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  • Question 1 - A 4 year old girl is brought to the emergency due to fever...

    Incorrect

    • A 4 year old girl is brought to the emergency due to fever and urinary urgency. The temperature is recorded to be 39C. Which of the following is the best investigation in this case?

      Your Answer:

      Correct Answer: Clean catch of urine

      Explanation:

      Urine culture and sensitivity is used to diagnose a urinary tract infection (UTI). A mid-stream clean catch urine sample is the most common type of sample collected. It is important to follow the clean catch process to have accurate results from an uncontaminated sample. Urine cultures can also check for infections of the bladder or kidney.

    • This question is part of the following fields:

      • Child Health
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  • Question 2 - A 30 year old previously well female presented with yellowish discolouration of her...

    Incorrect

    • A 30 year old previously well female presented with yellowish discolouration of her sclera. Investigations revealed low haemoglobin, a retic count of 8% and the occasional spherocyte on blood film. Which of the following is the most appropriate single investigation?

      Your Answer:

      Correct Answer: Direct coombs test

      Explanation:

      A low haemoglobin and a high retic count is suggestive of a haemolytic anaemia. Occasional spherocytes can be seen on blood film during haemolysis and it is not a specific finding. Direct Coombs test will help to identify autoimmune haemolytic anaemia, where there are antibodies attached to RBCs.

    • This question is part of the following fields:

      • Endocrine
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  • Question 3 - A 30-year-old woman complained of increasing difficulty in hearing in her right ear....

    Incorrect

    • A 30-year-old woman complained of increasing difficulty in hearing in her right ear. Examination reveals a normal eardrum, normal bone conduction and lateralization of a Weber test to the right. She says that she noticed the hearing loss following her last pregnancy. What is the most appropriate diagnosis?

      Your Answer:

      Correct Answer: Otosclerosis

      Explanation:

      This is a case of conductive hearing loss. Bone conduction is normal and the Weber test is lateralized to the right. Tympanosclerosis is excluded as the ear drum is of normal morphology. Thus, otosclerosis is the most likely answer.

    • This question is part of the following fields:

      • ENT
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  • Question 4 - 48 hours after having unprotected intercourse, a 16-year-old female requested a pregnancy test...

    Incorrect

    • 48 hours after having unprotected intercourse, a 16-year-old female requested a pregnancy test from her GP. What advice can you give her regarding the reliability of pregnancy testing at this time?

      Your Answer:

      Correct Answer:

      Explanation:

      Even if conception has already occurred, beta hCG is likely to be normal. Beta hCG is made by syncytiotrophoblast cells following conception. It then activates the corpus luteum to continuously produce progesterone for implantation to happen. In week 10/40, levels of HCG peak and the placenta can produce adequate progesterone by itself. As a general rule, a beta HCG concentration >25 U/I or a doubling of levels of HCG within two days is required to diagnose pregnancy. A urine pregnancy test would only likely prove positive around 8 days to 2 weeks following conception.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 5 - A 30-year-old patient has ataxia, nystagmus and vertigo with a history of headaches....

    Incorrect

    • A 30-year-old patient has ataxia, nystagmus and vertigo with a history of headaches. Where is the most likely site of the lesion?

      Your Answer:

      Correct Answer: Cerebellum

      Explanation:

      Damage to the cerebellum can cause asynergia, dysmetria, adiadochokinesia, intention tremor, staggering, ataxic gait, tendency toward falling, hypotonia, ataxic dysarthria and nystagmus.

    • This question is part of the following fields:

      • Neurology
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  • Question 6 - Drug-induced lupus erythematosus most often occurs after taking which of the following drugs?...

    Incorrect

    • Drug-induced lupus erythematosus most often occurs after taking which of the following drugs?

      Your Answer:

      Correct Answer: Procainamide

      Explanation:

      Many drugs are responsible for causing drug induced lupus. However, it is most commonly associated with hydralazine, procainamide and quinidine.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 7 - A 32 year old primigravida in her 12th week of gestation, presents to...

    Incorrect

    • A 32 year old primigravida in her 12th week of gestation, presents to her GP with concerns regarding the evolution of her pregnancy. She's afraid she might experience an obstetric cholestasis just like her older sister did in the past. What is the fundamental symptom of obstetric cholestasis?

      Your Answer:

      Correct Answer:

      Explanation:

      Cholestasis of pregnancy is associated with increased fetal morbidity and mortality and should be treated actively. The significance attached to pruritus in pregnancy is often minimal, but it is a cardinal symptom of cholestasis of pregnancy, which may have no other clinical features.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 8 - A 62 year old man arrives at the clinic with a history of...

    Incorrect

    • A 62 year old man arrives at the clinic with a history of cough and intermittent haemoptysis for the last 3 months. He has a 50 pack year smoking history and is currently waiting for bronchoscopy to assess a left lower lobe collapse. The patient also has a marked muscle weakness and wasting of proximal muscles of his shoulders and pelvic girdle. His wife states that lately he has been unable to eat solids. Which of the following statements would be true regarding this scenario?

      Your Answer:

      Correct Answer: He may have a photosensitive facial rash

      Explanation:

      The patient has presented with signs of small cell lung cancer. The associated proximal muscle weakness is most probably due to dermatomyositis which occurs as a paraneoplastic syndrome associated with lung carcinoma. In most cases, the first symptom is a distinctive skin rash on the face, eyelids, chest, nail cuticle areas, knuckles, knees or elbows. The rash is patchy and usually a bluish-purple colour. Corticosteroids are helpful in the management of the cutaneous changes and muscle weakness.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 9 - In the treatment of infants with gastroenteritis, which of the following statements is...

    Incorrect

    • In the treatment of infants with gastroenteritis, which of the following statements is the most accurate one?

      Your Answer:

      Correct Answer:

      Explanation:

      The main problem with infants having gastroenteritis is dehydration. So they should be admitted to the hospital for IV fluids if they are not tolerating oral fluids.

    • This question is part of the following fields:

      • Gastrointestinal
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  • Question 10 - A 4 year old boy is wetting his bed at night or whenever...

    Incorrect

    • A 4 year old boy is wetting his bed at night or whenever he gets excited. His parents are concerned. What is the best strategy?

      Your Answer:

      Correct Answer: Behavioural therapy

      Explanation:

      Generally, bed-wetting before age 7 isn’t a concern as the child may still be developing night-time bladder control. The child is less than 5 years and most children will outgrow bed-wetting on their own. Therefore only reassurance and behavioural therapy are suggested at this stage.

    • This question is part of the following fields:

      • Child Health
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  • Question 11 - A woman suffering from severe psoriasis has been undergoing treatment for it for...

    Incorrect

    • A woman suffering from severe psoriasis has been undergoing treatment for it for the last 3 years. She now presents with lethargy and dizziness. Her blood film shows large red blood cells. What is the cause of these symptoms in this woman?

      Your Answer:

      Correct Answer: Methotrexate

      Explanation:

      Methotrexate is also known as a DMARD (Disease Modifying Anti Rheumatic Drug). It reduces inflammation and suppresses the immune system, and is thought to cause folic acid deficiency leading to megaloblastic anaemia.
      NSAIDS and Sulfasalazine are known to cause haemolytic but not megaloblastic anaemia.
      Chronic disease might be accompanied with normocytic or microcytic anaemia as opposed to the macrocytic anaemia this patient is suffering from.
      Steroids are not known to cause anaemia.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 12 - A 25 year old female was admitted following the ingestion of 36 paracetamol...

    Incorrect

    • 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:

      Confusion and disorientation indicate that the patient has grade 3 hepatic encephalopathy. According to King’s College criteria for liver transplantation low pH (< 7.3), features of acute kidney injury (creatinine > 3.4 mg/dL), grade 3-4 hepatic encephalopathy and coagulopathy (INR >6.5 ) are positive criteria for this patient.

    • This question is part of the following fields:

      • Seriously Ill
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  • Question 13 - A 28-year-old young woman with acute psychosis on haloperidol 5mg twice daily is...

    Incorrect

    • A 28-year-old young woman with acute psychosis on haloperidol 5mg twice daily is now unable to sleep. What is the next line treatment?

      Your Answer:

      Correct Answer:

      Explanation:

      Propranolol prolongs the action of benzodiazepines. Thus, it is useful for sedation in acute psychosis rather than using high doses of benzodiazepines. Its use is also preferred because it decreases the addictive potential of benzodiazepines.

    • This question is part of the following fields:

      • Mental Health
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  • Question 14 - Which of the following procedures does not require antibiotic prophylaxis? ...

    Incorrect

    • Which of the following procedures does not require antibiotic prophylaxis?

      Your Answer:

      Correct Answer:

      Explanation:

      According to latest NICE guidelines, patients with isolated atrial septal defects do not require prophylactic antibiotics originally used in prevention of infective endocarditis in dental procedures.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 15 - As the SHO of a hospital, you come across the lab report of...

    Incorrect

    • As the SHO of a hospital, you come across the lab report of a patient. It shows the following: glucose 4mmol/L, K 5.2mmol/L, Na 129mmol/L. How would you manage this patient?

      Your Answer:

      Correct Answer: Normal Saline 0.9%

      Explanation:

      This patient’s blood glucose levels are within the normal range. From their lab report, they are suffering from milk hyperkalaemia and hypernatremia. Thus, normal saline 0.9 per cent is most appropriate in this case.

    • This question is part of the following fields:

      • Seriously Ill
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  • Question 16 - A neonate was brought in by her mother, for a skin lesion present...

    Incorrect

    • A neonate was brought in by her mother, for a skin lesion present over the neonate's back which is bluish in colour, but otherwise asymptomatic. The most appropriate course of action will be?

      Your Answer:

      Correct Answer: Reassure

      Explanation:

      A Mongolian spot can be present in new born babies which usually appears over the back and fades with time. There is nothing to worry about.

    • This question is part of the following fields:

      • Dermatology
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  • Question 17 - A young boy presents with a soft swelling in the midline neck that...

    Incorrect

    • A young boy presents with a soft swelling in the midline neck that moves with tongue protrusion. The swelling is present between the thyroid cartilage and the tongue. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Thyroglossal cyst

      Explanation:

      The thyroglossal duct cyst is the most common congenital anomaly of the central portion of the neck. The thyroglossal duct cyst is intimately related to the central portion of the hyoid bone and usually elevates along with the larynx during swallowing. Thyroglossal cysts can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during the developmental stages.

    • This question is part of the following fields:

      • Mental Health
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  • Question 18 - A 65 year old female presented in emergency 12 hours after the ingestion...

    Incorrect

    • A 65 year old female presented in emergency 12 hours after the ingestion of 14g of quinine sulphate. Which of the following is the most likely side effect of this drug?

      Your Answer:

      Correct Answer:

      Explanation:

      The main effects of quinine affect the nervous system. It particularly affects the optic and auditory nerves. While affecting the auditory nerve it may cause tinnitus and deafness but not hyperacusis. Blindness is the effect of this drug on the optic nerve.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 19 - A 38-year-old male presented to the outpatient clinic complaining of a right sided...

    Incorrect

    • A 38-year-old male presented to the outpatient clinic complaining of a right sided groin mass just above and lateral to the pubic tubercle. It is non-tender and reducible. There is no cough impulse. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Direct inguinal hernia

      Explanation:

      The patient is showing the symptoms of a hernia. The position of the hernia indicates an inguinal hernia. The absence of expansive impulse on cough by blocking the internal ring signifies a direct inguinal hernia.

    • This question is part of the following fields:

      • Genitourinary
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  • Question 20 - A 12-year-old boy hit his head on a pole on the school playground....

    Incorrect

    • A 12-year-old boy hit his head on a pole on the school playground. His friends noted that he lost consciousness for a few seconds. The school nurse sent him to the Emergency Department as he had a small nasal bleed that stopped spontaneously. In the intervening two hours, he has noticed a watery discharge from his nose. On examination, there is considerable bruising on his nose and forehead, he was complaining of a headache. Which is the most appropriate diagnosis?

      Your Answer:

      Correct Answer: Basilar skull fracture

      Explanation:

      Orbital bone fracture: The child has sustained a head injury and subsequently describes a CSF rhinorrhoea (indicating a cerebro-spinal fluid leak). CSF rhinorrhoea can occur in skull or nasal bone fractures. Given the symptoms of loss of consciousness and headache, this child is more at risk of having suffered a skull fracture requiring emergency CT head investigation and specialist neurosurgical management. An ethmoid bone fracture may also present this way. A skull x ray would help to determine an air fluid level and indeed allow some visualisation of the nasal bones, though in children the nasal bones do not visualise well due to lack of fusion. Either way this child would need assessment in the nearest Emergency Department and the school would be expected to follow a ‘head injury’ protocol.

    • This question is part of the following fields:

      • ENT
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  • Question 21 - A 29 year old soldier who returned from the army recently, presented with...

    Incorrect

    • A 29 year old soldier who returned from the army recently, presented with problems with sleep and concentration. He was diagnosed with post-traumatic stress disorder. Which of the following is the best treatment option for him?

      Your Answer:

      Correct Answer: Narrative exposure therapy + paroxetine

      Explanation:

      The main treatments for people with PTSD are psychotherapy, medication, or a combination of the two. Cognitive behavioural therapy is the main psychotherapy method. It mainly includes exposure therapy and cognitive restructuring. The pharmacological management mainly consists of SSRI. So the most appropriate answer is narrative exposure therapy + paroxetine.

    • This question is part of the following fields:

      • Mental Health
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  • Question 22 - A 51-year-old woman admitted to the hospital for 3 days due to haemoptysis...

    Incorrect

    • A 51-year-old woman admitted to the hospital for 3 days due to haemoptysis developed an ataxic gait, visual problems, and altered state of consciousness. What is the most appropriate management of this patient?

      Your Answer:

      Correct Answer: High potent vitamins

      Explanation:

      Wernicke’s encephalopathy presents with neurological symptoms as a result of biochemical deficits in the central nervous system due to depleted B-vitamin reserves, particularly thiamine (vitamin B1). Classically, Wernicke encephalopathy is characterised by the triad – ophthalmoplegia, ataxia, and confusion. Thiamine treatment should be started immediately and usually continued until clinical improvement ceases.

    • This question is part of the following fields:

      • Neurology
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  • Question 23 - A 30-year-old female admitted with pelvic pain, fever and vaginal discharge was diagnosed...

    Incorrect

    • A 30-year-old female admitted with pelvic pain, fever and vaginal discharge was diagnosed with PID. She was treated with IV antibiotics for 8 days. However, despite the antibiotics she continued to have a fever and lower abdominal pain. What is the most appropriate management that can be done at this stage?

      Your Answer:

      Correct Answer: US

      Explanation:

      Persistent fever and lower abdominal pain is suggestive of resistant conditions secondary to PID such as abscess formation. An US scan should be performed to rule out those possible conditions.

    • This question is part of the following fields:

      • Genitourinary
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  • Question 24 - A 75 year old male patient with type 2 diabetes mellitus, was admitted...

    Incorrect

    • A 75 year old male patient with type 2 diabetes mellitus, was admitted with confusion. On examination he was drowsy and had tremors. Which of the following is the best investigation, which is important for the further management?

      Your Answer:

      Correct Answer: Blood sugar

      Explanation:

      The presentation is highly suggestive of a hypoglycaemic episode, which is more common amongst older patient with diabetes mellitus. The chance of hypoglycaemia is higher with insulin users. Blood sugar measurement is crucial in the management.

    • This question is part of the following fields:

      • Endocrine
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  • Question 25 - Which is true of the composition of bile in the human hepatic duct?...

    Incorrect

    • Which is true of the composition of bile in the human hepatic duct?

      Your Answer:

      Correct Answer: Contains only actively secreted substances

      Explanation:

      Hepatic bile is an isotonic fluid and its electrolyte composition resembles that of plasma. 97% of water is found in the gallbladder bile, not hepatic duct. Hepatic bile is alkaline. The ratio of bile acids: phosphatidylcholine: cholesterol is 20:1:3. Hepatic bile contai9ns only actively secreted substances.

    • This question is part of the following fields:

      • Hepatobiliary
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  • Question 26 - A 54 year old gentleman presented with a 3 month history of a...

    Incorrect

    • A 54 year old gentleman presented with a 3 month history of a nodular growth over the dorsum of the his nose, about 0.6 cm in size. The base of nodule is slightly ulcerated and its margins are raised. The most likely diagnosis would be?

      Your Answer:

      Correct Answer: Basal cell carcinoma

      Explanation:

      Basal cell carcinoma is usually located on sun exposed sites. It has got many variants and clinically it presents as a slow growing mass/nodule with rolled margins and an ulcerated base.

    • This question is part of the following fields:

      • Dermatology
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  • Question 27 - A 35 year old Afro-Caribbean lady with a history of venous thrombosis, has...

    Incorrect

    • A 35 year old Afro-Caribbean lady with a history of venous thrombosis, has just had her 4th miscarriage. Lupus anticoagulant is positive. What is the most probable diagnosis?

      Your Answer:

      Correct Answer:

      Explanation:

      Antiphospholipid syndrome can cause recurrent miscarriage as it poses a high risk of developing blood clots. Miscarriage can happen due to venous or arterial thrombosis but the syndrome can also present with stroke, livedo reticularis, adrenal haemorrhage, myelitis, migraine, multi-infarct dementia or MI. Chances for venous thrombosis are noticeably higher if lupus anticoagulant is positive. If however, IgG or IgM antiphospholipid antibodies are positive, arterial thrombi are more common.

    • This question is part of the following fields:

      • Genitourinary
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  • Question 28 - A 27 year old woman presents with a 4cm bleeding ulcer on her...

    Incorrect

    • A 27 year old woman presents with a 4cm bleeding ulcer on her labia minora. The woman admits she is sexually active. Which lymph nodes will the ulcer drain to?

      Your Answer:

      Correct Answer: Superficial inguinal

      Explanation:

      The woman seems to have a chancroid, which may or may not drain to the lymph nodes of the groin. These nodes are the superficial inguinal lymph nodes.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 29 - A 6 month old baby presents with uncontrollable movements of her hands and...

    Incorrect

    • A 6 month old baby presents with uncontrollable movements of her hands and feet, shortly after being unconscious for a while. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Infantile spasm

      Explanation:

      Infantile spasm belongs to the spectrum of seizure disorders. Infantile spasm manifests itself with loss of consciousness and jerky movements. The peak age of onset is between 4 and 6 months. Approximately 90% of infantile spasms begin before 12 months of age. It is rare for infantile spasms to begin during the first 2 weeks of life or after 18 months.

    • This question is part of the following fields:

      • Child Health
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  • Question 30 - A patient was given Penicillin G pre-operatively. Which of the following procedures was...

    Incorrect

    • A patient was given Penicillin G pre-operatively. Which of the following procedures was he waiting for?

      Your Answer:

      Correct Answer: Splenectomy

      Explanation:

      Asplenic patients are at a high risk of fulminant sepsis which is usually caused by capsulated organisms such as Streptococcus pneumonia, Haemophilus influenzas and Neisseria meningitides. So all the patients who are awaiting splenectomy should be given antibiotic prophylaxis. (Penicillin, if allergy to Penicillin, Clarithromycin)

    • This question is part of the following fields:

      • Seriously Ill
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