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Question 1
Correct
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A 21 year-old software developer undergoes a planned lumbar puncture (LP) as part of a neurological investigation for possible multiple sclerosis. During the consent process, she expresses concern about a post-LP headache. What is the mechanism of post-LP headaches?
Your Answer: Leaking cerebrospinal fluid from the dura
Explanation:Leaking of cerebrospinal fluid from the dura is the most likely explanation for post-lumbar puncture headaches. It is thought that ongoing leak of cerebrospinal fluid (CSF) through the puncture site causes ongoing CSF loss, leading to low pressure. A post-LP headache is typically frontal or occipital and occurs within three days. It is normally associated with worsening on standing and improvement when lying down. Treatment in severe cases includes an epidural blood patch, but most resolve on their own.
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This question is part of the following fields:
- Nervous System
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Question 2
Incorrect
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Drugs and their actions are listed below. Which pair is correctly matched?
Your Answer: Digoxin stimulates Na/K ATPase
Correct Answer: Simvastatin inhibits HMGCoA reductase
Explanation:Amiodarone is a class III antiarrhythmic agent, and prolongs phase 3 of the cardiac action potential.
Digoxin increases the force of contraction of the heart muscle by inhibiting the Na-K-ATPase membrane pump, resulting in an increase in intracellular sodium.
Sotalol blocks beta-adrenoreceptors (Vaughan Williams Class II) and prolongs the cardiac action potential duration (Vaughan Williams Class III).
Streptokinase creates an active complex which promotes the cleavage of the Arg/Val bond in plasminogen to form the proteolytic enzyme plasmin. Plasmin degrades the fibrin matrix of the thrombus. -
This question is part of the following fields:
- Pharmacology
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Question 3
Correct
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A 50-year-old woman was investigated following an osteoporotic hip fracture. The following results are obtained:
TSH < 0.05 mu/l
Free T4 29 pmol/l
Which of the following autoantibodies is most likely to be present?Your Answer: TSH receptor stimulating autoantibodies
Explanation:The patient has hyperthyroidism and its most common cause is Grave’s Disease.
Grave’s Disease is an autoimmune disease due to circulating autoantibodies known as TSH receptor stimulating autoantibodies or Thyroid-stimulating immunoglobulins (TSIs) that bind to and activate thyrotropin receptors, causing the thyroid gland to grow and the thyroid follicles to increase the synthesis of thyroid hormone. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 4
Incorrect
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An 81-year-old male presented to the emergency department following a fall at home. He was diagnosed with osteoporosis about five years ago. He presently complains of significant low back pain.
A lumbar spine X-ray was suggestive of a fractured lumbar vertebra.
A subsequent MRI scan of the lumbosacral spine revealed a new L3 burst fracture with no evidence of cord compression.
A neurosurgical consult was sought and conservative management was planned accordingly in the form of pain control, physiotherapy, and mobilization (as allowed by the pain).
He also has been diagnosed with chronic renal disease (stage IV) with a creatinine clearance of 21 ml/min, he was started on a Buprenorphine patch.
Which of the following opioids would be safest to use for his breakthrough pain?Your Answer: Morphine
Correct Answer: Oxycodone
Explanation:Oxycodone is a safer opioid to use in patients with moderate to end-stage renal failure.
Active metabolites of morphine accumulate in renal failure which means that long-term use is contraindicated in patients with moderate/severe renal failure.
These toxic metabolites can accumulate causing toxicity and risk overdose.
Oxycodone is mainly metabolised in the liver and thus safer to use in patients with moderate to end-stage renal failure with dose reductions.
Adverse effects:
Constipation is the most common overall side effect. Others include: asthenia, dizziness, dry mouth, headache, nausea, pruritus, etc.Medications in renal failure:
Drugs to be avoided in patients with renal failure
Antibiotics: tetracycline, nitrofurantoin
NSAIDs
Lithium
Metformin
Drugs that require dose adjustment:
Most antibiotics including penicillin, cephalosporins, vancomycin, gentamicin, streptomycin
Digoxin, atenolol
Methotrexate
Sulphonylureas
Furosemide
Opioids
Relatively safe drugs:
Antibiotics: erythromycin, rifampicin
Diazepam
Warfarin -
This question is part of the following fields:
- Geriatric Medicine
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Question 5
Incorrect
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A 14-year-old girl came to the emergency room in a bizarre state with altered consciousness, presenting with symptoms of insomnia, logorrhoea, and anxiety, with incoherent discourse and amnesia of recent events. She has started calling herself The Queen, and is refusing to be her parents' daughter. What is the most likely diagnosis?
Your Answer: Capgras syndrome
Correct Answer: Ganser syndrome
Explanation:Ganser syndrome is a condition in which a person acts as if he is suffering from a specific psychological disorder in order to gain sympathy and relief.
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This question is part of the following fields:
- Nervous System
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Question 6
Correct
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A 71-year-old woman residing in a nursing home for a couple of years complains of drooling of saliva and sudden difficulty in swallowing while eating. She is a known hypertensive on treatment. What would be your next step?
Your Answer: Endoscopy
Explanation:Dysphagia or difficulty in swallowing. Endoscopy allows for visual examination of the oesophagus and is indicated in patients with dysphagia to determine the underlying aetiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy including dilation.
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This question is part of the following fields:
- Geriatric Medicine
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Question 7
Correct
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A girl suffered full thickness circumferential burn to her right arm. What is best step in management?
Your Answer: Escharotomy
Explanation:An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.
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This question is part of the following fields:
- The Skin
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Question 8
Correct
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A neonate was brought in by her mother, for a skin lesion present over the neonate's back which is bluish in colour, but otherwise asymptomatic. The most appropriate course of action will be?
Your Answer: Reassure
Explanation:A Mongolian spot can be present in new born babies which usually appears over the back and fades with time. There is nothing to worry about.
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This question is part of the following fields:
- The Skin
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Question 9
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 10
Correct
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The tumour suppressor gene is associated with multiple colonic polyps in which of the following autosomal dominant disorders?
Your Answer: Familial adenomatous polyposis (FAP)
Explanation:Familial adenomatous polyposis (FAP) is an inherited disorder where patients present with malignancy in their middle age. APC tumour suppressor gene is responsible for this disorder. Other disorders mentioned in the above options do not involve the tumour suppressor gene and are not autosomal dominant disorders.
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This question is part of the following fields:
- Gastrointestinal System
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Question 11
Incorrect
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A 44-year-old man presents suffering from retrosternal chest pain that started 2 hours ago and radiates to the throat. Which investigation would you immediately perform?
Your Answer: Electrocardiogram
Correct Answer: Troponin levels
Explanation:The patient’s age and symptoms are indicating a myocardial infarction. Although, the cause of the pain could also be related to the digestive system, a possible myocardial infarction should be excluded or, if present, managed immediately. Troponins are used to establish the diagnosis. Levels of troponin can become elevated in the blood within 3 or 4 hours after heart injury and may remain elevated for 10 to 14 days.
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This question is part of the following fields:
- Cardiovascular System
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Question 12
Incorrect
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A 51-year-old male patient presents with acute back pain, which worsens on prolonged walking and sitting. The pain radiates towards the lower limbs and seems to be relieved by lying down. What is the best next step?
Your Answer: Plain x-ray of spine
Correct Answer: Magnetic resonance imaging (MRI)
Explanation:A herniated disc seems to be the cause of the patient’s pain. MRI is the investigation of choice, since it can show soft tissue and establish a differential diagnosis.
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This question is part of the following fields:
- Nervous System
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Question 13
Correct
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A 36-year-old lady presents to the emergency department with right upper quadrant pain. She has also noticed that her skin seems slightly yellower over the last week or so and you notice a yellow tinge to her sclera. On further questioning, she complains of itching of her arms. Her only past medical history of note includes ulcerative colitis for which she takes mesalazine.
Given her presentation, what is the best investigation to diagnose the most likely underlying condition?Your Answer: ERCP (endoscopic retrograde cholangiopancreatography)
Explanation:With biliary obstructive symptoms in a patient with ulcerative colitis, one should immediately think of primary sclerosing cholangitis (PSC). PSC is characterized by inflammation and fibrosis of the intrahepatic and extrahepatic ducts. The best diagnostic test for PSC is ERCP. ANCA antibiotics may be positive, but not the best test to DIAGNOSE THE CONDITION. The same can be said of serum transaminase levels– they will be abnormal but nonspecific. While a liver ultrasound may be helpful, it is not the best test. Liver biopsy would be used to stage the PSC later.
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This question is part of the following fields:
- Hepatobiliary System
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Question 14
Incorrect
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An 18-year-old male was diagnosed with meningococcal meningitis, confirmed on lumbar puncture. After 6 months he presents in the infectious clinic with a second episode of meningitis. His past history is clear and he takes no regular medication. Which of the following is most probably deficient?
Your Answer: C1
Correct Answer: C5
Explanation:Pneumococcal meningitis is the most common and severe form of bacterial meningitis. Fatality rates are substantial, and long-term sequelae develop in about half of survivors. Disease outcome has been related to the severity of the proinflammatory response in the subarachnoid space. The complement system, which mediates key inflammatory processes, has been implicated as a modulator of pneumococcal meningitis disease severity in animal studies. C5 fragment levels in cerebrospinal fluid (CSF) of patients with bacterial meningitis correlated with several clinical indicators of poor prognosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 15
Correct
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A 42-year-old patient has been admitted with a very swollen and painful right knee. He was unable to walk on it so came into hospital. It is currently being treated as gout with non steroidal anti-inflammatory drugs. You notice he is of short stature, has shortened arms and legs and a flat nasal bridge. A mutation in which gene is responsible for this condition?
Your Answer: Fibroblast growth factor receptor
Explanation:Achondroplasia is a common cause of dwarfism. It is caused by a mutation in fibroblast growth factor receptor 3 (FGFR3). In normal development FGFR3 has a negative regulatory effect on bone growth. In achondroplasia, the mutated form of the receptor is constitutively active and this leads to severely shortened bones. The effect is genetically dominant, with one mutant copy of the FGFR3 gene being sufficient to cause achondroplasia, while two copies of the mutant gene are invariably fatal. A person with achondroplasia thus has a 50% chance of passing dwarfism to each of their offspring. People with achondroplasia can be born to parents that do not have the condition due to spontaneous mutation. It occurs as a sporadic mutation in approximately 80% of cases (associated with advanced paternal age) or it may be inherited as an autosomal dominant genetic disorder.
People with achondroplasia have short stature, with an average adult height of 131 centimeters (52 inches) for males and 123 centimeters (48 inches) for females. -
This question is part of the following fields:
- Musculoskeletal System
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Question 16
Correct
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A 68-year-old male presents with muscle weakness - he is unable to go up the stairs and has complained of mild breathlessness. He has said that he finds it difficult to swallow food sometimes. Lab tests are conducted and the reports show the following results: alkaline phosphatase 216 U/L; aspartate aminotransferase 49 U/L; alanine transaminase 43 U/L; creatine kinase 417; erythrocyte sedimentation rate 16 mm/h. From the list of options, choose the most likely diagnosis.
Your Answer: Polymyositis
Explanation:Muscle weakness and the inability to climb the stairs are consistent with a diagnosis of polymyositis. The condition usually affects those between 30-50 years of age and individuals present with stiffness in the muscles closest to the trunk which gradually worsens over time. Difficulty swallowing may be experienced if the muscle in the oesophagus is affected.
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This question is part of the following fields:
- Musculoskeletal System
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Question 17
Incorrect
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A 30-year-old agitated male was brought to the emergency department by his friend. Though there is little previous history, the friend believes that he has been suffering from depression for several years, and his medications have been changed by his general practitioner quite recently.
On examination the patient is agitated and confused, his pupils are dilated. He also has tremors, excessive sweating, and grinding of teeth. His heart rate is 118 beats/min, which is regular, and is febrile with a temperature of 38.5°C.
What is the most probable diagnosis?Your Answer: Malignant hyperthermia
Correct Answer: Serotonin syndrome
Explanation:The most probable diagnosis in this patient is serotonin syndrome.
The serotonin syndrome is a cluster of symptoms and signs (range from barely perceptible tremor to life-threatening hyperthermia and shock).
It may occur when SSRIs such as citalopram, escitalopram, fluoxetine, fluoxetine, paroxetine, and sertraline that impair the reuptake of serotonin from the synaptic cleft into the presynaptic neuron are taken in combination with monoamine oxidase inhibitors or tricyclic antidepressants. It has also been reported following an overdose of selective serotonin reuptake inhibitors (SSRIs) alone.Treatment:
Most cases of serotonin syndrome are mild and will resolve with removal of the offending drug alone.
After stopping all serotonergic drugs, management is largely supportive and aimed at preventing complications.
Patients frequently require sedation, which is best facilitated with benzodiazepines.
Antipsychotics should be avoided because of their anticholinergic properties, which may inhibit sweating and heat dissipation. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 18
Incorrect
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Which of the following forms of acute viral hepatitis has a much higher mortality in pregnant than non-pregnant females?
Your Answer: Hepatitis A
Correct Answer: Hepatitis E
Explanation:Pregnant patient in a third world country with hepatitis: The answer is most likely Hepatitis E. The mortality for Hepatitis E in pregnant women is very high. It is transmitted faecal-orally. There is no hepatitis G. Hepatitis C, B, A are less likely to be the correct answer than E given it’s classic association with pregnancy and poor living conditions.
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This question is part of the following fields:
- Infectious Diseases
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Question 19
Correct
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A 60-year-old female with a recent history of MI, complained of exertional dyspnoea. On examination there was a third heart sound. ECG showed ST elevations in leads V1 to V4. Which of the following is the most probable reason for this presentation?
Your Answer: Left ventricular aneurysm
Explanation:Electrocardiography is characterized by ST elevation that persists several weeks after an acute MI. The features of heart failure (exertional dyspnoea and third or fourth heart sound) favours the diagnosis.
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This question is part of the following fields:
- Cardiovascular System
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Question 20
Incorrect
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An 82-year-old woman is brought in by her carer with fluctuating consciousness. On examination she is deeply jaundiced, hypotensive with a tachycardia and has a hepatic flap. Initial blood tests reveal an ALT of 1000 U/l, INR 3.4, ALP 600 U/l and a bilirubin of 250 mmol/l.
Repeat blood tests 6 hours later show an ALT of 550 U/l, INR 4.6, ALP 702 U/l and bilirubin of 245 m mol/l. The toxicology screen for paracetamol and aspirin is negative; she is positive for hepatitis B surface antibody and negative for hepatitis B surface antigen.
Which of the following would best explain her clinical condition?Your Answer: Acute viral hepatitis which is now recovering
Correct Answer: Acute liver failure secondary to paracetamol
Explanation:Liver flap is pathognomonic for liver failure. Paracetamol (also known as acetaminophen) overdose usually presents with symptoms including liver failure, resulting in confusion, jaundice, and coagulopathy a few days after overdose. The first 24 hours, people usually have minimal symptoms. Diagnosis is based on blood levels of acetaminophen at specific times after it was taken (see reference). If she took it a few days ago, levels may indeed be undetectable. The hepatitis B serology suggests prior vaccination. Wilson’s disease is not the most likely diagnosis given her presentation. The AST:ALT ratio would be expected to be reversed in alcohol induced liver failure.
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This question is part of the following fields:
- Hepatobiliary System
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Question 21
Correct
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A 60-year-old man with a history of chronic lymphocytic leukaemia is admitted to the acute medical unit for pneumonia. This is his fourth admission for pneumonia in the past six months.
Which of the following factors is most likely to be responsible?Your Answer: Hypogammaglobulinaemia
Explanation:Hypogammaglobulinemia is a complication of chronic lymphocytic leukaemia (CLL) that leads to recurrent infections.
CLL is a type of cancer caused by monoclonal proliferation of well-differentiated lymphocytes, typically B cells (99%). Onset of the disease is usually asymptomatic and later constitutes anorexia, weight loss, bleeding, and recurrent infections. Lymphadenopathy is more marked in CLL than in chronic myelogenous leukaemia (CML).
Investigations to diagnose CLL include blood film and immunophenotyping. Smudge cells (also known as smear cells) seen on the blood film point towards CLL. Complications of the disease include hypogammaglobulinemia leading to recurrent infections, autoimmune haemolytic anaemia in 10-15% of the patients, and transformation to high-grade lymphoma (Richter’s transformation).
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This question is part of the following fields:
- Haematology & Oncology
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Question 22
Correct
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Which among these medications does NOT cause gastric ulceration?
Your Answer: Misoprostol
Explanation:Misoprostol is effective in preventing gastric ulceration since it is a prostaglandin analogue. Celecoxib, being a selective COX-2 inhibitor only elevates risk of ulceration as well as NSAIDs. Renal failure on the other hand results in elevated gastric acid after reducing the breakdown of gastrin.
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This question is part of the following fields:
- Gastrointestinal System
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Question 23
Incorrect
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A 35-year-old male who has smoked 20 cigarettes per day was referred to the National Chest Hospital because he has had a nine month history of shortness of breath which is getting worse. Tests revealed that he had moderate emphysema. His family history showed that his father died from COPD at the age of 52. Genetic testing found the PiSZ genotype following the diagnosis of alpha-1 antitrypsin (A1AT) deficiency. What levels of alpha-1 antitrypsin would be expected if they were to be measured?
Your Answer: 10% of normal
Correct Answer: 40% of normal
Explanation: -
This question is part of the following fields:
- Respiratory System
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Question 24
Correct
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A 28-year-old woman presents with painful genital ulceration. She reports that these attacks have been recurrent over the past 4 years. She has been treated previously with oral acyclovir but this has had little effect on the duration of her symptoms. Over the past year, she has noticed almost weekly attacks of mouth ulcers that heal slowly. Past medical history is significant for treatment of thrombophlebitis two years ago. Which of the following is the most likely diagnosis?
Your Answer: Behcet's syndrome
Explanation:Behçet disease is a rare vasculitic disorder that is characterized by a triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. The systemic manifestations can be variable. Ocular disease has the greatest morbidity, followed by vascular disease generally from active vasculitis. Cutaneous manifestations can occur in up 75% of patients with Behcet disease and can range from acneiform lesions, to nodules and erythema nodosum. GI manifestations can be severe. Differentiating Behçet disease from active inflammatory bowel disease can be clinically difficult. Herpes would have ideally responded to acyclovir. Sarcoidosis does not have genital and oral ulcerations.
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This question is part of the following fields:
- Musculoskeletal System
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Question 25
Correct
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A 78-year-old male with long-standing Alzheimer's disease is being reviewed in your clinic. Which among the following is true regarding memantine, a drug which has been approved for the management of dementia in the UK?
Your Answer: It is an NMDA-receptor agonist
Explanation:Memantine is an antagonist of the NMDA (N-Methyl-D-Aspartate)-receptor subtype of glutamate receptor. It is used to slow the neurotoxicity thought to be involved in Alzheimer’s disease and other neurodegenerative diseases.
Drug interactions:
When given concomitantly with other NMDA-receptor antagonists (e.g., ketamine, amantadine) increase the risk of psychosis.
Dopamine agonists, L-dopa, and anticholinergics enhance effects of memantine.
Antispasmodics (e.g., baclofen)Â enhance effects, as memantine has some antispasmodic effects.
Drugs excreted by cationic transporters in the kidney (e.g. quinine, cimetidine, ranitidine) reduce excretion.Common adverse effects include dizziness, headache, confusion, diarrhoea, and constipation.
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This question is part of the following fields:
- Pharmacology
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Question 26
Correct
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Which of the following involving the scalp may produce alopecia (hair loss)?
Your Answer: Discoid lupus erythematosus
Explanation:Infective causes of hair loss include:
Dissecting cellulitis
Fungal infections (such as tinea capitis)
Folliculitis
Secondary syphilis
Demodex folliculorum
Lupus erythematosus (hair loss may be permanent due to scarring of the hair follicles).
Psoriasis and seborrheic dermatitis commonly involve the scalp but do not produce hair loss. -
This question is part of the following fields:
- The Skin
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Question 27
Correct
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A 11-year-old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?
Your Answer: Pseudomonas
Explanation:History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 28
Incorrect
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A 70-year-old male patient presents with a history hematochezia and rectal tenesmus for the last six months. What is most probable diagnosis?
Your Answer: Haemorrhoids
Correct Answer: Colorectal adenocarcinoma
Explanation:The patient presents with symptoms of possible colorectal adenocarcinoma. When located in the left colon, it typically presents with tenesmus and bleeding. On the right side usually presents with anaemia, weight loss and abdominal pain.
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This question is part of the following fields:
- Gastrointestinal System
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Question 29
Correct
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A woman who is 36 weeks pregnant presents with chickenpox. How should she be treated?
Your Answer: Acyclovir
Explanation:Acyclovir is the correct answer. There has been no documented evidence of harm in pregnancy yet. Chickenpox can cause fetal abnormalities, and varicella zoster Immunoglobulin should be given to the infant immediately after birth (not the mother, won’t help). Steroids will actually make the chicken pox worse. Painkillers only, is obviously the wrong answer and pose severe risk to foetus.
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This question is part of the following fields:
- Infectious Diseases
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Question 30
Incorrect
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Which area in the body controls the hypoxic drive to breathe?
Your Answer: Areas on ventrolateral surface of the medulla
Correct Answer: Carotid body
Explanation:The carotid body consists of chemosensitive cells at the bifurcation of the common carotid artery that respond to changes in oxygen tension and, to a lesser extent, pH. In contrast to central chemoreceptors (which primarily respond to PaCO2) and the aortic bodies (which primarily have circulatory effects: bradycardia, hypertension, adrenal stimulation, and also bronchoconstriction), carotid bodies are most sensitive to PaO2. At a PaO2 of approximately 55-60 mmHg, they send their impulses via CN IX to the medulla, increasing ventilatory drive (increased respiratory rate, tidal volume, and minute ventilation). Thus, patients who rely on hypoxic respiratory drive will typically have a resting PaO2 around 60 mm Hg.
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This question is part of the following fields:
- Respiratory System
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Question 31
Correct
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A 22 year-old woman presents with a low body temperature and tremors. She reports seeing colour every time she shuts her eyes. What drug has she been using?
Your Answer: Lysergic acid diethylamide (LSD)
Explanation:Psychedelic drugs, like LSD, are strongly associated with closed-eye hallucinations that this patient is experiencing.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 32
Correct
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A 26-year-old woman presents for her first cervical smear. What is the most important aetiological factor causing cervical cancer?
Your Answer: Human papilloma virus 16 & 18
Explanation:It has been determined that HPV infection is the most powerful epidemic factor. This virus is needed, but not sufficient for the development of cervical cancer.
The WHO’s International Agency for Research on Cancer (IARC) classified HPV infection as carcinogenic to humans (HPV types 16 and 18), probably carcinogenic (HPV types 31 and 33) and possibly carcinogenic (other HPV types except 6 and 11).
Tobacco smoking, the use of contraceptives, and the number of births are factors that showed no statistically significant deviations in the studied population compared to other countries in the region, as well as European countries. They have an equal statistical significance in all age groups. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 33
Incorrect
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A 5-year-old girl was admitted for fever, anaemia, thrombocytopenia and signs of pulmonary infection. She now presents a few days later with signs of meningism. What is the most probable diagnosis?
Your Answer: Aplastic Anaemia
Correct Answer: Acute lymphoblastic leukaemia (ALL)
Explanation:Acute lymphoblastic leukaemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. Symptoms may include feeling tired, frequent infections with fever as well as anaemia with thrombocytopenia. As an acute leukaemia, ALL progresses rapidly and is typically fatal within weeks or months if left untreated. The patient’s age also favours the diagnosis of ALL as it occurs most commonly in children, particularly those between the ages of two and five.
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This question is part of the following fields:
- Haematology & Oncology
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Question 34
Incorrect
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A 35-year-old male developed difficulty in breathing following administration of IV Co-amoxiclav. On examination he was flushed, there were bilateral rhonchi and his blood pressure was 80/50 mmHg. What is the immediate management of this patient?
Your Answer: Epinephrine 0.5 mg IV
Correct Answer: Epinephrine 0.5 mg IM
Explanation:This case indicates an anaphylactic reaction. The causative factor should be stopped or removed as soon as possible and IM Epinephrine 0.5mg administered. IV Epinephrine can also be considered provided that it is adequately diluted.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 35
Correct
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A 78-year-old woman presents to the clinic complaining of left sided temporal headaches and jaw claudication that has been going on for a month. A left temporal artery biopsy is negative. Results show:
Hb: 130g/l
Platelets: 359*109/l
WBC: 10*109/l
CRP: 89 mg/l
Which of the following options would be the next best step in the management of this patient?Your Answer: Commence prednisolone
Explanation:Temporal arteritis is a chronic large- and medium-sized vessel vasculitis that typically involves the temporal arteries. Classical symptoms include temporal headaches, jaw claudication, amaurosis fugax. Physical exam shows scalp tenderness, palpation of the temporal area may demonstrate an absent pulse, knot-like swelling and vision loss. Lab results reveal an increased erythematous sedimentation rate and C-reactive protein. Temporal artery biopsy confirms the diagnosis. Management approach: high-dose systemic corticosteroids should be promptly administered even before the diagnosis is established. Temporal artery biopsy confirms the diagnosis. Inability to manage this or administer glucocorticoids might lead to development of blindness.
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This question is part of the following fields:
- Musculoskeletal System
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Question 36
Incorrect
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A 60 year-old patient known with stable angina was advised to have a contrast coronary angiography. Before the procedure, what will be the most appropriate step to take?
Your Answer: ECG
Correct Answer: IV 0.9% Saline
Explanation:Contrast material poses a greater threat for contrast induced nephropathy. In order to decrease the chance of contrast nephropathy, IV 0.9% saline is considered as the best fluid to maintain blood pressure. Normal Saline helps to expand intravascular volume and decrease the renin angiotensin system activity.
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This question is part of the following fields:
- Renal System
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Question 37
Correct
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A 28-year-old female presents to her GP with joint pain , fever, a butterfly rash and fatigue. She has marked peripheral oedema. She is found to be hypertensive, in acute renal failure, low albumin levels and proteinuria.
Â
A renal biopsy is performed and reveals focal glomerulonephritis with subendothelial and mesangial immune deposits.
Â
What is the most likely diagnosis?Your Answer: Lupus nephritis Class III
Explanation:This case presents with characteristic symptoms of SLE and with her renal biopsy results of focal glomerulonephritis, this is clearly Class III SLE.
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This question is part of the following fields:
- Renal System
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Question 38
Correct
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A diagnosed case of scabies presented in OPD for some medical advice. Which of the following statements best suits scabies?
Your Answer: It causes itchiness in the skin even where there is no obvious lesion to be seen
Explanation:Scabies is an infection caused by a microscopic mite known as Sarcoptes scabies. The chief presenting complaint is itching especially in skin folds and mostly during night. It spreads from one person to another through skin contact, and therefore it is more prevalent in crowded areas like hospitals, hostels and even at homes where people live in close contact with each other. Treatment options include benzyl benzoate, ivermectin, sulphur and permethrin.
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This question is part of the following fields:
- The Skin
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Question 39
Incorrect
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Question 40
Incorrect
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The increased risk of oesophageal malignancy in patients with Barrett's oesophagus is approximately:
Your Answer: 5 times the risk
Correct Answer: 50 - 100 times risk
Explanation:Barrett’s oesophagus is the transformation of the normal squamous epithelium of the oesophagus to columnar, intestinal type epithelium. It is often seen in patients with reflux and there is a 50-100 fold increased risk of oesophageal adenocarcinoma in patients with Barrett’s oesophagus.
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This question is part of the following fields:
- Gastrointestinal System
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SESSION STATS - PERFORMANCE PER SPECIALTY
