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Question 1
Correct
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A 22-year-old woman presents with anxiety and weight loss with increased appetite.
Thyrotoxicosis is suspected and various investigations are performed.
Which of the following findings is most consistent with Graves' disease?Your Answer: High titre of thyroid peroxidase autoantibodies
Explanation:Free T4 levels or the free T4 index is usually elevated, as is the free T3 level or free T3 index
– Assays for thyrotropin-receptor antibodies (particularly TSIs) almost always are positive.
– Detection of TSIs is diagnostic for Graves disease.
– Other markers of thyroid autoimmunity, such as antithyroglobulin antibodies or antithyroid peroxidase antibodies, are usually present.
– Other autoantibodies that may be present include thyrotropin receptor-blocking antibodies and anti-sodium-iodide symporter antibody.
The presence of these antibodies supports the diagnosis of autoimmune thyroid disease.
– The radioactive iodine uptake is increased and the uptake is diffusely distributed over the entire gland. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 2
Correct
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A 75-year-old man was brought to the clinic by his wife because lately he has lost interest in activities he previously enjoyed. His wife is worried and claims he's generally withdrawn. What would exclude depression in favour of dementia?
Your Answer: Urinary incontinence
Explanation:Urinary incontinence is not a usual symptom of depression. A depressed patient is usually capable of maintaining control of his body sphincters. In dementia, however, urinary incontinence is an important and late symptom of the disease, non-related to any urinary tract pathology. It is rather related to the cognitive impairment caused by dementia.
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This question is part of the following fields:
- Geriatric Medicine
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Question 3
Correct
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A 68-year-old man who has chronic obstructive pulmonary disease (COPD) is reviewed. On examination, there is evidence of cor pulmonale with a significant degree of pedal oedema. His FEV1 is 44%. During a recent hospital stay his pO2 on room air was 7.4 kPa.
Which one of the following interventions is most likely to increase survival in this patient?Your Answer: Long-term oxygen therapy
Explanation:Assess the need for oxygen therapy in people with:
– very severe airflow obstruction (FEV1 below 30% predicted)
– cyanosis (blue tint to skin)
– polycythaemia
– peripheral oedema (swelling)
– a raised jugular venous pressure
– oxygen saturations of 92% or less breathing air.Also consider assessment for people with severe airflow obstruction (FEV1 30-49% predicted).
Consider long-term oxygen therapy for people with COPD who do not smoke and who:
have a partial pressure of oxygen in arterial blood (PaO2) below 7.3 kPa when stable or have a PaO2 above 7.3 and below 8 kPa when stable, if they also have 1 or more of the following:
– secondary polycythaemia
– peripheral oedema
– pulmonary hypertension. -
This question is part of the following fields:
- Respiratory System
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Question 4
Correct
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A 50-year-old male was taken to hospital after he experienced tightness in his chest and a chronic cough. Upon examination, he revealed that he has been smoking 20 cigarettes a day for the past 35 years, and was subsequently diagnosed with COPD. From the list of options, choose the most appropriate ABG picture.
Your Answer: Respiratory Acidosis
Explanation:COPD impairs the lung’s ability to remove CO2 from the blood, and this removes acid from the body. Excess CO2 causes the pH of the blood to increase, making it far too acidic, and causing respiratory acidosis.
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This question is part of the following fields:
- Respiratory System
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Question 5
Incorrect
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An 80-year-old woman with advanced COPD has been admitted to the medicine ward in an unconscious state. She appears to have an acute lower respiratory tract infection. After consulting with an anaesthesiologist it was concluded that she was not a candidate for intensive care unit admission and thus, a decision was made to start the patient on doxapram therapy. Which of the following best fits the characteristics of doxapram?
Your Answer: It has a half-life of 12 h
Correct Answer: It is contraindicated in hyperthyroidism
Explanation:The two statements that fit the characteristics of doxapram are, epilepsy is a contraindication for doxapram use and concurrent use with theophylline may increase agitation.
Doxapram is a central respiratory stimulant. In clinical practice, doxapram is usually used for patients who have an acute exacerbation of chronic obstructive pulmonary disease (COPD) who are unsuitable for admission to the intensive therapy unit for ventilatory support. Doxapram infusion may buy an extra 24 h to allow for recovery.
Contraindications include: ischaemic heart disease, epilepsy, cerebral oedema, acute stroke, asthma, hypertension, hyperthyroidism, and pheochromocytoma.
The infusion may worsen agitation and dyspnoea and lead to hypertension, nausea, vomiting and urinary retention.Drug interactions:
Concomitant administration of doxapram and aminophylline (theophylline) can cause increased skeletal muscle activity, agitation, and hyperactivity. -
This question is part of the following fields:
- Geriatric Medicine
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Question 6
Correct
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A 21-year-old male presents with severe right-sided chest pain. On examination, percussion was hyper-resonant and breath sounds were reduced on the right side. He has no history of any respiratory illness or trauma. What condition is this patient suffering from?
Your Answer: Simple Pneumothorax
Explanation:Pneumothorax refers to a condition in which air or gases accumulate inside the pleural space causing the lungs to collapse. Because the patient did not have a history of any previous pulmonary disease or trauma, this is a case of simple pneumothorax.
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This question is part of the following fields:
- Respiratory System
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Question 7
Correct
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Which of the following conditions is not linked to hyperuricemia?
Your Answer: Osteoarthritis
Explanation:Hyperuricemia is an elevated uric acid level in the blood. The normal upper limit is 6.8mg/dL, and anything over 7 mg/dL is considered saturated, and symptoms can occur. Causes of hyperuricemia can be classified into three functional types:
1. Increased production of uric acid – Purine rich diet, Tumour lysis syndrome, HGPRT deficiency (Lesch-Nyhan and Kelley-Seegmiller syndromes), Increased PRPP synthetase activity and Polycythaemia
2. Decreased excretion of uric acid – Renal impairment, Metabolic syndrome, Drugs (diuretics, low-dose aspirin, cyclosporin, tacrolimus, pyrazinamide, ethambutol, levodopa, nicotinic acid), Acidosis, Pre-eclampsia and eclampsia, Hypothyroidism and hyperparathyroidism, Sarcoidosis, Familial juvenile gouty nephropathy, Chronic lead intoxication, Trisomy 21
3. Idiopathic and mixed type – Alcohol, Exercise, Glucose-6-phosphatase deficiency, Aldolase B deficiency -
This question is part of the following fields:
- Musculoskeletal System
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Question 8
Correct
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Which of the following describes the reason for the decline of the use of beta blockers as antihypertensives in last few years?
Your Answer: Less likely to prevent stroke + potential impairment of glucose tolerance
Explanation:According to the latest research, beta blockers are associated with higher incidence of fatal and non-fatal strokes, all cardiovascular events, and cardiovascular mortality. New-onset diabetes also associates with beta blockers.
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This question is part of the following fields:
- Cardiovascular System
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Question 9
Correct
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A 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: 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 10
Incorrect
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A 18-year-old female is brought to the emergency department by her boyfriend. He is concerned that she may have taken an overdose of her mom's morphine sulphate pills after being depressed about her mother, who is dying of carcinoma of the breast.
Which of the following may point towards his suspicion?Your Answer: Urinary incontinence
Correct Answer: Sweating
Explanation:Excessive sweating points towards a morphine overdose.
Morphine is considered the classic opioid analgesic with which other painkillers are compared. Like other medications in this class, morphine has an affinity for delta, kappa, and mu-opioid receptors.
Most commonly used in pain management, morphine provides major relief to patients afflicted with pain.Among the more common adverse effects of morphine use is constipation. Other side effects include nausea, vomiting, drowsiness, and confusion. Psychological and physical dependence may occur.
Other side effects include bronchospasm, angioedema, urinary retention, ureteric or biliary spasm, dry mouth, sweating, rash, facial flushing, vertigo, tachycardia, bradycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood change, hallucinations, seizures (adults and children) and miosis, headache and allergic reactions (including anaphylaxis) and decreased libido or potency.
Raised intracranial pressure occurs in some patients. Muscle rigidity may occur with high doses. Elevated liver enzymes may occur due to biliary sphincter constriction. Large doses can lead to respiratory depression, circulatory failure, and coma.
Treatment of opioid overdose:
Initial treatment of overdose begins with supportive care.
Naloxone is a pure competitive antagonist of opiate receptors and has no agonistic activity. The drug is relatively safe and can be administered intravenous, intramuscular, subcutaneous or via the endotracheal tube.
Alternatively, nalmefene and naltrexone maybe considered. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 11
Correct
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A 28-year-old woman is involved in a cycling accident. She has severe pain and swelling of her right upper leg. An x-ray confirms a fracture of neck of fibula. What is the most common associated nerve injury?
Your Answer: Lateral peroneal nerve
Explanation:Lateral peroneal nerve, also known as the superficial peroneal nerve.
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This question is part of the following fields:
- Musculoskeletal System
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Question 12
Correct
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A 47-year-old man is seen in clinic with a 3 month history of chronic epigastric discomfort. The pain comes and goes and radiates to his back and his right shoulder tip at times. It is worse after meals but there is no relieving factor. He feels nauseous most of the time and has foul-smelling stools. He has lost 2 stones in weight. He also complains of intermittent light-headedness. He drinks a bottle of wine on most nights and smokes 20 cigarettes /day.
On examination, he is thin and looks neglected. His abdomen is soft, but tender on deep palpation in the epigastric area. He has a 2 cm non-tender liver edge. He also has decreased sensation to light touch on both feet.
Bloods:
sodium 131 mmol/l
potassium 4.2 mmol/l
creatine 64 μmol/l
amylase 35 U/l
alanine aminotransferase (ALT) 104 U/l
alkaline phosphatase (ALP) 121 U/l
bilirubin 24 μmol/l
calcium 2.01 mmol/l
whole cell count (WCC) 12.1 × 109/l
haemoglobin (Hb) 10.2 g/dl
platelets 462 × 109/l
abdominal X-ray (AXR) normal
oesophago-gastro duodenoscopy (OGD) mild gastritis
Campylobacter-like organism (CLO) test negative
ultrasound abdomen mildly enlarged liver with fatty change
spleen and kidneys normal
pancreas partially obscured by overlying bowel gas
72-h stool fat 22 g in 72 h
He is referred for a secretin test:
volume collected 110 ml
bicarbonate 52 mEq/l
What is the most likely diagnosis?Your Answer: Chronic pancreatitis
Explanation:The question describes an alcohol abusing man with chronic epigastric discomfort, radiating into his back, worse with meals, and foul-smelling stools, weight loss, as well as chronic nausea. This is likely, thus chronic pancreatitis due to alcohol abuse. Hepatomegaly and peripheral neuropathy secondary to anaemia support the diagnosis of long term alcohol abuse. Bacterial overgrowth may present with diarrhoea and is a less likely diagnosis than pancreatitis. Celiac disease is a less likely diagnosis than pancreatitis, and you would also expect mention of diarrhoea. VIPoma would also likely present with diarrhoea. Cecal carcinoma would more than likely present with blood in the stool.
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This question is part of the following fields:
- Gastrointestinal System
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Question 13
Correct
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A 28-year-old male has presented to his doctor with hypertension. Upon examination, he is found to have palpable kidneys. An abdominal ultrasound shows enlarged cystic kidneys on both sides. From the list of options, choose the most likely condition present in this patient.
Your Answer: Polycythaemia
Explanation:The most likely diagnosis for this patient is adult polycystic kidneys. This disease is associated with the following: valvular heart abnormalities, incompetence, and aneurysms of the cerebral circulation. It can also be associated with excessive erythropoietin production and polycythaemia. There is an increased incidence of aortic incompetence, and mitral valve prolapse occurs in 25 per cent of patients. Hepatic cysts can also occur, and present in 70 per cent of patients – these can also involve the pancreas in 10 per cent of patients and the spleen. Cerebral berry aneurysms are present in around 5-8 per cent of patients, but familial clustering is also observed. That is if there is a family history, over 20 per cent of patients will also have an aneurysm. Diverticular disease is also thought to be increased in patients with polycystic kidney disease.
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This question is part of the following fields:
- Renal System
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Question 14
Correct
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The ECG of a 48-year-old man shows broad complex tachycardia with a HR of 154 bpm 2 days after an MI. His BP is 90/60 mmHg and he is complaining of palpitations and dyspnoea. What is the most appropriate management?
Your Answer: DC Shock
Explanation:Dysrhythmias are the most frequent MI complication. The patient seems to have a post MI atrial fibrillation which is treated, in an emergency context, with DC shock.
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This question is part of the following fields:
- Cardiovascular System
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Question 15
Correct
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A 50-year-old male is awaiting an anterior resection of rectum. Which of the following is the most common postoperative complication of the above surgery?
Your Answer: Infection
Explanation:The most frequent postoperative surgical complications after colorectal resections are surgical site infection, anastomotic leakage, intra-abdominal abscess, ileus and bleeding. Among them surgical site infection is the most common post-operative complication. Being a clean-contaminated procedure, there is contamination of both the peritoneal cavity and the surfaces of the surgical wound which leads to infections.
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This question is part of the following fields:
- Gastrointestinal System
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Question 16
Correct
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A 17-year-old boy presents with a 2 day history of colicky abdominal pain, vomiting and diarrhoea. He has been passing blood mixed with diarrhoea. He has no significant past medical history and takes no regular medication.
On examination he is pyrexial and clinically dehydrated. Cardiorespiratory and abdominal examinations are normal.
What is the most likely diagnosis?Your Answer: Campylobacter infection
Explanation:The patient has bloody diarrhoea that sounds like a food poisoning in the clinical scenario. Campylobacter is the most common cause of this in the United Kingdom. This is then followed by Salmonella and Shigella. The symptoms are usually self limiting. This is more likely to be bacterial from the food than a viral gastroenteritis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 17
Correct
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Regarding the 3rd heart sound, which one of the following statements is correct?
Your Answer: It may be a normal finding in women up to the age of 50
Explanation:The 3rd heart sound corresponds to early diastolic filling in ventricular relaxation after the closure of the aortic valve. Associated conditions include cardiac failure, constrictive pericarditis and atrial myxomas. It is low pitched and accentuated by inspiration. The 3rd heart sound may arise from ventricular relaxation and it can be seen as a normal finding among children, young adults and women till 50 years of age.
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This question is part of the following fields:
- Cardiovascular System
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Question 18
Correct
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A 70-year-old male patient with hypertension complains of acute urinary retention. He provides a history of urinary frequency for the past 18 months and has been taking Nifedipine and Propranolol for blood pressure control. Which of the following is the most probable cause for his acute presentation?
Your Answer: Drug induced
Explanation:Calcium channel blockers decrease smooth-muscle contractility in the bladder and this can cause urinary retention.
An enlarged prostate gland could be the reason if he gave a history of obstructive symptoms.
Diabetes presents with polyuria.
Bladder cancer commonly presents with painless haematuria. -
This question is part of the following fields:
- Renal System
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Question 19
Correct
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An 82-year-old man arrives at the clinic with painful right upper arm that he has been experiencing for the last few months. The pain is gradually worsening and often wakes him up at night. He is a known case of Paget's disease involving his lumbar spine and pelvis and is currently taking oral bisphosphonates. On examination, shoulder movements are intact. Which of the following is the most likely cause of his arm pain?
Your Answer: Osteosarcoma
Explanation:Paget’s accelerates the remodelling process with old bone breaking down more quickly which disrupts the normal growth process. New bone development eventually adjusts to the faster pace and speeds up on its own. The pace is too fast for healthy bone growth, and the regrowth ends up softer and weaker than normal. The effect of this accelerated process causes bone pain, fractures, and deformities. Since osteosarcoma is a type of bone cancer linked to abnormal bone growth, this makes it a rare but possible complication of Paget’s disease although the chances of developing osteosarcoma are minimal. Fractures are painful and restrict movement whereas this patients pain is gradually developing. Pain associated with osteoarthritis is usually mild to moderate and worsens as the day progresses.
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This question is part of the following fields:
- Musculoskeletal System
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Question 20
Correct
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A 40-year-old female is receiving a course of chemotherapy for breast cancer. She is, however, experiencing troublesome vomiting which is not responding to domperidone.
Which of the following is the most appropriate next step of management?Your Answer: Add a 5-HT3 antagonist
Explanation:Nausea and vomiting are the common side effects of chemotherapy. Risk factors for the development of these symptoms include age<50 years, anxiety, concurrent use of opioids, and the type of chemotherapy administered. For patients at low risk of these symptoms, drugs such as metoclopramide may be used. For high-risk patients, however, 5-HT3 receptor antagonists such as ondansetron are often effective, especially if combined with dexamethasone.
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This question is part of the following fields:
- Haematology & Oncology
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Question 21
Correct
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A 19-year-old female presented with irregular menstrual cycles for 4 months. On examination her weight was 85 kg and height was 145 cm. She was not on any medications. Which of the following is the most appropriate investigation to arrive at a diagnosis?
Your Answer: Pelvic ultrasound
Explanation:Oligomenorrhoea and BMI of 40.4 is suggestive of Polycystic ovary syndrome (PCOS). To diagnose PCOS 2 out of following 3 criteria should be present : oligo/anovulation, hyperandrogenism, clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone) and polycystic ovaries on ultrasound.
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This question is part of the following fields:
- Women's Health
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Question 22
Correct
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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: 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 23
Incorrect
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A 25-year-old male presents to the emergency department with fever, sweating, hyperventilation and breathing difficulty. He also complains of a continuous ringing sensation in both his ears for the past couple of days. He admits to consuming a lot of over the counter painkillers for the past few days. Which of the following drugs is the most likely cause of these symptoms?
Your Answer: Co-proxamol
Correct Answer: Aspirin
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
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Question 24
Correct
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A 16-year-old girl comes to clinic complaining of primary amenorrhoea, despite having developed secondary sexual characteristics at 11 years of age.
On examination, she has well-developed breasts and small bilateral groin swellings.
What is the most likely diagnosis?Your Answer: Complete androgen insensitivity syndrome
Explanation:Androgen insensitivity syndrome (AIS), previously referred to as testicular feminization, is an X-linked disorder in which the patients are genotypically male (possessing and X and Y chromosome) and phenotypically female. This disorder is rare, with reported incidences from 1 in 20,000 to 1 in 60,000 live male births, and is the result of a missing gene on the X chromosome that is responsible for the cytoplasmic or nuclear testosterone receptor. In its absence, the gonad, which is a testis, produces normal amounts of testosterone; however, the end tissues are unable to respond due to the deficient receptors leading to the external genitalia developing in a female fashion. Anti-mullerian hormone, which is produced by the testis, is normal in these patients, leading to regression of the Mullerian duct. Wolffian duct development, which depends on testosterone, does not occur as the ducts lack the receptors.
The cumulative effect is a genotypic male with normal external female genitalia (without pubic or axillary hair), no menses, normal breast development, short or absent vagina, no internal sex organs, and the presence of testis. Frequently, these patients have bilateral inguinal hernias in childhood, and their presence should arouse suspicion of the diagnosis. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 25
Correct
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A 22-year-old female presents with a history of a whitish discharge from her vagina. She previously underwent a dental procedure and completed a 7 day antibiotic course prior to it. Which of the following microorganisms has most likely lead to this?
Your Answer: Candida
Explanation:Candida albicans is the most common cause of candidiasis and appears almost universally in low numbers on healthy skin, in the oropharyngeal cavity, and in the gastrointestinal and genitourinary tracts. In immunocompetent individuals, C. albicans usually causes minor localized infections, including thrush (affecting the oral cavity), vaginal yeast infections (if there is an underlying pH imbalance), and infections of the intertriginous areas of skin (e.g., the axillae or gluteal folds). More widespread and systemic infections may occur in immunocompromised individuals (e.g., neonates, diabetics, and HIV patients), with the oesophagus most commonly affected (candida esophagitis). Localized cutaneous candidiasis infections may be treated with topical antifungal agents (e.g., clotrimazole). More widespread and systemic infections require systemic therapy with fluconazole or caspofungin.
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This question is part of the following fields:
- Infectious Diseases
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Question 26
Correct
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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: 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 27
Correct
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A 16-year-old woman presents with a 7 month history of secondary amenorrhoea and three months history of galactorrhoea. She has been otherwise well. She had menarche at the age of 12 and has otherwise had regular periods. She has been sexually active for approximately one year and has occasionally used condoms for contraception. She smokes five cigarettes daily and occasionally smokes cannabis.
On examination, she appears well, and clinically euthyroid, has a pulse of 70 bpm and blood pressure of 112/70 mmHg.
Investigations show:
Serum oestradiol 130 nmol/L (130-600)
Serum LH 4.5 mU/L (2-20)
Serum FSH 2.2 mU/L (2-20)
Serum prolactin 6340 mU/L (50-450)
Free T4 7.2 pmol/L (10-22)
TSH 2.2 mU/L (0.4-5.0)
What is the most likely diagnosis?Your Answer: Prolactinoma
Explanation:The patient has hyperprolactinaemia with otherwise normal oestradiol, FSH and LH. This is highly suggestive of Prolactinoma rather than a non functioning tumour.
In polycystic ovaries, there is increase in the level of LH while FSH is normal or low. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 28
Correct
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A 20-year-old male student presents to the clinic with swelling of his face, hands and feet along with diffuse abdominal pain. He has a history of similar recurrent episodes since he was 10 years old, with each episode lasting 2-3 days. Examination reveals swelling on face, hands, feet but no sign of urticaria. Family history is significant for similar episodes in the mother who experienced these since childhood, and a brother who passed away following respiratory distress at age of 8 during one such episode. Which of the following tests would be the most helpful in reaching the diagnosis?
Your Answer: C1 esterase inhibitor
Explanation:Hereditary C1 inhibitor deficiency leads to recurrent angioedema without urticaria or pruritus. Physical triggers include dental work, surgery or intubation. Medical triggers include angiotensin-converting enzyme (ACE) inhibitor, tamoxifen, oestrogen-containing medications (e.g., hormone replacement therapy and oral contraceptives). It is diagnosed on the basis of low levels of C1 esterase inhibitor or elevated levels of dysfunctional C1 esterase inhibitor. C4 levels are low between attacks. IgE levels, eosinophils, skin prick tests and RASTs are helpful in other allergic conditions and asthma but not of use in this case.
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This question is part of the following fields:
- Musculoskeletal System
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Question 29
Correct
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A 32-year-old female presented with a lump in the upper outer quadrant of her left breast, which is 1.5cm in size and tender. What is the initial investigation to be done?
Your Answer: Ultrasound
Explanation:Tenderness is usually suggestive of a benign breast mass such as a breast abscess. Ultrasound is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage.
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This question is part of the following fields:
- Women's Health
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Question 30
Correct
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A 58-year-old woman with a longstanding history of hypertension arrives at the hospital complaining of recurrent falls when trying to get out of bed or get up from sitting. She is currently on an antihypertensive regimen? What do you think is most likely responsible for her falls?
Your Answer: Thiazide
Explanation:The causes of orthostatic hypotension include the following: Hypovolemia (a drop in the volume of blood) and dehydration (low fluid volume in the body). Common causes of these are bleeding, elevated sugar, diarrhoea, vomiting, and medications like thiazide diuretics (HCTZ) and loop diuretics (furosemide, bumetanide)
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This question is part of the following fields:
- Emergency & Critical Care
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Question 31
Correct
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A 60-year-old patient diagnosed with Type-2 diabetes mellitus is not responding to dietary modifications and weight reduction. He needs to be started on an oral hypoglycemic agent. Which among the following statements regarding oral hypoglycaemic agents is true?
Your Answer: Acarbose inhibits ?-glucosidase
Explanation: -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 32
Correct
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A 50-year-old man had a fasting blood glucose test as part of a work-up for hypertension. It comes back as 6.5 mmol/l. The test is repeated and reported as 6.7 mmol/l. He says he feels constantly tired but denies any polyuria or polydipsia. How should these results be interpreted?
Your Answer: Impaired fasting glycaemia
Explanation:A fasting blood glucose level from 110 to 126 mg/dL (5.5 to 6.9 mmol/L) is considered prediabetes. This result is sometimes called impaired fasting glucose.
Diabetes mellitus (type 2): diagnosisThe diagnosis of type 2 diabetes mellitus can be made by plasma glucose. If the patient is symptomatic:
fasting glucose greater than or equal to 7.0 mmol/l
random glucose greater than or equal to 11.1 mmol/l (or after 75g oral glucose tolerance test)
If the patient is asymptomatic the above criteria apply but must be demonstrated on two separate occasions. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 33
Correct
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A 35-year-old gentleman is investigated for recurrent renal stones. He has been hospitalised on multiple occasions and has required lithotripsy three times. Investigations show the following:
Calcium 2.08 mmol/l
Phosphate 0.85 mmol/l
Parathyroid hormone 4.1 pmol/L (normal range = 0.8 - 8.5)
24 hour urinary calcium 521 mg/24 hours (normal range < 300)
Which one of the following treatments will most likely reduce the incidence of renal stones?Your Answer: Indapamide
Explanation:Indapamide is a mild thiazide-like diuretic with hypotensive effect, and compared to other thiazides, it is reported to also have less metabolic derangements. However, it may have beneficial hypo-calciuric effects that are often associated with thiazides, thus, in this case, we would recommend prescribing this to the patient.
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This question is part of the following fields:
- Renal System
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Question 34
Correct
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A 40 years old man collapsed at home and died. The GP's report says he suffered from type 2 Diabetes Mellitus and his BMI was 35. What is the most likely cause of death?
Your Answer: Myocardial infarction
Explanation:Diabetic patients usually have a higher risk of developing cardiovascular events by 2-4x that of the general population. In addition, diabetic patients are often obese and possibly have hyperlipidaemia, which are great risk factors of cardiovascular incidents.
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This question is part of the following fields:
- Cardiovascular System
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Question 35
Correct
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A 45-year-old male complains of angina pain. Which of the following features on exercise testing would have the strongest predictive value for ischaemic heart disease?
Your Answer: Decline in systolic BP by 20 mmHg in stage 1 of the Bruce protocol
Explanation:The classic criteria for visual interpretation of positive stress test findings include the following:J point (the junction of the point of onset of the ST-T wave; it is normally at or near the isoelectric baseline of the ECG), ST80 (the point that is 80 msec from the J point), depression of 0.1 mV (1 mm) or more and ST-segment slope within the range of ± 1 mV/sec in 3 consecutive beats
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This question is part of the following fields:
- Cardiovascular System
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Question 36
Correct
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Which of the following is correct regarding post-menopausal hormone replacement therapy (HRT) according to randomised clinical studies ?
Your Answer: Increases plasma triglycerides
Explanation:Oestrogen therapy reduces plasma levels of LDL cholesterol and increases levels of HDL cholesterol. It can improve endothelial vascular function, however, it also has adverse physiological effects, including increasing the plasma levels of triglycerides (small dense LDL particles). Therefore, although HRT may have direct beneficial effects on cardiovascular outcomes, these effects may be reduced or balanced by the adverse physiological effects.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 37
Incorrect
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Which feature is NOT characteristic of carcinoid syndrome?
Your Answer: Dermatitis
Correct Answer: Persistent hypotension
Explanation:Carcinoid syndrome is a paraneoplastic syndrome comprising of signs and symptoms that occur secondary to carcinoid tumours. Diarrhoea, dermatitis, bronchospasm and right sided cardiac valve lesions (tricuspid insufficiency and pulmonary stenosis) are characteristic of carcinoid syndrome.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 38
Correct
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A 25-year-old pregnant female suddenly developed a rash on her torso. It started as macules and then became vesicles. After 3 days she died. During her post-mortem, positive findings suggestive of pneumonitis were found. Which one of the following is the most common cause?
Your Answer: Varicella zoster virus (VZV)
Explanation:Varicella zoster virus (VZV) presents in this way and the rash transforms from macules to vesicles. Pneumonitis is a common complication of VZV infection.
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This question is part of the following fields:
- Infectious Diseases
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Question 39
Correct
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A 36-year-old man arrives at the clinic complaining of pain and swelling of the left knee, ankles and right hallux. He has acute conjunctivitis, and dysuria. He suffered from an episode of gastroenteritis two weeks back. Clinical examination shows left Achilles tendonitis and right plantar fasciitis. Radiological examination reveals left sacroiliitis, with evidence of enthesitis, joint erosions and periostitis. HLA-B27 is positive. Which of the following is the most likely diagnosis?
Your Answer: Reiter's syndrome
Explanation: -
This question is part of the following fields:
- Musculoskeletal System
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Question 40
Incorrect
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A 57-year-old female arrives at the emergency due to chest pain, shortness of breath and palpitations. ECG is done which shows a supraventricular tachycardia with a heart rate of 220/min. carotid massage fails to bring the heart rate down. How would you manage this patient?
Your Answer: IV adenosine
Correct Answer: DC shock
Explanation:Synchronized electrical cardioversion may also be used to treat stable ventricular tachycardia (VT) that does not respond to a trial of intravenous medications. Unstable patients with SVT and a pulse are always treated with synchronized cardioversion. The appropriate voltage for cardioverting SVT is 50-100 J. This is what AHA recommends and also SVT converts quite readily with 50-100 J.
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This question is part of the following fields:
- Cardiovascular System
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Question 41
Correct
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A 50-year-old man is referred with impotence. He has a history of angina, hypertension and type 2 diabetes.
Which one of the following drugs that he takes is a contraindication to him being able to receive sildenafil?Your Answer: Isosorbide mononitrate
Explanation:Sildenafil administration to patients who are using organic nitrates, either regularly and/or intermittently, in any form is contraindicated.
Organic nitrates and nitric oxide (NO) donors exert their therapeutic effects on blood pressure and vascular smooth muscle by the same mechanism as endogenous NO via increasing cGMP concentrations. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 42
Correct
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A 55-year-old female school teacher complains of double vision when she writes on the school blackboard. She has no history of trauma. Her most recent visit to her GP was to seek attention for a rash which developed after she was bitten when walking through the forest on a school trip. Choose the cranial nerve most likely to be affected here.
Your Answer: Abducens
Explanation:This nerve is responsible for the side to side movement of the eye, hence why damage can cause double vision.
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This question is part of the following fields:
- Nervous System
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Question 43
Correct
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A 60-year-old male complained of pain and redness at the metatarsophalangeal joints of left big toe. He was on treatment for hypertension. Which of the following antihypertensive drugs is responsible for the above symptom?
Your Answer: Bendroflumethiazide
Explanation:The clinical diagnosis is acute gout. According to the latest research diuretics, β blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout, as those drugs increase serum uric acid levels. Calcium channel blockers and losartan are associated with a lower risk. Thiazide diuretics have the highest association with gout.
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This question is part of the following fields:
- Pharmacology
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Question 44
Correct
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Which of the following drugs is NOT used in the treatment of MRSA?
Your Answer: Ceftriaxone
Explanation:Cephalosporins, such as ceftriaxone, do not cover methicillin-resistant staph aureus. They do cover some gram positives and gram negatives. Vancomycin and teicoplanin given intravenously have good coverage of MRSA and other gram positive bacteria. Rifampicin and doxycycline, although not the best treatment, can be used for outpatients if there are no systemic signs of illness.
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This question is part of the following fields:
- Infectious Diseases
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Question 45
Incorrect
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An 80-year-old woman is brought to the ER with altered sensorium. She is accompanied by her daughter who noticed the acute change. The patient has had a nagging cough with purulent sputum and haemoptysis for the last few days. Previous history includes a visit to her GP two weeks back because of influenza.
On examination, the patient appears markedly agitated with a respiratory rate of 35/min. Blood gases reveal that she is hypoxic. White blood cell count is 20 x 109/l, and creatinine is 250 mmol/l. Chest X-ray is notable for patchy areas of consolidation, necrosis and empyema formation.
Which of the following lead to the patient's condition?Your Answer: Mycoplasma pneumonia
Correct Answer: Staphylococcus aureus pneumonia
Explanation:Though a common community pathogen, Staphylococcus Aureas is found twice as frequently in pneumonias in hospitalized patients. It often attacks the elderly and patients with CF and arises as a co-infection with influenza viral pneumonia. The clinical course is characterized by high fevers, chills, a cough with purulent bloody sputum, and rapidly progressing dyspnoea. The gross pathology commonly reveals an acute bronchopneumonia pattern that may evolve into a necrotizing cavity with congested lungs and airways that contain a bloody fluid and thick mucoid secretions.
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This question is part of the following fields:
- Geriatric Medicine
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Question 46
Incorrect
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A patient complaining of nocturnal cough and wheeze is investigated for asthma. Which of the following tests would be most useful in aiding the diagnosis?
Your Answer: FEV1 and FVC measurements
Correct Answer: ANCA
Explanation:Churg-Strauss disease (CSD) is one of three important fibrinoid, necrotizing, inflammatory leukocytoclastic systemic small-vessel vasculitides that are associated with antineutrophil cytoplasm antibodies (ANCAs).
The first (prodromal) phase of Churg-Strauss disease (CSD) consists of asthma usually in association with other typical allergic features, which may include eosinophilia. During the second phase, the eosinophilia is characteristic (see below) and ANCAs with perinuclear staining pattern (pANCAs) are detected. The treatment would therefore be different from asthma. For most patients, especially those patients with evidence of active vasculitis, treatment with corticosteroids and immunosuppressive agents (cyclophosphamide) is considered first-line therapy -
This question is part of the following fields:
- Respiratory System
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Question 47
Correct
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A thin 18-year-old girl has bilateral parotid swelling with thickened calluses on the dorsum of her hand. What is the single most likely diagnosis?
Your Answer: Bulimia nervosa
Explanation:Bulimia nervosa is a condition in which a person is involved in binge eating and then purging. This patient has swollen parotid glands. The glands swell in order to increase saliva production so that the saliva lost in the vomiting is compensated. This patient also has thickened calluses on the back of her hand. This is known as Russell’s sign. This occurs because of putting fingers in the mouth again and again to induce the gag reflex and vomit. The knuckles get inflamed in the process after coming in contact with the teeth multiple times.
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This question is part of the following fields:
- Gastrointestinal System
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Question 48
Correct
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A 25-year-old patient has presented with symptoms which all point to the cerebellopontine angle (CPA) a tumour. These are numbness in the face, vertigo, and tinnitus. Choose the most appropriate investigation from the list of options.
Your Answer: MRI Brain
Explanation:MRI scans are used to diagnose tumours in the cerebellopontine angle.
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This question is part of the following fields:
- Nervous System
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Question 49
Incorrect
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A girl suffered full thickness circumferential burn to her right arm. What is best step in management?
Your Answer: Refer to burn unit
Correct Answer: Escharotomy
Explanation:An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.
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This question is part of the following fields:
- The Skin
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Question 50
Correct
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A 22-year-old man who has recently returned from a trip to Far East presents with sore eyes and symmetrical joint pain in his knees, ankles and feet. Labs reveal an elevated ESR. The synovial fluid aspirate is sterile and has a high neutrophil count. What is the most likely diagnosis?
Your Answer: Reactive arthropathy
Explanation: -
This question is part of the following fields:
- Musculoskeletal System
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SESSION STATS - PERFORMANCE PER SPECIALTY
