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Question 1
Incorrect
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An 8-month-old baby was investigated for failure to thrive. On examination, he was irritable with evidence of weight loss. His stools were pale, bulky and malodorous. What is the most appropriate test that can be done to confirm the diagnosis?
Your Answer: Stool Culture
Correct Answer: Jejunal Biopsy
Explanation:Pale, bulky, malodorous stools are evidence of fat malabsorption syndrome. The diagnostic test is jejunal biopsy to rule out other differential diagnoses such as celiac disease, giardiasis or Crohn’s disease etc.
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This question is part of the following fields:
- Child Health
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Question 2
Incorrect
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A teenage girl presented in the OPD with a history of amenorrhea. She said she was exercising daily and needs to lose weight. On examination, she is 162cm in height and 45kgs in weight. Which of the following is the most probable cause in this case?
Your Answer: Hyperthyroidism is the most likely diagnosis
Correct Answer: Hypomagnesaemia and hypocalcaemia are possibly present
Explanation:This scenario represents anorexia nervosa disorder, a psychological disorder. Extreme weight loss with a strict diet can lead to deficiency of many nutrients like magnesium and calcium. This can also cause amenorrhea.
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This question is part of the following fields:
- Endocrine
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Question 3
Incorrect
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A 22 year old male with exercise induced asthma, has had good control with a salbutamol inhaler. But recently he has had asthma attacks with exercise. Which of the following is the most appropriate management?
Your Answer: Oral steroid
Correct Answer: Sodium cromoglycate
Explanation:Steroids and theophylline have less of a role in the treatment of exercise induced asthma. The best method of treatment is pre-exercise short-acting β2-agonist administration. Long-acting β2-agonists, mast cell stabilizers (e.g.: Sodium cromoglycate), and antileukotriene drugs also play a role.
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This question is part of the following fields:
- Respiratory
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Question 4
Incorrect
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A 44 year old alcoholic man was operated on for a strangulated abdominal hernia, however a few days after the operation he became agitated. According to the patient, he used to see snakes curling over his body. O/E he was agitated, tachycardiac and confused. The most likely diagnosis would be?
Your Answer: Wernicke’s encephalopathy
Correct Answer: Delirium tremens
Explanation:Delirium tremens occurs due to alcohol withdrawal and presents clinically with hallucinations, agitations, confusion and hyperthermia. Wernicke’s encephalopathy is characterised by encephalopathy, oculomotor dysfunction and ataxic gait. In Korsakoff’s syndrome, there is marked short term memory loss, however the long term memory is preserved & the sensorium is also intact.
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This question is part of the following fields:
- Neurology
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Question 5
Incorrect
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A 42 year-old known smoker underwent emergency splenectomy after a road traffic accident. Later on, despite being mobile he developed a painful swelling of his right calf. Chest X-ray showed left sided lung collapse and abdominal US showed subphrenic fluid collection. The most likely cause of this deep vein thrombosis (DVT) would be?
Your Answer: Intraperitoneal haemorrhage
Correct Answer: Splenectomy
Explanation:Splenectomy: after splenectomy chances of thromboembolism are increased due to reactive thrombocytosis.
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This question is part of the following fields:
- Surgery
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Question 6
Incorrect
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A 1 year old child presents with barking cough, coryza and shortness of breath. What will be the most likely outcome associated with this condition?
Your Answer: Unknown
Correct Answer: Natural resolution
Explanation:Croup is the most common aetiology for hoarseness, cough, and onset of acute stridor in febrile children. Symptoms of coryza may be absent, mild, or marked. The vast majority of children with croup recover without consequences or sequelae.
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This question is part of the following fields:
- Mental Health
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Question 7
Incorrect
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Which one of the following has no role in increased gastric acid secretion in patients with peptic ulcer disease?
Your Answer: Gastrin
Correct Answer:
Explanation:Secretin is produced in the duodenum in response to a low pH and the presence of carbohydrate and fat. It turns off antral G cell gastrin synthesis. While others that are mentioned such as gastrin, histamine etc. are involved in increased acid secretion.
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This question is part of the following fields:
- Gastrointestinal
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Question 8
Incorrect
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Prenatal screening is recommended if ultrasound scan at 16 weeks confirms that the foetus is male and the mother has had an affected son previously. Choose the single most likely condition from the following list of options. 7
Your Answer:
Correct Answer: Duchene muscular dystrophy
Explanation:The condition should be an X-linked recessive condition, as it affects only male offspring. Duchene muscular dystrophy is an X-linked recessive condition. Cystic fibrosis is an autosomal recessive disorder. Spina bifida is a multifactorial condition. Down syndrome is caused by trisomy of chromosome 21. Spinal muscular atrophies are inherited in an autosomal-recessive pattern.
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This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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A 20-year-old male was admitted with a right sided pneumothorax. A chest drain was inserted just below the 4th rib in the mid clavicular line. What is the structure at risk of damage during the above procedure?
Your Answer:
Correct Answer: Intercostal artery
Explanation:From the given answers, the most suitable answer is the intercostal artery. However the most vulnerable structure is the intercostal nerve, then intercostal artery and finally intercostal vein.
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This question is part of the following fields:
- Seriously Ill
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Question 10
Incorrect
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A 12-year-old female presented with a bleeding nose. On examination by the ENT surgeon, it was noticed that the bleeding was coming from the anterior part of the nose and the bleeding point was clearly visualised. Which of the following options is the most suitable choice in this case?
Your Answer:
Correct Answer: Cautery
Explanation:In the case of anterior nasal bleeds, when the bleeding point is clearly visualised the best management step is cautery, either electrical or chemical.
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This question is part of the following fields:
- ENT
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Question 11
Incorrect
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A 60-year-old patient was admitted to the surgery department for elective herniorrhaphy. Due to a problem in his history, his operation was postponed. Which of the following is the most likely cause for this postponement?
Your Answer:
Correct Answer: MI 2 months ago
Explanation:After an MI, elective surgeries are recommended to be delayed for at least 6 months. This will help the patient become physically fit for the stress of surgery. Any surgery before this can carry a significant increased risk of mortality.
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This question is part of the following fields:
- Cardiovascular
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Question 12
Incorrect
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The hepatic portal vein is a large vessel formed by which of the following veins?
Your Answer:
Correct Answer: All of the above
Explanation:The portal vein is usually formed by the confluence of the superior mesenteric and splenic veins and also receives blood from the inferior mesenteric, gastric, and cystic veins.
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This question is part of the following fields:
- Hepatobiliary
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Question 13
Incorrect
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A 64 year old male patient was admitted for dysphagia, emesis and weight loss. He has a firm lump in his left supraclavicular fossa. What is the most probable diagnosis?
Your Answer:
Correct Answer: Gastric carcinoma
Explanation:The history is suggestive of gastric carcinoma with dysphagia, vomiting, weight loss and lymphatic metastasis to the supraclavicular node, known as Virchow’s node.
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This question is part of the following fields:
- Endocrine
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Question 14
Incorrect
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In which condition are β-blockers not recommended as the first line of therapy?
Your Answer:
Correct Answer: Hypertension
Explanation:For patients with hypertension, ACE inhibitors, diuretics, or calcium-channel blockers are given as first-line pharmacological agents. Patients with angina, chronic heart failure, myocardial infarction, and permanent atrial fibrillation with rapid ventricular rate, are given β-blockers as first-line therapy. In these cases, increased cardiac activity can not be met by the amount of blood being supplied to the heart. Giving β-blockers will reduce the workload of the heart and slow down the cardiac activity.
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This question is part of the following fields:
- Cardiovascular
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Question 15
Incorrect
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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:
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.
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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 70-year-old female presented to her ophthalmologist with a complaint of weakening eyesight despite continued use of her corrective glasses. She also had a history of mild headaches for a few weeks. On fundoscopy, the disc had blurred margins with mild cupping and a sickle shaped scotoma in both eyes. What is the most appropriate treatment in this case?
Your Answer:
Correct Answer: Pilocarpine eye drops
Explanation:Frequent change of eye glasses, scotoma, and mild cupping are suggestive of primary open angle glaucoma. This means that the anterior angle of the eye is normal but there is a problem in the trabecular meshwork, where the Schlemm’s Canal is not allowing the drainage of the aqueous humor. Pilocarpine should be given to the patient because it is a parasympathomimetic agent. It causes the ciliary muscle of the eye to contract, causing the trabecular meshwork to open up, allowing the aqueous humor to drain again.
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This question is part of the following fields:
- Ophthalmology
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Question 17
Incorrect
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A 35-year-old African female presents with a history of heavy menstrual bleeding and dysmenorrhoea for 4 months. Which of the following could be the most likely cause for this presentation?
Your Answer:
Correct Answer: Fibroid
Explanation:History of heavy menstrual bleeding and amenorrhoea favour the diagnosis of a fibroid uterus. All the given responses are causes for subfertility. Ectopic pregnancy presents with abdominal pain has an acute presentation. Endometriosis and adenomyosis usually don’t present with amenorrhoea or heavy bleeding respectively. PID presents with chronic pelvic pain and is not related to menstruation.
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This question is part of the following fields:
- Gynaecology
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Question 18
Incorrect
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A diagnosed case of scabies presented in OPD for some medical advice. Which of the following statements best suits scabies?
Your Answer:
Correct Answer:
Explanation:Scabies is an infection caused by a microscopic mite known as Sarcoptes scabies. The chief presenting complaint is itching especially in skin folds and mostly during night. It spreads from one person to another through skin contact, and therefore it is more prevalent in crowded areas like hospitals, hostels and even at homes where people live in close contact with each other. Treatment options include benzyl benzoate, ivermectin, sulphur and permethrin.
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This question is part of the following fields:
- Dermatology
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Question 19
Incorrect
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A 75 year old female has developed recurrent breathlessness after having a mitral valve replacement 13 years ago. Her husband has also noticed a prominent pulsation in her neck. She has also complained of ankle swelling and pain in the abdomen. Choose the most probable diagnosis from the list of options.
Your Answer:
Correct Answer: Tricuspid regurgitation
Explanation:Multiple symptoms point towards tricuspid regurgitation: recurrent breathlessness (if the cause if LV dysfunction); a prominent pulsation in her neck (giant V waves); pain in the abdomen (pain in liver upon exertion); and ankle swelling.
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This question is part of the following fields:
- Cardiovascular
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Question 20
Incorrect
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Tumour suppressor genes MLH1 and MSH2 are affected in which familial cancer?
Your Answer:
Correct Answer:
Explanation:In hereditary non-polyposis colonic carcinoma (HNPCC), mutations in MSH2, MSH6, PMS2 or MLH1 genes are found.
Ataxia telangiectasia – ATM gene is affected.
Familial adenomatous polyposis – APC gene is affected.
Li-Fraumeni syndrome – mutation of the TP53 tumour suppressor gene. Neurofibromatosis – mutation in or a deletion of the NF1 gene -
This question is part of the following fields:
- Gastrointestinal
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Question 21
Incorrect
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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:
Correct Answer:
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.
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This question is part of the following fields:
- Endocrine
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Question 22
Incorrect
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A 20-year-old boy returning from vacation in India presented with a history of fever, myalgia, headache and abdominal pain for 4 days duration. He revealed that he had bathed in a river during his vacation. On examination, he had severe muscle tenderness, hypotension (BP - 80/60mmHg) and tachycardia (140 bpm). What would be the first step in management?
Your Answer:
Correct Answer: IV normal saline
Explanation:The history is suggestive of leptospirosis. This is a zoonotic infection caused by a spirochete. As the patient is in shock, resuscitation with IV fluids is the first step in the management. IV antibiotics should be started (Doxycycline or Penicillin) as soon as possible. Other investigations mentioned are important during the management to rule out other possible diagnoses.
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This question is part of the following fields:
- Infectious Diseases
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Question 23
Incorrect
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A thin 18-year-old girl has bilateral parotid swelling with thickened calluses on the dorsum of her hand. What is the single most likely diagnosis?
Your Answer:
Correct Answer: Bulimia nervosa
Explanation:Bulimia nervosa is a condition in which a person is involved in binge eating and then purging. This patient has swollen parotid glands. The glands swell in order to increase saliva production so that the saliva lost in the vomiting is compensated. This patient also has thickened calluses on the back of her hand. This is known as Russell’s sign. This occurs because of putting fingers in the mouth again and again to induce the gag reflex and vomit. The knuckles get inflamed in the process after coming in contact with the teeth multiple times.
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This question is part of the following fields:
- Gastrointestinal
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Question 24
Incorrect
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A 45-year-old male patient came to the OPD with a complaint of severe headache on the right side, with right-sided jaw pain, and additional blurred vision in the right eye. The headache was throbbing in character. Which investigation will you prefer next?
Your Answer:
Correct Answer: Erythrocyte sedimentation rate (ESR)
Explanation:Age of the patient, headache only on one side, and loss of vision on that side suggest temporal arteritis, also known as giant cell arteritis. The laboratory hallmark of this condition is a raised ESR.
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This question is part of the following fields:
- Ophthalmology
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Question 25
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:
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 26
Incorrect
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A 28 year old female with a history of psoriatic arthritis would most likely have which of the following hand conditions?
Your Answer:
Correct Answer: Nail dystrophy
Explanation:Nail dystrophy (pitting of nails, onycholysis, subungual hyperkeratosis), dactylitis, sausage shaped fingers are most commonly seen with psoriatic arthropathy. There is asymmetric joint involvement most commonly distal interphalangeal joints. Uveitis and sacroiliitis may also occur. Arthritis mutilans may occur but is very rare. Cutaneous lesions may or may not develop. When they do, its usually much after the symptoms of arthritis.
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This question is part of the following fields:
- Rheumatology
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Question 27
Incorrect
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From the options provided, which statement would most likely points towards Munchausen's syndrome by proxy?
Your Answer:
Correct Answer: It is a cause of sudden infant death
Explanation:Munchausen syndrome by proxy is a mental illness and a form of child abuse. The caretaker of a child, most often a mother or a father, either makes up fake symptoms or causes real symptoms to make it look like the child is sick. The person with MSP gains attention by seeking medical help for exaggerated or made-up symptoms of a child in his or her care. As health care providers strive to identify what’s causing the child’s symptoms, the deliberate actions of the mother or caretaker can often make the symptoms worse.
The person with MSP does not seem to be motivated by a desire for any type of material gain. People with MSP may create or exaggerate a child’s symptoms in several ways. They may simply lie about symptoms, alter tests (such as contaminating a urine sample), falsify medical records, or they may actually induce symptoms through various means, such as poisoning, suffocating, starving, and causing infection. -
This question is part of the following fields:
- Child Health
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Question 28
Incorrect
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A 69 year old male, who is a hypertensive and a smoker presented with sudden onset central chest pain radiating to his back. Examination revealed a pulsatile mass in the abdomen. Which of the following is the most appropriate next step?
Your Answer:
Correct Answer: USG
Explanation:The history is suggestive of ruptured Abdominal Aortic Aneurysm (AAA). Characteristic pain, pulsatile abdominal mass and risk factors such as age>60, hypertension and smoking support the diagnosis. Ultrasonography is the standard imaging tool for AAA. It can also detect free peritoneal blood.
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This question is part of the following fields:
- Cardiovascular
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Question 29
Incorrect
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A 4-year-old female was suffering from an upper respiratory tract infection. Her mother treated her with paracetamol only, for 5 days. After that, she presented in the emergency room with severe pain in her left ear, high-grade fever and irritability. What is the most likely diagnosis?
Your Answer:
Correct Answer: Otitus media (OM)
Explanation:Upper respiratory tract infection when not treated accordingly can lead to otitis media and the patient presents with severe earache and fever.
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This question is part of the following fields:
- ENT
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Question 30
Incorrect
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A 70-year old man presents with difficulty speaking and has a history of weakness in his facial muscles, as well as in his right arm and leg. What is the most appropriate prophylactic regimen in this case?
Your Answer:
Correct Answer: Aspirin 300mg for 2 weeks followed by aspirin 75mg and dipyridamole 200mg
Explanation:Left-sided hemiparesis along with slurred speech are strong indications of stroke in the right cerebral hemisphere. This occurs due to poor blood flow to the brain from the heart. Aspirin 300mg has analgesic, antipyretic, and anti-inflammatory properties that can address the acute symptoms of stroke like migraine and neuralgic pain. With a reduced dose of 75mg of Aspirin, its anti-platelet effect can inhibit further thrombus formation and prevent another stroke. Dipyridamole 200mg is an anti-coagulant preventing clot formation in the blood.
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This question is part of the following fields:
- Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY
