Nash Qbank

Q.1. 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.2. 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.3. A 5 year old child presents with fever and pallor. His parents say he always feels tired and is not as active as the other children around his age. On examination, splenomegaly was noted. Blood results show: Hb 7 g/dL WCC 2 x 109/L Platelets 42 x 109/L What is the most likely diagnosis?

A:

Acute myeloid leukaemia

B:

Acute lymphoblastic leukaemia

C:

Chronic myeloid leukaemia

D:

Chronic lymphocytic leukaemia

Q.4. A 14 year old boy presents with a 3 hour history of severe left testicular pain. He has no urinary symptoms and is otherwise well. On examination, the right testis looks normal but the left hemiscrotum is swollen and acutely tender. The pain is not eased by elevation of the testes. What is the most appropriate initial step?

A:

Mid stream urine

B:

Ultrasound scan of the testes

C:

Urethral swab

D:

Exploratory surgery

Q.5. A patient with stage IIIB small cell lung cancer complains of new onset of back pain for the past 12 hours. Initial neurological examination is normal. Which of the following is the most appropriate immediate action to take?

A:

MRI

B:

Radiation therapy

C:

Take no immedaite action

D:

High dose IV corticosteroids and MRI

Q.6. A 38-year-old woman presents with a 3-month history of recurrent intense fear accompanied by irritability, excessive worry, palpitations, and chest tightness. She is avoiding social gathering fearing of having same symptoms. Physical examination findings are normal. Which of the following medications is the most appropriate first line of treatment?

A:

Selective serotonin reuptake inhibitor

B:

Monoamine oxidase inhibitor

C:

Tricyclic antidepressants

D:

Benzodiazepine

Q.7. A 78-year-old man and current smoker, with 50 pack-year smoking history, complains of shortness of breath, dry cough and fatigue progressing over the past 8weeks. The patient also reports a significant weight loss, corresponding to approximately 15% of body weight over the last 12 weeks. Physical examination is normal. Which of the following is the most likely diagnosis?

A:

COPD

B:

Pneumonia

C:

Lung cancer

D:

Interstitial lung disease

Q.8. Which of the following is the most likely side effect of bupropion when prescribed for smoking cessation?

A:

Arrythmia

B:

Xerostomia

C:

Headache

D:

Seizure

Q.9. A 6 year old boy presents to the paediatric outpatient clinic with a two day history of dramatic weight gain and bodily swelling, particularly in his lower limbs. He also had bilaterally puffy eyes two days ago, which he was given some antihistamine syrup for, but they have not improved his symptoms. He is otherwise happy and healthy. His mother reports an uneventful pregnancy and he was delivered via elective Caesarean section at 38 weeks of gestation. He has no medical problems and he is on the 50th centile on all of his growth charts. He takes no chronic medication. The mother reports no significant family history of renal problems. Analysis of the patient’s urine sample was done and is significant for 3+ proteinuria. What is the next best investigation?

A:

Serum albumin levels

B:

Repeat urine analysis

C:

Refer to nephrology

D:

Refer to dietician

Q.10. AA 30-year-old man presents to the clinic with 10-month history of restlessness, difficulty concentrating, and disturbance in his sleep pattern. He is diagnosed with generalized anxiety disorder. Which of the following is the most appropriate treatment?

A:

Alprazolam

B:

Bupropion

C:

Haloperidol

D:

Naltrexone

Q.11. A random study on pulmonary embolism shows 10 patients out of 100 died who did not get treatment and 10 patients out of 100 died who got proper treatment. What is the most likely absolute risk?

A:

Absolute risk 5%

B:

Absolute risk 2%

C:

Absolute risk 100%

D:

Absolute risk 10%

Q.12. What is the optimal duration of anticoagulation following an initial episode of pulmonary embolism?

A:

6weeks

B:

3months

C:

6months

D:

12months

Q.13. Which of the following is a prediction of the feeling of hopelessness?

A:

Impulse control problems

B:

Gender identity disorder

C:

Suicidal behaviour

D:

Panic disorder

Q.14. Which of the following sites is the best to aspirate a sample of right pleural effusion with a syringe and needle?

A:

Midclavicular line 6th intercoastals space

B:

Midaxillary line 6th intercoastals space

C:

Midaxillary line 9th intercoastal space

D:

Parasternal 6th intercoastals space

Q.15. A 35 year old woman had a spontaneous vaginal delivery 10 days ago. She delivered a healthy baby girl and is currently breastfeeding. There were no complications throughout labour and the midwife has documented that the placenta appears complete. She now presents with irregular dark red vaginal bleeding over the past 2 days. Her blood pressure is 130/75 mmHg, pulse rate is 85 beats/minute and respiratory rate is 18 breaths/minute. She has a temperature of 37.4 C. What is the next most appropriate action?

A:

Crossmatch 2 units of packed red cells

B:

Cervical smear

C:

Pelvic ultrasound

D:

High vaginal swab

Q.16. A 32 year old man is about to undergo an elective inguinal hernia surgery. His blood tests show: Haemoglobin 82 g/L Mean cell volume 70 fL White cell count 5 x 109/L Platelets 180 x 109/L What is the most appropriate next action?

A:

Investigate and postpone surgery

B:

Blood transfusion and proceed with surgery

C:

Blood transfusion and defer surgery

D:

Continue with surgery with 2 units cross matched blood on stand by

Q.17. A 35 year old woman drinks 2 litres of vodka a day. She is well known to the hospital as she is frequently brought into accident and emergency department drunk with minor injuries. She now wants to stop drinking alcohol and is willing to seek help for her alcohol dependence. However, her main concern is that she has no support and lacks encouragement. What would you do?

A:

Medication

B:

Refer to social services

C:

Refer to psychology

D:

Cognitive behavioural therapy

Q.18. A 24-year-old man presents to the clinic with history of gradual fear of automobiles. He has always been anxious of cars, but now can no longer look at them without experiencing shortness of breath, sweating, and fear. Which of the following disorders is the most likely diagnosis?

A:

Panic

B:

Specific anxiety

C:

Generalized anxiety

D:

Post-traumatic stress

Q.19. 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.20. A 74-year-old woman complains of a deep, aching pain of the hip which is aggravated by walking. She states that after a busy day, the pain keeps her awake at night, and each morning her hip is stiff for several hours. Which of the following is the most likely cause of the pain?

A:

Rheumatoid arthritis

B:

Osteomyelitis

C:

Osteoporosis

D:

Osteorthritis

Q.21. A 20-year-old woman presents to the clinic with a history of abdominal pain, nausea, vomiting, localized weakness in the right leg, and a history of irregular menses. In the past, she has sought treatment for head, back, joint, and chest pain. Factitious disorder and malingering have been excluded as diagnoses. Which of the following is the most likely diagnosis?

A:

Hypochondriasis

B:

Conversion disorder

C:

Somatization disorder

D:

Somatoform pain disorder

Q.22. A 15-year-old girl presents to the clinic with history of tetany, swollen glands, and eroded dental enamel (see lab result). Electrolytes test Result Normal Value Potassium 2.8 3.5-5.1 mmol/L Which of the following is the most likely diagnosis?

A:

Bulimia nervosa

B:

Substance abuse

C:

Anorexia nervosa

D:

Alcohol withdrawal

Q.23. A 20-year-old man presents to the clinic with poor personal hygiene, echolalia, echopraxia, muttering to self, sitting in an odd posture for hours, and insomnia for the past 2 months. On examination, his orientation and memory are normal. Which of the following is the most appropriate treatment?

A:

Oxcarbazepine

B:

Amisulpride

C:

Venlafaxine

D:

Lithium

Q.24. A 55-year-old smoker presents to a clinic with progressive shortness of breath (see report). Chest X-ray: It reveals a massive right pleural efusion. Which of the following is the best next step in management?

A:

Thoracentesis

B:

High resolution CT scan

C:

Intercostal tube under water seal

D:

Repeated bronchodilator inhalations

Q.25. For which of the following childhood psychiatric disorders, clozapine is the most appropriate medication?

A:

Bipolar iliness

B:

Schizophrenia

C:

Substance abuse

D:

Major depression

Q.26. A 55-year-old smoker presents to the Primary Health Care Clinic for the result of the biopsy of a lesion in his right lung. When informed that, he has a cancer in his right lung, he asked said it has to be a mistake. What's his response described as?

A:

Anger

B:

Denial

C:

Bargaining

D:

Sadness

Q.27. A young man comes into the clinic with intermittent haemoptysis for 2 months, associated with some blood in his urine. He is a non-smoker and was previously in excellent health. He also describe a weight gain of 20 kg over the past 3 weeks, with "puffy eyes" in the morning. He has an elevated serum creatinine concentration (see report). Lung Biopsy: Serum immunoglobulin on basement membrane. Which of the following is the most likely diagnosis?

A:

Acute myocardial infarction

B:

Goodpasture syndrome

C:

DiGeorge syndrome

D:

Grave's disease

Q.28. A 56 year old man has noticed a strange tingling around his mouth for the past few weeks. It was very subtle at first but has become increasingly apparent. On examination, twitching facial muscles were noticed. His past medical history includes type 1 diabetes. What is the most likely biochemical finding?

A:

Hyponatraemia

B:

Hypocalcaemia

C:

Hypercalcaemia

D:

Hypokaleimia

Q.29. A 55-year-old patient presents to the clinic with shortness of breath and a cough productive of yellow sputum for the past 2days. There has also been blood-stained sputum for the last 3hours. The patient has smoked 2 packs of cigarettes a day for the past 35 years. On examination, there are ronchi, wheezing, & crepitations heard over the right hemothorax (see report). Blood pressure 110/70 mmHg; Heart rate 84/min;Respiratory rate 22/min; Temperature 38.8 degree C. Oxygen saturation 95% on room air. Chest x-ray: It shows a dense infiltrate in the right lower lobe. Which of the following is the most likely diagnosis?

A:

Community-acquired pneumonia

B:

Acute bronchitis

C:

Tuberculosis

D:

COPD

Q.30. Which of the following drugs can cause bronchoconstriction?

A:

Atenolol

B:

Salbutamol

C:

Salmeterol

D:

Ipratropium bromide

Q.31. Which of the following is the peak of nicotine withdrawal symptoms after smoking cessation?

A:

1day

B:

2 to 4 days

C:

5 to 7days

D:

8 to 10 days

Q.32. A 3-year-old child is brought to the clinic for his yearly physical examination. His history revealed various behavioural issues. including poor interaction with peers and family, delayed language development, repetitive movements and difficulty of accepting change. The child stiffens physically when touched, does not respond to the examiner and does not make eye contact. Which of the following is the most likely diagnosis?

A:

Attention deficit hyperactivity disorder

B:

Asperger's syndrome

C:

Autistic disorder

D:

Down syndrome

Q.33. A new mother presents to the paediatric clinic with her 6 month old son. She says that she is worried about his development since he does not respond to loud noises. His motor milestones are normal and the patient’s mother says that he vocalizes well. The pregnancy and birth were unremarkable. What is the best management strategy for this child?

A:

Arrange hearing test

B:

Assess developmental milestones

C:

Reassure

D:

Refer to speech therapist

Q.34. A 38 year old man recently had an appendicectomy and has now developed severe pain in his right big toe. He is noted to consume an average of 30 units of alcohol in a week. On examination, the joint of the right big toe is red and swollen. What is the most likely diagnosis?

A:

Rhabdomyosarcoma

B:

Osteoarthritis

C:

Gout

D:

Pseudogout

Q.35. On a follow-up consultation of a patient with a squamous cell carcinoma, some abnormalities are notes in blood analysis (see lab results). Test results noramal values: Parathyroid hormone 1.0 1.1-5.3 pmol/L;Calcium 3,30 2.15-2.62 mmol/L;Calcium ionised 1.6 1.1-1.3 mmol/L; Sodium 140 134-146 mmol/L; Potassium 4.3 3.5-5.1 mmol/L; Which of the following is the most likely cause of the metabolic abnormality?

A:

Renal failure

B:

Primary hyperparathyroidism

C:

Secondary hyperparathyroidism

D:

Secretion of PTH-related peptide by the tumour

Q.36. A mother of a 3 month-old baby presents to the clinic and tells the physician that she is "going crazy.” She states that since the baby has been bom, she has continuously visualized a snake crawling into the baby’s crib at night. She states that she knows itis not likely to happen but cannot get the thought out of her mind. She checks the baby's crib up to 50 times per night to ensure that there is no snake. Which of the following is the most likely diagnosis?

A:

Delusions

B:

Obsessions

C:

Hallucinations

D:

Postpartum psychosis

Q.37. A 23-year-old man complains of having an unusually prominent jaw. He has been seen by 3 plastic surgeons, but each one has refused to do anything. On examination, he appears depressed and has no visible protrusion, the jaw and face are normal. He has past medical history of rhinoplasty and blepharoplasty. Which of the following is the most likely diagnosis?

A:

Dysthymia

B:

Hypochondriasis

C:

Somatization disorder

D:

Body dysmorphic disorder

Q.38. What anatomical structure or landmark lies just above the midpoint of the inguinal ligament?

A:

Femoral artery pulse felt

B:

McBurney’s point

C:

Stellate ganglion

D:

Deep inguinal ring

Q.39. A 32-year-old woman complains of severe joint pain in the fingers of both hands, especially in the morning during the winter months. Examination confirms deformity of her fingers. Which of the following is the most likely diagnosis?

A:

Gout

B:

Still's disease

C:

Rheumatoid arthritis

D:

Primary degenerative osteoarthritis

Q.40. A 39 year old man presents with numerous pink umblicated papules on his genitals, thighs, and lower abdomen. They are small measuring 1-3 mm. White material can be expressed when pinching the papules. He is a known HIV positive patient. What is the most likely diagnosis?

A:

Mycobacterium avium intracellulare

B:

Verruca vulgaris

C:

Molluscum contagiosum

D:

Condylomata acuminata

Q.41. Which of the following is an alternative treatment for severe depression?

A:

Psychotherapy

B:

Tricyclic antidepressants

C:

Electroconvulsive therapy

D:

Electroencephalogram therapy

Q.42. A 53-year-old woman with history of depression presents to the Emergency Department with history of nausea, vomiting, epigastric pain, tinnitus, and shortness of breath 6 hours after consuming 50 tablets of aspirin (see lab result). Test Result Normal Value Plasma salicylate concentration 54 15-30 mg/dL Which of the following is the most appropriate initial management?

A:

Hemodialysis

B:

Gastric lavage

C:

Activated charcoal

D:

Urine alkalinization

Q.43. A 52-year-old man presents to the clinic for a routine physical check-up. He has a history of pulling out hair when under stress. On examination, he has diffuse hair thinning along with the absence of eyelashes. Which of the following is the most likely diagnosis?

A:

Post-traumatic stress disorder

B:

Cicatricial syndrome

C:

Trichotillomania

D:

Alopecia areata

Q.44. A 41-year-old man presents to the clinic requesting a complete examination to exclude colon cancer. He recently had some investigations done and provided a list of test results. He complains that this fear is interfering severely with his work and social activities. Which of the following is the most likely diagnosis?

A:

Hypochondriasis

B:

Factitious disorder

C:

Somatization disorder

D:

Obsessive-compulsive disorder

Q.45. A 28-year-old patient with mild intermittent asthma, has daytime symptoms about once to twice a week, and none at night. Which of the following initial treatment should be given when necessary?

A:

Inhaled short-acting beta-2 agonist

B:

Inhaled high dose corticosteroids

C:

Inhaled leukotriene modifiers

D:

Oral aminophylline

Q.46. A 28-year-old patient develops the sudden onset of dyspnoea and tachycardia 5 days post a knee surgery. Which of the following is the most likely diagnosis?

A:

Pulmonary embolism

B:

Myocardial infarction

C:

Ventricular tachycardia

D:

Pulmonary emphysema

Q.47. Which of the following atypical antipsychotic agents is associated with the most weight gain?

A:

Ziprasidone

B:

Avipiprazole

C:

Olanzapine

D:

Quetiapine

Q.48. A 55-year-old patient with chronic obstructive pulmonary disease presents with shortness of breath. The patient is in severe respiratory distress and hypoxemic with decreased breath sound and a prolonged expiration phase. There is no improvement after bronchodilators. The patient is conscious with a pH of 7.3. Which of the following is the best next step in management?

A:

Aminophylline IV

B:

Methyprednisolone IV

C:

Repeat bronchodialtors

D:

Non-invasive positive pressure ventillation

Q.49. A 15 year old girl attends the surgery for contraception advice. She is mentally competent and understands the implications of her sexual relationship. What is the most appropriate action?

A:

Inform her that contraception cannot be given until age of 16

B:

Inform her that her parents or legal guardians must be informed of her sexual relationship.

C:

Enquire about her sexual relationship including the age of the partner

D:

Inform her that she would require a cervical smear if she becomes sexually active

Q.50. A 68 year old woman is brought into the Emergency Department with palpitations and chest discomfort. She gives a history of left hemiparesis four days ago which has partially resolved after a few hours. She has a blood pressure of 160/95 mmHg, respiratory rate of 22 breaths/minute and a heart rate of 120 beats/minute. A CT scan of the head was organised which shows evidence of a small cortical infarct. An ECG taken in the Emergency Department shows absent P waves and an irregularly irregular rhythm with a variable ventricular rate. Metoprolol was given intravenously and she was discharged once asymptomatic. Which long term medications is she likely to benefit from?

A:

Aspirn 300 mg

B:

Aspirin 75 mg

C:

Alteplase

D:

Warfarin

Q.51. A 55 year old woman has recently been diagnosed with multiple sclerosis and has been started on oral steroids. She is brought to the hospital after having ingested more than 40 tablets of paracetamol 3 hours ago. She is refusing all medical treatment as she wants to end her life. What is the most appropriate action?

A:

Admit and observe but do not provide any intervention

B:

Refer to psychiatrist to assess patient’s ability to refuse treatment

C:

Gastric lavage

D:

Activated charcoal

Q.52. A 45-year-old man is admitted with general tiredness and fever. There is a past history of a chest infection of 4-week duration, for which he was given oral antibiotics. He felt better initially, but never fully recovered and is now becoming worse (see report). Chest X-ray: It shows a right-sided pleural effusion. Which of the following is the most likely diagnosis?

A:

Lung cancer

B:

Tuberculosis

C:

Pulmonary embolism

D:

Para-pneumonic effusion

Q.53. A 45-year-old man newly diagnosed with type 2 diabetes presents to the clinic for futhur management. He is on time for the appointment, but because of an emergency case, the physician arrive late to the clinic. When the physician waks in, the patient appears extremely angry. Which of the following is the most appropriate response by the physician?

A:

Acknowledge the patient's anger

B:

Explore the reasons for the anger

C:

Help the patient understand their anger

D:

Empathise with newly diagnosed diabetic patient

Q.54. A 22 year old sexually active male comes into the hospital with a 2 day history of fever with increasing pain in the scrotal area. He also describes painful micturition. There is no history of trauma. On examination, the scrotal skin is red and tender. He has a temperature of 37.8 C. What is the most likely diagnosis?

A:

Testicular torsion

B:

Torsion of a pedunculated cyst of Morgagni

C:

Haematocele

D:

Epididymo-orchitis

Q.55. A 61-year-old man presents with history of constantly thinks about aliens landing in his. backyard, especially when away from home. Despite knowing that aliens do not exist, he feels overwhelmed with the idea that they have landed. He fears that he is "going insane". : Which of the following is the most likely diagnosis?

A:

Delusion

B:

Obsession

C:

Compulsion

D:

Hallucination

Q.56. A 42-year-old man with asthma presents with daily symptoms despite regularly using a long-acting beta-agonist inhaler and an inhaled high-dose corticosteroid. He also uses a short acting beta-agonist inhaler as "rescue medication". These episodes also wake him from sleep 2-3 times a week. Physical examination shows bilateral (see table). Blood pressure 140/85 mmHg; Heart rate 90/min; respiratory rate 18/min; Temperature 36.7 degree C. Forced expiratory volume in 1 second normal value. Before bronchodilator 65% 25-75%; after bronchodilators 91%. Which of the folllowing is the most appropriate next step in management?

A:

Add theophylline

B:

Add a leukotriene inhibitor

C:

Observe the patient using his inhaler

D:

Treat for gastroesophageal reflux disease

Q.57. 10000 women underwent a newly developed cervical smear screen. 1000 of them had a smear result which shows premalignant changes and had further investigations and biopsies. Only 100 women who had undergone biopsies had premalignancy changes seen on histology. What is the best term to describe the cervical smear test?

A:

High true positive rate

B:

High true negative rate

C:

High false negative rate

D:

Low specificity

Q.58. A 6 month old boy has been brought to A&E following an apnoeic episode at home. He is now completely well but his parents are very anxious as their family friend’s child died of sudden infant death syndrome at a similar age. The parents would like to know how to perform CPR on a baby of his age. What is the most recommended technique for cardiac compressions?

A:

All fingers of both hands

B:

All fingers of one hand

C:

Palm of one hand

D:

Index and middle fingertips of one hand

Q.59. A 42-year-old woman is concerned about losing her job because of tiredness and would like to take antidepressants because of having a difficult time falling asleep and getting up in the morning. Her sleep disturbance is related to the inability to relax after getting into bed. She is repeatedly checks to make sure that the door is locked, the oven is off, and the children’s school supplies are organized. A similar routine occurs in the morning. She states that her behaviour is out of control but fis not done, she will not be able to sleep or leave the house. Which of the following disorders is the most likely diagnosis?

A:

Obsessive-compuisive

B:

Generalized anxiety

C:

Somatization

D:

Delusional

Q.60. A 33 year old woman complains of tiredness for the last 3 months. On routine blood test, she is found to have a haemoglobin of 85 g/L, low mean cell volume, and low ferritin. What is the most likely diagnosis?

A:

Iron deficiency

B:

Folate deficiency

C:

Thalassaemia

D:

Anaemia of chronic disease

Q.61. A 68 year old woman presents to the emergency department from her nursing home complaining of shortness of breath. She has a temperature of 38.7 C and productive cough. Her sputum is noted to be a rusty colour. On auscultation, crackles are heard over the right lung base. A chest X-ray was done and shows right lower lobe consolidation. She has a blood pressure of 100/65 mmHg and a pulse rate of 102 beats/minute. A urinalysis shows 1+ leukocytes with no nitrates or protein. What is the most likely organism causing her symptoms?

A:

Streptococcus pneumoniae

B:

Staphylococcus aureus

C:

Coxiella burnetti

D:

Mycoplasma pneumoniae

Q.62. Which of the following investigations should be recommended for elderly patient with cognitive deficit?

A:

Brief IQ test

B:

Hearing loss evaluation

C:

Wechsler memory scale

D:

Involuntary movement test

Q.63. A 35-year-old healthy man presents to the clinic with a 3-month history of feeling depressed. He is distressed at work and burnt out. 4 months earlier, he was promoted to a managerial position and had an interpersonal conflict with 2 of the employees. Which of the following is the most appropriate next step in management?

A:

Selective serotonin reuptake inhibitors

B:

TCA tricyclic antidepressant

C:

Supportive psychotherapy

D:

Phenothiazine

Q.64. Which of the following is the most likely cause of lobar pneumonia in adults?

A:

Klebsiella pneumonia

B:

Haemophilus influenzae

C:

Staphylococcus pyogenes

D:

Streptococcus pneumonia

Q.65. A 47-year-old patient presents with 12-hour of severe pain and swelling of the right first metatarsopharyngeal joint. On examination, the affected joint is erythematous and tender. Blood pressure 110/65 mmHg; Heart rate 105/min;Respiratory rate 12/min; Temperature 38 degree C. Which of the following is the most likely cause?

A:

Sodium urate crystals

B:

Uric acid crystals

C:

Calcium crystals

D:

Calcium pyrophosphate crystals

Q.66. Which of the following antidepressants has a high efficacy in childhood and adolescent depression?

A:

Lithium

B:

Clozapine

C:

Fluoxetine

D:

Imipramine

Q.67. A 23-year-old woman is admitted to the Psychiatric Unit after causing superficially lacerations to her wists. The reason is that she felt that her therapist has abandoned her. She has depressed mood that varies by the hour. On admission, she claimed that she has heard a voice speaking 10 her, although she currently denies it. She caused a disagreement between the psychiatric resident and the nursing staff, who have conflicting views of her behaviour in the unit. Which of the following personality disorders is the most likely diagnosis?

A:

Antisocial

B:

Borderline

C:

Obsessive

D:

Schizoid

Q.68. A 45-year-old nurse working in the pulmonary clinic, complains of fever and a productive cough for the last 3 months. She has received 2 courses of oral antibiotics, but showed no improvement (see image). Which of the following is the most likely diagnosis?

A:

Pulmonary tuberculosis

B:

H. influenza pneumonia

C:

Infectious mononucleosis

D:

Streptococcal pneumonia

Q.69. 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:

Sclera

C:

Optic radiation

D:

Trigeminal nerve

Q.70. A 48-year-old woman calls the clinic expressing fear of leaving the house, and has been inside for 2 months. She becomes anxious at the thought of walking out the front door and is now unable to enter the room containing the front door. Which of the following is the most likely diagnosis?

A:

Depression

B:

Malingering

C:

Agoraphobia

D:

Substance abuse

Q.71. A 27-year-old man presents to the clinic for routine check-up. On examination, he kept looking at the right frequently. When questioned, he said, "My mother is there, but no one can see her except me". He claims that she comes and goes, even though the family indicates she died when the patient was a child. Which of the following is the most likely diagnosis?

A:

Delusion

B:

Visual hallucination

C:

Auditory hallucination

D:

Episode of disorganized thinking

Q.72. A 48 year old man with a 30 pack year smoking history is found to have an incidental finding of a chest X-ray showing a 2 cm hilar mass and was referred to the respiratory team for a biopsy. The histology report has returned with findings of large polygonal cells containing keratin pearls and intercellular bridges. What is the most likely type of lung cancer?

A:

Adenocarcinoma

B:

Squamous cell carcinoma

C:

Large cell carcinoma

D:

Undifferentiated non-small cell lung cancer

Q.73. A 40-year-old man presents to the Emergency Department with iritabilty, suspiciousness, over activity and poor hygiene. Emergency Department doctors regarded his behaviour as abnormal and called for a psychiatrist. Which of the following is the most likely diagnosis?

A:

Acute confusional state

B:

Alzheimers Disease

C:

Schizophrenia

D:

Psychoses

Q.74. A 38-year-old man presents to the clinic with history of hearing voices coming from the toaster and refrigerator, waming that all the food is poisoned. Which of the following is the most likely diagnosis?

A:

Delusional thinking

B:

Visual hallucination

C:

Disorganized thinking

D:

Auditory hallucination

Q.75. A 56 year old man was recently started on antihypertensive medication. His recent blood results show: Sodium 134 mmol/L Potassium 5.9 mmol/L Urea 7 mmol/L Creatinine 111 micromol/L What is the most likely medication responsible for the abnormal results?

A:

Amlodipine

B:

Bendroflumethiazide

C:

Doxazosin

D:

Ramipril

Q.76. A 58-year-old man presents to the outpatient clinic with very severe pain, swelling and redness of the first metatarsophalangeal joint. Some joint fluid is withdrawn (see lab results and reports). Test result normal values: Colour yellow clear, clarity opaque transparent; WBC per mm3 100,000<200; PMNs 75<25%;Fluid exam: Negatively birefringent urate crystals are seen on polarizing examination of the synovial fluid. Hands X-ray: Juxta-articular punched-out sclerotic erosions involving the first metatarsophalangeal and interphalangeal joint with associated periarticular soft tissue swelling. Which of the following treatments should be avoided in the current situation?

A:

NSAID

B:

Colchicine

C:

Allopurinol

D:

Corticosteroids

Q.77. A 28-year-old woman has had mild intermittent asthma for years. she uses a short-acting bronchodilator, as needed. Over the past 2months, she has noticed that she is using her inhaler atleast 3 times a week, and on occasions has had to woke up in the middle of the night to use her inhaler. Which of the following treatment should be added?

A:

Leukotriene receptor antagonist

B:

Long-acting beta-aonist

C:

Inhaled corticosteroids

D:

Cromolyn

Q.78. An 11 year old has increased laxity of joints and hyperelastic skin. He is noted to have mild spinal curvature and a blue sclera. What is the most likely diagnosis?

A:

Fragile X syndrome

B:

Prader-Willi syndrome

C:

DiGeorge syndrome

D:

Ehlers-Danlos syndrome

Q.79. A 30-year-old man with a history of drug abuse presents to the clinic weekly with a variety of health complaints, which vary each time, and are greatly exaggerated. When he is unaware of being observed he appears asymptomatic. Which of the following is the most likely diagnosis?

A:

Depression

B:

Malingering

C:

Somatic delusion

D:

Conversion reaction

Q.80. 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:

Heonch-Scholein purpura

C:

Minimal change nephropathy

D:

Wilson’s disease

Q.81. A 34-year-old healthy man presents to the clinic with a 2-year history of worsening sad mood, poor appetite, insomnia, fatigue, low self-esteem, and feeling of hopelessness. Which of the following is the most likely diagnosis?

A:

Organic mood disorder

B:

Depressive disorder

C:

Minor depression

D:

Dysthymia

Q.82. A 50-year-old woman presents to the clinic with history of anxiety. 2 months ago, during a meeting at her job, she became very anxious, sweaty, and short of breath. She had to leave the meeting in order to calm down. Since then, she has avoided meeting rooms out of fear that she will have a recurrence of her symptoms. Which of the following is the most likely diagnosis?

A:

Panic disorder

B:

Specific anxiety disorder

C:

Generalized anxiety disorder

D:

Posttraumatic stress disorder

Q.83. A 20-year-old man with sickel cell anaemia presents with right sided chest pain and shortness of breath for 2 days. It was associated with pain in both legs and back. On examnination, fine crackles were heard in right middle and lower zones (see image). Blood pressure 125/75 mmHg; Heart raate 92/min; Respiratory rate 25/min; Temperature 37.9 degree C. Oxygen saturation 91% on room air. Which of the following is the most likely diagnosis?

A:

Viral pericarditis

B:

Pulmonary embolism

C:

Acute chest syndrome

D:

Pneumocystis carinii pneumonia

Q.84. A mother has a child with 17-alpha-hydroxylase deficiency. She is now pregnant for the second time. What are the risks of her unborn child having congenital adrenal hyperplasia?

A:

1:1

B:

1:2

C:

1:4

D:

1:8

Q.85. A 10 month old child who weighs 10 kilograms has been diagnosed with a urinary tract infection. He has been prescribed trimethoprim at a dose of 4 mg/kg to be given twice daily. The preparation of trimethoprim is 50 mg/5 ml. What dose will you advise the parents to give to the child?

A:

10 ml BD

B:

4 ml BD

C:

5 ml BD

D:

4 ml OD

Q.86. A 25-year-old patient suddenly develops chest pain & dyspnoea. Vocal and tactile fremitus are reduced, and breath sounds are diminished (see report). Chest X-ray: It shows absent lung markings on the left side. Which of the following is the most likely diagnosis?

A:

Spontaneous pneumothorax

B:

Pulmonary tuberculosis

C:

Pulmonary embolism

D:

Emphysema

Q.87. An 81 year old Afro-Caribbean man presents with pain in his lower back and hip. He complains of waking up in the middle of the night to go to the washroom and often he wets himself before reaching the toilet. He also has to urinate much more frequent than in the past and has terminal dribbling. What is the most likely underlying diagnosis?

A:

Benign prostatic hyperplasia

B:

Prostatitis

C:

Bladder carcinoma

D:

Prostate carcinoma

Q.88. A 24 year old male presents to A&E with 40% partial thickness burns. His pulse rate is 105 bpm and respiratory rate is 25 breaths per minute. His systolic blood pressure is 80 mmHg. What is the most appropriate management?

A:

Intravenous fluids calculated from the time of hospital arrival

B:

Intravenous fluids calculated from the time of burn

C:

Oral rehydration

D:

Intravenous dextrose stat

Q.89. Which landmark or anatomical structure is located at the midpoint between the suprasternal notch and pubic symphysis?

A:

Fundus of the gallbladder

B:

McBurney’s point

C:

Stellate ganglion

D:

Transpyloric plane

Q.90. A 30-year-old man presents to the clinic with a 3-month history of aliens talking to him and putting thoughts into his mind Which of the following is the most appropriate management?

A:

Behavioural therapy

B:

Anti-psychotic therapy

C:

Bereavement counseling

D:

Anti-depressive medications

Q.91. A 15 year old boy injured his right ear during a rugby match. He reports pain around the right pinna. On examination, the pinna of the right ear is red and tender. The tympanic membrane as found to be normal. What is the most appropriate next step?

A:

Topical gentamicin

B:

Oral flucloxacillin

C:

Intravenous flucloxacillin

D:

No further intervention needed

Q.92. What is the optimal treatment for community-acquired pneumonia in an otherwise healthy patient?

A:

Fluoroquinolone

B:

Azithrmycin

C:

Vancomycin

D:

Dicloxacillin

Q.93. A 29-year-old woman is diagnosed with rapidly progressive glomerulonephritis. Which of the following pathological changes is characteristic of this diagnosis?

A:

Dilated proximal tubules with inflammation

B:

Crescent formation within bowman's space

C:

IgA deposition in glomerular capillaries

D:

Fat globules in urine sediment

Q.94. Which of the following crystals is responsible for the arthritic symptoms of pseudogout?

A:

Calcium urate

B:

Calcium oxalate

C:

Calcium chloride

D:

Calcium pyrophosphate

Q.95. A 70 year old man presents with persistent dysphagia to both solids and liquids for a few months now. There is no associated weight loss. He does not have regurgitation after meals. His medical history includes osteoporosis which he takes alendronate once a week for the past 2 years. What is the most likely diagnosis?

A:

Achalasia

B:

Oesophageal carcinoma

C:

Benign oesophageal stricture

D:

Barrett’s Oesophagus

Q.96. An 8-year-old boy recently moved to another city. Soon after moving, school started, but the boy hesitated to make friends with anyone and had a hard time paying attention in class. Which of the following is the most likely diagnosis?

A:

Dysthymia

B:

Hypomania

C:

Depression

D:

Adjustment disorder

Q.97. A 33 year old woman complains of waking in the middle of the night to rush to the toilet. Most of the time, she does not make it to the toilet in time and she wets herself. What is the most likely diagnosis?

A:

Stress incontinence

B:

Urge incontinence

C:

Mixed incontinence

D:

Overflow incontinence

Q.98. Which of the following factors is the most important in determining the success of a smoking cessation program?

A:

Patient's desire to quit smoking

B:

Behaviour-modification

C:

Pharmacologic agents

D:

Medical counseling

Q.99. A 27-year-old woman with asthma has not had a severe attack for the last 3 months. However, she has a history of cough and wheezing 2-3 times each week. Which of the following is the most appropriate management?

A:

Ipratropium bromide

B:

Inhaled corticosteroid

C:

Salbutamol

D:

Salmeterol

Q.100. Which of the following is the most effective treatment for adults with obstructive sleep apnoea?

A:

Modafinil

B:

Maintain a BMI less than 30 kg/m2

C:

Mandible-positioning oral appliances

D:

Continuous positive airway pressure

Q.101. In which of the following conditons is interstitial pneumonitis a characteristic histopathologic finding?

A:

Viral pneumonia

B:

Lobar pneumonia

C:

Bronchopneumonia

D:

Secondary tuberculosis

Q.102. A 63 year old man presents with muscle weakness. He finds it difficult to walk for long periods of time or climb stairs. Activities such as rising from a seated position is difficult. He also finds difficulty in swallowing foods. His blood results show: Alkaline phosphatase (ALP) 149 U/L Aspartate transaminase (AST) 37 U/L Alanine transferase (ALT) 44 U/L Creatine kinase 440 U/L Erythrocyte sedimentation rate (ESR) 16 mm/h What is the most likely diagnosis?

A:

Polymyositis

B:

Polymyalgia rheumatica

C:

Muscular dystrophy

D:

Oesophageal carcinoma

Q.103. A 25-year-old patient with moderate persistent asthma is currently on a low dose, inhaled corticosteroid but needs to use a beta-2 agonist rescue inhaler at least once a day. Which of the following should be added to the current treatment?

A:

Theophylline to steroid regimen

B:

Leukotriene inhibitor to the steroid regimen

C:

Long acting beta-2 agonist to steroid regimen

D:

Ipratropium bromide to corticosteroid regimen

Q.104. A 21-year-old woman comes to the clinic with episodes of shortness of breath on exertion for one year. She has to stop after 15-20 minutes of exercise, because of dyspnoea and coughing, which get better afer one hour of rest. There are no symptoms at rest. On physical examination and spirometry are normal. Blood pressure 125/75 mmHg; Heart rate 80/min;Respiratory rate 12/min; Temperature 37.0 degree C. Which of the following is the most appropriate inhaled treatment before exercise?

A:

Salmeterol

B:

Salbutamol

C:

Budesonide

D:

Ipratropium

Q.105. A 33 year old woman fell from playing volleyball and hit her right knee. Valgus stress test is seen to be positive. What is the most likely structure that is injured?

A:

Anterior cruciate ligament

B:

Posterior cruciate ligament

C:

Lateral collateral ligament

D:

Medial collateral ligament

Q.106. A 72 year old man brought to the emergency department with onset of paraplegia following a trivial fall. He was treated for prostatic malignancy in the past. What is the most likely diagnosis?

A:

Paget’s disease

B:

Osteoporotic fracture of vertebrae

C:

Secondary metastasis

D:

Multiple myeloma

Q.107. A 20-year-old man with sickle cell anaemia presents with right sided chest pain and shortness of breath for 2 days. It is associated with pain in both legs and back. On examination, fine crackles are heard in right middle and lower zones (see image). Blood pressure 125/75 mmHg Heart rate 92 /min Respiratory rate 25 /min Temperature 37.9° C Oxygen saturation 91% on room air What is the most effective drug to reduce this incidence?

A:

Folic acid

B:

Hydroxyurea

C:

5-azacytidine

D:

Erythropoietin

Q.108. A 52-year-old patient presents with isolated pain and swelling of the left knee. Arthrocentesis demonstrates innumerable needle-shaped negatively birefringent crystals. Which of the following is the most appropriate treatment?

A:

Probencid

B:

Methotrexate

C:

Indomethacin

D:

Sulfinpyrazone

Q.109. A 25 year old man presents to his GP with the complaint of diarrhoea for the last seven days. Upon further questioning, he reveals that he opens his bowels in excess of two to six times per day. He describes his stool as being watery in consistency. He has also noticed blood in his stool. When asked about the character of the blood, the patient claims that the blood appeared to be fresh and was bright red in colour. He also complains about abdominal pain and describes his pain as being cramping in nature. He complains about an urgency to visit the toilet all the time. The patient is a bank manager by profession and for the last seven days, has been unable to cope with his situation. He says that it is affecting his work and overall general health as he is feeling very tired and lethargic all the time. He also complains about a lack of appetite. He has not traveled outside of the United Kingdom for the last eight months. The patient has no significant past medical history and does not have any allergies. On examination, he has a blood pressure of 120/80 mmHg and a heart rate of 70 beats/minute. His abdomen is tender with no guarding or rigidity. What SINGLE most appropriate investigation will you perform to aid in the management of this patient?

A:

Faecal fat test

B:

Stool microscopy, culture and sensitivity

C:

Faecal antigen test

D:

Faecal blood occult test

Q.110. A 17-year-old high school athlete presents to the clinic for an annual physical check-up. On examination, he has gained 20 Kg in the past 4 months and has a very well developed musculature of the upper body, acne over the face and back, and foul breath Heart rate 94 /min Temperature 37.6° C Blood pressure 138/89 mmHg Respiratory rate 14 /min Which of the following should the patient be screened for?

A:

Depression

B:

Cocaine use

C:

Thyroid tumour

D:

Anabolic steroid use

Q.111. A 72-year-old man presents to the emergency department with fever, night sweats and cough for 2 weeks (see report). Chest X-ray: Right upper lobe consolidation. Which of the following is the next step in management?

A:

Perform bronchoscopy

B:

Admit the patient to the intensive unit

C:

2weeks follow up in outpatient

D:

Isolate the patient in a single, negative pressure room

Q.112. A 56-year-old woman presents to the clinic with history of constant counting of floor tles, cars, items on a dinner plate, and words in a conversation. She is upset by the counting but becomes ‘anxious and agitated when she tries to stop herself from counting. Which of the following is the most likely diagnosis?

A:

Delusion

B:

Obsession

C:

Compulsion

D:

Hallucination

Q.113. A 55-year-old man presents to the clinic with history of difficulty maintaining erections and impotence that occurs during stressful periods of fe. He is currently under stress at work. On examination, he has normal physical findings. Which of the following is the first step in management?

A:

Prescribe sildenafil

B:

Refer to an endocrinologist

C:

Refer to a urologist for evaluation

D:

Encourage use of relaxation strategies Alm.

Q.114. A 56-year-old man presents to the clinic for evaluation. The physician has difficulty in obtaining accurate information regarding reason of attendance. Which of the following is the most appropriate next step in consultation?

A:

Use medical terms that the patient understands

B:

Control the interview with direct questions

C:

Involve the patient in the treatment plan

D:

Use open-ended questions

Q.115. Which of the following is the antidote for an opiate overdose?

A:

Naloxone

B:

Flumazenil

C:

Lorazepam

D:

Buprenorphine

Q.116. A 16-year-old boy learns about the death of his father and within hours, his speech becomes disorganized, he is walking outside of his house with no clothes on, and he claims that his father is inside the house and telling him to do these things in his honour. The symptoms resolved after 3 days, and the son returned to a full pre-morbid level of function but is obviously confused over the events of the past few days. Which of the following is the most likely diagnosis?

A:

Schizophreniform disorder

B:

Schizo-affective disorder

C:

Brief psychotic disorder

D:

Reactive schizophrenia

Q.117. A 78-year-old man presents with 2-year history of slow and progressive deterioration in his memory. The patient is able to perform some activities of daly living, including dressingand bathing. His personality has changed from that of a kind and caring person into someone who has periods of agitation and aggression. Neurologic and musculoskeletal examination cannot be carried out. Which of the following is the most likely diagnosis?

A:

Mixed dementia

B:

Alzheimer's disease

C:

Multi-infarct dementia

D:

Major depressive disorder

Q.118. A 25 year old man was admitted to the hospital with a fever of 38.8 C and rigors. He complains of a three day history of general malaise, mild headaches, arthralgia and myalgia. He especially complained of bilateral calf pain. His past history is significant for a trip to the Caribbean from which he returned five days ago. He describes the trip to the Caribbean with his friends as being amazing and describes a host of activities such as swimming, hiking and fishing. Upon further questioning, he also revealed that he noticed a red discoloration of his eyes before they turned to yellow. The patient also mentions seeing “spots” on his skin. On physical examination, the patient appears to be jaundiced. Abdominal examination revealed generalised abdominal tenderness. His vitals are as follows: Blood pressure 98/56 mmHg Heart rate 122 beats per minute Respiratory rate 18 breaths per minute Oxygen saturation on room air 98% Blood tests were done and the laboratory results are as follows: Alanine transferase (ALT) 89 U/L (5-35 U/L) Aspartate transaminase (AST) 60 U/L (5-35 U/L) Alkaline phosphatase (ALP) 162 U/L (30-150 U/L) Gamma glutamyl transferase (GGT) 33 U/L (8-60 U/L) White blood cells 15 x 109/L (4-11 x 109/L) Platelets 180 x 109/L (150-400 x 109/L) What is the most appropriate investigation in this scenario to confirm the diagnosis?

A:

Unconjugated bilirubin

B:

Paul Bunnell test

C:

Blood and urine culture and sensitivity

D:

CSF analysis

Q.119. Which of the following is the best treatment for a generalized anxiety disorder?

A:

Buspirone

B:

Bupropion

C:

Alprazolam

D:

Escitalopram

Q.120. A 45 year old lady who was previously fit and well is admitted with breathlessness, palpitations and a history of two episodes of syncope over the past two days. Upon further questioning, she admits to having difficulty breathing when she sits upright. She finds great relief when she lies down flat on her couch. Upon examination, the tips of her fingers are noted to be blue and clubbing is noticed. Auscultation reveals a mid-diastolic rumble which changes when the patient changes position and a loud S1 at the cardiac apex. What is the most likely diagnosis?

A:

Mitral regurgitation

B:

Ventricular ectopics

C:

Pulmonary regurgitation

D:

Atrial myxoma

Q.121. A 19-year-old woman presents to the clinic for a routine physical check-up. On examination, she has fine hair all over the body. She feels fat and subsequently diets. BMI 16.8 kg/m2 Which of the following is the most likely diagnosis?

A:

Bulimia

B:

Anorexia nervosa

C:

Body dysmorphic disorder

D:

Generalized anxiety disorder

Q.122. A 27-year-old man presents to the clinic with history of sweating, palpitations, nausea, and a “panicky feeling” when required to deliver a speech at work. He has no other difficulties at work Which of the following is the most likely diagnosis?

A:

Malingering

B:

Agoraphobia

C:

Performance anxiety

D:

Generalized anxiety disorder

Q.123. A 17-year-old man with history of intravenous drug abuse presents to the clinic for clinical evaluation. Which of the following is the most appropriate next step in investigation?

A:

Methicillin resistant Staphylococcus aureus

B:

Human immunodeficiency virus

C:

Streptococcus viridans

D:

Viral hepatitis B

Q.124. A 55-year-old man presents with shortness of breath and a productive cough. The patient has a history of smoking. On auscultation, there is wheezing throughout the chest (see reports). Chest X-ray: Normal. Arterial Blood Gases: Normal. Which of the following is the most likely diagnosis?

A:

Pulmonary fibrosis

B:

Occupational lung disease

C:

idiopathic pulmonary hemosiderosis

D:

Chronic obstructive pulmonary disease

Q.125. A 46-year-old woman presents to the clinic with 8-month history of irritability, excessive worry, and difficulty falling asleep and concentrating. Which of the following is the most likely diagnosis?

A:

Mood disorder not otherwise specified

B:

Major depressive disorder with anxiety

C:

Anxiety disorder with depression

D:

Generalized anxiety disorder

Q.126. A 67-year-old patient presents to the emergency department with chest pain, shortness of breath, and haemoptysis following a car trip for more than 5 hours (see report). ECG: Right axis deviation, an S1-Q3-T3 pattern, and a right bundle branch block. Which of the following is the most likely diagnosis?

A:

Acute myocardial infarction

B:

Brochogenic carcinoma

C:

Pulmonary embolism

D:

Pericarditis

Q.127. A 76-year-old man admitted with a diagnosis of pneumonia has fluctuating levels of attention, changes in awareness, and a marked disturbance of the sleep-wake cycle. Which of the following is the most appropriate initial management?

A:

Isolation in a quiet, dark room

B:

Allow a relative to stay with the patient

C:

Haloperidol regularly until symptoms stop

D:

Rispiridone regularly untill symptoms abate

Q.128. A 5-year-old boy is brought to the clinic by his mother with a history of impaired language development, impaired intelligence, compulsive repetitive behavior, and a preoccupation with inanimate objects. Which of the following is the most likely diagnosis?

A:

Autism

B:

Dyslexia

C:

Conductive hearing loss

D:

Manic depressive disorder

Q.129. A 25 year old woman has been feeling anxious and nervous for the last few months. She also complains of palpitations and tremors. Her symptoms develop rapidly and last for a few minutes. She mentions that taking alcohol initially helped her relieve her symptoms but now this effect is wearing off and she has palpitations and tremors even after drinking alcohol. What is the most likely diagnosis?

A:

Panic attacks

B:

Depression

C:

Obsessive-compulsive disorder (OCD)

D:

Alcohol addiction

Q.130. A 35 year old HIV positive man presents with progressive visual deterioration. He complains of blurred vision and floaters. On examination, multiple cotton wool spots are seen in both eyes. What is the most likely causative organism?

A:

Herpes zoster

B:

Cryptosporidium

C:

Cytomegalovirus

D:

Pneumocystis jiroveci pneumonia

Q.131. An 18-year-old man presents to the Emergency Department with 1-week history of euphoria, increased blood pressure, tachycardia, nausea, weight loss, psychomotor agitation, chills, sweating and visual hallucinations. Which of the following is the most likely diagnosis?

A:

Amphetamine intoxication

B:

Cannabis intoxication

C:

Acute schizophrenia

D:

Cocaine withdrawal

Q.132. A 5 year old boy is brought to clinic by his mother. The young boy has a distinct nasal speech and snores heavily at night. He is hyperactive during the day but has poor concentration. He is noted to be constantly breathing through his mouth. What is the most appropriate action?

A:

Arrange hearing test

B:

Assess developmental milestones

C:

Refer to ENT surgeon

D:

Refer to speech therapist

Q.133. An 18-year-old man presents to the Emergency Department with 20-minute history of light- headedness, headaches, and nausea. He complains of tingling around the mouth and in the fingertips. On examination, he is anxious, tremulous, sweating, and breathing heavily. Which of the following is the most appropriate first action?

A:

Patient rebreathe into a paper bag

B:

Conduct an amobarbital interview

C:

Blood alcohol concentration

D:

CT Brain scan

Q.134. A 46-year-old women with schizophrinea presents to the clinic with 1-month history of abnormal orofacial movements. She has been prescribed amisulpride 600mg for many years and procycidine 5 mg daily. Which of the following is the most likely cause?

A:

Tardive dyskinesia

B:

Catatonic phenomenon

C:

Cerebrovascular accident

D:

Positive symptoms of schizophrinea

Q.135. A 50 year old man, known case of hypertension and deep vein thrombosis, presents to the Emergency Department with a sudden onset of vision loss in his right eye. It is painless and lasted for approximately 5 minutes. He describes the vision loss as a ‘black curtain coming down’. On examination, there is a bruit on his neck. What is the most likely condition?

A:

Retinal vein thrombosis

B:

Retinal artery occlusion

C:

Amaurosis Fugax

D:

Optic neuritis

Q.136. A 45-year-old woman presents to the Primary Health Care Clinic with symptoms of anxiety due to difficulties in her relationship with her co-workers. Her examination was normal and the doctor has decided that there is no need for any investigation. Which of the following would be the most effective approach for counselling?

A:

Instructing how to deal with others

B:

Empathy during consultation

C:

Asking humorous questions

D:

Standing up for her rights

Q.137. 38-year-old woman with pleurisy requires a thoracentesis. The needle should be placed on the maxillary line of the affected side. Which rib level should the needle penetrate through?

A:

At the 4th

B:

At the 5th

C:

Between the 6th and 7th

D:

Between the 8th and 10th

Q.138. A 40-year-old drug addict man presents to the Emergency Department with 1-hour history of unconsciousness. On examination, he has pinpoint pupils and a respiratory rate of minute. Which of the following is the most appropriate treatment?

A:

Atropine

B:

Naloxone

C:

Furosemide

D:

N-acetylcystein

Q.139. A 48-year-old man presents for a routine visit, while reporting his medical history, he reveals a significant alcohol intake. The physician wants to assess the drinking further using the cut- annoyed-guilty-eye (CAGE) screening questionnaire. Which of the following is a question in the CAGE screening questionnaire?

A:

"Do you eat more after you drink?"

B:

"Do you think you are an alcoholic?"

C:

"Have you ever felt guilty about your drinking?"

D:

"How many drinks do you consume on a daly basis?"

Q.140. A 27-year-old woman delivered a healthy baby 3 months ago. She is currently undergoing psychotherapy for postpartum depression. Which of the following is the most appropriate to be added to optimize treatment?

A:

Prescribe very small doses of imipramine

B:

Encourage continuation of breastfeeding

C:

Include family members in therapy

D:

Prescribe a calcium supplement

Q.141. A 23 year old intravenous drug user with known human immunodeficiency virus infection and ongoing alcohol dependence was found on the floor by his friend. According to a neighbour, the last time the patient was seen was two days ago. On examination, he is found to be very confused and disoriented. His blood tests show: Sodium 137 mmol/L Potassium 5.7 mmol/L Urea 45 mmol/L Creatinine 1100 mmol/L What is the best investigation to perform next?

A:

Full blood count

B:

Blood cultures

C:

Abdominal Ultrasound scan

D:

Creatinine kinase

Q.142. A 24-year-old inactive woman presents to the clinic with 5-month history of amenorrhea. On examination, she has a body mass index of 20, stable for the last 5 years (see lab results). Pregnancy test: Negative. Which of the following is the most likely diagnosis?

A:

Eating disorder

B:

legal drug use

C:

Pituitary neoplasm

D:

Chronic depression

Q.143. A 9-year-old girl is brought to the clinic by her mother with a bald patch on her scalp. Her mother noted that she plucks her hair while studying and under stress. Which of the following is the most appropriate treatment?

A:

Olanzapine

B:

Bupropion

C:

Fluoxetine

D:

Lithium

Q.144. Which of the following pneumoconiosis will commonly predispose to the development of pumlnonary tuberculosis?

A:

Silicosis

B:

Asbestosis

C:

Anthracosis

D:

Farmer's lung

Q.145. A 43 year old smoker presents with double vision. She tires easily, has difficulty climbing stairs, and reaching for items on shelves. On examination, reflexes are absent but elicited after exercise. The power in shoulder abduction after repeated testing is 4+/5 from 3/5. What is the most likely pathology associated with this patient’s diagnosis?

A:

Thyrotoxicosis

B:

Thrombotic even

C:

Diabetes

D:

Lung cancer

Q.146. An 8 year old boy is brought by his mother to the emergency department with bruises on his lower back and a left shoulder dislocation. The child currently lives with his stepfather. The young boy is quiet and makes no eye contact while in conversatikon. What is the most likely diagnosis?

A:

Non accidental injury

B:

Malnutrition

C:

Thrombocytopaenia

D:

Osteogenesis imperfecta

Q.147. Which of the following can improve survival in patients with severe chronic obstructive pulmonary disease?

A:

Inhaled corticosteroids

B:

Supplemental oxygen

C:

Smoking cessation

D:

Beta agonist

Q.148. A 45-year-old man presents with difficulty in breathing and a nocturnal cough for the last 3 weeks. Spirometry results show a forced vital capacity and the FEV/FVC ratio lower than normal. Which of the following consistent with these findings?

A:

Reduced strength of inspiratory muscles

B:

Decreased lung compliance

C:

Increased lung compliance

D:

Increased airway resistance

Q.149. A 60-year-old woman complains of pain in her right knee for the last 3 years. The pain is worse with activity and relieved by rest and analgesics. Physical examination reveals that she has a varus knee deformity and tenderness over the medial joint line. Which of the following is the most likely diagnosis?

A:

Inflammatory arthritis

B:

Medial meniscus tear

C:

Septic arthritis

D:

Osteoarthritis

Q.150. A 21-year-old woman presents to the clinic with a history of red dry skin on her hands. She washes her hands up to 70 times per day because she always feels dirty. Washing her hands relieves her anxiety, but as she touches anything, she wants to wash again. Which of the following disorders is the most likely diagnosis?

A:

Obsessive-compulsive

B:

Dysmorphic

C:

Phobic

D:

Panic

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Q.2. 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.3. A 5 year old child presents with fever and pallor. His parents say he always feels tired and is not as active as the other children around his age. On examination, splenomegaly was noted. Blood results show: Hb 7 g/dL WCC 2 x 109/L Platelets 42 x 109/L What is the most likely diagnosis?

Q.5. A patient with stage IIIB small cell lung cancer complains of new onset of back pain for the past 12 hours. Initial neurological examination is normal. Which of the following is the most appropriate immediate action to take?

Q.8. Which of the following is the most likely side effect of bupropion when prescribed for smoking cessation?

Q.10. AA 30-year-old man presents to the clinic with 10-month history of restlessness, difficulty concentrating, and disturbance in his sleep pattern. He is diagnosed with generalized anxiety disorder. Which of the following is the most appropriate treatment?

Q.11. A random study on pulmonary embolism shows 10 patients out of 100 died who did not get treatment and 10 patients out of 100 died who got proper treatment. What is the most likely absolute risk?

Q.12. What is the optimal duration of anticoagulation following an initial episode of pulmonary embolism?

Q.13. Which of the following is a prediction of the feeling of hopelessness?

Q.14. Which of the following sites is the best to aspirate a sample of right pleural effusion with a syringe and needle?

Q.16. A 32 year old man is about to undergo an elective inguinal hernia surgery. His blood tests show: Haemoglobin 82 g/L Mean cell volume 70 fL White cell count 5 x 109/L Platelets 180 x 109/L What is the most appropriate next action?

Q.18. A 24-year-old man presents to the clinic with history of gradual fear of automobiles. He has always been anxious of cars, but now can no longer look at them without experiencing shortness of breath, sweating, and fear. Which of the following disorders is the most likely diagnosis?

Q.20. A 74-year-old woman complains of a deep, aching pain of the hip which is aggravated by walking. She states that after a busy day, the pain keeps her awake at night, and each morning her hip is stiff for several hours. Which of the following is the most likely cause of the pain?

Q.22. A 15-year-old girl presents to the clinic with history of tetany, swollen glands, and eroded dental enamel (see lab result). Electrolytes test Result Normal Value Potassium 2.8 3.5-5.1 mmol/L Which of the following is the most likely diagnosis?

Q.24. A 55-year-old smoker presents to a clinic with progressive shortness of breath (see report). Chest X-ray: It reveals a massive right pleural efusion. Which of the following is the best next step in management?

Q.25. For which of the following childhood psychiatric disorders, clozapine is the most appropriate medication?

Q.26. A 55-year-old smoker presents to the Primary Health Care Clinic for the result of the biopsy of a lesion in his right lung. When informed that, he has a cancer in his right lung, he asked said it has to be a mistake. What's his response described as?

Q.30. Which of the following drugs can cause bronchoconstriction?

Q.31. Which of the following is the peak of nicotine withdrawal symptoms after smoking cessation?

Q.34. A 38 year old man recently had an appendicectomy and has now developed severe pain in his right big toe. He is noted to consume an average of 30 units of alcohol in a week. On examination, the joint of the right big toe is red and swollen. What is the most likely diagnosis?

Q.38. What anatomical structure or landmark lies just above the midpoint of the inguinal ligament?

Q.39. A 32-year-old woman complains of severe joint pain in the fingers of both hands, especially in the morning during the winter months. Examination confirms deformity of her fingers. Which of the following is the most likely diagnosis?

Q.40. A 39 year old man presents with numerous pink umblicated papules on his genitals, thighs, and lower abdomen. They are small measuring 1-3 mm. White material can be expressed when pinching the papules. He is a known HIV positive patient. What is the most likely diagnosis?

Q.41. Which of the following is an alternative treatment for severe depression?

Q.43. A 52-year-old man presents to the clinic for a routine physical check-up. He has a history of pulling out hair when under stress. On examination, he has diffuse hair thinning along with the absence of eyelashes. Which of the following is the most likely diagnosis?

Q.45. A 28-year-old patient with mild intermittent asthma, has daytime symptoms about once to twice a week, and none at night. Which of the following initial treatment should be given when necessary?

Q.46. A 28-year-old patient develops the sudden onset of dyspnoea and tachycardia 5 days post a knee surgery. Which of the following is the most likely diagnosis?

Q.47. Which of the following atypical antipsychotic agents is associated with the most weight gain?

Q.49. A 15 year old girl attends the surgery for contraception advice. She is mentally competent and understands the implications of her sexual relationship. What is the most appropriate action?

Q.60. A 33 year old woman complains of tiredness for the last 3 months. On routine blood test, she is found to have a haemoglobin of 85 g/L, low mean cell volume, and low ferritin. What is the most likely diagnosis?

Q.62. Which of the following investigations should be recommended for elderly patient with cognitive deficit?

Q.64. Which of the following is the most likely cause of lobar pneumonia in adults?

Q.66. Which of the following antidepressants has a high efficacy in childhood and adolescent depression?

Q.68. A 45-year-old nurse working in the pulmonary clinic, complains of fever and a productive cough for the last 3 months. She has received 2 courses of oral antibiotics, but showed no improvement (see image). Which of the following is the most likely diagnosis?

Q.70. A 48-year-old woman calls the clinic expressing fear of leaving the house, and has been inside for 2 months. She becomes anxious at the thought of walking out the front door and is now unable to enter the room containing the front door. Which of the following is the most likely diagnosis?

Q.73. A 40-year-old man presents to the Emergency Department with iritabilty, suspiciousness, over activity and poor hygiene. Emergency Department doctors regarded his behaviour as abnormal and called for a psychiatrist. Which of the following is the most likely diagnosis?

Q.74. A 38-year-old man presents to the clinic with history of hearing voices coming from the toaster and refrigerator, waming that all the food is poisoned. Which of the following is the most likely diagnosis?

Q.75. A 56 year old man was recently started on antihypertensive medication. His recent blood results show: Sodium 134 mmol/L Potassium 5.9 mmol/L Urea 7 mmol/L Creatinine 111 micromol/L What is the most likely medication responsible for the abnormal results?

Q.78. An 11 year old has increased laxity of joints and hyperelastic skin. He is noted to have mild spinal curvature and a blue sclera. What is the most likely diagnosis?

Q.79. A 30-year-old man with a history of drug abuse presents to the clinic weekly with a variety of health complaints, which vary each time, and are greatly exaggerated. When he is unaware of being observed he appears asymptomatic. Which of the following is the most likely diagnosis?

Q.81. A 34-year-old healthy man presents to the clinic with a 2-year history of worsening sad mood, poor appetite, insomnia, fatigue, low self-esteem, and feeling of hopelessness. Which of the following is the most likely diagnosis?

Q.84. A mother has a child with 17-alpha-hydroxylase deficiency. She is now pregnant for the second time. What are the risks of her unborn child having congenital adrenal hyperplasia?

Q.85. A 10 month old child who weighs 10 kilograms has been diagnosed with a urinary tract infection. He has been prescribed trimethoprim at a dose of 4 mg/kg to be given twice daily. The preparation of trimethoprim is 50 mg/5 ml. What dose will you advise the parents to give to the child?

Q.86. A 25-year-old patient suddenly develops chest pain & dyspnoea. Vocal and tactile fremitus are reduced, and breath sounds are diminished (see report). Chest X-ray: It shows absent lung markings on the left side. Which of the following is the most likely diagnosis?

Q.88. A 24 year old male presents to A&E with 40% partial thickness burns. His pulse rate is 105 bpm and respiratory rate is 25 breaths per minute. His systolic blood pressure is 80 mmHg. What is the most appropriate management?

Q.89. Which landmark or anatomical structure is located at the midpoint between the suprasternal notch and pubic symphysis?

Q.90. A 30-year-old man presents to the clinic with a 3-month history of aliens talking to him and putting thoughts into his mind Which of the following is the most appropriate management?

Q.91. A 15 year old boy injured his right ear during a rugby match. He reports pain around the right pinna. On examination, the pinna of the right ear is red and tender. The tympanic membrane as found to be normal. What is the most appropriate next step?

Q.92. What is the optimal treatment for community-acquired pneumonia in an otherwise healthy patient?

Q.93. A 29-year-old woman is diagnosed with rapidly progressive glomerulonephritis. Which of the following pathological changes is characteristic of this diagnosis?

Q.94. Which of the following crystals is responsible for the arthritic symptoms of pseudogout?

Q.96. An 8-year-old boy recently moved to another city. Soon after moving, school started, but the boy hesitated to make friends with anyone and had a hard time paying attention in class. Which of the following is the most likely diagnosis?

Q.97. A 33 year old woman complains of waking in the middle of the night to rush to the toilet. Most of the time, she does not make it to the toilet in time and she wets herself. What is the most likely diagnosis?

Q.98. Which of the following factors is the most important in determining the success of a smoking cessation program?

Q.99. A 27-year-old woman with asthma has not had a severe attack for the last 3 months. However, she has a history of cough and wheezing 2-3 times each week. Which of the following is the most appropriate management?

Q.100. Which of the following is the most effective treatment for adults with obstructive sleep apnoea?

Q.101. In which of the following conditons is interstitial pneumonitis a characteristic histopathologic finding?

Q.103. A 25-year-old patient with moderate persistent asthma is currently on a low dose, inhaled corticosteroid but needs to use a beta-2 agonist rescue inhaler at least once a day. Which of the following should be added to the current treatment?

Q.105. A 33 year old woman fell from playing volleyball and hit her right knee. Valgus stress test is seen to be positive. What is the most likely structure that is injured?

Q.106. A 72 year old man brought to the emergency department with onset of paraplegia following a trivial fall. He was treated for prostatic malignancy in the past. What is the most likely diagnosis?

Q.108. A 52-year-old patient presents with isolated pain and swelling of the left knee. Arthrocentesis demonstrates innumerable needle-shaped negatively birefringent crystals. Which of the following is the most appropriate treatment?

Q.111. A 72-year-old man presents to the emergency department with fever, night sweats and cough for 2 weeks (see report). Chest X-ray: Right upper lobe consolidation. Which of the following is the next step in management?

Q.113. A 55-year-old man presents to the clinic with history of difficulty maintaining erections and impotence that occurs during stressful periods of fe. He is currently under stress at work. On examination, he has normal physical findings. Which of the following is the first step in management?

Q.114. A 56-year-old man presents to the clinic for evaluation. The physician has difficulty in obtaining accurate information regarding reason of attendance. Which of the following is the most appropriate next step in consultation?

Q.115. Which of the following is the antidote for an opiate overdose?

Q.119. Which of the following is the best treatment for a generalized anxiety disorder?

Q.121. A 19-year-old woman presents to the clinic for a routine physical check-up. On examination, she has fine hair all over the body. She feels fat and subsequently diets. BMI 16.8 kg/m2 Which of the following is the most likely diagnosis?

Q.122. A 27-year-old man presents to the clinic with history of sweating, palpitations, nausea, and a “panicky feeling” when required to deliver a speech at work. He has no other difficulties at work Which of the following is the most likely diagnosis?

Q.123. A 17-year-old man with history of intravenous drug abuse presents to the clinic for clinical evaluation. Which of the following is the most appropriate next step in investigation?

Q.124. A 55-year-old man presents with shortness of breath and a productive cough. The patient has a history of smoking. On auscultation, there is wheezing throughout the chest (see reports). Chest X-ray: Normal. Arterial Blood Gases: Normal. Which of the following is the most likely diagnosis?

Q.125. A 46-year-old woman presents to the clinic with 8-month history of irritability, excessive worry, and difficulty falling asleep and concentrating. Which of the following is the most likely diagnosis?

Q.127. A 76-year-old man admitted with a diagnosis of pneumonia has fluctuating levels of attention, changes in awareness, and a marked disturbance of the sleep-wake cycle. Which of the following is the most appropriate initial management?

Q.128. A 5-year-old boy is brought to the clinic by his mother with a history of impaired language development, impaired intelligence, compulsive repetitive behavior, and a preoccupation with inanimate objects. Which of the following is the most likely diagnosis?

Q.130. A 35 year old HIV positive man presents with progressive visual deterioration. He complains of blurred vision and floaters. On examination, multiple cotton wool spots are seen in both eyes. What is the most likely causative organism?

Q.131. An 18-year-old man presents to the Emergency Department with 1-week history of euphoria, increased blood pressure, tachycardia, nausea, weight loss, psychomotor agitation, chills, sweating and visual hallucinations. Which of the following is the most likely diagnosis?

Q.132. A 5 year old boy is brought to clinic by his mother. The young boy has a distinct nasal speech and snores heavily at night. He is hyperactive during the day but has poor concentration. He is noted to be constantly breathing through his mouth. What is the most appropriate action?

Q.134. A 46-year-old women with schizophrinea presents to the clinic with 1-month history of abnormal orofacial movements. She has been prescribed amisulpride 600mg for many years and procycidine 5 mg daily. Which of the following is the most likely cause?