February 2021 Recalls

1. A 7year old boy with weight gain and bilateral pedal oedema for 3wks . He is otherwise normal on
examination. What is the most appropriate diagnostic blood test.
A Albumin
B.CRP
C. Hb.
D. Urea
E. Creatine kinase

2.   A child with rashes appeared? Days ago a classical picture of molluscum contagiosum was presented(has
vesicles with central umbilication). He had full vacinnation and is completely otherwise normal
What treatment will you give.
A. No treatment required
B. Oral acyclovir
C. Oral flucloxacillin
D. iv steroids

3. A 3 year old boy with duchenne muscular dystrophy whose mother is pregnant for the second child will want to
know of the second baby been affected with same condition.
A. Nil
B.25%
C.50%
D.100%

4. Healthy 36 yr old with 1+ of protein in Urinalysis what to do?

A. Start ACEI
B. Refer 
C.Advise on Protein Diet
DRepeat

5. 70yr old with Diplopia on lateral view.

Affected Nerve?
A. Left 3rd
B. Left 6th
C.Right 3rd
D. Right 6th

6. 4 year old boy with an anterior neck swelling of 6 months duration, it is smooth and not tender, temperature
36.8, swelling moves with swallowing and tongue protrusion. Diagnosis
A. Branchial cyst
Ɓ. Lymphadenopathy
C. Thyroglossal cyst

7. A 72 year old man with HF started ramipril 2 weeks ago what blood test to perform
A. BNP
B. FBC
C.LFT
D.KFT

8. A man had lung Ca and underwent lobectomy. Chest drain was inserted and removed 2 days ago. He started
feeling breathless
What’s the most appropriate action?
A.Insert Chest drain 
B.IV Abs
Some other tx I don’t remember 

9. On inserting chest drain in the 4th ICS what structure are we likely to damage?
A. ICS arterty

10. 22 year old woman presented with severe left sided headache and right sided body weakness. Headache
was preceded by nausea and photophobia. She is on COCP.
Body weakness has resolved. CT scan normal.
What is the most appropriate next management plan?
A. No need for further management
B. Start aspirin
C. Stop COCP
D. Start propranolol
E. Start topiramate

11. Q1. An old man on palliative care. CXR showing pleural effusion on right lower lung zone.
Treatment? Pleural aspiration

12.42 y/o man poorly malnourished with alcohol dependence. He has confusion ,ataxia and nystagmus. What is
the most appropriate immediate management 
A. 10% glucose infusion
B. Iv vitamin B complex 

13. 56year old man who cut himself on the wrist. Wound has been sutured. He has poor eye contact. He’s not
sure if he won’t attempt to take his life again. What to do next?
D. Refer to community health mental team
E. Refer to on call psychiatrist 

14. 76y/o man being managed for multiple myeloma

Na- normal
K- normal
Urea- high
Creatinine-high
Ca-3.3
He has been given IVF.  What to give next
A.Ivpamidronate

15 . An 80 year old had fluctuating confusion and disorientation for 3 days . Visited at home by his GP with his
sleep cycle disturbed. He was recently catherize for urinary incontinence few weeks back . 
What is the diagnosis?
a. Alcohol withdrawal 
b. Delirium 
c. Lewy body dementia 

16. . A 45 year old man presented with expanding rash of three we eks duration and aches and weakness. A
picture of erythema migrans . What is the most useful investigation?
a. Skin scrap 
b. Lyme disease serology

17. An 18yr old man who was treated for a sorethroat last week managed as glandular fever, now presenting
with abdominal pain after playing football. Which organ is affected?
A Pancreas
B Spleen
C kidney
D Urinary bladder
E Liver

18. A man found unconscious

Glucose 2.1 
Mgt?
A. Oral glucose gel
B. IM Glucagon
C. Iv 20% Glucose
D. 0.9% Normal saline

19. A pt with bipolar. Hav creps

Drugs responsible
A.Lithium
B.Thyroxine

20. A 96yr old patient who developed presured speech, flight of ideas, auditory Hallucination and bizzare
delusion. Was treated for infective excerbation about a few days ago.
Medication implicated
A.Amoxicillin
B.Doxycycline
C.Salbutamol
D.Prednisone
E.Tritopium

21.A 6yr old boy with fever for 6 days, with fissuring of the lips, non purulent conjunctivitis, cervical
lymphadenopathy
What is the Rx?
A. Antibiotics
B immunoglobulin
C Steroids
D Anagelsics

22. A girl presented to the Emergency department with severe headache. Headache was initially preceded by
nausea and vomiting. What is the most INITIAL management. She takes cocp
A) no treatment 
B) start aspirin
C) stop cocp 
D) start topiramate 
E) start propranolol

23. A man in the post surgical ward presents with 6hrs of vomiting. He had a colorectal surgery 6 days ago.
Temperature was 37.8, respiratory rate was 8. Abdomen was distended and mildly tender. They were no bowel
sounds. 
Hb - 13mg/dl 
WBC- 9  (4-11)
What is responsible for his symptoms 
a) anastomotic leak
b) paralytic ileus 
c) opioid toxicity 
d) ulcerative colitis 

24. 83 year old presents with gradually worsening vision. He is unable to read clearly or see at night
Cornea and conjunctiva appeared normal 
a) age related macular degeneration 
b) dementia associated eye disease 
c) acute angle closure glaucoma 
d) anterior uveitis

25.: A patient presents with 2day hx of epigastric pain. She was diagnosed with duodenal ulcer 6months ago and
received H. Pylori eradication therapy.  How will H. Pylori eradication be confirmed?
a) C-13 urea breath test
B) Feacal H. Pylori
C) H. Pylori serology

26. A 28yr old woman with that is having palpitations and is anxious, unable to sleep for the last one month
Investigation
Tsh..elevated, free T3 normal, free T4 normal. Rx
A. Levothyroxin
B USS of thyroid scan
C Reassure
D Propanolol

27. A 7yr old boy with weight gain and bilateral pedal oedema for 3wks . He is otherwise normal on examination
What is the most appropriate diagnostic blood test.
A Albumin
B.CRP
C. Hb.
D. Urea
E. Creatine kinase
28. A child with rashes appeared? Days ago a classical picture of molluscum contagiosum was presented(has
vesicles with central umbilication). He had full vacinnation and is completely otherwise normal
What treatment will you give.
A. No treatment required
B. Oral acyclovir
C. Oral flucloxacillin
D. iv steroids

29. A 30yr old paramedic who had a rash on his shin. Rash has been treated and disappeared.
He has had 4 HIV test dont in the last 3months which came out negative.
He still insists that he is positive.
Diagnosis.
A. Factitious disorder self imposed
B. Hypochondriasis
C. Malingering
D. GAD
E. 

30. A .74yr old man with sudden onset chest pain and difficulty in breathing.
He is been treated for cellulitis of the leg. All vital signs given were normal.
Normal FBC and Urea and Creatinine
What investigation to arrive at diagnosis.
A. CTPA
B. Ventilation perfusion scan
C. Chest Xray
D. 

31.A 73yr old woman with lower abdominal pain and bloating.
Has lost 10kg unintentionally in the last 3months. Vital signs all stable.
What is the initial investigation.
A.  Serum t-TG
B. Ca- 125
C. CT pelvis

32. A question on orbital blow out fracture

What bone affected
A.Frontal bone
B .Maxilla
C.Ethmoid
D.Temporal

33. A 5year boy with high fever ,polymorphic rashes and conjuctivitis (classical case of Kawasaki) 
Treatment
A. Iv immunoglobulin
B.Iv antibiotic
C.Steroids

34. A 27 yr old woman with painful genital ulcers and multiple ulcers on the vulva. Which investigation would lead
to a diagnosis?
A anti HSV antibodies
B dark field microscopy
C Treponema palidum serology
D. HSV viral culture.

35. A 58 yr old man who had CA bronchus, and presented with symptoms of SVC obstruction, what most
appropriate initial treatment?
A. dexamethasone
B. Diamorphine
C. Furosemide

36. A 3 yr old presented with a unilateral foul smelling discharge of 2 months duration, what's the cause of the
symptoms?
A.sinusitus
B. Nasal polyp
C. Foreign body.

37. A child with rashes on the mouth, hand and ankle

What is the cause
A. coxakie
B.Measels
C.Rubella

38. An 80yr old woman with painon the shoulder and difficulty standing up (features of PMR)
CK normal
ESR 80 high
Treatment
A. Prenisolone
B.Nsaids
C.Dihydrochlorouine

39. A 35 year old man with 2 days of epigastric pain, 6 months duodenal ulcer. Had one helicobaccter
eradication. 
What is the confirmatory test for h. pylori eradication?
a. Carbon 13
b. H.pylori stool antigen
c. H. pylori serology
d. Repeat endoscopy and biopsy 

40. A 3 yr old child with 3 days sore throat, muffled voice, 1 day neck pain. Temp 39, tonsil enlarged and
displaced to the left covered with exudate, uvula displced.
What is the next appropriate management?
a. Urgent hospital admission
b. Analgesia and review in 24 hours
c. Phenoxymethypenicillin and review in 72 hours
d. Nebulised salbutamol 

41. . A 2 yr old child came for mole stone assessment.  Can climb stairs, eats with spoon, say 2 words which
have meaning and tells when he wets his pants.
a. Delayed motor
b. Delayed social 
c. Delayed speech
d. Gross delay
e. Normal

42. A pregnant woman 18weeks gestation had contact with a child with chicken pox a day ago. 
Varicella antibody negative
Most appropriate treatment
A VZig
B.oral acyclovir
C Reassure

43. A picture of malignant melanoma Dx

44. A ckd patient with deranged EUCR elevated potassium  mgt 

A dialysis
B calcium gluconate
C salbutamol

45. 18wks preg woman exposed to chickenpox. Antibody negative

A give IVIG
B reassure her
C give acyclovir

46. A woman who came in with her daughter. Woman wants to participate in trial. Daughter refuses. What next
to do?

47. A  23yr old girl with breast lump, histology was done and reveal fibrous tissues, surrounded by low columnar
cells and fatty tissues(all normal histological findings )
Diagnosis
A. Fibroadenoma
B.invasive ductal papiloma
C.Fat necrosis

48. This on epidemiology. A trial test diagnosed 30 patients correctly, 20 was negative but was found to be
postive, 150 were correctly diagnosed as negative by the test and 50 were said to be positive but was found to
be negative.
What is the specificity?
A 50%
B 40%
C 60%
D
E 75%

49. A man having recurrent epigastric pain which is also worsened by spicy food, he was given trial of
omeprazole but symptoms persists.whay is the next most appropriate investigation.
Helicobacter test negative.
A barium meal
B fecalproteim
C
D: gastroduodenoscopy.

50. Malignant Melanoma Pic 'Specified' No Bleeding No Itch.

51. CKD Pt also had elevated Creatine Kinase

52. A male post MI patient what you should give that came down with depressive symptoms what will you give
A. Setraline
B. Fluoxetin
C Amitriptyline

53. 16. A 76year old man with musle pain for 2weeks, known diabetic on Metformin, bisoprolol, simvastatin etc.
LFTs normal, just creatinine kinase elevated. Medication to stop
A. Bisoprolol
B. Simvastatin
C. Metformin

54. A 14year old boy with 3months of watery stool and vague abdominal pain. Weight dropped from 48kg to
46.5kg. On palpation, mild tenderness and irregular mass at the right iliac fossa. Diagnosis?
A. Coeliac disease
B. Crohn's
C. Ulcerative colitis

55. A 65year old with loss of vision in the left visual field lasted 30mins and completed resolved. What artery was
affected?
A. Anterior cerebral
B. Anterior communicating
C. Posterior cerebral
D. Posterior cerebellar
E. Middle cerebral

56. An ECG showing anterior MI(ST segment in V1 to V6

Which artery is occluded
A. RcA
B.LAD
C. left circumflex
D.

57. A patient with Bipolar placed on lithium when will you check lithium level
A.4hrs
B.2hrs
C.12hrs
D.24 hrs

58. A 28yr old woman with central chest pain x3 days ago, hx of prior viral respiratory infection
Vitals: normal
Chest x-ray: normal
Picture of ECG

Diagnosis :
A. left bundle branch block
B. NSTEMI
C. Pericarditis
D. STEMI

59. A hx of Oligomenorrhea with mood swings BMI: 28kg/m2

Testosterone:3.6
Fsh: 15
LH : 22
Prolactin: 463
Tsh: 3.7
Sex receptor globulin:10

Diagnosis: 
A.CAH
B. Hypothyroidism
C. Pituatry tumor
D.Pcos
E. Premature ovarian failure

60. A woman with low mood, hears voices including voice of boyfriend who died 9months ago with auditory
hallucinations 
Diagnosis
A. Adjustment Disorder
B Atypical depression
C. Psychotic depression

61. A homeless man living on the street,weight loss,cough unkempt presented to a&e.PTB positive
Management plan
A.admit ward
B.discharge +DOT
C.discharge no Rx
D.refer chest clinic

62. A known asthmatic presenting with acute exacerbation of asthma,had back to back
salbutamol,steroids,aminophylline,mgso4,still breathless presently intubated
EUCR
All normal except hypoK n hyperCA
ABG
All normal except pco3 high

Cause of hypoK?
A.aminophylline
B.mgso4
C.salbutamol
D.1 resp failure
E. 2 resp failure 

63. A 26 year old male complain of eye pain,visual loss,irregular pupil

Flourestin(forgive my spelling)positive
Cause?
A.conjunctivitis 
B.anterior uveitis
C.retinal detachment 
D.

64. A pregnant woman with constipation has tried increase fluid intake and all and is constipated
A. Isphaghula
B. Macrogol
C. gycerol suppositories
D.
Sha Senna and lactulose wasn't in the option

65. A patient with classical features of Addison's and on hydrocortisone and fludrocortisone with acute illness
What change should be done to his medications
A. Doubt dose of hydrocortisone
B.Double dose of fludrocortisone
C. Administer antibiotic

66. 98.. Meningitis that has completed 14 days iv antibiotics and is has been well. Most likely long term prognosis
a. Complete recovery
b. Deafness
C. Blindness
...
67. A breast lump in a 25 old mobole and measuring 2.5cm. Histology showed well circumscribed leasion with
fibrous septa and coloumnar epithelium. Diagonosis?
A. Fibradenoma
B.breast ca

68.. 16 weeks  GA. Best diagnostic for foetal abnormalities

A. Amnioncentesis
B. Chronic villi sampling
C. Uss
D. .......

69. . A 34 year old woman with crohn's presented with painful rash on the left side of her face and the nose.
treatment options 
A. oral acyclovir 
B.iv acyclovir 
C.antibiotics topical
D. prednisone

70. One Osteoarthritis stem was there. Patient had gastric ulcer . Had used Diclofenac gel and Developed rash .
PCM has been given. Which one to be 
followed
A Codin  
B Tramadol
C NSAIDs

71. A 34 year old woman with crohn's on prednisone presented with painful rash on the left side of her face and
the nose. treatment options 
A.oral acyclovir 
B. IV acyclovir 
C.antibiotics topical
D. prednisone

72. A child had playing alone in the garden had seizure lasting 8minutes. and present with headache and
persistent vomiting several times.
What is the most appropriate action?
a. referal to E.D to be seen immediately 
b. Discharge home and reassure 
c. observe for 24hours
D. do LP
e. give dexa

73. 12 weeks pregnant woman

Had child with CF
Probability of her unborn child affected with CF
A.1.1
B.Nil
C.1:2
D.1:4

74. A man presents with ataxia and confusion. Known alcoholic. What is the most immediate treatment
A. Iv glucose
B. Iv thiamine

75. Patient is placed on sodium valproate which of the following should be monitored 
a) LFT
b) renal function test
c) ECG

76. Picture of an enlarging rash (typical of erythema migrans) what investigation? 

A. Lyme serology
B. Swab for bacteria culture
C. Swab for mycology 

77. A man fell from a height. Had a period of lucid interval then deteriorated and died. What will you tell coroner?
A. Extradural hemorrhage 
B. Subdural 
C. Subarachnoid

78. 53 year old man has Huntington chorea, his daughter is unaffected and wants to know the probability of her
child being unaffected 
a) 0
b) 1 in 1
c) 1 in 2
d) 1 in 4
e) 100%

79. A 80yr old woman who was found on the floor. Creatine-high, Creatine kinase-high.
Pathological q wave seen on ECG
What is the cause of elevated creatinine kinase?
A.Acute MI
B. Rhabdomyolysis
C. AKI

80.A lady that slashed her wrist when police tried to arrest her at a shop where she was stealing.
Police officer ask you to reveal her records.
What will you do?
1. Give them.
2. Contact GMC
3. Deny them.
4. Ask patient.

81. A 30 yr old with malaise and nausea. Pt has severe asthma and has been on fluticasone, salbutamol and
salmeterol for 2years.
Early morning cortisol-normal
Fasting blood glucose-normal
Hyponatremia
Hyperkalemia.
What is the next investigation?
A.Water restrictiction.
B. ACTH stimulation.

82. There was one on CLL/ Non Hodgkin's

Enlarged cervical Nodes with some biopsy results
Had leucocytosis and lymphocytosis. Cervical lyph node biopsy showed numerous small cells with 5% large
cells... something like that
83. 25. A man who had a left hemicolectomy about 4 days ago. Developed lower abdominal pain. Vitals were all
normal. Had lower abdominal tenderness in examination. What is the most appropriate investigation. 
a. CT abdomen 
b. abdominal X ray
c. Abdominal US scan 
d. MRI abdomen 

84. A woman who wanted to get pregnant and know the Likely cause of infertility. Has had 2 miscarriages, had
previous PID with Chlamydia and is currently on Depo Provera. What is the biggest risk for infertility?
a. previous miscarriages 
b. Previous PID 
c. Depot provera use. 

85. A 3 year old child who came in breathless, with reduced respiratory rate and laryngeal stridor  and drooling.
What’s the next appropriate management 
a. IV Antibiotics 
b. Intubate 
c. IV fluids.

86. A patient is taking aspirin, metformin, statin, ramipril... And has increased CK
Which should stop.  
Dont’t remember compete.
Last drug was simvastatin

87. An ECG showing anterior MI(ST segment in V1 to V6

Which artery is occluded
A. RcA
B.LAD
C. left circumflex
D.

88. 71. A woman who came in with her daughter and it was the research nurse who was assessing . Woman
wants to participate in trial. Woman has mild impairment. Daughter refuses. What next to do?
A.Assess capacity
B.Include in trial based on request
C.Obey daughter's request
D. Refer to psych for capacity assessment

89. Elderly man presents with malaise and confusion GCS was 11/15, respiratory rate 28 blood pressure was
110/80. Patient was drooling saliva  and had generalized fasciculations 
What’s the next immediate management 
a) intubate and ventilate 
b) non invasive ventilation 
c) administer antibiotics 
d) nebulized salbutamol?

90. 25. A man who had a left hemicolectomy about 4 days ago. Developed lower abdominal pain. Vitals were all
normal. Had lower abdominal tenderness in examination. What is the most appropriate investigation. 
a. CT abdomen 
b. abdominal X ray
c. Abdominal US scan 
d. MRI abdomen 

91. A woman who wanted to get pregnant and know the Likely risk of ectopic pregnancy. Has had 2 miscarriages,
had previous PID with Chlamydia and is currently on Depo Provera and has fibroids. What is the biggest risk for
ectopic pregnancy?
a. previous miscarriages 
b. Previous PID 
c. Depot provera use. 

92. . A 3 year old child who came in breathless, with reduced respiratory rate and laryngeal stridor  and drooling.
What’s the next appropriate management 
a. IV Antibiotics 
b. Intubate 
c. IV fluids.

93. A 25 yrs old man with painful dysphagia,  with history of haital hernia and 8 weeks of hoarseness of voice.
What is the most appropriate step:
a)  Referral to a Gastroenterologist
b)  Referral to ENT surgeon 
c)  Do USS

94. A patient with classical features of Addison's and on hydrocortisone and fludrocortisone with acute illness
What change should be done to his medications

A. Doubt dose of hydrocortisone

B.Double dose of fludrocortisone
C. Administer antibiotics
D.
E.

95. A 20 year old man presented to A&E following a development of Frank haematuria 2days ago, at
presentation, urinalysis showed haematuria++ & proteinuria+. He suffered from URTI with sore throat 2weeks
ago.
What is the most likely cause of his renal pathology?
(A) IgA GN
(B) post-infection GN
(C) Nephrotic syndrome
(D) Minimal change GN
(E) Membraneous GN

96.A 76year old Man developed dizziness while walking for the past 4weeks. He is a known hypertensive and
Type 2 diabetes mellitus patient on tab Bisoprol, indapamide and Metformin and achieved good control. At
presentation in A & E, his vitals are stable, BP sitting= 127/76mmHg and standing BP= 120/74mmHg.
What is the most appropriate NEXT investigation that may lead to the diagnosis?
(A) Ambulatory BP monitoring
(B) Ambulatory ECG
(C) Echocardiogram
(D) Stress ECG
(E) Random Blood Sugar Check

97. A 26year old man present to A&E with complaint of severe epigastric pain and vomiting for the past 6 hours,
He drank overdose tablets of a medication 2days ago after a heated argument with his girlfriend. He was drunk at
the time of taking the medication and did not know the exact drug he took. He was diagnosed with depression
and was placed on antidepressant 10days ago.
Below are the results of his blood test in A&E;
Random blood sugar: 5.5mmol
Bilirubin ( markedly increased)
Alkaline phosphatase ( markedly increased)
Alanine aminotransferase ( markedly increased)
Prothrombin time ( elevated)
Which of the following drugs did this man take in excess??
(A) Paracetamol
(B) Aspirin
(C) Fluoxetine
(D) Amitriptyline
(E) Cocaine

98. 53 year old man has Huntington chorea, his daughter is unaffected and wants to know the probability of her
child being an unaffected carrier
a) 0
b) 1 in 1
c) 1 in 2
d) 1 in 4
e) 100% ?
99. 2 questions on a patient who was on antibiotics for cellulitis for a week then developed profuse non bloody
diarrhoea.
What is the causative organism.
A. C. deficile
B. C. Jejuni
C. Norovirus

100. A man with COPD. Confused and having difficulty in breathing. RR 8/min
pH 7.15
Pco2  elevated
Po2 low
What to do.

A. Intubate and ventilate

B. Give doxapram
C. Salbutamol
D.

101. Can't remember the details . An 89 years old woman with breast CA,  who has shooting left leg pain , no
neurological deficit.  What to give
A. Pregabalin
B.  Morphine

102. A 18yr old with requiring ventilation.

He has a chronic neurological condition with drug refractory seizures.
He has been admitted in ICU like 4times in the last 6months. Doctors think it's best to do a DNR and this has
been explained to the parents but parents wants him ventilated.
What to do.
A. Go ahead and fill a DNR form 
B. Allow parents make decision
C. Explain what DNAR means to parents

103. A diabetic patient with peripheral neuropathy. 

What to use.
A. Duloxetine

104. There was a woman with tingling sensation, tiredness etc. Low hemoglobin, high MCV. Diagnosis?
A. Folate deficiency
B. Vit B12 deficiency
C. Aplastic anemia
D. Acute leukaemia

105. A woman 18wks pregnant exposed to a child with chicken pox 8days ago.
What to do.
A. Give oral acyclovir.
B. Ivig.
C.iv acyclovir

106. A child with molluscum contagiosum (picture was given) management.

A. Reassure
B. Acyclovir

107. A 76yr old woman hypertensive and diabetic complains of palpitations.

Ecg provided shows atrial fibrillation.
What is immediate management.
A. Give warfarin
B. Metoprolol 
C. Carotid massage

108. A woman with painful pale swollen upper limb( acute limb ischaemia scenario)
Echo shows atrial myxoma.
What to do.
A. Thrombolysis
B. Embolectomy
C.

109. Woman with recent upper respiratory tract infection now complaining of chest pain.
Ecg given shows wide spread ST elevation.
Diagnosis.
A. Pericarditis
B.

110. There was a post partum woman with breast pain etc. Commonest organism?
A.Staphylococcus aureus
B.Staphylococcus epidermidis
C.Group B streptococcus
D. E coli

111. A woman with cyclical mastalgia what to do.

A. Primrose oil 
B. Pcm.
Firm bra not in option

112. There was an acute red painful eye with irregular pupil , redness at the junction between sclera and cornea.
Diagnosis?
A.Glaucoma
B.Anterior uveitis
C. Acute conjunctivitis

113. A man who took overdose while drunk because girlfriend broke up with him 2 days ago. Presented with
epigastric pain and tenderness. PT prolonged, LFTs all slightly elevated. Possible drug?
A.Aspirin
B.Paracetamol
C.Amitryptylline
D.Sertraline (not sure, but it was an SSRI)

114. A woman with foul smelling discharge, has new sexual partner. Also has vulvovaginitis.cervix was normal.
PH was greater than 4.5. Causative organism?
A. Chlamydia
B. Gadnerella
C. Gonorrhea
D. Trichomoniasis
E. Candida

115. There was a guy with dilated pupils, confusion, some other symptoms. Possible drug used?
A.Cocaine
B.Amphetamine
C. Nobel psychoactive drugs

116. One very rich grandma with severe dementia. Daughter wanted her to sign £5000 for a new car and wants
you to be a witness. What to do?
A. Call police
B. Call safeguarding
C. Sign it
D. Decline as it is paid job

117. There was a homeless man with cough and fever for 3 months. Positive sputum AFB. What to do??
A. Discharge and do DOT
B. Admit in isolation I think
C. Discharge and advise to wear facemask
D. Arrange urgent accommodation.
E. Urgent referral to chest clinic

118. An alcoholic man with deranged LFT admitted 6hours ago for elective herniorrhaphy. What to use to
manage his alcohol dependence?
A.Disulfiram
B.Acamprosate
C.Chlordiazepoxide
D.Lorazepam
E. Thiamine

119. A 78 yr old woman with osteoarthritis presents with bone pains. She is being managed with paracetamol but
without relief of her pains. She used topical diclofenac but developed skin reactions. She has gastric ulcer. What
medication is the next best option ?
A. Fentanyl
B. Codeine
C. Naproxen
D. Tramadol

120.A 78 y/o man had right hemicolectomy for caecal cancer 6 days ago. He now presents with abdominal
distension and absent bowel sounds. His Electrolytes are
Na+..........124
K+.............2.2
Ca..............2
Which electrolyte derangement is likely responsible ?
A. Hyponatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia

121. A lady with chronic bloody diarrhoea. Currently having upto 20 episodes of diarrhoea within 24 hours. X-ray
showed enlarged transverse colon. What is the cause of her symptoms?
A.Giardia
B.Ulcerative colitis
C.Crohn's
D.Campylobacter

122. A young person with chronic abdominal pain and passage of mucus. Exacerbated by eating and relieved by
bowel movement. Diagnosis?
A.Irritable bowel syndrome
B.Food allergy
C. Crohn’s disease
Can't remember other options

123. There was a patient seen in the pre operative clinic with BP 162/102, when reviewed 2 weeks later BP
became 148/89. What to do?
A.Ambulatory BP
B.Lifestyle modification
C. Start antihypertensive

124. There was another person who developed hematuria 5 days after respiratory tract infection.
A.IgA nephropathy
B.Post streptococcal glomerulonephritis

125. A patient who has a progressive intermittent dysphagia, and regurgitation, and also a chest infection( can't
recall if pneumonia) 
What is the initial investigation to be done 
A. oesophageal manometery 
B.chest x ray 
- can't remember the other options

126. A 75year old lady went for pre op assessment  BP was 164/101 mmhg,She is for elective knee replacement
surgery.  Later reviewed in GP surgery 2 weeks later BP: 148/89
What is the next most appropriate mgt for her
a. Ambulatory BP monitoring 
b. Antihypertensive 
c. ECG
d. Echo
e. Lifestyle modification 
127. A 75 year old who underwent elective TURP . Had convulsions and confusion .Known diabetic
Here are his labs
Na:119
K: 6.1
FBS:7.8
ECG: Sinus rhythm
IVF 3% NaCl has been given

What isthe next appropriate mgt

a. 0.9% NaCl infusion
b. IV Calcium chloride
c. IV furosemide
d. Nebulised salbutamol 
e. Glucose-insulin infusion 

128.65 year old woman presented with nausea, vomiting, diarrhoea and fever
Known Diabetic, Hypertensive and Low back pain sufferer on Ramipril, Metformin and Gabapentin

Labs 
Na:145
K: 7.1
FBS:5.1
IV Calcium chloride has been given. What is the next most appropriate fluid
a. IV Actrapid Insulin 10units + IVF 50mls of 50% Dextrose
b. IV Actrapid Insulin 10units + IVF 50mls of 5% Dextrose
c. IV Actrapid Insulin 50units + IVF 50mls of 50% Dextrose
d. IV Actrapid Insulin 50units + IVF 50mls of 5% Dextrose
e. IV Actrapid Insulin 10units + IVF 50mls of 0.9% NaCl.

129. A question on orbital blow out fracture

What bone affected
A.Frontal bone
B .Maxilla
C.Ethmoid
D.Temporal
E.sphenoid

130. There was that question on a patient with vehicular rash in the maxillary division of trigeminal nerve.
Which single mucosal will be involved.
A.Buccal mucosa
B.Palate
C. Cheeks

131. A pregnant woman 18weeks gestation had contact with a child with chicken pox a day ago. Or 8 days ago
Varicella antibody negative
Most appropriate treatment
A VZig
B.oral acyclovir
C Reassure

132. A patient who is diabetic, not sure if hypertensive with TIA  has muscle pain and weakness on bisoprolol,
metformin, simvastatin, ramipril, 
Result revealed an elevated Creatinine kinase is elevated about 1000+ and creatinine slightly 

Which of the medication will need to be stopped

133. Patient with sudden painless visual loss.

Which artery is involved.
A.Middle cerebral artery 
B.Posterior cerebral artery
C.Anterior communicating artery
D.Posterior inferior communicating artery

134. Epidemiology 
Calculate specificity TP 30, FP 20 TN 150, FN 50
A- 20%
B- 50%
C- 60%
D 75%
E 33%

135. Patient with sudden painless visual loss.

Which artery is involved.
A.Middle cerebral artery 
B.Posterior cerebral artery
C.Anterior communicating artery
D.Posterior inferior communicating artery

136. Woman with multiple painful lesion, there were also ulcerated lesions
A. Hsv serology
B. Take swab from ulcerated lesion
C. Microscopy and sensitivity
D.viral culture

137. Dmd child. Mother pregnant and asking about probability of current pregnancy to be DMD
A. 0%
B. 25%
C .50%
D. 2/3.

138. A 32 year old aggressive man with no past medical and psychiatric history or mental disorder. What to use
as tranquilizer?
A.Haloperidol
B.Lorazepam
C. Midazolam

139.A 76yr old woman hypertensive and diabetic complains of palpitations.

Ecg provided shows atrial fibrillation.
What is immediate management.
A. Give warfarin
B. Bisoprolol 
C. Carotid massage
D.Apixaban

140. Young man having issues with driving at night and seeing at night
age
😏😏. Father had same complaint at his
A. Retinitis pigmentosa
B. Cataract
C. Glaucoma
D. Forget this one, answer dey up 😔😔😔
141. There was a guy who developed hematuria 2 weeks after respiratory tract infection, BP 150/90mmHg. 
A.IgA nephropathy
B.Post infectious nephropathy
C.Membranous nephropathy
D.Minimal change disease

142. There was an elderly man with LUTS, came in urinary retention. Prostate enlarged and smooth. Catheter
put to relieve retention. Most appropriate management.
A.Long term catherization
B.Bladder outlet surgery
C.Ultrasound of prostate/Biopsy of prostate
D. Prescribe alpha agonist and refer for trial without catheter
E. Intermittent catheterization

143. Another elderly man with hematuria, also seen on urinalysis. Investigation
A.Cystourethroscopy
B.Renal ultrasound
C.IVU

144. A 76year old with confirmed TCC of bladder. Most associated risk factor
A.Smoking
B.Age greater than 75
C. Family history
D. Alcohol

145. 25. A man who had a left hemicolectomy about 4 days ago. Developed lower abdominal pain. Vitals were all
normal. Had lower abdominal tenderness in examination. What is the most appropriate investigation. 
a. CT abdomen 
b. abdominal X ray
c. Abdominal US scan 
d. MRI abdomen 

146. A woman who wanted to get pregnant and know the Likely risk of ectopic pregnancy. Has had 2
miscarriages, had previous PID with Chlamydia and is currently on Depo Provera and has fibroids. What is the
biggest risk for ectopic pregnancy?
a. previous miscarriages 
b. Previous PID 
c. Depot provera use. 

147. . A 3 year old child who came in breathless, with reduced respiratory rate and laryngeal stridor  and drooling.
What’s the next appropriate management 
a. IV Antibiotics 
b. Intubate 
c. IV fluids.

148. An 18year old known epilepsy patient well controlled on carbamazepine who wants contraception
A.COCP
B.POP
C.Norplex inplant
D.IUS
E.IUCD

149. A woman with vaginal bleeding. Os opened with blood clot hanging at the opening. Diagnosis.
A.Complete abortion
B.Incomplete abortion
C. Missed abortion
D. Threatened abortion

150. Young girl caught shoplifting, started cutting herself before police could arrive. Police asking for medical
records and to be updated. 
A.Tell police to contact the hospital formally
B.Ask patient for permission
C.. Don't give police any information
D.Give police all the information they asked for

151. 22 year old woman presented with severe left sided headache and right sided body weakness. Headache
was preceded by nausea and photophobia. She is on COCP.
Body weakness has resolved
CT scan normal.
What is the most appropriate next management plan?
A. No need for further management
B. Start aspirin
C. Stop COCP
D. Start propranolol
E. Start topiramate

152. 2yr old healthy boy with generalized seizures initially well. No abnormalities or vital signs given. Initial most
important diagnostic investigation 
A. Urinalysis
B. Blood glucose level 
C.S/E/UCr
D. FBC

153. 24 yr old male with headache, photophobia, neck discomfort,etc with temp of 37.5°c, B.P - normal range. 
Diagnostic investigation 

🙏
A. Cerebrospinal fluid analysis
Cant remember the others

154. 4 year old boy with an anterior neck swelling of 6 months duration, it is smooth and not tender, temperature
36.8, swelling moves with swallowing and tongue protrusion. Diagnosis
A. Branchial cyst
Ɓ. Lymphadenopathy
C. Thyroglossal cyst
D thyroid adenoma

155. A patient presents with 2day hx of epigastric pain. She was diagnosed with duodenal ulcer 6months ago
and received H. Pylori eradication therapy.  How will H. Pylori eradication be confirmed?
a) C-13 urea breath test
B) Feacal H. Pylori
C) H. Pylori serology

156. 4 year old boy with an anterior neck swelling of 6 months duration, it is smooth and not tender, temperature
36.8, swelling moves with swallowing and tongue protrusion. Diagnosis
A. Branchial cyst
Ɓ. Lymphadenopathy
C. Thyroglossal cyst
D thyroid adenoma

157. A man on salbutamol and ics what is the next step

A.LABA 

158. 6yr old with repeated uti 3 episodes in 4/12

A.Uss
B.No investigation 
C.MCUG
D. DMSA

159. A man had hyperkalemia how to correct 

A.10iu of one stupid insulin plus 50ml of 50% dextrose
B.50iu of the same insulin plus 50ml of 5% dextrose
C.10iu of stupid insulin plus 10ml of 50% dextrose 

160. A man with lower abdominal pain 4/7 after  anterior resection
What to do ?
A.Uss
B.CT
C.Xray

161.Boy had pelvic stabilzation and Orif developed dyspnea few hrs later
A.Fat embolism
B.Pulmonary embolism 

162.Woman who was just treated with amoxicillin for cellulitis, developed dyspnea
A.Ctpa
B.Cxr

163. A man who had asthma, developed hypokalemia, he was resuscitated what caused it
A. Salbutamol 
B. Mgso4
C. Steriod

164. A patient presents with 2day hx of epigastric pain. She was diagnosed with duodenal ulcer 6months ago
and received H. Pylori eradication therapy.  How will H. Pylori eradication be confirmed?
a) hydrogen breath test
B) Feacal H. Pylori
C) H. Pylori serology
D.endoscopy

165. A man who had a left hemicolectomy about 4 days ago. Developed lower abdominal pain. Vitals were all
normal. Had lower abdominal tenderness in examination. What is the most appropriate investigation. 
a. CT abdomen 
b. abdominal X ray
c. Abdominal US scan 
d. MRI abdomen 

166. woman who wanted to get pregnant and know the Likely risk of ectopic pregnancy. Has had 2 miscarriages,
had previous PID with Chlamydia and is currently on Depo Provera and has fibroids. What is the biggest risk for
ectopic pregnancy?
a. previous miscarriages 
b. Previous PID 
c. Depot provera use. 
d. Fibroids 

167. A 3 year old child who came in breathless, with reduced respiratory rate and laryngeal stridor  and drooling.
What’s the next appropriate management 
a. IV Antibiotics 
b. Intubate 
c. IV fluids.

168. Patient with homonymous hemianopsia. Which artery is affected

A.Anterior Cerebral
B.Middle Cerebral
C.Anterior Communicating
D.Posterior Cerebral

169. A 65year old woman who had hysterectomy and BSO when she was 45years. What to do to prevent
fracture.
A.Venlafaxine
B.Bisphosphonates
C. Oetradiol

170. Q on patient with atrial myxoma presenting with acute limb ischemia
Tx
a. Anticoagulation 
b. Embolectomy
c. CT angiography

171. A question on What to do to help a man who had alcohol dependence 

A.Acamprosate
B.Dilsulfram
C.Chlordiazepoxide

172.A patient that is sha using inhaler containing saba and steroid. Presence of removable whitish oral plaques.
Treatment
A.Oral flucoxacillin
BFluconazole suspension
C.Metronidazole
D. Chlorhexidine mouth wash

173. 16. Young boy with vague abdominal pain and right sided abdominal mass. GGT was the only deranged
thing in investigations.
What is the likely diagnosis
A. Appendiceal Abscess 
B. Celiac Disease 
C. Crohn's Disease 
D. Ulcerative colitis 
E. Giardiasis
174. 16. Young boy with vague abdominal pain and right sided abdominal mass. GGT was the only deranged
thing in investigations.
What is the likely diagnosis
A. Appendiceal Abscess 
B. Celiac Disease 
C. Crohn's Disease 
D. Ulcerative colitis 
E. Giardiasis

175. A question on what to see on chest x ray of a patient with painful nodules on shin, and swollen painful joints.
Bilateral hilar lymphadenopathy 

176. Question on the most effective way to relieve a man of his breathlessness.
X ray of hemp thorax was given
A.Pleural aspiration 
B. Morphine or was it diamorphine

177. A man fell and broke his hand. What is the first step to prevent further fractures?
A.Dexa 
B. Vit D calcium and bisphonates

178. A man with 2 days painless blood in urine what test to perform
A. Cystourethroscopy

179. . 9
year old male with 6 hour history of right testicular pain and temperature of 38,9.
appropriate management
a) atibiotics
b)surgical exploration
c)analgesics
d)reassure

180. One with Swollen calf, red and tender joints. Had history of cellulitis and there was I think joint or synovial
effusion/fluid.
A.DVT
B.Ruptured popliteal cyst

181. A kid with 6 days fever, cracked lips , erythema tongue and cervical lymphadenopathy. What IV drug to give
A.Immunoglobulin 
B.Prednisone
C.Aciclovir

182. One about nerve root

Loss of elbow and tricep reflexes. Loss of sensation down to index and middle finger and part of middle finger.
What nerve root is affected?
A.C5
B.C6
C.C7
D.C8
E.T1

183. A question with high Tsh

Normal T4 and T3
A.Reassure and review in 3/12 
B.Propanolol
C.Carbimazole
D. Levothyroxine

pouch 🙆🏾‍♀
183. One with RIF tenderness, 7 weeks pregnant nothing seen in uterus or adnexal except blood in Douglas

Ectopic 
️

Appendicitis 
Incomplete abortion
Ovarian torsion
(Was repeated and twisted ) 
184.(Repeated
C.dificile 
😳)same with IV Abs in a patient that later developed diarrhea 
Salmonella 
Campylobacter

185. There was an elderly man with LUTS, came in urinary retention. Prostate enlarged and smooth. Catheter
put to relieve retention. Most appropriate management.
A.Long term catherization
B.Bladder outlet surgery
C.Ultrasound of prostate/Biopsy of prostate
D.Prescribe Finasteride and refer for Trial without Catheter
E.Prescribe Tamsulosin and refer for Trial without Catheter

186. There was one patient with chest pain with an ECG showing STEMI. He has been given Aspirin. SpO2 was
96%. He’s sweating and uncomfortable 
What is the next appropriate management?
A. Intravenous opioids 
B.?
C.PCI
D. Nitrates 
E?

187. A pt with 3 month intermittent diarrhea. Abdominal pain and serious diarrhea 3 days ago. Had 20 bouts in
24hrs. Pain in left iliac fossa. Xray shows toxic megacolon.

What is d cause of her symptoms. 

A. Amoebiasis
B. Campylobacter
C. Ulcerative colitis 
D. Crohn ds
E. Coeliac ds

188. Patient with herpes zoster rash along the distribution of maxillary division of Trigeminal nerve. Which
mucous mucosa will be involved?.

A. Cheek
B. Cornea
C. Conjuctiva
D. Oropharynx
E. Palate

189. A man with Huntington ds. His daughter is worried about her son been affected. 
What's the chance of any of his grandchildren being an unaffected carrier.

A. Nil
B. 1:2
C. 1:4
D. 1:1
E. 1: 3

190. A female Pxt presents with painful neck swelling, just treated URTI. Low TSH, elevated T4, elevated WBC
a) Graves
b) Hashimoto thyroiditis
c) Subacute thyroiditis
d) Toxic Nodule
e)

191. A question on 18yrs who needs a contraceptive and on cabamazepine. Appropriate contraceptive method
for this patient.
A. Cocp
B.Levonogesterol
C.progesterone only pill
D Progesterone implant
E.copper IUD

192. A woman delivered 5days ago and have been having low mood, crying and checking on the baby to see if
the baby is breathing . whats the diagnosis?
A.Post partum blues
B.Post partum depression
C.postpartum psychosis

193. A woman 6 hours post hysterectomy, urine output 30mls/hour, drowsy but arousable, no bowel sound. All
vitals were within normal range. 
What is the cause of her condition;
A. Anaesthetic effect
B. Injury to the ureter
C. Opiate overdose

194. A patient with status epilepticus and severe pneumonia, has been previously admitted in ICU twice. With
plenty co-morbidity.
The anaesthetic team don't want him resuscitated. But his family wants him to 
A. Fill DNR form
B. Discuss concerns of the anaesthetic team with the family 
C. Carry out the family wish 
D. Carry out anesthetic team wish

195. Patient wants to commence sodium valproate, what test to do 

Amylase
Ecg
LFT
Kidney function tests

196. Patient who was treated for asthma with infection.

Given nebulised salbutam, aminophylline, IV salbutamol, mag sulph.
PO2 = 13
PcO2 = 3.7 (not sure but it wasn't elevated)
 Labs show Potassium of 2.1 abi 2.8

What is responsible?
A. Aminophylline infusion
B. Salbutamol dose
C. Magnesium sulphate
D. Respiratory failure type 1
E. Respiratory failure type 2

197. A man with small cell carcinoma of the lungs

Presented with pale and swollen limbs , swollen face and headache 
A dexamethasone
B i cant remember the other options

198. A woman with copd on palliative care visited by her gp

Has worsening breathlessness . What do give ?
A nebulized salbutamol 
B Morphine

199. A woman on palliative care with hypercalcemia she has been given ivf
Next line of mgt
A.Withdraw tx
B.Pamidronate infusion

200. 73) A young lady with low mood, loss of interest, insomnia and significant  unintentional weight loss. Had a
previous history of euphoria, excessive energy and over spending. The most likely diagnosis
A) Depression
B) Borderline personality disorder
C) Bipolar Affective disorder
D) Anti social personality disorder
201. A patient with burning sensation in the left which is severe and disturbs his sleep. Has background type 1
DM with retinopathy and nephropathy. The appropriate management
A) Codeine
B) Duloxetine
C) Naproxen
D) Na Valporate
E) Topiramate

202. A patient who had interscapular pain following upper GI endoscopy was admitted for observation. Later
became febrile (38.4* c) and developed subcutaneous emphysema.. the possible cause
A) Aortic dissection
B) pneumothorax 
C) mediastinitis
D) Aspiration peumonitis

203. An elderly man with signs of depression, Idiopathic parkinsons, using levodopa and has cogwheel tremors,
stiffness and the  likes. What could be the cause of his symptoms
A.Depression
B.Dilurium
C Side effects of drugs
D. Dementia

204. Ecg with prolonged PT with occasional missed QRS, PR is 35,BP is 100/60, rep is normal. Best initial
management.
A.Give Atropine
B.Pace marker

205. There were 2questions on paralytic ileus.

Post op patient with abdominal distention and vomiting 2days post op. Mild generalised tenderness, No bowel
sound.
Serum K 2.3
Serum Na 135
What is the cause of the presentation.
A. Hypokalemia
B. Hyponatremia
C. 

206. The 2nd question, same presentation too. Diagnosis

A. Paralytic ileus
B. Anastomotic leak

207. A pt with dizziness when sitting and standing , something poor limb cordination on the left side(can’t 
remember) 
A.Cerebellar stroke
B.Menniere dx
C.Labrynithis
D.Vestibular neuritis

208. Their was a question on this too.

Patient with vertigo, Hallpike manoeuvre was positive. What to do.
A. Epley's manoeuvre
B. Prochloperazine

209. 64. 20yr old with bilatareal galactorhea and amennorhea of 6 month. What's the most appropaute hormone
to measure?
A. Oxytocin
B. Fsh.
C. Lh
D. 
E. Prolactin

210. A man with cough, chest pain and weight loss. Diagnosed with TB and homeless. How to manage
A. Admit, initiate treatment and commence contact training 
B. Discharge and do directly observed therapy
C. Discharge, to be visited by a community nurse

211. Where to admit a TB patient 

A. Positive pressure room 
B. Negative pressure room
C. Isolation room in medical ward
D. ...... open ward

212. Nurse in a nusing home, have ichy rashes, similar hx in one of the pts a week ago, what is the mechanism
of itching?
A) Allergic rxn

213. A child with a pink stump on the umbilicus, initial management. 

A. Fusidic acid
B. Clobetasol 
C. An antifungal 
D. Silver nitrate 
E. Table salt

214. A woman with painful bleeding PV at 38 weeks following SROM with a fetal heartbeat of 180bpm.
Diagnosis ?
A.Abruptio placenta
B. Placenta praevia
C. Vasa praevia

215. A child with a pink stump on the umbilicus, initial management. 

A. Fusidic acid
B. Clobetasol 
C. An antifungal 
D. Silver nitrate 
E. Table salt

216. 18. A man who had sudden blindness that resolved on  getting  to the emergency department. No deficits.
What arterial region is affected.
A. Anterior Cerebral Artery
B. Anterior Communicating Artery
C. Middle Cerebral Artery
D. Posterior Cerebral Artery
E. Posterior Cerebellar Artery

217. A ptx with 3hx of tonsillitis in 4 months .management plan

218. A 83 year old male frail elderly man  with fractured femur  following a fall still in pain despite oral morphine.
appropriate initial management
a) IV morphine 20mg
b) iliofascial block
c)sciatic nerve block
d)definitive surgery

219. patient with cancer on palliative treatment. patient on 200mg immediate release morphine bd and maybe
40mg for breakthrough pain, but still in pain. appropriate management
a) increase dose of immediate release morphine
b) change to oxycodone
c} change to fentanyl
d) change to buprenorphine
E. Change to hydromorphine

220. Question about a man who had an accident and  had surgery of nailing into the femur. Started having chest
pain on deep breaths. Slight hypoxia.  What is the likely diagnosis 
A. Pneumothorax
B. Fat Embolism 
C. Pulmonary Thromboembolism.
221. patient with MI who has been given aspirin 300mg in the ambulance. now in the emergency department
restless and sweaty. most appropriateinitial  management
a)intravenous opiods
b)sublingual nitrate
c) PCI
d)thrombolysis

222. patient with breathlessness and oxygen saturation was 90% on 15L/min 40% oxygen, whats the next step
a)increase oxygen
b)chest xray

223. breathlessness 6hrs post chest drain removal following a right pneumonectomy. management
a) aspiration
b)reinsert chest drain
c)antibiotics

224. Question about a man who had an accident,had confusion and  had surgery of nailing into the femur.
Started having chest pain on deep breaths. Slight hypoxia.  What is the likely diagnosis 
A. Pneumothorax
B. Fat Embolism 
C. Pulmonary Thromboembolism.

225. There was one funny question

On mild per vagina bleeding of 7 days in a woman who was 7weeks pregnant with a right sided iliac fossa pain
Uss showed an empty uterus with no adnexa mass
A.appendicitis
b.ectopic pregnancy
C.PID
D.ovarian torsion
E...?

226. patient started antidepressants 3 months ago, now presenting with a 2 month history of erectile dysfunction.
likely cause
a)depression
b)medication side effect

227. There is a pt also depressed with MI, what medication to give

228. 70 year old presents to the emergency department with confusion& behavior change following a minor head
injury 5 days ago when he slipped and fell in the bathroom.  GCS 13 on presentation. No lateralizing signs or
neurological deficit. He has a medical history of hypertension and atrial fibrillation which he uses daily
indapamide and warfarin. What investigation is most diagnostic;
A MRI brain
B X-ray skull
C CT scan brain
D PET Scan
E Duplex uss scan

229. 30 year old female, 10 days post partum with breast tenderness, fever (38 degrees), breast is swollen with
cracked nipple.
Which organism is most likely responsibile;
A. Pseudomonas
B  Group B strept
C E coli
D staph Aureus

230. Pt presents with pain in left shoulder for 2 weeks, and decreased sensation in left index and middle finger.
On examination, There is absent left Triceps reflex and decreased pin prick sensation in index and middle finger.
What nerve root is affected?
A.C5
B.C6
C.C7
D.C8
E. T1
231. A patient who suddenly could not see her left visual field, resolved after 30 mins
A.Middle cerebral 
B.Posterior cerebral 
C.Posterior inferior cerebral

232. A patient who had difficulty talking for 12hrs, on admission developed headaches and flashes which later
resolved. Neurological examination revealed persistent mild difficulty finding the right word to say
Ct scan done normal
What is the next mgt
A.MRI
B. PET
C LP
D. Discharge

233. A patient was treated with co amoxiclav

Liver function test deranged, increased bilirubin,ALT and ALP
A.Cholestatic hepatitis
B.Hepatitis 
C. Choledocholithiasis

234. 56 year old woman with a 8hr history of palpitation. hyprtensive on treatment PR 96 With ecg  showing Atrial
fibrillation as interpretation??patient was haemodynamically stable
They asked for the next step in mgt
A metoprolol 
B amiodarone

235. patient on slbutamol and low dose beclomethasone but still symptomatic. next step
a) insrease steroid
b) montelukast
c)salmeterol
d)tiotropium
e) use salbutamol more regularly

236. A young woman who had mutiple painful ulcers on her genitalia
What next to do
Anti hsv
Viral culture of the lesion 

237. A young girl with painful joints, Its a picture of SLE in summary. Diagnostic investigation
A. Anti Dna(exacty stated like that)
B. ANA

238. Patient with Addison c/ o cough , fever etc. Next appropriate mgt?
A.Double hydrocortisone 
B.Double flucocortisone
C. Double both A and B

239. There was an ECG on ? 3rd degree Heart block,ptx had PR of 56bpm
What is the best next line of mgt
A.?
B.atropine
C.pacemaker
D.Direct cardioversion
E.?

230. There was also a question about a woman who had a miscarriage 7 years ago and  treated chlamydia
infection 5 years ago and was asking about the risk of ectopic pregnancy. Options were
A. IUS
B.PID
C. Miscarriage

231. 6yr old with at least enuresis at least 3 times a day for several months. What is the most definitive mgt ?
A.Desmopressin
B.Bladder training 
C.Enuresis Alarm

232. One patient with chest pain on breathing. Has cellulitis. On oral antibiotics for 2weeks. Chest is clear.
Investigations to do
A.CXR
B.ECHO
C.CTPA
D.V/Q

233.A young boy with a medial mass 

Otherwise normal  moves with swallowing and protusion
A.Thyroglossal cyst
B. Goiter

234. 54 yr old male with right groin swelling below the inguinal ligament. cough impulse present
a)direct inguinal hernia
b)indirect inguinal hernia
c)femoral hernia

235. Elevated crp and bc 48hrs after surgery 

A.Repeat bc after 24hour
B.Reassure
C.Via antibiotics
D.?investigation

236. . Breathless 
Pco2
Ph 7.32
Hco3 22
Po2 normal 
A. Metabolic acidosis with respiratory compensation 
B. Metabolic alkaloids with compensation 
C. Respiratory acidosis
D respiratory alkalosis 
E. Mixed respiratory and metabolic

237. A 3 year old boy with duchenne muscular dystrophy whose mother is pregnant for the second child will
want to know of the second baby been affected with same condition.
A. Nil
B.25%
C.50%
D.100%

238.
Healthy 36 yr old with 1+ of protein in Urinalysis what to do?
A.Start ACEI
B.Refer 
C.Advise on Protein Diet
D.Repeat