Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 8TH MARCH 2019 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. A child who has type 1 diabetes is sad and unhappy at school. He has no friends and his glycaemic
control is poor. What would you do next?
A. Refer to diabetologist
B. Refer to psychiatrist
C. Refer for developmental assessment
D. Increase insulin dose

2. A 72 year old man is receiving chemotherapy for small cell lung cancer. He had his fourth treatment
eight days ago. He has a cough with some green sputum but feels well. He has a temperature of 37.6° C.
Chest examination shows a few coarse crepitations in the right base. His heart rate is 92 beats/minute. A
blood count shows:
Hb 12.5g/dl
WBC 1.1 X 109/L
Neutrophils 0.6 X 109/L Platelets 89 X 109/L
Sputum, urine and blood cultures have been sent to the laboratory for microbiology. What is the SINGLE
most appropriate management?
A. Broad spectrum antibiotic (intravenous)
B. Broad spectrum antibiotic (oral)
C. Granulocyte colony stimulating factor
D. Postpone treatment until bacteriology results available
E. Reassure and send home

3. A 23 year woman has been having pain at the base of her thumb since one week. The pain worsens
when she lifts her 3 month old baby or on changing the baby’s diapers. On examination there is pain on
forceful abduction against resistance. What is the likely cause?
A. Avascular necrosis of scaphoid
B. Trigger finger.
C. De Quervain’s tenosynovitis
D. Carpal tunnel syndrome
E. Mallet finger

4. A 55 year old man returns for routine follow-up six weeks after a myocardial infarction. He gets
breathless when walking uphill. His ECG shows ST elevation in chest leads V1, V2, V3 and V4. What is
the single most likely explanation for the abnormal investigation?
A. Heart Block
B. Right Ventricular Strain
C. Atrial Thrombus
D. Left Ventricular Aneurysm
E. Dressler Syndrome

5. A 34year old man after an RTA was brought to the A&E. He has BP 50/0mmHg and chest wall with
asymmetrical movement, RR 34bpm. What would be the initial action?

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A. IV fluid infusion
B. Intubation and ventilation
C. CT chest
D. Transfer to ITU

6. A thin 18-year-old girl has bilateral parotid swelling with thickened calluses on the dorsum of her hand.
What is the single most likely diagnosis?
A. Bulimia nervosa
B. C1 esterase deficiency
C. Crohn’s disease
D. Mumps
E. Sarcoidosis

7. A patient developed confusion, neck stiffness, photophobia and his temperature is around 38.9°C. What
test could be done for diagnosis of his problem?
A. CT brain
B. Blood culture
C. Urine culture
D. Lumbar Puncture

8. A 50 year old man presented with Left SNHL. On examination he showed finger past pointing, absent
left corneal reflex and ataxia. What is the investigation of choice?
A. CT scan brain
B. CSF analysis
C. MRI brain
D. ESR

9. Postmortem examination of a patient who died of massive GIT bleed shows a small nodular liver. What
is the most likely cause of bleed?
A. Perforated GIT ulcer
B. Portal hypertension
C. Liver abcess
D. Hepatocellular carcinoma

10. A 65 year old man presents with progressively worsening breathlessness and productive cough. He
has a history of treated tuberculosis and rheumatoid arthritis, he smoked 20 cigarettes/day since 35 years.
When he was given a trial of salbutamol nebuliser, FEV1/FEV changed from 1.7/2.0 to 1.8/2.1 (predicted
3.0/3.5). What is the most probable diagnosis?
A. Chronic bronchitis
B. Bronchiectasis
C. Bronchial carcinoma
D. Asthma
E. Pulmonary fibrosis

11. A 45 year old man was admitted for varicose vein stripping. Post surgery he complains of loss of
sensation at the medial side of foot. Which is the most common nerve to be injured?

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A. Medial plantar
B. Sural nerve
C. Saphenous
D. Tibial
E. Deep peroneal nerve

12. A 23 year old man sprained his right ankle six weeks ago while he was playing football. He was
treated with a below knee walking cast, on removing the cast the patient is noted to have a right foot drop.
He has weakness of extensors of the ankle and toes and diminished pin prick sensation over the dorsum of
the foot. The ankle jerk is present and the plantar reflex is flexor. What is the most likely cause of the foot
drop?
A. Compression of the common peroneal nerve
B. Compression of the tibial nerve
C. Compression of the S1 nerve root
D. Rupture of the Achillestendon
E. Treatment of the medial collateral ligament of the ankle

13. A patient on antihypertensive drugs presents to Accident and Emergency department complaining of
sudden loss of vision. On examination of the fundus, tortuous blood vessels and stormy sunset appearance
was seen. What is most likely diagnosis?
A. Papiloedema
B. CRAO
C. Anterior ischaemic optic neruropathy
D. CRVO
E. Retinal detachment

14. A patient on digoxin presenting with 3 days history of nausea and vomiting. He also complains of
severe tiredness and muscle pain. Since yesterday he also complained of some visual disturbances. What
is the next step of management?
A. Check digoxin level
B. Symptomatic management
C. Check visual acquity
D. Give Digibind
E. Give IV Fluids

15. A 75 year old man brought by son with fluctuating level of consciousness. He also complaints of
headache and sleepiness. He is on warfarin for the last 4 months. CT scan brain shows crescent shaped
collection of blood over the left hemisphere. What is the diagnosis?
A. Extradural hematoma D. Alzheimer’s disease
B. Subdural hematoma
C. Brain tumor

16. An 8 week pregnant lady is brought to the A and E due to severe vomiting. She was administered IV
fluids and oral anti-emetics. She still cannot tolerate anything orally. What is the next best treatment for
her?
A. Parenteral feeding
B. IV antiemetics
C. Termination of pregnancy
D. Proton Pump Inhibitor
E. IV Steroid

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17. A 60 year old diabetic patient on antidiabetic medication developed diarrhoea. What is the most likely
cause for his diarrhoea?
A. Autonomic neuropathy
B. Infective
C. Celiac disease
D. Crohn’s disease

18. A 30 years old lady was blaming the medical staff that they did not give her adequate pain killer post-
operation, however after some time the pain subsided and she calmed down and she thanked the team for
treating her pain appropriately. What is the most appropriate cause for her behaviour?
A. Adjustment disorder
B. Post trauma
C. Personality disorder
D. Depression

19. A child was playing and suddenly developed breathlessness. What is the best investigation for this
child?
A. Nasal Endoscopy D. Pulse Oximetry
B. Lateral neck X-Ray E. Spirometry
C. CT scan

20. Elderly man with urinary incontinence, doing well with urinary pad. Developed pereneal excoriation
and was noticed to have a palpable mass arriving from the pelvis. What is the most immediate
management?
A. Urethral Catheterization
B. Suprapubic Catheterization
C. Oxybutine
D. Desmopressin
E. Bladder washout

21. A West Indian woman with anaemia and mild jaundice comes with limb pains and abdominal pain.
And the symptoms are precipitated by ongoing infections. On examination spleen is no more palpable.
What is your most probable diagnosis?
A. G6PD deficiency
B. Sickle cell disease
C. Beta thalassemia major
D. Sideroblastic anaemia
E. Malaria

22. A pregnant woman wants to know the possibility of her unborn male child being affected by Duchene
muscular dystrophy. Her first son has the disease.
A. 25%
B. 50%
C. 75%
D. 100%
E. 33%
23. A family with a baby who has a cousin who died from cot death recently, mother asks for advice.
What advice will you give the mother?

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A. Child should sleep on the back with legs towards the end of the cot
B. Child should sleep on the front with the legs towards the end of the cot
C. Child should sleep on the back with the head towards the end of the cot
D. Child should sleep on the front with head towards the end of the cot
E. Reassure

24. An asymptomatic 35 year old lady with family history of ovarian carcinoma is concerned about her
risk. Her 2 sisters had Ovarian Cancer between the ages of 40 and 45. What is next step in plan of
management?
A. Pelvic ultrasound
B. CA 125
C. Genetic testing and counselling
D. Return if symptomatic
E. Reassurance

25. A 58 year old female comes complaining of brownish discharge since a week. This has never
happened ever since she attained menopause 4 years ago. An Ultrasound scan confirmed the endometrial
thickness of 8 mm. What will be the most appropriate investigation you would like to perform?
A. Colposcopy
B. CT pelvis and abdomen
C. Hysterocopy
D. Endometrial sampling

26. A woman present s with a history of poisoning 10 times with different substances. There are no
obvious signs of depression or suicidal behavior.
What is the best preventive step?
A. Open access to A&E
B. 24 hours help line
C. CBT
D. Antidepressants
E. Insight into the problem

27. A Caucasian patient with nephropathy now presents with hypertension. What is the best drug for him?
A. Propranolol E. Bendroflumathiazide
B. Ramipril
C. Nifedipine
D. Losartan

28. A woman 5 days post-operative for bilateral salpingo-oopherectomy and abdominal hysterectomy has
developed abdominal pain and vomiting with associated abdominal distension and cannot pass gas. No
bowel sounds heard, she is also hydrated. What is the most appropriate next step?
A. Plain X-ray abdomen
B. Exploratory Laparoscopy
C. CT scan
D. USG
E. Barium Enema

29. A 25 year old woman comes with complaints of lower abdominal pain accompanied by an offensive
vaginal discharge. She is pyrexial and moderately sick. On further questioning she recalls that her
boyfriend had been complaining of dysuria. What test will you perform that will confirm your diagnosis?

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A. Urine pregnancy test
B. Urine culture and sensitivity
C. High vaginal swab
D. Laparoscopy with visualisation of fallopian tubes.

30. An 82 year old man has woken up with incoherent speech and difficulty in finding the right words.
Examination is otherwise normal and his comprehension is good. Which anatomical site is most likely to
be affected?
A. Broca’s Area
B. Wernicke’s Area
C. Midbrain
D. Parietal Cortex
E. Pons

31. A 27 year old female comes to the ObGyn OPD with complaints of burning and painful micturition.
A general physical examination reveals her temperature to be 38 degree Celsius. On digital examination a
frothy foul-smelling discharge was observed. Her LMP was 3 weeks ago and she complains of bearable
vaginal itching since a week which she puts down to the new brand of tampons she started using. What
could be the possible diagnosis in this woman?
A. Urinary Tract Infection
B. Staphylococcal skin infection
C. Trichomona vaginalis infection
D. Normal finding

32. A patient suffers from repeated checking of doors and intrusive thoughts of being a dirty person. He is
not able to rest these thoughts. What is the most appropriate initial step of management?
A. CBT
B. Antipsychotics
C. Lithium
D. Counselling
E. Reassure

33. A mother comes with her 15 month old child. Which of the following will bother you?
A. Shies away from strangers
B. Can walk but cannot run
C. Vocabulary consists of only two meaningless words
D. She can’t make a sentence
E. None

34. A boy came presents with plenty of transparent sticky liquid coming from both the eyes. The mucosa
of the lids and the conjunctiva was intact and calm. What will you give him?
A. Antibiotics D. Wipe eye with damp cotton wool using cold water.
B. Steroids
C. Antibiotic and steroids
E. Tear Duct Development

35. A 34 year old lady presented with complains of vertigo for the last 4 days. It started suddenly and was
like a feeling of room rotating. It was aggravated by head movement. On examination there was
spontaneous, unidirectional, horizontal nystagmus. Romberg’s test was positive. What is the most likely
diagnosis?

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A. BPV (Benign positional vertigo )
B. Vestibular neuronitis
C. Menniere’s disease
D. Multiple Sclerosis

36. 6 year old child presented with drooling of saliva, and a severe stridor. He is febrile and sick looking.
X ray of the neck in extension shows a thumb sign. Choose the single most likely diagnosis from the list
of options given below.
A. Croup
B. Upper respiratory tract infection (URTI)
C. Diphtheria
D. Acute epiglottitis

37. A patient was admitted to A&E with prolonged hematemesis. Endoscopy revealed a bleeding gastric
ulcer which was then sutured. During the procedure, patient received 15 units of blood. The next day, the
drain contained 1 unit of blood. What is the next step in the management of this patient?
A. Urgent USG
B. Urea breath test
C. H.Pylori serology
D. Manometry

38. A 58year old patient presents with altered bowel habits and bleeding per rectum. Exam and
sigmoidoscopy showed an ulcer. What is the single most likely diagnosis?
A. Colorectal carcinoma
B. Celiac disease
C. Crohns disease
D. UC
E. IBS

39. Prenatal screening is recommended if ultrasound scan at 16 weeks confirms that the foetus is male
and the mother has had an affected son previously. Choose the single most likely condition from the
following list of options.
A. Duchene muscular dystrophy
B. Cystic fibrosis
C. Spina bifida
D. Down’s syndrome
E. Spinal muscular atrophy

40. An 82 year old man presented with weight loss, pallor and a mass in the right iliac fossa. What is the
most probable diagnosis?
A. IBD
B. IBS
C. Diverticulitis
D. Rectal cancer
E. Caner of the caecum

41. A 55 year old man presents with complaints of claudication pain in his right thigh and calf. On
examination the femoral and popliteal pulses are absent on the right leg. Localise the site of occlusion.

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A. External Iliac Artery
B. Aorto-Iliac
C. Ilio-Femoral
D. Internal Iliac
E. Abdominal aorta

42. A 35 year old man presented with dry cough and mild chest pain for 2 months. He also complains of
breathlessness on exertion. He also gave ahx of IV drug abuse for the past 3 years. CXR showed perihilar
fluffy shadows. What is the most appropriate Rx for him?
A. IV Co-trimazole
B. Oral high dose Co-trimazole
C. IV hydrocortisone
D. Oral Prednisolone

43. A 40 year old man has undergone detoxification programme. He wants some medications to help him
reduce cravings. What is the single most appropriate answer?
A. Disulfuram
B. Chlordiazepoxide
C. Diazepam
D. Thiamine
E. Acamprosate

44. A 70 year old man has been posted for anterior resection following a diagnosis of carcinoma of the
sigmoid. What is the most appropriate prophylactic antibiotics pre-operatively?
A. Penicillin
B. Broad spectrum antibiotics
C. Antipseudomonas
D. Amoxicillin
E. Chloramphenicol

45. A 29 year old mother of a 2 year old son comes to the GP clinic requesting reliable method of
reversible contraception. She had a normal vaginal delivery devoid of complications. she breastfed the
baby for 7 months following which she was prescribed contraceptive pills which she never took regularly
as she kept forgetting them. She suffers from painful periods and wants something for it as well. A recent
ultrasound shows normal uterus. What contraceptive will best suit her?
A. COCP
B. IUS
C. IUCD
D. POP

46. An 18 year old young female is losing weight despite eating 3 times a day. The skin on her bottom is
flaccid. What is the definite diagnosis?
A. Duodenal biopsy D. Anti glutaminase
B. Endomyseal antibodies
C. Anti reticulin

47. A 32 year old woman presents with attacks of numbness in the right hand and fingers followed by left
side headache. What is the most probable diagnosis?
A. Cerebral tumour
B. Epilepsy
C. Migraine

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D. Temporal arteritis
E. Cervical spondylosis

48. A 8 year old boy has had profuse diarrhoea and vomiting due to infective gastroenteritis for 2 days.
Investigation results show the following:
Sodium 148mmol/l Potassium 2.2mmol/l Urea 20mmol/l Glucose 4.3mmol/l What is the most
appropriate management?
A. IV normal saline and insulin
B. IV normal saline and potassium supplement
C. Plasma expanders
D. Dialysis
E. Oral potassium chloride

49. A 25 years old young male complaining of back pain in the morning now complaining of red eyes
with photophobia and decreased vision and has with blood in the stools. What is the most probable
diagnosis?
B. Gout
C. Rheumatoid arthritis
D. Reactive arthritis

50. A 30 year old female presents with complaints of weight loss, thinning hair, feeling cold all the time,
dryness of the skin, lethargy and constipation. What is the most likely diagnosis?
A. Hypothyroidism E. Pseudo hypoparathyroidism
B. Hyperthyroidism
C. Hypoparathyroidism
D. Hyperparathyroidism

51. A lady has been on contraception for a long time. She has regular periods and uterus also is normal.
She wants a contraception with least failure rate and side effects. Among the options given, which one
will you choose?
A. Depot Medroxyprogesterone Acetate( DMPA) injections
B. Cu intrauterine contraceptive device (IUCD)
C. Mirena coil
D. COCP
E. Female condom

52. A middle aged man with complaints of severe central chest pain radiating to the left upper limb and
sweating came to the A and E, ECG showed inferior MI changes. What is the best route to administer
morphine to this patient?
A. Intravenous
B. Subcutaneous
C. Oral
D. Intramuscular

53. A 28 year old man with a known psychiatric disease thinks that he is the professor of medicine and he
says later he will become God. What is the single most likely diagnosis?
A. Delusion of grandiose
B. Idea of reference
C. Identity disorder
D. Paranoid delusion
E. Delusion of reference

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54. A 5 years old child who is taking inhaled steroids for Asthma comes with lesions skin. Some of them
are weeping and some are crusted. What is the BEST treatment of choice?
A. No treatment required
B. Oral Acyclovir
C. I.V Acyclovir
D. NSAIDS
E. Antihistamines

55. A 40 year old man who is a Jehovah's witness who had previously mentioned no blood products to be
given at any condition requires life - saving blood transfusion. What would be the best step in
management?
A. Give blood to save the life.
B. Give only fresh frozen plasma
C. Respect the patient’s wishes
D. Obtain emergency court order for blood transfusion.
E. Assess patient’s mental capacity to refuse blood.

56. A 26 years old male has been operated for abdominal trauma and splenectomy was done. On the third
post- operative day the patient developed acute abdominal pain and distension in the upper abdominal
area with hypotension. On insertion of ryles tube 2 litres of coffee ground fluid was aspirated. What is the
most probable diagnosis for the condition above?
A. Acute gastric dilatation.
B. Reactionary haemorrhage.
C. Sub-phrenic abscess.
D. Deep vein thrombosis.
E. Left lower lobe atelectasis

57. A 6 year old boy has earache and hearing difficulty on the right ear for the past 3 weeks. On
examination his tonsils are swollen. The external ear is normal on both sides. The right tympanic
membrane is dull in appearance while the left is normal. The right cervical nodes are enlarged. What is
the likely cause of his earache?
A. Tonsillitis
B. Mastoiditis
C. Acute otitis media
D. Chronic otitis media
E. Otitis media with effusion

58. A post gastrectomy patient was on 60mg Morphine. Pain was well controlled with it but patient is not
able to swallow. What is the next appropriate step in management?

A. 60 mg per day SC Morphine

B. 100mg SC Morphine
C. 120mg SC Morphine
D. Fentanyl patch

59. Young female, returning from USA to UK developed shortness of breath and productive cough which
initially contained blood, but now is dry. She is taking COCPs. What is the most likely diagnosis?
A. Pneumonia D. PCP
B. Pulmonary embolism
C. Pulmonary TB

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60. A 14 year old girl is bought to the accident and emergency department after becoming increasingly
drowsy at home. She has recently lost weight and has complained of increasing thirst. She is tachypnoeic
and shocked. What is the single most appropriate diagnostic test?
A. Full Blood Count
B. Lumbar Puncture
C. Serum Glucose
D. Chest X-ray
E. Blood culture

61. A 28 years old man presents with a temperature of 38.7˚C and neck stiffness. There is no rash. His GP
calls, asking what should be done. How would you advise the GP?
A. Give the patient IV Benzyl penicillin
B. Give the patient IV Doxycycline
C. Give the patient IV Ceftriaxone
D. Send for a blood culture

62. A girl presents with signs of hyperventilation. What is the most likely arterial blood gas (ABG)
derangement?
A. pH increased pCo2 increased
B. pH decreased pCo2 increased
C. pH increased pCo2 decreased
D. pH decreased pCo2 decreased

63. A 45 year old heroin addict was involved in a car crash and is now paraplegic. During the first week
of his hospital stay he cried every day because he could not remember the accident.
What is the most likely diagnosis?
A. PTSD
B. Severe depression
C. Organic brain injury

64. A 60 year old man presents with progressive claudication without diabetes or hypercholesterolemia
who is taking low dose Aspirin. What is the best next step of management?
A. Statin
B. ACE inhibitor
C. Angiography
D. Cilostazol

65. A 35 year old man has fallen 10 m from a ladder and has been brought to emergency department. He
is drowsy and has swelling on the right parietal area. His GCS score is initially 13 but falls to 9. What is
the single most appropriate step?
A. CT scan of head
B. IV Mannitol
C. MRI of the brain
D. Skull xray
E. Observation

66. A 54 year old man presented with a sudden, unilateral, brief, stabbing, recurrent pain on the right side
of his face. This occurred 5-10 times in a day. What is the diagnosis?

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A. Ramsay Hunt Syndrome
B. Trigeminal neuralgia
C. Temporomandibular joint dysfunction
D. Post herpetic neuralgia

67. A woman has been prescribed long term steroids for polymyalgia rheumatic. What additional drug
should be added to prevent osteoporosis?
A. Calcium
B. Alendronate
C. Vit D
D. Calcium resonium

68. An 83 year old man with long standing Chronic Obstructive Pulmonary Disease has become
progressively breathless over the last two years. He is on Salbutamol, Ipratropium, Salmetrol,
Beclomethasone and Theophilline. His FEV1 < 30%. What is the next appropriate management?
A. Lung transplant
B. Trial of continuous positive airway pressure ventilation
C. Trial of non invasive ventilation
D. Assessment for long term oxygen therapy
E. Short course of oxygen therapy

69. A 30 year old lady with past medical history pulmonary embolism presents to out patient clinic
requesting contraception, She has irregular and painful periods. What is the single most appropriate
contraception?
A. Intra uterine contraceptive device
B. Combined pill contraception
C. Progesterone only pill
D. Mefenemic acid
E. Trenexemic acid

70. A 22 years old man keeps having persistent and intrusive thoughts that he is a dirty thief. No matter
what he tries these thoughts keep coming to him. Any attempt to avoid these thoughts leads to serious
anxiety. What is the most likely diagnosis?
A. Schizophrenia
B. Obsessive Compulsive Disorder (OCD)
C. Post traumatic stress disorder (PTSD)
D. Mania
E. Psychotic Depression

71. A child had three attacks of tonsillitis last year. What will be the most appropriate management for
this child?
A. Treat when ill
B. Surgery
C. Prophylactic Antibiotics
D. Refer to ENT
E. Do Nothing

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72. A 28 year old shipyard worker was admitted for pain in calf while at work which has been increasing
over last 3 months. There is no history of hypertension or diabetes but he is a smoker. On examination, he
has loss of posterior tibial and dorsalispedis pulsations along with a non-healing ulcer at the base of right
1st MCP joint. What is the most probable diagnosis?
A. ThromboangitisObliterans
B. Sciatica
C. Deep Vein Thrombosis
D. Baker’s cyst
E. Embolus

73. A 31 year old man has epistaxis following 10 days after Polypectomy. What is the most likely
diagnosis?
A. Nasal infection
B. Coagulation disorder
C. Carcinoma

74. A patient with past medical history of DM and HTN and on medications presents with constipation,
confusion, polyuria and polydypsia. On investigation : Serum calcium was 3.04, Serum electrophoresis is
negative and X-Ray is normal. What is the most probable etiology for the patients symptoms?
A. Drug induced-Bendroflumethiazide
B. Diabetes mellitus
C. Hypertension
D. Urinary Tract Infection(UTI)
E. Chronic Renal Failure

75. A 3 years old boy presents with difficulty in walking and skin lesions. He has a rash on the 3rd day
after the appearance of fever. What is the most likely causative agent?
A. Streptococcus pyogenes
B. Rubella virus
C. Parvovirus
D. Papova virus
E. Paramyxo virus

76. A 30 year old woman has been feeling low and having difficulty in concentrating since her mother
passed away 2 months ago. She feels lethargic and tends to have breathlessness and tremors from time to
time. What is the most likely diagnosis?
A. Adjustment Disorder
B. Post-traumatic stress disorder (PTSD)
C. Panic Disorder
D. Generalized anxiety disorder (GAD).
E. Bereavement

77. Patient with pain and swelling in left leg and thigh up to the level of inguinal ligament. Where is the
level of occlusion?
A. Femoro-poplitealartery
B. Left common iliacartery
C. Aortoiliac artery
D. Femoral artery
E. Profound femoral artery

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78. What is the choice of post –op analgesia in a patient who had appendectomy for gangrenous
appendix?
A. IM tramadol
B. IV Morphine
C. Oral morphine
D. Rectal diclofenac
E. Oral codeine

79. A man who wants to quit alcohol, but wants to avoid the unpleasant craving experiences. What do you
prescribe for him?
A. Acamprosate
B. Disulfiram
C. Methadone
D. Fluoxetine
E. Amitryptalline

80. A 54 year old lady presents with sudden, severe pain in the left half of her skull. She also complains
of pain around her jaw. What is the most likely next step?
A. CT scan
B. MRI
C. Fundoscopy
D. ESR
E. Temporal artery biopsy

81. A 45 year old alcoholic man presents with tremors, agitation and confusion. He has been given
chlordiazepoxide. He is already on oral thiamine.
What is the most appropriate next step in his management?
A. Intravenous fluids
B. Diazepam
C. IV High potency vitamins
D. Oral thiamine
E. High potency vitamins and thiamine

82. A 48 year old woman comes with complaints of constant weakness and tiredness. Blood examination
showed haemoglobin levels of 9.2 g/dl, MCV - 74 and MCH- 20. Physical examination was
unremarkable. On further questioning she admitted her childhood was plagued by bouts of lethargy but
she otherwise remained well. Peripheral blood smear showed microcytic hypochromic cells. Her iron
studies were found to be normal. What is the most likely diagnosis?
A. Beta thalassemia major
B. Beta thalassemia minor
C. Iron deficiency anaemia
D. Hereditary spherocytosis

83. A 21 year old male patient presents with vague abdominal pain and loose stool. He has had a history
one week earlier of having lower abdominal pain associated with a pyrexia which settled down on its
own. On examination, he is now pale and experienced some mild weight loss and an ill-defined mass is
present in right iliac fossa. What is the most likely diagnosis?
A. Appendicular mass
B. Crohn’s disease
C. Ulcerative colitis

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D. Colon cancer
E. Faecal impaction

84. A 73-year-old male presents with a 12 month history of falls. His relatives have also noticed rather
strange behaviour of late and more recently he has had episodes of enuresis. Examination reveals
disorientation in time and place and a broad based and rather clumsy gait. What is the most probable
diagnosis?
A. Dementia
B. Pituitary Adenoma
C. Cardiovascular disease
D. Syringomyelia
E. Normal Pressure Hydrocephalus

85. A 56 year old woman with breast cancer and widespread lung metastases has non-productive cough.
She has been given codeine and the cough is not relieved. What is the next step in management?
A. Oral antibiotics
B. Salbutamol/ Nebulizers
C. Oxygen
D. Nebulization with 0.9% NaCl
E. Anaesthetic nebulizer

86. For a patient presenting with Parkinson’s disease, which one of the following drugs is most useful
in the management of tremor?
A. Apomorphine
B. Cabergoline
C. Selegiline
D. Amantadine
E. Benzhexol

87. You are asked to see a 1 hour old baby. He is dysmorphic, with a small chin and low-set ears. He also
has a small head and rocker- bottom feet. , select the most likely karyotype:
A. 45XO
B. 47XXX
C. 47XXY
D. 47XY(13)
E. 47XY(18)

88. A 32 year old woman has recurrent breast abscesses, the latest one was 6 weeks ago. There is an area
of undulation between the junction of the areola which is discharging puss. What is the most likely
diagnosis?
A. Breast abscess
B. Ductectasia
C. Mammary duct fistula
D. Mastitis

89. A 36 year old woman has taken about 28 tablets of paracetamol 6 hours ago. She has been drinking a
bottle of vodka and a couple pints of lager everyday for the last few years. She feels nauseous and has
vomited a few times.

15
Sodium 144mmol/l Potassium 3.8mmol/l
Urea 5.6mmol/l Creatinine 86umol/l
Albumin30g/l Bilirubin15umol/l
ALT 30IU/l AST 32IU/l
Alkalinephosphatise230IU/l
Gamma glutammyl-‐transpeptidase1,261IU/l
Paracetamol80mg/l

Which is the single most appropriate immediate management?

A. Discussing with liver transplant unit
B. Give acetylcysteine
C. Give fresh frozen plasma
D. Give Vitamin K injection
E. Repeat the blood tests

90. An 18 year old female has just received her A-Level exam results and she didn’t get into the
University of her choice. She was brought into the A&E department after ingestion of 24 paracetamol
tablets. O/E: patient is slightly confused and tired. All initial management has been done. Investigations
done after 24 hours of admission showed normal FBC, ABG (pH 7.1), P.T (17 seconds), Bilirubin
(4µmol/L) and Creatinine (83µmol/L). What is the next step in management?
A. Keep under observation for the next 24 hours.
B. Refer to Psychologist.
C. Give N-Acetylcysteine.
D. Discharge with referral to Psychiatrist.
E. Arrange for liver transplantation

91. An 18 years old lady in her 30th week of pregnancy is brought to the hospital in altered sensorium.
She is taking slow, shallow breaths and her breath has a fruity smell. An ABG analysis shows a pH of
7.20. Urine shows the presence of ketones. What is the most probable diagnosis?
A. Hyperglycaemic Hyperosmolar Nonketotic Coma (HONK)
B. Diabetic Ketoacidosis (DKA)
C. HELLP syndrome (Hemolysis, elevated liver enzyme levels, and low platelet levels)
D. Pregnancy-Induced Hypertension (PIH)
E. Gestational Diabetes Mellitus

92. A 70 year old woman 3 days after a myocardial infarction presents with a pan systolicmurmur. What
is the most likely cause?
A. Rupture of papillary muscle
B. Ventricular Aneurysm
C. Pericarditis
D. Pericardial Effusion
E. Atrial Septal Defect

93. An Afro-Caribbean boy presented with fever and arthralgia. FBC shows: Hb : 6 g/dL
Reticulocyte count : 40%
Peripheral Smear : Target cells, Howell-Jolly bodies. What is the most appropriate diagnosis?
A. Haemophilia A
B. Thalassemia major
C. Sickle cell anaemia
D. Thalassemia minor
E. Acute lymphoblastic leukaemia

16
94. A 2 weeks old child presents with 70% O2 saturation on air. He is cyanosed and has a pan systolic
murmur. What is the most likely reason for this?
A. Tetralogy of Fallot (TOF)
B. Atrial septal defect (ASD)
C. Patent ductus arteriosus (PDA)
D. Pulmonary Hypertension
E. Type 1 respiratory failure

95. A 60 year old diabetic complains of pain in thigh and gluteal region on walking up the stairs for the
last 6 months. She is a heavy smoker and has ischemic heart disease. What is the most appropriate
diagnosis?
A. ThromboangitisObliterans
B. Sciatica
C. DVT
D. Atherosclerosis
E. Embolus

96. A young man comes with back pain and occasional painless haematuria. What is the most likely
pathology?
A. Ca. Bladder
B. Ca. Prostate
C. Nephropathy
D. Uretric Calculi

97. A patient with severe Alzeheimers and is on ‘end of life care’. A team of specialists managing him
had decided on a “DNAR in case of cardiac arrest” as the best management option for the patient in case
of cardiac arrest. As the managing FY1 doctor what would you do?
A. Access patient’s mental capacity
B. Carry out the DNAR specialist order
C. Take consent from relative.
D. Consent form should be signed by relative and patient.

98. A 50 year old male with increased BMI. Has muscle wasting, difficulty climbing upstairs. Has
polyuria, polydipsia. What is the cause of muscle wasting and difficulty walking upstairs?
A. Amyotrophy
B. Peripheral neuropathy
C. Polyneuropathy
D. Autonomic neuropathy

99. A 45 year old Schizophrenic patient is smashing down windows after being admitted ion the
psychiatric ward. What is the most immediate management?

A. Haloperidol IM
B. Diazepam
C. Olanzepine
D. Risperidone

100. In the development of a 15 month old child which of the following would concern you the most?

17
A. Child walks independently, but does not run
B. Child builds a block of 2 cubes
C. Child scribbles with a pencil
D. Child has no pincer grasp
E. Child cannot draw a triangle

101. A woman presented with intermittent pain in her left breast radiating to her left arm and it is not
related to her period. What is the diagnosis?
A. Cyclical mastalgia
B. Fibroadenoma
C. Non cyclical mastalgia
D. Duct Ectasia
E. Mondor’s disease

102. At birth a baby boy at 38 weeks gestation weighs 1.8 kg. He has hepato- splenomegaly and a rash.
Blood tests show raised level of bilirubin and liver enzymes. What is the most likely diagnosis?
A. Galactosemia
B. Biliary Atresia
C. Glucose-6-phosphate dehydrogenase deficiency (G6PD)
D. Rhesus Incompatibility
E. Congenital Viral Infection

103. An unconscious child is brought into Accident & Emergency. He is not breathing. What is your
initial management?
A. Capillary blood glucose E. 0.45% dextrose
B. Secure airway
C. CT scan
D. IV 0.9% normal saline

104. A 2 year old boy has had fever, sore throat, runny nose and lethargy for the past few days. Now he
presents at A &E, is sitting in mother’s lap with his body inclined forward with continuous stridor and is
drooling saliva. What is the most important next step in his management?
A. Call ENT specialist
B. High flow O2
C. Call Anaesthetist
D. Antibiotics IV
E. Immediate bronchoscopy

105. A 2 year child is severely dehydrated and needs immediate fluid resuscitation. 4 attempts to gain IV
access have failed. Which of the following access routes should be considered next?
A. Subclavian artery
B. Radial artery
C. Intraosseous
D. Internal jugular vein
E. Saphenous cut

106. An old woman develops sudden pain in upper part of the arm after carrying heavy loads. Which part
of the arm is affected?
A. Biceps tear D. Bursitis
B. Posterior capsulitis
C. Ruptured supraspinatus tendon

18
107. A 59-year-old man has shown a change in his mood and personality over a 9-month period. He has
subsequently developed difficulty with memory and concentration, and then progressive fidgety
movements of his limbs and facial musculature. By the time of medical assessment he has frank
choreiform movements and a Mini-Mental State Examination of 21/30. Other examination is normal. He
was adopted and therefore no information on his family history is available. He has three adult children
(aged 27, 30 and 33 years) of whom the two youngest are asymptomatic. However, the oldest son has
recently been investigated by the Neurology Department for slightly erratic behaviour and fidgety restless
movements of both legs. Based on the likely clinical diagnosis, which one of the following genetic
patterns of this condition is most likely?
A. Autosomal-dominant inheritance with anticipation E. Mitochondrial disorder
B. Autosomal-dominant with variable penetrance
C. Autosomal-recessive inheritance
D. X-linked inheritance

108. A 40 year old man came with fever and Urinary complaints. Urinalysis showed blood+ nitrites in the
urine. No history of discharge but groin is red, tender and swollen. What could be the most probable
cause of his symptoms?
A. E. Coli
B. Chlamydia
C. Neisseria gonorrhea
D. Mumps virus

109. A butcher was stabbed in the groin and bled so much that the towel was soaked in blood. His BP is
80/50mmHg and pulse 130bpm. What percent of circulatory blood did he lose?
A. Less than 15% D. 40-50%
B. 15-30% E. Above 50%
C. 20-40%

110. A maid complains of pain in anterior inferior part of the knee. What is the most likely bursa
involved?
A. Supra patella
B. Pre patella
C. Inferior patella
D. Medial patella

111. A 50 year old lady on regular treatment on tricyclic antidepressant should be checked regularly for
the following investigations to avoid complications.
A. Thyroid function test
B. Serum electrolyte
C. Electrocardiogram(ECG)
D. Liver function test

112. A 20 year old woman is 17 weeks pregnant. She is worried about the possibility of her baby with
spina bifida as she did not take folic acid supplement before conception and in early pregnancy .
A. Pre-implantation genetic diagram
B. Aminocentesis
C. Chorionic villus sampling (CVS)
D. Fetalcordocentesis
E. Genotyping fetal cell in Maternal circulation
F. Ultrasound scan at 18-20 week gestation

19
113. A 43 year old man was involved in an RTA. On examination, there was absent air entry on the right
side, tracheal deviation to the left and a dull percussion note on the right. BP is 80/60mmHg and pulse is
120/beats per min. CXR shows a diffuse opacity on the right side obscuring the right costo- phrenic angle.
What should be the most appropriate immediate management?
A. Needle aspiration on the right side
B. needle decompression on the right side
C. insertion of chest drain on the right side
D. give 100% oxygen and fluid resuscitation with 2 large bore IV-lines

114. A 20 year old lady developed post-influenza pneumonia. CXR shows bilateral cavitatory lesions.
What is the best treatment?
A. Amoxicillin
B. Doxycycline
C. Flucloxacillin
D. Clarithromycin

115. A 62 year old man has been smoking about 15 cigarettes a day for 45 years. He started working as a
builder since he was 24 years old. He presents with chest pain, shortness of breath and weight loss. Chest
X-ray shows bilateral fibrosis and left side pleural effusion. What is the best investigation that will lead to
diagnosis?
A. Chest x-ray E. CT Scan
B. Pleural fluid aspiration of cytology
C. Magnetic resonance imaging (MRI)
D. Pleural biopsy

116. A 30 year old woman has experienced restlessness, muscle tension and sleep disturbance on most
days over the last six months. She worries excessively about a number of every day events and activities,
and is unable to control these feelings which are impairing her ability to hold down her job. What is the
most likely diagnosis?
A. Panic Disorder D. Acute Stress Disorder
B. Generalized Anxiety Disorder GAD E. Social Phobia
C. Pheochromocytoma

117. MRI spine of a patient shows L3/ L4 spine compression. She complains of bladder control loss and
also has some eye problem. She has breast carcinoma in the past. What explains her symptoms the best?
A. Metastasis in brain
B. Metastasis in spine
C. Sciatica
D. Disc prolapse

118. A 5 year old child came from Ghana 6 weeks ago. Two days ago he developed fever, vomiting and
neck stiffness. He had taken malaria prophylaxis, from until 4 weeks ago he had no rash. What is the
diagnosis?
A. Cerebral abscess F. Pneumonia
B. Cerebral malaria
C. Meningococcal meningitis
D. Subarachnoid hemorrhage
E. Cerebral tumor

20
119. A 19 years old man presents with weight loss, increasing thirst and increased frequency of going to
the washroom. His father, grandfather and two sisters have been diagnosed with Diabetes Mellitus. What
is the most likely type of diabetes this patient is suffering from?
A. Insulin-dependent diabetes mellitus (IDDM)
B. Noninsulin-dependent diabetes mellitus (NIDDM)
C. Latent autoimmune diabetes of adults (LADA)
D. Maturity Onset Diabetes of the Young (MODY)
E. Diabetic ketoacidosis (DKA)

120. A woman with sickle cell disease comes for contraceptive advice. What do you give her?
A. COCP
B. Mirena
C. Depoprovera
D. IUCD
E. Condoms

121. A 64 years old diabetic has come for a routine eye check-up. Fundoscopy shows new vessels all over
the retina. What is the most appropriate management?
A. Strict Sugar Control E. Insulin
B. Regular eye check ups
C. Non urgent referral to a specialist
D. Laser photocoagulation

122. An 18 year old girl comes with complaints of fresh painless bleeding while passing stools. No other
symptoms. What is the most likely diagnosis?
A. Bowel Ca
B. IBDs
C. Anal stricture
D. Haemorrhoids

123. A couple are expecting their second baby. They have one son who has haemophilia A. What is the
likelihood of their second child also being born with haemophilia?
A. 25%
B. 50%
C. 75%
D. 100%
E. No likelihood

124. A 7 year old boy who is up to date with all his immunization has come to you 7 hrs after a metal
spike has injured his hand, wound is 0.5 cm deep. What is the most appropriate action?

A. Tetanus Ig + tetanus vaccine + antibiotics

B. Tetanus Ig + antibiotics
C. Tetanus Ig + tetanus vaccine
D. Tetanus vaccine + antibiotics
E. Antibiotics

125. An 80 year old woman who is on MR Morphine 60mg had to increase it to 120mg twice a day and
again with extra 10mg oral Morphine6 times a day. What is the best form of management?

21
A. Subcutaneous Morphine infusion
B. Fentanyl patches
C. Change to Oxycodone
D. Increase to 200 mg bd orally 90mg MR Morphine plus 30mg every 4 hours

126. A 24 year old woman has eight weeks amenorrhoea, right sided pelvic pain and vaginal bleeding.
She is apyrexial. Peritonism is elicited in the right iliac fossa. Vaginal examination reveals right-sided
cervical excitation. What is the most probable diagnosis?
A. Ectopic Pregnancy
B. Salpingitis
C. Endometriosis
D. Ovarian Torsion
E. Ovarian tumor

127. A 34 year old woman complains of low mood predominantly in winter. She says she feels low every
year during winter and starts to feel better once spring arrives. What is the most likely diagnosis?
A. Depression
B. Mania
C. Seasonal affective disorder
D. Cyclothymia
E. Dysthymia

128. A man has a BP of 160/90mmHg, proteinuria ++. On ultrasound kidneys are equally reduced in size
with smooth borders and normal pelvicalyceal system. What is the cause of hypertension in this man?
A. Chronic glomerulonephritis E. Polycystic Kidney
B. Chronic Pyelonephritis
C. Bilateral Renal Artery Stenosis
D. Essential HTN

129. A 6 year old sick looking child presents with high fever, drooling of saliva and breathing difficulty.
X ray of the neck shows thumb sign. What is the INITIAL step of management?
A. Adrenaline inhalation
B. Oxygen inhalation
C. Intubation
D. I.V Hydrocortisone
E. I.M MgSO4

130. A woman who returned from abroad after three weeks of holiday complains of severe diarrhoea of
three weeks duration, she has also developed iron deficiency anaemia and folic acid deficiency. What
condition best describes her situation?
A. Jejunal villous atrophy D. Increased catabolism
B. Chronic diarrhoea secretions E. Increased secretions of acids
C. Malabsorption

131. A 53year old man presents with a longstanding history of a 1cm lesion on his arm. It has started
bleeding on touch. What is the most likely diagnosis?
A. Basal cell carcinoma
B. Kaposi’s sarcoma
C. Malignant melanoma
D. Squamous cell carcinoma
E. Kerathoacanthoma

22
132. A 10 year old child presents with severe vomiting and lethargy. She feels dizzy and thirsty. She has
had urinary incontinence for the past 2 weeks. Which investigation would you wish to perform
immediately?
A. Urine glucose
B. Urine culture & sensitivity
C. FBC
D. Blood culture
E. CT scan

133. A 30 year old lady has blood film shows with picture of anaemia with spherocytes. What will you
do?
A. Direct Coomb Test
B. Indirect Coomb Test
C. Bone marrow examination
D. Serum ferritin

134. A pregnant lady on her 28 weeks pregnancy presents with BP 160/100mmHg and proteinuria of
0.2 gm/ day. What is your most probable diagnosis?
A. Gestational hypertension
B. Pre eclampsia
C. Eclampsia
D. Chronic hypertension

135. A patient with hepatocellular carcinoma has raised levels of ferritin. What is the most probable
cause?
A. Hemochromatosis D. Carcinomatosis
B. Wilsons disease
C. Alpha 1 antitrypsin deficiency

136. A 27 year old presents with abdominal pain, bleeding, vomiting and diarrohea. Her last menstrual
period was 7 weeks ago. On examination abdomen is tender and BP is 90/60mmHg. What is the next
appropriate management?
A. Immediate laparotomy
B. Laparoscopy
C. Salpingotomy
D. Salpingectomy
E. Metotrexate

137. During a basketball match, one of the players suddenly collapsed to the ground with coughing and
shortness of breath. What is the investigation of choice for this patient?
A. Chest x-ray
B. CT scan
C. Magnetic resonance imaging (MRI)
D. V/Q scan
E. CT pulmonary angiogram (CTPA)

138. A 37 years old lady strongly believes that a famous politician has been sending her flowers every
day and is in love with her. However, this is not the case. What is the most appropriate diagnosis?

23
A. Erotomania
B. Pyromania
C. Kleptomania
D. Trichotillomania
E. Grandiosity

139. A 25 year old woman was brought to the A&E by her boyfriend. She has many superficial
lacerations. On examination there are many scars of old cut in her forearm. She is so distressed and
constantly says her boyfriend is going to end the relationship. She denies trying to end her life. What is
the most likely diagnosis?
A. Acute psychosis
B. Severe depression
C. Psychotic depression
D. Border line personality disorder
E. Schitzophrenia

140. A 33 year old male came to the hospital with complaints of occasional left sided chest pain that lasts
less than 30 minutes, following exercise, which relieves upon taking rest. What is the most probable
diagnosis?
A. Unstable angina D. Coronary spasm
B. Decubitus angina E. Myocardial infarction
C. Stable angina

141. A man had MI 4 months ago. He now complains of low mood, lack of appetite and problems falling
sleep. What is the best medication for him?
A. Amitryptalline
B. Fluoxetine
C. Venlafaxine
D. Sertaline
E. Moclobemide

142. A patient with dysmenorrhea and dysfunctional uterine bleeding presents to you for contraceptive
advice. Uterus is normal. There is no past medical history. What is the best management for her?
A. Give COCP
B. Mirena Coil
C. IUCD
D. POP (Progestogen only pill)
E. Depo provera

143. A 5 year old child was found to have vesico-ureteric reflux. What is true about this condition?
A. Requires prophylactic antibiotics
B. Most will require surgery
C. In most kidney will be scarred by five years
D. No further action is required
E. It is usually asymptomatic

144. A 40year old divorced man with bipolar affective disorder attends hospital following an overdose of
30 TCA tablets. His new partner has left him and he has stopped taking his medicine and begun drinking
heavily. He appears depressed, feels hopeless and is ambivalent about being alive. He is now fit for
discharge from the medical ward and acknowledges the benefits of previous treatment. What is the
SINGLE most appropriate next management?

24
A. Admission to the psychiatry ward
B. Arrange psychiatric outpatient follow-up
C. Discharge to the care of the general practitioner
D. Referral to local alcohol treatment team
E. Referral to clinical psychologist

145. A woman with a spontaneous abortion at 14 and 23 weeks of gestational age presents at 8 weeks
gestational age with bleeding PV. What is the most appropriate intervention?
A. Bed rest
B. Aspirin
C. Reassurance
D. Trans-vaginal sonography (TVS)

146. A 55 year old alcoholic man complains of severe abdominal pain radiating to his back. He also
passes lose stool, pale stools and has weight loss. What is the most likely diagnosis?
A. Acute pancreatitis
B. Chronic pancreatitis
C. Esophagitis
D. Pancreatic carcinoma

147. A 27 year old man presents with jaundice. On examination there is hepatosplenomegaly. Peripheral
blood film shows occasional spherocytes. What is the next appropriate investigation?
A. Direct Coomb’s test
B. Bone marrow test
C. Indirect Coomb’s test
D. RBC life span
E. Osmotic fragility test

148. Pregnant woman at 34 weeks gestation presents with tingling and numbness with altered sensation of
her right middle and index finger. Tinel’s sign is negative. What is the most likely diagnosis?
A. Carpal Tunnel
B. Radial nerve entrapment
C. Blackberry’s thumb
D. Mallet finger

149. A 74 year old smoker presented to his GP with cough and shortness of breath. Examination revealed
pigmentation of the oral mucosa and also over the palms and soles. Tests show that he is diabetic and
hypokalaemic. What is the most probable diagnosis?
A. Pseudo Cushing syndrome
B. Conn’s Disease
C. Ectopic Adreno-corticotropic hormone (ACTH)
D. Cushing’s Disease
E. Hypothyroidism

150. Lady with 10 months amenorrhea, hypokalaemia, BMI- 32. What is the most probable cause?
A. PCOS
B. Cushings
C. Primary hyperaldosteronism
D. Pheochromocytoma

25
151. A 50 year old man presents with decreased body mass, mixed iron and folic acid deficiency, and
diarrhoea after recent travelling abroad to Barbados. He is also stating that his stools are smelly and
difficult to flush away. What is most discriminative investigation?
A. Blood cultures
B. Thyroid function tests (TFTs)
C. Serum calcium
D. CT scan
E. Jejunal biopsy

152. An 81 year old man complains of general malaise and chronic backache. He has a history of mild
concussion with episodes of blurring of vision. An X-ray report show pepper-pot skull. What is single
most appropriate next best test?
A. Full blood count
B. ECG
C. Serum electrophoresis
D. Blood glucose

153. A 30 year old professional athlete presents with amenorhea of 7 months duration. What is the Single
most likely cause from the following options? FSH 8, LH 6, Oestradiol 80, Prolactin 600.
A. Premature ovarian failure
B. Hypothalamic failure
C. PCOS
D. Prolactinoma

154. A 4year old child weighing 10kg with UTI on trimethoprim 50mg/5mls.
Prescribed 4mg/kg twice daily, what is the dosage?
A. 4mls twice daily
B. 2ml twice daily
C. 8mls twice daily
D. 12mls daily

155. A 4 year old boy presents with a sharp metal injury. He never had any vaccination as his parents
were worried about the side effects. What should be the next step?
A. full course of DPT vaccine
B. TT Immunoglobulin
D. No treatment
C. A+B

156. A 30 year old gentle man is brought to hospital and is found to have increased blood pressure and
low serum potassium levels on examination. Which hormone should be tested?
A. Aldosterone
B. Cortisol
C. Adrenaline
D. Glucagon
E. Growth hormone

157. A lady comes in 6 weeks after her normal vaginal delivery for contraceptive advice. She is breast
feeding her child and requests for reversible contraception. She is planning another pregnancy in 6
months time and is scared of injections. What is the best option for her?

26
A. COCP
B. Cu IUCD (intrauterine contraceptive device)
C. Mirena coil
D. POP
E. Transdermal patch

158. A middle aged man who has history of chronic sinusitis, nasal obstruction, blood stained nasal
discharge. He now presents with cheek swelling, epiphora, ptosis, diplopia and maxillary pain. What is
the single most likely diagnosis?
A. Nasopharyngeal cancer
B. Pharyngeal cancer
C. Sinus squamous cell cancer

159. A 62 year old woman complains of unsteadiness when walking. On examination she has pyramidal
weakness of her left lower limb, and reduced pain and temperature sensation of her right leg and right
side of her trunk up to the level of the umbilicus. Joint position sense is impaired at her left great toe but
is normal elsewhere. She has a definite left extensor plantar response, and the right plantar response is
equivocal. Where is the most likely site of the lesion?
A. Left cervical cord E. Left lumbo-sacral plexus
B. Midline mid-thoracic cord
C. Right mid-thoracic cord
D. Left mid-thoracic cord

160. A 64 year old man who has urinary frequency for past 2 years now complains of anuria. He is taking
nifedipine and propranolol. What is the mechanism of his anuria?
A. Drug induced
B. Diabetes
C. Enlarged prostate gland
D. High blood pressure
E. Cancer of the bladder

161. A 56 year old lady presented with sudden weakness in the left upper and lower limbs. On
examination the plantars are up going and there is hypertonia. She is hypertensive on anti HTN
medications. What is the most appropriate cause of her symptoms?
A. Space occupying lesion
B. Multiple Sclerosis
C. Stroke
D. Giant Cell Arteritis

162. A 22 year old lady comes complaining of painful sexual intercourse and abdominal pain 4 days after
moving in with her boyfriend a week ago. Since the last 2 days she also noticed increased frequency of
micturition. A vaginal examination showed foul- smelling cervical discharge which was collected and
sent for culture and sensitivity. She denies any itching and does not appear to be very ill. What would be
the appropriate initial treatment in this case?
A. Ceftriaxone with metronidazole
B. Meropenem and Paracetamol
C. Ofloxacin with metronidazole
D. Vaginal oestrogen cream

27
163. A man brought his wife who left consuming alcohol for a few days. She now presents with agitation
and hallucinations. His husband informs that she hadn't taken alcohol for last three days. What is
appropriate management?
A. Benzodiazepines E. Acomprosate
B. Thiamine
C. Vit B complex
D. Disulfiram

164. A 15 years old boy fell of his bicycle and hurt his abdomen. He presents with pain in abdomen, a CT
scan shows a small sub capsular spleen haematoma, his BP is 110/70mmHg and pulse is 80bpm. What is
the next step in his management?
A. Refer to surgeons for observation
B. Immediate Laparotomy
C. Immediate Laparoscopy
D. Discharge with advice
E. Blood transfusion

165. A 51 year old man was sitting for few hours with his legs crossed. Later he could not dorsiflex or
invert his foot . He also has got loss of sensation on the dorsum of his foot. Which nerve is most likely to
be damaged?
A. peroneal nerve
B. Sciatic nerve
C. Sura nerve
D. Femoral nerve
E. Tibial nerve.

166. A 50 year old patient has been prescribed propranolol for a cardiac condition, but his GP now wants
to stop this drug. Which of the following is the most important reason for this decision?
A. Familial tremor
B. Partial AV heart block
C. Mild hypertension
D. Angina pectoris
E. Supraventricular tachycardias

167. A 19 year old boy comes to A&E department. There is swelling, pain and tenderness 2cm distal to
Lister’s tubercle of radius. On examination proximal pressure on the extended thumb and index finger is
painful. The x- ray doesn’t show any fracture. What is the next appropriate management for the patient?
A. Immobilization with a cast
B. Repeat the x-ray
C. Magnetic resonance imaging (MRI)
D. Surgery
E. No treatment required

168. A 70 year old lady who has been treated on Carbamazepine for epilepsy, she now presents with
shortness of breath and light headedness. Blood results show MCV 70, Hb 8.5g/dl, WBC 2, Neutrophils 1
and Platelets 50.
A. Aplastic anaemia E. Haemorrhagic anaemia
B. Hereditary spherocytosis
C. Pernicious anaemia
D. Folate deficiency anaemia

28
169. A 57 year old man who had myocardial infarction a few months ago has been having low mood. A
diagnosis of moderate depression has been established. Which medication is the best treatment for him?
A. Selective serotonin re-uptake inhibitors (SSRI)
B. TACs
C. Monoamine oxidase inhibitor (MAOI)
D. Benzodiazepams
E. Mood stabilisers

170. A 72 year old woman who had a repair of strangulated femoral hernia two days ago becomes noisy,
aggressive and confused. She is afebrile, her full blood count is normal apart from a raised mean
corpuscular volume (MCV). What is the most likely diagnosis?
A. Electrolyte imbalance
B. Delirium Tremens
C. Wernicke’s Encephalopathy
D. Infection toxicity
E. Hypoglycemia

171. Patient with abdominal pain of sudden onset dies. Autopsy reveals ruptured abdominal aneurysm,
what is the pathophysiology resulting in this?
A. Atheroma
B. Aortic coarctation
C. Dissecting aneurysm

172. A 62 year old man has multiple liver metastases due to adenocarcinoma with an unknown primary.
He is deeply jaundiced and has ascites, with oedema of his legs up to the buttocks. He is now drowsy and
his family are worried that he is not drinking enough. His medication includes: Haloperidol 1.5 mg and
Lactulose 10 ml. Blood taken three days ago showed:
Normal electrolytes Urea 6.5 mmol/L
Creatinine 89mmol/L
Calcium 2.04mmol/L
Albumin 17g/L Total bilirubin 189 mmol/L

What is the SINGLE most appropriate management of his fluid intake?

A. Albumin infusion
B. Crystalloid fluids (continuous intravenous)
C. Crystalloid fluids (intermittent subcutaneous)
D. Fluids Via nasogastric tube
E. Oral fluids

173. A 50 year old female presents to the medical department with complaints of dizziness since few
days. She is a teacher by profession, and she describes her class room moving around her whenever she
turns her head to look at the door. She also feels nauseous in these few seconds. She has no other
complaints. What is the likely diagnosis?
A. Meniere’s Disease
B. BPPV
C. Vestibular Neuronitis
D. Acoustic neuroma
E. Cholesteatoma

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174. A 24 year old man presents to Accident & Emergency after his friends noticed his sclera turning
yellow. This happened after he had been taking paracetamol for a few days for an upper respiratory tract
infection. What is the single best cause for jaundice in him?
A. Gilbert’s syndrome
B. Criggler-Najjar syndrome
C. Glucose 6 phosphate dehydrogenase deficiency
D. Hereditary Spherocytosis
E. Hereditary Elliptocytosis

175. A 45year old woman comes with red, swollen and exudating ulcer on the nipple and areola of right
breast with palpable lump under the ulcer. What do you think is causing this skin condition?
A. Inflammatory cells releasing cytokines
B. Infiltration of the lymphatics by the carcinomatous cells
C. Infiltration of the malignant skin cells to the breast tissue

176. A young woman was stabbed in the neck. On tongue protrusion, there was deviation to the right side.
Which nerve is involved?
A. Hypoglossal nerve injury
B. Accessory nerve
C. Vagus nerve
D. Glossopharyngeal nerve

177. A 40 year old Man fell from 8ft high scaffolding . On Xray there was a fracture of the foot. Which
bone will be most likely fractured?
A. Calcaneus
B. Metatarsals
C. Phalanges
D. Tibia
E. Femur

178. A patient presented with a stab injury to his left groin, he keeps bleeding profusely. pressure has
been applied to stop bleeding , BP 80/60mmHg. What is the next appropriate action?
A. I/V fluid
B. Blood Transfusion
C. Oxygen
D. Elevate limb

179. A 50-year-old woman presents following a fall. She reports of pain and weakness in her hands for
several months, stiff legs and swallowing difficulties and has bilateral wasting of the small muscles of her
hands. Reflexes in the upper limbs are absent. Tongue fasciculations are present and both legs show
increased tone, pyramidal weakness and hyper reflexia with extensor plantar response. Pain and
temperature sensation are impaired in the upper limbs. What is the most likely diagnosis?
A. Multiple Sclerosis
B. Motor Neuron Disease
C. Syringobulbia
D. Syringomyelia
E. Myasthenia Gravis

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180. What is the mode of spread of chickenpox? Choose from the following options :
A. Airborne
B. Close contact
C. Feco-Oral
D. Blood
E. Vector borne

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