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Question 1
Correct
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A 42-year-old male undergoes a routine cranial nerve examination, which reveals the following findings:
Rinne's test: Air conduction > bone conduction in both ears
Weber's test: Localizes to the right side
What do these test results imply?Your Answer: Left sensorineural deafness
Explanation:Weber’s test – if there is a sensorineural problem, the sound is localized to the unaffected side (right), indicating a problem on the left side.
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This question is part of the following fields:
- Nervous System
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Question 2
Correct
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A 63-year-old gentleman presents with left-sided eye pain and diplopia for the past 2 days. Examination of his eyes shows his pupils equal and reactive to light with no proptosis. There is however an apparent palsy of the 6th cranial nerve associated with a partial 3rd nerve palsy on the left side. Examining the remaining cranial demonstrates hyperaesthesia of the upper face on the left side. Where is the likely lesion?
Your Answer: Cavernous sinus
Explanation:A lesion on the cavernous sinus would explain the palsy observed on the III and VI cranial nerves because the cranial nerves III, IV, V, and VI pass through the cavernous sinus. Pain in the eye is due to the nearby ophthalmic veins that feeds the cavernous sinus. Additionally, the lesions in the other structures would have presented with pupil abnormalities and less localized pain and symptoms.
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This question is part of the following fields:
- Nervous System
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Question 3
Incorrect
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Which of the given adverse effects should be anticipated following the administration of an anticholinesterase?
Your Answer: Tachycardia and diarrhoea
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 4
Incorrect
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A 60-year-old gentleman presents with symptoms of nocturia and difficulty in passing urine. He is not known to have any previous prostatic problems and denies any dysuria. Following a digital rectal examination, he is started on Finasteride and Tamsulosin. Three months later he presents to the emergency department with urinary retention and is catheterized, and a craggy mass is felt on rectal examination. He is referred to a urologist, and a prostatic ultrasound and needle biopsy are arranged, and prostate serum antigen (PSA) is requested.
Which of the following factors is most likely to give a false negative PSA?Your Answer:
Correct Answer: Finasteride
Explanation:Finasteride is often prescribed for patients with Benign Prostatic Hyperplasia (BPH) or enlarged prostate. However, it has been known to cause a decrease in Prostatic Specific Antigen (PSA) levels in patients with BPH, which may lead to false negatives in a case like this, where a palpable mass has been detected and malignancy is suspected.
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This question is part of the following fields:
- Renal System
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Question 5
Incorrect
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A 54-year-old man presents to the physician complaining of chest pain and fever. He underwent hemicolectomy a few days back. Echocardiography is done which shows a systolic murmur. Which other investigation would be required?
Your Answer:
Correct Answer: Blood culture
Explanation:Infective endocarditis (IE) is an infectious inflammation of the endocardium that affects the heart valves. The condition is a result of bacteraemia, which is most commonly caused by dental procedures, surgery, distant primary infections, and nonsterile injections. IE clinically presents with either an acute or subacute course. Acute disease is usually caused by Staphylococcus aureus and causes rapid endocardium destruction. Subacute progression is most commonly caused by viridans streptococci species and generally affects individuals with pre-existing damage to the heart valves, structural heart defects, or the presence of prosthetic valves. Clinical features include constitutional symptoms (fatigue, fever/chills, malaise) in combination with signs of pathological cardiac changes (e.g., new or changed heart murmur, heart failure signs) and possibly manifestations of subsequent damage to other organs (e.g., glomerulonephritis, septic embolic stroke). Diagnosis is made based on the Duke criteria, whose main features include positive blood cultures and evidence of endocardial involvement in echocardiography. Initial treatment of IE consists of empiric IV antibiotic therapy, which is then adapted to blood culture results and continued for four to six weeks. Prophylaxis is only administered in specific circumstances, e.g., in patients with pre-existing heart conditions undergoing dental or surgical procedures. If left untreated, infective endocarditis can be fatal within a few weeks.
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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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An 18-year-old prospective medical student is tested for hepatitis B. Her liver tests show alanine transaminase (ALT) 120 U/L and serology shows her to be positive for HBsAg, HBcAb and HBeAg, with a viral load of 105 genome equivalents/mL.
A liver biopsy is reported as showing early fibrosis with evidence of moderate inflammation.
Which of the following treatments should be offered?Your Answer:
Correct Answer: Interferon alfa 2b
Explanation:Interferon alfa alone, not interferon alfa and ribavirin, has been shown to achieve HBeAg seroconversion for patients with HBeAg-positive chronic hepatitis B.
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This question is part of the following fields:
- Infectious Diseases
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Question 7
Incorrect
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In chemotherapy, what is the rationale behind using combinations of chemotherapeutic agents rather than single agents?
Your Answer:
Correct Answer: Combination therapy decreases the chances of drug resistance developing
Explanation:There are two main reasons for using combinations of chemotherapeutic agents rather than single agents. First, different drugs exert their effects through different mechanisms, therefore, carefully combining them will increase the number of tumour cells killed in each cycle as well as decrease their chances of developing drug resistance. Second, there may be an even greater effect with drugs that are synergistic.
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This question is part of the following fields:
- Haematology & Oncology
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Question 8
Incorrect
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A 60-year-old female with a recent history of MI, complained of exertional dyspnoea. On examination there was a third heart sound. ECG showed ST elevations in leads V1 to V4. Which of the following is the most probable reason for this presentation?
Your Answer:
Correct Answer: Left ventricular aneurysm
Explanation:Electrocardiography is characterized by ST elevation that persists several weeks after an acute MI. The features of heart failure (exertional dyspnoea and third or fourth heart sound) favours the diagnosis.
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This question is part of the following fields:
- Cardiovascular System
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Question 9
Incorrect
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A 60-year-old patient with hypertension attended his regular clinic. His compliance was poor. His blood pressure was 180/100 mmHg. His pulse rate was 85 bpm which was irregularly irregular. On examination there was bibasal crepitation. No murmurs were heard. What is the most likely cause for these findings?
Your Answer:
Correct Answer: Left ventricular hypertrophy
Explanation:Left ventricular hypertrophy due to long standing hypertension is the most probable cause. The irregularly irregular pulse was suggestive of atrial fibrillation, which is due to diastolic dysfunction. Poor ventricular filling causes pulmonary congestion which manifests as bibasal crepitations.
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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 collapsed patient comes into A&E. He has a steroid user card and empty boxes of prednisolone. He has obvious rheumatoid features on examination and some unilateral consolidation on his chest X-ray. He is given intravenous fluids and broad-spectrum antibiotics.
Which one of the following would be the most useful addition to the current management?Your Answer:
Correct Answer: IV hydrocortisone 100 mg
Explanation:The empty boxes indicate that the patient has run out of his medication.
Chronic administration of high doses of glucocorticoids (GCs) (e.g., prednisone or prednisolone) and also other hormones such as oestrogens, progestins, androgens and growth hormone induce varying degrees of tolerance, resulting in a progressively decreased response to the effect of the drug, followed by dependence and rarely addiction.
The glucocorticoid withdrawal syndrome (GWS) has been considered a withdrawal reaction due to established physical dependence on supraphysiological GC levels.
The severity of GWS depends on the genetics and developmental history of the patient, on his environment, and on the phase and degree of dependence the patient has reached. Its management should include a temporary increase in the dose of GCs followed by gradual, slow tapering to a maintenance dose. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 11
Incorrect
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Which is the mechanism of action of trimethoprim?
Your Answer:
Correct Answer: Inhibition of folic acid metabolism
Explanation:Trimethoprim interferes with the action of dihydrofolate reductase and thus inhibits folic acid metabolism and restricts DNA synthesis.
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This question is part of the following fields:
- Pharmacology
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Question 12
Incorrect
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A 51-year-old obese female, with a history of smoking, presents to the clinic with worsening dyspnoea. She is currently on oestrogen therapy for menopausal symptoms.
Clinical examination, ECG and radiological findings correspond to right sided heart failure. There are no signs of left ventricular dysfunction.
Which of the following is the most likely cause of cor pulmonale?Your Answer:
Correct Answer: Recurrent small pulmonary embolisms
Explanation:Postmenopausal oestrogen therapy and hormone therapy are associated with an increased risk of thromboembolism. The relative risk seems to be even greater if the treated population has pre-existing risk factors for thromboembolism, such as obesity, immobilization, and fracture. Cor pulmonale can occur secondary to small recurrent pulmonary embolisms. Pneumonias and bronchiectasis usually present with purulent sputum, and in case of carcinoma there may be other associated symptoms like weight loss, etc.
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This question is part of the following fields:
- Respiratory System
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Question 13
Incorrect
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A 19-year-old woman comes to the endocrine clinic with excessive hairiness and acne. She tells you that she has a period only every few months and when she has one it tends to be very heavy.
On examination, she has obvious facial acne. Her BP is 142/78 mmHg, her pulse is 72 bpm and regular and her BMI is 30. There is facial hair and hair around her upper chest and breasts.
Investigations show:
Haemoglobin 11.9 g/dl (11.5-16.0)
White cell count 6.0 x 10(9)/l (4-11)
Platelets 202 x 10(9)/l (150-400)
Sodium 137 mmol/l (135-146)
Potassium 3.9 mmol/l (3.5-5)
Creatinine 90 µmol/l (79-118)
Total testosterone normal
Free androgen index elevated
LH / FSH ratio 2.2
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Polycystic ovarian syndrome
Explanation:Rotterdam criteria for the diagnosis of polycystic ovary syndrome:
Two of the following three criteria are required:
1. Oligo/anovulation
2. Hyperandrogenism
– Clinical (hirsutism or less commonly male pattern alopecia) or
– Biochemical (raised FAI or free testosterone)
3. Polycystic ovaries on ultrasound
Other aetiologies must be excluded such as congenital adrenal hyperplasia, androgen-secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia.
Cushing’s is excluded because there would have been marked obesity, hypertension and other related features. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 14
Incorrect
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A cohort study is being designed to look at the relationship between smoking and prostate cancer. What is the usual outcome measure in a cohort study?
Your Answer:
Correct Answer: Relative risk
Explanation:A cohort study is a particular form of longitudinal study that samples a cohort (a group of people who share a defining characteristic, typically those who experienced a common event in a selected period, such as birth or graduation), performing a cross-section at intervals through time.
The relative risk (RR) or risk ratio is the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group. Relative risk is used in the statistical analysis of the data of experimental, cohort and cross-sectional studies, to estimate the strength of the association between treatments or risk factors, and outcomes. -
This question is part of the following fields:
- Evidence Based Medicine
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Question 15
Incorrect
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While investigating a patient with hepatocellular carcinoma (HCC), blood tests reveal a raised level of serum ferritin. What would be the most probable cause for HCC in this patient?
Your Answer:
Correct Answer: Haemochromatosis
Explanation:Haemochromatosis is the excessive accumulation of iron in the body mainly involving the liver, pancreas, testes, skin etc. Serum ferritin is high indicating iron overload. Haemochromatosis is a known cause for chronic liver cell disease, cirrhosis and HCC.
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This question is part of the following fields:
- Gastrointestinal System
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Question 16
Incorrect
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A 40-year old male presented to the OPD with a history of difficulty swallowing and blood-stained vomit. History of weight loss is also present. The abdominal X-ray was normal. Which of the following should be done next?
Your Answer:
Correct Answer: Oesophagogastroduodenoscopy
Explanation:An esophagogastroduodenoscopy (OGD) should be ordered to visualize and identify the source of bleeding. This procedure can harvest tissue samples for histological analysis and can also treat varices that may be causing the bleeding.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 17
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 18
Incorrect
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A 68-year-old male with history of poorly controlled hypertension was admitted with shortness of breath on exertion, orthopnoea for three months. He was diagnosed with congestive cardiac failure and was started on digoxin 62.5 μg daily, furosemide 80 mg daily and amiloride 10 mg daily. On admission his lab results showed that his serum urea was 6 mmol/L and serum creatinine was 115 μmol/L. One month later he came for a follow up consultation. On examination he had bilateral ankle oedema. His blood pressure was 138/90 mmHg and pulse rate was 92 bpm. His JVP was not elevated. His apex beat was displaced laterally and he had a few bibasal crepitations on auscultation. There were no cardiac murmurs. His investigation results revealed the following:
Serum sodium 143 mmol/L (137-144)
Serum potassium 3.5 mmol/L (3.5-4.9)
Serum urea 8 mmol/L (2.5-7.5)
Serum creatinine 140 μmol/L (60-110)
Serum digoxin 0.7 ng/mL (1.0-2.0)
CXR showed cardiomegaly and a calcified aorta. ECG showed left ventricular hypertrophy.
Which of the following is the most appropriate next step in the management of this patient?Your Answer:
Correct Answer: Add an ACE inhibitor to the current regimen
Explanation:From the given history the patient has NYHA grade III heart failure. He can be safely started on an ACE inhibitor as his serum potassium was towards the lower limit. As there an impairment of renal function, his urea, creatinine and serum electrolytes should be closely monitored after commencing an ACE inhibitor. Adding atenolol will not have any clinical benefit. Increasing the digoxin dose is not needed as the patient is in sinus rhythm. Increasing furosemide will only have symptomatic relief.
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This question is part of the following fields:
- Cardiovascular System
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Question 19
Incorrect
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A woman with breast cancer develops urinary frequency. Which part of the brain has metastasis potentially spread to?
Your Answer:
Correct Answer: Diencephalon
Explanation:Diencephalon consists of four structures; thalamus, subthalamus, hypothalamus and epithalamus. The hypothalamus has a crucial role in controlling urinary frequency.
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This question is part of the following fields:
- Haematology & Oncology
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Question 20
Incorrect
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A 42-year-old man with alcoholic liver disease is admitted with pyrexia. He has been unwell for the past three days and has multiple previous admissions before with variceal bleeding. Examination shows multiple stigmata of chronic liver disease, ascites and jaundice.
Paracentesis is performed with the following results: Neutrophils 487 cells/ul
What is the most appropriate treatment?Your Answer:
Correct Answer: Intravenous cefotaxime
Explanation:This describes a clinical scenario of spontaneous bacterial peritonitis. The diagnosis is made when fluid removed (ascites) is found to have > 250/mm cubed of PMNs (polymorphonuclear leukocytes). Cefotaxime or another third generation cephalosporin is the treatment of choice.
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This question is part of the following fields:
- Hepatobiliary System
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Question 21
Incorrect
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A 18-year-old male was screened for hypertrophic cardiomyopathy (HOCM) as his brother had the same condition. What is the echocardiographic finding that is related to the highest risk of sudden cardiac death?
Your Answer:
Correct Answer: Significant thickening of the interventricular septum
Explanation:There are five prognostic factors which indicate poor prognosis in HOCM:
-family history of HOCM-related sudden cardiac death
-unexplained recent syncope
-large left ventricular wall thickness (MLVWT > 30 mm)
-multiple bursts of nsVT on ambulatory electrocardiography
-hypotensive or attenuated blood pressure response to exercise -
This question is part of the following fields:
- Cardiovascular System
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Question 22
Incorrect
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A 24-year-old woman presents as an emergency to her GP with acute vomiting which began some 3-4 hours after attending an afternoon meeting. Cream cakes were served during the coffee break.
Which of the following organisms is the most likely cause of this acute attack of vomiting?Your Answer:
Correct Answer: Staphylococcus aureus
Explanation:Staph. aureus is the most likely cause. It is found in foods like dairy products, cold meats, or mayonnaise. It produces a heat-stable ENDOTOXIN (remember this) that causes nausea, vomiting, and diarrhoea 1-6 hours after ingestion of contaminated food. B. cereus is classically associated with fried rice being reheated. Salmonella is typical with raw eggs and undercooked poultry. Campylobacter which is most commonly associated with food poisoning, is seen with poultry 50% of the time. Yersinia enterocolitica is seen with raw or undercooked pork, and may be a case presenting with mesenteric adenitis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 23
Incorrect
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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.
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This question is part of the following fields:
- Renal System
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Question 24
Incorrect
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A 41-year-old male patient presents with dysphagia, haemoptysis and vocal hoarseness. He's been smoking for 25 years and has a past history of regular cannabis use. What is the most probable diagnosis?
Your Answer:
Correct Answer: Squamous cell laryngeal cancer
Explanation:Progressive hoarseness of the voice is a very typical and early finding in people suspected to have squamous cell laryngeal cancer. Due to mechanical compression, patients might experience dysphagia as well as pain. The ‘lump in the throat sensation is not uncommon too. Haemoptysis might be present, together with respiratory symptoms such as dyspnoea. Other symptoms consist of constitutional complaints, such as weight loss or fatigue.
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This question is part of the following fields:
- Haematology & Oncology
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Question 25
Incorrect
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A 80-year-old male patient with ischaemic heart disease, hypertension and dyslipidemia presented with productive cough, fever with chills and loss of appetite for 4 days. On examination he was unwell and febrile with a temperature of 38.3. His blood pressure was 130/80 mmHg and pulse rate was 140 bpm. Respiratory rate was 18 breaths per minute. On auscultation there were crepitations over the left lower zone of his chest. His abdomen was soft and nontender. ECG showed an irregular narrow complex tachycardia. Which of the following is the most appropriate acute management to treat his tachycardia?
Your Answer:
Correct Answer: Antibiotics
Explanation:The most likely diagnosis is acute atrial fibrillation (AF) precipitated by acute pneumonia. History of fever, cough and the auscultation findings support it. So the most appropriate management is treating the pneumonia with antibiotics. Treating the underlying cause will reduce the heart rate. Other responses are helpful in the management of chronic AF.
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This question is part of the following fields:
- Cardiovascular System
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Question 26
Incorrect
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A 48-year-old male with a history of bipolar disorder presents with acute confusion. In-transit to hospital he had a generalized seizure which terminated spontaneously after around 30 seconds. On arrival to the emergency department, his GCS is 14/15 and he is noted to have a coarse tremor. Suspecting a diagnosis of lithium toxicity, intravenous access is obtained, a blood sample was drawn for investigations and a saline infusion is started. The blood investigations revealed:
Lithium level: 4.2 mmol/l
Na+: 136 mmol/l
K+: 4.6 mmol/l
Urea: 8.1 mmol/l
Creatinine: 99 µmol/l
Bicarbonate: 18 mmol/l
What is the most appropriate management for the patient?Your Answer:
Correct Answer: Arrange haemodialysis
Explanation: -
This question is part of the following fields:
- Fluids & Electrolytes
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Question 27
Incorrect
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All of the following statements suggesting a poor prognosis of Guillain-Barre syndrome are correct except?
Your Answer:
Correct Answer: Evidence demyelination on nerve conduction studies
Explanation:Guillain barre syndrome is a neurological disorder characterised by neuropathy along with ascending paralysis. Denervation rather than demyelination suggests poor prognosis in GB syndrome.
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This question is part of the following fields:
- Nervous System
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Question 28
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 29
Incorrect
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A 23-year-old woman experiences visual disturbances and anxiety associated with sudden change in posture. She also has nausea, vomiting, and dizziness occasionally. What is the most likely diagnosis?
Your Answer:
Correct Answer: BPPV
Explanation:The most probable diagnosis is benign paroxysmal positional vertigo (BPPV). It is a peripheral vestibular disorder characterized by short episodes of mild to intense dizziness and influenced by specific changes in head position. BPPV is the most common cause of vertigo accounting for nearly one-half of patients with peripheral vestibular dysfunction. In order to establish the diagnosis, the head roll test is performed where the head is turned about 90° to each side while supine.
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This question is part of the following fields:
- Nervous System
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Question 30
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 31
Incorrect
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A 60-year-old man with previous history of myocardial infarction and hypertension presented with severe retrosternal chest pain for the past 2 hours. During initial management he collapsed and pulseless ventricular tachycardia was detected. The external defibrillator arrived in 3 minutes. From the following answers, what is the most appropriate immediate management of this patient whilst waiting for the defibrillator?
Your Answer:
Correct Answer:
Explanation:Immediate Management of Pulseless Ventricular Tachycardia:
- Continuous Chest Compressions:
- Continuous chest compressions should be started immediately to maintain circulation while the defibrillator is being prepared. High-quality chest compressions are crucial and should not be delayed.
- Defibrillation:
- Once the defibrillator arrives, defibrillation should be performed as soon as possible. For pulseless ventricular tachycardia, delivering a shock is critical to attempt to restore a normal heart rhythm.
Other options:
He should be given a precordial thump: This is not recommended as a primary action when a defibrillator is available or arriving imminently.
A ventilation to compression ratio of 30:2 should be commenced: While ventilation is important, continuous chest compressions take precedence in the initial phase. The ratio of 30:2 is used during CPR when ventilations are also being provided, typically when two rescuers are present.
Await arrival of defibrillator, then deliver shock: Waiting passively without performing chest compressions is not appropriate.
Intravenous adrenaline should be given: Adrenaline is part of the advanced life support protocol, but the first immediate action should be chest compressions followed by defibrillation.
- Continuous Chest Compressions:
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This question is part of the following fields:
- Cardiovascular System
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Question 32
Incorrect
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The increased risk of oesophageal malignancy in patients with Barrett's oesophagus is approximately:
Your Answer:
Correct Answer: 50 - 100 times risk
Explanation:Barrett’s oesophagus is the transformation of the normal squamous epithelium of the oesophagus to columnar, intestinal type epithelium. It is often seen in patients with reflux and there is a 50-100 fold increased risk of oesophageal adenocarcinoma in patients with Barrett’s oesophagus.
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This question is part of the following fields:
- Gastrointestinal System
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Question 33
Incorrect
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A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a recent holiday abroad. Which of the following investigations is the least relevant?
Your Answer:
Correct Answer: PCR of CSF for Mycobacterium TB
Explanation:Amoebic, bacterial and fungal meningitis may present acutely but this is not common in tuberculous meningitis. Amoebic meningitis is caused by Naegleria fowleri as a result of swimming in infected freshwater. The organism may be found in fresh CSF specimens with phase contrast microscopy.
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This question is part of the following fields:
- Infectious Diseases
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Question 34
Incorrect
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A 24-year-old female presents with generalised irritation and erythematous skin after sunbathing on the beach. Which is the most appropriate immediate treatment for this patient?
Your Answer:
Correct Answer: Emollient cream
Explanation:Sun burn reactions usually occur after individuals with a light skin tone have prolonged exposure to the sun. The usual symptoms are redness and itching of the skin. The best treatment plan would be further avoidance of sun exposure and the topical application of emollients. These are Ist degree burns and aggressive therapy is not required in such cases.
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This question is part of the following fields:
- The Skin
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Question 35
Incorrect
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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:
Correct 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 36
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 37
Incorrect
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A study is developed to compare two chemotherapy schemas for individuals with small cell lung cancer. Which of the following would you choose to compare survival time with in this particular study?
Your Answer:
Correct Answer: Hazard ratio
Explanation:The hazard ratio describes the relative risk of the complication based on comparison of event rates.
Hazard ratios have also been used to describe the outcome of therapeutic trials where the question is to what extent treatment can shorten the duration of the illness. However, the hazard ratio, a type of relative risk, does not always accurately portray the degree of abbreviation of the illness that occurred. In these circumstances, time-based parameters available from the time-to-event curve, such as the ratio of the median times of the placebo and drug groups, should be used to describe the magnitude of the benefit to the patient. The difference between hazard-based and time-based measures is analogous to the odds of winning a race and the margin of victory. The hazard ratio is the odds of a patient’s healing faster under treatment but does not convey any information about how much faster this event may occur.
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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 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:
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 39
Incorrect
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A young alcoholic male patient presented at hospital with complaints of tachycardia and palpitations for the past few hours. During examination, his blood pressure and ECG were normal. What would be the next step in management of this patient?
Your Answer:
Correct Answer: Reassure and life Style modification
Explanation:Normal blood pressure and ECG rule out any pathological cause of the complaints described in this scenario. These symptoms are most probably due to anxiety or effects of alcohol intake. Lifestyle modification will be the best management plan along with reassurance to calm the patient.
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This question is part of the following fields:
- Cardiovascular System
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Question 40
Incorrect
-
A 50-year-old male patient with Pulmonary Tuberculosis is taking Ethambutol, Isoniazid, Pyrazinamide, Pyridoxine, and Rifampicin. Which of the above drugs is associated with peripheral neuropathy?
Your Answer:
Correct Answer: Isoniazid
Explanation:Isoniazid is associated with peripheral neuropathy, which occurs due to deficiency of biologically active pyridoxine. The deficiency is caused by the combination of isoniazid and pyridoxine to form a hydrazone which is excreted in the urine. Pyridoxine supplementation reduces the risk associated with Isoniazid.
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This question is part of the following fields:
- Pharmacology
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Question 41
Incorrect
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A 40-year-old lady who underwent a recent subtotal gastrectomy for peptic ulcer disease has now developed anaemia with a haemoglobin of 6.4, tiredness, fatigue and loss of vibration sensation in both legs. What is the underlying cause of her symptoms?
Your Answer:
Correct Answer: B12 deficiency
Explanation:Vit B12 needs intrinsic factor to be absorbed, which is secreted in the stomach. Its deficiency is characterised by macrocytic anaemia with peripheral neuropathy.
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This question is part of the following fields:
- Gastrointestinal System
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Question 42
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 43
Incorrect
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A 65-year-old male patient presents with a non-explosive cough, muscle twitching on the level of the tongue and aspiration pneumonia. He also claims that occasionally the food he swallows comes back through his nose. What is the most likely cause of dysphagia in this case?
Your Answer:
Correct Answer: Bulbar palsy
Explanation:Bulbar palsy and pseudobulbar palsy are rare types of a motor neuron disease that affect the cranial motor nerves. Bulbar palsy is a lower motor neuron palsy that affects the nuclei of the 9th to 12th cranial nerves. Pseudobulbar palsy is an upper motor neuron palsy that affects the corticobulbar tracts of the 5th, 7th and 9th to 12th cranial nerves. Any condition which disrupts or damages the cranial nerve nuclei or corticobulbar tracts can cause bulbar or pseudobulbar palsy (e.g., stroke, multiple sclerosis, infections, brain stem tumours). Both bulbar and pseudobulbar palsy are seen mainly in men over 75 years old and present with progressive dysarthria and dysphagia. In addition, patients with pseudobulbar palsy present with a lack of facial expression, difficulty chewing, and emotional lability. Lower motor neuron signs (atrophy and fasciculations of the tongue, absent gag reflex) differentiate bulbar palsy from pseudobulbar palsy, which presents with upper motor neuron signs (spastic tongue, exaggerated gag, and jaw jerk reflexes). Diagnosis is mainly clinical and treatment mostly supportive with a poor prognosis. Life expectancy is around 1-3 years following diagnosis.
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This question is part of the following fields:
- Haematology & Oncology
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Question 44
Incorrect
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A 52-year-old hypertensive, smoker presents to ER with right side weakness. He gives a history of multiple falls and lack of concentration. What is the most appropriate diagnosis?
Your Answer:
Correct Answer: Multi-infarct dementia
Explanation:The patient is a heavy smoker and hypertensive which are risk factors of atherosclerosis and cerebrovascular diseases. The acute onset of the weakness and the lateralization indicates a cerebral infarction.
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This question is part of the following fields:
- Nervous System
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Question 45
Incorrect
-
Regarding bupropion (Zyban), which one of the following statements is true?
Your Answer:
Correct Answer: It has an antidepressant effect
Explanation:The chief role of bupropion is that it acts as an antidepressant agent, which was used extensively to treat war veterans with post traumatic stress disorders. It is also very effective nicotine replacement therapy. Contraindications include epileptic seizures as it decreases the threshold of epilepsy in these patients to 1:1000.
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This question is part of the following fields:
- Pharmacology
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Question 46
Incorrect
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A 41-year-old woman who has a history of SLE presents with a dry cough, dyspnoea and fever. She is being treated with a monthly dose of IV cyclophosphamide for Grade IV nephropathy. The last cyclophosphamide dose was 10 years ago. Lab investigations are as follows:
WCC: 2.3 (lymphocyte count 0.7)
Platelets: 81
Hb: 10.5
ESR: 56
CRP: 43
PO2: 7.2 kPa, PCO2: 3.6 kPa after walking out to the toilet.
Chest X ray was unremarkable apart from some patchy pulmonary infiltration.
What is the likely diagnosis?Your Answer:
Correct Answer: Pneumocystis carinii pneumonia (PCP)
Explanation:Pneumocystis carinii pneumonia, is an opportunistic fungal lung infection occurring almost exclusively in immunocompromised individuals. In 50% of cases, PCP is the first manifestation of AIDS (acquired immune deficiency syndrome), but it may be caused by other immunodeficiency disorders. PCP should be suspected in patients with a history of progressive dyspnoea and a dry cough with resistance to standard antibiotic treatment. Signs that support this diagnosis include a CD4 count < 200/μL, an increased beta-D-glucan level, and diffuse bilateral infiltrates on chest x-ray. Management of PCP includes high-dose trimethoprim/sulfamethoxazole (TMP/SMX), treatment of the underlying immunodeficiency disorder, and steroids in the case of severe respiratory insufficiency. TB is less likely to be present in this case as ESR is relatively low and chest x-ray appeared normal.
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This question is part of the following fields:
- Musculoskeletal System
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Question 47
Incorrect
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A middle-aged female has undergone axillary lymph node clearance after being diagnosed with breast carcinoma. She was stung by a bee and developed a swollen arm. What is the most probable mechanism behind this arm swelling?
Your Answer:
Correct Answer: Lymphoedema
Explanation:Lymph nodes are necessary for the drainage of interstitial fluid to avoid swelling after some histamine reactions. In this case no lymph nodes are present and lymphoedema developed.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 48
Incorrect
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What is the most appropriate next step if a consultant is nominated at a directorate meeting to undertake the next clinical audit?
Your Answer:
Correct Answer: Needs assessment
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. The first step has to be initial assessment and identifying the issues.
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This question is part of the following fields:
- Ethical & Legal
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Question 49
Incorrect
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A 42-year-old man is a known case of Waldenström's macroglobulinemia and is admitted to the hospital with headache, visual disturbances, pale conjunctivae, and breathlessness. While in the assessment unit, he has had an episode of nosebleed that has been difficult to control. On examination, his heart rate is 120 bpm, blood pressure is 115/65 mmHg, and he is febrile with a temperature of 37°C. Fundoscopy shows dilated retinal veins with a retinal haemorrhage in the right eye.
What is the most appropriate next step of management?Your Answer:
Correct Answer: Plasmapheresis
Explanation:The patient is displaying signs and symptoms of hyperviscosity syndrome, secondary to the Waldenström’s macroglobulinemia. Treatment of choice is plasmapheresis.
Waldenström’s macroglobulinemia (also called lymphoplasmacytic lymphoma) is an uncommon type of non-Hodgkin lymphoma seen in older people. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein. Its features include monoclonal IgM paraproteinemia; hyperviscosity syndrome leading to bilateral central retinal vein occlusion (CRVO) and hence, visual disturbances; weight loss and lethargy; hepatosplenomegaly and lymphadenopathy; and cryoglobulinemia. It is not, however, associated with bone pain.
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This question is part of the following fields:
- Haematology & Oncology
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Question 50
Incorrect
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A 24-year-old smoker with testicular cancer presents with exertional dyspnoea, wheezing, and persistent non-productive cough. He completed a course of chemotherapy comprising of cisplatin, bleomycin, and etoposide three months ago. On examination, there are fine bilateral basal crackles.
Which of the following is the most likely diagnosis?Your Answer:
Correct Answer: Bleomycin toxicity
Explanation:The cytotoxic drug bleomycin can cause bleomycin-induced pneumonitis (BIP). It usually occurs during chemotherapy but can also occur up to six months post-therapy.
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This question is part of the following fields:
- Haematology & Oncology
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Question 51
Incorrect
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Around 30 patients have been admitted to the hospital following a suspected chemical attack in the city. The patients are extremely unwell, with symptoms of excessive salivation, lacrimation, diarrhoea, and emesis. Sarin gas was suspected as the most likely agent used in the attack. What is the mechanism of action of this chemical agent?
Your Answer:
Correct Answer: Inhibition of acetylcholinesterase
Explanation:Sarin acts by inhibiting acetylcholinesterase.
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase. This results in high levels of acetylcholine (ACh).The effects of excessive ACh can be remembered by the mnemonic DUMBELLS:
Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea/Bradycardia
Emesis
Lacrimation
Salivation/sweatingOrganophosphate insecticide poisoning:
One of the effects of organophosphate poisoning is inhibition of acetylcholinesterase
Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
miosis, muscle fasciculation.Organophosphate poisoning is treated with the anti-muscarinic atropine.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 52
Incorrect
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A 50-year-old heavy drinker is brought to the A&E in a drowsy state. He is responding to questions however on examination he has nystagmus and hyper-reflexia. His MCV is 103fL.What is the most likely cause for his cognitive impairment?
Your Answer:
Correct Answer: B1 Deficiency
Explanation:Thiamine deficiency is very common with alcoholism. It manifests by Wernicke-Korsakoff encephalopathy. The patient is usually agitated, with an abnormal gait and amnesia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 53
Incorrect
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A 35-year-old female with chronic pelvic pain, was recently diagnosed with PID. She was prescribed doxycycline. After 2 days she returned with complaints of abdominal bloating, nausea and regurgitation. Which of the following advice should be given to her?
Your Answer:
Correct Answer: Take Doxycycline after meals
Explanation:Doxycycline is known to cause dyspeptic symptoms. So advising to take Doxycycline after meals is important. Taking with meals or adding an antacid is not advised, as both will cause reduction in drug absorption.
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This question is part of the following fields:
- Pharmacology
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Question 54
Incorrect
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A 26-year-old male from Eastern Europe has been experiencing night sweats, fevers, and decreased weight for several months. He also has a chronic cough which at times consists of blood. He is reviewed at the clinic and a calcified lesion was detected in his right lung with enlarged calcified right hilar lymph nodes. His leukocytes are just below normal range and there is a normochromic normocytic anaemia. Acid-fast bacilli (AFB) are found in one out of five sputum samples. Sputum is sent for extended culture.
Which diagnosis fits best with his signs and symptoms?Your Answer:
Correct Answer: Active pulmonary tuberculosis
Explanation:Classic clinical features associated with active pulmonary TB are as follows (elderly individuals with TB may not display typical signs and symptoms):
– Cough
– Weight loss/anorexia
– Fever
– Night sweats
– Haemoptysis
– Chest pain (can also result from tuberculous acute pericarditis)
– FatigueTest:
Acid-fast bacilli (AFB) smear and culture – Using sputum obtained from the patient.
AFB stain is quick but requires a very high organism load for positivity, as well as the expertise to read the stained sample. This test is more useful in patients with pulmonary disease.
Obtain a chest radiograph to evaluate for possible associated pulmonary findings. If chest radiography findings suggest TB and a sputum smear is positive for AFB, initiate treatment for TB. -
This question is part of the following fields:
- Respiratory System
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Question 55
Incorrect
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A 18-year-old gentleman is referred to dermatology. He has around 10 hyperpigmented macules on his torso which vary in size from 1.5-5 cm in size. His GP also noted some freckles in the groin region. He is also currently under orthopaedic review due to a worsening scoliosis of the spine. His father suffered from similar problems before having a fatal myocardial infarction two years ago. Which chromosome is most likely to have a gene defect?
Your Answer:
Correct Answer: Chromosome 17
Explanation:The patient’s history and presentation and familial history, meets the diagnostic criteria for Neurofibromatosis type I, presenting with neurofibromas noted in this patient as hyperpigmented macules and freckles, musculoskeletal disorders like the scoliosis in this case, and a familial history. Neurofibromatosis type I is caused by a mutation on Chromosome 17.
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This question is part of the following fields:
- Nervous System
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Question 56
Incorrect
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A 69-year-old woman is admitted with confusion. She's known to have a history of multiple myeloma. Blood exam reveals the following: Na+ = 147 mmol/l, K+ = 4.7 mmol/l, Urea = 14.2 mmol/l, Creatinine = 102 μmol/l, Adjusted calcium = 3.9 mmol/l. What is the single most appropriate management?
Your Answer:
Correct Answer: IV 0.9% saline
Explanation:NICE guidelines on hypercalcemia recommend that maintaining good hydration equals drinking 3-4 L of fluid/day, provided there are no contraindications. A low calcium diet is not necessary because intestinal absorption of calcium is reduced. The patient should avoid any other drugs or vitamins that could worsen the hypercalcemia. Mobilization is encouraged and any symptoms of hypercalcemia should be reported.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 57
Incorrect
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Which one of the following is not associated with non-alcoholic steatohepatitis?
Your Answer:
Correct Answer: Type 1 diabetes mellitus
Explanation:There are two types of Non-alcoholic fatty liver disease (NAFLD); simple fatty liver and non-alcoholic steatohepatitis (NASH). Simple fatty liver and NASH are two separate conditions.
Simple fatty liver, also called non-alcoholic fatty liver (NAFL), is a form of NAFLD in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not progress to cause liver damage or complications.
Non-alcoholic steatohepatitis (NASH)
NASH is a form of NAFLD in which you have hepatitis and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer. Type I diabetes is not associated with NASH (non-alcoholic steatohepatitis), but type II diabetes is. Hyperlipidaemia, obesity, sudden weight loss/starvation and jejunoileal bypass are all associated with NASH. This is the most common cause of liver disease in the developed world. -
This question is part of the following fields:
- Hepatobiliary System
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Question 58
Incorrect
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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.
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This question is part of the following fields:
- Gastrointestinal System
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Question 59
Incorrect
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A 41-year-old gentleman undergoes a temporal lobectomy after the discovery of a brain tumour. Which one of the following consequences would be least likely to develop?
Your Answer:
Correct Answer: Astereognosis
Explanation:Astereognosis is associated with lesions to the parietal lobe, not the temporal lobe, so this symptom would not arise in this patient.
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This question is part of the following fields:
- Nervous System
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Question 60
Incorrect
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An 8-year-old boy is presented with arthritis, cough and non-blanching purpura. His coagulation profile is normal. His CBC: Hb 11.8 TLC 7.2*10^9 Plt 286*10^9. What is the most likely diagnosis?
Your Answer:
Correct Answer: Henoch-Schönlein Purpura (HSP)
Explanation:The best answer is Henoch-Schönlein Purpura (HSP). This patient has a characteristic rash and the labs are consistent with this diagnosis.
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This question is part of the following fields:
- Cardiovascular System
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Question 61
Incorrect
-
A 42-year-old previously well woman presented with acute severe central chest pain for the past 2 hours. She has a family history of premature coronary artery disease. Her husband passed away recently due to prostate cancer. On examination her blood pressure was 130/80 mmHg and pulse rate was 80 bpm. Her ECG showed ST segment elevation and her troponin was slightly elevated. Emergency angiogram revealed slight wall irregularities with no luminal obstruction. Cardiovascular MR showed an apical ballooning of the myocardium resembling an octopus pot. Which of the following is the most likely cause for the ST segment elevation?
Your Answer:
Correct Answer: Takotsubo cardiomyopathy
Explanation:Causes for ST segment elevation other than myocardial infarction
Natural variants
-Early repolarization
-Left ventricular hypertrophy and hypertrophic cardiomyopathy
-Left bundle branch block
Artefacts
-Leads mispositioning
-Electrical cardioversion
Cardiovascular diseases
-Pericarditis/ Myocarditis
-Aortic dissection
-Prinzmetal’s angina
-Takotsubo Cardiomyopathy
-Brugada Syndrome and arrhythmogenic right ventricular cardiomyopathy/dysplasia
Pulmonary diseases
-Pulmonary thromboembolism
-Pneumothorax
-Atelectasis and pulmonary metastases
Gastrointestinal diseases
-Acute pancreatitis
-Acute cholecystitis
Other conditions
-Hyperkalaemia
-Drug induced ST segment elevation (e.g. – clozapine)
-Haemorrhagic cerebrovascular diseaseCoronary artery disease and myocardial infarction can be excluded with a negative angiogram and a slightly elevated troponin. Hypertrophic cardiomyopathy can be excluded with cardiovascular MR findings. Left ventricular aneurysm usually occurs following a myocardial infarction, but there is no positive history for that. The characteristic findings on cardiovascular MR confirms the diagnosis of Takotsubo cardiomyopathy.
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This question is part of the following fields:
- Cardiovascular System
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Question 62
Incorrect
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A 10-year-old boy presents with generalized swelling. This includes puffiness in the face and swollen ankles - these symptoms have been present for 4 days. The swelling began just a few days after he suffered from a mild cold with a runny nose. His only past medical history is that of eczema. His urine analysis showed the following: haematuria; proteinuria (10g/24h); creat 60 umol/l; and albumin of 15g/l. From the list of options, what is the single most likely diagnosis for this patient?
Your Answer:
Correct Answer: IgA nephropathy
Explanation:A 10 year old child, with a history of URTI and haematuria, presents a picture consistent with a diagnosis of IgA nephropathy. This condition can present with proteinuria and generalized swelling. However, an important differentiating point from rapidly progressive GN is the duration. IgA nephropathy is usually <10 days (commonly 4-5 day history of infection).
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This question is part of the following fields:
- Renal System
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Question 63
Incorrect
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Which is the most likely lymph node involved in the presence of an ulcer on the scrotum?
Your Answer:
Correct Answer: Inguinal lymph node
Explanation:Inguinal LN’s drain the skin and subcutaneous tissue of the lower abdominal wall, perineum, buttocks, external genitalia, and lower limbs. They are subdivided into three groups of lymph nodes (nodi lymphoid):
– inferior group of superficial inguinal lymph nodes, located inferior to the saphenous opening, receiving drainage of the lower limb;
– superolateral superficial inguinal lymph nodes located lateral to the saphenous opening, receiving drainage of lateral buttock and lower anterior abdominal wall; and
– superomedial superficial inguinal lymph nodes, located medial to the saphenous opening, receiving drainage of the perineum and external genitalia. -
This question is part of the following fields:
- Men's Health
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Question 64
Incorrect
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A 30-year-old man with type-1 diabetes mellitus on insulin presents in the A&E with fever, cough, vomiting and abdominal pain.
Examination reveals a dry mucosa, decreased skin turgor and a temperature of 37.8 °C.
Chest examination reveals bronchial breathing in the right lower lobe, and a chest X-ray shows it to be due to a right lower zone consolidation.
Other investigations show:
Blood glucose: 35 mmol/l
Na+: 132 mmol/l
K+: 5.5 mmol/l
urea: 8.0 mmol/l
creatinine: 120 μmol/l
pH: 7.15
HCO3: 12 mmol/l
p(CO2): 4.6 kPa
chloride: 106 mmol/l.
Urinary ketones are positive (+++).
The patient is admitted to the hospital and treated. Which of the following should not be used while treating him?Your Answer:
Correct Answer: Bicarbonate
Explanation:Bicarbonate therapy is not indicated in mild and moderate forms of DKA because metabolic acidosis will correct with insulin therapy. The use of bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies. It is thought that the administration of bicarbonate may actually result in peripheral hypoxemia, worsening of hypokalaemia, paradoxical central nervous system acidosis, cerebral oedema in children and young adults, and an increase in intracellular acidosis. Because severe acidosis is associated with worse clinical outcomes and can lead to impairment in sensorium and deterioration of myocardial contractility, bicarbonate therapy may be indicated if the pH is 6.9 or less.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 65
Incorrect
-
A 17-year-old boy presents with tremors. Upon inquiry, the mother reports that the boy has a history of very aggressive episodes. She also reports that he has been hallucinating for some time. On examination, there were needle marks on his arm. What drug has been used?
Your Answer:
Correct Answer: Lysergic acid diethylamide (LSD)
Explanation:Psychedelic drugs, like LSD, bring on a state of altered consciousness, causing thought, audio, or visual changes. Low body temperature and tremors are associated with many drugs but closed-eye hallucinations are strongly associated with LSD and other psychedelic drugs.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 66
Incorrect
-
A young woman presents to the emergency after being involved in a fight where she was stabbed in the neck. On examination, her tongue deviates to the right side on protrusion. Which of the following nerves is involved?
Your Answer:
Correct Answer: Hypoglossal nerve injury
Explanation:The motor functions of the intrinsic tongue muscles, as well as the genioglossus, hyoglossus, and styloglossus muscles, are all innervated by the hypoglossal nerve. These muscles are essential for swallowing and speech. To test nerve function, the physical examiner has a patient protrude his or her tongue. In intranuclear, or lower motor neuron lesions, the tongue deviates toward the injured side, as the contralateral genioglossus is acting unopposed. In contrast, supranuclear (upper motor neuron) lesions result in deviation away from the lesion. In addition to causing deviation toward the lesion, an injury involving a hypoglossal nucleus may result in tongue atrophy and fasciculation
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This question is part of the following fields:
- Nervous System
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Question 67
Incorrect
-
A 23-year-old man is being investigated for excessive bleeding following a tooth extraction.
His coagulation profile shows:
Plts: 173 x 10^9/L
PT: 12.9 secs
APTT: 84 secs
Which clotting factor is he most likely deficient in?Your Answer:
Correct Answer: Factor VIII
Explanation:The patient is most likely a case of haemophilia A which is the genetic deficiency of clotting factor VIII in blood.
Haemophilia is an X-linked recessive disorder of coagulation. Up to 30% of patients have no family history of the condition. Haemophilia A is more common than haemophilia B and accounts for 90% of the cases. In haemophilia B (Christmas disease), there is a deficiency of clotting factor IX.
Characteristic features of haemophilia include hemarthrosis, haematomas, and prolonged bleeding following trauma or surgery. Coagulation profile of a haemophiliac person shows prolonged bleeding time, activated partial thromboplastin time (APTT), thrombin time (TT), but a normal prothrombin time (PT).
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This question is part of the following fields:
- Haematology & Oncology
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Question 68
Incorrect
-
A 50-year-old male was brought to the ER after the accidental consumption of 300 ml of diethylene glycol. Blood investigations were suggestive of metabolic acidosis and renal failure. What is the appropriate management in this patient?
Your Answer:
Correct Answer: Haemodialysis and oral ethanol
Explanation:Among the given options the most appropriate management in this patient would be ethanol and haemodialysis.
Ethanol competes with ethylene glycol for alcohol dehydrogenase and thus, helps manage a patient with ethylene glycol toxicity.
Ethylene glycol is a type of alcohol used as a coolant or antifreeze
Features of toxicity are divided into 3 stages:
Stage 1: (30 min to 12 hours after exposure) Symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness (CNS depression)
Stage 2: (12 – 48 hours after exposure) Metabolic acidosis with a high anion gap and high osmolar gap. Also tachycardia, hypertension
Stage 3: (24 – 72 hours after exposure) Acute renal failureManagement has changed in recent times:
Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol.
Ethanol has been used for many years works by competing with ethylene glycol for the enzyme alcohol dehydrogenase this limits the formation of toxic metabolites (e.g. glycolaldehyde and glycolic acid) which are responsible for the hemodynamic/metabolic features of poisoning.
Haemodialysis has a role in refractory cases. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 69
Incorrect
-
A 70-year-old woman had a major surgery for removal of cancer of the ovary and lymph node dissection 6 days ago. She had not passed any flatus or stool since then. She recently developed recurrent vomiting and severe abdominal distention. What is the next step of management?
Your Answer:
Correct Answer: NG tube suction and IV fluids
Explanation:This patient developed paralytic ileus. It should be treated conservatively using IV fluids and NG tube.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 70
Incorrect
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A 40-year-old male was diagnosed with HIV. He had had multiple sexual partners. He was not willing to change his lifestyle, nor was he willing to inform any of his former partners. What is the most suitable next step for the doctor?
Your Answer:
Correct Answer: Give general advice
Explanation:General advice should be given to the patient as HIV is not a notifiable disease. Informing someone about the disease without the patient’s consent will breach the confidentiality.
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This question is part of the following fields:
- Ethical & Legal
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Question 71
Incorrect
-
A 74-year-old man presents to the physician with complaints of hoarseness of voice and cough for the past 3 weeks. The patient has been a smoker and quit 3 years ago. Radiological examination reveals a mass in the mediastinum. Which investigation should be employed to establish a diagnosis?
Your Answer:
Correct Answer: LN biopsy
Explanation:Masses in the middle mediastinum most commonly represent lymph nodes that are enlarged by a malignant, infectious, or inflammatory process. Masses in the posterior mediastinum are usually benign tumours or cysts originating from either the nerves that are present in this area (neurogenic tumours) or from the oesophagus (foregut duplication cysts). Lymph node biopsy would be the ideal choice of investigation in this case.
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This question is part of the following fields:
- Respiratory System
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Question 72
Incorrect
-
Which one of the following features is least associated with Waldenström's macroglobulinemia?
Your Answer:
Correct Answer: Bone pain
Explanation:Waldenström’s macroglobulinemia (also called lymphoplasmacytic lymphoma) is an uncommon type of non-Hodgkin lymphoma seen in older people. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein. Its features include weight loss and lethargy; monoclonal IgM paraproteinemia; hyperviscosity syndrome leading to bilateral central retinal vein occlusion (CRVO) and hence, visual disturbances; hepatosplenomegaly and lymphadenopathy; and cryoglobulinemia. It is not, however, associated with bone pain.
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This question is part of the following fields:
- Haematology & Oncology
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Question 73
Incorrect
-
A 34-year-old male patient is admitted with hemisection of the spinal cord at the level T5, after being stabbed in the back. Which sign would you expect to see by assessing the patient's sensory function and muscle strength?
Your Answer:
Correct Answer: Contralateral loss of temperature, ipsilateral loss of fine touch and vibration, ipsilateral spastic paresis
Explanation:Depending on the level of SCI, patients experience paraplegia or tetraplegia. Paraplegia is defined as the impairment of sensory or motor function in lower extremities. Patients with incomplete paraplegia generally have a good prognosis in regaining locomotor ability (,76% of patients) within a year. Complete paraplegic patients, however, experience limited recovery of lower limb function if their NLI is above T9. The spinothalamic tract is the one responsible for sensory information such as pain or temperature. However, it decussates at the same level the nerve root enters the spinal cord, meaning that the sensory loss will be contralateral. However, the dorsal column carries sensory fibres for fine touch and vibration and it decussates at the medulla which means that the sensory loss will be ipsilateral. The corticospinal tract is responsible for motor functions and it decussates at the medulla, meaning that the motor function loss will be ipsilateral.
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This question is part of the following fields:
- Nervous System
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Question 74
Incorrect
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Which is the most common type of inherited colorectal cancer:
Your Answer:
Correct Answer: Hereditary non-polyposis colorectal carcinoma
Explanation:Hereditary non-polyposis syndrome (HNPCC) is the most common type of inherited colorectal cancer. It often presents in younger and younger generations down a family. FAP presents with 100’s-1000’s of polyps and is less common. Li-Fraumeni syndrome and Fanconi syndrome are rare. For Peutz-Jeghers syndrome, the thing you will look for in the question stem is discoloured spots on the lips, this is classic.
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This question is part of the following fields:
- Gastrointestinal System
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Question 75
Incorrect
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An 83-year-old retired musician is examined for progressive cognitive impairment. Which one of the following features is most suggestive of Lewy body dementia?
Your Answer:
Correct Answer: Symptoms worsen with neuroleptics
Explanation:Lewy body dementia is an increasingly recognised cause of dementia, accounting for up to 20% of cases. The characteristic pathological feature is alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas. Neuroleptics should be avoided in Lewy body dementia as patients are extremely sensitive and may develop irreversible parkinsonism. Questions may give a history of a patient who has deteriorated following the introduction of an antipsychotic agent.
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This question is part of the following fields:
- Nervous System
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Question 76
Incorrect
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Which among these medications does NOT cause gastric ulceration?
Your Answer:
Correct Answer: Misoprostol
Explanation:Misoprostol is effective in preventing gastric ulceration since it is a prostaglandin analogue. Celecoxib, being a selective COX-2 inhibitor only elevates risk of ulceration as well as NSAIDs. Renal failure on the other hand results in elevated gastric acid after reducing the breakdown of gastrin.
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This question is part of the following fields:
- Gastrointestinal System
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Question 77
Incorrect
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A 62-year-old software developer with lung cancer is currently taking MST 30 mg bd for pain relief.
What dose of oral morphine solution should he be prescribed for breakthrough pain?Your Answer:
Correct Answer: 10 mg
Explanation:The total daily morphine dose is 30 x 2 = 60 mg. Therefore, the breakthrough dose should be one-sixth of this, 10 mg.
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This question is part of the following fields:
- Haematology & Oncology
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Question 78
Incorrect
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During the examination of an elderly confused and non-coherent gentleman who was brought to casualty by a concerned neighbour, you notice that he has bilaterally small pupils, which do not appear to react to light. Under the circumstances, it is difficult to judge their response to accommodation.
Which of the following conditions may not account for the pupillary appearance in this patient?Your Answer:
Correct Answer: Acute alcohol intoxication
Explanation:Acute alcohol intoxication presents with pupillary dilation, thus, this is ruled out in this patient. All the other listed causes present with small pupils bilaterally.
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This question is part of the following fields:
- Nervous System
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Question 79
Incorrect
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A 48-year-old chronic smoker who smokes 20 cigarettes per day, presented with a persistent cough, wheezing and difficulty in breathing. He was treated with oxygen but the symptoms did not improve. Which of the following is the next step?
Your Answer:
Correct Answer: Check ABG
Explanation:The history is suggestive of a COPD exacerbation. As he is not responding to oxygen, an ABG should be performed to assess the level of hypoxaemia and then a decision about further management can be made. A CXR and salbutamol are also important in the acute management.
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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 51 year-old teacher presents complaining of numerous falls. He states he has difficulty walking up stairs, and he thinks it is because of his weak legs rather than blackouts. He is hypertensive and has suffered chronic back pain for many years. He has smoked for many years as well and has a chronic smokers cough. Upon examination, he has weakness of hip flexion and particularly knee extension. He is unable to keep his fingers flexed against force, with the right being weaker than the left. There are no sensory abnormalities and reflexes are preserved bilaterally. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Inclusion body myositis
Explanation:The pattern of muscle involvement seen with quadriceps and long-finger flexors is characteristic of inclusion body myositis, an inflammatory myopathy. Polymyositis is likely to cause a predominantly proximal weakness, associated with muscle pain. The signs and symptoms are not consistent with upper cord compression, as there would likely be sensory signs, reflex changes, and possible urinary symptoms. Motor neuron disease cannot be ruled out, but there are no findings of upper motor neuron or bulbar features.
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This question is part of the following fields:
- Nervous System
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Question 81
Incorrect
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A 64-year-old male patient was admitted for dysphagia, emesis and weight loss. He has a firm lump in his left supraclavicular fossa. What is the most probable diagnosis?
Your Answer:
Correct Answer: Gastric carcinoma
Explanation:The history is suggestive of gastric carcinoma with dysphagia, vomiting, weight loss and lymphatic metastasis to the supraclavicular node, known as Virchow’s node.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 82
Incorrect
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A 60-year-old man with a history of chronic lymphocytic leukaemia is admitted to the acute medical unit for pneumonia. This is his fourth admission for pneumonia in the past six months.
Which of the following factors is most likely to be responsible?Your Answer:
Correct Answer: Hypogammaglobulinaemia
Explanation:Hypogammaglobulinemia is a complication of chronic lymphocytic leukaemia (CLL) that leads to recurrent infections.
CLL is a type of cancer caused by monoclonal proliferation of well-differentiated lymphocytes, typically B cells (99%). Onset of the disease is usually asymptomatic and later constitutes anorexia, weight loss, bleeding, and recurrent infections. Lymphadenopathy is more marked in CLL than in chronic myelogenous leukaemia (CML).
Investigations to diagnose CLL include blood film and immunophenotyping. Smudge cells (also known as smear cells) seen on the blood film point towards CLL. Complications of the disease include hypogammaglobulinemia leading to recurrent infections, autoimmune haemolytic anaemia in 10-15% of the patients, and transformation to high-grade lymphoma (Richter’s transformation).
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This question is part of the following fields:
- Haematology & Oncology
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Question 83
Incorrect
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A 25-year-old female was admitted following the ingestion of 36 paracetamol tablets. On examination she was confused and disoriented. Investigations after 24 hrs showed a normal FBC, pH - 7.2, serum creatinine - 3.7mg/dl and INR 6.5. Which of the following is the most appropriate management for her?
Your Answer:
Correct Answer: Liver transplantation
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
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Question 84
Incorrect
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An elderly man presents with fever of 38°C and a very severe headache. His BP is 85/50 mm Hg. He has neck stiffness and photophobia. What is the most appropriate management?
Your Answer:
Correct Answer: CT head
Explanation:In elderly patients, symptoms suggestive of meningitis could be due to an intracranial mass lesion (such as abscess, tumour or an intracerebral haematoma). Therefore elderly patients are increased risk of cerebral herniation from an LP. A CT head should be done before an LP to exclude a mass lesion.
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This question is part of the following fields:
- Geriatric Medicine
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Question 85
Incorrect
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A 60-year-old previously well male patient was admitted with acute severe central chest pain associated with excessive sweating and nausea for the past 45 minutes. On examination he was found to have xanthelasma. His blood pressure was 170/100 mmHg and pulse rate was 104 bpm. His ECG showed ST elevation more than 2mm in leads II, III and aVF. His troponin T was 120 ng/ml. His FBC and renal functions were normal. He was given aspirin, clopidogrel, morphine and IV 5 mg of atenolol. Which of the following is the most appropriate next step?
Your Answer:
Correct Answer: Immediate referral to cardiologist for primary angioplasty
Explanation:The diagnosis is acute inferior ST elevation myocardial infarction so the most appropriate management is primary angioplasty.
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This question is part of the following fields:
- Cardiovascular System
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Question 86
Incorrect
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A 55-year-old male, known hypertensive on antihypertensive medications, presented with complaints of dizziness and lethargy, especially when rising from the chair. The most appropriate test would be?
Your Answer:
Correct Answer: Ambulatory blood pressure
Explanation:Ambulatory blood pressure recording is used to monitor BP for 24 hours whilst continuing the daily routine activities.
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This question is part of the following fields:
- Nervous System
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Question 87
Incorrect
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A patient has an autosomal recessive disorder, which causes lysine, arginine, ornithine and cystine to appear in his urine. The treatment proposed is the combination of urinary alkalinisation with penicillamine. Choose the most likely type of renal calculus present.
Your Answer:
Correct Answer: Cystine
Explanation:The presence in the urine of cystine, orthinine, arginine and lysine indicate a tubular reabsorption defect. This condition is a hereditary one, and stone formation is more common in homozygotes. The patient has no other abnormalities that could indicate stone formation.
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This question is part of the following fields:
- Renal System
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Question 88
Incorrect
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A 21-year-old patient is referred to the tertiary neurology clinic because of a possible diagnosis of Juvenile Parkinson's disease. His symptoms began predominantly with dystonia affecting the lower limbs, but he now has more classical signs of older onset Parkinson's including tremor, bradykinesia, and rigidity.
You map out his family tree and understand that his sister developed Parkinson's at the age of 16 but that his parents do not have signs of Parkinson's.
Which of the following is the most likely mode of inheritance?Your Answer:
Correct Answer: Autosomal recessive
Explanation:Juvenile Onset Parkinson’s is an autosomal recessive condition that usually presents in late childhood to early adulthood, initially with gait disorders caused by lower limb dystonia that later develops to the more classical signs Parkinson’s.
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This question is part of the following fields:
- Nervous System
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Question 89
Incorrect
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A 50-year-old woman diagnosed with non-Hodgkin's Lymphoma is about to be started on the CHOP regimen (cyclophosphamide, hydroxydaunorubicin, vincristine, and prednisolone). Her pre-chemotherapy blood investigations show:
Hb: 11.8 g/dl
Platelets: 423 x 109/l
WBC: 11.2 x 109/l
Na+: 143 mmol/l
K+: 3.9 mmol/l
Urea: 6.2 mmol/l
Creatinine: 78 μmol/l
Uric acid: 0.45 mmol/l
Ciprofloxacin is prescribed in addition to the CHOP regimen to reduce the risk of neutropenic sepsis. Which of the following drugs should be added to lower the risk of other complications?Your Answer:
Correct Answer: Allopurinol
Explanation: -
This question is part of the following fields:
- Haematology & Oncology
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Question 90
Incorrect
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A 50-year-old known patient with chronic liver cell disease was admitted complaining of unsteadiness and double vision following an episode of heavy alcohol consumption. On examination, he was confused. there was nystagmus and ataxia. What is the most possible cause for this presentation?
Your Answer:
Correct Answer: Wernicke's encephalopathy
Explanation:Wernicke’s encephalopathy is a neurological disorder induced by thiamine deficiency and presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion. As alcohol affects thiamine uptake and utilization, thiamine deficiency is usually associated with chronic alcoholism.
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This question is part of the following fields:
- Nervous System
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Question 91
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 92
Incorrect
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A 34-year-old man was brought to the ER following a road-traffic-accident. An X-ray of his left thigh revealed a fractured shaft of the left femur. He has a known history of opioid abuse. You are called to the ward to assess him after he becomes unwell. Which of the following clinical features are NOT compatible with a diagnosis of opioid withdrawal?
Your Answer:
Correct Answer: Hypothermia
Explanation:Among the options provided, hypothermia is not a symptom of opioid withdrawal.
Symptoms of opioid withdrawal include dysphoric mood, yawning, insomnia, muscle aches, lacrimation/rhinorrhoea, papillary dilatation, piloerection, fever, sweating, nausea/vomiting, diarrhoea.
If the patient is having an opioid withdrawal reaction, then give 10 mg of methadone syrup and wait about 60 min to determine its effect.COWS (Clinical Opioid Withdrawal Scale) assessment for opioid withdrawal is commonly used to determine the severity of opioid withdrawal.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 93
Incorrect
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A 49-year-old female is admitted to the hospital with shortness of breath and pleuritic chest pain. She also complains of loss of appetite for the past four months. Her admission CXR shows right-sided pleural effusion. An underlying malignancy is suspected and a series of tumour markers are requested, the results of which are:
CA 19-9: 36 IU/mL (<40)
CA 125: 654 IU/ml (<30)
CA 15-3: 9 IU/ml (<40)
What is the most likely underlying diagnosis?Your Answer:
Correct Answer: Ovarian fibroma
Explanation:The patient has Meigs syndrome. Meigs syndrome is defined as a triad of benign ovarian tumour with ascites and pleural effusion that resolves after resection of the tumour. Ovarian fibromas constitute the majority of the benign tumours seen in Meigs syndrome.
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 94
Incorrect
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A 55-year-old woman was found to have splenomegaly with her spleen palpable up to the umbilicus. Blood tests revealed the following results: Hb=8.7g/dl, Platelets=72 and WBC=100. What is the most probable diagnosis?
Your Answer:
Correct Answer: Chronic myeloid leukaemia
Explanation:Patients with chronic myeloid leukaemia (CML) can initially be asymptomatic but as the disease progresses, they appear to have elevated WBCs with anaemia and a lower than normal platelet count. The blood test results in addition to the profound splenomegaly, which is the most common finding in patients with CML, make CML the most possible diagnosis.
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This question is part of the following fields:
- Haematology & Oncology
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Question 95
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:
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 96
Incorrect
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Which virus is severe acute respiratory syndrome (SARS) caused by?
Your Answer:
Correct Answer: A coronavirus
Explanation:Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003.
In general, SARS begins with a high fever (temperature greater than 38.0°C). Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset. About 10 to 20 percent of patients have diarrhoea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia. -
This question is part of the following fields:
- Respiratory System
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Question 97
Incorrect
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What is the site of action of antidiuretic hormone?
Your Answer:
Correct Answer: Collecting ducts
Explanation:Vasopressin, also called antidiuretic hormone (ADH), regulates the tonicity of body fluids. It is released from the posterior pituitary in response to hypertonicity and promotes water reabsorption in the collecting ducts of the kidneys by the insertion of aquaporin-2 channels.. An incidental consequence of this renal reabsorption of water is concentrated urine and reduced urine volume. In high concentrations may also raise blood pressure by inducing moderate vasoconstriction.
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This question is part of the following fields:
- Renal System
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Question 98
Incorrect
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Using DEXA, which of the following bone mineral density values indicates osteopenia in the measured site?
Your Answer:
Correct Answer: A T score of -2.6
Explanation:Osteopenia is an early sign of bone weakening that is less severe than osteoporosis.
The numerical result of the bone density test is quantified as a T score. The lower the T score, the lower the bone density. T scores greater than -1.0 are considered normal and indicate healthy bone. T scores between -1.0 and -2.5 indicate osteopenia. T scores lower than -2.5 indicate osteoporosis.
DEXA also provides the patient’s Z-score, which reflects a value compared with that of person matched for age and sex.
Z-score values of -2.0 SD or lower are defined as below the expected range for age and those above -2.0 SD as within the expected range for age. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 99
Incorrect
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A 25-year-old male had an emergency appendicectomy. His doctor prescribed him prophylactic antibiotics to avoid infection after the surgery. Which of the following antibiotics is the best choice for post abdominal surgery?
Your Answer:
Correct Answer: Cefuroxime
Explanation:Cefuroxime is the best choice in the case of gut surgery as it is very effective in preventing infections against gut anaerobes, enterococci and coliforms.
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This question is part of the following fields:
- Gastrointestinal System
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Question 100
Incorrect
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A 60-year-old male patient with a history of heavy smoking was admitted complaining of acute severe central chest pain for the past one hour. His blood pressure was 150/90 mmHg and pulse rate was 88 bpm. His peripheral oxygen saturation was 93%. ECG showed ST elevation > 2 mm in lead II, III and aVF. He was given loading doses of aspirin, clopidogrel and atorvastatin and face mask oxygen was given. Which one of the following investigations should be done and then depending on result, definitive treatment can be initiated?
Your Answer:
Correct Answer: None
Explanation:The history and ECG findings are adequate to begin cardiac revascularization of this patient. There is no need for cardiac markers to confirm the diagnosis. Further delay in starting definite treatment is not recommended.
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This question is part of the following fields:
- Cardiovascular System
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SESSION STATS - PERFORMANCE PER SPECIALTY
