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Question 1
Incorrect
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Which one of the following features is least associated with Waldenström's macroglobulinemia?
Your Answer: Retinal vein thrombosis
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 2
Correct
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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: 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 3
Correct
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A 20-year-old female is suffering from amenorrhea. She has a BMI of 14 but still thinks that she needs to lose weight. She watches her food intake obsessively. Choose the most likely diagnosis.
Your Answer: Anorexia nervosa
Explanation:Anorexia is consistent with the symptoms described.
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This question is part of the following fields:
- Women's Health
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Question 4
Correct
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A 19-year-old girl suffers from a hereditary disease and presents at her GP with a renal colic. She claims that her mother had this problem too. What type of renal calculus is most likely responsible for the renal colic?
Your Answer: Cystine
Explanation:The patient seems to have inherited cystinuria which is an autosomal recessive disease. Typical for the disease is the abnormally high concentration of cysteine in the urine, finally causing cystinuria. In a person with cystinuria, the high concentrations of cysteine in the kidney results in the formation of stones with frequent colic pains and complications. If the genotype is partially expressed, then the phenotype might be even asymptomatic, thus the disease has a high variability.
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This question is part of the following fields:
- Renal System
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Question 5
Correct
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A 25-year-old man wants to start a relationship but is concerned about his small phallus. He also has difficulty becoming aroused. On examination, he is slim and has gynecomastia. There is a general paucity of body hair, his penis and testes are small.
Which diagnosis fits best with this history and examination?Your Answer: Klinefelter's syndrome
Explanation:The patient most likely has Klinefelter’s syndrome.
Klinefelter syndrome (KS) refers to a group of chromosomal disorders in which the normal male karyotype, 46,XY, has at least one extra X chromosome. XXY aneuploidy, the most common human sex chromosome disorder. It is also the most common chromosomal disorder associated with male hypogonadism and infertility.
Klinefelter syndrome is characterized by hypogonadism (micro-orchidism, oligospermia/azoospermia), gynecomastia in late puberty, hyalinization and fibrosis of the seminiferous tubules, elevated urinary gonadotropin levels, and behavioural concerns. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 6
Incorrect
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A 44-year-old obese woman presented with severe abdominal pain in her right hypochondrium. An US abdomen was done which showed the presence of gallstones. The next step in management would be?
Your Answer: Low fat diet
Correct Answer: Laparoscopic Cholecystectomy
Explanation:With patients who are obese and have gallstones, the best procedure to be done is a laparoscopic cholecystectomy. Reassurance and low fat diets would not have much affect because these symptoms would recur if a cholecystectomy is not done.
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This question is part of the following fields:
- Hepatobiliary System
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Question 7
Correct
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A 43-year-old woman is concerned about osteoporosis as she as a strong family history of it. She is one year postmenopausal and aware of hot flushes at night.
Which one of the following therapies would be most appropriate?Your Answer: Cyclical oestrogen and progestogen
Explanation:As the patient has early menopause, hormone replacement therapy (HT) is considered to be the first line of choice for prevention of bone loss and fracture in the early postmenopausal period for 5 years.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 8
Correct
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A 50-year-old woman came to the diabetes clinic for her regular follow up.
The following results are obtained:
Urine analysis: Protein+
HBA1c 86 mmol/mol (10.0%)
What is her average blood glucose level during the past 2 months?Your Answer: 15
Explanation:The level of haemoglobin A1c (HbA1c), also known as glycated haemoglobin, determines how well a patient’s blood glucose level has been controlled over the previous 8-12 weeks. Recent studies have been made to correlate between HbA1c and average glucose level.
Using the following formula: Average blood glucose (mmol/l) = (1.98 x 1 HbA1c) – 4.29 -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 9
Correct
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A 70-year-old smoker was recently diagnosed with small cell lung cancer. Which of the following electrolyte combinations confirms the diagnosis of SIADH?
Your Answer: Low serum Na, low serum osmolarity, high urine osmolarity
Explanation:Due to the high amount of ADH in their blood, patient is voiding a low volume of urine with high osmolarity and as a result low levels of electrolytes will be present in the serum.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 10
Correct
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A 4-year-old child was brought in by his mother with complaints of vesicular eruption over his palms, soles and oral mucosa for the last 5 days. He was slightly febrile. There were no other signs. The most likely causative organism in this case would be?
Your Answer: Coxsackie
Explanation:This patient is most likely suffering from hand, foot mouth disease which is caused by coxsackie virus A16. Its incubation period ranges from 5-7 days and only symptomatic treatment is required.
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This question is part of the following fields:
- The Skin
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Question 11
Incorrect
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A 25-year-old woman presents to the clinic with nausea, thirst and dehydration. She mentioned that she has an uncle with previous parathyroid gland excision and a cousin who has recently been diagnosed with insulinoma.
On examination, her BP is 135/72 mmHg, her pulse is 70/min and regular, her BMI is 20. Cardiovascular, respiratory and abdominal examinations are unremarkable.
Investigations show:
Hb 12.6 g/dl
WCC 5.4 x109/l
PLT 299 x109/l
Na+ 139 mmol/l
K+ 4.4 mmol/l
Creatinine 121 Ù‰mol/l
Albumin 37 g/l
Ca++ 2.95 mmol/l
PTH 18 (normal<10)
Which of the following is the most likely cause of her raised calcium?Your Answer: MEN 2a
Correct Answer: Parathyroid hyperplasia
Explanation:The combination of Insulinoma and Parathyroid diseases is suggestive of MEN 1 syndrome.
Multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary tumour syndrome inherited in an autosomal dominant manner and characterized by a predisposition to a multitude of endocrine neoplasms primarily of parathyroid, entero-pancreatic, and anterior pituitary origin, as well as non-endocrine neoplasms.
Other endocrine tumours in MEN1 include foregut carcinoid tumours, adrenocortical tumours, and rarely pheochromocytoma. Nonendocrine manifestations include meningiomas and ependymomas, lipomas, angiofibromas, collagenomas, and leiomyomas.Primary hyperparathyroidism (PHPT), due to parathyroid hyperplasia is the most frequent and usually the earliest expression of MEN-1, with a typical age of onset at 20-25 years.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 12
Incorrect
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A new-born male is admitted to NICU with convulsions, limb hypoplasia and rudimentary digits. Which of the following is the most likely cause?
Your Answer: Toxoplasmosis
Correct Answer: Varicella
Explanation:Infection of chickenpox in the first half of pregnancy can result in congenital varicella syndrome. It presents as cerebral, cortical and cerebellar hypoplasia with convulsions and rudimentary digits. Prevention is by administering varicella vaccine, even before pregnancy. Varicella immunoglobulin is administered to pregnant women who are exposed to infection. Infection during pregnancy is treated with acyclovir.
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Correct
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A 65-year-old female with a history of memory loss, presents with progressive decline of her cognitive functions. She had a MI 6 years ago. What is the most probable diagnosis?
Your Answer: Vascular dementia
Explanation:The patient has a history of MI and thus ischemic heart disease. This together with her age and progressive decline in cognitive functions and memory suggest vascular dementia.
Pick’s dementia presents with personality and behavioural changes.
Lewy body dementia is associated with frequent syncopal episodes, while Huntington’s disease presents with gait abnormalities.
Alzheimer’s dementia usually starts before the age of 65 and an ischemic heart disease history is not necessary. -
This question is part of the following fields:
- Nervous System
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Question 14
Incorrect
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A 65-year-old man known to have renal cell carcinoma, is currently undergoing treatment. He presents to the acute medical ward with one month history of worsening central lower back pain, which becomes worse at night and cannot be managed with an analgesia at home. He has no other new symptoms.
Out of the following, which investigation should be performed next?Your Answer: X-ray lumbar and sacral spine
Correct Answer: MRI whole spine
Explanation:An MRI whole spine should be performed in a patient suspected of spinal metastasis which can occur before developing metastatic spinal cord compression. This patient has renal cell carcinoma, which readily metastasises to the bones and also has progressive back pain. He, therefore, needs urgent imaging of his spine before any neurological compromise develops. MRI whole spine is preferable because patients with spinal metastasis often have metastases at multiple levels within the spine. Plain radiographs and CT scans should not be performed as they have a lower sensitivity for revealing lesions and cannot exclude cord compression.
In general, imaging should be performed within one week if symptoms suspicious of spinal metastasis without neurological symptoms are present. If there are symptoms suggestive of malignant spinal cord compression, then imaging should be done within 24 hours.
The signs and symptoms of spinal metastases include:
1. Unrelenting lumbar back pain
2. Thoracic or cervical back pain
3. Pain associated with tenderness and worsens with sneezing, coughing, or straining
4. Nocturnal pain -
This question is part of the following fields:
- Haematology & Oncology
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Question 15
Correct
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Which one of the following conditions is least likely to be associated with pyoderma gangrenosum?
Your Answer: Syphilis
Explanation:The following are conditions commonly associated with pyoderma gangrenosum:
Inflammatory bowel disease:
– Ulcerative colitis
– Crohn’s disease
Arthritides:
– Rheumatoid arthritis
– Seronegative arthritis
Haematological disease:
– Myelocytic leukaemia[8]
– Hairy cell leukaemia
– Myelofibrosis
– Myeloid metaplasia
– Monoclonal gammopathy
Autoinflammatory disease:
– Pyogenic sterile arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome)
– Granulomatosis with polyangiitis -
This question is part of the following fields:
- The Skin
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Question 16
Correct
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Tranexamic acid is used to treat heavy menstrual bleeding in women. It inhibits menorrhagia by which of the following mechanisms?
Your Answer: Inhibits fibrinolysis
Explanation:Tranexamic acid prevents menorrhagia by inhibiting fibrinolysis thus promoting coagulation.
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This question is part of the following fields:
- Pharmacology
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Question 17
Correct
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A 44-year-old woman was admitted with dull retrosternal chest pain. History reveals the pain has been present for two weeks. Clinical examination and ECG, however, show nothing interesting. CXR shows an air-fluid level behind the heart. Which hernia would explain this presentation?
Your Answer: Hiatal
Explanation:A hiatal hernia may be asymptomatic, however classically it presents on CXR with a very characteristic air-fluid level behind the heart. If pain is present, PPIs can be administered. If pain is persistent, surgical intervention should be considered to ameliorate the risk of strangulation. There are two types of hiatal hernias; sliding or Para oesophageal.
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This question is part of the following fields:
- Gastrointestinal System
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Question 18
Correct
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A 40-year-old male was recently diagnosed with hypertension and was prescribed Chlorothiazide. Now he complains of a painful swelling in his left big toe for two days. What is the single most appropriate investigation for reaching the diagnosis in this case?
Your Answer: Serum uric acid
Explanation:Bendroflumethiazide, like all thiazide diuretics, may cause hyperuricemia that can lead to gout and gouty arthritis. A test for serum uric acid will confirm this suspicion.
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This question is part of the following fields:
- Pharmacology
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Question 19
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: Absolute risk reduction
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 20
Incorrect
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Causes of dilated pupils include which of the following?
Your Answer: Organophosphate poisoning
Correct Answer: Ethylene glycol poisoning
Explanation:Ethylene glycol poisoning is the only poison listed that will cause dilation of the pupils whereas all the other listed conditions and poisons will present with small pupils other than in the case of Myotonic dystrophy wherein the patient will present with a cortical cataract.
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This question is part of the following fields:
- Nervous System
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SESSION STATS - PERFORMANCE PER SPECIALTY
