1.

With regard to the facial nerve:

A It carries taste sensation from the posterior third of the tongue

B It innervates the levator palpebrae superioris muscle

C It is secreto-motor to the lacrimal gland

D It is associated with the 3rd branchial arch

E It supplies the principal muscles of mastication

2. Haemophilia A:

A Is more common in females than males

B Is due to an abnormal gene on the Y chromosome

C Is synonymous with Christmas disease

D Is due to a deficiency in factor IX

E Affects the intrinsic, rather than the extrinsic, pathway for blood
coagulation

3. Risk factors for developing osteoporosis include:

A Obesity

B Low calcium intake

C Late menopause

D Excessive rigorous physical exercise

E Abstinence from alcohol

4. With regard to surfactant:

A It increases the surface tension of the film of liquid lining the alveoli

B It reduces lung compliance

C It is secreted by type I pneumocytes

D The surface tension of fluid containing surfactant increases as the surface

area of the fluid decreases

E It helps to prevent the formation of pulmonary oedema

5. With regard to tetanus:

A It is caused by a Gram-negative bacillus

B It is caused by an aerobic organism

C It results from the secretion of exotoxin

D It is caused by Clostridium perfringens

E It is caused by bacterial invasion of the nervous system

6.. With regard to the juxtaglomerular apparatus:

A The macula densa is a specialized region of the afferent arteriole

B Renin is secreted at the macula densa

C Renin is secreted in response to a raised sodium at the macula densa

D A fall in pressure in the afferent arteriole promotes renin secretion

E The juxtaglomerular (granular) cells are located in the wall of the distal
convoluted tubule

7. A 30-year-old man complains of polyuria and polydipsia. His fasting blood

glucose is 4.7 mmol/L. Biochemical investigations reveal: Na 140 mmol/L; K
4.2 mmol/L; Ca 2.85 mmol/L; phosphate 0.4 mmol/L; PTH 4.2 pmol/L. Select
the likely diagnosis. (Normal ranges are: sodium 135–145 mmol/L; potassium
3.4–5.0 mmol/L; calcium 2.20–2.65 mmol/L; phosphate 0.8–1.4 mmol/L; PTH
1.1–6.8 pmol/L.)

A Addison’s disease

B Cushing’s syndrome

C Hypercalcaemia of malignancy

D Primary hyperparathyroidism

E Secondary hyperparathyroidism

8. With regard to the gallbladder:

A Epithelium is stratified squamous

B It has a normal capacity of around 10 mL

C It is supplied by the cystic artery, a branch of the left hepatic artery

D It is stimulated to contract by cholecystokinin

E It is essential for life

9. With regard to gallbladder disease:

A Courvoisier’s law states that in the presence of obstructive jaundice an

impalpable gallbladder is always due to gallstones

B It may refer pain to the right shoulder tip

C The surface marking of the gallbladder is the right sixth intercostal space,
mid-clavicular line

D Gallstones are usually composed of calcium carbonate

E Gallstones always cause symptoms

10. Which of the following decreases insulin resistance:

A Cortisol

B Exercise

C Obesity

D Pregnancy

E Growth hormone

11. Which one of the following electrolytes is not found in Hartmann’s

solution?

A Potassium

B Lactate

C Magnesium

D Sodium

E Chloride

12. Common peroneal nerve injury is related to fracture of which one of the
following?

A Shaft of the tibia

B Neck of the fibula

C Lower tibio-fibular joint

D Shaft of the fibula

E Shaft of the femur

13. Which one of the following is not contained in the carpal tunnel?

A Median nerve

B Flexor pollicis longus

C Flexor digitorum profundus

D Flexor digitorum superficialis

E Palmaris longus

14. The serum of a patient needing a transfusion reacts (agglutinates) with

blood from Group B and the blood cells of this patient react (agglutinate)
with the antisera anti-A and anti-D. Which of the following is the blood group
of this patient?

A A-Positive

B A-Negative

C B-Positive

D B-Negative

E O-Negative

15. What is the function of the ductus arteriosus?

A Bypass brain in the fetus

B Bypass lungs in the fetus

C Bypass liver in the fetus

D Supply brain in the fetus

E Supply lungs in fetus

16. A 23-year-old man has acute appendicitis, which is exacerbated by

external rotation and extension of the leg. Which muscle is being irritated?

A Rectus femoris

B Adductor longus

C Hamstrings

D Psoas major

E Adductor magnus
17 19-year-old man returns from holiday in Tenerife. Four weeks later, he
develops a swollen, hot, painful, red knee joint, with an effusion.

A Acute gout

B Enteropathic arthritis

C Pseudogout

D Reiter’s syndrome

E Septic arthritis

18. An 18-year-old presents with jaundice. On questioning he admits that the

last time he had a cold he went a slightly yellow colour. His brother has had a
past episode of jaundice. Liver function tests reveal: bilirubin 80 μmol/L; ALT
25 IU/L; ALP 150 IU/L. Select the likely diagnosis. (Normal ranges are:
bilirubin 3–17 μmol/L; ALT 3–35 IU/L; ALP 30–300 IU/L.)

A Autoimmune hepatitis

B Gilbert’s syndrome

C Hepatitis A

D Hepatitis B

E Hepatitis C

19. An opera singer complains that her voice is becoming weak after singing
for a short period of time. Select the single most likely structure from the
options listed that was likely to have been injured.

A Phrenic nerve

B Stellate ganglion

C Parathyroid glands

D Recurrent laryngeal nerve

E External laryngeal nerve

20. Arising below and lateral to the pubic tubercle. Select the single most
likely diagnosis.

A Direct inguinal hernia

B Indirect inguinal hernia

C Obturator hernia

D Femoral hernia

E Epigastric hernia

21What is the most common cause of anesthetic death in obstetrics :

A. Failed intubation.

B. Hemorrhage

. C. Stroke.

D. Reaction to medication.

E. Aspiration pneumonitis

22. In cases with premature rupture of membranes, all the following are
acceptable in the conservative management except:

A. Frequent vaginal examination to assess cervical dilatation

B. serial complete blood count to diagnose rising of WBC

C. Close monitoring of maternal vital signs

D. Ultrasound to assess fetal weight and amount of liquor

E. Monitoring of the fetus by doing cardiotocogram

23. Transplacental infection occur with all, EXCEPT:

A. Cytomegalovirus.

B. Toxoplasma

C. Rubella

D. Syphilis

E. Gonorrhea

24. The following may be indicative of chorioamnionitis EXCEPT:

A. Maternal pyrexia

B. Maternal tachycardia.

C. Tender uterus
D. Fetal bradycardia

E. Increased white-cell count in the mother

25. Regarding Rubella immunization :

A. Rubella negative patients should be vaccinated during pregnancy

B. Rubella vaccine is a Toxoid

C. The majority of pregnant patients are rubella non immune

D. Breast feeding should be inhibited if vaccine is given postnatally

E. Pregnancy should be avoided for 3 months after vaccination

26. The β-hCG curve in maternal serum in a normal pregnancy peaks at:

A. 6 weeks of pregnancy.

B. 8 weeks of pregnancy.

C. 10 weeks of pregnancy.

D. 14 weeks of pregnancy.

E. 18 weeks of pregnancy

27. First trimester pregnancy may be terminated by

A. Prostaglandin inhibitor

B. Anti-progesterone

C. β sympathomimetic agonist

D. Synthetic estrogen

E. Medroxy-progesterone

28. During normal pregnancy, a weight gain anticipated. The average weight
gain is approximately:

A. 5-10 kg.

B. 10-15 kg.

C. 15-20 kg.

D. 20-30 kg.

E. 30-40 kg
29. The last menstrual period was June 30. the expected date of delivery
(EDD) is approximately:

A. March 23.

B. April 7.

C. March 28.

D. April 23.

E. March 7.

30 The ovarian artery is a branch of:

A. Common iliac artery.

B. Internal iliac artery.

C. Aorta

. D. Hypogastric artery.

E. Sacral artery.

31. . Hyperextension of the fetal head is found in:

A. Vertex presentation

B. Face presentation

C. Shoulder presentation

D. Breach presentation

E. Hydrocephalic baby

32. During the delivery, the fetal head follow the pelvic axis. The axis is best
described as:

A. A straight line.

B. A curved line, 1ST directed anteriorly then caudal.

C. A curved line, 1ST directed posteriorly then caudal

. D. A curved line, 1ST directed posteriorly then cephalic.

E. None of the above.

33. What is the station where the presenting part is at the level of the
ischialspines
A. -2 .

B. -1 .

C. 0 .

D. +1

. E. +2 .

34. In Turner’s syndrome patients, all of the following are true EXCEPT:

A. The streak ovaries should be removed surgically due to 25% tendency to

be malignant.

B. Are usually less than 5 feet tall.

C. Have raised FSH levels

. D. Have female internal genitalia.

E. Have normal but infertile external genitalia.

35. A sample of cervical mucus is taken on day 12 of the menstrual cycle.

The mucus is thin, clear, & stretchy. It placed on a slide and allowed to air
dry. When placed under microscopic, what would you expect:

A. Calcium citrate.

B. Clear fields, devoid of bacteria Cell.

C. Thick mucus with background bacteria.

D. A fren pattern characteristic of estrogen.

E. Clearly defined para-basal cells.

36. The Maternal blood volume in normal pregnancy:

A. remains stable.

B. Decreases 10%.

C. Increases 10%

D. Increases up to 40%

E. Decreases up to 40%.

37. The softening of the cervical isthmus that occurs early in gestation is
called:
A. Hegar's sign

. B. Chadwick's sign.

C. Braxton Hick's contraction.

D. Von fernwald's sign.

E. Cullen's sign.

38. Which of these drugs don’t cross the placenta?

A. Heparin

B. Warfarin

C. Tetracycline

D. Degoxin

E. None of the above

39. Regarding twin pregnancies all of the following are correct EXCEPT:

A. It has a higher incidence of preterm labor

B. Mal-presentation of one of the main factors leading to increase incidence

of C/S

C. Abruptio placenta may occur with the sudden decompression of the uterus
immediately after delivery of the first twin

D. Dexamethasone is useful in case preterm labor

E. Identical or monozygotic twin arise from fertilization of two ovum

40. A 26- year- old married white whose LMP was 2 ½ months ago developed
bleeding, uterine cramps, and passed some tissue per vagina. Two hours
later she began to bleed heavily I. The most likely diagnosis is :

A. Twin pregnancy

B. Threatened abortion

C. Inevitable abortion

D. Premature labor

E. Incomplete abortion.
41. Examples of secondary prevention would include all of the following,
except:

a) Pap smear for cervical cancer

b) Chemoprophylaxis in a recent TB converter

c) Proctoscopy for rectal cancer

d) Immunization for Haemophilus influenza B

e) Mammography for breast cancer

42. Which one of the following descriptors of a diagnostic test is influenced

by the prevalence of the disease being tested for:

a) Specificity

b) Sensitivity

c) Accuracy

d) Positive predictive value

e) Reliability

43. The occurrence of an illness, in a specific population or area, sudd

enly and in numbers clearly in excess of normal expectancy is called:

a) Hyperendemic

b) Epidemic

c) Endemic

d) Enzootic

e) Pandemic

44. Which of the following observational types of studies is usually used to

estimate prevalence of a health condition or prevalence of a behavior, risk
factor, or potential for disease?

a) Case-control

b) Cross-sectional

c) Randomized controlled trial

d) Cohort
e) Quasi-Experimental

45. What is the most common nutritional deficiency worldwide?

a) Iron

b) Vitamin B12

c) Vitamin D

d) Calories

e) Protein

46. Which one of the following would be most likely to have secondary
hypertension?

a) A 39-year-old white male who weighs 119 kg (262 lb) and whose blood
pressure is 142/94 mm Hg

b) A 48-year-old black female with left ventricular hypertrophy on

echocardiography whose blood pressure is 162/98 mm Hg

c) A 62-year-old black male with a strong family history of hypertension

d) A 78-year-old white female with abdominal bruits whose blood pressure

is 182/102 mm Hg

e) An 88-year-old white male with hemiparesis due to a previous stroke

whose blood pressure is 192/88 mm Hg.

47. Which one of the following chemical occupational exposures is associated

with leukemia?

a) Arsenic

b) Benzene

c) Cadmium

d) Organophosphates

e) Perchloroethylene (tetrachloroethylene)

48. Which one of the following variables is the most important risk factor for
being a victim of domestic abuse?

a) Educational background

b) Psychological problems
c) Race

d) Gender

e) Socioeconomic status

49. Which one of the following is true concerning breast cancer screening?
a) It is useful for detecting premalignant conditions

b) It can predict which of the discovered cancers are indolent, with a low
potential for harm

c) The decrease in mortality from breast cancer can be attributed almost

entirely to early detection

d) It has resulted in an increase in the diagnosis of localized disease

e) It has resulted in a significant decrease in the incidence of regional and

metastatic disease

50. You test a patient’s muscles and find that his maximum performance
consists of the ability to move with gravity neutralized. This qualifies as
which grade of muscle strength, on a scale of 5?

a) 0

b) 1

c) 2

d) 3

e) 4

51. A 45-year-old woman presented with repeated cleansing of her kitchen

floor and excessive hand washing for last 3 months. She has past medical
history alcohol withdrawal,acute pain,iron deficiency anemia and body
dysmorphic disorder. Which one of the following puts patient at high risk for
developing obsessive compulsive disorder?

a. Avoiding alcohol

b. Acute pain

c. Vitamin B12 deficiency

d. Iron deficiency anaemia

e. Body dysmorphic disorder

52Jack,a 23-year-old male presented with inability to straighten his right 5th
finger after playing a volleyball. On examination, he can not fully extend the
distal interphalangeal joint of the effected finger.X-ray has been done which
do not show any fracture of the right hand.

What is the most likely diagnosis?

a. Mallet finger

b. Swan neck deformity

c. Duputytren’s contracture

d. Hidden hematoma

e. Tenpin Bowler’s thumb

53. A known patient with rheumatoid arthritis is on long term methotrexate

therapy. Clinical features present with weakness and anorexia. Blood test
shows elevation in both AST and ALT.The peripheral blood smear shows the
anemia.

What would be the most appropriate management?

a. Folinic acid

b. Vitamin B12

c. Folic acid

d. Vitamin C

e. Vitamin A

54. Carcinoma of the breast is discovered at 2 weeks of gestation in the

second pregnancy of a 32-year-old woman. The tumour is 1.5cm in size, is
located in the upper outer quadrant of the left breast, and produces dimpling
of the overlying skin. A core biopsy has confirmed invasive ductal carcinoma.
There are no clinically suspicious axillary nodes and no evidence of
metastases on physical examination or chest imaging. Blood chemistry is
normal. Which one of the following is the most appropriate approach to the
treatment of this patient?

A. Treatment should be delayed until the baby is delivered at term.

B. The pregnancy should be terminated and a mastectomy performed two

months
later.

C. The patient should proceed to definitive surgery.

D. Preliminary local irradiation therapy should be followed by definitive

surgery after delivery.

E. Before consideration of mastectomy or other treatment, the response to

oophorectomy should be determined

55. A30-year-old woman who has been homeless for the past 10 years
presents to the Emergency Department complaining of fatigue, nausea,
vomiting and abdominal colic. She has been feeling unwell for four months.
She admits to currently living in

a derelict old house. Examination reveals she has a motor neuropathy with
wrist drop. Blood film shows basophilic stippling of the red blood cells. Which
one of the following is the most likely diagnosis?

A. Mercury poisoning.

B. Iron poisoning.

C. Lead poisoning.

D. Arsenic poisoning.

E. Carbon monoxide poisoning

56. A 53-year-old man is brought to the Emergency Department with

repetitive vomiting for four hours, despite his efforts to hold to back, followed
by sudden pain in the upper abdomen and left lower chest. He has a history
of prolonged heavy alcohol intake. On examination he is sweating and looks
unwell. His BP is 100/80mmHg, pulse rate is 110/min and regular,
temperature is36°C and there is slight peripheral cyanosis. Breath sounds
are absent over the left side of the chest. There is moderate tenderness in
the epigastrium. Which one of the

Following is the most likely diagnosis?

A. P e r f o r a t e d u l c e r .

B. Acute pancreatitis.

C. Spontaneous pneumothorax.

D. Myocardial infarct.
E. Perforated oesophagus.

57. A 70-year-old woman presents with weight loss of 3kg, vague headaches,
aching al over the body and morning stiffness of the shoulder and hip girdles.
These symptoms have been present for the past six months. Physical
examination is normal, except for some tenderness in the muscles of her
shoulder. Investigations show a normochromic normocytic anaemia,
erythrocyte sedimentation rate (ESR) of 65 mm/h (5-20) and raised C-
reactive protein. Al other investigations, including muscle enzymes, are
normal. Which one of the following is the most likely diagnosis?

A. Multiple myeloma.

B. Polymyalgia rheumatica.

C. Rheumatoid arthritis.

D. Occult malignancy.

E. Polymyositis.

58A 70-year-old woman complains of tiredness, fatigue and weight loss.

Blood tests reveal an elevated WCC and on examination splenomegaly is
palpated. Cytogenetics are positive for the Philadelphia chromosome and the
patient is diagnosed with chronic myeloid leukaemia. The most appropriate
treatment is:

A. Hydroxycarbamide

B. Imatinib

C. Venesection

D. Stem cell transplant

E. Dasatinib

59. A 27-year-old woman who suffers from rheumatic mitral stenosis

develops atrial fibrillation. She is placed on warfarin therapy. What is the
most appropriate target international normalized raio (INR) range?

A. <1.0

B. 1.0–2.0

C. 2.0–3.0

D. 3.0–4.0
E. >5.0

60.A 70-year-old woman complains of a dull pain in her lower back,

especially when bending forwards to lift things. She presents after a severe
episode in the last 2 days. An x-ray reveals a lumbar compression fracture.
Blood tests show a normocytic anaemia and urine electrophoresis reveals a
monoclonal gammopathy. A diagnosis of multiple myeloma is made. Which of
the following is not a recognized cause of multiple myeloma?

A. High-dose radiation

B. Human herpes virus-8 (HHV-8)

C. HIV

D. Herbecides and insecticides

E. Hereditary

61. A 44-year-old woman presents with recurrent fever, pallor, malaise and
shortness of breath. She has noticed a petechial rash on her skin and small
bruises on her arms. A blood test reveals a pancytopenia. During
examination, you palpate a large spleen. Which investigation would
differentiate between hypersplenism and aplastic anaemia?

A. Reticulocyte test

B. Direct Coombs test

C. Metabisulfite test

D. Ham’s test

E. Osmotic fragility test

62. A 66-year-old man presents complaining of a three-month history of

weakness, tingling in the limbs and a sore tongue. The patient notes an
undesired 5 kg weight loss over 2 weeks. A peripheral blood smear shows a
macrocytic anaemia, a Schilling test shows impaired vitamin B12 absorption
and a diagnosis of pernicious anaemia is made. Which of the following
antibodies is most closely associated with pernicious anaemia?

A. Anti-mitochondrial antibodies

B. Anti-intrinsic factor antibodies

C. Anti-gliadin antibodies
D. Anti-centromere antibodies

E. Anti-smooth muscle antibodies

63. A 5-year-old girl presents with her parents who have become concerned
about the small petechiae and ecchymoses on her skin. An abdominal
examination reveals hepatosplenomegaly. You suspect an acute leukaemia.
The most appropriate initial investigation for diagnosis is:

A. Chromosomal analysis of bone marrow cells

B. Cytochemical analysis of bone marrow cells

C. Direct microscopy of bone marrow cells

D. Electron microscopy

E. Flow cytometry

64. A 51-year-old man complains of severe, diffuse back pain. An x-ray finds
several lytic lesions in the vertebra alongside hypercalcaemia. Bence–Jones
protein is detected in the urine. What is a Bence–Jones protein?

A. IgG antibody

B. IgA antibody

C. IgE antibody

D. Light chain

E. IgM antibody

65. A 23-year-old man is stabbed in the neck. Once stabilized, his MRI shows
a right hemisection of the cord at C6. What is the expected result of this
injury?

A. Paralysed diaphragm

B. Absent sensation to temperature in the left hand

C. Paralysis of the left hand

D. Absent sensation to light touch in the left hand

E. Brisk right biceps reflex

66. A 41-year-old man complains of terrible headache. It started an hour ago,

without warning, while stressed at work. It affects the right side of his head.
He scores it ‘11/10’ in severity. When asked, he agrees that light does bother
him a little. He had a similar episode six months ago, experiencing very
similar headaches over 2 weeks which resolved spontaneously. On
observation, he looks quite distressed and prefers to pace up and down,
unable to sit still. What is the diagnosis?

A. Subarachnoid haemorrhage

B. Tension headache

C. Intracerebral haemorrhage

D. Migraine

E. Cluster headache

67. A 23-year-old woman is seen in clinic for recurrent funny turns. She is not
aware of them, but her family and friends have noticed them. They say she
looks around blankly, then starts picking at her clothes and sometimes
yawns, then she comes back after a minute. She can get drowsy after these
episodes. What seizure type does this patient describe?

A. Absence

B. Tonic clonic

C. Simple partial

D. Complex partial

E. Generalized

68. A patient is unable to move his right arm or leg. When asked to smile, the
left side of his mouth droops. Where is the lesion?

A. Left motor cortex

B. Right motor cortex

C. Left brainstem

D. Right brainstem

E. Cervical spine

69. A light is shone into a patient’s right eye and it constricts. When moved
to the left eye, the left eye constricts. When moved back to the right eye, the
right eye dilates. What is the diagnosis?

A. Afferent lesion
B. Efferent lesion

C. Relative afferent lesion

D. Relative efferent lesion

E. Normal

70. A 43-year-old woman presents with dizziness to accident and emergency.

It started suddenly this morning, she awoke with a headache and the
dizziness started when she sat up in bed. She describes the room spinning
for a couple of minutes. It settles if she keeps still, but returns on movement.
There is no tinnitus or deafness, but some nausea and no vomiting. The most
likely diagnosis is:

A. Brainstem stroke

B. Benign paroxysmal positional vertigo

C. Ménière’s disease

D. Vestibular neuronitis

E. Migraine

71. Which of the following is TYPICAL of neurogenic shock (vasovagal

syndrome)?

A. Sweating

B. Hypotension

C. Pallor

D. Bradycardia

E. Loss of consciousness

72 . In septic shock, the plasma level of:

A. Platelet activator factor is raised

B. Thrombomodulin is elevated

C. Protein C is raised

D. Protein S is raised

E. AT III is raised

73. Cryorecipitate is rich in:

A. Factor III

B. Factor VI

C. Factor VII

D. Factor VIII

E. Factor IX

74. About 4 h. after the starting of blood transfusion a patient complains of

pain in the joints, muscles and fever. There is no headache. The most likely
clinical diagnosis is:

A. Haemolyic reaction

B. Malaria

C.Allergic reaction

D. Septicaemia

E. Enteric fever

75. Which of the following radiological features is/are often seen in the
patient with ruptured spleen?

A. Loss of the splenic outline on coned views

B. Loss of t he left psoas shadow

C. Elevation of the left cupola of the diaphragm

D. Indentation of the gastric air bubble

E. Pneumoperitoneum

76. A carpenter who fell across a beam is brought to the Emergency Room
48h after the incident with lower abdominal pain, fever and vomiting. On
examination he was ill, pale and showed extravasation of urine over the
scrotum, penis and lower abdomen. There was a tender perineal
haematoma. . The most likely diagnosis is

: A. Rupture of the membranous urethra

B. Rupture of the bulbous urethra

C. Rupture of the penile urethra

D. Extraperitoneal rupture of the bladder

E. Intra-peritoneal rupture of the bladder

77. A patient with flash burns of the left side of the head, neck, left arm and
lower extremity (leg) has suffered what percentage body surface burn?

A. 9

B. 18

C. 5

D. 30

E. 27

78. You see a 23-year-old gravida 1 para 0 for her prenatal checkup at 38
weeks gestation. She complains of severe headaches and epigastric pain.
She has had an uneventful pregnancy to date and had a normal prenatal
examination 2 weeks ago. Her blood pressure is 140/100 mm Hg. A urinalysis
shows 2+ protein; she has gained 5 lb in the last week, and has 2+ pitting
edema of her legs. The most appropriate management at this point would
be:

a) Strict bed rest at home and reexamination within 48 hours

b) Admitting the patient to the hospital for bed rest and frequent monitoring
of blood pressure, weight, and proteinuria

c) Admitting the patient to the hospital for bed rest and monitoring, and
beginning hydralazine (Apresoline) to maintain blood pressure below 140/90
mm Hg

d) Admitting the patient to the hospital, treating with parenteral magnesium

sulfate, and planning prompt delivery either vaginally or by cesarean section

79. A 37-year-old gravida 6 para 5 is given oxytocin (Pitocin) to induce

delivery at 41 weeks gestation. Her prenatal course is significant for chronic
hypertension. She delivers a 4020-g (8 lb 14 oz) baby. Soon after delivery of
the placenta, she begins to have excessive vaginal bleeding. Which one of
the following would you do initially?

a) Perform manual uterine exploration and massage

b) Perform uterine curettage

c) Administer intramuscular methylergonovine

d) Administer subcutaneous terbutaline

e) Administer intramuscular prostaglandin F2alpha (carboprost) (Hemabate)

80. An absolute contraindication for vaginal delivery for a patient who had a
previous Cesarean section is:

a) Previous vertical uterine incision

b) Previous transverse uterine incision

c) Twin gestation

d) Noncephalic presentation

e) Patient's age > 40 years

81. A woman who is 28 weeks pregnant is seen on ultrasound as having

placenta previa. All of the following are common complications of this
condition, except:

a) Lower incidence of fetal malformations

b) Placental abruption

c) Hemorrhage

d) Premature delivery

e) Abnormal fetal presentation

82. A female patient develops a cystocele and procidentia (uterine prolapse).

What is the most appropriate treatment?

a) Vaginal hysterectomy

b) Vaginal hysterectomy and repair

c) Abdominal hysterectomy

d) Laparoscopic hysterectomy

83. A 34-year-old female G7P5A1 in the 30th week of gestation presents with
complaints of vaginal bleeding. She noticed the bleeding while at home and
was not involved in any strenuous activity or trauma. She denies any pain.
She denies alcohol or drug use. She underwent both vaginal and C-section
delivery (first 3 children and her last 2 children respectively). Her BP is
120/70 mmHg; HR is 80/min; T is 37.2°C; RR is 15/min, the blood loss seems
to be minimal. The Apt test is positive. Which of the following is least likely
to be a risk factor of this condition?
a) High positioned placenta

b) Velamentous cord insertion

c) Bilobed placenta

d) Multiple pregnancies

e) In vitro fertilization

84. A female patient is a newcomer to the country. She is single and in labor.
She has had no prenatal care. You decide to give her anti-Rh Ig (RhoGam) to
prevent which one of the following in subsequent pregnancies?

a) Immunodeficiency

b) Neonatal lupus

c) Hemolytic disease of the newborn

d) T cell immune deficiency syndrome

e) Transient hypogammaglobulinemia

85. An autistic 8 year old child puts a green pea in his ear while eating.
Otoscopy shows a green coloured object in the ear canal. What is the
SINGLE most appropriate approach to remove the green pea?

A. By magnet

B. Syringing

C. Removal under general anaesthesia

D. By hook

E. By instilling olive oil.

86. A 9 year old girl has been referred for assessment of hearing as she is
finding difficulty hearing her teacher in the class. Her hearing tests show
that bone conduction is normal and symmetrical, air conduction threshold is
reduced bilaterally. Weber does not lateralize. What is the SINGLE most
likely diagnosis?

A. Perforation of tympanic membrane

B. Otitis media with effusion

C. Congenital sensorineural defect

D. Otosclerosis

E. Presbycusis

87. A 15 year old boy presents to A&E with a nose bleed. The bleeding
started 3 hours ago and has not stopped. His blood pressure is 115/70
mmHg, heart rate is 80 bpm and respiratory rate is 18/min. What is the
SINGLE most appropriate next course of action?

A. IV fluids

B. Lean forward, open mouth and pinch cartilaginous part of nose firmly

C. Lean backwards, ice packs and pinch base of nose firmly

D. Start IV transexamic acid

E. Radiological arterial embolization

88. An 11 year old girl presents to the clinic with hoarseness of voice. She is
a known case of bronchial asthma and has been on oral steroids for half a
year. What is the SINGLE most likely cause of her hoarseness of voice?

A. Laryngeal candidiasis

B. Infective tonsillitis

C. Laryngeal edema

D. Allergic drug reaction

E. Ludwig’s angina

89. A 8 year old man has difficulty hearing. Bone conduction is better than
air conduction in the left ear. The sound was localised towards the left side
on Weber’s test. What is the SINGLE most likely diagnosis?

A. Right sensorineural deafness

B. Left sensorineural deafness

C. Right conductive deafness

D. Left conductive deafness

E. Bilateral conductive deafness

90. A 15 year old boy iis brought to the hospital by his parents complaining
of lower abdominal pains for the past three days. A clinical suspicion of
appendicitis and the decision to admit was made. The young boy refuses to
be admitted as he has plans to go out with his friends tonight. He is unable
to understand the serious nature of an untreated appendicitis. His parents
would like to overrule his wishes and to admit him. What is the4 SINGLE
most appropriate course of action?

A. Contact the local safeguarding officer

B. Respect his wishes and do not admit

C. Involve social services

D. Refer for a psychiatric evaluation before admission

E. Admit him under parental consent

91. A 15 year old child complains of right iliac fossa pain worsening over the
past few weeks. He also has bouts of diarrhoea coming in episodes for more
than a year. He has lost 7 kg in the last 5 months. On examination, perianal
skin tags were seen. He was subsequently referred on to the
gastroenterology team. A colonoscopy was performed which showed deep
ulcers and skip lesions on the colonic mucosa. What is the SINGLE mot
appropriate management?

A. Prednisolone

B. Mebeverine

C. Peppermint oil

D. Metronidazole

E. Vancomycin

92.An 11 year old has increased laxity of joints and hyperelastic skin. He is
noted to have mild spinal curvature and a blue sclera. What is the SINGLE
most likely diagnosis?

A. Fragile X syndrome

B. Prader-Willi syndrome

C. DiGeorge syndrome

D. Marfan’s syndrome

E. Ehlers-Danlos syndrome

93. A 5 year old boy has recurrent chest infections and offensive stool. He is
brought by his mother to his GP surgery with concerns that he has another
chest infection. They seem to happen very year and sometimes twice a
year. On physical examination, he has coarse inspiratory crepitations. It is
also noted that he has finger clubbing. He is prescribed antibiotics for his
chest infection. What investigation(s) should be requested?

A. Endomysial antibody (IgA)

B. Sweat test C. Heel prick test

D. Anti-gliadin antibody (IgA or IgG)

E. Random fasting glucose and HbA1c

94. A patient who presents with bilateral cerebellopontine tumours, bilateral

sensorineural hearing loss and café au lait spots is pregnant. What are the
chances of her child having the same condition?

A. 1:1

B. 1:2

C. 1:4

D. 3:4

E. 1:8

95. The incubation period of this disease is about 6 months:

a. Dracontiasis

b. Loiasis

c. Infectious parotitis

d. Mononucleosis

e. Viral hepatitis A

96. One of the fathers of epidemiology is

a. Pasteur

b. Snow

c. Jenner

d. Lister

e. Virchow
97. Loaisis is transmitted by:

a. Culex fatigans

b. Chrysops dimidata

c. Simulium damnosum

d. Aedes aegypti

e. Glossina palpalis

98. In Lepromatous leprosy, all are true except

a. Sensory impairment is not seen in early cases

b. Skin smear is always positive for Mycobacterium leprae

c. The Lepromin test is always negative

d. Spontaneous regression to borderline is a common feature

e. There may be loss of eyebrows and eyelashes

99. spot map is most useful in determining

a. Clustering of cases of a disease in a defined place

b. Seasonal pattern of an outbreak

c. Whether the epidemic is common source or propagate

d. The beginning of the epidemic

e. The source of the epidemic

100. The vaccine does not contain live organisms

:a. Small pox

b. Poliomyelitis (oral)

c. Measles

d. Tuberculosis

e. Tetanus