FACULTY OF MEDICINE

UNIVERSITY OF COLOMBO
FINAL MBBS EXAM – DECEMBER 2019
ACADEMIC YEAR – 2012
MEDICINE

Multiple choice questions

01. Drugs with survival benefit in cardiac failure
a. Digoxin
b. Ivabradine
c. Frusemide
d. Carvedilol
e. Spironolactone
02. Thrombocytopenia occurs in
a. Chronic liver cell disease
b. Hemophilia A
c. SLE
d. Leptospirosis
e. Polycythemia rubra vera
03. Renal diseases correctly matched with the cause
a. Membranous nephropathy – bronchial CA
b. Acute interstitial nephritis – ibuprofen treatment
c. Acute tubular necrosis – low dose aspirin
d. Acute cortical necrosis – Russel’s viper
e. Chronic interstitial nephritis – metformin
04. In the management of cardiac failure, influencing renin angiotensin aldosterone system,
a. Is done by the use of ramipril
b. …………………………
c. Improves remodeling of heart
d. Should be considered in all patients
e. Is indefinitely used in patients with left ventricular failure
05. Advantages of LMWH over unfractionated heparin
a. No need of monitoring
b. Effect is easily reversible
c. Due to its long half life, it doesn't have to be given as an infusion

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 d. Less heparin induced thrombocytopenia
e. Can be managed as outpatient

06. Regarding giant cell arteritis

a. Is a large vessel vasculitis
b. Visual loss is a complication
c. Is treated with high dose steroids
d. Is associated with polymyalgia rheumatica
e. ESR is < 50mm/ 1st hour in majority
07. Regarding erysipelas
a. Edges are discrete and merge into the skin
b. Caused mainly by group A beta hemolytic streptococci
c. Affect dermis and superficial subcutaneous tissue
d. Systemic spread can cause multi organ dysfunction
e. Penicillins are the treatment of choice
08. Regarding pneumonia
a. ………………………..
b. Erythromycin is an alternative for doxycycline in atypical pneumonia
c. Treatment with ciprofloxacin delays the diagnosis of tuberculosis
d. Cough persisting without fever is an indication to change the antibiotics
e. Chest radiography features resolve before the resolution of clinical symptoms
09. Prolonged use of inhaled corticosteroids cause,
a. Hoarseness of voice
b. Fetal growth restriction
c. Oropharyngeal candidiasis
d. Diabetes mellitus
e. Sleep disturbances
10. Hyponatraemia is a feature of,
a. Adrenal failure
b. Decompensated cirrhosis
c. Treatment with metformin

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 d. SIADH
e. Thiazide diuretics

11. Regarding scrub typhus

a. Causes meningoencephalitis
b. Causative organism is Rickettsia prowazekii
c. Presence of eschar is useful in the diagnosis
d. Weekly doxycycline therapy can prevent the disease
e. Causes thrombocytopenia
12. Regarding tuberculosis
a. People vaccinated with BCG rarely get TB
b. Isolation of bacteria in sputum is essential for diagnosis
c. …………………………….
d. If spine is involved, duration of therapy 9 months
e. It's a notifiable disease in Sri Lanka
13. Postural hypotension is a feature of,
a. Addison’s disease
b. Prazosin therapy
c. Diuretic therapy
d. Pheochromocytoma
e. Steroid therapy
14. Regarding a lesion in the posterior column
a. …………………………..
b. It causes ipsilateral joint position sensory loss
c. Causes contralateral hemiparesis
d. Tendon reflexes are absent
e. Rhomberg test is positive
15. Which of the following are true regarding X linked dominant diseases?
a. When females are affected, they show more signs.
b. Male to male transmission can occur
c. Consanguinity does not affect the outcome

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 d. Females transmit only to males
e. Affected females will transmit the disease to 25 % of their off springs.

16. Regarding Guillen Barre Syndrome,

a. Presence of a sensory level is a characteristic feature
b. Exaggerated tendon reflexes present
c. Cerebrospinal fluid protein is increased
d. MRI scan is essential in diagnosis
e. Steroids are the mainstay of treatment
17. Regarding ascites
a. More than 500ml causes shifting dullness
b. More than 100ml can be seen in USS
c. Polymorphs 250/µl is diagnostic of bacterial peritonitis
d. Adenosine deaminase will increase in TB peritonitis
e. Portal hypertension has a SAAG score more than 1.1
18. Regarding gastric mucosa
a. Secreted by G cells of the stomach
b. Acetylcholine stimulates gastrin secretion
c. Ranitidine blocks the action of H+ / K+ ATPase
d. Helicobacter pylori stimulates gastrin secretion
e. Gastric acid secretion is inhibited by prostaglandin E2
19. Regarding hepatitis virus serology
a. A positive Hepatitis B Surface antigen indicates active infection
b. IgM antibodies to hepatitis B core antigen is positive in acute infection
c. Hepatitis B surface antigen and anti HBs antibodies can co-exist
d. Presence of Hepatitis B e antigen is indicative of infectivity
e. Anti Hbs antibody in blood shows presence of immunity
20. Regarding acute kidney injury
a. Adequate replacement of the volume will reverse pre renal failure
b. Brown muddy granular casts- glomerular nephritis???
c. Renal biopsy is contraindicated in anuria

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 d. Pericarditis is a complication
e. Diuretics improve survival

Single best responses

01. A 35-year-old female with low grade fever and headache for 2 weeks. Imaging shows enlarged
ventricles and basal exudate. What would you expect in CSF report?
a. Lymphocytic predominant, low glucose, high protein
b. Lymphocytic predominant, normal glucose, low protein
c. Lymphocytic predominant, normal glucose, normal protein
d. Neutrophil predominant, normal glucose, normal protein
e. Neutrophil predominant, low glucose, high protein
02. A 35-year-old male, strong family history of diabetes presented for a medical checkup. BP –
130/90, CVS and RS examination normal.
Investigation results,
FBS – 140
HbA1c – 7.2%
Total cholesterol - 220 (>200)
LDL cholesterol – 160 (>150)
AST – 60 (10-40)
ALT – 80 (10-60)
Serum creatinine – normal
a. Start metformin
b. Start sitagliptin
c. Start gliclazide
d. Start Insulin
e. Review with fasting blood sugar after one month without starting medication
03. A 36-year-old male, with a history of an unprotected sexual act 4 weeks ago, presents to STD
clinic with a painless ulcer on penis. Previously well. What’s the Possible lesion?
a. Chancroid
b. Genital herpes
c. Gonorrhea
d. Syphilis

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 e. Chlamydia
04. A 35-year-old male presents with wheezing and productive cough of 4 days duration which is
not responding to inhaled salbutamol and high dose beclomethasone. He used to smoke 5
cigarettes per day since 25 years of age and stopped 1 year back as advised by a doctor. O/ E
dyspneic, diffuse BL rhonchi, normal CVS examination. CXR normal.
ESR 25
WBC 15
N 50%
L 38%
E 12%
HRCT - Right sided dilated primary and secondary bronchi
What is the most probable diagnosis?
a. Asthma
b. Chronic obstructive pulmonary disease
c. Pulmonary tuberculosis
d. Allergic Broncho-pulmonary aspergillosis
e. Bronchiectasis
05. 56y old male. Known diabetic. Past history of rheumatic heart disease. Presented with sudden
onset LL weakness. O/E bilateral flaccid paralysis. Power 2/5. Pain sensation impaired up to
umbilicus level. Intact joint position.
What is the most probable diagnosis?
a. GBS
b. Transverse myelitis
c. Cauda equina syndrome
d. Anterior spinal artery occlusion
e. Diabetic amyotrophy
06. In Cushing syndrome, what feature is more suggestive of an ectopic ACTH secreting tumor?
a. Hyponatremia
b. Excessive cortisol
c. Glucose intolerance
d. Metabolic alkalosis
e. Refractory hypokalemia

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 07. A 22-year-old male, returned from India 1 month back. Now has intermittent fever with chills
and rigors, headache, arthralgia and myalgia for 1 week. On examination mild hepatomegaly
with no lymph node enlargement. FBC: WBC normal, Hb – 10.8, platelets – 120,000.
Most appropriate initial investigation to come to a diagnosis?
a. Urine microscopy
b. HIV antibody
c. MAT for leptospirosis
d. Blood culture
e. Malaria blood film
08. A 50-year-old male from UK visiting Sri Lanka for a short vacation presented with acute onset
difficulty of breathing, cough and left sided chest pain. Well controlled asthma on combined
inhalers, smoking 10 pack years. On examination, no fever, Pulse rate was 120 and Blood
pressure 112/72 mmHg, Respiratory examination was unremarkable. SpO2 was 88%. ECG -
Sinus tachycardia with V1-V4 leads T inversions. Full Blood Count normal.
Most probable diagnosis?
a. Acute exacerbation of asthma
b. Acute exacerbation of COPD
c. Myocarditis
d. Acute coronary syndrome
e. Pulmonary embolism
09. A 65-year-old man presented with acute onset right sided upper limb and lower limb
weakness of 2 hours duration and he had difficulty in understanding what other people are
speaking. Blood pressure was 170/110mmHg and pulse rate 88 bpm. What’s the next step of
management?
a. ……………………
b. Infusion of IV labetalol
c. IV tissue plasminogen activator
d. Start him on warfarin 5mg/day treatment
e. Treat with S/C enoxaparin
10. A 35-year-old man with chronic bloody diarrhea. Which of the following favor the diagnosis of
Crohn’s disease over ulcerative colitis?
a. Pancolitis

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 b. Perianal abscess
c. Past history of perianal fistula
d. Elevated fecal calprotectin
e. Positive family history
11. A 40-year-old male presented with periorbital edema for 2 days. O/E : BP – 160/100, RS
examination – bilateral basal crepitations
UFR findings –
Protein +
RBC ++
Granular casts
Pus cells – nil
Serum creatinine – 1.8
Most probable diagnosis?
a. Acute interstitial nephritis
b. Acute glomerulonephritis
c. ………………………….
d. Nephrotic syndrome
e. Undiagnosed CKD
12. Which of the following best describes the confidence interval?
a. Ranges of the means of the population
b. 95% chance that the sample mean will fall within the confidence interval
c. ………………………
d. 95% chance that the population mean will fall within the confidence interval
e. 0.05 probability that the population mean will fall within the confidence interval
13. 25 year old male returned from holiday came with a left sided chest pain for 1 day duration.
He had flu for 3 days. The pain was episodic and ceases on expiration. ECG was done. There
were ST elevations in anterior and lateral leads. CRP=30, WBC=11, troponin +. What is the
most likely diagnosis?
a. Acute coronary syndrome
b. Acute pericarditis
c. Pneumothorax
d. Pleural effusion

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 e. ………………..
14. 35-year-old female presents with icterus and generalized pruritus. Her INR is 2.5, total
bilirubin 2.5 and ALP 800. USS is suggestive of CLCD. Best investigation to check for aetiology?
a. anti-mitochondrial antibody
b. Hepatitis B surface antibody
c. Hepatitis C antibody
d. Serum ceruloplasmin level
e. Anti – smooth muscle antibody
15. 45-year-old male presenting with first episode of UTI. Culture positive for E. coli. What is the
next best investigation?
a. Cystoscopy
b. DMSA
c. Screening for STD
d. USS KUB
e. IV urogram
16. 20-year-old previously healthy female, presenting to hospital after ingesting an unknown
number of paracetamol tablets. What is the next best management option?
a. Gastric lavage followed by NAC
b. N-acetyl cysteine
c. Active charcoal
d. Methionine
e. Wait for one more hour and do according to nomogram
17. 45-year-old IV drug user presenting with intermittent fever and a murmur on left lower
sternal edge. Diagnosed to have infective endocarditis. Most probable causative organism?
a. Streptococcus epidermidis
b. Streptococcus bovis
c. Streptococcus viridans
d. Pseudomonas aeruginosa
e. Staphylococcus aureus
18. 15-year-old girl presenting with past history of intermittent jaundice for last few years.
Investigations are as follows.
Hb – 13.2

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WBC – 6.3, N – 62%, L – 34%
Platelets – 282
LDH – 200
Direct bilirubin – 6
Indirect bilirubin – 34
AST – 14
ALT – 26
INR – 1.2
ALP – 140
GGT – 25
Most likely diagnosis?
a. Gilbert syndrome
b. Biliary atresia
c. Dubin Johnson syndrome
d. Cholecystitis
e. Rotor syndrome
19. 18-year-old school boy present with one day history of reduced urine output. He is previously
healthy and is a long-distance runner.
BU – 10
Serum creatinine – 900
Na – 132
K–6
Possible etiology for his renal failure?
a. CKD
b. Dehydration leading to hypotension
c. Interstitial nephritis
d. Rhabdomyolysis
e. ……………………………
20. A patient presenting 4 hours after ingestion of an organophosphate. BP – 80/50, PR – 56, RR –
23, SpO2 – 88%. On auscultation crackles were heard. Next most appropriate step of
management?
a. 250ml 0.9% NaCl

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 b. Nebulize with salbutamol
c. Oxygen via venturi mask
d. Atropine 3mg IV bolus
e. Pralidoxime 1g IV over 30 minutes
21. 50-year-old patient presenting with central chest pain which is relieved on expiration. CVS and
RS examination normal. ECG – prominent R wave and ST depression in V1 and V2. Most
probable diagnosis?
a. Brugada syndrome
b. NSTEMI
c. Posterolateral MI
d. True posterior MI
e. Myocarditis
22. 40-year-old banker who has taken ‘’long term over the counter’’ medication for a chronic
headache presented to the ward with headache. BP – 120/80. His father has died due to a
stroke at the age of 40 years. On examination, he has small ecchymotic patches over the
tongue and lateral aspects of fingers. Most likely condition?
a. PCKD
b. Chronic drug abuse causing gastric erosion
c. Chronic drug abuse causing chronic kidney disease
d. Drug induced aplastic anemia
e. Hereditary hemorrhagic telangiectasia
23. 45-year-old female complains of low grade fever, early morning joint stiffness and pain for
more than one hour duration. She also complains of pain and stiffness in neck, hip joint and
pelvic girdle. Most likely diagnosis?
a. Infective endocarditis
b. Polymyalgia rheumatica
c. Rheumatoid arthritis
d. SLE
e. Tuberculous polyarthritis
24. 18-year-old man presented following a hump nosed viper bite. No systemic envenomation
features noted. Only two fang marks are present. What is the next step in management?
a. Arrange WBCT

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 b. Arrange renal function tests
c. Start antivenom serum
d. Monitor for 24 hours
e. Hemodialysis
25. 32-year-old female presents with swollen lips for 5 days. She is on oral hypoglycemic
medication for diabetes which is well controlled. No other medical co morbidities. No pruritus
or past allergic history. She has recently used a new hair dye one week back. What is the most
likely diagnosis?
a. Urticaria
b. Angioedema
c. Anaphylaxis
d. Erythroderma
e. Pemphigus
26. ……………………..
27. 40-year-old male with history of back pain currently presents with a painful knee joint that
has persisting morning stiffness for more than two hours duration. Which of the following
describes the most likely condition?
a. Ankylosing spondylitis
b. Psoriatic arthritis
c. ………………
d. Reiter’s syndrome
e. Rheumatoid arthritis
28. 24-year-old female bank officer has a weight gain of 8kg over 3 months. She also complained
of lethargy and oligomenorrhea. BP – 170/100. K+ - 3.3, Na+ - 146, TSH - normal, Hb – normal.
What is the most likely cause for her elevated blood pressure?
a. Conn syndrome
b. Cushing syndrome
c. Hypothyroidism
d. Metabolic syndrome
e. Obstructive sleep apnoea

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29. 50 kg female presents with fever, myalgia and retro orbital pain, tenderness over the right
hypochondrium and no urine output for the past few hours duration. On examination BP –
80/60, PR – 96, fine crepitations in lung bases. Next step of management?
a. 250ml of normal saline bolus
b. 250ml of Hartman solution bolus
c. 250ml blood transfusion
d. 500ml dextran bolus
e. 500ml normal saline bolus
30. 45-year-old male presented with low grade fever for 5 days associated with headache and
myalgia. There has been a dry cough for the past few days. On examination he is mildly icteric
and has bilateral crepitations. Chest x ray reveals bilateral diffuse opacities over the lower
lobes of lungs. Most possible causative organism?
a. Streptococcus pneumoniae
b. Streptococcus epidermidis
c. Legionella pneumophila
d. Mycoplasma pneumoniae
e. Staphylococcus aureus

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