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Question 1
Incorrect
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A 70-year-old woman is having trouble in speaking following a stroke. Her limbs are paralyzed, both left upper and lower limbs. Which anatomical site is most likely affected?
Your Answer: Thalamus
Correct Answer: Internal capsule
Explanation:– The given scenario is typical of lesion in internal capsule.
– Memory impairment is caused by a hippocampal lesion,
– Impairment of arousal, facial paresis, visual field defect, facial paresis, hemiataxia, and hemispacial neglect are just some of the conditions caused by thalamic lesion.
– Brainstem stroke on the other hand causes breathing abnormality, altered consciousness, and blood pressure disorder. -
This question is part of the following fields:
- Geriatric Medicine
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Question 2
Incorrect
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A 25-year-old woman comes to the endocrine clinic for her regular follow up. She has hypertension, controlled by a combination of Ramipril and indapamide and was diagnosed with 11-beta hydroxylase deficiency since birth when she was found to have clitoromegaly.
Which of the following is most likely to be elevated?Your Answer: 17-OH progesterone
Correct Answer: 11-Deoxycortisol
Explanation:11-beta hydroxylase is stimulated by ACTH and responsible for conversion of 11-deoxycortisol to cortisol and deoxycorticosterone to corticosterone.
In 11-beta hydroxylase deficiency, the previously mentioned conversions are partially blocked, leading to:
– Increased levels of ACTH
– Accumulation of 11-deoxycortisol (which has limited biological activity) and deoxycorticosterone (which has mineralocorticoid activity)
– Overproduction of adrenal androgens (DHEA, androstenedione, and testosterone) -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 3
Incorrect
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Patients on digoxin therapy are required to receive an initially higher dose of the drug, in order to amplify the effect of the treatment. Which of the following makes this requirement necessary?
Your Answer: Plasma protein binding
Correct Answer: Half-life
Explanation:A loading dose is required for drugs that are eliminated from the body in a slow, progressive manner. Half-life is the indicator showing if a drug has a fast, intermediate or slow elimination rate.
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This question is part of the following fields:
- Cardiovascular System
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Question 4
Correct
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A study is done on 1000 patients to assess the specificity of a new rapid finger-prick blood test developed to help diagnose deep vein thrombosis (DVT). The new test was positive on 200 patients with DVT and on 100 patients without DVT. It was also negative on 20 patients with DVT and 680 without DVT. What is the specificity of the new test?
Your Answer: 680/780
Explanation: -
This question is part of the following fields:
- Evidence Based Medicine
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Question 5
Correct
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A 26-year-old student has been brought to the emergency department in a confused state. His friends report that he has been complaining of headaches for the past few weeks. He has a low-grade fever and on examination is noted to have abnormally pink mucosa. What is the most likely diagnosis?
Your Answer: Carbon monoxide poisoning
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
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Question 6
Incorrect
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A 35-year-old male has presented with a wrist drop of his right hand. After a medical examination, an area of sensory loss on the dorsum is revealed. Choose the nerve most likely to be affected from the list of options.
Your Answer: Ulnar nerve
Correct Answer: Radial nerve
Explanation:The radial nerve supplies the following: brachioradialis, extensor carpi radialis longus, and the extensor muscles of the forearm (which is via the posterior interosseous nerve). The sensory branches supply the following: dorsum of the thumb, dorsum of the fingers up to the PIPJ (proximal interphalangeal joint), and the middle of the ring finger. The loss of muscle power depends on the extent of the nerve damage – the usual posture is a wrist drop, coupled with thumb adduction and hand pronation. Sensation in this male patient is impaired in this area. The thoracic nerve supplies the serratus anterior muscle, and thus, damage causes winging of the scapula. A median nerve palsy causes the following: the inability to abduct and oppose the thumb; weakness in the forearm, pronation and finger flexion; and sensory loss of the thumb. A T1 nerve root lesion causes Klimke’s palsy – this is a loss of finger flexion, abduction and adduction, and reduced sensation in the medial upper limb. The ulnar nerve is usually compromised at the elbow which causes numbness in the 5th finger, the medial aspect of the ring finger, and the dorsum of the hand (over the 5th finger). A clawed hand can develop (the little and ring fingers curl in towards the palm) if the weakness of the small muscles of the hand is allowed to progress.
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This question is part of the following fields:
- Nervous System
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Question 7
Incorrect
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A 30-year-old male underwent an urgent appendectomy. 3 hours after the procedure he developed tachycardia and fever. He was also having pain in his abdomen and shoulder area. What is the first step in the management?
Your Answer: Start IV antibiotics
Correct Answer: Maintain IV access and give IV fluids
Explanation:The features mentioned in this case indicate an internal haemorrhage. This should be managed initially by passing an IV line and IV fluids.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 8
Correct
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The tumour suppressor gene is associated with multiple colonic polyps in which of the following autosomal dominant disorders?
Your Answer: Familial adenomatous polyposis (FAP)
Explanation:Familial adenomatous polyposis (FAP) is an inherited disorder where patients present with malignancy in their middle age. APC tumour suppressor gene is responsible for this disorder. Other disorders mentioned in the above options do not involve the tumour suppressor gene and are not autosomal dominant disorders.
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This question is part of the following fields:
- Gastrointestinal System
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Question 9
Correct
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A 40-year-old male was diagnosed with HIV. He had had multiple sexual partners. He was not willing to change his lifestyle, nor was he willing to inform any of his former partners. What is the most suitable next step for the doctor?
Your Answer: Give general advice
Explanation:General advice should be given to the patient as HIV is not a notifiable disease. Informing someone about the disease without the patient’s consent will breach the confidentiality.
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This question is part of the following fields:
- Ethical & Legal
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Question 10
Correct
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A 21-year-old woman presents with lethargy and confusion. On examination, you note a purpuric rash covering the abdominal wall and thighs, and a fever of 38C. Investigations reveal haemolytic anaemia, thrombocytopenia, and acute kidney injury.
Which feature of the presentation makes the diagnosis of thrombotic thrombocytopenic purpura more likely than haemolytic uremic syndrome?Your Answer: Confusion
Explanation:Confusion in the patient refers to neurological symptoms that are more associated with thrombotic thrombocytopenic purpura than with haemolytic uremic syndrome. All the other symptoms present in both conditions similarly.
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This question is part of the following fields:
- Renal System
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Question 11
Correct
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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: 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 & Oncology
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Question 12
Incorrect
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A 73-year-old woman presents with severe emphysema. She is on maximal therapy including high dose Seretide and tiotropium. She tells you that she is so unwell that she can barely manage the walk the 160 metres to the bus stop.
On examination she looks short of breath at rest. Her BP is 158/74 mmHg, pulse is 76 and regular. There are quiet breath sounds, occasional coarse crackles and wheeze on auscultation of the chest.
Investigations show:
Haemoglobin 14.2 g/dl (13.5-17.7)
White cell count 8.4 x 109/l (4-11)
Platelets 300 x 109/l (150-400)
Sodium 137 mmol/l (135-146)
Potassium 4.1 mmol/l (3.5-5)
Creatinine 127 micromol/l (79-118)
pH 7.4 (7.35-7.45)
pCO2 7.5 kPa (4.8-6.1)
pO2 9.7 kPa (10-13.3)
Chest x-ray - Prominent upper lobe emphysema.
FEV1 - 30% of predicted.
Which of the features of her history, examination or investigations would preclude referral for lung reduction surgery?Your Answer: pO2 9.8
Correct Answer: pCO2 7.4
Explanation:Nice guidelines for lung reduction surgery:
FEV1 > 20% predicted
PaCO2 < 7.3 kPa
TLco > 20% predicted
Upper lobe predominant emphysemaThis patient has pCO2 of 7.4 so she is unsuitable for referral for lung reduction surgery.
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This question is part of the following fields:
- Respiratory System
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Question 13
Incorrect
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Vancomycin is a glycopeptide. It acts by which mechanism?
Your Answer: Inhibition of protein synthesis (transcription)
Correct Answer: Cell wall inhibition
Explanation:Peptidoglycans are a component of bacterial cell wall and are inhibited by this antibiotic.
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This question is part of the following fields:
- Pharmacology
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Question 14
Incorrect
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A 3-year old boy presents with an abdominal mass. Which of the following is associated with Wilms tumour (nephroblastoma)?
Your Answer: Tuberose sclerosis
Correct Answer: Beckwith-Wiedemann syndrome
Explanation:Beckwith-Wiedemann syndrome is a inherited condition associated with organomegaly, macroglossia, abdominal wall defects, Wilm’s tumour and neonatal hypoglycaemia. Wilm’s tumour is a kidney cancer that usually occurs in children. The causes are unknown, however, risk factors include race and family history. Of note, Wilm’s tumour can occur as part of the following syndromes: WAGR syndrome, Denys-Drash syndrome, and Beckwith-Wiedmann syndrome and not the other listed options in this question.
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This question is part of the following fields:
- Renal System
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Question 15
Correct
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A 34-year-old man presents with haemoptysis and weight loss. History reveals he suffers from night sweats and upon auscultation you notice reduced breath sounds over the apex of his right lung and significant nail clubbing. You refer him to a pneumologist who administers the following antibiotics: rifampicin, ethambutol, pyrazinamide and isoniazid. What is the mechanism of action of the first drug?
Your Answer: Inhibit RNA synthesis
Explanation:Rifampicin specifically inhibits bacterial RNA polymerase, the enzyme responsible for DNA transcription, by forming a stable drug-enzyme complex with a binding constant of 10(-9) M at 37 C.
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This question is part of the following fields:
- Infectious Diseases
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Question 16
Correct
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An 83-year-old gentleman presents to his GP with increasing oedema and ascites. He is hypertensive, for which he takes amlodipine. There is shortness of breath on exercise. His alcohol history is two cans of stout per day.
ECG is normal, and CXR reveals normal heart size and no signs of cardiac failure. Serum albumin is 23 g/dl; urinary albumin excretion is 7 g/24 h, with no haematuria. He has mild anaemia with a normal MCV. Total cholesterol is elevated.
What diagnosis fits best with this clinical picture?Your Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome usually presents with the symptoms in this patient: low albumin, abnormal cholesterol, increased urinary albumin excretion, oedema, and as a consequence, hypertension as well.
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This question is part of the following fields:
- Renal System
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Question 17
Incorrect
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A 20-year-old pregnant female in her first trimester met a child with chickenpox. She was investigated for the varicella antibody, which came back negative. She visited her GP. Which of the following measures is the most appropriate one?
Your Answer: Vaccine only
Correct Answer: Ig
Explanation:After the exposure to chickenpox while pregnant, even if the patient is negative for antibodies she requires immunoglobulin to prevent further issues.
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This question is part of the following fields:
- Infectious Diseases
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Question 18
Correct
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A 46-year-old alcoholic, with a past history of gallstones, presented in a critical condition with complaints of severe abdominal pain which radiated backward, vomiting, dehydration and profuse sweating. He was tachycardic and hypotensive. What will be the first investigation to be performed in this case?
Your Answer: Serum lipase
Explanation:This patient is suffering from pancreatitis. Points favouring pancreatitis includes alcoholism, past history of gallstones and state of shock. Serum lipase and amylase should be performed to rule out the disease.
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This question is part of the following fields:
- Gastrointestinal System
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Question 19
Incorrect
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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
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Question 20
Correct
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A 25-year-old woman is found to have a blood pressure of 170/100 mmHg during a routine medical check. She is otherwise well and her physical examination is unremarkable.
Blood tests show:
Na+ 140 mmol/l
K+ 2.6 mmol/l
Bicarbonate 31 mmol/l
Urea 3.4 mmol/l
Creatinine 77 µmol/l
Which one of the following investigations is most likely to be diagnostic?Your Answer: Renin:aldosterone ratio
Explanation:Primary aldosteronism now is considered one of the more common causes of secondary hypertension (HTN).
Individuals with primary aldosteronism may present with hypokalaemia metabolic alkalosis; however, as many as 38% of patients with primary aldosteronism may be normokalaemia at presentation.
Routine laboratory studies can show hypernatremia, hypokalaemia, and metabolic alkalosis resulting from the action of aldosterone on the renal distal convoluted tubule (DCT) (i.e., enhancing sodium reabsorption and potassium and hydrogen ion excretion).
Plasma aldosterone/plasma renin activity ratio is used for screening because it is fairly constant over many physiologic conditions.The patient is clinically free, so Cushing diseases can be exclude.
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This question is part of the following fields:
- Endocrine System & Metabolism
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SESSION STATS - PERFORMANCE PER SPECIALTY
