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Question 1
Incorrect
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Which of the following abnormal facial movements is not a well-recognised association?
Your Answer: Facial tics - Tourette's syndrome
Correct Answer:
Explanation:Wilson’s disease may have an asymmetric tremor which is variable in character and may be predominantly resting, postural, or kinetic.
Progressive supra-nuclear palsy – blepharospasm, apraxia of lid opening and/or apraxia of lid closing.
Tourette’s syndrome – one or more motor or vocal tics.
Multiple Sclerosis – continuous facial myokymia.
Tardive dyskinesia is a side-effect of conventional antipsychotics, neuroleptics, anticholinergics, and toxins resulting in stiff, jerky movements of your face and body -
This question is part of the following fields:
- Neurology
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Question 2
Incorrect
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A 72 year old male presents to the ER with acute chest pain, fever and sweating. ECG shows an acute MI. Which of the following routes will be the most significant in alleviating the patient's pain?
Your Answer: Subcutaneous
Correct Answer: Intravenous
Explanation:The pain of myocardial infarction is usually severe and requires potent opiate analgesia. Intravenous diamorphine 2.5–5 mg (repeated as necessary) is the drug of choice and is not only a powerful analgesic but also has a useful anxiolytic effect.
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This question is part of the following fields:
- Cardiovascular
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Question 3
Incorrect
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A 16-year-old male fell whilst playing football and was injured by a sharp wooden splinter sustaining a cut to his left shin. His immunisation history is up to date. In relation to tetanus prevention, select the most suitable management step.
Your Answer: I.M 0.5 ml tetanus toxoid should be administered as single dose
Correct Answer:
Explanation:According to the US immunisation schedule, the child is immunised. So this boy does not need any extra immunisation for tetanus now.
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This question is part of the following fields:
- Infectious Diseases
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Question 4
Incorrect
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A 34 year old woman presented with poor sleep with the result that she often woke up early. She also reported a lack of interest in her usual activities. These symptoms began about three weeks ago and have been getting worse. Although her two children were both in school, she was concerned that she was not spending quality time with them and she felt she was worthless to them. Which of the following is the most likely diagnosis?
Your Answer: Severe depression
Correct Answer: Mild depression
Explanation:She has poor sleep, lack of lack of interest in usual activities and worthlessness and symptoms affecting her usual activities which are suggestive of mild depression.
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This question is part of the following fields:
- Mental Health
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Question 5
Correct
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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: 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
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Question 6
Incorrect
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A 46 year old male, known with Rheumatoid Arthritis presents with a swollen and painful right ankle. No drug allergies are reported. On examination, the vitals are as follows:
Temp: 38.8
BP: 90/60 mmHg
Pulse: 110/min.
Right ankle examination reveals tenderness, warmth, erythema and tense joint effusion. Blood samples including blood cultures are collected and fluid resuscitation is initiated. Which of the following interventions would be most appropriate for this man?Your Answer: Administer i.v. flucloxacillin, and arrange MRI of right ankle
Correct Answer: Administer i.v. flucloxacillin, and arrange joint aspiration urgently
Explanation:Although microscopic analysis of joint fluid aspirate and culture is the basis of septic arthritis diagnosis and should usually be collected before the administration of antibiotics, the patient is showing signs of septic shock. A delay in antibiotics might lead to worsening of symptoms so they are administered first.
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This question is part of the following fields:
- Rheumatology
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Question 7
Incorrect
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A hypertensive old woman develops gingival hyperplasia. What is the single most likely diagnosis?
Your Answer: Crohns disease
Correct Answer: Nifedipine
Explanation:Calcium channel blockers are medications proven to cause side effects such as gingival hyperplasia. Calcium channel blocking drugs are contraindicated in hypertensive patients with second and third degree heart block, sick sinus syndrome, and severe heart failure.
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This question is part of the following fields:
- ENT
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Question 8
Incorrect
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Which of the following conditions is not linked to hyperuricemia?
Your Answer:
Correct Answer: Osteoarthritis
Explanation:Hyperuricemia is an elevated uric acid level in the blood. The normal upper limit is 6.8mg/dL, and anything over 7 mg/dL is considered saturated, and symptoms can occur. Causes of hyperuricemia can be classified into three functional types:
1. Increased production of uric acid – Purine rich diet, Tumour lysis syndrome, HGPRT deficiency (Lesch-Nyhan and Kelley-Seegmiller syndromes), Increased PRPP synthetase activity and Polycythaemia
2. Decreased excretion of uric acid – Renal impairment, Metabolic syndrome, Drugs (diuretics, low-dose aspirin, cyclosporin, tacrolimus, pyrazinamide, ethambutol, levodopa, nicotinic acid), Acidosis, Pre-eclampsia and eclampsia, Hypothyroidism and hyperparathyroidism, Sarcoidosis, Familial juvenile gouty nephropathy, Chronic lead intoxication, Trisomy 21
3. Idiopathic and mixed type – Alcohol, Exercise, Glucose-6-phosphatase deficiency, Aldolase B deficiency -
This question is part of the following fields:
- Musculoskeletal
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Question 9
Incorrect
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A 64 year old woman who is of Asian descent and is diabetic (controlled by diet) presents with generalized body aches and difficulty rising from sitting for the last few months. Her blood glucose levels are in the normal range. Lab examination reveals normal blood cell count, low serum phosphate, calcium at the lower range, and raised alkaline phosphatase levels. Radiological examination shows which of the following?
Your Answer:
Correct Answer: Linear areas of low density
Explanation:Osteomalacia is a condition due to defective mineralization of osteoid. Occurs as a result of Vitamin D deficiency secondary to poor dietary intake and sun exposure, malabsorption e.g., inflammatory bowel disease and gastrointestinal bypass surgery. Radiological findings include reduced bone mineral density (a non specific finding), inability to radiologically distinguish vertebral body trabeculae (the film appears poor quality), looser pseudo fractures, fissures, or narrow radiolucent lines (these are the characteristic findings). Osteolytic or punched out lesions may be seen with multiple myeloma and bony metastases. Areas of sclerosis may be observed with conditions like osteosclerosis and Paget disease. A Brodie abscess is a subacute osteomyelitis, which may persist for years before progressing to a chronic, frank osteomyelitis.
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This question is part of the following fields:
- Rheumatology
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Question 10
Incorrect
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A 6 year old presents with fever and multiple vesicles on his back. What is the single most appropriate next step?
Your Answer:
Correct Answer: None
Explanation:This clinical picture is typical of chickenpox, which is treated with antihistamines and calamine lotion. In the case of fever, acetaminophen can be used. Generally treatment is purely for symptomatic relief.
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This question is part of the following fields:
- Child Health
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Question 11
Incorrect
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High titre of which of the following antibodies is not considered diagnostic for the mentioned disease?
Your Answer:
Correct Answer: Rheumatoid factor in rheumatoid arthritis (RA)
Explanation:Diagnosis of RA is mainly based on clinical features (e.g., morning stiffness, symmetrical joint swelling) and laboratory tests (e.g., anti-CCP). Rheumatoid factor is not very specific for this disease and hence has low reliability. X-ray findings (e.g., soft tissue swelling or joint space narrowing) occur late in the disease and are therefore not typically used for diagnosis.
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This question is part of the following fields:
- Rheumatology
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Question 12
Incorrect
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A 32 year old male presents to the emergency after being involved in a horrific fire incident at home with 55% burns over is trunk, back and arms. He has an episode of 300ml of hematemesis which prompts endoscopy. Endoscopy reveals several ulcers in the stomach. How would you manage this patient?
Your Answer:
Correct Answer: IV PPI
Explanation:Curling’s ulcer is an acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa. The medical management of patients with stress ulcers is more or less similar to the management of peptic ulcer disease in general. The medication targeting acid peptic disease includes proton pump inhibitors, antihistamines, and ulcer-healing drugs like sucralfate. Patients with overt GI bleeding from ulceration will require endoscopic evaluation and management of the stress ulcers. Endoscopic therapies may include epinephrine injection, electro-cauterization, or clipping of the bleeding vessels. Bleeding ulcers refractory to localized endoscopic treatment may need embolization of the culprit vessel or rarely surgical intervention as a last resort. Surgical interventions are commonly indicated for patients with refractory bleeding despite endoscopic or angiographic treatment or patients with unstable hemodynamics to undergo endoscopic or angiographic procedures. Surgeries are performed as an ultimate life-saving approach.
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This question is part of the following fields:
- Gastrointestinal
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Question 13
Incorrect
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A 55 year old male has complained of severe pain in the right hypochondrium - the pain has been ongoing for the past 24 hours. He describes the pain as coming in waves and it is accompanied by nausea. Nothing he has tried had relieved his pain. His temperature is within the normal range, but he feels hot and is sweating. What is the most appropriate investigation?
Your Answer:
Correct Answer: US Abdomen
Explanation:A US abdomen would be performed to confirm a diagnosis of biliary colic. A number of symptoms are consistent with this diagnosis: severe right hypochondria pain; pain coming in waves; nausea; no fever; and the absence of jaundice.
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This question is part of the following fields:
- Seriously Ill
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Question 14
Incorrect
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The conductive system of the heart anatomically includes the:
Your Answer:
Correct Answer: Atrioventricular node
Explanation:The cardiac conduction system is a collection of nodes and specialised cells including the:
Sinoatrial node
Atrioventricular node
Atrioventricular bundle (bundle of His)
Purkinje fibres -
This question is part of the following fields:
- Cardiovascular
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Question 15
Incorrect
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All of the following statements suggesting a poor prognosis of Guillain-Barre syndrome are correct except?
Your Answer:
Correct Answer:
Explanation:Guillain barre syndrome is a neurological disorder characterised by neuropathy along with ascending paralysis. Denervation rather than demyelination suggests poor prognosis in GB syndrome.
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This question is part of the following fields:
- Neurology
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Question 16
Incorrect
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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:
Correct 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
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Question 17
Incorrect
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A 16 year old boy presented, complaining that an insect had lodged in his left ear. Which of the following can be considered as the most appropriate method to remove the insect?
Your Answer:
Correct Answer:
Explanation:Removal of foreign bodies from the ear is indicated whenever a well-visualized foreign body is identified in the external auditory canal. Insects are better extracted with suction than with forceps or hooks. From the given answers, irrigation with warm water is the most suitable answer.
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This question is part of the following fields:
- ENT
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Question 18
Incorrect
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In the functional unit of the liver (acinus), the oxygenation…
Your Answer:
Correct Answer: Reduces towards the centre
Explanation:Cells located close to the portal triad or peripheral zone which consist of arterioles from the hepatic artery are the most oxygenated cells. Cells in the central zone are least oxygenated and mainly receive blood supply from the central vein which is a branch of the hepatic vein.
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This question is part of the following fields:
- Hepatobiliary
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Question 19
Incorrect
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A 7 day old baby weighed 3.5kg when born. His weight is now 3kg. Choose the most appropriate next step for this child.
Your Answer:
Correct Answer: Continue regular child care
Explanation:In the first week after birth, it is normal for the baby to lose weight and then gain it again. Therefore, regular child care should be maintained.
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This question is part of the following fields:
- Child Health
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Question 20
Incorrect
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During the peri-infarct period, which of these drug classes have been shown to have the greatest favourable benefit?
Your Answer:
Correct Answer:
Explanation:Statins and ACE inhibitors are beneficial initially for the first 24 hours but not proven to have a benefit in the post infarct period. Statins have plaque stabilising functions when activated early following infarction. In contrast, when started immediately, beta blockers are the most beneficial. Nitrates have not been proven beneficial for survival and some calcium channel blockers actually increased the mortality rate.
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This question is part of the following fields:
- Cardiovascular
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Question 21
Incorrect
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A 27 year old woman presents with a 4cm bleeding ulcer on her labia minora. The woman admits she is sexually active. Which lymph nodes will the ulcer drain to?
Your Answer:
Correct Answer: Superficial inguinal
Explanation:The woman seems to have a chancroid, which may or may not drain to the lymph nodes of the groin. These nodes are the superficial inguinal lymph nodes.
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This question is part of the following fields:
- Infectious Diseases
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Question 22
Incorrect
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A 60-year-old man suffers from depression, poor concentration and inability to sleep. A few months earlier, he had a few episodes of debauchery and tantrums. Which drug is most likely to benefit him?
Your Answer:
Correct Answer: Carbamazepine
Explanation:Carbamazepine would be the drug of choice in this case because it is an anti-convulsant. It helps to restore the normal levels of nerve activity in the brain.
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This question is part of the following fields:
- Pharmacology
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Question 23
Incorrect
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The endothelium of the sinusoids has the following important function:
Your Answer:
Correct Answer: Highly fenestrated, large subendothelial spaces, many macrophages
Explanation:Substances absorbed in the intestines reach the liver via the portal vein and contain toxic substances that needs to be detoxified in hepatocytes. Thus, hepatic sinusoids are fenestrated and contain large spaces which allows passage of substances freely. These fenestrations are rich in Kupffer cells which are macrophages.
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This question is part of the following fields:
- Hepatobiliary
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Question 24
Incorrect
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A 42-year-old woman who has been a smoker since she was a teenager has the following blood result: Hgb=19. What hormone should you check?
Your Answer:
Correct Answer: Erythropoietin
Explanation:An increase in the patient’s haemoglobin tells us that the patient might be having an increased number of red blood cells. Smoking causes raised carboxyhaemoglobin levels and thus hypoxemia. Hypoxemia will increase the erythropoietin levels in the blood.
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This question is part of the following fields:
- Haematology
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Question 25
Incorrect
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A 32 year old man complains of fever, rash and photophobia. The physician suspects this to be a case of meningitis. Which of the following medication would be ideally used in this patient?
Your Answer:
Correct Answer: Cefotaxime
Explanation:Broad-spectrum cephalosporins, especially cefotaxime and ceftriaxone, are widely used in the treatment of suspected pneumococcal meningitis and are considered the treatment of choice for meningitis caused by partially penicillin-resistant pneumococcal strains.
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This question is part of the following fields:
- Pharmacology
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Question 26
Incorrect
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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:
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.
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This question is part of the following fields:
- Autoimmune
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Question 27
Incorrect
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A 35 year old alcoholic presented with epigastric pain radiating backward. His pain was relieved with opioid analgesics and anti PUD medications, however after 1 week he developed a fever with a similar kind of abdominal pain to that of his initial presentation. US abdomen shows a fluid collection. The most likely site for the fluid collection would be?
Your Answer:
Correct Answer: Lesser sac
Explanation:The most likely diagnosis in this case is acute pancreatitis, which typically presents with severe abdominal pain and vomiting, along with deranged LFTs and raised serum amylase. It makes a boundary wall for the lesser sac and therefore the most likely site of fluid collection would be in the lesser sac.
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This question is part of the following fields:
- Gastrointestinal
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Question 28
Incorrect
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A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a recent holiday abroad. Which of the following investigations is the least relevant?
Your Answer:
Correct Answer: PCR of CSF for Mycobacterium TB
Explanation:Amoebic, bacterial and fungal meningitis may present acutely but is not common in tuberculous meningitis. Amoebic meningitis is caused by Naegleria fowleri as a result of swimming in infected freshwater. The organism may be found in fresh CSF specimens with phase contrast microscopy.
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This question is part of the following fields:
- Infectious Diseases
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Question 29
Incorrect
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A 25 year old male presented in the emergency room with a history of loose stools which were bloody and mucoid for the last 2 to 3 months. The stools were also associated with abdominal cramps. He undergoes a colonoscopy after which he will start treatment. What is the most suitable drug in this case?
Your Answer:
Correct Answer: Mesalazine
Explanation:Symptoms are suggestive of inflammatory bowel disease. In this disease mesalazine is very effective as an anti-inflammatory drug.
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This question is part of the following fields:
- Gastrointestinal
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Question 30
Incorrect
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A 74 year old patient presents with back pain, pallor and palpitations. Blood exams reveal multiple plasma cells in the peripheral smear. What is the most likely diagnosis?
Your Answer:
Correct Answer: Multiple myeloma
Explanation:Multiple myeloma presents with bone pain usually in the back or at the level of the ribs. Pathological fractures are common. The patient usually experiences fatigue, paleness, weakness, dyspnoea and gastro-intestinal complaints such as nausea and constipation. Characteristic for this case is the presence of many plasma cells in the peripheral blood smear.
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This question is part of the following fields:
- Haematology
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SESSION STATS - PERFORMANCE PER SPECIALTY
