Normal Lab Values

Note- The units provided are the same units of the lab results on the question

Haemoglobin – Male 13-18g/dl,,,, Female 11.5-16g/dl

MCV- 76-96fL

MCHC- 300-360

Platelets- 150 x 10^9

White cell count- 4-11 x 10^9

Sodium- 135-145

Pottasium- 3.5-5.0

Urea- 2.0- 7.0

Creatinine- 70-150

Bicarbonate- 22-26

Chloride- 95-105

eGFR-  >90

PT- 10-14 secs

APTT- 35-45 secs

Bleeding time- 3-9 minutes

Free T3- 3.5-6.5

Free T4- 9-18

TSH- 0-5-5.7

LH- 3-16

FSH-2-8

Estradiol- <130 postmenopausal

Testosterone- 10-25

Hba1c-4-6%

pH-7.35-7.45

pC02- 4.7-6.0 kPa

p02- 10-14kPa

Base excess- +2  to _ 2

Urine free cortisol- < 280

Bilirubin- 3-17

ALT- 5-35

AST- 5-35

ALP- 30-150

Albumin- 35-50

Total protein- 60-80

D-dimer- <500

Calcium- 2.1-2.6

Phosphate- 0.8-1.4

Amylase 0-140

CK- Male 25-195

       Female-5-170

Prolactin- Male <350

                     Female <440

1.       A 33 year old lady presented with low mood, poor sleep and lack of interest in her daily activities over the last 3 months. She admits that prior to the onset of these current symptoms she was very hyper active, spent lavishly on items she did not need and dashed out money to strangers. Your consultant has asked you to work up this patient for commencement of Lithium therapy. Her renal function and liver function tests are normal. What is the most appropriate other test you need to do?

A.            Urine for glucose

B.            Thyroid function tests answer

C.            EEG

D.            ECG

2.       50 year old man, known hypertensive has presented to the emergency with sudden onset chest pain radiating to his left shoulder. An ECG is yet to be done but the nurse has come to ask for the best way to administer Morphine in this situation. What would your response be?

A.      Intravenous

B.      Rectal

C.      Nasal spray

D.      Oral

E.       Subcutaneous

3.       A 34 year old lady presented to you about 3 weeks ago on account heavy menstrual bleed.  You counselled her on available options of treatment and she opted for Mirena, which was inserted on the same day. She comes to complain today of vaginal spotting since one week after the insertion.  Her cervical smear was 2 years ago. What is the single most appropriate next step?

A)      Reassure

B)      Take a swap

C)      Take a Routine cervical smear

D)      Advice to convert to COCP

E)      Advice to convert to Copper IUCD

4.       A 40 year old lady on Copper IUCD contraception has presented to you with purulent vaginal discharge, lower abdominal pain and fever of 38 degrees. You decide to take a swab on speculum examination and then you notice the thread of her IUCD is missing. A Transvaginal ultrasound was done and still the IUCD was not found. What is your singe most appropriate next step?

A)      Abdominal X-ray

B)      Abdominal CT

C)      Urgent laparotomy

D)      Urgent laparoscopy

E)      Examination under anaesthesia

5.       A 35 year old woman was involved in a road traffic accident about 2 weeks ago. She presents today with a hard painless but irregular mass on the breast. There is no nipple discharge and no skin changes in the breast. The mass is freely mobile. She admits to an intentional weight loss of 5kg over the last 2 months.  What is the single most likely diagnosis?

A)      Fibrocystic disease

B)      Breast cancer

C)      Fibroadenoma

D)      Fat necrosis

E)      Paget disease

6.       An 18 year old girl comes with complaints of fresh painless bleeding while passing stools. She has a chronic history of constipation. No other symptoms. What is the most likely diagnosis?

A.            Bowel Ca

B.            IBDs

C.            Anal stricture

D.            Haemorrhoids

7.       23 year woman has been having pain at the base of her thumb since one week. The pain worsens when she lifts her 3 month old baby or on changing the baby’s diapers. On examination there is pain on forceful abduction against resistance. What is the likely cause?

A. Avascular necrosis of scaphoid

B. Trigger finger.

C. De Quervain’s tenosynovitis

D. Carpal tunnel syndrome

E. Mallet finger

8.       A 55 year old man returns for routine follow-up six weeks after a myocardial infarction. He gets breathless when walking uphill. His ECG shows ST elevation in chest leads V1, V2, V3 and V4. What is the single most likely explanation for the abnormal investigation?

A.            Heart Block

B.            Right Ventricular Strain

C.            Atrial Thrombus

D.            Left Ventricular Aneurysm

E.            Dressler Syndrome

9.       A 34year old man after an RTA was brought to the A&E. He has BP 90/50mmHg and chest wall with asymmetrical/paradoxical movement, RR 34bpm. What would be the initial action?

A.            IV fluid infusion

B.            Intubation and ventilation

C.            CT chest

D.            Transfer to ITU

10.   A patient on antihypertensive drugs presents to Accident and Emergency department complaining of sudden loss of vision. On examination of the fundus, tortuous blood vessels and stormy sunset appearance was seen. What is most likely diagnosis?

A.            Papiloedema

B.            CRAO

C.            Anterior ischaemic optic neruropathy

D.            CRVO

E.            Retinal detachment

11.   An 8 week pregnant lady is brought to the A and E due to severe vomiting. She was administered IV fluids and oral anti-emetics. She still cannot tolerate anything orally. What is the next best treatment for her?

A.            Parenteral feeding

B.            IV antiemetics

C.            Termination of pregnancy

D.            Proton Pump Inhibitor

E.            IV Steroid

12.   A child was playing his call toys and suddenly developed breathlessness and cyanosis. Home first aid measures have been tried with no success. He has been rushed to the ER and luckily you are the able FY2 on duty. What is the next appropriate investigation for this child?

A.            Nasal Endoscopy                                              D.            Pulse Oximetry

B.            Lateral neck X-Ray                                           E.            Spirometry

C.            CT scan

13.   Elderly man with urinary incontinence, doing well with urinary pad. Developed pereneal excoriation and was noticed to have a palpable mass arriving from the pelvis with mild suprapubic pain.. What is the most immediate management?

A. Urethral Catheterization

B. Suprapubic Catheterization

C. Oxybutynin

D. Desmopressin

E. Bladder washout

14.    A pregnant woman wants to know the possibility of her unborn male child being affected by Duchene muscular dystrophy. Her first son has been diagnosed with the disease.

A.  25%

B.  50%

C.  75%

D. 100%

E. Depends on the genetic make-up of her husband

15.    A family with a baby who has a cousin who died from cot death recently, mother asks for advice. What advice will you give the mother?

A.            Child should sleep on the back with legs towards the end of the cot

B.            Child should sleep on the front with the legs towards the end of the cot

C.            Child should sleep on the back with the head towards the end of the cot

D.            Child should sleep on the front with head towards the end of the cot

E.            Reassure

16.   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.            Hysteroscopy

D.            Endometrial sampling

17.   A woman present s with a history of poisoning 10 times with different substances over the last 6 months. There are no obvious signs of low mood, anhedonia, poor sleep or suicidal behaviour.  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

18.    A 25 year old woman comes with complaints of lower abdominal pain accompanied by an offensive vaginal discharge. She is pyrexial and moderately sick. But cervical motion test is positive. 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.

E.            Endocervical swab

19.   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

20.    A 34 year old lady presented with complains of vertigo for the last 4 days. It started suddenly and was like a feeling of room rotating. It was aggravated by head movement. On examination there was spontaneous, unidirectional, horizontal nystagmus. What is the most likely diagnosis?

A.            BPV (Benign positional vertigo)

B.            Vestibular neuronitis

C.            Menniere’s disease

D.            Multiple Sclerosis

21.   6 year old child presented with drooling of saliva, and a severe stridor. He is febrile and sick looking. X ray of the neck in extension shows a thumb sign. What is the single most likely cause of his symptoms?

A.            Parainfuenza virus

B.            Adenovirus

C.            Hemophilus influenza

D.            Corona virus

E.            Streptococcus pneuminae

22.   A 55 year old man presents with complaints of claudication pain in his right thigh and calf. On examination the femoral and  popliteal pulses are absent on the right leg. He halso admits to gluteal pain when he walks with erectile dysfunction since onset of his symptoms Localise the site of occlusion.

A.            External Iliac Artery

B.            Aorto-Iliac

C.            Ilio-Femoral

D.            Internal Iliac

E.            Arch of aorta

23.   A 35 year old man presented with dry cough and mild chest pain for 2 months. He also complains of breathlessness on exertion. He also gave a history of IV drug abuse for the past 3 years. CXR showed perihilar fluffy shadows. What is the most appropriate Rx for him?

A.            IV Co-trimazole

B.            Oral high dose Co-trimazole

C.            IV hydrocortisone

D.            Oral Prednisolone

24.   A 40 year old heroin who desires to quit has undergone Methadone detoxification programme. He has presented to you today with concerns that he may relapse after his detoxification.He wants some medications to help him reduce cravings. What is the single most appropriate answer?

A.            Disulfuram

B.            Diazepam

C.            Naloxone

D.            Naltrexone

E.            Continue on Methadone

25.   An 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

26.    A lady has been on contraception for a long time. She has regular periods and uterus also is normal. She wants a contraception with least failure rate and side effects. Among the options given, which one will you choose?

A.            Depot MedroxyprogesteroneAcetate( DMPA) injections

B.            Cu intrauterine contraceptive device (IUCD)

C.            Mirena coil

D.            COCP

E.            Female condom

27.    40 year old man who is a Jehovah’s witness who had previously mentioned no blood products to be given at any condition requires life – saving blood transfusion. What would be the best step in management?

A.            Give blood to save the life.

B.            Give only fresh frozen plasma

C.            Respect the patient’s wishes

D.            Obtain emergency court order for blood transfusion.

E.            Assess patient’s mental capacity to refuse blood.

28.   A 26 years old male has been operated for abdominal trauma and splenectomy was done. On the third post- operative day the patient developed acute abdominal pain and distension in the upper abdominal area with hypotension. On insertion of ryles tube 2 litres of coffee ground fluid was aspirated. What is the most probable diagnosis for the condition above?

A.            Acute gastric dilatation.

B.            Reactionary haemorrhage.

C.            Sub-phrenic abscess.

D.            Deep vein thrombosis.

E.            Left lower lobe atelectasis

29.   A post gastrectomy patient was on 60mg Morphine. Pain was well controlled with it but patient is not able to swallow. What is the next appropriate step in management?

A.            60 mg per day SC Morphine

B.            100mg SC Morphine

C.            120mg SC Morphine

D.            Fentanyl patch

30.   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

31.   A 30 year old lady with past medical history pulmonary embolism presents to out patient clinic requesting contraception, She has irregular and painful periods. What is the single most appropriate contraception?

A.            Intra uterine contraceptive device

B.            Combined pill contraception

C.            Progesterone  only pill

D.            Mefenemic acid

E.            Trenexemic acid

32.   A 60 year old man has been diagnosed with Parkinson disease a year ago and he is on Levo-Carbi Dopa combination. His symptoms have improved but he is quite dstressed about his tremors as his job requires fairly steady hands. Which one of the following drugs is most useful in the management of tremor?

A.            Apomorphine

B.            Cabergoline

C.            Selegiline

D.            Amantadine

E.            Benzhexol

33.   A 32 year old woman has recurrent breast abscesses, the latest one was 6 weeks ago. There is an area of undulation between the junction of the areola which is discharging puss. What is the most likely diagnosis?

A.            Breast abscess

B.            Ductectasia

C.            Mammary duct fistula

D.            Mastitis

34.   An 18 year old female has just received her A-Level exam results and she didn’t get into the University of her choice. She was brought into the A&E department after ingestion of 24 paracetamol tablets. O/E: patient is slightly confused and tired.

All initial management has been done. Investigations done after 24 hours of admission showed normal FBC, ABG (pH 7.1), P.T (17 seconds), Bilirubin (4µmol/L) and Creatinine (83µmol/L). What is the next step in management?

A.            Keep under observation for the next 24 hours.

B.            Refer to Psychologist.

C.            Give N-Acetylcysteine.

D.            Discharge with referral to Psychiatrist.

E.            Arrange for liver transplantation

35.   An Afro-Caribbean boy presented with fever and arthralgia. FBC shows: Hb : 6 g/dL

Reticulocyte count : 40%

Peripheral Smear : Target cells, Howell-Jolly bodies.  What is the most appropriate diagnosis?

A.            Haemophilia A

B.            Thalassemia major

C.            Sickle cell anaemia

D.            Thalassemia minor

E.            Acute lymphoblastic leukaemia

36.   A 2 weeks old child presents with 70% O2 saturation on air. He is cyanosed and has a pan systolic murmur with a left parasternal heave. What is the most likely reason for this? 

A.            Tetralogy of Fallot (TOF)

B.            Atrial septal defect (ASD)

C.            Patent ductusarteriosus (PDA)

D.            Pulmonary Hypertension

E.            Type 1 respiratory failure

37.   A 60 year old diabetic complains of pain in thigh and gluteal region on walking up the stairs for the last 6 months. She is a heavy smoker and has ischemic heart disease. What is the most appropriate diagnosis?

A.            ThromboangitisObliterans

B.            Sciatica

C.            DVT

D.            Atherosclerosis

E.            Embolus

38.   A patient with severe Alzeheimers  and is on ‘end of life care’. A team of specialists managing him has decided on a “DNAR in case of cardiac arrest” as the best management option for the patient in case of cardiac arrest. As the managing FY2 doctor what would you do?

A.            Access patient’s mental capacity

B.            Carry out the DNAR specialist order

C.            Take consent from relative.

D.            Consent form should be signed by relative and patient.

39.   A 2 year child is severely dehydrated and needs immediate fluid resuscitation. 4 attempts to gain IV access have failed. Which of the following access routes should be considered next? 

A.            Subclavian artery

B.            Radial artery

C.            Intraosseous

D.            Internal jugular vein

E.            Saphenous cut

40.   A 62 year old man has been smoking about 15 cigarettes a day for 45 years. He started working as a builder since he was 24 years old. He presents with chest pain, shortness of breath and weight loss. Chest X-ray shows bilateral fibrosis and left side pleural effusion that yielded a bloody tap. What is the best investigation that will lead to diagnosis? 

A.            Chest x-ray                                                                         E. CT Scan

B.            Pleural fluid aspiration of cytology

C.            Magnetic resonance imaging (MRI)

D.            Pleural biopsy

41.   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

42.   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)

43.   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

44.   A 7 year old boy who is up to date with all his immunization has come to you 7 hrs after a metal spike has injured his hand, wound is 0.5 cm deep. What is the most appropriate action?

A.            Tetanus Ig + tetanus vaccine + antibiotics

B.            Tetanus Ig + antibiotics

C.            Tetanus Ig + tetanus vaccine

D.            Tetanus vaccine + antibiotics

E.            Antibiotics

45.    A 34 year old woman complains of low mood predominantly in winter. She says she feels low every year during winter and starts to feel better once spring arrives. What is the most likely diagnosis?

A.            Depression

B.            Mania

C.            Seasonal affective disorder

D.            Cyclothymia

E.            Dysthymia

46.   A man has a BP of 160/90mmHg, proteinuria ++. On ultrasound kidneys are equally reduced in size with smooth borders and normal pelvicalyceal system. What is the cause of hypertension in this man?

A.            Chronic glomerulonephritis                                         E.            Polycystic Kidney

B.            Chronic Pyelonephritis

C.            Bilateral Renal Artery Stenosis

D.            Essential HTN

47.   A 6 year old sick looking child presents with high fever, runny nose, stridor, breathing difficulty and a brassy cough.  These symptoms started about 4 days ago. X ray of the neck and chest revealed no abnormalities. Currently the child is in respiratory distress, sp02 is 94% and intranasal oxygen has been commenced. What is the next appropriate helpful step for this child?

A.            Adrenaline inhalation

B.            Steroid inhalation

C.            Intubation

D.            I.V Hydrocortisone

E.            Use hyperbaric oxygen instead

48.    A 53year old man presents with a longstanding history of a 1cm lesion on his arm. It has started bleeding on touch. What is the most likely diagnosis?

A.            Basal cell carcinoma

B.            Kaposi’s sarcoma

C.            Malignant melanoma

D.            Squamous cell carcinoma

E.            Kerathoacanthoma

49.   A 30 year old lady has blood film shows with picture of anaemia with spherocytes. What will you do?

A.            Direct Coomb Test

B.            Indirect Coomb Test

C.            Bone marrow examination

D.            Serum ferritin

50.    A pregnant lady who was previously normotensive, on her 28 weeks pregnancy presents with BP 160/100mmHg but on urinalysis did not show proteinuria. What is your most probable diagnosis?

A.            Gestational hypertension

B.            Pre eclampsia

C.            Eclampsia

D.            Chronic hypertension

51.   A patient with hepatocellular carcinoma has raised levels of ferritin. What is the most probable cause?

A.            Hemochromatosis                                                           D.            Carcinomatosis

B.            Wilsons disease

C.            Alpha 1 antitrypsin deficiency

52.   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

53.   A 40year old divorced man with bipolar affective disorder attends hospital following an overdose of 30 TCA tablets. His new partner has left him and he has stopped taking his medicine and begun drinking heavily. He appears depressed, feels hopeless and is ambivalent about being alive. He is now fit for discharge from the medical ward and acknowledges the benefits of previous treatment. What is the SINGLE most appropriate next management?

A.            Admission to the psychiatry ward

B.            Arrange psychiatric outpatient follow-up

C.            Discharge to the care of the general practitioner

D.            Referral to local alcohol treatment team

E.            Referral to clinical psychologist

54.   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.            Sinonasal squamous cell cancer

D.          Tonsillar cancer

55.   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

56.   A 70 year old lady who has been treated on Carbamazepine for epilepsy, she now presents with shortness of breath and light headedness. Blood results show MCV 70, Hb 8.5g/dl, WBC 2, Neutrophils 1 and Platelets 50.

A.            Aplastic anaemia                                                              E.            Haemorrhagic anaemia

B.            Hereditary spherocytosis

C.            Pernicious anaemia

D.            Folate deficiency anaemia

57.   A 24 year old man presents to Accident & Emergency after his friends noticed his sclera turning yellow. This happened after he had been taking paracetamol for a few days for an upper respiratory tract infection. What is the single best cause for jaundice in him?

A.            Gilbert’s syndrome

B.            Criggler-Najjar syndrome

C.            Glucose 6 phosphate dehydrogenase deficiency

D.            Hereditary Spherocytosis

E.            Hereditary Elliptocytosis

58.   A 71yo man with vascular dementia presents with some right sided weakness and swallowing difficulty. He previously had good appetite but no longer eats. However still takes medications. On examination you found white patches on buccal cavity and pharynx. What is the appropriate treatment for this patient? 
A. Amphotericin I.V 
B. Chorhexidine oral 
C. Flucloxacillin oral 
D. fluconazole suspension

59.   21 year old male with multiple painful blisters on penile shaft. There is associated dysuria. He Travelled recently and had unprotected sex. Swab was taken. What next?
A. Acyclovir
B. Steroid
C. Azithromycin

D. Erythromycin

        E. Doxycycline

60. Figure 1

A 72 year old woman, known hypertensive and diabetic had a strange experience. She suddenly lost vision in her right eye for about 2 hours and regained the vision back without any medical intervention. She says the visual loss was as if a curtain was pulled down to shut the eye. What Is the most likely vessel implicated from the list below?
A. Anterior communicating
B. Anterior cerebral 
C. Middle cerebral
D. PICA

61.   An elderly woman was brought in by her daughter in A and E at 10am. She collapsed at 8.30pm at home and then regained consciousness about 15 minutes later but could not move her right arm and leg. What is the most appropriate immediate Treatment?
A. Aspirin
B. Alteplase
C. Clopidogrel

D. Apixaban

E. Heparin

62.   A 67 year old man presents with imbalance and a false sensation of things rotating around him for the past 6 months. He also admits to tingling and occasional numbness on his face and reduced hearing. On examination you find nystagmus, loss of corneal reflex and sensori-neural hearing loss on the left side. What is the single most appropriate diagnosis?

a.       Meniere’s disease

b.       Neurofibromatosis

c.       Acoustic neuroma

d.       Cerebral abscess

e.       Trigeminal neuralgia

63.   56 year old woman just had total hemicolectomy following a diagnosis of early staged colon cancer. About 2 hours postop patient turned pale, had abdominal pain and seemed to be in respiratory distress. Temperature is 37.9 degrees, BP 80/50mmHg, pulse is 120bpm. The FY1 on duty already started patient on IV fluids before you came to review. At your review, BP is now 99/62mmHg and pulse is 98bpm, however patient remains pale. Which of the following best explains the clinical state of the patient?

a.       Cardiogenic shock

b.       Septic shock

c.       Peritonitis

d.       Hypovolemic shock

e.       Neurogenic shock

64.   A 40 year old woman has presented with some concerns. She complains of bloody discharge from the nipple of her left breast. Symptoms started 2 days ago. She denies history of trauma or weightloss. On examination you found no breast masses, nodularity, nipple changes or lymphadenopathy. She does not feel pain in the breast. What is the single most likely diagnosis?

a.       Ductal ectasia

b.       Ductal papilloma

c.       Breast abscess

d.       Subclinical breast cancer

e.       Periductal mastitis

65.    A young woman has lost 6 kg in 2 weeks. The weight loss was deliberate as she exercises 5 hours daily at the gym and is very concerned about her body. She admits to using laxatives and inducing vomiting. Her BMI is 22. She also admits staying up until 3am cleaning her apartment, spending lots of money on shopping and eating in very expensive restaurants. What is most probable diagnosis?

A.            Anorexia nervosa

B.            Bulimia nervosa

C.            Eating disorder not otherwise classified

D.            Depression

E.            Seasonal affective disorder

66.   A 29 year old female presents with intermittent episodes of unilateral headache. Headache is always on right side. She also complains of associated watering of the eye and nasal congestion on the same side. She had repeated episodes about 8 months ago and then the episodes stopped, she was completely healthy until last month when another set of episodes started. All these symptoms were worst particularly in the mornings. What is the single most likely diagnosis? 

A.            Trigeminal neuralgia

B.            Tension headache

C.            Space occupying lesion

D.            Cluster headache

E.            Acute angle closure glaucoma

67.   A man presents with scrotal swelling, the swelling is cystic and is non tender, and it is located at the upper pole of the posterior part of the testis.  What is the most likely diagnosis?

A.            Epididymal Cyst

B.            Testicular cancer

C.            Hydrocele

D.            Teratoma

E.            Testicular torsion

68.    A 36 year old gravida 3 para 2 delivered a baby boy via a vaginal delivery within 8 hours of spontaneous rupture of membranes 4 weeks ago. The placenta was delivered intact, no tears were noted and the delivery was entirely uneventful. She now comes with complains of massive vaginal bleeding and a history of pyrexia since the last 3 days. What could be the appropriate investigation to diagnose her condition?

A.            Transvaginal USS

B.            Reassure

C.            Vaginal examination

D.            High vaginal swab

69.   A 35 year old woman has presented with depressive symptoms. Your consultant made a prescription of fluoxetine and cognitive behavioural therapy. When prescribing an SSRI, what will you warn the patient about its onset of action?

A.            It will work within few days

B.            It will within 1 week

C.            It will work by 2-3 weeks

D.            It will work by 2-3 months

E.            It will work by 1 year

70.   A 56 years old lady presents with hot flushes, low mood, recurrent irritative bladder symtoms and bone pain. She had hysterectomy 2 years ago. She smokes cigarettes. What will you give her for her symptoms?

A.            Oestrogen and progesterone HRT

B.            Oestrogen only HRT

C.            Raloxifen

D.            Bisphosphonates

E.            Clonidine

71.   A 56 year old woman has woken up 5 times in the last month with a feeling of thumping in her chest. On sitting up for about 2 minutes and taking a few deep breaths, the sensation subsides over a further minute. Her ECG shows sinus rhythm. What is the single most appropriate investigation?

A.            Cardiac Enzymes

B.            24 hour Ambulatory Electrocardiogram

C.            Echocardiography

D.            Serum urea and electrolytes

E.            Cardiac Enzymes

72.   A 75 year old man presents with Acute Renal Failure. He has been troubled by recurrent epistaxis but over the last three weeks he reports to have coughed up blood too. What is the single most likely positive antibody?

A. P ANCA

B. C  ANCA

C. Anti Ro

D. Anti Ds DNA

E. Anti Centromere

73.   A mother brings her baby to the hospital complaining that the baby has stridor only upon breast- feeding. On examination, omega shaped cartilage was seen in the neck. What is the most probable diagnosis?

A.            Laryngomalacia

B.            Bronchiolitis

C.            Croup

D.            Epiglotitis

E.            Tracheo oesophageal fistula

74.   A 34 year old housemaid presents with headaches in the back of her head since several days. She also complains of pain on flexing her neck. What is the most likely cause?

A.            Subdural haemorrhage

B.            Cervical spondylosis

C.            Subarachanoid haemorrhage

D.            Meningitis

E.            Cluster headaches

75.   An elderly gentleman who used to work in the shipyard industry presented with cough and shortness of breath few weeks to months was given salbutamol, nebulization and antibiotics and admitted to the ward. He died 3 days later. His CT scan shows patchy infiltrates, pleural thickening and pleural effusions. Why is this a Coroner’s case?

A.            Patient got wrong diagnosis or wrong management

B.            Patient died soon after admission

C.            Death could be due to occupational illness

D.            Patient’s diagnosis is a clinical dilemma

76.   A 20 year old student presented to the Emergency Department after a fly entered her left ear. She is extremely uncomfortable. What is the best management?

A. Instil mineral oil before removal

B. Remove under GA

C. Remove with a pair of forceps

D. Instil lidocaine before removal

E. Remove using a hook

77.   A 30 years old woman has Pelvic inflammatory disease (PID), which was treated with oral Metronidazole, Doxycycline and IM Cephalosporin. It is getting worse. What is the next investigation?

A.            Endocervical swab

B.            Ultra sonography (USG)

C.            Laparotomy

D.            High vaginal swab

78.   A 45 year old man diagnosed with peptic ulcer presents with vomiting and regurgitation of  undigested food particles. What is the likely electrolyte imbalance he will develop?

A.            Hypernatremia

B.            Hyperkalemia

C.            Hypercalcemia

D.            Hyponatremia

E.            Hypokalemia

79.   A 2year old child aspirated a foreign object which was removed at the hospital. The parents are now asking how to remove it if that ever happens at home.

A.            Hemlich manoeuvre                                                       D. CPR

B.            Bring back to the hospital.                                            E. Remove manually by fingers

C.            Turn the child on his back and give thumps

80.   3 year old child presents with severe pain swelling and redness in the testis. On examination, one testis is higher than the other. What is the most appropriate step you will do next?

A.            Refer to surgery for exploration

B.            Antibiotics

C.            Observation

D.            Analgesia

81.   A 30 year old woman gets very anxious if she has to attend a party. She says she cannot eat in presence of anyone and refuses to attend social events. What is the most likely diagnosis?

A.            Agoraphobia

B.            Claustrophobia

C.            Social phobia

D.            Arachnophobia

E.            Hydrophobia

82.   A 28 year old woman at 39 weeks of gestation is in labour. She develops abdominal pain and heart rate of 125 beats/min. blood pressure is 100/42mmHg, temperature 37.2oC and saturations 99% in air. On examination, her lower abdomen is exquisitely tender. The CTG, which was previously normal, now shows reduced variability, and late deceleration develops with slow recovery. She has had one previous LSCS for a breech baby. Choose the most appropriate post C-Section complication for this lady?

A.            Endometriosis

B.            Urinary tract infection

C.            Urinary tract injury

D.            Pleurisy

E.            Uterine rupture

83.   A man has a habit of checking the locks of his house again and again. He tries to resist but he has palpitations. What is the most appropriate  1st line treatment?

A.            CBT + fluoxetine

B.            CBT only

C.            Fluoxetine only

D.            ECT

84.   A 27 year old lady complains of infertility and dyspareunia since 5 years. She has a normal menstrual cycle of 31 days. Although her periods have been very heavy and painful but she has never been a day late. Both her 28 year old partner and her self underwent numerous fertility tests but to no avail. Which is the most definitive investigation that can be done to make a diagnosis

A. Laparoscopy

B. Endocervical Swab

C. Vaginal swab

D. Pelvic ultrasound

85.   A six years old girl child presents with bed wetting. She has never been incontinent before. What is the best approach to treat this child? 

A.            Reassure

B.            Sleep alarms

C.            Desmopressin

D.            Imipramine

E.            Behavioural changes

86.   A 31 year old female had inflammatory changes on cervical smear, she did not complain of any pain or discharge and she was otherwise feeling well. What would be the most appropriate step?

A. Repeat smear

B. Repeat smear in 6 months

C. Colposcopy.

D. Repeat smear in 3 months

E.  Cervical biopsy

87.   A 6 year old boy presents with weight gain, bilateral pitting ankle oedema, peri orbital oedema and hyper lipidemia. What is the next most appropriate step?

A.            Renal biopsy

B.            USG abdomen

C.            24 Hours urinary protein

D.            X ray KUB

E.            Urine microscopy

88.   A 54 years old woman has presented with episodes of abdominal ache, vomiting and postural hypotension. She also has a dark pigmentation of her skin. A diagnosis of Addison’s disease was made. What is the most likely electrolyte abnormality expected in this patient?

A.            High Na, low K

B.            Low Na, high K

C.            Low Na, low K

D.            High Na, high K

E.            Low Na, normal K

89.    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

90.   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

91.   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

92.   A 60 year old lady has severe chest pain. ECG shows changes of inferior wall MI. ECG also shows progressive prolongation of PR interval until a P wave is dropped. What is the most probable diagnosis?

A.            Atrial Fibrillation

B.            Ventricular tachycardia

C.            SupraVentricular tachycardia

D.            Mobitz Type I Second Degree heart Block

E.            Mobitz Type II Second Degree heart Block

93.   A lady came in gynaecology assessment unit with a history of 8 weeks pregnancy and bleeding per vagina for the last two days. On bimanual examination uterus is 8 week in size. On speculum examination cervical os is closed.  What is the single most likely diagnosis?

A.            threatened abortion

B.            inevitable abortion

C.            molar pregnancy

D.            incomplete abortion

E.            ectopic pregnancy

94.    A 67 year old man with chronic urinary retention and  dribbling of urine undergoes prostatic procedure. What serum osmolality you would find in a patient after prostatic surgery?

A.            Low Na

B.            High K+

C.            High Ca

D.            High Na

95.   Figure 1

A 48 year old man, two days after MI presents with palpitations and breathlessness. An ECG was recorded and it showed the changes seen in fig 1. Blood pressure is 90/60mmHg and heart rate is 154 beats/min. What is the next best step in management?

A.            IV amiodarone

B.            DC Shock

C.            Adenosine

D.            Verapamil

E.            Cardiac Pacing

96.   An 85 year old man was found wandering in the streets and was brought to the hospital. His daughter was contacted and called to the hospital. She told that her father had been having problems like, memory loss, forgetting names of people and places, difficulty in finding words for things, difficulty in remembering recent events and also forgetting his appointments. What is the most probable cause? 

A.            Pick’s dementia                                D.            Neurosyphilis

B.            Multi infarct dementia

C.            Alzheimer’s disease

97.   A 35 years old male is bitterly annoyed with people around him. He thinks that people are putting ideas into his head. What is the single most likely option to describe this symptom? 

A.            Thought block

B.            Thought insertion

C.            Thought broadcasting

D.            Thought withdrawal

E.            Reference

98.    A 45 year old premenopausal woman is admitted for elective hernia repair. Hb is 8.4g/dl, MDH is 22pg, MCH 28g/dl, MCV is 70. Her WBC is within normal limits. What is the appropriate initial management?

A.            Immediate blood transfusion, proceed to surgery

B.            Defer operation and investigate

C.            Proceed with planned surgery

D.            Preoperative fluid load

99.   An elderly man on morphine for pain meds and well controlled now has constipation despite increased  fluid intake, moves bowel 3 times a week and stool has normal consistency. What will you give?

A. stimulant laxative

B. Fecal softener

C. Low residue diet

D. Phosphate enema

100.                       A patient with a history of DM is controlled on Gliclazide. He will undergo elective endoscopy. What should be done regarding diabetic management?

A.            Stop oral hypoglycemic drug night before

B.            Give insulin, glucose and potassium during procedure

C.            Change OHA to insulin the morning of the procedure

D.    Reduce evening dose of OHA the day before the procedure and miss the morning dose until after the procedure.

101.                       A 4 years old girl has had a temperature of 38.5 degree Celsius for the last two days

and refused to eat her food. Yesterday she developed sore throat and a small painful ulcer inside her mouth. Today she has small blisters on the palms of her hands and soles of her feet which are painful but not itchy. What is the single most likely underlying cause?

A.            Coxsackie virus

B.            Herpes Simplex virus

C.            Staphylococcus aureus

D.            Streptococcus pneumonia

E.            Varicella zoster virus

102.                       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

103.                       A 30 year old woman has brief episodes of severe shooting pains in the rectum. Rectal examination and flexible sigmoidoscopy are normal. What is the most probable diagnosis?

A.            Anal Hematoma

B.            Anal Fissure

C.            Rectal Carcinoma

D.            Proctalgia Fugax

E.            Piles

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

A.            USG Abdomen

B.            Flexible cystoscopy

C.            Magnetic resonance imaging (MRI)

D.            Nuclear Imaging

E.            Prostate-Specific Antigen (PSA)

105.                       50 year old man, known Diabetic, presents to you with a painful swelling around is anus. He adds that the swelling sometimes feels hot when he touches on it. What is the most probable diagnosis? 

A.            Anal fissure

B.            Abscess

C.            Haematoma

D.            Wart

E.            External haemorrhoids

106.                        A 30 year old man with complaints of left sided abdominal pain was diagnosed with gastric ulcer. On USG incidental finding of gall bladder stone was noted. What is the most appropriate management?

A.            Laparoscopic Cholecystectomy

B.            Statins

C.            No treatment

D.            Lithotripsy

107.                       A patient comes with complains of fullness in his flanks and occasional hematuria. His blood pressure is 160/90mmhg. He says his father had a similar problem but died after bleeding in his brain.  What is the most appropriate next step?  

A. Screen for Conn syndrome

B. Screen for cushion syndrome

C. U/S abdomen

D. MRI scan of the brain

E. No treatment needed

108.                       A 24 year old woman has severe depression three months after the birth of her first child. She is breastfeeding but is otherwise unable to look after the baby and is convinced that her family is likely to kill her. She has no interest in anything and keeps crying. What is the most appropriate treatment?

A.            Fluoxetine

B.            Citalopram

C.            Cognitive behavioural therapy

D.            ECT

E.            Haloperidol

109.                       A 40 year old man who had sore throat for 2 months now presents with mild pedal edema. BP is 190/100mmHg and has haematuria and proteinuria. What is the most probable diagnosis?

A.            IgA Nephropathy

B.            Buerger’s disease

C.            Membranous nephropathy

D.            Post streptococcal nephropathy

110.                        A 45 year old man presents with bitemporal hemianopia and spade like hands. He has a tall slim habitus with no axillary nor pubic hair and a feminine voice. What is the definitive test to confirm diagnosis?

A.            OGTT with growth hormone measurement

B.            Insulin tolerance test

C.            Early morning growth hormone

D.            Short ACTH test

111.                       24 day old Baby born with ambiguous genitalia and diagnosed to have congenital adrenal hyperplasia, nurses came to report to you that the baby was found unconscious in the ward. What would be the most likely finding in the baby?

A. Genital hyperpigmentation.

B. Hypotension.

C. Hypernatremic dehydration.

D. Hypokalemia

112.                                                    A patient comes with complaints of reflux and abdominal pain on and off for many months. Endoscopy shows multiple ulcerations in gastric and duodenal muscosa with mucosal changes in the oesophagus. What is the single most likely investigation to be done next?

A.            Serum Gastrin

B.            USG

C.            Urea Breath test

D.            Oesophageal pH monitoring

113.                       An alcoholic that was treated and is about to be discharged. Which of these would be used to make the diagnosis that the person is dependent on alcohol? 

A.            Takes a drink immediately after waking up.

B.            Driving under the influence of Alcohol.

C.            6 months detention due to alcohol abuse.

D.            70units of alcohol every month

114.                       A 40 year old teetotaller woman is recovering from a hysterectomy 2days ago. At night she becomes agitated and complains of seeing animals and children walking around the ward. What is the most likely diagnosis?

A.            Delirium tremens

B.            Toxic confusional state

C.            Hysteria

D.            Mania

115.                       A2 month old child has come to the emergency with a 3 day history of stooling and vomiting. You assess the child to be moderately dehydrated and then you started fluid resuscitation to replace deficits. What is the maintenance fluid you would prescribe for this child?

A.0.45% Saline + 5% Dextrose

B. 0.9 N/S + 5% Dextrose

C. 0.9% Normal Saline

D. ORS

116.                       A 46 year old man is being investigated for indigestion. Jejunal biopsy shows deposition of macrophages containing Periodic acid–Schiff (PAS) – positive granules with clumps. What is the most likely diagnosis? 

A.            Bacterial overgrowth

B.            Coeliac disease

C.            Tropical sprue

D.            Whipple’s disease

E.            Small bowel lymphoma

117.                       35 year old pregnant woman has been having tingling and numbness of her thumb, index and middle fingers for a while. She has been treated with local steroids but it has not helped much, and now she has been planned to undergo a surgical procedure. Which of the following structures will be incised?

A.            Flexordigitorumprofundus

B.            Transverse carpel ligament

C.            Palmar aponeurosis

D.            Extensor retinaculum

118.                       A 25 year old woman , 38 weeks pregnant , presents with blood pressure of 160/100 and +++ proteinuria . She has not had any seizure episodes. Her AST was 35 and ALT of 40. HB =12.7 g/dl. WBC count of 8×109 Platelet count of 115×109. What is your diagnosis?

A.            Eclampsia

B.            Preeclampsia

C.            HELLP

D.            Acute hepatitis

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

A.            Blood

B.            Throat swab

C.            Gastric washings

D.            Mantoux

E.            Cerebrospinal Fluid (CSF)

120.                       A 37year old woman presents with heavy bleeding. Although she has 2 children, shes still desires fertility. Investigations show sub-serosal fibroid measuring 4cm and intramural fibroid of 6cm.What is the most appropriate treatment for her? 

A.            Uterine artery embolization

B.            Abdominal Hysterectomy

C.            Hysteroscopic myomectomy

D.            Vaginal Hysterectomy

E.            Abdominal myomectomy

121.                       A 65 year old man presents with a history of progressive difficulty in swallowing solid food for 6 months, he has also noticed unintentional weight loss and anorexia. What is the most likely diagnosis?

A.            Achalasia cardia

B.            Hiatus hernia

C.            Gastroesophageal reflux disease

D.            Carcinoma of the oesophagus

E.            Oesophageal spasm

122.                       A 5 year girl with history of hay fever visited a friend’s farm. After playing around for a while she presented with cough, multiple itchy swellings on her body, She got stridor, wheeze and erythematous rash. What is the most appropriate treatment? 

A.            0.25ml IM adrenaline

B.            0.25ml PO adrenaline

C.            0.25ml IV adrenaline

D.            IV chlorpheniramine

E.            Oral antihistamines

123.                       A 30 years old female presented with a 1.5cm discrete lump in the upper outer quadrant of her right breast, which was tender. What is the initial investigation?

A.            USG

B.            FNAC

C.            Excisional biopsy

D.            Mammogram

E.            Open biopsy

124.                       A 7 years old boy presents with epistaxis of two hours duration. The bleeding has been controlled. His investigations are as follows: 

Platelets 210,000

PT 13 seconds

APTT 42 seconds Bleeding time: Normal

Which one of the following is the most likely diagnosis?

A.      Hemophilia

B.      Von-Willebranddisease

C.      Idiopathic thrombocytopenicpurpura

D.      Vitamin Kdeficiency

E.       Liverdisease

F.       Anatomicaldefect

125.                       A four week old girl has been diagnosed of having breast- milk jaundice. She is otherwise well. What is the SINGLE most appropriate management? 

A.            Continue breastfeeding

B.            Exchange transfusion

C.            Increase fluid intake

D.            Phototherapy

E.            Stop breastfeeding

126.                       A 22 year old man has a reduced conscious level and a fixed dilated pupil after being involved in a motor vehicle collision. What is the SINGLE most appropriate option?

A.            Facial nerve

B.            Oculomotor nerve

C.            Olfactory nerve

D.            Optic nerve

E.            Trigeminal nerve

127.                       A 49 year old man complains of fullness in the left ear, recurrent vomiting and tinnitus. What is the most appropriate medication for this condition? 

A.            Buccal Prochlorperazine

B.            Oral Chlorpheniramine

C.            Oral Fluphenazine

D.            Buccal Midazolam

E.            IV Ranitidine

128.                       A 20 year old pregnant, 32/40 weeks by date, presents to the antenatal clinic with a history of painless per vaginal bleeding after intercourse. On examination: Per/Abdomen – soft and relaxed, uterus = dates, CTG is reactive. Choose the SINGLE most likely diagnosis.

A.            Abruption of placenta secondary to pre- eclampsia

B.            Ante partum haemorrhage

C.            Placenta previa

D.            Preterm labour

E.            Placenta percreta

129.                       A 16 year old girl is brought to the hospital by her parents as they are worried about her poor appetite and her rigorous exercise regimen. And she does not think there is anything wrong with her eating habits. She says she is overweight which is why she follows such a strict diet and exercise regimen. What is your next line of management? The girl’s Height- 165cm. Weight- 33kg 

A.            Reassure parents

B.            Detain under mental health Act

C.            Eating disorder clinic

D.            Psychodynamic Therapy

130.                       A lady developed breast abscess after delivery. What is the most likely organism?

A.            Staph aureus

B.            Staph albus

C.            Group B streptococcus

D.            Strep pyogenes

E.            Strep faecalis

131.                       A 27 year old waitress has pelvic pain, dysmenorrhoea and increasingly heavy periods. She also complains of dyspareunia. There is generalized pelvic tenderness without peritonium. Pelvic ultrasound scan is reported as normal. What is the most likely diagnosis?

A.            Endometriosis

B.            Uterine Fibroid

C.            Pelvic Congestion Syndrome

D.            Pelvic Inflammatory Disease

E.            Tubal Pregnancy

132.                       Patient immunized against hep B. What do you expect to find on investigation?

A. HbsAg negative, Anti HBc positive, Anti HBe negative

B. HbsAg negative, Anti HBc negative,  Anti HBs positive /Anti HBe positive

C. HBsAg positive, Anti HBc negative, Anti HBe negative

D. HBsAg positive,  AntiHBs, HBeAg, Anti HBe, Anti HBc.

133.                       A 14 year old girl who asks for oral contraception. Her boyfriend is a school teacher.

A.      Tell her that you can’t prescribe because she is child

B.      Call her parents and tell them

C.      Report to police

D.      Report to local safe guards

134.                       A 28 year old man with complains of headaches and nose bleeds, also has pain in the lower limbs on exertion. Examination shows radio femoral delay. He also has cold legs with weak pulses and mid systolic murmur with normally audible S1 and S2.  What is the most probable diagnosis?

A.            Tetralogy of Fallot                                            D. Patent ductus arteriosus (PDA)

B.            Atrial septal defect (ASD)                             E. Coarctation of Aorta

135.                       A 52 year old woman speaks rapidly without any pause and ignores interruptions. She doesn’t even pause to take enough breaths. What term best describes this kind of speech?

A.            Flight of Ideas

B.            Broca’s Aphasia

C.            Wernicke’s Aphasia

D.            Pressure of Speech

E.            Verbal dysphasia

136.                       A 75 year old woman presents to the breast clinic having noticed that she has had a blood stained discharge from the left nipple, together with dry skin over the left areola. Exam: blood stained discharge with dry flaky skin noted on the left areola. The nipple was noted to be ulcerated. What is the most appropriate investigation?

A.            FNAC

B.            MRI

C.            Punch biopsy

D.            Open biopsy

E.            Stereotactic biopsy

137.                       A 53 year old woman presented with pain in the eye, blurry vision and clumsiness for 3 months. She had a history of difficulty in swallowing and weakness in her right upper limb 2 years ago wch resolved gradually after 4 months and she was healthy afterwards until recently. What is the investigation of choice?

A.            CSF analysis                                                        D. MRI of the brain

B.            Electroencephalography (EEG)                   E. Visuality Evoked Response test (VER)

C.            Electromyography (EMG)

138.                       Figure 2

A 40 years old man fell onto glass from the second floor. In the A and E he complained of shortness of breath and chest pain.his chest xray is shown as figure 2. What is the most probable diagnosis?  

A.       Cardiac Tamponade

B.      Tension Pneumothorax

C.      Simple Pneumothorax

D.      Flail Chest

E.       Atelectasis

139.                        A 48 year old man has continuous anterior chest pain, which is worse on inspiration, and has a temperature of 37.5° C four weeks after a myocardial infarction. His erythrocyte sedimentation rate (ESR) is 45 mm/hour. What is the single most likely explanation for the abnormal investigation?

A. Acute Pericarditis

B. Cardiac Tamponade

C. Atrial Thrombus         

D. Left Ventricular Aneurysm

E. Dressler’s Syndrome

140.                       A boy presents to the A&E department. He was playing with his pencil in the class. He scratched his ear with the pencil and when he took out his pencil, he found that the eraser at the pencil tip was missing. Choose the single most appropriate method of removal of foreign body for this person.

A. Removal with a hook

B. Syringing

C. Removal under GA

D. Putting oil

E. Putting alcohol

141.                       A 22 year old girl is type I diabetic. She is prescribed long acting insulin in the morning and short acting insulin before meals. She starts to become hypoglycaemic at about 4 pm. What should be the next management for her?

A. Stop long acting insulin

B. Stop short acting insulin

C. Decrease dose of long acting insulin

D. Increase dose of short acting insulin

E. Decrease dose of short acting insulin

142.                       A patient developed macular rashes with target lesions, four days after using antibiotics. The rash typically sparing the mouth. What is the most likely diagnosis?

A. Steven Johnson syndrome

B. Erythema nodosum

C. Erythema multiforme

D. Erythema infectiosum

E. Erythema marginatum

143.                       A 61 year old man presents with headache. He also complains of dizziness and tinnitus. He has recently realized he has visual problem. There is history of burning sensation in his fingers and toes. On examination there is splenomegaly. He says he feels itchy after a hot bath. The lab results show RBC 87 x104/L, Hb= 31.9/dL and platelet 796 x109. What is the most likely diagnosis?

A. Chronic myloid leukaemia

B. Chronic lymphoblastic leukaemia

C. Polycythaemia rubravera

D. Mylofibrosis

E. Non Hodgkin’s lymphoma

144.                       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

145.                       A 12 year old child is has a small lump on the dorsum of his foot, congenitally. Doctor  has advised removal of the lump. Mother agreed especially due to the fact that she feels it disfigueres her child’s foot but the child did not agree, as he doesn’t want any surgery and feels the lump is not hurting him. What will you do?

A. Agree with the child and respect his wishes

B. Agree with the parent since she is thinking in best interest of the child

C. Send the child for counselling

D. Convince child to take the surgery at all cost.

146.                       A 37 year old woman presents with more tiredness than usual, she is found to have angular stomatitis, no koilonychia. Choose the single cell type you will find on blood film.

A. Macrocytes

B. Microcytes

C. Granulocyte without blast cells

D. Blast cells

147.                       A 45 year old lady came to family planning clinic for contraception advice. She is not keen to be pregnant for the next 3 years. Her recent USG report showed multiple small submucosal fibroid. What is the best method of contraception for here from the list below?

A. Etonogestrol

B. Combined OCP

C. IUS (intrauterine system)

D. Progestogen only pill

E. IUCD (intrauterine contraceptive device)

148.                       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

149.                       51 year old man is here at the clinic for follow up today. She first presented about 3 months ago with low mood, anhedonia, poor appetite and sleep on account of which diagnosis of moderate depression was made. Patient was placed on fluoxetine since the last 3 months but has seen no improvement in symptoms. What is the next step in management?

A) Lithium

B) Mirtazapine

C) Switch to another SSRI

D) ECT

E)  Increase the dose of Fluoxetine

150.                       A 40 year old Man fell from 8ft high scaffolding . On Xray there was a fracture of the foot. Which bone will be most likely fractured? 

A. Calcaneus

B. Metatarsals

C. Phalanges

D. Tibia

E. Femur

151.                       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)

152.                       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

153.                       A 25 year old male had an injury to the knee while playing football. X ray reveals the condylar fracture of tibia. What is the SINGLE most probable deformity?

A.            Dinner fork deformity                                                    E.            Genu valgus

B.            Gibbus

C.            Cubitus valgus

D.            Garden spade deformity

154.                       A 63 year old female with a history of osteoporosis suddenly fall on her outstretched hand while shopping. X ray shows there is fracture at the distal radius with backward shift of the distal fragment. What is the SINGLE most probable deformity?

A.            Dinner fork deformity.

B.            Coxavara.

C.            Mallet finger

D.            Cubitus valgus

E.            Garden spade deformity

155.                       A 61 year old male who was recently diagnosed to have stable angina is waiting to have contrast coronary angiography. Which of the following should be done before the procedure?

A.            Buccal Nitrates

B.            IV 0.9% Saline

C.            IV Dextrose

D.            ECG

E.            Echo

156.                       A 34 years old alcoholic is found passed out in front of a local pub. The ambulance crew informs you that he was sweating when they found him and there were cans of cider lying empty around him. What is the initial stage of investigation?

A.            Capillary blood sugar

B.            CT head

C.            Magnetic resonance imaging (MRI) head

D.            ABG

E.            MCV (Mean Corpuscular Volume)

157.                       A 76 year old man presents with right hemiparesis. CT scan shows an ischaemic stroke and aspirin 300 mg is commenced. In terms of further management in the acute phase which of the following values should not be corrected?

A.            O2 saturation 94%

B.            BP 210/10mmHg

C.            Blood glucose 9.4 mmol/L

D.            Temp 38.5 C

158.                       A patient diagnosed with DVT is taking warfarin. What is his cut –off-international normalised ratio (INR) limit? 

A.  <1

B. 1-2

C. 2-3

D. 3-4

159.                       The risk of this foetal disease can be reduced by giving folic acid supplements for a few weeks before conception and 6-8 weeks after conception. Choose the single most likely condition.

A.            Down’s syndrome

B.            Duchene muscular dystrophy

C.            Spinal muscular atrophy

D.            Neurofibromatosis

E.            Spina bifida

160.                       A 17 year old man has acute pain and earache on the right side of his face. He has a temperature of 38.4˚C and has extensive pre- auricular swelling on the right, tender on palpation bilaterally. What is the single most likely diagnosis?

A.            Acute mastoiditis

B.            Acute otitis externa

C.            Acute otitis media

D.            Mumps

161.                       A 65 year old man has haematemesis. Endoscopy shows duodenal ulcer which was infected. He has a further haematemesis and his BP drops to 100/60mmHg. His Hb 6g/dl, MCH is 25pg, MCH concentration is 33g/dl, MCV is 85 ft. What is the most appropriate initial management?

A.            Defer operation and investigate

B.            Vit K injection

C.            Proceed with planned surgery

D.            Immediate blood transfusion stabilization and proceed to surgery

162.                       A 32 year old woman had progressive decrease in vision over 3 years that necessitated recurrent changing of glasses. She is now diagnosed as almost blind. On examination the consultant could not do a fundoscopy, he said there was no point doing it. What would be the most likely diagnosis?

A.            Cataract

B.            Glaucoma

C.            Retinopathy

D.            Uveitis

E.            Keratitis

163.                       A three- month old baby was miserable and cried for two hours following his first routine immunization with diphtheria, tetanus, polio, Haemophilus influenza- B (HiB) and meningitis. What is the single most appropriate action?

A.            Defer immunization for two weeks

B.            Do not give vaccine

C.            Give half dose of vaccine

D.            Give Paracetamol with future doses of the same vaccine

E.            Proceed with standard immunization schedule

164.                       A patient is on long standing indwelling catheter and now the catheter bag is turned purple. Dipstick test shows nitrates –ve, blood+. What investigation would you do next?

A.            Urine culture and sensitivity

B.            None

C.            Urine porphobilinogen

D.            USG abdomen

165.                       A middle aged lady presented with fever, altered sensorium, bleeding gums and jaundice. Laboratory results show deranged LFT’s, normal PT/APTT, fragmented RBC’s and low platelets. What is the likely diagnosis?  

A.            Cholesterol emboli

B.            Hemolytic uremic syndrome

C.            Thrombotic thrombocytopenic purpura

D.            Hepatorenal syndrome

E.            Sepsis

166.                       A healthy parents have two children, a child with cystic fibrosis and a healthy child. They want to have another child. What are the chances of that child being a carrier?

A. 1:4

B. 1:2

C. 2:3

D. 1:8

E. 1:16

167.                       A 59 years old patient has been diagnosed with hypertension. His blood pressure has been above 160/90 mmHg on three separate occasions. His biochemical profile is as follows:

Na:         145mmol/L

K:            6.2 mmol/L

Creatinine:        112 µmol/L

Urea:     5.7 mmol/L

Which antihypertensive will you choose for him?

A.            Diuretic

B.            ACE Inhibitors

C.            Hydralazine

D.            Angiotensin receptor blocker

168.                       A 35 years old woman undergoing treatment for Tuberculosis presents with a malar rash, photosensitivity and haematuria. What is the single most likely positive antibody?

A.            Anti Ds DNA

B.            Anti Sm

C.            Anti Histone

D.            Anti La

E.            Anti Centromere

169.                       A 34 years old African-Caribbean man, with a history of Sarcoidosis, has presented with bilateral kidney stones. What is the most likely cause for this patient’s stones?

A.            Hyper calcemia

B.            Hyper uricemia

C.            Diet

D.            Recurrent UTIs

E.            Hyperparathyroidism

170.                       A young girl complains of episodic headaches preceded by fortification spectra. Each episode last for two to three days. During headache patient prefers quite darkroom.

What is the treatment of choice for acute stage?

A.            Paracetamol

B.            Aspirin

C.            Sumatriptan

D.            Gabapentin

  E.          Cafergot

171.                       A 27 year old patient met with a RTA. While the NGT is passing, bowel sounds are heard in the chest. CXR shows NGT curled. What is the diagnosis?

A.            Diaphragm rupture

B.            Aortic rupture

C.            Splenic rupture

D.            Bowel rupture

E.            Liver rupture

172.                       A 60 year old man with anuria had left nephrectomy for left renal Ca. Ultrasound shows dilatation of the right upper renal tract with a stone impacted at the pelvic-ureteric junction. Bp 80/40mmHg. What is the appropriate management?

A. Urethral catheterization

B. Lithotripsy

C. Percutaneous right nephrostomy

D. Dormier basket

E. Mid streamurine for culture and sensitivity

173.                       An 8 week old boy is brought by his mother due to projectile vomiting after every feed. What will be most likely electrolyte abnormality seen in this patient?

A. Metabolic acidosis

B. Metabolic alkalosis

C. Respiratory acidosis

D. Respiratory alkalosis

174.                       A 45 years old female looking pale, has bluish discoloration of hands whenever she goes out in cold. She has also noticed some reddish spots on her body. She has symmetrical peripheral arthropathy for last 1-2 years. What is the most probable diagnosis?

A. Rheumatoid Arthritis

B. Osteosarcoma

C. Limited Systemic Sclerosis

D. Diffuse Systemic Sclerosis

E. Chondrosarcoma

175.                       A 85 year old man fell down and hit his head. 5 days later he came back with confusion. Which is the most likely site of bleeding?

A. Middle meningeal artery

B. Internal cerebral artery

C. Cerebral vein plexus

D. Berry aneurysm

176.                       A 62 year old male comes to the GP complaining of double vision while climbing downstairs. Which of the following nerve is most probably involved?

A. Abducens nerve

B. Trochlear nerve

C. Oculomotor

D. Optic nerve

E. Trigeminal

177.                       An 8 year old child, who is tall for his age and has a refractory error for which he wears glasses, has presented with severe crushing chest pain. What is the most likely diagnosis?

A. Fragile X Syndrome

B. PraderWilli Syndrome

C. Di George Syndrome

D. Marfan’s Syndrome

178.                       A 14 year old boy presents with recurrent abdominal pains, malaise, and weight loss over 6 months. On examination a vague mass is felt in right iliac fossa. Colonoscopy shows transmural inflammation and granulomata. What is the most appropriate management?

A. Sulfasalazine

B. Paracetamol

C. Metronidazole

D. Ibuprofen

179.                       A 25 years old woman presents with single lump in the breast and axilla. The lump is mobile and hard in consistency. The ultrasound, mammogram and fine needle aspiration turned out to be normal. What is the most appropriate investigation to confirm the diagnosis?

A. Fine Needle Aspiration Cytology (FNAC)

B. Magnetic resonance imaging (MRI)

C. Punch biopsy

D. Genetic testing and counselling

E. Core biopsy

180.                       A 54 year old man after a CVA (cerebral vascular accident) presents with ataxia, intention tremors and slurred speech. Which part of the brain has been affected by the stroke? 

A.            Inner Ear

B.            Brain Stem

C.            Diencephalon

D.            Cerebrum

E.            Cerebellum

 

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