1. A 65yo man presents w/ painless hematuria, IVU is normal, prostate is mildly enlarged with mild
frequency. What is the most appropriate next step?
a. US Abdomen
b. Flexible cystoscopy
c. MRI
d. Nuclear imaging
e. PSA
2. A 74yo smoker presented to his GP with cough and SOB. Exam revealed pigmentation of the oral
mucosa and also over the palms and soles. Tests show that he is diabetic and hypokalemic.
What is the most probable dx?
a. Pseudocushing syndrome
b. Conns disease
c. Ectopic ACTH
d. Cushings disease
e. Hypothyroidism
3. A 44yo woman has lost weight over 12 months. She has also noticed episodes where her heart
beats rapidly and strongly. She has a regular pulse rate of 90bpm. Her ECG shows sinus rhythm.
What is the most appropriate inv to be done?
a. Thyroid antibodies
b. TFT
c. ECG
d. Echocardiogram
e. Plasma glucose
4. A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency
and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 1.9 and he is
anemic. His BP is 165/95 mmHg. What is the most probable dx?
a. BPH
b. Prostate carcinoma
c. Chronic pyelonephritis
d. Benign nephrosclerosis
5. A 64yo man has recently suffered from a MI and is on aspirin, atorvastatin and ramipril. He has
been having trouble sleeping and has been losing weight for the past 4 months. He doesn’t feel
like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and
can’t concentrate on anything. What is the most appropriate tx?
a. Lofepramine
b. Dosulepin
c. Citalopram
d. Fluoxetine
e. Phenelzine
6. A 67yo man after a stroke, presents with left sided prosis and constricted pupil. He also has loss
of pain and temp on the right side of his body and left side of his face. Which part of the brain is
most likely affected?
a. Frontal cortex
b. Cerebellum
c. Pons
d. Medulla
e. Parietal cortex
,7. A 60yo man presents with dysphagia and pain on swallowing both solids and liquids. A barium
meal shows gross dilatation of the esophagus with a smooth narrowing at the lower end of the
esophagus. What is the SINGLE most likely cause of dysphagia?
a. Achalasia
b. Myasthenia gravis
c. Esophageal carcinoma
d. Esophageal web
e. Systemic sclerosis
8. A man undergoes a pneumonectomy. After surgery, invs show hyponatremia. What could be the
cause of the biochemical change?
a. Removal of hormonally active tumor
b. Excess dextrose
c. Excess colloid
d. Excessive K+
e. Hemodilution
9. A pregnant lady came with pain in her calf muscle with local rise in temp to the antenatal clinic.
What tx should be started?
a. Aspirin
b. LMWH
c. Paracetamol
d. Cocodamol
e. Aspirin and heparin
10. A 53yo female presents with an acute painful hot knee joint. She is a known case of RA. On
examination, the knee is red, tender and swollen. The hamstring muscles are in spasm. Her
temp is 38.5C and BP is 120/80mmHg. What is the SINGLE best next inv?
a. Joint aspiration for cytology and culture and sensitivity
b. Joint aspiration for positive birefrengent crystals
c. Joint aspiration for negative birefrengent crystals
d. Blood culture
e. Serum uric acid
11. An 80yo man presented with pain in his lower back and hip. He also complains of waking up in
the night to go to the washroom and has urgency as well as dribbling. What is the most likely dx?
a. BPH
b. Prostatitis
c. UTI
d. Prostate carcinoma
e. Bladder carcinoma
12. An 18yo female has peri-orbital blisters. Some of them are crusted, others secreting pinkish fluid.
What is the most likely dx?
a. Shingles
b. Chicken pox
c. Varicella
d. Rubella
e. Measles
13. A 29yo lady who is a bank manager is referred by the GP to the medical OPC due to a long hx of
tiredness and pain in the joints. An autoimmune screen result showed smooth muscle
antibodies positive. What is the most appropriate next inv?
a. ECG
, b. TFT
c. LFT
d. Serum glucose
e. Jejunal biopsy
14. A 5yo with recurrent chest pain, finger clubbing with offensive stool. Choose the single most
likely inv?
a. Endomyseal/Alpha glidin antibody
b. Sweat test
c. Barium meal
d. ECG
e. Glucose tolerance test
15. A clinical picture of breast cancer originated from the mammary duct. Biopsy was done ad there
were neoplastic cells found. Choose the histological picture of the cancer.
a. Neoplastic cells are arranged in small clusters occupying a space between collagen
bundles (Seirrhous carcinoma)
b. Spindle cell neoplasms with margins, which infiltrate adjacent structure, fat invaded
(Breast sarcoma)
c. Small cells with round nucleus and scant indistinct cytoplasm (Lobular carcinoma)
16. A 22yo man has a reduced conscious level and a fixed dilated pupil after being involved in a MVC.
Choose the single most appropriate option?
a. Facial nerve
b. Oculomotor nerve
c. Olfactory nerve
d. Optic nerve
e. Trigeminal nerve
17. A man with suspected active TB wants to be treated at home. What should be done to prevent
the spread of disease?
a. Immediate start of the tx with Anti-TB drugs
b. All family members should be immediately vaccinated with BCG vaccine
c. Patient should be isolated in a negative pressure chamber in his house
d. Universal prevention application protocol
18. A 7yo child is brought to the ED with a 1 day hx of being listless. On examination, the child is
drowsy with an extensive non-blanching rash. What advice would you give the parents?
a. All family members need antibiotic therapy
b. Only the mother should be given rifampicin prophylaxis
c. All family members need isolation
d. All family members should be given rifampicin prophylaxis
19. A 47yo man has a temp of 39C and is delirious. He has developed blisters mainly on his trunk,
which appeared a few hours ago. He is well and not on any medications. He last travelled 5
months ago to Italy. Which of the following is the most likely dx?
a. Shingles
b. Chicken pox
c. Pemphigoid
d. Bullous pemphigus
20. A 64yo pt has been having freq episodes of secretory diarrhea, which is extremely watery, with
large amts of mucus. A dx of villous adenoma was made after endoscopy. What electrolyte
abnormality is most likely in this pt?
a. Hyperkalemia
, b. Hypernatremia
c. Hyponatremia
d. Hypokalemia
e. Hypercalcemia
21. A pt with an acute gout attack came to the ED. What drug should be given to relieve symptoms?
a. NSAIDs
b. Allopurinol
c. Ibuprofen
22. A pt was lying down on the operating table in a position with his arms hanging down for 3 hours.
Soon after he woke up, he complains of numbness and weakness in that hand and has limited
wrist movement/wrist drop and sensory loss over dorsum of that hand, weakness of extension
of the fingers and loss of sensation at the web of the thumb. What structure is likely to be
damaged?
a. Radial nerve
b. Median nerve
c. Ulnar nerve
d. Axillary nerve
e. Suprascapular nerve
23. A pt who was previously on 120mg slow release oral morphine has had his dose increased to
200mg. He is still in significant pain. He complains of drowsiness and constipation. What is the
next step in the management?
a. Increase slow release morphine dose
b. Fentanyl patch
c. Replace morphine with oral hydromorphone
d. Replace morphine with oxycodone
e. Subcutaneous morphine
24. A 40yo woman notices increasing lower abdominal distention with little/no pain. On
examination, a lobulated cystic mass is felt and it seems to be arising from the pelvis. What is
the most appropriate inv?
a. CA 125
b. CA 153
c. CA 199
d. CEA
e. AFP
25. A resident of a nursing home presented with rashes in his finger webs and also on his abdomen,
with complaints of itching which is severe at night. He was dx with scabies. What the best tx for
his condition?
a. 0.5% permethrin
b. Doxycycline
c. 5% permethrin
d. Reassure
e. Acyclovir
26. A 34yo alcoholic is found passed out in front of a local pub. The ambulance crew informs you
that he was sweating when they found him and there were cans of cider lying empty around
him. What is the initial stage of inv?
a. Capillary blood sugar
b. CT head
c. MRI head
frequency. What is the most appropriate next step?
a. US Abdomen
b. Flexible cystoscopy
c. MRI
d. Nuclear imaging
e. PSA
2. A 74yo smoker presented to his GP with cough and SOB. Exam revealed pigmentation of the oral
mucosa and also over the palms and soles. Tests show that he is diabetic and hypokalemic.
What is the most probable dx?
a. Pseudocushing syndrome
b. Conns disease
c. Ectopic ACTH
d. Cushings disease
e. Hypothyroidism
3. A 44yo woman has lost weight over 12 months. She has also noticed episodes where her heart
beats rapidly and strongly. She has a regular pulse rate of 90bpm. Her ECG shows sinus rhythm.
What is the most appropriate inv to be done?
a. Thyroid antibodies
b. TFT
c. ECG
d. Echocardiogram
e. Plasma glucose
4. A 79yo anorexic male complains of thirst and fatigue. He has symptoms of frequency, urgency
and terminal dribbling. His urea and creatinine levels are high. His serum calcium is 1.9 and he is
anemic. His BP is 165/95 mmHg. What is the most probable dx?
a. BPH
b. Prostate carcinoma
c. Chronic pyelonephritis
d. Benign nephrosclerosis
5. A 64yo man has recently suffered from a MI and is on aspirin, atorvastatin and ramipril. He has
been having trouble sleeping and has been losing weight for the past 4 months. He doesn’t feel
like doing anything he used to enjoy and has stopped socializing. He says he gets tired easily and
can’t concentrate on anything. What is the most appropriate tx?
a. Lofepramine
b. Dosulepin
c. Citalopram
d. Fluoxetine
e. Phenelzine
6. A 67yo man after a stroke, presents with left sided prosis and constricted pupil. He also has loss
of pain and temp on the right side of his body and left side of his face. Which part of the brain is
most likely affected?
a. Frontal cortex
b. Cerebellum
c. Pons
d. Medulla
e. Parietal cortex
,7. A 60yo man presents with dysphagia and pain on swallowing both solids and liquids. A barium
meal shows gross dilatation of the esophagus with a smooth narrowing at the lower end of the
esophagus. What is the SINGLE most likely cause of dysphagia?
a. Achalasia
b. Myasthenia gravis
c. Esophageal carcinoma
d. Esophageal web
e. Systemic sclerosis
8. A man undergoes a pneumonectomy. After surgery, invs show hyponatremia. What could be the
cause of the biochemical change?
a. Removal of hormonally active tumor
b. Excess dextrose
c. Excess colloid
d. Excessive K+
e. Hemodilution
9. A pregnant lady came with pain in her calf muscle with local rise in temp to the antenatal clinic.
What tx should be started?
a. Aspirin
b. LMWH
c. Paracetamol
d. Cocodamol
e. Aspirin and heparin
10. A 53yo female presents with an acute painful hot knee joint. She is a known case of RA. On
examination, the knee is red, tender and swollen. The hamstring muscles are in spasm. Her
temp is 38.5C and BP is 120/80mmHg. What is the SINGLE best next inv?
a. Joint aspiration for cytology and culture and sensitivity
b. Joint aspiration for positive birefrengent crystals
c. Joint aspiration for negative birefrengent crystals
d. Blood culture
e. Serum uric acid
11. An 80yo man presented with pain in his lower back and hip. He also complains of waking up in
the night to go to the washroom and has urgency as well as dribbling. What is the most likely dx?
a. BPH
b. Prostatitis
c. UTI
d. Prostate carcinoma
e. Bladder carcinoma
12. An 18yo female has peri-orbital blisters. Some of them are crusted, others secreting pinkish fluid.
What is the most likely dx?
a. Shingles
b. Chicken pox
c. Varicella
d. Rubella
e. Measles
13. A 29yo lady who is a bank manager is referred by the GP to the medical OPC due to a long hx of
tiredness and pain in the joints. An autoimmune screen result showed smooth muscle
antibodies positive. What is the most appropriate next inv?
a. ECG
, b. TFT
c. LFT
d. Serum glucose
e. Jejunal biopsy
14. A 5yo with recurrent chest pain, finger clubbing with offensive stool. Choose the single most
likely inv?
a. Endomyseal/Alpha glidin antibody
b. Sweat test
c. Barium meal
d. ECG
e. Glucose tolerance test
15. A clinical picture of breast cancer originated from the mammary duct. Biopsy was done ad there
were neoplastic cells found. Choose the histological picture of the cancer.
a. Neoplastic cells are arranged in small clusters occupying a space between collagen
bundles (Seirrhous carcinoma)
b. Spindle cell neoplasms with margins, which infiltrate adjacent structure, fat invaded
(Breast sarcoma)
c. Small cells with round nucleus and scant indistinct cytoplasm (Lobular carcinoma)
16. A 22yo man has a reduced conscious level and a fixed dilated pupil after being involved in a MVC.
Choose the single most appropriate option?
a. Facial nerve
b. Oculomotor nerve
c. Olfactory nerve
d. Optic nerve
e. Trigeminal nerve
17. A man with suspected active TB wants to be treated at home. What should be done to prevent
the spread of disease?
a. Immediate start of the tx with Anti-TB drugs
b. All family members should be immediately vaccinated with BCG vaccine
c. Patient should be isolated in a negative pressure chamber in his house
d. Universal prevention application protocol
18. A 7yo child is brought to the ED with a 1 day hx of being listless. On examination, the child is
drowsy with an extensive non-blanching rash. What advice would you give the parents?
a. All family members need antibiotic therapy
b. Only the mother should be given rifampicin prophylaxis
c. All family members need isolation
d. All family members should be given rifampicin prophylaxis
19. A 47yo man has a temp of 39C and is delirious. He has developed blisters mainly on his trunk,
which appeared a few hours ago. He is well and not on any medications. He last travelled 5
months ago to Italy. Which of the following is the most likely dx?
a. Shingles
b. Chicken pox
c. Pemphigoid
d. Bullous pemphigus
20. A 64yo pt has been having freq episodes of secretory diarrhea, which is extremely watery, with
large amts of mucus. A dx of villous adenoma was made after endoscopy. What electrolyte
abnormality is most likely in this pt?
a. Hyperkalemia
, b. Hypernatremia
c. Hyponatremia
d. Hypokalemia
e. Hypercalcemia
21. A pt with an acute gout attack came to the ED. What drug should be given to relieve symptoms?
a. NSAIDs
b. Allopurinol
c. Ibuprofen
22. A pt was lying down on the operating table in a position with his arms hanging down for 3 hours.
Soon after he woke up, he complains of numbness and weakness in that hand and has limited
wrist movement/wrist drop and sensory loss over dorsum of that hand, weakness of extension
of the fingers and loss of sensation at the web of the thumb. What structure is likely to be
damaged?
a. Radial nerve
b. Median nerve
c. Ulnar nerve
d. Axillary nerve
e. Suprascapular nerve
23. A pt who was previously on 120mg slow release oral morphine has had his dose increased to
200mg. He is still in significant pain. He complains of drowsiness and constipation. What is the
next step in the management?
a. Increase slow release morphine dose
b. Fentanyl patch
c. Replace morphine with oral hydromorphone
d. Replace morphine with oxycodone
e. Subcutaneous morphine
24. A 40yo woman notices increasing lower abdominal distention with little/no pain. On
examination, a lobulated cystic mass is felt and it seems to be arising from the pelvis. What is
the most appropriate inv?
a. CA 125
b. CA 153
c. CA 199
d. CEA
e. AFP
25. A resident of a nursing home presented with rashes in his finger webs and also on his abdomen,
with complaints of itching which is severe at night. He was dx with scabies. What the best tx for
his condition?
a. 0.5% permethrin
b. Doxycycline
c. 5% permethrin
d. Reassure
e. Acyclovir
26. A 34yo alcoholic is found passed out in front of a local pub. The ambulance crew informs you
that he was sweating when they found him and there were cans of cider lying empty around
him. What is the initial stage of inv?
a. Capillary blood sugar
b. CT head
c. MRI head
