Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 1ST SEPTEMBER 2019 TIME ALLOWED: 3HRS

1. A 34 year old woman complains of low mood predominantly in winter. She says she feels low every
year during winter and starts to feel better once spring arrives. What is the most likely diagnosis?
A. Depression
B. Mania
C. Seasonal affective disorder
D. Cyclothymia
E. Dysthymia

2. Infection of which of the following areas in the face will lead to pre auricular lymph node enlargement?
A. Mastoid area
B. Mandibular area
C. Pinna of the ear
D. Upper eyelid

3. Lady with 10 months amenorrhea, hypokalaemia, BMI- 32. What is the most probable cause?
A. PCOS
B. Cushings
C. Primary hyperaldosteronism
D. Pheochromocytoma

4. A 15 year old boy presents with generalized oedema. His urinalysis reveals +++ proteins. His eGFR is
110. Which one of the following is the most likely diagnosis?
A. IGA nephropathy
B. Membranous nephropathy
C. Minimal change disease
D. Post streptococcal glomerulonephritis
E. Lupus nephritis

5. A 70 year old lady who has been treated on Carbamazepine for epilepsy, she now presents with
shortness of breath and light headedness. Blood results show MCV 70, Hb 8.5g/dl, WBC 2, Neutrophils 1
and Platelets 50.
A. Aplastic anaemia
B. Hereditary spherocytosis
C. Pernicious anaemia
D. Folate deficiency anaemia
E. Haemorrhagic anaemia

6. A woman presents with hematuria and her blood tests reveal ANA positive. What is the most likely
condition she is suffering from ?

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A. Good pasture's syndrome
B. Nephrotic syndrome
C. Urinary tract infection
D. SLE
E. Urinary tract trauma

7. A 74 years old man presents with sudden onset of weakness of the right side with slurred speech. He
also has loss of sensations over the right side of the body and visual field defects. CT Scan shows an
ischemic stroke. What is the most appropriate management for this patient?
A. Alteplase
B. Streptokinase
C. Nimodipine
D. Aspirin
E. Labetolol

8. A 54 year old man presented with a sudden, unilateral, brief, stabbing, recurrent pain on the right side
of his face. This occurred 5-10 times in a day. What is the diagnosis?
A. Ramsay Hunt Syndrome
B. Trigeminal neuralgia
C. Temporomandibular joint dysfunction
D. Post herpetic neuralgia

9. A 29 year old man is found to have proteins and blood cells in urine. There is no history of any renal
disease and no other significant medical history, other than fever 4 weeks ago. What is the most likely
explanation for proteinuria and haematuria seen in this man?
A. Thrombotic ThrombocytopoenicPurpura
B. Haemolytic Uraemic Syndrome
C. Post streptococcal glomerulonephritis
D. IgA Nephropathy
E. Minimal Change disease

10. You are asked to see a 1 hour old baby. He is dysmorphic, with a small chin and low-set ears. He also
has a small head and rocker- bottom feet. , select the most likely karyotype:
A. 45XO
B. 47XXX
C. 47XXY
D. 47XY(13)
E. 47XY(18)

11. A 9 year old child is diabetic and unhappy in school. What is your next step?
A. Refer to social worker
B. Clinical psychologist
C. Special school
D. Check child protection register
E. Give oral anti diabetics

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12. A 40 year old man came with fever and Urinary complaints. Urinalysis showed blood+ nitrites in the
urine. No history of discharge but groin is red, tender and swollen. What could be the most probable
cause of his symptoms?
A. E. Coli
B. Chlamydia
C. Neisseria gonorrhea
D. Mumps virus

13. A 61 year old man presents with headache. He also complains of dizziness and tinnitus. He has
recently realized he has visual problem. There is history of burning sensation in his fingers and toes. On
examination there is splenomegaly. He says he feels itchy after a hot bath. The lab results show RBC 87
x104/L, Hb= 31.9/dL and platelet 796 x109. What is the most likely diagnosis?
A. Chronic myloid leukaemia
B. Chronic lymphoblastic leukaemia
C. Polycythaemia rubravera
D. Mylofibrosis
E. Non Hodgkin’s lymphoma

14. During a basketball match, one of the players suddenly collapsed to the ground with coughing and
shortness of breath. What is the investigation of choice for this patient?
A. Chest x-ray
B. CT scan
C. Magnetic resonance imaging (MRI)
D. V/Q scan
E. CT pulmonary angiogram (CTPA)

15. A 1 week old baby presents with projectile vomiting. On examination there is an olive shaped mass in
his abdomen. What investigation would you do for him initially?
A. Ultrasound abdomen
B. Check serum potassium
C. Laparoscopy
D. CT abdomen

16. A 64 year old man who has urinary frequency for past 2 years now complains of anuria. He is taking
nifedipine and propranolol. What is the mechanism of his anuria?
A. Drug induced
B. Diabetes
C. Enlarged prostate gland
D. High blood pressure
E. Cancer of the bladder

17. A 7 year old child is being investigated for tuberculosis. His parents do not agree on taking a broncho-
alveolar lavage sample under general anaesthesia (GA).What other sample will show growth of the
organism?
A. Blood
B. Throat swab
C. Gastric washings

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D. Mantoux
E. Cerebrospinal Fluid (CSF)

18. A patient presented with a stab injury to his left groin, he keeps bleeding profusely. pressure has been
applied to stop bleeding , BP 80/60mmHg. What is the next appropriate action?
A. I/V fluid
B. Blood Transfusion
C. Oxygen
D. Elevate limb

19. A 85 year old man fell down and hit his head. 5 days later he came back with confusion. Which is the
most likely site of bleeding?
A. Middle meningeal artery
B. Internal cerebral artery
C. Cerebral vein plexus
D. Berry aneurysm

20. A 56 years old lady with lung cancer presents with urinary retention, postural hypotension,
diminished reflexes and a sluggish papillary reaction. What is the most likely explanation for her
symptoms?
A. Paraneoplastic syndrome
B. Progression of lung cancer
C. Brain Metastasis
D. Hyponatremia
E. Spinal Cord Compression

21. A 30 year old woman has been feeling low and having difficulty in concentrating since her mother
passed away 2 months ago. She feels lethargic and tends to have breathlessness and tremors from time to
time. What is the most likely diagnosis?
A. Adjustment Disorder
B. Post-traumatic stress disorder (PTSD)
C. Panic Disorder
D. Generalized anxiety disorder (GAD).
E. Bereavement

22. A patient was having proteinuria of 3.4g/day and slight edema of his feet. Renal biopsy was done and
it showed presence of a thin basement membrane. What is the most appropriate step to stop the
progression of this?
A. Steroid
B. immune suppressants
C. ACEI
D. Cyclophosphamide
E. No treatment needed

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23. A patient with severe Alzeheimers and is on ‘end of life care’. A team of specialists managing him
had decided on a “DNAR in case of cardiac arrest” as the best management option for the patient in case
of cardiac arrest. As the managing FY1 doctor what would you do?
A. Access patient’s mental capacity
B. Carry out the DNAR specialist order
C. Take consent from relative.
D. Consent form should be signed by relative and patient.

24. Passing six to eight loose stools. Temperature is 38.8°C. He is tender in the right lower quadrant and
has an anal fistula. Choose the single most likely cause of abdominal pain.
A. Inflammatory bowel disease (IBD)
B. Irritable bowel syndrome (IBS)
C. Pyelonephritis
D. Uretric calculus
E. Gastroenteritis

25. A 5 year old child came from Ghana 6 weeks ago. Two days ago he developed fever, vomiting and
neck stiffness. He had taken malaria prophylaxis, from until 4 weeks ago he had no rash. What is the
diagnosis?
A. Cerebral abscess F. Pneumonia
B. Cerebral malaria
C. Meningococcal meningitis
D. Subarachnoid hemorrhage
E. Cerebral tumor

26. An elderly woman who used to be always happy, spends money and hyperactive presents with
forgetfullness for the past 5 years and is found wandering. It has become worse after her husband's death
2 years back. She is neglecting herself, has low mood and is not on any treatment. What is the most
appropriate diagnosis?
A. Bipolar disorder
B. Depression
C. Dementia
D. Delusional disorder

27. A 27 year old man presents with jaundice. On examination there is hepatosplenomegaly. Peripheral
blood film shows occasional spherocytes. What is the next appropriate investigation?
A. Direct Coomb’s test
B. Bone marrow test
C. Indirect Coomb’s test
D. RBC life span
E. Osmotic fragility test

28. A 45 year old woman comes with complaints of bloody discharge from the nipple. No other
symptoms. What is the most likely diagnosis?
A. Pagets disease D. Ductal Ca. in situ
B. Duct ectasia
C. Duct papilloma

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29. A 72 year old woman who had a repair of strangulated femoral hernia two days ago becomes noisy,
aggressive and confused. She is afebrile, her full blood count is normal apart from a raised mean
corpuscular volume (MCV). What is the most likely diagnosis?
A. Electrolyte imbalance
B. Delirium Tremens
C. Wernicke’s Encephalopathy
D. Infection toxicity
E. Hypoglycemia

30. A 36 year old gravida 1 woman with gestational age of 30 weeks was brought to A&E as she started
to have bleeding from vagina. The bleeding was fresh and painless and was not preceded by trauma. On
examination her abdomen was not tender, BP was 90/60mmHg, pulse rate was 130/min, US shows low
lying placenta, CTG shows normal fetal heart sounds. How will you best manage this patient?
A. IV fluids → Blood trandfusion → delivery
B. IV fluids → blood transfusion→ investigations → delivery
C. Investigations→ IV fluids→ blood transfusion→ delivery
D. Deliver baby immediately

31. Which of the following electrolyte abnormalities is most likely to be seen in SIADH?
A. High serum Na, low serum osmolarity, high urine osmolarity
B. Low serum Na, low serum osmolarity, high urine osmolarity
C. Low serum Na, high serum osmolarity, high urine osmolarity
D. High serum Na, high serum osmolarity, low urine osmolarity
E. Normal Na, normal serum osmolarity, normal urine osmolarity

32. A 30 year old lady with two months history of abdominal cramps, bloating, blood, mucus in stool.
Most appropriate initial investigation :
A. Colonoscopy
B. Fecal occult blood
C. Stool culture and sensitivity
D. Fecal calprotectin

33. A patient presents with hypernatremia, hypokalemia, hypocalcemia and hypertension. He is 30 years
old and not on any medication. What hormone should be measured in him?
A. Aldosterone
B. Cortisol
C. Renin
D. Adrenocorticotropic hormone (ACTH)

34. For a patient presenting with Parkinson’s disease, which one of the following drugs is most useful in
the management of tremor?
A. Apomorphine
B. Cabergoline
C. Selegiline
D. Amantadine
E. Benzhexol

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35. A 46 year old man complains of feeling low and inability to fall asleep. He is disinterested in daily
life and does not find any joy in his life. Due to this he has started to drink alcohol excessively. What is
the most likely diagnosis?
A. Delirium tremens
B. Wernicke’s encephalopathy
C. Korsakoff’s syndrome
D. Schizophrenia
E. Depression

36. A 59-year-old man has shown a change in his mood and personality over a 9-month period. He has
subsequently developed difficulty with memory and concentration, and then progressive fidgety
movements of his limbs and facial musculature. By the time of medical assessment he has frank
choreiform movements and a Mini-Mental State Examination of 21/30. Other examination is normal. He
was adopted and therefore no information on his family history is available. He has three adult children
(aged 27, 30 and 33 years) of whom the two youngest are asymptomatic. However, the oldest son has
recently been investigated by the Neurology Department for slightly erratic behaviour and fidgety restless
movements of both legs. Based on the likely clinical diagnosis, which one of the following genetic
patterns of this condition is most likely?
A. Autosomal-dominant inheritance with anticipation E. Mitochondrial disorder
B. Autosomal-dominant with variable penetrance
C. Autosomal-recessive inheritance
D. X-linked inheritance

37. A patient developed macular rashes with target lesions, four days after using antibiotics. The rash
typically sparing the mouth. What is the most likely diagnosis?
A. Steven Johnson syndrome
B. Erythema nodosum
C. Erythema multiforme
D. Erythema infectiosum

38. Diabetic man feels hot painful lump near the anal region. What is the most probable diagnosis?
A. Anal fissure
B. Abscess
C. Haematoma
D. Wart
E. External haemorrhoids

39. A patient brought to the OPD due to cognitive impairment. On the mental assessment, the patient was
bored and gave inappropriate comments to doctors.
What is the most likely diagnosis?
A. Fronto temporal dementia E. Parkinson's disease
B. Alzeimers
C. Huntington
D. Vascular dementia

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40. A lady comes in 6 weeks after her normal vaginal delivery for contraceptive advice. She is breast
feeding her child and requests for reversible contraception. She is planning another pregnancy in 6
months time and is scared of injections. What is the best option for her?
A. COCP
B. Cu IUCD (intrauterine contraceptive device)
C. Mirena coil
D. POP
E. Transdermal patch

41. A 50 years old man presents with low mood, poor concentration, anhedonia and insomnia. He has had
two episodes of increased activity, promiscuity and aggressive behaviour in the past. He was arrested 8
months ago for trying to rob a bank, claiming it as his own. Which drug is most likely to benefit him?
A. Haloperidol E. Ethosuximide
B. Citalopram
C. Desipramine
D. Carbamazepine

42. What is the mode of spread of chickenpox? Chose from the following options :
A. Airborne
B. Close contact
C. Feco-Oral
D. Blood
E. Vector borne

43. A 45 years old female looking pale, has bluish discoloration of hands whenever she goes out in cold.
She has also noticed some reddish spots on her body. She has symmetrical peripheral arthropathy for last
1-2 years. What is the most probable diagnosis?
A. Rheumatoid Arthritis
B. Osteosarcoma
C. Limited Systemic Sclerosis
D. Diffuse Systemic Sclerosis
E. Chondrosarcoma

44. A 76 years old man presents with cough and haemoptysis. What is the most probable diagnosis based
on the Xray?
A. Lung Cancer
B. Bronchiectasis
C. COPD
D. Goodpasture’s Disease
E. Wegener’s Granulomatosus

45. A 25 years old woman presents with single lump in the breast and axilla. The lump is mobile and hard
in consistency. The ultrasound, mammogram and fine needle aspiration turned out to be normal. What is
the most appropriate investigation to confirm the diagnosis?
A. Fine Needle Aspiration Cytology (FNAC)
B. Magnetic resonance imaging (MRI)
C. Punch biopsy

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D. Genetic testing and counselling
E. Core biopsy

46. A 20 year old man presents to the A/E following motorcycle accident, where his foot was stuck under
the motorcycle. On examination he had tenderness of the foot, loss of sensation in the space between the
big and 2nd meta tarsal. His dorsalis pedis was not felt. What is the most likely diagnosis?
A. Compartmentsyndrome
B. Arterialrupture
C. Arterial embolus
D. DVT

47. A young man comes with back pain and occasional painless haematuria. What is the most likely
pathology?
A. Ca. Bladder
B. Ca. Prostate
C. Nephropathy
D. Uretric Calculi

48. A 57year old man with blood group A complains of symptoms of vomiting, tiredness, weight loss and
palpitations. On examination the patient has hepatomegaly, ascites, palpable left supraclavicular mass.
What is the most likely diagnosis?
A. Gastric carcinoma
B. Colorectal carcinoma
C. Peptic ulcer disease
D. Atrophic gastritic
E. Krukenburg tumor

49. MRI spine of a patient shows L3/ L4 spine compression. She complains of bladder control loss and
also has some eye problem. She has breast carcinoma in the past. What explains her symptoms the best?
A. Metastasis in brain
B. Metastasis in spine
C. Sciatica
D. Disc prolapse

50. A 23 year old female presented with a swelling of her neck that moved upwards on protrusion of
tongue. What is the next appropriate investigation?
A. FNAC
B. Punch biopsy
C. Core biopsy
D. MRI neck
E. Radioactive thyroid scan

51. A pregnant woman is concerned about her unborn baby. Her previous baby died because of severe
jaundice. She is worried that the same may happen this time. She has blood group O negative and the
baby’s father is A positive. What test can be done to determine if her baby could be at risk of sever
jaundice?

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A. Osmotic fragility test
B. Kleihauer-Betke test
C. FBC
D. Direct Coomb’s test
E. Indirect Coomb’s test

52. A 53 year old woman presented with pain in the eye, blurry vision and clumsiness for 3 months. She
had a history of difficulty in swallowing and weakness in her right upper limb 2 years ago. What is the
investigation of choice?
A. CSF analysis D. MRI of the brain
B. Electroencephalography (EEG) E. Visuality Evoked Response test (VER)
C. Electromyography (EMG)

53. A 19 year old boy comes to A&E department. There is swelling, pain and tenderness 2cm distal to
Lister’s tubercle of radius. On examination proximal pressure on the extended thumb and index finger is
painful. The x- ray doesn’t show any fracture. What is the next appropriate management for the patient?
A. Immobilization with a cast
B. Repeat the x-ray
C. Magnetic resonance imaging (MRI)
D. Surgery
E. No treatment required

54. A 30 year old woman has injured her left lower chest in a RTA. She has BP 80/50mmHg, pulse
120bpm. Auscultation of chest and bowel sounds present. What is the single most likely diagnosis?
A. Diaphragmatic rupture E. Tension pneumothorax
B. Flail chest
C. Fracture of ribs
D. Ruptured oesophagus

55. A boy with a history of recurrent swollen tender joints on both knees and elbows and not able to
participate in sports. What is the investigation of choice to diagnose his case?
A. Rheumatic factor/ASO titre
B. Clotting factor
C. ESR
D. Xray

56. A 22year old man says that he can hear the voice of his deceased uncle telling him that he is being
spied on. The patient is distressed by this and is becoming low in mood and anxious and has not left the
house for 2weeks. He is starting to drink increasing quantities of alcohol. He is noticed to have thought-
block and passivity phenomena. What is the single most suitable medication to treat his symptom?
A. Diazepam
B. Disulfiram
C. Fluoxetine
D. Lithium
E. Olanzapine

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57. A 50 year old lady who had fallen in a shopping centre was brought to the accident and emergency
department. She reported to have an attack of palpitations for 30 seconds before collapsing. An ECG was
done and shows atrial fibrillation. What is the single most appropriate treatment?
A. Digoxin
B. Warfarin
C. Amiodarone
D. Metoprolol
E. Flecanide

58. A 6 year old sick looking child presents with high fever, drooling of saliva and breathing difficulty. X
ray of the neck shows thumb sign. What is the INITIAL step of management?
A. Adrenaline inhalation
B. Oxygen inhalation
C. Intubation
D. I.V Hydrocortisone
E. I.M MgSO4

59. A 63 year old woman underwent knee surgery and was kept on low molecular weight heparin
postoperatively. On the 6th post-operative day she developed sudden severe chest pain with
breathlessness. Her ECG and chest x-ray were normal. What is your next action?
A. Stop low molecular weight heparin and start Warfarin
B. Keep on low molecular weight heparin and do CT. pulmonary angiography.
C. Increase the dose of low molecular weight heparin and do CT. pulmonary angiography.
D. Keep on low molecular weight heparin, add warfarin and do CT. pulmonary angiography.
E. Change to unfractionated heparin and do CT. pulmonary angiography.

60. An old woman develops sudden pain in upper part of the arm after carrying heavy loads. Which part
of the arm is affected?
A. Biceps tear
B. Posterior capsulitis
C. Ruptured supraspinatus tendon
D. Bursitis

61. An 18year old previously well student is in his 1st year at university. He has been brought to the
Emergency Room in an agitated, deluded and disoriented state. What is the most probable reason for his
condition from the following options?
A. Drug toxicity
B. Delirium tremens
C. Infection toxicity
D. Electrolyte imbalance
E. Head injury

62. A 65 year old man presents with painless haematuria, Intravenous Urogram (IVU) is normal, prostate
is mildly enlarged with mild frequency. What is the most appropriate next step?

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A. USG Abdomen
B. Flexible cystoscopy
C. Magnetic resonance imaging (MRI)
D. Nuclear Imaging
E. Prostate-Specific Antigen (PSA)

63. A 28 year old business man came to sexual clinic. He was worried that he has HIV infection. Three
HIV tests were done and all the results were negative. After a few months later he came back again and
claimed that he had HIV. What is the diagnosis?
A. Somatization D. Obsessive compulsive disorder
B. Hypochondriac E. Schitzophrenia
C. Mancheusens

64. A young college student is found in his dorm unconscious. He has a tachy-arrhythmia and is having
high fever. He also seems to be bleeding from his nose, which on examination shows a perforated nasal
septum. What is the most likely diagnosis?
A. Marijuana Overdose
B. Cocaine Overdose
C. Heroin Overdose
D. Alcohol Overdose
E. Carbon Monoxide poisoning

65. A 30 year old lady with past medical history pulmonary embolism presents to out patient clinic
requesting contraception, She has irregular and painful periods. What is the single most appropriate
contraception?
A. Intra uterine contraceptive device
B. Combined pill contraception
C. Progesterone only pill
D. Mefenemic acid
E. Trenexemic acid

66. A 40 year old Man fell from 8ft high scaffolding . On Xray there was a fracture of the foot. Which
bone will be most likely fractured?
A. Calcaneus
B. Metatarsals
C. Phalanges
D. Tibia
E. Femur

67. A 65 year old alcoholic male is brought into hospital with aggression, confusion, diplopia and ataxia.
IV chlordiazepoxide has been started. Which other medication would you like to give?
A. Antibiotics
B. IV fluids
C. Acamprosate
D. Disulfiram
E. High dose B vitamins

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68. A 58 year old man presented with chest pain, breathlessness and weight loss. He is a non-smoker
and is a shipyard worker. CXR is shown below. What is the most probable diagnosis?
A. Lung cancer
B. Mesothelioma
C. Pneumonia
D. T.B

69. A 74year old woman. Presents with recurrent collapse and falls. She lives a quiet life and has a
mark/scar on side of head. What is the diagnosis?
A. Hypoglycemia
B. Subdural hematoma
C. Aortic stenosis
D. Vasovagal syncope
E. carotid sinus syncope

70. A 46 year old man is being investigated for indigestion. Jejunal biopsy shows deposition of
macrophages containing Periodic acid–Schiff (PAS) – positive granules with clumps. What is the most
likely diagnosis?
A. Bacterial overgrowth
B. Coeliac disease
C. Tropical sprue
D. Whipple’s disease
E. Small bowel lymphoma

71. A 25 year old woman was brought to the A&E by her boyfriend. She has many superficial lacerations.
On examination there are many scars of old cut in her forearm. She is so distressed and constantly says
her boyfriend is going to end the relationship. She denies trying to end her life. What is the most likely
diagnosis?
A. Acute psychosis
B. Severe depression
C. Psychotic depression
D. Border line personality disorder
E. Schitzophrenia

72. A 44 years old obese patient presents with lab findings of:
Fasting blood sugar (FBS) 6mmol/L
Oral Glucose Tolerance Test (OGTT) 10mmol/L. What is the most likely diagnosis?
A. Impaired glucose tolerance
B. Diabetes Insipidus
C. Type 1 Diabetes Mellitus
D. Type 2 Diabetes Mellitus
E. Maturity Onset Diabetes of the Young (MODY)

73. A 30 year old woman has experienced restlessness, muscle tension and sleep disturbance on most
days over the last six months. She worries excessively about a number of every day events and activities,
and is unable to control these feelings which are impairing her ability to hold down her job. What is the
most likely diagnosis?

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A. Panic Disorder D. Acute Stress Disorder
B. Generalized Anxiety Disorder GAD E. Social Phobia
C. Pheochromocytoma

74. A 32-year-old man presents with confusion, ataxia and ophthalmoplegia. What is the most probable
diagnosis?
A. Wernicke’s Korsakoff
B. Meningitis
C. Stroke
D. TIA

75. A 40 year old female had history of use of COCP for 5 years and condom for a few years. She is
obese and is a heavy smoker. Smokes 20 cigarette/day .Had repeated episodes of chlamydial infections.
Her family history showed that her aunt died of carcinoma of the ovary at 48 years of age. What is the
major risk factor for development of ovarian cancer in this patient?
A. OCOP
B. Condom
C. Obesity
D. Smoking
E. Family history

76. A 37 year old woman presents with more tiredness than usual, she is found to have angular stomatitis,
no koilonychia. Choose the single cell type you will find on blood film.
A. Macrocytes
B. Microcytes
C. Granulocyte without blast cells
D. Blast cells

77. A 60 year old man describes detailed Lilliputian visual hallucinations. He has memory loss and
cannot recall his name. What is the most likely diagnosis?
A. Alzheimer’s
B. Vascular dementia
C. Pick’s disease
D. Lewy body dementia
E. Huntington’s disease

78. A man who wants to quit alcohol, but wants to avoid the unpleasant craving experiences. What do you
prescribe for him?
A. Acamprosate
B. Disulfiram
C. Methadone
D. Fluoxetine
E. Amitryptalline

79. A 23 year old woman has white discharge from her vagina. She had a 7 day course of broad spectrum
antibiotics before her dental procedure. What is the causative microorganism?

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A. Chlamydia
B. Candida
C. Trichomonas
D. Gardnerella
E. NesseriaGonorrhea

80. Patient with a history of alcoholism, ataxic gait, hallucinations and loss of memory. He is given
acamprosate. What other drug you can give with this?
A. Chlordiazepoxde
B. Thiamine
C. Diazepam
D. Disulfiram
E. Haloperidol

81. 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

82. 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?
A. Chronic glomerulonephritis
B. Chronic Pyelonephritis
C. Bilateral Renal Artery Stenosis
D. Essential HTN
E. Polycystic Kidney

83. 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

84. 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

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85. 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

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

87. 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

88. 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

89. 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

90. 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

16
91. 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 glutammyl-‐transpeptidase1,261IU/l
Paracetamol80mg/l

Which is the single most appropriate immediate management?

92. 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

93. 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

94. 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

95. 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?

17
A. Erotomania
B. Pyromania
C. Kleptomania
D. Trichotillomania
E. Grandiosity

96. 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

97. 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

98. 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

99. 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

100. 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

18
101. 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

102. 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

103. 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

104. 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

105. 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

106. 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

107. 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?

19
A. Carpal Tunnel
B. Radial nerve entrapment
C. Blackberry’s thumb
D. Mallet finger

108. 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)

109. 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

110. 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

111. 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

112. 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)

20
113. 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

114. 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

115. 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%

116. 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

117. 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?
A. Unstable angina D. Coronary spasm
B. Decubitus angina E. Myocardial infarction
C. Stable angina

118. 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

21
119. 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

120. 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

121. 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. Syringobulbia
D. Syringomyelia
E. Myasthenia Gravis

122. 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

123. 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-poplitealartery
B. Left common iliacartery
C. Aortoiliac artery
D. Femoral artery
E. Profound femoral artery

124. 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?

22
A. Basal cell carcinoma
B. Squamous cell carcinoma
C. LN
D. Melanoma
E. Kaposi’s sarcoma

125. 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

126. 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

127. 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)

128. 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

129. 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

23
 130.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. Ectasy
C. LSD
D. PCM
E. Cocaine
131. 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

132. 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?
A. Amytriptiline
B Gabapentin
C. Paracetamol
D. Codein
E. Ibuprofen

133. 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

134. 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

24
 135. 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

136. 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

137. 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

138. 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

139. 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

140, 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?

25
 A. HSP
B. TTP
C. ITP
D. Anemia
E. Thrombophilia

141. 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?
A. Protamine
B. Prothrombin complex concentrate
C. Vit. K
D. Fresh frozen plasma
E. Blood transfusion

142. 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

143. 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.

144. 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

145. 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 

26
146. 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

147. 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

148. 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

149. 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

150. 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 

151. 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

27
C. Tell to GMC
D. Tell to clinical supervisor 
E. Inform to safe guarding 

152. 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

153. 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 cant do that but will provide the best care for him.
E. Ignore his request and continue with current management

154. 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

155. 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
156. 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

157. 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

28
B. 2
C. 3
D. 4
E. 5

158. 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

159. 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
B. MRI
C. Dexa
D. Radionuleotide bone scan
E. PR examination

160. 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

161. A DM patient pesented 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

162. 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

163. 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?

29
A. folate def
B. Vit B12 def
C. IDA
D. Anemia of chronic illness
E. Pernicious Anemia

164. 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

165. 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

166. 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

F. 167. 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

168. 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

30
169. 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

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

171. 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

172. 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

173. 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

174. 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

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175. 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

176. 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

177. .A man sat cross legged for few hous 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

178. 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

179. 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

180. 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

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