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  • Question 1 - A 23-year-old patient was involved in a MVA. Clinical examination reveals a fixed...

    Incorrect

    • A 23-year-old patient was involved in a MVA. Clinical examination reveals a fixed dilated pupil and reduced consciousness. Which of the following nerves is most likely damaged?

      Your Answer: Optic nerve

      Correct Answer: Oculomotor nerve

      Explanation:

      The oculomotor nerve is the 3rd cranial nerve. When damaged it affects the ocular motility causing mainly ptosis or diplopia. Damage to it can also affect the pupillary functions causing pupil dilation and light reflex impairment.

    • This question is part of the following fields:

      • Nervous System
      19.5
      Seconds

  • Question 2 - A 32-year-old woman presents to the GP with tiredness and anxiety during the...

    Incorrect

    • A 32-year-old woman presents to the GP with tiredness and anxiety during the third trimester of her second pregnancy.
      The Examination is unremarkable, with a BP of 110/70 mmHg and a pulse of 80. Her BMI is 24 and she has an abdomen consistent with a 31-week pregnancy. The GP decides to check some thyroid function tests.
      Which of the following is considered to be normal?

      Your Answer: Decreased total T4

      Correct Answer: Elevated total T4

      Explanation:

      During pregnancy, profound changes in thyroid physiology occur to provide sufficient thyroid hormone (TH) to both the mother and foetus. This is particularly important during early pregnancy because the fetal thyroid starts to produce considerable amounts of TH only from approximately 20 weeks of gestation, until which time the foetus heavily depends on the maternal supply of TH. This supply of TH to the foetus, as well as increased concentrations of TH binding proteins (thyroxine-binding globulin) and degradation of TH by placental type 3 iodothyronine deiodinase, necessitate an increased production of maternal TH. This requires an intact thyroid gland and adequate availability of dietary iodine and is in part mediated by the pregnancy hormone human chorionic gonadotropin, which is a weak agonist of the thyroid-stimulating hormone (TSH) receptor. As a consequence, serum-free thyroxine (FT4) concentrations increase and TSH concentrations decrease from approximately the eighth week throughout the first half of pregnancy, resulting in different reference intervals for TSH and FT4 compared to the non-pregnant state.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      45.8
      Seconds

  • Question 3 - Choose the correct definition regarding the standard error of the mean: ...

    Incorrect

    • Choose the correct definition regarding the standard error of the mean:

      Your Answer: Square root (Standard deviation / number of patients)

      Correct Answer: Standard deviation / square root (number of patients)

      Explanation:

      The SEM is an indicator of how close the sample mean is to the population mean. In reality, however, only one sample is extracted from the population. Therefore, the SEM is estimated using the standard deviation (SD) and a sample size (Estimated SEM). The SEM computed by a statistical program is an estimated value calculated via this process.

      Estimated Standard Error of the Mean (SEM)=SDn?

    • This question is part of the following fields:

      • Evidence Based Medicine
      26.2
      Seconds

  • Question 4 - Which features may suggest malignant changes in a melanocytic naevi? ...

    Incorrect

    • Which features may suggest malignant changes in a melanocytic naevi?

      Your Answer: Irregularity of surface

      Correct Answer: Decrease in size

      Explanation:

      Melanocytic naevi are skin tumours produced by melanocytes. They usually present in childhood but increase during puberty. The mnemonic A-B-C-D, is used by institutions to assess for suspicion of malignancy. The letters stand for asymmetry, border, colour, and diameter. If a mole starts changing in size, colour, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include if it begins to crust over, bleed, itch, or become inflamed.

    • This question is part of the following fields:

      • The Skin
      14.1
      Seconds

  • Question 5 - A 23-year-old student presented with swelling and tenderness near the Lister tubercle of...

    Incorrect

    • 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: Repeat the x-ray

      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.

    • This question is part of the following fields:

      • Musculoskeletal System
      42.8
      Seconds

  • Question 6 - Which of the following types of reactions are a part of the phase...

    Correct

    • Which of the following types of reactions are a part of the phase II metabolism of a drug?

      Your Answer: Conjugation

      Explanation:

      Drug metabolism can be broadly classified into:
      Phase I (functionalization) reactions: also termed non-synthetic reactions, they include oxidation, reduction, hydrolysis, cyclization and de-cyclization. The most common and vital reactions are oxidation reactions. (Of the given enzymes only Alcohol dehydrogenase is involved in phase I drug metabolism. Succinate dehydrogenase, is a vital enzyme involved in the Kreb’s cycle and the mitochondrial electron transport chain). They are mainly catalysed by Cytochrome P-450 enzyme.

      Phase II (conjugation) reactions: occur following phase I reactions, they include reactions: glucuronidation and sulphate conjugation, etc. They are mostly catalysed by UDP-glucuronosyltransferase enzyme. Other phase II enzymes include: sulfotransferases, N-acetyltransferases, glutathione S-transferases and methyltransferases.

    • This question is part of the following fields:

      • Pharmacology
      19
      Seconds

  • Question 7 - A 25-year-old man having sickle cell anaemia presents with headache, lethargy, and pallor....

    Incorrect

    • A 25-year-old man having sickle cell anaemia presents with headache, lethargy, and pallor. His blood count shows: Haemoglobin: 4.6 g/dL Reticulocytes: 3% Infection with parvovirus is suspected. Out of the following, what is the most likely diagnosis?

      Your Answer: Sequestration crisis

      Correct Answer: Aplastic crisis

      Explanation:

      Aplastic crisis is characterized by a rapid fall in hemoglobin levels associated with few or no reticulocytes, indicating a failure of the bone marrow to respond to increased cell turnover. Folate deficiency can occur in the setting of chronic hemolytic anemia in some patients unless supplemental folate is taken. Parvovirus (B19) has been associated with bone marrow suppression and subsequent aplastic crisis; other viral infections or severe bacterial infections may also suppress the bone marrow. Treatment of aplastic crisis may be necessary when the hematocrit level becomes dangerously low. Packed red blood cells are given to support an adequate hematocrit until bone marrow suppression is resolved, folate is repleted, and the reticulocyte count improves.

    • This question is part of the following fields:

      • Haematology & Oncology
      27.7
      Seconds

  • Question 8 - A 32-year-old previously well primigravida in her 16th week of pregnancy came to...

    Incorrect

    • A 32-year-old previously well primigravida in her 16th week of pregnancy came to the antenatal clinic for a routine review. Her blood pressure was 152/90 mmHg. On her last clinic visit 4 weeks ago her blood pressure was 148/86 mmHg. She was put on ambulatory blood pressure monitoring and her mean blood pressure was 148/88 mmHg. Her urine examination was negative for protein. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Pre-existing hypertension

      Explanation:

      Pre-eclampsia is excluded from negative proteinuria. White coat hypertension is excluded with ambulatory blood pressure monitoring. Pregnancy induced hypertension develops after 20 weeks of gestation. So the most likely answer is pre-existing hypertension. She should be investigated for a secondary cause for hypertension.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 9 - A 22-year-old male presented with a cut injury at his wrist. Which of...

    Incorrect

    • A 22-year-old male presented with a cut injury at his wrist. Which of the following would be the expected clinical signs if his ulnar nerve was damaged?

      Your Answer:

      Correct Answer: Wasting of the interossei

      Explanation:

      Damage to the ulnar nerve at wrist will cause wasting of the interossei and adductor pollicis muscle. There won’t be any sensory loss, weakness of wrist flexion or wasting of hypothenar muscles.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 10 - A 22 year-old woman presents with a low body temperature and tremors. She...

    Incorrect

    • A 22 year-old woman presents with a low body temperature and tremors. She reports seeing colour every time she shuts her eyes. What drug has she been using?

      Your Answer:

      Correct Answer: Lysergic acid diethylamide (LSD)

      Explanation:

      Psychedelic drugs, like LSD, are strongly associated with closed-eye hallucinations that this patient is experiencing.

    • This question is part of the following fields:

      • Emergency & Critical Care
      0
      Seconds

  • Question 11 - A 54-year-old female presents with shortness of breath that has been going on...

    Incorrect

    • A 54-year-old female presents with shortness of breath that has been going on for the last 10 months. Physical examination shows that she has an irregularly irregular pulse and a loud P2 with fixed splitting accompanied by a systolic ejection murmur in the 2nd left intercostal space. Which of the following would be the most likely diagnosis?

      Your Answer:

      Correct Answer: Atrial septal defect (ASD)

      Explanation:

      Atrial septal defect (ASD) is one of the more commonly recognized congenital cardiac anomalies presenting in adulthood. ASD is characterized by a defect in the interatrial septum allowing pulmonary venous return from the left atrium to pass directly to the right atrium. Depending on the size of the defect, size of the shunt, and associated anomalies, this can result in a spectrum of disease ranging from no significant cardiac sequelae to right-sided volume overload, pulmonary arterial hypertension, and even atrial arrhythmias.

      With the routine use of echocardiography, the detection and, therefore, the incidence of ASD is increased compared to earlier incidence studies using catheterization, surgery, or autopsy for diagnosis. The subtle physical examination findings and often minimal symptoms during the first 2-3 decades of life contribute to a delay in diagnosis until adulthood, the majority (more than 70%) of which is detected by the fifth decade of life.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 12 - A diabetic 50-year-old male presented in the emergency room with ischaemic gangrene of...

    Incorrect

    • A diabetic 50-year-old male presented in the emergency room with ischaemic gangrene of the lower leg, ulceration over the medial malleolus and infection spreading proximally. Which of the following types of amputation is most suitable in this patient?

      Your Answer:

      Correct Answer: Below knee amputation

      Explanation:

      The type of amputation depends on the degree of gangrene, ischaemia and the extent of involvement of the foot, leg, knee etc. In this case, below-knee amputation is the most appropriate choice.

    • This question is part of the following fields:

      • Emergency & Critical Care
      0
      Seconds

  • Question 13 - A 72-year-old male presents to the ER with acute chest pain, fever and...

    Incorrect

    • A 72-year-old male presents to the ER with acute chest pain, fever and sweating. ECG shows an acute MI. Which of the following routes will be the most significant in alleviating the patient's pain?

      Your Answer:

      Correct Answer: Intravenous

      Explanation:

      The pain of myocardial infarction is usually severe and requires potent opiate analgesia. Intravenous diamorphine 2.5-5 mg (repeated as necessary) is the drug of choice and is not only a powerful analgesic but also has a useful anxiolytic effect.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 14 - A 25-year-old obese woman is diagnosed with polycystic ovarian syndrome (PCOS). Which of...

    Incorrect

    • A 25-year-old obese woman is diagnosed with polycystic ovarian syndrome (PCOS). Which of the following findings is most consistently seen in PCOS?

      Your Answer:

      Correct Answer: Ovarian cysts on ultrasound

      Explanation:

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 15 - A 43-year-old female presented with a 5 day history of a productive cough...

    Incorrect

    • A 43-year-old female presented with a 5 day history of a productive cough with rusty coloured sputum. Chest X-ray showed lobar consolidation on her left side. The most likely causative organism would be?

      Your Answer:

      Correct Answer: Streptococcus pneumoniae

      Explanation:

      Streptococcus pneumonia is the chief causative organism for lobar pneumonia in this age group patients. Typically patients present with rusty coloured sputum and a cough. Pneumocystis jiroveci is responsible for causing pneumocystis pneumonia among immunocompromised patients.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 16 - A 43-year-old man with hemochromatosis presents with a painful and swollen right knee....

    Incorrect

    • A 43-year-old man with hemochromatosis presents with a painful and swollen right knee. X-ray shows extensive chondrocalcinosis but no fracture. Given the most likely diagnosis, which of the following would be present in the joint fluid aspirate?

      Your Answer:

      Correct Answer: Positively birefringent rhomboid-shaped crystals

      Explanation:

      Pseudogout is a paroxysmal joint inflammation due to calcium pyrophosphate crystal deposition (calcium pyrophosphate dihydrate). 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
      0
      Seconds

  • Question 17 - A 40-year-old heavy smoker presents with a serum sodium level of 113 mmol/l....

    Incorrect

    • A 40-year-old heavy smoker presents with a serum sodium level of 113 mmol/l. A diagnosis of SIADH is confirmed.
      What is the most appropriate initial management for his fluid balance?

      Your Answer:

      Correct Answer: Fluid restriction

      Explanation:

      European guidelines for the treatment of syndrome of inappropriate antidiuresis include the following recommendations for the management of moderate or profound hyponatremia:
      – Restrict fluid intake as first-line treatment.
      – Second-line treatments include increasing solute intake with 0.25-0.50 g/kg per day or a combination of low-dose loop diuretics and oral sodium chloride.
      – Use of lithium, demeclocycline, or vasopressin receptor antagonists is not recommended.
      Recommendations on the treatment of SIADH from an American Expert Panel included the following:
      – If chronic, limit the rate of correction.
      – Fluid restriction should generally be first-line therapy.
      – Consider pharmacologic therapies if serum Na + is not corrected after 24-48 hr of fluid restriction or if the patient has a low urinary electrolyte free water excretion.
      – Patients being treated with vaptans should not be on a fluid restriction initially.
      – Water, 5% dextrose or desmopressin can be used to slow the rate of correction if the water diuresis is profound.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 18 - A 50-year-old patient was admitted to the hospital for elective herniorrhaphy. Which of...

    Incorrect

    • A 50-year-old patient was admitted to the hospital for elective herniorrhaphy. Which of the following options will lead to a postponement of his operation?

      Your Answer:

      Correct Answer: Myocardial infarction two months ago

      Explanation:

      Patients with a recent cerebrovascular incident (less than 60 days) are at very high risk of cardiac complications when under general anaesthesia. Complications like MI, heart failure and even death. Elective surgery should be postponed till stabilization of the cardiac condition is achieved.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 19 - A 47-year-old woman diagnosed with oestrogen receptor positive breast cancer three months back...

    Incorrect

    • A 47-year-old woman diagnosed with oestrogen receptor positive breast cancer three months back was started on treatment with tamoxifen. Which of the following is most likely a complaint of this patient during her review today?

      Your Answer:

      Correct Answer: Hot flushes

      Explanation:

      The most likely complaint of this patient would be hot flushes.

      Alopecia and cataracts are listed in the BNF as possible side-effects. They are however not as prevalent as hot flushes, which are very common in pre-menopausal women.

      Tamoxifen is a Selective Oestrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor-positive breast cancer

      Adverse effects:
      Menstrual disturbance: vaginal bleeding, amenorrhoea
      Hot flushes – 3% of patients stop taking tamoxifen due to climacteric side-effects.
      Venous thromboembolism.
      Endometrial cancer
      Tamoxifen is typically used for 5 years following the removal of the tumour.

      Raloxifene is a pure oestrogen receptor antagonist and carries a lower risk of endometrial cancer.

      Although antagonistic with respects to breast tissue tamoxifen may serve as an agonist at other sites. Therefore the risk of endometrial cancer is increased cancer.

    • This question is part of the following fields:

      • Women's Health
      0
      Seconds

  • Question 20 - A 34 year-old gentleman presented with 3 months history of abdominal pain, intermittent...

    Incorrect

    • A 34 year-old gentleman presented with 3 months history of abdominal pain, intermittent diarrhoea, melena and loss of weight. The most likely diagnosis will be?

      Your Answer:

      Correct Answer: Inflammatory bowel disease

      Explanation:

      Inflammatory bowel disease (IBD) is characterized by abdominal and pelvic pain, intermittent diarrhoea, loss of weight and tenesmus. Irritable bowel disease is associated either with diarrhoea or constipation and occurs in stressful conditions for the individual. A UTI is characterised by dysuria, fever and lumbar pain. Adenomyosis is characterised by heavy menstrual bleeding and chronic pelvic pain.

    • This question is part of the following fields:

      • Gastrointestinal System
      0
      Seconds

  • Question 21 - A 64-year-old woman presents with malaise, ankle swelling and shortness of breath. Her...

    Incorrect

    • A 64-year-old woman presents with malaise, ankle swelling and shortness of breath. Her blood pressure is 215/140 mmHg, she has +2 peripheral oedema and the skin over her fingers appears very tight. Fundoscopy discloses bilateral papilledema.
       
      Plasma creatinine concentration is 370 μmol/l, potassium is 4.9 mmol/l, haemoglobin is 8.9 g/dl and her platelet count is 90 x 109 /ml.
       
      What is the pathological hallmark of this condition?

      Your Answer:

      Correct Answer: Mucoid intimal thickening of vascular endothelium

      Explanation:

      The history is suggestive of scleroderma renal crisis, where we would expect thrombotic microangiopathy process with vascular endothelium involvement manifesting as mucoid intimal thickening or onion skin effect.

    • This question is part of the following fields:

      • Renal System
      0
      Seconds

  • Question 22 - A 48-year-old female presented in the emergency department with complaints of increased thirst,...

    Incorrect

    • A 48-year-old female presented in the emergency department with complaints of increased thirst, confusion and drowsiness. When taking her history it was found that she was treated successfully for breast malignancy 2 years ago. Which of the following abnormalities is most likely responsible for these symptoms?

      Your Answer:

      Correct Answer: Hypercalcemia

      Explanation:

      Treated breast malignancy is pointing towards hypercalcemia as it is very common in patients of CA. The symptoms of hypercalcemia are increased thirst, drowsiness and confusion.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 23 - A 4-year-old baby was brought in by her mother with complaints of generalized...

    Incorrect

    • A 4-year-old baby was brought in by her mother with complaints of generalized pallor, loss of weight and loose stools. The baby's stools were frothy in nature and difficult to flush. Which investigation can help in diagnosing this patient?

      Your Answer:

      Correct Answer: Anti-endomysial antibodies

      Explanation:

      The presence of anti-endomysial antibodies confirms the diagnosis of Celiac disease, which is the primary cause of illness in this patient. The sweat chloride test is performed with cystic fibrosis.

    • This question is part of the following fields:

      • Gastrointestinal System
      0
      Seconds

  • Question 24 - What is the rationale concerning the use of sodium cromoglycate in the prophylaxis...

    Incorrect

    • What is the rationale concerning the use of sodium cromoglycate in the prophylaxis of bronchial asthma?

      Your Answer:

      Correct Answer: Inhibition of mast-cell degranulation

      Explanation:

      Sodium cromoglycate principally acts by inhibiting the degranulation of mast cells triggered by the interaction of antigen and IgE.
      The inhibitory effect on mast cells appears to be cell-type specific since cromoglycate has little inhibitory effect on mediator release from human basophils.
      Thus, it inhibits the release of histamine, leukotrienes, and slow-reacting substance of anaphylaxis from mast cells by inhibiting degranulation following exposure to reactive antigens.

      Adverse effects include cough, flushing, palpitation, chest pain, nasal congestion, nausea, fatigue, migraine, etc.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 25 - A 42-year-old female with a history of hypertension presented with increased thirst, polyuria...

    Incorrect

    • A 42-year-old female with a history of hypertension presented with increased thirst, polyuria and nocturia for 2 weeks duration. Her random blood sugar was 12 mmol/l. Which of the following antihypertensives can cause the above clinical presentation?

      Your Answer:

      Correct Answer: Bendroflumethiazide

      Explanation:

      Thiazides and beta-blockers have been most commonly linked to the development of diabetes mellitus.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 26 - A 42-year-old man presented with palpitations and shortness of breath on exertion. On...

    Incorrect

    • A 42-year-old man presented with palpitations and shortness of breath on exertion. On examination his lungs were clear and heart sounds were normal. There was a left sided parasternal heave. His electrocardiogram (ECG) revealed atrial fibrillation with right axis deviation. Echocardiography showed dilated right heart chambers. Left and right heart catheterisation study revealed the following

      Inferior vena cava Oxygen saturations 63 %
      Superior vena cava Oxygen saturations 59 %
      Right atrium Oxygen saturations 77 %
      Right ventricle Oxygen saturations 78 %
      Pulmonary artery Oxygen saturations 82 %
      Arterial saturation Oxygen saturations 98 %

      What is the most likely diagnosis from the following answers?

      Your Answer:

      Correct Answer: Atrial septal defect

      Explanation:

      Right ventricular volume overload is indicated by a parasternal heave and right axis deviation. Oxygen saturation in right atrium is higher than oxygen saturation of the inferior and superior vena cavae. So the most probable diagnosis is atrial septal defect.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 27 - Bicuspid aortic valve is in association with which of the following. ...

    Incorrect

    • Bicuspid aortic valve is in association with which of the following.

      Your Answer:

      Correct Answer: Coarctation of the aorta

      Explanation:

      Bicuspid aortic valve is the most common congenital cardiovascular anomaly, occurring in 1-2% of the population. Coarctation and bicuspid aortic valve occur more frequently in males with a prevalence of approximately 4:1. A high prevalence of these same cardiovascular lesions is also found in women with Turner’s syndrome.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 28 - A 51-year-old real estate agent takes hydrocortisone 20mg in the mornings and 5mg...

    Incorrect

    • A 51-year-old real estate agent takes hydrocortisone 20mg in the mornings and 5mg at night for Addison's disease. The endocrinology consultant would like her to take prednisolone instead.

      What dose of prednisolone should be started?

      Your Answer:

      Correct Answer: 7 mg

      Explanation:

      1mg Prednisolone = 4mg hydrocortisone, so the actual equivalent daily dose is 7mg.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 29 - Choose the correct statement regarding hyponatremia: ...

    Incorrect

    • Choose the correct statement regarding hyponatremia:

      Your Answer:

      Correct Answer: Hyperlipidaemia may cause pseudohyponatraemia

      Explanation:

      The Hyperlipidaemia Effect: Pseudohyponatremia in Pancreatic Cancer; Patients who have disorders of cholestasis commonly present with volume depletion due to vomiting and poor oral intake, which, in turn, often leads to hypovolemic hyponatremia. It is less well known that disorders of cholestasis, including tumours of the hepatobiliary system, can be accompanied by hyperlipidaemia.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      0
      Seconds

  • Question 30 - A 21-year-old woman presents with lethargy and confusion. On examination, you note a...

    Incorrect

    • A 21-year-old woman presents with lethargy and confusion. On examination, you note a purpuric rash covering the abdominal wall and thighs, and a fever of 38C. Investigations reveal haemolytic anaemia, thrombocytopenia, and acute kidney injury.
       
      Which feature of the presentation makes the diagnosis of thrombotic thrombocytopenic purpura more likely than haemolytic uremic syndrome?

      Your Answer:

      Correct Answer: Confusion

      Explanation:

      Confusion in the patient refers to neurological symptoms that are more associated with thrombotic thrombocytopenic purpura than with haemolytic uremic syndrome. All the other symptoms present in both conditions similarly.

    • This question is part of the following fields:

      • Renal System
      0
      Seconds

  • Question 31 - A 65-year-old male who was treated for atrial fibrillation 6 months ago, complained...

    Incorrect

    • 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:

      Correct 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).

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 32 - A 15-year-old child with learning difficulties is referred to the endocrine clinic for...

    Incorrect

    • A 15-year-old child with learning difficulties is referred to the endocrine clinic for review. His lab results show hypocalcemia and increased serum concentration of parathyroid hormone. On examination, there is subcutaneous calcification and a short fifth metacarpal in each hand.

      What is the treatment of choice in this case?

      Your Answer:

      Correct Answer: Calcium and vitamin D supplementation

      Explanation:

      This child has pseudo hypoparathyroidism. It is a heterogeneous group of rare endocrine disorders characterized by normal renal function and resistance to the action of parathyroid hormone (PTH), manifesting with hypocalcaemia, hyperphosphatemia, and increased serum concentration of PTH.
      Patients with pseudo hypoparathyroidism type 1a present with a characteristic phenotype collectively called Albright hereditary osteodystrophy (AHO). The constellation of findings includes the following:
      Short stature
      Stocky habitus
      Obesity
      Developmental delay
      Round face
      Dental hypoplasia
      Brachymetacarpals
      Brachymetatarsals
      Soft tissue calcification/ossification
      The goals of therapy are to maintain serum total and ionized calcium levels within the reference range to avoid hypercalcaemia and to suppress PTH levels to normal. This is important because elevated PTH levels in patients with PHP can cause increased bone remodelling and lead to hyper-parathyroid bone disease.
      The goals of pharmacotherapy are to correct calcium deficiency, to prevent complications, and to reduce morbidity. Intravenous calcium is the initial treatment for all patients with severe symptomatic hypocalcaemia. Administration of oral calcium and 1alpha-hydroxylated vitamin D metabolites, such as calcitriol, remains the mainstay of treatment and should be initiated in every patient with a diagnosis of pseudo hypoparathyroidism.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 33 - A 26-year-old office worker presents with a 3 year history of epigastric pain,...

    Incorrect

    • A 26-year-old office worker presents with a 3 year history of epigastric pain, especially 30 minutes after eating. This is associated with nausea and belching. She also describes constipation with occasional explosive diarrhoea. The stools are normally hard with mucus and she needs to strain with every motion. Abdominal pain is relieved after defecation but abdominal bloating persists. She wakes up an hour earlier each morning to finish her breakfast in order to prevent vomiting. She has missed work on a few occasions and feels that her weight has fluctuated. Past medical history includes scarlet fever. She is not on any regular medications except intermittent laxatives over the counter. Abdominal examination is normal. Rectal examination reveals an anal fissure.

      Investigation results:
      Haemoglobin (Hb 13.1 g/dl
      White blood count (WBC) 6.0 × 109/l
      Platelets 180× 109/l
      Mean cell volume (MCV) 87 fL
      International normalised ratio (INR) 1.0
      Na+ 136 mmol/l
      K+ 3.9 mmol/l
      Urea 3.7 mmol/l
      Creatinine 70 μmol/l
      Albumin 39 glL
      Liver function test normal
      Anti-endomysial antibody negative
      Thyroid function test normal
      Gastroscopy normal
      Flexible sigmoidoscopy and biopsy normal
      Abdominal and pelvic ultrasound scans are normal

      What is the most likely diagnosis to account for her symptoms?

      Your Answer:

      Correct Answer: Overlap irritable bowel syndrome and functional dyspepsia

      Explanation:

      This is most likely describing irritable bowel syndrome (IBS). Symptoms are either diarrhoea, constipation, or both, abdominal pain, bloating, of varying duration. It is a functional, not an organic problem, as far as research shows at this point. It is essentially a diagnosis of exclusion. Treatment is a high fibre diet with fluids. Caffeine should be avoided as this can worsen symptoms.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 34 - A 55-year-old female with a history of hypertension presented with severe central chest...

    Incorrect

    • A 55-year-old female with a history of hypertension presented with severe central chest pain for the past one hour, associated with sweating and vomiting. Her ECG showed ST elevation myocardial infarction, evident in leads V2-V4. Which of the following is an absolute contraindication for thrombolysis?

      Your Answer:

      Correct Answer: Intracranial neoplasm

      Explanation:

      Absolute contraindications for fibrinolytic use in STEMI

      Prior intracranial haemorrhage (ICH)
      Known structural cerebral vascular lesion
      Known malignant intracranial neoplasm
      Ischemic stroke within 3 months
      Suspected aortic dissection
      Active bleeding or bleeding diathesis (excluding menses)
      Significant closed head trauma or facial trauma within 3 months
      Intracranial or intraspinal surgery within 2 months
      Severe uncontrolled hypertension (unresponsive to emergency therapy)
      For streptokinase, prior treatment within the previous 6 months

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 35 - Gentamicin is used along with benzylpenicillin in the treatment of infective endocarditis caused...

    Incorrect

    • Gentamicin is used along with benzylpenicillin in the treatment of infective endocarditis caused by streptococcus viridans. Which of the following mechanisms is present in this case?

      Your Answer:

      Correct Answer: Inhibition of protein synthesis (translation)

      Explanation:

      Gentamicin acts along with benzylpenicillin to inhibit protein synthesis at the level of ribosomes. Indirectly it inhibits the translation process.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 36 - A 70-year-old male patient with hypertension complains of acute urinary retention. He provides...

    Incorrect

    • A 70-year-old male patient with hypertension complains of acute urinary retention. He provides a history of urinary frequency for the past 18 months and has been taking Nifedipine and Propranolol for blood pressure control. Which of the following is the most probable cause for his acute presentation?

      Your Answer:

      Correct Answer: Drug induced

      Explanation:

      Calcium channel blockers decrease smooth-muscle contractility in the bladder and this can cause urinary retention.
      An enlarged prostate gland could be the reason if he gave a history of obstructive symptoms.
      Diabetes presents with polyuria.
      Bladder cancer commonly presents with painless haematuria.

    • This question is part of the following fields:

      • Renal System
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  • Question 37 - What is correct statement regarding pulsus alternans? ...

    Incorrect

    • What is correct statement regarding pulsus alternans?

      Your Answer:

      Correct Answer: It is found in association with a third heart sound

      Explanation:

      Pulsus alternans is the alternation of one strong and one weak beat without a change in the cycle length. It occurs most commonly in heart failure due to increased resistance to LV ejection, as occurs in hypertension, aortic stenosis, coronary atherosclerosis, and dilated cardiomyopathy. Pulsus alternans is usually associated with an S3 gallop, which is associated with a poor prognosis. It usually disappears with treatment of the heart failure.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 38 - In last 5 days, an old man has complained of severe left sided...

    Incorrect

    • In last 5 days, an old man has complained of severe left sided headache, which was aggravated by bright lights. He has not vomited but feels nauseated. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Migraine

      Explanation:

      Migraine without aura have the following characteristics: Nausea and vomiting accompanied by >5 headaches that last for 4-72 hours, plus any unilateral, pulsating headache or are aggravated by routine daily activities.

    • This question is part of the following fields:

      • Nervous System
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  • Question 39 - A 65-year-old heavy smoker presented with acute central chest pain for 2 hours....

    Incorrect

    • A 65-year-old heavy smoker presented with acute central chest pain for 2 hours. Which of the following ECG findings is an indication for thrombolysis in this patient?

      Your Answer:

      Correct Answer: 1 mm ST elevation in 2 limb leads

      Explanation:

      Thrombolytic therapy is indicated in patients with evidence of ST-segment elevation MI (STEMI) or presumably new left bundle-branch block (LBBB) presenting within 12 hours of the onset of symptoms if there are no contraindications to fibrinolysis. STEMI is defined as new ST elevation at the J point in at least two contiguous leads of 2 mm (0.2 mV) or more in men or 1.5 mm (0.15 mV) in women in leads V2-V3 and/or 1 mm (0.1 mV) or more in other contiguous limb leads.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 40 - A 53 year-old dancer presents to the ED with increasing weakness. She has...

    Incorrect

    • A 53 year-old dancer presents to the ED with increasing weakness. She has no pertinent past medical history aside from a recent diarrhoeal illness, which she attributes to an undercooked chicken meal. Her husband says that she has been unable to get up out of a chair for the past day. Upon examination, there is bilateral limb weakness and areflexia noted, but it is more severe in the lower limbs. You notice that if she lies flat in the bed, her oxygen saturations fall by around 2% on the pulse oximeter and she is unable to perform spirometry. Which of the following represents the most appropriate immediate management of choice in this patient?

      Your Answer:

      Correct Answer: ITU review for consideration of ventilation

      Explanation:

      This woman has a history that is suggestive of Guillain- Barre syndrome. This may be precipitated by Campylobacter, and her history of recent diarrhoeal illness is pointing towards that. Certain features point to a poor prognosis, including rapidity of onset, reduced vital capacity or respiratory failure, age >40 and reduced amplitude of compound muscle action potential. Her inability to perform spirometry and desaturating whilst lying flat are suggestive of impending respiratory muscle weakness. Review for consideration of ventilation is recommended. Further management of choice for Guillain-Barre syndrome is IV immunoglobulins. Steroids have no value in the treatment of the condition.

    • This question is part of the following fields:

      • Nervous System
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  • Question 41 - A 34-year-old HIV positive man is referred to gastroenterology due to jaundiced sclera....

    Incorrect

    • A 34-year-old HIV positive man is referred to gastroenterology due to jaundiced sclera. Liver function tests are as follows:


      Albumin 34 g/l
      ALP 540 iu/l
      Bilirubin 67 µmol/l
      ALT 45 iu/l

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Sclerosing cholangitis

      Explanation:

      HIV can cause strictures in the biliary tract (see source for details of the disease). This makes the diagnosis of primary sclerosing cholangitis most likely given the clinical presentation and lab values. Due to its association with HIV this is more likely than all of the other answer choices. Know this association.

    • This question is part of the following fields:

      • Hepatobiliary System
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  • Question 42 - A woman presents with pallor and jaundice. History reveals she has been taking...

    Incorrect

    • A woman presents with pallor and jaundice. History reveals she has been taking medication to treat her acne. Which of the following medication has she been taking?

      Your Answer:

      Correct Answer: Erythromycin

      Explanation:

      Oral erythromycin is used to treat acne, and has been known to cause various degrees of hepatotoxicity in many patients. It is believed to cause liver lesions leading to hampered bile formation and cholestasis. This presents as jaundice due to the increased movement of bile into the blood instead of into the duodenum. All the other drugs mentioned here are not known to cause such hepatotoxicity.

    • This question is part of the following fields:

      • Hepatobiliary System
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  • Question 43 - A 3-year-old boy presents with recurrent urinary tract infections. What is the most...

    Incorrect

    • A 3-year-old boy presents with recurrent urinary tract infections. What is the most common cause for this problem in a child of this age?

      Your Answer:

      Correct Answer: Vesicoureteric reflux

      Explanation:

      Vesicoureteral reflux is the condition when the urine flows backwards from the bladder into the kidneys, which is the most common cause of UTI in patients this age.

    • This question is part of the following fields:

      • Renal System
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  • Question 44 - A 24-year-old waiter applies for a job at a cafeteria. He gives a...

    Incorrect

    • A 24-year-old waiter applies for a job at a cafeteria. He gives a history of having had enteric fever 2 years ago. Which of the following investigations is most likely to indicate a chronic carrier status?

      Your Answer:

      Correct Answer: Culture of intestinal secretions

      Explanation:

      The chronic asymptomatic carrier state is thought to be why there is continued appearance of the bacterium in human populations. As shedding of the organism is intermittent and sometimes at low levels, methods to detect it have been limited. The Salmonella typhi may be cultured from intestinal secretions, faeces or urine in chronic carriers and is recommended to confirm the diagnosis. Vi agglutination test can also be high in normal people in areas with typhoid endemic. Full blood count or blood culture would not be helpful to determine carrier status. Widal antigen test is unable to differentiate carriers from people with a hx of prior infection.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 45 - Which of the following statements is true concerning gastrin? ...

    Incorrect

    • Which of the following statements is true concerning gastrin?

      Your Answer:

      Correct Answer: Release is triggered by GI luminal peptides

      Explanation:

      Gastrin is released by G cells in the antrum of the stomach. It stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and also aids in gastric motility. It is released in response to the following stimuli: vagal stimulation, antrum distention, hypercalcemia. It is inhibited by the following: presence of acid in stomach, SST, secretion, GIP, VIP, glucagon, calcitonin.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 46 - A 45-year-old female presented with weight loss, night sweats and abdominal pain for...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 47 - A gentleman arrives at the renal clinic for review. He has long standing...

    Incorrect

    • A gentleman arrives at the renal clinic for review. He has long standing chronic renal failure and is unfortunately suffering from metabolic bone disease. His GP has asked for an explanation of the causes and features of metabolic bone disease.

      Which of the following best describes the biochemical changes involved?

      Your Answer:

      Correct Answer: Phosphate excretion is decreased, parathyroid hormone levels are increased and 1,25-OH vitamin D levels are decreased

      Explanation:

      The patient’s chronic renal failure causes decreased renal hydroxylation of vitamin D which leads to decreased calcium absorption in the gut. Simultaneously, there is also decreased renal excretion of phosphate, and this combination of factors results in increased PTH levels.

    • This question is part of the following fields:

      • Renal System
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  • Question 48 - Three days after being admitted for a myocardial infarction, a male patient complains...

    Incorrect

    • Three days after being admitted for a myocardial infarction, a male patient complains of sudden change in vision. The medical registrar examines the patient and finds that the patient's vision in both eyes is significantly reduced although the patient still claims that he can see. The pupils are equal in size, and the pupil responses are normal with normal fundoscopy. Significantly, the patient has now developed atrial fibrillation.
      A referral is made to the ophthalmologist who confirms bilateral blindness. Despite this, however, the patient fervently believes that he can see and has taken to describing objects that he has never seen previously, in discriminating detail.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Bilateral occipital cortex infarction

      Explanation:

      Bilateral occipital cortex infarction will produce varying degrees of cortical blindness, wherein the patient has no vision but fundoscopy findings are normal. When there are extensive lesions, patients my present with denial of their condition, known as Anton’s Syndrome, and begin to describe objects that they have never seen before.

    • This question is part of the following fields:

      • Nervous System
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  • Question 49 - An 81-year-old male patient was admitted after an ischaemic stroke. Physical examination reveals...

    Incorrect

    • An 81-year-old male patient was admitted after an ischaemic stroke. Physical examination reveals left hemiparesis. How would you classify this hemiparesis based on the WHO International Classification of Functioning, Disability and Health?

      Your Answer:

      Correct Answer: Impairment of body function

      Explanation:

      Symptoms and signs are classified as ‘impairment of body function’.
      The types of impairment classified as ‘activity limitation’ include difficulties that a patient may have in executing certain activities.
      The type of impairment classified as ‘participation restriction’ are problems a patient may have in social roles.
      The type of impairment classified as ‘pathology’ would be the diagnosis/disease.
      Right total anterior circulation infarct relates to the Oxford Bamford classification for stroke.

    • This question is part of the following fields:

      • Geriatric Medicine
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  • Question 50 - A 25-year-old female presented with a history of sudden collapse. She had been...

    Incorrect

    • A 25-year-old female presented with a history of sudden collapse. She had been playing netball and had suddenly collapsed. This collapse had been accompanied by a brief period of loss of consciousness. She experienced palpitations for a brief period prior to losing consciousness. On examination her BP was 120/70 mmHg and pulse rate was 72 bpm, which was regular. The rest of the examination was also normal.
      She had similar experience of collapse, about two years ago. She was well except for these two incidents and she has not been on any medication. All the investigations done at the first presentation (2 years ago), including FBC, ECG and echocardiography were normal. Her ECG done at this presentation revealed QT prolongation of 0.50 s. FBC, CXR and other investigations were normal. Which of the following is the best way of managing this patient?

      Your Answer:

      Correct Answer: Start on a beta-blocker

      Explanation:

      Beta-blockers are drugs of choice for patients with LQTS. The protective effect of beta-blockers is related to their adrenergic blockade, which diminishes the risk of cardiac arrhythmias. They may also reduce the QT interval in some patients.

    • This question is part of the following fields:

      • Cardiovascular System
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SESSION STATS - PERFORMANCE PER SPECIALTY

Nervous System (0/1) 0%
Endocrine System & Metabolism (0/1) 0%
Evidence Based Medicine (0/1) 0%
The Skin (0/1) 0%
Musculoskeletal System (0/1) 0%
Pharmacology (1/1) 100%
Haematology & Oncology (0/1) 0%
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