- A 5yo girl had earache and some yellowish foul smelling discharge, perforation at the attic and
conductive hearing loss. She has no past hx of any ear infections. What is the most appropriate
dx?
a. Acute OM
b. OM with effusion
c. Acquired cholesteatoma
d. Congenital cholesteatoma
e. Otitis externa - A female with T1DM would like to know about an deficiency of vitamins in pregnancy that can
be harmful. A deficiency of which vitamin can lead to teratogenic effects in the child?
a. Folic acid
b. Vit B12
c. Thiamine
d. Riboflavin
e. Pyridoxine - A 23yo woman has been having pain at the base of her thumb, the pain is reproduced when
lifting her 3 month old baby or changing diapers and also with forceful abduction of the thumb
against resistance. What is the likely cause?
a. Avascular necrosis of scaphoid
b. Trigger finger
Đ. De QueƌǀaiŶ͛s teŶosLJŶoǀitis - A 6m child presents with fever and cough. His mother has rushed him to the ED asking for help.
Exam: temp=39C and the child is feeding poorly. Dx?
a. Bronchiolitis
b. Asthma
c. Bronchitis - A 75yo man collapsed while walking in his garden. He recovered fully within 30 mins with BP
110/80 mmHg and regular pulse of 70bpm. He has a systolic murmur on examination. His
activities have been reduced lately which he attributes to old age. What is the definitive
diagnostic inv that will assist you with his condition?
a. ECG
b. Echo
c. 24h ECG monitoring
d. 24h BP monitoring
e. Prv CIN - A 35yo man with a hx of schizophrenia is brought to the ER by his friends due to drowsiness. On
examination he is generally rigid. A dx of neuroleptic malignant syndrome except:
a. Renal failure
b. Pyrexia
c. Elevated creatinine kinase
d. Usually occurs after prolonged tx
e. Tachycardia - A 33yo drug addict wants to quit. She says she is ready to stop the drug abuse. She is supported
by her friends and family. What drug tx would you give her?
a. Benzodiazepines
b. Diazipoxide
c. Lithium
d. Methadone
e. Disulfiram - A 16m child presents with drooling, sore throat and loss of voice. He has fever with a temp of
38.2C. What is your next step towards management?
a. Direct pharynoscopy
b. Call ENT surgeon
c. Call anesthesiologist
d. IV fuilds
e. Start antibiotics - A 62yo woman complains of unsteadiness when walking. On examination she has pyramidal
weakness of her left lower limb and reduced pain and temp sensation on right leg and right side
of trunk up to the umbilicus. Joint position sense is impaired at her left great toe but is normal
elsewhere. She has a definite left extensor plantar response and the right plantar response is
equivocal. Where is the lesion?
a. Left cervical cord
b. Midline mid-thoracic cord
c. Right mid-thoracic cord
d. Left mid-thoracic cord
e. Left lumbo-sacral plexus - A 26yo man present to ED with increasing SOB on left side and chest pain. He has been a heavy
sŵokeƌ foƌ the past ϰ LJeaƌs. He doesŶ͛t haǀe aŶLJ past ŵed hx. What is the likely dx?
a. Pulmonary embolism
b. MI
c. Asthma
d. Pleural effusion
e. Pneumothorax - A pt with hepatocellular ca has raised levels of ferritin. What is the most probable cause?
a. Hemochromatosis
b. A1 antitrypsin def
c. Cystic fibrosis - A woman has electric pains in her face that start with the jaw and move upwards. Her corneal
reflexes are normal. What is the most likely dx?
a. Atypical face pain
b. Trigeminal neuralgia
c. Tempero-mandibular joint dysfunction
d. GCA
e. Herpes zoster - A 32yo man presented with slow progressive dysphagia. There is past hx of retro-sternal
discomfort and he has been treated with prokinetics and H2 blockers. What is the probably dx?
a. Foreign body
b. Plummer vinson syndrome
c. Pharyngeal puch
d. Peptic stricture
e. Esophageal Ca - A 56yo man comes with hx of right sided weakness & left sided visual loss. Where is the
occlusion?
a. Ant meningeal artery
b. Mid meningeal artery
c. Mid cerebral artery
d. Carotid artery
e. Ant cerebral artery
f. Ant communicating artery - A young college student is found in his dorm unconscious. He has tachyarrhythmia and high
fever. He also seems to be bleeding from his nose, which on examination shows a perforated
nasal septum. What is the most likely dx?
a. Marijuana OD
b. Cocaine OD
c. Heroin OD
d. Alcohol OD
e. CO poisoning - A 56yo pt whose pain was relieved by oral Morphine, now presents with progressively
worsening pain relieved by increasing the dose of oral morphine. However, the pt complains
that the increased morphine makes him drowsy and his is unable to carry out his daily activities.
What is the next step in his management?
a. Oral oxycodone
b. Oral tramadol
c. PCA
d. IV Fentanyl
e. Diamorphine - A 30yo man presents with a 5cm neck mass anterior to the sternocleido-mastoid muscle on the
left side in its upper third. He states that the swelling has been treated with antibiotics for
iŶfeĐtioŶ iŶ the past. What͛s the ŵost likelLJ Đause?
a. Branchial cyst
b. Parotitis
c. Pharyngeal pouch
d. Thyroglossal cyst
e. Thyroid swelling - An 18yo man is rushed into the ER by his friends who left him immediately before they could be
interviewed by staff. He is semiconscious, RR=8/min, BP=120/70mmHg, pulse=60bpm. He is
noted to have needle track marks on his arms and his pupils are small. What is the single best
initial tx?
a. Insulin
b. Naloxone
c. Methadone
d. Gastric lavage - A 30yo man and wife present to the reproductive endocrine clinic because of infertility. The man
is tall, has bilateral gynecomastia. Examination of the testes reveals bilateral small, firm testes.
Which of the following inv is most helpful in dx?
a. CT of pituitary
b. Chromosomal analysis
c. Measure of serum gonadotropins
d. Measure of serum testosterone
e. Semen analysis - An 18yo female just received her A-Leǀel ƌesults aŶd she didŶ͛t get iŶto the uŶiǀeƌsitLJ of heƌ
choice. She was brought into the ED after ingestion of 24 paracetamol tablets. Exam: confused
and tired. Initial management has been done. Inv after 24h: normal CBC, ABG = pH7.1, PT=17s,
Bilirubin=4umol/L, creatinine=83umol/L. What is the next step in management?
a. Observation for another 24h
b. Refer to psychologist
c. Give N-Acetylcysteine
d. Discharge with psychiatry referral
e. Liver transplantation - A 75yo alcoholic presents with a mass up to umbilicus, urinary dribbling, incontinence, and
clothes smelling of ammonia. What is the next step in management?
a. Urethral catheter
b. Suprapubic catheter
c. Antibiotics
d. Condom catheter
e. Nephrostomy - In CRF, main cause of Vit D deficiency is the failure of:
a. Vit D absorption in intestines
b. 25 alpha hydroxylation of Vit D
c. Excess Vit D loss in urine
d. 1 alpha hydroxylation of Vit D
e. Availability of Vit D precursors
ϳϯ. Pt ǁith puffiŶess of faĐe aŶd ƌash shoǁiŶg ĐottoŶ ǁool spots oŶ fuŶdosĐopLJ. What͛s the ddž?
a. Macular degeneration
b. Hypertensive retinopathy
c. Diabetic background
d. Proliferative diabetic retinopathy
e. SLE - A 35yo man presents with progressive breathlessness. He gave a hx of polyarthralgia with
paiŶful lesioŶs oŶ the shiŶ. CX‘: ďilateƌal hilaƌ lLJŵphadeŶopathLJ. What͛s the ŵost likelLJ ddž?
a. Bronchial asthma
b. Cystic fibrosis
c. Sarcoidosis
d. Bronchiectasis
e. Pneumonia - A child presents with clean wound, but he has never been immunized as his parents were
worried about it. There is no contraindication to immunization, what is the best management?
a. Full course of DTP
b. 1 single injection DT
c. 1 single injection DTP
d. Only Ig
e. Antibiotic - A 65yo HTN man presents with lower abdominal pain and back pain. An expansive abdominal
mass is palpated lateral and superior to the umbilicus. What is the single most discriminating inv?
a. Laparascopy
b. KUB XR
c. Pelvic US
d. Rectal exam
e. Abdominal US - A 55yo man has had severe pain in the right hypochondrium for 24h. The pain comes in waves
and is accompanied by nausea. Nothing seems to relieve the pain. He feels hot and sweaty but
has normal temp. What is the most appropriate next inv?
a. US Abdomen
b. ERCP
c. MRCP
d. Serum amylase
e. UGI endoscopy - A 67yo man has deteriorating vision in his left eye. He has longstanding COPD and is on multiple
drug therapy. What single medication is likely to cause this visual deterioration?
a. B2 agonist
b. Corticosteroid
c. Diuretic
d. Theophylline - A woman who returned from abroad after 3 weeks of holiday complains of severe diarrhea of 3
weeks. She also developed IDA and folic acid def. What condition best describes her situation?
a. Jejunal villous atrophy
b. Chronic diarrhea secretions
c. Malabsorption
d. Increased catabolism
e. Increased secretions of acid - A 35yo male is bitterly annoyed with people around him. He thinks that people are putting ideas
into his head. What is the single most likely dx?
a. Thought block
b. Thought insertion
c. Thought broadcasting
d. Thought withdrawal
e. Reference - A 10yo 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?
a. Laryngeal candidiasis
b. Infective tonsillitis
c. Laryngeal edema
d. Allergic drug reaction
e. Ludwigs angina - A lady with breast cancer has undergone axillary LN clearance. She develops arm swelling after
being stung by a bee. What is the most likely mechanism responsible for the swelling?
a. Lymphedema
b. Cellulitis
c. Hypersensitivity reaction
d. DVT
e. Fluid retention - A 34yo pt presents with 50% partial thickness burns. What should be the most appropriate
management?
a. IV fluids calculated from the time of hospital arrival
b. IV fluids calculated from the time of burn
c. No IVF
d. IV dextrose stat
e. Burns ointment - A 54yo man has recently been dx with moderate depression. He has hx of MI and is suffering
from insomnia. What is the drug of choice for him?
a. Citalopram
b. Lofepramine
c. ECT
d. Haloperidol
e. Diazepam - A man presented with cellulitis and swelling. He was started on flucloxacillin. What other
medication do you want to add?
a. Vancomycin
b. Penicillin
c. Metronidazole
d. Ceftriaxone
e. Amoxicillin - A 24yo college student presents with nausea, vomiting, headache, neck stiffness and a fever of
38.4C. What is the most appropriate empirical antibiotic to be started?
a. Ceftriaxone
b. Penicillin
c. Gentamicin
d. Tazobactam
e. Meropenem - A man with prosthetic heart valve underwent hemicolectomy and after some days complains of
left hypochondriac pain, fever and has a systolic murmur. What is the next inv to ascertain the
cause of HF?
a. CT
b. Blood culture
c. ECG
d. MRI
e. Radioactive thyroid scan - A 45yo man with posterior gastric ulcer presented with severe excruciating pain which subsided
after conservative treatment. 10 days later he developed swinging pyrexia. US shows a
collection in the peritoneum. What will be the most likely location of the collection?
a. Hepatorenal puch
b. Left paracolic gutter
c. Subphrenic
d. Pelvic cavity
e. Lesser sac - A 23yo 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?
a. Barrier
b. IUCD
c. POP
d. COCP - An 11yo boy is being checked by the diabetic specialist nurse. His HbA1c was high and he has
been skipping meals recently. He has been unhappy at school. Which single member of the
clinical team would you refer him to next?
a. GP
b. Pediatrician
c. Dietician
d. Clinical psychologist - A 35yo man who has served in the army presents with lack of interest in enjoyable activities and
feeliŶg loǁ. He doesŶ͛t feel like ƌeadiŶg the Ŷeǁs oƌ ǁatĐhiŶg ŵoǀies as he ďelieǀes theƌe is
violence everywhere. What is the most appropriate first line therapy?
a. Citalopram
b. Lofepramine
c. CBT
d. Chlordiazepoxide
e. Desensitization - A man has reducible bulge below the pubic tubercle, and on occlusion of the deep inguinal ring,
cough impulse is present. What is the most likely dx?
a. Direct inguinal
b. Indirect inguinal
c. Femoral
d. Spigelian
e. Lumbar - A 48yo woman is admitted to ED with a productive cough and moderate fever. She has often
central chest pain and regurgitation of undigested food most times but doesŶ͛t suffeƌ fƌoŵ aĐid
reflux. These symptoms have been present for the last 3.5 months which affects both food and
drink. A CXR shows an air-fluid level behind a normal sized heart. What is the most likely dx?
a. Pharyngeal pouch
b. Hiatus hernia
c. Bulbar palsy
d. Achalasia
e. TB - A 64yo man has been waking up in the middle of the night to go to the bathroom. He also had
difficulty in initiating micturition and complains of dribbling. A dx of BPH was made after a
transrectal US guided biopsy and the pt was prepared for a TURP. What electrolyte abnormality
is highly likely due to this surgery?
a. Hypokalemia
b. Hypocalcemia
c. Hyperkalemia
d. Hyponatremia
e. Hypernatremia - A 56yo lady has developed severe right sided headache which worsens whenever she comes to
ďƌight light siŶĐe the last ϰ daLJs. She feels Ŷauseated, ďut doesŶ͛t ǀoŵit. What is the ŵost likelLJ
dx?
a. SAH
b. Brain tumor
c. Migraine
d. Cluster headache
e. Subdural headache - A 35yo man presented with hematuria, abdominal swelling and has a BP of 190/140. What is the
most diagnostic inv?
a. Cystoscopy
b. USG
c. CT
d. Renal biopsy
e. Urine analysis - A young man is brought to the ED after a RTA. His GCS on initial evaluation is 6. What ist he most
appropriate next step?
a. CT
b. MRI
c. IV fluids
d. Skull XR
e. Secure airway - A 65yo man presented with frank hematuria. He has no other urinary symptoms. What is the
most appropriate next step that will lead to the dx?
a. IVU
b. US Abdomen
c. Cystoscopy
d. Mid-stream urine for culture
e. Transrectal US - A 30yo woman had a gradual decrease of visual acuity since the last 3 years. Now she has a
disaďilitLJ due to ǀeƌLJ loǁ ǀisioŶ. What͛s the ddž?
a. Glaucoma
b. Cataract
c. Macular degeneration
d. Retinitis pigmentosa
e. Keratitis - A 27yo lady has had an uncomplicated pregnancy so far. She came to the hospital 2h ago after
her water broke. The midwife is looking at her now. She has regular contractions. P.V exam
revealed 2cm dilated cervix. Vital signs are normal. What stage of labour is she in?
a. Second stage
b. First stage
c. Latent stage
d. Third stage
e. Active phase