NRE June 2025 — Recalled MCQs
B. Proximal convoluted tubule
NRE June 2025 — Recalled MCQs
Source: Mediverse app recall collection Total MCQs: 140 Status: Recalled paper — answers not included (use for self-assessment)
1. In which segment of the renal nephron does the majority of filtered sodium and water reabsorption take place?
A. Ascending loop B. Proximal convoluted tubule C. Descending loop D. Distal convoluted tubules
2. A 48-year-old woman with a known history of rheumatic mitral stenosis presents to the emergency department with sudden-onset palpitations and shortness of breath. An electrocardiogram is performed, confirming a diagnosis of atrial fibrillation. Which finding on the electrocardiogram is most characteristic of this patient’s arrhythmia?
A. P mitrale B. QRS absent C. Irregular R-R interval D. Regular P waves
3. A 4-year-old boy is diagnosed with hemophilia A following severe bleeding after a minor cut. During genetic counseling, the parents are reassured that his two sisters are unlikely to develop the disease. What is the mode of inheritance for this condition?
A. Autosomal dominant B. Autosomal recessive C. X linked recessive D. X linked dominant
4. A 22-year-old female at 13 weeks of gestation is involved in a road traffic accident, sustaining a crush fracture of her right femur. A few days later, she develops rapid breathing, shortness of breath, confusion, and a widespread pinpoint rash over her body. She deteriorates and dies three days later. What is the most likely cause of death?
A. Fat embolism B. Air embolism C. GAS embolism D. Amniotic fluid embolism E. Fat necrosis
5. A 45-year-old gardener is brought to the emergency department after collapsing while spraying insecticides. On examination, he is unconscious, diaphoresis is present, and he has profuse lacrimation, salivation, urinary incontinence, and severe respiratory distress. Which of the following drugs should be administered to directly antagonize these muscarinic symptoms of organophosphate toxicity?
A. Atropine B. Epinephrine C. Pralidoxime D. All of above
6. A 65-year-old man presents to the emergency department in severe respiratory distress due to acute pulmonary edema. He is administered a medication that produces rapid diuresis along with vascular smooth muscle relaxation. Which of the following drugs is being described?
A. Hydrochlorothiazide B. Spironolactone C. Acetazolamide D. Furosemide
7. A 5-year-old boy presents with a 5-day history of fever and cough. Two weeks ago, he visited his grandmother, who recently died of a chronic respiratory tract disease. A chest X-ray demonstrates a solitary 2 mm lesion in the right middle lobe along with hilar lymphadenopathy. Which of the following is the most likely diagnosis?
A. Small cell carcinoma of lung B. Aspergillus C. Pneumonia D. T.B
8. An elderly man being treated for arthritis presents with generalized weakness, pallor, a petechial rash, and easy bruising. Laboratory findings show a hemoglobin level of 6.0 g/dL, total leukocyte count of 3.5 x 10^9/L, platelet count of 100 x 10^9/L, and a reticulocyte count of 0.1%. Bone marrow biopsy reveals a hypocellular marrow with fatty changes. He has a past history of hepatitis. What is the most likely diagnosis?
A. Myelofibrosis B. Thalessemia C. Aplastic anemia D. Megaloblastic anemia
9. A 25-year-old patient undergoes a chest X-ray, which reveals a soft tissue mass located in the anterior mediastinum. The lung fields are clear, and there is no evidence of lymphadenopathy. Which of the following is the most likely origin of this mass?
A. Marrow B. Liver C. Thymus D. Inguinal LNs
10. A 35-year-old patient presents with jaundice. Laboratory investigations reveal a hemoglobin level of 7 g/dL, a reticulocyte count of 10%, serum bilirubin of 6 mg/dL with a direct bilirubin of 0.9 mg/dL, ALT of 17 U/L, and ALP of 75 U/L. Serum haptoglobin is decreased and the direct Coombs test is positive. What is the most likely cause of this presentation?
A. Pernicious anemia B. Anemia of chronic disease C. Macrocytic anemia D. Hemolytic anemia
11. A patient undergoing cardiac surgery receives a high dose of intravenous heparin. At the end of the procedure, the surgeon administers protamine sulfate to reverse the anticoagulation. What is the mechanism of action of protamine sulfate in this setting?
A. Reversible antagonism B. Chemical Antagonism C. Irreversible antagonism D. Physical antagonism
12. A 28-year-old woman presents with persistent pain and swelling in her left leg just below the knee joint. An X-ray of the proximal tibia demonstrates an eccentric, lytic lesion in the epiphyseometaphyseal region with a distinct soap-bubble appearance. Histopathological examination shows spindle-shaped stromal cells mixed with abundant multinucleated giant cells. What is the most likely diagnosis?
A. Ewings B. Osteoblastoma C. Osteosarcoma D. Giant cell tumor
13. During an emergency laparotomy for a perforated duodenal ulcer, significant hemorrhage occurs near the epiploic foramen (foramen of Winslow). Which of the following anatomical structures forms the posterior boundary of this foramen?
A. IVC B. Colic gutter C. Hepatoduodenal ligament D. Aorta E. Portal vein
14. A 65-year-old right-handed man presents with a stroke involving the superior division of the left middle cerebral artery. Physical examination reveals non-fluent, effortful speech with relatively preserved comprehension, consistent with expressive motor aphasia of the dominant hemisphere. Which area of the brain is primarily affected in this patient?
A. Inferior Frontal gyrus of Dominant Hemisphere B. Superior Frontal gyrus of Dominant Hemisphere C. Superior Temporal gyrus D. Inferior Temporal lobe E. Superior Occipital lobe
15. Echocardiography performed on a patient following a myocardial infarction demonstrates necrosis involving the anterior two-thirds of the interventricular septum. Which vessel, descending in the anterior interventricular groove, is directly responsible for supplying this portion of the heart?
A. LAD B. RCA C. LA D. Posterior branch
16. A 52-year-old man with a history of alcohol dependence presents with a fever, cough producing yellow jelly-like sputum, and general malaise. A chest X-ray shows right upper lobe consolidation with early cavitation. What is the most likely causative organism?
A. Staph aureus B. Mycoplasma C. H. influenza D. Klebsiella
17. A 35-year-old man is brought to the emergency department following a trauma with a high cervical spinal cord injury and develops neurogenic shock. Which hemodynamic change directly occurs as a result of this condition?
A. Loss of reflex B. More tone C. Dec. TPR D. Inc. TPR
18. A patient with chronic renal failure presents with pallor, fatigue, lethargy, and pedal edema. Laboratory investigations demonstrate a serum creatinine of 4 mg/dL, serum urea of 150 mg/dL, MCV of 86 fL, and increased serum ferritin levels. Which of the following is reduced in this patient and should be administered as treatment?
A. B12 replacement B. Erythropoietin with I/V iron C. Folate supplementation D. IV iron
19. At which anatomical level is the sternal angle (Angle of Louis) located relative to the vertebral column?
A. S2,3 B. Dorsal medulla C. T8 D. T7 E. Body of 4,5 thoracic vertebra
20. You are the house officer on call in ophthalmology department and a patient comes to you with some unknown chemical (ELFY, glue or any acidic/basic chemical) splashed in eye. There is diffuse conjunctival perfusion and pain. What is your initial management?
A. Slit lamp examination with fluorescein dye B. Wash with 1L sodium bicarbonate C. Patch eye after instilling with steroid eye drops D. Copious irrigation of eye with normal saline
21. A 2-year-old unvaccinated boy presents with sudden-onset unilateral left lower limb paralysis and absent superficial reflexes. Cerebrospinal fluid analysis reveals a total leukocyte count of 15,000/uL with 90% lymphocytes, normal glucose, and normal protein levels. What is the most likely diagnosis?
A. Polyradiculopathy B. Guillain-barre syndrome C. Poliomyelitis
22. A 65-year-old man is brought to the emergency department following a stroke. He demonstrates intact language comprehension but has severe difficulty producing spoken words, consistent with Broca motor aphasia. In which anatomical area of the brain is Broca motor speech area located?
A. Superior temporal B. Inferior gyrus of frontal C. Superior frontal D. Inferior occipital lobe E. Parietal lobe
23. A 16-year-old girl with a history of type 1 diabetes mellitus is brought to the emergency department due to confusion and drowsiness for 2 hours. Her mother reports a 4-day history of fever, abdominal pain, vomiting, weight loss, polyuria, and polydipsia. On examination, she is severely dehydrated with deep, rapid respiration and a fruity odor to her breath. Random blood glucose is 476 mg/dL. Arterial blood gas analysis shows a pH of 7.29, PaCO2 of 33 mmHg, and HCO3 of 12 mmol/L. Urinalysis is positive for ketones. What is the most likely diagnosis?
A. Lactic acidosis B. Diabetic ketoacidosis & Metabolic acidosis C. Hypoglycemia
24. Which of the following is a recognized risk factor for the development of malignant melanoma?
A. Xeroderma Pigmentosum B. Actinic Keratosis C. Prolonged Sunlight exposure D. SCC
25. A 42-year-old woman presents with episodic palpitations, severe headaches, anxiety, and diaphoresis. During an episode, her blood pressure is 190/140 mmHg and pulse is 56 beats/min. An abdominal ultrasound reveals an adrenal mass, and lab work confirms elevated adrenaline levels. What is the most likely cause of her paroxysmal hypertension?
A. Hyperthyroidism B. Ca breast C. Bronchogenic Ca D. Pheochromocytoma
26. Which artery provides the primary arterial blood supply to the lateral wall of the nasal cavity?
A. Sphenopalatine Artery B. Posterior Ethmoidal Artery C. Maxillary Artery D. Anterior Ethmoidal Artery
27. A 7-year-old boy presents with a 2-week history of repetitive sneezing, clear nasal discharge, and itchy eyes during the spring season. Physical examination reveals pale, boggy nasal mucosa. Which immunoglobulin is primarily involved in mediating this patient’s condition?
A. IgD B. IgM C. IgE D. IgA E. IgG
28. A 65-year-old man presents with persistent back pain, fatigue, and confusion. Laboratory findings reveal hypercalcemia and Rouleaux formation on peripheral blood smear. Serum protein electrophoresis shows an M-protein band, and skeletal radiography demonstrates punched-out lytic lesions in the skull, ribs, and vertebrae. Which of the following is the most likely diagnosis?
A. Leukemia B. Multiple myeloma C. Lymphoma D. Osteoporosis
29. A 45-year-old woman with a long-standing history of rheumatoid arthritis presents with progressive fatigue, lethargy, dyspnea, and chest pain that started yesterday morning. She reports a history of chronic productive cough for many years. Laboratory results show: WBC 10,000/uL, Hematocrit 25.4%, Hemoglobin 4 g/dL, slightly elevated TIBC, MCV 85 fL, Platelets 134,000/uL, Glucose 124 mg/dL, and a high serum ferritin level. This clinical scenario is most consistent with which type of anemia?
A. Thalassemia B. Folate deficiency C. Iron deficiency anemia D. Anemia of chronic disease
30. A lady traveling in a bus had a bump on the forehead just below the hairline. She consulted a general practitioner who told her that there is no cut but slight bruising on the area. A few weeks later she noticed that her sense of smell was diminishing. Which is the most probable site where the trauma might have occurred?
A. Nasal septum B. Anterior cranial fossa C. Cribriform plate of the ethmoid D. Middle cranial fossa
31. A 35-year-old woman, gravida 3, presents to the antenatal clinic with a history of two previous stillbirths at term involving macrosomic infants. A 50 g 1-hour oral glucose challenge test demonstrates a blood glucose level of 140 mg/dL. What is the most appropriate investigation to confirm the diagnosis of diabetes?
A. Urine analysis B. Blood sugar profile C. HbA1c D. Oral Glucose Tolerance Test (OGTT) E. Random blood sugar
32. A 2-year-old girl is brought to the clinic due to excessive crying and bleeding gums for 2 weeks. On physical examination, she is irritable with tender limbs, skin bruises, and periorbital hemorrhage. What is the most likely diagnosis?
A. Aplastic Anemia B. Scurvy C. Septic arthritis D. Iron Deficiency Anemia
33. A young man presents with 3 days history of red watering eyes, conjunctival follicles and foreign body sensation. On examination, there is preauricular lymphadenopathy. There is no sexual contact. The likely diagnosis is
A. Uveitis B. Pterygium C. Viral conjunctivitis D. Keratitis
34. A 50-year-old man presents after being awakened from sleep by an intense, episodic, right-sided periorbital throbbing headache accompanied by conjunctival injection, lacrimation, and rhinorrhea. He reports a history of similar episodes occurring weekly over the past 3 to 4 months that resolve spontaneously. What is the most likely diagnosis?
A. Brain tumor B. Migraine C. Cluster headache D. Intracranial hemorrhage
35. A 12-year-old boy presents with a painful, swollen scrotum and burning urination. He finds slight relief by supporting his affected testes. His urine shows protein, nitrites, and leukocytes. What is his most likely diagnosis?
A. Epididymo-orchitis B. Hydrocele C. Torsion of testes D. Testicular tumor
36. A 15 year old boy complains of swelling and severe pain in the left testis on the 8th day of a febrile illness. Fever shoots up to 41 degree C and then gradually comes down with medicines. On examination, the testis is markedly swollen and tender but the scrotal skin is normal. The most likely diagnosis is
A. Pyogenic epididymo-orchitis B. Mumps orchitis C. Torsion testis D. Epididymovasitis
37. A 2 year old boy presents with watery stools for 1 day. He also has vomiting and is irritable. He is drinking eagerly, has sunken eyes and skin pinch goes back slowly. Which of the following is true with this condition?
A. Some dehydration B. No dehydration C. Simple Dehydration D. Severe dehydration
38. Which receptor in the respiratory tract is primarily responsible for mediating the relaxation of airway smooth muscle, resulting in bronchodilation and decreased airway resistance?
A. D1 receptors B. Alpha adrenergic receptors C. MU receptors D. Beta 2 adrenergic receptors
39. At which age can a child copy a circle first?
A. 36 months B. 24 months C. 08 months D. 15 months
40. A 32-year-old pregnant woman at 34 weeks of gestation presents with sudden-onset heavy vaginal bleeding accompanied by a systemic coagulation disorder. What is the immediate initial step in the management of this patient?
A. Evacuation of the uterus B. Streptokinase C. Platelet transfusion D. Blood transfusion E. Heparin therapy
41. A 7 years child got admission in a class but his height is shorter than other class students although other body measurements are appropriate and balanced. What can be the cause?
A. Hypoparathyroidism B. Hypothyroidism C. Down’s syndrome D. Growth hormone Deficiency
42. In triage categorization after a disaster, which color is designated for patients with minor injuries who are not urgently in need of care?
A. Yellow B. Orange C. Red D. Black E. Green
43. A 39-year-old woman (P3+0) presents with heavy menstrual bleeding. She has regular 7-day cycles occurring every 30 days. Her BMI is 32 kg/m2 and her hemoglobin level is 10 g/dL. Which of the following is the most appropriate treatment of choice?
A. Hysterectomy B. Combined oral contraceptive pill C. GnRH analogue D. Danazol E. Antiprostaglandins & antifibrinolytics
44. A 73-year-old woman presents with a progressively worsening expressionless face, a resting pill-rolling tremor in her right hand, and cogwheel rigidity. Physical examination demonstrates bradykinesia, a shuffling gait with short turning steps, postural instability, and mild cognitive slowing. What is the most likely diagnosis?
A. Huntington’s disease B. Malignancy C. Progressive supranuclear palsy D. Normal pressure hydrocephalus E. Parkinson’s disease
45. What characterizes acute nephritic syndrome?
A. Proteinuria B. Hypoproteinaemia C. Haematuria and Hypertension D. Oedema
46. An overweight man with a BMI of 33 kg/m2 presents to the clinic for treatment of type 2 diabetes mellitus. Which of the following is the most appropriate initial drug to prescribe that functions primarily by improving insulin sensitivity?
A. Glucagon B. Gliclazide C. Metformin (Biguanides) D. Glucocorticoids
47. A 65-year-old male farmer with a history of alcohol consumption presents with right hypochondrial pain radiating to the right shoulder and progressive weight loss over the past 5 months. Physical examination reveals pallor and tenderness in the right hypochondrium. Laboratory investigations reveal elevated liver function tests, positive HBsAg, and a serum alpha-fetoprotein (AFP) level of 1000 ng/mL. What is the most likely diagnosis?
A. Sclerosing cholangitis B. GB carcinoma C. Pancreatic carcinoma D. HCC
48. A 45-year-old male came into the ER with a complaint of haematemesis for the last 2 hours. He is a diagnosed case of H.pylori PUD but didn’t take any treatment for that. What do you think will be the correct option regarding his active haematemesis management?
A. Angiography B. Endoscopy C. Propranolol D. Sclerotherapy
49. A 30-year-old female with hypovolemic shock after blunt trauma of the abdomen and a bruise in the left hypochondrium. What is the investigation of choice in this patient?
A. MRI B. CT-scan C. FAST D. X-ray
50. A 75-year-old man presents with lower urinary tract symptoms. Digital rectal examination reveals a hard prostatic mass, and biopsy shows prominent malignant cells. What is the most common anatomical site for carcinoma of the prostate?
A. Anterior zone B. Posterior zone C. Central zone D. Transitional zone E. Peripheral zone
51. What is the most common pathogen responsible for acute osteomyelitis in a two-year-old child?
A. S. aureus B. Pseudomonas C. E.Coli D. Salmonella E. S.pneumoniae
52. A 4-year-old boy presents with a 5-day history of a high fever reaching 103 F, cough, and a runny nose. Physical examination reveals posterior cervical lymphadenopathy, small white lesions on an inflamed oral mucosa, and a maculopapular rash that began behind the ears and spread to the rest of the body. His older sibling had similar symptoms 10 days ago. What is the most likely diagnosis?
A. Measles B. Rubella C. Drug rash D. Scarlet fever
53. Paradoxical (reverse) splitting of the second heart sound is seen in which condition?
A. RBBB B. VSD C. ASD D. LBBB
54. A 45-year-old woman presents with fatigue and a photosensitive rash across her face. Over the past year, she has experienced intermittent joint pain in both hands with morning stiffness. She was previously evaluated for microscopic haematuria and proteinuria. Blood tests show a positive ANA, negative ANCA, and elevated ESR. What is the SINGLE most likely diagnosis?
A. Drug induced vasculitides B. Systemic lupus erythematosus C. Churg-Strauss syndrome D. Rheumatoid arthritis E. Wegener’s granulomatosis
55. A 65 year old man with a three-year history of prostate cancer presents to the GP surgery with worsening thoracic backache over the past few weeks. He started having episodes of urinary incontinence today. He takes regular slow-release morphine for his pain however he still feels back pain at night which prevents a good night sleep. On examination, he has bilateral lower limb weakness. What is the SINGLE most appropriate investigation to request?
A. Urgent magnetic resonance imaging (MRI) of the whole spine B. Urgent computed tomography scan C. Dual Energy X-ray Absorptiometry (DEXA) scan
56. A 52-year-old man is evaluated for signs of liver failure and hepatic cirrhosis. What is the most common viral cause of hepatitis leading to chronic liver disease?
A. Hep C B. Hep A C. Hep B D. Hep E
57. A 28-year-old female is brought to the emergency department following an intentional overdose of six alprazolam tablets. On examination, she is drowsy but arousable, agitated, and confused, with slurred speech and shallow respirations. Which of the following is the most appropriate specific antidote in this case?
A. Flumazenil B. Dapsone C. Naloxone D. Furazolidone
58. A 28-year-old healthy individual undergoes a routine electroencephalogram (EEG). During the recording, the individual is relaxed, awake, and resting comfortably with their eyes closed. Which EEG rhythm is expected to predominate in this state?
A. Delta wave B. Alpha wave C. Theta wave D. Beta wave
59. A 28-year-old man presents to the emergency department with acute respiratory distress, lip swelling, and widespread urticaria shortly after a bee sting. His blood pressure is 80/50 mmHg and heart rate is 125 beats per minute. What is the immediate first-line treatment for this patient?
A. Epinephrine B. Atropine C. Diphenhydramine D. Hydrocortisone
60. What is the primary microorganism implicated in urinary tract infections (UTIs)?
A. Enterococcus B. Actinomyces C. All of them D. Clostridium difficile
61. What is the most prevalent fingerprint pattern?
A. Loop B. Whorl C. Arch D. Composite
62. A 65-year-old man presents with a history of resting tremor, shuffling gait, stooped posture, and a mask-like expressionless face. Physical examination reveals cogwheel rigidity and gait imbalance. Difficulty placing dentures in mouth. Degeneration of neurons in which region of the brain is the primary underlying cause of this patient’s condition?
A. Substantia nigra pars compacta (SNpc) B. Caudate and putamen C. Substantia nigra Pars Reticulata (SNpr) D. Globus pallidus
63. A 37-year-old man presents with sharp substernal chest pain that has progressively worsened over the past few days following an upper respiratory tract infection 3 weeks ago. The pain is constant, worsens in the supine position, and improves when leaning forward. On examination, a pericardial friction rub is heard and lung fields are clear. What is the most likely diagnosis?
A. Pericardial effusion B. Viral pericarditis C. Ventricular aneurysm D. Acute MI E. Tuberculosis
64. The ECG below shows a regular, narrow complex tachycardia in a patient presenting with sudden-onset, rapid palpitation. Which of the following should be used first in attempting to terminate this rhythm?
A. Direct current cardioversion B. Vagal maneuvers C. Oral beta blocker D. Intravenous adenosine E. Intravenous beta blocker
65. A 42-year-old morbidly obese man presents with polyuria, nocturia, and fatigue. His fasting blood glucose level is 8.2 mmol/L. Which of the following is the most appropriate first-line medication for this patient?
A. Metformin B. Pioglitazone C. Basal bolus insulin D. Rosiglitazone E. Gliclazide
66. A 30-year-old man is brought to the emergency department following a motor vehicle collision. He sustained a head injury and experienced a brief lucid interval, but his level of consciousness is now rapidly deteriorating. Which of the following is the most likely diagnosis?
A. Epidural B. Subarachnoid C. Subdural
67. A 15-year-old boy develops weakness in the lower limbs followed by the upper limbs. NCVs show acute axonal motor neuropathy. What is the best treatment for him?
A. IV immunoglobulins B. Interferon beta C. Observe D. IV methylprednisolone E. Thymectomy
68. A 34-year-old man presents with a 1-week history of fatigue, malaise, and mild jaundice. Serological testing demonstrates positive hepatitis B surface antigen (HBsAg), positive anti-hepatitis B core IgM (anti-HBc IgM), and negative anti-hepatitis B surface antibody (anti-HBs). What is the most likely interpretation of these findings?
A. Resolved infection B. Acute hepatitis B C. Window period D. Persistent hepatitis B
69. A young patient while playing cricket developed pain in the right testes, presented to surgical emergency with complain of sudden onset of severe pain in right testis that radiates to lower abdomen. On examination the right testis is tender to touch, swell, skin erythema, slightly pulled upwards, has a horizontal lie and a negative Prehn’s sign (pain is not relieved by elevation of testis, rather aggravated). What should be the management of this patient?
A. Testicular torsion B. Hematocele C. Undescended testis D. Idiopathic scrotal edema
70. A diabetic patient with valvular heart disease is planned for mesh hernioplasty for left sided inguinal hernia. The best time for antibiotic administration pre-operatively is?
A. At the time of surgical incision B. One day before surgery C. 1 hour before surgery D. 4 hours before surgery E. 2 hours before surgery
71. A 38-year-old man presents with a 5-day history of worsening fever and spreading redness over his left hand following a road traffic accident. On examination, he is febrile and tachycardic. The dorsum of the left hand shows erythema, palpable crepitus, foul-smelling discharge, and evidence of muscle necrosis. Laboratory investigations reveal marked leukocytosis. Which of the following organisms is most likely implicated?
A. Staphylococcus aureus B. Group A beta hemolytic Streptococcus C. Pseudomonas aeruginosa D. Clostridium Welchii
72. A 12 year old child was brought by her mother because of pain in right hip during walking. There is also pain in right knee joint. On examination his right lower limb is shortened and externally rotated. There is no evidence of any recent infection or trauma. What is the probable diagnosis?
A. Posterior Hip dislocation B. Legg-Calve-Perthes’ disease C. Extra-capsular femur fracture D. Slipped capital femoral epiphysis E. Fractured pelvis
73. A 31 year old male presented to surgical emergency with history of fall from bike. On examination, the right shoulder joint is tender and patient is unable to perform movements at shoulder joint. Which of following types of shoulder dislocation is most common?
A. Medial B. Anterior C. Lateral D. Posterior E. Superior
74. A 34 year old female presented with vomiting preceded by an occipital headache of acute onset. Examination: conscious and alert with photophobia but no neck stiffness. CT: normal. What is the most appropriate further management?
A. CSF exam B. Repeat CT brain in 24h C. Cerebral angio D. CT brain with contrast E. MRI brain
75. A 30 year old woman has been feeling low and having difficulty in concentrating since her mother passed away 2 months ago. She feels lethargic and tends to have breathlessness and tremors from time to time. What is the most likely diagnosis?
A. Adjustment disorder B. Bereavement C. GAD D. PTSD E. Panic disorder
76. A 25 year old male with a history of frequent binge drinking presents 4 hour after having had a takeaway meal following a night’s heavy drinking. He complains of nausea and has vomited on several occasions. After the last vomiting episode, he vomited approximately a cupful of blood. On admission, he smells of alcohol, pulse=100bpm, BP=140/80mmHg. He has some tenderness in the epigastrium. What is your diagnosis?
A. Esophageal varices B. Gastric carcinoma C. Peptic ulceration D. Esophageal carcinoma
77. A pregnant woman at 37 weeks of gestation presents with rapid weight gain, bilateral lower extremity edema, and shortness of breath. Her blood pressure is persistently elevated at 160-165/90-100 mmHg on repeat measurements. Urinalysis demonstrates 2+ proteinuria. What is the most likely diagnosis?
A. Chronic Hypertension B. Pre Eclampsia C. Gestational Hypertension D. HELLP Syndrome
78. What is the most common mechanism of action of combined oral contraceptive pills (COCPs)?
A. Tubal blockage B. Increase in estrogen C. Anti FSH/LH D. Decrease progesterone
79. Inguinal injury affecting knee extension, abduction, area overlying medial thigh, medial leg and medial ankle skin. What affected nerve?
A. Saphenous B. Obturator nerve C. Femoral nerve
80. A 12-year-old boy presents with fever, unilateral parotitis, and orchitis. What is the most likely diagnosis?
A. Mumps B. Rubella C. Measles D. Diphtheria
81. Essential fatty acids deficiency in TPN leads to:
A. Rashes + facial hairs fall B. Loss of vision C. Hairs fall D. Dry skin + rashes E. Dry mouth
82. A 45-year-old man presents with severe acid reflux and persistent diarrhea. Upper gastrointestinal endoscopy reveals severe esophagitis and multiple duodenal ulcers. Laboratory investigations demonstrate pernicious anemia. What is the most likely diagnosis?
A. Acid peptic disease B. None of the above C. Diphyllobothrium latum infection D. Zollinger Ellison syndrome E. Acute gastritis
83. A 68-year-old man with advanced chronic renal failure and type-2 diabetes, currently receiving peritoneal dialysis, is seen in the Cardiovascular Risk-reduction clinic. You are considering prescribing a statin. Which of the following best describes the lipid abnormalities most likely to be seen in this man?
A. Isolated increased LDL levels B. Isolated hypertriglyceridaemia C. Mixed hyperlipidaemia with increased LDL and triglyceride levels D. A combination of hypertriglyceridaemia, raised LDL and decreased HDL levels E. The predominant abnormality is low HDL cholesterol
84. In Down’s syndrome (Trisomy 21), which is the most common congenital heart defect?
A. Atrial septal defect B. Ventricular septal defect C. Tetralogy of Fallot D. Atrioventricular septal defect E. Patent ductus arteriosus
85. A child with epilepsy fell after an attack of tonic-clonic seizure and came with his shoulder flat and fixed adduction and internal rotation. Which type of shoulder dislocation?
A. Posterior dislocation B. Lateral dislocation C. Anterior dislocation D. Medical dislocation
86. A 50-year-old man with a history of diabetes mellitus presents with progressive ascites, fever, and weight loss over the past 3 months. Diagnostic paracentesis reveals a serum-ascites albumin gradient (SAAG) of less than 1.1 g/dL. Which of the following is the most likely cause of his ascites?
A. Peritoneal lining Tuberculosis B. Hepatic lymphatics C. Nephrotic syndrome D. Restrictive cardiomyopathy E. Veno-occlusive Hepatic vein
87. What is the inheritance pattern of sickle cell anemia?
A. X linked B. Dominant C. Autosomal dominant D. Autosomal Recessive
88. Pregnant c/o hand itching increased at night. Burrow-like lesions in the finger webs and wrists. Which of the following is most appropriate treatment?
A. 5% Permethrin cream B. Oral Ivermectin C. 1% Lindane lotion D. Calamine lotion
89. Pt with history of gastroenteritis took medication. Now came with dystonia and akathisia. Cause?
A. Metoclopramide
90. Which of the following statements if patient should go immediately to surgery in Crohn’s disease?
A. Abdominal mass B. Intestinal obstruction C. Intestinal bacterial overgrowth D. Fistula formation
91. A 28-year-old woman at 8 weeks gestation presents with a 12-hour history of vaginal bleeding and severe lower abdominal pain. She reports passing tissue per vaginam prior to arrival. On pelvic examination, the internal cervical os is dilated to 1 cm. What is the most likely diagnosis?
A. Complete abortion B. Threatened abortion C. Incomplete abortion D. Missed abortion
92. Female with amenorrhea for 6 weeks, pregnancy test positive, presented with abdominal pain, (can’t recall if there was bleeding or not), US showed no intrauterine pregnancy with minimal fluid in cul-de-sac and mass of 1.2 cm in tube. She was vitally stable. What’s your action?
A. Salpingostomy B. Salpingectomy C. Methotrexate
93. Sudden right lower limb pain. Diminished sensation + altered motor. Pt on anticoagulant for afib. Best next step:
A. CTA B. US C. Embolectomy
94. Most specific test for rheumatoid arthritis?
A. Rheumatoid Factor B. HLA 27 C. CRP D. AntiKDNAse
95. First line treatment of tenia pedis (athletes foot):
A. Systemic ketoconazole B. Topical antifungal C. Topical terbinafine
96. A 30-year-old woman presents with a painless lump in her left breast. She has a history of a similar breast lump in the past. Her grandmother was diagnosed with breast cancer at 70 years of age. On examination, there is a 1 cm x 1 cm, smooth, firm, discrete, and mobile mass in the outer quadrant of the left breast. What is the single most likely diagnosis?
A. Breast cyst B. Breast carcinoma C. Fibroadenoma D. Sebaceous cyst E. Breast abscess
97. A 47-year-old man presents to the accident and emergency department with full-thickness burns calculating up to 10% of his lower limbs from steam pipe. Analgesia has been given. What is the most appropriate immediate management?
A. Discharge home with analgesia and follow up in clinic B. Escharotomy C. Admit to general ward D. Intravenous fluids E. Refer to burns unit
98. A 36-year-old woman presents with a 3-month history of spontaneous bloody discharge from her right nipple. Examination reveals a small retroareolar nodule, and targeted pressure on the nipple-areolar complex at the 3 o’clock position reproduces the bloody discharge. Mammography is normal. What is the most likely diagnosis?
A. Intraductal carcinoma B. Breast cyst C. Carcinoma in situ D. Fat necrosis E. Intraductal papilloma
99. A 2-year-old child drinks kerosene that had been left in a glass. After the first swallow, she cries and drops the glass. She is most likely to develop which of the following?
A. Hepatitis B. Aplastic anemia C. Peripheral neuritis D. Coma and/or convulsions E. Chemical pneumonitis
100. A female patient presents with a swelling on the right side of her neck that moves with deglutition but does not move on tongue protrusion. She is asymptomatic, her thyroid function tests are normal, and her mother was previously treated for thyroid carcinoma. Which of the following is the most appropriate next step in investigation?
A. CT scan of the neck B. PET scan C. Neck ultrasound D. Thyroid scintigraphy E. Fine needle aspiration cytology (FNAC)
101. An adult psychiatric inpatient refuses to take a prescribed essential medication. Believing the treatment is necessary for the patient’s wellbeing, the medical team forcefully administers the drug. Which ethical principle is primarily violated by this action?
A. Beneficence B. Non-maleficence C. Autonomy D. Justice
102. A 30-year-old man presents to the clinic following a deep laceration to his anterior wrist. Physical examination reveals weakness in thumb opposition and flattening of the thenar eminence. Which of the following clinical features is characteristic of this nerve injury?
A. Footdrop B. Claw hand C. Ape hand D. Wrist drop
103. A 50-year-old man is found dead in his home with a single, self-inflicted gunshot wound to the head. When first responders arrive, the revolver is still tightly clasped in his right hand. Which of the following best describes this phenomenon?
A. Rigor mortis B. Secondary relaxation C. Instantaneous rigor D. Primary rigidity
104. A 65-year-old man with long-standing osteoarthritis managed on daily NSAIDs presents with progressive fatigue and dyspnea on exertion. On examination he is pale, and a stool guaiac test is positive. Laboratory studies reveal a hemoglobin of 7.2 g/dL. What is the most likely cause of his anemia?
A. Upper gastrointestinal bleeding B. Nutritional deficiency C. Hemolysis D. Bone marrow suppression
105. To prescribe dextromethorphan, which of the following best describes its primary therapeutic indication?
A. Antihistaminic B. Antitussive C. Analgesic D. Expectorant
106. What is the best position for performing gastric lavage in a dead person?
A. Prone position B. Left lateral decubitus C. Supine position D. Right lateral decubitus
107. A 52-year-old woman underwent a hysterectomy through a midline abdominal incision. A few months later, she presents with a bulge at the incision site, diagnosed as an incisional hernia. What is the most appropriate treatment?
A. Conservative management B. Laparoscopic hernia repair C. Herniorrhaphy (non-mesh repair) D. Open mesh repair
108. A 65-year-old diabetic patient underwent foot surgery. One month later, the surgical wound has still not healed. What is the most likely cause?
A. Poor hygiene B. Old age C. Decreased venous supply D. Delayed wound healing due to diabetes
109. A patient presents with shifting abdominal pain, nausea, vomiting, raised temperature, tenderness in the right iliac fossa, and a WBC count of 13,000/mm3. What is the most likely Alvarado score for this patient?
A. 7 B. 3 C. 6 D. 5
110. A 5-year-old child accidentally ingested his grandmother’s diazepam tablets. He is brought to the emergency department for gastric lavage. What is the best position for performing the procedure?
A. Left lateral decubitus B. Supine position C. Right lateral decubitus D. Prone position
111. Which of the following is the most accurate investigation for TNM staging of esophageal carcinoma?
A. CT scan of the chest B. Upper GI endoscopy C. Endoscopy D. Intraluminal (endoscopic) ultrasonography (EUS)
112. After a skin graft is taken, in how many weeks does the donor site typically heal?
A. 3 weeks B. 2 weeks C. 4 weeks D. 1 week
113. Ferrous sulfate exhibits pharmacological antagonism with which of the following?
A. Folic acid B. Vitamin C C. Cyanocobalamin D. Tetracycline
114. A Double J (DJ) stent is commonly used in which of the following surgical specialties?
A. Cardiology B. Neurology C. Gastroenterology D. Ureteroscopy
115. Pericardiocentesis is used to treat which of the following conditions?
A. Pericarditis B. Tension pneumothorax C. Myocardial infarction D. Cardiac tamponade
116. A patient has recently undergone thyroidectomy and now presents with dyspnea, hoarseness of voice, and pain radiating to the tip of the right shoulder. Laryngoscopy reveals vocal cord paresis. What is the most immediate next step in management?
A. Start corticosteroids B. Perform tracheostomy C. Wait for spontaneous recovery D. Reopen surgical wound immediately
117. A 3-year-old child presents after accidental ingestion of kerosene oil. He is coughing and tachypneic but has stable vital signs. What is the most appropriate initial treatment?
A. Supportive care plus antibiotics B. Gastric lavage C. Steroids plus antibiotics D. Beta nebulization
118. Which of the following is a known complication associated with intrauterine contraceptive device (IUCD) use?
A. Oligomenorrhea B. Pelvic infection C. Nulliparity D. Amenorrhea
119. Which of the following drugs is used in the treatment of gout by increasing uric acid excretion (uricosuric effect)?
A. Probenecid B. Febuxostat C. Colchicine D. Allopurinol
120. Linoleic acid is an essential fatty acid important for growth and development. Deficiency of essential fatty acids can lead to which of the following?
A. Marasmus B. Anemia C. Stunted growth D. Dermatitis
121. Damage to the hypothalamus primarily affects which of the following functions?
A. NREM sleep B. REM sleep C. Short-term memory D. Body temperature
122. Which joint is primarily responsible for the eversion and inversion movements of the foot?
A. Distal tibiofibular joint B. Subtalar joint C. Calcaneocuboid joint D. Ankle joint
123. A 1-year-old child presents with a history of diarrhea. On examination, the child is alert, has dry mucous membranes, and the skin pinch goes back slowly. The child drinks water eagerly when offered. What is the appropriate management plan according to IMNCI guidelines?
A. Plan C B. Plan B C. Reassurance D. Plan A
124. A patient undergoing thyroidectomy suddenly develops a drop in end-tidal CO2 (ETCO2) to 20 mmHg and a concurrent drop in oxygen saturation. What is the most likely cause?
A. Pneumothorax B. Bronchospasm C. Atelectasis D. Endotracheal tube (ETT) displacement
125. A patient with a known history of Chronic Myeloid Leukemia (CML) has died. What is the most likely cause of death in patients with CML?
A. Repeated blood transfusion complications B. Blast crisis (progression to acute leukemia) C. Hemorrhage D. Infection
126. A patient with a known case of prostate cancer presents for follow-up. On digital rectal examination (DRE), what is the most likely finding?
A. Firm, nodular, asymmetrical prostate B. Smooth, tender prostate C. Fluctuant, boggy prostate D. Soft, enlarged, symmetrical prostate
127. A patient presents with recurrent vomiting and signs of dehydration. Arterial blood gas shows metabolic alkalosis. Which electrolyte is most likely lost in this condition?
A. Sodium B. Potassium C. Calcium D. Bicarbonate
128. Which one of the following types of angina is excluded when beta-blockers are administered to counteract the symptoms of ischemia?
A. Chronic exertional angina B. Stable angina C. Unstable angina D. Prinzmetal angina
129. A 5-day-old neonate presents with poor feeding, vomiting, and progressive lethargy. On examination, the infant is hypotonic, and the parents report that the urine has a sweet, burnt sugar odor. Laboratory investigation confirms a diagnosis of maple syrup urine disease. A deficiency of which enzyme complex is responsible for this condition?
A. Methylmalonyl-CoA mutase B. Phenylalanine hydroxylase C. Pyruvate carboxylase D. Homogentisate oxidase E. Branched-chain alpha-ketoacid dehydrogenase (BCKDH) complex
130. A 34-year-old woman with a history of chronic alcohol consumption presents with progressive fatigue and pallor. Complete blood count shows macrocytic anemia. On neurological examination, there are no peripheral sensory or motor deficits. Laboratory investigations reveal normal serum methylmalonic acid levels and elevated serum homocysteine levels. Blood smear shows hypersegmented neutrophils. Which of the following nutritional deficiencies is the most likely cause of her presentation?
A. Folate B. Vitamin B2 C. Vitamin B12
131. A 55 year old man presents to the emergency department with severe chest pain radiating to his right arm. ECG shows ST segment elevation in leads II, III, and aVF. Coronary angiography reveals a 100% occlusion of the right coronary artery (RCA). What is the most likely location of the myocardial infarction (MI)?
A. Anterior wall B. Posterior wall C. Inferior wall D. Lateral wall
132. A 28-year-old woman presents with high fever, chills, right-sided flank pain, and dysuria. Physical examination reveals marked costovertebral angle tenderness. Urinalysis shows pyuria and white blood cell casts. Which of the following pathogens is most commonly associated with this condition?
A. Proteus mirabilis B. Escherichia coli C. Pseudomonas aeruginosa D. Staphylococcus aureus
133. A 62-year-old man presents to the emergency department with a sudden severe headache, vomiting, and transient loss of consciousness. A non-contrast head CT scan demonstrates an acute intracerebral hemorrhage. On examination, his blood pressure is 160/100 mmHg and he exhibits clinical signs of increased intracranial pressure. What is the most appropriate immediate management step?
A. Give mannitol B. Start aspirin C. Increase blood pressure to maintain cerebral perfusion D. Restrict oxygen E. Give thrombolysis (tPA)
134. A 35-year-old woman presents with ptosis and diplopia that worsen towards the end of the day. Her symptoms characteristically improve after periods of rest. Which of the following is the single most appropriate next step in management?
A. Plasma exchange B. Diaminopyridine C. Cyclophosphamide D. Pyridostigmine
135. A 17-year-old girl was brought to the emergency after ingestion of kerosene oil. Which is the most important common complication of this poisoning?
A. Acute Renal failure B. Acute hepatic failure C. Encephalopathy D. Bronchopneumonia
136. A 32-year-old woman presents with a 3-month history of fatigable muscle weakness, bilateral ptosis, and diplopia that worsens toward the end of the day. Electrodiagnostic testing supports a diagnosis of myasthenia gravis. What is the primary pathogenic mechanism underlying this condition?
A. Autoantibodies against postsynaptic acetylcholine receptors B. Acetylcholinesterase deficiency C. Destruction of motor neurons D. Presynaptic calcium channel antibodies
137. A 55-year-old woman presents with progressive jaundice, dark urine, pale stools, and generalized itching. Laboratory investigations reveal predominantly conjugated hyperbilirubinemia and a markedly elevated alkaline phosphatase level. What is the most likely cause of her condition?
A. Gilbert syndrome B. Hemolytic anemia C. Obstruction of the common bile duct D. Viral hepatitis
138. A 45-year-old woman presents with progressive fatigue and generalized pruritus. Laboratory investigation reveals significantly elevated serum alkaline phosphatase levels. Serological testing demonstrates high titers of anti-mitochondrial M2 antibodies (AMA). Which of the following is the most likely diagnosis?
A. Alcoholic hepatitis B. Autoimmune hepatitis C. Primary sclerosing cholangitis D. Primary biliary cholangitis
139. A 55-year-old man with a known history of rheumatic heart disease presents with a 2-week history of persistent fever, fatigue, splinter hemorrhages, and malaise after undergoing a dental extraction without antibiotic prophylaxis. Clinical examination reveals a new cardiac murmur, and subacute infective endocarditis is suspected. Which of the following microorganisms is the most common cause of infective endocarditis associated with dental procedures?
A. Enterococcus faecalis B. Staphylococcus aureus C. Pseudomonas aeruginosa D. Streptococcus viridans
140. A 31-year-old man presents with persistent cervical lymphadenopathy, low-grade fever, night sweats, and unintentional weight loss. A lymph node biopsy demonstrates granulomatous lesions featuring central structureless, eosinophilic, caseous necrosis. Which of the following infectious diseases is most classically associated with this type of tissue necrosis?
A. Tuberculosis B. Fat necrosis C. Myocardial infarction D. Syphilis E. Acute pancreatitis