- A 65yo man presents w/ painless hematuria, IVU is normal, prostate is mildly enlarged with mild
frequency. What is the most appropriate next step?
a. US Abdomen
b. Flexible cystoscopy
c. MRI
d. Nuclear imaging
e. PSA - A 74yo smoker presented to his GP with cough and SOB. Exam revealed pigmentation of the oral
mucosa and also over the palms and soles. Tests show that he is diabetic and hypokalemic.
What is the most probable dx?
a. Pseudocushing syndrome
b. Conns disease
c. Ectopic ACTH
d. Cushings disease
e. Hypothyroidism - A 44yo woman has lost weight over 12 months. She has also noticed episodes where her heart
beats rapidly and strongly. She has a regular pulse rate of 90bpm. Her ECG shows sinus rhythm.
What is the most appropriate inv to be done?
a. Thyroid antibodies
b. TFT
c. ECG
d. Echocardiogram
e. Plasma glucose - A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency
and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 1.9 and he is
anemic. His BP is 165/95 mmHg. What is the most probable dx?
a. BPH
b. Prostate carcinoma
c. Chronic pyelonephritis
d. Benign nephrosclerosis - A 64yo man has recently suffered from a MI and is on aspirin, atorvastatin and ramipril. He has
ďeeŶ haǀiŶg tƌouďle sleepiŶg aŶd has ďeeŶ losiŶg ǁeight foƌ the past ϰ ŵoŶths. He doesŶ͛t feel
like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and
ĐaŶ͛t ĐoŶĐeŶtƌate oŶ aŶLJthiŶg. What is the ŵost appƌopƌiate tdž?
a. Lofepramine
b. Dosulepin
c. Citalopram
d. Fluoxetine
e. Phenelzine - A 67yo man after a stroke, presents with left sided prosis and constricted pupil. He also has loss
of pain and temp on the right side of his body and left side of his face. Which part of the brain is
most likely affected?
a. Frontal cortex
b. Cerebellum
c. Pons
d. Medulla
e. Parietal cortex - A 60yo man presents with dysphagia and pain on swallowing both solids and liquids. A barium
meal shows gross dilatation of the esophagus with a smooth narrowing at the lower end of the
esophagus. What is the SINGLE most likely cause of dysphagia?
a. Achalasia
b. Myasthenia gravis
c. Esophageal carcinoma
d. Esophageal web
e. Systemic sclerosis - A man undergoes a pneumonectomy. After surgery, invs show hyponatremia. What could be the
cause of the biochemical change?
a. Removal of hormonally active tumor
b. Excess dextrose
c. Excess colloid
d. Excessive K+
e. Hemodilution - A pregnant lady came with pain in her calf muscle with local rise in temp to the antenatal clinic.
What tx should be started?
a. Aspirin
b. LMWH
c. Paracetamol
d. Cocodamol
e. Aspirin and heparin - A 53yo female presents with an acute painful hot knee joint. She is a known case of RA. On
examination, the knee is red, tender and swollen. The hamstring muscles are in spasm. Her
temp is 38.5C and BP is 120/80mmHg. What is the SINGLE best next inv?
a. Joint aspiration for cytology and culture and sensitivity
b. Joint aspiration for positive birefrengent crystals
c. Joint aspiration for negative birefrengent crystals
d. Blood culture
e. Serum uric acid - An 80yo man presented with pain in his lower back and hip. He also complains of waking up in
the night to go to the washroom and has urgency as well as dribbling. What is the most likely dx?
a. BPH
b. Prostatitis
c. UTI
d. Prostate carcinoma
e. Bladder carcinoma - An 18yo female has peri-orbital blisters. Some of them are crusted, others secreting pinkish fluid.
What is the most likely dx?
a. Shingles
b. Chicken pox
c. Varicella
d. Rubella
e. Measles - A 29yo lady who is a bank manager is referred by the GP to the medical OPC due to a long hx of
tiredness and pain in the joints. An autoimmune screen result showed smooth muscle
antibodies positive. What is the most appropriate next inv?
a. ECG
b. TFT
c. LFT
d. Serum glucose
e. Jejunal biopsy - A 5yo with recurrent chest pain, finger clubbing with offensive stool. Choose the single most
likely inv?
a. Endomyseal/Alpha glidin antibody
b. Sweat test
c. Barium meal
d. ECG
e. Glucose tolerance test - A clinical picture of breast cancer originated from the mammary duct. Biopsy was done ad there
were neoplastic cells found. Choose the histological picture of the cancer.
a. Neoplastic cells are arranged in small clusters occupying a space between collagen
bundles (Seirrhous carcinoma)
b. Spindle cell neoplasms with margins, which infiltrate adjacent structure, fat invaded
(Breast sarcoma)
c. Small cells with round nucleus and scant indistinct cytoplasm (Lobular carcinoma) - A 22yo man has a reduced conscious level and a fixed dilated pupil after being involved in a MVC.
Choose the single most appropriate option?
a. Facial nerve
b. Oculomotor nerve
c. Olfactory nerve
d. Optic nerve
e. Trigeminal nerve - A man with suspected active TB wants to be treated at home. What should be done to prevent
the spread of disease?
a. Immediate start of the tx with Anti-TB drugs
b. All family members should be immediately vaccinated with BCG vaccine
c. Patient should be isolated in a negative pressure chamber in his house
d. Universal prevention application protocol - A 7yo child is brought to the ED with a 1 day hx of being listless. On examination, the child is
drowsy with an extensive non-blanching rash. What advice would you give the parents?
a. All family members need antibiotic therapy
b. Only the mother should be given rifampicin prophylaxis
c. All family members need isolation
d. All family members should be given rifampicin prophylaxis - A 47yo man has a temp of 39C and is delirious. He has developed blisters mainly on his trunk,
which appeared a few hours ago. He is well and not on any medications. He last travelled 5
months ago to Italy. Which of the following is the most likely dx?
a. Shingles
b. Chicken pox
c. Pemphigoid
d. Bullous pemphigus - A 64yo pt has been having freq episodes of secretory diarrhea, which is extremely watery, with
large amts of mucus. A dx of villous adenoma was made after endoscopy. What electrolyte
abnormality is most likely in this pt?
a. Hyperkalemia
b. Hypernatremia
c. Hyponatremia
d. Hypokalemia
e. Hypercalcemia - A pt with an acute gout attack came to the ED. What drug should be given to relieve symptoms?
a. NSAIDs
b. Allopurinol
c. Ibuprofen - A pt was lying down on the operating table in a position with his arms hanging down for 3 hours.
Soon after he woke up, he complains of numbness and weakness in that hand and has limited
wrist movement/wrist drop and sensory loss over dorsum of that hand, weakness of extension
of the fingers and loss of sensation at the web of the thumb. What structure is likely to be
damaged?
a. Radial nerve
b. Median nerve
c. Ulnar nerve
d. Axillary nerve
e. Suprascapular nerve - A pt who was previously on 120mg slow release oral morphine has had his dose increased to
200mg. He is still in significant pain. He complains of drowsiness and constipation. What is the
next step in the management?
a. Increase slow release morphine dose
b. Fentanyl patch
c. Replace morphine with oral hydromorphone
d. Replace morphine with oxycodone
e. Subcutaneous morphine - A 40yo woman notices increasing lower abdominal distention with little/no pain. On
examination, a lobulated cystic mass is felt and it seems to be arising from the pelvis. What is
the most appropriate inv?
a. CA 125
b. CA 153
c. CA 199
d. CEA
e. AFP - A resident of a nursing home presented with rashes in his finger webs and also on his abdomen,
with complaints of itching which is severe at night. He was dx with scabies. What the best tx for
his condition?
a. 0.5% permethrin
b. Doxycycline
c. 5% permethrin
d. Reassure
e. Acyclovir - A 34yo alcoholic is found passed out in front of a local pub. The ambulance crew informs you
that he was sweating when they found him and there were cans of cider lying empty around
him. What is the initial stage of inv?
a. Capillary blood sugar
b. CT head
c. MRI head
d. ABG
e. MCV - A young boy fell on his outstretched hand and has presented with pain around the elbow. He
has absent radial pulse on the affected hand. What is the most likely dx?
a. Dislocated elbow
b. Angulated supracondylar fx
c. Undisplaced fx of radial head
d. Posterior dislocation of shoulder - A 65yo woman presented with transient arm and leg weakness as well as a sudden loss of vision
in the left eye. Her symptoms resolved within the next couple of hours. What is the most
appropriate next inv?
a. CT brain
b. Echo
c. Doppler USG
d. Arteriography
e. 24h ECG - A man complains of loss of sensation in his little and ring finger. Which nerve is most likely to be
involved?
a. Median nerve
b. Ulnar nerve
c. Radial nerve
d. Long thoracic nerve
e. Axillary nerve - A young man complains of double vision on seeing to the right. Which nerve is most likely to be
involved?
a. Left abducens
b. Right abducens
c. Left trochlear
d. Right trochlear
e. Right oculomotor
ϯϭ. A ϰϱLJo ŵaŶ keeps haǀiŶg iŶtƌusiǀe thoughts aďout haǀiŶg diƌt uŶdeƌ the ďed. He ĐaŶ͛t keep
himself from thinking about these thoughts. If he tries to resist, he starts having palpitations.
What is the most likely dx?
a. OC personality
b. OCD
c. Schizophrenia
d. Panic disorder
e. Phobia - A 33yo man presents with an itchy scaly annular rash on his thigh after a walk in the park. Which
of the following drugs will treat his condition?
a. Erythromycin
b. Doxycycline
c. Penicillin
d. Amoxicillin - A pt with cerebral mets has polyuria and polydipsia. What part of the brain would be affected?
a. Cerebral cortex
b. Cerebellum
c. Diencephalon
d. Pons
e. Medulla - A 32yo man presented with painless hematuria. He is hypertensive but the rest of the exam is
unremarkable. What is the most likely dx?
a. Polycystic kidneys
b. Ca bladder
c. Ca prostate
d. TTP
e. HUS - A 45yo female complains of pain in the inner side of her right thigh. She was dx with benign
ovarian mass on the right. Which nerve is responsible for this pain?
a. Femoral nerve
b. Obturator nerve
c. Iliohypogastric nerve
d. Ovarian branch of splanchic nerve
e. Pudendal nerve - A 37yo lady strongly believes that a famous politician has been sending her flowers every day
and is in love with her. However, this is not the case. What is the most likely dx?
a. Erotomania
b. Pyromania
c. Kleptomania
d. Trichotillomania
e. Grandiosity - A 3yo child has been brought with facial lacerations. On examination he has some cuts over his
right cheek and under the eye. The GCS on initial evaluation is 15. What is the appropriate next
inv?
a. Skull XR
b. Facial XR
c. CT scan
d. MRI
e. Observation - A 73yo woman has lymphadenopathy and splenomegaly. She feels well but has had recurrent
chest infections recently. Choose the single most likely blood film findings?
a. Atypical lymphocytes
b. Excess of mature lymphocytes
c. Plasma cells
d. Multiple immature granulocytes with blast cells
e. Numerous blast cells - A lady presents with itching around the breast and greenish foul smelling discharge from the
nipple. She had a similar episode before. What is the most likely dx?
a. Duct papilloma
b. Duct ectasia
c. Breast abscess
d. Periductal mastitis
e. Mammary duct fistula - A young male whose sclera was noted to be yellow by his colleagues has a hx of taking OTC
drugs for some pain. Tests showed raised bilirubin, ALT and AST normal. The provocation test
with IV nicotinic acid is positive and produces further rise in the serum bilirubin levels. What is
the most likely dx?
a. Acute hepatitis
b. Drug hypersensitivity
c. Gilberts syndrome
d. Acute pancreatitis - A 24yo biker has been rescued after being trapped under rocks for almost 12h. He complains of
reddish brown urine. His creatinine is 350umol/L and his urea is 15mmol/L. What is the most
imp step in the management of this patient?
a. Dialysis
b. IV NS
c. IV dextrose
d. IV KCl
e. Pain relief - A 74yo man who has been a smoker since he was 20 has recently been dx with SCLC. What
serum electrolyte picture will confirm the presence of SIADH?
a. High serum Na, low serum osmolarity, high urine osmolarity
b. Low serum Na, low serum osmolarity, high urine osmolarity
c. Low serum Na, high serum osmolarity, high urine osmolarity
d. High serum Na, low serum osmolarity, low urine osmolarity
e. High serum Na, high serum osmolarity, low urine osmolarity - A man brought into the ED after being stabbed in the chest. Chest is bilaterally clear with
muffled heart sounds. BP is 60/nil. Pulse is 120bpm. JVP raised. What is the most likely dx?
a. Pulmonary embolism
b. Cardiac tamponade
c. Pericardial effusion
d. Hemothorax
e. Pneumothorax - A 50yo pt is admitted for elective herniorraphy. Which of the following options will lead to a
postponement of the operation?
a. SBP <90mmHg
b. MI 2 months ago
c. Hgb 12g/dl
d. Pain around hernia
e. Abdominal distention - A 32yo woman of 39wks gestation attends the antenatal day unit feeling very unwell with
sudden onset of epigastric pain associated with nausea and vomiting. Her temp is 36.7C. Exam:
she is found to have RUQ tenderness. Her blood results show mild anemia, low platelets,
elevated liver enzymes and hemolysis. What is the most likely dx?
a. Acute fatty liver of pregnancy
b. Acute pyelonephritis
c. Cholecystitis
d. HELLP syndrome
e. Acute hepatitis - A woman comes with an ulcerated lesion 3 cm in the labia majorum. What is the lymphatic
drainage of this area?
a. External iliac
b. Superficial inguinal LN
c. Para-aortic
d. Iliac
e. Aortic - A man post-cholecystectomy presented with jaundice, fever and dark urine. What is the most
diagnostic inv?
a. ERCP
b. USG Abdomen
c. CT Scan
d. MRCP
e. MRI - A 79yo stumbled and sustained a minor head injury 2 weeks ago. He has become increasingly
confused, drowsy and unsteady. He has a GCS of 13. He takes warfarin for Afib. What is the most
likely dx?
a. Extradural hemorrhage
b. Cerebellar hemorrhage
c. Epidural hemorrhage
d. Subdural hemorrhage
e. Subarachnoid hemorrhage - A 25yo female complains of intermittent pain in her fingers. She describes episodes of
numbness and burning of the fingers. She wears gloves whenever she leaves the house. What is
the most probable dx?
a. Kawasaki disease
b. Takayasu arteritis
Đ. Bueƌgeƌ͛s disease
d. Embolism
e. ‘aLJŶaud͛s pheŶoŵeŶoŶ - A 22yo lady has been unwell for some time. She came to the hospital with complaints of fever
and painful vesicles in her left hear. What is the most probable dx?
a. Acne
b. Herpes zoster
c. Chicken pox
d. Insect bite
e. Cellulitis