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Multiple Choice

65 years old man known case of ischemic heart disease, hypertension, chronic kidney disease stage 2 and diabetes mellitus. His medication is Amlodipine, Losartan, Metformin, Gliclazide, Aspirin, Vasteral and Bisoprolol. Recently he was been admitted for compensated heart failure. On examination, his BP 160/90, HR 78, Lung examination is minimal crepitation. His chest x-ray showed borderline cardiomegaly and Hba1c 8.5%. As a physician in charge of him, what is the best medication to be added to prevent recurrence and progression of his disease?

• Frusemide

• Perindopril

• Dapagliflozin

• Plavix

• Liraglutide

Multiple Choice

34 years gentleman is investigated for frequent syncopal attack and recently he had an episode of collapse whilst at work. A resting ECG showed convex St elevation of V1-V3 with partial right bundle branch block pattern. What is the most likely diagnosis?

• Polymorphic vantricular tachycardia

• Hypertrophic obstructive cardiomyopathy

• ST elevation Myocardiac infarction

• Brugada syndrome

• Normal variant ECG

Multiple Choice

30 years old woman is admitted to hospital with abdominal pain and diarrhoea. She has no past medical history other than depression for which she takes citalopram. She smokes 20 cigarettes per day and drinks 20 unit of alcohol per weeks. Endoscopy show features cobblestone appearances. Besides glucocorticoid treatment, what is the best way to present recurrence or relapse of the disease?

• infliximab

• oral Budesonide

• Stop Smoking

• Mesalazine

• Stop Alcohol

Multiple Choice

59 years old woman presents with dysphagia. There is no history of heartburn, weight loss or change in bowel habit. during endoscopy, there is some difficulty passing through the lower esophageal sphincter but no other abnormality is noted. which one of the following test is most likely to reveal the diagnosis?

• Esophageal biopsy

• Endoscopy ultrasound

• CT abdomen

• Esophageal manometry

• Chest Xray

Multiple Choice

45 years old lady presented to the chest clinic with a history of persistent cough and dyspnea. The cough is associated with an amount large of sputum and sometimes difficult to cough it out. Her family has coal business, her father and brother have a similar problem thus make her think this is a common problem. She married for 20 years and no children. What is the most likely diagnosis?

• Cystic fibrosis

• Coal pneumoconiosis

• COPD

• Kartagener's syndrome

• Sjogren syndrome

Multiple Choice

79 years old man is admitted with right lower lobe pneumonia. As well as showing consolidation there is a moderated pleural effusion on the same side. An ultrasound-guided pleural tapping was done. The appearance of the fluid is clear and is sent off for investigation and culture & sensitivity. Which is the following is the most important factor in the pleural fluid to determine the insertion of a chest tube for this gentleman?

• Glucose

• Type of microorganism

• LDH

• pH

• Protein

Multiple Choice

34 years old female presents with a purpuric rash on the back of her calf. She also reported frequent nose bleeds and menorrhagia. Currently, she took OCP to regulate her menses. A full blood count reveals as per picture. What is the most likely diagnosis?

• Idiiopathic thrombocytopenic purpura

• Henoch-Schonlein purpura

• Thrombotc thrombocytopenic purpura

• Drug induce thrombocytopenia

• Antiphospholipid syndrome

Multiple Choice

62 year old man presents with letraghy. A full blood count is taken and reported

hb 10.2g/dL

platlet 330

WBC 15.2

Peripheral blood film as per picture. What is the most likely diagnosis?

• Myelodysplasia

• Chronic lymphocytic leukaemia

• Myelofibrosis

• Chronic myeloid leukemia

• Post-splenectomy

Multiple Choice

62 years old man is admitted to the emergency department with left hemiplegia. His symptoms started around 5 and half hours, but he initially thought he had slept in a backwards position. He has no past medical history of not but on examination is found to have an irregular pulse of 100 bpm. The ECG confirms atrial fibrillation. A CT head reported as normal. What is the most appropriate initial management?

• Dabigatran

• Dipyridamole

• Alteplase

• Warfarin

• Aspirin

Multiple Choice

A 30 years old lady presents with the acute occipital headache associated with vomiting, photophobia and neck stiffness. There is no history of rash or fever. She reported had a history of young hypertensionwhihc lead to pheochromocytoma diagnosis and surgical resection was done and currently, she is not on antihypertensive medication. Her father died due to kidney cancer and the brother is blind on the right eye due to bleed in the eye. What is the most likely diagnosis?

• Autosomal dominant polycyctic kidney disease

• Multiple endocrine neoplasia type 1

• Von Hipple Lindau disease

• Tuberous sclerosis

• Alport Syndrome

Multiple Choice

64 years old man presents with 8 months history of generalised weakness. On examination, he has fasciculation and weakness in both arms with absent reflexes and the lower limb reveal increased tone and exaggerated reflexes. The sensation is intact and there no cerebellar signs. what is the most likely diagnosis?

• Progressive muscular dysthrophy

• Amyothrophic lateral sclerosis

• Multiple sclerosis

• Vitamin B 12 dificiency

• Syringomyelia

Multiple Choice

27 years old woman presents with genital ulceration. She had recurrent similar attacks for the past 4 years. Oral aciclovir has some little effect on the duration of her symptoms. She notices for the past year almost weekly she had mouth ulcers which recently slow to heal. Her only past medical problem, she had been warded for thrombophlebitis. What is the most likely diagnosis?

• Polyarthritis Nodosa

• Systemic Lupus Erythromatous

• Bachet Disease

• Herpes Simplex Virus

• Syphilis

Multiple Choice

68 years old man presents with painful swollen left knee which failed to settle after a week rest. there is no history of trauma. On examination, he has a moderate-sized effusion. the plain radiograph was done. What is the most likely diagnosis?

• Pseudogout

• Rheumatoid arthritis

• Sarcoidosis

• Psoarisis athropathy

• Osteoarthritis

Multiple Choice

70 years old man admitted with abdominal pain. The surgeons wish to perform contrast-enhanced Ct Scan but he concerns about his chronic kidney disease stage 3b. Which the following is the best step to prevent contrast-induced nephropathy?

• Oral sodium bicarb

• N acetylcysteine

• Intravenous 0.9% sodium chloride

• Frusemide

• Mannitol

Multiple Choice

35 years old woman presents with a one-week history of progressive leg swelling. Her past medical history includes DM type 2. On examination, there is bilateral pedal edema up to knee and peri orbital dedema. Her HR is 88/min, BP 151/95mmHg, Temperature 37C. Urine dipstick showed protein 4+. Two days later, she complains of hematuria and left-sided pain. Her renal profile deranges to stage 1 AKI. What is the most likely diagnosis?

• Hemorrhagic Cyst

• Urinary tract infection

• Renal vein thrombosis

• Ureteric calculi

• Hemolysis

Multiple Choice

A 38 years old woman presents to the clinic with a history of hypertension since 10 years ago. Currently, she is on amlodipine and ramipril. On examination, the heart rate is 80 bpm, and blood pressure is 180/110mmHg. What is the most likely cause of her hypertension?

• Bartter Syndrome

• Bilateral renal artery stenosis

• Gitelman syndrome

• Primary hyperaldosteronism

• Acromegaly

Multiple Choice

35 years old man was diagnosed with HIV and is stable on antiretroviral therapy. He has a new regular partner and is concern about transmission of the disease to him. What is the factor is most likely to increase the risk of transmission?

• Circumcision

• Low CD4 Count

• Genital warts

• Diabetes

• Mucosal ulceration

Multiple Choice

28 years old man who has recently emigrated from Thailand presents with a penile ulcer. It initially started as papule which later progressed to become painful ulcer with an undermined ragged edge. Examination of the testes was unremarkable but tender inguinal lymphadenopathy was noted. What is the most likely diagnosis?

• Chancroid

• Lymphogranuloma Venerum

• Syphilis

• Herpes Simplex

• Granuloma inguinale

Multiple Choice

64 years old man present with severe mucosal ulceration associated with the development of blistering lesions over his torso and arm. On examination, the blisters are flaccid and easily ruptured when touched. What is the most likely diagnosis?

• Pemphigoid

• Dermatitis herpetiformis

• Psoriasis

• Pemphigus Vulgaris

• Epidermolysis bullosa

Multiple Choice

23 years old man with severe Chron's disease has been put on complete bowel rest for an indefinite period of time whilst he in-patient recovery. he received total parenteral nutrition for past few weeks. recently his skin become dry and scaly with mouth ulcers and lip swelling. what cause of this changes

• Cheilitis

• Extra bowel manifestation of Chrons

• folliculitis

• Palisaded neutrophilic and granulomatous dermatitis

• Acrodermatitis herpetiform

Multiple Choice

20years old man presents with a nine months history weight gain. Prior to this, he was of normal weight. On examination of his, BMI is 36, BP 150/90, he is noted to have abdominal striae and some degree of myopathy. Blood investigation as per attachment. what is the next best investigation?

• Plasma ACTH

• 24 Hour urine cortisol

• Renal:Aldosterone ratio

• thyroid fucntion test

• Insulin growth factor

Multiple Choice

52 years old woman in the ED with dyspnea accompanied by nausea and vomiting. She is suffering from DM type 2, hypertension, and obesity. Her current medication is metformin 1g bd, canagliflozin 100 mg od, ramipril 10 mg od and amlodipine 10 mg od. On examination RR 25 breath per min, and O2 saturation is 98% under room air. Other examination is unremarkable except she has epigastric tenderness. Blood result as per attachment. What is the most likely diagnosis?

• small bowel obstruction

• Metformin induce Lactic acidosis

• Starvation ketosis

• Euglycemic diabetic ketoacidosis

• Pancreatitis

Multiple Choice

45 years old women present with weight gain and recurrent dizziness. Over the past 4 months she has gained 20kg weight and "dizziness" episode occur on daily basis with blurring of vision, sweating, headaches nd palpitation. She went to KK and blood sugar record 1.4 mmol/L and it was persistently low even after correction. What is the single most useful test?

• Thyroid function test

• Glucagon Stimulation test

• C Peptide

• Short ACTH test

• Cortisol level

Multiple Choice

45 years old women present with weight gain and recurrent dizziness. Over the past 4 months she has gained 20kg weight and "dizziness" episode occur on daily basis with blurring of vision, sweating, headaches nd palpitation. She went to KK and blood sugar record 1.4 mmol/L and it was persistently low even after correction. What is the single most useful test?

• Thyroid function test

• Glucagon Stimulation test

• C Peptide

• Short ACTH test

• Cortisol level