A 17-year-old girl presents with hypothyroidism. On further questioning it transpires she has primary amenorrhoea. She is also of relatively short stature compared to her sisters. 

What is the most likely diagnosis? 

A. Turner's syndrome 

B. Down's syndrome 

C. Noonan's syndrome 

D. XXX syndrome 

E. Achondroplasia  


A 25-year-old woman presents to a reproductive endocrinology clinic with a history of being unable to conceive after 2 years of using no contraception. It is thought she may have polycystic ovarian syndrome.

Which of the following is most likely to be associated with this condition? A. A 28 day menstrual cycle B. Elevated LH/FSH ratio C. Normal free-androgen index D. Low levels of circulating insulin E. Normal BMI (body mass index)

A 65 year old woman presents with a swollen, red, tender left lower limb. She has had surgery for a hip replacement 10 days ago. Ultrasound demonstrated a non-compressible left superficial femoral vein. What is the most appropriate management?

a) Course of vancomycin
b) stripping of varicose veins
c) Percutaneous thrombolysis
d) Pulmonary Ventilation/Perfusion scintigraphy
e) Administer low-molecular-weight-heparin

A 44 year old man notices that in the last few months he is having blurred vision at normal reading distance. He has to hold reading materials at arm's length to read properly. He also complains of eye fatigue and headaches. Examination, including fundoscopy were unremarkable. 

The most likely pathology is?

a) presbyopia
b) age-related macular degeneration
c) bilateral occipital lobe infarcts
d) conversion disorder
e) retinal detachment

A 58 year old male complains of progressive dimunition of visual acuity. He describes that the vision from both eyes has been worsening over the past 2 years.

He has been on treatment for Diabetes Mellitus and hypertension for the last 5 years. Fundoscopy reveals optic disc neovascularization.

He is most likely to have?

a) non-proliferative diabetic retinopathy
b) proliferative diabetic retinopathy
c) vitreous detachment
d) systemic Lupus Erythematosus
e) multiple sclerosis

A 60 yr old lady is diagnosed to have breast CA and receiving a course of chemotherapy. She is experiencing troublesome vomiting which has not been helped by domperidone.

What is the most appropriate next course of action?

A. Add an antihistamine
B. Add a dopamine receptor antagonist
C. Add a 5HT3 antagonist
D. Add a 5HT2 antagonist
E. Add a phenothiazine

A 72 yr old male with terminal prostate cancer presents for a review. He currently takes oral, modified-release morphine 60mg bd for pain. Now he is incapable to take oral medications. His Oncologist decides to set-up a syringe driver.

What dose of diamorphine should be prescribed for the syringe driver, to cover a 24-hour period?
A. 30 mg
B. 120 mg
C. 40 mg
D. 20 mg
E. 60 mg

A 28-year-old previously fit and well woman presents with a 2-day history of progressive leg weakness and bladder dysfunction.

Examination reveals a spastic paraparesis.
What is the most important investigation for this patient?
A. Cerebrospinal fluid examination B. MRI scan of the spine C. Electromyography and nerve conduction studies D. Anti-ganglioside antibodies E. Creatine kinase

A 32-year-old man is admitted one hour after the sudden onset of severe headache, which he described as like 'being hit on the head with a hammer'. You suspect subarachnoid haemorrhage, but a CT scan of the brain is reported as normal.

To pursue the diagnosis you should:
A. Wait for12 hours after the onset of headache, then perform a lumbar puncture to look for xanthochromia B. repeat the CT scan C. perform a lumbar puncture to look for xanthochromia as soon as possible D. perform a lumbar puncture to look for red blood cells in the CSF as soon as possible E. refer to neuroradiologist for cerebral angiography.

A 65-year-old man presents with a 4-month history of dysarthria and progressive difficulty in swallowing. Examination reveals a weak fasciculating tongue, a brisk gag reflex, and jaw jerk. 

What is the most likely diagnosis?

A.  Basilar artery thrombosis 

B.  Multiple sclerosis 

C.  Miller Fisher syndrome 

D.  Amyotrophic lateral sclerosis 

E.  Wernicke's encephalopathy

An 84-year-old man presents to clinic with a 6- month history of increasing confusion, visual hallucinations, reduced mobility and falls.

What is the most likely cause for his problems?

A.  Alzheimer's disease 

B.  Frontotemporal dementia 

C.  Dementia with Lewy bodies 

D.  Parkinson's disease with dementia 

E.  Vascular dementia


A 75-year-old woman presents with acute pain and swelling in the left knee. On examination the left knee is hot and tender with moderate synovial fluid collection. Radiograph of the right knee shows calcification of the meniscus.

Synovial fluid was sterile on culture and rhomboid shaped crystals were identified on microscopy of the fluid.
Which of the following statements about this condition is NOT true?
A. Narrowing of the joint space is often present B. The symphysis pubis is one of many other joints that can be affected by this disorder C. Serum calcium levels may be elevated in some patients
D. Negatively birefringent crystals may be identified on synovial fluid analysis E. There may be large subchondral cysts

A 50 year old man with pyrexia and left lower quadrant pain is found on CT to have evidence of a diverticular abscess in the pelvis. It measures 5cm in maximum diameter. This is typically managed by

a) resection of the sigmoid colon

b) chemotherapy and radiatiotherapy

c) CT guided drainage

d) transverse colectomy

e) internal sphincterotomy

A 36 yr old woman comes to the physician for evaluation of a 4 year history of subfertility ,severe dysmenorrhea and increasing pain with sexual intercourse. On pelvic examination an adnexal mass is felt and nodules are palpated along the uterosacral ligaments. Which of the following is the most likely diagnosis?

a) dermoid cyst

b) ectopic pregnancy

c) endometriosis

d) follicular cyst

e) corpus luteum cyst

A 56 year old woman is suspected of having a coagulation disorder affecting the intrinsic pathway before the prothrombin to thrombin stage. Which of the tests would be most appropriate in this patient ?

a) Activated partial thromboplastin time

b) Venous clotting time

c) Activated whole blood clotting time

d) Thrombin time

e) Plasma fibrinogen

A 70-year-old man who presented to the outpatient clinic with diarrhea and complaints of a twelve pound weight loss over six months. He also had experienced anorexia for one month. He did not complain of fever, chills, lymphadenopathy, nausea, vomiting, abdominal pain, melena, hematochezia, palpitations or flushing. The patient's physical exam was notable only for heme-occult positive brown stool. His laboratory studies revealed a mild normocytic anemia (PCV 39.9%, MCV 91.3 ml) and a chronically elevated alkaline phosphatase of 138 IU/liter. The electrolyte panel, thyroid function tests, erythrocyte sedimentation rate, and prostate specific antigen were all within normal limits. what diagnostic test would you order?

a) Ultrasound abdomen

b) Chest Xray

c) CT scan of the abdomen

d) full colonoscopy

e) Prostatic biopsy 


A 60 year old man with chronic cardiac failure is on treatment with digoxin and a loop diuretic.

This combination is likely to cause digoxin toxicity by the following mechanism?

a) this combination increases the half-life of digoxin

b) diuretics decrease potassium levels

c) frusemide and digoxin interact to form a poisonous compound

d) digoxin is a competitive inhibitor of frusemide

e) the above statement is wrong, loop diuretics are not a recognized cause of increased digoxin toxicity


An immuno-competent patient develops diarrhea .

The treatment of choice would be
a) antiretroviral therapy
b) metronidazole
c) vancomycin
d) albendazole
e) no antibiotics are necessary


A 3 1/2-year-old boy says only three single words, and these are poorly articulated. He uses gestures to communicate. There are no other reported problems, gross and fine motor skills are normal for age and physical examination, including tympanography, is normal.

Which of the following is the MOST LIKELY explanation? A Intellectual disability. B Deafness. C Manipulative behaviour. D Dysarthria. E Autism

A 10-year-old boy regularly experiences moderately severe sneezing spells and watery eyes in May and June, September and October, and occasionally during January through March. Immediate skin test show a positive reaction to Alternaria, Cladosporium, house dust and grass and ragweed pollens. 

The most appropriate treatment would include?

a)  immunotherapy against the known offending antigen

b) oral adrenergic agonist

c) Antigen avoidance

d) Topical adrenergic agonist

e) Antihistamine-decongestant preparation

A 65 year old patient with chronic hypertension is on treatment with nifedipine, a calcium channel blocker.

Nifedipine lowers the blood pressure mainly by inhibiting the influx of extracellular calcium through the calcium channel of

a) skeletal muscle cells
b) smooth muscle cells
c) myocardial cells
d) cells in the atrioventricular (AV) node
e) cells in the sinoatrial (SA) node

An elderly woman with type 2 diabetes has poorly controlled blood glucose levels despite treatment with metformin. The physician decides to try pioglitazone.

Which best describes the mode of action of pioglitazone?

a) reduces insulin resistance and improves insulin sensitivity

b) suppresses basal hepatic glucose production

c) reduces fasting plasma glucose

d) activates the AMP-activated protein kinase

e) stimulates first-phase insulin secretion in the pancreatic beta cells 


A 16 yr. old male has a history of jaundice since the age of 7years. He presents with a chronic progressive course of clumsiness, falling, writing difficulties, intention tremor, flexor spasms, difficulty with speech and swallowing, and ataxia with normal sensation.

He is well known to the neurologist who has diagnosed the patient’s condition a few years ago following blood and urine tests.
This boy is likely to be on the following treatment:

a) Zinc suplements
b) Glucocorticoid supplements
c) Penicillamine medication
d) anti-cholesterol medication
e) He is unlikely to be on any specific medication since there is no effective treatment for this disorder

 A 8 year old child with chronic nasal obstruction has persistent disabling dysphagia causing sleep disturbance. On inspection there is an appearance of a 'clusters of grapes' located in the passage that connects the nasopharynx to the oropharxynx.

The most appropriate treatment for this child would be?
a) steroids
c) laser treatment
d) incision and drainage
b) adenoidectomy
e) interferon therapy

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