NOVEMBER 2019 RECALL ANSWERS

** The Recalls have been made to the best of our knowledge and extensive research of
questions and related answers. After discussion and extensive arguments, we have decided
upon these answers based on relevant and reliable websites. Few Answers have been
updated according to the Plabable explanations updated till date.

** Whenever you find answers marked with red colour, it’s because people had difference
of opinion and we couldn’t reach to one final answer.

--------------- Prepared by Dr. Shawn Gaurav & Dr. Altamash Ashfaque -------------

1. A 27yr old woman with redness around her areola of 4 weeks duration. She had used
some antibiotics which improved her symptoms slightly. 5ml of greenish fluid was aspirated
from the breast. She smokes regularly. What is the most likely diagnosis?

A. Breast abscess
B. Breast cancer
C. Duct papilloma
D. Paget's disease
E. Periductal mastitis

2. A 60year old woman who is to have a blood transfusion had a pre transfusion vitals of
T=37.3 Pulse rate- 114bpm, SpO2 96%, BP- 114/73mmhg 4hours post transfusion started
feeling unwell and her vitals were T 38.4 Pulse rate 94 spo2 96% BP 120/85mg What is the
most likely diagnosis

A. Acute haemolytic reaction

B. anaphylaxis
C. Bacteria contamination
D. Non haemolytic febrile reaction
E. Normal reaction

3. A 40-year-old woman who present to the clinic with 1 week history of multiple psychical
symptoms: headache, abdominal pain, weaknesses, urinary frequency and bloatedness.
Physical examination and investigation were normal. What is the likely diagnosis for her
condition?

A. Conversion disorder
B. Factitious disorder
C. Hypochondriasis
D. malingering
E. Somatisation disorder
4. 29-year-old female with sore throat. Has poorly controlled asthma. On beclomethasone,
montelukast, salbutamol, salmeterol, Aminophylline. Has white patch on the pharynx that
dislodges easily. What is the cause of her sore throat?
a) Aminophylline
b) Beclomethasone
c) Salmeterol
d) Salbutamol
e) montelukast

5. 6-year-old with three episodes of urinary incontinence in a day, ultrasound, examination,

investigation results are normal. Most effective management.
A. Bladder training B. Desmopressin C. Enuresis alarm D. fluid restriction E. antibiotics

6. A 28yr old female at 8weeks GA with 3 previous recurrent first trimester miscarriages.
Anti-cardiolipin antibody present. Management?
A. Aspirin
B. Aspirin and Heparin
C. Aspirin and Warfarin
D. Heparin
E. Warfarin

7. 78-year lady with giant cell arteritis on prednisolone 60mg and omeprazole, ESR 70. What
additional medication to add?
A) bisphosphonates
B) calcitonin
C) calcium supplement
D) HRT
E) Parathyroid hormone

8. A 54-year-old woman complains of low back pain for which she is was needing long time
steroid use. She is now complaining of her teeth being loose. Other examination appears
normal. What investigation will best lead to a diagnosis
A. CT of the low back
B. Dexa scan
C. MRI of the spine
D. Radio nuclear scan
E. Skeletal survey

9. A 52yr old woman with disseminated Renal carcinoma, presented with dilated abdominal
veins and pitting oedema of the right leg up to the groin. What's the cause of the leg
swelling?
A. Hypalbuminaemia
B. IVC obstruction
C. Lymphatic infiltration
D. Portal vein occlusion
10. 60yr old man with severe central chest pain he is hypertensive and on anti-hypertensive
he has not vomited but is pale and clammy, radial pulse was not felt. PR- 96 bpm, bp-
154/92mmhg spo2 was normal trachea central chest is clear. Ecg showed inversion of T
wave. He was started on iv morphine. What is the most appropriate next step(Considering
Aortic Dissection)
A. administer alteplase
B. coronary angiogram
C. CT scan chest with contrast
D. oral aspirin
E. Transthoracic echocardiography

11. A 65yr old man presented with prior history of influenza presenting with cough and
temperature of 38.5°c. Chest x-ray showed bilateral cavitation’s. What is the diagnosis?
A. Haemophilia Influenza
B. Mycobacterium Tuberculosis
C. Mycoplasma pneumonia
D. Staphylococcus aureus
E. Streptococcus pneumonia

12. a woman with 6-month history of amenorrhea PT is negative she is physical fit and is a
long-distance runner. Oestrogen: 80, FSH: 11, Prolactin: 600
A. hypothalamic amenorrhea
B. PCOS
C. Post Pill Amenorrhea
D. Premature Ovarian Failure
E. Prolactinoma

13. A 36-year-old lady with type 1 DM, planning to get pregnant and is anxious about fetal
abnormality. Which drug should be given in higher dose than normal?
A) Folic Acid B) Selenium C) Iron
D) Vitamin D E) Thiamine

14. A 97yr old man, 7days of reduced oral intake, increased confusion. Has dementia and
DM. Pulse rate is 98b/m, BP on lying down is 110/55mmHg, sitting BP is 84/50mmHg. Skin
turgor is decreased. Na+ = 152, K+ normal, Bicarbonate reduced, Urea increased,
hyperglycaemia. What's d appropriate fluid to give?
A. 0.9% NaCl (if Hypernatremic Dehydration- start with normal Saline to compensate
dehydration and then correct Na+)
B. 0.45 % NaCl
C. 0.18% NaCl + Dextrose

15. Heavy smoker and alcoholic fractured humerus, 3rd day on admission developed
confusion, nystagmus (not the exact word, but similar description to it), hyperreflexia,
hypertonia. what's the most important medication to give?
A. IV thiamine
B. Administer Sedative
C. Chlordiazepoxide
16. A 23-year-old with recurrent vertigo of 4 weeks lasting for a few seconds, What is the
site of the anatomical defect
A. Post semi-circular canal
B. Cochlea
C. Spiral ganglion
D. Temporal lobe of brain
E. Vestibular nucleus

17. A 54-year-old man had a cardiac and was successful resuscitated following defibrillation.
He was admitted to ICU on ventilation.HR 120 bpm BP: 90/65mmHg. The following ABG
values: pH : 7.04 pO2: 12kpa pCO2: 9.5kPa, HCO3: 19. What is the most important
immediate step?
A. Fluid challenge
B. Increase fiO2
C. Increase ventilation
D. Start ionotropes
E. Start bicarbonate

18. For the past 3 days a 30-year-old man has been having penile pain when he urinates. He
is otherwise fit and well. There are four tender ulcers on his penile glans. The ulcer is 2mm
in diameter and indurated. What is the most likely diagnosis?

A. Bechet disease
B. Chlamydia infection
C. Gonorrhoea infection
D. Herpes simplex infection
E. Primary syphilitic infection

19. 60-year-old man with metastasized bladder cancer on 120mg SR morphine. Pain not
controlled and dose was increased to 210mg break through dose. Had to increase oral
morphine too. Pain not controlled.

A. Increase Morphine Dose

B. change to SC morphine
C. change to hydromorphone
D. fentanyl patch
E. Change morphine to oxycodone
20. A 52-year-old female with metastatic breast
cancer to the lungs with dry cough. Cough not
responsive to linctus. Responded minimally to
codeine for 7 days. What is the most appropriate
management?
A. Nebulized normal saline
B. Nebulized local anaesthetic agent
C. Oral Morphine
D. Oral antibiotics
E. Oral steroids

21. 3 year old, drooling of saliva, temp 38.5, with stridor

A. Intravenous fluid
B. intubate and ventilate
C. nebulize

22. A 18 year old boy travelled to Ghana 6 weeks ago, took antimalarial until about 2 weeks
ago. He presented with headache, drowsiness, photophobia, neck stiffness, fever. Most
likely cause.

a) Cerebral malaria
b) meningococcal Meningitis
c) Glandular fever

23. 30-year-old with 3 days history of painful urination with vesicles around the frenulum
and scrotum. What Diagnostic investigation should be carried out?
A) HSV1 Antibody
B) treponema antibody
C) viral culture of lesion

24. 1 year old boy with persistent diarrhoea, abdominal pain and short stature, IgA TTG
negative, Total IgA – low. What is the Next investigation/ Most Diagnostic to do?
(Can’t recall the last line exactly !!)
A. IgG TTG - NEXT
B. Duodenal biopsy – Most Diagnostic
C. refer to dietician
D. Start gluten free diet
E. Repeat celiac screening

25. 36-year-old woman who has been using OCPs for 10yrs who presented for bright red
vaginal bleeding. She is in a stable relationship. Cervical smear reported normal. What’s the
most likely diagnosis?
a. Cervical ectropion
b. Chlamydial something
26. A 72-year-old woman who developed sudden chest pain. Had surgery 6 days ago. All
parameters given including troponin were within normal limit. What is the most likely
diagnosis?
A. Pneumonia
B. pericarditis
C. Pulmonary embolism

27. A 57-year-old male builder, has had pain in the left flank for 4 hours. He is a known
diabetic and has been drug compliant. Temp 36.7
Pulse rate 90b/m Bp. Normal. Based on the
image...what is the likely cause of this?
a. blunt force trauma
b. herpes zoster
c. erythema ab igne
d. old thoracotomy scar
e. fixed drug eruption

** It’s a similar picture and not an exact one

Since in the exam the lesion was on the left abdomen/ Flank

28. 54-year-old presented with productive cough. Sputum was initially yellowish and green,
but occasionally with streaks of blood. She has a 20-pack year smoking history. She has
coarse crepitations and bronchial thickening. X-ray showed patchy opacification. Dull
percussion note at lower zone of right lung, presence of weight loss, vital signs stable. What
is the single most likely diagnosis?
A. Lung abscess
B. Bronchial CA
C. bronchiectasis
D. COPD
E. recurrent pulmonary

29. A 3yrold boy with asthma presents to the Emergency dept with acute attack of wheeze.
He is drowsy and has cold periphery. His HR is 180bpm, he has intercostal recession and
widespread wheeze. What is the most significant feature that shows impending respiratory
failure?
A. Cold periphery
B. Drowsiness
C. HR of 180 bpm
D. Intercostal recession
E. Widespread wheeze
30. Chest X-ray picture with Kelly B lines signifying
Pulmonary oedema, I.v frusemide and oxygen given.
Breathing improved after Administering furosemide.
Which drug to add?
a. Bisoprolol
b. Digoxin
c. Candesartan
d. Verapamil
e. Lisinopril

31. woman who started chemotherapy yesterday for Burkitt’s lymphoma. Urinary output
reduced to 40mls in last 12hours. Lab tests on admission were normal. Lab results now
show raised K, Raised Urea, raised creatinine What test would point to the cause of her
deterioration? (few say it was urea that was given, few say uric acid was given).
A. Esr level
B. C reactive protein
C. creatinine kinase
D. Urate level
E. phosphate level

32. Man who just had surgery few hours ago. Urine bag is not draining. Vitals are stable.
What to do next:
A) check catheter
B) exploratory laparotomy
C) give furosemide
D) fluid challenge

33. A 57-year-old man presents with lethargy and he looks pale. Blood pressure 150/100.
Urinalysis: Blood +++, Protein +++, Creatinine: Elevated. Other tests were normal. What's
the investigation?
a. Urine for Bence Jones protein
b. Renal Ultrasound
c. Cystoscopy
d. Blood culture
e. 24hour urine collection

34. Anatomical structure pierced by a trocar when performing laparoscopic

cholecystectomy at the midpoint between the midline and mid axillary line.
a. Transverse abdominis
b. Linea alba
c. Conjoint tendon of internal and external abdominis muscles
d. Rectus sheet
e. Aponeurosis of external abdominis and the internal abdominis muscle

35. Middle aged guy, 2 episodes of microalbuminuria. BP 128/70 mmHg. Normal renal
function. He was overweight BMI was given high. What additional therapy would benefit
this patient?
a. ACE-I
b. Statins
c. B-blockers
d. diuretics

36. 68-year-old woman with a lump in her ant. neck painless, not mobile and was otherwise
fine. She had swelling of her ant cervical nodes, supraclavicular nodes, axillary nodes and
inguinal nodes all bilaterally, WBC 27*10^9, Lymphocytes 21*10^9, Other investigations
were mostly normal Blood film revealed lymphocytes with smear cells
A. ALL
B. CLL
C. Hodgkin’s lymphoma
D. Burkitt’s
E. CML

37. 19yr old male, painful swollen testis of 4 hrs had intermittent pain in the same testicle
over the last few months, he is sexually active. What is the most appropriate management?
A) Discharge on antibiotics
B) immediate referral to surgeons
C) refer to GP for follow up
D) USS of testis
E) Urethral swab

38. 14-year-old boy with short stature. father says he was also shortest in his class till he
was 15years. Growth is at the 9th centile, growth velocity is 6cm/yr. other examination
findings are normal. What is the most appropriate approach to evaluate short stature?
A) Endomysial antibodies status
B) MRI
C) review in 6 months
D) TFT
E) wrist X-ray for bone age

39. 79-year-old woman presents with increased thirst, polyuria, constipation of two weeks.
There is increasing confusion over the last 3 days. She had left mastectomy for breast Ca.
She is taking fluoxetine. Temp is 36.9, PR 100, BP?? reduced skin turgor. No papilledema or
focal neurological signs. Urinalysis showed trace ketones. What is the most likely cause?
A) Cerebral metastasis
B) DKA
C) hypercalcemia
D) hyponatremia
E) fluoxetine overdose

40. an elderly woman that had hip surgery and is on LMWH but developed sudden SOB and
chest pain.
A. increase LMWH and arrange for CTPA
B. Continue on current dose and arrange CTPA
C. Increase LMWH and arrange VQ scan
D. Ct scan of the chest
E. DC cardioversion

41. a renal cancer patient who was on morphine with good pain control started vomiting
and was placed on metoclopramide after which he developed neck stiffness and rigidity.
What is responsible for the symptoms?
a. side effect of metoclopramide
b. side effect of opioid
c. meningitis
d. cerebral metastasis

42. 30yr old having progressive painless peripheral visual loss of 6 months duration. Worse
at night. Similar history in father. What to do next?
A. Routine ophthalmologist referral
B. Oral prednisolone
C. high oral steroid
D. steroid eye drop
E. refer to his optician

43. Patient with 6 months of productive cough, fever present, left sided chest pain, worse
on breathing. Absent breath sounds on the left lower lobe, dull percussion notes on the left
lower lobe. What will be seen on chest x-ray
A. Enlarged hilar nodes
B. Left lobe collapse
C. left lobe consolidation
D. pleural effusion

44. Patient with cut to the wrist and inability to flex the distal phalanx of little finger. Which
structure is damaged?
A) flexor digitorum profundus
B) flexor digitorum superficialis
C) ulnar nerve

45. 18-year-old with deterioration/confusion and wide spread petechial rash+ symptoms of
meningitis. Bp 80/50. ECG sinus rhythm with pulse 120bpm. Most appropriate antibiotic
a. Vancomycin
b. Ceftriaxone
c. Ciprofloxacin
d. Amoxicillin
e. rifampicin

46. Young boy with Duchenne muscular dystrophy. Parents want to know the chances of
their second child being affected.
a) 25%
b) 50%
c) 100%
d) 75%
e) 0%

47. 45-year-old woman whose cervical smear revealed moderate dyskaryosis. What to do
next?
a) colposcopy
b) no action
c) repeat in 3 months
d) repeat in 6 months
e) take swab

48. Review of a 65-year-old who had post-abdominoperineal resection for rectal cancer.
Indwelling urinary catheter has not drained any urine in the last 2 hours. Urinary output in
the next 3 hours post-op was 51mls, 65mls and 76mls. Vitals given were stable. What was
the likely cause of the anuria?
a. Acute kidney injury
b. Catheter blockage
c. Dehydration
d. Intraoperative injury of bladder
e. Intraoperative injury of ureter

49. A 45-year-old woman who has had 4 episodes of palpitations wearing, hyperventilation
and? tachycardia in the last 1 month associated with worry, feeling she would lose her life.
What is the most likely diagnosis?
A) social phobia
B) Generalized anxiety disorder
C) Panic disorder
D) Obsessive Compulsive disorder
E) cotard

50. A woman with features suggestive of neurofibromatosis (cafe au lait spots, etc features)
wanted to know the risk of her child being affected with the disease
A. 1 in 4
B. 1 in 8
C. 1 in 2
D. 100%

51. A patient recently diagnosed of asthma which has been well controlled, now presents
with increase respiratory rate, temp 36.7, auscultation reveals absent breath sound.
Which of the following will indicate life threatening asthma?
A. Absent breath sound
B. Increased respiratory rate
C. Intercoastal recession

52. A 64-year-old with presenting with confusion. Has had cough for 1 month with weight
loss. Serum Ca: 3.4 (2.1-2.6) Most appropriate initial management?
a) IV 0.9% saline infusion
b) alendronate infusion
c) dialysis
d) resection of tumour

53. A man with chronic hepatic impairment being started on a new drug that is lipid soluble,
strongly binds to albumin and undergoes hepatic first pass metabolism. What adjustments
are to be made?
a) Give normal dose and shorten dosing interval.
b) No adjustment required
c) reduce dose and shorten the dosing interval
d) reduce dose and increase the dosing interval.
e) increase dose and increase the dosing interval

54. A man, 54, presents with vomiting, and ringing ears. Lost his wife months back, and
currently being treated for depression. Was brought to the hospital following intake of
some drugs. Sweating, temp: 39°C. Likely cause of his symptoms?
a) Aspirin
b) Lithium
c) Paracetamol
d) Thyroxine
e) diazepam

55. 10000 women screened using a new cervical cancer screening method. 1000 were
shown to have changes, 100 were positive after biopsy. Another 10 not picked initially by
the test went on to develop cervical CA. What term describe the 900 who were negative on
biopsy?
A. Incidence
B. False positive
C. False negative
D. True positive
E. True negative

56. 77year old billed to undergo elective TURP. On pre-anaesthetic evaluation and
asymptomatic inguinal hernia was found. What is the most appropriate action?
A) laparoscopic
B) no treatment
C) open hernia repair under general anaesthesia
D) open hernia repair under local anaesthic
E) pre -peritoneal repair

57. A 65-year-old woman who fractured her wrist had hysterectomy done. FBS and LFT are
normal. What to do to prevent further fractures.
A. Alendronate
B. Calcitriol
C. Oestrogen
D. Tibolone
58. A 38 year old woman presents to A and E with BP 80/50 after eating at a restaurant. She
has stridor and bilateral polyphonic wheeze. What is the initial management?
A. IM Epinephrine
B. IV fluid
C. IV hydrocortisone

59. A young man, 24 years, visits A and E requesting painkillers. At presentation he was
having Fever, abdominal pain, Muscle cramps, agitation and is sweaty. What is the most
likely reason for his symptoms?
A. "Some drug" toxicity
B. Cocaine
C. ecstasy overdose
D. Opiate withdrawal

60. 5year old girl with 5days history of bloody diarrhoea and dehydration. blood culture:
E.coli 0127 Na low, K high, Creatinine high, Urea high, Calcium N, Bicarbonate low What is
the like diagnosis?
a. Acute kidney injury
b. Addison's
c. Renal tubular acidosis

61. A woman who is seeking asylum presented with amenorrhoea of 12weeks. Present with
vaginal bleeding and vomiting. Fundal height measured was at 16 weeks., Pregnancy test
was positive, Cervix closed on examination. What is the most likely diagnosis?
a. Molar pregnancy
b. incorrect Lmp
c. twin gestation
d. ectopic pregnancy
e. threatened abortion

62. A Transgender woman (male to female) on spironolactone, oestrogen, Co-codamol,

lansoprazole, ramipril presents with hair loss and oesophageal reflux. Background history of
hypertension and osteoarthritis. Most like cause? (Confusing Question!!)
a. Oestrogen (As per Plabable update) Was prescribed lansoprazole (Zoton) for reflux. Cured reflux,
b. Spironolactone but caused hair loss. A headful of thick curly hair was reduced
to my scalp showing through, also lost all body hair and
c. Lansoprazole eyelashes! Stopped taking it but haven't got my hair etc back!
d. Co-codamol Can one sue the Pharmaceutical company?

e. Ramipril https://patient.info/forums/discuss/lansaprozole-18366

** Oestrogen and Spironolactone causes hair growth in MTF and not hair loss. Go through
the following Link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5367483/
** Ramipril Can also cause hair loss

63. A 73-year-old woman feeling unwell has longstanding RA with right swollen hot tense
effusion. Initial investigation of choice?
a. Arthroscopy
b. Aspirate for Microscopy and culture.
c. FBC ESR
d. MRI
e. X Ray

64. Young patient with abdominal cramp, blurring of vision and coloured distortion etc
(features classical of Ecstasy) What drug is misused?
a. Heroin
b. Ecstasy
c. Cocaine

65. Asthmatic patient who uses daily SABA inhalation for the last 4 months or so... Another
drug to add. (EXACT Q FROM GMC WEBSITE SAMPLE Q)
a. Inhalational steroids
b. Add LABA
c. Sodium cromoglycate

66. FY2 25 old Dr that was seen sending a friend request to a 30 year old patient who was
discharged from your unit recently, at a social event.
a. Confront your colleague and say him its against good medical practice.
b. Report to consultant
c. Report to GMC
d. Report to adult safe guarding
e. Do nothing (as per plabable)

67. A 4-year-old boy with recurrent UTI. What is the most likely anatomical abnormality?
A. Vesicoureteral reflux
B. Urethral valve
C. Horse shoe kidney
D. Bladder cancer

68. A man with upper respiratory infection. He then developed confusion, anxiety and
aggression. He is having lethargy intermittently. He says people are watching him and there
are cameras watching him. What's is the most likely diagnosis
A) Alzheimer's disease
B) Delirium
C) Lewy body dementia
D) schizophrenia
E) Mania

69. Man with 3-month Hx of low mood, insomnia, worthlessness. Hx of bph, htn and MI,
what to give
a. Amitriptyline
b. Duloxetine
c. Sertraline

70. Patient Came back after 7 days of adeno-tonsillectomy, vomiting blood. Temp 38.5.
What is the most appropriate step?
A. Admit for IV antibiotics
B. Admit for FFP and Vit k
C. Discharge home with oral antibiotics
D. urgent surgical exploration of wound site

71. A patient who has maculopapular rash in is palms, trunk, for the past 9 days. He had
mouth ulcers for one month and a painless penile ulcer that has healed for the past one
week. What is the most definitive investigation?
a. Treponema PCR
b. Serology for syphilis
c. Dark microscopy
d. swab of the ulcer
e. Treponema specific and non-specific antibody
** If mouth ulcer is present- choose Swab of the ulcer, If Not – Choose Serology

72. Man with BMI of 31 and Hba1c of 56 mmol/l, 3 months of lifestyle modification yet
Hba1c above 61, what is next important management?
a) Metformin
b) Insulin
c) Gliclazide
d) Pioglitazone
e) glibenclamide

73. Picture with rash on the back and legs. Had sore throat 3
weeks ago, now feels well. What to do about the rash.
(Morbilliform rash/ pityriasis rosea)
A. No treatment.
B. Topical corticosteroid
C. Topical antibiotic
D. oral steroids

74. A 72yr old woman presents with extreme weakness, hip and shoulder pain. Pain in the
wrist. Synovial joint thickening. No muscle pain. Raised ESR: 80, normal CK. Most definitive
treatment.
A. sulfasalazine
B. Ibuprofen
C. prednisolone
D. hydroxychloroquine.

75. A PX in depression. Switched from fluoxetine to citalopram. Presents with painful right
red eye with visual blurring.
A. fusidic acid eye drop
B. Urgent referral to psychiatric
C. Urgent referral to ophthalmology
D. clomipramine
76. Mother of a 3-year-old Caucasian boy is concerned about Vitamin D Deficiency in
children. He is healthy, well fed and eats balanced diet. All reports and physical examination
are normal. What advice would you give regarding Vitamin D requirement?
a) 400IU b) 800IU c) 1000IU d) 3000IU e) No requirement

77. A 4month old girl is due for routine immunisation for pertussis. What can be an absolute
contradiction for that?
a) Family history of peanut allergy.
b) Infective illness ongoing with temp of 36.5 and above.
c) Mother had febrile convulsions when she was growing.
d) Child has neurodevelopmental delay.
e) Severe eczema.

78. Child with Attention Deficit Hyperactivity Disorder Started on methylphenidate. He is

Disturbed at night and cannot stay quiet and is
sleeping less hours which is also affecting his
mother’s sleep and she is having problem in her
work. His performance in school is also declining
and mother having problem in her work. What is
the management for kid?
a) Advice mother on sleep hygiene.
b) Increase dose of Methylphenidate.
c) Prescribe melatonin. (can be added as adjuvant for circadian sleep rhythm)
d) Refer for family therapy.
e) Replace Methylphenidate with Lisdexamfetamine

https://www.health.harvard.edu/newsletter_article/attention-deficit-hyperactivity-
disorder-and-sleep

79. 25-year-old woman with progressive weakness and loss of sensation that started from
the lower limbs. Currently she is finding it difficult to swallow. She had malaise and bouts of
diarrhoea 2 weeks ago. What mechanism explains the symptoms she is having?
a) Demyelination of CNS
b) Demyelination of PNS
c) Spinal cord compression
d) Antibodies to muscular end plate

80. 62yr old man presented with increased urinary frequency, urge incontinence and
dribbling. PSA is 4.5ng/ml. what is the mechanism of action of the initial drug of choice for
treatment?
a) Alpha-adrenoceptor blockade
b) 5 alpha reductase inhibitor
c) GNRH agonist

81. A pregnant SCD carrier patient found out her partner is also SCD carrier. She wants to
know the chances of her unborn child having SCD.
A. 0%
B. 25%
C. 50%
D. 100%

82. 32-year-old woman, 34 weeks pregnant presents with maculopapular rash. Toddler son
had chicken pox 2 weeks ago. How would you treat?
A. IV varicella zoster
B. IV acyclovir
C. IV ganciclovir
D. IM immunoglobulin
E. SC varicella zoster Ig

83. Woman presented with low abdominal pain, foul smelling discharge and features of
peritonitis. Swab have been taken. Treatment options?
a. ofloxacin and metronidazole
b. ceftriaxone
c. azithromycin
d. doxycycline

84. A patient presented with chest pain and breathlessness. PR is 35 b/m. ECG shows broad
complexes with atrioventricular dissociation. Most appropriate initial treatment?
A. Adenosine
B. carotid massage
C. atropine
D. verapamil
E. Amiodarone

85. 20yr old with recurrent diarrhoea and abdominal pain on the left side for 6 months, she
did a biopsy which showed granulomas and inflammation. What is the most likely diagnosis?
a) UC
b) CD
c) Tb abdomen
d) Colorectal Ca

86. Pt with breast Ca and cerebral metastasis presents to A and E Complaining of headache
and intractable vomiting. Most appropriate medication to prescribe?
A. Dexamethasone
B. Haloperidol
C. Metoclopramide
D. Promethazine

87. An old patient accompanied by his son presents to A&E with low mood 6 months after
his wife death. He is having suicidal thoughts and does not want to live anymore. His son is
concerned about his father. He takes Warfarin for Atrial Fibrillation. What is the most
appropriate management?
A. CBT
B. Psychodynamic therapy
C. Sertraline
D. Mirtazapine
E. Olanzapine

88. Q about Cholesteatoma, classic picture describing about discharge, pearl like lesion
behind the TM, and not responding to antibiotics (Picture based MCQ’s)

89. Q about Gestational HTN requiring Meds?

A. Labetalol
B. Methyl Dopa
C. Nifedipine
D. ACEI

90. Q about Barret’s Oesophagus. What kind of histological change is seen?

A. Metaplasia
B. Hyperplasia
C. Dysplasia
D. Carcinoma in-situ

91. Painful red eye of 4 days. Sclera and Corneal junction are red with tearing. Pupil irregular
shape. Fluorescein staining is normal. Diagnosis?
a. Corneal ulcer
b. Acute conjunctivitis
C. Anterior Uveitis
D. Keratitis

92. boy who went to farm in Central America returned to the UK. Developed 6 weeks history
of night sweat, fever, weight loss and splenomegaly. Temp: 38°c
A. Brucellosis
B. Lymphoma
C. HIV
D. Tuberculosis

93. Young lady with acne/ pigmentation on her face relating to menstrual cycle. She was
prescribed Benzoyl Peroxide and (some other drug). These drugs acts against which group of
bacteria?
a. Propionibacterium
b. Staphylococcus
c. Streptococcus
d. Bacteroides

94. Q about Nephrotic Syndrome, Most Definitive Diagnosis?

A. Renal Biopsy
95. Q about a patient having respiratory depression after Surgery and having pin point pupil,
Put on Morphine? Initial Management?
A. Give Naloxone

96. Man who had cellulitis originating from ankle and spreading. Culture revealed MRSA
resistant staph aureus. What is the initial treatment?
a. Flucloxacillin
b. piperazine and tazobactam
c. vancomycin
d. meropenem
e. amoxicillin

97. A 76-year-old man was found outside by his carers this morning. He doesnt remember
what happened but denies history of pain. Temperature 35.1, BP: 102/70mmHg, PR:
108bpm, mucous membrane is dry. No stiffness of any limb, his heart sound is normal. His
chest is grossly normal apart from some scattered coarse crackle in his Left Lower lung zone.
He was catheterized and urinalysis showed Blood+++, Protein ++ and Ketone +, ECG showed
peaked T wave and broad complex Tachycardia. Which of the following is the appropriate
initial intravenous medication he should have?
A. Amiodarone
B. Calcium gluconate
C. Co- Amoxiclav
D. Insulin- Glucose infusion
E. Sodium Bicarbonate

98. A 15-year-old girl presents to her GP for Contraception. She is having sex with a boy who
is in her class. She doesn't want her parents to know because they would be upset. Which of
the following should the GP inform?
A. No one
B. Her Parents
C. Police
D. School Nurse
E. Social service

99. An 8year old boy was brought in by his parents because of some behavioural problems.
In an interview with the teacher, he was described as naughty, easily distracted and
sometimes aggressive. His parents say that he has always had difficulty concentrating on
tasks since infancy. What is the most likely diagnosis?
A. Autism spectrum
B. ADHD
C. Asperger's
D. Tourette
E. Oppositional defiant disorder

100. A 69yr old present to emergency department with thirst, anorexia & lethargy. A known
hypertensive not on regular medication or follow up. On P/E Bp was 170/100, Urea-high,
Creatinine- high, USG shows bilateral small kidneys. What is the most likely cause?
A. Htn nephropathy B. BPH
C. Prostate car D. Chronic pyelonephritis E. VUR

101. 15yr old with facial & ankle swelling. Urinalysis shows protein +++. What is the cause?
A. Minimal change B. Membranous
C. Post streptococcal D. Ig A nephropathy

102. 20yrs old stabbed at the rt hemithorax. Bp 100/40 PR-140. Heart sound clearly heard.
Dull percussion on the rt. Trachea deviated to the left. Next action to be taken
A. Needle thoracentesis
B. Chest tube
C. Intubate & ventilate
D. Tracheostomy

103. Patient with dry eyes. Schimer’s test shows 8mm (N > 15). (+) ANA. Management?
(*SJOGREN)
A: hypromellose (an artificial tear) B. Timolol
c. acetazolamide d. antibiotics e. maryrose oil

104. Q about Duchenne Muscular Dystrophy, Male Carrier? 0%

(We personally don’t remember this Q but people in groups are telling about this Q being
present.)

105. Elderly man 62 years of age, Alcoholic and difficulty swallowing solid and weight loss of
3 months; What is the Most likely diagnosis?
A. Esophageal Ca B. Achalasia C. Pharyngeal pouch

106. Left facial weakness with inability to close the left eye and ptosis. What is the
therapeutic approach?
a) Steroids
b) Aspirin
c) No treatment indicated
d) Acyclovir

107. a patient going for CTSCAN. How can you reduce contrast renal injury?
a) 0.9% saline

108) a 57 yr old presents with difficulty to swallow solids and weight loss of 5 months, what
is the investigation that will lead to a diagnosis?
a. Barium swallow
b. Upper GI endoscopy
c. Manometry
d. Ct scan

109. 28yr old woman with 2 wks history of fatigue, following URTI. T - 37.8°c HR - 100bpm.
She has mild tremors and painful tender thyroid gland which is normal in size. Most likely
diagnosis?
A. Graves Disease B. Hashimoto's thyroiditis
C. Subacute thyroiditis D. Toxic nodular goitre

110. 33yr old woman with weight loss of 6kg, has fine tremors. TSH - Decreased. T3 and T4
Increased. What to give?
A. Carbimazole B. Propythiouracil
C. Prednisolone D. Hydrocortisone

111. 77-year-old man, whose son noticed has been depressed since mother died 6 months
ago. Has depressive symptoms with suicidal tendencies and doesn't think he can go on
living. Q also said that the patient had severe self-neglect. What to do next?
A. Emergency Psychiatric referral
B. Urgent Psychiatry admission
C. urgent psychiatric review
D. Routine Psychiatric referral

112. Q about a patient with unstable HR > 150, BP 80/60 and Having broad complex
tachycardia. Most appropriate management was asked?
A. DC Shock

113. Patient with fever, cough, breathlessness. On certain medications including

simvastatin, Bisoprolol.Diabetic and hypertensive on ramipril simvastatin metformin.
Patient is to use erythromycin. What's the next thing to do?
A) Withhold simvastatin B) give half dose of erythromycin
C) reduce simvastatin dose D) stop Bisoprolol
E) stop Metformin

114. 5-year-old Girl with recurrent UTI (has had 3 UTIs) responsive to antibiotics.
Investigation of choice?
a. MCUG
b. Renal USS
c. DMSA
d. Urine mcs
e. CTSCAN

115. 6 months post stroke patient with intermittent dysphagia. Has lost weight and has
chest infection. What is the best way to administer nutrition?
a) Parenteral nutrition
b) Percutaneous gastrostomy
c) NG tube
c) Feeding jejunostomy

116. Progressive abdominal distension, spider nevi, shifting dullness. Most appropriate
initial management.
a) Spironolactone
b) Chlordiazepoxide
117. Father and son with severe bloody diarrhoea. Ate chicken barbecue causative organism
after culture at 42 degrees showed gram negative curved rods. Patient had also prodromal
symptoms. What is the organism?
a) Staph aureus
b) Campylobacter jejuni
c) E. coli
d) salmonella
e) Shigella

118. Burning Pain. Type 1 Diabetes Mellitus with retinopathy and nephropathy. Which drug
to give for his neuropathic pain? (No amitriptyline in options)
A. Naproxen B. topiramate
D. Steroids E. Duloxetine

119. Lady with frequent migraine. Sudden headaches. Photophobia with neck stiffness.
Temp:37.8 Drugs she uses for her migraine couldn't sort this headache out. Diagnosis
A. Migraine B. SAH
C. Meningitis D. Atypical migraine

120. 10 months old with generalized seizures and temperature of 39°c. Baby was Vomiting
and was febrile and had petechial rash. Most important investigation to carry out for
diagnosis?
A. CSF analysis B. EEG C. FBC
D. MRI brain E. Urine culture

121. There was this question about 60-year-old woman with lethargy, easy fatigability, pale,
etc Lab Values. Hb low, MCV high, Hb- 8.7mg/dl, bilirubin 40 (High). Spherocytes was seen
on the blood film. What investigation to be done?
A. Check serumB12 and folic acid
B. Direct antiglobulin test
C. indirect coombs test
D. solubility test

122. Patient with intracranial bleed INR 4.6 was given IV Vik K. Question is about what next
to give?
A. FFP B. PCC
C. Tranexamic acid D. IVF

123. old man, metastasis from Ca Bronchus. Investigations: hypercalcemia, others normal.
What’s the appropriate initial treatment?
a) 0.9% NS b) Bisphosphonates
c) Calcitonin d) Dexamethasone

124. Unable to abduct and adduct the fingers, Xray neck showed cervical vertebrae showing
degenerative changes. Nerve root of brachial plexus affected?
a. C5 b. C6 c. C7
d. C8 e. T1
125. 4-week-old baby having jaundice since few days after birth. She is healthy and fully
breastfed, stool is Yellow. Cause of jaundice?
A. ABO incompatibility B. Biliary atresia
C. Breastfeeding D. congenital rubella infection

126. 23-year-old with recent habit of handwashing habits, washes from left to right. Afraid
of germs. Family HX of anxiety and depression. Management?
A. Antidepressants B. CBT
C. family therapy D. benzodiazepine
E. beta blockers

127. A Lady Argued with boyfriend. She cuts her wrist. Takes alcohol. Has intense mood
swings but does not want to die.
a. Borderline
b. Histrionic
C. Anti-social.
D. avoidant
E. obsessional

128. Q about Kidney disease patient having Hypocalcaemia. What is the likely Cause?
1, 25 (OH) Vit D

129. A man, builder who was working with a screw driver, and felt something give way in
his upper arm. There is bulging present in the upper part of his arm.
A. Tendon rupture B. Muscle haematoma

130. Child known asthmatic, breathless for over 12hours, 86% Oxygen saturation on high
Flow Oxygen. Chest is silent. Most appropriate initial management?
A. Iv aminophylline
B. Iv magnesium sulphate
C. Intubate and ventilate
D. CPAP

131. Young aged, Rugby player with severe, sudden onset of testicular pain, testes is tender
and pain is not relieved on raising the testes.
A. IV antibiotics
B. Urgent referral to Surgeon

132. A man with BM1 of 35, HBA1c of 56, no hyperglycaemic symptoms, already started life
style modifications 3months ago, next appropriate medication
a. metformin
b. sitagliptin
c. insulin
d. glimepiride
e. lifestyle modification
133. A 68yr old woman with severe intermittent right sided facial pain that is sharp and
Stabbing. Most appropriate management
A. anticonvulsants
B. Nsaids
C. steroids
D. ssri
E. Tricyclic Antidepressants

134. 59-year-old man with lower limb and shoulder weakness and pain when trying to stand
from a chair. A known diabetic on metformin 1g daily. Muscular atrophy in shoulder and
lower limbs Hba1c-67, ESR-22, Ck- mildly elevated. What is the most appropriate diagnosis?
A) Diabetic Amyotrophy
B) Diabetic peripheral neuropathy
C) Polymyalgia rheumatica
D) Polymyositis
E) GBS

135. 80-year-old woman post coronary angiography and placement of 2 stents, stent was
removed later and started having abdominal pain and left groin swelling What is
appropriate management
A) Apply pressure on the swelling
B) CT scan
C) IVF 0.9NS
D) FFP

136. A man who had chest infection, seen by F2 doctor who requested CXR. Radiologist
reports normal findings and man is treated. Afterwards, abnormal findings are discovered
and patient is duly notified and treated. What should the doctor do?
a) Add an addendum to the initial notes, stating new findings with today's date n sign
b) no changes needed to record
c) Delete your previous documentation and write a new one
d) Write a letter to the px apologizing and put a copy in the px's record

137. A 68-year-old man with upper abdominal pain. Has colon cancer which has
metastasized to the liver. Refuses morphine because of previous bowel obstruction and
constipation. Paracetamol has minimal effect on pain. Liver enzymes are deranged. What
pain relief should be prescribed?
a) Naproxen
b) Codeine
c) Amitriptyline
d) Gabapentin

138. 7-year-old boy with increased weight and bilateral swollen legs. Nil other complains.
Next diagnostic investigation-
A. TFT
B. X-ray
C. Blood glucose
D. Urinalysis
E. LFT

139. a woman who became depressed after husband's death. She was using amitriptline.
Her appetite had improved, had the antidepressant for 3 weeks and wanted to stop. She
also felt she now had the cancer her husband had and was calling the Gp daily for him to do
something
A. stop amitriptyline
B. encourage to continue amitriptyline
C. change to SSRI
D. ECT
E. Bereavement counselling

140. 27-year-old Woman with a 1.5 cm lump, tender in left breast. Investigation of choice?
A. Ultrasound
B. mammogram
C. FNAC
D. excision biopsy
E. punch biopsy

141. 71 year with 3 weeks history of fever, 1 month post inferior myocardial infarct, chest
pain with soft systolic murmur, inverted Q waves in leads I, II & aVF. Temp- 37.5,
BP- ?118/68
A. Pericarditis
B. Costochondritis
C. Pulmonary Embolism
D. Infective endocarditis
E. Papillary muscle rupture

142. 76-year-old man with problems finding words and short-term memory. Tendency to cry
but no persistent low mood. The patient has a History of HTN for 12 years What is the most
likely Diagnosis?
A. Frontal lobe dementia
B. Vascular dementia
C. Alzheimers dementia
D. Lewy body dementia

143. Q about Hiccups due to Liver metastasis. Most appropriate management was asked?
A. Metoclopramide
B. Haloperidol

144. A patient with some mental changes and memory problem. Having MCV 98. Hb. 10
mg/dl. What investigation to be done for the patient’s mental change?
A. Blood
B. TFT
C. Vitamin B12 and folic acid
145 A lady 21yr old with positive family hx of breast ca, has a mass that’s firm, painless,
mobile, not attached to anything, skin over it intact. Mother had breast ca. Most likely
diagnosis?
a) Pagets
b) Ductal papilloma
c) Fibrocystic change
d) Fibroadenoma
e) Breast cancer

146. Patient with advanced ovarian carcinoma with gaseous distension and intermittent
pain. Management? Khalid Saifullah sir commented on my post on plab for this
A. Hyoscine butylbromide question.
B. Sc morphine ‘If bowel obstruction occurs in malignancy or as a complication of
C. Surgical palliative care with stoma chemotherapy, conservative treatment is not an option as in
most cases it fails. So answer for this question is C. Palliative
D. NG tube colostomy.’

147. Severe right leg pain cold and pale right foot. Pulses normal on left leg, only femoral
pulse felt on rt. What's the cause?
a) Deep vein thrombosis
b) Superficial femoral artery obstruction
c) Common iliac artery
d) Saddle embolus

148. A question on woman with eyes defect came

back from a travel to 'Turkey' with visual acuity of
6/12 and 6/18 for L/R respectively. She is
hypertensive with BP of 156/90. Fundoscopy
attached What is the diagnosis? (IMAGE BASED Q)
A. Diabetic retinopathy
B. Hypertensive retinopathy
C. Retinal artery occlusion
D. glaucoma
E. retinitis pigmentosa

149. 69 yr old man presents with dysuria, flank pain and fever. He has had prostate cancer
for 10 years. what is the investigation of choice?
A) Urine Culture and sensitivity
B) Serum acid phosphatase
C) serum PSA
D) Serum Calcium
E) Blood culture

150. Immunocompromised elderly patient with previous history of PE and MI. Taking
Medications for COPD since 10 years. Complained of breathlessness and Coughing.
Pneumonia as diagnosed and died after few hours. X-ray showed Multiple patchy Opacities.
What will be filled in the 1a part of the death certificate?
A. COPD
B. Pneumonia
C. Lung Failure
D. Chest Infections.

151. 72-year-old man with painful swelling in the groin. Swelling located inferior to the
inguinal ligament and lateral to the public tubercle. Cough impulse present. Patient had
radical orchidectomy surgery for a
seminoma at age 27. What is the
diagnosis?
A) femoral hernia
B) inguinal hernia
C) incision hernia
D) lymphedema
E) saphena varix

152. 38 yr old woman who presented with passing of blood per rectum. She complained of
occasionally staining of toilet paper for about 3months with blood. There was an episode
when she was just passing blood while trying to defecate. On examination, perineum is ok,
no mass felt in the rectum, rectum is empty. Gloved finger not stained with blood. What is
the next best investigation?
A) Colonoscopy
B) proctoscopy
C) Fecal calprotectin test
D) Faecal occult blood test

153. female patient requiring breast examination, she came to clinic with family and friends.
What is accepted as regards chaperone?
A) Allow family to chaperone
B) Allow friend to chaperone
C) Accept her refusal to chaperone, go ahead and examine and document what happened
D) Refuse to carry out the examination without a chaperone
E) a chaperone must be made available whether the patient consents or not

154. A man with Alport syndrome has a new partner without any renal anomalies pregnant
for him. Scan reveals baby is Male, what is the chance of the boy having the syndrome?
A. 0%
B. 25%
C. 30%
D. 50%
E. 100%

155. A man was admitted and developed ataxia, ophthalmoplegia what medication can be
used for his condition?
A. Chlordiazepoxide
B. Thiamine
C. Lorazepam
D. Acamprosate
E. Disulfiram

156. Post ERCP right hypochondriac pain with fever, elevated bilirubin and raised amylase.
What is the diagnosis?
A. Ascending cholangitis
B. Acute pancreatitis
C. Cholangitis
D. Acute cholecystitis

157. A question about not feeling femoral, popliteal pulses. Where’s the occlusion?
A. External iliac artery
B. Femoropopliteal artery
C. Aortoiliac artery
D. Popliteal artery

158. 53 yr old woman with post-menopausal symptoms. She has a history of HTN since 5
years. Most appropriate Treatment?
a) HRT
b) Clonidine
c) Estrogen patch
d) Primrose oil
e) Raloxifene

159. Q about lethargy and Raised MCV 108, Low Hb and tingling sensations over fingers.
Best investigation? Vit B12 and Folic Acid (Classical Picture of Vit B12 Def)

160. A 23-year-old man was found lying on the floor behind his flat. He is a known
intravenous drug user and has not been seen for 3 days. Results of his investigation are as
follows: Urea - 45mmol/L, Creatinine 1200 micromole/L. What investigation would confirm
the cause of his renal impairment?
A. Abdominal Ultrasound scan
B. Blood cultures
C. Serum creatinine phosphokinase
D. Echocardiograph
E. TFT

161. A 34-year-old woman presents with itchy rash. She is a taxi driver and requests
medication that will not affect her alertness. She has an urticaria like rash. What is the most
appropriate medication?
A. Cetirizine tablets
B. Chlopheniramine tablets
C. Hydroxyzine tablets
D. Hydrocortisone tablet
E. Prednisolone Tablet

162. A 60-year-old man presents to the Ear, nose and throat clinic with complaints of
gradual hearing loss in the left ear. There is a history of occasional vertigo and tinnitus. The
external auditory meatus and tympanic membrane appear normal. Audiology reveals left
ear hearing loss. What is the most appropriate investigation to lead to a diagnosis?
A. Brain stem evoked response
B. MRI of internal auditory meatus
C. Speech Audiogram
D. Tinnitus matching
E. Vestibular Tests

163. A man had anterior resection of the rectum. He was normal until 10th day. He
developed fever 39°C, lower abdominal pain, pulse 110bpm. What is the likely diagnosis?
A. Paralytic ileus
B. Pelvic abscess
C. Pelvic hematoma
D. Pelvic vein thrombosis
E. Urinary tract infection

164. Woman with pain and stiffness of the joints of her hand. Has a rash that across her
nose and cheeks. Medical history significant for mouth ulcers. Which antibodies?
A. Anti-cardiolipin
B. Anti CCP
C. Anti-ds DNA
D. ANCA
E. Anti-smooth muscle

165. A 32-year-old man presents with erectile dysfunction of 2 months. He had depression 3
months ago and was started on Sertraline. He has no medical history of note. What is the
most likely cause of his symptoms?
A. Sertraline side effects
B. Autonomic neuropathy
C. Performance anxiety
D. Depression

166. Patient being managed for infertility, when is the best test to assess ovulation?
a) mid luteal progesterone
b) mid luteal FSH
c) serum estrogen

167. Patient developed unilateral limb swelling 6 days post CS after prolonged obstructed
labour. Left Feet is cold, mottled up to the inguinal crease. Where is the occlusion?
A. Femoral artery thrombus
B. Femoral artery atheroma
C. Iliac artery thrombus
D. common iliac vein
E. Post phlebitis syndrome

168. patient present with sudden onset breathless. Previous hx of panic attack ABG revealed
respiratory alkalosis with hypoxia (Low PO2, Low HCO3, High pH, Low PaCO2)
a) Pulmonary embolism
b) Panic attack
c) Aspirin toxicity

169. Man, just out of the theatre for cholecystectomy. Vitals stable except BP- 90/50
Pulse- 120. What is the next step to carry out?
a. Fluid challenge
b. Adrenaline
c. Dopamine

170- man who takes alcohol hears voices ever since he stopped 2 weeks before, the voices
have reduced but not stopped. What to give to prevent symptoms?
a. Acamprosate
b. Disulfiram
c. Vit b complex
d. Chlordiazepoxide
e. Olanzapine

171- Man with crutches having weakness on the left arm on dorsiflexion of wrist, and wrist
drop, Nerve root involved?
a. C5
b. C6
C. Radial nerve
D. Interosseous nerve
E. Median nerve

172. A 54 yr old man with left sided facial pain and rash extending to the midline of his nose.
He had complained of headache 2 weeks prior with no cause found. What is the affected
structure?
a) extra cranial Facial nerve
b) Trigeminal ophthalmic nerve
c) Vestibulocochlear nerve
d) Oculomotor nerve

173. malignant melanoma excised. Which feature shows a bad prognosis on

histopathological examination?
a) Diameter > 6mm
b) Varying color
c) Depth of invasion
d) Grades of Differentiation.
174. Patient with Hx of MI presented after ___ days with chest pain which aggravates on
inspiration and is relieved on bending forward. Most likely Diagnosis?
A. Pericarditis
B. Pulmonary Embolism
C. Pleural Effusion

175. A young man presents with sudden pain in the chest while lifting weights. He is unable
to lift the arm above the head, difficulty in abducting his left hand beyond 90, when the arm
is stretched out against resistance, the scapula is noticed to be prominent. Injury to which of
the following nerves is implicated
A. Dorsal scapula nerve
B. Long thoracic nerve
C. Posterior interosseus nerve
D. Axillary nerve
E. Thoracodorsal nerve

176. A 38-year-old man presents to the emergency department feeling unwell and dizzy. He
has a heart rate of around 35 beats/minute. What is the SINGLE most appropriate first line
treatment?
A. Atropine
B. Adenosine
C. Dopamine
D. Epinephrine
E. Supplemental oxygen

177. An FY2 doctor sustained a needle stick Injury while taking a sample from an
unconscious patient with history of Intravenous drug use. The department of Public health
recommends that a sample be taken from the patient for further investigation. What is the
appropriate next step?
A. No need to take the sample
B. Ask for consent from the family of the patient
C. Take the sample inpatients best interest
D. Wait until the patient is conscious and take consent
E. obtain a court order for sampling

178. A child asymptomatic CMV, mother wants to know the early complications;
A. Blindness
B. Deafness
C. Hydrocephalus
D. Microcephaly
179. Old man with 20 years history of Parkinson’s, now with dementia, cognitive
dysfunction. Now has visual and tactile hallucinations for 6months with increased cognitive
impairment.
A. Alzheimer
b. Vascular Dementia
c. Lewy body Dementia
d. Parkinson’s associated dementia.
E. Picks dementia

180.Male child with diarrhoea vomiting and fewer wet diapers and did not eat for days. Best
fluid therapy for maintenance?
A. 0.45% N/S+ 5% dextrose B. 0.18%N/S+ 4%dextrose
C. Hartman solution D. 0.9%N/S
E. Dextrose infusion