Dr. Swamy PLAB Courses Ltd PLAB 1 MOCK TEST: MOCK 4 TIME ALLOWED: 3HRS SINGLE BEST ANSWER 1. A 75 - year - old woman who had a carcinoma of the distal rectum underwent an anterior resection. The blood supply of the tumour arises from which of the following? A. Coeliac artery B. Ileocolic artery C. Inferior mesenteric artery D. Internal iliac artery E. Superior m esenteric artery 2. A 34 year old p atient presented with redness and pain in the eye. He is also suffering with back pain that is worse in the morning. He i s taking NSAIDs for back pain. W hat is the cause of r ed eye? A. Ibuprofen B. Steroids C. Anterior Uveitis D. Post e rior Uveitis E. Trauma 3. A 33 year old female with bipolar affective disorder had an acute depressive episode which was controlled by antidepressants. Which drug will be best for prophylaxis in this patient? A. Mood stabiliser B. Selective serotonin reuptake inhibitors (SSRI) C. Tricyclic Antidepressant (TCA) D. Antipsychotic 4. A 15 year old boy presents with severe earache after having a swimming session. He does not allow you to do an otoscopy and the ear is severely tender to touch. What is the most appropriate antibiotic therapy for his condition? A. Amoxicillin B. Ciprofloxacin C. Flucloxacillin D. Meropenem 5. A young woman on combined oral contraceptive pills has been prescribed Amoxicillin for sinusitis. What should be the advi ce given to her? A. Increase dose of OCPS B. Reduce dose of Amoxicillin C. Use barrier methods for 2 weeks D. No extra precautions needed E. Barrier methods only if patient develops diarrhea 6. A middle aged man complains of a node which has been growing in his nose for several months. Now it is firm with central depression. It’s 0.6cm in size. What is the SINGLE most likely diagnosis? A. Basal cell carcinoma F. Kerato acanthoma B. Squ amous cell carcinoma G. Molluscum Contagiosum C. Lymph node D. Melanoma E. Kaposi’s Sarcoma 7. A 7 year old boy presents with her mother to the GP surgery. His mother describes he had presented this since 3 weeks ago. He had not experienced any trauma. No other symptoms associated with the condition. On examination the boy has non tender swollen ankles bilaterally. There is no rash or lesion. He is otherwise well. Which single test would be the best as an initial assessment? A. Plasma electrolytes. B. Album C. Total serum protein D. Anti - streptolysin 8. A lady comes in 6 weeks after her normal vaginal delivery for contraceptive advice. She is breast feeding her child and requests for reversible contraception. She is plannin g another pregnancy in 6 months tim e and is scared of injections. What is the best option for her? A. COCP B. Cu IUCD ( intrauterine contraceptive device) C. Mirena coil D. POP E. Transdermal patch 9. A 68 year old man with diabetes and hypertension was noted to have a cholesterol level on 3.4mmol/l. He was also noted to have micro - albuminuria. What is the best drug to add to his regimen? A. Ace inhibitors B. Statins C. Amylodipine D. Biguanides 10. A 65 year old man on dexamethasone underwent a surgery. During and after the surgery, his blood glucose level was around 17 – 19 mmol/l. What will you give the patient? A. Insulin B. Oral hypoglycaemics C. Remove dexamethasone D. IV saline E. IV dextrose 11. Which statement best describes the planes of the abdomen? A. The transpyloric plane lies halfway between the xiphoid and the symphysis pubis. B. The transpyloric plane passes through the hilar of the kidneys. C. The subcostal plane is a t the level of the body of L2. D. The iliac crests lie at the level of L5. E. The umbilicus usually lies at the level of the L4/L5 disc. 12. A 55 year old man is brought in the A& E department for acute abdominal pain. He is found to have a strangulated hernia for which he undergoes emergency surgery. 3 days post op, he is in a very agitated state claiming to see spiders on the wall and crawling over his body. He is sweaty, has palpitations and is confused. What is the most likely diagnosis? A. Delirium tre mens B. Wernicke’s encephalopathy C. Korsakoff’s syndrome D. Dysthymia E. C yclothymia 13. A 5 year old child was admitted with history of feeling tired and lethargic all the time, bleeding gums and sore throat since the last 3 months. On examination he is found to ha ve hepato - splenomegaly. What is the most probable diagnosis? A. Acute lymphoblastic leukemia (ALL) B. Acute myeloid leukemia (AML) C. Chronic myelogenous (or myeloid) leukemia (CML) D. Chronic lymphocytic leukaemia (CLL) E. Lymphoma 14. An 18 m onth old boy has been brought to the Emergency department because he has been refusing to move his left arm and crying more than usual for the past 24 hours. He has recently been looked after by his mother’s new boy friend while she attended college. Assess ment shows multiple bruises and a fracture of left humerus w hich is put in plaster. What is the SINGLE most appropriate next step? A. Admit under care of paediatrician B. Discharge with painkiller C. Follow up in fracture clinic D. Follow up in p aediatric outpatients E. Follow up with general practitioner (GP) 15. An 8 year old child presents with recurrent abdominal pains, occasional headaches but she maintains a good appetite. Examination is normal. FBC, U&E and other investigations are normal. What would you do for her next? A. Ultrasound abdomen B. CT head C. Reassure D. Analgesics 16. A young child just diagnosed with chicken pox. Usually goes to day care. What is the most appropriate advice? A. Child should be admitted to hospital straight away B. Isolate the child from parents and siblings at home C. Advise him he can go back to nursery when the rash is crusted over 17. A lady presents with abdominal pain, dysuria, dyspareunia and vaginal discharge. What is your next s tep? A. Laparoscopy E. Ultra sound B. High vaginal swab C. Hysteroscopy D. Laparotomy 18. 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 19. A three - month old baby was miserable and cried for two hours following his first routine immunization with diphtheria, tetanus, polio, Haemophilus influenza - B (HiB) and meningitis. What is the single most appropriate action? A. Defer immuniza tion for two weeks B. Do not give vaccine C. Give half dose of vaccine D. Give P aracetamol with future doses of the same vaccine E. Proceed with standard immunization schedule 20. A 55 year old lady with swelling on the abdomen below the umbilicus on the right side. What is the SINGLE most appropriate lymph node? A. External iliac lymph nodes F. Submental lymph nodes B. Pre aortic lymph nodes G. Submandibular lymph nodes C. Aortic lymph nodes H. Deep cervical lymph nodes D. Inguinal lymph n odes E. Iliac nodes 21. A 45 year old man presents to A&E with pain the chest and shortness of breath. He has no recollection of what has happened to him. His breath smells of alcohol. What is the most probable diagnosis looking at the given picture ? A. Shingles B. C ellulitis C. Blunt trauma D. ITP E. Hypersensitivity reaction 22. A 45 year old man diagnosed with Multiple Sclerosis is admitted after taking 100 P aracetamol tablets. He seems well, is not vomiting and is alert. He is refusi ng all treatment. What should you do next? A. Gastric lavage B. Activated charcoal C. N - Acetyl cysteine D. Methionine E. Evaluate his capacity to refuse treatment 23. A child had three attacks of tonsillitis last year. What will be the most appropriate management for this child? A. Treat when ill B. Surgery C. Prophylactic Antibiotics D. Refer to ENT E. Do Nothing 24. A patient 10 days post - op for rectal carcinoma present s with high grade fever and mass in pelvis. What is the most probable diagnosis? A. Pelvic Abscess B. Recurrence of rectal carcinoma C. Metastasis D. Pneumonia secondary to aspiration E. Septicemia 25. 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 26. A 19 year old girl is brought into A & E after an argument with her boyfriend. She has multiple superficial lacerations on her forearms and wrists which have been attended to by the medical team. She has attended A&E many times in the past with similar episodes of self - harm and drug overdoses. What is the most likely diagnosis? A. Obsessive compulsiv e personality B. Schizoid personality C. Borderline personality D. Dependent personality 27. A man with dementia has an ulcerative lesion on forehead. He wants it removed so ‘it can help improve his memory’. Wife says he is not fit to give consent. What w ill you do? A. Get letter signed from the GP B. Get letter signed from wife C. Get letter signed from patient D. Refer to psychiatrist to assess the mental capacity to give consent 28. A young woman is brought to the hospital after consuming 17 tablets of paracetamol to the A&E. On evaluation it is noted that she is clinically depressed and has not eaten anything for four days. She has been brought to the hospital after 9 hours on consum ing the tablets. What is the most important next step? A. N acetyl cysteine B. Paracetamol levels C. Gastric Lavage D. Activated Charcoal E. Psychiatric Evaluation 29. A 6 year old child presented with drooling of saliva, and a severe stridor. He is febrile and sick looking. X ray of the neck in extension shows a thumb sign. Choose the single most likely diagnosis from the list of options given below. A. Croup B. Upper respiratory tract infection (URTI) C. Diphtheria D. Acute epiglottitis 30. A child of 24 months can walk, run, can make a pyramid, speaks only two meaningful words such as mama and dada. How will you manage this child? A. Reassure B. Speech consultation C. Physiotherapy D. CT scan E. Admit further assessment 31. A 65 year old man presented with hearing impairment and weight loss. He complains of hearing buzzing sound and feeling dizziness that is becoming worse slowly. On examination facial numbness has been noticed. What is the best investigation option for thi s problem ? A. MRI acoustic meatus B. CT Head C. Blood culture D. Audiometry E. Tilt Test 32. A 15 years old boy fell of his bicycle and hurt his abdomen. He presents with pain in abdomen, a CT scan shows a small sub capsular spleen haematoma, h i s BP is 110/70 mmHg and p ulse is 80 bpm What is the next step in his management? A. Refer to surgeons for observation B. Immediate Laparotomy C. Immediate Laparoscopy D. Discharge with advice E. Blood transfusion 33. A 4 year boy has cough and arthritis followed by rash on legs and trunk which are non - blanching on glass test. No history of fever. PT: 13 APTT : 31 Hb : 12 WBC: 6.5 Platelet: 300x10 Choose the most likely diagnosis? A. Meningitis septicaemia B. Haemophillia C. Henoch - SchoenleinPupura D. Idiopathic thrombocytopenic purpura E. Thrombotic thrombocytopenic purpura 34. A 30 year old woman on oral contraceptives presents with dilated tortuous veins crossing he r 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) 35. A 45 year old heroin addict was involved in a car crash and is now paraplegic. During the first week of his hospital stay he cried everyday because he couldn’t remember the accident. What is the most likely diagnosis? A. PTSD B. Severe depression C. Organic brain injury 36. A 15 year old boy presents with testicular pain for 2 days. There is no history of trauma. On examination he has a temperature of 38.5 ̊C and there is tenderness of the right hemi - scrotum. What is the single most appropriate management? A. Giv e antibiotics B. Give analgesia C. Reassure D. USG of scrotum E. Exploratory surgery 37. A 25 years old man presents with fever and pain in the right lower thigh of one month duration. On examination the lower third of his thigh is red, hot and tender. Th e X - ray showed new bone formation. What is the most probable diagnosis? A. Osteosarcoma B. Ewing’s Sarcoma C. Tuberculus Arthritis D. Exostosis E. Fibrosarcoma 38. A 72 year old man had myocardial infarction a few weeks ago. Now he is on medi cation. He comes to outpatient department and he complains of yellow colour in his vision. What can be the cause of this? A. Digoxin B. Amitriptyline C. Atenolol D. Ramipril E. Bendroflumethiazide 39. In a laproscopic mesh repair for hernia, when the trochar is inserted at midpoint between umbilicus and ischial spine, what structure will be pierced? A. Linea alba B. Rectus muscle C. Conjoint tendon D. External and internal oblique muscles E. Inguinal ligam ent 40. A 25 year old male had an injury to the knee while playing football. X ray reveals the condylar fracture of tibia. What is the SINGLE most probable deformity? A. Dinner fork deformity B. Gibbus C. Cubitus valgus D. Garden spade deform ity E. Genu valgus 41. A 37 year old patient presented with hearing loss and offensive dis c harge from the ear. Otoscopy is performed and crusted tympanic membrane was noticed. A pearly white mass was seen on the attic when crust was removed. Choose the cor rect diagnosis from following options A. Frunculosis B. Basal cell carcinoma C. Cholesteatoma D. Acoustic Neuroma E. Squamous cell carcinoma 42. A 62 years old lady presents with a pathological fracture of thoracic vertebra, this is found to be associated with an underlying metastatic lesion, what is the most probable primary cancer site? A. Ovary B. Lung C. Breast D. Cervix E. Colon 43. A man with a family history of panic disorder is brought to the hospital with palpitations, tremors and sweating and muscle tightness on three occasions in the last six weeks. He does not complain of headache and his blood pressure on each presentation is within normal limits. What is the single most appropriate long term treatment for this patient? A. Diazepam B. Olanzapine C. Haloperidol D. Fluoxetine E. Alprazolam 44. A 37year old female working as a health care assistant in a nursing h ome, comes to the A&E with complaints of severe itching all over her body. On asking she replies that she had applied cream on the body of a resident in the nursing home who had similar itches. What is the mechanism of her itch? A. Allergic reaction B. Inflammation of keratinocytes C. Allergic reaction developed due to use of topical steroid creams D. Subcutaneous bleeding E. None of the above 45. A 55 year old male patient had TIA which he recovered from. He has a history of stroke and upon examination his heart rate was in sinus rhythm. He is already on aspirin 75mg and anti - hypertensive drugs. What other action should be taken? A. Add Clopidogrel only B. Increase the doses of aspirin to 300mg C. Add Warfarin D. Add Clopidogrel and S tatins E. Add Statins only 46. A man presents with medial deviation of his right eye. Which nerve is affected? A. Left trochlear B. Left oculomotor C. Right trochlear D. Right abducens E. Right oculomotor 47. A middle age male after myocardial infarction is feeling unwell. The ECG has been performed and shows a prolonged QRS complex and T wave is tented Sodium - 136 mol/L Potassium - 6.2mmol/L , Urea - 5.0 mmol/L What is the most appropriate management? A. Calcium gluconate E. Calciu m B. Calcium resonium C. Calcium with Vitamin D supplements D. Vitamin D 48. A 57 year old man who had myocardial infarction a few months ago has been having low mood. A diagnosis of moderate depression has been established. Which medication is the best t reatment for him? A. Selective serotonin re - uptake inhibitors (SSRI) B. TACs C. Monoamine oxidase inhibitor (MAOI) D. Benzodiazepams E. Mood stabilisers 49. A 64 year old man presents with ipsilateral vertigo, tinnitus and left side hearing loss. On examination Rinne's test is positive and Weber’s test is lateralised to the right ear. What is the most appropriate investigation? A. CT scan B. Magnetic resonance imaging (MRI) of brain C. X - ray D. Audiometry E. No investigation required F. Caloric Testing 50. A 74 years old lady who has had a stroke in the past, had an indwelling catheter for 10 months. She presents with bluish - purple discoloration of the catheter bag. What is the most likely explanation for this change? A. Normal Chang e B. Catheter Degradation C. Acidic Urine D. Alkaline Urine E. Bacterial Colonisation of the Urinary Tract 51. A patient on a ntihypertensive drugs presents to Accident and Emerge ncy department complaining of sudden loss of vision. O n examination of the fu ndus, tort uous blood vessels and stormy su nset appearance was seen. What is most l ikely diagnosis? A. Papiloedema B. CRAO C. Anterior ischaemic optic neruropathy D. CRVO E. Retinal detachment 52. A four years old boy with a febrile convulsion lasting eight minutes has been given intravenous (IV) Lorazepam to control the convulsion. What is the SINGLE most likely serious side - effect? A. Amnesia B. Anaphylactic shock C. Diabetes D. Bronchospasm E. Cardiac arrhythmia 53. A 33 year old female complains of diplopia on upright gaze. On examination ptosis can be seen. There are no other complains or any significant past medical history. What is the most appropriate investigation for this patient? A. Ophthalmoscopy B. Visual field test C.Thyroid function test D. CT scan E. Checking red reflex 54. A 57 year old man, who is a known hypertensive, is on oral anti - hypertensives. However, he is finding it difficult to mobilise as he feels dizzy whenever he tries to get up. What is the most appropriate investigation for him? A. Ambulatory blood pressure B. Electrocardiogram (ECG) C. Magnetic resonance imaging (MRI) D. Chest X ray E. CT scan 55. A 6 year old boy fell in the playground. He has not been using his forearm. He complains of pain. On examination there is no sign of deformity or swelling. However, there is minimal tenderness on examination. What is the most appropriate diagnosis? A. Fracture of mid radius B. Fracture o f mid ulnar C. Fracture of neck of humerus D. Fracture of shaft of humerus E. Green stick fracture of distal radius. 56. A 72 years old woman has been taking loop diuretics for left ventricular failure. She now presents with palpitations and muscle weakne ss. What is the SINGLE most likely serum electrolyte pattern to be found? A. Sodium 130 mmol/L, potassium 2.5 mmol/L B. Sodium 130 mmol/L, potassium 5.0 mmol/L C. Sodium 140 mmol/L, potassium 4.5 mmol/L D. Sodium 150 mmol/L, potassium 2.5 mmol/L E. Sodium 150 mmol/L, potassium 3.5 mmol/L 57. What is the best treatment for candidiasis in the throat? A. Chlorhexidine mouthwash B. Nystatin suspension C. Oral Fluconazole D. IV Metronidazole 58. A 45 year old man had recently started taking antihypertensive th erapy. Six months later his Random Blood Sugar was found to be 14.0 mmol/l. Which single drug is most likely to have caused this? A. Amlodipine B. Bendroflumethiazide C. Doxazosin D. Losartan E. Ramipril 59. A 24 year old woman has severe depression three months after the birth of her first child. She is breastfeeding but is otherwise unable to look after the baby and is convinced that her family is likely to kill her. She has no interest in anything and keeps crying. What is the most appropriate treatment? A. Fluoxetine B. Citalopram C. Cognitive behavioural therapy D. ECT E. Haloperidol 60. A 31 years old woman presents 7 - 10 days following childbirth, with loss of feeling for the child, loss of appetite, sleep disturbance and intrusive and unpleasant thoughts of harming the baby. What is the best treatment for this patient? A. Fluoxet ine B. Haloperidol C. Cognitive Behavioural Therapy D. Reassurance E. Electro Convulsive Therapy 61. A girl presents with signs of hyperventilation. What is the most likely arterial blood gas (ABG) derangement? A. pH increased pCo2 increased B. pH decreased pCo2 increased C. pH increased pCo2 decreased D. pH decreased pCo2 decreased 62. A 6 year old child fell on his nose 2 days ago. His parents have now brought him with difficulty in breathing. On examination he has a fever and his nasal bones are straight. W hat is the single most likely diagnosis? A. Nasal polyp B. Septal hematoma C. Septal abscess D. Deviated nasal septum E. Fractured nose 63. A 56 year old man with atrial fibrillation is prescribed digoxin. What side effect will you make the patient aware of? A. Seeing visual haloes B. Nausea C. Vomiting D. Diarrhoea 64. A pregnant woman with long - term history of osteoarthritis came to the antenatal clinic with the complaints of restricted joint movement and severe pain in her affected joints. What is the choice of drug? A. Paracetamol B. Steroid C. NSAID D. Paracetamol + Dihydrocodiene E. Pethidine 65. A 54 year old lady presents with sudden, severe pain in the left half of her skull. She also complains of pain around her jaw. What is t he most likely next step? A. CT scan B. MRI C. Fundoscopy D. ESR E. Temporal artery biopsy 66. A patient admitted due to repeated attacks of pancreatitis presents with dementia and loss of proprioception in the legs. What is the most appropriate treatment? A. Thiamine B. Pyridoxine C. Cobolamin D. Lypase E. Antibiotics 67. A 2 y ea r old boy with 38.4 ° C fever had an episode of tonic clonic seizure at home that lasted for 15 minu tes. In A&E patient is conscious and fit has stopped. When temperature was checked, it was normal. Wh at is most probable diagnosis? A. Febrile convulsion B. I nfantile spasm C. A bsence seizure D. Grandmal Epilepsy E. Focal seizure 68. A 10 years old girl pres ents with pallor and features of renal failure. She has haematuria as well as proteinuria. The serum urea and creatinine are elevated. These symptoms started after an episode of bloody diarrhoea 4 days ago. What is the most probable diagnosis? A. Thrombotic thrombocytopenia purpura (TTP) B. Haemolytic - uremic syndrome ( HUS ) C. Idiopathic thrombocytopenic purpura (ITP) D. Henoch - Schonleinpurpura ( HSP ) E. Acute renal failure ( ARF) 69. A 32 years old woman has undergone a biopsy for a breast lump. The report says “a well circumscribed lump with clear margins and separated from the surrounding fatty tissue”. What is the most appropriate interpretation of this report? A. Fibroade nosis B. Carcinoma of the Breast C. Mammary abscess D. Fibroadenoma E. Fat Necrosis 70. 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 s pleen 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 71. A 19 year old man presents for the first time with a firm and unshakable belief that he is being followed by terrorists who are plotting against him. What is the single best term for this man’s condition? A. Delusion of Persecution E. Delusi on of Nihilism B. Delusion of Grandeur C. Delusion of Control D. Delusion of Reference 72. 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. Stool culture B. Plain abdominal x - ray C. Per rectal examination D. Barium Enema 73. A boy with partial thickness, burn increased. What is the next step? A. Escharectomy B. Dressing C. Burst blisters D. Local antibiotics E. Refer to burn unit 74. A 64 years old diabetic has come for a routine eye check - up. Fundoscopy shows new vessels all over the retina. What is the most appropriate management? A. Strict Sugar Control B. Regular eye check ups C. Non urgent referral to a specialist D. Laser photocoagulation E. Insulin 75. A 45 year old man underwent emergency splenectomy following a fall from his bicycle. He smokes five cigarettes a day. Post - operatively despite mobile, he developed swinging pyrexia and a swollen painful le ft calf. His chest x - ray shows lungs atelectasis and abdominal USG demonstrates a small sub - phrenic collection.What is the SINGLE most likely risk factor for deep vein thrombosis in the patient? A. Immobility B. Intraperitonealhaemorrhage C. S moking D. Splenectomy E. Sub - phrenic collection 76. A young woman was brought to the hospital. On examination she has low temperature and tremor. She says when her eyes are closed she can see colour. What drug has been used? A. Methylenedioxyme thamphetamine (MDA) B. Lysergic acid diethylamide (LSD) C. Cocaine D. Heroine E. Ecstasy 77. A mother brings her 1 week old baby to the clinic because she is concerned about a large mark on his back. On examination there seems to be a large blue bruise like mark on the baby’s back. What is the most likely diagnosis? A. N on accidental injury B. Mongolian spot C. Accidental bruising D. HSP E. ITP 78. You are the SHO in the hospital and the lab report of a patient shows glucose: 4mmol/L, K: 5.2mmol/l, Na129 mm ol/l. What is the most appropriate management for this patient? A. Normal Saline 0.9% B. Normal saline 4.5% C. Normal Saline 0.9% + insulin D. Insulin E. Dextrose 79. A 10 year old male child was brought by his mother complaining that her child watches TV at very high volume, doesn’t like to play out and instead has become more sincere with reading. She also says that her son does not respond to her. What do you expect to see on otoscopy? A. Flamingo pink Tympanic Membrane B. Attic perforation C. Bluish grey Tympanic membrane with air fluid levels D. Inflamed tympanic membrane with cart wheel appearance of vessels E. Red and inflamed tympanic membrane 80. A patient is on long standing indwelling catheter and now the catheter bag is turned purple. Dipstick test shows nitrates – ve, blood+. What investigation would you do next? A. Urine culture and sensitivity B. None C. Urine porphobilinogen D. USG abdomen 81. A 60 years old man brought to A&E department with fracture of hip; he is deaf and has bil ateral pedal oedema. What is the SINGLE most probable diagnosis? A. Paget’s disease B. Osteoporotic fracture vertebrae C. Secondary D. Multiple myeloma E. Spondylosis 82. A 28 years old lady presents with dyspareunia and dysmenorrhoea. She is very obese. She now wants reversible contraceptive method. Which of the following will be most suitable for her? A. Mirena B. Combined Oral Contraceptive Pill (COCP) C. Pro gestogen only pill (POP) D. Copper - T E. Barrier method 83. Patient with widespread ovarian carcinoma had bowel obstruction and severe colic for 2 hrs and was normal in between. What is the most appropriate management? A. S/C morphine (PCA) B. Spasmolytics C. Palliative colostomy D. Oral Morphine E. Laxatives 84. An 80 year old man with prostatic cancer has confusion, thirst, abdominal pain and an abnormal electrocardiogram (ECG). What is the most appropriate investigation? A. CT scan B. Radionuclide bone scan C. Skeletal Survey D. Serum alkaline phosphatase iso - enzyme concentration E. Serum calcium concentration 85. A 35 year old man presents with a headache that worsens on bending his head forward. What is the most likely diagnosis? A. Chronic Sinusitis B. Subarachnoid Haemorrhage C. Migraine D. Cluster Headache E. Tension Headache 86. A 19 years old male presents with runny nose, cough and generalised rash. Blood MCS is positive for coagulase positive cocci. What is the best managemen t? A. Amoxicillin B. Rifampicin C. Gentamycin D. Flucloxacillin E. Co - amoxiclav 87. An 82 year old man has woken up with incoherent speech and difficulty in finding the right words. Examination is otherwise normal and his comprehension is good. Which anatomical site is most likely to be affected? A. Broca’s Area B. Wernicke’s Area C. M idbrain D. Parietal Cortex E. Pons 88. A 9 year old child is diabetic and unhappy in school. What is your next step? A. Refer to social worker B. Clinical psychologist C. Special school D. Check child protection register E. Give oral anti diabetics 89. A10 year old girl presents with hoarseness of the voice. She is a known case of bronchial asthma and has been on oral steroids for a while. What is the most likely cause of hoarseness of voice in this case? A. Candidial laryngitis B. Tonsillitis C. Chro nic laryngitis D. Laryngeal carcinoma 90. A 60 year old man presents with dysphagia and pain on swallowing both solids and liquids. A barium meal shows gross dilatation of the oesophagus with a smooth narrowing at the lower end of the oesophagus. What is th e SINGLE most likely cause of dysphagia from the given options? A. Achalasia B. Myasthenia gravis C. Oesophageal carcinoma D. Oesophageal web E. Systemic sclerosis 91. A patient operated for gastric carcinoma is on oral morphine for pain relief. He has adequate pain relief but is experiencing side effects due to high dose of morphine required. What is the most appropriate next step in his pain management? A. Pat ient controlled analgesia B. Oral oxycodone C. IV morphine D. Fentanyl patches 92. A 50 year old man with a known history of stroke. He cannot remember anything about his life. What is the single most likely defect? A. Homonymous hemianopia B. Homony mous upper quadrantanopia C. Bitemporal hemianopia D. Binasal hemianopia E. Homonymous lower quadrantanopia 93. A 27 year old woman had pre eclampsia and was delivered by c – section. She is now complaining of right upper quadrant pain different from wound pai n. What investigation will you do immediately? A. Coagulation profile B. Liver function tests C. Ultrasound liver D. MRCP E. None 94. A 37 year old woman presents with more tiredness than usual, she is found to have angul ar stomatitis, no koilonychia. Choose the single cell type you will find on blood film. A. Macrocytes B. Microcytes C. Granulocyte without blast cells D. Blast cells 95. A woman came with the complaint of pain in her right arm when she abducts it. She has recently moved to a new house. There is no history of trauma. What is the likely cause of her pain? A. Rupture of the long head of the biceps B. Sprain of the ac romio - clavicular ligament C. Tendinitis of the abductor sheet D. Supraspinatus tendinitis E. Shoulder dislocation 96. A man presents to A& E with pins and needles in his arms and legs, decreased sensation and reduced reflexes in lower limbs. Blood tests reveal a macrocytic anaemia. He sees things other people can’t see and has a long history of alcoholism. When asked simple questions he makes up nonsensical stories. What is the management? A. Diazepam B. Chlordiazepoxide C. Thiamine D. Folic acid 97. A 56 years old patient, whose pain was relieved by oral Morphine, now presents with progressively worsening pain relieved by increasing the dose of oral Morphine. However the patient complains that the increased Morphine makes him drowsy and he is unable to carry out his daily activities. What is the next step to manage this patient? A. Oral Oxycodone B. Oral Tramadol C. Patient Controlled Analgesia D. I.V. Fentanyl E. Diamorphine 98. A 20 years old young lady comes to her GP for advice regarding cervical cancer. She is worried as her mother past away because of this disease. She would like to know what is the best method of contraception in her case ? A. Progestrogen only pill (POP) B. Barrier method C. Intrauterine Contraceptive Device (IUCD) D. Comb ined Oral Contraceptive Pill (COCP) E. Intruterine system F. Osteoarthritis 99. A six year old girl has had two short episodes of cough and wheeze over the last 12 months. These two acute episodes responded quickly to bronchodilator, she has no symptoms o r abnormal physical signs. She has slight eczema and her mother has asthma. What is the SINGLE most appropriate investigation? A. Chest x - ray B. Peak flow rate diary C. Pulse oximetry D. Spirometry E. Sweat tes t 100. A pregnant patient present with tingling, numbness, pain and loss of sensation on middle and index finger of right hand. Tinel sign is negative. What is the most likely diagnosis? A. Carpal tunnel syndrome B. Hammer hypothenar syndrome C. Ulnar nerve injury D. Radial nerve injury 101. A 22 years old man keeps having persistent and intrusive thoughts that he is a dirty thief. No matter what he tries these thoughts keep coming to him. Any attempt to avoid these thoughts leads to serious anxiety. What is the most likely diagnosis? A. Schizophrenia B. Obsessive Compulsive Disorder (OCD) C. Post traumatic stress disorder (PTSD) D. Mania E. Psychotic Depression 102. A 32 year old woman, para 3 of 39 weeks of gestation, reports having had spontaneous rupture of membranes 4 days ago. She did not attend the delivery suite, as she knew that would happen and had already decided on a home birth. Today she feels very hot and sweaty. She thought that she was starting to have labour pains, but she describes the pain as more constant. On examination, her uterus is tender throughout. Blood tests show a raised CRP and white cell count. Select the most likely diagnosis from the following options: A. Round ligament stretching B. Chorioamnionitis C. Uterine rupture D. Labour E. Disseminated intravascular coagulation 103. Patient had all signs of cerebello - pontine angle (CPA) tumour facial numbness, tinnitus and vertigo. What is the best investigation? A. CT scan B. MRI Brain C. MRI Head D. X - ray head 104. A man has a habit of checking the locks of his house again and again. He tries to resist but he has palpitations. What is the most appropriate treatment? A. CBT + fluoxetine B. CBT only C. Fluoxetine only D. ECT 105. A 70 year old lady presents with feve r since 3 days and confusion. There is no significant past history. What is most probable diagnosis? A. Delirium B. Hypoglycemia C. Alzheimer’s disease D. Diabetic Ketoacidosis ( DKA) 106. A 6 year old girl has been brought to the hospital after being stung by a bee. She is complaining of generalized itching, rashes, redness and has developed stridor. What is the most appropriate treatment? A. Oral Chlorpheniramine B. IV Chlorpheniramine C. IM Adrenaline D. IV Adrenaline E. Reassurance 107. A child who has type 1 diabetes is sad and unhappy at school. He has no friends and his glycaemic control is poor. What would you do next? A. Refer to diabetologist B. Refer to psychiatrist C. Refer for developmental assessment D. Increase insulin dose 108. A 27 year old man believes that the whole world is plotting to kill him. What is the best treatment for him? A. Haloperidol B. Chlorpromazine C. Risperidone D. Thioridazone 109. A 70 year old patient presents with cough and shortness of breath. He stopped smoking cigarettes 2 years ago but he has been smoking for about 50 years before quitting. CXR shows consolidation and bilateral and bihilar lymphadenopathy. What is the best inv estigation for this patient? A. Lymphnode biopsy B. Pleural fluid cytology C. CT scan D. Magnetic resonance imaging (MRI) E. Ultrasound 110. A 12 year old boy with pain and swelling in multiple joints (small and large), has mild fever . Which of the following change in his blood investigations will definitely be there? A. RA factor positive B. Increase in ESR C. ANA – positive D. Rise in serum uric acid level 111. A 23 year old lady was prescribed with Azithromycin 1gm for her chlamydial pelvic infection. She has got a new boyfriend for the last 2 months. She has recently started contraception to avoid conception. Which of the following contraception method will be affected by Azithromycin? 23 RD NOVEMBER 2014 A. Barrier B. Intrauterine Contraceptive Device (IUCD) C. Progestogen only pill (POP) D. Combined Oral Contraceptive Pill (COCP) 112. 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. A. External Iliac Artery B. Aorto - Iliac C. Ilio - Femoral D. Internal Iliac E. Abdominal aorta 113. A child presents with projectile vomiting and is diagnosed with pyloric stenosis. What electrolyte should be checked next? A. Potassium B. Calcium C. Magnesium D. Iron 114. A 27 year old man presents with chest pain and respiratory distress. On examination there i s tachycardia, hypotension and neck vein distension. Trachea is deviated to the left side, breathing sound on the right side is absent and on the left side is diminished. What is the next appropriate management? A. A. Chest x - ray B. B. Right side as piration (16 G cannula) C. C. Left side aspiration (16 G cannula) D. D. Right side drainage with a small tube (12F) E. E. Left side drainage with a small tube (12F) 115. A 45 year old woman has had severe epigastric and right hypochondrial pain for a few hours. She has a normal full blood count; serum alkaline phosphatase is raised, normal transaminase. Three months ago she had a cholecystectomy done. What is the most appr opriate investigation? A. Ultrasound of the Abdomen B. Endoscopic Retgrograde Cholangiopancreatography C. Magnetic Resonance Cholangiopancreatography D. CT scan of the Abdomen E. Upper GI Endoscopy