Nash Qbank

Q.1. A 40-year-old man presents with an advanced colonic malignancy. What is the most likely site of metastasis?

A:

Lung

B:

Liver

C:

Thyroid

D:

Prostrate

Q.2. A 55-year-old butcher accidentally cut himself at work. Later that night, he noticed some red lines radiating from the wound. Which of the following is the most likely cause?

A:

Brucella

B:

Klebsiella

C:

Pseudomonas

D:

Streptococcus pyogenes

Q.3. Where is the most common primary location of basal cell carcinoma?

A:

Face

B:

Breast

C:

Lower limb

D:

Upper limb

Q.4. A young man received 4 litres of blood in the Emergency Department following a road traffic accident. Which of the following is the most likely complication?

A:

Hypokalaemia

B:

Citrate toxicity

C:

Hypocalcaemia

D:

Hyperalbunemia

Q.5. A 38-year-old patient developed a painful swelling in the right lower quadrant of his abdomen after moving a heavy object. Examination confirmed a localized tender swelling in the right lower ‘abdominal quadrant with negative cough impulse; it persisted even with contraction of ‘abdominal muscles. Which of the following is the most likely diagnosis?

A:

Ventral hernia

B:

Appendicular mass

C:

Extraperitoneal lipoma

D:

Rectus sheath hematoma

Q.6. A 25-year-old woman presented with a right breast lump, which has been increasing in size over the past year. Physical examination confirmed a 10x12 cm firm, mobile mass involving the upper halve of the right breast with no palpable axillary lymph nodes (see report). Core needle biopsy: Malignant phyllodes tumour. Which of the following is the most appropriate next step?

A:

Wide local excision

B:

Whole body PET scan

C:

Contrast CT scan of chest

D:

Immunohistochemistry for hormone receptors

Q.7. A 25-year-old patient sustained a blunt trauma to the right chest wall; there was paradoxical movement of the right side of the chest (see report). Heart rate 96 /min Respiratory rate 35 /min ; Oxygen saturation 84 % Chest X-ray: Fracture 2nd through 4th ribs at more than 1 site Which of the following is the most appropriate initial management?

A:

Fluid resuscitation

B:

Assisted ventilation

C:

Needle decompression

D:

Thoracostomy chest tube

Q.8. A 50-year-old hypertensive diabetic complains of a 2-month history of perianal swelling with discharge. 2 months ago, he noticed a small swelling, which ruptured. Blood pressure 160/100 mmHg Heart rate 90 /min Respiratory rate 18 /min Temperature 36.6 °C Which of the following is the most likely diagnosis?

A:

Anal fissure

B:

Perianal fistula

C:

Perianal abscess

D:

Thrombosed piles

Q.9. A 40-year-old diabetic patient complains of a painful perianal swelling with fever for the last 3 days (see lab results) Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 20 /min Temperature 38 °C Test Result Normal Values Hb 135 130-170 g/L (Male) 120-160 g/L (Female) WBC 164.5-10.5 x 109/L Neutrophils 80 40-60% Random Glucose 6.5 3.9-5.5 mmol/L Which of the following is the most likely diagnosis?

A:

Anal fissure

B:

Hemorrhoids

C:

Perianal abscess

D:

Thrombosed piles

Q.10. A young man presents with a lump on the ight mid-thigh. On examination, the overlying skinis normal, the mass is soft, movable with positive fluctuation test Which of the following is the most likely diagnosis?

A:

Lipoma

B:

Sarcoma

C:

Aneurysm

D:

Sebaceous cyst

Q.11. A 14-year-old patient presented with a painless neck swelling. Examination confirmed a midline neck swelling below the hyoid bone that moves up and down with swallowing. Which of the following is the most likely diagnosis?

A:

Cystic hygroma

B:

Thyroglossal cyst

C:

Midine dermoid cyst

D:

Submental lymphadenopathy

Q.12. A 55 year old man comes to the emergency department with severe abdominal pain and lower back pain. He has a history of a pulsatile swelling in the abdomen. He has a pulse rate of 125 beats/minute and a blood pressure of 70/40 mmHg. What is the most appropriate initial management?

A:

Urgent abdominal computed tomography

B:

Urgent abdominal ultrasound

C:

Intravenous fluids 0.9% normal saline to bring systolic blood pressure to 90 mmHg

D:

Intravenous fluids 0.9% normal saline to bring systolic blood pressure to 120 mmHg

Q.13. A 28-year-old woman was undergoing a laparoscopic cholecystectomy for gallstones. After creating pneumo-peritoneum and inserting the trocars, her heart rate was 40 beats/min. Which of the following is the most likely cause?

A:

Overhydration

B:

Cold gas insufflation

C:

Increased venous return

D:

Rapid stretching of parietal peritoneum

Q.14. A 6 year old boy is brought to the hospital by his mother with bleeding from his gums and nose. His mother complains that he has been having recurrent sore throats that come and go in last couple of months. Pale conjunctivae is noticed on examination. What is the most likely single cell type associated with his diagnosis?

A:

Clumped platelets

B:

Microcytes

C:

Granulocyte without blast cells

D:

Blast cells

Q.15. A 57-year-old hypertensive complained of non-specific lower abdominal pain. Hormona studies for adrenal glands are within normal values. A CT scan was ordered (see report) CT scan: 5 cm rounded hypodense left adrenal mass, described as lipid-rich lesion. Which of the following is the most appropriate management?

A:

Adrenal MRI

B:

No intervention is indicated

C:

Laparoscopic adrenalectomy

D:

Image guided adrenal biopsy

Q.16. A 33 year old man comes to the clinic complaining of hearing loss in one ear. There is no earache, fever, vertigo, or tinnitus. On inspection, a buildup of wax is observed. What is the most appropriate initial management?

A:

Olive oil ear drops

B:

Ear irrigation

C:

Refer to an Ear Nose and Throat specialist for removal of wax

D:

Advise to keep ear dry

Q.17. Which of the following is most likely to cause small bowel distention?

A:

Nitrous oxide

B:

Muscle relaxants

C:

Depolarizing agents

D:

Esophageal intubation

Q.18. A 30-year-old presented with intermittent perianal pain associated with purulent discharge. Examination confirmed a low-lying perianal fistula with an external opening posteriorly close to the anal verge. Which of the following is the most appropriate management?

A:

MRI pelvis

B:

Fistulogram

C:

Fistulotomy

D:

Lateral sphincterotomy

Q.19. Which of the following is the most definitive treatment for a post-renal transplant lymphocele?

A:

Percutaneous aspiration

B:

Observation and follow up

C:

Fenestration into the peritoneal cavity

D:

Percutaneous injection of sclerotherapy

Q.20. A 65-year-old man presented with a 3-month history of right upper quadrant abdominal pain, associated with a loss of appetite and weight loss. He has hepatitis C (see lab result and report). Test Result Normal Value Alpha fetoprotein 1160 0-40 ng/mL. CT scan abdomen: Hypervascular lesion at the right lobe of the liver. Which of the following is the most likely diagnosis?

A:

Hamartoma

B:

Cholangiocarcinoma

C:

Hepatocellular adenoma

D:

Hepatocellular carcinoma

Q.21. A 62 year old man has bone pain at his hips and back. On further investigatioin, alkaline phosphatase was found to be elevated in his blood. An X-ray shows multifocal sclerotic patches in the skull. What is the most likely diagnosis?

A:

Paget’s disease

B:

Osteoporosis

C:

Osteomalacia

D:

Multiple myeloma

Q.22. A 48 year old man attends clinic for a routine eye check up as he has a history of type 1 diabetes. Fundoscopy shows neovascularization at the retina. What is the most appropriate management?

A:

Strict blood glucose control

B:

Review in 12 months

C:

Non urgent referral to specialist

D:

Laser photocoagulation

Q.23. A 44 year old woman presents with memory loss, poor concentration and inability to recognize household objects. She has right-handed involuntary writhing movement which has just recently started. She reports occasional difficulty in walking. There is a strong family history with similar symptoms. What is the most likely diagnosis?

A:

Friedreich’s ataxia

B:

Wilson’s disease

C:

Huntington’s disease

D:

Motor neuron disease

Q.24. A 12 month old male infant presents to clinic because his mother is concerned that the child cannot sit on his own, crawling but not standing with support, unable to pick up small items, and is not socially interactive with his older sibling. What is the best management?

A:

Arrange hearing test

B:

Assess developmental milestones

C:

Reassure

D:

MRI brain

Q.25. A 40-year-old is admitted with a 3-day history of diffuse abdominal pain. On examination, there is diffuse abdominal tenderness along with Grey Tumers sign. Which of the following is the most likely diagnosis?

A:

Acute porphyria

B:

Mesenteric ischemia

C:

Necrotizing pancreatitis

D:

Ruptured aortic aneurysm

Q.26. A 27 year old woman has pelvic pain, dysmenorrhoea and increasingly heavy periods over the last 12 months. She also complains of dyspareunia. There is generalized pelvic tenderness without peritonism. A pelvic ultrasound was requested and was reported with no evidence of adenomyosis or ovarian endometrioma. What is the most likely diagnosis?

A:

Endometriosis

B:

Uterine fibroid

C:

Pelvic congestion syndrome

D:

Endometrial hyperplasia

Q.27. A young man presented with a chronic infection of both axillae. Examination confirmed the presence of multiple discharging sinuses. Which of the following is the most likely source?

A:

Hair follicles

B:

Sebaceous glands

C:

Eccrine sweat glands

D:

Apocrine sweat glands

Q.28. A young man comes fo the Emergency Department afer being involved in a road traffic | accident. A Focused assessment with sonography for trauma was ordered. Which of the following is the most likely finding?

A:

Pneumothorax

B:

Vascular injury

C:

Sub dural haematoma

D:

Intraperitoneal free fluid

Q.29. A 42-year-old man complains of chest pain after being involved in a motor vehicle accident. Examination confirmed a patent airway, equal air entry on both sides of the chest, and distended neck veins. Blood pressure 88/45 mmHg Heart rate 110 /min Respiratory rate 30 /min Which of the following is the most likely diagnosis?

A:

Flail chest

B:

Cardiac tamponade

C:

Tension pneumothorax

D:

Simple pneumothorax

Q.30. A 20-year-old man underwent left open inguinal hernia mesh repair 3 weeks ago. He presented today, with continuous intractable groin pain radiating to the left upper thigh and associated with persistent hyperesthesia. Physical examination excluded any recurrence or surgical site infection. Which of the following is the most appropriate treatment?

A:

Nerve block

B:

Nerve block

C:

Systemic antiinflammatory

D:

Neurectomy and mesh removal

Q.31. A 3 year old girl ingested 10 capsules from her grandmother’s medication bottle thinking it was candy. By the time the child is in the Emergency Department, she is drowsy and lethargic. Paramedics noted myoclonic twitching. ECG reveals tachycardia and widened QRS. Potassium is elevated. What most likely medication did the child ingest?

A:

Tricyclic antidepressants

B:

Acetaminophen

C:

Thyroxine

D:

Amiodarone

Q.32. A double-blind study was designed to test the efficacy of a drug. One group of patients consisting of 898 people were given a placebo drug and the other group of patients consisting of 701 were given the active drug. Both groups were to be followed up for one year. Halfway through the trial, 25% of participants in the placebo group dropped out of study and 3% of participants taking the active drug dropped out of the study. What is the best explanation for this occurrence?

A:

Chance event

B:

Breakdown of the double-blind study

C:

Failure of the active drug

D:

An initial randomisation error.

Q.33. A 38-year-old man presented with a 4-hour history of sudden severe abdominal pain. He reports frequent use of non-steroidal anti-inflammatory drugs for joint pain. Examination confirmed generalized abdominal tenderness and guarding with absent bowel sounds (see lab result). Temperature 37.8 °C Test Result Normal Value WBC 134.5-10.5 x 1091 Which of the following is the most appropriate initial imaging?

A:

Erect chest X-ray

B:

CT scan abdomen

C:

Ultrasound abdomen

D:

Supine abdominal X-ray

Q.34. A hypothyroid patient is scheduled to undergo an elective surgery. Which of the following is the most appropriate management?

A:

Perform surgery then start thyroxine

B:

Start thyroxin and proceed with surgery

C:

Perform surgery if clinical asymptomatic

D:

Delay surgery unti the patient is euthyroid

Q.35. A 25-year-old man was brought to the Emergency Department after being involved in a motor vehicle accident. He opened his eyes spontaneously and responded appropriately to verbal commands. His respiration was shallow and he had left chest wall contusion. He was able to shrug his shoulders but unable to move his elbows or lower limbs. Blood pressure 80/40 mmHg Heart rate 70 /min Respiratory rate 30 /min Which of the following is the most likely cause of the hypotension?

A:

Cardiac tamponade

B:

intemal hemorrhage

C:

High spinal cord injury

D:

Tension pneumothorax

Q.36. A 28 year old man has a headache that worsens on bending his head forward. He has no nausea or vomiting. The headache tends to be at its worst first thing in the morning and improves by the afternoon. What is the most likely diagnosis?

A:

Chronic sinusitis

B:

Trigeminal neuralgia

C:

Migraine

D:

Cluster headache

Q.37. A 28-year-old patient underwent resection of the terminal ileum for inflammatory bowel disease. | Which of the following nutrients is most important replace parenterally?

A:

Iron

B:

Zinc

C:

Bile salts

D:

Vitamin B12

Q.38. A 38-year-old man sustained a pelvic fracture in a motor vehicle accident. There was blood per urethra (see report). Retrograde urethrogram: Retroperitoneal urethral injury. Which of the following is the most appropriate next step?

A:

Urethroscopy

B:

Foley's catheter

C:

Laparoscopic repair

D:

Suprapubic cystostomy

Q.39. A 20-year-old primigravida complains of severe perianal pain post-defection along with fresh bleeding per rectum for the last 4 days. She describes the pain to be sharp and persisting long after the passage of stool. She denies any history of associated swelling or fever. Which of the following is the most likely diagnosis?

A:

Anal fissure

B:

Haemorrhoids

C:

Perianal abscess

D:

Thrombosed piles

Q.40. Which of the following is the most ikely pathogen to infect a polytetrafiucroethylene vascular graft?

A:

Klebsiella pneumonia

B:

Staphylococcus aureus

C:

Pseudomonas aeruginosa

D:

Staphylococcus epidermidis

Q.41. A 36-year-old man presents with a 2-day history of constipation. On examination, he looks nervous, and severe pain was experienced during parting of the perianal region. Linear cracks were noted at both at 6 and 12 O'clock positions. Which of the following is the most likely diagnosis?

A:

Anal fissure

B:

Perianal fistula

C:

Solitary rectal ulcer

D:

Intersphincteric abscess

Q.42. An immunocompromised patient presented with an acute painful perineal swelling. Examination confirmed erythematous fluctuant area with crepitus over it and a foul-smelling discharge. Which of the following is the most appropriate management?

A:

Penicillin G infusion

B:

Surgical debridement

C:

Aspiration of collection

D:

Topical polymycin ointment

Q.43. A 73 year old woman living in a nursing home, presents with rashes on her finger webs and also at her axillary folds. She complains of itching which is more severe at night. What is the most appropriate mananagement?

A:

0.5% permethrin

B:

Doxycycline

C:

5% permethrin

D:

Aciclovir

Q.44. A 37-year-old man presented to Emergency Department with a 10-day history of frequent vomiting. He was dehydrated, and his electrocardiogram showed flattening of the T-wave. Which of the following is the most likely acid-base abnormality?

A:

Metabolic alkalosis

B:

Metabolic alkalosis

C:

Compensated metabolic acidosis

D:

Compensated metabolic alkalosis

Q.45. A 60 year old diabetic presents with non-healing ulcers on his calves and a cramp-like pain in the calves relieved by rest. He does not smoke, but has a history of hypertension which is well controlled with medication. Physical examination shows cold extremities with lack of heair around the ankles and absent distal pulses. What is the most likely diagnosis?

A:

Acute limb ischaemia

B:

Peripheral arterial disease (PAD)

C:

Buerger’s disease

D:

Deep vein thrombosis

Q.46. A 55 year old man presents with “rubbery” painless lump on his neck. He also has significant weight loss over the past 6 months, fever and night sweats. The diagnosis of Hodgkin’s lymphoma was later confirmed with a lymph node excision biopsy. What type of cell is associated with Hodgkin’s lymphoma?

A:

T-cells

B:

Reed-Sternberg cells

C:

B-cells

D:

Macrophages

Q.47. A young man is hypoxic 24 hours after major upper abdominal surgery. Which of the following is the most likely cause?

A:

Pneumonia

B:

Basal atelectasis

C:

Pulmonary embolism

D:

Intra-abdominalbleeding

Q.48. A 32-year-old man underwent a hemorrhoidectomy for a prolapsed pile. § hours later, he complained of severe supra-pubic pain and was unable to pass urine. Which of the following is the most likely cause?

A:

Dehydration

B:

Urethral injury

C:

Inadequate analgesia

D:

Post-operative hematoma

Q.49. A 50-year-old woman post-modified radical mastectomy, presented with numbness and a burning sensation on the inner aspect of upper arm. Which of the following nerves is most likely injured?

A:

Thorcodorsal

B:

Long thoracic

C:

Medial pectoral

D:

Intercostobrachial

Q.50. A61 year oldman presents with fatigue and palpitations. His past surgical history includes an ileal resection which was performed one year ago. An FBC was requested and the results are as follows: Haemoglobin 93 g/L Mean cell volume (MCV) 111 fL What is the most likely diagnosis?

A:

Anaemia of chronic disease

B:

Iron deficiency

C:

Folate deficiency

D:

Vitamin B12 deficiency

Q.51. A patient complains of painless fresh bleeding post defecation over the last 6 Which of the following is the most likely diagnosis?

A:

Anal fissure

B:

Haemorrhoids

C:

Perianal fistula

D:

Perianal abscess

Q.52. A patient who has been in the Intensive Care Unit for 2 weeks is receiving parenteral nutrition (see results). Test Result in Normal Values Platelets count 250 150-400 x 109/L APTT 37 30-40 sec INR20.8-1.2 Total bilirubin 12 3.5-16.5 pmol/L Which of the following is the most likely cause?

A:

Disseminated intravascular coagulopathy

B:

Vitamin K deficiency

C:

Factor VII deficiency

D:

Chronic liver disease

Q.53. A 36 year old woman is planning to undergo a laparoscopic tubal sterilisation. What is the risk of pregnancy after sterilisation by tubal ligation?

A:

1:50

B:

1:200

C:

1:500

D:

1:1000

Q.54. A 35 year old male presents to his GP with the complaint of diarrhoea. He complains that he has been having recurrent, chronic diarrhoea for the past 5 months now. He claims to not have noticed any discernible pattern. Her does not smoke and is a teetotaler. Upon examination, the patient’s clothing appears to be ill-fitting. A blood test was subsequently done and revealed the following: Haemoglobin 118 g/L (130-180 g/L) Mean cell volume (MCV) 106 fL (76-96 fL) A peripheral blood film is significant for a diamorphic picture of red cells. Following the results of the blood tests, the patient was booked for an endoscopy. A few tissue samples were taken during the endoscopy and sent for histology evaluation. What is the most likely pathology to be seen on histology?

A:

Caseating granulomas

B:

Lymphocytic infiltration of the submucosa

C:

Focal infiltration of basophils

D:

Villous atrohy

Q.55. A 60-year-old man had a laparoscopic inguinal hernia repair 5 days ago. Today, he noticed a swelling at the wound area. Examination confirmed a swelling at the site of surgery that was not red, or hot, but mildly tender. There was no cough impulse. Blood pressure 135/80 mmHg Heart rate 80 /min Respiratory rate 24 /min Temperature 37.2 °C Which of the following is the most likely diagnosis?

A:

Seroma

B:

Hematoma

C:

Recurrence

D:

Wound infection

Q.56. A 60-year-old patient presented with a 6-month history of a dull achey abdominal swelling associated with weight loss. Examination confirmed a 20x20 cm firm, non-tender, intra- abdominal mass (see report). Abdominal CT scan: Lobulated soft tissue mass arising from retro-peritoneum, there was multiple hypodense liver lesions. Which of the following is the most likely diagnosis?

A:

Liposarcoma

B:

Lymphosarcoma

C:

Germ cell tumour

D:

Peripheral nerve tumour

Q.57. A 30-year-old woman sustained a burn from an oven grill. 8 days later, she noticed greenish discharge in the wound. Which of the following is the most likely cause?

A:

E.coli

B:

Kiebsiella

C:

Pseudomonas

D:

Streptococcus pyogenes

Q.58. A 75 year old woman has weakness of the left side of her face and pain deep within the left ear. The ear pain was paroxysmal at first but after a day it became constant and radiates into the pinna. Now she says she hears ringing in her left ear. A mild left hearing loss was noted. There are blisters on the skin of the ear canal and auricle. What is the most likely diagnosis?

A:

Chronic serous otitis media

B:

Herpes zoster oticus

C:

Herpes simplex infection

D:

Viral labyrinthitis

Q.59. A 32 year man presents to A&E with a fracture dislocation of his right elbow. He complains of loss of sensation in his little finger and ring finger. Which is the most likely nerve to be involved?

A:

Median nerve

B:

Radial nerve

C:

Superficial branch of radial nerve

D:

Ulnar nerve

Q.60. A 62-year-old man presented with sudden onset epigastric pain radiating to the back of 6 hours’ | duration. He has ischemic heart disease, on plavix and aspirin. Examination confirmed an ill : looking and dehydrated patient, with generalized abdominal tendemess and absent bowel ‘sounds (see report). Erect chest X-ray: Air under the left hemidiaphragm. Which of the following is the most likely diagnosis?

A:

Gall stone disease

B:

Acute pancreatitis

C:

Perforated peptic ulcer

D:

Gastric outlet obstruction

Q.61. A 50 year old smoker and heavy drinker presents with complaints of a racing heart. He has no chest pain. The palpitations usually occur when he drinks alcohol or after a meal. He has no significant past medical history. A 24 hours ECG is shown to be normal. What is the most appropriate action?

A:

Echocardiogram

B:

Reassure

C:

Exercise stress test

D:

24 hour BP monitoring

Q.62. Which of the following is most commonly cured by having a splenectomy?

A:

B-thalassemia

B:

athalassemia

C:

Sickle cell trait

D:

Idiopathic thrombocytopenia purpura

Q.63. A 43-year-old woman who recovered from acute pancreatitis 5 weeks ago, presented with epigastric pain and postprandial vomiting. Physical examination confirmed tendemess and fullness in the epigastric region (see lab results and reort). Blood pressure 127/70 mmHg Heart rate 70 /min Respiratory rate 16 /min Temperature 36.6 °C Test Result Normal Values WBC 6.4 4.5-10.5 x 100/L Amylase 430 24-151 IU/L CT scan of abdomen: Large cystic collection abutting the posterior wall of the stomach Which of the following is the most likely pancreatic pathology?

A:

Cancer

B:

Abscess

C:

Necrosis

D:

Pseudocyst

Q.64. A 28 year old woman presented to her GP with the complaint of amenorrhoea. On further questioning, she reveals that her last menstrual period was approximately twelve months ago and that she has not had a period since. Her menarche was at the age of twelve years. She reports no symptoms regarding the halt of her menses but claims that her menses have always been rather “light”. She has never had any children and does not think that she could be pregnant as she is not in a current relationship. She has lost 2.3 kilograms (around 5 pounds) of body weight over the past three months and reports a two week history of unilateral foot pain. She is a professional athlete and is currently training hard for the 10 km long distance race in the Olympics. She typically runs around twelve kilometres per day, at least five times per week. She has a very healthy lifestyle and does not smoke or drink alcohol. On physical examination, her body mass index is 19 kg/m2. There is dull pain on palpation along the fourth and fifth metatarsal of her left foot. The physical examination was otherwise normal. A blood sample was taken from the patient and her results are as follows: Follicle stimulating hormone (FSH) 10 U/L Luteinizing horome (LH) 5 U/L Prolactin 750 mU/L Oestradiol 120 pmol/L What is the most likely diagnosis for this patient?

A:

Polycystic ovarian syndrome

B:

Hypothalamic amenorrhoea

C:

Premature ovarian failure

D:

Ovulation induction drugs

Q.65. A 67-year-old man with ischemic heart disease presented with a 24-hour history of severe central abdominal pain. Physical examination was unremarkable (see lab results and report). Test Result Normal Values WBC 28 4.5-10.5 x 100. Amylase 600 24-151 UL ABG HCO3- 17 22-28 mmol/L ABG PCO2 4.2 4.76.0 kPa pH 7.27.36-7.45 ABG PO2 14 10.6-14.2 kPa Plain X-ray abdomen: Dilated small bowel with a thickened wall. Which of the following is the most likely diagnosis?

A:

Acute pancreatitis

B:

Intestinal obstruction

C:

Perforated duodenal ulcer

D:

Mesenteric vascular occlusion

Q.66. A 53 year old man with chronic heart failure, develops a red, swollen and acutely tender right large toe. He is subsequently diagnosed with gout and started on a new medication. A few days later his symptoms of gout have significantly improved however, he is now short of breath and complaining of orthopnea. What is the likely medication that he was started on?

A:

Prednisolone

B:

Paracetamol

C:

Ibuprofen

D:

Colchicine

Q.67. A 55 year old man has a firm belief that the headlines in the newspapers are written especially for him. He believes that the authors of the newspaper articles whom he has never met are sending secret and significant messages that only he can understand. What is the most likely type of delusion that this man is suffering from?

A:

Persecutory delusions

B:

Grandiose delusions

C:

Delusion of control

D:

Delusion of reference

Q.68. A 42-year-old woman complains of left-sided chest and abdominal pain that is worse on inspiration. She underwent a splenectomy a few days ago. Examination confirms a decreased air entry at the left lung base, dullness to percussion and left upper quadrant tenderness. Temperature 38.6 °C Which of the following is the most likely diagnosis?

A:

Gastric stasis

B:

Subphrenic abscess

C:

Lower lobe pneumonia

D:

Overwhelming post-splenectomy sepsis

Q.69. A 25-year-old man underwent a thyroidectomy due to a multinodular goiter. Post-operatively, he. was unable to maintain high pitch sound. Which of the following nerves is most likely injured?

A:

Vagus

B:

Inferior laryngeal

C:

Superior laryngeal

D:

Recurrent laryngeal

Q.70. An unstable trauma patient has confirmed multiple liver lacerations. Which of the following is the most appropriate management?

A:

Right hepatectomy

B:

Perihepatic packing

C:

Right hepatic artery ligation

D:

Individual ligation of the bleeding vessels

Q.71. A 35-year-old man post total thyroidectomy for multinodular goitre presented with persistent hypocalcaemia despite adequate replacement with oral and intravenous calcium. Which of the following is the most appropriate next step in management?

A:

Start diuretics

B:

Start recombinant PTH

C:

Check serum magnesium level

D:

IV bolus of potassium chloride

Q.72. A 35-year-old patient was brought to a small primary care hospital with no surgical facility. The patient primary survey confirmed a right tension pneumothorax, and a compound right femoral fracture. After insertion of chest tube and immobilization of the right lower limb, the treating doctor decided to transfer the patient to a trauma center. During the transfer to the ambulance, the patient's oxygen saturation suddenly dropped and he developed tachycardia and tachypnea. Which of the following is the most appropriate management?

A:

Proceed with the transfer

B:

Perform a rapid sequence intubation

C:

Check the femoral deformity for bleeding

D:

Check the chest tube for place and patency

Q.73. A patient in the Intensive Care Unit who is post-major surgery received 15 units of blood. The patient developed bleeding from the incision; nasogastric tube and vein puncture sites. Which of the following is the most likely cause?

A:

Hypocalcaemia

B:

Thrombocytopenia

C:

Transfusion reaction

D:

Von Willebrands disease

Q.74. A 40 year old heavy smoker presents with pain in the calves relieved by rest. These symptoms have been worsening over the last few months. He has a history of hypertension which is well controlled with medication. His distal pulses are difficult to palpate. What is the most likely diagnosis?

A:

Acute limb ischaemia

B:

Diabetes mellitus

C:

Buerger’s disease

D:

Deep vein thrombosis

Q.75. A 9-year-old child presented with blunt abdominal trauma (see lab result and report). Blood pressure 110/70 mmHg Heart rate 90 /min Respiratory rate 22 /min Temperature 36.6 °C Test Result Normal Value Hb 110 130-170 g/L (Male) 120-160 g/L (Female) CT scan abdomen: 2 cm splenic laceration with perisplenic fluid. Which of the following is the most appropriate management?

A:

Non-operative

B:

Laparoscopic splenectomy

C:

Laparotomy and splenorrhaphy

D:

Transfuse 2 units of packed RBCs

Q.76. A 30-year-old multigravida mother complains of severe perianal pain, swelling and absolute constipation for the last 2 days. On examination, swollen anal cushions, which are irreducible and tender to touch, are noted. Blood pressure 120/90 mmHg Heart rate 110 /min Respiratory rate 20 /min Temperature 37 °C Which of the following is the most likely diagnosis?

A:

Anal fissure

B:

Anal carcinoma

C:

Perianal abscess

D:

Thrombosed piles

Q.77. Which of the following is the most appropriate biopsy for a limb sarcoma?

A:

incisional

B:

Excisional

C:

Core needle

D:

Fine needle aspiration

Q.78. 5 days’ post-appendectomy, a patient developed diffuse abdominal distension, constipation, and absent bowel sounds. Which of the following is the most appropriate next step in management?

A:

Insert a rectal tube

B:

Check serum electrolyte level

C:

Re-exploration of the abdomen

D:

Abdominal computed tomography

Q.79. An elderly diabetic underwent major upper abdominal surgery 72 hours ago. Temperature 38 °C Oxygen saturation 87 % Which of the following is the most likely cause?

A:

Pneumonia

B:

Basal atelectasis

C:

Pulmonary embolism

D:

Sub-phrenic collection

Q.80. A 32-year-old man had excision and primary closure of a skin contracture that was 5x3 cm on the forearm, 1 year ago. He presented with an overgrowth at the scar site that extend beyond the surgical scar margins, it started few weeks after the surgery and gradually increased in size. Which of the following most accurately describes the lesion?

A:

Keloid

B:

Scar fibrosis

C:

Desmoid tumor

D:

Scar hypertrophy

Q.81. A 33 year olf man was painting his wall when he slipped from the ladder and fell from a height of 8 feet landing on his feet. On examination, his left foot is tender and swollen. Which bone is most likely to have been fractured?

A:

Talus

B:

Calcaneus

C:

Navicular

D:

Cuboid

Q.82. A 56 year old lady with lung cancer presents with urinary retention, postural hypotension, diminished reflexes and sluggish pupillary reaction. What is the most likely explanation for her symptoms?

A:

Paraneoplastic syndrome

B:

Progression of lung cancer

C:

Brain metastasis

D:

Hyponatraemia

Q.83. A 30-year-old man was hit by a truck 4 hours ago. On examination, he has raised jugular venous pressure and diminished heart sounds. Blood pressure 90/60 mmHg Heart rate 140 /min Respiratory rate 32 /min Temperature 36.6 °C Oxygen saturation 85 % What type of shock is the most likely diagnosis?

A:

Septic

B:

Cardiogenic

C:

Haemorrhagic

D:

Anaphylactic

Q.84. A 52-year-old woman presented with a recent rapid enlargement of a neck swelling associated with weight loss. She was diagnosed 25 years ago with Hashimoto's thyroiditis. Which of the following is the most likely diagnosis?

A:

Hemorrhagic goiter

B:

Thyroid lymphoma

C:

Papillary carcinoma

D:

Sub-acute thyroiditis

Q.85. A 52 year old man has a history of prostate cancer and bone metastasis. He has been taking regular codeine orally for his back pain for the past year. For the past three months, he finds the back pain worsening. He often wakes up in the middle of the night due to the back pain. What is the most appropriate management?

A:

Replace codeine with oral dihydrocodeine

B:

Add on buscopan to his regimen

C:

Replace codeine with oral oxycodone

D:

Replace codeine with oral morphine

Q.86. Which of the following is the most appropriate initial treatment for a liver amoebic abscess?

A:

Metronidazole

B:

Open drainage

C:

Percutaneous drainage

D:

Percutaneous aspiration

Q.87. An elderly woman developed hypoxia 24 hours after major pelvic surgery for ovarian cancer. Which of the following is the most likely cause?

A:

Pneumonia

B:

Pelvic abscess

C:

Basal atelectasis

D:

Pulmonary embolism

Q.88. Post laparoscopic cholecystectomy, transection of the common bile duct above the cystic duct is confirmed. Which of the following is the most appropriate treatment?

A:

Hepatico-jejunostomy

B:

Hepatico-duodenostomy

C:

Choledocho-jejunostomy

D:

Choledocho-duodenostomy

Q.89. A 59 year old man presents to the Emergency Department with abdominal pain which started 18 hours ago. The pain had gradual onset which initially started at the left abdomen associated with nausea. His medical history includes heart failure, diabetes and hypertension. On examination, his abdomen has generalised tenderness. A digital rectal examination shows blood per rectum. He has a heart rate of 80 beats/minute, blood pressure of 150/80 mmHg and a temperature of 37.9 C. What is the most likely diagnosis?

A:

Bowel perforation

B:

Rectal carcinoma

C:

Ischaemic colitis

D:

Acute mesenteric ischaemia

Q.90. An elderly man is brought to the Emergency Department with an altered level of consciousness after he fell down the air (see report), CT scan: Suggestive extradural hematoma. Which of the following arteries is most likely involved?

A:

Basilar

B:

Pontine

C:

Anterior cerebral

D:

Middle meningeal

Q.91. A 29-year-old underwent a left lower parathyoidectomy for a primary hyperparathyroidism. 4 months later, she presented with generalized fatigue, muscle and bone ache and constipation (see lab results). Test Result Normal Values Calcium 2.78 2.15-2.62 mmoliL Parathyroid hormone (intact PTH levels) 8 1.1-5.3 pmoliL Which of the following Is the most likely cause?

A:

New adenoma

B:

Missed adenoma

C:

Parathyroid cancer

D:

Parathyroid hyperplasia

Q.92. A 36-year-old man sustained a knife stab to the left side of his neck, below the cricoid cartilage (Zone 1). Examination confirmed diffuse neck subcutaneous emphysema. Blood pressure 110/70 mmHg Heart rate 90 /min Respiratory rate 20 /min Temperature 36.6 °C Which of the following is the most appropriate next step in management?

A:

Neck exploration

B:

Close observation

C:

CT of the neck and chest

D:

Interventional radiology embolization

Q.93. A 50-year-old diabetic man presented with a 5-year history of an unhealed foot ulcer. Physical examination confirmed a 2x2 cm irregular shaped ulcer at the dorsal aspect of the first toe with pearly white discoloration. Biopsy of the ulcer reported as pseudoepitheliomatous hyperplasia. Which of the following is the most appropriate management?

A:

Repeat biopsy

B:

First toe amputation

C:

Surgical debridement

D:

Negative pressure dressing

Q.94. A 49 year old woman presents to the Emergency Department with a productive cough of green sputum. She feels unwell, feverish and lethargic. On examination, bronchial breathing is heard at her right base. She has a respiratory rate of 27 breaths/minute, oxygen saturation of 90% on room air, pulse rate of 130 beats/minute and a blood pressure of 85/40 mmHg. What is the next most appropriate action?

A:

Intravenous fluids

B:

Chest X-ray

C:

Intramuscular adrenaline

D:

Sputum culture

Q.95. A 56-year-old woman presented with generalized muscle and bone ache associated with abdominal cramps that s relieved by drinking cold milk (see lab results). Test Resuit Normal Values Calcium 2.85 2.15-2.62 mmollL Calcium ionised 1.9 1.1-1.3 mmol Phosphate, inorganic 0.71 0.82-1.51 mmoliL Parathyroid hormone (intact PTH levels) 5.5 1.1-5.3 pmol/L 25-Hydroxy Vitamin D3 (Women) 15 25-60 nmol/L Which of the following is the most ikely diagnosis?

A:

Milk alkali syndrome

B:

Idiopathic hypercalcemia

C:

Primary hyperparathyroidism

D:

Secondary hyperparathyroidism

Q.96. Which of the following is associated with the highest risk of malignant transformation?

A:

Villous adenoma

B:

Tubular adenoma

C:

Hyperplastic polyp

D:

Tubulovillous adenoma

Q.97. An elderly man presents for follow-up after he sustained road traffic accident 3 days back. On examination, "Battle Sign" is noted. Which of the following is the most likely cause?

A:

Le Forte fracture

B:

Mandibular fracture

C:

Fracture base of skull

D:

Fracture middle cranial fossa

Q.98. A 23-year-old man sustained a closed right mid-shaft tibia-fbula fracture in a motor vehicle accident. He was alert, awake, complained of severe pain and numbness in his right lower extremity. Examination confirmed non-paipable dorsalis pedis and posterior tibial pulses. | Blood pressure 120/70 mmHg Heart rate 85 min Respiratory rate 20 min Temperature 36.6 °C Which of the following is the most appropriate management?

A:

Fasciotomy

B:

Angiography

C:

Leg elevation and splint

D:

Anticoagulation therapy

Q.99. A 60-year-old that underwent a cardiac bypass, presented with central abdominal pain. Examination confirmed high cardiac output and cardiac index with low peripheral vascular resistance. Blood pressure 90/60 mmHg Heart rate 120 /min Which of the following is the most likely diagnosis?

A:

Septic shock

B:

Unstable angina

C:

Cardiogenic shock

D:

Hypovolemic shock

Q.100. A 34 year old man comes to Accidents and Emergency with a knife wound on his arm. He tells you that he obtained it during a fight in the local pub. An hour later, the police arrive asking staff members for details as there was a murder at the pub and they are investigating it. What is the most appropriate action?

A:

Do not inform the police of the patient’s presence until a warrant is issued

B:

Provide the police with details and answers to their questions

C:

Provide only the name and date of birth of the patient injured

D:

Provide only necessary information after obtaining permission from the patient

Q.101. A heavy smoker man is going for major surgical procedure Which of the following is the most sensitive predictor of postoperative respiratory complications?

A:

Chest X-ray

B:

Bronchoscopy

C:

Lung function test

D:

Arterial blood gases

Q.102. A40-year-old woman underwent major bowel resection, and developed high output fistula. Which of the following is the most expected consequences?

A:

Fast loss of body fat

B:

Decrease total body weight

C:

Slow loss of lean body mass

D:

Expansion of the extracellular fluid

Q.103. A 44-year-old man presented with a 6-month history of vague central abdominal pain. CT scan of abdomen: | Pragence of 20x10 cm retroperitoneal mass. No enlarged mesenteric or par aortic lymph nodes Which of the following is the most likely diagnosis?

A:

Lymphoma

B:

Liposarcoma

C:

Germ cell tumor

D:

Metastatic testicular tumor

Q.104. A man presented with diarrhoea and persistent peptic ulcer refractory to proton pump inhibitors. Secretin stimulation test is positive. Which of the following is the most likely diagnosis?

A:

VIPoma

B:

Gastrinoma

C:

Glucagonoma

D:

Carcinoid tumor

Q.105. A 45 year old chronic smoker attends the outpatient department with complaints of persistent cough and copious amount of purulent sputum. He had history of measles in the past. On examination, finger clubbing is noted and inspiratory crepitations on auscultation is heard. A chest X-ray shows tram track opacies. What is the most likely diagnosis?

A:

Interstitial lung disease

B:

Bronchiectasis

C:

Asthma

D:

Sarcoidosis

Q.106. A 30 year old female is brought into the Emergency Department by her husband drifting in and out of consciousness following a road traffic accident. A FAST scan reveals a large collection of free fluid in the peritoneal cavity. She is in shock and requires immediate blood transfusion. Her husband objects saying they are devout Jehovah’s Witnesses and are against blood transfusion. Her condition is deteriorating. What is the most appropriate action?

A:

Do not transfuse blood because there is no consent

B:

Transfuse blood without consent

C:

Inform health authorities as situation is complicated

D:

Seek judicial review instructionsand contact Jehovah;s witness council

Q.107. A 50 year old man comes to A&E with abdominal pain that began suddenly about 1 hour ago. The pain is now generalized, constant, and extremely severe. He lies motionless on the stretcher, is diaphoretic, and has shallow, rapid breathing. His abdomen is rigid, very tender to deep palpation, and has guarding. X-rays show free air under the diaphragm. What is the most likely diagnosis?

A:

Biliary peritonitis

B:

Ischaemic colon

C:

Pancreatic necrosis

D:

Perforated peptic ulcer

Q.108. A 30-year-old presented with a 3-day history of painful perianal swelling. Examination confirmed a 1x1 cm tender swelling close to the anal verge (see lab result). Heart rate 84 /min Temperature 37.2 °C Test Result Normal Value WBC 845-105 x 1091L Which of the following is the most likely diagnosis?

A:

Anal fissure

B:

Prolapsed pile

C:

Perianal abscess

D:

Perianal hematoma

Q.109. A 37-year-old patient presented to the Emergency Department with a 2-day history of right upper quadrant abdominal pain associated with vomiting. Physical examination confirmed rebound tenderness at right hypochondrium (see lab result and report) Blood pressure 125/70 mmHg Heart rate 90 /min Respiratory rate 20 /min Temperature 38.8 °C Test Result Normal Values WBC 16.5 4.5-10.5 x 109/L Ultrasound abdomen: Edematous, thick gallbladder wall, pericholecystic fluid and multiple gallstones. Which of the following is the most appropriate management?

A:

Laparoscopic cholecystectomy

B:

Percutaneous cholecystostomy drain

C:

Exploratory laparotomy with cholecystectomy

D:

Endoscopic retrograde cholaniopancreatography

Q.110. A 53-year-old man presented with sudden onset of severe right lower abdominal pain. On examination, there is a 3x3 cm right lower abdominal tender mass, which becomes more ~~ prominent with abdominal wall contraction. The patient has been on anticoagulants for atrial fibrillation for the past 4 years (see lab results and report). Blood pressure 130/80 mmHg Heart rate 84 /min Respiratory rate 18 /min Temperature 36.8 °C Test Result Normal Values INR 1.50.8-1.2 Prothrombin time 11 10-13 sec CT scan 3x3 cm enhancing mass at the right rectus muscle.Which of the following is the most appropriate management?

A:

Surgical excision

B:

Rest and analgesia

C:

Fresh frozen plasma

D:

Angiography with embolization

Q.111. A 48-year-old woman presented with vague central abdominal pain (see reports). Upper GI endoscopy: 5 cm rounded mass at the posterior wall of the stomach. Biopsy: Gastrointestinal stromal tumour. Which of the following is the most appropriate management?

A:

Total gastrectomy

B:

Wide local excision

C:

Partial gastrectomy

D:

Enucleation of the lesion

Q.112. A 65-year-old woman presented with sudden onset epigastric pain radiating to the back for the past 4 hours. She has ischemic heart disease with a coronary stent, and is taking plavix and aspirin. She was diagnosed with a perforated viscus and was taken for an exploratory laparotomy, which confirmed a perforated anterior duodenal ulcer. Which of the following is the most appropriate management?

A:

Partial gastrectomy

B:

Gastrojejunostomy

C:

Closure with omental patch

D:

Selective truncal vagotomy

Q.113. A 39 year old woman presents with yellowing of her sclera and the complaint of feeling tired all the time. She has no other complaints however, she mentions that she had an upper respiratory tract infection a week ago. Her blood tests are as follows: Haemoglobin: 95 g/L Bilirubin 28 micromol/L Mean cell volume (MCV): 98 fL Alanine transferase (ALT): 25 U/L Aspartate transaminase (AST): 23 U/L Alkaline phosphatase (ALP): 72 U/L Gamma glutamyl transferase (GGT): 33 U/L A peripheral blood smear is significant for polychromasia and scattered spherocytes but no fragmented red blood cells or target cells were seen. What is the best diagnostic investigation?

A:

Direct antiglobulin test

B:

Indirect antiglobulin test

C:

Osmotic fragility test

D:

Bone marrow aspiration

Q.114. A 44 year old hypertensive male, loses vision in his left eye overnight. There is no pain or redness associated with his visual loss. On fundoscopy, venous dilation, tortuosity, and retinal haemorrhages are observed on his left eye. No abnormalities are found on his right eye on fundoscopy. What is the most likely cause of his unilateral visual loss?

A:

Hypertension retinopathy

B:

Central Retinal Artery Occlusion

C:

Central Retinal Vein Occlusion

D:

Background retinopathy

Q.115. A 39-year-old woman presented with a 3-day history of central abdominal pain associated with nausea and vomiting for 1 day. She underwent a laparoscopic sleeve gastrectomy for obesity 6 years ago. Examination confirmed a dehydrated patient with abdominal distention and exaggerated bowel sounds. Which of the following is the most likely cause?

A:

Adhesions

B:

Internal hernia

C:

Intussusception

D:

Incisional hernia

Q.116. A 50 year-old man becomes disoriented on the 4th post-operative day of abdominal aortic aneurysm repair. Vital signs remain outside of normal limits despite attempts at fluid resuscitation. He has passed a negligible volume of urine since he was catheterized one hour ago. His peripheries are warm to the touch Blood pressure 90/40 mmHg Heart rate 140 /min Respiratory rate 36 /min Temperature 36.6 °C What type of shock is the most likely diagnosis?

A:

Septic

B:

Cardiogenic

C:

Haemorhagic

D:

Anaphylactic

Q.117. A 60 year old man presented with a spontaneous painful swelling of his right knee which appears hot and very tender on touching. The swelling became worse over the last few days. About a week ago, he had an inguinal hernia repaired as a day case. His regular medications include Ramipril 10 mg daily, Bendroflumethiazide 2.5 mg daily and Glyceryl trinitrte tablets when required. He is apyrexial on examination. What is the best method for confirming the diagnosis?

A:

Joint aspirate for microscopy

B:

Blood culture

C:

D-dimer

D:

X-ray of knee

Q.118. A 32 year old woman has had a febrile illness and sudden onset of pain and swelling of the small joints of her feet and knees for the past two days. She has a maculopapular rash on her soles of her feet. She was previously well. There is no history of relevant travel outside the UK. On examination, conjunctivitis is noted. What is the most likely diagnosis?

A:

Septic arthritis

B:

Reactive arthritis

C:

Rheumatoid arthritis

D:

Psoriatic arthritis

Q.119. A patient underwent massive small bowel resection, and end with short bowel syndrome. Which of the following is most important factor for small bowel adaptation?

A:

Prolonged TPN

B:

Enteral feeding

C:

Parietal cell vagotomy

D:

Reversal of jejunal limb

Q.120. A 20-year-old man was hit by a car 2 hours ago. On examination, his abdomen is distended, tense and tender. Blood pressure 100/70 mmHg Heart rate 120 /min Respiratory rate 30 /min Temperature 35 °C Oxygen saturation 90 % What type of shock is the most likely diagnosis?

A:

Spinal

B:

Cardiogenic

C:

Haemorthagic

D:

Anaphylactic

Q.121. A 25-year-old was involved in a head on motor vehicle accident. On examination, he was unresponsive, had distended neck veins, absent breath sound, and hyper-resonant percussion on the right side. His GCS score was 8. Which of the following is the most urgent initial management?

A:

Pericardiocentesis

B:

Neck immobilization

C:

Endotracheal intubation

D:

Needle right thoracocentesis

Q.122. A 25-year-old man is undergoing appendectomy for acute appendicitis, upon entering the peritoneal cavity; the surgeon could not find the appendix. Which of the following is the most effective way to localize the appendix?

A:

Following the terminal ileum

B:

Palpating the lleocaecal valve

C:

Looking at the confluence of the taenia coli

D:

Following the course of the right colic artery

Q.123. A 47-year-old single woman with a positive family history of breast cancer presented witha lesion found on routine mammography at the lower outer quadrant of right breast (see report). Image guided core needle biopsy: Atypical ductal hyperplasia. Which of the following is the most appropriate next step in management?

A:

Simple mastectomy

B:

Wire localization excision

C:

Chemoprevention therapy

D:

6-month follow-up mammography

Q.124. A 5 year old child complains of sore throat and earache. He has a temperature of 38.6 C. Examination shows a enlarged hyperemic tonsils with pus. He has no cough. He is not on any medication. What is the most likely diagnosis?

A:

Infectious mononucleosis

B:

Acute tonsillitis

C:

Scarlet fever

D:

Acute epiglottitis

Q.125. A study was carried out in which 10,000 women participated. All the women underwent cervical smeare. 1000 of 10,000 women had a positive smear. Of these, 100 developed cervical cancer. 10 women who had negative smear developed cancer. What is the most likely terminology used to describe the 10 women with negatibe results who developed cervical cancer?

A:

Case control study

B:

False positive

C:

Chance incidence

D:

False negative

Q.126. Which of the following is the most effective way to minimize excessive scar formation?

A:

Pre-operative steroid

B:

Elimination of wound tension

C:

Post-operative topical steroid

D:

Closure with subcuticular suture

Q.127. A 50-year-old patient underwent a total thyroidectomy 5 hours ago. He has developed a large neck swelling associated with stridor and shortness of breath. Blood pressure 165/90 mmHg Heart rate 130 /min Respiratory rate 24 /min Temperature 37 °C Which of the following is the most appropriate next step in management?

A:

Tracheostomy

B:

Close observation

C:

Percutaneous drainage

D:

Bedside wound exploration

Q.128. In compartment syndrome of lower limb, the earliest symptom is severe pain. Which of the following best describes the mechanism of pain?

A:

Skin hypoxia

B:

Bone ischemia

C:

Nerve hypoxia

D:

Muscle engorgement

Q.129. A 49 year old man presents with a BP of 160/95 mmHg. He is otherwise asymptomatic. His renal function declined severely after starting ACE inhibitors. What is the most likely cause of his hypertension?

A:

Chronic glomerulonephritis

B:

Pheochromocytoma

C:

Bilateral renal artery stenosis

D:

Polycystic kidney disease

Q.130. A 69 year old man presented to clinic with worsening balance and difficulty walking over the past year. Recently, he has been prone to falling more frequently and his wife notes he forgets to turn off the stove or water taps. He has also started to have urinary urgency and incontinence. On examination he is walking with a cane and has difficulty turning. What is the most likely diagnosis?

A:

Parkinson’s disease

B:

Normal pressure hydrocephalus

C:

Alzheimer’s disease

D:

Dementia with Lewy bodies

Q.131. A 45-year-old diabetic man presents with a non-healing wound, which he developed after incision and drainage for diabetic foot 2 months ago (see lab result). Test Result Normal Value HbA1C658-6.2% Which of the following is the most likely etiology?

A:

Poor blood supply

B:

Underlying malignancy

C:

Peripheral neuropathy

D:

Non-complaint with treatment

Q.132. A 38-year-old multiparous woman presented with a 3-year history of abdominal bulging Physical examination confirmed a diffuse smooth midiine bulge on attempting to lean forward, with negative cough impulse (see report). CT scan of abdomen: No intra or extra abdominal mass lesion, and abdominal fascia is intact with no visible defect. Which of the following is the most likely diagnosis?

A:

Spigelian hernia

B:

Incisional hernia

C:

Divercation of recti

D:

Transveraslis muscle weakness

Q.133. A 40-year-old diabetic patient with good glycemic control is admitted electively for an inguinal hernia repair. What is the most accurate American Society of Anaesthesiologists physical status class?

A:

I

B:

II

C:

III

D:

IV

Q.134. A 30 year old woman complains of decreased appetite and weight gain. She has been having irregular, infrequent periods in the last 10 months. She also feels tired and lethargic majority of the day. On inspection, she has a dry coarse skin. What is the most likely diagnosis?

A:

Hypothyroidism

B:

Hyperthyroidism

C:

Polycystic ovary syndrome

D:

Addison’s disease

Q.135. A 32-year-old man presented with a 2-week history of frequent attacks of watery diarrhea. On examination, he was severely dehydrated. Blood pressure 90/45 mmHg Heart rate 130 /min Respiratory rate 18 /min Temperature 37.2 °C Which of the following is the most likely acid-base abnormality?

A:

Metabolic acidosis

B:

Metabolic alkalosis

C:

Compensated metabolic acidosis

D:

Compensated metabolic alkalosis

Q.136. A 44 year old man has sudden severe crushing chest pain radiating to both shoulders and his back. The pain is accompanied by shortness of breath. He is sweating profusely. There was no history of trauma. Examination shows cold peripheries. He is noted to have disproportionately long, slender limbs and long fingers and toes. What is the most appropriate diagnosis?

A:

Myocardial infarction

B:

Thoracic aortic dissection

C:

Pulmonary embolism

D:

Oesophageal perforation

Q.137. A 58-year-old woman presented with a right thigh mass that measured 5 x 6 cm (see report). Core biopsy: High grade sarcoma. Which of the following is most appropriate staging image?

A:

Bone scan

B:

MRI abdomen

C:

Chest CT scan

D:

Right thigh plain X-ray

Q.138. A 20-year-old woman with no past medical history is admitted with a perforated appendix and is in septic shock. On arrival, she was intubated. She requires high inotropic support to maintain minimum recordable blood pressure. What is the most accurate American Society of Anaesthesiologist physical status class?

A:

II

B:

lIl

C:

IV

D:

V

Q.139. A 75 year old woman was referred by her general practitioner to the same day ophthalmology clinic because of a 4 hour history of sudden painless loss of vision affecting her right eye. Her medical history includes hypertension and heavy smoking. Ophthalmic assessment showed visual acuity of light perception only in the right eye and 6/9 in the left eye. Apart from early questioning, the patient admitted that she had previously experienced episodes of vision loss in the same eye, which lasted for a few seconds to a few minutes. What is the most likely artery involved in this scenario?

A:

Anterior communicating artery

B:

Anterior cerebral artery

C:

Middle cerebral artery

D:

Central retinal artery

Q.140. A patient with obstructive jaundice developed septic cholangitis. Blood pressure 90/50 mmHg Heart rate 105 /min Respiratory rate 18 /min Temperature 39.2 °C Which of the following is most likely to be present?

A:

Hypoglycemia

B:

Increased cardiac output

C:

Generalized vasoconstriction

D:

Increased peripheral resistance

Q.141. A 47-year-old man presented with a 6-month history of right groin swelling. The swelling recently increased in size. Examination confirmed an inguino-scrotal swelling with positive cough impulse and separable from testis. Which of the following is the most likely diagnosis?

A:

Spermatocele

B:

Epidydimal cyst

C:

Vaginal hydrocele

D:

Indirect inguinal hernia

Q.142. A 36-year-old was undergoing a caesarean section, just before closure the surgeon noticed profound bleeding coming from the upper abdomen. Which of the following is the most likely source of bleeding?

A:

Splenic aneurysm

B:

Liver hemangioma

C:

Mesenteric aneurysm

D:

Perforated peptic ulcer

Q.143. A 44 year old man with a history of alcohol dependency presents with confusion. He responds poorly to questions and is seen to be irritable. He is unsteady and has uncoordinated walking. His blood glucose is 3.5 mmol/L. He has no other relevant medical history. What is the most appropriate immediate action?

A:

Intravenous thiamine

B:

Bolus of 50% glucose

C:

Intravenous 5% dextrose

D:

Normal saline

Q.144. A 48 year old man complains of rectal bleeding and loss of weight. He has a mass in left iliac fossa. What is the most likely diagnosis?

A:

Caecal carcinoma

B:

Carcinoma of sigmoid colon

C:

Carcinoma of transverse colon

D:

Volvulus

Q.145. A 38 year old woman with a history of severe depression and bipolar affective disorder presents to the Emergency Department with coarse tremors and muscular twitching. She feels nauseous and drowsy. She had vomited three times a few hours before presenting to the Emergency Department. She has brought in a bag full of the medications she would normally take with one of the medication boxes completely empty. Which is the most likely medication responsible for her symptoms?

A:

Lithium

B:

Levothryoxine

C:

Amitryptiline

D:

Methyldopa

Q.146. Which of the following is the strongest indicator for surgery in Graves' disease?

A:

Paediatric patient

B:

Presence of eye symptoms.

C:

Presence of anti-TSH antibodies

D:

Failure of anti-thyroid medication

Q.147. A 58 year old man has a progressively worsening headache and confusion. He had a fall three days ago after slipping and hitting his head in the garden. He has a history of alcohol abuse. What is the most appropriate investigation?

A:

X-ray skull

B:

Electrocardiogram

C:

Computed tomography brain scan

D:

Magnetic resonance imaging brain scan

Q.148. Which of the following has the highest diagnostic value for inhalation injuries?

A:

Tachypnea

B:

Voice hoarseness

C:

Low oxygen saturation

D:

Carbonaceous sputum

Q.149. A 63 year old man presented with sudden onset of severe dyspnoea, orthopnoea, raised jugular venous pressure and bilateral basal crackles three days after an episode of myocardial infarction. A diagnosis of acute congestive cardiac failure was made and intravenous furosemide was started. What is the most likely electrolyte abnormality to be expected?

A:

High sodium, Low potassium

B:

Low sodium, High potassium

C:

Low sodium, Low potassium

D:

Low sodium, Normal potassium

Q.150. A 4 year old child has progressive muscle weakness and frequent falls. He has a waddling gait when he attempts to run. He is unable to hop or jump. His motor milestones seemed to be delayed. What is the most likely diagnosis?

A:

Duchenne muscular dystrophy

B:

Becker’s muscular dystrophy

C:

Polymyositis

D:

Lambert-Eaton syndrome

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MOCK TEST 8

Q.1. A 40-year-old man presents with an advanced colonic malignancy. What is the most likely site of metastasis?

Q.2. A 55-year-old butcher accidentally cut himself at work. Later that night, he noticed some red lines radiating from the wound. Which of the following is the most likely cause?

Q.3. Where is the most common primary location of basal cell carcinoma?

Q.4. A young man received 4 litres of blood in the Emergency Department following a road traffic accident. Which of the following is the most likely complication?

Q.10. A young man presents with a lump on the ight mid-thigh. On examination, the overlying skinis normal, the mass is soft, movable with positive fluctuation test Which of the following is the most likely diagnosis?

Q.11. A 14-year-old patient presented with a painless neck swelling. Examination confirmed a midline neck swelling below the hyoid bone that moves up and down with swallowing. Which of the following is the most likely diagnosis?

Q.12. A 55 year old man comes to the emergency department with severe abdominal pain and lower back pain. He has a history of a pulsatile swelling in the abdomen. He has a pulse rate of 125 beats/minute and a blood pressure of 70/40 mmHg. What is the most appropriate initial management?

Q.13. A 28-year-old woman was undergoing a laparoscopic cholecystectomy for gallstones. After creating pneumo-peritoneum and inserting the trocars, her heart rate was 40 beats/min. Which of the following is the most likely cause?

Q.16. A 33 year old man comes to the clinic complaining of hearing loss in one ear. There is no earache, fever, vertigo, or tinnitus. On inspection, a buildup of wax is observed. What is the most appropriate initial management?

Q.17. Which of the following is most likely to cause small bowel distention?

Q.18. A 30-year-old presented with intermittent perianal pain associated with purulent discharge. Examination confirmed a low-lying perianal fistula with an external opening posteriorly close to the anal verge. Which of the following is the most appropriate management?

Q.19. Which of the following is the most definitive treatment for a post-renal transplant lymphocele?

Q.21. A 62 year old man has bone pain at his hips and back. On further investigatioin, alkaline phosphatase was found to be elevated in his blood. An X-ray shows multifocal sclerotic patches in the skull. What is the most likely diagnosis?

Q.22. A 48 year old man attends clinic for a routine eye check up as he has a history of type 1 diabetes. Fundoscopy shows neovascularization at the retina. What is the most appropriate management?

Q.24. A 12 month old male infant presents to clinic because his mother is concerned that the child cannot sit on his own, crawling but not standing with support, unable to pick up small items, and is not socially interactive with his older sibling. What is the best management?

Q.25. A 40-year-old is admitted with a 3-day history of diffuse abdominal pain. On examination, there is diffuse abdominal tenderness along with Grey Tumers sign. Which of the following is the most likely diagnosis?

Q.27. A young man presented with a chronic infection of both axillae. Examination confirmed the presence of multiple discharging sinuses. Which of the following is the most likely source?

Q.28. A young man comes fo the Emergency Department afer being involved in a road traffic | accident. A Focused assessment with sonography for trauma was ordered. Which of the following is the most likely finding?

Q.34. A hypothyroid patient is scheduled to undergo an elective surgery. Which of the following is the most appropriate management?

Q.36. A 28 year old man has a headache that worsens on bending his head forward. He has no nausea or vomiting. The headache tends to be at its worst first thing in the morning and improves by the afternoon. What is the most likely diagnosis?

Q.37. A 28-year-old patient underwent resection of the terminal ileum for inflammatory bowel disease. | Which of the following nutrients is most important replace parenterally?

Q.38. A 38-year-old man sustained a pelvic fracture in a motor vehicle accident. There was blood per urethra (see report). Retrograde urethrogram: Retroperitoneal urethral injury. Which of the following is the most appropriate next step?

Q.40. Which of the following is the most ikely pathogen to infect a polytetrafiucroethylene vascular graft?

Q.41. A 36-year-old man presents with a 2-day history of constipation. On examination, he looks nervous, and severe pain was experienced during parting of the perianal region. Linear cracks were noted at both at 6 and 12 O'clock positions. Which of the following is the most likely diagnosis?

Q.42. An immunocompromised patient presented with an acute painful perineal swelling. Examination confirmed erythematous fluctuant area with crepitus over it and a foul-smelling discharge. Which of the following is the most appropriate management?

Q.43. A 73 year old woman living in a nursing home, presents with rashes on her finger webs and also at her axillary folds. She complains of itching which is more severe at night. What is the most appropriate mananagement?

Q.44. A 37-year-old man presented to Emergency Department with a 10-day history of frequent vomiting. He was dehydrated, and his electrocardiogram showed flattening of the T-wave. Which of the following is the most likely acid-base abnormality?

Q.47. A young man is hypoxic 24 hours after major upper abdominal surgery. Which of the following is the most likely cause?

Q.48. A 32-year-old man underwent a hemorrhoidectomy for a prolapsed pile. § hours later, he complained of severe supra-pubic pain and was unable to pass urine. Which of the following is the most likely cause?

Q.49. A 50-year-old woman post-modified radical mastectomy, presented with numbness and a burning sensation on the inner aspect of upper arm. Which of the following nerves is most likely injured?

Q.50. A61 year oldman presents with fatigue and palpitations. His past surgical history includes an ileal resection which was performed one year ago. An FBC was requested and the results are as follows: Haemoglobin 93 g/L Mean cell volume (MCV) 111 fL What is the most likely diagnosis?

Q.51. A patient complains of painless fresh bleeding post defecation over the last 6 Which of the following is the most likely diagnosis?

Q.52. A patient who has been in the Intensive Care Unit for 2 weeks is receiving parenteral nutrition (see results). Test Result in Normal Values Platelets count 250 150-400 x 109/L APTT 37 30-40 sec INR20.8-1.2 Total bilirubin 12 3.5-16.5 pmol/L Which of the following is the most likely cause?

Q.53. A 36 year old woman is planning to undergo a laparoscopic tubal sterilisation. What is the risk of pregnancy after sterilisation by tubal ligation?

Q.57. A 30-year-old woman sustained a burn from an oven grill. 8 days later, she noticed greenish discharge in the wound. Which of the following is the most likely cause?

Q.59. A 32 year man presents to A&E with a fracture dislocation of his right elbow. He complains of loss of sensation in his little finger and ring finger. Which is the most likely nerve to be involved?

Q.62. Which of the following is most commonly cured by having a splenectomy?

Q.69. A 25-year-old man underwent a thyroidectomy due to a multinodular goiter. Post-operatively, he. was unable to maintain high pitch sound. Which of the following nerves is most likely injured?

Q.70. An unstable trauma patient has confirmed multiple liver lacerations. Which of the following is the most appropriate management?

Q.71. A 35-year-old man post total thyroidectomy for multinodular goitre presented with persistent hypocalcaemia despite adequate replacement with oral and intravenous calcium. Which of the following is the most appropriate next step in management?

Q.73. A patient in the Intensive Care Unit who is post-major surgery received 15 units of blood. The patient developed bleeding from the incision; nasogastric tube and vein puncture sites. Which of the following is the most likely cause?

Q.74. A 40 year old heavy smoker presents with pain in the calves relieved by rest. These symptoms have been worsening over the last few months. He has a history of hypertension which is well controlled with medication. His distal pulses are difficult to palpate. What is the most likely diagnosis?

Q.77. Which of the following is the most appropriate biopsy for a limb sarcoma?

Q.78. 5 days’ post-appendectomy, a patient developed diffuse abdominal distension, constipation, and absent bowel sounds. Which of the following is the most appropriate next step in management?

Q.79. An elderly diabetic underwent major upper abdominal surgery 72 hours ago. Temperature 38 °C Oxygen saturation 87 % Which of the following is the most likely cause?

Q.81. A 33 year olf man was painting his wall when he slipped from the ladder and fell from a height of 8 feet landing on his feet. On examination, his left foot is tender and swollen. Which bone is most likely to have been fractured?

Q.82. A 56 year old lady with lung cancer presents with urinary retention, postural hypotension, diminished reflexes and sluggish pupillary reaction. What is the most likely explanation for her symptoms?

Q.84. A 52-year-old woman presented with a recent rapid enlargement of a neck swelling associated with weight loss. She was diagnosed 25 years ago with Hashimoto's thyroiditis. Which of the following is the most likely diagnosis?

Q.86. Which of the following is the most appropriate initial treatment for a liver amoebic abscess?

Q.87. An elderly woman developed hypoxia 24 hours after major pelvic surgery for ovarian cancer. Which of the following is the most likely cause?

Q.88. Post laparoscopic cholecystectomy, transection of the common bile duct above the cystic duct is confirmed. Which of the following is the most appropriate treatment?

Q.90. An elderly man is brought to the Emergency Department with an altered level of consciousness after he fell down the air (see report), CT scan: Suggestive extradural hematoma. Which of the following arteries is most likely involved?

Q.96. Which of the following is associated with the highest risk of malignant transformation?

Q.97. An elderly man presents for follow-up after he sustained road traffic accident 3 days back. On examination, "Battle Sign" is noted. Which of the following is the most likely cause?

Q.99. A 60-year-old that underwent a cardiac bypass, presented with central abdominal pain. Examination confirmed high cardiac output and cardiac index with low peripheral vascular resistance. Blood pressure 90/60 mmHg Heart rate 120 /min Which of the following is the most likely diagnosis?

Q.101. A heavy smoker man is going for major surgical procedure Which of the following is the most sensitive predictor of postoperative respiratory complications?

Q.102. A40-year-old woman underwent major bowel resection, and developed high output fistula. Which of the following is the most expected consequences?

Q.103. A 44-year-old man presented with a 6-month history of vague central abdominal pain. CT scan of abdomen: | Pragence of 20x10 cm retroperitoneal mass. No enlarged mesenteric or par aortic lymph nodes Which of the following is the most likely diagnosis?

Q.104. A man presented with diarrhoea and persistent peptic ulcer refractory to proton pump inhibitors. Secretin stimulation test is positive. Which of the following is the most likely diagnosis?

Q.111. A 48-year-old woman presented with vague central abdominal pain (see reports). Upper GI endoscopy: 5 cm rounded mass at the posterior wall of the stomach. Biopsy: Gastrointestinal stromal tumour. Which of the following is the most appropriate management?

Q.119. A patient underwent massive small bowel resection, and end with short bowel syndrome. Which of the following is most important factor for small bowel adaptation?

Q.120. A 20-year-old man was hit by a car 2 hours ago. On examination, his abdomen is distended, tense and tender. Blood pressure 100/70 mmHg Heart rate 120 /min Respiratory rate 30 /min Temperature 35 °C Oxygen saturation 90 % What type of shock is the most likely diagnosis?

Q.121. A 25-year-old was involved in a head on motor vehicle accident. On examination, he was unresponsive, had distended neck veins, absent breath sound, and hyper-resonant percussion on the right side. His GCS score was 8. Which of the following is the most urgent initial management?

Q.122. A 25-year-old man is undergoing appendectomy for acute appendicitis, upon entering the peritoneal cavity; the surgeon could not find the appendix. Which of the following is the most effective way to localize the appendix?

Q.124. A 5 year old child complains of sore throat and earache. He has a temperature of 38.6 C. Examination shows a enlarged hyperemic tonsils with pus. He has no cough. He is not on any medication. What is the most likely diagnosis?

Q.126. Which of the following is the most effective way to minimize excessive scar formation?

Q.128. In compartment syndrome of lower limb, the earliest symptom is severe pain. Which of the following best describes the mechanism of pain?

Q.129. A 49 year old man presents with a BP of 160/95 mmHg. He is otherwise asymptomatic. His renal function declined severely after starting ACE inhibitors. What is the most likely cause of his hypertension?

Q.131. A 45-year-old diabetic man presents with a non-healing wound, which he developed after incision and drainage for diabetic foot 2 months ago (see lab result). Test Result Normal Value HbA1C658-6.2% Which of the following is the most likely etiology?

Q.133. A 40-year-old diabetic patient with good glycemic control is admitted electively for an inguinal hernia repair. What is the most accurate American Society of Anaesthesiologists physical status class?

Q.134. A 30 year old woman complains of decreased appetite and weight gain. She has been having irregular, infrequent periods in the last 10 months. She also feels tired and lethargic majority of the day. On inspection, she has a dry coarse skin. What is the most likely diagnosis?

Q.135. A 32-year-old man presented with a 2-week history of frequent attacks of watery diarrhea. On examination, he was severely dehydrated. Blood pressure 90/45 mmHg Heart rate 130 /min Respiratory rate 18 /min Temperature 37.2 °C Which of the following is the most likely acid-base abnormality?

Q.137. A 58-year-old woman presented with a right thigh mass that measured 5 x 6 cm (see report). Core biopsy: High grade sarcoma. Which of the following is most appropriate staging image?

Q.140. A patient with obstructive jaundice developed septic cholangitis. Blood pressure 90/50 mmHg Heart rate 105 /min Respiratory rate 18 /min Temperature 39.2 °C Which of the following is most likely to be present?

Q.141. A 47-year-old man presented with a 6-month history of right groin swelling. The swelling recently increased in size. Examination confirmed an inguino-scrotal swelling with positive cough impulse and separable from testis. Which of the following is the most likely diagnosis?

Q.142. A 36-year-old was undergoing a caesarean section, just before closure the surgeon noticed profound bleeding coming from the upper abdomen. Which of the following is the most likely source of bleeding?