- A 6yo boy is brought to the hospital for a 3rd episode of sore throat in 1 month. He is found
ďleediŶg fƌoŵ guŵs aŶd Ŷose aŶd has pale ĐoŶjuŶĐtiǀa. What͛s the siŶgle Đell tLJpe?
a. Clumped platelets
b. Microcytes
c. Granulocyte without blast cells
d. Blast cells
e. Mature lymphocytes - A 23yo man has been stabbed in the back and has SOB. The trachea is not deviated, he has
engorged neck veins and absent breath sounds on the right. What is the most appropriate dx?
a. Tension pneumothorax
b. Cardiac tamponade
c. Simple pneumothorax
d. Hemothorax
e. Pleural effusion - A 44yo pt comes with right hemiparesis. Exam: left sided ptosis and left dilated pupil. Where is
the lesion?
a. Cerebral infarct
b. Cerebellar infarct
c. Medulla oblongata
d. Pons
e. Midbrain - A 50yo man has a stab wound to his left anterior chest at the level of the 4th ICS. He has a BP
80mmHg, pulse=130bpm. His neck veins are dilated and his heart sounds are faint. His trachea is
central. What is the most appropriate dx?
a. Cardiac tamponade
b. Diaphragmatic rupture
c. Fractured ribs
d. Tension pneumothorax
e. Traumatic rupture of aorta - A 15yo boy has a soft painless swelling in the left scrotum, blue in color and can be compressed.
What is the most appropriate next step?
a. Analgesia
b. Antibiotic
c. Biopsy
d. Immediate surgery
e. Reassurance - A 12yo pt presents with copious diarrhea. Exam: urine output=low, mucous membrane=dry, skin
turgor=low. What is the most appropriate initial management?
a. Antibiotic
b. Antimotility
c. Anti-emetic
d. Fluid replacement
e. Reassurance - A 60yo smoker presents with cramp-like pain in the calves relived by rest and non-healing ulcers.
Exam: cold extremities with lack of hair around the ankles, absent distal pulses. What is the
most probable dx?
a. Intermittent claudication
b. Chronic ischemia of the limbs
Đ. Bueƌgeƌ͛s disease
d. DVT
e. DM - An otherwise healthy 13yo boy presents with recurrent episodes of facial and tongue swelling
and abdominal pain. His father has had similar episodes. What is the most likely dx?
a. C1 esterase deficiency
b. HIV
c. Mumps
d. Sarcoidosis
e. SjogƌeŶ͛s sLJŶdƌoŵe - A 25yo had an LSCS 24h ago for fetal distress. She now complains of intermittent vaginal
bleeding. Observations: O2 sat=98% in air, BP=124/82mmHg, pulse=84bpm, temp=37.8C. The
midwife tells you that she had a retained placenta, which required manual removal in the OT.
Choose the most appropriate C-Section complication in this case?
a. Retained POC
b. Aspiration pneumonitis
c. Endometritis
d. Uterine rupture
e. DIC - A 30yo woman has brief episodes of severe shooting pain in the rectum. Rectal examination and
flexible sigmoidoscopy are normal. What is the most probable dx?
a. Anal hematoma
b. Anal fissure
c. Rectal carcinoma
d. Proctalgia fugax
e. Piles - A 78yo male, DM and HTN, had a fall and since then is unable to walk. He presents with
deformity and tenderness over the right hip area. XR=fx of femur neck. What is the single most
associated nerve injury?
a. Sciatic nerve
b. Gluteal nerve
c. Lateral peroneal nerve
d. Tibial nerve
e. Femoral nerve - A 20yo man has a head on collision in a car. On presentation his is breathless, has chest pain and
fx of 5-7th rib. CXR confirms this. What is the most appropriate initial action in this pt?
a. Antibiotics
b. Analgesia
c. O2 by mask
d. Physiotherapy
e. Refer to surgeon - A 28yo man with complains of headache and nose bleeds also has pain in the lower limbs on
exertion. Exam: radio-femoral delay, cold legs with weak pulse and mild systolic murmur with
normal S1S2. What is the most probable dx?
a. TOF
b. ASD
c. VSD
d. PDA
e. CoA - A 23yo male has a tonic clonic seizure whilst at college. His GCS is 12, BP=120/77mmHg,
HR=99bpm. What is the most appropriate inv for his condition?
a. CT
b. MRI
c. Serum blood glucose
d. Serum drug levels - A 20yo man complains of recent onset of itching which followed a viral infection. There are
numerous wheals of all sizes on his skin particularly after he has scratched it. These can last up
to an hour. What is the most probable dx?
a. Uremia
b. Urticaria
c. Psychogenic itching
d. Atopic eczema
e. Primary biliary cirrhosis - A 75yo lady who had mitral valve replacement 13 yrs ago has developed recurrent
breathlessness. Her husband has noticed prominent pulsation in her neck. She complains of
abdominal pain and ankle swelling. What is the most probable dx?
a. Aortic regurgitation
b. Mitral regurgitation
c. Mitral stenosis
d. Tricuspid regurgitation
e. Pulmonary stenosis - A 45yo T1DM had an annual check up. Ophthalmoscopy showed dot and blot hemorrhage +
hard exudate and multiple cotton wool spots. What is the next step in management?
a. Reassurance and annual screening only
b. Urgent referral to ophthalmologist
c. Laser therapy
d. Non-urgent referral to ophthalmologist
e. Nothing can be done - A 2m baby who has ambiguous genitalia presents to the ED with vomiting. Labs:
Na+=125mmol/L, K+=6mmol/L. What is the most likely dx?
a. Fragile X syndrome
b. Turners syndrome
c. Noonan syndrome
d. Congenital adrenal hyperplasia - A 40yo man collapsed at home and died. The GPs report says he suffered from T2DM and
BMI=35. What is the most likely cause of death?
a. MI
b. DM
c. HF
d. PE
e. Renal failure - A 38yo pt presented with tingling, numbness, paraesthesia, resp stridor and involuntary spasm
of the upper extremities. She has undergone surgery for thyroid carcinoma a week ago. What is
the most likely dx?
a. Thyroid storm
b. Hyperparathyroidism
c. Unilateral recurrent laryngeal nerve injury
d. External laryngeal nerve injury
e. Hypocalcemia - A 50yo chronic smoker came to OPD with complaint of chronic productive cough, SOB and
wheeze. Labs: CBC=increase in PCV. CXR >6ribs seen above the diaphragm in midclavicular line.
ABG=pO2 decreased. What is the most likely dx?
a. Interstitial lung disease
ď. WegeŶeƌ͛s gƌaŶuloŵatosis
c. Ca bronchi
d. COPD
e. Amyloidosis - A 44yo pt has sudden onset of breathlessness and stridor few minutes after extubation for
thyroidectomy. The pat had longstanding goiter for which he had the surgery. What is the most
likely dx?
a. Thyroid storm
b. Hematoma
c. Unilateral recurrent laryngeal nerve injury
d. External laryngeal nerve injury
e. Tracheomalacia - A 15yo boy presents with generalized edema. His urinalysis reveals protein +++, eGFR =110.
What is the most likely dx?
a. IgA nephropathy
b. Membranous nephropathy
c. Minimal change disease
d. PSGN
e. Lupus nephritis - A 72yo man is receiving chemotherapy for SCLC. He has his 4th tx 8 days ago. He has a cough
with some green sputum but feels well. Temp=37.6C. Chest exam = few coarse crepitations in
the right base. HR=92bpm. CBC: Hgb=12.5g/dL, WBC=1.1, Neutrophils=0.6, Plt=89. Sputum,
urine and blood culture sent to microbiology. What is the most appropriate management?
a. Broad spectrum antibiotics IV
b. Broad spectrum antibiotics PO
c. GCSF
d. Postpone tx until bacteriology results available
e. Reassure and send home - A 25yo woman with T1DM has delivered a baby weighing 4.5kg. Her uterus is well contracted.
Choose the single most likely predisposing factor for PPH from the options?
a. Atonic uterus
b. Cervical/vaginal trauma
c. Retained POC
d. Large placental site
e. Rupture uterus
ϭϳϲ. A ϮϯLJo ladLJ pƌeseŶts ǁith headaĐhe. Edžaŵ: photophoďia aŶd geŶeƌalized ƌash that doesŶ͛t
blanch on pressure. What must be done immediately?
a. IV benzylpenicillin
b. Isolate pt
c. Gown and mask
d. Blood culture - A 4yo baby has generalized tonic-clonic seizure and fever of 39C. his mother informs you that
this has happened 3-4x before. What is the most likely dx?
a. Febrile convulsion
b. Absence seizures
c. Epilepsy
d. Partial complex seizure - A middle aged Asian presents with episodes of fever with rigors and chills for last 1y. Blood film:
ring form plasmodium with schaffners dots in RBCs. What is the drug to eradicate this infection?
a. Doxycycline
b. Mefloquine
c. Proguanil
d. Quinine
e. Artesonate - A 35yo woman had an uneventful lap chole 18h ago. She has a pulse=108bpm, temp 37.8C.
There are signs of reduced air entry at the right ďase ďut the CX‘ doesŶ͛t shoǁ aŶ oďǀious
abnormality. What is the most appropriate management strategy?
a. Cefuroxime PO
b. Ceftriaxone IV
c. Chlorpheniramine PO
d. Chest physiotherapy
e. Reassure - A 20yo pop star singer complains of inability to raise the pitch of her voice. She attributes this to
the thyroid surgery she underwent a few months back. What is the most likely dx?
a. Thyroid storm
b. Bilateral recurrent laryngeal nerve injury
c. Unilateral recurrent laryngeal nerve injury
d. External laryngeal nerve injury
e. Thyroid cyst - A 28yo woman at 39wk gestation is in labor. She develops abdominal pain and HR=125bpm,
BP=100/42mmHg, temp=37.2C and saturation=99%. Exam: lower abdomen is exquisitely tender.
CTG=prv normal, now showing reduced variability and late deceleration develops with slow
recovery. She has had 1 prv LSCS for a breech baby. Choose the most appropriate CS
complication for this lady?
a. Endometritis
b. UTI
c. Urinary tract injury
d. Pleurisy
e. Uterine rupture - An 8m infant presented with FTT and constipation. Exam: large tongue and fam hx of prolonged
neonatal jaundice. What is the most likely dx?
a. Downs syndrome
b. Fragile X syndrome
c. Praderwilli syndrome
d. DiGeorge syndrome
e. Congenital hypothyroidism - A 3m infant has presented with recurrent infections. He has abnormal facies and CXR shows
absent thymic shadow. What is the most likely dx?
a. Downs syndrome
b. Fragile X syndrome
c. DiGeorge syndrome
d. Marfans syndrome - A 30yo man presents with deep penetrating knife wound. He said he had TT when he left school.
What will you do for him now?
a. Human Ig only
b. Human Ig and TT
c. Full course of tetanus vaccine only
d. Human Ig and full course of tetanus vaccine
e. Antibiotic - A 32yo previously healthy woman has developed pain and swelling of both knees and ankles
with nodular rash over her shins. As part of the inv a CXR has been performed. What is the single
most likely CXR appearance?
a. Apical granuloma
b. Bilateral hilar lymphadenopathy
c. Lobar consolidation
d. Pleural effusion
e. Reticular shadowing in the bases
ϭϴϲ. A ŶeoŶate͛s CX‘ shoǁs douďle ďuďďle sigŶ. Edžaŵ: loǁ set eaƌs, flat oĐĐiput. What is the ŵost
likely dx?
a. Downs syndrome
b. Fragile X syndrome
Đ. TuƌŶeƌ͛s sLJŶdƌoŵe
d. DiGeorge syndrome - A 19yo boy complains of itching on the site of insect bite. What is the single most appropriate
management?
a. Penicillin oral
b. Doxycycline oral
c. Oral antihistamine
d. Oral ciprofloxacin
e. Reassurance - A man presents with scrotal swelling, the swelling is cystic and is non-tender. It is located in the
upper pole of the posterior part of the testis. What is the most likely dx?
a. Epididymal cyst
b. Testicular ca
c. Hydrocele
d. Teratoma
e. Testicular torsion - A young footballer has collapsed during a game. During initial evaluation: RR=14/min,
pulse=88bpm, BP=110/70mmHg. He seems to be sweating and muttering some
incomprehensible words. What is the most imp next step?
a. CT
b. MRI
c. Blood sugar
d. Body temp
e. IV fluids - A 45yo waitress complains of pelvic pain which worsens pre-menstrually and on standing and
walking. She also complains of post-coital ache. Select the most likely cause leading to her
symptoms?
a. PID
b. Endometritiosis
c. Pelvic congestion syndrome
d. Adenomyosis
e. Premature ovarian failure - A 37yo female had a fall with outstretched hand, presented with dinner fork deformity and
tenderness over the right arm. What is the single most associated nerve injury?
a. Axillary nerve
b. Radial nerve
c. Musculocutaneous nerve
d. Median nerve
e. Ulnar nerve - A mother comes with her 15m child. Which of the following will bother you?
a. Shies away from strangers
b. Can walk but not run
c. Vocabulary consists of only 2 meaningless words
d. She ĐaŶ͛t ŵake a seŶteŶĐe
e. None - A 35yo lady who has been using IUCD for one year now complains of pelvic pain and heavy
painful periods. Select the most likely cause leading to her symptoms?
a. PID
b. Endometriosis
c. Adenomyosis
d. Fibroids
e. Asherman syndrome - The dx cells of Hodgkin disease are:
a. T-cells
b. R-S cells
c. B-cells
d. Macrophages
e. Auer rods - A 16yo girl is admitted after taking a paracetamol OD 4 h ago. She has consumed lare amounts
of alcohol. Her plasma paracetamol conc is just below the conc that would suggest tx. What
should be the tx option for her?
a. Refer to psychiatry ward
b. Refer to medical ward
c. N-acetylcystine
d. Serum plasma paracetamol
e. No further investigation - A 64yo woman has been on HRT for 9yrs. She had regular withdrawal bleeds until 3 yrs ago and
since then has been taking a no bleed prep. Recently she noticed a brown vaginal discharge.
Choose the single most appropriate initial inv?
a. Cervical smear
b. High vaginal swab
c. TFT
d. Transvaginal US
e. Endometrial sampling - A young girl complains of episodic headaches preceded by fortification spectra. Each episode
last for 2-3 days. During headache pt prefers quiet, dark room. What is the tx of choice for acute
stage?
a. Paracetamol
b. Aspirin
c. Sumatriptan
d. Gabapentin
e. Cafergot - A 60yo pt recovering from a surgery for toxic goiter is found to be hypotensive, cyanosed in the
the RR. Exam: tense neck. There is blood oozing from the drain. What is the most likely dx?
a. Thyroid storm
b. Reactionary hemorrhage
c. Secondary hemorrhage
d. Primary hemorrhage
e. Tracheomalacia - A 33yo man is hit by a car. He loses consciousness but is found to be fine by the paramedics.
When awaiting doctors review in the ED he suddenly becomes comatose. What is the most likely
dx?
a. SAH
b. Subdural hemorrhage
c. Intracerebral hemorrhage
d. Extradural hemorrhage - A 77yo male presents with hx of enuresis and change in behavior. Exam: waddling gait. What is
the most likely dx?
a. Subdural hemorrhage
b. Brain tumor
c. Normal pressure hydrocephalus
d. Psychotic depression