Fawzia by Reda Harby

Fawzia by Reda Harby
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1
1. The pressure within the pleural space is negative with respect to
atmospheric pressure, except for which of the following?
A. At end expiration
B. At end inspiration
C. During a Valsalva maneuver
D. If the patient has a tracheostomy
E. When taking a deep breath
2. A 30-years-old alcoholic man presents with acute severe upper abdominal

pain and vomiting. He is admitted to the intensive therapy unit with a
diagnosis of severe acute pancreatitis Forty-eight hours later he develops
peripheral paraesthesiae and carpopedal spasms. The most likely
underlying metabolic abnormality is:
A. Hypercalcaemia
B. Hypernatraemia
C. Hypocalcaemia
D. Hypokalaemia
E. Hyponatraemia
3. A 50-year-old woman attends her Genera) Practitioner due to a change in

appearance. She finds difficulty removing her rings, reports: an increase 'in
shoe size and photographs reveal a change in her facial appearance. Visual
field tests are-performed to direct confrontation. Which of the following
defects is most likely to be associated with her presentation?
A. Binasal hemianopia
B. Bitemporal hemianopia
C. Homonymous hemianopia
D. Inferior quadrantanopia
E. Unilateral loss of vision
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4. A 24-year-old man falls off his motorbike, fracturing one arm, both femurs,
and rupturing- his spleen. He required surgery and 20 units of blood.
Twenty-four hours after admission he has passed 350 ml of urine. His blood
pressure is 90/50 mmHg. and he has low skin turgor. Which of the following
best describes the changes in the renin-angiotensin system initiated at the
juxtaglomerular apparatus in the patient?
Renin Aldosterone
Angiotensin II concentration
Concentration concentration
A ↓ ↓ ↓
B ↓ ↑ ↓
C ↑ ↓ ↓
D ↑ ↓ ↑
E ↑ ↑ ↑
5. A 35-year-old woman presents to the Emergency Department with a second

attack of painful frank haematuria. What is the most likely pathology
underlying this presentation?
A. Gram negative urinary tract infection
B. Interstitial cystitis
C. Renal cell carcinoma
D. Transitional cell carcinoma of bladder
E. Urinary tuberculosis
6. 60-year-old man presents with a short history of pain in the right cheek and
right upper teeth Maxillary sinus infection is diagnosed. This sinus is
particularly prone to infection because of?
A. Absence of cellia on the epithelium lining the sinus

B. Closeness of the sinus to the nasal cavity
C. Poor blood supply
D. Position of the sinus ostium high on the medial wall
E. Relationship of the front teeth to the floor of the sinus
7. A 75-year-old insulin-dependent diabetic man has undergone a
hemicolectomy. On the first postoperative day he is nil-by-mouth, on
subcutaneous insulin, maintenance IV infusion with-Saline and intravenous
morphine via patient controlled analgesia. He is confused after a brief
convulsion, has slurred speech and weakness of his right side. His pulse is
110 beats/minute, respiratory rate 25 breaths/minute, blood pressure 160/95
mmHg and Sp02 95% on room air The most likely cause of this convulsion
and confusion is:
A. Hypoglycemia
B. Hyponatremia
C. Inhibition of noradrenaline re-uptake
D. Stimulation of 3 opioid receptors
E. Stimulation of GABA receptors
8. A 30-year-old woman presents to the general surgical clinic with a 1.5 cm
cervical lymph node along the anterior border of sternocleidomastoid muscle.
Clinical examination and routine blood tests are; unremarkable. She
undergoes an excisional biopsy of the lump as a day case. The histology report
reveals Encapsulated infiltrative carcinoma with marked fibrosis and cystic
changes within the lymph node. What is the most likely primary pathology?
A. Anaplastic thyroid carcinoma
B. Follicular thyroid carcinoma
C. Malignant lymphoma of the thyroid
D. Medullary thyroid carcinoma
E. Papillary thyroid carcinoma
9. A 37-year-old man presents with severe headache, photophobia arid neck
stiffness. Karnig's sign is positive and a midline lumbar puncture is
performed immediately to determine if a cerebrospinal fluid (CSF)
pathogen is involved. In performing this procedure, which is 'he first of the
following structures to be pierced by the lumbar puncture needle?
A. Anterior longitudinal ligament
B. Arachnoid mater
C. Dura mater
D. Interspinous ligament
E. Posterior longitudinal ligament
10. A 26-year-old woman presents with severe headache, photophobia and neck
stiffness. Among other investigations, a lumbar puncture is earned out and
cerebrospinal fluid is sent for microscopy and culture. Culture shows a
growth of Neisseria meningitidis. What is likely to be the predominant-cell
type in the cerebrospinal Fluid?
A. Basophils
B. Eosinophils
C. Lymphocytes
D. Macrophages
E. Neutrophils
11. A 70-year-old woman from a nursing home presents to the! Emergency
Department with abdominal pain and vomiting. On examination, she is
dehydrated and her abdomen is distended. There is a 3 cm 4 cm swelling in
her right groin which is non-tender, and there is no cough impulse. At
operation, a femoral Hernia found. Which of the following lies medial to the
neck of the hernia?
A. Femoral artery
B. Femoral nerve
C. Femoral vein
D. Lacunar ligament
E. Pectineal ligament
12. A 26-year-old man presents to the Emergency Department with extensive
bleeding from his arm after sustaining a glass injury. On examination there
is a 7 cm transverse laceration across the anterior aspect of his elbow. On
exploring the cubital fossa you would expect the brachial artery to be:
A. Anterior to the median nerve
B. Lateral to the biceps tendon
C. Lateral to the median nerve
D. Medial to the median nerve
E. Superficial to the bicipital aponeurosis
13. A 52-year-old man is found to have multiple myeloma. What skull X-ray
appearances would be characteristic?
A. Diffuse thickening of the calvarium

B. Hair on end appearance.
C. Multiple fractures
D. Multiple osteolytic lesions
E. Multiple osteosclerotic lesions
14. A 50-year-old woman presents with a history of right upper quadrant pain
and jaundice. She reports that her urine was dark in colour and that her
stools are offensive and difficult to flush Which of the following explains the
dark urine?
A. Increase in conjugated bilirubinuria
B. Increase in unconjugated bilirubinuria
C. Increase in urea excretion
D. Increase in urinary urobilinogen
E. Reduced enterohepatic bile salt circulation

15. A 45-year-old mart presents with backache and leg pain due to a prolapsed
lumbar Intervertebral disc. The pain, which is aggravated by coughing and
sneezing, radiates to the lateral aspect of the foot. On examination, there is
weakness of the plantar flexors of the foot, which nerve root is most likely
to be involved?
A. T12
B. L4
C. L5
D. S1
E. S2
16. A 62-year-old woman presents to her General Practitioner with a two-week
history of backpain. She has lost 8 cm in height over the last five years
Investigations reveal:
Findings Normal
Adjusted ( corrected) Calcium 2.78 mmol/L 2.15-2.55 mmol/L
Phosphate 0.84 mmol/L 0.8-1.4
Estimated GFR 90 More than 90
PTH 8.9 pmol/L 0.95-5.7
Which of the following is the most likely cause?
A. Hypoparathyroidism
B. Primary hypemarathyroidism
C. Pseudo hypoparathyroidism
D. Secondary hyperparathyroidism
E. Tertiary hyperparathyroidism
17. A 21-year-old man fractures his ulna and radius. He is treated by means of
a plaster cast, which is removed after four weeks. What pathological
process is most likely to have affected the immobilized muscles?
A. Aplasia
B. Atrophy
C. Hyperplasia
D. Hypertrophy
E. Neoplasia
18. A 22-year-old man has been stabbed in the left fifth intercostal space at the
edge of the sternum. Which structure is most likely to have been penetrated?
A. Left atrium
B. Left lobe of the liver
C. Left ventricle
D. Right atrium
E. Right ventricle
19. An 80-year-old man dislocates his shoulder it is reduced in the Emergency
Department. At review three weeks later, he is unable to actively initiate
abduction of his arm. Which muscle most likely damaged?
A. Clavicular head oi pectoralis major
B. Infraspinatus
C. Supraspinatus
D. Teres major
E. Trapezius
20. An 8-year-old boy is admitted for assessment of rectal blood loss. His
mother describes this as bright red blood in the toilet pan. He has no pain
on defalcation. There is no family history. What is the most likely cause?
A. Adenomatous polyp
B. Familial adenomatous polyposis
C. Juvenile polyp
D. Metaplastic polyp
E. Peutz-Jegher's syndrome
21. A 48-year-old woman presents with abdominal pain and five to six episodes
of bloody diarrhoea each day. She also complains of pain- in the knees and
elbows and recent visual problems. What is the most likely diagnosis?
A. Collagenous colitis
B. Diverticulitis
C. Infective colitis
D. Intestinal tuberculosis
E. Ulcerative colitis
22. A 56-year-old man presents with acute epigastric pain and vomiting. On
examination he has guarding in the upper abdomen. Investigations reveal:
Value Normal
Serum amylase 900IU/L <100
Serum ALT 61 IU/l <50
Alkaline Phosphatase 98 IU/l 20-120
Albumin 38 g/L 35-50
Gamma GT 76 IU/L <60
Bilirubin 15 umol/L 0-20
Triglyceride 1.6 mmol\L <1.7
Corrected Calcium 3.30 mmol\L 2.20-2.70
Which of the following is the most likely etiology of this condition?
A. Alcohol
B. Choledocholithiasis
C. Hyperparathyroidism
D. Hypertriglyceridaemia
E. Mumps
23. A 30-year-old man is admitted to the intensive care unit with an isolated
severe head injury. A CT can shows multiple intracerebral bleeds but no
midline shift. He is intubate and ventilated. His pupils are dilated and react
sluggishly to light. His heart rate is 50 beats/minute blood pressure 170, 110
mmHg and his respiratory rate is set at 10 breaths/minute. The rising blood
pressure is likely to be caused by:
A. Aortic and carotid baroreceptor stimulation
B. Cortisol stimulation
C. Renin-angiotensin stimulation
D. Sympathetic stimulation related to blood loss
E. Sympathetic stimulation related to intracranial pressure
24. A 42-year-old multiparous woman is admitted to the Emergency Department
due to pelvic discomfort. The duty gynecologist diagnoses uterine prolapse.
Which anatomical structure gives significant direct support to theuterus?
A. Cervical ligaments
B. Mesometrial part of the broad ligament
C. Mesosalpingial part of the broad ligament
D. Round ligaments
E. Transverse perinea! Muscles
25. An 80-year-old man is admitted to the surgical admission unit with central
abdominal pain. His blood pressure is 100/60 mmHg and his pulse is 110
beats/minute with a respiratory rate of 25 breaths/minute. He is known to
have severe chronic obstructive pulmonary disease (COPD) and has been a
heavy smoker all his life. On examination he has a rigid abdomen Arterial
blood gases show:
PH pO2 pCo2 Bicarbonate Base Excess
Finding 7.24 9 kPa 5.3 kPA 17 mmol/L -3
Normal 7.35-7.45 11.9-13.3 4.7-6.0 22-26 -2 to +2
What is the most likely diagnosis?
A. Hypovolemic shock complicated by COPD
B. Metabolic acidosis due to COPD
C. Metabolic acidosis due to peritonitis
D. Respiratory-acidosis due to COPD
E. Respiratory acidosis due to peritonitis
26. In describing the sino-atrial node, which one of the following statements is
correct?
A. It is part of the somatic nervous system
B. It is usually supplied by the left coronary artery
C. If lies in the wall of the left atrium
D. It lies in the wall of the right ventricle
E. It receives fibers derived from the vagus nerves
27. A fit 21-year-old man is admitted with an acute abdomen, subsequently
diagnosed as gastroenteritis. As part of the host immune response, which of
the following immunoglobulins and cells are correctly paired?
A. IgA-macrophage
B. IgD-small bowel epithelium
C. IgE-endothelium
D. IgG-plasma cell
E. IgM thymocyte
28. A 45-year-old man presents with fever and pain in his right loin and groin.
A soft swelling was noted in his femoral triangle. Diagnosis of a psoas
abscess was made. Which of the following statements is most accurate
regarding psoas major?
A. It arises from the lateral borders of the bodies of T12 to L5 •
B. It extends the hip
C. It inserts into the greater trochanter of the femur
D. It is innervated from T12 and LI
E. It passes posterior to the capsule of the hip joint
29. Which one of me following muscles is an extensor of the hip?
A. Adductor longus
B. Gracilis
C. Iliopsoas
D. Pectineus
E. Semitendinosus
30. A tall, thin, 25-year-old woman presents to the surgical clinic with a complaint
of swelling in the front of her neck for the last four months. On clinical
examination she has a swelling in the left lobe of the thyroid and multiple
neuromatous lesions within the oral cavity. Her blood pressure is 220/120
mmHg. Laboratory investigations show that her calcium and electrolytes are
normal and serum calcitonin and urinary VMA levels are elevated, Which of
the following is the most likely cause of thehypertension?
A. Conn's syndrome
B. Cushing's disease
C. Essential hypertension
D. Phaeochromocytoma
E. Renal artery stenosis
31. A 65-year-old man presents with haematuria and left loin pain.
Computerised tomography demonstrates a left renal tumour. He undergoes
a left radical nephrectomy. Where does the left renal artery lie?
A. Anterior to the left gonadal vein

B. Anterior to the left renal vein
C. Anterior to the splenic vein
D. Posterior to the left renal vein
E. Superior to the superior mesenteric artery
32. Within the posterior triangle, which nerve is at particular risk of damage
during surgery?
A. Auricular branch of the facial

B. Glossopharyngeal
C. Phrenic
D. Recurrent laryngeal
E. Spinal accessory
33. The right and left pulmonary arteries are derived from which of the
following embryological aortic arches?
A. Second aortic arch
B. Third aortic arch
C. Fourth aortic arch
D. Fifth aortic arch
E. Sixth aortic arch

34. A 47-year-old man presents to the Emergency Department six hours after a
climbing accident initial assessment suggests that he had lost 1 L of blood.
His blood pressure is 105/70 mmHg and his pulse rate is 88 beats/minute.
He is catheterised and his bladder contains 120 ml of urine. Activation of
which of the following transport systems best describes how aldosterone
leads to maintenance of the intravascular volume and oliguria in this men?
A. Na+/glucose in the proximal tubule
B. Na/H+ in the descending loop of Henle
C. Na+/K in the ascending loop of Henle
D. Na+/Cl in the distal tubule
E. Na/K in the collecting ducts

35. During arch aortography, the vertebral artery would be seen to arise
directly from which of the following?
A. Arch of the aorta
B. Brachiocephalic artery
C. Common carotid artery
D. Internal carotid artery
E. Subclavian artery
36. A 65-year-old man, remains, on the high dependency unit following a
gastrectomy, three days previously. His urine output: has averaged 80ml/hour
for the last 24 hours. He has one dry abdominal drain arid no nasogastric
losses: His urea and electrolytes are normal He is to stay nil by mouth for a
further 24 hours. Which of the following fluid regimes is most appropriate to
his electrolyte and water requirements over the next 24 hours?
A. 1 L of 0.9 % saline plus 1.5 L. of 4 % dextrose/0.18 % saline

B. 1 L of 0.9 % saline plus 1.5 L of 5 % dextrose
C. 1 L of 0.9 % saline plus 1.5 L of Hartmann's solution
D. 2 L of 0.9% saline
E. 2 L of 4 % dextrose/0,18 % saline
37. A 3-year-old boy is admitted to hospital with severe vomiting. Radiographic
examination reveals that he is suffering from annular pancreas. Which of
these structures is constricted?
A. First part of duodenum

B. Second part of duodenum
C. Third part of duodenum
D. Proximal jejunum
E. Pylorus of stomach
38. A 20-year-old man with a severe head injury is being ventilated using
intermittent positive pressure. Which of the following is a physiological
consequence of this?
A. Decreased extracellular fluid volume

B. Decreased cardiac preload
C. Increase in intrathoracic blood volume
D. Increased cardiac preload
E. Increased cardiac stroke volume
39. A 36-year-old man presents with a two-month history of low back pain radiating
to his left leg After clinical examination he is referred for an MRI scan. This
shows a prolapsed intervertebral disc. The clinical signs are consistent with
pressure on SI roots. Which combination of clinical signs is most likely?
A. Weak ankle plantarfiexion; altered sensation on the dorsum of the foot;
normal ankle jerk reflex
B. Weak ankle plantarfiexion; altered sensation on the sole of the foot; loss of
ankle jerk reflex.
C. Weak hallux dorsiflexion; altered sensation on the anterior surface of the leg;
loss-of ankle jerk reflex.
D. Weak hallux dorsiflexion; altered sensation on the dorsum of the foot; normal
ankle jerk reflex.
E. Weak hallux dorsiflexion; altered sensation on the sole of the foot; loss of
knee jerk reflex
40. A 55-year-old woman undergoes a cholecystectomy; The gallbladder contains
multiple dark irregular small stones. The most likely, cause of this type of
gallstone is an increased blood levelof:
A. Bile acids
B. Calcium
C. Cholesterol
D. Conjugated bilirubin
E. Unconjugated bilirubin
41. A 55-year-old man presents with a deep venous thrombosis. His full blood
count shows a haemoglobin of 18.3 g/dL (normal 13.5-17.5), a white cell
count of 8 x 109/L (normal 3.910.0 x 109) and a platelet count of 200 x
109/L (normal 150-400 x 109) This hematological picture is most likely to be
associated with:
A. Bronchial carcinoma
B. Pancreatic carcinoma
C. Prostatic carcinoma
D. Renal cell carcinoma
E. Transitional cell carcinoma of the kidney
42. A 27-year-old has had pancolitis for the last five years. Which one of these
complications is he least likely to develop?
A. Arthritis
B. Cholangitis
C. Iritis
D. Polyarteritis
E. Toxic megacolon
43. A surgeon makes a Pfannenstiel incision for access to the pelvic organs. He
incises theabdominal wall down to and through the rectus sheath. He retracts
the rectus abdominis muscles laterally from the midline to expose the:
A. Linea alba
B. Peritoneum
C. Posterior rectus sheath
D. Transversalis fascia
E. Transversus abdominis muscle

44. A 25-year-old man undergoes splenectomy following blunt abdominal
trauma. Three days postoperatively venous blood testing is likely to reveal:
A. High platelet count
B. High red cell count
C. Low platelet count
D. Low while cell count
E. Low red cell count
45. A 46-year-old woman is seen in the pre-admission clinic. She had a
myocardial infarction two years ago. On examination she is in atrial
fibrillation and a recent echocardiogram shows that she has a dilated left
ventricle: She is on warfarin and her INR is 6.1. Warfarin inhibits which of
the following?
A. Antithrombin
B. Kallikrein
C. Plasminogen
D. Prothrombin
E. von Willebrand's factor

46. A 75-year-old man is admitted for elective repair of an abdominal aortic
aneurysm. Following the operation his systolic blood pressure falls below 90
mmHg and during resuscitation he is given an infusion of fluids. There is a
choice of colloid or crystalloid. Which of the following best describes why
the intensive therapy unit registrar decides to administer a colloid?
A. Colloids are not freely filterable across semi-permeable membranes

B. Colloids can prevent pulmonary oedema by inducing fluid flow out of the
interstitial space
C. Colloids decrease the transcapillary oncotic pressure gradient
D. Colloids expand the plasma volume by 200 ml for each liter infused
E. Colloids migrate from the intravascular space
47. A 35-year-old man develops septicaemia following surgery for perforated
acute appendicitis He is hypotensive. Arterial blood gas analysis reveals:
PH pO2 pCo2 Bicarbonate

Finding 7.25 7.2 kPa 7.5 kPA 17 mmol/L
Normal 7.35-7.45 11.9-13.3 4.7-6.0 22-26
What is the most likely explanation for these readings?
A. Compensated metabolic acidosis
B. Compensated respiratory acidosis
C. Mixed metabolic and respiratory acidosis
D. Uncompensated metabolic acidosis
E. Uncompensated respiratory acidosis

48. A.20-year-old man presents to the Emergency Department with a stab
injury to the thenar eminence. On examination he is found to have a 2 cm
long laceration with loss of sensation in the thumb and index finger and
weakness: of the thenar muscles. Which of the following structures is most
likely to have been injured?
A. Anterior interosseous nerve

B. Recurrent branch of median nerve
C. Sensory and motor branches of median nerve
D. Sensory and motor branches of radial nerve
E. Sensory and motor branches of ulnar nerve
49. A 65-year-old man presents with vomiting and.weight loss. On examination
he had 3 palpable epigastric mass. The transpyloric plane lies at which;
vertebral level?
A. T11
B. T12
C. L1
D. L2
E. L3
50. A 30-year-cid motorcyclist is brought to the Emergency Department after a
road traffic accident. He has an open fracture of the right femur. On arrival
he is tachypnoeic and. confused, with cold and clammy skin. Which of the
following physiological changes is most likely to occur?
A. Decreased reabsorption of water from the collecting tubules

B. Decreased serum bicarbonate level
C. Increased pH of blood
D. Increased secretion of sodium in the urine
E. Increased synthesis of glycogen in the liver
51. In an emergency situation what is the most appropriate surgical method of
obtaining an airway?
A. Cutting and retracting the cricothyroid muscle
B. Cutting the thyrohyoid membrane.
C. Dividing the thyroid isthmus
D. Entering the trachea at the C7 level
E. Piercing the cricothyroid membrane

52. A 75-year-old man presents with hepatomegaly and ascites. Computerised
tomography shows evidence of post hepatic portal hypertension. The
inferior vena cava passes through the Diaphragm at which vertebral level?
A. T8
B. T9
C. T10
D. T11
E. T12
53. A 20-year-old woman presents acutely with abdominal pain, imaging
reveals a right ovarian cystic lesion which is excised. Histoiogicai
examination shows a cyst lined by keratinizing stratified squamous
epithelium. Areas of fat, muscle, thyroid and neural tissue are seen in the
wall. What is the appropriate pathological designation for this lesion?
A. Adenocarcinoma
B. Cystadenoma
C. Dysgerminoma
D. Squamous cell carcinoma
E. Teratoma
54. A 25-year old woman who is two months post-partum, presents with a tender
mass in the left breast. She is pyrexial with a raised white cell count and a
raised C-reactive protein level. A diagnosis of lactational mastitis with abscess
is made. Which of the following is the most likely causative organism?
A. Aeromonas hydrophilia
B. Escherichia coli
C. Streptococcus' miileri
D. Lactobacillus caseii
E. Staphylococcus aureus
55. A 62-year-oid alcoholic man is admitted with severe acute pancreatitis.
Three days after admission he becomes hypoxic (pOa is 7.5 kPa) and
confused. Chest X-ray shows a uniform opacification of both lung fields.
Which of the following is the most likely clinical diagnosis?
A. Acute left ventricular failure

B. Adult respiratory distress syndrome
C. Bilateral bronchopneumonia
D. Bilateral lobar pneumonia
E. Massive pulmonary embolism
56. A 58-year-oid woman presented to the Emergency Department with a large
fluctuant swelling the site of a recent insect bite. She is anxious,
tachycardic, and pyrexial. An ECG shows critical fibrillation. She is noted
to have a goiter. The swelling at the site of the bite requires surgical
drainage. Which of the following classes of drug would be most appropriate
as part of her preoperative preparation for surgery?
A. Alpha-1 adrenoceptor agonist
B. Alpha-2 adrenoceptor agonist
C. Alpha adrenoceptor blocker
D. Beta adrenoceptor agonist
E. Beta adrenoceptor blocker
57. A nulliparous 30-year-old Woman presents with a recurrent painful red
area in the areola. She gives a history of smoking cigarettes. The lesion is
excised and the histology shows squamous metaplasia of lactiferous ducts.
Microbiological culture does not grow any organism. Which of the
following is the most likely diagnosis?
A. Breast abscess
B. Carcinoma of the breast
C. Fibroadenoma
D. Galactorrhea
E. Subareolar abscess
58. A 65-year-old man undergoes right hemicolectomy; On the second
postoperative day he is afebrile, nauseous has a distended abdomen but
very little pain. He is on intravenous morphine via a patient-controlled
analgesia pump. Plain X-ray confirms distended loops of small intestine.
The physiologic basis of postoperative paralytic ileus involves:
A. Stimulation of dopaminergic receptors
B. Stimulation of reversed migrating motor complexes
C. Stimulation of p receptors
D. Suppression of muscarinic receptors.
E. Suppression of motilin due to starvation
59. A 42-year-old woman has a cholecystectomy arid develops a self-limiting
postoperative wound infection. By what process would bacterial ingestion
have been enhanced?
A. Apoptosis
B. Autophagy
C. Metaplasia
D. Opsonisation
E. Phagocytosis
60. A 60-year-old non-smoker presents with three-month history of loss of
weight, malaise and breathlessness. On examination he has left
supraclavicular lymph node enlargement. Chest radiograph reveals
multiple bilateral opacities. What abnormality would a biopsy of a left
supra-clavicular lymph node most probably show?
A. Chronic inflammatory cells

B. Granuloma
C. Langerhan's type giant cells
D. Multiple abnormal mitotic figures in cells
E. Reed Sternberg cells
61. A 78-year-old woman with emphysema receiving 28% oxygen by mask has
the following blood gas results The most likely interpretation is:
Finding 7.28 6.2 kPa 8 kPA 36 mmol/L +5
Normal 7.35-7.45 11.9-13.3 4.7-6.0 22-26 -2 to +2
A. Mixed respiratory and metabolic acidosis

B. Partially compensated metabolic acidosis
C. Partially compensated respiratory acidosis
62. A 2-year-old child is referred because of an impalpable testis in the left
scrotum. Which of the following positions describes an ectopic testis?
A. At the deep inguinal ring

B. At the root of the penis
C. At the superficial inguinal ring
D. In the inguinal canal.
E. In the upper part of the scrotum
63. A 60-year-oid man is found to have a 2 cm diameter mass in the upper lobe
of his left lung. The lesion is excised and it is found that the lesion includes
connective tissue, mature cartilage and ciliated epithelium. What is the
most likely diagnosis?
A. Adenoma
B. Carcinoma
C. Chondroma
D. Hamartoma
E. Sarcoma
64. A 23-year-oid man presents three months following extraction of carious
teeth with a plaque like infiltration over the upper jaw with sinus
formation. Yellow granules are present in the discharging pus. What is the
most likely causative organism?
A. Actinomyces
B. Aspergillus
C. Blastomyces
D. Cryptococcus
E. Histoplasma
65. An 82-year-old man has complete occlusion of his inferior mesenteric artery
on angiography but no symptoms or signs of colonic ischemia. Which of the
following arteries s the most likely additional source of blood supply to the
territory of the inferior mesenteric artery?
A. Left colic
B. Left gastroepiploic
C. Middle colic
D. Splenic
E. Superior rectal
66. An intravenous drug abuser is having an echocardiogram for suspected
endocarditis. Closure of the tricuspid valve occurs at the onset of which
phase of the cardiac cycle?
A. Atrial systole
B. Isovolumetric contraction
C. Isovolumetric relaxation
D. Rapid ejection
E. Rapid ventricular filling
67. After being stabbed in the left groin, a previously healthy 20-year-old man
was admitted to The emergency Department. He developed hemorrhagic
shock. During resuscitation, 10 units of type O negative red cells and 6 L of
colloid were administered; Twenty-four hours later, he noted to have severe
dyspnoea for which he required intubation and ventilation on the intensive
care unit. Which of the following would be the most likely cause of his
respiratory insufficiency?
A. ABO blood incompatibility
B. Adult respiratory distress syndrome (ARDS)
C. Congestive cardiac failure
D. Tension pneumothorax
E. Viral pneumonitis
68. An 80-year-old man with a history of hypertension, controlled with thiazide
diuretics. undergoes transurethral resection of prostate under general
anaesthetic. The surgery.is prolonged and in the recovery room he
complains of nausea and a headache. He later becomes agitated and
confused. Which of the following is the most likely diagnosis?
A. Hypercalcaemia
B. Hyperuricaemia
C. Hypoglycaemia
D. Hypokalaemia
E. Hyponatremia
69. A 35-year-old man is admitted to hospital with vomiting, nausea and severe
headaches. An MRI scan reveals a tumour of the cerebellopontine angle.
Which one of the following pairs of cranial nerves is most likely to be
compressed by this tumour?
A. Accessory and vagus
B. Facial and vagus
C. Facial and vestibulocochlear
D. Glossopharyngeal and vestibulocochlear
E. Vagus and vestibulocochlear

70. After resection of d rectal tumour a patient experiences erectile
dysfunction. Which of the following nerves is most likely to have been
damaged in surgery?
A. Genitofemoral nerve
B. Lumbosacral plexus
C. Pelvic splanchnic nerves
D. Perineal branch of S4
E. Pudendal nerve
71. A 45-year-old woman presents with pain, swelling and stiffness affecting all
her metacarpophalangeal joints. She has noticed weakness in her grip and
her handwriting has changed. She is unable to extend her fingers fully. The
index, middle and ring fingers in both hands show an ulnar deviation. The
most likely diagnosis is:
A. Dupuytren's contracture
B. Gouty arthritis
C. Osteoarthritis
D. Radial nerve palsy
E. Rheumatoid arthritis
72. A 22-year-old man arrives to the Emergency Department with sudden
breath less ness due to a large pneumothorax. A chest drain is inserted into
the fifth left intercostal space in 5th mid-axillary line. There is haemorrhape
into the drainage bottle. Which of the following structures is the most likely
cause of this acute haemorrhage?
A. Intercostal artery
B. Left pericardiophrenic artery
C. Lingula of the lung
D. Right ventricle of the heart
E. Spleen
73. 65-year-old woman collapses after a total hip replacement. A pulmonary
embolism is suspected. Which of the following electrocardiogram changes
would support this diagnosis?
A. Dominant R wave in V6
B. Left axis deviation
C. Left bundle branch block
D. ST elevation in V1-V3
E. T wave inversion in V1-V3
74. 40-year-old woman had the anterior lobe of the pituitary removed because
of a tumour. Without postoperative supplements, which of the following
could occur?
A. Failure to produce adequate amounts of thyroxine

B. Fail to produce parathyroid hormone in response to hypocalcaemia
C. Failure to secrete catecholamine in response to stress
D. Failure to secrete insulin in hyperglycemia
E. Inability to concentrate urine in response to water deprivation
75. A 38-year-oid man in end-stage renal failure resulting from polycystic
kidney disease receives a cadaveric renal transplant. Good renal function is
established but four weeks later deteriorates, the serum creatinine rising by
25%. Which of the following processes is most likely to be responsible for
this deterioration?
A. B-cell mediated rejection

B. Circulating immune complex disease
C. IgG antibody mediated rejection
D. Post-transplant lymphoproliferative disorder
E. T-cell mediated rejection
76. In order to expose the right axillary artery, a transverse skin incision is
typically made below the clavicle from a point just lateral to the sternal end
of the clavicle to the deltopectoral groove. Which of the following structures
would be encountered in the dissection down to the vessel?
A. Lateral thoracic artery

B. Phrenic nerve
C. Suprascapular artery
D. Thoracic duct
E. Thoraco-acromial artery
77. A 4-year-old boy presents to the Emergency Department with a two-day
history of headache vomiting and drowsiness. A CT scan reveals dilatation
of both his lateral ventricles and his third cerebral ventricle. His fourth
ventricle was of normal size. It is suspected that he has an obstruction to his
cerebrospinal fluid flow. At which of the following sites is the obstruction
most likely to be?
A. Cerebral aqueduct (of Sylvius)
B. Infundibular recess
C. Interventricular foramen (of Monro)
D. Lateral foramen of fourth ventricle (foramen of Luschka)
E. Median foramen of fourth ventricle (foramen of Magendie)
78. A 12-year-old boy presents to the Emergency Department two hours after
helping his father cut the grass. He complains of rhinorrhea, itchy eyes,
sneezing and a blocked nose. He is apyrexial with a haemoglobin of 12.2 g/dl
and white blood cell count of 6.8 * 109/L with a raised eosinophil count. Chest
X-ray is clear. Which immunoglobulin is most likely t cause this reaction?
A. IgA
B. IgD
C. IgE
D. IgG
E. IgM
79. A 35-year-old woman undergoes gastric bypass surgery for morbid obesity.
At a subesequent surgical clinic review she complains of dizziness,
sweating, palpitation and collapsing episodes after big meals without any
vomiting or pain. she is otherwise well and has no medical problems. What
is the most likely explanation for her symptoms?
A. Operative denervation of stomach
B. Release of gastrin
C. Release of glucagon
D. Release of insulin
E. Vasovagal syncope
80. A 56-year-old man with chronic emphysema is on the high dependency unit
(HDU), ten days after anterior resection. He has developed acute shortness
of breath' and hypotension): Which of the following landmarks would be
the most appropriate to use to obtain a femoral arterial blood gas sample?
A. A point midway between the anterior superior iliac spine and the pubic tubercle
B. A point midway between the anterior superior iliac-spine and the' pubic symphysis
C. A point midway between the greater trochanter and the pubic symphysis
D. A point 1 cm inferior and 4 cm lateral to the pubic tubercle
E. A point 2 cm lateral to the midway point between the anterior superior iliac
spine and pubic symphysis
81. A 70-year-old man complains of persistent numbness since.an inguinal
hernia repair one year previously. The numbness affects the top of the
scrotum, root of penis, and a small area below the medial part of the
inguinal ligament. Which nerve is likely to have been damaged?
A. Femoral branch of the genitofemoral nerve

B. Genital branch of the genitofemoral nerve
C. lliohypogastric nerve
D. Ilioinguinal nerve
E. Medial cutaneous branch of the femoral nerve
82. A 12-year-old girl has a diastolic murmur. It is maximally audible in the
second left intercostal space. Pathology of which structure is the most likely
cause?
A. Aortic valve
B. Ductus arteriosus
C. Mitral valve
D. Pulmonary valve
E. Tricuspid valve
83. A 34-year-old pregnant woman develops a swollen leg. Her mother and
maternal aunt also had similar problems during their pregnancies. Which
of the following tests is likely to be positive?
A. Antiendomysial antibodies
B. Antimitochondrial, antibodies
C. Antinuclear antibodies
D. Antiphospholipid antibodies
E. Antithyroglobuiin antibodies
84. The "fight or flight", response produces a release of epinephrine (adrenaline).
What is the primary metabolic effect of epinephrine?
A. Alanine shunt activation
B. Cortisol release
C. Glycolysis
D. Tachycardia
E. Vasoconstriction
85. A 58-year-old-man underwent an emergency appendectomy. Which of the
following physiological parameters are consistent with sepsis?
Heart Rate Systemic Vascular Resistance Cardiac output

A ↓ ↓ ↑
B ↑ ↑ ↓
C ↑ ↓ ↑
D ↓ ↑ ↓
E ↑ ↓ ↓
86. A 50-year-old man with a 30-year history of pancolitis undergoes surveillance
colonoscopy which reveals a plaque-like lesion in the descending colon. Biopsy
reveals a pre-malignant change. What is the name of this pre-malignant change?
A. Anaplasia
B. Dysplasia
C. Hyperplasia
D. Metaplasia
E. Neoplasia
87. A 60-year-old man undergoes cystectomy for a bladder carcinoma. During
surgery, the ureters are identified. On which region of the bladder do the
ureters pierce the bladder wall?
A. Anterior surface
B. Apex
C. Lateral surfaces
D. Neck
E. Posterior surface
88. A year-old patient in the intensive care unit has a tracheostomy performed
via the second, third and fourth tracheal rings. Which intervening structure
is most likely to require transection?
A. Anterior jugular vein
B. Inferior thyroid veins
C. Sternothyroid muscle
D. Thymus
E. Thyroid isthmus
89. A 23-year old man is assaulted and sustains a stabbing injury to the left
groin. The wound- is cleaned and a simple dressing applied; Six months
later the patient returns with pulsatile swelling at the site of the injury. The
most probable:
lesion present is:
A. Abscess
B. False aneurysm of the femoral artery
C. Lymphocoele
D. Mycotic aneurysm of the femoral artery
E. Saphena varix
90. A 72-year-old man with a body mass index of 18.4 has not eaten for four
days following the removal of an adenocarcinoma from his descending
colon. His urea is found to be 12 mmol/L (normal 3.2-7^) and creatinine
346 umol/L (normal 35-110). A blood gas profile is ordered. The most likely
set of results would be:
A 7.23 13.6 kPa 3.8 kPA 13.5 mmol/L
B 7.30 8.8 kPa 8.3 kPa 30.5 mmol/L
C 7.36 11.5 kPa 5.3 kPa 30.5 mmol/L
D 7.43 16.4 kPa 3.7 kPa 21.0 mmol/L
E 7.49 12.6 kPa 3.9 kPa 24.0 mmol/L
Normal 7.35-7.45 11.9-13.3 4.7-6.0 22-26
91. A 16-year-old boy is hit on the left side of the face by a ball. There are no
broken bones but the boy complains of numbness of the face below the eye.
Which nerve has most likely been compromised?
A. Abducens nerve.
B. Facial nerve
C. Glossopharyngeal nerve.
D. Infra-orbital nerve
E. Zygomatic nerve
92. A 74-year-old man, who has undergone emergency major abdominal
surgery two-days previously, is noted to be confused. He has been on
furosemide for mild heart failure. The plasma sodium is 122 mmol/L
Inspection of the fluid chart shows that he has been written- up for 1L,
four-hourly intravenous 5% glucose infusions. What is the most likely
cause for the hyponatremia?
A. An ACTH (Adrenocorticotrophic hormone) response to surgery
B. Excessive sodium-free intravenous fluid administration
C. Osmotic effect of hyperglycemia induced by glucose infusions
D. Syndrome of inappropriate antidiuretic hormone
E. Use of loop diuretic in the long term
93. The Cori cycle is important in lactate metabolism in the Septic surgical
patient It is used to describe a pathway in which glucose is metabolised
anaerobically to lactate in one tissue and the lactate is converted back to
glucose in another; Which one of the following relies on this cycle to meet
all of its energy needs?
A. Erythrocyte
B. Hepatocyte
C. Leukocyte
D. Osleocyte
E. Pneumocyte
94. After receiving an intermascular Injection in the buttock, a 25 year-old
man complains of inability to evert his foot Which nerve is most likely to
have been injured?
A. Common peroneal (fibular) component of sciatic
B. Inferior gluteal
C. Pudendal
D. Superior gluteal
E. Tibial component of sciatic
95. A 73-year-old man with a history of irregular bowel movements presents
with dysuria, pneumaturia and an Escherichia ccli urinary tract Infection.
CT scans show a mass involving the sigmoid colon and the bladder. What is
the commonest cause of this presentation?
A. Adenocarcinoma of the sigmoid colon
B. Colonic diverticular disease
C. Crohn's disease
D. Transitional cell carcinoma of the bladder
96. A 7 year-old woman is in the recovery area arid receives 28% oxygen by
mask. Blood Gas Shows
PH pO2 pCo2
Finding 7.2 12 kPa 10 kPA
Normal 7.35-7.45 11.9-13.3 4.7-6.0
Reduced sensitivity of which receptors is most likely to be responsible for this
blood gas picture?
A. Adrenergic receptors
B. Baro receptors
C. Central chemo-receptors
D. J receptors
E. Lung stretch-receptors
97. A 76-year-old woman falls and sustains an inter-trochanteric fractured
neck of femur Following operative fixation her recovery is prolonged and
she is discharged to a rehabilitation unit Six weeks after her original
operation she is readmitted. She is drowsy, hypotensive and bradycardic.
An ECG shows low voltage complexes and a prolonged QT interval Under-
activity of which of the following glands gives the best explanation of the
clinical picture?
A. Adrenal
B. Pancreas
C. Parathyroid
D. Pituitary
E. Thyroid
98. A 36-year-old man falls on his outstretched right hand. Examination reveals
tenderness in the anatomical snuff box. Which one of the following tendons
form a boundary of the anatomical snuff box?
A. Abductor pollicis brevis
B. Extensor carpi radialis brevis
C. Extensor carpi radia lis longus
D. Extensor indicis
E. Extensor pollicis longus
99. A 65-year-old woman with metastatic breast cancer is admitted to hospital
confused and acutely unwell, with nausea and vomiting. Her vital signs are
within normal limits. What abnormality is most likely to contribute to her
clinical condition?
A. Hypercalcaemia
B. Hyperkalemia
C. Hypocalcaemia
D. Hypokalemia.
E. Hyponatremia
history of fever, difficulty walking and is unable to weight bear on the
right leg. He has been on oral Amoxycillin 250 mg three times a day for a
chest infection over the last five days. He is irritable with a temperature
of 39.4°C. He does not allow examination and keeps his right hip flexed
and abducted. Blood tests are: white blood cell count; (WBC) 12.3 x -
109/dL, C-Reactive protein (CRP) 146, haemoglobin 11.3 g/dL What is
the most likely diagnosis?
A. Acute avascular necrosis of hip
B. Dislocation of hip
C. Perthes disease
D. Septic arthritis
E. Slipped upper femoral epiphysis
101. A 35-year-old woman presents with recurrent peptic ulceration. She is on
proton pump inhibitors and previously received Helicobacter pylori
eradication therapy three months ago. Which of the following is likely to
be raised on venous blood testing?
A. Cholecystokinin
B. Gastrin
C. Histamine
D. Pancreozymin
E. Secretin
102. A 55-year-old man presents with back ache. Neurological examination
reveals lack of extension of the left great toe.; Which of the following
spinal cord segments are likely to be involved?
A. L1, L2 & L3
B. L2, L3 & L4
C. L4, L5 & S1
D. S1, S2, & S3
E. S3, S4 & S5
103. A 34-year-old man is seen in the Emergency Department with a fibular
fracture following football match. On examination he is noted to have loss
of foot eversion. Which area of skin should be examined to confirm. loss
of the cutaneous distribution of the affected-nerve?
A. Along the lateral aspect of the foot

B. Along the medial aspect of the foot
C. Cross the dorsal surface of the foot
D. On the plantar Surface of the foot
E. Over the heel
104. A 68-year-old man with insulin-dependent diabetes presents to the
preadmission clinic prior to surgery for rectal carcinoma. His creatinine
is found to be 590 pmol/L. He is referred to a renal unit where a measure
of his glomerular filtration rate (GFR) is made. Which of the following
best describes why inulin could be used to measure his GFR?
A. It is filtered and not reabsorbed
B. It is filtered and reabsorbed
C. It is filtered, secreted and reabsorbed
D. It is filtered, secreted but not reabsorbed
E. It is not filtered but is secreted and not reabsorbed
105. A 60-year-old man presents with a one-month history of headache,
confusion and recent onset of right sided hemiparesis. A CT scan
demonstrates a 4 cm >- 4 cm lesion with central necrosis in the left frontal
lobe. It is seen extending across the midline along the corpus callosum.
There is extensive oedema around the lesion. Which of the following is the
most likely diagnosis of this lesion?
A. Central neurocytoma
B. Ependymoma
C. Glioblastoma
D. Meningioma
E. Oligodendroglioma
106. A 65-year-old woman presents with a 2.5 cm diameter mass in the upper
outer quadrant of the left breast with associated axillary lymphadenopathy.
A core biopsy is taken which confirms the presence of carcinoma. Which
of the following types of carcinoma is this most likely to be?
A. Invasive ductal carcinoma
B. Invasive lobular carcinoma
C. Medullary carcinoma
D. Mucinous carcinoma
E. Tubular carcinoma
107. A 26-year-old man is admitted to the Emergency Department with
multiple peripheral fractures. He is clinically shocked. Which is the
structure responsible for the first; hemostatic response to a fall in
systemic arterial blood pressure?
A. Adenohypophysis
B. Baroreceptor
C. Chemoreceptor
D. Kidney
E. Neurohypophysis
108. Vitamin K is required for normal blood clotting. Which one of the following
statements is true about the effects and availability of vitamin K?
A. Affects platelet function
B. Causes bleeding if taken in excess
C. Is provided only by fresh food
D. Is depleted by broad spectrum oral antibiotics
E. Vitamin K absorption is affected by resection of the terminal ileum

109. In septic shock, norepinephrine (noradrenaline) is used to increase the
systemic vascular resistance. This action is a result of the stimulation of
which of the following receptors?
A. α 1
B. α2
C. β 1
D. β 2
E. µ
110. A 10-year-old child presents with progressive facial weakness and a
squint. On examination there is a lower motor neuron facial weakness
and failure of abduction of one eye. An MRI scan shows a small, intrinsic
mass lesion within the central nervous system. Where is this most likely to
be located?
A. The cerebellar vermis
B. The cerebellar tonsil
C. The medulla
D. The midbrain
E. The pons
111. A 65-year-old man, with a history of ischaemic heart disease, has an
abdominoperineal excision of the rectum after which he is stable. Two
days later he is clammy, has cool peripheries, a tachycardia and a blood
pressure of 80/60 mmHg. His temperature is normal. What is the most
likely cause?
A. Anaphylactic shock
B. Cardiogenic shock
C. Hypovolaemic shock
D. Neurogenic shock
E. Septic shock
112. A 55-year-old1 man presents to his General Practitioner with a four-
month history of feeling tired. The General Practitioner notes breast
enlargement. Investigations reveal:
Result Normal
TSH 0.2 mIU/L 0.4-4.3
Free T4 6 mmol/L 9-23
Which of the following is the most likely cause?
A. Primary hyperthyroidism
B. Primary hypothyroidism
C. Secondary hyperthyroidism
D. Secondary hypothyroidism
E. Sick euthyroid syndrome
113. A 40-year-old woman presents with a parotid tumour. A biopsy reveals
extensive perineural invasion. Which is the most likely pathology?
A. Acinic cell carcinoma

B. Adenocarcinoma
C. Adenoid cystic carcinoma
D. Lymphoma
E. Pleomorphic salivary adenoma
114. A 50-year-old man presents with malaise, abdominal pain, weight loss,
fever and myalgia Polyarteritis nodosa is associated with all of the
following except:
A. Erythema nodosum
B. Livedo reticularis
C. Mononeuritis multiplex
D. Nailfold infarcts
E. Palpable purpura.
115. A 30-year-old woman undergoes subtotal thyroidectomy. Five days later
the wound appears red and inflamed. Which of the following is the most
likely causative organism?
A. Haemophilus influenzae
B. Proteus-mirabilis
C. Pseudomonas aeruginosa
D. Staphylococcus aureus
E. Streptococcus pyogenes
116. A 50-year-old man complains of recent onset diplopia. On examination he
is unable to lookinwards and downwards with his right eye; The most
likely diagnosis is a lesion of the?
A. Abducens nerve
B. Ciliary ganglion
C. Nasociliary nerve
D. Oculomotor nerve
E. Trochlear nerve
117. A 57-year-old heart transplant recipient is keen-to join the cardiac,
rehabilitation programme Which of the following factors is most likely to
increase cardiac output in this patient during moderate exercise?
A. Decreased negative intrathoracic pressure
B. Decreased venous tone
C. Decreased ventricular compliance
D. Increased atrial filling ITS
E. Increased intrapericardial Pressure
118. A 69-year man with recta! cancer undergoes low anterior resection. The
liver is disease free. The pathology of his tumour was reported as a large
tumour invading from the rectum into the mesorectum. Two nodes of 24
lymph nodes, close to the tumour were carcinoma on histology. The
tumour was completely excised. What is the correct pathological staging
of his tumour?
A. Dukes' A
B. Dukes' B
C. Dukes' C
D. Dukes' D
E. T2N1
119. A 21 -year-old man is admitted to the Emergency Department with a stab
injury to his right chest. Pulse rate is 110 beats/minute and blood pressure
is 85/40 mmHg. Chest X-ray shows a large right haemothorax. and a very
small light apical pneumothorax. Which is the first substance secreted in
the process leading to increased renal reabsorption of sodium in response
to the above injury?
A. Angiotensin I
B. Angiotensin 11
C. Angiotensinogen
D. Antidiuretic hormone.
E. Renin
120. During the second (proliferative) phase of wound healing the
predominant cells in the wound site are fibroblasts. This cell is of
mesenchymal origin and produces the matrix and collagen needed to
strengthen the scar. Cross linkage of collagen requires hydroxy-proline
and hydroxy-lysine residues, which requires a specific vitamin to be
available in sufficient quantities. Deficiency of which vitamin results in
collagen that is unstable?
A. Vitamin B2 (riboflavine)
B. Vitamin B6 (pyridoxine)
C. Vitamin C (ascorbic acid)
D. Vitamin D (cholecalciferol)
E. Vitamin E (tocopherol)
121. A 62-year-old woman presents with a firm irregular mass in the upper outer
quadrant of the right breast. This appears malignant on mammography, and
fine needle aspiration cytology is reported as Co. Which is the first lymph
node to which the tumour is most likely to metastasise?
A. Initial node
B. Primary riode
C. Secondary node
D. Sentinel node
E. Virchow's node
122. Which of the following statements is true with relation to cardiac muscle?
A. Contraction does not involve release of Ca by the sarcoplasmic reticulum
B. Contraction is triggered by an influx of Ca through the sarcolemma
C. Excitation is passed from one cardiac cell to another through desmosomes
D. Hypertrophy is brought about by division of existing cardiac cells
E. There is capacity for regeneration
123. A 70-year-old retired farm worker presents with a scaly lesion on the
back of his left wrist. Biopsy shows enlarged pleomorphic squamous cells
with mitoses that have breached the basement membrane. What is the
name of this process?
A. Dysplasia
B. Hyperplasia
C. Hypertrophy
D. Metaplasia
E. Neoplasia
124. A 45-year-old man has established cirrhosis. At a follow-up appointment
a palpable spleen four fingers breadths below the costal margin, is
noticed. Full blood counts have shown a persistent thrombocytopaenia.
Bone marrow examination shows megakaryocyte hyperplasia. What is
the most likely cause of the thrombocytopaenia?
A. Ineffective production in the bone marrow

B. Platelet destruction in the bone marrow
C. Platelet destruction in the liver
D. Platelet destruction in the spleen
E. Platelet storage in the spleen
125. A surgeon is carrying out an elective splenectomy for congenital
spherocytosis. Which structure will be divided in order to mobilize the
spleen from the posterior abdominal wall?
A. Gastrosplenic ligament
B. Lesser omentum
C. Lienorenal ligament
D. Phrenicocolic ligament
E. Short gastric vessels
126. A 50-year-old man is admitted with epigastric pain and a rigid abdomen
He is diagnosed with, a perforated duodenal ulcer. Ulceration due to
excessive gastrin activity may be: caused by increased levels of?
A. Adrenaline (epinephrine)
B. Calcitonin
C. Glucagon
D. Secretin
E. Somatostatin
127. A 66-year-old woman with known tumour of her spine has started to
retain urine and is experiencing decreased anal and rectal tone. The
tumour is pressing directly on the conus medullaris. At which one of the
following vertebral levels is the tumour most likely to be located?
A. T9/T10
B. T11/T12
C. L1/L2
D. L3/C4
E. L5/S1
128. A 26-year-old man presents with a two-month history of unilateral
testicular swelling. An ultrasound scan shows a heterogeneous mass within
the testis with surrounding fluid. His blood test show- an elevated alpha
fetoprotein level. Which of the following is the most likely diagnosis?
A. Lymphoma
B. Orchitis
C. Seminoma
D. Teratoma
E. Tuberculosis
129. A 50-year-old woman presents with a history of faecal incontinence over
the past few year She had a prolonged and difficult first stage of labor 20
years previously. Physical examination reveals a relatively lax anal
sphincter. Which nerve is likely to have been damaged in labour?
A. Autonomic nerves to the rectum
B. Genitofemoral nerve
C. Lumbosacral trunk
D. Obturator nerve
E. Pudendal nerve
130. A 70-year-old man is admitted to hospital with a 12-hour history of a
painful white leg. Afemoral artery embolus is shown on angiography. He
is an insulin-controlled diabetic and takes ibuprofen for longstanding
osteoarthritis. Twenty-four hours after emergency embolectomy his blood
pressure is 90/60 mmHg and he passes very dark brown urine. A dipstick
shows myoglobin and traces of blood. His blood glucose is 15 mmol/L
(normal- 4.0-6.0), urea 12 mmol/L (normal 3.2-7^) and creatinine 180
mmol/L (normal 35-110). What is the most likely cause of his abnormal
renal function?
A. Drug induced nephropathy
B. Hypovoiaemia
C. Methaemoglobinuria
D. Rhabdornyolysis
E. Uncontrolled diabetes
131. An 86-year-old woman, with a history of partial gastrectomy, is in the
high dependency unit for a chest infection that is being treated with
antibiotics. She complains of difficulty swallowing. Endoscopy shows
multiple white plaques on the mucosal surface of the oesophagus. Biopsy
is most likely to show:
A. Acid reflux oesophagitis

B. Barrett's oesophagitis
C. Candida oesophagitis
D. Eosinophilic oesophagitis
E. Herpes oesophagitis
132. A 65-year-old woman has been given a total of 15 mg of morphine/over a
30-minute period for pain relief following a femoral neck fracture,
mellowing observations are found: Sp02 on 80% oxygen is 80%; blood
pressure 90/60 respiratory rate 6 breaths/minute.-The immediate
intervention should be:
A. High flow oxygen

B. Intravenous fluid replacement
C. Intravenous Naloxone
D. Monitor her ECG
E. Tracheal intubation
133. The following drugs are used to treat patients with peripheral vascular
disease. They all reduce the rate of myocardial infarction and stroke except:
A. A.C.E inhibitors
B. Antihypertensive medication
C. Aspirin
D. Cholesterol lowering drugs
E. Oxypentifylline
134. A 4-year-old boy, is brought to the Emergency Department with a painful
right elbow. His father stales that he was swinging his son by his arms
when the pain came on suddenly An X-ray shows that the radial head is
displaced from its usual position. What is the ligament (of the proximal
radio-ulnar joint) that holds the radial head in place?
A. Annular ligament
B. Conoid ligament
C. Quadrate ligament
D. Radial ligament
E. Ulnar ligament
135. A 35-year-old man presents with a three-week history of low back pain
and a three- day history of pain and weakness in his left leg. Physical
examination demonstrates numbness over the posterior aspect of the left
calf extending to the lateral aspect of the foot. Left ankle reflex is absent.
A magnetic resonance scan shows compression of the left S1 nerve root.
What is the most likely responsible structure?
A. Annulus fibrosus
B. Anterior longitudinal ligament
C. Nucleus pulposus
D. Posterior longitudinal ligament
E. Vertebral end plate
136. A 26 years old man motorcyclist loses 1 L of blood secondary to an open
fracture of the femur sustained in RTA. Which of the following is the most
likely earliest compensatory response in hypovolemeia in thispatient?
A. Baroreceptors induced venoconstriction
B. Capillary fluid shifts
C. Decreased atrial natriuretic peptide (AMP), secretion
D. Renal fluid retention
E. Renin Angiotensin system activation
137. Histology of a discrete palpable lump in the breast o 1 a 34-year-oM
woman has shown Apocrine metaplasia, epithelial overgrowth and
papillary projections. What is the most Likely pathological process?
A. Benign breast cyst
B. Carcinoma of the breast
C. Fibroadenoma
D. Phylloids tumor
E. Plasma mastiditis
138. A 35 -year-old woman 'presents with recurrent peptic ulceration. She is
on a proton pump inhibitor previously received Helicobacter pylori
eradication therapy three months ago. Which of the following is likely to
be raised on venous blood testing?
A. Cholecystokinin
B. Gastrin
C. Histamine
D. Pancreozymin
E. Secretin
139. A 3-year-old male boy presented with his mother for rectal blood loss, his
mother describes it as a bright red blood in the toilet pan. He has no pain
on defecation with negative family history. What is the most likely cause?
A. Adenomatous polyp
B. Juvenile polyp
C. Metastatic polyp
D. Multiple polyposis coli
E. Peutz jegher syndrome
140. A 32-years old man presents with a painful torticollis there is no past
medical history and his only complaint is that he has been feeling rather
tired over the last 4 nights. On examination, he has large rubbery mass in
the lateral aspect of his neck as well as a few smaller masses along his
internal jugular vein. You correctly assume that the muscular neck spasm
and the large mass are connected. The most likely cause of his torticollis
is due to pressure on?
A. Ansa cervicalis
B. Cervical plexus branch
C. Cranial accessory nerve
D. Spinal accessory nerve
E. Vagus nerve
141. A thin menopausal 52-vear-frld woman is diagnosed with breast cancer.
Her menarche was at the age of 14. she had her first child at age40 years.
During lactation, she developed breast abscess that necessitated surgical
intervention. She has no family history of breast cancer. Which of the
following is the most significant risk factor for this patient?
A. Age at first full term pregnancy
B. Familial predisposition
C. History of breast abscess
D. Interval between in menarche and menopause
E. Physical stature
142. A 30-ycar-old woman is sent to the outpatient clinic with weight loss of 5
kg over the Last 6 months, She also complains of anxiety, panic attacks
and palpations. On Examination. There is a swelling in the anterior neck
which moves on swallowing Which of the following is most likely
pathology underlying this presentation?
A. Graves disease
B. Hasliimoto's thyroiditis
C. Metastasis to the thyroid
D. Papillary carcinoma
E. Undifferentiated carcinoma
143. A 69-yeac-oJd man has been admitted to the high dependency unit
following an anterior resection under general anesthesia. He was given 2
mg of intrathecal morphine. On examination, he looks pale and drowsy.
Arterial blood gasses results are:
PH pCo2 pO2 Base Excess Gluose Lactate
Finding 7.28 8.1 kPA 10.2 kPa -2.1 21 mmol/L 4.0 mmol/L
Normal 7.35-7.45 4.7-6.0 11.9-13.3 -2 to +2 4-7 0.5-2.2
Which of the following is the most likely diagnosis?
A. Diabetic ketoacidosis
B. Metabolic acidosis
C. Metabolic alkalosis
D. Respiratory acidosis
E. Respiratory Alkalosis
144. A 32 year-old woman has a pigmented lesion excised from her left calf. The
histopathological diagnosis is melanoma in situ, which is completely excised
with a- 1 cm margin. What is the next most appropriate management?
A. Education about skin self-examination and discharge from follow up
B. Elective inguinal lymph node dissection
C. Re excision with 2 cm margin
D. Removal of any other pigmented lesions
E. Sentinel lymph node biopsy
145. A 60-year-old man with a past history of angina undergoes an
uncomplicated operation, for an inguinal hernia. Postoperatively he is
found to be hypotensive, tachycardic, and has a raised jugular venous
pressure. What is the most likely Underlying cause Of his hypotension?
A. Reduced afterload
B. Reduced parasympathetic tone
C. Reduced preload
D. Reduced stroke volume
E. Reduced sympathetic tone
146. A 4-years old boy presents to the Emergency Department with a two-day
history of fever, difficulty walking and is unable to weight bear on the
right leg. He has been on oral Amoxycillin 250 mg three times a day for a
chest infection over the last five days. He is irritable with a temperature
of 39.4°C. He does not allow examination and keeps his right hip flexed
and adducted. Blood tests are, (WBC) 18.3 (CRP) 146, haemoglobin 11.3
g/dL. What is the most likely diagnosis?
A. Acute avascular necrosis of hip
B. Dislocation of hip
C. Perthes disease
D. Septic arthritis
E. Slipped upper femoral epiphysis
147. A 34-year-oid man is admitted to-the Emergency Department with a head
injury. On examination his Glasgow coma scale is 9. A CT scan of the
brain demonstrates an extra dural haemorrhage. Which of the following
arteries is the most likely source of this?
A. Anterior cerebral
B. Middle cerebral
C. Middle meningeal
D. Posterior cerebral
E. Superficial temporal
148. A 65-year-old man has a history of transient ischemic attacks. He is due
to undergo carotid endarterectomy. Which one of the following is true of
the internal carotid artery?
A. Begins at the level of the sixth cervical vertebra
B. Divides into the anterior, middle and posterior cerebral arteries
C. Gives off the ophthalmic artery
D. Is accompanied within the skull by preganglionic sympathetic nerves
E. Passes through the foramen ovale
149. A 25-year-old male athlete is in training. At rest, how many liters of blood
per minute does his heart pump out?
A. 0.9
B. 2 to 3
C. 5 to 6
D. 8 to 10
E. 15 to 20
150. A 26-year-old man presents to the Emergency Department after
sustaining a glass cut to his arm. On examination there is a 10 cm
longitudinal laceration on the anterior aspect of his upper arm. He has
symptoms suggestive of ulnar nerve injury. On exploring the upper part
of the arm we would expect the ulnar nerve to be:
A. Anterior then medial to the brachial artery

B. Medial then anterior to the brachial artery
C. Medial to the brachial artery
D. Posterior then medial to the brachial artery
E. Posterior to the brachial artery
151. A 55-year-old man presents with acute back pain following a severe road
traffic accident. Neurological examination reveals lack of sensation of the
umbilicus and below. What is the spinal level of the neurological deficit
likely to be?
A. T8
B. T9
C. T10
D. T11
E. T12
152. A- 65-year-oid man complains of being thirsty and getting up in the
middle of the night to get to the toilet. His weight is 95.5 kg. height 1.65 in
and blood pressure 167/94 mmHg. An oral glucose tolerance test was
performed and produced the following results:
The most likely diagnosis:
Fasting plasma glucose 5.9 mmol/L
Two hours plasma glucose 11.3 mmol/L
A. Diabetes insipidus
B. Diabetes mellitus
C. Impaired fasting Glycemia
D. Impaired glucose tolerance
E. Normoglycemia
153. In a 9-year-old child with cellulitis of the hand, which chronological
sequence of immunoglobulin production is correct?
A. IgD precedes IgE production

B. IgG precedes IgA production
C. IgG precedes IgE production
D. IgM precedes IgA production
E. IgM precedes IgG production
154. A 60-year»old man presents to the-Emergency Department with epistaxis.
The source 0f the bleeding is identified as Little's area and resolves with
direct cautery. Which vessel is most likely responsible for the bleeding?
A. Anterior ethmoidal artery

B. Infraorbital artery
C. Middle meningeal artery
D. Sphenopalatine artery
E. Supratrochlear artery
155. A 75-year-old man presents with esophageal reflux. Endoscopy confirms
the Presence of a hiatus hernia. The esophagus passes through the
diaphragm at which level?
A. T8
B. T9
C. T10
D. T11
E. T12
156. A 78-year-ojd woman with emphysema receiving 28% oxygen by mask
has the Following blood gas results:
Finding 7.28 6.2 kPa 8 kPA 36 mmol/L +5
Normal 7.35-7.45 11.9-13.3 4.7-6.0 22-26 -2 to +2
Which of the following is the most likely interpretation?
A. Mixed respiratory and metabolic Acidosis
B. Partially compensated metabolic acidosis
C. Partially compensated respiratory acidosis
E. Uncompensated respiratory acidosis.
157. A 26-year-old man is having a stereotactic frame fitted to his skull prior to
radiosurgery on a cerebral arteriovenous malformation. Four pins secure
the frame tightly through the scalp to the outer table of the skull, two
anteriorly, two posteriorly. On insertion of one of the-posterior pins,
arterial haemorrhage is encountered. Which artery is most likely to have
been punctured?
A. The ascending pharyngeal artery

B. The middle meningeal artery
C. The occipital artery
D. The posterior cerebral artery
E. The posterior communicating artery
158. A 26-year-old man presents with a two-month history of unilateral
testicular swelling. An ultrasound scan shows a heterogeneous mass within
the testis with surrounding fluid. His blood test shows an elevated alpha
fetoprotein level Which of the following is the most likely diagnosis?
A. Lymphoma
B. Orchitis
C. Seminoma
D. Teratoma
E. Tuberculosis
159. A 2 day old baby presents with increasing respiratory distress. He was
born at term By normal vaginal delivery. On examination he has cyanosis
of the lower limbs and marked respiratory in drawing of the chest His
femoral pulses ate absent bilaterally and he has been anuric for the last 2
hours. Pulse rate is 140 beats/minute, regular, and his blood pressure is
60/30 mmhg in both upper limbs. What is the most likely diagnosis?
A. Hypoplastic left heart syndrome
B. Interrupted aortic arch = coarction of the aorta
C. Pulmonary atresia and ventricular septal defect
D. Transposition of the great arteries
E. Tricuspid atresia
160. A 50-years old woman presents with a history of right upper quadrant
pain and jaundice. She reports that her urine was dark in colour and that
her stools are offensive and difficult to flush. Which of the following
explains the dark urine?
A. Increase in conjugated bilirubinuria
B. Increase in unconjugated bilirubinuria
C. Increase in urea excretion
D. Increase in urinary urobilinogen
E. Reduced enterohepatic bile salt circulation
161. An 80-year-old woman, who has suffered a fall, is found lying on the floor,
where, she has-been for over 12 hours. Initial assessment shows that she
has a core temperature of 28°C. What would the expected early
physiological response to her body temperature be?
A. Increased fat metabolism
B. Increased constriction of peripheral blood vessels
C. Increased hypothalamic set-point
D. Increased metabolic rate.
E. Increased thyroid activity
162. A -12-year-old boy presents to the Emergency Department two hours
after helping his father cut the grass. He complains of rhinorrhoea, itchy
eyes, sneezing and a a blocked nose. He is apyrexial with a haemoglobin
of 12.2 g/dL and white blood cell count of 6.8 * I09/L with a raised
eosinophil count. Chest X-ray is; clear. Which immunoglobulin is most
likely to cause this reaction?
A. IgA
B. JgD
C. IgE
D. IgG
E. IgM
163. A 45-year-old man presented with backache and leg pain due to -
prolapsed lumbar • intervertebral' disc. The pain, which is aggravated by
coughing and sneezing; radiates to the dorsum of the foot On
examination there is weakness, of the dorsiflexion of the foot. Which
nerve root is most likely to be involved?
A. T12
B. L3
C. L5
D. S1
E. S2
164. A 75-year-old woman, who has a carcinoma of the upper rectum, undergoes
anterior resection. The arterial blood supply of the upper rectum arises
from which of the following?
A. Coeliac artery
B. Iliocolic artery
C. Inferior mesenteric artery
D. Internal iliac artery
E. Superior mesenteric artery
165. A 65-year-old man is undergoing an abdominal aortogram, A stenosis is
demonstrated in a lateral aortic branch, arising at the level of the body of
the second lumbar vertebra. The stenosed vessel is most likely to be the:
A. Coeliac artery
B. Inferior mesenteric artery
C. Left renal artery
D. Second left lumbar artery
E. Superior mesenteric artery
166. A 40-year-old man is admitted tc the surgical day case unit for repair of
his left inguinal hernia. On examination he is noted to have diffuse skin
tanning, spotty pigmentation of the elbows, nipples and buttocks, and
pigmentation of the scar from A previous right inguinal hernia repair.
Three hours after the operation be becomes severely hypotensive. ’What
is the most likely cause?
A. ACTH deficiency
B. Adrenal insufficiency
C. Growth hormone deficiency
D. Potassium deficiency
E. Thyroxine deficiency
167. A 19-year-old woman presents to the Emergency. Department profoundly
hypovolemic having fallen from a horse. A postero-anterior (PA) chest
radiograph shows a fracture to the medial third of the left clavicle. Which
of the following vessels was-most likely damaged?
A. Brachiocephalic trunk
B. Left axillary artery
C. Left common carotid artery
D. Left subclavian artery
E. Left vertebral artery
168. 65 years old man presented with an inguino-scrotal swelling in the right
groin which is non tender. A cough impulses is elicited, At operation, an
indirect inguinal hernia is repaired. The cremasteric muscle is derived
from which of the following
A. External oblique aponeurosis
B. Internal oblique muscle
C. Rectus abdaminis muscle
D. Rectus sheath
E. Trsusversalis fascia
169. A 70-year-old woman is in the recovery area and receives 28% oxygen by
mask. Blood gas shows:
PH Pco2 Po2
Findings 7.1 10.0 kPa 12 kPa
Normal 7.35-7.45 4.7-6.0 11.9-13.3
Reduced sensitivity of which receptors is most likely to be responsible for this
blood gasses picture?
A. Adrenergic receptors
B. Baro receptors
C. Central chemo receptors
D. J receptors
E. Lung stretch-receptors
170. A 28-year-old man presents with pain in his left scrotum. A diagnosis of
varicocele is made. Which vessel is involved?
A. Femoral vein
B. Inferior epigastric vein
C. Long saphenous vein
D. Internal pudendal vein
E. Testicular vein
171. A 60-year-old man, who is a heavy smoker, presents with a 10-day history
of frank painless haematuria. His prostate is slightly enlarged on rectal
examination. his haemoglobin is 11.3 g/dL. creatinine 84 pmol/L and
prostate specific antigen (PSA.) is 3,1 mg/dL. What is the most likely
pathological process?
A. Benign prostatic hyperplasia

B. Prostate cancer
C. Renal cell carcinoma
D. Transitional cell carcinoma of bladder
E. Urinary tract infection
172. A 34-year-old woman presents with an irregular mass in the right breast
which is clinically. radiologically and histologically malignant. Her
mother died of breast cancer at the age of 58 and her grandmother died
of ovarian- cancer at the age of 55. Which gene is most likely to be
involved in the development of this woman tumor?
A. ABRCA1
B. hMLH1
C. KRAS
D. p53
E. PTEN
173. 65-year-old man presents with a non-tender swelling in the right hemi-
scrotum. At operation, the hydrocele sac is opened and 400 ml of fluid is
drained. Which anatomical structure surrounds the fluid?
A. Dartos muscle
B. Patent processus vaginalis
C. Testicular capsule
D. Tunica albuginea
E. Tunica vaginalis
174. A 24 years old man is brought to the Emergency Department following a
road traffic accident. He has obvious airway compromise due to mouth/
facial haemorrhage which requires a surgical airway. The surface
landmarks used to localise, the optimal site for a tracheostomy incision
are midway between the suprasternal notch and which of the following?
A. Cricoid
B. Hyoid
C. Mastoid
D. Laryngeal prominence
E. Thyroid
175. A 60-year-old man has -an anterior resection for a high rectal carcinoma.
The histopathology report indicates the lesion is Dukes' stage B. What is the
approximate average five years survival rate for patients with theselesions?
A. 10%
B. 20%
C. 35%
D. 70%
E. 90%
176. A 20-years man presents to the Emergency Department after accidentally
tripping over and lacerating his hand on a glass bottle. On examination
there is a 2 cm laceration on the hypothenar eminence with loss of flexion
in the distal interphalangeal joint of the little finger. What is the most
likely tendon to be injured?
A. Flexor digiti minimi brevis
B. Flexor digitorum profundus
C. Flexor digitorum superficialis
D. Fourth palmar interosseous
E. Lumbirical
177. A 75-year-old man, who smokes heavily, underwent coronary artery bypass
grafting six months ago. A left internal-mammary artery graft was used. He
now complains of angina on pegging his laundry on the washing line to dry.
Which of the following lesions best explains hissymptoms?
A. Micro-emboli from the left common carotid artery
B. Micro-emboli from the le\t internal carotid artery
C. Stenosis of the subclavian artery at the level of the costo-cervical trunk
D. Stenosis of the subclavian artery distal to the insertion of scalenus anterior
E. Stenosis of the subclavian artery proximal to the first branch
178. A 50-year-old alcoholic man presents-to the Emergency Department and
is found to be unable to extend his wrist, thumb and fingers of his right
hand. He is also found to have weak extension of the right elbow joint and
loss of sensation on the dorsum of the first web space. Which nerve is
most likely to have been injured?
A. Median nerve
B. Musculocutaneous nerve
C. Posterior interosseous nerve
D. Radial nerve
E. Ulnar nerve
179. A 55 year-old man presents with acute back pain following a severe road
traffic accident. Neurological examination reveals lack of dorsi-flexion of
the left ankle joint. Which of the following spinal cord, segments are most
likely to be injured?
A. L1, L2 & L3
B. L2, L3 & L4
C. L4, L5 & S1
D. S1, S2& S3
E. S3, S4 & S5
180. A 21 -year-old man is admitted to the Emergency Department with a stab
injury to his right chest. Pulse rate is 110 beats/minute and blood pressure
is 85/40 mmhg Chest X-ray shows a large right haemothorax and a very
small right apical pneumothorax. Which is the first substance secreted in
the process leading to increased renal reabsorption of sodium in response
to the above injury?
A. Angiotensin I
B. Angiotensin II
C. Angiotensinogen
D. Antidiuretic hormone
E. Renin
181. A 21-year-old man has been stabbed in the back of the knee, dividing the
popliteal artery, and is undergoing repair via a posterior approach.
Which of the following structures is most likely to be encountered first,
when dissecting deep from the skin, incision?
A. Popliteal artery
B. Popliteus muscle
C. Popliteal vein
D. Tibial nerve
E. Soleus muscle
182. A 78-year-old woman presents with urinary urgency and incontinence.
The external urethral sphincter is innervated by which of the following
nerve roots?
A. L 3, 4 & 5
B. L4, 5 & SI
C. L 5, Si & 2
D. Si, 2 & 3
E. S2.3& 4
183. A 40-year-Qld woman presents with a parotid tumour. A biopsy reveals
perineural invasion. Which is the most likely pathology?
A. Acinic cell carcinoma
B. Adenocarcinoma
C. Adenoid cystic carcinoma
D. Lymphoma
E. Pleomorphic salivary adenoma

184. A 19-year-old man was assaulted and sustained injuries to the right side of
his head. After two weeks he notices dial his right eye is dry and it could
not produce tears. from which ganglion is post synaptic fibers arise to
supply lacrimal gland?
A. Geniculate ganglion
B. Inferior ganglion of the vagus nerve
C. Otic ganglion
D. Pterygopalatine ganglion
E. Superior cervical ganglion
185. A 35-year-old man undergoes a right inguinal hernia repair under
general anaesthetic as a day patient. He has a nerve block after the
procedure. On recovery he has weakness of the right leg. Which nerve
has been affected?
A. Femoral nerve
C. Ilioinguinal nerve
D. Lateral cutaneous nerve
E. Sciatic nerve
186. A man suffers a brachial plexus injury. On examination, he has a
Horner's syndrome in association with upper limb paralysis. Which nerve
roots does the Homer's syndrome suggest involvement of?
A. C2 & C3 roots
B. C4 & C5 roots
C. C6 & C7 roots
D. C8 & T1 roots
E. T2 & T3 roots
187. A 60-year-old woman with breast carcinoma complains of difficulty
chewing her food and is found to have numbness of the lower lip on one
side. CT scanning shows a small metastatic lesion affecting the bony skull
base on. The same side as the lip numbness. Which foramen is the most
likely to involve?
A. Foramen caecum
B. Foramen magnum
C. Foramen ovale
D. Foramen rotundum
E. Foramen spinosum
188. Which one of the following muscles is an extensor of the hip?
A. Adductor longus
B. Gracilis
C. Iliopsoas
D. Pectineus
E. Semitendinosus
189. In order to expose the right axillary artery, a transverse skin incision is
typically made below the clavicle from a point just lateral- to the sternal
end of the clavicle to the deltopectoral groove. Which of the following
structures would be encountered in the dissection down to the vessel?
A. Lateral thoracic artery
B. Phrenic nerve
C. Suprascapular artery
D. Thoracic duct
E. Thoraco-acromial artery
190. A 55-year-old man presents to the-Emergency Department after
collapsing. On examination his pulse is 124 beats/minute, blood pressure
is 60/30 mmHg, respiratory rate is 34 breaths/minute and his peripheries
are warm. What is the most likely diagnosis, for this patient?
A. Cardiac failure
B. Haemorrhage
C. Hypovolemia
D. Pulmonary embolus
E. Sepsis
191. In the posterolateral approach to a posterior malleolar fracture, an
incision is made between the calcaneal (Achilles) tendon and the distal-
fibula. Which of the following structures is at risk?
A. Deep peroneal (fibular) nerve
B. Saphenous nerve
C. Superficial peroneal, (fibular) nerve
D. Sural nerve
E. Tibial nerve
192. A 25-year-old woman undergoes.an elective right thoracoscopic procedure
for treatment of right palmar hyperhidrosis. Diathermy is applied to a
neural structure lying anterior to-the neck of tire right first rib. What is the
most likely complication to occur as a result of this procedure?
A. Bradycardia
B. Hoarseness
C. Homer's syndrome
D. Raised right hemi diaphragm
E. Reduced right biceps tendon reflex
193. A 33-year-old man presents to the orthopedic outpatient clinic with a six-
month history of low back pain radiating to the lateral aspect of the left
upper thigh. Micturition and defecation are normal and there is no history
of previous Injury. On examination, left lateral flexion of the spine is limited
but a full range of hip movements are observed, although it is painful.
Sensation is altered over the front of the knee. Left knee reflex is reduced.
Which spinal nerve-is most likely to have beencompressed?
A. L1
B. L2
C. L3
D. L4
E. L5
194. A 25-year old motorcyclist is admitted following a road traffic accident,
having sustained- bilateral femoral fractures and a ruptured spleen.
Three days postoperatively lie is noted to be confused, hypoxemic and
difficult to ventilate. His observations show a blood pressure, of 120/8O
mmHg, regular pulse of 88 beats/minute and he is apyrexial. A chest X-
ray shows bilateral diffuse lung infiltrates. What is the most likely
underlying diagnosis?
A. Adult respiratory distress syndrome
B. Atelectasis
C. Bronchopneumonia
D. Pulmonary oedema
E. Pulmonary thrombo-emboilism
195. On-an ultrasound scan of the popliteal fossa when investigating-a swelling,
which of the following structures is closest to the capsule of the knee joint?
A. Great (long) saphenous vein
B. Popliteal artery
C. Popliteal vein
D. Small (short) saphenous vein
E. Tibial nerve
196. A 25 years old man sustains a twisting injury while playing football. He
develops immediate swelling of the knee and he cannot continue the
game. Six months later, he Is still not able to play football. His knee feels
unsteady and tends to give way. On examination, he has a full range of
knee motion. There is a positive anterior draw test and a small effusion.
What is the most likely structure damaged?
A. Anterior cruciate ligament
B. Lateral collateral ligament
C. Medial collateral ligament -
D. Oblique popliteal ligament
E. Posterior cruciate ligament
197. A 62-year-old man required a partial gastrectomy for a large benign ulcer
in his gastric antrum. When he is reviewed in clinic, six months later he
complains of palpitations, weakness and sweating along with a cramp-like
abdominal pain which occurs within an hour of eating n meal. Usually, he
has to lie down for 30-40 minutes until the symptoms subside. What is the
most likely cause of his symptom pattern?
A. Chronic gastroparesis
B. Dumping syndrome
C. Delayed gastric emptying
D. Reflux gastritis
E. Recurrent ulceration
198. In septic shock, noradrenaline is used to increase the systemic vascular
resistance This action is a result of the stimulation of which of the following?
A. Ai
B. A2
C. Pi
D. P2
E. 3i
199. A 56-year-old man presents with acute epigastric pain and vomiting. On
examination he has guarding in the upper abdomen His test results are:
Value Normal
Serum amylase 900IU/L <100
Serum ALT 61 IU/l <50
Alkaline Phosphatase 93 IU/l 20-120
Albumin 38 g/L 35-50
Gamma GT 500IU/L <60
Bilirubin 15 umol/L 0-20
Triglyceride 2.9 mmol\L <1.7
Which of the following is the most likely etiology of this condition?
A. Alcohol
B. Choledocholithiasis
C. Hypertriglyceridemia
D. Hypocalcaemia
E. Mump
200. A 47-year-old woman with end stage renal failure requires an elective
cholecystectomy for symptomatic gallstone disease. Her hemoglobin
preoperatively is 7.2 g/dL. What is the major cause of her anaemia?
A. Calcium deficiency
B. Erythropoietin deficiency
C. Folate deficiency
D. Iron deficiency
E. Vitamin B12 deficiency

201. A 60-y
202. ear-old man undergoes cystectomy a bladder carcinoma. During surgery,

the ureters are identified. On which region of the bladder do the ureters
pierce the bladder wall?
A. Anterior surface
B. Apex
C. Lateral surfaces
D. Neck
E. Posterior surface
203. A 65 year-old man had a colonic resection for carcinoma 12 hours ago. He
is now passing concentrated urine at a rale of 0,5 ml/kg/hr. Which
endocrine response is most likely to have caused this?
A. Decreased aldosterone release
B. Decreased insulin release
C. Decreased thyroxine release
D. Increased adreno-coriticotrophic hormone (ACTH) release
E. Increased Vassopressin release

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204. A 28-year-old man presents with an ischiorectal abscess. Where is ths
abscess cavity likely to be sited?
A. Above the levator ani
B. Between external and internal anal sphincter
C. Lateral to the obturator internus
D. Medial to the internal anal-sphincter
E. Medial to the pudendal canal

205. A 36-year-old man falls on his outstretched right hand. Examination
reveals tenderness in the anatomical snuffbox. Which one of the following
tendons form a boundary of the anatomical snuff box?
A. Abductor pollicus brevis.
B. Extensor carpi radialis brevis
C. Extensor cairpi radial is longus
D. Extensor indicis
E. Extensor poliicis longus

206. A 55-year-old- woman complains of cramps and tingling in her legs and arms
48 hours following a sub total thyroidectomy. Her vital signs, are stable.
Investigations reveals a normal white-cell count and normal haemoglobin.
The NA is 132 mmol/L K+3.2 mmoI/L and Ca 1.60 mmol/L. Serum albumin
is normal The next appropriate step is intravenous infusion of?
A. Calcium chloride
B. Magnesium sulphate
C. Potassium chloride
D. Sodium bicarbonate
E. Sodium chloride
207. A 40-year-old. woman presents with faecal incontinence and; anatomically
intact internal and external anal- sphincters. Which structure is most likely
to have been damaged?
A. First sacral nerve-root

B. Obturator nerve:
D. Perineal nerve
E. Pudendal nerve
208. Abdominal free fluid will collect in the lowest part of the peritoneal
cavity. At operation with the patient supine, in which of the following will
the fluid collect first?
A. A Hepatorenal pouch
B. Left subphrenic space
C. Lesser sac
D. Right paracolic gutter
E. Right subphrenic space
209. A 45-year-old homeless man presents with a cough and weight loss over
three months. On examination his BMI (Body Mass Index) is 19 and he
has reduced breath sounds in the right upper zone. His chest X-ray shows
a cavitaing lesion in the right upper lobe. He undergoes a bronchoscopy
and a brornchial biopsy. The biopsy shows featureless necrosis surrounded
by epithelioid macophages and giant cells. Which of the following is the
most likely diagnosis?
A. Actinomycosis
B. Bronchiectasis
C. Sarcoidosis
E. Tuberculosis
210. A healthy 36 years old man is being assessed with a view to being a life
related kidney donor which are of following investigations is most
accurate for measuring the GFR?
A. Creatinine clearance
B. Glucose Clarence
C. Inulin Clarence
D. PAH
E. Urea clearance
211. A 34-year-old pregnant woman develops a swollen leg. Her mother and
maternal aunt also had a similar problem during their pregnancies.
Which of the following tests is likely to be positive?
A. Antiendomysial antibodies
B. Antimitochondrial antibodies
C. Antinulear antibodies
D. Antiphospholipid antibodies
E. Antithyroglobulin antibodies
212. A 72-year-old alcoholic man is known to suffer from chronic obstructive
pulmonary disease (COPD). He has now been diagnosed with carcinoma
of the urinary bladder and-has a history of a gastric ulcer. Which of the
following agents is most likely to be responsible for all these problems?
A. Alcohol
B. Cigarette smoking
C. Drugs
D. Dust
E. Virus
213. A 3-year-old boy is admitted to hospital with severe vomiting.
Radiographic examination and history reveals that he is suffering from
annular pancreas. Which of these structures is constricted?
A. First part of duodenum
B. Second part of duodenum
C. Third part of duodenum
D. Proximal jejunum
E. Pylorus of stomach
214. A 45 year-old man presents with a 3 cm * 4 cm swelling in the right groin
which is non-tender. A cough impulse is elicited. At operation, an indirect
inguinal hernia is found. The external inguinal ring is a defect in which of
the following abdominal
A. External oblique aponeurosis
B. External oblique muscle
C. Internal oblique muscle
D. Transversus abdominis muscle
E. Transversalis fascia
215. A 45-year-old woman suffers from spina bifida and is confined to a
wheelchair. Her legs are not fully developed. What is the pathological
process which has occurred in the legs?
A. Apoptosis
B. Atrophy
C. Hyperplasia
D. Hypertrophy
E. Hypoplasia
216. A 23-year-old man presents to the Emergency Department-with non-specific:
chest pains. A postero-anterior (PA) chest radiograph is performed and is
normal. Immediately inferior cauidal to the outline of the aortic knuckle was
a farther structure with a convex border. What is this structure?
A. The left atrium
B. The pulmonary trunk
C. The oesophagus
D. The right atrium
E. The superior vena cava

217. A 45-year-old woman presents to the hospital with jaundice. She undergoes an
ultrasound scan and is diagnosed with a hepatocellular carcinoma affecting the
left lobe of her liver. Which virus is the most likely to be implicated?
A. Epstein Bar virus (EBV)
B. Hepatitis B virus (HBV)
C. HIV
D. Human papilloma virus (HPV)
E. Human T cell lymph a trophic virus-1 (HTLV1)

218. An 82-year-old man has complete occlusion of his inferior mesenteric
artery on angiography but no symptoms or signs of colonic ischaemia.
Which of the following arteries is the most likely additional source of
blood supply to the territory of the inferior mesenteric artery?
A. Left colic artery
B. Left gastroepiploic
C. Middle colic
D. Splenic
E. Superior rectal
219. A 56-year-old man with documented Type 1 diabetes mellitus presents to
the Surgical outpatient clinic with 3 months history of right leg pain
brought on by walking 50 meters. He has no history of back pain. He has
been a smoker for 10 years (10 cigarettes a day), He stales his alcohol
consumption to be 30 units per week. On clinical examination, significant
findings include weak right foot pulses with altered sensation on dorsum of
the right toot. What is the most likely diagnosis D from the followinglist?
A. Autonomic neuropathy
B. Femro popliteal stenosis
C. Neuropathic joint disease
D. Polyneuropathy
E. Radiculopathy
220. A 35-year-old man presents with a three-week history of low back pain
and a three day history of pain and weakness in his left leg. Physical
examination demonstrates numbness over the posterior aspect of the left
calf extending to the lateral aspect, of the foot. Left ankle reflex is absent.
A magnetic resonance scan shows compression of the left Si. nerve root.
What is the most likely structure compressing the nerve?
A. Annulus fibrosus
B. Anterior longitudinal ligament
C. Nucleus pulposus
D. Posterior longitudinal ligament
E. Vertebral end plate
221. A 72-year-old man who is a smoker presents to his doctor with a second
episode of frank hematuria. When an ultrasound scan of his urinary tract
was performed it a solid lesion in the right kidney. What is the most likely
pathology underlying this presentation?
A. Angiomyolipoma
B. Renal cell carcinoma,
C. Renal cyst
D. Renal oncocytoma
E. Transitional cell carcinoma
222. A 20-years old man presents with abdominal pain and shock. He is found to
have hemoperotonium Due to a ruptured spleen. He denies any history of
trauma what is the most likely predisposing cause of his splenic rupture?
A. Epstein Barr virus infection
B. Human immunodeficiency virus (HIV) infection
C. Measles virus infection
D. Mumps virus infection
E. Varicella zoster virus infection
223. A 30-year-old woman presents to the outpatient' clinic witlr a three-
month history of diarrhoea, which is intermittently bloody. On rectal
biopsy, the histology has shown a granulomatous inflammation. What is
the most likely diagnosis?
A. Ameobiasis
B. Crohn's disease
C. Sarcoidosis
D. Tuberculosis
224. A 56 year-old motorcyclist presents to the Emergency Department after
being involved in a road traffic accident. He is a smoker and known to
have hypertension. He is conscious (Glasgow coma score of 1-3/15), and
maintaining his own airway and breathing. He is found to have an open
right femoral fracture with normal distal pulses and- sensation.
Resuscitation is started. Urethral catheterisation drained 250 ml.
immediately but over the following 60 minutes he drained only 10 ml.
Which of the following is the most likely cause of his low urine output?
A. Blocked catheter
B. Cardiogenic shock
C. Hypovolemic shock
D. Ruptured bladder
E. Septic shock
225. A 35-year-old man is admitted with pancreatitis, which leads to admission
to the surgical high dependency unit. After 48 hours, he develops breathing
difficulties with elevated, respiratory rate and increasing hypoxia. You
suspect he is developing respiratory failure. Which of the following
mechanisms is responsible for the regulation ofrespiration?
A. Brainstem receptors producing voluntary breathing.
B. CO2 concentration in medulla
C. Elevated bicarbonate levels in cerebrospinal fluid
D. Hydrogen ion diffusion across blood brain barrier
E. Hypoxic stimulation' of chemoreceptors

226. A 70-year-old man undergoes transurethral resection of bladder uimonr
(TURBT). The tumour lies over the lateral side wall of the bladder just
above the opening of the right ureteric orifice. Use of the diathermy
suddenly causes the patient to 'kick' because of contraction of the hip
adductors muscles. Which nerve has been stimulated?
A. Femoral nerve
C. Lateral femoral cutaneous nerve
D. Obturator nerve
E. Sciatic nerve
227. Witch of the following statements is true with relation to cardiac muscle?
A. Contraction does not involve-release of Ca 2 + by the sarcoplasmic reticulum
B. Contraction is triggered by an influx of Ca 2+ through the sacrolemma
C. Excitation is passed from one cardiac cell to another through desmoses
D. Hypertrophy is brought about by division of existing cardiac cells
E. There is capacity for regeneration
228. A 39-year-old man presents with searing left-sided loin to groin pain.
Investigation. reveals a radiodense opacity, confirmed to be in the ureter
on intravenous urography. What is the most likely composition of this
man’s ureteric stone?
A. Ammonium magnesium phosphate

B. Calcium oxalate
C. Cholesterol
D. Cysteine
E. Urate
229. A 25-year-oid man is playing football when he complains of posterior
thigh pain whilst sprinting with the ball. On examination he has
tenderness in the lower lateral posterior thigh. He is unable to fully
extend the knee due to pain. What is the most likely injury?
A. Biceps femoris tear

B. Gracilis tear
C. Gastrocnemius tear
D. Semimembranosus tear
E. Semiteodinosus tear
230. A 23 years old man is assaulted and sustains a stab injury to the left
groin. The wound is cleaned and a simple dressing applied. Six months
later the patient returns-with a pulsatile swelling in the site of the injury.
The most probable lesion present is:
A. Abscess
B. False aneurysm of the femoral artery
C. lymphocele
D. mycotic aneurysm of the femoral artery
E. Saphena varix
231. 12 years old girl has a diastolic murmur it is maximally audible in the 2nd
left intercostal space. Pathology of which structure is the most likely cause?
A. Aortic valve
B. Ductus arteriosus
C. Mitral valve
D. Pulmonary valve
E. Tricuspid valve
232. A 25-year-old man is admitted having been stabbed in the interior chest.
On examination he is alert and coherent. He has congested neck veins.
His pulse is 140 beats/minute and his blood pressure 90/60 mmHg. He has
normal breath sounds. What is the most likely cause of his cardiac arrest
15 minutes later?
A. Cardiac tamponade
B. Congestive cardiac failure
C. Hypovolemia
D. Tension pneumothorax
E. Ventricular arrhythmia
233. A 20-year-old woman presents acutely with abdominal pain. Imaging
reveals a right ovarian cystic lesion which is excised. Histological
examination shows a cyst lined by keratinising stratified squamous
epithelium. Areas of fat, muscle, thyroid and neural tissue are seen in the
wall. What is the appropriate pathological designation for this lesion?
A. Cystadenoma
B. Dysgerminoma.
C. Mesenchymoma,
E. Teratoma
234. A 21-year-old map comes into the Emergency Department with a severe
headache and neck stiffness of recent onset. You suspect acute meningitis
and decide immediately to treat with antibiotics and perform a lumbar
puncture. After your third attempt to obtain for cerebrospinal fluid (CSF)
you notice that the fluid obtained is stained red. However during the
collection of CSF into three containers it is noted that the final bottle is
now cleared of any blood. Which anatomical structure is the most likely
to be responsible for this bleeding?
A. Anterior spinal artery
B. Epidural artery
C. Subarachnoid vein
D. Veins within the erector spinae muscles
E. Vertebral venous plexus

235. A 25-year-old woman presented in the surgical clinic with a three-month
history of diarrhoea. On examination she is found to have a smooth 2 cm
swelling in the front of her neck her sister has a similar swelling which
was operated on 2 years ago The swelling moves on swallowing and the
patient is clinically euthyroid Fine needle aspiration cytology of the
swelling shows amyloid stroma and serum calcitonin levels are elevated.
A. Anaplastic thyroid carcinoma
B. Follicular thyroid carcinoma
C. Medullary thyroid carcinoma
D. Metastatic thyroid carcinoma
E. Papillary thyroid carcinoma.
236. A 74-year-old man with known prostatic hyperplasia presents to the
Emergency Department with acute urinary obstruction. Thirty minutes
after urinary catheterization he Collapses with a blood pressure of 74/34
mmhg a heart rate of 128 beats/minute. What is the most likely diagnosis?
A. Cardiac failure
B. Haemorrhagic shock
C. Latex allergy
D. Septic shook
E. Vasovagal syncope
237. A 70-year-old man has a basal cell carcinoma resected from his left
temple. What is the most important prognostic indicator?
A. Clinical pathological type

B. Completeness of excision
C. Intensity of the lymphocytic infiltrate
D. Lymphovascular space invasion
E. Mitotic index in the tumour islands
238. A 68-year-old man has undergone emergency surgery to repair a leaking
aortic abdominal aneurysm. He underwent transfusion with 6 units of
packed red cells, Blood tests were performed two hours postoperatively:
haemoglobin 10.1 g/dl WBC 12.3 x 109/L , platelets 40 x109 /L, APTT 36
seconds, INR 2.2, fibrinogen 1.5 g/L, fibrin degradation products 25
mg/mi. What will these results be consistent with?
A. Disseminated intravascular coagulation

B. Inactivation of Antithrombin III
C. Increased level of vitamin K dependent
D. Plasminogen inactivation
E. Protein C deficiency
239. A 46-year-old woman is seen in the pre-admission clinic. She had a
myocardial infarction two years ago. On examination she is in atrial
fibrillation and a recent echocardiogram show that she had a dilated left
ventricle. She is on warfarin and her INR. (International Normalized
Ratio) is 6.1 Warfarin inhibits which of the:
A. Antithrombin
B. Kallikrein
C. Plasminogen
D. Prothrombin
E. von Willebrand factor
240. A 29-year-old pregnant woman is having uncontrolled labor pains. She
has an epidural for pain relief. Which of the following is true?
A. An epidural puncture should only be performed below the L1 level to avoid
damage to the spinal cord
B. An epidural puncture should only be performed below the L4 level to avoid
the spinal cord
C. The epidural space (also known as the extradural space) contains numerous
nerve roots and a venous plexus
D. The liganientum flavum is rarely pierced during a low epidural procedure
E. The supraspinous and interspinous ligaments are rarely pierced during the
procedure.
241. A 28-year-old motorcyclist presents to the Emergency Department after
being involved in a road, traffic accident. He has a closed isolated injury
to his right leg. Radiographs show a segmental fracture of the tibia and
the fibula. Intramedullary nailing of the tibia is undertaken. Six hours
following the operation he complains of severe calf pain which does not
respond to analgesics. Movement of the toes severely increases the pain.
What is the most likely cause of this pain?
A. Deep vein thrombosis
B. Deep-infection
C. Embolic episode
D. Raised intra-compartmental pressure
E. Movement of the unstabilized fibula
242. A 65-year-old woman with metastatic breast cancer is admitted to hospital
confused and acutely unwell, with nausea and vomiting. Her vital signs are
within normal limits. What abnormality is most likely to contribute to her
clinical condition?
A. Hypercalcaemia
B. Hyperkalaemia
C. Hypocalcaemia
D. Hypokalemia
E. Hyponatraemia
243. During recovery from varicose veins surgery 35 years old woman
complains of weakness of dorsiflexion of the ankle Physical examination
reveals absent sensation over the dorsum of the foot. Which of the
following nerves is most likely injured?
A. Common peroneal nerve
B. Deep peroneal nerve
C. Saphenous nerve
D. Superficial peroneal nerve
E. Sural nerve
244. A 78 -year-old woman, with chronic obstructive pulmonary disease
(COPD), becomes confused after a right hemicolectomy. She is oh 30%
oxygen and her blood gas analysis shows:
Po2 pCO2
Finding 6.2 kPa 8.5 kPA
Normal 11.9-13.3 4.7-6.0
From what is she most likely to be suffering?
A. Severe asthma attack
B. Emphysema
C. Pulmonary embolus
D. Type 1 respiratory failure
E. Type 2 respiratory failure.
245. A 19-year-old man fell down a flight of stairs. On presentation to the
Emergency Department his Glasgow coma scale (GCS) was 14/15 with no
focal neurological signs. An hour later he vomited and his GCS
deteriorated to 10. He developed a fixed and dilated left pupil-. Which of
the following accounts for the pupillary signs?
A. Compression of oculomotor nerve parasympathetic fibres
B. Compression of sympathetic fibres to the left iris
C. Compression of the afferent fibres in the left optic nerve
D. Compression of the Edinger Westphal nucleus
E. Compression of the optic chiasma
246. A 32-year-oid mountain biker presents to the outpatient clinic. He fell
awkwardly, with excessive lateral flexion of his neck to the left side. He
describes some paresthesia over his right shoulder and lateral arm.
Which appears to have been improving over the past hour. What is the
most likely injury suggested by this history?
A. Axonotmesis of the C5 nerve root
B. Axonotmesis of the T1 nerve root
C. Neuropraxia of the C5 nerve root
D. Neuropraxia of the T1 nerve root
E. Neurotmesis of the C5 nerve foot
247. A 62-year-old woman presents with a firm irregular mass in the upper
outer quadrant of the right breast This appears malignant on
mammography, and fine needle aspiration cytology is reported as C5 which
is the first lymph nodes to which the tumour is most likely to metastasize?
A. Initial node.
B. Primary node
C. Secondary node
D. Sentinel node.
E. Virchow's nodes
248. A 50-year-old woman presents with a history of faecal incontinence over
the past, few years. She had a prolonged and difficult first stage of labour
20 years previously. Physical examination reveals a relatively lax anal
sphincter. Which nerve is likely to have been damaged in labour?
A. Autonomic! nerves to the rectum.

D. Obturator nerve
E. Pudendal nerve
249. A 26-year-old man presents to the Emergency Department with extensive
bleeding from his arm, after sustaining a glass injury. On examination-
there is n 7 cm transverse laceration across tire anterior aspect of his
elbow. On exploring the cubital fossa, you would expect the brachial
artery to be?
A. Anterior to the median nerve
B. Lateral to the biceps tendon.
C. Lateral to the median nerve
D. Medial to the median nerve
E. Superficial to the bicipital aponeurosis
250. A 53-year-old man complains of 'crushing' chest pain at rest He has
chronic hypertension and is a heavy smoker. His pulse rate is 138
beats/minute and blood pressure 140/90 mmHg. What is the principal
cause underlying his reduced coronary artery blood flow?
A. Decreased cardiac muscle wall tension

B. Decreased coronary oxygen extraction
C. Decreased diastolic interval
D. Decreased systolic interval
E. Decreased vagal tone
251. A 58-year-old woman, a known patient with thoracic right-sided
meningioma, presents with features suggestive of a Brown-Sequard
syndrome. The clinical, findings will include which of the following?
A. Left sided weakness, left sided proprioception and vibration loss, right sided
loss of pin prick sensation
B. Right sided weakness, right sided proprioception and vibration loss, left sided
C. Right sided weakness, right sided proprioception and vibration loss, right
sided loss of pin prick sensation
D. Right sided weakness, left sided proprioception and vibration loss, right sided
E. left sided weakness, right sided proprioception and vibration loss, left sided
loss of pin prick sensation.
252. 70-year-old woman presents with a fractured left humerus. X-rays show
an osteolytic lesion at the site of the fracture. Histological examination of
a sample taken at the time of internal fixation shows a metastatic
carcinoma. Where is the most likely primary site?
A. Breast
B. Colon
C. Endometrium
D. Ovary
E. Stomach
253. A 74-year-old. man presents with a pulsatile swelling in his abdomen. The
principal abnormality within the wall of arterial aneurysms is loss of?
A. Adventitial collagen
B. Adventitial elastin
C. Intimal collagen
D. Intimal elastin
E. Medial elastin
254. A 24-year-old woman presents with a swelling in the thyroid gland. She
also has enlarged lymph nodes in the left anterior triangle of the neck.
A. Anaplastic carcinoma
B. Follicular adenoma
C. Follicular carcinoma
D. Medullary carcinoma
E. Papillary carcinoma
255. A 20-year-old man with a severe head injury is being ventilated using positive
pressure. which of the following is a physiological consequence of this?
A. Decreased extra fluid volume
B. Decreased cardiac preload
C. Increase in intrathoracic blood volume
D. Increased cardiac preload
E. Increased cardiac stroke volume

256. A 70-year-old man presents with a one-week history of epigastric pain
and -profuse vomiting The most likely consequence is?
A. Hypochloremic acidosis
B. Hypckalaeinic alkalosis
C. Raised serum chloride
D. Raised urine sodium
E. Reduced renin release
257. A 22-year-old men arrives in the Emergency Department with sudden
breathlessness due to a large pneumothorax. An immediate chest drain is
inserted into the fifth left intercostal space in the mid-axillary line, There
is hemorrhage into the drainage bottle. Which of the following structures
is the most likely cause of this acute hemorrhage?
A. Intercostal artery m
B. Left pericardiophrenic artery
C. Linguia of the lung
D. Right ventricle of the heart
E. Spleen
258. The right and left pulmonary arteries are derived from which of the
following embryological aortic arches?
A. Second aortic arch
B. Third aortic arch
C. Fourth aortic arch
D. Fifth aortic arch
E. Sixth aortic arch

259. In the fetal circulation, the majority of blood passing from the inferior
vena cava into tire right atrium subsequently passes next into which; one
of the following?
A. Aorta
B. Left atrium
C. Left ventricle
D. Pulmonary artery
E. Right ventricle
260. A 36-year-oid butcher injures his left index finger with a knife, suffering a
deep laceration on the palmar aspect of the middle phalanx. On examination
he is unable to flex DIP, which tendon is likely to have been injured?
A. Flexor carpi facialis
B. Flexor carpi ulnaris
C. Flexor digitorum profundus
D. Flexor digitorum superficialis
E. Flexor indicis
261. A 39-year-old woman with large, expanding ovarian mass that is removed
surgically, requiring a lateral pelvic wall clearance, of lymph nodes. Four
days postoperatively she complains of painful spasms in the groin area
and remarks that she has an area of numbness on the medial side of her
thigh. The most likely explanation for these, problems is that during
surgery an injury was inflicted on the:
A. Femoral nerve
D. L3 ventral ramus
E. Obturator nerve
262. A 70-year-old patient is found to have a sodium of 125 mmoI/L on
examination There is no signs of hypovolemia. His plasma osmolality is
280 mOsm/L and his Urine osmolality is 1000 mOsm/L. Which of the
following is-the best explanation of these findings?
A. Central diabetes insipidus

B. Cerebral salt wasting syndrome
C. Nephrogenic diabetes insipidus.
D. Syndrome of inappropriate anti-diuretic hormone (ADK) secretion.
E. Water deprivation
263. A surgeon is carrying out an elective splenectomy for congenital
spherocytosis. Which structure will be divided in order to mobilise the
spleen from the posterior Abdominal wall?
A. Gastrosplenic ligament
B. Lesser omentum
C. Lienoreaal ligament
D. Phrenicocolic ligament
E. Short gastric vessels
264. A 45-year-old man has established post hepatic cirrhosis. At a follow-up
appointment, a palpable spleen four fingers breadths below the costal
margin, is noticed. full blood counts have shown a persistent
thrombocytopenia. Bone marrow examination has shown megakaryocytic
hyperplasia. 'What is the most likely cause of the thrombocytopenia?
A. Ineffective production in bone marrow

B. Platelet destruction in the bone marrow
C. Platelet destruction in the liver
D. Platelet destruction in the spleen
E. Platelet storage in the spleen
265. A 7 years old boy presents with recurrent attacks of pneumonia. Culture
showed. Psudomonas aeruginosa. His mother confirms that he had
meconium ileus in the neonatal period. Which of the following is the most
likely finding in this boy?
A. Increased sweat alanine transaminase

B. Increased sweat chloride
C. Increased sweat creatinine
D. Increased sweat potassium
E. Increased sweat urea
266. A 42 years old woman has a cholecystectomy and develops a self-limiting
postoperative wound infection. By what process would bacterial ingestion
have been enhanced?
A. Apoptosis
B. Autophagy
C. Metaplasia
D. Opsonisation
E. Phagocytosis
267. After resection of a rectal tumour a patient experiences erectile
dysfunction. Which of the following nerves is most likely to have been
damaged in surgery?
A. Genitofemoral nerve
B. Lumbosacral, plexus
D. Perinea! branch of S4
E. Pudendal nerve
268. A 15-year-old girl has been treated for tuberculosis over the previous 6
months. She presents to Her doctor with fatigue, loss of Appetite and weight
loss. On examination. her blood pressure is 90/55 mmHg and she has
increased pigmentation. What is the next most appropriateinvestigations?
A. Aldosterone level
B. Oral glucose tolerance test
C. Random Cortisol level
D. ACTH stimulation test
E. Water deprivation test
269. A 73-year-old man with a history of irregular bowel movements presents
with dysuria, pneumaturia and an Escherichia ccli urinary tract
Infection. CT scans show a mass involving the sigmoid colon and the
bladder. What is the commonest cause of this presentation?
A. Adenocarcinoma of the sigmoid colon
B. Colonic diverticular disease
C. Crohn's disease
D. Transitional cell carcinoma of the bladder
270. A 30-year-old man is assaulted with a hammer and sustains a depressed
fracture at the Vertex, of the skull Profuse venous bleeding is noted at the
fracture site. Which vascular structure is most likely to have been perforated?
A. Cavernous sinus
B. Inferior sagittal sinus
C. Sigmoid sinus
D. Superior petrosal sinus
E. Superior sagittal sinus

271. A 57-year-old heart transplant recipient is keen-to join the cardiac,
rehabilitation programme Which of the following factors is most likely to
increase cardiac output in this patient during moderate exercise?
A. Decreased negative intrathoracic pressure
B. Decreased venous tone
C. Decreased ventricular compliance
D. Increased atrial filling
E. Increased intrapericardial Pressure
272. An 18-year-old woman fell 9 meters while rock climbing. She had a renal
transplant two years ago. She is brought to the Emergency Department
for resuscitation and appropriate analgesia given. When correctly
prescribed, witch of following analgesic drugs would be most likely to
adversely affect her renal function in this situation?
A. Diclofenac
B. Dihyclrocodeine
C. Morphine
D. paractamol
E. Tramadol
273. A 77-year-old man is admitted with acute urinary retention secondary to
benign prostatic hyperplasia. A urinary catheter is inserted and ot has
free flow of concentrated urine. Which of the following best accounts for
the action of the counter current multiplier mechanism that leads to the
concentration of urine in the Loop of Henle?
A. Active transport of solute out of thin section ascending limb

B. Impermeability to water in thick ascending limb
C. Permeability to solute in descending limb
D. Permeability to solute in thick ascending limb
E. Permeability to water of thin section ascending limb;
274. A 52-year-old man is found to have multiple myeloma, What skull X-ray
appearances would be characteristic?
A. Diffuse thickening of the calvarium

B. Hair on end* appearance
C. Multiple fractures
D. Multiple osteolytic lesions
E. Multiple osteosclerotic lesions
275. A 56-year-old man undergoes resection of his ileum secondary to ischemic
bowel Which of the following effects is most likely to be seen in this
patient postoperatively?
A. Decreased bile salt synthesis by the liver
B. Decreased concentration of bile salts in colonic content?
C. Decreased mean corpuscular volume
D. Decreased reabsorption of vitamin B12
E. Decreased stool frequency
276. A previously healthy 45 years old woman undergoes emergency
splenectomy following traumatic rupture of the spleen. A left subclavian
central venous pressure (CVP) line to guide fluid therapy is inserted. At
this time she becomes distressed and acutely dyspneic, with a blood
pressure of 75/40 mmHg. There are decreased breath sounds on the left.
Her temperature is 35.5°C. What is the most likely cause?
A. Acute blood Loss
B. Anaphylaxis
C. Myocardial infarction
D. Sputum retention
E. Tension pneumothorax
277. During the second (proliferative) phase of wound healing the
predominant cells in the wound site are fibroblasts. This cell is of
mesenchymal origin -and produces the matrix and collagen needed; to
strengthen the scar. Cross linkage of collagen requires hydroxy-proline
and hydroxy-lysine residues, which requires a specific vitamin to be
available in sufficient quantities. Deficiency of which vitamin results in
collagen that is unstable?
A. Vitamin B2 (riboflaVine)
B. Vitamin B6 (pyridoxine)
C. Vitamin C (ascorbic acid)
D. Vitamin D (cholecalciferol)
E. Vitamin E (tocopherol)
278. A 19- year-old man fell down a flight of stairs. On presentation to the
Emergency Department his Glasgow Coma Score (GCS) was 14/15 with
no local neurological signs. An hour later he Vomited and his GCS
deteriorated to 10. He developed a fixed and dilated left pupil. Which of
the following is likely to seen on the scan?
A. Left-sided acute subdural haematoma
B. Left-sided extradural haematoma
C. Left-sided midbrain haematoma
D. Right-sided acute subdural haematoma
E. Right-sided extradural haematoma

279. A 70-year-old woman weighing 50 kg undergoes open cholecystectomy.
Postoperative pain relief is administered by intravenous morphine infusion
(morphine 1 mg; 5 minute lock out). Twenty-four hours postoperatively she
is in an agitated, confused state. Her temperature is 37.1°C-.pulse 90
beats/minute 110/80 mmHg. Her urine output is 35 ml/hour. Arterial blood
gases are

Finding 7.27 9.6 kPa 10.0 kPA 29 mmol/L -6
Normal 7.35-7.45 11.9-13.3 4.7-6.0 22-26 -2 to +2
Which of the following is the most likely explanation to account for false
findings?
A. Hypovolaemia
B. Opiate induced hypoventilation
C. Pain induced hyperventilation
D. Pulmonary embolus
E. Silent myocardial infarction
280. A 70-year-old woman from a nursing home is brought to1 the Emergency
Department with abdominal pain and vomiting. On examination, she is
dehydrated and her abdomen is distended. There is a 3 cm x 4 cm
swelling in the right groin which is nontender, and there is no cough
impulse. At operation, a femoral hernia is found. Which one of the
following lies immediately lateral to the hernial neck?
A. Femoral artery
B. Femoral nerve
C. Femoral vein
D. Inguinal ligament
281. A 64-year-old woman is-reviewed in the Emergency Department with an
acute right groin swelling, below and lateral to the pubic tubercle. Which
of the following forms the medial boundary of the ring through which this
hernia is protruding?
A. Conjoint tendon
B. Inferior epigastric artery
C. Inguinal ligament
D. Lacunar ligament
282. A. 27-year-old has had pancolitis for the last five years. Which one of
these complications is he least likely to develop?
A. Arthritis
B. Cholangitis
C. Iritis
D. Polyarteritis
E. Toxic megacolon
283. An 82-year-oid woman had a hemiarthroplasty of the hip six hours ago!
She is an insulin-dependent diabetic and has been on long-term non-
steroidal analgesics, In the last three hours she passed,, via her urinary
catheter, a total of 20 ml of urine. Her pulse rate is 120 beats/minute and
regular, her blood, pressure 100/60 mmHg and capillary refill is 3
seconds. Blood urea and electrolyte levels are:
Sodium Potassium Creatinine Urea
Finding 135 mmol/L 4.0 mmol/L 140 umol/L 12.0 mmol/L
Normal 137-144 3.5-4.9 35-110 3.2-7.5
The most likely cause of this is:
A. Acute Tubular necrosis
B. Blocked urinary catheter
C. Diabetic nephropathy
D. Non-steroidal: anti-inflammatory drugs
E. Reduced renal perfusion
284. Witch single respiratory test parameter (FEVJ Forced expiratory volume
in one second; FVC - Forced vital capacity) is the best prediction for
morbidity and mortality after surgery?
A. Confronted flow volume loop
B. FEV1 < 1L
C. FEV1/FVC <70%
D. Maximum inspiratory Volume < 2 L
E. Reduced residual volume
285. A 58-year-old man, admitted for inguinal hernia surgery, is found to have
an enlarged heart shadow on his chest radiograph. Which one of
the/following statements is true of the right ventricle?
A. Has a muscular wall that is normally thicker than that of the Left ventricle
B. Forms the apex of the heart
C. Forms the right border of the heart
D. Is directly related to the diaphragm
E. Gives rise to the aorta
286. A 67-year-oid man is admitted to hospital for investigation of at irregular
heart beat. The 'conducting system' of the heart includes which one of the
following anatomical structures?
A. Atrioventricular node
B. Chordae tendineae
C. Fibrous skeleton of the heart
D. Interatrial septum
E. Phrenic nerve
287. A 28-year-old man is found in the sea by the emergency services. he is
alert but confused. His core temperature is below 33°C. ECG changes
that may occur include which one of the following?
A. Atrial flutter
B. Inverted T wave at the junction of the QRS & T wave
C. Narrowed QRS complex
D. Prolonged PR interval
E. Shortened QT interval
288. A 75-year-old woman presents to the outpatients clinic with a three-
months history of painless ulcer on the sole of her left foot. On
examination she is obese" with a 1.5 cm deep ulcer over the first
metatarsal head. Her foot is warm and pedal pulsesare palpable. She has
a hemoglobin of 13 g/dL, normal urea and electrolyte level. What is the
most likely cause of her ulcer?
A. Atherosclerosis
B. Diabetic neuropathy
C. Embolism
D. Venous hypertension
E. Vasculitis
289. A 24-year-old man is assaulted and sustains a deep 2 cm long laceration to
the lateral aspect of his lower leg. Physical examination show's that the
laceration is anterior to the lateral malleolus. Which of the following
structures is most at risk of being divided?
A. Peroneus brevis
B. Peroneuslongus
C. Saphenous nerve
D. Superficial peroneal nerve
E. Sural nerve
290. A 48-year-old woman presented to the Emergency Department with
persistent diarrhoea. On examination, she was apyrexial and had an
irregularly irregular pulse: of 140 beats/minute. The most likely cause of
the abnormal cardiac rhythm is:
A. Hypernatraemia
B. Hypokalaemia
C. Hypovolemia
D. Myocardial ischemia
E. Sepsis
291. A 45 years old woman is investigated after two episodes of renal colic. A plain
abdominal X-ray reveals small opacities in both kidneys. No abnormalities
are found on physical examination. Biochemical investigations show:
Findings Normal
Adjusted ( corrected) Calcium 2.85 mmol/L 2.15-2.55 mmol/L
Phosphate 0.70 mmol/L 0.6-1.25
Alkaline phosphatase 195 IU/L 20-120
Creatinine 72 umol/L 35-110
PTH 12.7 pmol/L 0.95-5.7
Which, of the following is the most likely cause?
A. Primary hyperparathyroidism
B. Primary hypoparathyroidism
C. Pseudohyperparathyroidism
D. Secondary hyperparathyroidism
E. Tertiary hyperparathyroidism
292. A 35-year-cld man develops septicaemia following surgery for perforated
acute appendicitis. He is hypotensive. Arterial blood-gas analysis reveals
Finding 7.25 7.2 kPa 7.5 kPA 17 mmol/L
Normal 7.35-7.45 11.9-13.3 4.7-6.0 22-26
Which of the following is the most likely explanation to these findings?
A. Compensated metabolic acidosis
B. Compensated respiratory acidosis
C. Mixed metabolic and respiratory acidosis
293. A 75-year-old man is assessed for surgery. he has smoked 25 cigarettes a
day for - the past 45 years. He is short of breath on minimal exertion.
Chest: auscultations reveals a widespread wheeze. A chest X-ray shows
hyperinfilated lungs. An arterial blood gas sample is likely to reveal
which of the following changes?
pCO2 Bicarbonate
A High High
B High Low
C Low High
D Low Low
E Normal Normal
294. An 18-year-old woman present with recurrent tonsillitis and spontaneous
skin bruising. On examination there is no lymphadenopathy or
splenomegaly. What is the most likely diagnosis?
A. Acute myelocytic leukemia

B. Agranulocytosis
C. Aplastic anemia
D. Hodgkin's disease
E. Human immune deficiency virus infection
295. A 62-year old woman presents with a firm "irregular mass in-the upper
outer quadrant of the right breast. This is shown to be malignant on
mammography and fine needle aspiration-cytology. She is treated with
wide local excision and axillary clearance. Which of the following
histopathological findings would imply a better prognosis?
A. Absence of HER2 amplification

B. Bloom and Richardson Grade III
C. More than three positive axillary nodes
D. Presence of lymphovascular invasion
E. Presence of estrogen receptors
296. A 58 year-old man is due to have surgery for Dupuytrens contracture to
release the ring finger of the light hand. 'Which one of the following
regarding the anatomy of the ring finger is correct?
A. Has a cutaneous innervation from the radial nerve

B. Has no cutaneous innervation from the median nerve
C. Has no cutaneous innervation from the ulnar nerve
D. Has the flexor digitorum profundus inserting into the middle phalanx
E. Is abducted by a palmar interosseous muscle
297. A 75-year-old man presents with deep vein thrombosis. Computerized
Tomography confirms the presence of a thrombus' in His common iliac
vein extending into the inferior vena cava The common iliac veins join to
form the inferior vena cava at which vertebral level?
A. L3
B. L4
C. L5
D. S1
E. S2
298. A 35-year-old motorcyclist is involved in a road traffic accident and
fractures his temporal bone, completely transecting the facial nerve just
distal to the geniculate ganglion. Which function of this nerve remains?
A. Lacrimation
B. Salivation from the submandibular gland
C. Taste Sensation to the anterior 2\3 tongue
D. Smile
299. A 30-year-okl motorcyclist is brought to the Emergency Department after
a road traffic accident. He has an open fracture of his right femur, On
arrival he-is tachypnoeic and confused, with cold and clammy skin.
Which of the following physiological changes is most likely to be seen?
A. Decreased reabsorption of water from, the collecting tubules
B. Decreased serum bicarbonate level
C. Increased pH of blood
D. Increased secretion of sodium in the urine
E. Increased synthesis of glycogen in the liver

300. A 50-year-old man on the waiting list for a hip replacement attends the
preoperative clinic. He has a body mass index (SMI) of 41 and a risk of
perioperative hypoxia. Reduction of which of the following volumes or
capacities is this risk most likely to be due to?
A. Expiratory reserve, volume
B. Functional residual capacity
C. Inspiratory reserve volume
D. Total lung volume
E. Vital capacity
103
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history of Headache, vomiting and drowsiness. A. CT scan reveals
dilatation of both his lateral ventricles and his third cerebral ventricle:
His fourth ventricle was of normal size. It is suspected that he has an
obstruction to his cerebrospinal fluid flow at which of the following sites
is the obstruction most likely to be?
A. Cerebral aqueduct of Sylvius
B. Infundibular recess
C. Interventricular foramen (of Monro)
D. Lateral foramen of fourth ventricle (foramen of Luschka)
E. Median foramen of fourth ventricle (foramen of Magedie)
302. A 74-ysar-old man, who has undergone emergency major abdominal
surgery two days previously, is noted to be confused. He has been on
furosemide for mild heart failure. The plasma sodium is 122 mmol/L.
Inspection of the fluid chart shows that he has been written up for four-
hourly intravenous 5% glucose infusions. What is the most likely cause
for the hyponatremia?
A. An ACTH (Adrenocorticotrophic hormone) response to surgery
B. Excessive intravenous fluid administration
C. Osmotic effect of hyperglycemia induced by glucose infusions
D. Syndrome of inappropriate antidiuretic hormone
E. Use of loop diuretic in the long term
303. During arch aortography, the vertebral artery would be seen to; a rise
directly from which of the following?
A. Arch of the aorta
B. Brachiocephalic artery
C. Common carotid artery
D. Internal carotid-artery
E. Subclavian artery
304. A 60-year-old non-smoker presents with a three-month history: of loss of
weight, malaise and breathlessness. On examination, he has left
supraclavicular lymph node enlargement! Chest radiograph reveals
multiple bilateral opacities. What will biopsy of left supraclavicular
lymph nodes most probably show?
A. Chronic inflammatory cells

B. Granuloma
C. Langerhan's type giant cells
D. Multiple abnormal mitotic figures in cells
E. Reed Stenberg cells
305. A 12-year-old child was admitted to the Emergency Department having
inhaled a peanut. Where will the peanut most likely to have lodged?
A. Left lower lobe bronchus

B. left upper lobe bronchus
C. Right lower lobe bronchus
D. Right middle lobe bronchus
E. Right upper lobe bronchus
306. A 39 years old multiparous woman who smokes 10 cigarettes per day
presents with 2cm x 2 cm tender lump in her right breast. There is a
brown discharge from the nipple. Mammography is unhelpful. And
ultrasound shows some dilated lactation ducts What is the most likely
pathological diagnosis?
A. Breast abscess
B. Fat. Necrosis
C. Fibrocystic disease
D. Phylloides tumor
E. Plasma ceil mastitis
307. A-56 year old man presents with headache and vomiting with
deterioration over the last two weeks. On examination he has
papilledema. A CT scan shows a space occupying lesion in the right
parietal lobe. He develops a sudden homonymous hemianopia. Which
past of the visual system to be affected?
A. Lens
B. Optic Chiasm
C. Optic radiation
D. Retina
E. Second cranial nerve
308. Atrial depolarization is shown by which ECG change?
A. P
B. Q
C. R
D. S
E. T
309. A 65 years old man with known ischemic heart disease and atrial
fibrillation presents with a paralysis of his right lower limb. Which
arterial territory is most likely to be involved?
A. Left anterior cerebral
B. Left middle cerebral
C. right anterior cerebral
D. Right middle cerebral
E. Right posterior cerebral
310. A 91-year-old man becomes hypotensive two days after THR. He is found
to be in atrial fibrillation with a pulse of 140 beats/minute. After
treatment with digoxin his AF slows and he has a pulse rate of 90 BPM.
Which form of the venous wave form is absent?
A. Awave
B. C wave
C. V wave
D. A decent
E. Y decent
311. A 56-year-old man with chronic emphysema is on the high dependency
unit (HDU), ten days after anterior resection. He has developed acute
shortness of breath' and hypotension): Which of the following landmarks
would be the most appropriate to use to obtain a femoral arterial blood
gas sample?
A. A point midway between the anterior superior iliac spine and the pubic tubercle
B. A point midway between the anterior superior iliac-spine and the pubic symphysis
C. A point midway between the greater trochanter and the pubic symphysis
D. A point 1 cm inferior and 4 cm lateral to the pubic tubercle

E. A point 2 cm lateral to the midway point between the anterior superior iliac
spine and pubic symphysis
312. A 4S-year-old woman with insulin-dependent diabetes attends to the ER

with abdominal pain and confusion. She has been treated for three days
with antibiotics for chest infection. The creatinine is 400umol/L and her
blood sugar 42 mmol/L. The most likely severe electrolyte abnormality is:
A. Hypercalcemia
B. Hyperkalemia
C. Hypermagnesemia
D. Hypocalcemia
E. Hypomagnemsia
Answers
1 C 30 D 59 D
2 C 31 D 60 D
3 B 32 E 61 C
4 E 33 E 62 B
5 A 34 E 63 D
6 E 35 E 64 A
7 A 36 B 65 C
8 E 37 B 66 B
9 D 38 B 67 B
10 E 39 B 68 E
11 D 40 E 69 C
12 C 41 D 70 C
13 D 42 D 71 E
14 A 43 D 72 A
15 D 44 A 73 E
16 B 45 D 74 A
17 B 46 A 75 E
18 E 47 C 76 E
19 C 48 C 77 A
20 C 49 C 78 C
21 E 50 B 79 D
22 C 51 E 80 B
23 E 52 A 81 D
24 E 53 E 82 D
25 C 54 E 83 D
26 E 55 B 84 C
27 D 56 E 85 C
28 A 57 E 86 B
29 E 58 C 87 E
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108
88 E 117 D 146 D
89 B 118 C 147 C
90 A 119 E 148 C
91 D 120 C 149 C
92 B 121 D 150 C
93 A 122 B 151 C
94 A 123 E 152 B
95 B 124 D 153 E
96 C 125 C 154 D
97 C 126 A 155 C
98 E 127 C 156 C
99 A 128 D 157 C
100 D 129 E 158 D
101 B 130 D 159 B
102 C 131 C 160 A
103 C 132 C 161 B
104 A 133 E 162 C
105 C 134 A 163 C
106 A 135 C 164 C
107 B 136 A 165 D
108 E 137 A 166 B
109 A 138 B 167 D
110 E 139 B 168 B
111 B 140 D 169 C
112 D 141 A 170 E
113 C 142 A 171 D
114 A 143 D 172 A
115 D 144 A 173 E
116 E 145 D 174 A
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109
175 D 204 E 233 E
176 B 205 A 234 C
177 E 206 E 235 C
178 D 207 A 236 B
179 C 208 E 237 A
180 E 209 C 238 D
181 D 210 D 239 C
182 E 211 B 240 D
183 C 212 B 241 A
184 D 213 A 242 A
185 A 214 E 243 E
186 D 215 B 244 A
187 C 216 B 245 C
188 E 217 C 246 D
189 E 218 B 247 E
190 E 219 C 248 C
191 D 220 B 249 C
192 C 221 A 250 B
193 C 222 B 251 A
194 A 223 B 252 E
195 B 224 B 253 E
196 A 225 D 254 B
197 B 226 B 255 B
198 A 227 B 256 A
199 A 228 A 257 E
200 B 229 B 258 B
201 E 230 D 259 C
202 E 231 A 260 E
203 E 232 E 261 D
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110
262 C 291 C
263 D 292 A
264 B 293 C
265 D 294 E
266 C 295 A
267 D 296 C
268 B 297 C
269 E 298 A
270 D 299 E
271 A 300 A
272 B 301 B
273 D 302 E
274 B 303 D
275 E 304 C
276 C 305 C
277 B 306 C
278 B 307 C
279 C 308 A
280 D 309 A
281 D 310 A
282 E 311 B
283 E
284 D
285 A
286 E
287 B
288 C
289 B
290 A
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Fawzia by Reda Harby

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Fawzia by Reda Harby

2. A 30-years-old alcoholic man presents with acute severe upper abdominal

3. A 50-year-old woman attends her Genera) Practitioner due to a change in

5. A 35-year-old woman presents to the Emergency Department with a second

A. Gram negative urinary tract infection

C. Renal cell carcinoma

D. Transitional cell carcinoma of bladder

A. Absence of cellia on the epithelium lining the sinus

E. Relationship of the front teeth to the floor of the sinus

A. Diffuse thickening of the calvarium

A. Increase in conjugated bilirubinuria

B. Increase in unconjugated bilirubinuria

C. Increase in urea excretion

D. Increase in urinary urobilinogen

E. Reduced enterohepatic bile salt circulation

A. Clavicular head oi pectoralis major

B. Familial adenomatous polyposis

A. Aortic and carotid baroreceptor stimulation

D. Sympathetic stimulation related to blood loss

E. Sympathetic stimulation related to intracranial pressure

B. IgD-small bowel epithelium

A. It arises from the lateral borders of the bodies of T12 to L5 •

B. It extends the hip

C. It inserts into the greater trochanter of the femur

D. It is innervated from T12 and LI

E. It passes posterior to the capsule of the hip joint

29. Which one of me following muscles is an extensor of the hip?

A. Anterior to the left gonadal vein

A. Auricular branch of the facial

A. Second aortic arch

B. Third aortic arch

C. Fourth aortic arch

D. Fifth aortic arch

E. Sixth aortic arch

A. Na+/glucose in the proximal tubule

B. Na/H+ in the descending loop of Henle

C. Na+/K in the ascending loop of Henle

D. Na+/Cl in the distal tubule

E. Na/K in the collecting ducts

A. Arch of the aorta

C. Common carotid artery

D. Internal carotid artery

A. 1 L of 0.9 % saline plus 1.5 L. of 4 % dextrose/0.18 % saline

A. First part of duodenum

A. Decreased extracellular fluid volume

C. Posterior rectus sheath

E. Transversus abdominis muscle

A. High platelet count

B. High red cell count

C. Low platelet count

D. Low while cell count

E. Low red cell count

E. von Willebrand's factor

A. Colloids are not freely filterable across semi-permeable membranes

C. Colloids decrease the transcapillary oncotic pressure gradient

E. Colloids migrate from the intravascular space

PH pO2 pCo2 Bicarbonate

A. Compensated metabolic acidosis

B. Compensated respiratory acidosis

C. Mixed metabolic and respiratory acidosis

D. Uncompensated metabolic acidosis

E. Uncompensated respiratory acidosis

A. Anterior interosseous nerve