Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 7TH MARCH 2020 TIME ALLOWED: 3HRS

1. A 45 year old lady came to family planning clinic for contraception advice. She is not keen to be
pregnant for the next 3 years. Her recent USG report showed multiple small submucosal fibroid. What is
the best method of contraception for here from the list below?
A. Etonogestrol
B. Combined OCP
C. IUS (intrauterine system)
D. Progestogen only pill
E. IUCD (intrauterine contraceptive device)

2. A 4 year old boy presents with bleeding from nose, bleeding time is increased. What is the most likely
diagnosis?
A. ITP
B. Haemophilia
C. HSP
D. Von-willbrand disease

3. A 30 years old female presented with a 1.5cm discrete lump in the upper outer quadrant of her right
breast, which was tender. What is the initial investigation?
A. USG
B. FNAC
C. Excisional biopsy
D. Mammogram
E. Open biopsy

4. Young girl who is known to have type 1 diabetes presented with drowsiness, deep breathing. Her sugar
level is 20. Her blood pressure is 120/80mmHg. Her mucous membrane is dry. What would be the next
appropriate step?
A. Serum urea
B. Blood culture
C. CTscan
D. HbA1c
E. Arterial blood gas

5. A 24 year old woman has eight weeks amenorrhoea, right sided pelvic pain and vaginal bleeding. She
is apyrexial. Peritonism is elicited in the right iliac fossa. Vaginal examination reveals right-sided cervical
excitation. What is the most probable diagnosis?
A. Ectopic Pregnancy E. Ovarian tumor
B. Salpingitis
C. Endometriosis
D. Ovarian Torsion

1
6. A 82 years old lady, who has atrial fibrillation is well maintained on digoxin, has now developed
diarrhoea and vomiting for last 3 days. She is also dehydrated. Her Abbreviated Mental score is 4 out of
10 and she is experiencing yellow-green visual halos. What is the most important investigation to give the
likely cause of the vomiting?
A. Gastroscopy
B. Stool Culture
C. Calcium Level
D. Digoxin Level
E. Blood culture

7. A 68 year old lady complains of falls to the ground without any warning, maintains consciousness, and
no confusion. She says this has occurred number of times before. What is the diagnosis?
A. Stokes Adams attack
B. Hypoglycemia
C. Vasovagal syncope
D. Drop attacks
E. Epilepsy

8. A 6 year old boy is clinically obese; his body mass index is above the 95th centile. He has no other
medical problems and examination is unremarkable. His mother says that she has tried everything to help
him lose weight. What is the most probable diagnosis?
A. Cushing’s Syndrome
B. Congenital Hypothyroidism
C. Down’s syndrome
D. Lawrence Moon Biedel Syndrome
E. Primary Obesity

9. A 35 year old woman came for a routine cervical smear examination. Inflammatory changes were seen.
her past cervical smears have been negative. She does not complain of any discharge or any other
symptom. What will you do next?
A. Repeat cervical smear in 3yrs
B. Repeat smear in 6months
C. Colposcopy
D. Cauterization
E. Take swab

10. A 36 year old woman has taken about 28 tablets of paracetamol 6 hours ago. She has been drinking a
bottle of vodka and a couple pints of lager everyday for the last few years. She feels nauseous and has
vomited a few times.
Sodium 144mmol/l Potassium 3.8mmol/l
Urea 5.6mmol/l Creatinine 86umol/l
Albumin30g/l Bilirubin15umol/l
ALT 30IU/l AST 32IU/l
Alkalinephosphatise230IU/l
Gamma glutamyl-‐transpeptidase1,261IU/l
Paracetamol80mg/l

2
 Which is the single most appropriate immediate management?
A. Discussing with liver transplant unit
B. Give acetylcysteine
C. Give fresh frozen plasma
D. Give Vitamin K injection
E. Repeat the blood tests

11. What is the choice of post –op analgesia in a patient who had appendectomy for gangrenous
appendix?
A. IM tramadol
B. IV Morphine
C. Oral morphine
D. Rectal diclofenac
E. Oral codeine

12. A woman has been prescribed long term steroids for polymyalgia rheumatic. What additional drug
should be added to prevent osteoporosis?
A. Calcium
B. Alendronate
C. Vit D
D. Calcium resonium

13. A 50-year-old woman presents following a fall. She reports of pain and weakness in her hands for
several months, stiff legs and swallowing difficulties and has bilateral wasting of the small muscles of her
hands. Reflexes in the upper limbs are absent. Tongue fasciculations are present and both legs show
increased tone, pyramidal weakness and hyper reflexia with extensor plantar response. Pain and
temperature sensation are impaired in the upper limbs. What is the most likely diagnosis?
A. Multiple Sclerosis
B. Motor Neuron Disease
C. Syringo bulbia
D. Syringomyelia
E. Myasthenia Gravis

14. A 52 year old known COPD patient on long term oxygen treatment was bought into the emergency
with complains difficulty in breathing. He was given oxygen by the paramedics. On examination his
SpO2 is 96%. ABG shows po2 = 18, PCO2 = 8, pH: 7.3. What is the next step in management?
A. Non-invasive positive pressure ventilation
B. Decrease O2
C. CPAP
D. Salbutamol neb
E. Anesthetist to intubate

15. A 50 year old patient was bought in to the emergency department with persistent nose bleeding since
morning. He is on Warfarin since a year. On investigations his INR is 7. What is the single best
management?

3
 A. Protamine
B. Prothrombin complex concentrate
C. Vit. K
D. Fresh frozen plasma
E. Blood transfusion

16. You are a FY2 in the medical department. A FY1 collegue is upset because a patient has argued with
him. What would you do?
A. Reassure
B. Tell to educational superviser
C. Tell to GMC
D. Tell to clinical supervisor 
E. Inform to safe guarding 

17. A DM patient presented with BMI 33. He is not getting good control with Metformin. What is the
next step of management in this patient?
A. Lifestyle modification 
B. Add medication
C. Insulin on sliding scale
D. Increase metformin dose
E. OHA with lifestyle modification

18. A 14 year old girl presented with neck stiffness, fever, photophobia. She looked tired out. What is the
likely causative organism?
A. Listeria 
B. Streptococcus pneumonia 
C. Neisseria
D. Hemophilus influenza
E. Meningococcus

19. A 15 years old boy fell of his bicycle and hurt his abdomen. He presents with pain in abdomen, a CT
scan shows a small sub capsular spleen haematoma, his BP is 110/70mmHg and pulse is 80bpm. What is
the next step in his management?
A. Refer to surgeons for observation
B. Immediate Laparotomy
C. Immediate Laparoscopy
D. Discharge with advice
E. Blood transfusion

20. A 71 year old woman looks disheveled, unkempt and sad, with poor eye contact. She has recently lost
her husband. Which of the following describes her condition the best?
A. Anxiety
B. Hallucination
C. Mania
D. High Mood
E. Low Mood

21. A 45 year old woman who is taking Lithium for Bipolar affective disorder for past 14 years presents
with coarse tremor. What investigation should be done?

4
A. Thyroid function test E. Reassure
B. Creatinine clearance
C. Urea and electrolytes
D. Serum lithium levels

22. A 19 year old boy was brought in by his mother with complaint of lack of interest and no social
interactions. He has no friends, he doesn’t talk much, he has interest only in collecting cars/vehicles, he
has around 2,000 toy cars. What is the most appropriate diagnosis?
A. Borderline personality disorder
B. Depression
C. Schizoaffective disorder
D. Autistic spectrum behaviour disorder

23. A 34 year old woman complains of low mood, loss of interest in everyday activities, loss of appetite
and weight. She also has trouble falling asleep and wakes up early in the morning. What is the best
treatment for her?
A. Fluoxetine—antidepressant--SSRI
B. Minaprine—antidepressant-MAOI
C. Moclobemide – antidepressant--Reversible selective MAOI
D. Curcumine ?chemical curcuminoid -turmeric

24. A 68 year old retired shipyard worker presents with cough and increasing breathlessness. CT scan of
the chest reveals thickening of the pleura and effusion. What is the most likely diagnosis?
A. Mesothelioma
B. Pneumonia
C. Tuberculosis
D. Asthma

25. A first year college student is brought into A&E unconscious with constricted pupils, redness around
the nasal alae, inflamed and swollen nasal mucosa and high fever. Toxicity with what substance is
suspected?
A. Cocaine E. Marijuana
B. Heroin
C. Ecstasy
D. LSD

26. A 52 year old man presents with hyponatremia, hyperkalemia, hypercalcemia and hyperpigmentation.
What hormone should be measured in him?
A. Aldosterone
B. Cortisol
C. Renin
D. ACTH
E. Testosterone

27. A man has a BP of 160/90mmHg, proteinuria ++. On ultrasound kidneys are equally reduced in size
with smooth borders and normal pelvicalyceal system. What is the cause of hypertension in this man?

5
A. Chronic glomerulonephritis
B. Chronic Pyelonephritis
C. Bilateral Renal Artery Stenosis
D. Essential HTN
E. Polycystic Kidney

28. A 48 year old man with renal cancer had radiotherapy for metastatic spinal cord compression at the
11th thoracic vertebrae 4 weeks ago. he had reduced sensation but is unable to stand. He has pain in the
band around the lower trunk which is controlled by regular oral Morphine. He is distressed by
increasingly frequent episodes of painful muscle spasms in his right leg. What is the most appropriate
treatment?
A. Amitriptyline
B. Gabapentin
C. Increased Morphine dose
D. Baclofen

29. A patient has injury to the right hand. He has lost triceps reflex. Which nerve is not affected?
A. C5
B. C6
C. C7
D. T1

30. A 70 year old hypertensive white British man on thiazide diuretics needs a second drug to control his
blood pressure. Which one of the following is the best choice for him?
A. Amlodipine (CCB)
B. Enalapril (ACE inhibitor)
C. Propanolol (B blocker)
D. Increase dose of diuretic
E. Prazocin (Alpha blocker)

31. A middle aged lady was lying the bed sheet when her index finger got stuck in between the bed and
mattress. She is unable to extend her proximal interphalangeal joint. What is the most appropriate
management?
A. Twin plaster the finger
B. Cast
C. Sling
D. Splint the finger

32. A 60-year-old male with a history of diabetes mellitus type 2 is referred to the neurology clinic for
pain in his feet. The patient was diagnosed with diabetes mellitus type 2 approximately 12 years ago.
About 5 years ago, he started to notice stabbing pains in all of his toes. There was also numbness in his
feet with some gait imbalance when he walked on uneven surfaces. Since that time, the numbness has
slowly migrated up to the middle of his shins. Furthermore, the pain has progressed and become quite
bothersome. In addition, he describes burning in his feet when he lies down at night. He does not smoke,
drink alcohol, or use illicit substances. What is the best medication to prescribe to this patient?

6
 A. Amytriptiline
B Gabapentin
C. Paracetamol
D. Codein
E. Ibuprofen

33. A 56 year old man returned from his trip to Sudan a week ago. He now presents to the A and E with
complains of chills and rigors, feeling lethargic, vomiting. On examination he has fever of 39 C and has
jaundice. What is the most probable diagnosis?
A. Malaria
B. Leptospirosis
C. Zika
D. Acute viral illness
E. PUO

34. You are a FY2 in the gynaecology department. A 15 year old girl came for asking oral contraceptive
pill. She tells she has multiple boyfriends and their Ages are 23 and 25. What is the next appropriate step
of action?
A. Refuse to give contraceptive 
B. Inform to police
C. Inform to safe guarding
D. Inform parents
E. Give OCP and assure patient confidentiality

35. A 50 year old was diagnosed with HTN and was started on medications. Despite the treatment his BP
was not well controlled. He was also seen to have elevated fasting blood sugar but was
asymptomatic. What is the next appropriate step in management?
A. Lifestyle modification 
B. Repeat fasting blood sugar
C. Change Anti HTN medications and add OHA
D. A and B
E. Start OHA and continue same Anti HTN medication

36. A 69yr old lady who had urinary incontinence and had to wear a diaper on daily basis. In the past she
underwent radiotherapy for carcinoma of the cervix when she was 48 yrs old. What is the cause of urinary
incontinence in this patient?
A. Hyperactive bladder
B. Detrusor overactivity
C. Vesicovaginal fistula
D. UTI
E. A and D

37. A 54 year woman was found to have glycosuria at a routine medical examination. She has a body
mass index (BMI) of 32kg/m2. Her fasting blood sugar is 6mmol/l.
After a glucose tolerance test 2 hours later, her plasma glucose is 9mmol/l. What is the single most likely
diagnosis?
A. Cushing’s syndrome E. Type 2 diabetes
B. Fanconi’s syndrome
C. Impaired glucose tolerance
D. Type 1 diabetes

7
38. A baby boy when examined a few hours after birth, was found to have a machinery murmur. On
examination, he had heart rate of 160 bpm, he was not cyanosed and was asymptomatic. His parents were
told that the murmur will disappear on its own after a few weeks. What is the most likely diagnosis?
A. Coarctation of the aorta
B. Tetralogy of Fallot
C. Patent ductusarteriosus
D. Atrial septal defect
E. Ventricular septal defect

39. A patient, from Africa, comes with nodular patch on the shin. It has a reddish brown colour. What is
the most probable diagnosis?
A. Lupus vulgaris
B. Erythema nodosum
C. Pyodermagangrenosum
D. Erythema marginatum
E. Solar Keratosis

40. A 55 year old man presents with an ulcer of the scrotum. Which of the following lymph node is
involved?
A. External iliac lymph nodes F. Sub-mental lymph nodes
B. Pre aortic lymph nodes G. Submandibular lymph nodes
C. Aortic lymph nodes H. Deep cervical lymph nodes
D. Inguinal lymph nodes
E. Iliac nodes

41. A 71 year old man presents with coarse tremor. He is on some medications. Which one can be the
reason for his tremors?
A. Lithium D. Imipramine
B. Diazepam E. Haloperidol
C. Fluoxetine

42. A 9 year old boy has been brought by his mother to the GP. She says he is a loner and does not like to
play with other children of his age. He has collected 200 toy airplane models and spends all his time with
them. He has never been good academically and his teachers complain that he does not participate in
classroom activities, and seems not to be making any effort to learn. What is the most likely diagnosis in
this boy?
A. Phenylketonuria
B. Autism
C. Down’s syndrome
D. Tourette’s syndrome

43. A 64 year old man presents with ipsilateral vertigo, tinnitus and left side hearing loss. On
examination Rinne's test is positive and Weber’s test is lateralised to the right ear. What is the most
appropriate investigation?
A. CT scan
B. Magnetic resonance imaging (MRI) of brain
C. X-ray

8
D. Audiometry
E. No investigation required

44. An 8 year old child, who is tall for his age and has a refractory error for which he wears glasses, has
presented with severe crushing chest pain. What is the most likely diagnosis?
A. Fragile X Syndrome
B. PraderWilli Syndrome
C. Di George Syndrome
D. Marfan’s Syndrome

45. A new mother has been feeling tired, tearful and overwhelmed for the past 2 weeks after the birth of
her baby. She feels like she cannot cope and is unfit to take care of the child. What is your most likely
diagnosis?
A. Postpartum Blues
B. Postpartum Depression
C. Postpartum Psychosis
D. Psychotic Depression

46. A lady comes with severe liver disease and hematemesis. Her INR is more than 10. What should she
be given?
A. Fresh Frozen Plasma
B. Steroids
C. Whole blood
D. IV Fluids
E. Vitamin K

47. A 45 year old Schizophrenic patient is smashing down windows after being admitted ion the
psychiatric ward. What is the most immediate management?
A. Haloperidol IM
B. Diazepam
C. Olanzepine
D. Risperidone

48. A 32 year old woman has recurrent breast abscesses, the latest one was 6 weeks ago. There is an area
of undulation between the junction of the areola which is discharging puss. What is the most likely
diagnosis?
A. Breast abscess
B. Ductectasia
C. Mammary duct fistula
D. Mastitis

49. Patient with pain and swelling in left leg and thigh up to the level of inguinal ligament. Where is the
level of occlusion?
A. Femoro-popliteal artery E. Profound femoral artery
B. Left common iliac artery
C. Aortoiliac artery
D. Femoral artery

9
50. A 45 year old lady of african carribean ethnicity was diagnosed with Hypertension by her GP 6
months ago. He started her on Amlodipine and asked her to constantly monitor her blood pressure.
On follow ups he noticed that she still had elevated blood pressure despite being compliant to
medications. What is the next best medication to be prescribed to her?
A. Ramipril
B. Atenolol
C. Diuretic
D. Beta blocker
E. Increase dose of Amlodipine

51. A 26 year old patient presents to the GP with jaundice. He was treated for URTI with antibiotics a
week ago. His blood tests show howell jolly bodies. What is the most probable diagnosis?
A. G6pd deficiency
B. Thalassemia
C. Sideroblastic anemia
D. Lead poisoning
E. Sickle cell anemia.

52. A 50 year old man who is on Morphine for Pancreatic cancer. He is still in pain and requests you to
inject him with a lethal dose of the morphine for his pain control. What would you do?
A. Say it's not possible
B. Give it to him
C. Ask for psychiatric evaluation
D. Tell him you can’t do that but will provide the best care for him.
E. Ignore his request and continue with current management

53. A 30 year old vegan complained of light headedness and fatigue. On investigations he was noticed to
have developed anemia with raised MCV. What is the cause of the anemia?
A. Folate deficiency
B. Vit B12 deficiency
C. IDA
D. Anemia of chronic illness
E. Pernicious Anemia

54. A 51 yr old woman presented with hot flushes, sweating and some post menopausal symptoms. She is
a regular smoker. She also underwent hysterectomy 2 years ago. What is the most appropriate treatment
for her symptoms? 
A. Raloxifene
B. Propranolol 
C combined estrogen replacement 
D estrogen only therapy
E Tibolone

55. A 46 year old man is being treated for a pleural effusion. A chest drain has been sited just below the
fourth rib in the mid-axillary line on his right side. What SINGLE structure is at particular risk of injury?
A. Azygos vein
B. Diaphragm
C. Intercostal artery
D. Internal thoracic artery
E. Liver

10
56. A 30 year old male got up after sitting on the floor crossed leg, complained of tingling sensation on
lateral part of leg and difficulty in flexing foot.
A. Common peroneal nerve injury E. Sciatic nerve
B. Anterior tibial nerve
C. Obturator nerve
D. Femoral nerve

57. A child living with his step father brought by the mother with multiple bruise, fever, fractures. What
do you suspect?
A. Non accidental injury
B. Malnutrition
C. Thrombocytopenia
D. HIV
E. Type 1diabetes

58. A man has symptoms of sleep apnoea and daytime headaches and somnolence. Spirometry shows a
decreased tidal volume and vital capacity. What is the Single most appropriatediagnosis?
A. Ankylosingspondylitis
B. Churg-Strausssyndrome
C. Good pasture’ssyndrome
D. Motor neurondisease
E. Progressive massivefibrosis(PMF)
F. Spinal CordCompression

59. A 55 year female presented with complaining of chest pain, shortness of breath and palpitation. On
admission ECG showed SVT with HR of 220/min. No response to carotid massage. What is the next step
in management?
A. DC shock
B. IV adenosine
C. Verapamil
D. PCI
E. Amiodarone

60. A 6 week old child is brought in with vomiting, constipation and decreased serum Potassium. What is
the most probable diagnosis?
A. Pyloric stenosis: hypokalemichypochloremic metabolic alkalosis
B. Duodenal atresia
C. Hirschprung disease
D. Achalasia cardia
E. Tracheo-esophageal fistula

61. A 50 year old man has been laid off work because he is unreliable and is now homeless. He was
bought to the accident and emergency department by police in a very agitated state who found him
wandering about and muttering to himself about a plot to kill him. He is confused, unkempt and smells of
stale sweat. What is the single most important initial management?

11
A. IV antipsychotics
B. IV benzodiazepines
C. IV glucose
D. IV antibiotics

62. A patient with proteinuria ++. What medication in this patient will prevent the progression of this
disease?
A. ACE inhibitors
B. Calcium channel blockers
C. Thiazide
D. Beta blockers
E. Alpha blockers

63. A 74 year old smoker presented to his GP with cough and shortness of breath. Examination revealed
pigmentation of the oral mucosa and also over the palms and soles. Tests show that he is diabetic and
hypokalaemic. What is the most probable diagnosis?
A. Pseudo Cushing syndrome
B. Conn’s Disease
C. Ectopic Adreno-corticotropic hormone (ACTH)
D. Cushing’s Disease
E. Hypothyroidism

64. A 62 years old man has slow palpitations and the following ECG. What is the most likely diagnosis?
A. Sinus Bradycardia
B. First Degree Heart Block
C. Mobitz Type I Block
D. Mobitz Type II Block
E. Complete Heart Block

65. A young child just diagnosed with chicken pox. Usually goes to day care. What is the most
appropriate advice?
A. Child should be admitted to hospital straight away
B. Isolate the child from parents and siblings at home
C. Advise him he can go back to nursery when the rash is crusted over

66. A two year old boy fell off his tricycle, hurting his arm. He got up and started to cry but before there
was any sound he went pale, unconscious and rigid. He recovered after 1-2 minutes but remained pale.
After an hour he was back to normal. His mother says she was afraid he was going to die and that he had
a similar episode three months previously after he fell down some steps.
What SINGLE investigation is indicated?
A. Computed tomography scan of the head
B. Electroencephalogram
C. Full blood count
D. None
E. Skeletal survey

12
 67. A middle aged man complains of a node which has been growing on his nose for several months.
Now it’s firm with central depression. It is 0.6cm in size. What is the single most likely diagnosis?
A. Basal cell carcinoma
B. Squamous cell carcinoma
C. LN
D. Melanoma
E. Kaposi’s sarcoma

68. A 45 year old woman presented to the emergency department with complains of electric like pain in
face since 3 days. She says she notices aggravation of pain especially when eating. What is the best drug of
choice to prescribe to this patient?
A. Anticonvulsant
B. Antipsychotic
C. Antidepressant
D. Paracetamol
E. Nerve stimulation

69. A 72 year old man was bought into the hospital with history of nocturia. He now complains of acute
urinary retention that was relieved by catheterisation. No history of weight loss can be obtained from the
patient. What is the most appropriate next step in management?
A. Long term catheterisation 
B. Intermittent self catheterisation 
C. Surgery
D. Trial without catheterisation finasteride
E. Trial without catheterisation tamsulosin

70. A 50 year old Patient with type 2 DM, HTN, asthma died suddenly. How would you write the cause
of death under the 1a section of a death certificate where in the main cause of death has to be certified?
A. HTN
B. Asthma
C. Type 2 DM
D. Silent cardiac arrest
E. Unknown

71. A 4 year old boy was noticed to have rashes on buttock few days ago. He was now bought into the
hospital with acute abdominal pain. What is most appropriate diagnosis?
A. Peritonitis
B. Intussesception
C. Appendicitis
D. Viral Fever
E. Autoimmune conditions

72. A 16 week pregnant woman presented with right iliac fossa pain since few hours. The Pain is colicky
and is associated with nausea. Ultrasound examination shows a 4cm mixed echo mass. What is the most
appropriate diagnosis?
A. Ovarian torsion E. PID
B. Ectopic pregnancy 
C. Ovarian cyst rupture
D. Threatened abortion

13
73. Patient with widespread ovarian carcinoma had bowel obstruction and severe colic for 2 hrs and was
normal in between. What is the most appropriate management?
A. S/C morphine (PCA)
B. Spasmolytics
C. Palliative colostomy
D. Oral Morphine
E. Laxatives

74. An 11 year old boy is being checked by the diabetic specialist nurse. His HBA1C was high and he has
been skipping meals recently. He has been unhappy at school. Which single member of clinical team
would you refer him to next?
A. Refer to GP
B. Refer to paediatrician
C. Refer to dietician
D. Refer to clinical psychologist
E. Refer to school nurse

75. A 5 year old boy was diagnosed with urinary tract infection, which was later found to be due to
[Link]. What is the most appropriate treatment?
A. Trimethoprim
B. Nitrofurantoin
C. Amoxicillin
D. Cefalexin
E. Metronidazole

76. A 36 years old man walks into a bank and demands money claiming he owns the bank. On being
denied, he goes to the police station to report this. What kind of delusions is this man suffering from?
A. Delusion of Reference
B. Delusion of Control
C. Delusion of Guilt
D. Delusion of Persecution
E. Delusion of Grandeur

77. A 48 year old woman who has been taking medications for asthma for a long time has now presented
with decreasing vision. What is the most probable cause for her decrease in vision?
A. Inhaled Salbutamol
B. Inhaled Steroids
C. Aminophylline
D. Beta blockers
E. Oral Steroids

78. A man complains of loss of sensation in little and ring finger. Which nerve is most likely to be
involved?
A. Median Nerve
B. Ulnar Nerve
C. Radial Nerve

14
D. Long Thoracic Nerve
E. Axillary Nerve

79. A 3 years old boy presents with difficulty in walking and skin lesions. He has a rash on the 3rd day
after the appearance of fever. What is the most likely causative agent?
A. Streptococcus pyogenes
B. Rubella virus
C. Parvovirus
D. Papova virus
E. Paramyxo virus

80. An 80 year old woman who is on MR Morphine 60mg had to increase it to 120mg twice a day and
again with extra 10mg oral Morphine6 times a day. What is the best form of management?
A. Subcutaneous Morphine infusion
B. Fentanyl patches
C. Change to Oxycodone
D. Increase to 200 mg bd orally 90mg MR Morphine plus 30mg every 4 hours

81. A 65 year old man, scheduled for a hernia surgery, has been informed that his surgery has been
postponed. What is the most likely reason for cancelling the surgery?
A. Hb<10
B. Diastolic Blood Pressure <90mmHg
C. Previous myocardial infarction
D. Diabetes Mellitus DM
E. Seizure disorder

82. A 37 years old lady strongly believes that a famous politician has been sending her flowers every day
and is in love with her. However, this is not the case. What is the most appropriate diagnosis?
A. Erotomania
B. Pyromania
C. Kleptomania
D. Trichotillomania
E. Grandiosity

83. A woman who returned from abroad after three weeks of holiday complains of severe diarrhoea of
three weeks duration, she has also developed iron deficiency anaemia and folic acid deficiency. What
condition best describes her situation?
A. Jejunal villous atrophy D. Increased catabolism
B. Chronic diarrhoea secretions E. Increased secretions of acids
C. Malabsorption

84. A butcher was stabbed in the groin and bled so much that the towel was soaked in blood. His BP is
80/50mmHg and pulse 130bpm. What percent of circulatory blood did he lose?
A. Less than 15% D. 40-50%
B. 15-30% E. Above 50%
C. 20-40%

15
85. A 50 year old male with increased BMI. Has muscle wasting, difficulty climbing upstairs. Has
polyuria, polydipsia. What is the cause of muscle wasting and difficulty walking upstairs?
A. Amyotrophy
B. Peripheral neuropathy
C. Polyneuropathy
D. Autonomic neuropathy

86. A 50 year old known case of Metastatic Hepatic carcinoma. He has come for pain control advice. He
is currently on morphine and codeine for pain. However there is no relief. What is the next line of advice?
A. Ibuprofen
B. Gabapentin
C. Codein
D. Paracetamol
E. Morphine infusion

87. A 60 year old man presented with weight loss, nocturia along with parenthesis of legs and bladder
retention. What is the most appropriate investigation?
A. Dexa scan 
B. Radionuleotide bone scan
C. CT
D. MRI spine
E. X-ray 

88. A 40 year old man presented to the medical department with cough and breathlessness for few weeks.
On examination he was noticed to have ipsilateral ptosis and miosis. He also said he had lost weight in
these few weeks. What is the most appropriate diagnosis?
A. Pancoast Tumor
B. Small Cell Carcinoma of lung
C. Bronchogenic Carcinoma
D. Squamous cell Carcinoma of lung
E. TB

89. A 3 year old boy was presented to the emergency department with first time UTI. The investigations
led to the diagnosis of bilateral VUR. What is the most appropriate management?
A. Long term Prophylactic antibiotic 
B. Ureter surgery
C. IVU
D. Intermittent catherterization
E. No treatment needed

90. A 30 year old lady with history of congenital uterus abnormality and a recent history of DVT recently
got married. She has come in to ask for contraception. What is the most appropriate contraception we
could offer?
A Estrogen only OCP
B COCP
C Implant
D Barrier Contraception
E POP

16
91. A 36 years old man undergoes an elective hernia repair. 12 hour after the surgery he presents with the
following x-ray. What is the most likely diagnosis?
A. Pulmonary Effusion
B. Pneumothorax
C. Atelectasis
D. Pulmonary Edema
E. Pneumonia

92. An old lady has breast CA with metastases to L3. She is on Codeine but still cannot with manage
pain. Which further drug would you choose?
A. NSAIDS
B. Gabapentin
C. Morphine
D. Tamoxifen
E. Carbamazepine

93. A woman with sickle cell disease comes for contraceptive advice. What do you give her?
A. COCP
B. Mirena
C. Depoprovera
D. IUCD
E. Condoms

94. A person is being prepared for excision of sebaceous cyst. He is given local anaesthetic with
lignocaine and adrenaline. What is the purpose of adding adrenaline?
A. Augments the effect
B. Prolongs the effect
C. Shortens the duration
D. Reduces side effects
E. Assists with wound healing

95. A 2 year old child is very naughty. His teacher complains that he is easily getting distracted. His
parents say that he can’t do a particular task for a long time. He sometimes hurts himself and breaks many
things. This causes many troubles in his family life. What is the diagnosis?
A. Autism spectrum disorder
B. Dyslexia
C. Attention deficient hyperactive disorder
D. Antisocial personality disorder
E. Oppositional defiant

96. A 14 year old girl is clinically obese. She has not started her periods yet and has severe acne. Among
her investigations, a high insulin level is found. What is the most probable diagnosis?
A. Cushing’s Syndrome
B. Grave’s disease
C. Acquired Hypothyroidism
D. Polycystic ovarian syndrome
E. Addison’s disease

17
97. A 23year old man feels anxious and agitated when faced with stress. He has an interview in 3days and
would like some help in relieving his symptoms. What is the most appropriate management?
A. SSRI
B. CBT
C. Propranolol
D. Diazepam

98. A 24 year old, male patient, presents with bizarre behavior. What single characteristic symptom
would confirm the diagnosis to be most likely to be schizophrenia?
A. Thought insertion
B. Visual hallucination
C. Aggressive, violent behavior
D. Low mood
E. Body dysmorphic image

99. What is the ideal method of providing nutrition to a terminally ill bedridden stroke patient?
A. Parenteral
B. Percutaneous Gastrostomy
C. Jejunostomy
D. Nasogastric

100. A 62 year old woman complains of unsteadiness when walking. On examination she has pyramidal
weakness of her left lower limb, and reduced pain and temperature sensation of her right leg and right
side of her trunk up to the level of the umbilicus. Joint position sense is impaired at her left great toe but
is normal elsewhere. She has a definite left extensor plantar response, and the right plantar response is
equivocal. Where is the most likely site of the lesion?
A. Left cervical cord E. Left lumbo-sacral plexus
B. Midline mid-thoracic cord
C. Right mid-thoracic cord
D. Left mid-thoracic cord

101. A 40 year old lady was bitten by a bee on her right hand 3 weeks ago. She has past history of past
medical history breast cancer for which she had Radiotherapy and surgery with axillary clearance She
presents to accident and emergency department with swelling of the right hand. What is the single most
likely diagnosis?
A. Anaphylaxis
B. Delayed allergic reaction
C. Cellulitis
D. Lymphoedema
E. Superior vena cava obstruction

102. Patient with pain and swelling in left leg and thigh up to the level of inguinal ligament. Where is the
level of occlusion?
A. Femoro-popliteal artery
B. External iliac artery
C. Aortoiliac artery
D. Femoral artery

18
 103. A 28 year old woman who is 32 weeks pregnant, in her third pregnancy, is diagnosed as a case of
placental abruptio. After all the effective measures she is still bleeding. What is the underlying pathology?
A. Clotting factors problem
B. Clauser’s syndrome
C. Platelets problem
D. Succenturiate lobe

104. A 50 year woman is a known case of osteoporosis. She now comes to the GP clinic with complains
of pain on the leg while sleeping. She says that the pain disturbs her sleep and feels very low because of lack
of sleep. What is the best medication to give her?
A. Celecoxib
B. Morphine
C. Naproxen
D. Codeine
E. Paracetamol

105. A patient underwent hemicolectomy for Inflammatory Bowel disease. After four hours of the
surgenry he developed low BP and low urine output that responded to IV fluids. What is the cause of the
sudden hypotension?
A. Hypovolemic shock
B. Cardiogenic shock
C. Anaphylactic shock 
D. Septic shock
E. Post anesthesia complication

106. A 45 year old Patient diagnosed with HIV presents with cough. There is no hemoptysis but
occasional breathelessnes. What is the most appropriate drug of choice?
A. Clarithtomycin
B. Rifampicin
C. Tetracycline
D. Co-trimoxazole
E. Amoxicillin

107. A 3 year old child goes to playschool. He was diagnosed with meningococcal meningitis, now he is
good and discharged from hospital. What is your next step in management?
A. Playschool should be closed for 2 weeks
B. Everyone with his contact should be vaccinated 
C. Everyone contact given rifampacin prophylaxis 
D. Isolate child for 1 week
E. No particular precautions needed

108. A 50 year old woman presented with dilated pupil and lid lag on the left side for 2 weeks. She did
not complain of any other symptoms. Which Cranial nerve involved in he condition?
A. 3rd
B. 4th
C. 5th
D. 3rd and 4th
E. 6th

19
109. A 36 Weeks pregnant patient has been admitted with bleeding per vaginum and severe constant pain
in abdomen. A diagnosis of abruptio placentae has been made. What will be your immediate next step?
A. Check Clotting profile
B. Ultrasound
C. CTG
D. Caesarian section
E. Check BP

110. A 40 year old manual worker presents with a swelling in the groin. On examination the mass is
found to be just above and lateral to pubic tubercle. There is no cough impulse and it is reducible. On
applying the pressure on the internal ring there is no cough impulse seen. What is the most probable
diagnosis?
A. Direct Inguinal Hernia
B. Indirect Inguinal Hernia
C. Femoral Hernia
D. Strangulated Hernia
E. Femoral Aneurysm

111. A woman had an emergency LSCS 7 days ago. She now presents with fever and excessive vaginal
bleeding. What is the single most likely diagnosis?
A. Endometriosis
B. Endometritis
C. Vaginal infection
D. Retained placenta

112. A 54 years old patient 7 days after a total hip replacement presents with acute onset breathlessness
and a raised JVP. Which of the following investigations will be most helpful in leading to a diagnosis?
A. CXR
B. CTPA
C. V/Q Scan
D. D Dimers
E. Doppler USG of legs

113. A 35 year old man has fallen 10 m from a ladder and has been brought to emergency department. He
is drowsy and has swelling on the right parietal area. His GCS score is initially 13 but falls to 9. What is
the single most appropriate step?
A. CT scan of head
B. IV Mannitol
C. MRI of the brain
D. Skull xray
E. Observation

114. A 14 year old boy presents with recurrent abdominal pains, malaise, and weight loss over 6 months.
On examination a vague mass is felt in right iliac fossa. Colonoscopy shows transmural inflammation and
granulomata. What is the most appropriate management?

20
A. Sulfasalazine
B. Paracetamol
C. Metronidazole
D. Ibuprofen

115. A 50 year old man has had anterior resection of the rectum for carcinoma. He expressed concerns
about control of post-operative pain in discussions with the anaesthetist before surgery. What is the best
management strategy?
A. OralDiclofenac
B. OralCodeine
C. IMMorphine
D. IM Dihydrocodeine
E. Ondansetronoral

116. A 55 year old alcoholic man complains of severe abdominal pain radiating to his back. He also
passes lose stool, pale stools and has weight loss. What is the most likely diagnosis?
A. Acute pancreatitis
B. Chronic pancreatitis
C. Esophagitis
D. Pancreatic carcinoma

117. A 50 year old lady with history of breast cancer treated with chemotherapy and surgery. Now she
has come back with pelvic pain. What is the most appropriate management?
A. DEXA
B. Radiotherapy
C. Additional chemotherapy
D. Biphosphanates
E. Mamography

118. A 24 years old woman is afraid to leave her house as whenever she goes out; she tends to have
shortness of breath and sweating. She has stopped going out except with her husband. What is the most
likely diagnosis?
A. Social Phobia D. Panic Disorder
B. Claustrophobia E. Agoraphobia
C. Depression

119. Pregnant woman at 34 weeks gestation presents with tingling and numbness with altered sensation of
her right middle and index finger. Tinel’s sign is negative. What is the most likely diagnosis?
A. Carpal Tunnel
B. Radial nerve entrapment
C. Blackberry’s thumb
D. Mallet finger

120. A 33 year old male came to the hospital with complaints of occasional left sided chest pain that lasts
less than 30 minutes, following exercise, which relieves upon taking rest. What is the most probable
diagnosis?

21
A. Unstable angina D. Coronary spasm
B. Decubitus angina E. Myocardial infarction
C. Stable angina

121. A 19 years old man presents with weight loss, increasing thirst and increased frequency of going to
the washroom. His father, grandfather and two sisters have been diagnosed with Diabetes Mellitus. What
is the most likely type of diabetes this patient is suffering from?
A. Insulin-dependent diabetes mellitus (IDDM)
B. Noninsulin-dependent diabetes mellitus (NIDDM)
C. Latent autoimmune diabetes of adults (LADA)
D. Maturity Onset Diabetes of the Young (MODY)
E. Diabetic ketoacidosis (DKA)

122. A 52 year old patient came into the medical department. He has a history of Type 2 DM. On
routine laboratory investigations his serum cholesterol was 5.7. He has a strong family history of
diabetes mellitus. Apart from lifestyle improvement, what other management will you suggest this
patient?
A. Start insulin
B. Start Statins
C. Nothing
D. Change OHA and add statin
E. Add sulfonamides

123. A 70 year old lady was becoming increasingly confused and drowsy after being given 5% dextrose
after surgery. Tests showed Hypoatremia, reduced urea levels. Other parameters were normal. What is the
cause of the drowsiness in this patient?
A. cerebral oedema
B. osmotic shrinkage
C. osmotic demyelination
D. Age related
E Post anesthesia complication

124. A Patient is 55 year old and diagnosed with pneumonia. His urea is 6.5, respiratory rate 35/min. He
is looking well. What CURB 65 score he will have?
A. 1
B. 2
C. 3
D. 4
E. 5

125. A 14year old had 3 previous episodes of tonsillitis in the last year. He had missed 4 days of school
and had sleep problems due to snoring and hallitosis. What is the most important indication for
tonsilectomy?
A. Hallitosis
B. Mother's concern 
C. Missed school
D. Snoring
E. Repeated infection

22
126. A man sat cross legged for few hours after which he had difficulty with dorsiflexion and experienced
loss of sensation over dorsum of foot. What nerve was involved in this process?
A. Femoral
B. Peroneal
C. Sural
D. Obturator
E. Iliofemoral

127. A maid complains of pain in anterior inferior part of the knee. What is the most likely bursa
involved?
A. Supra patella
B. Pre patella
C. Inferior patella
D. Medial patella

128. A 28 year old pregnant lady presents with severe lower abdominal pain with excessive per vaginal
bleeding at her 34 weeks of pregnancy. What should be the initial investigation of choice?
A. Coagulation profile
B. US scan of abdomen
C. CT pelvis
D. D-dimer
E. Kleiuher Test

129. A 29 year old lady complains that she hears everyone saying that she is an evil person. What type of
hallucination is she suffering from?
A. Second person auditory hallucination
B. Third person auditory hallucination
C. Echo de la pensne
D. Gerdemankessane

130. Young boy with one sided facial swelling associated with pain tenderness and swelling around eye.
There is no proptosis and ophthalmoplegia. What is the most probable diagnosis?
A. Peri-orbital cellulitis
B. Orbital cellulitis
C. Sinusitis
D. Conjunctivitis
E. Erysipelas

131. A child comes with recurrent joint pain, multiple bruise, swollen ankle and unable to move his legs.
What is the investigation of choice?
A. Erythrocyte sedimentation rate (ESR)
B. Rheumatoid factor
C. Clotting factor

132. A 36 year old man had hematemesis and was found at endoscopy to have a duodenal ulcer. He was
treated with [Link] eradication therapy. Some months later, he returns with epigastric pain.
What single investigation is most likely to review eradication of [Link]?

23
A. Barium meal
B. C13 urea breath test
C. [Link] serology
D. Repeat endoscopy

133. A 4 year old girl presented with complaints of fever and rash, she was diagnosed with bacterial
meningitis. She is an only child living with both her parents. Doctors are concerned about her parents and
decided to give them prophylactic treatment. Which is the best prophylactic medicine for the parents?
A. Ampicillin 
B. Cefotaxime
C. Tetracycline 
D. Ciprofloxacin
E. Azythromycin

134. A 25 year old woman , 38 weeks pregnant , presents with blood pressure of 160/100 and +++
proteinuria . Her AST was 35 and ALT of 40. HB =12.7 g/dl. WBC count of 8×109 Platelet count of
115×109. What is your diagnosis?
A. Eclampsia
B. Preeclampsia
C. HELLP
D. Acute hepatitis

135. A 45 year old Afro-Caribbean female was recently diagnosed with hypertension. For this her GP
prescribed her an antihypertensive medication. After some time she developed swelling around her
ankles. What is the most probable cause of her swelling?
A. ACE inhibitors
B. Diuretics
C. Calcium channel blockers
D. Beta blocker
E. Alpha blocker

136. A middle aged hypertensive man presents with bleeding from the nose for half an hour. Bleeding is
not controlled with pressure. What is the most appropriate next step in management?
A. Refer to ENT surgeon
B. Anterior packing
C. Silver nitrate cautery
D. Posterior packing
E. Give antihypertensive

137. A man had a soft mass on his mandible. Mass is freely mobile and has started growing progressively
over the past six months. The mass still moves freely. What is the best investigation for this patient?
A. Fine-needle aspiration cytology (FNAC)
B. CT scan
C. X ray
D. Magnetic resonance imaging (MRI)
E. Erythrocyte sedimentation rate (ESR)

24
 138. A 75 year old alcoholic presents with a mass up to the umbilicus, urinary dribbling, incontinence,
and clothes smelling of ammonia. What is the next step in management?
A. Urethral catheter
B. Suprapubic catheter
C. Antibiotics
D. Condom catheter
E. Nephrostomy

139. A girl with history of allergies visited a friend’s farm. She got stridor, wheeze and erythematous
rash. What is the most appropriate treatment?
A. 0.25ml IM adrenaline
B. 0.25ml PO adrenaline
C. 0.25ml IV adrenaline
D. IV chlorpheniramine

140. A 40 year old woman presented to the GP clinic with complains of neck swelling, tremors,
palpitation. Lab investigations showed TSH = 1, FT4 = 28. The patient is already on propanolol. What
is the most appropriate next management?
A. Carbimazole
B. PTU
C. Prednisolone
D. Thyroxine
E. Radioiodine

141. A 40 year old man with bloody diarrhoea presented with diarrhoea since 6 months . He has a history
of two episode of bloody diarrhoea last year. What is the most appropriate diagnosis?
A. Gastroenteritis 
B. Ca
C. UC
D. Celiac disease 
E. Divertoculosis

142. A 60 year old man presents with cough , breathlessness and weight loss. What type of metabolic
changes can be seen?
1. Hypocalcemia
2. Hyponatremia
3. Hyperkalemia
4. Hypercalcemia
5. Hypernatremia

143. An 1 week old neonate was presented with jaundice. Investigations showed Elevated unconjugated
bilirubin but conjugated bilirubin was normal. What is the cause of the jaundice?
A. Breast milk jaundice
B. Physiological jaundice 
C. Biliary atresia
D. G6PD deficiency
E. Milk alkali Syndrome

25
144. A 30 year old man fell from height while scaffolding. What is the most likely bone to be injured?
A. Calcaneus
B. Talus
C. Navicular
D. Femur
E. Tibia

145. A 50 year old man presented with acute onset of severe breathlessness and cough with pink, frothy
sputum. He is a known case of IHD. What should be the first step?
A. Give IVFurosamide
B. Give supplemental Oxygen
C. Give nitrates
D. Give opiates

146. A 24 year old man presents to Accident & Emergency after his friends noticed his sclera turning
yellow. This happened after he had been taking paracetamol for a few days for an upper respiratory tract
infection. What is the single best cause for jaundice in him?
A. Gilbert’s syndrome
B. Criggler-Najjar syndrome
C. Glucose 6 phosphate dehydrogenase deficiency
D. Hereditary Spherocytosis
E. Hereditary Elliptocytosis

147. A 72 year old man presented with joint pains on both sides. He also complained of weakness and
stiffness in his shoulders which made it difficult for him to stand up from the chair after sitting for a
while. His ESR was raised and CPK was normal. What would be the appropriate treatment for him?
A. Physiotherapy
B. Methotrexate
C. Prednisolone
D. Allopurinol
E. Bed rest

148. What is the most appropriate antibiotic to treat uncomplicated Chlamydia infection in a 21 year old
female who is not pregnant?
A. Erythromycin
B. Ciprofloxacin
C. Metronidazole
D. Cefixime
E. Doxycycline

149. A 33 years old lady who is a drug addict wants to quit. She says she is ready to stop the drug abuse.
She is supported by her friends and family. What drug treatment would you give her?
A. Benzodiazepines
B. Diazipoxide
C. Lithium
D. Methadone
E. Disulfiram

26
150. A 65 year old man presents with a history of progressive difficulty in swallowing solid food for 6
months, he has also noticed unintentional weight loss and anorexia. What is the most likely diagnosis?
A. Achalasia cardia
B. Hiatus hernia
C. Gastroesophageal reflux disease
D. Carcinoma of the oesophagus
E. Oesophageal spasm

151. A 53 years old man presents with a long standing history of a 1cm lesion on his arm. It has started to
bleed on touching. What is the most likely diagnosis?
A. Basal cell carcinoma E. Kerathoacanthoma
B. Kaposi’s sarcoma
C. Malignant melanoma
D. Squamous cell carcinoma

152. 78 year old man with past history of ischemic heart disease presents with yellow haloes, nausea and
vomiting. ECG reveals arrhythmia. Which of the following medication is most likely responsible for his
symptoms?
A. Amlodipine
B. Digoxin
C. Aminophyline
D. Propanolol
E. Diltiazem

153. A footballer has been struck in the groin by a kick and presents with severe pain and mild swelling
in the scrotum. What is the most appropriate next step?
A. USG D. IV fluids
B. Doppler E. Antibiotics
C. Exploratory Surgery

154. A 45 year old man diagnosed with Multiple Sclerosis is admitted after taking 100 Paracetamol
tablets. He seems well, is not vomiting and is alert. He is refusing all treatment. What should you do next?
A. Gastric lavage
B. Activated charcoal
C. N-Acetyl cysteine
D. Methionine
E. Evaluate his capacity to refuse treatment

155. A 28 year old lady with a family history of cystic fibrosis comes for genetic counselling and wants
the earliest possible diagnostic test for cystic fibrosis for the baby she is planning. She is not in favour of
termination. What would you recommend for her?
A. Chorionic villous sampling
B. Amniocentesis
C. Pre implantation genetic diagnosis
D. Chromosomal karyotyping
E. Maternal serum test
F. Reassure

27
156. A 40 year old lady came into the emergency department with complains of mild headache. She
persistently kept asking for pain medications. On inspection she has dilated pupils and decreased
respiratory rate. What is the most likely used drug as overdose?
A. Heroin
B. Ecstasy
C. LSD
D. PCM
E. Cocaine

157. A 28 year old man presented to the emergency department. He came in with complains of abdominal
pain and rash on buttocks. On examination abdomen was soft but tender to touch. He was seen to have
purpuric rashes on buttocks. What is the probable diagnosis for this patient?
A. HSP
B. TTP
C. ITP
D. Anemia
E. Thrombophilia

158. A 90 year old lady was bought into the medical department with back pain of few months. No other
significant complains. On further evaluations all investigations are normal. What is the next appropriate
step of management?
A. Collateral information
B. Check for bence Jones protein
C. MRI spine
D. Plain XRAY Spine
E. No investigations needed. Symptomatic management

159. A newborn was presented with sticky eye . There was No redness or abnormal lacrimation noted.
What will be your most appropriate management?
[Link] eye drops
B. Clean with sterile water
C. Steroid eye drops
D. Hot compress
E. No treatment

160. A Lady working in nursing home was presented with itching in fingers and axilla. What is the most
appropriate diagnosis?
A. Allergic reaction
B. Steroids use infection
C. Scabies
D. Drug allergy
E. None of the above

161. You are a FY2 in the medical department. You have noticed that your colleague is taking picture of
patients investigation without asking the patient. When asked he says he is took the photographs for his
knowledge and will not share with anyone. What will be the most appropriate next step of your action?
A. Tell to GMC
B. Tell to nurse
C. Tell to him to inform his educational supervisor 
D. Ignore
E. Tell to his clinical supervisor 

28
162. A 9 year old boy has rash on his extensor surface with a history of itching. His aunt has similar
problems. What is the most probable diagnosis?
A. Psoriasis
B. Eczema
C. Impetigo
D. Scabies

163. A 27 year old woman presented with amenorrhoea of 10 months duration. FSH – 28, LH – Normal,
Testosterone – 1.8, Estradiol – 80. What is the most probable diagnosis?
A. Hypothalamic
B. Polycystic ovary syndrome (PCOS)
C. Premature ovarian failure
D. Hyper androgenism

164. A 64 year old female presents to the emergency department with sudden loss of vision in her right
eye. There is no history of headache or eye pain. Patient is on anti-hypertensive medications. On
examination the right eye shows no signs of congestion. Visual acuity is 20/200. Red reflex is present.
Ophthalmoscopy shows hyperaemia with numerous flame shaped haemorrhages and increased tortuosity
of the retinal blood vessels. What is the likely diagnosis?
A. CRAO
B. Retinal detachment
C. GCA
D. BRAO
E. CRVO

165. A lady developed breast abscess after delivery. What is the most likely organism?
A. Staph aureus
B. Staph albus
C. Group B streptococcus
D. Strep pyogenes
E. Strep faecalis

166. A 60 year old lady who had stroke three years ago now reports having increased dyspnea on
exertion, she has atrial fibrillation. On the chest X- ray there is a straight left border on the cardiac
silhouette. What is the most probable diagnosis?
A. Aortic Regurgitation
B. Ischemic Mitral Regurgitation
C. Mitral Valve Prolapse
D. Pulmonary Stenosis
E. Rheumatic Mitral Valve Stenosis

167. A 27 year old presents with abdominal pain, bleeding, vomiting and diarrohea. Her last menstrual
period was 7 weeks ago. On examination abdomen is tender and BP is 90/60mmHg. What is the next
appropriate management?
A. Immediate laparotomy
B. Laparoscopy
C. Salpingotomy

29
D. Salpingectomy
E. Metotrexate

168. A patient complains of shortness of breath, wheeze, cough and nocturnal waking. He has dry scaly
shin with rashes that are itchy. What is the single most likelydiagnosis?
A. Scabies
B. Eczema
C. Rheumatitis
D. Dermatitis
E. Psoriasis

169. A 75 year old woman presents to the breast clinic having noticed that she has had a blood stained
discharge from the left nipple, together with dry skin over the left areola. Exam: blood stained discharge
with dry flaky skin noted on the left areola. The nipple was noted to be ulcerated. What is the most
appropriate investigation?
A. FNAC
B. MRI
C. Punch biopsy
D. Open biopsy
E. Stereotactic biopsy

170. An 83 year old man with long standing Chronic Obstructive Pulmonary Disease has become
progressively breathless over the last two years. He is on Salbutamol, Ipratropium, Salmetrol,
Beclomethasone and Theophilline. His FEV1 < 30%. What is the next appropriate management?
A. Lung transplant
B. Trial of continuous positive airway pressure ventilation
C. Trial of non invasive ventilation
D. Assessment for long term oxygen therapy
E. Short course of oxygen therapy

171. A12 year old child is ill. Doctor prescribed treatment. Mother agreed but the child did not agree.
What will you do?
A. Agree with the child
B. Agree with the parent since she is thinking in best interest of the child
C. Send the child for counseling

172. A 57 year old man who had myocardial infarction a few months ago has been having low mood. A
diagnosis of moderate depression has been established. Which medication is the best treatment for him?
A. Selective serotonin re-uptake inhibitors (SSRI)
B. TACs
C. Monoamine oxidase inhibitor (MAOI)
D. Benzodiazepams
E. Mood stabilisers

30
173. A 9 year old girl presents with weekly abdominal pain and with occasional headaches but not
associated with vomiting and diarrhea. She has good appetite. Full blood count, urea and electrolytes and
other investigations are normal. On examination no abnormality was found and the abdomen was soft and
non-tender. What is the most likely next step?
A. Ultrasound scan of the abdomen
B. CT of thorax
C. Liver Function test
D. Reassure
E. Analgesia

174. A middle aged man who has history of chronic sinusitis, nasal obstruction, blood stained nasal
discharge. He now presents with cheek swelling, epiphora, ptosis, diplopia and maxillary pain. What is
the single most likely diagnosis?
A. Nasopharyngeal cancer
B. Pharyngeal cancer
C. Sinus squamous cell cancer

175. A 50 year old man presented to the emergency clinic with severe pain on the left leg. He
is afebrile and has movement restriction. On examination there is intact ankle and knee jerk
reflex. Which is the most likely nerve compression?
A. L4
B. L5
C. S1
D. Cauda equina
E. L2

176. A 46 year old lady came into the emergency department. She is on long term steroids and has the
follow up lab reports with her. The reports were normal except for low sodium and potassium reports.
Which of the following test will you do immediately?
A. Dexamethason suppression test
B. Synacthen test
C. IGF measurement
D. HbA1c
E. S Calcium

177. A 30 year old man was noticed to have jaundice. He complained of pale stools but did not have any
abdominal pain or distension. On investigations ALP was markedly raised but all the other markers were
normal. What is the most appropriate diagnosis?
A. Hepatocellular cancer
B. Primary biliary cirrhosis
C. Pancreatic Cancer
D. Chronic Hepatitis
E. Acute Viral Infection

178. A 70 year old man presented with weight loss, urgency and nocturia. He complains of pain in the
back for couple of weeks. What is the most appropriate investigation for diagnosis?
A. CT E. PR examination
B. MRI
C. Dexa
D. Radionuleotide bone scan

31
179. A Hepatitis B carrier mother who is envelope negative has delivered via normal vagina delivery.
What is the most appropriate treatment for her newborn child?.
A. Vaccination
B. Immunoglobulin
C. Test baby first
D. Vaccination and Ig
E. No treatment required

180. A 52 year old man came into the Emergency department with feeling of burning pain at the outer
side of thigh. It was noticed to be below the inguinal ligament. On examination there is no weakness of
muscles. Which of the following nerve injury is causing this?
A. Femoral nerve
B. Illiogastric nerve
C. Illioinguinal nerve
D. Lateral cutaneous nerve
E. Obturator nerve

32