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Question 1
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A 21-year-old student presents with yellowish discolouration of her sclera. She says she has had severe headaches over the last few weeks for which she has been taking paracetamol. What is the most likely cause of her jaundice?
Your Answer: Gilbert's syndrome
Explanation:Gilbert’s syndrome is a mild liver disorder in which the liver does not properly process bilirubin. Many people never have symptoms. Occasionally a slight yellowish colour of the skin or whites of the eyes may occur. Other possible symptoms include feeling tired, weakness, and abdominal pain.
The enzymes that are defective in Gilberts – UDP glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1) – are also responsible for some of the liver’s ability to detoxify certain drugs. While paracetamol (acetaminophen) is not metabolized by UGT1A1,[10] it is metabolized by one of the other enzymes also deficient in some people with Gilberts. Therefore a subset of people with Gilberts may have an increased risk of paracetamol toxicity. -
This question is part of the following fields:
- Hepatobiliary System
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Question 2
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Which type of cell is responsible for the production of surfactant?
Your Answer: Type II pneumocyte
Explanation:Type I pneumocyte: The cell responsible for the gas (oxygen and carbon dioxide) exchange that takes place in the alveoli. It is a very thin cell stretched over a very large area. This type of cell is susceptible to a large number of toxic insults and cannot replicate itself.
Type II pneumocyte: The cell responsible for the production and secretion of surfactant (the molecule that reduces the surface tension of pulmonary fluids and contributes to the elastic properties of the lungs). The type 2 pneumocyte is a smaller cell that can replicate in the alveoli and will replicate to replace damaged type 1 pneumocytes. Alveolar macrophages are the primary phagocytes of the innate immune system, clearing the air spaces of infectious, toxic, or allergic particles that have evaded the mechanical defences of the respiratory tract, such as the nasal passages, the glottis, and the mucociliary transport system. The main role of goblet cells is to secrete mucus in order to protect the mucous membranes where they are found. Goblet cells accomplish this by secreting mucins, large glycoproteins formed mostly by carbohydrates. -
This question is part of the following fields:
- Respiratory System
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Question 3
Incorrect
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A 46-year-old man presents with a swollen, red, and painful left calf. He does not have a history of any recent surgery or a long-haul flight. He is generally fit and well and takes no regular medication other than propranolol for migraine prophylaxis. There is also no history of venous thromboembolism (VTE) in his family.
The patient is referred to the deep vein thrombosis (DVT) clinic where he is diagnosed with a proximal DVT in his left calf. Following the diagnosis, he is started on low-molecular-weight heparin (LMWH) whilst awaiting review by the warfarin clinic.
Other than commencing warfarin, what further action, if any, is required?Your Answer: No further action is required
Correct Answer: Investigate for underlying malignancy + check antiphospholipid antibodies
Explanation: -
This question is part of the following fields:
- Haematology & Oncology
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Question 4
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A 8-year-old boy who recently migrated from Nigeria was seen in A&E department with a six-week history of progressive swelling of his jaw, fever, night sweats, and weight loss. His mother reported an episode of sore throat in the past which was treated with antibiotics, but he developed a rash subsequently. Other than that, there was no other significant past medical history. On examination, a painless, nontender 4x3cm mass was found that was fixed and hard. The only other examination finding of note was rubbery symmetrical cervical lymphadenopathy.
Which of the following translocation would most likely be found on biopsy karyotyping?Your Answer: t(8;14)
Explanation: -
This question is part of the following fields:
- Haematology & Oncology
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Question 5
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Type 2 hypersensitivity is mediated by:
Your Answer: IgG, IgM & complement
Explanation:In type II hypersensitivity the antibodies, IgG and IgM bind to antigens to form complexes that activate the classical pathway of complement to eliminate cells presenting foreign antigens.
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This question is part of the following fields:
- Immune System
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Question 6
Incorrect
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Which of the following vaccinations is contraindicated in patients with malignancy undergoing chemotherapy?
Your Answer: Influenza
Correct Answer: Rubella
Explanation:MMR vaccine is a live vaccine. It contains measles, mumps and rubella. These vaccines should be avoided during chemotherapy and for 6 months after.
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This question is part of the following fields:
- Pharmacology
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Question 7
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Which of the following findings would point towards a diagnosis of neonatal hypothyroidism?
Your Answer: Mother has hyperthyroidism
Explanation:Transient congenital hypothyroidism can be due to: iodine deficiency or excess, maternal consumption of goitrogens or antithyroid medications during pregnancy, transplacental passage of TSH receptor-blocking antibodies, and neonatal very low birth weight and prematurity
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 8
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A 25-year-old male presented in the OPD with the complaint of recurrent lower back pain. The doctor suspected a diagnosis of ankylosing spondylitis. Which one of the following investigations is the most useful to confirm this diagnosis?
Your Answer: XR sacro-iliac joints
Explanation:An X-ray of the sacroiliac joint will show fusion of both joints and symmetrical, thin syndesmophytes bridging the intervertebral disc spaces. None of the other investigations could clearly show this picture.
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This question is part of the following fields:
- Musculoskeletal System
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Question 9
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A 60-year-old man, newly diagnosed with acromegaly, may have all of the following, except?
Your Answer: Hypohydrosis
Explanation:Acromegaly occurs due to excessive action of insulin-like growth factor I (IGF-I) after the growth plate cartilage fuses in adulthood.
It can be an insidious disease. Symptoms, which may precede diagnosis by several years, can be divided into the following groups:
1. Symptoms due to local mass effects of an intracranial tumour
Tumour damage to the pituitary stalk may cause hyperprolactinemia (Increased blood prolactin levels associated with galactorrhoea) due to loss of inhibitory regulation of prolactin secretion by the hypothalamus
2. Symptoms due to excess of GH/IGF-I including:
– Hyperhidrosis (Not hypohidrosis)
– Arthritis
– Peripheral Neuropathies e.g. Carpal Tunnel Syndrome -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 10
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A 25-year-old male presented in the emergency room with a history of loose stools which were bloody and mucoid for the last 2 to 3 months. The stools were also associated with abdominal cramps. He undergoes a colonoscopy after which he will start treatment. What is the most suitable drug in this case?
Your Answer: Mesalazine
Explanation:Symptoms are suggestive of inflammatory bowel disease. In this disease mesalazine is very effective as an anti-inflammatory drug.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 11
Incorrect
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A 35-year-old female admitted with heat intolerance, neck pain, palpitations and recent onset weight loss despite increased appetite. Which of the following is most likely to be associated with diagnosis of thyroiditis associated with viral infection?
Your Answer: Positive thyroid peroxidase antibodies
Correct Answer: Reduced uptake on thyroid isotope scan
Explanation:Subacute thyroiditis (De Quervain’s thyroiditis) is a self-limiting thyroid condition presenting with three clinical courses of hyperthyroidism, hypothyroidism, and return to normal thyroid function. In subacute thyroiditis serum thyroglobulin (TG) levels are elevated. ESR is usually greater than 50 mm/h, often exceeding 100 mm/h. Radio-iodine uptake is low or nil. Antithyroperoxidase antibodies are associated with autoimmune thyroiditis
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 12
Incorrect
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A 34-year-old man presents with haemoptysis and weight loss. History reveals he suffers from night sweats and upon auscultation you notice reduced breath sounds over the apex of his right lung and significant nail clubbing. You refer him to a pneumologist who administers the following antibiotics: rifampicin, ethambutol, pyrazinamide and isoniazid. What is the mechanism of action of the first drug?
Your Answer: Inhibit 50S subunit of ribosomes
Correct Answer: Inhibit RNA synthesis
Explanation:Rifampicin specifically inhibits bacterial RNA polymerase, the enzyme responsible for DNA transcription, by forming a stable drug-enzyme complex with a binding constant of 10(-9) M at 37 C.
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Correct
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A 37-year old female nurse presents with severe generalized itching, claiming that she had previously applied cream to the body of a patient with similar symptoms. What is the mechanism that produces her itch?
Your Answer: Allergic reaction
Explanation:Contact dermatitis is a red, itchy rash caused by direct contact with a substance or an allergic reaction to it. The entry of allergen into the epidermis or dermis causes a localized allergic reaction. Local mast-cell activation in the skin leads immediately to a local increase in vascular permeability, which causes extravasation of fluid and swelling. Histamine released by mast cells activated by allergen in the skin causes large, itchy, red swellings of the skin.
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This question is part of the following fields:
- The Skin
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Question 14
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A 72-year-old female presents with tiredness and weakness. On examination, she is pale and has a haemoglobin of 72 g/L with an MCV of 68 fL. Which nail changes may be seen in association with this patient's condition?
Your Answer: Koilonychia
Explanation:Koilonychia, known as spoon nails, is a condition of the nails bending inwards, taking the shape of a spoon. This is a strong indication of iron-deficiency anaemia (IDA). The rest of the patient’s symptoms further indicate IDA.
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This question is part of the following fields:
- The Skin
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Question 15
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A young woman is concerned that she has put on weight since she was a medical student, as she now no longer finds time to exercise. She decides to try various weight loss tablets temporarily.
After 2 months, she is successfully losing weight but also has trouble with increased stool frequency, difficulty in climbing stairs and getting up out of chairs. However, she has no problems walking on the flat.
She also has difficulty in sleeping at the moment but puts that down to the increased frequency of headaches for the past 2 months.
Which one of the following is the most likely cause of her weakness?Your Answer: She is abusing thyroxine tablets
Explanation:Exogenous thyroid hormone use has been associated with episodes of thyroid storm as well as thyrotoxic periodic paralysis.
It presents with marked proximal muscle weakness in both upper and lower limbs, hypokalaemia and signs of hyperthyroidism.
Hyperthyroidism generally presents with tachycardia, hypertension, hyperthermia, and cardiac arrhythmiasLaxatives and diuretics can result in electrolyte abnormalities.
Medical complications associated with laxatives include chronic diarrhoea which disrupts the normal stool electrolyte concentrations that then leads to serum electrolyte shifts; acutely, hypokalaemia is most typically seen. The large intestine suffers nerve damage from the chronic laxative use that renders it unable to function properly. The normal peristalsis and conduction are affected; the disorder is thought to be secondary to a degeneration of Auerbach’s Plexi. However, it does not cause muscle weakness.Insulin tends to cause weight gain, not weight loss.
Metformin does not cause muscle weakness but can cause headaches. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 16
Correct
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A 57-year-old diabetic, smoker complains of non-healing ulcers and cramp-like pain in the calves relieved by rest. Examination results are as follows: absent distal pulses, and cold extremities with hair loss around the ankles. What is the most probable diagnosis?
Your Answer: Chronic ischemia of the limbs
Explanation:Chronic Limb Ischaemia presents with calf pain that is relieved by rest.
Intermittent claudication is not a diagnosis but a symptom and is not necessarily associated with diabetes.
Buerger’s disease occurs in younger heavy smokers (usually before age of 50).
DVT causes pain that is consistent, not intermittent as in claudication. -
This question is part of the following fields:
- Musculoskeletal System
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Question 17
Incorrect
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A 45-year-old male who is a heavy alcoholic was admitted with loss of memory, hallucinations and difficulty walking. On examination, he had an ataxic gait. He was given Acamprosate. Which one of the following can be given with the above drug?
Your Answer: Disulfiram
Correct Answer: Thiamine
Explanation:Wernicke’s encephalopathy is characterised by the triad of ophthalmoplegia, ataxia, and confusion. It must be viewed as a medical emergency with rapid correction of thiamine deficiency as the goal of therapy. Acamprosate is a medication used to treat alcohol dependence by stabilizing chemical signalling in the brain that would otherwise be disrupted by alcohol withdrawal
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This question is part of the following fields:
- Nervous System
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Question 18
Correct
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In a patient with type-1 diabetes mellitus, which cells when affected, lead to insulin deficiency?
Your Answer: B cells of the pancreatic islets
Explanation:Insulin is produced by the beta-cells in the islets of Langerhans in the pancreas while Glucagon is secreted from the alpha cells of the pancreatic islets of Langerhans.
Type 1 diabetes mellitus is the culmination of lymphocytic infiltration and destruction of the beta cells of the islets of Langerhans in the pancreas. As beta-cell mass declines, insulin secretion decreases until the available insulin is no longer adequate to maintain normal blood glucose levels. After 80-90% of the beta cells are destroyed, hyperglycaemia develops and diabetes may be diagnosed. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 19
Incorrect
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Following a road traffic accident, a gentleman is brought to A&E. He is found to have oliguria and diagnosed with acute renal tubular necrosis.
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What is the most common complication and cause of death in this condition?Your Answer: Electrolyte abnormalities
Correct Answer: Infection
Explanation:In patients with acute renal tubular necrosis, infection in the form of gram-negative septicaemia is the most common cause of death, especially while the patient is awaiting spontaneous recovery of their renal function.
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This question is part of the following fields:
- Renal System
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Question 20
Correct
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A 32-year-old asthmatic woman presents with an acute attack. Her arterial blood gases breathing air are as follows:
pH 7.31
pO2 9.6 kPa
pCO2 5.1 kPa
What do these results signify?Your Answer: Her respiratory effort may be failing because she is getting tired
Explanation:In any patient with asthma, a decreasing PaO2 and an increasing PaCO2, even into the normal range, indicates severe airway obstruction that is leading to respiratory muscle fatigue and patient exhaustion.
Chest tightness and cough, which are the most common symptoms of asthma, are probably the result of inflammation, mucus plugs, oedema, or smooth muscle constriction in the small peripheral airways. Because major obstruction of the peripheral airways can occur without recognizable increases of airway resistance or FEV1, the physiologic alterations in acute exacerbations are generally subtle in the early stages. Poorly ventilated alveoli subtending obstructed bronchioles continue to be perfused, and as a consequence, the P(A-a)O2 increases and the PaO2 decreases. At this stage, ventilation is generally increased, with excessive elimination of carbon dioxide and respiratory alkalemia.
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This question is part of the following fields:
- Respiratory System
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Question 21
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 22
Incorrect
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A 34-year-old male presented with exertional dyspnoea and chest pain for the past 2 weeks. On examination there was a mid-systolic murmur which is best heard at the apex and double apical impulse. His ECG showed left ventricular hypertrophy (LVH). What is the risk factor which would be most indicative of the potential for sudden death in this patient?
Your Answer: Asymmetrical septal hypertrophy
Correct Answer: Degree of left ventricular hypertrophy
Explanation:The history is suggestive of hypertrophic obstructive cardiac myopathy. The degree of left ventricular hypertrophy is strongly associated with sudden cardiac death.
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This question is part of the following fields:
- Cardiovascular System
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Question 23
Correct
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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
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:
- Nervous System
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Question 24
Incorrect
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A 4-year-old child was brought in by his mother with complaints of vesicular eruption over his palms, soles and oral mucosa for the last 5 days. He was slightly febrile. There were no other signs. The most likely causative organism in this case would be?
Your Answer: Rubella
Correct Answer: Coxsackie
Explanation:This patient is most likely suffering from hand, foot mouth disease which is caused by coxsackie virus A16. Its incubation period ranges from 5-7 days and only symptomatic treatment is required.
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This question is part of the following fields:
- The Skin
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Question 25
Correct
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A 13-year-old patient presents in the A&E with a fracture of his left femur. He was a passenger in a car involved in a traffic accident. Upon clinical examination, his left posterior tibial and dorsalis pedis arteries are not palpable. Which of the following is most probably injured?
Your Answer: Femoral artery
Explanation:The femoral artery is the one accompanying the femoral shaft, being the most important blood supplier of the leg. Femoral artery injury during a femur shaft fracture is quite common as a result of blunt trauma.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 26
Correct
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A 25-year-old male presents at the OPD complaining of excessive tiredness and frequent headaches. On examination, his blood pressure was 205/100 mmHg. Blood tests reveal a decreased serum potassium and renin level and elevated aldosterone level. Which condition is this patient most likely suffering from?
Your Answer: Primary hyperaldosteronism (Conn's disease)
Explanation:Conn’s disease is a condition in which excessive amounts of aldosterone are secreted from the adrenal glands. Because aldosterone increases the reabsorption of sodium, it leads to a very high blood pressure.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 27
Correct
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Bicuspid aortic valve is in association with which of the following.
Your Answer: Coarctation of the aorta
Explanation:Bicuspid aortic valve is the most common congenital cardiovascular anomaly, occurring in 1-2% of the population. Coarctation and bicuspid aortic valve occur more frequently in males with a prevalence of approximately 4:1. A high prevalence of these same cardiovascular lesions is also found in women with Turner’s syndrome.
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This question is part of the following fields:
- Cardiovascular System
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Question 28
Correct
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A 36-year-old man is being investigated for recurrent gastric and duodenal ulceration diagnosed at endoscopy. He has suffered from bouts of abdominal pain and intermittent diarrhoea although his weight is stable.
Some of his investigations are outlined below.
Basal acid secretion 20 mEq/h (1-5)
Fasting gastrin 200 pg/ml (<100)
Secretin test:
Basal gastrin 200 pg/ml
Post-secretin 500 pg/ml
Which of the following are responsible for the elevated gastrin levels?Your Answer: Gastrinoma
Explanation:This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. The secretin test is a test that can differentiate gastrinoma from other causes of high gastrin levels. Gastrin will rise after secretin injection if the patient has a gastrinoma.
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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 57-year-old homeless man presents with fever and a productive cough which has green sputum with streaks of blood. A chest x-ray reveals consolidation in the right upper lobe with evidence of cavitation. He is a known alcoholic.
What is the most likely causative agent?Your Answer: Klebsiella Pneumoniae
Explanation:Infection with Klebsiella organisms occurs in the lungs, where they cause destructive changes. Necrosis, inflammation, and haemorrhage occur within lung tissue, sometimes producing a thick, bloody, mucoid sputum described as currant jelly sputum.
The illness typically affects middle-aged and older men with debilitating diseases such as alcoholism, diabetes, or chronic bronchopulmonary disease. An increased tendency exists toward abscess formation, cavitation, empyema, and pleural adhesions. -
This question is part of the following fields:
- Respiratory System
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Question 30
Correct
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A 68-year-old man who has chronic obstructive pulmonary disease (COPD) is reviewed. On examination, there is evidence of cor pulmonale with a significant degree of pedal oedema. His FEV1 is 44%. During a recent hospital stay his pO2 on room air was 7.4 kPa.
Which one of the following interventions is most likely to increase survival in this patient?Your Answer: Long-term oxygen therapy
Explanation:Assess the need for oxygen therapy in people with:
– very severe airflow obstruction (FEV1 below 30% predicted)
– cyanosis (blue tint to skin)
– polycythaemia
– peripheral oedema (swelling)
– a raised jugular venous pressure
– oxygen saturations of 92% or less breathing air.Also consider assessment for people with severe airflow obstruction (FEV1 30-49% predicted).
Consider long-term oxygen therapy for people with COPD who do not smoke and who:
have a partial pressure of oxygen in arterial blood (PaO2) below 7.3 kPa when stable or have a PaO2 above 7.3 and below 8 kPa when stable, if they also have 1 or more of the following:
– secondary polycythaemia
– peripheral oedema
– pulmonary hypertension. -
This question is part of the following fields:
- Respiratory System
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SESSION STATS - PERFORMANCE PER SPECIALTY
