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Question 1
Incorrect
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A 20-year-old woman presents to casualty with flank pain and a 48 hour history of dysuria. Her past medical history includes polycystic ovarian syndrome. She is not in a steady relationship at present. There is haematuria and proteinuria on urine dipstick testing.
Examination reveals a pyrexia of 38.1 °C and flank pain.
What diagnosis fits best with this clinical picture?Your Answer: Acute glomerulonephritis
Correct Answer: Pyelonephritis
Explanation:The patient presents with flank pain and fever with haematuria and proteinuria associated with a social history of not being in a steady relationship. This patient is a young presumably sexually active female, so the diagnosis is most likely pyelonephritis which has an increased incidence in young sexually active women or men of >50 years of age.
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This question is part of the following fields:
- Renal System
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Question 2
Incorrect
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A 28-year-old male arrives at the clinic complaining of fever, arthralgia and urethritis. On examination, the ankle is swollen and there is a pustular rash on the dorsal foot. What is the most likely diagnosis?
Your Answer: Lyme disease
Correct Answer: Disseminated gonorrhoea
Explanation:DGI presents as two syndromes: 1) a bacteremic form that includes a triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis and 2) a septic arthritis form characterized as a purulent arthritis without associated skin lesions. Many patients will have overlapping features of both syndromes. Time from infection to clinical manifestations may range from 1 day to 3 months. There is no travel history and the rash of Lyme disease is not purulent. Reactive arthritis presents with conjunctivitis, urethritis and arthritis usually with a red hot tender and swollen joint.
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This question is part of the following fields:
- Musculoskeletal System
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Question 3
Correct
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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: 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 4
Incorrect
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A 36-year-old man arrives at the clinic complaining of pain and swelling of the left knee, ankles and right hallux. He has acute conjunctivitis, and dysuria. He suffered from an episode of gastroenteritis two weeks back. Clinical examination shows left Achilles tendonitis and right plantar fasciitis. Radiological examination reveals left sacroiliitis, with evidence of enthesitis, joint erosions and periostitis. HLA-B27 is positive. Which of the following is the most likely diagnosis?
Your Answer: Ankylosing spondylitis
Correct Answer: Reiter's syndrome
Explanation: -
This question is part of the following fields:
- Musculoskeletal System
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Question 5
Incorrect
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A 25-year-old man having sickle cell anaemia presents with headache, lethargy, and pallor. His blood count shows: Haemoglobin: 4.6 g/dL Reticulocytes: 3% Infection with parvovirus is suspected. Out of the following, what is the most likely diagnosis?
Your Answer: Haemolytic crisis
Correct Answer: Aplastic crisis
Explanation:Aplastic crisis is characterized by a rapid fall in hemoglobin levels associated with few or no reticulocytes, indicating a failure of the bone marrow to respond to increased cell turnover. Folate deficiency can occur in the setting of chronic hemolytic anemia in some patients unless supplemental folate is taken. Parvovirus (B19) has been associated with bone marrow suppression and subsequent aplastic crisis; other viral infections or severe bacterial infections may also suppress the bone marrow. Treatment of aplastic crisis may be necessary when the hematocrit level becomes dangerously low. Packed red blood cells are given to support an adequate hematocrit until bone marrow suppression is resolved, folate is repleted, and the reticulocyte count improves.
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This question is part of the following fields:
- Haematology & Oncology
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Question 6
Correct
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A 63-year-old gentleman is admitted to the Emergency Department, with a past history of chronic renal failure, who complains of increasing shortness of breath. Bloods reveal a creatinine of 570 μmol/l, urea of 48 mmol/l. He is also anaemic with a haemoglobin (Hb) of 8.9 g/dl.
On examination he has a pericardial rub and there are bibasal crackles consistent with heart failure.
Which of the following represents the best treatment option for this patient?Your Answer: Urgent haemodialysis
Explanation:This case presents with symptoms and lab results suggestive of uremic pericarditis, which is an indication for immediate haemodialysis. Uremic pericarditis is caused by inflammation of the membranes of the pericardial sac, which usually resolves after a period of intensive dialysis.
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This question is part of the following fields:
- Renal System
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Question 7
Correct
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Which virus is severe acute respiratory syndrome (SARS) caused by?
Your Answer: A coronavirus
Explanation:Severe acute respiratory syndrome (SARS) is a viral respiratory illness caused by a coronavirus called SARS-associated coronavirus (SARS-CoV). SARS was first reported in Asia in February 2003.
In general, SARS begins with a high fever (temperature greater than 38.0°C). Other symptoms may include headache, an overall feeling of discomfort, and body aches. Some people also have mild respiratory symptoms at the outset. About 10 to 20 percent of patients have diarrhoea. After 2 to 7 days, SARS patients may develop a dry cough. Most patients develop pneumonia. -
This question is part of the following fields:
- Respiratory System
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Question 8
Incorrect
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A defect in DNA gyrase can lead to which of the following cancerous conditions?
Your Answer: von Hippel-Lindau
Correct Answer: Xeroderma pigmentosum
Explanation:Xeroderma pigmentosum is an X-linked recessive condition, which is caused by mutations in DNA gyrase which further encodes the XP gene. The defect may lead to skin cancer at an early stage of life, especially at photo exposed sites.
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This question is part of the following fields:
- The Skin
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Question 9
Correct
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A 26-year-old man with type-1 diabetes presents for review. His HbA1c is 6.8% yet he is concerned that his morning blood sugar levels are occasionally as high as 24 mmol/l. He is currently managed on a bd mixed insulin regimen.
He was sent for continuous glucose monitoring and his glucose profile reveals dangerous dipping in blood glucose levels during the early hours of the morning.
Which of the following changes to his insulin regime is most appropriate?Your Answer: Move him to a basal bolus regime
Explanation:The patients high morning blood sugar levels are suggestive to Somogyi Phenomenon which suggests that hypoglycaemia during the late evening induced by insulin could cause a counter regulatory hormone response that produces hyperglycaemia in the early morning.
Substitution of regular insulin with an immediate-acting insulin analogue, such as Humulin lispro, may be of some help. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 10
Correct
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A 18-year-old gentleman is referred to dermatology. He has around 10 hyperpigmented macules on his torso which vary in size from 1.5-5 cm in size. His GP also noted some freckles in the groin region. He is also currently under orthopaedic review due to a worsening scoliosis of the spine. His father suffered from similar problems before having a fatal myocardial infarction two years ago. Which chromosome is most likely to have a gene defect?
Your Answer: Chromosome 17
Explanation:The patient’s history and presentation and familial history, meets the diagnostic criteria for Neurofibromatosis type I, presenting with neurofibromas noted in this patient as hyperpigmented macules and freckles, musculoskeletal disorders like the scoliosis in this case, and a familial history. Neurofibromatosis type I is caused by a mutation on Chromosome 17.
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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 65-year-male patient was started on warfarin for chronic atrial fibrillation (AF). Which of the following clotting factors is not affected by warfarin?
Your Answer: Factor VII
Correct Answer: Factor XII
Explanation:Carboxylation of factor II, VII, IX, X and protein C is affected by warfarin. Factor XII is not affected.
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This question is part of the following fields:
- Cardiovascular System
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Question 12
Incorrect
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A 42-year-old man with alcoholic liver disease is admitted with pyrexia. He has been unwell for the past three days and has multiple previous admissions before with variceal bleeding. Examination shows multiple stigmata of chronic liver disease, ascites and jaundice.
Paracentesis is performed with the following results: Neutrophils 487 cells/ul
What is the most appropriate treatment?Your Answer: Intravenous ciprofloxacin
Correct Answer: Intravenous cefotaxime
Explanation:This describes a clinical scenario of spontaneous bacterial peritonitis. The diagnosis is made when fluid removed (ascites) is found to have > 250/mm cubed of PMNs (polymorphonuclear leukocytes). Cefotaxime or another third generation cephalosporin is the treatment of choice.
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This question is part of the following fields:
- Hepatobiliary System
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Question 13
Correct
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A 42-year-old female with a history of hypertension presented with increased thirst, polyuria and nocturia for 2 weeks duration. Her random blood sugar was 12 mmol/l. Which of the following antihypertensives can cause the above clinical presentation?
Your Answer: Bendroflumethiazide
Explanation:Thiazides and beta-blockers have been most commonly linked to the development of diabetes mellitus.
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This question is part of the following fields:
- Pharmacology
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Question 14
Correct
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A 66-year-old gentleman is seen in the Emergency Department complaining of muscle weakness and lethargy. Admission bloods show the following:
Na+ 138 mmol/l
K+ 6.6 mmol/l
Bicarbonate 15 mmol/l
Urea 9.2 mmol/l
Creatinine 110 µmol/l
An ECG is done which shows no acute changes.
What is the most appropriate initial treatment to lower the serum potassium level?Your Answer: Insulin/dextrose infusion
Explanation:Insulin/dextrose infusion will increase the activity of the sodium-potassium pump in the cells, which will in turn decrease serum potassium levels.
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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 33-year-old man with a known history of alcoholic liver disease is reviewed following a suspected oesophageal variceal haemorrhage. He has been resuscitated and intravenous terlipressin has been given. His blood pressure is now 104/60 mmHg and his pulse is 84/min. What is the most appropriate intervention?
Your Answer: Endoscopic variceal band ligation
Explanation:The correct course of action after giving terlipressin and resuscitating with IV fluids is to perform an EGD with endoscopic variceal band ligation. According to NICE: ‘Offer endoscopic variceal band ligation for the primary prevention of bleeding for people with cirrhosis who have medium to large oesophageal varices. There are serious complications of a TIPS procedure and it is not the first line treatment.
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This question is part of the following fields:
- Gastrointestinal System
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Question 16
Incorrect
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Wolff-Parkinson-White syndrome is not linked with which of the following?
Your Answer: Hypertrophic cardiomyopathy
Correct Answer: Ventricular tachycardia in the absence of drug therapy
Explanation:Ventricular tachycardia is not linked with Wolff-Parkinson-White syndrome. The other options are linked to WPW syndrome.
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This question is part of the following fields:
- Cardiovascular System
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Question 17
Correct
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A 20-year-old male presented after an episode where he had collapsed. This was the second time he has collapsed during the past 3 weeks. His father passed away at the age of 40 due to sudden cardiac death. Echocardiography showed evidence of hypertrophic cardiomyopathy. His 24 hr ECG revealed several short runs of nonsustained ventricular tachycardia (VT). Which of the following is the most appropriate management for this patient?
Your Answer: Implantable cardiovertor defibrillator
Explanation:This patient has a high risk of sudden cardiac death due to a strong family history and non sustained VT. So the most appropriate management is implantable cardiovertor defibrillator.
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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 22-year-old nulliparous female presents with shortness of breath. She has a history of recurrent deep vein thrombosis. Complete blood count and clotting screen reveals the following results:
Hb: 12.4 g/dl
Plt: 137
WBC: 7.5*109/l
PT: 14 secs
APTT: 46 secs
Which of the following would be the most likely diagnosis?Your Answer: Third generation oral contraceptive pill use
Correct Answer: Antiphospholipid syndrome
Explanation:The combination of APTT and low platelets with recurrent DVTs make antiphospholipid syndrome the most likely diagnosis.
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This question is part of the following fields:
- Musculoskeletal System
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Question 19
Incorrect
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A 22-year-old female presents to the ER with a respiratory infection for which the physician prescribes her azithromycin. She, however, is currently on combined oral contraceptive pills. Regarding her contraception, what should be advised to this patient?
Your Answer: Using 14d condoms after antibiotics and avoid pill free break
Correct Answer: No extra precaution
Explanation:Rifampicin is the only antibiotic that has been reported to reduce plasma oestrogen concentrations. When taking Rifampicin, oral contraceptives cannot be relied upon and a second method of contraception is mandatory. Amoxicillin, ampicillin, griseofulvin, metronidazole and tetracycline have been rarely associated with contraceptive failure. When these agents are used, the clinician should discuss the available data with the patient and suggest a second form of birth control. Other antibiotics are most likely safe to use concomitantly with oral contraceptives.
The danger with COCP is enzyme inducers which can lower the levels of the hormone in he blood, azithromycin is not an enzyme inducer. No additional precautions are required to maintain contraceptive efficacy when using antibiotics that are not enzyme inducers with combined hormonal methods for durations of 3 weeks or less. The only proviso would be that if the antibiotics (and/or the illness) caused vomiting or diarrhoea, then the usual additional precautions relating to these conditions should be observed.Inducers: RASAG
– Rifampicin
– Anticonvulsants, particularly phenytoin, carbamazepine, phenobarbitone and primidone
– Spironolactone, St Johns wort
– Alcohol, long term
– Griseofulvin -
This question is part of the following fields:
- Women's Health
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Question 20
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: Nebulised ipratropium bromide
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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SESSION STATS - PERFORMANCE PER SPECIALTY
