Nash Qbank

Q.1. A 40-year-old man, alcoholic and smoker is brought to the Emergency Department with a 4-hour history of severe upper abdominal pain radiating to the back. On examination, his abdomen is distended, tense, and tender. Digital Rectal examination confirms a collapsed empty (see image). Blood pressure 100/70 mmHg Heart rate 110 /min Respiratory rate 20 /min Temperature 37 °C Which of the following is the most likely diagnosis?

A:

Pancreatitis

B:

Pneumothorax

C:

Duodenal perforation

D:

Acalculous cholecystitis

Q.2. A 6 week old child is brought to A&E with persistent non-bilious vomiting. The child feels hungry and wants to feed despite constant vomiting. Biochemistry shows K+ of 3.1 mmol/L. What is the most likely diagnosis?

A:

Pyloric stenosis

B:

Duodenal atresia

C:

Malrotation

D:

Achalasia cardia

Q.3. A 5-month-old baby is presented with bilateral groin swelling that has been present since birth. On examination, there are small bilateral inguino-scrotal swellings, which become prominent ‘when the child cries. His abdomen is soft and non-tender. Which of the following is the most appropriate management?

A:

Herniotomy

B:

Lichtenstein repair

C:

Laparoscopic mesh repair

D:

Biological mesh placement

Q.4. A 58 year old lady with a medical history of type 1 diabetes mellitus has a tender lump near the anal opening which has been increasing in size for the last 3 weeks. She complains of constipation and throbbing pain when she sits down. She has a temperature of 38.1 C. The mass is seen to be swollen, erythematous and tender at the edge of the anus. What is the most appropriate management?

A:

Incision, drainage and antibiotics

B:

Intravenous antibiotics only

C:

Rubber band ligation

D:

Glycerol suppositories

Q.5. A 76 year old who is on medication for hypertension comes to clinic suffering from pain and redness at the metatarsophalangeal joint of his right first toe. Which of the following antihypertensive medication is the most likely to have caused his symptoms?

A:

Losartan

B:

Bendroflumethiazide

C:

Ramipril

D:

Bisoprolol

Q.6. 42 year old obese woman presents to the emergency department with a 12 hour history of severe epigastric pain. The pain started suddenly and radiates to her back. It is relieved when sitting forward. She is nauseous and has vomited twice since the pains started. She drinks one and a half glasses of wine per day. She has no significant past medical history. She has a pulse rate of 110 beats/minute and is tender in the epigastric region. What is the most appropriate investigation?

A:

Chest X-ray

B:

Abdominal ultrasound

C:

Serum lipase

D:

Abdominal X-ray

Q.7. A 20-year-old woman complains of the recent onset of a swelling in her left breast. Examination confirms a smooth walled oval shaped mass measuring 2x2 cm. Which of the following is the most likely diagnosis?

A:

Breast cyst

B:

Duct ectasia

C:

Fibroadenoma

D:

Carcinoma of breast

Q.8. A 65-year-old diabetic presents with a 4-day history of severe perianal pain with high grade fever. On examination, there is no external swelling. On digital rectal examination, there is posterior bogginess and tenderness with slight purulent discharge coming from the anal canal. Temperature 38 °C Which of the following is the most likely diagnosis?

A:

Perianal fistula

B:

Ulcerative colitis

C:

Intersphincteric abscess

D:

Condylomata acuminate

Q.9. A 24-year-old lactating mother presents with pain in her right breast. Examination confirms a 5 cm tender swelling. The overlying skin is red, inflamed and thinned out. Temperature 38.7 °C What is the most appropriate management?

A:

Lump excision

B:

Needle aspiration

C:

Incision and drainage

D:

Conservative management with antibiotics

Q.10. A 12-year-old patient presents with a 4-hour history of right sided lower abdominal pain. Examination confirms a slightly elevated, tender right esis. The lie of the testis is horizontal ‘with no redness or oedema of the scrotum. : Which of the following is the most appropriate management?

A:

Oral analgesics

B:

Oral antibiotics

C:

Doppler ultrasound

D:

Scrotal exploration

Q.11. An 82 year old woman with a background history of long standing dementia comes to the hospital with symptoms of pneumonia. She rapidly deteriorates after a few days. The medical team has deemed that resuscitation would not be in the patient’s best interest as it would lead to poor quality of life. Tehre is no advanced notice or living will in her notes which sttes her decision for resuscitation. Her daughter tells you that she thinks she should be resuscitated. What is the most appropriate action in regards to a Do Not Resuscitate (DNR) order?

A:

Take patient’s consent as required for a DNR order

B:

Take consent from her daughter as required for a DNR order

C:

Involve patiennt and daughter regarding decision, but no consent is necessary from daughter or patient for a DNR order

D:

Assess mental capacity of patient

Q.12. A 75-year-old woman presents with a 7-day history of severe pain in the epigastrium. The pain is relieved by vomiting and becomes worse when eating. History confirms that she has been taking medication for joint pain for the last 2 months. Which of the following is the most likely diagnosis?

A:

Esophagitis

B:

Acute gastritis

C:

Boerhaave's syndrome

D:

Perforated peptic ulcer

Q.13. A 55-year-old man presents to the Emergency Department with severe abdominal pain and absolute constipation for 2 days associated with nausea and vomiting. He has a significant past history of constipation requiring use of laxatives. On examination, his abdomen is distended, tense, tender all over with a palpable mass in the left lumbar and hypochondrium (see image) Which of the following is the most likely site of volvulus?

A:

Caecum

B:

Rectum

C:

Sigmoid colon

D:

Transverse colon

Q.14. A 25-year-old man underwent an open appendectomy for a perforated appendix. He was. discharged on the 2nd post-operative day uneventfully. He returned on the 8th post-operative day complaining of pain and redness around the wound site. On examination, there is purulent discharge from the wound site. His abdomen is soft with tender over the wound site. Digital rectal examination was unremarkable Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 38 °C Which of the following is the most appropriate management?

A:

IV antibiotics

B:

Open drainage

C:

CT scan abdomen

D:

Exploratory laparotomy

Q.15. A 45-year-old patient complains of recurrent episodes of upper abdominal pain for the past 2 ‘week with fever. On examination, the patient is jaundiced, abdomen is soft with marked tenderness all over the abdomen (see lab results and report). Blood pressure 90/60 mmHg Heart rate 130 /min Respiratory rate 18 /min Temperature 38 °C Test Result Normal Values Indirect bilirubin 5 3.2-12.1 pmollL Direct birubin 20 1.56.5 umollL Total bilirubin 25 3.5-16.5 pmollL Alkaline phosphatase 450 39-117 IU/L Amylase 1400 24-151 UL Ultrasound: CBD of 1.4 cm with dilatation of intrahepatic ducts. Which of the following is the most likely diagnosis?

A:

Hepatitis

B:

Cholangitis

C:

Pancreatitis

D:

Acute Cholecystitis

Q.16. A 65 year old female patient has become increasingly distressed. She cries all the time and has been forgetting to lock her doors at night and turn off the stove after she has used it. She is forgetful, having forgotten her son’s birthday this year, which she has never done before. She also gets lost when she goes out, and has difficulty in finding her way back home. On occasion she puts her house keys in the microwave, and she does not appear to know how to use it to cook food anymore. She also has a prominent impairment of recent memory but has an intact immediate recall. She has no impairment in her level of consciousness. She has no significant past medical history of note and is not on any chronic medications. A mini mental state examination was done for her (MMSE) and she was scored 26 out of 30. What is the most likely diagnosis for this patient?

A:

Alzheimer’s disease

B:

Bipolar affective disorder

C:

Major depressive disorder

D:

Schizophrenia

Q.17. A 20-year-old woman recently had an infant complains that she has been having recurrent episodes of upper abdominal pain since the third trimester. The pain radiates to her back and is associated with nausea. On examination, her abdomen is soft and non-tender. On deep palpation, there is a mass measuring 8 x 8 cm in the epigastric region, which appears to be non- pulsatile and non-tender (see lab result). Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Test Result Normal Value Lipase 250 0-160 IU/L Which of the following is the most likely diagnosis?

A:

Hydated cyst

B:

Gall bladder mucocele

C:

Pancreatitc Pseudocyst

D:

Gastrointestinal stromal tumour

Q.18. A 60-year-old woman presents with a 12-hour history of severe pain in the epigastrium radiating to her back. Itis associated with nausea and 2 episodes of vomiting. She has a history of cholelithiasis. Abdominal examination confirms generalized tendemess in abdomen. Which of the following is the most likely diagnosis?

A:

Biliary colic

B:

Acute pancreatitis

C:

Acute cholecystitis

D:

Empyema gallbladder

Q.19. A 65year-old patient is intubated in the Intensive Care Unit because of septic shock. Which of the following will best indicate adequate systemic perfusion?

A:

Cardiac index

B:

Central venous pressure

C:

Mixed venous oxygen saturation

D:

Pulmonary capillary wedge pressure

Q.20. A 55-year-old man underwent an open appendectomy for a perforated appendix. He presented to the Emergency Department on the 6th post-operative day complaining of severe abdominal pain, distension and an inability to pass stool. On examination, there is feculent discharge from the wound site with signs of peritonitis (see lab results and report). Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 18 /min Temperature 38 °C Oxygen saturation 95 % Test Result Normal Values ABG HCO3- 10 22-28 mmol ABG PCO2 4.8 4.7-6.0 kPa PH7.257.36-7.45 ABG PO2 1110.6-14.2 kPa Base access 12-2 10 2 mmolL Ultrasound abdomen: Moderate ascites with echoes and septations. Which of the following is the most appropriate management?

A:

Wound care

B:

IV antibiotics

C:

CT scan abdomen

D:

Exploratory laparotomy

Q.21. A 5-year-old child complains of a painful left testicular swelling. On examination, there is a firm swelling in his left hemi-scrotum, it is irreducible, with negative transillumunation test. Which of the following is the most appropriate management?

A:

Herniotomy

B:

Orchidopexy

C:

Herniorthaphy

D:

Tension free repair

Q.22. A 35-year-old man sustained a right tibia fracture in a road traffic accident. He is being managed by closed reduction with cast but he develops swelling in his toes and pain. Which of the following is the earliest alarming sign?

A:

Pain

B:

Foot drop

C:

Diminished pulses

D:

Paraesthesia between toes

Q.23. A 45 year old man has developed an annular rash with a scaly edge on his thigh. The rash has been spreading over the last 3 weeks. He also complains of general aches and pains. What is the most appropriate investigation?

A:

Antinuclear antibodies

B:

Biopsy of the lesion

C:

Skin scrap for mycology

D:

Antibodies to Borrelia burgdorferi

Q.24. A 12-year-old presents with left sided lower abdominal pain. Examination confirms a slightly elevated, tender left testis with redness and oedema of the scrotum. Which of the following is the most likely diagnosis?

A:

Testicular torsion

B:

Epididymo-orchitis

C:

Incarcerated inguinal hernia

D:

Torsion of a testicular appendage

Q.25. A 3-year-old uncircumcised boy has a history of foreskin ballooning during micturition. Examination confirms a fing of white scarred tissue and an inability to retract foreskin. Which of the following is the most likely diagnosis?

A:

Chordee

B:

Phimosis

C:

Hypospadias

D:

Paraphimosis

Q.26. A 41 year old man presents with visual symptoms and a headache. An ophthalmoscopic examination shows papilloedema. Which anatomical site is most likely to be affected?

A:

Retina

B:

Optic disc

C:

Optic radiation

D:

Macula

Q.27. A 27-year-old woman complains of a 3-month history of right upper quadrant pain, fever, and malaise. On examination, she is febrile, her abdomen is soft and tender in the right upper quadrant. Indirect hemagglutination titer for Echinococcus granulosus is positive (see image). Blood pressure 110/70 mmHg Heart rate 95 /min Temperature 37.4 °C Which of the following is the most appropriate management?

A:

Albendazole therapy

B:

Percutaneous drainage

C:

Open cyst deroofing

D:

Laparoscopic pericystectomy

Q.28. A 12-year-old boy presents to the Emergency Department after a fall that led to a supra- condylar fracture. Presently his distal pulses are not palpable. Blood pressure 110/70 mmHg Heart rate 120 /min Which of the following is the most appropriate management?

A:

Early K-wire

B:

Hand elevation

C:

Watchful waiting

D:

Surgical exploration

Q.29. A 35-year-old woman presented with partial thickness burns on her arms and leg due to hot water spillage 1 day ago, with wound edema and congestion. Which of the following is the most likely responsible mediator?

A:

Serotonin

B:

Bradykinin

C:

Prostaglandin I2

D:

Thromboxane A2

Q.30. A 55-year-old is scheduled to undergo laparoscopic cholecystectomy. Which of the following is the most appropriate prophylactic antibiotic regimen?

A:

Regular dose for 5 days

B:

3 doses postoperatively

C:

Single dose with anaesthesia induction

D:

Single dose 1 hour before skin incision

Q.31. A 25-year-old complains of an inability to extend her fingers and numbness over her left wrist On examination, there is paraesthesia of the skin over the left wrist and anatomical snuffbox, and an inability to extend her metacarpophalangeal joint. She also demonstrates wrist drop. Clinical injury to radial nerve is suspected. Which of the following is the most likely site of injury?

A:

In the axilla

B:

Carpel tunnel

C:

OlecrBatman process

D:

Spiral groove of humerus

Q.32. A study of a new drug to decrease the risk of a myocardial infarction shows the following results: 100 out of 1000 patients on the placebo drug developed a myocardial infarction in 5 years, 50 out of 1000 patients on the new drug developed a myocardial infarction in 5 years. What is the absolute risk reduction in a 5 year period in this study?

A:

0.05

B:

0.1

C:

0.5

D:

5

Q.33. A 27 year old woman presents with tremors, anxiety. She has a history of significant weight loss over the last 6 months.She has a heart rate of 112 beats/minute. Mild proptosis was seen on examination. What is the most likely mechanism that accounts for her symptoms?

A:

Deficiency in thyroid hormone

B:

Increased level of calcitonin

C:

Increased metabolic rate

D:

Reduced caloric intake

Q.34. A 32 year old smoker presents with double vision on looking upwards. She also complains of pain on eye movement as well as dry eyes most of the day. The eye pain is described as an ache which is worse in the morning. On examination, her eyelids appear to move more slowly than the eyes on looking downwards. There is noticeable swelling of her eyelids. What is the most appropriate investigatin that would lead to a diagnosis?

A:

Thyroid function tests

B:

Tensilon test

C:

Fundoscopy

D:

Autoantibodies

Q.35. A 65-year-old with ischaemic heart disease is complaining of chest pain 2 hours aftera laparoscopic cholecystectomy. Examination confirms an irregular pulse. Blood pressure 80/58 mmHg Respiratory rate 22 /min Temperature 36.6 °C Which of the following is the most appropriate management?

A:

ECG

B:

Chest X-ray

C:

CT angiography

D:

Doppler scan of lower limbs

Q.36. A 27 year old woman visits the general practitioner for a routine annual examination. She has had a lump in her breast for two years but has not sought any medical advice. The mass has remained the same size for the past two years. On examination, the mass is located on the right upper quadrant and it is felt as a firm 3 cm by 2 cm mass. It is nontender and mobile. What is the most likely diagnosis?

A:

Fat necrosis

B:

Atypical hyperplasia

C:

Phyllodes tumour

D:

Fibroadenoma

Q.37. A 90 year old woman is brought to the hospital complaining of back pain and has been referred to the orthopaedic surgeon. She has been saying that her mother is due to visit her today and that somebody must have broken her lower back as she is in agony. Her blood tests show: Haemoglobin 109 g/L Serum urea 7.5 mmol/L Serum creatinine 293 micromol/L Serum calcium 3.02 mmol/L What investigations is most likely to lead to a diagnosis?

A:

Ultrasound KUB

B:

X-ray Spine

C:

Intravenous urogram

D:

Urine protein electrophoresis to look for Bence-Jones protein

Q.38. A 38 year old man was slapped over his right ear during a fight. There is blood coming from his right external auditory canal. He describes the pain as intense and he also has ringing in his ears. He is also noted to have decreased hearing on that ear. What is the most appropriate initial investigation?

A:

Compute tomography

B:

Magnetic resonance imaging

C:

Otoscopy

D:

Skull X-ray

Q.39. A 24-month-old baby is brought in with a right sided red inflamed hemiscrotum. On exploration, the right testis is viable however; the cord is thick and oedematous. Which of the following is the most likely diagnosis?

A:

Testicular torsion

B:

Epididymo-orchitis

C:

Incarcerated inguinal hernia

D:

Torsion of a testicular appendage

Q.40. A 72-year-old underwent a subtotal colectomy 5 days ago. His urine output over the past 8 hours has been 7 muh. Blood pressure 110/70 mmHg Heart rate 90 /min Temperature 36.6 °C Which of the following is most appropriate to administer intravenously?

A:

Diuretics

B:

Inotropes

C:

Antibiotics

D:

500 NS fluid challenge

Q.41. A 55-year-old man was admitted with a 2-year history of recurrent upper abdominal pain attacks. History confirmed a recurrent colicky pain aggravated my morphine or ts analogues (see lab results and report). Blood pressure 110/70 mmHg Heart rate 96 /min Respiratory rate 18 /min Temperature 36.6 °C Test Result Normal Values Indirect bilirubin 5 3.2-12.1 pmol/L Direct bilirubin 10 1.5-6.5 pmol/L. Total bilirubin 15 3.5-16.5 pmol/L Alkaline phosphatase 250 39-117 IU/L Amylase 150 24-151 ULL Ultrasound abdomen: Prominent common bile duct along with dilated minimal dilatation of intrahepatic ducts. Which of the following is the most likely diagnosis?

A:

Pancreatitis

B:

Biliary colic

C:

Cholecystitis

D:

Sphincter of oddi dysfunction

Q.42. A 75-year-old diabetic hypertensive man underwent an exploratory laparotomy for a perforated duodenal ulcer. Postoperatively, he was kept in Intensive Care with ventilator support. His cardiac output is 2.5L/min and pulmonary capillary wedge pressure is elevated to 20 mm Hg. Blood pressure 80/50 mmHg Heart rate 115 /min Respiratory rate 22 /min Temperature 36.6 °C Oxygen saturation 91 % Which of the following is the most likely type of shock?

A:

Septic

B:

Cardiogenic

C:

Hypovolemic

D:

Anaphylactic

Q.43. A young man was brought to the Emergency Department after he was hit in the chest while playing football. On examination, he was dyspnoeic and drowsy with GCS 11/15. Tracheal shifting to the left and raised JVP were noted. He has barely audible breath sounds on the right side. Blood pressure 80/50 mmHg Heart rate 130 /min Respiratory rate 32 /min Temperature 36.6 °C Oxygen saturation 90 % Which of the following is the most likely diagnosis?

A:

Flail segment

B:

Cardiac tamponade

C:

Pulmonary contusions

D:

Tension Pneumothorax

Q.44. A 3-day-old is presented for circumcision. Examination confirms chordee and hooded foreskin. Urethral opening is at mid-penile level. Which of the following is the most appropriate management?

A:

Open circumcision

B:

Plastibell circumcision

C:

Circumcision using gumco

D:

Referral to paediatric surgeon

Q.45. A 25 year old male presents to Accident & Emergency with the complaint of substernal sharp chest pain. The patient claims that the pain is much worse on inspiration. His pas medical history is insignificant however, he smokes 20 cigarettes daily and drinks 50 units of alcohol weekly. On examination, his chest is clinically clear and his abdominal examination was found to be normal. His vitals are noted as: Temperature 38 C Respiratory rate 18 breaths/minute Blood pressure 110/70 mmHg Oxygen saturation 97% What is the most likely diagnosis for this patient?

A:

Myocardial infarction

B:

Pericarditis

C:

Pulmonary embolism

D:

Pneumonia

Q.46. The parents of two children would like to try for another child. Their first child was diagnosed with cystic fibrosis and their second child is healthy. Both the parents are healthy. What is the chances of their next child being a carrier?

A:

1:4

B:

1:2

C:

2:3

D:

1:8

Q.47. A 30-year-old woman presents with a mass in the right upper quadrant of her breast for the last 4 years. According to the patient, the mass was initially small but over the past 2 years, it has been constantly growing in size. On examination, the mass measures 15 x 15 cm, is mobile and not attached to underlying muscle. Overlying skin is thinned out due to the mass effect (see report). Ultrasound breast: Solid mass containing single or multiple, round or cleft like cystic spaces and demonstrating posterior acoustic enhancement. Which of the following is the most appropriate management?

A:

Radiation therapy

B:

Simple mastectomy

C:

Neoadjuvant chemotherapy

D:

Modified radical mastectomy

Q.48. An 8 week infant has been diagnosed as HIV positive. What is the most appropriate immunization plan for the infant?

A:

Avoid MMR vaccinations and tetanus vaccinations

B:

Administer all vaccines as scheduled except live attenuated vaccines

C:

Administer only BCG vaccine

D:

Administer all vaccines as scheduled except BCG vaccine

Q.49. A 23 year old woman has been found unconscious by her partner. There are several packets of paracetamol and an empty bottle of vodka alongside her. When she comes to the Emergency Department, she is confused and unable to estimate when she took the tablets. Her Glasgow Coma Scale (GCS) score is 14/15. Which is the most appropriate next step?

A:

CT head

B:

Haemodialysis

C:

Start N-acetylcysteine immediately

D:

Start N-acetylcysteine 4 hours after presentation

Q.50. A 37-year-old woman complains of abdominal fullness, epigastric discomfort and loss of appetite, She is recovering from an episode of acute pancreatitis 5 weeks ago. On examination, her abdomen is distended and there is vague fullness in epigastrium (see report). CT scan: Cystabout 24 x 18 cm in the lesser sac. Which of the following is the most appropriate management?

A:

Excision of cyst

B:

Surgical drainage

C:

Image guided aspiration

D:

Endoscopic Internal drainage

Q.51. A 25-year-old woman who is taking steroids for inflammatory bowel disease complains of abdominal pain and bilious vomiting. On examination, her abdomen is distended and tender in the right iliac fossa. She had a colonoscopy 2 weeks ago which was normal. Contrast barium ~~ study was ordered (see report). Blood pressure 110/70 mmHg Heart rate 100 /min Barium study: Single stricture at the terminal ileum, 1 cm from the ileocecal valve. Which of the following is the most appropriate management?

A:

Stricturoplasty

B:

Right hemicolectomy

C:

Conservative medical management

D:

Segmental resection with ileostomy

Q.52. A 35-year-old woman presents with difficulty in breastfeeding her baby. Examination confirms unilateral nipple inversion. Gentle pressure everts the nipple and itis transversely slitted. Which of the following is the most likely diagnosis?

A:

Breast cyst

B:

Duct ectasia

C:

Fibroadenoma

D:

Carcinoma of breast

Q.53. A 22-year-old complains of a 2-day history of right sided chest pain and dyspnoea. It started during landing from a long flight. On examination, he is tall, breath sounds are absent on the fight side and percussion note is resonant (see report). CXR: Right pneumothorax. Which of the following is the most appropriate initial management?

A:

Thoracentesis

B:

Tube thorcostomy

C:

Thoracoscopic blebectomy

D:

Conservative management

Q.54. A 60-year-old woman presents with a mass in her right breast. Clinical examination confirms a hard, non-tender irregular lump with skin tethering. Which of the following is the most likely diagnosis?

A:

Breastoyst

B:

Duct ectasia

C:

Fibroadenoma

D:

Carcinoma of breast

Q.55. A 45-year-old woman complains of chills and rigors. She underwent a common bile duct exploration a few hours ago (see lab results). Blood pressure 110/70 mmHg Heart rate 80 /min Respiratory rate 18 /min Temperature 38 °C Test Result Normal Values Hb 130 130-170 g/L (Male) 120-160 g/L (Female) WBC 945-105 x 109 Neutrophils 50 40-60% Which of the following is the most likely diagnosis?

A:

Sepsis

B:

Bacteraemia

C:

Severe sepsis

D:

Systemic inflammatory response syndrome

Q.56. A 15 year old boy presents to A&E with a nose bleed. The bleeding started 3 hours ago and has not stopped. His blood pressure is 115/70 mmHg, heart rate is 80 bpm and respiratory rate is 18/min. What is the most appropriate next course of action?

A:

IV fluids

B:

Lean forward, open mouth and pinch cartilaginous part of nose firmly

C:

Lean backwards, ice packs and pinch base of nose firmly

D:

Strat IV transexamic acid

Q.57. A 45 year old man had an endoscopy earlier in the day for investigations for chronic abdominal pain. The next day evening, he returns to the hospital with complaints of chest pain and shortness of breath. The pain isseen worse at the epigastric area and radiates to the interscapular region of the back. His abdomen is soft and nontender. His respiratory rate is 29 breaths/minute, pulse rate is 110 beats/minute, a temperature of 37.8 C and blood pressure is 120/70 mmHg. A chest X-ray reveals mediastinal widening. What is the most likely diagnosis?

A:

Aspiration pneumonia

B:

Mediastinitis

C:

Pneumothorax

D:

Posterior mediastinitis

Q.58. A 45-year-old presents after a 50 feet fall. On examination, he looks pale, peripheral pulses are feeble, and his chest has decreased breath sounds on left side (see image and report). Blood pressure 100/60 mmHg Heart rate 100 /min Respiratory rate 20 /min X-ray trauma series: Left dislocated hip and calcaneal fracture. Which of the following is the most appropriate management?

A:

Left tube thoracostomy

B:

Emergency thoracotomy

C:

Aortography and stenting

D:

Intubation and ventilation

Q.59. A 60-year-old woman complains of a large amount of fresh bleeding per rectum and weakness. She had similar episodes 2 weeks ago. On examination, she looks pale and dehydrated. Her abdomen is soft and non-tender Digital rectal examination revealed bright red blood on finger (see lab results and reports). Blood pressure 90/60 mmHg Heart rate 120 /min Test Result Normal Values Hb 55 120-160 g/L HCT 0.16 0.37-0.48 Colonoscopy: Normal mucosa. Technetium scan: Angiodysplasia in left colon. Which of the following is the most appropriate management?

A:

Left hemicolectomy

B:

Conservative treatment

C:

Endoscopic laser ablation

D:

Mesenteric angioembolization

Q.60. A 33 year old woman has complaints of pain in her right arm and shoulder when she abducts it. The pain is worse at night and disturbs her sleep. She finds it difficult to perform task which involve lifting her arm such as combing her hair. She has recently moved to a new house and was involved in carrying heavy items. There is no history of trauma. What is the most likely cause of her pain?

A:

Rutpure of the long head of biceps

B:

Acromioclaviculre ligament tear

C:

Sternocleidomastoid injury

D:

Supraspinatus tendinitis

Q.61. A 50 year old man attends the Emergency Department with complaints of shortness of breath and palpitations which started 4 hours ago. He denies chest pain. He has a pulse of 142 beats/minute, a blood pressure of 110/80 mmHg and a respiratory rate of 20 breaths/minute. His past medical history includes hypertension, type 2 diabetes mellitus and angina. An ECG was performed which shows supraventricular tachycardia. Carotid sinus massage was attempted but he is still tachycardic. What is the most appropriate next management?

A:

Adenosine intravenously

B:

Amlodipine orally

C:

Aspirin orally

D:

Verapamil intravenously

Q.62. A 55-year-old man complains of dark stool and weakness. He has peptic ulcer disease and endoscopy investigations have confirmed multiple ulcers in the antrum. He has been kept on medical therapy. On examination, his abdomen is soft and non-tender. Repeat endoscopy confirms multiple ulcers in the antrum (see lab results) Test Result Normal Values Hb 58 130-170 g/L | HCT 0.18 0.42-0.52 Which of the following is the most appropriate management?

A:

Total gastrectomy

B:

Partial distal gastrectomy

C:

Endoscopic laser photocoagulation

D:

Truncal vagotomy and pyloroplasty

Q.63. A 58 year old man underwent surgery for varicose veins of the leg. He is now complaining of numbness on the medial side of his foot. What is the most likely nerve involved?

A:

Common peroneal nerve

B:

Tibial nerve

C:

Sural nerve

D:

Saphenous nerve

Q.64. A 28-year-old lactating mother presents with pain in her right breast. Examination confirms a 3 cm tender swelling with red and hot overlying skin. Temperature 37.9 °C Which of the following is the most likely diagnosis?

A:

Duct ectasia

B:

Fibroadenosis

C:

Fibroadenoma

D:

Breast Abscess

Q.65. A 75-year-old man complains of severe diarrhoea for the past 2 days. He has been taking antibiotics for the past 2 weeks for a lower respiratory tract infection. Examination confirms ~~ generalized distension and tendemess. Blood pressure 100/60 mmHg Heart rate 110 /min Respiratory rate 22 /min Temperature 38 °C Which of the following is the most appropriate management?

A:

CT scan of chest

B:

Diagnostic laparoscopy

C:

Exploratory laparotomy

D:

Stool for clostridium difficile toxins

Q.66. A 33-year-old woman underwent surgery for her right leg varicose veins. On the 2nd postoperative day, she complained of pain and paraesthesia on the medial aspect of her leg and foot. On examination, there is sensory loss of fine touch and pain in her right leg and foot, but no motor loss. Wounds are healthy. Which of the following nerves is most likely injured?

A:

Sciatic

B:

Femoral

C:

Obturator

D:

Saphenous

Q.67. A 5-year-old child is brought to the Emergency Department after being stabbed in the right lower | chest. His abdomen is distended. A focused abdominal sonogram for trauma is suggestive of free fluid in the abdomen. Blood pressure 100/80 mmHg Heart rate 110 /min ; Respiratory rate 20 /min Temperature 36.6 °C Oxygen saturation 90 % Which of the following is the most appropriate management?

A:

Thoracotomy

B:

Tube thoracostomy

C:

Exploratory laparotomy

D:

Angiographic embolization

Q.68. A 50-year-old man presented to the Emergency Department following a fall from 20 feet, on arrival he has a Glasgow Coma Scale of 8 with no external sign of injury. Mean arterial pressure 65 mmHg Intracranial pressure 15 mmHg. Which of the following Is the most likely cerebral perfusion pressure in mmHg?

A:

40

B:

40

C:

60

D:

70

Q.69. A 45-year-old diabetic man underwent a laparotomy for a diverticular perforation. On the 4th post-operative day, he developed a high-grade fever with chills and multiple spikes. On examination, his wound is healthy and his chest is clear to auscultation. On Digital rectal examination, there is bogginess anteriorly Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 18 /min Temperature 38 °C Which of the following is the most appropriate treatment?

A:

IV antibiotic

B:

IV paracetamol

C:

Abdominal cavity washout

D:

Ultrasound guided drainage

Q.70. A 13 month old female baby presents to the emergency department with dificulty in breathing. On examination, she has intercostal recessions and a bilateral widespread wheeze. Her temperature is 37.9 C and respiratory rate is 35 breaths/minute. What is the most likely diagnosis?

A:

Bacterial upper respiratory tract infection

B:

Pneumonia

C:

Bronchiolitis

D:

Respiratory distress syndrome

Q.71. A 30 year old woman comes to clinic in tears trying to describe the constant irritability she is in when dealing with her 2 small children. She describes herself as easilystartled. She is unable to concentrate for long but attributes it to poor sleep as she often gets nightmares of a house fire. Her husband died in a house fire while she was sleeping in the other room last year. What is the most appropriate management?

A:

Reasurance

B:

Relaxation therapy

C:

Quietiapine

D:

Fluoxetine

Q.72. A 34 year old female presents with a very strong foul smelling vaginal discharge. What organism(s) could cause such a symptom?

A:

Chlamydia, Gonorrhoea

B:

Chlamydia, Gardnerella

C:

Gonorrhoea, Gardnerella

D:

Gardnerella only

Q.73. A 25 year old woman presents to the GP with low mood. She has an increased appetite and has gone up 2 dress sizes. She also complains that she feels very tired and often only gets out of bed in the afternoon despite sleeping early. What is the most likely diagnosis?

A:

Pseudo depression

B:

Moderate depression

C:

Severe depressin

D:

Atypical depression

Q.74. A 40 year old woman has repeated retching and intractable vomiting following an elective varicose veins ligation and stripping surgery a few hours ago. Her pain is well controlled but she feels extremely nauseous. What is the most appropriate medication to administer?

A:

Oral domperidone

B:

Intravenous lorazepam

C:

Intramusculaer morphine

D:

Intravenous ondansetron

Q.75. A 55-year-old patient is diagnosed with a gastrointestinal stromal tumour of the stomach (4 x 3 ccm), confined to the body of the stomach, no surrounding infiltration, no distant metastases or : lymphadenopathy. Which of the following is the most appropriate management?

A:

Gastrectomy

B:

Endoscopic ablation

C:

Systemic chemo radiation

D:

Wedge resection with clear margins

Q.76. A 48 year old woman presented to her general practitioner with the complaint of new onset right shoulder pain and right thoracic spine pain. She says that the pain started a few weeks ago. Initially, it was just a minor discomfort but now it is a constant dull ache, which becomes worse when she lies down. She has had no relief with regular paracetamol or ibuprofen, which she purchased over the counter. She believes that the pain is probably due to her intense gym session last week and has presented today for further evaluation of her pain. Upon further questioning, she reveals that she was diagnosed with breast cancer one year ago. She finished her treatment successfully a few months ago and says that her oncologist reported to her that she was in remission. Upon examination of her shoulder, tenderness could be elicited over the shoulder joint and the surrounding areas. Her left shoulder appears to be normal and an upper limb neurological examination reveals no further abnormalities. An X-ray of her right shoulder was done which showed some degenerative changes. What is the SINGLE most appropriate investigation that you will perform to add in the management of this patient?

A:

DEXA (Dual Energy X-ray Absorptiometry) scan

B:

CT (Computed Tomography) scan

C:

Serum calcium

D:

Bone scintigraphy

Q.77. A 25-year-old man was brought to the Emergency Department with a penetrating chest injury 45 minutes ago. He was initially fine in the ambulance but then collapsed. Emergency response personal started resuscitation. On aval, he had a weak thread pulse, raised JVP and bilateral equal breath sounds. Blood pressure 90/60 mmHg Heart rate 140 /min Respiratory rate 30 /min Temperature 36.6 °C Oxygen saturation 85 % Which of the following is the most likely diagnosis?

A:

Flail segment

B:

Pneumothorax

C:

Cardiac tamponade

D:

Pulmonary contusions

Q.78. A 65-year-old smoker with diabetes mellitus presents with a long history of intermittent buttock pain and claudication that has worsened over the past few weeks. On examination, there is atrophy of buttock muscles with decreased power and painful movements. The femoral pulses are weak (see report) Angiogram: Aortoiliac insufficiency. Which of the following is the most appropriate management?

A:

Vasodilator therapy

B:

Aortofemoral bypass

C:

Axilobifemoral bypass

D:

Lumbar sympathectomy

Q.79. A 63 year old man presents with back pain, polydipsia and polyuria which have been present for the last couple of weeks. He complains of being tired lately. He has recurrent nose bleeds which started 6 months ago. His previous full blood count shows a normocytic, normochromic anaemia. His eGFR was found to be 40. Monoclonal proteins were seen during further investigations of which he was referred to secondary care. What is the most appropriate investigation to perform next that would lead to a diagnosis?

A:

Bone marrow biopsy

B:

Vitamin D levels

C:

Electrophoresis

D:

Renal biopsy

Q.80. A 70-year-old woman is bed bound due to basal ganglia bleed is having difficulty swallowing and has experienced significant weight loss. On examination, she is emaciated, and lethargic: Weak muscles of mastication and an absent gag reflex Which of the following is the most appropriate option to establish feeding?

A:

Gastrostomy tube

B:

Jejunostomy tube

C:

Parenteral nutrition

D:

Nasogastric tube feeding

Q.81. A 55-year-old hypertensive diabetic with ischemic heart disease woman presented with sudden: onset of left-sided lower abdominal pain associated with vomiting for 6 hours. On examination, she is pale, dehydrated and flushed. Peripheral pulses are regularly irregular. Her abdomen is distended, tender all over (see lab results). Blood pressure 170/100 mmHg Heart rate 121 /min Respiratory rate 20 /min Test Result Normal Values ABG HCO3- 13 22-28 mmol/L ABG PC02524.7-6.0 kPa pH7.237.36-745 ABG PO2 10.8 106-142 kPa Which of the following is the most likely diagnosis?

A:

Diverticulitis

B:

Ulcerative colitis

C:

Perforated viscus

D:

Mesenteric ischemia

Q.82. A 33 year old man suffered a mandibular fracture and now has loss of sensation over the chin and mucosal surface of the lower lip. Which nerve is most likely to be involved?

A:

Mandibular nerve

B:

Inferior alveolar nerve

C:

Buccal nerve

D:

Lingual nerve

Q.83. A 29 year old woman presents with a single 2 cm by 2 cm lump in the breast. The lump is mobile and hard in consistency. On examination, the mass is painless and there is also palpable lymph node in the axilla. An ultrasound was performed which shows a mass with hypoechoic, ill-defined, spiculated and microlobulated margins. A mammogram shows ill-defined, spiculate borders. A fine needle aspiration cytology was performed which results came back as normal. What is the most appropriate investigations to confirm the diagnosis?

A:

Repeat fine needle aspiration cytology

B:

Magnetic resonance imaging

C:

Punch biopsy

D:

Core biopsy

Q.84. A 55 year old man has numbness in hands and feet. His medical history is significant for asthma associated with nasal polyps and facial pain. Eosinophilia was shown on his last blood test. A pulmonary CT scan shows ground-glass inflammation. What is the most likely diagnosis?

A:

Churg-Strauss syndrome

B:

Temporal arteritis

C:

Poylarteritis nodosa

D:

Inflammatory myopathies

Q.85. A 65-year-old patient complains of chills and rigors 12 hours after undergoing removal of infected ureteric stent. Prior to the cystoscopy, her urine culture was positive for E. Coli (see lab result). Blood pressure 110/70 mmHg Heart rate 96 /min Respiratory rate 18 /min Temperature 38.6 °C Test Result Normal Value WBC 154.5-10.5 x 1091 Which of the following is the most likely diagnosis?

A:

Sepsis

B:

Bacteraemia

C:

Severe sepsis

D:

Systemic inflammatory response syndrome.

Q.86. A 45-year-old man with achalasia cardia presents to the Emergency Department with retrosternal pain and dyspnoea. He underwent oesophageal dilation 12 hours ago. On examination, he has crepitus at right lateral chest wall and neck (see lab results and report). | Blood pressure 100/60 mmHg Heart rate 120 /min : Respiratory rate 28 /min Temperature 40.6 °C Test Result Normal Values WBC 21.8 4510.5 x 109 Gastrograffin study: Contrast leak. Which of the following is the most appropriate management?

A:

Esophagectomy

B:

Parenteral feeding

C:

Esophageal stenting

D:

Surgical drainage and repair

Q.87. A 75-year-old man in the Intensive Care Unit has developed a discharging sacral wound. Examination confirms necrotic skin and subcutaneous fat. Which of the following is the most appropriate management?

A:

Primary repair

B:

Debridement and primary closure

C:

Debridement and primary skin grafting

D:

Debridement and vacuum-assisted closure

Q.88. A 30-year-old woman underwent an exploratory laparotomy for a perforated duodenal uicer. Post-operatively she developed septic shock syndrome. Which of the following is the most common physiological response?

A:

Hypokalaemia

B:

Respiratory acidosis

C:

Cellular anaerobic respiration

D:

Increase glomerular filtration rate

Q.89. A 26-year-old woman complains of right upper quadrant pain and nausea. She is 20 weeks pregnant. On examination, her abdomen is soft and non-tender. Ultrasound: Cholelithiasis. Which of the following is most appropriate management?

A:

Cholecytostomy tube

B:

Open cholecystectomy

C:

Conservative treatment

D:

Laparoscopic cholecystectomy

Q.90. A 38 year old woman recently returned from Bangkok. She did not have any malaria prophylaxis before leaving the UK on her trip. She presents with a high fever, generalized macular blanching rash, tender and swollen cervical lymphadenopathy and generalized myalgia. What is the most likely diagnosis?

A:

Cerebral Malaria

B:

Dengue fever

C:

Typhoid

D:

Diphtheria

Q.91. A T.day-d is presented or cirumcision. Examination confi uretal paring on the dorsal Which of the following is the most likely diagnosis?

A:

Epispadias

B:

Coronal hypospadias

C:

Glandular hypospadias

D:

Mid-penile hypospadias

Q.92. A 35-year-old woman is concerned about her mother history of invasive breast cancer and sister with ovarian cancer. Her diinical examination was unremarkable. Which of the following is the most appropriate breast cancer screening?

A:

Ultrasound

B:

Mammogram

C:

BRCA gene test

D:

Breast self-examination

Q.93. A 35 year old man presents to his GP surgery with a history of dyspepsia intermittently for the past 3 months. Serum antibodies for Helicobacter pylori which were performed a month ago for his symptoms were negative. There has been no improvement with his symptoms despite taking a proton pump inhibitor for the past 1 month. He reports no weight loss or blood in his stools. There is no previous history of non-steroidal anti-inflammatory drug (NSAID) use. He does not smoke and drinks a cup of coffee a day. An abdominal examination reveals slight tenderness at the epigastric region without any mass felt. What is the most appropriate next step?

A:

Urea breath test

B:

Repeat serum antibodies

C:

Change type of proton pump inhibitor

D:

Request an endoscopy

Q.94. A 13-year-old boy presents for elective surgery. He has a significant past history of bleeding tendency and has contracture of the right knee and hemarthrosis Which of the following is the most likely underlying clinical disorder?

A:

Haemophilia

B:

Aplastic anaemia

C:

Wilsons disease

D:

Henoch-schonlein purpura

Q.95. A 24-year-old woman complains of abdominal pain, sweating and palpitation. She was recently diagnosed with hypertension and has had a low response to medical therapy. On examination, her abdomen is soft, and non-tender (see lab result and report) Blood pressure 215/110 mmHg Heart rate 124 /min Respiratory rate 21 /min Temperature 38.6 °C Test Result Normal Values Catecholamines 2100 <591 nmoliday Ultrasound: 4 cm mass in right adrenal cortex. Which of the following is the most appropriate management for the hypertension?

A:

Beta blockers

B:

ACE inhibitors

C:

Alpha blockers

D:

Calcium channel blocker

Q.96. A 44 year old man with learning difficulties presents to the Emergency Department with vomiting blood earlier in the day. On admission, hisbloods show: Haemoglobin 99 g/L He is clinically stable but continues to vomit and requires an endoscopy to investigate the bleeding. Unfortunately, he is unable to understand the procedure or make an informed decision. What is the most appropriate action?

A:

Obtain a signed consent from his guardian with power of attorney

B:

Obtain a consent from two consultants and carry out the procedure

C:

Proceed with procedure without consent

D:

Cancel procedure

Q.97. Which of the following is most commonly associated with retroperitoneal sarcoma?

A:

Retroperitoneal bleeding

B:

Systemic lymphadenopathy

C:

Invasion into surrounding tissues

D:

Compression of surrounding tissues

Q.98. A 35-year-old man with gastroesophageal reflux disease presents to discuss his family history of oesophageal and gastric carcinoma. Which of the following is the main risk factor for oesophageal carcinoma?

A:

Smoking

B:

Idiopathic

C:

Barrets oesophagus

D:

Long standing achalasia

Q.99. A 68 year old man had a fall down the stairs. His daughter has brought him into the emergency department where he was having lucid intervals. Shortly after admission he becomes unconscious. What is the most likely vessel affected?

A:

Basilar artery

B:

Bridging veins

C:

Vertebral artery

D:

Middle meningeal artery

Q.100. A 65-year-old man diabetic complains of intermittent claudication of his right leg, the foot and sole are cold and numb. He underwent right lower limb angiography showing diffuse disease. 2 days later he developed a painful swelling in his right groin, On examination, there is a firm swelling below the inguinal crease, partially mobile, irreducible, nonexpansile, and tender with transmissible pulse. Which of the following is the most likely diagnosis?

A:

Psoas abscess

B:

Saphena varix

C:

Femoral hernia

D:

Pseudoaneurysm

Q.101. A 15 year old girl presents to the GP surgery with primary amenorrhoea. She has a short stature, low set of ears and a broad chest with widely spaced nipples. Wht is the most likely diagnosis?

A:

Down’s syndrome

B:

Klinefelter’s syndrome

C:

Turner syndrome

D:

Normal physiological findings

Q.102. A 39 year old woman has been having gradual loss of vision in both eyes over the past 6 months. She has a diagnosis of rheumatoid arthritis and has been on treatment for it for the past 4 years. Her intraocular pressure is within normal limits and red reflex is absent in both eyes. What is the most likely diagnosis?

A:

Cataract

B:

Diabetic retinopathy

C:

Hypermetropia

D:

Macular degeneration

Q.103. A 55-year-old man with no known co-morbidities underwent a Graham's patch repair for a perforated duodenal ulcer 10 days ago. On examination, his abdomen is soft and non-tender. | On auscultation, there is decreased breath sounds on the right lower chest. Blood cultures | obtained from the central and periphery line of the patient are growing gram positive cocci. Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 18 /min Temperature 38 °C Which of the following is the most appropriate treatment?

A:

Chest physiotherapy

B:

Removal of central Line

C:

Abdominal cavity washout

D:

Ultrasound guided drainage

Q.104. A 55-year-old woman complains of abdominal pain, distention and bilious vomiting. On examination she is pale, dehydrated, abdomen is soft, distended, with hyper dynamic gut sounds. She was diagnosed with gallstone disease 10 years ago (see report). Blood pressure 140/90 mmHg Heart rate 120 /min Temp 36.7 Test Result Normal Values Hb 100 120-160 gL Platelets count 125 150-400 x 109/L WBC 18.6 45-10.5 x 1091L CT scan: Airin the biliary system. Which of the following is the most likely diagnosis?

A:

Cholengitis

B:

Pancreatitis

C:

Cholecystitis

D:

Gall stone ileus

Q.105. A 33-year-old man was brought to the Emergency Department after a high velocity trauma. He had distended neck veins and markedly decrease breath sounds on the right side. Heart rate 105 /min Blood Pressure 90/60 mmHg Oxygen saturation 85% Which of the following is the most likely cause?

A:

Flail chest

B:

Right hemothorax

C:

Pericardial tamponade

D:

Right tension pneumothorax

Q.106. A 28 year old woman, with a background of chronic alcoholism presents with bright-red haematemesis and abdominal pains. On examination, she has cool extremities and is seen to be confused. Her blood pressure is 85/60 mmHg and her heart rate is 120 beats/minute. What is the most appropriate next step in management?

A:

Emergency endoscopic band ligation

B:

Emergency endoscopic sclerotherapy

C:

Octreotide

D:

Intravenous fluids

Q.107. A 30 year-old patient complains of a 2-year history of perianal itching and discomfort. On perianal examination, there are cauifiower-iike multiple lesions clustered together. They are pink to grey in colour and tender to touch. Which of the following is the most likely diagnosis?

A:

Anal carcinoma

B:

Rectal carcinoma

C:

Fibroepithelial polyps

D:

Condylomata acuminate

Q.108. A 20 year-old weight-ifter complains of a 2-day history of bilious vomiting and abdominal distention. Examination revealed swelling in the left inguinal region, which is firm and tender (see report). Blood pressure 100/70 mmHg Heart rate 116 /min Respiratory rate 20 /min Temperature 36.6 °C X-ray abdomen: Multiple air fluid levels with no air in the large bowel. What type of hemia is the most likely diagnosis?

A:

Obstructed

B:

Imeducible

C:

Incarcerated

D:

Strangulated

Q.109. A 66-year-old man recently underwent an anterior resection of the rectum and is making a slow recovery. He complains that in the middie of the night he has pain in the left calf. On examination, he has a tender left calf, which is slightly swollen and red (see report). Blood pressure 110770 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturation 90 % Ultrasound Doppler: Deep vein thrombosis in the left popliteal region extending up to the common femoral junction. Which of the following is the most appropriate management?

A:

Heparin

B:

Warfarin

C:

IVC filter

D:

Enoxaparin

Q.110. A patient that underwent a cholecystectomy earlier has pyrexia with temperature spikes. On examination, the wound is healthy. His abdomen is soft with mild tenderness in the right hypochondriac region. There is decreased air entry on the right side of the chest on auscultation. Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 20 /min Temperature 38.5 °C Ultrasound: collection of 10 x 15 cm in the gall bladder fossa. Which of the following is the most appropriate management?

A:

IV antibiotics

B:

Chest physiotherapy

C:

Ultrasound guided drainage

D:

Endoscopic retrograde cholangiopancreatography

Q.111. A 45-year-old man complains of pain the bilateral groin swelling over the last 6-months. On examination, there are small bilateral inguino-scrotal swellings. Cough impulse is positive and his abdomen is soft and non-tender. Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturation 95 % BMI 30 kg/m2 Which of the following is the most appropriate management?

A:

Hemiotomy

B:

Lichtenstein repair

C:

Laparoscopic mesh repair

D:

Biological mesh placement

Q.112. A 24-month-old is presented with redness of both hemi-scrotum. Examination confirms non- tender, redness and oedema of the scrotum extending to both groins. Which of the following is the most likely diagnosis?

A:

Testicular torsion

B:

Epididymo-orchitis

C:

Idiopathic scrotal oedema

D:

Torsion of a testicular appendage

Q.113. A 65-year-old required intubation and transfer to Intensive Care Unit after collapsing in the ward. 2 days previously, she underwent an operation for empyema of the gallbladder (see lab result). Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 24 /min Temperature 38.7 °C Test Result Normal Value WBC 194.5-10.5 x 1091 Which of the following is the most likely diagnosis?

A:

Sepsis

B:

Bacteraemia

C:

Severe sepsis

D:

Systemic inflammatory response syndrome

Q.114. A 55 year-old diabetic woman with steroid dependent bronchial asthma underwent a right hemicolectomy for carcinoma of the caecum. Postoperatively she was kept in the Intensive Care Unit (see lab results). Blood pressure 80/40 mmHg Heart rate 140 /min Respiratory rate 25 /min Temperature 35.1 °C Oxygen saturation 95 % Test Result Normal Values Sodium 131 134-146 mmol/L Potassium 6.0 3.5-5.1 mmol/L. Bicarbonate 18 21-28 mmol Random Glucose 2.3 3.9-5.5 mmolL Which of the following is the most likely clinical condition?

A:

Thyroid storm

B:

Adrenal insufficiency

C:

Diabetic ketoacidosis

D:

Septic shock syndrome

Q.115. A 15 year old girl is brought to the hospital by her parents with mild lower abdominal pain. An ultrasound scan reveals a large ovarian cyst. The decision for a laparoscopic ovarian cystectomy has been made but she refuses treatment. She understands the consequences of not having the surgery and is deemed competent. Her parents ask if they can override her decision and sign the consent form on her behalf. What is the most appropriate action?

A:

Seek legal advice

B:

Obtain a consent from parents and carry out the surgery

C:

Obtain a consent from two consultant gynaecologists and carry out the surgery

D:

Contact social services

Q.116. 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 diseas

D:

Deep vein thrombosis

Q.117. Which of the following is most likely involved in neuro-hormonal stress response?

A:

Androgen

B:

Parathyroid

C:

Thyroid stimulating

D:

Corticotrophin releasing

Q.118. A 30-year-old patient was brought to the Emergency Department after being shot in the chest 1 hour ago. A tube thoracostomy on the left side was done for a pneumothorax. Afer 15 minutes, the underwater seal bottle is filed with 2 litres of blood. Blood pressure 90/60 mmHg Heart rate 120 /min Respiratory rate 22 min Temperature 36.6 °C Oxygen saturation 90 % Which of the following is the most appropriate management?

A:

Thoractomy

B:

CT scan chest

C:

Tube thoracostomy

D:

Angographic embolization

Q.119. A 27 year old male is admitted with acute exacerbation of asthma. He is treated intiated with 100% oxygen and salbutamol nebulizers. Intravenos hydrocortisone was prescribed but it was not available in the department. He has a respiratory rate of 21 breaths/minute, a heart rate of 90 beats/minute and an oxygen saturation of 92%. What is the most appropriate next step in management?

A:

Oral prednisolone 40 mg

B:

IV magnesium sulphate

C:

IV salbutamol

D:

IM adrenaline

Q.120. A 25-year-old underwent an open appendectomy for a perforated appendix 8 days ago and returns for follow-up. On examination, there is a seroma formation at the wound site, which is draining freely through a gaping wound. There are no signs of surrounding inflammation. Blood pressure 110/70 mmHg Heart rate 76 /min Respiratory rate 18 /min Temperature 36.6 °C Which of the following is the most appropriate treatment?

A:

Antibiotics

B:

CT scan abdomen

C:

Regular wound dressings

D:

Ultrasound guided drainage

Q.121. A young woman underwent a laparoscopic cholecystectomy for symptomatic gallstones 1 day ago. Post-operatively, there are decreased breath sounds in the lower chest on auscultation. Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 36.6 °C Oxygen saturation 90 % Which of the following is the most appropriate management?

A:

IV antibiotics

B:

Bronchodilators

C:

Ultrasound chest

D:

Incentive spirometry

Q.122. A 40-year-old presents with a right breast lump that has been present for 2 years. On examination, there is firm lump about 4 x 5 cm in the inner quadrant, overlying skin is normal ~~ and no palpable axillary nodes (see report) Trucut biopsy: Cystosarcoma Phylloides. Which of the following is the most appropriate management?

A:

Chemotherapy

B:

Radiation therapy

C:

Wide local excision

D:

Simple mastectomy

Q.123. A 10 year old girl with diagnosed asthma ishaving frequent coughs and wheezing that wakes her up at night. She is compliant with her asthma medications which consist of a short-acting B2 agonist inhaler as required, inhaled corticosteroid 400 mcg/day and a long-acting B2 agonist inhaler. Her inhaler technique is good. What is the most appropriate next step in management?

A:

Add daily steroid tablets

B:

Increased dose of inhaled corticosteroid

C:

Add sodium cromoglicate

D:

Intramuscular adrenaline

Q.124. A 20-year-old woman presents with fever and pain in her right leg. On examination, her right leg is swollen, tender with multiple red streaks, and palpable inguinal nodes. Which of the following is the most likely causative organism?

A:

Bacteroides

B:

Enterococcus

C:

Klebsiella pneumoniae

D:

Streptococcus pyogenes

Q.125. What colour of nipple discharge is most commonly associated with intraductal papilloma of the breast?

A:

Red

B:

Black

C:

White

D:

Green

Q.126. A 20-year-old woman presents with a lump in the right lower quadrant of her breast that has been present for the last 2 years. The lump was initially small but over the past 6 months has constantly been growing in size. On examination, the mass measures 8 x 10 cm, is mobile and not attached to underlying muscles. Overlying skin is thinned out due to pressure effect of the mass. There are no signs of surrounding inflammation or infection. Which of the following is the most likely diagnosis?

A:

Mastitis

B:

Phyllodes

C:

Galactocele

D:

Fibroadenoma

Q.127. A 36-year-old woman presents with pain in both breasts associated with multiple lumps that become prominent during her premenstrual phase. Examination confirms multiple nodules of variable size and consistency. Examination of the axillae is normal (see report) Ultrasound: Multiple bilateral cysts of variable sizes, and 2 solid oval-shaped lesions in left breast. Which of the following is the most likely diagnosis?

A:

Fibroadenoma

B:

Chronic mastitis

C:

Fibrocystic disease

D:

Carcinoma of breast

Q.128. A 25-year-old man presents to the Emergency Department his left thigh was run over accidentally by a car. Examination confirms stripping of skin and subcutaneous fat. Underlying neurovascular structures are exposed. Heart rate 100 /min Respiratory rate 20 /min Temperature 36.6 °C Oxygen saturation 95 % Which of the following is the most appropriate management?

A:

Debridement and primary closure

B:

Primary repair of injured structures

C:

Debridement and secondary skin grafting

D:

Debridement and vacuum-assisted closure

Q.129. A study was conducted to look for associations between hard warter and childhood eczema. Patients were selected and allocated into 2 groups by the method of computerized generated randomisation. Group A had a water softener installed in their homes before the birth of their child. Group B was the control group and did not have any changes to their water system. Both groups were followed for 6 months with monly follow-ups and skin testing of the newborns. The researchers did not know which groups the patients were allocated throughout the study. What is the most likely study design?

A:

Case-controlled study

B:

Cohort study

C:

Single-blinded randomised control trial

D:

Double-blinded randomised control trial

Q.130. A 15-year-old girl underwent an exploratory laparotomy for a perforated appendix. On 7th postoperative day she remained febrile and developed respiratory distress requiring mechanical ventilation. On examination her, abdomen was distended, tense, and tender. A contrast enhanced computed tomography was ordered. Post-CT she developed bleeding from her mouth, trachea and IV puncture site. Blood pressure 90/50 mmHg Heart rate 121 /min Respiratory rate 25 /min Temperature 35.6 °C Which of the following is the most likely diagnosis?

A:

Haemophilia

B:

Anaphylactic contrast reaction

C:

Idiopathic thrombocytopenic purpura

D:

Disseminated intravascular coagulation

Q.131. A 12-year-old presents with a 2-day history of right-sided scrotal pain. Examination confirms Tight testis with vertical orientation. There is an area of tenderness around the superior pole and the scrotum is red and oedematous. Which of the following is the most likely diagnosis?

A:

Testicular torsion

B:

Epididymo-orchitis

C:

Incarcerated inguinal hernia

D:

Torsion of a testicular appendage

Q.132. A 60-year-old patient complains of sudden onset of upper abdominal pain after a few bouts of vomiting. Examination confirms a sick patient with tenderness in the epigastrium and supraciavicular subcutaneous emphysema. Which of the following is the most likely diagnosis?

A:

Esophagitis

B:

Acute gastritis

C:

Perforated peptic ulcer

D:

Boerhaave's syndrome

Q.133. A 45-year-old patient complains of perianal swelling, fresh bleeding per-rectum and weight loss over the last 3 months. On examination, there is a mass 1 cm from the anal verge. She has no obstructive symptoms (see report). Blood pressure 110/70 mmHg Heart rate 96 /min Respiratory rate 18 /min Temperature 36.6 °C Biopsy: MRI abdomen: Localized lesion with cranio-caudal extension of 3 cm with associated lymphadenopathy. CT scan chest: There is no evidence of metastasis. Which of the following is the most appropriate treatment?

A:

Diversion colostomy

B:

Low anterior resection

C:

Concurrent chemoradiation

D:

Abdominoperineal resection

Q.134. A 5-month-old baby was admitted with an inability to tolerate food and non-bilious vomiting over | the past 2-days. On examination, he appears to be dehydrated. There is an olive shaped mass palpable in the epigastric region measuring 2 x 2 cm. i Which of the following is the most appropriate management?

A:

Pyloromyotomy

B:

Balloon dilatation

C:

Gastrojejunostomy

D:

Resection anastomosis

Q.135. A 25-year-old man underwent surgery for inflammatory bowel disease. He requires regular replacement of fat-soluble vitamins parenteral. Which part of the bowel was most likely removed?

A:

Distal ileum

B:

Mid jejunum

C:

Transverse colon

D:

Descending colon

Q.136. A 26 year old man was found on the street to be unsteady and drunk by police. On admission to Emergency, he had a sudden onset of headache with severe intensity. The headache is localized to his occipital area and is continuous. On examination, his GCS is 15/15, afebrile and no focal neurological signs. What is the most likely diagnosis?

A:

Subdural haemorrhage

B:

Subarachnoid haemorrhage

C:

Epidural haemorrhage

D:

Cluster headache

Q.137. A 3 year old child has been diagnosed with Duchenne muscular dystrophy. His mother is now pregnant with her second child who is also male. There is no family history of the disease besides the 3 year old child who is affected. She wishes to know the chances of her second child also being affected. What is the likelihood of her second child having Duchenne muscular dystrophy?

A:

100%

B:

50%

C:

25%

D:

12.5%

Q.138. A 45-year-old man is complaining of chills and rigors. He underwent an elective sublotal | colectomy for ulcerative colitis 12 hours ago (see lab results) Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 38 °C Test Result Normal Values Hb 110 130-170 g/L (Male) 120-160 g/L (Female) HCT 0.40 0.42-0.52 (Male) 0.37-0.48 (Female) WBC 15 4.5-10.5 x 1091 Neutrophils 60 40-60% Which of the following is the most likely diagnosis?

A:

Sepsis

B:

Bacteraemia

C:

Severe sepsis

D:

Systemic inflammatory response syndrome

Q.139. A 25-year-old woman is bought to the Emergency Department after being rescued from a burning house after 2 hours. She is drowsy. and covered in black soot. On examination, she has 35% bums and nostrils and mouth are filled with soot. After initial resuscitation, her carboxyhemoglobin levels are raised (40%). Blood pressure 90/50 mmHg Heart rate 125 /min Respiratory rate 32 /min Temperature 36.6 °C Which of the following is the most appropriate management?

A:

Exchange transfusion

B:

Hyperbaric oxygen therapy

C:

Carbonic anhydrase inhibitor therapy

D:

Intubation and ventilation with 100% oxygen

Q.140. A 30 year-old patient presents to the Emergency Department with 8-hour history of severe upper abdominal pain that is not relieved by oral medications. History confirmed recurrent similar events over the last year that was relieved by anti-spasmodic and anti-inflammatory drugs. Examination revealed jaundiced patient, with soft abdomen and marked tenderness in the right hypochondriac region (see lab results and report). Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 37.9 °C Test Result Normal Values WBC 16 4.5-10.5 x 1091 Indirect bilirubin 5 3.2-12.1 pmol/L Direct bilirubin 15 1.5-6.5 pmol/L Total bilirubin 20 3.5-16.5 pmol/L Alkaline phosphatase 400 39-117 IU/L Amylase 115 24-151 IUL Utrasound: Minimal CBD of 1.1 cm with dilatation of intrahepatic ducts.

A:

Hepatitis

B:

Cholangitis

C:

Pancreatitis

D:

Cholecystits

Q.141. A 34 year old man suffers from depression. He was recently started on sertraline by his GP. When can a therapeutic effect of sertraline be seen?

A:

1-2 hours

B:

1-2 days

C:

1-2 weeks

D:

1-2 months

Q.142. A 25-year-old presents with a 2-week history of severe perianal pain and an inability to pass stool for the last 2 days. History confirmed a haemorrhoidectomy 12-mothns ago. On examination, he is uneasy and in distress. On rectal examination, finger could not be passed beyond the anal verge due to severe pain. Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 18 /min Temperature 36.6 °C Which of the following is the most likely diagnosis?

A:

Anal fissure

B:

Anal stenosis

C:

Anal carcinoma

D:

Intersphincteric abscess

Q.143. A 19-year-old married woman complains of a 6-hour history of right lower abdominal pain and nausea. On Examination, she is tender in her right lower abdomen with rebound tenderness. Her LMP was 2 weeks back (see lab results) Blood pressure 110/70 mmHg Heart rate 100 /min Temperature 36.4 °C Test Resuit Normal Values Hb 105 120-160 g/L HCT 0.310.37-0.48 WBC 9.8 4.5-10.5 x 109/L Which of the following is the most likely diagnosis?

A:

Ureterocele

B:

Ovarian torsion

C:

Honeymoon cystitis

D:

Pelvic inflammatory disease

Q.144. A 45-year-old sustained a knife injury to his left wrist. Examination confirms a clean wound with division of the underlying tendons and median nerve. Which of the following is the most appropriate management?

A:

Debridement and primary closure

B:

Primary repair of injured structures

C:

Debridement and secondary closure

D:

Debridement and secondary skin grafting

Q.145. A 10 year old boy presents to clinic with poor grades in school and difficulty in hearing. There has been recurrent ear infections in the past which was resolved by medication. On examination: bone conduction is normal, air conduction is reduced bilaterally, and there is no lateralization in the Weber’s test. There is no pain. What is the most likely diagnosis?

A:

Acute otitis media

B:

Perforation of tympanic membrane

C:

Otitis media with effusion

D:

Congenital sensorineural deficit

Q.146. A 65-year-old complains of a 6-month change in bowel habits. On examination, he is pale, thin and emaciated. His abdomen is slightly distended. On digital rectal examination, there is a lesion 2 cm from the anal verge. On proctoscopy, the lesion appears to be caulifiower like mass, which is friable to touch. Which of the following Is the most likely diagnosis?

A:

Anal carcinoma

B:

Rectal carcinoma

C:

Fibroepithelial polyps

D:

Condylomata acuminate

Q.147. A 70-year-old alcoholic complains of a 6-month history of gradual progressive dysphagia and weight loss. On examination, he is cachectic and pale. His abdomen is soft and non-tender. | Digital rectal examination confirms altered coloured stool in the rectum (see lab resuits). ; Blood pressure 110/70 mmHg Heart rate 110 /min Respiratory rate 18 /min Temperature 36.6 °C Test Result Normal Values WBC 9.54.5-10.5 x 109/L. ; Hb 90 130-170 g/L. ; Urea 8 2.75-7.4 mmollL Creatinine 120 44-115 pmol Which of the following is the most likely diagnosis?

A:

Pancreatitis

B:

Oesophageal cancer

C:

Acid peptic disease

D:

Duodenal perforation

Q.148. A 24 year old woman with multiple sexual partners complains of non-cyclical intermittent lower abdominal pain, deep dyspareunia and menstrual irregularities that has been ongoing for 18 months. On vaginal examination, cervical excitation was noted and she is tender on both adnexae. She has no significant past medical history. Which is the most likely cause of her symptoms?

A:

Pelvic inflammatory disease (PID)

B:

Endometriosis

C:

Fitz-Hugh-Curtis syndrome

D:

Asherman syndrome

Q.149. A 7-month-old baby is brought in with a red and inflamed left hemiscrotum. Examination confirms a firm, tender, irreducible lump in the scrotum extending to the groin. The left testis cannot be palpated. Which of the following is the most likely diagnosis?

A:

Testicular torsion

B:

Epididymo-orchitis

C:

Incarcerated inguinal hernia

D:

Torsion of a testicular appendage

Q.150. A 42-year-old woman complains of recurrent episodes of upper abdominal pain over the past 2 weeks with associated high grade fever. On examination, she looks icteric. Her abdomen is soft with marked tenderness in the right hypochondiac region (see lab results). Blood pressure 110/70 mmHg Heart rate 120 /min Respiratory rate 18 /min Temperature 38 °C Test Resuit Normal Values Indirect bilirubin 10 3.2-12.1 pmol/L. ; Direct bilirubin 20 1.5-6.5 mol/L Total bilirubin 30 3.5-16.5 pmol/L. ; Alkaline phosphatase 250 39-117 IU/L. Amylase 100 24-151 UL WBC 204.5-10.5 x 1091 Which of the following is the most appropriate management?

A:

CBD exploration

B:

Laparoscopic cholecystectomy

C:

Percutaneous cholecystostomy

D:

Endoscopic retrograde cholangiopancreatography

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Q.2. A 6 week old child is brought to A&E with persistent non-bilious vomiting. The child feels hungry and wants to feed despite constant vomiting. Biochemistry shows K+ of 3.1 mmol/L. What is the most likely diagnosis?

Q.5. A 76 year old who is on medication for hypertension comes to clinic suffering from pain and redness at the metatarsophalangeal joint of his right first toe. Which of the following antihypertensive medication is the most likely to have caused his symptoms?

Q.7. A 20-year-old woman complains of the recent onset of a swelling in her left breast. Examination confirms a smooth walled oval shaped mass measuring 2x2 cm. Which of the following is the most likely diagnosis?

Q.9. A 24-year-old lactating mother presents with pain in her right breast. Examination confirms a 5 cm tender swelling. The overlying skin is red, inflamed and thinned out. Temperature 38.7 °C What is the most appropriate management?

Q.10. A 12-year-old patient presents with a 4-hour history of right sided lower abdominal pain. Examination confirms a slightly elevated, tender right esis. The lie of the testis is horizontal ‘with no redness or oedema of the scrotum. : Which of the following is the most appropriate management?

Q.12. A 75-year-old woman presents with a 7-day history of severe pain in the epigastrium. The pain is relieved by vomiting and becomes worse when eating. History confirms that she has been taking medication for joint pain for the last 2 months. Which of the following is the most likely diagnosis?

Q.19. A 65year-old patient is intubated in the Intensive Care Unit because of septic shock. Which of the following will best indicate adequate systemic perfusion?

Q.21. A 5-year-old child complains of a painful left testicular swelling. On examination, there is a firm swelling in his left hemi-scrotum, it is irreducible, with negative transillumunation test. Which of the following is the most appropriate management?

Q.22. A 35-year-old man sustained a right tibia fracture in a road traffic accident. He is being managed by closed reduction with cast but he develops swelling in his toes and pain. Which of the following is the earliest alarming sign?

Q.23. A 45 year old man has developed an annular rash with a scaly edge on his thigh. The rash has been spreading over the last 3 weeks. He also complains of general aches and pains. What is the most appropriate investigation?

Q.24. A 12-year-old presents with left sided lower abdominal pain. Examination confirms a slightly elevated, tender left testis with redness and oedema of the scrotum. Which of the following is the most likely diagnosis?

Q.25. A 3-year-old uncircumcised boy has a history of foreskin ballooning during micturition. Examination confirms a fing of white scarred tissue and an inability to retract foreskin. Which of the following is the most likely diagnosis?

Q.26. A 41 year old man presents with visual symptoms and a headache. An ophthalmoscopic examination shows papilloedema. Which anatomical site is most likely to be affected?

Q.28. A 12-year-old boy presents to the Emergency Department after a fall that led to a supra- condylar fracture. Presently his distal pulses are not palpable. Blood pressure 110/70 mmHg Heart rate 120 /min Which of the following is the most appropriate management?

Q.29. A 35-year-old woman presented with partial thickness burns on her arms and leg due to hot water spillage 1 day ago, with wound edema and congestion. Which of the following is the most likely responsible mediator?

Q.30. A 55-year-old is scheduled to undergo laparoscopic cholecystectomy. Which of the following is the most appropriate prophylactic antibiotic regimen?

Q.33. A 27 year old woman presents with tremors, anxiety. She has a history of significant weight loss over the last 6 months.She has a heart rate of 112 beats/minute. Mild proptosis was seen on examination. What is the most likely mechanism that accounts for her symptoms?

Q.35. A 65-year-old with ischaemic heart disease is complaining of chest pain 2 hours aftera laparoscopic cholecystectomy. Examination confirms an irregular pulse. Blood pressure 80/58 mmHg Respiratory rate 22 /min Temperature 36.6 °C Which of the following is the most appropriate management?

Q.39. A 24-month-old baby is brought in with a right sided red inflamed hemiscrotum. On exploration, the right testis is viable however; the cord is thick and oedematous. Which of the following is the most likely diagnosis?

Q.40. A 72-year-old underwent a subtotal colectomy 5 days ago. His urine output over the past 8 hours has been 7 muh. Blood pressure 110/70 mmHg Heart rate 90 /min Temperature 36.6 °C Which of the following is most appropriate to administer intravenously?

Q.44. A 3-day-old is presented for circumcision. Examination confirms chordee and hooded foreskin. Urethral opening is at mid-penile level. Which of the following is the most appropriate management?

Q.46. The parents of two children would like to try for another child. Their first child was diagnosed with cystic fibrosis and their second child is healthy. Both the parents are healthy. What is the chances of their next child being a carrier?

Q.48. An 8 week infant has been diagnosed as HIV positive. What is the most appropriate immunization plan for the infant?

Q.52. A 35-year-old woman presents with difficulty in breastfeeding her baby. Examination confirms unilateral nipple inversion. Gentle pressure everts the nipple and itis transversely slitted. Which of the following is the most likely diagnosis?

Q.54. A 60-year-old woman presents with a mass in her right breast. Clinical examination confirms a hard, non-tender irregular lump with skin tethering. Which of the following is the most likely diagnosis?

Q.56. A 15 year old boy presents to A&E with a nose bleed. The bleeding started 3 hours ago and has not stopped. His blood pressure is 115/70 mmHg, heart rate is 80 bpm and respiratory rate is 18/min. What is the most appropriate next course of action?

Q.63. A 58 year old man underwent surgery for varicose veins of the leg. He is now complaining of numbness on the medial side of his foot. What is the most likely nerve involved?

Q.64. A 28-year-old lactating mother presents with pain in her right breast. Examination confirms a 3 cm tender swelling with red and hot overlying skin. Temperature 37.9 °C Which of the following is the most likely diagnosis?

Q.70. A 13 month old female baby presents to the emergency department with dificulty in breathing. On examination, she has intercostal recessions and a bilateral widespread wheeze. Her temperature is 37.9 C and respiratory rate is 35 breaths/minute. What is the most likely diagnosis?

Q.72. A 34 year old female presents with a very strong foul smelling vaginal discharge. What organism(s) could cause such a symptom?

Q.73. A 25 year old woman presents to the GP with low mood. She has an increased appetite and has gone up 2 dress sizes. She also complains that she feels very tired and often only gets out of bed in the afternoon despite sleeping early. What is the most likely diagnosis?

Q.74. A 40 year old woman has repeated retching and intractable vomiting following an elective varicose veins ligation and stripping surgery a few hours ago. Her pain is well controlled but she feels extremely nauseous. What is the most appropriate medication to administer?

Q.75. A 55-year-old patient is diagnosed with a gastrointestinal stromal tumour of the stomach (4 x 3 ccm), confined to the body of the stomach, no surrounding infiltration, no distant metastases or : lymphadenopathy. Which of the following is the most appropriate management?

Q.82. A 33 year old man suffered a mandibular fracture and now has loss of sensation over the chin and mucosal surface of the lower lip. Which nerve is most likely to be involved?

Q.84. A 55 year old man has numbness in hands and feet. His medical history is significant for asthma associated with nasal polyps and facial pain. Eosinophilia was shown on his last blood test. A pulmonary CT scan shows ground-glass inflammation. What is the most likely diagnosis?

Q.87. A 75-year-old man in the Intensive Care Unit has developed a discharging sacral wound. Examination confirms necrotic skin and subcutaneous fat. Which of the following is the most appropriate management?

Q.88. A 30-year-old woman underwent an exploratory laparotomy for a perforated duodenal uicer. Post-operatively she developed septic shock syndrome. Which of the following is the most common physiological response?

Q.89. A 26-year-old woman complains of right upper quadrant pain and nausea. She is 20 weeks pregnant. On examination, her abdomen is soft and non-tender. Ultrasound: Cholelithiasis. Which of the following is most appropriate management?

Q.91. A T.day-d is presented or cirumcision. Examination confi uretal paring on the dorsal Which of the following is the most likely diagnosis?

Q.92. A 35-year-old woman is concerned about her mother history of invasive breast cancer and sister with ovarian cancer. Her diinical examination was unremarkable. Which of the following is the most appropriate breast cancer screening?

Q.94. A 13-year-old boy presents for elective surgery. He has a significant past history of bleeding tendency and has contracture of the right knee and hemarthrosis Which of the following is the most likely underlying clinical disorder?

Q.97. Which of the following is most commonly associated with retroperitoneal sarcoma?

Q.98. A 35-year-old man with gastroesophageal reflux disease presents to discuss his family history of oesophageal and gastric carcinoma. Which of the following is the main risk factor for oesophageal carcinoma?

Q.99. A 68 year old man had a fall down the stairs. His daughter has brought him into the emergency department where he was having lucid intervals. Shortly after admission he becomes unconscious. What is the most likely vessel affected?

Q.101. A 15 year old girl presents to the GP surgery with primary amenorrhoea. She has a short stature, low set of ears and a broad chest with widely spaced nipples. Wht is the most likely diagnosis?

Q.105. A 33-year-old man was brought to the Emergency Department after a high velocity trauma. He had distended neck veins and markedly decrease breath sounds on the right side. Heart rate 105 /min Blood Pressure 90/60 mmHg Oxygen saturation 85% Which of the following is the most likely cause?

Q.107. A 30 year-old patient complains of a 2-year history of perianal itching and discomfort. On perianal examination, there are cauifiower-iike multiple lesions clustered together. They are pink to grey in colour and tender to touch. Which of the following is the most likely diagnosis?

Q.112. A 24-month-old is presented with redness of both hemi-scrotum. Examination confirms non- tender, redness and oedema of the scrotum extending to both groins. Which of the following is the most likely diagnosis?

Q.117. Which of the following is most likely involved in neuro-hormonal stress response?

Q.124. A 20-year-old woman presents with fever and pain in her right leg. On examination, her right leg is swollen, tender with multiple red streaks, and palpable inguinal nodes. Which of the following is the most likely causative organism?

Q.125. What colour of nipple discharge is most commonly associated with intraductal papilloma of the breast?

Q.131. A 12-year-old presents with a 2-day history of right-sided scrotal pain. Examination confirms Tight testis with vertical orientation. There is an area of tenderness around the superior pole and the scrotum is red and oedematous. Which of the following is the most likely diagnosis?

Q.132. A 60-year-old patient complains of sudden onset of upper abdominal pain after a few bouts of vomiting. Examination confirms a sick patient with tenderness in the epigastrium and supraciavicular subcutaneous emphysema. Which of the following is the most likely diagnosis?

Q.135. A 25-year-old man underwent surgery for inflammatory bowel disease. He requires regular replacement of fat-soluble vitamins parenteral. Which part of the bowel was most likely removed?

Q.141. A 34 year old man suffers from depression. He was recently started on sertraline by his GP. When can a therapeutic effect of sertraline be seen?

Q.144. A 45-year-old sustained a knife injury to his left wrist. Examination confirms a clean wound with division of the underlying tendons and median nerve. Which of the following is the most appropriate management?