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Question 1
Incorrect
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A 35-year-old female patient presents with butterfly rash, haematuria and photosensitivity. She is currently on TB treatment. Which antibody would you expect positive?
Your Answer: Anti-Ds DNA
Correct Answer: Anti-Histone
Explanation:This patient is probably suffering from a drug-induced lupus. There’s a 95% chance that anti-histone antibodies are positive. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The drugs most commonly connected with drug-induced lupus are: hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms) and isoniazid (used to treat tuberculosis).
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This question is part of the following fields:
- Musculoskeletal System
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Question 2
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A 50-year-old known patient with chronic liver cell disease was admitted complaining of unsteadiness and double vision following an episode of heavy alcohol consumption. On examination, he was confused. there was nystagmus and ataxia. What is the most possible cause for this presentation?
Your Answer: Wernicke's encephalopathy
Explanation:Wernicke’s encephalopathy is a neurological disorder induced by thiamine deficiency and presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion. As alcohol affects thiamine uptake and utilization, thiamine deficiency is usually associated with chronic alcoholism.
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This question is part of the following fields:
- Nervous System
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Question 3
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A 60-year-old male patient was admitted for further investigations, after complaining of symptoms of obstructive uropathy and lower back pain. His wife has noticed that he lost weight over the past two months. Which tumour marker would you expect to see elevated?
Your Answer: Prostate specific antigen (PSA)
Explanation:The symptoms suggest prostate cancer with possible bone metastasis, due to the lower back pain. PSA is used for screening for prostate cancer as well as other prostate pathologies. A high PSA level of more than 4 ng/ml will require investigation to exclude cancer, benign prostatic hypertrophy, prostatitis and perineal trauma.
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This question is part of the following fields:
- Men's Health
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Question 4
Incorrect
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Which is the most common type of inherited colorectal cancer:
Your Answer: Familial adenomatous polyposis
Correct Answer: Hereditary non-polyposis colorectal carcinoma
Explanation:Hereditary non-polyposis syndrome (HNPCC) is the most common type of inherited colorectal cancer. It often presents in younger and younger generations down a family. FAP presents with 100’s-1000’s of polyps and is less common. Li-Fraumeni syndrome and Fanconi syndrome are rare. For Peutz-Jeghers syndrome, the thing you will look for in the question stem is discoloured spots on the lips, this is classic.
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This question is part of the following fields:
- Gastrointestinal System
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Question 5
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A 53-year-old female, longstanding case of rheumatoid arthritis comes for a review. Which of the following features are commonly associated with her condition?
Your Answer: Proximal interphalangeal joint involvement in the hands
Explanation:Rheumatoid arthritis is a polyarthritis that results in symmetrical pain and swelling of the affected joints (also at rest). It particularly affects the metacarpophalangeal joints (MCPJs) and proximal interphalangeal joints (PIPJs), not the distal interphalangeal joints (DIPs).
Ulcerative colitis and IBD are associated with seronegative arthritides, not RA. The condition can also cause various extra-articular manifestations such as ocular symptoms, rheumatoid nodules and pulmonary fibrosis. Scleritis, episcleritis and keratoconjunctivitis sicca are more common than uveitis. Early intervention with disease-modifying antirheumatic drugs (DMARDs) plays a decisive role in successful treatment. -
This question is part of the following fields:
- Musculoskeletal System
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Question 6
Incorrect
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A 4-year-old baby was brought in by her mother with complaints of generalized pallor, loss of weight and loose stools. The baby's stools were frothy in nature and difficult to flush. Which investigation can help in diagnosing this patient?
Your Answer: Sweat chloride test
Correct Answer: Anti-endomysial antibodies
Explanation:The presence of anti-endomysial antibodies confirms the diagnosis of Celiac disease, which is the primary cause of illness in this patient. The sweat chloride test is performed with cystic fibrosis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 7
Incorrect
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Which of the following statements regarding the proton pump inhibitors is true?
Your Answer: They reversibly block parietal cell proton pumps
Correct Answer: They cause hair loss, diarrhoea, and headache
Explanation:Common side effects of omeprazole include: headache, abdominal pain, diarrhoea, nausea, vomiting, gas (flatulence), dizziness, upper respiratory infection, acid reflux, constipation, rash, cough.
Less common side effects of Omeprazole include: bone fracture (osteoporosis related), deficiency of granulocytes in the blood, loss of appetite, gastric polyps, hip fracture, hair loss, chronic inflammation of the stomach, destruction of skeletal muscle, taste changes, abnormal dreams.
Rare side effects of Omeprazole include: liver damage, inflammation within the kidneys, pancreatitis, dermatologic disorder, potentially life threatening (toxic epidermal necrolysis). -
This question is part of the following fields:
- Pharmacology
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Question 8
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Question 9
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A 33-year-old artist who recently arrived in the UK from New York presents in ED. He has a past history of insulin-dependant diabetes mellitus. He describes a few days of fever, headache and myalgia. Admission was prompted by worsening headache and back pain. While waiting in the medical receiving unit, he becomes progressively drowsier. Examination revealed flaccid paralysis and depressed tendon reflexes. He was reviewed by the intensive care team and arrangements were made for ventilation. A computerised tomography (CT) brain is performed that is normal.
Cerebrospinal fluid examination reveals:
Protein 0.9 g/l (<0.45 g/l)
Glucose 4 mmol/l
White cell count (WCC) 28/mm3 (mostly lymphocytes)
Blood testing reveals:
Haemoglobin (Hb) 14 g/dl (13-18)
Platelets 620 x 109/l (150-400 x 109)
WCC 12 x 109/l (4-11 x 109)
Sodium 135 mmol/l (137-144)
Potassium 4.6 mmol/l (3.5-4.9)
Urea 8 mmol/l (2.5-7.5)
Creatinine 120 mmol/l (60-110)
Glucose 6 mmol/l
Which of the following is the most likely infective process?Your Answer: West Nile disease
Explanation: -
This question is part of the following fields:
- Nervous System
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Question 10
Incorrect
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A 51-year-old woman complains of sudden onset of severe headache and vomiting that is worse when she is lying flat. Fundoscopy confirms bilateral papilledema. Which is the definitive investigation in this case?
Your Answer: Magnetic resonance imaging
Correct Answer: Computed tomography scan
Explanation:A head CT scan is the best step to rule out a mass lesion or bleed. Since the patient has symptoms that may suggest elevated intracranial pressure (ICP), a lumbar puncture should be consulted first with a neurologist since it is contraindicated in this case due to raised ICP and risk of coning.
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This question is part of the following fields:
- Nervous System
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Question 11
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: Sub phrenic
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 System
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Question 12
Incorrect
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Which of the following peripheral neuropathy inducing clinical diagnoses is predominantly associated with sensory loss?
Your Answer: Hereditary sensorimotor neuropathies
Correct Answer: Uraemia
Explanation:Diseases that cause predominantly sensory loss include diabetes, uraemia, leprosy, alcoholism, vitamin B12 deficiency, and amyloidosis.
Those that cause predominantly motor loss include Guillain-Barre syndrome, porphyria, lead poisoning, hereditary sensorimotor neuropathies, chronic inflammatory demyelinating polyneuropathy, and diphtheria. -
This question is part of the following fields:
- Nervous System
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Question 13
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A 26-year-old male was being investigated further following several hypertensive episodes. There was a marked difference in his systolic blood pressures between the right brachial and the right femoral arteries. Which of the following is most probable diagnosis?
Your Answer: Coarctation of the aorta
Explanation:From the given physical findings (the difference in BP between the radial and femoral arteries), the most probable diagnosis is coarctation of the aorta.
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This question is part of the following fields:
- Cardiovascular System
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Question 14
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A 60-year-old male has complained of a recent onset of postural syncope, impotence, diarrhoea, and profuse sweating. He also has diabetes. In this patient, what is the most likely cause of syncope?
Your Answer: Autonomic neuropathy
Explanation:Due to the symptoms, a diabetic autonomic neuropathy should be a suspect as a cause for the syncope. Unless associated with atrial fibrillation, mitral regurgitation is not usually expected to cause syncope. PAF can sometimes present with palpitations and a feeling of light-headedness followed by syncope, but is not always the case.
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This question is part of the following fields:
- Cardiovascular System
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Question 15
Incorrect
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A 67-year-old male presents to the emergency complaining of frank haematuria. There are no associated symptoms. Which of the following would be the most helpful in pointing towards a diagnosis?
Your Answer: US Abdomen
Correct Answer: Cystoscopy
Explanation:Diagnostic indications for cystoscopy include the following: evaluation of patients with voiding symptoms (storage or obstructive), gross or microscopic haematuria, urologic fistulas, urethral or bladder diverticula and congenital anomalies in paediatric population.
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This question is part of the following fields:
- Renal System
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Question 16
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An 80-year-old male has been receiving treatment for prostate cancer. He has complained of pain in his pelvis and, following radiological investigations, is shown to have pelvic metastases. Choose the most appropriate course of investigation for this patient.
Your Answer: Palliative radiotherapy
Explanation:The patient could respond well to palliative radiotherapy. This course of action is likely to shrink the cancer and will, therefore, reduce the pain felt. Analgesics should then be used to control the symptoms.
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This question is part of the following fields:
- Haematology & Oncology
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Question 17
Correct
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A 55-year-old female with a history of osteoarthritis of the knee, obesity and depression, presents with neck and right arm pain. She claims that the pain is present for two months and is triggered by flexing her neck. Clinical examination reveals sensory loss over the middle finger and palm of the hand without any obvious muscle atrophy or weakness. Which nerve root is most probably affected?
Your Answer: C7
Explanation:The most common cause of cervical radiculopathy is degenerative disease in the cervical spine. In 80-90% of patients with cervical radiculopathy, the C5/C6 or C6/C7 motion segments are affected by degenerative disease and the nearby C6 and/or C7 nerve roots are producing the symptoms. Patients with cervical radiculopathy complain of neck pain and radiating pain in the arm sometimes combined with sensory and motor disturbances in the arm and/or hand. These symptoms are accepted as being caused by the nerve root compression. Middle finger and palm of the hand are mostly rising the suspicion for C7 nerve root and median nerve involvement.
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This question is part of the following fields:
- Nervous System
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Question 18
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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, 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 19
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A 24-year-old smoker with testicular cancer presents with exertional dyspnoea, wheezing, and persistent non-productive cough. He completed a course of chemotherapy comprising of cisplatin, bleomycin, and etoposide three months ago. On examination, there are fine bilateral basal crackles.
Which of the following is the most likely diagnosis?Your Answer: Bleomycin toxicity
Explanation:The cytotoxic drug bleomycin can cause bleomycin-induced pneumonitis (BIP). It usually occurs during chemotherapy but can also occur up to six months post-therapy.
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This question is part of the following fields:
- Haematology & Oncology
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Question 20
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A 16-year-old boy suffers recurrent episodes of haematuria following a flu-like illness. He is otherwise well. Physical examination is normal. Urinalysis reveals no proteinuria, blood ++, and 2-3 white blood cells/mm3.
What is the most probable diagnosis?Your Answer: IgA nephropathy
Explanation:IgA nephropathy’s characteristic presentation is haematuria following a non-specific upper respiratory infection as was evident in this case. IgA nephropathy also usually occurs in children and young males, like this patient.
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This question is part of the following fields:
- Renal System
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SESSION STATS - PERFORMANCE PER SPECIALTY
