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Question 1
Correct
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Which of the following measurements is a poor prognostic factor in patients suffering from pneumonia?
Your Answer: Respiratory rate 35/min
Explanation:CURB Pneumonia Severity Score estimates the mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.
Select Criteria:
Confusion (abbreviated Mental Test Score <=8) (1 point)
Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point)
Respiratory Rate > 30 per minute (1 point)
Blood Pressure: diastolic < 60 or systolic < 90 mmHg (1 point) The CURB-65 scores range from 0 to 5. Clinical management decisions can be made based on the score:
Score Risk Disposition
0 or 1 – 1.5% mortality – Outpatient care
2 – 9.2% mortality – Inpatient vs. observation admission
> 3 – 22% mortality – Inpatient admission with consideration for ICU admission with score of 4 or 5 -
This question is part of the following fields:
- Respiratory System
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Question 2
Incorrect
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A 65-year-old female presented in emergency 12 hours after the ingestion of 14g of quinine sulphate. Which of the following is the most likely side effect of this drug?
Your Answer: Hyperacusis
Correct Answer: Blindness
Explanation:The main effects of quinine affect the nervous system. It particularly affects the optic and auditory nerves. While affecting the auditory nerve it may cause tinnitus and deafness but not hyperacusis. Blindness is the effect of this drug on the optic nerve.
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This question is part of the following fields:
- Pharmacology
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Question 3
Correct
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Which of the following is correct regarding lead poisoning?
Your Answer: Causes a peripheral neuropathy due to demyelination
Explanation:Lead can be absorbed through the skin and by inhalation. It is associated with iron deficiency and a microcytic anaemia. The most common gastrointestinal symptoms are abdominal colic and constipation.
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This question is part of the following fields:
- Pharmacology
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Question 4
Correct
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A 22-year-old gentleman presents to A&E for the third time with recurrent urinary stones. There appear to be no predisposing factors, and he is otherwise well; urine culture is unremarkable. The urine stones turn out to be cystine stones.
What is the most likely diagnosis in this case?Your Answer: Cystinuria
Explanation:Cystinuria is strongly suspected because of the recurrent passing of cystine stones and otherwise non-remarkable medical history of this young adult patient. Like Cystinuria, all the conditions listed are also inherited disorders, however, the other differentials usually present in the early years of childhood, usually with failure to thrive.
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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 41-year-old gentleman required high doses of intravenous diuretics after his renal transplant for the purposes of fluid management. Soon after administration he developed hearing loss, tinnitus, and vertigo.
Which diuretic is most likely to have caused this?Your Answer: Furosemide
Explanation:Furosemide is a loop diuretic that is known to have significant ototoxicity side-effects although the mechanism is not fully known.
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This question is part of the following fields:
- Renal System
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Question 6
Correct
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A child with jaundice and pale stools would most likely be evaluated by which of the following tests?
Your Answer: US
Explanation:Blood tests do not help in the diagnosis of jaundice except of course by telling the level of jaundice (bilirubin) and providing some corroborative evidence such as autoantibodies, tumour markers or viral titres in the case of hepatitis. Classifying causes of jaundice on the basis of ultrasound provides a quick and easy schema for diagnosing jaundice which is applicable in primary care as well as hospital based practice.
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This question is part of the following fields:
- Hepatobiliary System
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Question 7
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: Clopidogrel 75mg
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:
- Emergency & Critical Care
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Question 8
Incorrect
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Out of the following, which is not associated with polycythaemia vera?
Your Answer: Hypertension
Correct Answer: Raised ESR
Explanation:Polycythaemia vera (PV) is associated with a low ESR.
PV, also known as polycythaemia rubra vera, is a myeloproliferative disorder caused by clonal proliferation of marrow stem cells leading to an increase in red cell volume, often accompanied by overproduction of neutrophils and platelets. It has peak incidence in the sixth decade of life, with typical features including hyperviscosity, pruritus, splenomegaly, haemorrhage (secondary to abnormal platelet function), and plethoric appearance. PV is associated with a low ESR.
Some management options of PV include lose-dose aspirin, venesection (first-line treatment), hydroxyurea (slightly increased risk of secondary leukaemia), and radioactive phosphorus (P-32) therapy.
In PV, thrombotic events are a significant cause of morbidity and mortality. 5-15% of the cases progress to myelofibrosis or acute myeloid leukaemia (AML). The risk of having AML is increased with chemotherapy treatment.
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This question is part of the following fields:
- Haematology & Oncology
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Question 9
Incorrect
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Three days after being admitted for a myocardial infarction, a male patient complains of sudden change in vision. The medical registrar examines the patient and finds that the patient's vision in both eyes is significantly reduced although the patient still claims that he can see. The pupils are equal in size, and the pupil responses are normal with normal fundoscopy. Significantly, the patient has now developed atrial fibrillation.
A referral is made to the ophthalmologist who confirms bilateral blindness. Despite this, however, the patient fervently believes that he can see and has taken to describing objects that he has never seen previously, in discriminating detail.
What is the most likely diagnosis?Your Answer: Bilateral central retinal artery occlusion
Correct Answer: Bilateral occipital cortex infarction
Explanation:Bilateral occipital cortex infarction will produce varying degrees of cortical blindness, wherein the patient has no vision but fundoscopy findings are normal. When there are extensive lesions, patients my present with denial of their condition, known as Anton’s Syndrome, and begin to describe objects that they have never seen before.
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This question is part of the following fields:
- Nervous System
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Question 10
Incorrect
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An soccer player suddenly collapsed on the field and started coughing along with shortness of breath. The investigation of choice in this case would be?
Your Answer: CT pulmonary angiogram (CTPA)
Correct Answer: Chest x-ray
Explanation:Exercise induced asthma is characterised by sudden onset wheezing, cough and shortness of breath while performing hectic physical activity. The best investigation to perform is a chest X-ray.
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This question is part of the following fields:
- Respiratory System
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Question 11
Incorrect
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A 18-year-old male was screened for hypertrophic cardiomyopathy (HOCM) as his brother had the same condition. What is the echocardiographic finding that is related to the highest risk of sudden cardiac death?
Your Answer: A gradient of 10 mmHg across the left ventricular outflow tract
Correct Answer: Significant thickening of the interventricular septum
Explanation:There are five prognostic factors which indicate poor prognosis in HOCM:
-family history of HOCM-related sudden cardiac death
-unexplained recent syncope
-large left ventricular wall thickness (MLVWT > 30 mm)
-multiple bursts of nsVT on ambulatory electrocardiography
-hypotensive or attenuated blood pressure response to exercise -
This question is part of the following fields:
- Cardiovascular System
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Question 12
Incorrect
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A 71-year-old male got trapped under a cupboard for 4 hours which accidentally fell on his leg while he was moving his house. Which enzyme activity would you measure in this patient?
Your Answer:
Correct Answer: Creatinine kinase
Explanation:Creatine kinase (CK) is an enzyme found in the heart, brain, skeletal muscle, and other tissues. Increased amounts of CK are released into the blood when there is muscle damage. This test measures the amount of creatine kinase in the blood.
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This question is part of the following fields:
- Musculoskeletal System
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Question 13
Incorrect
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A 32-year-old male who is a known case of sickle cell disease presents to the Accident and Emergency (A&E) department with fever, tachypnoea, and rib pain. On examination, he has a low-grade fever of 37.9°C, oxygen saturation of 95% on air, and bilateral vesicular breath sounds on chest auscultation. CXR shows opacification in the right middle zone.
Which of these statements most accurately describes the initial management of this patient?Your Answer:
Correct Answer: Incentive spirometry is indicated
Explanation:This is a typical picture of acute chest syndrome (ACS). According to the British Committee for Standards in Haematology (BCSH), ACS is defined as ‘an acute illness characterised by fever and/or respiratory symptoms, accompanied by a new pulmonary infiltrate on chest X-ray’. ACS occurs in sequestration crisis, which is one of the four main types of crises occurring in sickle cell disease.
The fundamentals of initial management are as follows:
1. Oxygen therapy to maintain saturation >95%
2. Intravenous fluids to ensure euvolemia
3. Adequate pain relief
4. Incentive spirometry in all patients presenting with rib or chest pain
5. Antibiotics with cover for atypical organisms
6. Bronchodilators if asthma co-exists with acute chest syndrome, or if there is an evidence of acute bronchospasm on auscultation
7. Early consultation with the critical care team and haematology departmentA senior haematologist then makes a decision as to whether a simple or exchange transfusion is necessary in order to achieve a target Hb of 10.0-11.0g/dL in either instance.
Sickle Cell Crises:
Sickle cell anaemia is characterised by periods of good health with intervening crises:
1. Sequestration crisis: acute chest syndrome (i.e. fever, dyspnoea, chest/rib pain, low pO2, and pulmonary infiltrates)2. Thrombotic (painful or vaso-occlusive) crisis: precipitated by infection, dehydration, and deoxygenation
3. Aplastic crisis: sudden fall in haemoglobin without marked reticulocytosis, usually occurring secondary to parvovirus infection
4. Haemolytic crisis: fall in haemoglobin secondary to haemolysis, rare type of sickle cell crises
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This question is part of the following fields:
- Haematology & Oncology
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Question 14
Incorrect
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An elderly woman is referred with worsening chronic pulmonary disease (COPD). She smokes seven cigarettes per day. Her exercise tolerance is only a few yards around the house now. Her FEV1 is 37% of predicted.
What is the most appropriate intervention for this patient?Your Answer:
Correct Answer: Give regular high-dose inhaled fluticasone and inhaled long-acting β-agonist
Explanation: -
This question is part of the following fields:
- Respiratory System
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Question 15
Incorrect
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A study is developed to assess a new mandibular advancement device designed to reduce snoring. A 10 point scale was used to assess the severity of snoring before and after applying of the device by the respective partner. The number of the people involved in the study was 50. What test would you apply in this particular study?
Your Answer:
Correct Answer: Wilcoxon signed-rank test
Explanation:Steps required in performing the Wilcoxon signed rank test:
1 State the null hypothesis and, in particular, the hypothesized value for comparison
2 Rank all observations in increasing order of magnitude, ignoring their sign. Ignore any observations that are equal to the hypothesized value. If two observations have the same magnitude, regardless of sign, then they are given an average ranking
3 Allocate a sign (+ or -) to each observation according to whether it is greater or less than the hypothesized value (as in the sign test)
4 Calculate:
R+ = sum of all positive ranks
R- = sum of all negative ranks
R = smaller of R+ and R-
5 Calculate an appropriate P value What makes this test the most appropriate for this study is that the data is non-parametric, paired and comes from the same population. -
This question is part of the following fields:
- Evidence Based Medicine
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Question 16
Incorrect
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A 45-year-old man with diabetes comes to the clinic for his annual review.
He has had diabetes for eight years and he is also being treated for hypertension. He is on the following medications: metformin 500 mg tds, gliclazide 80 mg daily, atorvastatin 10 mg/d, Ramipril 10 mg/d and Bendroflumethiazide 2.5 mg/d.
He is noted to be obese (130kg). Physical examination is otherwise unremarkable.
Investigations reveal:
HbA1c 8.1% (3.8-6.4)
Fasting glucose 9 mmol/L (3.0-6.0)
24 hr Urine free cortisol 354 mmol/d (<250)
9am Plasma ACTH 4 ng/dL (10-50)
CT abdomen 3 cm right adrenal mass
Which of the following is most likely to be the adrenal mass?Your Answer:
Correct Answer: Cortisol secreting adenoma
Explanation:The patient has Cushing syndrome suggested by the elevated 24hr urine free cortisol. Hence, the mass is most probably a cortisol secreting adenoma.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 17
Incorrect
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Which of the following features of the jugular venous waveform indicates the closure of the tricuspid valve?
Your Answer:
Correct Answer: c wave
Explanation:The a wave indicates atrial contraction. The c wave indicates ventricular contraction and resulting bulging of the tricuspid valve into the right atrium during isovolumetric systole. The v wave indicates venous filling. The x descent indicates the atrium relaxation and the movement of tricuspid valve downward. The y descent indicates the filling of the ventricle after the opening of the tricuspid valve.
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This question is part of the following fields:
- Cardiovascular System
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Question 18
Incorrect
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A 50-year-old male presented with acute severe central chest pain and acute ST elevation myocardial infarction was diagnosed. He was treated with streptokinase. 2 days later he was sweating excessively and he was found to be hypotensive. Which of the following cannot be considered as a reason for this presentation?
Your Answer:
Correct Answer: Hypotensive effect of streptokinase
Explanation:Hypotensive effect of streptokinase occurs during the streptokinase infusion which is usually transient. Acute mitral regurgitation due to rupture of papillary muscles, ventricular septal defects and reinfarctions (left or right) are known to cause hypotension after 24 hrs. Pulmonary embolism is less likely but cannot be excluded.
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This question is part of the following fields:
- Cardiovascular System
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Question 19
Incorrect
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A 21 year-old software developer undergoes a planned lumbar puncture (LP) as part of a neurological investigation for possible multiple sclerosis. During the consent process, she expresses concern about a post-LP headache. What is the mechanism of post-LP headaches?
Your Answer:
Correct Answer: Leaking cerebrospinal fluid from the dura
Explanation:Leaking of cerebrospinal fluid from the dura is the most likely explanation for post-lumbar puncture headaches. It is thought that ongoing leak of cerebrospinal fluid (CSF) through the puncture site causes ongoing CSF loss, leading to low pressure. A post-LP headache is typically frontal or occipital and occurs within three days. It is normally associated with worsening on standing and improvement when lying down. Treatment in severe cases includes an epidural blood patch, but most resolve on their own.
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This question is part of the following fields:
- Nervous System
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Question 20
Incorrect
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A 30-year-old male presented with exercise related syncope and dyspnoea for 2 weeks. His father passed away at the age of 40, due to sudden cardiac death. His ECG showed left ventricular hypertrophy with widespread T wave inversions. Which of the following is the most appropriate next investigation to confirm the diagnosis?
Your Answer:
Correct Answer: Transthoracic echo
Explanation:The most likely diagnosis is hypertrophic obstructive cardiomyopathy which is suggestive by the history, positive family history and ECG findings. Two-dimensional echocardiography is diagnostic for hypertrophic cardiomyopathy. In general, a summary of echocardiography findings includes abnormal systolic anterior leaflet motion of the mitral valve, LV hypertrophy, left atrial enlargement, small ventricular chamber size, septal hypertrophy with septal-to-free wall ratio greater than 1.4:1, mitral valve prolapse and mitral regurgitation, decreased midaortic flow, and partial systolic closure of the aortic valve in midsystole.
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This question is part of the following fields:
- Cardiovascular System
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Question 21
Incorrect
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A 20-year-old football player has fallen and hit his head on the ground. He did not lose consciousness but has a left side subconjunctival haemorrhage, swelling, and tenderness over his left cheek. Which of the following is the most appropriate initial investigation?
Your Answer:
Correct Answer: Facial XR
Explanation:History and examination findings are suggestive of facial injury and intracranial haemorrhage is unlikely. To exclude any facial fracture, an X-ray is suggested.
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This question is part of the following fields:
- Nervous System
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Question 22
Incorrect
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A 35-year-old chronic smoker complains of pain in the calf while walking. This symptom has been increasing in severity for 4 months. There is a painful ulcer at the base of left first toe, which despite treatment has not improved. Dorsalis pedis and posterior tibial pulses were absent on the same side. What is the most compatible diagnosis of this presentation?
Your Answer:
Correct Answer: Thromboangitis Obliterans
Explanation:Thromboangitis obliterans or Buerger’s disease is an inflammatory vasculopathy which is characterized by an inflammatory endarteritis and mainly affects small and medium-sized arteries as well as veins of the upper and lower extremities. It is caused by a prothrombotic state and subsequent obstruction of blood vessels. Ischemic pain, features of inflammation along the vein affected, Raynaud’s phenomenon and painful non-healing ulcers are common presentations.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 23
Incorrect
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A 63-year-old man with known allergic bronchopulmonary aspergillosis presents to the A&E Department with an exacerbation. Which therapy represents the most appropriate management?
Your Answer:
Correct Answer: Oral glucocorticoids
Explanation:Allergic bronchopulmonary aspergillosis (ABPA) is a form of lung disease that occurs in some people who are allergic to Aspergillus. With ABPA, this allergic reaction causes the immune system to overreact to Aspergillus leading to lung inflammation. ABPA causes bronchospasm (tightening of airway muscles) and mucus build-up resulting in coughing, breathing difficulty and airway obstruction.
Treatment of ABPA aims to control inflammation and prevent further injury to your lungs. ABPA is a hypersensitivity reaction that requires treatment with oral corticosteroids. Inhaled steroids are not effective. ABPA is usually treated with a combination of oral corticosteroids and anti-fungal medications. The corticosteroid is used to treat inflammation and blocks the allergic reaction. Examples
of corticosteroids include: prednisone, prednisolone or methylprednisolone. Inhaled corticosteroids alone – such as used for asthma treatment – are not effective in treating ABPA. Usually treatment with an oral corticosteroid is needed for months.The second type of therapy used is an anti-fungal medication, like itraconazole and voriconazole. These medicines help kill Aspergillus so that it no longer colonizes the airway. Usually one of these drugs is given for at least 3 to 6 months. However, even this treatment is not curative and can have side effects.
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This question is part of the following fields:
- Respiratory System
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Question 24
Incorrect
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A 50-year-old male patient with schizophrenia complained of chest pain and palpitations. His ECG revealed torsades de pointes ventricular tachycardia. He was on thioridazine for schizophrenia. What is the most appropriate management for his presentation?
Your Answer:
Correct Answer: IV magnesium
Explanation:Thioridazine has a quinidine-like action on the heart and is known to cause cardiac arrhythmias including prolonged PR and QT intervals and widening of QRS complexes. Intravenous magnesium sulphate is regarded as the treatment of choice for this arrhythmia.
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This question is part of the following fields:
- Cardiovascular System
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Question 25
Incorrect
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Which one of the following conditions is least likely to be associated with pyoderma gangrenosum?
Your Answer:
Correct Answer: Syphilis
Explanation:The following are conditions commonly associated with pyoderma gangrenosum:
Inflammatory bowel disease:
– Ulcerative colitis
– Crohn’s disease
Arthritides:
– Rheumatoid arthritis
– Seronegative arthritis
Haematological disease:
– Myelocytic leukaemia[8]
– Hairy cell leukaemia
– Myelofibrosis
– Myeloid metaplasia
– Monoclonal gammopathy
Autoinflammatory disease:
– Pyogenic sterile arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome)
– Granulomatosis with polyangiitis -
This question is part of the following fields:
- The Skin
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Question 26
Incorrect
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A 35-year-old female with chronic pelvic pain, was recently diagnosed with PID. She was prescribed doxycycline. After 2 days she returned with complaints of abdominal bloating, nausea and regurgitation. Which of the following advice should be given to her?
Your Answer:
Correct Answer: Take Doxycycline after meals
Explanation:Doxycycline is known to cause dyspeptic symptoms. So advising to take Doxycycline after meals is important. Taking with meals or adding an antacid is not advised, as both will cause reduction in drug absorption.
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This question is part of the following fields:
- Pharmacology
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Question 27
Incorrect
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Question 28
Incorrect
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A 70-year-old thyroid cancer patient is admitted due to dyspnoea. Which investigation should be done to assess for possible compression of the upper airways?
Your Answer:
Correct Answer: Flow volume loop
Explanation:Flow-volume loop is an easy, non-invasive diagnostic tool that can be used even in severely-ill patients. It can provide information about the location of the obstruction and can differentiate between obstructive pulmonary disease and upper-airway obstruction. Therefore, it is recommended to obtain a flow-volume loop during the assessment of patients with upper airway obstruction.
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This question is part of the following fields:
- Respiratory System
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Question 29
Incorrect
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A 24-year-old male has been found unconscious by a stranger in an alleyway. His RR is 6 bpm and his HR is 60 bpm. His pupils are also constricted. From the list of options, what is the best treatment option?
Your Answer:
Correct Answer: Naloxone
Explanation:The respiratory depression and miosis in this patient indicate opiate poisoning. For this, the best treatment is naloxone.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 30
Incorrect
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A 35-year-old previously well male gives a history of on-and-off retrosternal heaviness during exertion, relieved by resting. Pain lasts about 20-25 minutes. What is the clinical diagnosis of this presentation?
Your Answer:
Correct Answer: Stable angina
Explanation:The history is suggestive of stable angina because of it’s duration, aggravating and relieving factors. Patients get retrosternal pain or discomfort which sometimes radiates to jaw or left axilla during a period of increased myocardial demand. Pain relieves during resting when myocardial demand meets supply.
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This question is part of the following fields:
- Cardiovascular System
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Question 31
Incorrect
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Regarding Giardia Lamblia which one of the following statements is true?
Your Answer:
Correct Answer: May cause intestinal malabsorption
Explanation:Giardiasis also known as travellers diarrhoea is caused by Giardia lamblia, which is an anaerobic parasite affecting the small intestine. It can lead to diarrhoea, flatulence, abdominal cramps, malodourous greasy stools and intestinal malabsorption. It can also cause bloody diarrhoea. The investigation of choice is stool examination for trophozoites and cysts. It is treated by metronidazole and tinidazole as first line therapies.
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This question is part of the following fields:
- Infectious Diseases
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Question 32
Incorrect
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A 36-year-old man is being investigated for recurrent gastric and duodenal ulceration diagnosed at endoscopy. He has suffered from bouts of abdominal pain and intermittent diarrhoea although his weight is stable.
Some of his investigations are outlined below.
Basal acid secretion 20 mEq/h (1-5)
Fasting gastrin 200 pg/ml (<100)
Secretin test:
Basal gastrin 200 pg/ml
Post-secretin 500 pg/ml
Which of the following are responsible for the elevated gastrin levels?Your Answer:
Correct Answer: Gastrinoma
Explanation:This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. The secretin test is a test that can differentiate gastrinoma from other causes of high gastrin levels. Gastrin will rise after secretin injection if the patient has a gastrinoma.
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This question is part of the following fields:
- Gastrointestinal System
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Question 33
Incorrect
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A 3-year-old boy presents with facial puffiness, frothy urine, lethargy and oliguria for two weeks. Urine analysis reveals proteinuria. Which of the following is the most appropriate treatment for this child?
Your Answer:
Correct Answer: Prednisolone
Explanation:The presentation is suggestive of nephrotic syndrome. A trial of corticosteroids is the first step in treatment of idiopathic nephrotic syndrome. Diuretics are useful in managing symptomatic oedema. Cyclosporin and cyclophosphamide are indicated in frequently relapsing and steroid dependant disease.
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This question is part of the following fields:
- Renal System
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Question 34
Incorrect
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What is the mechanism of action of sumatriptan?
Your Answer:
Correct Answer: 5-HT1 agonist
Explanation:Triptans are specific 5-HT1 agonists used in the acute treatment of migraine. They are generally used as first-line therapy in combination with an NSAID or paracetamol.
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This question is part of the following fields:
- Pharmacology
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Question 35
Incorrect
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A 48-year-old woman with chronic pancreatitis due to gallstones presents with a macrocytic anaemia. The anaemia is most likely caused by:
Your Answer:
Correct Answer: Vitamin B12 deficiency
Explanation:Vit b12 requires trypsin enzyme to split it from its R-binders in order to make the vitamin bind to intrinsic factor required for absorption. In alcoholic patients, chronic pancreatitis is very common. Other causes related to alcoholism can be folate deficiency or bone marrow dysfunction.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 36
Incorrect
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Which of the following is most consistent with achondroplasia?
Your Answer:
Correct Answer: May be diagnosed radiologically at birth
Explanation:Achondroplasia is the most common type of short-limb disproportionate dwarfism. A single gene mapped to the short arm of chromosome 4 (band 4p16.3) is responsible for achondroplasia and is transmitted as an autosomal dominant trait. All people with achondroplasia have a short stature.
Characteristic features of achondroplasia include an average-size trunk, short arms and legs with particularly short upper arms and thighs, limited range of motion at the elbows, and an enlarged head (macrocephaly) with a prominent forehead. Fingers are typically short and the ring finger and middle finger may diverge, giving the hand a three-pronged (trident) appearance. People with achondroplasia are generally of normal intelligence.
Examination of the infant after birth shows increased front-to-back head size. There may be signs of hydrocephalus. It may be diagnosed radiographically at birth, or becomes obvious within the first year with disparity between a large skull, normal trunk length and short limbs. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 37
Incorrect
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Which of the following is not a recognised feature of methemoglobinemia?
Your Answer:
Correct Answer: Decreased pO2 but normal oxygen saturation
Explanation:Normal pO2 but decreased oxygen saturation is characteristic of methemoglobinemia.
Methemoglobinemia is a rare condition in which the haemoglobin iron is in oxidized or ferric state (Fe3+) and cannot reversibly bind oxygen. Normally, the conversion of ferrous form of iron (Fe2+) to its ferric form (Fe3+) is regulated by NADH methaemoglobin reductase, which results in the reduction of methaemoglobin to haemoglobin. Disruption in the enzyme leads to increased methaemoglobin in the blood. There is tissue hypoxia as Fe3+ cannot bind oxygen, and hence the oxygen-haemoglobin dissociation curve is shifted to the left.
Methemoglobinemia can occur due to congenital or acquired causes. Congenital causes include haemoglobin variants such as HbM and HbH, and deficiency of NADH methaemoglobin reductase. Acquired causes are drugs (e.g. sulphonamides, nitrates, dapsone, sodium nitroprusside, and primaquine) and chemicals (such as aniline dyes).
The features of methemoglobinemia are cyanosis, dyspnoea, anxiety, headache, severe acidosis, arrhythmias, seizures, and loss of consciousness. Patients have normal pO2 but oxygen saturation is decreased. Moreover, presence of chocolate-brown coloured arterial blood (colour does not change with addition of O2) and brown urine also point towards the diagnosis of methemoglobinemia.
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This question is part of the following fields:
- Haematology & Oncology
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Question 38
Incorrect
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A patient was admitted due to vomiting for further investigations. He noticed blood in his vomit and the physicians decided to perform an esophagogastroduodenoscopy which revealed haemorrhage in the lesser curvature of the stomach. Which artery is responsible for the bleeding?
Your Answer:
Correct Answer: Right gastric artery
Explanation:The right gastric artery arises from the hepatic artery or the left hepatic artery and supplies the pylorus, traveling along the lesser curvature of the stomach anastomosing with the left gastric artery.
The pancreaticoduodenal artery supplies mainly the upper and lower duodenum and the head of the pancreas.
The gastro-omental arteries supply the greater curvature of the stomach. -
This question is part of the following fields:
- Gastrointestinal System
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Question 39
Incorrect
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A 68-year-old male patient presents with central chest pain and associated flushing. He claims the pain is crushing in character. ECG reveals T wave inversion in II, III and AVF. Blood exams are as follows: Troponin T = 0.9 ng/ml. Which substance does troponin bind to?
Your Answer:
Correct Answer: Tropomyosin
Explanation:Troponin T is a 37 ku protein that binds to tropomyosin, thereby attaching the troponin complex to the thin filament.
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This question is part of the following fields:
- Musculoskeletal System
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Question 40
Incorrect
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High titre of which of the following antibodies is not considered diagnostic for the mentioned disease?
Your Answer:
Correct Answer: Rheumatoid factor in rheumatoid arthritis (RA)
Explanation:Diagnosis of RA is mainly based on clinical features (e.g., morning stiffness, symmetrical joint swelling) and laboratory tests (e.g., anti-CCP). Rheumatoid factor is not very specific for this disease and hence has low reliability. X-ray findings (e.g., soft tissue swelling or joint space narrowing) occur late in the disease and are therefore not typically used for diagnosis.
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This question is part of the following fields:
- Musculoskeletal System
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Question 41
Incorrect
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A 50-year-old female was admitted to the emergency department with a moderate fever and productive cough. She commonly experiences central chest pain and regurgitation of undigested food particles. She did not suffer from acid reflux. Solid and liquid diet have both been affected for the last 4 months. A CXR showed an air-fluid level behind a normal sized heart. What is the most likely diagnosis?
Your Answer:
Correct Answer: Achalasia
Explanation:The diagnosis is aspiration pneumonia due to the retained food in the oesophagus. This is the case with achalasia. There is no acid reflux in this disease. An air fluid level behind the heart also favours achalasia. In hiatus hernia, GORD is usually present with nausea and vomiting. In the case of a pharyngeal pouch being present, halitosis would be evident.
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This question is part of the following fields:
- Gastrointestinal System
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Question 42
Incorrect
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A 36-year-old man is scheduled to start on interferon-alpha and ribavirin for the treatment of hepatitis C. His past history includes intravenous drug usage. Which are the most common side effects of interferon-alpha?
Your Answer:
Correct Answer: Depression and flu-like symptoms
Explanation:Adverse effects due to IFN-alpha have been described in almost every organ system. Many side-effects are clearly dose-dependent. Taken together, occurrence of flu-like symptoms, haematological toxicity, elevated transaminases, nausea, fatigue, and psychiatric sequelae are the most frequently encountered side effects.
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This question is part of the following fields:
- Infectious Diseases
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Question 43
Incorrect
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A 65-year-old, heavily alcohol dependent man came to the hospital with bleeding gums and petechiae upon examination. Which of the following is the likely vitamin deficiency?
Your Answer:
Correct Answer: C
Explanation:Vitamin deficiencies can happen in alcoholics due to malabsorption. Vitamin C deficiency or scurvy can result in bleeding gums and early symptoms including body weakness and lethargy. Other vitamin deficiencies can cause the following:
B1 or thiamine – Wernicke’s encephalopathy
B12 or cyanocobalamin – spinal cord degeneration
Vitamin K – anticoagulant effects
Vitamin E – neuropathies. -
This question is part of the following fields:
- Gastrointestinal System
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Question 44
Incorrect
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A 32-year-old female patient has the following signs and symptoms: smooth goitre, lid lag and bilateral exophthalmos with puffy eyelids and conjunctival injections. She has a history of thyrotoxicosis but wants to fall pregnant. What would be the most appropriate treatment for her?
Your Answer:
Correct Answer: 18m of Propylthiouracil (PTU) alone
Explanation:Propylthiouracil (PTU) is a safe choice for a woman that is planning a pregnancy because it does not have the teratogenic effects as carbimazole does. Methimazole (MMI) and propylthiouracil (PTU) are the standard anti-thyroid drugs used in the treatment of hyperthyroidism in pregnancy. Carbimazole can cause spina bifida, CV malformations as well as hypospadia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 45
Incorrect
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A 23-year-old pregnant woman presents with glycosuria. What is the most likely mechanism?
Your Answer:
Correct Answer: Reduced renal reabsorption
Explanation:Throughout pregnancy the tubular reabsorption of glucose is less effective than in the non-pregnant state, this leads to glycosuria.
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This question is part of the following fields:
- Renal System
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Question 46
Incorrect
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Choose the molecule that acts as the co-receptor for cells expressing antigens linked with MHC class I molecules:
Your Answer:
Correct Answer: CD8
Explanation:CD8+ T cells recognize antigens in the form of short peptide fragments bound to major histocompatibility complex class I (MHCI) molecules on the target cell surface.1 Specific engagement of peptide-MHCI (pMHCI) complexes via the clonotypically expressed ?β T-cell receptor (TCR) triggers a range of effector functions that play a critical role in protective immunity against intracellular infections and various malignancies.
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This question is part of the following fields:
- Immune System
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Question 47
Incorrect
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A 36 year-old accountant presents with a sudden onset of headache which progressed to him collapsing. Upon arrival in A&E, he has a heart rate of 76 bpm, blood pressure 220/140, and Glasgow Coma Score of 9 (E2, M5, V2). Which of the following should be done immediately?
Your Answer:
Correct Answer: Give high flow oxygen via a non-rebreather mask
Explanation:This man is likely suffering from a subarachnoid haemorrhage or intracerebral bleed. The priority is to prevent a secondary brain injury. Important first steps include ensuring a secure airway, normalizing cardiovascular function, and treating seizures. His airway is likely to be protected with a GCS of 9, although he may benefit from a nasal or oral airway, and close attention should be paid to his airway if going for a CT scan. He should receive high flow oxygen and his blood pressure should not be treated acutely, as i is often appropriate to compensate for a rise in intracranial pressure. Nimodipine should be given if a subarachnoid haemorrhage is proven. Attention should also be given to maintaining a normal blood sugar, as hyperglycaemia worsens outcomes.
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This question is part of the following fields:
- Nervous System
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Question 48
Incorrect
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A 28-year-old female presented with complaints of joint pains, myalgia, haematuria and a facial rash which exacerbates on exposure to sunlight. RFTs show raised urea and creatinine, and there were red cell casts on urine microscopy. The investigation of choice in this case would be?
Your Answer:
Correct Answer: Auto antibodies
Explanation:Considering the history and presenting complaints, this patient is most likely suffering from systemic lupus erythematosus, which will be confirmed by testing for auto antibodies like ANA, anti ds DNA, anti histone antibodies etc.
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This question is part of the following fields:
- Immune System
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Question 49
Incorrect
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An elderly man presents with fever of 38°C and a very severe headache. His BP is 85/50 mm Hg. He has neck stiffness and photophobia. What is the most appropriate management?
Your Answer:
Correct Answer: CT head
Explanation:In elderly patients, symptoms suggestive of meningitis could be due to an intracranial mass lesion (such as abscess, tumour or an intracerebral haematoma). Therefore elderly patients are increased risk of cerebral herniation from an LP. A CT head should be done before an LP to exclude a mass lesion.
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This question is part of the following fields:
- Geriatric Medicine
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Question 50
Incorrect
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A homeless woman presented with a cough and fever for the last 3 months. She also complained of night sweats and weight loss. Her CXR showed lung opacities. What is the next appropriate step for this patient?
Your Answer:
Correct Answer: Acid fast bacilli
Explanation:History and CXR are suggestive of tuberculosis. Acid fast bacilli should be seen on microscopy to confirm the diagnosis.
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This question is part of the following fields:
- Infectious Diseases
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