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P L A B T R A I N E R

PLAB- l M O C K - T E S T : 3 )c(o5[lO(l T I M E A L L O W E D : 3HRS

SINGLE BEST ANSWER:

1. A boy is brought to the A&E. He has felt unwell for a few days and is now vomiting. His pulse rate is 100 beats/minute and his capillary refill is 3 seconds. He is confused and his arterial blood gas results are:

(Aj) Metabolic acidosis B. Metabolic alkalosis C. Normal D. Respiratory disorder E. Respiratory alkalosis

SINGLE BEST ANSWER:

2. A mother has brought her three year old son to the Emergency department two hours after he has taken an unknown quantity of paracetamol suspension. He appears well and is playing normally. .

What is the SINGLE most appropriate time to measure his serum paracetamol levels?

A^ Immediately \Bj In 2 hours

C. In 4 hours D. In 8 hours E. In 24 hours

pH : 7.25 t-. tx- o-isu

PaC02 :3.2kpa I h | a <\, « u u 4s y (cc^u^^

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Theme: Neck swellings

Options:

A. Ultrasound B. FNAC C. CT D. Excision Biopsy E. X-ray F. Contrast X-ray G. Doppler ultrasound H. Aspiration with cytology and microscopy

Instruction: For each presentation below choose the Single most likely investigation from the above list of options. Each option may be used once, more than once or not at all.

/^3. 18 year old man presents with a painless swelling in the midline of the neck, just in front of the trachea. The swelling moves on swallowing and protrusion of the tongue. —) Wtffzfj^&A l\

L J L A 4. A 14 year old girl presents with a painless swelling in the upper part of the right of the ^ . ^ ^ j ' ^ T , t x c ^ neck. On examination it is a fluctuant swelling felt beneath the upper third sterno-mastoid.

5. A 75 year old man presents with dysphagia, regurgitation of food and chronic cough. On ^ examination, a 7cm soft, smooth, non- tender and compressible swelling behind the mastoid

and inferior to the thyroid cartilage is noted, p ftcf-fflfA jM/c-h fiUuj ft*

SINGLE BEST ANSWER:

6. A 52 year old woman has pruritus, jaundice and general malaise. She describes abdominal discomfort, dark urine and pale offensive stools. She takes thyroxine. On examination, she is mildly icteric with scratch marks and splenomegaly. Blood tests are: HblO.Og/dl, WBC 3.5*109/L, Pits 110* 109L, INR1.7, bilibrubin 140 umol/1, ALP 800 iu/1, ALT 150iu/l, Alb30g/1. o Oi [r>Jtk)til j <£Ci1#-6. k i p ^ i o ^ ^ l - ' -x : >Lf--i-G.w ^ L

Which of the following is the most appropriated investigation? . / - . - • )

0 L i v e r biopsy fc-~ t W , " | l ^ f 1 ^ B. Abdominal ultrasound , - H * ! ^ ' ^

C. Anti-smooth muscle antibody 7-fP ^ " D. Anti-mitochondrial antibody -5 s f W l E. Viral serology.

SINGLE BEST ANSWER:

7. A 55 year old man has weight loss, dyspnoea and syncope. He smokes 20 cigarettes a day. Investigation confirms a squamous cell carcinoma in the left bronchus.

What is the SINGLE most likely biochemical abnormality to be associated with the

B. Hyperkalaemia C. Hypermatraemia D. Hypocalcaemia E. Hypomagnesaemia

Theme : Diagnosis of anxiety

Options:

A. Acute stress syndrome H. Post traumatic stress disorder(PTSD) B. Agoraphobia I . Psychotic disorder C. Alcohol withdrawal J. Social phobia D. Generalized anxiety disorder K. Substance abuse E. Obsessive compulsive disorder(OCD L. Thyrotoxicosis. F. Panic disorder G. Phaeochromocytoma

Instruction: For each patient described below, choose the most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

8. A 30 year old woman has experienced restlessness, muscle tension and sleep disturbance on most days over the last six months. She worries excessively about a number of every day events and activities, and is unable to control these feelings which are impairing her ability to hold down her j ob.

9. A 26-year old political refugee has sought asylum in the UK and complains of poor concentration. He keeps getting thoughts of his family whom he saw killed in a political coup. He is unable to sleep and feels hopeless about his survival. Because of this he is afraid to go out.

10. A 30-year-old man is becoming concerned about safety of his family. He has been checking the locks of the door every hour during the night. He becomes very anxious i f his wife tries to stop him.

condition?

11. A 48 year old woman always socially with-drawn has stopped going out of the house. She is afraid to socialize because she fears that people wil l criticize her.

Theme: Treatment of Septicaemia

Options:

A. Ceftazidim F. Co- Amoxiclave B. Cefuroxime G. Piperacillin+ Tazobactam C. Ceftriaxone 1 ,v-.v,v....... D. Gentamicin . _ .." v

E. Cefalexin L < ' v , ° " ^ ^ '

Instruction: For each patient described below, choose the most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

H 12. An old lady had UTI treated with antibiotics then developed diarrhoea. Â/donviwkt^ciX cJJas _L 13. A patient with penicillin allergy. £j 14. A patient has Hodgkin Lymphoma under treatment developed high fever and WBC less

than 2000 and chest infection. e^micvfuiXhl ^â^ - W ^ l c ficûU^x^ t 74?e,fca cfr^

Theme : Side effects of Antipsychotic Medications

Options:

A. Lithium carbonate G. Fluoxetine B. Phenelzine H. Valproate C. Diazepam I . Clozapine D. Haloperidol J. Chlorpromazine E. Thioridazine K. Amphetamines

Instruction: For each patient described below, choose the SINGLE most relevant option from the above list of options. Each option may be used once, more than once or not at all.

jS- 15. Dosages above the recommended upper limit can lead to retinitis pigmentosa.

| I 16. Inhibition of ejaculation is a characteristic side effect.

P5, 17. Sudden development of severe throbbing headache signals a possible medical emergency.

A" 18. Gastro intestinal distress and fine tremor of the hands indicate toxicity.

3) 19. In low dosages, its relative lack of autonomic side effects makes it a drug of choice in the treatment of agitation in elderly individual.

Theme : Speech disorder in children

Options:

A. Arrange hearing test B. Arrange magnetic resonance imaging(MRI) brain scan C. Broad spectrum antibiotic D. Reassure E. Refer for developmental assessment F. Refer to department of child psychiatry G. Refer to ear, nose and throat ENT surgeon H. Refer to social services I . Refer to speech therapist

Instruction: For each child described below, choose the single most appropriate management strategy from the above list of option. Each option may be used once, more than once, or not at all.

20. A mother is concerned that her 18-month-son has vocabulary of ten words but cannot form a sentence.

P[ 21. A mother presents with her 6-month-old son who is vocalizing. She has also noticed that he does not respond to loud noises. His motor milestones are normal.

£1 22. A mother presents with her 12-month-old daughter. The child has no meaningful words, is unable to sit unaided and cannot play with her toys. She does not laugh and has poor interaction with her siblings.

23. A mother presents with her 3-year-old son who has indistinct nasal speech. He snores at night and has restless sleep. He is tired by day.

SINGLE BEST ANSWER:

24. A 60 year old man has had spontaneous painful swelling of his right knee for three days. Five days previously he had an inguinal hernia repaired as a day case. He takes , ,j, J bendroflumethiazide 2.5 mg daily. He is apyrexial. (>oof t ^ f ^ i t c — ^ s ^ ^ v ^

What is the SINGLE most appropriate diagnostic investigation? j&Jl

A. Blood cultures B. C -reactive protein C. D- dimer D. Plain x-ray of the knee

(^E?) Serum uric acid

SINGLE B E S T ANSWER:

25. A man presents with knee injury while skiing. On examination there is pain on valgus stressing. What is the most likely affected ligament?

Medial collateral ligament B. Lateral collateral ligament —^Y^UVS

C. Anterior cruciate ligament D. Posterior cruciate ligament

Theme: Treatment of vision loss

Options

A. Pan retinal photo coagulation G. Physiotherapy B. B complex vitamins H. Spectacles C. Pilocarpine eye drops I . Analgesics alone D. Corticosteroids J. Surgical extraction of lens E. Peripheral iridectomy K. Pressure over eyeball Y.J Scleral buckling

Instruction: For each of the patient described below choose the single most appropriate treatment from the above list of options. Each may be used once, more than once or not at all.

~\ 26. A 38 year old female presents with sudden loss of vision but fundoscopy is normal. She had a similar episode about 1 year back, which resolved completely within 3 months. On

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examination, she has mild weakness of right upper limb and the reflexes are exaggerated. 27. A 54 year old myopic develop[s flashes of light and then sudden loss of vision. rerc/W c

^ 28. A 65 year old female presents with head ache and loss of vision. Her ESR is markedly elevated. 6cA

29. A 55 year old hypertensive suddenly lost his vision. The retina is pale and fovea appears as a bright cherry red spot.

^ 30. A 55 year old man presents with mild headache. He has changed his spectacles thrice in one year. There is mild cupping present in the disc and sickle shaped scotoma present in both eyes. (Wyaic . ^i&rr&

Theme: Pain in pregnancy

Options:

A. Acute fatty liver of pregnancy

B. Acute pyelonephritis

C. Braxton hicks contractions

D .Cholecystitis

E. Chorioamnionitis

F. HELLP syndrome

G. Labour

Instruction: Each of the following scenario, select the most likely diagnosis. Each option may be used once, more that once or not at all.

_£T 31. A 32 year old woman of 39 weeks of gestation attends the antenatal day unit feeling very ^ unwell with sudden onset epigastric pain associated with nausea and vomiting. Her

temperature is 36.7°C. On examination, she is found to be tender over the right upper quadrant. Her blood results show mild anaemia, low platelets, elevated liver enzymes and haemolysis.

/v 32. A 32 year old woman of 38 weeks of gestation complains of felling unwell with fever, Is, rigors and abdominal pains. The pain was initially located abdomen and was associated with

urinary frequency and dysuria. The pain has now become more generalized specifically radiating to her right loin. She says that she has felt occasional 'uterine tightening'. A CTG is .reassuring.

H. Obstretic cholestasis

I . Placental abruption

J. Round ligament stretching

K. Symphysis pubis dysfunction

L. Urinary tract infection

M . Uterine rupture

& 33. A 32 year old woman para 3 of 39 weeks of gestation reports having had spontaneous ruptureof membranes 4 days, ago. She did not attend the delivery suite, as she knew that would happen and had already decided on a home birth. Today, she feels very hot and sweaty. She thought that she was starting to have labour pains, but she describes the pain as more constant. On examination, her uterus is tender throughout. Blood tests show a raised CRP and white cell count.

^ 34. A 32 year old woman of 40 weeks gestation attends the antenatal day unit with sudden onset epigastric pain with nausea and vomiting. She is clinically jaundiced. Her biochemistry ivfruniH results show a raised bilirubin, abnormal liver enzyme, high uric acid and hypoglycaemia. t^~ipd- iSl ^

^ 35. A 32 year old woman of 38 weeks gestation attends the antenatal day unit with pain in the supra-pubic area that radiates to the upper thighs and perineum. It is worse on walking. Her urine dipstick showed a trace of protein but in white cells, nitrates or blood. nf ^ { j ^ , /

Theme: Haematuria

Option:

A. Benign prostatic hypertrophy G. Schistosomiasis B. Carcinoma of the bladder H. Trauma to the kidney C. Cystitis I . Tuberculosis of the kidney D. Hypernephroma J. Ureteric calculus E. Polycystic kidney disease K. Wilm's tumour F. Renal calculus

Instruction : For each of the following presentations, choose the single most likely cause from the above list of options. Each option may be used once, more than once or not at all.

36. A 60 year old man presents with frank haematuria. He has lived for many years in the Middle East company reveals pseudo-tubercles and sandy patches.

37. A 25 year old woman presents with urinary frequency dysuria and fever. Urine microscopy shows 20-50 red blood cells and 10-20 leucocytes in each field.

38. A 70 year old man presents with severe, right sided colicky loin pain radiating towards the inguinal region. Urine microscopy shows 50-100 red blood cells in each field.

39. A 40 year old man presents with haematuria. On examination both his kidneys are easily palpable and non tender and his blood pressure is 190/1 lOmmHg. His father had the same symptoms and died at the age of 55 years.

40. A 65 year old man complains of haematuria frequency, hesitancy and nocturia. He reports that one certain occasion he finds it difficult to control the urge to pass urine. Urine microscopy confirms the presence of blood but shown no other features.

SINGLE BEST ANSWER:

41. A 19 year old man has had fever, neck pain and generalized rash for 12 hours. He is not on any medication. He has a temperature of 39.5°C. He has limitation of neck flexion and no lymphadenopathy. The rash is sparse and mainly on the trunk and looks slightly hemorrhagic, non-blanching on pressure.

What is the SINGLE most likely diagnosis?

A. Henoch-Schonlein purpura B. Measles C. Idiopathic thrombocytopenic purpura (ITP)

LyMeningitis —> LI u i n i ^ X l V ^ M ' l E. Chickenpox frtto^CCoJ^"*** ~9 ^

Theme: Treatment of dysphagia

Options:

A. Antifungal therapy B. Incision and drainage C. Endoscopic diverticulectomy D. External excision of pharyngeal pouch E. Reassurance F. Nasogastric intubation G. Intravenous antibiotic and analgesia H. Antispasmodics I . Dilatation of the lower oesophageal sphincter J. H2- receptor antagonists

Instruction : For each case below, choose the SINGLE most appropriate treatment from the above list of options. Each option may be used once, more than once or not at all.

T 42. A 50 year old man complains of dysphagia after eating bread. Barium swallow reveals a lower oesophageal ring, ^fihabzfcf axy

A 43. A 40 year old woman on chemotherapy for metastatic breast carcinoma now presents with painful swallowing. On examination she has white plaques on top of friable mucosa in her mouth and more seen on oesophagoscopy. c^mAjc&'-t^

44. A 20 year old man presents with painful swallowing. On examination he has trismus and unilateral enlargement of his tonsils. The peri-tonsilar region is red, inflamed and swollen. Q vi^^\

. ^ 45. A 40 year old woman presents with dysphagia. On examination she is febrile with neck ' tf7x> 1 ^ erythema and a middle neck swelling. J> j^oa S&xp^&igaJ

-- j - 46. A 40 year old woman complains of dysphagia for both solids and liquids. She sometimes suffers from severe retrosternal chest pain; Bariums swallow reveals a dilated oesophagus which tapers to a fine distal end. ^ i d ^ t f u ^


47. A 46 year old man is being investigated for indigestion. Jejunal biopsy shows deposition of macrophages containing PAS - positive granules. What is the most likely diagnosis?

A. Bacterial overgrowth $y\cvtfob»L i ^ c h ^ l

B. Coeliac disease

C. Tropical sprue

D/Whipple's disease

E. Small bowel lymphoma

SINGLE BEST ANSWER:

48. A 42 years old man has been tired and sleepy for the last few weeks in the morning. His work has started being affected as he feels sleepy in the meeting. His body mass index (BMI) is 36kg/m


A. Idiopathic hypersomnia B. Narcolepsy

Chest hyperventilation syndrome Obstructive sleep apnoea syndrome

E. REM- related sleep disorder

Theme : Disease of the ear

Options:

A. Acute mastoiditis H. Herpes zoster infection B. Acute otitis externa I . Mumps C. Acute otitis media J. Oro- pharyngeal malignancy D. Cholesteatoma K. Otitis media with infusion E. Dental abscess L. Perforated tympanic membrane F. Ear wax M . Tosilitis G. Foreign body

Instruction: For each child described below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

49. A four years old boy, who previously had normal hearing, has mild earache relieved by paracetamol. He has been noticed to turn up the volume on the television. He has bilateral dull tympanic membranes. His pre-school hearing test shows symmetrical loss at 40 db. t] U/t

50. A 17 year old man has acute pain and earache on the right side of his face. He has a temperature of 38.4° C and has extensive pre- auricular swelling on the right, tender on palpation bilaterally.

51. A 68 year old woman has a sudden onset of pain in her left ear, loss of hearing on the left ear and unsteadiness when walking. There are small lesions visible on her palate and left external auditory meatus. Qs&JV-m K v ^ . o-\

52. A 75 year old man has left- sided earache and discomfort when he swallows. There is ulceration at the back of his tongue and he has a palpable non- tender cervical mass.

Theme : Genetic disorders

Options:

A. 45X0 B. 47XXX C. 4 7 X X Y k l ^ j e U ^ r ' i D. 47XY(13) fda^ ' E. 47XY(18) ( f iord ' s F. 47XY(21) G. 69XXY H. Fragile X syndrome

Instrcutions: For each of the following scenarios, select the most likely karyotype. Each option may be used once, more than once or not at all.

53. You are performing the postnatal check on a 3 day old girl. She has swollen hands and feet, and you find it difficult to palpate her femoral pulses.

54. You are asked to see a 1 hour old baby. He is dysmorphic, with a small chin and low-set ears. He also has a small head and rocket- bottom feet.

55. A 15 year old boy presents to the general pediatrics clinic. He and his family are concerned as he has not entered puberty yet. He is tall for his age and has small, firm tests. He is a shy boy and has some behavioural problems at school.

ffivcO 56. You are asked to see a 1 hour-old baby. He is dysmorphic with a round face. On examination you notice that he is very floppy.

57. A 5 year old boy presents to the outpatient clinic. He has learning difficulties, a large head and large testiclg.s. He has quite a characteristic facial appearance, with a prominent forehead and large ears . U 1 - ^ ^fiXx)


58. A retired ship worker has pleural effusion and pleural thickening on right side with bilateral lung shadowing. What would you do to improve his symptoms?

A. Aspiration. (By Chest drain . C. Chemotherapy C. Diuretic


59. Which single drug is unlikely to cause depression as a side effect?

^ A: Amoxicillin

B. Digoxin

C. Haloperidol

D. Indomethacin

E. Prednisolone


60. A 76 year old woman on paroxetine has increasingly become weak and confused. What the single most likely reason for her confusion?

A. Hypercalcaemia

B. H>"pematraemia

C. Hypocalcaemia

D. Hypoglycaemia

E. Hyponatraemia

SINGLE BEST ANSWER:

61. An 83 year old woman who is resident in a nursing home is admitted to hospital with a four history of diarrhoea. She has had no weight loss or change in appetite. She has been on analgesics for three weeks for her back pain. She is in obvious discomfort. On rectal examination, she is found to have fecal impaction.

What is the SINGLE most appropriate irnmediate management?

A. Codeine phosphate for pain relief B. High fibre diet C. Oral laxative

E. Urinary catheterization

SINGLE BEST ANSWER:

62. A 35 year old woman has had brusing and petechiae for one week. She has also had recent menorrhagia but is otherwise well. A blood count shows:

Haemoglobin (Hb) 11. lg/dl ^

White blood cell (WBC) 6.3 X10 9 L (normal differential) .-«, UOUWWJK i

Platelets 14 X 109L j

What is SINGLE most likely diagnosis?

A. Actue leukaemia B. Aplastic anaemia C. Human immunodeficiency (HIV) infection

(D) Idiopathic thrombocytopaenic purpura E. Systemic lupus erythematosus(SLE)

Theme: Diagnosis of sore throat

Options:

A. Diphtheria B. Infectious mononucleosis C. Acute follicular tonsillitis D. Scarlet fever E. HIV F. Agranulocytosis G. Acute otitis media

Instruction: For each patient described below, choose the SINGLE most relevant diagnosis from the above list of options. Each option may be used once, more than once or not at all.

63. A 5 year old child complains of sore throat and earache. He is pyrexial. On examination tonsils are enlarged and hyperemic exude pus pressed upon.

64 A 25 year old man presents with severe malaise and sore throat. He has red tonsils with yellow membranes and enlarged lymph nodes on the neck.

65. A 30 year old man presents in Accident and Emergency department with difficulty in breathing. He has returned from India. Recently examination of his throat revealed grey membranes on the tonsils and uvula. He has mild pyrexia.

66. A 7 years old girl presents to her GP with sore throat, a punctuate erythematosus rash and circum-oral pallor.

1

SINGLE BEST ANSWER:

67. A child recovered from meningitis. What investigation wil l you do before discharge?

A. CT scan. B. EEG. C. Blood culture. D. Repeat lumbar puncture.

(jB^Ffearing test 10 cM ctf ^.•.< <

SINGLE BEST ANSWER:

68. A 75 years old man complaining of dripping incontinence and has an ammonia smell. On examination he has furred tongue & has a painless abdominal mass which extends to the umbilical level. Urine analysis shows proteins ++ & nitrates + & no growth.

What is the most appropriate management for this patient?

A. Suprapubic catheterization ^ ifl f^X fm&*L / jcU«i * i>W~: ' r b

B. Trimethoprim (c) Intraurethral catheterization

D. Condom catheter E. Laparotomy

Theme: Pelvic pain

Options:

A. Pelvic inflammatory disease B. Endometriosis C. Ectopic pregnancy D. Miscarriage E. Inflammatory bowel disease F. Diverticulosis G. Irritable bowel disease H. Pelvic congestion syndrome I . Adenomyosis

Instruction: For each presentation described below choose the Single most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

> 69. A 28 year old woman complains of chronic cyclic_pelvic pain. On taking history it is revealed that she has been trying to conceive since she was 17 and her periods are heavy.

f\. A 25 year old lady complains of chronic pelvic pain and infertility. She has changed three sexualpartners in one year.

^ 71. A 30 year old lady complains of irrtermittent diarrhoea, chronic abdominal pain and jtenesmus.jSometimes she notices^looînher stools?

Ij 72. A 45 year old waitress complains of pelvic pain which WOTênspre-inensfaTaally and on standing and walking. She also complains of post -coital ache, bc*^ wf U'-W feh/jfC V'eor - KA-J -f^h^J

73. A 35 year old lady who has been using IUCD for one year now complains of pelvic pain andheavyjainMperiods. ~ U , j f ( ^ , K ,uM ^ k p l i h j t ^ ^ ^ c ^ x .

Diagnostic tests for headache relating to eye problem

Options:

A. Colour vision test B. Computed tomography (CT) scan of the brain C. Electroencephalogram (EEG) D. Erythrocyte sedimentation rate (ESR) E. Full blood count F. Intra- ocular pressure measurement G. Serum urea and electrolyte concentration H. Visual acuity assessment I . Visual field mapping

Instructions: For each patient described below, choose the SINGLE most appropriate initial test from the above list of options. Each option may be used once, more than once or not at all.

74. A 76 year old woman presents with symptoms of feeling generally unwell and anorexia with weight loss. She complains of sudden loss of vision in her left eye. On the left side the papillary light reaction is sluggish. Qc A C^f-ui

|^ 75. A 40 year old woman presents with sudden onset of severe occipital headache, photophobia and vomiting. £f\\\

j - ^ 76. A 22 year old woman complains of afternoon headache which have progressively worsened. She works as a visual display and (VDU)j)perator. < > JYUch v) tQfp&T

.L7 77. A 72 year old woman presents with tunnel and severe headache, nausea and vomiting of recent onset. She has noticed coloured haloes for six months. cXîc-taP'

p 78. A 27 year old woman presents with severe morning headache for two months. Full neurological examination is normal apart from bilateral papilledema. Her blood pressure is 120/70 mmHg. B iÛ mc^f^j U & M '

79. A two year old boy has been unable to bear weight since a fall from a chair the previous night. He is tender over the mid-tibia but there is no obvious limb deformity.

What is SINGLE most likely radiographic appearance?

A. Angulated fracture B. Compound fracture C. Epiphyseal fracture D. No fracture likely

^R) Spiral fracture

Theme: Diagnosis of jaundice in childhood

Options:

A. Alpha 1 - antitrypsin deficiency G. Glucose-6-phosphate dehydrogenase deficiency

(G6PD) B. Biliary atresia H. Hepatitis A infection C. Breast milk jaundice I . Hypothyroidism D. Congenital sphercytosis J. Physiological jaundice E. Congenital viral infection K. Rhesus hemolytic disease F. Galactosaemia L. Urinary tract infection

Instructions: For each patient described below, choose the Single most likely diagnosis from the above list of options, each option may be used once, more than once, or not at all.

80. A previously well 10 year old girl presents with a two day history of nausea, anorexia, low grade fever and loose stools. She has yellow sclera and is tender in the right upper quadrant on abdominal palpation.

81. At birth a baby boy at 38 weeks gestation weighs 1.8 kg. He has hepato-splenomegaly and a rash. Blood tests show raised level of bilirubin and liver enzymes.

82. A baby girl on the post natal ward becomes progressively more jaundiced and pale. A cord blood tested at birth shows Coomb's test positive. £ V\^ toU^j

83. A six week old formula fed baby_boy is found at child health surveillance to be deeply jaundiced. His weight gain is poor and his stools are pale. Yj&s*nj (XMZK-^

84. An eight week old baby boy is noted to be jaundiced. He is breastfeeding well and has gained 3OOg from birth. His stools are yellow and his urine is pale straw coloured. ^fM^

SINGLE BEST ANSWER:

85. A 57 year old man presents with pain in his right knee. An X-ray shows Osteoarthritis. He has no past medical history of note. What is the most suitable treatment option for the management of his pain?

A. Diclofenac with Omeprazole

B. Co-codamol (30/500)

C. Diclofenac

D. Ibuprofen

Paracetamol 1 toc&ti&

SINGLE BEST ANSWER:

86. What is the most appropriate antibiotic to treat uncomplicated Chlamydia infection in a 21 year old female who is not pregnant?

A Erythromycin cuw^ ' lU/! *~ 'if W ff^^LM

B. Ciprofloxacin

C. Metronidazole

D. Cefixime

^EyDoxycycline

SINGLE BEST ANSWER:

87. For patient with Parkinson's disease, which one of following drugs is most useful in the management of tremor?

A. Apomorphine

B. Cabergoline

C. Selegiline

D. Amantadine

^E\Benzhexol

SINGLE BEST ANSWER:

88. A 60 year old man presents with increasing forgetfulness poor sleep, loss of interest. He shows psychomotor retardation and answers every question with T don't know'

What single diagnosis explains his condition?

[A/ Depression B. Dementia C. Bipolar affective disorder D. Normal aging process E. Panic disorder

Theme: Investigations for Pulmonary Conditions in Children

Options A. Barium swallow I . No investigation needed B. Bronchial lavage J. Peak flow rate diary C. Capillary blood gases K. Per nasal swab D. Chest x-ray L. Pulse oximetry E. CT scan of the chest M. Spirometry F. Exercise challenge N . Sputum culture G. MRI of the chest O. Sweat test H. Mantoux test

Instruction: For each child described below, choose the SINGLE mojtap^opnate investigation from the above list of options. Each option may be used once, more than once or not at all.

89. An eight year old boy has longstanding asthma. He has been admitted with a severe episode and is tired and drowsy. He has not improved on Oxygen, inhaled Beta 2 Agonists and Intravenous (IV) Hydrocortisone. A chest x-ray shows bilateral hyperinflation. He is too breathless to use a peak flow meter and his oxygen saturation is below 90% on Oxygen. , \ ^ ' \

90. A 10 year old boy takes regular high dose inhaled steroids for his longstanding asthma has been advised to use bronchodilators to control acute attacks. His parents are unsure when should he use his bronchodilator inhaler. j v x W ; utfydiT

91. A six year old girl has had two short episodes of cough and wheeze over the last 12 months. These two acute episodes responded quickly to bronchodilator, she has no symptoms or abnormal physical signs. She has slight eczema and her mother has asthma. (<i rftk.^ ^ M ^

92. A 14 year old boy with asthma suddenly developed chest pain and increasing breathlessness during a game of football. When seen in the Emergency Department not cyanosed. He has reduced breath sounds on the right side. His oxygen saturation is 94% on air.

SINGLE BEST ANSWER:

93. A child complains of right iliac fossa, pain and diarrhoea. On colonoscopy, granular transmural ulcers are seen near ilecoecal junction. What should be the management? v

Sulfasalazine

B. Paracetamol

C. Ibuprofen

D. Metronidazole

Diagnosis of scrotal swelling

Options

A. Epididymal cyst B. Epididymo-orchitis C. Hydrocele D. Inguinal hernia E. Scrotal abscess F. Sebaceous cyst of scrotum G. Testicular hematoma H. Testicular neoplasm I . Torsion of testis

Instruction : From each patient described below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

^ 94. A 70 year old man has had a painful swelling of his right testis for 36 hours. He has a history of dysuria and frequency of micturation and has a of temperature of38°C.

^ 95. A 25 year old man has had painless enlargement of his left testis for three months. The „ v ^ left testis is three times the size of the right testis and in non-taider.- ^ ^ ^ w 'M U S i 6

96. A 39 year old man had a painless_soft 1 cm swelling near the upper pole of his right testis for six months.

97. A 4 year old boy has had one hour of severe right testicular pain of sudden onsets

Theme : Overdose

Options

A. B. C. D.

Amphetamines Aspirin Cannabis Carbon monoxide

E. F. G. H.

Cocaine Organophosphate insecticides Theophyline Tricyclic antidepressants

Instruction : For each patient described below, choose the single most likely agent from the above list of options. Each option may be used once, more than once or not at all.

98. A 26 year old man changed his job from a labourer to a paint tWpppr About two months to his job he went to his GP complaining of recurrent bouts of headache and mild exertional dyspnoea. The GP diagnosed a viral illness. However, his condition did not improve and during the next two months his symptoms gradually became worse. He was brought to the hospital with generalized tonic- clonic convulsion which was followed by cardio respiratory arrest.

99. A 66 year old man with known asthma was brought to the hospital with nausea and vomiting and a single episode of haematemesis. He also complained of central abdominal pain and diarrhoea. His ECG shows supra-ventricular tachycardia at 150 beats per minute. Blood tests show hypokalaemia and acidosis.

100. A 56 year old farmer was brought in to the hospital with nausea, vomiting, abdominal colic and diarrhoea. He also complained of chest tightness. Examination of the eyes showed miosis. A diagnosis has been confirmed be measuring erythrocyte acetycholinesterase activity.

101. A 26^y^ar_okTw^man presented with hyperventilation, sweating, nausea, vomiting and abdominal pain. Blood gas analysis shows mixed acid base disturbances with respiratory alkalosis and metabolic acidosis.

Acute trauma life support:

Options

A. B. C. D. E.

Guedel airway Intubation Needle thoracocenthesis

Chest drain insertion ECG

F. G. H. I . J.

Pericardio-centhesis Secondary survey Thomas splint Trauma X-ray series Two wide bore cannulas and IV fluids

Instruction : For each patient described below, choose the SINGLE most appropriate management from the above list of options. Each option may be used once, more than once or not at all.

102. A 20 year old woman has been brought to the resuscitation room after being involved in high speed RTA. Her airways and her breathing are clear. She raised JVP, hypotension and muffled heart sounds.

103. A 57 year old man fell from his roof while installing an antenna and landed on his head. His GCS score is 7.

104. A 17 year old boy is brought to the A&E after a motor bike accident in which he injured his right tibia. His airways and breathing are clear and his observations are stable.

105. A 34 year old man presents A&E following RTA. His breathing is laboured and you can hear a moaning sound, even after chin lift and jaw thrust. '

106. A 54 year old man presents with cyanosis and breathlessness following a RTA. Chest percussion in hyper resonant.

Theme: Anatomical land marks

Options:

-Superficial- inguinal ring A. Apex beat G. -Superficial- inguinal ring B. Chest-drain insertion H. Termination of the spinal cord C. Femoral artery pulse is felt I . Transpyloric plane D. Fundus of the fall bladder J. Vena caval opening in to the diaphragm E. McBurney's point F. Stellate ganglion

Instructions: For each of locations described below choose the Single most appropriate land mark form the list of options above. Each option maybe used once, more than once or not at all.

107. L I level. - ; ' ' *

108. Midpoint between the supra-sternal notch and pubic symphysis. <•

109. Tip of the ninth costal cartilage. • '•<.

110. Just above the mid-inguinal point.

111. Fifth intercostal space in the anterior axillary line, A-v u v

S I N G L E BEST ANSWER:

112. A 62 year old man who was admitted for minor surgery three days ago suddenly recedes conf jsed. His attention span is reduced. He is restless and physically aggressive and ricks ar Ms bed sheets.

Wzs: SINGLE aspect of the patient's history recovered in his notes is most likely to aid in —-<r-? a diagnosis?

Ay Alcohol consumption — 1 * B. Head trauma C. History of anxiety D. Prescribed medication E. Obvious cognitive impairment

SINGLE BEST ANSWER:

113. A 34 year old man with multiple sclerosis has taken an overdose of 100 tablets of paracetamol with intent to end his life. He has been brought to the Emergency department of treatment but is refusing all interventions.

A. Assessment of suicide (JS)Evaluate patient's capacity to refuse treatment

C. Establish i f patient has a previous mental illness

SINGLE BEST ANSWER:

114. A 45 year old man underwent emergency splenectomy following a fall from his bicycle. He smokes five cigarettes a day. Post -operatively despite mobile, he developed swinging pyrexia and a swollen painful left calf. His chest x-ray shows lungs atelectasis and abdominal ultra-sonography demonstrates a small sub-phrenic collection.

What is the SINGLE most likely risk factor for deep vein thrombosis in the patient? . ;* !

A. Immobility , \„ r , B. Intraperitoneal hemorrhage , ., ;

C. Smoking . v ^ (_L\ Splenoctomy

E. Sub-phrenic collection

j Theme: Skin lesion

Options :

A. Psoriasis

B. Basal cell Ca

C. Lichen planus

D. Venous Ulcer

E. Bed Sore

F. Bullous Phemphigoid Instructions: For each of locations described below choose the Single most appropriate land mark form the list of options above. Each option maybe used once, more than once or not at all.

C- 115. Flexor papules and white thread in the mouth - ' ' , +~116. An old man has itching and tense blisters f 117. A young lady has a scaly rash on her head and her extensors, her aunt has the same rash. % 118. A 60 year old man has a lesion with pearly edge on his face.

119. A ulcer on medial maleolus with loss of hair & shiny skin on lower limps.

. ft'--

• (

Theme : Obesity

Options:

A. Acquired hypothyroidism B. Addision's disease C. Bulimia nervosa D . Congenital hypothyroidism E. Cushing's disease F. Cushing's syndrome G .Hyper-insulinaemia secondary to diabetes

H. Lawrence-moon-biedl syndrome I . Obesity secondary to behavioural disorder J. Ploycystic ovarian syndrome K. Prader-willi syndrome L. Primary obesity M . Tricyclic antidepressant use

Instruction : For each of the following patients who are clinically obese, select the most likely diagnosis. Each option may be used once, more than once or not at all.

k 120. An 8 year old boy is clinically obese. As a baby, he was floppy and difficult to feed. He now has learning difficulties, and is constantly eating despite measures by his parents to hide food out of reach. f V ' ' e t ' ; ', t, v-' ! ' V'.', (^ ' . ^ ' j f , / ' '^.p^'r^.,.-. 121. A 6 year old boy is clinically obese; his body mass index is above the 95th centile. He has no other medical problems and an examination is unremarkable. His mother says that she has tried everything to help him lose weight. ; ' ; , v -

T 122. A 10 years old boy is clinically obese and the shortest in his class. He had a renal transplant last year and his mother is worried that he is being bullied.

A 123.A 17 year old girl is clinically obese. She has put a lot of weight on over the last year. She says that she is always tired and is becoming more constipated, jJ.-1

^ 124. A 14 year old girl is clinically obese. She has not started her periods yet and has severe ^ acne. Among her investigations, a high insulin level is found.

Theme : Hearing difficulty

Options:

A. Encephalopathy B. Chronic perforation of tympanic

membrane C> Chronic secretory otitis media'';

\yith effusion ... y D. Congenital sensori neural deficit E. Cytomegalo virus (CMV) infection F. Functional hearing loss

G. Tympano-sclerosis H. Otosclerosis

I . Post meningococcal neural deficit

J. Presbycusis K. Syndromic deafness

Instructions: For each hearing assessment described below, choose the most likely diagnosis from the above list of options. Each option may be used once, more than once, or not at all.

| • 125. A 26 year old woman has become aware of increasing right - sided hearing deficiency '• since her recent pregnancy. Her eardrums are normal. Her hearing tests show:

Bone conduction normal Weber test lateralizes to the right ear.

^ 126. A 32 year old man cannot hear in his left ear following recovery from a motor vehicle collision in which he sustained a left parietal fracture and whiplash associated disorder. Her hearing tests shows air conduction and bone conduction thresholds symmetrically reduced greater than 90% | A ; : - ; : * - , Weber test lateralizes to the right ear. > • ' • • ' 1 ~c • '

127. A 10 year old girl has been referred for assessment of hearing as she difficulty hearing her teacher in class. Her hearing tests show: /•:_., c .„ , Bone conduction normal ' * ;

Symmetrical air conduction thresholds reduced bilaterally _ Weber test shows no lateralization. -

128. A 59 year old man has had increasing conversational difficulties because of background noise. His eardrums are normal in appearance. His hearing tests show: Bone conduction and air conduction thresholds equally reduced in both ears. Weber test shows no lateralization.

Theme : Antenatal diagnosis of children with potential congenital abnormalities

Options:

A. Aminocenthesis B. Chorionic villus sampling (CVS) C. Chorionic and DNA studies of

both parents D. Fetal cordo-centhesis

protein S (PAPP-A) E. Genotyping fetal cell in

maternal circulation F. Maternal serum alpha-fetoprotien

G. Pre-implantation genetic screening H. Serum anti - D titers I . Serum creatinine kinase.(CK)

J. Serum pregnancy associated plasma

K. Ultra sound scan at 12 weeks gestation L. Ultrasound scan at 18-20 week gestation

Instruction: For each disorder described below, choose the SINGLE most useful test from the above list of options. Each option may be used once, more than once or not at all.

129. A 27 year old woman who is eight week pregnant asks for a test on her unborn baby possible skeletal dysplasia. Her first baby died shortly after birth with short-limb dwarfism.

130. A couple attend to discuss risks of cystic fibrosis (CF) in their future pregnancy because of family history of CF on the maternal side.

131. The mother of a child with Duchene muscular dystrophy plans to become pregnant in the near future. She enquires about the earliest test to identify i f the fetus of a future pregnancy would be affected.

132. A 20 year old woman is 17 weeks pregnant. She is worried about the possibility of her baby with spina- bifida as she did not take folic acid supplement before conception and in early pregnancy.

133. A 29 year old woman reports that her partner's father has recently been diagnosed as Huntington chorea. She wants to know what diagnostic test would be certain to avoid problem in a future child.

Theme : Diagnostic tests for patients presenting with chest pain

Options:

A. Abdominal ultrasound B. Blood culture C. Bronchoscopy D. Cardiac enzymes E. CXR F. CT scan G. ECG H. FBC I . LP J. Oesophago-gastro-duodenoscopy (OGD) K. V/Qscan

Instruction: For each patient described below, choose the single next most appropriate test from the above list of options. Each option may be used once, more than once or not at all.

134. A 68 year old man has had malaise for five days and fever for two days. He has cough and there is dullness to percussion at the left lung base. .. . .

135. A 50 year old woman returned by air to the UK from Australia. Three days later she p/w sharp chest pain and breathlessness. Her CXR and ECG are normal.

136. A tall, thin, young man has sudden pain in the chest and becomes breathless while crying.

137. A 45 year old manual worker p/w a two hour h/o chest pain radiating into his left arm. His ECG is normal. < * -

138. A 52 year old obese man has been having episodic anterior chest pain particularly at night for three weeks.

SINGLE BEST ANSWER:

139. A middle aged man presents with splenomegaly, hepatomegaly, bleeding and more prone to infections. He has a very high leukocyte count (mainly neutrophils).

What is the most likely diagnosis? ' ~~

A. A M L B. ALL C. Aplastic anaemia , "

( rx )CML E. CLL

Theme: Later complications of HIV infections

Options:

A. Kaposi's sarcoma G. Candida infection B. Molluscum contagiosum ' ' H. Pneumocystiscarinii infection C. Hairy leukoplakia f'^ ,-; I . Cryptociccal infection ^/^I'wkHtflfe D. Tuberculosis " ' j > * ' ' J. Toxoplasma abscess ^ .vf""^ E. Cryptosporidium po^HrT^wi ^V^ji- K. AIDS dementia F. CMV infection ^ ^ V ^ ^ ^ ^

Instruction: For each patient described below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

140. A patient presents with progressive visual deterioration. On examination there are large, multiple fcotton wools spots)in both eyes,.

141. A patient presents with gradual onset of headache, neck stiffness, photophobia and fluctuating level of consciousness. CSF shows a lymphocytosis but no organisms on gram stain. CT brain is normal. <•-,•. , >. <

142. A patient presents with purple popular lesions on his face and upper trunk measuring one to two centimetres across. They are not painful or itchy.

^ 143. A patient presents with dysphagia and pain on swallowing. He has a sore mouth and soreness in the corners of the mouth.

\. A patient presents with fever, dry cough and breathlessness. He is tachypnoeic but chest is clear on examination. Oxygen saturation is normal at rest but drops on exercise.

Theme : Initial Investigations In Women's Health

Options:

A. Cervical smear B. DEXA scan(dual energy x ray)

absorptiometry) C. High vaginal swab (HVS) J.

H. Serum estradiol concentration I . Serum follicle stimulating

hormone/Leuteninsing hormones Serum haemoglobin (Hb) concentration

D. E. F.

Lumbar spine x- ray Mammogram No investigation

K. L. M .

Serum progesterone concentration Thyroid function tests Transvaginal ultrasound scan

Instructions: For each patient described below, choose the SINGLE most appropriate initial investigation from the above list of options. Each option may be used once, more than once or not at all.

145. A 39 year old woman has not had a period for 10 months. She feels well but is anxious as her mother had an early menopause.

146. A 65 year old woman under long term follow up after a lumpectomy and anti -oestrogen therapy for breast cancer attends following a diagnosis of stress fracture in a metatarsal bone.

147. A 64 year old woman has been on hormone replacement therapy (HRT) for nine years. She had regular withdrawal bleeds until three years ago and since then has been taking a no bleed preparation. Recently she noticed a brown vaginal discharge.

148. A 48 year old nulliparous woman feels tiered all the time. Her periods are regular but have always lasted for at least 10 days, :v> •:• '

Theme : Acute Abdomen

Option:

A. Ovarian cancer J. Ovarian torsion B. Appendicitis K. Pelvic congestion syndrome C. Cervicitis L. Pelvic inflammatory disease D. Crohn's disease M . Tubal(ectopic) pregnancy E. Diverticular disease N. Uterine fibroid F. Endometriosis 0. Utero-vaginal prolapse G. Genital herpes infection P. Vaginal moniliasis (thrush) H. Irritable bowel syndrome

Instruction: For each patient described below, choose the single most appropriate conditions from the above list of options. Each option may be used once, more than once or not at all.

M 149. A 24 year old woman has eight weeks amenorrhoea, right sided pelvic pain and vaginal bleeding. She is apyrexial. Peritonism is elicited in the right iliac fossa. Vaginal examination reveals right-sided cervical excitation.

XJ~ 150. A 28 year old nulliparous woman has had secondary dymenorrhoea and deep dysparunia for 10 months. There is restricted mobility of her uterus with some tender nodules in the utero-sacral ligaments.

x \. A 25 year old woman has had generalized pelvic discomfort from the last years, ' * particularly after sexual intercourse. She has some intermittent loose motion. Examination

and ultrasound scan show normal pelvic organs.

152. A 27 year old woman has pelvic pain, dysmenorrhea and increasingly heavy periods. , v ^ y ^ ^ She has a six year history of involuntary infertility in three partnerships. Her current partner ^ c

has three young children. There is generalized pelvic tenderness without peritonism. Pelvic^'T^ \yû{v'l ultrasound scan is reported as normal. ^ [jûil f fzkii iKjwf ^> <Shdfv °{ # W f < "^^fe^ t t?

153. A 25 year old woman who is 11 weeks pregnant had central abdominal pain for 36 hours .The pain is now colicky. There is no vaginal bleeding. She has vomited once and an episode of loose motions. She looks i l l , has a temperature of 37.8 °C and there is rebound tenderness in the right iliac fossa.

^ SINGLE BEST ANSWER: -^XtÂS :

154. Which one of the following is not a degenerative corneal disease?

A. Band Keratopathy

B. Marginal Dystropathy

C. Fatty or lipoid degeneration

D)MooreH'5 Ulcer - ^ ) « ^ ! X ^ ^ l ^

E. Keratconus

SINGLE BEST ANSWER:

155. An 18 month old boy has been brought of the Emergency department because he has been refusing to move his left arm and crying more than usual for the past 24 hours. He has recently been looked after by his mother's new boy friend while she attends college. Assessment shows multiple bruises and a fracture of left humerus, which is put in plaster.

What is the SINGLE most appropriate next step?

Admit under care of pediatrician —-j b^1 J ^ ••' U^^S*^)X^S

B. Discharge with painkiller C. Follow up in fracture clinic D. Follow up in paediatric outpatients E. Follow up with general practitioner (GP)

Theme : Immunization in children

Options:

A. Defer immunization for two weeks B. Do not give vaccine C. Give half dose of vaccine D. Give paracetamol with future doses of the same vaccine E. Give simultaneous gamma globulin F. Give vaccine as separate Components G. Give vaccine in hospital H. Immunize other household members I . Proceed with standard immunization schedule

Instruction: For each child described below, choose the SINGLE most appropriate actionfrom the above list of options. Each options may be used once, more than once or not at all.

" f 156. A three- month old baby was miserable and cried for two hours following his first routine immunization with diphtheria, tetanus, polio, Haemophilus influenza- B (HiB) and meningitis.

A 157. A fifteen month old child is due his measles, mumps and rubella (MMR) vaccine. There is a family history of egg allergy. He is febrile, with acute otits media.

^ 158. A two - month child is due to have her first immunization with diphtheria. Polio, tetanus, Homophelies influenza - B (HiB) and meningitis. There is a family history of epilepsy.

pL 159. A twelve- month old child with acquired immunodeficiency syndrome (AIDS) is due for his measles, mumps, and rubella (MMR) vaccination.^ Wtru/x.

SINGLE BEST ANSWER:

160. A 72 year old woman is reviewed following course of oral flucloxacillin for right lower limb cellulitis. The local protocol suggests oral Clindamycin should be used next line. i i , „

Which one of the following side effects is it most important to warn her about? , u l . ' u A * , - / •] .J

A. Heart burn or indigestion

B. Jaundice

C. Sore throat, bruising or lethargy

D. Avoid any food or drink containing alcohol

E. Diarrhoea

SINGLE BEST ANSWER:

161. A 67 year old man has deteriorating vision in his left eyes. He has longstanding chronic obstructive pulmonary disease (COPD) and is on multiple drug therapy, r,^ ^ , _

What SINGLE medication is most likely to be responsible for his visual deterioration? ; '

A. Beta2 agonist (a. Corticosteroid TJ. Diuretic D. Oxygen E. Theophyline


162. A 22 year old man has rushed into A & E asking for help. He describes recurrent episodes of fearfulness, palpitations, faintness, hyperventilation, dryness of the mouth with peri-oral tingling & cramping of the hands. His symptoms last 5 to 10 mins & have worsened since their onset 3 months ago. He is worried he may be having heart attack. An ECG shows sinus tachycardia (lOObeats/ min) '

What is the SINGLE appropriate immediate intervention?

A. High flow oxygen B. Intravenous (IV) sedation

(Cy> Re-breathe into a paper bag D. Refer for anxiety management course E. Refer for urgent cardiology opinion

SINGLE BEST ANSWER:

163. A 28 year old man believes that each time the traffic lights changes from amber to red means that his mother needs to see his urgently, and return home. He has slept for two hours in the last two days and eats very little. He believes that his thought are being taken out of his head and made available to people n vicinity.


A. Depressive disorder B. Generalized anxiety disorder C. Manic disorder

D. Obsessive compulsive neurosis \E.y Schizophrenia

Theme : Diagnosis of central chest pain

Options:

A. Achalasia I . Pericarditis B. Angina J. Pneumonia C. Anxiety K. Pneumothorax D. Contochonditis( Tietz's disease) L. Pulmonary embolism E. Dissecting aneurysm M . Rib fracture F. Gall stone colic G. Hiatus hernia H. Myocardial infraction

Instructions: For each patient described below, choose the single most likely diagnosis from the above list of option, each option may be used once, more than once, or not at all.

.. / 164. A tall 35 year old man suddenly develops acute localized left sided anterior chest pain * with breathlessness whilst walking along the street.

165. A 55 year old woman with a persistent cough and history of smoking develops left sided chest pain exacerbated by deep breathing with fever and localized crackles.

166. A 50 year old man with diabetes suddenly develops persistent crushing central chest pain radiating to the neck.

167. A 35 year old woman taking the combined oral contraceptive pill has a sudden onset of central chest pain and presents to the A&E department hypotensive and cyanosed with a raised jugular venous pressure(JVP).

168. A 48 year old man develops central chest pain over two or three days which is affected by posture and associated with a pericardial friction run and inverted T waves widely spread through the electrocardiogram (ECG).

SINGLE BEST ANSWER:

169. A 45 year old woman with a history of rheumatoid arthritis presents to the Accident and Emergency department with a two day history of a hot, painful, swollen right elbow joint.

What is the most appropriate management?

^ ) Joint aspiration ^s^dr^j e ^ V M f ^ '

B. Start infliximab

C. Oral high dose

D. Short course of methotrexate

E. Depomederone injection

Theme : Neck lump

Options X4-

A. Carcinoma of larynx ^ B. Carcinoma of lungs C. Carcinoma of the left main bronchus D. Carcinoma of the right main bronchus E. Carcinoma of the thyroid F. Functional dysphonia

G. H. I . J.

K.

Pan coast tumor Myxoedema

Mycobacterium tuberculosis Thyrotoxocosis Vocal card nodular

Instruction: For each patient described below, choose the SINGLE most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

170. A 52 year old woman has had a swelling in the neck, hoarseness and stridor, both inspiratory and expiratory, for two months.

171. A 50 year old man has had hoarseness and dropping eyelid for two months. A mass is palpable in the right supra-clavicular fossa. He smokes 20 cigarettes a day.

172. A 25 year old woman has a recent cough, hoarseness and swelling in the neck. There are several non-tender swellings on both sides of her neck. She has lost 13 kg in weight. She takes recreational drugs.

SINGLE BEST ANSWER:

173. A man has brought to A&E department from a shopping mall after collapsing there. He is consious and answering questions. His ECG shows irregular rhythm. _____

ferry Choice of investigation : A. CT scan B. MRI

' c l 24 hr ECG * ^ ^ D. Echo— .-. j «. | /ncti^) Afrd^r*-'-

Theme: Post-Partum Hemorrhage - Causes

Options

A. Atonic uterus B. Cervical/vaginal trauma C. DIC D. Fibroid uterus E. Large placental site

F. Placenta praeiva G. Retained product H. Rupture uterus I . Uterine infection J. Von willebrand's disease

Instruction: For each woman with postpartum hemorrhage (PPH) described below, choose the single most likely predisposing factor from the above list of options. Each option may be used once, more than once or not at all.

174. A 38 years old woman has delivered after an induced labour which lasted 26 hours.

175. A 28 years old woman has delivered with rotational forceps after an eight hours labours and a three hours second stage.

176. A 32 years old woman had normal vaginal delivery 10 days ago. Her uterus has involuted normally.—^ l o ^ ' c K ^ l fs [Y-GNT coom^ V pfZ-l

177. A 29 years old woman has just delivered still born infant vaginally, following a major placental abruption.

178. A 25 years old woman with type one diabetes has delivered a baby weighting 4.5 kg. Her uterus is well contracted.

Theme : Asthma

Options

A. Barium swallow 1. No investigation needed B. Bronchial lavage J. Peak flow rate diary C. Capillary blood gases K. Per nasal swab D. Chest x-ray L. Pulse oximetry E. CT scan of the chest M . Spirometry F. Exercise challenge N . Sputum culture G. Mantoux test 0. Sweat test

Insturction: For each child described below, choose the SINGLE most appropriate investigation from the above list of options. Each option may be used once, more than once or not at all.

179. An eight year old boy has longstanding asthma. He has been admitted with a severe episode and is tired and drowsy. He has not improved on oxygen, inhaled beta 2 agonists and intravenous(IV) hydro-coristone. A chest x- ray shows bilateral hyperinflation. He is too breathless to use a peak flow meter and his oxygen saturation is below 90% on oxygen.

180. A 10 year old boy takes regular high dose inhaled steroids for his longstanding asthma has been advised to use bronchodilators to control acute attacks. His parents are unsure when should used his bronchodilator inhaler.

181. A six year old girl has had two short episodes of cough and wheeze over the last 12 months. These two acute episodes responded quickly to bronchodilators she has no symptoms or abnormal physical signs. She has slight eczema and her mother has asthma.

182. A 14 year old boy with asthma suddenly developed chest pain and increasing breathlessness during a game of foot ball. When seen in the Emergency department not cyanosed. He has reduced breath sound on the right. His oxygen saturation is 94% in air.


183. A man who is a heavy smoker presents with a long history of breathlessness on exertion and productive cough. His blood gas results are:

P 0 2 : 7.0kPa PC0 2 : 6.5KPa pH : 7.30 . . . w ^ i A * ^

What is the single most appropriate treatment?

A. Aminophyline infusion } . B. Invasive ventilation —? kecCff If ' °i US. ^ x -C. Non invasive ventilation

24% OXYGEN E. 100% O X Y G E N . ,~ .... A . - h l , . ,,\

p

Theme : Scientific basis of speech disorder

Options

A. Brocca's area (Frontal cortex) —? c ~ p < ^ ' B. Facial nerve C. Glossopharyngeal nerve D. Hypoglossal nerve E. Internal capsules F. Phrenic nerve G. Recurrent laryngeal nerve H. Spinal root of accessory nerve I . Thalamus J. Wernicke's area" (temporo-parietal cortex) - >>M,^kc^' < !"U_n>

Instruction: For each patient described below, choose the SINGLE most likely anatomical site to be affected from the above list of options. Each option may be used once, more than once or not at all.

Jy 184. An 82 year old man has woken up with incoherent speech. Examination is otherwise normal and his comprehension is food.

185. A 52 year old man who became hoarse following thyroid surgery one week ago shows X no improvement.

186. A 23 year old man is having difficulty speaking following a stab wound to the right of his neck. On being asked to protrude his tongue, it is noticed that the tip deviates to the right.

187. A 62 year old man who has recently has flu- like illness has woken to find his speech £v altered. Movement of his eyelids and lips are weak on the right side. Examination is

otherwise normal. p ^ f r M U l " ^ w C ^ cc~\im^a Cm,* * j -

^ 188. A 69 year old woman has had a stroke. Her left upper and lower limbs are paralyzed and she is having difficulty speaking."—^ hju>wpl^fu<.

SINGLE BEST ANSWER:

189. A 52 year old man has had left -sided chest pain for one day. It is severe, constant and worse on respiration. He is also short of breath, nausea and feels unwell. He has a body mass index of 27kg/m2 and smokes 15 cigarettes per day. His chest x-ray is normal and he has had a tachycardia on ECG.

What is the SINGLE most likely diagnosis? \ ^$njm*. £C6 ci-^j

A. Acute Coronary syndrome - "y ^- '^(^v! B. Costochondritis

w

C. Gastro- oesophageal reflux disease (GORD) 'Pericarditis Pulmonary embolism , . „ _

( v ,C r6C& Car) be. fytX^db i/} rt>


190. A 58 year old man has dyspnoea, syncope and has lost weight. He is breathless at rest. His blood pressure is 110/60mmHG on standing and 140/80mrnHg on lying. He smokes 30 cigarettes a day. CA

What is the SfNGLE most appropriate initial investigation in establishing a diagnosis?

A) Chest x-ray . Echocardiogram " ' — — r ~ — ^ — '"" "-^Y'J ^ ^'•AJ("UJ

C. ECG D. Pulmonary oedema E. 24-hour ECG


191. A 34 year old man from Zimbabwe is admitted with abdominal pain to the Emergency Department. An abdominal x-ray reveals bladder calcification. What is the most likely cause?

A. Schistosomamansoni ! ( •' { ^ ' M K : (

B. Sarcoidosis

C. Leishmaniasis

D. Tuberculosis

E. /Schistosoma haematobium


192. A 74 year old female presents with headache and neck stiffness to the Emergency Department. Following a lumbar puncture the patient was stated on IV Ceftriaxone. CSF culture grows listeria monocytogenes. What is most appropriate treatment?

A. Add IV Amoxicillin

B. Change to IV amoxicillin + gentamicin

C. Add IV Ciprofloxacin

D. Add IV co Amoxicalv

( 4

E. Continue IV Ceftriaxone as mono-therapy

SINGLE BEST ANSWER:

193. A woman gives a vaginal birth to a boy at term. She has Hepatitis B and is concerned about the risk of transmitting it to her baby.

What is the most appropriate management?

A. Give hepatitis B vaccine B. Hepatitis B anti-body test.

(Tj Hepatitis B vaccine + Hepatitis B Ig D. Hepatitis B Ig only E. Do nothing

Theme: Oral and parotid swellings

Options:

A. ACE inhibitor therapy G. Dietary allergy B. Beta blocker therapy H. HIV disease C. Bulimia nervosa I . Mumps D. CI esterase deficiency J. Nifedipine therapy E. Chronic alcohol use K. Sarcoidosis F. Crohn's disease L. Sjogren's syndrome

Instruction: For each of the following scenarios, choose the most likely diagnosis from the above list of options. Each option may be used once, more than once or not at all.

J ~ 194. A 65- year- old man with hypertension develops gingival hyperplasia. J pnint^xu?

J) 195. An otherwise healthy 13-year-old boy presents with recurrent episodes of facial and tongue swelling and abdominal and abdominal pain. His father has had similar episodes.

196. A 70-year -old woman presents with recurrent episodes of parotid swelling. She complains of difficulty talking and speaking and her eyes feel gritty on waking in the morning.

Q 197. A thin 18 -year-old girl has bilateral parotid swelling with thickened calluses on the dorsum of her hand.

198. A 40-year old man with marked weight loss over the preceding 6 months has bilateral white, vertically corrugated lesion on the lateral, surfaces of the tongue.

•GUrt-j CO) l x i M ^ U t

SINGLE BEST ANSWER:

199. A 70 years old man with few months history of loss of weight and dysphagia presented with sandwich stuck in throat. What is the most appropriate step of the following?

A. Barium meal B. Barium swallow

('CT. Endoscopy (oesophagoscopy) foreign body removal and biopsy V U S G E. Chest X-ray

SINGLE BEST ANSWER:

200. A 50 year old lady with weak limbs when examined was found to have burn marks on linger tips, wasted and weak hands with diminished reflexes. She also has weak spastic legs and dissociated sensory loss.

What is the diagnosis?

A. Multiple sclerosis ,~ , (^,^r-u Lnc<

( B.jSyringomyelia f-k/d (jwi^ ^ K-ftw • « > I T ^ _^ ^

C. Motor neuron disease

D. Guillian barre syndrome

E. Freidriechs ataxia.

mock3 10thmarch comp

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