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E. Loop
diuretics
5.
A
12
year
old
boy
presents
with
testicular
pain
without
a
history
of
trauma.
He
Is
afebrile
and
on
examination,
the
right
testis
is
slightly
higher
that
the
left
one.
What
is
the
diagnosis?
a. Testicular
torsion
b. Epidydymo-‐orchitis
c. Teratoma
d. Seminoma
e. Varicocele
6.
A
59
year
old
post
menopausal
woman
present
with
a
month
history
of
bleeding
per
vaginum.
On
speculum
examination,
the
cervix
appears
normal
and
there
is
no
vaginal
discharge.
What
is
the
single
most
appropriate
diagnostic
tests?
a. Cervical
smear
b. Hysteroscopy
c. Pelvic
ultrasound
d. Serum
FSH
level
e. Transvaginal
ultrasound
with
endometrial
sampling
7.
An
80
year
old
woman
is
brought
in
by
her
family
as
they
are
concerned
that
she’s
been
getting
progressively
more
confused
over
the
past
few
months.
She
is
disoriented
to
time,
place
and
person
and
often
wanders
in
the
streets
aimlessly.
What
is
the
single
most
likely
diagnosis?
a. Alzheimer’s
b. Delirium
c. Parkinson’s
d. Subdural
hematoma
e. Vascular
dementia
8.
A
32
year
old
woman
has
increasing
white
vaginal
discharge.
She
is
7
weeks
pregnant.
Her
Chlamydia
swab
is
positive.
All
other
tests
are
normal.
What
is
the
single
most
appropriate
treatment?
a. Amoxicillin
b. Clindamycin
c. Doxicycline
d. Erythromycin
e. Metronidazole
9.
A
2
year
old
is
brought
in
by
his
parents
as
they
are
concerned
that
he
has
a
past
history
of
febrile
convulsions.
His
last
convulsion
was
6
months.
There
is
also
a
family
history
of
epilepsy.
What
is
the
single
most
appropriate
management?
a. Arrange
EEG
b. Arrange
MRI
c. Arrange
sleep
studies
d. Commence
regular
lorazepam
e. Educate
parents
in
when
and
how
to
administer
rectal
diazepam
10.
A
50
year
old
man
presents
with
right
sided
hemiparesis.
There
is
a
bruit
on
neck
auscultation.
What
is
the
single
most
appropriate
investigation?
a. Blood
pressure
measurement
b. Carotid
Doppler
c. CT
head
d. MRI
e. Slit
lamp
examination
11.
A
60
year
old
woman
is
recovering
from
an
operation
following
a
hysterectomy
and
anterior
vaginal
repair.
She
has
had
voiding
difficulty
and
has
been
catheterized
for
3
days.
A
catheter
specimen
of
urine
is
taken
due
to
a
low
grade
pyrexia
and
confirms
a
UTI.
Which
organism
is
the
causative
agent?
a. E.coli
b. Klebsiella
pneumonia
c. Proteus
d. Pseudomonas
e. Staphylococcus
epidermidis
12.
A
17
year
old
man
presents
to
the
A&E
department
with
a
traumatic
hip.
On
examination,
he
has
a
foot
drop
and
is
unable
to
dorsiflex
or
evert
over
his
left
ankle.
Sensation
is
lost
over
the
front
and
lateral
side
of
the
leg
and
dorsum
of
the
foot.
Which
nerve
is
most
likely
damaged?
a. Common
peroneal
nerve
b. Femoral
nerve
c. Sciatic
nerve
d. Superficial
peroneal
nerve
e. Tibial
nerve
13.
A
22
month
old
girl
has
severe
dehydration.
You
are
unable
to
gain
peripheral
venous
access.
What
is
the
single
most
appropriate
management?
a. Administer
subcutaneous
fluids
b. Arrange
for
a
PEG
c. Inset
a
central
line
d. Insert
an
NG
tube
b. Fat
embolism
c. Hypovolemic
shock
d. Pericardial
effusion
e. Pulmonary
embolism
19.
A
30
year
old
woman
reports
with
palpitations
at
rest.
The
resting
pulse
is
70b/m
and
regular.
Holter
ECG
monitoring
shows
irregularities
associated
with
the
palpitations.
What
is
the
single
most
likely
diagnosis?
a. Atrial
fibrillation
b. Atrial
flutter
c. Heart
block
d. SVT
e. Ventricular
ectopic
20.
A
55
year
old
man
complains
of
pleuritic
chest
pain
5
days
after
an
MI
and
is
found
to
have
widespread
ST
elevation
on
ECG.
Pain
is
worse
with
movement.
What
is
the
single
most
likely
diagnosis?
a. Acute
pericarditis
b. Acute
pulmonary
embolus
c. Dissecting
aortic
aneurysm
d. Dressler’s
syndrome
e. Ventricular
rupture
21.
A
35
year
mother
of
4
reports
urinary
incontinence.
Urometry
suggests
stress
incontinence.
What
is
the
single
most
appropriate
form
of
treatment?
a. Bladder
neck
surgery
b. Oxybutynin
c. Pelvic
floor
exercises
d. Ring
pessary
e. Topical
vaginal
oestrogens
22.
A
15
year
old
boy
presents
to
the
A&E
with
severe
asthma.
He
is
using
his
accessory
muscles
of
respiration
and
is
unable
to
speak
in
sentences.
What
is
the
single
most
appropriate
treatment?
a. Inhaled
short
acting
B-‐2
agonist
b. Inhaled
long
acting
B-‐2
agonist
c. IV
aminophylline
d. IV
hydrocortisone
e. Nebulised
short
acting
B-‐2
agonist
23.
A
40
year
old
man
presents
with
bleeding
per
rectum,
constipation
and
diarrhea.
Sigmoidoscopy
reveals
an
ulcerated
stricture
in
the
sigmoid
colon.
What
is
the
single
most
likely
diagnosis?
a. Angiodysplasia
b. Crohn’s
disease
c. Diverticular
disease
d. Sigmoid
colon
cancer
e. Ulcerative
colitis
24.
A
27
year
old
man
has
had
mild
dysuria
for
1
week.
He
has
been
having
sex
with
his
current
girlfriend
for
4
weeks,
occasionally
using
condoms.
She
has
no
symptoms.
His
last
sex
with
his
previous
female
partner
was
3
months
ago.
There
is
a
slight
mucoid
discharge
at
the
urethral
meatus.
Which
single
organism
is
the
most
likely
cause?
a. Chlamydia
b. Mycoplasma
hominis
c. Neisserria
gonorrhoea
d. Trichomonas
vaginalis
e. Ureaplasma
urealyticum
25.
A
32
year
old
man
has
weight
loss
and
general
malaise.
He
takes
an
HIV
test
which
is
positive
and
his
CD4
count
is
180x10/L
(12%)
Normal
range
is
450-‐
1600x10/L.
He
is
otherwise
well.
He
does
not
feel
ready
to
start
antiretroviral
therapy
straight
away,
but
wishes
to
stay
well
in
the
interim.
For
which
single
organism
should
he
be
offered
primary
prophylaxis?
a. Cryptococcus
neoformans
b. Mycobacterium
avium
intracellulare
c. Mycobacterium
tuberculosis
d. Pneumocystitis
jiroveci
e. Toxoplasma
gondii
26.
A
21
year
old
university
student
is
just
back
from
a
hiking
holiday
in
Massachusetts
and
presents
with
bilateral
facial
palsy
and
a
raised
pink
annular
lesion
on
her
lower
leg.
She
says
this
was
all
preceded
by
flu-‐like
symptoms.
What
is
the
single
most
likely
diagnosis?
a. Erythema
multiforme
b. Erythema
nodosum
c. Herpes
zoster
d. Infected
insect
bite
e. Lyme
disease
27.
A
15
year
old
girl
with
neural
tube
defect
is
brought
in
by
her
mother
for
advice
on
urinary
incontinence.
What
is
the
single
most
appropriate
management?
a. Desmopressin
b. Incontinence
pads
c. Intermittent
self-‐catheterisation
d. Oxybutinin
e. Prophylactic
trimethoprim
28.
A
38
year
old
married
working
mother
of
3
asks
for
contraception.
She
states
that
she
had
a
pill
failure
in
the
past
and
also
has
a
history
of
heavy
periods.
What
is
the
single
most
appropriate
form
of
contraception?
a. Bilateral
tubal
ligation
b. Condoms
c. Depoprovera
injection
d. Mirena
coil
e. Norethisterone
POP
29.
A
56
year
old
NIDDM
male
presents
with
persistently
elevated
BP
of
180/110mmHg.
Blood
tests
are
unremarkable.
What
is
the
single
most
appropriate
medication?
a. Amlodipine
b. Atenolol
c. Bendroflumethiazide
d. Furosemide
e. Perindopil
30.
A
40
year
old
man
returns
from
Africa
with
a
high
swinging
pyrexia
and
diarrhea.
On
examination,
there
is
tenderness
in
the
right
upper
quadrant
of
the
abdomen.
What
is
the
single
most
likely
diagnosis?
a. Acute
cholecystitis
b. Acute
hepatitis
c. Amoebic
liver
abscess
d. Falciparum
malaria
e. Salmonella
poisoning
31.
A
35
year
old
male
heavy
smoker
states
that
his
right
leg
toe
becomes
pale
and
painful
when
walking.
What
is
the
single
most
likely
diagnosis?
a. Embolism
b. Gout
c. Peripheral
atherosclerosis
d. Raynauld’s
phenomenon
e. Thromboangitis
obliterans
32.
A
55
year
old
male
presents
with
TIA
and
is
found
to
have
a
pulse
rate
of
100b/m
with
irregular
rhythm.
What
is
the
single
most
appropriate
treatment?
a. Aspirin
b. DC
cardioversion
c. Heparin
d. Streptokinase
e. Warfarin
33.
A
40
year
old
man
with
past
history
of
total
thyroidectomy
presents
with
dizziness.
Blood
tests
shows
Hb10.2,
MCV
110,
What
is
the
single
most
appropriate
investigation?
A. Serum
folate
levels
B. Serum
B12
C. Thyroid
function
tests
D. Upper
GI
endoscopy
E. Ultrasound
scan
of
the
neck
34.
A
36
year
old
naval
seaman
presents
with
a
rash
on
his
forehead.
He
states
that
he
has
had
the
rash
for
years
and
often
forgets
to
wear
his
cap
while
he
is
on
duty.
What
is
the
most
likely
diagnosis?
a. Actinic
keratosis
b. Acne
vulgaris
c. Keratoacanthoma
d. Lentigo
maligma
e. Squamous
cell
carcinoma
35.
A
30
year
old
pedestrian
was
involved
in
an
RTA
and
presents
with
loss
of
consciousness
in
the
A&E
department.
He
regains
consciousness
and
complains
of
headache.
He
also
has
a
stiff
neck
on
examination
with
a
deep
laceration
to
his
right
temple.
What
is
the
likely
diagnosis?
a. Basal
skull
fracture
b. Cerebral
haemorrhage
c. Extradural
haemorrhage
d. Subarachnoid
haemorrhage
e. Subdural
hematoma
36.
A
16
year
old
girl
has
painful
periods
for
6
months.
Her
periods
are
regular
and
lasts
for
3
days.
She
misses
a
couple
of
days
of
school
every
month
due
to
the
pain.
She
is
not
sexually
active.
What
is
the
most
appropriate
initial
management?
a. COCP
b. Gonadotrophin-‐releasing
hormone
analogues
c. Intra-‐uterine
system
(Mirena)
d. Mefanemic
acid
e. Tranexamic
acid
37.
A
20
year
old
cyclist
is
hit
by
an
oncoming
vehicle
and
now
presents
with
loss
of
consciousness.
On
examination,
there
is
blood
behind
the
ear
drum
and
peri-‐
orbital
ecchymoses.
What
is
the
single
most
likely
diagnosis?
a. Basilar
skull
fracture
b. Extradural
hematoma
c. Linear
skull
fracture
d. Subarachnoid
hematoma
e. Subdural
hematoma
38.
A
35
year
old
woman
complains
of
severe
pain
on
defecation.
She
is
unable
to
tolerate
digital
rectal
examination.
She
also
has
a
history
of
constipation.
What
is
the
single
most
likely
diagnosis?
a. Anal
fissure
b. Crohn’s
disease
c. Haemorrhoids
d. Perianal
hematoma
e. Pilonidal
cyst
39.
A
70
year
old
woman
being
treated
for
temporal
arteritis
now
presents
with
fever,
severe
abdominal
pain
and
vomiting.
What
is
the
single
most
likely
diagnosis?
a. Acute
cholecystitis
b. Acute
pancreatitis
c. Gallstone
peritonitis
d. Perforated
peptic
ulcer
e. Ruptured
aortic
aneurysm
40.
A
55
year
old
man
presents
with
prostatic
symptoms.
On
digital
rectal
examination,
you
palpate
a
firm
nodule
on
the
prostate.
What
is
the
next
single
most
appropriate
nest
step
investigation?
a. Acid
phosphatase
b. IVU
c. Scinti
scan
d. Serum
PSA
levels
e. Transrectal
USS
and
biopsy
41.
A
45
year
old
man
was
admitted
for
the
treatment
of
alcohol
withdrawal
He
has
been
treated
successfully
but
now
he
has
ataxia
and
ophthalmoplegia.
What
is
the
most
appropriate
treatment?
A. Oral
thiamine
B. Intravenous
vitamin
B
complex
C. Acamproste
D. Disulfiram
E. Intravenous
fluids
only
42.
A
15
year
old
girl
is
brought
in
by
her
family
as
they
are
concerned
that
she
is
anorexic
and
depressed.
She
has
no
suicidal
ideation.
What
is
the
single
most
appropriate
treatment?
a. Commence
fluoxetine
b. CBT
c. Refer
to
rapid
access
mental
health
team
d. Section
and
admit
to
the
hospital
e. Suggest
family
counseling
43.
A
30
year
old
man
with
ankylosing
spondylitis
now
presents
with
eye
pain
and
redness.
What
is
the
single
most
likely
diagnosis?
a. Acute
angle
closure
glaucoma
b. Acute
conjunctivitis
c. Herpetic
ulcer
d. Iritis
e. Scleritis
44.
A
10
year
old
boy
has
shortness
of
breath
and
wheezing
when
playing
football.
What
is
the
single
most
appropriate
treatment?
a. Inhaled
steroids
b. Nebulised
salbutamol
c. Sodium
chromoglycate
d. Trial
of
leukotrene
receptor
antagonist
e. Trial
of
short
acting
B-‐2
agonis
45.
A
60
year
old
man
presents
with
severe
shortness
of
breath
with
basal
crepitations
on
auscultation.
Blood
pressure
is
160/110mmHg
with
a
pulse
of
100b/m.
Chest
x-‐ray
confirms
suspicions.
What
is
the
single
most
appropriate
treatment?
a.
Amlodipine
b.
Bendroflumethiazide
c.
Furosemide
d.
Nifedipine
e.
Spironolactone
46.
A
25
year
old
man
complains
of
bouts
of
alternating
intermittent
diarrhea
and
constipation
for
the
past
1
month.
He
describes
a
sensation
of
incomplete
evacuation
and
bloating.
Symptoms
are
relieved
by
defecation.
Sigmoidoscopy
is
normal.
What
is
the
single
most
likely
diagnosis?
a. Diverticulitis
b. Gastroenteritis
c. Irritable
bowel
syndrome
d. Pseudomembranous
colitis
e. Ulcerative
colitis
47.
A
50
year
old
man
post
operatively
for
cholecystectomy
presents
with
fever,
jaundiced
and
dark
urine.
What
is
the
single
most
definitive
management?
a. Abdominal
USS
b. CT
scan
c. ERCP
d. Laparatomy
e. Percutaneous
transhepatic
cholangiography
48.
A
26
year
old
man
with
NIDDM
and
a
history
of
haemochromatosis
now
presents
with
jaundice.
What
is
the
single
most
definitive
investigation?
a. Abdominal
USS
b. ERCP
c. Liver
biopsy
d. Serum
ferritin
levels
e. Viral
hepatitis
serology
49.
A
56
year
old
man
with
new
onset
dyspepsia
now
reports
with
no
relief
with
antacids.
What
is
the
single
most
appropriate
management?
a. Barium
meal
b. Urgent
endoscopy
54.
A
1
year
old
child
develops
swollen
lips
after
eating
peanuts.
What
is
the
single
most
appropriate
management?
a. IM
Adrenaline
b. IV
Hydrocortisone
c. IV
Chlorphenamine
d. Urgent
admission
e. Oral
antihistamine
55.
A
30
year
old
woman
develops
bilateral
conductive
hearing
loss
after
giving
birth.
On
examination,
the
tympanic
membranes
appear
normal.
What
is
the
single
most
likely
diagnosis?
a. Acoustic
neuroma
b. Acute
otitis
media
c. Gentamicin
toxicity
d. Meniere’s
disease
e. Otosclerosis
55.
A
2
year
old
boy
presents
with
gradual
swelling
of
both
feet.
Even
if
his
feeding
has
been
poor
recently
he
has
gained
weight.
His
urine
is
dark
in
colour.
What
is
the
single
most
appropriate
investigation?
A. calcium
B. Serum
albumin
C. Serum
urea
and
creatinine
D. Glucose
E. Liver
function
tests
56.
A
young
girl
presents
with
crusted
lesion
on
her
neck
which
has
spread
from
the
neck
to
her
face.
She
is
otherwise
normal.
Which
investigation
will
establish
the
diagnosis?
a. Viral
culture
b. Bacterial
culture
c. Skin
biopsy
d. Temperature
e. ABG
57.
A
coal
miner
presents
with
a
diagnosis
of
transitional
cell
cancer
of
the
bladder
What
is
the
single
most
important
risk
factor
for
his
condition?
a. Coalmine
b. Smoking
c. Family
history
d. Vitamin
e. Alcohol
a. Metoprolol
59.
A
patient
has
cervical
smear
with
the
result
showing
mild
dyskaryosis.
What
is
the
next
appropriate
management?
a. Refer
for
biopsy
b. Refer
for
colposcopy
c. Repeat
smear
in
3
months
d. Repeat
smear
in
6
months
e. Repeat
smear
in1
year
60.
A
4
week
old
baby
girl
has
been
diagnosed
as
having
breast
milk
jaundice.
She
is
otherwise
well.
What
is
the
single
most
appropriate
management?
a. Continue
breast
feeding
b. Exchange
transfusion
c. Increase
fluid
intake
d. Phototherapy
e. Stop
breast
feeding
61.
An
8
year
old
boy
is
suspected
to
be
allergic
to
strawberries.
What
is
the
single
most
appropriate
investigation?
a. Double
blind,
placebo
controlled
food
provocation
challenge
b. Skin
prick
test
c. Radio-‐allergo
sorbent
test
(RAST)
d. Tissue
transglutaminase
antibody
e. Total
IgE
blood
test
62.
A
60
year
old
married
woman
is
brought
in
by
her
husband
as
he
reports
that
she
is
behaving
oddly.
She
has
suddenly
been
making
inappropriate
sexual
remarks
in
public.
She
has
always
been
a
shy
person
and
is
now
extremely
extroverted.
What
is
the
most
likely
diagnosis?
a. Alzheimer’s
b. Delirium
c. Picks
disease
d. Subdural
hematoma
e. Tourette’s
syndrome
63.
A
50
year
old
man
complains
of
pain
on
defecation.
On
examination,
there
is
a
tender
reddish
blue
swelling
near
the
anal
verge.
What
is
the
likely
diagnosis?
a. Fistula-‐in-‐ano
b. Hemorrhoids
c. Perianal
abscess
d. Perianal
hematoma
e. Pilonidal
cyst
64.
A
30
year
old
banker
complains
of
headache
and
blurry
vision.
He
sits
in
front
of
his
VDU
screen
for
8
hours
a
day
checking
the
stock
market.
What
is
the
single
most
appropriate
investigation?
a. ESR
b. Intraocular
pressure
c. Split
lamp
test
d. Refer
to
optician
for
visual
acuity
testing
e. Visual
field
test
65.
A
77
year
old
man
present
s
with
difficulty
in
reading
the
newspaper
with
missing
words
and
seeing
straight
lines
as
wavy
and
with
an
empty
spot
in
the
centre
of
his
vision.
What
is
the
single
most
likely
diagnosis?
a. Acute
glaucoma
b. Age
related
macular
degeneration
c. Cataract
d. Central
retinal
vein
thrombosis
e. Optic
neuritis
66.
A
34
year
old
man
from
Asia
retuned
to
the
United
Kingdome
with
fever
,
night
sweats
and
splenomegaly.
What
is
the
single
most
appropriate
diagnosis?
A. Brucelosis
B. Tuberculosis
C. Typhoid
D. Lymphoma
E. Leukemia
67.
A
55
year
old
woman
presents
with
plaque
like
lesion
on
her
lower
calf
and
a
painless
ulcer
on
the
sole
of
her
foot.
What
is
the
single
most
useful
investigation?
a. ESR
b. Fasting
blood
sugar
c. Lyme
disease
serology
d. Peripheral
arteriogram
e. Skin
biopsy
68.
A
50
year
old
woman
complains
of
tinnitus,
vertigo
and
deafness.
It
is
so
disturbing
that
she
is
house
bound.
The
deafness
however
improves
gradually.
What
is
the
single
most
likely
diagnosis?
a. Acoustic
neuroma
b. Meniere’s
disease
c. Presbyacusis
d. Otosclerosis
e. Viral
labyrynthitis
69.
An
80
year
old
female
resident
of
a
nursing
home
is
seen
in
the
casualty
for
generalized
bruising.
A
month
prior
to
this
time,
she
was
admitted
for
a
femoral
neck
fracture
sustained
while
falling
out
of
bed.
A
year
ago,
she
sustained
a
Colle’s
fracture
after
tripping
over
her
feet.
What
is
the
single
most
likely
diagnosis?
a. Balance
disorder
b. Non-‐accidental
injury
c. Osteoporosis
d. Postural
hypertension
e. Vitamin
K
deficiency
70.
A
45
year
old
alcoholic
male
would
like
medication
to
help
him
abstain
from
drinking.
He
attends
an
AA
and
has
been
sober
for
1
week.
What
is
the
single
most
useful
treatment?
a. Acamprosate
b. Chlormethiazole
c. Diazepam
d. Disulfiram
e. Lorazepam
71.
A
31
year
old
lady
with
history
of
eczema
and
rheumatoid
arthritis
presents
with
shortness
of
breath.
He
also
has
got
tremors,
palpitations
and
hyperpigementation
lesion
on
his
leg.
He
smokes
20
cigarettes
a
day.
What
is
the
single
most
likely
diagnosis?
A. Sarcoidosis
B. Asthma
C. COPD
D. Thyrotoxicosis
E. Rheumatoid
arthritis
72.
A
12
year
old
girl
with
physical
and
mental
disability
is
on
treatment
for
some
condition.
She
then
develops
ataxia
and
on
examination
she
found
to
have
nystagmus.
What
is
the
single
most
likely
cause?
A. Anti-‐psychotic
B. Anti-‐depressant
C. Anti-‐epileptic
D. Metochlorpramide
E. Cimetidine
73.
A
4
day
old
breast
fed
baby
presents
with
jaundice.
The
mother
is
concerned
as
her
baby
has
also
lost
250g
in
weight.
The
stools
are
also
pale.
What
is
the
single
most
likely
diagnosis?
a. Biliary
atresia
b. Breast
feeding
jaundice
c. Breast
milk
jaundice
d. Galactosemia
e. Rh
incompatibility
74.
A
5
year
old
boy
is
noted
to
have
a
clumsy
gait
and
mild
scolisosis.
When
he
gets
off
the
floor,
he
uses
his
hands
to
climb
up
the
stairs.
What
is
the
single
most
likely
diagnosis?
a. Duchenne’s
muscular
dystrophy
b. Gullian-‐Barre
syndrome
c. Hunter’s
syndrome
d. Motor
neuron
disease
e. Poliomyelitis
75.
A
5
year
old
girl
presents
after
a
fall
on
her
right
arm
after
falling
off
a
swing.
On
examination,
there
is
no
swelling
or
deformity
but
the
forearm
is
extremely
tender.
What
is
the
single
most
likely
diagnosis?
a. Greenstick
fracture
b. Non-‐accidental
injury
c. Pulled
elbow
d. Smith’s
fracture
e. Spiral
fracture
76.
A
6
week
old
baby
is
brought
in
by
her
mother
who
is
concerned
that
the
baby
is
always
hungry
and
cannot
keep
food
down.
The
mother
denies
that
the
baby
has
been
vomiting
bile.
On
examination,
a
small
mass
is
palpated
in
the
upper
abdomen.
What
is
the
single
most
likely
diagnosis?
a. Celiac
disease
b. Gastroenteritis
c. GERD
d. Intussusception
e. Pyloric
stenosis
77.
A
5
year
old
boy
who
has
asthma
is
taking
inhaled
steroid
and
salbutamol
as
required.
At
night
he
gets
short
of
breath
and
also
during
exercise.
What
is
the
single
most
appropriate
management?
80.
A
17
year
old
man
who
is
a
known
asthmatic
presents
to
accident
and
emergency
department
with
severe
shortness
of
breath
and
wheeze.
He
has
been
given
nebulised
salbutamol
and
ipratropium
bromide
and
intravenous
steroid.
Which
other
intravenous
medication
would
you
give?
A. Magnesium
sulphate
B. Hydrocortisone
C. Salbutamol
D. Aminophylline
E. Ipratropium
bromide
81.
A
female
driver
had
a
head
on
collision.
What
is
the
last
vertebrae
that
the
X-‐ray
should
be
done?
a. C5-‐C6
b. C7-‐C6
c. T1-‐T2
d. C7-‐T1
82.
A
40
year
old
man
has
got
a
hematoma
over
the
mastoid
area
after
being
involved
in
a
fight.
Which
bone
is
likely
to
be
fractured?
a. Parietal
b. Temporal
c. Sphenoidal
d. Mandibular
e. Occipital
83.
A
38
year
old
female
presents
in
the
morning
with
unconsciousness.
There
is
no
previous
history
of
such
but
there
has
been
some
headache
prior
to
presentation.
The
BP
is
140/90mmHg.
There
is
also
neck
stiffness
and
extensor
plantar
reflex.
What
is
the
most
appropriate
investigation?
a. CT
scan
b. Lumbar
puncture
c. Blood
culture
d. CSF
analysis
e. Sputum
MCS
84.
A
15
year
old
boy
who
has
asthma
gets
exacerbation
of
asthma
whenever
he
plays
football.
What
is
the
single
most
appropriate
management?
B. Phenytoin
C. Chlordiazepoxide
D. Intravenous
diazepam
E. Per
rectal
diazepam
87.
A
69
year
old
man
is
found
to
have
pansystolic
murmur
4
days
after
suffering
myocardial
infarction.
What
is
the
single
most
appropriate
investigation?
A. Electrocardiogram
B. Echocardiogram
C. CT
scan
chest
D. MRI
scan
chest
E. Chest
X-‐ray
88.
A
67
year
old
man
is
scheduled
to
have
a
hemicolectomy.
He
is
presently
on
warfarin.
What
will
you
do?
a. Change
warfarin
to
heparin
b. Change
warfarin
to
aspirin
c. Clopidogrel
d. Reduce
the
dose
of
warfarin
e. Continue
warfarin
89.
A
70
year
old
man
presents
with
right
sided
weakness
and
loss
of
consciousness
for
10
minutes.
He
is
already
on
aspirin
75mg,
bendroflumethiazide
and
statin.
What
drug
will
you
add
to
his
medication?
a. Clopidogrel
75mg
b. Aspirin
300mg
c. Dypiridamole
200mg
d. Clopidogrel
300mg
e. Tissue
plasminogen
activator
90.
A
35
year
old
man
sustained
55%
burs
to
his
body.2
weeks
after
the
incident
he
presents
with
upper
GI
bleeding.
On
endoscopy
he
is
found
tp
have
multiple
ulcers
What
is
the
single
most
appropriate
management?
A. Oral
proton
pump
inhibitor
B. Intravenous
proton
pump
inhibitor
C. Oral
antiacids
D. H.
Pylori
eradication
E. H2
antangonist
orally
91.
A
78
year
old
man
with
inoperable
colorectal
carcinoma
presents
with
fatigue,
malaise
and
feels
generally
unwell.
He
also
passes
stools
2-‐3
times
a
week.
What
is
the
appropriate
management?
a. Admit
b. Dexamethasone
c. Palliative
care
nurse
d. Laxatives
e. Analgesia
through
PCA
92.
A
7
year
old
child
presents
with
shortness
of
breath,
lethargy
and
dehydration.
What
is
the
initial
management?
a. 0.8%
saline
b. 0.9%
saline
c. 0.45%
saline
d. Insulin
e. Dextrose
93.
A
man
presents
with
a
swelling
in
the
groin
which
lies
above
and
lateral
to
pubic
tubercle.
On
examination
it
is
found
to
be
an
indirect
hernia.
Through
which
structure
will
the
content
come
through?
A. Deep
ring
B. External
ring
C. Linea
alba
D. Umbilicus
94.
A
5
year
old
boy
with
eczema
presents
with
vesicles
on
top
of
the
eczematous
lesions.
What
is
the
single
most
56. appropriate
investigation?
95. Antifungal
96. Anti-‐viral
97. Antibiotics
98. Oral
steroid
99. Iv
steroid
95.
A
60
year
old
man
has
developed
vesicles
on
the
maxillary
division
of
the
trigeminal
nerve.
What
is
the
most
likely
mucous
membrane
to
have
been
involved?
a. Tonsils
b. Palletal
c. Submental
d. Buccal
99.
An
11
year
old
girl
presents
with
recurrent
bilateral
joint
pains
.
He
also
complains
of
general
malaise.
Which
of
the
following
test
will
be
positive?
A. Rheumatoid
factor
B. ESR
C. White
cell
count
D. Haemoglobin
E. HLA
27
100. A
75year
old
lady
with
lung
cancer
was
found
to
have
sodium
of
125mmol/l,
potassium
3.5,
Urea
2.5mmol/l.
.
What
is
the
most
likely
cause
for
electrolytes
abnormality
?
A. Syndrome
inappropriate
anti-‐diuretic
hormone
B. Tumour
lysis
syndrome
C. Conn’s
syndrome
D. Sqamous
cell
carcinoma
E. Cushing
syndrome
101.
A
74
year
old
gentleman
was
started
on
antihypertensive
therapy.
1
week
later
he
comes
back
with
a
severe
cough.
Which
drug
is
most
likely
to
be
responsible?
a.
Enalapril
b.
Amlodipine
c.
Propanolol
d.
Verapamil
e.
Diltiazem
102.
A
45
year
old
gentleman
3
hours
after
a
hemicolectomy
presents
with
a
BP
of
90/40mmHg
and
heart
rate
of
110b/m.
What
is
the
most
appropriate
next
step
in
management?
a.
Take
to
the
theatre
b.
CT
scan
c.
Intravenous
fluids
d.
Take
blood
for
U&E
e.
USS
103.
A
47
year
old
gentleman
has
got
blisters
in
the
trigeminal
root.
He
is
noted
to
have
loss
of
sensation
on
the
middle
part
of
his
lower
lips
and
gums.
Which
part
of
the
trigeminal
nerve
is
involved?
a.
Submental
b.
Lingual
c.
Palatal
d.
Mandibular
e.
Ophthalmic
104.
A
79
year
old
lady
has
had
a
change
in
bowel
habits
since
the
last
2
months
and
she
has
noticed
that
her
stools
are
mixed
with
blood.
What
is
the
most
appropriate
investigation?
a.
Barium
enema
b.
Colonoscopy
c.
Sigmoidoscopy
d.
USS
of
the
abdomen
e.
MRI
of
the
abdomen
105.
A
60
year
old
gentleman
presents
with
sensori-‐neural
hearing
loss
and
corneal
reflex
loss
on
the
left
side.
What
is
the
most
definitive
investigation?
a.
CT
internal
auditory
meatus
b.
Nuclear
imaging
of
the
brain
c.
MRI
of
the
internal
auditory
meatus
d.
MRI
pituitary
e.
MRI
posterior
fossa
of
the
brain
106.
A
40
year
old
gentleman
presents
with
athralgia
and
skin
lesions
on
his
shin.
Calcium
is
raised.
What
will
be
the
finding
on
the
chest
X-‐ray?
a.
Bilateral
hilar
lymphadenopathy
b.
Bilateral
interstitial
shadowing
c.
Bilateral
consolidation
d.
Absent
lung
markings
e.
Increased
lung
markings
107.
A
30
year
old
lady
7
weeks
pregnant
presents
with
vomiting.
She
is
unable
to
eat
or
drink.
What
is
the
most
appropriate
treatment?
a.
Nil
by
mouth
b.
Intravenous
fluids
c.
Intravenous
Vitamin
B12
d.
Intravenous
Fe
e.
Bed
rest
108.
A
90
year
old
lady
with
a
history
of
MI
and
hypertension
presents
with
a
step
wise
deterioration
in
memory.
What
is
the
most
likely
diagnosis?
a.
Pseudodementia
b.
Vascular
dementia
c.
Alzheimer’s
disease
d.
Lewy
body
dementia
e.
Alcohol
109.
A
5
year
old
boy
presents
with
abdominal
pain
and
diarrhea.
On
duodenal
biopsy,
he
is
found
to
have
a
short
villy
crypt.
What
is
the
most
likely
diagnosis?
a.
Peptic
ulcer
b.
Celiac
disease
c.
Hirshprung’s
disease
d.
Malabsorption
e.
Galactosemia
110.
A
60
year
old
man
presents
with
pain
in
the
left
leg
when
walking.
What
is
the
single
most
appropriate
management?
A. Anti-‐hypertensive
B. Statin
C. Lifesyle
modification
D.
Bendroflumethiazide
E.
Calcium
channel
blockers
111.
An
8
year
old
girl
was
found
to
have
Vitamin
B12
deficiency
and
is
about
to
be
started
on
oral
therapy.
What
is
the
most
appropriate
test
that
needs
to
be
done
before
commencing
oral
therapy?
a.
Vitamin
B1
b.
Intrinsic
factor
c.
Folic
acid
d.
Endoscopy
e.
Iron
112.
A
14
year
old
boy
after
playing
football
presents
with
itching
and
redness
on
his
arm.
What
is
the
most
appropriate
treatment?
a.
IM
adrenaline
b.
IV
hydrocortisone
c.
Oral
prednisolone
d.
Chlorpheniramine
e.
IV
adrenaline
113. A 40 year old lady returned from U.S few days ago and now has night
sweats and splenomegaly. Examination is unremarkable. What is the most
likley diagnosis?
a. Lymphoma
b. Tuberculosis
c. Pumonary embolism
d. Brucelosis
e. Malaria
114.
A
60
year
old
lady
with
confirmed
diagnosis
of
hypothyroidism
presents
with
dizziness,
shortness
of
breath
and
light
headedness.
FBC
shows
low
Hb
and
high
119.
A
45-‐year-‐old
man
presents
with
a
chest
pain
for
more
than
20
minutes.
ECG
shows
St
depression
in
II,
II,
aVF.
What
is
the
most
appropriate
treatment?
A.
Aspirin+
heparin
B.
Angioplasty
C.
Streptokinase
D.
Aspirin+
warfarin
E.
Aspirin+
clopidogrel
120.
A
60
year
old
lady
presents
with
per
vaginal
bleeding.
Her
last
menstrual
period
was
5
years
ago.
What
is
the
most
appropriate
investigation
to
do?
a.
Cervical
smear
b.
Hysteroscopy
and
biopsy
c.
Colposcopy
d.
Per
vaginal
examination
e.
Cone
biopsy
121.
A
40
year
old
lady
presents
with
occasional
per
vaginal
spotting.
What
is
the
most
appropriate
next
step
investigation
to
do?
a.
Colposcopy
b.
Cervical
smear
c.
PV
examination
d.
Hysteroscopy
e.
Cone
biopsy
122.
A
35
year
old
lady
presents
with
post
coital
bleeding.
Her
last
cervical
smear
was
2
years
ago.
What’s
the
most
appropriate
investigation?
a.
Colposcopy
b.
Cervical
biopsy
c.
Cervical
smear
d.
Hysteroscopy
e.
CT
scan
123.
An
80
year
old
lady
has
had
constipation
for
the
past
2
weeks.
She
is
on
large
dose
of
opiates
for
back
pain.
She
has
been
confused
for
the
past
24
hours
and
also
has
fecal
incontinence.
What
is
the
most
appropriate
management?
a.
Stimulant
laxative
b.
Phosphate
enema
c.
High
fibre
diet
d.
Bulk
laxatives
e.
Reduce
dose
of
opiate
124.
A
5
year
old
boy
has
had
ear
ache
for
the
past
2
days.
Otoscopy
reveals
red
tympanic
membrane
with
fluid.
What
is
the
most
appropriate
treatment?
a.
Amoxicillin
b.
Benzylpenicillin
c.
Gentamicin
d.
Ciprofloxacin
e.
Flucloxacillin
125.
A
70
year
old
lady
has
had
several
falls
especially
whilst
getting
up
from
bed
in
the
morning.
She
has
got
history
of
hypertension
and
is
on
treatment
for
bendroflumethiazide.
What
is
the
most
appropriate
investigation?
a.
24
hour
ECG
b.
ECHO
c.
Standing
and
lying
blood
pressure
d.
CT
head
e.
Tilt
test
126.
A
30
year
old
lady
who
is
36
weeks
pregnant
has
got
a
BP
of
170/110mmHg
and
protein
+++
in
the
urine.
What
is
the
most
appropriate
treatment?
a.
Atenolol
b.
Oral
methyldopa
c.
IV
hydralazine
d.
IV
magnesium
sulphate
e.
BP
monitoring
127.
A
70
year
old
gentleman
presents
with
severe
unilateral
headache.
On
eye
examination,
the
cornea
is
hazy
and
the
eye
is
congested.
What
is
the
most
appropriate
management?
a.
Intraocular
pressure
measurement
b.
CT
head
c.
Fundoscopy
d.
FBC
e.
ESR
128.
31.
A
45-‐year-‐old
lady
has
tingling
and
numbness
in
her
thumb,
index
and
middle
finger.
She
has
tried
splinting
and
steroid
injections
both
of
which
have
failed.
She
has
now
decided
to
do
surgery.
What
is
the
only
anatomical
structure
that
you
need
to
divide?
A.
Palmar
aponeurosis
B.
Flexor
retinaculum
C.
Pronator
sheath
D.
Extensor
digitorum
profundus
E.
Extensor
digitorum
superfacialis
129.
A
40-‐year-‐old
man
on
treatment
for
dyspepsia
has
duodenal
ulcers.
He
has
had
triple
therapy
and
he
has
come
back
with
epigastric
pain
after
6
months.
What
investigation
will
you
do?
A.
Urea
breath
test
B.
Endoscopy
C.
24
hour
PH
monitoring
D.
Fundoplication
E.
H.
pylori
serology
130.
A
40
year
old
female
is
diagnosed
with
Grave’s
disease.
She
is
on
treatment
but
develops
a
sore
throat.
What
investigation
will
you
do
for
her?
a.
ESR
b.
Thyroid
function
tests
c.
Urea
and
electrolytes
d.
Ultrasound
e.
White
blood
cell
count
131.
A
60
years
old
man
complains
of
blurred
speech
and
weakness
with
tingling
of
the
left
arm.
The
whole
episode
lasted
for
3
hours.
What
is
the
single
investigation
likely
to
give
a
definitive
diagnosis?
a.
CT
head
b.
Doppler
carotid
c.
EEG
d.
MRI
scan
e.
12
lead
ECG
132.
A
15
year
old
female
presents
with
colicky
abdominal
pain
in
the
pelvic
region
since
1
year
ago
that
has
now
increased.
The
pain
is
situated
in
the
right
iliac
fossa.
What
is
the
diagnosis?
a.
Ovarian
torsion
b.
Twisted
ovarian
cyst
c.
Ovarian
cancer
d.
Endometriosis
e.
Appendicular
mass
133.
A
blood
film
shows
a
picture
of
anaemia
with
spherocyte.
What
investigation
will
you
do?
a.
Indirect
Coomb’s
test
b.
Bone
marrow
examination
c.
Measure
serum
ferritin
d.
Liver
function
test
e. Direct
coombs
test
134.
A
68
year
old
man
presents
with
pan-‐systolic
murmur
in
the
apex
which
radiates
to
the
axilla.
What
is
the
likely
diagnosis?
a.
Mitral
stenosis
b.
VSD
c.
Mitral
regurgitation
d.
Tricuspid
regurgitation
e.
Aortic
regurgitation
135.
A
40-‐year-‐old
man
has
had
deafness
for
1
year.
He
now
presents
to
accident
and
emergency
department
with
the
same
complaint.
Otoscopy
shows
yellow
discharge
form
the
upper
drum.
What
is
the
most
likely
diagnosis?
A.
Otosclerosis
B.
Ramsay
Hunt
syndrome
C.
Cholesteatoma
D.
Acute
otitis
media
E.
Otitis
externa
136.
A
70
year
old
man
presents
with
urinary
retention.
He
has
been
catheterised.
His
prostate
is
enlarged
but
he
has
no
other
symptoms
and
all
blood
tests
are
normal.
What
is
the
most
appropriate
management?
A.
Bladder
outlet
surgery
B.
Fenesteride
C.
TWOC
+fenesteride
D.
TWOC
+
tamsulosin
E.
No
action
required.
138.
A
30
year
old
lady
presents
with
generalized
tonic-‐clonic
seizures.
What
is
the
single
most
appropriate
treatment?
a.
Clonazepam
b.
Gabapentin
c.
Phenytoin
d.
Sodium
valproate
e.
Vigabatrin
139.
A
70-‐year-‐old
man
with
a
terminal
CA.
His
pain
was
well
controlled
with
60
mg
of
oral
morphine,
now
he
cannot
swallow
due
to
recurrent
chest
infection
from
aspiration.
What
is
the
most
appropriate
analgesia?
A.
60
mg
morphine
subcutaneously
B.
120
mg
morphine
subcutaneously
C.
60mgmorphineIV
D.
60
mg
morphine
IM
E.
Continue
same
treatment.
140.
A
50
year
old
inpatient
has
diarrhea
while
on
treatment
for
osteomyelitis.
What
is
the
single
most
likely
organism
responsible?
a.
Clostridium
difficile
b.
Clostridium
perfringes
c.
E.coli
d.
Salmonella
e.
Shigella
141.
A
30
year
old
female
who
returned
from
Africa
1
month
ago
now
complains
of
fever
and
malaise
and
is
noted
to
have
faint
erythematous
maculopapules
(rose
spot)
on
her
torso.
What
single
investigation
will
give
the
highest
sensitivity?
a.
Blood
culture
b.
Bone
marrow
biopsy
c.
Stool
culture
d.
Typhoid
M
test
(IgG
and
IgM
antibodies
test)
e.
Urine
culture
142.
A
55
year
old
man
with
asthma
was
recently
started
on
an
antihypertensive
drug
which
he
now
thinks
is
responsible
for
his
impotence.
What’s
the
single
most
likely
culprit?
a.
Amlodipine
b.
Atenolol
c.
Bendroflumethiazide
d.
Frusemide
e.
Peridopril
143.
A
30
year
old
woman
exhibits
pressured
speech
and
flight
of
ideas
changing
144.
A
30
year
old
pregnant
lady
gets
in
contact
with
a
child
who
has
chicken
pox.
Varicella
antibodies
are
negative.
What
is
the
most
appropriate
management?
A.
Reassure
B.
Immuniglobulin
G
C.
Varicella
Vaccination
D.
Acyclovir
E
.
Antibiotics
145.
A
50
year
old
woman
post
thyroidectomy
complains
of
tingling
sensation
around
her
lips.
What
investigation
will
you
do?
a.
CT
scan
of
the
head
b.
Serum
calcium
c.
Thyroid
function
tests
d.
Urea
and
electrolytes
e.
Ultrasound
scan
of
the
neck
146.
An
80
year
old
woman
is
noted
to
have
unilateral
right
sided
tonsilar
hypertrophy.
What
is
the
single
most
likely
diagnosis?
a.
Lymphoma
b.
Peritonsilar
cellulitis
c.
Quinsy
d.
Tonsilar
carcinoma
e.
Viral
tonsillitis
148.
An
80
year
old
man
resident
in
a
nursing
home
presents
with
urinary
retention.
On
examination,
the
bladder
is
distended
and
the
sigmoid
colon
is
palpable.
What
is
the
single
most
likely
diagnosis?
a.
UTI
b.
Sigmoid
colon
carcinoma
c.
Fecal
impaction
d.
Diverticulosis
e.
BPH
149.
A
55
year
old
alcoholic
man
complains
of
severe
upper
abdominal
pain
radiating
to
his
back.
He
also
passes
loose,
pale
stools
and
has
weight
loss.
What
is
the
most
likely
diagnosis?
a.
Acute
pancreatitis
b.
Chronic
pancreatitis
c.
GERD
d.
Oesophagitis
e.
Pancreatic
carcinoma
150.
A
10
year
old
boy
with
cerebral
palsy
has
urinary
retention.
2
times
urine
culture
was
negative.
What
is
the
most
appropriate
management?
A.
Intermittent
self
catheterisation
B.
Permanent
catheterisation
C.
Surgery
D.
Mid
stream
urine
E.
Antibiotics
151.
10
year
old
girl
presents
with
polyuria,
ploydipsia,
and
weight
loss.
You
suspect
diabetes.
Which
of
the
following
would
confirm
diagnosis
of
diabetes?
A.
Random
glucose
8
B.
Random
blood
glucose
14
C.
Urine
dip
stick
protein
+2
and
fasting
glucose
6.5
D.
Fasting
glucose
5.2
E.
Urine
Dipstick
protein
+2
and
fasting
blood
glucose
152.
A
30
year
old
heroin
addict
presents
with
purple
papules
in
his
mouth
and
on
his
leg.
What
is
the
most
likely
diagnosis?
a.
Henoch-‐Schonlein
purpura
b.
Kaposi
sarcoma
c.
Lichen
planus
d.
Malignant
melanoma
e.
TTP
153.
A
2
year
old
fire
fighter
presents
to
the
A&E
with
painful
throat
and
coughing
up
of
black
sputum.
He
states
that
he
was
in
a
confined
space
in
a
burning
building
for
20
minutes.
On
examination,
the
eyebrows
and
nose
hair
in
the
vestibules
are
singed.
He
has
also
become
disoriented.
What
is
the
single
most
appropriate
management?
a.
Intubation
b.
Analgesia
c.
Arterial
blood
gas
and
carbon
monoxide
levels
d.
High
flow
oxygen
e.
Surgical
tracheostomy
154.
A
20
year
old
lady
presents
with
intermenstrual
bleeding.
She
was
started
on
combined
oral
contraception
4
months
ago
and
now
has
a
new
partner.
What
is
the
single
most
relevant
investigation?
a.
Endocervical
swab
b.
Endometrial
sampling
c.
Cervical
smear
d.
Urine
for
Chlamydia
e.
Transvaginal
USS
155.
An
18
month
old
baby
is
brought
in
with
dehydration
from
diarrhea
and
vomiting
for
the
past
72
hours.
On
examination
she
is
found
to
have
mild
dehydration.
What
is
the
single
most
useful
treatment?
a.
Water
by
mouth
b.
0.9%
saline
c.
Oral
rehydration
solution
(60mmol)
d.
Oral
rehydration
solution
(90mmol)
e. No
action
required
156.
A
28
year
old
man
presents
with
a
2
week
history
of
painful
swollen
right
knee.
On
examination,
he
is
found
to
have
iritis
and
non-‐specific
urethritis.
A
week
prior
to
this,
he
had
a
severe
bout
of
diarrhea.
What
is
the
single
most
appropriate
treatment?
a.
Allopurinol
b.
Ciprofloxacin
c.
Colchicines
d.
Naproxen
e.
Paracetamol
157.
A
month
old
baby
is
brought
to
the
A&E
by
her
mother
who
is
concerned
that
her
baby
is
inconsolable.
Her
baby
has
been
vomiting
and
cannot
keep
food
down.
On
examination,
the
abdomen
is
distended
and
a
sausage
shaped
mass
is
palpable.
What
is
the
most
definitive
investigation?
a.
Abdominal
USS
b.
Abdominal
X-‐ray
c.
Barium
enema
d.
CT
scan
of
the
abdomen
e.
Protoscopy
158.
A
70
year
old
man
presents
with
swollen
right
knee.
He
is
on
bendroflumethiazide
2.5mg.
What
is
the
diagnostic
investigation?
a.
Blood
culture
b.
C-‐reactive
protein
c.
D-‐dimer
d.
Plain
X-‐ray
of
the
knee
e.
Serum
uric
acid
159.
38
year
old
lady
30
weeks
pregnant
presents
with
proteinurea
+++
and
BP
160/100?
What
is
the
most
likley
diagnosis?
A.
Pregnancy
induced
hypertension
B.
Eclampsia
C.
Pre
eclampsia
D.
HELP
syndrome
E.
Hyperemesis
gravidarum
160.
A
53
year
old
Asian
woman
with
diabetes
mellitus
type
2
has
a
BMI
of
35.
She
had
an
operation
for
ovarian
cancer
for
which
she
received
prophylactic
low
molecular
weight
heparin.
5
days
later,
she
develops
pain,
redness
and
swelling
in
the
left
calf.
What
is
the
single
most
appropriate
investigation?
a.
C-‐reactive
protein
b.
D-‐dimer
c.
Doppler
ultrasound
d.
Thrombophilia
screen
e.
Venography
161.
A
70
year
old
man
who
has
rheumatoid
arthritis
has
a
painful
wrist.
He
takes
methotrexate,
NSAID’s
and
anti-‐hypertensive
medication.
His
Hb
is
low.
What’s
the
most
likely
anemia
you
will
find
in
the
blood?
a.
Hemolytic
anemia
b.
Aplastic
anemia
c.
Anemia
of
chronic
disease
d.
Haemolytic
uraemic
anaemia
e.
Megaloblastic
anaemia
162.
A
45
year
old
man
had
geastrectomy.
He
now
presents
with
lethargy,
weakness
and
paraesthesia
of
the
limbs.
His
MCV
is
110.
What
is
the
likely
cause
of
his
symptoms?
164.
A
20
year
old
lady
with
6
weeks
history
of
amenorrhoea.
She
presents
with
excessive
vomiting.
USS
finds
the
uterus
to
be
16
weeks
in
size.
What
is
the
most
likely
cause
of
vomiting?
A.
Molar
pregnancy
B.
Twins
C.
Ectopic
pregnancy
D.
Polyhydrominous
E.
Diabetes
165.
20
year
old
lady
who
is
10
weeks
pregnant
presents
with
heavy
PV
bleeding
and
she
is
passing
clots.
The
os
is
open.
The
most
appropriate
management?
A.
TV
scan
B.
Laporoscopy
C.
Laparotomy
D.
No
treatment
E.
Anti
D
166.
20
year
old
lady
who
is
10
weeks
pregnant
presents
with
slight
PV
bleeding.
The
os
is
open.
The
most
appropriate
management?
A.
reassure
B.
TV
scan
C.
Abdominal
USS
D.
Laparoscopy
E.
Surgery
167.
A
70
year
old
man
presents
with
a
few
months
history
of
weight
loss
and
dysphagia.
What’s
the
appropriate
next
step?
a.
Barium
meal
b.
Barium
swallow
c.
Endoscope
d.
USS
e.
Chest
X-‐ray
168.
A
45
year
old
man
presents
with
acute
testicular
pain.
One
testes
is
higher
than
the
other.
MSU
shows
no
nitrate
and
white
blood
cells.
What
is
the
most
appropriate
management?
a.
Analgesia
b.
IV
saline
and
observe
c.
Reassure
d.
Immediate
surgical
exploration
e.
Antibiotics
169.
A
54
year
old
man
was
moving
things
from
his
house
during
which
a
cupboard
fell
on
his
legs
and
thighs.
The
cupboard
was
on
his
legs
for
3
hours.
Later
he
presented
with
blood
in
the
urine.
What’s
the
cause
of
his
renal
problem?
a.
Creatinine
phosphakinase
b.
Haemoglobin
c.
Myoglobin
d.
Troponin
e.
Blood
loss
170.
A
79
year
old
lady
who
had
breasts
carcinoma
present
with
seizures.
What
is
the
best
route
of
administration
of
the
anti-‐epileptic
drug?
a.
Oral
b.
Intravenous
c.
Intramuscular
d.
Rectal
e.
Subcutaneous
171.
A
30-‐year-‐old
lady
with
painful
labial
ulcers.
Which
investigation
will
you
do?
A.
VDPL
B.
Treponema
pallidum
C.
HPV
D.
Anti
HSV
antibodies
E.
chlamydia
swab
172.
A
38
year
old
female
with
family
history
of
polycystic
kidney
disease
dies
suddenly.
She
also
had
hypertension.
Her
bother
wants
to
know
the
exact
reason
for
her
death.
a.
Intracranial
haemorrhage
b.
Epidural
haematoma
c.
Subdural
haematoma
d.
Subarachnoid
haematoma
e.
Intracerebral
haemorrhage
173.
30
year
old
lady
on
COCP
has
got
nodular
lesions.
What
is
the
most
likely
cause?
A.
Human
papilloma
virus
B.
Warts
C.Herpes
simples
virus
D.
Syphillis
E.
Pyederma
gangrenosum
174.
A
74-‐year-‐old
woman
experiences
dizziness
while
decorating
the
house.
What’s
the
cause?
A.
Carotid
artery
disease
B.
Meniers’
disease
C.
BPV
D.
Vestibular
neuritis
E.
Wax
175.
An
8
year
old
girl
presents
with
fever,
low
abdominal
pain.
On
examination,
she
has
splenomegaly,
all
blood
tests
are
normal.
Treated
with
antibiotics.
In
a
few
days
she
comes
back
with
same
complains.
What
is
the
most
likely
diagnosis?
A.
ALL
B.
CLL
C.
Aplastic
anaemia
D.
Myelodysplastic
anaemia
E.
AML
175.
A
4
month
old
baby
is
brought
in
with
acute
nose
bleeding
but
is
now
stable.
What
is
the
single
action
that
can
stop
the
nose
bleeding?
a.
Ice
pack
b.
Pinch
the
bridge
of
the
nose
c.
Pinch
the
soft
tissue
of
the
nose
d.
Anterior
packing
e.
Reassure
176. An 70 year old man presents with painless haematuria. What is the most
appropriate investigation?
A. Cystoscopy
B. Intravenous urogram
C. Ultrasound of the kidney
D. Mid stream urine
E. Renal biopsy.
177.
A
patient
with
long
standing
1cm
lesion
on
the
hand
that
has
started
to
bleed
on
touching.
What
is
the
diagnosis?
a.
Basal
cell
carcinoma
b.
Kaposi
sarcoma
c.
Malignant
melanoma
d.
Sqaumous
cell
carcinoma
178.
A
man
presents
with
a
lesion
on
his
thigh
with
central
clearing
which
has
been
clearing
since
3
weeks
ago.
He
also
has
malaise
and
generalized
aches.
What
is
the
test
to
diagnose
his
lesion?
a.
Skin
biopsy
b.
Skin
scrapping
and
culture
c.
Lyme
serology
d.
Antibacterial
culture
e.
Blood
culture
179.
A
patient
presents
with
acute
onset
of
red
eye,
pain
and
blurry
vision.
He
also
has
peri-‐orbital
edema.
What
is
the
best
initial
management?
a.
Put
patient
in
a
dark
room
with
reduced
light
b.
IV
morphine
and
routine
ophthalmological
referral
c.
IV
morphine
and
emergency
ophthalmological
referral
d.
IM
morphine
e.
IV
morphine
and
antibiotics
180.
A
60
year
old
man
presents
with
increasing
forgetfulness,
poor
sleep
and
loss
of
interest.
He
shows
psychomotor
retardation
and
answers
every
question
with
‘I
don’t
know.’
What
single
diagnosis
explains
his
condition?
a.
Depression
b.
Dementia
c.
Bipolar
affective
disorder
d.
Normal
aging
process
e.
Panic
disorder
181.
An
84
year
old
lady
with
metastatic
breast
cancer
presents
with
shortness
of
breath
due
to
pleural
effusion.
She
has
got
few
weeks
remaining
for
her
to
live.
What
is
the
most
appropriate
management?
a.
Insert
a
pleural
drainage
b.
Pleural
aspiration
c.
Pleurodesis
d.
Home
oxygen
e.
Analgesia
182.
A
34
year
old
man
presents
unwell.
Her
blood
tests
show
hyponatremia
and
hypokalemia.
What
is
the
likely
diagnosis?
a.
Acute
gastroenteritis
b.
Acute
renal
failure
c.
Addison’s
disease
d.
Crohn’s
disease
e.
Respiratory
acidosis
183.
A
51
year
old
man
after
hernia
repair
has
been
constipated.
Recently
she
has
been
complaining
of
loose
stool.
What
is
the
most
appropriate
management?
a.
Laxatives
b.
Phosphate
enema
c.
High
fiber
diet
d.
Exercise
e.
Intravenous
fluids
184.
A
52
year
old
boy
presents
with
sudden
onset
of
testicular
pain
with
the
right
testes
swollen
and
tender.
There
is
no
history
of
trauma
and
he
has
a
temperature
of
38.5C.
What
is
the
most
appropriate
next
step
in
his
management?
a.
Give
antibiotics
b.
USS
of
the
scrotum
c.
Immediate
surgical
referral
d.
Reassure
185. A 45 year old woman who has breast cancer develop paresthesias and
sensory loss of the fingers after chemotherapy. What is the cause?
B. Hypocalcemia
his
mother’s
knee
and
is
tolerating
an
oxygen
mask
but
looks
unwell.
He
has
constant
noisy
breathing
and
is
drooling
saliva.
His
temperature
is
39.C.
What
is
the
single
most
important
diagnosis
to
rule
out?
a.
Acute
asthma
b.
Bronchiolitis
c.
Croup
d.
Epiglotitis
e.
Tonsillitis
189.
A
17
year
old
man
complains
of
severe
eye
pain
and
blurry
vision.
He
also
takes
pain
killers
for
his
long
standing
back
pain.
What’s
his
likely
clinical
condition?
a.
Episcleritis
b.
Iritis
c.
Posterior
uveitis
d.
Acute
closed
angle
glaucoma
e.
Scleritis
190. An 18-year-old boy has come back after working in a farm and now has
fever with splenomegaly, myalgia, bone pain.
What is the diagnosis?
A. Brucellosis
B. Lyme disease
C. Leishmania
D. Tuberculosis
E. Lymphoma
191.
A
62
year
old
man
has
multiple
liver
metastases
due
to
adenocarcinoma
with
an
unknown
primary.
He
is
deeply
jaundiced
and
has
ascites
with
oedema
of
his
legs
up
to
the
buttocks.
He
is
now
drowsy
and
his
family
are
worried
that
he
is
not
drinking
enough.
His
medication
includes:
Haloperidol
1.5mg,
Lactulose
10ml
Blood
taken
3
days
ago
showed
the
following
results:
Normal
electrolytes,
Urea
6.5mmol/l,
Creatinine
89mmol/l,
Calcium
2.04mmol/l,
Albumin
17g/L,
Total
bilirubin
189mmol/l
What
is
the
single
most
appropriate
management
of
his
fluid
intake?
a.
Albumin
infusion
b.
Crystalloids
fluids
(continuous
IV)
c.
Crystalloids
fluids
(intermittent
subcutaneous)
d.
Fluids
via
nasogastric
tube
e.
Oral
fluids
192.
A
14
year
old
develops
an
itchy
scaly
patch
on
her
scalp.
She
had
a
similar
patch
on
her
scalp
that
had
healed
spontaneously
2
years
ago.
Her
aunt
has
a
similar
undiagnosed
rash
on
the
extensor
aspects
of
her
elbows
and
knees.
What
is
the
single
most
likely
diagnosis?
a.
Eczema
b.
Fungal
infection
c.
Impetigo
d.
Lichen
planus
e.
Psoriasis
193.
A
4
week
old
baby
was
brought
to
the
A&E
by
the
mother
with
a
condition
of
expiratory
wheeze,
cough
and
nasal
discharge
and
also
vomits
after
feeding
for
the
last
3-‐5
days.
What
is
the
most
likely
diagnosis?
a.
Bronchiolitis
b.
Croup
c.
Broncho
pulmonary
dysplasia
d.
Bronchitis
194.
A
woman
presents
with
increasing
forgetfulness,
lethargy
and
tiredness.
She
has
given
up
her
job
as
a
teacher
in
the
university.
She
has
increasing
dyspnea
and
breathlessness
on
exertion.
Her
only
medication
is
L-‐thyroxine.
There
are
no
neurological
symptoms.
What
single
test
will
help
to
establish
her
diagnosis?
a.
MRI
scan
of
the
head
b.
Erythrocyte
sedimentation
rate
c.
Hb
concentration
d.
Thyroid
function
test
e.
Vitamin
B12
level
195.
A
30
year
old
woman
was
treated
successfully
for
CIN2
some
years
back.
She
was
a
heavy
smoker
and
discontinued
smoking
a
few
months
back.
She
was
on
oral
contraceptives
all
these
years
but
now
her
partner
uses
condoms.
She
is
anxious
as
her
aunty
died
of
ovarian
cancer
at
the
age
of
48.
The
single
most
important
factor
which
puts
her
at
risk
of
ovarian
cancer
is?
a.
Age
b.
Family
history
c.
Smoking
d.
CIN
2
e.
Oral
contraceptives
196.
A
30
year
old
lady
presents
with
hyperventilation
and
classical
signs
of
panic
attack.
To
accident
and
emergency
department.
What
is
the
single
most
appropriate
management?
a.
Rebreathe
into
an
airbag
b.
Diazepam
c.
Salbutamol
d.
Morphine
e.
Diclofenac
197.
A
22
year
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,
is
starting
to
have
low
mood,
is
anxious
and
has
not
left
the
house
for
weeks.
He
is
starting
to
drink
increasing
quantities
of
alcohol.
He
is
also
noticed
to
have
thought
block
and
passivity
phenomena.
What
is
the
single
most
suitable
medication
to
treat
his
symptoms?
a.
Diazepam
b.
Disulfiram
c.
Fluoxetine
d.
Lithium
e.
Olanzapine
198.
An
18
month
old
boy
has
been
brought
to
the
emergency
department
because
he
has
been
refusing
to
move
his
left
arm
and
crying
more
than
usual
for
the
past
24
hours.
He
has
been
recently
looked
after
by
his
mother’s
new
boyfriend
while
she
attends
college.
Assessment
shows
multiple
bruises
and
a
fracture
of
the
left
humerus
which
has
been
put
in
a
plaster.
What
is
the
single
most
appropriate
next
step?
a.
Admit
under
the
care
of
a
pediatrician
b.
Discharge
with
painkiller
c.
Follow
up
in
fracture
clinic
d.
Follow
up
in
pediatric
outpatients
e.
Follow
up
with
general
practitioner
199.
A
75
year
old
woman
had
an
emergency
total
hip
replacement
following
fracture
of
the
neck
of
femur.
6
days
post-‐operatively
she
wakes
up
in
the
middle
of
the
night
with
left
sided
chest
pain,
haemoptysis
and
breathlessness.
What
is
the
single
most
appropriate
immediate
management?
a.
Ampicillin
b.
Furosemide
c.
Heparin
d.
Salbutamol
e.
Warfarin
200.
A
mother
has
brought
her
3
year
old
son
to
the
emergency
department
2
hours
after
he
has
taken
an
unknown
quantity
of
paracetamol
suspension.
He
appear
well
and
is
playing
normally.
What
is
the
single
most
appropriate
time
to
measure
his
serum
paracetamol
levels?
a.
Immediately
b.
In
2
hours
c.
In
4
hours
d.
In
8
hours
e.
In
24
hours
GOOD
LUCK
FROM
DR
SAMSON