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Question 1
Incorrect
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A 60 year old male smoker presented in the emergency room with a history of chest pain and a cough for the last few days. He is now complaining of increasing dyspnoea and sharp pains around the 4th and 5th ribs. On CXR, there is right sided hilar enlargement. Which of the following is the most likely diagnosis?
Your Answer: Bronchogenic carcinoma
Correct Answer:
Explanation:The history of smoking with a cough and bone pain is suggestive of bronchogenic carcinoma. CXR findings are also supportive of this diagnosis. In COPD, a cough with dyspnoea and wheezing is prominent.
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This question is part of the following fields:
- Respiratory
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Question 2
Incorrect
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A patient was admitted due to vomiting for further investigations. He noticed blood in his vomit and the physicians decided to perform an esophagogastroduodenoscopy which revealed haemorrhage in the lesser curvature of the stomach. Which artery is responsible for the bleeding?
Your Answer: Left gastro-omental artery
Correct Answer: Right gastric artery
Explanation:The right gastric artery arises from the hepatic artery or the left hepatic artery and supplies the pylorus, traveling along the lesser curvature of the stomach anastomosing with the left gastric artery.
The pancreaticoduodenal artery supplies mainly the upper and lower duodenum and the head of the pancreas.
The gastro-omental arteries supply the greater curvature of the stomach. -
This question is part of the following fields:
- Gastrointestinal
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Question 3
Correct
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A 6 month old child was brought in after choking on a foreign body, which had resulted in the child having difficulty breathing. The best possible site for the incision would be?
Your Answer: Cricoid cartilage
Explanation:Cricothyroidectomy is done in life threatening condition, where an incision is made in cricothyroid membrane to establish a patent airway.
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This question is part of the following fields:
- ENT
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Question 4
Incorrect
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A 67 year old male presented with a history of chronic backache and altered sensation over the lateral side of his right calf and foot. Which of the following nerve roots will most likely be involved in this patient?
Your Answer: L5-S1
Correct Answer:
Explanation:Lesions in L5-S1 region leads to altered sensation on the lateral side of calf and foot, along with back pain. There might be difficulty in extension of the leg, foot inversion, plantar flexion and toe flexion, as muscles controlling these functions are supplied by S1.
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This question is part of the following fields:
- Neurology
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Question 5
Incorrect
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A 50-year-old man presented with a rash over his forearms, shins and face when he visited the clinic in the summer. Which of the following medications is the most likely to be associated with this photosensitive rash?
Your Answer: Digoxin
Correct Answer:
Explanation:Photosensitivity is a common adverse effect of cardiology drugs including amiodarone and thiazide diuretics. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (A2RBs) commonly also cause rashes only some of which appear to be photosensitive.
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This question is part of the following fields:
- Pharmacology
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Question 6
Incorrect
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A 35 year old mother of 3 children presented with poor sleep. She has had constant nightmares of an accident which she faced with her family members few months ago, which has disturbed her sleep. She was irritable towards her children and has difficulty in concentrating on her daily activities. She blamed her husband for the car accident inappropriately. Which of the following is the most appropriate treatment for her?
Your Answer: Relaxation therapy
Correct Answer:
Explanation:The history is suggestive of post traumatic stress disorder (PTSD) as the patient had a traumatic event, nightmares of the incidence, poor sleep, irritability etc. The main treatments for people with PTSD are psychotherapy, medication, or a combination of the two. Cognitive behavioural therapy is the main psychotherapy method used. The most studied medications for treating PTSD are SSRIs. So from the given answers, Fluoxetine is the correct answer.
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This question is part of the following fields:
- Mental Health
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Question 7
Correct
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A 38-year-old male complained of painless, right sided testicular enlargement for 4 months. The size has been gradually increasing. On examination, there was no tenderness or redness. It was firm in consistency and not transiluminating. The most likely diagnosis is?
Your Answer: Testicular tumour
Explanation:History is suggestive of testicular tumour due to the gradual onset, non tender, firm mass. Hydroceles transiluminate and a varicocele has a bag of worms texture. Epididymo-orchitis is tender and often red or inflamed. An ependymal cyst is confined to the epididymis.
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This question is part of the following fields:
- Genitourinary
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Question 8
Incorrect
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An 8 year old boy is admitted to the ward with renal colic. Family history is significant for similar renal calculi in his mother. Which of the following is the most likely explanation for this recurrent colic in both mother and child?
Your Answer: Cystinuria
Correct Answer: Idiopathic hypercalciuria
Explanation:Idiopathic hypercalciuria (IH) is the commonest metabolic abnormality in patients with calcium kidney stones. It is characterized by normocalcemia, absence of diseases that cause increased urine calcium, and calcium excretion that is above 250 mg/day in women and 300 mg/day in men. Subjects with IH have a generalized increase in calcium turnover, which includes increased gut calcium absorption, decreased renal calcium reabsorption, and a tendency to lose calcium from bone. Despite the increase in intestinal calcium absorption, negative calcium balance is commonly seen in balance studies, especially on a low calcium diet. The mediator of decreased renal calcium reabsorption is not clear; it is not associated with either an increase in filtered load of calcium or altered PTH levels. There is an increased incidence of hypercalciuria in first-degree relatives of those with IH, but IH appears to be a complex polygenic trait with a large contribution from diet to expression of increased calcium excretion. Increased tissue vitamin D response may be responsible for the manifestations of IH in at least some patients.
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This question is part of the following fields:
- Renal
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Question 9
Correct
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A 60-year-old female underwent a surgery involving the posterior triangle of the neck. After the surgery, she had difficulty when moving her right shoulder joint. Which of the following nerves is most probably involved?
Your Answer: Accessory nerve
Explanation:The accessory nerve innervates the trapezius muscle which is involved in shoulder movements. Any injury to this nerve will result in the difficulty of movements around the shoulder.
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This question is part of the following fields:
- Musculoskeletal
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Question 10
Incorrect
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A 65 year old male patient presents with a non-explosive cough, muscle twitching on the level of the tongue and aspiration pneumonia. He also claims that occasionally the food he swallows comes back through his nose. What is the most likely cause of dysphagia in this case?
Your Answer: Pharyngeal pouch
Correct Answer: Bulbar palsy
Explanation:Bulbar palsy and pseudobulbar palsy are rare types of a motor neuron disease that affect the cranial motor nerves. Bulbar palsy is a lower motor neuron palsy that affects the nuclei of the 9th to 12th cranial nerves. Pseudobulbar palsy is an upper motor neuron palsy that affects the corticobulbar tracts of the 5th, 7th and 9th to 12th cranial nerves. Any condition which disrupts or damages the cranial nerve nuclei or corticobulbar tracts can cause bulbar or pseudobulbar palsy (e.g., stroke, multiple sclerosis, infections, brain stem tumours). Both bulbar and pseudobulbar palsy are seen mainly in men over 75 years old and present with progressive dysarthria and dysphagia. In addition, patients with pseudobulbar palsy present with a lack of facial expression, difficulty chewing, and emotional lability. Lower motor neuron signs (atrophy and fasciculations of the tongue, absent gag reflex) differentiate bulbar palsy from pseudobulbar palsy, which presents with upper motor neuron signs (spastic tongue, exaggerated gag, and jaw jerk reflexes). Diagnosis is mainly clinical and treatment mostly supportive with a poor prognosis. Life expectancy is around 1–3 years following diagnosis.
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This question is part of the following fields:
- Oncology
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Question 11
Correct
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A 72 year old female, known with rheumatoid arthritis for last 17 years, presents with recurrent attacks of red eyes with a sensation of grittiness. Which of the following is most likely cause of the red eyes?
Your Answer: keratoconjunctivitis sicca
Explanation:Rheumatoid arthritis is an inflammatory systemic disease associated with some extraarticular manifestations. Keratoconjunctivitis sicca, episcleritis, scleritis, corneal changes, and retinal vasculitis are the most common ocular complications among extraarticular manifestations of RA. The overall prevalence of keratoconjunctivitis sicca also known as dry eye syndrome among patients of RA is 21.2% and is the most common with sense of grittiness in the eyes.
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This question is part of the following fields:
- Rheumatology
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Question 12
Incorrect
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A 56 year old woman taking procainamide develops drug induced erythematosus. Which of the following features is the most characteristic of this condition?
Your Answer: The symptoms may be alleviated with long-term steroids
Correct Answer: It may occur with chlorpromazine
Explanation:Drug induced lupus is usually positive for antinuclear and antihistone antibodies, typically without renal or neurologic involvement. However, pulmonary involvement is common. Drugs that can induce lupus include isoniazid, hydralazine, procainamide, chlorpromazine, and other anticonvulsants.
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This question is part of the following fields:
- Rheumatology
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Question 13
Correct
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A 65 year old diabetic who recently underwent a laparotomy, presented with complaints of abdominal distension, vomiting and failure to pass stool. He was labelled as a case of intestinal obstruction. What will be the best initial step in the management?
Your Answer: NG tube + IV fluids
Explanation:During intestinal obstruction, the initial step that needs to be taken includes IV fluids and passing an NG tube. This will help in fluid and electrolyte balance and will also help with decompression of the intestine, resulting in an improvement of the vomiting.
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This question is part of the following fields:
- Surgery
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Question 14
Incorrect
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In over 70% of the cases, inflammatory bowel disease associates which of the following?
Your Answer: Steatohepatitis
Correct Answer: Primary sclerosing cholangitis
Explanation:More than 70% of cases with inflammatory bowel disease are associated with primary sclerosing cholangitis. The most common association is that of ulcerative colitis, in which case it progresses independently.
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This question is part of the following fields:
- Gastrointestinal
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Question 15
Correct
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Which is the most likely lymph node involved in the presence of an ulcer on the scrotum?
Your Answer: Inguinal lymph node
Explanation:Inguinal LN’s drain the skin and subcutaneous tissue of the lower abdominal wall, perineum, buttocks, external genitalia, and lower limbs. They are subdivided into three groups of lymph nodes (nodi lymphoid):
– inferior group of superficial inguinal lymph nodes, located inferior to the saphenous opening, receiving drainage of the lower limb;
– superolateral superficial inguinal lymph nodes located lateral to the saphenous opening, receiving drainage of lateral buttock and lower anterior abdominal wall; and
– superomedial superficial inguinal lymph nodes, located medial to the saphenous opening, receiving drainage of the perineum and external genitalia. -
This question is part of the following fields:
- Surgery
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Question 16
Correct
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A 25-year-old pregnant mother who is known to have hepatitis B gave birth to a male infant. She is now concerned about her child contracting hep B. Which of the following is the most suitable option for the baby in this case?
Your Answer: HepB full vaccine and Ig
Explanation:Hepatitis B full vaccine and Ig should be given to babies born to hepatitis B positive mothers. Hepatitis B vaccine alone or Ig alone is not sufficient to prevent the infection in the new-born baby.
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This question is part of the following fields:
- Infectious Diseases
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Question 17
Incorrect
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A 7-month-old baby boy was brought by his parents due to frequently regurgitating his milk. On examination, he was pale and lethargic. FBC showed a microcytic anaemia. Which of the following is the most probable diagnosis?
Your Answer: Alpha1-antitrypsin deficiency
Correct Answer: Hiatus hernia
Explanation:Frequent regurgitation of milk and microcytic anaemia is suggestive of a hiatus hernia. The reflux causes regurgitation of milk and frequent ulceration of the lower oesophageal mucosa potentially resulting in blood loss and anaemia. Duodenal atresia usually presents with bilious vomiting and pyloric stenosis presents with projectile vomiting. Alpha 1 antitrypsin deficiency and cystic fibrosis usually do not present with vomiting.
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This question is part of the following fields:
- Child Health
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Question 18
Correct
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A 25-year-old female patient diagnosed with recurrent depressive disorder was admitted to the hospital after overdosing on her medication. At the ED, she presents with nausea, vomiting and a coarse tremor. Which is the drug that most likely caused her symptoms?
Your Answer: Lithium
Explanation:Side effects of lithium overdose include coarse tremor, nausea and vomiting. Fine tremor, however, is present in therapeutic dosages.
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This question is part of the following fields:
- Mental Health
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Question 19
Incorrect
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A 6 year old boy presented in the emergency department with a cough and knee swelling after falling on the road. He had a non-blanching rash on his buttocks and investigations revealed: PT=13, APTT=71, Hgb=11, WBC=8, Plt=200. Which is the most likely diagnosis?
Your Answer: Von-Willebrand disease
Correct Answer: Haemophilia
Explanation:From the options mentioned here, the closest diagnosis is haemophilia. This is a mixed picture, as a purpuric rash on the buttocks does not correlate with this diagnosis. However, the most appropriate diagnosis is haemophilia.
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This question is part of the following fields:
- Child Health
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Question 20
Incorrect
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A 72-year-old woman who presented with headache and neck stiffness was started on IV ceftriaxone after undergoing a lumber puncture. The CSF culture shows listeria monocytogenes. What is the treatment of choice?
Your Answer: Add IV amoxicillin
Correct Answer: Change to IV amoxicillin + gentamicin
Explanation:The best option would be the combination of ampicillin and gentamycin. Changing to IV amoxicillin+gentamycin is however the best among the given choices here.
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This question is part of the following fields:
- Infectious Diseases
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Question 21
Correct
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A patient suffering from schizophrenia laughs while talking about his father’s death. Which term best describes his condition?
Your Answer: Incongruent affect
Explanation:Incongruent affect is a sign of schizophrenia and presents as a mismatch between the patient’s thoughts and his/her mood.
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This question is part of the following fields:
- Mental Health
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Question 22
Incorrect
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Which of the following diseases correctly matches the incubation period?
Your Answer: Measles - five to seven days
Correct Answer:
Explanation:The incubation periods of disorders is extremely important to diagnose, treat, prevent or attenuate a disease.
Chickenpox: 7-21 days.
Whooping cough: 10-14 days.
Hand, foot and mouth disease: 2-6 days. German measles: 14-21 days.
Mumps: 14-18 days. -
This question is part of the following fields:
- Infectious Diseases
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Question 23
Incorrect
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Barrett's oesophagus is well recognized as a complication of gastroesophageal reflux disease. What is the pathological change that occurs in the above condition?
Your Answer: Metaplasia
Correct Answer: Squamous to columnar epithelium
Explanation:Barrett’s oesophagus is characterised by the metaplastic replacement of the normal squamous epithelium of the lower oesophagus by columnar epithelium.
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This question is part of the following fields:
- Gastrointestinal
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Question 24
Correct
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A 45-year-old female presented in the OPD with complaints of tiredness and lethargy. On examination, her BP was 160/100mmHg. On lab examination her Na+=142mmol/L, K+=3.0mmol/L. Which is the most likely diagnosis?
Your Answer: Conn’s syndrome
Explanation:In Conn’s syndrome hypokalaemia and hypertension are present due to high levels of aldosterone with normal to high sodium levels. In this disease, the patient presents with hypertension and feelings of tiredness or fatigue.
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This question is part of the following fields:
- Endocrine
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Question 25
Incorrect
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A 75 year old female has developed recurrent breathlessness after having a mitral valve replacement 13 years ago. Her husband has also noticed a prominent pulsation in her neck. She has also complained of ankle swelling and pain in the abdomen. Choose the most probable diagnosis from the list of options.
Your Answer: Mitral regurgitation
Correct Answer: Tricuspid regurgitation
Explanation:Multiple symptoms point towards tricuspid regurgitation: recurrent breathlessness (if the cause if LV dysfunction); a prominent pulsation in her neck (giant V waves); pain in the abdomen (pain in liver upon exertion); and ankle swelling.
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This question is part of the following fields:
- Cardiovascular
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Question 26
Incorrect
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A 62 year old patient presents to the ophthalmology OPD with progressive deterioration of vision and dazzling of view in well lit environments. Which of the following is the most likely diagnosis leading to this presentation?
Your Answer: Cataracts
Correct Answer:
Explanation:Cataract is a condition characterized by clouding of the lens of the eye. This condition most frequently occurs due to age-related degenerative processes in the lens, but can also be associated with ocular trauma, metabolic disorders, side-effects of drugs, or congenital infections. The clouding causes distortion of light, as it passes through the lens, resulting in visual impairment and glare. Initially, a cataract presents discretely and may even go unnoticed, but the visual impairment worsens as the cataract grows larger.
Diagnosis is typically established on the basis of a thorough history and direct visualization of the cataract (by means of slit-lamp microscopy). Surgery is indicated with significant visual impairment and involves lens extraction and implantation of an artificial lens. Untreated cataracts eventually lead to complete blindness.
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This question is part of the following fields:
- Ophthalmology
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Question 27
Incorrect
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Which one of the following skin conditions is matched correctly with its treatment?
Your Answer:
Correct Answer:
Explanation:One of the options of Psoriasis treatment is vitamin D analogues i.e. calcipotriol. Acne is exacerbated by steroids. Erythema nodosum can be caused by various diseases and the treatment of the primary condition resolves the symptoms. Lipomas requires surgery, whereas Steven-Johnson syndrome requires use of steroids and eliminating the culprit drug, which is one of the most common causes.
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This question is part of the following fields:
- Dermatology
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Question 28
Incorrect
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A 51-year-old woman admitted to the hospital for 3 days due to haemoptysis developed an ataxic gait, visual problems, and altered state of consciousness. What is the most appropriate management of this patient?
Your Answer:
Correct Answer: High potent vitamins
Explanation:Wernicke’s encephalopathy presents with neurological symptoms as a result of biochemical deficits in the central nervous system due to depleted B-vitamin reserves, particularly thiamine (vitamin B1). Classically, Wernicke encephalopathy is characterised by the triad – ophthalmoplegia, ataxia, and confusion. Thiamine treatment should be started immediately and usually continued until clinical improvement ceases.
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This question is part of the following fields:
- Neurology
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Question 29
Incorrect
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An 18 year old boy with a history of bloody diarrhoea and fever, presents with a skin rash and low urine output. Blood tests and urinalysis reveal increased levels of urea and creatinine and haematuria. What is the most probable diagnosis?
Your Answer:
Correct Answer: Haemolytic Uraemic Syndrome
Explanation:Signs and symptoms of haemolytic uremic syndrome can include bloody diarrhoea, low urine output, nausea, vomiting, abdominal pain and general fatigue. Increased values of urea and creatinine are also typical.
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This question is part of the following fields:
- Haematology
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Question 30
Incorrect
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The drug of choice for delirium tremens will be?
Your Answer:
Correct Answer: IV Chlordiazepoxide
Explanation:The drugs of choice for delirium tremens are benzodiazepines such as chlordiazepoxide, diazepam or lorazepam. Chlordiazepoxide is a long acting drug and is the preferred drug, before the other benzodiazepines. Barbiturates are the 2nd drugs of choice.
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This question is part of the following fields:
- Neurology
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SESSION STATS - PERFORMANCE PER SPECIALTY
