Free MCQS Exam Questions Online

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1. A 38-year-old man presents with acute infection of skin in the leg. Diagnosis of cellulitis
has been made.

What should be prescribed?

 Ceftriaxone + Flucloxacillin
 Vancomycin + Metronidazole
 Metronidazole + Erythromycin
 Ceftriaxone + Terbinafine
 Penicillin + Flucloxacillin
Question was not answered

Explanation:

Penicillin + Flucloxacillin. Cellulitis is usually caused by bacteria, such as staphylococci or streptoc

are commonly present on the skin. So Penicillin + Flucloxacillin should be given
2. A 28-year-old man presents with a 2 hours’ history of rapid palpitations. He feels a little
light headed but is other exam: pulse=170 bpm and regular, BP=100/68 mmHg. He has had
2 similar episodes in the past.

What is the most disturbance?

 SVT
 VF
 A-fibrillation
 VT
 Ventricular-ectopic
Question was not answered

Explanation:

Palpitation, light headedness with a tachycardia of 170 bpm that is regular are most likely a SVT.
3. A 29-year-old lady who is a bank manager is referred by the GP to the medical OPC due
to a long history of tin in the joints. An autoimmune screen result showed smooth muscle
antibodies positive.

What is the most appropriate investigation?

 Jejunal biopsy
 Thyroid function test
 Liver function test
 Serum glucose
 ECG
Question was not answered

Explanation:

Autoimmune hepatitis. Definitive investigation is liver biopsy Steroid [start with high dose
prednisolone]. Azathioprine is commonly added with steroid to reduce its dose as more side effects
than azathioprine.
4. A 65-year-old man presents with significant weight loss and complains of cough, SOB
and chest pain. Exam constricted, drooping of left eyelid.

What is the most likely diagnosis?

 Thoracic outlet syndrome
 Cervical rib
 Bronchogenic carcinoma
 Pancoast tumor
 Pneumonia
Question was not answered

Explanation:

Pancoast tumor. Pancoast tumour is the apical lung cancer that is associated with destructive lesion
thoracic inlet and involvement of the brachial plexus and cervical sympathetic nerves (the stellate
ganglion) le horner’s syndrome.
5. A 26-year-old political refugee has sought asylum in the UK and complains of poor
concentration. He keeps his family whom he saw killed in a political coup. He is unable to
sleep and feels hopeless about his survival. But he is afraid to go out.

What is the most likely diagnosis?

 PTSD
 Acute stress disorder
 OCD
 Social phobia
 GAD
Question was not answered

Explanation:

PTSD. Keep getting thoughts of his family disaster, insomnia, to avoid similar circumstances he is
out these are suggestive of PTSD.
6. Victim of RTA came with multiple injuries to abdomen, chest and limbs. BP is 80/ 50.
upper limb has upper third near amputation that bleeds profusely, what is your first thing to
do:
 Tourniquet the limb to stop the bleeding
 Check the airway and breathing
 Five IV fluid
 Call orthopedic
Question was not answered

Explanation:

As rule ABC also in description near amputation so difficult to make tourniquet enough which stops
bleeding.
7. lady presents with hot flashes and other symptoms of menopause.

What is the treatment option?

 Topical estrogen
 Conbined Oral Contraceptive
 Biosphosphonate
 Raloxifen
 Hormone Replacement Therapy
Question was not answered

8. 40-year-old manual worker presents with a swelling in the groin. Exam: mass is found to
be just above and l pubic tubercle. It is reducible. On applying pressure on the internal ring
there is no cough impulse seen.

What probable diagnosis?

 Direct inguinal hernia
 Indirect inguinal hernia
 Femoral hernia
 Femoral aneurysm
 Strangulated hernia
Question was not answered

Explanation:

Indirect inguinal hernia. [Swelling in the groin; mass just above and lateral to the pubic tubercle mea
hernia. It is reducible. On applying pressure on the internal ring there is no cough impulse; it means
the hernia through deep ring, and enters scrotum passing through the Superficial ring. That means it
is indirect inguinal hernia.
9. During a basketball match, one of the players suddenly collapsed to the ground with
coughing and SOB.

What choice?
 V/Q
 CTPA
 MRI
 CT scan
 CXR
Question was not answered

Explanation:

CXR. Likely diagnosis is pneumothorax. So investigation of choice is CXR

10. A 27-year-old man presents with abdominal pain. He says his urine is dark. Exam:
BP=160/105mmHg.

What is investigation?
 Urine microscopy
 Renal biopsy
 Urine protein
 US
  CT
Question was not answered

Explanation:

US. Abdominal pain, Dark urine (hematuria and hypertension suggests ADPKD. The sensitivity of ult
ADPKD1 is 99% for at-risk patients older than 20 years.
11. A 70-year-old man with prostatic cancer has had severe acute back pain waking him up
at night for 6wks.

What is appropriate investigation?

 DEXA scan
 Serum ALP concentration
 Serum calcium concentration
 MRI spine
Question was not answered

Explanation:

Radionuclide bone scan. MRI is good for soft tissue but not for bone. If it was radiculopathy, spina
compression or prolapsed disc creating pressure on nerve MRI would be fine but not for bony
metastasis. Her choice is radionuclide bone scan.
12. A 62-year-old man diagnosed with T2DM with BMI=33. Lifestyle modifications have
failed to control blood. Labs: urea=3.6mmol/l, creatinine=89mmol/l.

What is the next appropriate management?

 Sulfonylurea receptor binder
 Glitazone
 Biguanide
 Sulfonylurea
Question was not answered

Explanation:

Explanation Patient is obese type 2 diabetic. So biguanide is the treatment of choice

13. A 65-year-old man presents with significant weight loss and complains of cough, SOB
and chest pain. Exam constricted, drooping of left eyelid.

What is the most likely diagnosis?

 Pancoast tumor
 Cervical rib
 Thoracic outlet syndrome
 Pneumonia
Question was not answered

14. The strongest type of epidemiological studies is:

 Time line
 Prospective cohort studies
 Retrospective control case studies
 Cross sectional
Question was not answered

Explanation:

Prospective cohort study is a cohort study that follows over time a group of similar individuals
(cohorts) who differ with respect to certain factors under study, to determine how these factors affect
rates of a certain outcome. For example, one might follow a cohort of middle-aged truck drivers who
vary in terms of smoking habits, to test the hypothesis that the 20-year incidence rate of lung cancer
will be highest among heavy smokers, followed by moderate smokers, and then nonsmokers. The
prospective study is important for research on the etiology of diseases and disorders. The
distinguishing feature of a prospective cohort study is that at the time that the investigators begin
enrolling subjects and collecting baseline exposure information, none of the subjects have
developed any of the outcomes of interest. After baseline information is collected, subjects in a
prospective cohort study are then followed "longitudinally," i.e. over a period of time, usually for
years, to determine if and when they become diseased and whether their exposure status changes
outcomes. In this way, investigators can eventually use the data to answer many questions about
the associations between "risk factors" and disease outcomes. For example, one could identify
smokers and non-smokers at baseline and compare their subsequent incidence of developing heart
disease. Alternatively, one could group subjects based on their body mass index (BMI) and compare
their risk of developing heart disease or cancer. Prospective cohort studies are typically ranked
higher in the hierarchy of evidence than retrospective cohort studies and can be more expensive
than a caseC control study. One of the advantages of prospective cohort studies is they can help
determine risk factors for being infected with a new disease because they are a longitudinal
observation over time, and the collection of results is at regular time intervals, so recall error is
minimized.
15. A 2-year-old baby with atrophy of the buttocks, distended abdomen with frequent
offensive smelly stool.

What is the most likely investigation?

 Upper GI endoscopy
 Colonoscopy
 Stool culture
 Sweat test
 Endomysium/alpha gliadin antibody
Question was not answered

Explanation:

Endomysium/alphagliadin antibody. Atrophy of buttock due to fat malabsorption and distended abdo
(sometimes with everted umbilicus) with frequent offensive smelly stools are seen in coeliac disease.
Hence gliadin antibody should be done.
16. A 57-year-old man having hypertension on oral anti-HTN. However, he is finding it
difficult to mobilize as he tries to get up.

What is the most appropriate investigation for him?

 ECG
 CXR
 Ambulatory BP
 CT SCAN
 MRI
Question was not answered
Explanation:

Ambulatory BP. Ambulatory BP to document low BP as cause of presenting symptom. The case
sees hypotension and low BP as a result of given anti-hypertensive.
17. A new screening test has been devised to detect early stages of prostate cancer.

However, the test tends t of people with no cancer, although they do have cancer as
diagnosed by other standard tests.

What is this flaw?

 True Cve
 False +ve
 Poor specificity
 True +ve
 False -ve
Question was not answered

18. A 24-year-old woman known to be suffering from panic disorder presents to the hospital
with tingling and nu fingers. ABG: pH=7.52, PCO2=2.2kPa, PO2=11kPa, Bicarbonate-20.

What is the most likely condition?

 Acute respiratory alkalosis
 Compensated metabolic acidosis
 Compensated respiratory alkalosis
 Acute metabolic alkalosis
Question was not answered

Explanation:

In panic attack there occurs hyperventilation which causes washout of acute respiratory alkalosis
resulting in raised pH >7.45 (here 7.52), low PCO2 (here 2.2 kPa) with compensatory HCO3 (here
20meq/l).
19. 19-year-old sexually active lady came for her annual check-up, she is otherwise healthy
using no contraceptive, her pap smear and all investigations are normal.

What will you suggest regarding her next check-up?

 After 6 months
 After 5 years
 After 1 year
 After 3 years
Question was not answered

Explanation:

Usually pap smear should be started after 21 years of age regardless of sexual activeness but if a
female is sexually active and u suspect any abnormality then u can do pap smear before 21 years of
age as in this case. Pap Smear = Negative, then should be followed for screening after 3 years. Pap
smear + HPV Testing = Negative, then should be followed after 5 years
20. An 8 year’s boy has his tonsils and adenoids removed. On the 7th post-op day, he
comes back to the hemoptysis and fever.
What is the most appropriate management?
 Reassurance
 Packing
 Admit for IV antibiotics
 Surgery
 Prescribe oral antibiotics and discharge
Question was not answered

Explanation:

Most secondary hemorrhage occurs due to infection which erodes a vessel. S be admitted for IV
antibiotics.
21. Which type of contraceptive is contraindicative in lactation?
 UID
 Depo-Provera
 Mini pills
 OCPs
 Condom
Question was not answered

Explanation:

Based on the available evidence, expert opinion in the United States holds that the risks of
combination contraceptive products usually outweigh the benefits before 4 weeks postpartum.
Between 4 weeks and 6 months postpartum, the advantages of using the method generally outweigh
the theoretical or proven risks, although the evidence of lack of effect on lactation is poor and does
not include preterm or ill infants. Introduction of a combined oral contraceptive containing 30 mcg of
ethinyl estradiol on day 42 or beyond may not affect milk intake or infant growth. After 6 months
postpartum, combination contraceptives, including oral tablets, the transdermal patch and vaginal
ring, can be used, but progestin-only methods are preferred if breastfeeding will be continued.
22. A 2-days baby’s mother is worried about the baby’s hearing. Mother has a history of
conductive hearing lo most appropriate test?
 MRI
 Fork test
 CT scan
 Reassure
 Brain stem evoked response
Question was not answered

Explanation:

Brain stem evoked response. A BAER (brainstem auditory evoked response) test can help to
diagnose nervous system disorders, especially in newborns, young children, and others who may
not be able to participate hearing test.
23. A study was done amongst 2 hospitals for the equal number of cancer patients. It was
noted that hospital A higher of mortality than hospital B for treated cancer patients.

What is the study done here classified as?

 Cohort
  Observational
 Retrospective
 Case study
Question was not answered

Explanation:

A cohort is a group of people who share a common characteristic or experience within (e.g., are
born, are

exposed to a drug or vaccine or pollutant, or undergo a certain medical procedure].

24. An 8-week baby boy is noted to be jaundiced. He is breast-feeding well and has gained
300g since birth. His s and his urine is pale straw colored.

What is the most likely diagnosis?

 Breast milk jaundice
 G6PD deficiency
 Galactosemia
 Congenital viral infection
 Biliary atresia
Question was not answered

Explanation:

Biliary atresia causes obstructive picture where stools are pale and urine becomes da disorder like
G6PD or spherocytosis causes appearance of jaundice in 1st 24 hours. In breast milk jaundice, ja
develops in 2nd week. Also congenital viral infection (TORCH) occurs in 1st 24 hours. So likely
cause in the p is Galactosemia.
25. After starting Antidepressant drug, if patient is not improving then when you decide to
stop drugs?
 3-4 weeks
 1 day
 1 week
 2 weeks
Question was not answered

Explanation:

Some people notice an improvement within a few days of starting treatment.

However, an antidepressant often takes 2-4 weeks to build up its effect and work fully. Some people
stop treatment after a week or so thinking it is not helping. It is best to wait for 3-4 weeks before
deciding if an antidepressant is helping or not. If poor sleep is a symptom of the depression, it is
often helped first, within a week or so. With some types of tricyclic antidepressant, the initial dose
that is started is often small and is increased gradually to a full dose. (One problem that sometimes
occurs is that some people remain on the initial dose which is often too low to work fully.) If you find
that the treatment is helpful after 3-4 weeks, it is usual to continue. A normal course of
antidepressants lasts at least six months after symptoms have eased. If you stop the medicine too
soon, your symptoms may rapidly return. Some people with recurrent depression are advised to take
longer courses of treatment (up to 2 years or longer)
26. A young woman fell and hit her knee. Exam: valgus test +ve.

What ligament was most probably injured?

 Lateral collateral
 Ant cruciate
 Post cruciate
 Medial collateral
 Meniscus
Question was not answered

Explanation:

Medial collateral. The valgus stress test involves placing the leg into extension, with one hand place
on the knee. With the other hand placed upon the foot applying an abducting force, an attempt is
then made to at the knee into valgus. If the knee is seen to open up on the medial side, this is
indicative of medial collateral damage.
27. A 32-year-old man with schizophrenia and a history of violence and distressing auditory
hallucinations was a ward with aggressive behavior and has already smashed his room. He
is refusing any oral meds.

What is the s appropriate injection?

 Flupenthixol
 Risperidone
 Haloperidol
 Fluphenazine
Question was not answered

Explanation:

Protocol of treating agitated violent patient.

Try to talk to the patient but don’t touch him.

If he agrees on oral meds, give oral atypical antipsychotics olanzapine, risp or quetiapine

If refusing oral, give IV atypical antipsychotics preferably its Olanzapine or Risperidone

If agitation not controlled give IM Lorazepam

If that doesn’t work, give IV Haloperidol as last resort.

If acute sedation is required, for immediate effect give IV Diazepam.

28. A 14-year-old girl presents with primary amenorrhea and a short stature.

What is the most likely diagnosis?

 Down’s syndrome
 Fragile X syndrome
 Turner’s syndrome
 Klinefelter’s syndrome
 Normal finding
Question was not answered
Explanation:

Down’s syndrome and Fragile x syndrome don’t have primary amenorrhea. Klinefelter’s patients are
tall males. So the likely diagnosis is Turner’s syndrome.
29. A 65-year-old lady who is on thiazide suffers from falls in the morning.

What is the cause for her symptoms?

 Epilepsy
 Orthostatic hypotension
 TIA
Question was not answered

Explanation:

Thiazide diuretic is associated with orthostatic hypotension.

30. A patient with gross hematuria after blunt abdominal trauma has a normal-appearing
cystogram after the int instillation of 400 ml of contrast. You should next order:
 A retrograde urethrogram.
 A voiding cystourethrogram.
 An intravenous pyelogram.
 A cystogram obtained after filling, until a detrusor response occurs.
Question was not answered

Explanation:

A Urethrography refers to the radiographic study of the urethra using iodinated contrast media and is
generally carried out in males. Also referred to as ascending urethrography/urethrogram (ASU) or
retrograde urethrography/urethrogram (RUG). Indications • pelvic trauma in the emergency
department • diminished urinary stream • urethral strictures • urethral diverticula • urethral
obstruction • suspected urethral foreign bodies • urethral mucosal tumors • suspected urethral fistula
31. A 10-year-old child has got progressive bilateral hearing loss. He has started to increase
the TV volume. All other is normal.

What is the most likely diagnosis?

 Wax
 Bilateral OM with effusion
 Foreign body
 Meningitis due to meningococcus
Question was not answered

32. A 27-year-old lady after C-section developed epigastric pain after 8h.

What is the appropriate investigations?

 Liver enzyme
 Liver biopsy
 ABG
 Coagulation
Question was not answered
Explanation:

Epigastric pain is a warning sign of HELLP syndrome. So to rule out HELLP syndrome should be
done.
33. Healthy parents have 2 children, a child with Cystic fibrosis and a healthy child.

They want to have another are the chances of that child being a carrier?
 1:2
 1:4
 1:8
 1:16
 2:3
Question was not answered

Explanation:

As the parents have a child with cystic fibrosis and they are healthy both of them are carrier.
autosomal recessive disease where if both parents are carrier mode of inheritance is as follows:
Chance of being child 1:4, Chance of being diseased 1:4 and chance of being carrier 1:2.
34. A 30-year-old female has chronic diarrhea, mouth ulcers and skin tags. She complains
of visual problems, low morning stiffness. Inv: ESR & CRP=raised, Hgb=10mg/dl.

What is the most probable diagnosis?

 SLE
 Seronegative arthritis
 Gout
 Reactive Arthritis
Question was not answered

Explanation:

Chronic diarrhea, mouth ulcers and skin tags are features of IBD. There is a w association between
IBD and seronegative arthritis (particularly AS). Here low back pain, visual problem, morn raised
ESR and CRP, low hemoglobin indicates the diagnosis of seronegative arthritis.
35. 14-year-old boy has been diagnosed with nephrotic syndrome. 5days later he presents
with flank pain, hem urea levels. A diagnosis of renal vein thrombosis is made.

What is the most likely cause for renal vein thrombo?

 Loss of anithrombin III
 Stasis
 Protein C deficiency
 High estrogen levels
 Vasculitis
Question was not answered

36. A 33 year’s man has a temp-38.5C, cough and chest pain on the right side on
inspiration. He also has puru.

What is the most likely organism to cause pneumonia in this patient?

 PCP cold agglutinins
  AFB
 Gram Cve doplicoccic
 Gram +ve doplococcic
 Coagulase +ve cocci
Question was not answered

Explanation:

It is a case of community acquired pneumonia caused by streptococcus pneumonia.

37. A 54-year-old patient wakes up with right sided weakness. His current medication is
bendroflumethiazide for BP=160/90mmHg. CT shows left cerebral infarct.

What is the most appropriate treatment?

 Alteplase
 Aspirin
 Simvastatin
 Dipyridamole
 Clopidogrel
Question was not answered

38. A 45-year-old man has developed an annular rash with a scaly edge on his thigh. The
rash has been spreading. He has some general aches and pains.

What is the single most useful investigation?

 ANA
 Skin scrap for mycology
 Skin swab for bacteria
 Biopsy lesion
 Lyme antibodies
Question was not answered

Explanation:

Explanation Spreading annular rash suggests erythema migrans of lyme disease.

39. Drug of choice of generalized anxiety disorder is ______________.
 Acetalopram
 Bubropion
 Buspirone
 beta blocker
Question was not answered

Explanation:

What is Citalopram an antidepressant in a group of drugs called selective serotonin reuptake

inhibitors (SSRIs). Citalopram is used to treat depression. Treatment for Anxiety Disorders Many
variables influence the selection of medication for individual patients. The following is general
information regarding beginning treatment. Most common – sertraline (Zoloft), citalopram (Celexa),
and escitalopram (Lexapro). These allow a low starting dose (12.5mg of Zoloft, 5mg of Celexa) and
slow titration (anxiety patients are very vulnerable to initial activation and worsening of symptoms).
Effective ranges: 50-200 mg of Zoloft, 20- 40 mg of Celexa, and 10-20 mg of Lexapro. We routinely
utilize much higher doses than those previously listed to treat OCD. We rarely use benzodiazepines
as first line drugs for these disorders and generally discourage as needed/rescue use.
Benzodiazepines remain widely used drugs for panic and other anxiety disorders in both primary
care and mental health settings. While they have clear value in some circumstances, we avoid them
as first line treatments because they so powerfully reinforce the anxious patient’s wish for a simple
and quick way to avoid the distressing experience of his or her anxiety. Overcoming this desire to
flee distressing circumstances or feelings is the bedrock of CBT and is absolutely critical to
successful long-term outcomes. Benzodiazepines often make these efforts more difficult.
40. Fluoxetine half-life after acute administration is ______________________________
 1-4 days
 6-9 days
Question was not answered

Explanation:

The relatively slow elimination of fluoxetine (elimination half-life of 1 to 3 days after acute
administration and 4 to 6 days after chronic administration) and its active metabolite, nor fluoxetine
(elimination half-life of 4 to 16 days after acute and chronic administration), leads to significant
accumulation of these active species in chronic use. After 30 days of dosing at 40 mg/day, plasma
concentrations of fluoxetine in the range of 91 to 302 ng/mL and nor fluoxetine in the range of 72 to
258 ng/mL have been observed. Plasma concentrations of fluoxetine were higher than those
predicted by single dose studies, presumably because fluoxetine’s metabolism is not proportional to
dose. Nor fluoxetine, however, appears to have linear pharmacokinetics. Its mean terminal half-life
after a single dose was 8.6 days and after multiple dosing was 9.3 days.
41. 72-year-old lady is drowsy and her relatives want to take her home.

She has been prescribed diazepam 2.5m delivery route?

 Per rectal
 Intra Muscular
 Subcutaneous
 Oral
 Intravenous
Question was not answered

42. A 53-year-old lady presents with hot flash and night sweats. Her LMP was last year.
She had Myocardial infarction.

What is the most appropriate management for her?

 Raloxifene
 COCP (Combined OCP)
 Evening primrose
 Clonidine
 Estrogen
Question was not answered

43. A 64-year-old man complains of increasing dyspnea and cough for the past 18months.
He coughs up a Table mucopurulent sputum with occasional specks of blood.

What is the most likely underlying cause?

 Acute bronchitis
  Bronchiectasis
 Chronic bronchitis
 Lung cancer
 Pneumonia
Question was not answered

Explanation:

Chronic bronchitis. There may be specks of blood in sputum in both bronchiectasis, acute and
chronic. Duration of disease is 18 months, so it is not acute bronchitis. Again only one tablespoonful
sputum does not term copious sputum of bronchiectasis in which sputum will be much more in
amount.
44. A 25-year-old girl saw a tragic RTA in which a young boy was killed. The night of the
event she couldn’t sleep after she suddenly lost her vision. She was previously fine and
there was no history of medical or psychologic

What is the diagnosis?

 Dissociation
 Generalize Anxiety disorder
 Post-traumatic Stress disorder
 Somatization
 Conversion
Question was not answered

Explanation:

Conversion reaction. Conversion reaction is sometimes applied to patients who present with neurol
such as numbness, blindness, paralysis, or fits, which are not consistent with a well-established
organic cause significant distress. It is thought that these symptoms arise in response to stressful
situations affecting mental health
45. Best method to maintain air way in conscious multiple injury is
_______________________.
 Intubation
 Oropharyngeal device
 Nasopharyngeal device
Question was not answered

46. You are supposed to keep a child NPO he’s 25 kgs, how much you will give:
 1500
 1300
 1400
 1600
Question was not answered

Explanation:

For first 10kg 100×10=1000 For next 10 kg 50×10=500 For next 5 kg 5×20= 100 So the total is 1600
ml.
47. A 73-year-old man who is recovering from surgery on the left carotid artery in his neck.
He has slurred speech of his tongue, the tip deviated to the left.
What is the single most appropriate option?
 Accessory nerve
 Hypoglossal nerve
 Glossopharyngeal nerve
 Facial nerve
 Vagus nerve
Question was not answered

Explanation:

Testing function of the nerve is performed by asked the subject to stick their ton out. If there is a loss
of innervation to one side, the tongue will curve toward the affected side, due to unopposed the
opposite genioglossus muscle. If this is the result of. A lower motor neuron lesion, the tongue will be
curve damaged side, combined with the presence of fasciculations or atrophy.

However, if the deficit is caused by a neuron lesion, the tongue will be curved away from the side of
the cortical damage, without the presence of fa or atrophy.
48. 33-year-old female complains of diplopia on upright gaze. Exam: ptosis can be seen.
There are no other co significant Past medical history.

What is the most appropriate test for him?

 Ophthalmoscopy
 Checking red reflex
 Thyroid function test
 Visual field test
Question was not answered

Explanation:

This is a wrong key. Right key should be D. CT. A case of 3rd nerve palsy. So to cause CT should
be done. Red reflex is seen to diagnose cataract.
49. A 6-year-old boy fell in the playground and has been holding his forearm complaining of
pain. Exam: no sign swelling.

However, there is minimal tenderness on exam.

What is the diagnosis?

 Green stick fx of distal radius
 Fracture neck of humerus
 Fracture mid ulnar
 Fracture mid radius
Question was not answered

50. A 37-year-old woman presents with heavy bleeding. Investigation shows subserosal
fibroid-4cm and intramu.

Which is the most appropriate treatment?

 Abdominal Hysterectomy
 Vaginal Hysterectomy
  Abdominal Myomectomy
 Hysteroscopic Myomectomy
Question was not answered

Explanation:

As patient is young we should go for myomectomy. As hysteroscopic myo mainly sub mucosal
fibroids we should go for abdominal myomectomy which will deal with both subserosal a fibroids.
51. Which vitamin has a protective effect against colon cancer?
 Vitamin C
 Vitamin D
 Folic acid
 Vitamin K
Question was not answered

Explanation:

Calcium and vitamin D Calcium may protect against bowel cancer, according to the World Cancer
Research Fund. A 2004meta analysis showed that people with the highest levels of calcium intake
(from food and supplements) reduced their risk of bowel cancer by 22% compared to people with the
lowest calcium intake.

However, 2 meta analyses in 2010 found that calcium supplements had no effect on bowel cancer
risk in the general population. But they did find a link between calcium intake and a reduced risk of
polyps coming back in the bowel after previous treatment. Polyps are growths in the bowel that may
develop into cancer over a long period of time, if left untreated. To reduce bowel cancer risk, it may
be better to take vitamin D and calcium together. We need vitamin D to be able to absorb calcium. A
large randomized controlled trial in 2006 showed that only the people with high intakes of both
calcium and vitamin D had a reduced risk of bowel cancer. Other studies have shown that people
with the highest intakes of vitamin D have a lower risk of bowel cancer and bowel polyps. Dairy
There is some evidence that drinking milk reduces the risk of bowel cancer. A review in 2011
showed that the benefit of dairy in reducing bowel cancer risk was only seen at levels over 100
grams (g) a day. Having 500 to 800g milk a day reduced bowel cancer risk by 20 to 30%. One pint,
or 0.5 liters, of semi skimmed milk weighs about 550g. The effect of milk on lowering bowel cancer
risk may be partly due to the calcium. But milk contains many other substances which may also play
a role. There is limited evidence that eating cheese may increase the risk of bowel cancer. It is not
clear how cheese may increase the risk, but it may have something to do with the saturated fatty
acids.
52. A 32-year-old woman presents with malaise fatigue and fever. She complains about
weight loss. Exam: malar nasolabial fold can be seen.

What is the most appropriate investigation?

 Anti-histone
 Anti-centromere
 Anti-ds DNA
 Anti Jo
 Anti Scl70
Question was not answered
Explanation:

Features are suggestive of SLE. So most appropriate investigation from the given option DNA.
53. 23-year-old man presents with severe pain in the right flank radiating to his groin. He is
rolling about on the an IVU confirms a stone in the ureter which is 8mm in size.

Which transfusion modality will be most effective?

 ESWL (Lithotipsy)
 Dormier basket
 Fluids and alpha blockers
 PCNL
Question was not answered

54. A 72years presents with polyuria and polydipsia. The fasting blood sugar is 8 and
10mmol/l.BP=130/80mm cholesterol=5.7mmol/l. There is microalbuminuria.

What is the single most appropriate next management?

 Statin and glitazone
 ACEi and sulfonylurea
 Statin and Biguanide
 Statin and ACEi
Question was not answered

55. A middle aged woman has some weakness of hand after an injury.

Which vertebra will be the lowest to be x-ray to diagnosis the injury?

 C7/T1
 C5/C6
 c8/T1
 C6/C7
Question was not answered

56. A 80 year’s man with prostatic cancer has confusion, thirst, abdominal pain and an
abnormal ECG.

What is appropriate investigation?

 DEXA scan
 Redionuclide bones scan
 Serum calcium concentration
 MRI spine
Question was not answered

57. A 20 year’s man presents with painful swallowing. Exam: trismus and unilateral
enlargement of his tonsils Peritonsillar region is red, inflamed and swollen.

What is the most appropriate treatment?

 Oral antibiotics
 Analgesics with antipyretics
 I&D with antibiotics
 IV antibiotics and analgesics
  Tonsillectomy
Question was not answered

58. An 18years female has periorbital blisters. Some of them are crusted, others secreting
pinkish fluid.

What likely diagnosis?

 Rubella
 Shingles
 Measles
 Chicken pox
 Varicella
Question was not answered

Explanation:

Shingles Ophthalmic division of trigeminal nerve. Typically, shingles is unilateral.

59. A patient presented to you who is known case of hypothyroidism and on thyroxin, he
also has increase PT normal Vitamin D, Creatinine is very high.

On examination tapping of the angle of jaw produce facial spasms, what diagnosis?
 Pseudohypoparathyroidism
 DiGeorge syndrome
 Chronic renal failure
 Uncontrolled thyroid functions
Question was not answered

Explanation:

Secondary hyperparathyroidism Hypocalcemia, hyperphosphatemia, inc creatinine.

60. An 82-year-old man has woken up with incoherent speech and difficulty in finding the
right words. Exam: good comprehension.

Which anatomical site is most likely to be affected?

 Pons
 Wernicke’s area
 Broca’s area
 Midbrain
 Parietal cortex
Question was not answered

Explanation:

A person with expressive aphasia will exhibit halting and effortful speech. Speech m important
content words. Word comprehension is preserved. The person may still be understood, but sentence
grammatical. This contrasts with receptive or Wernicke’s aphasia, which is distinguished by a
patient’s inability comprehend language or speak with appropriately meaningful words though
fluency, may be preserved.
61. A HTN patient on bendroflumethiazide 2.5mg/d has come for his routine checkup.

Exam: BP=145/85mmHg.

What is the most appropriate management for this patient?

 Continue same dose
 Stop meds
 Repeat the blood test
 Increase the dose
Question was not answered

Explanation:

Bendroflumethiazide causes hyponatremia and hypokalemia. But the findings is probably error of
test. Hence blood test should be repeated to confirm the level of potassium and sodium.
62. Which of the following is not a degenerative corneal disease?
 Keratokonus
 Marginal dystropathy
 Fatty/lipid degeneration
 Moorens’s ulcer
 Band keratopathy
Question was not answered

Explanation:

All other options are degenerative disease of cornea except Mooren’s ulcer which is ulcerative
keratitis.
63. A terminally ill with metastatic carcinoma presents with dysphagia and difficulty in
swallowing.

What is possible treatment?

 Analgesic
 Cotrimazole
 PO fluconazole
 Nystatin suspension
 Amphotericin B IV
Question was not answered

Explanation:

PO fluconazole. Treatment of carcinoma can predispose to development of esophageal candidiasis

as follows: Oral fluconazole (200 C 400mg) daily for 14 to 21 days (if needed IV fluconazole can also
be given).
64. A lady developed breast abscess after delivery.

What is the most likely organism?

 GBS
 Staph albus
 Strep pyogenes
 Staph aureus
Question was not answered

65. A 55 year’s man who is hypertensive suddenly lost his vision. The retina is pale and
fovea appears as a spot.

What is the single most appropriate treatment?

 Corticosteroids
 Pan retinal photocoagulation
 Press over eyeball
 Scleral buckling
Question was not answered

Explanation:

In central retinal artery occlusion (CRAO) retina becomes pale and fovea. Hypertension is a major
cause of CRAO. Apply direct pressure for 5-15 seconds, then release. Repeat several massage can
dislodge the embolus to a point further down the arterial circulation and improve retinal perfusion.
66. A mother presents with her 14months child. He holds furniture and other things to help
him stand and says ‘mama’ and ‘papa’. He makes eye contact and smiles. He can transfer
objects from one hand to another.

What do you interpret from his development?

 Normal development
 Delayed social development
 Delayed fine motor development
 Delayed gross motor development
 delayed verbal development
Question was not answered

67. A 28-weeks pregnant woman presents with uterine bleeding after sexual intercourse.

What is the most appropriate diagnosis?

 Placental abruption
 Missed abortion
 Placental previa
 Ectropion
Question was not answered

Explanation:

Post coital bleeding can be either placenta previa or cervical ectropion. But as ectropion pregnancy
so it is the option here.
68. A 48-year-old woman always socially withdrawn has stopped going out of the house.
She is afraid to socialize fears that people will criticize her.

What is the most probable diagnosis?

 PTSD
 GAD
 Social anxiety
 Agoraphobia
  OCD
Question was not answered

Explanation:

Social anxiety disorder is a type of complex phobia. This type of phobia has a disrupt disabling
impact on a person’s life. It can severely affect a person’s confidence and self-esteem, interfere with
relationships and impair performance at work or school.
69. 33-year-old lady who is a drug addict wants to quit. She says she is ready to stop the
drug abuse.

What drug treatment would you give her?

 Benzodiazepines
 Methadone
 Disulfiram
 Lithium
 Diazipoxide
Question was not answered

70. A patient with Type-1diabetes has a fundus showing micro-aneurysm and hard exudate.

What is the single diagnosis?

 Hypertensive retinopathy
 Diabetic background
 MS
 Macular degeneration
 Proliferative DM retinopathy
Question was not answered

Explanation:

Diabetic background retinopathy. Microanurysm, hard exudates are seen in background diabetic ret
71. A 3-month-old female infant is brought in because her parents say she will not eat
anymore. Upon physical examination, a loud pansystolic murmur is appreciated. The child
also appears small for her age, but her records show no maternal or delivery complications.

Which of the following is the most likely finding on EKG?

 ST segment elevation
 Right ventricular hypertrophy
 QT interval elongation
 Right bundle branch block
Question was not answered

Explanation:

The key to this case is understanding that a child who was otherwise healthy but presents with a
holosystolic murmur and symptoms of failure to thrive most likely has a VSD. Right ventricular
hypertrophy occurs from blood shunting from the high pressure left system to the low pressure right
system. This could later lead to Eisenmenger syndrome (ES). ES is defined as the process in which
a left-to-right shunt caused by a VSD reverses into a right-to-left shunt due to hypertrophy of the
right ventricle.
72. 70 year’s woman is admitted with diarrhea, vomiting and dehydration. Exam: yellow
visual halos in her e ECG=bradycardia. She has a history of chronic Atrial-fib.

Which drug causes the above mentioned side effects?

 Nifedipine
 Digoxin
 Ramipril
 Atenolol
Question was not answered

73. 17 year’s female with lump in the breast, freely mobile, not attached to the skin.

What is the next investigation?

 Ultrasound
 Mammogram
 FNA
 Biopsy
Question was not answered

74. A 20 year’s woman with no previous history of ear complains, presents with 1day history
of severe pain in is extremely tender to examine.

What is the single most likely diagnosis?

 Chondromalasia
 Myringitis
 Furuncle
 Otitis media
 Otitis Externa
Question was not answered

Explanation:

Extreme tenderness to examine indicate otitis externa.

75. 60 year’s old patient has only HTN best drug to start with:
 Beta blocker
 ACEI
 Diuretics
 ARB
 Alpha blocker
Question was not answered

Explanation:

Antihypertensive therapy has been shown to reduce morbidity and mortality in older patients with
elevated systolic or diastolic blood pressures. This benefit appears to persist in patients older than
80 years, but less than one third of older patients have adequate blood pressure control. Systolic
blood pressure is the most important predictor of cardiovascular disease. Blood pressure
measurement in older persons should include an evaluation for orthostatic hypotension. Low-dose
thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting
enzyme inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line
medications that should be selected based on comorbidities and risk factors.
76. A 78 year’s retired teacher was admitted for a hernioplasty procedure. After the
operation he became agitate and confused.

What is the most appropriate management?

 Diazepam
 Clozapine
 Chlordiazepoxide
 Thiamine
 Vitamin B
Question was not answered

77. A woman with sickle cell disease complains of heavy menstrual blood loss.

What is the most appropriate combined oral contraceptive pills?

 Depot provera
 Transdermal patch
 Copper IUCD
 Mirena
Question was not answered

78. A 28 year’s woman has been on treatment for Rheumatoid arthritis for 3yrs. She has
gradual loss of vision Her ocular pressure is normal. Red reflex is absent in both eyes.

What is the single most likely diagnosis?

 Hypermetropia
 Cataract
 Macular degeneration
 HTN retinopathy
 DM retinopathy
Question was not answered

79. A young girl presented to gynecologist for assessment with lower abdominal pain and
per vaginal bleedin of hysterosalpingograph as a part of her infertility treatment.
Observation: BP=90/50mmHg, pulse-120bpm, and revealed rigid abdomen.

What is the most appropriate next investigation?

 Coagulation profile
 Chest X ray
 Ultrasound abdomen
 X-ray erect and supine
 CT SCAN
Question was not answered

Explanation:

Likely cause of bleeding and shock is ruptured fallopian tube for which appropriate ne is US
abdomen.
80. What is the most specific test for syphilis?
 TPI
 Treponema antibody absorption test FTA-ABS
 FAAT
Question was not answered

Explanation:

This test is used when a screening test for syphilis is positive to confirm that there is a true infection.
A negative or nonreactive result means there you do not have a current or past infection with
syphilis. 52Ans- Management of dog, cat and human bite is essentially similar. They are managed
with Amoxycillin/ Clavulanate and Tetanus vaccine booster if more than 5 years since last
immunization/vaccine Dog and cat bite-Pasteurellamultocida Human bite-EikenellaCorrodens
Humab bites are more damaging then dog bite and cat bites
81. A patient presents with mild dyskaryosis. 1 year ago smear was normal.

What is the most appropriate next test?

 Cone biopsy
 Cauterization
 Repeat smear
 Colposcopy
 Swab and culture
Question was not answered

Explanation:

For mild, moderate or severe dyskaryosis the next step is colposcopy.

82. Patient with major depression what is the first line treatment?
 Tricyclic antidepressant
 SSRIs
 MAOI
Question was not answered

Explanation:

A SSRIs are the initial antidepressants of choice for uncomplicated depression because of their
minimal anti-cholinergic effects
83. 65years man had a bowel resection 5days ago. He is anuric and breathless. His
BP=150/110mmHg.He has lung bases and sacral edema. Bloods: K+=6.8mmol/l,
urea=58mmol/l, creatinine=600umol/l.

What is the single immediate management?

 Bolus of 20U insulin
 5% dextrose infusion
 Calcium resonium enema
 10U insulin, 50ml of 50% dextrose infusion
 Dextrose-saline infusion
Question was not answered
84. 45 year’s female looking pale has bluish discoloration of hands whenever she goes out
in the cold. She has reddish spots on her body. She has symmetrical peripheral arthroplasty
for the last year.

What is the most appropriate diagnosis?

 Limited systemic sclerosis
 Osteosarcoma
 Chondrosarcoms
 Diffuse systemic sclerosis
 RA
Question was not answered

85. A 64 year’s man believes a female newscaster is communicating directly with him when
she turns a page.

Where is he suffering from?

 Delusion of Reference
 Nihilistic
 Grandeur
 Control
 Persecutory
Question was not answered

Explanation:

A delusion of reference is a type of delusion wherein the individual perceives unrelated events or
objects in his/her surroundings to be of significance for himself/herself. For example, a person with
schizophrenia might believe a billboard or a celebrity is sending a message meant for them.
86. Which of following favor diagnosis of SLE?
 Raynaud syndrome
 Joint deformity
 Anti RNP+
 Cystoid body in retina
 Lung cavitations
Question was not answered

87. A 61year man was found with K+=7.5 and ECG with prolong QRS complex.

What is the best possible treatment?

 IV calcium gluconate
 Dialysis
 Loop diuretics
 Salbutamol nebulizer
 IV insulin and dextrose
Question was not answered

Explanation:

In this high level of potassium, we have to shift this potassium into cells to red level and save heart
from arrest or life threatening arrhythmia. For keep the heart safe option of first choice in emergency
is IV calcium gluconate! However, it does not shift or reduce potassium level but protects heart from
buy time for definitive measure to take place.
88. The patient passed a 4 mm stone in his urine. Does he have a 3mm stone in the renal
pelvis found on an ultrasound?
 ESWL
 None
 Surgery
 Dormia basket
 PCNL
Question was not answered

Explanation:

Stones less than 5 mm in diameter pass spontaneously in up to 80% of people. -Stones between 5
mm and 10 mm in diameter pass spontaneously in about 50% of people. -Stones larger than 1 cm in
diameter usually require intervention.
89. A young man comes up with a headache, which he describes that this headache is the
most severe headache in his life.

Which of the following will be less useful?

 Lumbar Puncture
 Do MRI or CT scan
 Skull X ray
 Asking more details about headache
Question was not answered

90. An asymptomatic 56years man who has never consumed alcohol came for a routine
checkup. Exam: increase spider angioma, Cardiomegaly, S3 gallop, liver firm with 8cm
span, no ascites.

He is in the risk of which condition?

 Werniecke’s encephalopathy
 Hepatoma
 Renal failure
 cerebellar degeneration
 Hepatic vein thrombosis
Question was not answered

91. A 75-yearold man has been attending the clinic for lower urinary tract symptoms. His
mood is very low and he is unhappy, anxious and unable to sleep. He has been diagnosed
with moderate depression.

What treatment would you use for this patient?

 Amitryptaline
 CBT
 Citalopram
 Dosulepin
 Diasepam
Question was not answered
Explanation:

Mild depression = CBT, Moderate depression = Antidepressant, Severe depression & Ps = ECT,
Amitriptyline and Dosulepine causes urinary retention (which is comparatively less in citalopram) so
no a patient with lower urinary symptoms. Hence Citalopram is the preferred option.
92. A 30 years’ woman presents with acute headache. She complains of seeing halos
especially at night.

What is likely defect?

 Mono-ocular field loss
 Central scotoma
 Paracentral scotoma
 Cortical blindness
 Tunnel vision
Question was not answered

Explanation:

The diagnosis is glaucoma (headache and haloes especially at night). In glaucoma the vision.
93. A 75 year’s lady who had mitral valve replacement 13 years ago has developed
recurrent breathlessness. There is a prominent pulsation in her neck. She complains of
abdominal pain and ankle swelling.

What is the most probably diagnosis?

 Aortic regurgitation
 Mitral stenosis
 Tricuspid regurgitation
 Mitral regurgitation
 Pulmonary stenosis
Question was not answered

94. A homeless lady presents with cough and fever. She complains of night sweats and
weight loss. CXR has opacity.

What is the next appropriate management?

 IFN gamma testing
 Mantoux
 Bronchoscopy
 AFB
 CT chest
Question was not answered

Explanation:

Cough and fever and night sweat and weight loss are very suggestive of TB. She should do AF
investigation.
95. A 78-year-old woman is admitted to the intensive care unit for acute pulmonary edema.
She has rales to the apices and Jugular vein distention. Her EKG shows ventricular
tachycardia.
Which of the following is the best therapy?
 Synchronized cardioversion
 Amiodarone
 Lidocaine
 Unsynchronized cardioversion
 Procainamide
Question was not answered

Explanation:

Synchronized cardioversion is used when ventricular tachycardia is associated with acute pulmonary
edema. Unsynchronized cardioversion is used for ventricular fibrillation or ventricular tachycardia
without a pulse. Medical therapy, such as lidocaine, amiodarone, or procainamide, can be used for
sustained ventricular tachycardia that is hemodynamically stable.
96. A child with a small head, minor anomalies of the face including a thin upper lip, growth
delay, and developmental disability can have all of the following, except:
 A polygenic syndrome
 Teratogenic syndrome
 A mendelian syndrome
Question was not answered

Explanation:

The features given can occur as a part of a chromosomal / teratogenic / mendelian syndrome.
Polygenic in answer of exclusion. In a polygenic inheritance, multiple genes are involved in the
phenotypic expression. of polygenic inheritance are hypertension and diabetes.
97. A 24-year-old male with a history of gang violence presents to the emergency room with
3 stab wounds to the abdomen. He was intubated in the field for airway protection and is
barely conscious. Blood pressure is 70/30 mm Hg and pulse is 140/min. On exam, 3
penetrating wounds covered by abdominal pressure pads are noted.

Which of the following is the best next step in management of this patient?
 IV fluids
 Abdominal x-ray
 Obtain consent for surgery
 IV antibiotics
Question was not answered

Explanation:

This patient is in hemorrhagic shock and requires immediate resuscitation. Of the choices listed, the
best next step in management is IV fluids after obtaining venous access. The best form of venous
access is 2 large-bore IVs in the periphery and/or central venous access. Applying direct pressure to
the abdomen (a) does not treat the underlying cause. Getting an abdominal x-ray (b) will take too
long for a patient with this rate of blood loss. IV antibiotics (c) may be needed later in the care of this
patient, but stabilizing blood pressure is now the more urgent need. Surgical consent (e) is implied in
a life-threatening emergency in which a patient cannot communicate his wishes.
98. A 47-year old man comes to the emergency department with fever, headache,
photophobia, and a stiff neck.
What is the next best step in the management of this patient?
 Head Ct scan
 Lumbar puncture
 Ceftriaxone and vancomycin
Question was not answered

Explanation:

When you suspect bacterial meningitis, administer antibiotics quickly. Further, do blood cultures stat
simultaneously with a lumbar puncture (LP), or immediately prior. Penicillin can never be used as
empiric therapy for meningitis; it is not sufficiently broad in coverage to be effective empiric therapy.
In this case, perform the LP.
99. Condition not associated with increased alpha fetoprotein:
 Myelomeningocele
 Down syndrome
 Spina bifida
 Gastroschisis
Question was not answered

Explanation:

Down syndrome associated with DECREASED levels of alpha fetoprotein. Not increased.

Reference: https://en.m.wikipedia.org/wiki/Triple_test
100. A pregnant woman comes with weakness and elevated liver function tests. She is in
her 35th week of pregnancy. The prothrombin time is normal. The smear of blood shows
fragmented red cells. Platelet count is low.

What is the treatment?

 Delivery of the baby
 Fresh frozen plasma
 Prednisone
Question was not answered

Explanation:

Deliver the baby with the HELLP syndrome. HELLP syndrome stands for hemolysis, elevated liver
function tests, and low platelets. This disorder is idiopathic and can be distinguished from DIC by the
normal coagulation studies, such as the prothrombin time and aPTT.