Mcq Bank / Viva Questions

Zambian foreign trained doctors

Dr. K. Lupiya
Section A
Pediatrics section
1. While doing a ward round in a paediatric ward, a mother rushes over to call you to see her 4 year old
child who she has noticed stopped breathing. When you assess the child you observe that there is no
spontaneous breathing and no pulse. Your immediate management will be to?
• -Extend the head to a sniffing position and commence giving breaths using an ambu bag and
chest compressions in the ratio 2:15 and give an adrenaline injection to the heart through the
chest
• Give hydrocortisone and 10% dextrose intravenously and oxygen
• Extend the head to a sniffing position and commence and commence giving breaths using an
ambu bag and chest compressions in the ratio of 2:15 and give 10% dextrose
• Extend the head to a sniffing position, give 5 rescue breaths using an ambu bag and then process
with breaths and chest compression in the ratio of 2:15 and give 10% dextrose
2) While working in OPD, the triage nurse brings to you a 7 month year old infant from the queue whom
she has noticed is very sick. The baby is lethargic, has cool peripheries, a weak and thread brachial pulse
and a capillary refill time of 4 sec. The weight of the baby is 6kg and the mid-upper arm circumference is
12.5cm. The fluid management of this baby will be to give?
A. 120mll normal saline fluids as a bolus to run rapidly within 15min.
B. 90% normal strength darrows in 10% dex. Over 1 hour
C. 600ml normal saline maintenance fluid in 24 hours
D. 180ml half strength darrows in 10% dex. Over 1 hour and then 420ml over 5 hours
3) Zinc sulphate in diarrheal disease
A. Reduces the duration and severity of the diarrhea episodes for up to 3 months
B. Should be given for 5 days
C. Has benefit in acute but not persistent diarrhea
D. should be reserved for diarrhea disease with established zinc deficiency
4) mapalo a 6 year old boy is brought to the hospital with complaints of weakness and shortness of
breath on exertion. On evaluation ,he is found to have hypochromic, microcytic anemia with
reticulocytopenia . The likely cause of his anemia may be?
A. Sickle cell anemia
B. Lead poisoning
C. Aplastic anemia
 D. HIV infection
5) You are on call attending to a 2 year old child in OPD who had been brought in for fever for the past
two days. While taking the history, the child stats having generalized tonic clonic seizures. Your
immediate management of the child within the first 5 min. will be to

• Give the child 10% dextrose and the diazepam intravenously

• Give the child 10% dextrose and then phenobarbitone loading dose intravenously
• Extend the head to a sniffing position and turn the head to the side, give high flow oxygen and
10% dextrose
• Put a wooden tongue depressor across the mouth to keep the child from biting the tongue and
give diazepam

6) The primary prevention of Rheumatic fever includes

A. Monthly benzathine penicillin injections in children with RHD
B. Echocardiography screening of all children presenting with a murmur
C. treatment with an antibiotic before a dental procedure in RHD
D. Treating all sore throats with pen v for 10 days
7) According to the Zambia Demographic and health Survey of 2013-14 the following are true except
A. the neonatal mortality rate is 24 deaths per 1,000 live births
B. Infant mortality is defined as the probability of dying between birth and the first birthday
C. child mortality is the probability of dying between exact ages 1 and 5
D. Infant mortality rate is 45 deaths per 1,000 live births
8) Pellagra
A. Is caused by vitamin B12 deficiency
B. Causes mainly skin and GIT symptoms
C. Occurs in unfortified maize diets low in tryptophan
D. Causes skin lesions in Sun-covered areas
9) The principles of management of severe malnutrition includes the following except
A. treat/prevent Anemia
B. Treat/prevent hypoglycemia
C. Correct electrolyte imbalance
D. Start cautious feeding
10) Speech delay is
A. commoner in females
B. common in Autism
C. Associated with a tongue tie
D. family history is usually irrelevant
11) Which of the following is major Duckett-jones criteria for the diagnosis of rheumatic fever
A. Arthralgia
B. Subcutaneous nodules
C. Huntington’s chorea
D. Erythema nodosum
12) A 16 year old boy presents to the Emergency department with chest pain, fever, fatigue,arthralgias.
His past medical history is significant for Rheumatic heart disease and a dental procedure a few weeks
before admission. He currently shows no “stigma” of endocarditis. On physical examination although
endocarditis is suspected. The most likely organism is
A. viridans streptococci
B. Staphylococcus Aureus
C. Enterococcus fecalis
D. Pneumococcus
13) A patient involved in an accident finds that he is unable to taste sweet/sour or salty tastes. Which of
the following cranial nerves is likely to be responsible for this sensory loss?
A. facial nerve
B. Hypoglossal nerve
C. glossalpharyngeal nerve
D. vagus nerve
14) A 7 year old girl presents with acute cough and wheeze and is given nebulized zalbutamol. Which of
the following is an indication for admission to the hospital?
A. A peak flow rate of 80% of that predicted for height
B. Respiratory rate of 40/min
C. Saturation of 90% in air
D. bilateral Rhonchi
15) concerning tuberculosis
A. Cavitary tuberculosis is uncommon in children younger than 5 years
B. Overcrowded living conditions do not significantly affect prevalence
 C. The treatment of lymph node infection is of a greater duration than pulmonary infection
D. The tuberculin skin test is a good indicator of disease activity
16) In acute bronchiolitis
A. Dexamethasone is the treatment of choice for hospitalized cases
B. Lung volume is usually decreased
C. Bronchodilators are usually effective
D. feeding difficulties are common
17) Oal rehydration therapy
A. Works by active cotransport of glucose and sodium at the intestinal lumen
B. Should not be used in hypernatremic dehydration
C. Contains 6 mmol/l of potassium
D. can be made up safely at home using salt and sugar
18) In Examination of the cardiovascular system in childhood
A. ventricular septal defect may not be clinically detectable in the first few days of life
B. Intercostals recession is useful evidence for a right to left shunt
C.Normal femoral pulses at birth exclude co-arctaton of aorta
D. Peripheral oedema is a valuable sign of heart failure in infancy
19) Congenital syphilis
A. Is not likely to a baby born to a mother who had a positive RPR in pregnancy and was treated
With an alternative penicillin
B. Is always unlikely when RPR is negative in the baby
C. Can only be transmitted in the first trimester of pregnancy
D. Can cause deafness if left untreated
20) Concerning management of diarrhoea in severe malnutrition. The following are true except
A. Skin turgor and moistness of mucosa membranes constitute good indicators of a patients
Hydration status
B. ReSoMal is the preferred fluid for oral rehydration
C. Fluids which are hypertonic are preferred for management of shock in malnutrition because this
This fluid allows use of smaller volumes
D Management of hypovolemic shock involves use of normal saline boluses
21) Which statement is true regarding community acquired pneumonia in infancy?
A. Streptococcus pneumoniae is the most common pathogen
B. It is never caused by staphylococcus aureus
C. Ciprofloxacin is an appropriate treatment if blood cultures are negative
D. It may be caused by mycoplasma species
22) Which of the following is a recognized cause of acute upper airway obstruction?
A. Angio-oedema
B. Asthma
C. Mumps
D. Laryngomalacia
23) The following is not a recognized complication of foreign body inhalation
A. Pulmonary abscess
B. Asthma
C. Sudden onset cough
D. Hyperinflation of the opposite lung
24) Which of the following statements is true about juvenile idiopathic rheumatoid arthritis?
A. Juvenile idiopathic arthritis is a common rheumatic disease of children and a major cause of
Chronic disability
B. Vascular endothelial hyperplasia is not prominent
C. It is characterized by infiltration of eosinophilic cells
D. The involved joints are usually erythematous
25) In ventricular septal defects (VSD)
A. The smallest defects tend to produce the softest murmurs
B. Left to right shunting leads to increased risk of cerebral abscess
C. There maybe diastolic murmur at the apex
D. The systolic murmur increases in intensity as pulmonary hypertension develops
26) A 12 year old girl presents with anxiety and weight loss. She is noticed to have a fine tremor and a
pulse of 100 beats /min. Thyroid function tests confirm thyrotoxicosis. Which of the following statements
is true of thyrotoxicosis in children?
A. Is more common in males
B. Is often associated with short stature
C. Is usually not due to an auto immune process
 D. Is treated in the first instance with anti-thyroid drugs such as carbimazole
27) Sickle cell anemia presents with the following except
A. Reticulocytosis is noted in parvovirus B19
B. Dactylitis is frequently the first presentation of SCD
C. Acute splenic sequestration may occur as early as week 5 of age
D. Trans cranial Doppler velocity >200cm/sec. is a predictor for a stroke
28) You are reviewing an 8 year old boy who was admitted a day ago in DKA. One admission he was semi
conscious but improved after treatment was initiated. However the nurse reports that his condition has
deteriorated and he is now unconscious and has irregular respirations and a raised blood pressure. The
likely cause of this deterioration in this condition is
A. Rising hyperglycemia due to unresponsiveness to insulin
B. Cerebral edema due to excessive fluid administration
C. Hypoglycemia due to rapid insulin administration
D. hypokalemia due t insufficient potassium chloride administration
29) A previously 4 year old boy is brought to the clinic with an acute onset of bleeding after a minor
injury to the foot. The bleeding continues despite the application of pressure. Subsequently the patient
is noted to develop diffuse swelling of the left elbow joint and right knee joint. The most likely diagnosis
is
A. Hemophilia A
B. Idiopathic thrombocytopenia purpura
C. Aplastic Anemia
D. Acute lymphocytic leukemia
30) Which of the following statements is true about ready to use feeds (RUTF)
A. Feed of choice I the acute phase of severe malnutrition treatment
B. Not used in children with Edema
C. Has the same nutritional value as F100
D. Is superior to F100 in nutritional value
31) Sydenham’s chorea
A. Typically occurs about 10 days after streptococcal infection
B. Causes behavioral problems
C. Does not require secondary penicillin prophylaxis
D. Alone cannot make the diagnosis of acute rheumatic fever
32) An infant who is 7 months old is able to do the following except
 A. Roll over from supine to prone position and vice versa
B. Pincer grasp
C. make monosyllabic sounds (ba,da,pa)
D. Recognize strangers/stranger anxiety
33) Co-trimoxazole is used as prophylaxis against the following except
A. Pneumocystis jirovecii pneumonia
B. Toxoplasmosis
C. Isosporidia
D. Histoplasmosis
34) TB meaningitis is treated with the following combination of anti-tuberculosis drugs
A. 2HRZE, 4HR
B. 2HRZE, 10HR
C.2HRZE, 3HRZ, 10HR
D. 2HRZE, 10HR
35) A child has been admitted with severe pneumonia. Ablood culture showed a gram negative aerobic
bacilli. The causative agent is
A. Streptococcus pneumonia
B. Listeris monocytogenes
C. Mycoplasma pneumonia
D. Pseudomonas aeruginosa

36. Martin a 2 year old boy is referred from Kasama general hospital with a history of
difficulties in breathing and signs of heart failure. On examination the child had finger
clubbing and central cyanosis. The ECG showed tall P waves, right axis deviation and tall R
waves in V1 and V2. The most likely diagnosis is:
a. Tetralogy of Fallot
b. Tricuspid atresia
c. Pulmonary hypertension
d. Transposition of the great vessels
e. Ebstein anomaly
 37. A 2 year old child previous well presents with a progressive history of weakness, lethargy
and fever. Prior to the onset of the above symptoms there is a history of vomiting and
sudden repeated episodic severe paroxysmal colicky pain accompanied by straining efforts
with knees and legs flexed and loud cries. There is also a history of passing red currant jelly
stool comprising blood-stained mucus. What is the most likely diagnosis?
a. Enterocolitis
b. Intussusception
c. Henock-Schonlen Purpura
d. Meckel diverticulum bleeding
b. Gastroenteritis

38. Which of the following is a common clinical presentation of gastro-esophageal reflux

(GERD) in a 13 years old girl?
a. Difficulty in swallowing
b. Regurgitation of food
c. Failure to gain weight
d. Abdominal and chest pain
e. Feeding aversion

39. The following statement is true about Downs syndrome:

a. There is a recognized association with pyloric stenosis
b. Most cases are due to chromosomal translocation
c. Patients with severe mental retardation are usually due to mosaicism
d. Half of Down syndrome babies are born from young women
e. The large number of Down syndrome babies are born from women above the age of
35 years

40. A 2 year old child with Cerebral Palsy, Choreoathetoid type secondary
to Kernicterus is at
increased risk of having;
a. Blindness
b. Deafness
c. Microcephaly
d. Macrocephaly
e. Severe mental retardation
41. A 10 day old neonate is seen in the emergency room with features of congenital syphilis.
The cerebral spinal fluid done shows involvement of central nervous system. The treatment
of this child will be:
a. Intravenous crystalline penicillin for 14 days

42. Monica has been on antiretroviral drugs for HIV for the past 3 years. She is now planning
to have a child and plans to breast feed the child as she has heard that breast milk has a lot
of benefit. She wants to know if there is something which can be done to prevent her pass
the infection to her child. Which of the following is a correct advice to the mother?
a. Give Nevirapine to the infant for 6 weeks after birth

43. A diagnosis of Fallot’s tetralogy is supported by:

a. Cyanosis at birth.
b. Left ventricular hypertrophy on ECG.
c. Episode of squatting.
d. Pulmonary plethora on chest x-ray.
e. A murmur loudest at the lower left sternal edge.

44. The most common organism in patients with empyema (purulent pleurisy) is:
a. Staphylococcus aureus
b. Group A Streptococcus
c. Tuberculosis
d. E. coli
e. Streptococcus pneumoniae

45. The order of development of secondary sexual characteristics in males is:

a. Testicular development — pubic hair — Axillary hair — beard
OBS AND GYN. Remember answers are from all booklet

1. In eclampsia, which is true?

A. Caesarean section must be carried out in all cases
B. Hypotensive drugs should not be used
C. Urinary output is increased
D. Ergometrine should be avoided
2. the following , the greatest predisposing cause of puerperal infection is
A. Retained placental tissue
B. Iron deficiency
C. Poor nutrition
D.Maternal exhaustion
3. The most common complication of breastfeeding is
A. Amenorrhea
B. Excessive weigh tloss
C. Puerperal mastitis
D. Breast abscess
4. Face presentation in labor, which is correct?
A. All cases must be delivered by c-section
B. The presenting diameter id occipitofrontal
C. The fetal head is hyperflexed
D. Mentoposterior position must be delivered by c section
5. An absolute contraindication of vagina breech delivery is
A) Hyperextension of the head
B) Prolonged latent phase of labor
C) A fetus with estimated biparietal diameter of 9cm
D) Previous pregnancy loss
6. Which is a contraindication of induction of labor?
A) History of upper segment c-section
B) Severe PET at 39 weeks
C) Gestation diabetes on insulin at 39 weeks
D) Post term pregnancy
7. In HIV infection which of the following is correct
A) A pregnant woman should wait for delivery to commence antiretroviral therapy
B) Breast feeding increase transmission to the baby without therapy
C) C-section increases transmission of infection to the baby
D) Negative HIV antibodies guarantees absence of infection
8. In cases with premature rupture of membranes, all the following are acceptable in the
Conservative management except
Frequent vaginal examination to assess cervical dilatation
Serial complete blood count to diagnose rising of WBC
Close monitoring of maternal vital signs
Ultrasound to assess fetal weight and amount of liquid

9. Obstructed labor which is true

A) Diagnosis only when the cervix is fully dilated
B) Usually predicted before onset of labor
C) More common in developed countries
D) Mento-posterior position could be a cause
10) Regarding benign endometrial polyps all are the correct except
A) May present with postmenopausal bleeding
B) May present with menorrhagia
C) Are often pre malignant
D) Can be diagnosed by hysteroscopy
11) Acceptable treatment foe uterine fibroids includes all the following except
A) Myomectomy during pregnancy if red degeneration occurs
B) Myomectomy
C) Hysterectomy
D) GnRH agonist
12) primary dysmenorrhagia is most likely caused by
A) Uterine hypercontractility
B) Increased parity
C) High level of estrogen
D) coitus during menses
13) Menorrhagia, which is true
A) Intermittent irregular vaginal bleeding
B) Heavy menstrual cycle more than 80 ml
C) Infrequent spaced cycles every 45 days
D) The main presentation in case of Asherman’s syndrome
14) Postmenopausal women, all are false except
A) Malignancy is the commonest cause of postmenopausal bleeding
B) FSH and LH are characteristically low
C) Fibroid uterus tends to grow bigger
D) Hormonal replacement therapy increases the risk of breast cancer
15) The use of unopposed estrogen (without progestin) in menopausal women increases the risk of
A) Endometrial cancer
B) Ovarian cancer
C) Bone cancer
D) Bowel cancer
16) Detrusor instability should be managed by all except
A) Drug therapy
B) Electrical therapy
C) Operative therapy
D) Psychiatric therapy
17) Which one statement best describes urinary stress incontinence is
A) The loss is of small amount of urine when intra abdominal pressure increases
B) Inability to control the bladder of all urine
C) Inability to pass urine
D) Constant loss of small amounts of urine
18) The treatment of cystocele in a 32 year old may include the following except
A) Pelvic floor exercise
B) Weight loss
C) Anterior calporrhaphy
D) Vaginal pessary
19) Perinatal mortality correctly refers to which one
A) Number of stillbirths per 1000 total births
B) Number of stillbirths and early neonatal deaths per100 total births
C) Number of still births and neonatal deaths per 1000 live births
D) Number of still births and neonatal deaths per 100 000 total births
20) Treatment of pelvic inflammatory disease (PID) includes all the following except
A) Oral doxycycline
B) Removal of IUCD
C) Clindamycin
D) Dilatation and Currettage (D&C)
21) All the following are possible causes of anovulation except
A) Anorexia nervosa
B) Polycystic Ovarian Syndrome
C) Premature Ovarian failure
D. Sickle cell trait
22) Postmenopausal women which one statement Is true
A) Malignancy is the commonest cause of postmenopausal bleeding
B) FSH and LH are characteristically low
C) Fibroid uterus tends to grow bigger
D) Hormonal replacement therapy increases the risk of breast cancer
23) An obese 63 years old woman present with a 3 month history of continuous scanty bleeding .
After adequate history and physical examination what is your one main recommendation?
a. Cervical cone biopsy
b. D&C
c. Cycling with progestin
d. Official visit every 6 month for the evaluation

24) A 23 years old G1P0 presents at 18 weeks gestational age with right sided groin pain. It is sharp
And occurs with movement and exercise. There was no change in urinary or bowel habits, nor
any fever or chills. A heat pad helps alleviate discomfort. The most likely etiology of this pain is
A. Round ligament pain
B. Preterm labor
C. Kidney stone
D. Urinary tract infection

25) A 35 year old woman non pregnant, para 3 complains of sever , progressive secondary dysmenorrhea
and menorrhagia .Pelvic examination demonstrates a tender diffusely enlarged uterus with no adnexal
tenderness. Results of endometrial biopsy are normal. This patient most likely has
A. Endometriosis
B. Endometritis
C. Adenomyosis
D. Uterine sarcoma

26) A postpartum woman after a normal delivery complains she still bleeding from the vagina, it is
normal for bloody lochia to last up to
A. 2 daya
B. 5 days
C. 8 days
D. 14 days

27) In patient with three consecutive spontaneous abortion in the second trimester, the most useful
investigation is
A. Chromosomal analysis
B. Hysterosalpingiogram
C. Endometrial biopsy
D. Post coital test

28) The combined contraceptive pills, which is true

A) Pre dispose to PID
B) Predispose to ovarian cyst
C) Predispose to benign breast cyst
D) Contraindicated in a patient with history of deep vein thrombosis
29) Vulvovagina candidiasis, which is false
A) Frequently associated with systemic symptoms
B) Maybe diagnosed microscopically by mixing discharge with KOH
C) Is treated with doxycycline.
D) Is one of the sexually transmitted diseases
30) Which of the following is a late sequel of salpingitis
A) Endometrial hyperplasia
B) Fallopian tube cancer
C) Hydrosalpinx
D) Cervicitis
31. Evaluation of infertile couples, which one statement is true?
A) History of regular cycles is suggestive of anovulation
B) History of severe dysmenorrhea and dyspareunia is suggestive of endometriosis
C) Endometriosis is diagnosed by hysteroscopy
D) Thyroid disease does not affect fertility
32) Induction of ovulation agents
A) Clomiphene citrate is an anti androgen
B) Gonadotropins is given orally
C) Ultrasound is not needed with induction
D) Causes multiple follicles
33) The presentation of Asherman’s syndrome typically involves:
A) Hypomenorrhea and amenorrhea
B) Galactorrhea
C) Metrorrhagia
D) Dysmenorrhea
34) Secondary Amenorrhea is a recognized feature of
A) Imperforated hymen
B) Testicular ferminization syndrome
C) Pregnancy
D) Sickle cell anemia
35) Which one of the following factors predisposes th genital prolapse
A) Repeated LSCS
B) Multiparity
C) Pelvic inflammatory disease
36) Which one statement is true regarding bleeding continuing for four weeks after delivery?
A) Is most likely to be due to retained products of conception
B) Maybe physiological
C) Is associated with cancer of the endometrium
D) Is commonly due to choriocarcinoma
37) Regarding breech presentation, which one statement is false
A) The preferred method of delivery at term for a multiparous with an investigated breech is
C- section
B) The shoulders are delivered by the Mauriceau smellie veit procedure
C) Is sometimes due to fetal congenital abnormalities
D) Cord compression during delivery is the main cause of fetal morbidity or death
38) The following are true of rupture of the uterus except
A) Fetal distress
B) Haematuria
C) Hypotension
D) Rectovaginal fistula
39) When compared to singleton pregnancy ‘multiple pregnancy/ is associated with higher incidence of
which one of the following
A) Fetal macrosomia
B) Preterm deliveries
c) B12 Deficiency
D) Postpartum haemorrhaga due to placenta praevia
40) Disseminated intravascular coagulation (DIC), which one statement is true?
A) Can cause decrease fibrinogen degeneration products
B) Can cause decrease in PT and PPT
C) Is characterized by increased platelet count
D) Can be encountered in case of IUFD
41) The most serious maternal complication of intrauterine fetal death (IUFD)
A) Acute amnionitis
B) Acute psychosis
C) pelvic thrombophlebitis
D) Hypofibrinogenemia
42) A pregnant woman in her 32nd weeks of gestation is given magnesium sulfate for pre eclampsia. The
earliest clinical indication of hypermagnesemia is
A. Loss of deep tendon reflexes
B. Flaccid paralysis
C. Respiratory arrest
D. Stupor

43) The greatest diameter of the fetal head is

A) Occipitofrontal
B) Occipitomental
C) sub occipital bregmatic
D) Biparietal
44) Moulding of the fetal head in labor, which statement is correct?
A) Usually causes brain damage
B) Becomes progressively easier as gestational age increase
C) Does not have time to occur in breech delivery
D) Does not happen when maternal pelvis is adequate
45) A transverse lie of the fetus is least likely in the presence of
A) Placenta previa
B) Pelvic contraction
C) Preterm fetus
D) Normal term fetus
46) what is the station where the presenting part is at the level of the ischal spine
A) -2
B) -1
C) 0
D) +1
47) Which of the following is not a characteristic of normal labor
A) Progressive cervical dilation
B) Increasing intensity of contractions
C) Moderate bleeding
D) Moderate pain
48) Components of biophysical profile include all the following except
A) Fetal movement
B) Placental thickness
C) Fetal tone
D) fetal breathing movement
49) Atonic postpartum hemorrhage is best managed with
A) Intra-venous progesterone
B) Ten units oral syntocinon and uterine massage
C) Uterine massage
D) Uterine massage with oxytocin infusion
50) Which of the following is always an indication for caesarean section
A) Hydrocephalus
B) Abruptio placenta
C) Active primary genital herpes
D) Severe pre-eclampsia

51.The following characteristics of ovarian masses are more suggestive of a malignant than
benign etiology, EXCEPT?
a. Bilaterally
b. Cystic consistency
c. Ascites
d. Hydronephrosis
e. Thick septa
52. Uterine prolapse – all are correct EXCEPT?
a. Can be diagnosed when the cervix protrudes through the vulval orifice
b. Is also known as complete procidentia if third degree
c. Typically presents with menorrhagia.
d. Causes lumbar backache.
e. Is best examined with a bivalve Sim’s speculum

53. All the following are true regarding septic abortion, EXCEPT:
a. May result after an attempted criminal abortion
b. is frequently due to coliforms
c. should be treated by immediate curettage of the uterus
d. may lead to endotoxic shock
e. risk of clostridia infection is a remote possibility

54. In polycystic ovary syndrome, which one is FALSE?

a. obesity is common
b. there is loss of hair
c. FSH levels are high
d. Irregular, widely spaced menstruation is typical
e. Clomifene may restore the ovulation and menstruation

55. Regarding hyperprolactinaemia, which one is FALSE?

a. dopamine is an inhibitor
b. may be due to use of the combined oral contraceptive pill
c. bromocriptine is an inhibitor
d. can manifest as galoctorrhea
e. visual disturbances can be an association

56. Regarding cephalohaematoma, which one of the following statements is TRUE?

a. Is caused by oedema of the subcutaneous layers of the scalp
b. Should be treated by aspiration
c. Most commonly lies over the occipital bone
d. Typically gets infected
e. May result in ossification and asymmetry of the skull

57. For a pregnant woman that is HIV positive, all are true EXCEPT?
a. HIV viral load to be done every 6 months during pregnancy
b. Those on Cotrimoxazole Prophylaxis Therapy (CPT) should not be given
Sulfadoxine-Pyrimethamine (SP; malaria prophylaxis in pregnancy)
c. Combination antiretroviral therapy including Dolutegravir (DTG), a newer
Integrase Inhibitor is safe in pregnancy
d. Known HIV-positive women on cART for more than 12 weeks
Continue cART All exposed infants to be put on AZT/3TC+NVP for 6 weeks
e. Mothers should exclusively breastfeed HIV-infected infants and young children for
6 months minimum and may continue up to 2 years old

58. Regarding augmentation of labour, which one statement is TRUE?

a. is more often required in multiparous patients
b. aggravates fetal distress
c. can be carried out using an infusion of ergometrine
d. requires intramuscular oxytocin
e. commonly uses misoprostol

59.

Surgery

1. Causes of fistula include the following except

A. Crohn’s disease
B. Cholecystitis
C. Penetrating wound
D. Anastomotic leak

2.Partial thickness burns

A. Sunburn involves the epidermise and part of the dermis
B. Expect blistering and peeling in a few days
C. Heal in 3 to 4 weeks and generally has scaring
D. They need antibiotics cover

3. Which of the following is the best guide to fluid replacement in burns patient?
A. Hemoglobin and haematocrit
B. Urine output
C. Urine osmolality
D. Specific burns

4. HIV and surgery , the cardinal rules are that

A. A used needle can safely be used after 10 seconds since that virus is dead
B. Saliva is assumed contaminated
C. Gloves are 100% safe
D. Recap the needles after using both hands

5. A swelling in a 10 year old boy on the left lateral groin is most likely
A. Undescended testicle
B. Inguinal scrotal hernia
C. Inguinal node
D. Femoral hernia

6. Malignancy is characterized by
A. Metastasis
B. Weight gain
C. Slow growth
D. Well defined margins
7. Characteristic features of a lipoma are
A. Slow growing
B. No defined edges
C. Fixed to the surrounding tissue
D. Grow in bone prominences

8. The sigmoid colon

A. Terminates at the rectum anterior to the sacral promontory
B. In the pelvis lies adjacent to the bladder and uterus
C. Is supplied by the parasympathetic fibers from the vagus nerve
D. Has lymphatics which drain in the internal iliac lymph node

9. When examining a patient with a crush injury to the lower leg, sensory and motor disturbance is
identified only in the distribution of the superficial peroneal nerve. In which compartment does
intramuscular pressures most likely to be elevated
A. Anterior
B. Deep posterior
C. Superficial posterior
D. Plantar compartment of the foot

10. The nerve injured in supracondylar fractures of the humerus is the

A. Radial nerve
B. Ulnar nerve
C. Median nerve
D. Anterior interosseous nerve

11. Common radiographic presentation of classic intramedullary osteosarcoma include the following
except
A. Codman’s triangle
B. Pathological fractures
C. Mixed lytic and blastic appearance
D. Soft tissue extension

12. Cardinal Radiographic features of osteoarthritis include the following except

A. Subchondral sclerosis
B. Osteophytes
C. subluxation
D. Narrowing of joint space

13. In the brachial plexus, which nerve arises from the upper trunk other than the nerve to subclavium
A. Suprascapular nerve
B. Thoracodorsal nerve
C. Upper subscapular nerve
D. Long thoracic nerve

14. Septic arthritis is known to spread from infection of a metaphysis which is intracapsular, the following
joints have intracapsular metaphysis except
A. Shoulder
B. Elbow
C. Hip
D. Knee

15. The following action should be taken when there is a blood transfusion reaction
A. Stop transfusion
B. Discard the remaining blood
C. Replace the blood with a drip of 5% dex.
D. Warm the patient never to receive blood transfusion again

16. Normal thyroid stimulating hormone is seen in

A. Hashimoto’s thyroiditis
B. Euthyroid goiter
C. Thyroiditis
17. Brest cancer
A. Commonest histological types is lobular carcinoma
B. Intraductal carcinoma tends to affect the contralateral breast
C. Advanced cancer rarely spreads to the bone
D. Triple assessment is necessarry

18. The radial nerve maybe damaged in the fractures of the humerus. The common fracture location
which causes radial nerve injury is the
A. Humeral neck
B. Humeral shaft
C. Supracondylar fractures
D. Medial condylar fracture

19. Regarding osteomyelitis

A. Can be due to salmonella infection in patients with sickle cell anemia
B. Infection usually involves the epiphysis of long bones
C. Dead bone within the medullary canal is known as the involucrum
D. New bone forming beneath the periosteum is known as the sequestration

20. Death 3 days after pelvic fracture is most likely to be due to

A. Pulmonary embolism
B. Fat embolism
C. Respiratory distress
D. Infection

21. In acute scrotum

A. Doppler ultrasound can be done
B. Exploration should be done after ultrasound
C. Exploration should only be done after ultrasound
D.. Start antibiotics immediatel
22. Which of the following is a complication of untreated priapism
A. Paraphimosis
B. Penile cancer
C. Urethral stricture
D. Erectile dysfunction

23. The following are premalignant conditions of the oesophagus except

A. Barrett’s esophagus
B. Plummer vinson’s syndrome
C. Achalasia cardia
D. Tilosis all this are pre malignant conditions of esophagus

24. In obstructive jaundice, which one of the following statements is not true
A. There is absence of stercobilinogen in stool
B. Alkaline phosphate in the blood is elevated
C. Indirect bilirubin is elevated
D. Direct bilirubin is elevated

25. Post-traumatic space occupying lesions may present with the following features except
A. Bradycardia
B. Raised blood pressure
C. Vomiting
D. Glasgow coma score as low as 2/15

26. In a patient lying in lithotomy, a fissure in ano is characteristically located in

A. Midline posterior
B. Midline anteriorly
C. Right lateral quadrant
D. Left lateral quadrant

27. When considering the depth of a burn, which one of the following is incorrect
A. The presence of severe pain denotes full thickness burn
B. Knowledge of the cause of burn is important
C. Impairment of sensibility on the burn site should b tested
D. The presence of blisters on the site of burn is of clinical significance

28. Which of the following statement is not true about breast carcinoma
A. Lobular carcinoma tends to be familial, multifocal and bilateral
B. Carcinoma in situ implies non-invasive cancer that has not breached the basement membrane
C. Macroscopically , schirrhous carcinoma is hard, greyish and grates on cutting
D. Indian file pattern of tumor cells is a feature predominantly seen In ductal carcinoma

29. A painful red eye with lacrimation and photophobia are features of
A. Glaucoma
B. Conjunctivitis
C. Corneal ulcer
D. Cataract

30. Tumor markers can be useful in the diagnosis of diseases in surgical practice. Which one of the
following has been used more in this regard In Zambia
A. Alpha feto protein
B. Prostate specific antigen
C. Carcinoembryonic antigen
D. Acid phosphatase

31. Which statement about indirect inguinal hernia is correct ?????????

A. It is more common in females
B. In males, it is commoner on the left side
C. Indirect hernia contents in a sac tend to lodge in the hesselburg Triangles

32. A 52 year old comes to your male ward for admission. He is to undergo a groin hernia repair the
following day. You notice he has paroxysmal of raised blood pressure, he is very anxious and sweating.
He has had similar episodes the past six months and the operation was cancelled twice. Which one of
the following is likely a diagnosis
A. Primary aldosteronism
B. Crohn’s disease
C. Phaeocromocytoma
D. Anxiety episodes

33. Which of the following malignancies will give osteosclerotic features to the bone after metastasis
A. Breast carcinmona
B. Bronchogenic carcinoma
C. Prostate carcinoma
D. Renal cell carcinoma

34. Cellulitis is a common infecti in surgical ractice. Which one of the following organisms is most likely to
cause this kind of pathology
A. Staphylococcus aureus
B. Streptococcus species
C. Pseudomonas aepromontor
D. Klebsiella species

35. Which one of the following is more common in secondary thyrotoxicosis

A. Exophthalmos
B. Cardiac arrhythmias
C. Chemosis
D Lig lag and lid retraction

36. In acute appendicitis, all the following are true except

A. High grad fever
B. Pain that starts from midline and shifts to right iliac fossa
C. Nausea and vomiting
D. Psoas sign
37. Protraction the scapular is mediated by which nerve
A. Long thoracic
B. Thoracodorsal
C. Dorsal scapular
D. Spinal accessory

38. A 36 year old male sustains a open segmental tibia fracture associated with an overlying 8 cm soft
tissue avulsion that requires skin grafting for soft tissue coverage no. No vascular injury is identified.
What is the most appropriate Gustilo Anderson classification of this injury
A. Type l
B. Type ll
C. Type lllA
D. Type lllB

39. The incidence of complicated and poor outcomes is high in fractures with vascular injury treatment
for fractures with vascular injury should begin with which of the following?
A. Fracture alignment and stability
B. Early (within 6 hours of injury) restoration of blood flow
C. Wound management
D. Recognition of compartment syndrome

40. On average the radial nerve travels from the posterior compartment of the arm and enters the
anterior compartment at which of the following sites
A. Spiral groove of the humerus
B. At the acute ligament of Osborne
C. 10 cm distal to the lateral acromion
D. 10 cm proximal to radiocapitellar joint

41. During an open reduction internal fixation pf a humerus fracture using the posterior approach, a
surgeon can identify the posterior antebrachial cutaneous nerve and trace it proximally to which of the
following nerves?
A. Ulnar
B. Mussculocutaneous
C. Radial
D. Axillary

42. What is the most common site of metastasis for osteosarcoma

A. Bone
B. Liver
C. Lung
D. Lymph node

Medicine

1. Which of the following is a feature of chronic extravascular haemolysis?

A. Raised serum conjugated bilirubin
B. Low reticulocyte count
C. Hypocellular bone marrow
D. Gallstones
2. Macrocytic anemia maybe seen with all the following except
A. Liver disease
B. Copper deficiency
C. Thiamine deficicency
D. Orotic aciduria
3. Which of the following is true about oral therapy for iron deficiency anemia
A. If 300mg of elemental iron given 100mgs gets absorbed
B. Reticulocytosis appears in 1-2 weeks and then peaks in 3-4 weeks
C. Haemoglobin levels are usually corrected in 6 weeks after starting therapy
D. Stop treatment after normalizing the haemoglobin
4. All the following are causes of iron deficiency anemia except
A. Chronic renal failure
B. Celiac disease
C. Hookworm
D. Carcinoma colon
5. Which of the following best differentiates anemia of chronic disease and iron deficiency anemia
A. Serum ferritin
B. Red cell transferrin receptors
C. TIBC
D. Transferrin saturation
6. A patient with sickle cell disease should avoid the following
A. Swimming
B. Dehydration
C. Pneumococcal Immunization
D. Early antibiotics for respiratory infections
7. Which of the following is a major risk factors for venous thrombosis
A. Smoking
B. High cholesterol
C. Hypertension
D. Diabetes
8. Which of the following classically is found in lower motor neuron lesions?
A. Flaccidity, hyporeflexia, Fasciculations and wasting
B Spasticity, hyperreflexia, with no fasciculation nor wasting
C. Spasticity, hyporreflexia, fasciculations and wasting
D. Flaccidity, hyperreflexia, fasciculations and no wasting
9. The following are conditions that can present with a positive rheumatoid factor except
A. Wegner’s granulomatosis (GPA)
B. Sjogren’s syndrome
C. Infective endocarditis
D. Felty’s syndrome
10. The following are connective tissue Disease except
A. Systemic sclerosis
B. SLE
C. OA
D. Dermatomyositis
11. In the diagnosis of SLE, Hematological parameters are included. The following are included except
A. Lymphopenia
B. Thrombocytopenia
C. Leucopenia
D. Eosinophilia
12. A female patient aged 60 comes in with pain in her left foot of sudden onset. She is hypertensive on
moduretic and Atenolol. She is not vegetarian and takes a very occasional glass of wine. The following
are risk factors in this patient for gout except
A. Moduretic
B. Wine
C. Consume meat
D. Age
13. According to the 2010 ACR/EULAR Rheumatoid Arthritis classification criteria, which of the following
scores is incorrect?
A. Arthritis of right MCP2 and PIPS= 1
B. ACPA 5X upper normal limit= 3
C. Raised ESR, raised CRP, Arthritis of all PIPs in hands and both shoulders= 4
D. Arthritis of shoulders, knees, hips, ankles and elbows= 1
14. Mrs mutale has osteoarthritis (OA) of her hand joints. The following are pathological features of OA
except
A. Erosion of articular cartilage
B. Subchondrial sclerosis
C. Osteophyte formation
D. Pencil in cup appearance
15. A patient presents with severe dyspnea. There is a history of paresthesia and progressive ascending
paralysis involving the lower limbs. Examination reveals flaccidity and areflexia. Which one of the
following will be the most appropriate pharmacological intervention
A. High dose levodopa
B. High dose lorazepam
C. High dose immunoglobulin
D. High dose meropenem
16. Pontine stroke is associated with all except
A. Bilateral pin pointed pupils
B. Pyrexia
C. Vagal palsy
D. Quadriparesis
17. Subacute combined degeneration due to vitamin B12 deficiency mainly involves
A. Peripheral nerves
B. Corticospinal tracts
C. Posterior columns
D. Spinalthalamic tracts
18. All the following are correct about Argll Robertson pupil except
A. Near reflex normal
B. Direct light reflex absent
C. Consensual light reflex normal
D. Visual acuity normal
19. Which of the following is not seen in TB meaningitis?
A. Low CSF sugar
B. High CSF protein
C. Low open pressure
D. Lymphocytic pleocytosis
20. Which of the following statements is true about prions?
A. They are infectious proteins
B. They are made up of Bacteria and virus
C. They have rich nuclear material
D. They can be cultured in cell free media
21. Human herpes virus 8 (HHV8) is associated with?
A. Kaposi sarcoma
B. Primary Effusion lymphoma
C. Multicenteric Castleman’s disease
D. All the above
22. Which of the following about tuberculosis pleural effusion is false?
A. WBC usually 500 to 6000/ul
B. Protein concentration >50% that of serum
C. Normal to low glucose concentration
D. PH generally >7.4
23. Multidrug resistant tuberculosis is defined as
A. Resistance to isoniazid
B. Resistance to Rifampicin
C. Resistance to both isoniazid and Rifampicin
D All the above
24. Which of the following processes is central to the pathogenesis of falciparum malaria?
A. Cytoadherence
B. Rosetting
C. Agglutination
D. All the above
25. Which of the following about cerebral malaria is false?
Diffuse systemic encephalopathy
Focal neurogenic signs are unusual
Pout reflex is uncommon
Abdominal and cremasteric reflexes are absent

Section B
Combined Questions
• Which one of the following is a late sequelae of salpingitis?

• Endometrial hyperplasia

• Fallopian tube cancer

• Hydrosalpinx

• Cervicitis
• Which one sentence best describes urinary stress incontinence?

• The loss of small amount of urine when intra-abdominal pressure increases.

• Inability to control the bladder of all urine.

• Inability to pass urine.

• Constant loss of small amounts of urine.

• Which of the following is the greatest predisposing cause of puerperal infection?

• Retained placental tissue.

• Iron deficiency.

• Poor nutrition.

• Maternal exhaustion.

• Perinatal mortality correctly refers to which one?

• Number of still births per 1000 total births.

• Number of still births and early neonatal deaths per 1,000 total births.

• Number of still births and neonatal deaths per 1,000 live births.

• Number of still births amd neonatal deaths per 100,000 total births.

• Treatment of pelvic inflammatory disease inclue the following except

• Oral doxycycline.

• Removal of IUCD.

• Clindamycin.

• Dilatation and curettage.

• Which is a contraindication of induction of laor?

• History of upper segment caesarean section.

• Severe pre-eclampsia at 36 weeks.

 • Gestational diabetes on insulin at 39 weeks.

• Post term pregnancy.

• An absolute contraindication for vaginal breech delivery is:

• Hyperextension of the head.

• Prolonged latent phase of labor.

• A foetus with estimated biparietal diameter of 9cm.

• Previous pregnancy loss.

• A 35-year-old woman, non-pregnant, para 3, complains of severe progressive secondary

dysmenorrhea and menorrhagia. Pelvic examination demonstrates a tender, diffusely enlarged
uterus with no adnexal mass. Results of endometrial biopsy are normal. This patient most likely has:

A . Endometriosis.

B. Endometritis

C. Adenomyosis

D. Uterine sarcoma

• A post-partum woman after a normal delivery complains she is bleeding from the vagina. It is normal
for bloody lochia to last up to

• 2 days

• 5 days

• 8 days

• 14 days

• Breastfeeding

• In HIV-exposed infants should be encouraged in the first 6 months and then stopped.

• Can cause breastfeeding jaundice, which is an indication to stop breastfeeding.

• Should be supported in mothers of low socio-economic status but not in those who can
afford formula milk.
 • Exclusively in the first 6 months, protects against diarrhea disease and respiratory infection.

• Kondwani, a 2-year-old boy has a positive sickling test and the Hb electrophoresis results that were
ordered at his last review are in. which of the following results will indicate sickle cell anemia?

• Hb A, F

• Hb A,S,F

• Hb S,F

• Hb S,C,F

• Hydrocephalus

• Presents with enlarging head circumference in congenital but not in acquired causes.

• Can be due to Arnold-Chiari malformation which is results from cystic dilatation of the fourth
ventricle.

• Produces a copper beaten appearance in acute causes.

• Can be treated with endoscopic third ventriculostomy except communicating hydrocephalus.

• While working in OPD, a triage nurse bring to you a 7 months old infant from the queue whom she
has noticed is very sick. The baby is lethargic, has cool peripheries, a weak and thready brachial
pulse and a capillary refill time of 4 secs. The weight of the baby is 6kg and a mid upper arm
circumference is 12.5cm. the fluid management of this baby will be to give:

• 120mls normal saline fluids as a bolus to run rapidly within 15 mins

• 90mls of half strength Darrow’s in 10% dextrose to run over 1 hour

• 600mls normal saline maintenance fluid in 24 hours

• 180mls half strength Darrow’s on 10% dextrose over 1 hour and then 420 over 5 hours

• Zinc sulphate in diarrhea disease:

• Reduces the duration and severity of diarrhea for upto 3 months

• Should be given for 5 days.

• Has benefit in acute but not persistent diarrhea.

 • Should be preserved for diarrhea disease with established zinc deficiency.

• Mapalo, a 6 years old boy is brought to the hospital with complaints of weakness and shortness of
breath on exertion. On evaluation he is found to have hypochromic, microcytic anemia with
reticulocytopenia. The likely cause of his anemia may be

• Sickle cell anemia

• Lead poisoning

• Aplastic anemia

• HIV infection

• A child has been admitted with severe pneumonia. A blood culture showed a gram negative aerobic
bacillus. The causative agent is:

• Streptococcus pneumonia

• Mycoplasma pneumonia

• Listeria monocytogenes

• Pseudomonas aeruginosa

• TB meningitis is treated with the following combination of anti tuberculous drugs

• 2HRZE, 4HR

• 2HRZE, 10 HR

• 2HRZE, 3 HRZ, 10 HR

• 2HRZE, 10 HR

• Co-trimoxazole is used as prophylaxis against the following except

• Pneumocystis jirovecii pneumonia

• Toxoplasmosis

• Isosproridia

• Histoplasma
• An infant who is 7 months old is able to do the following except:

• Roll over from supine to prone position and vice versa

• Pincer grasp

• Make monosyllabic sounds (ba,da,pa)

• Recognize strangers/ stranger anxiety

• You are reviewing an 8 year old boy who was admitted a day ago in DKA. On admission, he was
semi-conscious, but improved after treatment was initiated. However, the nurse reports that his
condition has deteriorated and he is now unconscious and has irregular respirations and a rasied
blood pressure. The likely cause of the deterioration in condition is:

• Rising hyperglycemia due to unresponsiveness to insulin

• Cerebral edema due to excessive fluid administration

• Hypoglycemia due to rapid insulin administration

• Hypokalemia due to insufficient potassium administration

• Sydenhams chorea

• Typically occurs about 10 days after a streptococcal infection

• Causes behavioural problems

• Does not require secondary penicillin prophylaxis

• Alone can not make the diagnosis of rheumatic heart fever

• Which one of the following is true about ready to use feeds (RTUF)?

• Feed of choice in the acute phase of severe malnutritiontreatment.

• Not used in children with edema

• Has the same nutritional value as F100

• Is superior to F100 in nutritional value

• A previously healthy 4 year old boy is brought to the clinic with an acute onset of bleeding after a
minor injury to the foot. The bleeding continues despite application of pressure. Subsequently the
 patient is noted to develop diffuse swelling of the left elbow joint and right knee joint. The most
likely diagnosis is:

• Haemophilia A

• Idiopathic thrombocytopenic purpura

• Aplastic anemia

• Acute lymphocytic leukemia

• In ventricular septal defect (VSD):

• The smallest defect tend to produce the softest murmurs

• Left to right shunting leads to increased risk of cerebral abscess

• There may be diastolic murmur at apex

• The systolic murmur increases in intensity bas as pulmonary hypertension develops

• The following are true concerning management of severe diarrhea in malnutrition except:

• Skin turgor and moistness of mucus membranes constitute good indicators of a patients
hydration status

• ReSoMal is the preferred fluid of oral rehydration

• Fluids which are hypertonic are preffered in the management of shock in malnutrition because
this allows use of smaller volumes

• Management of hypovolemic shock involves the use of normal saline boluses

• Which one is true regarding bleeding continuing 4 weeks after delivery?

• Is most likely to be due to retained products of conception

• May be physiological

• Is associated with cancer of the endometrium

• Is commonly due to choriocarcinoma

• Regarding breech presentation, which one of the following statements is false?

 • The preferred method of delivery at term for a multiparous with an univestigated breech is
caesarian section

• The shoulders are delivered by the Mauriceau Viet procedure

• Is sometimes due to focal congenital abnormalities

• Cord compression during delivery is the main cause of fetal morbidity or death

• The following are true of rupture of the uterus except:

• Fetal distress

• Hematuria

• Hypotension

• Rectalvaginal fistula

• When compared to singleton pregnancy ‘multiple pregnancy’ is associated with which one of the
following?

• Fetal macrosomia

• Preterm deliveries

• B12 deficiency

• Post partum hemorrhage due to placenta previa

• Which one of the following statements is true about disseminated intravascular coagulation?

• Can cause decrease fibrinogen degeneration products

• Can cause decrease in PT and PTT

• Is characterized by increased platelet count

• Can be encountered in case of IUFD

• The most serious complication of intrauterine fetal death is:

• Acute amionitis

• Acute psychosis
 • Pelvic thrombophlebitis

• Hyporfibrinogenemia

• A pregnant woman in her 32 nd week of gestation is given magnesium sulphate for pre-eclampsia.
The earliest clinical manifestation of hypermagnesemia is

• Loss of deep tendon reflexes

• Flaccid paralysis

• Respiratory arrest

• stupor

• In a patient with 3 consecutive spontaneous abortions in the second trimester the most useful
investigation is:

• Chromosomal analysis

• Hysterosalpingogram

• Endometrial biopsy

• Post coital test

• You are on call attending to a two year old child who had been brought in for fever for the past 2
days. While taking the history, the child starts to have generalized tonic clonic seizures. Your
immediate management of the child within the first 5 minutes will be to:

• Give the child 10% dextrose and then diazepam intravenously

• Give the child 10% dextrose and then phenobarbitone loading dose intravenously

• Extend the head to a sniffing position then turn the child to the side, give high flow oxygen and
10% dextrose

• Put a wooden tongue depressor across the mouth to prevent the child from biting the tongue
then give 10% dextrose

• While doing a ward round in a pediatric ward, a mother rushes over to you to see her 4 year old
child who she noticed had stopped breathing. When you assess the child, you observe that there is
no spontaneous breathing and no pulse. Your immediate management will be to:

• Extend the head to a sniffing position and commence giving breaths using an ambu-bag and
 chest compressions in the ratio 2:15 and give an adrenaline injection to the heart through the
chest.

• Give hydrocortisone and 10% dextrose intravenously and oxygen

• Extend the head to a sniffing position and commence giving breaths using an ambu-bag and
chest compressions in the ratio of 2:15 and give 10% dextrose

• Extend the head to a sniffing position, and give 5 rescue breaths using an ambu-bag, and then
proceed with breaths and chest compressions in the ratio 2:15 and give 10% dextrose.

• A 45-year-old man with a history of gallstones presents in A &E with severe epigastric pain radiating
to the back and vomiting, what is the most likely cause for this finding?

• Large bowel obstruction

• Acute pancreatitis

• Colorectal cancer

• Diverticulosis

• Mesenteric adenitis

• A 21-year-old student presents with a cramping diffuse abdominal pain associated with alternating
constipation and diarrhea. Colonoscopy and inflammatory markers are normal. Which is the most
likely cause for this clinical finding?

• Perforated duodenal ulcer

• Irritable bowel syndrome

• Hepatocellular carcinoma

• Umbilical hernia

• A 76-year-old man with a history of hemicolectomy 3 years ago presents to his GP with worsening
colicky abdominal pain associated with vomiting and abdominal distention. Basic observation on
arrival are: pulse 98/min, BP 165/75mmHg, temp 37.8 degrees Celsius. On abdominal examination
there is a distended abdomen with no tenderness, rebound or guarding. Bowel sounds are tinkling.
Which one of the following is the likely diagnosis?

• Adhesions

• Meckel’s diverticulum
 • Small bowel atresia

• Intra-abdominal abscess

• Mid-gut volvulus

• A 75-year-old man with a 3-month history of dyspepsia presents with weight loss and abdominal
distension. On examination a 3.5 cm hard, tender epigastric mass can be felt which moves on
respiration. Percussion of the distended abdomen reveals shifting dullness. The left supraclavicular
node is palpable. Which one of the following is the most likely diagnosis?

• Ovarian cysts

• Fibroids

• Gastric carcinoma

• Psoas abscess

• Abdominal aortic aneurysm

• A 32-year-old woman who has recently given birth complains of excruciating pain on defacation
that persists for hours afterwards. Rectal examination is not possible due to pain. Which one of the
following is the most likely diagnosis;

• Fissure-in-ano

• Perianal warts

• Syphilitic gumma

• Anal carcinoma

• Fitula-in-ano

• A 69 year old man is brought to A & E with an acute abdomen. He is resuscitated then taken to
theatre for exploratory laparotomy. He is found to have a perforated sigmoid colon secondary to a
mass with malignant features. Which one of the following is the most appropriate intervention?

• Total colectomy

• Anterior resection

• Hartmanns procedure

• Right hemicolectomy
 • Repair of the perforation

• Select the appropriate investigation for an alcoholic who presents with hematemesis.

• Colonoscopy

• Fecal occult blood

• CT-abdomen

• Esophago-gastroduodenoscopy

• A 7 months old child is brought to the emergency department crying inconsolably and drawing his
legs up. He has had one episode of vomiting and has been passing bloody stools. On examination, a
small mass is palpable on the right upper quadrant. Which one of the following is the most likely
diagnosis?

• Hydrocele

• Celiac disease

• Intussusseption

• Duodenal atresia

• Infantile colic

• A 42 year old man is found unconscious on the street. on examination there is bruising around

both eyes and a clear nasal discharge. What is the likely diagnosis?

• Subdural hematoma

• Cerebral contusion

• Extradural hemorrhage

• Basal skull fracture

• Subarachnoid hemorrhage

• A 75 year old patient is found to be acutely short of breath. After receiving her third unit of packed
red cells. On examination there are fine end inspiratory course crackles up to mid zones in both lung
fields. What is the likely cause?

• Iron over load

• Hypocalcemia

• Circulatory overload

• Hyperkalemia
 • Viral infection

• A 45 year old patient is involved in a road traffic accident and is noted to have bruising all over his
chest. On examination he has a shallow tachypnea with indrawing of the chest wall on inspiration.
SaO2 is 94 percent on air, pulse 100/min. BP 100/65mmHg. What is the likely diagnosis?

• Hemorrhage

• Pleural effusion

• Tension pneumothorax

• Flail chest

• A 45 year old woman presents with fever and right upper quadrant pain. On examination there is
marked jaundice and the nurse has reported that the patient is having rigors. Blood tests show
plasma, bilirubin 250mmol/L, ALP 800U/L, WCC 23 x 109. Which one of the following is the most
likely diagnosis?

• Gallstone ileus

• Mucocoele

• Ascending cholangitis

• Empyema

• A 45 year old man presents with severe epigastric pain and vomiting. Abdominal film shows absent
psoas shadow and a ‘sentinel loop’of the proximal jejunum. which one of the following is the most
likely diagnosis

• Gluten sensitive enterropathy

• Chrohns disease

• Acute pancreatitis

• Small bowel obstruction

• Intussusception

• A 55 year old with several months of epigastruc discomfort presents acutely unwell at A&E. an xray
film shows free gas under the diaphragm. Which one of the following is the most likely diagnosis?

• Pyloric stenosis

• Acute pancreatitis

• Chronic pancreatitis

• Perforated duodenal ulcer

• Ulcerative colitis
 • A 71 year old man presents with an exquisitely painful punched out ulcer on the tip of his big right
toe. On examination the surrounding area is cold. Which one of the following is the most likely
diagnosis?

A. ischemic ulcer

B. bowens disease

C. venous ulcer

D. gumma

E. Tuberculous ulcer

52. A 58 year old diabetic patient presents with a painless punched out ulcer on the sole of the right
foot. The surrounding area has reduced pain sensation. Which one of the following is the most likely
diagnosis?

A. basal cell carcinoma

B. Apthouse ulcer

C.Marjolins ulcer

D. neuropathic ulcer

E. Gumma

53. Which of the following would be the most appropriate response to a 75 year old manpresenting with
acute chest pain?

A. perform an ECG immediately

B. do cardiac enzyme immediately

C. Give low dose aspirin immediately

D. Give atenolol immediately

54. A 65 year old man has recently been diagnosed with diabetes mellitus and hypertension and is deemed
at increased risk of cardiovascular disease. which of the following drugs has been associated with the
improved prognostic value in such diabetic patients?

A. Glimepiride

B. metformin

C. insulin

D. Empagliflozin

55. In a patient with heart failure, which one of the following agents will have little or no impact on patient
long term survival?
 A. spironolactone

B. enalapril

C. carvedilol

D. Furosemide

56. A 52 year old black Zambian man is found with hypertension requiring treatment. Which drug class
would you initiate him on if he has no target organ damage?

A. ACE inhibitor (enalapril)

B. Angiotensin receptor blocker (losartan)

C. calcium channel bloker (amlodipine)

D. Beta blocker (atenolol)

57. A known asthmatic presents in a severe asthmatic attack. Which drug agent will be most useful to
relieve his attack?

A. inhaled salbutamol

B. nebulized salbutamol

C. intravenous aminophylline

D. Subcutaneous salmeterol

58. Which of the following is a kmown side effect ofloop diuretics such as furosemide?

A. Hypokalemia

B. Hypoglycemia

C. acidosis

D. hypermagnesmia

59. Which of the following conditions causes renal failure?

A. Class V lupus nephritis

B. Hepatitis B viral induced nephropathy

C. Membranous nephropathy

D. Wegener’s granulomatous

60. A middle aged lady who is 1.6m tall with weight issues visits her physician for advice on the correct
range of weight she should attain. Her doctor starts by checking her weight which is 92kg with a body
mass index (BMI) of36kg/m2 . HE correctly classifies her as?
 A. morbid obesity

B. over weight

C. obese

D. super obesity

61. Bone marrow aspiration is not indicated in

A. Myelofibrosis

B. Acute myeloid leukemia

C. Multipe myeloma

D. Leishmaniasis

62. Multi drug resistant tuberculosis is defines as

A. Resistance to isoniazid

B. resistant to rifampicin

C. resistance to both isoniazid and rifampicin

D. resistance to pyrazinamide and ethambutol

63. A 57 year old man presents with complaints of chest pain and fever. Which is not associated with
exertion and is alleviated somewhat by leaning forward. The patient states that he had a recent upper
respiratory tract infection last week. Physical examination reveals a friction rub on cardiac auscultation.
What is the most likely etiology of the patients chest pain?

A. Costochondritis

B. Ischemic heart disease

C. pericarditis

D. reflux esophagitis

64. A 29 year old man is admitted to the surgical ward following an acute exacerbation of Chrohn’s disease,
he had a limited small bowel resection several months ago and has subsequently developed a high
enterocutaneous fistula. On examination he appears malnourished. What is the best feeding option?

A. Elemental diet

B.normal oral intake

C. 50% dextrose

D. Nasogastric feeding
 E. total parenteral nutrition

65. A 75 year old woman presents with acute airway obstruction and a thyroid mass after several weeks of
worsening shortness of breath. Post mortem show a thyroid mass that has invaded the trachea and
surrounding structures. Histology contains giant cells containing pleomorphic hyperchromatic nuclei.
Choose the appropriate diagnosis

A. Follicullar adenoma

B. Grave’s disease

C. Papillary carcinoma

D. Anaplastic carcinoma

E. Rriedel’s thyroiditis

66. A 32 year old patient present with a 2.5cm invasive ductal carcinoma. She has a palpable axillary lymph
node which reveals cancer cells on cytology. The tumor is estrogen receptor negative. Which one of the
following is the most likely intervention?

A. Wide local excision, axillary node clearance and chemotherapy

B. Tamoxifen

C. Immunotherapy

D.radical mastectomy

E. quadrantectomy

67. In a patient found with hepatitis. Which of the following is an indication for anti-hepatitis B viral
treatment?

A. Presence of anti-hep B core IgM

B. Presence of anti- Hep B core IgG

C. Presence of Hep B DNA copies greater than 103/ml

D. Co-infection with HIV

68. A known alcoholic presents with hypoglycemia and during resuscitation with 50% dextrose, which other
drug should be administered to overcome the effects of giving dextrose in such patients?

A. Riboflavin

B. Nicotinamide

C. Thiamine

D. Folic acid
69. A 55 year old man is brought to the emergency room in a confused but non agitated state. Examination
of the patient reveals opthalmoparesis, nystigmas and ataxia. A diagnosis of wernikes
encephalopathy is made. Which of the following should be immediately administered?

A. Thiamine

B. Glucose

C. Pyridoxine

D. Cyanocobalamine

70. Which of the following intervention would be the most useful immediate step in the management of
hyperkalemia?

A. Insulin

B. Glucose

C. Calcium gluconate

D. Haemodialysis

71. A young man is brought to the emergency ward due to intractable seizure activity later deduced to be
due to hypoglycemia. Which of the following conditions could underlie this presentation?

A. Cushings syndrome

B. Hyperthyroidism

C. Addisons disease

D. Metformin use

72. A 45 year old lady admitted with a 1 day stroke is reported to have developed sudden onset dyspnea
accompanied with cyanosis and tachypnea. Which of the following is incorrect in relation to the clinical
presentation?

A The patient has aspiration pneumonitis

B. The patient has aspiration pneumonia

C. The likely affected areas are the posterior segments of the upper lobe

D. Lung abscess is a complication with aspiration pneumonitis

73. A 57 year old man presents with complaints of chest pain and fever which is not associated with
exertion and as alleviated somewhat by leaning forward. THE patient states that he had a recent upper
respiratory tract infection last week. Physical examination reveals a friction rub on cardiac auscultation.
What is the most likely etiology of this patients chest pain?
 A. Costochondritis

B. Ischemic heart disease

C. Pericarditis

D. Reflux esophagitis

74. Mpuno has an obvious big nose and the father amusingly states that God gifted the family with this
unique feature which makes them stand out. This is likely as a result of

A. X-linked inheritance

B. Polygenic phenomenon

C. Autosomal dominant inheritance

D. chromosomal depletion

75. Immediate complications of birth asphyxia include the following, EXCEPT:

A. Acute tubular necrosis

B. Surfactant deficiency

C. Necrotizing enterocolitis

D. Hemothorax

76. The following statements are true, EXCEPT:

A. Walking after the age of 20 months should be considered as a delay

B. The average Zambian child weighs 9kg at 12 months of age

C. Hearing is the highly developed sense in neonates

D. Rapid growth and development are observed in the first year of life

77. The following are the common characteristics of congenital infections, EXCEPT:

A. Microcephaly

B. Splenomegaly

C. Intra-uterine growth retardation

D. Generalized lymphadenopathy

78. The following are risk factors of Early onset neonatal sepsis, EXCEPT:

A. Congenital heart disease

B. Prematurity
 C. Birth asphyxia

D. Low birth weight

79. The following statements are true about Early onset neonatal sepsis, EXCEPT:

A. Group B Streptococcus is the predominate causative organism

B. In prematurity, it occurs within 3 days from birth

C. Has lower mortality compared to late onset sepsis

D. Involves more than one body system

80. Which of the following neonatal infant values is incorrect?

A. Average weight at 6 months: 6kg

B. Average height at 2 years: 94cm

C. Average head circumference at 1 year: 45cm

D. Average heart rate in a neonate: 140/min

81. The following are as a result of refeeding syndrome in severe malnutrition, EXCEPT:

A. Constipation

B. Tachycardia

C. Seizures

D. Renal failure

82. These are characteristics of febrile convulsions, EXCEPT:

A. They are almost benign and generally not associated with neurological sequela

B. The mainstay of investigation and treatment is to rule out infection

C. Brain CT scan is a compulsory indication to rule out space occupying lesion

D. They usually last up to 15 minutes

SECTION C

SURGERY

1. Which of the following cause hypocalcaemia?

A. Sarcoidosis

B. Primary hyperparathyroidism
 C. Acute pancreatitis

D. Metastatic bronchial carcinoma

1. Which is true about Heparin?

A. Pontentiates the actions of antithrombin III

B. Has a half life of 12 hours

C. Can be reversed by protamine sulphate

D. Can induce thrombocytopenia

1. Infantile hypertrophic pyloric stenosis

A. More common in female infants

B. Surgical treatment is by Ramstedt’s pyloromyotomy

C. Invariably presents between six and eight months of age

D. Typically presents with bile stained projectile vomiting

1. The following are features of Fallot’s tetralogy EXCEPT

A. An atrial septal defect

B. Pulmonary Stenosis

C. Right ventricular hypertrophy

D. A right to left cardiac shunt

1. A tracheostomy will

A. By pass a lower airway obstruction

B. Increase the anatomical dead space

C. Increase airway resistance

D. Allow frequent airway suction

1. The following are features of thyrotoxicosis EXCEPT

A. Weight gain

B. Palpitations
 C. Proximal myopathy

D. Increased skin pigmentation

1. Regarding local anesthesia

A. Local anesthetics act on large before small nerve fibers

B. Their main toxic effects are seen on the central nervous system

C. Preparations containing adrenaline are safe to use on digits and appendages

D. Lignocaine has a longer duration of action than bupivacaine

1. Which is not true about intussusception

A. Is most common in children from 6 to 12 years

B. Presents with colicky abdominal pain, rectal bleeding and an abdominal mass

C. 10% present with diarrhea and vomiting suggestive of gastroenteritis

D. A Meckel’s diverticulum can induce an intussusception

1. In obstructive jaundice

A. Urinary conjugated bilirubin is reduced

B. Urinary urobilinogen is increased

C. Serum conjugated bilirubin is reduced

D. Fecal sterocobilinogen is reduced

1. Regarding the anatomy of the inguinal canal

A. The internal ring lies medial to the inferior epigastric vessels

B. The external oblique aponeurosis forms the anterior boundary

C. The inguinal ligament forms the posterior boundary

D. The conjoint tendon forms the lateral part of the posterior wall

1. The thyroid gland

A. The isthmus lies at the level of the thyroid cartilage

B. The superior thyroid artery lies close to the external laryngeal nerve

C. The inferior thyroid artery arises from the costo-cervical trunk

D. The middle thyroid vein joins the external jugular artery

1. Cryptorchidism

A. Is not associated with malignancy

B. Is associated normal fertility

C. Occurs in 5% of newborn boys

D. Should be treated by orchidopexy at puberty

1. Regarding small bowel obstruction

A. Causes colicky abdominal pain and vomiting

B. Abdominal distention is seen in all patients

C. All cases can be managed conservatively for the first 24 hours

D. Rarely requires aggressive fluid resuscitation

1. Regarding gas gangrene

A. It is due to clostridium botulinum infection

B. Clostridial species are gram-negative spore forming anaerobes

C. The clinical features are due to the release of protein endotoxin

D. Gas is invariably present in the muscle compartments

1. Tetanus

A. Is due to an infection with a gram-negative spore forming rod

B. The organism produces a power endotoxin

C. The toxin prevents the release of inhibitory neurotransmitter

D Clostridium tetani is not sensitive to penicillin

1. The following classification concerning Gustilo and Anderson’s classification of open fractures is
true

A. Type IIIB injuries have adequate soft tissue cover

B. Type I injuries have a wound less than 2cm long

C. Type IIIA injuries have adequate soft tissue cover despite extensive lacerations or flaps

D. All arterial injuries are graded type IIIC regardless whether the arterial injury requires repair or not

1. Contraindication for Gallows traction for fractures of the femur include all of the below EXCEPT

A. Open fracture
 B. Angulation of 30 degrees at the fracture site

C. Skin contusions

D. Weight over 15 kg

1. In wound healing, inflammation is triggered by

A. Neutrophils

B. Platelets

C. Monocytes

D. Lymphocytes

1. Which organism is most associated with acute haematogenous osteomyelitis?

A. Staphylococcus aureus

B. Beta-haemolytic streptococcus

C. Haemophilus influenza

D. Staphylococcus epidermidis

1. Septic arthritis is known to spread from infection of a metaphysis which is intracapsular. The
following joints have intracapsular metaphyses except?

A. Elbow

B. Hip

C. Knee

D. Ankle

1. In the brachial plexus, which nerve arises from the upper trunk other than the nerve to
subclavius

A. Suprascapular nerve

B. Thoracodorsal nerve

C. Axillary nerve

D. Long thoracic nerve

1. The predominant collagen in articular cartilage is

A. Type I

B. Type II
C. Type III

D.Type V

1. Cardinal radiographic features of osteoarthritis include the following except:

A. Subchondral sclerosis

B. Cyst formation

C. Osteophytes

D. Subluxation

1. Common radiographic presentation of classic intramedullary osteosarcoma include the following

except:

A. Codman’s triangle

B. Sunray spicules

C. Pathological fractures

D. Mixed lytic and blastic appearance

1. The nerve commonly injured in supracondylar fractures of the humerus is the

A. Radial nerve

B. Ulnar nerve

C. Median nerve

D. Anterior interosseous nerve

INTERNAL MEDICINE

1. Which of the following is a feature of chronic extravascular haemolysis?

A. Raised serum conjugated bilirubin

B Low reticulocyte count

C. Hypocellular bone marrow

D. Gallstones

1. Joint haematoma may be seen in all except:

A. Haemophilia A

B. Haemophilia B
 C. Bernard soulier syndrome

D. Type III von willebrand

1. Bone marrow aspiration is not indicated in:

A. Myelofibrosis

B. Acute myeloid leukemia

C. Multiple myeloma

D. Leishmaniasis

1. The earliest change in iron deficiency anemia is

A. Erythroid hyperplasia

B. Subjective feeling of the body and increased appetite

C. Lymphoid hyperplasia

D. Reticulocytosis

1. Autoimmune haemolytic anemia is seen in

A. Chronic lymphocytic leukemia

B. Chronic myeloid leukemia

C. Acute lymphocytic leukemia

D. Acute myeloid leukemia

1. Dry mouth, swelling in the lower end of esophagus, smooth tongue and craving for ice or clay
are features of

A. Folic acid deficiency anemia

B. Iron deficiency anemia

C. Biotin deficiency

D. Riboflavin deficiency

1. Which drug should be included in HAART regimen when hepatitis B and HIV occur together?

A. Interferon alpha

B. Entecavir

C. Tenofovir

D. None of the above

1. HIV infection can be transmitted from the mother to her fetus during?

A. Pregnancy

B. Delivery

C. Breastfeeding

D. All of the above

1. Presentation of IRIS includes all of the following EXCEPT:

A. Pulmonary infiltrates

B. Increased intracranial pressure

C. Uveitis

D. Hypothyroidism

1. Underlying mechanism of IRIS is phenomenon similar to

A. Type I hypersensitivity

B. Type II hypersensitivity

C. Type III hypersensitivity

D. Type IV hypersensitivity

1. Which one of the following about tuberculosis pleural effusion is false?

A. WBC usually 500 to 600/ul

B. Protein concentration >50% that of serum

C. Normal to low glucose concentration

D. PH generally >7.4

1. Multidrug resistant tuberculosis is defined as

A. Resistance to isoniazid

B. Resistance to rifampicin

C. Resistance to both isoniazid and rifampicin

D. All of the above

1. Which of the following processes is central to the pathogenesis of falciparum malaria?

A. Cytoadherence
 B. Rosetting

C. Agglutination

D. All of the above

1. Which of the following about cerebral malaria is false?

A. Diffuse systemic encephalopathy

B. Focal neurologic signs are unusual

C. Pout reflex is uncommon

D. Abdominal and cremasteric reflexes are absent

1. For most adults, what phases of korotkoff sounds are used to determine systolic and diastolic
blood pressure

A. Phase I for systolic blood pressure; phase II for diastolic blood pressure

B. Phase I for systolic blood pressure; phase V for diastolic blood pressure

C. Phase II for systolic blood pressure; phase IV for diastolic blood pressure

D. Phase I for systolic blood pressure; phase IV for diastolic blood pressure

1. A known diabetic patient presents with hypoglycemic episode on his insulin formulation and is
assessed to have developed chronic kidney disease. How would you alter his glycemic control

A. Stop all his insulin injections and switch to metformin

B. Cut his daily insulin dose by 25% and assess response

C. Cut his daily insulin dose by 10% and assess response

D. Stop his insulin injections and put him on strict dietary control

1. A 65 year old man has recently been diagnosed with diabetes mellitus and hypertension and is
deemed at risk of cardiovascular disease. Which of the following drugs has been associated with the
improved prognostic value in such patients?

A. Glimipiride

B. Metformin

C. Insulin

D. Empagliflozin

1. Which of the following is a recognized complication of persistent vomiting in an adult?

A. Increased excretion of bicarbonate in the urine

 B. Vitamin B12

C. Metabolic alkalosis

D. Metabolic acidosis

1. A patient presents with severe anemia (Hb 4g/dl) and hyperglycemia for which hemodialysis is
indicated. The hospital policy is that hemodialysis should only be commenced in patients with Hb above
7 g/dl due to high mortality rates in those with lower Hb. The patient and his family decline to accept
blood transfusion on religious ground. What would you do in such a situation?

A. Convience patient to accept secretly and then give hemodialysis

B. Transfuse without patient knowledge during dialysis

C. Proceed with hemodialysis and hope for the best

D. Discharge the patient if they continue to decline blood transfusion to avoid mortality on your hands

1. Which condition below is not typically associated with hypoglycemia?

A. Acute alcohol intake

B. Addisonian crises

C. Vipoma

D. Liver cirrhosis

1. Which of the following would be the most appropriate response to a 75 year old man presenting
with acute chest pain ?

A. Perform ECG immediately

B. Do cardiac enzyme immediately

C. Administer low dose aspirin immediately

D. Give atenolol immediately

1. Which of the following renal conditions causes renal failure?

A. Class V lupus nephritis

B. Wegener’s granulomatosis

C.Membranous nephropathy

D. Diabetic nephropathy

1. An 18 year old girl presents to the emergency department due to severe generalized muscle
weakness and kussmaul’s breathing. A blood gas analysis reveals a potassium 2 mmol/L and bicarbonate
of 13 mmol/L. What is the likely cause of this presentation?
 A. Type IV renal tubular acidosis

B. Acute kidney injury

C. Glue sniffing

D. Diabetic ketoacidosis

1. In a patient presenting with heart failure, which of the following agents will have little or no
impact on patient long term survival ?

A. Spironolactone

B. Enalapril

C. Carvedilol

D. Frusemide

1. A patient comes in with symptoms suggestive of a restrictive lung disease. Possible cause include
the following EXCEPT;

A. Obesity

B. Ascites

C. Pneumonia

D. Asthma

OBSTERICS AND GYNAECOLOGY

1. The first line treatment for dysmenorrhoea in young ladies is

A. Abdominal ultrasound

B. Non-steroidal analgesics

C. Oestrogen only pill

D. Antibiotics

1. Which one of the following is not associated with molar pregnancy?

A. Dermoid cysts

B. Hyperemesis

C. Pre-eclampsia

D. Diploidy
1. The dye test in gynaecology practice is ordered to exclude or confirm

A. Infertility

B. Endometriosis

C. Uterine outline

D. Vesical vagina fistula

1. The management of a cervical smear showing moderate dyskaryosis is

A. Repeat smear in six months time

B. HPV vaccination

C. Colposcopy and biopsy

D. Hysterectomy

1. A patient presents with vulva itching, sore vagina and a profuse white, curdy discharge with
erythema and redness at the introitus. The likely diagnosis is

A. Bacterial vaginosis

B. Trichomonas vaginalis

C. Candida

D. Chlamydia

1. Which of the following is not risk factor for cervical cancer ?

A. Human papilloma virus (HPV) types 16 and 18

B. Family history of cervical cancer

C. Early sexual intercourse

D. Multiple sexual partners

1. Which of the following is true concerning the oral contraceptive pill?

A. It stimulates ovulation

B. It improves menstrual cycle control

C. It has a 3 hour window

D. It is relatively contraindicated in patients with acute / severe liver disease

1. The procedure most suitable for a woman with pelvic pain is

A. A pelvic xray
 B. Laparotomy

C. Hysterosalpinogram

D. Laparoscopy

1. The specific treatment of choice for advanced cancer of the cervix is

A. Palliative chemotherapy

B. Radiotherapy

C. Partial cone biopsy

D. Total abdominal hysterectomy and bilateral salpingo-oophrectomy (BSO)

1. Which statement is true concerning uterine fibroids ?

A. Genetic predisposition is not known

B. Menorrhagia is manifested only in submucous fibroids

C. The environment within the myoma is hyperestrogenic

D. Corporeal fibroid is too frequently associated with pressure symptoms

1. The most common cause of Menorrhagia in the child-bearing period is

A. Uterine fibroids

B. Dysfunctional uterine bleeding

C. Pelvic Endometriosis

D. Adenomyosis

1. Causes of first trimester miscarriages include all of the following EXCEPT

A. Chromosomal abnormalities of the fetus

B. Cervical incompetence

C. Polycystic ovarian disease

D. Immunological e.g antiphospholipid syndrome

1. Subtotal hysterectomy may be indicated in all of the following EXCEPT

A. Difficult tubo-ovarian mass

B. Extensive endometriosis involving the rectovaginal septum

C. To preserve menstruation
 D. Intractable postpartum hemorrhage

1. Best investigations of an infertile couple include

A. Semen analysis

B. Hysterosalpingraphy

C. Laparoscopy and dye

D. All of the above

1. A 31-year old woman presented to Gynaecology clinic with a 12 month history of amenorrhoea
and galactorrhoea. The most likely diagnosis is

A. Pituitary adenoma

B. Polycystic ovary syndrome

C. Premature menopause

D. Sheehan’s syndrome

1. A couple (both 25 years age) come to the clinic with a history of trying to conceive for 2 years .
The woman has a history of oligomenorrhea and hirsutism. Some investigations: day 2 FSH=4IU/L, day 2
LH=24IU/L, day 21 progesterone =2 nmol/L; Hysterosalpinogram : bilateral tubal patency; semen
analysis: count 50x106/ml, motility 55%, morphology 50% normal. The most appropriate form of
treatment would be

A. Clomifene citrate

B. In-vitro fertilisation

C. Intrauterine insemination

D. Intractoplasmic sperm injection (ICSI)

1. The following are true about pelvic examination, EXCEPT

A. Should not be done in a child or virgin

B. Bivalve speculum examination is performed before sim’s speculum examination

C. It’s possible to palpate shortened uterosacral ligaments

D. Bimanual digital examination is performed after speculum examination

1. Medical treatment of Menorrhagia includes the following EXCEPT

A. Tranexamic acid

B. Copper T IUCD
 C. LNG-IUS

D. Mefenamic acid

1. Concerning abnormal uterine bleeding

A. All women should have endometrial biopsy

B. Uterine artery embolization can be done in woman with a large uterine fibroid

C. Treatment is the same regardless of the cause

D. Complete blood count is not necessary

1. A 39 year old woman, gravida 3, para 3, complains of severe ,progressive secondary

dysmenorrhoea and menorrhagia. Pelvic examination demonstrates a tender, diffusely enlarged uterus
with no adnexal tenderness. Results of endometrial biopsy are normal. This patient most likely has ?

A. Endometriosis

B. Adenomyosis

C. Uterine sarcoma

D. Leiomyoma

1. An 18-year old girl with rapid pulse of 100-beats -per-minute, presents to Gynaecology
Emergency ward with severe acute abdominal pain for the last 2-hours, and slight vaginal bleeding. She
thinks she is 6-weeks pregnant. What is the first appropriate action?

A. Arrange for an urgent transvaginal ultrasound scan

B. Check urinary pregnancy test

C. Establish IV access

D. Rush to theatre for emergency Laparoscopy

1. A 45 year woman presents complaining of an asymptomatic pelvic mass. The subsequent pelvic
ultrasound scan shows a 10cm ovarian cyst. Which of the following would be the next appropriate
primary investigation?

A. Ca 125

B. Chest x-ray

C. Laparoscopy

D. Liver function test

1. A 20 year old woman presents to a gynaecology clinic with a rapidly increasing abdominal mass
and discomfort over the precious three months. A pregnancy test is negative , and a subsequent
ultrasound scan shows a complex cystic pelvic mass with solid compartments. What is the most likely
diagnosis?

A. Constipation

B. Epithelial ovarian cancer

C. Fibroids

D. Germ cell tumour of the ovary

1. A 35 year old woman is referred from a local clinic because of an aceto white lesion on VIA. At
the time of the colposcopy she is diagnosed with CIN 3 (cervical intraepithelial neoplasia). What is the
most appropriate treatment to offer this woman?

A. Knife cone biopsy of the cervix under general anesthesia

B. Repeat cervical smear in 3 years

C. Total abdominal hysterectomy

D. Large loop excision of the transformation zone of the cervix under local anesthetic

1. Characteristics of a normal vaginal discharge

A. May turn yellow on contact with air

B. It increases on the day 21 on the menstrual cycle

C. Mucus comes from the Mucus glands on the ectocervix

D. Combined contraceptive pills have no effect

PAEDIATRICS AND CHILD HEALTH

1. The following is not a recognized complication of foreign body inhalation

A. Pulmonary abscess

B. Asthma

C. Sudden onset cough

D. Hyperinflation pf the opposite lung

1. Which of the following is a recognized cause of acute upper airway obstruction?

A. Angio-oedema

B. Asthma

C. Mumps
 D. Laryngomalacia

1. Which statement is true regarding community acquired pneumonia in infancy?

A. Streptococcus pneumonia is the most common pathogen

B. It is never caused by staphylococcus aureus

C. Ciprofloxacin is an appropriate treatment if blood cultures are negative

D. It may be caused by mycoplasma species

1. Concerning management of diarrhea in severe malnutrition. The following are true EXCEPT

A.Skin turgor and moistness of mucus membranes constitute good indicators pf a patients hydration
status

B. ReSoMal is the preferred fluid for oral rehydration

C. Fluids which are hypertonic are preferred for management of shock in malnutrition because this
allows use of smaller volumes

D. Management of hypovolemic shock involves use of normal saline boluses

1. Congenital syphilis

A. Is not likely in a baby born to a mother who had a positive RPR in pregnancy and was treated with
alternative to penicillin

B. Is always unlikely when RPR is negative in the baby

C. Can only be transmitted in the first trimester of pregnancy

D. Can cause deafness if left untreated

1. The following conditions are recognized causes of clubbing EXCEPT

A. LIP

B. Fibrosing alveolitis

C. Asthma

D. Tetralogy of fallot

1. In examination of the cardiovascular system in childhood

A. Ventricular septal defect may not be clinically detectable in the few days of life

B. Intercostals recession is useful evidence for a right to left shunt

C. Normal femoral pulses at birth exclude co-arctation of the aorta

 D. Peripheral oedema is a valuable sign of heart failure in infancy

1. A diagnosis of Fallot’s tetralogy is supported by

A. Cyanosis at birth

B. Left ventricular hypertrophy on ECG

C. Episode of squatting

D. Pulmonary plethora on chest x-ray

1. In suspected acute rheumatic fever the following indicate carditis

A. An ESR of 120mm in one hour

B. Strong cardiac impulse at the apex, which is displaced laterally

C. Short apical soft systolic bruit

D. Erythema nodosum

1. The most common organism in patients with empyema (purulent pleurisy) is

A. E.coli

B. Tuberculosis

C. Group A streptococcus

D. Staphylococcus aureus

1. The following statement is not true about poisoning in children

A. The most common site of poisoning is the home

B. Most commonly occurs under 5 years of age

C. Majority of cases involve non-drug products

D. Education regarding prevention of poisoning should be discussed in all-child visits, after a child is
mobile

1. A 2 year old boy appears with intermittent loose stools for the past 1 month. Stools typically
occur during the day and not overnight. The boy is otherwise healthy. The growth and development are
normal.The most likely diagnosis is

A. Chronic enteritis

B. Rotavirus enteritis

C. Toddlers diarrhea
 D. Food allergy

1. The order of development of secondary sexual characteristics in males is

A. Testicular development - Pubic hair - Axillary hair - Beard

B. Pubic hair - Testicular development - Axillary hair - Beard

C. Testicular development - Beard - Pubic hair - Axillary hair

D. Axillary hair - Beard - Pubic hair - Testicular development

1. A 5 year old presents with a febrile generalized tonic-clonic seizure lasting for 5 minutes.
Previously he was healthy and had no such problem. On examination there is no abnormality. Your plan
of management should be

A. Start anticonvulsant therapy

B. Request for and EEG and wait for its report

C. Request for and EEG and start anticonvulsant therapy immediately

D. Request for and EEG and MRI brain

1. A child in status epilepticus can be given the following drugs, EXCEPT

A. Paraldehyde

B. Chlorpromazine

C. Phenytoin

D. Lorazepam

1. The following are recognized causes of secondary nephritic syndrome EXCEPT

A. Hepatitis B virus

B. Penicillin

C. Systemic lupus erythematosus

D. On-steroidal anti-inflammatory drugs

1. Oral rehydration therapy

A. Works by active co-transport of glucose and sodium at the intestinal lumen

B. Should not be used in hypernatraemic dehydration

C. Contains 5mmol/l of potassium

D. Can be made up safely at home using salt and sugar

1. In acute bronchiolitis

A. Dexamethasone is the treatment of choice for hospitalized cases

B. Lung volume is usually decreased

C. Bronchiodilators are usually effective

D. Feeding difficulties are common

1. Concerning tuberculosis

A. Cavitary TBis uncommon in children younger than 5 years

B. Overcrowded living conditions do not significantly affect prevalence

C. The treatment of lymph node infection is of a greater duration that pulmonary infection

D. The tuberculin skin test is a good indicator of disease activity

1. A 7 year old girl presents with acute cough and wheeze, and is given nebulized salbutamol.
Which of the following ia an indication for admission to hospital?

A. A peak flow rate of 80% of that predicted for height

B. Respiratory rate of 40/min

C. Saturation of 90% in air

D. Bilateral rhonchi

1. A patient involved in accident finds that he is unable to taste sweet/salty or sour taste. Which of
the following cranial nerves is likely to be responsible for this sensory loss?

A. Facial nerve

B. Hypoglossal nerve

C. Glossopharyngeal nerve

D. Vagus nerve

1. A 16 year old boy presents to the emergency department with chest pain, fever, fatigue and
arthralgias. His past medical history is significant for rheumatic heart disease a dental procedure a few
weeks before admission. He currently shows no “stigmata”of endocarditis on physical examination,
although endocarditis is suspected. The most likely organism is

A. Viridans streptococci

B. Staphylococcus aureus

C. Enterococcus fecalis
 D. Pneumococcus

1. Which of the following is a major Duckett-Jones criteria for the diagnosis of rheumatic fever?

A. Arthralgia

B. Subcutaneous nodules

C. Huntington’s chorea

D. Erythema nodosum

1. Speech delay

A. more common in females

B. Common in autism

C. Associated with a tongue tie

D. Family history is usually irrelevant

1. A 12 year old girl presents with anxiety and weight loss. She is noted to have a fine tremor and a
pulse of 100 beats per minute. Thyroid function tests confirm thyrotoxicosis. Which one of the following
statements is true of thyrotoxicosis

A. Is more common in males

B. Is often associated with short stature

C. Is usually not due to an auto-immune process

D. Is treated in the first instance with an anti-thyroid drug such as carbimazole

For the questions above get answers from your friends

Thank you for taking your previous time to go through mcqs.

All the best for your exams and most of the mcqs are from the book called EMQs in Clinical Medicine by
Irfan Syed

Dr M. Wallace
SECTION C

Levy Medical University ( Viva Questions)

( From September 2019 to March

INTERNAL MEDICINE
• Diabetes mellitus
-DKA
-known DM patient comes for review, what questions are you asking?
-DM woman on medication comes to your clinic, what questions would you ask her in relation to
compliance of her medications?
-known DM patient, what do you want to know about them?
-DM patient you are not sure if hyper/hypo glycemic coma and you cannot do labs or RBS, what
immediate thing do you do?
- MI in a DM patient.
2) PE
3) Pneumonia
4) Food poisoning
5) Malaria
6) Chronic liver disease
-presentation
-physical features
-treatment
7) Hepatic encephalopathy
8) Obese male complaining of chest pain, management BMI 35
9) -patient brought in comatose, management
-in a rural setting patient comes in coma what do you do, no labs no nothing( no RBS test )
10) Types of anemia and their causes
11) TB
-drugs side effects
-how to give the drugs
-differential diagnosis
-PJP
-x Ray appearance
-diagnostic test
12) Wernickes encephalopathy
13) Hemogram with hypochromic anemia
14) Cryptococcal meningoencephalitis
-emergency management
-diagnosis
-treatment

PEDIATRICS
• Neonatal resuscitation
• Zambian demographics for children under 5 and 15 years and vaccination schedule
• History taking in child with diarrhea
• Dehydration ( types and management)
• Shock
• PMTCT
-mother has not been on treatment and has a kid, what are some of the signs and symptoms you
see in a 1 year old child having hiv starting from the mouth
 -baby born from an hiv mother what are you going to do for this baby?
7) Bilirubin in neonates
8) -term new born is having a seizure
-neonate comes with seizures and jaundice
-Neonatal seizures
9) Malaria
10) Prematurity
11) A 5 years old comes bleeding from mouth and nose for the last 3 days and bone pains ( diagnosis
and management)
12) SCD in children
-5 crisis
-long term management
-3 prophylactic vaccines
-mother brings a 2 year old that’s complaining of joint pain, recurrent jaundice and abdominal
pain
-complications of sickle cell anemia, what test for confirmation and the one drug that you want to
give in this condition?
13). Rota virus
14). Child presents with OOP
15). 10 year old with a coma

OBSTETRICS AND GYNECOLOGY

• Antepartum hemorrhage
• Postpartum hemorrhage
• Ectopic pregnancy
• Placenta abruption
• Contraceptives
• Obstetric indications of misoprotol
• HELLP syndrome
• Antenatal care and blood tests
• A woman with amenorrhea, hypotension and pain as a complaint
• Preeclampsia
• Eclampsia
• Woman comes back after six weeks of delivery with difficulties in breathing and history of having
seizures before, what’s your approach?
• Woman is brought in to the emergency room by her husband, he said she’s been having seizures
and she’s past six weeks postpartum. How would you manage her?
• Husband brings six days postpartum convulsing wife, your management?
• A woman 32 weeks with draining.
-what would you ask her?
-how would you diagnose it?
16). A woman comes to you her EDD is 26/02/2020 and today is 26/02/2020, what’s her GA?
17) Oxytocin
-gyn indications
-complications
-obs indications except PPH and active management of third stage of labor
18). Transxemic acid
-obs indications
-dosage
19). -Calculate EDD from LMP 28/02/19
-EDD 04/03/20 according to scan, calculate GA
20). Uses of magnesium sulfate
 21). Abortions
-definition
-types
-management

SURGERY
• Burns
• Endoscopy
• Trauma
• Snake bites
• Intestinal obstruction
• Flail chest
• Patient fell from high place, management?
• A woman comes in with a breast lump
• A 30years old man comes in with complaints of abdominal pains and a 3 day history of
constipation, management?
• 18 year old comes to the clinic with abdominal pain. How would you manage her?
• A 20 year old girl with fever and constipation
• 28 year old woman with abdominal pain, fever and diarrhea.
• Stab would( lung collapsed, distended neck vein) what type of pneumothorax?

Dr M. Wallace
Thank You