PROMETRIC EXAM PREPERATION FOR GP

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?
▪ Ceftriaxone + Flucloxacillin
▪ Vancomycin + Metronidazole
▪ Metronidazole + Erythromycin
▪ Ceftriaxone + Terbinafine
▪ Penicillin + Flucloxacillin
Explanation:
Penicillin + Flucloxacillin. Cellulitis is usually caused by bacteria, such as staphylococci or streptoc are commonly present
on the skin. So Penicillin + Flucloxacillin should be given

2. 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?
▪ SVT
▪ VF
▪ A-fibrillation
▪ VT
▪ Ventricular-ectopic
Explanation:
Palpitation, light headedness with a tachycardia of 170 bpm that is regular are most likely a SVT.

3. 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?
▪ Jejunal biopsy
▪ Thyroid function test
▪ Liver function test
▪ Serum glucose
▪ ECG
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.
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4. 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?
▪ Thoracic outlet syndrome
▪ Cervical rib
▪ Bronchogenic carcinoma
▪ Pancoast tumor
▪ Pneumonia
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 horner’s syndrome.

5. 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.
What is the most likely diagnosis?
▪ PTSD
▪ Acute stress disorder
▪ OCD
▪ Social phobia
▪ GAD
Explanation:
PTSD. Keep getting thoughts of his family disaster, insomnia, to avoid similar circumstances he is out these are
suggestive of PTSD.

6. 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:
▪ Tourniquet the limb to stop the bleeding
▪ Check the airway and breathing
▪ Five IV fluid
▪ Call orthopedic
Explanation:
As rule ABC also in description near amputation so difficult to make tourniquet enough which stops bleeding.

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7. lady presents with hot flashes and other symptoms of menopause.
What is the treatment option?
▪ Topical estrogen
▪ Conbined Oral Contraceptive
▪ Biosphosphonate
▪ Raloxifen
▪ Hormone Replacement Therapy

8. 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?
▪ Direct inguinal hernia
▪ Indirect inguinal hernia
▪ Femoral hernia
▪ Femoral aneurysm
▪ Strangulated hernia
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.

9. During a basketball match, one of the players suddenly collapsed to the ground with coughing and SOB.
What choice?
▪ V/Q
▪ CTPA
▪ MRI
▪ CT scan
▪ CXR
Explanation:
CXR. Likely diagnosis is pneumothorax. So investigation of choice is CXR

10. A 27-year-old man presents with abdominal pain. He says his urine is dark. Exam: BP=160/105mmHg.
What is investigation?

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 ▪ Urine microscopy
▪ Renal biopsy
▪ Urine protein
▪ US
▪ CT
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.

11. A 70-year-old man with prostatic cancer has had severe acute back pain waking him up at night for 6wks.

What is appropriate investigation?

▪ DEXA scan
▪ Serum ALP concentration
▪ Serum calcium concentration
▪ MRI spine
Explanation:
Radionuclide bone scan. MRI is good for soft tissue but not for bone. If it was radiculopathy, spina compression or
prolapsed disc creating pressure on nerve MRI would be fine but not for bony metastasis. Her choice is radionuclide
bone scan.

12. A 62-year-old man diagnosed with T2DM with BMI=33. Lifestyle modifications have failed to control blood. Labs:
urea=3.6mmol/l, creatinine=89mmol/l.

What is the next appropriate management?

▪ Sulfonylurea receptor binder
▪ Glitazone
▪ Biguanide
▪ Sulfonylurea
Explanation:
Explanation Patient is obese type 2 diabetic. So biguanide is the treatment of choice

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13. 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?
▪ Pancoast tumor
▪ Cervical rib
▪ Thoracic outlet syndrome
▪ Pneumonia
Question was not answered

14. The strongest type of epidemiological studies is:

▪ Time line
▪ Prospective cohort studies
▪ Retrospective control case studies
▪ Cross sectional
Explanation:
Prospective cohort study is a cohort study that follows over time a group of similar individuals (cohorts) who differ with
respect to certain factors under study, to determine how these factors affect rates of a certain outcome. For example,
one might follow a cohort of middle-aged truck drivers who vary in terms of smoking habits, to test the hypothesis that
the 20-year incidence rate of lung cancer will be highest among heavy smokers, followed by moderate smokers, and
then nonsmokers. The prospective study is important for research on the etiology of diseases and disorders. The
distinguishing feature of a prospective cohort study is that at the time that the investigators begin enrolling subjects and
collecting baseline exposure information, none of the subjects have developed any of the outcomes of interest. After
baseline information is collected, subjects in a prospective cohort study are then followed "longitudinally," i.e. over a
period of time, usually for years, to determine if and when they become diseased and whether their exposure status
changes outcomes. In this way, investigators can eventually use the data to answer many questions about the
associations between "risk factors" and disease outcomes. For example, one could identify smokers and non-smokers at
baseline and compare their subsequent incidence of developing heart disease. Alternatively, one could group subjects
based on their body mass index (BMI) and compare their risk of developing heart disease or cancer. Prospective cohort
studies are typically ranked higher in the hierarchy of evidence than retrospective cohort studies and can be more
expensive than a caseC control study. One of the advantages of prospective cohort studies is they can help determine
risk factors for being infected with a new disease because they are a longitudinal observation over time, and the
collection of results is at regular time intervals, so recall error is minimized.

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15. A 2-year-old baby with atrophy of the buttocks, distended abdomen with frequent offensive smelly stool.
What is the most likely investigation?
▪ Upper GI endoscopy
▪ Colonoscopy
▪ Stool culture
▪ Sweat test
▪ Endomysium/alpha gliadin antibody
Explanation:
Endomysium/alphagliadin antibody. Atrophy of buttock due to fat malabsorption and distended abdo (sometimes with
everted umbilicus) with frequent offensive smelly stools are seen in coeliac disease. Hence gliadin antibody should be
done.

16. A 57-year-old man having hypertension on oral anti-HTN. However, he is finding it difficult to mobilize as he tries to
get up.
What is the most appropriate investigation for him?
▪ ECG
▪ CXR
▪ Ambulatory BP
▪ CT SCAN
▪ MRI
Explanation:
Ambulatory BP. Ambulatory BP to document low BP as cause of presenting symptom. The case sees hypotension and
low BP as a result of given anti-hypertensive.

17. A new screening test has been devised to detect early stages of prostate cancer.
However, the test tends t of people with no cancer, although they do have cancer as diagnosed by other standard tests.
What is this flaw?
▪ True Cve
▪ False +ve
▪ Poor specificity
▪ True +ve
▪ False -ve
Question was not answered

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18. A 24-year-old woman known to be suffering from panic disorder presents to the hospital with tingling and nu fingers.
ABG: pH=7.52, PCO2=2.2kPa, PO2=11kPa, Bicarbonate-20.
What is the most likely condition?
▪ Acute respiratory alkalosis
▪ Compensated metabolic acidosis
▪ Compensated respiratory alkalosis
▪ Acute metabolic alkalosis
Explanation:
In panic attack there occurs hyperventilation which causes washout of acute respiratory alkalosis resulting in raised pH
>7.45 (here 7.52), low PCO2 (here 2.2 kPa) with compensatory HCO3 (here 20meq/l).

19. 19-year-old sexually active lady came for her annual check-up, she is otherwise healthy using no contraceptive, her
pap smear and all investigations are normal.
What will you suggest regarding her next check-up?
▪ After 6 months
▪ After 5 years
▪ After 1 year
▪ After 3 years
Explanation:
Usually pap smear should be started after 21 years of age regardless of sexual activeness but if a female is sexually
active and u suspect any abnormality then u can do pap smear before 21 years of age as in this case. Pap Smear =
Negative, then should be followed for screening after 3 years. Pap smear + HPV Testing = Negative, then should be
followed after 5 years

20. An 8 year’s boy has his tonsils and adenoids removed. On the 7th post-op day, he comes back to the hemoptysis and
fever.
What is the most appropriate management?
▪ Reassurance
▪ Packing
▪ Admit for IV antibiotics
▪ Surgery
▪ Prescribe oral antibiotics and discharge
Explanation:
Most secondary hemorrhage occurs due to infection which erodes a vessel. S be admitted for IV antibiotics.

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21. Which type of contraceptive is contraindicative in lactation?
▪ UID
▪ Depo-Provera
▪ Mini pills
▪ OCPs
▪ Condom
Explanation:

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.

22. A 2-days baby’s mother is worried about the baby’s hearing. Mother has a history of conductive hearing lo most
appropriate test?
▪ MRI
▪ Fork test
▪ CT scan
▪ Reassure
▪ Brain stem evoked response
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.

23. 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?

▪ Cohort
▪ Observational

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 ▪ Retrospective
▪ Case study
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].

24. 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.
What is the most likely diagnosis?
▪ Breast milk jaundice
▪ G6PD deficiency
▪ Galactosemia
▪ Congenital viral infection
▪ Biliary atresia
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.

25. After starting Antidepressant drug, if patient is not improving then when you decide to stop drugs?
▪ 3-4 weeks
▪ 1 day
▪ 1 week
▪ 2 weeks
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 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)

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26. A young woman fell and hit her knee. Exam: valgus test +ve.
What ligament was most probably injured?
▪ Lateral collateral
▪ Ant cruciate
▪ Post cruciate
▪ Medial collateral
▪ Meniscus
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.

27. 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?

▪ Flupenthixol
▪ Risperidone
▪ Haloperidol
▪ Fluphenazine
Explanation:
Protocol of treating agitated violent patient.
Try to talk to the patient but don’t touch him.
If he agrees on oral meds, give oral atypical antipsychotics olanzapine, risp or quetiapine
If refusing oral, give IV atypical antipsychotics preferably its Olanzapine or Risperidone
If agitation not controlled give IM Lorazepam
If that doesn’t work, give IV Haloperidol as last resort.
If acute sedation is required, for immediate effect give IV Diazepam.

28. A 14-year-old girl presents with primary amenorrhea and a short stature.
What is the most likely diagnosis?
▪ Down’s syndrome
▪ Fragile X syndrome

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 ▪ Turner’s syndrome
▪ Klinefelter’s syndrome
▪ Normal finding
Explanation:

Down’s syndrome and Fragile x syndrome don’t have primary amenorrhea. Klinefelter’s patients are tall males. So the
likely diagnosis is Turner’s syndrome.

29. A 65-year-old lady who is on thiazide suffers from falls in the morning.
What is the cause for her symptoms?
▪ Epilepsy
▪ Orthostatic hypotension
▪ TIA
Explanation:
Thiazide diuretic is associated with orthostatic hypotension.

30. 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 retrograde urethrogram.
▪ A voiding cystourethrogram.
▪ An intravenous pyelogram.
▪ A cystogram obtained after filling, until a detrusor response occurs.
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 • pelvic trauma in the emergency department • diminished urinary stream • urethral strictures •
urethral diverticula • urethral obstruction • suspected urethral foreign bodies • urethral mucosal tumors • suspected
urethral fistula

31. A 10-year-old child has got progressive bilateral hearing loss. He has started to increase the TV volume. All other is
normal.
What is the most likely diagnosis?
▪ Wax
▪ Bilateral OM with effusion

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 ▪ Foreign body
▪ Meningitis due to meningococcus

32. A 27-year-old lady after C-section developed epigastric pain after 8h.
What is the appropriate investigations?
▪ Liver enzyme
▪ Liver biopsy
▪ ABG
▪ Coagulation
Explanation:
Epigastric pain is a warning sign of HELLP syndrome. So to rule out HELLP syndrome should be done.

33. 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?
▪ 1:2
▪ 1:4
▪ 1:8
▪ 1:16
▪ 2:3
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.

34. 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?
▪ SLE
▪ Seronegative arthritis
▪ Gout
▪ Reactive Arthritis
Explanation:
Chronic diarrhea, mouth ulcers and skin tags are features of IBD. There is a w association between IBD and seronegative

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arthritis (particularly AS). Here low back pain, visual problem, morn raised ESR and CRP, low hemoglobin indicates the
diagnosis of seronegative arthritis.

35. 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?
▪ Loss of anithrombin III
▪ Stasis
▪ Protein C deficiency
▪ High estrogen levels
▪ Vasculitis

36. A 33 year’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?
▪ PCP cold agglutinins
▪ AFB
▪ Gram Cve doplicoccic
▪ Gram +ve doplococcic
▪ Coagulase +ve cocci
Explanation:
It is a case of community acquired pneumonia caused by streptococcus pneumonia.

37. 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?
▪ Alteplase
▪ Aspirin
▪ Simvastatin
▪ Dipyridamole
▪ Clopidogrel

38. 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?

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 ▪ ANA
▪ Skin scrap for mycology
▪ Skin swab for bacteria
▪ Biopsy lesion
▪ Lyme antibodies
Explanation:
Explanation Spreading annular rash suggests erythema migrans of lyme disease.

39. Drug of choice of generalized anxiety disorder is ______________.

▪ Acetalopram
▪ Bubropion
▪ Buspirone
▪ beta blocker
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.

40. Fluoxetine half-life after acute administration is ______________________________

▪ 1-4 days
▪ 6-9 days
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

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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.

41. 72-year-old lady is drowsy and her relatives want to take her home.
She has been prescribed diazepam 2.5m delivery route?
▪ Per rectal
▪ Intra Muscular
▪ Subcutaneous
▪ Oral
▪ Intravenous

42. 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?
▪ Raloxifene
▪ COCP (Combined OCP)
▪ Evening primrose
▪ Clonidine
▪ Estrogen

43. 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?
▪ Acute bronchitis
▪ Bronchiectasis
▪ Chronic bronchitis
▪ Lung cancer
▪ Pneumonia
Explanation:
Chronic bronchitis. There may be specks of blood in sputum in both bronchiectasis, acute and chronic. Duration of

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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.

44. A 25-year-old girl saw a tragic RTA in which a young boy was killed. The night of the event she couldn’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?
▪ Dissociation
▪ Generalize Anxiety disorder
▪ Post-traumatic Stress disorder
▪ Somatization
▪ Conversion
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

45. Best method to maintain air way in conscious multiple injury is _______________________.
▪ Intubation
▪ Oropharyngeal device
▪ Nasopharyngeal device

46. You are supposed to keep a child NPO he’s 25 kgs, how much you will give:
▪ 1500
▪ 1300
▪ 1400
▪ 1600
Explanation:
For first 10kg 100×10=1000 For next 10 kg 50×10=500 For next 5 kg 5×20= 100 So the total is 1600 ml.

47. 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?

▪ Accessory nerve

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 ▪ Hypoglossal nerve
▪ Glossopharyngeal nerve
▪ Facial nerve
▪ Vagus nerve
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.

48. 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?
▪ Ophthalmoscopy
▪ Checking red reflex
▪ Thyroid function test
▪ Visual field test
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.

49. 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.
What is the diagnosis?
▪ Green stick fx of distal radius
▪ Fracture neck of humerus
▪ Fracture mid ulnar
▪ Fracture mid radius

50. A 37-year-old woman presents with heavy bleeding. Investigation shows subserosal fibroid-4cm and intramu.
Which is the most appropriate treatment?
▪ Abdominal Hysterectomy

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 ▪ Vaginal Hysterectomy
▪ Abdominal Myomectomy
▪ Hysteroscopic Myomectomy
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.

51. Which vitamin has a protective effect against colon cancer?

▪ Vitamin C
▪ Vitamin D
▪ Folic acid
▪ Vitamin K
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.
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.

52. 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?
▪ Anti-histone

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 ▪ Anti-centromere
▪ Anti-ds DNA
▪ Anti Jo
▪ Anti Scl70
Explanation:
Features are suggestive of SLE. So most appropriate investigation from the given option DNA.

53. 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?
▪ ESWL (Lithotipsy)
▪ Dormier basket
▪ Fluids and alpha blockers
▪ PCNL

54. 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?
▪ Statin and glitazone
▪ ACEi and sulfonylurea
▪ Statin and Biguanide
▪ Statin and ACEi

55. 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?
▪ C7/T1
▪ C5/C6
▪ c8/T1
▪ C6/C7
Question was not answered
56. A 80 year’s man with prostatic cancer has confusion, thirst, abdominal pain and an abnormal ECG.
What is appropriate investigation?
▪ DEXA scan
▪ Redionuclide bones scan

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 ▪ Serum calcium concentration
▪ MRI spine
57. A 20 year’s man presents with painful swallowing. Exam: trismus and unilateral enlargement of his tonsils
Peritonsillar region is red, inflamed and swollen.
What is the most appropriate treatment?
▪ Oral antibiotics
▪ Analgesics with antipyretics
▪ I&D with antibiotics
▪ IV antibiotics and analgesics
▪ Tonsillectomy

58. An 18years female has periorbital blisters. Some of them are crusted, others secreting pinkish fluid.
What likely diagnosis?
▪ Rubella
▪ Shingles
▪ Measles
▪ Chicken pox
▪ Varicella
Explanation:
Shingles Ophthalmic division of trigeminal nerve. Typically, shingles is unilateral.

59. 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?
▪ Pseudohypoparathyroidism
▪ DiGeorge syndrome
▪ Chronic renal failure
▪ Uncontrolled thyroid functions
Explanation:
Secondary hyperparathyroidism Hypocalcemia, hyperphosphatemia, inc creatinine.

60. An 82-year-old man has woken up with incoherent speech and difficulty in finding the right words. Exam: good
comprehension.
Which anatomical site is most likely to be affected?

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 ▪ Pons
▪ Wernicke’s area
▪ Broca’s area
▪ Midbrain
▪ Parietal cortex
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 Wernicke’s aphasia, which is distinguished by a patient’s inability comprehend language or speak with
appropriately meaningful words though fluency, may be preserved.

61. 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?
▪ Continue same dose
▪ Stop meds
▪ Repeat the blood test
▪ Increase the dose
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.

62. Which of the following is not a degenerative corneal disease?

▪ Keratokonus
▪ Marginal dystropathy
▪ Fatty/lipid degeneration
▪ Moorens’s ulcer
▪ Band keratopathy
Explanation:
All other options are degenerative disease of cornea except Mooren’s ulcer which is ulcerative keratitis.

63. A terminally ill with metastatic carcinoma presents with dysphagia and difficulty in swallowing.
What is possible treatment?
▪ Analgesic

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 ▪ Cotrimazole
▪ PO fluconazole
▪ Nystatin suspension
▪ Amphotericin B IV
Explanation:
PO fluconazole. Treatment of carcinoma can predispose to development of esophageal candidiasis as follows: Oral
fluconazole (200 C 400mg) daily for 14 to 21 days (if needed IV fluconazole can also be given).

64. A lady developed breast abscess after delivery.

What is the most likely organism?
▪ GBS
▪ Staph albus
▪ Strep pyogenes
▪ Staph aureus

65. A 55 year’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?
▪ Corticosteroids
▪ Pan retinal photocoagulation
▪ Press over eyeball
▪ Scleral buckling
Explanation:

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.

66. A mother presents with her 14months child. He holds furniture and other things to help him stand and says ‘mama’
and ‘papa’. He makes eye contact and smiles. He can transfer objects from one hand to another.
What do you interpret from his development?
▪ Normal development
▪ Delayed social development
▪ Delayed fine motor development
▪ Delayed gross motor development

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 ▪ delayed verbal development

67. A 28-weeks pregnant woman presents with uterine bleeding after sexual intercourse.
What is the most appropriate diagnosis?
▪ Placental abruption
▪ Missed abortion
▪ Placental previa
▪ Ectropion
Explanation:
Post coital bleeding can be either placenta previa or cervical ectropion. But as ectropion pregnancy so it is the option
here.

68. 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.
What is the most probable diagnosis?
▪ PTSD
▪ GAD
▪ Social anxiety
▪ Agoraphobia
▪ OCD
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.

69. 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?
▪ Benzodiazepines
▪ Methadone
▪ Disulfiram
▪ Lithium
▪ Diazipoxide

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70. A patient with Type-1diabetes has a fundus showing micro-aneurysm and hard exudate.
What is the single diagnosis?
▪ Hypertensive retinopathy
▪ Diabetic background
▪ MS
▪ Macular degeneration
▪ Proliferative DM retinopathy
Explanation:
Diabetic background retinopathy. Microanurysm, hard exudates are seen in background diabetic ret

71. 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?
▪ ST segment elevation
▪ Right ventricular hypertrophy
▪ QT interval elongation
▪ Right bundle branch block
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.

72. 70 year’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?
▪ Nifedipine
▪ Digoxin
▪ Ramipril
▪ Atenolol

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73. 17 year’s female with lump in the breast, freely mobile, not attached to the skin.
What is the next investigation?
▪ Ultrasound
▪ Mammogram
▪ FNA
▪ Biopsy

74. A 20 year’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?
▪ Chondromalasia
▪ Myringitis
▪ Furuncle
▪ Otitis media
▪ Otitis Externa
Explanation:
Extreme tenderness to examine indicate otitis externa.

75. 60 year’s old patient has only HTN best drug to start with:
▪ Beta blocker
▪ ACEI
▪ Diuretics
▪ ARB
▪ Alpha blocker
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.

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76. A 78 year’s retired teacher was admitted for a hernioplasty procedure. After the operation he became agitate and
confused.
What is the most appropriate management?
▪ Diazepam
▪ Clozapine
▪ Chlordiazepoxide
▪ Thiamine
▪ Vitamin B

77. A woman with sickle cell disease complains of heavy menstrual blood loss.
What is the most appropriate combined oral contraceptive pills?
▪ Depot provera
▪ Transdermal patch
▪ Copper IUCD
▪ Mirena

78. A 28 year’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?
▪ Hypermetropia
▪ Cataract
▪ Macular degeneration
▪ HTN retinopathy
▪ DM retinopathy

79. 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?
▪ Coagulation profile
▪ Chest X ray
▪ Ultrasound abdomen
▪ X-ray erect and supine
▪ CT SCAN

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Explanation:
Likely cause of bleeding and shock is ruptured fallopian tube for which appropriate ne is US abdomen.

80. What is the most specific test for syphilis?

▪ TPI
▪ Treponema antibody absorption test FTA-ABS
▪ FAAT
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. 52Ans- 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

81. A patient presents with mild dyskaryosis. 1 year ago smear was normal.
What is the most appropriate next test?
▪ Cone biopsy
▪ Cauterization
▪ Repeat smear
▪ Colposcopy
▪ Swab and culture
Explanation:
For mild, moderate or severe dyskaryosis the next step is colposcopy.

82. Patient with major depression what is the first line treatment?
▪ Tricyclic antidepressant
▪ SSRIs
▪ MAOI
Explanation:
A SSRIs are the initial antidepressants of choice for uncomplicated depression because of their minimal anti-cholinergic
effects

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83. 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?
▪ Bolus of 20U insulin
▪ 5% dextrose infusion
▪ Calcium resonium enema
▪ 10U insulin, 50ml of 50% dextrose infusion
▪ Dextrose-saline infusion
Question was not answered

84. 45 year’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?
▪ Limited systemic sclerosis
▪ Osteosarcoma
▪ Chondrosarcoms
▪ Diffuse systemic sclerosis
▪ RA
85. A 64 year’s man believes a female newscaster is communicating directly with him when she turns a page.
Where is he suffering from?
▪ Delusion of Reference
▪ Nihilistic
▪ Grandeur
▪ Control
▪ Persecutory
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.

86. Which of following favor diagnosis of SLE?

▪ Raynaud syndrome
▪ Joint deformity
▪ Anti RNP+

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 ▪ Cystoid body in retina
▪ Lung cavitations

87. A 61year man was found with K+=7.5 and ECG with prolong QRS complex.
What is the best possible treatment?
▪ IV calcium gluconate
▪ Dialysis
▪ Loop diuretics
▪ Salbutamol nebulizer
▪ IV insulin and dextrose
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.

88. The patient passed a 4 mm stone in his urine. Does he have a 3mm stone in the renal pelvis found on an ultrasound?
▪ ESWL
▪ None
▪ Surgery
▪ Dormia basket
▪ PCNL
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.

89. 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?
▪ Lumbar Puncture
▪ Do MRI or CT scan
▪ Skull X ray
▪ Asking more details about headache

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90. 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?

▪ Werniecke’s encephalopathy
▪ Hepatoma
▪ Renal failure
▪ cerebellar degeneration
▪ Hepatic vein thrombosis

91. 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?
▪ Amitryptaline
▪ CBT
▪ Citalopram
▪ Dosulepin
▪ Diasepam
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.

92. A 30 years’ woman presents with acute headache. She complains of seeing halos especially at night.
What is likely defect?
▪ Mono-ocular field loss
▪ Central scotoma
▪ Paracentral scotoma
▪ Cortical blindness
▪ Tunnel vision
Explanation:
The diagnosis is glaucoma (headache and haloes especially at night). In glaucoma the vision.

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93. A 75 year’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?
▪ Aortic regurgitation
▪ Mitral stenosis
▪ Tricuspid regurgitation
▪ Mitral regurgitation
▪ Pulmonary stenosis

94. 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?
▪ IFN gamma testing
▪ Mantoux
▪ Bronchoscopy
▪ AFB
▪ CT chest
Explanation:
Cough and fever and night sweat and weight loss are very suggestive of TB. She should do AF investigation.

95. 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?
▪ Synchronized cardioversion
▪ Amiodarone
▪ Lidocaine
▪ Unsynchronized cardioversion
▪ Procainamide
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.
96. 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:

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 ▪ A polygenic syndrome
▪ Teratogenic syndrome
▪ A mendelian syndrome
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.

97. 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?
▪ IV fluids
▪ Abdominal x-ray
▪ Obtain consent for surgery
▪ IV antibiotics
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.

98. 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?
▪ Head Ct scan
▪ Lumbar puncture
▪ Ceftriaxone and vancomycin
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.99. Condition not associated
with increased alpha fetoprotein:

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 ▪ Myelomeningocele
▪ Down syndrome
▪ Spina bifida
▪ Gastroschisis
Explanation:
Down syndrome associated with DECREASED levels of alpha fetoprotein. Not increased.

100. 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?
▪ Delivery of the baby
▪ Fresh frozen plasma
▪ Prednisone
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.

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