5TH September 2020 Plab 1 Mock

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Dr Swamy PLAB Courses Ltd.

PLAB 1 MOCK TEST: 5TH SEPTEMBER 2020 TIME ALLOWED: 3HRS
SINGLE BEST ANSWER
1. A patient was admitted to A&E with prolonged hematemesis. Endoscopy revealed a bleeding gastric
ulcer which was then sutured. During the procedure, patient received 15 units of blood. The next day, the
drain contained 1 unit of blood. What is the next step in the management of this patient?
A. Urgent USG
B. Urea breath test
C. H.Pylori serology
D. Manometry
2. A patient developed confusion, neck stiffness, photophobia and his temperature is around 38.9°C. What
test could be done for diagnosis of his problem?
A. CT brain D. Lumbar Puncture
B. Blood culture
C. Urine culture
3. A child was playing and suddenly developed breathlessness. What is the best investigation for this
child?
A. Nasal Endoscopy D. Pulse Oximetry
B. Lateral neck X-Ray E. Spirometry
C. CT scan
4. A 40 year old man who is a Jehovah's witness who had previously mentioned no blood products to be
given at any condition requires life - saving blood transfusion. What would be the best step in
management?
A. Give blood to save the life.
B. Give only fresh frozen plasma
C. Respect the patient’s wishes
D. Obtain emergency court order for blood transfusion.
E. Assess patient’s mental capacity to refuse blood.
5. A patient with past medical history of DM and HTN and on medications presents with constipation,
confusion, polyuria and polydypsia. On investigation : Serum calcium was 3.04, Serum electrophoresis is
negative and X-Ray is normal. What is the most probable etiology for the patient’s symptoms?
A. Drug induced-Bendroflumethiazide
B. Diabetes mellitus
C. Hypertension
D. Urinary Tract Infection(UTI)
E. Chronic Renal Failure
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6. A 70 year old woman 3 days after a myocardial infarction presents with a pan systolicmurmur. What is
the most likely cause?
A. Rupture of papillary muscle
B. Ventricular Aneurysm
C. Pericarditis
D. Pericardial Effusion
E. Atrial Septal Defect
7. A maid complains of pain in anterior inferior part of the knee. What is the most likely bursa involved?
A. Supra patella
B. Pre patella
C. Inferior patella
D. Medial patella
8. A 10 year old child presents with severe vomiting and lethargy. She feels dizzy and thirsty. She has had
urinary incontinence for the past 2 weeks. Which investigation would you wish to perform immediately?
A. Urine glucose
B. Urine culture & sensitivity
C. FBC
D. Blood culture
E. CT scan
9. Lady with 10 months amenorrhea, hypokalaemia, BMI- 32. What is the most probable cause?
A. PCOS
B. Cushings
C. Primary hyperaldosteronism
D. Pheochromocytoma
10. A 72 year old woman who had a repair of strangulated femoral hernia two days ago becomes noisy,
aggressive and confused. She is afebrile, her full blood count is normal apart from a raised mean
corpuscular volume (MCV). What is the most likely diagnosis?
A. Electrolyte imbalance
B. Delirium Tremens
C. Wernicke’s Encephalopathy
D. Infection toxicity
E. Hypoglycemia
11. A 58year old patient presents with altered bowel habits and bleeding per rectum. Exam and
sigmoidoscopy showed an ulcer. What is the single most likely diagnosis?
A. Colorectal carcinoma
B. Celiac disease
C. Crohns disease
D. UC
E. IBS
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12. A student living in a hostel at university has come back home with fever and non blanching rash.
What is the single most likely diagnosis?
A. CO poisoning
B. Meningitis
C. Subarachnoid haemorrhage
D. Extradural hematoma
E. Intracerebral haemorrhage
13. A child with signs of meningism shows presence of abnormal blood cells in CSF. What is the single
most likely diagnosis?
A. Streptococcal Meningitis
B. Meningococcal Meningitis
C. Viral Meningitis
D. Tubercular Meningits
E. Leukemic Infiltration
14. A previously well 82 year old man wakes up with slurred speech and unsteadiness. He appears
confused when trying to get to the toilet and put on his clothes. Four hours later he regains all function.
Choose the single most likely cause?
A. Alcohol withdrawal
B. Constipation
C. TIA
D. UTI
E. Stroke
15. In which of the following would you see a wedge shaped area of discoloration involving both grey
and white matter?
A. Meningioma
B. Astrocytoma
C. Medulloblastoma
D. Cerebral infarction
E. Cerebral haemorrhage
16. A 75 year old man has been taking bendrofluazide for hypertension for 10years, He has recently been
diagnosed with Parkinson's disease and has been prescribed Levodopa 125 mg tablets. His wife says he
has had a few falls recently. Choose the single most appropriate initial investigation?
A. CT scan of head
B. Electrocardiogram (ECG)
C. Tilt Test
D. Standing blood pressure
E. Carotid Doppler ultrasound
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17. A three year old boy has a high fever and started a seizure at home. On admission to the A&E dept he
is still convulsing. His cardio respiratory status is stable and an intravenous (1V) lien has been
established. Choose the single most appropriate next action?
A. CT scan of head
B. Give intravenous ( IV) Iorazepam
C. Serum U&E
D. Arrange electroencephalogram (EEG)
E. Lumbar puncture
18. A 62 year old woman reports episodes of postmenopausal bleeding and discharge. Two years ago, she
had a negative smear but there is an obvious ulcer on her cervix. Which is the single most appropriate
investigation from the given options?
A. Colposcopy
B. Cervical smear
C. TVscan
D. Hysteroscopy
19. A 38 year old woman has delivered after an induced labour which lasted 26 hours. The placenta was
delivered completely and there are no perineal tears. She is exhausted and starts to bleed heavily 45mins
after birth. What is the most probable cause from the given options?
A. Uterine atony
B. Concealed haemorrhage
C. coagulation defects
D. retained products
20. A 50 year old man presents with decreased body mass, mixed iron and folic acid deficiency, and
diarrhoea after recent travelling abroad to Barbados. He is also stating that his stools are smelly and
difficult to flush away. What is most discriminative investigation?
A. Blood cultures
B. Thyroid function tests (TFTs)
C. Serum calcium
D. CT scan
E. Jejunal biopsy
21. Patient with abdominal pain of sudden onset dies. Autopsy reveals ruptured abdominal aneurysm,
what is the pathophysiology resulting in this?
A. Atheroma
B. Aortic coarctation
C. Dissecting aneurysm
22. Prenatal screening is recommended if ultrasound scan at 16 weeks confirms that the foetus is male
and the mother has had an affected son previously. Choose the single most likely condition from the
following list of options.
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A. Duchene muscular dystrophy

B. Cystic fibrosis
C. Spina bifida
D. Down’s syndrome
E. Spinal muscular atrophy
23. An 18 year old girl comes with complaints of fresh painless bleeding while passing stools. No other
symptoms. What is the most likely diagnosis?
A. Bowel Ca
B. IBDs
C. Anal stricture
D. Haemorrhoids
24. A West Indian woman with anaemia and mild jaundice comes with limb pains and abdominal pain.
And the symptoms are precipitated by ongoing infections. On examination spleen is no more palpable.
What is your most probable diagnosis?
A. G6PD deficiency
B. Sickle cell disease
C. Beta thalassemia major
D. Sideroblastic anaemia
E. Malaria
25. A 6 year old boy has earache and hearing difficulty on the right ear for the past 3 weeks. On
examination his tonsils are swollen. The external ear is normal on both sides. The right tympanic
membrane is dull in appearance while the left is normal. The right cervical nodes are enlarged. What is
the likely cause of his earache?
A. Tonsillitis
B. Mastoiditis
C. Acute otitis media
D. Chronic otitis media
E. Otitis media with effusion
26. A 30 year old woman has been feeling low and having difficulty in concentrating since her mother
passed away 2 months ago. She feels lethargic and tends to have breathlessness and tremors from time to
time. What is the most likely diagnosis?
A. Adjustment Disorder
B. Post-traumatic stress disorder (PTSD)
C. Panic Disorder
D. Generalized anxiety disorder (GAD).
E. Bereavement
27. A 2 weeks old child presents with 70% O2 saturation on air. He is cyanosed and has a pan systolic
murmur. What is the most likely reason for this?
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A. Tetralogy of Fallot (TOF)

B. Atrial septal defect (ASD)
C. Patent ductus arteriosus (PDA)
D. Pulmonary Hypertension
E. Type 1 respiratory failure
28. A 20 year old woman is 17 weeks pregnant. She is worried about the possibility of her baby with
spina bifida as she did not take folic acid supplement before conception and in early pregnancy .
A. Pre-implantation genetic diagram
B. Aminocentesis
C. Chorionic villus sampling (CVS)
D. Fetalcordocentesis
E. Genotyping fetal cell in Maternal circulation
F. Ultrasound scan at 18-20 week gestation
29. A pregnant lady on her 28 weeks pregnancy presents with BP 160/100mmHg and proteinuria of
0.2 gm/ day. What is your most probable diagnosis?
A. Gestational hypertension
B. Pre eclampsia
C. Eclampsia
D. Chronic hypertension
30. An 81 year old man complains of general malaise and chronic backache. He has a history of mild
concussion with episodes of blurring of vision. An X-ray report show pepper-pot skull. What is single
most appropriate next best test?
A. Full blood count
B. ECG
C. Serum electrophoresis
D. Blood glucose
31. A person who has been hypertensive since last 10 years, not on any treatment, presents with sudden
loss of consciousness. What is the single most likely diagnosis?
A. Hypoglycaemia
B. Subdural haematoma
32. CSF examination of a child with meningitis reveals presence of Gram negative encapsulated
diplococci. What is the single most likely diagnosis?
A. Streptococcal Meningitis D. Tubercular Meningitis
B. Meningococcal Meningitis E. Leukemic Infiltration
C. Viral Meningitis
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33. A 75 year old woman has been treated by her GPwith amitriptyline 25 mg at night for the past four
months, together with diazepam 2 mg at night. She becomes confused and agitated, particularly at night.
Choose the single most likely cause?
A. Tricyclic drug toxicity
B. Benzodiazepine toxicity
C. Psychosis
D. UTI
E. TIA
34. Which of the following is present in between the middle cerebral artery and the anterior cerebral
artery?
A. Meningioma
B. Astrocytoma
C. Medulloblastoma
D. Berry aneurysm
E. Cerebral haemorrhage
35. An 80 year old woman reports several episodes of dizziness, double vision and brief blackouts which
seem to be related to head movements. Between attacks she is well and not on any regular, medication.
Choose the single most appropriate initial investigation?
A. CT scan of head
B. Cervical spine Xray
C. Tilt Test
D. Standing blood pressure
36. A man has a history of stable angina for which he is taking isosorbidemononitrate and aspirin. He
presents with a two month history of dizziness and palpitation lasting a few hours. These occur almost
every day. Choose the single most discriminatory test?
A. CT scan of head
B. Ambulatory electrocardiogram (ECG)
C. Serum U&E
D. Ambulatory blood pressure monitoring
E. Serum drug levels
37. A 54 year old woman is referred with irregular vaginal bleeding. Vaginal examination has proved
impossible as she has never had a sexual relationship. She is diabetic with a. body mass index (BMI) of
34 kg/m2.Which is the single most appropriate investigation from the given options?
A. Transvaginal Ultrasound Scan
B. Examination Under Anaesthesia
C. Outpatient Hysteroscopy
D. Trans abdominal ultrasound
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38. A 19 year old girl is very distressed due to thick white curdy vaginal discharge. She cannot sleep
because of the vaginal pruritis. On examination you find that she had vulvo-vaginitis due to monilia. She
says that this has happened before.What is the most appropriate treatment of choice?
A. Local application of Clotrimizole
B. Oral Nystatin
C. Local application of Ketokinazole
D. Local Clotrimizole plus single dose of oral Fluconazole
39. A 43 year old man was involved in an RTA. On examination, there was absent air entry on the right
side, tracheal deviation to the left and a dull percussion note on the right. BP is 80/60mmHg and pulse is
120/beats per min. CXR shows a diffuse opacity on the right side obscuring the right costo- phrenic angle.
What should be the most appropriate immediate management?
A. Needle aspiration on the right side
B. needle decompression on the right side
C. insertion of chest drain on the right side
D. give 100% oxygen and fluid resuscitation with 2 large bore IV-lines
40. A patient with hepatocellular carcinoma has raised levels of ferritin. What is the most probable cause?
A. Hemochromatosis
B. Wilsons disease
C. Alpha 1 antitrypsin deficiency
D. Carcinomatosis
41. A 30 year old professional athlete presents with amenorhea of 7 months duration. What is the Single
most likely cause from the following options? FSH 8, LH 6, Oestradiol 80, Prolactin 600.
A. Premature ovarian failure
B. Hypothalamic failure
C. PCOS
D. Prolactinoma
42. A 50 year old female presents to the medical department with complaints of dizziness since few days.
She is a teacher by profession, and she describes her class room moving around her whenever she turns
her head to look at the door. She also feels nauseous in these few seconds. She has no other complaints.
What is the likely diagnosis?
A. Meniere’s Disease
B. BPPV
C. Vestibular Neuronitis
D. Acoustic neuroma
E. Cholesteatoma
43. A 55 year old man presents with complaints of claudication pain in his right thigh and calf. On
examination the femoral and popliteal pulses are absent on the right leg. Localise the site of occlusion.
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A. External Iliac Artery

B. Aorto-Iliac
C. Ilio-Femoral
D. Internal Iliac
E. Abdominal aorta
44. A 7 year old boy who is up to date with all his immunization has come to you 7 hrs after a metal spike
has injured his hand, wound is 0.5 cm deep. What is the most appropriate action?
A. Tetanus Ig + tetanus vaccine + antibiotics
B. Tetanus Ig + antibiotics
C. Tetanus Ig + tetanus vaccine
D. Tetanus vaccine + antibiotics
E. Antibiotics
45. A family with a baby who has a cousin who died from cot death recently, mother asks for advice.
What advice will you give the mother?
A. Child should sleep on the back with legs towards the end of the cot
B. Child should sleep on the front with the legs towards the end of the cot
C. Child should sleep on the back with the head towards the end of the cot
D. Child should sleep on the front with head towards the end of the cot
E. Reassure
46. Young female, returning from USA to UK developed shortness of breath and productive cough which
initially contained blood, but now is dry. She is taking COCPs. What is the most likely diagnosis?
A. Pneumonia
B. Pulmonary embolism
C. Pulmonary TB
D. PCP
47. What is the choice of post –op analgesia in a patient who had appendectomy for gangrenous
appendix?
A. IM tramadol
B. IV Morphine
C. Oral morphine
D. Rectal diclofenac
E. Oral codeine
48. A young man comes with back pain and occasional painless haematuria. What is the most likely
pathology?
A. Ca. Bladder
B. Ca. Prostate
C. Nephropathy
D. Uretric Calculi
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49. A 20 year old lady developed post-influenza pneumonia. CXR shows bilateral cavitatory lesions.
What is the best treatment?
A. Amoxicillin
B. Doxycycline
C. Flucloxacillin
D. Clarithromycin
50. A 8 year old diabetic child presents with loss of consciousness. What is the single most likely
diagnosis?
A. Hypoglycaemia
B. Meningitis
51. 73 year old man is brought to the Accident and Emergency Department unconscious. His GCS is 12.
On initial examination his pulse rate is 80 beats/ minute, he is sweatingand he has arterial blood oxygen
saturation (SAO2) of 98% on air. Choose the single most useful discriminating investigation?
A. ABG
B. Blood cultures
C. Blood Glucose concentration
D. ECG
E. CT Brain
52. A man brings his wife into A&E after finding her unconscious at home. He says that at breakfast time
she had complained of a suddenheadache and had vomited. Her mother died at the age of 40 due to
sudden death. She took Paracetamol and aspirin for the pain. She is now in A&E with a low GCS. Choose
the single most likely cause?
A. Subarachnoid Hemorrhage
B. Subdural Hemorrhage
C. Extradural Hemorrhage
D. Migraine
E. Intracerebral Hemorrhage
53. A 35 year old woman first presented with a feeling of unsteadiness and dysarthria. Past history
revealed an episode of visual impairment. She recovered almost fully from both of these events. A year
later she presents with parasthesiae in her right leg. Choose the single most likely underlying condition?
A. Normal pressure hydrocephalus
B. Multiple sclerosis
C. Multi — infarct dementia
D. Parkinson's disease
E. Carotid artery disease
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54. An 18 year old man of insulin for diabetes mellitus is found collapsed at home in the afternoon by his
mother and immediately brought to the Accident and emergency departament. Choose the single most
appropriate Diagnostic investigation?
A. CT scan of head
C. Blood glucose concentration
D. Blood culture
55. A 12 year old girl is referred to the Paediatric outpatient clinic because she has had a first episode of a
single generalized seizure during sleep which lasted for three minutes. Clinical examination is normal.
Choose the single most appropriate next action?
A. Arrange CT scan of head
B. Arrange electroencephalogram (EEG)
C. Exclude child from all sports at school
D. Provide parents with rectal diazepam
E. Start first line anticonvulsant
56. A 44 year old healthy woman is referred with intermenstrual bleeding and discharge.At the age of 32
she was successfully treated for carcinoma in situ. She has had regular follow-up with no recurrence. A
recent smear was negative.What is the next best step in management?
A. Repeat smear
B. Colposcopy
C. TV scan
D. Hysteroscopy
57. A man who wants to quit alcohol, but wants to avoid the unpleasant craving experiences. What do you
prescribe for him?
A. Acamprosate
B. Disulfiram
C. Methadone
D. Fluoxetine
E. Amitryptalline
58. A patient with severe Alzeheimers and is on ‘end of life care’. A team of specialists managing him
had decided on a “DNAR in case of cardiac arrest” as the best management option for the patient in case
of cardiac arrest. As the managing FY1 doctor what would you do?
A. Access patient’s mental capacity
B. Carry out the DNAR specialist order
C. Take consent from relative.
D. Consent form should be signed by relative and patient.
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59. A 62 year old man has been smoking about 15 cigarettes a day for 45 years. He started working as a
builder since he was 24 years old. He presents with chest pain, shortness of breath and weight loss. Chest
X-ray shows bilateral fibrosis and left side pleural effusion. What is the best investigation that will lead to
diagnosis?
A. Chest x-ray E. CT Scan
B. Pleural fluid aspiration of cytology
C. Magnetic resonance imaging (MRI)
D. Pleural biopsy
60. During a basketball match, one of the players suddenly collapsed to the ground with coughing and
shortness of breath. What is the investigation of choice for this patient?
A. Chest x-ray
B. CT scan
C. Magnetic resonance imaging (MRI)
D. V/Q scan
E. CT pulmonary angiogram (CTPA)
61. A 4 year old boy presents with a sharp metal injury. He never had any vaccination as his parents were
worried about the side effects. What should be the next step?
A. full course of DPT vaccine
B. TT Immunoglobulin
D. No treatment
C. A+B
62. A 45year old woman comes with red, swollen and exudating ulcer on the nipple and areola of right
breast with palpable lump under the ulcer. What do you think is causing this skin condition?
A. Inflammatory cells releasing cytokines
B. Infiltration of the lymphatics by the carcinomatous cells
C. Infiltration of the malignant skin cells to the breast tissue
63. Patient with CA head of pancreas, what structure is directly affected?

A. Common bile duct
B. Pylorus
C. Kidney
D. Liver
64. 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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65. 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
66. A 75 year old lady who had mitral valve replacement 13 years ago has developed recurrent
breathlessness. Her husband has noticed prominent pulsation in her neck. She complains of abdominal
pain and ankle swelling. What is the most probable diagnosis?
A. Aortic Regurgitation
B. Mitral Regurgitation
C. Mitral Stenosis
D. Tricuspid Regurgitation
E. Pulmonary Stenosis
67. A 30 year old man felt feverish, 2 days later he developed pain in anus. On examination a warm lump
was found. What is the appropriate management?
A. Haemorrhoidectomy
B. Fistulectomy
C. High residue diet
D. Paracetomol
E. Incision & drainage
68. A student living in a hostel presents with cherry red colour of his skin and loss of consciousness after
a fire in the hotel. What is the single most likely diagnosis?
A. CO poisoning
B. Meningitis
C. Hypoglycaemia
69. A 45 year old woman is brought to the Accident and emergency department unconscious. Her GCS is
7 on initial examination, her pulse rate is 110 beats / minute, temperature normal, blood glucose 4.6
mmol/L. She was found with an empty bottle of her antidepressant dosulepin. Choose the single most
useful discriminating investigation?
A. ABG
B. Blood cultures
C. Blood Glucose concentration
D. ECG
E. CT Brain
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70. A 25 year old woman with a history of migraine has a sudden onset of severe headache. The headache
has not resolved with her usual medication. She is photophobic, has neck stiffness and is apyrexial. What
is the SINGLE most likely diagnosis?
A. Intracranial space occupying lesion
B. Meningitis
C. Migraine
D. Stroke
E. Subarachnoid haemorrhage
71. 59 year old man first presented with an episode of weakness in his right arm and leg which recovered
within a few hours. Past history reveals an episode of visual loss in the left eye four months previously.
Six weeks later he develops numbness in his right leg. Choose the single most likely underlying
condition?
B. Multiple sclerosis
C. Multi — infarct dementia
E. Carotid artery disease
72. An 80 year old woman has repeated attacks of sudden loss of consciousness without warning, but
recovers completely within two minutes. Choose the single most appropriate Diagnostic investigation?
A. CT scan of head
B. Electrocardiogram (ECG) 24hrs
D. Serum potassium concentration
E. Electroencephalogram (EEG)
73. An acutely ill eight month old girl is admitted to hospital following a five minute seizure. She has
been unwell with fever and vomiting for the past 24 hours. She is drowsy but a computed tomography
(CT) scan of the brain, is normal. Choose the single most appropriate next action?
C. Give intravenous ( IV) Iorazepam
D. LP
74. A 50 year old woman had a carcinoma of the cervix 5 years ago. It was confined to the ectocervix.
She was treated for it and comes for regular follow ups. She now presents as she is has lack of appetite
and slight weight loss.On examination the uterus is mobile, no masses are palpable and her chest is
clear.Which is the single most appropriate investigation from the given options?
A. CT abdomen and pelvis
B. Abdominal and pelvic USG
C. MRI pelvis and abdomen
D. Full blood count
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75. 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
76. A 12 year old boy leaks urine all the time. He has history of spina bifida. What is the appropriate
management?
A. Intermittent catheterisation
B. Desmopressin
C. Condom catheter
D. Urinary incontinence pad
77. 20 year old student presented to the Emergency Department after a fly entered her left ear. She is
extremely uncomfortable. What is the best management?
A. Instil mineral oil before removal
B. Remove under GA
C. Remove with a pair of forceps
D. Instil lidocaine before removal
E. Remove using a hook
78. A 20 year old young woman present with pain and swelling on the right side of the face. She said her
pain increases most often after taking meal. What is the most appropriate diagnosis for the presenting
complain?
A. Submandibular calculus
B. Parotid infection
C. Dental carries
D. Otitis media
79. You are called to see a 20 year old woman 2 hours post LSCS. She has not passed urine since her
operation. She denies any urinary symptoms preoperatively. On examination, she appears unwell, with a
temperature of 37.5oC, blood pressure 94/73mmHg, pulse 116 beats/min and saturations 97% in air. Her
abdomen id distended, with tenderness in the left flank and supra-pubic region. Bowel sounds are not
audible. Choose the most appropriate post C-Section complication for this lady?
A. Urinary tract infection D. Acute pyelonephritis
B. Urinary tract injury E. Paralytic ileus
C. Pleurisy
80. A60 year old smoker presents with cramp-like pain in the calves relieved by rest and non-healing
ulcers. On examination cold extremities with lack of hair around the ankles, absent distal pulses is found.
What is the most probable diagnosis?
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A. Intermittent claudication
B. Chronic ischemia of the limbs
C. Buerger’s disease
D. Deep venous thrombosis
E. Diabetes Mellitus
81. A man has been brought into Accident & Emergency for alternating episodes of over activity and
depression. What is the most likely diagnosis?
A. Dysthymia
B. Bipolar affective disorder
C. Cyclothymia
D. Mania
E. Phobia
82. An old man with a gastric cancer is fit to undergo a surgery, he totally understands the doctor’s
explanation but refuses any further treatment what to do?
A. Go ahead with the surgery without further action as it is in the best interest of the patient
B. Ask two doctors to sign him for the surgery
C. Ask the family member who look after him to sign him for the surgery
D. Respect the patient view and tell him to contact you if he changed his mind.
83. A 70 year old woman has been diagnosed with Type 2 Diabetes. Her body mass index is 22kg/meter
square. Random plasma glucose concentrations are 8mmol/l and 10mmol/l. Her BP is 130/80mmHg and
her fasting cholesterol is 5.7mmol/l. She is currently symptom free but has micro albuminuria. What is
the single most appropriate drug management?
A. Ace inhibitor and metformin
B. Ace inhibitor and glibenclamide
C. Statin and Ace inhibitor
D. Statin and Metformin
84. 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
85. 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
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86. A woman was in labour with amniotic fluid drainage for 48hrs before delivery at 36wks gestation.
Child presents with respiratory distress and flaring of alae nasi, what investigation will you do before you
start treatment?
A. Chest X ray
B. Blood culture
C. FBC
D. Electrolytes
87. A woman presents with severe headache at the back of her head. She says it’s the worst headache she
has ever experienced. What is the single most likely diagnosis?
A. Subdural haematoma
B. Meningitis
88. A 43 year old man is brought to the Accident and Emergency Department unconscious. His GCS is 7.
On initial examination his pulse rate is 90 beats / minute, blood glucose 5.3 mmol/1 arterial blood oxygen
saturation( SaO2) is 97% on air. He smells of alcohol. There are no external signs of injury. Choose the
single most useful discriminating investigation?
A. ABG
B. Skull Xray
C. Chest Xray
D. ECG
E. CT Brain
89. In which disease Demylination of nerve fibres present in large areas of the brain is seen?
A. Meningioma
B. Multiple Sclerosis
C. Scleroderma
D. Medulloblastoma
E. Alzheimer's dementia
90. A 47 year old man, known to be a belligerent heavy drinker, becomes increasingly
drowsy over a period of several days. He has previously been well. He Isrousable but mental state
examination reveals considerable cognitive impairment. Choose the single most likely underlying
condition?
B. Benign intracranial hypertension
C. Cerebral tumour
D. Subdural hematoma
E. Multi — infarct dementia
__________________________________________________________________________________________________
18
91. A 48 year old woman who was previously well suddenly becomes unconscious whilst shopping. On
arrival at hospital she is not breathing and requires ventilation. Examination reveals fixed dilated pupils
and bilateral extensor plantar response. Choose the single most appropriate Diagnostic investigation?
A. CT scan of head
B. Electrocardiogram (ECG) 24hrs
E. Electroencephalogram (EEG)
92. A 15 year old girl had her epilepsy well controlled on sodium valproate. Her parents bring her in with
two new concerns; increasing seizure frequency and unexplained absence from school. Examination is
normal apart from mild obesity. Choose the single most appropriate next action?
C. Add second anticonvulsant
D. Review anticonvulsant dose
93. A lady has undergone abdominal hysterectomy with bilateral salpingo-oopherectomy with
omentectomy for carcinoma of the ovary. Now she came for follow up. Her CA125 had come to normal
levels after surgery. What is the single most appropriate investigation for follow up?
A. Pelvic CT
B. CA 125
C. CA 153
D. Paracenthesis
94. 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
95. 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
__________________________________________________________________________________________________
19
96. Neonatal Hypothyroidism can be diagnosed by which of the following features?

A. Mother has hyperthyroidism
B. Diarrhoea
C. Sweating
D. Hyperactivity
E. Hyperphagia
97. Child presents with severe pain in testis. On examination, one testis is higher than the other. What is
the most appropriate step you will do next?
A. Refer to surgery for exploration
B. Antibiotics
C. Observation
D. Analgesia
98. A primiparous woman with no previous infection with Herpes zoster is 18 weeks pregnant. She
had a recent contact-history with a young patient, aged 21, having widespread chicken pox. What is the
most suitable management for the pregnant lady?
A. Acyclovir orally
B. IV Acyclovir +IV Immunoglobulin
C. IV Acyclovir
D. Reassure
E. IV Immunoglobulin
99. A patient was diagnosed with pyloric stenosis what is the initial investigation?
A. Electrolytes
B. Urea
C. FBC
D. USG
100. A 72 year old presents with ipsilateral ptosis and contralateral hemiparesis. Which of the following
structure is affected?
A. Medulla D. Cerebellum
B. Cortex E. Pons
C. Midbrain
101. An elderly man on morphine for pain meds and well controlled now has constipation despite
increased fluid intake, moves bowel 3 times a week and stool has normal consistency. What will you
give?
A. stimulant laxative
B. Fecal softener
C. Low residue diet
D. Phosphate enema
__________________________________________________________________________________________________
20
102. A 6 year old boy presents with weight gain, bilateral pitting ankle oedema, peri orbital oedema and
hyper lipidemia. What is the next most appropriate step?
A. Renal biopsy
B. USG abdomen
C. 24 Hours urinary protein
D. X ray KUB
E. Urine microscopy
103. A 70 year old man working in his garden suddenly collapses and fractures his femur. What is the
single most likely diagnosis?
A. Balance abnormality
B. Vasovagal syncope
C. Decreased vision
D. Postural hypotension
E. TIA
104. A 44 year old man is brought to the Accident and emergency department unconscious. His GCS is 7.
On initial examination his pulse rate is 100 beats / minute , arterial blood oxygen saturations 100% on air,
blood Glucose 4.3 mmol/L. He is accompanied by members of his family who also report feeling unwell.
Choose the single most useful discriminating investigation?
A. ABG
B. Skull Xray
C. Blood CO concentration
D. ECG
E. CT Brain
105. In which of the following, a circumscribed and limited lesion with glandular columnar cells with
pleomorphic nuclei, is seen?
A. Meningioma
B. Multiple Sclerosis
C. Scleroderma
D. Medulloblastoma
E. Alzheimer's dementia
106. A 57 year old man presents with increasing difficulty in walking over the last two
years. This problem has continued to get worse and he now sometimes finds difficulty in starting to walk,
and he has developed a shuffling gait. Choose the single most likely underlying condition?
B. Alzheimer's disease
C. Cerebral tumour
E. Motor neurone disease
__________________________________________________________________________________________________
21
107. An 18 year old is playing rugby at school. Following a tackle he has a brief loss of consciousness.
He then presents with paraesthesia in his arms. Choose the single most appropriate Diagnostic
investigation?
A. CT scan of head
B. Chest x – ray
C. Cervical spine x-ray
E. Serum calcium concentration
108. A two year old boy has had a single, prolonged febrile fit. The fit lasted 20 minutes and now he is
completely normal. There is a family history of febrile convulsions in childhood. Choose the single most
appropriate next action?
C. Start first line anticonvulsant
D. LP
E. Provide parents with rectal diazepam
109. A 24 year old woman has been diagnosed with gonococcal cervicitis. What is the most appropriate
drug of choice for treating it?
A. Doxycyclin
B. Ciprofloxacin
C. Metronidazole
D. Clindamycin
110. A 7 year old boy presents with epistaxis, bleeding is not being controlled. Investigations are as
follows:
Platelets : 210,000 PT : 13 sec
APTT : 42 sec Bleeding : normal.
Which one of the following is the most likely diagnosis?
A. Haemophilia
B. Von willibrand disease
C. ITP
D. Vit K deficiency
111. A 15 year old girl is brought by her mother. She has not started menstruation yet, has no axillary or
pubic hair and has webbed neck. What is the most likely diagnosis?
A. Turner’s syndrome
B. Klinefelter’s syndrome
C. Fragile X syndrome
D. Edwards’s syndrome
E. Patau syndrome
__________________________________________________________________________________________________
22
112. A 50 year old woman comes with fever, jaundice and right hypochondrial pain. What is the most
appropriate investigation to be done next?
A. USG
B. Radiography
C. MRCP
D. ERCP
113. 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
114. A 80 year old woman who is a known COPD, patient is on salbutamol inhalers, salmetrol inhalers,
steroid inhalers and oral steroids. She still gets shortness of breath at rest. What is the most appropriate
treatment of this patients’ symptoms.
A. Noninvasive ventilation
B. Long term oxygen therapy
C. Mechanical ventilation
D. Continue current treatment
E. Short term oxygen therapy
115. A young woman complains of diarrhea, abdominal cramps and mouth ulcers. AXR shows distended
transverse colon with globet cell depletion on rectal biopsy. What is the most probable diagnosis?
A. Coeliac Disease
B. Ulcerative colitis
C. Bowel Carcinoma
D. Bowel obstruction
E. IBS
116. A 17-year-old boy who went playing football, suddenly develops unilateral swelling of the RT
hemiscrotum, non-tender on raising it. What is the next appropriate management? D 23RD June 2018
A. Reassure
B. Urgent surgical exploration
C. IV antibiotics
D. US of the scrotum
117. 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?
__________________________________________________________________________________________________
23
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.
118. 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
119. 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
120. A 65 year old woman fractured her hand after a fall. She has a history of regular falls in the
afternoons. She works at the video display unit(VDU). What is the single most likely diagnosis?
C. Decreased vision
E. TIA
121. A 41 year old woman is brought to A&E unconscious. Her GCS is 7. Pulse rate 110b/min, arterial
blood oxygen saturation 95% on air, blood Glucose 4.5 mmol/L. A purpuric rash is noted on both her
arms. Choose the single most useful discriminating investigation?
A. LP
B. Skull Xray
C. Blood cultures
D. ECG
E. CT Brain
122. A tumour present on the outer aspect of the brain, with pressure over the brain.
(Pasammomabodies ) present. What is the most likely diagnosis?
A. Meningioma D. Medulloblastoma
B. Secondary ca E. Alzheimer's dementia
C. Astrocytoma
__________________________________________________________________________________________________
24
123. A 49 year old man first presented with increasing difficulty in swallowing. Severalmonths later he
developed weakness in his right foot. Now he can no longer feedhimself, chokes on food and has become
confined to a wheelchair. Choose the single most likely underlying condition?
B. Alzheimer's disease
C. Huntington's disease
E. Motor neurone disease
124. An 84 year old woman with a history of hypertension, treated with bendrofluazide, presents with
dizziness and falls. The symptoms are worse on getting up in the morning. Choose the single most
discriminatory test?
A. CT scan of head
C. Serum U&E
D. Standing & lying BP
125. A 75 year old widow lives alone. She has been found lying on the floor several times lately and is
brought to the Accident and Emergency Department. She is known to take aspirin (75 mg daily),
bendroflurnethiaziade (2.5 mg daily), Paracetamol (2-4 tables daily) and nitrazepam (5 mg at night).
Choose the single most appropriate intervention to prevent falls?
A. Review antihypertensive medication
B. Review dose of sedative medication
C. Advice about posture
D. Modification to the home
E. Eyesight testing
126. A 27 year old woman has acute pelvic inflammatory disease. She gives history ofunprotected
intercourse with a new partner two weeks ago. You suspect infection with Chlamydia. What is the most
appropriate treatment of choice?
A. Doxicycline for 2 weeks
B. Ciprofloxacine for 1 week
C. Doxicycline with Metronidazole for 2 weeks
D. Azithromycin single dose stat
127. 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
__________________________________________________________________________________________________
25
128. 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
129. A 28 year old woman presents with 18 weeks of amenorrhoea. A scan was done and it revealed an
ovarian mass on the right side with solid and cystic areas, with a bright nodular structure suggestive of
tooth. What is your most likely diagnosis?
A. Ovarian cancer
B. Endometriosis
C. Tubo-ovarian abscess
D. Dermoid cyst
130. A 65 year old woman, who is under a long term follow up after a lumpectomy and anti – oestrogen
therapy for breast cancer, attends following a diagnosis of stress fracture in a metatarsal bone. Choose the
SINGLE most appropriate initial investigation?
A. Serum estradiol concentration
B. DEXA scan (Dual Energy X ray Absorptiometry)
C. Lumbar spine X- ray
D. X-ray of affected joint
E. Serum calcium levels
131. A thin 25 year old man who looks unwell has an ascitic fluid tap done for abdominal pain and
distension. Protein- 10g/l Lymphocytes- 70%. What is the most likely cause?
A. Liver Cirrhosis
B. Malignant ascites
C. TB Peritonitis
D. Sub acute bacterial Peritonitis
132. 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
133. A 54 year 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 3d. Her only medication is haloperidol
for hiccoughs. Today she is disorientated and has left sided weakness. What is the most likely diagnosis?
__________________________________________________________________________________________________
26
A. Hyperglycemia
B. Hypercalcemic Hypoglycemia
C. Brain metastases
D. Liver failure
134. A 30 year old woman on oral contraceptives presents with dilated tortuous veins crossing her
abdomen to join the tributaries of superior vena-cava. What is the single most likely cause?
A. Intra-abdominal malignancy
B. Ovarian cyst
C. Fibroids
D. Ascites
E. Deep vein thrombosis (DVT)
135. An 85 year old woman with Alzheimer’s dementia wants to change her will. What do you do?
A. Refer for assessment of capacity
B. Allow her to change her will
C. Refuse the change
D. Consult her family
136. 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
B. PET scan brain
C. MRI (brain)
D. Carotid angiography
E. Monitor for 24 hours
137. A 75 year old woman with history of recurrent falls while waiting for her bus. She went pale before
she fell. What is the single most likely diagnosis?
C. Decreased vision
E. TIA
138. An elderly female living in a care home develops severe itching and erythema on her body. There
are green wavy lines between her fingers and toes. What is the most likely diagnosis?
A. Scabies
B. Measles
C. Erythema nodosum
D. Chickenpox
E. Urticaria
__________________________________________________________________________________________________
27
139. In which of the following would you expect to see an organ protruding into the thoracic cavity?
A. Barretts oesophagus
B. Plummer vinsonsynd
C. Hiatus hernia
D. Secondary ca
E. Gastric ulcer
140. A 64 year old man has had several blackouts during-which he briefly loses consciousness and falls to
the ground injuring himself. He has never been incontinent or seen to jerk. Choose the single most
appropriate initial investigation?
A. Blood glucose concentration
B. Electroencephalogram (EEG)
C. Electrocardiogram (ECG) 24hrs
D. Standing and lying blood pressure
141. A 69 year old man presents with a progressive history of angina and dizziness on exertion. He has a
heart murmur. Choose the single most discriminatory test?
A. CT scan of head
C. Serum U&E
E. Echocardiogram
142. An 82 year old woman is brought to the accident and Emergency DepaitaLent after a fall at home.
Electrocardiogram. (EGG) and physical examination are normal. She takes spironolactone for mild
oedema, Gliben.claraide (500 mg daily) for type 2 diabetes and uses ibuprofen get for a painful shoulder.
Choose the single most appropriate intervention to prevent falls?
A. Review antihypertensive medication
B. Review dose of diabetic medication
E. Eyesight testing
143. A 32 year old pregnant woman with chlamydial cervicitis. What is the most appropriate drug of
choice in her case?
A. Ampicillin
B. Erythromycin
C. Azithromycin
D. Clindamycin
144. A patient with a history of DM is controlled on Gliclazide. He will undergo elective endoscopy.
What should be done regarding diabetic management?
__________________________________________________________________________________________________
28
A. Stop oral hypoglycemic drug night before

B. Give insulin, glucose and potassium during procedure
C. Change OHA to insulin the morning of the procedure
D. Reduce evening dose of OHA the day before the procedure and miss the morning dose until after
the procedure.
145. A 54 years old woman has presented with episodes of abdominal ache, vomiting and postural
hypotension. She also has a dark pigmentation of her skin. A diagnosis of Addison’s disease was made.
What is the most likely electrolyte abnormality expected in this patient?
A. High Na, low K
B. Low Na, high K
C. Low Na, low K
D. High Na, high K
E. Low Na, normal K
146. 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
147. 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
148. 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 D. Barium swallow
B. Colonoscopy
C. Stool culture
149. A 28 year old woman presents with pain and an ulcer on labia major. What is the lymphatic drainage
of labia major?
A. Superficial inguinal
B. Deep inguinal
C. Para aortic
D. Iliac
__________________________________________________________________________________________________
29
150. A 29 year old young man complains of recurrent attacks of diarrhoea. He says his stools contain
blood and mucus. Sometimes she has low grade fever. What is the most appropriate investigation?
A. Stoolculture
B. Plain abdominal x-ray
C. Per rectal examination.
151. A 50 year old man presented with stroke. Onset was 1 hour ago. CT scan showed a non
haemorrhagic stroke. What is the most appropriate next best step?
A. Aspirin
B. Carotid Doppler
C. tPA thrombolysis
D. Clopidogrel
152. A 22 year old girl who is unhappy about her weight with BMI : 22. She likes to have her dinner in an
expensive restaurant. She does excessive shopping. K+:3.3. What is the most probable diagnosis?
A. Anorexia nervosa
B. Bipolar
C. OCD
D. Bulimia
153. A 45 year old premenopausal woman is admitted for elective hernia repair. Hb is 8.4g/dl, MDH is
22pg, MCH 28g/dl, MCV is 70. Her WBC is within normal limits. What is the appropriate initial
management?
A. Immediate blood transfusion, proceed to surgery
B. Defer operation and investigate
C. Proceed with planned surgery
154. A child is diagnosed with meningitis. CSF examination reveals 10 blood cells with 1-2 lymphocytes,
normal glucose levels. What is the single most likely diagnosis?
C. Viral Meningitis
155. A previously well 90 year old woman who had a repair to a fractured neck of femur five days
previously becomes confuses and febrile. Her chest x-ray is normal. Choose the single most likely cause?
A. Alcohol withdrawal
B. Constipation
C. TIA
D. UTI
E. Stroke
__________________________________________________________________________________________________
30
156. Where do you see a change in squamous epithelium to columnar epithelium?

A. Multiple Sclerosis
B. Scleroderma
C. Barretts oesophagus
D. Meningioma
E. SLE
157. An obese 79 year old woman is brought unconscious into the Accident and Emergency Department.
In her handbag there are bottles of Glibenclamide. Metformin, pravastatin, paracetamol and an antacid.
Choose the single most appropriate initial investigation?
C. Electroencephalogram (EEG)
D. Echocardiogram
158. A 73 year old man has been treated for seizures following a stroke six months earlier. Over the past
two weeks, he has developed dizziness and poor balance. He has nystagmus on examination. Choose the
single most discriminatory test?
A. CT scan of head
C. Serum U&E
159. A 26 year old woman complains that she has a mild vaginal discharge with a strange fishy odour.
She denies any vaginal itching, but reveals that she had a preterm birth 8months ago. Choose the single
most appropriate diagnosis from the given options.
A. Candidiasis
B. Trichomonasis
C. Bacterial vaginosis
D. STI
160. A 63 years old woman underwent knee surgery and was kept on low molecular weight heparin
postoperatively. On the 6th post-operative day she developed sudden sever chest pain with breathlessness.
Her ECG and chest x-ray were normal. What is your next action?
A. Stop low molecular weight heparin and start Warfarin
B. Keep on low molecular weight heparin and do CT. pulmonary angiography.
C. Increase the dose of low molecular weight heparin and do CT. pulmonary angiography.
D. Keep on low molecular weight heparin, add warfarin and do CT. pulmonary angiography.
E. Change to unfractionated heparin and do CT. pulmonary angiography.
161. A 37 year old infertile lady with 5cm subserosal and 3 cm submucosal fibroid. She is trying to get
pregnant, management?
__________________________________________________________________________________________________
31
A. Clomifene therapy E. Intra uterine insemination

B. IVF
C. Myomectomy
D. Hysterectomy
162. 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
163. 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
164. A 30 year old man has facial flushing and warm upper limbs. There is pallor seen with cold
peripheries on both lower limbs. There is a murmur on auscultation of chest. What is the most appropriate
test to diagnose the condition?
A. Echo cardiography D. MRI scan
B. CXR
C. CT scan
165. A 64 years old patient has been having frequent episodes of secretory diarrhea, which is extremely
watery, with large amounts of mucus. A diagnosis of villous adenoma was made after endoscopy. What
electrolyte abnormality is most likely in this patient?
A. Hyperkalemia E. Hypercalcemia
B. Hypernatremia
C. Hyponatremia
D. Hypokalemia
166. A 23 year old woman with painless vaginal bleeding in 36 weeks of pregnancy otherwise seems to
be normal. What should be done next?
A. Vaginal U/S
B. Abdominal U/S
C. Vaginal examination
D. Reassurance
__________________________________________________________________________________________________
32
167. 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
168. A 15 year old girl is brought into hospital after taking 50 paracetamol tablets 10 hours ago. What is
the most appropriate management?
A. Wait 4 hours for serum paracetamol levels
B. Wait 2 hours for serum paracetamol levels
C. Start N-Acetylcysteine
D. Activated charcoal
E. Gastric lavage
169. A 49 year old patient with obstructive lung disease presented with acute severe shortness of breath.
ABGs were done which showed type 2 respiratory failure (hypercapnia and hypoxia). He was started on
24% oxygen via Venturi mask. His symptoms were still not improving. Repeat ABGs showed a rise in
pCO2 levels. NIPPV (Non-invasive Positive Pressure Ventilation) also failed. What is the next best
appropriate step?
A. Intubate and ventilate
B. 100% oxygen
C. Continue Non-invasive positive pressure ventilation
D. 35-60% oxygen via face mask
170. A 3 year old boy developed URTI and ear discharge. He now presents with neck stiffness. What is
the single most likely diagnosis?
C. Viral Meningitis
171. A 25 years old female has a blackout while watching a disco show on TV with strobe lights on.
A. Vasovagal syncope
B. Stoke-Adams attack
C. Anxiety
D. Epilepsy
E. Hypoglycaemia
172. In which if the following, A layer of sub-mucosal fibrosis, is seen?

A. Multiple Sclerosis D. Meningioma
B. Scleroderma E. SLE
C. Barretts oesophagus
__________________________________________________________________________________________________
33
173. A 24 year old woman who collapsed at the gym was resuscitated and brought into the Accident and
emergency department. Her husband says she has had some dizzy spells in the past and an
electrocardiogram (ECG) shows some minor non-specific abnormalities. Choose the single most
appropriate initial investigation?
C. Electrocardiogram (ECG) 24hrs
D. Echocardiogram
174. A 70 year old woman has a history of a mild stroke which occurred five years ago. She is taking
aspirin. She complains of increasing breathlessness and light headedness. Choose the single most
discriminatory test?
A. CT scan of head
C. Serum U&E
D. FBC
E. Echocardiogram
175. An 81 year old women collapses trying to put curtains in her bedroom. She is physical well and takes
no medication apart from multivitamins. She reports several episodes of dizziness in similar
circumstances. Choose the single most appropriate intervention to prevent falls?
A. Exercise
B. Neck collar
E. Eyesight testing
176. A young man has come to the GUM clinic with dysuria after recently travelling abroad. A urine PCR
confirms Chlamydia. What is the most appropriate treatment of choice for him and his partner?
A. Erythromycin
B. Doxicycline and Metronidazole
C. Single dose of 1gm Azithriomycin stat to each.
D. Local antibiotic cream application
177. An adult with facial and leg swelling, had proteinuria+++ on urinalysis. What investigation will lead
to a specific diagnosis?
A. Renal biopsy
B. Renal scan
C. 24 hours urine
D. USG
E. Serum albumin
__________________________________________________________________________________________________
34
178. A 42-year-old with loin pain and +1 blood on urinalysis. There is no fever. All the vitals are normal.
His family history is also less significant. What is the most appropriate next investigation?
A. USS abdomen
B. Cystoscopy
C. CT abdomen
D. X-ray KUB
E. Urine analysis
179. A 50year old man presented with passage of large volumes of urine, nocturia and fungal balanitis.
What is the most appropriate investigation that should be performed in this patient?
A. FBS (Fasting Blood Sugar)
B. Swab for fungal balanitis
C. Blood culture
D. FBC
180. A 59 years old woman presents with frequency, urgency and urinary incontinence. What is the initial
investigation?
A. Culture for urine
B. USS of KUB
C. Cystoscopy
D. Urinalysis
__________________________________________________________________________________________________

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1

Dr Swamy PLAB Courses Ltd.

A. Duchene muscular dystrophy

A. Tetralogy of Fallot (TOF)

A. External Iliac Artery

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

96. Neonatal Hypothyroidism can be diagnosed by which of the following features?

A. Investigate the possible cause of confusion.

A. Stop oral hypoglycemic drug night before

156. Where do you see a change in squamous epithelium to columnar epithelium?

A. Clomifene therapy E. Intra uterine insemination

172. In which if the following, A layer of sub-mucosal fibrosis, is seen?

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