1-A 45 year old alcoholic with clinical features of cirrhosis and portal hypertension has a variceal bleed.

He has ascites. What single test best provides early information about the possible presence of ascitic
fluid infection?

a) ascitic fluid neutrophil count.

b) gram stain of ascitic fluid.

c) bacterial culture of ascitic fluid.

d) ascitic fluid pH.

e) ascitic fluid protein.

2-A 40 year old woman presents with increased lethargy and diminishing exercise tolerance over six
months. She was treated for Greave’s desease in the past with radioiodine. She is pale and
haemograman shows:

Haemoglobin 6.0 g/dL

Mean Corpuscular Volume 115 fL

White Blood Count 2.4 x 109/L

Platelet 50 x 109 /L

The most likely diagnosis:

a) pernicious anaemia.

b) anaemia due to menorrhagia.

c) radiation-induced bone marrow disease.

d) autoimmune haemolytic anaemia.

e) iron deficiency anaemia.

3- A 45 year old obese diabetic male who is known to have gout presents with swelling, erythema and
tenderness of his right knee. He has fever tachycardia. Which of the following tests is most likely to
confirm septic arthritis?
a) urate crystals.

b) elevated peripheral white blood cell count.

c) positive gran stain on joint aspirate.

d) elevated ESR.

e) decrease glucose in joint aspirate.

4- A 17 year old boy is diagnosed with diabetes mellitus on a routine blood test. His body mass index is
35 kg/m2 , and his physical examination is otherwise normal. His mother has diabetes but none of his
siblings. His most likely diagnosis is:

a) Type I diabetes.

b) Type 2 diabetes.

c) MODY, type2.

d) surreptitious ingestions of steroids.

e) diabetes secondary to chronic pancreatitis.

5- Of the following, the most likely cause resulting from paralysis of the 3rd cranial nerve is:

a) constricted pupil on the left.

b) ptosis of the right.

c) normal consensual light reflex on the right.

d) absence of sweating on the right side of the face.

e) normal direct light reflex on the left.

6-A 48 year old smoker presents with crushing central chest pain and dizziness. ECG shows ST segment
elevation in the inferior leads with sinus rhythm and a normal axis. Which drug is most likely to decrease
the risk of fatal arrhythmias within the next five days?
a) aspirin.

b) isosorbide dinitrate.

c) atenolol.

d) ramipril.

e) nifedipine.

7-A 70 year old female presents with sudden onset severe pain in the right eye, with diminished visual
acuity as well as vomiting. The right eye is red, feels tense and the pupil is dilated. The most likely
diagnosis is:

a) subarachnoid haemorrhage due to a IIIrd cranial nerve palsy.

b) acute bacterial conjunctivitis.

c) subconjunctival haemorrhage.

d) acute glaucoma.

e) episcleritis.

8- Of the following, the most likely cause of localized non scarring alopecia is:

a) lichen planus.

b) tinea capitis.

c) alopecia areata.

d) radiodermatitis.

e) carbuncle.
9- A 33 year old man presented to hospital with painless haematuria. He also had hearing impairment.
He has two siblings with similar conditions and one of them is on haemodialysis. The most likely
diagnosis is:

a) IGA nephropathy.

b) sickle cell trait.

c) neurosyphilis.

d) Alport syndrome.

e) focal and segmental glomerulosclerosis.

10- An 18 year old woman presented with anxiety and palpitations. Her mother had received radio-
oidine for thyrotoxicosis and is on long term thyroxine replacement therapy. On examination, her pulse
was regular 104 beats/minute, her thyroid gland was not palpable and there was no lid lag. The
following are her laboratory results.

serum total T4 210mmol/L (50-150)

serum free T4 32 pmol/L (10-20)

serum total T3 3.7 nmol/L ( 1 -3.2 )

plasma thyroid stimulating hormone (TSH) 0.01 mmol/L (0.4 – 5.0 )

serum antithyroid peroxide (anti-TPO) thyroid scan 36 IU/L (normal uptake < 50)

What is the most likely cause of her symptoms?:

a) factitious thyrotoxicosis. c) Grave’s disease e) T3 thyrotoxicosis

b) familial hyperthyoglobulinaemia. d) subacute thyroiditis

11-A 30 year old female gives a history of menstrual irregularity and headaches. On examination she has
galactorrhoea, CT scan shows a pituitary macroadenoma. The most likely finding on visual field
examination is:

a) (R) homonymous hemianopia.

b) (L) homonymous hemianopia.

c) binasal field defect.

d) bitemporal hemianopia.

e) quadrantinopia.

12- In a 70 year old with a recent stroke, the feature most indicative of poor prognosis is:

a) level of consciousness.

b) density of paresis.

c) expressive dysphasia.

d) receptive dysphasia.

e) dysphagia.

13- Concerning polycystic ovarian syndrome, choose the most likely correct answer:

a) associated with cyst in the pancreas and kidneys.

b) a forerunner of type 2 diabetes mellitus.

c) a forerunner of premature ovarian failure.

d) uncommon in clinical practice in the Caribbean.

e) a pre-malignant condition.
14- A 46 year old female has a one-week history of pain in her neck radiating to the ear following a flu-
like illness. She is also experiencing palpitations, sweating and irritability together with low grade fever.
The thyroid is slightly enlarged and tender. The most likely likely diagnosis is:

a) Grave’s desease.

b) Hashimoto’s thyroiditis.

c) De Quervain’s thyroiditis.

d) Thyroid lymphoma.

e) Thyroglosal cyst.

15- A 67 year old female has longstanding rheumatoid arthritis. She is on steroids as well as intermittent
NSAIDS. Two weeks ago, she noticed that her ankle were swelling. She consults her general practitioner
who diagnosed the nephrotic syndrome and ultrasound showed enlarged kidneys. What is the most
likely cause of this condition ?

a) renal amyloidosis.

b) chronic intersticial nephritis.

c) analgesic nephropathy.

d) chronic pyelonephritis.

e) focal and segmental glomerulosclerosis.

16- A 46 year old male who has consumed a pint of run daily for 18 years, presents with right upper
quadrant pain. The pain is of four days duration. He gives a history of taking two extra strength
acetaminophen tablets every four hours for the past week to relieve headache. There is no history of
jaundice or gallstones. The patient had a blood transfusion 20 years ago when he was hospitalized for a
motor vehicle accident. There is no history of recent exposure to hepatitis. Physical examination
revealed an enlarged tender liver with a span of 18 cm. The most likely diagnosis is:

a) alcoholic hepatitis.
b) acute cholecystitis.

c) acetaminophen hepatotoxicity.

d) acute viral hepatitis B.

e) acute viral hepatitis C.

17- A 75 year old chronic smoker is experiencing rapid weight loss, hyperpigmentation and muscle
weakness associated with marked hypokalaemia. The most likely cause of the clinical presentation is :

a) metastasic disease to the brain.

b) metastasic desease to kidney causing potassium wasting.

c) superimposed tuberculosis.

d) ACTH production by the tumor.

e) myasthenia gravis.

18- A 65 year old man, who has been well previously ,presents with acute onset of dyspnea. On
examination of the respiratory system he has tracheal deviation to the right. There is reduced
expansion, hyper-resonant percussion, reduced breath sounds and reduced tactile vocal fremitus on the
left side of the chest. His oxygen saturation is 88% breathing air. The blood pressure is 80mmHg systolic.
Of the following the most appropriate emergency management would be to:

a) arrange a spiral CT scan of the chest.

b) aspirate the left side of the chest.

c) give antibiotics intravenously.

d) give increased inspired oxygen with 24 % mask.

e) treat with non-invasive positive pressure ventilation by face mask.

19- An 80 year old male has atrial fibrillation and hypertension. Which therapy would best reduce his
chances of having and ischaemic stroke?
a) warfarin.

b) digoxin.

c) aspirin.

d) furosemide.

e) clopidogrel.

20- In the assessment of patients with hypertension, the presence of coarctation of the aorta is best
identified clinically by:

a) sustained hypertension.

b) unequal arterial arm pulses.

c) radiofemoral impulse delay.

d) abscense of arterial foot pulses.

e) slow rising carotid artery pulsation.

21- Of the following, a flapping tremor with a foetor oris best occurs in:

a) alcohol withdrawal.

b) liver failure.

c) pancreatitis.

d) chronic obstructive airway disease.

e) diabetic ketoacidosis.

22- An enlarged spleen is a typical feature of which one of the following:

a) adult sickle cell disease.

b) adult coeliac disease.

c) portal hypertension.

d) aplastic anaemia.
 e) multiple myeloma.

23- A 50 year old female has atrial fibrillation which is controlled by digoxin. On auscultation a rumbling
mid-diastolic murmur is heard at the apex. What is the most likely underlying condition?

a) aortic regurgitation.

b) atrial septal defect.

c) ventricular septal defect.

d) aortic stenosis.

e) mitral stenosis.

24- Of the following, which organism is most likely to be associated with pseudomomembranous colitis?

a) Escherichia coli.

b) Staphylococcus aureus.

c) Helicobacter pylori.

d) Campylobacter jejuni.

e) Clostridium difficile.

25- In which ECG leads are pathological Q waves most likely to be seen in acute inferior wall myocardial
infarction:

a) I and II

b) II, III and aVF.

c) V1, V2 and V3.

d) I, aVF and V6.

e) V4, V5 and V6.

26- A 65 year old male smoker has a history of hypertension. His wife observed that he developed
drooping in the left eyelid. On examination, the left pupil measured 2mm and the right 4mm. No other
neurological signs were present on the left side of the face but the skin was dry. Which of the following
is the most appropriate first investigation?

a) MRI brain.

b) carotid duplex.

c) chest X-ray.

d) ophthalmology referral.

e) plasma glucose level.

27- A 58 year old woman is taking to hospital complaining of fever, body pain, decreased appetite and
right-sided pleuritic chest pain for two weeks. On examination, the temperature is 38 C. There is right
hypochondrial tenderness without hepatomegaly and normal chest findings. The following results were
obtained:

Haemoglobin 12.3 g/dL, white blood cell count 22 x 109/L,

Urea 6.7 mmol/L, creatinine 130 ummol/L, Na 135 mmol/L

K 4 mmol/L, AST 300 U/L, ALT 250 U/L, ESR 96 mm/hour (Westergren)

Chest X-Ray showed raised right hemidiaphragm with normal lung fields

What is the most likely aetiology?

a) Viral Hepatitis.

b) atypical pneumonia.

c) liver abscess.

d) acute pyelonephritis.

e) splenic abscess.

28- Concerning ulcerative colitis, which of the following is the single best true :

a) skin lesions are characteristic

b) micro-abscesses do not accur

c) it is not transmural

d) it may cause anal fistulae

e) it less common than Crohn’s disease.

29- Of the following the most likely association with digital clubbing is:

a) renal artery stenosis.

b) hypothyroidism

c) bronchial asthma

d) mitral valve prolapse

e) fibrosing alveolitis

30- Concerning examination of the urine in acute tubular necrosis, the most likely correct urinary finding
is:

a) red blood cell casts

b) massive proteinuria

c) the urine osmolality is high

d) the urinary spot sodium is usually greater than 20 mmol/L

e) urobilinogen

31- Which of the following is the most appropriate answer in the treatment of anaemia of chronic renal
failure:

a) iron supplementation is contraindicated

b) the haemoglobin level should be corrected to normal levels

c) treatment with recombinant erythropoietin is usually effective

d) the patient may develop hypotension as a result of erythropoietin

 e) the patient should have regular blood transfusion every month

32- Of the following, which is the best option in acute uncomplicated pyelonephritis in females:

a) the most likely source of infection is from the blood stream

b) in a sample of urine obtained by catheterization of the bladder, the colony count of

bacteria should be more than or equal to 105 /ml of urine to diagnose an infection

c) ciprofloxacin is a good choice of antibiotics to treat the infection

d) it is less frequent than males

e) the patients can be treated with a three-day course of antibiotics

33- The most likely gastrointestinal side effects of chronic NSAID is:

a) gastritis

b) duodenitis

c) strictures

d) colitis

e) diverticular bleeding

34- The most likely indication for surgery in peptic ulcer disease is:

a) chronic dyspeptic symptoms

b) intestinal bowel obstruction

c) chronic duodenal scarring

d) gastric oulet obstruction

e) pain when hungry

35- The most likely causes of upper gastrointestinal bleeding associated with prolonged vomiting is:

a) Mallory-Weis tear

b) Barret’s oesophagus

c) Plummer-Vinson syndrome

d) Duodenal and gastric

e) Oesophagitis

36- Colonoscopy as a screening tool for colorectal cancer in average risk individuals should begin at this
age:

a) 35 years

b) 40 years

c) 45 years

d) 50 years

e) 55 years

37- A 32 year old patient known to have AIDS, presents dysphagia. Which of the following is the
commonest cause of this complaint in AIDS patient?

a) Bactrim

b) cytomegalovirus infection

c) candidiasis

d) oesophageal ulcer

e) Zidovudine

38- Which of the following is most likely to be associated with vitiligo:

a) tuberous sclerosis

b) leprosy
 c) thyroid disease

d) Crohn’s disease

e) pityriasis versicolor

39- If a patient has an absent corneal reflex on clinical exam, which of the following is most likely to be
damaged pathway?

a) afferent pathway for the occulomotor nerve

b) efferent pathway for the occulomotor nerve

c) afferent pathway for the trigeminal nerve

d) efferent pathway for the abducens nerve

e) afferent pathway for the facial nerve

40- A 55 year-old hypertensive patient has a 24-hour history of pain behind the left eye. Examination
revealed left ptosis, dilated left pupil, paralysis of the external ocular muscles of the left eye and reduced
sensation within the first division of the left trigeminal nerve. The MOST likely cause is:

a) giant cell arteritis

b) berry aneurysm of posterior communicating artery

c) brain stem infarction

d) intracavernous aneurysm of the internal carotid artery

e) diabetes mellitus

41- A 65 year old man presents with vertebral collapse and parparesis. The following blood result were
obtained:

Haemoglobin 9.2 g/dL

White cell count 5.0 x 109 /L

Platelets 156 x 109 /L

MCV 92 fL
 ESR 95 mm/h

Total protein 95 g/L

Calcium 3.2 mmol/L

Phosphate 1.3 mmol/L

Which of the following statement is MOST applicable:

a) this is consistent with pernicious anaemia

b) this is consistent with osteoporosis

c) the patient has acute myeloid leukemia

d) serum protein electrophoresis should be done

e) serum parathyroid hormone should be elevated

42-A middle-aged patient presents with worsening breathlessness for one year. On examination you find
tachypnoea, widespread crackles and finger clubbing. Spirometry shows a low vital capacity associated
with a relatively well-preserved peak flow rate. Arterial blood gases reveal hypoxaemia .What is the
MOST likely diagnosis:

a) pulmonary fibrosis

b) recurrent pulmonary emboli

c) early emphysema associated with alpha-1 antitrypsin deficiency

d) Lams-Twort malformation

e) barrel chest deformity

43- A 23 year old soldier presents to his General Practitioner with one-weak history of an upper
respiratory tract infection. Physical examination was unremarkable, apart from mild jaundice. Liver
function tests were normal apart from the serum bilirubin ( x 2 upper limit of normal ). Complete blood
count was normal. No bilirubin was in the urine . Which one of the following is most likely?

a) Gilbert’s syndrome

b) veno-occlusive disease
 c) sickle cell trait

d) acute hepatitis

e) acute cholecystitis

44- A 22 year old female presents with secondary amenorrhoea and weight loss. On examination she is
noted to have mild parotid swelling She has a low BP and a BMI of 15. The most likely reason for her
amenorrhoea is:

a) Prolactinoma.

b) Addison’s disease

c) premature ovaria failure

d) anorexia nervosa

e) bulimia

45- An asymptomatic 60 year old man is found to have an isolated raised alkaline phosphatase on
routine biochemistry. Serum calcium and phosphate level are normal. The most likely diagnosis is:

a) osteomalacia

b) multiple myeloma

c) Paget’s disease

d) cirrhosis

e) hyperthyroidism

46- The most common anterior mediastinal tumour in adults is :

a) thymoma

b) lymphoma

c) mesothelioma

d) myoma

e) fibroma
47- A 70 year old diabetic has an ataxic and stamping gait. He walks on a wide base watching his feet
and the ground .Of the following the most likely condition is:

a) cerebellar disease

b) lateral popliteal nerve palsy

c) spinal cord compression

d) subacute combined degeneration of the cord

e) Parkinson’s disease

48- A 65 year old woman is brought to hospital by her relatives because she no longer speaks fluently.
She has difficulty finding some words and may produce the wrong word. Her comprehension is well
preserved . She has a cerebrovascular accident most likely affecting this area of the brain;

a) posterior part of the dominant superior temporal gyrus

b) the dominant inferior frontal gyrus

c) the cerebellum

d) the calcarine cortex

e) the vermis

50- A two year old child was found by his mother chewing a paracetamol tablet while holding the empty
bottle in his hand. The mother knows that there were10 tablets of 500mg strength in the bottle . She
brought the child to the Emergency Department within half an hour. He was playful and active.

The most appropriate management is:

a) reassure the mother and send the child home

b) admit the child and institute forced alkaline diuresis

c) administer ipecac to induce vomiting

d) take blood for serum paracetamol levels

e) administer N-acetylcysteine orally

51- A 6 year old girl is brought to hospital because of numbness of the toes and a history of unsteady
gait for two days. On examination, she is found to have symmetric weakness of the lower limbs and
there is difficulty eliciting the deep tendon reflexes. The examination of the upper limbs is normal and
there are no obvious sensory abnormalities. The remainder of the examination is normal.

Of the following the most likely diagnosis is:

a) acute cerebellar ataxia

b) acute transverse myelitis

c) cerebrovascular accident

d) Guillain Barre syndrome

e) poliomyelitis

52- Of the following, the most likely recognized adverse effect of sodium valproate is:

a) diplopia

b) weight gain

c) polyuria

d) gingivitis

e) permanent hair loss

53- A midwife calls you to see a newborn who has an small penis with an opening at its base and

no palpable testes. The child is otherwise well.

Of the following the most appropriate course of action is to:

a) reassure the mother that she has a boy

b) reassure the father that he has a girl

c) make a diagnosis of hermaphroditism

 d) make a diagnosis of ambiguous genitalia

e) discharge the baby to the endocrine clinic and review in a month

54- A mother brings her four-year old son to the clinic because she is concerned that he has a body
odour and increasing amounts of acne. She also notes that he is not doing well at school and is taller
than his peers.

Of the following, the most likely parameter to denote abnormal pathology is:

a) abnormal body mass index

b) abnormal height velocity

c) abnormal weight velocity

d) normal height velocity

e) normal weight velocity

55- A three day old infant was noted to have seizures. He was born at term, had normal APGAR scores
at birth and weighed 2 kg

In the initial management of this neonate, the most appropriate anti-epileptic drug is:

a) carbamazepine

b) diazepam

c) phenobarbitone

d) phenytoin

e) valproic acid

56- Of the following, the single best advantage of breast milk compared with cow’s milk is:

a) higher iron concentration

b) higher caloric content per ounce

c) higher vitamin D concentration

 d) higher protein content per ounce

e) higher whey :casein ratio

57- Which of the following is inherited as a sex linked single gene defect?

a) duchenne muscular dystrophy

b) Turner syndrome

c) galactosaemia

d) achondroplasia

e) cleft lip

58- A five-year old child has a patch of alopecia of 2 weeks’ duration . Within the patch are black dot
hairs and scale. Which of the following is the most appropriate treatment?

a) cephalexin orally

b) griseofulvin orally

c) hydrocortisone 1% topically

d) miconazole nitrate topically

e) nystatin topically

59- A three-year old presents with an enlarged cervical lymph node for which he was prescribed
antibiotics with non response. The Mantoux test was 8mm. The next best line of action is:

a) excision biopsy of the node

b) INH therapy

c) to request an Erythrocyte Sedimentation Rate (ESR)

d) to order a chest X-ray

e) to give a follow up appointment

60- A seven-year old girl presents with fever, abdominal pain and vomiting for two days. On
examination, she was normal except for the temperature of 39.50C . Her total white blood cell count
was 20 x 109/L, 80% of which were neuthrophilis. Urinalysis revealed that there were 80 white cells per
high power field. Urine culture from a clean catch grew between 10.000 and 100.000 colonies of
Escherichia coli per ml.

The most likely cause is:

a) inflamed retrocoecal appendix

b) acute pyelonephritis

c) mesenteric adenitis

d) acute gastroenteritis

e) renal abscess

61- Concerning HIV disease in children, the most likely correct response is:

a) depressed levels of serum immunoglobulins are seen in the majority of cases

b) there is an enhanced ability to produce antibodies against tetanous toxoid

c) advanced cases show an increased ratio of helper to suppressor T cells

d) chronic pulmonary interstitial disease is associated with lymphocytic infiltration of the

lungs

e) the diagnosis cannot be confirmed before 18 months of age

62- Concerning acute rheumatic fever, the most likely correct response is:

a) C3 complement level is elevated

b) Huntington chorea is a major criterion for diagnosis

c) a history of rheumatic arthritis is a minor criterion for diagnosis

d) erythema toxicum is a major criterion for diagnosis

e) pericarditis is a recognized feature

63- A one-day old neonate was noted to be deeply cyanosed despite adequate oxygen administration.
His respiratory system is normal. The most likely cause of his cyanosis is:

a) tricuspid incompetence

b) tetralogy of Fallot

c) hypoplastic left heart syndrome

d) transposition of the great vessels e) congestive cardiac failure

64- A 6-month old infant was seen in the Accident & Emergency Department in moderate respiratory
distress with a respiratory rate of 60/min, heart rate 220/min and is afebrile. There is a one-week history
of cold and cough prior to his presentation at the Emergency department. He received the primary
immunizations. The most likely diagnosis is:

a) aspiration pneumonitis

b) atypical pneumonia

c) bronchiolitis

d) viral myocarditis

c) bronchopneumonia

65- A 3-year old boy presents with fever of 8 days duration associated with oral hyperaemia stripping of
the lips and redness in the eyes. The examination finding includes swollen red palms and soles.

The pathogenesis of his illness is most likely:

a) drug allergy

b) immune-mediated

c) Stevens-Johnson syndrome

d) Scarlet fever

e) systemic inflammatory response

66- A 4-month old child with Trisomy 21 is noted to have shortness of breath and weight loss. The most
likely congenital cardiac lesion is:

a) atrial septal defect

 b) ventricular septal defect

c) patent ductus arteriosus

d) endocardial cushion defect

e) aortic incompetence

67- A three-year old boy presents to Casualty with a 4-day history of pruritic sores on his legs. On
examination, he has multiple crushed lesion on his legs bilaterally and one similar lesion on his right
nostril. The most likely causative organism is :

a) Streptococcus pneumonia

b) Sarcoptyes scabei

c) Streptococcus viridans

d) Coagulase negative Staphylococcus

e) Staphylococcus aureus

68- Candida diaper rash is best characterized by which of the following:

a) typically spares the flexures

b) is ideally treated with oral antifungal agents

c) responds well to zinc and castor oil creams

d) may be associated with antibiotic use e) is diagnostic of category C in HIV infection

69- Eczema is best characterized by the following statement:

a) a rash involving the eyesbrows is typical of atopic eczema

b) most cases of atopic eczema are exacerbated by ingestion of cow’s milk based formula

c) recurrence of eczema usually results from using steroids creams of inapropriate potency

d) emollient use is important in most forms of eczema

e) involvement of the neck flexures in infants is characteristic of atopic eczema

70- The following patients are seen in your office for well baby visits. Identify the one whom you would
be most concerned about:

a) the 3-year old boy who stutters

b) the 18-month old boy whose vocabulary consists of 10 words and is a bit garbled

c) the 13-month old boy who creeps, pulls to stand, cruises and walks with support

d) the 6-month old boy who is able to sit without support and rolls from back to front

e) the 1-year old boy who appears to be right handed

71- A two –year old has respiratory distress. Her family has recently migrated from Haiti. She has had
high fever for one day. She developed difficulty breathing just hours ago. On examination she appears ill,
has stridulous respiration and is leaning forward and drooling.

Of the following, the best initial management includes:

a) comfort patient and place in a controlled setting for endotracheal intubation

b) administer ceftriaxone intravenously

c) administer dexamethasone intramuscularly

d) administer racemic epinephrine via a nebulizer treatment, and repeat as needed

e) perform a complete ear, nose and throat examination to determine diagnosis

72- A two-year old is brought to the emergency department with respiratory arrest. She becomes
asystolic shortly after arrival. The patient is intubated and, despite administration of oxygen via ET tube,
as well as adequate chest wall movement, the patient remains asystolic.

Of the following, the most appropriate action is:

a) bolus of normal saline

b) atropine
 c) epinephrine

d) bolus of dextrose 25%

e) bicarbonate

73- A four-year boy is brought to the emergency department for an allergic reaction. He has a known
allergy reaction to peanuts and accidentally ingested some peanuts approximately 15 minutes ago.
Despite intravenous (IV) fluids, his blood pressure remains 65/30 mmHg

Of the following, the next best step in management is:

a) diphenhydramine intravenously

b) epinephrine intravenously

c) hydrocortisone intravenously

d) dopamine intravenously

e) cimetidine intravenously

74- Of the following the best statement regarding immunization is:

a) MMR vaccine should not to be given to HIV positive children.

b) live polio vaccine should not be given to siblings of children receiving chemotherapy

c) pertussis vaccine is contraindicated if there is a first degree relative with convulsions

d) MMR vaccine is effective if given within three months of immunoglobulin therapy

e) live polio vaccine should not to be given to siblings of children receiving maintenance

steroid therapy

75- An eighteen-month old boy is admitted with a high fever and a generalized convulsion that lasted
five minutes. He was a fullterm baby, has no chronic illnesses and has never been hospitalized. His
developmental age was appropriate. His examination was unremarkable, except for a temperature of
40C. He has no neck stiffness. By day three of admission he becomes afebrile, and develops a
generalized maculopapular rash . He otherwise looks well.
Of the following, the most likely diagnosis is:

a) measles

b) rubella

c) Rocky Mountain Spotted Fever

d) roseola

e) scarlet fever

76- A thirteen-year old male presents with bloody diarrhoea and tenesmus. You suspect an enteric
organism:

Of the following, the most likely site of infection is:

a) duodenum

b) colon

c) jejunum

d) stomach

e) oesophagus

77- A four-year old male is brought to the Accident & Emergency Unit with a history of lethargy and
drowsiness on the morning of presentation. His temperature is 39oC and he has a vesicular rash on the
peri-oral region. Intermittent jerky movement of the left upper and lower are observed.

The most likely aetiology of this child’s clinical problem is:

a) Streptococcus pneumonia

b) Staphylococcus aureus

c) Herpes simplex virus type I

d) Herpes hominis virus type 6

e) Adenovirus
78- A normal two-weeks old infant born at term is breastfeeding on demand

Of the following, he most likely to have:

a) 1 stool every 72 hours

b) 1 stool per day

c) 2 stools per day

d) 6 stools per day

e) 12 stools per day

79- You are asked to evaluate the hips of a fullterm newborn infant who was born by breach delivery:

The best way to screen for a congenitally dislocated hip is to:

a) compare the symmetry of the thigh folds

b) examine for leg discrepancy

c) examine for decreased ranged of motion of the hips

d) perform the Barlow and Ortolani manoeuvres

e) examine the “clicking” of the hips

80- Of the following, the most common congenital cardiac lesion seen in infants of diabetic mother is:

a) transposition of the great arteries

b) ventricular septal defect

c) septal hypertrophy

d) tetralogy of fallot

e) truncus arteriosus

81- A three-day old term male neonate is brought to the neonatal unit for poor feeding and irritability.
On examination his temperature is 350C , respiratory rate 80/min, heart rate 160/min. He is pale, icteric,
lethargic and irritable when disturbed.
Of the following investigations, the one that will best assist you in arriving at a definitive diagnosis is:

a) urea and electrolytes

b) complete liver function tests

c) complete blood count and differential

d) chest radiograph and ECG

e) blood cultures

82- A full term female infant is noted to be jaundiced at age 18 hours. She was delivered by a Gravida 2,
group O Rhesus positive mother. When asked, the father says that his blood type is group B Rhesus
negative. The newborn is active and breastfeeds appropriately:

Of the following, the most likely cause of the jaundice is:

a) Rhesus incompatibility

b) ABO incompatibility

c) G6PD deficiency

d) neonatal sepsis

e) breast milk jaundice

83- A four-year old boy presented to A/E Department with a three-week history of puffiness around the
eyes and increasing weight. Since two days ago he has experienced abdominal pain and occasional loose
stools. On examination, he has shifting dullness and tenderness.

Of the following, the most likely organism causing the abdominal problem is:

a) Escherichia coli

b) Haemophilus influenza

c) Streptococcous faecalis
 d) Streptococcus pneumonia

e) Staphylococcus aurus

84- An eleven-month old boy is brought to Casualty with a two-day history of high fever. He has a one-
day history of clear rhinorrhoea and cough. On examination, the only significant findings are
temperature 400C , and a bulging, hyperaemic left tympanic membrane. Shortly after completion of the
examination he has a generalized tonic clonic seizure.

The laboratory investigation that would most likely influence your initial management is:

a) white blood cell count

b) blood culture

c) cerebrospinal fluid analysis

d) urinalysis

e) computed tomography brain scan

85- An eight-year old girl is brought by her mother to the Casualty Department as she has been noted to
be inattentive during class and there has been recent decline in her school performance. An EEG was
done and shows 3 per second spike and wave activity.

You should advise the child and her parents that the expected duration of treatment should be:

a) lifelong

b) one year

c) two years

d) one year after the last seizure

c) two years after the last seizure

86- Of the following, the best statement regarding infant feeding is:

a) cereals should be added to bottle feeds no later than six months

 b) term infants are at risk for malnutrition during the period of weaning

c) whole milk may be used in the preparation of infant cereal after nine months of age

d) breast fed infants gain weight faster than formula fed infants

e) foods which elicit the extrusion reflex should be omitted from the diet

87- The most likely correct response that relates to a patient’s imitation of the examiner’s movements
even when asked not to do so is:

a) echolalia

b) echopraxia

c) ambivalence

d) waxy flexibility

e) mannerism

88- Which of the following is the most appropriate indicator of poor prognosis in schizophrenia?

a) acute onset of illness

b) late age of onset

c) schizoptypal premorbid personality

d) presence of mood symptoms

e) family history of mood disorder

89- In the mental status examination, the most appropriate parameter assessed in asking a patient to
interpret a proverb is:

a) general intelligence

b) abstraction

c) reality testing

d) presence of delusions
 e) judgement

90-A 24-year old man visited a toilet which he later learnt was visited by a gay men for sexual liaisons.
Despite tests and reassurance by his doctor, he could not get the thought out of his mind that he
contracted AIDS, although he knew that this was unrealistic. He would take soap and a towel to work to
wash his genitals several times a day. They most likely diagnosis is:

a) obsessive compulsive personality disorder

b) obsessive compulsive disorder

c) hypochondriasis

d) social phobia

e) ego-dystonic homosexuality

91-A young man was always suspicious of others, thinking that they were hostile or involved in
conspiracies against him . He felt a sense of injustice and was preoccupied with imagined wrong, was
litiginous and held grudges. The most likely diagnosis is:

a) paranoid schizophrenia

b) paranoid personality disorder

c) delusional disorder

d) antisocial personality disorder

e) borderline personality disorder

92- The most likely pathological changes characteristic of Alzheimer’s disease is:

a) enlarged ventricles and narrowed sulci

b) plaques of amyloid

c) focal loss of neurons confined to subcortical areas

d) increased cholinergic neurons

93- A mother who has a child she does not want becomes very protective of the child .

The most likely an example of the defence mechanism:

a) sublimation

b) suppression

c) reaction formation

d) rationalization

e) projection

94- A new office screening test for haematuria claims to be 95% sensitive and 100% specific. In using the
test in an average clinic population, the most likely correct response is:

a) few false positives

b) many false positives

c) no false positive

d) no false negatives

e) many false negatives

95-The high prevalence of the Aedes egypti mosquito in a community will most likely contribute to
increasing the risk of which of the following conditions?:

a) malaria

b) filariasis

c) AIDS

d) yellow fever

e) dengue fever

96- A statistical report states that in a certain country, approximately 12 people die from
cerebrovascular accidents (strokes) every year for every 100,000 persons estimated to be alivein that
country that year. Which of the following measure can best be obtained from this information?
 a) case fatality rate for strokes

b) standardized mortality rate for strokes

c) crude mortality rate for strokes

d) adjusted mortality for strokes

e) risk ratio of death from strokes

97- An epidemic investigation of food poisoning arising from a church picnic showed that the median
time for eating potato salad and having symptoms of diarrhoea and vomiting was 14 hrs. Which of the
following best describes the time interval:

a) communicable period

b) pre pathogenic period

c) pre-infectious period

d) incubation period

e) period of sub-clinical disease

98-In a study which began in 2006, 3000 adults were asked about past school consumption. The
occurrence of cases of liver cancer will be determined between 2006 and 2009. Of the following which
best describes the type of study?

a) cross-sectional study

b) concurrent cohort study

c) retrospective cohort study

d) clinical trial

e) case-control study

99- Not recommended antihypertensive in pregnancy:

a) Loop diuretics
 b) ACE inhibitors

c) Ca channel blockers

d) ACE inhibitors, Ca channel blockers, loop diuretics

100- V.B.A.C if previous L.S.C.S. was done if:

a) Breach delivery

b) Cord prolapse

c) Prematurity with classic caesarean secton

d) active genital herpes

e) foetal distress

101- Paroximal Supra Ventricular Tachycardia the E.C.G. shows:

a) Prolonged P-R interval

b) Decreased Q-T interval

c) J waves

d) Peaked T waves

e) Delta waves

102- three months old with running nose for 4 days, cough for 3 days, wheezing and Short Of Breath for
1 day, respiratory rate 64/min, spO2,94%, next step in management:

a) blood culture

b) arterial blood gas

c) full blood count

d) Trail neb with salbutamol

e) chest X-Ray
103- Newborn was noted to be drooling 4 hours following delivery and became cyanotic after attempted
feeding. Which most pausable explanation:

a) Inflamation

b) trauma

c) infection

d) neoplasia

e) atresia

104- Incorrect for urine analysis in Nephrotic Syndrome:

a) Daily urine for protein should be performed on an every morning urine sample.

b) Relapsed id defined by protein >2+ , 3 to 5 consecutive days or any day with edema.

c) The sulfosalicylic acid test for urine protein is an unexpensive alternative as the dipstick

d) fever may give a false positive test for protein.

e) Remission if the patient present presence 1+ protein for 3 to 5 consecutive days.

105- Commonest organ damaged ( injured ) in blunt trauma in children:

a) kidney

b) liver

c) spleen

d) small intestine

e) large intestine

106- Complication of bottle feeding at bedtime in children:

a) dental caries

b) asfixia

c)
 d)

e)

107- acarbose mechanism of action

108- Minimal changes disease in a girl 13 year-old

109- Metabolic syndrome. Treatement

110- Leg ulcers in DM .Tx

111- Type of sutures for rectum muscle and fascia

Which of the following techniques is best used to define an enlarged parathyroid gland:

a) Ultrasonagraphy

b) Thyrocervical angiography.

c) CT scan of the neck.

d) Sestamibi nuclear scan.

e) MRI of the neck.

23 year old female presents with itchy, soreness and mild dyspareunia, on examination there is a white,
clumpy exudate on a background of erythematous mucosa:

a) Gonorrhea

b) Candidiasis.

c) Atrophy vaginitis.

e) Cervical atrophy.

d) A physiological discharge.

In which of the following a friction rub is NOT heard on auscultation:

a) Contricted pericarditis.

b) Hemopericardiun.

c) Rheumatic heart disease.

d) Autoinmune pericarditis.

e) Tb pericarditis.

Oligohydramnios is associated with:

a) Renal agenesia.

b) Oesophageal atresia.

c) Down syndrome.

d) Pulmonary hypoplasia

e) Anaencephaly.

Contracted paralysis greater in the lower limbs than upper limbs is characterized of a stroke in the
distribution of which of the following:

a) middle cerebral artery.

b) vertebrobasilar artery system.

c) posterior cerebral artery.

d) anterior cerebral artery

In a boy a daytime wetting is a problem in which age:

a) 2 year

b) 6 year

c) 4 year

d) 3 year

e) 5 year

Cerebral palsy commonest type:

a) Tetraplegic type.

b) Choreathous type.

c) Diplegia type.

d) Mixed type.

e) Hemiplegic type.

In HIV the most common neurologic complications:

a) Cerebral edema.

b) CNS astrocytoma.

c) Acute inflammatory polyneuropathy.

d) Cerebral toxoplasmosis.

THYROID DISEASE MATCHING

38 year old female presented with 1.5 cm neck mass present in the right posteriortriangle, core biopsy
of this mass reveal well differentiated thyroid tissue which had cell characterized by cleaned membranes
and orphan Anne (Papillary Thyroid Ca)

24 year old female complaint of palpitations and weight lose and on examination has a uniform enlarged
anterior neck mass which has normal up take of thyroid radio-labeled scan

73 year old female who presents with 4 weeks history of an enlarging neck mass associated with
hoarseness , stridor, and local neck pain, FNAC shows colloid cell with spindle characterized by
prominent nuclei.

Plummer diseasse.

Papillary Ca

Follicular Ca

medullar Ca

Anaplastic Ca

Lateral aberrant thyroid

Lymphadenopathy.

Thyroglosal cyst.

Graves Disease

HashimotoDisease.