5.

All preterm babies should be subjected to cranial ultrasound for detection of intraventricular
hemorrhage during the first 3-7 days of life if delivered below:

A. 24 weeks of gestation

B. 26 weeks of gestation

C. 28 weeks of gestation

D. 30 weeks of gestation

E. 32 weeks of gestation

6. What is the MOST effective preventive strategy for necrotizing enterocolitis?

A. Human milk

B. Probiotics

C. Synbiotics

D. Pretreatment with H2 receptors agonist

E. Good antibiotic coverage for bacteria that colonize intensive care unit

7. According to Sarnat classification of hypoxic-ischaemic encephalopathy, a term infant who appears to

be hyperactive with mydriatic pupil, exaggerated pupil, exaggerated Moro reflex and myoclonus has:

A. Ongoing subtle seizure activity

B. HIE stage I

C. HIE stage II

D. HIE stage III

E. Unclassified

8. What is the IDEAL timing of initiation of therapeutic hypothermia in hypoxic-ischemic

encephalopathy?

A. As early as first 30 minutes of life

B. First 6 hours of life

C. First 12 hours of life

D. First 24 hours of life

E. First 48 hours of life

9. You are shown a chest X-ray showing multiple lung abscesses………..cough and fever. What is the
MOST likely diagnosis?

A. Pneumothorax

B. Staphylococcal Pneumonia

C. Military Tuberculosis the correct answer if it was a typing error

D. Lobar Pneumonia

E. Asthma

10. A 5-year-old child presents with fever, halitosis (bad breath) and amphoric breathing on
auscultation. What is the correct treatment for this condition?

A. Cloxacillin 50mg/kg intravenously

B. Intercostal Chest drain

C. Amoxicillin 40 mg/kg per dose for 5 days wrong

D. Gentamycin 7.5m/kg?? mg/kg intravenously

E. Nebulized Salbutamol

11- The brain involvement of periventricular-area-in process of hypoxic-ischaemic encephalopathy can

lead to future development of:

A. Cognitive delay

B. Visual and auditory processing difficulty

C. Dystonia

D. Seizure disorder

E. Spastic diplegia.

12. What is the MOST common acquired neuronal injury in newborns?

A. Phrenic nerve

B. Brachial plexus

C. Facial nerve

D. Spinal cord transection

E. Horner syndrome
13. A 3-year-old child presents with swelling in the back of the pharynx, pain on swallowing and fever.
What is the MOST likely diagnosis?

A. Viral croup

B. Retropharyngeal Abscess

c. Foreign body

D. Diphtheria

E. Epigtottitis

14. What is the MOST common complication of infective endocarditis?

A. Haematuria

B. Pericardial effusion

C. Splenomegaly

D. Cerebral stroke

E. Congestive heart failure

15. Differential diagnoses for a chronic cough in a child will include:

A. Tuberculosis

B. Asthma

C. Pneumonia

D. Bronchiectasis

E. A, B and D

16. What is the most common congenital heart defect with a left to right shunt causing heart failure in
a paediatric age group?

A. Atrial septal defect

B. Atrioventricular septal defect

C. Ventricular septal defect

D. Patent ductus arteriosus

E. Aortopulmonary window
17. A feature of Tuberculosis on a Chest X ray in a child is mainly

A. Miliary pattern

B. Chest opacification

C. Keriey B line

D. Multiple small abscesses

E. Only A and B

18. A child is brought to the emergency room after being found unconscious in a where a brazier had
been left on with the windows closed. The pulse oximeter reading shows 90% oxygen saturation. The
MOST likely diagnosis is:

A. Carbon Dioxide poisoning

B. Hysteria

C. Carbon Monoxide poisoning

D. Inhalational Burns

E. Sleep Apnea

19. What are the signs of Cardiac failure in children? Choose from the items listed below

A. Tachycardia

B. Tachypnea

C. Gallop Rhythm

D. Pulsatile liver

E. A, C and D

20. Acute rheumatic fever diagnosis:

A. Sydenham's chorea alone can be used to make the diagnosis

B. It is easy to make the diagnosis in a child with Rheumatic

C. Always Jones criteria has to be met to make the diagnosis

D. The presence of vegetation on heart valves is part of major criteria

E. First degree heart block is a major criteria in Jones criteria

21. Diabetes mellitus in children:

A. Can often be managed with oral hypoglycaemic agents

B. May be associated with prior mumps infection

C. Always presents with keto acidosis

D. Has a peak incidence at 1 - 3 years

E. Does not remit for a variable period of time

22. A girl of 2 years has 3+ proteinuria. The following should be considered in the differential
diagnosis:

A. Ectopic……

B.

C.

D.

E.

23. Presenting features of HIV infection in childhood include:

A. Persistent oral thrush beyond the neonatal period

B. Hepatosplenomegaly

C. Failure to thrive

D. Recurrent otitis media

E. All of the above

24. Regarding septic shock:

A. The peripheries may be warm

B. Bacterial may be important in its aetiology

C. Capillary leak results from an uncontrolled immunological response

D. Tumour necrosis factor alpha and interleukin 1 levels are typically elevated.
E. All of the above

25. All the following statements about Zidovudine (AZT) are ture, EXCEPT:

A. Inhibits reverse transcriptase

B. Is a uridine analogue

C. Causes thrombocytopaenia

D. Reduces vertical transmission of HIV in combination with Nevirapine

E. Is contraindicated if neutrophil count is less than 0.75 × 109/L

26. Which of the following statement concerning abnormalities; of the haemoglobin is molecule is
TRUE?

A. Alpha thalassaemia is due to a deficiency of beta-chain production

B. Hb S is caused by a single base mutation on the beta-chain

C. Genes for the alpha and beta chains are located on the same chromosome

D. In thalassaemia persistence of Hb F is an adverse prognostic sign

E. Oligonucleotide probes may assist in the diagnosis of haemoglobinopathies

27. Which of the following definitions is TRUE:

A. Still birth rate is the rate of fetal death after 28 completed weeks of pregnancy per 1,000 total
pregnancies.

B. The perinatal mortality rate is the total of still births plus deaths within the first pet 1,000 live •and
still births

C. The neonatal mortality rate is the deaths of live born infants less than 28 days of age per 1,000 live
births

D. An abortion is a premature expulsion from the uterus of the products of conception before 26
completed week's gestation

E. A miscarriage is the loss of the products of conception from the uterus before 16 completed weeks.

28. The following statements about hyaline membrane disease are true EXCEPT:

A. It is caused by deficiency of surfactant production by type 2 respiratory cells

B. The hyaline membrane seen histologically is caused by a protenacious exudate

C. It may be exacerbated by hypoxia, acidosis or hypothermia

D. It occurs in 45% of children born before 28 weeks of completed gestation

E. Steroids given antenatally to the mother stimulate surfactant production

29. The following are all recognized clinical features of neonatal sepsis EXCEPT:

A. Hypothermia

B. Vomiting

C. Hyperglycaemia

D. Jitteriness

E. Hypocalcaemia

30. Decreased glucose and high polymorphonuclear cell count in the CSF may be seen in:

A. Echo virus meningitis

B. Early tuberculous meningitis

C. E. coli meningitis

D. Cryptococcal meningitis

E. Meningococcal meningitis

31. The following findings are all common in Sickle Cell Disease, EXCEPT:

A. Jaundice is not necessarily pronounced in sequestration crisis

B. Clubbing is not a common finding

C. Acute onset syndrome is often associated with sepsis

D. Dactylitis is often one of the earliest manifestations of the disease

E. Asplenia causes susceptibility to largely viral but also bacterial infections

32. Regarding BCG vaccine, the following are all true, EXCEPT:

A. Provides more consistent protection against TB meningitis than pulmonary TB injection

B. It is given as intradermal injection

C. Typically given in the left upper arm

D. Contra-indicated in symptomatic HIV infection

E. May be given to individuals beyond the neonatal period

33. The following facts are all true of malaria, EXCEPT:

A. One generalized tonic clonic is characteristic of severe malaria

B. Plasmodium malariae causes nephrosis

C. Meningitis should be excluded in case of severe malaria

D. Young children and pregnant women are more vulnerable

E. Hyperparasitaemia is where more than 5% of red cells are infected with the parasite

34. Which of the following signs/symptoms distinguishes lobar pneumonia from pleural effusion on
physical examination:

A. Tachypnoea

B. Flaring of nasal wings

C. Dullness to percussion

D. Reduced air entry

E. Tracheal tag

35. Dehydration fever is characterised by all of the fallowing, EXCEPT:

A. Occurs at any gestational age

B. Rectal temperature of 37.8⁰C and above

C. Negative culture of body fluids

D. Can be caused by any organism

E. C reactive protein is typically within normal ranges

36. Kabaso, an 8-year-old boy of Rufunsa, presents with fever of 3-week duration. He was treated for
malaria a week ago despite a negative malaria thick smear. He has remarkably lost weight and is
complaining of abdominal pain associated with constipation. The mother says that he loses his
memory at times and would be incoherent in his speech. The MOST likely diagnosis is:

A. Meningo-encephaliüs

B. Cerebral malaria

C. Meningitis

D. Enteric fever

E. Presenile dementia

37. Lulu is a 1-year-old girl brought to the clinic with suspicion of TB. Which of the following points in
the history may suggest she has active TB?

A. The grandfather had smear positive TB four year ago.

B. The child coughs and wheezes at night

C. She has weighed 6 kg in the last 3 under-five clinic attendances

D. She is HIV negative

E. She is thriving well

38. In enteric fever, positive blood cultures are highest during:

A. First week of illness

B. Second week of illness

C. Third week of illness

D. Fourth week of illness

E. None of the above

39. An 8-month-old girl is brought to the emergency department because of a 1-day history of rapid
breathing. Her temperature 38.4⁰C, pulse is 160/min, respirations are 60/min, and blood pressure is
100/68 mm Hg. Bilateral expiratory wheezing and crackles are heard on auscultation. A chest x-ray
shows areas of atelectasis and hyperinflation. Which of the following is the MOST likely causal virus?

A. Measles virus

B. Respiratory syncytial virus

C. Rhinovirus
D. Rotavirus

E. Parvovirus

F. Varicella-zoster virus

40. A 5- old child presents with history of vomiting and diarrhoea for 4 days. The child has tachycardia,
sunken eyes, dry cough and loss of skin turgor, the child is restless. What would be the BEST course of
action:

A. Commence Oral Rehydration therapy

B. Start IV antibiotics

C. Commence 5% dextrose intravenously

D. Give 100ml/kg of Normal Saline (0.9%) intravenously

E. Give Ringers Lactate of 30ml/'kg in the first 30minutes followed by 70ml/kg in the next 2hours 30
minutes intravenously.

41. In the eighteenth and nineteenth centuries, a series of eminent scientists laid the foundations of
our understanding of homeostasis and the response to injury. Which of the following statement is
TRUE?

A. Body systems act to maintain internal constancy.

B. Complex homeostatic responses involving (he brain, nerves, heart, lungs, kidneys and spleen work not
to maintain body constancy.

C. Responses to injury are, in general, deleteriousto to the host and allow healing/survival.

D. Body systems are inimical to the maintenance of internal constancy

E. Homeostasis involves the coordinated physiological process which maintains most of the fitful
states of the organism.

42. The innate immune system (principally macrophages) interacts in a complex manner with the
adaptive immune system in co-generating the metabolic response to injury. ALL of the following are
examples of pro-inflammatory cytokines EXCEPT:

A. Interleukin-1 (IL-1)

B. Tumour necrosis factor alpha (TNFα)

C. IL-6

D. IL-8
E. T cells, B cells

43. Which one of the following types. of shock is caused by reduced circulating volume?

A. Cardiogenic

B. Obstructive

C. Distributive

D. Hypovolaemic

E. None of the above

44. You are shown a radiograph during a ward round of a neonate, who has presented with non-
bilious vomiting. What sign would you see?

A. Omega sign

B. Bird's beak sign

C. Rats Tail appearance

D. Double Bubble Sign

E. Cock screw sign

45. The agenda for medical education and clinical governance requires doctors to expand their skills to
encompass audit and research capabilities as useful tools for continued outcome measurement,
service improvement and innovations for the benefit of patient care. Audits are formal processes that
require a structure. Which of the following steps are essential to establish an audit cycle?

A. Define the audit question in a multidisciplinary team.

B. Identify the body of evidence and current standards.

C. Design the audit to measure performance against agreed standards based on strong evidence.

D. None of the above

E. All of the above

46. A 64-year-old man presents with effortless vomiting of bright red blood. The patient is a known
chronic alcoholic and has caput medusa. What is the MOST Iikely diagnosis?
A. Oesophageal Varices

B. Mallory Weiss Tear

C. Gastric Ulcer

D. Duodenal Ulcer

E. Rupture Aortic Aneurysm

47. .........the emergency room with a bull dog neck.............What is the most likely diagnosis and the
treatment?

A. ... Trachea and neck exploration

B. Surgical Emphysema and Intercostal Drain

C. Rupture Common Carotid Aneurysm and Common Carotid Repair

D. Avulsion of the clavicle and collar and cuff

E. Cervical Vertebrae dislocation and MUA with Cervical Collar

48. A Junior Resident Medical Officer working in the accidents and emergency department of a
tertiary hospital attends to a 20-year-old male patient with a strangulated right inguinal Hernia. What
is the best action to take?

A. Attempt to reduce the Hernia

B. Admit the patient, commence an IV line, group and cross match the patient

C. Consent the patient for emergency theatre

D. Group and X match, consent for Emergency theatre and immediately inform the second on call

E. Wheel the patient to theatre scrub for operation and then call the second on call

49. A 56-year-old male patient presents with severe pain and fails to pass urine. The clinical
examination shows a mass which is dull to percussion mid-way above the suprapubic bone. The MOST
likely diagnosis:
A. Chronic Urinary Retention.

B. Acute Urinary Retention.

C. Ruptured Bladder

D. Bladder Hematoma,

E. Cancer of the Bladder.

50. A patient develops air embolism after more than 15ml of air is accidentally introduced during
insertion of a venous catheter. Which of the following is one of the features of air embolism?

A. A rise in the blood pressure

B. A drop in the pulse rate

C. Distension of the jugular venous pressure (JVP)

D. All of the above

E. Only B

51. Which of the following is not a risk factor for DVT?

A. Age < 40 years

B. Recent surgery, particularly pelvic and lower limb surgery

C. Immobilization

D. Trauma

E. Oral contraceptive pill

52. Primary brain injury occurs at the time of impact and includes all of the following injuries EXCEPT:

A. Brainstem and hemispheric contusions

B. Diffuse axonal injury

C. Cortical lacerations

D. All of the above

E. Only A
53. Severity of head injury is classified according to the Glasgow Coma Score (GCS). Which of the
following correctly depicts moderate head injury according to the GCS?

A. GCS 15 with no loss of consciousness (LOC)

B. GCS 14 or 15 with LOC

C. GCS 9-13

D. GCS 3-8.

E. GCS 13-15

Coma Score (GCS). Which the GCS?

54. Diagnostic peritoneal lavage (DPL) is especially useful ill the hypotensive, unstable patient with
multiple injuries as a means of excluding intra-abdominal bleeding inpatients at health facilities where
focused abdominal sonar for trauma (FAST) is not available. What DPL finding is finding is deemed
positive?

A. The presence of >90 000 red cells µl—l > 400 white cells µl—l of

B. The presence of > 80 000 red cells µl—l or > 350 white cells µl—l

C. The presence of > 70 000 red cells µl—l or > 200 white cells µl—l

D. The presence of > 200 000 red cells µl—l or > 600 white cells µl—l

E. The presence of > 100 000 000 red cells µl—l or 500 white cells µl—l

55. A 25-year-old man working at a factory sustained a burn injury secondary to hot water. His entire
anterior torso and anterior aspect of the right upper arm were involved. On examination, there was
blanching, erythema and a normal pinprick sensation. Classify the burn injury if the Lund and Browder
chart was used

A. Superficial partial-thickness burns 20%

B. Superficial partial-thickness burns 15%

C. Deep partial-thickness bun 20%

D. Superficial partial-thickness burns 13%

E. Deep partial-thickness burn 25%

56. Which statement is false about the Muir and Barclay formula?

A. One portion=0.5 × percentage body surface area burnt ×weight.

B. It has periods of 4/4/4, 6/6 and 12 hours respectively.

C. One portion to be given in each period.

D. Half a portion to be given in each period.

E. It's a colloid-based formula

57. A 42-year-old goal keeper playing football in the Zambian Super League was injured during a
match because he was hit by another player while blocking a shot. The goal-keeper was substituted
and later complained of pain over the anterior shoulder that radiates down the arm. The pain was
worse at night and presented with difficulties in raising the arm above head. Speed's and Vergason's
tests were positive. What is the MOST likely diagnosis?

A. Acromioclavicular joint dislocation

B. Sternoclavicular joint dislocation

C. Rotator cuff tear

D. Clavicular fracture

E. Proximal humerus fracture (non-displaced)

58. The glenohumeral joint is controlled by the deltoid and the rotator cuff muscles. Which of the
following muscles is not found in the latter?

A. Subscapularis

B. Superior supraspinatus

C. Superoposterior infraspinatus

D. Teres minor.

E. Biceps brachii

59. Name the sensory nerve supply to the larynx above the vocal folds?

A. Cervical nerve C1

B. Recurrent laryngeal nerve.

C. Superior laryngeal nerve

D. Cervical nerve C2

E. Cervical nerve C3
60. What is true about the anatomical description of the larynx

A. Supraglotíis

B. Glottis

C. Subglottis

D. None of the above

E. All of the above

61. Which of the following is an early postoperative complication of tracheostomy?

A. Swallowing dysfunction

B. Difficult decannulation

C. Tracheoecutaneous fistula

D. Tracheo-oesophageal fistula, tracheoinnonainate artery fistula with severe haemorrhage

E. Tracheal stenosis

62. Retrosternal goitre is often symptomless and discovered on a routine chest radiograph. Which of
the following symptom(s) may occur in a retrosternal goitre?

A. Dyspnoea, particularly at night, cough and stridor.

B. Dysphagia.

C. Engorgement of facial, neck and superficial chest wall veins

D. All of the above

E. Only C

63. What is the relative incidence of anaplastic carcinoma of the thyroid gland?

A. 5%

B. 7%

C. 10%

D. 20%

E. 60%
64. Which of the following is synonymous to Sipple's syndrome?

A. MEN-1

B. Werner's syndrome

C. Gardner's syndrome

D. MEN-2A

E. MEN-2B

65. Which cranial nerve(s) is at risk during removal of the submandibular gland?

A. The marginal mandibular branch of the facial nerve

B. The glossopharyngeal nerve

C. The hypoglossal nerve

D. Only A and C

E. None of the above

66. Which of the following statements is not true about epistaxis?

A. The most common site of bleeding is from Kiesselbach's plexus in Little's area of the portion of the
septum

B. Less often bleeding is from the lateral nasal wall

C. Anterior bleeding is con.lùlon in the elderly, as a result of nose blowing or picking

D. In the elderly, arteriosclerosis and hypertension are the underlying causes of arterial bleeding from
the posterior part of the nose

E. Hereditary haemorrhagic telangiectasia (Osler's disease) gives rise to recurrent multifocal bleeding
thin-walled vessels deficient in muscle and elastic tissue.

67. The sigmoid colon

A. Terminates. at the rectum anterior to the sacral promontory

B. In the pelvis lies adjacent to the bladder and uterus

C. Has no appendices epiploicae

D. Is supplied by the parasympathetic fibres from the phrenic nerve

E. Has lymphatics which drain into the inguinal lymph nodes

68. The wall of pseudo cyst is commonly lined with

A. Epithelium

B. Granulation tissue

C. Endothelium

D. Mesothelium

E. Smooth muscle

69. Which one is not a complication of a cyst

A. Torsion

B. Infection

C. Rupture

D. Compression on the surrounding structures

E. Complete resolution

70. Characteristic features of a lipoma are

A. Slow growing

B. No defined edges

C. Usually painful

D. Fixed to the surrounding tissues

E. Ali the above

71. Anal neoplasm common in HIV patients include

A. Kaposi's. sarcoma, condylomata acuminata, NHL

B. NHL, lipoma, teratoma

C. Squamous carcinoma, teratoma, anal fissures

D. None of the above

E. All of the above

72. The following is a common AIDS defining condition in surgery

A. Cirrhosis

B. Sclerosing cholangitis

C. Cholelithiasis

D. Choledochal cyst

E. Lymphoma

73. The following arc not reservoirs of HIV

A. B cells

B. RBCs

C. Macrophages

D. Neural cell

E. T cells

74. Which of the following is the best guide to fluid replacement in a burns patient?

A. Haemoglobin and haematocrit

B. Urine output

C. Urine osmolali(y

D. Plasma volurne

E. Specific gravity

74. A 60-year-old man seeks medical attention because of recurrent urinary tract infections. The
patient also reports a history of increasing difficulty in urination (decreased flow, straining, and
hesitancy) over the last several months. A prostate-specific antigen (PSA) level is mildly elevated, and
a prostate biopsy proves benign. Which of the following is the most appropriate initial management
of this patient with benign prostatic hyperplasia (BPH)?

A. α-Adrenergic blocker

B. 5-alpha reductase inhibitor blocker

C. α-Adrenergic blocker and 5-alpha reductase inhibitor

D. Transurethral resection of the prostate (TURP)

E. Open prostatectomy

76. The commonest microorganism causing osteomyelitis in Sickle Cell Disease patients is:

A. S. aureus

B. S. pneumonia

C. Salmonella

D. E. coli

E. Proteus

77. The pathophysiology of osteomyelitis may include all of the following EXCEPT:

A. Direct spread

B. Haematogenous spread

C. Incisional infection

D. Decubitus sores

E. Closed fracture

78. Immediately after the completion of a normal labour, the uterus should be:

A. Firm & contracted at the level of the umbilicus.

B. At the level of the symphysis pubis.

C. Immobile.

D. Atonic.

E. Boggy

79. A woman is admitted to the Labour ward with Cervical dilatation of 8cm. You are the House officer
on the hand over round. There has been no progress on the Cervicogram. What action should be
taken.

A. Induction of Labour

B. Augmentation of Labour

C. Arrange for Emergency Caesarian Section (CS)

D. Do Forceps delivery

E. Rupture the Membranes

80. The mechanism of action of alpha methyldopa:

A. Increased-peripheral vascular resistance.

B. Increased sodium & water diuresis.

C. Act centrally to decrease sympathetic outflow.

D. Relaxes arterial smooth muscles.

E. Decrease the cardiac output.

81. Sensitivity of uterine musculature:

A. Enhanced by progesterone

B. Enhanced by estrogen

C. Inhibited by estrogen

D. No effect of estrogen

E. Enhanced by estrogen and inhibited by progesterone

82. A woman from Kalingalinga is brought into Labour ward at 38 weeks of pregnancy. She is referred
to Levy Mwanawasa Hospital with premature rupture of membrane (PROM). The Os is closed. What is
the best course of action?

A. Admit her to antenatal ward for observation

B. Admit her to labour ward and commence to Labour ward and commence antibiotics.

C. Do a vaginal Examination to ascertain the stage of Labour.

D. Put in a knee chest position for Emergency Caesarian section.

E. Commence antibiotic and plan for C/S if she does not deliver in 24 hours

83. You are in the Gynaecology clinic and you see a Catholic Nun, who complains of abdominal pain
with her periods as well as menorrhagia. What is the most likely diagnosis?

A. Cervical Cancer

B. Endometrial Cancer
C. Endometriosis

D. Fibroid Uterus

E. Pelvic inflammatory Disease (PID)

84. A 23-year-old female is seen in the Gynecology Clinic with Dyspareunia. She complains of pain and
per vaginal discharge. What is the most likely diagnosis?

A. Uterine Fibroids

B. Ovarian Cysts

C. Endometriosis.

D. Pelvic Inflammatory Disease (PID).

E. Urinary Tract Infection (UTI)

85. The second stage of labor involves:

A. Separation of the placenta.

B. Effacement of the cervix.

C. Expulsion of the placenta.

D. Dilation of the cervix.

E. Expulsion of the fetus.

86. The persistence of which of the following is usually incompatible with spontaneous delivery at
term:

A. Occiput left posterior

B. Mentum posterior

C. Mentum anterior.

D. Occiput anterior.

E. Sacrum posterior.

87. Concerning amniotic fluid and meconium staining in labour:

A. No amniotic fluid is considered the same risk as meconium grade 3

B. Grade 3 meconium is used to describe old meconium

C. Grade 3 meconium-stained liquor is described as heavy suspension of meconium

D. Grade 2 meconium is thick undiluted meconium

E. All the above are true

88. Which of the following is an emergency Obstetric indication for Caesarian Section:

A. Vaginal warts

B. Obstructed Labour

C. Diabetes in Pregnancy

D. Multiple Pregnancy

E. Post Maturity

89. A 35-year-old presents with a 32-week pregnancy with per vaginal bleeding, this is associated with
a Tense abdomen and pain. She feels that the fetal movements are reducing.

A. Placenta Previa

B. Vasa Previa

C. Ante Hemorrhage

D. Incidental Hemorrhage

E. Abruptio Placenta

90. A diabetic in her second pregnancy presents to your hospital at 32 weeks gestational age. She
gives a history of intrauterine fetal demise at term in her last pregnancy. Her vitals are normal, sugar
is controlled and the fetus is stable. Which among the following will be the most appropriate
management?

A. Induce labour at 3S weeks

B. Induce labour at 40 weeks

C. Do a cesarean section at 38 weeks

D. Wait for spontaneous delivery

E. Induce labour when she is post-term

91. Contraindications to breast milk feeding:

A. Mother is sputum negative for TB

B. Bromocriptine therapy for mother

C. Heavy breast engorgement

D. Mastitis

E. Mother on domperidone

92. You are called to a maternity ward to see a 23-year-old primip patient who delivered a 2.7kg baby
boy 2 days back. She had a normal vaginal delivery and the placenta delivered spontaneously. Now
she complains of bloody vaginal discharge with no other signs. On examination you notice a sweetish
odor bloody discharge on the vaginal walls and introitus. Further exanimation shows a soft non-
tender uterus. Her pulse rate is 78/min, BP-110/76 mm of Hg, Temp-37 C, RR- 16/min. Her WBC
count=10,000 with predominant granulocytes. What is the most appropriate step?

A. Curettage

B. Oral antibiotics

C. Reassurance

D. Order urinalysis

E. Vaginal culture

93. A 30-year-old woman develops a vein thrombosis in her left calf on the fourth postoperative day
following a cesarean section done for fetal distress. The patient is started on heparin and is scheduled
to begin a 6-week course of warfarin therapy. The patient is a devoted mother who wants to
breastfeed her baby. What is the appropriate advice given to the patient?

A. The patient may continue breastfeeding at her own risk

B. The patient should breastfeed her baby only if her INR is at <2.5

C. The patient can breast feed her baby after 6 weeks course of warfarin is over

D. Warfarin is not a contraindication for lactation

E. Warfarin contraindicated during lactation.

94. A pre-eclamptic patient just delivered and has a soft uterus with moderate bleeding. Examinations
reveals no laceration. Of the options below, the BEST choice is:

A. 0.2 mg IV ergometrine
B. 0.5 mg oral ergometrine

C. 5 units of oral oxytocin

D. 0.5 mg IM ergometrine

E. 20 units of oxytocin in 500 ml of normal saline given IV.

95. Eclampsia occurring before 20 weeks of gestation is most commonly seen in women with:

A. A history of chronic hypertension.

B. Multiple gestation

C. Gestational trophoblastic diseases.

D. A history of seizure disorder.

E. A history of chronic renal diseases.

96. A female of 36 weeks gestation presents to the hospital as a referral from a local clinic with
hypertension, blurring of vision and headache. Her blood pressure reading is 180/120mmHg and
174/110mmHg after 20 minutes. How will you manage the patient?

A. Admit the patient and observe

B. Admit the patient, start antihypertensives, give six doses of magnesium sulphate and continue
pregnancy until term.

C. Admit the patient, start antihypertensives, magnesium sulphate and terminate the pregnancy

D. Give oral antihypertensives and allow her to go home to rest and be followed up as an outpatient

E. Start antihypertensives and follow her up as an outpatient in the antenatal care clinic in one week's
time.

97. A 27-Far-old primigravida at 39 weeks' gestation presents to the labour ward of hospital and
progresses through the stages of labour normally. During delivery of the infant, the bead initially
progresses beyond the perineum and then retracts. Gentle traction does not facilitate the delivery of
the infant. Which of the following options is the first step in management?

A. Abduct the mother's thighs and apply suprapubic pressure

B. Apply fundal pressure

C. Flex mother’s thighs against her abdomen

D. Push the infants head back into the uterus and do a caesarean section
E. Encourage fundal pressure by an assistant

98. A 34-year-old patient presents with secondary infertility in the Gynaecology Clinic. She has had
one child in a previous marriage 10 years ago and is trying to get pregnant again. She is in a second
marriage and has regular sexual intimacy with her new partner. He has been assessed urology unit
and has normal fertility. What investigation would you recommend?

A. Ultrasound

B. Hysterosalpingography (HSG)

C. High Vaginal Swab

D. Prolactin Levels

E. Hormonal Profile.

99. A primigravid 24-year-old patient is in the special observation unit in Labour ward with oedema of
the legs, proteinuria and BP of 140/95 mmHg, she is fully dilated, you do a vaginal examination and
find the fetus is Cephalic presentation, with the station just below the ischial spines. The patient
begins to fit as you are just completing your pelvic examination. What is the most appropriate action
you should take:

A. Prepare for Caesarean section (CIS).

B. Prepare for Vacuum Extraction/Ventouse of the fetus

C. Commence Magnesium Sulphate 20mg/IV and assisted delivery when the fits are stabilized,

D. Do the A,B,Cs, give Magnesium Sulphate and do assisted delivery by Ventouse.

E. Start A,B,C, give Hydralazine intravenously and caesarean Section.

100. Which of the following is a contraindication to a trial of labour after caesarean section:

A. Prior classical incision.

B. Prior cesarean delivery for dystocia.

C. Prior IUFD

D. Ultrasound estimation of fetal weight of 3500g.

E. Prior cesarean delivery for breech.

101. A 32-year-old Gravida 2 Para 1 patient with Diabetes in Pregnancy is planned for induction of
Labour at 38 weeks. You assess her Bishops score and it is 6. What is the next appropriate action to
take:
A. Commence induction with Oxytocin of 10iu in 5% dextrose

B. Insert Prostaglandin Pessaries; (PGE), Misoprostol vaginally to improve the Bishops Score before
commencing induction.

C. Proceed to sweep the membranes and check the Bishops Score again

D. Take to Labour Ward for delivery

E. Sweep the membranes, check the Bishops Score if favorable commence induction, if not insertt PGE
pessaries.

102. The serum insulin level in the newborn infant of a diabetic is generally:

A. Higher

B. The same as euglycemic

C. Lower

D. Extremely labile

E. None of the above

103. Regarding the different types of Abortion; which is CORRECT:

A. Missed abortion has a closed os and minimal vaginal bleeding

B. Inevitable Abortion has a closed os with severe pain and vaginal bleeding

C. Incomplete Ab01tion has an open os., no bleeding and pain

D. Septic Abortion has an open severe vaginal bleeding with no foul discharge

E. Threatened Abortion has an open os, bleeding and severe pain

104. The most common cause of vaginal bleeding complicating premature labor is:

A. Vaginal laceration.

B. An endocervical polyp.

C. Cervical dilation.

D. Placenta previa.

E. Placental abruption.
105. Risk factor(s) for fetal compromise in labour:

A. Multiple pregnancy

B. Precipitate labour

C. Cord prolapse

D. All the above are

E. None of the above is true

106. A 30-year-old woman presents to you with the fear of developing ovarian cancer. She tells you
that her 70-year-old grandmother recently died from ovarian cancer. You discuss with and prevention
for ovarian cancer. Which of the following can decrease a woman’s risk of ovarian cancer?

A. Use of oral contraceptive therapy

B. Menopause after age 55

C. Nonsteroidal anti-inflammatory

D. Nulliparity

E. Ovulation induction medications

107. Usually the first endocrinal evidence of approaching menopause is:

A. Raised FSH

B. Raised LH

C. Raised testosterone

D. Decreased oestrogen

E. Raised progesterone

108. An intrauterine pregnancy of approximately 10 weeks gestation is confirmed in a 30year-old

G5P4 woman with an IUD in place. The patient expresses a strong desire for the pregnancy to be
continued. On examination, the string of the IUD is noted to be protruding the cervical OS. Which of
the following is the most appropriate course of action?

A. Leave the IUD in place without any other treatment.

B. Leave the IUD in place and continue prophylactic antibiotics throughout pregnancy.

C. Remove the IUD immediately,

D. Terminate the pregnancy because of the high risk of infection.

E. Perform a laparoscopy to rule out a heterotopic ectopic pregnancy.

109. Five patients present for contraceptive counseling to the family planning clinic in ward B02, each
requesting that an IUCD be inserted, which of the following is a recognized contraindication to the
insertion of an IUCD?

A. Pelvic inflammatory disease

B. Previous with an IUCD

C. Dysfunctional uterine bleeding

D. Cervical conization

E. Chorioamnionitis in previous pregnancy

110. The preferred treatment of CIN-3/CIS in a parous woman aged 45 years is:

A. Hysterectomy

B. Cold knife conization

C. Cryosurgery

D. Cauterization

E. Cervical biopsy

111. Diagnosis of a small submucous fibroid can be best done by:

A. Curettage with a feel of irregular 'bump'

B. Hysterography

C. Hysteroscopy

D. Sonography

E. Use of a Pippele

112. Clomiphene citrate:

A. Antiandrogen

B. Synthetic steroid
C. Antiestrogen

D. GnRH analogue

E. Antiprogesterone

113. A functional cyst of the ovary is characterized by:

A. It does not usually exceed 6 cm

B. It may persist even after the cure of the functional disorder to which it is associated

C. It is more associated with patient taking oral 'pill'

D. It is usually multilocular

E. It is usually malignant

114. A 26-year-old woman attends the emergency department feeling unwell and complaining of
lower abdominal pain. On examination she has a temperature of 39 degrees Celsius and a pulse rate
of 110 beats per minute. She has lower abdominal tenderness with guarding and cervical excitation. A
reveals profuse discharge. What is the most appropriate management?

A. Admit for intravenous antibiotics and supportive care

B. Book for exploratory laparotomy

C. Organize a pelvic ultrasound

D. Refer to the surgeons for further management

E. Refer to a sexual health clinic for screening and pat-filer contact tracing

115. A 40-year-old woman complains of heavy regular periods for 5 years. Pelvic ultrasound scan has
revealed no abnormality. Her family is complete. What is the most appropriate first line treatment for
this patient?

A. Combined contraceptive pill

B. Laparoscopic assisted vaginal hysterectomy

C. Levonorgestrel-releasing intrauterine system (IUS)

D. Norethisterone tablet 5 mg three times daily from day 5 to 26

E. Tranexamic acid
116. A 19-year-old university student is admitted to the accident and medical emergency unit (AMEU)
with a 24-hour history of headache, nausea and vomiting. There is neck stiffness on physical
examination. Which of the following physical signs would be a CONTRADICATION to the taking of a
cerebrospinal fluid via lumbar puncture?

A. Positive Kernig's sign

B. Tachycardia and hypotension

C. Purpuric skin rash

D. Blurred disc on ophthalmoscopy

E. Systolic murmur on auscultation

117. A 24-ycar-old patient presents with 2 days history of fever to the Adult Medical Emergency unit
while you are the intern. On examination, you find that his Blood pressure is 82/55 mmHg; he is
jaundiced and has splenomegaly. He is passing urine well though the color had changed to dark coca
cola like urine. The unit consultant tells you on the phone that the patient has severe malaria and
needs to be treated urgently. Which of the following clinical feature made the consultant conclude
so?

A. The presence of the 2 days history of fever

B. The presence of splenomegaly

C. The presence of algid malaria features

D. The presence of black water fever

E. C&D

118. A 30-year-old patient was admitted to the Adult Medical Emergency Unit (AMEU) with 2 days of
history of fever and passing dark urine. On examination, the Glasgow Coma Scale is 11/15, her blood
pressure 94/73 mmHg and the urine output decreased below 0.5 ml/hour. The blood slide shows
trophozites of plasmodium falciparum. Urea and creatinine are elevated on two consecutive
measurements. The patient condition deteriorates further and she develops melena. Which of the
following will be your next course of action?

A. Give more fluid in the presence of anuria

B. Switch artesunate to Quinine

C. Double the dose of Artesunate

D. Hemodialysis might be required

E. Kidney transplant
119. You are the clinician on duty and receive a 30-year-oldmale patient Cow Boy from Namwala
district with a persistent cough of over three weeks. On your enquiry, he tells you that he has been
losing weight Which of the following is the investigation of choice if you suspect Tuberculosis?

A. Chest Xray

B. Sputum microscopy and sensitivity

C. Full blood Count

D. India Ink

E. MTB/IUF

120. A 35-year-old male patient is diagnosed with pulmonary tuberculosis based on a positive genetic
test. You order for culture and sensitivity test on Lowenstein Jensen media. In which of the following
scenario are you going to diagnose multi-drug resistant tuberculosis?

A. Resistance to Rifampicin

B. Resistance to Streptomycin and Quinolones

C. Resistance to Ethambutol and Penicillin

D. Resistance to Rifampicin and Isoniazid

E. Resistance to Streptomycin, Rifampicin and quinolones

121. A 40-year-old immune competent patient presents with long standing productive cough with
hemoptysis. You are investigating the patient for suspected tuberculosis. Which of the following
features are typical of pulmonary tuberculosis?

A. Pleural effusion

B. Pneumonia

C. Ascites

D. Presence of cavitation in lung parenchyma

E. Bones TB

122. A 64-year-old man presents to the emergency department with chest pain, fever, fatigue, and
arthralgias. His past medical history is for rheumatic heart disease and a dental procedure a few
weeks before admission. He currently shows no "stigmata" of endocarditis on physical examination,
although endocarditis is suspected. The most likely organism is which of the following?

A. Viridans streptococci.
B. Staphylococcus aureus.

C. Enterococcus faecalis.

D. Pseudomonas aeruginosa.

E. Staphylococcus aureus

123. A patient that recently had mitral valve replacement (38 days ago) was admitted to the clinic
with persistent fever and malaise. Endocarditis is suspected, the most likely aetiology is which of the
following organisms?

A. Group A streptococcus.

B. Vilidans streptococci.

C. Staphylococcus epidermidis.

D. Enterococcus faecalis.

E. Streptococcus aureus

124. A 45-year-old woman is scheduled for a major dental extraction in 3 days. She has a history of
rheumatic heart disease with mitral regurgitation. She is allergic to penicillin. Her physician asks whether
she should receive antibiotic before her procedure. Which of the following is the most appropriate
response?

A. Yes, ampicillin 2g orally 1 hour before the procedure.

B. Yes, clindamycin 600 mg orally 1 hour before the procedure
C. Yes, cephalexin 500 mg orally 2 hours before the procedure.
D. No, the most recent guidelines do not recommend prophylaxis in this situation.
E.

125. Diseases typically acquired from animals include:

A. Mycobacterium tuberculosis

B. Hepatitis A

C. Psittacosis

D. Vibrio cholera

E. Treponema pallidum

126. Live viruses are usually used for active immunization against:

A. Pertussis
B. Hepatitis

C. Typhoid fever

D. Poliomyelitis

E. Chikungunya

127. Prognosis of Diabetes:

A. Diabetic patients with proteinuria have a higher cardiovascular risk than those without it

B. Cardiovascular mortality is higher in diabetic than in non-diabetic people up to the age of 40

C. When sulfonylureas became available, there was a noticeable in cardiovascular mortality

D. Good glycemic control, on the balance of available evidence, can reduce cardiovascular mortality in
both type I and type 2 DM

E. Mildly ‘impaired glucose tolerance' do not increase cardiovascular risk

128. In a ward with several patients where two of the nurses have had much vomiting and some
diarrhoea over a 48-hour period, you should:

A. Send the patients home

B. Culture stools (and vomitus) for viruses

C. Treat everyone with metronidazole

D. Prevent only the patients affected from leaving the ward for investigations, physiotherapy etc.

E. Prevent the patients (affected or not) from leaving the ward for investigations,

physiotherapy etc.

129. Pleural aspiration is useful in the following situations:

A. In diagnosing mesothelioma

B. Pleural tuberculosis

C. Viral pleurisy

D. Empyema

E. Relieving breathlessness in patients with pneumonia

130. Pneumothorax is a recognized complication of:

A. Kyphoscoliosis

B. Lordosis

C. Cystic fibrosis

D. Pneumocystis carinii pneumonia

E. Chlamydia pneumonia

131. In acute myocardial infarction:

A. The diagnosis should be questioned if the jugular venous pressure is not raised

B. Streptokinase should not be given until the diagnosis has been confirmed by two sets of raised cardiac
enzymes

C. Dysrhythmias in the early hours after presentation carry a poor prognosis

D. Lidocaine should routinely be given to prevent dysrhythmias

E. Rupture of the interventricular septum is an uncommon but serious complication

132. Endocarditis:

A. In patients with a new stroke, endocarditis can be ruled out

B. It is important to take blood cultures over at least 24 hours to make the diagnosis

C. Transthoracic echocardiography is a sensitive

D. Most patients with Staphylococcus aureus bacteremia have endocarditis

E. Viral endocarditis leads to abnormality

133. In gout:

A. Furosemide (frusemide) helps to increase urate excretion

B. Large joints are not affected

C. Raised serum urate makes the diagnosis certain

D. Tophi are a late sign

E. Allopurinol is used to treat the acute attack

134. For primary hemochromatosis, the treatment of choice is:

A. Iron chelating therapy

B. Phlebotomy

C. Hydoxyuria

D. Plasmapheresis

E. Allogenic bone marrow transplant

135. Transfused red blood cells have a lifespan of:

A. 30 days

B. 60 days

C. 75 days

D. 90 days

E. 120 days

136. The Philadelphia chromosome is a feature of:

A. Acute Myeloid Leukemia

B. Chronic Lymphocytic Leukemia

C. Chronic Myeloid Leukemia

D. Acute Lymphoblastic Leukemia

E. Hairy Cell Leukemia

137. The commonest HIV-associated Lymphoma is:

A. Mantle Cell lymphoma

B. Diffuse Large B-Cell Lymphoma

C. Follicular Lymphoma

D. Hodgkin's Lymphoma

E. Plasma Cell Lymphoma

138. The commonest manifestation of Vaccine-Induced Immune Thrombotic Thrombocytopenia

(VITT):
A. Cerebral venous sinus thrombosis (CVST)

B. Splanchnic vein thrombosis

C. Pulmonary embolism

D. Ischaemic stroke

E. Myocardial infarction

139. Concerning bleeding disorders, the commonest cause globally is:

A. Haemophilia

B. Hereditary Haemorrhagic Telangiectasia

C. Von Willebrand Disease

D. Immune Thrombocytopenia

E. DIC

140. A 52-year-old woman with past medical history of HIV, Hypertension and T2DM presents with
acute onset of right-sided weakness and cessation of speech. What imaging study would you order?

A. Skull X-ray

B. CT brain

C. MRI brain

D. Carotid Doppler

E. Trans-cranial Doppler

141. A 59-year-old male newly diagnosed HIV presents with a two-week history of being unable to
walk. He reports ascending numbness and weakness over the past two weeks. There are no
bowel/bladder symptoms. Exam is notable for a flaccid paraplegia with areflexia. Toes are dowin
going. Which investigation would be most appropriate for him?

A. MRI spine

B. CXR

C. CSF studies

D. RPR

E. Urine LAM
142. A 21-year-old female college student is brought into the local emergency department with
multiple seizures. She was previously well except for a two-day history of headache and neckache.
She is intermittently following some simple commands and has neck stiffness. Her initial temperature
is 38.9°C. She underwent a non-contrasted head CT, which was normal. What is her diagnosis?

A. Meningitis

B. Meningoencephalitis

C. Encephalitis

D. Acute bacterial meningitis

E. Brain abscess

143. Which of the following is not a non-epileptic seizure?

A. Syncope

B. Migraine

C. Transient ischemic attack

D. Automatisms

E. Malingering

144. A 49-year-old alcoholic is not compliant with his anti-tuberculosis medication. He has increasing
fatigue and weakness with weight loss. His BP is 80/50mmHg. He has increased hyper-pigmentation
over the elbows. His cardiac exam is normal. What is the treatment of choice for this patient?

A. Hydrocortisone once per day

B. Hydrocortisone twice per day with fludrocortisone

C. Hydrocortisone only during periods of stress

D. Daily ACTH

E. Daily Dexamethasone

145. A 23-year-old man is brought to the emergency ward due to intractable seizure activity. His blood
sugar is found to be 1.8mmol/L. Which of the following conditions could underlie this presentation?

A. Cushing's syndrome

B. Hyperthyroidism
C. Addison's disease

D. Metformin use

E. Furosemide use

146. A 30-year-old woman presents with bilateral leg weakness and numbness following an episode of
diarrhoea 4 weeks ago. On examination, she has distal weakness in the hands and legs. Her reflexes
are difficult to elicit. Which one of the following should be used to monitor

A. ... blood pressure

B. ...X-ray

C. PEFR

D. FEV1/FVC ratio

147. A 35-year-old woman presents 6 hours after a deliberate overdose of paracetamol. The
paracetamol level is above the treatment line. Thirty minutes after starting an infusion of N-acetyl
cysteine (NAC) she becomes flushed and hypotensive with a blood pressure of 80/55 mmHg. The
infusion is stopped immediately, and 500 ml IV 0.9% saline administered over 30 minutes. Which of
the following is the correct ongoing management?

A. IV clorphenamine maleate and restart NAC infusion at lowest rate once symptoms resolved.

B.IV chlorpromazine and restart NAC infusion at lowest rate once symptoms resolved.

C. IV chlorphenamine maleate and give 2.5 g of oral mehionine.

D. IV chlorpromazine and give 2.5 g of oral methionine

E. Withhold treatment and recheck paracetamol level at 12 hours

148. A 21-year-old university student complains of difficulty sleeping. She is in the middle of sitting
her final examination and would like some medication for a few days to help her sleep. However, she
is concerned about potential 'hang-over' effects and would prefer a drug which doesn't cause daytime
drowsiness. Which agent would you prescribe?

A. Diazepam

B. Midazolam

C. Promethazine

D. Loprazolam

E. Clomethiazole
149. A 74-year-old woman presents with breathlessness. She is a small woman (55 kg) with a chest
infection. She is not very unwell, but is in atrial fibrillation at a rate of 170/min. Her electrolytes are
normal (K 4.2 mmol/L). As well as treating her pneumonia, you decide to digitalize by prescribing
digoxin:

A. 0:25 mg orally once daily

B. 1.0 mg orally over 24 hours in divided doses

C. 1.0 mg intravenously over 20 minutes

D. 0.125 g orally once daily 25 mg orally three times daily for one week

150. Which of the following sites is not involved in a posterior cerebral artery infarct:

A. Midbrain

B. Thalamus

C. Temporal lobe

D. Anterior Cortex

E. Frontal visual eye fields