SAMSONPLAB

ACADEMY LIMITED
BOW BUSSINESS CENTRE
BOW ROAD 153-159
E3 2SE, LONDON
EMAIL: info@samsonplab.co.uk
Telephone: 07940433068/

SAMSONPLAB ACADEMY PLAB 1 MOCK 4

1. A 17 year old man with testicular pain. He denies any history of trauma. On
examination his temperature is 37, BP 120/70 and respiratory rate is 14
cycles/minute. What is the most likely diagnosis?
a. Testicular torsion
b. Epidydimo- orchitis
c. Teratoma
d. Seminoma
e. Hydrocele

2. A 54 year old man had a plaster fitted for tibia/fibula fracture. On routine follow
up in clinic he was found to foot drop and unable to dorsiflex or evert the ankle.
Which nerve is most likely damaged?
a. Common peroneal nerve
b. Femoral nerve
c. Sciatic nerve
d. Superficial peroneal
e. Tibia nerve

3. A 12 year old girl with neural tube defect is brought in by her mother for advice on
urinary incontinence. What is the appropriate management?
a. Clean Intermittent self- catheterization
b. Foley catheter
c. Coude catheter
d. Bladder surgery
e. Permanent catheterisation

4. A 47 year old woman is found to have a 2.5 cm nodule in the left side of the
thyroid. What is the single most definitive investigation?
a. FNAC
b. Ultrasound
c. Stereotactic biopsy
d. CT scan
e. X-ray

5. A 60 four year old man with history of constipation complains of severe pain on
defecation. She is unable to tolerate digital rectal exam. What is the single most
likely diagnosis?
a. Anal fissure
b. Crohns disease
c. Haemorrhoids
d. Faecal impaction
e. Rectal carcinoma

6. A 60 year old patient with heart failure now presents with moderate to severe
depression. What is the single most appropriate treatment?
a. Amitriptyline
b. Cognitive Behaviour Therapy
c. Exercise 3 times a week
d. Fluoxetine
e. Phenelzine

7. A 45 year old man presents with tinnitus, vertigo and deafness. What is the most
likely diagnosis?
a. Meneires disease
b. Acoustic neuroma
c. Otosclerosis
d. Benign positional vertigo
e. Presbyacusis

8. A pregnant lady presents with pain in the wrist at night with tingling and
numbness at the thenar eminence and lateral 3 and half fingers. Which nerve is
involved and at what level?
a. Median nerve at wrist
b. Median nerve at elbow
c. Radial nerve at elbow
d. Radial nerve at wrist
e. Ulnar nerve at wrist

9. A young man with bloody diarrhea and diagnosed of Ulcerative

colitis. What investigation will you do?
a. Colonoscopy
b. Sigmoidoscopy
c. Barium enema
d. Ultrasound
e. X-ray


10. A couple have not been able to conceive despite regular sex for 2years. The
ladys menstrual cycle are regular and of 28days. 21 days progesterone test
shows low level. What is the best treatment for this clinical scenario?
a. Bromocriptine
b. Clomiphene
c. IVF
d. Testosterone

11. A man comes with pain and swelling in front of the knee. Which bursa might
have been involved?
a. Prepatellar bursa
b. Suprapatellar bursa
c. Infrapatellar bursa
d. Semimembranous bursa

12. A 3 year old lady took an overdose of paracetamol after being left unsupervised
for a short period of time. Which of the following is most likely to be a
complication?
a. Hypoglycemia
b. Renal failure
c. Deranged coagulopathy
d. GIT bleeding
e. Headache

13. A 70 year old man with history of hypertension and pain on walking presents
with abdominal pain radiating to his back. What is the most likely diagnosis?
a. Acute pericarditis
b. Pericarditis
c. Dissecting aortic aneurysm
d. Renal stones
e. Chronic pancreatitis

14. A 30 year old man presents with sudden onset of chest pain, which started while
he was cycling. On examination, the trachea was deviated to the left. What is the
most appropriate management?
a. Chest drain
b. Aspirin
c. Cannula decompression
d. Chest X-ray
e. Admit patient

15. A 35 year old Irish business man presents with palpitations, chest tightness and
generalized chest pain. He says he also experiences peri-oral anaesthesia. What
is the most likely diagnosis?
a. Myocardial infarction
b. Tension pneumothorax
c. Anxiety
d. Asthma
e. Gastro esophageal reflux

16. A 53 year old builder has injured his arm and is admitted to the ward. Late at
night he becomes aggressive, shouting at nurses and other patients, wanting to
leave the ward and saying that he can see ants running all over the walls. Which
is the single most likely cause of the symptoms?
a. Abnormal reaction to analgesic medication
b. Alcohol withdrawal
c. Dissocial personality disorder
d. Head injury
e. Past history of schizophrenia

17. A 20 year old woman took 40 tablets of paracetamol 9 hours ago. Which is the
single most appropriate treatment?
a. Activated charcoal
b. Diazepam
c. Fulmazenil
d. N-acetylcysteine
e. Naloxone

18. A 34 year old woman has severe abdominal pain and blood in her stool.
Abdominal and pelvic examination are normal except for multiple surgical scars
all over the abdomen consistent with laparascopies and an appendicectomy. She
gives stool sample from home with blood in it but has not managed to produce
one in the hospital. Blood and urine investigations are normal but she insists on
further investigations. Which is the single most likely diagnosis?
a. Delusional disorder
b. Hypochondrial disorder
c. Malingering
d. Mild-moderate depressive episode
e. Munchausen syndrome

19. A 25 year old man is disoriented and has slurred speech and respiratory
depression. He also has miosis. What is the single most likely cause?
a. Alcohol abuse
b. Carbon monoxide poisoning
c. Opiod abuse
d. Paracetamol overdose
e. Salicylate overdose

20. A 70 year old woman on paroxetine has increasingly become weak and
confused. What is the single most likely reason for her confusion?
a. Hypercalcemia
b. Hypernatremia
c. Hypocalcemia
d. Hypoglycemia
e. Hyponatremia

21. A 26 year old woman and her 28 year old partner came to the p surgery
complaining of primary infertility for 2 years. She gives a history of irregular
menstrual cycles. What is the best test to see whether she is ovulating or not?
a. Basal body temperature
b. Cervical smear test
c. Day 2 LH and FSH
d. Day 21 progesterone level
e. Endometrial biopsy

22. A young man has a viral infection and after recovery he develops
pain around the eyes and maxilla. What is the diagnosis?
a. Sinusitis
b. Herpes zoster

c. Orbital cellulitis


23. Which of the following medication is preferred in patients with hypertension and
renal failure if the renal failure is normal and renal artery stenosis has been
excluded?
a. Loop diuretics
b. Beta blocker
c. Amlodipine
d. Lisinopril
e. Simvastatin

24. An elderly man keeps blaming the wife for unusual things. He
forgetful, emotionally labile and sometimes found wandering about.
Which of the following is supportive of Alzheimers
a. Stepwise deterioration in memory
b. Progressive memory and cognition loss
c. Strong family history
d. Unusual sexual adventures
25. A pregnant patient present with severe vomiting in the 1st trimester.
Which IV fluids should be given?
a. 0.9% normal saline
b. 5% Dextrose
c. 9% normal saline

26. A 21 years old female in her first pregnancy at 38 weeks was brought to the
emergency with a generalized tonic clonic seizure. What treatment will you give?
a. Mgso4
b. Lorazepam
c. Diazepam
d. Barbiturate
e. Phenytoin

27. A 26 year old lady in her 38 week of pregnancy has been admitted with
eclampsia for which she has magnesium sulphate. A few hours later she has a
seizure again. What is the single most important immediate management of this
patient?
a. IV MgSO4 repeat
b. IV Diazepam
c. Immediate caesarian section

d. IV Phenytoin
e. IV Lorazepam

28. What would be the latest time to give anti-Rho in unsensitized

woman
after
delivery?
a.
6
hrs
b.
24hrs
c.
48hrs
d. 72hrs

29. A patient has indirect inguinal hernia...which is the anatomical

landmark which differentiate the indirect inguinal hernia from the direct
one?
a- passes through Superficial inguinal ring
b- passes through Deep inguinal ring.
c- passes through Pubic tubercle.......
d- Mid-point of inguinal ligament

30. A 60 year old lady is being treated for breast cancer. She is about to be started
on Tamoxifen. What is the single most important side effects to worry about?
a. Cataract
b. Dysuria
c. Vaginal bleeding
d. Skin blisters
e. Myalgia

31. A 53 years old man was admitted to the hospital for

investigations of hemoptysis. 3 days after admission he developed
alternating state of consciousness, ataxic gait and some visual
problems.
What is the most appropriate management of this patient?
a. Acomprosate
b. Chlordiazepoxide
c. Diazepam
d. High potency vitamins
e. Disulfiram

32. A 15 years old boy presents with testicular pain for 2 days. There is no history of
trauma. He has a temperature of 38.5 C and right testes are swollen and tender.
What is the single most appropriate next step in the management?

a. Give antibiotics
b. USG of Scrotum
c. Immediate surgical referral
d. Give analgesics
e. Mid stream urine

33. A 30 year old man present with a swelling in her right breast. Recently she was
involved in a road traffic accident and she sustained injury to her right breast
with a seat belt. What is the most likely diagnosis?
a. Fibroadenoma
b. Breast cancer
c. Fat necrosis
d. Breast abscess
e. Fibroadenosis

34. A 10 year old boy presents with episodes of lack of concentration in class. His
teacher says that the boy has short periods of about 10seconds during which he
doesnt responds but continues whatever he was doing thereafter. What is the
most appropriate investigation?
a. CT scan of the head
b. ECG
c. Electroencephalogram
d. Tilt test
e. Full blood count

35. An 11 year old girl was diagnosed with cystic fibrosis. Her sister who is 10 years
old was tested and found to have no cystic fibrosis. The sister is
asking what is the chance that she may have cystic fibrosis?
a. 1:4
b. 1:2
c. 1:8
d. 100%
e. 0%

36. A 60 year old man presents with chronic back pain. Prostate
specific antigen is 2ng/dl. Urine density is high. What is the single
most likely diagnosis?
A. Benign prostate hyperplasia
B. Hypertensive neuropathy
C. Tuberculosis
D. Myeloma

E. Prostate cancer

37. A 5 year old girl has been brought to accident and emergency department
pencil rubber stuck in her right ear. What is the most
appropriate action?
a. Remove with forceps
b. Remove under general anaesthesia
c. Use a hook
d. Reassure
e. Remove with a needle

38. A 24 year old man from Nigeria was admitted with a week history of headaches.
He was found to have a CD count of 50 and a ring enhanced lesion on CT head.
What treatment would you give?
a. Acyclovir
b. Gancyclovir
c. Pyrimethamine + Sulphadiazine
d. Amphotericin
e. Benzylpenicillin

39. A 50 year old man is stabbed in the neck. He was later found to have abnormal
chest movement. Which structure is damaged?
a. Vagus nerve
b. Phrenic nerve
c. Recurrent laryngeal nerve
d. Intercostals nerve
e. Diaphragm

40. A 10 month old baby has developed blisters all over his body ranging from 2mm
to 10mm in size. Some of the lesions are weeping and crusted. He is febrile.
Which of the following treatment will be the most effective form?
a. Oral acyclovir
b. Oral antibiotics
c. Topical cream
d. No treatment
e. Antifungal




41. A child is diagnosed with cystic fibrosis. Mother is pregnant again and the

parents want to know the chances of their second child developing cystic
fibrosis
a. All children will develop cystic fibrosis
b. There is 1 in 4 chances of all future children developing cystic fibrosis
c. There is 1 in 2 chances of all future children developing cystic fibrosis
d. None of the children will develop cystic fibrosis
e. There is 1 in 2 chances of all future children will be a carrier

42. A lady with jaundice, splenomegaly and schistocytes present in the blood. What
is the most likely diagnosis?
a. Haemolytic anaemia
b. Gilbert syndrome
c. Crigler Najjar
d. Hepatitis A
e. Hepatitis B

43. A child complains of pain and ear discharge after upper respiratory tract
infection. What should be the drug of choice for him?
a. Gentamicin ear drops
b. Ampicillin
c. Amoxicillin
d. Benzyl penicillin
e. Paracetamol

44. A 23 year old African woman presents with heavy menses. What is the most
likely cause?
a. Leiomyoma
b. Leiosarcoma
c. Sickle cell crisis
d. Hypertension
e. SLE

45. A 20 years old man is brought by his parents suspecting that he has taken some
drug. The man is agitated, cant sleep and has a runny nose.
Which one of the following is most likely to be responsible for his symptoms?
a. Cocaine
b. LSD
c. Ecstasy
d. Alcohol
e. Heroin

46. A 2 year old has mid stream urine prove a UTI. What is the next investigation to
be done?
a. Abdominal ultrasound
b. Micturating urethral cystogram
c. CT scan of kidney, ureter and bladder
d. Intravenous unrography
e. Renal biopsy
47. A 70 year old patient with bladder carcinoma and smoking history. What is the
most likely reason for his bladder cancer?
a. Dust
b. smoke
c. diet
d. Alcohol
e. Aniline dye

48. A 17 years old girl presents with a breast lump. She has a strong family history of
breast carcinoma. The lump is 2 cm in diameter and painless, located in upper
outer quadrant of left breast. Which one of the following is the most appropriate
initial investigation for this lump?
a. USG
b. FNAC
c. Mammography
d. Excision biopsy
e. Incision biopsy

49. A 36 year old man goes to a plastic surgeon insisting on surgery saying that his
nose is too big and crooked. He says that people stare at him when he goes out
so he prefers not to leave the house. He feels depressed as a result. He
attributes his recent job loss to his deformed nose. He wants to wear make-up to
camouflage it, but would like surgery to correct what appears to be a normal
nose. Which is the most likely diagnosis?
a. Body dysmorphic disorder
b. Hypochondriasis
c. Mild-moderate depressive episode
d. Obsessive-compulsive disorder
e. Social phobia

50. A 61 year old man attends his GP at the request of his wife who thinks he drinks
too much alcohol. Which single factor is a sign of alcohol dependence?
a. A wide repertoire of alcoholic drinks
b. Decreased tolerance to alcohol
c. Drinking 28 units of alcohol once a week
d. Drinking despite evidence of its harm to job and family
e. Drinking until late in the evening

51. A 20year old man has a first episode of psychosis. Your consultant asks you to
prescribe a typical anti-psychotic. Which single drug
should be prescribed?
a. Chlorpromazine
b. Haloperidol
c. Lorazepam
d. Mirtazapine
e. Olanzapine

52. A 52 year old woman has low mood, tiredness and weight gain with decreased
appetite. She is tearful and overweight with dry skin and thin hair. Which is the
single most useful test to aid disgnosis?
a. Chest X-ray
b. Electrocardiogram
c. Full blood count
d. Thyroid function test
e. Urea and electrolytes

53. A 60 year old man with long standing hypertension for 30 years
has a residual urine of 80ml. What is the single most likely cause?
A. BPH
B. Normal residual volume
C. Hypertensive retinopathy
D. Prostate cancer
E. Urinary tract infection


54. An 85 year old lady who is a resident of a nursing home presents with intractable
itching. On exam there are burrows between fingers. What is the single most
appropriate management?
a. Treat with 5% permithrin
b. Hydrocortisone
c. Ketonazole cream
d. Wash hands
e. Topical acyclovir
55. A 47 year old man presents with shortness of breath. He is noticed to have
nodules on shin. Chest x-ray shows bilateral hilar enlargement. How would you
describe the lesion on his shin?
a. Erythema nodosum
b. Erythema multiforms

c. Papules
d. Urticaria
e. Erythema Chronicum migrans

56. An 85 year old diabetic patient with blood pressure 128/85 presents with
microalbuminuria. What is the best treatment you would give her?
a. Angiotensin converting enzymes inhibitor
b. Calcium Channel Blocker
c. B-blocker
d. Thiazide diuretic
e. Spinorolactone

57. A 40 year old man presents with abdominal bloating and pale bulky stools which
is difficult to flash in the toilet. What is most definitive investigation?
a. Endomysial antibodies
b. Sweat test
c. Duodenal biopsy
d. Anti globulin antibodies
e. Fatty stool studies

58. A 70 year old woman has been getting forgetful gradually for the
past 4 weeks and now she has got low mood. He has also been
indifferent towards her Husband. What is the single most likely
diagnosis?
A. Depression
B. Schizophrenia
C. Alzheimers
D. Lewy body dementia
E. Urinary tract infection.

59. A 56 year old man with long standing COPD is complaining of blurry visual
disturbance. He is on multiple medications for COPD. Which of the medications
is responsible for the visual disturbance?
a. Theophylline
b. Corticosteroids
c. Oxygen
d. Ipatropium bromide
e. Salbutamol

60. Fat kid with Diabetes Mellitus type 1 keeps eating haphazardly
and skips his insulin intentionally. He hates to go to school. Who

will
you
a.
b.
c.
d. Social worker

refer
Child

this

patient
to?
psychologist
Pediatrician
Dietician

61. A 2 year old child presents with sudden onset of testicular pain. There is no
history of trauma. He has temperature of 38.5 and the right testis is swollen and
tender. What is the most appropriate next step in management?
a. Give antibiotics
b. USS of the scrotum
c. Immediate surgical referral
d. Reassure
e. Herniotomy
62. A man who has been on treatment for 20 years for type 1 diabetes mellitus
complains of blurring vision and frequent changes of his reading glasses. Where
could be the location of his eye lesion?
a. Retina
b. Choroid
c. Lens
d. Iris
e. Cornea

63. A child presents with absence seizures. What treatment will you
give?
a. Lorazepam
b. Ethosuximide
c. Vigabatriene
d. Sodium valproate
e. Lorazepam

64. A woman had a motor car accident and comes to the A&E with pain and
rigidness of the abdomen. Her condition is settled now. What investigation
should be done next?
a. CT scan of the abdomen
b. Ultrasound scan
c. Abdominal X-ray
d. 0.9% saline
e. Percutaneous lavage

65. A 55 year old man presents with recurrent episodes of chest pain. All the

investigations on ECG are normal. You however suspect angina. What

investigation would you do to confirm the diagnosis?
a. Repeat ECG
b. Cardiac enzymes
c. Exercise ECG
d. Echocardiography
e. Doppler USS

66. A 70 year old man has had progressive difficulty on swallowing especially for
solids. What investigation will you do to confirm the diagnosis?
a. Barium swallow
b. Chest X-ray
c. Endoscopy and biopsy
d. CT scan
e. No investigation

67. A 35 year old man had an operation for nasal polyp. He has come back after 6
days with nasal bleeding. What is the most likely cause?
a. Sinusitis
b. Nasopharyngeal Carcinoma
c. Septicemia
d. Nasal picking
e. Post operation bleeding

68. A 24 year old man had sex with another man. Later he developed an ulcer on the
penis, which later healed. He is now presenting with urethral discharge. What
investigation would you do to confirm the diagnosis?
a. MSU
b. Syphilis serology
c. Blood culture
d. Antibodies
e. PCR



69. A child complains of pain in the abdomen and headache for the past 6months.
On examination, everything is normal and nothing significant is found on USG
and CT scan. What management should be done for the child?
a. Plain abdominal X-ray
b. Reassurance
c. Paracetamol

d. Antispasmodics
e. Codeine sulphate

70. A woman complains of dyspareunia, dry mouth, dryness of the eyes, dry vagina
and difficulty in eating biscuits. What tests should be done?
a. DsDNA
b. ANCA
c. Anti centromere antibodies
d. Anti- Ro, anti-A (SSa, SSb)

71. A nurse washing hospital platforms and work stations many times repeatedly
feeling they are dirty and keeps cleaning despite being told by head nurse and
supervisors that the work stations are clean. Choose the most appropriate action
a. Anti-depressants
b. CBT
c. Reassure
d. ECT
e. Anti-psychotic therapy

72. A 36 year old man with psychotic depression complains that someone is
controlling him and saying that he should die. Choose the most appropriate
action.
a. Clonazepine
b. ECT
c. Amitriptyiline
d. CBT
e. Haloperidol

73. A 33 year old woman with bipolar affective disorderis due to be started on a
mood stabilizer. She has some questions about lithium. Which single symptom or
sign is a common side effect of lithium at therapeutic levels?
a. Coarse tremor
b. Dysarthria
c. Improvement of pre-existing skin condition
d. Thirst
e. Weight loss

74. AA 10 year old boy has fever and now presents with blisters on
his face and neck which are now spreading. What is the diagnosis?
a. Chicken pox
b. Herpes zoster

c. Measles
d. Rubella
75. A patient is found to have hypercalcemia on investigation at the
hospital. What should be the initial treatment?
a. IV fluid
b. Bisphosphonates
c. Calcitonin
d. Calcium

76. A 79 year old man has personality change and worsening orientation. He has
tremor and plantar reflexes and bilateral small pupils that dont constrict to light
but constrict on accommodation. Which is the single most useful diagnostic
investigation?
a. Chest X-ray
b. CT scan of the brain
c. Electroencephalogram
d. MRI of the brain
e. Veneral Disease Research Laboratory (VDRL) test

77. An 8 year old boy with body mass index (BMI) of 28kg/m2 was admitted to a
surgical ward following a motor vehicle accident. He was found to have glycosuria.
When he recovers from his injury, the glycosuria resolves. What is the single
most
appropriate follow up investigation?
a. Fasting blood glucose concentration
b. Glycosylated haemoglobin
c. Oral glucose tolerance test
d. Random blood glucose concentration
e. Serum cortical concentration

78. A 60 year old lady presents for review for hypertension. She is well controlled
with a BP of 138/86mmHg. On reviewing her cholesterol, her total cholesterol
level is 7.8mmol/l and her High Density Lipoprotein (HDL) is 0.8mmol/l. she also
has intermittent claudication. Her BMI is 25. Which of the following is the most
effective preventive measure?
a. Stop smoking
b. Loose weight
c. Beta blocker
d. Statin
e. Exercise

79. A 35 year old lady has 2 children and also has a BMI of 22. She is normally fit but
decided to have a laparoscopic sterilization. What is the chance of failure of this
procedure in the lady?
a. 1 in 50
b. 1 in 200
c. 1 in 1,000
d. 1 in 5,000
e. 1 in 10,000

80. A 70 year old man presents to the emergency department with abdominal pain.
He has a pulsatile mass in the abdomen. Which of the following is the
investigation of choice?
a. Abdominal ultrasound
b. CT abdomen
c. Spiral CT
d. Laparoscopy
e. CT pulmonary angiogram

81. A patient with metastatic breast cancer, presented with altered

sensorium, swelling of the upper part of the body and the neck and
has been on adjuvant therapy, what is the next line of management,
a. IV dexamethasone
b. Oral prednisolone
c. Radiotherapy
d. Chemotherapy
e. Surgery
82. A man presented with severe gastric tenderness, a biopsy shows
abnormal cell infiltration of the lamina propria, what is the most
likely diagnosis?
a. Adenocarcinoma
b. Squamous cell carcinoma
c. Basal cell carcinoma
d. Melanoma
e. Lymphoma
83. A woman presented with pain, x-ray shows low density and
sclerotic edges and she is on hormone replacement therapy. What
other medication will u add?
a. Proton pump inhibitor
b. Bisphosphonate
c. Raloxifene

84. A 29 year old woman has recently been diagnosed as having generalized anxiety
disorder. Which is the single best initial approach to management?
a. Advise her to keep a diary of when she feels anxious
b. Explain the condition to her writing down the essential points
c. Give her a standard information leaflet
d. Provide information on the medication that can be used
e. Recommend a self help book

85. A 48 year old man with alcohol dependence has been found wandering in the
street. He has some clouding of consciousness, nystagmus and opthalmoplegia.
Which is the single most appropriate medication to administer initially?
a. Acamprosate
b. Disulfiram
c. Metoclopramide
d. Naloxone
e. Thiamine



86. A 30 year old woman with panic disorder has been treated with cognitive
behavioral therapy, which has only partially helped her symptoms. She requests
further treatment and is prescribed citalopram. Which is the single most likely
side effect profile that she should be warned about?
a. Confusion and memory problems
b. Drowsiness, palpitations and postural hypotension
c. Dry mouth, blurred vision and constipation
d. Nausea, gastrointestinal upset, restlessness and insomnia
e. Weight gain

87. A 27 year old woman with anxiety and weight loss has a tachycardia, tremor and
proptosis. What single mechanism accounts for her weight loss?
a. Deficiency of thyroid hormone
b. Increased levels of calcitonin
c. Increased metabolic rate
d. Insulin resistance
e. Reduced calorie intake

88. A patient has had his Upper Limb dangling over the operating
table and has loss of sensation in the first web space.

What
a.
b.
c.
d. Ulnar nerve

nerve
is
Musculo-cutaneous
Radial
Brachial

affected?
nerve
nerve
plexus

89. A 23 year old woman who is 12 weeks pregnant has been admitted with nausea
and vomiting. What is the single most useful blood test in the immediate
management?
a. Plasma estradiol
b. Serum beta human gonadotropin (bHCG)
c. Serum free thyroxine
d. Serum human placental lactogen (HPL)
e. Serum electrolytes and urea

90. A 15 year old girl has irregular menses and heavy menstrual
bleeding.
What
is
the
most
appropriate
treatment?
a.
Combined
oral
contraceptive
pill
b.
Progestion-only
pill
c.
Levonorgestrel
IUCD
d.
mefenemic
acid
e. Tranexamic acid

91. A 25 year old woman had diarrhea for 4 days and still looks quite unwell. What
will be the ABG finding?
a. Ph 7.2, Pa CO2 2
b. Ph 7.2, Pa CO2 12.5
c. Ph 7.4, Pa CO2 5
d. Ph 7.6, Pa CO2 2
e. Ph 7.6, Pa Co2 12

92. An 18 year old boy is brought to the emergency dept with a

history of sudden severe testicular pain that has been present for 3
hours. Urinalysis shows no glucose, protein of leukocytes and is
negative for nitrates. There is no palpable mass. What is the
diagnosis?
a. epididymoorchitis
b. Haemangioma

c. Testicular torsion
d. Testicular tumour

93. A 6week old child with a history of vomiting for 1 week has gained 300gm
weight since birth despite being hungry. On examination, the eyes are sunken
and skin turgor is decreased. What is the most likely diagnosis?
a. UTI
b. Pyloric stenosis
c. Meningitis
d. Duodenal atresia
e. Cystic fibrosis

94. A 4 year old child presents with recurrent swelling of knees and elbow. He
generally feels unwell and cannot take part in sports. What investigation will be
abnormal?
a. Uric acid
b. ESR
c. Rheumatoid factor
d. Neutrophils
e. Joint fluid aspiration

95. A 2 month old child with diarrhea and vomiting for 6 days. The mother says the
child has not been himself and has been lethargic for the past few days. What is
the most appropriate immediate investigation?
a. FBC
b. USS of the abdomen
c. Urea and electrolytes
d. Liver function tests
e. Stool culture

96. A 23 year old man has pain in the left flank. He says his mother and sister had
the same problem. What is the most appropriate investigation to do?
a. Angiogram
b. CT Scan of the abdomen
c. USS of the abdomen
d. IVU
e. Barium enema

97. A 2 weeks old child has jaundice. He is breast fed and is gaining weight fine and
also playing normally. What investigation would you do to confirm the diagnosis?
a. Breast milk analysis

b.
c.
d.
e.

Total bilirubin
Split bilirubin
USS liver
Coombs test

98. An 18year old girl took paracetamol overdose and left a suicide note. She was
admitted to the ICU. After 2 days she recovers and wants to go to a dress party.
What is the next step in management?
a. Discharge the patient
b. Counsel the patient
c. Refer to the psychiatric nurse
d. Allow her to go home and come back
e. Send her to the outpatient department

99. A 29 year old man had a chest drain inserted following a traumatic
pneumothorax. Which structure is likely to be damaged during the procedure?
a. Azygous vein
b. Intercostal nerve
c. Intercostal artery
d. Liver
e. Intercostals vein
100. A 50 year old man has been complaining of hearing loss in the right ear as well
as nystagmus and ataxia.
Rhinnes is positive on both sides and Weber lateralizes to the left
What is the most appropriate diagnostic investigation?
a. CT brain
b. MRI brain
c. Skull X-ray
d. Otoscopy
e. Audiogram

101. A 56 year old man has been passing blood at the end of his micturition. What
investigation will you do?
a. Cystosopy
b. USS pelvis
c. MSU
d. Urine dipstick
e. Auto-antibody screen

102. A 70 year old lady has been found to have peripheral neuropathy and
nephropathy. She recently has been complaining of decrease in her vision.

What is the most likely cause of the decrease in her vision?

a. Cataract
b. Glaucoma
c. Age related macular degeneration
d. Diabetic retinopathy
e. Hypertensive retinopathy

103. A 5 day old baby was found to have no gas bubble on abdominal X-ray. It was
noted from the history that during intrauterine life the mother had
polyhydramnios. What is the single most likely abnormality?
a. Pyloric stenosis
b. Duodenal atresia
c. Esophageal atresia
d. Tracheal atresia
e. Esophageal trachea-fistula

104. A 56 year old man was brought to accident and emergency

department by her friend his short of breath. His respiratory rate
is 24, blood pressure 100/80 and pulse 100. His abdomen is
tender and has rigid. What is the single most appropriate
immediate management?
A. secure airway and cervical spine
B. Get intravenous access and give normal saline
C. Give CT scan abdomen
D. Ultrasound scan abdomen

105. A 60 year old man is found to have corneal ulcer with prolonged discharge.
What is the most likely organism?
a. Staphylococcus aureus
b. E. coli
c. Pseudomonas
d. Streptococcus
e. H. influenza

106. A 40 year old alcoholic man had fractured femur for which he underwent an
operation. 2 days post-op he becomes noisy, confused and irritable. Which of
the following medication is the most appropriate for the next step of
management?
a. Oral diazepam
b. Oral lorazepam
c. Chlordiazepoxide
d. Vitamin B

e. Amoxicillin

107. A 4 year old girl was found to have a 1st episode of UTI and was treated with
trimethoprim. She has responded well to treatment. What is the next step in
management?
a. No investigation
b. Pediatric follow up for recurrence
c. USG of the kidneys
d. IVU
e. Cystoscopy

108. Which one of the following is supplied by the maxillary division of the
trigeminal nerve?
a. Cornea
b. Palate
c. Cheek
d. Oropharynx
e. Tongue

109. An 80 year old lady has had several episodes of collapse without warning. The
daughter said she looked pale before falling. What is the most appropriate
investigation?
a. BP monitoring
b. 24 hours ECG monitoring
c. ECG
d. No investigation
e. CT head
110. A 30 year old lady took 30 tablets of paracetamol. She needs to be treated but
she is refusing treatment. She wants to self discharge. What is the single most
appropriate next step in her management?
a. Allow her to self discharge
b. Take counsel from her mother
c. Refer to the psychiatrist
d. Assess her capacity to refuse treatment
e. Admit involuntarily

111. A 4 year old boy presents with bleeding from he nose and into
his joints for an hour. Clotting screen shows APPT 50, Bleeding
time 6min. What is the single most likely diagnosis?
A. Vitamin K deficiency

B.
C.
D.
E.

Hamophillia
Von Wilebrand disease
Idioppathic thrombocytopenic purura
Haemolytic uraemic syndrome

112. A 67 year old man after myocardial infarction has developed depression. Which
is the most appropriate anti-depressant?
a. Amitriptyline
b. Citalopram
c. Fluoxetine
d. Diazepam
e. Lorazepam


113. A 39 year old woman while in the restaurant developed shortness of breath,
angioedema and uritcaria with itching. She has been brought to the hospital.
Which is the most appropriate treatment?
a. IV Hydrocortisone
b. IV Adrenaline 1: 1,000
c. IV Adrenaline 1:10,000
d. IM Adrenaline 1: 1,000
e. IM Adrenaline 1: 10,000

114. A 60 year old fell on an outstretched hand and sustained a closed fracture of
the distal radius. On examination, there is deformity and X-ray shows
displacement and angulation of the distal radius. The ulnar nerve is affected.
What is the most appropriate next step in management?
a. Send to the fracture clinic
b. Admit and review the following morning
c. Closed reduction in emergency department
d. Open reduction in emergency department
e. Take to the theatre immediately

115. A 67 year old man who lost his job following consist bad performance at work
and bad behavior. He was then found wandering in the park. On testing, no
alcohol was found in his blood. Whats the most appropriate next step?
a. IV Thiamine
b. Mental state examination
c. Neuropsychological analysis
d. CT head
e. EEG

116. A 50 year old man lost his job and is now homeless. He was found wandering in
the park and muttering as if people were after him. Alcohol was tested and was
negative. What is the most appropriate management?
a. Thiamine
b. EEG
c. Neuropsychological analysis
d. CT head
e. EEG

117. A 40 year old lady presents with nausea, vomiting and severe pain in the right
eye. She also sees haloes when she looks at bright lights. Her vision is affected
as well. What is the most appropriate investigation?
a. Visual acuity
b. Intraocular pressure management
c. Temporal artery biopsy
d. ESR
e. Fundoscopy

118. A 17 year old presents with 5 day history of urinary frequency and dysuria. She
has a weight of 20kg despite good appetite. She has been taking over the
counter preparation for premenstrual tension for several months.
Urinalysis show no glycosuria but positive for nitrates. What is the single most
likely diagnosis?
a. UTI
b. Diabetes insipidus
c. Diabetes mellitus
d. Diuretic therapy
e. Vesicourethral reflux

119. A child with sore throat for hours, sitting on the mothers knee and is tolerating
an oxygen mask but looks unwell. He has constant noisy breathing and he is
drooling saliva. His temperature is 39 degrees Celsius, Blood pressure is
120/80mmHg. Heart rate is 105b/m.
What is the single most appropriate diagnosis?
a. Epiglotitis
b. Bronchilitis
c. Croup
d. Tonsillitis
e. Asthma

120. A 50 year old man presents with a lesion on the left side of the mouth, on
protrusion of the tongue, it is deviated to the left. What investigation will you
do next?
a. USS
b. FNAC
c. CT
d. X-ray
e. MRI

121. A 40 year old man presents with perioral itching, bronchospasm, shortness of
breath and stridor. What is the best initial management?
a. IM adrenaline
b. Chlorphenamine
c. Antihistamine
d. Nebulised salbutamol
e. Nebulized adrenaline

122. A 65 year old man has anterior resection performed for rectal carcinoma. His
initial operative recovery was uneventful but on day five he has a sudden onset
of severe lower abdominal pain. He has tachycardia and marked lower
abdominal tenderness. What is the single most likely diagnosis?
a. Anastomotic leak
b. Atelectasis
c. Pneumonia
d. Paralytic ileus
e. Sepsis

123. A 50 year old man with renal failure presents feeling unwell. Hi urea and
electrolytes shows potassium 7.3, calcium 2.51, sodium 143 , urea 12 and
creatinine 160 mmol/l and normal liver function test. What is the initial most
appropriate management?
a. Calcium gluconate
b. Insulin and glucose
c. Salbutamol nebulizer
d. Hemodialysis
e. Furosemide

124. A 45 year old man was involved in road traffic accident and sustained head
injury. Which of the following is the electrolyte imbalance in head injury with
SIADH?
a. Low serum osmolarity and hyponatremia

b.
c.
d.
e.

High serum osmolarity and hypernatremia

Low serum osmolarity and hypernatremia
High serum osmolarity and hyponatremia
High serum osmolarity and normal sodium

125. A 2 year old boy presents with bloating of the abdomen and diarrhea. Which of
the following features suggest celiac disease?
a. Endomysial antibody
b. Ant-phospholipid antibodies
c. Anti-mitochondrial antibodies
d. Low amylase
126. A 2 year old boy was brought to the hospital by her mother because he has a
white discharge from the eyes. There is no redness or swelling of the eye. There
is also no fever and the child has the white sticky discharge when he wakes up
in the morning. What is the most appropriate action?
a. Topical antibiotics
b. Clean with sterile water
c. Acyclovir
d. Admit
e. Systemic antibiotics through an IV line

127. An 8 year old girl presents with unconsciousness. Her respiration is deep and
sighing. Her blood glucouse is 29mmol/l. What is the most appropriate
management?
a. 0.9% saline with insulin
b. 9% saline with insulin
c. 0.45% saline with insulin
d. 5% dextrose
e. Normal saline

128. A 60 year old lady had extensive surgery for breast cancer. Which of the
following makes it more unlikely that he had a complete clearance?
a. Family history
b. Tumour grading
c. Lymph node involvement
d. Age
e. None of the above

129. A 23 year old man was eating in the restaurant when he developed urticaria,
facial swelling and itching. He had asthma as a child. He has now been treated
successfully and he is going home. What is the most appropriate action?
a. Oral chlorpheniramine
b. Epiphen
c. Oral prednisolone
d. Non-steroidal anti-inflammatory drugs
e. Anti-histamine

130. A 32 year old lady took 30 tablets of paracetamol 6 hours ago. What is the
most appropriate treatment?
a. Activated charcoal
b. Gastric lavage
c. N-acetyl cysteine
d. Observe for 24 hours
e. Discharge home


131. A 50 year old man has developed erectile dysfunction after treating treatment
on some medication. Which of the following medication is likely to be
responsible for the side effect?
a. SSRI
b. Anti-epileptic
c. Organic cause
d. NSAIDs
e. Paracetamol

132. A 36 year old man had eradication therapy for H.pylori 4 weeks ago. Which of
the flowing test is the most appropriate to check for eradication?
a. Upper GI endoscope
b. Urea breath test
c. H.pylori serology
d. Ph monitoring
e. Manometry

133. A 64 year old man with a long standing 1cm lesion on his arm. Recently it
started to bleed on touch. What is the most probable diagnosis?
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Malignant melanoma
d. Psoriasis

134. A man with diabetes mellitus comes to the A&E after he collapsed in his house.
His GCS is 10. What should be the next initial investigation for this man?
a. Capillary blood sugar
b. MRI scan of the head
c. CT scan of the head
d. Serum electrolytes

135.A 30 year old man who is a known asthmatic fell down and
sustained injury to his let arm. X-ray were done and no fracture
was found. What is the single most appropriate analgesia?
A. Paracetamol
B. Morphine oraly

C. Non steroid anti-inflammatory Drugs

D. Tramadol and codeine
E. Intravenous morphine

136. A 68 year old lady with type II diabetes mellitus. Which drug should be
prescribed?
a. Biguanides
b. Sulphonylurea tablets
c. Insulin
d. Dietary modifications

137. A 24 year old lady in her 24 weeks of pregnancy comes to the antenatal clinic
for follow up. She says that she cannot feel the kicks of her baby for the past 4
days. What is the most appropriate test that should would you do to check that
the baby is viable?
a. Kieheur test
b. Cardiotocography machine
c. Fetoscope
d. Pawlick grip
e. Mothers blood test

138. A 78 year old man with known COPD was carried by ambulance from his home
to the hospital with shortness of breath. He was given oxygen in the ambulance.
He arrives in the hospital and he is now virtually comatose. What is the most
appropriate investigation to do?
a. Pulse oximetry
b. Arterial blood gases
c. Chest X-ray
d. Peak expiratory flow meter
e. Blood culture

139. A 21 year old lady was brought to the hospital by her parents who are worried
that she has lost a lot of weight. The patient herself is concerned as she is
preparing for her A level exams. On examination, you find that she has a BMI of
21 and is wasted. What is the most appropriate action?
a. Admit for treatment
b. Refer to the psychiatrist
c. Follow up in the outpatient clinic
d. Advise about diet
e. Refer to the dietician

140. A 76 year old lady has just been diagnosed with giant cell arteritis and she has

been put on appropriate treatment. What other treatment is required?

a. Biphosphonate
b. Calcium
c. Paracetamol
d. Ferrous sulphate

141. The blood report of a 70year old man shows the following results
Ph 7.15, Pa Co2 2.2, PaO2 7.0, HCO3 18.
What does the result show?
a. Metabolic acidosis
b. Hyperventilation
c. Metabolic alkalosis
d. Respiratory alkalosis
e. Respiratory acidosis


142. A 57 year old man had a circumferential burn on his upper arm. He presents to
the accident and emergency department with tingling and numbness in his
fingers. What is the appropriate management?
a. Fasciotomy
b. Escharotomy
c. Apply ice
d. Analgesia and reassure
e. Intravenous fluids

143. A 56 year old man presents to the emergency department with 3 days history
of palpitations. An ECG shows atrial fibrillation. What is the most appropriate
treatment?
a. Metoprolol
b. Digoxin
c. Diltiazem
d. Amlodipine
e. Aspirin

144. A 30 year old man presents with renal colic. KUB shows a stone in the pelvis
which looks like a pointed opening part of an envelope. What is the
composition of the stone?
a. Calcium
b. Urate and calcium
c. Phosphate
d. Calcium, magnesium and ammonium
e. Cysteine, phosphate and urate

145. A 2 month old baby presents with swelling in the neck. On examination, you
notice that it transilluminates brightly. What is the diagnosis?
a. Cystic hygroma
b. Dermoid cyst

c. Lipoma
d. Thyroglossal cyst
e. Carotid body tumour

146. A man who is a heavy smoker presents with a long history of breathlessness on
exertion and productive cough. His blood gas results are as follows;
PO2 7.0kpa, PCO2 6.5kpa, Ph 7.30.
What is the single most appropriate treatment?
a. Aminophyline infusion
b. Invasive ventilation
c. Non-invasive ventilation
d. 24% oxygen
e. 100% oxygen



147. A child comes to the A&E with severe asthma and is not responding to
salbutamol nebulizer and is also vomiting many times. What is the most
appropriate management?
a. Salmetrol
b. Monteleuklast
c. Prednisolone
d. Budsonide inhaler
e. oxygen
f. IV salbutamol

148. A woman 5 days post operative for bilateral salphingoopherectomy and
abdominal hysterectomy has developed abdominal pain and vomiting with
associated abdominal distension and cannot pass gas. No bowel sounds are
heard and she is also dehydrated. Choose the most appropriate next step
a. Plain abdominal X-ray
b. Exploratory laparatomy
c. CT scan
d. USG
e. Barium enema

149. A 48 year old woman is admitted to the hospital for routine surgery. She takes
once daily lithium for treatment of bipolar disorder. Which is the single correct
time to take her blood to check the plasma levels of lithium?
a. Immediately before her dose
b. 2hours after her dose
c. 8hours after her dose
d. 12hours after her dose
e. 20hours after her dose

150. A pregnant woman in her 2nd trimester has a BP of 160 / 90,

without any other signs or symptoms. What is the drug of choice?
a. Labetalol

b.
c.
d.
e.

Hydralazine
Atenolol
Calcium channel blocker
Magnesium sulphate

151. A previously healthy 78 year old man has a severe depressive illness. He has
not responded to various treatment so far and his consultant wants to
prescribe a tricyclic antidepressant. Which is the single most important
investigation before commencing treatment?
a. CT scan of the brain
b. ECG
c. Full blood count
d. Urea and electrolytes
e. Urinalysis
152. A 60 year old man presents with weakness of his left side with dysphasia and
loss of vision in the right eye. By the time she reaches accident and emergency
department all the symptoms had disappeared. What is the single most
appropriate next step investigation.
a. Carotid doppler
b. CT scan
c. MRI
d. Blood glucose
e. Angiograph of carotid arteries

153. A 67 year old diabetic patient is taking diabetic medication. He has to undergo
gastroscopy. When would you advice to stop the medication?
a. Never stop the medication
b. 1 day before the procedure
c. 1 week before the procedure
d. 2 weeks before the procedure
e. 3 days before the procedure

154. A 30 year old man had cholecystectomy 4 days ago . He now has constipation
and vomiting but no abdominal pain. What is the most likely cause?
a. Paralytic ileus
b. Anastomotic leak
c. Intussuception
d. Perforated bowel
e. Intestinal obstruction

155. A patient, post myocardial infarction presents with depression. What
antidepressant to give?

a.
b.
c.
d.
e.

Citalopram
amitriptyline
Dosulepin
Chlorpromazine
Haloperidol

156. A man presented with 55% burns and severe chest pain, on
oesophagogastroduodenoscopy, there were multiple ulcers in the
duodenum. He is haemodynamically stable. What is the
management will you give?
a. IV fluids
b. Proton Pump Inhibitor
c. Analgesia

157. A 60 year old man presents with dysphagia, difficulty to swallow solid and liquid.
What is the single most appropriate initial investigation?
a. Barium meal
b. Endoscopy and biopsy
c. CT scan chest
d. BNMRI scan chest
e. Chest X-ray

158. A 35 year old woman presents with diarrhea and vomiting and dehydration.
What is the most appropriate treatment?
a. IV normal saline
b. IV saline and potassium
c. Water by moth
d. 5% glucose
e. Oral Rehydration Solution

159. A 53 year old presented with pain in the eye, blurry vision and clumsiness for 3
months. She had a history of difficulty swallowing and weakness in her right
upper limb 2 years ago. What is the investigation of choice?
a. CSF analysis
b. EEG
c. EMG
d. MRI of the brain
e. Visually Evoked Response test (VER)

160. An employer sent his worker to the A&E department after having hit his head
on a machine. On examination he is found to be normal. What is the most
appropriate management?
a. Skull X-ray
b. CT scan head
c. MRI head

d. Reassure
161. A 65 year old lady presents with hypertension without any history of cough and
renal failure. What drug should be prescribed to her?
a. Thiazide diuretics
b. ACE-I
c. B-blockers
d. Ca- channel blockers
e. Alpha blockers

162. A child after falling has facial lacerations on his right cheek and sub-conjunctival
hemorrhage. There is no history of loss of consciousness or any neurological
features. What investigation should be done?
a. Facial X-ray
b. Skull X-ray
c. CT scan head
d. MRI head
e. Ultrasound scan of the head.

163. A 45 year old man was found to have his disc prolapsed following heavy lifting.
Which one of the following is the most appropriate management?
a. Take rest for 1 week
b. Immobilization
c. Early mobilization and analgesia
d. Analgesia
e. Bed rest for 1 week
164. A 65 year old man has had central crushing chest pain and palpitation which
lasted for 2 hours. ECG shows left bundle block. What is the most likely
diagnosis?
a. Acute coronary syndrome
b. Acute myocardial infarction
c. Pericarditis
d. Unstable angina
e. Stable angina

165. A 35 year old man has had severe right-sided loin pain, which radiates to his
testicles. What is the most appropriate analgesia?
a. Morphine
b. Paracetamol and codeine
c. Diclofenac IM
d. Morphine IM
e. Tramadol


166. A 78 year old man with past history of ischemic heart disease present with
yellow visual haloes, nausea and vomiting. ECG reveals arrhythmia. Which of
the following medication is most likely responsible for his symptoms?

a. Amlodipine
b. Digoxin
c. Aminophylline
d. Propanolol
e. Diltiazem

167. A 21 years old female in her first pregnancy at 38 weeks was

brought to the emergency with a generalized tonic clonic seizure.
Mgso4 was given but she presents with a fit again.
What is the single most important immediate management of this
patient?
a.
IV
MgSO4
repeat
b.
IV
diazepam
c.
Immediate
c
section
d.
IV
phenytoin
e. IV lorazepam


168. A 45 year old man presents with generalized malaise and double vision which is
worse by the end of the day. On examination he is noted to be failing to look
upward. Which of the following is the most appropriate investigation?
a. Anti-DNA antibodies
b. Fundoscopy
c. Tensilon test
d. Muscle biopsy
e. Liver biopsy

169. A 50 year old man presents to the hospital with dizziness, which is worse when
he is lying in bed especially when he is turning in bed. Which of the following is
the most appropriate test to do?
a. Vasava manoeuver
b. Hallpick manoeuver
c. Caloric test
d. Rhines and Webers test
e. Tilt test

170. A middle aged man complains of a node, which has been growing, in his nose
for several months. Now it is firm with central depression/umbilication. The size is
0.6cm. What is the single most likely diagnosis?
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Melanoma
d. Bowens disease
e. Benign mole

171. A 34 year old man is brought to the Emergency Department by the police. He is

agitated and elated. His blood pressure is 140/90mmHg. His pulse rate is
120b/m and his pupils are dilated. Which single substance is he most likely to
have been using?
a. Cocaine
b. Heroin
c. Organic solvents
d. Oxazepam
e. Psilocybin


172. A 68 year old man has a prominent impairment of recent memory with intact
immediate recall. He has no evidence of his level of consciousness. Which is the
single most likely diagnosis?
a. Alzheimers disease
b. Delirium
c. Korsakofs syndrome
d. Normal pressure hydrocephalus
e. Post-ictal state

173. In a second day postnatal rounds a patient is concered that

her son might be deaf. There is family history of deafness.
What
test
will
you
do?
a.Tuning
fork.
b.Startle
Reflux
c.Pure
tone
audiogram,
d.Auditory
Brain
stem
Response.
e.Distracting Test.

174. A 40 year old woman is having intrusive and persistent thoughts that she is a
dirty prostitute. She recognizes her thoughts as silly but still feels ashamed of
them. Although these thoughts get her down, she still enjoys life. Which is the
single most likely diagnosis?
a. Depressive disorder
b. Generalised anxiety disorder
c. Obsessive-compulsive disorder
d. Psychotic episode
e. Schizophreni

175. A 53 years old female presents with an acute painful hot

knee joint. She is a known case of rheumatoid arthritis.
On examination, the knee is red, tender and swollen. The
hamstring muscles are in spasm. Her temperature is 38.5
C and blood pressure is 120/80 mm Hg.
What is the single best NEXT investigation?

a. Joint aspiration for cytology and culture and sensitivity

b. Join aspiration for positively birefrengent crystals
c. Joint aspiration for negatively birefringent crystals
d.
Blood
culture
e. Serum uric acid


176. A 45 year old man with known COPD has an acute exacerbation of COPD. He
was given 28% oxygen. His arterial blood gas are as follows;
Pa O2 = 10.3
Pa CO2 = 12
Ph = 7.23
What would you do next?
a. Continue 28% oxygen
b. Reduce to 24% oxygen
c. Increase to 35% oxygen
d. Give nebulizer salbutamol
e. Give 100% oxygen

177. A 40 year old woman on the ward on treatment with broad spectrum
antibiotics for severe infection. She then develops white patches in her vagina.
What is the most likely diagnosis?
a. Chlamydia
b. Candida
c. Gonorrhea
d. Bacterial vaginosis
e. Trichomonas

178. A 30 year old woman with pelvic inflammatory disease is on broad spectrum
antibiotics. Which of the flowing organisms need to be covered by the
antibiotics?
a. Neisseria gonorrhea and Chlamydia
b. Neisseria only
c. Chlamydia trachomatis
d. Staphylococcal
e. E.coli only

179. A 15 year old girl with sickle cell anaemia has a sickle cell crisis everytime she
has her her period. What is the cause?
a. DVT
b. Period pains
c. Normal phenomenon
d. Sickle cell crisis

180. A 45 year old man has had fracture of the radial head, which is not displaced.
What is the single most appropriate way of immobilizing this fracture?
a. Above arm backslab

b. Broad arm sling

c. Collar and cuff
d. Futura splint
e. High arm sling

181. An 89 year old man has epistaxis. He is on warfarin for atrial fibrillation. Which
single drug that has been started is most likely to be related to the cause of the
epistaxis?
a. Aspirin
b. Bedroflumethaizide
c. Clopidrogel
d. Erythromycin
e. Penicillin

182. A 27 year old man has a sudden onset of severe occipital headache. Which
single clinical sign is of greatest concern?
a. Loss of consciousness
b. Neck stiffness
c. Photophobia
d. Unilateral pain
e. Vomiting

183. A patient with hypopigmentation of the body, hyperkalemia,

hyponatremia, what is the most approprite investigation?
a.
b.
c.
d.
e.

Cortisol
ACTH stimulation test
Aldosterone
Catecholamines
Renin

184. A girl has come to you for emergency contraception pill. What si
the mechanism of action?
a. inhibit implantation
b. Inhibits ovulation
c. Destroys sperms
d. Alters cervical mucus
e. Inhibits spermatogenesis
185. A 33 yr old woman with kids has menorrhagia and dysmenorhia.
What is your management?
a. IUCD

b. Mirena coil
c. COCP
d. Transexamic acid

186. A man after sitting with crossed legs for a long time presented
with eversion of the foot, loss of sensation at the sole of the big
toe. What nerve is responsible?
a. Sciatic nerve
b. common peroneal nerve
c. fermoral nerve
d. tibialis anterior
e. Tibialis posterior
187. A 37yr old man presented with frank haematuria. All other
investigations are normal. What next investigation will you do?
a. Cystoscopy
b. IVU
c. Ultrasound
d. MCU
e. CT scan kidneys
188. A woman presents with a mobile, well circumscribed lump in the
breast. What is the diagnosis?
a. Breast cancer
b. Fibroadenoma
c. Pagets disease
d. Fibroadenosis
e. Fat necrosis
189. A 5 year old boy child with bleeding from the nose. He has
prolonged APTT. What is the likely diagnosis?
a. Hemophilia
b. Von willebrands
c. Vitamin K deficiency
d. Fibrinogen deficiency
e. DIC
190. A patient presented with loss of sensation on the maxillary size
of the face with some skin rashes. what other organ will be
affected in this patient.
a. Cornea
b. Conjuctiva
c. Teeth

d. Iris
e. Lens
191. A patient suffering from COPD, which has been well controlled,
just developed a sudden breathlessness, which is the immediate
next important first line investigation ?
a. chest x-ray
b. arterial blood gases
c. bronchoscopy
d. CTPA
e. Respiratory fucntion tests

192. An 80 year old lady presents to the emergency department with weakness of
her right leg arm. What is the most appropriate immediate management?
a. Aspirin
b. Clopidogrel and aspirin
c. CT scan of the brain
d. Observe for the symptoms
e. Provide basic care


193. A 70 year man with history of atrial fibrillation and on warfarin had a fall and
sustained a laceration to his head. There was no loss of consciousness, vomiting,
fits or drowsiness. Examination is also normal. What is the most appropriate
immediate management?
a. Aspirin
b. CT scan of the head
c. Skull X-ray
d. MRI scan
e. Discharge home with head injury advice

194. An 80 year old man present to the emergency department with right sided
weakness. Initially she was unable to talk and use her warms but in the last half
hour she is using her right arm and leg and able to communicate with her family
members. She is saying she is back to her normal self. What is the most
appropriate immediate management?
a. Aspirin
b. Clopidogrel and aspirin
c. CT scan of the brain
d. Observe for symptoms
e. Provide basic care

195. A 40 year old man presents to the emergency department with cold and

pulseless painful right leg. On examination, his toes are white. What is the most
immediate appropriate management?
a. Aspirin
b. Take to the theatre
c. Consult the vascular surgeon at once
d. Consult the neurosurgeon at once
e. Arrange Doppler ultrasound

196. A 60 year old lady has been prescribed aspirin following ischemic stroke. What
is the mechanism of action of aspirin?
a. Inhibits motor neurons
b. Blocks peripheral receptors
c. Inhibits cyclooxygenase
d. Blocks the central opiate receptors

192. A lady with ptosis, diplopia and dilated pupil. What nerve is
affected?
a.
Abducens
b.
Optic
c.
Occulomotor
d. Trochlear
193. A pt has diplopa, pain on looking, with mild dilation of pupils ,
unreactive to light, which is the main nerve involved?
a. Occulomotor
b. Trochlear
c. Optic
d. Abducens

194. A swelling that extended from the mandibular side of the face
which moves freely. It is painless. What is the most likely
diagnosis?
a. Cystic hygroma
b. mandibular cancer
c. mumps
d. Acute otitis media.
195. A 53 years old man presents with a long standing history of a

1cm lesion on his arm. It has started bleeding on touching.

What
is
the
most
likely
diagnosis?
a.
Basal
cell
carcinoma
b.
Kaposis
sarcoma
c.
Malignant
melanoma
d.
Squamous
cell
carcinoma
e. Kerathoacanthoma
196. Which of these shows that the child is in severe respiratory
failure
a. intercostal and subcoastal recession
b. Respiratory rate 25
c. Cyanosis
d. Crying
e. None of the above
a. Aspiration
197. A man presents with vision loss. Fundoscopy shows flamed
haemorrhages. What is the diagnosis?
a. CRVO
b. CRAO
c. ARMD
d. Chronic glaucoma
198. An elderly man fell down in the garden and a 24hr ECG was
taken which was normal. What will you do next?
a. Echo
b. CT head
c. 24 hour ECG
d. MRI head
e. Ambulatory ECG
199. A lady post colostomy closure has a small swelling around the
stoma.
What
is
the
management?
a.
Local
exploration
b.
Exploratory
laporotomy
c.
Open
laparotomy
d. Resuture
200. 25 year old man has had sticky eye for one day. There is no
history of trauma, no foreign body. What treatment will you give?
a. antibiotics (topical)
b. antibiotics (oral)
c. chlorhexidine

d. antiseptic