Question

1. 22 year old female with lower limb cellulitis. Which of the following is
the most appropriate treatment with antibiotics?
a. Benzylpenicillin + Flucloxacillin
b. Penicillin + Metronidazole
c. Fludoxacillin + Ciprofloxacin
d. Ceftriaxone + Ciprofloxacin
e. Ceftriaxone alone

Question
2. A woman with ovarian cancer has had 5 cycles of chemotherapy. Each one
of them have been associated with vomiting and poor intake. She develops
tingling and numbness of her fingertips. There is also decreased sensation to
touch. There are no other neurological deficits. What is the most likely
cause?
a. Cervical vertebra metastases
b. Chemotherapy related neuropathy
c. Hypocalcemia
d Barium meal
e. None

Question
3. A lady who is a heroin addict wants to quit. She says she needs
someone to motivate her. What is your management of this patient?
a. Refer to clinical psychologist
b. Refer to community mental health team
c. Admit to medical team
d. Admit under psychiatric
e. Refer to substance abuse team

Question
4. 31 weeks of gestation, patient came to old with bleeding per vagina. On
examination tender uterus.
a. placenta previa
b. Infection
c. Abrupbo placentae
d. coagulation disorders
e. DIC

Question
5. A 6 year old boy who travailed from New York to united kingdom with a
fever. He presents to hospital in the united kingdom with night sweats. On
examination he has splenomegaly and his temperature 36.4. What is the single
most likely diagnosis?
a. Tuberdosis
b. Lymphoma
c. Brucelosis
d. Sarcoidosis
e. Malaria

Question
6. A 50 year old man presents with pain in his right ear. On examination
there are blisters in the ear. What is the most likely cause?
a. Herpes simplex
b. Acute otitis media
c. Acute otitis externa
d. Herpes zoster
e. H. Influenza

Question
7. Swelling on anterior triangle of neck, he is also a chronic
smoker, coughing out blood as well
a. Cystic hygroma
b. sternocleidomastoid tumor
 c. lymphadenopathy
d. branchial cyst
e. carotid body tumour

Question
8. A 50 year old alcoholic man presents with ataxia. confusion and
opthalmoplegia. What is the diagnosis?
a. Delirium tremens
b. Wernicke's Encephalopathy
c. Korsakoff's Psychosis
d. Water intoxicabon
e Acute psychosis

Question
9. A male adult went to a night club and was brought to the hospital. He was
commenting on a friends shirt color. Which drug is most likely responsible for
this?
a. Ectasy
b. Cocaine
c. Opiate
d. Her oin
e. Methadone

Question
10. A lady came with whiplash injury 10 days after RTa. pain over the
sternum, having sternum fracture, displacement, there is a firm tender
swelling on the breast, which was not present lOdays before.
a. Breast cancer
b. Breast abscess
c. Fat necrosis
d. fibroadenoma
e. Pagets disease of the breast

Question
11. patient with multiple painful ulcers in the mouth and over tongue with
striae in the mouth
a. Aphthous ulcer
b. Lichen planus
c. tongue cancer
d. lymphoma
e. herpes simplex

Question
12. A 45 year old male had pyrexia after surgery following acute abdomen. He
also had post-operative profuse diarrhoea. He was given pre-operative
antibiotics with IV ceftriaxone. What is the next step in management?
a. Repeat IV Ceftriaxone
b. Give Clindamycin
c. Give oral Vancomycin
d. Intravenous Vancomycin
e. Intravenous penicillin

Question
13. A 65 year old man presents with chest pain of 1 hour duration. An ECG shows
ST elevation, VI-VS, Lead I and AVL. GTN and aspirin has already been given.
What is the single most appropriate management?
a. Streptokinase
b. Tissue Plasminogen Activator
c. Low molecular weight heparin
d. Percutaneous Coronary Intervention
e. Beta-Blocker

Question
14. A 28 year old lady presents with a molar rash on the both sides of her
cheeks. She also complains of joint pains. What is the single most appropriate
investigation?
a. Anti-DNA
b. Anti-jo
c. Anti-ANA
d. Anti-Ro
e. Anti-mitochomdrial

Question
15. A 30 years old post op surgical patient comes complains of sudden
onset breath. What is the most definitive investigation?
a. CTPA
b. Ventilation perfusion scan
c. D dimer
d Pulmonary angiogram
e. Doppler ultrasound

Question
16. A 45 year old patient presents with COPD and has workecl in an asbestos
company. He now has shortness of breath and pleural effusion. How would
diagnose the fluids?
a. Chest drain
b. Antibiotic
c. CT scan of the chest
d. Oxygen
e. Pleural effusion

Question
17. 50 year old male smoker, who works in the coal industry. Which of the
following factors predisposes to bladder cancer?
a. Coal dust exposure
b. Smoking
c. Dust
d. Tar
e. Asbestosis

Question
18. 50 year old man presents with a headache. fever and neck stiffness. His
heart rate is 50, Respiratory rate is 28 and blood pressure is 200/110. What is
the single most appropriate treatment?
a. Dexamethasone
b. Mannitol
c. Beta-blockers
d. Adrenaline
e. IV fluids

Question
19. A 28 years old man who is sexually active presents with painful scrotal
content. He has no urethral discharge. gram stain shows no pus cells but urine
dipstix is positive for nitrites and leucocytes. What is the most Lillehammer
cause of the symptoms
a. e. Coll
b. Gonorrhoea
c. Proteus
d. Klebsiella
e. Chlamydia

Question
20. A 60 years old man presents with ascites He had ascitic tap done which
should low glucose and red blood cells in high numbers and protein 32g/l . What
is the most likely cause?
a. Cirrhosis
b. Liver failure
c. Tuberculosis
 d. Peritonei carcinoimatosis
e. Heart failure

Question
21. A lady with URTI,took antibiotics full course now presents with a rash and
blisters with basal necrosis all over the body sparing her mouth and
genitalia?
a. Erythema marginatum
b. Erythema multiforme
c. Erythema nodosum
d. Steven johnson syndrome
e. Impetigo

Question
22. A 30 year lady was found to have inflammatory changes on routine
cervical smear. What is the most appropriate action?
a. Do colposcopy
b. Repeat smear in 6 months
c. Reassure
d. Repeat cervical smear immediately
e. Take biopsy

Question
23. A 25 year old man rarely left his house for the last 2 months. He believes
that his neighbours are spying him. His sleep and appetite are poor and he has
lost weight. Mental state examination reveals that he hears derogatory voices
even when he is alone. Neurological examination is normal. What is the single
most appropriate management?
a. Diazepam
b. ECT
c. Fluoxetine
d. Lithium
e. Olanzapine

Question
24 A 45 year old homosexual who has multiple partners presents with urethral
discharge. He describes a transiet painless ulcer few weeks back. What is the
single most appropriate diagnostic investigation?
a. Ulcer swabs and culture
b. Buccal mucosa swab
c. PCR for antigen
d. Antibodies to treponema pallidum
e. Biopsy of the liver

Question
25. A 40 year old man is seen with a hematoma over the mastoid after being
involved in a fight. Which bone is fractured?
a. Parietal
b. Temporal
c. Sphenoidal
d. Mandibular
e. Occipital

Question
26. A 15 year old female presents with colicky pain in the pelvis region since
1 year ago which has now increased. The pain is in the right iliac fossa.
What is the diagnosis?
a. Ovarian torsion
b. Twisted ovarian cyst
c. Appendicitis
d. Ovarian cancer
e. Endometriosis

Question
27. A 30 year old lady had blood film which shows a picture of
anaemia with spherocytes. What will you do?
a. Indirect Coomb's test
b. Bone marrow examinabon
c. Measure serum ferritin
d. Bilirubin
e. Direct Coomb's test

Question
28. A 45 year old man presents with pain, loss of sense and reflexes on
both legs. Where is the lesion?
a. Aorta
b. External iliac
c. Internal iliac
d. Common iliac
e. Femoral

Question
29. Kid from school came with dry cough and chest x-ray shows
bilateral infiltrates?
a. Mycoplasma
b. Streptococcus
c. egionella
d. staph aureus
e H. inifluenza

Question
30. A 40 year old lady patient with rheumatoid arthritis presents with
redness in the lateral side of the eye. The vision is normal. What is the
diagnosis?
a. uveitis
b. Cataracts
c. Posterior uveitis
d. Glaucoma
e. Central retinal vein occlusion

Question
31. A 35 year old female presents with 5 percent full thickness burns.
What is the most appropriate? What will you do?
a. Reassure
b. IV fluids
c. Fresh frozen plasma
d. Do not give fluids
e. IV fluids

Question
32. A 40 year old woman with diabetes mellitus has high ferritin levels.
What cancer is she predisposed to?
a. Liver carcinoma
b. Lung carcinoma
c. Renal carcinoma
d. Intestinal carcinoma
e. Pancrease carcinoma

Question with
33. A 30 year old female is afraid of developing ectopic pregnancy. Which
of the following is likely to increase the risk of ectopic pegnancy?
a. Chlamydial infection
b. PCOS
c. Smoking
d. Bleeding per vaginum
e. Multiple pregnancies

Question
34. A 30 year old man has had diarrhea for the past 4 days. What
metabolic changes will you see in the blood?
a. PH increased bicarbonate decreased
b. Increased bicarbonate. increased PH
c. Decreased PH, decreased bicarbonate
d. Normal PH, normal bicarbonates

Question
35. A 17 years old man presents with testicular pain and the left scrotum is
elevated. What is the single most appropriate management?
a. Antibiotics
b. Reassurance
c. Surgical exploration
d. Anti-viral
e. No treatment required

Question
36. A 60 year old man who is hypertensive and on bendroflumethiazide What
electrolytes changes do loop cause?
a. Hyponatremia and hypokalemia
b. Hypokalemia
c. Hypercalcemia
d. Hypocalcemia
e. Hypokalemia and hyponatremia

Question
37. An 18 year old young female is losing weight despite eating 3 times a
day. The skin On her bottom is flaccid. What is the definitive diagnosis?
a. Jejuna biopsy
b. Duodenal biopsy
c. Endomysial antibodies
d. Anti-reticulin
e. Anti-glutaminase

Question
38. A 38-year-old lady has undergone open cholecystectomy, 8 hrs after the
procedure she is found to be unconscious and had pinpoint pupils. Her
Respiratory rate was 6 breaths /min. What is the next best step in the
management?
a. IV Fluid
b. Morphine
c. Naloxone
d. IV Antibiotics
e. Diazepam

Question
39. A 70 year old man with known prostrate cancer which has grown outside the
capsule presents with increasing confusion. He also has high urea and
creatinine.
a. Ivu
b. Furosemide
c. Ultrasound scan
d. MSU

Question
40. A child of 10 years has positive anti-hepatitis A IgM and is hepatitis
C IgM negative. What do you check to confirm the diagnosis?
a. Hepatitis B antigen
b. Hepatitis A IgG
c. PCR for hepatitis C
d. Envelope hepatitis C antigen

Question
41. A 20 year old man presents with syphillis ulcers. What investigation will
you do.
a. Antibody for treponema pallidum
b. Antigen for treponema
c. PCR for treponema
d. Swab from lesions
e. Syphilis antigen

Question
42. A 30 years old pregnant woman is exposed to a 10 year old. with chicken pox.
The woman goes and checks for anti-varicella antibodies which were found to be
negative. What is the most appropriate action?
a. Aciclovir oral
b. Aciclovir intravenous
c. Immunoglobulin
d. Reassure

Question
43. A 40 year old woman presents with very painful ulcers on her vulva. She
recently changed her partner. What is the single most likely cause?
a. Syphilis
b. Herpes simplex
c. Herpes zoster
d. Erythema multiforme

Question
44. A 45 year old man patient developed infected peritonitis after an
appendicectomy for perforated gangrenous appendicitis. What analgesia will
you give?
a. Morphine IM
b. Diclofenac PR
c. Paracetamol PO
d. Patient controlled analgesia
e. Diamorphine IM

Question
45. A 4-year-old girl is undergoing treatment for fever and dysuria. Her MSU
showed nitrates negative now. On micturating cystourethrogram she is found to
have bilateral vesico-ureteric reflux What is the most appropriate treatment?
a. Prophylactic antibiotic
b. surgery
c. Reassurance
d. No treatment required
e. IVU

Question
46. A 65 year menopausal woman presents with recurrent UTI and a little
bleeding PV, Transvaginal ultrasound scan was normal. What is the
appropriate management
a. Hormonal replacement
b. Vaginal oestrogen
c. Vaginal lubricant
d. Combined contraception

Question
47. A 70 year old man has lung cancer and is confused. There is also
decreased sodium on blood testing.Examination is normal. What is the
diagnosis?
a. SIADH
b. Fluid overload
c. Cushing syndrome
d. Phaechromocytoma
e. Acamprostate

Question
48. A 40 year old female on sodium valproate 5mg twice daily for epilepsy
has been getting attacks more frequently than usual. On examination she has
mild obesity. What is the most appropriate management?
a. Increase the dose
b. Change the medicabon
c. Review the dose
d. Check the serum drug levels
e. Add a second drug

Question
A 24 year tall man is found to have shortness of breath after a road traffic
accident. His trachea is deviated to the left. What is the immediate treatment
required.
a. Left needle thoracocentasis
b. Right needle thoracocentasis
c. Right chest drain
d. Left Chest Drain
e. Thoracotomy

Question
50. A 60 year old lady presents with ovarian carcinoma Which lymph
drainage is involved?
a. Internal iliac lymph nodes
b. Paraortic lymph nodes
c. External iliac lymph nodes
d. Deep inguinal lymph nodes

Question
51. A female of 74 years presents with repeated falls. She is diabetic.
hypertensive and is on medication for diabetes. She is also on
bendroflumethiazide and some other drug. What is the next investigation?
a. Ambulatory ECG
b. ECHO
c. Tilt table BP
d. Carotid angiography
e. Standing and lying blood pressure

Question
52. A 74 year old male who is a known diabetic presents with falls. He is on
the following medication; aspirin, diclofenac glibenclamide and metformin. What
is the most appropriate investigation?
a. Ambulatory ECG
b. ECHO
c. Carotid angiography
d. Blood glucose
e. Standing and Lying BP

Question
53. A 24 year old woman whose last menstrual period was 6-8 weeks ago
presents with sudden onset of right sided iliac fossa pain. What is the most
likely diagnosis?
a. Miscarriage
b. Ectopic pregnancy
c. Ovarian cyst
d. Torsion of ovarian cyst
e. Pelvic Inflammatory disease

Question
54. A 15 year old female presents with right iliac fossa pain every 4-8 weeks
which is very severe in recent weeks. What is the most likely diagnosis?
a. Miscarriage
 b. Ectopic pregnancy
c. Ovarian cyst
d. Torsion of ovarian cyst
e. Pelvic Inflammatory Diesease

Question
55 A 19 year old presents with per vaginal bleeding. She was treated for
chlamydia in the past. She has 6 weeks of amenorrhea. Pregnancy test is
positive. What is the most appropriate investigation?
a. Pregnancy test
b. Transvaginal ultrasound scan
c. Serum beta HCG
d. Laparascopy
e. Laparotomy

Question
56. A 35 year old woman with 5 children presents with right upper quadrant
pain. She also has fever and vomiting. 3 years ago she had intermittent pain in
the right upper quadrant. What is the most appropriate management?
a. ultrasound scan
b. Midstream urine
c. Intravenous urogram
d. Laparoscopy
e. Retrograde pyelography

Question
57. A 3 month old child collapses and was resuscitated and is now well.
His parents are asking how to do CPR in case it happens again.
a. 5:1 with mouth and nose together
b. 5:1 with just mouth nose pinched
c. 15:2 with mouth plus nose
d. 15:2 with mout:h, pinch nose

Question
58. A 45 year oldman has withdrawn recently and feels that he is responsible
for the floods in Thailand. what is the likely diagnosis?
a. Schizophrenia
b. Depression
c. Schophrenia
d. Anxiety
e. Mania

Question
59. A man fell off his roof from
a 4m height. He was stable and answering questions. Suddenly he became
unconscious. On auscultation, there is decreased air entry on the right side of
his chest. What is most appropriate next step?
a. CT scan
b. IV fluids
c. Thoracocentesis
d. Chest X-ray
e. MRI Brain

Question
60. An 8 year old girl fell down and fainted at the school assembly. She
went pale and light headed. What is the most likely diagnosis?
a. Decreased blood sugar
b. Vasovagal syncope
c. Anxiety
d. Arrhythmia
e. Heat stroke
Question
61. A 7 year old boy with epilepsy is admitted to hospital and is presently on
valproate. He has a seizure in the night What is the initial investigation?
a. Check drug serum levels
b. CT head
c. EEG
d. ECG
e. MRI brain

Question
62. A 70 year old gentleman has sudden severe painful medial side of left calf
on walking up the hill. He has no ankle swelling, and he can extend his foot
easily. What is the single most likely diagnosis?
a. Popliteal cyst (Baker's cyst)
b. Deep vein thrombosis
c. Tendon achilles rupture
d. Acute limb ischaemia
e. Fracture

Question
63. A 38 year old woman presents with pruritius for 5 years. What is
the most appropriate investigation?
a. FBC
b. Serum amylase
c. Anti-mitochondrial antibodies
d. Liver ultrasound scan
e. LFTs

Question
64. A 45 year old man recently returned from Malaysia. For the past 2 days,
he has developed fever and upper right quadrant pain and jaundice. What is the
most appropriate investigation?
a. CT abdomen
b. Hepatitis screen
c. Serum amylase
d. Ultrasound scan of the abdomen
e. LFTs

Question
65. A 22 year old man presents with bilateral facial swelling. What is the
most likely diagnosis?
a. Parotid calculi
b. Submandibular calculi
c. Lympadenopathy
d. TB adenitis
e. Mumps

Question
66. A 6 week old girl with pyloric stenosis presents with vomiting. What
is the most appropriate test?
a. Calcium
b. Potassium
c. Sodium
d. HCI
e. Magnesium

Question
67. A 75 yr old lady is breathless and suffering from Mesothelioma. She has
massive Pleural effusion. She has been told that she has just 2 weeks to live.
What is the most appropriate treatment for her?
a. pleural aspirabon
b. pleural aspirabon and pleurodesis
c. continuous negative pressure drainage
d. pleural biopsy and plaque removal
 e. thoracotomy

Question
68. A 5O year old man presents with sudden loss of vision in his right eye. On
fundoscopy - there are hard exudates and flame shaped hemorrhages. What is the
most likely diagnosis?
a. Central retinal vein occlusion
b. Central retinal vein artery
c. Retinal detachment
d. Optic neuritis
e. Branch of Retinal Artery Occlusion

Question
69. A 40 year old lady while walking at home develop sudden onset of vomiting
and loss of consciousness. In accident and emergency department her GCS is
5/15. Initially she lost consciousness and later she was ok with GCS 15/15.
What is the single most appropriate investigahon? She had a laceration to her
temple area
a. CT scan of the head
b. Facial X-ray
c. MRI brain
d. No investigation

Question
70. A child presented with symptoms cf meningitis on lumbar punctures
glucose is lows protein is high and gram +ve diplococci are found?
a. H. influenza
b. Staph aureus
c streptococcus pneumonia
d. legionella
e. mycobacteria

Question
71. A 45 year old lady was found to have CIN 2 on routine test What is
the most appropriate next step?
a. Smear
b. Colposcopy
c. Cervical biopsy
d. Transvaginal ultrasound scan
e. Endometrial Carcinoma

Question
72. A lady with history of DVT and PE wants some contraception, she has
menorrhagia?
a. POP
b. mirena coil
c. COCP
d. copper IUCD
e. devo provera

Question
73. A pregnant lady wakes up in the middle of the night due to tingling in her
thumb, index and middle fingers. It has been happening
for the past 3 weeks. Which of the following structures is involved?
a. Ulnar artery at wrist
b. Median nerve at wrist
c. Median nerve at elbow
d. Brachial artery
e. Ulnar nerve at elbow

Question
74. A 3 year old boy develops haematui 2 weeks after upper respiratory tract
infection. What is the single most
likely diagnosis?
 a. Post-streptococcal glomerulonephritis
b. Ig A nephropathy
c. Chronic pyelonephritis
d. Urinary tract infection
e. Bladder tumour

Question
75. A patient came with migraine and photophobia, she has uterine fibroids
distorting the uterine cavity she is a mother of two children and needs
contraception
a. Endometrial ablation
b. Copper IUCD
c. Mirena coil
d. Dapo progesterone
e. COCP

Question
76. A 56 year old man who has never smoked presents with regurgitation of
food when lying down. He also has hoarseness of voice for few months. Who do
you refer to?
a. ENT surgeon
b. GIT surgeon
c. General surgeon
d. Voice therapist
e. Speech therapist

Question
77. A 43 year old pregnant woman presents with tingling and numbness in
middle finger. What is the lost likely diagnosis?
a. Carpal tunnel syndrome
b. Diabetes in pregnancy
c. Hypertension in pregnancy
d. Cushing syndrome
e. Acromegaly

Question
78. A 40 year old man presents with 2 months history of chronic short breath
and an erythema on his shin. What is the most likely cause of the lesion?
a. Erythema nodosum
b. Erythema multiforme
c. Urticaria
d. Purpura
e. Maculopapular Rash

Question
79. A 60 year old woman presents with bleeding per vaginum. Her last cervical
smear was 3 years ago. What is the diagnosis?
a. CervicaI cancer
b. Endometrial carcinoma
c. Cervical poly
d. Vaginal cancer
e. PID

Question
80. A 50 year old woman presents with bleeding from one of her mammary duct.
What is the most appropriate investigation?
a. Mammography
b. Open biopsy
c. FNAC
d. Ductography
e. Core biopsy

Question
81. A 70 year old lady with severe heart failure presents with stress urinary
incontinence. She has got feeling of dragging sensation in her perineum. What
is the most appropriate management? a. Pelvic floor exercise
b. Ring pessary
c. Oxybutinin
d. Bladder neck surgery
e. Local Estrogen

Question
82. A lady wants to know the risk factor of ectopic pregnancy she has
two previous miscarriages which is the most significant among the
following?
a. Alcohol
b. Smoking
c. IUCD
d. uterine fibroids
e. endometriosis

Question
83. A 20 year old man presents with severe asthma. Which of the following is a
criteria for severe asthma?
a. Silent chest
b. Cyanosis
c. Not speaking in full sentences
d. RR > 27cycles/minute
e. PEFR < 30

Question
84. A man fell from the roof, his BP low, pulse high, radio femoral delay,
trachea is central, on X-ray mediastinum is widening?
a. Cardiac tamponade
b. Aortic dissection
c. splenic rupture
d. head injury
e. femur fracture

Question
85. patient with bleeding P/R, whole family has familial adenomatosis
polyposis gene. If not treated what complicabon would cause? a. familial
adenomatous polyposis
b. Ca rectum
c. Ca stomach
d. Ca pancreas
e. Ca ileum

Question
86. A 30 year old lady who is 27 weeks pregnant is found to have anemia of
10. She has normal MCHC and MCV. What is the most appropriate action?
a. No treatment required
b. Endoscopy
c. Blood transfusion
d. Vitamin B12 replacement
e. iron tablets

Question
87. 50 year old diabetic patient is going to undergo an endoscopy. He
is on oral hypoglycemic medication. What is the single most appropriate
management plan?
a. stop medication 3 days before the procedure
b. Stop medication 1 day before the procedure
c. Stop medication on the morning of the procedure
d. Continue medication as usual
e. Stop medication 1 week before
Question
88. A 23 year old lady in her 34 weeks of pregnancy presents with seizures.
Her BP is 170/llOmmHg What is the most appropriate management?
a. Intravenous hydralazine
b. Intravenous methyldopa
c. Intravenous magnesium sulphate
d. Caesarian section

Question
89. A 30 year pregnant lady presents with a BP of 170/90. She has a
previous history of recurrent UTI. Urine dipstix show proteinuria of ++. She
is 10 weeks pregnant. What is the single most likely cause of her
hypertension?
a. Chronic Pyelonephritis
b. Essential Hypertension
c. Chronic Glomerulonephritis
d. Pregnancy Induced Hypertension
e. SLE

Question
90. A 70 year old woman with breast cancer has had it spread to her lung liver
and bones. There is also increasing constipation weakness, thirst and anorexia
for 3 days. She is taking only haloperidol for hiccups. She is more
disorientated today. What is the most likely diagnosis?
a. Cerebral metastases
b. Hypercalcemia
c. Spinal cord compression
d. UTI
e. Chest Infection

Question
91. A 30 year old man after an appendicectomy develops abdominal pain radiating
to the shoulder. What is the most likely nerve to be involved?
a. Phrenic nerve
b. TIO
c. Aortic nerve
d. T12
e. Blood Transfusion

Question
92. A 30-year-old 10 weeks pregnant lady has come for antenatal check up.
Her haemoglobin 10.89/dl and MCV is 80. What is the single most appropriate
treatment?
a. Ferrous Sulphate
b. Folate
c.None
d. Vitamin B12
e. Blood Transfusion

Question
93. A 40 year old man is stabbed in the hest SP is 60/O, HR 140. On
examination he has engorged neck veins and trachea is on the midline.
What is the single most likely diagnosis?
a. simple pneumothorax
b. Tension pneumothorax
c. Haemothorax
d. Cardiac temponade
e. Aortic laceration

Question
94. A smoker with histology findings of pleomorphic cells producing
keratin
a. squamous cell cancer
b. small cell cancer
 c. large cell cancer
d. bronchogenic carcinoma
e. mesothelioma

Question
95. A 6 month old child develops fever and difficulty in breathing and feeding.
What is the most likely diagnosis?
a. Pneumonia
b. URTI
c. Broncholitis
d. Croup
e. Epiglottis

Question
96. A 6 week old child has repeated vomiting after feeding. What is the
most appropriate investigation?
a. CT abdomen
b. USS abdomen
c. Endoscopy
d. Barium enema
e. No investigation required

Question
97. A boy 18 months old weighs 10kg. Trimethoprim 50mg/5ml, Patient is to
receive it twice a day. Child is to receive 4mg/kg. What dose is required?
a. 4ml bd
b. 2 ml once a day at night
c. 0.8 ml bd
d. 8ml bd
e. 8ml od at night

Question
98. A 30 year old lady presents with fresh blood per rectum after defecation
She has been constipated for the past 2 months. She has no pain. What is the
diagnosis?
a. Anal fissure
b. Haemorrhoids
c. Inflammatory bowel disease
d. Colonic cancer
e. Rectal Cancer

Question
99. A 25 year old lady presents with intermittent abdominal pain and bloody
diarrhea. What is the most likely diagnosis?
a. Crohn's disease
b. Ulcerative colitis
c. Irritable bowel syndrome
d. Colonic cancer
e. Abdominal migraine

Question
100. A 76 year old man suddenly collapses and dies. The post mortem
examination shows a retroperitoneal hematoma due to a ruptured aneurysm. What
is the most likely cause of this aneurysm?
a. Atheroma
b. Cystic medical necrosis
c. Dissecting aneurysm
d. Polyarteritis nodosa
e. Syphilis

Question
101. A new born baby, born 3 hours ago, 48 hours after premature rupture of
membranes at 36 weeks gestation, has nasal flaring, normal temperature and
interciostal recessions. What is the single most likely investigation that
should be done before commencing treatment?
a. chest X-Ray
b. Blood Glucose
c. Blood Culture
d. Echocardiogram
e. ECG

Question
102. A 70 year old man with previous history of lung cancer which was
treated with surgery and radiotherapy presents with headache and swelling of
the upper limb. The lower limbs were normal. What is the single most
appropriate management?
a. Dexamethesaone
b. Radiotherapy
c. Chemotherapy
d Prednisolone
e. Mannitol

Question
103. A 3 year old child presents with burns on his shoulder and upper arm
covering 4% of the total body surface. He is in pain and screaming. What is
the most appropriate management?
a. Analgesia
b. IV fluid
c. Dressing
d. Antibiotics
e. Refer to Burns team

Question
104 A patient had an injury to his hand. he has lost his tricep reflex. Which
nerve root is affected?
a. C5
b. C6
c. C7
d. C8
e. T1

Question
105 A 30 year old lady who is 38 weeks pregnant, presents with abdominal
pain. On examination the uterus is tender and woody hard. She also has per
vaginal bleeding and fetal distress. What is the single most likely
diagnosis?
a. Placenta Praevia
b. Placental Abruption
c. Chorioamnionitis
d. Maternal sepsis
e. Ectopic pregnancy

Question
106. An 18 years old lady presents with sudden loss of vision a day after she
witnessed a road traffic accident during which people died. What is the most
likely diagnosis?
a. Post traumatic disorder
b. Conversion disorder
c. Somatization
d. Hypochondria
e. Nihilistic syndrome

Question
107. A 25 year old man presented with history of breathlessness. A
transthoracic echo revealed patent foramen ovale. What diagnostic investigation
would you do?
a. Trans esophageal ECHO
 b. Bubble ECHO
c. Trans thoracic ECHO
d. ECG

Question
108. A 4 year old child comes to the hospital with foot sprain. History reveals
that the child has had recurrent admissions to the hospital due to severe
asthma. What is the most appropriate analgesia?
a. Diclofenac
b. Ibuprofen
c. Paracetamol
d. Codeine

Question
109. A 60 year of man 6 months after the road traffic accident presents with low
mood. loss of interest in daily activities and weight loss. What is the most
appropriate management?
a. Cognitive beihour therapy
b. Psychoanalysis
c. Benzodiazepines
d. Systemic dissentitization
e. Behayiour therapy

Question
110. A 35 year old lady flew from South Africa to United Kingdom. 3 days later
she present cough with blood stained sputum? What is the single most
appropriate investigation?
a. D-dimmer
b. Ventilation perfusion scan
c. Pulmpnary angiogram
d. Chest X-Ray
e. MRI of the Chest

Question
111. A 50 year old man with epilepsy took an overdose of his medication 1 hour
ago. He has dry mouth and dilated pupils but is not drowsy. What is the most
appropriate management?
a. Haemodialysis
b. Activated charcoal
c. Gastric lavage
d. Forced emesis
e. Hyperbaric Oxygen

Question
112. An 80 year old lady presents with frequency, weight loss, hematuria and
blood dots. USS of the abdomen is inconclusive. What is the most appropriate
investigation?
a. IVU
b. CT abdomen
c. Cystoscopy
d. X-Ray KUB

Question
113. A patient with Rheumatoid Arthritis has swelling of the calf with joint
effusion, dorsiflexion and planter flexion of foot are normal, fluctuating
swelling at the back of the knee?
a. Popliteal cyst rupture
b Popliteal artery aneurysm
c. DVT
d. Septic arthritis

Question
114. A 30 year old woman presents to hospital with different types of symptoms
from abdominal pain, ,headache Vomiting, dizziness. She has had extensive
investigations She has multiple laparoscopic scars on her abdomen. What is the
most Likely diagnosis?
a. Borderline personality disorder
b. Somatization
c. Fibromyalgia
d. Hypochondriasis
e. Hysteria

Question
115. A 35 year old lady presents with painless bleeding from a single duct.
What is the most likely diagnosis?
a. Rupture popliteal cyst
b. Ruptured achilles tendon
c. DVT
d. Tendinitis
e. Sepbc arthritis

Question
116. Patient has got claw hand, what examination you would do against
resistance?
a. Abduction of fingers
b. Adduction of fingers
c. Flexion of fingers
d. Extension of fingers
e. Abduction of thumb

Question
117. A 26 year old female taking deep progesterone has amenorrhea for the
last 6 months. She has been on this pill for 6 months. What is the
investiga6on?
a. FSH level
b. Urine pregnancy test
c. Abdominal ultrasound
d. CT abdomen
e. MRI Scan

Question
118. A couple had a child who died from cot death, which was found to be
sudden onset death syndrome, they need to know how to resuscitate what
advise would you give?
a. 15:2 with mouth only
b. 15:2 with mouth and pinch nose
c. 15:2 with mouth and nose
d. 5:1 with mouth and nose
e. 5:2 mouth and nose

Question
119. A 64 year old man presents with dyspepsia and epigastric pain. He has no
past history of helicobacter pylori. What is the single most appropriate
investigation?
a. Ultrasound scan abdomen.
b. Upper GI endoscopy
c. H. Pylori serology
d. Urea breath tests
e. Barium swallow

Question
120. A 7 year old boy fell down from a bicycle. He now presents with swelling
of the right knee and is unable to bear weight. What is the most appropriate
management?
a. X-ray of the knee
b. Analgesia
c. Immobilise in a cast
d. Refer to fracture clinic
 e. Reassure

Question
121. A 30-year-old female had low mood, losing weight but has episodes of
hyperactivity and buying a lot of cars. What is the most likely diagnosis?
a. Bipolar disorder
b. Mania
c. Obsessive compulsive disorder
d. Hypochondriasis
e. Schizophrenia

Question
and
122. A 45 years old man had
72 hours after an operation for acute cholecystitis develops vomiting
abdominal tenderness. What is the single most likely diagnosis?
a. Mechanical obstruction
b. Paralytic ileus
c. Anastomotic leak
d. Wound infection
e. Wound dihescence

Question
123. A 70 year old man presents with back-pain, anaemia and raised ESR.
Corrected serum blood calcium is 3.70. He is already on intravenous fluid.
What is the most appropriate management?
a. Pamidronate
b. Rehydration
c. Calcitonin
d. Allopurinol
e. Parathormone

Question
124. A 45 year old man while in the gym had sudden onset of back pan. He
presents wot accident and emergency department with lower back pain. He has
been given analgesia and now feels better. All examination is normal What is
most appropriate advice to him?
a. Continue moving
b. Bed rest
C Needs MRI scan of the spine
d. Needs CT scan spine
e. Continue moving

Question
125. A 76 year old man fell down and hit his head. Five days later he comes
back with confusion. Which of the following is the most likely sight of
bleeding?

a. Middle meningeal artery

b. Internal cerebral artery
c. Cerebral vein plexes
d. Bery aneuryms
e. Inernal carotid vein

Question
126. A 70 year old man presents with back pain, anemia and raised calcium.
What finding will be on bone marrow aspirate?

a. Increased plasma B cell

b. Increased leucocytes
c. Increased T-cells
d. Reduced plasma cells
e. Increased neutrophils
Question
127. A 20 year old lady with painless vaginal bleeding, abdomen
examination and pelvis examination is normal, she has got mild ectropion
without contact bleeding. Smear test done 3 years ago with was normal, what
is the next investigation?
a. Colposcopy
b. Reassure
c. Cervical smear
d. cervical cryocautery
e. hysterectomy

Question
128. A 2 year old boy presents with reddish blistering rash on the face
especially around the mouth and nose. What is the single most likely
diagnosis?
a. Impetigo
b. Shingles
c. Chicken pox
d. Measles
e. Herpes simplex

Question
129. An elderly woman cannot carry on her household chores and has to sit down
every few minutes. A chest Xray shows diffuse reticular nodular shadows
especially in the lower lobes. What is the next step in management?
a. Oxygen
b. Thymectomy
c. Chemotherapy
d. Change occupation
e. Radiotherapy

Question
130. A 16 years old lady with known epilepsy and on sodium valproate is having
fits despite being on increased dose of sodium valproate. She develops a fit
during the night which terminated with per rectal diazepam after 4 minutes .
What should the night team do which would help in the management of this
patient?
a. EEG
b. CT scan of the head
c. Serum drug levels
d. ECG
e. Increase the dose

Question
131. A 45 year old man presents with knee pain to accident and emergency
department. He was later found to have gout. What is the single most
appropriate management?
a. Allopurinol
b. Non steroid anti-inflammatory drugs
c. Colchicine
d. Paracetamol
e. Oral morphine

Question
132. A 36 year old lady with long standing history of migraine presents
with severe headache. She says it is the worst headache of her life. What is
the most appropriate management?
a. Give analgesia
b. CT scan of the head
c. Reassure
d. Observe in emergency department
e. Admit for 24 hours

Question
133. A boy !s brought to the A&E with feeling of being unwell for a few days
and vomibng. His pulse is lOOb/m and cappilary refill is 3 seconds. He is
confused and his arterial blood gas results are hown as follows;
Ph: 7.25
PaCO2: 3.2kPa
PaO2: 2OkPa
Base excess: -15
What is the single correct interpretation of the blood gas result?
a. Metabolic acidosis
b. Metabolic alkalosis
c. Normal
d. Respiratory disorder
e. Respiratory alkalosis

Question

134. A 79 years old lady was found confused and incontinent of urine by her son.
She recovered with 30 minutes. She surved big stroke 5 years ago. She is on
aspirin What is the most likely diagnosis?
a. Urinary tract infection
b. Stroke
c. Epilepsy
d. Vertebra basilar insufficiency
e. Transient ischemic Attack

Question
135. A patient had back pain at the level of lilac crest, which level of
vertebrae is affected?
a. L1
b. L2
c. L3
d. L4
e. L5

Question
136. A 25 year old man was brought to the A&E department after partying in the
night club. He is hallucinated, has high temperature and his pupils are
dilated. His friends would not admit which substance he took. The patient said
that the orange colored doctor is talking to him. What drug is most likely
implicated?
a. LSD
b. Ecstasy
c. Cocaine
d Alcohol
e. Heroin

Question
137. A child had URTI, now develops swelling around the eye and the swelling
worsening. O/E there is proptosis. Next investigation is?
a. CT scan of orbit
b. Facial x-ray of orbit
c. MRI scan
d. Ultrasound
e. Angiography

Question
138. An old woman develops sudden pain in the upper part of her arm after
carrying heavy loads. Which part of the arm is affected?
a. Ruptured supraspinatus tendon
b. Posterior capsulitis
c. Biceps tear
d. Bursistis

Question
139. A lady said that she is being controlled by some outside force who
tells her to do everything. What is this condition that she is having?
a. Delusion
b. Thought insertion
c. Thought broadcasting
d. Acute anxiety
e. Passivity phenomenon

Question
140. A 40 year old patient presents with dry cough and confusion Blood
tests reveal lymphopenia and hyponatremia. Chest Xray shows right lobar
shadowing. What is the single most appropriate treatment?
a. Erythromycin
b. Cyclophosphamide
c. Tobramycine and carbenicillin
d. Plasmaphoresis
e. Ciprofloxacin

Question
141. A 76 year old lady who is a know chronic obstructive pulmonary disease
patient is on salbutamol inhalers regularly , salmeterol inhaled steroid and
oral steroid . He still gets shortness of breath at rest. What is the most
appropriate treatment of this patient symptoms?
a. Non invasive venblabon
b. Long term oxygen therapy
c. Short term oxygen therapy
d. Mechanical ventilabon
e. Continue current treatment

Question
142. A 40 year old man presents with vertigo, nystagmus and weakness.
He also has tingling sensation in his right arm and diplopia. On
examination, there is loss of central vision, nystagmus and ataxia. What is
the most likely diagnosis?
a. Vertebra-basilar ischemia
b. Multiple sclerosis
c. Acoustic neuroma
d. Lateral medullary syndrome
e. Carotid Artery Disease

Question
143. A 40 year old Afro-Caribbean womans lung function tests are as follows:
PET/FEVI 2.51, FEVI/FVC 86%, Serum ACE levels -High. What is the single most
likely diagnosis?
a. Pneumonectomy
b. Pulmonary fibrosis
c. Pulmonary embolism
d. Panic attack
e. Sarcoidosis

Question
144. A patient with single tutor in brain is on dexamethasone. now
presents with hyperglycaemia with FBS l2mmol/l. What is the next immediate
step?
a. Long acting insulin in morning
b. short acting insulin with every meal
c. stop dexamethasone
d. oral hypoglycaemic drugs
e. give diuretic

Question
145. A 62 year old man has a 5 years history of diabetes. On examination,
his blood pressure is 120/80 mmHg. laboratory tests for a 24 hour urine
collection show a protein level of 2OOmg/l. What medication should be added
to this patient?
a. B-blockers
b. Calcium channel blockers
c. ACE inhibitors
d. Diuretics
e. Losartan

Question
146. A 30 year old lady presents to the outpatient clinic with difficulty in
conceiving. She has a 32 day menstrual cycle What would be the best test to do
for ovulation?
a. FSH and LH
b. Day 21 Progesterone
c. Day 25 Progesterone
d. Day 28 Progesterone
e. Oestrogen

Question
147. A patient after trauma has a claw hand. What clinical test should you
perform to prove the diagnosis?
a. Abduction of the fingers
b. Extension of the wrist
c. Flexion of the wrist
d. Abduction of the thumb
e. Opposition of the thumb

Question
148. A middle aged woman presents with chronic cough and purulent sputum
Recently she has become very wheezy and dyspnoeic. ECG gives a low voltage
reading and chest X-ray shows a large heart shadow. What is the most appropriate
management?
a. Antibiotics
b. Sputum culture
c. Pericardial aspiration
d. Streptokinase
e. Furosemide

Question
149. A 60 year old farmer presents with fever, cough and shortness of
breath. He was forking hay that morning. Chest X-ray shows fatty nodular
shadows in the upper zone. What is the single most appropriate treatment?
a. Prednisolone
b. Erythromycin
c. Cyclophosphamide
d. Tobramycin and carbenicillin
e. Benzylpenicillin

Question
150. A person is having lung cancer, now he has ptosis, mitosis. What is
the cause of this condition?
a. Cervical sympathetic ganglia
b. Brain metastases
c. Myasthenia gravis
d. third nerve palsy
e. fourth nerve palsy

Question
151. A person came with ringing in ears, vomiting, temperature 38.2 degrees
and sweating. R/R 30breaths/min. Which drug overdose is it?
a. paracetamol
b. lithium
c. aspirin
d. thyroxine
e. amoxicillin
Question
152. A 22 year old collapses at a football match and is brought in by the
ambulance. He is pale. sweaty and has a Glasgow coma scale of 10. His eyes are
open to pain, he also localizes to painful stimuli and is speaking
inappropriate words. His blood pressure is 120/30 mmHg pulse rate is lOOb/m
and the capillary refill time is less than 2 seconds. His airways are also
patent. What is the single most appropriate initial investigation?
a. Blood ethanol (alcohol) level
b. Capillary blood glucose
c. Computed tomography scan of the brain
d. Drug screen
e. Serum U&E

Question
153. A 23 year old lady who 10 weeks pregnant presents to antenatal clinic
and she is worried that her child could have cystic fibrosis. What would be the
most appropriate investigation?
a. amniocentesis
b. Chorionic villus sampling
c. Triple tests
d. Anomaly ultrasound scan
e. Prenatal Diagnosis

Question
154. A 34 yr old female had pain in her right knee joint. She now presents with
red and tender left metatorso-phalangeal joint. What is the investigation of
choice?
a. Joint aspiration for culture and sensitivity
b. Joint aspiration for crystals
c. Serum uric acid
d. Urine uric acid
e. Kidney biopsy

Question
155. A person with difficiulty in closing the right eye. Which nerve is
affected?
a. facial nerve
b. oculomotor nerve
c. trigeminal nerve
d. abducens nerve
e. optic nerve

Question
156. A patient with cervical spondylosis, has haziness of cornea and
irregular pupils, diminished light reflex. What is the diagnosis?
a. Iridocyclitis
b. conjunctivitis
c. scleritis
d. glaucoma
e. subconjunctival haemorrhage

Question
157. A 76 year old man presents with a right hemiparesis. CT scan shows an
Ischemic stroke and Aspirin 3OOmg is commenced In terms of further management
in the acute phase. which one of the following values should be corrected?

a. Blood pressure 210/110 mmHg

b. Blood glucose 9.4mmol/l
c. Oxygen saturation 94%
d. Blood glucose 2.5mmol/l
e. Temperature 38.5 C

Question
158. A female complains of amenorrhea. fatigue, weakness for l0months, BMI
32. K+ is 2.3mmol/l. What is the diagnosis?
a. Cushings disease
b. Secondary hyperaldosteronism
c. Conns disease
d. pheochromocytoma
e. hyperthyroidism

Question
159. A woman presents with a lump in her breast with lymphadenopathy and
possible malignancy suspected after fine needle biopsy. What is the next step
of investigation?
a. Core biopsy
b. Mammography
c. Ultrasound
d. Open biopsy
e. FNAC

Question
160. A 48 year old man, 4 weeks after MI, presents with a pain which is worse
with breathing. ESR is 45mm/hour What is the single most likely diagnosis?
a. Acute pericarditis
b. Ventricular Aneurysm
c. Pulmonary Embolism
d. Dressler's Syndrome
e. Myocarditis

Question
161. A 35 year old man presents with acute onset of red eye. pain
and blurry vision. He has periorbital edema and redness. What is the best
initial management?
a. Put patient in a dark room with reduced light
b. IV morphine and routine ophthalmological referral
c. IV morphine and emergeny ophthalmological referral
d. IV morphine and antibiotics

Question
162. A 5 year old child was admitted to hospital with chest infection 5
day after admission he was found to be MSRA positive. What is the most
appropriate next action to help find the source of the infection?
a. Isolate the child
b. Take swab from all hospital staff
c. Close the theatre
d. Close the ward
e. Vaccinate all hospital staff

Question
163. A 17 year old girl took 12 tablets of paracetamol. After 4 hours,
the paracetamol levels are above the treatment level curve. What will
you do?
a. Observe and give basic care
b. Acetylcysteine
c. Discharge
d. Refer to psychiatrist
e. NAloxone

Question
164. A 50 year old man who was painting in his bathroom suddenly lost
consciousness. He was brought to accident and emergency department. What is
the single single most likely diagnosis?
a. Carbon monoxide poisoning
b. CT scan head
c. MRI head
d. Blood culture
 e. Standing & lying BP

Question
165. A 35 year old woman suddenly fell and died. Post mortem shows
bleeding from a berry aneurysm. What type Of hemorrhage was it?
a. Extradural hemorrhage
b. Subdural hemorrhage
c. Subarachnoid hemorrhage
d. Intracranial hemorrhage
e. Intraventricular hemorrhage

Question
166. A patient had MI 6 days ago, now collapsed, no pulse. What is the
diagnosis?
a. SVT
b. Ventricular fibrillation
c. Ventricular ectopics
d. Atrial fibrillation
e. Wolf parkinson white syndrome

Question
167. A patient had nasal packing done for nose bleed which did not respond
to nose pressure, he is on warfarin for AF, What the initial step?
a. Vitamin K
b. Protamine sulphate
c. Fresh frozen plasma
d. prothrombin complex concentrates
e. heparin

Question
168. A middle aged man develops constipation with overflow diarrhea and bright
red bleeding per rectum. Barium enema revealed an ulcerated stricture in the
sigmoid colon. What is the likely diagnosis?
a. Sigmoid carcinoma
b. Crohns involvement of the colon
c. Ulcerative colitis
d. Ulcerative pancolitis
e. Diverticular disease

Question
169. A 40 vear old patient presentswith symptoms of depression and mania and
he is about to be started on lithium. Which investigatidn will you do?
a. urea and electrolytes
b. Parathyroid hormone
c. Full blood count
d. ECG
e. ECHO

Question
170. A 12 year old boy presents with vomiting. On examination - he is
dehydrated. Has cold peripheries and deep breathing. His blood glucose is 28
mmol/l. What is the first step in management?
a. Give IV insulin
b. Give normal saline 0.9%
c. Reassure the patient
d. Give normal saline 9%
e. Give insulin SC

Question
171. An 18 months old child choked on food. What will be your next step?
a. Helmich manoeuvre
b. Back blows with abdominal thrusts with child on parents lap
c. Chest compression with child on parents lap
d. Induced vomiting
Question
172. An elderly man had pneumonia and then suffered myocardial infarction for
which he was thrombosed. Then he was found to have multiple mucosa hemorrhages
and ulcer l5cm in diameter at the splenic flexure of the colon. What is the
cause?
a. Thrombosis
b. Antibiobcs
c. Ischemia
d. Malignancy

Question
173. A 5 year old child was involved in a road traffic accident with her
parents. On examination she has noise breathing? What is the single most
appropriate management?
a. Intravenous fluid
b. Secure airway
c. CT scan head
d. MRI chest
e. MRI brain

Question
174. A female who is 34 weeks pregnant, came for routine follow up, have BP
144.5/95, protein +++ in urine, immediate management?
a. Admit
b. Ask midwife to come for review after 48 hours
c. discharge with home advice
d. review in one week
e. reassure

Question
175. A 4 year old child develops chicken pox. The parents brings her to
hospital, she is advised that no treatment is required. The mother says when can
the child go back to school?
a. When rash crusted over
b. After 2 days
c. All the times
d. Never
e. 10 days from the onset of illness

Question
176. A 45 year old man who is on multiple medication presents with tremors of
the hands and difficulty initiate movement. Which of the following medication is
the most likely cause?
a. Anti-depressant
b. Anti-epileptic medication
c. Anti-psychotic
d. Aspirin
e. Simvastatin

Question
177. A 45 year old man travelled to Thailand for a holiday and returned a
few days ago. He now presents with fever and cough. On examination he has
cervical lymphadenopathy. What is the most likely diagnosis?
a. Estein Barr Virus
b. Tuberculosis
c. Herpes simplex
d. Human immunodeficiency syndrome

Question
178. A 70 year old lady who has been on treatment who has been treated with
carbamazepine for epilepsy. She now presents with shortness of breath and
light headedness. Blood results show MCV 70, Hb 8.5, WBC 2.0, Neutrophils 1,
Platelets 50.
 a. Hemorrhage anaemia
b. Aplastic anemia
c. Pernicious anaemia
d. Folate deficiency anemia

Question
179. A 60 year lady fell down and sustained neck of femur fracture. Which
artery is she likely to bleed from?
a. Femoral artery
b. Circumferential artery
c. Popliteal
d. Common iliac artery
e. Femoral vein

Question with Correct

180. A 45 year old man had developed lower back pain radiating down the
posterior Aspect of of his legs down to his knees. What is the most likely
diagnosis?
a. Spinal cord compression
b. Disc prolapse
c. Spine malignancy
d. Tuberculosis
e. Musculoskeletal pain

Question
181. An 11 year old girl presents with meningococcemia. Intravenous line has
failed. What is the most appropriate management? a. Intravenous central line
insertion
b. Intraosseous
c. NGT tube
d. Subcutaneous fluids
e. Intramuscular fluids

Question
182. A 55 year old man has weight loss, dyspnoea and syncope. He smokes 20
cigarettes a day. Investigation confirms a squamous cell carcinoma in the
left bronchus. What is the single most likely biochemical abnormality?
a. Hypercalcemia
b. Hyperkalemia
c. Hypernatremia
d. Hypocalcemia
e. Hypomagnesemia

Question
183. A man who was a smoker. He had appendicectomy 5 years ago. He
is a chronic smoker, he has a persistent cough. Now he presents with
mass in the groin. What is the diagnosis?
a. inguinal hernia
b. femoral hernia
c. saphena varix
d. incisional hernia
e. Umbilical hernia

Question
184. A middle aged lady was laying the bed sheet when her index finger
got stuck in between the bed and mattress. She is unable to extend the
proximal interphalangeal joint. What is the most appropriate management?
a. splint the finger
b. Twin plaster the finger
c. Cast
d. Sling
e. Open reduction and internal fixation

Question
185. A 46 years old man 8 week after thyroidectomy was found to Mohave
paralysed left vocal cord. Which nerve is likely to be damaged?
a. Recurrent laryngeal nerve palsy
b. Phrenic nerve
c. Brachial plexus
d. Glossopharyngeal nerve

Question
186. A man presents with hoarseness of voice he has hiatus hernia and high
BMI, who would you refer to?
a. ENT
b. GIT
c. Dietician
d. Cardiologist
e. Neurologist

Question
187. An old man suffers from end stage prostatic cancer. He has pain,
anuria and bilateral hydronephrosis. His daughters wedding is in 3 weeks
time and he is looking forward to enjoying the ceremony. What is the most
appropriate palliative treatment for him?
a. Bilateral nephrostomy
b. Palliative chemotherapy
c. Catheterization
d. Palliative radiotherapy

Question
188. A patient shows flexible laryngoscope. He had bilateral symmetrical
nodes, had dysphonia. What is the possible cause?
a. Voice misuse
b. recent intubabion
c. ENT instrumentabon
d. Laryngitis
e. URTI

Question
189. A 34 year old man present with mass in the testis which has been found to
malignant. To which of the following lymph nodes will it metastasis first?
a. Para-aortic
b. Internal iliac
c. Common Iliac
d. Superficial inguinal
e. Deep inguinal.

Question
190. Which of the flowing results establish a diagnosis of diabetes
mellitus?
a. Asymptomatic patient with fasting glucose 7.9mmol/l on one occasion.
b. Symptomatic patient with fasting glucose 6.8mmol/l on 2 occasions.
c. Asymptomatic patient with random glucose 22.0mmol/l on 1 occasion.
d. Symptomatic patient with random glucose 12.0mmol/l on 1 occasion.

Question
191. A 45 year old man presents with bi-temporal hemianopia and spade like
hands. What is the definitive test to confirm the diagnosis?
a. Early morning growth hormone
b. Insulin tolerance test
c. OGTT with growth hormone measurements
d. Random insulin growth hormone measurements
e. Short ACTH test

Question
192. A 26 year old man with history of hereditary hemorrhagic telangiectasia is
planning to start a family. What will the mode of inheritance?
 a. Autosomal dominant with incomplete penetrance
b. Autosomal co-dominant
c. Autosomal recessive with incomplete penetrance
d. Autosomal dominant
e. Autosomal recessive

Question
193. A patient had polyhydramnios in pregnancy and is on routine
followup, the foetus had no stomach bubble. What is the diagnosis?
a. Duodenal atresia
b. oesophageal atresia
c. Tracheal atresia
d. trachea-esophaeal fistula
e. achalasia

Question
194. A patient has diabetes, microalbumiuria. His BP is 128/70,
cholesterol 4.4. What is the treatment?
a. ACE inhibitor
b. Thiazide
c. Statins
d. Calcium channel blocker
e. beta blocker

Question
195. A 45 year old man presents with malaise and weakness. Chest X-ray shows
bilateral cavitations on the lung bases. What is the single most likely
diagnosis?
a. legionella
b. Mycoplasma
c. Staphyllococus
d. Pnumocysti carinii
e. Chlamydial pneumonia

Question
196. A 45 year old lady with swelling on her face. ankle oedema, protein
+++, BP 145/98mmHg. She was previously healthy. What is the diagnosis?
a. Membranous GN
b. Post streptococcus GN
c. Minimal change GN
d. IgA GN
e. Henoch Schonlein purpura

Question
197. A 34 year old man from Zimbabwe is admitted with abdominal pain to the
A&e. An abdominal X-ray reveals bladder calcification. What is the most likely
cause?
a. Schistosomiasis mansoni
b. Sarcoidosis
c. Leishmaniasis
d. Tuberculosis
e. Schistosomiasis haematobium

Question
198. A 40 year-old female with breast cancer with metastasis to the brain, CT
scan shows localized metastasis with cerebral oedema. What the immediate step in
management?
a. Chemotherapy
b. Mannitol
c. Dexamethasone
d. Radiotherapy
e. Surgery

Question
199. A 70 year old man with few month history of weight loss and dysphagia
presented with sandwich stuck in his throat. What is the most appropriate next
step?
a. Barium meal
b. Barium swallow
c. Endoscopy foreign body removal and biopsy
d. USG
e. Chest X-ray

Question
200. A 50 year old lady with weak limbs when examined was found to have burn
marks on her finger tips, is wasted and has weak hand with diminished
reflexes. She also has weak spastic legs and dissociated sensory loss. What
is the diagnosis?
a. Multiple sclerosis
b. Syringomyelia
c. Motor neuron disease
d. Guillian Barre syndrome
e. Freidrieches ataxia

Question
201. Patient has got claw hand. what examination you would do against
resistance?
a. Abduction of fingers
b. Adduction of fingers
c. Flexion of fingers
d. Extension of fingers
e. Abduction of thumb