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  • Question 1 - A 45-year-old male presented with chronic diarrhoea and right lower abdominal pain. On...

    Correct

    • A 45-year-old male presented with chronic diarrhoea and right lower abdominal pain. On examination he was febrile and there was tenderness over the right lower quadrant and an anal fissure. Which of the following is the most probable cause for his abdominal pain?

      Your Answer: Inflammatory bowel disease (IBD)

      Explanation:

      From the given answers, IBD and IBS are the causes for chronic diarrhoea. Pyelonephritis and ureteric colic are associated with urinary symptoms. Tenderness of pyelonephritis is at the loin region. Perianal disease is associated with fifty percent of patients with Crohn’s disease.

    • This question is part of the following fields:

      • Gastrointestinal System
      23.4
      Seconds

  • Question 2 - A 63-year-old gentleman with chronic kidney disease secondary to diabetes mellitus is reviewed....

    Incorrect

    • A 63-year-old gentleman with chronic kidney disease secondary to diabetes mellitus is reviewed. When assessing his estimated glomerular filtration rate (eGFR), which one of the following variables is not required by the Modification of Diet in Renal Disease (MDRD) equation?

      Your Answer: Ethnicity

      Correct Answer: Serum urea

      Explanation:

      A formula for estimating glomerular filtration rate (eGFR) is the Modification Diet of Renal Disease (MDRD) equation which takes into account the following variables: serum creatinine, age, gender, and ethnicity. Thus, serum urea is not required in this formula.

    • This question is part of the following fields:

      • Renal System
      18.4
      Seconds

  • Question 3 - Which of the following drugs will most likely trigger an exacerbation of acute...

    Incorrect

    • Which of the following drugs will most likely trigger an exacerbation of acute intermittent porphyria (AIP)?

      Your Answer: Barbiturates

      Correct Answer: Oral contraceptive pill

      Explanation:

      Hormonal contraceptives all contain man-made oestrogen and progestin hormones in a limited amount. These hormones prevent pregnancy by inhibiting the body’s natural cyclical hormones to prevent pregnancy. Even though all of these drugs except Ibuprofen can cause AIP in a vulnerable woman. The most likely cause is the OCP.

    • This question is part of the following fields:

      • Pharmacology
      13.5
      Seconds

  • Question 4 - Which one of the following conditions is least likely to be associated with...

    Correct

    • Which one of the following conditions is least likely to be associated with pyoderma gangrenosum?

      Your 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
      7.2
      Seconds

  • Question 5 - Which of the following is the drug of choice for the treatment of...

    Incorrect

    • Which of the following is the drug of choice for the treatment of Chlamydia trachomatis infection during pregnancy?

      Your Answer: Clindamycin

      Correct Answer: Amoxicillin

      Explanation:

      Tetracycline is not recommended in pregnancy because of the risk to fetal development (bones, teeth!). Metronidazole in pregnancy: currently not thought to be an increased risk in pregnancy; however this is not effective against chlamydia. Amoxicillin is shown to be an adequate treatment for chlamydia, so this is the correct answer.

    • This question is part of the following fields:

      • Infectious Diseases
      18.8
      Seconds

  • Question 6 - A 32-year-old man notices a pruritic scaly annular rash on his thigh. He...

    Correct

    • A 32-year-old man notices a pruritic scaly annular rash on his thigh. He claims that the rash appeared after a walk in the park. Which drug would you suggest he starts?

      Your Answer: Doxycycline

      Explanation:

      The clinical picture of an itchy, scaly annular rash after a walk in the park suggests erythema migrans. The pathogen responsible is a spirochete, Borrelia Burgdorferi transmitted by ticks leading to Lyme disease. Doxycycline is the antibiotic of choice if no contraindications.

    • This question is part of the following fields:

      • Infectious Diseases
      35
      Seconds

  • Question 7 - Arrange the following opioid analgesics in order of increasing potency. ...

    Incorrect

    • Arrange the following opioid analgesics in order of increasing potency.

      Your Answer: Codeine, oxycodone, morphine, diamorphine

      Correct Answer: Codeine, morphine, oxycodone, diamorphine

      Explanation:

      Opioid analgesics produce pain relief by attaching to the opioid receptors in the brain. Out of these, codeine is the least potent and diamorphine the most potent. Codeine is used to relieve mild to moderate pain. Morphine is a stronger analgesic used to treat pain like that experienced after surgery or injury. Oxycodone acts like the endorphins in the brain and reduces pain sensation. It is more potent than codeine and morphine and is used for relieving moderate to severe forms of pain. Among the listed, diamorphine is the most potent opioid analgesic. It is administered intravenously, subcutaneously, or intramuscularly to treat severe pain after surgery or in terminally-ill patients.

    • This question is part of the following fields:

      • Pharmacology
      21.1
      Seconds

  • Question 8 - A 3-year old boy presents with an abdominal mass. Which of the following...

    Incorrect

    • A 3-year old boy presents with an abdominal mass. Which of the following is associated with Wilms tumour (nephroblastoma)?

      Your Answer:

      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.

    • This question is part of the following fields:

      • Renal System
      0
      Seconds

  • Question 9 - Which of the following describes the reason for the decline of the use...

    Incorrect

    • Which of the following describes the reason for the decline of the use of beta blockers as antihypertensives in last few years?

      Your Answer:

      Correct Answer: Less likely to prevent stroke + potential impairment of glucose tolerance

      Explanation:

      According to the latest research, beta blockers are associated with higher incidence of fatal and non-fatal strokes, all cardiovascular events, and cardiovascular mortality. New-onset diabetes also associates with beta blockers.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 10 - A 35-year-old woman is referred to the oncology clinic by a general surgeon....

    Incorrect

    • A 35-year-old woman is referred to the oncology clinic by a general surgeon. She has undergone mastectomy for carcinoma of the right breast.

      Out of the following, which factor is associated with a poor prognosis in patients with breast cancer?

      Your Answer:

      Correct Answer: Young age

      Explanation:

      Poor prognostic factors for breast cancer include:
      1. Young age (<40 years)
      2. Premenopausal at the time of diagnosis
      3. Increased tumour size
      4. High-grade tumour
      5. Oestrogen and progesterone receptor-negative tumour
      6. Positive lymph node status

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 11 - A 24-year-old male was involved in a traffic collision. X-rays indicated that the...

    Incorrect

    • A 24-year-old male was involved in a traffic collision. X-rays indicated that the neck of the humerus had suffered a fracture. Choose the single most associated nerve injury from the list of options.

      Your Answer:

      Correct Answer: Axillary nerve

      Explanation:

      Fractures in the neck of the humerus are well documented to cause damage to the auxiliary nerve.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 12 - A 28-year-old male was admitted with palpitations and chest discomfort for the past...

    Incorrect

    • A 28-year-old male was admitted with palpitations and chest discomfort for the past 1 hour. On examination his pulse rate was 200 bpm and blood pressure was 80/50 mmHg. His ECG revealed narrow complex tachycardia with a heart rate of 200 bpm. Which of the following is the most appropriate management of this patient?

      Your Answer:

      Correct Answer: Synchronised DC synchronised cardioversion

      Explanation:

      Narrow complex tachycardia with hypotension is a medical emergency. Immediate synchronized cardioversion is the ideal management.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 13 - A 39 year-old engineer presents with progressive weakness of his hands. Upon examination,...

    Incorrect

    • A 39 year-old engineer presents with progressive weakness of his hands. Upon examination, you notice wasting of the small muscles of the hand. A diagnosis of syringomyelia is suspected. Which one of the following features would most support this diagnosis?

      Your Answer:

      Correct Answer: Loss of temperature sensation in the hands

      Explanation:

      Syringomyelia is a development of a cavity (syrinx) within the spinal cord. Signs and symptoms include loss of feeling, paralysis, weakness, and stiffness in the back, shoulders, and extremities. Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. Symptoms typically vary depending on the extent and, often more critically, on the location of the syrinx within the spinal cord.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 14 - A 69-year-old man complains of a significant decrease in weight, SOB, chest pain...

    Incorrect

    • A 69-year-old man complains of a significant decrease in weight, SOB, chest pain discomfort and cough. Examination results are constricted left pupil and drooping left eyelid. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Pancoast tumour

      Explanation:

      Destructive lesions of the thoracic inlet is related to the apical lung cancer called Pancoast tumour, along with the involvement of cervical sympathetic nerves (the stellate ganglion) and brachial plexus which can lead to a Horner’s syndrome

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds

  • Question 15 - The digital rectal examination and flexible sigmoidoscopy of a 30-year-old woman are normal....

    Incorrect

    • The digital rectal examination and flexible sigmoidoscopy of a 30-year-old woman are normal. However, she still complains of recurrent and brief episodes of severe rectal pain. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Proctalgia fugax

      Explanation:

      The digital rectal examination and sigmoidoscopy are normal, a fact that excludes all the other possible diagnoses. Proctalgia fugax is a functional anorectal disorder characterized by severe, intermittent episodes of rectal pain that are self-limiting. The diagnosis of proctalgia fugax requires exclusion of other causes of rectal or anal pain.

    • This question is part of the following fields:

      • Gastrointestinal System
      0
      Seconds

  • Question 16 - A middle-aged male presented in the OPD with scrotal swelling that is cystic...

    Incorrect

    • A middle-aged male presented in the OPD with scrotal swelling that is cystic in nature and painless. It is located on the posterior part of the testis. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Epididymal Cyst

      Explanation:

      Epididymal cysts present as a swelling is behind the testis and are non-tender/painless in nature.

    • This question is part of the following fields:

      • Men's Health
      0
      Seconds

  • Question 17 - A 25-year-old woman is found to have a blood pressure of 170/100 mmHg...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 18 - A 33-year-old man with a known history of alcoholic liver disease is reviewed...

    Incorrect

    • 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:

      Correct 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.

    • This question is part of the following fields:

      • Gastrointestinal System
      0
      Seconds

  • Question 19 - A 70-year-old male presents with an ulcer between his toes - it has...

    Incorrect

    • A 70-year-old male presents with an ulcer between his toes - it has a punched-out appearance. He is known to both smoke and drinks heavily. Upon examination, the ulcer is yellow in colour. His foot also turns red when it hangs from the bed. From the list given, choose the single most likely diagnosis for this patient.

      Your Answer:

      Correct Answer: Arterial ischemia ulcer

      Explanation:

      Arterial ischemia ulcers present with many of the symptoms observed in this patient: ulcer on the lower extremities, pain, swelling, yellow sores, a punched-out appearance, the foot turning red when dangling from a bed. Smoking a lot is also known to be a causative factor here. This type of ulcer develops due to damage to the arteries caused by a lack of blood flow to the tissue – they are also deep wounds. Venous ischemic ulcers usually form in the knee or inner ankle area as opposed to the foot.

    • This question is part of the following fields:

      • The Skin
      0
      Seconds

  • Question 20 - A 34-year-old man was brought to the ER following a road-traffic-accident. An X-ray...

    Incorrect

    • A 34-year-old man was brought to the ER following a road-traffic-accident. An X-ray of his left thigh revealed a fractured shaft of the left femur. He has a known history of opioid abuse. You are called to the ward to assess him after he becomes unwell. Which of the following clinical features are NOT compatible with a diagnosis of opioid withdrawal?

      Your Answer:

      Correct Answer: Hypothermia

      Explanation:

      Among the options provided, hypothermia is not a symptom of opioid withdrawal.

      Symptoms of opioid withdrawal include dysphoric mood, yawning, insomnia, muscle aches, lacrimation/rhinorrhoea, papillary dilatation, piloerection, fever, sweating, nausea/vomiting, diarrhoea.
      If the patient is having an opioid withdrawal reaction, then give 10 mg of methadone syrup and wait about 60 min to determine its effect.

      COWS (Clinical Opioid Withdrawal Scale) assessment for opioid withdrawal is commonly used to determine the severity of opioid withdrawal.

    • This question is part of the following fields:

      • Emergency & Critical Care
      0
      Seconds

  • Question 21 - A middle-aged female presented in the emergency department with breathlessness for the last...

    Incorrect

    • A middle-aged female presented in the emergency department with breathlessness for the last few hours. Lung function tests were performed and the results showed her TLCO to be very low but the KCO was 190%. Which of the following is the most probable cause of such findings?

      Your Answer:

      Correct Answer: Neuromuscular chest wall disorder

      Explanation:

      A patient suffering from extrapulmonary restriction like a neuromuscular chest wall disorder would show similar signs and symptoms. Due to the restriction the lungs cannot fully inflate for gaseous exchange and hence TLCO drops. On the other hand, no change in cardiac output takes place and this leads to higher density of blood per unit volume resulting in raised KCO. No such findings are observed in diseases like scleroderma, PPH, hereditary haemorrhagic telangiectasia and alpha-1 antitrypsin deficiency.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds

  • Question 22 - A 72-year-old woman presents with a 3 month history of colicky abdominal pain...

    Incorrect

    • A 72-year-old woman presents with a 3 month history of colicky abdominal pain after eating, and diarrhoea. She has lost 7 kg in weight over the last few months. A recent gastroscopy and colonoscopy were normal. Her past medical history includes angina and a right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan.

      right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan.
      Blood tests revealed:
      Haemoglobin (Hb) 118 g/l
      Mean corpuscular volume (MCV) 80 fl
      White cell count (WCC) 12.3 x 109/l
      Platelets 210 x 109/l
      Na+ 133 mmol/l
      K+ 5.2 mmol/l
      Urea 8.1 mmol/l
      Creatinine 134 mmol/l

      Select the most appropriate further investigations.

      Your Answer:

      Correct Answer: Contrast-enhanced computed tomography (CT) of the abdomen

      Explanation:

      The patient is 74 years old. She has had a recent gastroscopy and colonoscopy. She has a history of angina and a right CEA. She is having colicky abdominal pain after meals and weight loss, which points to a possible diagnosis of chronic mesenteric ischemia. Thus, you would want to do a contrast-enhanced CT scan of the abdomen to look for this. A 24 hour cardiac monitor would also be helpful to look for any abnormal rhythm that could be a potential aetiology of her disease.

    • This question is part of the following fields:

      • Gastrointestinal System
      0
      Seconds

  • Question 23 - An 8-year-old boy was admitted following a MVA. His BMI is 28 kb/m2...

    Incorrect

    • An 8-year-old boy was admitted following a MVA. His BMI is 28 kb/m2 and he's been found to have glycosuria, which resolved after his recovery. Which investigation is necessary to perform as part of the follow-up?

      Your Answer:

      Correct Answer: Fasting blood glucose concentration

      Explanation:

      The boy has an increased BMI which implies he is overweight. Possible trauma to his pancreas might have led to a diabetes-like condition, induced by damage to the beta cells. Fasting blood glucose should be measured as a follow-up strategy to see if the damage is reversible or irreversible and to conclude if the glycosuria is related to his metabolic profile or to his accident.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 24 - Regarding neonatal meningitis, which of the following statements is true? ...

    Incorrect

    • Regarding neonatal meningitis, which of the following statements is true?

      Your Answer:

      Correct Answer: Has an above average incidence in babies with a meningomyelocele

      Explanation:

      The commonest time for bacterial meningitis is in the 1st month of life and group B Streptococcus is the commonest organism. The anterior fontanelle is full, but does not bulge with normal flexion. Neurological manifestations include seizures, irritability, poor tone, lethargy and tremors, however no findings of sensorineural deafness have been noted. One of the risk factors for introduction of meningeal infection is Meningomyelocele.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 25 - A 51-year-old male patient presents with acute back pain, which worsens on prolonged...

    Incorrect

    • A 51-year-old male patient presents with acute back pain, which worsens on prolonged walking and sitting. The pain radiates towards the lower limbs and seems to be relieved by lying down. What is the best next step?

      Your Answer:

      Correct Answer: Magnetic resonance imaging (MRI)

      Explanation:

      A herniated disc seems to be the cause of the patient’s pain. MRI is the investigation of choice, since it can show soft tissue and establish a differential diagnosis.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 26 - A 54-year-old patient presented with a dry cough after starting treatment for hypertension....

    Incorrect

    • A 54-year-old patient presented with a dry cough after starting treatment for hypertension. He was prescribed ramipril 2.5mg and the dry cough started after that, which disturbed his sleep. His blood pressure was normal. Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer: Stop the ramipril and prescribe candesartan

      Explanation:

      ACE inhibitors are known to cause a dry cough and they should be stopped, to settle the cough. The next drug of choice is an angiotensin receptor blocker such as candesartan.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 27 - A 48-year-old male patient presents with fever and signs of delirium. A few...

    Incorrect

    • A 48-year-old male patient presents with fever and signs of delirium. A few hours ago, blisters appeared on his trunk. His past history revealed nothing serious and he's not on any medication. He admits that he went to Italy five months ago on vacation. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Chicken pox

      Explanation:

      Chicken pox in adults may manifest with acute encephalitis, causing the confusional syndrome known as delirium. Blisters on the trunk favour the diagnosis. The trip to Italy however seems unimportant since the incubation period of chicken pox is 10 to 21 days.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 28 - A 1-month-old boy was brought to the ED by his mother because he...

    Incorrect

    • A 1-month-old boy was brought to the ED by his mother because he has been irritable and feeding poorly for the last 24 hours. His CXR shows cardiomegaly but with clear lung fields while his ECG shows a regular narrow complex tachycardia with difficulty identifying the P wave. The boy is conscious but has cold extremities. What is the most appropriate next step?

      Your Answer:

      Correct Answer: Synchronized DC cardio-version

      Explanation:

      The most possible diagnosis is SVT. The boy is suffering from hemodynamic instability, as indicated by his cold extremities. DC cardioversion is the treatment of choice.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 29 - A 45-year-old female presented with weight loss, night sweats and abdominal pain for...

    Incorrect

    • A 45-year-old female presented with weight loss, night sweats and abdominal pain for 6 months. Abdominal ultrasound scan showed a tubo-ovarian mass. What is the most likely organism, which is responsible for this presentation?

      Your Answer:

      Correct Answer: Mycobacterium tuberculosis

      Explanation:

      Constitutional symptoms such as weight loss, evening pyrexia and night sweats are associated with Mycobacterium Tuberculosis (TB). TB can affect any system of the body and should be top in the list of differentials particularly if the patient has a history of contact with a known TB patient.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 30 - A 85-year-old male with a history of faecal impaction, who lived at a...

    Incorrect

    • A 85-year-old male with a history of faecal impaction, who lived at a nursing-home presented with abdominal pain and distension, confusion and agitation. Which of the following is the first step of the management.

      Your Answer:

      Correct Answer: Phosphate enema

      Explanation:

      The most probable cause for this presentation is faecal impaction following constipation, which is common among old people who live in nursing-homes. There can be number of reason for constipation in old age, including medications, endocrine and metabolic diseases, neurologic disorders, myopathic disorders, dietary habits etc. Enemas are a way of removing impacted faeces, which helps rectal evacuation.

    • This question is part of the following fields:

      • Geriatric Medicine
      0
      Seconds

  • Question 31 - A 55-year-old diabetic male presents with a feeling of generally being unwell. He...

    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:

      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
      0
      Seconds

  • Question 32 - A 65 year old gentleman presented with 4 months history of a non...

    Incorrect

    • A 65 year old gentleman presented with 4 months history of a non healing lesion over the right ear. It is about 1cm in size and bleeds when palpated. The most likely diagnosis will be?

      Your Answer:

      Correct Answer: Squamous cell carcinoma

      Explanation:

      Squamous cell carcinoma like other skin cancers mostly arise on photo exposed sites. A patient usually presents with a history of a non healing lesion or wound. Confirmatory diagnosis requires a skin biopsy and histopathological screening. It is rarely metastatic and treatment of choice is surgical excision.

    • This question is part of the following fields:

      • The Skin
      0
      Seconds

  • Question 33 - A woman is being seen at the clinic. Her clinic notes are missing...

    Incorrect

    • A woman is being seen at the clinic. Her clinic notes are missing and the only results available are lung function tests. Her date of birth is also missing from the report. 
      FEV1 0.4 (1.2-2.9 predicted)
      Total lung capacity 7.3 (4.4-6.8 predicted)
      Corrected transfer factor 3.3 (4.2-8.8 predicted)
       
      Which disease can be suspected From these results?

      Your Answer:

      Correct Answer: Moderate COPD

      Explanation:

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds

  • Question 34 - A 62-year-old male presents to the OPD with a deep painless ulcer on...

    Incorrect

    • A 62-year-old male presents to the OPD with a deep painless ulcer on the heel. His previous history includes increased thirst, urinary frequency, and weight loss for the last 4 years. Which of the following investigations would be most appropriate in this case?

      Your Answer:

      Correct Answer: Blood sugar

      Explanation:

      People with diabetes are prone to foot problems that develop due to prolonged periods of high blood sugar levels. Diabetic neuropathy and peripheral vascular disease are the two main causes of foot problems and both can have serious complications. Diabetes can cause serious foot problems that can result in feet or limb loss, deformity, and infections. However, it is possible for a person to prevent or minimize many of these problems. While controlling blood sugar by following the recommended diabetes treatment plans is the best way to prevent these serious problems, self-care and regular check-ups with a doctor can also help prevent problems from developing.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 35 - A 72-year-old man presents to the emergency department with dyspnoea and low exercise...

    Incorrect

    • A 72-year-old man presents to the emergency department with dyspnoea and low exercise tolerance. He's known to have a history of ischemic heart disease on medication. Which drug most probably caused his presenting complaint?

      Your Answer:

      Correct Answer: Diclofenac Sodium

      Explanation:

      Diclofenac sodium is a non-selective reversible and competitive inhibitor of cyclooxygenase (COX), subsequently blocking the conversion of arachidonic acid into prostaglandin precursors. This leads to an inhibition of the formation of prostaglandins that are involved in pain, inflammation and fever. Clinical trials of several COX-2 selective and non-selective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI), and stroke, which can be fatal.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 36 - A 53-year-old gentleman presents with several months' history of generalised swelling, fatigue, dyspnoea...

    Incorrect

    • A 53-year-old gentleman presents with several months' history of generalised swelling, fatigue, dyspnoea and several episodes of haemoptysis. There is no significant past medical history and he did not take any regular medication. He smokes 20 cigarettes per day and drinks 14 units of alcohol per week.

      On examination, he is grossly oedematous and has ascites. Cardiorespiratory examination is unremarkable and there are no neurological signs or rashes.

      Investigation results are below:

      Haemoglobin (Hb) 10.2 g/dl
      White cell count (WCC) 6.0 × 109/l
      Platelets 380 × 109/l
      Mean corpuscular volume (MCV) 90fl
      Na+ 145 mmol/l
      K+ 3.7 mmol/l
      Urea 8.2 mmol/l
      Bilirubin 16 μmol/l
      Creatinine 180 μmol/l
      Albumin 22 g/l
      Aspartate transaminase 32 iu/l
      Alkaline phosphatase 120 iu/l
      Urinalysis: Protein +++
      24 h urinary protein excretion: 5g
      Chest radiograph: Enlarged right hilum
      Echocardiogram: Mild left ventricular impairment, no valve lesion
      Abdominal ultrasound scan: Normal-sized kidneys, no abnormality seen


      A renal biopsy was performed. What is it most likely to show?

      Your Answer:

      Correct Answer: Thickened glomerular basement membrane with deposits of IgG and C3

      Explanation:

      Renal biopsy in this patient will most likely show thickened glomerular basement membrane with deposits of IgG and C3 as a result of membranous glomerulonephritis that has caused the nephrotic syndrome in this patient. Membranous glomerulonephritis in this case is most likely associated with an underlying bronchial carcinoma, consistent with the patient’s smoking history and physical presentation.

    • This question is part of the following fields:

      • Renal System
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  • Question 37 - A 19 year-old male was brought to the OPD with GCS of 15...

    Incorrect

    • A 19 year-old male was brought to the OPD with GCS of 15 after a head injury. After admission his GCS deteriorated to 12. What investigation needs to be done?

      Your Answer:

      Correct Answer: CT head

      Explanation:

      CT scan head will be the investigation of choice in this case. The best possible cause will be an intracranial haemorrhage which can be visualized easily with CT scan brain.

    • This question is part of the following fields:

      • Nervous System
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  • Question 38 - A 48-year-old patient with type 1 diabetes and chronic kidney disease attends for...

    Incorrect

    • A 48-year-old patient with type 1 diabetes and chronic kidney disease attends for review. His blood tests show:

      Haemoglobin 11.2 g/dl (13.0 - 18.0 g/dL)
      MCV 87 fl (80 - 96 fL)
      Sodium 133 mmol/l (137 - 144 mmol/L)
      Potassium 4.3 mmol/l (3.5 - 4.9 mmol/L)
      Urea 19.1 mmol/l (2.5 - 7.5 mmol/L)
      Creatinine 267 μmol/l (60 - 110 μmol/L)
      Ferritin 150 μg/l (15 - 300 μg/L)
      C reactive protein <5 mg/l (< 10 mg/L)

       
      What is the most appropriate management of his anaemia?

      Your Answer:

      Correct Answer: Monitor haemoglobin, no treatment required at present

      Explanation:

      Because the patient has chronic kidney disease, we need to consider the associated adverse effects of trying to maintain normal haemoglobin levels (14-18g/dl in this patient) and instead only instigate therapy when the level falls below 11 g/dl. Thus, in this case we should just monitor the haemoglobin levels and not initiate therapy just yet.

    • This question is part of the following fields:

      • Renal System
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  • Question 39 - A 24-year-old male is admitted with worsening shortness of breath with signs of...

    Incorrect

    • A 24-year-old male is admitted with worsening shortness of breath with signs of left ventricular failure. He has a known genetic condition.
      On examination, there is an ejection systolic murmur loudest over the aortic area radiating to the carotids, bibasal crepitations and pitting oedema to the knees bilaterally. On closer inspection of the patient, you note a wide vermillion border, small spaced teeth and a flat nasal bridge. The patient also has a disinhibited friendly demeanour.
      What is the likely precipitating valvular issue?

      Your Answer:

      Correct Answer: Supravalvular aortic stenosis

      Explanation:

      Supravalvular aortic stenosis, is associated with a condition called William’s syndrome.
      William’s syndrome is an inherited neurodevelopmental disorder caused by a microdeletion on chromosome 7. The most common symptoms of Williams syndrome are heart defects and unusual facial features. Other symptoms include failure to gain weight appropriately in infancy (failure to thrive) and low muscle tone. Individuals with Williams syndrome tend to have widely spaced teeth, a long philtrum, and a flattened nasal bridge.
      Most individuals with Williams syndrome are highly verbal relative to their IQ, and are overly sociable, having what has been described as a cocktail party type personality.

    • This question is part of the following fields:

      • Emergency & Critical Care
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  • Question 40 - A 25-year-old man having sickle cell anaemia presents with headache, lethargy, and pallor....

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 41 - A 52-year-old chef presents to the ED with acute visual changes. He has...

    Incorrect

    • A 52-year-old chef presents to the ED with acute visual changes. He has a past medical history of hypertension and type 2 diabetes mellitus. On neurological examination, his upper and lower limbs are normal however he has a homonymous hemianopia with central preservation. Where is the most likely cause of his problems within the central nervous system?

      Your Answer:

      Correct Answer: Optic radiation

      Explanation:

      Lesions in the optic radiation can cause a homonymous hemianopia with macular sparing, as a result of collateral circulation offered to macular tracts by the middle cerebral artery.
      Lesions in the optic tract also cause a homonymous hemianopia, but without macular sparing.
      Lesions in the optic chiasm, optic nerve, and temporal lobe cause bitemporal hemianopia, ipsilateral complete blindness, and superior homonymous quadrantanopia respectively.

    • This question is part of the following fields:

      • Nervous System
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  • Question 42 - A 50-year-old smoker with a history of hypertension presented with acute severe chest...

    Incorrect

    • A 50-year-old smoker with a history of hypertension presented with acute severe chest pain and acute myocardial infarction was diagnosed. Which of the following is a contraindication for thrombolysis?

      Your Answer:

      Correct Answer: History of likely ischaemic stroke within the past month

      Explanation:

      Absolute contraindications for fibrinolytic use in STEMI

      Prior intracranial haemorrhage (ICH)
      Known structural cerebral vascular lesion
      Known malignant intracranial neoplasm
      Ischemic stroke within 3 months
      Suspected aortic dissection
      Active bleeding or bleeding diathesis (excluding menses)
      Significant closed head trauma or facial trauma within 3 months
      Intracranial or intraspinal surgery within 2 months
      Severe uncontrolled hypertension (unresponsive to emergency therapy)
      For streptokinase, prior treatment within the previous 6 months

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 43 - A 73-year-old female is being reviewed in the osteoporosis clinic. She had a...

    Incorrect

    • A 73-year-old female is being reviewed in the osteoporosis clinic. She had a fracture of her left hip 5 years ago and was started on alendronate. Following the development of persistent musculoskeletal pain, alendronate was replaced with risedronate, which was also stopped for similar reasons. Strontium ranelate was therefore started but was also stopped due to the development of deep vein thrombosis in the right leg. Her current T-score is -4.1. A decision is made to start a trial of denosumab. What is the mechanism of action of denosumab?

      Your Answer:

      Correct Answer: Inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts

      Explanation:

      The principal mechanism by which strontium inhibits osteoclast activity is by enhancing the secretion of osteoprotegerin (OPG) and by reducing the expression of the receptor activator of nuclear factor κB ligand (RANKL) in osteoblasts.

      Osteoporosis is defined as low bone mineral density caused by altered bone microstructure ultimately predisposing patients to low-impact, fragility fractures.

      Management:
      Vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
      Alendronate is the first-line treatment. Around 25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate.
      Strontium ranelate and raloxifene are recommended if patients cannot tolerate bisphosphonates.
      Other medications that are useful in the treatment of osteoporosis are denosumab, teriparatide, raloxifene, etc.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 44 - A 30-year-old male patient presented with palpitations that occur randomly at rest. There...

    Incorrect

    • A 30-year-old male patient presented with palpitations that occur randomly at rest. There have however been episodes of fast palpitations and dizziness on exertion. On examination there was a systolic murmur at the apex as well as a prominent apex beat and the chest was clear. Which of the following is LEAST likely to suggest a diagnosis of hypertrophic cardiomyopathy?

      Your Answer:

      Correct Answer: A history of hypertension for 10 years

      Explanation:

      Hypertrophic cardiomyopathy is an autosomal dominant condition. Patients present with sudden cardiac death, dyspnoea, syncope and presyncope, angina, palpitations, orthopnoea and paroxysmal nocturnal dyspnoea, Congestive heart failure and dizziness. Physical findings include double or triple apical impulse, prominent a wave in the JVP, an ejection systolic crescendo-decrescendo murmur and a holosystolic murmur at the apex and axilla of mitral regurgitation.
      ECG shows ST-T wave abnormalities and LVH, axis deviation (right or left), conduction abnormalities (P-R prolongation, bundle-branch block), sinus bradycardia with ectopic atrial rhythm, atrial enlargement, abnormal and prominent Q wave in the anterior precordial and lateral limb leads.
      2D echocardiography shows abnormal systolic anterior leaflet motion of the mitral valve, LVH, 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, partial systolic closure of the aortic valve in midsystole

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 45 - A 9-year-old boy was admitted with gastroenteritis. The boy's symptoms started two days...

    Incorrect

    • A 9-year-old boy was admitted with gastroenteritis. The boy's symptoms started two days ago with profound diarrhoea and emesis. Blood exams show the following: Sodium=148 mmol/l, Potassium=2.2mmol/l, Urea=20 mmol/l, Glucose=4.3mmol/l. What would be the best management?

      Your Answer:

      Correct Answer: V normal saline and potassium supplement

      Explanation:

      The boy needs re-hydration and hydro-electrolytic re-balancing due to fluid losses from the gastroenteritis and subsequent dehydration.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 46 - Which of the following is most commonly associated with the development of pseudomembranous...

    Incorrect

    • Which of the following is most commonly associated with the development of pseudomembranous colitis?

      Your Answer:

      Correct Answer: Cefuroxime

      Explanation:

      Pseudomembranous colitis is caused by a C. difficile infection that causes membranes to form on the colon wall. It is caused most commonly by broad-spectrum antibiotics. This would include cephalosporins, broad-spectrum penicillin, and clindamycin. Macrolides and quinolones have also been reported as potential aetiologies, but much less commonly.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 47 - A 76-year-old man has been admitted with a respiratory tract infection.
    On examination,...

    Incorrect

    • A 76-year-old man has been admitted with a respiratory tract infection.
      On examination, he was found to be confused and dyspnoeic with O2 saturation of 88%. He has a 60 pack-year smoking history. An arterial blood gas analysis reveals CO2 retention. He has been deemed unfit for admission into the intensive care unit. The physician elects to begin a doxapram infusion.
      Among the following statements which best fits with the characteristics of doxapram?

      Your Answer:

      Correct Answer: Epilepsy is a contraindication for doxapram use

      Explanation:

      The statement that fits the characteristics of doxapram is, epilepsy is a contraindication for doxapram use. Concurrent use with theophylline may increase agitation not relaxation.

      Doxapram is a central respiratory stimulant. In clinical practice, doxapram is usually used for patients who have an acute exacerbation of chronic obstructive pulmonary disease (COPD) who are unsuitable for admission to the intensive therapy unit for ventilatory support. Doxapram infusion may buy an extra 24 h to allow for recovery.

      Contraindications include: ischaemic heart disease, epilepsy, cerebral oedema, acute stroke, asthma, hypertension, hyperthyroidism, and pheochromocytoma.
      The infusion may worsen agitation and dyspnoea and lead to hypertension, nausea, vomiting and urinary retention.

      Drug interactions:
      Concomitant administration of doxapram and aminophylline (theophylline) can cause increased skeletal muscle activity, agitation, and hyperactivity.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 48 - A 21-year-old patient presents with multiple itchy wheals on his skin. The wheals...

    Incorrect

    • 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:

      Correct 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
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  • Question 49 - A 26-year-old woman is 24 weeks pregnant had a recent ultrasound that shows...

    Incorrect

    • A 26-year-old woman is 24 weeks pregnant had a recent ultrasound that shows the foetus large for dates.
      She has an oral glucose tolerance test (OGTT) which was requested due to a combination of her Asian ethnicity and background of obesity.
      The following results are obtained:
      Time (hours) Blood glucose (mmol/l)
      0 9.2
      2 14.2

      What is the most appropriate management?

      Your Answer:

      Correct Answer: Start insulin

      Explanation:

      Insulin remains the standard of care for the treatment of uncontrolled gestational diabetes. Tight control maintained in the first trimester and throughout pregnancy plays a vital role in decreasing poor fetal outcomes, including structural anomalies, macrosomia, hypoglycaemia of the new-born, adolescent and adult obesity, and diabetes.
      The baby is already large for dates so nutritional therapy can not be used alone.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
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  • Question 50 - Which of the following is the most common clinical feature of carbon monoxide...

    Incorrect

    • Which of the following is the most common clinical feature of carbon monoxide poisoning?

      Your Answer:

      Correct Answer: Headache

      Explanation:

      The symptoms and signs of carbon monoxide poisoning are variable and nonspecific. The most common symptoms of CO poisoning are headache, dizziness, weakness, nausea, vomiting, chest pain, and altered mental status.

      The clinical presentation of CO poisoning is the result of its underlying systemic toxicity. Its effects are caused not only by impaired oxygen delivery but also by disrupting oxygen utilization and respiration at the cellular level, particularly in high-oxygen demand organs (i.e., heart and brain).

      Symptoms of severe CO poisoning include malaise, shortness of breath, headache, nausea, chest pain, irritability, ataxia, altered mental status, other neurologic symptoms, loss of consciousness, coma, and death; signs include tachycardia, tachypnea, hypotension, various neurologic findings including impaired memory, cognitive and sensory disturbances; metabolic acidosis, arrhythmias, myocardial ischemia or infarction, and noncardiogenic pulmonary edema, although any organ system might be involved.

    • This question is part of the following fields:

      • Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY

Gastrointestinal System (1/1) 100%
Renal System (0/1) 0%
Pharmacology (0/2) 0%
The Skin (1/1) 100%
Infectious Diseases (1/2) 50%
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