Q- A 24-year-old man is started on isoniazid for latent tuberculosis. He is advised to take a vitamin supplement to prevent a potential side effect.
Which of the following supplements is most appropriate?

A-Vitamin B1
B-Vitamin B6
C-Vitamin B9
D-Vitamin B12

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Q- Which of the following is the initial treatment of choice for a case of hyperkalemia accompanied by ECG changes?

A-Calcium gluconate
B-Furosemide
C-Insulin with glucose
D-Sodium polystyrene sulfonate

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Q- Which one of the following lipid-lowering agents can cause skin flushing and pruritus?

A-Atorvastatin
B-Cholestyramine
C-Gemfibrozil
D-Niacin
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Q, A 48-year-old man presents with progressive fatigue, exertional breathlessness, generalized weakness, and reduced exercise tolerance. Examination reveals pallor. Laboratory investigations demonstrate a microcytic anaemia with increased serum iron and ferritin, and bone-marrow examination shows ring sideroblasts.
Deficiency of which of the following vitamins is most likely responsible for these findings?

A. Vitamin B1
B. Vitamin B6
C. Vitamin B9
D. Vitamin B12
E. Vitamin C

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Q, A 62-year-old man with stage 4 chronic kidney disease presents with several months of generalised bone aches, proximal muscle weakness and difficulty climbing stairs. On examination, he has mild diffuse bone tenderness with no focal joint abnormalities.
Blood tests show:
- Creatinine: 285 µmol/L
- eGFR: 23 mL
- Phosphate: 1.85 mmol/L
- Corrected calcium: 2.28 mmol/L
- PTH: 42 pmol/L
- ALP: 245 U/L
- 25-hydroxyvitamin D: 78 nmol/L
- Bicarbonate: 22 mmol/L
Dietary phosphate intake has been addressed and his vitamin D status is adequate. He is not receiving dialysis.
Which medication is most appropriate for reducing his markedly elevated PTH?
A. Cinacalcet
B. Calcitriol
C. Alendronate
D. Calcium carbonate
E. Teriparatide

Q, A 45-year-old woman presents with 3 weeks of persistent vomiting and poor oral intake. She complains of generalised weakness, muscle cramps and occasional palpitations. Her ECG shows prolongation of the QT interval.
Blood tests show:
Na⁺: 138 mmol/L
K⁺: 2.7 mmol/L
Mg²⁺: 0.42 mmol/L
Ca²⁺: 2.30 mmol/L
HCO₃⁻: 34 mmol/L
Which electrolyte abnormality is most likely responsible for the ECG finding?

A. Hyperkalaemia
B. Hypokalaemia
C. Hypomagnesaemia
D. Hypercalcaemia
E. Hypernatraemia

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Q, A 42-year-old man was diagnosed with Helicobacter pylori infection after presenting with recurrent epigastric pain. He completed a 14-day eradication regimen and is now asymptomatic. Confirmation of successful eradication is planned.
Which of the following is the preferred non-invasive test to confirm H. pylori eradication?

A. Serum H. pylori IgG antibody
B. urea breath test
C. Monoclonal stool antigen test
D. Serum H. pylori IgM antibody
E. Histopathological examination

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A 38-year-old woman presents with fatigue, weight gain, constipation, and cold intolerance. Examination reveals a firm, non-tender thyroid gland. Laboratory investigations show:
TSH: 18.6 mIU/L (elevated)
Free T4: 0.5 ng/dL (low)
Anti-thyroid peroxidase (anti-TPO) antibodies: negative
Autoimmune thyroiditis remains strongly suspected.
Which of the following is the most appropriate additional antibody test?

A. TSH-receptor antibody (TRAb)
B. Thyroid-stimulating immunoglobulin (TSI)
C. Anti-thyroglobulin antibody (TgAb)
D. Anti-centromere antibody
E. Repeat Anti-thyroid peroxidase (anti-TPO) antibodies

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Q, A 46-year-old man is diagnosed with Helicobacter pylori infection during evaluation for recurrent dyspepsia. Chronic H. pylori infection has been associated with several gastrointestinal and extra-gastrointestinal disorders.
Which of the following conditions is NOT a recognized association of H. pylori infection?

A. Gastric MALT lymphoma
B. Unexplained iron-deficiency anaemia
C. Immune thrombocytopenia (ITP)
D. Vitamin B12 deficiency
E. Folate Deficiency

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Q, A 55-year-old woman with a gastric ulcer tested positive for H. pylori and completed eradication therapy. Her symptoms have improved, and a test of cure is planned.
What is the earliest appropriate time to perform testing to confirm eradication?

A. Immediately after completing treatment
B. 1 week after completing treatment
C. 2 weeks after completing treatment
D. At least 4 weeks after completing treatment
E. At least 6 months after completing treatment

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Q, A 62-year-old man with bipolar disorder has been taking a long-term medication. Two weeks ago, a thiazide diuretic was added for hypertension.
He now presents with confusion, worsening hand tremor, nausea, and several episodes of diarrhoea. On examination, he has a coarse tremor and an unsteady gait.
What is the most likely diagnosis?

A. Serotonin syndrome
B. Lithium toxicity
C. Neuroleptic malignant syndrome
D. Symptomatic hyponatraemia
E. Acute gastroenteritis

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