Q.1.

Which of following antibiotic therapy is most appropriate to start for tetanus with tetanus
immunoglobulin ?

A. I.v clarithromycin

B. I.v benzylpemcillin

C. I.v gentamicin

D. I.v metronidazole

E. I.v ciprofloxacin

Q.2.Which of following organism is most contagious??

A. Varicella zoster vIrus

B. Epstein bar virus

C. Rotavirus

D. Herpes simplex virus

E. H. Influenza

Qno.3Which of the following is most appropriate antibiotic to use in cholera?

A. Erythromycin

B. Metronidazole

C. Doxycycline

D. Pencillin v

E. Trimethoprim

Qno.4.A student give himself a needle stick injury whilst taking blood from a patient who is known to
have HIV infection. What is chance to develop HIV in student?

A. 0.03%

B. 0.3%

C. 1%

D. 3%

E. 5-10%

Qno.5Black water fever is a special manifestation of malaria caused by;

a. P. falciparum

b. P. malariae
c. P. ovale

d. P. vivax

E .P.knowiesi

Q. 6. A 35 years old vegetarian female presents with weakness and easy fatigability on examination
she is anemic and had cheloiosis her blood CBC shows Hb of 7.5 mg/dl WBC 3000/ cmm plat
88000/cmm-MCV 120 f1, which of the following feature is most suggestive of megaloblastic
anemia?
A. Low ret[c count
B. Raised LDH
C. Hypersegmeted neutrophils in peripheral blood film
D. Pancytopenia
E. Atrophic gastritis

Q.7.A 60 years old female presents with weakness and chest infection her CBC shows picture of acute
myeloblastic leukemia which of the following is used as a prognostic marker
A. Karyotype of bone marrow
B. Elevated LDH
C. Monocytic morphology
D. The number of blasts in bone marrow
E. White cell count at diagnosis

Q.8.A 40 years old male complaining of headache , weakness ,dizziness and pruritus for last two month
he has also noted the weight loss of about 8 kg his uric acid is 8.6 mg /dl on examination he is cyanosed
has hepatosplenomegaly and his blood pressure is 170/100 mm of hg what is the most likely diagnosis
A. CML
B. AML
C. CLL
D. Multiple myeloma
E. Polycythemia Vera
Q.9.A 50 years old male is found to be anemic on routine medical checkup his CBC show Hb of 10.5
mg/dl ,WBC 5800/cmm plat 244000/cmm MCV 66 f1 MCH 28 pgm serum ferritin level is 244
nanogram/mm what would be your next step of managements?
A. Barium enema
B. Iron therapy
C. Upper/lower GI Endoscopy
D. HB Electorphoresis
E. Labelled red cell scan
Q.10.A35 year’s old male presents with shortness of breath following one week of flue like symptoms he
also has a nonproductive cough chest x-ray shows bilateral consolidation and examination reveals
Erythematous lesions on his limbs and trunk. Which one of the following is most likely investigation for
diagnosis?
A. Cold agglutins
B. Sputum culture
C. Urine antigen for legionela
D. Serology for mycoplasma
E. Blood culture

Q.11.A 65 years known case of COPD comes to OPD with pedal edema. On exanimation he had raised
JVP left parasternal have wheezes in chest ECG show peaked p wave in lead II echocardiography show
normal ejection faction with dilated right side of heart which one of following interventions is most likely
to increase survival in this patients
A. Inhaled corticosteroids
B. Heart lung transplantation
C. Pulmonary rehabilitation
D. Long term oxygen therapy
E. Loop diuretic therapy

Q.12.Which are of the following factor not predisposes to development of obstructive sleep apnea
A. Acromegaly
B. COPD
C. Amyloidosis
D. Obesity
E. Hypothyroidism
Q.13.A65 years old male presents with progressive shortness of breath on examination he had fine
crackle in both lung bases and oxygen saturation is 93% on room air a diagnosis of idiopathic palmary
fibrosis
is suspected. Which of the chest X-ray finding develop first in patients with idiopathic pulmonary fibrosis
A. asymmetrical upper zone ground glass changes
B. small peripheral opacities in lower zone
C. perihillar horizontal septal lines
D. honey combing
E. loss of left heart border
Q.14.46 year’s old female with a history rheumatoid arthritis is investigated for progressive shortness of
breath she is currently treated with methotraxate and ibuprofen the spirometry show s FEVI/FVC 45%
what is most likely cause of her dyspnea

A. Bronchiolitis obliteranes
B. Methotraxate pneumonitis
C. Pulmonary fibrosis
D. Caplans syndrome
E. Lung cancer
Q, 15.A 43 years old male is admitted due to due to shortness of breath and is noted to have cavitating
lesion on his chest x-ray .which one of the following condition is not part of the differential diagnosis?
A. Lung cancer
B. Pulmonary embolism
C. Wagner’s granulomatosis
D. Churg_strauss syndrome
E. Tuberculosis

Q.16.A 50 years old man is referred by his GP he is a smoker of 20 cigarettes per day and has
suffered from exertional angina for the past few months. On this occasion he has been referred
after a collapse at a wedding. Atenolol has not improve his symptoms of angina and GP is
looking further advice. On examination pulse 86/mn regular BP 165/120 mmhg and he has an
ejection systolic murmur radiating to the carotids what is the next step in the management of
this patient?

A. add isosorbide dintrate to his regime

B. arrange smoking cessation advice

C. add amlodpine to his regime

D. arrange echocardiography

E. advise an exercise program

Q.17. A 20 years old female present to emergency department with complaining of severe
epigastric and retro sterna pain. On further enquiry she told that she suffered from fever for
few days. Chest pain worse on the lying down. On examination temperature 100 C BP 135/85
mmhg pulse 120/min in CVS, there is a friction rub heard over the precordium and chest is clear.
ECG shows wide spread ST elevation. His blood tests shows.

HB 13gm/d1
WBC 15.6x109/1
PLT 253x109/1
ESR 60mm/h
CPK 250u/1(25-195u/1)
 UREA 40mg/d1
Cretnine 1.2mg/d1
Na+ 138mmol/1
K+ 4 mmo1/1
What is diagnosis?
A. Acute Pancreatitis
B. Pulmonary embolus
C. Myocarditis ‘
D. Viral pleurisy
E. Myocardial infarction

Q.18.50 years old he smoker presented to the CCU with severs anterior chest pain. An ECG on
admission revealed no ST segment changes and he was started on Aspirin and low molecular weight
heparin and with pending troponin results. Six hours later he develops more severe pain and has ST
2.5 mm elevation in leads V3 to V6 what is the management of choice?
A. Start tenecteplace
B. Start him on B Blocker +
C. Arrange urgent angioplasty angioplasty stenting
D. Start a 11b 111 a receptor antagonist
-
E. Start streptokinase
 Q. 19A 60 year old male with CCF come to the clinic for review. He has suffered two
previous myocardial infarctions and takes ramirpril 10 mg, furosemide 80 md
bisoprolol 10 mg, digoxen 0.25mg 1 x od spironolactone 25mg, On examination his
BP is 142/82 mmhg pulse 80b/mm regular. He has Bibasilar crackles and bilateral
pitting Edema Labs.

HB 11g/d1
WBC 5.5x10 9/1
PLT 200x109/1
Na 135mmol/1
K 4.9mmol/1
Creatinine 1.3 mg1d1
Which of the following is the most appropriate management for him?
A. Increase Digoxine
B. Increase Biosprolol
C. Increas furosomde
D. Increas spironolactone
E. Reduce Biosprolol

Q.20 A 25 years old 1/v heroin abuser is admitted to the emergency department he has been suffering
from fevers for the past few days and is feeling very unwell. On examination he look emaciated with
a BMI calculated at 16. CVS examination revealed murmur consistent with pulmonary regurgitation
Labs shows.
HB 10g/d1
MCV 97fl
WBC 12.3x109/1
N+ 135mmol/1
K+ 5 mmo1/1
Creatinine 1.8mgl/d1
Urea 80mg/1d
ESR 87 mm/hr
?Which of the following is the most like diagnosis
A. Staphylococcus aureus Endocarditis
B. Pseudomonas Endocarditis
C. Atrial Myxoma
D. .Streptococcus viridians Endocarditis
E. Klabsella endocarditis
 Q.21. A 35 year old female presented to emergency department with a 2 day history of SOB on
minimal exertion, paroxysmal nocturnal dyspnea and non productive cough. she is 36 week
pregnant ,on examination patient is tachypnoic with R/R 24 Br per minute pulse 130 b/m regular
elevated JVP a loud P 2 and coarse crackles at both lung bases, BP130/80 mmmg, CX R (PAV),
shows cardiomegaly and bilateral pulmonary oedema. Transessophageal echocardiography
reveals left systolic dysfuntion with E.F of 30, ECG, reveals sinus Tachycadira . urine D/R is
normal what is most likely diagnosis?
A. Pre-eclampsia
B. Eclampsia
C. HTN Cardiomyopathy
D. Peripartum Cardiomyopathy
E. Non cardiogenic pulmonary oedema of pregnancy

Q.22.A 50 years old female present with variety of physical symptoms that have been present for the past
9 years. Numerous investigations and review by variety of specialties have indicated no organic basis for
her symptoms. This is an example of?

A. Somatisation disorder
B. Conversation disorder
C. Munchausen’s syndrome
D. Dissociative disorder
E. Hypochondrial disorder

Q.23.A 40 years old female who takes chlorpromezine for schizophrenia presents with severe
restlessness what side effects of antipsychotic medication is this an example of?

A. Neuroleptic syndrome
B. Acute Dystonia
C. Akathisia
D. Parkinsonsim
E. Tardive dyskinesia

Q.24.A 20 years old male demands a CT scan of his abdomen in clinic. He states it is obvious he
has cancer despite previous negative investigations. This is an example of ?
A. Somatization disorder
B. Dissociative disorder
C. Conversion disorder
D. Munchausen’s syndrome
E. Hypochondyial disorder.

Q.25 A renal biopsy from a 56 years old women with progressive renal failure for the past 3 years shows glomerular
and vascular deposition of pink amorphous material. It shows apple-green birefringence under polarized light after
Congo red staining;. These deposits are positive for lambda light chains. The person is most likely to suffer from
:
A. Rheumatoid arthritis.
B. Tuberculosis.
C. Systemic lupus erythematosus.
D. Multiple myeloma.

E.IgA nephropathy

Q.26. 28 year old male met with an accident and sustained severe crush injury. He is
most likely develop –

A. Acute renal failure

B. Hypophosphatemia
C. Hypercalcemia
D. Acute myocardial infarction
E.hyponatremia

Q.27. what is the likely diagnosis in a 25 year old who develops hematuria after 3 days of URI?

A.IgA NEPHROPATHY
B.PSGN
C.HSP
D.HUS
E.Membranous glomerulonephritis

Q.28.45 years man is seen in the emergency department with nausea, pallor lethargy he has no past
medical history of note. A cannula inserted and blood show the following.
Na 140 mmol/1
K+ 6.7mmol/1
Bicarbonate 14mmol/1
Urea 105mg/dl/
Creatinine 2.3mg/dl

What is most appropriate initial management?

A. Nebulised salbutamol
B. 1/v Bicarbonate
C. Haeomodialysis
D. Insulin /dexerose infrusion
E. 1/v calcium gluconate
Q.29.18 years old male having projectile vomiting and is unable to feed orally. What characteristic
finding would you expect to find in a blood test?

A.hyperchloraemia
 B.Metabolic acidosis
C. hyperkalemia
D.increased serum bicarbonate
E.raised anion gap
Q.30.A 60 years old man with history of hypertension presents with central chest pain. Acute
coronary syndrome is diagnosed and conventional management is given. A few days latter a
diagnostic coronary angiogram is performed. The following week a deteriorating of renal function
is noted associate with pupuric rash on his feet. what is the most likely diagnosis ?
A. Aspirin induced interstial nephritis
B. Cholestol embolisation
C. Heparin induced thrombocytopenia
D. Antiphospholipid antibody syndrome
E. Renal artery stenosis

Q.31.A 40 years female with a history of rheumatoid arthritis presents to the emergency
department with a two day history of a hot, painfull swollen right elbow joint. what is the most
appropriate?
A. Start infliximab
B. Joint aspiration
C. Oral high dose prednisolone
D. De pomederone injecton
E. Short course of methotrexate

Q.32.A diabetic man is diagnosed as having painful diabetic neuropathy in his feet, he has no others
medical history of note. what is most suitable first line treatment to relieve his pain?
A. Pregablin
B. Referal to pain management clinic
C. Carbamazepine
D. Duloxetiine
E. Gabapentin

Q.33,The preferred noninvasive test to confirm H. pylori eradication is

A) a stool antigen test.

B) a whole-blood antibody-detection test.

C) a serologic antibody detection test.

D) a urea breath test.

E. None of above

Q.34.30y old female give 6months h/o intermittent dysphagia. She also reports occasional heart burn
and chest pain. Barium swallow shows dilated esophagus with reduced peristalsis. What is most likely
diagnosis?
A. Achlasia

B. GERD

C. Ca esophagus

D. Esophagitis

E. Peptic ulcer

Q.35. 40y old female complais of profuse diarrhoea and frequent facial flushing. On examination
pansystolic murmur heard over precardium loudest at lower left sternal edge. What is likely diagnosis?

A. Peptic ulcer disease

B. Zolinger elison syndrome

C. Carcinoid syndrome

D. Rheumatic heart disease

E. Viral gastroenteritis

Q.36.The most frequent cause of UGI bleeding is:

A. Esophageal varices

B. Peptic ulcer disease

C. Angioma

D. Mallory Weiss tear

E. Gastritis

Q.37. which of following is most suggestive of wilsons disease?

A. Reduced hepatic copper concentration

B. Reduced 24h urine copper excretion

C. Increased skin pigmentation

D. Reduced serum ceruloplasmin

E. Reduced serum copper

Q.38. A 59-year-old man with cirrhosis secondary to chronic hepatitis C is seen in clinic for follow-up. He
reports recent worsening of ascites and decreased urine output. Physical examination is significant for
jaundice, moderate ascites, and tenderness in the right upper quadrant. Ultrasound of the liver shows
cirrhosis and a 3 cm lesion in the right hepatic lobe, raising concern for possible hepatocellular
carcinoma (HCC). Serum AFP is normal, however.

What is the most appropriate next step?

A. Repeat ultrasound in 6 months

B. Check the patient's serum CA19-9 level

C. Perform a biopsy of the liver lesion

D. Perform a contrast-enhanced CT scan

E. Perform a PET-CT scan

Q.39.Young patient came with complain of lethargy. Routine lab shows abnormal LFT, so hepatitis
screen sent, results given as below;

Anti-HAV. Negative

HbsAg. Negative

Anti-Hbs. Positive

Anti-Hbc. Negative

Anti-HCV Positive

What do these results most likely demonstrate?

A. Hepatitis B infection

B. Hepatitis C infection

C. Previous vaccination to hepatitis B and C

D. Hepatitis C infection with hepatitis B vaccination

E. Hepatitis B and C infection

Q.40.Regarding NAFLD which is incorrect

A. Often asymptomatic.

B.Elevated aminotransferase levels and/or hepatomegaly.

C.Predominantly macrovesicular steatosis

D. ratio of ALT to AST is almost always >1 in NAFLD

E. Percutaneous liver biopsy is contraindicated.

Q.41.A 17-year-old boy was found to have an isolated increase in his total bilirubin (40μmol/L) on blood
tests performed for general tiredness. Liver function tests were otherwise normal.

In this case

A. An unconjugated bilirubin fraction would be helpful

B. An increase in alkaline phosphatase would suggest liver disease

C. He should be advised to avoid alcohol

D. A normal INR would exclude liver disease

E. Genetic testing for haemochromatosis is recommended.

Q.42. A 32 year old male presents to ED at 11pm with a sudden onset headache 4 hours earlier. She
describes the event as suddenly being hit on the head. Subsequent to this she experienced an ongoing
sudden severe occipital headache and vomiting. The provisional diagnosis of a subarachnoid
haemorrhage is made. CT scanning however is unyielding. What is the most appropriate next step in the
management?

(A) arrange an urgent MRI brain

(B) Address his analgesic requirements and discharge him after pain control is sufficient

(C) Perform a lumbar puncture and CSF for xanthochromia immediately

(D) Perform a lumbar puncture and CSF for xanthochromia the next morning

(E) Observe him in hospital and arrange repeat CT brain the next day

Q.43.A 34 year old male presents acutely with quadraplegia and complete paralysis of his facial muscles.
He is able to move his eyes and blink on command. Where is the most likely lesion?

(A) dorsal medulla

(B) cerebellum

(C) dorsal pons

(D) ventral pons

(E) reticular activating system

Q.44.Parkinsonism includes combination of the following:

A. tremor, bradykinesia & muscles rigidity

B. paresis, anesthesia & muscles spasticity

C. chorea & muscles hypotonia

D. tremor, ataxia & muscles hypotonia

E. None of above

Q.45.An obese 36y old female presents with headache and blurred vision. Examilantion reveals bilateral
blurring of optic discs but otherwise unremarkable with no other neurological signs. B.p is 130/90 and
afebrile. What is most likely diagnosis?

A. Multiple Sclerosis

B. Meningitis

C. Brain abscess

D. Normal pressure hydrocephalus

E. Idiopathic intracranial Hypertension

Q.46.Which of following drug is used for management of multiple sclerosis?

A. Beta interferon

B. Gamma interferon

C. Infliximab

D. Rituximab

E. Alpha interferon

Q.47.58 yes old female comes in emergency ward with complains of slowly enlarging hard mass
in anterior neck thyroid ultrasound reveals infiltration and biopsy reveals dense infiltration of
the gland .her free T4 is low and TSH is markedly raised consistent with hypothyroid thyroid anti
bodies are negative what is most likely diagnosis?

A. Riedel’s thyroiditis
B. Hashimoto’s Thyroiditis
C. Thyroid carcinoma
D. Toxic multinodular goiter
E. Grave’s disease
 Q.48.65 year’s old female comes to OPD with chronic low backache and severe sharp pain in the
left groin after minor fall and is unable to walk. On X-ray fracture of neck of femur was present
.on investigations serum calcium concentration of 1.9 mmo1/lit , serum phosphorus
concentration of 0.68 mmol/lit and increased alkaline phosphorous activity. Serum PTH level was
found to be elevated the most likely diagnosis is?

A. Primary hyperparathyroidism
B. Hypervitminosisy D
C. Pagets disease of bone
D. vitamin D deficiencies
E. Osteoporosis

Q.49.72 year’s old man with long history of COPD was admitted with pneumonia. prior to
admission he had becomes increasingly confused. on examination he was drowsy had BP of
145/75 mm of hg and was clinically euvolaemic chest auscultation consists with pneumonia
investigation reveals Na 121mmol/l ,k 3.9 mmok/lit creatinine 64 micro mol/lit and glucose 4.2
mmol/ lit plasma osmolarity was 261 mosmol /lit –TFTS was normal urine test revealed an
osmolality of 560 mosmol/kg and sodium concentration of 55 mosmol/lit what is likely cause of
hyponatremia

A.Addison’s disease
B.Renal failure
C.Cardiac failure
D.SIADH
E.Cirrhosis of liver
Q.50.21 years old student comes to OPD with complains that he is suffering from acute
headaches and panic attacks and is unable to continue his work in university. On examination he
had marfanoid look having multiple neuromas around his lips his Bp is 150/100mm of hg his 24
hour urinary catecholamine levels are raised what is his likely diagnosis?

A. Multiple endocrine neoplasia (MEN) 1

B. Multiple endocrine neoplasia(MEN) 2a
C. Multiple endocrine neoplasia (MEN)2b
D. Neurofibromatosis
E. Carcinoid syndrome

Q.51.40 years old male presents with headaches excessive swelling galactorrhoea polyuria and
polydipsia visual field examination reveals bitemporal hemianopia his blood pressure is 160/110
mm of Hg, FBS 9 mmol /lit prolactin 1200 mu/lit(<360), what is most probable diagnosis?

A. Prolactinoma
B. Diabetes mellitus
 C. Acromegaly
D. Cummings disease
E. craniopharyngioma

Q.52.Which one of the following statement regarding maturity onset diabetes of the young (MODY) is
true?
A. There is usually strong family history
B. Body mass index is typically >30
C. Does not respond to glimepiride
D. Autosomal inheritance
E. Frequent episode of DKA are typical

Q.53.A diabetic man is diagnosed as having painful diabetic neuropathy in his feet, he has no others
medical history of note. What is most suitable first line treatment to relieve his pain?
F. Pregablin
G. Referal to pain management clinic
H. Carbamazepine
I. Duloxetine
J. Gabapentin
Q.54.A 50 years old female with suspected diabetes mellitus has an oral glucose tolerance test
following the Standard who protocol the following result obtained
Time (hours ) blood glucose (mg/d/1)
O 106mg/d1
2 151mg1dl
How should these results be interpreted?
A. Impaired fasting glucose and impaired glucose tolerance
B. Normal
C. Diabetes mellitus
D. Impaired glucose tolerance
E. Improved fasting glucose
Q.55.Which one of the following combinations of treatments should be avoided in patients with type
2 DM?
A. Sulfonylurea + DPP 4 inhibitors
B. Metformin + insulin exenatide
C. Metformin + Sulfonylurea + exenatide
D. Metformin + Sulfonylurea
E. Insulin + Metformin Sulfonylurea
 Q.56.Which one of the following statement regarding SLE is true?
A. It is linked with HLA A5
B. Onset is typically between 20-40 years old
C. The incidence has decreased in the past 30 years
D. The female; male ratio 3:1
E. It is more common in Caucasians

Q.57A40 year female intolerant of methotrxate is started on azthioprine for rheumatoid. Arthritis routine
blood monitoring shows

Hb; 7.7mg/dlI
WBC 2.7X109/1
PLT 96X109/1

Which of the following factors to predispose her to the azthioprine toxicity ?

A. Alchol execeis
B. Fast acetyloto stus
C. Cimctidine
D. Rfonprim
E. Thioprune methyal transferase deficiency
Q.58.Which one of the following features is least commonly seen in drug induced Lupus?
A. Pleurisy
B. Myalgia
C. Malar rash
D. Glomeruolnephrtis
E. Arthrgia

Q.59.30 years old women presents in dermatology OPD complaining that she
develop increasingly dark areas of pigmentation on her face since few weeks she
has noticed weight increase over the past few month’s and has not had periods
for 5 months what is most likely diagnosis?

A. Eczema
B. Lupus
C. Chloasma
D. Vitiligo
E. Prolactinoma
Q.60.The most useful bedside test to suggest snake bite envenomation is;

a. Prothrombin time

b. 20 min whole blood clotting time

c. International normalized ratio

d. Platelet count

e. None of above
 ANSWER KEY

Question
Question
No:No: KeyKey Question
Question
No:No: Key
Q:1Q:1 D D Q:31
Q:31 B B
Q:2Q:2 A A Q:32
Q:32 C C
Q:3Q:3 C C Q:33
Q:33 D D
Q:4Q:4 B B Q:34
Q:34 A A
Q:5Q:5 A A Q:35
Q:35 C C
Q:6Q:6 C C Q:36
Q:36 B B
Q:7Q:7 A A Q:37
Q:37 D D
Q:8Q:8 E E Q:38
Q:38 D D
Q:9Q:9 D D Q:39
Q:39 D D
Q:10
Q:10 D D Q:40
Q:40 E E
Q:11
Q:11 D D Q:41
Q:41 A A
Q:12
Q:12 B B Q:42
Q:42 D D
Q:13
Q:13 B B Q:43
Q:43 D D
Q:14
Q:14 A A Q:44
Q:44 A A
Q:15
Q:15 D D Q:45
Q:45 E E
Q:16
Q:16 A A Q:46
Q:46 A A
Q:17
Q:17 C C Q:47
Q:47 A A
Q:18
Q:18 C C Q:48
Q:48 D D
Q:19
Q:19 A A Q:49
Q:49 D D
Q:20
Q:20 A A Q:50
Q:50 C C
Q:21
Q:21 D D Q:51
Q:51 C C
Q:22
Q:22 A A Q:52
Q:52 A A
Q:23
Q:23 C C Q:53
Q:53 D D
Q:24
Q:24 E E Q:54
Q:54 D D
Q:25
Q:25 D D Q:55
Q:55 B B
Q:26
Q:26 A A Q:56
Q:56 B B
Q:27
Q:27 A A Q:57
Q:57 E E
Q:28
Q:28 E E Q:58
Q:58 D D
Q:29
Q:29 D D Q:59
Q:59 C C
Q:30
Q:30 B B Q:60
Q:60 B B