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Question 1
Correct
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A 52-year-old female who was a smoker, with a history of asymptomatic atrial septal defect (ASD) presented with difficulty in breathing on exertion and ankle oedema for the past 2 weeks. She has defaulted on her follow up for ASD. On examination she was cyanosed and clubbing was noted. Her pulse rate was 92 and blood pressure was 100/60 mmHg. Echocardiography revealed a dilated right ventricle of the heart. The right ventricular pressure was 90 mmHg. Significant tricuspid and pulmonary regurgitation were also noted. Which of the following is the most probable diagnosis?
Your Answer: Eisenmenger's syndrome
Explanation:According to echocardiography findings pulmonary pressure is closer to systemic blood pressure and it is evidence of pulmonary hypertension. Because of the reversal of shunt due to pulmonary hypertension, cyanosis and clubbing have developed. So the most probable diagnosis is Eisenmenger’s syndrome.
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This question is part of the following fields:
- Cardiovascular System
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Question 2
Correct
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A 53-year-old cashier with a history of chronic back pain presents for a check-up. He is aware of a dragging feeling affecting his left foot when he tries to walk. This has developed since a minor injury to his left knee. On examination, he has weakness of dorsiflexion and eversion of the left foot. The right is unaffected and plantar flexion and inversion are normal on the left. MRI of the spinal cord shows degenerative disc changes at multiple levels, but no evidence of cord or nerve root impingement. Nerve conduction studies and EMG results are pending. Which of the following sensory loss patterns would you expect to find in association with this motor defect?
Your Answer: Sensory loss over the dorsum of the foot and anterolateral leg
Explanation:This patient presentation is unlikely to be an L5 nerve root lesion given the results of the MRI scan. Therefore, the most likely diagnosis is a mononeuritis affecting the left common peroneal nerve. This would lead to sensory loss over the dorsum of the foot and anterolateral leg on the left.
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This question is part of the following fields:
- Nervous System
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Question 3
Incorrect
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A 17-year-old girl presented with fever, headache and photophobia. Cerebrospinal fluid examination reveals:
Opening pressure 260 mm H20 (50-180)
Total protein 0.8 g/l (0.15-0.45)
Glucose 4.2 mmol/l (3.3-4.4)
White cell count 60 per ml (<5)
Lymphocytes 90%
Plasma glucose 6.4 mmol/l (3.0-6.0)
Which of the following is the most likely diagnosis?Your Answer: Tuberculosis meningitis
Correct Answer: Viral meningitis
Explanation:Normal cerebrospinal fluid (CSF) glucose together with lymphocytosis, an increased opening pressure and raised CSF protein are typical of a viral meningitis.
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This question is part of the following fields:
- Nervous System
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Question 4
Correct
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A 62-year-old female with a history of COPD and hypertension presents with pain on swallowing. Current medication includes a salbutamol and becotide inhaler, bendrofluazide and amlodipine. What is the most likely cause of the presentation?
Your Answer: Oesophageal candidiasis
Explanation:The history gives you a woman who is on inhaled steroid therapy. It is always a good idea for patients to rinse their mouths well after using inhaled steroids. Odynophagia (pain on swallowing) is a symptom of oesophageal candidiasis, which is the most likely answer given the steroids. Typically, you might see this in someone who is immunocompromised (classically, in HIV+ patients).
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This question is part of the following fields:
- Gastrointestinal System
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Question 5
Correct
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A 47-year-old man with a history of alcohol induced liver disease is admitted to the gastroenterology ward. He has developed tense ascites again and a plan is made to site an ascitic drain. His renal function after 2 days is as follows:
Na+ 131 mmol/l
K+ 3.8 mmol/l
Urea 12.2 mmol/l
Creatinine 205 µmol/l
Which of the following pathophysiological changes is most likely to be responsible for the declining renal function?Your Answer: Splanchnic vasodilation
Explanation:Hepatorenal syndrome is renal vasoconstriction that cannot overcome the effects of splanchnic vasodilation. Vasoactive mediators cause this splanchnic vasodilation, reducing SVR, which is sensed by the juxtaglomerular apparatus, activating the RAAS system, leading to renal vasoconstriction. However, the overall splanchnic vasodilation effect is greater than this renal vasoconstriction effect.
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This question is part of the following fields:
- Gastrointestinal System
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Question 6
Correct
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As the SHO of a hospital, you come across the lab report of a patient. It shows the following: glucose 4 mmol/L, K 5.2mmol/L, Na 129 mmol/L. How would you manage this patient?
Your Answer: Normal Saline 0.9%
Explanation:This patient’s blood glucose levels are within the normal range. From their lab report, they are suffering from milk hyperkalaemia and hypernatremia. Thus, normal saline 0.9 per cent is most appropriate in this case.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 7
Correct
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A 30-year-old previously well female presented with yellowish discolouration of her sclera. Investigations revealed low haemoglobin, a retic count of 8% and the occasional spherocyte on blood film. Which of the following is the most appropriate single investigation?
Your Answer: Direct coombs test
Explanation:A low haemoglobin and a high retic count is suggestive of a haemolytic anaemia. Occasional spherocytes can be seen on blood film during haemolysis and it is not a specific finding. Direct Coombs test will help to identify autoimmune haemolytic anaemia, where there are antibodies attached to RBCs.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 8
Correct
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Which of the following options is true of patients with oesophageal varices?
Your Answer: In spontaneous bacterial peritonitis cefotaxime appears to be a useful antibiotic
Explanation:Spironolactone has been shown to have no effect on the mechanisms of portal hypertension. Also, chronic use of propranolol can reduce the risk of variceal bleeding. The banding of large varices has been shown to be effective, too. Octreotide and terlipressin are also both used to prevent secondary haemorrhage. Cefotaxime is the most commonly used cephalosporin when treating spontaneous bacterial peritonitis. Spironolactone helps to combat secondary hyperaldosteronism which is related to liver failure. It also helps to treat salt and water retention, which both contribute to portal hypertension.
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This question is part of the following fields:
- Gastrointestinal System
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Question 9
Correct
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An 80-year-old woman with advanced COPD has been admitted to the medicine ward in an unconscious state. She appears to have an acute lower respiratory tract infection. After consulting with an anaesthesiologist it was concluded that she was not a candidate for intensive care unit admission and thus, a decision was made to start the patient on doxapram therapy. Which of the following best fits the characteristics of doxapram?
Your Answer: It is contraindicated in hyperthyroidism
Explanation:The two statements that fit the characteristics of doxapram are, epilepsy is a contraindication for doxapram use and concurrent use with theophylline may increase agitation.
Doxapram is a central respiratory stimulant. In clinical practice, doxapram is usually used for patients who have an acute exacerbation of chronic obstructive pulmonary disease (COPD) who are unsuitable for admission to the intensive therapy unit for ventilatory support. Doxapram infusion may buy an extra 24 h to allow for recovery.
Contraindications include: ischaemic heart disease, epilepsy, cerebral oedema, acute stroke, asthma, hypertension, hyperthyroidism, and pheochromocytoma.
The infusion may worsen agitation and dyspnoea and lead to hypertension, nausea, vomiting and urinary retention.Drug interactions:
Concomitant administration of doxapram and aminophylline (theophylline) can cause increased skeletal muscle activity, agitation, and hyperactivity. -
This question is part of the following fields:
- Geriatric Medicine
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Question 10
Incorrect
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The ECG of a 29-year-old female shows an irregular rhythm with a HR of 154 bpm. She presented complaining of heart palpitations and hot flashes for the past 4 days. What is the most likely treatment?
Your Answer: Flecainide
Correct Answer: Beta blockers
Explanation:At 29 years old, the most probable cause of this arrhythmia is thyrotoxicosis. β blockers relieve symptoms such as tachycardia, tremor, and anxiety in thyrotoxic patients. β blockade should be used as the primary treatment only in patients with thyrotoxicosis due to thyroiditis.
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This question is part of the following fields:
- Cardiovascular System
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Question 11
Correct
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A 50-year-old smoker with a history of hypertension presented with acute severe chest pain and acute myocardial infarction was diagnosed. Which of the following is a contraindication for thrombolysis?
Your Answer: History of likely ischaemic stroke within the past month
Explanation:Absolute contraindications for fibrinolytic use in STEMI
Prior intracranial haemorrhage (ICH)
Known structural cerebral vascular lesion
Known malignant intracranial neoplasm
Ischemic stroke within 3 months
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed head trauma or facial trauma within 3 months
Intracranial or intraspinal surgery within 2 months
Severe uncontrolled hypertension (unresponsive to emergency therapy)
For streptokinase, prior treatment within the previous 6 months -
This question is part of the following fields:
- Cardiovascular System
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Question 12
Correct
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A 30-year-old female went to her local doctor's surgery for a follow-up to a cervical smear test. The smear was sent to histology and was identified as CIN2. Choose the most appropriate management for this patient.
Your Answer: Refer for colposcopy
Explanation:Screening for cervical carcinoma helps to prevent the development of the disease. According to NICE, the screening interval using liquid-based cytology (as opposed to PAP) is 3 years for women less than 50 years old and 5 years for women over 50 years old. If a smear test is conducted and it shows no endocervical cells then it should be conducted again. This is because there was either inadequate preparation or sampling, or the sampling was done at the wrong point in the menstrual cycle. For severe dyskaryosis or carcinoma in situ, the patient needs treatment and should, therefore, be referred for a colposcopy. Clue cells are vaginal epithelial cells that are fuzzy (i.e.. without distinct edges) when looking at through a microscope. When bacterial vaginosis is present, over 20 per cent of the sample cells are clue cells. Bacterial vaginosis is treated with metronidazole therapy. Although trichomoniasis is treated with metronidazole too, the patient should be tested for other sexually transmitted diseases.
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This question is part of the following fields:
- Women's Health
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Question 13
Correct
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In a patient with Hashimoto's thyroiditis, which of the following is most specific to the disease?
Your Answer: Anti-thyroid peroxidase antibodies
Explanation:Hashimoto thyroiditis is part of the spectrum of autoimmune thyroid diseases (AITDs) and is characterized by the destruction of thyroid cells by various cell- and antibody mediated immune processes. It usually presents with hypothyroidism, insidious in onset, with signs and symptoms slowly progressing over months to years.
The diagnosis of Hashimoto thyroiditis relies on the demonstration of circulating antibodies to thyroid antigens (mainly thyroperoxidase and thyroglobulin) and reduced echogenicity on thyroid sonogram in a patient with proper clinical features.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 14
Correct
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A 27 year-old ballet instructor presents with 1-day history of left-sided facial weakness and an increased sensitivity to noise in her left ear. She is very anxious because 2 years ago she had some problems with her vision and was told that multiple sclerosis was a possibility. Her medical history is significant only for type 1 diabetes mellitus managed with insulin, and she is also taking a combined oral contraceptive pill. Upon examination, she has a lower motor neuron lesion of the left VII (facial) nerve with Bell's phenomenon present and difficulty closing her left eye. There is no objective hearing loss and no sensory signs. Examination of the auditory meatus and canal is unremarkable. The remainder of the neurological examination appears normal. The next management step in her care should be:
Your Answer: Eye patch and artificial tears
Explanation:From the given history and physical examination findings, this patient has Bell’s palsy. There is no evidence to suggest involvement of any other cranial nerves, which might raise suspicion of a cerebello-pontine angle space-occupying lesion. With her history of possible optic neuritis, there is a possibility that the lesion is in fact a manifestation of multiple sclerosis, although this should be differentiated by examination of an upper motor neuron lesion (with sparing of the forehead facial muscles because of bilateral innervation). In light of her diabetes and the limited evidence of benefit from corticosteroid use, the most sensible first management step for her would be meticulous eye care to avoid corneal ulceration, as a result of the difficulty she is having closing her left eye.
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This question is part of the following fields:
- Nervous System
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Question 15
Incorrect
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A 41-year-old yoga instructor presents with a 2-month history of left-hand weakness. She has no significant past medical history. On examination, there is mild weakness of the left upper and lower limbs with a right sided facial weakness, which spares the forehead. Which of the following is the most likely location of the lesion?
Your Answer: Right cerebrum
Correct Answer: Right pons
Explanation:The pons is above the level of decussation of the corticospinal tracts so a pontine lesion would cause a contralateral limb weakness.
The facial motor nucleus is located in the pons and supplies the ipsilateral facial muscles.
A right cerebral lesion would give left upper and lower limb weakness. It would also cause a left sided facial weakness.
A left cerebral lesion would give right upper and lower limb weakness with right facial weakness.
Finally, a cervical spinal cord lesion would not cause a facial weakness. -
This question is part of the following fields:
- Nervous System
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Question 16
Correct
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A 62-year-old man arrives at the clinic with a history of cough and intermittent haemoptysis for the last 3 months. He has a 50 pack year smoking history and is currently waiting for bronchoscopy to assess a left lower lobe collapse. The patient also has a marked muscle weakness and wasting of proximal muscles of his shoulders and pelvic girdle. His wife states that lately he has been unable to eat solids. Which of the following statements would be true regarding this scenario?
Your Answer: He may have a photosensitive facial rash
Explanation:The patient has presented with signs of small cell lung cancer. The associated proximal muscle weakness is most probably due to dermatomyositis which occurs as a paraneoplastic syndrome associated with lung carcinoma. In most cases, the first symptom is a distinctive skin rash on the face, eyelids, chest, nail cuticle areas, knuckles, knees or elbows. The rash is patchy and usually a bluish-purple colour. Corticosteroids are helpful in the management of the cutaneous changes and muscle weakness.
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This question is part of the following fields:
- Musculoskeletal System
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Question 17
Correct
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Out of the following, which malignant tumour has the highest predilection for dissemination to the bones?
Your Answer: Prostate
Explanation:Prostate cancer is the most common primary tumour that metastasises to the bone.
Most common tumours causing bone metastasis (in descending order):
1. Prostate (32%)
2. Breast (22%)
3. Kidneys (16%)
4. Lungs
5. ThyroidMost common sites of bone metastasis (in descending order):
1. Spine
2. Pelvis
3. Ribs
4. Skull
5. Long bones -
This question is part of the following fields:
- Haematology & Oncology
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Question 18
Incorrect
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A patient presented with complaints of difficulty in swallowing, diplopia on left lateral gaze and ptosis of his left eye. The investigation of choice would be?
Your Answer: CT head
Correct Answer: Serum anti-acetylcholine receptor antibodies
Explanation:Myasthenia gravis clinically manifests with ptosis, diplopia and difficulty in swallowing. The initial investigation which is needed to confirm the diagnosis would be serum anti-acetylene receptor antibodies, after which other investigations like an EMG should be done.
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This question is part of the following fields:
- Nervous System
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Question 19
Correct
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All of the following statements regarding iron metabolism are correct EXCEPT?
Your Answer: In iron deficiency anaemia total iron binding capacity and transferrin saturation will both be decreased
Explanation:Iron deficiency anaemia is characterised by decreased iron stores, however there is increased iron binding capacity. Transferrin is the iron transporting protein. Because of the decreased presence of iron in blood, the transferrin saturation is decreased. Ferritin is an iron storage protein that is affected according to the iron stores but its also an acute phase reactant and levels can be effected by other conditions. Each unit of packed RBCs transfused to an adult contains 200 ml of RBCs and 200mg of iron. Only 5-10% of dietary iron is absorbed in the portal circulation which can be increased by the intake of vitamin C, animal foods and amino acids.
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This question is part of the following fields:
- Gastrointestinal System
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Question 20
Correct
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A 52-year-old woman with polycystic kidney disease and a slowly rising creatinine, which was 320 μmol/L at her last clinic visit 3 weeks ago, is brought into the Emergency Department having been found collapsed at home by her partner. She is now fully conscious but complains of a headache.
Â
What is the most likely diagnosis?Your Answer: Subarachnoid haemorrhage
Explanation:One of the most important complications in patients with PKD is being affected by berry aneurysms that may burst, causing a subarachnoid haemorrhage, which seems to be the case in this patient.
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This question is part of the following fields:
- Renal System
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Question 21
Correct
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Which one of the following is most suggestive of Wilson's disease?
Your Answer: Reduced serum caeruloplasmin
Explanation:In Wilson’s disease, serum caeruloplasmin is decreased. Skin pigmentation is not increased, but may become jaundiced. 24 hour urine copper excretion is increased. Hepatic copper concentration is increased. Serum copper level is also increased. Key point: high copper. Remember Kayser-Fleisher rings for the eyes in Wilson’s disease.
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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 62-year-old male patient with long standing COPD presented with reduced vision of his right eye. He had been on multiple medications. Which of the following drugs is responsible for his visual deterioration?
Your Answer: Theophylline
Correct Answer: Corticosteroid
Explanation:Prolonged use of corticosteroids causes cataracts and this would be the reason for his presentation. B2 agonists, diuretics and Theophylline can cause blurred vision.
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This question is part of the following fields:
- Pharmacology
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Question 23
Incorrect
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Psoriatic arthropathy most commonly presents with which of the following types of arthritis?
Your Answer: Arthritis mutilans
Correct Answer: Peripheral asymmetric oligoarthropathy
Explanation:Most patients with psoriatic arthritis present with monoarthritis or asymmetric oligoarthritis. The most common form of the disease is the one involving a few joints of the peripheral skeleton with a distinct asymmetry of symptoms. Involvement of the smaller joints of the hands and feet, especially distal interphalangeal joints, seems to be a characteristic feature. Arthritis mutilans is a rare and severe complication of psoriatic arthritis.
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This question is part of the following fields:
- Musculoskeletal System
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Question 24
Incorrect
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A 30-year-old woman is referred to endocrinology with thyrotoxicosis. Following a discussion of management options, she chooses to have radioiodine therapy. Which one of the following is the most likely adverse effect?
Your Answer: Precipitation of thyroid eye disease
Correct Answer: Hypothyroidism
Explanation:Approximately one third of patients treated with radioiodine therapy develop transient hypothyroidism. Unless a patient is highly symptomatic, thyroxine replacement may be withheld if hypothyroidism occurs within the first 2 months of therapy. If it persists for longer than 2 months, permanent hypothyroidism is likely and replacement with T4 should be initiated.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 25
Correct
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From the following responses, what is the commonest cardiovascular abnormality associated with Marfan's syndrome of an adult?
Your Answer: Aortic root dilatation
Explanation:The main cardiovascular manifestations associated with Marfan’s syndrome are aortic dilatation and mitral valve prolapse.
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This question is part of the following fields:
- Cardiovascular System
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Question 26
Incorrect
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In an emergency bowel procedure, which among these antibiotics are indicated during anaesthetic induction?
Your Answer: Ceftriaxone
Correct Answer: Metronidazole
Explanation:Antibiotic prophylaxis is utilized to avert infection and is based on the degree of contamination involved in the surgical procedure. Operations where the wound is contained with minimal risk of contamination, antibiotic prophylaxis is questionable. In this case there is a high risk of contamination.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 27
Correct
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Which of the following is most consistent with congenital adrenal hyperplasia (CAH)?
Your Answer: Premature epiphyseal closure
Explanation:Exposure to excessive androgens is usually accompanied by premature epiphyseal maturation and closure, resulting in a final adult height that is typically significantly below that expected from parental heights.
congenital adrenal hyperplasia (CAH) is associated with precocious puberty caused by long term exposure to androgens, which activate the hypothalamic-pituitary-gonadal axis. Similarly, CAH is associated with hyperpigmentation and hyperreninemia due to sodium loss and hypovolaemia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 28
Incorrect
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Around 30 patients have been admitted to the hospital following a suspected chemical attack in the city. The patients are extremely unwell, with symptoms of excessive salivation, lacrimation, diarrhoea, and emesis. Sarin gas was suspected as the most likely agent used in the attack. What is the mechanism of action of this chemical agent?
Your Answer: Anti-cholinergic
Correct Answer: Inhibition of acetylcholinesterase
Explanation:Sarin acts by inhibiting acetylcholinesterase.
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase. This results in high levels of acetylcholine (ACh).The effects of excessive ACh can be remembered by the mnemonic DUMBELLS:
Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea/Bradycardia
Emesis
Lacrimation
Salivation/sweatingOrganophosphate insecticide poisoning:
One of the effects of organophosphate poisoning is inhibition of acetylcholinesterase
Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
miosis, muscle fasciculation.Organophosphate poisoning is treated with the anti-muscarinic atropine.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 29
Incorrect
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Which of the following types of reactions are a part of the phase II metabolism of a drug?
Your Answer:
Correct Answer: Conjugation
Explanation:Drug metabolism can be broadly classified into:
Phase I (functionalization) reactions: also termed non-synthetic reactions, they include oxidation, reduction, hydrolysis, cyclization and de-cyclization. The most common and vital reactions are oxidation reactions. (Of the given enzymes only Alcohol dehydrogenase is involved in phase I drug metabolism. Succinate dehydrogenase, is a vital enzyme involved in the Kreb’s cycle and the mitochondrial electron transport chain). They are mainly catalysed by Cytochrome P-450 enzyme.Phase II (conjugation) reactions: occur following phase I reactions, they include reactions: glucuronidation and sulphate conjugation, etc. They are mostly catalysed by UDP-glucuronosyltransferase enzyme. Other phase II enzymes include: sulfotransferases, N-acetyltransferases, glutathione S-transferases and methyltransferases.
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This question is part of the following fields:
- Pharmacology
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Question 30
Incorrect
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A 45-year-old woman has been diagnosed with T1N1M1 malignancy in the left breast, with metastases detectable in the lower thoracic vertebrae and the left lung. Before the initiation of treatment of this patient with trastuzumab, which is the most important investigation to perform?
Your Answer:
Correct Answer: Echo
Explanation:Before the initiation of trastuzumab, an echocardiography is a must to rule out any pre-existing cardiac abnormalities as trastuzumab is cardiotoxic.
Trastuzumab (Herceptin) is a monoclonal antibody directed against the HER2/neu receptor. It is used mainly in metastatic breast cancer although some patients with early disease are now also given trastuzumab.
Adverse effects include:
Flu-like symptoms and diarrhoea are common.
Cardiotoxicity:
– Risk increases when anthracyclines are used concomitantly.
– Trastuzumab-induced cardiac dysfunctions are regarded as less severe and largely reversible because primary cardiomyocyte do not show ultrastructure changes unlike those associated with anthracycline-induced cardiotoxicity.
– Primary myocyte injury does not occur in patients who were treated with trastuzumab. -
This question is part of the following fields:
- Women's Health
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Question 31
Incorrect
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A 32-year-old male who is a known case of sickle cell disease presents to the Accident and Emergency (A&E) department with fever, tachypnoea, and rib pain. On examination, he has a low-grade fever of 37.9°C, oxygen saturation of 95% on air, and bilateral vesicular breath sounds on chest auscultation. CXR shows opacification in the right middle zone.
Which of these statements most accurately describes the initial management of this patient?Your Answer:
Correct Answer: Incentive spirometry is indicated
Explanation:This is a typical picture of acute chest syndrome (ACS). According to the British Committee for Standards in Haematology (BCSH), ACS is defined as ‘an acute illness characterised by fever and/or respiratory symptoms, accompanied by a new pulmonary infiltrate on chest X-ray’. ACS occurs in sequestration crisis, which is one of the four main types of crises occurring in sickle cell disease.
The fundamentals of initial management are as follows:
1. Oxygen therapy to maintain saturation >95%
2. Intravenous fluids to ensure euvolemia
3. Adequate pain relief
4. Incentive spirometry in all patients presenting with rib or chest pain
5. Antibiotics with cover for atypical organisms
6. Bronchodilators if asthma co-exists with acute chest syndrome, or if there is an evidence of acute bronchospasm on auscultation
7. Early consultation with the critical care team and haematology departmentA senior haematologist then makes a decision as to whether a simple or exchange transfusion is necessary in order to achieve a target Hb of 10.0-11.0g/dL in either instance.
Sickle Cell Crises:
Sickle cell anaemia is characterised by periods of good health with intervening crises:
1. Sequestration crisis: acute chest syndrome (i.e. fever, dyspnoea, chest/rib pain, low pO2, and pulmonary infiltrates)2. Thrombotic (painful or vaso-occlusive) crisis: precipitated by infection, dehydration, and deoxygenation
3. Aplastic crisis: sudden fall in haemoglobin without marked reticulocytosis, usually occurring secondary to parvovirus infection
4. Haemolytic crisis: fall in haemoglobin secondary to haemolysis, rare type of sickle cell crises
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This question is part of the following fields:
- Haematology & Oncology
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Question 32
Incorrect
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A 50-year-old known patient with chronic liver cell disease was admitted complaining of unsteadiness and double vision following an episode of heavy alcohol consumption. On examination, he was confused. there was nystagmus and ataxia. What is the most possible cause for this presentation?
Your Answer:
Correct Answer: Wernicke's encephalopathy
Explanation:Wernicke’s encephalopathy is a neurological disorder induced by thiamine deficiency and presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion. As alcohol affects thiamine uptake and utilization, thiamine deficiency is usually associated with chronic alcoholism.
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This question is part of the following fields:
- Nervous System
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Question 33
Incorrect
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Where is the site of action of spironolactone?
Your Answer:
Correct Answer: Distal convoluted tubule
Explanation:Spironolactone is an aldosterone antagonist which acts in the distal convoluted tubule. It is a potassium-sparing diuretic that prevents the body from absorbing too much salt and keeps the potassium levels from getting too low. Spironolactone is used to treat heart failure, high blood pressure (hypertension), or hypokalaemia (low potassium levels in the blood).
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This question is part of the following fields:
- Pharmacology
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Question 34
Incorrect
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Which of the following statements is the most characteristic of primary Raynaud's phenomenon?
Your Answer:
Correct Answer: Fingers are symmetrically involved during an attack
Explanation:A typical attack may last less than an hour but can also persist for longer. In primary Raynaud’s, attacks are more likely symmetric, episodic, and without evidence of peripheral vascular disease. Patients more commonly have a negative ANA and normal inflammatory markers. There should be no evidence of tissue gangrene, digital pitting, or tissue injury in primary Raynaud’s. In contrast, patients with secondary Raynaud’s will describe attacks that are more frequent, painful, often asymmetric and may lead to digital ulcerations.
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This question is part of the following fields:
- Musculoskeletal System
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Question 35
Incorrect
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A 25-year-old male had an emergency appendicectomy. His doctor prescribed him prophylactic antibiotics to avoid infection after the surgery. Which of the following antibiotics is the best choice for post abdominal surgery?
Your Answer:
Correct Answer: Cefuroxime
Explanation:Cefuroxime is the best choice in the case of gut surgery as it is very effective in preventing infections against gut anaerobes, enterococci and coliforms.
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This question is part of the following fields:
- Gastrointestinal System
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Question 36
Incorrect
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A 19-year-old lady with established anorexia nervosa is admitted with a BMI of 16. However, she gives the consent to be fed by a nasogastric tube. Which of the following electrolyte disturbances are you most likely to find?
Your Answer:
Correct Answer: Hypophosphataemia
Explanation:Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 37
Incorrect
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A 40-year old male presented to the OPD with a history of difficulty swallowing and blood-stained vomit. History of weight loss is also present. The abdominal X-ray was normal. Which of the following should be done next?
Your Answer:
Correct Answer: Oesophagogastroduodenoscopy
Explanation:An esophagogastroduodenoscopy (OGD) should be ordered to visualize and identify the source of bleeding. This procedure can harvest tissue samples for histological analysis and can also treat varices that may be causing the bleeding.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 38
Incorrect
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A 61-year-old male presented to the emergency with renal colicky pain and a subsequent passage of stone the next day. Radiological examination, however, revealed no signs of calculi. The renal calculus was most likely composed of which of the following?
Your Answer:
Correct Answer: Uric acid
Explanation:Calcium-containing stones are relatively radio dense, and they can often be detected by a traditional radiograph of the abdomen that includes the kidneys, ureters, and bladder (KUB film). Some 60% of all renal stones are radiopaque. In general, calcium phosphate stones have the greatest density, followed by calcium oxalate and magnesium ammonium phosphate stones. Cystine calculi are only faintly radio dense, while uric acid stones are usually entirely radiolucent.
Uric acid is the relatively water-insoluble end product of purine nucleotide metabolism. It poses a special problem because of its limited solubility, particularly in the acidic environment of the distal nephron of the kidney. It is problematic because humans do not possess the enzyme uricase, which converts uric acid into the more soluble compound allantoin. Three forms of kidney disease have been attributed to excess uric acid: acute uric acid nephropathy, chronic urate nephropathy, and uric acid nephrolithiasis. These disorders share the common element of excess uric acid or urate deposition, although the clinical features vary.
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This question is part of the following fields:
- Renal System
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Question 39
Incorrect
-
A 50-year-old patient was admitted to the hospital for elective herniorrhaphy. Which of the following options will lead to a postponement of his operation?
Your Answer:
Correct Answer: Myocardial infarction two months ago
Explanation:Patients with a recent cerebrovascular incident (less than 60 days) are at very high risk of cardiac complications when under general anaesthesia. Complications like MI, heart failure and even death. Elective surgery should be postponed till stabilization of the cardiac condition is achieved.
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This question is part of the following fields:
- Cardiovascular System
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Question 40
Incorrect
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All of the following are associated with yellow nail syndrome except:
Your Answer:
Correct Answer: Cardiomegaly
Explanation:Yellow nail syndrome is a very rare medical syndrome that includes pleural effusions, lymphedema (due to under development of the lymphatic vessels) and yellow dystrophic nails. Approximately 40% will also have bronchiectasis. It is also associated with chronic sinusitis and persistent coughing and it usually affects adults.
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This question is part of the following fields:
- The Skin
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Question 41
Incorrect
-
A 80-year-old male patient with ischaemic heart disease, hypertension and dyslipidemia presented with productive cough, fever with chills and loss of appetite for 4 days. On examination he was unwell and febrile with a temperature of 38.3. His blood pressure was 130/80 mmHg and pulse rate was 140 bpm. Respiratory rate was 18 breaths per minute. On auscultation there were crepitations over the left lower zone of his chest. His abdomen was soft and nontender. ECG showed an irregular narrow complex tachycardia. Which of the following is the most appropriate acute management to treat his tachycardia?
Your Answer:
Correct Answer: Antibiotics
Explanation:The most likely diagnosis is acute atrial fibrillation (AF) precipitated by acute pneumonia. History of fever, cough and the auscultation findings support it. So the most appropriate management is treating the pneumonia with antibiotics. Treating the underlying cause will reduce the heart rate. Other responses are helpful in the management of chronic AF.
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This question is part of the following fields:
- Cardiovascular System
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Question 42
Incorrect
-
A 51-year-old man speaks fast and does not take enough breaths before speaking again. He ignores interruptions and does not want to pause in between. What best describes this kind of speech?
Your Answer:
Correct Answer: Pressure of speech
Explanation:A pressured speech is too fast for the listener to understand and is very difficult to interrupt.
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This question is part of the following fields:
- Nervous System
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Question 43
Incorrect
-
A 44-year-old alcoholic man was operated on for a strangulated abdominal hernia, however a few days after the operation he became agitated. According to the patient, he used to see snakes curling over his body. O/E he was agitated, tachycardiac and confused. The most likely diagnosis would be?
Your Answer:
Correct Answer: Delirium tremens
Explanation:Delirium tremens occurs due to alcohol withdrawal and presents clinically with hallucinations, agitations, confusion and hyperthermia. Wernicke’s encephalopathy is characterised by encephalopathy, oculomotor dysfunction and ataxic gait. In Korsakoff’s syndrome, there is marked short term memory loss, however the long term memory is preserved & the sensorium is also intact.
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This question is part of the following fields:
- Nervous System
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Question 44
Incorrect
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A 60-year-old man with atrial fibrillation (AF) who is on warfarin and is awaiting tooth extraction. Recent INR was 2.7 and his target INR was 2.0-3.0. Which of the following is the most appropriate management?
Your Answer:
Correct Answer:
Explanation:The latest reserches say that simple tooth extraction in patients on warfarin treatment can be performed safely without high risk of bleeding, providing that the INR is equal to or less than 3.5 on the day of extraction. A close follow-up and monitoring of patients taking warfarin is mandatory after dental extraction.
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This question is part of the following fields:
- Cardiovascular System
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Question 45
Incorrect
-
A 14 year-old is brought to the ED after being hit on the head with a cricket ball during a match. His teacher describes that he initially collapsed on the ground and complained of a sore head. Two minutes later, he got up and said he felt OK and continued playing. However, 30 minutes later he suddenly collapsed and lost consciousness. What injury is he most likely to have sustained?
Your Answer:
Correct Answer: Extradural haematoma
Explanation:A lucid interval, in which the patient portrays a temporary improvement in condition after a traumatic brain injury, is especially indicative of an epidural haematoma.
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This question is part of the following fields:
- Nervous System
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Question 46
Incorrect
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A young alcoholic male patient presented at hospital with complaints of tachycardia and palpitations for the past few hours. During examination, his blood pressure and ECG were normal. What would be the next step in management of this patient?
Your Answer:
Correct Answer: Reassure and life Style modification
Explanation:Normal blood pressure and ECG rule out any pathological cause of the complaints described in this scenario. These symptoms are most probably due to anxiety or effects of alcohol intake. Lifestyle modification will be the best management plan along with reassurance to calm the patient.
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This question is part of the following fields:
- Cardiovascular System
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Question 47
Incorrect
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Which one of the following features is most helpful in distinguishing beta thalassaemia trait from iron deficiency anaemia?
Your Answer:
Correct Answer: Haemoglobin A2 levels
Explanation:Elevated haemoglobin A2 level is seen in beta thalassaemia trait, whereas, it is typically low in iron deficiency anaemia unless the patient has received a recent blood transfusion.
Low mean corpuscular volume (MCV) and reduced haematocrit (Ht) are encountered in both conditions. Peripheral blood smear is grossly abnormal in both beta thalassaemia and severe iron deficiency anaemia, showing bizarre morphology, target cells, and a small number of nucleated red blood cells.
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This question is part of the following fields:
- Haematology & Oncology
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Question 48
Incorrect
-
A 69-year-old diabetic female presents for a regular outpatient visit. Her BMI is calculated to be 33. Lab results: GFR=29, Urea=13, Creatinine=390 mmol/L. Which of the following drugs should ideally be used by this patient?
Your Answer:
Correct Answer: Insulin
Explanation:The management of patients with diabetes and nephropathy necessitates attention to several aspects of care. Importantly, glycaemic control should be optimized for the patient, attaining the necessary control to reduce complications but done in a safe, monitored manner. Screening for development of nephropathy should be performed on a regular basis to identify microalbuminuria or reductions in GFR and if identified, the diabetes regimen should be tailored accordingly. Prevention and treatment of diabetic nephropathy and other complications necessitates a multifactorial approach. From the options provided insulin is the most suitable as sulfonylureas and biguanides are contraindicated in renal failure. Glitazones are known to cause many side effects including fluid retention and oedema. Hence, insulin will be the best option in this scenario.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 49
Incorrect
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A 71-year-old female presents with a pansystolic murmur. History reveals a myocardial infarction which manifested three days ago. What is the most likely cause of the murmur?
Your Answer:
Correct Answer: Rupture of papillary muscle
Explanation:A pan-systolic murmur is the result of mitral regurgitation. Mitral regurgitation in this case is most probably due to post-MI rupture of the papillary muscle of the mitral valve.
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This question is part of the following fields:
- Cardiovascular System
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Question 50
Incorrect
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From the options provided below, which intervention plays the greatest role in increasing survival in patients with COPD?
Your Answer:
Correct Answer: Smoking cessation
Explanation:Smoking cessation is the most effective intervention in stopping the progression of COPD, as well as increasing survival and reducing morbidity. This is why smoking cessation should be the top priority in the treatment of COPD. Long term oxygen therapy (LTOT) may increase survival in hypoxic patients. The rest of the options dilate airways, reduce inflammation and thereby improve symptoms but do not necessarily increase survival.
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This question is part of the following fields:
- Respiratory System
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Question 51
Incorrect
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A 23-year-old male presents with a history of lower back pain for the last one year. Presence of which of the following features most likely points towards ankylosing spondylitis?
Your Answer:
Correct Answer: Bilateral erosion of sacroiliac joints on X-ray
Explanation:Bilateral erosions of the sacroiliac joints on pelvic radiographs of patients with ankylosing spondylitis are an important feature of the modified New York classification criteria. Although HLA-B27 is commonly associated with AS, it can also be found in normal individuals. Back stiffness is worse in the morning and gets better as the day progresses. Tenderness and limited lumbar motion can be associated with other spine problems as well and is not characteristic of rheumatoid arthritis.
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This question is part of the following fields:
- Musculoskeletal System
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Question 52
Incorrect
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A 75-year-old woman presented with difficulty in climbing the stairs and difficulty in holding her head up, for the past 6 months. She didn't have any significant joint pain. Her creatinine phosphokinase level was very high and ESR was normal. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Polymyositis
Explanation:Polymyositis is an idiopathic inflammatory myopathy characterized by symmetrical, proximal muscle weakness, elevated skeletal muscle enzyme levels and characteristic electromyography (EMG) and muscle biopsy findings. Weak neck extensors cause difficulty holding the head up. Pain is not a significant symptom, which differentiates it from arthritic conditions. ESR is elevated in only 50% of patients with polymyositis.
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This question is part of the following fields:
- Musculoskeletal System
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Question 53
Incorrect
-
In a patient with cardiomyopathy, which one of the following statements would be aetiologically significant?
Your Answer:
Correct Answer: The presence of diabetes mellitus in a tanned patient
Explanation:Hemochromatosis is a condition that leads to abnormal iron deposition in specific organs. There are two main types: primary (hereditary) and secondary (e.g., transfusion-related). The most common form is hereditary autosomal recessive hemochromatosis type 1, which is caused by an underlying genetic defect that results in partially uninhibited absorption of iron in the small intestine.
Hemochromatosis is mostly asymptomatic but can become symptomatic, usually between the third and fifth decade of life, when poisonous levels of iron have had time to accumulate in the body. Symptoms include fatigue, hyperpigmentation, diabetes mellitus (bronze diabetes), and arthralgia. The deposits may lead to various organ diseases, the most typical being the development of liver cirrhosis, which is accompanied by an increased risk of hepatocellular carcinoma (HCC). Serum ferritin and transferrin saturation levels are typically elevated. Molecular genetic testing or a liver biopsy may be used to confirm the diagnosis. Treatment primarily consists of repeated phlebotomy to reduce iron levels. In addition, dietary changes and drug therapy (chelating agents such as deferoxamine) may be used to influence the amount of iron in the body. -
This question is part of the following fields:
- Cardiovascular System
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Question 54
Incorrect
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A 55-year-old woman complains of weight gain, hoarseness of voice, constipation, and muscle weakness 1 month after undergoing thyroid surgery. On examination, her face is puffy. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Hypothyroidism
Explanation:All the symptoms this patient is suffering from are the classic features of a hypothyroid state.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 55
Incorrect
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A 31-year-old homosexual male is complaining of recent weight loss and blurred vision. A fundoscope was performed showing retinal haemorrhage. What is the single most appropriate option?
Your Answer:
Correct Answer: Cytomegalovirus (CMV)
Explanation:CMV is the best answer . Weight loss is mostly caused by HIV, which commonly presents with retinal haemorrhage and retinopathy when associated with CMV.
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This question is part of the following fields:
- Infectious Diseases
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Question 56
Incorrect
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Which of the following peripheral neuropathy inducing clinical diagnoses is predominantly associated with sensory loss?
Your Answer:
Correct Answer: Uraemia
Explanation:Diseases that cause predominantly sensory loss include diabetes, uraemia, leprosy, alcoholism, vitamin B12 deficiency, and amyloidosis.
Those that cause predominantly motor loss include Guillain-Barre syndrome, porphyria, lead poisoning, hereditary sensorimotor neuropathies, chronic inflammatory demyelinating polyneuropathy, and diphtheria. -
This question is part of the following fields:
- Nervous System
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Question 57
Incorrect
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A 32-year-old primigravida in her 37th week of pregnancy was admitted for the management of pre-eclampsia. Her blood pressure was 180/110 mmHg and urine protein was +++. Magnesium sulphate was started. Which of the following are important parameters that should be monitored during the administration of magnesium sulphate?
Your Answer:
Correct Answer: Reflexes + respiratory rate
Explanation:The clinical effect and toxicity of MgSO4 can be linked to its concentration in plasma. A concentration of 1.8 to 3.0 mmol/L has been suggested for treatment of eclamptic convulsions. Maternal toxicity is rare when MgSO4 is carefully administered and monitored. The first warning of impending toxicity in the mother is loss of the patellar reflex at plasma concentrations between 3.5 and 5 mmol/L. Respiratory paralysis occurs at 5 to 6.5 mmol/L. Cardiac conduction is altered at greater than 7.5 mmol/L, and cardiac arrest can be expected when concentrations of magnesium exceed 12.5 mmol/L. Careful attention to the monitoring guidelines can prevent toxicity. Deep tendon reflexes, respiratory rate, urine output and serum concentrations are the most commonly monitored parameters.
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This question is part of the following fields:
- Cardiovascular System
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Question 58
Incorrect
-
A 65-year-male patient was started on warfarin for chronic atrial fibrillation (AF). Which of the following clotting factors is not affected by warfarin?
Your Answer:
Correct Answer: Factor XII
Explanation:Carboxylation of factor II, VII, IX, X and protein C is affected by warfarin. Factor XII is not affected.
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This question is part of the following fields:
- Cardiovascular System
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Question 59
Incorrect
-
A number of tests have been ordered for a 49-year-old male who has systemic lupus erythematosus (SLE). He was referred to the clinic because he has increased shortness of breath. One test in particular is transfer factor of the lung for carbon monoxide (TLCO), which is elevated. Which respiratory complication of SLE is associated with this finding?
Your Answer:
Correct Answer: Alveolar haemorrhage
Explanation:Alveolar haemorrhage (AH) is a rare, but serious manifestation of SLE. It may occur early or late in disease evolution. Extrapulmonary disease may be minimal and may be masked in patients who are already receiving immunosuppressants for other symptoms of SLE.
DLCO or TLCO (diffusing capacity or transfer factor of the lung for carbon monoxide (CO)) is the extent to which oxygen passes from the air sacs of the lungs into the blood.
Factors that can increase the DLCO include polycythaemia, asthma (can also have normal DLCO) and increased pulmonary blood volume as occurs in exercise. Other factors are left to right intracardiac shunting, mild left heart failure (increased blood volume) and alveolar haemorrhage (increased blood available for which CO does not have to cross a barrier to enter). -
This question is part of the following fields:
- Respiratory System
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Question 60
Incorrect
-
A 35-year-old woman under treatment for long-term epilepsy with valproate presented with complaints of excessive weight gain. She is consuming oral contraceptive pills.
Which among the following is the best alternative to valproate for treating long-term epilepsy?Your Answer:
Correct Answer: Lamotrigine
Explanation:Among the given anti-epileptics the best drug that can be given in this patient is lamotrigine.
Topiramate, carbamazepine, phenytoin, and phenobarbital are all hepatic enzyme inducers and are associated with decreased effectiveness of the oral contraceptive (OCP) due to acceleration of the metabolism of oestrogens and progestogens.
If she is planning on pregnancy then registry studies suggest that lamotrigine would also be the best choice.
Other hepatic enzyme inducers include rifampicin, spironolactone, griseofulvin, etc. -
This question is part of the following fields:
- Pharmacology
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Question 61
Incorrect
-
A 40-year-old man has had multiple blood transfusions for sideroblastic anaemia. However, this time, 15 minutes into the blood transfusion, he complains of severe breathlessness. CXR shows diffuse bilateral pulmonary infiltrates.
What is the most likely diagnosis?Your Answer:
Correct Answer: Transfusion-related acute lung injury (TRALI)
Explanation:Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion characterised by the acute onset of non-cardiogenic pulmonary oedema following transfusion of blood products.
TRALI is a more severe manifestation of the febrile non-haemolytic group of transfusion reactions and usually occur in patients who have had multiple previous transfusions. TRALI is related to leucocyte antibodies which are present in the plasma of the blood donor. Multiparous women are the highest-risk donors for TRALI.
For management, leucocyte-depleted blood is now used for transfusion and this is associated with a reduced risk of this type of transfusion reaction.
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This question is part of the following fields:
- Haematology & Oncology
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Question 62
Incorrect
-
A 32-year-old female presented with a lump in the upper outer quadrant of her left breast, which is 1.5cm in size and tender. What is the initial investigation to be done?
Your Answer:
Correct Answer: Ultrasound
Explanation:Tenderness is usually suggestive of a benign breast mass such as a breast abscess. Ultrasound is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage.
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This question is part of the following fields:
- Women's Health
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Question 63
Incorrect
-
A 3 month old infant born to HIV positive mother presented with jaundice, epileptic seizures and microcephaly. The most likely cause will be?
Your Answer:
Correct Answer: Cytomegalovirus
Explanation:Congenital cytomegalovirus infection causes; jaundice, hepatosplenomegaly, petechia, microcephaly, hearing loss and seizures.
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This question is part of the following fields:
- Infectious Diseases
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Question 64
Incorrect
-
A 65-year-old man with a history of type 2 diabetes comes to the clinic for review. His HbA1c is elevated at 64 mmol/mol despite taking 1g of metformin BD. On examination, his blood pressure is 142/88 mmHg, his pulse is 82 beats per minute and regular. His BMI is 33 kg/m². A decision is made to start him on dapagliflozin. Which of the following would you expect on starting therapy?
Your Answer:
Correct Answer: Increased total cholesterol
Explanation:Dapagliflozin works by inhibiting sodium glucose cotransporter 2 (SGLT2) and blocking resorption of glucose in the kidney, leading to an increase in urinary glucose excretion and lowering of both plasma glucose levels and body weight.
All studies with SGLT2 inhibitors have found significant reductions in BP, with greater reductions seen in systolic (1.66 to 6.9mmHg) than diastolic (0.88 to 3.5mmHg) BP.
While some trials have shown no change in lipid parameters, others have shown a modest but statistically significant increase in both HDL and LDL cholesterol with no effect on triglycerides or the LDL/HDL ratio. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 65
Incorrect
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Question 66
Incorrect
-
A 65-year-old male patient is found to have an elevated serum paraprotein level of 35 g/L. Bone marrow aspirate reveals 32% monoclonal plasma cell infiltrate. He has no evidence of anaemia, renal impairment, hypercalcaemia, or lytic lesions.
What should be the next step in management?Your Answer:
Correct Answer: Observe and monitor
Explanation:The patient is asymptomatic but matches the diagnostic criteria for multiple myeloma (MM). Therefore, the underlying diagnosis of this condition is smouldering multiple myeloma (SMM). SMM is an early precursor to MM. Its treatment is typically to watch and wait.
MM is a neoplasm of the bone marrow plasma cells. Peak incidence is in patients aged 60-70 years.
Clinical features of MM include:
1. Ostealgia, osteoporosis, pathological fractures (typically vertebral), and osteolytic lesions
2. Lethargy
3. Infections
4. Hypercalcaemia
5. Renal failure
6. Other features: amyloidosis e.g. macroglossia, carpal tunnel syndrome; neuropathy; hyperviscosityDiagnosis of MM is based on the confirmation of (a) one major criterion and one minor criterion or (b) three minor criteria in an individual who has signs or symptoms of multiple myeloma.
Major criteria:
1. >30% plasma cells on bone marrow biopsy
2. Monoclonal band of paraprotein on electrophoresis: >35g/L for IgG, 20g/L for IgA, or >1g of light chains excreted in the urine per dayMinor criteria:
1. 10-30% plasma cells on bone marrow biopsy
2. Abnormal monoclonal band but levels less than listed above
3. Lytic bone lesions observed radiographically
4. Immunosuppression -
This question is part of the following fields:
- Haematology & Oncology
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Question 67
Incorrect
-
A patient presents with occasionally severe retrosternal chest pain and dysphagia for both solids and liquids. What would be the best management option if the barium swallow showed a dilated oesophagus which tapers to a fine distal end?
Your Answer:
Correct Answer: Dilatation of the LES
Explanation:Dysphagia for both solids and liquids indicates either obstruction or impaired oesophageal peristalsis which is usually due to neuromuscular causes such as achalasia. Achalasia is the failure of smooth muscle fibres to relax, which can cause the lower oesophageal sphincter to remain closed. The lower part of the oesophagus is more narrow than normal and presents as a birds beak appearance on barium swallow. If dysphagia was present only on solid food consumption, a benign or malignant tumour must be suspected.
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This question is part of the following fields:
- Gastrointestinal System
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Question 68
Incorrect
-
A 73-year-old woman presents with severe emphysema. She is on maximal therapy including high dose Seretide and tiotropium. She tells you that she is so unwell that she can barely manage the walk the 160 metres to the bus stop.
Â
On examination she looks short of breath at rest. Her BP is 158/74 mmHg, pulse is 76 and regular. There are quiet breath sounds, occasional coarse crackles and wheeze on auscultation of the chest.
Â
Investigations show:
Â
Haemoglobin 14.2 g/dl (13.5-17.7)
White cell count 8.4 x 109/l (4-11)
Platelets 300 x 109/l (150-400)
Sodium 137 mmol/l (135-146)
Potassium 4.1 mmol/l (3.5-5)
Creatinine 127 micromol/l (79-118)
pH 7.4 (7.35-7.45)
pCO2 7.5 kPa (4.8-6.1)
pO2 9.7 kPa (10-13.3)
Chest x-ray - Prominent upper lobe emphysema.
FEV1 - 30% of predicted.
Â
Which of the features of her history, examination or investigations would preclude referral for lung reduction surgery?Your Answer:
Correct Answer: pCO2 7.4
Explanation:Nice guidelines for lung reduction surgery:
FEV1 > 20% predicted
PaCO2 < 7.3 kPa
TLco > 20% predicted
Upper lobe predominant emphysemaThis patient has pCO2 of 7.4 so she is unsuitable for referral for lung reduction surgery.
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This question is part of the following fields:
- Respiratory System
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Question 69
Incorrect
-
A 63-year-old gentleman with chronic kidney disease secondary to diabetes mellitus is reviewed. When assessing his estimated glomerular filtration rate (eGFR), which one of the following variables is not required by the Modification of Diet in Renal Disease (MDRD) equation?
Your Answer:
Correct Answer: Serum urea
Explanation:A formula for estimating glomerular filtration rate (eGFR) is the Modification Diet of Renal Disease (MDRD) equation which takes into account the following variables: serum creatinine, age, gender, and ethnicity. Thus, serum urea is not required in this formula.
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This question is part of the following fields:
- Renal System
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Question 70
Incorrect
-
Which of the following medications is a long acting adrenergic beta-receptor agonist?
Your Answer:
Correct Answer: Formoterol
Explanation:Terbutaline is a long acting beta receptor agonist. It is used as an add on drug for step 3 in treatment of bronchial asthma. It causes relaxation of bronchial smooth muscles and thus, bronchodilatation.
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This question is part of the following fields:
- Pharmacology
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Question 71
Incorrect
-
A 21-year-old male presented in the OPD with a testicular mass. During examination, the mass was found to be painless and 2.5cm in diameter. The surface is irregular and non-transilluminating. What is the most likely diagnosis?
Your Answer:
Correct Answer: Teratoma
Explanation:The age group of the patient (20 to 30 years) is indicative of teratoma. It is also painless and non-transilluminating.
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This question is part of the following fields:
- Men's Health
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Question 72
Incorrect
-
A 25-year-old patient with no prior medical history is admitted unconscious. Which should be done as an initial investigation?
Your Answer:
Correct Answer: Blood glucose
Explanation:The patient’s blood glucose should be evaluated in order to rule out a reversible diabetic come due to high or low blood glucose.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 73
Incorrect
-
A 50-year-old woman diagnosed with non-Hodgkin's Lymphoma is about to be started on the CHOP regimen (cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone). Her pre-chemotherapy blood investigations show:
Hb: 11.8 g/dl
Platelets: 423 x 109/l
WBC: 11.2 x 109/l
Na+: 143 mmol/l
K+: 3.9 mmol/l
Urea: 6.2 mmol/l
Creatinine: 78 μmol/l
Uric acid: 0.45 mmol/l
Ciprofloxacin is prescribed in addition to the CHOP regimen to reduce the risk of neutropenic sepsis. Which of the following drugs should be added to lower the risk of other complications?Your Answer:
Correct Answer: Allopurinol
Explanation: -
This question is part of the following fields:
- Haematology & Oncology
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Question 74
Incorrect
-
A 30-year-old woman is admitted for drainage of an abscess in her left forearm. She has revealed that she was regular heroin user and has stopped for the past few days. Clinical signs are pointing towards opioid withdrawal. What is the next step in managing this patient?
Your Answer:
Correct Answer: Give her 10 mg of methadone syrup and wait 60 min to determine its effect
Explanation:The next step in managing this patient is to give 10 mg and continue administering in 10 mg increments each hour until symptoms are under control.
Methadone alleviates opioid withdrawal symptoms and reduces cravings. Methadone is useful for detoxification from longer-acting opioids such as morphine or methadone itself.
Methadone should be used with caution if the patient has:
Respiratory deficiency
Acute alcohol dependence
Head injury
Treatment with monoamine oxidase inhibitors (MAOIs)
Ulcerating colitis or Crohn’s disease
Severe hepatic impairment
The dose must be reviewed on a daily basis and adjusted based upon how well the symptoms are controlled and the presence of side effects. The greater the dose of opioids used by the patient, the greater the dose of methadone required to control withdrawal symptoms.To avoid the risk of overdose in the first days of treatment The recommended dosing of methadone is 30mg in two doses of 15mg morning and evening.
It is important to note that a methadone dose equivalent to what the patient reports they are taking should never be given.
It is rare to need more than 40 mg per 24 hours: beware of overdosing which can lead to respiratory arrest. -
This question is part of the following fields:
- Pharmacology
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Question 75
Incorrect
-
A 50-year-old man is referred with impotence. He has a history of angina, hypertension and type 2 diabetes.
Which one of the following drugs that he takes is a contraindication to him being able to receive sildenafil?Your Answer:
Correct Answer: Isosorbide mononitrate
Explanation:Sildenafil administration to patients who are using organic nitrates, either regularly and/or intermittently, in any form is contraindicated.
Organic nitrates and nitric oxide (NO) donors exert their therapeutic effects on blood pressure and vascular smooth muscle by the same mechanism as endogenous NO via increasing cGMP concentrations. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 76
Incorrect
-
A 74-year-old widow is undergoing haemodialysis for chronic renal failure. What is the most common problem that can arise in this case?
Your Answer:
Correct Answer: Protein-calorie malnutrition
Explanation:Protein-calorie malnutrition is observed in almost 50% of dialysis patients, contributing to increased morbidity and mortality. All the other complications listed can usually be prevented thanks to modern-day dialysis techniques.
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This question is part of the following fields:
- Renal System
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Question 77
Incorrect
-
A 25-year-old woman is reviewed in clinic. She was previously treated with omeprazole, amoxicillin and clarithromycin for Helicobacter pylori (H. pylori). She remains on PPI therapy but continues to have epigastric discomfort. You suspect she has ongoing H. pylori infection and request a urea breath test to investigate this.
How long would the patient need to stop her PPI therapy before the urea breath test?Your Answer:
Correct Answer: 14 days
Explanation:PPI will affect the accuracy of the test. In general, most recommend discontinuing PPI therapy for 2 weeks prior to a urea breath test. PPI’s have an anti-H. pylori effect.
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This question is part of the following fields:
- Gastrointestinal System
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Question 78
Incorrect
-
A 23-year-old man visited the OPD with a complaint of pain in the abdomen and dark urine. His blood pressure was found to be elevated. Which of the following should be done next to reach a diagnosis?
Your Answer:
Correct Answer: US
Explanation:Hypertension along with haematuria give an indication of cystic kidneys which can be diagnosed with an ultrasound.
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This question is part of the following fields:
- Renal System
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Question 79
Incorrect
-
Which features may suggest malignant changes in a melanocytic naevi?
Your Answer:
Correct Answer: Decrease in size
Explanation:Melanocytic naevi are skin tumours produced by melanocytes. They usually present in childhood but increase during puberty. The mnemonic A-B-C-D, is used by institutions to assess for suspicion of malignancy. The letters stand for asymmetry, border, colour, and diameter. If a mole starts changing in size, colour, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include if it begins to crust over, bleed, itch, or become inflamed.
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This question is part of the following fields:
- The Skin
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Question 80
Incorrect
-
A 23-year-old man is referred to the pneumologist with a suspicion of bronchiectasis. History reveals he's been having recurrent pulmonary infections his whole life together with difficulties gaining weight. He's a non-smoker with a clear family history and he admits inhalers haven't helped him in the past. He is finally suspected of having cystic fibrosis. What is the normal function of the cystic fibrosis transmembrane regulator?
Your Answer:
Correct Answer: Chloride channel
Explanation: -
This question is part of the following fields:
- Respiratory System
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Question 81
Incorrect
-
A 60-year-old male presented with ventricular tachycardia which was successfully cardioverted. To check whether he had prolonged QT interval, which of the following is the most appropriate method to measure the QT interval in ECG?
Your Answer:
Correct Answer: Time between the start of the Q wave and the end of the T wave
Explanation:The QT interval is the time from the start of the Q wave to the end of the T wave. It represents the time taken for ventricular depolarisation and repolarisation. The QT interval should be measured in either lead II or V5-6.
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This question is part of the following fields:
- Cardiovascular System
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Question 82
Incorrect
-
A 32-year-old male with a history of smoking half a pack of cigarettes per day complains of worsening breathlessness on exertion. He was working as a salesman until a few months ago. His father passed away due to severe respiratory disease at a relatively young age. Routine blood examination reveals mild jaundice with bilirubin level of 90 µmol/l. AST and ALT are also raised. Chest X-ray reveals basal emphysema. Which of the following explanation is most likely the cause of these symptoms?
Your Answer:
Correct Answer: ?-1-Antitrypsin deficiency
Explanation:Alpha-1 antitrypsin deficiency is an inherited disorder that may cause lung and liver disease. The signs and symptoms of the condition and the age at which they appear vary among individuals. This would be the most likely option as it is the only disease that can affect both liver and lung functions.
People with alpha-1 antitrypsin deficiency usually develop the first signs and symptoms of lung disease between ages 20 and 50. The earliest symptoms are shortness of breath following mild activity, reduced ability to exercise, and wheezing. Other signs and symptoms can include unintentional weight loss, recurring respiratory infections, fatigue, and rapid heartbeat upon standing. Affected individuals often develop emphysema. Characteristic features of emphysema include difficulty breathing, a hacking cough, and a barrel-shaped chest. Smoking or exposure to tobacco smoke accelerates the appearance of emphysema symptoms and damage to the lungs.
About 10 percent of infants with alpha-1 antitrypsin deficiency develop liver disease, which often causes yellowing of the skin and sclera (jaundice). Approximately 15 percent of adults with alpha-1 antitrypsin deficiency develop liver damage (cirrhosis) due to the formation of scar tissue in the liver. Signs of cirrhosis include a swollen abdomen, swollen feet or legs, and jaundice. Individuals with alpha-1 antitrypsin deficiency are also at risk of developing hepatocellular carcinoma. -
This question is part of the following fields:
- Respiratory System
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Question 83
Incorrect
-
Which area in the body controls the hypoxic drive to breathe?
Your Answer:
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 84
Incorrect
-
A 25-year-old previously well female, in her 10th week of pregnancy presented with a left sided painful calf swelling. An ultrasound scan revealed deep venous thrombosis (DVT) of her left leg. Which of the following is the most appropriate management of this patient?
Your Answer:
Correct Answer: Initiate and then continue treatment with heparin until delivery
Explanation:Warfarin is contraindicated during pregnancy due to its teratogenic effects. She should be given heparin throughout her pregnancy. It can be converted to warfarin if necessary after the delivery.
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This question is part of the following fields:
- Cardiovascular System
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Question 85
Incorrect
-
A patient complaining of nocturnal cough and wheeze is investigated for asthma. Which of the following tests would be most useful in aiding the diagnosis?
Your Answer:
Correct Answer: ANCA
Explanation:Churg-Strauss disease (CSD) is one of three important fibrinoid, necrotizing, inflammatory leukocytoclastic systemic small-vessel vasculitides that are associated with antineutrophil cytoplasm antibodies (ANCAs).
The first (prodromal) phase of Churg-Strauss disease (CSD) consists of asthma usually in association with other typical allergic features, which may include eosinophilia. During the second phase, the eosinophilia is characteristic (see below) and ANCAs with perinuclear staining pattern (pANCAs) are detected. The treatment would therefore be different from asthma. For most patients, especially those patients with evidence of active vasculitis, treatment with corticosteroids and immunosuppressive agents (cyclophosphamide) is considered first-line therapy -
This question is part of the following fields:
- Respiratory System
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Question 86
Incorrect
-
A 45-year-old female has presented to her doctor with rotational vertigo, nausea, and vomiting (especially when she moves her head). She had a similar incident 2 years ago. It is noted that these vertigo episodes follow a runny nose, cough, cold, and a fever. Given the symptoms, what is the most likely diagnosis for the patient?
Your Answer:
Correct Answer: Vestibular neuritis
Explanation:In this patient, there is no sensorineural hearing loss (which is often present in Meniere’s disease, labyrinthitis, and acoustic neuroma). Additionally, a runny nose, cold, cough, and fever are all recognised as triggers of vestibular neuritis (but not BPPV).
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This question is part of the following fields:
- Nervous System
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Question 87
Incorrect
-
A 51-year-old real estate agent takes hydrocortisone 20mg in the mornings and 5mg at night for Addison's disease. The endocrinology consultant would like her to take prednisolone instead.
What dose of prednisolone should be started?Your Answer:
Correct Answer: 7 mg
Explanation:1mg Prednisolone = 4mg hydrocortisone, so the actual equivalent daily dose is 7mg.
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This question is part of the following fields:
- Pharmacology
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Question 88
Incorrect
-
Causes of dilated pupils include which of the following?
Your Answer:
Correct Answer: Ethylene glycol poisoning
Explanation:Ethylene glycol poisoning is the only poison listed that will cause dilation of the pupils whereas all the other listed conditions and poisons will present with small pupils other than in the case of Myotonic dystrophy wherein the patient will present with a cortical cataract.
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This question is part of the following fields:
- Nervous System
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Question 89
Incorrect
-
According to the Vaughan Williams classification of antiarrhythmic agents, lidocaine is a:
Your Answer:
Correct Answer: Class Ib agent
Explanation:Lidocaine is an example of class IB antiarrhythmics.
The Vaughan-Williams classification of antiarrhythmics
I: Membrane stabilizing agents
IA: Quinidine, Procainamide, Disopyramide
IB: Lidocaine, Mexiletine
IC: Propafenone, Flecainide
II: β blockers – Propranolol, Esmolol
III: Agents widening AP – Amiodarone, Dronedarone, Dofetilide, Ibutilide, Sotalol
IV: Calcium channel blockers – Verapamil, Diltiazem
V: Miscellaneous – Digoxin, adenosine, magnesium -
This question is part of the following fields:
- Pharmacology
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Question 90
Incorrect
-
Which of the following is the most common clinical feature of carbon monoxide poisoning?
Your Answer:
Correct Answer: Headache
Explanation:The symptoms and signs of carbon monoxide poisoning are variable and nonspecific. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and altered mental status.
The clinical presentation of CO poisoning is the result of its underlying systemic toxicity. Its effects are caused not only by impaired oxygen delivery but also by disrupting oxygen utilization and respiration at the cellular level, particularly in high-oxygen demand organs (i.e., heart and brain).
Symptoms of severe CO poisoning include malaise, shortness of breath, headache, nausea, chest pain, irritability, ataxia, altered mental status, other neurologic symptoms, loss of consciousness, coma, and death; signs include tachycardia, tachypnea, hypotension, various neurologic findings including impaired memory, cognitive and sensory disturbances; metabolic acidosis, arrhythmias, myocardial ischemia or infarction, and noncardiogenic pulmonary edema, although any organ system might be involved.
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This question is part of the following fields:
- Pharmacology
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Question 91
Incorrect
-
A case-control study is being designed to look at the relationship between eczema and a new vaccine for yellow fever. What is the usual outcome measure in a case-control study?
Your Answer:
Correct Answer: Odds ratio
Explanation:A case-control study (also known as case-referent study) is a type of observational study in which two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute. Case-control studies are often used to identify factors that may contribute to a medical condition by comparing subjects who have that condition/disease (the cases) with patients who do not have the condition/disease but are otherwise similar (the controls).
An odds ratio (OR) is a statistic that quantifies the strength of the association between two events, A and B. The odds ratio is defined as the ratio of the odds of A in the presence of B and the odds of A in the absence of B or vice versa. -
This question is part of the following fields:
- Evidence Based Medicine
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Question 92
Incorrect
-
A 66-year male with long standing diabetes was bed bound for a right femur fracture. Family members called for help as he developed a sudden onset dyspnoea. By the time help arrived, the patient had passed away. What is the most probable cause for his death?
Your Answer:
Correct Answer: Pulmonary embolism
Explanation:Prolonged immobilization could have caused deep vein thrombosis which ultimately resulted pulmonary embolism. Other causes are also possible but the most probable cause is acute pulmonary embolism.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 93
Incorrect
-
A 10-year-old gentleman is referred with a six month history of daily headache, which is mostly frontal in location and occasionally associated with nausea.
He has been taking paracetamol 3 g daily, aspirin 300 mg thrice daily, and codeine 40 mg thrice daily, all of which have had only a temporary effect. He has a two year history of depression treated with paroxetine. No abnormalities were found on examination.
What is the most likely diagnosis?Your Answer:
Correct Answer: Analgesic misuse headache
Explanation:Because of the patient’s history of chronic analgesic use of daily paracetamol intake, the most likely diagnosis of this case is Analgesic misuse headache. In these cases, the headache is only temporarily relieved by analgesics. Treatment involves gradual withdrawal of analgesics.
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This question is part of the following fields:
- Nervous System
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Question 94
Incorrect
-
A 53-year-old man is brought into the emergency department by the paramedics. He collapsed at home suffering from a myocardial infarction and was subsequently resuscitated following a cardiac arrest. Blood tests show impaired liver function (ALT 1400 u/l). He is on a statin, and at his appointment last week his LFT was normal. There is nothing to note on examination and he is currently not complaining of any pain.
Given this man's presentation, what is the most likely cause of his impaired liver function tests?Your Answer:
Correct Answer: Ischaemic hepatitis
Explanation:When you have abnormal liver function tests after a cardiac arrest, the most likely aetiology, barring history that is known or given excluding this diagnosis, would be ischemia. Chronic alcohol abuse would not see an acute elevation like this. Hepatitis B is just unlikely given the clinical picture, ischemia is much more likely. The same is for Budd-Chiari syndrome (venous thrombosis) and Wilson’s disease.
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This question is part of the following fields:
- Hepatobiliary System
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Question 95
Incorrect
-
A 72-year-old woman presents with a 3 month history of colicky abdominal pain after eating, and diarrhoea. She has lost 7 kg in weight over the last few months. A recent gastroscopy and colonoscopy were normal. Her past medical history includes angina and a right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan.
right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan.
Blood tests revealed:
Haemoglobin (Hb) 118 g/l
Mean corpuscular volume (MCV) 80 fl
White cell count (WCC) 12.3 x 109/l
Platelets 210 x 109/l
Na+ 133 mmol/l
K+ 5.2 mmol/l
Urea 8.1 mmol/l
Creatinine 134 mmol/l
Select the most appropriate further investigations.Your Answer:
Correct Answer: Contrast-enhanced computed tomography (CT) of the abdomen
Explanation:The patient is 74 years old. She has had a recent gastroscopy and colonoscopy. She has a history of angina and a right CEA. She is having colicky abdominal pain after meals and weight loss, which points to a possible diagnosis of chronic mesenteric ischemia. Thus, you would want to do a contrast-enhanced CT scan of the abdomen to look for this. A 24 hour cardiac monitor would also be helpful to look for any abnormal rhythm that could be a potential aetiology of her disease.
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This question is part of the following fields:
- Gastrointestinal System
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Question 96
Incorrect
-
A husband visits the clinic with his wife because he wants to be screened for cystic fibrosis. His brother and wife had a child with cystic fibrosis so he is concerned. His wife is currently 10 weeks pregnant. When screened, he was found to be a carrier of the DF508 mutation for cystic fibrosis but despite this result, the wife declines testing. What are the chances that she will have a child with cystic fibrosis, given that the gene frequency for this mutation in the general population is 1/20?
Your Answer:
Correct Answer: Jan-80
Explanation:The chance of two carriers of a recessive gene having a child that is homozygous for that disease (that is both genes are transmitted to the child) is 25%. Therefore, the chances of this couple having a child with CF are 25%(1/4) x 1/20 = 1/80.
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This question is part of the following fields:
- Respiratory System
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Question 97
Incorrect
-
An 80-year-old woman is admitted with a right lower lobe pneumonia. There is consolidation and a moderate sized pleural effusion on the same side. An ultrasound guided pleural fluid aspiration is performed. The appearance of the fluid is clear and is sent off for culture. Whilst awaiting the culture results, which one of the following is the most important factor when determining whether a chest tube should be placed?
Your Answer:
Correct Answer: pH of the pleural fluid
Explanation:In adult practice, biochemical analysis of pleural fluid plays an important part in the management of pleural effusions. Protein levels or Light’s criteria differentiate exudates from transudates, while infection is indicated by pleural acidosis associated with raised LDH and low glucose levels. In terms of treatment, the pH may even guide the need for tube drainage, suggested by pH <7.2 in an infected effusion, although the absolute protein values are of no value in determining the likelihood of spontaneous resolution or chest drain requirements. pH is therefore the most important factor.
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This question is part of the following fields:
- Respiratory System
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Question 98
Incorrect
-
A 18-year-old female is brought to the emergency department by her boyfriend. He is concerned that she may have taken an overdose of her mom's morphine sulphate pills after being depressed about her mother, who is dying of carcinoma of the breast.
Which of the following may point towards his suspicion?Your Answer:
Correct Answer: Sweating
Explanation:Excessive sweating points towards a morphine overdose.
Morphine is considered the classic opioid analgesic with which other painkillers are compared. Like other medications in this class, morphine has an affinity for delta, kappa, and mu-opioid receptors.
Most commonly used in pain management, morphine provides major relief to patients afflicted with pain.Among the more common adverse effects of morphine use is constipation. Other side effects include nausea, vomiting, drowsiness, and confusion. Psychological and physical dependence may occur.
Other side effects include bronchospasm, angioedema, urinary retention, ureteric or biliary spasm, dry mouth, sweating, rash, facial flushing, vertigo, tachycardia, bradycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood change, hallucinations, seizures (adults and children) and miosis, headache and allergic reactions (including anaphylaxis) and decreased libido or potency.
Raised intracranial pressure occurs in some patients. Muscle rigidity may occur with high doses. Elevated liver enzymes may occur due to biliary sphincter constriction. Large doses can lead to respiratory depression, circulatory failure, and coma.
Treatment of opioid overdose:
Initial treatment of overdose begins with supportive care.
Naloxone is a pure competitive antagonist of opiate receptors and has no agonistic activity. The drug is relatively safe and can be administered intravenous, intramuscular, subcutaneous or via the endotracheal tube.
Alternatively, nalmefene and naltrexone maybe considered. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 99
Incorrect
-
A 27-year-old woman presents with diarrhoea. She has had a previous ileal resection for Crohn's Disease. Her inflammatory markers are normal. What is the most likely cause of her diarrhoea?
Your Answer:
Correct Answer: Bile Acid Malabsorption
Explanation:The question describes a patient who has had an ileal resection. Bile acids are reabsorbed in the distal ileum. Since this has been resected in this patient, one would expect her to have malabsorption of bile acids, causing her diarrhoea. This is a more likely correct answer than a Crohn’s flare, bacterial overgrowth, gastroenteritis, or tropical sprue, given the details included in the question prompt.
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This question is part of the following fields:
- Gastrointestinal System
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Question 100
Incorrect
-
A 45-year-old male was discharged recently after treatment of bleeding peptic ulcers. 3 days after discharge he was readmitted complaining of acute severe chest pain for the past 1 hour. His ECG showed an acute ST elevation myocardial infarction. His FBC, blood urea, serum electrolytes and serum creatinine were within normal ranges. Faecal occult blood was negative. Which of the following is the most appropriate management for this patient?
Your Answer:
Correct Answer: Primary angioplasty
Explanation:The patient has a recent history of bleeding peptic ulcer disease, which is an absolute contraindication for thrombolysis. So he should be offered primary angioplasty.
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This question is part of the following fields:
- Cardiovascular System
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Question 101
Incorrect
-
A 25-year-old farmer presents with a fever, headache, malaise and neck stiffness. The first line empirical antibiotic is?
Your Answer:
Correct Answer: Ceftriaxone
Explanation:The most likely diagnosis is meningitis which requires admission and iv antibiotics. The drug of choice is a 3rd generation cephalosporin. In patients older than 55 , ampicillin cefotaxime combination is used.
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This question is part of the following fields:
- Nervous System
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Question 102
Incorrect
-
A phrenic nerve palsy is caused by which of the following?
Your Answer:
Correct Answer: Aortic aneurysm
Explanation:Phrenic nerve palsy causing hemidiaphragm paralysis is a very uncommon feature of thoracic aortic aneurysm.
Thoracic aortic aneurysms are usually asymptomatic however chest pain is most commonly reported symptom. Left hemidiaphragm paralysis, because of left phrenic nerve palsy, is a very rare presentation of thoracic aortic aneurysm.
Thoracic aortic aneurysm may present atypical symptoms such as dysphagia due to compression of the oesophagus; hoarseness due to vocal cord paralysis or compression of the recurrent laryngeal nerve; superior vena cava syndrome due to compression of the superior vena cava; cough, dyspnoea or both due to tracheal compression; haemoptysis due to rupture of the aneurysm into a bronchus; and shock due to rupture of the aneurysm.
Common causes of phrenic nerve palsy include malignancy such as bronchogenic carcinoma, as well as mediastinal and neck tumours. Phrenic nerve palsy can also occur due to a penetrating injury or due to iatrogenic causes arising, for example, during cardiac surgery and central venous catheterization. Many cases or phrenic nerve palsy are idiopathic. -
This question is part of the following fields:
- Respiratory System
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Question 103
Incorrect
-
A 23-year-old woman experiences visual disturbances and anxiety associated with sudden change in posture. She also has nausea, vomiting, and dizziness occasionally. What is the most likely diagnosis?
Your Answer:
Correct Answer: BPPV
Explanation:The most probable diagnosis is benign paroxysmal positional vertigo (BPPV). It is a peripheral vestibular disorder characterized by short episodes of mild to intense dizziness and influenced by specific changes in head position. BPPV is the most common cause of vertigo accounting for nearly one-half of patients with peripheral vestibular dysfunction. In order to establish the diagnosis, the head roll test is performed where the head is turned about 90° to each side while supine.
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This question is part of the following fields:
- Nervous System
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Question 104
Incorrect
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Question 105
Incorrect
-
A 60-year-old male was diagnosed with advanced intestinal carcinoma with metastasis. His doctor prescribed him NSAIDs and tramadol initially but his pain was not responding to it. Which of the following drugs is the most suitable alternative option?
Your Answer:
Correct Answer: Oramorph
Explanation:According to WHO, initial pain management for patients with malignancy involves NSAIDs and weak opioids. After their pain stops responding to them, stronger opioids such as oxycodone and morphine are prescribed.
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This question is part of the following fields:
- Pharmacology
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Question 106
Incorrect
-
A 50-year-old man is found incidentally to have hypercalcaemia during a routine health screen.
Which one of the following biochemical findings would be most suggestive of primary hyperparathyroidism rather than any other cause of hypercalcaemia?Your Answer:
Correct Answer: Serum PTH concentration within the normal range
Explanation:Primary hyperparathyroidism (PHPT) is diagnosed based upon levels of blood calcium and parathyroid hormone (PTH). In most people with PHPT, both levels are higher than normal. Occasionally, a person may have an elevated calcium level and a normal or minimally elevated PTH level. Since PTH should normally be low when calcium is elevated, a minimally elevated PTH is considered abnormal and indicates PHPT.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 107
Incorrect
-
A 53-year-old woman presents with upper GI haemorrhage. She has a history of rheumatoid arthritis for which she is managed with low dose prednisolone, diclofenac and codeine phosphate.
On examination in the Emergency ward her BP is 90/60 mmHg, pulse 100/min. You fluid resuscitate her and her BP improves to 115/80 mmHg, with a pulse of 80/min.
Investigations;
Hb 10.4 g/dl
WCC 6.1 x109/l
PLT 145 x109/l
Na+ 139 mmol/l
K+ 4.9 mmol/l
Creatinine 180 μmol/l
ECG - Lateral ST depression , Upper GI endoscopy reveals a large bleeding ulcer on the posterior aspect of the duodenum. It cannot be easily reached with the endoscope, and you decide to attempt embolization.
Which of the following is the artery that should be targeted?Your Answer:
Correct Answer: Posterior Superior Pancreaticoduodenal artery
Explanation:The most common location for a duodenal ulcer bleed is the posterior duodenum (remember: posterior bleeds, anterior perforates). The perfusion to this area is most specifically from the posterior superior pancreaticoduodenal artery.
The anterior superior pancreaticoduodenal artery supplies the anterior region. The gastroepiploic artery supplies mostly the stomach. The splenic artery goes, obviously, toward the spleen, in the other direction. The gastroduodenal artery is a branch of the celiac artery, and it’s branches are the anterior superior pancreaticoduodenal artery and posterior superior pancreaticoduodenal artery.
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This question is part of the following fields:
- Gastrointestinal System
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Question 108
Incorrect
-
Following a head injury, a 22-year-old patient develops polyuria and polydipsia. He is suspected to have cranial diabetes insipidus so he undergoes a water deprivation test.
Which one of the following responses would most indicate a positive (abnormal) result?Your Answer:
Correct Answer: Failure to concentrate the urine during water deprivation, but achievement of urine osmolality of 720 mmol/kg following the administration of desmopressin
Explanation:The water deprivation test (i.e., the Miller-Moses test), is a semiquantitative test to ensure adequate dehydration and maximal stimulation of ADH for diagnosis. It is typically performed in patients with more chronic forms of Diabetes Insipidus (DI). The extent of deprivation is usually limited by the patient’s thirst or by any significant drop in blood pressure or related clinical manifestation of dehydration.
In healthy individuals, water deprivation leads to a urinary osmolality that is 2-4 times greater than plasma osmolality. Additionally, in normal, healthy subjects, administration of ADH produces an increase of less than 9% in urinary osmolality. The time required to achieve maximal urinary concentration ranges from 4-18 hours.
In central and nephrogenic DI, urinary osmolality will be less than 300 mOsm/kg after water deprivation. After the administration of ADH, the osmolality will rise to more than 750 mOsm/kg in central DI but will not rise at all in nephrogenic DI. In primary polydipsia, urinary osmolality will be above 750 mOsm/kg after water deprivation.
A urinary osmolality that is 300-750 mOsm/kg after water deprivation and remains below 750 mOsm/kg after administration of ADH may be seen in partial central DI, partial nephrogenic DI, and primary polydipsia. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 109
Incorrect
-
A thin 18-year-old girl has bilateral parotid swelling with thickened calluses on the dorsum of her hand. What is the single most likely diagnosis?
Your Answer:
Correct Answer: Bulimia nervosa
Explanation:Bulimia nervosa is a condition in which a person is involved in binge eating and then purging. This patient has swollen parotid glands. The glands swell in order to increase saliva production so that the saliva lost in the vomiting is compensated. This patient also has thickened calluses on the back of her hand. This is known as Russell’s sign. This occurs because of putting fingers in the mouth again and again to induce the gag reflex and vomit. The knuckles get inflamed in the process after coming in contact with the teeth multiple times.
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This question is part of the following fields:
- Gastrointestinal System
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Question 110
Incorrect
-
Choose the molecule that acts as the co-receptor for cells expressing antigens linked with MHC class I molecules:
Your Answer:
Correct Answer: CD8
Explanation:CD8+ T cells recognize antigens in the form of short peptide fragments bound to major histocompatibility complex class I (MHCI) molecules on the target cell surface.1 Specific engagement of peptide-MHCI (pMHCI) complexes via the clonotypically expressed ?β T-cell receptor (TCR) triggers a range of effector functions that play a critical role in protective immunity against intracellular infections and various malignancies.
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This question is part of the following fields:
- Immune System
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Question 111
Incorrect
-
Which of the following is not associated with right axis deviation?
Your Answer:
Correct Answer: Wolf-Parkinson-White syndrome with right-sided accessory pathway
Explanation:Causes for right axis deviation:
-Right ventricular hypertrophy and Left posterior fascicular block
-Lateral myocardial infarction.
-Acute or chronic lung diseases: Pulmonary embolism, pulmonary hypertension, chronic obstructive pulmonary disease (COPD), cor pulmonale.
-Congenital heart disease (e.g., dextrocardia, secundum atrial septal defect).
-Wolff-Parkinson-White syndrome.
-Ventricular ectopic rhythms (e.g., ventricular tachycardia). -
This question is part of the following fields:
- Cardiovascular System
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Question 112
Incorrect
-
A 50-year-old female was examined after complaining of weak limbs. It was discovered she had burn marks on her fingers, diminished reflexes, and wasted and weak hands. Additionally, she has dissociated sensory loss and weak spastic legs. What is the diagnosis for this patient?
Your Answer:
Correct Answer: Syringomyelia
Explanation:All of the symptoms experienced by this patient are consistent with Syringomyelia. The sensory features are as follows: loss of temperature and pain sensation; sensory loss in the arms, shoulders, and upper body; touch, vibration, and position senses are affected in the feet as the syrinx enlarges into the dorsal column. Motor features are as follows: muscle wasting and weakness which begins in the hand, and moves onto the forearms and shoulders; loss of tendon reflexes. Autonomic involvement, such as the bladder and bowel, can occur.
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This question is part of the following fields:
- Nervous System
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Question 113
Incorrect
-
A 74-year-old man presents with a history of falls and enuresis. Recently his behaviour has been bizarre but the falling has persisted for the last 12 months. Upon examination he's found to be disorientated for time and place. His gait is clumsy and broad-based. What is the most likely diagnosis?
Your Answer:
Correct Answer: Normal pressure hydrocephalus
Explanation:The patient has a history of:
1 – Balance and gait disturbance – falls and broad based clumsy gait
2 – Dementia – strange behaviour and disorientation to time and place
3 – Urinary incontinence – episodes of enuresis.
All of the symptoms constitute the classic triad of normal pressure hydrocephalus. -
This question is part of the following fields:
- Nervous System
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Question 114
Incorrect
-
A middle aged male arrives at the clinic due to chest pain and productive cough. The temperature is recorded to be 38CÖ¯. Radiological examination reveals lobar consolidation and pleurisy. Which of the following would be the best management plan for this patient?
Your Answer:
Correct Answer: Amoxicillin
Explanation:The mainstay of drug therapy for bacterial pneumonia is antibiotic treatment. The choice of agent is based on the severity of the patient’s illness, host factors (e.g., comorbidity, age), and the presumed causative agent. Lobar pneumonia is frequently associated with pneumococcus and Hemophilus infection. Amoxicillin can be effectively used in such cases.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 115
Incorrect
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A 50-year-old doctor developed a fever of 40.2 °C which lasted for two days. He has had diarrhoea for a day, shortness of breath and dry cough.
His blood results reveal a hyponatraemia and deranged LFTs. His WBC count is 10.4 × 109/L and CX-ray shows bibasal consolidation.
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Which treatment would be the most effective for his condition?Your Answer:
Correct Answer: Clarithromycin
Explanation:Pneumonia is the predominant clinical manifestation of Legionnaires disease (LD). After an incubation period of 2-10 days, patients typically develop the following nonspecific symptoms:
Fever
Weakness
Fatigue
Malaise
Myalgia
ChillsRespiratory symptoms may not be present initially but develop as the disease progresses. Almost all patients develop a cough, which is initially dry and non-productive, but may become productive, with purulent sputum and, (in rare cases) haemoptysis. Patients may experience chest pain.
Common GI symptoms include diarrhoea (watery and non bloody), nausea, vomiting, and abdominal pain.Fever is typically present (98%). Temperatures exceeding 40°C occur in 20-60% of patients. Lung examination reveals rales and signs of consolidation late in the disease course.
Males are more than twice as likely as females to develop Legionnaires disease.
Age
Middle-aged and older adults have a high risk of developing Legionnaires disease while it is rare in young adults and children. Among children, more than one third of reported cases have occurred in infants younger than 1 year.Situations suggesting Legionella disease:
-Gram stains of respiratory samples revealing many polymorphonuclear leukocytes with few or no organisms-Hyponatremia
-Pneumonia with prominent extrapulmonary manifestations (e.g., diarrhoea, confusion, other neurologic symptoms)
Specific therapy includes antibiotics capable of achieving high intracellular concentrations (e.g., macrolides, quinolones, ketolides, tetracyclines, rifampicin).
Clarithromycin, a new macrolide antibiotic, is at least four times more active in vitro than erythromycin against Legionella pneumophila. In this study the safety and efficacy of orally administered clarithromycin (500 to 1,000 mg bid) in the treatment of Legionella pneumonia were evaluated.
Clarithromycin is a safe effective treatment for patients with severe chest infections due to Legionella pneumophila. -
This question is part of the following fields:
- Respiratory System
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Question 116
Incorrect
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A 23-year-old designer is requesting the combined oral contraceptive pill. During the history taking, she states that in the past she has had migraines with aura. She asks why the combined oral contraceptive pill is contraindicated. Which of the following is the most appropriate response?
Your Answer:
Correct Answer: Significantly increased risk of ischaemic stroke
Explanation:SIGN produced guidelines in 2008 on the management of migraines. Key points include that if patients have migraines with aura then the combined oral contraceptive (COC) is absolutely contraindicated due to an increased risk of stroke (relative risk 8.72).
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This question is part of the following fields:
- Nervous System
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Question 117
Incorrect
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A 50-year-old heavy drinker is brought to the A&E in a drowsy state. He is responding to questions however on examination he has nystagmus and hyper-reflexia. His MCV is 103fL.What is the most likely cause for his cognitive impairment?
Your Answer:
Correct Answer: B1 Deficiency
Explanation:Thiamine deficiency is very common with alcoholism. It manifests by Wernicke-Korsakoff encephalopathy. The patient is usually agitated, with an abnormal gait and amnesia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 118
Incorrect
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A young man complains of dyspnoea and tiredness. His blood film shows spherocytes and 6% reticulocytes. What test would you perform next?
Your Answer:
Correct Answer: Coomb's Test
Explanation:A Coomb’s test should be performed to test for autoimmune haemolytic anaemia. Spherocytes and reticulocytes in the blood film are indications for haemolytic anaemia.
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This question is part of the following fields:
- Haematology & Oncology
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Question 119
Incorrect
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A 23-year-old pregnant woman presents with glycosuria. What is the most likely mechanism?
Your Answer:
Correct Answer: Reduced renal reabsorption
Explanation:Throughout pregnancy the tubular reabsorption of glucose is less effective than in the non-pregnant state, this leads to glycosuria.
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This question is part of the following fields:
- Renal System
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Question 120
Incorrect
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A 60-year-old man with type 1 diabetes is brought to the clinic with his wife. He is limping and his wife noticed that his ankle was abnormally-shaped after he stepped out of the shower.
Examination of his right ankle reveals a painless warm swollen joint.
There is crepitus and what appears to be palpable bone debris. X-ray reveals gross joint destruction and apparent dislocation. Joint aspiration fluid shows no microbes.
Investigations:
His CRP and white count are of normal values.
Historical review of HB A1c reveals that it has rarely been below 9%.
What is the most likely diagnosis?Your Answer:
Correct Answer: Charcot's ankle
Explanation:Charcot arthropathy is a progressive condition of the musculoskeletal system that is characterized by joint dislocations, pathologic fractures, and debilitating deformities. It results in progressive destruction of bone and soft tissues at weight-bearing joints. In its most severe form, it may cause significant disruption of the bony architecture.
Charcot arthropathy can occur at any joint; however, it occurs most commonly in the lower extremity, at the foot and ankle. Diabetes is now considered to be the most common aetiology of Charcot arthropathy. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 121
Incorrect
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A 16-year-old woman presents with a 7 month history of secondary amenorrhoea and three months history of galactorrhoea. She has been otherwise well. She had menarche at the age of 12 and has otherwise had regular periods. She has been sexually active for approximately one year and has occasionally used condoms for contraception. She smokes five cigarettes daily and occasionally smokes cannabis.
On examination, she appears well, and clinically euthyroid, has a pulse of 70 bpm and blood pressure of 112/70 mmHg.
Investigations show:
Serum oestradiol 130 nmol/L (130-600)
Serum LH 4.5 mU/L (2-20)
Serum FSH 2.2 mU/L (2-20)
Serum prolactin 6340 mU/L (50-450)
Free T4 7.2 pmol/L (10-22)
TSH 2.2 mU/L (0.4-5.0)
What is the most likely diagnosis?Your Answer:
Correct Answer: Prolactinoma
Explanation:The patient has hyperprolactinaemia with otherwise normal oestradiol, FSH and LH. This is highly suggestive of Prolactinoma rather than a non functioning tumour.
In polycystic ovaries, there is increase in the level of LH while FSH is normal or low. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 122
Incorrect
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Which is the most likely lymph node involved in the presence of an ulcer on the scrotum?
Your Answer:
Correct 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:
- Men's Health
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Question 123
Incorrect
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A 35-year-old female with chronic pelvic pain, was recently diagnosed with PID. She was prescribed doxycycline. After 2 days she returned with complaints of abdominal bloating, nausea and regurgitation. Which of the following advice should be given to her?
Your Answer:
Correct Answer: Take Doxycycline after meals
Explanation:Doxycycline is known to cause dyspeptic symptoms. So advising to take Doxycycline after meals is important. Taking with meals or adding an antacid is not advised, as both will cause reduction in drug absorption.
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This question is part of the following fields:
- Pharmacology
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Question 124
Incorrect
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A 60-year-old male presented with complaints of chest pain, a productive cough, blood in the sputum, and night sweats. He also has a history of weight loss. His chest X-ray revealed multiple infiltrates. Which of the following is the most appropriate investigation to be done in this case?
Your Answer:
Correct Answer: Acid fast bacilli test for sputum
Explanation:All the symptoms of this patient are characteristic features of tuberculosis. The ideal test is the acid fast bacilli test for sputum, it will confirm the preserve of Mycobacterium Tuberculosis using the Ziehl-Nelson stain.
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This question is part of the following fields:
- Respiratory System
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Question 125
Incorrect
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A 48-year-old man presents with severe retrosternal pain, which was present for the past 40 minutes. ECG shows ST elevation and blood tests reveal high troponin levels. He has already been given oxygen, GTN and morphine. What is the next most appropriate step?
Your Answer:
Correct Answer: Percutaneous angiography
Explanation:The patient is experiencing an acute myocardial infarction and percutaneous angiography is the next most appropriate step in management. Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a nonsurgical technique for treating obstructive coronary artery disease, including unstable angina, acute myocardial infarction (MI), and multivessel coronary artery disease (CAD).
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This question is part of the following fields:
- Cardiovascular System
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Question 126
Incorrect
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A 4-year-old boy admitted with fever for 2 days had a left sided focal fits, which persisted for 4 minutes. There was no history of head injury. On examination, he was drowsy but there were no focal neurological signs. Urine dipstick was negative. What is the investigation of choice that can be done at this stage to arrive at a diagnosis?
Your Answer:
Correct Answer: CSF analysis
Explanation:This presentation could be due to either a meningitis or encephalitis, which are clinically not distinguishable from the given history. Encephalitis is mostly viral and in UK herpes simplex virus is the main cause. Advanced neuro imaging and EEG will help to differentiate them however from the given answers CSF analysis is the most appropriate, provided that intracranial pressure is not raised. CSF analysis will help to differentiate a pyogenic meningitis from other forms of meningitis and encephalitis.
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This question is part of the following fields:
- Infectious Diseases
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Question 127
Incorrect
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A 30-year-old female who was on chemotherapy developed a high-grade fever and productive cough over 2 days. On examination, there was evidence of a chest infection. Her WBC was 2100/ml. What is the most suitable treatment for this condition?
Your Answer:
Correct Answer: Piperacillin+tazobactam
Explanation:This patient has leukopenia following chemotherapy and she is more prone to severe bacterial infections. Neutropenic sepsis is common among cancer patients and it is one of the main reasons for death amongst these patients. As the first line monotherapy for high-risk patients, Piperacillin-tazobactam, Cefepime, Meropenem and Imipenem-cilastatin can be started as they all have antipseudomonal activity.
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This question is part of the following fields:
- Haematology & Oncology
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Question 128
Incorrect
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The chorda tympani of the facial nerve (CN VII) carries:
Your Answer:
Correct Answer: parasympathetic fibres to the submandibular and sublingual glands and taste fibres from the anterior two-thirds of the tongue
Explanation:In the petrous temporal bone the facial nerve produces three branches:
1. The greater petrosal nerve, which transmits preganglionic parasympathetic fibres to the sphenopalatine ganglion. These postganglionic fibres supply the lacrimal gland and the glands in the nasal cavity;
2. The nerve to stapedius;
3. Parasympathetic fibres to the submandibular and sublingual glands and taste fibres from the anterior two-thirds of the tongue. -
This question is part of the following fields:
- Nervous System
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Question 129
Incorrect
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A 63-year-old man presents with painless jaundice and weight loss over the last few months. He is a heavy smoker and has a past medical history of COPD. On examination his abdomen is soft and non tender and he is clearly icteric.
His bloods reveal deranged LFTs with an alkaline phosphates of 240 and a bilirubin of 92, ALT and AST are both around 200. An ultrasound of his abdomen is performed and shows both intra and extrahepatic bowel duct dilatation within the liver.
What's the first line investigation of his case?Your Answer:
Correct Answer: MRCP
Explanation:When you hear painless jaundice and weight loss in the same sentence, the first thing you should think is cancer. Likely cholangiocarcinoma here or some other biliary tract obstructing cancer. The first line imaging for this would be MRCP because you’re looking for obstruction– the dilatation of the intra and extrahepatic ducts suggests this. This is less invasive than an ERCP or a liver biopsy. CT C/A/P will likely be needed for staging later but it is asking for the initial test.
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This question is part of the following fields:
- Hepatobiliary System
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Question 130
Incorrect
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A 34-year-old woman is admitted to the oncologist clinic for further investigations. She has experienced fever, sometimes glandular and night sweats. Clinical examination reveals lymphadenopathy and a biopsy is performed. The biopsy reveals the presence of Reed-Sternberg cells, confirming what was suspected to be a Hodgkin's lymphoma. Which cell surface marker is associated with this condition?
Your Answer:
Correct Answer: CD15
Explanation:The CD15 antigen, also known as Lewis (hapten)X, serves as an immuno-phenotypic marker for Reed-Sternberg cells and its expression has diagnostic, but also prognostic significance in Hodgkin Lymphoma.
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This question is part of the following fields:
- Haematology & Oncology
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Question 131
Incorrect
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A 68-year-old man is admitted with an infective exacerbation of chronic obstructive pulmonary disease (COPD).
Investigations: blood gas taken whilst breathing 28% oxygen on admission:
pH 7.30
p(O2) 7.8 kPa
p(CO2) 7.4 kPa
Which condition best describes the blood gas picture?Your Answer:
Correct Answer: Decompensated type-2 respiratory failure
Explanation:The normal partial pressure reference values are:
– PaO2 more than 80 mmHg (11 kPa)
– PaCO2 less than 45 mmHg (6.0 kPa).
This patient has an elevated PaCO2 (7.4kPa)
Hypoxemia (PaO2 <8kPa) with hypercapnia (PaCO2 >6.0kPa).
The pH is also lower than 7.35 at 7.3Type 2 respiratory failure is caused by inadequate alveolar ventilation; both oxygen and carbon dioxide are affected. Defined as the build-up of carbon dioxide levels (PaCO2) that has been generated by the body but cannot be eliminated. The underlying causes include:
– Increased airways resistance (chronic obstructive pulmonary disease, asthma, suffocation)
– Reduced breathing effort (drug effects, brain stem lesion, extreme obesity)
– A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis)
– Neuromuscular problems (Guillain-Barre syndrome, motor neuron disease)
– Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest. -
This question is part of the following fields:
- Respiratory System
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Question 132
Incorrect
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A non-cyanosed 1-year-old female patient has a continuous murmur which is loudest at the left sternal edge. What pulse abnormality is most associated with patent ductus arteriosus if that's her suspected diagnosis?
Your Answer:
Correct Answer: Collapsing pulse
Explanation:DIAGNOSIS:
A consensus definition for hemodynamically significant PDA is lacking. The diagnosis is often suspected clinically, when an infant demonstrates signs of excessive shunting from the arterial to pulmonary circulation. Continuous or a systolic murmur; note, a silent PDA may also occur when the ductus shunt is large enough that nonturbulent flow fails to generate a detectible murmur.
A low diastolic blood pressure (due to runoff into the ductus during diastole, more frequent in the most premature infants).
A wide pulse pressure (due to ductus runoff or steal)Hypotension (especially in the most premature infants)
Bounding pulses
Increased serum creatinine concentration or oliguria
Hepatomegaly -
This question is part of the following fields:
- Cardiovascular System
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Question 133
Incorrect
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A 62-year-old male presents to the OPD with a deep painless ulcer on the heel. His previous history includes increased thirst, urinary frequency, and weight loss for the last 4 years. Which of the following investigations would be most appropriate in this case?
Your Answer:
Correct Answer: Blood sugar
Explanation:People with diabetes are prone to foot problems that develop due to prolonged periods of high blood sugar levels. Diabetic neuropathy and peripheral vascular disease are the two main causes of foot problems and both can have serious complications. Diabetes can cause serious foot problems that can result in feet or limb loss, deformity, and infections. However, it is possible for a person to prevent or minimize many of these problems. While controlling blood sugar by following the recommended diabetes treatment plans is the best way to prevent these serious problems, self-care and regular check-ups with a doctor can also help prevent problems from developing.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 134
Incorrect
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A 74-year-old man presents with 12 kg weight loss and persistent back pain that is unrelated to activity for the past several months. Laboratory findings show :
WCC: 6.7 x 109/l (5.4 neutrophils, 1.2 lymphocytes and 0.2 monocytes)
Haemoglobin: 11.2 g/dl
haematocrit: 33.3%
MCV: 88 fl
Platelet count: 89 x 109/l.
The biochemistry shows:
sodium 144 mmol/l
potassium 4.5 mmol/l
chloride 100 mmol/l
bicarbonate 26 mmol/l
urea 14 mmol/l
creatinine 90 μmol/l
a glucose of 5.4 mmol/l.
A CT scan of the spine reveals scattered 0.4 to 1.2 cm bright lesions in the vertebral bodies.
Which of the following additional laboratory test findings is he most likely to have?Your Answer:
Correct Answer: Serum prostate specific antigen of 35 microgram/l
Explanation:Old age, persistent backache, weight loss, and osteosclerotic lesions make prostatic adenocarcinoma the most likely diagnosis. The sequelae include severe pain, pathological fractures, hypercalcemia and cord compression. Prostatic adenocarcinoma is detected by elevated levels of prostate specific antigen. Positive serology for borrelia burgdorferi would hint at Lyme disease which does not cause osteosclerotic bone lesions, neither would Neisseria gonorrhoeae have such a presentation.
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This question is part of the following fields:
- Musculoskeletal System
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Question 135
Incorrect
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A 47-year-old hypertensive man presents with difficulty using his right arm, slow walking and occasional loss of balance. He has a broad-based gait with cogwheel rigidity and intention tremor of his right arm. His blood pressure is 140/80 mmHg sitting and 100/60 mmHg standing. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Multiple system atrophy
Explanation:This patient presents with a combination of akinetic rigid syndrome, cerebellar signs and the suggestion of autonomic features. This is most indicative of a diagnosis of multiple system atrophy.
Multiple system atrophy (MSA) is a rare neurodegenerative disorder characterized by autonomic dysfunction, tremors, slow movement, muscle rigidity, and postural instability (collectively known as parkinsonism) and ataxia.
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This question is part of the following fields:
- Nervous System
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Question 136
Incorrect
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A 62-year-old woman with scleroderma and Raynaud's phenomenon complains of weight loss and has been referred for an opinion. Gastrointestinal associations of progressive systemic sclerosis include which of the following?
Your Answer:
Correct Answer: Oesophageal stricture
Explanation:Oesophageal stricture is a complication of systemic sclerosis, think of the oesophagus as sclerosing (fibrosing) leading to stricture and you never forget. Based on the clinical presentation of systemic sclerosis this is more likely than pancreatic dysfunction, PSC, lymphoma, or diverticulitis. Additionally, CREST syndrome stands for: calcinosis cutis, Raynaud’s phenomenon (which the patient has), oesophageal dysmotility, sclerodactyly, and telangiectasias), this is a form of systemic sclerosis you should be familiar with.
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This question is part of the following fields:
- Gastrointestinal System
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Question 137
Incorrect
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Which of the following types of renal stones are said to have a semi-opaque appearance on x-ray?
Your Answer:
Correct Answer: Cystine stones
Explanation:Only cystine stones are semi-opaque because they contain sulphur. All the other stones will appear either radio-lucent or radio-opaque.
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This question is part of the following fields:
- Renal System
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Question 138
Incorrect
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A 40-year-old man is admitted to the Emergency Department in a confused state. He tells you that he consumed two bottles of antifreeze.
On examination, his pulse is 120 bpm and blood pressure is 140/90 mmHg. An arterial blood gas analysis shows uncompensated metabolic acidosis. He is transferred to the high dependency unit and ethanol is given via a nasogastric tube.
How does ethanol help this patient?Your Answer:
Correct Answer: Competes with ethylene glycol for alcohol dehydrogenase
Explanation:Ethanol competes with ethylene glycol for alcohol dehydrogenase and thus, helps manage a patient with ethylene glycol toxicity.
Ethylene glycol is a type of alcohol used as a coolant or antifreeze
Features of toxicity are divided into 3 stages:
Stage 1: (30 min to 12 hours after exposure) Symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness (CNS depression)
Stage 2: (12 – 48 hours after exposure) Metabolic acidosis with a high anion gap and high osmolar gap. Also tachycardia, hypertension
Stage 3: (24 – 72 hours after exposure) Acute renal failureManagement has changed in recent times:
Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol.
Ethanol has been used for many years works by competing with ethylene glycol for the enzyme alcohol dehydrogenase this limits the formation of toxic metabolites (e.g. glycolaldehyde and glycolic acid) which are responsible for the hemodynamic/metabolic features of poisoning.
Haemodialysis has a role in refractory cases. -
This question is part of the following fields:
- Pharmacology
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Question 139
Incorrect
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A 70-year-old female from a nursing home presented in the emergency department with complaints of headache, blurred vision and confused state for the last 4 to 5 days. On examination, she has several bruises on her head. Which of the following is the most likely cause behind the confused state of this patient?
Your Answer:
Correct Answer: Subdural hematoma
Explanation:Bruises on her head are suggestive of a head injury. Confused state with a headache and blurred vision are due to a subdural hematoma.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 140
Incorrect
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A 24-year-old gentleman presents with visual loss in his right eye, and this is diagnosed as optic neuritis.
Which one of the following statements would be seen in an afferent pupillary defect?Your Answer:
Correct Answer: Accommodation response is unaffected
Explanation:Afferent pupillary defect is simply a delayed pupillary response to light. Accommodation is otherwise unaffected.
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This question is part of the following fields:
- Nervous System
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Question 141
Incorrect
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A 58-year-old gentleman with a long history of gout presents with loin pain. Other past history of note includes an ileostomy after bowel surgery. There is no history of weight loss from malabsorption syndrome after his bowel surgery. Excretion urography reveals evidence of bilateral renal stones.
What is the most likely composition of his renal stones?Your Answer:
Correct Answer: Uric acid stones
Explanation:Uric acid stones will most likely be found in this case because of the patient’s long history of gout. Additionally, studies have shown that ileostomy patients have an increased risk for the development of uric acid stones.
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This question is part of the following fields:
- Renal System
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Question 142
Incorrect
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A 34-year-old female presents to the clinic with skin tightness. On examination she has sclerodactyly, thickened skin of the shoulders and bi-basal crepitations. Her HRCT chest shows ground glass changes. Raynaud phenomenon is suspected and she is started on a monthly dose of IV cyclophosphamide (1 gm/month) for 6 months and a daily dose of 10 mg of oral prednisolone. However, she returned over a period of few weeks after developing exertional dyspnoea, pedal oedema and feeling unwell. On examination, JVP is raised, there is marked pedal oedema and bi basal crepitations on chest auscultation. Urine dipstick shows haematuria (++) and proteinuria (++). What in your opinion is the most likely cause of her deteriorating renal function?
Your Answer:
Correct Answer: Scleroderma renal crisis
Explanation:Scleroderma renal crisis (SRC) is a rare but severe complication in patients with systemic sclerosis (SSc). It is characterized by malignant hypertension, microangiopathic haemolytic anaemia with schistocytes and oligo/anuric acute renal failure. SRC occurs in 5% of patients with systemic scleroderma, particularly in the first years of disease evolution and in the diffuse form. Patients may develop symptoms of fluid overload.
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This question is part of the following fields:
- Musculoskeletal System
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Question 143
Incorrect
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A 65-year-old gentleman with a history of chronic renal failure due to diabetes comes to the clinic for review. He has reported increasing bone and muscle aches over the past few weeks.
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Medications include ramipril, amlodipine and indapamide for blood pressure control, atorvastatin for lipid management, and insulin for control of his blood sugar. On examination his BP is 148/80 mmHg, his pulse is 79 and regular. His BMI is 28.
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Investigations show:
Haemoglobin 10.7 g/dl (13.5-17.7)
White cell count 8.2 x 10(9)/l (4-11)
Platelets 202 x 10(9)/l (150-400)
Serum sodium 140 mmol/l (135-146)
Serum potassium 5.0 mmol/l (3.5-5)
Creatinine 192 μmol/l (79-118)
Calcium 2.18 mmol/l (2.2-2.67)
Phosphate 1.9 mmol/l (0.7-1.5)
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He has tried following a low phosphate diet.
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Which of the following would be the next most appropriate step in controlling his phosphate levels?Your Answer:
Correct Answer: Sevelamer
Explanation:Sevelamer is a phosphate-binding drug that can lower raised serum phosphate levels in chronic kidney disease. Because of its aluminium-related side-effects, aluminium hydroxide is no longer the drug of choice.
The other options are calcium-containing salts that may increase risks of tissue calcification. -
This question is part of the following fields:
- Renal System
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Question 144
Incorrect
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A 67-year-old man who has terminal lung cancer and is taking morphine slow release tablet (MST) 60mg bd as an analgesic, is reviewed. Recently, he has been unable to take medications orally and, thus, a decision has been made to set up a syringe driver.
Out of the following, what dose of diamorphine should be prescribed for the syringe driver?Your Answer:
Correct Answer: 40mg
Explanation:The dose is calculated, using the conversion factor, as follows:
(Conversion factor used to convert oral morphine to subcutaneous diamorphine = Divide the total daily dose of oral morphine by 3)
Hence,
60mg*2 = 120mg
120mg/3 = 40mgThe side effects of opioids can be transient or persistent, and these include constipation, nausea, and drowsiness. Therefore, all patients taking opioids should also be prescribed a laxative and an anti-emetic (if the nausea is persistent). Dose-adjustment may be necessary in cases of persistent drowsiness. Moreover, strong opioids can also provide quick relief from metastatic bone pain, as compared to NSAIDs, bisphosphonates, and radiotherapy.
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This question is part of the following fields:
- Haematology & Oncology
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Question 145
Incorrect
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A 27-year-old woman presents with recurrent headaches and sweating. On examination, a nodule is felt in the region of the thyroid gland. She mentions that her mother had kidney stones and died following a tumour in her neck. A surgeon recommends complete thyroidectomy as her treatment of choice.
What is the most important investigation to be done before the surgery?Your Answer:
Correct Answer: 24-hour urinary catecholamines
Explanation:The patient is most likely to have Medullary Thyroid Carcinoma (MTC).
Sporadic, or isolated MTC accounts for 75% of cases and inherited MTC constitutes the rest.
Inherited MTC occurs in association with multiple endocrine neoplasia (MEN) type 2A and 2B syndromes, but non-MEN familial MTC also occurs.
A 24-hour urinalysis for catecholamine metabolites (e.g., vanillylmandelic acid [VMA], metanephrine) has to be done to rule out concomitant pheochromocytoma in patients with MEN type 2A or 2B, as Pheochromocytoma must be treated before MTC. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 146
Incorrect
-
A 70-year-old male diagnosed previously with villous adenoma presented in the OPD with severe diarrhoea. Which of the following electrolyte or fluid imbalances is most commonly associated with such a condition?
Your Answer:
Correct Answer: Hypokalaemia
Explanation:Lower GIT fluid is rich in potassium. So, in the case of severe diarrhoea, potassium loss occurs leading to hypokalaemia. Loss of bicarbonate ions also occurs. Both of these disturbances will lead to hyperchloremic metabolic acidosis.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 147
Incorrect
-
An 18-year-old boy from Middle East presented with a 1 month history of a yellowish, crusted plaque over his scalp, along with some scarring alopecia. What will the likely diagnosis be?
Your Answer:
Correct Answer: Favus
Explanation:Favus is a fungal infection of the scalp, resulting in the formation of a yellowish crusted plaque over the scalp and leads to scar formation with alopecia. Tinea capitus is a fungal infection of the scalp resulting in scaling and non scarring hair loss. Folliculitis presents with multiple perifollicular papules which can be caused by both bacteria and fungi. Cradle cap usually affects infants where the whole scalp is involved. It can lead to hair loss and responds to topical antifungals and keratolytics.
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This question is part of the following fields:
- The Skin
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Question 148
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:
Correct Answer: Bendroflumethiazide
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 149
Incorrect
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Which is the most common type of inherited colorectal cancer:
Your Answer:
Correct Answer: Hereditary non-polyposis colorectal carcinoma
Explanation:Hereditary non-polyposis syndrome (HNPCC) is the most common type of inherited colorectal cancer. It often presents in younger and younger generations down a family. FAP presents with 100’s-1000’s of polyps and is less common. Li-Fraumeni syndrome and Fanconi syndrome are rare. For Peutz-Jeghers syndrome, the thing you will look for in the question stem is discoloured spots on the lips, this is classic.
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This question is part of the following fields:
- Gastrointestinal System
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Question 150
Incorrect
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Which of the following indicates the opening of tricuspid valve in jugular venous waveform?
Your Answer:
Correct Answer: y descent
Explanation:The a wave indicates atrial contraction. The c wave indicates ventricular contraction and the resulting bulging of tricuspid valve into the right atrium during isovolumetric systole. The v wave indicates venous filling. The x descent indicates the atrium relaxation and the movement of the tricuspid valve downward. The y descent indicates the filling of the ventricle after tricuspid opening.
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This question is part of the following fields:
- Cardiovascular System
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Question 151
Incorrect
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A 6 week old female patient was brought by her mother to the emergency department with icterus. Although she's had a good appetite, and breast-feeding well, she hasn't gained any weight. Her mother noticed that her stools are pale while her urine is noticeably dark. What is the most probable diagnosis?
Your Answer:
Correct Answer: Biliary atresia
Explanation:Biliary atresia is a rare condition that usually becomes symptomatic 2 to 8 weeks after birth. It can be congenital or acquired. Typical symptoms include jaundice, weight loss, dark urine and pale stools.
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This question is part of the following fields:
- Hepatobiliary System
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Question 152
Incorrect
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Which is NOT true of vitiligo?
Your Answer:
Correct Answer: A positive family history is not a risk factor
Explanation:The cause of Vitiligo is typically unknown. It is believed to be due to genetic susceptibility that is triggered by an environmental factor such that an autoimmune disease occurs. This results in the destruction of skin pigment cells. Risk factors include a family history of the condition or other autoimmune diseases, such as hyperthyroidism, alopecia areata, and pernicious anaemia. Vitiligo is classified into two main types: segmental and non-segmental. Most cases are non-segmental meaning they affect both sides and typically get worse with time. The prevalence of vitiligo is 0.5-1% of populations worldwide. Typical sites include backs of hands, wrists, knees, neck and around body orifices. The Koebner phenomenon refers to skin lesions appearing on lines of trauma. This occurs in vitiligo secondary to scratching.
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This question is part of the following fields:
- The Skin
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Question 153
Incorrect
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A 55-year-old alcoholic is admitted with portal hypertension. The wedged hepatic venous pressure is recorded. This pressure is reflective of which part of the hepatic vascular system?
Your Answer:
Correct Answer: Sinusoids
Explanation:The wedged hepatic venous pressure is a reflection of the portal venous pressure in the hepatic sinusoids. This is a fact to remember. Here is a great but concise explanation as to why: https://www.ncbi.nlm.nih.gov/pubmed/18695309
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This question is part of the following fields:
- Hepatobiliary System
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Question 154
Incorrect
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A 78-year-old retired journalist known to have prostatic carcinoma presents to the ED complaining of pain in the spine and the onset of severe lower-leg weakness accompanied by a loss of sensation. On examination, he is found to have percussion tenderness of his spine, loss of sensation up to the umbilicus and a distended bladder. He has markedly reduced power of the lower legs with hyperreflexia. Which of the following should not be part of your management of this patient?
Your Answer:
Correct Answer: Spinal X-rays
Explanation:Acute cord compression is a medical emergency. Typically, signs of segmental damage at the level of compression are usually combined with corticospinal tract dysfunction (e.g., hyperreflexia, Babinski’s sign and weakness) and sensory deficits below the level of compression. Symptoms include spinal pain that precedes the development of weak legs and sensory loss. There may be loss of bladder (and anal) sphincter control, manifesting as hesitancy, frequency and, finally, painless retention.
Spinal X-rays are rarely diagnostic. MRI is usually the investigation of choice and should not be delayed, but if not available consider doing a CT scan and myelography to confirm cord compression and fully define the level and extent of the lesion. If malignancy is the cause, it is important to give dexamethasone (oral or intravenous) while considering therapy more specific to the cause. -
This question is part of the following fields:
- Nervous System
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Question 155
Incorrect
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A 44-year-old female is admitted to the emergency with dyspnoea, syncope, fever and arthropathy. She was recently diagnosed with pulmonary emboli. Cardiovascular examination reveals an early diastolic sound with a mid diastolic rumble. The JVP is found to be elevated and there are prominent a waves. Which of the following would be the most likely cause of her symptoms?
Your Answer:
Correct Answer: Atrial myxoma
Explanation:Cardiac myxomas are the most common type of primary tumour of the heart. They are usually benign and arise from primary connective tissue. Most cardiac myxomas arise sporadically; however, 10% are hereditary (following an autosomal dominant pattern). Even though they may develop in any chamber of the heart, most (+-75 %) cardiac myxomas arise in the left atrium, usually from the interatrial septum, while the rest occur in the right atrium (ventricular myxomas are rare). Clinical features are primarily caused by obstruction of the blood flow through the heart and include dyspnoea on exertion, palpitations, syncope, weight loss, or even sudden death. Rarely, life-threatening conditions (e.g., stroke) may result from an embolization from the myxoma. Typical examination findings include abnormal heart sounds, such as a rumbling diastolic murmur over the apex or a characteristic tumour plop.
The diagnosis is not easily established clinically because of the nonspecific nature of symptoms. Echocardiography is the diagnostic procedure of choice. Surgical resection of the tumour is the curative treatment of choice. The prognosis is usually favourable, but tumours can recur after inadequate resection. -
This question is part of the following fields:
- Cardiovascular System
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Question 156
Incorrect
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A female patient presents with pain upon inspiration and dyspnoea. She had a myocardial infarction four days ago. What is the most probable diagnosis?
Your Answer:
Correct Answer: Pericarditis
Explanation:Although viral infection is the most common identifiable cause of acute pericarditis, the condition may be associated with many diseases. Non-viral causes of pericarditis include bacterial infection, MI, chest trauma, and neoplasm. Post-MI pericarditis may develop two to four days after an acute infarction and results from a reaction between the pericardium and the damaged adjacent myocardium. Dressler’s syndrome is a post-MI phenomenon in which pericarditis develops weeks to months after an acute infarction; this syndrome is thought to reflect a late autoimmune reaction mediated by antibodies to circulating myocardial antigens.
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This question is part of the following fields:
- Cardiovascular System
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Question 157
Incorrect
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A 24-year-old smoker with testicular cancer presents with exertional dyspnoea, wheezing, and persistent non-productive cough. He completed a course of chemotherapy comprising of cisplatin, bleomycin, and etoposide three months ago. On examination, there are fine bilateral basal crackles.
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Bleomycin toxicity
Explanation:The cytotoxic drug bleomycin can cause bleomycin-induced pneumonitis (BIP). It usually occurs during chemotherapy but can also occur up to six months post-therapy.
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This question is part of the following fields:
- Haematology & Oncology
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Question 158
Incorrect
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A 67-year-old male presents to the emergency complaining of frank haematuria. There are no associated symptoms. Which of the following would be the most helpful in pointing towards a diagnosis?
Your Answer:
Correct Answer: Cystoscopy
Explanation:Diagnostic indications for cystoscopy include the following: evaluation of patients with voiding symptoms (storage or obstructive), gross or microscopic haematuria, urologic fistulas, urethral or bladder diverticula and congenital anomalies in paediatric population.
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This question is part of the following fields:
- Renal System
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Question 159
Incorrect
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A 28-year-old woman is referred to the endocrinology clinic. She has been trying to conceive for the last 3 years without any success. Her prolactin level is 2600 mU/l (normal <360). The Endocrinologist arranges pituitary magnetic resonance imaging (MRI) that demonstrates a microprolactinoma.
Which two of the following pharmacological agents may be appropriate treatment choices?Your Answer:
Correct Answer: Carbergoline
Explanation:Cabergoline, an ergot derivative, is a long-acting dopamine agonist. It is usually better tolerated than Bromocriptine (BEC), and its efficacy profiles are somewhat superior to those of BEC. It offers the convenience of twice-a-week administration, with a usual starting dose of 0.25 mg biweekly to a maximum dose of 1 mg biweekly. Some studies have shown efficacy even with once-a-week dosing. Cabergoline appears to be more effective in lowering prolactin levels and restoring ovulation. Up to 70% of patients who do not respond to BEC respond to cabergoline.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 160
Incorrect
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Which of the following statements is incorrect regarding etanercept?
Your Answer:
Correct Answer: Must be given intravenously
Explanation:Etanercept is a TNF receptor fused with human immunoglobulin. It binds to TNF-alpha preventing it from binding to its normal receptor. Thus, inhibiting it competitively. It is used for treatment of rheumatoid arthritis in adults when traditional treatments fail. When injected subcutaneously, it is accompanied with skin reactions and urticaria. It should be given intravenously. Serious blood disorders and demyelination have also been associated.
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This question is part of the following fields:
- Musculoskeletal System
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Question 161
Incorrect
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A 53 year-old dancer presents to the ED with increasing weakness. She has no pertinent past medical history aside from a recent diarrhoeal illness, which she attributes to an undercooked chicken meal. Her husband says that she has been unable to get up out of a chair for the past day. Upon examination, there is bilateral limb weakness and areflexia noted, but it is more severe in the lower limbs. You notice that if she lies flat in the bed, her oxygen saturations fall by around 2% on the pulse oximeter and she is unable to perform spirometry. Which of the following represents the most appropriate immediate management of choice in this patient?
Your Answer:
Correct Answer: ITU review for consideration of ventilation
Explanation:This woman has a history that is suggestive of Guillain- Barre syndrome. This may be precipitated by Campylobacter, and her history of recent diarrhoeal illness is pointing towards that. Certain features point to a poor prognosis, including rapidity of onset, reduced vital capacity or respiratory failure, age >40 and reduced amplitude of compound muscle action potential. Her inability to perform spirometry and desaturating whilst lying flat are suggestive of impending respiratory muscle weakness. Review for consideration of ventilation is recommended. Further management of choice for Guillain-Barre syndrome is IV immunoglobulins. Steroids have no value in the treatment of the condition.
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This question is part of the following fields:
- Nervous System
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Question 162
Incorrect
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A 30-year-old male presented with palpitations for 1 week. The palpitations were intermittent and lasted a few hours per day. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: 24 hr ECG
Explanation:Palpitations can be due to many reasons. As palpitations are not constant in this case, a 24 hr ECG is important to isolate these episodes and find any cardiac cause. Drugs depend on the cause for the palpitations.
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This question is part of the following fields:
- Cardiovascular System
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Question 163
Incorrect
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A 22-year-old man presents with red and flaky patches at the corners of his mouth. Upon examination, angular cheilitis is diagnosed. Anamnesis reveals a history of excessive drinking and malnutrition. What is the most probable deficiency responsible for his condition?
Your Answer:
Correct Answer: Vitamin B2 deficiency
Explanation:Riboflavin, vitamin B2, is a water-soluble and heat-stable vitamin that the body uses to metabolize fats, protein, and carbohydrates into glucose for energy. Riboflavin deficiency can cause fatigue, swollen throat, blurred vision, and depression. It can affect the skin by causing skin cracks, itching, and dermatitis around the mouth. Hyperaemia and oedema around throat, liver degeneration, and hair loss can also occur along with reproductive issues. Usually, people with riboflavin deficiency also have deficiencies of other nutrients. In most cases, riboflavin deficiency can be reversed unless it has caused anatomical changes such as cataracts.
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This question is part of the following fields:
- The Skin
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Question 164
Incorrect
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A 28-year-old male was admitted with palpitations and chest discomfort for the past 1 hour. On examination his pulse rate was 200 bpm and blood pressure was 80/50 mmHg. His ECG revealed narrow complex tachycardia with a heart rate of 200 bpm. Which of the following is the most appropriate management of this patient?
Your Answer:
Correct Answer: Synchronised DC synchronised cardioversion
Explanation:Narrow complex tachycardia with hypotension is a medical emergency. Immediate synchronized cardioversion is the ideal management.
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This question is part of the following fields:
- Cardiovascular System
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Question 165
Incorrect
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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:
Correct 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 166
Incorrect
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A 50-year-old male patient was started on amiodarone. Prior to commencement, his blood urea and electrolytes were checked. What is the reason for doing this investigation before starting amiodarone?
Your Answer:
Correct Answer: To detect hypokalaemia
Explanation:Any antiarrhythmic drugs can potentially cause arrhythmias. Before starting amiodarone, any electrolyte imbalance including hypokalaemia, hypomagnesemia, or hypocalcaemia should be corrected to prevent any arrhythmias.
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This question is part of the following fields:
- Cardiovascular System
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Question 167
Incorrect
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A 41-year-old male experiences hand tremors that are absent at rest, but aggravated on extension and continuous with movement. What is the most probable diagnosis?
Your Answer:
Correct Answer: Benign essential tremor
Explanation:Tremors that linger on movement, seen on an outstretched hand, and absent on rest are called benign essential tremors.
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This question is part of the following fields:
- Nervous System
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Question 168
Incorrect
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A 35-year-old woman is referred to the oncology clinic by a general surgeon. She has undergone mastectomy for carcinoma of the right breast.
Out of the following, which factor is associated with a poor prognosis in patients with breast cancer?Your Answer:
Correct Answer: Young age
Explanation:Poor prognostic factors for breast cancer include:
1. Young age (<40 years)
2. Premenopausal at the time of diagnosis
3. Increased tumour size
4. High-grade tumour
5. Oestrogen and progesterone receptor-negative tumour
6. Positive lymph node status -
This question is part of the following fields:
- Haematology & Oncology
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Question 169
Incorrect
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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:
Correct 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 170
Incorrect
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A 24-year-old waiter applies for a job at a cafeteria. He gives a history of having had enteric fever 2 years ago. Which of the following investigations is most likely to indicate a chronic carrier status?
Your Answer:
Correct Answer: Culture of intestinal secretions
Explanation:The chronic asymptomatic carrier state is thought to be why there is continued appearance of the bacterium in human populations. As shedding of the organism is intermittent and sometimes at low levels, methods to detect it have been limited. The Salmonella typhi may be cultured from intestinal secretions, faeces or urine in chronic carriers and is recommended to confirm the diagnosis. Vi agglutination test can also be high in normal people in areas with typhoid endemic. Full blood count or blood culture would not be helpful to determine carrier status. Widal antigen test is unable to differentiate carriers from people with a hx of prior infection.
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This question is part of the following fields:
- Gastrointestinal System
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Question 171
Incorrect
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Which of the following does the inferior mesenteric artery supply?
Your Answer:
Correct Answer: From the splenic flexure to the first third of the rectum
Explanation:The coeliac axis supplies the liver and stomach and from the oesophagus to the first half of the duodenum.
The second half of the duodenum to the first two thirds of the transverse colon is supplied by the superior mesenteric artery.
The inferior mesenteric supplies the last third of the transverse colon (approximately from the splenic flexure) to the first third of the rectum.
The last two thirds of the rectum are supplied by the middle rectal artery.
The greater curvature of the stomach is supplied by branches of the splenic artery, which itself comes from the coeliac axis. -
This question is part of the following fields:
- Gastrointestinal System
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Question 172
Incorrect
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A 32-year-old man presents with progressive central abdominal pain and vomiting associated with significant weight loss (five stone in 3 months).He gives a history of binge drinking and depression, and smokes twenty cigarettes per day. Because eating provokes abdominal pain and vomiting, he has eaten virtually nothing for a month. CT scanning of his abdomen showed a normal pancreas but dilated loops of small bowel with a possible terminal ileal stricture. His albumin level was 20 and C-reactive protein level was 50. Which statement is NOT true?
Your Answer:
Correct Answer: Infliximab should be prescribed as soon as possible
Explanation:Stricturing is associated with Crohn’s disease, and elevated CRP supports this diagnosis in this patient, as well. Infliximab should not yet be started. Acute treatment is steroids (of a flare) however this man needs surgery. Although surgery should be avoided if at all possible in Crohn’s disease, and minimal surgery should occur (resecting as little as possible, given possible need for future resections), including possible stricturoplasty instead of resection. Chronic pancreatitis is unlikely given it would not cause stricture. Patients undergoing surgery should always have informed consent, which always includes risk of a stoma for any bowel surgery. Given the amount of weight he has lost he is at significant risk for refeeding syndrome, which can cause hypokalaemia, hypophosphatemia and hypomagnesemia.
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This question is part of the following fields:
- Gastrointestinal System
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Question 173
Incorrect
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A 33-year-old lady who is known hepatitis C positive comes to your clinic. She is 28 weeks pregnant and her obstetrician wants you to assess her and provide medical advice for the mother and child.
Which of the following statements concerning hepatitis C are most accurate in her case?Your Answer:
Correct Answer: Breast-feeding does not increase the risk of transmission
Explanation:Breast feeding has not been shown to increase the risk of transmission of HCV from mother to baby. This is simply a fact to memorize. The other answer choices are not the most accurate as there is no evidence-proven way to decrease the chance that baby will get HCV from the mother during the birth. About 5 out of every 100 infants born to HCV infected mothers become infected.
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This question is part of the following fields:
- Infectious Diseases
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Question 174
Incorrect
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A 42-year-old man presented with palpitations and shortness of breath on exertion. On examination his lungs were clear and heart sounds were normal. There was a left sided parasternal heave. His electrocardiogram (ECG) revealed atrial fibrillation with right axis deviation. Echocardiography showed dilated right heart chambers. Left and right heart catheterisation study revealed the following
Inferior vena cava Oxygen saturations 63 %
Superior vena cava Oxygen saturations 59 %
Right atrium Oxygen saturations 77 %
Right ventricle Oxygen saturations 78 %
Pulmonary artery Oxygen saturations 82 %
Arterial saturation Oxygen saturations 98 %
What is the most likely diagnosis from the following answers?Your Answer:
Correct Answer: Atrial septal defect
Explanation:Right ventricular volume overload is indicated by a parasternal heave and right axis deviation. Oxygen saturation in right atrium is higher than oxygen saturation of the inferior and superior vena cavae. So the most probable diagnosis is atrial septal defect.
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This question is part of the following fields:
- Cardiovascular System
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Question 175
Incorrect
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A 57-year-old male presented to the OPD with a complaint of yellow discoloration of his skin. On examination, he was found to have digital clubbing, jaundice, an enlarged and nodular liver, as well as caput medusa. Clinical investigations revealed normal electrolyte levels but low albumin levels. Which of the following is the appropriate management of this patient's fluid intake?
Your Answer:
Correct Answer: Albumin infusion
Explanation:This patient has an accumulation of fluid inside his body which, along with the lowered albumin level, tells us that the oncotic pressure of the blood is very low in this patient. Therefore, albumin infusion is the best option for him because albumin is the key human protein that contributes the most to the oncotic pressure.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 176
Incorrect
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A 70-year-old male presented in the OPD with a complaint of abdominal pain and blood in his stools for the last two days. He reports that the stools are black in colour and sometimes accompanied by fresh blood. There is also a history of significant weight loss. Blood tests revealed elevated CA 19-9. What is the patient most likely suffering from?
Your Answer:
Correct Answer: Colorectal carcinoma
Explanation:The patient’s symptoms along with his age indicates a diagnosis of colorectal cancer. Blood test marker CA-19-9 is a prognostic index for colorectal cancer which confirms the suspicion.
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This question is part of the following fields:
- Gastrointestinal System
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Question 177
Incorrect
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A 28-year-old female presented with complaints of weight gain, thinning of scalp hair, dryness and coldness of the skin, constipation and fatigue. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Hypothyroidism
Explanation:The symptoms this female presented with in the OPD are major symptoms of hypothyroidism due to insufficient thyroid hormone.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 178
Incorrect
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A 55-year-old female presents with complaints of retrosternal chest pain and dysphagia (which is intermittent and unpredictable in nature). When she swallows, food very suddenly 'sticks' in her chest. She is able to clear it when she drinks water, and then can finish the meal without any further incidence. A barium meal shows she has a corkscrew oesophagus. What is the most likely type of dysphagia here?
Your Answer:
Correct Answer: Oesophageal spasm
Explanation:All of the symptoms observed in this patient are typical of uncoordinated irregular oesophageal peristalsis – this is characteristic of oesophageal spasm. The cork-screw oesophagus is also diagnostic of the condition.
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This question is part of the following fields:
- Gastrointestinal System
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Question 179
Incorrect
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A 28-year-old manual worker had stepped on a rusty nail. He says he received tetanus toxoid 8 years ago. What should be done for him now?
Your Answer:
Correct Answer: Human immunoglobulin only
Explanation:Only immunoglobulins are required, as he is already immunized.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 180
Incorrect
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A 47-year-old male with type II diabetes mellitus presents to your clinic with a history suggestive of erectile dysfunction. You decide to start him on sildenafil citrate. What is the mechanism of action of this drug?
Your Answer:
Correct Answer: Phosphodiesterase type V inhibitor
Explanation:Sildenafil (Viagra) is a phosphodiesterase type V inhibitor used in the treatment of impotence.
Contraindications:
– Patients taking nitrates and related drugs such as nicorandil
– Hypotension
– Recent stroke or myocardial infarction (NICE recommend waiting 6 months)Side-effects:
Visual disturbances e.g. cyanopsia, non-arthritic anterior ischaemic Neuropathy
Nasal congestion
Flushing
Gastrointestinal side-effects
Headache -
This question is part of the following fields:
- Pharmacology
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Question 181
Incorrect
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From the following drugs, which is an inhaled glucocorticoid that is used for maintenance therapy, but not important in mild asthmatic attacks?
Your Answer:
Correct Answer: Fluticasone propionate
Explanation:From the given answers Fluticasone propionate is the inhaled glucocorticoid. It is not important as a reliever medication but important in maintenance therapy.
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This question is part of the following fields:
- Respiratory System
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Question 182
Incorrect
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Which of the following physical findings is least typical on a patient with multiple sclerosis?
Your Answer:
Correct Answer: Decreased tone
Explanation:Attacks or exacerbations of multiple sclerosis (MS) are characterized by symptoms that reflect central nervous system (CNS) involvement, hence upper motor neuron symptoms are seen.
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This question is part of the following fields:
- Nervous System
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Question 183
Incorrect
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A 63-year-old man presents to the clinic complaining of a 6-month history of shortness of breath on exertion and a non-productive cough.
Â
On examination there is clubbing, and crepitations heard at the lung bases. Lung function tests show a reduced vital capacity and an increased FEV1/FVC ratio.
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What is his diagnosis?Your Answer:
Correct Answer: Idiopathic pulmonary fibrosis
Explanation:Idiopathic pulmonary fibrosis (IPF) is a condition in which the lungs become scarred and breathing becomes increasingly difficult.
The most common signs and symptoms of idiopathic pulmonary fibrosis are shortness of breath and a persistent dry, hacking cough. Many affected individuals also experience a loss of appetite and gradual weight loss.The clinical findings of IPF are bibasilar reticular abnormalities, ground glass opacities, or diffuse nodular lesions on high-resolution computed tomography and abnormal pulmonary function studies that include evidence of restriction (reduced VC with an increase in FEV1/FVC ratio) and/or impaired gas exchange (increased P(A-a)O2 with rest or exercise or decreased diffusion capacity of the lung for carbon monoxide [DLCO]).
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This question is part of the following fields:
- Respiratory System
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Question 184
Incorrect
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A 48-year-old woman with chronic pancreatitis due to gallstones presents with a macrocytic anaemia. The anaemia is most likely caused by:
Your Answer:
Correct Answer: Vitamin B12 deficiency
Explanation:Vit b12 requires trypsin enzyme to split it from its R-binders in order to make the vitamin bind to intrinsic factor required for absorption. In alcoholic patients, chronic pancreatitis is very common. Other causes related to alcoholism can be folate deficiency or bone marrow dysfunction.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 185
Incorrect
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What is the mechanism of action of sumatriptan?
Your Answer:
Correct Answer: 5-HT1 agonist
Explanation:Triptans are specific 5-HT1 agonists used in the acute treatment of migraine. They are generally used as first-line therapy in combination with an NSAID or paracetamol.
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This question is part of the following fields:
- Pharmacology
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Question 186
Incorrect
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A 17-year-old Jewish girl presents with primary amenorrhoea. On examination, she looks a little hirsute and has evidence of facial acne. She is within her predicted adult height and has normal breast and external genitalia development, however, there is excess hair over her lower abdomen and around her nipple area.
Investigations were as follows:
Hb 13.1 g/dl
WCC 8.6 x109/l
PLT 201 x109/l
Na+ 139 mmol/l
K+ 4.5 mmol/l
Creatinine 110 µmol/l
17-OH progesterone 1.4 times the upper limit of normal
Pelvic ultrasound: bilateral ovaries and uterus visualised.
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Non-classical congenital adrenal hyperplasia
Explanation:Mild deficiencies of 21-hydroxylase or 3-beta-hydroxysteroid dehydrogenase activity may present in adolescence or adulthood with oligomenorrhea, hirsutism, and/or infertility. This is termed nonclassical adrenal hyperplasia.
Late-onset or nonclassical congenital adrenal hyperplasia (NCAH) due to 21-hydroxylase deficiency is one of the most common autosomal recessive disorders. Reported prevalence ranges from 1 in 30 to 1 in 1000. Affected individuals typically present due to signs and symptoms of androgen excess.
Treatment needs to be directed toward the symptoms. Goals of treatment include normal linear growth velocity, a normal rate of skeletal maturation, ‘on-time’ puberty, regular menstrual cycles, prevention of or limited progression of hirsutism and acne, and fertility. Treatment needs to be individualized and should not be initiated merely to decrease abnormally elevated hormone concentrations.
Normal Ultrasound rules out Turner’s syndrome. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 187
Incorrect
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A 50-year-old female known with diabetes visited the OPD with a tender lump near her anal opening. She says she also has fever. Which of the following management options should be recommended to the patient in this case?
Your Answer:
Correct Answer: Incision and drainage and antibiotics
Explanation:The lump near the anal opening is an anal abscess that should be treated via incising and draining it in order to cure the fever the patient has. Antibiotics will then be given in order to prevent any further infections.
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This question is part of the following fields:
- Gastrointestinal System
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Question 188
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:
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 189
Incorrect
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A study is developed to assess a new mandibular advancement device designed to reduce snoring. A 10 point scale was used to assess the severity of snoring before and after applying of the device by the respective partner. The number of the people involved in the study was 50. What test would you apply in this particular study?
Your Answer:
Correct Answer: Wilcoxon signed-rank test
Explanation:Steps required in performing the Wilcoxon signed rank test:
1 State the null hypothesis and, in particular, the hypothesized value for comparison
2 Rank all observations in increasing order of magnitude, ignoring their sign. Ignore any observations that are equal to the hypothesized value. If two observations have the same magnitude, regardless of sign, then they are given an average ranking
3 Allocate a sign (+ or -) to each observation according to whether it is greater or less than the hypothesized value (as in the sign test)
4 Calculate:
R+ = sum of all positive ranks
R- = sum of all negative ranks
R = smaller of R+ and R-
5 Calculate an appropriate P value What makes this test the most appropriate for this study is that the data is non-parametric, paired and comes from the same population. -
This question is part of the following fields:
- Evidence Based Medicine
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Question 190
Incorrect
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A 60-year-old male presented in the OPD with a severe pain in the chest, which radiated to the jaw and his left shoulder. What is your diagnosis?
Your Answer:
Correct Answer: MI
Explanation:Risk of myocardial infarction is high in patients with diabetes mellitus. High levels of sugar in the blood can damage the arteries and lead to an increased risk of atherosclerosis of the coronary arteries. This is why diabetic patients have an increased risk of Myocardial Infarction.
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This question is part of the following fields:
- Cardiovascular System
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Question 191
Incorrect
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A 55-year-old male is admitted with vomiting. He has a long history of alcohol abuse, appears slightly jaundiced and is dishevelled and unkempt. He was started on an intravenous glucose infusion and diazepam and he symptomatically improved.
One day later he becomes confused, develops vomiting, diplopia and is unable to stand. What is the most likely diagnosis?Your Answer:
Correct Answer: Vitamin B deficiency
Explanation:The most likely diagnosis is Wernicke’s encephalopathy. This presents in a long time alcoholic from vitamin BI deficiency. Symptoms include confusion and confabulation, oculomotor symptoms/signs, and ataxia.
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This question is part of the following fields:
- Gastrointestinal System
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Question 192
Incorrect
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A COPD patient presented with shortness of breath, a cough and wheezing. He didn't respond to salbutamol, IV hydrocortisone or oxygen therapy. Following this initial treatment, he was given IV aminophylline and atem+ventolin nebulization. ABGs showed an acidotic pH. The next step in management would be?
Your Answer:
Correct Answer: Nasal intermittent positive pressure ventilation
Explanation:Nasal IPPV is given to the patients when all other techniques have failed. It is a non invasive procedure to improve the oxygenation of the patients suffering from lung disease.
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This question is part of the following fields:
- Respiratory System
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Question 193
Incorrect
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A 40-year-old female is suffering from chronic cough. Which of the following additional symptoms will strongly indicate that she has asthma?
Your Answer:
Correct Answer: Symptoms in response to exercise
Explanation:An attack of asthma is characterized by severe dyspnoea accompanied by wheezing. During an attack, the person experiences breathing difficulty during inspiration and expiration, but might feel completely well between attacks. An attack can be triggered by factors like cold, dry air, tobacco smoke, pollen, pet dander, as well as stressful situations like exercise. Dizziness, voice disturbances, and coryzal illness are not features of asthma.
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This question is part of the following fields:
- Respiratory System
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Question 194
Incorrect
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A 76-year-old man has been admitted with a respiratory tract infection.
On examination, he was found to be confused and dyspnoeic with O2 saturation of 88%. He has a 60 pack-year smoking history. An arterial blood gas analysis reveals CO2 retention. He has been deemed unfit for admission into the intensive care unit. The physician elects to begin a doxapram infusion.
Among the following statements which best fits with the characteristics of doxapram?Your Answer:
Correct Answer: Epilepsy is a contraindication for doxapram use
Explanation:The statement that fits the characteristics of doxapram is, epilepsy is a contraindication for doxapram use. Concurrent use with theophylline may increase agitation not relaxation.
Doxapram is a central respiratory stimulant. In clinical practice, doxapram is usually used for patients who have an acute exacerbation of chronic obstructive pulmonary disease (COPD) who are unsuitable for admission to the intensive therapy unit for ventilatory support. Doxapram infusion may buy an extra 24 h to allow for recovery.
Contraindications include: ischaemic heart disease, epilepsy, cerebral oedema, acute stroke, asthma, hypertension, hyperthyroidism, and pheochromocytoma.
The infusion may worsen agitation and dyspnoea and lead to hypertension, nausea, vomiting and urinary retention.Drug interactions:
Concomitant administration of doxapram and aminophylline (theophylline) can cause increased skeletal muscle activity, agitation, and hyperactivity. -
This question is part of the following fields:
- Pharmacology
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Question 195
Incorrect
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What does Caplan's syndrome refer to?
Your Answer:
Correct Answer: Rheumatoid lung nodules and pneumoconiosis
Explanation:Caplan’s syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is rare and usually diagnosed in an advanced stage of RA. It generally affects patients with a prolonged exposure to silica.
Caplan’s syndrome presents with rheumatoid lung nodules and pneumoconiosis. Originally described in coal miners with progressive massive fibrosis, it may also occur in asbestosis, silicosis and other pneumoconiosis. Chest radiology shows multiple, round, well defined nodules, usually 0.5 – 2.0 cm in diameter, which may cavitate and resemble tuberculosis.
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This question is part of the following fields:
- Respiratory System
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Question 196
Incorrect
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A 11-year-old boy is admitted to the hospital with diarrhoea and lethargy. There is a known local outbreak of E coli 0157:H7, and his initial bloods show evidence of acute renal failure. Given the likely diagnosis, which one of the following investigation results would be expected?
Your Answer:
Correct Answer: Fragmented red blood cells
Explanation:The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli. The laboratory results will usually include fragmented RBCs, decreased serum haptoglobin, reduced platelet count, nonspecific WBC changes, and normal coagulation tests (PTT included).
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This question is part of the following fields:
- Haematology & Oncology
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Question 197
Incorrect
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Which of the following statements regarding psoriasis is incorrect?
Your Answer:
Correct Answer: Mediated by type 2 helper T cells
Explanation:Psoriasis is a long-lasting autoimmune disease characterized by patches of skin typically red, dry, itchy, and scaly. Psoriasis can affect the nails and produces a variety of changes in the appearance of finger and toe nails including pitting and onycholysis. Nail psoriasis occurs in 40-45% of people with psoriasis affecting the skin and has a lifetime incidence of 80-90% in those with psoriatic arthritis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response.
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This question is part of the following fields:
- The Skin
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Question 198
Incorrect
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A 17-year-old boy presents with a 2 day history of colicky abdominal pain, vomiting and diarrhoea. He has been passing blood mixed with diarrhoea. He has no significant past medical history and takes no regular medication.
On examination he is pyrexial and clinically dehydrated. Cardiorespiratory and abdominal examinations are normal.
What is the most likely diagnosis?Your Answer:
Correct Answer: Campylobacter infection
Explanation:The patient has bloody diarrhoea that sounds like a food poisoning in the clinical scenario. Campylobacter is the most common cause of this in the United Kingdom. This is then followed by Salmonella and Shigella. The symptoms are usually self limiting. This is more likely to be bacterial from the food than a viral gastroenteritis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 199
Incorrect
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A 28-year-old female hiker begins complaining of headache and nausea after reaching a height of 5010 metres. Despite having the headache and feeling nauseous, she continues to hike but becomes progressively worse. She is seen staggering, complains of feeling dizzy and has an ataxic gait.
Which of the following is the appropriate treatment of this patient?Your Answer:
Correct Answer: Descent + dexamethasone
Explanation:High Altitude Cerebral Oedema (HACE) is a severe and potentially fatal manifestation of high altitude illness and is often characterized by ataxia, fatigue, and altered mental status. HACE is often thought of as an extreme form/end-stage of Acute Mountain Sickness (AMS). Although HACE represents the least common form of altitude illness, it may progress rapidly to coma and death as a result of brain herniation within 24 hours, if not promptly diagnosed and treated.
HACE generally occurs after 2 days above 4000m but can occur at lower elevations (2500m) and with faster onset. Some, but not all, individuals will suffer from symptoms of AMS such as headache, insomnia, anorexia, nausea prior to transitioning to HACE. Some may also have concomitant High Altitude Pulmonary Oedema (HAPE). HACE in isolation is rare, but the absence of concomitant HAPE or symptoms of AMS prior to deterioration does not rule-out the presence of HACE.
Most cases develop as a progression of AMS and will include a history of recent ascent to altitude and prior complaints/findings of AMS including a headache, fatigue, nausea, insomnia, and/or light-headedness. Some may also have signs/symptoms of HAPE. Transition to HACE is heralded by signs of encephalopathy including ataxia (usually the earliest clinical finding) and altered mentation which may range from mild to severe. Other symptoms may include a more severe headache, difficulty speaking, lassitude, a decline in the level of consciousness, and/or focal neurological deficits or seizures.
The mainstay of treatment is the immediate descent of at least 1000m or until symptoms improve. If descent is not an option, one may use a portable hyperbaric chamber and/or supplemental oxygen to temporize illness, but this should never replace or delay evaluation/descent when possible. If available, dexamethasone 8mg for one dose, followed by 4mg every 6 hours should be given to adults via PO, IM, or IV routes.
Acetazolamide has proven to be beneficial in only a single clinical study. The suggested dosing regimen for Acetazolamide is 250 mg PO, given twice daily. Though effective in alleviating or temporizing symptoms, none of the adjunct treatment modalities are definitive or a replacement for an immediate descent. -
This question is part of the following fields:
- Respiratory System
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Question 200
Incorrect
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A 70-year-old male patient with hypertension complains of acute urinary retention. He provides a history of urinary frequency for the past 18 months and has been taking Nifedipine and Propranolol for blood pressure control. Which of the following is the most probable cause for his acute presentation?
Your Answer:
Correct Answer: Drug induced
Explanation:Calcium channel blockers decrease smooth-muscle contractility in the bladder and this can cause urinary retention.
An enlarged prostate gland could be the reason if he gave a history of obstructive symptoms.
Diabetes presents with polyuria.
Bladder cancer commonly presents with painless haematuria. -
This question is part of the following fields:
- Renal System
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SESSION STATS - PERFORMANCE PER SPECIALTY
