MEDICAL AND DENTAL SPECIALIST
EXAMINATION — (250 Ques) 2025/2026
COMPLETE QUESTIONS WITH CORRECT
DETAILED ANSWERS & rationales
EXAM DOMAIN COVERAGE SUMMARY:
Domain 1 – Internal Medicine (Q1–60) — 60 questions Domain 2 – Surgery (Q61–80) — 20
questions Domain 3 – Pediatrics (Q81–100) — 20 questions Domain 4 – Obstetrics &
Gynaecology (Q101–120) — 20 questions Domain 5 – Pharmacology & Therapeutics (Q121–
140) — 20 questions Domain 6 – Dentistry & Oral Medicine / Pathology (Q141–190) — 50
questions Domain 7 – Psychiatry & Neurology (Q191–200) — 10 questions Domain 8 –
Emergency Medicine & Critical Care (Q201–250) — 50 questions
DOMAIN 1: INTERNAL MEDICINE & GENERAL MEDICINE (Questions 1–60)
1. A 55-year-old male presents with crushing chest pain radiating to the left arm, diaphoresis,
and nausea. ECG shows ST elevation in leads II, III, and aVF. The MOST likely diagnosis is:
A) Unstable angina B) Inferior ST-Elevation Myocardial Infarction (STEMI) (correct answer)
C) Pulmonary embolism D) Aortic dissection
.Rationale: ST elevation in leads II, III, and aVF indicates inferior wall MI, supplied by the
right coronary artery (RCA). Classic symptoms of STEMI include crushing chest pain,
radiation to the left arm, diaphoresis, and nausea. Immediate reperfusion therapy (PCI or
thrombolytics) is indicated.
2. Which of the following is the FIRST-LINE treatment for a patient with newly diagnosed type
2 diabetes mellitus without contraindications?
A) Insulin glargine B) Sulfonylurea C) Metformin (correct answer) D) GLP-1 receptor agonist
,.Rationale: Metformin is the universally accepted first-line pharmacological treatment for
type 2 DM unless contraindicated (eGFR <30, hepatic failure, contrast procedures). It
reduces hepatic gluconeogenesis, improves insulin sensitivity, has a favorable safety profile,
is weight-neutral or causes modest weight loss, and is cost-effective.
3. A 30-year-old woman presents with fatigue, pallor, and koilonychia. Her CBC shows Hb 8.5
g/dL, MCV 68 fL, low serum ferritin. The MOST appropriate treatment is:
A) Vitamin B12 injections B) Folic acid supplementation C) Oral ferrous sulfate (correct
answer) D) Blood transfusion
.Rationale: The clinical picture — fatigue, pallor, koilonychia (spoon-shaped nails), low
Hb, microcytic (low MCV) anemia, and low ferritin — is classic iron deficiency anemia.
First-line treatment is oral ferrous sulfate (elemental iron 150–200 mg/day). Blood
transfusion is reserved for symptomatic severe anemia (Hb <7 g/dL).
4. Which ONE of the following is characteristic of rheumatoid arthritis but NOT osteoarthritis?
A) Joint pain worsening with activity B) Morning stiffness lasting more than 1 hour (correct
answer) C) Involvement of distal interphalangeal joints D) Osteophyte formation on X-ray
.Rationale: Prolonged morning stiffness (>1 hour) is a hallmark of inflammatory arthritis
(RA). In OA, morning stiffness is brief (<30 minutes). RA typically spares the DIPJs
(affects MCPs, PIPs, wrists), while OA involves DIPJs (Heberden's nodes) and is
characterized by osteophytes and joint space narrowing.
5. A patient with known chronic kidney disease (CKD) stage 3 presents with hyperkalemia (K+
6.5 mEq/L) and ECG changes (peaked T waves). The MOST immediate intervention is:
A) Sodium bicarbonate IV B) Calcium gluconate IV (correct answer) C) Furosemide IV D)
Hemodialysis
.Rationale: IV calcium gluconate is the IMMEDIATE first-line treatment for hyperkalemia
with ECG changes. It stabilizes cardiac membrane excitability within minutes, preventing
life-threatening arrhythmias. It does NOT lower serum potassium. Insulin/dextrose and
bicarbonate shift K+ intracellularly; kayexalate and dialysis eliminate K+.
6. Which of the following physical findings is MOST specific for liver cirrhosis?
,A) Jaundice B) Ascites C) Spider angiomata (correct answer) D) Peripheral edema
.Rationale: Spider angiomata (spider nevi) — central arteriole with radiating vessels
blanching on pressure — are highly specific for liver disease, particularly cirrhosis. They
result from elevated estrogen levels due to impaired hepatic metabolism. Multiple lesions
(>5) strongly suggest chronic liver disease.
7. A 65-year-old smoker presents with a chronic productive cough for over 3 months per year for
2 consecutive years. Spirometry shows FEV1/FVC ratio of 0.62. The MOST likely diagnosis is:
A) Asthma B) Pulmonary fibrosis C) Chronic Obstructive Pulmonary Disease (COPD) (correct
answer) D) Bronchiectasis
.Rationale: COPD diagnosis requires: (1) spirometric evidence of persistent airflow
limitation — post-bronchodilator FEV1/FVC <0.70, (2) chronic cough with sputum
production for ≥3 months/year for ≥2 years (chronic bronchitis), and (3) significant
exposure history (smoking). Asthma is typically reversible and episodic.
8. Which of the following is the GOLD STANDARD for diagnosis of pulmonary embolism?
A) D-dimer assay B) Chest X-ray C) CT Pulmonary Angiography (CTPA) (correct answer) D)
V/Q scan
.Rationale: CTPA is the gold standard for diagnosing PE due to its high sensitivity (83–
100%) and specificity (96–100%), rapid availability, and ability to visualize clots directly in
pulmonary vasculature. D-dimer is highly sensitive but non-specific (used to rule out PE in
low-probability cases). V/Q scan is used when CTPA is contraindicated.
9. A patient presents with polyuria, polydipsia, and a random blood glucose of 240 mg/dL with
glycosuria. HbA1c is 8.9%. This is MOST consistent with:
A) Diabetes insipidus B) Type 2 diabetes mellitus (correct answer) C) Cushing's syndrome D)
Hyperosmolar hyperglycemic state
.Rationale: Diagnosis of DM requires: fasting glucose ≥126 mg/dL, random glucose ≥200
mg/dL with symptoms, HbA1c ≥6.5%, or 2-hour glucose ≥200 mg/dL on OGTT. This
patient meets multiple criteria. HbA1c 8.9% indicates poorly controlled DM over the
preceding 3 months.
, 10. Which of the following drugs is the MOST appropriate for prophylaxis against Pneumocystis
jirovecii pneumonia (PCP) in an HIV patient with CD4 count <200 cells/µL?
A) Fluconazole B) Trimethoprim-sulfamethoxazole (TMP-SMX) (correct answer) C)
Azithromycin D) Acyclovir
.Rationale: TMP-SMX (co-trimoxazole) is the first-line prophylaxis for PCP in HIV
patients with CD4 <200 cells/µL. It also provides protection against toxoplasmosis.
Alternatives include dapsone, atovaquone, or aerosolized pentamidine for patients
intolerant of TMP-SMX.
11. A 45-year-old woman presents with butterfly rash across cheeks, joint pain, photosensitivity,
and positive ANA. Anti-dsDNA and anti-Smith antibodies are elevated. The MOST likely
diagnosis is:
A) Dermatomyositis B) Systemic Lupus Erythematosus (SLE) (correct answer) C) Sjögren's
syndrome D) Mixed connective tissue disease
.Rationale: SLE diagnosis uses the ACR/EULAR criteria. Anti-dsDNA and anti-Smith
(anti-Sm) are HIGHLY SPECIFIC for SLE. Anti-Smith is the most specific autoantibody
for SLE. The malar (butterfly) rash spares the nasolabial folds and is pathognomonic when
combined with other features.
12. The MOST common cause of community-acquired pneumonia (CAP) in immunocompetent
adults is:
A) Haemophilus influenzae B) Streptococcus pneumoniae (correct answer) C) Mycoplasma
pneumoniae D) Legionella pneumophila
.Rationale: Streptococcus pneumoniae (pneumococcus) remains the most common
identifiable cause of CAP in adults across all age groups. It presents with acute onset high
fever, productive cough with rusty-brown sputum, pleuritic chest pain, and lobar
consolidation on chest X-ray.
13. Which of the following ECG changes is MOST associated with hyperkalemia?
A) Prolonged QT interval B) Delta waves C) Peaked T waves (correct answer) D) ST
depression in precordial leads
EXAMINATION — (250 Ques) 2025/2026
COMPLETE QUESTIONS WITH CORRECT
DETAILED ANSWERS & rationales
EXAM DOMAIN COVERAGE SUMMARY:
Domain 1 – Internal Medicine (Q1–60) — 60 questions Domain 2 – Surgery (Q61–80) — 20
questions Domain 3 – Pediatrics (Q81–100) — 20 questions Domain 4 – Obstetrics &
Gynaecology (Q101–120) — 20 questions Domain 5 – Pharmacology & Therapeutics (Q121–
140) — 20 questions Domain 6 – Dentistry & Oral Medicine / Pathology (Q141–190) — 50
questions Domain 7 – Psychiatry & Neurology (Q191–200) — 10 questions Domain 8 –
Emergency Medicine & Critical Care (Q201–250) — 50 questions
DOMAIN 1: INTERNAL MEDICINE & GENERAL MEDICINE (Questions 1–60)
1. A 55-year-old male presents with crushing chest pain radiating to the left arm, diaphoresis,
and nausea. ECG shows ST elevation in leads II, III, and aVF. The MOST likely diagnosis is:
A) Unstable angina B) Inferior ST-Elevation Myocardial Infarction (STEMI) (correct answer)
C) Pulmonary embolism D) Aortic dissection
.Rationale: ST elevation in leads II, III, and aVF indicates inferior wall MI, supplied by the
right coronary artery (RCA). Classic symptoms of STEMI include crushing chest pain,
radiation to the left arm, diaphoresis, and nausea. Immediate reperfusion therapy (PCI or
thrombolytics) is indicated.
2. Which of the following is the FIRST-LINE treatment for a patient with newly diagnosed type
2 diabetes mellitus without contraindications?
A) Insulin glargine B) Sulfonylurea C) Metformin (correct answer) D) GLP-1 receptor agonist
,.Rationale: Metformin is the universally accepted first-line pharmacological treatment for
type 2 DM unless contraindicated (eGFR <30, hepatic failure, contrast procedures). It
reduces hepatic gluconeogenesis, improves insulin sensitivity, has a favorable safety profile,
is weight-neutral or causes modest weight loss, and is cost-effective.
3. A 30-year-old woman presents with fatigue, pallor, and koilonychia. Her CBC shows Hb 8.5
g/dL, MCV 68 fL, low serum ferritin. The MOST appropriate treatment is:
A) Vitamin B12 injections B) Folic acid supplementation C) Oral ferrous sulfate (correct
answer) D) Blood transfusion
.Rationale: The clinical picture — fatigue, pallor, koilonychia (spoon-shaped nails), low
Hb, microcytic (low MCV) anemia, and low ferritin — is classic iron deficiency anemia.
First-line treatment is oral ferrous sulfate (elemental iron 150–200 mg/day). Blood
transfusion is reserved for symptomatic severe anemia (Hb <7 g/dL).
4. Which ONE of the following is characteristic of rheumatoid arthritis but NOT osteoarthritis?
A) Joint pain worsening with activity B) Morning stiffness lasting more than 1 hour (correct
answer) C) Involvement of distal interphalangeal joints D) Osteophyte formation on X-ray
.Rationale: Prolonged morning stiffness (>1 hour) is a hallmark of inflammatory arthritis
(RA). In OA, morning stiffness is brief (<30 minutes). RA typically spares the DIPJs
(affects MCPs, PIPs, wrists), while OA involves DIPJs (Heberden's nodes) and is
characterized by osteophytes and joint space narrowing.
5. A patient with known chronic kidney disease (CKD) stage 3 presents with hyperkalemia (K+
6.5 mEq/L) and ECG changes (peaked T waves). The MOST immediate intervention is:
A) Sodium bicarbonate IV B) Calcium gluconate IV (correct answer) C) Furosemide IV D)
Hemodialysis
.Rationale: IV calcium gluconate is the IMMEDIATE first-line treatment for hyperkalemia
with ECG changes. It stabilizes cardiac membrane excitability within minutes, preventing
life-threatening arrhythmias. It does NOT lower serum potassium. Insulin/dextrose and
bicarbonate shift K+ intracellularly; kayexalate and dialysis eliminate K+.
6. Which of the following physical findings is MOST specific for liver cirrhosis?
,A) Jaundice B) Ascites C) Spider angiomata (correct answer) D) Peripheral edema
.Rationale: Spider angiomata (spider nevi) — central arteriole with radiating vessels
blanching on pressure — are highly specific for liver disease, particularly cirrhosis. They
result from elevated estrogen levels due to impaired hepatic metabolism. Multiple lesions
(>5) strongly suggest chronic liver disease.
7. A 65-year-old smoker presents with a chronic productive cough for over 3 months per year for
2 consecutive years. Spirometry shows FEV1/FVC ratio of 0.62. The MOST likely diagnosis is:
A) Asthma B) Pulmonary fibrosis C) Chronic Obstructive Pulmonary Disease (COPD) (correct
answer) D) Bronchiectasis
.Rationale: COPD diagnosis requires: (1) spirometric evidence of persistent airflow
limitation — post-bronchodilator FEV1/FVC <0.70, (2) chronic cough with sputum
production for ≥3 months/year for ≥2 years (chronic bronchitis), and (3) significant
exposure history (smoking). Asthma is typically reversible and episodic.
8. Which of the following is the GOLD STANDARD for diagnosis of pulmonary embolism?
A) D-dimer assay B) Chest X-ray C) CT Pulmonary Angiography (CTPA) (correct answer) D)
V/Q scan
.Rationale: CTPA is the gold standard for diagnosing PE due to its high sensitivity (83–
100%) and specificity (96–100%), rapid availability, and ability to visualize clots directly in
pulmonary vasculature. D-dimer is highly sensitive but non-specific (used to rule out PE in
low-probability cases). V/Q scan is used when CTPA is contraindicated.
9. A patient presents with polyuria, polydipsia, and a random blood glucose of 240 mg/dL with
glycosuria. HbA1c is 8.9%. This is MOST consistent with:
A) Diabetes insipidus B) Type 2 diabetes mellitus (correct answer) C) Cushing's syndrome D)
Hyperosmolar hyperglycemic state
.Rationale: Diagnosis of DM requires: fasting glucose ≥126 mg/dL, random glucose ≥200
mg/dL with symptoms, HbA1c ≥6.5%, or 2-hour glucose ≥200 mg/dL on OGTT. This
patient meets multiple criteria. HbA1c 8.9% indicates poorly controlled DM over the
preceding 3 months.
, 10. Which of the following drugs is the MOST appropriate for prophylaxis against Pneumocystis
jirovecii pneumonia (PCP) in an HIV patient with CD4 count <200 cells/µL?
A) Fluconazole B) Trimethoprim-sulfamethoxazole (TMP-SMX) (correct answer) C)
Azithromycin D) Acyclovir
.Rationale: TMP-SMX (co-trimoxazole) is the first-line prophylaxis for PCP in HIV
patients with CD4 <200 cells/µL. It also provides protection against toxoplasmosis.
Alternatives include dapsone, atovaquone, or aerosolized pentamidine for patients
intolerant of TMP-SMX.
11. A 45-year-old woman presents with butterfly rash across cheeks, joint pain, photosensitivity,
and positive ANA. Anti-dsDNA and anti-Smith antibodies are elevated. The MOST likely
diagnosis is:
A) Dermatomyositis B) Systemic Lupus Erythematosus (SLE) (correct answer) C) Sjögren's
syndrome D) Mixed connective tissue disease
.Rationale: SLE diagnosis uses the ACR/EULAR criteria. Anti-dsDNA and anti-Smith
(anti-Sm) are HIGHLY SPECIFIC for SLE. Anti-Smith is the most specific autoantibody
for SLE. The malar (butterfly) rash spares the nasolabial folds and is pathognomonic when
combined with other features.
12. The MOST common cause of community-acquired pneumonia (CAP) in immunocompetent
adults is:
A) Haemophilus influenzae B) Streptococcus pneumoniae (correct answer) C) Mycoplasma
pneumoniae D) Legionella pneumophila
.Rationale: Streptococcus pneumoniae (pneumococcus) remains the most common
identifiable cause of CAP in adults across all age groups. It presents with acute onset high
fever, productive cough with rusty-brown sputum, pleuritic chest pain, and lobar
consolidation on chest X-ray.
13. Which of the following ECG changes is MOST associated with hyperkalemia?
A) Prolonged QT interval B) Delta waves C) Peaked T waves (correct answer) D) ST
depression in precordial leads
