16 Sept 2023 PLAB 45 Mock

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Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 6TH SEPTEMBER 2020 TIME ALLOWED: 3HRS
SINGLE BEST ANSWER
1. A 20 year old woman eats only little solid food as she fears it will stick in her throat and lead to her
death. What is the most likely diagnosis?
A. Anorexia nervosa
B. Phobic anxiety disorder
C. Bulimia nervosa
D. Schizophrenia
E. Severe depressive disorder
2. A patient underwent surgery and now is receiving medicines for pain relief. On 3rd postop day he
has tremors, sweating and agitation. What is the Single most likely diagnosis from the following
options?
A. Acute confusional state
B. Post-traumatic stress disorder
C. Drug induced psychosis
D. Mania
3. An old man suffers from end stage prostatic cancer. He has pain, aneuria, bilateral hydronephrosis.
His son’s wedding is in 3 weeks. He is looking forward to enjoy the ceremony. What is the most
appropriate palliative treatment for him?
A. Palliative chemotherapy
B. Palliative radiotherapy
C. Bilateral nephrostomy
D. Catheterisation
4. A young woman fainted in the street and was brought into A&E. She weighs 33kgs. She is alert and
well in A&E and states that she is on a diet and admits to not eating or drinking anything for the past
48 hrs. She says she wants to reach her target weight of 30kgs. She is annoyed that she has been
brought to the hospital and adamantly states she wants to leave. What is the Single most appropriate
next best step in management?
A. Detain her under the Mental Health Act.
B. Refer to dietician
C. Refer to her GP
D. Allow her to be discharged
5. A 53 years old female presents with an acute painful hot knee joint. She is a known case of
rheumatoid arthritis. On examination, the knee is red, tender and swollen. The hamstring muscles are
in spasm. Her temperature is 38.5 ˚C and blood pressure is 120/80 mm Hg. What is the single best
next investigation?
A. Joint aspiration for cytology and culture and sensitivity
B. Join aspiration for positively birefrengent crystals
C. Joint aspiration for negatively birefringent crystals
D. Blood culture
E. Serum uric acid
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6. A 29 year old man with a history of schizophrenia is receiving an antipsychotic agent. He becomes
physically unwell and is found to have an elevated temperature, unstable blood pressure, excessive
sweating, a raised white blood count (WBC) and raised serum creatinine phosphokinase (CPK).
Which drug is most likely responsible for these adverse effects?
A. Clozapine
B. Fluoxetine
C. Imipramine
D. Phenelzine
E. Risperidone
F. Chlorpromazine
7. A 55 year old man has been on long term steroids for rheumatoid arthritis. What other drug should
he be given?
A. Vit B12
B. Vit D
C. Betablocker
D. Alendronate
8. Patient is a heroin addict. He is now in the ward undergoing withdrawal and wants u to help him.
What is your next best step?
A. Methadone
B. Propranolol
C. Diazepam
D. Acomprosate
9. A 19 year old man dos not talk to anyone. He has collected 2000 toy cars. He is indifferent to his
mum. What is the single most appropriate investigation?
A. Autistic spectrum disorder
B. Psychosis
C. Borderline personality disorder
D. Dissociative disorder
E. Schizotypal disorder
10. An 81 year old man has become acutely confused. He is brought to the Accident and Emergency
department. His wife says that his speech had become slurred and he was not using his right hand.
These signs had disappeared by the time he was seen in the A & E dept, he was otherwise well. What
is the next best management?
A Give intravenous (IV) saline
B Give pain relief
C Observe and give basic care
D Stop all drugs
11. A 4 year old boy presents with bleeding from nose, bleeding time is increased. What is the most
likely diagnosis?
A. ITP
B. Haemophilia
C. HSP
D. Von-willbrand disease
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12. A 34 year old man, from Congo, is admitted with abdominal pain to the A&E, and abdominal
Xray reveals bladder calcification. What is the most likely cause?
A. Schistosoma haematobium
B. Schistosoma mansoni
C. Sarcoidosis
D. Tuberculosis
13. A woman on Lorazepam, wishes to withdraw from it. Which is the Single most appropriate
management for this patient?
A. Anti-psychotics
B. Long acting benzodiazepine
C. Tricyclic antidepressants
D. Multivitamin
14. Patient with multiple fibroids which has distorted uterus, does not like pills because she is not
compliant and requires contraception for 3 years. What will you give?
A. Mirena
B. Implanon
C. POP
D. Depot provera
15. A 30 year old woman has experienced restlessness, muscle tension and sleep disturbance on most
days over the last six months. She worries excessively about number of everyday events and activities
and is unable to control these feelings, impairing her ability to hold down her job. What is the most
likely diagnosis from the given options?
A. Generalized anxiety disorder
B. Obsessive compulsive disorder
C. Panic disorder
D. Social Phobia
16. A 55 year old lady was brought by her daughter who complained of deteriorating function and
inappropriate behaviour. Which lobe is affected?
A. Parietal lobe
B. Occipital lobe
C. Frontal lobe
D. Temporal lobe
E. All the lobes
17. A 55 year old man with no previous history of disease brought to A&E by his wife who thinks
that he has become progressively more forgetful and tends to lose his temper and is emotionally
labile. What is the most probable diagnosis from the given options?
A. Alzheimer’s dementia
B. Alcoholic dementia
E. Pick’s disease
F. Lewy body dementia
G. Multi infarct dementia
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18. A 14 year old boy presents with recurrent abdominal pains, malaise, and weight loss over 6
months. On examination a vague mass is felt in right iliac fossa. Colonoscopy shows transmural
inflammation and granulomata. What is the most appropriate management?
A. Sulfasalazine
B. Paracetamol
C. Metronidazole
D. Ibuprofen
19. A 45 year old lady presents with back pain to accident and emergency department. She had a
lumbo-sacral X-ray done which was normal. On examination she is found to have loss of sensation of
the lower legs on pin prick. What is the most appropriate investigation?
A. Bone nuclear scan
B. MRI scan
C. Skeletal survey
D. CT scan spine
E. No investigation
20. A woman after pregnancy becomes very fearful and sleepless and avoids going out. She has
frequent emotional outbursts, sleeplessness and clings to her child claiming inadequate bonding.
Choose the single most appropriate diagnosis from the given options.
A. Postpartum psychosis
B. Normal reaction
C. Depression
D. Acute stress reaction
21. A 26 year old man presents to the A&E with increasing shortness of breath in left side and chest
pain. He has been a heavy cigarette smoker for the past 4 years. He does not have any past medical
history. What is the most likely diagnosis?
A. Pulmonary Embolism D. Pleural effusion
B. Myocardial Infarction E. Pneumothorax
C. Asthma
22. A 50 year old woman is receiving treatment for depression. She complains a dry mouth, blurred
vision, constipation and tremors. Which drug is most likely responsible for these adverse effects?
A. Amitriptyline
B. Chlorpromazine
C. Clozapine
D. Diazepam
E. Fluoxetine
23. A young woman was brought to the hospital. On examination she has low temperature and tremor.
She says when her eyes are closed she can see colour. What drug has been used?
A. Methylenedioxymethamphetamine (MDA)
B. Lysergic acid diethylamide (LSD)
C. Cocaine
D. Heroine
E. Ecstasy
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24. A 35 year old man has had four admissions to a psychiatric hospital in the last 18 months with two
episodes of depression, one of mania and the other a mixed where he showed symptoms of both
hypomania and depression. What is the most appropriate management from the given options?
A Benzodiazepine
B Lithium
C Carbamazepine
D Cognitive behaviour therapy
E Monoamine - oxidase ( MAO) inhibitor
25. A 2 year old was brought to the accident and emergency, with bruises on the right anterior thigh
and anterior leg. The left ankle was swollen and she refuses to move it. She was crying inconsolably.
What is the investigation of choice?
A. Blood culture
B. FBC
C. Bone marrow aspirate
D. Skeletal survey
E. Coagulation Screen
26. An 18 year old woman is brought by ambulance to the Accident and emergency department
having taken 18 paracetamol tablets and some alcohol following arguments with her boy. She has no
previous history of mental illness. What is your next step from the given options?
A. Arrange compulsory admission under Mental Health Act
B. Refer to community mental health team
C. Arrange voluntary admission to psychiatric ward
D. Refer to medical team
E. Refer to surgical team
F. Refer to clinical psychologist
27. A 73 year old lady with liver metastasis, having severe pain and cholestasis, does not want opioids
due to constipation. What other medication can she be given?
A. Cholestyramine
B. Naproxen
C. Amitriptyline
D. Gabapentin
28. A 24 year old man has a fracture running across the anterior, cranial fossa and is found to have
rhinorrhoea. .He has anosmia. Choose the single most likely damaged cranial nerve?
A. Olfactory
B. Optic
C. Occulomotor
D. Trochlear
E. Trigeminal
29. A patient presented to A & E with polyphonic wheeze. He was unable to complete sentence, pulse
was >110 bpm, RR > 25/min and PEFR 30-50% of predicted. What is the most likely diagnosis?
A. Mild asthma
B. Moderate asthma
C. Severe asthma
D. Life threatening asthma
E. Exercise induced
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30. A 69 year old woman had a stroke, her left upper and lower limbs are paralysed. She is having
difficulty in speaking. Which anatomical site is most likely affected?
A. Thalamus E. Internal Capsule
B. Brainstem
C. Cerebellum
D. Hippocampus
31. A 26 year old man with a long history of substance abuse has been stable for six years. He has a
job and wishes to stop using drugs. What is the Single most appropriate next best step in
management?
A Lofexidine tablets
B Methadone mixture
C Naltrexone tablets
D Refer to self-help group
32. A 55 year old man diagnosed is with IHD, he has normal BMI. He is a smoker and smokes 20
cigarettes a day. He drinks 8 pints of beer. His clinical examination is normal and no systemic
findings were found. Where would you refer him to first?
A. To alcohol anonymous
B. Smoking cessation clinic
C. Dietician
D. No referral needed
33. A 55 old woman wishes to attend her daughter's wedding in New Zealand in two weeks’ time. She
is frightened of flying and feels she would be unable to get on the plane. What is the most appropriate
management?
A. Cognitive behavioural therapy
B. Lofepramine
C. Counselling
D. Desensitization
E. Diazepam
34. A 28 years old male had an Accident and presented with head trauma. What choice of
investigation would you do to rule out haemorrhages?
A. CT scan
B. MRI
C. X ray skull
D. X ray spine
E. USG
35. A 50 year old woman has had increasing difficulty swallowing and a tendency to regurgitate. She
has weight loss. What is the most likely diagnosis?
A. Anorexia nervosa
B. Phobiod anxiety disorder
C. Bulimia nervosa
D. Oesophageal carcinoma
E. Thyrotoxicosis
36. A patient, from Africa, comes with nodular patch on the shin. It has a reddish brown colour. What
is the most probable diagnosis?
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A. Lupus vulgaris
B. Erythema nodosum
C. Pyodermagangrenosum
D. Erythema marginatum
E. Solar Keratosis
37. A 68 year old man with diabetes and hypertension was noted to have a cholesterol level on
3.4mmol/l. He was also noted to have micro-albuminuria. What is the best drug to add to his regimen?
A. Ace inhibitors
B. Statins
C. Amylodipine
D. Biguanides
38. A 27 year old man with a long standing history of schizophrenia is receiving antipsychotic agent.
He has extra-pyramidal side effects but complains of reduced - sexual libido and erectile impotence.
His Prolactin is markedly increased. Which drug is most likely responsible for these adverse effects?
A. Amitriptyline
B. Chlorpromazine
C. Clozapine
D. Diazepam
39. A 3 years old child, who was wasted on examination, has a history of diarrhoea on and off. The
mother describes the stool as bulky, frothy and difficult to flush. What is the single investigation most
likely to lead to a diagnosis?
A. Sweat Chloride test
B. Anti Endomysial Antibodies
C. Liver Function tests
D. Ultrasound Abdomen
E. Thyroid Function Test
40. A 73 year old woman has stopped eating and drinking. She was diagnosed as having psychotic
depression in her early 30s and has had 10 episodes, each requiring admission. She is on long term
antidepressants and lithium. What is the next best step from the given options?
A. Cognitive behavioural therapy (CBT)
B. Tricyclic antidepressants
C. Electroconvulsive therapy
D. Sodium Valproate
41. A 33 years old male involved in street fight presents with bruises and deformity in the upper part
of his leg. X-ray shows fracture of the neck of fibula. What is the SINGLE most associated nerve
injury?
A. Sciatic nerve.
B. Gluteal nerve.
C. Musculocutaneous nerve
D. Lateral peroneal nerve
E. Tibial nerve
F. Femoral nerve
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42. A girl has oral numbness and limb paraesthesia after an argument with her friend. What is the
single most suitable medication to treat his symptoms?
A. Methadone
B. Propranolol
C. Diazepam
E. Zopiclone
43. A 46 year old man complains of feeling low and inability to fall asleep. He is disinterested in daily
life and does not find any joy in his life. Due to this he has started to drink alcohol excessively. What
is the most likely diagnosis?
A. Delirium tremens
B. Wernicke’s encephalopathy
C. Korsakoff’s syndrome
D. Schizophrenia
E. Depression
44. A 78 year old woman who was previously very fit and healthy became acutely confused. She was
brought to the Accident and Emergency department. Her daughter, with whom she lives, says that she
had complained of some burning sensation on passing water yesterday and has been incontinent since.
Urine testing shows blood, protein and nitrites. Her temperature is 37.5°C. What is the best
management?
A. Give antibiotic
B. Give Chlormethiazole
C. Give Glucagons
D. Observe
45. An 18year old previously well student is in his 1st year at university. He has been brought to the
Emergency Room in an agitated, deluded and disoriented state. What is the most probable reason for
his condition from the following options?
A. Drug toxicity
B. Delirium tremens
C. Infection toxicity
D. Electrolyte imbalance
E. Head injury
46. A 6 months old child presents with cough and fever. What is most appropriate diagnosis?
A. Bronchiolitis
B. Asthma
C. Bronchitis
47. A heroin addict is clinically depressed and comes for treatment. Which is the Single most
appropriate management for this patient?
A. Disulfiram
B. Methadone
C. Acamprosate
D. Selective serotonin reuptake inhibitor (SSRI)
48. A 24 year old male is admitted with acute severe asthma. Treatment is initiated with 100%
oxygen, nebulised Salbutamol and Ipratropium Bromide nebulizers and IV hydrocortisone. Despite
initial treatment there is no improvement. Which is the next step in management?
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A. IV Aminophylline
B. IV Magnesium Sulphate
C. IV Salbutamol
D. IM Adrenaline
E. IV Adrenaline
49. Prevalence worldwide of 2.4/1000. One in a hundred people will develop it in their lifetime.
Average age of onset 25 earlier in men than women outcome is worse in developed countries. Choose
the single most appropriate condition from the given options.
A Narcotic abuse
B Obsessive compulsive disorder
C Schizophrenia
D Generalized anxiety disorder
E Panic disorder
50. A 28 year old woman presents with foul smelling discharge with pH < 4.5. What is the single
most likely diagnosis?
A. Trichomoniasis
B. Candidiasis
C. Bacterial vaginosis
D. Chlamydia
51. A patient is restless, since the death of her husband, she pads up and down at night with difficulty
falling asleep. What is the most appropriate best management for this patient?
A. Propranolol
B. Diazepam
C. Acomprosate
D. Zopiclone
E. Amitriptyline
52. A man with heart failure recently was started on medication for Gout. His gout improved however
the medication worsened his heart failure. Can you state the causative drug?
A. Prednisolone
B. Paracetamol
C. NSAID
D. Colchicine
E. B-blockers
53. A woman is in the hospital and feels that the staff knows what she is thinking. What is this called?
A. Chronic fatigue syndrome
B. Thought broadcasting
C. Thought insertion
D. Paranoid delusion
E. Flight of ideas
54. A 33 year old man is hit by a car. He loses consciousness but is found to be fine by the
paramedics. When awaiting doctor’s review in the A&E he suddenly becomes comatose. What is the
most likely diagnosis?
A. Subarachanoid haemorrhage
B. Subdural haemorrhage
C. Intracerebral haemorrhage
D. Extradural haemorrhage
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55. Patient comes with multiple painful ulcers over buccal mucosa and white striae on mouth and
tongue. What is the most likely diagnosis from the following list of options?
A. Candida
B. Oral Ca.
C. Aphthous ulcers
D. Lichen planus
56. A 48 year old woman, always socially withdrawn, has stopped going out of the house since the
sudden death of her husband. She complains of palpitations, breathlessness and restlessness as soon as
she steps out of the house. She has to rush back and allay her anxiety with a drink. What is the most
likely diagnosis from the given options?
A. Panic disorder
B. Social Phobia
C. Agoraphobia
D. Depression
57. A 12 year old boy complains of acute development of purpura on the dependent areas of his body
2 weeks after an upper respiratory tract infection. The purpura does not blanch on pressure. tests
reveal: Hb 12 g/dL, platelets 50 x 10*9/L, WCC 5 x 10*9/L. Bleeding time is 10 mins, APTT : 40 s,
PT: 1.02. What is the most likely diagnosis?
A. Idiopathic thrombocytopenic purpura (ITP)
B. Thrombotic thrombocytopenic purpura (TTP)
C. Von Willebrand's disease
D. Haemophilia A
E. Haemophilia B
58. A 22 year old man complains that he can hear the voice of his deceased uncle telling him that he
is being spied on. The patient is distressed by this, becoming low in mood and anxious, and has not
left the house for two weeks. He is starting to drink alcohol to excess. He is noted to have thought
block and passivity phenomena. What is the single most suitable medication to treat his symptoms?
A. Amitriptyline
B. Diazepam
C. Disulfiram
D. Haloperidol
E. Lithium
59. A 34 year old woman presents with severe jaundice, fever and pruritus. What is the best initial
management to control the pruritus in her?
A. IV 0.9 % normal saline D. Cholestyramine
B. IV dextrose
C. Cimetidine
60. A 25 year old woman presents at the accident and emergency department with fresh superficial
lacerations of both wrists. They do not require suturing. There are numerous scars across both
forearms. She has attended the accident and emergency department on several occasions recently. She
is distressed and regrets her actions. What is your next best step from the given options?
C. Arrange urgent psychiatric outpatient appointment.
D. Arrange voluntary admission to psychiatric ward.
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E. Discharge with no treatment

F. Refer to clinical psychologist
61. A 9 year old child is diabetic and unhappy in school. What is your next step?
A. Refer to social worker
B. Clinical psychologist
C. Special school
D. Check child protection register
E. Give oral anti diabetics
62. A 45 year old woman is brought to the accident and emergency department by her husband who
reports that she collapsed in the bathroom. She is unconscious with bilateral extensor plantar
responses. Her blood sugar is normal. Choose the single most appropriate action?
A. Serum U&E
B. Blood Cultures
C. CT scan of head
D. Angiography
E. Arterial blood gas analysis
63. A patient developed macular rashes with target lesions, four days after using antibiotics. The rash
typically sparing the mouth. What is the most likely diagnosis?
A. Steven Johnson syndrome
B. Erythema nodosum
C. Erythema multiforme
D. Erythema infectiosum
64. A Schizophrenic patient not compliant on oral medication. What is the best long term
management?
A. Depot (Risperidone)
B. Depot (Haloperidol)
C. Quetiapine
D. Chorpromazine
65. A 25 year old man thinks that a stranger put an amphetamine tablet into his drink at a party the
previous evening. What is the Single most appropriate next best step in management?
A. Buprenorphine tablets
B. Chlordiazepoxide capsules
C. Clomethiazole capsules
D. No treatment needed
E. Notify police
66. A 42year old woman reports to the surgeon that she is worried about a lump that she feels in her
right breast. The surgeon observes a 2 cm by 3 cm mass in the right lower quadrant of the breast.
There are no associated skin changes and the mass has limited mobility. There is no discharge from
the nipple. There is no axillary lymph node enlargement. Examination of the left breast and axilla was
completely normal. A mammogram report suggests the presence of micro-calcifications. Which is the
most appropriate next step in the management of this patient?
A. Observation for one year and repeat the mammography
B. A needle-guided biopsy of the breast
C. Excision biopsy of the breast
D. Partial mastectomy
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67. A 45 year old woman has become tearful and feels unable to cope. She worries about everything.
She has difficulty getting to sleep and wakes early in the morning. She is always tried. What is the
most appropriate management?
B. Lofepramine
C. Counselling
D. Desensitization
68. A 20 year old primigravida woman is in her 8th week of gestation. She presents with severe
repeated nausea and vomiting. What is the initial intravenous fluid to be used?
A. Normal saline 0.9%
B. Glucose water 5%
C. Saline 0.45%
D. Dextrose 5%
69. A 30 year old woman has stopped eating because she feels guilty about worldwide famine. What
A Anorexia nervosa
B Phobic anxiety disorder
C Bulimia nervosa
D Schizophrenia
E Severe depressive disorder
70. A 32 year old patient presents with cervical lymphadenopathy and splenomegaly. What is the
SINGLE most appropriate option?
A. Streptokinase
B. Haemophilus
C. Streptococcus
D. Toxoplamosis
E. Non Hodgkins Lymphoma
F. Pneumocystis jerovici
71. A 25 year old man, found deeplyunconscious is brought to the accident and emergency
department . He has an abrasion over his left temple and puncture marks on his left forearm. Choose
the single most appropriate action?
A. Administer naloxone parenterally
B. Administer broad - spectrum Antibiotic intravenously
C. CT scan of head
D. Arterial blood gas analysis
E. Toxicology Screen
72. A 74year old woman. Presents with recurrent collapse and falls. She lives a quiet life and has a
mark/scar on side of head. What is the diagnosis?
A. Hypoglycemia
B. Subdural hematoma
C. Aortic stenosis
D. Vasovagal syncope
E. carotid sinus syncope
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73. A 24 year old woman complains of pain over the base of her right thumb. She finds that she
cannot extend her right thumb. The pain is worse when she is changing her son’s nappies and subsides
with rest. She noticed it for the first time a few months after the birth of her son. What is the most
likely diagnosis?
A. Trigger finger
B. Mallet finger
C. Gamekeepers thumb
D. Mommy’s thumb
74. A 26 year old woman has been promoted at work to a job that requires a lot of publics speaking.
She is worried and anxious about it and feels that she might faint. What is the Single most useful
intervention?
B. Diazepam
C. Fluoxetine
D. Psychoanalytic psychotherapy
E. Relaxation therapy
75. A 22 year old man presents with red hot swollen metatarsal phalangeal joint pain, sacro-ilitis and
onycholysis. What is the single most likely cause of this condition?
A. Gout
B. Psoriatic arthritis
C. Rheumatoid arthritis
D. Septic arthritis
76. A 70 year old man has early loss of speech and memory. His visuospatial orientation is preserved.
What is the most probable diagnosis from the given options?
B. Pick’s disease
C. Lewy body dementia
D. Multi infarct dementia
E. Frontotemporal dementia
77. A 2 week old girl is found to have ambiguous genitalia, sodium is 128mmol/l and potassium in
5.7mmol/l. What is the most likely diagnosis?
A. Down’s Syndrome
B. Turner’s Syndrome
C. Adrenal Hyperplasia
D. Adrenal Adenoma
E. Pituitary Tumor
78. A 31 year old woman who is a known heroin addict says that she has been stealing football shirts
to fund her addiction. She wants to stop taking drugs. What is the best management?
A. Methadone mixture
B. Notify the home office
C. Notify the police
D. No treatment indicated
E. Refer to self-help group
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79. A two year old boy fell off his tricycle, hurting his arm. He got up and started to cry but before
there was any sound he went pale, unconscious and rigid. He recovered after 1-2 minutes but
remained pale. After an hour he was back to normal. His mother says she was afraid he was going to
die and that he had a similar episode three months previously after he fell down some steps. What
SINGLE investigation is indicated?
A. Computed tomography scan of the head
B. Electroencephalogram
C. Full blood count
D. None
E. Skeletal survey
80. Patient with cardiac problem who takes 8units of alcohol in a week and 20 cigarette in a day.
What is the advice that can be given to the patient?
A. Alcohol group
B. Smoking ceasation group
C. Aspirin
81. A man presents to the addiction clinic and wishes to give up his habit of drinking. Which is the
Single most appropriate management for this patient?
A. Disulfiram
B. Methadone
C. Acamprosate
D. Multi Vitamins
82. A child presents with history of two weeks of poor feeding, lethargy, facial swelling, oliguria and
proteinuria. What is the appropriate treatment for this child?
A. Prednisolone
B. Cyclosporin
C. Cyclophosphamide
D. Diurectics
E. No treatment needed
83. Prevalence of 5-10% in younger adults. Women affected twice as much as men. It is the fourth
most common cause of disability worldwide and expected to rise. Choose the single most appropriate
condition from the given options.
A Narcotic abuse
C Depression
E Panic disorder
84. A 23 year old woman has been having pain at the base of her thumb, the pain is reproduced when
lifting her 3 months old baby or changing diapers and also with forceful abduction of the thumb
against resistance . What is the most likely cause?
A. Avascular necrosis of the scaphoid
B. Trigger finger
C. De Quervain’s tenosynovitis
D. Mallet finger
E. Gamekeepers Thumb
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85. A patient presents with sweaty palms and palpitations as he has to go for an interview. What is the
single most suitable medication to treat his symptoms?
A. Propranolol
B. Diazepam
C. Acomprosate
D. Zopiclone
86. An 8 week old boy is brought by his mother due to projectile vomiting after every feed. What will
be most likely electrolyte abnormality seen in this patient?
A. Metabolic acidosis
B. Metabolic alkalosis
C. Respiratory acidosis
D. Respiratory alkalosis
87. A 92 year old woman had been found on the floor of her home. She had last been seen by her son
two days prior to this. He said that his mother walked poorly with a frame and was prone to falls. On
examination she was confused, but had no bony injuries. Investigation revealed urea was 11.3 mmol/l,
creatinine — 145 mmol/1, potassium — 4.3 mmo1/1 sodium. What is the next best management?
A Give intravenous (IV) dextrose 5%
B Give intravenous (IV) saline
C Give pain relief
D Observe and give basic care
88. A man is being admitted for an open fracture of the femur following RTA. During the induction of
anaesthesia the BP drops to 60/40 and HR is 130 bpm. The likely explanation is :
A. Fat embolism
B. Severe bleeding
C. Reaction to anaesthesia
D. Pulmonary Embolism
89. A patient known to be HIV positive, has now got chicken pox in the maternity ward. What
precautions should be taken to prevent further spread of infection?
A. Vaccinate all the patients and staff in the ward
B. immunoglobulins to all the pregnant women in the ward
C. Immunoglobulins to all pregnant women who have negative serology
D. Start 7 days course of Acyclovir for all patients in the ward
E. No action required
90. A 30 year old man with psychiatric problems is put on oral anti psychotics. What is the Single
most appropriate next best step in management?
A. Stop treatment
B. Continue same treatment
C. Review after 3 months
D. Regular visits to the doctor
91. A 20 year old lady has got brother and sister and all of them have got adenomatous polyposis.
Which cancer are they most likely to develop?
A. Gastric carcinoma
B. Colorectal carcinoma
C. Lymphoma
D. Duodenal lymphoma
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16
92. A 77 year old man had weakness in his arm and leg from which he recovered within few days
with short term memory loss and diminished extensor plantar response. He had such episodes 2 year
ago and became unable to identify objects and make proper judgments. What is the most probable
diagnosis from the given options?
A. Creutzfeldt- Jakob disease
B. Pick’s disease
C. Lewy body dementia
D. Multi infarct dementia
93. A 55 year old had left nephrectomy done 2 years back, he now complains of passing very little
urine. His USG shows a big stone in pelvicalcyeal system. Lining of his pelvicalcyeal system is
smooth. What will your action be?
A. Supra pubic catheter
B. Ureteric catheter
C. Nephrolithostomy
D. Antegrade pyelography
E. Retrograde pyelography
94. A 39 year old man presents at 9.00 am, smelling of alcohol. His Gamma Glutamyl
Transpeptidase(GGT) is three times the upper limit of normal. He says that he drinks three pints of
beer daily. What is the next best management?
A. Advice on harm minimization
B. Advice to cut down drinking
C. Amphetamine tablets
D. Buprenorphine tablets
E. Clonethiazole tablets
95. A 6 year old child fell on his nose 2 days ago. His parents have now brought him with difficulty in
breathing. On examination he has a fever and his nasal bones are straight. What is the single most
likely diagnosis?
A. Nasal polyp
B. Septal hematoma
C. Septal abscess
D. Deviated nasal septum
E. Fractured nose
96. A 23 year old woman with diabetes arrives in the accident and emergency department she is pale
sweaty and conscious. Her companion says she was well 30 minute ago. But suddenly become
confused and then could not be roused. Choose the single most appropriate action?
A. Blood glucose concentration
B. Blood Cultures
C. CT scan of head
D. Serum U&E
E. Arterial blood gas analysis
97. A 36 Weeks pregnant patient has been admitted with bleeding per vaginum and severe constant
pain in abdomen. A diagnosis of abruptio placentae has been made. What will be your immediate next
step?
A. Check Clotting profile E. Check BP
B. Ultrasound D. Caesarian section
C. CTG
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17
98. A 70 year old man with lung cancer presents with a cough. He is already on codeine, steroid and
salbutamol inhalers. What is the single most appropriate management?
A. Nebilised adrenaline
B. 0.9% saline nebulized
C. Oral morphine
D. Antibiotics
E. Benzodiazepine
99. A 21 year old man tells you he is smoking 1 g of heroin daily. He has multiple injection marks on
his hands and arms. He admits to injecting but says he is not yet ready to consider stopping. What is
the Single most appropriate next best step in management?
A. No treatment needed
B. Methadone
C. Notify to the drug misuse database
D. Advise him on harm reduction
E. Gradual withdrawal
100. A 60 year old man was brought in by his wife complaining of ataxia, urinary incontinence and
erectile dysfunction. He also complains of rigidity and slowing of movement with a pill-rolling tremor
of the hands. What is the most likely diagnosis?
A. Parkinson's Disease D. Huntington's disease
B. Idiopathic Parkinson's Disease
C. Shy-Drager Syndrome
101. A 35 year old lawyer has become increasingly anxious before count appearances. She is now
very reluctant to speak in public, but this is necessary for she is searching for a long term solution to
her problem. What is the most appropriate management from the given options?
A Chlorpromazine E Diazepam
B Cognitive behavioural therapy
C Counselling
D Desensitization
102. A 74 year old woman with dizziness, nausea, and vomiting since 5 to 7 hours. The symptoms are
worse when she turns around in bed and are present most of the time. She is anxious and afraid of
getting out of bed. She is on antihypertensive and oral hypoglycaemic medications for her high blood
pressure and Diabetes. What is the most likely diagnosis?
A. Acoustic neuroma
B. BPPV
C. Cerebellar infraction.
D. Meniere’s Disease
E. Vestibular neuronitis
103. A 21 year old man is brought by his family to the Accident and Emergency department following
several days of bizarre behaviour during which there was concern that he might jump from a railway
bridge. He thinks there is nothing wrong with him. What is the next step from the given options?
C. Arrange urgent psychiatric outpatient appointment
D. Discuss with carer / relative
E. Refer to clinical psychologist
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18
104. A 45 years old female looking pale, has bluish discoloration of hands whenever she goes out in
cold. She has also noticed some reddish spots on her body. She has symmetrical peripheral
arthropathy for last 1-2 years. What is the most probable diagnosis?
A. Rheumatoid Arthritis
B. Osteosarcoma
C. Limited Systemic Sclerosis
D. Diffuse Systemic Sclerosis
E. Chondrosarcoma
105. A 23 year old man has blunt head trauma and is found to have paralysis of voluntary movement
of the lower part of the face on the ipsilateral side, with sparing of the forehead. Involuntary
movement remains normal. Choose the single most likely damaged cranial nerve?
A. Glossopharyngeal
B. Facial
C. Trigeminal
D. Vagus
E. Accessory
106. A 45 year old lady came to family planning clinic for contraception advice. She is not keen to be
pregnant for the next 3 years. Her recent USG report showed multiple small submucosal fibroid. What
is the best method of contraception for here from the list below?
A. Etonogestrol
B. Combined OCP
C. IUS (intrauterine system)
D. Progestogen only pill
E. IUCD (intrauterine contraceptive device)
107. A 55 year old male patient had TIA which he recovered from. He has a history of stroke and
upon examination his heart rate was in sinus rhythm. He is already on aspirin 75mg and anti-
hypertensive drugs. What other action should be taken?
A. Add Clopidogrel only
B. Increase the doses of aspirin to 300mg
C. Add Warfarin
D. Add Clopidogrel and Statins
E. Add Statins only
108. A 47 year old man with a longstanding history of schizophrenia is being treated with an
antipsychotic agent. He complains of a sore throat and fever and is found to have a low white blood
count (WBC) and reduced neutrophils. Which is the most likely drug that is responsible for these
adverse effects?
A. Amitriptyline E. Risperidone
B. Chlorpromazine
C. Clozapine
D. Diazepam
109. An 8 week old baby vomits after feeding. On initial assessment no signs of dehydration detected
but mother is worried about his weight. Lab results show Hb 11g/dl, urea 6 mmol/L, creatinine 95
umol/L, K 2.5 mmol/L, Na 130 mmol/L, Cl 93 mmol/L. What is the SINGLE most likely diagnosis?
A. Congenital adrenal hyperplasia (CAH)
B. Pyloric Stenosis
C. Duodenal Atresia
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19
D. Gastroesophageal Reflux
E. Septicaemia
110. An 18 year old woman is noted to have bouts of dieting, interspersed with bouts of excessive
eating, sometimes followed by vomiting. She has lost about 7 lbs of weight and feels depressed. What
A Anorexia nervosa
B Phobic anxiety disorder
C Bulimia nervosa
D Obesity
111. A woman is brought in with complaints of not eating or drinking after her husband died a few
weeks ago. She is crying all the time and refuses any offers of help. She admits to feeling low and
anhedonia. If left untreated, what is the most likely outcome for this woman?
A. Sleep disorder
B. Personality disorder
C. Mood disorder
D. Panic disorder
E. Schizophrenia
112. A patient keeps on talking and he jumps from one topic to another. What is the most probable
A. Thought broadcasting
B. Thought insertion
C. Insight
D. Paranoid delusion
E. Flight of ideas
113. A 37 years old woman believes that her neighbours have been using her shower while she is
away from home. Her 42 years old partner is convinced about this and calls the police. What term best
describes this situation?
A. Capgras Syndrome
B. Cotard Syndrome
C. Delusion of Persecution
D. Folie a Deux
E. Munchausen Syndrome
114. A 55 year old man presented to the A and E with complains of calf muscle tendernes. On
examination the bulk of the muscle had decreased on the right side and also the foot was cold. Further
examination revealed no distal pulses palpable and also absent popliteal and femoral pulse. What is
the level of the occlusion?
A. Ext Illiac artery
B. Internal Illac artery
C. Inguinal artery
D. Abdominal Aorta
E. Common iliac artery
115. A man keeps running to the police station, saying that his house is not safe, but on checking
that's not the case. What is the Single most likely diagnosis from the following options?
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20
A. Acute confusion state

D. Schizophrenia
116. A man with a family history of panic disorder is brought to the hospital with palpitations,
tremors and sweating and muscle tightness on three occasions in the last six weeks. He does not
complain of headache and his blood pressure on each presentation is within normal limits. What is the
single most appropriate long term treatment for this patient?
A. Diazepam E. Alprazolam
B. Olanzapine
C. Haloperidol
D. Fluoxetine
117. Life time prevalence of 1 in 20. It affects women twice as frequently as men. Reduced
prevalence in older people. Choose the single most appropriate condition from the given options.
A Narcotic abuse
C Depression
E Panic disorder
118. A 34 year old patient presented with redness and pain in the eye. He is also suffering with back
pain that is worse in the morning. He is taking NSAIDs for back pain. What is the cause of red eye?
A. Ibuprofen
B. Steroids
C. Anterior Uveitis
D. Posterior Uveitis
E. Trauma
119. A female presents with chest tightness and feeling like dying and sinking. She wants some
medication for her condition. What is the single most suitable medication to treat her symptoms?
A. Methadone
B. Diazepam
C. Zopiclone
D. Amitriptyline
120. A 28 year old lady with a family history of cystic fibrosis comes for genetic counselling and
wants the earliest possible diagnostic test for cystic fibrosis for the baby she is planning. She is not in
favour of termination. What would you recommend for her?
A. Chorionic villous sampling F. Reassure
B. Amniocentesis
C. Pre implantation genetic diagnosis
D. Chromosomal karyotyping
E. Maternal serum test
121. An 80 year old man arrives in the A & E dept. by ambulance. He had been found wandering
around the park. On examination, he is quite confused but physical examination and investigation are
normal. His neighbour had not seen him for a while and he lives alone. His neighbour says that the
man's general practitioner called last week. What is the next best management?
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21
A Discuss with the General Practitioner (GP)

B Give antibiotics
C Give Chlormethiazole
D Give Digoxin
E Observe
122. A 85 year old man fell down and hit his head. 5 days later he came back with confusion. Which
is the most likely site of bleeding?
A. Middle meningeal artery
B. Internal cerebral artery
C. Cerebral vein plexus
D. Berry aneurysm
123. A 75 year old man was noticed to have increasing loss of memory of recent events. He is unable
to dress himself and has difficulty feeding himself. What is the main feature that will assist in the
diagnosis of this condition?
A. Progressive loss of function
B. Loss of control of bladder
C. Decreased visual acuity
D. Disinhibition
E. Visual hallucinations
124. A patient on anti-psychotics is found to be doing well on his regular visit to his GP after 3
months since he was started on the treatment. What is the Single most appropriate next best step in
management?
A. Stop treatment
B. Continue same treatment
C. Review after 3 months
D. Regular visits to the doctor
125. A pregnant patient present with tingling, numbness, pain and loss of sensation on middle and
index finger of right hand. Tinel sign is negative. What is the most likely diagnosis?
A. Carpal tunnel syndrome
B. Hammer hypothenar syndrome
C. Ulnar nerve injury
D. Radial nerve injury
126. A 26 year old political refuge has sought asylum in the UK and complains of poor concentration.
He keeps getting thoughts of his family whom he saw killed in a political coup. He is unable to sleep
and feels hopeless about his survival. Because of this he is afraid to go out. What is the most likely
A. Agoraphobia
B. Post traumatic stress disorder
C. Panic disorder
D. Social Phobia
127. A lady has complains of lower abdominal pain, low grade fever and vaginal discharge suggestive
of pelvic inflammatory disease (PID). She is not toxic. What is the appropriate empirical treatment for
Pelvic inflammatory disease?
A. Ceftriaxone
B. Metronidazole
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22
C. Doxycycline
D. Erythromycin
E. Ciprofloxacin
128. A man has psychiatric problems and he knows he has it. What is the most probable diagnosis
from the given options?
A. Thought broadcasting E. Flight of ideas
B. Thought insertion
C. Has insight
D. Judgment
129. What is the maintenance fluid of choice in paediatric rehydration?

A. 0.9-5% Dextrose
B. 0.9 % normal saline
C. 0.18 % normal saline
D. 0.45 % normal saline
E. Hartmann’s solution
130. A 19 year old university student went home early from class because of a headache. The next
morning she is found drowsy and unwell. She has a purpuric rash and a fever. Choose the single most
appropriate action?
A. Administer broad - spectrum Antibiotic intravenously
B. Blood Cultures
C. CT scan of head
D. Serum U&E
E. LP
131. What is the Route of administration for Benzodiazepines at home?

A. S/C
B. Rectal
C. I/M
D. I/V
132. A 10 year old male child was brought by his mother complaining that her child watches TV at
very high volume, doesn’t like to play out and instead has become more sincere with reading. She also
says that her son does not respond to her. What do you expect to see on otoscopy?
A. Flamingo pink Tympanic Membrane
B. Attic perforation
C. Bluish grey Tympanic membrane with air fluid levels
D. Inflamed tympanic membrane with cart wheel appearance of vessels
E. Red and inflamed tympanic membrane
133. A 72 year, woman, who has lived alone since her husband's death one year ago, presents with
forgetfulness and social withdrawal. She misses her husband but appears normal in mood. Her recent
memory is impaired but she tends to minimize this, blaming it on tiredness. What is the Single most
appropriate next step?
A. Computed tomography (CT) scan of brain
B. Full blood count
C. Neuro psychological testing
D. Therapeutic trial of treatment with antidepressant
E. Thyroid function test
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23
134. A 40 year old woman requests post coital contraception. Her condom broke 36 hours ago. On 7th
day of regular 29th day of cycle this is her 2nd condom accident in 2 months. She has tried OC pills
but stopped it 6 months ago because of concerns about weight gain. She is undecided about future
contraceptive use. Her pregnancy test is -ve. Which is the most effective form of contraception for
her?
A. OC pills
B. POP pills
C. IUS or Mirena coil
D. IUCD
135. A 28 year old dentist has developed symptom of low mood and is convinced that he is a failure
despite evidence to the contrary. He is intelligent and articulate. He has poor self-esteem and makes
excuses for not going into work as he feels that he is not doing a good job. He has no confidence in
himself but there are no somatic symptoms of depression. What is the most appropriate management
A. Monoamine - oxidase (MAO) inhibitor
B. Cognitive behavioural therapy
C. Sodium valproate
D. Tricyclic antidepressant
E. Selective serotonin reuptake inhibitor
136. A 24 year old man presented to the A and E with swelling in his left scrotum. On examination he
is afebrile and he has a left swollen non tender testis that is firm and irregular. Some
lymphadenopathy is also appreciated. Which group of lymph nodes will be involved?
A. External iliac
B. Internal iliac
C. Inguinal
D. Para aortic
E. Pre aortic
137. A 46 year old woman who has been alcohol dependent for 20 year attends the Accident and
Emergency Department. She has previously taken overdoses. She has recently increased her alcohol
intake. She is alert and is asking for help for her problem. What is the next step from the given
options?
A. Arrange compulsory admission under mental health act
C. Arrange voluntary admission to psychiatric ward
D. Discharge with no treatment
E. Refer to social worker
138. A 50 years old man presents with low mood, poor concentration, anhedonia and insomnia. He
has had two episodes of increased activity, promiscuity and aggressive behaviour in the past. He was
arrested 8 months ago for trying to rob a bank, claiming it as his own. Which drug is most likely to
benefit him?
A. Haloperidol E. Ethosuximide
B. Citalopram
C. Desipramine
D. Carbamazepine
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24
139. A 28 year old man has a fracture of the base of the skull. He is found to have a loss of taste
sensation in the anterior two thirds of his tongue with drooping of the corner of the mouth. Choose the
single most likely damaged cranial nerve?
A. Glossopharyngeal
B. Facial
C. Trigeminal
D. Vagus
E. Accessory
140. A 65 year old alcoholic male is brought into hospital with aggression, confusion, diplopia and
ataxia. IV chlordiazepoxide has been started. Which other medication would you like to give?
A. Antibiotics
B. IV fluids
C. Acamprosate
D. Disulfiram
E. High dose B vitamins
141. A 27 year old female patient has been brought in with flight of ideas and attempted suicide. She
overdosed on 100 paracetamol tablets. She says there is nothing wrong with her. What should be your
next step?
A. Detain under Mental Health Act
B. Discharge
C. IV Haloperidol
D. Lithium
E. Fluoxetine
142. A 50 year old man who is receiving treatment for bipolar affective disorder on a prophylactic
agent. His thyroid stimulating hormone (TSH) level is increased and T3 and T4 levels are reduced.
Which is the most likely drug that is responsible for these adverse effects?
A. Amitriptyline E. Lithium
B. Chlorpromazine
C. Clozapine
D. Diazepam
143. A 8 weeks old baby with a fever of 38˚C. How will you manage this neonate?
A. Admit for infection screen and start IV antibiotic
B. Give antipyretic and ask to come later
C. Observe for 24hrs
D. Admit for infection screening
E. Reassure
144. An 18 year old man presents in the Accident and emergency department. He is in a state of terror
and is convinced that he is being pursued by people who are out to kill him. What is the most
appropriate best management?
A. Chlorpromazine
B. Cognitive behavioural therapy
C. Counselling
D. Desensitization
145. A 45 years old known hypertensive man presents with haematuria, proteinuria and oedema. What
is the definitive diagnostic test for him?
_______________________________________________________________________________________________
25
A. Urine protein
B. Renal biopsy
C. Renal function tests
D. Urine microscopy
E. Serum protein
146. A 37 year old alcoholic is found wandering in a park. His partner says he has had a number of
falls recently and in the accident and emergency department the patient is confused. His blood glucose
concentration is normal. Choose the single most appropriate action?
A. Blood alcohol concentration
B. Administer broad - spectrum Antibiotic intravenously
C. CT scan of head
D. Serum U&E
E. Toxicology Screen
147. A 60 year old lady who had anterior resection of his bowel 5 days ago presents with selling on
her wound. There is 4 cm swelling is around the colostomy which tender and it fluctuating. She is not
systemically unwell. What is the single most appropriate action?
A. Laparotomy
B. Local anaesthesia
C. Laparotomy with wound repair.
D. Exploration of the wound
E. Abdominal Xray
148. A 60 year old man with IHD. He is on his heart medications. His daughter noticed some
abnormal behaviour including memory loss and cognitive impairment in a stepwise progression. What
is the most likely cause?
A. Lewy body dementia
B. Vascular dementia
C. Pick’s dementia
D. Parkinson’s disease
149. A person was stopped by the police and he was found to be jumping from one topic to another.
What is the Single most likely diagnosis from the following options?
A. Acute confusion state
D. Mania
150. A 65 years old woman has being having tinnitus for more than 6 months. Each episode lasts
more than 30 seconds and occurs whenever she rotates in her bed. Choose the most appropriate
investigation that will assist you in making a diagnosis.
A. Caloric test
B. Hallpike test
C. Audiometry
D. CT head
151. Prevalence 0.5.10 % even social class distribution, incidence higher in developed countries than
developing countries, 90% amongst young women and prevalence varies across ethnic groups. The
condition is more common in cultures in which thinness is considered desirable. Choose the single
most appropriate condition from the given options.
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26
A. Bulimia nervosa
B. Depressive disorder
C. Generalized anxiety disorder
D. Panic disorder
152. A known COPD patient presented to the hospital with complains of persistent cough, copious
sputum production and intermittent hemoptysis. On examination, finger clubbing and coarse
inspiratory crepitations were observed. What is the most probable diagnosis?
A. Lung cancer
B. Cystic fibrosis
C. Bronchiectasis
D. Pulmonary edema
E. Lung abscess
153. An alcoholic now has been detoxified. He wants to remain sober but is scared that he might
relapse. What is the best management for this patient?
A. Methadone
B. Propranolol
C. Diazepam
D. Acomprosate
154. Two healthy parents had their first child with cystic fibrosis. They are expecting another baby
and are concerned about the probability of disease in next child. What is the probability of their next
child having cystic fibrosis?
A. 5% B. 10% C. 25% D. 50%
155. An 87 year old woman had been admitted with confusion. Her daughter says that she has been
withdrawn in the last few months, has been sleeping badly and preoccupied with dying and the
worthlessness of it all. She went to her (GP) who prescribed a tablet a couple of days ago. She was not
on any other treatment and examination was normal apart from confusion. What is the next best
management?
A Discuss with the General Practitioner (GP)
B Give antibiotics
C Give Chlormethiazole
D Give Digoxin
156. A 74year old lady called an ambulance for an acute chest pain. She has a history of DM and
HTN, and is a heavy smoker. Paramedics mentioned that she was overweight and recently has been
immobile because of a hip pain. She collapsed and died in the ambulance. What is the most likely
cause of her death?
A. Pulmonary embolism
B. MI
C. Stroke
D. Cardiac arrhythmia
E. Cardiac failure
157. A mother comes to ask for contraception for her 12 year old daughter. What would you do?
A. Give COCP D. Ask her to accompany her daughter
B. Refuse
C. Call the police
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27
158. A woman is on a holiday. She presents with confusion and vomiting after binge drinking for 4
hours at a rave party. Which is the Single most appropriate management for this patient?
A. Antipsychotics
B. Long acting benzodiazepine
C. Tricyclic antidepressants
D. Multivitamin
159. A 28 years old lady presents with dyspareunia and dysmenorrhoea. She is very obese. She now
wants reversible contraceptive method. Which of the following will be most suitable for her?
A. Mirena
B. Combined Oral Contraceptive Pill (COCP)
C. Progestogen only pill (POP)
D. Copper-T
E. Barrier method
160. A 30 year old man is becoming concerned about the safety of his family. He has been checking
the locks of the door every hour during the night. He becomes very anxious if his wife tries to stop
him. What is the most likely diagnosis from the given options?
A. Schizophrenia
B. Obsessive compulsive disorder
C. Panic disorder
D. Social Phobia
161. A 64year old man believes a female newscaster is communicating directly with him when she
turns a page. What kind of delusions is he suffering from?
A. Persecutory E. Reference
B. Control
C. Grandeur
D. Nihilistic
162. A 40 year old lady presents with right handed involuntary writhing movement and has a strong
family history. What is the most probable diagnosis from the given options?
B. Alcoholic dementia
C. Huntington’s chorea
D. Creutzfeldt- Jakob disease
163. A patient presenting with systolic murmur, left sided pain and fever. What is the most likely
diagnosis?
A. Infective endocarditis
B. Pulmonary embolism
C. Pericarditis
164. A 72 year old man has been recently diagnosed with metastatic Ca Prostate, and he is
symptomatic. A team of doctors have discussed the best treatment option of radiotherapy and chemo
with him, and their possible side effects. He fully understands the best treatment options discussed
with him but refuses the treatment. What should you as the primary doctor do?
A. Override his wish.
B. Invite the psychiatry team to assess his capacity to refuse treatment.
C. Respect his wishes but counsel him on other treatment options available.
_______________________________________________________________________________________________
28
D. Accept his wish, and let him know that should he change his mind at any time, you are always
available
E. Involve his relatives about him not accepting the treatment option
165. A Kosovan gets startled easily when he hears any loud noises and has constant nightmares.
What is the Single most likely diagnosis from the following options?
A. Acute confusional state
D. Mania
166. A 16 year old boy following a RTA was brought to the A&E with a swelling and deformity in his
right thigh. On examination airway is patent and he is found to have a pulse less leg. Which is the
most likely structure involved from the following options?
A. Femoral artery
B. Posterior tibial artery
C. Common peroneal nerve
D. Dorsalispedis
167. A 20 year old woman is a former heroin addict who completed a detoxification programme two
weeks ago. Her partner is still using heroin and he is putting her under increasing pressure. What is
the Single most appropriate next best step in management?
A. No treatment needed
B. Dexamphetamine tablets
C. Notify to the drug misuse database
D. Notify police
E. Refer to self-help group
168. A man undergoes a pneumonectomy, and after the surgery, investigations show hyponatremia.
What could be the cause of the biochemical changes?
A. Removal of hormonally active tumour
B. Excess dextrose
C. Excess colloid
D. Excessive Potassium
E. Hemo-dilution
169. A 26 year old woman had previously suffered from the blues after the birth of her first baby.
After having the second baby three months ago, she has become withdrawn, depressed and lethargic.
She is convinced that her husband is trying to kill their baby. She is already on antidepressant therapy.
What is the best management from the given options?
A Benzodiazepine
B Lithium
C Electroconvulsive therapy (ECT)
D Cognitive behaviour therapy
E Monoamine - oxidase (MAO) inhibitor
170. A 30 year old pregnant lady presents with 175/90 mmHg. Has previous history of recurrent UTI.
Urine dipstick show proteinuria ++. She is 10 weeks pregnant. What is the most likely cause of
hypertension?
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29
A. Pregnancy induced hypertension

B. Essential hypertension
C. Chronic pyelonephritis
D. Chronic glomerulonephritis
171. A 76 year old man who has been living alone since his wife died six months ago, is brought to
the Accident and Emergency Department by his family who are visiting him. He has lost interest in
life and has been reflecting on his life. He feels that life is not worth living without his wife. His sons
are very concerned and cannot cope with his father, the patient refuses help. What is the next step
A Arrange compulsory admission under mental health act
B Refer to community mental health team
C Arrange urgent psychiatric outpatient appointment
D Arrange voluntary admission to psychiatric ward
E Discuss with carer / relative
172. A 48 year old woman who has been taking medications for asthma for a long time has now
presented with decreasing vision. What is the most probable cause for her decrease in vision?
A. Inhaled Salbutamol
B. Inhaled Steroids
C. Aminophylline
D. Beta blockers
E. Oral Steroids
173. A 26 year old man has fracture running to the jugular foramen. When he recovers from the
trauma, it is noted that he is unable to shrug his ipsilateral shoulder. Choose the single most likely
damaged cranial nerve?
A. Glossopharyngeal
B. Optic
C. Occulomotor
D. Vagus
E. Accessory
174. A woman was brought in unconscious with an empty bottle of medications (PCM or others, not
sure) beside her. It is assumed she tried to commit suicide. What will you do?
A. Go to court for warrant to treat her
B. Start treating in her best interest and collect collateral info
C. Wait for her to wake up and seek consent from her
D. Ask her relatives for consent to treat her
175. A 6 year old child has vomiting and diarrhoea for past 4 days. He is lethargic, has oliguria, dry
mucus membranes and decreased skin turgor. His brother had a similar illness a few days ago. What is
the most likely diagnosis?
A. Pyloric stenosis
B. Intestinal obstruction
C. Gastroenteritis
D. Gastro oesophageal reflux disease
E. Hirschsprungs
176. A 24 year old pregnant woman, who is injecting heroin, is concerned about her baby. What is the
Single most appropriate next best step in management?
_______________________________________________________________________________________________
30
A. Lofexidine tablets
B. Methadone mixture
C. Naltrexone tablets
D. Refer to self-help group
177. A 55 year old man has had severe pain in the right hypochondrium for 24 hours. The pain comes
in waves and is accompanied by nausea. Nothing seems to relieve the pain. He feels hot and sweaty
but has normal temperature. What is the most appropriate next investigation?
A. Ultrasound Abdomen
B. Endoscopic retrograde cholangiopancreatography (ERCP)
C. Magnetic resonance cholangiopancreatography (MRCP)
D. Serum Amylase
E. Upper gastro-intestinal Endoscopy
178. A 50 year old man in the surgical ward has suddenly become anxious and somewhat agitated. He
was admitted three days ago with hematemesis which has now settled and there appears to be no other
physical cause to explain his behaviour. What is the most appropriate best management?
B. Counselling
C. Desensitization
D. Diazepam
E. Hypnotherapy
179. A 25 year old boy went to forest with his parents. He was stung by an insect and now presents
with rash which is increasing in size. What is the most likely diagnosis?
A. Brucellosis
B. Lyme disease
C. Dengue fever
D. Trypanosomiasis
180. A 30 year old lady complains of intermittent diarrhoea, chronic abdominal and pelvic pain and
tenesmus. Sometimes she notices blood in her stool. Select the most likely cause leading to her
symptoms?
A. Inflammatory bowel disease
B. Diverticulosis
C. Irritable bowel disease
D. Adenomyosis
E. UTI
_______________________________________________________________________________________________

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Dr Swamy PLAB Courses Ltd.

E. Discharge with no treatment

A. Acute confusion state

A Discuss with the General Practitioner (GP)

129. What is the maintenance fluid of choice in paediatric rehydration?

131. What is the Route of administration for Benzodiazepines at home?

A. Pregnancy induced hypertension

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