-
Question 1
Incorrect
-
A study is developed to compare the calcemia of men and women with Crohn's disease. The objective of the study is to detect any differences between the average calcium levels in men compared to women. Previous studies have shown a normal distribution regarding calcium levels. Which of the the following tests would you most likely apply?
Your Answer: Pearson's test
Correct Answer: Student's unpaired t-test
Explanation:A t test is a type of statistical test that is used to compare the means of two groups. It is one of the most widely used statistical hypothesis tests in pain studies. There are two types of statistical inferences: parametric and nonparametric methods. Parametric methods refer to a statistical technique in which one defines the probability distribution of probability variables and makes inferences about the parameters of the distribution. In cases in which the probability distribution cannot be defined, nonparametric methods are employed. T tests are a type of parametric method; they can be used when the samples satisfy the conditions of normality, equal variance, and independence. In this case the data is parametric, comparing two independent samples from the same population.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 2
Incorrect
-
An 80-year-old patient known to have diabetes mellitus presented in the emergency room with the complaint of involuntary movements of his right arm and leg which disappeared during sleep. Which of the following is the most suitable explanation for this complaint?
Your Answer: Ipsilateral caudate nucleus infarction
Correct Answer: Contralateral subthalamic nucleus infarction
Explanation:These symptoms represent hemiballismus which is common in diabetic patients after the infarction of contralateral subthalmic nucleus. These symptoms are usually present during activity phase and resolve while resting.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 3
Incorrect
-
A 30-year-old woman presents with amenorrhoea and galactorrhoea. She has normal visual fields. You are concerned that she may have a prolactinoma.
Investigations were done and the results are as shown below:
Hb 12.5 g/dl
WCC 4.9 x109/l
PLT 199 x109/l
Na+ 140 mmol/l
K+ 4.9 mmol/l
Creatinine 90 Ù‰mol/l
Prolactin 1150 mU/l
MRI shows a 7 mm pituitary microadenoma.
Which of the following hormones would you expect to be lower than normal?Your Answer: Thyroxine
Correct Answer: LH
Explanation:Prolactinomas, benign lesions that produce the hormone prolactin, are the most common hormone-secreting pituitary tumours.
Based on its size, a prolactinoma can be classified as a microprolactinoma (< 10 mm diameter) or a macroprolactinoma (>10 mm diameter). If the prolactinoma is large enough to compress the surrounding normal hormone-secreting pituitary cells, it may result in deficiencies of one or more hormones (e.g., thyroid-stimulating hormone [TSH], growth hormone [GH], adrenocorticotropic hormone). However, the patient has microadenoma so it is unlikely to cause compression manifestations.
Hyperprolactinemia inhibits GnRH secretion from the medial basal hypothalamus and LH release from the pituitary. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 4
Correct
-
A 56-year-old male has presented with visual loss on his left side and a history of right sided weakness. Where is the occlusion in this patient?
Your Answer: Carotid artery
Explanation:The carotid artery divides itself into two parts: the internal carotid and the external carotid. The internal carotid continues down as the middle cerebral and gives rise to the ophthalmic branch. For this reason, middle cerebral occlusion may give rise to partial visual loss but not complete mono-ocular blindness. Middle cerebral artery occlusion causes paralysis or weakness of contralateral face and arm (faciobracheal). It also causes sensory loss of the contralateral face and arm. Anterior cerebral artery occlusion causes paralysis or weakness of the contralateral foot and leg. Again, sensory loss is experienced at the contralateral foot and leg.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 5
Incorrect
-
A 54-year-old lady was found unconscious at home and passed away later in the ambulance, due to cardiac arrest. The paramedic's report reveals the woman was a diabetic patient on anti-diabetic medication, lately immobilized due to hip pain. Ulcers were also found on the medial side of her ankle. What is the most likely cause of her death?
Your Answer: Pulmonary embolus
Correct Answer: Acute myocardial infarction
Explanation:The patient was old and had a major cardiovascular risk because she was a diabetic. The ulcers indicate poor glycaemic control and advanced disease which further increased her risk for an ischemic heart attack. Immobilization most probably was the favouring background on which the MI occurred.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 6
Correct
-
A 19-year-old male who is a first year student at university presented in the emergency room with acute disorientation. He was previously relaxed and well. Which of the following is the most likely cause behind his condition?
Your Answer: Drug toxicity
Explanation:History of being well and sudden appearance of agitation and confused state at this age is suggestive of drug intake and toxicity.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 7
Correct
-
A 43-year-old female presents with an array of symptoms including weakness, lethargy, dysphagia, dry mouth, gritty sensation in her eyes and increased photosensitivity. In order to confirm the suspected diagnosis, which of the following tests should be performed?
Your Answer: Labial gland biopsy
Explanation:To confirm the diagnosis, especially in patients with negative anti-Ro or anti-La antibodies, labial gland biopsy is done. In performing a labial biopsy, the surgeon typically makes a shallow 1/2 inch wide incision on either side of the inner lip after numbing the area with a local anaesthetic. Schirmer’s test determines whether the eye produces enough tears to keep it moist. This test can be done for ocular symptoms of Sjogren syndrome but is of no diagnostic importance as it can be positive with many other diseases.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 8
Incorrect
-
A 16-year-old patient was admitted with walking difficulties and knee pain. Upon examination, his leg is externally rotated and is 2 cm shorter. His ability to flex, abduct and medially rotate his leg is limited and when he flexes his hip, external rotation is increased. What is the most probable diagnosis?
Your Answer: Osgood-Schlatter disease
Correct Answer: Slipped femoral epiphysis
Explanation:The clinical presentation is typical of a slipped femoral epiphysis, which refers to a fracture through the growth plate (physis), resulting in slippage of the overlying end of the femur. It is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. The range of motion in the hip is restricted in internal (medial) rotation, abduction, and flexion.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 9
Correct
-
An echocardiogram of a 50-year-old male patient showed an infarct in the anterolateral aspect of the left side of the heart and apex. An angiogram was then done. Obstruction of which of the following arteries is the cause of this myocardial infarction?
Your Answer: Left anterior descending artery
Explanation:The left coronary artery is responsible for supplying the entire left side of the heart, however, it divides into the left anterior descending artery which supplies the apex of the heart and the interventricular septum, and the left circumflex artery which supplies the posterolateral part of the left ventricle and a portion of the papillary muscle. The infarction is noted at the apex of the heart and the interventricular septum, therefore, the obstruction has occurred in the left anterior descending artery.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 10
Correct
-
A 3-year-old girl presents to A&E following a few days of being lethargic, having runny nose, sore throat, and fever. She has unceasing stridor and drooling of saliva while her body is inclined forward. What is the most important next step in her management?
Your Answer: Call ENT specialist
Explanation:A consultation with an ENT is required to establish the reason for the child’s drooling and stridor indicating and obstructive process. Enlarged tonsils and adenoids should be checked.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 11
Correct
-
A 45-year-old male is brought to the emergency department after being found collapsed, outside a nightclub. The ER team found an empty bottle of amyl nitrate in his pocket. The patient is hypoxic with an O2 saturation of 84% and is confused. Which of the following is the best treatment for this patient?
Your Answer: Methylene blue
Explanation:The best treatment for the patient in question would be methylene blue.
The most probable diagnosis in this patient is methemoglobinemia due to the ingestion of amyl nitrate.Amyl nitrate promotes the formation of methaemoglobin, which avidly conserves oxygen and leads to decreased tissue oxygen saturations.
Treatment of choice includes methylene blue and vitamin C.
Adverse effects:
Benign side effects include green or blue discoloration of urine and patients should be forewarned.
Significant side effects are based on methylene blue, itself, being an oxidizing agent and an inhibitor of monoamine oxidase A (MAO-A).
As an oxidizing agent, methylene blue can actually precipitate methemoglobinemia or haemolysis in high doses or when ineffectively reduced.
Methylene blue administration in a patient taking a serotonergic agents may predispose to serotonin syndrome.Note: Although methylene blue administration is controversial in the setting of G6PD-deficiency due to reduced levels of NADPH, it is not contraindicated and should be administered cautiously and judiciously.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 12
Correct
-
A 30-year-old lawyer presents with non-specific symptoms of tiredness.
Blood tests reveal normal thyroid function, cortisol, growth hormone and gonadotropins. Pituitary MRI reveals a 0.8cm microadenoma.
Which of the following represents the most appropriate course of action?Your Answer: Observation and reassurance
Explanation:The patient has a non-functioning pituitary tumour as her hormone profile is normal.
Non-functioning pituitary tumours are relatively common. A large number of these tumours are incidentally found pituitary microadenomas (<1 cm) and are usually of no clinical importance. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 13
Correct
-
A 66-year-old baker presents to the oncology clinic with six-month history of weight loss and anorexia. Tumour marker profile shows an elevated level of bombesin.
Out of the following, which is the most likely cancer to account for this result?Your Answer: Small cell lung carcinoma
Explanation:Bombesin is a tumour marker elevated in small cell lung carcinomas, as well as in gastric carcinomas and retinoblastomas.
Tumour markers can be divided into:
1. Monoclonal antibodies
CA 125: Ovarian cancer, primary peritoneal cancer
CA 19-9: Pancreatic cancer
CA 15-3: Breast cancer2. Tumour specific antigens
Prostate specific antigen (PSA): Prostatic carcinoma
Alpha-feto protein (AFP): Hepatocellular carcinoma, teratoma
Carcinoembryonic antigen (CEA): Colorectal cancer
S-100: Melanoma, schwannomas
Bombesin: Small cell lung carcinoma, gastric cancer3. Enzymes
Alkaline phosphatase (ALP)
Neuron specific enolase (NSE)4. Hormones
Calcitonin
Antidiuretic hormone (ADH)
Human chorionic gonadotropin (hCG) -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 14
Correct
-
A 50-year-old male patient with atrial fibrillation, who was on warfarin came to the clinic with an INR report of 7. Upon questioning it was revealed that he had been started on another drug recently, which was the reason for the prolonged INR. Which of the following drugs cause this?
Your Answer: Cimetidine
Explanation:Cimetidine inhibits hepatic microsomal activity, which may cause reduced metabolic clearance of warfarin and augments its anticoagulant effect. Pravastatin doesn’t affect the warfarin metabolism. Other drugs are enzyme inducers which will increase warfarin clearance.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 15
Correct
-
A 45-year-old male, came to the OPD with a complaint of severe headache on the right side with right-sided jaw pain and additional blurred vision in the right eye. The headache was throbbing in character. What is the single most appropriate investigation?
Your Answer: ESR
Explanation:The age of the patient, one sided headache and loss of vision on that side suggest temporal arteritis, also known as giant cell arteritis. The laboratory hallmark of this condition is a raised ESR.
-
This question is part of the following fields:
- Nervous System
-
-
Question 16
Incorrect
-
Which one of the following is true of gamma delta T cells?
Your Answer: They develop in the peripheral lymph nodes
Correct Answer: They play a role in the skin and gut
Explanation:Gamma delta T cells are of low abundance in the body, are found in the gut mucosa, skin, lungs and uterus, and are involved in the initiation and propagation of immune responses. Their ligands are not known in detail, but the gamma delta T cell receptors recognise intact proteins rather than MHC-presented peptides. Like alpha beta T cells, they develop in the thymus.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 17
Correct
-
A 20-year-old female has been referred for investigation of an iron deficiency anaemia. Her mother passed away at age 28, due to colonic carcinoma complicating Peutz-Jegher syndrome. Choose the mode of inheritance of Peutz-Jegher syndrome which is most likely.
Your Answer: Autosomal dominant
Explanation:Peutz-Jegher syndrome is an autosomal dominant condition which is characterised by perioral pigmentation and hamartomas of the bowel. It was initially assumed that these did not predispose to malignancy, but due to recent studies, the opposite is now believed to be true.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 18
Correct
-
A 45-year-old male who has had chemotherapy recently, presented with uncontrollable vomiting. What is the most appropriate treatment for this patient?
Your Answer: Ondansetron IM
Explanation:Ondansetron is the drug of choice for chemotherapy induced vomiting. IM or IV Ondansetron should be considered due to uncontrollable vomiting and thus inability to take medication orally.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 19
Correct
-
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: 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.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 20
Correct
-
A 51-year-old woman recently put on antihypertensives showed the following results on 2 occasions: Na+ = 132, K+ = 7.6, Urea = 11.3, and Creatinine = 112. Which of the following drugs is responsible for this result?
Your Answer: Ramipril
Explanation:Ramipril is an ACE Inhibitor. Treatment with angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) has consistently been shown to reduce the risk of renal and cardiovascular morbidity and mortality in a range of patients. However, ACEI and ARB therapy increase serum potassium which increases the risk of hyperkalaemia.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 21
Incorrect
-
A 35-year-old previously well male gives a history of on-and-off retrosternal heaviness during exertion, relieved by resting. Pain lasts about 20-25 minutes. What is the clinical diagnosis of this presentation?
Your Answer:
Correct Answer: Stable angina
Explanation:The history is suggestive of stable angina because of it’s duration, aggravating and relieving factors. Patients get retrosternal pain or discomfort which sometimes radiates to jaw or left axilla during a period of increased myocardial demand. Pain relieves during resting when myocardial demand meets supply.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 22
Incorrect
-
A 19-year-old female presented with irregular menstrual cycles for 4 months. On examination her weight was 85 kg and height was 145 cm. She was not on any medications. Which of the following is the most appropriate investigation to arrive at a diagnosis?
Your Answer:
Correct Answer: Pelvic ultrasound
Explanation:Oligomenorrhoea and BMI of 40.4 is suggestive of Polycystic ovary syndrome (PCOS). To diagnose PCOS 2 out of following 3 criteria should be present : oligo/anovulation, hyperandrogenism, clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone) and polycystic ovaries on ultrasound.
-
This question is part of the following fields:
- Women's Health
-
-
Question 23
Incorrect
-
A 43-year-old man is about to be started on chemotherapy for a high-grade lymphoma. He is given intravenous rasburicase to help lower the risk of tumour lysis syndrome (TLS).
What is the mechanism of action of this drug?Your Answer:
Correct Answer: Converts uric acid to allantoin
Explanation:Rasburicase is a recombinant version of urate oxidase which is an enzyme that metabolizes uric acid to allantoin.
TLS is a potentially fatal condition occurring as a complication during the treatment of high-grade lymphomas and leukaemias. It occurs from the simultaneous breakdown (lysis) of the tumour cells and subsequent release of chemicals into the bloodstream. This leads to hyperkalaemia and hyperphosphatemia in the presence of hyponatraemia. TLS can occur in the absence of chemotherapy, but it is usually triggered by the introduction of combination chemotherapy. Awareness of the condition is critical for its prophylactic management.
Patients at high risk of TLS should be given IV rasburicase or IV allopurinol immediately prior to and during the first few days of chemotherapy. Allantoin is much more water soluble than uric acid and is therefore more easily excreted by the kidneys. Patients in lower-risk groups should be given oral allopurinol during cycles of chemotherapy in an attempt to avoid the condition.
TLS is graded according to the Cairo-Bishop scoring system as:
1. Laboratory tumour lysis syndrome
2. Clinical tumour lysis syndrome -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 24
Incorrect
-
A 72-year-old male presents complaining of having intermittent trouble with swallowing. He has also been regurgitating stale food material. He sometimes wakes up in the middle of the night feeling like he is suffocating. Choose the most likely diagnosis.
Your Answer:
Correct Answer: Pharyngeal pouch
Explanation:In benign stricture, oesophageal carcinoma, and systemic sclerosis, there is persistent dysphagia (rather than intermittent). In oesophageal spasm, there is no regurgitation of stale food material. The symptoms described are consistent with pharyngeal pouch.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 25
Incorrect
-
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.
-
This question is part of the following fields:
- Renal System
-
-
Question 26
Incorrect
-
A 64-year-old woman presents with malaise, ankle swelling and shortness of breath. Her blood pressure is 215/140 mmHg, she has +2 peripheral oedema and the skin over her fingers appears very tight. Fundoscopy discloses bilateral papilledema.
Â
Plasma creatinine concentration is 370 μmol/l, potassium is 4.9 mmol/l, haemoglobin is 8.9 g/dl and her platelet count is 90 x 109 /ml.
Â
What is the pathological hallmark of this condition?Your Answer:
Correct Answer: Mucoid intimal thickening of vascular endothelium
Explanation:The history is suggestive of scleroderma renal crisis, where we would expect thrombotic microangiopathy process with vascular endothelium involvement manifesting as mucoid intimal thickening or onion skin effect.
-
This question is part of the following fields:
- Renal System
-
-
Question 27
Incorrect
-
A 24-year-old woman develops hyperthyroidism 6 weeks after delivery. On examination, she has a painless, firm enlarged thyroid gland.
Which of the following statements is most correct regarding her probable diagnosis?Your Answer:
Correct Answer: The condition is more likely in those in whom thyroid peroxidase (TPO) antibodies were positive prior to delivery
Explanation:Up to 10% of postpartum women may develop lymphocytic thyroiditis (postpartum thyroiditis) in the 2-12 months after delivery. The frequency may be as high as 25% in women with type 1 diabetes mellitus.
Some patients return spontaneously to a euthyroid state within a few months, but most patients experience a phase of hypothyroidism that takes 2 to 6 months to resolve; of this group, some develop permanent hypothyroidism. About 50% of patients, however, will develop permanent hypothyroidism within 5 years of the diagnosis of postpartum thyroiditis.
High titres of anti-TPO antibodies during pregnancy have been reported to have high sensitivity and specificity for postpartum autoimmune thyroid disease.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 28
Incorrect
-
A 64-year-old male patient was admitted for dysphagia, emesis and weight loss. He has a firm lump in his left supraclavicular fossa. What is the most probable diagnosis?
Your Answer:
Correct Answer: Gastric carcinoma
Explanation:The history is suggestive of gastric carcinoma with dysphagia, vomiting, weight loss and lymphatic metastasis to the supraclavicular node, known as Virchow’s node.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 29
Incorrect
-
A 35-year-old chronic smoker complains of pain in the calf while walking. This symptom has been increasing in severity for 4 months. There is a painful ulcer at the base of left first toe, which despite treatment has not improved. Dorsalis pedis and posterior tibial pulses were absent on the same side. What is the most compatible diagnosis of this presentation?
Your Answer:
Correct Answer: Thromboangitis Obliterans
Explanation:Thromboangitis obliterans or Buerger’s disease is an inflammatory vasculopathy which is characterized by an inflammatory endarteritis and mainly affects small and medium-sized arteries as well as veins of the upper and lower extremities. It is caused by a prothrombotic state and subsequent obstruction of blood vessels. Ischemic pain, features of inflammation along the vein affected, Raynaud’s phenomenon and painful non-healing ulcers are common presentations.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 30
Incorrect
-
A 70-year-old male came to the OPD with complaints of nocturia, difficulty in initiating urination and continuous dribbling of urine afterwards. A transrectal US guided biopsy was performed and the diagnosis of BPH was made. His TURP was planned. Which of the following electrolyte imbalance is most likely to occur?
Your Answer:
Correct Answer: Hyponatremia
Explanation:In a TURP procedure, fluid is used to irrigate the bladder and to remove blood clots. IV fluids are also given to the patient post-operatively. These factors will lead to dilutional hyponatremia.
-
This question is part of the following fields:
- Fluids & Electrolytes
-
-
Question 31
Incorrect
-
A 42-year-old male with long history of diabetes is complaining of a red-hot tender lump near his anus. What is the most possible diagnosis?
Your Answer:
Correct Answer: Abscess
Explanation:A diabetic patient is a patient with depressed immunity. It is not uncommon to develop abscesses. Diabetic patients have a defected cellular innate immunity. On the other hand, bacteria become much more virulent in a high glucose environment in the interstitium.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 32
Incorrect
-
A 63-year-old gentleman is admitted to the Emergency Department, with a past history of chronic renal failure, who complains of increasing shortness of breath. Bloods reveal a creatinine of 570 μmol/l, urea of 48 mmol/l. He is also anaemic with a haemoglobin (Hb) of 8.9 g/dl.
On examination he has a pericardial rub and there are bibasal crackles consistent with heart failure.
Which of the following represents the best treatment option for this patient?Your Answer:
Correct Answer: Urgent haemodialysis
Explanation:This case presents with symptoms and lab results suggestive of uremic pericarditis, which is an indication for immediate haemodialysis. Uremic pericarditis is caused by inflammation of the membranes of the pericardial sac, which usually resolves after a period of intensive dialysis.
-
This question is part of the following fields:
- Renal System
-
-
Question 33
Incorrect
-
A 70-year-old male tells doctors he has been exposed to asbestos 20 years ago and has attempted to quit smoking. He has lost a lot of weight and his voice is very hoarse. Choose the most likely cancer diagnosis in this patient.
Your Answer:
Correct Answer: Bronchial Carcinoma
Explanation:A hoarse voice, exposure to asbestos, and smoking are all consistent with bronchial carcinoma in this patient.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 34
Incorrect
-
Which of the following statements regarding restless leg syndrome is not true?
Your Answer:
Correct Answer: It is three times as common in females
Explanation:In restless leg syndrome (RLS), males and females are thought to be equally affected. RLS is a syndrome of spontaneous, continuous lower limb movements that may be associated with paraesthesia. It is extremely common, affecting between 2-10% of the general population and a family history may be present.
-
This question is part of the following fields:
- Nervous System
-
-
Question 35
Incorrect
-
In end stage renal disease, deficiency of erythropoietin can lead to which of the following conditions?
Your Answer:
Correct Answer: Anaemia
Explanation:Erythropoietin is necessary for normal Hb levels. Reduced levels of erythropoietin in renal failure leads to anaemia in these patients.
-
This question is part of the following fields:
- Renal System
-
-
Question 36
Incorrect
-
A 60-year-old male smoker presented in the emergency room with a history of chest pain and a cough for the last few days. He is now complaining of increasing dyspnoea and sharp pains around the 4th and 5th ribs. On CXR, there is right sided hilar enlargement. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Bronchogenic carcinoma
Explanation:The history of smoking with a cough and bone pain is suggestive of bronchogenic carcinoma. CXR findings are also supportive of this diagnosis. In COPD, a cough with dyspnoea and wheezing is prominent.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 37
Incorrect
-
A 75-year-old male with rheumatoid arthritis underwent a colectomy 2 days ago for colon cancer. He was put on a prophylactic dose of low molecular weight heparin postoperatively as well as prednisolone. Now he complains of central chest pain and his ECG revealed an acute ST elevation myocardial infarction. He was given aspirin and oxygen as the initial treatment. Which of the following is the most appropriate management for this patient?
Your Answer:
Correct Answer: IV diamorphine + arrange percutaneous coronary intervention
Explanation:There is a high risk of bleeding due to recent surgery and heparin. So thrombolysis is not an option. The most appropriate management is percutaneous coronary intervention.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 38
Incorrect
-
An 81-year-old male patient was admitted after an ischaemic stroke. Physical examination reveals left hemiparesis. How would you classify this hemiparesis based on the WHO International Classification of Functioning, Disability and Health?
Your Answer:
Correct Answer: Impairment of body function
Explanation:Symptoms and signs are classified as ‘impairment of body function’.
The types of impairment classified as ‘activity limitation’ include difficulties that a patient may have in executing certain activities.
The type of impairment classified as ‘participation restriction’ are problems a patient may have in social roles.
The type of impairment classified as ‘pathology’ would be the diagnosis/disease.
Right total anterior circulation infarct relates to the Oxford Bamford classification for stroke. -
This question is part of the following fields:
- Geriatric Medicine
-
-
Question 39
Incorrect
-
A 25-year-old female presented following an insect bite she complained of itching at the site of bite. What is the most appropriate management can be done at this stage?
Your Answer:
Correct Answer: Oral antihistamine
Explanation:Itching is due to release of histamine locally as a reaction to insect bites. Oral antihistamines are adequate as she doesn’t have other systemic features of anaphylaxis.
-
This question is part of the following fields:
- Immune System
-
-
Question 40
Incorrect
-
A 42-year-old male has suffered a stroke - he is unable to walk in a straight line and has slurred speech. From the list of options, choose the most appropriate investigation to proceed with.
Your Answer:
Correct Answer: CT scan brain
Explanation:CT scans are used to produce images of the brain. It can be used to detect a stroke from a blood clot or bleeding within the brain.
-
This question is part of the following fields:
- Nervous System
-
-
Question 41
Incorrect
-
What is the sign of life threatening asthma?
Your Answer:
Correct Answer: Deteriorating level of consciousness
Explanation:A drop in level of consciousness is an indicator of high levels of PCO2 and cerebral cortex depression. It is a life threatening condition that requires intervention which may include mechanical ventilation.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 42
Incorrect
-
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.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 43
Incorrect
-
A gentleman arrives at the renal clinic for review. He has long standing chronic renal failure and is unfortunately suffering from metabolic bone disease. His GP has asked for an explanation of the causes and features of metabolic bone disease.
Which of the following best describes the biochemical changes involved?Your Answer:
Correct Answer: Phosphate excretion is decreased, parathyroid hormone levels are increased and 1,25-OH vitamin D levels are decreased
Explanation:The patient’s chronic renal failure causes decreased renal hydroxylation of vitamin D which leads to decreased calcium absorption in the gut. Simultaneously, there is also decreased renal excretion of phosphate, and this combination of factors results in increased PTH levels.
-
This question is part of the following fields:
- Renal System
-
-
Question 44
Incorrect
-
A 60-year-old male had an MI one week ago, but has now presented with a pericardial rub and dyspnoea. An ECG was performed and shows ST elevation. A chest x-ray shows loss of margin at the costovertebral angle. Choose the single most likely cause.
Your Answer:
Correct Answer: Dressler's syndrome
Explanation:The pericardial rub indicates pericarditis, which then causes widespread ST elevation. Therefore, the condition is not a new MI but is Dressler’s syndrome.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 45
Incorrect
-
A 35-year-old man who has haemophilia B with associated arthropathy presents with a large swollen right knee, after playing football with his son. He is unable to bear weight on the affected knee joint.
What should be the most appropriate first step of treatment?Your Answer:
Correct Answer: Intravenous factor IX concentrate
Explanation:Haemophilia B (Christmas disease), is the deficiency of clotting factor IX and is inherited in an X-linked recessive pattern. The factor IX level dictates the disease severity and established arthropathy is usually seen in those with severe disease.
The aforementioned patient’s history and presentation is consistent with the development of hemarthrosis. Joint aspiration is not recommended. The treatment, therefore, should be intravenous replacement of the deficient clotting factor with plasma-derived factor IX concentrate.
The other listed options are ruled out because:
1. Joint aspiration is not preferred over the administration of clotting factor as the first step of management.
2. DDAVP (desmopressin) can increase factor VIII levels transiently in those with mild haemophilia A and is useful prior to minor surgical procedures in such patients.
3. Cryoprecipitate is rich in fibrinogen, factor VIII, and von Willebrand factor and is used in the treatment of haemophilia A. -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 46
Incorrect
-
A 60-year-old female with a recent history of MI, complained of exertional dyspnoea. On examination there was a third heart sound. ECG showed ST elevations in leads V1 to V4. Which of the following is the most probable reason for this presentation?
Your Answer:
Correct Answer: Left ventricular aneurysm
Explanation:Electrocardiography is characterized by ST elevation that persists several weeks after an acute MI. The features of heart failure (exertional dyspnoea and third or fourth heart sound) favours the diagnosis.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 47
Incorrect
-
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.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 48
Incorrect
-
Psoriatic arthropathy most commonly presents with which of the following types of arthritis?
Your Answer:
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.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 49
Incorrect
-
A 25-year-old girl's ECG revealed a normal PR interval and QRS while the QT is prolonged. History reveals she has been having frequent fainting attacks since childhood. What is the cause of these syncopal attacks?
Your Answer:
Correct Answer: Torsade de pointes
Explanation:Patients with a long QT wave syndrome are prone to recurrent syncope if they have Torsade’s de pointes since it degenerates into fibrillation of the ventricles.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 50
Incorrect
-
A 22-year-old man is being evaluated for chronic lower backache. Which of the following would most strongly point towards the diagnosis of ankylosing spondylitis?
Your Answer:
Correct Answer: Reduced lateral flexion of the lumbar spine
Explanation:Ankylosing spondylitis (spondylarthritis) is a chronic inflammatory disease of the axial skeleton that leads to partial or even complete fusion and rigidity of the spine. Males are disproportionately affected and upwards of 90% of patients are positive for the HLA-B27 genotype, which predisposes to the disease. The most characteristic early finding is pain and stiffness in the neck and lower back, caused by inflammation of the vertebral column and the sacroiliac joints. The pain typically improves with activity and is especially prominent at night. Other articular findings include tenderness to percussion and displacement of the sacroiliac joints (Mennell’s sign), as well as limited spine mobility, which can progress to restrictive pulmonary disease.
The most common extra-articular manifestation is acute, unilateral anterior uveitis. Diagnosis is primarily based on symptoms and x-ray of the sacroiliac joints, with HLA-B27 testing and MRI reserved for inconclusive cases. There is no curative treatment, but regular physiotherapy can slow progression of the disease. Additionally, NSAIDs and/or tumour necrosis factor-? inhibitors may improve symptoms. In severe cases, surgery may be considered to improve quality of life. The spine adopts a bamboo shape, not lordosis. The pain usually improves as the day progresses. leg raise test causes pain in cases of meningitis etc not in this case. -
This question is part of the following fields:
- Musculoskeletal System
-
SESSION STATS - PERFORMANCE PER SPECIALTY
