GP 4

PROMETRIC MODEL MCQ FOR GP
Question 1 ( Topic 1)
A 38-year-old man presents with acute infection of skin in the leg. Diagnosis of cellulitis has been made. What should be
prescribed?
A. Ceftriaxone + Flucloxacillin
B. Vancomycin + Metronidazole
C. Metronidazole + Erythromycin
D. Ceftriaxone + Terbinafine
E. Penicillin + Flucloxacillin
A 28-year-old man presents with a 2 hours' history of rapid palpitations. He feels a little light headed but is other exam:
pulse=170 bpm and regular, BP=100/68 mmHg. He has had 2 similar episodes in the past.
What is the most disturbance?
A. SVT
B. VF
C. A-fibrillation
D. VT
E. Ventricular-ectopic
Answer : A
Explanation:
Palpitation, light headedness with a tachycardia of 170 bpm that is regular are most likely a SVT.
A 29-year-old lady who is a bank manager is referred by the GP to the medical OPC due to a long history of tin in the
joints. An autoimmune screen result showed smooth muscle antibodies positive.
What is the most appropriate investigation?
A. Jejunal biopsy
B. Thyroid function test
C. Liver function test
D. Serum glucose
E. ECG
Answer : C
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Explanation:
Autoimmune hepatitis. Definitive investigation is liver biopsy Steroid [start with high dose prednisolone]. Azathioprine is
commonly added with steroid to reduce its dose as more side effects than azathioprine.
A 65-year-old man presents with significant weight loss and complains of cough, SOB and chest pain. Exam constricted,
drooping of left eyelid.
What is the most likely diagnosis?
A. Thoracic outlet syndrome
B. Cervical rib
C. Bronchogenic carcinoma
D. Pancoast tumor
E. Pneumonia
Answer : D
Explanation:
Pancoast tumor. Pancoast tumour is the apical lung cancer that is associated with destructive lesion thoracic inlet and
involvement of the brachial plexus and cervical sympathetic nerves (the stellate ganglion) le horner‫ג‬€™s syndrome.
A 26-year-old political refugee has sought asylum in the UK and complains of poor concentration. He keeps his family
whom he saw killed in a political coup. He is unable to sleep and feels hopeless about his survival. But he is afraid to go
out.
A. PTSD
B. Acute stress disorder
C. OCD
D. Social phobia
E. GAD
Answer : A
Explanation:
PTSD. Keep getting thoughts of his family disaster, insomnia, to avoid similar circumstances he is out these are
suggestive of PTSD.
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Victim of RTA came with multiple injuries to abdomen, chest and limbs. BP is 80/ 50. upper limb has upper third near
amputation that bleeds profusely, what is your first thing to do:
A. Tourniquet the limb to stop the bleeding
B. Check the airway and breathing
C. Five IV fluid
D. Call orthopedic
Answer : B
Explanation:
As rule ABC also in description near amputation so difficult to make tourniquet enough which stops bleeding.
lady presents with hot flashes and other symptoms of menopause. What is the treatment option?
A. Topical estrogen
B. Conbined Oral Contraceptive
C. Biosphosphonate
D. Raloxifen
E. Hormone Replacement Therapy
Answer : E
40-year-old manual worker presents with a swelling in the groin. Exam: mass is found to be just above and l pubic
tubercle. It is reducible. On applying pressure on the internal ring there is no cough impulse seen.
What probable diagnosis?
A. Direct inguinal hernia
B. Indirect inguinal hernia
C. Femoral hernia
D. Femoral aneurysm
E. Strangulated hernia
Answer : B
Explanation:
Indirect inguinal hernia. [Swelling in the groin; mass just above and lateral to the pubic tubercle mea hernia. It is
reducible. On applying pressure on the internal ring there is no cough impulse; it means the hernia through deep ring,
and enters scrotum passing through the Superficial ring. That means it is indirect inguinal hernia.
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During a basketball match, one of the players suddenly collapsed to the ground with coughing and SOB. What choice?
A. V/Q
B. CTPA
C. MRI
D. CT scan
E. CXR
Answer : E
Explanation:
CXR. Likely diagnosis is pneumothorax. So investigation of choice is CXR
A 27-year-old man presents with abdominal pain. He says his urine is dark.
Exam: BP=160/105mmHg.
What is investigation?
A. Urine microscopy
B. Renal biopsy
C. Urine protein
D. US
E. CT
Answer : D
Explanation:
US. Abdominal pain, Dark urine (hematuria and hypertension suggests ADPKD. The sensitivity of ult ADPKD1 is 99% for
at-risk patients older than 20 years.
Question 11
14-year-old boy has been diagnosed with nephrotic syndrome. 5days later he presents with flank pain, hem urea levels.
A diagnosis of renal vein thrombosis is made.
What is the most likely cause for renal vein thrombo?
A. Loss of anithrombin III
B. Stasis
C. Protein C deficiency
D. High estrogen levels
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E. Vasculitis
Answer : A
Question 12
A 33 year‫ג‬€™s man has a temp-38.5C, cough and chest pain on the right side on inspiration. He also has puru.
What is the most likely organism to cause pneumonia in this patient?
A. PCP cold agglutinins
B. AFB
C. Gram ‫ג‬€"ve doplicoccic
D. Gram +ve doplococcic
E. Coagulase +ve cocci
Answer : C
Explanation:
It is a case of community acquired pneumonia caused by streptococcus pneumonia.
Question 13
A 54-year-old patient wakes up with right sided weakness. His current medication is bendroflumethiazide for
BP=160/90mmHg. CT shows left cerebral infarct.
What is the most appropriate treatment?
A. Alteplase
B. Aspirin
C. Simvastatin
D. Dipyridamole
E. Clopidogrel
Answer : A
Question 14
A 45-year-old man has developed an annular rash with a scaly edge on his thigh. The rash has been spreading. He has
some general aches and pains.
What is the single most useful investigation?
A. ANA
B. Skin scrap for mycology
C. Skin swab for bacteria
D. Biopsy lesion
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E. Lyme antibodies
Answer : E
Explanation -
Spreading annular rash suggests erythema migrans of lyme disease.
Question 15
Drug of choice of generalized anxiety disorder is ______________.
A. Acetalopram
B. Bubropion
C. Buspirone
D. beta blocker
Answer : A
Explanation:
What is Citalopram an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs).
Citalopram is used to treat depression. Treatment for Anxiety Disorders Many variables influence the selection of
medication for individual patients. The following is general information regarding beginning treatment. Most common -
sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). These allow a low starting dose (12.5mg of Zoloft,
5mg of Celexa) and slow titration (anxiety patients are very vulnerable to initial activation and worsening of symptoms).
Effective ranges: 50-200 mg of Zoloft, 20- 40 mg of Celexa, and 10-20 mg of Lexapro. We routinely utilize much higher
doses than those previously listed to treat OCD. We rarely use benzodiazepines as first line drugs for these disorders and
generally discourage as needed/rescue use. Benzodiazepines remain widely used drugs for panic and other anxiety
disorders in both primary care and mental health settings. While they have clear value in some circumstances, we avoid
them as first line treatments because they so powerfully reinforce the anxious patient's wish for a simple and quick way
to avoid the distressing experience of his or her anxiety. Overcoming this desire to flee distressing circumstances or
feelings is the bedrock of CBT and is absolutely critical to successful long-term outcomes. Benzodiazepines often make
these efforts more difficult.
Question 16
Fluoxetine half-life after acute administration is ______________________________
A. 1-4 days
B. 6-9 days
Answer : A
Explanation:
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The relatively slow elimination of fluoxetine (elimination half-life of 1 to 3 days after acute administration and 4 to 6
days after chronic administration) and its active metabolite, nor fluoxetine (elimination half-life of 4 to 16 days after
acute and chronic administration), leads to significant accumulation of these active species in chronic use. After 30 days
of dosing at 40 mg/day, plasma concentrations of fluoxetine in the range of 91 to 302 ng/mL and nor fluoxetine in the
range of 72 to 258 ng/mL have been observed. Plasma concentrations of fluoxetine were higher than those predicted by
single dose studies, presumably because fluoxetine's metabolism is not proportional to dose. Nor fluoxetine, however,
appears to have linear pharmacokinetics. Its mean terminal half-life after a single dose was 8.6 days and after multiple
dosing was 9.3 days.
Question 17
72-year-old lady is drowsy and her relatives want to take her home.
She has been prescribed diazepam 2.5m delivery route?
A. Per rectal
B. Intra Muscular
C. Subcutaneous
D. Oral
E. Intravenous
Answer : A
Question 18
A 53-year-old lady presents with hot flash and night sweats. Her LMP was last year. She had Myocardial infarction.
What is the most appropriate management for her?
A. Raloxifene
B. COCP (Combined OCP)
C. Evening primrose
D. Clonidine
E. Estrogen
Answer : D
Question 19
A 64-year-old man complains of increasing dyspnea and cough for the past 18months. He coughs up a Table
mucopurulent sputum with occasional specks of blood.
What is the most likely underlying cause?
A. Acute bronchitis
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B. Bronchiectasis
C. Chronic bronchitis
D. Lung cancer
E. Pneumonia
Answer : C
Explanation:
Chronic bronchitis. There may be specks of blood in sputum in both bronchiectasis, acute and chronic. Duration of
disease is 18 months, so it is not acute bronchitis. Again only one tablespoonful sputum does not term copious sputum
of bronchiectasis in which sputum will be much more in amount.
Question 20
A 25-year-old girl saw a tragic RTA in which a young boy was killed. The night of the event she couldn‫ג‬€™t sleep after
she suddenly lost her vision. She was previously fine and there was no history of medical or psychologic
What is the diagnosis?
A. Dissociation
B. Generalize Anxiety disorder
C. Post-traumatic Stress disorder
D. Somatization
E. Conversion
Answer : E
Explanation:
Conversion reaction. Conversion reaction is sometimes applied to patients who present with neurol such as numbness,
blindness, paralysis, or fits, which are not consistent with a well-established organic cause significant distress. It is
thought that these symptoms arise in response to stressful situations affecting mental health
Which type of contraceptive is contraindicative in lactation?
A. UID
B. Depo-Provera
C. Mini pills
D. OCPs
E. Condom
Answer : D
Explanation:
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Based on the available evidence, expert opinion in the United States holds that the risks of combination contraceptive
products usually outweigh the benefits before 4 weeks postpartum. Between 4 weeks and 6 months postpartum, the
advantages of using the method generally outweigh the theoretical or proven risks, although the evidence of lack of
effect on lactation is poor and does not include preterm or ill infants. Introduction of a combined oral contraceptive
containing 30 mcg of ethinyl estradiol on day 42 or beyond may not affect milk intake or infant growth. After 6 months
postpartum, combination contraceptives, including oral tablets, the transdermal patch and vaginal ring, can be used, but
progestin-only methods are preferred if breastfeeding will be continued.
A 2-days baby‫ג‬€™s mother is worried about the baby‫ג‬€™s hearing. Mother has a history of conductive hearing lo most
appropriate test?
A. MRI
B. Fork test
C. CT scan
D. Reassure
E. Brain stem evoked response
Answer : E
Explanation:
Brain stem evoked response. A BAER (brainstem auditory evoked response) test can help to diagnose nervous system
disorders, especially in newborns, young children, and others who may not be able to participate hearing test.
A study was done amongst 2 hospitals for the equal number of cancer patients. It was noted that hospital A higher of
mortality than hospital B for treated cancer patients.
What is the study done here classified as?
A. Cohort
B. Observational
C. Retrospective
D. Case study
Answer : A
Explanation:
A cohort is a group of people who share a common characteristic or experience within (e.g., are born, are exposed to a
drug or vaccine or pollutant, or undergo a certain medical procedure].
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An 8-week baby boy is noted to be jaundiced. He is breast-feeding well and has gained 300g since birth. His s and his
urine is pale straw colored.
A. Breast milk jaundice
B. G6PD deficiency
C. Galactosemia
D. Congenital viral infection
E. Biliary atresia
Answer : C
Explanation:
Biliary atresia causes obstructive picture where stools are pale and urine becomes da disorder like G6PD or
spherocytosis causes appearance of jaundice in 1st
24 hours. In breast milk jaundice, ja develops in 2nd week. Also congenital viral infection (TORCH) occurs in 1st 24 hours.
So likely cause in the p is
Galactosemia.
After starting Antidepressant drug, if patient is not improving then when you decide to stop drugs?
A. 3-4 weeks
B. 1 day
C. 1 week
D. 2 weeks
Answer : A
Explanation:
Some people notice an improvement within a few days of starting treatment. However, an antidepressant often takes 2-
4 weeks to build up its effect and work fully. Some people stop treatment after a week or so thinking it is not helping. It
is best to wait for 3-4 weeks before deciding if an antidepressant is helping or not.
If poor sleep is a symptom of the depression, it is often helped first, within a week or so. With some types of tricyclic
antidepressant, the initial dose that is started is often small and is increased gradually to a full dose. (One problem that
sometimes occurs is that some people remain on the initial dose which is often too low to work fully.) If you find that the
treatment is helpful after 3-4 weeks, it is usual to continue. A normal course of antidepressants lasts at least six months
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after symptoms have eased. If you stop the medicine too soon, your symptoms may rapidly return. Some people with
recurrent depression are advised to take longer courses of treatment (up to 2 years or longer)
A young woman fell and hit her knee. Exam: valgus test +ve. What ligament was most probably injured?
A. Lateral collateral
B. Ant cruciate
C. Post cruciate
D. Medial collateral
E. Meniscus
Answer : D
Explanation:
Medial collateral. The valgus stress test involves placing the leg into extension, with one hand place on the knee. With
the other hand placed upon the foot applying an abducting force, an attempt is then made to at the knee into valgus. If
the knee is seen to open up on the medial side, this is indicative of medial collateral damage.
A 32-year-old man with schizophrenia and a history of violence and distressing auditory hallucinations was a ward with
aggressive behavior and has already smashed his room. He is refusing any oral meds.
What is the s appropriate injection?
A. Flupenthixol
B. Risperidone
C. Haloperidol
D. Fluphenazine
Answer : B
Explanation:
Protocol of treating agitated violent patient.
1. Try to talk to the patient but don't touch him.
2. If he agrees on oral meds, give oral atypical antipsychotics olanzapine, risp or quetiapine
3. If refusing oral, give IV atypical antipsychotics preferably its Olanzapine or Risperidone
4. If agitation not controlled give IM Lorazepam
5. If that doesn't work, give IV Haloperidol as last resort.
6. If acute sedation is required, for immediate effect give IV Diazepam.
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A 14-year-old girl presents with primary amenorrhea and a short stature.
A. Down‫ג‬€™s syndrome
B. Fragile X syndrome
C. Turner‫ג‬€™s syndrome
D. Klinefelter‫ג‬€™s syndrome
E. Normal finding
Answer : C
Explanation:
Down‫ג‬€™s syndrome and Fragile x syndrome don‫ג‬€™t have primary amenorrhea. Klinefelter‫ג‬€™s patients are tall
males. So the likely diagnosis is Turner‫ג‬€™s syndrome.
A 65-year-old lady who is on thiazide suffers from falls in the morning. What is the cause for her symptoms?
A. Epilepsy
B. Orthostatic hypotension
C. TIA
Answer : C
Explanation:
Thiazide diuretic is associated with orthostatic hypotension.
A patient with gross hematuria after blunt abdominal trauma has a normal-appearing cystogram after the int instillation
of 400 ml of contrast. You should next order:
A. A retrograde urethrogram.
B. A voiding cystourethrogram.
C. An intravenous pyelogram.
D. A cystogram obtained after filling, until a detrusor response occurs.
Answer : A
Explanation:
A Urethrography refers to the radiographic study of the urethra using iodinated contrast media and is generally carried
out in males. Also referred to as ascending urethrography/urethrogram (ASU) or retrograde urethrography/urethrogram
(RUG). Indications ‫ג‬€¢ pelvic trauma in the emergency department ‫ג‬€¢ diminished urinary stream ‫ג‬€¢ urethral strictures
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‫ג‬€¢ urethral diverticula ‫ג‬€¢ urethral obstruction ‫ג‬€¢ suspected urethral foreign bodies ‫ג‬€¢ urethral mucosal tumors ‫ג‬€¢
suspected urethral fistula
A 10-year-old child has got progressive bilateral hearing loss. He has started to increase the TV volume. All other is
normal.
A. Wax
B. Bilateral OM with effusion
C. Foreign body
D. Meningitis due to meningococcus
Answer : B
A 27-year-old lady after C-section developed epigastric pain after 8h.
What is the appropriate investigations?
A. Liver enzyme
B. Liver biopsy
C. ABG
D. Coagulation
Answer : A
Explanation:
Epigastric pain is a warning sign of HELLP syndrome. So to rule out HELLP syndrome should be done.
Healthy parents have 2 children, a child with Cystic fibrosis and a healthy child. They want to have another are the
chances of that child being a carrier?
A. 1:2
B. 1:4
C. 1:8
D. 1:16
E. 2:3
Answer : A
Explanation:
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As the parents have a child with cystic fibrosis and they are healthy both of them are carrier. autosomal recessive
disease where if both parents are carrier mode of inheritance is as follows: Chance of being child 1:4, Chance of being
diseased 1:4 and chance of being carrier 1:2.
A 30-year-old female has chronic diarrhea, mouth ulcers and skin tags. She complains of visual problems, low morning
stiffness. Inv: ESR & CRP=raised,
Hgb=10mg/dl.
What is the most probable diagnosis?
A. SLE
B. Seronegative arthritis
C. Gout
D. Reactive Arthritis
Answer : B
Explanation:
Chronic diarrhea, mouth ulcers and skin tags are features of IBD. There is a w association between IBD and seronegative
arthritis (particularly AS). Here low back pain, visual problem, morn raised ESR and CRP, low hemoglobin indicates the
diagnosis of seronegative arthritis.
14-year-old boy has been diagnosed with nephrotic syndrome. 5days later he presents with flank pain, hem urea levels.
A diagnosis of renal vein thrombosis is made.
What is the most likely cause for renal vein thrombo?
A. Loss of anithrombin III
B. Stasis
C. Protein C deficiency
D. High estrogen levels
E. Vasculitis
Answer : A
A 33 year‫ג‬€™s man has a temp-38.5C, cough and chest pain on the right side on inspiration. He also has puru.
What is the most likely organism to cause pneumonia in this patient?
A. PCP cold agglutinins
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B. AFB
C. Gram ‫ג‬€"ve doplicoccic
D. Gram +ve doplococcic
E. Coagulase +ve cocci
Answer : C
Explanation:
It is a case of community acquired pneumonia caused by streptococcus pneumonia.
A 54-year-old patient wakes up with right sided weakness. His current medication is bendroflumethiazide for
BP=160/90mmHg. CT shows left cerebral infarct.
A. Alteplase
B. Aspirin
C. Simvastatin
D. Dipyridamole
E. Clopidogrel
Answer : A
A 45-year-old man has developed an annular rash with a scaly edge on his thigh. The rash has been spreading. He has
some general aches and pains.
What is the single most useful investigation?
A. ANA
B. Skin scrap for mycology
C. Skin swab for bacteria
D. Biopsy lesion
E. Lyme antibodies
Answer : E
Explanation -
Spreading annular rash suggests erythema migrans of lyme disease.
Drug of choice of generalized anxiety disorder is ______________.
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A. Acetalopram
B. Bubropion
C. Buspirone
D. beta blocker
Answer : A
Explanation:
What is Citalopram an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs).
Citalopram is used to treat depression. Treatment for Anxiety Disorders Many variables influence the selection of
medication for individual patients. The following is general information regarding beginning treatment. Most common -
sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro). These allow a low starting dose (12.5mg of Zoloft,
5mg of Celexa) and slow titration (anxiety patients are very vulnerable to initial activation and worsening of symptoms).
Effective ranges: 50-200 mg of Zoloft, 20- 40 mg of Celexa, and 10-20 mg of Lexapro. We routinely utilize much higher
doses than those previously listed to treat OCD. We rarely use benzodiazepines as first line drugs for these disorders and
generally discourage as needed/rescue use. Benzodiazepines remain widely used drugs for panic and other anxiety
disorders in both primary care and mental health settings. While they have clear value in some circumstances, we avoid
them as first line treatments because they so powerfully reinforce the anxious patient's wish for a simple and quick way
to avoid the distressing experience of his or her anxiety. Overcoming this desire to flee distressing circumstances or
feelings is the bedrock of CBT and is absolutely critical to successful long-term outcomes. Benzodiazepines often make
these efforts more difficult.
Fluoxetine half-life after acute administration is ______________________________
A. 1-4 days
B. 6-9 days
Answer : A
Explanation:
The relatively slow elimination of fluoxetine (elimination half-life of 1 to 3 days after acute administration and 4 to 6
days after chronic administration) and its active metabolite, nor fluoxetine (elimination half-life of 4 to 16 days after
acute and chronic administration), leads to significant accumulation of these active species in chronic use. After 30 days
of dosing at 40 mg/day, plasma concentrations of fluoxetine in the range of 91 to 302 ng/mL and nor fluoxetine in the
range of 72 to 258 ng/mL have been observed. Plasma concentrations of fluoxetine were higher than those predicted by
single dose studies, presumably because fluoxetine's metabolism is not proportional to dose. Nor fluoxetine, however,
appears to have linear pharmacokinetics. Its mean terminal half-life after a single dose was 8.6 days and after multiple
dosing was 9.3 days.
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72-year-old lady is drowsy and her relatives want to take her home.
She has been prescribed diazepam 2.5m delivery route?
A. Per rectal
B. Intra Muscular
C. Subcutaneous
D. Oral
E. Intravenous
Answer : A
A 53-year-old lady presents with hot flash and night sweats. Her LMP was last year. She had Myocardial infarction.
What is the most appropriate management for her?
A. Raloxifene
B. COCP (Combined OCP)
C. Evening primrose
D. Clonidine
E. Estrogen
Answer : D
A 64-year-old man complains of increasing dyspnea and cough for the past 18months. He coughs up a Table
mucopurulent sputum with occasional specks of blood.
What is the most likely underlying cause?
A. Acute bronchitis
B. Bronchiectasis
C. Chronic bronchitis
D. Lung cancer
E. Pneumonia
Answer : C
Explanation:
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Chronic bronchitis. There may be specks of blood in sputum in both bronchiectasis, acute and chronic. Duration of
disease is 18 months, so it is not acute bronchitis. Again only one tablespoonful sputum does not term copious sputum
of bronchiectasis in which sputum will be much more in amount.
A 25-year-old girl saw a tragic RTA in which a young boy was killed. The night of the event she couldn‫ג‬€™t sleep after
she suddenly lost her vision. She was previously fine and there was no history of medical or psychologic
A. Dissociation
B. Generalize Anxiety disorder
C. Post-traumatic Stress disorder
D. Somatization
E. Conversion
Answer : E
Explanation:
Conversion reaction. Conversion reaction is sometimes applied to patients who present with neurol such as numbness,
blindness, paralysis, or fits, which are not consistent with a well-established organic cause significant distress. It is
thought that these symptoms arise in response to stressful situations affecting mental health
Best method to maintain air way in conscious multiple injury is _______________________.
A. Intubation
B. Oropharyngeal device
C. Nasopharyngeal device
Answer : C
You are supposed to keep a child NPO he's 25 kgs, how much you will give:
A. 1500
B. 1300
C. 1400
D. 1600
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Answer : D
Explanation:
For first 10kg 100x10=1000 For next 10 kg 50x10=500 For next 5 kg 5x20= 100 So the total is 1600 ml.
A 73-year-old man who is recovering from surgery on the left carotid artery in his neck. He has slurred speech of his
tongue, the tip deviated to the left.
What is the single most appropriate option?
A. Accessory nerve
B. Hypoglossal nerve
C. Glossopharyngeal nerve
D. Facial nerve
E. Vagus nerve
Answer : B
Explanation:
Testing function of the nerve is performed by asked the subject to stick their ton out. If there is a loss of innervation to
one side, the tongue will curve toward the affected side, due to unopposed the opposite genioglossus muscle. If this is
the result of. A lower motor neuron lesion, the tongue will be curve damaged side, combined with the presence of
fasciculations or atrophy. However, if the deficit is caused by a neuron lesion, the tongue will be curved away from the
side of the cortical damage, without the presence of fa or atrophy.
33-year-old female complains of diplopia on upright gaze. Exam: ptosis can be seen. There are no other co significant
Past medical history.
What is the most appropriate test for him?
A. Ophthalmoscopy
B. Checking red reflex
C. Thyroid function test
D. Visual field test
Answer : B
Explanation:
This is a wrong key. Right key should be D. CT. A case of 3rd nerve palsy. So to cause CT should be done. Red reflex is
seen to diagnose cataract.
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A 6-year-old boy fell in the playground and has been holding his forearm complaining of pain. Exam: no sign swelling.
However, there is minimal tenderness on exam.
A. Green stick fx of distal radius
B. Fracture neck of humerus
C. Fracture mid ulnar
D. Fracture mid radius
Answer : A
A 37-year-old woman presents with heavy bleeding. Investigation shows subserosal fibroid-4cm and intramu.
Which is the most appropriate treatment?
A. Abdominal Hysterectomy
B. Vaginal Hysterectomy
C. Abdominal Myomectomy
D. Hysteroscopic Myomectomy
Answer : C
Explanation:
As patient is young we should go for myomectomy. As hysteroscopic myo mainly sub mucosal fibroids we should go for
abdominal myomectomy which will deal with both subserosal a fibroids.
Which vitamin has a protective effect against colon cancer?
A. Vitamin C
B. Vitamin D
C. Folic acid
D. Vitamin K
Answer : B
Explanation:
Calcium and vitamin D Calcium may protect against bowel cancer, according to the World Cancer Research Fund. A
2004meta analysis showed that people with the highest levels of calcium intake (from food and supplements) reduced
their risk of bowel cancer by 22% compared to people with the lowest calcium intake.
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However, 2 meta analyses in 2010 found that calcium supplements had no effect on bowel cancer risk in the general
population. But they did find a link between calcium intake and a reduced risk of polyps coming back in the bowel after
previous treatment. Polyps are growths in the bowel that may develop into cancer over a long period of time, if left
untreated. To reduce bowel cancer risk, it may be better to take vitamin D and calcium together. We need vitamin D to
be able to absorb calcium. A large randomized controlled trial in 2006 showed that only the people with high intakes of
both calcium and vitamin D had a reduced risk of bowel cancer. Other studies have shown that people with the highest
intakes of vitamin D have a lower risk of bowel cancer and bowel polyps. Dairy There is some evidence that drinking milk
reduces the risk of bowel cancer. A review in 2011 showed that the benefit of dairy in reducing bowel cancer risk was
only seen at levels over 100 grams (g) a day. Having 500 to 800g milk a day reduced bowel cancer risk by 20 to 30%. One
pint, or 0.5 liters, of semi skimmed milk weighs about 550g. The effect of milk on lowering bowel cancer risk may be
partly due to the calcium. But milk contains many other substances which may also play a role. There is limited evidence
that eating cheese may increase the risk of bowel cancer. It is not clear how cheese may increase the risk, but it may
have something to do with the saturated fatty acids.
A 32-year-old woman presents with malaise fatigue and fever. She complains about weight loss. Exam: malar nasolabial
fold can be seen.
What is the most appropriate investigation?
A. Anti-histone
B. Anti-centromere
C. Anti-ds DNA
D. Anti Jo
E. Anti Scl70
Answer : C
Explanation:
Features are suggestive of SLE. So most appropriate investigation from the given option DNA.
23-year-old man presents with severe pain in the right flank radiating to his groin. He is rolling about on the an IVU
confirms a stone in the ureter which is 8mm in size.
Which transfusion modality will be most effective?
A. ESWL (Lithotipsy)
B. Dormier basket
C. Fluids and alpha blockers
D. PCNL
21 | P a g e
Answer : A
A 72years presents with polyuria and polydipsia. The fasting blood sugar is 8 and 10mmol/l.BP=130/80mm
cholesterol=5.7mmol/l. There is microalbuminuria.
What is the single most appropriate next management?
A. Statin and glitazone
B. ACEi and sulfonylurea
C. Statin and Biguanide
D. Statin and ACEi
Answer : D
A middle aged woman has some weakness of hand after an injury. Which vertebra will be the lowest to be x-ray to
diagnosis the injury?
A. C7/T1
B. C5/C6
C. c8/T1
D. C6/C7
Answer : A
A 80 year‫ג‬€™s man with prostatic cancer has confusion, thirst, abdominal pain and an abnormal ECG.
What is appropriate investigation?
A. DEXA scan
B. Redionuclide bones scan
C. Serum calcium concentration
D. MRI spine
Answer : C
A 20 year‫ג‬€™s man presents with painful swallowing. Exam: trismus and unilateral enlargement of his tonsils
Peritonsillar region is red, inflamed and swollen.
22 | P a g e
A. Oral antibiotics
B. Analgesics with antipyretics
C. I&D with antibiotics
D. IV antibiotics and analgesics
E. Tonsillectomy
Answer : C
An 18years female has periorbital blisters. Some of them are crusted, others secreting pinkish fluid.
What likely diagnosis?
A. Rubella
B. Shingles
C. Measles
D. Chicken pox
E. Varicella
Answer : B
Explanation:
Shingles Ophthalmic division of trigeminal nerve. Typically, shingles is unilateral.
A patient presented to you who is known case of hypothyroidism and on thyroxin, he also has increase PT normal
Vitamin D, Creatinine is very high.
On examination tapping of the angle of jaw produce facial spasms, what diagnosis?
A. Pseudohypoparathyroidism
B. DiGeorge syndrome
C. Chronic renal failure
D. Uncontrolled thyroid functions
Answer : C
Explanation:
Secondary hyperparathyroidism Hypocalcemia, hyperphosphatemia, inc creatinine.
An 82-year-old man has woken up with incoherent speech and difficulty in finding the right words. Exam: good
comprehension.
23 | P a g e
Which anatomical site is most likely to be affected?
A. Pons
B. Wernicke‫ג‬€™s area
C. Broca‫ג‬€™s area
D. Midbrain
E. Parietal cortex
Answer : C
Explanation:
A person with expressive aphasia will exhibit halting and effortful speech. Speech m important content words. Word
comprehension is preserved. The person may still be understood, but sentence grammatical. This contrasts with
receptive or Wernicke‫ג‬€™s aphasia, which is distinguished by a patient's inability comprehend language or speak with
appropriately meaningful words though fluency, may be preserved.
A HTN patient on bendroflumethiazide 2.5mg/d has come for his routine checkup. Exam: BP=145/85mmHg.
What is the most appropriate management for this patient?
A. Continue same dose
B. Stop meds
C. Repeat the blood test
D. Increase the dose
Answer : C
Explanation:
Bendroflumethiazide causes hyponatremia and hypokalemia. But the findings is probably error of test. Hence blood test
should be repeated to confirm the level of potassium and sodium.
Which of the following is not a degenerative corneal disease?
A. Keratokonus
B. Marginal dystropathy
C. Fatty/lipid degeneration
D. Moorens‫ג‬€™s ulcer
E. Band keratopathy
Answer : D
Explanation:
24 | P a g e
All other options are degenerative disease of cornea except Mooren‫ג‬€™s ulcer which is ulcerative keratitis.
A terminally ill with metastatic carcinoma presents with dysphagia and difficulty in swallowing.
What is possible treatment?
A. Analgesic
B. Cotrimazole
C. PO fluconazole
D. Nystatin suspension
E. Amphotericin B IV
Answer : C
Explanation:
PO fluconazole. Treatment of carcinoma can predispose to development of esophageal candidiasis as follows: Oral
fluconazole (200 400 "€‫ג‬mg) daily for 14 to 21 days (if needed IV fluconazole can also be given).
A lady developed breast abscess after delivery. What is the most likely organism?
A. GBS
B. Staph albus
C. Strep pyogenes
D. Staph aureus
Answer : D
A 55 year‫ג‬€™s man who is hypertensive suddenly lost his vision. The retina is pale and fovea appears as a spot.
What is the single most appropriate treatment?
A. Corticosteroids
B. Pan retinal photocoagulation
C. Press over eyeball
D. Scleral buckling
Answer : C
Explanation:
25 | P a g e
In central retinal artery occlusion (CRAO) retina becomes pale and fovea. Hypertension is a major cause of CRAO. Apply
direct pressure for 5-15 seconds, then release. Repeat several massage can dislodge the embolus to a point further
down the arterial circulation and improve retinal perfusion.
A mother presents with her 14months child. He holds furniture and other things to help him stand and says ‫ג‬€˜mama‫ג‬
€™ and ‫ג‬€˜papa‫ג‬€™. He makes eye contact and smiles.
He can transfer objects from one hand to another.
What do you interpret from his development?
A. Normal development
B. Delayed social development
C. Delayed fine motor development
D. Delayed gross motor development
E. delayed verbal development
Answer : A
A 28-weeks pregnant woman presents with uterine bleeding after sexual intercourse. What is the most appropriate
diagnosis?
A. Placental abruption
B. Missed abortion
C. Placental previa
D. Ectropion
Answer : D
Explanation:
Post coital bleeding can be either placenta previa or cervical ectropion. But as ectropion pregnancy so it is the option
here.
A 48-year-old woman always socially withdrawn has stopped going out of the house. She is afraid to socialize fears that
people will criticize her.
A. PTSD
B. GAD
26 | P a g e
C. Social anxiety
D. Agoraphobia
E. OCD
Answer : C
Explanation:
Social anxiety disorder is a type of complex phobia. This type of phobia has a disrupt disabling impact on a person's life.
It can severely affect a person's confidence and self-esteem, interfere with relationships and impair performance at
work or school.
33-year-old lady who is a drug addict wants to quit. She says she is ready to stop the drug abuse.
What drug treatment would you give her?
A. Benzodiazepines
B. Methadone
C. Disulfiram
D. Lithium
E. Diazipoxide
Answer : A
A patient with Type-1diabetes has a fundus showing micro-aneurysm and hard exudate.
What is the single diagnosis?
A. Hypertensive retinopathy
B. Diabetic background
C. MS
D. Macular degeneration
E. Proliferative DM retinopathy
Answer : B
Explanation:
Diabetic background retinopathy. Microanurysm, hard exudates are seen in background diabetic ret
27 | P a g e
A 3-month-old female infant is brought in because her parents say she will not eat anymore. Upon physical examination,
a loud pansystolic murmur is appreciated.
The child also appears small for her age, but her records show no maternal or delivery complications.
Which of the following is the most likely finding on EKG?
A. ST segment elevation
B. Right ventricular hypertrophy
C. QT interval elongation
D. Right bundle branch block
Answer : B
Explanation:
The key to this case is understanding that a child who was otherwise healthy but presents with a holosystolic murmur
and symptoms of failure to thrive most likely has a VSD. Right ventricular hypertrophy occurs from blood shunting from
the high pressure left system to the low pressure right system. This could later lead to
Eisenmenger syndrome (ES). ES is defined as the process in which a left-to-right shunt caused by a VSD reverses into a
right-to-left shunt due to hypertrophy of the right ventricle.
70 year‫ג‬€™s woman is admitted with diarrhea, vomiting and dehydration. Exam: yellow visual halos in her e
ECG=bradycardia. She has a history of chronic Atrial-fib.
Which drug causes the above mentioned side effects?
A. Nifedipine
B. Digoxin
C. Ramipril
D. Atenolol
Answer : B
17 year‫ג‬€™s female with lump in the breast, freely mobile, not attached to the skin. What is the next investigation?
A. Ultrasound
B. Mammogram
C. FNA
D. Biopsy
Answer : B
28 | P a g e
A 20 year‫ג‬€™s woman with no previous history of ear complains, presents with 1day history of severe pain in is
extremely tender to examine.
What is the single most likely diagnosis?
A. Chondromalasia
B. Myringitis
C. Furuncle
D. Otitis media
E. Otitis Externa
Answer : E
Explanation:
Extreme tenderness to examine indicate otitis externa.
60 year‫ג‬€™s old patient has only HTN best drug to start with:
A. Beta blocker
B. ACEI
C. Diuretics
D. ARB
E. Alpha blocker
Answer : C
Explanation:
Antihypertensive therapy has been shown to reduce morbidity and mortality in older patients with elevated systolic or
diastolic blood pressures. This benefit appears to persist in patients older than 80 years, but less than one third of older
patients have adequate blood pressure control. Systolic blood pressure is the most important predictor of cardiovascular
disease. Blood pressure measurement in older persons should include an evaluation for orthostatic hypotension. Low-
dose thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting enzyme
inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line medications that should be
selected based on comorbidities and risk factors.
A 78 year‫ג‬€™s retired teacher was admitted for a hernioplasty procedure. After the operation he became agitate and
confused.
What is the most appropriate management?
29 | P a g e
A. Diazepam
B. Clozapine
C. Chlordiazepoxide
D. Thiamine
E. Vitamin B
Answer : C
A woman with sickle cell disease complains of heavy menstrual blood loss.
What is the most appropriate combined oral contraceptive pills?
A. Depot provera
B. Transdermal patch
C. Copper IUCD
D. Mirena
Answer : A
A 28 year‫ג‬€™s woman has been on treatment for Rheumatoid arthritis for 3yrs. She has gradual loss of vision Her ocular
pressure is normal. Red reflex is absent in both eyes.
What is the single most likely diagnosis?
A. Hypermetropia
B. Cataract
C. Macular degeneration
D. HTN retinopathy
E. DM retinopathy
Answer : B
A young girl presented to gynecologist for assessment with lower abdominal pain and per vaginal bleedin of
hysterosalpingograph as a part of her infertility treatment. Observation: BP=90/50mmHg, pulse-120bpm, and revealed
rigid abdomen.
What is the most appropriate next investigation?
A. Coagulation profile
B. Chest X ray
30 | P a g e
C. Ultrasound abdomen
D. X-ray erect and supine
E. CT SCAN
Answer : C
Explanation:
Likely cause of bleeding and shock is ruptured fallopian tube for which appropriate ne is US abdomen.
What is the most specific test for syphilis?
A. TPI
B. Treponema antibody absorption test FTA-ABS
C. FAAT
Answer : C
Explanation:
This test is used when a screening test for syphilis is positive to confirm that there is a true infection. A negative or
nonreactive result means there you do not have a current or past infection with syphilis. 52-Ans- Management of dog,
cat and human bite is essentially similar. They are managed with Amoxycillin/Clavulanate and Tetanus vaccine booster if
more than 5 years since last immunization/vaccine Dog and cat bite-Pasteurellamultocida Human bite-
EikenellaCorrodens Humab bites are more damaging then dog bite and cat bites
A patient presents with mild dyskaryosis. 1 year ago smear was normal. What is the most appropriate next test?
A. Cone biopsy
B. Cauterization
C. Repeat smear
D. Colposcopy
E. Swab and culture
Answer : D
Explanation:
For mild, moderate or severe dyskaryosis the next step is colposcopy.
Patient with major depression what is the first line treatment?
A. Tricyclic antidepressant
31 | P a g e
B. SSRIs
C. MAOI
Answer : B
Explanation:
A SSRIs are the initial antidepressants of choice for uncomplicated depression because of their minimal anti-cholinergic
effects
65years man had a bowel resection 5days ago. He is anuric and breathless. His BP=150/110mmHg.He has lung bases and
sacral edema. Bloods: K+=6.8mmol/l, urea=58mmol/l, creatinine=600umol/l.
What is the single immediate management?
A. Bolus of 20U insulin
B. 5% dextrose infusion
C. Calcium resonium enema
D. 10U insulin, 50ml of 50% dextrose infusion
E. Dextrose-saline infusion
Answer : D
45 year‫ג‬€™s female looking pale has bluish discoloration of hands whenever she goes out in the cold. She has reddish
spots on her body. She has symmetrical peripheral arthroplasty for the last year.
What is the most appropriate diagnosis?
A. Limited systemic sclerosis
B. Osteosarcoma
C. Chondrosarcoms
D. Diffuse systemic sclerosis
E. RA
Answer : A
A 64 year‫ג‬€™s man believes a female newscaster is communicating directly with him when she turns a page.
Where is he suffering from?
32 | P a g e
A. Delusion of Reference
B. Nihilistic
C. Grandeur
D. Control
E. Persecutory
Answer : A
Explanation:
A delusion of reference is a type of delusion wherein the individual perceives unrelated events or objects in his/her
surroundings to be of significance for himself/ herself. For example, a person with schizophrenia might believe a
billboard or a celebrity is sending a message meant for them.
Which of following favor diagnosis of SLE?
A. Raynaud syndrome
B. Joint deformity
C. Anti RNP+
D. Cystoid body in retina
E. Lung cavitations
Answer : C
A 61year man was found with K+=7.5 and ECG with prolong QRS complex.
What is the best possible treatment?
A. IV calcium gluconate
B. Dialysis
C. Loop diuretics
D. Salbutamol nebulizer
E. IV insulin and dextrose
Answer : A
Explanation:
In this high level of potassium, we have to shift this potassium into cells to red level and save heart from arrest or life
threatening arrhythmia. For keep the heart safe option of first choice in emergency is IV calcium gluconate! However, it
does not shift or reduce potassium level but protects heart from buy time for definitive measure to take place.
33 | P a g e
The patient passed a 4 mm stone in his urine. Does he have a 3mm stone in the renal pelvis found on an ultrasound?
A. ESWL
B. None
C. Surgery
D. Dormia basket
E. PCNL
Answer : B
Explanation:
Stones less than 5 mm in diameter pass spontaneously in up to 80% of people. -Stones between 5 mm and 10 mm in
diameter pass spontaneously in about 50% of people. -Stones larger than 1 cm in diameter usually require intervention.
A young man comes up with a headache, which he describes that this headache is the most severe headache in his life.
Which of the following will be less useful?
A. Lumbar Puncture
B. Do MRI or CT scan
C. Skull X ray
D. Asking more details about headache
Answer : C
An asymptomatic 56years man who has never consumed alcohol came for a routine checkup. Exam: increase spider
angioma, Cardiomegaly, S3 gallop, liver firm with 8cm span, no ascites.
He is in the risk of which condition?
A. Werniecke‫ג‬€™s encephalopathy
B. Hepatoma
C. Renal failure
D. cerebellar degeneration
E. Hepatic vein thrombosis
Answer : B
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A 75-yearold man has been attending the clinic for lower urinary tract symptoms. His mood is very low and he is
unhappy, anxious and unable to sleep. He has been diagnosed with moderate depression.
What treatment would you use for this patient?
A. Amitryptaline
B. CBT
C. Citalopram
D. Dosulepin
E. Diasepam
Answer : C
Explanation:
Mild depression = CBT, Moderate depression = Antidepressant, Severe depression & Ps = ECT, Amitriptyline and
Dosulepine causes urinary retention (which is comparatively less in citalopram) so no a patient with lower urinary
symptoms. Hence Citalopram is the preferred option.
A 30 years' woman presents with acute headache. She complains of seeing halos especially at night.
What is likely defect?
A. Mono-ocular field loss
B. Central scotoma
C. Paracentral scotoma
D. Cortical blindness
E. Tunnel vision
Answer : E
Explanation:
The diagnosis is glaucoma (headache and haloes especially at night). In glaucoma the vision.
A 75 year‫ג‬€™s lady who had mitral valve replacement 13 years ago has developed recurrent breathlessness. There is a
prominent pulsation in her neck. She complains of abdominal pain and ankle swelling.
What is the most probably diagnosis?
A. Aortic regurgitation
B. Mitral stenosis
C. Tricuspid regurgitation
35 | P a g e
D. Mitral regurgitation
E. Pulmonary stenosis
Answer : C
A homeless lady presents with cough and fever. She complains of night sweats and weight loss. CXR has opacity.
What is the next appropriate management?
A. IFN gamma testing
B. Mantoux
C. Bronchoscopy
D. AFB
E. CT chest
Answer : D
Explanation:
Cough and fever and night sweat and weight loss are very suggestive of TB. She should do AF investigation.
A 78-year-old woman is admitted to the intensive care unit for acute pulmonary edema. She has rales to the apices and
Jugular vein distention. Her EKG shows ventricular tachycardia.
Which of the following is the best therapy?
A. Synchronized cardioversion
B. Amiodarone
C. Lidocaine
D. Unsynchronized cardioversion
E. Procainamide
Answer : A
Explanation:
Synchronized cardioversion is used when ventricular tachycardia is associated with acute pulmonary edema.
Unsynchronized cardioversion is used for ventricular fibrillation or ventricular tachycardia without a pulse. Medical
therapy, such as lidocaine, amiodarone, or procainamide, can be used for sustained ventricular tachycardia that is
hemodynamically stable.
36 | P a g e
A child with a small head, minor anomalies of the face including a thin upper lip, growth delay, and developmental
disability can have all of the following, except:
A. A polygenic syndrome
B. Teratogenic syndrome
C. A mendelian syndrome
Answer : A
Explanation:
The features given can occur as a part of a chromosomal / teratogenic / mendelian syndrome. Polygenic in answer of
exclusion. In a polygenic inheritance, multiple genes are involved in the phenotypic expression. of polygenic inheritance
are hypertension and diabetes.
A 24-year-old male with a history of gang violence presents to the emergency room with 3 stab wounds to the abdomen.
He was intubated in the field for airway protection and is barely conscious. Blood pressure is 70/30 mm Hg and pulse is
140/min. On exam, 3 penetrating wounds covered by abdominal pressure pads are noted.
Which of the following is the best next step in management of this patient?
A. IV fluids
B. Abdominal x-ray
C. Obtain consent for surgery
D. IV antibiotics
Answer : A
Explanation:
This patient is in hemorrhagic shock and requires immediate resuscitation. Of the choices listed, the best next step in
management is IV fluids after obtaining venous access. The best form of venous access is 2 large-bore IVs in the
periphery and/or central venous access. Applying direct pressure to the abdomen (a) does not treat the underlying
cause. Getting an abdominal x-ray (b) will take too long for a patient with this rate of blood loss. IV antibiotics (c) may be
needed later in the care of this patient, but stabilizing blood pressure is now the more urgent need. Surgical consent (e)
is implied in a life-threatening emergency in which a patient cannot communicate his wishes.
A 47-year old man comes to the emergency department with fever, headache, photophobia, and a stiff neck.
What is the next best step in the management of this patient?
A. Head Ct scan
37 | P a g e
B. Lumbar puncture
C. Ceftriaxone and vancomycin
Answer : B
Explanation:
When you suspect bacterial meningitis, administer antibiotics quickly. Further, do blood cultures stat simultaneously
with a lumbar puncture (LP), or immediately prior. Penicillin can never be used as empiric therapy for meningitis; it is not
sufficiently broad in coverage to be effective empiric therapy. In this case, perform the
LP.
Condition not associated with increased alpha fetoprotein:
A. Myelomeningocele
B. Down syndrome
C. Spina bifida
D. Gastroschisis
Answer : B
Explanation:
Down syndrome associated with DECREASED levels of alpha fetoprotein. Not increased.
Reference:
https://en.m.wikipedia.org/wiki/Triple_test

A pregnant woman comes with weakness and elevated liver function tests. She is in her 35th week of pregnancy. The
prothrombin time is normal. The smear of blood shows fragmented red cells. Platelet count is low.
What is the treatment?
A. Delivery of the baby
B. Fresh frozen plasma
C. Prednisone
Answer : A
Explanation:
Deliver the baby with the HELLP syndrome. HELLP syndrome stands for hemolysis, elevated liver function tests, and low
platelets. This disorder is idiopathic and can be distinguished from DIC by the normal coagulation studies, such as the
prothrombin time and aPTT.
38 | P a g e
A 45-year-old woman has a 2-cm breast cancer tumor removed by lumpectomy, and the breast is irradiated. The cancer
is negative for estrogen receptors and positive for progesterone receptors. Three of 14 nodes removed from the axilla
are positive for cancer.
What is the next best step in management?
A. Tamoxifen and adjuvant chemotherapy
B. Oophorectomy and chemotherapy
C. Anastrozole (aromatase inhibitor) for 5 years
D. Tamoxifen for 5 years
Answer : A
Explanation:
Tamoxifen is used whenever there are either estrogen receptors or progesterone receptors positive. If both receptors
are positive, tamoxifen will be of greater benefit. Adjuvant chemotherapy is used whenever the axillary nodes are
positive or the cancer is > 1 cm in size.

A 62-year-old male comes to the GP complaining of double vision while climbing downstairs.
Which of the following nerve is most likely involved?
A. Oculomotor nerve
B. Optic nerve
C. Trochlear nerve
D. Trigeminal nerve
Answer : C

Female with recently inserted IUCD coming with watery brownish vaginal discharge & abdominal pain what is the most
likely diagnosis?
A. Bacterial vaginosis
B. D-ectopic pregnancy
C. Uterine rupture
D. Ovarian torsion
Answer : A
39 | P a g e
Old diabetic man with sudden unilateral visual loss. There is multiple pigmentation in retina with macular edema with
hemorrhage.
A. Diabetic retinopathy
B. Retinal vein thrombosis
C. Retinal artery occlusion
D. Retinal detachment
Answer : C

A 41-year-old woman awoke from a nap with severe pain in her index finger and found it to be flexed while all other
fingers were extended. When she tried to pull it free she heard a loud popping sound and the pain subsided. The
following day she comes to her doctor‫ג‬€™s office concerned about the sound and pain.
What is the most appropriate next stop in the management of this patient?
A. Steroid injection
B. Admit to the hospital.
C. NSAID therapy
D. Amputate the finger
E. Rehabilitate the finger
Answer : A
Explanation:
Trigger finger is an acutely flexed and painful finger. Steroid injections have been shown to decrease pain and recurrence
of trigger finger. It is the most cost- effective treatment, and studies have shown a trial of steroids should be attempted
prior to surgery. Trigger finger is caused by a stenosis of the tendon sheath leading to the finger in question. If steroids
fail, surgery to cut the sheath that is restricting the tendon is the definitive treatment.

In breast cancer, all true except:
A. Chemotherapy is must for pre-menopausal with +ve axilla
B. Yearly mammogram for contra-lateral breast
C. Radical mastectomy is the choice of surgery
D. 2 cm mass with free axilla is stage I
40 | P a g e
Answer : C

Pneumothorax is a complication of which of the following blocks?
A. Brachial
B. Epidural
C. High spinal
Answer : A

A 6-year-old girl presents with her 3rd episode of pallor and mildly icteric sclera associated with symptoms of mild upper
RTI. On examination, she has an easily tipped spleen.
Which one of following investigations is most likely to confirm her diagnosis?
A. Eosin-5-maleimide (E5M) staining test
B. Hb electrophoresis
C. Howell-jolly bodies in a RBC smear
D. Reticulocyte count
Answer : B

A premature infant is born with a patent ductus arteriosus. In closure can be stimulated by administration of:
A. Prostaglandin inhibitors
B. Anti-estrogen compounds
C. Estrogen
D. Prostaglandin analogue
Answer : A
Explanation:
Prostaglandin inhibitors Normally ductus arteriosus closes soon after birth. Vasodilatory effect of prostaglandin is what
maintains to ductus arteriosus in intrauterine life. Hence in cases of delayed closure of ductus arteriosus, we can use p
inhibitors to induce its closure.
41 | P a g e
A 31-year-old woman presents to the ED with a sudden onset of left-sided chest pain and difficulty breathing. She states
her only medication is birth control pills.
She has smoked 1 pack of cigarettes per day for 10 years. She is tachypneic (24 BrPM) and her heart rate is 120 beats per
minute. Physical examination reveals diminished breath sounds on the left and the trachea deviated to the right.
A. Tension pneumothorax
B. Pulmonary embolus
C. Pericardial tamponade
Answer : A
Explanation:
Tension pneumothorax presents with decreased breath sound on one side and tracheal deviation PE does not give
tracheal deviation, although it does have chest pain and tachycardia. Muffled heart sounds are seen typically in
pericardial tamponade. This patient's risk for pneumothorax is that she is a smoker. It is likely she has a pleural bleb that
burst due to her smoking history.

A 76-year-old woman is brought in for respiratory distress and altered mental status. Her medical history records right-
sided hemiplegia from a stroke several years ago. She has blood pressure 86/52; heart rate 123 BPM, breathing rate 33
Br PM, temperature 102.3ֲ°F, and O2 sat 84%. Exam reveals rhonchi bilaterally with ‫ג‬€E to Ah‫ג‬€ changes and warm
extremities with faint pulses. Chest x-ray shows bilateral infiltrates.
What is the likely etiology of this patient‫ג‬€™s hypotension?
A. Neurogenic shock
B. Cardiogenic shock
C. Septic shock
D. Hypovolemic shock
Answer : C
Explanation:
This patient is presenting with 3 SIRS criteria: hypotension, altered mental status, and a source of infection (pneumonia).
The physical exam is also consistent with septic shock: Massive vasodilation has yielded warm extremities and faint
pulses. Both hypovolemic shock and cardiogenic shock would have pale and cool extremities. There is no mention of
bleeding, ruling out hemorrhagic shock.
42 | P a g e
60 years old patient has only HTN best drug to start with:
A. Diuretics
B. ACEI
C. ARB
D. Beta blocker E-Alpha blocker
Answer : A
Explanation:
Antihypertensive therapy has been shown to reduce morbidity and mortality in older patients with elevated systolic or
diastolic blood pressures. This benefit appears to persist in patients older than 80 years, but less than one third of older
patients have adequate blood pressure control. Systolic blood pressure is the most important predictor of cardiovascular
disease. Blood pressure measurement in older persons should include an evaluation for orthostatic hypotension. Low-
dose thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting enzyme
inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line medications that should be
selected based on comorbidities and risk factors.
Reference:

Highest source/cause of increased ACTH in Cushing syndrome:
A. Increase ACTH from adrenal
B. Ectopic source
C. Increase ACTH from pituitary adenoma
D. Unknown
Answer : C

A 36-year-old woman presents with pains in both hands for the last few months and stiffness that improves as the day
goes on. Multiple joints are swollen on exam. X-rays of the hands show some erosion.
What is the single most accurate test?
A. ANA
B. Rheumatoid factor
C. Sedimentation rate
D. Anti-cyclic citrullinated peptide (anti-CCP)
43 | P a g e
Answer : D
Explanation:
Rheumatoid factor (RF) is present in only 7585"€‫ ג‬percent of patients with rheumatoid arthritis (RA).It can also be
present in a number of other diseases; hence, the
RF is rather nonspecific. Anti-cyclic citrullinated peptide (anti-CCP) is the single most accurate test for RA. It is > 95
percent specific for RA, and it appears earlier in the course of the disease than the RF. There is nothing specific on joint
aspiration to determine a diagnosis of RA.

Which of the following lowers mortality in COPD?
A. Home oxygen therapy (continuous)
B. Smoking cessation
C. Both of above
Answer : C

A 70-year-old man comes to the emergency department having had chest pain for the last hour. His initial EKG shows ST
segment elevation in leads V2‫ג‬€"V4.
Aspirin has been given.
Which of the following will most likely benefit this patient?
A. Diltiazem
B. Angioplasty
C. Thrombolytics
D. Metoprolol
Answer : B
Explanation:
Angioplasty will lower the risk of mortality most for this patient. If it can be obtained within 90 minutes, angioplasty is
the best therapy. Metoprolol lowers mortality but is not dependent on how soon you give it, as long as the patient
receives it before going home.

An infant boy is born at 39 weeks' gestation by way of spontaneous vaginal delivery to a healthy, 32-year-old primigravid
women. Prenatal care was appropriate and there were no problems at the time of delivery. Physical examination by the
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staff pediatrician is normal, with the exception of the genital examination. She observes that the urethral meatus is
located on the ventral aspect of the penile shaft.
Which of the following is the most correct statement about this condition?
A. The infant may have a circumcision now
B. Voiding cystourethrogram should be ordered
C. A-Circumcision should be delayed
D. The infant may never have a circumcision
Answer : C
Explanation:
This infant has hypospadias. This condition occurs when there is incomplete invagination of ectoderm that is located at
the glans penis where the normally located urethral meatus should be. When this occurs, the urethral opening is located
on the ventral side of the penis, somewhere between the tip and the base of the shaft. Circumcision should never be
performed directly after an infant is born with this condition (choice B). Rather, it should be delayed until approximately
6 months of age when the infant can better tolerate anesthesia. The reason to delay circumcision is because the prepuce
will be needed for the plastic reconstruction that will need to be done. At the time of reconstruction, the infant will also
undergo a circumcision (choice C). These patients do not have an increased risk for urinary tract infections. Therefore, a
urine culture is not necessary (choice D). A voiding cystourethrogram (VCUG) allows for evaluation of the bladder,
urinary reflux, and the presence or absence of posterior urethral valves. None of these conditions are associated with
hypospadias

Ophthalmoplegic migraine is best characterised as?
A. Headache associated with irreversible palsy of 3 nerve rd
B. Headache with optic neuritis
C. Recurrent headache with transient palsy of 3, 4 and / or 6 cranial nerves th
Answer : C
Explanation:
Recurrent headache with transient palsy of 3, 4 and / or 6th cranial nerves OPHTHALMOPLEGIC MIGRAINE It is a rare
condition which was previously considered as a type of migraine. Recent studies suggest that is it likely to be an
inflammatory cranial neuropathy. The International Headache Classification has reclassified ophthalmoplegic migraine as
a type of neur earlier classification as a type of migraine.It is characterised by transient migraine like headache asso
paresis of oculomotor, trochlear and/or abducens nerves.To arrive at a diagnosis of ophthalmoplegic m causes should be
ruled out by appropriate investigations
(like digital subtraction angiography / magne angiography of the brain).
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12 years old girl with malaise, fatigue, sore throat and fever. On examination there were petechial rash on palate, large
tonsils with follicles, cervical lymphadenopathy and hepatosplenomegaly.
All are complications except:
A. Chronic active hepatitis
B. Splenic rupture
C. Transverse myelitis
D. Encephalitis
E. Aplastic anemia
Answer : A

A man develops erectile dysfunction after an infarction. What is the most common cause?
A. ACE inhibitors
B. Anxiety
C. Aspirin
D. Nitrates
Answer : B
Explanation:
Anxiety is the most common cause of erectile dysfunction postinfarction. Although beta blockers may be the most
common medication associated with erectile dysfunction, anxiety is still a more common cause of erectile dysfunction
than beta blockers.

A pregnant lady comes at 37 weeks with 3+ proteinuria, confusion and Blood pressure 170/110 mmhg.
What is the best step in her management?
A. Admit and monitor / mgso4 E-Send home
B. Hydralazine
C. Deliver the baby immediately
D. C-section
Answer : C
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Hypogammaglobulinemia is often present at the time of the diagnosis.
Which one of the following clinical findings is NOT characteristic of chronic lymphatic leukaemia?
A. Coombs test is positive in 10-20% of cases
B. Bone marrow examination is essential to confirm the diagnosis
C. B-lymphocytes are the leukaemia cell line in the majority of cases
D. It converts to lymphoma
Answer : A
Explanation:
Bone marrow examination is essential to confirm the diagnosis Chronic lymphatic leukaemia (CLL) is characterized by
accumulation of small mature lymphocytes in the bone marrow and peripheral blood. The presenting features are
persistent lymphocytosis, lymphadenopathy and hepatosplenomegaly.
Hypogammaglobulinemia is often present at the time of the diagnosis. Autoimmune hemolytic anemia occurs in 25% of
cases. The diagnosis is usually confirmed on peripheral blood examination; bone marrow examination is rarely needed.
Evolution in to a more aggressive disease such as diffuse large cell lymphoma
(Richter‫ג‬€™s syndrome) can occur.

A 35-year-old car driver crashed into a concrete block without a safety belt on. Thirty minutes after and on the way by
ambulance to the hospital he begins to become breathless. On administration of 100% oxygen there is not much
improvement in this condition. On arrival at the Emergency Department he has lost consciousness and appears
cyanosed with markedly distended jugular veins. Blood pressure 80/40 mmHg Heart rate 120 /min Respiratory rate
34 /min
Temperature 36.6 ֲ°C. Oxygen saturation 60% on room air.
What‫ג‬€™s immediate action should be taken?
A. Rapid infusion of crystalloid
B. IV 0.2 mg adrenaline
C. Intubation and 100% oxygen
D. Needle decompression
Answer : D

A 42-year-old man presents with a target shaped rash that has developed over the last several days. He was on a
camping trip in the woods last week in Maine.
What is the next best step in management?
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A. Western blot
B. Doxycycline E-Ceftriaxone
C. ELISA
D. Serology for IgM
Answer : B
Explanation:
A rash suggestive of Lyme is enough to indicate treatment. A 5-cm-wide targetshaped rash, particularly with a history of
camping/hiking, is enough to indicate the need for antibiotic treatment with doxycycline. A characteristic rash is more
specific than serology.

A 11-year-old boy comes with decreased appetite and abdominal pain around his umbilicus. His parents think he doesn't
want to go to school, and while in math class he begins to have sharp pain in his right lower abdomen. He is rushed to
the ED and laboratory analysis shows a WBC of 12,500.
A. Acute appendicitis
B. Acute pancreatitis
C. Cholecystitis
D. Acute diverticulitis
Answer : A
Explanation:
Acute appendicitis presents with pain that originates in the umbilical region and later begins to localize to the right
lower quadrant. The patient will then develop signs of peritonitis. This patient is too young for diverticulitis.
Diverticultitis also gives pain in the left lower quadrant. Cholecystitis would present with right upper quadrant pain.
Pancreatitis would have midepigastric pain that radiates to the back with high amylase and lipase levels. The number
one consideration is the location of the pain. It gives away 95% of the diagnosis.

To prevent tetanus in neonate:
A. Give penicillin to child to kill tetanus bacilli
B. Give immunoglobulin to mother
C. Give tetanus toxoid to mother
D. Give antibiotics to mother
Answer : C
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Explanation:
Antitetanus vaccination in multiple doses (23"€‫ )ג‬is up to 98% effective in preventing neonatal tetanus and neonatal
tetanus deaths in under-resourced settings.
Single doses of the tetanus vaccine are not enough to prevent neonatal tetanus deaths. In addition to administration of
antitetanus vaccines, efforts should be made to ensure that women receive obstetric care to ensure clean deliveries.

The tumor, which may occur in the residual breast or overlying skin following wide local excision and radiotherapy for
mammary carcinoma, is:
A. Squamous cell carcinoma
B. Leiomyosarcoma
C. Angiosarcoma
D. Basal cell carcinoma
Answer : C

An elderly man comes to the emergency department with fever, headache, a stiff neck, and photophobia. He is HIV
positive with < 50 CD4 cells and a history of pneumocystis pneumonia. His head CT is normal. CSF shows 2,500 white
cells that are all neutrophils; Gram stain is normal.
What is the best initial therapy?
A. Cefoxitin and mefloquine
B. Fluconazole
C. Ceftriaxone, ampicillin, and vancomycin
Answer : C
Explanation:
Listeria monocytogenes is a cause of meningitis that is not adequately treated by any form of cephalosporin. Ampicillin is
added to the usual regimen of ceftriaxone and vancomycin to cover Listeria. This cannot be fungal meningitis, because
the CSF is characterized exclusively by a high number of neutrophils; neutrophils are not consistent with fungal
meningitis.
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A 28-year-old female presents with 1-week history of jaundice and 2days history of altered sleep pattern and moods.
She was diagnosed with hypothyroidism for which she is receiving thyroxine. Thyroid function showed increased TSH.
PT=70s.
A. Hyper-acute liver failure
B. Acute liver failure
C. Acute on chronic liver failure
D. Autoimmune hepatitis
Answer : D

The most common cause of SAH (subarachnoid hemorrhage) is ________________________.
A. Trauma
B. Congenital arteriovenous malformation
C. Berry Aneurysms
D. HTN
Answer : C
Explanation:
Subarachnoid hemorrhage is sudden bleeding into the subarachnoid space. The most common cause of spontaneous
bleeding is a ruptured aneurysm.
Symptoms include sudden, severe headache, usually with loss or impairment of consciousness.
Question 131
A 10-year-old child has got progressive bilateral hearing loss. He has started to increase the TV volume. All other is
normal.
A. Wax
B. Bilateral OM with effusion
C. Foreign body
D. Meningitis due to meningococcus
Answer : B
Question 133
A 27-year-old lady after C-section developed epigastric pain after 8h.
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What is the appropriate investigations?
A. Liver enzyme
B. Liver biopsy
C. ABG
D. Coagulation
Answer : A
Explanation:
Epigastric pain is a warning sign of HELLP syndrome. So to rule out HELLP syndrome should be done.
Question 134
Healthy parents have 2 children, a child with Cystic fibrosis and a healthy child. They want to have another are the
chances of that child being a carrier?
A. 1:2
B. 1:4
C. 1:8
D. 1:16
E. 2:3
Answer : A
Explanation:
As the parents have a child with cystic fibrosis and they are healthy both of them are carrier. autosomal recessive
disease where if both parents are carrier mode of inheritance is as follows: Chance of being child 1:4, Chance of being
diseased 1:4 and chance of being carrier 1:2.
Question 135
A 30-year-old female has chronic diarrhea, mouth ulcers and skin tags. She complains of visual problems, low morning
stiffness. Inv: ESR & CRP=raised,
Hgb=10mg/dl.
A. SLE
B. Seronegative arthritis
C. Gout
D. Reactive Arthritis
Answer : B
Explanation:
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Chronic diarrhea, mouth ulcers and skin tags are features of IBD. There is a w association between IBD and seronegative
arthritis (particularly AS). Here low back pain, visual problem, morn raised ESR and CRP, low hemoglobin indicates the
diagnosis of seronegative arthritis.
Question 136
Best method to maintain air way in conscious multiple injury is _______________________.
A. Intubation
B. Oropharyngeal device
C. Nasopharyngeal device
Answer : C
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