Nash Qbank

Q.1. A 45-year-old man presents to the clinic with bilateral ptosis and weakness of the proximal upper and lower limb muscles. Physical examination is normal except for a positive simpson test. Edrophonium test is performed that shows transient improvement in the ptosis [see report]. Chest X-ray - normal. Which of the following would be the most suitable treatment?

A:

Rivastigmine

B:

Pyridostigmine

C:

Physostigmine

D:

Echothiophate

Q.2. A patient with hypothyroidism on 0.025 mg of L-thyroxin, complains of fatigue, cold intolerance, & weight gain (see lab result). Blood pressure 120/60 mmHg; Heart rate 57/min; Respiratory rate 16/min; Temperature 36.6 degree C. Test result normal values: TSH 19.9 mU/L 0.4-6.5 mU/L. Which of the following is the most appropriate treatment?

A:

Increase L-thyroxin and check TSH in 6weeks

B:

Increase L-thyroxin and check TSH in 3 weeks

C:

Decrease L-thyroxin and check TSH in 6 weeks

D:

Decrease L-thyroxin and check TSH in 3weeks

Q.3. A 60-year-old diabetic patient presents for follow-up. Currently, the patient takes metformin that maintains fasting blood glucose lower than 5.5 mmol/L with HbA1c level of 5.8%. Physical exmination is normal, including a lower extremity neurologic examination. The patient has regular eye exams that shows no signs of retinopathy. Blood pressure 149/90mmHg (Three readings);Heart rate 76/min; Respiratory rate 18/min; Temperature 36.6 degree C. which of the following is the most appropriate management?

A:

No change in therapy

B:

Add ACE inhibitor

C:

Add beta-blocker

D:

Add sulfonylurea

Q.4. An individual who has received all 3 doses of hepatits B vaccine and has never had hepatitis B virus infection. Which of the following serologic markers is expected to be positive?

A:

HBcAb

B:

HBsAb

C:

HBeAb

D:

HBeAb and HBsAb

Q.5. A 28-year-old woman presents with a painful neck swelling for the last week. The swelling has been increasing over time. She has a sore throat and difficulty in swallowing. She has frequent bowel motions. On physical examinations, there is a diffuse tender anterior neck swelling and both hands show a fine tremor (see lab results). Blood pressure 140/90 mmHg; Heart rate 105/min;Resrpiratory rate 18/min;Temperature 38.1 degree C; Test result normal value: Thyroxine (T4 free) 26.4 8.5-15.2 pmol/L; Thyroid-Stimulating Hormone 0.03 0.4-5.0 micro U/L; ESR 58 3-15 mm/h. Which of the following is the most appropriate treatment?

A:

Prednisone

B:

Methimazole

C:

Propythiouracil

D:

Radioactive iodine

Q.6. A 15 year old boy presents with fever and pain in the right lower thigh. The pain has been ongoing for the past one month. On examination, there is a 2 cm by 2 cm mass at the lower third of his thigh which is red, warm and tender. An X-ray shows bone destructionwith overlying onion-skin layers of periosteal bone formation and a soft tissue mass. What is the most likely diagnosis?

A:

Tuberculous arthritis

B:

Ewing’s sarcoma

C:

Osteosarcoma

D:

Osteomyelitis

Q.7. A 53-year-old woman presents to the outpatient department. she has been unwell for 6 months with arthralgia, fever, weightloss, and more recently has developed pleuritic chest pains. She also has synovitis of the small joints of the hands. There were no rashes or nail fold infarcts. Heart sounds are normal (see lab results and reports). Blood pressure 110/70 mmHg;Heart rate 70/min; Respiratory rate 18/min; Test result normal values: Hb 89 120-160 g/L; WBC 3.2 3-10.5 X 109/L;Platelets count 99 150-400 x 109/L; Neutrophils 80 40-60%; Lymphocytes 17 20-40%;MCV 90 80-85 fl;C-reactive peptide 99<8.2 mg/L; ESR 56 3-15 mm/h; Clotting time 7 5-10 min;Ferritin 920 22-340 microg/L; ANA 1:320=1:40;Pulmonary Angiography CT: Confirms a small left pleural effusion. There is no consolidation, pulmonary embolus and no lymphadenopathy. ECG: Sinus tachycardia. Which of the following is the most likely diagnosis?

A:

Infective endocarditis

B:

Adult-onset still's disease

C:

Systemic lupus erythematosus

D:

Rheumatoid arthritis with vasculitis

Q.8. A 31 year old female with known gallstones undergoes a cholecystectomy. Unfortunately, she continues to have pain, and her liver function tests suggest an obstructive jaundice. An ERCP is performed which demonstrates a calculus lodged in the second part of the duodenum. What is the most likely place that the stone was lodged?

A:

Hepatic duct

B:

Cystic duct

C:

Accessory pancreatic duct

D:

Hepatopancreatic ampulla

Q.9. A 70-year-old man, with no past medical history, presents to the Emergency Department 4 hours after the onset of severe crushing substernal chest pain radiating to the neck and left arm (see report). Electrocardiography: Significant ST- segment elevation in leads I, AVL,V5, & V6. Where is the most likely site of cardiac infarction?

A:

Inferior

C:

Lateral

D:

Posterior

Q.10. A 28-year-old patient presents with a history of 10-day of palpitations, sweating and neck discomfort (see lab results). Blood pressure 110/70 mmHg; Heart rate 116/min; Respiratory rate 18/min; Temperature 37.7 degree C; Oxygen saturation 95% on room air;Test result normal values: Thyroxine (T4 free) 76.5 8.5-15.2 pmol/L; Thyroid stimulating Hormone 0.15 0.4-5.0 micro U/L; WBC 5.2 4.5-10.5X109/L; ESR 73 2-10m/h. Which of the following is the most likely diagnosis?

A:

Grave's disease

B:

Subacute thyroiditis

C:

Hashimoto's thyroiditis

D:

Multinodular toxic goitre

Q.11. A 33 year old woman who recently came from India has a nodular patch on both her shins which is reddish brown. The nodules are slightly raised above the surrounding skin. She also has a fever and feels unwell. What is the most probable diagnosis?

A:

Lupus vulgaris

B:

Erythema nodosum

C:

Pyoderma gangrenosum

D:

Erythema marginatum

Q.12. A 45-year-old man is diagnosed with type 2 diabetes 3 months ago, and started on metformin 500mg TDS, comes for his first follow-up (see lab results). Blood pressure 125/75 mmHg; Heart rate 80/min;Test Result Normal Values: Glucose, fasting 7.4 3.5-6.5 mmol/L; Creatinine 125 44-115 micromol/L;HbA1C 6.8 4.7-5.6%. Which of the following investigations is recommended to assess his renal function annually?

A:

Serum creatinine

B:

Urine microalbumin

C:

Urine albumin/creatinine ratio

D:

Estimated glomerular filtration rate

Q.13. A 38 year old male was rushed to Accident & Emergency after his wife foiund him unconscious on the floor of his home. Initial evaluation of the patient revealed severe dehydration, hypotension, tachycardia and a body temperature of 39°C. Blood tests done in A&E revealed hyponatraemia, hyperkaleimia and hypoglycaemia. His wife mentions that he had been diagnosed with Addison’s disease a few yeaers ago. Following resuscitation with normal saline, what is the other treatment that you should give this patient?

A:

5% glucose infusion

B:

0.45% normal saline

C:

100 mg intravenous hydrocortisone

D:

Intravenous potassium

Q.14. A 60-year-old patient complains of irritability, heat intolerance and recent onset of heart palpitations. The neck examinations is normal (see lab results). Test result normal values: Thyroid-stsimulating hormone 0.1 0.4-0.5 micro U/L; Thyroxine (T4 free) 30.4 8.5-15.2 pmol/L; Triiodothyronine (T3 free) 9.5 3.5-6.5 pmol/L. Which of the following is the most likely diagnosis?

A:

Sick euthyroid syndrome

B:

Primary hypothyroidism

C:

Thyrotoxicosis

D:

T3 Toxicosis

Q.15. A 23-year-old pregnant patient complaints of irritablity and sweating. On examination, She is thin and appears anxious. Her thyroid gland is nodular, diffusely enlarged, but not tender. She has brisk deep tendon reflexes. Her uterus is appropriate for gestational age (see lab results and report). Blood pressure 115/70 mmHg; Heart rate 110/min; Respiratory rate 12/min;Temperature 37.1 degree C; Test result normal values: thyroid stimulating hormone 0.1 0.4-5.0 micro U/L; Antithyroid Antibody negative negative; Thyroid ultrasound: Diffuse nodular enlargement. No cyst identified. Which of the following is the best next step in managemnet?

A:

Thyroid biopsy

B:

Radioactive iodine

C:

Subtotal throidectomy

D:

Anti-thyroid medication

Q.16. A 26-year-old woman presents for pre-marital counselling (see lab results). Test result normal values: Hb 110 120-160 g/L; HCT 0.33 0.37-0.48; MCV 67 80-95 fl; Hb A2 4.5<3.5% Sickling negative. Which of the following is the most likely diagnosis?

A:

Beta Thalassemia minor

B:

Beta Thalassemia major

C:

Sickle Beta thalassemia

D:

Beta Thalassemia intermedia

Q.17. A 71-year-old man comes to the outpatient clinic with difficulty walking and a hand tremor at rest for the last 3 months. There is no history of trauma or past illness. General exaination reveals an expressionless face, slow and slurred speech, and a hand tremor at rest. There is no sensory abnormality but the motor system showed brisk reflexes and hepertonia. The gait is quick, with short steps and diminished associated movements, such as no arm swinging. Which of the following is the most probable location of the defect?

A:

Cerebellum

B:

Frontal lobe

C:

Lateral ventricle

D:

Substantia nigra

Q.18. A 21 year old man isbrought into A&E semi-conscious by his friends. They were at a party and have been drinking alcohol when they found him unconscious in a corner. He is groaning and unable to give any information to the doctors. During the initial evaluation, his respiratory rate is 17/min and pulse rate is 88 bpm, BP is 110/70 mmHg, pupils are responsive. His Glasgow Coma Scale (GCS) score is 11/15. What is the most appropriate next course of action?

A:

Computed tompography of head

B:

Magnetic resonance imaging of head

C:

Check blood glucose

D:

Check body temperature

Q.19. A-60-year-old man presents to the Emergency Department with epigastric pain radiating to the back. He is a smoker and has long-standing diabetes and hypertension. Abdominal examination reveals a pulsatile supra-umbilical mass. Which of the following is the most likely diagnosis?

A:

Abdominal aortic aneurysm

B:

Secondary liver metastasis

C:

Renal cell carcinoma

D:

Peri-umbilical hernia

Q.20. A 72-year-old man presents to the emergency department with fever, night sweating and cough for 2 weeks. Which of the following is the most appropriate immediate action?

A:

Bronchoscopy

B:

Send sputum for Acid fast bacilli

C:

Isolate in a single, negative pressure room

D:

Appointment in outpatient clinic after 2 weeks

Q.21. A 38-year-old man is unable to lose weight despite being on an intensive lifestyle management plan of a low calorie diet and exercise (see lab results). Blood pressure 145/95 mmHg;Heart rate 80/min; Height 173; Weight 125 kg; Test result normal values: Glucose fasting 7.1 3.5-6.5 mmol/L; HbA1C 8.1 4.7-5.6%. Which of the following is the most appropriate advice to reduce weight?

A:

Bariatric surgery

B:

Intesify exercise

C:

Further reduce calories in diet

D:

Weight reducing medications

Q.22. A 30-year-old man presents with a history of increased urine output, especially during the night and increased thirst for the past 2 months (see report). Water deprevtion test: Serum osmolality above normal without adequate concentration of urine osmolality; no response to desmopressin administration. Which of the following is the most likely diagnosis?

A:

Nephrogenic diabetes insipidus

B:

Surreptitious diuretic abuse

C:

Central diabetes insipidus

D:

Hysterical polydipsia

Q.23. A 22 year old woman who was diagnosed with a missed miscarriage a week ago now presents to the hospital because of abdominal pain. She says she passed a small fetus and a number of clots this morning. On examination, abdomen is tender, and cervical os is opened. A transvaginal ultrasound scan shows products of conception still present in the uterus. What is the single most likely diagnosis?

A:

Threatened miscarriage

B:

Inevitable miscarriage

C:

Incomplete miscarriage

D:

Complete miscarriage

Q.24. A 55-year-old women presents with sudden left eye visual loss for 20 minutes. The vision returned to normal after this episode. History reveals, she has diabetes mellitus. The physical examination is normal. Blood pressure 125/75 mmHg; Hea rate 75/min;Respiratory rate 16/min;Temeprature 37.2 degree C.Which of the following is most likely diagnosis?

A:

Multiple sclerosis

B:

Retinal detachment

C:

Conversion disorder

D:

Transient ischemic attack

Q.25. A 28 year old woman complains of recurrent attacks of vertigo and nausea that last around 30 minutes to a few hours. They occur several times a year. Between attacks she is asymptomatic. She also reports a mild hearing loss in the left ear. What is the SINGLE most appropriate treatment?

A:

Aspirin

B:

Metoclopramide

C:

Cyclizine

D:

Clotrimazole

Q.26. A 50-year-old woman with major depression, complains of excessive urination and thirst for 2 months. She had a right mastectomy 1year ago. 3 months before, lung metastases was diagnosed. The physical examination is normal except for the surgical scar (see lab results). Blood pressure 115/75 mmHg; Heart rate 80/min; Respiratory rate 16/min; Temperature 37.1 degree C. Test result normal values: Sodium 150 134-146 mmol/L; Potassium 3.8 3.5-5.1 mmol/L;Urea 6.7 2.75-7.4 mmol/L; 24 Urine analysis Test result normal values; Osmolality 110 280-910 mOsm/kg H2O. Which of the following is the most likely diagnosis?

A:

Diabetes insipidus

B:

Adipsic hypernatremia

C:

Psychogenic polydipsia

D:

Syndrome of inappropriate Antidiuretic Hormone Secretion

Q.27. A 60-year-old woman with congestive heart failure complains of shortness of breath for 3 months. It is precipitated by daily activity at home. The shsortness of breath awakened her several times at night. Her medication included fosinopril, cardivelol and furosimide. On examination, there is bilateral basilar crepitation (see report). Echocardiogram: There is dialted left ventricular chamber. The left ventricular ejection fraction is 30%. The blood pressure 125/80 mmHg; Heart rate 60/min; Respiratory rate 16/min;Temperature 37.1 degree C. Which of the following drugs is indicated?

A:

Aspirin

B:

Amlodipin

C:

Spironolactone

D:

Isosorbide dinitrate

Q.28. A 36-year-old man has recently been found to have high blood pressure. Both his parents and 2 sisters also have high blood pressure. Physical examination is normal (see lab results). Blood pressure 160/100 mmHg; Heart rate 84/min; Height 173 cm; Weight 78 kg;Test Result Normal Values: Creatinine 138 44-115 micro mol/L; Glucose, fasting 5.1 3.5-6.5 mmol/L; Urine analysis protein 2+ negative. Which of the following is the most appropriate therapy?

A:

Diuretic

B:

Beta blocker

C:

ACE inhibitor

D:

Alpha blocker

Q.29. A-77-year-old woman with poorly controlled long-standing type 2 diabetes and hypertension is complaining of dizziness when standing up rapidly. Current medications include aspirin, atenolol, insulin, metformin, and multivitamins. Sitting: Blood pressure 140/85 mmHg, Standing: Blood pressure 115/80 mmHg; Heart rate 95/min (unchanged on standing);Respiratory rate 18/min; Temperature 36.6 degree C. Which of the following is the most likely explanation?

A:

Hypoglycemia

B:

Medication side effect

C:

Autonomic neuropathy

D:

Left ventricular dysfunction

Q.30. What is the immunological status of a patient with negative HBsAg, positive anti-HBC & positive anti-HBs?

A:

Immune due to hepatitis B vaccination

B:

Immune due to natural infection

C:

Chronically infected

D:

Acutely infected

Q.31. A 60 year old man had a myocardial infarction 2 weeks ago. He now presents with dyspnoea and pleuritic chest pain. A pericardial friction rub was noticed on examination. ECG shows widespread ST elevation. A chest x-ray shows an enlarged, globular heart. His pulse rate is 95 beats/minute and his respiratory rate is 24 breaths/minute. What is the most likely cause of his symptoms?

A:

Cardiac tamponade

B:

Mitral regurgitation

C:

Dressler’s syndrome

D:

Atrial fibrillation

Q.32. A 35-year-old women comes to the clinic complaining of infertility for 3 years. She notices excessive breast milk production for 4 months. The physical examination is unremarkable (see lab results and report). Blood pressure 130/80 mmHg; Heart rate 80/min;Respiratory rate 18/min;Temperature 37.2 degree C. Test Result Normal Values: Thyroxine (T4 free) 12.4 8.5-15-2 pmol/L;Prolactin 1452<870 pmol/L. Brain MRI: Well defined pituitary mass about 0.7 cm, which represent an adenoma. Which of the following is the most appropriate traetment?

A:

Surgery

B:

Cabergoline

C:

Observation

D:

Radiotherapy

Q.33. Which of the following findings in the urine would indicate diabetic nephropathy in type 2 diabetes?

A:

Hematuria

B:

Proteinuria

C:

Hyaline casts

D:

Red blood cells casts

Q.34. A patient with atrial fibrillation is on warfarin 5 mg daily, the latest INR is 7.0 on routine evaluation. There is no evidence of abnormal bleeding. Which of the following is the most appropriate action?

A:

Increase warfarin to 7.5 mg daily

B:

Decrease warfarin to 2.5 mg daily

C:

Continue with same dose of warfarin

D:

Hold warfarin and repeat INR next day

Q.35. A 29-year-old woman presents to the emergency deartment complaining of being unable to sleep flat for the last 2 nights due to difficulty in breathing. She has just delivered 1week earlier. Physical examination confirms a lately displaced apex beat and the presence of a third heart sound. The jugular veins were distended and bilateral lung crackles could be easily heard. Which of the following is the most likely diagnosis?

A:

Peripartum cardiomyopathy

B:

Pulmonary embolism

C:

Myocardial infarction

D:

Pneumonia

Q.36. A 61-year-old woman has had type 2 diabetes for 12 years. She takes insulin and does not smoke. she was recently started on enalapril 10mg daily for hypertension but could not tolerate it because of a cough (see lab results). Blood pressure 160/95 mmHg; Hear rate 84/min; Test Result Normal Value: Creatinine 142 44-115 micro mol/L; 24 Urine analysis: Test Result Normal Values: Creatinine clearance 66 100-140 mL/min; 24-hour urine protein 1500 0-150 mg/24 hr. Which of the following is the most appropriate therapy?

A:

Beta blocker

B:

Thiazide diuretics

C:

Calcium channel blocker

D:

Angiotensin receptor blocker

Q.37. A 26 year old mountain biker was rescued after being trapped under heavy rocks for almost 12 hours. His urine is dark and urine is positive for blood on dipstick. His heart rate is 120 bpm and systolic blood presure is 100 mmHg. Lab results show a creatinine of 35 micromol/L and urea of 15 mmol/L. What is the most appropriate management?

A:

Dialysis

B:

Intravenous normal saline

C:

Intravenous dextroes

D:

Intravenous KCl

Q.38. A-55-year-old diabetic & hypertensive patient presents with a history of bilateral intermittent leg pain brought on by walking for 300 meters and releived by rest. What is the most likely diagnosis?

A:

Varicose vein

B:

Diabetic foot infection

C:

Peripheral neuropathy

D:

Peripheral arterial disease

Q.39. A 55 year old man on anti-hypertensives develops hyperkalaemia. What is the most likely anti-hypertensive drug to cause it?

A:

Nifedipine

B:

Indapamide

C:

Bendroflumethiazide

D:

Enalapril

Q.40. A 25-year-old patient is diagnosed with diabetic ketoacidosis (see lab results). Blood pressure 80/50 mmHg; Heart rate 140/min; Respiratory rate 26/min; Temperature 36.6 degree C. Test Result Normal Values: Random Glucose 52.7 3.9-5.5 mmol/L; Potassium 6 3.5-5.1 mmol/L; Bicarbonate 5 21-28 mmol/L. Which of the following is the best initial management?

A:

Dopamine drip to raise blood pressure above 90mm/Hg

B:

2L of normal saline with Kcl 20 mEq/L intravenously

C:

20-unit regular insulin intravenously, followed by 5% dextrose in water at 200 mL/h

D:

Normal saline 2L as an intravenous bolus and insulin intravenous infusion at 0.1 U/kg/hr

Q.41. A 55-year-old man with a family history of type 2 diabetes undergoes screening (see lab results). Blood pressure 130/85 mmHg; Heart rate 80/min;Height 185 cm; Weight 91kg; Test result normal values: Glucose, fasting 7.4 3.5-6.5 mmol/L; Hemoglobin A1C 6.3 4.7-5.65%. Which of the following should be recommended?

A:

Random plasma glucose

B:

Haemoglobin A1C after 6 weeks

C:

Fasting plasma glucose after 3months

D:

2-hour 75 g oral glucose tolerance test

Q.42. A 75-year-old type 2 diabetic undergoes a bowel resection for colon cancer. He is well prior to the operation with well-controlled diabetes and no other underlying condition. The operation is successful and the patient is given postoperative insulin and IV dextrose. 2days after the operation he becomes very agitated (see lab results). Test result normal values: sodium 124 134-146 mmol/L; Potassium 3.2 3.5-5.1 mmol/L; Creatinine 80 44-115 micromol/L; Blood urea nitrogen 4.6 2.8-8.9 mmol/L;Serum osmolality 270 280-300 mmol/kg;24 Urine analysis; Test result normal values: Osmolality 310 280-910 mOsm/kg H2O. Which of the following is the most likely cause?

A:

Water overload

B:

Addison's disease

C:

Diabetic nephropathy

D:

Inappropriate anti-diuretic hormone

Q.43. A-55-year-old patient presents to the clinic with leg pain brought on by walking and relieved by rest. The patient reports a history of many years of smoking. Physical examination confirms loss of hair over the lower shins as well as dystrophic nails. An ankle-brachial index 0.80. Which of the ollowing is the most likely diagnosis?

A:

Lumbar disc prolapse

B:

Deep vein thrombosis

C:

Chronic limb ischemia

D:

Chronic venous insufficiency

Q.44. An 55-year-old man presents to the emergency department with continuous retrosternal chest pain.An ECG was obtained. Which of the following is most likely diagnosis?

A:

Anterior wall ST-elevation MI

B:

Inferior wall ST-elevation MI

C:

Acute coronary syndrome with unstable angina

D:

Acute Non-ST-elevation MI

Q.45. 60-year-old patient presents to the hospital, complaining of a sudden onset of chest pain radiating to the back. The blood pressure is low in the left arm and the femoral pulse is not palpable (see report). Chest X-ray: A left plural effusion. ECG: Left ventricular hypertrophy. Which of the following is most likely to confirm the diagnosis?

A:

Echocardiography

B:

Cardiac isoenzymes

C:

Aortic CT angiography

D:

Complete blood count

Q.46. Which of the following is a recognized side effect of furosemide in congestive heart failure?

A:

Hypokalemia

B:

Bronchospasm

C:

Hypoglycemia

D:

Haemolytic anemia

Q.47. A 46-year-old man recovering from an acute MI 1-days ago. He develops a sharp pian behind the sternum which is made worsen by coughing. The patient gets relief when sitting forward. On examination,a scratchy superficial sound is heard at the left sternal edge, and heart sounds are muffled. There is ascites and a 2cm raised JVP is confirmed. Which of the following ECG changes would most likely be found?

A:

Atrial fibrilation

B:

Sinus tachycardia

C:

Diffuse ST elevation

D:

Prlonged PR interval

Q.48. A-35-year-old woman presents with bilateral leg deep vein thrombosis. She has a history of recurrent still births (see lab results). Test Result Normal Values: APTT 55 30-40 sec. Which of the folllowing is the most likely diagnosis?

A:

Antiphospholipid syndrome

B:

Antithrombin deficiency

C:

Protein S deficiency

D:

Protein C deficiency

Q.49. A 66 year old man presents to the hospital with palpitations. An ECG taken shows atrial fibrillation. He has no history of any ischaemic heart diseases. His blood pressure is 110/70 mmHg, heart rate is 130 beats/minute and respiratory rate is 20 breaths/minute. He looks sweaty on examination. His chest is clear clinically on auscultation. What is the most approprite management?

A:

Adenosine

B:

Metoprolol

C:

Electrical cardioversion

D:

Amiodarone

Q.50. A 73-year-old man comes to the primary Health Care Clinic with severe shortness of breath at night and swelling of the ankles. He has reduced his activity over the past year because of chest pain when he exerts himself. Physical examinations confirms crackles over both lungs, enlargement of the liver, pitting edema of the ankles. ECG, cardiac enzmes and blood electrolytes are normal. Blood pressure 140/90 mmHg; Heart rate 95/min; Respiratory rate 24/min; Temperature 36.6 degree C. Which of the following is the most appropriate to be included in immediate management?

A:

Digoxin

B:

Atenolol

C:

Furosemide

D:

Hydrochlorothiazide

Q.51. A 22 year old woman thinks she is overweight. She has a body mass index of 21.8 kg/m2. She often has constipation and abdominal pain. She eats uncontrollably and feels guilty resulting in a self-induced vomiting. Sometimes to compensate for her big meal, she would exercise intensively. What is the most likely diagnosis?

A:

Anorexia nervosa

B:

Pituitary tumour

C:

Hypothyroidism

D:

Bulimia nervosa

Q.52. A 16 year old girl was brought to Accident and Emergency with the complaint of sudden loss of consciousness. This occurred while shopping with her mother a few hours ago. The episode lasted for less than a minute followed by full recovery. There was no head injury. The mother informed the staff that her daughter had not eaten anything for the last four days because she is extremely fanatic about losing weight. She began a strict diet and exercise regimen to lose weight a few months ago. Her mother appears distressed as she has tried everything to get her daughter to eat, but to no avail. The patient herself is adamant that she is fat and that her goal is to lose weight until she is 35 kg. The patient has no past medical history of note and is not taking any regular medications. On examination, the patient was found to be sweaty and wearing a baggy dress. Weight 49 kilgrams Height 165 centimetres BMI 18 kg/m2 Capillary blood glucose 2.1 mmol/L It was proposed that the patient be admitted but when the subject was broached to the patient, she began to scream and demanded to be released. What is the best treatment option in this patient?

A:

Compulsory admission

B:

Refer for cognitive behavioural therapy

C:

Refer to psychiatrist as outpatient

D:

Seek legal advice

Q.53. A 43-year-old patient man presents with headache and neck stiffness (see reports). CSF Analysis: Appearance cloudy; Glucose low; Protein high; White cells 100/mm3 (70% polymorphs);CT Brain: Normal. Which of the following is the most likely cause of the infection?

A:

Cryptococcal

B:

Tuberculous

C:

Bacterial

D:

Viral

Q.54. A-60-old year patient with a previous ischemic stroke presents with a regular narrow complex tachycardia. The patient is a haemodynamically stable. The decision is made to administer IV adenosine. In the presence of which of the following should the dose of adenosine be reduced?

A:

Theophylline

B:

Dipyridamol

C:

Chronic renal failure

D:

Significant mitral regurgitation

Q.55. A 60 year old man has right upper quadrant discomfort. He has lost 10 kg in the last 4months. On examination, a palpable liver with nodularities was found. Three years ago,he had a right hemicolectomy for a colorectal cancer. What is the mostappropriate tumour marker to investigate?

A:

CA 125

B:

CA 15-3

C:

CA 19-9

D:

Carcinoembryonic antigen (CEA)

Q.56. Half of a group of observations lies above this level and it is particularly important if the distributions are not normal. What is the SINGLE most likely term?

A:

Chi-square test

B:

Linear regression

C:

Mean

D:

Median

Q.57. A 6 year old boy presents with a fever, cough and a sore throat. On examination, the tonsils are erythematous but without any exudates. There are no palpable lymphadenopathy. He had 3 similar episodes last year which were self limiting. He has a temperature of 38.3°C. The diagnosis of tonsillitis is given. What is the most appropriate treatment for this child?

A:

Tonsillectomy

B:

Paracetamol

C:

Oral penicillin

D:

Oral amoxicillin

Q.58. A 62 year old IV drug abuser is brought into the emergency department with complaint of fever, shivering, malaise, shortness of breath and productive cough. Around 8 days ago he developed symptoms consistent with a flu-like illness. Initially there was an improvement in his condition but deteriorated over the past three days. He now has a temperature of 39 C, a pulse of 110 beats/minute, a blood pressure of 100/70 mmHg and a respiratory rate of 22 breaths/minute. A chest x-ray shows bilateral cavitations. What is the most likely causative organism?

A:

Mycoplasma pneumoniae

B:

Staphylococcus aureus

C:

Chlamydia pneumoniae

D:

Eschericia coli

Q.59. A 22-year-old man presents with altered sensorium for the last 2days and headaches for 5 days, with a history of fever for the preceding month. On examination, there is nuchal rigidity (see lab results). Test result normal values: Hb 100 130-170 g/L; WBC 11 4.5-10.5 X 109/L; Glucose, fasting 7.22 3.5-6.5 mmol/L; Cerebrospinal fluid: Test result normal values: Appearance turbid clear; Cells 240 0-3/microL; Total protein 3.6 0.22-0.33 g/L; Glucose 2.7 2.50-3.89 mmol/L; Neutrophils 23 0-1%; Lymphocytes 73 0-1%. Which of the following is the most likely diagnosis?

A:

Septicemia

B:

Tubercular meningits

C:

Phylogenetic meningitis

D:

Viral meningoencephalitis

Q.60. An-81-year-old diabetic presents to the clinic with a recent onset of redness of the skin on the left lower extremity. The redness worsens when the leg is in a dependent position. On examination, pedal pulses in the left leg are diminished. The leg is cold and there is no tenderness on palpation. Which of the following is the most likely diagnosis?

A:

Cellulitis

B:

Necrotizing fasciitis

C:

Arterial insufficiency

D:

Superficial thrombophlebitis

Q.61. A 6 year old girl has had 2 short episodes of cough and wheeze over the last 12 months. These 2 acute episodes responded quickly to bronchodilator. She has no symptoms or abnormal physical signs at the moment. She has slight eczema and her mother has a history of asthma when she was young. What is the most appropriate investigation?

A:

Chest X-ray

B:

Peak flow rate diary

C:

Pulse oximetry

D:

Spirometry

Q.62. A 45 year old woman has itchy, dry eyes. There is mild pain in the morning but worsens during the day. She says her eyes feel gritty especially in an air conditioning room. A Schirmer’s test was performed and results show 7 mm of moisture on the filter paper. What is the most appropriate management? (A normal Schirmer’s test is considered to have more than 10 mm of moisture on the filter paper)

A:

Cyclopentolate

B:

Steroids drops

C:

Hypromellose drops

D:

Topical ciclosporin

Q.63. A-58-year-old hypertensive patient presented with a 10-day history of a left-sided hemiparesis. The CT scan of the brain confirmed an area of infarction. There was no significant finding on a clinical examination apart from his hemiparesis. The patient had already started physiotherapy, and is taking 20mg lisinopril and hydrochlorothiazide once daily. Blood pressure 140/90 mmHg, Heart rate 76/min, Respiratory rate 18/min, Temperature 36.6 degree C, Oxygen saturation 95% on room air. Which of the following is the best management?

A:

Apixaban

B:

Warfarin

C:

Aspirin

D:

(T-PA1) Tissue plasminogen -1

Q.64. A-67-year-old man is brought to the Emergency Department by his family with confusion and a decreased level of consciousness. The family reported his being feverish and feeling unwell for 2 dyas that was also associated with diarrhoea and poor oral intake. The patient has bronchial asthma, hypertension and an old myocardial infarction. He has not been able to take his regular medications for 2 days due to the acute illness. On examination, the JVP is not visible, heart sounds are normal, no cardiac murmurs and lungs are clear with no rhonchi or crepitation. The patient's extremities are cold and peripheral pulses feeble(see report). Blood pressure 83/45 mmHg;Heart rate 120/min [regular]; Respiratory rate 20/min; Oxygen Saturation 95% (room air); ECG: Sinus tachycardia and evidence of an old inferior myocardial infarction. Which of the following is the most appropriate next step in management?

A:

IV boluses of normal saline

B:

Intravenous beta blockers

C:

Nasogastric tube feeding

D:

Dopamine infusion

Q.65. A 40-year-old man presents to the clinic complaining of numbness of the feet for 1month. He was diagnosed with pulmonary tuberculosis 4 months ago. He has been taking isoniazid and rifampin and has 2 moths of treatment remaining. He has well controlled diabetes mellitus for the last 3 years. The physical examination is normal. Blood pressure 110/70 mmHg, Heart rate 80/min;Respiratory rate 18/min;Temperature 37.7 degree C. Which of the following drugs should be given?

A:

Thiamine

B:

Pyridoxine

C:

Vitamin B12

D:

Amitriptyline

Q.66. A 72-year-old patient with a 20-year history of non-insulin dependent diabetes mellitus, but wit no history of angina pectoris or other significant vascular disease. The patient has never been occasions, with the readings remaining the same. Blood pressure 170/105 mmHg; Heart rate 76/min; Respiratory rate 18/min; Temperature 36.6 degree C; Oxygen saturation 95% on room air. Which of the following treatments should be prescribed?

A:

Calcium-channel blocker

B:

Thiazide diuretics

C:

ACE inhibitor

D:

Beta blocker

Q.67. A 45-year-old patient is recently diagnosed with hypertension and begins taking lisinopril but then develops a persistent cough. Which of the following drugs should be prescribed instead of lisinopril?

A:

Atenolol

B:

Enalopril

C:

Losartan

D:

Nifedipine

Q.68. A 20-year-old woman comes to the medical outpatient department with a large swelling in the front of her neck that she had for the last 3years. She also complains of excessive sweating, occasional palpitations, and for the last month, the inability to stay in the kitchen for a long period. She has lost weight despite having a good appetite and intake. The examinations of the swelling in her neck showed a soft, nodular mass measuring 8x15 cm with an audible bruit. Regional lymph nodes are not palpable (see lab results). Blood pressure 130/85mmHg; Heart rate 110/min; Respiratory rate 20/min; Temperture 37.0 degree C; Test result normal values: Thyroxine (T4 free) 20.2 8.5-15.2 pmol/L; Thyroid stimulating Hormone 0.1 0.4-0.5 microU/L; Hb 140 120-160 g/L. Which of the following is the most appropriate management for palpitations?

A:

Ipodate

B:

Propranolol

C:

Methimazole

D:

Propylthiouracil

Q.69. A 55-year-old man had a MI 6days before. He suddenly develops dyspnoea,cough and frothy sputum. For the first time a harsh systolic murmur is heard over the pericardium. Which of the following is the most likely cause of this development?

A:

Ruptured aortic cusp

B:

Pulmonary embolism

C:

Tricuspid regirgitation

D:

Ruptured papillary muscle

Q.70. A 30-year-old overweight man presents to the general physician with 6-month of intermittent epigastric burning pain. He has also noted that for the past 2 onths he has been experiencing episodes of nausea, an unpleasant taste in the mouth, hoarseness, and a nocturnal cough. Which of the following is the most likely diagnosis?

A:

Peptic ulcer

B:

Atypical angina

C:

Chronic cholelithiasis

D:

Gastroesophageal reflux disease

Q.71. Which of the following is located at the level of the first lumbar vertebra (L1)?

A:

Mcburney’s point

B:

Stellate ganglion

C:

Deep inguinal ring

D:

Transpyloric plane

Q.72. A 4 year old boy is referred by the GP to the paediatrician with a cervical lymphadenopathy that is 2 cm in size. His mother says that she thinks the lymph node is growing. It was first noticed 6 weeks ago. The child is generally well with no complaints of tenderness. He has no history of fever. On examination, the spleen is not palpable and there are no other palpable lymph nodes around the body. The cervical lymph node is firm, non-tender and immobile. His throat is clear with no signs of infection. What is the most appropriate initial investigation to perform?

A:

Full blood count and blood film

B:

Ultrasound of lymph node

C:

Lactate dehydrogenase

D:

Liver function test

Q.73. A 42-year-old woman presents with tiredness and lethargy. She has tingling in her hands and feet. Investigations confirm a megaloblastic anemia. She had a total gastrectomy 3 years ago. Which of the following vitamin deficiencies is most likely to cause these symptoms?

A:

B1

B:

B2

C:

B6

D:

B12

Q.74. A 35-year-woman comes to the clinic complaining of severe "pin and needles" sensations on the dorsum of her left hand over parts of the thumb, index and middle fingers. History reveals, she works as a typist. On physical examination, the patient has weakness of wrist dorsiflexion and fingers extension. Which of the following nerves is most likely to be injured?

A:

Axillary

B:

Median

C:

Radial

D:

Ulnar

Q.75. A 26-year-old woman has become increasingly tired for the past 2months. During the past week she has noted purple blotches on her skin. On physical examination, there are petechial haemorrhages on her trunk and extremities (see lab results). Test result normal values: Hb 72 120-160 g/L; HCT 0.22 0.37-0.48; MCV 92 80-95 fl; WBC 1.5 4.5-10.5 X 109/L;Platelet count 10 150-400 x 109/L. Which of the following is the most likely diagnosis?

A:

Aplastic anaemia

B:

Sickel cell anemia

C:

Haemolytic anemia

D:

Iron deficiency anemia

Q.76. A 40-year-old man presents to the doctor with a hsitory of central weight gain, Change in facial appearance, poor libido, easy bruising and back pain. Examination reveals pigmentation of the skin, a buffalo hump, edema, proximal muscle wasting, and an elevated blood pressure. Which of the following is the most likely diagnosis?

A:

Cushing's disease

B:

Adrenal adenomas

C:

Adrenal carcinomas

D:

Alcohol-induces pseudo-cushing's syndrome

Q.77. A-52-year-old man was diagnosed in the Emergency Department with an acute inferior wall MI. An intavenous morphine bolus and IV nitroglycerine infusion were administered for severe on-going chest discomfort, 20 minutes later, and while preparing the patient for a primary percutaneius coronary intervention, his condition became worse. His JVP at this time was elevated and his lungs were clear. Initial Emergency Department Record: Blood pressure 120/70 mmHg; Heart Rate 90/min (regular); Respiratory rate 22/min; Oxygen saturation 96% (room air); 30 minutes later: Blood pressure 75/40 mmhg;Heart rate 105/min (regular). Whic of the following is the most likely cause of the hypotesion?

A:

Cardiac tamponade

B:

Complete heart block

C:

Papillary muscle rupture

D:

Right ventricular infarction

Q.78. A-40-year-old man is brought to the emergency department with progressive difficulty in breathing. History reveal, he is being treated for bronchogenic carcinoma. On examination, the JVP is elevated; lungs clear and heart sounds are very quiet. Blood pressure88/50 mmHg;Heart rate 125/min (regular), Respiratory rate 24/min; Temperature 36.8 degree C. Which of the following is the most appropriate test to confirm the diagnosis?

A:

Chest X-ray

B:

Echocardiogram

C:

Electrocardiogram

D:

Arterial blood gases

Q.79. An 85 year old war veteran complains of loss of appetite and says that he has lost weight over the past few months. He says that he has passed some blood in his urine however, there was no pain. He finds it difficult to empty his bladder completely and complains of having to urinate more often than usual. He also states that he has worsening pelvic pain over the past 3 months. A recent report shows that PSA is 9.5 ng/ml. What is the most likely reason for his symptoms?

A:

Benign prostatic hyperplasia

B:

Renal cell carcinoma

C:

Bladder stones

D:

Prostate cancer

Q.80. A patient has presented with a 2cm solid thyroid nodule on the ultrasound. Which of the following is the best next step in the management?

A:

Repeat the ultrasound after 6months

B:

Thyroid scan with iodine

C:

Fine needle aspiration

D:

CT neck

Q.81. A 17 year old boy is brought into the Emergency Department unconscious following a road traffic accident. What is the SINGLE most appropriate action?

A:

Resuscitate without consent

B:

Wait for relatives to consent before beginning resuscitation

C:

Inform health authorities as situation is complicated

D:

Seek judicial review instructions

Q.82. A 70-year-old patient has a sudden onset of pain in the left lower limb. The pain is severe and associated with numbness. The patient had an acute MI 2weeks before and was discharged 24 hours before this presentation. The left leg is cold and pale, the right leg is normal. Which of the following is the most likely diagnosis?

A:

Acute arterial thrombosis

B:

Acute arterial embolus

C:

Deep vein thrombosis

D:

Dissecting aneurysm

Q.83. A 30-year-old man comes to the outpatient clinic because of the recent development of the marked peripheral oedema. He hhas no significant past medical history. On examnination, he has 4+ edema of the lower extremities (see lab results and reports). Blood pressure 105/80 mmHg; Test result normal values:Albumin 18 34-56 g/L; Urea 5 2.8-8.9 mmol/L; Creatinine 85 44-115 micro mol/L; Dipstick analysis: 4+proteins. Urinalysis: Oval fat bodies, and some hyaline casts and occassional RBCs. Which of the following is the most likely diagnosis?

A:

Interstitial nephritis

B:

Nephritic syndrome

C:

Nephrotic syndrome

D:

Ischemic nephropathy

Q.84. A 55-year-old man with family history of type 2 diabetes undergoes screening. he gives the history of polyuria (see lab results). Blood pressure 130/85 mmHg; Heart rate 80/min;Height 185 cm; Weight 91kg; Test result normal values: Glucose,fasting 7.0 3.5-5.5 mmol/L; Haemoglobin A1C 7.1 5.7-6.4%. Which of the following is the mot likely diagnosis?

A:

Prediabeties

B:

Type 2 diabetes

C:

Impaired glucose tolerance

D:

Mature onset diabetes of youth

Q.85. A 30-year-old woman with controlled hypothroidism comes for follow up. She had been using thyroxin 175 mcg but the dose was increased 3 months ago to 200 mcg. Physical examination is normal (see lab results). Blood pressure 130/80 mmHg; Heart rate 80/min; Respiratory rate 18/min; Temperature 37.2 degree C. Test result normal values: Thyroxine (T4 free) 12.4 8.5-15.2 pmol/L; Thyroid stimulating hormone 17.2 0.4-5.0 micro U/L. What is the most likely explanation for these lab findings?

A:

Small dose

B:

Ectopic thyroid

C:

Poor medication adherence

D:

Secondary hypothyroidism

Q.86. A 67 year old female who was initially admitted to hospital for hip replacement surgery is incidentally found to be confused and drowsy by the ward nurse. The ward nurse also discovers that she has been receiving a continuous infusion of 5% dextrose in sodium chloride 0.45% intravenously since her admission into hospital. The fluid was immediately stopped following this discovery and bloods were taken for a test. Laboratory values show: Sodium 120 mmol/L Potassium 4.8 mmol/L Urea 6.2 mmol/L Creatinine 89 micromol/L Bicarbonate 23 mmol/L Chloride 100 mmol/L What is the most likely cause of this patient’s symptoms?

A:

Osmotic shrinkage of the brain

B:

Cerebral oedema

C:

Cerebral demyelination

D:

Cytotoxicity

Q.87. A 45-year-old patient presents to the clinic with a 3 month history of stumbling, weak grip, dysphagia and generalized weakness, and also had 2 episodes of aspiration pneumonia in the last 2 months. Examination confirms brisk reflexes, spastic muscles and fasciculation of the tongue and thigh. Which of the following is the most likely diagnosis?

A:

Mononeuropathy

B:

Myasthenia gravis

C:

Myasthenic syndrome

D:

Motor neuron disease

Q.88. A 25 year old man has a burning sensation in his left eye for the last 2 days. His eye is red and has thick purulent discharge. His lids are often stuck shut on waking. What is the most appropriate initial management?

A:

Oral antibiotic

B:

Oral antihistamine

C:

Topical antibiotics

D:

Clean discharge using cotton wool soaked in water

Q.89. A 70-year-old patient presents with a 6-month history of decline in cognitive capacity and conscious level. On examination, the patient has bradykinesia, resting tremors, a mask like face, and a shuffling gait. Which of the following is the most likely diagnosis?

A:

Parkinson disease

B:

Tardive dyskinesia

C:

Alzheimer disease

D:

Huntingtin's disease

Q.90. A 65-year-old patient presents with 2hours of chest pain that feels like indigestion. In the past medical history, hypertension has been diagnosed, but no evidence of MI or angina. This emergency department does not have facilities for a percutaneous transluminal angioplasty (see report). Blood pressure 170/94mmHg; Heat rate 104/min; Respiratory rate 18/min; Temperature 36.6 degree C; Oxygen saturation 95% on room temperature; ECG- ST segment elevation in the anterolateral leads. Which of the of the following is the most appropriate initial intervention?

A:

ASA, Streptokinase, nitroglycerine, beta blockers

B:

ASA, streptokinase, heparin, beta-blockers

C:

Nitroglycerin, ASA,heparin, beta-blockers

D:

ASA, streptokinase, beta-blockers

Q.91. A-15-year-old boy presents to the clinic for an annual physical assessment. The patient has normal growth and development and is able to do usual activites. His elder brother died due to a sudden cardiac death while walking to work. On physical examination, there is no cardiac murmur. Pulses are equal in all extremities. Which condition must be excluded before any sport is allowed?

A:

Bicuspid aortic valve

B:

Patent ductus arteriosus

C:

Ventricular septal defect

D:

Hypertrophic cardiomyopathy

Q.92. A 13 year old girl has mucosal bleeding and petechial rashes. She has been feeling tired lately. She looks pale. A blood count shows: Haemoglobin 74 g/L White cell count 1.9 x 109/L Neutrophils 0.1 x 109/L Platelets 24 x 109/L Blood film morphology was unremarkable. Reticulocytes are absent. A bone marrow aspirate shows a gross reduction in all haematopoietic tissue that is replaced by fat spaces. What is the most likely underlying diagnosis?

A:

Pernicious anaemia

B:

Chronic myeloid leukaemia

C:

Aplastic anaemia

D:

Acute myeloid leukaemia

Q.93. A 72-year-old patient is evaluated for mid-thoracic back pain. The patient does not smoke cigarettes and rarely drinks alcohol. The only medications taken are aspirin, calcium supplements, and a multivitamins. Very few diary products are consumed. On physical examination, the patient has a mild dorsal kyphosis with mild tenderness over the mid and lower thoracic regions (see lab results).Test result normal values: Thyroid stimulating Hormone 8.2 0/4-5.0 micro U/L; Calcium 2.45 2.15-2.62 mmol/L; Albumin 35 34-56 g/L;Alkaline phosphatase 290 39-117 U/L; T- score (bone mineral spine L1-4) - 1.9>-1; T-score (Bone mineral Total hip)-2.1>-1; Urine analysis: Test result normal values: Urine calcium 5.1<7.5 mmols/day; X-ray Spine: Compression fractures at T8,L2 & L3. Which of the following is the most likely diagnosis?

A:

Paget's disease

B:

Osteomalacia

C:

Osteoporosis

D:

Osteopenia

Q.94. Which of the following agents has been shown to reduce mortality in patients with congestive heart failure?

A:

Digitalis

B:

Enalapril

C:

Furosemide

D:

Procainamide

Q.95. A 45-year-old woman comes to the clinic for a follow-up. She was started on levothyroxine for treatment of hypothyroidism 2 weeks before (see lab result). Test result normal value: TSH 7.5 0.4-6.5 mU/L. Which of the following would be the best treatment plan?

A:

Same dose, check TSH level in 1 to 2 months

B:

Reduce dose, check TSH level in 1 to 2 months

C:

Reduce dose, check TSH level in 48 to 72 hours

D:

Stop treatment untill TSH normal, and then restart

Q.96. A 29 year old man has developed a red, raised rash on his trunk after playing football. The rash is becoming increasingly itchy over the past few hours and has now spread to his arms. His past medical history includes asthma which was diagnosed when he was 7 years old. What is the most appropriate management?

A:

Oral chlorpheniramine

B:

Oral amoxicillin

C:

IM adrenaline

D:

Nebulized salbutamol

Q.97. A-40-year old woman presents to emergency department with vomiting and generalized abdominal pain. She does not know her medications. She states her that her vision has been slightly yellow tinged recently [see image].Blood pressure 90/50 mmHg, Heart rate 60/min, Respiratory rate 16/min, Temperature 37 degree C. Which of the following is the most likely diagnosis?

A:

Myocardial infarction

B:

Digoxin toxicity

C:

Hypokalemia

D:

Hypothermia

Q.98. A 42 year old female presents to you with the concern of ovarian cancer. She has two older sisters who have both been diagnosed with ovarian cancer and she is worried that she may have ovarian cancer as well. A pelvic ultrasound was carried out as part of investigating her symptoms of menorrhagia a month ago and was unremarkable. What is the next best step in management of this patient?

A:

CA 125 level

B:

Genetic counselling

C:

Abdominal ultrasound

D:

Computed tomography scan of the pelvis and abdomen

Q.99. A-52-year-old man comes to the clinic for a checkup. He has hypertension for 5 years is currently being treated with hydrochlorothiazide 25mg/day (see lab results). Blood pressure 155/101 mmHg, Heart rate 84/min,Test Normal Values: Sodium 141 134-146mmol/L, Potassium 4.1 13-5.1 mmol/L, Creatinine 105 44-115 micromol/L, Glucose, fasting 7.3 3.5-6.5mmol/L. Which of the following is most appropriate manaement modification?

A:

Add a beta blocker

B:

Add a calcium channel blocker

C:

Double the hydrochlrothiazide dose

D:

Add an angiotensin converting enzyme inhibitor

Q.100. A 45-year-old man was being investigated for hypertension. He was prescribed a drug for his lipid disorder but returned 1week later with intense face flushing after taking the tablet prescribed. He was then adviced to tkae a full dose of aspirin 3 times daily instead of a low dose once daily. This gave complete relief (see lab results).Test at first visit, Tset result normal values: Cholesterol (HDL) 0.72<1.03 mmol/L; Cholesterol (LDL) 5.30<3.36 mmol/L; Total cholesterol 6.12<5.1 mmol/L; Triglycerides 2.20<2.16 mmol/L. Alanine aminotransferase 35 5-40 IU/L;Creatinine kinase 205 24-194 IU/L. Which of the following drugs was he prescribed?

A:

Niacin

B:

Clofibrate

C:

Atrovastatin

D:

cholestyramine

Q.101. A 22 year old man presents with a 2 month history of diarrhoea. He says his bowels have not been right for the past few months and he frequently has to run to the toilet. These symptoms seemed to be improving up until two weeks ago and for the past week, he notices the presence of blood when he passes stool. On examination, there are aphthous oral ulcers. He has not lost any weight and has a good appetite. Examination of his abdomen demonstrates mild tenderness in the left lower quadrant but no guarding. What is the most likely diagnosis?

A:

Ulcerative colitis

B:

Crohn’s disease

C:

Infective diarrhoea

D:

Colorectal cancer

Q.102. A 34 year old woman requests for sterilization. Her last born child has cerebral palsy. Her husband strongly objects to the procedure. She has considered all other modes of contraception but has decided on sterilization. What is the most appropriate action?

A:

Perform a mental capacity assessment

B:

Proceed with patient wishes and carry out sterilization

C:

Seek judicial review instructions

D:

Referral to social services

Q.103. A 32 year old female smoker has a history of wheeze, shortness of breath and fever. Her past medical history includes eczema. FEV1/forced vital capacity (FVC) was measured and was found to be low. This was improved after taking bronchodilators. What is the most likely diagnosis?

A:

COPD

B:

Infective exacerbation of asthma

C:

Tuberculosis

D:

Bronchiectasis

Q.104. A 52 year old known diabetes mellitus presents to the Emergency Department with a sudden onset of pain in the left loin and haematuria. An ultrasound scan shows a 7 mm stone in left lower ureter. Diclofenac was administered for the renal colic pain and nifedipine and prednisolone was prescribed as initial treatment as part of an expulsive therapy. He returns to the emergency department the following day with worsening pain, vomiting and a history of having passed two stones. A repeat ultrasound scan reveals hydronephrosis in the left ureter and the presence of stones. His renal function test indicate an acute kidney injury. He has a heart rate of 100 beats/minute and a temperature of 38.5 C. What is the most appropriate management?

A:

Repeat a similar regimen

B:

Administer an alpha blocker

C:

Extracorporeal shock wave lithotripsy

D:

Percutaneous nephrostomy

Q.105. A 55-year-old woman has had type 2 diabetes for the past 20 years. She is on an 1800 kcal/day diet and takes metformin 850 mg 3 times a day (see lab results). Blood pressure 130/85mmHg; Heart rate 80/min;Test result normal values: Glucose fasting 7.1 3.5-6.5 mmol/L; HbA1C 7.8 4.7-5.6%. What should be the target Harmoglobin A1C percentage?

A:

<5.0

B:

<5.5

C:

<6.0

D:

<7.0

Q.106. A 40-year-old man with Gastroesophageal reflux disease presents to the general physician with 3-month history of intermittent retrosternal burning pain, worse on bending, nausea, regurgitation with an unpleasant taste in the mouth, and a nocturnal cough. The patient has been using over the counter antacids with no relief. Which of the following is the most appropriate course of action?

A:

Surgery

B:

Antibiotic

C:

Lifestyle modification

D:

Proton pump inhibitors

Q.107. A 58 year old man has renal colic for the past 12 hours. In the last two years, he has presented with three episodes of acute onset of pain in his right knee. What is the most likely cause of his renal colic?

A:

Systemic lupus erythematosus associated glomerulopnephritis

B:

Hypercalcaemia

C:

Hyperuricaemia

D:

Chlamydia trachomatis

Q.108. A 32-year-old patient is having repititive generalized seizures that continue for 35 minutes. The patient received 20 mg of diazepam intravenously, but there has been no response.Which of the following is the best next step in management?

A:

Phenytoin IV

B:

Phenobarbital IV

C:

Ethosuximide orally

D:

Carbamazepine orally

Q.109. A 60-year-old an is admitted to the coronary care unit with an acute MI. His hameodynamic parameters 2 hours later are: Blood pressure 80/50 mmHg; Heart rate 40/min; Respiratory rate 18/min; Temperature 36.6 degree C; Oxygen saturation 95% on room air. Which of the following would be the appropriate management?

A:

IV 0.6 mg atropine sulphate

B:

Normal saline infusion

C:

IV isoproterenol

D:

IV dobutamine

Q.110. A 65-year-old woman is brought to the emergency department of a tertiary care hospital with rapid onset shortness of breath and left shoulder and arm ache. Blood pressure 100/50 mmHg; Heart rate 90/min;Respiratory rate 25/min; Temeperature 36.9 degree C. Which of the following is the most appropriate treatment after the initial emergency department management?

A:

Low molecular weight heparin

B:

Reperfusion with streptokinase

C:

Thrombolytic therapy with t-PA

D:

Primary coronary artery stenting

Q.111. A 55 year old smoker presents to the emergency department with complaint of severe left leg and foot pain that began earlier in the day. The pain spreads to the level just above the inguinal ligament. His past medical history includes hypertension. On examination, he has atrophic skin changes in his left leg and his left limb is cold to touch. He has no palpable pulses in the left lower extremity. Gross motor and sensory functions were intact in the symptomatic leg and foot. What is the most likely occluded artery?

A:

Left femoro-popliteal artery

B:

Left common iliac artery

C:

Aortoiliac artery

D:

Left femoral artery

Q.112. 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.113. A 44-year-old woman comes to her physician as she is unable to close her left eye. There is a facial asymmetry, when she smiles and inability to wrinkle the left side of her left forehead. Which of the following nerves is mostly?

A:

Ophtalmic

B:

Maxillary

C:

Facial

D:

Optic

Q.114. A group of patients with atherosclerosis are followed forward over a period of time to investigate the outcome according to exposure to different factors. It started with 2 groups free of disease and followed forward for a period of time. What is the most likely study design?

A:

Prospective cohort study

B:

Restroscpective cohort study

C:

Case-control study

D:

Randomized controlled study

Q.115. A 40-year-old man presents to the emergency department after fainting while exercising. He reports past episodes of the chest pain, which have occured both at rest and with exercise. On examination of the chest there is II/IV systolic ejection murmur heard at the left sternal border. Which does not radiate. The intensity of the murmur increases when the patient bears down or stands up. The lung fields are clear (see report). Blood pressure 125/75 mmHg; Heart rate 110/min;Respiratory rate 18/min;Temperature 36.6 degree C. ECG: Non-specific ST and T wave changes with left atrial enlargement. Which of the following is the most likely diagnosis?

A:

Aortic stenosis

B:

Pulmonic stenosis

C:

Restrictive cardiomyopathy

D:

Hypertrophic cardiomyopathy

Q.116. A 68 year old male patient is on Ramipril 10 mg daily and Bendroflumethiazide 2.5 mg daily for hypertension. He has come for his routine checkup with a blood pressure of 135/85 mmHg. His blood tests show: Serum potassium level 5.9 mmol/L Serum sodium 126 mmol/L Serum creatinine 79 micromol/L What is the most likely side effect of thiazide diuretics which contributed to his blood results?

A:

Hypocalcemia

B:

Hyponatraemia

C:

Hypouricaemia

D:

Hyperkaleimia

Q.117. A 26 year old primigravida pregnant woman at 34 weeks gestation presents with tingling and numbness with occasional pain of her right hand in addition to altered sensation over her right middle and index finger. Tinel test is negative. What is the most likely diagnosis?

A:

Carpal Tunnel Syndrome

B:

Radial nerve entrapment

C:

Scaphoid fracture

D:

Median nerve entrapment

Q.118. Which of the following drugs used in the treatment of chronic heart failure has been shown to increase survival?

A:

Digoxin

B:

Enalpril

C:

Furosimide

D:

Hydralazine

Q.119. A 35 year old woman presents to her GP’s office with the complaint of a lump in her left breast. She first noticed the mass two weeks ago in the shower and the patient says that she has not noticed whether the mass appears and disappears with the occurrence of her menses. The patient’s past medical history was insignificant and she claims that she is on no long term medication. Further questioning reveals that the patient has no further complaints of night sweats, weight loss or a fever and this is the first breast mass that she has noticed. She has no family history of breast cancer. On physical examination, it was revealed that a 2.5 cm by 1.5 cm mass is present in the left lower quadrant of her left breast. The mass was regular and firm in consistency and was non-tender and mobile. The skin over her left nipple appeared to be normal and no discharge from her left nipple could be appreciated. The rest of the breast examination was unremarkable with no enlarged lymph nodes palpated in her neck or axillary region. Examination of her right breast was unremarkable. Fine needle aspiration cytology (FNAC) was subsequently done. The results show duct-like epithelium surrounded by fibrous bridging. What is the most likely diagnosis?

A:

Fibroadenoma

B:

Firboadenosis

C:

Breast cancer

D:

Fat necrosis

Q.120. A 35-year-old woman complains of discomfort in both breast with milk production when expressed manually for a month. It has been associated with headache and low sexual interest. He has been married for 3 years and his wife has not been able to become pregnant. On examination, he has mild acne on his face (see lab results). Weight 97kg; Height 173 cm; Test result normal values: Thyroxine (T4 free) 8.4 8.5-15.2 pmol/L; Thyroid stimulating hormone 6.8 0.4- 5.0 micro U/L; Follicle stimulating hormone 5.8 5-20 IU/L; Luteinizing hormone 7.1 5-22U/L; Prolactin 2350<870 pmol/L. Which of the following is the most likely visual field defect?

A:

Junctional scotoma

B:

Bitemporal hemianopia

C:

Superior quadrantanopia

D:

Homonymous hemianopia

Q.121. A 10 year old boy is rushed to Accident & Emergency after his parents found him unconscious on the kitchen floor. It is revealed that he ingested some medication belonging to his grandmother. His grandmother was unable to identify which medications are missing. On examination, the child is hypotensive with dilated pupils and dryness in the mouth. His ECG showed prolongation of the PR, QRS, and QT intervals. Which most likely medication has he taken in excess?

A:

Amitriptyline

B:

Carbamazepine

C:

Digoxin

D:

Metoprolol

Q.122. A 45-year-old woman comes to the clinical complaining of episodes of pain with swelling and warmth of her hands and feet for the past 3 weeks. During these episodes, lasting hours to days, it is difficult for her to walk or to prepare meals. On physical examination, she has painful 1cm subcutaneous nodules on the extensor surfaces of her elbows. Over the next 6 years, her hands become deformed so that it is difficult to perform tasks as simple as opening a door or buttoning her blouse. Which of the following laboratory would confirm the diagnosis?

A:

HLA-B27

B:

ANA positive at 1:256

C:

Anti-CCP antibody positive

D:

Markedly decreased serum complement

Q.123. A 53 year old woman has complaints of vaginal dryness, hot flashes and night sweats for the past 6 months. Her last menstrual period was more than a year ago. She currently takes an ACE inhibitor as part of her management for her blood pressure. What is the most appropriate management for her symptoms?

A:

Raloxifene

B:

Hormone replacement therapy

C:

Progesterone only pill

D:

Topical oestrogen

Q.124. A neonate’s chest X-ray shows a double bubble sign. He has low set ears and a flat occiput. What is the most likely diagnosis?

A:

Down’s syndrome

B:

Fragile X syndrome

C:

Turner’s syndrome

D:

DiGeorge syndrome

Q.125. A 26-year-old man has been diagnosed with sarcoidosis 2 years before, he now presents with mild pallor (see lab results and report). Test result normal values: Hb 100 130-170 g/L; HCT 0.29 0.42-0.52; MCV 79 80-95 fl; WBC 7.5 4.5-10.5 x 109/L; Platelet count 200 150-400 x 109/L; Ferritin 915 22-561 ng/L; Haemoglobin electrophoresis: Normal. Which of the following is the most likely diagnosis?

A:

Sideroblastic anaemia

B:

Beta Thalassemia minor

C:

Iron deficiency anemia

D:

Anemia of chronic diease

Q.126. A 55-year-old man presents to the clinic with headaches and increased tiredness for the last 4 months. On physical examination he is afebrile and his spleen tip is palpable (see lab results and report). Test result normal values: Hb 200 130-170 g/L;HCT 0.67 0.42-0.52; MCV 93 80-95 fl; WBC 12 4.5-10.5 X 109/L;Platelet 420 150-400x1099/L;The serum erythropoietin: very low levels. Which of the following is the most likely diagnosis?

A:

Myelofibrosis

B:

Polycythemia rubra vera

C:

Congenital heart disease

D:

Essential thrombocythemia

Q.127. A-39-year-old man presents to the clinic with unexplained fever 19 days after an attack of acute rheumatic fever. Several of his teeth have been extracted prior to the hospital admission. Clinical examination confirms a systolic murmur and spleenomegaly(see lab results). Test Result Normal Values: WBC 14.0 4.5-10.5X109/L Neutrophils 72 40-60 %, Urinalysis: Test Result Normal Values: Erythrocytes 25 0-2 per HPF. Which of the following is the most likely diagnosis?

A:

Floppy mitral valve

B:

Bacterial endocarditis

C:

Acute myocardial infarction

D:

Recurrent rheumatic heart disease

Q.128. A 62-year-old man presents with recurrent retrosternal chest pain, which he said has become much worse over the last 3weeks. He describes the pai as lasting much longer than before and tat it occurs even while he is sitting in a chair or in a bed at night reading. Which of the following is the most likely type of angina?

A:

Unstable

B:

Heberden

C:

Exertional

D:

Prinzmetal

Q.129. A-38-year-old intravenous drug user presents with fever,night sweats, chest pain, and arthralgia. On examination, painless erythematous lessions noted on the palms of the hands, with round erythematous lesions and central clearing noted in the retina and splinter haemorrhage under the fingernails. Which of the following is the most likely diagnosis?

A:

Syphilis

B:

HIV Infection

C:

Infectious hepatitis

D:

Bacterial endocarditis

Q.130. A 44 year old HIV positive man complains of a two week history of worsening headache, facial weakness and visual hallucinations. He also reports new onset of eye pain. An MRI head reveals multiple ring shaped contrast enhancing lesions. What is the most likely causative organism?

A:

Cytomegalovirus

B:

Streptococcus

C:

Toxoplasma gondii

D:

Herpes simplex virus

Q.131. A 29-year-old woman comes to the emergency department with vomiting, profuse watery diarrhoea and abdominal cramps. It started within 4 hours of eating a steak in a local restaurant. Which of the following is the most likely cause?

A:

Escherichia coli

B:

Salmonella

C:

Campylobacter jejuni

D:

Staphylococcus aureus

Q.132. A 32-year-old woman complains that her menstrual cycle has stopped for the last 9months. She also has discomfort in both breasts with milk production when expressed manually. Her sexual drive has been decreased for the last year. She has been married for 3 years and faled to become pregnant. The physical examination is normal and pregnancy test is negative (see lab results). Weight 81 kg; Height 165 cm; Test result normal values: Thyroxine (T4 free)9.1 8.5-15.2 pmol/L; Thyroid Stimulating hormone 5.2 0.4-5.0 micro U/L; Follicle-stimulating hormone 5 5-20 IU/L; Luteinizing hormone 10 5-22 U/L; Prolactin 2450<870 pmol/L. Which of the following is the most appropriate investigation?

A:

Brain MRI

B:

Neck ultrasound

C:

Pelvis ultrasound

D:

Breast mammogram

Q.133. A 75-year-old man who has been followed up routinely for hypertension and type 2 diabetes mellitus was found to have an irregular pulse which was not found 6 months earlier. In addition to hypertension and diabetes, his past history confirms a previus transient ischemic attack. He is currently asymptomatic and is complaint with his medications (see report) ECG: Atrial fibrillation at rate of 70 beats per minute. Which of the following is the most appropriate management plan?

A:

Add digoxin to his current treatment regimen

B:

Pharmacological cardio-version to sinus rythm

C:

Start anticoagulation therapy to prevent stroke

D:

No further step is needed as he is asymptomatic

Q.134. A 26-year-old patient presents with a 6-month history of decreased libido and weak erections (see lab results) Test result normal values: Prolactin 2100<870 pmol/L; Follicle-stimulating hormone 12 5-20 IU/L; Luteinizing hormone 18 5-22 U/L. Which of the following is the next most useful investigation?

A:

Abdominal/ pelvic CT scan

B:

Fasting blood sugar

C:

Testosterone level

D:

Brain MRI

Q.135. A 60-year-old man presents with diminished pulses, angina and syncope with exercise. On physical examination, he has an ejection murmur radiating into the carotid arteries. Which of the following is most likely diagnosis?

A:

Aortic stenosis

B:

Pulmonary stenosis

C:

Mitral regurgitation

D:

Tricuspid regurgitation

Q.136. A 66-year-old woman has recently been found to have high blood pressure. she had a cholecystectomy 15 years ago and has osteoarthritis in the knees for which she uses ibuprofen (see lab results). Blood pressure 160/95 mmHg; Heart rate 84/min; Test result normal values: Creatinine 138 44-115 micromol; Sodium 142 134-146 mmol/L; Potassium 2.9 3.5-5.1 mmol/L; Chloride 100 97-108 mmol/L; Bicarbonate 31 21-28 mmol/L. Which of the following is the most likely diagnosis?

A:

Essential hypertension

B:

Pheochromocytoma

C:

Primary hyperaldosteronism

D:

NSAIDS induced hypertension

Q.137. A 60-year-old man presents to the emergency department with heavy retrosternal chest discomfort. The discomfort started 3days earlier as intermittent brief episodes whcih became more frequent ad prolonged over the last 24 hours. In the emergency department he experienced a similar type of discomfort (5/10 on the pain scale of 1-10) which responded well to sublingual nitrglycerine. Serial cardiac enzymes are normal (see report). ECG: An intial ECG showed ST segment depression of 0.2 mV in the antero-lateral chest leads, which later normlized completely. Which of the following is the most likely diagnosis?

A:

Unstable Angina

B:

Acute pericarditis

C:

Myocardial infarction

D:

Acute aortic dissection

Q.138. A-70-year-old man is brought to the clinic with an acute confessional state. On examination, he has postural hypotension and dry mucus membranes. Test Result Normal Value: Calcium 3.41 2.15-2.62 mmol/L. Which of the following is the most appropriate initial treatment?

A:

IV 0.9% Sodium chloride

B:

IV Sodium pamidronate

C:

Oral prednisolone

D:

IV Furosemide

Q.139. A 35 year old first time donor suddenly passes out as she is donating blood. She is not known to have any medical problems in the past. Which of the following steps would be the least useful in managing this adverse event?

A:

Ensure donor is adequately hydrated and has not skipped a meal

B:

Elevating the donor’s legs as this is usually due to a vasovagal syncope

C:

Ensure haemoglobin of the donor meets the minimum requirements for donation

D:

The donation is continued along with simultaneous normal saline infusion

Q.140. A 3 month old infant presents with recurrent infections and feeding difficulties. His face looks dysmorphic and has a cleft palate. A chest X-ray shows absent thymic shadow. What is the most likely diagnosis?

A:

Down’s syndrome

B:

Fragile X syndrome

C:

DiGeorge syndrome

D:

Marfan’s syndrome

Q.141. A 4 year old child is brought to your GP practice by her mother. She has painful crusted lesions on her face and neck, mostly localized around her mouth. Her face feels hot to the touch. She is other well. What is the most likely diagnosis?

A:

Contact dermatitis

B:

Impetigo

C:

Measles

D:

Chickenpox

Q.142. A-55-year-old man who is a heavy smoker is being evaluated for increasing bilateral lower limb swellings. Chest examinations confirms resonant lungs with reduced breath sounds and occasional rhonchi. The apex beat could not be easily located. No cardiac murmur is heard, but P2 is markedly loud. The JVP is elevated and bilateral pitting edema was confirmed. Which of the following is the most likely cause of the lower limb swelling?

A:

Liver cirrhossis

B:

Bilateral DVT

C:

Cor pulmonale

D:

Nephrotic syndrome

Q.143. A 55 year old woman presents to A&E with the complaint of aching chest pain. She is very nervous and anxious as she thinks that this could be a heart attack. She has no family history of cardiac disease and has no other medical problems. She was given sublingual GTN which has failed to relieve her symptoms. Upon further questioning, she admits that the pain is worse when she breathes in. Her chest X-ray is reported as ‘normal’ and an ECG is performed, which also shows no significant acute changes. Her vitals are as follows: Temperature: 37.2oC Heart rate: 110 beats/minute Blood pressure: 125/85 mmHg A full blood count has been done and shows: Haemoglobin: 12.8 g/dL Platelets: 320 x 109/L White chell count: 7.8 x 109/L CRP is 10.7 mg/L What is the most likely diagnosis in this patient?

A:

Costochondritis

B:

Pericarditis

C:

Acute coronary syndrome

D:

Unstable angina

Q.144. A 76 year old man suddenly collapsed and died. At postmortem exam, a retroperitoneal haematoma was found due to ruptured abdominal aortic aneurysm. What is the most likely underlying aetiology of the aortic aneurysm?

A:

Atheroma

B:

Cystic medial necrosis

C:

Marfan’s syndrome

D:

Polyarteritis nodosa

Q.145. A 44-year-old woman presents with a neck swelling for the last 2 months. It is associated with frequent bowel movement, increased appetite and weight loss. Over the last 6months, her period has stopped and she has noticed a discharge from her nipples. On physical examination, there is a small diffuse goiter. Pregnancy test is negative (see lab results). Blood pressure 120/75 mmHg; Heart rate 80/min; Respiratory rate 17/min; Temperature 37.1 degree C; Test result normal values: Thyroxine (T4 free) 19.5 8.5-15.2 pmol/L; Thyroid stimulating hormone 8.7 0.4-5.0 mU/L. Which of the following is the most appropriate radiological imaging?

A:

Pituitary MRI

B:

Thyroid ultrasound

C:

Ovarian ultrasound

D:

Best mammogram

Q.146. A 28-year-old woman developed gestational diabetes during her second pregnancy. She gave birth to a healthy baby 6 months ago. There is a strong family history of type 2 diabetes and now wants to be evaluated for diabetes (see lab results). Height 166 cm; Weight 91 kg; Test result normal values: Glucose fasting 6.5 3.5-6.5 mmol/L; HbA1C 5.5 4.7-5.6%; WHich of the following is the most appropriate therapy?

A:

Insulin

B:

Acarbose

C:

Glyburide

D:

Metformin

Q.147. A 65-year-old patient presents with a 3-day history of seizures (see lab results). Test result normal values: Sodium 112 134-146mmol/L; Potassium 3.9 3.5-5.1 mmol/L; Urea 3.4 2.75-7.4 mmol/L;Serum osmolality 240 280-300 mmol/kg; Urine analysis; Test result normal values: Osmolality 860 280-910 mOsm/kg H20. Which of the following is the most likely diagnosis?

A:

Conn's syndrome

B:

Addison's disease

C:

Cushing's syndrome

D:

Inappropriate anti-diuretic hormone secretion

Q.148. A man on treatment for multiple sclerosis, presents with acute onset diplopia, atexia and weakness of the right hand (see report). MRI brain scan:New active lessions compared to previous scans. Which of the following is the best treatment for this development?

A:

Interferon

B:

I.V Corticosteroids

C:

I.V immunoglobulin

D:

oral corticosteroids

Q.149. A 30 year old man attends the GP surgery with pain at the base of his right first toe that started 5 days ago. On examination, there is swelling and redness of the surrounding the joint. He denies any fever. This is his first episode of pain at that area and there is no history of injury at that area. He has not taken any medication for pain relief. What is the most appropriate first line management?

A:

Naproxen

B:

Colchicine

C:

Allopurinol

D:

Corticosteroids

Q.150. A 28 year old man presents with a widespread maculopapular rash over his soles and palms. He also has mouth ulcers. He had a penile ulcer which healed six weeks ago. What is the most likely organism responsible?

A:

Mycoplasma genitalium

B:

Treponema pertenue

C:

Treponema pallidum

D:

Lymphgranuloma venereum

Hello,

Hello Doctor, Welcome!

Profile

MOCK TEST 4

Q.4. An individual who has received all 3 doses of hepatits B vaccine and has never had hepatitis B virus infection. Which of the following serologic markers is expected to be positive?

Q.11. A 33 year old woman who recently came from India has a nodular patch on both her shins which is reddish brown. The nodules are slightly raised above the surrounding skin. She also has a fever and feels unwell. What is the most probable diagnosis?

Q.16. A 26-year-old woman presents for pre-marital counselling (see lab results). Test result normal values: Hb 110 120-160 g/L; HCT 0.33 0.37-0.48; MCV 67 80-95 fl; Hb A2 4.5<3.5% Sickling negative. Which of the following is the most likely diagnosis?

Q.19. A-60-year-old man presents to the Emergency Department with epigastric pain radiating to the back. He is a smoker and has long-standing diabetes and hypertension. Abdominal examination reveals a pulsatile supra-umbilical mass. Which of the following is the most likely diagnosis?

Q.20. A 72-year-old man presents to the emergency department with fever, night sweating and cough for 2 weeks. Which of the following is the most appropriate immediate action?

Q.25. A 28 year old woman complains of recurrent attacks of vertigo and nausea that last around 30 minutes to a few hours. They occur several times a year. Between attacks she is asymptomatic. She also reports a mild hearing loss in the left ear. What is the SINGLE most appropriate treatment?

Q.30. What is the immunological status of a patient with negative HBsAg, positive anti-HBC & positive anti-HBs?

Q.33. Which of the following findings in the urine would indicate diabetic nephropathy in type 2 diabetes?

Q.34. A patient with atrial fibrillation is on warfarin 5 mg daily, the latest INR is 7.0 on routine evaluation. There is no evidence of abnormal bleeding. Which of the following is the most appropriate action?

Q.38. A-55-year-old diabetic & hypertensive patient presents with a history of bilateral intermittent leg pain brought on by walking for 300 meters and releived by rest. What is the most likely diagnosis?

Q.39. A 55 year old man on anti-hypertensives develops hyperkalaemia. What is the most likely anti-hypertensive drug to cause it?

Q.44. An 55-year-old man presents to the emergency department with continuous retrosternal chest pain.An ECG was obtained. Which of the following is most likely diagnosis?

Q.46. Which of the following is a recognized side effect of furosemide in congestive heart failure?

Q.48. A-35-year-old woman presents with bilateral leg deep vein thrombosis. She has a history of recurrent still births (see lab results). Test Result Normal Values: APTT 55 30-40 sec. Which of the folllowing is the most likely diagnosis?

Q.53. A 43-year-old patient man presents with headache and neck stiffness (see reports). CSF Analysis: Appearance cloudy; Glucose low; Protein high; White cells 100/mm3 (70% polymorphs);CT Brain: Normal. Which of the following is the most likely cause of the infection?

Q.54. A-60-old year patient with a previous ischemic stroke presents with a regular narrow complex tachycardia. The patient is a haemodynamically stable. The decision is made to administer IV adenosine. In the presence of which of the following should the dose of adenosine be reduced?

Q.55. A 60 year old man has right upper quadrant discomfort. He has lost 10 kg in the last 4months. On examination, a palpable liver with nodularities was found. Three years ago,he had a right hemicolectomy for a colorectal cancer. What is the mostappropriate tumour marker to investigate?

Q.56. Half of a group of observations lies above this level and it is particularly important if the distributions are not normal. What is the SINGLE most likely term?

Q.67. A 45-year-old patient is recently diagnosed with hypertension and begins taking lisinopril but then develops a persistent cough. Which of the following drugs should be prescribed instead of lisinopril?

Q.69. A 55-year-old man had a MI 6days before. He suddenly develops dyspnoea,cough and frothy sputum. For the first time a harsh systolic murmur is heard over the pericardium. Which of the following is the most likely cause of this development?

Q.71. Which of the following is located at the level of the first lumbar vertebra (L1)?

Q.73. A 42-year-old woman presents with tiredness and lethargy. She has tingling in her hands and feet. Investigations confirm a megaloblastic anemia. She had a total gastrectomy 3 years ago. Which of the following vitamin deficiencies is most likely to cause these symptoms?

Q.80. A patient has presented with a 2cm solid thyroid nodule on the ultrasound. Which of the following is the best next step in the management?

Q.81. A 17 year old boy is brought into the Emergency Department unconscious following a road traffic accident. What is the SINGLE most appropriate action?

Q.88. A 25 year old man has a burning sensation in his left eye for the last 2 days. His eye is red and has thick purulent discharge. His lids are often stuck shut on waking. What is the most appropriate initial management?

Q.89. A 70-year-old patient presents with a 6-month history of decline in cognitive capacity and conscious level. On examination, the patient has bradykinesia, resting tremors, a mask like face, and a shuffling gait. Which of the following is the most likely diagnosis?

Q.94. Which of the following agents has been shown to reduce mortality in patients with congestive heart failure?

Q.95. A 45-year-old woman comes to the clinic for a follow-up. She was started on levothyroxine for treatment of hypothyroidism 2 weeks before (see lab result). Test result normal value: TSH 7.5 0.4-6.5 mU/L. Which of the following would be the best treatment plan?

Q.102. A 34 year old woman requests for sterilization. Her last born child has cerebral palsy. Her husband strongly objects to the procedure. She has considered all other modes of contraception but has decided on sterilization. What is the most appropriate action?

Q.103. A 32 year old female smoker has a history of wheeze, shortness of breath and fever. Her past medical history includes eczema. FEV1/forced vital capacity (FVC) was measured and was found to be low. This was improved after taking bronchodilators. What is the most likely diagnosis?

Q.107. A 58 year old man has renal colic for the past 12 hours. In the last two years, he has presented with three episodes of acute onset of pain in his right knee. What is the most likely cause of his renal colic?

Q.108. A 32-year-old patient is having repititive generalized seizures that continue for 35 minutes. The patient received 20 mg of diazepam intravenously, but there has been no response.Which of the following is the best next step in management?

Q.113. A 44-year-old woman comes to her physician as she is unable to close her left eye. There is a facial asymmetry, when she smiles and inability to wrinkle the left side of her left forehead. Which of the following nerves is mostly?

Q.114. A group of patients with atherosclerosis are followed forward over a period of time to investigate the outcome according to exposure to different factors. It started with 2 groups free of disease and followed forward for a period of time. What is the most likely study design?

Q.117. A 26 year old primigravida pregnant woman at 34 weeks gestation presents with tingling and numbness with occasional pain of her right hand in addition to altered sensation over her right middle and index finger. Tinel test is negative. What is the most likely diagnosis?

Q.118. Which of the following drugs used in the treatment of chronic heart failure has been shown to increase survival?

Q.124. A neonate’s chest X-ray shows a double bubble sign. He has low set ears and a flat occiput. What is the most likely diagnosis?

Q.130. A 44 year old HIV positive man complains of a two week history of worsening headache, facial weakness and visual hallucinations. He also reports new onset of eye pain. An MRI head reveals multiple ring shaped contrast enhancing lesions. What is the most likely causative organism?

Q.131. A 29-year-old woman comes to the emergency department with vomiting, profuse watery diarrhoea and abdominal cramps. It started within 4 hours of eating a steak in a local restaurant. Which of the following is the most likely cause?

Q.135. A 60-year-old man presents with diminished pulses, angina and syncope with exercise. On physical examination, he has an ejection murmur radiating into the carotid arteries. Which of the following is most likely diagnosis?

Q.138. A-70-year-old man is brought to the clinic with an acute confessional state. On examination, he has postural hypotension and dry mucus membranes. Test Result Normal Value: Calcium 3.41 2.15-2.62 mmol/L. Which of the following is the most appropriate initial treatment?

Q.139. A 35 year old first time donor suddenly passes out as she is donating blood. She is not known to have any medical problems in the past. Which of the following steps would be the least useful in managing this adverse event?

Q.140. A 3 month old infant presents with recurrent infections and feeding difficulties. His face looks dysmorphic and has a cleft palate. A chest X-ray shows absent thymic shadow. What is the most likely diagnosis?

Q.141. A 4 year old child is brought to your GP practice by her mother. She has painful crusted lesions on her face and neck, mostly localized around her mouth. Her face feels hot to the touch. She is other well. What is the most likely diagnosis?

Q.144. A 76 year old man suddenly collapsed and died. At postmortem exam, a retroperitoneal haematoma was found due to ruptured abdominal aortic aneurysm. What is the most likely underlying aetiology of the aortic aneurysm?