-
Question 1
Correct
-
Which of the following drugs would be the safest to prescribe in a 22-year-old man with seropositive rheumatoid arthritis who is planning to start a family?
Your Answer: Prednisolone
Explanation:Prednisolone although has many undesirable side effects it may be considered relatively safe compared to the drugs that are provided here. Prolonged treatment with sulphasalazine may depress semen quality and cause irreversible infertility. Methotrexate and leflunomide both inhibit purine/pyrimidine synthesis (the former by inhibiting folate metabolism) and are contraindicated in pregnancy or while trying to conceive. In males, a temporary or permanent decrease in sperm count may occur with cyclophosphamide. Because the recovery of fertility after cyclophosphamide therapy is variable, sperm banking should be considered before treatment is begun.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 2
Incorrect
-
A 25-year-old female presented with a history of sudden collapse. She had been playing netball and had suddenly collapsed. This collapse had been accompanied by a brief period of loss of consciousness. She experienced palpitations for a brief period prior to losing consciousness. On examination her BP was 120/70 mmHg and pulse rate was 72 bpm, which was regular. The rest of the examination was also normal.
She had similar experience of collapse, about two years ago. She was well except for these two incidents and she has not been on any medication. All the investigations done at the first presentation (2 years ago), including FBC, ECG and echocardiography were normal. Her ECG done at this presentation revealed QT prolongation of 0.50 s. FBC, CXR and other investigations were normal. Which of the following is the best way of managing this patient?Your Answer: Insert a pacemaker
Correct Answer: Start on a beta-blocker
Explanation:Beta-blockers are drugs of choice for patients with LQTS. The protective effect of beta-blockers is related to their adrenergic blockade, which diminishes the risk of cardiac arrhythmias. They may also reduce the QT interval in some patients.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 3
Correct
-
Fabry's disease is a rare genetic disorder that leads to excessive deposition of neutral glycosphingolipids in the vascular endothelium of several organs and in epithelial and smooth muscle cells. Which of the following is least likely to be associated with Fabry's disease?
Your Answer: Inherited in an autosomal dominant fashion
Explanation:Fabry disease (Angiokeratoma corporis diffusum) is an X-linked lysosomal disorder which occurs due to deficiency or absence of alpha-galactosidase A (?-GAL A) activity as a result of a genetic mutation in the GLA gene. As Fabry’s disease follows X-linked genetics it manifestis predominantly in men. Ongoing burning, tingling pain and discomfort, known as acroparesthesia, mainly affecting the hands and feet is the most debilitating symptom in childhood.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 4
Incorrect
-
An 81-year-old woman had fallen down in her house. She is now unable to walk. An x-ray was done on her left hip joint, which showed a fracture in the neck of the femur. Which nerve is most likely to be injured?
Your Answer: Femoral nerve
Correct Answer: Sciatic nerve
Explanation:Femoral neck fractures are common injuries that most often result from low-energy falls in the elderly; however, they also can occur in young patients as a result of high-energy mechanisms
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 5
Correct
-
What is the mechanism of action (MOA) of cisplatin?
Your Answer: Causes cross-linking in DNA
Explanation:Cisplatin is a cytotoxic agent that acts by causing cross-linking in DNA. Its adverse effects include ototoxicity, peripheral neuropathy, hypomagnesaemia, etc.
The causative cytotoxic agents acting through the other aforementioned MOAs are as follows:
1. Doxorubicin: Stabilizes DNA topoisomerase II complex and inhibits DNA and RNA synthesis.
2. Hydroxyurea (hydroxycarbamide): Inhibits ribonucleotide reductase, decreasing DNA synthesis.
3. Mercaptopurine (6-MP): Purine analogue that is activated by HGPRTase, decreasing purine synthesis.
4. Vincristine, vinblastine: Inhibits formation of microtubules.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 6
Incorrect
-
A 62-year-old obese female presented with dilated veins over the lateral aspect of her right ankle. Which of the following is most responsible for her presentation?
Your Answer: Long saphenous vein
Correct Answer: Short saphenous vein
Explanation:Varicose veins (venous insufficiency syndrome) are dilated, tortuous veins due to reverse venous flow. All the given veins can be affected from this condition. As the patient has varicose veins over lateral aspect of ankle, the short saphenous vein is affected. The great or long saphenous vein travels along the medial aspect of the ankle
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 7
Correct
-
A 28-year-old woman presents with painful genital ulceration. She reports that these attacks have been recurrent over the past 4 years. She has been treated previously with oral acyclovir but this has had little effect on the duration of her symptoms. Over the past year, she has noticed almost weekly attacks of mouth ulcers that heal slowly. Past medical history is significant for treatment of thrombophlebitis two years ago. Which of the following is the most likely diagnosis?
Your Answer: Behcet's syndrome
Explanation:Behçet disease is a rare vasculitic disorder that is characterized by a triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. The systemic manifestations can be variable. Ocular disease has the greatest morbidity, followed by vascular disease generally from active vasculitis. Cutaneous manifestations can occur in up 75% of patients with Behcet disease and can range from acneiform lesions, to nodules and erythema nodosum. GI manifestations can be severe. Differentiating Behçet disease from active inflammatory bowel disease can be clinically difficult. Herpes would have ideally responded to acyclovir. Sarcoidosis does not have genital and oral ulcerations.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 8
Correct
-
A 23-year-old student presented with swelling and tenderness near the Lister tubercle of the radius. Passive extension of thumb and index finger further increases the pain. X-ray was normal. What will be the next step in the management of this case?
Your Answer: Immobilization with a cast
Explanation:This patient most likely has distal intersection syndrome, which occurs in the proximal forearm due to the tenosynovitis of extensor pollicis longus muscle tendons.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 9
Incorrect
-
A 32 year-old active male presents with a three month history of pain in his feet and lower legs. He was previously diagnosed with diabetes at age 14 and treated with insulin. He admits to drinking 30 units of alcohol per week and is a current cannabis smoker. On examination, pain and temperature sensation in his feet are diminished, but joint position and vibratory sensation appear normal. What is the most likely diagnosis?
Your Answer: Alcoholic polyneuropathy
Correct Answer: Diabetic polyneuropathy
Explanation:The given history suggests a small fibre painful peripheral sensory neuropathy, the most common cause of which is diabetes. Joint position sense and vibratory sensation are carried through large fibres, and therefore are not currently affected. Sensory nerves are affected more often than motor, so reflexes usually remain in tact.
Vitamin B12 deficiency causes impairment of joint position and vibratory sensation.
Chronic inflammatory demyelinating polyneuropathy (CIPD) causes a large fibre peripheral neuropathy with areflexia.
In syringomyelia there is impaired pain and temperature noted in the upper limbs.
Finally, with alcoholic polyneuropathy, all fibre types are affected (sensory and motor loss). It is usually gradual with long term alcohol abuse and may be accompanied by a nutritional deficiency. In addition, pain is a more dominant feature.
-
This question is part of the following fields:
- Nervous System
-
-
Question 10
Incorrect
-
Of the following medications, which is available over the counter (OTC) to treat heavy blood loss during menstruation?
Your Answer: Non steroidal anti-inflammatory drugs (NSAIDS)
Correct Answer: Tranexamic acid
Explanation:Since March 2011, tranexamic acid has been available to buy from pharmacies to help treat heavy blood loss during menstruation. NSAIDs (such as ibuprofen and naproxen) are available to purchase over the counter, but these aid in the treatment of dysmenorrhea rather than menorrhagia. MIRENA, norethisterone, and COCP are not available to purchase over the counter to treat heavy blood loss (however COCP is available for contraceptive use).
-
This question is part of the following fields:
- Pharmacology
-
-
Question 11
Correct
-
A patient presented with complaints of difficulty in swallowing, diplopia on left lateral gaze and ptosis of his left eye. The investigation of choice would be?
Your Answer: Serum anti-acetylcholine receptor antibodies
Explanation:Myasthenia gravis clinically manifests with ptosis, diplopia and difficulty in swallowing. The initial investigation which is needed to confirm the diagnosis would be serum anti-acetylene receptor antibodies, after which other investigations like an EMG should be done.
-
This question is part of the following fields:
- Nervous System
-
-
Question 12
Incorrect
-
Which of the following drugs will most likely trigger an exacerbation of acute intermittent porphyria (AIP)?
Your Answer: Barbiturates
Correct Answer: Oral contraceptive pill
Explanation:Hormonal contraceptives all contain man-made oestrogen and progestin hormones in a limited amount. These hormones prevent pregnancy by inhibiting the body’s natural cyclical hormones to prevent pregnancy. Even though all of these drugs except Ibuprofen can cause AIP in a vulnerable woman. The most likely cause is the OCP.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 13
Correct
-
Barrett's oesophagus is well recognized as a complication of gastroesophageal reflux disease. What is the pathological change that occurs in the above condition?
Your Answer: Squamous to columnar epithelium
Explanation:Barrett’s oesophagus is characterised by the metaplastic replacement of the normal squamous epithelium of the lower oesophagus by columnar epithelium.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 14
Correct
-
A 24-year-old waiter applies for a job at a cafeteria. He gives a history of having had enteric fever 2 years ago. Which of the following investigations is most likely to indicate a chronic carrier status?
Your Answer: Culture of intestinal secretions
Explanation:The chronic asymptomatic carrier state is thought to be why there is continued appearance of the bacterium in human populations. As shedding of the organism is intermittent and sometimes at low levels, methods to detect it have been limited. The Salmonella typhi may be cultured from intestinal secretions, faeces or urine in chronic carriers and is recommended to confirm the diagnosis. Vi agglutination test can also be high in normal people in areas with typhoid endemic. Full blood count or blood culture would not be helpful to determine carrier status. Widal antigen test is unable to differentiate carriers from people with a hx of prior infection.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 15
Correct
-
Which of the following statements describe the mechanism of fibrates most accurately?
Your Answer: Increased lipoprotein lipase activity via PPAR-alpha
Explanation:The main mechanism of fibrate drugs is activation of gene transcription factors known as PPARs, particularly PPAR-?, which regulate the expression of genes that control lipoprotein metabolism. There are several consequences of PPAR-? activation, which reduce circulating LDL cholesterol and triglycerides and increase HDL cholesterol.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 16
Correct
-
A 45-year-old appears at the OPD with symptoms of persistent cough and purulent sputum. He is a chronic smoker and had measles in the past. Upon auscultation, inspiratory crepitation and finger clubbing are noted. What is the single most likely diagnosis?
Your Answer: Bronchiectasis
Explanation:A history of measles, whooping cough, or other severe lung infections like tuberculosis (TB) and pneumonia can lead to airway damage and possibly bronchiectasis.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 17
Correct
-
A 17-year-old boy was brought to clinic, as his parents were concerned regarding possible delayed puberty. He was otherwise well, played sports regularly and his academic performance was good. His height was 1.7m and weight was 70 kg. On examination, he had a small penis and testes, absent pubic hair, but no other abnormalities. Investigations revealed: Serum testosterone 4 nmol/L (9-35) Plasma follicle stimulating hormone (FSH) 1 U/L (1-7) Plasma luteinising hormone (LH) 1 U/L (1-10) Plasma prolactin 300 mU/L (<450) Plasma TSH 2 mU/L (0.5-5) Which one of the following is the most likely cause?
Your Answer: Kallman's syndrome
Explanation:Klinefelter’s syndrome: The low follicle-stimulating hormone (FSH) and luteinising hormone (LH), together with the low testosterone, suggests a hypogonadotropic hypogonadism. We know that there is no mental retardation, and we are told that physical examination is normal and sense of smell would usually not be tested. Consequently a diagnosis of Kallman’s is suggested. We are not told of a family history of growth delay, thus this is unlikely to be constitutional delay. The thyroid-stimulating hormone (TSH) is normal, making hypothyroidism unlikely and this together with the normal prolactin make hypopituitarism most unlikely.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 18
Correct
-
A 55-year-old lady who a known case of normal pressure hydrocephalus (NPH) presented with complaints of weakness in her lower limbs, urinary incontinence and progressively worsening confusion. Which of the following statements is true regarding NPH?
Your Answer: Is associated with gait disturbance
Explanation:Normal pressure hydrocephalus is a form of communicating hydrocephalus characterised by enlarged ventricles with normal opening pressure on lumbar puncture. For diagnostic purposes, a triad of urinary incontinence, gait abnormality and dementia is necessary. It is necessary to diagnose the condition early because it is reversible by placing a ventriculoperitoneal shunt. It is most common in patients aged more than 60 years.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 19
Correct
-
A 70-year-old thyroid cancer patient is admitted due to dyspnoea. Which investigation should be done to assess for possible compression of the upper airways?
Your Answer: Flow volume loop
Explanation:Flow-volume loop is an easy, non-invasive diagnostic tool that can be used even in severely-ill patients. It can provide information about the location of the obstruction and can differentiate between obstructive pulmonary disease and upper-airway obstruction. Therefore, it is recommended to obtain a flow-volume loop during the assessment of patients with upper airway obstruction.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 20
Correct
-
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.
-
This question is part of the following fields:
- Renal System
-
-
Question 21
Correct
-
A 60-year-old male patient with hypertension presented with acute onset retrosternal chest pain for 3 hours. On examination his pulse rate was 68 bpm, BP was 100/60 mmHg and JVP was seen 3mm from the sternal notch. Respiratory examination was normal. His ECG showed narrow QRS complexes, ST segment elevation of 2mm in leads II, III and aVF and a complete heart block. What is the most immediate treatment from the following answers?
Your Answer: Chewable aspirin 300 mg
Explanation:The diagnosis is inferior ST elevation myocardial infarction. As the right coronary artery supplies the SA and AV nodes and bundle of His, conduction abnormalities are more common with inferior MIs. The most immediate drug management is high dose Aspirin. Definite treatment is urgent cardiac revascularization.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 22
Incorrect
-
A 60-year-old lady has been admitted to the stroke ward following a sudden onset of dizziness and visual disturbances, which started yesterday morning. She initially thought she was just dehydrated, however, later realised she was unable to read her own shopping list. On the ward rounds, the consultant examines her and finds she is indeed unable to read. She is, however, able to write. When she writes a sentence it makes perfect sense, although she is again unable to read it out. She has no problems with her speech and is able to converse normally. She has no motor focal neurological deficit. The consultant asks you where the lesion is likely to be?
Your Answer: Right (non-dominant) parietal lobe
Correct Answer: Corpus callosum
Explanation:The patient presents with sudden onset of alexia (the inability to read) WITHOUT agraphia (inability to write) which is consistent with lesions of the corpus callosum where there is a disconnect syndrome and the patient’s language and visual centres are actually in tact, but are unable to communicate between hemispheres. In this case, the damage due to the stroke is most likely in the left visual cortex, leaving visual processing to the intact right hemisphere which unfortunately cannot communicate the information to the language centres (Broca and Wernicke’s) in the left hemisphere, hence the alexia. Alternatively, the speech and writing are unaffected as the language centres can still communicate with the primary motor cortex.
-
This question is part of the following fields:
- Nervous System
-
-
Question 23
Incorrect
-
A 5-month-old baby presents with symptoms of irritability, blood in the stools and vomiting. Examination reveals a rigid abdomen and drawing of knees upon palpation. Which is the most appropriate action you should take for this baby?
Your Answer: Abdominal x ray
Correct Answer: Refer to paediatric surgeons
Explanation:Intussusception is the most suggested case here based on the child’s symptoms. The urgent course of treatment is to bring the child to a paediatric surgical unit. If air reduction attempts fail, surgery will have to be done. Risk factors for intussusception include viral infection and intestinal lymphadenopathy.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 24
Correct
-
A 36-year-old man presents with severe pain in his right big toe which is erythematous and swollen. He recently had an appendicectomy. Personal history reveals that he consumes 30 units of alcohol per week. Choose the most likely diagnosis.
Your Answer: Gout
Explanation:Chronic alcoholism leads to increased levels of uric acid in the blood. Gout is caused by high levels of uric acid.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 25
Correct
-
A 30-year-old man has been unwell for the last 3 weeks and now developed a rash. Chickenpox is diagnosed.
What is the appropriate treatment?Your Answer: Acyclovir
Explanation:You may treat chickenpox with acyclovir if it is commenced within the first 24 hours of the rash’s appearance. Erythromycin, doxycycline, and ampicillin would not help because it’s a viral infection (Varicella) not a bacterial infection.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 26
Correct
-
A 70-year-old male patient presented with chronic congestive heart failure. Which of the following is the most important factor to consider when prescribing drugs for this patient?
Your Answer: Administration of a B-blocker reduces the time spent in hospital
Explanation:It is proven that spironolactone has survival benefits and loop diuretics only give symptomatic relief. Beta blockers are however, known to improve exercise tolerance, left ventricular function and reduce symptoms. They also reduce the mortality associated with heart failure. So administration of beta blockers will reduce the time spent in hospital by improving symptoms.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 27
Correct
-
A 50-year-old man presented with polyuria and orthostatic hypotension. Which of the following medications is the most likely to be associated with this condition?
Your Answer: Bendroflumethiazide
Explanation:Bendroflumethiazide is known to cause photosensitive rash as part of an allergic reaction during which the person might also have wheezing, chest tightness or dyspnoea. The rash typically occurs on the areas of body exposed to the sun, like the back, hands, arms and legs.
Comparatively, digoxin produces a rash that comprises of nearly the whole body.
Atenolol may also cause skin rash but that is not photosensitive.
Clopidogrel might produce an non-photosensitive urticarial rash.
Ezetimibe causes a severe allergic reaction but only rarely. This rash is also non-photosensitive and is in the form of blisters, associated with itching. -
This question is part of the following fields:
- Pharmacology
-
-
Question 28
Correct
-
A 17-year-old girl, known to suffer from asthma, was admitted with dyspnoea. Usually her best PEFR is 410 L/min. Which of the following would favour the diagnosis of a severe asthma attack?
Your Answer: PEFR 200 L/min
Explanation:According to the British Thoracic Society, the inability to complete sentences, a HR>110 bpm, a RR>25/min, a PEFR=33-50% of predicted value are all indications of acute severe asthma. Life-threatening asthma would present with hypotension, silent chest, bradycardia and hypoxia.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 29
Correct
-
A 40-year-old female is suffering from chronic cough. Which of the following additional symptoms will strongly indicate that she has asthma?
Your Answer: Symptoms in response to exercise
Explanation:An attack of asthma is characterized by severe dyspnoea accompanied by wheezing. During an attack, the person experiences breathing difficulty during inspiration and expiration, but might feel completely well between attacks. An attack can be triggered by factors like cold, dry air, tobacco smoke, pollen, pet dander, as well as stressful situations like exercise. Dizziness, voice disturbances, and coryzal illness are not features of asthma.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 30
Correct
-
A 23-year-old woman comes for the advice regarding contraceptives. Her mother passed away due to cervical cancer and she worries about cervical cancer. Which of the following is the most suitable contraceptive method for her?
Your Answer: Barrier method
Explanation:Cervical cancer results from genital infection with HPV. PV infections can be transmitted via nonsexual routes, but the result from sexual contact. So the best contraceptive method in relation to prevention of cervical cancer is the barrier method. But it will not prevent cervical cancer a 100%.
-
This question is part of the following fields:
- Women's Health
-
-
Question 31
Correct
-
Question 32
Correct
-
A 60-year-old male with a history of diabetes and hypertension presented with left sided arm and leg weakness and loss of vision in the left eye for a brief period. His symptoms improved within a few hours. Which of the following is the most appropriate investigation that can be done at this stage?
Your Answer: Doppler USG
Explanation:Amaurosis fugax (transient ipsilateral visual loss) and transient ischemic attacks (TIAs) are presentations of atherosclerotic disease of the carotid artery which can be identified by carotid duplex ultrasonography (US), with or without colour. This is the screening test of choice to evaluate for carotid stenosis.
-
This question is part of the following fields:
- Nervous System
-
-
Question 33
Correct
-
A study is developed to assess a new mandibular advancement device designed to reduce snoring. A 10 point scale was used to assess the severity of snoring before and after applying of the device by the respective partner. The number of the people involved in the study was 50. What test would you apply in this particular study?
Your Answer: Wilcoxon signed-rank test
Explanation:Steps required in performing the Wilcoxon signed rank test:
1 State the null hypothesis and, in particular, the hypothesized value for comparison
2 Rank all observations in increasing order of magnitude, ignoring their sign. Ignore any observations that are equal to the hypothesized value. If two observations have the same magnitude, regardless of sign, then they are given an average ranking
3 Allocate a sign (+ or -) to each observation according to whether it is greater or less than the hypothesized value (as in the sign test)
4 Calculate:
R+ = sum of all positive ranks
R- = sum of all negative ranks
R = smaller of R+ and R-
5 Calculate an appropriate P value What makes this test the most appropriate for this study is that the data is non-parametric, paired and comes from the same population. -
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 34
Correct
-
Which of the following is correct regarding lead poisoning?
Your Answer: Causes a peripheral neuropathy due to demyelination
Explanation:Lead can be absorbed through the skin and by inhalation. It is associated with iron deficiency and a microcytic anaemia. The most common gastrointestinal symptoms are abdominal colic and constipation.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 35
Correct
-
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.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 36
Correct
-
Which one of the following is not associated with non-alcoholic steatohepatitis?
Your Answer: Type 1 diabetes mellitus
Explanation:There are two types of Non-alcoholic fatty liver disease (NAFLD); simple fatty liver and non-alcoholic steatohepatitis (NASH). Simple fatty liver and NASH are two separate conditions.
Simple fatty liver, also called non-alcoholic fatty liver (NAFL), is a form of NAFLD in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not progress to cause liver damage or complications.
Non-alcoholic steatohepatitis (NASH)
NASH is a form of NAFLD in which you have hepatitis and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer. Type I diabetes is not associated with NASH (non-alcoholic steatohepatitis), but type II diabetes is. Hyperlipidaemia, obesity, sudden weight loss/starvation and jejunoileal bypass are all associated with NASH. This is the most common cause of liver disease in the developed world. -
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 37
Incorrect
-
An 18-year-old male was diagnosed with meningococcal meningitis, confirmed on lumbar puncture. After 6 months he presents in the infectious clinic with a second episode of meningitis. His past history is clear and he takes no regular medication. Which of the following is most probably deficient?
Your Answer: C4
Correct Answer: C5
Explanation:Pneumococcal meningitis is the most common and severe form of bacterial meningitis. Fatality rates are substantial, and long-term sequelae develop in about half of survivors. Disease outcome has been related to the severity of the proinflammatory response in the subarachnoid space. The complement system, which mediates key inflammatory processes, has been implicated as a modulator of pneumococcal meningitis disease severity in animal studies. C5 fragment levels in cerebrospinal fluid (CSF) of patients with bacterial meningitis correlated with several clinical indicators of poor prognosis.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 38
Correct
-
A 36 year-old accountant presents with a sudden onset of headache which progressed to him collapsing. Upon arrival in A&E, he has a heart rate of 76 bpm, blood pressure 220/140, and Glasgow Coma Score of 9 (E2, M5, V2). Which of the following should be done immediately?
Your Answer: Give high flow oxygen via a non-rebreather mask
Explanation:This man is likely suffering from a subarachnoid haemorrhage or intracerebral bleed. The priority is to prevent a secondary brain injury. Important first steps include ensuring a secure airway, normalizing cardiovascular function, and treating seizures. His airway is likely to be protected with a GCS of 9, although he may benefit from a nasal or oral airway, and close attention should be paid to his airway if going for a CT scan. He should receive high flow oxygen and his blood pressure should not be treated acutely, as i is often appropriate to compensate for a rise in intracranial pressure. Nimodipine should be given if a subarachnoid haemorrhage is proven. Attention should also be given to maintaining a normal blood sugar, as hyperglycaemia worsens outcomes.
-
This question is part of the following fields:
- Nervous System
-
-
Question 39
Correct
-
Following a head injury, a 22-year-old patient develops polyuria and polydipsia. He is suspected to have cranial diabetes insipidus so he undergoes a water deprivation test.
Which one of the following responses would most indicate a positive (abnormal) result?Your Answer: Failure to concentrate the urine during water deprivation, but achievement of urine osmolality of 720 mmol/kg following the administration of desmopressin
Explanation:The water deprivation test (i.e., the Miller-Moses test), is a semiquantitative test to ensure adequate dehydration and maximal stimulation of ADH for diagnosis. It is typically performed in patients with more chronic forms of Diabetes Insipidus (DI). The extent of deprivation is usually limited by the patient’s thirst or by any significant drop in blood pressure or related clinical manifestation of dehydration.
In healthy individuals, water deprivation leads to a urinary osmolality that is 2-4 times greater than plasma osmolality. Additionally, in normal, healthy subjects, administration of ADH produces an increase of less than 9% in urinary osmolality. The time required to achieve maximal urinary concentration ranges from 4-18 hours.
In central and nephrogenic DI, urinary osmolality will be less than 300 mOsm/kg after water deprivation. After the administration of ADH, the osmolality will rise to more than 750 mOsm/kg in central DI but will not rise at all in nephrogenic DI. In primary polydipsia, urinary osmolality will be above 750 mOsm/kg after water deprivation.
A urinary osmolality that is 300-750 mOsm/kg after water deprivation and remains below 750 mOsm/kg after administration of ADH may be seen in partial central DI, partial nephrogenic DI, and primary polydipsia. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 40
Correct
-
Which of the following is correct regarding toxoplasmosis?
Your Answer: Can present with fits in patients with AIDS
Explanation:T. gondii infection in immunocompetent people is usually asymptomatic. It can present as fits in patients with AIDs, who are immunosuppressed. Additionally, infection in the first trimester of pregnancy is very harmful. Congenital toxoplasmosis presents with intracranial calcifications, classically. It can also present with hydrocephalus, microcephaly, blindness, petechiae. Siramycin is the drug of choice to try to prevent vertical transmission from mother to baby. It is typically gotten from cat faeces or raw/undercooked meat, not raw eggs (raw eggs: think salmonella).
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 41
Correct
-
A west Indian man complains of limb and abdominal pain. He is also anaemic and has frequent infections, which precipitate these symptoms. On examination, his spleen is not palpable and he has a mild jaundice. What is your most probable diagnosis?
Your Answer: Sickle cell disease
Explanation:Sickle cell disease (SCD) and its variants are genetic disorders resulting from the presence of a mutated form of haemoglobin, haemoglobin S (HbS). This leads to a rigid, sickle-like shape of red blood cells under certain circumstances which can result in attacks of pain (sickle cell crisis), anaemia, swelling in the hands and feet, bacterial infections and stroke. Anaemia and jaundice happen due to insufficient healthy red blood cell capacity and increased breakdown of haem groups by the liver.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 42
Incorrect
-
A 8-year-old girl with suspected patent foramen ovale, presented with her parents for the confirmation of the diagnosis. Which of the following is the best investigation to confirm the diagnosis?
Your Answer: Bubble Echocardiography
Correct Answer: Transoesophageal Echocardiography
Explanation:A 3-dimensional transoesophageal echocardiography (3D TEE) provides direct visualization of the entire PFO anatomy and surrounding structures. It allows more accurate diagnosis.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 43
Correct
-
A 14-year-old girl came to the emergency room in a bizarre state with altered consciousness, presenting with symptoms of insomnia, logorrhoea, and anxiety, with incoherent discourse and amnesia of recent events. She has started calling herself The Queen, and is refusing to be her parents' daughter. What is the most likely diagnosis?
Your Answer: Ganser syndrome
Explanation:Ganser syndrome is a condition in which a person acts as if he is suffering from a specific psychological disorder in order to gain sympathy and relief.
-
This question is part of the following fields:
- Nervous System
-
-
Question 44
Correct
-
A 60-year-old man with a history of recent thyrotoxicosis underwent major surgery a week ago. He now presents with altered mental status, tachycardia, high-grade fever, vomiting and cardiac failure. A diagnosis of thyroid storm (crisis) is made.
What is the most important next step in management?Your Answer: Transfer the patient to ITU
Explanation:Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis.
Patients with thyroid storm should be treated in an ICU setting for close monitoring of vital signs and for access to invasive monitoring and inotropic support, if necessary.
– Supportive measures
If needed, immediately provide supplemental oxygen, ventilatory support, and intravenous fluids. Dextrose solutions are the preferred intravenous fluids to cope with continuously high metabolic demand.
– Correct electrolyte abnormalities.
– Treat cardiac arrhythmia, if necessary.
– Aggressively control hyperthermia by applying ice packs and cooling blankets and by administering acetaminophen (15 mg/kg orally or rectally every 4 hours).
– Antiadrenergic drugs.
– Thionamides: Correct the hyperthyroid state. Administer antithyroid medications to block further synthesis of thyroid hormones (THs).
High-dose propylthiouracil (PTU) or methimazole may be used for treatment of thyroid storm.
– Administer glucocorticoids to decrease peripheral conversion of T4 to T3. This may also be useful in preventing relative adrenal insufficiency due to hyperthyroidism and improving vasomotor symptoms.
– Bile acid sequestrants prevent reabsorption of free THs in the gut (released from conjugated TH metabolites secreted into bile through the enterohepatic circulation).
– Treat the underlying condition. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 45
Correct
-
A 30-year-old woman presents with amenorrhoea and galactorrhoea. She has normal visual fields. You are concerned that she may have a prolactinoma.
Investigations were done and the results are as shown below:
Hb 12.5 g/dl
WCC 4.9 x109/l
PLT 199 x109/l
Na+ 140 mmol/l
K+ 4.9 mmol/l
Creatinine 90 Ù‰mol/l
Prolactin 1150 mU/l
MRI shows a 7 mm pituitary microadenoma.
Which of the following hormones would you expect to be lower than normal?Your Answer: LH
Explanation:Prolactinomas, benign lesions that produce the hormone prolactin, are the most common hormone-secreting pituitary tumours.
Based on its size, a prolactinoma can be classified as a microprolactinoma (< 10 mm diameter) or a macroprolactinoma (>10 mm diameter). If the prolactinoma is large enough to compress the surrounding normal hormone-secreting pituitary cells, it may result in deficiencies of one or more hormones (e.g., thyroid-stimulating hormone [TSH], growth hormone [GH], adrenocorticotropic hormone). However, the patient has microadenoma so it is unlikely to cause compression manifestations.
Hyperprolactinemia inhibits GnRH secretion from the medial basal hypothalamus and LH release from the pituitary. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 46
Correct
-
Cocaine abuse has many serious side effects. Which of the following is not a notable side effect of chronic cocaine abuse?
Your Answer: Hyponatraemia
Explanation:Chronic cocaine abuse can produce many serious side effects such as erectile dysfunction, ejaculatory dysfunction, hypersomnia, anxiety, hallucinations etc.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 47
Correct
-
A 60-year-old male patient was admitted for further investigations, after complaining of symptoms of obstructive uropathy and lower back pain. His wife has noticed that he lost weight over the past two months. Which tumour marker would you expect to see elevated?
Your Answer: Prostate specific antigen (PSA)
Explanation:The symptoms suggest prostate cancer with possible bone metastasis, due to the lower back pain. PSA is used for screening for prostate cancer as well as other prostate pathologies. A high PSA level of more than 4 ng/ml will require investigation to exclude cancer, benign prostatic hypertrophy, prostatitis and perineal trauma.
-
This question is part of the following fields:
- Men's Health
-
-
Question 48
Correct
-
A 53-year-old female, longstanding case of rheumatoid arthritis comes for a review. Which of the following features are commonly associated with her condition?
Your Answer: Proximal interphalangeal joint involvement in the hands
Explanation:Rheumatoid arthritis is a polyarthritis that results in symmetrical pain and swelling of the affected joints (also at rest). It particularly affects the metacarpophalangeal joints (MCPJs) and proximal interphalangeal joints (PIPJs), not the distal interphalangeal joints (DIPs).
Ulcerative colitis and IBD are associated with seronegative arthritides, not RA. The condition can also cause various extra-articular manifestations such as ocular symptoms, rheumatoid nodules and pulmonary fibrosis. Scleritis, episcleritis and keratoconjunctivitis sicca are more common than uveitis. Early intervention with disease-modifying antirheumatic drugs (DMARDs) plays a decisive role in successful treatment. -
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 49
Incorrect
-
Which one of the following paraneoplastic features is less likely to be seen in patients with squamous cell lung cancer?
Your Answer: Hyperthyroidism
Correct Answer: Lambert-Eaton syndrome
Explanation:Lambert-Eaton myasthenic syndrome (LEMS) is a rare presynaptic disorder of neuromuscular transmission in which release of acetylcholine (ACh) is impaired, causing a unique set of clinical characteristics, which include proximal muscle weakness, depressed tendon reflexes, post-tetanic potentiation, and autonomic changes.
In 40% of patients with LEMS, cancer is present when the weakness begins or is found later. This is usually a small cell lung cancer (SCLC). However, LEMS has also been associated with non-SCLC, lymphosarcoma, malignant thymoma, or carcinoma of the breast, stomach, colon, prostate, bladder, kidney, or gallbladder.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 50
Correct
-
A 25-year-old gentleman presents to the hospital feeling unwell and breathless. History reveals that he has chronic renal failure, for which he receives haemodialysis three times per week. Since one week prior to consultation, he has been on vacation and has missed two dialysis sessions.
Examination reveals pulmonary oedema. His ECG shows no P waves, broad QRS complexes and peaked T waves.
What should you do?Your Answer: Give 10 ml of 10% calcium gluconate intravenously
Explanation:The patient is most likely complaining of the effects of hyperkalaemia, due to missing his dialysis sessions. Additionally, because the patient presents with a risk of cardiac arrest (based on pulmonary oedema and ECG findings), the best intervention is to give calcium gluconate that will address the hyperkalaemia as well as improve the cardiac condition.
-
This question is part of the following fields:
- Fluids & Electrolytes
-
-
Question 51
Incorrect
-
A 6-year-old boy arrives at the clinic seven hours after having injured his hand with a metal spike. Examination reveals a puncture wound 0.5 cm deep. His immunization schedule is uptodate. How will you manage this patient?
Your Answer: Tetanus Ig + tetanus vaccine + antibiotics
Correct Answer: Tetanus Ig + antibiotics
Explanation: -
This question is part of the following fields:
- Immune System
-
-
Question 52
Incorrect
-
An soccer player suddenly collapsed on the field and started coughing along with shortness of breath. The investigation of choice in this case would be?
Your Answer: CT pulmonary angiogram (CTPA)
Correct Answer: Chest x-ray
Explanation:Exercise induced asthma is characterised by sudden onset wheezing, cough and shortness of breath while performing hectic physical activity. The best investigation to perform is a chest X-ray.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 53
Correct
-
Which of the following is not a tumour suppressor gene?
Your Answer: myc
Explanation:Myc is a family of regulator genes and proto-oncogenes that code for transcription factors.
A tumor suppressor gene, or antioncogene, is a gene that protects a cell from one step on the path to cancer. When this gene mutates to cause a loss or reduction in its function, the cell can progress to cancer, usually in combination with other genetic changes. Tumor suppressor genes can be grouped into categories including caretaker genes, gatekeeper genes, and landscaper genes; the classification schemes are continually evolving.
Examples include:
Gene Associated cancers
p53 Common to many cancers, Li-Fraumeni syndrome
APC Colorectal cancer
BRCA1 Breast and ovarian cancer
BRCA2 Breast and ovarian cancer
NF1 Neurofibromatosis
Rb Retinoblastoma
WT1 Wilm’s tumour -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 54
Incorrect
-
A 14-year-old known asthmatic presents to the A&E department with difficulty breathing. She was seen by her regular doctor the day before with a sore throat which he diagnosed as tonsillitis and was prescribed oral Amoxicillin for 5 days.
Past medical history:
Ulcerative colitis diagnosed four years ago.
Current medications:
Inhaled salbutamol and beclomethasone
Mesalazine 400 mg TDS
She was observed to be alert and oriented but she had laboured breathing. Inspiratory wheeze was noted. She was pale, sweaty and cyanosed. Her temperature was 36.7ºC, pulse 121/minute and blood pressure 91/40 mmHg. The lungs were clear and the remainder of the examination was normal. She was given high-flow oxygen through a face mask but despite this her breathing became increasingly difficult.
Â
What is the most likely causative agent?
Your Answer: Peptostreptococcus
Correct Answer: Haemophilus influenzae
Explanation:Acute epiglottitis is a life-threatening disorder with serious implications to the anaesthesiologist because of the potential for laryngospasm and irrevocable loss of the airway. There is inflammatory oedema of the arytenoids, aryepiglottic folds and the epiglottis; therefore, supraglottitis may be used instead or preferred to the term acute epiglottitis.
Acute epiglottitis can occur at any age. The responsible organism used to be Hemophilus influenzae type B (Hib), but infection with group A b-haemolytic Streptococci has become more frequent after the widespread use of Hemophilus influenzae vaccination.
The typical presentation in epiglottitis includes acute occurrence of high fever, severe sore throat and difficulty in swallowing with the sitting up and leaning forward position in order to enhance airflow. There is usually drooling because of difficulty and pain on swallowing. Acute epiglottitis usually leads to generalized toxaemia. The most common differential diagnosis is croup and a foreign body in the airway. A late referral to an acute care setting with its serious consequences may result from difficulty in differentiation between acute epiglottitis and less urgent causes of a sore throat, shortness of breath and dysphagia.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 55
Correct
-
A 20-year-old woman presents with weakness and is found to have a serum potassium of 2.2 mmol/l and pH 7.1.
Â
Which of the following would be LEAST useful in differentiating between renal tubular acidosis Types 1 and 2?Your Answer: Osteomalacia
Explanation:Osteomalacia is a marked softening of the bones that can present in both type I and type II Renal Tubular Acidosis (RTA) and will thus not differentiate the two types in any case. The other measures will allow differentiation of the two types.
-
This question is part of the following fields:
- Renal System
-
-
Question 56
Correct
-
A 22 year-old university graduate presented with progressive unsteadiness during walking over the last year. She had been otherwise healthy apart from recent difficulty hearing her lecturer in classes. She took no prescription medication but had occasionally taken cocaine during her first year of college. She also admits to drinking up to 30 units of alcohol per week and smoked 10 cigarettes per day. Her parents were both well, but her father's sister had problems with walking before she died. Examination reveals normal tone and power throughout all four limbs. Reflexes were normal in the upper limbs but decreased at the knees and absent at the ankles. Coordination was normal in all four limbs but her gait was ataxic. Sensation in the upper limbs was normal but decreased vibratory sensation and proprioception was noted to the ankles bilaterally. What is the most likely diagnosis?
Your Answer: Friedreich's ataxia
Explanation:Friedreich’s ataxia is an autosomal recessive disorder that usually begins before the end of the teens. It has an estimated prevalence in Europe of 1 in 50,000 and life expectancy is around 40-50 years. Neurological features include a progressive ataxia, cerebellar dysarthria, lower limb areflexia, decreased vibratory sensation and proprioception, and pyramidal weakness. Pes cavus and scoliosis are also both seen. Cardiomyopathy occurs in over 70% of cases. Less common features include optic atrophic, diabetes mellitus, and deafness.
-
This question is part of the following fields:
- Nervous System
-
-
Question 57
Incorrect
-
A 30-year-old male came in with chills and dilated pupils, which were withdrawal signs and symptoms of a certain drug. Which of the following can cause above presentation?
Your Answer: Cocaine
Correct Answer: Heroine
Explanation:Both cocaine and heroine withdrawal cause dilated pupils. Heroine withdrawal causes chills.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 58
Correct
-
In which condition is the sniff test useful in diagnosis?
Your Answer: Phrenic nerve palsy
Explanation:The phrenic nerve provides the primary motor supply to the diaphragm, the major respiratory muscle.
Phrenic nerve paralysis is a rare cause of exertional dyspnoea that should be included in the differential diagnosis. Fluoroscopy is considered the most reliable way to document diaphragmatic paralysis. During fluoroscopy a patient is asked to sniff and there is a paradoxical rise of the paralysed hemidiaphragm. This is to confirm that the cause is due to paralysis rather than unilateral weakness. -
This question is part of the following fields:
- Respiratory System
-
-
Question 59
Incorrect
-
A 55-year-old male presented with a mass in his right groin. On examination there was a pulsatile mass just below the midpoint of the inguinal ligament. Which of the following is the most probable diagnosis?
Your Answer: Direct inguinal hernia
Correct Answer: Femoral hernia
Explanation:Midpoint of the inguinal ligament is halfway between the pubic tubercle and the anterior superior iliac spine (the two attachments of the inguinal ligament). The opening to the inguinal canal is located just above this point. The femoral artery is at the mid-inguinal point which is halfway between the pubic symphysis and the anterior superior iliac spine. As the mass is at the midpoint of the inguinal ligament, the most probable answer is a femoral hernia. A femoral aneurysm is also a possibility.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 60
Correct
-
A 74-year-old male has received his 3rd cycle of chemotherapy for malignant melanoma 3 days ago. He is presented with a productive cough with greenish sputum. Otherwise he feels well. On examination, he has scattered crepitations, more on the lower right part of the chest. He is afebrile. His labs are: Hb 12.5, TLC 0.9 *10^9 , Plt. 84*10^9. Pan culture was collected and sent. What is the most appropriate next step?
Your Answer: Broad spectrum antibiotic (intravenous)
Explanation:This is a case of hospital acquired infection in an immunocompromised patient. It should be treated vigorously. On the other hand, patients who receive chemotherapy usually have atrophic gastritis and malabsorption syndrome.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 61
Correct
-
β-blockers are used in the treatment of angina because they have which one of the following properties?
Your Answer: Decrease the heart rate and myocardial contractility
Explanation:The cardiovascular effects of β-adrenoceptor block result from reduction of the sympathetic drive which includes reduced heart rate (automaticity) and reduced myocardial contractility (rate of rise of pressure in the ventricle). This will lead to reduced cardiac output and an overall fall in oxygen consumption.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 62
Correct
-
A 65-year-old male was admitted for surgery 4 days ago. He suddenly became confused and aggressive. His attention span was reduced, and he became very restless. Which single option from the history best explains his condition?
Your Answer: Alcohol consumption
Explanation:Patient was dependent on alcohol. After 4 days of admission he developed signs of alcohol withdrawal.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 63
Correct
-
A 9-year-old girl complains of perioral blisters and a burning sensation of her face. Some of the blisters are crusted and some are weeping. What is the most likely diagnosis?
Your Answer: Impetigo
Explanation:Impetigo appears more commonly on the face than other exposed areas like the limbs. Its blisters are clustered and may have a fluid discharge.
-
This question is part of the following fields:
- The Skin
-
-
Question 64
Incorrect
-
A 54-year-old female presents with fatigue and xerostomia. Bloods tests reveal the following:
Hb 13.9 g/dl
WBC 6.1 *109/l
Platelets 246 *109/l
Bilirubin 33 µmol/l
ALP 292 u/l
ALT 47 u/l
What is the most likely diagnosis?Your Answer: Primary Sjogren's syndrome
Correct Answer: Primary biliary cirrhosis
Explanation:With a bilirubin of 33, automatically the diagnosis from the choices listed is primary biliary cirrhosis or autoimmune hepatitis, not SLE, mono, or Primary Sjogren’s Syndrome. With autoimmune hepatitis, however, you would not expect such a high bilirubin and would expect very high AST/ALT, which here is just mildly elevated. This makes primary biliary cirrhosis the most likely answer. The classic presentation is itching in a middle-aged woman. The dry mouth is likely due to Sicca Syndrome, which occurs in 70% of cases of PBC, but with these liver function tests, PBC is most the likely answer.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 65
Correct
-
A 41-year-old male was involved in a fight and received a stab wound in the left 4th intercostal space. He was transferred to ER immediately with a BP 80/40 and HR 125. On examination, his neck veins are dilated and his heart sounds are faint. His trachea is central. What is the SINGLE most likely diagnosis?
Your Answer: Cardiac tamponade
Explanation:The cardinal symptom of the cardiac tamponade is a shocked patient with tachycardia and congested neck veins.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 66
Correct
-
A 60-year-old male presented in the OPD with a severe pain in the chest, which radiated to the jaw and his left shoulder. What is your diagnosis?
Your Answer: MI
Explanation:Risk of myocardial infarction is high in patients with diabetes mellitus. High levels of sugar in the blood can damage the arteries and lead to an increased risk of atherosclerosis of the coronary arteries. This is why diabetic patients have an increased risk of Myocardial Infarction.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 67
Correct
-
A 55-year-old male presents with complaints suggestive of erectile dysfunction. He also provides a history of ischaemic heart disease for which he is under treatment. The GP decides to start him on sildenafil citrate. Which of the following medications may contraindicate the use of sildenafil in this patient?
Your Answer: Nicorandil
Explanation:The use of nitrates and nicorandil concomitantly with sildenafil citrate is contraindicated.
Sildenafil (Viagra) is a phosphodiesterase type V inhibitor used in the treatment of impotence.
Contraindications
– Patients taking nitrates and related drugs such as nicorandil
– Hypotension
– Recent stroke or myocardial infarction (NICE recommend waiting 6 months)Side-effects:
Visual disturbances e.g. cyanopsia, non-arthritic anterior ischaemic Neuropathy
Nasal congestion
Flushing
Gastrointestinal side-effects
Headache -
This question is part of the following fields:
- Pharmacology
-
-
Question 68
Correct
-
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.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 69
Correct
-
A 16-year-old patient was admitted with walking difficulties and knee pain. Upon examination, his leg is externally rotated and is 2 cm shorter. His ability to flex, abduct and medially rotate his leg is limited and when he flexes his hip, external rotation is increased. What is the most probable diagnosis?
Your Answer: Slipped femoral epiphysis
Explanation:The clinical presentation is typical of a slipped femoral epiphysis, which refers to a fracture through the growth plate (physis), resulting in slippage of the overlying end of the femur. It is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. The range of motion in the hip is restricted in internal (medial) rotation, abduction, and flexion.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 70
Incorrect
-
A 34 year male is brought to the emergency by the paramedics who found him unconscious after being hit by a car. However, he regained consciousness and began talking. While waiting for the doctor's review, he suddenly becomes comatose and the condition deteriorates. What will be the most likely diagnosis?
Your Answer: SAH
Correct Answer: Extradural haemorrhage
Explanation:Extradural haemorrhage occurs as a result of head trauma and subsequent acute haemorrhage, primarily from the middle meningeal artery between the skull and the dura mater. Typical symptoms are due to compression of the brain and appear after a lucid interval that follows an initial loss of consciousness. Increased intracranial pressure leads to a decline in mental status and anisocoria, in which the ipsilateral pupil is dilated. Diagnosis is confirmed by CT (biconvex, hyperdense, sharply demarcated mass). Emergency treatment is necessary and involves neurosurgical opening of the skull and hematoma evacuation.
-
This question is part of the following fields:
- Nervous System
-
SESSION STATS - PERFORMANCE PER SPECIALTY
