7.

64 years old male presented with two months history of persistant cough and shortness of breath,
along with right sided chest discomfort. He was a heavy smoker and had multiple history of hospital
admission for exacerbation of COPD. On examination he is afebrile and has marked weight loss and
right sided pleural effusion. His pleural fluid analysis is as:
7.34
PH
protein
5gm/L
Glucose
LDH
64mg%
460 U/L Negative
800(cells/mcl
) Gram's stain
WBC
N
10%
L
90%
b) Malignant pleural effusion
d) Tuberculous pleural effusion
8. 60 yrs old male presented with right sided chest pain associated with fever and cough for 1 week.
On examination patient was alert, BP was 100/60 and respiratory rate was 32/min. Chest
examination reveals dullness to percussion with inspiratory crackles and bronchlal breath sounds on
right side. CXR done show right lower lobe consolidation. Instead of receiving appropriate antibiotics
for 1 week he remains unwell with Intermittent fever. A repeat CXR done which shows right sided
pleural effusion. Pleural fluid analysis shows
What is the most likely diagnosis?
Empyema
Parapneumonic effusion
Appearance
Purulent
Glucose
36mg%
pH
7.1
LDH
800 U/L Positive
Protein
5 gm/L
Gram's stain
WBC
16,000(cells/mcl)
N
78%
L
22%
a) Continue same antibiotic for another week
What should be the most appropriate next step?
b) Perform pleural biopsy
c) Start anti-tuberculous therapy
d) Tube thoracostomy drainage
9. 54 years old male, smoker presented in emergency department with acute onset of chest pain
and shortness of breath. On examination 02 saturation is 92% on room air, respiratory rate is
22breaths/min. There is decreased chest expansion, hyper resonant to percussion with reduced air
entry on auscultation on left side. What is the most likely diagnosis?
a) Primary pneumothorax
b) Secondary pneumothorax
c) Tension pneumothorax
d) Traumatic pneumothorax
10. 50 years old male with history of smoking and diabetes mellitus referred to the respiratory clinic
with two weeks history of fever, cough and shortness of breath on exertion. On examination
temp1000F, respiratory rate24/min and BP 110/70mmHg.Chest examination shows signs of
consolidation which is confirmed on CXR. What is the appropriate antiblotic treatment for this
scenario?
a) Beta-lactam(amoxicillin)
b) b) Doxycycline
c) Macrolides (clarithromycin, azithromycin)
d) Respiratory quinolones (moxifloxacin, levofloxacin)
11. A 56 yrs old male who has recently returned from holiday presents with a 5 day history of
malaise, dry cough, headache and diarrhea. The CXR shows widespread shadowing in both lung
fields. Which is the most likely causative organism of pneumonia in this patient?
Haemophilus influenza a)
b) Klebsiella pneumonia
c) Lgionellapneumophilia
d) Streptococcus pneumonia
12. All are the physical findings of Pneumonia EXCEPT
a) Bronchial breathing
b) Decreased vocal resonance
c) Dull to percussion
d) Whispering pectoriloquy
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13. A 54 years old male has been on anti-tuberculous drug for the last 6 months, complaining of
numb feet. Nerve conduction studies done shows axonal neuropathy. Which is the likely explanation
in this patient?
a) Isoniaizid induced neuropathy
b) Ethambutol induced neuropathy
c) Rifampicin induced neuropathy
d) Pyrazinamide induced neuropathy
14. 56 years old, non-smoker male presented with 3 months history of fever and night sweats. He
also complains that he is having productive cough, frequently with blood tinged sputum for the last 2
months. CXR shows nodular shadowing in the right upper zone. What is the likely diagnosis?
a) Post primary tuberculosis
b) Primary tuberculosis
c) Sarcoidosis
d) Small cell carcinoma of lung
15. Syndrome of Inappropriate antidiuretic harmone (SIADH) can develop in 10 to 15% cases of
a) Adenocarcinoma
b) Small cell carcinoma
c) Squamous cell carcinoma
d) Large cell carcinoma.
16. 30 yrs old female presented with 2 days history of acute shortness of breath and sharp right
sided chest pain. The patient also complaints of mild paln in right leg, which she is relating to 15 hrs
travelling one week back. Examination of the chest is clear however she is tachycardic. There is
evidence of swollen
tender right calf. The most likely diagnosis is: Deep vein thrombosis
b) Pneumothorax.
c) Pulmonary embolism
d) Myocardial infarction
17. The most appropriate statement regarding chronic bronchitis is:
a) Characteristically present in the fourth decade of life.
b) Daily productive cough for four months or more in at least three consecutive years. c) 80% of
patients have history of exposure to environmental smoke and occupational dust.
다 d) Type 11 respiratory failure is the late satge complication
18. 70 years old male has cough with blood stained sputum, mild chest pain and difficulty in
breathing, for the last one month. CXR shows a mass lesion with ipsilateralhilar lymphadenopathy.
You are suspecting bronchial carcinoma. Which of the following is most appropriate regarding
bronchial carcinoma?
a) Chest pain the most common presentation of bronchial carcinoma.
b) Squamous cell carcinoma is the commonest type, approximately 40% of all carcinomas.
Neuroendocrine markers are most often associated with non-small cell carcinoma.
d) Adenocarcinoma is rapidly growing and respond to chemotherapy and radiotherapy.
19. A 62 years old male known case of COPD presented with dyspnoea and bilateral pedal swelling
for the last six months. On examination there is raised juglar venous pressure, hepatomegaly and
peripheral edema. There is also loud second heart sound on cardiac auscultation. What is the most
likely diagnosis?
a) Cirrhosis of liver
b) Congestive heart failure
c) Cor-pulmonale
d) Pulmonary venous thromboembolism
20. You have advised a pulmonary function test to a patient whom you are suspecting Interstitial lung
disease. Which of the following will confirm your diagnosis?
a) Obstructive ventilatory defect with reduced carbon monoxide diffusing capacity
b) Obstructive ventilatory defect with Increased carbon monoxide diffusing capacity
c) Restrictive ventilatory defect with reduced carbon monoxide diffusing capacity
d) Restrictive ventilatory defect with increased carbon monoxide diffusing capacity
21. Which one of the following would shift the oxygen dissociation curve to the right?
a) Alkalosis
b) HbF
c) Low 2,3-DPG levels
d) High pCO2 levels
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22. A 62-year-old female is admitted with a suspected infective exacerbation of COPD. A chest x-ray
shows no evidence of consolidation. What is the most likely causative organism?
Pseudomonas aeruginosa a)
b) Haemophilus Influenzae
d) Streptococcus pneumonlae
c) Staphylococcus aureus
23. A 30-year-old female with a past history of asthma presents to the Emergency Department with
pleuritic chest pain. Chest x-ray shows a right-sided pneumothorax with a 1.5cm rim of air and no
mediastinal shift. What is the most appropriate management?
Admit for 48 hours observation
Intercostal drain Insertion b)
c) Aspiration
d) Discharge
24. Which one of the following causes of lung fibrosis predominately affect the lower zones?
Methotrexate a)
Sarcoidosis b)
c) Coal worker's pneumoconiosis
d) Ankylosing spondylitis
25. Each one of the following is a risk factor for lung cancer, except:
a) Radon
b) Cryptogenic fibrosing alveolitis
c) Coal dust
d) Asbestos
26. Which one of the following types of lung cancer is most associated with cavitating lesions?
a) Carcinoid
b) Large cell
c) Small cell
d) Squamous cell
27. Each one of the following is least associated with the development of chorea
a) Sarcoidosis
b) Wilson's disease
Anti-phospholipid syndrome c)
d) Pregnancy
28. A 53yo woman presented with pain in the eye, blurry vision and clumsiness for 3 months. She
has a history of difficulty in swallowing and weakness in her right upper limb 2y ago. What is the
investigation of cholce?
al CSF analysis
bl EEG
c) EMG
d) MRI brain
29. A woman has electric pains in her face that start with the jaw and move upwards. Her corneal
reflexes are normal. What is the most likely diagnosis?
Trigeminal neuralgia b)
a) Atypical face pain
c) Tempero-mandibular Joint dysfunction
d) GCA
30. Which one of the following functions is not induded in temporal lobe lesion?
a) Agraphia
b) Brocas aphasia
c) Acalculla
d) Homonymus field defect
31. Which one of the following functions is not included in occipital lobe lesion?
a) Flashes
b) Personality change
c) Visual field defects
d) Visiospatial defects
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32. Which one of the following is not included as a cause of amnestic syndrome?
a) Duchenne dystrophy
b) Alcohol
c) Arsenic
d) Stroke
33. A 25 years old lady came in the outpatient department with bitemporal hemianopla, where is the
lesion?
a) Optic tract
b) Optic chiasma.
c) Optic radiation
d) Occipital lobe
34. A 30 years old lady came in with presenting complaints of reduced vision in the right eye for one
week. She has similar complaints 2 months back for which she consulted a nearby GP who gave her
some medicines and the visual defect resolved in a couple of days. On examination her gait is
normal limbs normal, co ordination normal, bilateral planters downgoing, cranial nerves intact except
a slight pale disc of the right eye. What is the most likely diagnosis?
a) Multiple sclerosis.
b) Lebers hereditary optic neuropathy
c) Toxic optic neuropathy
d) Hypervitaminosis A
35. 60 years old diabetic male came in with presenting complaints of unilateral complete ptosis and
the eye faces down and out. Both pupils are reactive to light. Where is the lesion?
Trochlear nerve palsy
bl Oculomotor nerve palsy
c) Abducent nerve palsy
d) Internuclear ophthalmoplegia.
36. A 72 years old male came in the out patient department with presenting complaints of electric
shock like sensation in the lower right side of his face which is unilateral. It is aggravated by cold air
and cold water. Examination is unremarkable. What is the most likely diagnosis?
a) Facial nerve palsy (UMN)
b Facial nerve palsy (LMN)
c) Trigeminal neuralgia/tic douloureux
d) Hemifacial spasm
37. TAR DNA-binding protein 43 (TDP-43) is associated with which neurological dysfunction?
a) Demyelinating disease
b) Myopathic disease
c) Neurodegenerative disease
d) Neuro-oncologic disease
38. An 80-year-old gentleman attends the Emergency departmentwith a stroke affecting his left arm
and leg. He has had radiotherapy to the neck and there is a lot of scarring present. Carotid scanning
shows 70% stenosis on the right side. Which statement is correct?
a) Carotid endarterectomy is contraindicated
b) Carotid stenting is contraindicated
c) Carotid stenting is proven to be safer than carotid endarterectomy
d) Carotid stenting should be performed
39. A 90-year-old-lady attends the Emergency department with a dense stroke affecting her left arm
and leg. She is hemiplegic and confused. A CT scan confirms that there is a right CVA. Carotid
scanning shows stenosis of 75% on the right and 90% on the left. What is the best course of action?
a) Admit but no surgical Intervention
b) Bilateral carotid endarterectomy
c) Discharge and GP follow up
d) Urgent carotid endarterectomy on the left
40. A 75-year-old lady attends the Emergency Department with dizziness and fainting. She has fully
recovered. Neurological examination is normal. Carotid scanning shows stenosis of 80% on the right
and 90% on the left. Which of the following is the best course of action?
Bilateral carotid endarterectomy
b) Discharge and GP follow up
c) Discharge and outpatient follow up
d) Urgent carotid endarterectomy on the left
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41. A 79yo stumbled and sustained a minor head injury 2 weeks ago. He has become Increasingly
confused, drowsy and unsteady. He has a GCS of 13. He takes warfarin for atrial fibrillation. What is
the most likely diagnosis?
a) Extradural hemorrhage
b) Cerebellar hemorrhage
c) Epidural hemorrhage
d) Subdural hemorrhage
42. A 23-year-old female has a lumbar puncture to exclude a subarachnold haemorrhage following a
negative CT scan. Which one of the following factors would be most likely to influence the Incidence
of post-lumbar puncture headache?
a) Position of the patient
b) Increased fluld Intake post procedure
c) Opening pressure of CSF
d) Bed rest following the procedure
43. A 27-year-old man presents to the Emergency Department with 2 day history of severe
headache and pyrexia (38.2°C). A CT scan is reported as follows: CT Brain: Petechlal
haemorrhages in the temporal and inferior frontal lobes. No mass effect. Brain parenchyma
otherwise normal. What is the most likely diagnosis?
a) Brain abscess
b) Meningococcal meningitis.
c) Cerebral malaria
d) Herpes simplex encephalitis
44. In patients with Guillain-Barre syndrome, respiratory function should be monitored with:
a) Oxygen saturations
b) PEFR
c) Forced vital capacity
d) Arterial blood gases
45. An old man presents to his GP with difficulty driving. He reports not seeing cars approaching
from the right. On examination he has a right inferior homonymous quadrantanopia. Where is the
lesion most likely to be?
a) Left optic tract
b) Left parietal lobe
c) Optic chiasm
d) Right occipital lobe
46. A 47-year-old man with a known history of schizophrenia is admitted to the Emergency
Department due to confusion. A bottle of procyclidine tablets are found in his pocket. On
examination the temperature is 38.1°C with a blood pressure of 155/100 mmHg. Neurological
examination reveals a GCS of 13/15 but assessment of his peripheral nervous system is difficult due
to generalized increased muscle tone. What is
the most likely diagnosis? Neuroleptic malignant syndrome (e
b) Procyclidine overdose
c) Catatonic schizophrenia
d) Clozapine induced agranulocytosis
47. A 67-year-old woman is referred to a neurologist complaining of difficulty getting out of her chair
She is noted to have discrete erythematous papules over her metacarpophalangeal joints Her
creatine kinase is >4000, What is your diagnosis?
a) Dermatomyositis
b) Myasthenia gravis
c Myotonic dystrophy
d) Polymyositis
48. A pt was lying down on the operating table in a position with his arms hanging down for 3 hours.
Soon after he woke up, he complains of numbness and weakness in that hand and has limited wrist
movement/wrist drop and sensory loss over dorsum of that hand, weakness of extension of the
fingers and loss of sensation at the web of the thumb. What structure is likely to be damaged?
a) Radial nerve
b) Median nerve
c) Ulnar nerve
d) Axillary nerve
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49. A 41-year-old woman is Investigated for hot flushes and night sweats. Bloods show a
significantly raised FSH level and her symptoms are attributed to the menopause. Following
discussions with the patient she elects to have hormone replacement treatment. What is the most
significant risk of prescribing an oestrogen-only preparation rather than a combined
oestrogen-progestogen preparation?
Increased risk of venous thromboembolism
b) Increased risk of ovarian cancer
c) Increased risk of endometrial cancer
d) Increased risk of breast cancer
50. A 27-year-old female develops eye pain and reduced visual acuity following the initiation of
treatment for her recently diagnosed Grave's disease. Which one of the following treatments is likely
to have been started?
a) Radiolodine treatment
b) Thyroidectomy
c) Propylthiouracil
d) Carbimazole and thyroxine
51. A 63 years old male patient, known diabetic for last 15 years, two months ago his HbA1c was
9.8% and currently on combination of Sitagliptin/Metformin. He reports that for last 8 months he is
suffering from ongoing fatigue, loss of appetite and Right foot numbness that has now progressed to
foot drop. He reports history of significant unintentional weight loss. Which complication of Diabetes
mellitus has this patient developed?
a) Symmetric sensory Polyneuropathy
b) Diabetic Amyotrophy
c) Mononeuritis Multiplex
d) Autonomic Neuropathy
52. 13 years old girl presented in emergency room in altered level of consciousness. Her mother
tells you that she had 3 episodes of vomiting at home. On examination, She is having BP
80/40.Pulse 120bpm, R/R 40/min. She appears clinically dehydrated and confused. Her Initial RBS
is 578mg/dl with a serum osmolarity if 300mosm/kg. Her family denies any significant past history.
What is the likely diagnosis
a) Hyperglycemic Hyperosmolar state
b) Diabetic ketoacidosis
Metabolic encephalopathy
d) Acute gastroenteritis with complications
53. A 74yo smoker presented to his GP with cough and SOB. Exam revealed pigmentation of the
oral mucosa and also over the palms and soles. Tests show that he is diabetic and hypokalemic.
What is the most probable dx?
a) Pseudocushing syndrome
b) Conns disease
c) Ectopic ACTH
d) Cushings disease
54. A 45 years old patient is newly diagnosed as Type 2 DM, his HbA1c is 7.5%, BMI 29kg/m2.You
advice. weight loss and dietary modification. Which medication will you consider starting if no
response to above measures?
a) Biguanide
b) Sulfonylurea
c) DPP-4 inhibitor
d) GLP-1 analogue
55. Which one of the following is a recognised cause of hypokalaemia associated with hypertension?
(e Liddle's syndrome
b) Bartter's syndrome
c) Gitelman syndrome
d) Ciclosporin
56. A woman presents to her GP with a painful neck, rapid heartbeat, palpitations and feeling warm.
A few weeks ago, she experienced general malaise and fever and suspected she had viral flu which
has resolved. She is otherwise healthy and takes no medications. On examination, her thyrold is
palpable, enlarged and tender. Labs show TSH 0.08mU/L (0.5-5.5), FT4 26pmol/L (9.0-18). What is
the likely diagnosis
a) Graves Disease
b) Hashimoto thyroiditis
c) de Quervain's thyroiditis
d) Multinodular golter
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57. A 32 years old woman presented with a 6 weeks history of 7kg weight loss and heat intolerance.
Investigations revealed raised FT4 and low TSH. Which of the following feature would support
diagnosis of Graves disease
a) Unilateral exophthalmos
b) TSH receptor antibodies.
c) Anti thyroperoxidase antibodies.
d) Thyroid swelling with nodules.
58. A 17 years old female presented with one year history of secondary amenorrhea. On
examination, she has galatrorhhea, Her Prolactine concentration is 6000mU/L. Pregnancy test is
negative What is most likely
a) diagnosis Non functioning pitultary tumour
b) Polycystic ovarian syndrome.
c) Pluitary micro adenoma
d) Turner syndrome
59. A 24 years old woman who is 2 months pos: partum and breast feeding, attends your clinic with
symptomatic hyperthyroidism Which of the following treatment would you initiate in this patient to
treat
her hyperthyroidism Radioactive lodine. a)
b) Carbimazole
c) Propylthiouracil
d) Immediate subtotal thyroidectomy
60. 45 years old man comes for follow up after a recent emergency department visit for abdominal
pain. The pain subsided with analgesics. He was found to have raised Blood pressure and an
incidental right adrenal mass on abdominal ultrasound. He has no symptoms except mild headache
which he thinks is due to work related stress. On examination BP 160/94mmHg.Labs reveal serum
potassium 3.0 and Sodium 146mEq/L. Further workup will most likely show
al High plasma renin, High plasma aldosterone
b) Low plasma renin, low plasma aldosterone
c) High plasma renin, low plasma aldosterone
d) Low plasma renin, High plasma aldosterone
61. A 21 year old man with type 1 Diabetes mellitus presents to the emergency department with
complains of abdominal pain, nausea and vomiting. His temperature is 36C, pulse 110/min, BP
102/60mmHg and RR 26/min. Lungs are clear to auscultation. Abdomen is soft and non-tender.
Blood tests done which include Na 130mEq/L, Potassium 5.2mEq/L, CI 90mEq/L, Bicarbonate
10mEq/L, Blood sugar 450mg/dl. Which of the following is most appropriate step in management?
a) Normal saline and regular insulin
bl 0.45% saline and regular insulin
5% Dextrose water and NPH insulin
d) Sodium bicarbonate.
62. A 29 years old female presents to emergency department with nausea, vomiting, generalized
abdominal pain and hypotension. Her past medical history is significant for Hashimoto thyroiditis, for
which she is taking levothyroxine. Her BP 70/50, Pulse 110/min, Temp 37C and RR 24/min. Mucous
membranes are pigmented and skin creases also show increased pigmentation. Lab tests reveal
serum sodium 130mEq/L, Serum potassium 6.1mEq/L, Blood glucose 56mg/dl. What is most likely
diagnosis?
a) Cushing disease
b) Addison disease
c) Primary Hyperaldosteronism
d) D.Worsening of her thyroid Iliness
63. A 49 years old woman comes with complains of progressively worsening headaches. She also
reports diffuse joint pain, pain on the lateral half of her right hand, difficulty getting her wedding ring
off due to finger swelling. She has poorly controlled hypertension despite being compliant with
medications. Her facial features has become coarse and palms are sweaty. Keeping in mind the
probable diagnosis, which Investigation will you order?
a) IGF-1 level
b) Serum cortisol
c) Random growth hormone level
d) Dexamethasone suppression test
64. Famillal hypercholesterolemla follows which mode of Inheritance?
a) Autosomal recessive
b) Autosomal Dominant
c) X-linked recessive
d) X-linked dominant
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65. A 45-year-old woman is investigated for weight gain. She had had been unwell for around four
months and described a combination of symptoms including depression, facial male-pattern hair
growth and reduced libido. During the work-up she was found to be hypertensive with a blood
pressure of 170/100 mmHg. Which one of the following tests is most likely to be diagnostic?
a) A High-dose dexamethasone suppression test
b) A Pelvic ultrasound
c A Overnight dexamethasone suppression test
d) A 24 hr urinary free cortisol
66. Predominant hypertriglyceridemia is treated with
a) Statins
b) Fibrates
c) Bile acid sequestering resins.
d) Ezetimibe
67. Which of the following is east associated with Hypothyroidism
a) Carpal tunnel syndrome
b) Myxoedema
c) Atrial fibrillation
d) Periorbital puffiness.
68. A 24 year old man is presented in ER, collapsed at the gym. He describes symptoms of
headache, feeling flushed with associated palpitations and sweating. He was observed by his friends
to become pale before he collapsed. He is persistently hypertensive and a 24-hour urine collection
shows elevated metanephrines. First-line treatment for this condition should be with which of the
following?
a) Dexamethasone
b) Fludrocortisone
c) Phenoxybenzamine
d) Bisoprolol
69. A 33 year old man undergoes a CT scan for recurrent headaches, which reveals a pituitary
adenoma. On further questioning, he has been feeling more tired over recent months and low in his
mood. He is tested for pituitary dysfunction and visual field disturbance. The secretion of which
hormone is often the first to be affected due to mass effect by a pituitary macroadenoma?
a) ACTH
b) GH
c) LH
d) TSH
70. A 53 years old woman whose thyroid function tests have been stable and within the normal
range on 200micrograms of levothyroxine for the last 6 months .Which of the following is associated
with increased bioavailability of levothyroxine?
a) Calcium
b) Iron
Cholestyramine
d) Vitamin C
71. A 45-year-old woman presents with weight gain and recurrent 'dizzy' episodes. Over the past
four months she has gained 20 kg. The episodes occur on an almost daily basis and are
characterised by blurred vision, sweating, headaches and palpitations. Her GP checked a blood
sugar during one of these episodes which was record as being 1.4 mmol/l. What is the single most
useful test?
a) Glucagon stimulation test
b) Oral glucose tolerance test with growth hormone measurements
c) Insulin + C-peptide levels during a hypoglycaemic episode
d) Short ACTH test
72. A 25-year-old woman presents for her first cervical smear. What is the most important
aetiological factor causing cervical cancer?
a) Human papilloma virus 6 & 11
b) Herpes simplex virus 2
c) Smoking
d) Human papilloma virus 16 & 18
73. What chromosome abnormality is associated with Klinefelter's syndrome?
a) 47, XO
b) 47, XXY
c) 46, XXY
d) 47, XYY
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74. A 61-year-old man presents as he developed enlargement of his breast tissue. He has become
very self-conscious and is worried about going on holiday in the summer. Which one of the following
drugs is most likely to be responsible?
a) Amitriptyline
b) Isoniazid
c) Verapamil
d) Spironolactone
75. A 25-year-old Asian woman who Is 26 weeks pregnant has an oral glucose tolerance test
(OGTT). This was requested due to a combination of her ethnicity and a background of obesity. A
recent ultrasound shows that the fetus is large for dates. The following results are obtained:
Time (hours)
0
2
Blood Glucose (mg/dl)
166
266
What is the most appropriate management?
a) Start Insulin
bl Give advice about a diabetic diet
c) Give advice about a diabetic diet + repeat OGTT In 4 weeks
d) Start metformin
76. A 35-year-old gentleman is followed up In general practice after a routine health check at work
has identified high blood pressure. He has been started on initial anti-hypertensive therapy whilst
awaiting investigation. He is otherwise well with no past medical history of note. He reports that his
grandfather had been previously diagnosed with Conn's syndrome at an early age. Which of the
following can interfere with testing for primary hyperaldosteronism?
a) Digoxin
b) Amlodipine
c) Ivabradine
d) Ramipril
77. A 30-year-old female is started on carbimazole 20mg bd following a diagnosis of Grave's
disease. What is the best blochemical marker to assess her response to treatment?
a) Total T4
b) TSH
c) Free T4
d) ESR
78. Which one of the following is not associated with Addison's disease?
al Hypoglycaemia
b) Metabolic alkalosis
c) Hyponatraemia
d) Hyperkalaemia
79. A 53 year man presents as his wife has noticed a change in his appearance. He has also noticed
his hands seem larger. On examination blood pressure is 170/94 and he is noted to have bitemporal
hemianopia. What is the most appropriate first-line treatment?
Octreotide
b) External irradiation
c) Pegvisomant
d) Trans-sphenoidal surgery
80. An Insulin stress test is most useful in the Investigation of:
a) Glucagonoma
b) Insulinoma
cl Addison's disease
d) Hypopituitarism
81. A 42 years male with past history of asthma presents with arthralgia and right wrist drop. On
examination palpable purpura are present over the extremitles. Complete blood count reveals
eosinophilia and urine D/R shows RBCs +++and protein++.What is the most likely diagnosis:
a) Microscopic polyangitis
b) Polyarteritis nodosa
c) Churg Strauss disease
d) Henoch-Schonlein purpura
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82. In a patient with dermatomyositis the best Investigation to perform is:

a) MRI of affected muscle
b) Electromyography
c) Muscle biopsy
d) Creatine kinase.
83. A 60 year old female history of long standing deforming rheumatoid arthritis, she has been on
DMARD therapy for past couple of years presents with one week history of worsening painful
swollen left knee, and fever. On examination she is febrile, left knee Is warm, tender, with erythema
and marked limitation of both active and passive range of motion. Which of the following
investigations would be most helpful in this clinical scenario?
a) X ray left knee Joint
b) C-reactive proteins
c) Complete blood count
d) Arthrocentesis
84. A 39 year old married woman presents to clinic with an oligoarthritis affecting her right ankle,
right knee, and both wrists. Four weeks ago she had diarrheal Illness. On examination she is
afebrile, having effusions of her right ankle, right knee and both wrists. Initial investigations: WCC 3.5
x109/1, CRP 92 mg/L. Right knee aspirate-no organisms. Moderate white cells. No growth. What is
the most likely diagnosis?
al Infectious mononucleosis
b) Relters Syndrome
c) Reactive arthritis
d) Enteropathic arthritis
85. A 45-year-old women has been receiving chloroquine for Rheumatoid arthritis, which one of the
following should be monitored on regular basis?
a) Renal toxicity
b) Retinal toxicity
c) Liver toxicity
d) Pulmonary toxicity
86. Which of the following pharmacologic classes has been shown to be effective in treating
Raynaud's phenomenon?
a) Calcium channel blockers.
b) ACE receptor blockers.
c) Alpha-1 blockers.
d) Beta-1 blockers
87. Regarding clinical management of systemic lupus erythematosus intravenous pulse therapy with
methylprednisolone is used under which of the following clinical condition?
a) Fever, arthritis, and weight loss
b) lupus pneumonitis
c) digital gangrene
d) Leucopenia and thrombocytopenla
88. Which one of the following is related to the radiological features of osteomalacia:
a) Looser zones are complete stress fractures of long bones b) Codfish vertebrae are formed due to
pressure of discs
c) Trefoil pelvis is due to fracture of pelvis girdle
d) Looser zones commonly found at vertebral disc
89. Low levels of which one of the following types of complement are associated with the
development of systemic lupus erythematous?
a) C4
bl C5
c) C6
d) C7
90. A 50 years male having no known co- morbid presents with severe pain and swelling of right
ankle Joint which is red, hot and tender. Which of the following is the most likely diagnosis?
a) Pseudogout
b) Gout
c) Septic arthritis
d) Reactive Arthtitis
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91. A 70-year-old man with a history of hypertension and type 2 diabetes mellitus, presents to the
emergency department with a 5 days history of sudden onset of throbbing headache, right sided
facial and jaw pain when chewing food. He also complains of new-onset progressive blurry vision in
his right eye. On examination his blood pressure is 120/80mmHg and scalp tenderness is present on
right side. Laboratory investigation sreveal HbA1c of 5.5%, and an erythrocyte sedimentation rate
(ESR) greater than 115 mm/hr. What is the most appropriate Investigation to establish the
diagnosis?
a) Computed tomography scan of head
b) Magnetic resonance angiography braln
c) Fundoscopic examination
d) Temporal artery blopsy
92. A 38 years old male patient who presented with fatigue and polyarthalgia is found to be ANA
positive. He is suspected to be suffering from drug Induced SLE. Which of the following drug has
shown to be associated with drug Induced SLE?
a) Isoniazid
b) Rifampicin
c)
Leflunomide
d) Methotrexate
93. A 32years old female presents with six months history of arthralgia, photosensitivity and bluish
discoloration of fingers and toes upon exposure to cold. Which of the following is the best screening
test for this patient?
a) C-reactive protein
b) Anti double stranded DNA
cl Anti neutrophil antibody(ANA)
d) Anti Smith antibody
94. A patient with rheumatoid arthritis taking DMARD combination therapy since 2 years presented
with disease progression and increasing joint deformities. Which one of the following drug would be
most effective in this scenario:
a) Cyclophosphamide
b) Cyclosporin
c) TNF blockers
d) Azathioprin
95. A 27-year-old chronic smoker presents with ulceration of the tip of the right second, third, and
fourth toes. He gives a history of recurrent pain in both lower limbs, migratory superficial phlebitis of
the feet occurring a few months ago. Physical examination findings are remarkable for absent
bilateral posterior tibial and dorsalispedis pulses with palpable popliteal pulses. What Is the most
likely diagnosis?
a) Thromboanglitisobliterans (Buerger's disease)
b) Lupus vasculiti
c) Raynaud's syndrome
d) Atherosclerosis obliteran
96. A 32 years old diabetic patient presented with shortness of breath and cough. On examination
her sinuses found to be tender. There is also one episode of hemoptysis. On imaging studies, CT
chest shows cavitatory lesions. The most probable diagnosis is:
a) Chrugstrauss syndrome.
b) Granulomatosis with polyangitis.
c) Interstitial pneumonitis.
d) SLE with tuberculosis.
97. Which of the following vasculitis is not ANCA associated vasculitis?
a) Granulomatosis with polyangitis
b) Chrugstrauss syndrome.
c) Microscopic Polyangitis
d) Buergers disease
98. A 45 years old female with history of recurrent episodes of pain and bluish discoloration of digits
upon exposure to cold presents with dysphagia.Examination reveals yellowish deposits and skin
thickning over extensor surface of hands along with dilated vessels over hands and face. What is the
most likely
diagnosis? Anti phosholipid syndrome a)
b) CREST syndrome
c) Overlap syndrome
d) Sjogrens syndrome
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99. A 30 years homosexual male presents with one week history of high grade fever and severe pain
and swelling In right knee Joint. Synovial fluid reveals purulent fluid and WBC of>50,000cell/mm. A
diagnosis of gonococcal arthritis is suspected. Which of the following antibiotic combination should
be started after
sending synovial fluid culture? a) Azithromycin and third generation Cephalosporins
b) Amoxacillin and third generation Cephalosporin
c) Vancomycin and third generation Cephalosporin
d) Levofloxacin and third generation Cephalosporin
100. Which one of the following is the most appropriate investigation for the diagnosis of
osteoporosis in a 55-years-old female with history of premature menopause and having body mass
index (BMI) of 18.57
a) Serum calcium & alkaline phosphatase
b) Serum hydroxyl vitamin D levels
c) X-ray lumbosacral spine & hips
d) Dual energy x-ray absorptiometry
101. Which one of the following is not associated with carpal tunnel syndrome?
a) Tinel's sign
b) Compression of the median nerve
c) Wasting of the hypothenar eminence
d) Flexion of the wrist reproduces symptoms
102. Which one of the following is most recognised as a potential complication in a patient with
ankylosing spondylitis?
a) Heart block
b) Aortic stenosis
c) Achalasia
d) Diabetes mellitus
103. Olanzapine is known to block D2 dopamine receptors. What other type of receptor does it
mainly act on?
a) Alpha-adrenoceptors
bl Acetylcholine receptors
c) Serotonin receptors
d) D1 dopamine receptors
104. A 24-year-old female is reviewed following a course of cognitive behavior therapy for bulimia.
She feels there has been no improvement in her condition and is interested in trying
pharmacological treatments. Which one of the following is most sultable?
a) Low-dose citalopram
b) Low-dose fluoxetine
Low-dose amitriptyline.
d) High-dose fluoxetine
105. A 25-year-old man with a history of schizophrenia is prescribed olanzapine. Which one of the
following adverse effects he is most likely to experience?
a) Anorexia
b) Parkinsonism
c) Hypertension
d) Weight gain
106. Which one of the following is not associated with a poor prognosis in schizophrenia?
a) Acute onset
b) Strong family history
c) Low IQ
d) Premorbid history of social withdrawal
107. A patient with a history of depression presents for review. Which one of the following suggests
an
Increased risk of suicide?
al Being 25-years-old
b) History of arm cutting
c) Being married
d) Female sex
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108. 72-year-old man who is having trouble sleeping is prescribed temazepam. What is the
mechanism of action of temazepam?
Inhibits the effect of acetylcholine
b) c) Enhances the effect of gamma-aminobutyric acid Inhibits the effect gamma-aminobutyric acid
d) Inhibits the effect of glutamate
109. A 24-year-old male is admitted to the Emergency Department complaining of severe abdominal
pain. On examination he is shivering and rolling around the trolley. He has previously been
investigated for abdominal pain and no cause has been found. He states that unless he is given
morphine for the pain he will kill himself. This is an example of:
a) Hypochondrial disorder
b) Conversion disorder
c) Malingering
d) Munchausen's syndrome
110. A 36-year-old patient presents with nausea, headaches and palpitations. He has had multiple
previous admissions with such symptoms over the past 2 years, each time no organic cause was
found. What kind of disorder is this likely to represent?
a) Munchausen's syndrome
b) Hypochondrial disorder
c) Somatisation disorder
d) Conversion disorder