Nash Qbank

Q.1. A 33 year old mother of a child with cystic fibrosis is concerned of her next baby also having cystic fibrosis. She is with the same partner and they both are completely healthy. What is the most likely probability of their future child having cystic fibrosis?

A:

1:2

B:

1:4

C:

1:8

D:

1:1

Q.2. A 30-year-old man gives a history of pancreatic carcinoma and reports having lost all his prescriptions. He says that despite having recently completed chemotherapy he has developed new symptoms and is afraid of a recurrence. There is no medical records for him in the hospitals. When confronted with this information, the patient ran away from the ciinic. Which of the following is the most likely diagnosis?

A:

Conversion disorder

B:

Factitious disorder

C:

Hypochondriasis

D:

Malingering

Q.3. A 36-year-old newly diagnosed hypertensive man presents for follow-up visit. After a thorough assessment, the physician discussed with him his diagnosis, the etiology of his illness, the probable side effects of the prescribed medicine, and the prognosis of his iliness and finally the restrictions the patient might experience due to the illness. Which of the following professional skis is the physician used?

A:

Developing rapport

B:

Improving communication

C:

Providing informational care

D:

Developing bonding with the patient

Q.4. A 65-year-old man with congestive heart failure and osteoarthritis moved into a nursing home 3 months ago. During the past 4 weeks, the patient has lost 3.6 kg, lost interest in all social activities, and has been crying almost every day. The mood is worse in the morning. At times, especially when the mood is impaired, the patients short-term memory appears to be lost. Which of the following is the most likely diagnosis?

A:

Multiinfarct dementia

B:

Alzheimer's disease

C:

Hypothyroidism

D:

Depression

Q.5. A 40-year-old diabetic man was treated appropriately with small doses of insulin. On next follow- up visit, he bought a very expensive watch as a gesture of gratitude to his physician. Which of the following is the most appropriate response?

A:

Accept and advise not to repeat

B:

Refuse and give a warning

C:

Politely refuse the gift

D:

Accept from the rich

Q.6. A 72-year-old man experiences inability to sustain attention, disorganized thinking, hallucinations, and disorientation commencing 12 hours after an aortic femoral popliteal bypass. The symptoms fluctuated during the next 2 days. Which of the following is the most likely diagnosis?

A:

Multiinfract dementia

B:

Depression

C:

Delirium

D:

Mania

Q.7. A 40-year-old woman presented with progressive redness over the dorsum of the left hand associated with pain and fever. She gave a history of a knife prick at the affected area 3 days ago. Temperature 37.9 °C. Which of the following is the most likely diagnosis?

A:

Cellulites

B:

Carbuncle

C:

Gas gangrene

D:

Necrotizing fasciitis

Q.8. A 45-year-old man involved in a motor vehicle accident with an isolated head injury, remains in coma for 5 days after the accident. Which of the following is the most appropriate feeding method in the early stage of management?

A:

Gastrostomy tube feeding

B:

Nasogastric tube feeding

C:

Central parenteral feeding

D:

Peripheral parenteral feeding

Q.9. Which of the following ciinical signs caused by a lesion in Wernicke's area?

A:

Can understand but unable to say words easily

B:

Cannot understand spoken or written words

C:

Loss of ability to recognize faces

D:

Loss of short term memory

Q.10. A 31 year old woman who was found unconscious is brought by ambulance to the Emergency Department. The paramedics state that she was seen next to empty packets of paracetamol. Serum paracetamol levels were requested and the results were plotted above the treatment line. Her blood pressure is 120/80 mmHg. She has a pulse of 80 beats/minute and a respiratory rate of 18 breaths /minute. A venous blood gas was performed which shows a pH of 7.38. She remains unconscious but reacts to pain. What is the most appropriate next step?

A:

Refer to psychiatric team

B:

Wait for consent from relatives prior to starting treatment

C:

Seek legal advice

D:

Start treatment and collect collateral information

Q.11. A 55-year-old man presents to the clinic with 2 months history of anxiety, irritability, impotence, difficulty in sleeping, and a weight loss of 10 kg. There is no evidence of marital disharmony or any extemal causes for the patient's anxiety. The physical examination was normal. Which of the following is the most likely diagnosis?

A:

Social phobia

B:

Major depression

C:

Secondary depression

D:

Generalized anxiety disorder

Q.12. A 32-year-old man who is known to have ulcerative colitis, presented to Emergency Department | with a history of frequent attacks of watery diarrhoea for 10 days . On examination, he was ; severely dehydrated with non-distended, soft abdomen. Which of the following is the most expected acid-base abnormality?

A:

Metabolic acidosis

B:

Metabolic alkalosis

C:

Compensated metabolic acidosis

D:

Compensated metabolic alkalosis

Q.13. A 45-year-old man presents in an anxious, tearful state. He complains of chronic, upper abdominal pain and is certain that he has stomach cancer but no one believes him. He has seen 6 different physicians in the past year and has had a GI series and barium enema performed an ultrasound of the abdomen twice and a CT scan. The patient was thinking of next going to a Herbal Clinic. Which of the following is the most likely diagnosis?

A:

Somatoform pain disorder

B:

Somatization disorder

C:

Conversion disorder

D:

Hypochondriasis

Q.14. A 22 year old woman complains of recent onset of severe itching and wheals which followed a viral infection. On inspection, numerous wheals of all sizes are noticed on her skin. The wheals tend to come and go within hours. What is the most likely diagnosis?

A:

Primary sclerosing cholangi

B:

Urticaria

C:

Pyschogenic itching

D:

Atopic eczema

Q.15. A 34-year-old woman presents to the clinic with a 6-month history of extreme fear of going to the park, the 200 and sporting events. This has worsened o the point where she has stopped going out of the house. Which of the following is the most likely diagnosis?

A:

Conversion disorder

B:

Schizophrenia

C:

Social phobia

D:

Agoraphobia

Q.16. A 4 year old girl presents to the emergency center with difficulty breathing and stridor. She has a temperature of 39.1 C. The parents state that the child had been in her usual state of health but awoke with a hoarse voice, and difficulty swallowing. They tell you that she has not been immunised because they are afraid of the side effects of the vaccination. What is the most likely diagnosis?

A:

Cystic fibrosis

B:

Acute epiglottitis

C:

Immunodeficiency

D:

Inhaled foreign body

Q.17. A 30-year-old woman presents with a complaint of lower back pain for 1 year. During the last 2 years, she had presented with recurrent abdominal pain, bloating, headache and migratory joint pain. Her menstrual periods are irregular and heavy. She was terminated twice from the job due to frequent absence from the work. She is upset that proper diagnosis or treatment was not given to her. She had multiple laboratory tests done during the ast 2 years and all were normal. The physical examination is unremarkable. Which of the following is the most likely diagnosis?

A:

Malingering

B:

Hypochondriasis

C:

Factitious disorder

D:

Somatization disorder

Q.18. Which of the following is the most appropriate management plan for major depression?

A:

Select any drug to start as all have equal efficacy

B:

Initiate therapy with one medication for 2 weeks

C:

Stop medication with symptomatic improvement

D:

Change medications if the patient doesn't respond

Q.19. A 24 year old patient was lying down on the operating table in a position with his arms hanging down for 3 hours. Soon after he woke up, he complains of numbness and weakness on his left hand and has a wrist drop. There is a loss of sensation over a small area between the dorsal aspect of 1st and 2nd metacarpals. What is the most likely structure to be damaged?

A:

Radial nerve

B:

Median nerve

C:

Ulnar nerve

D:

Axillary nerve

Q.20. Which of the following is a contraindication for liver transplantation?

A:

Acute liver failure

B:

Liver cirrhosis with active alcohol

C:

End stage liver disease with ascites

D:

End stage liver disease with encephalopathy

Q.21. A small town has a population of 250,000. In a five year period there were 1,000 cases of lung cancer diagnosed in that town. The neighbouring town also has a population of 250,000 but only 400 people were diagnosed with lung cancer during the five year period. What is the annual incidence per million of lung cancer in the population of both of these towns?

A:

2800

B:

1400

C:

700

D:

560

Q.22. Which of the following selective serotonin reuptake inhibitors is the most toxic in overdose?

A:

Sertraline

B:

Citalopram

C:

Paroxetine

D:

Fluoxetine

Q.23. A 15 year old girl presents with an itchy and scaly rash over her face and the extensor surfaces of her arms. Her grandmother also suffers from a similar skin disease. Her mom is worried that the rash is contagious. Which of the following is the best advice that you can give her?

A:

The rash is not contagious

B:

Isolate the young girl and her grandmother until the rash disappears

C:

Use permethrin 5% solution

D:

Change towels frequently

Q.24. A 15-year-old girl who had a serious disagreement with her friend. She did not want to meet her friend or talk to her anymore. If the girl saw her friend coming towards her or sitting in a room, she would move away and not go in that direction. Which of the following defense mechanisms is the most likely explanation for this behaviour?

A:

Denial

B:

Acting out

C:

Avoidance

D:

Repression

Q.25. Which of the following is the most likely a characteristic of a major depressive illness?

A:

Hypomania

B:

Late morning awakening

C:

Hallucination and flight of ideas

D:

Decreased eye contact in conversation

Q.26. A 6-year-old boy is brought to the clinic by his mother. She noticed that the child has been eating clay and paper for the last 4 months. Which of the following is the most appropriate initial treatment?

A:

Fluoxetine

B:

Imipramine

C:

Clonazepam

D:

Behavioural therapy

Q.27. A 35-year-old man with a history of open appendectomy 5 years ago presented with abdominal pain, distension, vomiting and constipation for 3 days. On physical examination, he was dehydrated, abdomen was distended with marked tendemess in the right iliac fossa and exaggerated bowel sounds. He was scheduled for emergency exploratory laparotomy (see report). Plain abdominal X-ray: Distended small bowel, multiple air fluid levels with collapsed colon. Which of the following is contraindicated?

A:

Propofol

B:

Ketamine

C:

Sevoflurane

D:

Nitrous oxide

Q.28. A 25-year-old man brought to the Emergency Department unconscious with massive bleeding from stab wound in the right thigh. On examination, he was pale with active bleeding from the stab wound (see lab result). Test Result Normal Value Hb 89 130-170 lL Which of the following is the most important initial step in management?

A:

Intravenous ringer lactate infusion

B:

Tourniquet around right thigh

C:

Transfusion of fresh blood

D:

Orotracheal intubation

Q.29. This is the measure of dispersion of a set of values. What is the most likely term

A:

Null hypothesis

B:

Prevalence

C:

Probability

D:

Standard deviation

Q.30. A 34-year-old woman presents to the clinic for postpartum care. She has experienced tearfulness and irritability during the 1 week following the delivery of her child. This episode resolved spontaneously and her mood has been normal since then. Which of the following is the most likely diagnosis?

A:

Maternity blues

B:

Postnatal depression

C:

Postpartum psychosis

D:

Postnatal non-bonding

Q.31. A 43-year-old woman delivered a full-term infant. On examination, he has an epicanthic folds, delayed milestones, flat facial profile, simian paimar creases and an atrial septal defect. Which of the following is the most likely diagnosis?

A:

Trisomy 12

B:

Trisomy 21

C:

Di-George syndrome

D:

Robertsonian tansiocation

Q.32. Which of the following is the diagnostic criteria for Attention deficit hyperactivity disorder in children, according to the Intemational Classification of Diseases-10?

A:

1 inattentive, 3 hyperactive and 1 impulsive symptoms

B:

A. 1i1 inattentive, 3 hyperactive and 3 impulsive symptoms

C:

3 inattentive, 3 hyperactive and 1 impulsive symptoms

D:

6 inattentive, 3 hyperactive and 1 impulsive symptoms

Q.33. A 12-year-old obese boy presents to the Primary Care Clinic with history of being teased by sen tachool and, 28 8 rest. hes considered "king 2 tof pls oust go fo seep and not Which of the following is the most appropriate action?

A:

Weight loss advice

B:

Reassuring the patient

C:

Immediate psychiatry referral

D:

Prescription of a fast acting antidepressant

Q.34. A couple attends a marriage counselling session because of marital problems. The wife states that her husband is having affairs although she has no proof of this. The husband states that she is “insane” because she is having him followed by a private detective and she is overly preoccupied about him being unfaithful. She goes through his personal belongings almost every day to look for signs of infidelity. Her actions are putting considerable strain on their marriage. What is the most likely syndrome she is suffering from?

A:

Frégoli delusion

B:

Cotard syndrome

C:

Capgras syndrome

D:

Othello syndrome

Q.35. A 26 year old man strongly believes that every elderly man he meets is likely to be his father. Although they look different, he is sure that it is his father wearing a different disguise. What is the most likely kind of delusion this man is suffering from?

A:

Persecutory delusion

B:

Erotomania

C:

Grandiose delusions

D:

Frégoli delusion

Q.36. A mother brings her 2-week-old infant to the Well-Baby Clinic for a check-up. During the visit, the physician found the child to be normal but the mother gives inappropriate answers to the questions. She appeared disoriented in time and date. She states that the child is deformed and unlikely to live long. Which of the following is the most likely diagnosis?

A:

Postnatal non-bonding

B:

Postpartum psychosis

C:

Neurosis

D:

Fatigue

Q.37. A 42 year old lady presents with a history of double vision, ptosis and facial numbness. Which anatomical site is the most likely to be affected?

A:

Cerebral cortex

B:

Trigeminal nerve

C:

Oculomotor nerve

D:

Brainstem

Q.38. A 23-year-old man is brought to the psychiatrist clinic because for the first time he started to hear some voices talking to him with unknown sources. On examination, he was apathetic and emotionally withdrawn. Which of the following is the best management?

A:

Olanzapine

B:

Fluoxetine

C:

Cognitive behavioural therapy

D:

Antipsychotic and cognitive behavioural therapy

Q.39. Which of the following is associated with dyslexia?

A:

Abnormal gait

B:

Brainstem defects

C:

Verbal language difficulties

D:

Defect in visual or hearing acuity

Q.40. Which of the following is a potential side effect of amitriptyline?

A:

Dystonia

B:

Weight gain

C:

Hypersalivation

D:

Hyperpigmentation

Q.41. A 45 year old man with type 1 diabetes mellitus has his annual checkups. Ophthalmoscopy shows dot and blot haemorrhage with hard exudates. What is the most likely diagnosis?

A:

Macular degeneration

B:

Retinal detachment

C:

Multiple sclerosis

D:

Diabetic background retinopathy

Q.42. A 50-year-old man who is known to have non-insulin dependent diabetes, presented with a progressive painful swelling on the back of the neck for 5 days. On physical examination, there is a 5x6 cm swelling and redness with multiple discharging openings. Which of the following is the most likely diagnosis?

A:

Abscess

B:

Cellulitis

C:

Furuncle

D:

Carbuncle

Q.43. A 7-year-old boy is brought by his mother because he was unable to sit in school without interrupting the class, wandering around the classroom or poking his neighbours. On ‘examination, he has normal growth parameters. Which of the following is the best management?

A:

Bupropion

B:

Paroxetine

C:

Guanfacine

D:

Dextroamphetamine

Q.44. A 58-year-old man presents to the clinic with a history of a disturbed recent memory as a cardinal feature of his disturbed state of mind along with behavioural changes. Which of the following is the most likely diagnosis?

A:

Multiple Sclerosis

B:

Alzheimer's Disease

C:

Huntington's chorea

D:

Multiinfarct dementia

Q.45. A 30 year old man has frequent episodic headaches with palpitations. He suffers from anxiety and has the occasional tremor on both his hands. His blood pressure was found to be 160/110 mmHg. What is the most likely diagnosis?

A:

Hyperthyroidism

B:

Panic attacks

C:

Phaeochromocytoma

D:

Cushing’s disease

Q.46. An 80 year old woman with mild dementia at a nursing home tripped and fell on her hand. She was brought to the Emergency Department with tenderness throughout her wrist. Distal pulses and sensation of her hand is intact. Her hand looks well perfused. X-ray revealed a fracture of the distal end of the radius with a 10 degree dorsal angulation. What is the best management for her?

A:

Closed reduction of the fracture

B:

Open reduction and internal fixation

C:

Above elbow backslap cast

D:

Closed reduction followed by Plaster of Paris cast below elbow

Q.47. A 32-year-old man brought to Emergency Department after he was involved in a road traffic accident. He was diagnosed with a massive intra-abdominal bleeding due to a severe splenic injury. He underwent exploratory laparotomy and splenectomy. Which of the following is most likely to be low in the early postoperative period?

A:

Insulin

B:

Glucagon

C:

Prolactin

D:

Vasopressin

Q.48. A 67-year-old man, known to have advanced antral carcinoma with liver metastasis, presented to the Emergency Department with a history of frequent vomiting for 10 days. On examination, he was jaundiced and dehydrated (see report). ECG: Flatted T-wave. Which of the following is most expected finding in urinalysis?

A:

Aciduria

B:

High sodium

C:

High potassium

D:

Alkaline urine

Q.49. Which of the following conditions is most often associated with manic behaviour?

A:

Paranoid schizophrenia

B:

Bipolar affective disorder

C:

Grandiose mood disorder

D:

Generalized anxiety disorder

Q.50. A 55-year-old woman presents to the Primary Health Care Centre complaining of loss of interest and pleasure in daily activities for 3 weeks. She also complains that she has difficulty in concentrating and sleeping. Further, she has also expressed that she feels that she is worthless in the world and therefore wants to end her life. Which of the following biochemical substance deficiency is the most likely cause?

A:

Aspartate

B:

Serotonin

C:

Glutamate

D:

Acetylcholine

Q.51. A 55-year-old woman presents to the Primary Health Care Centre complaining of loss of interest and pleasure in daily activities for 3 weeks. She also complains that she has difficulty in concentrating and sleeping. Further, she has also expressed that she feels that she is worthless. in the world and therefore wants to end her life Which of the following reuptake inhibitors is the best treatment?

A:

DOPA

B:

GABA

C:

Serotonin

D:

Acetylcholine

Q.52. A 22-year-old man presents to the ciinic with history of approaching strangers and asking them the same inappropriate question without stopping when instructed to do so. The patient seemed unaware of the fact that this was an inappropriate behaviour. Which of the following is the most likely description for this behaviour?

A:

Flight of ideas

B:

Perseveration

C:

Thought insertion

D:

Loosening of associations

Q.53. A 21-year-old man with depression presents for follow-up visit. During the consultation, the psychiatrist asked, “Do you think that you are mentally ili?" Which of the following findings is the psychiatrist wants to assess?

A:

Insight

B:

Judgment

C:

Compliance

D:

Guilt feeling

Q.54. A 55-year-old woman known to have a chronic duodenal ulcer, presented to the Emergency Department with a history of frequent vomiting for 2 weeks. Examination revealed dehydration, with distended upper abdomen and normal bowel sounds (see report) Upper Gastrointestinal Endoscopy Severely narrowed pylorus due to chronic peptic ulcer disease. Which of the following is the most expected?

A:

High urinary potassium

B:

Respiratory alkalosis

C:

Metabolic acidosis

D:

Hypokalaemia

Q.55. A 19-year-old girl presents with a 12 kg weight loss over the last 6 months. She feels fat with an intense fear of gaining weight. Over the last 4 months, the patient has had amenorrhea. On examination, she has lanugo hair distribution. Height 167 cm weight 42 kg Which of the following is the most likely diagnosis?

A:

Bulimia

B:

Anorexia nervosa

C:

Masked depression

D:

Generalized anxiety disorder

Q.56. A 76-year-old man presents to the Psychiatry Clinic for follow-up accompanied by his son. He has progressive memory loss, difficulty in finding words, wandering, and agitation, as well as urinary and fecal incontinence for the last 3 years. On examination, he was conscious but not oriented in time and place; his short memory was severely impaired with an intact long memory (see report). Brain CT scan: Atrophied hippocampal and temporal lobes. Which of the following chromosomes harbors the mutated gene is responsible for this presentation?

A:

13

B:

15

C:

21

D:

X

Q.57. A 45 year old man presents to the Emergency Department with sudden excruciating pain in the right leg. On examination, his right lower limb is pale and cold. The dorsalis pedis and posterior tibial pulses are absent in the right foot. He has a pulse of 95 beats/minute with an irregular rhythm. What is the most likely reason for his pain?

A:

Infection

B:

Nerve compression

C:

Deep vein thrombosis

D:

Embolus

Q.58. A 76-year-old man newly diagnosed with depression started 30 mg of amitriptyline each night Shortly after the beginning of treatment, he complained of dizziness every morning. Which of the following is the most appropriate next step in management?

A:

Change to a selective serotonin reuptake inhibitor

B:

Advise to take the medication with food

C:

Advice to take the medication in the morning

D:

Change amitriptyline dose to 10 mg 3 times a day

Q.59. A 25-year-old healthy man complains of episodes of chest tightness, palpitations, dizziness and breathlessness. These episodes resolved after about 5 minutes. He remains normal between episodes and the interval may extend for several days before a new episode occurs. He has had constant anxiety about having another attack and feels sad about the situation. The patient cannot identify a triggering mechanism. Which of the following is the most ikely diagnosis?

A:

Generalized anxiety disorder

B:

Major depressive disorder

C:

Phobic reaction

D:

Panic disorder

Q.60. A 28-year-old was brought to the Emergency Department complaining that his neighbours are trying to harm him and plotting to kill him. On questioning, he was very sure about this and said that he is still hearing their voices talking with each other, though none of them were present Which of the following is the most likely diagnosis?

A:

Cognitive and perceptive disturbance

B:

Depersonalization and derealization

C:

Obsessive-compulsive disorder

D:

Hallucinations and delusions

Q.61. A 45-year-old man with recurrent episodes of schizophrenia is on maintenance therapy to maintain suppression of symptoms, prevent relapse, improve quality of life, and support engagement in psychosocial therapy. Which of the following is the best outcome following the maintenance therapy?

A:

Complete resolution

B:

5% will achieve remission

C:

70% will have a satisfactory quality of life

D:

33% obtained long-lasting symptom reduction

Q.62. A 36-year-old diabetic woman presents to the clinic for follow-up visit, and after an initial assessment, the physician wished to perform a physical examination. He first asked her permission, which was granted. Which of the following ethical measures was the physician adopting?

A:

Obtain informed consent

B:

Respect for the patient

C:

Fulfil his responsibility

D:

Show his efficiency

Q.63. Which of the following is the most likely clinical presentation of delusional patients?

A:

Disturbance in perception

B:

Rare in in manic disorders

C:

Found only in schizophrenia

D:

Disturbance of thought content

Q.64. A 72-year-old man who lost his spouse 2 months ago after a prolonged illness, presents with a sad mood, decreased appetite, and sieep disturbance. Which of the following is the most likely diagnosis?

A:

Dysthymia

B:

Bereavement

C:

Major depression

D:

Minor depression

Q.65. A 41-year-old man underwent blood transfusion for postoperative bleeding. He developed pain’ at the site of the infusion with fever and chest tightness after few minutes of starting the transfusion. Temperature 38 °C. Which of the following is the most likely diagnosis?

A:

Febrile non-haemolytic reaction

B:

Bacterial blood contamination

C:

Haemolytic reaction

D:

Allergic reaction

Q.66. A 78-year-old man is brought to the Outpatient Clinic with a 2-year history of slow and progressive deterioration in his memory. He is able to perform some activities of daily living, including dressing and bathing as well as cooking. He has personality changes, once a kind and caring parent he now displays periods of both agitation and aggression. Neurologic and musculoskeletal examination cannot be carried out Which of the following is the best management?

A:

Cost-effective laboratory investigation

B:

Prescribe Risperidone for the patient

C:

Admission to a chronic care facility

D:

Refer to a geriatrician

Q.67. A 20-year-old man presents with a 2-year history of intense fear before giving classes asa | teacher in a secondary school. He claims that itis only a matter of ime before a major teaching | mistake is made. Which of the following phobias is the most likely diagnosis?

A:

Social

B:

Mixed

C:

Specific

D:

Agoraphobia

Q.68. Which of the following factors indicates a poor prognosis for schizophrenia?

A:

Acute onset of psychosis

B:

Onset during adolescence

C:

Family history of schizophrenia

D:

Anxiety during psychotic episodes

Q.69. A 30-year-old man presents to the clinic complaining of reduced energy, lack of enjoyment, reduced sleep, reduced appetite, suicidal ideas and lack of self-confidence. Examination and ab results are normal. Which of the following is the most likely diagnosis?

A:

Anxiety disorder

B:

Depressive disorders

C:

Drug induced psychoses

D:

Dissociative conversion disorder

Q.70. A 48 year old man attends his GP surgery. He was started on fluoxetine 8 weeks ago for depression and is now requesting to stop his medication as he feels well and does not think he is depressed any longer. What is the most appropriate advice to give to him in regards to his treatment?

A:

Stop fluoxetine right away

B:

Continued fluoxetine for at least another 6 months

C:

Fluoxetine dose should be gradually reduced over a 4 week period

D:

Fluoxetine dose should be gradually reduced over a 1 week period

Q.71. A 60 year old man has sudden severe chest pain radiating to both shoulders and accompanied by shortness of breath. There was no history of trauma. His medical history includes hypertension. Examination shows cold peripheries and paraplegia. What is the most appropriate diagnosis?

A:

Myocardial infarction

B:

Thoracic aortic dissection

C:

Pulmonary embolism

D:

Oesophageal perforation

Q.72. Stress leads to an increase in cortisol and catecholamine secretion that can alter the levels of lymphocyte production that fight disease. Which of the following is the most likely explanation for these effect?

A:

Interpretation of the sitting

B:

Psychoneuroimmunology

C:

Vaccination effect

D:

Personal effects

Q.73. 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.74. Which of the following is the main difference between delirium and dementia?

A:

Disturbance of consciousnes

B:

Multiple cognitive deficits

C:

Memory impairment

D:

Aphasia

Q.75. An autistic 8 year old child puts a green pea in his ear while eating. Otoscopy shows a green coloured object in the ear canal. What is the most appropriate approach to remove the green pea?

A:

By magnet

B:

Syringing

C:

Removal under general anaesthesia

D:

By hook

Q.76. A 67 year old smoker presents with cough, breathlessness and wheeze. 24% oxygen by Venturi face mask was initiated and nebulized salbutamol and hydrocortisone were administered. As his dyspnoea did not improve, intravenous aminophyllin was administered and an arterial blood gas was sent. He has a respiratory rate of 32 breaths/minute. His arterial blood gas results show: pH 7.32 pCO2 7.7 kPa pO2 10.1 kPa What is the most appropriate next step in management?

A:

Non-invasive ventilation

B:

Invasive mechanical ventilation

C:

Long-acting beta-adrenoceptor agonist

D:

Oral amoxicilin

Q.77. A 38-year-old man who is known to have Crohn's disease, presented to the Emergency Department with a history of 8-12 episodes of diarrhoea per day over the last 5 days. On examination, he was dehydrated; abdomen was distended with generalized muscles weakness (see report). ECG: Flattened T-waves. Which of the following is the most likely electrolyte abnormality?

A:

Hypomagnesaemia

B:

Hyponatremia

C:

Hypocaicaemia

D:

Hypokalaemia

Q.78. Which of the following medications causes insomnia, anxiety and restlessness?

A:

Tricyclic antidepressant

B:

Tetracydiic Antidepressant

C:

Monoamine oxidase inhibitor

D:

Selective serotonin-reuptake inhibitor

Q.79. A 23-year-old woman with frequent panic attacks, presents to clinic complains that during her fast attack 3 days ago she felt that she was disconnected from the world, as if the environment is strange. Which of the following would best describe her feelings?

A:

Illusion

B:

Derealisation

C:

Dull perception

D:

Depersonalization

Q.80. A 44 year old man presents with muffled hearing and constant high-frequency tinnitus. He also complains of the feeling of pressure in the right ear and vertigo. He has double vision when looking to the right. What is the most likely diagnosis?

A:

Meniere’s disease

B:

Acoustin neuroma

C:

Acute labyrinthitis

D:

Meningioma

Q.81. A 16 year old boy has lower abdominal pain. A clinical suspicion of acute appendicitis was made and the surgical team has decided to go ahead with an appendectomy. The patient is happy to go ahead with the surgery but his parents refuse to sign the consent form as they are opposed to any form of surgery. The procedure has been explained clearly to the patient and his parents and they understand the risk of not going for surgery. What is the most appropriate action?

A:

Cancel the surgery once proper documentation by parents are filled

B:

Obtain a consent from patient and proceed with surgery

C:

Contact the local safeguarding officer

D:

Involve social services

Q.82. A 27 year old lady was admitted with fever, rigors, and right loin pain. A dipstick urinalysis was positive for blood, leukocyte esterase and nitrites. A midstream specimen of urine (MSU) was sent for culture. She has no medical history of significance. What is the appropriate action?

A:

Start antibiotics immediately

B:

Wait for culture results to start antibiotics

C:

Encourage good fluid intake

D:

Computerised tomography of kidney, ureter and bladder

Q.83. A 27 year old man attends the GP surgery with complaints of headaches, nose bleeds and pain in the lower limbs on exertion. A radio-femoral delay was noted on examination. His legs are cold and his femoral pulse is difficult to feel. Auscultation reveals a systolic murmur heard in the left infraclavicular area. What is the most likely diagnosis?

A:

Tetralogy of Fallot (TOF)

B:

Atrial septal defect (ASD)

C:

Ventricular septal defect (VSD)

D:

Coarctation of the aorta

Q.84. A 23 year old man has been using intravenous drugs. You explain to him the dangers of this, including the risk of contracting a blood borne virus such as Hepatitis B. Which of the following laboratory tests will first become abnormal after acquiring hepatitis B infection?

A:

Bilirubin

B:

Hepatitis B surface antigen

C:

Hepatitis B core IgM antibody

D:

Alanine aminotransferase (ALT)

Q.85. Which of the following antipschotic medications is most likely cause weight gain?

A:

Clozapine

B:

Olanzapine

C:

Risperidone

D:

Ziprasidone

Q.86. A 26-year-old woman presents to the Psychiatric Outpatient Clinic with history of psychomotor excitation and initabilty. She has grandiose delusions and auditory hallucinations. On a mental state examination, she exhibited a lack of insight and flight of ideas. Which of the following disorders is the most likely diagnosis?

A:

Neurosis

B:

Psychoses

C:

Personality disorder

D:

Dissociative conversion

Q.87. A 50 year old lady presents with tiredness and weight gain over the last 6 months. She has glucose in her urine and has recently been diagnosed with hypertension. Investigations were performed and a diagnosis of Cushing’s disease was made. Which of the following findings is NOT found in Cushing’s disease?

A:

A high adrenocorticotropic hormone (ACTH) level

B:

Failure to suppress morning cortisol with dexamethasone

C:

Hypertension requiring more than 2 antihypertensive agents

D:

Unilateral adrenal enlargement

Q.88. A 23-year-old college student was brought to the Psychiatric Outpatient Clinic with a 3-month history of persecutory delusions, hearing voices commenting on his actions, and disorganized behaviour without disturbance of mood, then returning to normal with no medication. Which of the following is the most likely diagnosis?

A:

Schizophreniform disorder

B:

Brief psychotic disorder

C:

Delusional disorder

D:

schizophrenia

Q.89. A 34 year old man has an acute painful, red right eye for the last 24 hours. He complains of blurring of vision. He has a past medical history of cervical spondylitis and is on chronic diclofenac treatment for the past 4 years for back pain and stiffness. On examination, his pupil is irregular in shape and he is very sensitive to light. What is the most likely clinical diagnosis?

A:

Acute close-angle glaucoma

B:

Conjunctivitis

C:

Episcleritis

D:

Iridocyclitis

Q.90. A 27 year old female attends outpatient department with a fever and dry cough. She has had a headache, muscle pain and joint pain for more than one week. She has a temperature of 37.5 C, a pulse of 100 beats/minute, a blood pressure of 110/70 mmHg and a respiratory rate of 20 breaths/minute. A Chest X-ray report shows bilateral patchy consolidation. What is the most likely causative organism?

A:

Pneumococcal pneumonia

B:

Legionella

C:

Mycoplasma pneumoniae

D:

Chlamydia pneumoniae

Q.91. A 19-year-old healthy man is brought to the clinic for evaluation of progressive erratic behaviour. Over the past 4 months, he has believed that people on television are reading his thoughts. He expressed the presence of supematural powers and that he has begun to act out in response to these ideations. He has not caused injuries, but the trends are becoming more violent. On examination, he is normal. Which of the following is the most likely diagnosis?

A:

Schizophrenia

B:

Conversion disorder

C:

Rapid cycling depression

D:

Manic phase of bipolar disorder

Q.92. Which of the following is described as "False belief not in accordance with a person's intelligence or culture™?

A:

Ellusion

B:

Delusion

C:

Hallucination

D:

Somatisation

Q.93. A 65 year old lady has severe pain along one side of her head and jaw. She complains that she is unable to comb her hair because of severe pain when the comb touches her scalp. She has no neurological deficits on examination. What is the most likely cause of her symptoms?

A:

Arterial inflammation

B:

Arterial vasospasm

C:

Infection

D:

Aneurysm

Q.94. Which of the following is an example of the open-ended questions in consultation?

A:

“Tell me about the pain."

B:

"Tell me about the pain in your chest"

C:

"Point to the area of pain in your chest."

D:

"Have you seen a doctor in the past 6 months?"

Q.95. A 52-year-old woman presents with a 5-day history of insomnia and crying because of the death of a sibling. The patient has not slept for the last 2 days. Which of the following is the most appropriate short course of therapy? Which of the following factors indicates a poor prognosis for schizophrenia?

A:

Fluoxetine

B:

Imipramine

C:

Lorazepam

D:

Chlorpromazine

Q.96. A 4 week old female infant presents to the Emergency Department with vomiting after every feed. The mother describes the vomiting as projectile and non-bilious. The child is also constipated. On examination, there is a right sided olive-sized abdominal mass on palpation. What is the most appopriate next step of action?

A:

Abdominal ultrasound

B:

Abdominal X-ray

C:

Intravenous fluids

D:

Serum potassium level

Q.97. A 26-year-old man presents to the clinic with history of unusual behaviour. He keeps a blanket over the television believing that the goverment uses the actors to spy through the TV. He believes that the instructions to cover the TV came from God who spoke through the light bulb. Which of the following is the most likely diagnosis?

A:

Schizophrenia

B:

Agoraphobia

C:

Dementia

D:

Mania

Q.98. A 2 year old girl preseents with a painless limp. On examination, there is unequal skin folds and the left leg is shortner than the right leg. What is the most likely diagnosis?

A:

Transient synovitis

B:

Developmental dysplasia of the hip

C:

Perthes’ disease

D:

Juvenile idiopathic arthritis

Q.99. A 56-year-old man with schizophrenia is started on neuroleptic medications to treat his psychotic symptoms. Which of the following side effects is the patient at greatest risk?

A:

Seizures

B:

Akathisia

C:

Hyperthermia

D:

Myocardial infarction

Q.100. Which of the following is the most likely benefit of using antipsychotic therapy in schizophrenic patients?

A:

Improve apathy

B:

Reduce delusions

C:

Improve thinking ability

D:

Increase social interaction

Q.101. Which of the following conditions is the most likely cause of dementia?

A:

Spinocerebellar ataxia

B:

Vitamin B12 deficiency

C:

Idiopathic parkinsonism

D:

Amyotrophic lateral sclerosis

Q.102. A 49 year old man with known HIV presents with history of cough and shortness of breath. His CD4 count is measured at 350 mm3. A chest x-ray was performed and shows lobar consolidation. He has a temperature of 38.1 C, a respiratory rate of 30 breaths/minute and a heart rate of 90 beats/minute. What is the most likely causative organism?

A:

Mycobacterium avium intracellulare

B:

Cytomegalovirus

C:

Streptococcus pneumoniae

D:

Toxoplasmosis

Q.103. A 75 year old man is found to be unresponsive. The ward doctor is called to the patient’s bedside. He is not breathing and has no detectable pulse. Which is the most appropriate next step?

A:

Get a defibrillator

B:

Give two rescue breaths immediately

C:

Check notes for a Do Not Attempt Resuscitation (DNAR) order

D:

Start chest compressions at a rate of 30:2

Q.104. A 35-year-old depressed housewife was started with antidepressants. After 2 weeks of taking the medication, the patient started complaining of constipation. Which of the following groups of antidepressants is the most likely cause?

A:

Tricyclic anti-depressants

B:

Monoamine oxidase inhibitors

C:

Selective serotonin reuptake inhibitors

D:

Selective nor-adrenaline and serotonin inhibitors

Q.105. A 28 year old type 1 diabetic has intermittent diarrhoea and abdominal bloating over the last 6 months. He also complains of feeling tired all the time. His blood results show the following: Haemoglobin 135 g/L (130-180 g/L) Ferritin 30 ng/ml (20-300 ng/ml) Thyroid stimulating hormone (TSH) 2.5 mU/L (0.5-5.7 mU/L) Immunoglobulin A (IgA) tissue transglutaminase positive What is the most appropriate next step in action?

A:

Duodenal biopsy

B:

Colonoscopy

C:

Sweat test

D:

Thyroid function test

Q.106. A 23-year-old woman is newly diagnosed with paranoid schizophrenia based on presence of both negative and positive symptoms of schizophrenia. Which of the following is the most effective medication?

A:

Clozapine

B:

Trazodone

C:

Fluphenazine

D:

Chlorpromazine

Q.107. An 18 year-old woman developed urticaria and wheezing following intravenous injection of contrast for abdominal CT scan. Blood Pressure 90/50 mmHg Heart rate 110 /min Temperature 37.2 °C. Which of the following is the most appropriate immediate therapy?

A:

Steroids

B:

Intubation

C:

Epinephrine

D:

Beta-blocker

Q.108. A 32-year-old man presents to the clinic with 2-year history of getting orgasm too readily during the sexual act. He complains that during the sexual intercourse he is having palpitations and worrying thoughts in his mind all the time. On examination, he has normal findings. Which of the following is the most likely diagnosis?

A:

Anxiety disorder

B:

Depressive disorder

C:

Bipolar affective disorder

D:

Primary erectile dysfunction

Q.109. A 29-year-old woman presents to the clinic with recurrent attacks of palpitations, chest pain, difficulty in breathing, and a fear of dying. She alsa trembles, experiences numbness and | tingling sensations in the hands and feet. The past medical history is not significant, On ~~ examination, she looks tense, and the hands are cold with fine tremors. Heart rate 108 /min, regular Temperature 37.2" C Blood pressure 120/82 mmHg Respiratory rate 14 /min Which of the following is the most likely diagnosis?

A:

Pheochromocytoma

B:

Hyperthyroidism

C:

Panic disorder

D:

Agoraphobia

Q.110. A 16-year-old girl is brought by her father to the Emergency Department with complaints of tachypnoea, light-headedness, paraesthesia and palpitations. Her father gives the history that she has recently failed her math test Which of the following is the most likely diagnosis?

A:

Oppositional defiant disorder

B:

Hyperventiation syndrome

C:

Munchausen syndrome

D:

Anxiety disorder

Q.111. Which of the following drugs used in Alzheimer's disease is most likely to cause hepatotoxicity?

A:

Tacrine

B:

Donepezil

C:

Rivastigmine

D:

Galantamine

Q.112. A 70-year-old man with Alzheimer's dementia becomes agitated and aggressive after developing hallucinations and delusions. A complete evaluation does not reveal any environmental, medical, or psychiatric cause and behavioural interventions failed to improve the. agitation. Which of the following is the most appropriate next step in management?

A:

Thioridazine

B:

Haloperidol

C:

Olanzapine

D:

Buspirone

Q.113. A 14 year old girl has a recent diagnosis of Turner syndrome. Which of the following statements are correct in relation to women with Turner syndrome?

A:

Turner syndrome females have no learning problems

B:

Human growth hormone is not effective in increasing height of girls with Turner syndrome

C:

Oestrogen replacement therapy for Turner syndrome is only started in adulthood

D:

Mother’s age is a strong risk factor

Q.114. A 20-year-old student presents to the Psychiatric Outpatient Clinic complaining that she feels ‘embarrassed, dizzy, and tremulous whenever she tries to answer verbally in the classroom. Which of the following is the best treatment?

A:

Small doses of alprazolam

B:

Behavioural therapy

C:

Relaxation training

D:

Bupropion

Q.115. A 37-year-old man with a history of chronic duodenal ulcer, presented to the Emergency Department complaining of frequent postprandial vomiting since last 2 weeks. On physical examination, he was dehydrated with positive succussion splash when shaking the abdomen. Which of the following is the most expected acid-base abnormality?

A:

Metabolic acidosis

B:

Metabolic alkalosis

C:

Compensated metabolic acidosis

D:

Compensated metabolic alkalosis

Q.116. Which of the folowing drug mechanism of action is most appropriate fo treat obsessional behavioural disorder?

A:

Blocks serotonin production

B:

Increases the availabilty of serotonin

C:

Increases the production of serotonin

D:

Decreases the availability of serotonin

Q.117. A 16-year-old girl presents for a follow-up visit complaining that she is unable to eat because of an intense desire to reduce her weight. Some time she develops an impulse to eat excessively and she then follows the impulse. She then intermittently self-induces vomiting. On examination, she looked weak. Which of the following is the most likely diagnosis?

A:

Bulimia nervosa

B:

Anorexia nervosa

C:

Personality disorder

D:

Obsessive compuisive disorder

Q.118. A 60 year old man presents with a lump in the left supraclavicular region. He complains of reduced appetite and he has lost 7 kg in the last two months. What is the most probable diagnosis?

A:

Thyroid carcinoma

B:

Gastric carcinoma

C:

Bronchial carcinoma

D:

Mesothelioma

Q.119. A 45 year old chronic alcoholic presents to A&E with an ataxic gait, hallucinations and is confused. He is given chlordiazepoxide. What is the most appropriate medication to be given with chlordiazepoxide?

A:

Acamprostate

B:

Thiamine

C:

Diazepam

D:

Disulfiram

Q.120. A 64-year-old man with emphysema was admitted with hematemesis. On endoscopy, a bleeding duodenal ulcer was diagnosed and controlled but the patient became confused and agitated (see lab results). Test Result from Normal Values ABG PCO2 75 4.7-6.0 kPa pH 7.23 7.36-7.45 ABG P02 42 106-142 kPa. Which of the following is the most appropriate therapy?

A:

Dexamethasone

B:

Sodium bicarbonate

C:

High flow O2 therapy

D:

Intubate and hyperventilate

Q.121. A mother brings her 12 year old son to you requesting surgery for his sticking out ears. She says that he is constantly teased in school because of his ears and wants him to undergo cosmetic surgery for it. The boy says he does not want surgery. What is the most appropriate action?

A:

Refer to private practice

B:

Schedule surgery as his consent is not needed

C:

Contact social services and explore their concerns

D:

Explain to mother that surgery is not possible without her son’s consent

Q.122. A 36-year-old man presented to the Emergency Department with a history of right liac fossa pain for 9 days associated with fever and vomiting. Physical examination revealed tender abdominal mass in the right iliac fossa with sluggish bowel sounds (see report). Temperature 39 °C CT scan: Appendicular abscess, 15 x 18 cm in size, in the right iliac fossa. Which of the following is a characteristic pathophysiology?

A:

Redistribution of blood flow

B:

Peripheral vasoconstriction

C:

Decreased cardiac index

D:

Bradycardia

Q.123. A 34-year-old man presents to the clinic for routine visit. During the consultation, he speaks loudly and rapidly without completely expressing one thought before beginning another. Speech patterns are rhyming and the patient is easily distracted by cues in the immediate surroundings. Which of the following is the most likely description for these findings?

A:

Flight of ideas

B:

Perseveration

C:

Thought insertion

D:

Loosening of associations

Q.124. A 58 year old man with a history of type 1 diabetes mellitus and hypertension for 13 years develops sudden central chest pain and abdominal pain for 45 minutes. The pain radiates to his jaw. It started while he was driving and it was associated with cold sweating and dyspnoea. He describes the pain as a burning pain. What is the most likely diagnosis?

A:

Myocardial infarction

B:

Pericarditis

C:

Pulmonary embolism

D:

Costochondritis

Q.125. A 35 year old man sat cross-legged for 30 minutes after which he found himself unable to dorsiflex his left foot and had loss of sensation in the web space between the big toe and the second toe. What is the most likely anatomical structure to be affected?

A:

Femoral nerve

B:

Sural nerve

C:

Sciatic nerve

D:

Deep peroneal nerve

Q.126. A 62 year old lady presents with right sided headache and decreased, blurry vision. She also has pain around her jaw especially when chewing. What is the most appropriate initial investigation?

A:

ESR

B:

Temporal artery biopsy

C:

CT head

D:

X-ray orbit

Q.127. A 28-year-old women with bipolar disorder, treated for 6 months, presents for follow-up visit. On examination, she has 8 kg weight gain, generalized weakness and hair loss. Which of the following is the most likely cause?

A:

Hypothalamic disorder

B:

Hypothyroidism

C:

Verapamil

D:

Lithium

Q.128. A 23-year-old man with bronchial asthma presents with a 5-year history of severe anxiety in social gatherings. He often has sweating and palpitation when he leads discussions at work. He prefers to sit alone at home. He notices that his presenting complaint is provoked by salbutamol. His physical examination is unremarkable. Which of the following is the most appropriate therapy?

A:

Sertraline

B:

Bupropion

C:

Alprazolam

D:

Propranolol

Q.129. Which of the following is the lowest fatal dose of tricyclic antidepressant?

A:

500 mg

B:

1gm

C:

2gm

D:

3gm

Q.130. A 4 year old girl presents to the emergency center with difficulty breathing and stridor. She has a temperature of 39.1 C. The parents state that the child had been in her usual state of health but awoke with a hoarse voice, and difficulty swallowing. They tell you that she has not been immunised because they are afraid of the side effects of the vaccination. What is the most likely diagnosis?

A:

Cystic fibrosis

B:

Acute epiglottitis

C:

Immunodeficiency

D:

Inhaled foreign body

Q.131. A 27-year-old man presents to the ciinic with a 1-month history of low mood and lack of sleep. It was associated with weight gain, isolation and concentration impairment. His wife mentioned that he bought a very expensive car and thinking that he is wealthy man 3 months ago. He is very talkative and difficult to interrupt. Which of the following medications is the most effective for long-term management?

A:

Lithium

B:

Bupropion

C:

Olanzapine

D:

Mitazapine

Q.132. A 35 year old lady presents with urinary incontinence 4 months after having a normal vaginal delivery of her second child. She says that she urinates a little every time she sneezes or coughs. On a speculum examintion, there are no anatomical abnormalities. What is the most approprite next step in management?

A:

Tension-free vaginal tape operation

B:

Bladder drill (retraining

C:

Ring pessary

D:

Pelvic floor exercise

Q.133. A 27-year-old man admitted to the Intensive Care Unit 4 weeks ago with severe infected necrotizing pancreatitis. He underwent several interventions for sepsis control and drainage of collections. He is on mechanical ventiation and inotropes. Which of the following metabolic responses is most expected?

A:

Reduced insulin resistance

B:

Reduced gluconeogenesis

C:

Increased lipolysis

D:

Hypoglycaemia

Q.134. A 21-year-old woman presents to the clinic with history of changes in the voice that she hears. Until now, it had been merely making critical comments about everything she did. For the past 2 weeks, however, she thinks the voices seemed to have been able to "suck thoughts out” of her and send them to others. Which of the following is the most ikely diagnosis?

A:

Mania

B:

Agoraphobia

C:

Schizophrenia

D:

Mood disorder

Q.135. A 56 year old man whose pain was relieved by oral Morphine, now presents with progressively worsening pain. Increasing the dose of oral morphine helps to relieve his pain. However, he now complains that the increased morphine makes him drowsy and he is unable to carry out his daily activities. What is the most appropriate next step?

A:

Replace oral morphine with oral oxycodone

B:

Replace oral morphine with oral tramadol

C:

Patient-controlled analgesia (PCA)

D:

Intravenous fentanyl

Q.136. A 40-year-old woman presents to the clinic with 2-month history of a sleep disturbance, loss of interest, low energy. poor memory, and suicidal ideation. On examination, she looks weak and inactive. Laboratory investigations are normal Which of the following is the most likely diagnosis?

A:

Dysthymia

B:

Bipolar disorder

C:

Major depression

D:

Minor depression

Q.137. A 16 year old clinically obese girl has not started her menstrual periods yet. She has severe acne and facial hair growth. Among her investigations, a high level of insulin was found. What is the most likely diagnosis?

A:

Cushing’s syndrome

B:

Graves’ disease

C:

Acquired hypothyroidism

D:

Polycystic ovary syndrome

Q.138. Which of the following is the most useful communication technique when taking a patient history?

A:

Humour

B:

Silent listening

C:

Specific questions

D:

Open-ended questions

Q.139. A 44 year old woman had a total abdominal hysterectomy and bilateral salpingo-oophorectomy 5 days ago. She now has increasing abdominal discomfort and is now bloating. She was encouraged to stay well hydrated but she is still unable to pass gas. No bowel sounds are heard. What is the most appropriate next step?

A:

X-ray abdomen

B:

Exploratory laparoscopy

C:

CT abdomen

D:

Ultrasound abdomen

Q.140. 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.141. A 38-year-old man has suffered from a severe hypovolemic shock due to traumatic splenic injury and underwent splenectomy. He received 8 units of packed red blood cells during resuscitation and surgery. He was admitted to the intensive care unit. On the 3rd post-operative day, he was febrile (see report). Gram stain of blood: Positive for gram-negative bacilli. Which of the following is the most likely source of bacteremia?

A:

Contaminated blood

B:

Urinary tract infection

C:

Respiratory tract infection

D:

Translocation from the bowel

Q.142. A 30-year-old man presents to the Outpatient Clinic with manifestations of opioid withdrawal. After full investigations, he was diagnosed as a heroin addict. As part of the rehabilitation process, he was prescribed a substitute for the addictive drug. Which of the following drugs should be prescribed?

A:

Naloxone

B:

Papaverine

C:

Methadone

D:

Dextromethorphane

Q.143. A 30-year-old man has personality disorder, which is characterized by being aggressive and violent. Which of the following is the most likely associated with violence?

A:

Low levels of serotonin

B:

High levels of serotonin

C:

Low levels of endorphins

D:

High levels of endorphins

Q.144. A 74 year old woman with breast cancer and bone metastasis has her pain relieved with oral morphine 60 mg twice a day. For the past 2 weeks she has needed to use an additional 20 mg of oral morphine every 4 hours. What is the most appropriate regimen of analgesia to prescribe?

A:

Tramadol 100 mg every 4 hours

B:

Oral morphine 120 mg twice a day and 5 mg oral morphine as required

C:

Oral morphine 120 mg twice a day and 10 mg oral morphine as required

D:

Oral morphine 120 mg twice a day and 40 mg oral morphine as required

Q.145. A 65-year-old man with depression presents to the clinic for follow-up visit. The physician did his consultation using a bio-psycho social model of treatment. Which of the following is a characteristic of this treatment model?

A:

Evidence based medicine

B:

Traditional allopathy

C:

Geriatric medicine

D:

Holistic medicine

Q.146. A 33-year-old man is known to have renal impairment, underwent appendectomy for acute appendicitis. On the first day after surgery, he was complaining of papitation (see lab result and report). Test Result Normal Value Potassium 6.5 3.5-5.1 mmollL ECG: Tented T-waves. Which of the following is the most appropriate initial step in management?

A:

Intravenous infusion of dextrose with insulin

B:

Intravenous infusion of sodium bicarbonate

C:

Intravenous calcium gluconate

D:

Immediate haemodialysis

Q.147. Which of the following systems is stimulated by stressful situation?

A:

Urinary

B:

Respiratory

C:

Sympathetic

D:

Parasympathetic

Q.148. A 55 year old woman complains of retrosternal chest pain and difficulty swallowing which is intermittent and unpredictable. She says that food gets stuck in the middle of the chest and she has to clear it with a drink of water. She is then able to finish the meal without any further problem. A barium meal shows a ‘corkscre patterned oesophagus’. What is the most likely cause of the dysphagea?

A:

Oesophageal candidiasis

B:

Oesophageal carcinoma

C:

Oesophageal spasm

D:

Pharyngeal pouch

Q.149. A 6 year old child is brought to the clinic by his mother. She says that his teacher complains that he is easily distracted and interruptes others when it is their turn to answer questions. His mother says that he is not able to do a particular task for a long time and cannot play quietly. He is careless and often breaks things. What is the most likely diagnosis?

A:

Autism spectrum disorder

B:

Dyslexia

C:

Attention deficit hyperactivity disorder (ADHD)

D:

Antisocial personality disorder

Q.150. A patient presented with frequent vomiting due to gastric outlet obstruction. Which of the following is the most expected abnormalities?

A:

Metabolic acidosis with hyperkalemia

B:

Metabolic alkalosis with hypokalaemia

C:

Metabolic acidosis with hypokalaemia

D:

Metabolic alkalosis with hyperkalaemia

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MOCK TEST 6

Q.1. A 33 year old mother of a child with cystic fibrosis is concerned of her next baby also having cystic fibrosis. She is with the same partner and they both are completely healthy. What is the most likely probability of their future child having cystic fibrosis?

Q.5. A 40-year-old diabetic man was treated appropriately with small doses of insulin. On next follow- up visit, he bought a very expensive watch as a gesture of gratitude to his physician. Which of the following is the most appropriate response?

Q.6. A 72-year-old man experiences inability to sustain attention, disorganized thinking, hallucinations, and disorientation commencing 12 hours after an aortic femoral popliteal bypass. The symptoms fluctuated during the next 2 days. Which of the following is the most likely diagnosis?

Q.7. A 40-year-old woman presented with progressive redness over the dorsum of the left hand associated with pain and fever. She gave a history of a knife prick at the affected area 3 days ago. Temperature 37.9 °C. Which of the following is the most likely diagnosis?

Q.8. A 45-year-old man involved in a motor vehicle accident with an isolated head injury, remains in coma for 5 days after the accident. Which of the following is the most appropriate feeding method in the early stage of management?

Q.9. Which of the following ciinical signs caused by a lesion in Wernicke's area?

Q.14. A 22 year old woman complains of recent onset of severe itching and wheals which followed a viral infection. On inspection, numerous wheals of all sizes are noticed on her skin. The wheals tend to come and go within hours. What is the most likely diagnosis?

Q.15. A 34-year-old woman presents to the clinic with a 6-month history of extreme fear of going to the park, the 200 and sporting events. This has worsened o the point where she has stopped going out of the house. Which of the following is the most likely diagnosis?

Q.18. Which of the following is the most appropriate management plan for major depression?

Q.20. Which of the following is a contraindication for liver transplantation?

Q.22. Which of the following selective serotonin reuptake inhibitors is the most toxic in overdose?

Q.23. A 15 year old girl presents with an itchy and scaly rash over her face and the extensor surfaces of her arms. Her grandmother also suffers from a similar skin disease. Her mom is worried that the rash is contagious. Which of the following is the best advice that you can give her?

Q.25. Which of the following is the most likely a characteristic of a major depressive illness?

Q.26. A 6-year-old boy is brought to the clinic by his mother. She noticed that the child has been eating clay and paper for the last 4 months. Which of the following is the most appropriate initial treatment?

Q.29. This is the measure of dispersion of a set of values. What is the most likely term

Q.31. A 43-year-old woman delivered a full-term infant. On examination, he has an epicanthic folds, delayed milestones, flat facial profile, simian paimar creases and an atrial septal defect. Which of the following is the most likely diagnosis?

Q.32. Which of the following is the diagnostic criteria for Attention deficit hyperactivity disorder in children, according to the Intemational Classification of Diseases-10?

Q.33. A 12-year-old obese boy presents to the Primary Care Clinic with history of being teased by sen tachool and, 28 8 rest. hes considered "king 2 tof pls oust go fo seep and not Which of the following is the most appropriate action?

Q.35. A 26 year old man strongly believes that every elderly man he meets is likely to be his father. Although they look different, he is sure that it is his father wearing a different disguise. What is the most likely kind of delusion this man is suffering from?

Q.37. A 42 year old lady presents with a history of double vision, ptosis and facial numbness. Which anatomical site is the most likely to be affected?

Q.38. A 23-year-old man is brought to the psychiatrist clinic because for the first time he started to hear some voices talking to him with unknown sources. On examination, he was apathetic and emotionally withdrawn. Which of the following is the best management?

Q.39. Which of the following is associated with dyslexia?

Q.40. Which of the following is a potential side effect of amitriptyline?

Q.41. A 45 year old man with type 1 diabetes mellitus has his annual checkups. Ophthalmoscopy shows dot and blot haemorrhage with hard exudates. What is the most likely diagnosis?

Q.43. A 7-year-old boy is brought by his mother because he was unable to sit in school without interrupting the class, wandering around the classroom or poking his neighbours. On ‘examination, he has normal growth parameters. Which of the following is the best management?

Q.44. A 58-year-old man presents to the clinic with a history of a disturbed recent memory as a cardinal feature of his disturbed state of mind along with behavioural changes. Which of the following is the most likely diagnosis?

Q.45. A 30 year old man has frequent episodic headaches with palpitations. He suffers from anxiety and has the occasional tremor on both his hands. His blood pressure was found to be 160/110 mmHg. What is the most likely diagnosis?

Q.49. Which of the following conditions is most often associated with manic behaviour?

Q.53. A 21-year-old man with depression presents for follow-up visit. During the consultation, the psychiatrist asked, “Do you think that you are mentally ili?" Which of the following findings is the psychiatrist wants to assess?

Q.58. A 76-year-old man newly diagnosed with depression started 30 mg of amitriptyline each night Shortly after the beginning of treatment, he complained of dizziness every morning. Which of the following is the most appropriate next step in management?

Q.61. A 45-year-old man with recurrent episodes of schizophrenia is on maintenance therapy to maintain suppression of symptoms, prevent relapse, improve quality of life, and support engagement in psychosocial therapy. Which of the following is the best outcome following the maintenance therapy?

Q.62. A 36-year-old diabetic woman presents to the clinic for follow-up visit, and after an initial assessment, the physician wished to perform a physical examination. He first asked her permission, which was granted. Which of the following ethical measures was the physician adopting?

Q.63. Which of the following is the most likely clinical presentation of delusional patients?

Q.64. A 72-year-old man who lost his spouse 2 months ago after a prolonged illness, presents with a sad mood, decreased appetite, and sieep disturbance. Which of the following is the most likely diagnosis?

Q.65. A 41-year-old man underwent blood transfusion for postoperative bleeding. He developed pain’ at the site of the infusion with fever and chest tightness after few minutes of starting the transfusion. Temperature 38 °C. Which of the following is the most likely diagnosis?

Q.67. A 20-year-old man presents with a 2-year history of intense fear before giving classes asa | teacher in a secondary school. He claims that itis only a matter of ime before a major teaching | mistake is made. Which of the following phobias is the most likely diagnosis?

Q.68. Which of the following factors indicates a poor prognosis for schizophrenia?

Q.69. A 30-year-old man presents to the clinic complaining of reduced energy, lack of enjoyment, reduced sleep, reduced appetite, suicidal ideas and lack of self-confidence. Examination and ab results are normal. Which of the following is the most likely diagnosis?

Q.70. A 48 year old man attends his GP surgery. He was started on fluoxetine 8 weeks ago for depression and is now requesting to stop his medication as he feels well and does not think he is depressed any longer. What is the most appropriate advice to give to him in regards to his treatment?

Q.71. A 60 year old man has sudden severe chest pain radiating to both shoulders and accompanied by shortness of breath. There was no history of trauma. His medical history includes hypertension. Examination shows cold peripheries and paraplegia. What is the most appropriate diagnosis?

Q.72. Stress leads to an increase in cortisol and catecholamine secretion that can alter the levels of lymphocyte production that fight disease. Which of the following is the most likely explanation for these effect?

Q.74. Which of the following is the main difference between delirium and dementia?

Q.75. An autistic 8 year old child puts a green pea in his ear while eating. Otoscopy shows a green coloured object in the ear canal. What is the most appropriate approach to remove the green pea?

Q.78. Which of the following medications causes insomnia, anxiety and restlessness?

Q.79. A 23-year-old woman with frequent panic attacks, presents to clinic complains that during her fast attack 3 days ago she felt that she was disconnected from the world, as if the environment is strange. Which of the following would best describe her feelings?

Q.80. A 44 year old man presents with muffled hearing and constant high-frequency tinnitus. He also complains of the feeling of pressure in the right ear and vertigo. He has double vision when looking to the right. What is the most likely diagnosis?

Q.82. A 27 year old lady was admitted with fever, rigors, and right loin pain. A dipstick urinalysis was positive for blood, leukocyte esterase and nitrites. A midstream specimen of urine (MSU) was sent for culture. She has no medical history of significance. What is the appropriate action?

Q.84. A 23 year old man has been using intravenous drugs. You explain to him the dangers of this, including the risk of contracting a blood borne virus such as Hepatitis B. Which of the following laboratory tests will first become abnormal after acquiring hepatitis B infection?

Q.85. Which of the following antipschotic medications is most likely cause weight gain?

Q.92. Which of the following is described as "False belief not in accordance with a person's intelligence or culture™?

Q.93. A 65 year old lady has severe pain along one side of her head and jaw. She complains that she is unable to comb her hair because of severe pain when the comb touches her scalp. She has no neurological deficits on examination. What is the most likely cause of her symptoms?

Q.94. Which of the following is an example of the open-ended questions in consultation?

Q.98. A 2 year old girl preseents with a painless limp. On examination, there is unequal skin folds and the left leg is shortner than the right leg. What is the most likely diagnosis?

Q.99. A 56-year-old man with schizophrenia is started on neuroleptic medications to treat his psychotic symptoms. Which of the following side effects is the patient at greatest risk?

Q.100. Which of the following is the most likely benefit of using antipsychotic therapy in schizophrenic patients?

Q.101. Which of the following conditions is the most likely cause of dementia?

Q.103. A 75 year old man is found to be unresponsive. The ward doctor is called to the patient’s bedside. He is not breathing and has no detectable pulse. Which is the most appropriate next step?

Q.104. A 35-year-old depressed housewife was started with antidepressants. After 2 weeks of taking the medication, the patient started complaining of constipation. Which of the following groups of antidepressants is the most likely cause?

Q.106. A 23-year-old woman is newly diagnosed with paranoid schizophrenia based on presence of both negative and positive symptoms of schizophrenia. Which of the following is the most effective medication?

Q.107. An 18 year-old woman developed urticaria and wheezing following intravenous injection of contrast for abdominal CT scan. Blood Pressure 90/50 mmHg Heart rate 110 /min Temperature 37.2 °C. Which of the following is the most appropriate immediate therapy?

Q.110. A 16-year-old girl is brought by her father to the Emergency Department with complaints of tachypnoea, light-headedness, paraesthesia and palpitations. Her father gives the history that she has recently failed her math test Which of the following is the most likely diagnosis?

Q.111. Which of the following drugs used in Alzheimer's disease is most likely to cause hepatotoxicity?

Q.113. A 14 year old girl has a recent diagnosis of Turner syndrome. Which of the following statements are correct in relation to women with Turner syndrome?

Q.114. A 20-year-old student presents to the Psychiatric Outpatient Clinic complaining that she feels ‘embarrassed, dizzy, and tremulous whenever she tries to answer verbally in the classroom. Which of the following is the best treatment?

Q.116. Which of the folowing drug mechanism of action is most appropriate fo treat obsessional behavioural disorder?

Q.118. A 60 year old man presents with a lump in the left supraclavicular region. He complains of reduced appetite and he has lost 7 kg in the last two months. What is the most probable diagnosis?

Q.119. A 45 year old chronic alcoholic presents to A&E with an ataxic gait, hallucinations and is confused. He is given chlordiazepoxide. What is the most appropriate medication to be given with chlordiazepoxide?

Q.121. A mother brings her 12 year old son to you requesting surgery for his sticking out ears. She says that he is constantly teased in school because of his ears and wants him to undergo cosmetic surgery for it. The boy says he does not want surgery. What is the most appropriate action?

Q.125. A 35 year old man sat cross-legged for 30 minutes after which he found himself unable to dorsiflex his left foot and had loss of sensation in the web space between the big toe and the second toe. What is the most likely anatomical structure to be affected?

Q.126. A 62 year old lady presents with right sided headache and decreased, blurry vision. She also has pain around her jaw especially when chewing. What is the most appropriate initial investigation?

Q.127. A 28-year-old women with bipolar disorder, treated for 6 months, presents for follow-up visit. On examination, she has 8 kg weight gain, generalized weakness and hair loss. Which of the following is the most likely cause?

Q.129. Which of the following is the lowest fatal dose of tricyclic antidepressant?

Q.136. A 40-year-old woman presents to the clinic with 2-month history of a sleep disturbance, loss of interest, low energy. poor memory, and suicidal ideation. On examination, she looks weak and inactive. Laboratory investigations are normal Which of the following is the most likely diagnosis?

Q.137. A 16 year old clinically obese girl has not started her menstrual periods yet. She has severe acne and facial hair growth. Among her investigations, a high level of insulin was found. What is the most likely diagnosis?

Q.138. Which of the following is the most useful communication technique when taking a patient history?

Q.143. A 30-year-old man has personality disorder, which is characterized by being aggressive and violent. Which of the following is the most likely associated with violence?