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Question 1
Correct
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A 62-year-old male patient with long standing COPD presented with reduced vision of his right eye. He had been on multiple medications. Which of the following drugs is responsible for his visual deterioration?
Your Answer: Corticosteroid
Explanation:Prolonged use of corticosteroids causes cataracts and this would be the reason for his presentation. B2 agonists, diuretics and Theophylline can cause blurred vision.
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This question is part of the following fields:
- Pharmacology
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Question 2
Incorrect
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A 72-year-old man presents with chronic back and right hip pain which has been increasingly affecting him over the past few months. He finds it very difficult to mobilise in the mornings. Clinical examination is unremarkable, apart from a limitation of right hip flexion due to pain. Investigations show: Haemoglobin:    12.1 g/dl (13.5-17.7) White cell count:  8.2 x 109/l (4-11) Platelets:         200 x 109/l (150-400) C reactive protein: 9 nmol/l (<10) ESR:             15 mm/hr (<20) Sodium:          140 mmol/l (135-146) Potassium:       3.9 mmol/l (3.5-5) Creatinine:       92 µmol/l (79-118) ALT:             12 U/l (5-40) Alkaline phos:    724 U/l (39-117) Calcium:         2.55 mmol/l (2.20-2.67) Which of the following is the most likely diagnosis?
Your Answer: Osteoporotic collapse lumbar spine
Correct Answer: Paget's disease
Explanation:Paget’s disease of bone is a chronic disease of the skeleton. In healthy bone, a process called remodeling removes old pieces of bone and replaces them with new, fresh bone. Paget’s disease causes this process to shift out of balance, resulting in new bone that is abnormally shaped, weak, and brittle. Paget’s disease most often affects older people, occurring in approximately 2 to 3% of the population over the age of 55.
Many patients with Paget’s disease have no symptoms at all and are unaware they have the disease until X-rays are taken for some other reason. When bone pain and other symptoms are present, they can be related to the disease itself or to complications that arise from the disease — such as arthritis, bone deformity, and fractures. In patients with Paget’s disease, alkaline phosphatase levels are usually quite elevated — a reflection of the high bone turnover rate.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 3
Correct
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An 82-year-old patient presents to the clinic complaining of palpitations. ECG reveals waves with saw-tooth pattern, QRS complex of 80ms duration, a ventricular rate of 150/min and a regular R-R interval. Which of the following is most likely responsible for these findings?
Your Answer: Atrial flutter
Explanation:Atrial flutter is a common supraventricular tachyarrhythmia that is usually caused by a single macroreentrant rhythm within the atria, associated with a sawtooth appearance on the ECG. In stable patients the treatment includes rate control and rhythm control, however in unstable patients, a synchronized cardioversion is required.
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This question is part of the following fields:
- Cardiovascular System
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Question 4
Incorrect
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A 57-year-old architect presents with weakness of the right hand. You note global wasting of the small hand muscles. There is also sensory loss over the medial border of the forearm around the elbow. Which of the following nerve roots is damaged?
Your Answer: C5
Correct Answer: T1
Explanation:This patient has Klumpke’s paralysis due to damage to the T1 nerve root. This root eventually supplies the median and ulnar nerves. The ulnar nerve supplies all of the intrinsic hand muscles except for those of the thenar eminence and the first and second lumbricals, which are innervated by the median nerve.
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This question is part of the following fields:
- Nervous System
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Question 5
Incorrect
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Which of the following is not a tumour suppressor gene?
Your Answer: Rb
Correct 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
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Question 6
Incorrect
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In diabetes, what is the most common finding on renal biopsy?
Your Answer: Mesangial proliferation
Correct Answer: Glomerulosclerosis
Explanation:Glomerulosclerosis is the scarring and hardening of the glomeruli known as diabetic glomerulosclerosis occurring in long-standing diabetes.
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This question is part of the following fields:
- Renal System
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Question 7
Incorrect
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A 35-year-old female, known case of antiphospholipid syndrome, arrives at the clinic due to a swollen and painful left leg. Doppler ultrasonography confirms the diagnosis of a deep vein thrombosis. She was previously diagnosed with DVT 4 months back and was on warfarin therapy (target INR 2-3) when it occurred. How should her anticoagulation be managed?
Your Answer: Life-long warfarin, target INR 2 - 3
Correct Answer: Life-long warfarin, increase target INR to 3 - 4
Explanation:If the INR in the range of 2-3 has still resulted in thrombosis, the target INR is increased to 3-4. However, because the risk of bleeding increases as the INR rises, the INR is closely monitored and adjustments are made as needed to maintain the INR within the target range.
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This question is part of the following fields:
- Musculoskeletal System
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Question 8
Correct
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Which of the following drugs does not cause broncho-dilatation?
Your Answer: Atenolol
Explanation:Atenolol is a beta-selective (cardio selective) adrenoceptor blocking drug without partial agonist or membrane stabilising activity. Higher doses of Atenolol causes broncho-constriction.
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This question is part of the following fields:
- Pharmacology
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Question 9
Correct
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In a study, 50 out of 100 smokers develop lung cancers and 50 out of 200 non-smokers develop lung cancers. Which of the following is accurate?
Your Answer: Relative risk=2
Explanation:Relative risk = (Incidence in exposed group)/incidence in unexposed group). So in this case RR = (50/100)/(50/200) = 2.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 10
Incorrect
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A man was admitted to the hospital and developed varicella zoster after 48h. Which of the following categories of people should be administered immunoglobulin only?
Your Answer: All staff in contact with the patient
Correct Answer: All pregnant women who are tested negative for antibodies.
Explanation:Immunoglobulin should be given to all seronegative women within 4 days. However, it is strongly advised to seek medical care immediately if the disease develops.
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This question is part of the following fields:
- Infectious Diseases
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Question 11
Incorrect
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A 28-year-old man is investigated for lethargy. His full blood count (FBC) report shows:
Hb: 8.6 g/dL
Plts: 42 x 10^9/L
WCC: 36.4 x 10^9/L
His blood film report reveals 30% myeloblasts with Auer rods. Given the likely diagnosis, which one of the following is associated with a good prognosis?Your Answer: Translocation between chromosome 9 and 14
Correct Answer: Translocation between chromosome 15 and 17
Explanation:A translocation between chromosome 15 and 17 is seen in acute promyelocytic leukaemia (APL), which is known to carry a good prognosis.
Acute myeloid leukaemia (AML) is the acute expansion of the myeloid stem line, which may occur as a primary disease or follow the secondary transformation of a myeloproliferative disorder. It is more common over the age of 45 and is characterized by signs and symptoms largely related to bone marrow failure such as anaemia (pallor, lethargy), frequent infections due to neutropenia (although the total leucocyte count may be very high), thrombocytopaenia (bleeding), ostealgia, and splenomegaly. The disease has poor prognosis if:
The disease has poor prognosis if:
1. Age of the patient >60 years
2. >20% blasts seen after the first course of chemotherapy
3. Chromosomal aberration with deletion of part of chromosome 5 or 7.APL is an aggressive form of AML. It is associated with t(15;17) and has a good prognosis. The general age of presentation is less than that in other types of AML (average age is 25 years old). On blood film, abundant Auer rods are seen with myeloperoxidase staining. Thrombocytopaenia or DIC is seen in patients presenting with this disease.
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This question is part of the following fields:
- Haematology & Oncology
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Question 12
Incorrect
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Which of the following is most consistent with small cell lung cancer?
Your Answer: syndrome of inappropriate antidiuretic hormone secretion (SIADH) is rarely seen
Correct Answer: hypertrophic pulmonary osteoarthropathy is rarely seen
Explanation:The clinical manifestations of Small cell lung cancer (SCLC) can result from local tumour growth, intrathoracic spread, distant spread, and/or paraneoplastic syndromes.
Hypertrophic pulmonary osteoarthropathy (HPO) is a rare paraneoplastic syndrome that is frequently associated with lung cancer; however, the incidence of clinically apparent HPO is not well known.
SIADH is present in 15% of cases and most commonly seen.
Although hypercalcaemia is frequently associated with malignancy, it is very rare in small cell lung cancer despite the high incidence of lytic bone metastases.
Ectopic Cushing’s syndrome in SCLC does not usually exhibit the classic signs of Cushing’s syndrome and Cushing’s syndrome could also appear during effective chemotherapy.
Chemotherapy is the treatment of choice in SCLC. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 13
Correct
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A 38-year-old male presented with multiple bruises and fractured pelvis after a road traffic accident. He is also complaining of anuria for the past 4 hours. The next management step would be?
Your Answer: Suprapubic catheter
Explanation:Stress and urge urinary incontinence has been observed in patients who have sustained pelvic fractures due to trauma. The best treatment option would be to pass suprapubic catheter. If there is still no urine output, then ureteral damage might be the cause, which needs to be managed.
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This question is part of the following fields:
- Renal System
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Question 14
Correct
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Which of the following signs is least suggestive of cervical myelopathy?
Your 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.
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This question is part of the following fields:
- Nervous System
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Question 15
Correct
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Choose the molecule that acts as the co-receptor for cells expressing antigens linked with MHC class I molecules:
Your Answer: CD8
Explanation:CD8+ T cells recognize antigens in the form of short peptide fragments bound to major histocompatibility complex class I (MHCI) molecules on the target cell surface.1 Specific engagement of peptide-MHCI (pMHCI) complexes via the clonotypically expressed ?β T-cell receptor (TCR) triggers a range of effector functions that play a critical role in protective immunity against intracellular infections and various malignancies.
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This question is part of the following fields:
- Immune System
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Question 16
Correct
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A 3-year-old boy presents with facial puffiness, frothy urine, lethargy and oliguria for two weeks. Urine analysis reveals proteinuria. Which of the following is the most appropriate treatment for this child?
Your Answer: Prednisolone
Explanation:The presentation is suggestive of nephrotic syndrome. A trial of corticosteroids is the first step in treatment of idiopathic nephrotic syndrome. Diuretics are useful in managing symptomatic oedema. Cyclosporin and cyclophosphamide are indicated in frequently relapsing and steroid dependant disease.
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This question is part of the following fields:
- Renal System
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Question 17
Correct
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A 34-year-old male has been brought to accident and emergency after being involved in a road collision. After his initial evaluation, his score on the Glasgow Coma Scale is 6. What is the most appropriate next step in his treatment?
Your Answer: Secure airway
Explanation:The appropriate next step in this patient’s treatment is to secure his airway.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 18
Incorrect
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A 29-year-old woman presents to clinic complaining of intermittent diarrhoea and constipation. Full blood count and viscosity were normal. Flexible sigmoidoscopy was unremarkable.
What is the next most appropriate management step?Your Answer: Full colonoscopy
Correct Answer: High-fibre diet
Explanation:This is most likely describing irritable bowel syndrome (IBS). Symptoms are either diarrhoea, constipation, or both, abdominal pain, bloating, with various durations. It is a functional, not organic, problem, as far as research shows at this point. It is essentially a diagnosis of exclusion. Treatment is a high fibre diet with fluids. Caffeine should be avoided as this can worsen symptoms. Full colonoscopy is not warranted at this time, neither is a barium enema. A wheat-free diet is not likely to help as there is no evidence they have an allergy to this.
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This question is part of the following fields:
- Gastrointestinal System
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Question 19
Incorrect
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A 1-day-old baby started having pallor and jaundice. The mother's first child did not have jaundice at birth. On clinical investigations, direct Coombs test is positive. Mother's blood group is A negative. Baby's blood group is O positive. What is the most probable cause of the condition of this new-born?
Your Answer: Breast milk jaundice
Correct Answer: Rhesus incompatibility
Explanation:Jaundice in a new-born on the day of delivery is most likely due to Rh incompatibility. This occurs when the mother is Rh-negative and the baby is Rh-positive. Antibodies in the mother against the Rh factor in the baby will destroy the red blood cells in the baby, increasing the bilirubin in the blood. Breast milk jaundice and Galactosemia do not occur immediately after birth, and congenital rubella syndrome and formula feeding does not cause jaundice in babies.
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This question is part of the following fields:
- Immune System
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Question 20
Incorrect
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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.
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This question is part of the following fields:
- Respiratory System
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Question 21
Incorrect
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A 58-year-old male patient complains of emesis, fatigue, palpitations and weight loss. His blood group is type A. Clinical examination revealed an enlarged liver, ascites and a left supraclavicular lump which is palpable. What is the most probable diagnosis?
Your Answer: Colorectal carcinoma
Correct Answer: Gastric carcinoma
Explanation:Gastric carcinoma may present as atypical general symptoms including emesis, fatigue and weight loss. It may also result in anaemia which might be responsible for the palpitations. The left supraclavicular swelling is referring to Virchow’s node, strongly associated with gastric cancer. Ascites and hepatomegaly generally appear late in the course of the disease and Blood group A has been shown to be associated with gastric cancer.
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This question is part of the following fields:
- Gastrointestinal System
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Question 22
Incorrect
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Regarding bupropion (Zyban), all of the following statements are true except?
Your Answer: It is an inhibitor of the cytochrome P450 enzyme system
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.
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This question is part of the following fields:
- Pharmacology
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Question 23
Incorrect
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A 26-year-old patient, previously fit and well, is admitted with fluctuating confusion and frank haematuria. He has recently been complaining of generalised malaise and joint pains. Examination reveals jaundice, splenomegaly, and petechiae. His blood pressure is 155/84 mmHg, temperature 37.9oC.
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Initial investigations reveal:
Haemoglobin 9.5 g/dl
White cell count 12 × 109/l
Platelets 40 × 109/l
Creatinine 142 μmol/l
Sodium 139 mmol/l
Potassium 4.5 mmol/l
Urea 9.2 mmol/l
Lactate dehydrogenase 495 U/l (10-250)
Urinalysis Protein ++, blood +++
Blood film shows schistocytes
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What treatment should NOT be given to this patient?Your Answer: Plasma exchange with fresh frozen plasma
Correct Answer: Platelet transfusion
Explanation:There is a strong suspicion of Thrombotic Thrombocytopenic Purpura (TTP) in this patient as he presents with neurological changes (from confusion to convulsions and coma), fever, haemolysis, thrombocytopenia, and renal failure. Additionally, TTP cases may present with jaundice, splenomegaly, and hypertension as seen in this patient. With a diagnosis of TTP, recent studies have shown that platelet transfusion is not recommended in this case because it has been shown to increase the risk for arterial thrombosis and mortality possibly due to increased aggregations.
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This question is part of the following fields:
- Renal System
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Question 24
Incorrect
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Which one of the following types of thyroid cancer is associated with the RET oncogene?
Your Answer: Follicular
Correct Answer: Medullary
Explanation:RET (rearranged during transfection) is a receptor tyrosine kinase involved in the development of neural crest derived cell lineages, kidney, and male germ cells. Different human cancers, including papillary and medullary thyroid carcinomas, lung adenocarcinomas, and myeloproliferative disorders display gain-of-function mutations in RET.
In over 90% of cases, MEN2 syndromes are due to germline missense mutations of the RET gene.
Multiple endocrine neoplasias type 2 (MEN2) is an inherited disorder characterized by the development of medullary thyroid cancer (MTC), parathyroid tumours, and pheochromocytoma. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 25
Correct
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A 23-year-old man is being investigated for excessive bleeding following a tooth extraction.
His coagulation profile shows:
Plts: 173 x 10^9/L
PT: 12.9 secs
APTT: 84 secs
Which clotting factor is he most likely deficient in?Your Answer: Factor VIII
Explanation:The patient is most likely a case of haemophilia A which is the genetic deficiency of clotting factor VIII in blood.
Haemophilia is an X-linked recessive disorder of coagulation. Up to 30% of patients have no family history of the condition. Haemophilia A is more common than haemophilia B and accounts for 90% of the cases. In haemophilia B (Christmas disease), there is a deficiency of clotting factor IX.
Characteristic features of haemophilia include hemarthrosis, haematomas, and prolonged bleeding following trauma or surgery. Coagulation profile of a haemophiliac person shows prolonged bleeding time, activated partial thromboplastin time (APTT), thrombin time (TT), but a normal prothrombin time (PT).
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This question is part of the following fields:
- Haematology & Oncology
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Question 26
Correct
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A 55-year-old woman complains of weight gain, hoarseness of voice, constipation, and muscle weakness 1 month after undergoing thyroid surgery. On examination, her face is puffy. Which of the following is the most likely diagnosis?
Your Answer: Hypothyroidism
Explanation:All the symptoms this patient is suffering from are the classic features of a hypothyroid state.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 27
Correct
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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: 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
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This question is part of the following fields:
- Musculoskeletal System
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Question 28
Incorrect
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A 35-year-old female with chronic pelvic pain, was recently diagnosed with PID. She was prescribed doxycycline. After 2 days she returned with complaints of abdominal bloating, nausea and regurgitation. Which of the following advice should be given to her?
Your Answer: Take Doxycycline before meals
Correct Answer: Take Doxycycline after meals
Explanation:Doxycycline is known to cause dyspeptic symptoms. So advising to take Doxycycline after meals is important. Taking with meals or adding an antacid is not advised, as both will cause reduction in drug absorption.
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This question is part of the following fields:
- Pharmacology
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Question 29
Incorrect
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A 40-year-old female presented in the OPD with a 4-day history of severe episodes of dizziness. She reports that her room starts spinning and then she tends to fall. She also complains of deafness, tinnitus, and a sensation of clogging in the ear. What condition do you think this patient is suffering from?
Your Answer: Benign positional vertigo
Correct Answer: Meniere's disease
Explanation:The patient presents with the classic symptoms of Meniere’s disease. This is a condition in which the amount of endolymph in the internal ear increases because of an increase in endolymph production, a reduction of endolymph drainage, or as a result of an infection. Hearing and balance tests should be done for the proper analysis of the patient’s condition and to rule out other conditions.
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This question is part of the following fields:
- Nervous System
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Question 30
Incorrect
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Vancomycin is a glycopeptide. It acts by which mechanism?
Your Answer: Inhibition of protein synthesis (transcription)
Correct Answer: Cell wall inhibition
Explanation:Peptidoglycans are a component of bacterial cell wall and are inhibited by this antibiotic.
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This question is part of the following fields:
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
