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Question 1
Incorrect
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A 56-year-old woman taking procainamide develops drug induced erythematosus. Which of the following features is the most characteristic of this condition?
Your Answer: It rarely causes pulmonary disease
Correct Answer: It may occur with chlorpromazine
Explanation:Drug induced lupus is usually positive for antinuclear and antihistone antibodies, typically without renal or neurologic involvement. However, pulmonary involvement is common. Drugs that can induce lupus include isoniazid, hydralazine, procainamide, chlorpromazine, and other anticonvulsants.
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This question is part of the following fields:
- Musculoskeletal System
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Question 2
Correct
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A 65-year-old male who was treated for atrial fibrillation 6 months ago, complained of painful swelling of the right breast/pectoral region. Following atrial fibrillation, he has taken a number of drugs. Which of the following drugs is responsible for the above presentation?
Your Answer: Spironolactone
Explanation:Spironolactone induces gynecomastia by blocking androgen production. It blocks androgens from binding to their receptors, and increasing both total and free oestrogen levels. Generally, discontinuation of treatment results in resolution of the gynecomastia. Other drugs which cause gynecomastia are calcium channel blockers (Nifedipine, Amlodipine, Verapamil, Diltiazem), ACE inhibitors (Captopril, Enalapril), alpha receptor blockers (Doxazocin, Prazosin) and centrally acting agents (Clonidine, Methyldopa, Reserpine).
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This question is part of the following fields:
- Pharmacology
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Question 3
Incorrect
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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: Not at all
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 4
Incorrect
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A 78-year-old male presents to the emergency department with shortness of breath that has developed gradually over the last 4 days. His symptoms include fever and cough productive of greenish sputum. Past history is notable for COPD for which he was once admitted to the ICU, 2 years back. He now takes nebulizers (ipratropium bromide) at home. The patient previously suffered from myocardial infarction 7 years ago. He also has Diabetes Mellitus type II controlled by lifestyle modification.
On examination, the following vitals are obtained.
BP : 159/92 mmHg
Pulse: 91/min (regular)
Temp: Febrile
On auscultation, there are scattered ronchi bilaterally and right sided basal crackles. Cardiovascular and abdominal examinations are unremarkable.
Lab findings are given below:
pH 7.31
pa(O2) 7.6 kPa
pa(CO2) 6.3 kPa
Bicarbonate 30 mmol/l
Sodium 136 mmol/l
Potassium 3.7 mmol/l
Urea 7.0 mmol/l
Creatinine 111 μmol/l
Haemoglobin 11.3 g/dl
Platelets 233 x 109 /l
Mean cell volume (MCV) 83 fl
White blood cells (WBC) 15.2 x 109 /l.
CXR shows an opacity obscuring the right heart border.
Which of the following interventions should be started immediately while managing this patient?Your Answer: An antibiotic
Correct Answer: Salbutamol and ipratropium bromide nebulisers
Explanation:Acute exacerbations of chronic obstructive pulmonary disease (COPD) are immediately treated with inhaled beta2 agonists and inhaled anticholinergics, followed by antibiotics (if indicated) and systemic corticosteroids. Methylxanthine therapy may be considered in patients who do not respond to other bronchodilators.
High flow oxygen would worsen his symptoms. Usually titrated oxygen (88 to 92 %) is given in such patients to avoid the risk of hyperoxic hypercarbia in which increasing oxygen saturation in a chronic carbon dioxide retainer can inadvertently lead to respiratory acidosis and death. -
This question is part of the following fields:
- Geriatric Medicine
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Question 5
Correct
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A 54-year-old woman presents to the A&E department with a five-day history of back pain which is located in the lower thoracic region and is worsened by coughing and sneezing. There has been no change in bowel habit or urinary symptoms. Her past medical history includes breast cancer and osteoarthritis. On examination, there is diffuse tenderness in the lower thoracic region. Perianal sensation is normal and lower limb reflexes are brisk.
Which one of the following is the most appropriate management plan?Your Answer: Oral dexamethasone + urgent MRI
Explanation:The patient has spinal cord compression until proven otherwise. Urgent assessment is required.
Spinal cord compression is an oncological emergency and affects up to 5% of cancer patients. Extradural compression accounts for the majority of cases, usually due to vertebral body metastases. One of the most common causes of spinal cord compression is osteoarthritis. It is also more commonly seen in patients with lung, breast, or prostate cancer.
Clinical features include:
1. Back pain: the earliest and most common symptom, may worsen on lying down or coughing
2. Lower limb weakness
3. Sensory changes: sensory loss and numbness
4. Neurological signs: depending on the level of the lesion.
Lesions above L1 usually result in upper motor neurone signs in the legs. Lesions below L1 usually cause lower motor neurone signs in the legs and perianal numbness. Tendon reflexes are increased below the level of the lesion and absent at the level of the lesion.Management options are:
1. High-dose oral dexamethasone
2. Urgent MRI for consideration of radiotherapy or surgery -
This question is part of the following fields:
- Haematology & Oncology
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Question 6
Correct
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A 65-year-old man, after suffering from a pathological rib fracture, complains of recurrent infection. Bone marrow aspiration revealed a calcium level of 3.9 mmol/l and alkaline phosphatase level of 160u/l. What type of cell would be found in abundance in the marrow spear?
Your Answer: Plasma cells
Explanation:Multiple myeloma or plasma cell myeloma, is a cancer of plasma cells, responsible for producing antibodies. It often, presents early with no symptoms followed by bone pain and pathological fractures (metastases), raised calcium levels, bleeding, frequent infections, and anaemia. It usually occurs around the age of 61 and is more common in men than women.
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This question is part of the following fields:
- Geriatric Medicine
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Question 7
Correct
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A 42-year-old obese man complains of a painful swollen ankle. The pain has worsened over the past 2 weeks. He is a diabetic and gives a history of recent alcohol consumption. Joint aspirate shows rhomboid crystals with numerous neutrophils. Radiological examination shows evidence of chondrocalcinosis. Which of the following is the most likely diagnosis?
Your Answer: Pseudogout
Explanation:Pseudogout is a paroxysmal joint inflammation due to calcium pyrophosphate crystal deposition (calcium pyrophosphate dihydrate). Aetiology includes mostly idiopathic (primary form) and secondary form occurring as a result of joint trauma, familial chondrocalcinosis, hyperparathyroidism, hemochromatosis, gout, hypophosphatemia. Clinical presentation: Often asymptomatic.
Acute (pseudogout attack): monoarthritis (rarely oligoarthritis), mostly affecting the knees and other large joints (e.g., hips, wrists, and ankles). It may become chronic (can affect multiple joints). Osteoarthritis with CPPD (most common form of symptomatic CPPD): progressive joint degeneration with episodes of acute inflammatory arthritis typical of pseudogout attacks. Arthrocentesis should be performed, especially in acute cases. Polarized light microscopy: detection of rhomboid-shaped, positively birefringent CPPD crystals. Synovial fluid findings: 10,000-50,000 WBCs/μL with > 90% neutrophils. X-ray findings: cartilage calcification of the affected joint (chondrocalcinosis). Fibrocartilage (meniscus, annulus fibrosus of intervertebral disc) and hyaline cartilage (joint cartilage) may be affected. -
This question is part of the following fields:
- Musculoskeletal System
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Question 8
Incorrect
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A 57-year-old female presented to the cardiology centre with a history of chest tightness accompanied by pain radiating to the left side of the neck and left shoulder. The pain started 3 hours ago. ECG was normal. What is the next best investigation for this patient?
Your Answer: ECG
Correct Answer: Cardiac enzymes
Explanation:This patient’s symptoms of angina radiating to the neck and shoulders gives a strong suspicion of MI. Cardiac enzymes such as troponins are highly specific and sensitive for a heart attack.
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This question is part of the following fields:
- Cardiovascular System
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Question 9
Correct
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A 80-year-old male was found on the floor. His blood pressure was 100/60 mmHg. His core temperature was 31ºC. His FBC and serum electrolytes were within normal limits. Which of the following would be found in his ECG?
Your Answer: Long QT interval
Explanation:Hypothermia is defined as a core body temperature of < 35 °C.
Hypothermia may produce the following ECG changes:
-Bradyarrhythmia
-Osborne Waves (= J waves)
-Prolonged PR, QRS and QT intervals
-Shivering artefact
-Ventricular ectopics
-Cardiac arrest due to VT, VF or asystole -
This question is part of the following fields:
- Cardiovascular System
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Question 10
Incorrect
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A 75-year-old man has presented to the clinic with a complaint of disturbed sleep. The physician has prescribed temazepam. Which of the following best describes the mechanism of action of this drug?
Your Answer: Inhibits the effect gamma-aminobutyric acid
Correct Answer: Enhances the effect of gamma-aminobutyric acid
Explanation:Temazepam is an orally available benzodiazepine used in the therapy of insomnia.
The soporific activity of the benzodiazepines is mediated by their ability to enhance gamma-aminobutyric acid (GABA) mediated inhibition of synaptic transmission through binding to the GABA-A receptor.
The recommended initial dose for insomnia is 7.5 mg before bedtime, increasing as needed to a maximum dose of 30 mg.The most common side effects of temazepam are dose-related and include daytime drowsiness, lethargy, ataxia, dysarthria, and dizziness.
Tolerance develops to these side effects, but tolerance may also develop to the effects on insomnia. -
This question is part of the following fields:
- Pharmacology
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Question 11
Correct
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A 34-year-old known alcoholic male has been found unconscious near a pub. The paramedics that attended to him said he was sweating and surrounded by empty cans of cider. Choose the most appropriate initial investigation from the list of options.
Your Answer: Capillary blood sugar
Explanation:Capillary blood sugar should be tested as alcohol-induced hypoglycaemia can present itself in cases such as these.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 12
Correct
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A 65-year-old male patient presented with acute severe central chest pain for one hour. His ECG confirmed the diagnosis of acute ST elevation myocardial infarction and he was treated with thrombolysis. Two days later he developed sudden onset breathlessness and became unwell. On examination he had bibasal crepitation and a systolic murmur at the apex which radiated to the axilla. Which of the following is the most likely cause for this presentation?
Your Answer: Ruptured papillary muscle
Explanation:The most likely cause for acute breathlessness is due to papillary muscle rupture which causes mitral regurgitation.
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This question is part of the following fields:
- Cardiovascular System
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Question 13
Correct
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A 44-year-old woman is investigated for hot flushes and night sweats. Her blood tests show a significantly raised FSH level and her symptoms are attributed to menopause. Following discussions with the patient, she elects to have hormone replacement treatment. What is the most significant risk of prescribing an oestrogen-only preparation rather than a combined oestrogen-progestogen preparation?
Your Answer: Increased risk of endometrial cancer
Explanation:The use of hormone replacement therapy (HRT) based on unopposed oestrogen increases the risk of endometrial cancer, and uterine hyperplasia or cancer.
Evidence from randomized controlled studies showed a definite association between HRT and uterine hyperplasia and cancer. HRT based on unopposed oestrogen is associated with this observed risk, which is unlike the increased risk of breast cancer linked with combined rather than unopposed HRT. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 14
Correct
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A 65-year-old female presented in emergency 12 hours after the ingestion of 14g of quinine sulphate. Which of the following is the most likely side effect of this drug?
Your Answer: Blindness
Explanation:The main effects of quinine affect the nervous system. It particularly affects the optic and auditory nerves. While affecting the auditory nerve it may cause tinnitus and deafness but not hyperacusis. Blindness is the effect of this drug on the optic nerve.
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This question is part of the following fields:
- Pharmacology
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Question 15
Incorrect
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A 50-year-old woman came to the diabetes clinic for her regular follow up.
The following results are obtained:
Urine analysis: Protein+
HBA1c 86 mmol/mol (10.0%)
What is her average blood glucose level during the past 2 months?Your Answer: 9
Correct Answer: 15
Explanation:The level of haemoglobin A1c (HbA1c), also known as glycated haemoglobin, determines how well a patient’s blood glucose level has been controlled over the previous 8-12 weeks. Recent studies have been made to correlate between HbA1c and average glucose level.
Using the following formula: Average blood glucose (mmol/l) = (1.98 x 1 HbA1c) – 4.29 -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 16
Incorrect
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A young woman with facial butterfly rash suffers from symmetrical joint pains in her knees and elbows. Moreover, she experiences morning stiffness and her ESR is raised. Which of the following would determine the diagnosis?
Your Answer: Anti la antibodies
Correct Answer: Anti-DNA antibodies
Explanation:The symptoms described in the question lead to suspicion of SLE because they fulfil three out of four criteria for a positive diagnosis. Anti-DNA antibodies have a diagnostic power for systemic lupus erythematosus (SLE), being a formal classification criterion.
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This question is part of the following fields:
- Musculoskeletal System
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Question 17
Incorrect
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A 59-year-old man complains of weakness in his right lower and upper limb since 3 for a few hours. He is has been taking Digoxin for 2 years. What is the most definitive investigation for this condition?
Your Answer: MRI
Correct Answer: Angiography
Explanation:Digoxin is a cardiac glycoside, having positive inotropic effects on the heart. It increases the strength of contractility of the heart, increasing the heart rate, but lowering blood pressure. This patient developed weakness in his limbs most likely caused by extremely low blood pressure that could be due to diseased blood vessels reacting to the side-effects of digoxin, therefore an angiography would be the best investigation.
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This question is part of the following fields:
- Cardiovascular System
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Question 18
Incorrect
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A middle-aged female presented in the emergency department with breathlessness for the last few hours. Lung function tests were performed and the results showed her TLCO to be very low but the KCO was 190%. Which of the following is the most probable cause of such findings?
Your Answer: Primary pulmonary hypertension (PPH)
Correct Answer: Neuromuscular chest wall disorder
Explanation:A patient suffering from extrapulmonary restriction like a neuromuscular chest wall disorder would show similar signs and symptoms. Due to the restriction the lungs cannot fully inflate for gaseous exchange and hence TLCO drops. On the other hand, no change in cardiac output takes place and this leads to higher density of blood per unit volume resulting in raised KCO. No such findings are observed in diseases like scleroderma, PPH, hereditary haemorrhagic telangiectasia and alpha-1 antitrypsin deficiency.
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This question is part of the following fields:
- Respiratory System
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Question 19
Correct
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A 30-year-old male is brought to the emergency department following his collapse in a nightclub. His friends who accompanied him admit that, of recent, he has been using increasing amounts of cocaine. Which among the following is commonly associated with cocaine overdose?
Your Answer: Metabolic acidosis
Explanation:Metabolic acidosis is associated with cocaine overdose.
In overdose, cocaine leads to agitation, tachycardia, hypertension, sweating, hallucinations, and finally convulsions.
Metabolic acidosis, hyperthermia, rhabdomyolysis, and ventricular arrhythmias also occur.
Chronic use may be associated with premature coronary artery disease, dilated cardiomyopathy, and increased risk of cerebral haemorrhage.
There are 3 stages for acute cocaine toxicity:
Stage I: CNS symptoms of headache, vertigo, pseudo hallucinations, hyperthermia, hypertension.
Stage II: increased deep tendon reflexes, tachypnoea, irregular breathing, hypertension.
Stage III: Areflexia, coma, fixed and dilated pupils, hypotension, ventricular fibrillation, apnoea, and respiratory failure.Treatment:
– Airway, breathing, and circulation to be secured. The patient’s fever should be managed, and one should rule out hypoglycaemia as a cause of the neuropsychiatric symptoms.
– Cardiovascular toxicity and agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic outflow.
– The mixed beta/alpha blocker labetalol is safe and effective for treating concomitant cocaine-induced hypertension and tachycardia.
– Non-dihydropyridine calcium channels blockers such as diltiazem and verapamil have been shown to reduce hypertension reliably, but not tachycardia.
– Dihydropyridine agents such as nifedipine should be avoided, as reflex tachycardia may occur.
– The alpha-blocker phentolamine has been recommended but only treats alpha-mediated hypertension and not tachycardia. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 20
Correct
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A 70-year-old male patient presents with a history hematochezia and rectal tenesmus for the last six months. What is most probable diagnosis?
Your Answer: Colorectal adenocarcinoma
Explanation:The patient presents with symptoms of possible colorectal adenocarcinoma. When located in the left colon, it typically presents with tenesmus and bleeding. On the right side usually presents with anaemia, weight loss and abdominal pain.
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This question is part of the following fields:
- Gastrointestinal System
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Question 21
Incorrect
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Which of the following forms of acute viral hepatitis has a much higher mortality in pregnant than non-pregnant females?
Your Answer: Hepatitis C
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 22
Incorrect
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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: Febrile non-haemolytic blood reaction
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 23
Incorrect
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Which of the following is the most useful marker of prognosis in multiple myeloma?
Your Answer: Urine Bence Jones protein levels
Correct Answer: B2-microglobulin
Explanation:B2-microglobulin is a useful marker of prognosis in multiple myeloma (MM). Raised levels imply a poorer prognosis. Low levels of albumin are also associated with a poor prognosis.
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This question is part of the following fields:
- Haematology & Oncology
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Question 24
Incorrect
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A 35-year-old gentleman presents to the Emergency Department with abdominal pain. This started earlier on in the day and is getting progressively worse. The pain is located on his left flank and radiates down into his groin. He has no history of this pain or any other condition. Examination reveals a gentleman who is flushed and sweaty but is otherwise unremarkable. What is the most suitable initial management?
Your Answer: IM diclofenac 75 mg + start bendroflumethiazide to prevent further episodes
Correct Answer: IM diclofenac 75 mg
Explanation:Because of the patient’s presentation with flank pain that radiates to the groin, we are suspecting renal colic. We should follow guidelines for acute renal management and prescribe IM diclofenac for immediate relief of pain.
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This question is part of the following fields:
- Renal System
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Question 25
Incorrect
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A 39-year-old accountant with long-standing gastro-oesophageal reflux disease is reviewed in clinic. He has recently switched from ranitidine to omeprazole.
What is the main benefit of omeprazole compared to ranitidine?Your Answer: More effective histamine receptor antagonism
Correct Answer: Irreversible blockade of H+/K+ ATPase
Explanation:Proton pump inhibitors can reduce gastric acid secretion by up to 99%. Acid production resumes following the normal renewal of gastric parietal cells.
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This question is part of the following fields:
- Pharmacology
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Question 26
Incorrect
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A 21-year-old male was brought in unconscious state with high fever, swollen nasal mucosa and constricted pupils. Which of the following substances can cause this presentation?
Your Answer: Heroin
Correct Answer: Cocaine
Explanation:This presentation is suggestive of cocaine toxicity. The major effects of cocaine poisoning include CNS effects such as agitation, seizures and psychosis, and cardiovascular effects such as dysrhythmias, myocardial infarction and cardiovascular collapse. The common route for cocaine ingestion is through the nose, hence the irritated swollen septum.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 27
Incorrect
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Which of the given adverse effects should be anticipated following the administration of an anticholinesterase?
Your Answer: Tachycardia and lacrimation
Correct Answer: Bradycardia and miosis
Explanation:Bradycardia and miosis should be anticipated following the administration of anticholinesterases.
Anticholinesterase agents include the following medications:
– Pyridostigmine, neostigmine, and edrophonium which play a significant role in the diagnosis and the management of myasthenia gravis.
– Rivastigmine, galantamine and donepezil are cholinesterase inhibitors found to be significantly useful in the management of Alzheimer’s disease.Mechanism of action and pharmacological effects:
Inhibition of cholinesterase increases the level and the duration of action of acetylcholine within the synaptic cleft.Thus, cholinergic effects such as a reduction in heart rate (bradycardia), miosis (pupillary constriction), increased secretions, increased gastrointestinal motility and reduction in BP may occur with anticholinesterases.
Toxins such as organophosphates and carbamates also are primarily anticholinergic and cause the following typical SLUDGE symptoms:
– Salivation
– Lacrimation
– Urination
– Diaphoresis
– Gastrointestinal upset
– Emesis -
This question is part of the following fields:
- Pharmacology
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Question 28
Correct
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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: 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 29
Correct
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A 28-year-old man is investigated for lethargy. His full blood count (FBC) report shows:
Hb: 8.6 g/dL
Plts: 42 x 10^9/L
WCC: 36.4 x 10^9/L
His blood film report reveals 30% myeloblasts with Auer rods. Given the likely diagnosis, which one of the following is associated with a good prognosis?Your Answer: Translocation between chromosome 15 and 17
Explanation:A translocation between chromosome 15 and 17 is seen in acute promyelocytic leukaemia (APL), which is known to carry a good prognosis.
Acute myeloid leukaemia (AML) is the acute expansion of the myeloid stem line, which may occur as a primary disease or follow the secondary transformation of a myeloproliferative disorder. It is more common over the age of 45 and is characterized by signs and symptoms largely related to bone marrow failure such as anaemia (pallor, lethargy), frequent infections due to neutropenia (although the total leucocyte count may be very high), thrombocytopaenia (bleeding), ostealgia, and splenomegaly. The disease has poor prognosis if:
The disease has poor prognosis if:
1. Age of the patient >60 years
2. >20% blasts seen after the first course of chemotherapy
3. Chromosomal aberration with deletion of part of chromosome 5 or 7.APL is an aggressive form of AML. It is associated with t(15;17) and has a good prognosis. The general age of presentation is less than that in other types of AML (average age is 25 years old). On blood film, abundant Auer rods are seen with myeloperoxidase staining. Thrombocytopaenia or DIC is seen in patients presenting with this disease.
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This question is part of the following fields:
- Haematology & Oncology
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Question 30
Correct
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A 25-year-old woman with type-1 diabetes mellitus attends for her routine review and says she is keen on becoming pregnant.
Which of the following is most likely to make you ask her to defer pregnancy at this stage?Your Answer: Hb A1C 9.4%
Explanation:Pregnancies affected by T1DM are at increased risk for preterm delivery, preeclampsia, macrosomia, shoulder dystocia, intrauterine fetal demise, fetal growth restriction, cardiac and renal malformations, in addition to rare neural conditions such as sacral agenesis.
Successful management of pregnancy in a T1DM patient begins before conception. Research indicates that the implementation of preconception counselling, emphasizing strict glycaemic control before and throughout pregnancy, reduces the rate of perinatal mortality and malformations.
The 2008 bulletin from the National Institute for Health and Clinical Excellence recommends that preconception counselling be offered to all patients with diabetes. Physicians are advised to guide patients on achieving personalized glycaemic control goals, increasing the frequency of glucose monitoring, reducing their HbA1C levels, and recommend avoiding pregnancy if the said level is > 10%.
Other sources suggest deferring pregnancy until HbA1C levels are > 8%, as this margin is associated with better outcomes. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 31
Correct
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A 23-year-old female visited the OPD with a complaint of postcoital bleeding as well as excessive vaginal discharge. Her past medical history is positive for oral contraceptive pills. Which of the following investigations would you recommend in this case?
Your Answer: Speculum with or without cervical smear
Explanation:A speculum test is necessary in order to visualize the cervix to rule out cervical ectropion that may be responsible for the post-coital bleeding. A smear is not necessary if the cervix is adequately visualized, however, it can rule out infection as well.
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This question is part of the following fields:
- Women's Health
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Question 32
Incorrect
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A 62 year male presented with epistaxis, nasal blockage, double vision, ear fullness and left sided conductive deafness for 1 week. He was a heavy smoker and alcoholic. Which of the following is the most probable diagnosis?
Your Answer: Pharyngeal ca
Correct Answer: Nasopharyngeal ca
Explanation:Because of the involvement of nose, ear and vision, the most probable diagnosis is nasopharyngeal carcinoma. Both smoking and alcohol are risk factors.
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This question is part of the following fields:
- Respiratory System
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Question 33
Incorrect
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A 85-year-old previously well man was found to have a BP of 155/90 mmHg. His average reading from the monitoring of his ambulatory BP was 147/92 mmHg. His calculated 10 year cardiovascular risk was 15%. Which of the following is the most appropriate management of this patient?
Your Answer: Start a calcium channel blocker
Correct Answer: Give lifestyle advice and repeat blood pressure in 6 months
Explanation:According to different guidelines for patients above 80 years, the targeted systolic blood pressure varies from 140-150 mmHg. As this patient’s BP is within that range, he can be kept under observation.
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This question is part of the following fields:
- Cardiovascular System
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Question 34
Incorrect
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Which of the following is true of Koplik's spots?
Your Answer: Only appear when fever is over 39°C
Correct Answer: Are diagnostic of measles
Explanation:Koplik’s spots are pathopneumonic for MEASLES. They are blue/white spots, small, occurring on the buccal mucosa. They typically occur next to premolars, not opposite to the incisors. They are not related to fever height. They are not on the hands. They usually occur BEFORE the rash.
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This question is part of the following fields:
- Infectious Diseases
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Question 35
Incorrect
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A 30-year-old female presented with complaints of anxiety, tremors, sweating, tachycardia and weight loss despite increased appetite. Which of the following pathogenesis is responsible for such symptoms?
Your Answer: Increased level of calcitonin
Correct Answer: Increased metabolic rate
Explanation:These symptoms are suggestive of thyrotoxicosis. In this disease, the basal metabolic rate of the patients is increased due to excessive thyroid hormones in the blood.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 36
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: Diverticulitis
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 37
Incorrect
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A new blood test developed to screen individuals for cardiac failure was performed on 500 patients. The results were positive for 40 out of 50 patients with echocardiography-established heart failure. However, the test was also positive for 20 patients with no signs of heart failure. What is the positive predictive value of the test?
Your Answer: 0.33
Correct Answer: 0.66
Explanation:Positive predictive value = TP (true positives) / [TP + FP (false positives)] = 40 / (40 + 20) = 0.66
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This question is part of the following fields:
- Evidence Based Medicine
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Question 38
Incorrect
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A 29-year-old male patient with a history of three previous chest infections in the past seven months presents with fever, pleuritic pain and productive cough. Chest x-ray shows lobar consolidation and the diagnosis of a fourth chest infection is established, after sputum culture reveals Haemophilus influenzae. The previous chest infections were due to Streptococcus pneumoniae. After a period of six weeks, a full blood count, urea, CRP, electrolytes and chest x-ray turn out as normal. What is the investigation you would choose next?
Your Answer: Spirometry
Correct Answer: Serum immunoglobulins
Explanation:Hypogammaglobulinemia occurs due to a variety of underlying primary or secondary immunodeficient states, including HIV which is suspected in this case. The most commonly recognised clinical feature is recurrent infection.
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This question is part of the following fields:
- Respiratory System
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Question 39
Incorrect
-
A study is carried out to assess the efficacy of a rapid urine screening test developed to detect Chlamydia. The total number of people involved in the study were 200. The study compared the new test to the already existing NAAT techniques. The new test was positive in 20 patients that were Chlamydia positive and in 3 patients that were Chlamydia negative. For 5 patients that were Chlamydia positive and 172 patients that were Chlamydia negative the test turned out to be negative. Choose the correct value regarding the negative predictive value of the new test:
Your Answer: 20/23
Correct Answer: 172/177
Explanation:The definition of negative predictive value is the probability that the individuals with truly negative screening test don’t have Chlamydia. The equation is the following: Negative predictive value = Truly negative/(truly negative + false negative) = 172 / (172 + 5) = 172 / 177
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This question is part of the following fields:
- Evidence Based Medicine
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Question 40
Incorrect
-
A 17-year-old Caucasian woman presents with lethargy and chronic nausea. Her mother is worried she may be depressed.
On examination, there are signs of chronic liver disease and a gold-yellow ring at the periphery of the iris in both eyes. Her serum copper level is low.
What is the most likely diagnosis?Your Answer: Haemochromatosis
Correct Answer: Wilson's disease
Explanation:This patient has Wilson’s disease. They Kayser-Fleischer ring (ring that encircles the iris) is diagnostic of this. Low serum copper is seen in Wilson’s disease. With the Kayser-Fleischer ring, this makes all of the other answer choices incorrect.
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This question is part of the following fields:
- Gastrointestinal System
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Question 41
Incorrect
-
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: Ventricular Aneurysm
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 42
Incorrect
-
A 60-year old male presented to the OPD with a complaint of a rusty-coloured sputum along with a cough for 3 days. His has a history of smoking for 40 years, and a history of significant weight loss. His chest X-ray revealed solid nodules in both lungs and bilateral hilar lymphadenopathy. Out of the following, which one is the most appropriate investigation?
Your Answer: US
Correct Answer: LN biopsy
Explanation:The patient’s age, a history of long-term smoking, and bilateral hilar lymphadenopathy are strong indications of malignancy. Lymph node biopsy would be essential in order to check the degree of metastasis in the mediastinal lymph nodes.
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This question is part of the following fields:
- Respiratory System
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Question 43
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: Penicillin
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 44
Incorrect
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A 71-year-old woman residing in a nursing home for a couple of years complains of drooling of saliva and sudden difficulty in swallowing while eating. She is a known hypertensive on treatment. What would be your next step?
Your Answer: Chest CT
Correct Answer: Endoscopy
Explanation:Dysphagia or difficulty in swallowing. Endoscopy allows for visual examination of the oesophagus and is indicated in patients with dysphagia to determine the underlying aetiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy including dilation.
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This question is part of the following fields:
- Geriatric Medicine
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Question 45
Correct
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A 72-year-old man is referred to the haematology department with raised haemoglobin and platelet levels. A diagnosis of polycythaemia vera is suspected.
Which other abnormality of the blood would be most consistent with this diagnosis?Your Answer: Neutrophilia
Explanation:Neutrophilia is also commonly associated with polycythaemia vera.
Polycythaemia vera (PV), also known as polycythaemia rubra vera, is a myeloproliferative disorder caused by clonal proliferation of marrow stem cells leading to an increase in red cell volume, often accompanied by overproduction of neutrophils and platelets. It has peak incidence in the sixth decade of life, with typical features including hyperviscosity, pruritus, splenomegaly, haemorrhage (secondary to abnormal platelet function), and plethoric appearance.
Some management options of PV include lose-dose aspirin, venesection (first-line treatment), hydroxyurea (slightly increased risk of secondary leukaemia), and radioactive phosphorus (P-32) therapy.
In PV, thrombotic events are a significant cause of morbidity and mortality. 5-15% of the cases progress to myelofibrosis or AML. The risk of having AML is increased with chemotherapy treatment.
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This question is part of the following fields:
- Haematology & Oncology
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Question 46
Correct
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A 69-year-old male with a history of Hepatitis C liver cirrhosis presented with spontaneous bacterial peritonitis. He had no symptoms of hypovolaemia. Choose the best treatment option to prevent the patient from developing hepatorenal syndrome.
Your Answer: Intravenous albumin administration
Explanation:In randomised controlled trials, the administration of albumin has been shown to lower the risk of the hepatorenal syndrome – this is thought to be due to its positive effect on circulatory systems. Diuretics can aid in the prevention of renal failure, but this patient is not showing signs of hypovolaemia. Synthetic disaccharide lactulose is primarily used for the prevention of hepatic encephalopathy, which has no function in preventing hepatorenal syndrome. Limited evidence is available for the use of Neomycin as a treatment for hepatic encephalopathy, but is associated with nephrotoxicity and ototoxicity.
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This question is part of the following fields:
- Renal System
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Question 47
Incorrect
-
Which of the following conditions is least likely to exhibit the Koebner phenomenon?
Your Answer: Molluscum contagiosum
Correct Answer: Lupus vulgaris
Explanation:The Koebner phenomenon refers to skin lesions appearing on lines of trauma, exposure to a causative agents including: molluscum contagiosum, warts and toxicodendron dermatitis or secondary to scratching rather than an infective or chemical cause include vitiligo, psoriasis, lichen planus, lichen nitidus, pityriasis rubra pilaris, and keratosis follicularis (Darier disease).
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This question is part of the following fields:
- The Skin
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Question 48
Incorrect
-
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.
Â
Which treatment would be the most effective for his condition?Your Answer: Flucloxacillin
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 49
Incorrect
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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: Repeat blood film
Correct 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 50
Incorrect
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A patient presented with acute onset of mild right hemiparesis affecting the body. He also has evidence of sensory loss on the right hand side. There is evidence of Horner's syndrome and sensory loss on the face on the left hand side.
Which of the following structures are involved?Your Answer: Parietal lobe
Correct Answer: Brain stem
Explanation:The patient is presenting with symptoms of lateral medullary syndrome also known as Wallenberg’s syndrome or posterior inferior cerebellar artery syndrome, where the symptoms are due to an ischemia in the brainstem. The classical symptoms include contralateral sensory deficits of the trunk region paired with ipsilateral facial sensory deficits.
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This question is part of the following fields:
- Nervous System
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Question 51
Correct
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A 32-year-old man, who is on salbutamol and low dose budesonide, has be suffering from recurrent asthma attacks for the last week. What is the next drug of choice?
Your Answer: Salmeterol
Explanation:According to recent guidelines on asthma management, after administering SABA as needed, low doses of ICS are indicated. In this case the patient already takes budesonide so he now requires a long acting beta agonist (LABA), in this case salmeterol.
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This question is part of the following fields:
- Respiratory System
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Question 52
Incorrect
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A 4-year-old girl is diagnosed with acute lymphoblastic leukaemia after presenting with lethargy and easy bruising. Which of the following is a marker of a bad prognosis in this disease?
Your Answer:
Correct Answer: Philadelphia chromosome positive
Explanation:Philadelphia translocation, t(9;22), is a marker of poor prognosis in acute lymphoblastic leukaemia (ALL).
ALL is the malignancy of lymphoid progenitor cells affecting B or T cell lineage. This results in the arrest of lymphoid cell maturation and proliferation of immature blast cells (lymphoblasts), leading to bone marrow and tissue infiltration.
ALL is the most common type of childhood cancers. Its peak incidence is between two to three years of age.
Acute B lymphoblastic leukaemia (B-ALL) is the most common type of ALL, involving overproduction of B-cell lymphoblasts. It is manifested by low initial WCC and is associated with a good prognosis.
Poor prognostic factors for ALL include:
1. Pre-B cell or T-cell ALL (T-ALL)
2. Philadelphia translocation, t(9;22)
3. Age <2 years or >10 years
4. Male sex
5. CNS involvement
6. High initial WBC (e.g. >100 x 10^9/L)
7. non-Caucasian -
This question is part of the following fields:
- Haematology & Oncology
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Question 53
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 54
Incorrect
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Which one of the following congenital infections is most characteristically associated with chorioretinitis?
Your Answer:
Correct Answer: Toxoplasma gondii
Explanation:The common congenital infections encountered are rubella, toxoplasmosis and cytomegalovirus. Cytomegalovirus is the most common congenital infection in the UK. Maternal infection is usually asymptomatic.
Congenital toxoplasmosis is associated with fetal death and abortion, and in infants, it is associated with neurologic deficits, neurocognitive deficits, and chorioretinitis. -
This question is part of the following fields:
- Infectious Diseases
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Question 55
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 56
Incorrect
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A 30-year-old female presents with a 4-day history of diarrhoea and vomiting. She has been unable to keep fluids down for 4 days and has been treated with metoclopramide. She develops a dystonic reaction.
What is the most appropriate treatment for the woman?Your Answer:
Correct Answer: Benztropine
Explanation:Acute dystonic reactions (extrapyramidal symptoms) such as spasmodic torticollis, trismus, and oculogyric crises can occur following the administration of metoclopramide or stemetil and thus, neither is recommended for the treatment of nausea in young women.
Such reactions respond well to treatment with benztropine or procyclidine.
– Benztropine: It is an anticholinergic medication with significant CNS penetration.
A single dose of benztropine 1 to 2 mg IV followed by 1 to 2 mg p.o twice a day for up to 7 days to prevent a recurrence. Subsequently, both the offending agent and those from the same group should be avoided.
– Alternatively, diphenhydramine can be used intravenously (up to a dose of 50mg) or intramuscularly followed by p.o therapy every 6 hours for 1 to 2 to prevent a recurrence.
– Second-line therapy with IV benzodiazepines is reserved for those patients who do not respond to anticholinergics. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 57
Incorrect
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A 42-year-old female presents with morning stiffness that usually takes an hour to settle and a one year history of intermittent pain and swelling of the small joints of her hands. Examination reveals symmetric soft tissue swelling over the PIP and MCP joints and rheumatoid nodules on the elbows. There is also an effusion of both wrists. Lab results are positive for rheumatoid factor. X-ray of the wrists and hands shows erosions and bony decalcification. NSAIDs are started and the patient is referred to a rheumatologist for consideration of DMARD. Previous history is significant for TB. Which of the following should be avoided?
Your Answer:
Correct Answer: Infliximab
Explanation:Anti-TNF-? therapy is effective for patients with arthritis but it can oftentimes lead to the reactivation of latent TB. Hence it should be used with great caution in patients with a past history of TB or current infection.
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This question is part of the following fields:
- Musculoskeletal System
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Question 58
Incorrect
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A 62 year-old patient with a history of a stroke, presented with chest pain and exertional dyspnoea. ECG revealed atrial fibrillation and on chest X-ray there was straightening of the left heart border. The most likely diagnosis will be?
Your Answer:
Correct Answer: Rheumatic mitral valve stenosis
Explanation:Symptoms of exertional dyspnoea, atrial fibrillation and radiological evidence of straightening of the left heart border favours the diagnosis of rheumatoid mitral valve stenosis.
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This question is part of the following fields:
- Cardiovascular System
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Question 59
Incorrect
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A newly married female presented with fever, dysuria, frequency and lower abdominal pain for 2 days duration. On examination, she was febrile with lower abdominal tenderness. Urine microscopy reveals 20-30 pus cells/hpf and 10-20 red cells/hpf. Which of the following would be the most probable cause for this presentation?
Your Answer:
Correct Answer: Cystitis
Explanation:The patient has what is known as ‘honeymoon cystitis’.
Most common presentation of schistosomiasis is haematuria.
Patients with kidney trauma also present with haematuria following a positive history for such injury.
Pain due to calculi are colicky in nature and severe. -
This question is part of the following fields:
- Women's Health
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Question 60
Incorrect
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A 65-year-old woman was referred due to a pulse rate of 40 bpm. Which of the following answers is associated with the least risk of asystole?
Your Answer:
Correct Answer: Complete heart block with a narrow complex QRS
Explanation:From the given answers, complete heart block with a narrow complex QRS complex is associated with the least risk of asystole. Transvenous pacing is indicated by the other given responses.
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This question is part of the following fields:
- Cardiovascular System
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Question 61
Incorrect
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A 40-year-old male returning from an African country, presented with lower abdominal pain and haematuria. Bladder calcifications were detected on abdominal x-ray. Which of the following is the most probable cause?
Your Answer:
Correct Answer: Schistosoma haematobium
Explanation:Schistosoma haematobium characteristically causes urinary tract disease. S.mansoni, S. mekongi, S. intercalatum, and S. japonicum cause intestinal tract and liver disease.
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This question is part of the following fields:
- Infectious Diseases
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Question 62
Incorrect
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A 37-year-old woman presents with sudden blindness. She claims she had a similar episode last year which resolved in three months. Fundoscopy is normal. Upon examination, mild weakness of the right upper limb is found. Reflexes on the same limb are exaggerated. What is the best treatment?
Your Answer:
Correct Answer: Corticosteroids
Explanation:The age of the patients together with sudden loss of vision, remission and relapse of optic neuritis, focal neurological symptoms and exaggerated reflexes all suggest multiple sclerosis. This is treated with corticosteroids.
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This question is part of the following fields:
- Nervous System
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Question 63
Incorrect
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From the following options, choose the one which is not a cause of liver cirrhosis.
Your Answer:
Correct Answer: Schistosomiasis
Explanation:Schistosomiasis is a cause of portal hypertension and periportal fibrosis – it is, however, not a cause of cirrhosis. The main causes of cirrhosis include: alcohol and hepatitis B, C, and D. Autoimmune causes include: both primary and secondary biliary cirrhosis and autoimmune hepatitis. There are a number of inherited conditions which cause cirrhosis, such as hereditary hemochromatosis, Wilson’s disease, Alpha-1 anti-trypsin deficiency, galactosaemia glycogen storage disease, and cystic fibrosis. Additionally, there are also vascular causes, such as hepatic venous congestion, Budd-Chiari syndrome, and veno-occlusive disease. Intestinal bypass surgery has also been implicated as a causative factor for cirrhosis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 64
Incorrect
-
A 48-year-old hairdresser presents to the GP with loss of sensation over the lateral three and a half fingers of her right hand, tenderness over her right forearm, and inability to make a tight fist. She complains of pain in her right arm when twisting door handles anticlockwise. Phalen's and Tinel's tests are negative. She is otherwise neurologically intact. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Pronator teres syndrome
Explanation:Entrapment of the median nerve by pronator teres causes a median nerve neuropathy, which is worse during pronation of the forearm. Examination should involve excluding carpal tunnel syndrome and pronation of the affected forearm against resistance, which brings on the pain. Unlike carpal tunnel syndrome, the median nerve proximal to the wrist may be tender to palpation.
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This question is part of the following fields:
- Nervous System
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Question 65
Incorrect
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Which of the following is the drug of choice for the treatment of Chlamydia trachomatis infection during pregnancy?
Your Answer:
Correct Answer: Amoxicillin
Explanation:Tetracycline is not recommended in pregnancy because of the risk to fetal development (bones, teeth!). Metronidazole in pregnancy: currently not thought to be an increased risk in pregnancy; however this is not effective against chlamydia. Amoxicillin is shown to be an adequate treatment for chlamydia, so this is the correct answer.
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This question is part of the following fields:
- Infectious Diseases
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Question 66
Incorrect
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Which type of myocardial infarction has the worst prognosis?
Your Answer:
Correct Answer: Anterior wall MI complicated with continuing left ventricular failure and an exercise tolerance of 3 METS on a predischarge exercise test
Explanation:Exercise tolerance of 3 METS on a predischarge exercise test is the most important indicator of a poor post-MI prognosis. Other similar features that predispose the individual to a poor prognosis are resuscitation from a secondary ventricular tachyarrhythmia after the fist 24h and poor left ventricular function on echo.
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This question is part of the following fields:
- Cardiovascular System
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Question 67
Incorrect
-
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:
Correct 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 68
Incorrect
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A 45-year-old smoker presented with sudden onset of chest pain radiating to his left arm, with associated sweating. ECG showed ST elevation in leads I, aVL and V1-V4. The most likely diagnosis would be?
Your Answer:
Correct Answer: Anterior MI
Explanation:An anterior wall myocardial infarction is characterised by ST elevation in leads I, aVL and V1-V5.
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This question is part of the following fields:
- Cardiovascular System
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Question 69
Incorrect
-
A 69 year-old librarian with motor neuron disease is seen in clinic. Which of the following interventions will have the greatest effect on survival?
Your Answer:
Correct Answer: Non-invasive ventilation
Explanation:Motor neuron disease is a neurological condition of unknown cause which can present with both upper and lower motor neuron signs. It rarely presents before age 40 and various patterns of disease are recognised, including amyotrophic lateral sclerosis, progressive muscular atrophy and bulbar palsy.
Non-invasive ventilation (usually BIPAP) is used at night, with studies having shown a survival benefit of around 7 months. Riluzole prevents stimulation of glutamate receptors, used mainly in amyotrophic lateral sclerosis and has been shown to prolong life by about 3 months. -
This question is part of the following fields:
- Nervous System
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Question 70
Incorrect
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A 71-year-old woman presents with dyspnoea and unsteadiness. She's known to suffer from epilepsy and is managed on carbamazepine. Blood exams are as follows: MCV=70, Hb=8.5, WBC=2, Neutrophils=1, Platelets=50. What is the most likely diagnosis?
Your Answer:
Correct Answer: Aplastic anaemia
Explanation:The results of the blood exam are suggestive of aplastic anaemia which might be secondary to carbamazepine use. The use of antiepileptic’s, in particular carbamazepine and valproate, is associated with a nine fold increased risk of aplastic anaemia.
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This question is part of the following fields:
- Haematology & Oncology
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Question 71
Incorrect
-
A 35-year-old male developed difficulty in breathing following administration of IV Co-amoxiclav. On examination he was flushed, there were bilateral rhonchi and his blood pressure was 80/50 mmHg. What is the immediate management of this patient?
Your Answer:
Correct Answer: Epinephrine 0.5 mg IM
Explanation:This case indicates an anaphylactic reaction. The causative factor should be stopped or removed as soon as possible and IM Epinephrine 0.5mg administered. IV Epinephrine can also be considered provided that it is adequately diluted.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 72
Incorrect
-
Regarding the pathophysiology of diabetes mellitus, which of the following is true?
Your Answer:
Correct Answer: Concordance between identical twins is higher in type 2 diabetes mellitus than type 1
Explanation:Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4. Although the genetic aspect of type 1 DM is complex, with multiple genes involved, there is a high sibling relative risk. Whereas dizygotic twins have a 5-6% concordance rate for type 1 DM, monozygotic twins will share this diagnosis more than 50% of the time by the age of 40 years.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 73
Incorrect
-
A team of physicians presented their audit of fluid management for dengue haemorrhagic fever one year ago. A number of recommendations were made at that time and changes were implemented. Which of the following is the most appropriate next step that this team should take?
Your Answer:
Correct Answer: Re-audit
Explanation:Clinical audit is defined as a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. To see whether the recommendations have been implemented, a re-audit has to be performed.
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This question is part of the following fields:
- Ethical & Legal
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Question 74
Incorrect
-
A 70-year-old man underwent emergency surgery for an acute abdomen. Following surgery, he was noted to be oliguric. Investigations revealed the following: Sodium 121 mmol/L (137-144) Potassium 6.6 mmol/L (3.5-4.9) Chloride 92 mmol/L (95-107) Urea 17.2 mmol/L (2.5-7.5) Creatinine 250 µmol/L (60-110) pH 7.16 (7.36-7.44) Standard bicarbonate 15.6 mmol/L (20-28). What is the calculated anion gap for this patient?
Your Answer:
Correct Answer: 20 mmol/L
Explanation:Anion gap is calculated as (Na + K) − (Cl + HCO3). Therefore in this patient, the calculated value is 20 mmol/L. The normal anion gap is between 8-16 mmol/l. The excessive value here reflects the presence of other acidic anions, and in this case with the metabolic acidosis, the constituents may be lactate, etc.
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This question is part of the following fields:
- Renal System
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Question 75
Incorrect
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A 35-year-old male was brought to you in a confused state. Although not your patient, you can make out that the man has a history of schizophrenia, and has recently had his medications altered. Clinically, you find evidence of a lower respiratory tract infection, and blood investigations indicate a neutropenic picture.
What is the most likely drug causing the neutropenia?Your Answer:
Correct Answer: Clozapine
Explanation:Clozapine can cause neutropenia or agranulocytosis.
Clozapine is an atypical antipsychotic used in the treatment of schizophrenia, and in patients who are intolerant to, or unresponsive to other antipsychotics.
It is a weak D2-receptor and D1-receptor blocking activity, with noradrenolytic, anticholinergic, and antihistaminic properties.
Many antipsychotic drugs can occasionally cause bone marrow depression, but agranulocytosis is particularly associated with clozapine.
Other side effects include:
Hypotension, tachycardia
Fever, sedation, seizures (with high doses)
Appetite increase
Constipation
Heartburn
Weight gain
Extrapyramidal symptoms
Agranulocytosis
Neuroleptic malignant syndrome -
This question is part of the following fields:
- Pharmacology
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Question 76
Incorrect
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A 60-year-old male was diagnosed as diabetic (DM type 2). He has a BMI=32. Lifestyle modification and exercise have failed to control his blood glucose levels. His labs were: urea=3.5mmol/l, creatinine=90 mmol/l, HbA1c=7.5g/dl. What will be the next management step?
Your Answer:
Correct Answer: Biguanide
Explanation:For type 2 diabetics, biguanides are the treatment of choice.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 77
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 78
Incorrect
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A 42-year-old female presented with pain in her calves during walking which settled after resting. On examination there were orange colour deposits in the her palmar creases. Her fasting lipid profile showed a total cholesterol of 9.2 mmol/l (<5) and triglycerides of 7.0 mmol/l (<2). Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Type III hyperlipidaemia
Explanation:Palmar xanthomas are found in type III hyperlipoproteinemia. Her total cholesterol level and triglyceride level support the diagnosis.
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This question is part of the following fields:
- Cardiovascular System
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Question 79
Incorrect
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A 21-year-old male presents with severe right-sided chest pain. On examination, percussion was hyper-resonant and breath sounds were reduced on the right side. He has no history of any respiratory illness or trauma. What condition is this patient suffering from?
Your Answer:
Correct Answer: Simple Pneumothorax
Explanation:Pneumothorax refers to a condition in which air or gases accumulate inside the pleural space causing the lungs to collapse. Because the patient did not have a history of any previous pulmonary disease or trauma, this is a case of simple pneumothorax.
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This question is part of the following fields:
- Respiratory System
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Question 80
Incorrect
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A child with jaundice and pale stools would most likely be evaluated by which of the following tests?
Your Answer:
Correct Answer: US
Explanation:Blood tests do not help in the diagnosis of jaundice except of course by telling the level of jaundice (bilirubin) and providing some corroborative evidence such as autoantibodies, tumour markers or viral titres in the case of hepatitis. Classifying causes of jaundice on the basis of ultrasound provides a quick and easy schema for diagnosing jaundice which is applicable in primary care as well as hospital based practice.
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This question is part of the following fields:
- Hepatobiliary System
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Question 81
Incorrect
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A 51-year-old man was admitted with right-sided hemiparesis and right upper motor neuron facial nerve palsy. He was known to be on warfarin for a mitral valve replacement and had been adequately anticoagulated. He was also taking furosemide and had recently been started on St John's wort for low mood.
On examination, his pulse was 90 bpm and regular, and his blood pressure was 150/80 mmHg. Cardiac examination demonstrated normal prosthetic valve sounds with an ejection systolic murmur at the left sternal edge. CT scan showed evidence of a left middle cerebral artery infarction.
What is the possible explanation for the presentation?Your Answer:
Correct Answer: St John's wort reduces the activity of warfarin
Explanation:St John’s wort interferes with warfarin by increasing its breakdown and decreasing its effectiveness. This leads to the need for adjustment in the dose of warfarin and careful attention to monitoring if the patient decides to continue with the drug. Ideally, an alternative antidepressant should also be considered.
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This question is part of the following fields:
- Haematology & Oncology
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Question 82
Incorrect
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All of the following statements regarding glucagon-like peptide-1 (GLP-1) are true, except?
Your Answer:
Correct Answer: Increased levels are seen in type 2 diabetes mellitus
Explanation:Glucagon-like peptide 1 (GLP-1) is a 30-amino acid peptide hormone produced in the intestinal epithelial endocrine L-cells by differential processing of proglucagon. GLP-1 is released in response to meal intake.
The main actions of GLP-1 are to stimulate insulin secretion (i.e., to act as an incretin hormone) and to inhibit glucagon secretion, thereby contributing to limit postprandial glucose excursions. It also inhibits gastrointestinal motility and secretion and thus acts as an enterogastrone and part of the ileal brake mechanism. GLP-1 also appears to be a physiological regulator of appetite and food intake.
Decreased secretion of GLP-1 may contribute to the development of obesity, and exaggerated secretion may be responsible for postprandial reactive hypoglycaemia. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 83
Incorrect
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An ECG taken on a patient shows dominant R wave in V1. Which of the following cannot be the reason for above ECG change?
Your Answer:
Correct Answer: Primary pulmonary hypertension
Explanation:Dominant R wave in V1 can be a normal variant in children and young adults. Other causes are right ventricular hypertrophy, pulmonary embolus, persistence of left to right shunt, Right Bundle Branch Block (RBBB), posterior myocardial infarction (ST elevation in Leads V7, V8, V9), Wolff-Parkinson-White (WPW) Type A, Incorrect lead placement (e.g. V1 and V3 reversed), dextrocardia, hypertrophic cardiomyopathy and dystrophy (myotonic dystrophy and Duchenne Muscular dystrophy).
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This question is part of the following fields:
- Cardiovascular System
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Question 84
Incorrect
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An 82-year-old woman is brought in by her carer with fluctuating consciousness. On examination she is deeply jaundiced, hypotensive with a tachycardia and has a hepatic flap. Initial blood tests reveal an ALT of 1000 U/l, INR 3.4, ALP 600 U/l and a bilirubin of 250 mmol/l.
Repeat blood tests 6 hours later show an ALT of 550 U/l, INR 4.6, ALP 702 U/l and bilirubin of 245 m mol/l. The toxicology screen for paracetamol and aspirin is negative; she is positive for hepatitis B surface antibody and negative for hepatitis B surface antigen.
Which of the following would best explain her clinical condition?Your Answer:
Correct Answer: Acute liver failure secondary to paracetamol
Explanation:Liver flap is pathognomonic for liver failure. Paracetamol (also known as acetaminophen) overdose usually presents with symptoms including liver failure, resulting in confusion, jaundice, and coagulopathy a few days after overdose. The first 24 hours, people usually have minimal symptoms. Diagnosis is based on blood levels of acetaminophen at specific times after it was taken (see reference). If she took it a few days ago, levels may indeed be undetectable. The hepatitis B serology suggests prior vaccination. Wilson’s disease is not the most likely diagnosis given her presentation. The AST:ALT ratio would be expected to be reversed in alcohol induced liver failure.
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This question is part of the following fields:
- Hepatobiliary System
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Question 85
Incorrect
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A 68-year-old gentleman has been receiving dialysis for 6 years. His PTH is elevated at 345 pg/ml (NR 25-65), phosphate 2.13 mmol/l and corrected calcium 2.01 mmol/l.
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Of the following, which is most likely responsible for renal osteodystrophy?Your Answer:
Correct Answer: Diminished activity of renal 1-?-hydroxylase
Explanation:Renal osteodystrophy is a metabolic bone disease often affecting long-term dialysis patients. The kidneys are no longer able to maintain the calcium levels in the blood, thus the PTH increases as the body attempts to raise blood calcium levels. Osteomalacia in these cases is most likely caused by the diminished activity of renal 1-a-hydroxylase that is important for hydroxylation of Calciferol to calcitriol (Vitamin D). This bioactive form of Vitamin D is responsible for increasing intestinal absorption of calcium.
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This question is part of the following fields:
- Renal System
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Question 86
Incorrect
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A 12-year-old boy has a history of fever for one week (39C), with no other symptoms leading up to the fever. He recently had a surgical extraction of one of his incisors two weeks before consultation. On examination of CVS, a mid-systolic click followed by a late systolic murmur is heard. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Infection
Explanation:Tooth extraction or any surgical procedure may introduce bacteria into the blood stream. The most commonly involved organisms include Staphylococcus aureus and Streptococcus viridans. Once in the blood, these organisms have a very high tendency of attaching to the walls of the heart and causing inflammation known as endocarditis.
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This question is part of the following fields:
- Cardiovascular System
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Question 87
Incorrect
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A 50-year-old lung cancer patient presents with diminished reflexes, retention of urine, postural hypotension and sluggish pupillary reaction. What is the most likely explanation for her symptoms?
Your Answer:
Correct Answer: Paraneoplastic syndrome
Explanation:Paraneoplastic syndromes are more common in patients with lung cancer. Signs and symptoms include inappropriate antidiuretic hormone secretion, finger clubbing, hypercoagulability and Eaton-Lambert syndrome.
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This question is part of the following fields:
- Respiratory System
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Question 88
Incorrect
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A 40-year-old man presents with recurrent headaches, 2-3 times a day, associated with sweating and palpitations.
His blood pressure during the attacks is around 220/120 mmHg.
Given the likely diagnosis, what is the next appropriate investigation?Your Answer:
Correct Answer: 24 hour urinary collection of metanephrines
Explanation:Classically, pheochromocytoma manifests with the following 4 characteristics:
– Headaches
– Palpitations
– Sweating
– Severe hypertensionThe Endocrine Society, the American Association for Clinical Chemistry, and the European Society of Endocrinology have released clinical practice guidelines for the diagnosis and management of pheochromocytoma.
Biochemical testing via measurement of plasma free metanephrines or urinary fractionated metanephrines should be performed in patients suspected of having pheochromocytoma.Catecholamines produced by pheochromocytomas are metabolized within chromaffin cells. Norepinephrine is metabolized to normetanephrine and epinephrine is metabolized to metanephrine. Because this process occurs within the tumour, independently of catecholamine release, pheochromocytomas are best diagnosed by measurement of these metabolites rather than by measurement of the parent catecholamines.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 89
Incorrect
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A 28-year-old male complained of an annular rash following an insect bite he received during a hiking trip. Which of the following is the drug of choice?
Your Answer:
Correct Answer: Doxycycline PO
Explanation:The described rash is the typical rash of erythema migrans of Lyme disease, which is treated by doxycycline PO
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This question is part of the following fields:
- Infectious Diseases
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Question 90
Incorrect
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A patient was given Penicillin G pre-operatively. Which of the following procedures was he waiting for?
Your Answer:
Correct Answer: Splenectomy
Explanation:Asplenic patients are at a high risk of fulminant sepsis which is usually caused by capsulated organisms such as Streptococcus pneumonia, Haemophilus influenzas and Neisseria meningitides. So all the patients who are awaiting splenectomy should be given antibiotic prophylaxis. (Penicillin, if allergy to Penicillin, Clarithromycin)
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This question is part of the following fields:
- Emergency & Critical Care
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Question 91
Incorrect
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Which of the following features is not associated with an oculomotor nerve palsy?
Your Answer:
Correct Answer: Miosis
Explanation:Oculomotor nerve palsy is an eye condition resulting from damage to the third cranial nerve or a branch thereof. A complete oculomotor nerve palsy will result in a characteristic down and out position in the affected eye. This is because the lateral rectus (innervated by the sixth cranial nerve) and superior oblique (innervated by the fourth cranial or trochlear nerve), is unantagonized by the paralyzed superior rectus, inferior rectus and inferior oblique. The affected individual will also have a ptosis, or drooping of the eyelid, and mydriasis (pupil dilation), not miosis.
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This question is part of the following fields:
- Nervous System
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Question 92
Incorrect
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A 20-year-old boy presented with left hemiscrotal pain and fever for 2 days. He denied any history of trauma. On examination he was febrile. There was redness and tenderness of the left hemiscrotum. Which of the following is the most appropriate management for this patient?
Your Answer:
Correct Answer: Give antibiotics
Explanation:The history is suggestive of acute Epididymo-orchitis. The treatment option is antibiotics.
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This question is part of the following fields:
- Men's Health
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Question 93
Incorrect
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A 43-year-old woman is concerned about osteoporosis as she as a strong family history of it. She is one year postmenopausal and aware of hot flushes at night.
Which one of the following therapies would be most appropriate?Your Answer:
Correct Answer: Cyclical oestrogen and progestogen
Explanation:As the patient has early menopause, hormone replacement therapy (HT) is considered to be the first line of choice for prevention of bone loss and fracture in the early postmenopausal period for 5 years.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 94
Incorrect
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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.
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What is the most likely diagnosis?Your Answer:
Correct 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 95
Incorrect
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A young woman is concerned that she has put on weight since she was a medical student, as she now no longer finds time to exercise. She decides to try various weight loss tablets temporarily.
After 2 months, she is successfully losing weight but also has trouble with increased stool frequency, difficulty in climbing stairs and getting up out of chairs. However, she has no problems walking on the flat.
She also has difficulty in sleeping at the moment but puts that down to the increased frequency of headaches for the past 2 months.
Which one of the following is the most likely cause of her weakness?Your Answer:
Correct Answer: She is abusing thyroxine tablets
Explanation:Exogenous thyroid hormone use has been associated with episodes of thyroid storm as well as thyrotoxic periodic paralysis.
It presents with marked proximal muscle weakness in both upper and lower limbs, hypokalaemia and signs of hyperthyroidism.
Hyperthyroidism generally presents with tachycardia, hypertension, hyperthermia, and cardiac arrhythmiasLaxatives and diuretics can result in electrolyte abnormalities.
Medical complications associated with laxatives include chronic diarrhoea which disrupts the normal stool electrolyte concentrations that then leads to serum electrolyte shifts; acutely, hypokalaemia is most typically seen. The large intestine suffers nerve damage from the chronic laxative use that renders it unable to function properly. The normal peristalsis and conduction are affected; the disorder is thought to be secondary to a degeneration of Auerbach’s Plexi. However, it does not cause muscle weakness.Insulin tends to cause weight gain, not weight loss.
Metformin does not cause muscle weakness but can cause headaches. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 96
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 97
Incorrect
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A 71-year-old male got trapped under a cupboard for 4 hours which accidentally fell on his leg while he was moving his house. Which enzyme activity would you measure in this patient?
Your Answer:
Correct Answer: Creatinine kinase
Explanation:Creatine kinase (CK) is an enzyme found in the heart, brain, skeletal muscle, and other tissues. Increased amounts of CK are released into the blood when there is muscle damage. This test measures the amount of creatine kinase in the blood.
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This question is part of the following fields:
- Musculoskeletal System
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Question 98
Incorrect
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A 68-year-old man who has chronic obstructive pulmonary disease (COPD) is reviewed. On examination, there is evidence of cor pulmonale with a significant degree of pedal oedema. His FEV1 is 44%. During a recent hospital stay his pO2 on room air was 7.4 kPa.
Which one of the following interventions is most likely to increase survival in this patient?Your Answer:
Correct Answer: Long-term oxygen therapy
Explanation:Assess the need for oxygen therapy in people with:
– very severe airflow obstruction (FEV1 below 30% predicted)
– cyanosis (blue tint to skin)
– polycythaemia
– peripheral oedema (swelling)
– a raised jugular venous pressure
– oxygen saturations of 92% or less breathing air.Also consider assessment for people with severe airflow obstruction (FEV1 30-49% predicted).
Consider long-term oxygen therapy for people with COPD who do not smoke and who:
have a partial pressure of oxygen in arterial blood (PaO2) below 7.3 kPa when stable or have a PaO2 above 7.3 and below 8 kPa when stable, if they also have 1 or more of the following:
– secondary polycythaemia
– peripheral oedema
– pulmonary hypertension. -
This question is part of the following fields:
- Respiratory System
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Question 99
Incorrect
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Which of the following cancers is responsible in producing osteoblastic bone metastases instead of osteolytic?
Your Answer:
Correct Answer: Prostate adenocarcinoma
Explanation:Osteoblastic (or sclerotic) bone metastases, characterized by deposition of new bone, present in prostate cancer, carcinoid, small cell lung cancer, Hodgkin lymphoma or medulloblastoma.
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This question is part of the following fields:
- Musculoskeletal System
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Question 100
Incorrect
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An 8-year-old girl was bought immediately to the emergency department. She is fully conscious but has stridor, is wheezing and has a generalised erythematous rash. She has known allergies. What is the single immediate management?
Your Answer:
Correct Answer: Give 0.3ml in 1000 adrenaline by IM injection
Explanation:This is a case of an anaphylactic reaction that requires immediate intervention. IM adrenaline dose for 6-12 year old children is 300 micrograms IM.
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This question is part of the following fields:
- Emergency & Critical Care
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SESSION STATS - PERFORMANCE PER SPECIALTY
