Medical Officer & Lady Medical Officer Tests

Subject: Medicine

Time 100 Min

Test No. 1

Easy Level (1-20)

Question No. 1

The most important step in reaching a clinical diagnosis is:

  1. Laboratory investigations
  2. Detailed history taking
  3. CT scan
  4. Histopathological examination

Question No. 2

Normal oral body temperature in a healthy adult is:

  1. 35.5°C
  2. 36.0°C
  3. 37.0°C
  4. 38.2°C

Question No. 3

Which electrolyte is the principal extracellular cation?

  1. Potassium
  2. Calcium
  3. Sodium
  4. Magnesium

Question No. 4

A Body Mass Index (BMI) of 23 kg/m² is classified as:

  1. Underweight
  2. Normal
  3. Overweight
  4. Obese

Question No. 5

Which vitamin deficiency causes scurvy?

  1. Vitamin A
  2. Vitamin C
  3. Vitamin D
  4. Vitamin K

Question No. 6

The normal resting pulse rate in adults is:

  1. 40–60 beats/min
  2. 60–100 beats/min
  3. 100–120 beats/min
  4. 120–140 beats/min

Question No. 7

The most common cause of gastroesophageal reflux disease (GERD) is:

  1. Helicobacter pylori infection
  2. Lower esophageal sphincter incompetence
  3. Esophageal carcinoma
  4. Achalasia

Question No. 8

Which hepatitis virus is transmitted mainly by the fecal-oral route?

  1. Hepatitis B
  2. Hepatitis C
  3. Hepatitis A
  4. Hepatitis D

Question No. 9

The most common cause of uncomplicated urinary tract infection is:

  1. Klebsiella pneumoniae
  2. Escherichia coli
  3. Proteus mirabilis
  4. Enterococcus faecalis

Question No. 10

Which bronchodilator is the drug of choice for rapid relief during an acute asthma attack?

  1. Salbutamol
  2. Tiotropium
  3. Montelukast
  4. Theophylline

Question No. 11

The most common organism causing community-acquired pneumonia is:

  1. Pseudomonas aeruginosa
  2. Staphylococcus aureus
  3. Streptococcus pneumoniae
  4. Mycoplasma pneumoniae

Question No. 12

The normal blood pressure in a healthy adult is approximately:

  1. 90/60 mmHg
  2. 100/70 mmHg
  3. 120/80 mmHg
  4. 140/90 mmHg

Question No. 13

Which cardiac biomarker is considered the most specific for acute myocardial infarction?

  1. LDH
  2. CK-MB
  3. Troponin I
  4. AST

Question No. 14

The most common type of stroke is:

  1. Subarachnoid hemorrhage
  2. Intracerebral hemorrhage
  3. Ischemic stroke
  4. Epidural hemorrhage

Question No. 15

The first-line drug for terminating an active generalized tonic-clonic seizure is:

  1. Diazepam
  2. Phenytoin
  3. Carbamazepine
  4. Sodium valproate

Question No. 16

Osteoarthritis primarily affects:

  1. Synovium
  2. Articular cartilage
  3. Bone marrow
  4. Tendons

Question No. 17

The most common cause of iron deficiency anemia in adults is:

  1. Hemolysis
  2. Chronic blood loss
  3. Vitamin B12 deficiency
  4. Bone marrow failure

Question No. 18

Which hormone is deficient in Type 1 Diabetes Mellitus?

  1. Glucagon
  2. Insulin
  3. Cortisol
  4. Thyroxine

Question No. 19

Which organism causes dengue fever?

  1. Plasmodium falciparum
  2. Dengue virus
  3. Salmonella Typhi
  4. Leptospira interrogans

Question No. 20

The preferred route for administration of rabies vaccine after exposure is:

  1. Intramuscular
  2. Intravenous
  3. Subcutaneous
  4. Oral

Moderate Level

Question No. 21

A 28-year-old woman presents with fatigue, pallor, spoon-shaped nails, and pica. The most likely diagnosis is:

  1. Hemolytic anemia
  2. Iron deficiency anemia
  3. Aplastic anemia
  4. Sickle cell disease

Question No. 22

A patient with chronic liver disease develops abdominal distension due to ascites. Which mechanism is primarily responsible?

  1. Increased plasma oncotic pressure
  2. Portal hypertension
  3. Increased lymphatic drainage
  4. Hypercalcemia

Question No. 23

A patient presents with fever, productive cough, pleuritic chest pain, and consolidation on chest X-ray. The most likely diagnosis is:

  1. Pulmonary embolism
  2. Pneumonia
  3. Bronchial asthma
  4. COPD

Question No. 24

A diabetic patient presents with polyuria, dehydration, Kussmaul breathing, and metabolic acidosis. The most likely diagnosis is:

  1. Hyperosmolar hyperglycemic state
  2. Diabetic ketoacidosis
  3. Acute pancreatitis
  4. Addisonian crisis

Question No. 25

A patient presents with sudden onset severe chest pain radiating to the left arm associated with sweating and nausea. The most likely diagnosis is:

  1. Acute pancreatitis
  2. Acute myocardial infarction
  3. Pulmonary tuberculosis
  4. Costochondritis

Question No. 26

A patient with nephrotic syndrome is most likely to present with:

  1. Hematuria
  2. Generalized edema
  3. Severe hypertension
  4. Oliguria only

Question No. 27

Which investigation is considered the gold standard for confirming pulmonary tuberculosis?

  1. Chest X-ray
  2. Mantoux test
  3. Sputum culture for Mycobacterium tuberculosis
  4. ESR

Question No. 28

A patient with atrial fibrillation is at greatest risk of developing:

  1. Pulmonary fibrosis
  2. Ischemic stroke
  3. Pneumothorax
  4. Peptic ulcer disease

Question No. 29

Which laboratory finding is characteristic of megaloblastic anemia?

  1. Microcytic hypochromic RBCs
  2. Macrocytic RBCs with hypersegmented neutrophils
  3. Normal RBC morphology
  4. Spherocytes

Question No. 30

The first-line treatment for uncomplicated essential hypertension in most adults includes:

  1. Oral corticosteroids
  2. ACE inhibitors or ARBs
  3. Broad-spectrum antibiotics
  4. Digoxin

Question No. 31

A patient presents with severe epigastric pain radiating to the back and elevated serum lipase. The most likely diagnosis is:

  1. Acute cholecystitis
  2. Acute pancreatitis
  3. Gastritis
  4. Duodenal ulcer

Question No. 32

Which electrolyte abnormality is most commonly associated with ECG changes such as peaked T waves?

  1. Hyponatremia
  2. Hyperkalemia
  3. Hypocalcemia
  4. Hypermagnesemia

Question No. 33

A positive Murphy’s sign is most suggestive of:

  1. Acute appendicitis
  2. Acute cholecystitis
  3. Acute pancreatitis
  4. Peritonitis

Question No. 34

The most common cause of chronic kidney disease worldwide is:

  1. Polycystic kidney disease
  2. Diabetes mellitus
  3. Glomerulonephritis
  4. Renal tuberculosis

Question No. 35

Which of the following is the most appropriate initial investigation for suspected deep vein thrombosis?

  1. ECG
  2. Duplex Doppler ultrasonography
  3. Echocardiography
  4. Spirometry

Question No. 36

A patient with chronic obstructive pulmonary disease (COPD) most commonly presents with:

  1. Productive cough and progressive dyspnea
  2. Hematemesis
  3. Polyuria
  4. Diplopia

Question No. 37

Which organism is the most common cause of infective endocarditis on native valves?

  1. Staphylococcus aureus
  2. Salmonella typhi
  3. Vibrio cholerae
  4. Neisseria meningitidis

Question No. 38

The preferred imaging modality for diagnosing pulmonary embolism in a hemodynamically stable patient is:

  1. Chest X-ray
  2. CT Pulmonary Angiography
  3. MRI Brain
  4. Echocardiography

Question No. 39

Which thyroid disorder commonly presents with weight loss, heat intolerance, tremors, and tachycardia?

  1. Hypothyroidism
  2. Hyperthyroidism
  3. Thyroid cyst
  4. Thyroid carcinoma

Question No. 40

A patient with bacterial meningitis should receive empirical antibiotic therapy:

  1. Only after culture results are available
  2. Immediately after appropriate cultures are obtained
  3. Only after CT scan in every patient
  4. After lumbar puncture regardless of delay

Moderate-Difficult Level

Question No. 41

A 65-year-old man with long-standing hypertension presents with acute left ventricular failure. Which clinical finding is most consistent with this diagnosis?

  1. Bradycardia
  2. Bilateral basal crackles with orthopnea
  3. Right iliac fossa tenderness
  4. Hepatosplenomegaly

Question No. 42

A patient develops sudden severe headache described as “the worst headache of my life” with neck stiffness. The most likely diagnosis is:

  1. Migraine
  2. Tension headache
  3. Subarachnoid hemorrhage
  4. Temporal arteritis

Question No. 43

Which arterial blood gas finding is most consistent with metabolic acidosis?

  1. Low pH with decreased bicarbonate
  2. High pH with elevated bicarbonate
  3. Normal pH with elevated PaCO₂
  4. High pH with low PaCO₂

Question No. 44

A patient with liver cirrhosis develops confusion and asterixis. The most likely diagnosis is:

  1. Acute stroke
  2. Hepatic encephalopathy
  3. Viral meningitis
  4. Parkinson’s disease

Question No. 45

Which of the following is the strongest risk factor for colorectal carcinoma?

  1. Irritable bowel syndrome
  2. Ulcerative colitis of long duration
  3. Hemorrhoids
  4. Lactose intolerance

Question No. 46

A patient with fever, hypotension, tachycardia, and elevated serum lactate most likely has:

  1. Cardiogenic shock
  2. Septic shock
  3. Neurogenic shock
  4. Hypovolemic shock

Question No. 47

The presence of Bence Jones proteins in urine is classically associated with:

  1. Acute leukemia
  2. Multiple myeloma
  3. Iron deficiency anemia
  4. Hemophilia A

Question No. 48

A patient with diabetic ketoacidosis has an initial serum potassium of 5.8 mmol/L. The elevation is primarily due to:

  1. Excess dietary potassium
  2. Extracellular shift of potassium caused by insulin deficiency and acidosis
  3. Chronic renal artery stenosis
  4. Increased aldosterone secretion

Question No. 49

A patient presents with fever, petechiae, hypotension, prolonged PT, prolonged aPTT, and low fibrinogen. The most likely diagnosis is:

  1. Hemophilia A
  2. Disseminated intravascular coagulation
  3. Idiopathic thrombocytopenic purpura
  4. Von Willebrand disease

Question No. 50

A patient develops sudden dyspnea, hypotension, distended neck veins, and absent breath sounds on one side after chest trauma. The most likely diagnosis is:

  1. Massive pleural effusion
  2. Tension pneumothorax
  3. Acute asthma exacerbation
  4. Acute pulmonary edema

Question No. 51

A 58-year-old diabetic presents with sudden painless loss of vision in one eye. Fundoscopy reveals retinal hemorrhages and cotton wool spots. The most likely diagnosis is:

  1. Cataract
  2. Diabetic retinopathy
  3. Glaucoma
  4. Retinal detachment

Question No. 52

A patient with chronic alcoholism develops confusion, ophthalmoplegia, and gait ataxia. The most likely diagnosis is:

  1. Alzheimer’s disease
  2. Wernicke encephalopathy
  3. Parkinson’s disease
  4. Huntington’s disease

Question No. 53

A patient presents with recurrent oral ulcers, genital ulcers, and uveitis. The most likely diagnosis is:

  1. Behçet disease
  2. Rheumatoid arthritis
  3. Systemic sclerosis
  4. Sjögren syndrome

Question No. 54

A patient with COPD develops increasing drowsiness. Arterial blood gas shows elevated PaCO₂. The most likely cause is:

  1. Metabolic alkalosis
  2. Hypercapnic respiratory failure
  3. Pulmonary embolism
  4. Hypoglycemia

Question No. 55

The most appropriate initial management of severe hyperkalemia with ECG changes is:

  1. Oral potassium supplements
  2. Intravenous calcium gluconate
  3. Loop diuretics only
  4. Sodium bicarbonate tablets

Question No. 56

A patient with nephritic syndrome is expected to have:

  1. Massive proteinuria with hypoalbuminemia
  2. Hematuria with red blood cell casts
  3. Hyperglycemia
  4. Glycosuria without proteinuria

Question No. 57

A patient with severe ulcerative colitis is at increased risk of developing:

  1. Hepatocellular carcinoma
  2. Colorectal carcinoma
  3. Pancreatic carcinoma
  4. Gastric carcinoma

Question No. 58

A patient develops fever, hypotension, and diffuse rash shortly after receiving a blood transfusion. The most likely diagnosis is:

  1. Acute hemolytic transfusion reaction
  2. Iron overload
  3. Polycythemia
  4. Thalassemia

Question No. 59

The most common endocrine cause of secondary hypertension is:

  1. Addison disease
  2. Primary hyperaldosteronism
  3. Hypothyroidism
  4. Diabetes insipidus

Question No. 60

A patient with malaria develops altered consciousness and repeated seizures. The most likely diagnosis is:

  1. Uncomplicated malaria
  2. Cerebral malaria
  3. Dengue hemorrhagic fever
  4. Typhoid encephalopathy

Difficult Level

Question No. 61

A 68-year-old man presents with severe chest pain radiating to the back. Blood pressure is significantly different in both arms. The most likely diagnosis is:

  1. Acute myocardial infarction
  2. Aortic dissection
  3. Pulmonary embolism
  4. Acute pericarditis

Question No. 62

A patient with cirrhosis suddenly develops hematemesis. The most likely source of bleeding is:

  1. Gastric ulcer
  2. Esophageal varices
  3. Duodenal ulcer
  4. Mallory-Weiss tear

Question No. 63

A patient with septic shock remains hypotensive despite adequate intravenous fluid resuscitation. The preferred first-line vasopressor is:

  1. Dopamine
  2. Norepinephrine
  3. Epinephrine
  4. Dobutamine

Question No. 64

A patient with chronic kidney disease has persistent anemia despite adequate iron stores. Which treatment is most appropriate?

  1. Vitamin B12
  2. Erythropoiesis-stimulating agent
  3. Fresh frozen plasma
  4. Platelet transfusion

Question No. 65

Which laboratory finding is most suggestive of disseminated intravascular coagulation (DIC)?

  1. Increased fibrinogen
  2. Elevated D-dimer with prolonged PT and aPTT
  3. Increased platelet count
  4. Shortened PT

Question No. 66

A patient presents with proximal muscle weakness, moon face, truncal obesity, hypertension, and purple striae. The most likely diagnosis is:

  1. Addison disease
  2. Cushing syndrome
  3. Hyperthyroidism
  4. Acromegaly

Question No. 67

A patient with infective endocarditis develops hematuria and reduced renal function. The most likely mechanism is:

  1. Renal infarction only
  2. Immune complex glomerulonephritis
  3. Diabetic nephropathy
  4. Obstructive uropathy

Question No. 68

A patient presents with ascending muscle weakness and areflexia following a respiratory infection. The most likely diagnosis is:

  1. Myasthenia gravis
  2. Guillain-Barré syndrome
  3. Multiple sclerosis
  4. Amyotrophic lateral sclerosis

Question No. 69

A patient with long-standing rheumatoid arthritis develops atlantoaxial instability. The most serious potential complication is:

  1. Cervical spinal cord compression
  2. Lumbar disc prolapse
  3. Hip dislocation
  4. Osteomalacia

Question No. 70

A patient with diabetic ketoacidosis should receive which intervention immediately after initial fluid resuscitation, provided serum potassium is adequate?

  1. Sodium bicarbonate infusion in all patients
  2. Intravenous insulin infusion
  3. Oral metformin
  4. Intramuscular glucagon

Question No. 71

A patient with severe community-acquired pneumonia develops PaO₂/FiO₂ ratio below 300 mmHg with bilateral pulmonary infiltrates not explained by heart failure. The diagnosis is:

  1. Acute respiratory distress syndrome
  2. Pulmonary fibrosis
  3. Congestive heart failure
  4. Pleural effusion

Question No. 72

Which ECG finding is most characteristic of acute pericarditis?

  1. ST-segment depression in all leads
  2. Diffuse ST-segment elevation with PR-segment depression
  3. Pathological Q waves only
  4. Complete heart block

Question No. 73

A patient receiving long-term corticosteroid therapy suddenly stops medication and develops hypotension, vomiting, and hypoglycemia. The most likely diagnosis is:

  1. Thyroid storm
  2. Acute adrenal insufficiency
  3. Hyperosmolar hyperglycemic state
  4. Pheochromocytoma crisis

Question No. 74

A patient with HIV infection develops progressive dysphagia and odynophagia. Endoscopy demonstrates white plaques throughout the esophagus. The most likely diagnosis is:

  1. Esophageal carcinoma
  2. Candida esophagitis
  3. Achalasia
  4. Barrett esophagus

Question No. 75

A patient develops sudden hypotension, bronchospasm, generalized urticaria, and facial swelling immediately after receiving intravenous penicillin. The most appropriate initial treatment is:

  1. Intravenous hydrocortisone only
  2. Intramuscular epinephrine
  3. Oral antihistamine only
  4. Intravenous furosemide

Question No. 76

A patient with advanced liver cirrhosis develops spontaneous bacterial peritonitis. Which organism is most commonly responsible?

  1. Escherichia coli
  2. Clostridium difficile
  3. Mycobacterium tuberculosis
  4. Staphylococcus epidermidis

Question No. 77

A patient with long-standing diabetes mellitus develops persistent albuminuria. Which is the earliest clinical indicator of diabetic nephropathy?

  1. Elevated serum creatinine
  2. Microalbuminuria
  3. Gross hematuria
  4. Nephrotic syndrome

Question No. 78

A patient presents with severe headache, papilledema, fever, and altered consciousness. Which investigation should be performed before lumbar puncture?

  1. Abdominal ultrasound
  2. CT scan of the brain
  3. ECG
  4. Echocardiography

Question No. 79

Which laboratory parameter is most useful for monitoring unfractionated heparin therapy?

  1. INR
  2. PT
  3. aPTT
  4. Bleeding time

Question No. 80

A patient develops severe hypocalcemia after total thyroidectomy. Which hormone deficiency is responsible?

  1. Thyroxine
  2. Calcitonin
  3. Parathyroid hormone
  4. Growth hormone

Complex Clinical Scenarios

Question No. 81

A 62-year-old man with hypertension and diabetes presents with crushing retrosternal chest pain of two hours’ duration. ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate immediate management?

  1. Oral aspirin only
  2. Immediate reperfusion therapy
  3. Intravenous antibiotics
  4. Observation for 24 hours

Question No. 82

A 24-year-old woman presents with fever, malar rash, arthritis, proteinuria, and positive ANA. The most likely diagnosis is:

  1. Rheumatoid arthritis
  2. Systemic lupus erythematosus
  3. Dermatomyositis
  4. Polyarteritis nodosa

Question No. 83

A patient with COPD receiving high-flow oxygen develops increasing drowsiness and worsening hypercapnia. The most likely explanation is:

  1. Carbon dioxide retention due to excessive oxygen administration
  2. Acute myocardial infarction
  3. Severe anemia
  4. Pulmonary fibrosis

Question No. 84

A 30-year-old woman presents with recurrent episodes of palpitations, sweating, headache, and markedly elevated blood pressure. Which diagnosis should be suspected?

  1. Hyperthyroidism
  2. Pheochromocytoma
  3. Essential hypertension
  4. Cushing syndrome

Question No. 85

A patient presents with fever, productive cough, hypotension, tachypnea, serum lactate of 5 mmol/L, and altered mental status. The diagnosis is:

  1. Cardiogenic shock
  2. Septic shock
  3. Neurogenic shock
  4. Hypovolemic shock

Question No. 86

A patient with chronic atrial fibrillation suddenly develops right-sided weakness and aphasia. The most likely mechanism is:

  1. Intracerebral hemorrhage
  2. Cardioembolic cerebral infarction
  3. Brain abscess
  4. Hypertensive encephalopathy

Question No. 87

A patient develops severe metabolic acidosis, hyperglycemia, positive ketones, and dehydration. Which electrolyte should be monitored most closely during treatment?

  1. Sodium
  2. Potassium
  3. Calcium
  4. Magnesium

Question No. 88

A patient presents with progressive dysphagia for solids followed by liquids, weight loss, and long-term smoking history. The most likely diagnosis is:

  1. Achalasia
  2. Esophageal carcinoma
  3. GERD
  4. Diffuse esophageal spasm

Question No. 89

A patient with nephrotic syndrome suddenly develops flank pain and gross hematuria. Which complication should be suspected?

  1. Renal vein thrombosis
  2. Acute pyelonephritis
  3. Renal tuberculosis
  4. Hydronephrosis

Question No. 90

A patient with acute pancreatitis develops hypotension, hypoxemia, oliguria, and elevated serum creatinine. The most likely explanation is:

  1. Multiple organ dysfunction syndrome
  2. Irritable bowel syndrome
  3. Cholelithiasis
  4. Peptic ulcer disease

Question No. 91

A patient with severe dengue develops abdominal pain, rising hematocrit, thrombocytopenia, and hypotension. These findings indicate:

  1. Recovery phase
  2. Dengue shock syndrome
  3. Chronic dengue
  4. Viral hepatitis

Question No. 92

A patient receiving chemotherapy presents with fever, absolute neutrophil count of 300/µL, and hypotension. The most appropriate management is:

  1. Oral antibiotics at home
  2. Immediate broad-spectrum intravenous antibiotics
  3. Observation only
  4. Oral corticosteroids

Question No. 93

A patient presents with severe organophosphorus poisoning. Which combination constitutes the specific antidotal therapy?

  1. Naloxone and dextrose
  2. Atropine and pralidoxime
  3. Vitamin K and calcium
  4. Protamine and atropine

Question No. 94

A patient with severe hyperthyroidism develops fever, delirium, tachycardia, and heart failure. The diagnosis is:

  1. Addisonian crisis
  2. Thyroid storm
  3. Myxedema coma
  4. Pheochromocytoma

Question No. 95

A patient with chronic kidney disease presents with chest pain relieved by sitting forward and a pericardial friction rub. The most likely diagnosis is:

  1. Acute myocardial infarction
  2. Uremic pericarditis
  3. Pulmonary embolism
  4. Aortic stenosis

Question No. 96

A patient develops sudden unilateral pleuritic chest pain, tachycardia, and hypoxemia two days after major surgery. The most likely diagnosis is:

  1. Pulmonary embolism
  2. Bronchial asthma
  3. Community-acquired pneumonia
  4. Acute bronchitis

Question No. 97

A patient with advanced cirrhosis becomes progressively confused despite treatment and develops fetor hepaticus and asterixis. Which precipitating factor should be excluded first?

  1. Hypothyroidism
  2. Gastrointestinal bleeding
  3. Osteoarthritis
  4. Hyperlipidemia

Question No. 98

A patient presents with fever, neck stiffness, petechial rash, and rapidly progressive hypotension. Which organism is the most likely cause?

  1. Neisseria meningitidis
  2. Escherichia coli
  3. Mycoplasma pneumoniae
  4. Candida albicans

Question No. 99

A patient develops severe dyspnea immediately after receiving incompatible blood. Which diagnosis is most likely?

  1. Acute hemolytic transfusion reaction
  2. Iron deficiency anemia
  3. Hemophilia
  4. Polycythemia vera

Question No. 100

A 70-year-old man with diabetes, hypertension, chronic kidney disease, fever, hypotension, altered mental status, serum lactate of 6.5 mmol/L, oliguria, bilateral pulmonary infiltrates, thrombocytopenia, prolonged PT, elevated D-dimer, and metabolic acidosis is admitted to the ICU. Which condition best explains the overall clinical picture?

  1. Cardiogenic shock
  2. Septic shock with multiple organ dysfunction syndrome
  3. Acute exacerbation of COPD
  4. Acute viral hepatitis
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