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Question 1
Incorrect
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A 85-year-old male with a history of Alzheimer's dementia was brought into Casualty by family members, who stated that he had episodes of aggression. Which of the following drugs is most suitable as the pharmacological management for this presentation?
Your Answer: Quetiapine
Correct Answer: Risperidone
Explanation:Regarding the pharmacological management, Risperidone is the most suitable drug from the given answers as it is recommended for the treatment of aggression associated with moderate to severe Alzheimer’s disease. Quetiapine and Benzodiazepine are not recommended.
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This question is part of the following fields:
- Geriatric Medicine
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Question 2
Incorrect
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Which one of the following statements regarding minimal change glomerulonephritis is incorrect?
Your Answer: The majority of cases are steroid responsive
Correct Answer: Hypertension is found in approximately 25% of patients
Explanation:Hypertension and haematuria are not common presentations in minimal change glomerulonephritis, all other statements are correct.
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This question is part of the following fields:
- Renal System
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Question 3
Incorrect
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A 51-year-old smoker was recently diagnosed with non small cell lung carcinoma. Investigations show presence of a 3 x 3 x 2 cm tumour on the left side of the lower lung lobe. the mass has invaded the parietal pleura. Ipsilateral hilar node is also involved but there is no metastatic spread.
What is the stage of this cancer?Your Answer: T4 N1 M0
Correct Answer: T2 N1 M0
Explanation:The tumour has only invaded the visceral pleura and measures 3cm in the greatest dimension. Hence it is designated at T2. Ipsilateral peribronchial and/or hilar lymph node involvement would make it N1. There is no distal metastasis so M would be 0.
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This question is part of the following fields:
- Respiratory System
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Question 4
Correct
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A 30-year-old patient with schizophrenia was brought to Emergency Department, due to reduced level of consciousness. On examination he was febrile, rigid and had tremors. Which of following does not support the diagnosis of neuroleptic malignant syndrome?
Your Answer: Usually occurs after prolonged treatment
Explanation:Neuroleptic Malignant Syndrome is a life-threatening condition associated with neuroleptic medications. It is characterized by severe muscular rigidity, hyperthermia, autonomic instability (tachycardia, tachypnoea etc) and changes in the level of consciousness. It usually occurs 4-14 days after the start of therapy. Renal failure and elevated creatinine kinase are also associated with this condition.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 5
Incorrect
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A 65-year-old male patient admitted with myocardial infarction received thrombolysis, which lead to full resolution of the ST elevations on his ECG. He was on aspirin, clopidogrel, atorvastatin and enalapril. The next day he complained of pain in his legs and there was a diffuse petechial rash over his lower legs, especially in the feet. All his peripheral pulses were palpable. His FBC revealed neutrophilia with eosinophilia. His IgE antibodies were 3 kU/L (<2). What is the most likely reason for this presentation?
Your Answer: Allergic reaction to thrombolysis
Correct Answer: Cholesterol emboli
Explanation:He has a consequence of atherosclerotic disease (MI). The most probable diagnosis is cutaneous cholesterol emboli as it is more common after anticoagulation or thrombolytics, the skin involvement, eosinophilia and raised IgE. It is more common above 60 yrs. of age.
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This question is part of the following fields:
- Cardiovascular System
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Question 6
Incorrect
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According to the Ann Arbor staging system for Hodgkin lymphoma, which one of the following would be staged as IIIB?
Your Answer: Two or more lymph nodes on the same side of the diaphragm with night sweats
Correct Answer: Nodes on both sides of diaphragm with night sweats
Explanation: -
This question is part of the following fields:
- Haematology & Oncology
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Question 7
Incorrect
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An 80-year-old woman with advanced COPD has been admitted to the medicine ward in an unconscious state. She appears to have an acute lower respiratory tract infection. After consulting with an anaesthesiologist it was concluded that she was not a candidate for intensive care unit admission and thus, a decision was made to start the patient on doxapram therapy. Which of the following best fits the characteristics of doxapram?
Your Answer: It causes hypotension
Correct Answer: It is contraindicated in hyperthyroidism
Explanation:The two statements that fit the characteristics of doxapram are, epilepsy is a contraindication for doxapram use and concurrent use with theophylline may increase agitation.
Doxapram is a central respiratory stimulant. In clinical practice, doxapram is usually used for patients who have an acute exacerbation of chronic obstructive pulmonary disease (COPD) who are unsuitable for admission to the intensive therapy unit for ventilatory support. Doxapram infusion may buy an extra 24 h to allow for recovery.
Contraindications include: ischaemic heart disease, epilepsy, cerebral oedema, acute stroke, asthma, hypertension, hyperthyroidism, and pheochromocytoma.
The infusion may worsen agitation and dyspnoea and lead to hypertension, nausea, vomiting and urinary retention.Drug interactions:
Concomitant administration of doxapram and aminophylline (theophylline) can cause increased skeletal muscle activity, agitation, and hyperactivity. -
This question is part of the following fields:
- Geriatric Medicine
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Question 8
Incorrect
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A young man has ingested 25 tablets of paracetamol 500 mg. What is the suggested minimum time interval between ingestion and measuring the blood plasma paracetamol levels?
Your Answer:
Correct Answer: 4 hours
Explanation:The post-ingestion plasma level, which is required in order to guide the treatment, reaches a peak at 4 hours. Levels requiring antidote (N-acetyl cysteine) include: 100 mcg per ml at 4 hours, 35 mcg per ml at 10 hours and 25 mcg per ml at 12 hours. These levels are in conjunction with the levels recorded and they should all be put down on a treatment nomogram.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 9
Incorrect
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The phonocardiogram of a 40-year-old male patient showed a normal S1 but an abnormal S2. S2 was fixed and widely split. Out of the following, which condition do you think this patient most likely suffering from?
Your Answer:
Correct Answer: Secundum atrial septal defect
Explanation:The second heart sound (S2) corresponds to the closing of the semilunar valves, first the aortic and then the pulmonary valve. The gap between the closure of these two valves is normally insignificant and is heard as a single heart sound. In certain pathological conditions, this gap increases when there is a delay in right ventricular emptying, but in cases other than an atrial septal defect, the sound is not fixed. In an atrial septal defect, the right ventricle continuously receives blood, causing a delay and a fixed and split S2.
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This question is part of the following fields:
- Cardiovascular System
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Question 10
Incorrect
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A social worker has been diagnosed with hepatitis C infection. Which test will conclusively establish the presence of this infection?
Your Answer:
Correct Answer: HCV RNA
Explanation:The most sensitive test for detecting Hepatitis C infection (acute) is HCA RNA; it can be detected 1-2 weeks after infection. Anti-HCV antibodies take at least 6 weeks to develop and be positive.
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This question is part of the following fields:
- Infectious Diseases
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Question 11
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 12
Incorrect
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Which of the following is correct regarding toxoplasmosis?
Your Answer:
Correct Answer: Can present with fits in patients with AIDS
Explanation:T. gondii infection in immunocompetent people is usually asymptomatic. It can present as fits in patients with AIDs, who are immunosuppressed. Additionally, infection in the first trimester of pregnancy is very harmful. Congenital toxoplasmosis presents with intracranial calcifications, classically. It can also present with hydrocephalus, microcephaly, blindness, petechiae. Siramycin is the drug of choice to try to prevent vertical transmission from mother to baby. It is typically gotten from cat faeces or raw/undercooked meat, not raw eggs (raw eggs: think salmonella).
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Incorrect
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A 32-year-old female who is 37 weeks pregnant presents with a swollen, painful right calf. A deep vein thrombosis (DVT) is confirmed on Doppler scan.
What should be the preferred anticoagulant?Your Answer:
Correct Answer: Subcutaneous low molecular weight heparin (LMWH)
Explanation:Subcutaneous (S/C) low-molecular-weight heparin (LMWH) is a preferred anticoagulant in pregnancy. Warfarin is contraindicated due to its teratogenic effects, especially in the first trimester and at term.
Pregnancy is a hypercoagulable state with the majority of VTE incidents occurring in the last trimester.
Hypercoagulability in pregnancy is caused by:
1. Increase in factors VII, VIII, X, and fibrinogen
2. Decrease in protein S
3. Uterus pressing on IVC causing venous stasis in legsManagement options include:
1. S/C LMWH preferred to IV heparin (less bleeding and thrombocytopaenia)
2. Warfarin contraindicated -
This question is part of the following fields:
- Haematology & Oncology
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Question 14
Incorrect
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A 60-year-old man presented with severe central chest pain for the last 2 hours. He was on insulin for diabetes mellitus and he was dependent on haemodialysis because of end stage renal failure. He had undergone haemodialysis 48 hours prior to this presentation. His ECG showed an acute inferior myocardial infarction. Despite thrombolysis and other appropriate treatment, he continued to have chest pain after 6 hours from the initial presentation. His blood pressure was 88/54 mmHg and he had bibasal crepitations. His investigation results are given below.
Serum sodium 140 mmol/l (137-144)
Serum potassium 6.6 mmol/l (3.5-4.9)
Serum urea 50 mmol/l (2.5-7.5)
Serum creatinine 940 μmol/l (60-110)
Haemoglobin 10.2g/dl (13.0-18.0)
Troponin T >24 g/l (<0.04)
Left ventricular ejection fraction was 20%
What is the most appropriate management for this patient?Your Answer:
Correct Answer: Coronary angiography and rescue PCI
Explanation:According to the history the patient has cardiogenic shock and pulmonary oedema. On-going ischaemia is indicated by persisting symptoms. So the most appropriate management is coronary angiography and rescue PCI. There are no indications for blood transfusion at this moment and it will aggravate the pulmonary oedema. Haemodialysis, beta blockers and furosemide cannot be given due to low blood pressure.
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This question is part of the following fields:
- Cardiovascular System
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Question 15
Incorrect
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A 25-year-old man wants to start a relationship but is concerned about his small phallus. He also has difficulty becoming aroused. On examination, he is slim and has gynecomastia. There is a general paucity of body hair, his penis and testes are small.
Which diagnosis fits best with this history and examination?Your Answer:
Correct Answer: Klinefelter's syndrome
Explanation:The patient most likely has Klinefelter’s syndrome.
Klinefelter syndrome (KS) refers to a group of chromosomal disorders in which the normal male karyotype, 46,XY, has at least one extra X chromosome. XXY aneuploidy, the most common human sex chromosome disorder. It is also the most common chromosomal disorder associated with male hypogonadism and infertility.
Klinefelter syndrome is characterized by hypogonadism (micro-orchidism, oligospermia/azoospermia), gynecomastia in late puberty, hyalinization and fibrosis of the seminiferous tubules, elevated urinary gonadotropin levels, and behavioural concerns. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 16
Incorrect
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Tranexamic acid is used to treat heavy menstrual bleeding in women. It inhibits menorrhagia by which of the following mechanisms?
Your Answer:
Correct Answer: Inhibits fibrinolysis
Explanation:Tranexamic acid prevents menorrhagia by inhibiting fibrinolysis thus promoting coagulation.
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This question is part of the following fields:
- Pharmacology
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Question 17
Incorrect
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A patient with a history of asthma presents with worsening of her symptoms and dyspnoea. She recently started taking a new medicine and she feels it might have aggravated her symptoms.
Which of the following is likely responsible for her symptoms?Your Answer:
Correct Answer: Timolol eye drops
Explanation:β-blockers are the class of drug most often chosen to treat glaucoma, although other medical therapies are available. Systemic absorption of timolol eye drops can cause unsuspected respiratory impairment and exacerbation of asthma. Physicians should be alert to the possibility of respiratory side-effects of topical therapy with β-blockers. Leukotriene antagonists and salbutamol are used in asthma treatment. HRT and ferrous sulphate do not lead to the exacerbation of asthma.
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This question is part of the following fields:
- Respiratory System
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Question 18
Incorrect
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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:
Correct 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 19
Incorrect
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What is the mode of spread of chickenpox?
Your Answer:
Correct Answer: Airborne
Explanation:Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).
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This question is part of the following fields:
- Infectious Diseases
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Question 20
Incorrect
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A 67-year-old male presented with a history of chronic backache and altered sensation over the lateral side of his right calf and foot. Which of the following nerve roots will most likely be involved in this patient?
Your Answer:
Correct Answer: L5-S1
Explanation:Lesions in L5-S1 region leads to altered sensation on the lateral side of calf and foot, along with back pain. There might be difficulty in extension of the leg, foot inversion, plantar flexion and toe flexion, as muscles controlling these functions are supplied by S1.
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This question is part of the following fields:
- Nervous System
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Question 21
Incorrect
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A 45-year-old female presented with weight loss, night sweats and abdominal pain for 6 months. Abdominal ultrasound scan showed a tubo-ovarian mass. What is the most likely organism, which is responsible for this presentation?
Your Answer:
Correct Answer: Mycobacterium tuberculosis
Explanation:Constitutional symptoms such as weight loss, evening pyrexia and night sweats are associated with Mycobacterium Tuberculosis (TB). TB can affect any system of the body and should be top in the list of differentials particularly if the patient has a history of contact with a known TB patient.
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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 45-year-old known asthmatic was admitted with acute severe asthma and was treated with nebulised salbutamol, ipratropium and bromide, along with 100% oxygen therapy. He was also given IV hydrocortisone, however there was no significant improvement. What would be the next step in management of this patient?
Your Answer:
Correct Answer: IV Aminophylline
Explanation:Aminophylline is a very effective bronchodilator. It is short acting and therefore very effective in acute scenarios.
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This question is part of the following fields:
- Respiratory System
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Question 23
Incorrect
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A 52-year-old woman who is a known case of breast cancer is being reviewed six months after she had a mastectomy following the diagnosis.
Which of the following tumour markers is the most useful in monitoring her disease?Your Answer:
Correct Answer: CA 15-3
Explanation:Tumour marker CA 15-3 is mostly associated with breast cancer.
Tumour markers can be divided into:
1. Monoclonal antibodies
CA 125: Ovarian cancer, primary peritoneal cancer
CA 19-9: Pancreatic cancer
CA 15-3: Breast cancer2. Tumour specific antigens
Prostate specific antigen (PSA): Prostatic carcinoma
Alpha-feto protein (AFP): Hepatocellular carcinoma, teratoma
Carcinoembryonic antigen (CEA): Colorectal cancer
S-100: Melanoma, schwannomas
Bombesin: Small cell lung carcinoma, gastric cancer3. Enzymes
Alkaline phosphatase (ALP)
Neuron specific enolase (NSE)4. Hormones
Calcitonin
Antidiuretic hormone (ADH)
Human chorionic gonadotropin (hCG) -
This question is part of the following fields:
- Haematology & Oncology
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Question 24
Incorrect
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A 35-year-old soldier presented with a painless, erythematous crusted plaque over the dorsum of his hand, after serving in a hilly area of Columbia for 2 months. The most likely diagnosis will be?
Your Answer:
Correct Answer: Leishmaniasis
Explanation:The chief presentation in Leishmaniasis is a non healing, ulcerated, painless and non pruritic plaque, which does not respond to oral antibiotics. It can be classified into cutaneous and visceral forms and is caused by the sand fly. It is more prevalent in the hilly areas. Fusobacterium causes a tropical ulcer which is painful and shallow, while Troanasomiasis causes sleeping sickness.
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This question is part of the following fields:
- The Skin
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Question 25
Incorrect
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A 23-year-old student presented with swelling and tenderness near the Lister tubercle of the radius. Passive extension of thumb and index finger further increases the pain. X-ray was normal. What will be the next step in the management of this case?
Your Answer:
Correct Answer: Immobilization with a cast
Explanation:This patient most likely has distal intersection syndrome, which occurs in the proximal forearm due to the tenosynovitis of extensor pollicis longus muscle tendons.
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This question is part of the following fields:
- Musculoskeletal System
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Question 26
Incorrect
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How should DVT during pregnancy be managed?
Your Answer:
Correct Answer: Dalteparin
Explanation:Deep vein thrombosis (DVT) is a serious condition in which a blood clot forms in a deep vein, usually in the leg.
Subcutaneous low molecular weight heparin (LMWH) is the preferred treatment for most patients with acute DVT, including in pregnancy. A large meta-analyses comparing LMWH to unfractionated heparin (UFH) showed that LMWH decreased the risk of mortality, recurrent veno-thrombo embolism (VTE), and haemorrhage compared with heparin. Other advantages of LMWH may include more predictable therapeutic response, ease of administration and monitoring, and less heparin-induced thrombocytopenia. Disadvantages of LMWH include cost and longer half-life compared with heparin.
Warfarin, which is administered orally, is used if long-term anticoagulation is needed. The international normalized ratio (INR) is followed, with a target range of 2-3. Warfarin crosses the placenta and is teratogenic, causing a constellation of anomalies known as warfarin embryopathy, with greatest risk between the sixth and twelfth week of gestation.
Other options are not indicated for use. -
This question is part of the following fields:
- Respiratory System
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Question 27
Incorrect
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A 58-year-old woman has multiple non-healing leg ulcers. She reports feeling unwell for several months. Examination findings include a normal blood pressure, pulse 90 bpm, pale conjunctivae and poor dentition associated with bleeding gums. What is the most likely underlying diagnosis?
Your Answer:
Correct Answer: Vitamin C deficiency
Explanation:Severe vitamin C deficiency results in scurvy, a disorder characterized by hemorrhagic manifestations and abnormal osteoid and dentin formation.
Vitamin C plays a role in collagen, carnitine, hormone, and amino acid formation. It is essential for bone and blood vessel health and wound healing and facilitates recovery from burns. Vitamin C is also an antioxidant, supports immune function, and facilitates the absorption of iron (see table Sources, Functions, and Effects of Vitamins).
Dietary sources of vitamin C include citrus fruits, tomatoes, potatoes, broccoli, strawberries, and sweet peppers. (See also Overview of Vitamins.) -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 28
Incorrect
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A 40-year-old female presented in the OPD with a 4-day history of severe episodes of dizziness. She reports that her room starts spinning and then she tends to fall. She also complains of deafness, tinnitus, and a sensation of clogging in the ear. What condition do you think this patient is suffering from?
Your Answer:
Correct Answer: Meniere's disease
Explanation:The patient presents with the classic symptoms of Meniere’s disease. This is a condition in which the amount of endolymph in the internal ear increases because of an increase in endolymph production, a reduction of endolymph drainage, or as a result of an infection. Hearing and balance tests should be done for the proper analysis of the patient’s condition and to rule out other conditions.
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This question is part of the following fields:
- Nervous System
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Question 29
Incorrect
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A 57-year-old, alcoholic male was admitted to the medical ward for an ascitic tap. The ascitic fluid was found to be yellow in colour. Which of the following had most likely lead to this observation?
Your Answer:
Correct Answer: Decompensated cirrhosis
Explanation:Uncomplicated cirrhotic ascites is usually translucent. If the patient is deeply jaundiced, the fluid might appear yellow/brown.
Turbidity or cloudiness of the ascites fluid suggests that infection is present and further diagnostic testing should be performed.
Pink or bloody fluid is most often caused by mild trauma, with subcutaneous blood contaminating the sample.
Bloody ascites is also associated with hepatocellular carcinoma or any malignancy-associated ascites.
Milky-appearing fluid usually has an elevated triglyceride concentration. Such fluid, commonly referred to as chylous ascites, can be related to thoracic duct injury or obstruction or lymphoma, but it is often related primarily to cirrhosis. -
This question is part of the following fields:
- Hepatobiliary System
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Question 30
Incorrect
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An 18-year-old female patient presents with a history of headache and photophobia. You believe that the diagnosis is subarachnoid haemorrhage but your colleague insists on bacterial meningitis. Which of the following would you use to support your diagnosis?
Your Answer:
Correct Answer: A family history of polycystic renal disease
Explanation:Hypertension could be the result of polycystic renal disease and is a risk factor for subarachnoid haemorrhage (SAH). What are common in polycystic renal disease are cerebral aneurysms which could rupture if hypertension is present. Both meningitis and SAH can lead to a fluctuating level of consciousness and opiate abuse is not a risk factor for either SAH nor meningitis. Finally, diabetes is not linked with none of the possible diagnoses because hypertension is not a risk factor of diabetes.
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This question is part of the following fields:
- Nervous System
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SESSION STATS - PERFORMANCE PER SPECIALTY
