-
Question 1
Incorrect
-
A 11-year-old is referred to neurology due to episodes her GP feels are epileptiform. Her mother reports that she appears to just 'stop', sometimes even in mid conversation, for several seconds at random times during the day. During these episodes, she can be unresponsive to questioning and has no recollection of them.
Which of these drugs is contraindicated in this condition?Your Answer: Clonazepam
Correct Answer: Carbamazepine
Explanation:The patient’s history points to absence seizures. Carbamazepine has been shown to aggravate generalized seizure types, especially absence seizures, because it acts directly on the ventrobasal complex of the thalamus which is critical to the neurophysiology of absence seizures.
-
This question is part of the following fields:
- Nervous System
-
-
Question 2
Incorrect
-
A 35-year-old soldier presented with a painless, erythematous crusted plaque over the dorsum of his hand, after serving in a hilly area of Columbia for 2 months. The most likely diagnosis will be?
Your Answer: Trypanosomiasis
Correct Answer: Leishmaniasis
Explanation:The chief presentation in Leishmaniasis is a non healing, ulcerated, painless and non pruritic plaque, which does not respond to oral antibiotics. It can be classified into cutaneous and visceral forms and is caused by the sand fly. It is more prevalent in the hilly areas. Fusobacterium causes a tropical ulcer which is painful and shallow, while Troanasomiasis causes sleeping sickness.
-
This question is part of the following fields:
- The Skin
-
-
Question 3
Incorrect
-
A 22-year-old male presents with loose stools and abdominal pain that is vague in nature. He previously had an episode of lower abdominal pain that was associated with pyrexia which settled on its own. He has also experienced mild weight loss recently. On examination, he is pale and has an ill defined mass in the right iliac fossa. What is the most likely diagnosis?
Your Answer: Appendicular mass
Correct Answer: Crohn's disease
Explanation:Crohn’s Disease (CD) is an inflammatory bowel disease, the pathogenesis of which is not fully understood. The clinical presentation of CD may be similar to ulcerative colitis (UC), the other most common inflammatory bowel disease. CD mostly affects young adults and adolescents between the ages of 15 and 35. It is typically located in the terminal ileum, but can discontinuously affect the entire gastrointestinal tract and commonly leads to complications such as fistulas, abscesses, and stenosis. Clinical features include diarrhoea, weight loss, and abdominal pain in the right lower quadrant (RLQ), as well as extraintestinal manifestations in the eyes, joints, or skin. It is often difficult to diagnose because there is no confirmatory test. Diagnosis is therefore based on the patient’s medical history, physical examination, lab tests, imaging (e.g., MRI), endoscopy, and serological testing. Acute episodes are treated with corticosteroids, and in severe cases, immunosuppressants may be indicated. Antibiotics and surgical intervention may be needed to help treat complications. Because the entire gastrointestinal tract may be affected, Crohn disease cannot be cured (in contrast to ulcerative colitis). The goal of treatment is thus to avoid the progression and recurrence of inflammatory episodes.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 4
Correct
-
A 28-year-old male is involved in a motorcycle accident. He sustained a direct blow to his lower chest. His blood pressure is 83/48, HR 113 bpm. On examination, there are multiple bruises on the chest with bowel sounds heard on auscultation of his chest. The single most likely diagnosis is?
Your Answer: Diaphragmatic rupture
Explanation:Ruptured diaphragm is a serious condition that is very difficult to diagnose and requires rapid intervention. The presence of bowel sounds on chest auscultation is highly suggestive of this.
Ruptured oesophagus is excluded by the absence of haematemesis and normal intestinal sounds.
Fractured ribs could be life threatening if associated with a tension pneumothorax which is excluded by a normal chest auscultation.
Flail chest is characterised by paradoxical breathing and respiratory failure. -
This question is part of the following fields:
- Respiratory System
-
-
Question 5
Incorrect
-
A 20-year-old male, who was otherwise completely healthy, has developed severe and sudden pain in his lower back. It started after getting up from his bed. What is the most probable diagnosis in this case?
Your Answer: AS
Correct Answer: PID
Explanation:Sudden onset of severe lower back pain whilst is felt more when bending (such as getting up from a bed) is consistent with a diagnosis of a prolapsed intervertebral disc.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 6
Incorrect
-
A 62-year-old lady is referred with painless jaundice and weight loss. Bilirubin is 214 mmol/L, alanine transaminase (ALT) 62 U/L, alkaline phosphatase (ALP) 605 U/L, albumin 34 g/L and prothrombin time 17 seconds. Ultrasound of the abdomen shows a grossly dilated biliary tree and a dilated pancreatic duct, but no mass is seen.
What is the next most appropriate step in her management?Your Answer: Endoscopic retrograde cholangiopancreatography (ERCP)
Correct Answer: Abdominal CT scan
Explanation:This scenario is suggestive of a pancreatic head mass with obstructive jaundice and US showing a ‘double duct’ sign. A CT Scan would be recommended to evaluate for a pancreatic head mass. If a mass was found, the next step would then be to do an ERCP with EUS to obtain a biopsy of the mass for tissue diagnosis. Laparoscopy would not be recommended. CA19-9 would not be diagnostic.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 7
Incorrect
-
A 23-year-old woman complains of numbness in her right hand that improves by shaking it. The surgeon has suggested a surgical option. Ligation of which of the following structures will improve the condition?
Your Answer: Common flexor sheath
Correct Answer: Flexor retinaculum
Explanation:The most likely cause is median nerve inflammation due to carpal tunnel syndrome. It is treated surgically with ablation of the flexor retinaculum.
-
This question is part of the following fields:
- Nervous System
-
-
Question 8
Incorrect
-
Which is the most likely lymph node involved in the presence of an ulcer on the scrotum?
Your Answer: External iliac lymph node
Correct Answer: Inguinal lymph node
Explanation:Inguinal LN’s drain the skin and subcutaneous tissue of the lower abdominal wall, perineum, buttocks, external genitalia, and lower limbs. They are subdivided into three groups of lymph nodes (nodi lymphoid):
– inferior group of superficial inguinal lymph nodes, located inferior to the saphenous opening, receiving drainage of the lower limb;
– superolateral superficial inguinal lymph nodes located lateral to the saphenous opening, receiving drainage of lateral buttock and lower anterior abdominal wall; and
– superomedial superficial inguinal lymph nodes, located medial to the saphenous opening, receiving drainage of the perineum and external genitalia. -
This question is part of the following fields:
- Men's Health
-
-
Question 9
Incorrect
-
A 72-year-old female, known with rheumatoid arthritis for last 17 years, presents with recurrent attacks of red eyes with a sensation of grittiness. Which of the following is most likely cause of the red eyes?
Your Answer: episcleritis
Correct Answer: keratoconjunctivitis sicca
Explanation:Rheumatoid arthritis is an inflammatory systemic disease associated with some extraarticular manifestations. Keratoconjunctivitis sicca, episcleritis, scleritis, corneal changes, and retinal vasculitis are the most common ocular complications among extraarticular manifestations of RA. The overall prevalence of keratoconjunctivitis sicca also known as dry eye syndrome among patients of RA is 21.2% and is the most common with sense of grittiness in the eyes.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 10
Correct
-
A 28-year-old male was admitted with severe central abdominal pain managed as an acute pancreatitis due to his serum amylase being markedly elevated. He is a known epileptic patient and has been on anti-epileptics. What would be the antiepileptic drug responsible for this clinical presentation?
Your Answer: Sodium valproate/Carbamazepine
Explanation:Both Sodium valproate and Carbamazepine are correct. These drugs can cause drug induced pancreatitis however more cases have been reported with Sodium valproate.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 11
Correct
-
The family of a 10-year-old boy was advised to take the boy to see an oncologist, for suspected lymphoma. The boy had lymphadenopathy on presentation. His mother says that he's had a fever, night sweats and has experienced weight loss. The boy underwent a lymph node biopsy at the oncologist which suggests Burkitt's lymphoma. Which oncogene are you expecting to see after molecular testing?
Your Answer: c-MYC
Explanation:Burkitt lymphoma is a germinal centre B-cell-derived cancer that was instrumental in the identification of MYC as an important human oncogene more than three decades ago. Recently, new genomics technologies have uncovered several additional oncogenic mechanisms that cooperate with MYC to create this highly aggressive cancer.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 12
Incorrect
-
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 glucose tolerance
Correct 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
-
-
Question 13
Correct
-
A 56-year-old female patient is complaining of a swollen upper limb after an insect bite. Although the bite site looks better, the gross oedema is still present. What is the most likely aetiology? Keep in mind that she has a history of breast cancer and radical mastectomy with axillary lymphadenectomy 10 years ago.
Your Answer: Lymphedema
Explanation:Lymphedema is most commonly the result of removal or damage to lymph nodes.
-
This question is part of the following fields:
- The Skin
-
-
Question 14
Incorrect
-
Which of the following signs is least suggestive of cervical myelopathy?
Your Answer: Loss of vibration sense in the hands
Correct Answer: Bladder disturbance
Explanation:Cervical myelopathy is mostly caused by spondylosis of C5-C7. Sphincters are usually not involved. The lower limbs usually are hypertonic with weakness and up going planter reflex. Vibration and proprioception tend to be lost. Biceps jerk is inverted or even absent. Although cervical spondylosis is the most common cause, an intrinsic lesion might give a similar picture.
-
This question is part of the following fields:
- Nervous System
-
-
Question 15
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 16
Correct
-
A 36-year-old lady presented with increased bowel motions, palpitations, heat intolerance and loss of weight. She is also tachycardiac. The investigation of choice in this case would be?
Your Answer: Thyroid function test
Explanation:Hyperthyroidism is characterised by heat intolerance, loss of weight, increased sweating, increased bowel frequency and tachycardia. On GPE, there might be proptosis of eyes and tremors in the hands.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 17
Correct
-
A 17-year-old Caucasian woman presents with lethargy and chronic nausea. Her mother is worried she may be depressed.
On examination, there are signs of chronic liver disease and a gold-yellow ring at the periphery of the iris in both eyes. Her serum copper level is low.
What is the most likely diagnosis?Your Answer: Wilson's disease
Explanation:This patient has Wilson’s disease. They Kayser-Fleischer ring (ring that encircles the iris) is diagnostic of this. Low serum copper is seen in Wilson’s disease. With the Kayser-Fleischer ring, this makes all of the other answer choices incorrect.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 18
Incorrect
-
A 55-year-old woman diagnosed with type 2 diabetes presents with vomiting and diarrhoea after eating a meal of chicken and chips. She said her stool had small amounts of blood in. Campylobacter Jejuni was found on her stool culture exam. Which of the following is the most appropriate therapy?
Your Answer: Amoxicillin
Correct Answer: IV fluids
Explanation:Campylobacter is the most likely cause of diarrheal illness often due to undercooked meat being ingested. It is also a major cause of traveller’s diarrhoea. Sufficient fluid replacement and anti-emetics are indicated first followed by the antibiotic, Erythromycin although antibiotic treatment in adults is still in question. Ciprofloxacin and Tetracycline may also be effective.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 19
Incorrect
-
A 15-year-old girl presents with vomiting and her investigations show:
Sodium 115 mmol/L (137-144)
Potassium 3.0 mmol/L (3.5-4.9)
Urea 2.1 mmol/L (2.5-7.5)
Urine sodium 2 mmol/L
Urine osmolality 750 mosmol/kg (350-1000)
What is the most likely diagnosis?Your Answer: Syndrome of inappropriate antidiuretic hormone secretion
Correct Answer: Bulimia nervosa
Explanation:The patient is most likely to have Bulimia nervosa. A young girl with a low body mass contributes to the low urea. Hypokalaemia and hyponatraemia are due to vomiting. Her urine sodium is also low.
– In Addison’s diseases, there are low levels of sodium and high levels of potassium in the blood. In acute adrenal crisis: The most consistent finding is elevated blood urea nitrogen (BUN) and creatinine. Urinary and sweat sodium also may be elevated.
– In Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) there is hyponatremia with corresponding hypo-osmolality, continued renal excretion of sodium, urine less than maximally dilute and absence of clinical evidence of volume depletion. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 20
Correct
-
A 53-year-old man is brought into the emergency department by the paramedics. He collapsed at home suffering from a myocardial infarction and was subsequently resuscitated following a cardiac arrest. Blood tests show impaired liver function (ALT 1400 u/l). He is on a statin, and at his appointment last week his LFT was normal. There is nothing to note on examination and he is currently not complaining of any pain.
Given this man's presentation, what is the most likely cause of his impaired liver function tests?Your Answer: Ischaemic hepatitis
Explanation:When you have abnormal liver function tests after a cardiac arrest, the most likely aetiology, barring history that is known or given excluding this diagnosis, would be ischemia. Chronic alcohol abuse would not see an acute elevation like this. Hepatitis B is just unlikely given the clinical picture, ischemia is much more likely. The same is for Budd-Chiari syndrome (venous thrombosis) and Wilson’s disease.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 21
Incorrect
-
A 18-year-old male was screened for hypertrophic cardiomyopathy (HOCM) as his brother had the same condition. What is the echocardiographic finding that is related to the highest risk of sudden cardiac death?
Your Answer: A gradient of 10 mmHg across the left ventricular outflow tract
Correct Answer: Significant thickening of the interventricular septum
Explanation:There are five prognostic factors which indicate poor prognosis in HOCM:
-family history of HOCM-related sudden cardiac death
-unexplained recent syncope
-large left ventricular wall thickness (MLVWT > 30 mm)
-multiple bursts of nsVT on ambulatory electrocardiography
-hypotensive or attenuated blood pressure response to exercise -
This question is part of the following fields:
- Cardiovascular System
-
-
Question 22
Correct
-
A 60-year-old male has been taken to the doctor with dysphagia and pain when swallowing. A barium meal shows he has gross dilation of the oesophagus, with a smooth narrowing at the lower end. Choose the single most likely cause of his symptoms.
Your Answer: Achalasia
Explanation:Finding it difficult to swallow both food and drink with a narrow oesophagus is consistent with a diagnosis of achalasia.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 23
Correct
-
A 48-year-old artist presented with tremors. Which of the following is more suggestive of parkinsonism than an essential tremor?
Your Answer: Unilaterality
Explanation:Essential tremors are usually symmetrical and generalized. It often affects the head and the voice of the patient. Usually it is first noticed by first degree relatives. It is improved by benzodiazepines and beta blockers. On the other hand, Parkinsonism tends to develop in older patients. It is characterised by bradykinesia and rigidity. It improves by L-dopa and dopamine agonists. A simple test is to ask the patient to write a short sentence. Parkinsonism shows micrographiam whilst essential tremors will have tremulous writing.
-
This question is part of the following fields:
- Nervous System
-
-
Question 24
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 25
Incorrect
-
A 52-year-old gentleman known with rheumatoid arthritis presented with a 5 day history of red, painful swollen knee joint. He was afebrile and the joint was warm on touch. Hamstring muscles were spastic. Which of the following tests should be done next?
Your Answer: Joint aspiration for negatively birefringent crystals
Correct Answer: Joint aspiration for cytology and culture and sensitivity
Explanation:Rheumatoid arthritis can affect any joint of the body. Aspirate will reveal increased TLC, and it will be sterile.
-
This question is part of the following fields:
- Immune System
-
-
Question 26
Incorrect
-
A 60 year-old patient known with stable angina was advised to have a contrast coronary angiography. Before the procedure, what will be the most appropriate step to take?
Your Answer: Buccal Nitrates
Correct Answer: IV 0.9% Saline
Explanation:Contrast material poses a greater threat for contrast induced nephropathy. In order to decrease the chance of contrast nephropathy, IV 0.9% saline is considered as the best fluid to maintain blood pressure. Normal Saline helps to expand intravascular volume and decrease the renin angiotensin system activity.
-
This question is part of the following fields:
- Renal System
-
-
Question 27
Correct
-
A 74-year-old man presents with 12 kg weight loss and persistent back pain that is unrelated to activity for the past several months. Laboratory findings show :
WCC: 6.7 x 109/l (5.4 neutrophils, 1.2 lymphocytes and 0.2 monocytes)
Haemoglobin: 11.2 g/dl
haematocrit: 33.3%
MCV: 88 fl
Platelet count: 89 x 109/l.
The biochemistry shows:
sodium 144 mmol/l
potassium 4.5 mmol/l
chloride 100 mmol/l
bicarbonate 26 mmol/l
urea 14 mmol/l
creatinine 90 μmol/l
a glucose of 5.4 mmol/l.
A CT scan of the spine reveals scattered 0.4 to 1.2 cm bright lesions in the vertebral bodies.
Which of the following additional laboratory test findings is he most likely to have?Your Answer: Serum prostate specific antigen of 35 microgram/l
Explanation:Old age, persistent backache, weight loss, and osteosclerotic lesions make prostatic adenocarcinoma the most likely diagnosis. The sequelae include severe pain, pathological fractures, hypercalcemia and cord compression. Prostatic adenocarcinoma is detected by elevated levels of prostate specific antigen. Positive serology for borrelia burgdorferi would hint at Lyme disease which does not cause osteosclerotic bone lesions, neither would Neisseria gonorrhoeae have such a presentation.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 28
Correct
-
Of the following options, which is an absolute contraindication to β blockers?
Your Answer: Heart block
Explanation:The Joint British Societies’ 2005 guidelines list asthma and heart block as ‘compelling contraindications’ to β blockers – this is because complications can occur which can prove to be fatal. All of the other options listed may be exacerbated by β blockers, and so are only considered to be ‘relative’ contraindications.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 29
Correct
-
A 45-year-old woman is HIV positive. She is very concerned that she is at increased risk of cancer. Which one of the following cancers is NOT increased in HIV positive people?
Your Answer: Breast cancer
Explanation:Breast cancer has a lower incidence in HIV positive patients. Seminoma, Hodgkin’s disease, anal cancer, and non-small cell lung cancer are all increased incidence. Memorize this breast cancer fact.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 30
Incorrect
-
A 60-year-old woman presents to the oncology clinic with a general feeling of being unwell and temperature of 38.1°C. She is a known case of neuroendocrine cancer of the cervix, treated with carboplatin and etoposide. Her last treatment was eight days ago.
Blood cultures are taken and she is started on neutropenic sepsis protocol.
What will gram-staining of the blood cultures most likely show?Your Answer: Gram-negative rods
Correct Answer: Gram-positive cocci
Explanation: -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 31
Correct
-
A 60-year-old diabetic female patient presented with spasmodic pain in her left thigh and calf muscle. During examination the doctor noticed that the femoral and popliteal pulses were absent on the left side. Which of the following vessels is most probably occluded?
Your Answer: External Iliac Artery
Explanation:The external iliac artery supplies both the thigh and calf muscles. The absence of pulses in femoral and popliteal vessels indicates the obstruction of the external iliac artery.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 32
Incorrect
-
A 13-year-old girl is brought by her mother to the A&E with breathlessness, fatigue and palpitations. Anamnesis does not reveal any syncope or chest pain in the past. on the other hand, these symptoms were present intermittently for a year. Clinical examination reveals a pan-systolic murmur associated with giant V waves in the jugular venous pulse. Chest auscultation and resting ECG are normal. 24 hour ECG tape shows a short burst of supraventricular tachycardia. What is the most probable diagnosis?
Your Answer: Pulmonary stenosis
Correct Answer: Ebstein's anomaly
Explanation:Ebstein’s anomaly is characterised by apical displacement and adherence of the septal and posterior leaflets of the tricuspid valve to the underlying myocardium, thereby displacing the functional tricuspid orifice apically and dividing the right ventricle into two portions. The main haemodynamic abnormality leading to symptoms is tricuspid valve incompetence. The clinical spectrum is broad; patients may be asymptomatic or experience right-sided heart failure, cyanosis, arrhythmias and sudden cardiac death (SCD). Many Ebstein’s anomaly patients have an interatrial communication (secundum atrial septal defect (ASD II) or patent foramen ovale). Other structural anomalies may also be present, including a bicuspid aortic valve (BAV), ventricular septal defect (VSD), and pulmonary stenosis. The morphology of the tricuspid valve in Ebstein anomaly, and consequently the clinical presentation, is highly variable. The tricuspid valve leaflets demonstrate variable degrees of failed delamination (separation of the valve tissue from the myocardium) with fibrous attachments to the right ventricular endocardium.
The displacement of annular attachments of septal and posterior (inferior) leaflets into the right ventricle toward the apex and right ventricular outflow tract is the hallmark finding of Ebstein anomaly. -
This question is part of the following fields:
- Cardiovascular System
-
-
Question 33
Correct
-
A 51-year-old man speaks fast and does not take enough breaths before speaking again. He ignores interruptions and does not want to pause in between. What best describes this kind of speech?
Your Answer: Pressure of speech
Explanation:A pressured speech is too fast for the listener to understand and is very difficult to interrupt.
-
This question is part of the following fields:
- Nervous System
-
-
Question 34
Correct
-
A 50-year-old woman is investigated for weight loss and anaemia. Clinical examination reveals splenomegaly associated with pale conjunctivae.
Her full blood count (FBC) report shows:
Hb: 10.9 g/dL
Plts: 702 x 10^9/L
WCC: 56.6 x 10^9/L
Moreover, all stages of granulocyte maturation are seen on her blood film.
Given the likely diagnosis, what should be the most appropriate treatment?Your Answer: Imatinib
Explanation:This patient is a case of chronic myeloid leukaemia (CML) and should be started on imatinib as the first-line drug of choice.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 35
Correct
-
A 35-year-old female had an oral glucose tolerance test. Her oral glucose test after 2 hrs was 10mml/l. What is the result of her test?
Your Answer: Impaired glucose tolerance
Explanation:Impaired glucose tolerance is a pre-diabetic state of hyperglycaemia that is associated with insulin resistance and increased risk of cardiovascular pathology. To diagnose impaired glucose tolerance, the OGTT value after 2 hrs should be 140-199mg/dl (7.7 – 11.0 mmol/l). Impaired fasting glucose is diagnosed as fasting blood sugar between 100 mg/dl to 125 mg/dl.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 36
Incorrect
-
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: Nifedipine
Correct 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 37
Correct
-
You are asked to fill the first part of a cremation form. Which of the following would need to be removed prior to cremation?
Your Answer: Pacemaker
Explanation:Pacemakers have small electrical parts installed in them that can explode when exposed to extreme heat and pressure.
-
This question is part of the following fields:
- Ethical & Legal
-
-
Question 38
Correct
-
A 30-year-old male with Down's Syndrome was found to have a systolic murmur during routine clinical examination. Which of the following is the most common cardiac defect associated with Down's Syndrome which will explain this finding?
Your Answer: Endocardial cushion defect
Explanation:Atrioventricular septal defect (AVSD) also known as endocardial cushion defect is the most common cardiac abnormality in Down’s Syndrome.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 39
Correct
-
In which part of the body is conjugated bilirubin metabolised to urobilinogen?
Your Answer: Large intestine
Explanation:Urobiligen is produced by the action of bacteria on bilirubin in the intestine. As a reminder, unconjugated bilirubin becomes conjugated in the hepatocyte. Conjugated bilirubin goes through enterohepatic circulation. About half of the urobiligen is reabsorbed and excreted by the kidneys in the urine. The rest is converted to stercobilinogen –> stercobilin, which is excreted in stool, giving it its brown colour.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 40
Incorrect
-
A 28-year-old manual worker had stepped on a rusty nail. He says he received tetanus toxoid 8 years ago. What should be done for him now?
Your Answer: Human immunoglobulin and tetanus toxoid
Correct Answer: Human immunoglobulin only
Explanation:Only immunoglobulins are required, as he is already immunized.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 41
Correct
-
A 69-year-old diabetic female presents for a regular outpatient visit. Her BMI is calculated to be 33. Lab results: GFR=29, Urea=13, Creatinine=390 mmol/L. Which of the following drugs should ideally be used by this patient?
Your Answer: Insulin
Explanation:The management of patients with diabetes and nephropathy necessitates attention to several aspects of care. Importantly, glycaemic control should be optimized for the patient, attaining the necessary control to reduce complications but done in a safe, monitored manner. Screening for development of nephropathy should be performed on a regular basis to identify microalbuminuria or reductions in GFR and if identified, the diabetes regimen should be tailored accordingly. Prevention and treatment of diabetic nephropathy and other complications necessitates a multifactorial approach. From the options provided insulin is the most suitable as sulfonylureas and biguanides are contraindicated in renal failure. Glitazones are known to cause many side effects including fluid retention and oedema. Hence, insulin will be the best option in this scenario.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 42
Correct
-
A 16-year-old boy suffers recurrent episodes of haematuria following a flu-like illness. He is otherwise well. Physical examination is normal. Urinalysis reveals no proteinuria, blood ++, and 2-3 white blood cells/mm3.
Â
What is the most probable diagnosis?Your Answer: IgA nephropathy
Explanation:IgA nephropathy’s characteristic presentation is haematuria following a non-specific upper respiratory infection as was evident in this case. IgA nephropathy also usually occurs in children and young males, like this patient.
-
This question is part of the following fields:
- Renal System
-
-
Question 43
Correct
-
Of the following medications, which is available over the counter (OTC) to treat heavy blood loss during menstruation?
Your 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 44
Incorrect
-
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: Associated dizziness
Correct 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 45
Incorrect
-
An 8-year-old girl was bought immediately to the emergency department. She is fully conscious but has stridor, is wheezing and has a generalised erythematous rash. She has known allergies. What is the single immediate management?
Your Answer: Give 0.5ml in 1000 adrenaline by IM injection
Correct Answer: Give 0.3ml in 1000 adrenaline by IM injection
Explanation:This is a case of an anaphylactic reaction that requires immediate intervention. IM adrenaline dose for 6-12 year old children is 300 micrograms IM.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 46
Incorrect
-
Which of the following features is characteristic of acute intermittent porphyria?
Your Answer: Autosomal recessive inheritance
Correct Answer: Increased urinary porphobilinogen between acute attacks
Explanation:Urinary porphobilinogen is increased between attacks of acute intermittent porphyria (AIP) and even more so, between acute attacks.
AIP is a rare autosomal dominant condition caused by a defect in porphobilinogen deaminase, an enzyme involved in the biosynthesis of haem. This results in the toxic accumulation of delta-aminolaevulinic acid and porphobilinogen.
Abdominal and neuropsychiatric symptoms are characteristic of AIP especially in people between the ages of 20-40 years. The disease is more common in females than in males (5:1). Major signs and symptoms of AIP include abdominal pain, vomiting, motor neuropathy, hypertension, tachycardia, and depression.
Diagnosis:
1. Urine turns deep red on standing (classical picture of AIP)
2. Raised urinary porphobilinogen (elevated between attacks and to a greater extent, between acute attacks)
3. Raised serum levels of delta-aminolaevulinic acid and porphobilinogen
4. Assay of red blood cells for porphobilinogen deaminase -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 47
Incorrect
-
A 25-year-old athlete presented with a 7-month history of difficulty gripping things. He complained of finding it particularly difficult in cold weather. He remembered his father having similar problems. Upon examination, he had a bilateral ptosis with weakness of the facial muscles. He also had difficulty opening his eyes quickly. Limb examination revealed distal weakness in both hands with difficulty opening and closing both hands quickly. Which of the following is the most likely diagnosis?
Your Answer: Myopathy, encephalopathy, lactic acidosis and stroke-like episodes
Correct Answer: Myotonic dystrophy
Explanation:Myotonic dystrophy is the most likely diagnosis here.
It is a multisystem disorder causing cognitive impairment, cataracts, cardiac problems and testicular atrophy, as well as affecting the muscles. Patients have muscle weakness, normally worse distally, and/or myotonia (which is worse in cold weather).
On examination, patients may also have frontal balding, a myopathic facies, bilateral ptosis, an ophthalmoplegia and wasting of facial muscles and other limb muscles. Myotonic dystrophy is associated with diabetes mellitus and pituitary dysfunction.
Diagnosis is normally based on clinical features with a characteristic electromyogram (EMG) of myotonic discharges. Creatine kinase is generally normal and muscle biopsy is non-specific. -
This question is part of the following fields:
- Nervous System
-
-
Question 48
Incorrect
-
Regarding bupropion (Zyban), all of the following statements are true except?
Your Answer: It is an amphetamine derivative
Correct Answer: It is associated with an idiosyncratic risk of seizure
Explanation:Bupropion (Zyban) is an amphetamine derivative which is used primarily as an anti depressant and for smoking cessation. It acts by increasing dopamine levels in the CNS. It has fewer withdrawal symptoms compared to other drugs. It is associated with dose associated risk of epileptic seizures in 1: 1000 patients and is contraindicated in a patient already suffering from epilepsy. Chief side effects include tremors, anxiety, insomnia, depression and a hypersensitivity urticarial rash. It inhibits the cytochrome p450 enzyme system in the liver and greater precaution is required when it is to be administered with other drugs like paroxetine, risperidone, beta blockers, propafenone and flecainide.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 49
Incorrect
-
A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling in her feet and hands. She has recently developed an ulcer on her left heel, after having burnt her foot in a hot bath. A number of depigmented areas are readily seen over her upper limbs.
She is currently taking low-dose prednisolone (7.5 mg daily), alendronic acid, lansoprazole, paracetamol, indomethacin, methotrexate and rituximab.
Her blood tests demonstrate:
Haemoglobin 9.9 g/l
MCV 102 fl
Platelets 410 x 109/l
White blood cells 12.3 x 109/l
Vitamin B12 97 pg/ml
Folate 12.3ng/ml
Random blood glucose 9.9 mmol/l
Thyroid-stimulating hormone 4.7 mU/ml
Thyroxine 12.8 pmol/l
Which autoantibody would be most diagnostic for the underlying disease?Your Answer: Antigastric parietal cell (PCA)
Correct Answer: Anti-intrinsic factor (IF)
Explanation:This clinical scenario describes pernicious anaemia. Anti-intrinsic factor (IF) antibodies are most specific for pernicious anaemia. Antigastric parietal cell antibodies have a higher sensitivity but are less specific for pernicious anaemia. The other antibodies listed are not related to pernicious anaemia. Anti-TTG is seen with Celiac’s disease, anti-TPO is seen with thyroid disease, GAD is seen with type I diabetes, but this does not explain her anaemia.
-
This question is part of the following fields:
- Immune System
-
-
Question 50
Incorrect
-
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:
Correct 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
-
SESSION STATS - PERFORMANCE PER SPECIALTY
