Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 22ND JUNE 2019 TIME ALLOWED: 3HRS

SINGLE BEST ANSWER

1. A 2 day baby started to have jaundice but is breast feeding well and gaining weight. She is passing
white stool 2-3 times per day. What is the single most likely cause of jaundice?
A. Biliary atresia
B. Haemolysis
C. Physiological
D. Congenital spherocytosis
E. Breast milk jaundice

2. A 2 year old was brought to the accident and emergency, with bruises on the right anterior thigh and
anterior leg. The left ankle was swollen and she refuses to move it. She was crying inconsolably. What is
the investigation of choice?
A. Blood culture
B. FBC
C. Bone marrow aspirate
D. Skeletal survey
E. Coagulation Screen

3. A mother brings her 12 year old son to you requesting surgery for his sticking out ears. The boy says he
does not want surgery. What do you do?
A. Refer to private practice
B. Schedule surgery
C. Contact social services and explore their concerns

4. 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

5. A 34 year old man fell off a ladder and hit his head on the pavement. He now has blood coming out of
his ears and nose. Which bone has he fractured?
A. Maxilla
B. Base of skull
C. Mandible

6. A 26 year old man with history of hereditary haemorrhagictelegectasia. He is planning to start a family.
What is the mode of inheritance?
A. Autosomal dominant with incomplete penetrance
B. Autosomal recessive with incomplete penetrance
C. Autosomal dominant
D. Autosomal recessive

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7. A patient presents with right sided hemiplegia and aphasia. Symptoms resolved in 6 hours. What is the
best scoring method to assess his risk for future stroke?
A. Well’s score
B. CHADS score
C. ABCD2 score
D. CURB 65

8. A 62 year old man presents with cough, breathlessness and wheeze. 24% oxygen, Salbutamol and
hydrocortisone were given. The symptoms have not improved and so nebulised bronchodilator was
repeated and IV Aminophylline was given. ABG showed pH: 7.31 and respiratory rate is 32. What is the
next appropriate management?
A. Nasal intermittent positive pressure ventilation
B. Intubation and ventilation
C. Long acting beta agonist
D. Toxapram
E. Amoxicillin oral

9. A man was brought to A&E department from a shopping mall after collapsing there. He is conscious
and answering questions now. His ECG shows irregular rhythm. Your choice of investigation:
A. CT scan
B. Magnetic resonance imaging (MRI)
C. 24 hour ECG
D. Echo

10. A middle aged man develops constipation with overflow diarrhoea and bright red bleeding per
rectum. Barium enema reveals ulcerative stricture in sigmoid colon. What is the most likely diagnosis?
A. Diverticular disease
B. Ulcerative colitis
C. Crohn's disease
D. Sigmoid carcinoma

11. A man is admitted in a ward and develops varicella zoster after two days. Which of the following
group below should get immunoglobulin only?
A. All staff in contact with the patient
B. All pregnant women who are tested negative for antibodies.
C. All family members
D. None
E. All children

12. Which of the following group of drugs will be treatment of choice for Trigeminal neuralgia?
A. Anti epileptics
B. Anti depressant
C. Opioids
D. Benzodiazepens
E. NSAIDS

13. A 20 years old pop star singer complains of inability to raise the pitch of her voice. She attributes this
to the thyroid surgery she underwent a few months back. What is the most probable diagnosis?

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A. Thyroid Storm
B. Bilateral Recurrent Laryngeal Nerve Injury
C. Unilateral Recurrent Laryngeal Nerve Injury
D. External Laryngeal Nerve Injury
E. Thyroid cyst

14. A child suddenly squats while playing. He is on 70% O2. What is the most probable diagnosis?
A. Tetralogy of Fallot
B. Patent DuctusArteriosus (PDA)
C. Pulmonary stenosis
D. Aortic stenosis
E. Mitral regurgitation

15. What is the best treatment for candidiasis in the throat?

A. Chlorhexidine mouthwash
B. Nystatin suspension
C. Oral Fluconazole
D. IV Metronidazole

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

17. A 6 week old baby is brought to hospital due to vomiting. He was found to have lost 300gm in weight
and to have hyponitraemia, despite feeding well. What is the most appropriate diagnosis?
A. Pyloric stenosis
B. SIADH
C. Viral gastroenteritis
D. URTI

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

19. A 28 years old man presents with sudden onset abdominal pain. He has no significant history apart
from an appendectomy when he was 12. His Abdominal X-ray finding is below.
What is the single most appropriate next step in the management?

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Options:
A. Urgent Laparotomy
B. Urgent Colonoscopy
C. Insert Nasogastric tube
D. High dose Laxatives
E. USG Abdomen

20. An 80 year old woman with few month history of weight loss and dysphagia presented with sandwich
stuck in his throat. What is the most appropriate next step?
A. Barium meal
B. Barium swallow
C. Endoscopy foreign body removal and biopsy

21. A 60 year old man presents with dysphagia and pain on swallowing both solids and liquids. A barium
meal shows gross dilatation of the oesophagus with a smooth narrowing at the lower end of the
oesophagus. What is the SINGLE most likely cause of dysphagia from the given options?
A. Achalasia
B. Myasthenia gravis
C. Oesophageal carcinoma
D. Oesophageal web
E. Systemic sclerosis

22. A 65year old woman had an excision of colonic tumor 3years ago. Now she is losing weight and feels
lethargic. On examination she is pale but has no abdominal findings. What is the most appropriate
investigation?
A. CA 125
B. CA 153
C. CA 199
D. CEA
E. AFP

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23. A 6 months old child presents with cough and fever. What is most appropriate diagnosis?
A. Bronchiolitis
B. Asthma
C. Bronchitis

24. A patient is to be put on 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

25. You are FY2 working in the Orthopaedic department. An 80 year old lady with fracture neck of femur
has been admitted overnight and is on the trauma list today. She needs to be consented but she is
confused. Her daughter lives nearby and is on her way to the hospital. What is the most appropriate action
you will take?
A. Investigate the possible cause of confusion.
B. Phone the theatre to cancel the operation.
C. Inform the operating surgeon about the situation
D. Point to the signature line on the consent form and ask the patient to sign.

26. A child presented with right sided hearing loss. Tuning fork test was done and showed Air conduction
> Bone conduction. Weber test localised to left ear. What is the most appropriate diagnosis?
A. Acute Otitis Media
B. Acute Otitis externa
C. Serous Otitis Media with effusion (glue ear)
D. Otosclerosis
E. Acoustic neuroma

27. A 7 year old child is on inhaled salbutamol. His symptoms are not controlled. What should be the next
step?
A. Add LABA
B. Increase the dose of salbutamol
C. Add a regular, low-dose inhaled steroids
D. Add leukotriene antagonists

28. A 50 year old man has been admitted for investigations for breathlessness and weight loss. He has
been taking thiazide diuretics for hypertension for 2 years. His BP is 150/100mmHg. Investigation shows
Na: 138, K: 2.9, Urea 5.8, Glucose 5.7. What is the single most appropriate management?
A. IV normal saline and insulin
B. IV normal saline and K supplements
C. Plasma expanders
D. Dialysis
E. Oral KCL

29. A patient admitted due to repeated attacks of pancreatitis presents with dementia and loss of
proprioception in the legs. What is the most appropriate treatment?
A. Thiamine E. Antibiotics
B. Pyridoxine
C. Cobolamin
D. Lypase

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30. A young man has been found in the park, drunk and brought to the A&E by ambulance. He recently
lost his job and got divorced. He thinks nurses are plotting against him. What is the most likely diagnosis?
A. Schizoid personality D. Psychotic depression
B. Borderline personality E. Paranoid
C. Schizophrenia

31. A 57 year old man post gastrectomy developed loss of joint position and vibration. What is the most
probable diagnosis?
A. IDA
B. Vit. B12 deficiency
C. Folic acid deficiency
D. Sideroblasticanemia

32. A 10 years old boy is clinically obese and the shortest in his class. He had a renal transplant last year
and his mother is worried that he is being bullied. What is the most probable diagnosis?
A. Cushing’s Syndrome
B. Congenital Hypothyroidism
C. Pseudo Cushing’s Syndrome
D. Lawrence Moon Biedel Syndrome
E. Down’s syndrome

33. A patient had closed tibial fracture. Cast was applied. Four days later, he presented to the clinic with
complaint of pain over fractured area. On examination limb is warm with good pulses. What will you do
next?
A. Remove cast
B. Fasciotomy
C. X- ray
D. Increase analgesics
E. Reassure

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

35. A 46 year old man while in the gym had sudden onset of back pain. He presents at the A&E with
lower back pain. He has been given oral analgesia and now feels better. All examination is normal. What
is the most appropriate advice for him?
A. Bed rest
B. MRI spine
C. CT scan spine
D. Continue moving

36. 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 E. Echo
B. IV 0.9% Saline
C. IV Dextrose
D. ECG

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37. A young man presented with cough, high grade fever and chest pain. CXR shows bilateralcavitating
bronchopneumonia. He was diagnosed with influenza infection a week ago. What is the most probable
cause of his pneumonia?
A. Legionella
B. Mycoplasma
C. StaphylococcusAureus
D. Streptococcus pneumonia

38. A patient with severe pre eclampsia has just delivered a baby at 37 weeks gestation. 20min after
delivery she has her first fit. Her blood pressure is 160/90 mmHg. An IV line is established. What will
you administer?
A. MgSO4 drip
B. Hydralazine
C. Methyldopa
D. MgSO4 bolus dose
E. Calcium Gluconate

39. A 62 year old man has had ano-rectal pain aggravated by defecation for 3days. Rectal exam: purple,
tender lump at the anal verge. Flexible sigmoidoscopy report shows normal rectal mucosa and hard
faeces. What is the best management strategy?
A. Anal hematoma
B. Anal fissure
C. Rectal ca
D. Diverticulitis
E. Angiodysplasia

40. A patient was brought to the emergency department following an RTA. He was diagnosed with
fracture of femur and an ORIF was planned. During anaesthesia, vital signs began to deteriorate following
intubation. What is the most likely cause of this deterioration?
A. Fat embolism
B. Pulmonary embolism
C. Intra-abdominal bleeding
D. Cardiac tamponade
E. Tension pneumothorax

41. A Schizophrenic patient not compliant on oral medication. What is the best long term management?
A. Depot (Risperidone)
B. Depot (Haloperidol)
C. Quetiapine
D. Chorpromazine

42. A 70 year old lady fell down and sustained neck of the femur fracture. Which artery is likely to bleed
from?
A. Femoral artery
B. Circumferential artery
C. Popliteal artery
D. Common iliac artery
E. External ilial artery

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43. A 26 year old lady presents with high fever, lower abdominal pain and purulent vaginal discharge.
She looks very unwell. What is the most appropriate management for this patient?
A. Tetracycline 250mg 6 hourly
B. Doxycycline 100 mg 12 hourly po and Metronidazole 400mg 12 hourly
C. Ceftriaxone 2g 24 hourly I/V with Doxycycline 100mg po
D. Ceftriaxone 2g 24 hourly I/V with Doxycycline 500mg po
E. Ofloxacin 400mg 12 hourly po and Metronidazole 400 mg 12 hourly po

44. A 34 year old man had a 4 mm ureteric stone which he passed with urine. This time he presents with 3
cm stone in a right kidney. What is the single most appropriate treatment?
A. No treatment
B. Lithotripsy-‐shock wave
C. Laparotomy
D. Operative stone removal
E. Observe

45. A 35 year old patient is complaining of severe pain along the right side of the jaw and face. What is
the best choice for this neuralgic pain?
A. Methadone
B. Ibuprofen
C. Carbamazepine
D. Lorazepam
E. Amphetamine

46. A 6 week child is very sick -looking. Blood results show Na :124mmol/l, K: 2.8mmol/l. He is also
dehydrated. What would you chose to resuscitate?
A. 0.18% Normal Saline + 4% Dextrose + 20mmol KCl
B. 0.9% Normal Saline
C. 0.45% Normal Saline + 5% Dextrose
D. 0.45% Normal Saline + 5% Dextrose + 20mmol KCl

47. A 75 year old man complains of prostatism and anorexia. Ultra sound shows bilateral hydronephrosis.
What is the cause of this finding?
A. Prostate carcinoma
B. Benign prostatic hyperplasia (BPH)
C. Hypertension

48. A 62 year old man who has recently had flu- like illness has woken to find his speech altered.
Movement of his eyelids and lips are weak on the right side. Examination is otherwise normal. Which
anatomical site is most likely to be affected?
A. Facial Nerve
B. Hypoglossal Nerve
C. Oculomotor nerve
D. Trigeminal Nerve
E. Glossopharyngeal Nerve

49. A 77 year old man is admitted to hospital for investigation of an irregular heart beat. The conducting
system of the heart includes which one of the following anatomical structures?
A. Atrioventricular node
B. Chordae tendineae
C. Fibrous skeleton of the heart

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D. Interatrial septum
E. Phrenic nerve

50. A 19 year old lady with bilateral iliac Fossa pain, dyspareunia and foul smelling vagina discharge.
Patient looked very unwell.What will be the antibiotics group of choice for management.
A. Ceftriaxone, metronidazole
B. Ciprofloxacin, amoxicillin, metronidazole
C. Ceftriaxone, doxycycline, metronidazole.
D. Ciprofloxacin, doxycycline, metronidazole
E. Ciprofloxacin, amoxicillin, metronidazole

51. A 28 year old pregnant woman with poly-hydramnios and shortness of breath comes for an anomaly
scan at 31 weeks. On ultrasound, there is absence of gastric bubble. What is the most likely diagnosis?
A. Duodenal atresia
B. Oesophageal atresia
C. Gastroschisis
D. Exomphalos

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

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

53. A man with fever, neck stiffness, photophobia, but no raised intra cranial pressure. What will you do
next?
A. Give antibiotics and FBC
B. Give antibiotics and Lumbar puncture
C. Give antibiotics only
D. Give antipyretics and

54. An 18 year old woman says that she can’t walk around as she is very big for that room. What is the
most likely hallucination?
A. Extra-campine visual hallucinations
B. Lilliputian visual hallucinations
C. Alice in wonderland syndrome
D. Hypnagogic hallucinations

55. A patient on insulin is booked in for a hernia operation. What is the most appropriate management of
insulin?
A. Give insulin and saline pre op
B. Stop insulin for the duration of the operation
C. Give intravenous insulin + dextrose + saline pre op
D. Give insulin as usual pre op
E. None

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56. A man brings his wife to see the doctor. He says she has been talking about their private life openly
and is throwing tantrums. Her mood changes quickly and she becomes aggressive. Physical examination
is normal. There is no history of trauma and she is not on any medications. What is the most likely
diagnosis?
A. Huntington’s dementia
B. Lewy body dementia
C. Alzheimer’s dementia
D. Vascular dementia
E. Benign old age related dementia

57. Patient with cardiac problem who takes 8units of alcohol in a week and 20 cigarette in a day. What is
the advice that can be given to the patient?
A. Alcohol group
B. Smoking ceasation group
C. Aspirin

58. A 70 year old man presents with back pain, anaemia and raised calcium. What is the finding on the
marrow aspirate?
A. Increased T cell
B. Reduced plasma B cells
C. Increased Plasma B cells
D. Increase in neutrophils

59. A child presents with history of two weeks of poor feeding, lethargy, facial swelling, oliguria and
proteinuria. What is the appropriate treatment for this child?
A. Prednisolone
B. Cyclosporin
C. Cyclophosphamide
D. Diurectics
E. No treatment needed

60. A 29 year old lady came to A & E with complaints of palpitations that have been there for the past
four days and also feeling warmer than usual. Upon examination her heart rate was 154 bpm and rhythm
was irregular. What is the treatment for her condition?
A. Amiadarone E. Flecainide
B. Beta blocker D. Verapamil
C. Adenosine

61. A 42 year old man presents with stroke, he is not able to walk straight and his speech is slurred. What
is the initial appropriate investigation?
A. CT scan brain E. Monitor for 24 hours
B. PET scan brain
C. MRI (brain)
D. Carotid angiography

62. A boy who was in boarding school, he has cough and fever and rash all over his body. His leukocytes
are not increased. What is the most probable organism for pneumonia?
A. Legionela
B. Mycoplasma
C. Pneumocystis
D. Chlamydia

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63. A lady with depression has a bag full of medicines. She now presents with coarse tremors. Which
drug caused her symptom?
A. Lithium
B. Thyroxine
C. Amitriptyline
D. Sodium valproate
E. Tetrabenazine

64. A 54 year old male builder has fallen off his ladder, hit his head and now presents with bruises over
his right mastoid region. He has no other injuries. There was no loss of consciousness and his GCS is now
15. Which bone is affected in relation to the mastoid area bruising?
A. Parietal
B. Temporal
C. Mandible
D. Ethmoid
E. Frontal

65. A 42 year old man 72 hours after an operation for acute cholecystitis develops vomiting and
abdominal distension. He has no abdominal tenderness. What is the single most likely diagnosis?
A. Paralytic ileus
B. Mechanical obstruction
C. Anastomotic leak
D. Wound adhesions

66. A 40 year old woman with breast cancer and metastasis to brain, CT scan shows localised metastasis
with cerebellar edema. What is the next step in management?
A. Mannitol
B. Dexamethasone
C. Radiotherapy
D. Surgery

67. A man is brought to A&E after he was stabbed in the chest. Chest is clear bilaterally with muffled
heart sounds. Blood pressure is 60/40mmHg. Pulse is 120 bpm. JVP is raised. What is the most probable
diagnosis?
A. Pulmonary Embolism
B. Cardiac Tamponade
C. Pericardial Effusion
D. Hemothorax
E. Pneumothorax

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

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69. A 73 year old man who was a smoker has quit smoking for the past 3 years. He now presents with
hoarseness of voice and cough since past 3 weeks. On X-ray a mass is visible in the mediastinum. What is
the best investigation to confirm the diagnosis?
A. Bronchoscopy
B. Thoracoscopy
C. USG
D. CT Thorax
E. Lymph node biopsy

70. 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

71. A 65 year old female patient was given Tamoxifen, which of the following side effect caused by it
will concern you?
A. Fluid retention
B. Vaginal bleeding
C. Loss of appetite
D. Headache and dizziness

72. A 55 year old woman suffered from acute myocardial infarction 5 days ago, while in hospital the
patient developed features of pulmonary oedema and heart failure. What is the most probable cause of her
present condition?
A. Ventricular Septal Defect (VSD)
B. Rupture papillary muscle
C. Pericarditis
D. Atrial fibrillation
E. Re-infarction

73. A 65 year old woman complaining of symptoms suggestive of Reynaud’s phenomena and difficulty in
swallowing. O/E she has painful lesions on her finger tips and facial telangiectasia. What is the single
most likely positive antibody?
A. Anti Jo 1
B. Anti Scl 70
C. Anti Ro
D. Anti Ds DNA

74. Patient in the post surgical ward develops calf pain and redness following open reduction and internal
fixation of fracture of the femur sustained after an RTA. What is the most likely cause of his symptoms?
A. Fat embolus
B. DVT
C. Cellulitis
D. Reaction to drugs

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75. A 70 year old man with lung cancer presents with a cough. He is already on codeine, steroid and
salbutamol inhalers. What is the single most appropriate management?
A. Nebilised adrenaline
B. 0.9% saline nebulized
C. Oral morphine
D. Antibiotics
E. Benzodiazepine

76. A 2 year old boy with 38.4°C fever had an episode of tonic clonic seizure at home that lasted for 15
minutes. In A&E patient is conscious and fit has stopped. When temperature was checked, it was normal.
What is most probable diagnosis?
A. Febrile convulsion
B. Infantile spasm
C. Absence seizure
D. Grandmal Epilepsy
E. Focal seizure

77. A 60 year old man was brought in by his wife complaining of ataxia, urinary incontinence and erectile
dysfunction. He also complains of rigidity and slowing of movement with a pill-rolling tremor of the
hands. What is the most likely diagnosis?
A. Parkinson's Disease D. Huntington's disease
B. Idiopathic Parkinson's Disease
C. Shy-Drager Syndrome

78. A 57 year old man, who is a known hypertensive, is on oral anti-hypertensives. However, he is
finding it difficult to mobilise as he feels dizzy whenever he tries to get up. What is the most appropriate
investigation for him?
A. Ambulatory blood pressure
B. Electrocardiogram (ECG)
C. Magnetic resonance imaging (MRI)
D. Chest X ray
E. CT scan

79. A 37 year old infertile lady with 5cm subserosal and 3 cm submucosal fibroid. She is trying to get
pregnant, management?
A. Clomifene therapy E. Intra uterine insemination
B. IVF
C. Myomectomy
D. Hysterectomy

80. A 58 year old man is scheduled to have anterior resection of rectal Ca. What is the most appropriate
preoperative antibiotic management?
A. Give IV antibiotics 24hr prior to surgery
B. Give broad spectrum antibiotics a dose before induction of anaesthesia.
C. Perioperative rectal therapy
D. No treatment needed

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81. A 50 year diabetic patient is going to undergo an endoscopy. He is on oral hypoglycemic medications.
What is the single most appropriate management plan?
A. Stop medications 1 week before
B. Stop medications in the morning of procedure
C. Stop medications one day before the procedure
D. Stop medications 3 days before the procedure

82. A drug addict has bitten a police officer. What would you advise the police officer?
A. HIV serology
B. Hepatitis & HIV serology
C. No test required at this stage
D. Tetanus toxoid

83. A young man has been brought to the hospital after being hit on the head by a metal rod. On
evaluation his GCS is 7. What is the best next step?
A. CT scan
B. MRI
C. PET scan
D. Call anaesthetist
E. Refer to a neurosurgeon

84. A 2week old girl presents with E-coli which is confirmed by urine culture. What is themost
appropriate next investigation?
A. US
B. Intravenous Urography
C. CT kidney
D. X ray KUB
E. MCUG

85. A 16 year old girl presents with heavy regular periods. What is the single most appropriate treatment?
A. Combined oral contraception
B. Progesterone only pill
C. Trenexemic acid
D. Mefenemic acid
E. Levenogrel intrauterine system

86. 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

87. When prescribing an SSRI, what will you warn the patient about its time 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

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88. 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

89. A woman was in labour with amniotic fluid drainage for 48hrs before delivery at 36wks gestation.
Child presents with respiratory distress and flaring of Alaenasi, what investigation will you do before you
start treatment?
A. Chest X ray
B. Blood culture
C. FBC
D. Electrolytes

90. A 70 year old man has been brought in by his wife. She says he has been losing his temper, is
aggressive and talks about their sex life with strangers. He does not agree with her and says he does not
know who she is. What test would you like to do?
A. EEG
B. ECG
C. MMSE
D. CT scan
E. MRI

91. A 55 year old man presented to the A and E with complains of calf muscle tendernes. On examination
the bulk of the muscle had decreased on the right side and also the foot was cold. Further examination
revealed no distal pulses palpable and also absent popliteal and femoral pulse. What is the level of the
occlusion?
A. Ext Illiac artery
B. Internal Illac artery
C. Inguinal artery
D. Abdominal Aorta
E. Common iliac artery

92. A 70 years old patient has a large gall stone which was an incidental finding. What will be the
management?
A. Medical management
B. Endoscopic Retrograde Cholangio-. Pancreatography( ERCP)
C. Magnetic resonance cholangiopancreatography (MRCP)
D. Symptomatic management
E. Laparoscopic removal of gall stone
F. Laparotomy and removal of gall stone

93. A man with a family history of panic disorder is brought to the hospital with palpitations, tremors and
sweating and muscle tightness on three occasions in the last six weeks. He does not complain of headache
and his blood pressure on each presentation is within normal limits. What is the single most appropriate
long term treatment for this patient?
A. Diazepam
B. Olanzapine

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C. Haloperidol
D. Fluoxetine
E. Alprazolam

94. Which is the correct statement regarding febrile seizures.

A. Most cases will resolve by the age of 6 years
B. All cases will progress to epilepsy
C. There is some learning difficulty later in life
D. A child can have a febrile fit only once

95. A 34 year old patient presented with redness and pain in the eye. He is also suffering with back pain
that is worse in the morning. He is taking NSAIDs for back pain. What is the cause of red eye?
A. Ibuprofen
B. Steroids
C. Anterior Uveitis
D. Posterior Uveitis
E. Trauma

96. A 55year old woman with breast ca which has spread to lung, liver and bone now presents with
increasing constipation, weakness, thirst and anorexia for the past 3days. Her only medication is
haloperidol for hiccoughs. Today she is disorientated and has left sided weakness. What is the
most likely diagnosis?
A. Brain metastasis
B. Hypercalcemia
C. Liver failure

97. A 56 year old man presents with progressive dysphagia to solids, weight loss, and anaemia. Which is
the most diagnostic investigation?
A. Oesophageal manometry
B. Barium meal
C. Gastroscopy
D. CT scan

98. A 14 year old boy with asthma suddenly developed chest pain and increasing breathlessness during a
game of football. When seen in the Emergency Department he was not cyanosed. He has reduced breath
sounds on the right side. His oxygen saturation is 94% on air. What is the SINGLE most appropriate
investigation?
A. Capillary blood gases
B. Chest x-ray
C. CT scan of the chest
D. Exercise challenge
E. MRI of the chest

99. A 4 year old boy is brought by his parents with complains of wetting his bed at night and whenever he
gets excited. What would be the most appropriate management for this child?
A. Desmopressin
B. Oxybutynin
C. Behavioural Therapy
D. Tamsulosin
E. Restrict fluid intake

16
100. A 45 year old patient was bought to the A and E with complaints of breathlessness. He was
diagnosed with Asthma and was on medications. He was given salbutamol inhaler and steroid along with
100% oxygen. What is the next step of management?
A. Continue asthma
B. Salmetrol
C. Beclometasone
D. IV Aminophylline
E. Iv MgSo4

101. Among the risk factors given, which one will most likely enhance a woman’s chances of getting
ovarian cancer?
A. Family history
B. Previous history of breast cancer
C. Environmental factor
D. Young age
E. Nulliparity

102. A 32 year old man presents with lateral deviation of his right eye. Which nerve is affected?
A. Left trochlear
B. Left oculomotor
C. Right trochlear
D. Right abducens
E. Right oculomotor

103. 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

104. 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

105. A 3 year old girl was playing with her brother when she fell off her bicycle. She was about to cry but
fell unconscious without making any sound. She regained consciousness within 10 seconds and was
normal. The mother says similar episodes have happened in the past and she was afraid her daughter as
going to die. What is the appropriate investigation?
A. 24 hour EEG
B. CT scan
C. No investigation needed
D. MRI
E. Neuropsychological examination

17
106. A 55 year old male presents to the accident an emergency after an RTA with breathlessness,
engorged neck veins and a dull percussion note on the right side of his chest. On examination his pulse is
140bpm and BP is 80/50mmHg, what is the most likely diagnosis?
A. Haemothorax
B. Haemopneumothorax
C. Tension pneumothorax
D. Simple pneumothorax

107. A 17 year old male complains of fever and generally feeling unwell. On examination widespread
lesions on trunk were noticed. Lesions did not look the same everywhere, they were in various stages,
some of them were scabbed. What is the most likely diagnosis?
A. Herpes zoster
B. Varicella zoster
C. Impetigo
D. Psoriasis
E. None of the above

108. Man presented with acute myocardial infarction and was managed at the coronary care unit. On the
way to the wards his left toe was hot, red and swollen. What medication caused this?
A. Aspirin
B. Dalteparin
C. Diamorphine
D. Furosemide
E. Ramipril

109. A 10 year old male child was brought by his mother complaining that her child watches TV at very
high volume, doesn’t like to play out and instead has become more sincere with reading. She also says
that her son does not respond to her. What do you expect to see on otoscopy?
A. Flamingo pink Tympanic Membrane
B. Attic perforation
C. Bluish grey Tympanic membrane with air fluid levels
D. Inflamed tympanic membrane with cart wheel appearance of vessels
E. Red and inflamed tympanic membrane

110. A 7 year old boy is brought in by his mother. She is concerned that he does not have any friends at
school and is not doing well in his studies. He only likes to collect toy cars of which he has 2000. He does
not understand emotions and has poor interaction with his siblings. He gets angry and throws tantrums if
his daily routine is changed. What is the most likely diagnosis?
A. Schizophrenia
B. Depression
C. Autism spectrum disorder
D. Tourette’s syndrome
E. Alice in Wonderland syndrome

111. A 40 year old woman requests post coital contraception. Her condom broke 36 hours ago. On 7th
day of regular 29th day of cycle this is her 2nd condom accident in 2 months. She has tried OC pills but
stopped it 6 months ago because of concerns about weight gain. She is undecided about future
contraceptive use. Her pregnancy test is -ve. Which is the most effective form of contraception for her?
A. OC pills D. IUCD
B. POP pills
C. IUS or Mirena coil

18
112. A middle aged plumber, who is a known case of COPD and has a history of smoking, presents with
breathlessness and chest pain on inspiration. CXR shows :
What is the most likely diagnosis?
A. Heart failure
B. Bronchiectasis
C. Pulmonary edema
D. Mesothelioma.

113. A 24 year old man presented to the A and E with swelling in his left scrotum. On examination he is
afebrile and he has a left swollen non tender testis that is firm and irregular. Some lymphadenopathy is
also appreciated. Which group of lymph nodes will be involved?
A. External iliac
B. Internal iliac
C. Inguinal
D. Para aortic
E. Pre aortic

114. Patient had all signs of cerebello-pontine angle (CPA) tumour facial numbness, tinnitus and vertigo.
What is the best investigation?
A. CT scan
B. MRI Brain
C. MRI Head
D. X-ray head

19
115. 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

116. A 67 year old man presents to the A&E with pain in his left groin. He suddenly collapses and he is
not able to move or lift his leg. He is on Alendronate. What is the diagnosis?
A. Fracture of neck of femur D. Pelvic base fracture
B. Posterior hip dislocation E. Peripheral vascular disease
C. Fracture of shaft of femur

117. A 40 year old woman presents to the GP with low mood. Of note, she has an increased appetite and
has gone up to two dress sizes. She also complains that she cannot get out of bed until the afternoon.
What is the most likely diagnosis for this patient?
A. Pseudo Depression
B. Moderate Depression
C. Severe Depression
D. Dysthymia
E. Atypical Depression

118. A patient has back pain at the level of iliac crest. What is the level of vertebrae?
A. L1
B. L2
C. L3
D. L4
E. L5

119. A 45 year old lady presented with weakness in left half of the body that resolved after two hours. Ct
scan showed area of reduced blood flow. What is the next best investigation?
A. Echo
B. Carotid Doppler plus angiography
C. Glucose
D. Lipids
E. ECG

120. Patient with history of recurrent breast abscess for 2 years. Now presents with a swelling and
purulent discharge from the breast with induration, located between the nipple and areola. What do you
think the patient is suffering from?
A. Breast abscess
B. Mammary duct Fistula
C. Duct ectasia
D. Duct papilloma

121. Patient with CA head of pancreas, what structure is directly affected?

A. Common bile duct
B. Pylorus
C. Kidney
D. Liver

20
122. A 20 year old woman has had abdominal pain in the left iliac fossa of 6 weeks duration. Over the
past 48 hours, she had had severe abdominal pain and fever of 39.C. Pelvic ultrasound shows a complex
cystic 7cm mass in the left iliac fossa. What is the most likely diagnosis?
A. Endometriosis
B. Dermoid cyst
C. Ovarian carcinoma
D. Tubo-ovarian abscess
E. Ectopic pregnancy

123. A 56 years old lady presents with hot flushes. 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

124. A 2 year old girl previously well, presents with a history of vomiting and diarrhoea for 48 hrs. What
is the most suitable indication for IV fluid administration?
A. Capillary refilling time > 4secs
B. HR > 90/min
C. Increased RR
D. Stools > 10 times/ 24hrs
E. Weight of child 10kg

125. A 36 week pregnant woman presents with sudden onset of uterine pain and bleeding, uterus is
tender, no previous LSCS. What is the most appropriate cause?
A. Preclampsia E. Ectopic pregnancy
B. Disseminated intravascular coagulation (DIC) F. Missed abortion
C. Placental abruption G. Ectropion
D. Placenta-previa

126. A 12 years old boy with a history of fall on an outstretched hand was brought to A&E with swelling
and pain around the elbow. His radial nerve was affected. What type of fracture is it?
A. Angulated fracture
B. Epiphyseal fracture
C. Compound fracture
D. Spiral fracture

127. A 65 years old woman has being having tinnitus for more than 6 months. Each episode lasts more
than 30 seconds and occurs whenever she rotates in her bed. Choose the most appropriate investigation
that will assist you in making a diagnosis.
A. Caloric test
B. Hallpike test
C. Audiometry
D. CT head

128. Patient with myocardial infarction now presents with breathlessness, bi-basal crepitations. ECG is
normal. What is the most likely cause of his symptom?

21
 A. Pulmonary embolism
B. Pulmonary oedema
C. Pneumothorax
D. Haemothorax
E. Mitral regurgitation

129. A known COPD patient presented to the hospital with complains of persistent cough, copious
sputum production and intermittent hemoptysis. On examination, finger clubbing and coarse inspiratory
crepitations were observed. What is the most probable diagnosis?
A. Lung cancer
B. Cystic fibrosis
C. Bronchiectasis
D. Pulmonary edema
E. Lung abscess

130. A 32 year old woman has given birth 2 weeks ago to a healthy baby girl. She feels low in mood and
feels she cannot care for the baby. She says the world does not have enough food to feed itself so she
must not breastfeed her baby. She feels her husband is trying to poison the baby. What is the most likely
diagnosis?
A. Baby blues
B. Post partum depression
C. Post partum psychosis
D. Delirium
E. Mania

131. A patient has amenorrhea for last 6 months. Previously she was taking COCP pills. Her LH : FSH
ratio is 1:1. What is the most probable diagnosis?
A. Post pill amenorrhea
B. PCOS
C. Hypothalamic amenorrhea
D. Premature ovarian failure

132. Patient having pansystolic murmur at apex radiating to the axilla on the next day after MI with low
BP. What is the most likely cause?
        A. Ventricular aneurysm
        B. Papillary muscle rupture
        C. VSD
        D. Pericarditis
        E. Aortic stenosis

133. 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

22
134. A 46 year old woman is brought to A&E after falling in bathroom while painting. She is drowsy and
gives history of sudden severe headache at the back of the head prior to the fall. What investigation would
be best choice in this case?
A. Carboxy haemoglobin
B. MRI head
C. CT Head
D. Lumbar puncture
E. Skull X-ray

135. A 63 years old female is noted to have left pupil irresponsive to light and is dilated. What is the
most probable diagnosis?
A. Pontine hemorrhage
B. Subdural hemorrhage
C. Cerebellar hemorrhage
D. Extradural hemorrhage
E. Sub arachnoid hemorrhage

136. A 7 year old boy has clean wound on his foot. He has no past history of immunisation. His parents
are scared that he might get some disease. His wound has been cleaned and dressed. What is the next step
in management?
A. Reassure
B. Tetanus toxoid and immunoglobulin
C. Full course of DPT
D. Tetanus Immunoglobulin only

137. A 62 year old female who had an episode of postmenopausal bleeding PV was sent for a TV USG.
Endometrial thickness was found to be 7mm. What is the next best step in management?
A. Total hysterectomy
B. Laparoscopy
C. Hysteroscopy and Endometrial biopsy
D. Pipelle’s endometrial sampling
E. MRI of pelvis

138. A 65 year old man with recently diagnosed myocardial infarction developed atrial fibrillation. On
examination he had a pulse of 240 bpm and BP 90/60mmHg. What is the most appropriate next step?
A. DC Cardio version
B. IV Adenosine
C. IV Amiodarone
D. IV Digoxin

139. 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.
All these symptoms were worst particularly in the mornings. What is the most likely diagnosis?
A. Sinusitis
B. Tension headache
C. Space occupying lesion
D. Cluster headache
E. Acute angle closure glaucoma

140. 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?

23
A. Epididymal Cyst
B. Testicular cancer
C. Hydrocele
D. Teratoma
E. Testicular torsion

141. An 80 years old lady was found on the floor by her daughter, brought to the A&E. She was
unconscious, unable to walk unaided, horizontal nystagmus was noticed. She was being treated for
depression, osteoporosis and epilepsy. The daughter doesn't know which medications her mother is on.
What is the most probable cause of her symptoms?
A. Alcohol
B. Aspirin
C. Digoxin
D. Phenytoin

142. 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

143. A Patient with several anal fistulae, abdominal pain, stool with mucus and blood. What is the
definitive investigation to make a diagnosis?
A. Pelvic MRI
B. Colonoscopy
C. Stool culture
D. Barium swallow

144. A 14 year old girl suffers from hay fever which bothers her school attendance and performance.
What is the best treatment option?
A. Oral steroids
B. Topical steroids
C. Oral Antihistamines
D. Topical antihistamines
E. Adrenaline IM

145. A 55 year old man has been on long term steroids for rheumatoid arthritis. What other drug should
he be given?
A. VitB12
B. VitD
C. Betablocker
D. Alendronate

146. A 49 year old woman presents to the Out Patient Clinic. Her oral glucose test, after 2 hours of
glucose intake, versus plasma level in 2 different tests are 6mmol/L and 10mmol/L. This situation can be
categorized as :
A. Impaired glucose tolerance
B. Impaired fasting glucose
C. Diabetes Mellitus Type I

24
D. Diabetes Mellitus Type II
E. Metabolic syndrome

147. 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

148. A 31 year old woman who is 32 weeks pregnant attends antenatal clinic. Her blood result shows Hb
10.7 and MCV 91. What is the most appropriate management for this patient?
A. Folate supplement
B. Ferrous sulphate 200mg/24 Po
C. Iron dextran
D. No treatment required

149. A 45 year old man was trapped under a rock for 4 hours. He then presents with red urine and renal
failure. What is the most appropriate treatment?
A. Urgent dialysis
B. Fluid challenge
C. Glucose and insulin
D. Dobutamin
E. Antibiotics

150. A 40 year old man is having bilateral hilar lymphadenopathy on the CXR. She has rash on each shin
and his calcium is found to be high. Which of the following test is appropriate to perform in this patient.
A. Lymphnode biopsy
B. U&E
C. Angiotensin converting enzyme
D. Serum creatinine

151. A 40 years old lady complains of 10 months amenorrhoea. She presents with hot flush, mood
swings, irritability and insomnia. What will be the single most effective diagnostic test for this lady?
A. Serum FSH and LH E. Serum cortisol
B. Serum FSH
C. Serum Progesterone
D. Serum estradiol

152. An 8year old boy with a BMI=28 was admitted to a surgical ward following a Motor Vehicle
Accident. He was found to have glycosuria. When he recovered from his injury the glycosuria resolved.
What is the single most appropriate follow-up investigation?
A. Fasting blood glucose conc
B. Glycosylated hemoglobin - HbA1c
C. OGTT
D. Random blood glucose conc
E. Serum cortisol conc

25
153. A child comes to the A&E with severe asthma, has vomited several times and is not responding to
salbutamol nebulizer.What is the most appropriate management?
A. Salmetrol
B. Montelukast
C. Prednisolone
D. Budesonide inhaler
E. Oxygen
F. IV Salbutamol

154. Patient with jaundice who had test showing IgG Hep A is positive. Which other test will be
appropriate to do?
A. Hep A IgM
B. Hep B surface antigen
C. Hep B core antibody
D. Hep C testing

155. A 2 year old child was found to have meningitis. The child recovered well. He was not resuscitated.
What would be the expected outcome of the child?
A. Goes back to normal status like before theillness.
B. Hearingloss
C. Visualloss
D. Mental stateretardation
E. Hemiparesis

156. 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

157. A 12 year old boy leaks urine all the time. He has history of spina bifida. What is theappropriate
management?
A. Intermittent catheterisation
B. Desmopressin
C. Condom catheter
D. Urinary incontinence pad

158. A 20 year old lady is suffering from fever and loss of appetite. She has been diagnosed with
Toxoplasmosis. What is the treatment for Toxoplasmosis?
A. Pyrimethamine
B. Pyrimethamine plus Sulfadiazine.
C. Clindamycin
D. Spiramycin
E. Trimethoprim and Sulfamethoxazole
D. Chest xray

26
159. 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

160. A 21 year old girl who is sexually active presents with small painful multiple genital ulcers. Which
of the followings maybe useful topically as an initial treatment for her condition?
A. Acyclovir
B. Amantadine
C. Ritonavir
D. Trifluridine
E. Foscarnet

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

162. A mother brings her 2 days old baby worried she could be deaf. The mother is deaf herself and thee
is family history of deafness as well. What is the single most appropriate investigation?
A. Brainstem evoked response
B. Distraction
C. Tuning folk tests
D. Startle reflex.
E. Audiogram

163. A man undergoes a pneumonectomy, and after the surgery, investigations show hyponatremia. What
could be the cause of the biochemical changes?
A. Removal of hormonally active tumour
B. Excess dextrose
C. Excess colloid
D. Excessive Potassium
E. Hemo-dilution

164. A 50 year old man with worsening dyspepsia, on PPI and previously treated for duodenal ulcer.
Endoscopy showing gastric, duodenal and oesophageal ulcers. What is the investigation of choice?

27
A. CT abdomen
B. Test for H pylori
C. Endoscopy with biopsy
D. Barium study
E. Serum gastrin levels

165. A 30 year old pregnant lady presents with 175/90 mmHg. Has previous history of recurrent UTI.
Urine dipstick show proteinuria ++. She is 10 weeks pregnant. What is the most likely cause of
hypertension?
A. Pregnancy induced hypertension
B. Essential hypertension
C. Chronic pyelonephritis
D. Chronic glomerulonephritis

166. What is the minimum age for consent ?

A. 14 years
B. 15 years
C. 16 years
D. 18 years

167. A 23 year old female has repeated admissions to A& E department for self-harm. She denies trying
to commit suicide. What is the best treatment option for her?
A. Flooding
B. Desensitization
C. Token economy
D. Problem focused cognitive behavioural therapy
E. Thought stopping

168. A 23 year old pregnant lady presents with tingling and numbness in her right hand. She has been
bothered by it but lately she has discovered that shaking her hand relieves the symptoms. The
neurosurgeon has offered her a surgical option. What structure would he want to cut ?
A. Common flexor sheath
B. Flexor retinaculum
C. Flexor carpi ulnaris
D. Flexor carpi radialis
E. Extensor retinaculum

169. A 33 year old female complains of diplopia on upright gaze. On examination ptosis can be seen.
There are no other complains or any significant past medical history. What is the most appropriate
investigation for this patient?
A. Ophthalmoscopy
B. Visual field test
C. Thyroid function test
D. CT scan
E. Checking red reflex

170. A 23 year old man has been stabbed in the back and has shortness of breath. The trachea is deviated,
he has engorged neck veins and absent breath sounds on the right. What is the most appropriate
diagnosis?

28
A. Tension pneumothorax
B. Cardiac tamponade
C. Simple pneumothorax
D. Haemothorax
E. Pleural effusion

171. A 30 year old lady taking COCP pills is on amoxicillin tablets for a week. What advice would you
give to the patient?
A. Stop COCP and continue amoxicillin
B. Use condom for a week
C. Use condom for 2 weeks
D. No precaution required

172. A 12 year old girl when playing in the garden accidentally stepped on a hive and was bitten several
times. She has numerous wheals on her body and complains of severe itching. What is the SINGLE most
appropriate management?
A. Oral antihistamine
B. IV antihistamine
C. IM adrenaline
D. Oral Ciprofloxacin
E. Reassurance

173. A 31 year old primigravida who is into her 36th week of pregnancy was diagnosed with pregnancy
induced hypertension during her 16th week of gestation. She was brought with complaints of headache
and severe epigastric pain following which she threw a fit in the labor room. Once her fit was controlled
after administration of 4 gms of MgSO4, she was started on a maintenance dose when she threw another
fit .From the given options, choose your next line of management?
A. Deliver the baby
B. Another infusion of MgSO4 4gms
C. Continue Labetalol with IV MgSO4 2 gms bolus
D. Start her on sodium valproate.

174. A young man is brought to the hospital with a history of fall and hitting his head on the pavement
after excessive drinking. His friends say he lost consciousness after the fall but did not have any other
symptoms. At the moment he appears completely fine, talkative and is determined to go home. What is
the next step in the management of this patient?
A. Reassure
B. CT and discharge
C. Check Blood glucose levels
D. Admit for observation

175. A man presents with massive hepato-splenomegaly and pancytopenia which investigation would be
diagnostic?
A. Bone marrow biopsy
B. FBC
C. Lymph node biopsy
D. CT

29
176. 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

177. 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

178. 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

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

180. A 6 week old male baby vomits after feeding. Tummy is noted to be distended after feeding. On
examination, baby is lethargic with poor weight gain and an Olive shape mass is found on the right side
of tummy. What will be the SINGLE most likely diagnosis?
A. Gastroesophageal Reflux
B. Pyloric Stenosis
C. Intussusception
D. Duodenal Atresia
E. Volvulus

30