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WorksheetsGEM Module 7 Mock
Total questions: 100
Worksheet time: 2hrs 40mins
Name
Class
Date
1.
A 25-year-old woman presents with a painful, swollen perineum following a traumatic vaginal delivery. On examination, there is bruising and swelling that extends into the labia majora and up the anterior abdominal wall. The spread of this haematoma is primarily contained by which anatomical structure?
a)
Camper's fascia
b)
Scarpa's fascia
c)
Dartos fascia
d)
Buck's fascia
e)
Denonvilliers' fascia
2.
During a radical hysterectomy for cervical cancer, the surgeon must carefully identify and ligate the uterine artery. Which critical structure passes immediately inferior to this artery at the level of the cervix, risking injury if not isolated ("water under the bridge")?
a)
Ureter
b)
Uterine tube
c)
Ovarian artery
d)
Internal iliac artery
e)
Pudendal nerve
3.
A 60-year-old man is diagnosed with prostate cancer. Biopsy confirms adenocarcinoma, which most commonly originates in which anatomical zone of the prostate?
a)
Anterior fibromuscular zone
b)
Central zone
c)
Peripheral zone
d)
Transition zone
e)
Periurethral zone
4.
A 22-year-old man is kicked in the perineum during a football match. He develops intense pain and a subsequent haematoma that is confined to the penis and does not extend to the abdomen or scrotum. Which fascia is responsible for containing this haematoma?
a)
Scarpa's fascia
b)
Colles' fascia
c)
Buck's fascia
d)
Dartos fascia
e)
Camper's fascia
5.
Lymphatic drainage from the glans penis is primarily to which nodal group?
a)
Superficial inguinal nodes
b)
Deep inguinal nodes
c)
External iliac nodes
d)
Internal iliac nodes
e)
Para-aortic nodes
6.
A 45-year-old woman undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrial cancer. Postoperatively, she reports constant leakage of urine into her vagina. A vesicovaginal fistula is suspected. During the surgery, the most likely site of iatrogenic injury to the bladder was at which anatomical location?
a)
The dome of the bladder
b)
The trigone of the bladder
c)
The urethrovesical junction
d)
The base of the bladder, near the vaginal fornix
e)
The ureteric orifices
7.
A 30-year-old man presents with a swelling in his scrotum that is located superior and posterior to the testis, transilluminates, and is separate from the testis on palpation. What is the most likely diagnosis?
a)
Varicocele
b)
Testicular tumour
c)
Spermatocele
d)
Indirect inguinal hernia
e)
Hydrocele of the cord
8.
The pudendal nerve block is a common regional anaesthetic technique used during childbirth. Through which anatomical structure does the pudendal nerve pass to enter the perineum?
a)
Obturator foramen
b)
Greater sciatic foramen
c)
Lesser sciatic foramen
d)
Inguinal canal
e)
Sacral foramen
9.
A 65-year-old man presents with back pain. Imaging reveals osteoblastic metastases in the lower vertebrae. The primary cancer is most likely located in which organ, given its venous drainage via Batson's plexus?
a)
Liver
b)
Lung
c)
Prostate
d)
Colon
e)
Kidney
10.
Which of the following structures is a homologue of the labia majora in the male?
a)
Scrotum
b)
Penile urethra
c)
Glans penis
d)
Prostate gland
e)
Bulbourethral glands
11.
A 29-year-old woman with a regular 28-day menstrual cycle presents for fertility advice. On which day of her cycle is she most likely to ovulate?
a)
Day 5
b)
Day 10
c)
Day 14
d)
Day 21
e)
Day 26
12.
The sustained high level of oestradiol from a dominant follicle in the late follicular phase has what primary effect on the anterior pituitary?
a)
Negative feedback, suppressing FSH and LH
b)
Positive feedback, triggering an LH surge
c)
Direct inhibition of GnRH release
d)
Stimulation of prolactin release
e)
Suppression of inhibin B
13.
A 40-year-old man has a serum testosterone level of 6 nmol/L (normal range 10-35 nmol/L). Which of the following patterns of gonadotropin levels would be consistent with a diagnosis of primary hypogonadism?
a)
Low FSH, Low LH
b)
High FSH, High LH
c)
High FSH, Low LH
d)
Low FSH, High LH
e)
Normal FSH, Normal LH
14.
Which of the following is the primary hormonal driver of the secretory changes in the endometrium during the luteal phase of the menstrual cycle?
a)
Oestradiol
b)
Follicle-Stimulating Hormone (FSH)
c)
Progesterone
d)
Luteinising Hormone (LH)
e)
Inhibin A
15.
A 25-year-old woman is in the active phase of labour. Pain from the dilation of the cervix and the stretching of the proximal vagina is transmitted via which nerve pathway?
a)
Sympathetic nerves (T10-L1)
b)
Somatic nerves from the lumbar plexus (L1-L2)
c)
Visceral afferents travelling with parasympathetic pelvic splanchnic nerves (S2-S4)
d)
The ilioinguinal nerve (L1)
e)
The genitofemoral nerve (L1-L2)
16.
What is the primary physiological mechanism by which Human Chorionic Gonadotropin (hCG) maintains early pregnancy?
a)
It directly stimulates the endometrium to decidualise.
b)
It suppresses maternal immune rejection of the trophoblast.
c)
It prevents the regression of the corpus luteum.
d)
It stimulates placental production of progesterone.
e)
It promotes fusion of cytotrophoblast cells into syncytiotrophoblast.
17.
A 32-year-old pregnant woman at 30 weeks gestation has a blood pressure of 115/70 mmHg, a heart rate of 95 bpm, and a cardiac output of 6.5 L/min. Which of the following best describes her cardiovascular status compared to pre-pregnancy?
a)
Normal cardiac output
b)
Decreased heart rate and increased stroke volume
c)
Markedly decreased cardiac output
d)
Increased cardiac output due to increased heart rate and stroke volume
e)
Increased cardiac output solely due to increased stroke volume
18.
In the thick ascending limb of the Loop of Henle, which transporter is primarily responsible for reabsorbing sodium chloride and establishing the medullary concentration gradient?
a)
Na+/H+ exchanger (NHE3)
b)
Na+/K+/2Cl- cotransporter (NKCC2)
c)
Na+/Cl- cotransporter (NCC)
d)
Epithelial Sodium Channel (ENaC)
e)
Aquaporin-2 channel
19.
A patient with severe vomiting has a blood pH of 7.50, HCO3- of 34 mmol/L, and pCO2 of 48 mmHg. What is the most likely acid-base diagnosis?
a)
Metabolic acidosis with partial respiratory compensation
b)
Metabolic alkalosis with appropriate respiratory compensation
c)
Respiratory alkalosis with metabolic compensation
d)
Mixed metabolic and respiratory alkalosis
e)
Respiratory acidosis
20.
The principal cells of the collecting duct regulate potassium secretion. Which of the following is the primary stimulator of this process?
a)
Atrial Natriuretic Peptide (ANP)
b)
Aldosterone
c)
Parathyroid Hormone (PTH)
d)
Antidiuretic Hormone (ADH)
e)
Insulin
21.
A 30-year-old woman with anovulatory infertility due to PCOS is prescribed a drug that acts as an oestrogen receptor antagonist in the pituitary. This relieves the negative feedback on GnRH secretion, leading to increased FSH and LH and stimulation of ovulation. Which drug is this?
a)
Letrozole
b)
Tamoxifen
c)
Clomiphene
d)
Mifepristone
e)
Goserelin
22.
A 55-year-old man with metastatic prostate cancer is treated with a GnRH agonist. What is the expected initial hormonal response following the first dose?
a)
Immediate suppression of FSH and LH
b)
A transient surge in FSH and LH, leading to a "testosterone flare"
c)
Direct inhibition of testosterone production in Leydig cells
d)
Blockade of androgen receptors
e)
Suppression of 5-alpha-reductase
23.
Which of the following drug classes is most appropriate for first-line medical management of heavy menstrual bleeding in a woman without structural pathology who does not desire immediate pregnancy?
a)
Tranexamic acid
b)
Aromatase inhibitors
c)
GnRH antagonists
d)
Danazol
e)
Mifepristone
24.
A 45-year-old woman with severe endometriosis and associated pain is prescribed a drug that induces a pseudo-menopausal state. Which of the following medications works by acting as a GnRH agonist?
a)
Medroxyprogesterone acetate
b)
Danazol
c)
Goserelin
d)
Letrozole
e)
Norethisterone
25.
A 65-year-old man with benign prostatic hyperplasia (BPH) is started on a medication that relaxes smooth muscle in the prostate and bladder neck, providing rapid symptom relief. Which class of drug is this?
a)
5-alpha-reductase inhibitors (e.g., Finasteride)
b)
Alpha-1 adrenergic antagonists (e.g., Tamsulosin)
c)
Phosphodiesterase-5 inhibitors (e.g., Sildenafil)
d)
Muscarinic antagonists (e.g., Oxybutynin)
e)
Beta-2 adrenergic agonists (e.g., Salbutamol)
26.
A patient with nephrotic syndrome secondary to membranous nephropathy is started on a medication to reduce proteinuria and slow disease progression. Which drug, by reducing intraglomerular pressure, is a cornerstone of this renoprotective strategy?
a)
Furosemide
b)
Spironolactone
c)
Lisinopril (an ACE inhibitor)
d)
Hydrochlorothiazide
e)
Amlodipine
27.
A 28-year-old woman with Polycystic Ovarian Syndrome (PCOS) and insulin resistance is started on a medication to improve her metabolic profile and potentially restore ovulation. Which drug is most appropriate for this purpose?
a)
Levothyroxine
b)
Metformin
c)
Spironolactone
d)
Prednisolone
e)
Cabergoline
28.
Which of the following diuretics acts on the thick ascending limb of the Loop of Henle and is most likely to cause hypokalaemia and ototoxicity as adverse effects?
a)
Spironolactone
b)
Hydrochlorothiazide
c)
Amiloride
d)
Furosemide
e)
Acetazolamide
29.
A patient with syndrome of inappropriate ADH secretion (SIADH) and symptomatic hyponatraemia is prescribed a drug that blocks V2 receptors in the collecting duct, promoting the excretion of water without electrolytes (aquaresis). Which drug is this?
a)
Desmopressin
b)
Furosemide
c)
Tolvaptan
d)
Spironolactone
e)
Hydrochlorothiazide
30.
A postmenopausal woman is started on Raloxifene for osteoporosis prevention. What is its primary mechanism of action?
a)
It acts as an oestrogen agonist on bone and an antagonist on breast and endometrium.
b)
It inhibits bone resorption by osteoclasts.
c)
It is a pure oestrogen receptor antagonist.
d)
It stimulates calcium absorption from the gut.
e)
It inhibits aromatase, reducing peripheral oestrogen synthesis.
31.
A 38-year-old woman presents with chronic pelvic pain, dysmenorrhoea, and dyspareunia. Laparoscopy reveals pigmented "powder-burn" lesions on the uterosacral ligaments. What is the most likely diagnosis?
a)
Pelvic Inflammatory Disease
b)
Adenomyosis
c)
Endometriosis
d)
Ovarian cancer
e)
Uterine fibroids
32.
According to the Rotterdam criteria, which of the following is NOT a required feature for the diagnosis of Polycystic Ovarian Syndrome (PCOS)?
a)
Oligo- or anovulation
b)
Clinical or biochemical hyperandrogenism
c)
Polycystic ovaries on ultrasound
d)
Elevated LH:FSH ratio
e)
(Any 2 out of A, B, and C are required)
33.
A 55-year-old postmenopausal woman presents with painless vaginal bleeding. Transvaginal ultrasound reveals an endometrial thickness of 10 mm. What is the most important next step in management?
a)
Prescribe topical oestrogen cream
b)
Perform an endometrial biopsy
c)
Schedule a hysteroscopy in 3 months
d)
Start a trial of progesterone
e)
Reassure and discharge
34.
A 25-year-old woman presents with a sudden onset of generalised oedema. Investigations reveal heavy proteinuria (4.5 g/day), hypoalbuminaemia, and hyperlipidaemia. What is the underlying glomerular pathology most commonly associated with this presentation in adults?
a)
Minimal Change Disease
b)
Focal Segmental Glomerulosclerosis (FSGS)
c)
Membranous Nephropathy
d)
IgA Nephropathy
e)
Post-streptococcal Glomerulonephritis
35.
A 20-year-old man presents with cola-coloured urine one day after a sore throat. Urinalysis shows haematuria with dysmorphic red blood cells and red cell casts. Serum complement C3 is low. What is the most likely diagnosis?
a)
IgA Nephropathy
b)
Lupus Nephritis
c)
Post-streptococcal Glomerulonephritis
d)
Anti-GBM Disease
e)
Minimal Change Disease
36.
A 35-year-old woman with a history of miscarriages and venous thromboses is found to have a prolonged PTT that does not correct on mixing studies. Which antibody is most likely responsible for this "lupus anticoagulant" and her clinical presentation?
a)
Anti-dsDNA
b)
Anti-Smith (anti-Sm)
c)
Anti-Ro/SSA
d)
Anti-phospholipid
e)
Anti-histone
37.
A 28-year-old man presents with a painless testicular mass. Ultrasound confirms a solid intratesticular lesion. Orchidectomy is performed, and histology shows sheets of uniform cells with clear cytoplasm and central nuclei. What is the most likely diagnosis?
a)
Seminoma
b)
Embryonal carcinoma
c)
Yolk sac tumour
d)
Choriocarcinoma
e)
Leydig cell tumour
38.
A 40-year-old woman with Autosomal Dominant Polycystic Kidney Disease (ADPKD) is concerned about her risk of intracranial aneurysm. She has a strong family history of this complication. What is the gene mutation most commonly associated with a more severe renal phenotype and a higher risk of aneurysms in ADPKD?
a)
PKD1
b)
PKD2
c)
TSC1
d)
VHL
e)
COL4A5
39.
A 65-year-old man has a PSA of 8 ng/mL. A prostate biopsy reveals a Gleason score of 4+3=7. What does this score represent?
a)
The serum level of prostate-specific antigen
b)
The clinical staging of the cancer
c)
The histological grade and aggressiveness of the tumour
d)
The number of positive biopsy cores
e)
The ratio of free to total PSA
40.
A 50-year-old woman presents with unilateral, bloody nipple discharge. There is no palpable mass. Which of the following is the most likely underlying pathology?
a)
Invasive ductal carcinoma
b)
Fibroadenoma
c)
Intraductal papilloma
d)
Mammary duct ectasia
e)
Phyllodes tumour
41.
According to the four pillars of medical ethics, respecting a patient's right to refuse treatment, even if it is not in their best medical interest, primarily upholds which principle?
a)
Beneficence
b)
Non-maleficence
c)
Autonomy
d)
Justice
e)
Veracity
42.
A 16-year-old girl requests the combined oral contraceptive pill. She is assessed to be Fraser competent. According to UK law and guidelines, can she be prescribed the pill without parental consent?
a)
No, she is under 18 and parental consent is always required.
b)
No, unless she is married.
c)
Yes, if the doctor believes it is in her best interest.
d)
Yes, if she is deemed competent to understand the implications.
e)
Only if she has a specific medical condition like PCOS.
43.
During a consultation for a terminal illness, a patient asks the doctor, "How long do I have?" The doctor believes full disclosure would cause severe distress and harm, so they decide to withhold the prognosis. Which ethical principle is the doctor prioritising over the patient's autonomy?
a)
Justice
b)
Veracity
c)
Beneficence
d)
Fidelity
e)
Confidentiality
44.
Partner notification (contact tracing) for sexually transmitted infections is a key public health measure. When a healthcare professional directly informs the contacts of an infected patient without revealing the patient's identity, this is known as:
a)
Patient referral
b)
Provider referral
c)
Contract referral
d)
Anonymous referral
e)
Mandatory reporting
45.
In the UK, the legal grounds for an abortion under the Abortion Act 1967 (as amended) require that:
a)
The woman's life must be in immediate danger.
b)
The pregnancy must be a result of rape.
c)
There must be a substantial risk of fetal abnormality.
d)
Two registered medical practitioners must certify that the legal grounds are met.
e)
The pregnancy must be under 12 weeks gestation.
46.
A 32-year-old woman is found to have a bicornuate uterus on ultrasound. This congenital anomaly results from the failure of which embryological structures to fuse completely?
a)
Mesonephric (Wolffian) ducts
b)
Paramesonephric (Müllerian) ducts
c)
Urogenital sinus
d)
Ureteric buds
e)
Metanephric mesenchyme
47.
A 70-year-old man presents with obstructive lower urinary tract symptoms. Digital rectal exam reveals a symmetrically enlarged, smooth, firm prostate. Serum PSA is 4 ng/mL. What is the most likely diagnosis?
a)
Prostate cancer
b)
Acute bacterial prostatitis
c)
Chronic prostatitis
d)
Benign Prostatic Hyperplasia (BPH)
e)
Neurogenic bladder
48.
The fetal circulation is characterised by shunts that bypass the non-functional lungs and liver. Which shunt carries highly oxygenated blood from the umbilical vein to the inferior vena cava?
a)
Foramen ovale
b)
Ductus arteriosus
c)
Ductus venosus
d)
Umbilical artery
e)
Sinus venosus
49.
A 25-year-old man presents with infertility. Semen analysis reveals azoospermia. His FSH and LH are elevated, and testosterone is low. Karyotype is 47,XXY. What is the diagnosis?
a)
Kallmann Syndrome
b)
Klinefelter Syndrome
c)
Turner Syndrome
d)
Androgen Insensitivity Syndrome
e)
5-alpha-reductase deficiency
50.
A 40-year-old woman with a BMI of 38 kg/m² is being worked up for infertility. Which of the following hormonal profiles is most consistent with her diagnosis of PCOS?
a)
Low LH, High FSH, Low Testosterone
b)
High LH, Normal/Low FSH, High Testosterone
c)
Low LH, Low FSH, Low Oestradiol
d)
High FSH, High LH, Low AMH
e)
High Prolactin, Low TSH
51.
A 60-year-old man with a history of smoking presents with painless haematuria. Cystoscopy reveals a papillary, exophytic tumour in the bladder. Histology shows finger-like projections with fibrovascular cores. What is the most likely diagnosis?
a)
Squamous cell carcinoma
b)
Adenocarcinoma
c)
Urothelial (Transitional cell) carcinoma
d)
Nephroblastoma
e)
Small cell carcinoma
52.
A 55-year-old woman presents with urinary frequency, urgency, and incontinence associated with a strong desire to void. She has no significant stress incontinence. What is the first-line pharmacological treatment for this condition?
a)
Alpha-1 agonist (e.g., Pseudoephedrine)
b)
Beta-3 adrenergic agonist (e.g., Mirabegron)
c)
5-alpha-reductase inhibitor (e.g., Finasteride)
d)
Alpha-1 antagonist (e.g., Tamsulosin)
e)
Diuretic (e.g., Furosemide)
53.
A 28-year-old woman at 32 weeks gestation is diagnosed with pre-eclampsia. Which of the following is the definitive treatment for this condition?
a)
Intravenous labetalol
b)
Delivery of the baby and placenta
c)
Intravenous magnesium sulphate
d)
Oral methyldopa
e)
Bed rest and fluid restriction
54.
A 65-year-old man with BPH is started on Finasteride. What is its mechanism of action?
a)
Alpha-1 adrenergic receptor blockade
b)
Inhibition of 5-alpha-reductase type II
c)
Muscarinic receptor antagonism
d)
Beta-2 adrenergic receptor agonism
e)
Inhibition of phosphodiesterase-5
55.
A 19-year-old man presents with acute scrotal pain and nausea. On examination, the testis is tender, high-riding, and has a transverse lie. The cremasteric reflex is absent. What is the most urgent investigation?
a)
Urinalysis
b)
Serum beta-hCG
c)
Doppler ultrasound of the scrotum
d)
Testicular MRI
e)
Scrotal X-ray
56.
A 30-year-old woman presents with primary amenorrhoea. She has normal breast development but no pubic hair. Pelvic examination reveals a blind-ending vagina and no cervix. What is the most likely diagnosis?
a)
Androgen Insensitivity Syndrome
b)
Turner Syndrome
c)
Müllerian agenesis (Mayer-Rokitansky-Küster-Hauser syndrome)
d)
Polycystic Ovarian Syndrome
e)
Kallmann Syndrome
57.
A 45-year-old woman undergoes a total abdominal hysterectomy for fibroids. Postoperatively, she develops fever, and a purulent discharge is noted from her abdominal wound. A swab grows Staphylococcus aureus. Which virulence factor is primarily responsible for the pus formation?
a)
Coagulase
b)
Protein A
c)
Alpha-toxin
d)
Panton-Valentine Leukocidin (PVL)
e)
Toxic Shock Syndrome Toxin (TSST-1)
58.
A 50-year-old man with a history of recurrent calcium oxalate kidney stones is advised to increase his fluid intake and modify his diet. Which of the following dietary modifications is most appropriate?
a)
Increase sodium intake
b)
Increase oxalate intake (spinach, nuts)
c)
Increase animal protein intake
d)
Increase citrate intake (lemon juice)
e)
Decrease calcium intake
59.
A 25-year-old woman presents with sudden onset right-sided pelvic pain. She has a positive urine pregnancy test. Transvaginal ultrasound shows no intrauterine gestational sac and a complex adnexal mass. Serum beta-hCG is 2500 IU/L. What is the most likely diagnosis?
a)
Ruptured ovarian cyst
b)
Appendicitis
c)
Ectopic pregnancy
d)
Molar pregnancy
e)
Threatened miscarriage
60.
A 60-year-old man presents with painless haematuria. CT urogram shows a filling defect in the renal pelvis. Cytology from ureteric washings shows clusters of atypical cells with hyperchromatic, enlarged nuclei. What is the most likely diagnosis?
a)
Renal cell carcinoma
b)
Urothelial carcinoma of the renal pelvis
c)
Squamous cell carcinoma of the bladder
d)
Nephrolithiasis
e)
Xanthogranulomatous pyelonephritis
61.
A 70-year-old man is admitted with acute kidney injury. His medications include Lisinopril, Ibuprofen, and Metformin. Which mechanism best explains the potential synergistic nephrotoxicity of this combination?
a)
Direct tubular toxicity
b)
Acute interstitial nephritis
c)
Haemolytic uraemic syndrome
d)
Inhibition of renal autoregulation
e)
Crystal nephropathy
62.
A 35-year-old woman with systemic lupus erythematosus (SLE) develops nephrotic syndrome. A renal biopsy shows "wire loop" lesions on light microscopy and subendothelial deposits on electron microscopy. What is the WHO class of this lupus nephritis?
a)
Class II
b)
Class III
c)
Class IV
d)
Class V
e)
Class VI
63.
A 28-year-old man presents with a 2-day history of dysuria and purulent urethral discharge. A Gram stain of the discharge reveals Gram-negative diplococci within neutrophils. What is the first-line treatment?
a)
Doxycycline
b)
Ceftriaxone
c)
Azithromycin
d)
Ciprofloxacin
e)
Penicillin G
64.
A 22-year-old woman is diagnosed with a Chlamydia trachomatis infection. She is treated with Azithromycin. What is the mechanism of action of this antibiotic?
a)
Inhibition of cell wall synthesis
b)
Inhibition of protein synthesis by binding to the 50S ribosomal subunit
c)
Inhibition of DNA gyrase
d)
Inhibition of folic acid synthesis
e)
Disruption of cell membrane integrity
65.
A 40-year-old woman is found to have an elevated serum calcium on routine testing. Further investigation reveals a low serum phosphate and an elevated PTH level. What is the most likely diagnosis?
a)
Multiple myeloma
b)
Primary hyperparathyroidism
c)
Sarcoidosis
d)
Vitamin D intoxication
e)
Bone metastases
66.
A 65-year-old man with a history of smoking presents with painless haematuria. Cystoscopy reveals a solid, ulcerated tumour on the lateral wall of the bladder. Biopsy shows invasion into the muscularis propria. What is the most appropriate next step in management?
a)
Intravesical BCG therapy
b)
Radical cystectomy
c)
Transurethral resection of the bladder tumour (TURBT)
d)
Radiotherapy alone
e)
Systemic chemotherapy alone
67.
A 30-year-old woman presents with secondary infertility. Hysterosalpingography reveals bilateral proximal tubal blockage. Which infective organism is most classically associated with this finding?
a)
Escherichia coli
b)
Streptococcus agalactiae
c)
Mycoplasma genitalium
d)
Chlamydia trachomatis
e)
Candida albicans
68.
A 55-year-old man with diabetes mellitus presents with foul-smelling urine and pneumaturia. Cystoscopy shows oedema and inflammation of the bladder mucosa. What is the most likely causative organism?
a)
Proteus mirabilis
b)
Escherichia coli
c)
Klebsiella pneumoniae
d)
Candida albicans
e)
Enterococcus faecalis
69.
A 72-year-old man presents with acute urinary retention. A bladder scan shows a post-void residual of 800 mL. Which of the following medications is most likely to have contributed to this?
a)
Metformin
b)
Atorvastatin
c)
Oxybutynin
d)
Lisinopril
e)
Aspirin
70.
A 19-year-old woman presents with primary amenorrhoea. She has tall stature, webbed neck, and a wide carrying angle. Serum FSH is markedly elevated. What is the most likely karyotype?
a)
46,XX
b)
46,XY
c)
45,X
d)
47,XXX
e)
47,XXY
71.
A 28-year-old woman at 10 weeks gestation presents with vaginal bleeding and passage of grape-like vesicles. Ultrasound shows a "snowstorm" appearance. Serum beta-hCG is 250,000 IU/L. What is the diagnosis?
a)
Ectopic pregnancy
b)
Complete hydatidiform mole
c)
Partial hydatidiform mole
d)
Choriocarcinoma
e)
Missed miscarriage
72.
A 60-year-old woman presents with stress urinary incontinence. On examination, there is descent of the bladder base during a Valsalva manoeuvre. What is the most likely underlying anatomical defect?
a)
Weakness of the pelvic diaphragm
b)
Weakness of the urogenital diaphragm
c)
Detrusor overactivity
d)
Urethral sphincter deficiency
e)
Vesicovaginal fistula
73.
A 35-year-old man presents with a painless testicular lump. Orchidectomy is performed. Histology shows a mixed pattern including seminoma, embryonal carcinoma, and teratoma. What is the diagnosis?
a)
Seminoma
b)
Mixed germ cell tumour
c)
Yolk sac tumour
d)
Leydig cell tumour
e)
Sertoli cell tumour
74.
A 50-year-old woman with a history of nephrolithiasis presents with metabolic acidosis (normal anion gap), hypokalaemia, and a urinary pH of 6.5. What is the most likely diagnosis?
a)
Diabetic ketoacidosis
b)
Type 1 (distal) Renal Tubular Acidosis
c)
Type 2 (proximal) Renal Tubular Acidosis
d)
Lactic acidosis
e)
Uraemic acidosis
75.
A 25-year-old man presents with acute scrotal pain that started 6 hours ago. He has a fever and dysuria. The testis is tender but in a normal position. The cremasteric reflex is present. Urinalysis shows pyuria and bacteriuria. What is the most likely diagnosis?
a)
Testicular torsion
b)
Torsion of the testicular appendage
c)
Epididymo-orchitis
d)
Incarcerated inguinal hernia
e)
Testicular tumour
76.
A 40-year-old woman with recurrent urinary tract infections is found to have a cystocele. This represents a herniation of the:
a)
Bladder into the vagina
b)
Urethra into the vagina
c)
Small intestine into the pouch of Douglas
d)
Rectum into the vagina
e)
Uterus into the vagina
77.
A 65-year-old man undergoes a transurethral resection of the prostate (TURP) for BPH. Postoperatively, he develops confusion, nausea, and visual disturbances. Serum sodium is 118 mmol/L. What is the most likely cause?
a)
Syndrome of Inappropriate ADH (SIADH)
b)
Transurethral Resection of the Prostate (TURP) syndrome
c)
Diabetic ketoacidosis
d)
Addisonian crisis
e)
Acute kidney injury
78.
A 30-year-old woman presents with dyspareunia and chronic pelvic pain. Laparoscopy reveals multiple, red, flame-like lesions on the peritoneal surface. What is the most likely stage of these endometriotic lesions?
a)
Early/active
b)
Late/inactive
c)
Mixed
d)
Atypical
e)
Clear vesicle
79.
A 55-year-old man with chronic kidney disease stage 4 has a serum phosphate of 2.0 mmol/L (high). Which of the following is the first-line treatment to lower phosphate levels?
a)
Calcium acetate (a phosphate binder)
b)
Cinacalcet
c)
Parathyroidectomy
d)
Calcitriol
e)
Sevelamer
80.
A 28-year-old woman presents with oligomenorrhoea and hirsutism. Ultrasound shows polycystic ovaries. Which of the following serum hormone levels is most likely to be elevated?
a)
Follicle-Stimulating Hormone (FSH)
b)
Progesterone
c)
Inhibin B
d)
Luteinising Hormone (LH)
e)
Sex Hormone-Binding Globulin (SHBG)
81.
A 70-year-old man presents with fatigue, bone pain, and renal impairment. Serum electrophoresis shows an IgG kappa paraprotein. Bone marrow biopsy shows 30% plasma cells. What is the diagnosis?
a)
Waldenström's macroglobulinaemia
b)
Multiple myeloma
c)
Monoclonal gammopathy of undetermined significance (MGUS)
d)
Primary amyloidosis
e)
Chronic lymphocytic leukaemia
82.
A 45-year-old woman is diagnosed with a 3 cm renal stone in the renal pelvis. She is asymptomatic. What is the most appropriate management?
a)
Extracorporeal shock wave lithotripsy (ESWL)
b)
Percutaneous nephrolithotomy (PCNL)
c)
Ureteroscopy and laser lithotripsy
d)
Conservative management with follow-up
e)
Open pyelolithotomy
83.
A 32-year-old woman presents with sudden onset severe left loin pain radiating to the groin. Urine dipstick is positive for blood. Non-contrast CT KUB shows a 5 mm stone at the vesicoureteric junction. What is the first-line management?
a)
Immediate ureteroscopy
b)
Percutaneous nephrostomy
c)
Medical expulsive therapy (e.g., Tamsulosin)
d)
Extracorporeal shock wave lithotripsy (ESWL)
e)
Open surgery
84.
A 58-year-old man presents with painless haematuria. CT urogram shows a 6 cm enhancing mass in the upper pole of the right kidney. There is evidence of tumour thrombus in the renal vein. What is the most likely diagnosis?
a)
Urothelial carcinoma
b)
Renal cell carcinoma (Clear cell)
c)
Wilms' tumour
d)
Renal oncocytoma
e)
Angiomyolipoma
85.
A 25-year-old man is brought to A&E after a motorcycle accident. He has a pelvic fracture. On urinary catheterisation, he has gross haematuria. After resuscitation, a cystogram shows extravasation of contrast around the bladder. What is the most likely diagnosis?
a)
Urethral injury
b)
Bladder rupture
c)
Renal contusion
d)
Ureteric avulsion
e)
Prostatic injury
86.
A 40-year-old woman with a history of recurrent UTIs is diagnosed with a small vesicovaginal fistula. What is the most common cause of this condition in the developed world?
a)
Obstetric trauma
b)
Gynaecological surgery
c)
Pelvic radiotherapy
d)
Advanced cervical cancer
e)
Inflammatory bowel disease
87.
A 65-year-old man with metastatic prostate cancer is started on Abiraterone. What is its mechanism of action?
a)
GnRH agonist
b)
Androgen receptor antagonist
c)
Inhibitor of CYP17A1 (17-alpha-hydroxylase/C17,20-lyase)
d)
5-alpha-reductase inhibitor
e)
Oestrogen receptor agonist
88.
A 30-year-old woman presents with primary amenorrhoea. She has well-developed breasts but little pubic or axillary hair. Pelvic ultrasound shows testes in the inguinal canals. Karyotype is 46,XY. What is the diagnosis?
a)
Turner Syndrome
b)
Androgen Insensitivity Syndrome
c)
5-alpha-reductase deficiency
d)
Müllerian agenesis
e)
Kallmann Syndrome
89.
A 50-year-old woman is diagnosed with stress urinary incontinence. She undergoes a mid-urethral sling procedure. This procedure aims to correct the pathophysiology by:
a)
Increasing bladder capacity
b)
Providing a suburethral hammock to support the mid-urethra
c)
Tightening the bladder neck
d)
Denervating the detrusor muscle
e)
Reinforcing the pelvic diaphragm
90.
A 28-year-old man presents with azoospermia. His FSH is normal, and testicular volume is normal. What is the most likely cause?
a)
Klinefelter Syndrome
b)
Post-testicular obstruction (e.g., congenital bilateral absence of the vas deferens)
c)
Sertoli-cell-only syndrome
d)
Hypogonadotropic hypogonadism
e)
Testicular failure
91.
A 75-year-old man presents with acute urinary retention. After catheterisation, he is started on Tamsulosin. He returns to clinic 3 days later feeling dizzy and lightheaded. His BP is 100/60 mmHg. What is the most likely cause of his symptoms?
a)
Sepsis
b)
Myocardial infarction
c)
First-dose hypotension from alpha-blockade
d)
Pulmonary embolism
e)
Stroke
92.
A 40-year-old woman with recurrent vulvovaginal candidiasis is prescribed Fluconazole. What is its mechanism of action?
a)
Inhibition of ergosterol synthesis
b)
Binding to ergosterol and forming pores in the membrane
c)
Inhibition of beta-glucan synthesis
d)
Inhibition of nucleic acid synthesis
e)
Disruption of the cytoskeleton
93.
A 60-year-old man with BPH is considering treatment options. He wants to avoid surgery. Which medication has been shown to reduce the risk of BPH progression and the need for surgery?
a)
Tamsulosin
b)
Finasteride
c)
Oxybutynin
d)
Furosemide
e)
Sildenafil
94.
A 25-year-old woman is diagnosed with a unilocular, thin-walled, anechoic ovarian cyst measuring 6 cm on ultrasound. She is asymptomatic. What is the most appropriate management?
a)
Immediate laparoscopic cystectomy
b)
Oophorectomy
c)
Serial ultrasound in 3-6 months
d)
Serum CA-125 testing
e)
CT scan of the abdomen and pelvis
95.
A 32-year-old woman at 28 weeks gestation is diagnosed with a symptomatic urinary tract infection. What is the most appropriate antibiotic?
a)
Doxycycline
b)
Ciprofloxacin
c)
Trimethoprim
d)
Nitrofurantoin
e)
Co-amoxiclav
96.
A 68-year-old man presents with hesitancy, poor stream, and nocturia. DRE reveals a hard, irregular, fixed prostate. Serum PSA is 45 ng/mL. Bone scan shows multiple areas of increased uptake in the vertebrae and pelvis. What is the most appropriate initial systemic treatment?
a)
Radical prostatectomy
b)
External beam radiotherapy
c)
Androgen deprivation therapy (e.g., GnRH agonist)
d)
Chemotherapy (e.g., Docetaxel)
e)
Watchful waiting
97.
A 55-year-old woman undergoes an abdominal hysterectomy. Postoperatively, she develops oliguria. Her urine output is 15 mL/hr, and her urine sodium is 60 mmol/L. What is the most likely type of acute kidney injury?
a)
Pre-renal
b)
Intrinsic renal
c)
Post-renal
d)
Hepatorenal
e)
Cardiorenal
98.
A 19-year-old man presents with a sudden onset of severe testicular pain while playing rugby. On examination, the testis is exquisitely tender, high-riding, and the cremasteric reflex is absent. What is the most appropriate immediate action?
a)
Administer strong analgesia and antibiotics
b)
Order a scrotal ultrasound
c)
Attempt manual detorsion
d)
Arrange immediate surgical exploration
e)
Apply ice packs and advise rest
99.
A 30-year-old woman presents with heavy menstrual bleeding. Pelvic ultrasound shows a 4 cm submucosal fibroid. What is the first-line surgical management option for this patient?
a)
Total abdominal hysterectomy
b)
Myomectomy
c)
Uterine artery embolisation
d)
Hysteroscopic resection of the fibroid
e)
Magnetic Resonance-guided Focused Ultrasound
100.
A 45-year-old man presents with renal colic. A non-contrast CT KUB shows a 4 mm stone in the proximal ureter. What is the likelihood of spontaneous passage for this stone?
a)
>90%
b)
0.75
c)
0.5
d)
0.25
e)
<10%
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