Nash Qbank

Q.1. 32 year old lady works as a file clerk developed sudden onset of low back pain when she was bending to take the files, moderately severe of 3 days duration. There is no evidence of nerve root compression. What is the appropriate action?

A:

Bed rest for 7 to 10 days

B:

Traction

C:

Narcotic analgesia

D:

Early activity with return to work

Q.2. Family went to a dinner party after 6 hours they all had symptoms of abdominal pain, nausea, vomiting and dehydration. Some of them recovered while others needed hospitalization. What’s the most likely organism?

A:

Giardia

B:

Staphylococcus aureus

C:

Salmonella

D:

C. perfringes

Q.3. Many harmful bacteria produces toxins. Which one of the following is used in amiddirs?

A:

Botulism

B:

Tetanus

C:

Diphtheria

D:

Rabies

Q.4. A 50 year old lady presents with a sudden onset of severe occipital headache associated with neck pain and vomiting. CT brain was inconclusive and a lumbar puncture was performed which revealed xanthochromia. What is the best likely diagnosis?

A:

Bacterial meningitis

B:

Viral meningitis

C:

Migraine

D:

Subarachnoid haemorrhage

Q.5. An 18 year old male who was involved in an RTA had fracture of the base of the skull. O/E he had loss of sensation of the anterior 2/3 of the tongue & deviation of the angle of mouth. Which nerve is affected?

A:

I (Olfactory)

B:

III (Occulomotor)

C:

V (Trigeminal)

D:

IV (Abducens)

Q.6. Male patient presents with prostatitis (history suggested prostatitis), culture showed gram negative rods. What is the drug of choice?

A:

Ciprofloxacin

B:

Ceftriaxone

C:

Erythromycin

D:

Trimethoprime

Q.7. 30 years old man presented with upper abdominal pain and dyspepsia. Which of the following doesn’t support the diagnosis of peptic ulcer?

A:

Hunger pain

B:

Heart burn

C:

Epigastric mass

D:

Epigastric tenderness

Q.8. The strongest type of epidemiological studies is?

A:

Prospective cohort studies

B:

Retrospective control case studies

C:

Cross sectional

D:

Time line

Q.9. 25 year old male complaining of scaly lesions in his chest, which turns hypopigmented. History of spending his time near to sea since last 2 months. On examination showed hypopigmented lesions over chest & arms. What's the diagnosis?

A:

Fungal infection

B:

Taenia versicolor

C:

Pityriasis versicolor

D:

Scabies

Q.10. A case of hypothyroidism on thyroxin, TSH high. What is the appropriate next step?

A:

Continue the dose of thyroxine and follow up after 3months

B:

Reduce dose

C:

Stop treatment till TSH level is normal

D:

Increase the thyroxine dose

Q.11. Patient presents with high blood pressure (systolic 200), tachycardia, Mydriasis (Dilated pupils), sweating. Symptoms indicate toxicity of which drug?

A:

Anticholinergic

B:

Sympathomimetic drug

C:

Tricyclic antidepressant

D:

Organophosphorous compounds

Q.12. Surgery in C3 colon cancer is?

A:

Curative

B:

Palliative

C:

Diagnostic

D:

None

Q.13. A 45 year old waitress complains of pelvic pain which worsens pre-menstrually. The pelvic pain is usually worse when standing and has been present for the last one year. She also complains of post-coital ache that is felt deep within the vagina. There was no discharge on vaginal examination. A diagnostic laparoscopy was performed which did not show any abnormalities. What is the most likely diagnosis?

A:

Pelvic inflammatory disease (PID)

B:

Endometriosis

C:

Pelvic congestion syndrome

D:

Premature ovarian failure

Q.14. In a patient with anaphylactic shock, all are correct treatment, EXCEPT?

A:

Epinephrine

B:

Hydralazine

C:

Adrenaline

D:

Aminophylline

Q.15. A 7 year old boy fell on his outstretched arm and presents with pain around the elbow. On examination, radial pulse is absent on the affected hand. What is the most likely diagnosis?

A:

Dislocated elbow

B:

Angulated supracondylar fractures of the humerus

C:

Posterior dislocation of shoulder

D:

Pulled elbow

Q.16. What's the management for a pregnant lady with negative antibodies for rubella and measles?

A:

MMR vaccine

B:

Give antibodies

C:

Terminate pregnancy

D:

Do nothing

Q.17. A 26 year old woman presents to her GP with a headache, photophobia and a fever. On examination, a generalized rash that does not blanch on pressure was observed. What is the most appropriate initial management?

A:

IM benzylpenicillin

B:

IV Gentamicin

C:

Blood culture

D:

IV Ceftriaxone

Q.18. Patient needs CS but the patient refuses to do CS. What will you do?

A:

Take permission from husband

B:

Respect her wishes

C:

Refer to other hospital

D:

Forcefully conduct CS

Q.19. A 32 year old woman complains of dull pain in her right eye for the past one week which worsens when moving her eye. Her past medical history includes multiple sclerosis which was diagnosed 6 months ago. An opthalmoscopy shwos pallor of the optic disc. Which anatomical site is most likely to be affected?

A:

Optic nerve

B:

Trigeminal nerve

C:

Sclera

D:

Oculomotor nerve

Q.20. What is the most specific test for syphilis?

A:

TPI

B:

VDRL

C:

Treponema antibody absorption test FTA-ABS

D:

NAAT

Q.21. What is the best early sign to detect tension pneumothorax?

A:

Distended neck veins

B:

Tracheal shift

C:

Hypotension

D:

Reduced breath sounds

Q.22. A 20 year old man with sickle cell anaemia has shortness of breath, pallor, headache and lethargy. He has been having flu-like symptoms for the past week. For the past few days, he has been having aches on his hands, knees and ankles. His initial blood tests show: Haemoglobin 53 g/L Infection with parvovirus B19 is suspected and further blood tests have been sent for specific IgM and IgG antibodies to parvovirus B19. What is the most likely diagnosis?

A:

Aplastic crises

B:

Haemolytic crises

C:

Splenic sequestration crisis

D:

Acute chest syndrome

Q.23. Which gross motor development is seen at age of 6 months?

A:

Standing

B:

Roll from prone to supine position

C:

Roll from supine to prone position

D:

Sitting without support

Q.24. A 43 year old chronic alcoholic stopped drinking alcohol for the last 3 days. He is anxious, has tremors and is now having hallucinations. His heart rate is 106 beats/minute. What is the most appropriate treatment?

A:

Olanzapine

B:

Diazepam

C:

Acamprosate

D:

Disulfiram

Q.25. A 30 year old woman complains of tiredness, lethargy and constipation. On inspection, she has dry coarse skin, hair loss and cold peripheries. On examination, a diffuse and lobulated goitre can be palpated on her anterior neck. A full blood count and peripheral smear is done which shows a macrocytic anaemia. What is the most likely diagnosis?

A:

Cushing’s syndrome

B:

Hyperthyroidism

C:

Pernicious anaemia

D:

Addison’s disease

Q.26. A 75 year old male presents with enlarged cervical nodes. He has several recurrrent infections over the year. His conjunctiva is pale and he feels weak. What is the most likely cell type to be found on a blood smear of this patient?

A:

Granulocytes without blast cells

B:

Myofibroblasts

C:

Mature lymphocytes

D:

Plasma cells

Q.27. A 33 year old woman with 3 previous normal vaginal deliveries is diagnosed with stress incontinence. She has tried pelvic floor exercises and lifestyle modifications but they have not been successful. Her BMI is 29. What is the most appropriate management?

A:

Tension free vaginal tape

B:

Bladder training

C:

Intermittent urethral catheters

D:

Antimuscarinic medications

Q.28. Which of following increases during pregnancy?

A:

Tidal Volume

B:

Functional residual volume

C:

Dead lung space

D:

Residual volume

Q.29. 20 year old man involved in RTA brought to ER by his friends. On examination, found to be conscious but drowsy. HR 120/min, BP 80/40. What is the MOST urgent initial management measure is?

A:

CT brain

B:

X-ray cervical spine

C:

Rapid infusion of crystalloids

D:

ECG to exclude hemopericardium

Q.30. Patient is 22 years old with unilateral headache. What is the likely diagnosis?

A:

Cluster headache

B:

Migraine

C:

Tension headache

D:

Subarachnoid hemorrhage

Q.31. Pregnant lady came to antenatal clinic for routine checkup, her Glucose tolerance test was high. Diagnosed as gestational DM. What's the management?

A:

Nutritional advice

B:

Insulin

C:

OHA

D:

Repeat GGT

Q.32. What does Henoch-Scholein purpura affect?

A:

Capillary

B:

Capillary and venule

C:

Arteriole, capillary and venule

D:

Veins

Q.33. A 34 year old woman developed a purpuric rash on the back of her legs. She also reports frequent nose bleeds and menorrhagia. A blood count shows: Haemoglobin 119 g/L White cell count 6.8 x 109/L Platelets 59 x 109/L What is the most likely diagnosis?

A:

Idiopathic thrombocytopenic purpura

B:

Thrombotic thrombocytopenic purpura

C:

Von Willebrand’s diease

D:

Henoch-Schonlein purpura

Q.34. What is the management of breast engorgement?

A:

Cold compression with cessation of breast feeding

B:

Cloxacillin with continued breast feeding

C:

Warm compression with continued breast feeding

D:

Antibiotics

Q.35. Which organism in cat bite predisposes to skin infection?

A:

Staphylococcus aureus

B:

Streptococcus aureus

C:

Pasteurella multocida

D:

Pseudomonas

Q.36. A 35 year old lady presents with urinary incontinence 4 months after having a normal vaginal delivery of her second child. She says that she urinates a little every time she sneezes or coughs. On a speculum examintion, there are no anatomical abnormalities. What is the most approprite next step in management?

A:

Tension-free vaginal tape operation

B:

Pelvic floor exercise

C:

Ring pessary

D:

Bladder drill (retraining)

Q.37. What is the inheritance type of Adult polycystic kidney disease?

A:

Autosomal dominant

B:

Autosomal recessive

C:

X linked

D:

None

Q.38. What is the most serious complication of acute pancreatitis?

A:

Abscess

B:

Pseudocyst

C:

Bowel obstruction

D:

Peritonitis

Q.39. A 5 year old girl is brought to the hospital by her mother with complaints of sudden right facial weakness, numbness and pain around her ear. She reports no other symptoms. On examination, her right eyebrow is unable to raise and the right hand corner of her mouth is drooping. What is the most likely diagnosis?

A:

Subarachnoid haemorrhage

B:

Stroke

C:

Bell’s palsy

D:

Transient ischaemic attack

Q.40. What is seen in Primary hyperaldosteronism?

A:

Hypernatremia

B:

Hypomagnesemia

C:

Hypokalemia

D:

Hyperkalemia

Q.41. A heavy smoker comes to ask you about his risks of cancer apart from lung cancer. What will you tell him?

A:

Colon

B:

Bladder

C:

Liver

D:

Pancreas

Q.42. The first line treatment of panic disorder is?

A:

TCA

B:

SSRI

C:

Beta blockers

D:

Benzodiazpine

Q.43. A 45 year old man has been admitted for an electrive surgery. 2 days later he develops agitation, sweating and complains of seeing snakes on the hospital wall. A history of chronic alcoholic abuse is revealed and chlordiazepoxide has been started. What is the most appropriate next course of action?

A:

Add Diazepam

B:

Add Acamprosate

C:

Add Disulfiram

D:

Add Thiamine

Q.44. Man who received blood transfusion back in 1975 developed jaundice, he most likely has?

A:

Hepatitis A

B:

Hepatitis C

C:

Hepatitis D

D:

Hepatitis E

Q.45. Child ingested acoustic material, looks ill and is drooling. What is your immediate action?

A:

Intubate

B:

Endoscopy

C:

Chelating agent

D:

Airway assessment

Q.46. A 79 year old man was seen in the memory clinic as an outpatient. On his mental state examination, he was noted to be disengaged, expressing boredome as well as making inappropriate comments to the doctor of a sexual nature. What is the most likely diagnosis?

A:

Alzheimer’s disease

B:

Huntington’s disease

C:

Frontotemporal dementia

D:

Cerebrovascular accident

Q.47. A 25 year old woman presents with a severe headache. She had migraines for the last 14 years but has been symptom free for the last year. There are no other neurological signs. She has no other medical history of note. Her observations are stable. What is the most appropriate investigation for this woman?

A:

Computed tomography of head

B:

Lumbar puncture

C:

No further investigation required

D:

Magnetic resonance imaging of head

Q.48. A 26 year old woman presents with a “fishy” vaginal discharge. On examination, a homogeneous grey-white vaginal discharge is seen. Vaginal pH is 5.8. What is the most appropriate management?

A:

Metronidazole

B:

Azithromycin

C:

Ceftriaxone

D:

Flucloxacillin

Q.49. A 30 year old woman complains of tiredness, lethargy and constipation. On inspection, she has dry coarse skin, hair loss and cold peripheries. On examination, a diffuse and lobulated goitre can be palpated on her anterior neck. A full blood count and peripheral smear is done which shows a macrocytic anaemia. What is the most likely diagnosis?

A:

Cushing’s syndrome

B:

Pernicious anaemia

C:

Hyperthyroidism

D:

Crohn’s disease

Q.50. At what distance should you stand to read the Snellen's Chart?

A:

6 meters

B:

12 meters

C:

10 meters

D:

15 meters

Q.51. Child with DM came with picture of DKA, which HLA is responsible?

A:

DR4

B:

DR5

C:

DR6

D:

DR3 and DR4

Q.52. Which of the following diseases is NOT transmitted by mosquitoes?

A:

Malaria

B:

Yellow fever

C:

Relapsing fever

D:

Filariasis

Q.53. What is Physician's carelessness termed as?

A:

Criminal neglect

B:

Malfeasance

C:

Malpractice

D:

Non feasance

Q.54. What is questionnaire used to differentiate between sleep apnoea and snoring?

A:

Michigan

B:

Epworth

C:

Cooner

D:

None

Q.55. A 30 year old woman visits her GP surgery with concerns of vaginal spotting. She has had a Mirena coil inserted for contraceptive use 6 weeks ago. Her last menstrual period was 2 weeks ago. She denies abdominal pain or abnormal vaginal discharge. Her last cervical smear was 2 years ago. A speculum examination reveals a healthy looking cervix with the Mirena coil threads visible. What is the most appropriate action?

A:

Take an endocervical swab

B:

Take a high vaginal swab

C:

Reassure

D:

Remove the Mirena coil

Q.56. Middle aged male is involved in RTA, his RR is 30/min, heart sounds are muffled & the JVP is elevated. BP: 80/40 & has a bruise over the sternum. What is the diagnosis?

A:

Pericardial tamponade

B:

Pneumothorax

C:

Pulmonary contusion

D:

Hemothorax

Q.57. A 5 year old boy was brought to his GP with a temperature of 38.8 C and numerous pruritic vesicles on his chest and back. They appear in circular crops and initially started on his face before spreading to his chest and back. What is the most appropriate management?

A:

Intravenous aciclovir

B:

Oral aciclovir

C:

Reassurance

D:

Oral antibiotics

Q.58. A 66 year old patient wakes up with slurred speech and right sided weakness. He is brought to the hospital by his wife. A computed tomography was ordered and shows a cerebral infarction. What is the most appropriate treatment to be given?

A:

Aspirin

B:

Streptokinase

C:

Alteplase

D:

Warfarin

Q.59. What could cause painful vision loss?

A:

Acute closed angle glaucoma

B:

Retinal detachment

C:

Retinal vein occlusion

D:

Retinal artery occlusion

Q.60. Old lady came to clinic as routine visit, she mentions of decreased intake of calcium food. Doctor suspects osteoporosis. What is the next appropriate investigation to confirm?

A:

DEXA

B:

Serum calcium

C:

Thyroid function test

D:

Vitamin D

Q.61. All of the following drugs are contraindicated in G6PD deficiency, EXCEPT?

A:

Aspirin

B:

Nitrofurantoin

C:

Chlorquine

D:

Sulphonamide

Q.62. Newborn brought with red patch on left shoulder. What's the diagnosis?

A:

Lipoma

B:

Haemangioma

C:

Naevi

D:

Melanoma

Q.63. A 19 year old female with previous history of repeated pain over the medial canthus and chronic use of nasal decongestants, presents with abrupt onset of a severe headache, fever with chills and rigor, diplopia on lateral gaze, moderate proptosis and chemosis. On examination optic disc is congested. Which of the following is the most likely diagnosis?

A:

Cavernous sinus thrombosis

B:

Orbital cellulitis

C:

Orbital apex syndrome

D:

Acute ethmoidal sinusitis

Q.64. What is the injection that is routinely given to new-born to inhibit haemorrhage?

A:

Vitamin C

B:

Vitamin D

C:

Vitamin K

D:

Vitamin E

Q.65. 23 year old female presented with jaundice. Lab findings of hyperbilirubinemia, normal examination. Investigation shows total bilirubin= 3.1, direct bilirubin= 0.4. What's the most likely diagnosis?

A:

Gilbert's disease

B:

Criggler najjar syndrome 1

C:

Duben Johnson syndrome

D:

Rotor's disease

Q.66. Which of the following increases the quality of the randomized controlled study & makes it stronger?

A:

Systemic assignment predictability by participants

B:

Open Allocation

C:

Including only the participants who received the full intervention

D:

Following at least 50 % of the participants

Q.67. Female with atypical squamous cells of undetermined significance (ASCUS) on pap smear, started 30 day treatment with estrogen & told her to come back after 1 week but is still +ve on pap smear. What will you do next?

A:

Cervical biopsy

B:

Endometrial biopsy

C:

Syphilis serology

D:

Repeat PAP

Q.68. A 3 week old baby boy presented with a scrotal mass that was transparent & non reducible. What is the diagnosis?

A:

Hydrocele

B:

Inguinal hernia

C:

Varicocele

D:

Congenital

Q.69. Patient known case of IDDM, presented with DKA, K= 6 mmol/L and blood sugar= 350 mg/dl. How will you manage?

A:

IV fluids

B:

Sodium bicarbonate

C:

IV fluid and insulin

D:

Insulin

Q.70. Type 1 diabetic, what is the target HbA1C?

A:

9

B:

8

C:

6.5

D:

8.7

Q.71. What is the drug of choice of generalized anxiety disease?

A:

Acetalopram

B:

Buspirone

C:

Buspirone

D:

Sertaline

Q.72. A 41 year old man presents with visual symptoms and a headache. An ophthalmoscopic examination shows papilloedema. Which anatomical site is most likely to be affected?

A:

Retina

B:

Optic disc

C:

Optic radiation

D:

Optic chiasma

Q.73. How will you treat a human bite?

A:

Cleanse and debride as usual

B:

Tetanus prophylaxis as indicated

C:

Antibiotic prophylaxis

D:

Topical antibiotics

Q.74. What is the agent of choice in reversing heparin induced life threatening bleeding?

A:

FFP

B:

Protamine sulphate

C:

Vitamin K

D:

Prothrombin complex concentrate

Q.75. All are primary prevention of anaemia except?

A:

Health education about food rich in iron

B:

Iron fortified food in childhood

C:

Limitation of cow milk before 12 months of age

D:

Genetic screening for hereditary anemia

Q.76. A 38 year old female, 32 weeks pregnant presents with thick white marks on the inside of her mouth for 3 weeks. Her mouth including her tongue appears inflamed on examination. She smokes 20 cigarettes a day despite advice to quit. What is the most likely diagnosis?

A:

Candidiasis

B:

Aphthous ulcer

C:

Molluscum contagiosum

D:

Leukoplakia

Q.77. Young male healthy, comes for routine examination he is normal except enlarged thyroid gland without any symptoms. What is the next step?

A:

CT

B:

MRI

C:

US

D:

Iodine study

Q.78. A 45 year old known hypertensive man presents with tiredness, lethargy, fluid retention and proteinuria. His albumin levels are low. What is the most definitive diagnostic test?

A:

Mid stream urine for culture

B:

Urine microscopy

C:

Renal function test

D:

Renal biopsy

Q.79. A young female patient who is an office worker presented with itching in the vagina associated with the greenish-yellowish vaginal discharge. Examination revealed red spots on the cervix. What is the diagnosis?

A:

Trichomoniasis

B:

Candidiasis

C:

Gonorrhea

D:

Gardnerella vaginalis

Q.80. You are supposed to keep a child NPO. He's 25 kgs. How much fluids will you give?

A:

1300

B:

1400

C:

1500

D:

1600

Q.81. Female underwent abdominal operation she went to physician for check ultrasound which reveals metal clip (10 cm) inside abdomen (missed during operation). What will you do?

A:

Call the surgeon and ask him what to do

B:

Call attorney and ask about legal action

C:

Tell her what you found and refer her to surgery

D:

Tell her that is one of possible complications of operation

Q.82. An 18 year old man reports having several episodes of visible haematuria over the last 24 hours. There is no history of abdominal pain or loin pain. These typically seem to occur within a day or two of developing an upper respiratory tract infection. Urine testing by dipstick shows albumin and blood. What is the most likely diagnosis?

A:

IgA nephropathy

B:

Minimal change nephropathy

C:

Heonch-Scholein purpura

D:

Post-streptococcal glomerulonephritis

Q.83. A 55 year old HIV man presents with painless peripheral lymphadenopathy, fever, night sweats and weight loss. Abdominal examination reveals an enlarged spleen. What is the most likely diagnosis?

A:

Hodgkin’s lymphoma

B:

Non-Hodgkin’s lymphoma

C:

Acute lymphoblastic leukaemia (ALL)

D:

Chronic myeloid leukaemia (CML)

Q.84. A 33 year old known drug abuser has swelling and erythema in his arm where he injects. He has a fever and appears sick. He is asking for morphine as the pain is severe and seems to be disproportionate to the clinical appearance. Bullae is seen on the skin of his arm. He was started on intravenous flucloxacillin but the infection has not responded to antibiotics and seems to be worsening. What is the most likely diagnosis?

A:

Cellulitis

B:

Necrotising fasciitis

C:

Pyoderma gangrenosum

D:

Erysipelas

Q.85. Female patient did urine analysis which shows epithelial cells. What is the source?

A:

Cervix

B:

Urethra

C:

Ureter

D:

Vulva

Q.86. Old patient with crampy abdominal pain, nausea, vomiting and constipation but no tenderness. What is the diagnosis?

A:

Diverticulitis

B:

Colon cancer

C:

Obstruction

D:

Appendicitis

Q.87. Mother complains of sharp pain on radial styloid process when carrying her baby. The pain increases with extension of the thumb against resistance, Finkelstein test was positive. What is the diagnosis?

A:

Osteoarthritis of radial styloid

B:

De Quervain Tenosynovitis

C:

Carpal tunnel syndrome

D:

Fracture styloid process

Q.88. Which one of these patients with pneumonia will you treat as outdoor patient?

A:

80 Years old with 104 F temperature, BR 24/min PR 126/min, BP 180/110

B:

60years old with 102 F temperature BR 22/min PR 124/min, BP 160/110

C:

80 years old with 96 F temperature, BR 18/min, HR 70/min, BP 110/80

D:

50years old with 98 F temperature, BR 20/min. HR 110/min, BP 180/110

Q.89. A 48 year old man who has been taking medications for asthma for several years has now presented with decreased vision on his right eye. He complains of glare especially during the night. What SINGLE medication is most likely to cause his visual deterioration?

A:

Inhaled salbutamol

B:

Inhaled steroids

C:

Aminophylline

D:

Oral steroids

Q.90. 19 year sexually active lady came for her annual check-up, she is otherwise healthy using no contraception. Her pap smear and all investigations are normal. What will you suggest regarding her next check-up?

A:

After 6 months

B:

After 1 year

C:

After 3 years

D:

After 5 years

Q.91. A girl's height is 10th percentile. When will her spinal length be completed after menarche?

A:

6m

B:

12 m

C:

24m

D:

36 m

Q.92. A 56 year old lady has developed severe right sided headache which worsens whenever she goes under the bright light. This has been occurring for the last 3 days. She feels nauseated, but has not vomited. She does not take any medication and has no relevant medical history. What is the most likely diagnosis?

A:

Subarachnoid haemorrhage

B:

Chronic subdural haemorrhage

C:

Migraine

D:

Cluster headache

Q.93. How do you control communicable diseases?

A:

Control the source of infection

B:

Block the source of transmission

C:

Protect the susceptible patient

D:

All of the above

Q.94. Child has 39*C fever, red tonsils with no exudate, slightly enlarged LN but not tender. What's the management?

A:

Could be viral or bacterial

B:

It is unclear so start antibiotic

C:

It is more likely viral

D:

It is more likely bacterial

Q.95. A 52 year old man has incoherent speech. He is awaree of his speech difficulties but finds difficulty in using the right words when speaking. He has no other symptoms apart from his speech issue. He has good comprehension. Which anatomical site is most likely to be affected?

A:

Broca’s area

B:

Wernicke’s area

C:

Midbrain

D:

Brainstem

Q.96. 11 months old baby, 10 kgs, what is the maintenance daily fluid?

A:

1000 ml

B:

500 ml

C:

2000 ml

D:

2500 ml

Q.97. What's true about Kwashiorkor?

A:

High protein & high carbohydrate

B:

Low protein & high carbohydrate

C:

High protein & low carbohydrate

D:

Low protein

Q.98. A 10 year old boy has been diagnosed with nephrotic syndrome and started on steroids. 5 days later he presents with flank pain, haematuria and fluctuating urea levels. A diagnosis of renal vein thrombosis is made. What is the most likely cause for renal vein thrombosis?

A:

Protein C deficiency

B:

Loss of antithrombin III

C:

Vasculitis

D:

Stasis

Q.99. A 5 year old child started having a fever two days ago associated with neck stiffness, chills, impaired consciousness and vomiting. He has a history of travel with his parents to Ghana and returned 6 weeks ago. Before he left to Ghana, he was started on malaria prophylaxis. A full blood count shows that the young child is anaemic. What is the most likely diagnosis?

A:

Cerebral abscess

B:

Meningococcal meningitis

C:

Cerebral tumour

D:

Cerebral malaria

Q.100. What is the management of Acute Gout?

A:

Allopurinol

B:

NSAIDs

C:

Paracetamol

D:

Gold salt

Q.101. 70 year old woman presented with a 3 days history of perforated duodenal ulcer. She was febrile, semi comatose and dehydrated on admission. What is the best treatment?

A:

Blood transfusion, Rehydrate, perform Vagotomy & drainage urgently

B:

NGT suction, Rehydrate, systemic AB & observe

C:

NGT suction, Rehydrate, systemic AB & perform Plication of the perforation

D:

Rehydrate, Blood transfusion, systemic AB & perform hemigastrectomy

Q.102. A 46 year old man is being investigated for indigestion. A jejunal biopsy shows deposition of macrophages in the lamina propria-containing granules which stain positive for Period Acid-Schiff (PAS). What is the most likely diagnosis?

A:

Bacterial overgrowth

B:

Tropical sprue

C:

Coeliac disease

D:

Whipple’s disease

Q.103. A 10-day-old full-term boy presents with abdominal distension for 1 week. It is associated with greenish vomiting and difficulty in passing stool. His stools are loose in constancy. On per-rectal examination, the rectum is empty and he passed a large amount of stool and gases after the figure was removed. Which of the following is the most likely diagnosis?

A:

Pyloric stenosis

B:

Intussusception

C:

Incarcerated hernia

D:

Hirschsprung's disease

Q.104. Pregnant women has allergy to Sulfa drugs & penicillin. Which drug is safe for her?

A:

Nitrofurantoin

B:

Amoxicillin

C:

Ciprofloxacin

D:

Trimethoxazole

Q.105. Which type of contraception is contraindicated in lactation?

A:

OCPs

B:

Mini pills

C:

IUD

D:

Condom

Q.106. 17 year old football player gave history of left knee giving way. What is the most likely diagnosis?

A:

Lateral Menisceal injury

B:

Medial menisceal injury

C:

Lateral collateral ligament

D:

Anterior Cruciate ligament

Q.107. Newborn came with congenital hepatomegaly, high LFT, jaundice. What is the cause?

A:

Congenital TB

B:

Rubella

C:

HIV

D:

CMV

Q.108. A 68 year old woman has a sudden onset of pain and loss of hearing in her left ear and unsteadiness when walking. There are small lesions visible on her palate and left external auditory meatus. What is the most likely diagnosis?

A:

Acute mastoiditis

B:

Oropharyngeal malignancy

C:

Herpes zoster infection

D:

Cholesteatoma

Q.109. A 75 year old male presents with enlarged cervical nodes. He has several recurrrent infections over the year. His conjunctiva is pale and he feels weak. What is the most likely cell type to be found on a blood smear of this patient?

A:

Granulocytes without blast cells

B:

Myofibroblasts

C:

Plasma cells

D:

Mature lymphocytes

Q.110. What is the most common chromosomal abnormality?

A:

Down's syndrome (trisomy 21)

B:

Turner's syndrome

C:

Klienfilter's syndrome

D:

Patau syndrome

Q.111. What is the cause of death in flame burns?

A:

Airway involvement

B:

Hypovolemic shock

C:

Dehydration

D:

Infection

Q.112. A 44 year old woman has a two week history of electric shock-like stabbing facial pain starting from her left jaw and radiates towards her forehead. The pain is unilateral and it is descrbed as very severe and coming in spasms. The pain is trigerred by chewing but occurs at other times as well. Her corneal reflexes are found to be normal. What is the most likely diagnosis?

A:

Trigeminal neuralgia

B:

Temporomandibular joint disorder

C:

Herpes zoster ophthalmicus

D:

Giant cell arteritis (GCA)

Q.113. Patient came with neck swelling; moves when patient protrudes his tongue. What is the diagnosis?

A:

Goiter

B:

Thyroglossal cyst

C:

Cystic Hygroma

D:

Multinodular goitre

Q.114. Long term use of which drug causes vertigo, reduced hearing, inability to perceive termination of movement & difficulty in sitting or standing?

A:

Penicillamine

B:

Tetracycline

C:

Amphotericin B

D:

Streptomycin

Q.115. In new born what needs immediate treatment?

A:

Asymptomatic Hydrocele

B:

Erupted tooth

C:

Absent femoral pulse

D:

VSD

Q.116. A 58 year old man has visual hallucinations of animals walking around his room. He is amused by them but is conscious that they are not real. He is noted to have functioning levels of awareness and attention and a decline in problem solving ability. Signs of mild parkinsonism are also seen. What is the most likely diagnosis?

A:

Frontotemporal dementia

B:

Lewy body dementia

C:

Delirium tremens

D:

Alzheimer’s disease

Q.117. What are you trying to treat by forcing the child to go to the toilet before bedtime and in the morning?

A:

Enuresis

B:

Insomnia

C:

Cystitis

D:

UTI

Q.118. A 67 year old woman with a history of atrial fibrillation presents to emergency with slurred speech, asymmetric facial weakness, left sided hemiparesis and ataxia. On arrival to the A&E, her GCS is 14/15. She is increasingly agitated. Which is the most appropriate next course of action?

A:

Anticoagulation

B:

Start thrombolysis treatment

C:

Give aspirin

D:

Urgent CT head

Q.119. A 2-day-old baby is brought to the hospital because of reluctance to feed and seizures since last | night. On examination, the baby weighed 3 kg, is inactive and has a generalized increased tone. A cerebral spinal fluid sample was obtained (see lab results). Test Result Normal Values Gross appearance Clear Clear and colourless Glucose 3.5 2.8-5 mmol/L. ; Total protein 0.22 0.22-0.33 g/L Cells 10 Up to 30/pL. Which of the following is the most likely diagnosis?

A:

Neonatal sepsis

B:

Neonatal tetanus

C:

Pyogenic meningitis

D:

Hypoxic- ischemic encephalopathy

Q.120. Patient with recent history of URTI, developed severe conjunctival redness, tearing, photophobia. What is the management?

A:

Topical antibiotic

B:

Topical acyclovir

C:

Oral acyclovir

D:

Topical steroid

Q.121. Patient has cancer but he responded that there is a mistake, what is this behavior called?

A:

Bargaining

B:

Arrogance

C:

Denial

D:

Innocence

Q.122. What is the average length of the menstrual cycle?

A:

22 days

B:

25 days

C:

28 days

D:

35 days

Q.123. Patient with seasonal watery nasal discharge, sneezing and nasal block. What is the treatment?

A:

Topical steroid

B:

Decongestants

C:

Antihistamines

D:

Systemic steroids

Q.124. A 65 year old woman with diabetes, and hypertension underwent a total right hip replacement. She had massive haemorrhage during the operation and was given 8 units of packed red blood cells. The blood pressure dropped to 60/40 mmHg for about two hours before it was corrected with intravenous fluids and blood transfusions. Two days after the surgery, her blood results show: Serum creatinine level rose to 255 micromol/L Potassium 5.1 mmol/L She had a normal kidney function prior to the surgery. What is the most likely diagnosis?

A:

Diabetic nephropathy

B:

Rhabdomyolysis

C:

Malignant hypertension

D:

Acute tubular necrosis

Q.125. What's the management of Attention Deficit Hyperactivity Disorder child?

A:

Ecitalpram

B:

Atomoxetine

C:

Olanzapine

D:

Clonazepam

Q.126. Patient treated for auditory hallucination and paranoia. He developed drooling, dizziness, neutropenia, QTc prolongation. Which one can cause these symptoms ?

A:

Clozapine

B:

Risperidone

C:

Aripiprazole

D:

Lithium

Q.127. What is the dosage of adult varicella vaccine?

A:

2 doses 2 weeks apart

B:

2 doses 4 weeks apart

C:

2 doses 6 months apart

D:

3 doses 4 weeks apart

Q.128. A 78 year old lady has been brought in after a fall in her home. She is now complaining of pain in her left hip and is unable to walk or weight bear. On examination, the left leg is noted to be shorter than the right and is externally rotated. What is the most likely diagnosis?

A:

Pelvic fracture

B:

Fracture of the coccyx

C:

Fracture of the neck of left femur

D:

Fracture of shaft of left femur

Q.129. Young man comes with headache, he describes that this headache is the worst headache of his life. Which of the following will be least helpful?

A:

Asking more details about headache

B:

MRI or CT scan

C:

Skull x ray

D:

Lumbar puncture

Q.130. 17 years old girl missed her second dose of varicella vaccine, the first one about 1 y ago. What is the next appropriate step?

A:

Give her double dose now

B:

Give her the second dose only

C:

Revaccinate from start

D:

See if she has antibody and act accordingly

Q.131. A 65 year old man has been recently diagnosed with atrial fibrillation. He has suffered from a transient ischaemic attack 3 years ago. His medical history is significant for diabetes mellitus type 2. What is the SINGLE best scoring method to assess for anticoagulation?

A:

ABCD2

B:

CHA2DS2-VASc

C:

CURB-65

D:

Well’s score

Q.132. A 26 year old Greek man has recently recovered from a haemolytic episode 6 weeks ago. The haemolytic episode occurred a day after he ate a traditional Greek dish. Glucose-6-phosphate dehydrogenase deficiency is suspected. What is the most definitive diagnostic test?

A:

Osmotic fragility test

B:

G6PD enzyme assay

C:

Bite cells seen on blood film

D:

Heinz bodies seen on blood film

Q.133. A 17 year old girl with primary amenorrhoea complains of severe abdominal pain every 4 to 8 weeks which is now getting worse. On abdominal examination, a lower abdominal mass is felt. What is the most likely diagnosis?

A:

Ectopic pregnancy

B:

Haemotometra

C:

Ovarian carcinoma

D:

Adenomyosis

Q.134. A 60 year old man is brought to the emergency department with a fractured hip. He has been having progressive hearing loss and was recently diagnosed with cardiac failure. Hypercalcaemia was noted on his blood test. What is the most likely diagnosis?

A:

Paget’s disease

B:

Osteoporosis

C:

Osteomalacia

D:

Multiple myeloma

Q.135. A 65 year old lady presents to the Accident and Emergency department with a 6 hour history of facial droop and weakness on her left side of her body. A CT scan was performed and ruled out a haemorrhagic stroke. She is allergic to Penicillin and takes Simvastatin and Amlodipine regularly. What is the SINGLE most appropriate medication to be prescribed long term for this patient?

A:

Alteplase

B:

Clopidogrel

C:

Aspirin

D:

Dipyridamole

Q.136. Female patient manager presents with depression, she says she can't manage the conflicts that happen at workplace between the employees. What is the diagnosis?

A:

Depression

B:

Generalized anxiety disorder

C:

Adjustment Disorder

D:

Somatiform disorder

Q.137. A 67 year old woman with a history of atrial fibrillation presents to emergency with slurred speech, asymmetric facial weakness, left sided hemiparesis and ataxia. On arrival to the A&E, her GCS is 14/15. She is increasingly agitated. Which is the most appropriate next course of action?

A:

Anticoagulation

B:

Start thrombolysis treatment

C:

Urgent CT head

D:

Give Lorazepam

Q.138. Female complains of painless, odourless and colourless vaginal discharge that appear after intercourse. What is the treatment?

A:

Give her antibiotics

B:

Douche after intercourse

C:

Cervical cancer should be considered

D:

May be due to chronic salpingitis

Q.139. Victim of RTA came with multiple injuries to abdomen, chest and limbs. BP is 80/ 50. Upper third limb near amputation that bleeds profusely. What is the first thing to do?

A:

Call orthopaedic team

B:

Tourniquet the limb to stop the bleeding

C:

Check the airway and breathing

D:

Give IV fluids

Q.140. What is the differentiating factor between polycythemia vera and secondary polycythemia?

A:

Hepatomegaly

B:

Splenomegaly

C:

Venous engorgement

D:

Hypertension

Q.141. Patient has complete ptosis in his right eye. Outwards and downwards, fixed & dilated pupils. Restricted ocular movements. What's the diagnosis?

A:

3 rd cranial nerve palsy

B:

4 th cranial nerve palsy

C:

3 rd and 4 th

D:

6 th cranial nerve palsy

Q.142. A 42 year old woman complainsof heavy bleeding and prolonged menstrual period. She is not planning for children at the moment as she already has 2 children. She smokes 20 cigarettes a day. What is the most appropriate management?

A:

Tranexamic acid

B:

Combined oral contraceptive pills

C:

Mefenamic acid

D:

Levonorgestrel intra-uterine system

Q.143. What is the best diagnostic tool in acute diverticulitis?

A:

CT

B:

Barium enema

C:

Colonoscopy

D:

Sigmoidoscopy

Q.144. 50 year old female with breast cancer and CA125 elevated. What is the cause?

A:

Breast cancer

B:

Associated with ovarian cancer

C:

Colon cancer

D:

Normal variation

Q.145. A 79 year old man was seen in the memory clinic as an outpatient. On his mental state examination, he was noted to be disengaged, expressing boredome as well as making inappropriate comments to the doctor of a sexual nature. What is the most likely diagnosis?

A:

Alzheimer’s disease

B:

Huntington’s disease

C:

Frontotemporal dementia

D:

Cerebrovascular accident

Q.146. Case of asymptomatic woman with trichomoniasis. What will you do?

A:

Treat if symptomatic

B:

Treat if she is pregnant

C:

Treat her anyway

D:

Self limiting

Q.147. What's the most commonly affected organ in blunt abdominal trauma?

A:

Liver

B:

Spleen

C:

Kidney

D:

Intestine

Q.148. Common cause of Acute Otitis media in all age groups?

A:

H influenza

B:

Streptococcus pneumoniae

C:

Staphylococcus aureus

D:

Pseudomonas

Q.149. What is the treatment of opioid toxicity?

A:

Naloxone

B:

N-Acetylcysteine

C:

Gastric lavage

D:

None

Q.150. Known risk factors for suicide include all the following EXCEPT?

A:

Repeated attempts at self injury

B:

Male sex

C:

Symptoms of depression with guilt

D:

Try to find out the cause of suicide

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MOCK TEST 2

Q.1. 32 year old lady works as a file clerk developed sudden onset of low back pain when she was bending to take the files, moderately severe of 3 days duration. There is no evidence of nerve root compression. What is the appropriate action?

Q.2. Family went to a dinner party after 6 hours they all had symptoms of abdominal pain, nausea, vomiting and dehydration. Some of them recovered while others needed hospitalization. What’s the most likely organism?

Q.3. Many harmful bacteria produces toxins. Which one of the following is used in amiddirs?

Q.4. A 50 year old lady presents with a sudden onset of severe occipital headache associated with neck pain and vomiting. CT brain was inconclusive and a lumbar puncture was performed which revealed xanthochromia. What is the best likely diagnosis?

Q.5. An 18 year old male who was involved in an RTA had fracture of the base of the skull. O/E he had loss of sensation of the anterior 2/3 of the tongue & deviation of the angle of mouth. Which nerve is affected?

Q.6. Male patient presents with prostatitis (history suggested prostatitis), culture showed gram negative rods. What is the drug of choice?

Q.7. 30 years old man presented with upper abdominal pain and dyspepsia. Which of the following doesn’t support the diagnosis of peptic ulcer?

Q.8. The strongest type of epidemiological studies is?

Q.9. 25 year old male complaining of scaly lesions in his chest, which turns hypopigmented. History of spending his time near to sea since last 2 months. On examination showed hypopigmented lesions over chest & arms. What's the diagnosis?

Q.10. A case of hypothyroidism on thyroxin, TSH high. What is the appropriate next step?

Q.11. Patient presents with high blood pressure (systolic 200), tachycardia, Mydriasis (Dilated pupils), sweating. Symptoms indicate toxicity of which drug?

Q.12. Surgery in C3 colon cancer is?

Q.14. In a patient with anaphylactic shock, all are correct treatment, EXCEPT?

Q.15. A 7 year old boy fell on his outstretched arm and presents with pain around the elbow. On examination, radial pulse is absent on the affected hand. What is the most likely diagnosis?

Q.16. What's the management for a pregnant lady with negative antibodies for rubella and measles?

Q.17. A 26 year old woman presents to her GP with a headache, photophobia and a fever. On examination, a generalized rash that does not blanch on pressure was observed. What is the most appropriate initial management?

Q.18. Patient needs CS but the patient refuses to do CS. What will you do?

Q.20. What is the most specific test for syphilis?

Q.21. What is the best early sign to detect tension pneumothorax?

Q.23. Which gross motor development is seen at age of 6 months?

Q.24. A 43 year old chronic alcoholic stopped drinking alcohol for the last 3 days. He is anxious, has tremors and is now having hallucinations. His heart rate is 106 beats/minute. What is the most appropriate treatment?

Q.26. A 75 year old male presents with enlarged cervical nodes. He has several recurrrent infections over the year. His conjunctiva is pale and he feels weak. What is the most likely cell type to be found on a blood smear of this patient?

Q.27. A 33 year old woman with 3 previous normal vaginal deliveries is diagnosed with stress incontinence. She has tried pelvic floor exercises and lifestyle modifications but they have not been successful. Her BMI is 29. What is the most appropriate management?

Q.28. Which of following increases during pregnancy?

Q.29. 20 year old man involved in RTA brought to ER by his friends. On examination, found to be conscious but drowsy. HR 120/min, BP 80/40. What is the MOST urgent initial management measure is?

Q.30. Patient is 22 years old with unilateral headache. What is the likely diagnosis?

Q.31. Pregnant lady came to antenatal clinic for routine checkup, her Glucose tolerance test was high. Diagnosed as gestational DM. What's the management?

Q.32. What does Henoch-Scholein purpura affect?

Q.33. A 34 year old woman developed a purpuric rash on the back of her legs. She also reports frequent nose bleeds and menorrhagia. A blood count shows: Haemoglobin 119 g/L White cell count 6.8 x 109/L Platelets 59 x 109/L What is the most likely diagnosis?

Q.34. What is the management of breast engorgement?

Q.35. Which organism in cat bite predisposes to skin infection?

Q.37. What is the inheritance type of Adult polycystic kidney disease?

Q.38. What is the most serious complication of acute pancreatitis?

Q.40. What is seen in Primary hyperaldosteronism?

Q.41. A heavy smoker comes to ask you about his risks of cancer apart from lung cancer. What will you tell him?

Q.42. The first line treatment of panic disorder is?

Q.44. Man who received blood transfusion back in 1975 developed jaundice, he most likely has?

Q.45. Child ingested acoustic material, looks ill and is drooling. What is your immediate action?

Q.46. A 79 year old man was seen in the memory clinic as an outpatient. On his mental state examination, he was noted to be disengaged, expressing boredome as well as making inappropriate comments to the doctor of a sexual nature. What is the most likely diagnosis?

Q.48. A 26 year old woman presents with a “fishy” vaginal discharge. On examination, a homogeneous grey-white vaginal discharge is seen. Vaginal pH is 5.8. What is the most appropriate management?

Q.50. At what distance should you stand to read the Snellen's Chart?

Q.51. Child with DM came with picture of DKA, which HLA is responsible?

Q.52. Which of the following diseases is NOT transmitted by mosquitoes?

Q.53. What is Physician's carelessness termed as?

Q.54. What is questionnaire used to differentiate between sleep apnoea and snoring?

Q.56. Middle aged male is involved in RTA, his RR is 30/min, heart sounds are muffled & the JVP is elevated. BP: 80/40 & has a bruise over the sternum. What is the diagnosis?

Q.57. A 5 year old boy was brought to his GP with a temperature of 38.8 C and numerous pruritic vesicles on his chest and back. They appear in circular crops and initially started on his face before spreading to his chest and back. What is the most appropriate management?

Q.58. A 66 year old patient wakes up with slurred speech and right sided weakness. He is brought to the hospital by his wife. A computed tomography was ordered and shows a cerebral infarction. What is the most appropriate treatment to be given?

Q.59. What could cause painful vision loss?

Q.60. Old lady came to clinic as routine visit, she mentions of decreased intake of calcium food. Doctor suspects osteoporosis. What is the next appropriate investigation to confirm?

Q.61. All of the following drugs are contraindicated in G6PD deficiency, EXCEPT?

Q.62. Newborn brought with red patch on left shoulder. What's the diagnosis?

Q.64. What is the injection that is routinely given to new-born to inhibit haemorrhage?

Q.65. 23 year old female presented with jaundice. Lab findings of hyperbilirubinemia, normal examination. Investigation shows total bilirubin= 3.1, direct bilirubin= 0.4. What's the most likely diagnosis?

Q.66. Which of the following increases the quality of the randomized controlled study & makes it stronger?

Q.67. Female with atypical squamous cells of undetermined significance (ASCUS) on pap smear, started 30 day treatment with estrogen & told her to come back after 1 week but is still +ve on pap smear. What will you do next?

Q.68. A 3 week old baby boy presented with a scrotal mass that was transparent & non reducible. What is the diagnosis?

Q.69. Patient known case of IDDM, presented with DKA, K= 6 mmol/L and blood sugar= 350 mg/dl. How will you manage?

Q.70. Type 1 diabetic, what is the target HbA1C?

Q.71. What is the drug of choice of generalized anxiety disease?

Q.72. A 41 year old man presents with visual symptoms and a headache. An ophthalmoscopic examination shows papilloedema. Which anatomical site is most likely to be affected?

Q.73. How will you treat a human bite?

Q.74. What is the agent of choice in reversing heparin induced life threatening bleeding?

Q.75. All are primary prevention of anaemia except?

Q.76. A 38 year old female, 32 weeks pregnant presents with thick white marks on the inside of her mouth for 3 weeks. Her mouth including her tongue appears inflamed on examination. She smokes 20 cigarettes a day despite advice to quit. What is the most likely diagnosis?

Q.77. Young male healthy, comes for routine examination he is normal except enlarged thyroid gland without any symptoms. What is the next step?

Q.78. A 45 year old known hypertensive man presents with tiredness, lethargy, fluid retention and proteinuria. His albumin levels are low. What is the most definitive diagnostic test?

Q.79. A young female patient who is an office worker presented with itching in the vagina associated with the greenish-yellowish vaginal discharge. Examination revealed red spots on the cervix. What is the diagnosis?

Q.80. You are supposed to keep a child NPO. He's 25 kgs. How much fluids will you give?

Q.81. Female underwent abdominal operation she went to physician for check ultrasound which reveals metal clip (10 cm) inside abdomen (missed during operation). What will you do?

Q.83. A 55 year old HIV man presents with painless peripheral lymphadenopathy, fever, night sweats and weight loss. Abdominal examination reveals an enlarged spleen. What is the most likely diagnosis?

Q.85. Female patient did urine analysis which shows epithelial cells. What is the source?

Q.86. Old patient with crampy abdominal pain, nausea, vomiting and constipation but no tenderness. What is the diagnosis?

Q.87. Mother complains of sharp pain on radial styloid process when carrying her baby. The pain increases with extension of the thumb against resistance, Finkelstein test was positive. What is the diagnosis?

Q.88. Which one of these patients with pneumonia will you treat as outdoor patient?

Q.89. A 48 year old man who has been taking medications for asthma for several years has now presented with decreased vision on his right eye. He complains of glare especially during the night. What SINGLE medication is most likely to cause his visual deterioration?