Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 25TH OCTOBER 2018 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. 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?
A. Panic Disorder D. Acute Stress Disorder
B. Generalized Anxiety Disorder GAD E. Social Phobia
C. Pheochromocytoma

2. 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

3. Postmortem examination of a patient who died of massive GIT bleed shows a small nodular liver.
What is the most likely cause of bleed?
A. Perforated GIT ulcer
B. Portal hypertension
C. Liver abcess
D. Hepatocellular carcinoma

4. A 65 year old man presents with progressively worsening breathlessness and productive cough. He
has a history of treated tuberculosis and rheumatoid arthritis, he smoked 20 cigarettes/day since 35
years. When he was given a trial of salbutamol nebuliser, FEV1/FEV changed from 1.7/2.0 to 1.8/2.1
(predicted 3.0/3.5). What is the most probable diagnosis?
A. Chronic bronchitis
B. Bronchiectasis
C. Bronchial carcinoma
D. Asthma
E. Pulmonary fibrosis

5. A 45 year old man was admitted for varicose vein stripping. Post surgery he complains of loss of
sensation at the medial side of foot. Which is the most common nerve to be injured?
A. Medial plantar
B. Sural nerve
C. Saphenous
D. Tibial
E. Deep peroneal nerve

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6. A 23 year old man sprained his right ankle six weeks ago while he was playing football. He was
treated with a below knee walking cast, on removing the cast the patient is noted to have a right foot
drop. He has weakness of extensors of the ankle and toes and diminished pin prick sensation over the
dorsum of the foot. The ankle jerk is present and the plantar reflex is flexor. What is the most likely
cause of the foot drop?
A. Compression of the common peroneal nerve
B. Compression of the tibial nerve
C. Compression of the S1 nerve root
D. Rupture of the Achilles tendon
E. Treatment of the medial collateral ligament of the ankle

7. A young female presents with sweating and confusion. Her vitals are stable, ABG shows metabolic
acidosis. What investigation should be done for her next?
A. Capillary blood glucose
B. Dexamethasone suppression test
C. Oral Glucose Tolerance Test (OGTT)
D. Head CT

8. A young man presents complaining of seeing coloured halos when his eyes are closed. What drug is
most likely to be the cause of his symptoms?
A. Heroin
B. Cocaine
C. Ecstasy
D. Lysergic acid diethylamide (LSD)

9. How to keep a check on salbutamol's efficiency?

A. PEFR
B. Spirometry
C. Vital capacity
D. FEV/ FEV1 ratio
E. Lung function test

10. Which of the following is NOT a physiological change during pregnancy?

A. Tidal volume 500ml.
B. Red cell volume 1.64L.
C. Cardiac output 6.5L/min.
D. Uterus weight 1.1Kg.
E. ESR up by 4 folds

11. A 32 year old lady has recently become more active, sleeps less and bought a house and 2 new
cars. What is the most likely diagnosis?
A. Bipolar disorder
B. Mania
C. Hypomania
D. Schizophrenia

12. A 22 year old boy as frequent fainting attacks since childhood. ECG shows normal PR interval
and QRS, however QT is prolonged. What is the cause of the faint?
A. Torsade de pointes
B. Complete heart block
C. Atrial Fibrillation
D. Sick sinus syndrome
E. Ventricular fibrillation

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13. 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?
A. Osmotic fragility test
B. Kleihauer-Betke test
C. FBC
D. Direct Coomb’s test
E. Indirect Coomb’s test

14. Prenatal amniocentesis for karyotype is offered if maternal blood tests at 16 weeks gestation
showed a high chorionic gonadotropin level and low alpha fetoprotein level. Choose the single most
likely condition from the following options.
A. Duchene muscular dystrophy
B. Cystic fibrosis
C. Spina bifida
D. Down’s syndrome
E. Spinal muscular atrophy

15. Man who took a bunch of over the counter drugs presented with jaundice. What is the most
probable cause of his Jaundice?
A. Hemochromatosis
B. Cholelithiasis
C. Gilbert's syndrome
D. Portal hypertension
E. Hepatitis

16. A 2 years old child who can run down steps, says mama and dada and understands what he says,
and also says one word. How is the development of this child?
A. Delayed motor milestones
B. Delayed speech
C. Normal
D. Global milestones delay
E. Delayed speech and motor milestones

17. A 72 year old man investigated for anaemia is booked for colonoscopy in 24hrs. What is the
single most appropriate management night before the procedure?
A. Bisacodyl tablet
B. Senna Tablet
C. Magnesium citrate orally
D. Lactulose syrup

18. 78 year old man with past history of ischemic heart disease presents with yellow haloes, nausea
and vomiting. ECG reveals arrhythmia. Which of the following medication is most likely responsible
for his symptoms?
A. Amlodipine
B. Digoxin
C. Aminophyline
D. Propanolol
E. Diltiazem

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19. A 40 year old man has undergone detoxification programme. He wants some medications to help
him reduce cravings. What is the single most appropriate answer?
A. Disulfuram
B. Chlordiazepoxide
C. Diazepam
D. Thiamine
E. Acamprosate

20. A 70 year old man has been posted for anterior resection following a diagnosis of carcinoma of
the sigmoid. What is the most appropriate prophylactic antibiotics pre-operatively?
A. Penicillin
B. Broad spectrum antibiotics
C. Antipseudomonas
D. Amoxicillin
E. Chloramphenicol

21. A 29 year old mother of a 2 year old son comes to the GP clinic requesting reliable method of
reversible contraception. She had a normal vaginal delivery devoid of complications. she breastfed the
baby for 7 months following which she was prescribed contraceptive pills which she never took
regularly as she kept forgetting them. She suffers from painful periods and wants something for it as
well. A recent ultrasound shows normal uterus. What contraceptive will best suit her?
A. COCP
B. IUS
C. IUCD
D. POP

22. An 18 year old young female is losing weight despite eating 3 times a day. The skin on her bottom
is flaccid. What is the definite diagnosis?
A. Duodenal biopsy D. Anti glutaminase
B. Endomyseal antibodies
C. Anti reticulin

23. A 32 year old woman presents with attacks of numbness in the right hand and fingers followed by
left side headache. What is the most probable diagnosis?
A. Cerebral tumour
B. Epilepsy
C. Migraine
D. Temporal arteritis
E. Cervical spondylosis

24. A 8 year old boy has had profuse diarrhoea and vomiting due to infective gastroenteritis for 2
days. Investigation results show the following:
Sodium 148mmol/l Potassium 2.2mmol/l Urea 20mmol/l Glucose 4.3mmol/l What is the most
appropriate management?
A. IV normal saline and insulin
B. IV normal saline and potassium supplement
C. Plasma expanders
D. Dialysis
E. Oral potassium chloride

25. A 19 year old lady with bilateral iliac Fossa pain, dyspareunia and foul smelling vagina discharge.
Patient looked very unwell. What will be the antibiotics group of choice for management.

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A. Ceftriaxone, metronidazole
B. Ciprofloxacin, amoxicillin, metronidazole
C. Ceftriaxone, doxycycline, metronidazole.
D. Ciprofloxacin, doxycycline, metronidazole
E. Ciprofloxacin, amoxicillin, metronidazole

26. A woman who has experienced 2 early pregnancy losses was concerned if it is preventable. Two
tests for APS both 6 weeks apart was positive. What would be the best management of this lady?
A. Aspirin
B. Aspirin and Heparin
C. Aspirin and Warfarin
D. Heparin and Warfarin
E. Heparin

27. A 55 year old male presents with a gradually increasing right sided scrotal swelling over 3
months. On examination, the swelling transilluminates and it is possible to palpate above it. What is
the most appropriate diagnosis?
A. Testicular tumour E. Varicocele
B. Indirect inguinal hernia
C. Direct inguinal hernia
D. Hydrocele

28. A 40 year old gentleman with a fistula which discharging on the anal midline posterior to anus.
What is the single most appropriate treatment?
A. Lay open fistula
B. Oral antibiotics
C. Local anaesthetics
D. Observe
E. GTN cream

29. A random study on Pulmonary Embolism shows:

A. 100 patients out of 1000 died who did not get the treatment.
B. 5 patients out of 100 died who got proper treatment.

Choose the single most likely absolute risk for each of the above mentioned study.
A. Absolute risk 5%
B. Absolute risk 10%
C. Absolute risk 2%
D. Absolute risk 15%
E. Absolute risk 20%

30. A 18 year old man is rushed into A&E by his group of friends who left him immediately before
they can be interviewed by the medical staff. He is semiconscious, has a respiratory rate of 8/min, BP
of 120/70 mmHg and pulse 60 beats per minute. He is noted to have needle track marks on his arms
and his pupils are small. What is the single best initial treatment you would administer?
A. Insulin
B. Naloxone
C. Methadone
D. Gastric lavage

31. Parents of a 4 year old child are worried since the child recently started wetting the bed at night
again despite being dry for the past 6 months. What advice from the following list of options would
you give them?

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A. Reassure
B. Fluid restriction
C. Alarm Training
D. Desmopressin

32. A sick child presents with drooling of saliva and fever. What is the most probable diagnosis?
A. Acute asthma
B. Bronchiolitis
C. Croup
D. Epiglottitis
E. Tonsilitis
F. URTI
G. Pharyngitis

33. A 60 years old man brought to A&E department with fracture of hip; he is deaf and has bilateral
pedal oedema. What is the SINGLE most probable diagnosis?
A. Paget’s disease
B. Osteoporotic fracture vertebrae
C. Secondary
D. Multiple myeloma
E. Spondylosis

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

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

36. A patient underwent liver biopsy. What is the most important investigation before the biopsy?
A. Viral screen
B. Coagulation profile
C. Serum electrolytes
D. Liver function tests
E. Abdominal US

37. A 58 year old female comes complaining of brownish discharge since a week. This has never
happened ever since she attained menopause 4 years ago. An Ultrasound scan confirmed the
endometrial thickness of 8 mm. What will be the most appropriate investigation you would like to
perform?
A. Colposcopy
B. CT pelvis and abdomen
C. Hysterocopy
D. Endometrial sampling

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38. A woman present s with a history of poisoning 10 times with different substances. There are no
obvious signs of depression or suicidal behavior.
What is the best preventive step?
A. Open access to A&E
B. 24 hours help line
C. CBT
D. Antidepressants
E. Insight into the problem

39. A Caucasian patient with nephropathy now presents with hypertension. What is the best drug for
him?

A. Propranolol E. Bendroflumathiazide
B. Ramipril
C. Nifedipine
D. Losartan

40. A woman 5 days post-operative for bilateral salpingo-oopherectomy and abdominal hysterectomy
has developed abdominal pain and vomiting with associated abdominal distension and cannot pass
gas. No bowel sounds heard, she is also hydrated. What is the most appropriate next step?
A. Plain X-ray abdomen
B. Exploratory Laparoscopy
C. CT scan
D. USG
E. Barium Enema

41. A 25 year old woman comes with complaints of lower abdominal pain accompanied by an
offensive vaginal discharge. She is pyrexial and moderately sick. On further questioning she recalls
that her boyfriend had been complaining of dysuria. What test will you perform that will confirm your
diagnosis?
A. Urine pregnancy test
B. Urine culture and sensitivity
C. High vaginal swab
D. Laparoscopy with visualisation of fallopian tubes.

42. An 82 year old man has woken up with incoherent speech and difficulty in finding the right
words. Examination is otherwise normal and his comprehension is good. Which anatomical site is
most likely to be affected?
A. Broca’s Area
B. Wernicke’s Area
C. Midbrain
D. Parietal Cortex
E. Pons

43. A seven year old girl is brought by her mother with bright red staining of her underpants; she also
gives a history that her daughter recently started taking horse riding lessons. What is the single most
appropriate next action?
A. Local Examination
B. Examination under Anaesthesia
C. Continue Regular Child Care
D. Inform Child protection Services
E. Coagulation profile

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44. A 68 year old man presents with muscle weakness. He is not able to climb the stairs. He also
complains of mild breathlessness. He says that he sometimes feels difficulty in swallowing food. The
lab report shows the following:
Alkaline phosphatise (ALP) 216 U/L Aspartate aminotransferase (AST) 49 U/L Alanine
transaminase (ALT) 43 U/L
Creatine Kinase (CK) 417
Erythrocyte Sedimentation Rate (ESR) 16mm/h. What is the most likely diagnosis?
A. Polymyositis
B. Polymyalgia rheumatica
C. Muscular dystrophy
D. Esophageal carcinoma
E. Myasthenia Gravis

45. A 60 year old man post cholecystectomy presented with jaundice, fever and dark urine. What is
the single most diagnostic investigation?
A. ERCP
B. MRCP
C. CT Scan
D. USG

46. Withdrawal from which of the following drugs can result in chills, pupil dilatation?
A. Cocaine
B. Heroine
C. Salicylates
D. Theophylline
E. Methanol

47. A middle aged man presents with bilateral pitting pedal edema and ascites, raised JVP. The ascitic
fluid is found to be transudate. Choose the most likely cause of ascites.
A. Liver cirrhosis
B. Bacterial peritonitis
C. Congestive cardiac failure
D. TB peritonitis

48. A 19 year old man with exercise induced asthma is on Salbutamol inhaler as-required and
Beclamethasone 400µg twice a day. He complains that he has to wake up at night for his inhaler.
What is the most appropriate medication for this patient?
A. Salmeterol 50mcg twice a day
B. Beclomethasone 1000 µg twice
C. Prednisolone 30mg per day
D. Sodium Cromoglycate
E. Monteleukast

49. 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

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50. 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

51. 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

52. All of the following drugs do cause broncho-dilatation except:

A. Atenolol
B. Salbutamol
C. Salmeterol
D. Ipratropium bromide
E. Cocaine

53. A Young female with epilepsy. She is on Sodium valproate. Seizures are not controlled on
valproate. What is the next investigation you will do?
A. Check drug levels
B. CT brain
C. MR Brain
D. EEG

54. A 1 year old boy has been bought to the accident and emergency department with diarrhoea and
vomiting for 5 days. For the past 24 hours he has been unable to tolerate and fluids. In the last hour he
has become drowsy, his skin turgor is reduced and his skin is mottled. His eyes are sunken. His heart
rate is 180 beats/minute and his capillary refill is prolonged. What is the single most appropriate
immediate treatment?
A. IV fluid bolus over 20 minutes
B. IV fluids over 24 hours
C. IV rehydration over 48 hours
D. Nasogastric rehydration over 24 hours
E. Oral rehydration solution over 48 hours

55. A young woman was stabbed in the neck. On tongue protrusion, there was deviation to the right
side. Which nerve is involved?
A. Hypoglossal nerve injury
B. Accessory nerve
C. Vagus nerve
D. Glossopharyngeal nerve

56. 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?

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A. Calcaneus
B. Metatarsals
C. Phalanges
D. Tibia
E. Femur

57. 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

58. 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

59. 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

60. 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

61. A 35 year old woman had an uneventful laparoscopic cholecystectomy 18 hours ago. She has a
pulse rate of 108 beats/minute and a temperature of 37.8° C. There are signs of reduced air entry at
the right base but the chest X ray does not show any obvious abnormality. What is the most
appropriate management strategy?
A. Cefuroxime oral
B. Ceftriaxone I.V
C. Chlorpheniramine oral
D. Chest Physiotherapy
E. Reassure

62. A patient operated for gastric carcinoma is on oral morphine for pain relief. He has adequate pain
relief but is experiencing side effects due to high dose of morphine required. What is the most
appropriate next step in his pain management?
A. Patient controlled analgesia
B. Oral oxycodone
C. IV morphine
D. Fentanyl patches

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63. A hypertensive patient who is on Bendroflumethiazide 2.5mg per day, has come for his routine
check-up. On examination his blood pressure is 145/85mmHg and lab report shows K=5.9 and
Na=137. What is the most appropriate management for this patient?
A. Stop medication
B. Continue the same dose
C. Increase the dose
D. Decrease the dose
E. Repeat the blood test

64. A 25 year old man has rarely left his house for the past 12 months. He believes that his neighbors
are spying on him. His sleep and appetite are poor and he has lost weight. Mental state examination
reveals that he hears derogatory voices even when he is alone. Neurological examination is normal.
A. Paranoia
B. Agoraphobia
C. Dementia
D. Hyperthyroidism
E. Schizophrenia

65. A 13-year-old girl complains of a 2-day history of hoarseness of voice associated with dry cough.
She feels feverish. On direct laryngoscopy her vocal cords are grossly oedematous. What is the single
most appropriate investigation?
A. No investigation required. D. Bronchoscopy
B. Sputum for acid fast bacilli. E. Cervical spine X-ray.
C. Laryngoscopy.

66. A 64 year old man presents with ipsilateral vertigo, tinnitus and left side hearing loss. On
examination Rinne's test is positive and Weber’s test is lateralised to the right ear. What is the most
appropriate investigation?
A. CT scan
B. Magnetic resonance imaging (MRI) of brain
C. X-ray
D. Audiometry
E. No investigation required

67. A 70 years old male presents with balance difficulties, vomiting and nausea. Which of the
following is the best investigation?
A. MRI of Cerebellum
B. CT Scan of cerebellum
C. Skull X-RAY
D. Lumbar puncture
E. Blood Culture

68. A 4 year old boy presents with a febrile convulsion lasting 8 minutes and has been given
intravenous lorazepam to control the convulsion.
What is the single most likely serious side effect?
A. Amnesia
B. Anaphylactic shock
C. Bronchospasm
D. Cardiac arrhythmia
E. Apnoea

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69. A patient presents 4 days after having myocardial infarction, complains of pain on inspiration and
unable to breathe with ease. What is the most likely diagnosis?
A. Pericarditis
B. Angina
C. Pancreatitis
D. Cholecystitis
E. Dressler’s syndrome

70. A patient in the post op ward develops persistent vomiting with a distended abdomen and no
bowel sounds. What is the primary electrolyte imbalance in this patient?
A. Hyponatremia
B. Hyperkalaemia
C. Hypernatremia
D. Hypokalaemia

71. A 65 year old man presents with a 3rd degree haemorrhoid, what will be the single most
appropriate action?
A. Rubber band ligation
B. Sclerotherapy
C. Do nothing
D. Haemorroidectomy
E. Cryotherapy

72. An HIV drug abuser and alcoholic was found to have markedly raised creatinine levels,
proteinuria of 3.7g/day and hyperlipidemia. What is the most definitive investigation?
A. HIV serology
B. STI screening
C. Renal function tests
D. Renal biopsy
E. U/S

73. A 28 years old man presents with a temperature of 38.7˚C and neck stiffness. There is no rash. His
GP calls, asking what should be done. How would you advise the GP?
A. Give the patient IV Benzyl penicillin
B. Give the patient IV Doxycycline
C. Give the patient IV Ceftriaxone
D. Send for a blood culture

74. A girl presents with signs of hyperventilation. What is the most likely arterial blood gas (ABG)
derangement?
A. pH increased pCo2 increased
B. pH decreased pCo2 increased
C. pH increased pCo2 decreased
D. pH decreased pCo2 decreased

75. A 45 year old heroin addict was involved in a car crash and is now paraplegic. During the first
week of his hospital stay he cried every day because he could not remember the accident.
What is the most likely diagnosis?
A. PTSD
B. Severe depression
C. Organic brain injury

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76. A 60 year old man presents with progressive claudication without diabetes or
hypercholesterolemia who is taking low dose Aspirin. What is the best next step of management?
A. Statin
B. ACE inhibitor
C. Angiography
D. Cilostazol

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

78. 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

79. A 32 year old woman has had three episodes of slurred speech and two episodes of transient
weakness of both legs in the past five years. Each episode has resolved within three months. What is
the SINGLE most likely diagnosis?
A. Meningioma
B. Migraine
C. Multiple sclerosis
D. Stroke
E. Transient ischaemic attack

80. A child was admitted following a road traffic accident with initial GCS of 15. Then during night
the nurse noticed GCS to be reduced to 13. What is the management for this patient?
A. Refer to neuro surgeon
B. IV fluids
C. Oxygen
D. CT scan of the brain
E. X-ray skull

81. A 40 year old male presented with chest pain and breathlessness following exercise, which was
relieved after taking rest. What is the best investigation to determine his condition?
A. Exercise ECG
B. 24 hour ECG
C. Cardiac enzymes
D. Echocardiography
E. Chest X-ray

82. A 46 year old man who is a heavy drinker is brought to the A&E in a drowsy state. He is
responding vaguely to questions asked. On examination he has nystagmus and hyper-reflexia. His
MCV is [Link] is the most likely cause for his cognitive impairment?
A. B1 Deficiency E. Alcohol withdrawal
B. B12 Deficiency
C. Folate Deficiency
D. B6 deficiency

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83. A 71 year old man has liver metastases from an unknown primary. He has cerebrovascular
dementia with some right sided weakness and inability to talk. He is alert and responsive. He has
stopped taking food in the last 24 hours having previously had a good appetite although he still takes
his medication. There are white patches over the mucous membranes of the mouth and pharynx.
A. Amphotericin intravenously
B. Chlorhexidene mouthwash
C. Flucloxacillin suspension
D. Metronidazole orally

84. A 56 year old man with atrial fibrillation is prescribed digoxin. What side effect will you make the
patient aware of?
A. Seeing visual haloes
B. Nausea
C. Vomiting
D. Diarrhoea

85. A 38 years old female returns from a holiday in Greece. Now has dry cough, bilateral consolidated
areas in the chest X-ray. What is the best antibiotic you would prescribe?
A. Clarithromycin
B. Ciprofloxacin
C. Amoxycillin
D. Cephalexin
E. Gentamycin

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

87. 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

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

89. 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

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90. A 24 year old unconscious man was brought by his friends from a party where he was said to have
drank vodka. While he was being attended to by the doctor in the emergency department, he became
conscious and said the green tie the attending doctor was wearing was talking to him. What substance
could this patient have taken?
A. Cocaine
B. Alcohol
C. Heroin
D. Cannabis
E. LSD

91. A 54 year old lady presents with sudden, severe pain in the left half of her skull. She also
complains of pain around her jaw. What is the most likely next step?
A. CT scan
B. MRI
C. Fundoscopy
D. ESR
E. Temporal artery biopsy

92. A 45 year old alcoholic man presents with tremors, agitation and confusion. He has been given
chlordiazepoxide. He is already on oral thiamine.
What is the most appropriate next step in his management?
A. Intravenous fluids
B. Diazepam
C. IV High potency vitamins
D. Oral thiamine
E. High potency vitamins and thiamine

93. A 48 year old woman comes with complaints of constant weakness and tiredness. Blood
examination showed haemoglobin levels of 9.2 g/dl, MCV - 74 and MCH- 20. Physical examination
was unremarkable. On further questioning she admitted her childhood was plagued by bouts of
lethargy but she otherwise remained well. Peripheral blood smear showed microcytic hypochromic
cells. Her iron studies were found to be normal. What is the most likely diagnosis?
A. Beta thalassemia major
B. Beta thalassemia minor
C. Iron deficiency anaemia
D. Hereditary spherocytosis

94. A 21 year old male patient presents with vague abdominal pain and loose stool. He has had a
history one week earlier of having lower abdominal pain associated with a pyrexia which settled down
on its own. On examination, he is now pale and experienced some mild weight loss and an ill-defined
mass is present in right iliac fossa. What is the most likely diagnosis?
A. Appendicular mass
B. Crohn’s disease
C. Ulcerative colitis
D. Colon cancer
E. Faecal impaction

95. A 73-year-old male presents with a 12 month history of falls. His relatives have also noticed rather
strange behaviour of late and more recently he has had episodes of enuresis. Examination reveals
disorientation in time and place and a broad based and rather clumsy gait. What is the most probable
diagnosis?
A. Dementia E. Normal Pressure Hydrocephalus
B. Pituitary Adenoma
C. Cardiovascular disease
D. Syringomyelia

15
96. A 56 year old woman with breast cancer and widespread lung metastases has non-productive
cough. She has been given codeine and the cough is not relieved. What is the next step in
management?
A. Oral antibiotics
B. Salbutamol/ Nebulizers
C. Oxygen
D. Nebulization with 0.9% NaCl
E. Anaesthetic nebulizer

97. A 75 year old woman had an emergency total hip replacement following a fractured neck of
femur. 8 days post operatively, she has a sudden onset of left-sided chest pain and an episode of
hemoptysis associated with breathlessness. What single investigation is most likely to provide the
definitive diagnosis?
A. Arterial blood gases
B. Chest X-ray
C. CT pulmonary angiogram (CTPA)
D. D-dimer
E. Electrocardiogram (ECG)

98. A 50 year old presented to the hospital with complain of chest tightness wheeze and chronic
cough. He has been smoking 20 cigarettes per day since last 35 years. A diagnosis of COPD was
made. What will be the picture of ABG for this patient?
A. Respiratory Acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
E. Normal pH

99. 43 year old woman has had low mood for past 4 weeks. She says that when the traffic lights turn
green, her mother is calling her. She feels guilty and ashamed that she is still alive. What is the most
likely diagnosis?
A. Mild depression
B. Moderate depression
C. Severe depression
D. Mania
E. Psychotic depression

100. A 65 year old man complains of sudden onset chest pain in the middle of his chest radiation to
his back. On examination he has an expansile mass in his abdomen. What is the next most appropriate
step?
A. USG D. Serum Lipase
B. PET Scan E. Doppler USG
C. Serum Amylase
101. 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

102. 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.

16
A. Inflammatory bowel disease (IBD)
B. Irritable bowel syndrome (IBS)
C. Pyelonephritis
D. Uretric calculus
E. Gastroenteritis

103. Half of a group of observations lies above this level and it is particularly important if the
distributions non normal. Choose the single term from the list of options given
A. Chi squared (X²) test E. Mode
B. Linear regression
C. Mean
D. Median

104. Which statement best describes the planes of the abdomen?

A. The transpyloric plane lies halfway between the xiphoid and the symphysis pubis.
B. The transpyloric plane passes through the hilar of the kidneys.
C. The subcostal plane is at the level of the body of L2.
D. The iliac crests lie at the level of L5.
E. The umbilicus usually lies at the level of the L4/L5 disc.

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

106. A 45 year old woman who is taking Lithium for Bipolar affective disorder for past 14 years
presents with coarse tremor. What investigation should be done?
A. Thyroid function test E. Reassure
B. Creatinine clearance
C. Urea and electrolytes
D. Serum lithium levels

107. An elderly male who is immunocompromised has whitish plaques in the pharynx. He has
dementia, has stopped taking food due to the whitish plaques on the tongue. How will you treat this
elderly male?
A. Fluconazole suspension E. IV Fluconazole
B. Nystatin suspension
C. Oral Miconazole
D. Oral Fluconazole

108. 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

109. 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?

17
A. Amyotrophy
B. Peripheral neuropathy
C. Polyneuropathy
D. Autonomic neuropathy

110. 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

111. In the development of a 15 month old child which of the following would concern you the most?
A. Child walks independently, but does not run
B. Child builds a block of 2 cubes
C. Child scribbles with a pencil
D. Child has no pincer grasp
E. Child cannot draw a triangle

112. A woman presented with intermittent pain in her left breast radiating to her left arm and it is not
related to her period. What is the diagnosis?
A. Cyclical mastalgia
B. Fibroadenoma
C. Non cyclical mastalgia
D. Duct Ectasia
E. Mondor’s disease

113. At birth a baby boy at 38 weeks gestation weighs 1.8 kg. He has hepato- splenomegaly and a
rash. Blood tests show raised level of bilirubin and liver enzymes. What is the most likely diagnosis?
A. Galactosemia
B. Biliary Atresia
C. Glucose-6-phosphate dehydrogenase deficiency (G6PD)
D. Rhesus Incompatibility
E. Congenital Viral Infection

114. An unconscious child is brought into Accident & Emergency. He is not breathing. What is your
initial management?
A. Capillary blood glucose
B. Secure airway
C. CT scan
D. IV 0.9% normal saline
E. 0.45% dextrose

115. A 32 year old man presented with painless haematuria. He is hypertensive but the rest of the
examination was fine. What is the most likely diagnosis?
A. Polycystic kidneys
B. Ca bladder
C. Ca prostate
D. Thrombotic thrombocytopenia purpura (TTP)
E. Hemolytic uremic syndrome (HUS)

18
116. A 64year old man has recently suffered from an myocardial infarction and is on Aspirin,
Atorvastatin and Ramipril. He has been having trouble sleeping and has been losing weight for the
past 4 months. He doesn’t feel like doing anything he used to enjoy and has stopped socializing. He
says he gets tired easily and can’t concentrate on anything. What is the most appropriate treatment?
A. Lofepramine
B. Dosulepin
C. Citalopram
D. Fluoxetine
E. Phenelzine

117. A 75 year old man is on digoxin and develops weakness in the right upper and lower limbs
which resolves within a few hours. What is the most definitive investigation for this condition?
A. CarotidDoppler
B. Angiography
C. CT head
D. Digoxin level
E. MRI

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

119. A patient was brought by his wife saying that he has progressive worsening of cognitive
functions.
A. Alzeimers
B. Vascular dementia
C. Lewy body dementia
D. Huntington
E. Fronto temporal dementia

120. An 18 year old girl has started college 4 months ago. For the past 3 months she is eating very
little and has poor sleep. She wakes up early in the mornings and says she feels very sad all the time.
She stopped going to piano lessons which she used to enjoy earlier. What is the most likely diagnosis?
A. Dysthymia
B. Cyclothymia
C. Depression

121. A 37 year old lady stopped taking COCP 18 months ago and she had amenorrhea for 12 months
duration. What is the most appropriate cause? FSH : 8, LH: 7 and Prolactin is 400 and Estradiol : 500.
A. Hypothalamic amenorrhea
B. Polycystic ovary syndrome (PCOS)
C. Prolactinoma
D. Post pill amenorrhea
E. Premature ovarian failure

122. A housebound 78 year old man with severe chronic obstructive pulmonary disease has had a
gradual deterioration over recent months and is now breathless at rest. He is on maximal inhaled
therapy. Results show the following:
Ph: 7.36
PaCO2: 5.9kPa PaO2: 6.9kPa

What is the single most appropriate additional treatment?

19
A. Aminophylline (oral)
B. Angiotensin converting enzyme (ACE) inhibitor (oral)
C. Antibiotic (oral)
D. Oxygen
E. Steroid (oral)

123. A 53 year old woman was found to have an enlarged spleen which is palpable up to the
umbilicus. Blood tests show HB 8.7g/dl, WBC 100 and Platelets 72. What is the single most likely
diagnosis?
A. Chronic myeloid leukemia
B. Chronic lymphoid leukemia
C. Acute myeloid leukemia
D. Lymphoma
E. Splenic carcinoma

124. A man with prosthetic heart valve underwent hemicolectomy and after some days complains of
left hypochondriac pain, fever and has a systolic murmur. What is the next investigation to ascertain
the cause of heart failure?
A. CT scan
B. Blood culture
C. ECG
D. Magnetic resonance imaging (MRI)
E. Radioactive thyroid scan

125. A 25 year old had an LSCS 24 hours ago for foetal distress. She now complains of intermittent
vaginal bleeding. Observations include saturations 98% in air, blood pressure 124/82 mmHg, pulse 84
beats/min and temperature 37.8oC. The midwife tells you that she had a retained placenta, which
required manual removal in the operating theatre. Choose the most appropriate post C-Section
complication in this case?
A. Retained products of conception
B. Aspiration pneumonitis
C. Endometritis
D. Uterine rupture
E. Disseminated intravascular coagulation

126. A 36 year old man had hematemesis and was found at endoscopy to have a duodenal ulcer. He
was treated with [Link] eradication therapy. Some months later, he returns with epigastric pain.
What single investigation is most likely to review eradication of [Link]?
A. Barium meal
B. C13 urea breath test
C. [Link] serology
D. Repeat endoscopy

127. A 22 year old lady comes complaining of painful sexual intercourse and abdominal pain 4 days
after moving in with her boyfriend a week ago. Since the last 2 days she also noticed increased
frequency of micturition. A vaginal examination showed foul- smelling cervical discharge which was
collected and sent for culture and sensitivity. She denies any itching and does not appear to be very ill.
What would be the appropriate initial treatment in this case?
A. Ceftriaxone with metronidazole
B. Meropenem and Paracetamol
C. Ofloxacin with metronidazole
D. Vaginal oestrogen cream

20
128. A man brought his wife who left consuming alcohol for a few days. She now presents with
agitation and hallucinations. His husband informs that she hadn't taken alcohol for last three days.
What is appropriate management?
A. Benzodiazepines E. Acomprosate
B. Thiamine
C. Vit B complex
D. Disulfiram

129. 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

130. 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)
.

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

132. A 64 years old diabetic has come for a routine eye check-up. Fundoscopy shows new vessels all
over the retina. What is the most appropriate management?
A. Strict Sugar Control E. Insulin
B. Regular eye check ups
C. Non urgent referral to a specialist
D. Laser photocoagulation

133. A 23 year old woman presents with offensive vaginal discharge. Vaginal Ph is 4.5. What is the
most likely causative organism?
A. Gardenella
B. Trichomonas
C. Candida
D. Mycoplasma

134. After eating a cookie at a garden party, a child began to cough and went blue. The mother also
noticed that there were swollen patches on the skin. What is the diagnosis?
A. Allergic reaction E. Achalasia cardia
B. Aspiration of food
C. Cyanotic heart disease
D. Tracheo-esophageal fistula

21
135. A 74 years old lady who has had a stroke in the past, had an indwelling catheter for 10 months.
She presents with bluish-purple discoloration of the catheter bag. What is the most likely explanation
for this change?
A. Normal Change
B. Catheter Degradation
C. Acidic Urine
D. Alkaline Urine
E. Bacterial Colonisation of the Urinary Tract

136. 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
B. Duct ectasia
C. Duct papilloma
D. Ductal Ca. in situ

137. A lady underwent debulking surgery for ovarian carcinoma. Soon after the surgery she presents
with signs of intestinal obstruction. What is the Single most appropriate investigation?
A. Pelvic CT
B. CA 125
C. Laparotomy
D. Laparoscopy
E. Abdominal USG

138. A 40 year old man complains of thirst and lethargy. His BP is 140/90mmHg and his calcium
which was corrected is 3.7mmol/l. What is the most appropriate management at this stage?
A. IV fluids
B. Prednisolone
C. IV hydrocortisone
D. Calcium preparation
E. Bisphosphonates

139. 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

140. 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

141. A woman with breast carcinoma developed supra ventricular tachycardia following MI. Now she
suffers from right side arm pain, which comes like electric pain. Pain was controlled by fentanyl
patches but she suffers from prolong sedation. What is the drug you can add to control her arm pain?
A. Amytriptaline E. Carbamezepine
B. Morphine
C. Gabapentine
D. Codeine

22
142. 3A 55 year old man has taken an overdose of his antidepressant medication. He presents with dry
mouth, blurred vision, urinary retention and constipation. What is the most appropriate investigation
to be done?
A. Thyroid function tests
B. EEG
C. Creatinine clearance
D. ECG
E. CT

143. A lady 76 years old had loss of consciousness but was fine after 10 minutes. She was taking
Aspirin, Bendroflumethiazide and Simvastatin. All examinations were normal. CT scan was done.
What is the most appropriate management?
A. Add aspirin 300
B. Clopidogrel
C. Dipyramidamole
D. Clopidogrel +Dipyramidamole

144. A 60 year old man was diagnosed with atrial fibrillation and is prescribed [Link] INR
should be?
A. 2-3
B. 1.5 -2.5
C. 2.5- 3.5
D. 1-2

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

146. 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

147. 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

148. A man had myocardial infarction 4 months ago. He now complains of low mood, lack of appetite
and problems falling sleep. What is the best medication for him?
A. Amitryptalline D. Sertaline
B. Fluoxetine E. Moclobemide
C. Venlafaxine

23
149. A patient with dysmenorrhea and dysfunctional uterine bleeding presents to you for
contraceptive advice. Uterus is normal. There is no past medical history. What is the best management
for her?
A. Give COCP
B. Mirena Coil
C. IUCD
D. POP (Progestogen only pill)
E. Depo provera

150. A 5 year old child was found to have vesico-ureteric reflux. What is true about this condition?
A. Requires prophylactic antibiotics
B. Most will require surgery
C. In most kidney will be scarred by five years
D. No further action is required
E. It is usually asymptomatic

151. A 20 year old man has a head on collision in a car. On presentation he is breathless and has chest
pain as he has fractured his 5 to 7 ribs. Chest x-ray shows fracture of 5th to 7th ribs. What is the most
appropriate initial action in this patient?
A. Antibiotics
B. Analgesia
C. Oxygen by mask
D. Physiotherapy
E. Refer to surgeon

152. A 45 year old man, presented with a erythematous nodular rash on both his shins. He also
complained of dry cough for the last 3 weeks. What could be the most probable finding on his CXR?
A. Pleural effusion
B. Lung opacity in apical zone
C. A cavitating lesion
D. Bilateral hilar lymphadenopathy

153. A 32 years old married woman complains of feeling low and has had two episodes of drug
overdose. She has a family history of depressive disorders. She has reduced social contacts now.
Which risk factor greatly increases risk of suicide?
A. Lack of Social Support D. Married status
B. Past history of overdose E. Female sex
C. Family history of depression

154. 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

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

24
A. Good pasture's syndrome
B. Nephrotic syndrome
C. Urinary tract infection
D. SLE
E. Urinary tract trauma

156. 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

157. A 39 year old woman will undergo tubal sterilization and she wants to know the failure rate of
this type of sterilization.
A. 1:50
B. 1:200
C. 1:500
D. 1:1000
E. 1:5000

158. A 45 year old woman with a history of rheumatoid arthritis presents to the A&E department with
a 2 day history of hot, painful and swollen right elbow joint. What is the most appropriate
management?
A. Joint aspiration
B. Start infliximab
C. Oral high dose
D. Short course of methotrexate
E. Dexamethasone injection

159. A 70 year old man admits to asbestos exposure 20 years ago and has attempted to quit smoking.
He has noted weight loss and hoarseness of voice. Choose the single most likely type of cancer
associated with the risk factors presented.
A. Basal cell Carcinoma
B. Bronchial Carcinoma
C. Oesophageal Carcinoma
D. Nasopharyngeal Carcinoma
E. Oral carcinoma

160. A 32 years old lady delivered 3 days back. Today she developed sudden left leg pain and
swelling up to inguinal crease. She is advised to take antibiotic but she has a history of taking COCP
before she become pregnant. What is most definitive diagnosis for this lady?
A. Post-partum phlebitis Syndrome
B. Aorto iliac thrombosis
C. Rheumatoid arthritis
D. Septic arthritis

161. A 79 year old anorexic male complains of thirst and fatigue. He has symptoms of frequency,
urgency and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 1.9 and
he is anaemic. His blood pressure is 165/95mmHg. What is the most probable diagnosis?
A. Benign prostatic hypertrophy
B. Prostate carcinoma
C. Chronic pyelonephritis
D. Benign nephro sclerosis

25
162. The patient developed falls, pill rolling tremor and masked like face after start of a new
treatment. What could be the treated disease?
A. Depression
B. Schizophrenia
C. Obesity
D. Gord
E. Prostate gland enlargement

163. A 30 year old gentle man is brought to hospital and is found to have increased blood pressure
and low serum potassium levels on examination. Which hormone should be tested?
A. Aldosterone
B. Cortisol
C. Adrenaline
D. Glucagon
E. Growth hormone

164. 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

165. 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

166. 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

167. 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

168. A 56 year old lady presented with sudden weakness in the left upper and lower limbs. On
examination the plantars are up going and there is hypertonia. She is hypertensive on anti HTN
medications. What is the most appropriate cause of her symptoms?

26
A. Space occupying lesion
B. Multiple Sclerosis
C. Stroke
D. Giant Cell Arteritis

169. A 24 years old man was brought by his mother to the hospital with concerns about his unkempt
clothes and hygiene. He no longer enjoys going to any parties or events and also held a rigid pose for
3 hours last week. He pauses a lot while speaking lately and mentions hearing his own thoughts aloud.
He laughed very loud when informed about a friend's untimely death.
What is the underlying condition?
A. Psychomotor retardation E. Erotomania
B. Cotard's syndrome
C. Parkinson's disease
D. Schizophrenia

170. A 14years old girl comes to your clinic requesting for contraceptives, she has a 15year old
boyfriend What will you do.
A. Give her COCP and advise you get her parents involved.
B. Don't give her COCP.
C. Report to social services.
D. Dont give her COCP, Inform her parents
E. Dont give her COCP, advise she end relationship

171. Which of the following histological finding is associated with Barret's esophagus.
A. Columnar displasia
B. Squamous displasia
C. Squamous metaplasia
D. Columnar metaplasia

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

173. A 73 year old woman has lymphadenopathy and splenomegaly. She feels well but has had
recurrent chest infections recently. Choose the SlNGLE most likely blood film finding?
A. Atypical lymphocytes E. Numerous blast cells
B. Excess of mature lymphocytes
C. Plasma cells
D. Multiple immature granulocytes without blast cells

174. 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

27
175. A 16 year old teenager was brought into A & E after being stabbed on the upper right side of his
back. Erect Chest X ray revealed homogenous opacity on the lower right lung, trachea was centrally
placed. What is the most probable explanation for the X-ray findings?
A. Pneumothorax
B. Haemothorax
C. Pneumonia
D. Tension pneumothorax
E. Empyema

176. A 31 year male HIV patient presents with Oral candidiasis and white patches in pharynx and
complains of mild pain in the mouth and on swallowing. What is the most appropriate management?
A. Oral fluconazole
B. IV amphotericin
C. Amoxycillin
D. Nystatin suspension
E. Oral morphine

177. A young girl presented in Gynae assessment Unit with lower abdominal pain and per vaginal
bleeding after a history of hystero-salpingo-graph as a part of her infertility treatment. On observation
her BP was 90/50mmHg and pulse was 120bpm and examination revealed rigid abdomen. What is the
most appropriate next investigation?
A. CT abdomen
B. X-ray abdomen in erect and supine
C. Ultrasound abdomen
D. Coagulation profile
E. X-ray chest

178. A 32-year-old woman presents to the Emergency Department with headache and vomiting. She
was decorating her ceiling that morning when the headache began, felt mainly at the occiput with
neck pain. Some two hours later she felt nauseated, vomited and was unable to walk; she also noticed
that her voice had altered. She takes no regular medication and has no significant past history. On
examination, her acuity, fields and fundi are normal. She has upbeat nystagmus in all directions of
gaze, with normal facial muscles and tongue movements. Her uvula is deviated to the right and her
speech is slurred. Limb examination reveals left arm past- pointing and dysdiadochokinesis with
reduced pinprick sensation in her right arm and leg. Although power is normal, she cannot walk, as
she feels too unsteady. Where is the most likely site of her lesion?
A. Right medial medulla
B. Left medial pons
C. Left cerebellar hemisphere
D. Right lateral medulla
E. Left lateral medulla

179. A 70 year old man has sudden severe painful medial side of left calf on walking uphill. He has
no ankle swelling and he can extend his foot easily. What is the single most likely diagnosis?
A. Popliteal cyst
B. DVT
C. Tendon Achilles rupture
D. Fracture
E. Acute limb ischemia

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180. A 7 year old child is suspected to have a foramen oval. What is the most appropriate
investigation?
A. Bubble Echocardiography
B. Transoesphageal Echocardiography
C. Transthoracic Echocardiography
D. ECG
E. CT chest

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