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Question 1
Correct
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A 54-year-old male, with a smoking history of 15 pack years presents with worsening dyspnoea, fever and cough. He works at a foundry. Vitals are as follows:
Respiratory rate: 28/min
Heart rate: 80 bpm
Temp: 37.6C
Chest auscultation reveals bilateral crepitations throughout the lung fields.
Calcified hilar nodules are visible on the chest X-ray. Further evaluation shows an eggshell calcification on HRCT.
Which of the following is the most likely diagnosis?Your Answer: Silicosis
Explanation:Silicosis is a common occupational lung disease that is caused by the inhalation of crystalline silica dust. Silica is the most abundant mineral on earth. Workers that are involved for example in construction, mining, or glass production are among the individuals with the highest risk of developing the condition. Acute silicosis causes severe symptoms (e.g., exertional dyspnoea, cough with sputum) and has a very poor prognosis.
Chronic silicosis has a very variable prognosis and affected individuals may remain asymptomatic for several decades. However, radiographic signs are usually seen early on. Typical radiographic findings are calcifications of perihilar lymph nodes, diffuse ground glass opacities, large numbers of rounded, solitary nodules or bigger, confluent opacities. Avoiding further exposure to silica is crucial, especially since the only treatment available is symptomatic (e.g., bronchodilators). Silicosis is associated with an increased risk of tuberculosis and lung cancer. Berylliosis typically affects individuals who are exposed to aerospace industry. Histoplasmosis and tuberculosis do not form eggshell calcifications. -
This question is part of the following fields:
- Respiratory System
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Question 2
Correct
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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: 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.
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This question is part of the following fields:
- Immune System
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Question 3
Correct
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A 7-year-old female presented with complaints of haematuria and fatigue. She had a history of bloody diarrhoea starting 7 days previously. On investigation, her serum urea and creatinine were raised and proteinuria was present. Which of the following is the most suitable diagnosis for her?
Your Answer: Haemolytic-uremic syndrome (HUS)
Explanation:HUS syndrome occurs mostly in children after some days of bloody diarrhoea. Damaged red blood cells also damage the kidney filtering unit and lead to sudden renal failure.
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This question is part of the following fields:
- Renal System
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Question 4
Incorrect
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A 23-year-old man visited the OPD with a complaint of pain in the abdomen and dark urine. His blood pressure was found to be elevated. Which of the following should be done next to reach a diagnosis?
Your Answer: Urine microscopy
Correct Answer: US
Explanation:Hypertension along with haematuria give an indication of cystic kidneys which can be diagnosed with an ultrasound.
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This question is part of the following fields:
- Renal System
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Question 5
Correct
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A 72-year-old woman presents with 18 month history of gait ataxia, dysarthria, and dysphagia.
On examination there is down beating nystagmus and slurred speech. There is past pointing in both upper limbs and a wide-based ataxic gait. Reflexes and sensation are normal. There is no wasting or fasciculations. Plantar response is flexor bilaterally.
What is the most likely diagnosis?Your Answer: Arnold-Chiari malformation
Explanation:Downbeat nystagmus (DBN) suggests a lesion in the lower part of the medulla. Arnold-Chiari malformation usually presents with symptoms due to brainstem and lower cranial nerve dysfunction such as DBN.
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This question is part of the following fields:
- Nervous System
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Question 6
Incorrect
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A 45-year-old male, chronic smoker presented with a 6 month history of a productive cough with blood stained sputum and shortness of breath. The most likely diagnosis would be?
Your Answer: Chronic Bronchitis
Correct Answer: Bronchiectasis
Explanation:Bronchiectasis is characterised by a blood stained productive cough with copious amount of sputum production, along with dyspnoea.
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This question is part of the following fields:
- Respiratory System
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Question 7
Correct
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An 85-year-old elderly male presents with complaint of worsening breathlessness over the last 2 years. He has a longstanding history of COPD and currently takes salbutamol, ipratropium, salmeterol, beclomethasone and theophylline. FEV1 comes out to be less than 30%. What will be the most suitable next step in the management of this patient?
Your Answer: Assessment for long term O2 therapy
Explanation:Long-term oxygen therapy (LTOT) is the cornerstone mode of treatment in patients with severe chronic obstructive pulmonary disease (COPD) associated with resting hypoxaemia. When appropriately prescribed and correctly used, LTOT has clearly been shown to improve survival in hypoxemic COPD patients. Requirements to proceed to LTOT is the patient should be stable and on appropriate optimum therapy (as in given case) and having stopped smoking tobacco. The patient should be shown to have a PaO2 of less than 7.3 kPa and/or a PaCO2 of greater than 6 kPa on two occasions at least 3 weeks apart. FEV1 should be less than 1.5 litres, and there should be a less than 15% improvement in FEV1 after bronchodilators. Patients with a PaO2 between 7.3 and 8 kPa who have polycythaemia, right heart failure or pulmonary hypertension may benefit from LTOT.
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This question is part of the following fields:
- Respiratory System
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Question 8
Correct
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Which of the following may cause a downbeat nystagmus?
Your Answer: Chiari type I malformation
Explanation:Downbeat nystagmus (DBN) suggests a lesion in the lower part of the medulla. Chiari Type I malformation usually presents with symptoms due to brain stem and lower cranial nerve dysfunction, which includes DBN.
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This question is part of the following fields:
- Nervous System
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Question 9
Incorrect
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Which of the following abnormal facial movements is not a well-recognised association?
Your Answer:
Correct Answer: Facial synkinesis - Wilson's disease
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:
- Nervous System
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Question 10
Incorrect
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A 35-year-old woman under treatment for long-term epilepsy with valproate presented with complaints of excessive weight gain. She is consuming oral contraceptive pills.
Which among the following is the best alternative to valproate for treating long-term epilepsy?Your Answer:
Correct Answer: Lamotrigine
Explanation:Among the given anti-epileptics the best drug that can be given in this patient is lamotrigine.
Topiramate, carbamazepine, phenytoin, and phenobarbital are all hepatic enzyme inducers and are associated with decreased effectiveness of the oral contraceptive (OCP) due to acceleration of the metabolism of oestrogens and progestogens.
If she is planning on pregnancy then registry studies suggest that lamotrigine would also be the best choice.
Other hepatic enzyme inducers include rifampicin, spironolactone, griseofulvin, etc. -
This question is part of the following fields:
- Pharmacology
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Question 11
Incorrect
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A 57-year-old male presented to the OPD with a complaint of fever, cough and chest pain for 3 days. The right lung base was dull on percussion and the breath sounds were reduced in intensity. Which of the following investigations is most appropriate?
Your Answer:
Correct Answer: CXR
Explanation:Because of the patient’s acute presentation of symptoms accompanied by lung abnormalities observed on physical examination, the next step is to visualize the suspected acute inflammatory process by ordering a CXR. Bronchoscopy, CT and MRI are done in cases in which there is suspicion of any tumour formation. V/Q scan is done in cases where pulmonary embolism is suspected.
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This question is part of the following fields:
- Respiratory System
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Question 12
Incorrect
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A 26-year-old patient without a known medical history presents to casualty unconscious. What should be done as soon as possible?
Your Answer:
Correct Answer: Blood Glucose
Explanation:Blood glucose should be evaluated immediately in order to investigate for diabetic coma triggered by hyperglycaemia or hypoglycaemia.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 13
Incorrect
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An elderly woman is admitted to the hospital with a community-acquired pneumonia (CAP). Her medical notes state that she developed a skin rash after taking penicillin a few years ago. She has a CURB score of 4 and adverse prognostic features. Which of the following would be an appropriate empirical antibiotic choice?
Your Answer:
Correct Answer: Cefotaxime and erythromycin
Explanation:Community-acquired pneumonia (CAP) is one of the most common infectious diseases and is an important cause of mortality and morbidity worldwide. Typical bacterial pathogens that cause CAP include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
The CURB-65 is used as a means of deciding the action that is needed to be taken for that patient.
Score 3-5: Requires hospitalization with consideration as to whether they need to be in the intensive care unitRecent studies have suggested that the use of a beta-lactam alone may be noninferior to a beta-lactam/macrolide combination or fluoroquinolone therapy in hospitalized patients.
Therapy in ICU patients includes the following:
– Beta-lactam (ceftriaxone, cefotaxime, or ampicillin/sulbactam) plus either a macrolide or respiratory fluoroquinolone
– For patients with penicillin allergy, a respiratory fluoroquinolone and aztreonamTherefore the appropriate treatment would be Cefotaxime and erythromycin.
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This question is part of the following fields:
- Respiratory System
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Question 14
Incorrect
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A middle-aged female has undergone axillary lymph node clearance after being diagnosed with breast carcinoma. She was stung by a bee and developed a swollen arm. What is the most probable mechanism behind this arm swelling?
Your Answer:
Correct Answer: Lymphoedema
Explanation:Lymph nodes are necessary for the drainage of interstitial fluid to avoid swelling after some histamine reactions. In this case no lymph nodes are present and lymphoedema developed.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 15
Incorrect
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A 66 year-old marketing analyst presents to the respiratory clinic with a 2-month history of progressive weakness and shortness of breath. He finds it difficult to stand from sitting, and struggles climbing stairs. He is an ex-smoker with chronic obstructive pulmonary disease (COPD). He had a recent exacerbation one month ago for which he was treated by the GP with a course of oral prednisolone, during which time his weakness transiently improved. On examination, you note a left-sided monophonic wheeze and reduced breath sounds at the left lung base. Blood tests and a chest x-ray are requested.
Hb 145 g/L
WCC10.5 109/l
Na+136 mmol/L
K+ 4.3 mmol/L
Urea 6.8 mmol/L
Creatinine 93 mmol/L
Calcium 2.62 mmol/L
Phosphate 1.44 mmol/L
Chest x-ray shows hyperinflated lungs, left lower lobe collapse and a bulky left hilum
What is the most likely cause of this patient's weakness?Your Answer:
Correct Answer: Lambert-Eaton myasthenic syndrome
Explanation:This man has a small-cell lung cancer (SCLC) and associated Lambert-Eaton myasthenic syndrome – a well-recognized paraneoplastic manifestation of SCLC. This classically affects the proximal muscles, especially in the legs, causing difficulty in standing from a seated position and climbing stairs. In contrast to myasthenia gravis, eye involvement is uncommon. Treatment with steroids is often helpful, which explains his transient symptomatic improvement during treatment for his COPD exacerbation. Steroid myopathy does not fit as the symptoms started well before his course of prednisolone. Although the patient is mildly hypercalcaemic, this would not be sufficient to produce his presenting symptoms, although it does reinforce the suspicion of lung malignancy. Motor neurone disease would be unlikely in this context and would not improve with steroids. Myasthenia gravis could produce these symptoms, but in the context of a new lung mass is a less viable diagnosis.
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This question is part of the following fields:
- Nervous System
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Question 16
Incorrect
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A 32-year-old woman presents with a painful elbow which she has been feeling for the past two weeks. Which of the following will be consistent with a diagnosis of tennis elbow?
Your Answer:
Correct Answer: Pain on wrist extension against resistance
Explanation:Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles and thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which will result in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.
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This question is part of the following fields:
- Musculoskeletal System
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Question 17
Incorrect
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Which of the following is most likely linked to male infertility in cystic fibrosis?
Your Answer:
Correct Answer: Failure of development of the vas deferens
Explanation:The vas deferens is a long tube that connects the epididymis to the ejaculatory ducts. It acts as a canal through which mature sperm may pass through the penis during ejaculation.
Most men with CF (97-98 percent) are infertile because of a blockage or absence of the vas deferens, known as congenital bilateral absence of the vas deferens (CBAVD). The sperm never makes it into the semen, making it impossible for them to reach and fertilize an egg through intercourse. The absence of sperm in the semen can also contribute to men with CF having thinner ejaculate and lower semen volume.
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This question is part of the following fields:
- Respiratory System
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Question 18
Incorrect
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A 63-year-old gentleman with chronic kidney disease secondary to diabetes mellitus is reviewed. When assessing his estimated glomerular filtration rate (eGFR), which one of the following variables is not required by the Modification of Diet in Renal Disease (MDRD) equation?
Your Answer:
Correct Answer: Serum urea
Explanation:A formula for estimating glomerular filtration rate (eGFR) is the Modification Diet of Renal Disease (MDRD) equation which takes into account the following variables: serum creatinine, age, gender, and ethnicity. Thus, serum urea is not required in this formula.
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This question is part of the following fields:
- Renal System
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Question 19
Incorrect
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A 55-year-old man known with Addison's disease presented with complaints of recurrent attacks of postural hypotension. What kind of electrolyte imbalance would be seen in his biochemical profile investigations?
Your Answer:
Correct Answer: Low Na+, High K+
Explanation:Patients suffering from Addison’s disease have low aldosterone. Aldosterone increases Na+ absorption and excretion of K+. So in these patients there would be decreased Na+ and increased K+ levels.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 20
Incorrect
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A 50-year-old male patient was started on amiodarone. Prior to commencement, his blood urea and electrolytes were checked. What is the reason for doing this investigation before starting amiodarone?
Your Answer:
Correct Answer: To detect hypokalaemia
Explanation:Any antiarrhythmic drugs can potentially cause arrhythmias. Before starting amiodarone, any electrolyte imbalance including hypokalaemia, hypomagnesemia, or hypocalcaemia should be corrected to prevent any arrhythmias.
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This question is part of the following fields:
- Cardiovascular System
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SESSION STATS - PERFORMANCE PER SPECIALTY
