-
Question 1
Correct
-
A 21-year-old patient presents with multiple itchy wheals on his skin. The wheals are of all sizes and they are exacerbated by scratching. The symptoms started after a viral infection and can last up to an hour. What is the most likely diagnosis?
Your Answer: Urticaria
Explanation:Urticaria is a group of disorders that share a distinct skin reaction pattern, namely the occurrence of itchy wheals anywhere on the skin. Wheals are short-lived elevated erythematous lesions ranging from a few millimetres to several centimetres in diameter and can become confluent. The itching can be prickling or burning and is usually worse in the evening or night time. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear.
-
This question is part of the following fields:
- The Skin
-
-
Question 2
Incorrect
-
A 35-year-old male who has smoked 20 cigarettes per day was referred to the National Chest Hospital because he has had a nine month history of shortness of breath which is getting worse. Tests revealed that he had moderate emphysema. His family history showed that his father died from COPD at the age of 52. Genetic testing found the PiSZ genotype following the diagnosis of alpha-1 antitrypsin (A1AT) deficiency. What levels of alpha-1 antitrypsin would be expected if they were to be measured?
Your Answer: 20% of normal
Correct Answer: 40% of normal
Explanation: -
This question is part of the following fields:
- Respiratory System
-
-
Question 3
Incorrect
-
A 23-year-old male patient presents with urethritis for the last 2 weeks that has not responded to antibiotics. Lately he has developed an onset of new range of symptoms that are linked to his HLA B27 positivity. Which of the following signs is not related to Reiter's syndrome?
Your Answer: Pustular lesions on the soles of the feet
Correct Answer: A mild fever with a generalised macular rash
Explanation: -
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 4
Correct
-
A 49-year-old female presents to the clinic complaining of pain in her left elbow that is localized to the left lateral epicondyle. She has spent the weekend painting her house. A diagnosis of lateral epicondylitis is suspected. The pain would characteristically worsen on which of the following movements?
Your Answer: Resisted wrist extension with the elbow extended
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, 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 results 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.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 5
Correct
-
A 60-year-old man with a history of recent thyrotoxicosis underwent major surgery a week ago. He now presents with altered mental status, tachycardia, high-grade fever, vomiting and cardiac failure. A diagnosis of thyroid storm (crisis) is made.
What is the most important next step in management?Your Answer: Transfer the patient to ITU
Explanation:Thyroid storm, also referred to as thyrotoxic crisis, is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis.
Patients with thyroid storm should be treated in an ICU setting for close monitoring of vital signs and for access to invasive monitoring and inotropic support, if necessary.
– Supportive measures
If needed, immediately provide supplemental oxygen, ventilatory support, and intravenous fluids. Dextrose solutions are the preferred intravenous fluids to cope with continuously high metabolic demand.
– Correct electrolyte abnormalities.
– Treat cardiac arrhythmia, if necessary.
– Aggressively control hyperthermia by applying ice packs and cooling blankets and by administering acetaminophen (15 mg/kg orally or rectally every 4 hours).
– Antiadrenergic drugs.
– Thionamides: Correct the hyperthyroid state. Administer antithyroid medications to block further synthesis of thyroid hormones (THs).
High-dose propylthiouracil (PTU) or methimazole may be used for treatment of thyroid storm.
– Administer glucocorticoids to decrease peripheral conversion of T4 to T3. This may also be useful in preventing relative adrenal insufficiency due to hyperthyroidism and improving vasomotor symptoms.
– Bile acid sequestrants prevent reabsorption of free THs in the gut (released from conjugated TH metabolites secreted into bile through the enterohepatic circulation).
– Treat the underlying condition. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 6
Correct
-
Surfactant reduces the surface tension at the air/liquid interface in the lung. Which of the following cells produce surfactant in the lung parenchyma?
Your Answer: Type II pneumocyte
Explanation:Pulmonary surfactant is a mixture of lipids and proteins which is secreted by the epithelial type II cells into the alveolar space.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 7
Correct
-
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
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 8
Correct
-
A 25-year-old gentleman presents to the hospital feeling unwell and breathless. History reveals that he has chronic renal failure, for which he receives haemodialysis three times per week. Since one week prior to consultation, he has been on vacation and has missed two dialysis sessions.
Examination reveals pulmonary oedema. His ECG shows no P waves, broad QRS complexes and peaked T waves.
What should you do?Your Answer: Give 10 ml of 10% calcium gluconate intravenously
Explanation:The patient is most likely complaining of the effects of hyperkalaemia, due to missing his dialysis sessions. Additionally, because the patient presents with a risk of cardiac arrest (based on pulmonary oedema and ECG findings), the best intervention is to give calcium gluconate that will address the hyperkalaemia as well as improve the cardiac condition.
-
This question is part of the following fields:
- Fluids & Electrolytes
-
-
Question 9
Correct
-
In last 5 days, an old man has complained of severe left sided headache, which was aggravated by bright lights. He has not vomited but feels nauseated. What is the most likely diagnosis?
Your Answer: Migraine
Explanation:Migraine without aura have the following characteristics: Nausea and vomiting accompanied by >5 headaches that last for 4-72 hours, plus any unilateral, pulsating headache or are aggravated by routine daily activities.
-
This question is part of the following fields:
- Nervous System
-
-
Question 10
Incorrect
-
A 29-year-old male patient with a history of three previous chest infections in the past seven months presents with fever, pleuritic pain and productive cough. Chest x-ray shows lobar consolidation and the diagnosis of a fourth chest infection is established, after sputum culture reveals Haemophilus influenzae. The previous chest infections were due to Streptococcus pneumoniae. After a period of six weeks, a full blood count, urea, CRP, electrolytes and chest x-ray turn out as normal. What is the investigation you would choose next?
Your Answer: HIV test
Correct Answer: Serum immunoglobulins
Explanation:Hypogammaglobulinemia occurs due to a variety of underlying primary or secondary immunodeficient states, including HIV which is suspected in this case. The most commonly recognised clinical feature is recurrent infection.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 11
Correct
-
Which of the following statements describe the mechanism of fibrates most accurately?
Your Answer: Increased lipoprotein lipase activity via PPAR-alpha
Explanation:The main mechanism of fibrate drugs is activation of gene transcription factors known as PPARs, particularly PPAR-?, which regulate the expression of genes that control lipoprotein metabolism. There are several consequences of PPAR-? activation, which reduce circulating LDL cholesterol and triglycerides and increase HDL cholesterol.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 12
Correct
-
A 65-year-old woman presents at clinic complaining of worsening hoarseness of voice and dyspnoea over the past month. She has a history of toxic multinodular goitre successfully treated with radioiodine. On examination, she has a firm asymmetrical swelling of the thyroid gland. Laryngoscopy demonstrates a right vocal cord paralysis and apparent external compression of the trachea.
What is the most likely diagnosis?Your Answer: Anaplastic thyroid cancer
Explanation:Thyroid malignancies are divided into papillary carcinomas (80%), follicular carcinomas (10%), medullary thyroid carcinomas (5-10%), anaplastic carcinomas (1-2%), primary thyroid lymphomas (rare), and primary thyroid sarcomas (rare).
Hürthle cell carcinoma is a rare thyroid malignancy that is often considered a variant of follicular carcinoma.
– Papillary and Follicular carcinoma are slow-growing tumours
– Sporadic cases of Medullary thyroid carcinoma also typically manifest with painless solitary thyroid nodules in the early stages.
– Anaplastic thyroid carcinoma has the most aggressive biologic behaviour of all thyroid malignancies and has one of the worst survival rates of all malignancies in general. It manifests as a rapidly growing thyroid mass in contrast to a well-differentiated carcinoma, which are comparatively slow-growing. Patients commonly present with associated symptoms due to local invasion. Hoarseness and dyspnoea resulting from the involvement of the recurrent laryngeal nerve and airway occur in as many as 50% of patients.
– Almost all patients with primary thyroid lymphoma have either a clinical history or histological evidence of chronic lymphocytic thyroiditis. The risk of primary thyroid lymphoma increases 70-fold in patients with chronic lymphocytic thyroiditis compared with the general population. Regional and distant lymphadenopathy is common. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 13
Correct
-
A 12-year-old boy has a history of fever for one week (39C), with no other symptoms leading up to the fever. He recently had a surgical extraction of one of his incisors two weeks before consultation. On examination of CVS, a mid-systolic click followed by a late systolic murmur is heard. Which of the following is the most probable diagnosis?
Your Answer: Infection
Explanation:Tooth extraction or any surgical procedure may introduce bacteria into the blood stream. The most commonly involved organisms include Staphylococcus aureus and Streptococcus viridans. Once in the blood, these organisms have a very high tendency of attaching to the walls of the heart and causing inflammation known as endocarditis.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 14
Correct
-
A 28-year-old male complained of an annular rash following an insect bite he received during a hiking trip. Which of the following is the drug of choice?
Your Answer: Doxycycline PO
Explanation:The described rash is the typical rash of erythema migrans of Lyme disease, which is treated by doxycycline PO
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 15
Incorrect
-
A 55-year-old man presented with retrosternal chest pain associated with excessive sweating and vomiting. On examination his BP was 100/60 mmHg and pulse rate was 72 bpm. Bibasal crepitations were auscultated. His ECG showed ST elevation in V1 to V4 and ST depression in leads II, III and aVF. Which of the following would be the finding during angioplasty?
Your Answer: Complete occlusion of the right coronary artery
Correct Answer: Complete occlusion of the left anterior descending artery
Explanation:The ECG findings are suggestive of anterior myocardial infarction and the most likely artery affected is the left anterior descending artery. Occlusion of the right coronary artery will be shown by ST elevation in lead II, III, aVF and occlusion of the circumflex artery will show changes in leads I, aVL, V5 and V6. To have ST elevation, there should be complete occlusion of the artery.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 16
Correct
-
Which of the following statements is true concerning gastrin?
Your Answer: Release is triggered by GI luminal peptides
Explanation:Gastrin is released by G cells in the antrum of the stomach. It stimulates secretion of gastric acid (HCl) by the parietal cells of the stomach and also aids in gastric motility. It is released in response to the following stimuli: vagal stimulation, antrum distention, hypercalcemia. It is inhibited by the following: presence of acid in stomach, SST, secretion, GIP, VIP, glucagon, calcitonin.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 17
Incorrect
-
Which of the statements given below would be the most accurate regarding airway obstruction in the newborn?
Your Answer: The commonest cause is subglottic stenosis
Correct Answer: In Pierre Robin syndrome the airway can be improved by a nasopharyngeal tube
Explanation:Pierre Robin syndrome (PRS) is a congenital defect observed in humans which is characterized by an unusually small mandible, posterior displacement or retraction of the tongue, and upper airway obstruction. Cleft palate (incomplete closure of the roof of the mouth) is present in the majority of patients.
PRS is generally diagnosed clinically shortly after birth. The infant usually has respiratory difficulty, especially when supine. The palatal cleft is often U-shaped and wider than that observed in other people with cleft palate.
Treatment:
If moderate dyspnoea: symptomatic treatment, non-invasive ventilation, supervision and assistance while eating
If severe dyspnoea: surgical correction, special interventions for long-term correction
In cases of acute life-threatening respiratory distress → tracheostomy -
This question is part of the following fields:
- Respiratory System
-
-
Question 18
Correct
-
A 34-year-old known alcoholic male has been found unconscious near a pub. The paramedics that attended to him said he was sweating and surrounded by empty cans of cider. Choose the most appropriate initial investigation from the list of options.
Your Answer: Capillary blood sugar
Explanation:Capillary blood sugar should be tested as alcohol-induced hypoglycaemia can present itself in cases such as these.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 19
Incorrect
-
A 30-year-old painter presents with a burning pain in both feet, which has deteriorated over the last six months. He drinks 60 units of alcohol weekly and has a family history of pernicious anaemia.
On examination he has impairment of all modalities of sensation in both feet but particularly pain, temperature and absent ankle jerks.
What is the most likely diagnosis?Your Answer: Vitamin B12 deficiency
Correct Answer: Alcoholic peripheral neuropathy
Explanation:Because of the patient’s history of excessive alcohol consumption, there is a strong suspicion of alcoholic peripheral neuropathy. In the UK, alcohol abuse and diabetes are the most common causes of peripheral neuropathy.
-
This question is part of the following fields:
- Nervous System
-
-
Question 20
Correct
-
In a patient with Hashimoto's thyroiditis, which of the following is most specific to the disease?
Your Answer: Anti-thyroid peroxidase antibodies
Explanation:Hashimoto thyroiditis is part of the spectrum of autoimmune thyroid diseases (AITDs) and is characterized by the destruction of thyroid cells by various cell- and antibody mediated immune processes. It usually presents with hypothyroidism, insidious in onset, with signs and symptoms slowly progressing over months to years.
The diagnosis of Hashimoto thyroiditis relies on the demonstration of circulating antibodies to thyroid antigens (mainly thyroperoxidase and thyroglobulin) and reduced echogenicity on thyroid sonogram in a patient with proper clinical features.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 21
Correct
-
Which of the following medications is a long acting adrenergic beta-receptor agonist?
Your Answer: Formoterol
Explanation:Terbutaline is a long acting beta receptor agonist. It is used as an add on drug for step 3 in treatment of bronchial asthma. It causes relaxation of bronchial smooth muscles and thus, bronchodilatation.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 22
Incorrect
-
A 55-year-old diabetic male presents with a feeling of generally being unwell. He also has a history of atrial fibrillation and epilepsy. His main complaint is a blue tinge to his vision. Which one of his medications is most likely to be responsible?
Your Answer: Phenytoin
Correct Answer: Sildenafil
Explanation:Blue tinge of vision/cyanopsia is caused due to the intake of sildenafil citrate.
Sildenafil citrate (Viagra) is the first oral drug to be widely approved for the treatment of erectile dysfunction.
It is a potent and selective inhibitor of type-V phosphodiesterase, the primary form of the enzyme found in human penile erectile tissue, thereby preventing the breakdown of cyclic guanosine monophosphate (cGMP), the intracellular second messenger of nitric oxide.Uses:
It is used for the treatment of erectile dysfunction, idiopathic pulmonary hypertension, premature ejaculation, high altitude illness, penile rehabilitation after radical prostatectomy, angina pectoris, and lower urinary tract symptoms.Adverse effects:
Mild headache, flushing, dyspepsia, cyanopsia, back pain, and myalgias – due to a high concentration of PDE11 enzyme in skeletal muscle, which shows significant cross-reactivity with the use of tadalafil.
It can also cause hypotension, dizziness, and rhinitis.Note: Xanthopsia (yellow-green vision) may occur secondary to treatment with digoxin.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 23
Incorrect
-
A 53-year-old male underwent a partial gastrectomy 15 years ago for a complicated peptic ulcer. Which of the following elements may be deficient in this man?
Your Answer: Folate
Correct Answer: Iron
Explanation:The proper gastric acidity is required to transform iron from ferric to ferrous state in order to be absorbable. Even partial gastrectomy may cause dumping syndrome. Malabsorption is rare.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 24
Incorrect
-
A 32-year-old female has had an episode of a severe occipital headache. This is accompanied by vomiting and unconsciousness. She has been taken to the emergency department, where she is conscious and completely alert. Her pulse is normal and no abnormal neurological signs are found. From the list of options, choose the next step in her treatment.
Your Answer: MRI head
Correct Answer: CT brain
Explanation:Severe headaches and LOC can be caused by basilar migraines (but here the patient has no neurological deficit and becomes completely alert when recovering from unconscious periods). In order to diagnose basilar migraines, there needs to be a history of at least two other migraine attacks with an aura. The diagnostic criteria of a basilar migraine are not fulfilled and so the patient must not be discharged without a CT scan (or MRI).
-
This question is part of the following fields:
- Nervous System
-
-
Question 25
Correct
-
A 22-year-old woman has ingested an unknown quantity of paracetamol tablets four hours ago. She now presents with nausea, vomiting, anorexia and right subchondral pain.
Which of the following features suggest that she should be transferred to the liver unit?Your Answer: pH 7.25
Explanation:The most widely used prognostic predictors for acetaminophen over-ingestion is King’s College Criteria, which is: arterial PH < 7.3 after fluid resuscitation, Cr level > 3.4, PT > 1.8x control or > 100s, or INR > 6.5, and Grave III or IV encephalopathy.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 26
Incorrect
-
A 14-year-old girl came to the emergency room in a bizarre state with altered consciousness, presenting with symptoms of insomnia, logorrhoea, and anxiety, with incoherent discourse and amnesia of recent events. She has started calling herself The Queen, and is refusing to be her parents' daughter. What is the most likely diagnosis?
Your Answer: Cotard syndrome
Correct Answer: Ganser syndrome
Explanation:Ganser syndrome is a condition in which a person acts as if he is suffering from a specific psychological disorder in order to gain sympathy and relief.
-
This question is part of the following fields:
- Nervous System
-
-
Question 27
Incorrect
-
Which among the following antihypertensives is centrally acting?
Your Answer: Minoxidil
Correct Answer: Moxonidine
Explanation:Moxonidine and alpha-methyl dopa are centrally acting antihypertensives and modify blood pressure through modifying sympathetic activity.
Other options:
Verapamil is a calcium antagonist.
Minoxidil and hydralazine are both vasodilators.
Phenoxybenzamine is an alpha-blocker.Adverse effects:
Dry mouth and somnolence were the most frequently reported adverse events, followed by headache, dizziness, nausea and allergic skin reactions. -
This question is part of the following fields:
- Pharmacology
-
-
Question 28
Correct
-
A 75-year-old male with rheumatoid arthritis underwent a colectomy 2 days ago for colon cancer. He was put on a prophylactic dose of low molecular weight heparin postoperatively as well as prednisolone. Now he complains of central chest pain and his ECG revealed an acute ST elevation myocardial infarction. He was given aspirin and oxygen as the initial treatment. Which of the following is the most appropriate management for this patient?
Your Answer: IV diamorphine + arrange percutaneous coronary intervention
Explanation:There is a high risk of bleeding due to recent surgery and heparin. So thrombolysis is not an option. The most appropriate management is percutaneous coronary intervention.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 29
Incorrect
-
A study is developed to compare two chemotherapy schemas for individuals with small cell lung cancer. Which of the following would you choose to compare survival time with in this particular study?
Your Answer: Absolute risk reduction
Correct Answer: Hazard ratio
Explanation:The hazard ratio describes the relative risk of the complication based on comparison of event rates.
Hazard ratios have also been used to describe the outcome of therapeutic trials where the question is to what extent treatment can shorten the duration of the illness. However, the hazard ratio, a type of relative risk, does not always accurately portray the degree of abbreviation of the illness that occurred. In these circumstances, time-based parameters available from the time-to-event curve, such as the ratio of the median times of the placebo and drug groups, should be used to describe the magnitude of the benefit to the patient. The difference between hazard-based and time-based measures is analogous to the odds of winning a race and the margin of victory. The hazard ratio is the odds of a patient’s healing faster under treatment but does not convey any information about how much faster this event may occur.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 30
Correct
-
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.
-
This question is part of the following fields:
- Pharmacology
-
SESSION STATS - PERFORMANCE PER SPECIALTY
