Mock exam MBChB

For numbers 1-9. Choose the most appropriate clinical scenario based on the chest xray
appearance.

A. A 22 year old male presents with worsening chronic productive cough and
breathlessness. He is clubbed and has been underweight since childhood.
B. A 48 year old male presents with 2 week history of worsening dyspnea, dry cough and
hypoxia. He has no abnormalities on auscultation of his chest.
C. A 78 year old female current smoker presents with wheeze, productive cough and
breathlessness worsening over 6 days.
D. A 60 year old man is intubated in ED having presented by ambulance profoundly
hypoxaemic in respiratory distress. On examination he has right sided apple core
dullness and bronchial breath sounds.
E. A 71 year old lady presents with chest pain radiating to her back. Initial BP 95/60,
repeat on the other arm 105/65, pulse 100/min, regular RR – 16/min.
F. A 27 year old male drowned in sea water, intubated at scene and transferred to the
ER.
G. An 18 year old HIV positive male presents with fevers, productive purulent cough
with fresh hemoptysis and wheeze. He has a history of frequent chest infections as a
child and teenager.
H. A 74 year old ex-smoker presents with worsening breathlessness.
I. A 45 year old male presents with a 3 week history of cough, night sweats and loss of
appetite. On examination, he is confused and hypoxaemic.

10. This 34-year-old man presented with a 3 month history of jaundice, weight
loss, epigastric pain, and a left neck mass. Which malignancy is he likely to
have?
A. Cancer of the thyroid
B. Cancer of the head of pancreas
C. Hodgkin’s lymphoma
D. Multiple myeloma
E. Renal cell carcinoma

11. This nail sign was observed in a 32-year-old man who presented to the clinic.
What underlying condition is he likely to have?
A. Liver failure
B. Respiratory failure
C. Renal failure
D. Adrenal failure
E. Cardiac failure

12. This 23 year-old ART naïve HIV positive woman presented to the hospital
following a 2 week history of dysphagia and odynophagia. An upper
gastrointestinal tract endoscopy showed the findings represented in the image.
She was also complaining of blurring of vision in the right eye which rapidly
progressed in a week to complete visual loss. Which organism is most likely to
be responsible for these findings?
 A. Herpes Simplex virus
B. Cytomegalovirus
C. Measles virus
D. Ebstein Barr virus
E. Human herpes virus 8

13. This 89 year-old-woman presented 5 years after a mastectomy and receiving

chemotherapy for stage 3 breast cancer with the following neurological
abnormality. You suspect she may have recurrence of the tumor with
metastases to the brain stem. Which cranial nerve is shown to be affected?
A. 12
B. 5
C. 11
D. 9
E. 10

14. A 26-year-old homeless man presented with a 3 week history of gradual

worsening shortness of breath. He also reports a 2 month history of cough,
night sweats and significant weight loss. On examination he is diaphoretic,
hypotensive, with a right supraclavicular lymph node. His CXR is as shown.
Which of these is the most likely cause of his symptoms ?
A. Pulmonary embolus
B. Tuberculosis
C. Sarcoidosis
D. Histoplasmosis
E. Pneumonia

15. This 34-year-old alcoholic man presents with a 2 day history of severe
abdominal pain following a night of bingeing on alcohol. The physical finding
shown on his abdomen is associated with which condition?
A. Acute appendicitis
B. Acute pancreatitis
C. Acute cholecystitis
D. Acute pyelonephritis
E. Acute cholangitis

16. The following condition is associated with the appearance on this slide.
A. Acute pulmonary embolus
B. Pneumococcal pneumonia
C. Carcinoma of the bronchus
D. Bronchiectasis
E. Cytomegalovirus pneumonia

17. A previously healthy 37-year-old Caucasian male developed a 3 day history of

fever, chills, myalgias, pruritic rash and headache after returning home in
Australia from a 2 week trip in Botswana. He went canoeing and camping
whilst in Botswana. A peripheral smear done on his blood specimen is
consistent with which infection?
A. Brucellosis
 B. Trypanosomiasis
C. Schistosomiasis
D. Malaria
E. Dengue fever

18. Middle-aged diabetic patient presenting with shortness of breath. Clinical

evidence of pulmonary oedema. 
What electrical abnormality is associated with these ECG findings?
A. Hypercalcemia
B. Hyperkalemia
C. Hypermagnessemia
D. Hypernatremia
E. Hyperphosphatemia

19. Middle aged female presenting with dyspnoea. Previous mastectomy for
breast carcinoma. What urgent investigation can be done to confirm the
diagnosis?
A. Holter ECG
B. Coronary angiography
C. Echocardiogram
D. Chest X-ray
E. CT pulmonary angiogram

For questions 20-23 these patients have all presented with breathlessness.
Choose the most appropriate diagnosis from the list below.

A. Pneumocystis jiroveci pneumonia B. Pulmonary embolism

C. Acute pneumothorax D. Lactic acidosis
E. Biventricular cardiac failure F. Pulmonary Kaposi sarcoma
G. Severe anaemia H. Pulmonary tuberculosis
I. Pulmonary hypertension J. Chronic kidney injury

20. A 25-year-old HIV-positive man who is allergic to cotrimoxazole, started

antiretroviral therapy 6 weeks ago and has been breathless for ten days,
mostly on exercise. He is apyrexial, tachypnoeic and cyanosed.

21. A 25-year-old man who is 2.1m tall presents with a sudden onset of
breathlessness and a feeling of left sided chest discomfort. He has never
 been ill before, but he is noted to have a slight scoliosis, arachnodactyly and
he has poor vision.

22. A 30-year-old woman presents with breathlessness on exertion and at night,

as well as ankle swelling. She is on chronic medication for her heart and she
was told many years ago that she needed to have an operation to replace one
of her heart valves which was damaged and ‘leaky’. Auscultation reveals a
third heart sound and mitral valve murmurs.

23. A 40-year-old man has been on antiretroviral therapy for five years and now
presents with a swollen left leg, a painful lump in his throat which interferes
with swallowing, and breathlessness. Chest X-ray shows bilateral effusions;
HIV viral load is 250,000 c/ml.

24. Six hours after a road accident a patient is seen with shortness of breath of
sudden onset. There is deviation of the trachea to the left on examination and
marked tachypnoea. Which process would account for this finding?

A. Left upper lobe pneumonia

B. Right haemothorax
C. Right lung collapse
D. Left tension pneumothorax
E. Haemopericardium

25. A 65-year-old man presents with tiredness and has severe pallor. HB is 6g/dL,
MCV is 55fL and there is a lymph node in the left supraclavicular fossa. Which
clinical sign is consistent with the haematological diagnosis?

A. Beau’s lines
B. white nails
C. koilonychia
D. onycholysis
E. hyperpigmented palms
26. An 80-year-old woman has been housebound for over 10 years and was
admitted after a fall which resulted in a fracture of her left hip. Previously she
had a slow but distinctive waddling gait and severe backache, using two sticks
to get around. What is the likely explanation for her mobility problems?
A. increased bone turnover
B. multiple bone cysts
C. reduced cortical bone density
D. severe osteomalacia
E. aseptic necrosis of the femoral head

27. A 70-year-old woman has had muscle cramps for the past 2 days. She also
feels rather weak and dizzy. She has been taking furosemide 80 mg orally
twice daily for an exacerbation of cardiac failure. Examination reveals
decreased tone in all limbs, temperature 36.5˚C, pulse 120 beats/minute, BP
 100/75 mmHg. Which single management option would improve her
symptoms?

A. digoxin 0.5mg iv immediately

B. potassium chloride 10mmol/hour iv
C. quinine sulphate 300mg nocte
D. spironolactone 25mg orally bd
E. indomethacin 25mg tid

28. A 29-year-old woman has had tender swollen wrists for 3 weeks. A similar
episode occurred a year ago and resolved spontaneously. She has also
noticed a reddish rash on her face for 2 months. Which autoantibody is most
consistent with the diagnosis?
A. anti-acetylcholine receptor
B. anti-ds DNA
C. anti-mitochondrial
D. antiScl-70
E. anti-smooth muscle

29. A 40-year-old man with a history of multiple sexual partners presents for
evaluation at the OI clinic. He has recently been diagnosed with HIV infection,
and presents with low grade fever, malaise and a diffuse slightly erythematous
maculo-papular rash involving the palms and soles. He also notes a recent
onset of alopecia. Which of the following diagnostic tests is most reliable in
making the clinical diagnosis?

A. Serum RPR test

B. HIV viral load
C. Serial blood cultures
D. Dark field microscopy on a skin lesion
E. Response to empiric doxycycline therapy

30. A 35-year-old woman presents to the neurology clinic after developing odd
movements of the limbs and face over the last nine months. Her father had
similar problems and died in his 50’s. On examination she had grimacing of the
face and involuntary, irregular movements of the arms and legs. What is the
most likely diagnosis?

A. Wilson’s disease
B. Huntington’s disease
C. Parkinson’s disease
D. Sydenham’s chorea
E. Myoclonic seizures
 31. A 38-year-old man is admitted via casualty with a short history of abdominal
pain and vomiting. Which of the following would most strongly suggest a
diagnosis of acute pancreatitis?

A. Haemoglobin concentration of 9.5 g/dL

B. Glucose concentration 12.5 mmol/L
C. Serum amylase 192 IU/L (normal range 60-80 IU/L)
D. Corrected serum calcium 1.94 mmol/L
E. Serum total cholesterol 6.8 mmol (3.65-5.5 mmol/L)

32. A 55-year-old man presents with itching of the skin, worse after bathing. He is
noticed to have reddening of the palms and moderate splenomegaly. He
reports that he was treated for a deep vein thrombosis last year and that he
bruises easily. Which of the following is the most likely diagnosis?

A. Systemic lupus erythematosus

B. Idiopathic thrombocytopenia
C. Rheumatoid arthritis
D. Chronic renal failure
E. Polycythaemia vera