract 1089. Low Na+. Low K+ b. High K+ e. High Na+. A 24yo lady has been low after the death of her husband and had stopped contacting her family. Normal K+ 1087. CBT e. What is the possible complication if left untre ated? a. What electrolyte abnormality is expected? a. What is the most likely explanation for this? a. Antipsychotics 1084. Low K+ d. Social phobia 1086. Propranolol (BB) d. GAD c. Normal change b. On discontinuating the meds she starts feeling that she has developed cancer just like her husband. What is the most likely dx? . A 74yo lady who has had a stroke in the past has an indwelling catheter for 10m. Panic disorder d. Amlodipine (CCB) b. Balanitis c. Catheter degradation c.

He says his stools contain blood and mucos. CSOM c. Emollient d. Complete heart block A 29yo woman presents with lid lag. Sometimes he has low grade fever. ITP c. a. Permethrin e. Sinus bradycardia b. Sickle cell d. Autoantibodies e. Corticosteroid b. Coal tar A young boy has a hx of epistaxis. Acquired cholesteatoma d. HUS e. Mobitz type 1 block d. What med should be added next? a. Fundoscopy d. CBC=normal. What is the most likely dx? a. except APTT=47s. Congenital cholesteatoma e. 1092. 1093. What is the most appropriate inv for his condition? a. Barotrauma A 9yo child presented with a rash on his skin which didn’t respond to antibacterial ointment. lid retraction and diplopia.1090. Thalassaemia A 29yo young man presents with complaints of recurrent attacks of diarrhea. Stool culture b. Mobitz type 2 block e. What is the most approp riate next step? a. 1091. TFT b. Otoscopy showed perforation of the pars flacida and a mass in the upper part of the middle ear. Hemophilia b. Plain abdominal XR c. Per rectal exam . ASOM b. 1094. 1st degree heart block c. Tensilon test c. EMG A 41yo man presents with longstanding foul smelling ear discharge and progressive hearing loss. Antifungal c. What is the most likely dx? a.

Pt also had conductive hearing loss. A 26yo young man presents with chx of passing loose stools for the past 2m. Folliculitis c. She is having fits again. Exam: skin around the ear is black in color and there was foul smelling discharge from the ear.8mmol/l. Her mother wants further tests done. Exam: the lump was free and mobile and not attached to the skin. IV diazepam e. MI 2m ago 1098. Carbuncle b. What is the most appropriate tx for his condition? a. progesterone=normal. What is the single most appropriate next step in management? a. US breast c. prolactin=400IU. IV phenytoin b. A 52 yo male with poorly controlled DM has now presented to his GP with pain in the ear. What is the single most imp immediate management of this pt? a. Stereotactic biopsy 1101. LH=33. What should be the next step? a. A 24yo lady with BMI=30 complains of facial hair growth and hx of amenorrhea. PCOS b. Immediate C-section f. Barium enema 1095. MgSO4 bolus c. POF 1100.d. Punch biopsy d. Mesalazine b. He says his stools contain blood and mucus and are a/w abdominal pain. Which among the following can be the reason to delay his surgery? a. IV MgSO4 was given but fits was not controlled. CT b. What is the most probable dx? a. Abdominal US . He undergoes a colonscopy after which he was started on tx. DBP 90mmHg e. A lady comes with a missing IUCD thread. Furuncle 1097. estradiol=177. What is the most probable dx? a. Cyclosporine 1096. A 55yo male has been admitted for elective herniorraphy. Cushing’s disease d. Corticosteroids c. Her LMP was 2wks ago. Controlled A-fib c.9. Infliximab d. CAH e. FSH=10. A 21yo female in her first pregnancy at 38wks was brought to the ED with generalized tonic clonic seizure. Malignant OE d. Cholesteatoma e. Controlled asthma b. IV lorezepam 1099. Reassure and send home e.2. DVT 2yrs ago d. Pregnancy c. IV MgSO4 d. A 17yo girl with a lump in her breast was seen in the clinic.

But she has not had her periods since then. Prolactinoma d. Colposcopy . Results showed borderline benign changes. Hypothalamic amenorrhea b. 1103. Ectopic pregnancy e. Post pill amenorrhea e. Cone biopsy e. Post pill amenorrhea c. prolactin=400. estradiol=80. US c. MRI c. LH=7. Cauterization b. Vaginal exam A 32yo woman presents with hx of lower abdominal pain and vaginal discharge. She has a temp of 38. Premature ovarian failure A 25yo woman presents with a single lump in the breast and axilla. What is the most suitable dx? a. 1104. Labs: FSH=8.1102. b. 1107. The US. Genetic testing and counselling e. What is the your next? a. What is the most appropriate dx? a. CT d. What is the most appropriate next step? a. Acute PID c. She had her menses 4wk ago. She also has a fam hx of breast cancer. POF A lady with a firm smooth breast lump in outer quadrant had a FNAC done. 1y ago smear was normal. mammogram and FNA turn out to be normal. Repeat smear c.6C. estradiol=500. Genetic testing and counselling e. Mammography b. UTI A 40yo female was on COCP which she stopped 6m ago. LH=24. The lump is mobile and hard in consistency. PCOS c. Acute appendicitis b. 1105. Punch biopsy d. Swab and culture d. Labs: FSH=22. Prolactinoma d. Core biopsy d. What is the cause? a. Serum BHCG e. Prescribe contraceptives c. prolactin=700. FNAC b. Core biopsy A 37yo lady stopped taking COCP 18m ago and she had amenorrhea for 12m duration. 1106. Pregnancy e. Endometriosis d. Hypothalamic amenorrhea b. What is the most appropriate inv to confirm the dx? a. Punch biopsy A pt presents with mild dyskaryosis.

What other inv should be done? a. There is no vaginal discharge. Serum BHCG d. Treat with antibiotics d. Repeat smear in 6m b. A 37yo infertile lady with 5cm subserosal and 3cm submucosal fibroid is trying to get pregnant. Blood dyscrasia b. She experiences hyperemesis. IVF c. Exam: uterus=16wks. Estradiol . She then passes 100ml of blood per vagina. On inv the man has primary infertilitiy and azoopermia. A young tall man and his wife are trying for babies and present at the infertility cli nic. FSH d. A 29yo at 38wks GA presents with a 2h hx of constant abdominal pain. Cone biopsy 1113. Hgb e. Oral fluid replacement c. IU insemination 1114. CTG c. What is the most probable dx? a. Myomectomy d. Colposcopy e. headache and reduced urine output. US b. Parental anti-emetics e. Now she presents with vaginal bleed. Hysterectomy e. Kleihauer Betke test 1110. What is the next step? a. A 26yo woman had amenorrhea for 10wks and is pregnant. no pelvic pain and no fever. Twins d. Which is the most suitable option? a. An African lady presents with heavy but regular periods. Her uterine size correlates to 14wks pregnancy. Adenomyosis e. Hyperemesis gravidarum c. IV fluids 1112. What is the most appropriate dx? a. USS b. LSH c. Incomplete abortion 1109.1108. Fibroids d. Thyrotoxicosis b. Molar pregnancy 1111. closed os. A pregnant woman of G2. Urine analysis shows ketonuria. Clomifen therapy b. Clotting screen d. Hematoma c. GA 11wks presents with heavy vomiting. Testosterone b. What is the next appropriate inv? a. Choose the next best step? a. A pt had inflammatory changes on cervical smear. Take swab c. Wrong dates e.

Ferrous sulphate hemodynamic anemia d. Karyotyping 1115. What do you do for her? a. Her last cervical smear was 1y ago and was negative. Raloxifen b. POP e. Danazol b. IUCD 1120. None g. What would you advice? a. Epilepsy d. Pregnancy induced HTN 1119. Eclampsia b. Pelvic US shows a complex cystic 7cm mass in the LIF. Topical estrogen 1117. A 34yo woman who never had fits or high BP developed fits 6h after delivery of a term healthy child. Explain this physiologic c. Dermoid cyst c. MCHC=350. Continue COCP and backup contraception using condoms for 2wks 1116. HRT c. What test would you recommend for her initially? a. Her blood results: Hgb=10. COCP e. MCV=95. Colposcopy b. What is the tx option? a. Continue regular COC b. Folate e.6. Endocervical swab d. Preeclampsia c. Endometriosis b. A 32yo woman comes with intermenstrual bleeding. Continue COCP and backup contraception using condoms for 7d d. Mirena c. Pulmonary embolism e. Pelvic CT 1121. What is the most likely dx? a. Transvaginal US e. Implanon f. A lady presents with hot flashes and other symptoms of menopause. Ovarian ca d. Cervical smear c. Over the past 48h. she has severe abdominal pain and has a fever of 39.1C. A 28yo woman at 34wks GA for her first pregnancy attends antenatal clinic. COCP d. A woman who is on regular COCP presented to you for advice on what to do as she has to now start to take a course of 7d antibiotics. A 30yo lady who already has one child through a prv C-section demands a reversible contraception. What is the most appropriate contraceptive you will recommend for her? a. What is the most likely dx? a. Blood transfusion 1118. Dextran f.e. Bisphosphonate d. Tubo-ovarian abscess e. IV FeSO4 b. She presently experiences heavy and painful periods. Ectopic pregnancy . Continue COCP and backup contraception using condoms for 2d c. A 20yo woman has had abdominal pain in the LIF for 6wks duration.

Essential HTN . Placental previa 1129.1122. Coomb’s test e. Missed abortion c. Preeclampsia e. Pre-implantation genetic dx 1123. DIC f. Placental previa 1126. Ectopic pregnancy b. CVS d. Placental abruption g. low plt. uterus is tender. Ectopic pregnancy b. Acute fatty live e. Ectropion d. A woman is 16wk pregnant and she is worried about abnormal chromosomal anomaly in her child. What is the definitive inv at this stage? a. HELLP syndrome d. Preeclampsia e. bilirubin=22. Placental abruption g. Reassure th 1124. A 39yo woman in her 36 week GA with acute abdominal pain is rushed for immediate delivery. Placental previa 1128. DIC f. Hgb=low. APTT=60.6. She has prv hx of PID. Amniocentesis b. What is the most likely dx? a. Pre-implantation genetic dx f. Ectropion d. Ectropion d. Missed abortion c. A 33wk pregnant woman presents with vaginal bleeding. A 28yo lady with a fam hx of CF comes for genetic counselling and wants the earliest possible dx test for CF for the baby she is planning. Ectopic pregnancy b. Parents karyotyping d. Missed abortion c. increased bilirubin. AST normal. DIC f. Missed abortion c. A 28wk pregnant woman presents with uterine bleeding after sexual intercourse. What is the most likely dx? a. She is not in favor of termination. A 25yo lady at her 28th week GA came for check up. Chromosomal karyotyping b. Ectropion d. Pregnancy induced hypertension b. Placental abruption g. AST=35. DIC c. Her report: BP=110/60mmHg. Preeclampsia e. What is the most likely dx? a. What is the most appropriate cause? a. What would you recommend for her? a. Her BP=160/95mmHg. Placental abruption g. protein in urine=6g/d. What is the most appropriate cause? a. Placental previa 1127. CVS c. Ectopic pregnancy b. Plt=60. A 36wk pregnant woman presents with sudden onset of uterine pain and bleeding. Preeclampsia e. DIC f. low Hgb. PT=30. Maternal serum test c. Obstetric cholestasis 1125. Amniocentesis e. A 6wk pregnant woman presents with abdominal pain. no prv LSCS. APTT & PT increased. Fibrinogen=0. What is the cause? a.

She is now k een to conceive again. Between the episodes he is totally fine. Chronic HTN d. IUCD e. Mefenemic acid e. and 20wks. 1132. Preeclampsia A 32yo woman has a hx of spontaneous abortions at 6wks. Mirena A 32yo presents with heavy blood loss. MgSO4 b. G6PD deficiency c. 1131. IU system (mirena) A 37yo woman presents with heavy bleeding. IUCD e. IUCD e. Mefenemic acid d. Warfarin d. 12wks. COCP c. Which is the most appropriate tx? a. What is the most likely dx? a. 1133. Sickle cell disease e. Norethisterone A 17yo senior school girl with complain of prolonged irregular menstrual period and heavy blood losses. Thalassemia d. Vaginal Hysterectomy e. Tranexemic acid b. COCP c. What is the most appropriate tx for her? a. Abdominal hysterectomy c. Mother gives hx of jaundice being bought about by ongoing infections. Congenital storage disorder A 42yo woman who smokes 20 cigarettes/d presents with complains of heavy bleeding and prolonged menstrual period.1130. Heparin A 6yo child presents with hx of recurrent jaundice. Mefenemic acid b. Inv show subserosal fibroid=4cm and intramural fibroid=6cm. 1136. POP d. Hysteroscopic Myomectomy d. b. Aspirin c. UAE b. Mefenemic acid b. Which of the following would you prescribe for the next pregnancy? a. US: uterine thickness>14mm. What is the most appropriate tx for her? a. 1134. Hereditary spherocytosis b. What is the most appropriate tx? . COCP c. Gestational HTN c. Abdominal myomectomy A woman with sickle cell disease complains of heavy menstrual blood loss. POP d. What is the most appropriate tx for her? a. 1135.

Exam: full knee movement with slight tenderness. Lithium d. She has symmetrical peripheral arthropathy for the last yr. She says she is ready to stop the drug abuse. Chondrosarcoma A 60yo female has pain and stiffness in her right hip joint. She has also noticed some reddish spots on her body. Diffuse systemic sclerosis e. Digoxia A 33yo lady who is a drug addict wants to quit. Lymphangiosarcoma e.1137. GI hemorrhage c. Anemia of chronic disease b. Mirena c. Transdermal patch A 70yo woman is admitted with diarrhea. Diazipoxide c. Pseudogout . Copper IUS e. She is supported by her friends and family. vomiting and dehydration. 1139. Ramipril c. What is the most probable dx? a. Osteoarthritis c. Disulfiram A 50yo lady has been suffering from chronic RA and is on metrotraxate and naproxen. Her CBC shoes microcytic anemia. RA b. Which drug causes the above mentioned side effects? a. COCP b. Benzodiazepines b. What is the most likely cause? a. 1142. Ewing’s sarcoma c. Gout d. Osteosarcoma c. Lithium e. Osteosarcoma b. Inv: Hgb=low. Atenolol d. Exam: yellow visual halos in her eyes. 1141. ECG=bradycardia. 1140. a. Menorrhagia A 15yo male noticed swelling on the left knee following a fall while playing. 1138. She has a hx of chronic A-fib. He has painless palpable mass in left inguinal region. Pain is not severe in the morning but increases as the day progresses. The swelling has not subsided in spite of rest and analgesia. She has noticed some nodules in her hands. What is the most probable dx? a. Limited systemic sclerosis d. Nifedipine b. Chondrosarcoma d. Osteodosteoma A 45yo female looking pale has bluish discoloration of hands whenever she goes out in the cold. Depot provera d. What is the most probable dx? a. Methadone e. What drug tx would you give her? a. RA b.

He has BP=50/0mmHg and chest wall with asymmetrical movement. Bolus of 20U insulin b. SLE b. Red reflex is absent in both eyes. What inv would you do for her? a. Gout d. Plasma RF c. urea=58mmol/l. ESR 1146. What is the single most likely dx? a. Dextrose-saline infusion . She has gradual loss of vision in both eyes. Transfer to ITU 1148. His BP=150/110mmHg.8mmol/l. C&S of joint aspirate c. What is the most probable dx? a. Calcium resonium enema c. creatinine=600umol/l. Congenital diaphragmatic hernia b. HTN retinopathy 1145. A 28yo woman has been on tx for RA for 3yrs. Her IOP is normal. Macular degeneration e. CT chest d. Multiple myeloma 1143. Reactive Arthritis c. MRI e. US d. Joint fluid uric acid crystals d. CT 1147. RDS e. He now develops severe joint pain in his left ankle with swelling and redness. He has crackles at both lung bases and sacral edema. RR=34bpm. Intubation and ventilation c. He is anuric and breathless. Seronegative arthritis 1144. A 34yo man after an RTA was brought to the ED. What is the single most appropriate immediate management? a. An elderly man with recently dx HF has been treated with diuretics. What would be the initial action? a. She complains of visual prbs. A 30yo female has chronic diarrhea. Cataract b. Pseudogout e.e. What is the most likely dx? a. DM retinopathy c. XR b. Hgb=10mg/dl. IV fluid infusion b. low back pain and morning stiffness. Alpha 1 antitrypsin deficiency 1149. What is single most likely inv? a. XR of bone b. Bronchiolitis d. Inv: ESR & CRP=raised. Hypermetropia d. swollen and tender knee joint. mouth ulcers and skin tags. Congenital cystic adenomatoid malformation c. A 65yo man had a bowel resection 5d ago. A 7yo presented with chronic cough and is also found to be jaundiced on exam. A 60yo lady with a hx of HTN and suffering from RA since the last 10y now presents with hot. Bloods: K+=6.

SNHL e. Meningitis due to meningococcus A child had a patchy rash following tx for sore throat & cervical LN enlargement. What is the most probable dx? a. Cervix c. Ampicillin b. 5% dextrose infusion e. Impetigo c. Breast A 10yo child has got progressive bilateral hearing loss. 1156. She presented with severe back pain. Lungs b. generalized skin lesion. Blood culture A child was admitted with fever. he is found to have perihilar lymphadenopathy. 50ml of 50% dextrose infusion A 25yo woman presents with a painful shallow ulcer on the vulva. Where do you expect the cancer to be? a.1150. Chronic sialadenitis b. 1151. Contact dermatitis e. Swab for hemophilus ducreyi d. Adenoid cystic carcinoma e. Varicella b. Drug reaction d. What is the most likely dx? a. some of them are weeping lesions and some of them are crusted. Ovary d. Urine culture e. On routine CXR. d. Which is the best analgesic for her? a. Cefuroxime d. HSV antibodies b. Erythromycin c. Paracetamol b. What is the most probable dx? a. 1152. Bilateral OM with effusion d. 1153. What inv has to be done? a. Uterus e. 10U insulin. He has started to increase the TV volume. Wax b. Foreign body c. Metronidazole e. Syphilis serology c. Mikulicz’s disease A woman has widespread metastasis from a carcinoma. Carcinoma of salivary gland d. Thyroid adenoma c. Which is the most appropriate antibiotic? a. Tetracycline A child with a hx of asthma is brought to ED with a cut on knee and sprained on her left wrist. NSAIDs . 1154. All other examination is normal. 1155. Scabies A pt comes with 6m hx of painless bilateral swelling of the face which has been progressively increasing in size.

plt=30. 1:1 A 14yo boy has been dx with nephrotic syndrome. He doesn’t remember anything what happened. APTT=prolonged. 1:2 b. What is the most probable dx? a. Temp=normal. Intracranial HTN A 28yo female presented with complains of difficulties in swallowing liquids only. DIC c. Huntington’s chorea e. hematuria and fluctuating urea levels. Pneumonia c. Stasis A 36yo woman presented with massive bleeding from multiple sites. Plummer vinson syndrome c. Vasculitis c. 5d later he presents with flank pain. Space occupying lesion c. High estrogen levels e. Alpha 1 antitrypsin deficiency An 8yo boy develops a seizure affecting his right arm. 1162. c. Exam: she has intercostal recessions and a wheeze. PT=prolonged. What is the most probable dx? a. Factor V leiden e. What is the risk of getting another baby? a. Protein C deficiency b. On his CT: lesion in left hemisphere. 1:8 c. Lab: fibrin degradation products: +++. Epilepsy b. Peptic stricture e. 1:4 d. Bronchiolitis d. Achalasia cardia d. What is the most likely cause for renal vein thrombosis? a. What is the most likely dx? a. bleeding time=prolonged. Dementia d. Hemophilia b. seizure lasts for several mins. A dx of renal vein thrombosis is made. 1160. 1159. 1158. Warfarin . Foreign body b.1157. 1:16 e. Ibuprofen A 15m baby girl presented to the ED with difficulty in breathing. RDS e. Esophageal carcinoma Mother having 2 children with CF. 1161. What is the most likely dx? a. Loss of antithrombin III d. URTI b. Cocodemol d. ITP d. She also suffers from recurrent chest infection in the past few months.

It causes an early miscarriage d. Initially he wasn’t resuscitated. pH high. A young child. A 17yo girl comes to see her GP after having unprotected sex 2d ago. He will have brain abscess d. Delayed fine motor development c. A pt presented with jaundice. It helps to prevent implantation b. A 2d baby’s mother is worried about the baby’s hearing. MRI e. Biliary infection b. It releases progesterone and stops ovulation e. Perforation 1168. PCO2 low b. Exam: mild-mod dehydration. He will have encephalitis 1167. He can say ‘mama’ and ‘papa’. He will recover fully to his prv health b. He responds to his name. A mother presents with her 14m child. fever and upper abdominal pain within 24h after removal of gallstone by ERCP. He will have hearing impairment c. Acute pancreatitis c. PCO2 high c. Delayed verbal development d. What is his ABG profile likely to show? a. pH low. He holds furniture and other things to help him stand and walk. Normal development e. It causes local enzymatic reaction 1165. Delayed gross motor development b. pH high. Brain stem evoked response b. Cohort d. What is the possible cause of his complaints? a. The cholangiography was done and it was patent. pH low. a. Observational c. It helps in preventing or delaying ovulation c. 3yo. It was noted that hosp A had the higher rate of mortality than hosp B for treated cancer pts. A healthy 8yo boy had antibiotic tx for meningitis. A study was done amongst 2 hosp for the equal number of cancer pts. Case study 1164. What will be the outcome if he receives full tx? a. Fork test d. He can transfer objects from one hand to another. Delayed social development 1169. What is the study done here classified as? a. Reassure 1166. Mother has a hx of conductive hearing loss. PCO2 low d. what do you inte rpret from his development? a. PCO2 high .1163. He makes eye contact and smiles. What is the most appropriate test? a. Retrospective b. She asks if her GP can explain to her how this prescribed procedure would work by helping her not to get pregnant. has presented with vomiting for 3d. CT c.

CBT c. In the last 2 wks his symptoms have worsened and he has to take salbutamol more frequently during the day time. Antipsychotics 1171. A 72yo presents with polyuria and polydipsia. weight loss. Chest drain c. What is the most appropriate tx? a. What is the most appropriate management? a. A 25yo man has been suffering from breathlessness and wheeze for 3m. He also complains of excessive dyspnea at night. Prednisolone b. ACEi and sulfonylurea b. Interpersonal therapy d. Thiamine 1172. Dissociation e. She was prv fine and there was no hx of medical or psychological prbs. Fluticasone + salbutamol inhaled c. Montelukast PO e. What drugs or regimen would you like to add? a. What is the single most appropriate next management? a. BP=130/80mmHg and the level of cholesterol=5. He has been taking salbutamol 2puffs as required. A 25yo girl saw a tragic RTA in which a young boy was killed. A 64yo man who was exposed to asbestos for 40yrs presents with weight loss and chest pain.7mmol/l. ECT e. poor concentration and self neglect for 3wks. Chlordiazepoxide c. Anti depressants b. PTSD d. Diazepam b. He develops SOB and XR=pleural effus ion. aggressive and confused. Radiation therapy d. Pneumonectomy e. There is microalbuminuria. Statin and biguanide c. She has been on antidepressant therapy for the past 3m with no improvement. After the operation he became agitated. Conversion b. A 78yo retired teacher was admitted for a hernioplasty procedure. Beclomethasone inhaled d.e. She has not been eating or drinking adequately and has rarely left her bed. A 68yo woman has been admitted with poor appetite. Statin and glitazone . Somatization c. PCO2 normal 1170. Thoracocenthesis b. She is expressive suicidal ideas and is convinced that people are out to kill her. GAD 1173. The dx of mesothelioma has been made. Salmetrol PO 1174. Chemotherapy 1175. pH normal. The night of the event she couldn’t sleep and the day after she suddenly lost her vision. Vit B d. What is the most appropriate management? a. The fasting blood sugar is 8 and 10mmol/l. Clozapine e. What is the dx? a.

statin and metformin. IV calcium gluconate . He is currently on aspirin. CTPA A 7yo child is being inv for TB. Insulin and ACEi e. 1182. T2DM e. what other sample will show growth of the organism? a. Throat swab c. Exam: tachycardia. What can be the cause of this symptom? a. 1177. Impaired glucose tolerance b. What is the next appropriate management? a. Echo was done and showed a pansystolic murmur. TCA c. 1180. A dx of moderate depression has been established. Her oral glucose test after 2h of glucose intake vs plasma level in 2 different tests are 6mmol/l and 10mmol/l. Dialysis b. Ruptured papillary muscle b. Diuretic c. His parents don’t agree for taking a BAL. Dresslers syndrome d. Chest drainage d. MAOi d. dilated neck veins and the trachea is not centrally placed. Needle thoracocenthesis c. ABG e. SSRI b. Blood test b. Gastric washing d. Ventricular aneurysm A 61yo man was found with K+=7. Which medication is the best tx for him? a. 1178. Statin and ACEi A 49yo woman presents to the OPD. Acute pericarditis c. Mantoux test e. 1181. What is the best possible tx option? a. What would you add to the tx? a. CSF A 51yo man had a MI a few days ago. Metabolic syndrome A white English man with a past hx of MI is a known HTN and DM. Portable XR b.5 and ECG with prolong QRS complex. Mood stabilizer A 12yo presents with chest pain. CCB A 57yo man who had MI a few months ago has been having a low mood.1176. Insulin d. T1DM d. He developed breathlessness. ACEi b. Malignant VT e. hypotension. Benzodiazepam e. 1179. Beta blocker e. This situation can be categoraized as a. d. Impaired fasting glucose c.

She complains of night sweats and weight loss. Anti Scl70 . Bronchoscopy e. AFB b. Dx of sellutitis has been made. She gave hx of having low mood at 12y. Exam: malar rash with sparing of nasolabial fold can be seen. Bipolar affective disorder d. Lateral MI d. Anterior MI b. NSTEMI 1185. A 38yo man presents with acute infection of skin in the leg. Ceftriaxone + terbinafine e. Loop diuretics 1183. Anti Jo e. Borderline personality disorder e. Mania b. Vancomycin + metronidazole d. Posterior MI e. IV insulin and dextrose d. What is the most appropriate inv? a. A 32yo woman presents with malaise fatigue and fever. Dysthymia 1186. She goes out almost every night with her friends. Depression c. Ceftriaxone + flucloxacillin 1184. CXR has been done and shows opacity. She complains about weight loss. Anti ds DNA b. A 72yo man presents to the ED with chest pain.c. Mantoux test c. Salbutamol nebulizer e. She believes that she knows better than her friends. so she should choose the restaurant for eating out with her friends. Inferior MI c. A homeless lady presents with cough and fever. What meds should be prescribed? a. Metronidazole + erythromycin c. Penicillin + Flucloxacillin b. What is the most likely dx? a. What is the dx? a. CT 1187. The following ECG was taken. A 36yo woman has recently spent a lot of money on buying clothes. What is the next appropriate management? a. Anti centromere d. IFN gamma testing d. Anti histone c.

She insists on getting further inv although no abnormalities are found. A 64yo man believes a female newscaster is communicating directly with him when she turns a page. over activity and disinhibition. 2:3 d. She is receiving oxygen.1188. Nihilistic e. Leukemia e. Bipolar affective disorder b. Multiple myeloma b. What kind of delusions is he suffering from? a. A 27yo man presents with symptoms characterized by alternating mood swings a/w flight of ideas. Grandeur d. Conversion disorder e. Reference 1194. or low mood with lack of energy and social withdrawal. Hypomania e. Control c. Disc prolapse d. A 36yo woman contacts the police to notify them she was responsible for a recent disastrous flood with loss of lives. Guilt d. They want to have another child. A 75yo man presents with back pain. Myelofibrosis 1189. What are the chances of that child being a carrier? a. 1:16 1193. What is the most probable dx? a. Reference 1191. elation. What kind of delusions is she suffering from? a. She is fully conscious but has got stridor. Her urine and blood tests are normal. 1:2 c. A 7yo girl with allergy became acutely unwell while visiting a friend’s house and has been brought immediately to the ED. Somatization c. Cyclothymia 1192. She brings the stool sample from home but has never been able to produce a sample at the hospital. Poverty c. What is the single immediate management? . Persecutory b. A 45yo woman presents with complains of abdominal pain and blood in stool. Nihilistic e. What is the most likely dx? a. Persecutory b. 1:4 b. Malingering b. AS c. 1:8 e. a child with CF and a healthy child. Mania d. wheeze and erythematous rash. What is the most probable dx? a. Inv: plasma cells are found. Healthy parents have 2 children. Dysthymia c. Exam: multiple scars on the abdomen consistent with laparoscopies and appendectomy. Munchausen syndrome 1190. Hypochondriasis d.

Othello syndrome A 65yo lady who is on thiazide suffers from falls in the morning. Nystatin suspension b. 1196. 1197. 1199. TIA c. a.25ml in 1000U epinephrine IM c. Microglossia b. Anal tag e. 1198. Amphotericin B IV c. What feature is a/w it? a. Burst blisters d. Ekbom syndrome e. Give 0. Escharectomy b. 1201. what is your next step? a. Epilepsy A boy was admitted with partial thickness burn. BP=100/68mmHg.1195. PO fluconazole d. What is the best possible tx? a. Cotard syndrome c. Orthostatic hypotension b. Check airway patency and prepare intubation b. 1200. The wife states that her husband is having affairs although she has no proof of this. What is the cause for her symptoms? a. Prolonged neonatal jaundice c. Analgesic A couple attends their GP because of marital problems. Give 10mg chlorphearamine IM d. What is the most likely rhythm disturbance? a. Fregoli syndrome b. Mood disorder d. He feel s a little light headed but is otherwise well. Left soft palate A 2wk girl presents with E-coli which is confirmed by urine culture. A-fib A child has hypothyroidism. The husband states that she even had him followed by a private detective and this is putting considerable strain on their marriage. Local antibiotics e. Dressing c. Cotrimazole e. VT d. V-ectopics e. Obtain secure IV access A terminally ill pt with metastatic carcinoma presents with dysphagia and difficulty in swallowing. Refer to burn unit A 28yo man presents with a 2h hx of rapid palpitations. He has had 2 similar episodes in the past. What is the most appropriate next inv? . Exam: pulse=170bpm and regular. Give 50ml hydrocortisone IM e. Undescended testis d. VF c. SVT b. What is the most likely dx? a.

1207. Temp=38. Some of which are weeping and others are crusted. What is the single most likely dx? a. Toxoplasmosis intercellular e. 1203. OE d. Mesothelioma A 32yo woman has undergone a biopsy for a breast lump. 1204. IVU c. irregular and he has a pansystolic murmur at apex.1202. Varicella zoster c. CMV f. Mycobacterium avium d. Scabies e. Dental caries b. Mumps c. Herpes simplex A 39yo man comes with umbilicated papules on his face. DVT d. Pulse=88bpm. What is the single most appropriate dx? a. Fat necrosis A young boy presented with peri-oral blisters. FNAC has been done and revealed lesions with caseous material in the center surrounded by fibrosis. Mammary abscess d. Streptokinase A 45yo man is admitted to ED with excruciating pain in the right leg. Atherosclerosis e. Lymphoma d.5C. Fibroadenoma e. Inf Mono e. Embolus An 18yo man has a smooth. Sciatica c. 1205. Pneumocystis jerovici b. OM e. What is the most probable dx? a. Thromboangitis Obliterans b. 1206. BUE e. Exam: limb is pale and dorsalis pedis and posterior tibial pulses are absent. MCUG A lady from Asia presented with lump in her neck. What is the single most appropriate option? a. CT kidney d. The report says: a well circumscribed lump with clear margins and separated from the surrounding fatty tissue. TB lymphadenitis c. Ca Breast c. What is the most appropriate interpretation of this report? a. Thyroid carcinoma b. a. What is the most probable dx? a. Temporomandibular joint pain . His CD4 count is measured to be 35. Fibroadenosis b. Impetigo b. Moluscum contagiosum c. Shingles d. US b. tender swelling extending from the ear to the angle of the jaw of sudden onset.

CT 1209. What would you do for her next? a. MCV=132fl. BUE. Metastasis 1210. A 6wk baby has a blue mark near coccyx since birth.59. CBC.2. Lab: normal. Nucleated RBC c. Meningitis e. Sulfonylurea c. Hyponatremia c. What is the best next step in management? a. Sugar free diet e. He is responding vaguely to questions. Coag profile c. Morphine d. She maintains a good appetite. A 9yo girl with weekly abdominal pain and occasional headaches but not a/w vomiting or diarrhea. Urine shows glycosuria. Fentanyl c. WBC=7. Hyperkalemia 1214. microcytic RBC e. Hypersegmented neutrophils b. Skeletal survey e. Metoclopramide b. plt=242. Analgesics 1212. US abdomen b. Schistocytes 1211. Morphine was stopped and he was started on metoclopramide and fentanyl patches. Insulin d. No other abnormalities are found. Hypernatremia d. What is the cause of these symptoms? a. A 51yo man has become increasingly fatigued for the past 10m. Hypochromic. Reassure b.9%. Blasts d. A 46yo man who is a heavy drinker is brought to the ED in a drowsy state. Biguanide b. etc are normal. Hypocalcemia b. His mother is worried. He then develops neck stiffness and fever. PE: no abnormal findings. What is the most likely cause for his cognitive impairment? . Labs: Hgb=9. LFT d. Which of the following morphologic findings is most likely to be present on examination of his peripheral blood smear? a.1208. CT thorax c. A 54yo male pt DM with BMI=33 who has been treated using dietary control up till now presents to his GP with a fasting blood sugar of 14mmol/l and creatinine=90mmol/l. ACEi 1213. Hct=27. Exam: no abnormality as found and the abdomen was soft and non-tender. Reassure e. Exam: nystagmus and hyperreflexia. His pain has been well controlled with morphine but he develops vomiting. Karyotyping d. What are the side effects of thiazide diuretics? a. MCV=103fl. What would you do? a. A man presents with inoperable carcinoma and back pain.

Laxative abuse e. Which antibiotic would be the 1st line of tx? a. UC d. Flucloxacillin d. AFB for sputum b. 1219. Conservative . Ciprofloxacillin c. CT d. What is the single most appropriate management? a. CXR c. Celiac disease b. What is the single most discriminating inv? a. Amoxicillin b. Ceftazidime e. Radioactive thyroid scan A 34yo man from Asia presented with 5m hx of productive cough. Gastroenteritis A 10yo boy presents with irritability. Punch biopsy c. TFT e. a. Exam: tenderness in lower abdomen. Delusion of doubles e. 1218. 1216. Open Surgery d. Alcohol withdrawal A 23yo female presented with a swelling of her neck that moved upwards on protrusion of tongue. B1 deficiency b. sudeen onset of pain and discharge from the right ear. On US a 3mm stone is found in the renal pelvis. 1217. B6 deficiency e. 1220. None c. His CXR reveals some shadowing in the left upper zone. ESWL b. FNAC b. Erotomania c.1215. Delusion of reference A 26yo passed a 4mm stone in his urine. Delusion of persecution b. Delusion of grandeur d. Core biopsy d. B12 deficiency c. What kind of delusions is this man suffering from? a. MRI neck e. night sweats and weight loss. Although they look different. What is the most appropriate dx? a. Colorectal polyps c. Benzyl penicillin A 26yo man strongly believes that every elderly man he meets is his father. US abdomen A prv healthy 23yo presented a week hx of bloody diarrhea and abdominal pain with cramps and fever. What is the next appropriate inv? a. Folate deficiency d. he is sure it is father wearing different disguises.

She denies being sexually active. Select the most appropriate management for her menorrhagia? . Cardiac tamponade c. Below elbow full plaster of paris b. Cerebral cortex b. Parotid calculus e. Acute dacryocystitis b. Scleritis 1223. Left ventricular aneurysm e. the visual acuity is up to counting fingers. What is the single most appropriate tx? a. A 35yo man has had acute pain and swelling below the mandible on the left side for 2h. A 58yo man suddenly becomes shocked several days after suffering an acute ant MI. Open reduction and internal fixation 1227. His CXR shows a large globular-shaped heart and clear lung fields. How would you help him? a. Cerebellum c. Laryngocele b. Acute pericarditis b. Dressler syndrome 1225. Atrial thrombus d. In the left eye. Which site is most likely to be affected? a. She presents with a positive Romberg’s test. She is requesting tx for these complaints. Despiramine e. Retrobulbar neuritis e. Refer to community mental health support group 1226. He also notes loss of color vision in the same eye. Thoracic spinal cord e. What is the single most likely explanation for the abnormal inv? a. Cervical spinal cord d. Papillitis d. Refer to GP d.1221. When the pupil is stimulated with light. She also has weakness and loss of sensations in all her 4 limbs. A 45yo man has had impaired vision and pain on eye movement in his left eye over the last 5d. A 56yo alcoholic man who has increased the amount of alcohol he is using wants to attend his daughter’s wedding that is in 2wks. A 56yo pt has been dx with MS. Elasticated support bandage e. Acute iritis c. Submandibular calculus 1222. A 16yo girl who is normally fit and well attends her GP complaining of heavy and painful periods. Closed reduction of fx d. Acamprosate b. His fundus is normal. Brain stem 1224. He is now coming to you for help. it dilates. Ranula c. What is the single most appropriate clinical dx? a. What is the single most likely dx? a. An 80yo woman fell over at her nursing home. Neck abscess d. The swelling occurred after eating a large meal. XR shows fx of radius with <10degree of dorsal angulation. Below elbow split plaster of paris c. Refer to clinical psychologist c.

Addisons b. 1229. The esophagus can’t be negotiated beyond the crico-pharynx. 1233. Inguinal LN e. He takes a regular lunch. IUS progestrogens (mirena) e. Endometrial ablation d. No matter what he tries these thoughts keep coming to him. but has been having hypoglycemic attacks at around 4pm each day. Carcinoma of cecum b. Antifibrinolytics (tranexamic acid) b. Diagonal branch A 55yo female presented with anemia and dysphagia. What is the single most appropriate option? a. Plummer vinson syndrome c. COCP c. Review both drug e. Left main stem. Review morning drug c. Dexamethasone side effect c. Review evening drug d. 1234. According to her biochemical results her K+=normal and her Na+=low. 1231. Carcinoma of descending colon c. External iliac LN b. Dilutional hyponatremia A diabetic has been prescribed a long acting hypoglycemic in the morning and short acting in the evening. Esophageal carcinoma A pt is on cancer tx with dexamethasone. Carcinoma of rectum A 22yo man keeps having persistent and intrusive thoughts that he is a dirty thief. What is the most probable dx? a. Circumflex artery d. a. Which is the single most appropriate LN involved? a. Pharyngeal carcinoma d. Pre-aortic LN c. What is the most likely dx? . Foreign body b. Barret’s esophagus e. What is the most appropriate intervention? a. What is the dx? a. There is a feeling of something stuck in the throat. post descending artery e. Iliac LN A branch of the dominant coronary artery that supplies the inferior portion of the septum. Septal branches b. What is the dx? a. Any attempt to avoid these thoughts leads to serious anxiety. 1232. Aortic LN d. He has also noticed weight loss but has no hx of altered bowel habits. Reassure A male pt presented with blood and mucus in stool.1228. Carcinoma of sigmoid colon d. NSAIDS (mefenamic acid) A 67yo lady with an ulcer on the anal margin. Obtuse marginal branches c. Recommend a heavier lunch b. 1230.

1235. Left ant descending artery c. Hemopneumothorax c. high urine osmolarity d. 1238. OCD e. 1240. Tension pneumothorax d. Don’t give any vaccine b. Secure airways b. engorged neck veins and a dull percussion note on the right side of his chest. What is the most likely dx? a. Give all vaccines except live attenuated vaccines c. low serum osmolarity. High serum Na. Which immunization plan will you opt for him? a. Hemothorax b. OCD c. Paranoid delusion b. Coronary sinus d. Bed rest b. Physiotherapy . IV phenytoin d. Exam: pulse=140bpm. Normal Na. 1237. low urine osmolarity e. What will you advice her? a. normal serum osmolarity. normal urine osmolarity The artery that supplies the ant right ventricular wall. Psychotic depression A 45yo female comes to the ED while having a generalized tonic clonic seizure and she has having difficulty breathing and is cyanosed. Right coronary artery A 55yo male presents to the ED after an RTA with breathlessness. 1236. What is the single most appropriate option? a. high serum osmolarity. a. Give all vaccines except BCG vaccine A 36yo man has been dx with DI. high urine osmolarity b. Give only BCG vaccine d. What is the most likely dx? a. 1241. He becomes very anxious if his wife tries to stop him. Acute marginal branch b. low serum osmolarity. Low serum Na. PTSD d. Simple pneumothorax A 32yo woman presents with complaints of having low back pain. Circumflex artery e. 1239. IV diazepam c. All inv are normal. Low serum Na. Social phobia d. BP=80/50mmHg. Schizophrenia b. What electrolyte picture is expected to be seen? a. Mania e. high serum osmolarity. Oxygen mask A 30yo man is becoming concerned about the safety of his family. What is the tx option for her? a. GAD A 6wk baby has been dx as HIV+ve. High serum Na. PTSD c. He has be en checking the locks of the door every hour during the night. high urine osmolarity c. She is taking analgesics for it.

Staphylococcus d. The GP has prescribed him complete bed rest. She is brought to the hosp where she is found to be conscious and completely alert. What is the most likely dx? a. Exam: normal pulse and BP with no abnormal neurological sign. Mycobacterium TB d. Sprain of the back muscles e. Streptococcus A pt is about to undergo surgery. 1249. 1246. XR skull A 30yo woman is taking tx for asthma. Mycoplasma c. Reassurance and discharge home e. She has a HR=130bpm and peak expiratory flow rate=400. a man presents with pansystolic murmur which is radiating to the axilla. Muscle injury A young man returns to his hostel and gets headache and lethargy. What is the most likely organism which would have caused his symptoms? a. c. Intervertebral disc prolapse c. He also has gait prbs. CT brain c. 1248. Which class of drug is causing this? a.1242. His CXR showed bilateral consolidations. He also complains of shooting pain down his leg. Anti-HTN A 16yo boy came home from boarding school with a cough. There are crepitations on the auscultation of lung. Review drugs A pt presents with a mask face. Aortic stenosis d. Admission for observation b. Pneumocystis jiroveci e. Mycoplasma pneumonia c. Advice to be more active d. 1244. What is the most appropriate management? a. Legionella pneumophilia b. 1243. Anti-depressant b. Atenolol b. 1247. What is the dx? a. Her Hgb=8. Peripheral vascular disease b. with painkillers and also scheduled an MRI for him. What is the most likely organism which would have caused his symptoms? a. What is the next step in her management? a. Admit A 32yo woman suffers an episode of severe occipital headache with vomiting and LOC. Mitral regurgitation c. 1245. Mitral stenosis A 34yo laborer developed severe pain in his lower back after lifting a sack of sand. MRI head d. Pseudomonas aeruginosa After an MI. What is the best option for her? . Hairline fx of the spine d. Now presents with fever. Tricuspid regurgitation b. Digoxin c. Anti-psychotic c.9g/dl and MCV=70. Legionella pneumonia b.

Left main stem (LMS) post descending artery e. He has no other complaints and on examination no other abnormality is found. OCD d. 1255. urea=5. Exam: scrotal skin is normal. Inpatient referral to psychiatrist d. Amlodipine b. Continue with surgery A 24yo male presents with discomfort in the groin area and scrotal swelling. 1251. Labetolol The artery that runs along the left AV groove. Urgent surgery c.2mmol/l. Lorsartan e. K+=6. She does excessive shopping. What is the most appropriate management? a. Aspirin e. Cystoscopy . Streptokinase c. Diagonal branch A 26yo man presents with painless hematuria. She likes to have her dinner in an expensive restaurant. Inv and postpone the surgery b. CT shows ischemic stroke. 1252. OPD referral d. Transfuse and proceed with surgery c. Transfuse and defer surgery d. He also has loss of sensation over the right side of the body and visual field defects.7mmol/l. She was commenced on N-acetyl cysteine and she was medically fit to go home the following day. Alteplase b. Anorexia nervosa b. a. Which of the following does she require? a. Nimodipine d. Antibiotics A 22yo girl unhappy about her weight with BMI=22. His biochemical profile is as follows: Na+=145mmol/l. What is the most appropriate anti-HTN drug for him? a. Bipolar c. What is the single most appropriate option? a.3. 1253. Circumflex artery d. creatinine=112umol/l. What is the dx? a. 1254. Ramipril d. 1256. OPD referral to relationship counselor b. Left internal mammary artery b. Propranolol A 22yo girl had a fight with her boyfriend and then took 22 tabs of paracetamol. What would be the next best step? a. Left anterior descending artery c. His BP has been >160/90mmHg on 3 separate occasions. OPD referral to psychiatrist c. Urgent US b. Inpatient referral to psychologist A 74yo man presents with sudden onset of with right sided weakness and slurred speech. What is the most appropriate initial inv to get to a dx? a.1250. Bulimia A 59yo pt has been dx with HTN. K+=3. Bendroflumethiazide c.

Fatty necrosis of breast A pregnant pt with Rh –ve who hasn’t been prv sensitized delivers her first baby without any prbs. 1258. no visible signs of fetal movements. Midstream urine for culture c. Exam: BP=170/110mmHg. MRI spine e. Now she is 24wks pregnant and presents with left upper quadrant mass with dimpling. 5d PP A 30yo primigravida who is 30wks GA presents to the L&D with absent fetal movements. Vaginal US reveals uterine thickness=12mm. Choose the single most likely dx? a. She also complains of severe headache. Carcinoma c. 50yo smoker and heavy drinker. what is the most probable dx? a. Abruption of placenta 2nd pre-eclampsia b.1257. Echo b. 72h PP e. Coag screening A pt. b. Endometrial ca c. 1259. A 24h EKG comes out normal. 6h PP b. Breast ca b. High vaginal swab A pregnant woman had hit her chest 3wks ago. Fibroadenoma d. Cervical ca b. 1262. urine protein=++++. Laparotomy d. Reassure c. Abruption of placenta due to trauma . US c. heartburn and seeing floaters before her eyes for the last few days. 1261. Stress test A 36yo woman came with uterine bleeding. Placenta previa d. What is the next best inv? a. Antepartum hemorrhage c. Abdominal US d. Vaginal ca A 30yo woman has PID which was treated with metronidazole and cephalosporin. 48h PP d. What would be the latest time to administer anti-sensitization? a. Fibroadenosis e. Endocervical swab b. What is the most probable dx? a. Primary PPH e. rock hard uterus. It is getting worse. 1260. presents with complaints of racing heart. IUFD f. Ovarian ca d. Breast ca e. 24h PP c. What is your next step in management? a.

Pudendal block c. easy fatiguability and even intermittent abdominal pain. 10d post partum. C-section b. Pethidine 1267.1263. Abruption of placenta 2nd pred. Reassure 1265. Stockholm syndrome e. What is the single most likely dx? a. uterus tender on palpation and fundus is 2cm above umbilicus. What method of pain relief best matches this lady’s request? a. She wishes to feel her baby being born but at the same time she wants something to work throughout her labour. Retained placenta b. A 36yo pregnant woman comes for evaluation with her husband. 28wks GA came to her ANC with a concern about pain relief during labour. Paris syndrome . Oral acyclovir e. Scabies c. Repeat vaginal examination in 4h b. Miscarriage e. TENS e. A primipara at fullterm in labor has passed show and the cervix is 3cm dilated. blood clots +++. Ganser syndrome b. She was investigated and was +ve for varicella antibody. Secondary PPH eclampsia e. What is the husband suffering from? a. APH d. What is the single most appropriate management for her labor? a. Induction of labour 1268. Exam: BP=90/40mmHg. What is the single most appropriate management? a. A 22yo lady who is in her last trimester of pregnant comes with hx of exposure to a child dx with chicken pox 1d ago. Concealed hemorrhage f. Repeat vaginal examination in 2h e. Entonox d. She has no medical illnesses and her pregnancy so far has been uncomplicated. Couvade syndrome c. presents to her GP with a hx of passing blood clots per vagina since yesterday. IV syntocin drip d. Her husband has been complaining of morning sickness. Choose the single most likely dx? a. Primary PPH 1264. Quarantine c. A 22yo woman who is 20wk pregnant came with pain and bleeding per vagina. Pseudo-psychosis d. Give varicella Ig b. Missed abortion c. pulse=110bpm. A 32yo lady G1. CTG c. temp=38C. Exam: os is not open. A 38yo woman. Threatened abortion b. Inevitable abortion 1266. Give varicella vaccination d.

Cervical ca b. Laparotomy e. A 34yo primigravida who is 16wk GA comes for routine antenatal check up.1269. Inevitable abortion 1273. the membranes have ruptured. Anti-phospholipid screen c. Gonococcal cervicitis 1271. The cervix is 3cm dilated. A 28yo woman 8wks GA had PID treated prvly and now comes with vaginal bleeding. Acute pyelonephritis d. What is the single most likely cause of her vaginal discharge? a. What is the most likely cause of her high BP? a. HCG measurements c. Chronic UTI 1274. What is the most probable dx? a. Threatened abortion b. A 23yo woman who has had several recent partners has experienced post-coital bleeding on gentle contact. What is the single most appropriate action? a. Her BP=160/100mmHg. CBC d. Cervical ectropion 1272. she has 7wks amenorrhea. A pt is at term and in labor. She has a hx of repeated childhood UTI. A 24yo woman has had lower abdominal pain for 12h. the liquor contains meconium but the CTG is normal. Culdo-centhesis 1270. Transvaginal US e. What is the single most appropriate test to inv the cause of acute abdomen in this lady? a. Her pregnancy test is +ve and US scan shows an empty uterus. What is the next step? a. Atrophic vaginitis c. Essential HTN b. She is at 10wks GA in a planned pregnany. Abdominal US b. Endometrial polyp d. pulse=140bpm. Cervical ca e. Chronic pyelonephritis c. A 68yo woman presents with post-coital bleeding following her first episode of sexual intercourse in 10yrs. Pre-eclampsia e. Cervical ectropion c. Laparoscopy 1275. Laparoscopy b. Miscarriage c. rigid abdomen. A woman comes to the ED complaining of pain in the right side of the abdomen. BP=80/50mmHg. Endometrial ca b. What is the single most likely cause that has led to post-coital bleeding? a. CIN d. Tubal pregnancy e. US d. Chlamydial cervicitis e. She is otherwise well. BP monitoring . Missed abortion d.

What is the single most appropriate action? a. PCOS b. Termination of pregnancy b. POF c. Lactulose e. Hysteroscopy d. estradiol and prolactin. Instrumental delivery A 29yo female at 28wks GA presents to you with complains of hard stools and constipation for last 2wks. b. normal prolactin and low estradiol. What is the single most appropriate tx? a. What is the most appropriate initial inv? a. Choose the single most likely dx? . Absent uterus d. CTG shows fetal tachycardia. External rotation d. FSH. The head has been delivered and you suspect shoulder dystocia. Endometrial sampling b. 1279. Exam under anesthesia A woman who is 7wks pregnant presents with excessive and severe vomiting and put on IV fluids and anti-emetic (ondansteron). She has high LH. Fiber diet c. PCOS b. She is complaining of severe headache and can’t take oral fluids. Phosphate enema d. C-section b. normal FSH and slightly high prolactin levels. TPN c. What is the most appropriate management? a. Pelvic US e. Primary obesity A 38yo lady presents with amenorrhea has very high LH and FSH levels. 1282. Feeds via NGT d. P6 acupressure e. Choose the single most likely dx? a. 1277. Choose the single most likely dx? a. IV hydrocortisone A young lady with primary amenorrhea has normal LH. POF c. Absent ovaries e. 1281. Episiotomy c. 1280. Turner’s syndrome An obese lady presents with primary amenorrhea. 1278. Hypothyroidism d. Reassure A 16yo girl presents with heavy bleeding. Fetal scalp blood sample e. C-section d. Internal rotation A pt is at term and labor. Fetal scalp blood sample e.1276. CTG c. Oral laxatives b. Transvaginal US c. Pregnancy e.

UAE c. HRT b. Supra-pubic aspirate of urine for culture A child with T1DM who is not compliant with meds and eats a lot. He is then given an IV drug which settles this confusion. Vaginal myomectomy c. Endometrial ablation A pt comes with sudden loss of vision. 1285. Clean catch urine specimen for culture c. Abdominal myomectomy d. Drugs e. Exam: high BP. Which way will you remove the fibroids? a. poor appetite. Testosterone gel A 35yo lady with subserosal fibroid=4cm and submural fibroid=6cm is planning for a child. Diazepam b. CRVO A 2yo girl has had a temp=39C. COCP c. Refer to pediatrician . 1288. 1286. CBC d. Which of the following drugs was given for his confusion? a.1283. Reassure A 32yo presents with heavy blood loss. Branch RAO c. 1289. What is the single most appropriate inv? a. Laproscopy b. Menopause A 77yo publican was admitted for an appendectomy. 1287. Hysteroscopy myomectomy d. He is not happy. Thiamine d. abdominal pain and urinary frequency for 3d. Hypothyroidism d. CRAO d. He thinks that he is short in his class. Pregnancy e. PCOS b. KUB US e. What would you do next? a. Post-op he becomes confused. Chlordiazepoxide c. COCP b. Estrogen gel d. Refer to psychologist b. a. Fundoscopy: retina appears swollen. Abdominal myomectomy e. What is the best possible management for her? a. agitated and starts to pick at things. Vit B A 65yo lady presents with dyspareunia. Which blood vessel occlusion is involved? a. US: uterine thickness>14mm. Branch RVO b. 1284. What will you give her for her condition? a. POF c. Catheter specimen of urine for culture b.

What is the single most appropriate follow-up inv? a. Albumin IV b. 1292. 1295. What is the single most imp initial tx? a. c. Blood test show raised level of bilirubin and liver enzymes. What is the most appropriate management? a. CRVO d. hyperventilating and dehydrated. Macular degeneration b. Change type of insulin An 8yo boy with a BMI=28 was admitted to a surgical ward following a MVC. 1296. On fundoscopy. CRAO b. What is the single most likely dx? a. His blood glucose is 28mmol/l. Congenital viral infection A 12yo boy with T1DM has poor long-term control. Galactosemia b. Bicarbonate IV c. OGTT d.1290. 1294. Saline 0. Intra-abdominal malignancy b. Ascites e. Glycosylated hemoglobin . Fundoscopy: new vessels all over the retina.HbA1c c. MS d. What is the most probable dx? a. Optic atrophy A 64yo DM has come for a routine eye check up. Refer to GP d. DM background e.9% IV A 30yo woman on OCP presents with dilated tortuous veins crossing her abdomen to join the tributaries to SVC. Insulin SC e.8kgs. dots and blots were noted with huge red swollen optic disc. What is the single most likely cause? a. Random blood glucose conc e. Fibroids d. Branch RAO c. Fasting blood glucose conc b. Strict sugar control . He is unconscious. Refer to social services e. DVT An 84yo woman with drusen and yellow spots in the center of retina. Biliary atresia c. Insulin IV d. Proliferative DM retinopathy A pt presents with headache. Serum cortisol conc At birth. He has hepato-splenomegaly and a rash. HTN retinopathy c. What is the most likely dx? a. Rh incompatibility e. blurring of vision and acuity loss. He was found to have glycosuria. Ovarian cyst c. 1293. G6PD deficiency d. 1291. When he recovered from his injury the glycosuria resolved. a baby boy at 38wks GA weighs 1.

Instill olive oil c. Otosclerosis e. All their unaffected children will be carriers of CF c. Acoustic neuroma b. What is the most appropriate management? a. Oral amoxicillin g. Presbyacusis The biological parents of a child with CF come to you to know about the chances of their future children with the same disease. Remove GA d. Ibuprofen . Syringing ENT A 45yo man has noticed difficulty hearing on the telephone. Non urgent referral to specialist d. What is the most likely dx? a. He took out the pencil from his ear and realized the end of the pencil with the rubber part is still stuck in his ear. Placental abruption c. Nothing can be predicted d. 1302. Regular eye check ups c. 1298. Exam: vague mass is felt in RIF. Nasal decongestant f. Remove with magnet instrument e. What would you say to them? a. b.1297. Laser photocoagulation e. Appendicitis b. There is little amount of blood in the auditory canal and a small perforation of the eardrum. Sulfasalazine b. What is the single most likely dx? a. What is the most appropriate management? a. An audiogram shows moderate hearing loss in both ears across all frequencies. The internal os is open. Do syringing A 16yo boy presents with acute pain in the right ear and little bleeding from the same ear. Metronidazole d. He is concerned because his father has been moderately hard of hearing since middle age. There is a 1:4 chance that your future child will have this disease b. Admission for parental d. malaise and weight loss over 6m. Remove with a hook b. Paracetamol c. He had been in a boxing match and had sustained a blow to the ear. OPD review antibiotics e. Menieres’ disease c. BC=normal. 1299. It can 100% dx antenatally A 14yo boy presents with recurrent abdominal pain. Ectopic pregnancy d. Colonoscopy shows transmural inflammation and granulomata. 1300. What is the most appropriate management? a. Abortion A man developed intense pain after using the end of a pencil to scratch his inner ear. 1301. Insulin A 25yo primigravida of 8wk GA presents with severe lower abdominal pain. Packing of ear b. vaginal bleeding and passage of clots. Noise induced deafness d. Surgical intervention c.

Mobitz I heart block d. A 46yo man with tachycardia has the following ECG. Atrial fibrillation e. IV aminophylline b. CXR d. Uretric calculus k. nebulized salbutamol and ipratropium bromide nebulizers and IV hydrocortisone. He had a fall 2wk ago. What is the best management for this pt? a. Burr hole drainage c. Despite initial tx there is no improvement. SVT b. What inv would you do for him? a.pylori breath test c. Psoas hematoma d. Excision and biopsy 1305. Which is the next step in management? a. VT c.1303. Tx is initiated with 100% oxygen. Bronchoscopy c. Muscle strain j. What is the most likely dx? a. ABG b. IBD g. IV salbutamol d. IV magnesium sulphate c. Transfer factor 1304. Pleural biopsy e. Endoscopy and biopsy d. A 62yo prv shipyard worker complains of breathlessness and chest pain for 6m. What is your dx? a. US 1306. WPW syndrome 1308. H. Pyelonephritis e. Conservative management d. A 24yo male is admitted with acute seere asthma. He has now developed a large pleural effusion. Craniotomy b. A 67yo man presents with a hx of increasing confusion and drowsiness. Meckel’s diverticulum i. A 13yo boy with umbilical pain for the last 12h presents with anorexia. Which is the single best diagnostic inv? a. CT head reveals a chronic subdural hematoma. 1307. Ovarian cysts b. IM adrenaline . ECG b. IBS h. A 45yo male with epigastric discomfort has been given triple therapy. nausea and has not passed a bowel motion 24h. Acute appendicitis f. He has now returned after 4wks of epigastric discomfort. PID c.

Cheek c. he chokes on food and has become confined to a wheelchair. Naltrexone 1312. What is the most likely dx? a. Lambert-Eaton syndrome d.e. Methadone d. Huntington’s disease 1314. What is the songle best advice to prevent recurrent stone formation? a. She would like to stop taking heroin and asked for something to help her stay away from it. Now he can no longer feed himself. Lewy body dementia c. IBD b. Uretric calculus e.8C. Temp=38. A pt with vesicles in the maxillary divison of trigeminal nerve. Frontotemporal dementia b. He is tender in the right lower quadrant and has an anal fistula. Naloxone b. High fibre diet c. Conjunctiva 1313. Choose the single most likely cause of abdominal pain. A 40yo woman who has recently returned from working in the middle east complains of thirst. a. Low protein diet . She plans to return to the Middle East in a month’s time. Increase fluid intake d. Myasthenia gravis c. Cornea d. Cerebral tumor b. urinary frequency. IBS c. Pyelonephritis d. A 10yo boy with lower abdominal pain for the last 10d presents with a hx of passing 6-8 loose stools. Drink less milk b. Several months later he developed weakness in his right foot. Chlordiazepoxide e. Which area of mucus membrane will be involved? a. A 49yo man first presented with increasing difficulty in swallowing. Palate b. Low calcium diet e. IV adrenaline 1309. A 28yo woman with hx of drug addiction wants to start a family and have a baby. What drug tx would you give her? a. Alzheimer’s disease e. Cerebro-vascular disease 1310. dysuria and has passed a urinary stone. What is the most likely dx? a. Acamprosate c. Delirium tremens d. A 52yo man presents with visual hallucinations and features of cognitive impairment. episode of loin pain. All inv are normal. Motor neuron disease e. Gastroenteritis 1311.

A 55yo pt presents with collapse and complains of abdominal pain that radiates to the back. Post infection nephritis b. Fournier’s gangrene e. Prostate ca c. Which of the following inv’s will be most helpful in localizing the cause for Cushing’s syndrome? a. What is the single most likely dx? a. swollen. high BP and depression. hyperglycemia. Low dose dexamethasone suppression test d. What is the most appropriate management? a. What is the dx? a. liver and bone now presents with increasing constipation. An elder man who has anorexia. Glomerulonephritis 1318. hot. A 22yo man presents with a red. Cellulitis b. A 34yo woman presents with truncal obesity. Reiter’s syndrome d. Exam: thickening o the left testis and it is hot to touch. weakness. Psoriatic arthropathy 1321. thirst and anorexia for the past 3d. RA c. Antibiotics d. Gout b. 24h urinary cortisol c. High dose dexamethasone suppression test e. Analgesia b. prostate synptoms and HTN. What is the most likely dx? a. metatarsal phalangeal joint. Liver failure 1320. sarcoilitis and onycholysis.1315. easy bruising. IgA nephropathy c. A 55yo woman with breast ca which has spread to lung. There are small kidneys on US. Erysipelas d. Hypercalcemia c. Membranous nephritis d. An expansile abdominal mass if felt on examination and the pt is in shock. Hypertensive renal disease b. A 32yo man presents with 3d of scrotal pain. Renal colic . BPH 1319. Today she is disorientated and has left sided weakness. What is the dx? a. Which of the following conditions requires operative management? a. Dyshidrosis c. What is the single most likely cause of his condition? a. Reassurance c. He r only medication is haloperidol for hiccoughs. Serum cortisol b. Brain mets b. Referral to surgeon 1316. Ruptured aortic aneurysm b. Lymphangitis 1322. Overnight dexamethasone suppression test 1317. A 32yo man develops hematuria 2wks after a sore throat.

He had a dry mucous membrane with a BP=118/70mmHg and PR=90bpm. Antibiotics A 34yo man has supra-orbital pain and tenderness and developed tenderness over the maxilla. nystagmus and opthalmoplegia. Passes through the deep inguinal ring A 56yo woman with hx of breast cancer 10y ago has undergone radical mastectomy and axillary LN removal. Antibiotic PO d. What is the single likely cause for these symptoms? a. Only passes through the superficial inguinal ring e. He also has mild fever.9%NS d. Erythrocytes A 24yo woman presents with tingling and twitching of her fingers followed by throbbing unilateral headache. What is the cause? a. Alcohol breath test= ve. Comes through femoral ring b. a. Lies below and lateral to the pubic tubercle d.9kPa. He is on maximal inhaled medical therapy. Oxygen e. He had ataxic gait. He looked unkempt and his clothes had a sweaty odour. Acute sinusitis b. PaCO2=5. Lymphedema b. 1325. Endocarditis e. ACEi PO c. Doesn’t pass through the deep inguinal ring c. now complains of swollen upper limb 3wks after an insect bite. Choose the single cell type you will find on the blood film. There is no koilonychea. Oval macrocytes e. Vit B complex c. What is the most likely dx? . Filariasis A homeless person is found wandering on the street. Bolus IV 0. PaO2=6. 1328. Mexican hat cells c. Maxillary carcinoma A 51yo woman presents with painful tongue and complains of tiredness. What is the single feature of the hearnia sac that would confirm the dx? a. 1326. c. IV dextrose e. Breast Ca c. GCA c. IV insulin b. She is pale and has angular stomatitis and a smooth red tongue. Aminophylline PO b. 1327. Result: pH=7. Microcytic hypochromic b. Blood sugar level=8. Numerous blast cells d.36. Trigeminal neuralgia d. What would the most imp initial inv? a. Steroid PO A 79yo man has a swelling of the right groind which was clinically dx to be indirect inguinal hernia. 1324.9kPa. The bite site is better but gross edema is still present. Atheroma A house-bound 78yo man with severe COPD has had a gradual deterioration over recent months and is now breathless at rest. What is the single most appropriate additional tx? a. Trauma d. 1329. Spherocytes f.1323. Allergy d.

Herpes zoster c. What is the dx? a. Tension headache b. Psoriasis A 5yo boy is rescued from a burning building and is presented to the ED. He has 5% partial thickness burns over the arms and legs and had soot in the mouth and nose. What would you give to the baby? a. Varicella zoster b. Fungal infection d. Hep B full vaccine and Ig c. Somatization b. 1332. Her child is born and she is worried about the risk of infection to the baby with Hep B. What is the most appropriate advice? a. TOF d. SAH A young child dx with chicken pox. He also has splenomegaly. Some vesicles are crusted and some are not. What is the dx? a. Nothing until immune status is checked . Hypochondriasis A 26yo man has returned from NY to the UK and noticed weight loss. Oropharyngeal airway e. 1331. Advice that he can go back to nursery when the rash is crusted over A 7yo boy is brought by his mother. What is the single most immediate management? a. 1334. Nebulized salmetarol and oxygen c. Impetigo e. Migraine c. TIA e. 1333. abdominal pain and fatigue. Bronchial carcinoma d. night sweats. His breathing has become noisy. 1335. a. All the tests are found to be normal. PDA A woman complaining of diarrhea. Nebulized adrenaline b. Intubation of airway A new born bay is borught with pansystolic murmur at sternal border but the baby is not cyanosed.5C and cervical lymphadenopathy. Needle cricothyrodotomy d. VSD b. The face is hot. Cluster headache d. TB b. Isolate the child from parents and siblings at home c. What is the cause? a. Lymphoma c. temp=37. Hep B vaccine only once d. Usually goes to day care.1330. There are multiple perioral and forehead vesicles. What is the most likely dx? a. Conversion c. ASD c. 1336. Child should be admitted to hospital straight away b. Bronchitis A mother got infected with Hep B during pregnancy. Hep B Ig only b.

A 63 yo man with vague but persistent pain. Schizophrenia d. Adenoma c. Popliteal artery b. Personality disorder c. Occipital lobe e. Profundafemoris artery f. A 16yo boy in boarding school feels unwell. Rett syndrome e. difficulty in writing and inability to differentiate the fingers of his hand. Adenocarcinoma b. What is the dx? a. Hep B vaccine once and Ig 1337. Brainstem 1342. What is the dx? a. Circumflex femoral artery e. A 10yo boy is brought to the ED 10h after injury to the foot. Ig and vaccine c. Streptococcus 1343. Dorsalispedis artery 1339. It was punctured with a metal spike that passed through his shoe. Parietal lobe c. Antibiotics 1344. Social anxiety 1340. Palate 1338. His CXR showed bilateral consolidations. Obturator artery c. A 9yo child doesn’t play with his peers and has collected 200 cars. Conjunctiva d. On endoscopy: columnar epithelium was found to be pouched into muscularis. A 24yo man after a head injury presents with difficulty dressing himself. Clean the wound e. Exam: distal pulses are not palpable. A 34yo man sustains a fx to shaft of femur after falling from the roof of his house. Cornea c. Oropharynx e. What is the most likely dx? . pylori infection 1341. Femoral artery d. A 56yo male presents with persistent watery diarrhea. Peptic ulcer d. H. Vaccine only d. What is the next best step? a. Temporal lobe d. Legionella c. Which of the following mucos membrane is to be affected? a. A man suffers from Herpes Zoster affecting his face. Ig b. Frontal lobe b. Mycoplasma d. Autism b. Cheek b. Which part of the brain is most likely to be affected? a. He developed cough and rash. Staph aureus b. He doesn’t respond to any criticism.e. Which vessel is damaged? a. What is the cause of his symptoms? a.

What is her most common primary ca? a. She has some supra pubic tenderness. IVU e. He is otherwise feeding well and is not dehydrated. Deep cervical LN A young boy presented to the OPD 12wks after renal transplantation with fever and pain in lower abdomen. ITP . Drug toxicity e. Submandibular LN e.1345. What is the most probable dx? a. 1350. 1346. Treponema pallidum b. USG d. There is found to be an underlying metastatic lesion. Clean catch of urine for C&S c. conjugated bilirubin<85% A 29yo man took a tour of Japan and also travelled to other parts of Asia. HSP c. What is the most likely dx? a. conjugated bilirubin>85% d. Submental LN d. Brain A 6m infant has breast milk jaundice. He didn’t take malaria prophylaxis prior to travel. HIV d. Graft vs host disease A 56yo lady presents with a pathological fx of T11 vertebra. Acute rejection d. Pyelonephritis b. Dengue fever e. Total bilirubin:40. 1347. Pseudomonas aeruginosa A 2yo girl has frequency. Breast c. Total bilirubin:400. MCUG An 89yo man presents with carcinoma of posterior oropharynx. Cryptosporidium d. Which is the single most appropriate LN involved? a. urgency and burning micturition. 1348. petecia and rash on his body. Total bilirubin:500. Supra pubic aspiration of urine for C&S b. Uterine d. 1349. a. Chronic graft rejection c. Malaria b. Pre-aortic LN b. conjugated bilirubin<5% b. Nesseria meningitides c. developed fever. Aortic LN c. Renal biopsy showed immune cell infiltrate and tubular damage. Which one of the following is the most appropriate initial inv? a. Staph aureus e. What would his LFTs look like? a. conjugated bilirubin 85% c. Total bilirubin:300. Renal functions were deranged. Lung b.

What is the most likely cause of his hypercalcemia? a. Clotting factor c. What is the inv of choice? a. Digoxin 1352. Toxoplasma gondii c. swollen ankle and unable to move his legs. Sarcoidosis 1358. HSV d. Papovirus . What is the most likely dx? a. A 46yo male presents with confusion and drowsiness. Paracetamol c. Hyperuricemia e. Melanoma b. A child has developed rash after the tx of penicillin. Hyperoxaluria 1356. Drug reaction b. Strep pyogenes b. A 26yo man is referred for gastroscopy because of a hx of several months of dyspepsia. A boy with a hx of recurrent swollen tender joints on both knees and elbows and not able to participate in sports. ESR b. Renal and LFT are both mornal. What is the inv of choice to dx? a. Parvovirus d. CMV e. Amitryptiline b. Iron d. CXR is normal. A child comes with recurrent joint pain. A 3yo boy presents with difficulty in walking and skin lesions. What will be the cause of rash? a.1351. RF/ASO titre b. Hypercalcemia c. What is the cause? a. HTN d. What is the most likely causative agent? a. He has routine bloods checked and is found to have a serum calcium level=3.2mmol/l with a venous bicarbonate level of 33mmol/l. Primary hyperparathyroidism e. Inf Mono 1354. ESR 1357. Candida albicans 1353. He has also presented with acute onset pain in his knee in the past. Milk alkali syndrome d. Cryptococcus neoformans b. Kawasaki c. A 4yo boy ingested his grandmother’s medicine and has developed dilated pupil. SLE associated GN b. RF c. A 66yo man has renal colic. Clotting factors 1355. Rubella virus c. Metastatic malignancy c. multiple bruises. What is the single most likely cause for renal failure? a.

Ureteric calculus 1361. TB c. He has lost 5kgs in 2m. Klebsiella b. AV block c. Acute cystitis b. What is the single most likely cause? a. No masses are palpated. Chlamydia pneumonia d. H. PCP e. Gastrinoma c. He had not experienced any trauma. In lyme disease. Mild encephalitis d. What is the single most likely causative organism? a. Anti-streptolysin 1363. Inv: CXR=bilateral interstitial shadowing. He is otherwise well. His mother describes he had presented this since 3wks ago. Tracheal intubation 1360. Which single test would be the best as an initial assessment? a. A 27yo female who had a RTA 7m back now complaints of attacks of sudden onset rotational vertigo which comes on with sharp movements of the head and neck. Plasma electrolytes b. A 40yo man complains of severe colicky loin pain that radiates to his scrotum. Dilated CM b. Pancreatitis 1362. Myocarditis 1364. Albumin c. Meningitis e. Acute pyelonephritis e. What could be the origin for ascites? a. Total serum protein d. He is an IV drug abuser. A 55yo man is having slow growing ascites. TB e. A pt after his house fire came with hematemesis with erosion/ulcer of esophagus and on examination there is 55% burn and on endoscopy there is a stomach/gastric erosion and soot in the mouth. A 7yo boy presents with his mother to GP surgery. Chlamydia psitacci 1365. Budd-Chiari b. Paramyxovirus 1359. Renal vein thrombosis d.e. Which of the following would be most helpful? . He is noted to have microscopic hematuria. PPI and antibiotic d. IV PPI c. which complication is most likely to lead to collapse? a. Hepatoma d. There is no rash or lesion. When we tap the peritoneal fluid the protein is <25 and it is clear and yellow. Bladder ca c. A 30yo pt came to the OPD with complaint of breathlessness and dry cough. What is the tx? a. pylori test e. Exam: non tender swollen ankles bilaterally. No other symptoms a/w the condition. PO PPI b.

Hyperbaric oxygen in a hyperbaric chamber d. Otoscopy A man rescued from a building on fire presented with unconsciousness without any evidence of burns or external injury or soot. Oculomotor nerve d. Heparin e. 1371. Optic nerve e. Mood stabilizers d. Gastric washing e. Caloric testing b. Meniere’s test e. The parents don’t want him to have a BAL under anesthesia. Analgesia e. Which one would you prescribe? a. CSF d. Now. Warfarin A young boy presents with fever and cough. Blood c. Abducent nerve b. 1370. a. I&D b. No additions req A man presented with a purplish swelling at the anal area. His father was dx with TB a week ago. Reassure d. 100% oxyen inhalation b. Gutenbergers test d. 1368. It is acutely painful and he complains of constipation for the last 2m. Intubation e. What would you do next? a.1366. 24% oxygen by mask c. What additional pharmacological tx would now act as a prophylaxis for his condition? a. Urine b. Refer to specialist unit A pt has had 1 ep of depression and 2 eps of mania over the last year and now presents with depression. Which nerve is involved? a. Aspirin c. He is on anti-depressants. he also complains of double vision on looking at an outward gaze. Trochlear nerve c. there is left sided weakness and right side facial numbness. Antidepressants b. Alteplase b. Sclerotherapy A pt came to the ED after he had banged his car quite a few times on reversing. I&D + antibiotics c. 1367. Sweat . CT shows ischemic stroke. Trigeminal nerve A pt had a stroke. Antipsychotics c. What is the most appropriate management? a. Clopidogrel d. 1369. Hallpikes maneuver c. He was complaining of seeing double while he tried to look back during the process of reversing the car. Which other samples can be taken for dx? a.

ECG b. CMV and rubella e.1372. A 40yo woman with breast cancer has back pain which keep her awake at night. Exam: everything normal. S1 and S2 were heard on auscultation. 24h ECG c. Tramadol 1374. She has diminished fine touch and temp sensation in her right foot. A 32yo male complains of tremors everytime he tends to use his muscles and when he is pointing at objects. Under general anesthesia d. A 73yo stroke pt has been on aspirin for 2yrs. What is the most appropriate inv of choice? a. A 50yo man came to the hosp a few months after he had a MI. MRI spine d. Syringing e. Magnet 1375. What is the most probable dx? a. Rubella and syphilis b. NSAIDs c. Omeprazole Morphine d. Thyrotoxicosis d. CT head c. The child is screaming that there is something in her ear and she appears agitated. Nuclear bone scan e. There is tenderness over the right thoracic spine. A 2yo girl is brought to the ED by her mother. Laparotomy b. During antenatal visits. What is the best method of removal? a. Parkinsonism b. What is the most appropriate management? a. He now presents with epigastric pain and is asking for a tx. Bone density scan b. Benign essential tremor 1377. Hook c. She blames it on a gym session she had 2wks ago. She now has difficulty in climbing stairs. Forceps b. No complaints at rest. CXR e. CT 1373. His father complained of similar problems. Exam: a plastic bead is seen inside the ear. What is the single most appropriate inv? a. Lithium toxicity c. the following tests are routinely offered to all pregnant mothers apart from HIV and Hep B? a. but there is a new pan-sytolic murmur. Hep C & thalassemia d. Echo d. Syphilis and toxoplasmosis c. XR thoracolumbar spine . Sickle cell anemia and Hep 1376.

What is the most appropriate dx? a. Both C and D 1383. Tonsillar ca b. CXR: pneumonia. What is the most appropriate tx? a. Streptococcus pneumonia e. Delivery of baby c. Exam: scattered pansystolic murmur all over the precordium. OE c. Irritant ingestion . A man suffering from Influenza A since 5d ago. ECG b. During a laparoscopic procedure. CXR 1382. Linea alba c. Klebsiella c. Internal oblique and transverse abdominal e. A pt admitted due to repeated attacks of pancreatitis presents with dementia and loss of proprioception in the legs. What is the likely dx? a. A pregnant lady at her 39wk GA present with eclampsia. Rectus sheath b. What is the next inv that will lead to dx? a. Pyridoxine c. Hemophilius influenze b. What is your next step in management? a. External oblique aponeurosis d. He also complains of odynophagia. Diazepam 1379. Perforation of the tympanic membrane e. earache and tympanic membrane is dull. Blood culture e. A man after MI presented with sudden breathlessness and dyspnea. What organism is responsible for pneumonia in this pt? a. CT d. Cobolamin d. Staphylococcus aureus d. Pseudomonas 1380. Antibiotics 1381. Thiamine b. What are the structures most likely to be pierced? a. Echo c. A 72yo male who is a regular smoker has come to the ED with complaints of loss of weight and loss of appetite. OM b. Glue ear d. a trochar is inserted halfway between the umbilicus and the ant superior iliac spine. Exam: actively bleeding ulcer on right tonsil. Vincent’s angina c. A pt. Referred ear ache 1384. Soon after her arrival in the labour suit. Mg SO4 bolus b. Lipase e. IV MgSO4 and IV hydralazine has been prescribed. The pt then develops another fit in the hosp and maintenance dose of MgSO4 has been started. a small child presented with URTI and later developed fever. MgSO4 loading dose d.1378.

The biopsy shows infiltration of the gastric epithelium by lymphocytes. 1388. 1389. He complains of difficulty in breathing. Gentamicin c. d. Lynch syndrome d. 1391. Peritoneal tumor A 55yo man presented with hot. Labrynthitis A pt with celiac disease from birth. SC adrenaline d. Pilocarpine e. What is the immediate action that needs to be taken? a. Ciprofloxacin b. Acoustic neuroma c. Cevimiline A pt presented after eating a seafood dish at a local restaurant. Metronidazole d. Benzylpenicillin e. raised. He only hears them when he wakes up from sleep and not at other times. What is the likely dx? a. 1390. Aceclidine d. Ceftriaxone A 65yo man has incurable bronchial cancer. PO chlorpheniramine e. Neurological exam=normal. What type of hallucinations is he having? a. What is the most likely dx? a. now as an adult presented with some abdominal symptoms.1385. Which of the following drugs is most likely to help him? a. Xanomeline c. Lymphoma b. Diverticular disease c. IV morphine c. vertigo and tinnitus lasting >30min. 1387. IV morphine and immediate ophthalmoscopy b. His speech is slurred and his BP=85/55mmHg. IV adrenaline b. Benign positional vertigo e. Somatic . Herpes simplex infection A pt with regular episodes of SNHL. Otosclerosis d. IM adrenaline c. Observation only A schizophrenic man complains that he can hear voices talking about him and telling him to end his life by cutting his throat. tender area of skin on his right leg. Scopolamine b. Meniere’s disease b. He is unable to cough up his secretions. Paracoccidiodmycosis e. Gastric TB e. IV chlorpheniramine A 7yo boy presents with proptosis and periorbital edema. He is febrile with rigors. He has been started on flucloxacillin. 1386. This is leading to a distressing cough. What other meds will you add? a. What would be the most appropriate next step? a.

Hypnogogic d. 1397. Pericardial effusion d. b. Hepatic encephalopathy A 38yo man presented to ED with severe pain in upper abdomen. Congestive heart failure d.1392. Cotard syndrome c. Haloperidol d. Hemothorax e. Ca stomach A 68yo man who is a known case of liver cirrhosis has developed ascites. Pneumothorax A 64yo alcoholic who has been dx with liver cirrhosis presents with a massive ascites. BP=60/0mmHg. She says there is no one in the room except her. 1396. 1393. Hypoalbuminemia d. Hypnogogic hallucinations d. What is the most probable dx? a. He has already taken course of triple therapy and now had elective endoscopy 2d ago. Valproate e. What is the most likely alt to the drug causing the prb? a. Hypnopompic e. Lilliputian hallucinations e. Mediastinitis d. On evaluation she has no other problems. Portal HTN c. Hypoalbuminemia c. Chest is clear bilaterally with muffled heart sounds. Lithium b. Liver failure e. Cirrhosis b. Portal HTN b. Liver failure . Cardiac tamponade c. What is the most probable dx? a. JVP is raised. What is she suffering from? a. Kinesthetic c. 1394. pulse=120bpm. 1395. Delusion of persecution b. Ca esophagus b. Lilliputian A 28yo woman complains of hearing strange voices in her bedroom as she is falling asleep in the night. Pulmonary embolism b. Diazepam c. He is in shock. What is the mechanism for the development of ascites? a. Citalopram A man is brought to the ED after he was stabbed in the best. What is the mechanism of fluid accumulation in a pt with liver disease? a. Barret’s esophagus c. Schizophrenia A 32yo man on psychiatric meds presents with coarse tremors and diarrhea.

Esophageal ca f. Anemia of chronic disease c. Mallory-weiss tear e. Sweat test b. diarrhea. Rectal Ca 1399. Gastric ca d.1398. Schimmer test e. Gabapentin b. FNAC d. Fistula in ano d. What is the most appropriate inv? a. A 22yo Greek man presents with rapid anemia and jaundice following tx of malaria. Feacal incontinence b. A 23yo woman presents with a 1cm small smooth. Which test will help in dx? a. What is the most likely dx? a. Addison’s disease b. Esophagitis c. A 45yo male alcoholic presents after a large hematemesis. Peptic ulceration 1404. Vit B12 deficiency 1402. A man feels mild discomfort in the anal region and purulent discharge in underpants. Anal abscess c. What is the most probable dx? a. Esophageal varices b. A 38yo female presents with difficult in looking upward and on examination she was found to have lid lag as well. Choose the single most likely cause from the given options? a. Tensilon test b. Morphine 1403. Cushing syndrome . US breast c. Young Helmholtz ophthalmoscopy 1400. Heel prick test c. What is the most appropriate inv? a. Amitryptiline d. He has a swollen abdomen with shifting dullness. Mammography b. firm. A pt was admitted with abdominal pain. Mammography and US 1405. Radiotherapy c. A 65yo has terminal cancer and his pain is relieved by a fentanyl patch but he now complains of shooting pain in his arm. BP=100/76mmHg. She also complains of her heart racing at times. pulse=110bpm. Anal tags e. 24h ECG c. TFT d. Breath test d. A young anxious mother of a 10m boy comes to you and requests a test for CF. CXR 1401. She is very anxious. He has some spider naevi on his chest. mobile mass in her left breast. G6PD deficiency b. Which of the following will add to his pain relief? a. He is noted to have Heinx bodies. IDA e. pigmented palmar creases and buccal mucosa. Pernicious anemia d. a.

What is the most likely rhythm disturbance? a. Thiamine d. AS b. What is the single most likely dx? a. Crytogenic organizing d. c. He has palpitations for the last 3h. Exam: pulse=regular. Pheochromocytoma d. LMP was 10d ago. What med would be that drug of choice? a. Churg-strauss syndrome c. What is the most probable dx? a. Clarithromycin b. Exam: peripheral neuropathy with tingling and numbness in a ‘glove and stocking’ distribution. Facial nerve b. The pt is responding well to corticosteroids. Extrinsic allergic alveolitis e. 1407. Skin elsions are present in the form of tender subcutaneous nodules. Diazepam A 68yo man awoke to find that he is unable to close his left eye and dribbling saliva from the left angle of his mouth. Doxycycline c. Carotid sinus massage settled his pulse down to 80bpm. Hyperthyroidism e. 1410. Clotrimazole A 35yo man has been given a dx of allergic rhinitis and asthma. Tubo-ovarian abscess c. What is the single most appropriate option? a. Ovarian torsion e. 1408. Optic nerve e. Vancomycin f. CD d. Ectopic pregnancy b. Tropical pulmonary eosinophilia A 28yo woman comes with sudden onset vomiting and pain per abdomen. 1412. Penicillin h. Fluconazole d. IBS A 45yo man has undergone detox and now wants a drug to stop him from craving alcohol. Metronidazole g.1406. Vagus nerve A 19yo female dx with trichomonas vaginalis. SVT . Hypoglossal nerve d. Diverticulitis A 68yo man on tx for an irregular heart beat comes to the ED. Naloxone e. What is the best antibiotic tx? a. Colorectal ca b. Disulfiram b. 154bpm. weight loss and fistula. Acamprosate c. Celiac disease c. Exam: mobile swelling in the right iliac fossa. Hypoparathyroidism A 36yo pt came with diarrhea. Glossopharyngeal nerve c. UC e. 1409. 1411. bleeding. Acute appendicitis d. What is the single most appropriate dx? a. Erythromycin e.

What is the most likely rhythm? a. 1415. Pressured speech e. low K+ e. TTP b. Psychosis b. His CD4 count is measured as 350. 1416. Schizophrenia d. normal K+ d. Reflux nephropathy A 76yo man is in the CCU 2d after an acute MI. CXR shows lobar consolidation. SVT b. 1417.1413. ITP c. proteinuria and hematuria. He remains conscious throughout. What effect do loop diuretics produce? a. She is found to have a congenital abnormality of the insertion of the ureters into the urinary bladder. VF c. Measles A pt is on loop diuretics. Mania c. Acute tubular necrosis e. A-fib A 43yo man with a hx of hospital admissions talk about various topics. What is the single most appropriate option? a. He tells you that he had an episode of rapid pounding in the chest lasting for about 2mins. CMV c. Low Na+. High Na+. 1418. VT d. SLE b. What is the single most likely cause for renal failure in this pt? a. abdominal pai n. high K+ A 6yo girl is being investigated for renal failure. VT d. V-fib c. Normal Na+. A-fib A 49yo man comes with hx of cough and SOB. moving from one loosely connected topic to another. Pneumocystis jerovici . 1414. Toxoplasmosis e. Wilm’s tumor d. HUS e. What is the most likely dx? a. V-ectopics e. V-ectopics e. b. What is the most probable dx? a. Low Na+. Mycobacterium avium intercellular b. PKD c. Verbal diarrhea An 18yo girl presents with rahs on her trunk. normal K+ c. low K+ b. HSP d. arthritis. Streptococcus d. High Na+.

Pulmonary embolism d. She also says that abdominal contractions are coming veery few minutes and she is having a blood stained show per vagina for the last few minutes. Discharge and allow to go home 1423. She doesn’t need med tx for the OD. What is the most probable dx? a. Cerebral tumor b. What is the single most likely dx? a. Exam: alert and oriented. Exam: cervix is fully affaced. A 63yo male presents after having had a seizure. Psychiatric OPD review the next day c. MI b. Community psychiatric nurse visit b. Cerebellar abscess d. Pituitary adenoma c. A 32yo woman with prv hx of PID now presents with severe abdominal pain. A 70yo lady on Raloxifene for osteoporosis has recently to the UK from Australia. Aortic dissection c. Exam: inattention on the left side and hyperreflexia of the arm. 9cm dilated. What is the single most appropriate dx? a. Choose the single most likely dx? a. Costochondritis e. A 30yo woman has a painless lump in the outer aspect of her left breast.1419. Cholecystitis 1420. firm. Breast carcinoma c. Her LMP was 8wks ago. She now presents with severe chest pain. Admission under the mental health act e. Hematometrium d. Ectopic pregnancy b. Pneumothorax . Huntington’s chorea e. IUGR 1421. A 38yo woman is in the ED following an OD of her meds. SOB and suddenly collapsed in the ED. Chronic PID e. What is the single most appropriate management? a. discrete. Labour d. Breast abscess b. Ovarian torsion c. APH b. Sebaceous cyst 1422. What is the most probable dx? a. Her grandmother had breast cancer at 70yrs. IUFD e. mobile lump in the other quadrant region of the left breast. Parkinsonism 1424. She says she wishes to be discharged. Fibro-adenoma e. She has had a prv breast lump. Breast cyst d. She has a 1cm smooth. cephalic presentation and station is +1. Prescribe anti-depressants d. A 25yo who is 38wks pregnant presents to the labour ward with a hx of fewer fetal movements than usual during the evening. Concealed hemorrhage c.

She had no hx of phonation probs before the surgery. Delusion of nihilism b. He is slightly confused. What is the single most appropriate inv? a. What is the single most likely causative organism? a. Bronchoscopy c. Exam: temp=39C. CT neck d. proximal muscle weakness and nocturia. Legionella b. Clang association 1431. CXR: bi -basal consolidation. Streptococcus e. A man says his insides are rotting and nobody has buried him. breathlessness and anorexia. Chlamydia psitacci 1427. CXR: patchy consolidation. Mycoplasma c. Exam: temp=38C. Incongruent affect e. Barium swallow 1426. Cushing’s syndrome 1430. What is the single most likely causative organism? a. A 35yo woman complains of hoarseness of voice 3h after partial thyroidectomy. Chlamydia psitacci 1428. Chlamydia pneumonia c. Delusion of guilt c. Streptococcus e. What is the most probable dx? a. PCP d. Familial hyperaldosteronism d. Laryngoscopy b. A 45yo man presented to his GP with vague symptoms of headache. Pneumococcal pneumonia b. A 40yo pt came to OPD with complaint of fever. Cushing’s disease e. Test results show him to be severely HTN (230/130mmHg) and hypokalemic. He has a hx of splenectomy last yr. Klebsiella d. productive cough and painful vesicles around the lips. Which term best describes his condition? a. Pneumococcal pneumonia b. Staphylococcus c. Conn’s disease c. According to him he had flu like symptoms a week ago. A 20yo student came to the OPD with complains of headache. dry cough. CXR e. A 37yo male pt who recently returned back to UK from UAE attends the OPD with complaint of dry cough. Viral pneumonia e.1425. PCP 1429. Addison’s disease b. What is the single most dx? . Delusion of persecution d. Klebsiella d. What is the single most likely causative organism? a. pleuritic chest pain. A man with chronic cough presents with copious purulent sputum. malaise. Inv: lymphopenia & decreased Na+. joint pain and vomiting.

BAL e. Legionella b. 1433. 1436. Pneumonia e. Cerebral abscess d. Exam: dullness on left side of the chest. pleuritic rub and crackles been heard on the same side. He has been in the hosp for 2wks having been treated for a DVT. 1434. His gf has got similar symptoms. TB A 67yo female presents with balance prbs. a loss of the let corneal reflex and reduced hearing in the left ear. Bronchoscopy d. Bronchiectasis c. a GCS of 8 and bilateral up-going plantar response. Mycoplasma c. Exam: small scalp laceration. None b. Delirium tremens c. Pericarditis b. cough and anorexia. Laryngoscopy c. He had hx of sore throat and ear discharge a month ago. PCP e. Chlamydia pneumonia d. What is the single most likely causative organism? a. Sputum for AFB b. What is the most likely dx? a. 1437. What is the single most appropriate inv? a. He denies any weight loss but he has been smoking for 4yrs. a. CXR A 25yo pt came to the OPD with complaint of fever. What is the single most appropriate inv? a. 1435. Extradural hematoma . COPD d. Meniere’s disease b. malaise. Chlamydia psitacci A 72yo male presents with acute confusion. Infection toxicity b. CCF e. Pituitary tumor e. Laryngoscopy c. Bronchoscopy d. Gentamicin A 22yo man reports a 2d hx of hoarseness of voice. Pleural effusion d. Acoustic neuroma c. What is the single most likely dx? a. CXR A 34yo IVDA presents with a 4m hx of productive cough. breathlessness. CT neck e. Emphysema A 32yo man working in a shipyard comes with SOB. Bronchitis b. pain in left side of chest. Pleurisy c. a. The nurses have noticed that he became increasingly drowsy. He has lost 10kgs. Exam: nystagmus on left lateral gaze.1432.

Delusion of grandeur A 20yo student who recently visited Asia came to the OPD with complains of low grade fever. although this is not true when checked. What is the most likely dx? a. Klebsiella c. Viral pneumonia A 35yo man with T1DM is dehydrated with BP=90/50mmHg. 1442.1438. Sometimes he feels as though his actions are being controlled by his radio. Drug induced psychosis c. Hyperthyroidism b. Hyperthyroidism c. Subdural hematoma e. Staphylococcus d. LFT e. Streptococcus A 20yo man complains that all his movements are being watched. He claims to be helping the prime minister with economic policy. Lichen planus . At other times he is aware of voices describing what he is doing. d. Psoriasis d. Hypomania d. Inv: raised ALP and presence of anti-mitochondrial antibodies. Exam: pallor. Mania b. Schizophrenia c. Delusion of control d. night sweats. BUE A 45yo woman presents with pruritis. Korsakoff psychosis A 35yo is agitated and euphoric. Exam: skin pigmentation. HbA1c d. What is the single most likely dx? a. 1441. Inv: CXR=upper lobe cavitation. anorexia and productive cough. ABG b. CBC c. dry cough and anorexia. What is the single most likely causative organism? a. polyuria and nausea and vomiting. Mania b. Inv: CXR=cavitatory lesions in upper lobes. 1439. What is the single most likely dx? a. Scabies e. He also has nocturia. lethargy and itching that is severe after a hot bath. Mycoplasma b. PCP e. Schizophrenia e. Primary biliary cirrhosis A 60yo man complains of tiredness. TB d. Dermatitis herpetiformis b. Klebsiella e. 1440. muscle ache. 1444. 1443. Atopic eczema f. Drug induced personality disorder e. What is the single most likelt causative organism? a. Electrolyte imbalance A 50yo DM pt came to the OPD with complaint of of fever. Mycoplasma c. Legionella b. What is the most probable dx? a. pigmentation and generalized edema. What is the single most appropriate initial inv? a.

What is the single most appropriate option? a. He is found to have proteinuria and hematuria. Uremia A 7yo child presents with lesions on the trunk. Urine microscopy and culture e. Circumflex artery e.1445. Exam: pallor. What is the single most likely dx? a. Herpes simplex b. Herpes zoster . Eczema e. Psoriasis d. 1450. 1451. None of the above A 40yo woman presented with generalized itching and tiredness for few months. Coronary sinus d. ANCA c. Lymphoma e. Left ant descending artery c. 1448. Metaprolol c. CRF A 30yo man complains of vague pain in the loin with BP=140/90mmHg. What is the single most likely causative factor? a. IDA b. Dermatitis herpitiformis d. Right coronary artery Which virus is transmitted by the fecal-oral route? a. Exam: some lesions are weeping and others are crusted with a red base. What is the single most appropriate tx in the acute phase? a. What is the causative organism? a. What is the inv to confirm the dx? a. Dengue d. Dermatitis herpetiformis b. Hep C b. Abdominal US b. Coxsackie virus c. Stool culture A 54yo man comes with sudden onset of palpitations and breathlessness. Eczema f. Acute marginal branch b. Her nails have ridges and her buccal mucosa is lined with a lacy white pattern. c. 1447. Adenosine b. Amiodarone A 29yo woman has developed and itchy scaly rash particularly over her wrist with fine white streaks overlying the lesion. Verapamil d. His HR=164bpm. Scabies e. Rubella virus d. Hyperthyroidism c. Lichen planus The artery that runs in the ant inter-ventricular groove. 1446. 1449. Varicella zoster c. Lichen planus c. ANA d. Urtericaria f. Liver failure d. She gave a hx of heavy menstrual periods.

Drug induced 1454. Uremia e. dysphagia and a sensation of a lump in his throat. Iris 1458. An 87yo woman with a hx of HTN has acute breathlessness. What is the single most appropriate option? a. Ciliary body b. Lymphoma b. Sinus squamous cell ca d. Salbutamol e. MRCP e. XR= fx at distal radius with forward angulations. ERCP b. A 25yo male presents with fever and pain in the right lower thigh of 1m duration. Neb. Sclera c. Nasopharyngeal ca b. 100% oxygen 1453. Fibrosarcoma 1455. Cornea e. Squamous cell laryngeal ca e. A 37yo laborer comes with hx of redness of left eye with foreign body sensation in the same eye. pulse=120bpm. Hypopharyngeal ca 1456. A 42yo female who is obese comes with severe upper abdominal pain and right shoulder tip pain with a temp=37. Conjunctivitis d. hot and tender. US abdomen 1457. Exam: lower third of his thigh is red. The XR showed new bone formation. Ewing’s sarcoma c. Her peripheral O2 sat=85%. IV furosemide c. BP=160/90mmHg and elevated venous pressure.1452. She has 5 children. A 25yo man presented with painless cervical lymphadenopathy with lethargy. Cubitus valgus . night sweats and itching. What is the single most likely causative factor? a. widespread lung crackles. What is the most probable dx? a. What is the single most probable dx? a. An 11yo boy came to the hospital with pain after falling off his bicycle. What is the most probable dx? a. A 76yo man presents with sore throat. Osteosarcomoa b. She has a RR=32bpm. What is the single most likely dx? a. IDA d. Nitrate infusion d. Dinner fork deformity b. Tuberculus arthritis d. Pharyngeal ca c. What is the single most appropriate initial management? a. Polycythemia c. Exotosis e. IV antibiotics b. Serum amylase d.8C. LFT c. He has a 20y hx of smoking. local irritation by hot food.

Latex d. Genu valgus A middle aged man with a lump in front of his neck which moves up while he’s swallowing. ALL b. Polycythemia d. Dinner fork deformity b. He also complains of vomiting and headache. Silica A 62yo man presents with left sided hearing loss and tinnitus. 1460. What is the single most likely cause? a. Garden spade deformity A 25yo male had an injury to the knee while playing football. What is the most probable dx? a. Garden spade deformity e. Scabies e. And spread to the sternocleidomastoid and adjacent muscles. What is the single most likely dx? a. 1463. night sweats and weight loss. Aniline b. Thyroid cyst e. c. Genu valgus A 50yo man presents with itching after hot shower with dizziness. 1464. He wants to know what dye has caused it. Asbestos c. US shows a mass replacing the left lobe of thyroid. Gibbus c. Eczema A man presented with carcinoma of the bladder and has been working in factories. What is the most probable dx? . Exam: splenomegaly. What is the single most probable deformity? a. XR=condylar fx of tibia. Larynx ca A 28yo male complains of severe pain while trying to grasp any object. Bronchus ca d. 1465. Pharyngeal pouch c. Gun stock deformity d. 1462. 1461. Exam: rupture of the ulnar collateral ligament of MCP joint of the thumb. Nasopharyngeal ca c. Cubitus valgus d. It started since he participated in skiing and had a fall and caught his thumb in the matting. chest pain after exercise. Gun stock deformity e. Acoustic neuroma d. Meniere’s disease A HIV +ve 55yo man presents with painless lymphadenopathy. Meningioma b. What is the single most likely causative factor? a. Thyroid ca b. Dinner fork deformity b. Exam: papilledema and SNHL in the left ear. Garden spade deformity e. Lymphoma c. What is the single most probable deformity? a. Pharyngeal ca e. fever. Game keeper thumb c. Mallet finger d.1459.

Mefloquine c. He is distractible. confused and overactive. What is the single most suitable med to treat his symptom? a. MRI brain d. Psychosis e. Diazepam b. Quinine e. bulging eyes. Fluoxetine d. a. chest pain. Acute confusional state A pt presents with a lid lag. What is the most likely dx? a. 1468. The pt is distressed by this becoming low in mood and anxious and has not left the house for 2wks. Hodgkin’s lymphoma b. PET brain A 29yo woman who returned from Egypt 2wks ago now presents with difficulty in breathing. What is the next most appropriate inv to do? a. Eye sight c. Blood film: ring form of plasmodium with schuffners dots in RBCs. Mania c. Disulfiram c. What is the drug to eradicate this infection? a. Pneumonia . Acoustic analysis shows SNHL. opthalmoplegia and thyroid bruit. Tensilon test d. He is starting to drink increasing quantities of alcohol. Artesunate A 50yo man presents with flight of ideas which are rambling and disinhibited. What is the most likely dx? a. ALL d. TFT b. Doxycycline b. CT acoustic canal c.1466. Schizophrenia d. 1470. CML A 22yo man says that he can hear the voice of his deceased uncle telling him that he is being spied on. Proguanil d. He is noticed to have thought-block and passivity phenomena. CT brain b. Pulmonary embolism b. Dementia b. FNAC A 30yo lady complaining of right ear deafness with decreased corneal reflex and past pointing. Olanzapine A middle age Asian presents with episodes of fever with rigors and chills for last 1yr. NHL c. US e. 1471. AML e. cough and purulent sputum with an episode of blood staining. Lithium e. MRI acoustic canal e. She is on COCPs. 1467. What inv will you do? a. 1469.

Tramadol b. Lung abscess d. Thyroid storm b. Furosemide e. Tracheomalacia A 40yo woman has had varicose vein surgery. she is distressed by repeated retching and vomiting. 1473. PO ondansetron A pt with renal failure has serum K+=7. What is the most probable dx? a. IM morphine d. HONK b. Tx was given but she became confused and again presented with above said symptoms. Pulmonary edema A 60yo pt recovering from a surgery for toxic goiter is found to be hypotensive. What is the most appropriate inv? a. IV ondansetron e. PIH e. Sotalol An 18yo lady in her 30th wk of pregnanct is brough to the hosp in an altered sensorium.5. shallow breaths and her breath has a fruity smell.1472. cyanosed in the recovery room. Drug toxicity d. Her pain is currently well controlled. raised creatinine and broad complex tachycardia. DKA c. 1476. Stool C&S b. His stools have been mucoid and sometimes blood stained. Gastroscopy c. Co-codamol c. Secondary hemorrhage d. She is taking slow. Reactionary hemorrhage c. Barium meal e. Alveolar damage due to drugs c. Sodium bicarbonate c. planned as a day pt. What is the best management strategy? a. What is the most appropriate management? a. 1477. Calcium gluconate b. urine ketones: +ve. Dialysis d. GDM A 26yo man presented with abdomen distension and pain.20. HELLP syndrome d. Pneumothorax . 1475. Jejunal biopsy An 83yo elderly woman presented in the ED with cough. After the op. Aspiration due to confusion b. c. An ABG: pH=7. Exam: neck is tense. What is the cause of her condition? a. What is the most probable dx? a. Primary hemorrhage e. Pneumothorax e. IgG tissue transglutaminase d. There is oozing of blood from the drain. 1474. fever and sne ezing.

What is the dx? a. Which of the following is the most likely dx? a. rigor and seizures. Hydrogen breath test b. Gastroscopy c. A 35yo woman who usually has 4 days mid-cycle bleeding. Check airway c. Her smear was normal 6m ago. None 1481. Malaria c. What would you do? a. Laparotomy h. Transvaginal US b. Cervical smear e. He came with cough and also complains of arthralgia. What is the single most likely cause? a. What inv should be undertaken? a. ITP f. Hep C . Recovery position 1485. A young lady with cervical ectropion bleeds on touch. Hemophilia d. She has now presented with spots of blood. Colposcopy 1480. A pregnant woman returns from Sudan. bleeding time=normal. A 7yo boy presents with epistaxis of 2h duration. Meningitis d. What is the single best initial inv? a. Serum estradiol e. Von willebrand disease e. A 28yo man with recent onset of dyspepsia after eating spicy food and alcohol consumption. CD b. TB 1479. A man was bitten by a drug addict and comes to the hosp with a wound.1478. A pt is unresponsive and cyanosed. Exam: bilateral hilar lymphadenopathy and erythema nodosum is present. US guided biopsy g. Exam: cervical ectropion which doesn’t bleed on touch. Cervical smear c. Vit K deficiency b. Streptococcal infection e. now presenting with intermittent fever. Punch biopsy c. Chest compressions b. H. Lyme disease 1484. Serum estradiol d. PT=13. Punch biopsy d. Sarcoidosis d. APTT=42. Endocervical swab f. Inv: Plts=210. The bleeding has been controlled. Transvaginal US b. Liver disease c. What is the most appropriate next inv? a. A 37yo man presents with some raised lesions on the shin. TB b. Anatomical defect 1483. What is the most definitive 1 st step in management? a. Call 999 d. Colposcopy 1482. Mouth to mouth e. He returns after 1m with similar symptoms despite being given omeprazole 40mg. had her period 10d ago. UC c. Barium meal d. pylori fecal antigen was negative.

Hepatorenal syndrome e. 1489. b. Cholesterol emboli b. 1488. Spinal cord compression e. bleeding gums and jaundice. She often has central chest pain and she regurgitates undigested food most of the time but doesn’t suffer from acid reflus. Alice in wonderland syndrome d. Pharyngeal pouch . Salmetrol b. 1490. CXR: air-fluid level behind a normal sized heart. minimal knee and absent ankle tendon reflexes. What is the single most likely dx? a. She has been started on dexamethasone 16mg daily. IFN e.5m which affects her daily food intake.What is the single most likely cause of her weakness? a. Bisphosphonates b. She has weakness of her legs. There is reduced sensation in the perineum. and tenderness over the 2nd lumbar vertebra. Labs: deranged renal function tests. ESR=70mm/hr. fragmented RBCs and low plts. 1491. Steroid induced myopathy A 78yo woman presents with unilateral headache and pain on chewing. What is the most appropriate management? a. Hep A An 18yo woman says that she can’t walk around as she is very big for that room. Syphilis e. What is the most likely hallucination? a. IV salbutamol A 73yo woman with skeletal and brain mets from breast ca has worsening low back pain and blurring of vision. Progression of brain tumor c. Extracampine visual hallucinations b. ACEi d. These symptoms have been present for the last 3. a palpable bladder. TTP d. Prednisolone d. HRT c. a power of 2/5 at the hip. Montelukast c. Lyme disease c. PID at L2/L3 d. HUS c. normal PT/APTT. Sepsis A child came to the ED with severe asthma and not responding to salbutamol nebulizer and vomiting many times. Liliputian visual hallucinations c. 3/5 at the knee and ankle. What is the appropriate additional therapy? a. Paraneoplastic neuropathy b. altered sensorium. Hep B d. Hypnagogic hallucinations A middle aged lady presented with fever. IV steroids A 48yo woman is admitted to the ED with a productive cough and mod fever. 1487. Budesonide inhaler e.1486. What’s the most likely dx? a. Oxygen f. She is on oral steroids.

Anti-epileptic A 23yo woman presents with offensive vaginal discharge. Truss b. Chemotherapy d. Diclofenac sodium b. PCOS d.5. None A young woman who is a marathon runner comes with secondary amenorrhea. Ibuprofen c. Prolactinoma e. She had a long 1st stage and troublesome 2nd stage. K+=2. Anorexia A 4yo child comes with a sprain in his foot. K+=3. Inv: normal LH. K+=5.5mmol/L d. Codeine A 34yo pregnant woman. Urgent herniorrhaphy d. She presents with an irreducible herniation over the incision region of a surgery which she underwent in her childhood. What is the most appropriate analgesic? a.1492. Bulbar palsy d. Elective herniotomy e. Diuretic An 88yo woman is a known smoker. TB A retired ship worker has pleural effusion and pleural thickening on right side with bilateral lung shadowing. Reassure A 72yo woman who is taking loop diuretics for left ventricular failure. What is the most likely organism? . What is the most appropriate tx? a. What is the most likely dx? a. b. Diazepam IV c. FSH and estradiol. Na+=130mmol/L. Pregnancy c. 1494. MgSO4 IV b. Hx reveals that the child has had recurrent admissions to the hosp due to severe asthma. Na+=150mmol/L. 38wk GA is in labor. 1496. 1497. Na+=130mmol/L. K+=4. She now is suffering from palpitations and muscle weakness. Aspiration b. Chest drain c.5mmol/L e. 1498. After her placenta was delivered she had a convulsion. Hiatus hernia c. Elective herniorrhaphy c. has delivered a baby. IV fluid d. What is the electrolyte imbalance found? a. 1493. Paracetamol d. Achalasia e. What would you do to improve his symptoms? a. Vaginal pH=4. She had an attack of MI 2y back and is known to have peripheral vascular disease. Hydralazine IV e. Na+=140mmol/L. Hypothalamic amenorrhea b. What is the most probable management? a.5mmol/L c. prolactin=600. 1495.5mmol/L b.

5 c. pH increased. vomiting. K+=6. Romberg’s test c. Na+=13. Surgery A pt came to the hosp with a complaint of severe chest pain lasting for >1h. 1502. Diverticulitis e.1499. Na+=130. Na+=140. K+=2. Pressure over base of the nose b. Trendelenburg test d. Flexible aigmoidoscopy: normal rectal mucosa and hard feces. pH increased. What is the most likely ABG derangement? a. On being asked to protude his tongue. Rectal exam: purple. Following ECG test. Trigeminal nerve e. Which anatomical site is most likely to be affected? a. PCO2 increased c. Candida d. GTN . Heel-shin test A 23yo man is having difficulty in speaking following a stab wound to the right of his neck. PCO2 decreased d. K+=6. abdominal pain and postural hypotension. Mycoplasma A 62yo man has had ano-rectal pain aggravated by defecation for 3d. K+=1. K+=8 e. Hypoglossal nerve c.0 d. What is the best management strategy? a. What electrolyte abnormality is likely to occur? a. Rectal ca d. Anal hematoma b. Gardenella b. 1504. pH decreased. Nasal packing e. Facial nerve b. pt revealed to have ST depression. Angiodysplasia A 43yo presents with severe vertigo on moving sidewards whilst sleeping. He was already on aspirin. Anal fissure c. What test would you do to confirm the dx? a. Trichomonas c. Pressure over the soft tissues d.5 A 10yo boy develops nasal bleeding. Hallpikes maneovure b. Glossopharyngeal nerve A girl presents with signs of hyperventilation. tender lump at the anal verge. the tip deviated to the right. Na+=130. Vagus nerve d. Na+=130. pH decreased. What is the most specific tx for this pt? a. a. PCO2 increased b. 1501. PCO2 decreased A pt presents with skin pigmentation. Ice packs c. 1505. 1503. What is the best way to stop the bleeding from the nose? a.5 b. 1500. diarrhea.

What is the best possible management for this pt? a. There are no visual field defects. Extradural hematoma b.1506. swallowing and sensation are normal. Right vertebral artery atheroembolic stroke A 34yo man has an intermittent epigastric pain for 3wks. 1509. Meningitis c. pulse=100 and regular heart sounds. Carcinoma of the salivary glands c. SAH A 27yo man presents to the ED with 2d hx of severe headache and pyrexia (38. What is the most likely cause of this pt’s symptoms? a. Parotid duct stones A 74yo man has been admitted unconscious with no hx. Speech. Barium meal c. Simvastatin c. There is a mild facial weakness sparing the forehead. CT: petechial hemorrhage in the temporal and inf frontal lobes. Mikulicz’s disease d. Cardioembolic stroke b. Clopidogrel d. LOC. Choose the most probable dx? a. no carotid bruit. C13 urea breath test e. COCP b. He has a GCS=6 and a dilated left puil which becomes insensitive to light. Exam: BP=180/90mmHg. Reflexes and tone are normal. Higher mental function tests are normal. Brain abscess . What is the most appropriate next inv? a. visual. Pleomorphic adenoma b. 1507. Right internal carotid artery dissection e. She is known to be hypertensive. speech or sensory symptoms. What is the single most likely dx? a. Adenoid cystic carcinoma e. No apraxia or neglect.9C).Pylori antibodies d. UAE e. Upper GI endoscopy A girl with sickle cell anemia has painful bleeding and vaso-occlusive crisis during her periods. There has been no headache. He had a similar episode 3yrs ago and his doctor gave him a course of 3 types of tablets at the time. Tranexamic acid c. Exam: gland is soft and cystic. Serum H. Lacunar stroke c. 1510. 1508. LMWH A 69yo woman presents with a sudden onset of weakness of her right arm and leg. b. Opioid OD d. What is the most likely dx? a. There is a right extensor plantar response. BB e. Copper IUS d. Abdomen US b. The right arm and leg are flaccid and weak. Depot provera A 70yo pt comes with swelling in the parotid region for the last 10y. 1511. It is worse by food but helped by some tablets he obtained from the pharmacy. Right internal carotid artery atheroembolic stroke d. Pontine hemorrhage e.

Thalassemia d. GCS=4 and dilated left pupil. He has hypertension and takes warfarin for prosthetic heart valve. Vascular dementia A 38yo woman with hemophilia who received several blood transfusions a few years ago presents with irritability and increasing memory deficit. What’s the single most likely dx? a. Creutzfeldt Jacob disease b. Post circulation stroke c. She has right-handed involuntary writhing movement. 1514. HIV associated dementia e. Congenital storage disorder A 71yo man with no prv immediate hx is brought to the ED by his wife who says he has become progressively more forgetful. Space occupying lesion An 18yo girl has menorrhagia and dysmenorrhea and requires contraception. 1516. Pic’s dementia b. What drug will you give her? a.5kg is thriving well but is deeply jaundiced. Galactosemia b. Mirena coil c. Drug toxicity c. b. COCP b. What is the single most likely dx? a. Fronto-temporal dementia c. Huntington’s disease d. HIV associated dementia e. Breast milk jaundice c. Copper T d. New variant CID A 44yo woman with memory loss. There is no hx of infectious disease or trauma. What is the single most likely dx? a. Huntington’s disease d. Alzheimer’s disease e. Meningococcal meningitis c. Fronto-temporal dementia A 54yo man has collapsed suddenly following a headache. Intracerebral hemorrhage d. Wilson’s disease c. UAE . What is the single most likely dx? a. He is on anti-TB tx.1512. She is unable to speak properly. 1515. Pontine hemorrhage A 5wk breast fed baby whose birth weight was 3.5kg and is now 4. Herpes simplex encephalitis e. Sickle cell disease e. Pic’s dementia b. 1513. Cerebral malaria d. Vascular dementia d. 1517. poor concentration and inability to recognize household projects. tends to lose his temper and is emotionally liable. What is the most likely dx? a. There is strong fam hx of similar complain. Ant circulation stroke b. Intracerebellar hemorrhage e.

3d post-op. A 4yo child presents with repeated chest infections. Calcium chloride IV b. Plasma Na+ increase and urine osmolarity increase 1522. Calcium gluconate IV c. A 63yo male undergoes abdominal surgery. He was inv and other testis was located in the abdomen.e. repeat samples confirm serum K+=7.1mmol/l. Depo provera 1518. On Monday morning. A newborn that is electively intubated at birth and is due for surgery 48h after birth. Mid cerebral artery c. She is dysphasic. Plasma Na+ decrease and urine osmolarity decrease c. Jejunal biopsy e. IV testosterone . Orchidectomy c. MRI e. Internal carotid artery e. Reassurance e. An 82yo woman has been admitted from a nursing home with dense hemiplegia and homonymous hemianopia. What vessel is most likely to be involved? a. Ant cerebral artery b. He has yellow discoloration of sclera and the mother gives a hx of diarrhea as well. Orchidopexy d. Insulin subcutaneously d. A 25yo man attended in urological OPD has single testis. CF b. What is the best management plan for this pt? a. Which is the best inv for this pt? a. Post cerebral artery d. What is the most likely dx? a. What is the single inv most likely to lead to a dx? a. Blood culture 1519. RDS e. Choose the appropriate biochemical change. Which one of the following can be used as an effective tx for this pt’s hyperkalemia? a. The condition was suspected on antenatal US on CXR. US d. Short trial of HCG b. Plasma Na+ decrease and urine osmolarity increase b. Post inf cerebellar artery 1521. CT c. Furosemide IV 1524. His ECG shows broad QRS complexes. XR b. LFT d. Anti-endomysial antiboides c. Alpha 1 antitrypsin deficiency 1523. A pt is dx with SIADH. TFT 1520. a. A pt of tuberculous abscess with the hx of prv abscess drainage presented with fever and tenderness between L2/L3 vertebra. Sweat chloride test b. Congenital cystic adenomatoid malformation d. Plasma Na+ increase and urine osmolarity decrease d. Congenital diaphragmatic hernia c.

IV fluids c. CBC c. Reassurance b. What structure will be pierced? a. Insulin b. What is the most probable dx? a. The ECG of an 80yo pt of IHD shows sawtooth like waves. Stop dexamethasone d. A-fib b. Conjoint tendon d. Stop sodium valproate and change to another anti-epileptic 1526. A-flutter c. Which drug should be prescribed? a. External and internal oblique muscles e. A man brings his wife into the ED after finding her unconscious at home. Linea alba b. What is the single most appropriate immediate tx? a. Rectus muscle c. XR c. CT brain d. SVT d. Mobitz type 1 2nd degree heart block e. In a laparoscopic mesh repair for hernia. The newborn is of mixed race and was delivered normally. when the trochar is inserted at midpoint between umbilicus and ischial spine. Lifestyle modifications 1531. Biguanides b. A mother brings her newborn to the hosp concerned about a blue patch on the buttocks. A 56yo male who presented with epilepsy like symptoms has been dx with an intracranial space occupying lesion. A 68yo lady with T2DM. SVT d. What is the most appropriate management? a. He says at breakfast time she had complained of sudden severe headache. He now complains of thirst and mild dehydration. Carotid Doppler 1530.1525. Sinus tachycardia 1528. The ECG of a 65yo shows absent P waves. MRI b. Sinus tachycardia 1529. Plt count 1527. Sulphonyl urea c. His blood glucose is also increased. narrow QRS complex. Insulin d. Inguinal ligament . What is the most appropriate inv? a. ventricular rate of 150bpm and regular R-R interval. A-fib b. XR d. Mobitz type 1 2nd degree heart block e. QRS complex of 80ms. A-flutter c. ventricular rate of 120bpm and irregular R-R interval. What is the most probable dx? a.

CEA e. DM retinopathy b. Renal biopsy: amorphous homogenous substance that stained red with congo-red. weakness and numbness of hands and swollen feet. Urine: proteinuria. CT head d. CA 199 d. Fasting serum glucose conc d. A 60yo DM pt presented with easy fatigability. Mirena coil c. Depo provera 1538. Amyloidosis e. MRI head c. Wilms tumor d. influenza b. Colles fx b. What is the most appropriate inv? a. UAE e. An obese woman with hx of migraine presented with heavy bleeding during menstruation which is painful and needs contraception too. TFT e. XR=no fx. A 48yo man has intermittent left sided lower abdominal pain and feels generally unwell. Which organism is responsible for this pneumonia? a. Temp=38. frequency and nocturia. Rectal exam: large hard prostate. A 75yo man has urinary symptoms of hesitancy. Endomysial antibodies c. Exam: pedal edema. His GCS=10. CA 153 c. What is the single most likely dx? a. Copper T d. Glycogen storage disease 1535. A 2yo fell on outstretched hand on playground. pneumonia e. Klebsiella c. sensory neuropathy and palpable liver and spleen.3C and he has BP=190/100mmHg. What is the best possible management for this pt? a. US abdomen: enlarged kidney. What is the single inv most likely to lead to dx”? a. COCP b. Head of radius . S. PSA 1536. US abdomen 1533. Capillary blood sugar b. A child suffering from CF developed pneumonia. He has lost his appetite and has lost weight.1532. S. H. He presents ith pain on base of the thumb. A man with DM comes to the ED after he collapsed at home. What should be the next initial inv for this man? a. Pseudomonas 1537. Serum electrolytes 1534. What is the dx? a. CA 125 b. Colonoscopy b. aureus d. Sarcoidosis c.

1539.

1540.

1541.

1542.

1543.

1544.

c. Mellet finger
d. Scaphoid fx
e. No fx
A pt was admitted with increased frequency of passing urine, increased thirst, weakness and
muscle cramps. What is the most probable dx?
a. Conn’s syndrome
b. Cushing’s syndrome
c. Pheochromocytoma
d. Hyperthyroidism
e. Hypoparathyroidism
A 69yo male presented with sudden onset of dysphagia. He is neither able to swallow liquid no r
solid, he recently had a denture fitting. What is the most probable dx?
a. Foreign body
b. Plummer vinson syndrome
c. Achalasia cardia
d. Esophageal rupture
e. Esophageal ca
A 62yo man with chronic schizophrenia presents with a mask like face and involuntary pill rolling
movement in both hands. He complains of chronic cough and forgetfulness. He is on long term
antipsychotic meds. What is the single most likely dx?
a. Shy drager syndrome
b. Parkinsonism
c. Huntington’s chorea
d. Tardive dyskinesia
e. Akathisia
A 34yo female presented with vomiting preceded by an occipital headache of acute onset. Exam:
conscious and alert with photophobia but no neck stiffness. CT: normal. What is the most
appropriate further management?
a. CT brain with contrast
b. Repeat CT brain in 24h
c. CSF exam
d. Cerebral angio
e. MRI brain
A lady with post ileo-colectomy closure of stoma has a small 4cm swelling around the stoma.
What is the most appropriate management of the swelling?
a. Local exploration of swelling
b. Exploratory laparotomy
c. Open laparotomy and re-closure
d. Abdominal binder
e. Truss
f. Laparotomy with mesh repair
A 64yo woman has been brought by her son for psychiatric evaluation. She says that she has
stopped living with her husband because she is convinced it is someone else posing to be him.
What kind of delusions is she suffering from?
a. Delusion of reference
b. Delusion of control
c. Delusion of guilt
d. Delusion of persecution

e. Delusion of doubles
1545. A 19yo man with known hx of OM presents with headache, lethargy, sweating and shivering.
What is the single most likely dx?
a. Furuncle
b. Meningitis
c. Myringitis
d. Nasopharyngeal tumor
e. OM
1546. A 46yo woman has gained weight. She has sensitivity to cold. Her pulse = regular at 50bpm and
heart=enlarged. What is the single most likely underlying mechanism for this condition
a. Autoimmune
b. Degenerative
c. Congenital
d. Infective
e. Nutritional
1547. A 70yo man presents with a punched out ulcer between his toes. He is a heavy drinker and
smoker. Exam: ulcer is yellow and the foot turns red when dangling off the bed. What is the
single most likely dx?
a. Arterial ischemia ulcer
b. Malignancy
c. Neuropathic ulcer
d. Pressure ulcer
e. Venous stasis ulcer
1548. A 65yo woman complains of a painful discharging ulcer above her ankle on the inner side of her
left lower leg. Exam: the base of the ulcer is red and covered by a yellow fibrous tissue. The
border is irregular. The skin is tight. What is the single most likely dx?
a. Arterial ischemia ulcer
b. Malignancy
c. Neuropathic ulcer
d. Pressure ulcer
e. Venous stasis ulcer
1549. A 55yo woman suffered from an acute MI 5d ago. While she was in the hosp the pt developed
features of pulmonary edema and heart failure. What is the most probable cause of her present
condition?
a. VSD
b. Ruptured papillary muscle
c. Pericarditis
d. A-fib
e. Re-infarction
1550. A 76yo woman presents with deep stroke 6h ago. What would the immediate tx be?
a. Aspirin 75mg
b. Aspirin 300mg
c. Streptokinase
d. IV heparin
e. Dipyridamole 200mg
1551. A 19yo man accuses his friend of making his right arm swing out at a stranger. What is the best
term to describe his condition?
a. Control

1552.

1553.

1554.

1555.

1556.

1557.

b. Persecution
c. Guilt
d. Reference
e. Grandeur
A 26yo man with hx of hereditary hemorrhagic telengectasia is planning to start a family. What
is the mode of inheritance?
a. AD with incomplete penetrance
b. Autosomal co-dominant
c. AR with incomplete penetrance
d. AD
e. AR
A 50yo man with a known hx of stroke is unable to get out of his house because he can’t find
where the door is. He refuses help from his wife and says he is not blind. What is the single most
likely defect?
a. Paracentral scotoma
b. Tunnel vision
c. Total blindness
d. Central scotoma
e. Cortical blindness
An elderly lady presents with confusion. She is apyrexial but complains of dysuria for 2d
duration. What is the def dx inv?
a. Blood culture
b. Urine nitrates
c. CT head
d. ECG
e. IVU
A 40yo woman on chemotherapy for metastatic breast carcinoma now presents with painful
swallowing. Exam: she has white plaques on top of friable mucosa in her mouth and more seen
on esophagoscopy. What is the most effective tx for this pt?
a. Antispasmodic
b. H2 blocker
c. Antibiotics
d. Antifungals
e. I&D
A 43yo woman has suffered with heavy periods for many years and has tried many medical tx
without success. She is constantly flooding and at times can’t leave her house due to heavy
bleeding. She has completed her family of 5 children and her last blood te st showed
Hgb=8.9g/dl. She feels that she can’t cope with the bleeding anymore and her husband is asking
for a tx that can guarantee success. What is the most appropriate management to improve
menorrhagia in this pt?
a. Endometrial ablation
b. Hysterectomy
c. Hysteroscopic/Laser resection of fibroids
d. Myomectomy
e. UAE
A man on antipsychotic meds develops features of retinitis pigmentosa. Which drug is most
likely to cause these symptoms?
a. Thioridazine

1558.

1559.

1560.

1561.

1562.

1563.

1564.

b. Haloperidol
c. Chlorpromazine
d. Risperidone
Pt with low Hgb, MCV=76, angular stomatitis, red tongue, and koilonichea. What is the most
probable dx?
a. Folate def
b. B12 def
c. Iron def
d. Vit E def
e. Hemolytic anemia
A pt with sudden severe eye pain, red eye, visual blurring, acuity of only finger counting, nausea,
vomiting with a shallow ant chamber that is hazy on shining a torch. What is the dx?
a. CRVO
b. Acute closed angle glaucoma
c. Uveitis
d. Iritis
e. Open angle glaucoma
A pt who works in a pet shop has temp=37.5C, dyspnea, chest pain and cough. CXR: patchy
consolidation. What is the most suitable tx?
a. Amoxicillin
b. Tetracyclin
c. Erythromycin
d. Clarithromycin
e. Penicillin
A 50yo man complains of dysphagia after eating bread. Barium swallow reveals a lower
esophageal ring. What is the most appropriate tx?
a. Reassurance
b. Antispasmodics
c. Dilatation of the LES
d. Endoscopic diverticulectomy
e. I&D
A 48yo nulliparous woman feels tired all the time. Her periods are regular but have always
lasted for at least 10d. Choose the single most appropriate intial inv?
a. High vaginal swab
b. Serum Hgb conc
c. TFT
d. None
e. Abdominal US
A man got his hand caught in machinery at work. The fingers are swollen but the XR shows no fx.
What is the most appropriate management?
a. Splint
b. Put in plaster
c. Broad arm sling for 1wk
d. Elevate in high sling for 2d
e. Neighbor strapping
A 39yo woman presents with symptoms recurring annually characterized by depressed moob,
being socially withdrawn hypersomnia, lack of enjoyment in life, last for several months. What is
the most likely dx?

1565.

1566.

1567.

1568.

1569.

1570.

a. Seasonal Affective Disorder
b. Mod depression
c. Dysthymia
d. GAD
e. Bipolar disorder
A 75yo man presents with ARF. He has been troubled by recurrent epistaxis but over the last
3wks he reports to have coughed up blood too. What is the single most likely positive antibody?
a. P ANCA
b. C ANCA
c. Anti Ro
d. Anti DS DNA
e. Anti centromere
A woman is admitted to the hosp for elective abdominal hysterectomy. 2m ago she was dx with
DVT and pulmonary embolism and was started on warfarin. What is the most appropriate pre op measure you will take on this occasion?
a. Continue warfarin
b. Stop warfarin
c. Stop warfarin and start heparin
d. Increase warfarin dose
e. Add heparin
This condition affects middle aged women more than men and is characterized by low mood,
early morning waking, loss of libido, tiredness and suicidal intention last for at least 2wks. What
is the most probable dx?
a. Bipolar affective disorder
b. Dysthymia
c. Major depressive disorder
d. Schizoaffective disorder
e. Recurrent brief depression
A 10yo boy has fallen from a tree and injured his right chest. He has pain and difficulty breathing.
He is tachypenic and tender with an area of paradoxical chest wall movement on the right side.
What is the single most likely dx?
a. Diaphragmatic rupture
b. Flail chest
c. Fx ribs
d. Hemothorax
e. Tension pneumothorax
A 37yo woman had an elective LSCS 1d ago. You are called to see her as she becomes SOB with
left sided chest pain and a cough. She has had 3 children, 2 born by LSCS. Exam: she has reduced
air entry at left lung base. Her observations include sat=92% on ai r, BP=105/84mmHg,
pulse=120bpm, temp=37.2C. Choose among the options which C-section complications has she
developed?
a. Aspiration pneumonia
b. Aspiration pneumonitis
c. Spontaneous pneumothorax
d. Pulmonary embolism
e. DVT
A pt presents with increasing retrosternal pain and dysphagia for both solids and liquids over
18m but denies weight loss. Chest is clear. What is the most likely dx?

Buerger’s disease d. What is the most probable dx? a. She has BP=80/50mmHg. Ca larynx b. a. 1576. Auscultation of chest=bowel sounds present. Femoral hernia d. Femoral aneurysm A 30yo woman has injured her left lower chest in a RTA. Kawasaki disease b. Fx ribs d. Strangulated hernia c.1571. Saphena varix A 52yo woman has had a swelling in the neck. 1574. Tension pneumothorax A 23yo female presents with paresthesias and loss of distal pulses in her arms. Observation: HR=88bpm. What is the most probable dx? a. Exam: mass found just below and lateral to the pubic tubercle. Takayasu arteritis c. What is the single most likely dx? a. hoarseness and stridor-both inspiratory and expiratory for 2m. Esophageal stricture A 70yo man presents with a fluctuant swelling of the scrotum which feels like worms when he is standing but regresses when he lies down. 1573. Pulmonary embolism e. There is no cough impulse and it is irreducible. Hematocele c. Ruptured esophagus . Varicocele b. Saphenavarix e. BP=112/76mmHg. Ca thyroid c. Epidydimal cyst e. Thyrotoxicosis A woman became acutely SOB in the recovery bay and is coughing after GA.8C and sat=91% in air. What is the most probable dx? a. Choose among the options which C-section complication has she developed? a. Spontaneous pneumothorax c. Raynaud’s phenomenon A 35yo woman presents with mass in the groin. She is noted to be hypertensive. temp=37. Achalasia b. Aspiration pneumonitis b. Embolism e. pulse=120bpm. Diaphragmatic rupture b. Auscultation: reduced air entry at the right lung base and diffuse wheeze. Flail chest c. Esophageal spasm d. Ca bronchus e. Endometritis d. Vocal chord nodules d. What is the most probable dx? a. Pharyngeal carcinoma c. Testicular ca d. 1575. Direct inguinal hernia b. 1572. She describes feeling unwell a month prior with fever and night sweats.

Complicated femoral hernia 1579. Inguinal hernia b. A 32yo woman of 38wks GA attends the antenatal day unit with pain in the suprapubic area that radiates to the upper thighs and perineum. Femoral hernia d. A lady presents with a swelling below the groin crease that can be reduced. Strangulated hernia c. Saphenous vein varicocoele d. Truss b. It is worse on walking. Symphasis pubis dysfunction d. Labor e. A 25yo man present with a mass in the groin after heavy lifting. The swelling has increased in size gradually over the last two years and the patient feels she has difficulty with breathing. Elective herniotomy e. On applying pressure on the internal ring. impulse on coughing is present. Exam: mass measures 8cm by 10 cm. Oral thyroxine c. Oral propylthiouracil d. A 46yo laborer reports swelling in the right groin. Femoral hernia c. cough impulse is still present. soft and not warm to touch. A 35yo woman presents with a swelling in the neck. What is the most probable dx? a. Epidydimal cyst e. Femoral aneurysm 1581. Tension pneumothorax 1577. Indirect inguinal hernia c. Reassure 1580. Her urine dipstick showed a trace of protein but no white cells. Direct inguinal hernia b. Exam: non-tender irreducible 4 cm mass in the right groin below and on the medial side of the inguinal ligament. It moves with deglutition. Braxton hicks contractions b. Hydrocoele . Which is the most appropriate management of this mass? a. otherwise he’s normal. Exam: mass is found just above and medial to the pubic tubercle. Elective herniorrhaphy c. There is no med hx of note. Indirect inguinal hernia b.e. What’s the most likely dx? a. Urgent herniorrhaphy d. What is the best management strategy? a. Round ligament stretching c. Partial thyroidectomy b. He has mild dragging pain in the abdomen. Which is the most likely dx in this pt? a. A 45yo mechanic presents with a reducible swelling in the groin. Testicular tumor d. Excision biopsy 1582. Femoral hernia 1578. It is reducible. The non-painful swelling is observable in both the erect and the recumbent positions. What is the most likely dx? a. Strangulated hernia e. nitrates or blood.

There is no mass or tenderness in the epigastrium. Which is next appropriate step in management? a. A 42yo woman reports to the surgeon that she is worried about a lump that she feels the right breast. Clinical exam: shows a frail woman with mild conjuctival palor. Which is th e most appropriate inv for the cause of the patient’s pain? a. Lateral popliteal b. There is no jaundice but there is marked tenderness in the epigastrium both on deep and superficial palpations. he is unable to either dorsiflex or evert the foot. The liver is palpable for 3 cm below the costal margin and not tender. Peroneal c. Gall bladder cancer d. She was informed of the presence of gallstones in her gall bladder four weeks earlier when she reported pain in the right hypochondrium. There is no axillary lymph node enlargement. The surgeon observes a 2 cm by 3 cm mass in the right lower quadrant of the breast. A camel rider sustained a kick to the lateral side of his right leg just below the knee caused by the camel stick. She has vomited twice since the onset of attack.1583. The patient is not jaundiced. Gastric cancer c. CT scan of the abdomen d. BP=90/60mmHg. rapid infusion of intravenous normal saline while he requests for haemoglobin level and whole blood for transfusion. Clinical exam: the radial pulse=120/min. The pain is made worse by lying flat on her back and she is more comfo rtable sitting up and bending forwards. Which is the most likely dx? a. There is loss of sensation over the front and outer half of the leg and dorsum of the foot. Serum Amylase c. The site is slightly bruised and tender to touch. Serum bilirubin d. She has lost 5 kgs in weight over the last one month. Exploratory laparotomy c. Upper gastrointestinal endoscopy 1587. There are no associated skin changes and the mass has limited mobility. Barium Swallow b. A 46yo woman presents with sudden episode of abdominal pain which started about 2h ago. which is the most likely nerve affected? a. Barium Swallow 1585. A 45yo man. Plain abdominal X-ray b. He estimated the volume blood vomited at each bout to be more than 500mls. Which is the most appropriate next step in the management of this pt? . If these observations are the result of damage to a nerve bundle. Oesophageal cancer 1586. The oral temp=39C. presents in the ED and reports two episodes of vomiting fresh bright red blood in the previous 6h. BP=120/80mmHg and the radial pulse=118/min. Colon cancer b. Examination of the left breast and axilla was completely normal. There is no discharge from the nipple. known to be chronically addicted to alcohol. Exam: non-tender slightly mobile mass in the epigastric region. A mammogram report suggests the presence of microcalcifications. During physical examination. A 75yo Japanese woman reports repeated episodes of vomiting of undigested food mixed with blood. The physician resuscitates the patient with oxygen by face mask. Sural 1584. The pain is located in the epigastrium and radiates to her back. Tibia d.

Presence of pain b. Kawasaki disease b. septic-looking child with drooling of saliva and stridor. Which of the following features suggests that the mass might be malignant? a. Which is the most likely dx? a. The mass was first obse rved three months ago but has recently become visibly larger. runny nose and conjunctivitis. Herpes zoster d. 10m female child presents to your clinic with a 1-day history of high fever. Measles A 3d term. She also notices jaundice. He has larger calves than other boys but he runs more slowly. 1593. Stenosed duct meatus A 6yo boy presents with jaundice following treatment with sulphathiazole. He feels pain over the mass and is unable to blow a whistle. Partial mastectomy A 45yo man presents with a mass on the right side of the face. Exam: child's oropharynx shows that it is inflammed and there are small white spots on the oral mucosa. Inherited as sex-linked recessive condition d. Duchenne muscular dystrophy d. Anteroposterior & lateral neck x-ray A 6yo boy has been noticed to have problems with co-ordinating his voluntary movements over the last two years. Which is true regarding etiology of G6DP deficiency? a.1588. 1590. The child looks unwell and is irritable. On examination you find an anxious. breathing difficulties and fever. He has a waddling gait and needs to support himself on his hands when rising from the floor. Insertion of nasogastric tube c. Intubation under general anaesthesia b. Clinical examination shows that the mass is likely to be the parotid gland. Which is the most likely dx? a. Inherited as autosomal dominant condition b. Investigations suggest that the jaundice is due to haemolysis caused by G6DP deficiency. a. 1591. A needle-guided biopsy of the breast c. Excision biopsy of the breast d. Recent enlargement c. which was not present at birth and is . Parvovirus infection c. Results from auto-antibodies to red cell antigens A 5yo previously healthy child has a 1-day history of severe pain in the throat. Myasthenia gravis c. Observation for one year and repeat the mammography b. Fluid resuscitation and antibiotics IV d. Myotonia b. Muscular atrophy A previously healthy. breast-fed infant is brought by the mother who reports that the child has not been active and not feeding well. Inherited as sex-linked dominant condition c. An oral examination shows a foul smelling discharge from the duct of the gland and gentle probing shows that it is stenosed at the meatus. 1592. Which is the most appropriate initial management? a. Facial nerve palsy d. 1589.

Exam: the temp=35.5 mg/dl). Interstitial nephritis A 78yo pt is diagnosed with metastatic lung cancer.0 mmol/l). Which of the following is the most likely dx? a. dizziness. Malignant hypertension c. Two days after the surgery the serum creatinine le vel rose to 4.1594. there is no cure for his condition. BUN was 50 mg/dl (normal 10-20 mg/dl) and potassium 5. but no tissue has been expelled. Inevitable abortion b. d. Patient autonomy b. who was previously healthy. 1597. Social phobia A 30yo woman. Alcohol withdrawal phenomena d. HTN and normal kidney function underwent a total right hip replacement. Panic attack b. His father tells you that his son. the physician must not tell his father. His son tells the physician that in the case of a diagnosis of cancer. for no apparent reason. a sudden attack of fear. crampy abdominal pain. Delirious state c. The uterus is bulky. at 37 weeks gestation mentions that her 3-year-old son has just developed chickenpox. Threatened Abortion . Acyclovir tablets orally d. Beneficence c. She is not certain whether she has had the disease herself.0 mmol/L (normal 3. Which is the most likely dx? a. Congenital biliary tract obstruction.4°C. Which is the next step in management? a. increasing. Measurement of varicella IgG level A 24yo primigravida presents to the ED with a history of 8-week amenorrhoea followed by heavy vaginal bleeding and severe. Justice d. Measurement of varicella IgM level c. Which one of the following ethical principles supports the son’s request? a. He wishes that his father does not suffer any psychological distress caused by the knowledge of a terminal diagnosis. and the liver is palpable 2 cm below the costal margin. palpitations and the feeling that his heart is going to stop beating. Acute tubular necrosis d. Inadequate breast milk c. sweating. The blood pressure dropped to 60/40 mm Hg for about two hours before it was corrected with blood transfusion. 1596. She had massive haemorrhage during the operation and was given 8 units of packed RBC. Rhesus isoimmunisation b. Non-maleficence A 23yo single male was brought to Emergency exhausted and frightened. The symptoms started to decrease gradually after about 10 minutes. had. Which is the most likely dx? a. 1595.5-5. G2P1. Which is the most likely cause of this complication? a. Exam: HR=110/min and BP=120/80mmHg. Diabetic nephropathy b. There were brown granular casts in the urine sediment.2 mg/dl (normal <1. The cervix is dilated and there is active bleeding from the cervical os. Administration of varicella-zoster immune globulin IM b. 1598. Sepsis A 65yo woman with DM.

Immediate laparotomy. On the calf of the same leg there are varicosities on the medial aspect. Which is the next best step for establishing a dx? a. His CXR=widening of the mediastinum. The pain is persistent. c. Saphena varix d.1599. Tension pneumothorax e. Missed Abortion A 46yo woman comes for a routine gynaecological visit. Pregnancy test (urine or serum). The last menstrual period was 6 weeks ago. Colposcopy A 31yo woman. which is firm and bleeds on contact. d. The radial pulse=130/min and BP=80/40mmHg. Transvaginal ultrasound d. Inguinal hernia b. 1601. There is a delay between the radial and femoral pulse. 1602. Endometriosis c. Immediate laparoscopy. Spigelian hernia . There is a cough impulse and it disappears on lying down. Threatened abortion A married 25yo woman presents with 6h hx of abdominal pain located in the LIF. granular lesion is noted on the posterior cervical lip. Pelvic US shows free intra-peritoneal fluid. Tubal pregnancy b. Fx ribs d. G5P4. Femoral hernia e. Symphysial-fundal height measurement corresponds to 22 weeks gestation. What is the single most likely dx? a. It empties with minimal pressure and refills with release. Varicocele c. Inguinal hernia A man presents with a swelling above the groin crease in the abdomen. Observation for 24 hours in the ICU A 40yo man has fallen off a roof. b. 1603. What is the most appropriate next step in management? a. On pelvic examination. What is the most likely dx? a. 1600. Incomplete abortion d. Varicose vein b. What is the most probable dx? a. No fetal parts are seen during the examination. c. Cardiac tamponade b. He is shocked and has chest pain. Exam: swelling is diffuse and soft and lies below the inguinal ligament. 1604. The cervix is closed. a 1-cm red. Which is the most likely dx? a. Ultrasound examination reveals bilateral cystic masses. Cervical cytological smear b. of increasing intensity and not radiating first experienced while she was lying down. Hydatidiform mole d. who has amenorrhoea for 12 weeks and a positive pregnancy test presents to the ED with vaginal bleeding. Diaphragmatic rupture c. Traumatic rupture of aorta A 36yo woman presents with swelling in the groin. He has not had any med prbs of note. She feels giddy when she tries to stand erect. Punch biopsy c.

1608. Intermittent claudication b. What’s the most likely dx? a.1605. 1610. Immediate surgical referral e. What is the most probable dx? a. abnormal liver enzymes. Diazepam c. He is lashing out violently. Clozapine e. Cardiovascular syphilis c. Testicular tumor d. Her biochemistry results show a raised bilirubin. Anti Scl 70 c. Fluoxetine d. Anti centromere A 65yo woman complaining of symptoms suggestive of Raynaud’s phenomenon and difficulty in swallowing. Epidydimal cyst e. Anti Jo1 b. Exam: painful lesions on her finger tips and facial telangiectasis. Acute fatty liver of pregnancy b. Anti Jo1 b. What is the single most likely positive antibody? a. Reassure d. Irreducible hernia A 70yo mn presents with acutely painful. Acute limb ischemia A 50yo woman complains of several months hx of weakness and difficulty climbing stairs. He is noted to have a-fib. Pain was not relieved by any strong analgesic. Anti Ro d. pale paralysed and pulseless left leg. Give strong analgesic b. Chlorpromazine A 32yo woman of 40wks gestation attends the antenatal day unit with sudden onset epigastric pain with nausea and vomiting. Anti ds DNA e. Anti centromere A 6yo boy presented about 4h ago with acute severe pain on the testis with the left half slightly higher than the right. 1606. high uric acid and hypoglycemia. IV NS and monitor vital signs c. What is the single most likely positive antibody? a. She is clinically jaundiced. Obstetric cholestasis . Buerger’s disease d. Anti ds DNA e. Anti Ro d. What is the initial management? a. 1607. Haloperidol b. CXR: pulmonary fibrosis. Chronic limb ischemia e. 1609. Cover with antibiotics A 60yo man is brought to the ED in an agitated state. Anti Scl 70 c. Which drug in low dosage due to its relative lack of autonomic side effects is a drug of choice in the tx of agitation in this pt? a. c. Exam: fissuring of the skin of her hands.

What is the single most likely dx? a. c. cornea and pupils are normal. Citalopram d. 1616. Endometrial ablation c. What is the most appropriate initial inv which is helpful to get a dx? a. MSU c. Imipramine A 24yo man presents with painless hematuria. Cystoscopy d. Which drug is most likely to cause these symptoms? a. Capgras syndrome b. Macular degeneration b. Abdominal US A 29yo woman presents to her GP with troublesome heavy periods. Nihilistic e. Danazol b. Fregoli syndrome e. 1612. You confirm that she is currently trying for more children. 1615. Factitious c. Todd syndrome d. HELLP syndrome e. She is known to have large uterine intramural fibroids. Myomectomy A 30yo schizophrenic female attacks her mother believing that aliens have replaced her with an exact double. 1614. Diazepam c. DM background e. Persecutory b. 1613. The med tx that she has tried have made little difference. Proliferative DM retinopathy A man under psychiatric tx develops GI distress and tremors. Hysteroscopic resection of fibrosis e.1611. Acute hepatitis A 24yo man believes his bowels are blocked and his life is in ruin. Cholecystitis d. HTN retinopathy c. What condition is she suffering from? a. Ganser syndrome c. What kind of delusion is he suffering from? a. MRI spine e. fundus shows obscured margins. MS d. Clozapine e. No other complaint and no abnormality is found on physical exam. Hypochondriacal A 75yo man with declining vision. Hysterectomy d. Cotard syndrome . Lithium b. Select the most appropriate management for menorrhagia in this pt? a. Coag screening b. Guilt d.

What is the singe most appropriate tx? a. Barium meal c. Laparoscopy b. swollen and acutely painful. OE d. Courses of DPT vaccine b. What is the best management? a. Munchausen syndrome b. ECT c. CT scan b. Reassure 1620. Now his right ear is hot. A 38yo man has just returned from a holiday where he went swimming everyday. Bronchoscopy 1623. Single inj of DPT vaccine d. Antipsychotic 1622. recently he has passed stool only once every 2-3d. red. What inv will you do to confirm the dx? a. What term best describes her condition? a. Now on routine follow up the thread is missing. He has a 2cm clean laceration. Imipramine d. He has not received any routine immunizations as his parents are concerned about possible side effects. AFB stain c. For the last few days he has had irritation in both ears. Single inj of tetanus Ig 1619. Pelvic XR 1621. Pelvic CT c. There are no contraindications to immunizations. Munchausen’s by proxy . A 45yo woman has been extensively inv for alump she believes to be cancer. What inv should be done next? a. A pt comes with weight loss and sleep disturbance has mild depression.1617. What is the single most likely dx/ a. A healthy 2yo boy is brought to the ED having cut his hand playing in the garden. Laparotomy d. Courses of DT c. He has a hx of MI. XR: cavitations. A 30yo woman had an IUCD inserted 8-9m ago. Diazepam b. Single inj of DT e. A 6wk child has hx of frequent vomiting which became worse during the last weeks. Impacted earwax c. Blood culture d. Uterine US showed no IUCD in the uterus. What is the single most appropriate follow up inv? a. Feed test e. He has no fever. A pt comes back from India and presents with night sweats and lymphadenopathy. Foreign body b. Lithium e. OM e. Perforation of eardrum 1618. Abdominal US b. She doesn’t think doctors take her seriously and demands another referral. Erect XR abdomen d.

Hepatitis B vaccine as single dose e. 3wks later her blood count has returned to a similar picture. What SINGLE preventative intervention should be given to the baby? a. CML e. None until hepatitis B status confirmed A previously well 15yo girl had an acute onset of fever. sweating. His new partner has left him and he has stopped taking his medicine and begun drinking heavily. Hypochondriasis d. What is the definite test to confirm the dx? a. AML c. ALL b. Conjunctivitis c. Chorioretinitis b. Hepatitis B vaccine and hepatitis B immunoglobulin d. 1627.1mg/L. Iritis e.1. WBC=1. A blood count showed: Hgb=63g/L. Insulin tolerance test c. She was transfused and given IV antibiotics and her condition improved. Phobia A 15yo man presents with bitemporal hemianopia and spade-like hands. Short ACTH test A 22yo man has had an acute. Pernicious anemia . Keratitis A 40yo divorced man with bipolar affective disorder attends hospital following an OD of 30 TCA tablets. 1625. Episcleritis d. red right eye with blurring of vision for one day. Referral to clinical psychologist A healthy baby boy is born at term to a woman who was unwell with confirmed acute hep B during pregnancy. Early morning growth hormone b. painful. Arrange psychiatric outpatient follow-up c. OGTT with growth hormone measurements d. Aplastic anemia d. What is the SINGLE most appropriate next management? a. Admission to the psychiatry ward b. Discharge to the care of the general practitioner d. Neutrophils=0. Malingering e. Full course of hepatitis B vaccine b. No abnormal white cells were seen on the blood film. c. Hepatitis B immunoglobulin alone c.1624. Random insulin-like growth factor (IGF-1) e. feels hopeless and is ambivalent about being alive. What is the SINGLE most likely cause of his red eye? a. He appears depressed. 1626. What is the SINGLE most likely underlying dx? a. 1628. He had a similar episode 1y ago and has had episodic back pain and stiffness relieved by exercise and diclofenac for four years. He is now fit for discharge from the medical ward and acknowledges the benefits of previous tx. bruising and petechiae. Referral to local alcohol treatment team e. The mother is very concerned that she may have infected the baby with hep B. plt=14.

Amoxicillin b. In a five year period there are 1250 cases of bladder cancer diagnosed at the only hospital. There is no significant prv psychiatric hx. Progestogen implant e. What is the SINGLE most appropriate management? a. 2100 b. 700 e. Laparotomy and re-suture wound . 1750 c. Drug induced psychosis c. 1400 d. 350 1631. Abdominal support b. A 28yo woman who has had a prv pulmonary embolism in pregnancy wishes to discuss contraception. Lewy body dementia d. He is anxious about safety and checks the locks of his doors repeatedly before going to bed. POP 1632. Her temperature is 39.1629. He is not systemically unwell. A 65yo man had closure of colostomy performed 5d ago. Psychotic depression 1630. Antidepressant b. 20-30 times a day. An 8yo girl has had left earache for 2d. A town has a population of 500. An 83yo woman admitted with a chest infection becomes confused with impaired attention and poor concentration. Delirium b. Multi-infarct dementia e. COCP b. She is restless and frightened. Clindamycin d. The earache subsided about 2h ago with the onset of a purulent discharge which relieved the pain. Antipsychotic c. Erythromycin e. What is the SINGLE most likely dx? a. Antibiotics c. For the last 8wks he has been washing his hands every time he touches the lock. localised fluctuant swelling 4 cm in diameter in the wound.2C. Levonorgestrel intra-uterine system d. Psychodynamic psychotherapy 1634. There is a tender. CBT e. She is verbally abusive and has perceptual abnormalities. Ciprofloxacin c. What is the annual incidence per million of bladder cancer in this population? a.000. A 38yo man has disturbing thoughts about his house being infected by germs. Flucloxacillin 1633. What is the SINGLE most appropriate management? a. Copper IUCD c. During the same period the occupational health department diagnosed a further 500 cases. She has menorrhagia but is otherwise well. What is the SINGLE most suitable contraceptive method for this patient? a. What is the SINGLE most appropriate antibiotic? a. Anxiolytic d.

She has a 2 x 2 cm enlarged LN in the anterior triangle of the neck with several smaller associated LN palpable. he gradually becomes semi-conscious again. He has a temp=39. There is no history of relevant trave l outside the UK. CT brain scan b. Sarcoidosis e. Internal iliac e. She has a maculopapular rash and a few palpable. Infectious mononucleosis b. He was given naloxone and rapidly became alert. Tuberculosis A 60yo man has had increasing pain in both buttocks. Her last cervical smear . Oropharyngeal examination shows tonsillar membranes. 1639. pulse=122bpm. IV antibiotic. The pt has misused another substance that is absorbed more slowly than methadone A 27yo woman who takes the COCP has had painless vaginal spotting and discharge for 3 days. 1637.2C. He has also recently developed impotence. What is the SINGLE most likely site of arterial obstruction? a. IV fluids. Some hours later. IV fluids. SLE A 16yo girl has had an enlarging mass in the right side of her neck for the last 6wks. IV antibiotic e.What is the SINGLE most likely reason for this patient becoming semi-conscious again in hospital? a. Methadone is eliminated from the body more slowly than naloxone c. d.1635. LP A 16yo boy was brought to hospital in a comatose state having taken methadone belonging to his sister. Leukaemia c. Sarcoidosis e. Psoriasis b. What is the SINGLE most likely dx? a. Femoropopliteal d. What is the SINGLE most likely dx? a. Her last menstrual period. IV fluids. External iliac c. 1636. BP=84/60mmHg and RR=34bpm but his chest is clear. Lymphoma d. Tibial A 78yo man has collapsed. which lasted four days. Local exploration of wound e. He has had a severe headache for 12 hours and had an URTI 3d ago. Naloxone is a partial agonist at the central nervous system opioid receptor d. What is the SINGLE most appropriate immediate management? a. 1640. thighs and calves on walking for three months. He has a GCS=10 and some neck stiffness. Methadone hepatotoxicity has caused acute liver failure b. She has had no other symptoms. She was previously well. He has been started on high-flow oxygen. Reactive arthritis c. She has two young children. Rheumatoid arthritis d. wrists and knees for two days. The pt has misused another substance that has caused an intracranial bleed e. 1638. Observation A 32yo woman has had a febrile illness and swelling of the small joints of her hands. IV antibiotic. small cervical lymph nodes. Femoral and distal pulses are absent in both limbs. CT brain scan d. Aorto iliac b. feet. finished 10 days ago. LP c.

Increase morphine dose A 4yo girl has had a temp=38. He is distressed by increasingly frequent episodes of painful muscle spasms in his right leg. Endometrial biopsy e. Bisacodyl tablets b. What is the SINGLE most appropriate management of his symptoms? a. Stroke . What is the SINGLE most appropriate initial inv? a. Baclofen c. Migraine c. Cervical smear b. Lactulose syrup d. Today she has small blisters on the palms of her hands and soles of her feet which are painful but not itchy. Endocervical swab d. Senna tablets A 19yo woman has had progressive bilateral iliac fossa pain and dyspareunia for 3days. What is the SINGLE most likely underlying cause? a. Neisseria gonorrhoeae and Chlamydia trachomatis and Candida albicans e. Meningioma b. What SINGLE set of organisms are the most appropriate for the antimicrobial regimen to cover? a. Yesterday she developed a sore throat and small. Magnesium citrate (orally) e. Gabapentin e. Coxsackie virus b. Herpes simplex virus c. He has retained sensation but is unable to stand. Each episode has resolved in 3m. 1642. Abdominal and vaginal examinations are normal apart from a mild ectropion with contact bleeding. Amitriptyline b. What is the SINGLE most likely dx? a. He has pain in a band around his lower trunk controlled by regular oral morphine. An initial antimicrobial regimen is commenced. Her temp=39C. Neisseria gonorrhoeae and Candida albicans b. Streptococcus pneumonia e. Glycerine suppository c. Neisseria gonorrhoeae and Chlamydia trachomatis and Gardnerella vaginalis A 48yo man with renal cancer had radiotherapy for metastatic spinal cord compression at the 11th thoracic vertebra 4wks ago. Staphylococcus aureus d. two years ago was normal. Varicella zoster virus A 32yo woman has had 3 episodes of slurred speech and 2 episodes of transient weakness of both legs in the past 5yrs. Fentanyl patch d. 1645. She has an offensive vaginal discharge and feels unwell and feverish. 1644. painful ulcers inside her mouth. 1643.5C for 2days and has not wanted to eat her food. Pelvic US A 72yo man being investigated for anaemia is booked for a colonoscopy in 24 hours. What is the SINGLE most appropriate management the night before the procedure? a.1641. Colposcopy c. Multiple sclerosis d. Neisseria gonorrhoeae and Chlamydia trachomatis d. Neisseria gonorrhoeae and Candida albicans and Gardnerella vaginalia c.

What is the most probable dx? a. What is the SINGLE most likely dx? a. Nocturnal enuresis d. He has subsequently developed difficulty with memory and conc. Amiodarone b. Add leukotriene antagonist b. Anxiety b. Warfarin e. Bisoprolol d. AD with variable penetrance c. A 59yo man has shown a change in his mood and personality over a 9m period. AR . What would be the SINGLE most appropriate change in her treatment? a. Short course of oral corticosteroid 1647. Other exam is normal. Transient ischaemic attack 1646. which one of the following genetic patterns is most likely? a. What is the SINGLE most likely dx? a. Foreign body e. Optic neuritis e. He is unwell. Benign positional vertigo c. She now has a frequent night cough and mild exercise-induced wheeze. Furuncle c. Periorbital cellulitis 1650. He was adopted and therefore no information on his fam hx is available. the oldest son has recently been inv by the neurology dept for slightly erratic behavior and fidgety restless movements of both legs. An 84yo woman with Alzheimer's dementia has recently become incontinent and more confused than usual. A 38yo man with longstanding alcohol dependence has vertigo and a tremor every morning. Add regular long-acting bronchodilator d. Temporal lobe epilepsy 1648. and then progressive fidgety movements of his limbs and facial musculature. Allergic reaction b. Her inhaler technique is good. Detrusor overactivity b. febrile and also suffers from pain on the right side of his face. However. Cerebellar degeneration d. 30. An 8yo girl is complying with her asthma treatment of low-dose inhaled corticosteroid prophylaxis and short-acting bronchodilators as required. Increase dose of inhaled corticosteroid e. UTI e. Folliculitis d. A pt presents with irregularly irregular pulse of 162bpm. 33) of whom the 2 youngest are asymptomatic.e. He has 3 adult children (27. What drug is most useful initially? a. Uterine prolapse 1649. Based on the likely clinical dx. A 4yo boy complains of pain around his right eye. Add oral theophylline c. By the time of medical assessment he has frank choreiform movements and a mini-mental state exam of 21/30. Neuropathic bladder c. AD inheritance with anticipation b. Heparin 1651. Digoxin c.

1652. Impaired growth hormone response to glucose loading e. Polydactyly e. Anosognosia A pt has loss of sensation on the tip of her tongue and the inner aspect of the lip. TCA b. Lingual nerve d. HTN and a suggestive body habitus. X-linked e. Ulnar deformity A 37yo female working as a healthcare assistant in a nursing home comes to the ED with complaints of severe itching all over her body. He mimics the doctors and attendants – doing the same physical actions as them. Mitochondrial disorder A 35yo pt has been dx with schizophrenia. Vagus nerve b. d. Inflammation of keratinocytes c. 1656. Unilateral adrenal enlargement . 1657. Facial nerve A 51yo woman complains of difficulty swallowing and also reddish dots on her skin. Echopraxia b. Allergic reaction developed due to use of topical steroid creams d. Which nerve is most likely to be involved? a. Buccal nerve e. 1655. Failure to suppress morning cortisol with dexamethasone c. Perseveration d. What symptom does this pt have? a. A pic of her hand is seen. None A 65yo pt who had MI 1yr ago now comes to the ED complaining that his neighbor is conspiring against him. Allergic reaction b. Clozapine c. Lorazepam You suspect Cushing's disease in a 50yo woman who has attended clinic with glycosuria. he denies it and also narrates that sometimes his father says that everybody in his office is always talking about him. Echolalia c. On asking she replies that she had applied cream on the body of a resident in the nursing home who had similar itches. HTN requiring >2 antihypertensive agents d. which is not the case. 1653. What is the mechanism of itching? a. What is the most appropriate med? a. 1654. RA c. Swan neck deformity d. Apraxia e. A normal 8am cortisol b. What is the most appropriate term for the condition you would expect to see? a. Glossopharyngeal nerve c. Initial inv point you towards a dx of Cushing's disease. When his son is asked. Sclerodactyly b. Subcutaneous bleeding e. Which of the following findings would be against this dx? a. Olanzapine d.

HUS c. Cytotoxic chemotherapy d. on clinical examination of the pulse. Pleomorphic adenoma h. Chronic liver disease b. Typically affects the face An anemic young man is found to have a macrocytosis of 90%. Pulsus bisferiens e. Phenytoin e. Ischemic colitis c. 1661. Pulsus alternans c. Mucocele c. It is caused by Staphylococcus aureus e. Chronic renal disease h. Epulis fissuratum b. Thalassemia minor g. Zieve’s syndrome f. Fibroma j. IDA i. Parulis e. Pulsus bigeminus d. Gallstone ileus b. 1663. Pulsus paradoxus 1659. Is best treated by salicylate emulsion b. Large bowel obstruction d. Sigmoid volvulus e. It can be spread by a droplet infection c. Irregularly irregular pulse suggesting A-fib b. Exotosis g. Small bowel obstruction A 17-year-old boy is diagnosed with scabies. It causes itchiness in the skin even where there is no obvious lesion to be seen d. Which finding. a.aorto-iliofemoral reconstruction with a Dacron vascular prosthesis? . Folate def An association with HPV is a most characteristic feature of? a. On examination he has abdominal swelling. Which of the following statements regarding scabies is correct? a. What is the likely dx? 1660. Torus f. suggests a diagnosis of hypertrophic obstructive cardiomyopathy (HOCM)? a. 1662. Verruca vulgaris i. guarding and numerous audible bowel sounds.1658. A 60yo male is admitted with a 2d hx of lower abdominal pain and marked vomiting. Pyogenic granuloma d. The most likely cause is ? a. Ranula For the following type of surgery what is the most likely agent that may cause post-operative infection -.

Intracerebral hematoma g. IV alfentanil peri-orbital skin h. Placental migration g. C. He has a hx of facial erythema particularly of the cheeks and nose. Epidural anesthesia c. What is the anaesthetic of choice? a. Staphylococcus aureus i. Topical xylocaine b. Following rescusitation with 6 units of blood. IV midazolam i. Staphylococcus epidermis j. Acne rosacea c. Skull vault XR appears normal. Vasa previa j. E. 1666. 1667. Papules and pustules have been erupting at intervals over the last 10yrs. Despressed skull fx b. Tinea versicolor j. General anesthesia d. By the end of her pregnancy she is likely to develop? a. Bupivacaine infiltration of the g.perfringens b. Proteus f. Neck. abdominal XR d. Pemphigus vulgaris b. SAH e. He developed considerable nausea and vomiting during his therapy and at the end of the course began to have bloody vomiting.1664. Hepatic encephalopathy f. Extradural hematoma i. a. Uterine rupture h. Uterine myoma placenta c. Malignant melanoma d. Retrobulbar xylocaine Inj e. Atopic dermatitis A 60yo man who presented with metastatic adenocarcinoma of unknown source. Chronic subdural hemorrhage j.coli g. CT abdomen . Chorangioma i. Epidermolysis bullosa h. Brucella melitensis A primigravida in the 17th week of her symptomless gestation is found. Brain stem injury h. Pseudomonas aeruginosa c. Streptococcus fecalis d. Vertibrobasilar ischemia c. Peribulbar acupuncture j. Dermatomyositis i. Placenta previa An elderly lady with COPD has chronic SOB. Acute subdural hematoma d. He developed rapidly progressive weakness of his arms and was found to have a deposit of tumour in his cervical spine. Subplacental abruption b. This was emergently treated with radiation. While being taken up the stairs to his bedroom he falls down the flight of 5 steps but sustains no obvious injuiry. She is listed for cataract extraction. 24h esophageal pH probe test b. Exam: noted to have rhinophyma. Streptococcus pneumonia e. Choriocarcinoma placenta e. 1668. Bacteroides fragilis h. what is the next test of choice? a. to have evidence of placental tissue covering the cervical os. He is brought in in a comatose state and both pupils appear dilated. a. Herpes simplex g. Facial nerve block f. Apt test c. 1665. chest. He admits to a moderate regular consumption of alcohol. Eczema f. The most likely dx is? a. Peribulbar lignocaine infiltration A 55yo chronic alcoholic with known hepatic cirrhosis has been on a heavy bout of alcohol the night before and was brought home by friends after falling several times in the pub. Psoriasis e. Placenta accrete f. His wife calls the ED the next day because she could not rouse him in the morning. Subchorionic abruption d. on US. Severe migraine attack A 58yo man complains of nose disfigurement.

Anemia of chronic disease b. e. Thallium toxicity b. Hemochromatosis . Acute blood loss c. Mycobacterium avium complex f. The x-ray shows patchy shadowing throughout the lung fields. Legionella pneumophila j. MCV: Decreased Serum ferritin: Decreased Total iron binding capacity: Increased Serum iron: Decreased Marrow iron: Absent. Atropine i. MRI temporal lobe A pt being sedated with fentanyl develops severe respiratory depression. US abdomen h. Protein energy malnutrition i. 1674. What would you do next? a. Barium swallow j. Phyostigmine h. MRI frontal lobe e. What is your dx? a. PCP e. Hypoalbuminemia e. Zinc deficiency d. nausea. effortful speech with dysarthria. Pellagra j. 4-vessel cerebral angiogram i. severe cough and breathlessness which has not improved with a seven day course of amoxycillin. IDA d. 7 people who shared in the lunch become ill with similar symptoms. Angiography f. Folic acid f. Oral contraceptives e. Psoriasis A young man develops nonfluent. Calcium disodium ethylene b. These findings are commonly associated with? a. Thalassemia trait f. MRI pituitary gland j. Ethanol g. Lichen planus i. a. One day. This is best reversed using? a. Strep pneumococcus b. There is nothing significant to find on examination. Staph aureus An 18yo male works in a company where lunches are often catered. malaise and jaundice. 1673. Mycoplasma pneumonia d. Flumazenil e. he becomes sick. Diphenhydramine A pt presented with the following blood work. The blood film shows clumping of red cells with suggestion of cold agglutinins. TB c. Onychomycosis h. Megaloblastic anemia A 20yo prv healthy woman presents with general malaise. Pancreatic ca b. Chronic renal failure j. Escherichia coli (Gram -ve) h. Contact dermatitis c. Nuclear scan g. Single vessel cerebral b. Coxiella burnetii g. Yellow nail syndrome f. What is a likely dx? a. the water at the company facility is not working. Haemophilus influenza i. 1672. Contrast MRI optic nerves h. Deferoxamine mesylate d. Methylene blue j. During the course of the next 4wks. After a few wks. MRI abdomen i. Hypoparathyroidism g. Cerebral angiography d. but they manage to have the lunch anyway. Non-contrast CT brain angiogram c. each of the 7 people completely recovers and they replace their caterer. Leukonychia g.1669. Hereditary sideroblastic anemia h. Naloxone diamine tetra-acetic acid c. Contrast CT brain g. 2wks later. 1671. 1670. XR skull f. He develops anorexia. small yellow-brown areas of discoloration in the nailbed involving the nails on both hands. He is able to undertsand speech. He fails to repeat the sentence. Endoscopy A pt has fine nail pitting.

Primary biliary cirrhosis d. Seminoma j. Orchitis e. Oral NSAIDs f. You find that she has an enlarged liver which is hard and irregular. The tx of choice would be? a. 1677. 6 months h.1675. neonate f. Hep B f. The likely cause is? a. epidural anaesthetic d. Phenylpropanolamine j. Gilbert’s syndrome e. Hydrocele h. On examination the swelling is seen to transilluminate. Hep A h. There is marked localised tenderness over the right lobe of her liver. 1679. Cerebellum b. fourteen year A mother is concerned because her 1m boy has a swelling in his scrotum. TENS g. He has a palmer and rooting reflex as well as a social smile. Intermittent catheterization treatment c. Biofeedback-assisted behavioral b. The child can hold its head up and lifts its chest off a table. Ensure donor is adequately hydrated and has not skipped a meal b. one year i. She is known to have both local recurrence and liver mets and her pain has been under control on MST 90mg bd. Spermatocele A 2m girl has an ante-natal diagnosis of right hydronephrosis. He is not afraid of strangers. Appropriate management should include? a. Lymphogranuloma Venereum f. The donation is usually continued along with simultaneous normal saline infusion e. Pitocin e. Elevating the donor's legs as this is usually due to a vasovagal syncope c. Haemoglobin of the donor meets the minimum requirement for donation d. Vaginal Estrogen therapy e. one and a half years j. 1676. She has had quite severe pain in the RUQ for the past hour despite having taken her normal dose of MST. She is apyrexial. Paracetamol j. Lymphoma d. Rotor’s syndrome j. Hemolysis A 35yo 1st time donor suddenly passes out as she is donating blood. radio therapy to the liver h. 1680. Prednisolone b. Mature teratoma b. 2 months g. 1678. Gellhorn pessary Jean is a 72yo woman with recurrent bowel cancer following a hemi-colectomy 2y ago. seven years d. Testicular Torsion g. c. Which of the following steps would be least useful in managing this adverse event? a. Surgical repair g. What is the most likely age of this child? a. Oral Estrogen therapy d. Basal ganglia . two years b. He was born prematurely. No reflux was demonstrated on a MUCG. Ring pessary f. Physiotherapy c. Laennec’s cirrhosis g. The donor should be encouraged to mobilise after they have recovered An infant is being examined as part of a routine examination. Varicocele c. ten years e. Epididymitis i. Her abdomen is otherwise soft and non-tender and the bowel sounds are normal. Anticholinergic agents i. Postnatal serial US exams revealed increasing dilatation of the right pelvicalyceal system. four years c. Aspirin Titubation is a feature of disease involving the? a. HCC i. Diuresis renography h. IM diamorphine i.

Reiter's Syndrome e. Aspergillosis b. Bleeding time: Normal. Exam: he appears to have a neuropathy affecting isolated nerves in multiple. and tachycardia. Optic chiasma d.5% Normal Saline h. Cellulitis j. Pelger-Hüet anomaly j. 0. Creutzfeld-Jacob e. APTT:Elevated. 3rd ventricle e. She describes that following a common cold her child's voice has become hoarse and has developed a cough that sounds harsh and brassy and was worse at night. HIV j. 1685. Wegener’s granulomatosis c. markedly decreased urine output. The cause is most likely to be? a. A likely diagnosis is? a. Haemophilia macroglobulinaemia g. HIV infection b.5N saline d. A CXR reveals a cavitating intrapulmonary lesion containing a movable rounded ball lesion. Packed cells solution e. Heparin h. c. Tuberculosis f. Plasmapheresis and plasma f. FFP b. 5% dextrose in 0. Waldenström's f. Rotavirus b. 1684. Exam: he is noted to have dry mucous membranes. Pulmonary hemosiderosis i. Plt count:Normal. Pulmonary embolism e. Rubella INR:Normal. Occipital lobe j. 1682. A likely aetiology is? a. His BP=normal and compression-release of the nail beds shows satisfactory refilling. Pituitary gland A 50yo farmer complains of pain in his left arm. Vit K deficiency e. Mitral stenosis j. Corpus callosum g. poor skin turgor. 1683. Thrombin time:Elevated. DIC c.1681. Lactated Ringer's injection i. random areas of his left arm. double strength Normal Saline c. Polyarteritis nodosa g. Non-SCLC A mother brings her 1yo infant to her pediatrician. Sézary cell leukaemia i. Temporal lobe i. Rhinovirus g. Hypothalamus f. Platelets infusion g. von Willebrand's disease An infant has diarrhea for 3d with weight loss from 10 kg to 9 kg. There was visible stridor on inhalation. CMV c. Appropriate treatment would include? a. Rheumatoid arthritis b. Angina Pectoris h. IV heparin . Parainfluenza h. EBV f. Exam: the child was noted to have trouble drawing air into its lungs between coughs and had trouble drawing air into its lungs. Kemerovo d. Acanthocytosis d. Flavivirus i. He also has a palpable purpura and tender nodules on both of his upper and lower limbs. Pons h. Polymyalgia Rheumatica A patient with chronic neutropenia develops a chronic cough. Fascitis d. A likely dx is? a. Goodpasture’s syndrome d. Gout i. Carpal tunnel syndrome f. Bronchiectasis g. Erysipelas c. Whole blood j. Cystic fibrosis h.

AML e. He has WBC=100. Sub-arachnoid space b. Failure of alpha chain f.000mm and numerous circulating blast cells. Into which space should the local anaesthetic be normally injected? a. Presence of hemoglobin M b. Lead poisoning j. The patient was lost to follow up with the neurologist. Transverse colostomy c. Sarcoidosis i. He begins experiencing bleeding of his gums and frequent bloody noses. Retinoblastoma e. The patient had been seen once by a neurologist 2yrs prv for flashes. Lymphangioma b. Pseudotumor f. CML j. with lymphadenopathy and hepatosplenomegaly. Right hemicolectomy h. ALL c. Mucormycosis 1690. Internal sphincterotomy j. Aryepiglottic space f. The patient did not experience visual changes with activity or movement. Burkitt lymphoma b. Transverse colectomy radiatherapy e. Infectious lymphocytosis g. Retinal vascular shunts d. IDA 1689. His mother takes him to his pediatrician. Deficiency of B12 i. Chemotherapy and d. Optic glioma j. Hairy cell leukemia d. Blood tests show a normal serum iron. Middle ear d. Failure of beta chain production h. This baby's anemia is likely to be secondary to? a. The anesthetist describes that if the patient wishes he can use medication as a local anesthetic to block the pain sensations of labour. CLL 1687. At that time a head CT was normal. A pregnant woman in an early stage of labour expresses the wish to have pain relief during labour. pelvic muscles or lymph nodes. A 4yo boy has the sudden onset of bone pain.1686. Inability to manufacture heme e. A 2m baby develops a life-threatening anemia. Vestibule space g. Space of Disse c. Epidural space h. A 63yo male has anal canal carcinoma with no evidence of spread to the pelvic wall. Rhabdomyosarcoma c. Hemoglobin electrophoresis reveals a markedly decreased Hemoglobin A content and an increased hemoglobin F content. This is typically managed by? a. A 30yo caucasian man presented with a 2wk hx of gradually worsening vision in his left eye. Which of the following is most likely? a. Goldmann visual fields were done and showed a central scotoma. Diverticulectomy b. Resection of the sigmoid colon g. He is admitted to the hospital. Optic neuritis h. Deficiency of folate c. Anterior pararenal space e. Mycosis fungoides macroglobulinemia i. but the flashes had continued for the 2yr period. A likely diagnosis is? a. Exam: he is pale and has numerous petechiae over his body. Bone marrow failure d. Presence of hemoglobin S production g. ferritin and TIBC. Orbital teratoma g. A bone marrow biopsy=35% blast cells. The patient reported continued decreasing vision. Posterior pararenal space . CT guided drainage 1688. Left hemicolectomy i. Waldenstrom’s h. Mantle cell lymphoma f. Abdominal perineal resection f. A MRI was done at this time and showed inflammation of the left optic nerve.

Thiazide diuretics g. TENS 1693.20 mmol/l.i. A young girl with a psychiatric hx on med tx is brought to the dermatologist by her mother because of recurrent patchy hair loss. Brivudin d. Orchitis e. Spermatocele 1695.7mmol/l. Lontophoresis b. Infection with Microsporum g. Vasculitis 1696. Alopecia areata i. The management of choice should be : a. The symptoms have been present for 2m. Steroid use i. IV acyclovir e. Mature teratoma b. Testicular Torsion g. a teacher. Lymphogranuloma Venereum f. Oral Corticosteroids petechiae with wide margin i. Hgb SS disease h. Impaired venous drainage g. ALP 30-300iu/L. Trichorrhexis nodosa d. Lymphoma d. Multiple myeloma c. Trichotillomania 1694. Varicocele c. Sarcoidosis e. This suggests the following pathology: a. missed fracture c. Gaucher's disease b. Primary hyperparathyroidism i. Septic emboli f. has just read about a nonsteroidal medication which acts on the mast cells. A 7yo boy with frequent episodic asthma is on tx with sodium cromoglycate. Ventilatory support f. Androgenetic Alopecia tonsurans f. Phosphate: 0. Epididymitis i. PO43-: 1. Syphilis typically causes a. The removed femoral head is sent for pathology and is found to contain enlarged fat cells. Cushing's disease d.69 mmol/l. His ESR is elevated. Alcoholism j. Serum 25(OH) D: 20-105nmol/l. A likely aetiology is a. Hyperthyroidism 1692. Urea: 2.65mmol/l. stopping them from releasing harmful . Infection with Trichophyton e. Supraglottic space j. Ca: 2. Resection of superficial h. Osteoporosis f. A 29yo Afro-Caribbean man presents with a non-productive cough mild aches in the ankles.45mmol/l. Paget's disease of bone d. CXR: a large patch of consolidation is seen. Lichen planus b. Alopecia totalis c. Hydrocele h. Normal values for Calcium: 2. ALP: 80 iu/L. His physician wants to add a non-steroid preventer. Telogen Effluvium j. Hypoparathyroidism j. The pathologist explains that this is the likely cause of the patient's femoral head collapse. He is noted to have low urine output and large petechiae all over his body.8-1. Serum 25(OH) D: 180 nmol/l. Radiation e. The mother of the boy. He now presents with confusion. Exam: the hair shafts revealed twisting and fractures. Seminoma j.5-6. A 22yo has had recent chickenpox. Open surgical debridement g. Osteomalacia b. A middle aged woman has severe collapse of the right femoral head requiring replacement. Nephrostomy c. Booster vaccine j. Creatinine: 70-120µmol/l a. Traction Alopecia canis h. Skeletal metastases h. Lesser sac 1691.12-2.

Ankle fx b. chronic headaches and body aches and severe physical and mental exhaustion. Endoscopy e. Chronic fatigure syndrome c. Short Q-T interval An elderly male pt with prior hx of hematemesis is having hx of long term use of aspirin and other drugs. 1701. Analgesia A 68yo man presents with bruising and hx of falls. He has slight swelling. SC adrenaline g. no dysmorphic features. now presents with severe epigastric pain. Ankle sprain c. DM c. Depression . He cries immediately and refuses to walk. Inhaled sodium cromoglycate bronchodilator f. Nebulised bronchodilators bronchodilator j. His mother carries him to hospital. chemicals. warmth and discomfort on the lower 1/3 of the left tibia. What is the management? a. Polymyalgia rheumatic d. Short P-R interval d. He was connected to vital monitors which were not reassuring. He is found to have a mask-like face. His immunisations are up to date. 1698. What is the most likely dx? a. AP and lateral x rays of the tibia are normal. Oral steroids d. Exam: looks well and well-nourished. dysphagia and vomiting. Tibial fx Which one of the following electrocardiographic changes is found in hypercalcaemia? a.1697. Prolonged Q-T interval c. IV PPI c. She has no underlying conditions and all inv are non-conclusive. What is the most likely dx? a. pillrolling tremor and shuffling gait. Nedocromil Sodium h. Oral PPI d. Her physician agrees to add this medication to the boy's drug regimen. HTN b. Inhaled steroids b. EEG=normal. Inhaled SABA c. even on no exertion. and refuses to weight bear. Somatization b. Psychosis d. Inhaled long acting i. 1700. Which of the following conditions is he most likely being treated for? a. 1699. He had a full term NVD with no neonatal complications. GCA e. Increased QRS interval b. Knee dislocation e. TIA e. Inhaled short acting e. Oral theophylline A 3yo boy is playing with his brother when he falls. Complex partial seizure A 45yo woman presents with easy fatigability. Oral antacids b. Fibular fx d. Which medication is the physician most likely to add to the boy's treatment? a.

GCS 11/15. . Her HR=110bpm. some bruises on chest wall and abdomen and a deformed thigh. Activated charcoal b. Febrile convulsion b. Single most appropriate mgmt? a. What’s the initial management? a. ESWL c. This time he presents withh 3cm stone in the right kidney. Laparotomy d. Observe e. A 23yo male presents to his GP 2wks after a RTA concerned about increasing anxiety lethargy and headache. A 4yo baby has a generalized tonic-clonic convulsions and fever of 39C. Reassure c. Operative stone removal 1704. N-acetyl cysteine c. Absence seizures c. What did his original symptoms likely represent? a. High flow oxygen via mask given. Gastric lavage d. Conversion disorder b. 6m following this episode his symptoms have resolved. CT abdomen d. MCUG showed bilateral vesicoureteric reflux. CXR b. Most immediate radiological inv required during initial resuscitation phase? a. Somatization disorder d.1702. A 22yo says she has taken about 40 tabs of paracetamol 3h ago. Prophylactic antibiotics b. Ureteric surgery 1705. CT brain c. No treatment b. He has a large hematoma on temporal scalp. His mother informs you that this has happened 3-4 times ebfore. Epilepsy d. BP=110/80mmHg and RR=22bpm. At the time he had a CT brain after banging his head on the steering wheel. which revealed no abnormality. Partial complex seizure 1708. What is the most probable dx? a. Wait for 4h paracetamol level 1706. A 34yo man had a 4mm ureteric stone which he passed in urine. Single most appropriate treatment? a. An 18m girl who has had single UTI is seen in the OPD. No treatment d. She has fever and vomiting but these improved with course of trimethoprim. Subsequently. GAD e. A 35yo man skidded on a wet road while riding his motorbike at a speed of 70mph. XR femur 1707. Post-concussion syndrome 1703. PTSD c.