1700 MOCK

1. A 6yo boy has completed an induction course of chemo for ALL. He has an enlarged left scrotum.
What is the most appropriate next step?
a. Herniotomy
b. CT abdomen
c. Biopsy
d. Immediate surgery
e. Reassurance

2. A 2yo child aspirated a foreign object which was removed at the hosp. the parents are now asking
how to remove it if that ever happens at home. What
do you advise?
a. Heimlich manoeuvre
b. Bring to the hospital
c. Turn the child on his back and give thumps
d. CPR
e. Remove manually by fingers

3. A child playing with toys suddenly develops breathlessness and stridor. Which investigation will
lead to the dx?
a. Laryngoscopy
b. CXR
c. Peak flow meter
d. ABG
4. A child born at 36wks developed difficulty in breathing with intercostal recession and nasal
flaring. His temp is normal but his mother had PROM 48h ago. What is the
most likely inv that will lead to tx?
a. Blood culture
b. CXR
c. Stool culture
d. Sputum culture

85. A 6yo child presents with edema and mild proteinuria. No hematuria. What is the most likely dx?
a. PSGN
b. Membranous GN
c. Minimal change GN
d. RPGN

6. A 2yo girl presents with a 4d hx of fever that started with a cough. Her RR=45bpm, sat=94%,
temp=38.9C, capillary refill time=1s. There are crepitations at the left base on auscultation. Urine
shows negative dipstick. What is the single inv most likely to lead to dx?
a. Blood for C&S
b. ESR
c. CXR
d. Urine for C&S
e. CSF analysis
7. A 6m boy is admitted with persistent irritability. He is lethargic and is not feeding as well as
usual. His RR=30bpm, sat=97%, temp=38.0C, capillary refill time=2s. Urine reveals leucocytes on
dipstick. What is the single inv most likely to lead to dx?
a. Blood for C&S
b. ESR
c. CXR
d. Urine for C&S
e. CSF analysis

8. A 2yo child presents with severe vomiting. Exam: mass felt in abdomen. What inv is most
appropriate?
a. US
b. XR
c. CT
d. CBC

9. A mother is concerned because her 1m boy has a swelling in his scrotum. He was born
prematurely. On examination, the swelling is seen to transilluminate. The likely cause is?
a. Lymphogranuloma Venereum
b. Testicular Torsion
c. Hydrocele
d. Epididymitis
e. Seminoma
f. Mature teratoma
g. Varicocele
h. Lymphoma
i. Orchitis
j. Spermatocele
10. A 10yo male child was brought by his mother complaining that her child watches TV at very high
volumes, doesn’t like to play outside and instead has become more sincere with reading. She also
says that her son doesn’t respond to her. What do you expect to see 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

11. A 45yo woman undergoing tx for RA for the last 5yrs presents with dizziness, easy fatigabiliy and
lack of energy. A blood film shows MCV 106. What could be the most probable reason for her
anemia?
a. Steroids
b. Chronic disease
c. NSAIDs
d. Methotrexate
e. Sulfasalazine

12. A 5yo boy has cough and swelling at the knee after falling on the ground with rashes on the
buttocks which are non-blanching. PT=13, APTT=71, Hgb=11, WBC=8, Plt=200. Choose the most likely
dx?
a. NAI
b. Hemophilia
c. HSP
d. Osler weber rendu syndrome
e. Von-Willebrand disease
13. A 6yo came with full thickness burn. He is crying continuously. What is the next step of
management?
a. Refer to burn unit
b. IV fluid stat
c. Antibiotic
d. Analgesia
e. Dressing

14. . A 15m child is due for his MMR vaccine. There is a fam hx of egg allergy. He is febrile with acute
OM. What is the single most appropriate action?
a. Defer immunization for 2wks
b. Don’t give vaccine
c. Give half dose of vaccine
d. Give paracetamol with future doses of the same vaccine
e. Proceed with standard immunization schedule

15. . A 3m baby was miserable and cried for 2h following his 1st routine immunization with DTP, HiB
and meningitis. What is the single most appropriate action?
a. Defer immunization for 2wks
b. Don’t give vaccine
c. Give half dose of vaccine
d. Give paracetamol with future doses of the same vaccine
e. Proceed with standard immunization schedule
16. A 10yo boy is taken to his GP by his parents with behavioural problems. He attends a special
school
due to inappropriate behaviour and during the interview with his parents the boy barks at
infrequent episodes and shouts expletives. What is the most likely dx?
a. Asperger syndrome
b. Cotard syndrome
c. Rett syndrome
d. Ekbom syndrome
e. Tourette’s syndrome

17. A 2 yo pt presents with colicky pain which radiates from loin to groin. He complains of similar
episodes in the past. Inv has been done and 7mm stone was found in the ureter. What is the most
appropriate management?
a. Percutaneous nephrolithiotomy
b. Open surgery
c. Ureterscopy or laser
d. Conservative tx
e. ESWL

18. A child presents with blue marks on the sclera, short stature and heart murmur. What is the dx?
a. Osteogenesis imperfect
b. Hypopituitarism
c. VSD
d. Achondrogenesis
e. Dwarfism
19. 11m baby had an apnea event. The parents are worried that if something like this happens in the
future, how they are to deal. Advise them about infant CPR.
a. Index and middle finger compression
b. Compression with palm of one hand
c. Compression with palm of two hands
d. Compression with rescue breaths 30:2
e. Compression with rescue breaths 15:2

20. A 7yo is brought by his mother who says that he was well at birth but has been suffering from
repeated chest and GI infections since then. She also says that he is not growing well for this age.
What is the likely condition of this child?
a. CF
b. SCID
c. Primary Tcell immunodeficiency
d. Primary Bcell immunodeficiency
e. Malabsorption

21. A woman who returned from abroad after 3 weeks of holiday complains of severe diarrhea of 3
weeks. She also developed IDA Iron Deficiency Anaemia and folic acid def. What condition best
describes her situation?
a. Jejunal villous atrophy
b. Chronic diarrhea secretions
c. Malabsorption
d. Increased catabolism
e. Increased secretions of acid
22. A 45yo man with posterior gastric ulcer presented with severe excruciating pain which subsided
after conservative treatment. 10 days later he developed swinging pyrexia. US shows a collection in
the peritoneum. What will be the most likely location of the collection?
a. Hepatorenal puch
b. Left paracolic gutter
c. Subphrenic
d. Pelvic cavity
e. Lesser sac

23. A 35yo man presents with hx of dyspepsia. H.Pylori antibodies are negative. No improvement is
seen after 1m of tx. What is the next step?
a. Urea breath test
b. Gastroscopy
c. CT
d. MRI

24. A 22yo woman with longstanding constipation has severe ano-rectal pain on defecation. Rectal
exam: impossible due to pain and spasm. What is the
most probable dx?
a. Anal hematoma
b. Anal fissure
c. Anal abscess
d. Protalgia fugax
e. Hemorrhoids
25. A 3yo child who looks wasted on examination has a hx of diarrhea on and off. The mother
describes the stool as bulky, frothy and difficult to flush. What is the single inv most likely to lead to
dx?
a. Sweat chloride test
b. Anti-endomysial antibodies
c. LFT
d. US abdomen
e. TFT

26. A 45yo woman has had severe epigastric and right hypochondrial pain for a few hours. She has a
normal CBC, serum ALP is raised, normal transaminase. 3 months ago she had a cholecystectomy
done. What is the most appropriate inv?
a. US abdomen
b. ERCP
c. MRCP
d. CT abdomen
e. Upper GI endoscopy

27. A young woman complains of diarrhea, abdominal cramps and mouth ulcers. AXR shows
distended transverse colon with goblet cell depletion on rectal biopsy. What is the most
probable dx?
a. CD
b. UC
c. Bowel Ca
d. Bowel obstruction
e. IBS
28. A 28 yo female presents with a 3m hx of diarrhea. She complains of abdominal discomfort and
passing stool 20x/day. Exam=febrile. Barium enema shows cobblestone mucosa. What is the most
likely dx?
a. Ameoba
b. Colon Ca
c. GE
d. CD
e. UC

29. An old lady 72yo staying at a nursing home for a few years, a known HTN on reg tx presented with
sudden dysphagia while eating with drooling of saliva and req urgent inv. What would be your next
step?
a. Ba swallow
b. Chest CT
c. Endoscopy
d. Laryngoscopy
e. CXR
f. Endoscopy with biopsy

30. A 68yo male presented with swelling in the lower pole of the parotid gland for the last 10yrs.
Exam: firm in consistency. What’s the most probable dx?
a. Pleomorphic adenoma
b. Adenolymphoma
c. Mikulicz’s disease
d. Parotiditis
e. Frey’s syndrome
31. A child complains of RIF pain and diarrhea. On colonoscopy, granular transmural ulcers are seen
near the ileo-cecal junction. What should be the management?
A. Sulfasalazine
B. Paracetamol
C. Ibuprofen
D. Metronidazole

32. A pt presented with hx of swelling in the region of the sub-mandibular region, which became
more prominent and painful on chewing. He also gave hx of sour taste in the mouth, the area is
tender on palpation. Choose the most probable dx?
a. Chronic recurrent sialadenitis
b. Adenolymphoma
c. Mikuliczs disease
d. Adenoid cystic carcinoma
e. Sub-mandibular abscess

33. A 4m girl has severe FTT failure to thrive and increasing jaundice which was 1st noticed at 1wk of
age. She has an enlarged liver and scratches on her skin. Her parents have been unable to seek
medical care.
What is the most likely dx?
a. Biliary atresia
b. G6PD deficiency
c. Hep B
d. Spherocytosis
34. A 45yo woman complains of pain in her hands precipitated by exposure to the cold weather. She
is breathlessness on walking. When she is eating, she can feel food suddenly sticking to the gullet. It
seems to be in the middle of the esophagus but she can’t localize exactly where it sticks. It is usually
relieved with a drink of water. Choose the single most likely cause of dysphagia from the options?
a. Esophageal carcinoma
b. Systemic sclerosis
c. SLE
d. Pharyngeal carcinoma
e. Globus hystericus

35. A 45yo man with colon cancer now develops increased thirst, increased frequency in urination
and weight loss. His fasting blood glucose=9mmol/L. what is the most appropriate management?
a. Oral hypoglycemic
b. Insulin long acting
c. Short acting insulin before meal
d. IV insulin
e. Subcutaneous insulin

36. A 40yo man with marked weight loss over the preceding 6m has bilateral white, vertically
corrugated lesion on the lateral surfaces of the tongue. What is the single most likely dx?
a. C1 esterase deficiency
b. Crohns disease
c. HIV disease
d. Sarcoidosis
e. Sjogren’s syndrome
37. A 78yo woman presents with unilateral headache and pain on chewing. ESR= 70mm/hr. She is on
oral steroids. What is the appropriate additional tx?
a. Bisphosphonates
b. HRT hormonal replacement therapy
c. ACEi
d. IFN
e. IV steroids

38. A 58yo pt presents with altered bowel habits and bleeding per rectum. Exam and sigmoidoscopy
showed an ulcer. What is the single most likely dx?
a. Colorectal carcinoma
b. Celiac disease
c. Crohn's disease
d. UC
e. IBS

39. . A 72yo man presents with intermittent difficulty in swallowing with regurgitation of stale food
materials. Sometimes he wakes up at night with a feeling of suffocation. Choose the single most
likely cause of dysphagia?
a. Benign structure
B b. Esophageal carcinoma
C Esophageal spasm
D pharyngeal pouch
E Systemic sclerosis
40. A 36yo pt came with diarrhea, bleeding, weight loss and fistula. What is the single most likely dx?
a. Celiac disease
b. Crohns disease
c. UC
d. IBS

41. A 70yo man had a right hemicolectomy for ceacal carcinoma 6days ago. He now has abdominal
distention and recurrent vomiting. He has not opened his bowels since surgery. There are no bowel
sounds. WBC=9, Temp=37.3C. What is the single most appropriate next management?
a. Antibiotic therapy IV
b. Glycerine suppository
c. Laparotomy (48 hours of no bowl sound/ WBC count rising> peritonitis)
d. NG tube suction and IV fluids
e. TPN

42. A 63yo lady with a BMI=32 comes to the ED with complaints of pigmentation on her legs. Exam:
dilated veins could be seen on the lateral side of her ankle. Which of the following is involved?
a. Short saphenous vein
b. Long saphenous vein
c. Deep venous system
d. Popliteal veins
e. Saphano-femoral junction
43. A 72yo woman who had a repair of strangulated femoral hernia 2 days ago becomes noisy,
aggressive and confused. She is febrile, CBC normal apart from raised MCV. What is the most likely
dx?
a. Electrolyte imbalance
b. Delirium tremens
c. Wernicke͛s encephalopathy
d. Infection toxicity
e. Hypoglycemia

44. Anatomical structure to be pierced during surgery midline port during gallstone removal.
a. External iliac muscle
b. Cricoid cartilage
c. Linea alba
d. Rectus sheath muscle
e. Duramater
f. 1st tracheal cartilage
g. Conjoined tendon
h. Intercostal muscles

45. Inserting a drain in the mid-axillary line. What is the single most appropriate anatomical
structure?
a. External iliac muscle
b. Linea alba
c. Rectus sheath muscle
d. Conjoined tendon
e. Intercostal muscles
46. A child is not breathing and intubation failed. At what anatomical site should the incision be
made?
a. External iliac muscle
b. Cricoid cartilage
c. Linea alba
d. Rectus sheath muscle
e. Duramater
f. 1st tracheal cartilage
g. Conjoined tendon
h. Intercostal muscles

47. A 23yo woman presents with a 1cm small smooth, firm, mobile mass in her left breast. She is very
anxious. What is the most appropriate inv?
a. Mammography
b. US breast
c. FNAC
d. Mammography and US

48. A 33yo female presents with sudden severe colicky abdominal pain in her RIF. A mobile mass is
felt on examination. What is the most likely dx?
a. PID
b. Appendicitis
c. Ovarian torsion
d. Constipation
49. 60yo man presents with weight loss and Hgb=6. Hx reveals that he has abdominal pain and
diarrhea for the past 6m. What is the most appropriate inv?
a. Barium enema
b. Colonoscopy
c. Sigmoidoscopy

50. A lady presents with itching around the breast and greenish foul smelling discharge from the
nipple. She had a similar episode before. What is the most likely dx?
a. Duct papilloma
b. Duct ectasia
c. Breast abscess
d. Periductal mastitis
e. Mammary duct fistula

51. A man has reducible bulge below the pubic tubercle, and on occlusion of the deep inguinal ring,
cough impulse is present. What is the most likely dx?
a. Direct inguinal
b. Indirect inguinal
c. Femoral
d. Spigelian
e. Lumbar
52. A 50yo man has had anterior resection of the rectum for carcinoma. He expressed concerns about
control of post-op pain in discussions with the anaesthetist before surgery. What is the best
management strategy?
a. Oral diclofenac
b. Oral codeine
c. IM morphine
d. IM dihydrocodeine
e. Ondansetron oral

53. A woman is admitted to the hospital for elective abdominal hysterectomy. 2 months ago she was
dx with DVT and pulmonary embolism and was started on warfarin. What is the most appropriate
pre-op measure you will take on this occasion?
a. Continue warfarin
b. Stop warfarin
c. Stop warfarin and start heparin
d. Increase warfarin dose
e. Add heparin

54. A 63yo male undergoes abdominal surgery. On Monday morning, 3d post-op, repeat samples
confirm serum K+=7.1mmol/l. His ECG shows broad RS complexes. Which one of the following can be
used as an effective tx for this pt’s hyperkalemia?
a. Calcium chloride IV
b. Calcium gluconate IV
c. Insulin subcutaneously
d. Furosemide IV
55. A 2yo fell on outstretched hand on playground. He presents with pain on base of the thumb.
XR=no fx. What is the single most likely dx?
a. Colles fx
b. Head of radius
c. Mellet finger
d. Scaphoid fx
e. No fx

56. A 60yo pt recovering from a surgery for toxic goiter is found to be hypotensive, cyanosed in the
the RR. Exam: tense neck. There is blood oozing from the drain. What is the most likely dx?
a. Thyroid storm
b. Reactionary hemorrhage
c. Secondary hemorrhage
d. Primary hemorrhage
e. Tracheomalacia

57. A 79 yo lady who is otherwise well recently started abdominal pain. She is afebrile and complains
that she passed air bubbles during urination. A urethral catheter showed fecal leakage in the urinary
bag. What is the likely pathology?
a. Diuretics
b. CD
c. Rectosigmoid tumor
d. Large bowel perforation
e. UC
58. A 28yo shipyard worker was admitted for pain in calf while at work which has been increasing
over the last 3m. There is no hx of HTN or DM but he is a smoker. Exam: loss of posterior tibial and
dorsalis pedis pulsation along with a non-healing ulcer at the base of the right 1st MTP joint.
What is the most probably dx?
a. Thromboangitis obliterans
b. Sciatica
c. DVT
d. Baker’s cyst
e. Embolus

59. 524. Just above the mid-inguinal point. What is the single most appropriate landmark?
a. Femoral artery pulse felt
b. Mcburney’s point
c. Stellate ganglion
d. Deep inguinal ring
e. Transpyloric plane

60. A 35yo construction worker is dx with indirect inguinal hernia. Which statement below best
describes it?
A Passes through the superficial inguinal ring only
B Lies above and lateral to the pubic tubercle
C Does not pass through the superficial inguinal ring
D Passes through the deep inguinal ring
61. A 45yo female looking pale has bluish discoloration of hands whenever she goes out in the cold.
She has also noticed some reddish spots on her body. She has symmetrical peripheral arthropathy for
the last yr. What is the most probable dx?
a. RA
b. Osteosarcoma
c. Limited systemic sclerosis
d. Diffuse systemic sclerosis
e. Chondrosarcoma

62. A 30yo female has chronic diarrhea, mouth ulcers and skin tags. She complains of visual prbs, low
back pain and morning stiffness. Inv: ESR and CRP=raised, Hgb=10 mg/dl. What is the most probable
dx?

a. SLE
b. Reactive Arthritis
c. Gout
d. Pseudogout
e. Seronegative arthritis

63. A 60yo lady with a hx of HTN and suffering from RA since the last 10y now presents with hot
swollen and tender knee joint. What inv would you do for her?
a. XR
b. C&S of joint aspirate
c. US
d. MRI
e. CT
64. A 67yo builder presents witha persistent nodular lesion on upper part of pinna with some
telangiectasia around the lesion. What is the dx?
a. Basal cell
b. Squamous cell
c. Keratocanthoma
d. Actinic keratosis
e. Bowens diseas

65. A 62yo man with rheumatoid arthritis struck his hand against a door. He subsequently found that
although he could extend the interphalangeal joint of his right thumb, the MCP joint of the thumb
remained flex. What is the single most likely tendon to have been damaged?

a. Extensor carpi ulnaris

66. A 35yo woman undergoing tx for TB presents with malar rash, photosensitivity and hematuria.
What is the single most likely positive antibody?
a. Anti Ds DNA
b. Anti Sm
c. Anti Histone
d. Anti La
e. Anti centromere
67. A 45yo woman has been dx with Giant Cell A and is being treated with steroids. What is the other
drug that can be added to this?
a. ACEi
b. Beta blockers
c. Aspirin
d. Interferons
e. IVIG

68. A 68yo man presents with muscle weakness. He is not able to climb stairs. He also complains of
mild breathlessness. He says that he sometimes feels difficulty in swallowing food. Labs: ALP=216,
AST=49, ALT=43, CK=417, ESR=16.
What is the most likely dx?
a. Polymyosis (CK raised)- weakness
b. Polymyalgia rheumatic- weakness (CK =N)
c. Muscular dystrophy
d. Esophageal carcinoma
e. Osteoarthritis

69. A 35yo woman has butterfly rash on her face and she suffers symmetrical joint pains on knee and
elbow, ESR is raised. What is the most discriminative inv for dx?
a. Anti DNA antibodies
b. Anti Jo1 antibodies
c. Anti nuclear antibodies
d. Anti centromere antibodies
e. Anti la antibodies
70. A 26yo man present to ED with increasing SOB on left side and chest pain. He has been a heavy
smoker for the past 4 years. He doesn’t have any past med hx. What is the likely dx?
a. Pulmonary embolism
b. MI
c. Asthma
d. Pleural effusion
e. Pneumothorax

71. A 28yo man has developed a red, raised rash on trunk after playing football. His PMH shows he
had childhood asthma. The rash is becoming increasingly itchy. What is the most appropriate tx?
a. Oral chlorpheneraime
b. Oral amoxicillin
c. IM adrenaline
d. Nebulized salbutamol
e. Histamine

72. A 50yo chronic smoker came to OPD with complaint of chronic productive cough, SOB
andwheeze. Labs: CBC=increase in PCV. CXR >6ribs seen above the diaphragm in midclavicular line.
ABG=pO2 decreased. What is the most likely dx?
a. Interstitial lung disease
b. Wegener’s granulomatosis
c. Ca bronchi
d. COPD
e. Amyloidosis
73. A 35yo woman had an uneventful lap chole 18h ago. She has a pulse=108bpm, temp 37.8C. There
are signs of reduced air entry at the right base but the CXR doesn’t show an obvious abnormality.
What is the most appropriate management strategy?
a. Cefuroxime PO
b. Ceftriaxone IV
c. Chlorpheniramine PO
d. Chest physiotherapy
e. Reassure

74. A 70yo man admits to asbestos exposure 20yrs ago and has attempted to quit smoking. He has
noted weight loss and hoarseness of voice. Choose the single most likely type of cancer a.w risk
factors present.
a. Basal cell carcinoma
b. Bronchial carcinoma
c. Esophageal carcinoma
d. Nasopharyngeal carcinoma
e. Oral carcinoma

75. A 33yo man has a temp=38.5C, cough and chest pain on the right si e on inspiration. He also has
purulent sputum. What is the most likely organism to cause pneumonia in this pt?
a. Gram +ve diplococci
b. Coagulase +ve cocci
c. PCP cold agglutinins
d. AFB
e. Gram –ve diplococci
76. A 62yo man has been smoking about 15 cigarettes/day for 45yrs, and has been working as a
builder since he was 24yo. He presents with chest pain, SOB, weight loss. CXR shows bilateral fibrosis
and left side pleural effusion. What is the best inv that will lead to dx?
a. CXR
b. Pleural fluid aspiration of cytology
c. MRI
d. Pleural biopsy
e. CT

77. A 73yo man who was a smoker has quit smoking for the past 3yrs. He now presents with
hoarseness of voice and cough since past 3wks. XR: mass is visible in the mediastinum. What is the
best inv to confirm the dx?

a. Bronchoscopy
b.Thoracoscopy
c. US
d. CT thorax
e. LN biopsy

78. A 56 yo lady with lung cancer presents with urinary retention, postural hypotension, diminished
reflexes and sluggish papillary reaction. What is the most likely explanation for her symptoms?
a. Paraneoplastic syndrome
b. Progression of lung cancer
c. Brain metastasis
d. Hyponatremia
e. Spinal cord compression
79. A 16yo teenager was brought to the ED after being stabbed on the upper right side of his back.
Erect CXR revealed homogenous opacity on the lower right lung, trachea was centrally placed. What
is the most probable
explanation for the XR findings?
i. Pneumothorax
j. Hemothorax
k. Pneumonia
l. Tension pneumothorax
m. Empyema
80. An 8yo boy has longstanding asthma. He has admitted with a severe episode and is tired and
drowsy. He has not improved on oxygen, inhaled B2 agonist and IV hydrocortisone. CXR shows
bilateral hyperinflation. He is too breathless to use a peakflow meter and is O2 sat <90%. What is the
single most appropriate inv?
f. ABG
g. CXR
h. CT chest
i. Pulse oximetry
j. Spirometry

81. A 55yo woman with a persistent cough and hx of smoking develops left sided chest pain
exacerbated by deep breathing with fever and localized crackles. What is the single most appropriate
dx?
a. Dissecting aneurysm
b. Pericarditis
c. Pneumonia
d. Pneumothorax
e. Pulmonary embolism

82. A 14yo boy with asthma suddenly developed chest pain and increasing breathlessness during a
game of football. When seen in the ED 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 inv?
a. Capillary blood gases
b. CXR
c. CT chest
d. Exercise challenge
e. MRI chest
83. A mother presents with her 3yo son who has indistinct nasal speech. He snores at night and has
restless sleep. He is tired by day. What is the best management strategy?
a. Arrange hearing test
b. Assess development milestones
c. Refer to ENT surgeon
d. Refer to speech therapist
e. MRI brain

84. An 8yo boy dx with asthma is on salbutamol and beclomethasone. However, he wakes up at night
due to his symptoms. What is the next appropriate management?
a. LABA
b. High dose steroid
c. Aminophylline
d. Oral prednisolone
e. Sodium cromoglicate

85. 776. A 68yo man with DM and HTN was noted to have cholesterol level of 3.4mmol/l. he was also
noted to have microalbuminuria. What is the best drug to add to his regimen?
a. ACEi
b. Statin
c. Amylodipine
d. Biguanides
86. A pt presents with progressive dyspnea. He complains of cough, wheeze and a table spoonful of
mucopurulent sputum for the last 18m. Spirometry has been done. FEV1/FVC=2.3/3.6. After taking
salbutamol, the
ratio=2.4/3.7. What is the most likely dx?
a. Chronic bronchitis
b. Asthma
c. Bronchiectasis
d. Lung fibrosis
e. Sarcoidosis

87. A 27yo man presents with chest pain and respiratory distress. Exam: tachycardia, hypotension and
neck vein distension. Trachea is deviated to the left side, breathing sounds on right side are absent
and diminished on left side. What is the next appropriate management?
a. CXR
b. Right side aspiration (16G)
c. Left side aspiration (16G)
d. Right side drain with a small tube (12F)
e. Left side drain with a small tube (12F)

88. An 83yo man with longstanding COPD has become progressively breathless over the last 2yrs. He
is on salbutamol, ipratropium, salmetarol, beclomethasone and theophylline. His FEV1<30%. What is
the next appropriate management?
a. Lung transplant
b. Trial of CPAP
c. Trial of non-invasive ventilation
d. Assessment for long term O2 therapy
e. Short course of O2 therapy
89. A 4yo child presents with repeated chest infections. He has yellow
discoloration of sclera and the mother gives a hx of diarrhea as well. What is the
single inv most likely to lead to a dx?
a. Sweat chloride test
b. Anti-endomysial antiboides
c. LFT
d. Jejunal biopsy
e. TFT

90. A 20yo student who recently visited Asia came to the OPD with complains of low grade fever,
night sweats, anorexia and productive cough. Inv: CXR=cavitatory lesions in upper lobes. What is
the single most likely causative organism?
a. Mycoplasma
b. Klebsiella
c. TB
d. PCP
e. Viral pneumonia

91. A 67yo man after a stroke, presents with left sided ptosis and constricted pupil. He also has loss of
pain and temp on the right side of his body and left side of his face. Which part of the brain is most
likely affected?
a. Frontal cortex
b. Cerebellum
c. Pons
d. Medulla
e. Parietal cortex
92. A pt was lying down on the operating table in a position with his arms hanging down for 3 hours.
Soon after he woke up, he complains of numbness and weakness in that hand and has limited wrist
movement/wrist drop and sensory loss over dorsum of that hand, weakness of extension of the
fingers and loss of sensation at the web of the thumb. What structure is likely to be damaged?
a. Radial nerve
b. Median nerve
c. Ulnar nerve
d. Axillary nerve
e. Suprascapular nerve

93. A young man complains of double vision on seeing to the right. Which nerve is most likely to be
involved?
a. Left abducens
b. Right abducens
c. Left trochlear
d. Right trochlear
e. Right oculomotor

94. A pt with cerebral metastasis has polyuria and polydipsia. What part of the brain would be
affected?
a. Cerebral cortex
b. Cerebellum
c. Diencephalon
d. Pons
e. Medulla
95. A 45yo female complains of pain in the inner side of her right thigh. She was dx with benign
ovarian mass on the right. Which nerve is responsible for this pain?
a. Femoral nerve
b. Obturator nerve
c. Iliohypogastric nerve
d. Ovarian branch of splanchic nerve
e. Pudendal nerve

96. A 79yo stumbled and sustained a minor head injury 2 weeks ago. He has become increasingly
confused, drowsy and unsteady. He has a GCS of 13. He takes warfarin for Atrial fibrillation. What is
the most likely dx?
a. Extradural hemorrhage
b. Cerebellar hemorrhage
c. Epidural hemorrhage
d. Subdural hemorrhage
e. Subarachnoid haemorrhage

97. A 23yo woman has been having pain at the base of her thumb, the pain is reproduced when lifting
her 3-month old baby or changing diapers and also with forceful abduction of the thumb against
resistance. What is the
likely cause?
a. Avascular necrosis of scaphoid
b. Trigger finger
c. De Quervain’s tenosynovitis
98. A 32yo woman suffers an episode of severe occipital headache with vomiting and LOC. She is
brought to the hosp where she is found to be conscious and completely alert. Exam: normal pulse and
BP with no abnormal
neurological sign. What is the next step in her management?
a. Admission for observation
b. CT brain
c. MRI head
d. Reassurance and discharge home
e. XR skull

99. A 49yo man first presented with increasing difficulty in swallowing. Several months later he
developed weakness in his right foot. Now he can no longer feed himself, he chokes on food and has
become confined to a
wheelchair. What is the most likely dx?
a. Cerebral tumor
b. Myasthenia gravis
c. Lambert-Eaton syndrome
d. Motor neuron disease
e. Cerebro-vascular disease

100. A 55yo woman with breast ca which has spread to lung, liver and bone now presents with
increasing constipation, weakness, thirst and anorexia for the past 3d. Her only medication is
haloperidol for hiccoughs. Today she is disorientated and has left sided weakness. What is the most
likely dx?
a. Brain mets
b. Hypercalcemia
c. Liver failure
101. A 24yo woman presents with tingling and twitching of her fingers followed by throbbing
unilateral headache. What is the most likely dx?
a. Tension headache
b. Migraine
c. Cluster headache
d. TIA
e. SAH

102. A 50yo woman presents following a fall. She reports pain and weakness in her hands for several
months, stiff legs, swallowing difficulties, and has bilateral wasting of the small muscles of her hands.
Reflexes in the upper limbs are
absent. Tongue fasciculations are present and both legs show increased tone,
pyramidal weakness and hyper-reflexia with extensor plantars. Pain and
temp sensation are impaired in the upper limbs. What is the most likely dx?
a. MS
b. MND
c. Syringobulbia
d. Syringomyelia
e. Myasthenia gravis

103. A 26yo woman has become aware of increasing right sided hearing deficiency since her recent
pregnancy. Her eardrums are normal. Her hearing tests show: BC-normal. Weber test lateralizes to
the right ear. What is the single most likely dx?
• a. Encephalopathy
• b. Functional hearing loss
• c. Tympano-sclerosis
• d. Otosclerosis
• e. Sensorineural deafness
104. A 40yo man with a 25y hx of smoking presents with progressive hoarseness of voice, difficulty
swallowing and episodes of hemoptysis. He mentioned that he used to be a regular cannabis user.
What is the single most likely dx?
a. Nasopharyngeal cancer
b. Pharyngeal carcinoma
c. Sinus squamous cell carcinoma
d. Squamous cell laryngeal cancer
e. Hypopharyngeal tumor

105. An 82yo man has woken up with incoherent speech and difficulty in finding the right words.
Exam: otherwise normal, good comprehension. Which anatomical site is most likely to be affected?
a. Broca’s area
b. Wernicke’s area
c. Midbrain
d. Parietal cortex
e. Pons

106. A 35yo man presents with a headache that worsens on bending his head forward.
What is the most likely dx?
a. Chronic sinusitis
b. SAH
c. Migraine
d. Cluster headache
e. Tension headache
107. A 26yo male presents with speech difficulties. Exam: nystagmus. Which anatomical site is most
likely to be affected?
a. Midbrain
b. Pons
c. Cerebellum
d. Cerebrum
e. Vestibule cochlear nerve

108. 1015. A 42yo man presents with stroke. He is not able to walk straight and his speech is slurred.
What is the initial appropriate inv?
a. CT brain
b. PET brain
c. MRI brain
d. Carotid angiography
e. Monitor for 24h

109. A 35yo woman presents with visual problems. CT brain reveals pituitary tumor.
What is the single most likely defect?
a. Homonymous hemianopia
b. Homonymous upper quadrantopia
c. Bitemporal hemianopia
d. Cortical blindness
e. Homonymous lower quadrantopia
110. A 60yo woman was found by her son. She was confused and had urinary incontinence. She has
recovered fully after 6h with no neurological complaints. What is the most likely dx?
a. Stroke
b. Vestibular insufficiency
c. TIA
d. Intracranial haemorrhage

111. A pregnant woman with long term hx of osteoarthritis came to the antenatal clinic with
complaints of restricted joint movement and severe pain in her affected joints. What is the drug of
choice?
a. Paracetamol
b. Steroid
c. NSAID
d. Paracetamol+dihydrocoiene
e. Pethadine

112. A 24yo 18wk pregnant lady presents with pain in her lower abdomen for the last 24h. She had
painless vaginal bleeding. Exam: abdomen is tender, os is closed. What is the most probable dx?
a. Threatened miscarriage
b. Inevitable miscarriage
c. Incomplete miscarriage
d. Missed miscarriage
e. Spontaneous miscarriage
113. A 24yo lady who is 37wk pregnant was brought to the ED. Her husband says a few hours ago she
complained of headache, visual disturbance and abdominal pain. On arrival at the ED she has a fit.
What is the next appropriate management for this pt?
a. 4g MgSO4 in 100ml 0.9%NS in 5mins2g MgSO4 IV bolus
b. 2g MgSO4 in 500ml NS in 1h
c. 4g MgSO4 IV bolus
d. 10mg diazepam in 500ml 0.9%NS in 1h

114. A 27yo lady came to the ED 10 days ago with fever, suprapubic tenderness and vaginal
discharge. PID was dx. She has been on the antibiotics for the last 10days. She presents again with
lower abdominal pain. Temp=39.5C. what is the most appropriate next management?
a. Vaginal swab
b. Endocervical swab
c. US
d. Abdominal XR
e. Laparoscopy

115. A 27yo presents with abdominal pain, bleeding, vomiting and diarrhea. Her LMP was 7wks ago.
Exam: abdominal tenderness, BP=90/60mmHg. What is the next appropriate management?
a. Immediate laparotomy
b. Laparoscopy
c. Salpingotomy
d. Salpingectomy
e. MTX
116. A 45yo lady came to family planning clinic for contraception advice. She is not keen to be
pregnant for the next 3yrs. Her recent US showed multiple small submucosal fibroid. What is the best
method of contraception for her?
a. Etonogestrol
b. COCP
c. IUS
d. POP
e. IUCD

117. A pregnant lady came with pain in her calf muscle with local rise in temp to the antenatal clinic.
What tx should be started?
a. Aspirin
b. LMWH
c. Paracetamol
d. Cocodamol
e. Aspirin and heparin

118. A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with sudden
onset of epigastric pain associated with nausea and vomiting. Her temp is 36.7C. Exam: she is found to
have RUQ tenderness. Her blood results show mild anemia, low platelets, elevated liver enzymes and
hemolysis. What is the most likely dx?
a. Acute fatty liver of pregnancy
b. Acute pyelonephritis
c. Cholecystitis
d. HELLP syndrome
e. Acute hepatitis
119. A 29yo woman had just delivered a still born vaginally, following a major placental abruption.
Choose the single most likely predisposing factor for developing PPH in this lady?
a. Retained product
b. DIC
c. Fibroid uterus
d. Uterine infection
e. Large placental site

120. A 28yo woman has delivered with rotational forceps after an 8h labor and 3h second stage. Choose
the single most likely predisposing factor for PPH for this pt?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Retained product
d. Preterm labor
e. Uterine infection

121. A 38yo woman has delivered after an induced labor which lasted 26h. choose the single most
likely predisposing factor for postpartum hemorrhage?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Rupture uterus
d. Fibroid uterus
e. Age of mother

122. A 65yo lady presents with dyspareunia. What will you give her for her condition?
a. HRT
b. COCP
c. Estrogen gel
d. Testosterone gel
123. A 35yo lady with subserosal fibroid=4cm and submural fibroid=6cm is planning for a child.
Which way will you remove the fibroids?
a. Laproscopy
b. Vaginal myomectomy
c. Abdominal myomectomy
d. Drugs
e. Reassure

124. A 32yo presents with heavy blood loss, US: uterine thickness>14mm. What is the best possible
management for her?
a. COCP
b. UAE
c. Hysteroscopy myomectomy
d. Abdominal myomectomy
e. Endometrial ablation

125. A 24yo woman has had lower abdominal pain for 12h. She is otherwise well. She is at 10wks GA
in a planned pregnancy. What is the single most appropriate test to inv the cause of acute abdomen
in this lady?
a. Abdominal US
b. Anti phospholipid screen
c. CBC
d. Transvaginal US
e. Laparoscopy
126. An obese lady presents with primary amenorrhea. She has high LH, normal FSH and slightly high
prolactin levels. Choose the single most likely dx?
a. PCOS (2:1 LH: FSH, but in normal : 1:2)
b. POF
c. Hypothyroidism (menorrhagia)
d. Pregnancy
e. Primary obesity

127. A 38yo lady presents with amenorrhea has very high LH and FSH levels, normal prolactin and low
estradiol. Choose the single most likely dx?
a. PCOS
b. POF
c. Hypothyroidism
d. Pregnancy
e. Menopause

128. A 20yo pregnant 32wks by date presents to the antenatal clinic with hx of painless vaginal
bleeding after intercourse. Exam: P/A – soft and relaxed, uterus=dates, CTG=reactive (normal- if ace
or decc only- then abnormal). Choose the single most likely dx?
a. Abruption of placenta 2nd to pre-eclampsia
b. Antepartum hemorrhage
c. Placenta previa
d. Preterm labor
e. Placenta percreta
129. A 65yo presents with dyspareunia after sex. She in menopause. She complains of bleeding after
sex. What is the most probably dx?
a. Cervical ca
b. Endometrial ca
c. Ovarian ca
d. Breast ca
e. Vaginal ca

130. A 23yo woman with painless vaginal bleeding at 36wks pregnancy otherwise seems to be
normal. What should be done next?
a. Vaginal US
b. Abdominal US
c. Vaginal exam
d. Reassurance

131. A 26yo woman had amenorrhea for 10wks and is pregnant. She experiences hyperemesis. Now
she presents with vaginal bleed. Exam: uterus=16wks, closed os. What is the most probable dx?
a. Thyrotoxicosis
b. Hyperemesis gravidarum
c. Twins
d. Wrong dates
e. Molar pregnancy
132. A 55yo male presents with malaise and tiredness. Exam: spleen approaching RIF (right iliac fossa),
no lymphadenopathy. Choose the single cell type?
a. Helmet shaped cell
b. Sickle cell
c. Granulocyte without blast cells
d. Blast cells

133. A 6yo boy is brought to the hospital for a 3rd episode of sore throat in 1 month. He is found
bleeding from gums and nose and has pale conjunctiva. What’s the single cell type?
a. Clumped platelets
b. Microcytes
c. Granulocyte without blast cells
d. Blast cells
e. Mature lymphocytes

134. A 60 yo man has a pathological rib fx. He also complains of recurrent infection. BMA is done. Labs:
Ca2+ = 3.9mmol/L and ALP = 127u/L. what type of cell would be found in abundance in the marrow
smear?
a. Plasma cell
b. Myeloid cell
c. Bence-jones protein
d. Megakaryocytes
e. Reticulocytes
135. 456. A 35yo lady is admitted with pyrexia, weight loss, diarrhea and her skin is lemon yellow in
color. CBC = high MCV. What is the most probably dx?
a. Aplastic anemia
b. Pernicious anemia
c. Leukemia
d. ITP
e. Lymphoma

136. A 53yo had a dental extraction after which he recently had a mitral valve prolapse, high temp of
39C, cardiac failure and new cardiac murmur. What is the single most likely dx?
a. Atheroma
b. Congenital
c. Regeneration
d. Infection
e. Neoplastic

137. A 43yo lady is admitted with pyrexia, arthropathy, breathlessness and syncope. She was recently
dx with pulmonary emboli. There is an early diastolic sound and a mid-diastolic rumble. Her JVP is
elevated with prominent a-waves. What is the most likely cause?
a. Mitral regurgitation
b. Ventricular ectopics
c. Pulmonary regurgitation
d. Atrial myxoma
e. Complete heart block
138. A 60yo lady has severe chest pain. ECG shows changes of inferior wall MI. ECG also shows
progressive prolongation of PR interval until a QRS complex is dropped. What is the most probable dx?
a. Atrial fibrillation
b. VT
c. SVT
d. Mobitz type I 2nd degree heart block
e. Mobitz type II 2nd degree heart block

139. A 63yo man continues to experience chest pain and has a temp of 37.8C 2 days after an acute MI.
His ECG shows widespread ST elevation with upward concavity. What is the single most likely
explanation for the abnormal inv?
a. Acute pericarditis
b. Cardiac tamponade
c. Atrial thrombus
d. Left ventricular aneurysm
e. Dressler syndrome

140. A 40yo woman suddenly collapsed and died. At the post-mortem autopsy, it was found that there
a bleed from a berry aneurysm from the circle of Willis. In which space did the bleeding occur?
a. Subarachnoid
b. Subdural
c. Extradural
d. Subparietal
e. Brain ventricles
141. A 65yo male presents with dyspnea and palpitations. Exam: pulse=170bpm, BP=120/80mmHg.
Carotid massage has been done as first instance. What is the next step of the management?
a. Adenosine
b. Amilodipine
c. DC cardioversion
d. Lidocaine
e. Beta blocker

142. An ECG of an elderly lady who collapsed in the ED shows rapid ventricular rate of
220bpm,QRS=140ms. What is the most probable dx?
a. Atrial fibrillation
b. VT
c. SVT
d. Mobitz type1 2nd degree heart block
e. Sinus tachycardia

143. A 65yo man presents with dyspnea 3d after an MI. On auscultation he has a pansystolic murmur
at the apex radiating to the axilla. What is the most likely dx?
a. Ruptured papillary muscle
b. Ventricular aneurysm
c. Pericarditis
d. Pericardial effusion
e. VSD
144. A white English man with a past hx of MI is a known HTN and DM. He is currently on aspirin, statin
and metformin. What would you add to the tx?
a. ACEiz
b. Diuretic
c. Insulin
d. Beta blocker
e. CCB

145. A 72yo woman who is taking loop diuretics for left ventricular failure. She now is suffering from
palpitations and muscle weakness. What is the electrolyte imbalance found?
a. Na+=130mmol/L, K+=2.5mmol/L
b. Na+=130mmol/L, K+=5.5mmol/L
c. Na+=140mmol/L, K+=4.5mmol/L
d. Na+=150mmol/L, K+=3.5mmol/L
e. None

146. 1505. A pt came to the hosp with a complaint of severe chest pain lasting for >1h. Following ECG
test, pt revealed to have ST depression. He was already on aspirin. What is the most specific tx for this
pt?
a. GTN (next)
b. Simvastatin
c. Clopidogrel
d. BBlocker
e. LMWH
147. A 54yo man has collapsed suddenly following a headache. He has hypertension and takes warfarin
for prosthetic heart valve. GCS=4 and dilated left pupil. What is the single most likely dx?
a. Ant circulation stroke
b. Post circulation stroke
c. Intracerebral hemorrhage
d. Intracerebellar haemorrhage (no cerebellar signs)
e. Pontine haemorrhage (pinpoint)

148. A 55yo man returns for routine follow up 6wks after a MI. He gets breathless when walking
uphill. His ECG shows ST elevation in leads V1, V2, V3 and V4. What is the single most likely
explanation for the abnormal investigation?
a. Heart block
b. Right ventricular strain
c. Atrial thrombus
d. Left ventricular aneurysm
e. Dressler’s syndrome

149. A 33yo male came to the hospital with complaint of occasional left sided chest pain that lasts
<30mins, following exercise, which relieves upon taking rest. What is the most probable dx?
a. Unstable angina
b. Decubitus angina
c. Stable angina
d. Coronary spasm
e. MI
150. A 28yo man presents with a 2h hx of rapid palpitations. He feels a little light headed but is
otherwise well. Exam: pulse=170bpm and regular, BP=100/68mmHg. He has had 2 similar episodes in
the past. What is the most likely rhythm disturbance?
a. SVT
b. VF
c. VT
d. V-ectopics
e. A-fib

151. A 58yo man suddenly becomes shocked several days after suffering an acute ant MI. His CXR
shows a large globular-shaped heart and clear lung fields. What is the single most likely explanation for
the abnormal inv?
a. Acute pericarditis
b. Cardiac tamponade
c. Atrial thrombus
d. Left ventricular aneurysm
e. Dressler syndrome

152. After an MI, a man presents with pansystolic murmur which is radiating to the axilla. What is the
dx?
a. Tricuspid regurgitation
b. Mitral regurgitation
c. Aortic stenosis
d. Mitral stenosis
153. A 68yo man gets repeated attacks of LOC and TIA. What is the most likely cause for this?
a. Atrial fib
b. Mitral stenosis
c. Aortic stenosis
d. HOCM
e. Carotid artery stenosis

154. A 42yo lady had corrective surgery for cyanotic congenital heart disease at the age of 3y, after a
palliative operation during infancy. There is a parasternal impulse and an early diastolic murmur. What
is the most probable dx?
a. Aortic regurgitation
b. Ischemic mitral regurgitation
c. Aortic stenosis
d. Pulmonary stenosis
e. Pulmonary regurgitation

155. A patient presents with progressive visual deterioration. Exam: large, multiple cotton wool spots
in both eyes. What is the single most likely dx?
a. Kaposi’s sarcoma
b. Cryptosporidium
c. CMV infection
d. Pneumocystis carinii infection
e. Cryptococcal infection
156. A 17yo has acute pain around his right eye, pain on one side of his face and earache too. What is
the single most dx?
a. Ear wax
b. Ear foreign body
c. Dental abscess
d. Cellulitis
e. Herpes zoster

157. 3yo boy presents with difficulty in walking and skin lesions. What is the most likely causative
agent?
a. Strep pyogenes
b. Rubella virus
c. Parvovirus
d. Papovirus
e. Paramyxovirus

158. 40yo woman with breast cancer has back pain which keep her awake at night. She blames it on a
gym session she had 2wks ago. She now has difficulty in climbing stairs. There is tenderness over the
right thoracic spine. She has diminished fine touch and temp sensation in her right foot.
What is the single most appropriate inv?
a. Bone density scan
b. CT head
c. MRI spine
d. Nuclear bone scan
e. XR thoracolumbar spine
159. A young boy presented with peri-oral blisters. Some of which are weeping and others are
crusted. What is the single most appropriate dx?
a. Impetigo
b. Varicella zoster
c. Shingles
d. Scabies
e. Herpes simplex

160. A 6wk baby has been dx as HIV+ve. Which immunization plan will you opt for him?
a. Don’t give any vaccine
b. Give all vaccines except live attenuated vaccines
c. Give only BCG vaccine
d. Give all vaccines except BCG vaccine

161. A 16wk pregnant pt who was exposed to a child with chickenpox came to GP for help. She was
tested –ve for varicella antibody. What is the next most imp step in management?
a. Reassurance
b. Ig
c. Ig + vaccine
d. Vaccine only
e. Acyclovir
162. A 28yo man presents with a maculopapular rash over his trunk and palms. He also has
numerous mouth ulcers. He had a penile ulcer which healed 2wks ago. What will you do to
confirm the dx?
a. PCR for treponemal and non-treponemal antibiodies
b. Dark ground microscopy from mouth ulcer
c. Blood culture for treponema
d. Dengue fever

163. A 6yo child presented with drooling of saliva and severe stridor. He is febrile and sick looking. XR
Neck in extension shows a thumb sign. Choose the single most likely dx.
a. Croup
b. URTI
c. Diphtheria
d. Acute epiglottitis

164. A 10yo girl presents with pallor and features of renal failure. She has hematuria as well as
proteinuria. The serum urea and creat are elevated. These symptoms started after an episode of
bloody diarrhea 4days ago. What is the most probable dx?
a. TTP
b. HUS
c. ITP
d. HSP
e. ARF
165. An elderly lady presents with confusion. She is apyrexial but complains of dysuria for 2 days
duration. What is the definitive dx investigation?
a. Blood culture
b. Urine nitrites
c. CT head
d. ECG
e. IVU

166. A 61yo man, known smoker, comes to the hospital with complaints of painless hematuria, urgency
and dysuria. He has been worried about his loss of weight and reduced general activity. Which inv
would be diagnostic of his condition?
a. Urine microscopy
b. IVU
c. CT
d. Cystoscopy
e. US abdomen
f. KUB
g. Cystoscopy with biopsy
h. Mid stream urine for culture
i. Transrectal USG

167. A 36yo man has been dx with DI. What electrolyte picture is expected to be seen?
a. High serum Na, low serum osmolarity, high urine osmolarity
b. Low serum Na, low serum osmolarity, high urine osmolarity
c. Low serum Na, high serum osmolarity, high urine osmolarity
d. High serum Na, high serum osmolarity, low urine osmolarity
e. Normal Na, normal serum osmolarity, normal urine osmolarity
168. A 15yo boy presents with generalized edema. His urinalysis reveals protein +++, eGFR =110.
What is the most likely dx?
a. IgA nephropathy
b. Membranous nephropathy
c. Minimal change disease
d. PSGN
e. Lupus nephritis

169. 46yo man, known case of chronic GN presents to OPD. He feels well. BP = 140/90mmHg. Urine
dipstick: protein ++, blood ++ and serum creatinine=106mmol/L. Which medication can prevent the
progression of this dx?
a. ACEi
b. Diuretics
c. Cytotoxic meds
d. Longterm antibiotics
e. Steroids

170. A pt presents with complete anuria following prolonged hypotension and shock in a pt who bled
profusely from a placental abruption. What is the most probable dx?
a. Post viral infection
b. Acute papillary necrosis
c. Acute cortical necrosis
d. HUS
e. Renal vein thrombosis
171. A 10yo boy presents with generalized swelling. This has been present for 4days and included
swollen ankles and puffiness of the face. It started a few days after he had a mild cold with runny nose.
His only PMH was eczema. Urine analysis: hematuria, proteinuria 10g/24h, creat
60umol/l and albumin=15g/l. What is the single most likely dx?
a. IgA nephropathy
b. HSP
c. Minimal change nephropathy
d. Wilson’s disease
e. Cardiac failure

172. A 30yo man presents to hospital complaining that his urine has been very dark recently,
resembling coffee at worst. He has been under the weather 2wks back and had taken a few days off
work with a sore throat and coryzal symptoms. Urine dipstick in hospital returns highly positive for
blood and protein. He is admitted for supportive management and is scheduled for a renal biopsy,
which shows mesangial proliferation with a positive immune-fluorescence pattern. What is the most
probable dx?
a. Membranous glomerulonephropathy
b. SLE
c. Wegener’s granulomatosis
d. Post – strep GN
e. IgA nephropathy
173. A 64yo man has been waking up in the middle of the night to go to the bathroom. He also had
difficulty in initiating micturition and complains of dribbling. A dx of BPH was made after a transrectal
US guided biopsy and the pt was prepared for a TURP. What electrolyte abnormality is highly likely
due to this surgery?
a. Hypokalemia
b. Hypocalcemia
c. Hyperkalemia
d. Hyponatremia
e. Hypernatremia

174. A 65yo man presented with frank hematuria. He has no other urinary symptoms. What is the
most appropriate next step that will lead to the dx?
a. IVU
b. US Abdomen
c. Cystoscopy
d. Mid-stream urine for culture
e. Transrectal US

175. A 32yo man presents with 3d of scrotal pain. Exam: thickening of the left testis and it is hot to
touch. What is the most appropriate management?
a. Analgesia
b. Reassurance
c. Antibiotics
d. Referral to surgeon
176. A man with a family hx of panic disorder is brought to the hospital with palpitations, tremors,
sweating and muscles tightness on 3 occasions in the last 6 wks. He doesn’t complain of headache and
his BP is WNL. What is the single most appropriate longterm tx for him?
a. Diazepam
b. Olanzapine
c. Haloperidol
d. Fluoxetine
e. Alprazolam

177. A 21yo woman has had several sudden onset episodes of palpitations, sweating, nausea and
overwhelming fear. On one occasion she was woken from sleep and feared she was going insane. There
is no previous psychiatric disorder. What is the most probable dx?
a. Pheochromocytoma
b. Panic disorder
c. GAD
d. Phobia
e. Acute stress disorder

178. An old man comes to the doctor complaining that a part of this body is rotten and he wants
it removed. What is the most likely dx?
a. Guilt
b. Hypochondriasis
. Munchauses
d. Nihilism
e. Capgras syndrome
179. A 28 yo female who delivered 6 weeks ago feels sad and has no interest to feeding the baby.
She has been eating poorly and having difficulty sleeping. She feels weak throught the day and
has stopped taking the baby out of the house. She also says that the baby has evil eyes. What is
the most likely diagnosis?
a. Postpartum blues
b. Postpartum depression
c. Postpartum psychosis
d. Schizophrenia
e. Psychotic depression.

180. A 25 yo woman was brought to the ED by her boyfriend. She has many superficial lacerations on
her forearm. She is so distressed and constantly says her boyfriend is going to end the relationship. She
denies trying to end her life. What is the most likely dx?
a. Acute psychosis
b. Severe depression
c. Psychotic depression
d. Borderline personality disorder
e. Schizophrenia

181. 37 yo man who has many convictions and has been imprisoned many times has a hx of many
unsuccessful relationships. He has 2 boys but doesn͛ t contact them. What is the most probable dx?
a. Borderline personality disorder
b. Schizophrenia
c. Avoidant personality disorder
d. Histrionic personality disorder
e. Antisocial behavior disorder
182. A 32yo had a normal vaginal delivery 10 days ago. Her uterus has involuted normally. Choose the
single most likely predisposing factor for PPH?
a. Retained product
b. DIC
c. Uterine infection
d. Von Willebrand disease
e. Primary PPH

183. A 34yo pt presents with 50% partial thickness burns. What should be the most appropriate
management?
a. IV fluids calculated from the time of hospital arrival
b. IV fluids calculated from the time of burn
c. No IVF
d. IV dextrose stat
e. Burns ointment

184. A 4yo boy with a febrile convulsion lasting eight minutes has been given IV lorazepam to control
them. What is the single most likely serious side effect?
a. Amnesia
b. Anaphylactic shock
c. Apnea
d. Bronchospasm
e. Cardiac arrhythmia
185. A 35yo male builder presented with sudden onset of severe abdominal pain. He was previously fit
and well other than taking ibuprofen for a long term knee injury. On examination he is in severe pain,
pulse=110bpm, BP=110/70mmHg and has a rigid abdomen. What is the most likely dx?
a. Biliary peritonitis
b. Ischemic colon
c. Pancreatic necrosis
d. Perforated diverticulum
e. Perforated peptic ulcer

186. A woman 5 days post-op for bilateral salpingo-oophorectomy and abdominal hysterectomy has
developed abdominal pain and vomiting associated with abdominal distension and can’t pass gas. No
bowel sounds heard, although well hydrated. What is the most appropriate next step?
a. XR abdomen
b. Exploratory laparoscopy
c. CT
d. USG
e. Barium enema

187. A 67yo man presents to the ED with pain in his left groin. He suddenly collapses and his is not able
to move or lift his leg. He is on alendronate. What is the dx?
a. Fx of neck of femur
b. Post hip dislocation
c. Fx of shaft of femur
d. Pelvic base fx
e. Peripheral vascular disease
188. A 63yo man has been brought to the hosp after collapsing during a wedding. His ECG is below.
What is the most likely dx?
a. VT
b. A-fib
c. VF
d. A-flutter
e. SVT

189. A 28yo drug user presents to ED collapsed and anuria. His serum K+=7.5mmol/l. CXR shows early
pulmonary edema. What is the next appropriate management for this pt?
a. Urgent hemodialysis
b. IV calcium gluconate
c. IV insulin + dextrose
d. Furosemide
e. IV 0.9% NS
190. A 34yo man was involved in a RTA and whilst in the ambulance his GCS deteriorated and RR
increased from 30-48. What is the most appropriate management for this pt?
a. IV fluid
b. Needle thoracocentesis
c. 100% oxygen
d. Portable XR

191. A 4yo is brought to the ED by ambulance. His mother reports that he has been unwell with a sore
throat for 8h. He is sitting on his mother’s knee and is tolerating an oxygen mask but looks unwell. He
has constant noisy breathing and he is drooling saliva. His temp=39C. What is the most
imp dx?
a. Acute asthma
b. Bronchiolitis
c. Croup
d. Epiglottitis
e. Tonsillitis

192. A child was admitted following a RTA with initial GCS=15. Then during the night the noticed GCS
reduced to 13. What is the management?
a. Refer to neuro-surgeon
b. IV fluids
c. Oxygen
d. CT brain
e. Skull XR
193. A 1m boy has been brought to the ED, conscious but with cool peripheries and has HR=222bpm.
He has been irritable and feeding poorly for 24h. CXR=borderline enlarged heart with clear lung
fields. ECG=regular narrow complex tachycardia, with difficulty identifying p wave. What is the
single most appropriate immediate tx?
a. Administer fluid bolus
b. Administer oxygen
c. Oral beta-blockers
d. Synchronized DC cardio-version
e. Unilateral carotid sinus massage

194. A 40yo chronic alcoholic who lives alone, brought in the ED having been found confused at
home after a fall. He complains of a headache and gradually worsening confusion. What is the
most likely dx?
a. Head injury
b. Hypoglycemia
c. Extradural hematoma
d. Subdural hematoma
e. Delirium

195. A 39yo man presents to the ED with persistent cough, sputum and dyspnoea. He gave a hx of
smoking 20 cigarettes/d for the last 10 years. Pt was given oxygen in ambulance but he is not
improving. What is the next step?
a. Prednisolone
b. Salbutamol
c. Check ABG
d. CXR
e. ECG
196. A woman comes with an ulcerated lesion 3 cm in the labia majorum. What is the lymphatic
drainage of this area?
a. External iliac
b. Superficial inguinal LN
c. Para-aortic
d. Iliac
e. Aortic

197. A 16yo boy following a RTA was brought to the ED with a swelling and deformity in his
Right thigh. Exam: airway is patent and is found to have a pulseless leg. Which structure is
involved in this fx?
a. Femoral artery
b. Posterior tibial artery
c. Common peroneal nerve
d. Dorsalis pedis

198. A 73yo woman with RA is unable to extend the fingers of her right hand at the MCP joint and IP
joints following a fall. What is the single most likely tendon to have been damaged?
a. Extensor carpi radialis
b. Extensor carpi ulnaris
c. Extensor digitorum
d. Extensor indicis
e. Flexor digitorum profundum
199. An alcoholic who has completely given up drinking hears voices. What is the most appropriate tx?
a. Olanzapine
b. Diazepam
c. Acamprosate
d. Disulfiram
e. Haloperidol

200. A 52yo woman has had a swelling in the neck, hoarseness and stridor-both inspiratory and
expiratory for 2 months. What is the most probable dx?
a. CA larynx
b. CA thyroid
c. Vocal cord nodules
d. CA bronchus
e. Thyrotoxicosis

THE END