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Question 1
Incorrect
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Which one of the following statements regarding hepatocellular carcinoma is correct?
Your Answer: Alcohol excess is the most common underlying cause worldwide
Correct Answer: Diabetes mellitus is a risk factor
Explanation:Diabetes is a risk factor for hepatocellular carcinoma. Screening has been shown to be effective. Bevacizumab is not used for advanced cases. The incidence is higher in men. Alcohol is not the most common underlying cause worldwide; this is from cirrhosis from diseases like hepatitis B and C.
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This question is part of the following fields:
- Hepatobiliary System
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Question 2
Correct
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A 70-year-old man underwent emergency surgery for an acute abdomen. Following surgery, he was noted to be oliguric. Investigations revealed the following: Sodium 121 mmol/L (137-144) Potassium 6.6 mmol/L (3.5-4.9) Chloride 92 mmol/L (95-107) Urea 17.2 mmol/L (2.5-7.5) Creatinine 250 µmol/L (60-110) pH 7.16 (7.36-7.44) Standard bicarbonate 15.6 mmol/L (20-28). What is the calculated anion gap for this patient?
Your Answer: 20 mmol/L
Explanation:Anion gap is calculated as (Na + K) − (Cl + HCO3). Therefore in this patient, the calculated value is 20 mmol/L. The normal anion gap is between 8-16 mmol/l. The excessive value here reflects the presence of other acidic anions, and in this case with the metabolic acidosis, the constituents may be lactate, etc.
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This question is part of the following fields:
- Renal System
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Question 3
Incorrect
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A 35-year-old male who has smoked 20 cigarettes per day was referred to the National Chest Hospital because he has had a nine month history of shortness of breath which is getting worse. Tests revealed that he had moderate emphysema. His family history showed that his father died from COPD at the age of 52. Genetic testing found the PiSZ genotype following the diagnosis of alpha-1 antitrypsin (A1AT) deficiency. What levels of alpha-1 antitrypsin would be expected if they were to be measured?
Your Answer: 20% of normal
Correct Answer: 40% of normal
Explanation: -
This question is part of the following fields:
- Respiratory System
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Question 4
Incorrect
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Which of the following statements about smoking is correct?
Your Answer: Peak nicotine withdrawal time is 14 days
Correct Answer: Quitting is associated with average weight gain of 2 kg
Explanation:A study conducted showed that the average post smoking cessation weight gain was about 2 kg.
Withdrawal symptoms usually peak after 1-3 days and then decrease over a period of 3-4 weeks. After this time, the body has expelled most of the nicotine, and the withdrawal effects are mainly psychological. -
This question is part of the following fields:
- Respiratory System
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Question 5
Incorrect
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A 35-year-old gentleman is investigated for recurrent renal stones. He has been hospitalised on multiple occasions and has required lithotripsy three times. Investigations show the following:
Calcium 2.08 mmol/l
Phosphate 0.85 mmol/l
Parathyroid hormone 4.1 pmol/L (normal range = 0.8 - 8.5)
24 hour urinary calcium 521 mg/24 hours (normal range < 300)
Which one of the following treatments will most likely reduce the incidence of renal stones?Your Answer: Bisphosphonates
Correct Answer: Indapamide
Explanation:Indapamide is a mild thiazide-like diuretic with hypotensive effect, and compared to other thiazides, it is reported to also have less metabolic derangements. However, it may have beneficial hypo-calciuric effects that are often associated with thiazides, thus, in this case, we would recommend prescribing this to the patient.
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This question is part of the following fields:
- Renal System
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Question 6
Incorrect
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A 60-year-old male with a history of diabetes and hypertension presented with left sided arm and leg weakness and loss of vision in the left eye for a brief period. His symptoms improved within a few hours. Which of the following is the most appropriate investigation that can be done at this stage?
Your Answer: CT brain
Correct Answer: Doppler USG
Explanation:Amaurosis fugax (transient ipsilateral visual loss) and transient ischemic attacks (TIAs) are presentations of atherosclerotic disease of the carotid artery which can be identified by carotid duplex ultrasonography (US), with or without colour. This is the screening test of choice to evaluate for carotid stenosis.
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This question is part of the following fields:
- Nervous System
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Question 7
Incorrect
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A 28-year-old man is investigated for cervical lymphadenopathy. Lymph node biopsy reveals nodular sclerosing Hodgkin lymphoma.
Which one of the following factors is associated with a poor prognosis?Your Answer: Lymphocytes 20% of total white blood cells
Correct Answer: Night sweats
Explanation: -
This question is part of the following fields:
- Haematology & Oncology
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Question 8
Incorrect
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A 32-year-old previously well primigravida in her 16th week of pregnancy came to the antenatal clinic for a routine review. Her blood pressure was 152/90 mmHg. On her last clinic visit 4 weeks ago her blood pressure was 148/86 mmHg. She was put on ambulatory blood pressure monitoring and her mean blood pressure was 148/88 mmHg. Her urine examination was negative for protein. Which of the following is the most likely diagnosis?
Your Answer: Pregnancy-induced hypertension
Correct Answer: Pre-existing hypertension
Explanation:Pre-eclampsia is excluded from negative proteinuria. White coat hypertension is excluded with ambulatory blood pressure monitoring. Pregnancy induced hypertension develops after 20 weeks of gestation. So the most likely answer is pre-existing hypertension. She should be investigated for a secondary cause for hypertension.
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This question is part of the following fields:
- Cardiovascular System
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Question 9
Incorrect
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A 19-year-old lady with established anorexia nervosa is admitted with a BMI of 16. However, she gives the consent to be fed by a nasogastric tube. Which of the following electrolyte disturbances are you most likely to find?
Your Answer: Metabolic acidosis
Correct Answer: Hypophosphataemia
Explanation:Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 10
Incorrect
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Following a head injury, a 22-year-old patient develops polyuria and polydipsia. He is suspected to have cranial diabetes insipidus so he undergoes a water deprivation test.
Which one of the following responses would most indicate a positive (abnormal) result?Your Answer: A rise in plasma osmolality to 302 mmol/kg during water deprivation
Correct Answer: Failure to concentrate the urine during water deprivation, but achievement of urine osmolality of 720 mmol/kg following the administration of desmopressin
Explanation:The water deprivation test (i.e., the Miller-Moses test), is a semiquantitative test to ensure adequate dehydration and maximal stimulation of ADH for diagnosis. It is typically performed in patients with more chronic forms of Diabetes Insipidus (DI). The extent of deprivation is usually limited by the patient’s thirst or by any significant drop in blood pressure or related clinical manifestation of dehydration.
In healthy individuals, water deprivation leads to a urinary osmolality that is 2-4 times greater than plasma osmolality. Additionally, in normal, healthy subjects, administration of ADH produces an increase of less than 9% in urinary osmolality. The time required to achieve maximal urinary concentration ranges from 4-18 hours.
In central and nephrogenic DI, urinary osmolality will be less than 300 mOsm/kg after water deprivation. After the administration of ADH, the osmolality will rise to more than 750 mOsm/kg in central DI but will not rise at all in nephrogenic DI. In primary polydipsia, urinary osmolality will be above 750 mOsm/kg after water deprivation.
A urinary osmolality that is 300-750 mOsm/kg after water deprivation and remains below 750 mOsm/kg after administration of ADH may be seen in partial central DI, partial nephrogenic DI, and primary polydipsia. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 11
Incorrect
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A 14-year-old girl came to the emergency room in a bizarre state with altered consciousness, presenting with symptoms of insomnia, logorrhoea, and anxiety, with incoherent discourse and amnesia of recent events. She has started calling herself The Queen, and is refusing to be her parents' daughter. What is the most likely diagnosis?
Your Answer: Cotard syndrome
Correct Answer: Ganser syndrome
Explanation:Ganser syndrome is a condition in which a person acts as if he is suffering from a specific psychological disorder in order to gain sympathy and relief.
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This question is part of the following fields:
- Nervous System
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Question 12
Correct
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A 6-year-old boy presented in the emergency department with a cough and knee swelling after falling on the road. He had a non-blanching rash on his buttocks and investigations revealed: PT=13, APTT=71, Hgb=11, WBC=8, Plt=200. Which is the most likely diagnosis?
Your Answer: Haemophilia
Explanation:From the options mentioned here, the closest diagnosis is haemophilia. This is a mixed picture, as a purpuric rash on the buttocks does not correlate with this diagnosis. However, the most appropriate diagnosis is haemophilia.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 13
Correct
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A 19-year-old football player was hit in his chest by an opponent. He became breathless and turned blue. What will be the initial management?
Your Answer: Give oxygen
Explanation:As the patient is turning blue, giving oxygen will be the first priority in his management.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 14
Incorrect
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All of the following statements regarding iron metabolism are correct EXCEPT?
Your Answer: Iron absorption is increased by vitamin C and in iron deficiency
Correct Answer: In iron deficiency anaemia total iron binding capacity and transferrin saturation will both be decreased
Explanation:Iron deficiency anaemia is characterised by decreased iron stores, however there is increased iron binding capacity. Transferrin is the iron transporting protein. Because of the decreased presence of iron in blood, the transferrin saturation is decreased. Ferritin is an iron storage protein that is affected according to the iron stores but its also an acute phase reactant and levels can be effected by other conditions. Each unit of packed RBCs transfused to an adult contains 200 ml of RBCs and 200mg of iron. Only 5-10% of dietary iron is absorbed in the portal circulation which can be increased by the intake of vitamin C, animal foods and amino acids.
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This question is part of the following fields:
- Gastrointestinal System
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Question 15
Incorrect
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A 45-year-old male admitted with acute onset retrosternal chest pain was diagnosed with unstable angina. Which of the following will mostly contribute to the acute risk stratification of this patient?
Your Answer: Coronary angiography
Correct Answer: Troponin testing
Explanation:Troponin testing is the most important investigation in risk stratification. Troponin positive patients should be referred for urgent coronary revascularization as troponin indicates cardiac cell damage.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 16
Incorrect
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A 23-year-old woman experiences visual disturbances and anxiety associated with sudden change in posture. She also has nausea, vomiting, and dizziness occasionally. What is the most likely diagnosis?
Your Answer: Vertebrobasilar insufficiency
Correct Answer: BPPV
Explanation:The most probable diagnosis is benign paroxysmal positional vertigo (BPPV). It is a peripheral vestibular disorder characterized by short episodes of mild to intense dizziness and influenced by specific changes in head position. BPPV is the most common cause of vertigo accounting for nearly one-half of patients with peripheral vestibular dysfunction. In order to establish the diagnosis, the head roll test is performed where the head is turned about 90° to each side while supine.
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This question is part of the following fields:
- Nervous System
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Question 17
Correct
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A 45-year-old woman with a history of hypothyroidism, presents with ptosis and muscle weakness. She's noticed that her muscle weakness becomes worse towards the end of the day. Clinical examination reveals fatigable ptosis and proximal limb weakness. Myasthenia gravis is suspected. Which receptor is implicated in the pathophysiology of this condition?
Your Answer: Nicotinic acetylcholine receptors
Explanation:Myasthenia gravis (MG) is an organ-specific autoimmune disease caused by an antibody-mediated assault on the muscle nicotinic acetylcholine receptor (AChR) at the neuromuscular junction. Binding of antibodies to the AChR leads to loss of functional AChRs and impairs the neuromuscular signal transmission, resulting in muscular weakness.
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This question is part of the following fields:
- Immune System
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Question 18
Correct
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A 62-year-old male presented with worsening breathlessness and fatigability. On examination there was bilateral ankle swelling and pulsatile liver. Auscultation revealed a pansystolic murmur best heard at the lower left sternal border. Which of the following is the most probable diagnosis?
Your Answer: Tricuspid regurgitation
Explanation:All the clinical features are suggestive of tricuspid regurgitation. The pansystolic murmur of mitral regurgitation is best heard at the apex.
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This question is part of the following fields:
- Cardiovascular System
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Question 19
Correct
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An alcoholic man was found in a critical condition outside the pub. He was sweating heavily, was drowsy and there were some empty cans of cider lying near him. What is the most appropriate initial test that should be done in such patients?
Your Answer: Capillary blood sugar
Explanation:The most appropriate initial test should be checking the blood sugar level. Patients with hypoglycaemia can present with drowsiness, profuse sweating and dizziness.
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This question is part of the following fields:
- Nervous System
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Question 20
Correct
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A young alcoholic male patient presented at hospital with complaints of tachycardia and palpitations for the past few hours. During examination, his blood pressure and ECG were normal. What would be the next step in management of this patient?
Your Answer: Reassure and life Style modification
Explanation:Normal blood pressure and ECG rule out any pathological cause of the complaints described in this scenario. These symptoms are most probably due to anxiety or effects of alcohol intake. Lifestyle modification will be the best management plan along with reassurance to calm the patient.
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This question is part of the following fields:
- Cardiovascular System
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Question 21
Correct
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A 41-year-old male patient presents with dysphagia, haemoptysis and vocal hoarseness. He's been smoking for 25 years and has a past history of regular cannabis use. What is the most probable diagnosis?
Your Answer: Squamous cell laryngeal cancer
Explanation:Progressive hoarseness of the voice is a very typical and early finding in people suspected to have squamous cell laryngeal cancer. Due to mechanical compression, patients might experience dysphagia as well as pain. The ‘lump in the throat sensation is not uncommon too. Haemoptysis might be present, together with respiratory symptoms such as dyspnoea. Other symptoms consist of constitutional complaints, such as weight loss or fatigue.
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This question is part of the following fields:
- Haematology & Oncology
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Question 22
Incorrect
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Regarding the thymus, which of the following is true?
Your Answer: T cells positive for both CD4 and CD8 are rarely found in the thymus
Correct Answer: DiGeorge's syndrome is a developmental abnormality affecting the thymus
Explanation:The thymus is a lymphoid organ located in the anterior mediastinum. In early life, the thymus is responsible for the development and maturation of cell-mediated immunologic functions. The thymus is composed predominantly of epithelial cells and lymphocytes. Precursor cells migrate to the thymus and differentiate into lymphocytes. Most of these lymphocytes are destroyed, with the remainder of these cells migrating to tissues to become T cells.
DiGeorge’s syndrome (DGS) is a developmental abnormality affecting the thymus. The classic triad of features of DGS on presentation is conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcaemia (resulting from parathyroid hypoplasia). -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 23
Incorrect
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A 22-year-old male presents with loose stools and abdominal pain that is vague in nature. He previously had an episode of lower abdominal pain that was associated with pyrexia which settled on its own. He has also experienced mild weight loss recently. On examination, he is pale and has an ill defined mass in the right iliac fossa. What is the most likely diagnosis?
Your Answer: Appendicular mass
Correct Answer: Crohn's disease
Explanation:Crohn’s Disease (CD) is an inflammatory bowel disease, the pathogenesis of which is not fully understood. The clinical presentation of CD may be similar to ulcerative colitis (UC), the other most common inflammatory bowel disease. CD mostly affects young adults and adolescents between the ages of 15 and 35. It is typically located in the terminal ileum, but can discontinuously affect the entire gastrointestinal tract and commonly leads to complications such as fistulas, abscesses, and stenosis. Clinical features include diarrhoea, weight loss, and abdominal pain in the right lower quadrant (RLQ), as well as extraintestinal manifestations in the eyes, joints, or skin. It is often difficult to diagnose because there is no confirmatory test. Diagnosis is therefore based on the patient’s medical history, physical examination, lab tests, imaging (e.g., MRI), endoscopy, and serological testing. Acute episodes are treated with corticosteroids, and in severe cases, immunosuppressants may be indicated. Antibiotics and surgical intervention may be needed to help treat complications. Because the entire gastrointestinal tract may be affected, Crohn disease cannot be cured (in contrast to ulcerative colitis). The goal of treatment is thus to avoid the progression and recurrence of inflammatory episodes.
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This question is part of the following fields:
- Gastrointestinal System
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Question 24
Incorrect
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A 30-year-old woman presents with amenorrhoea and galactorrhoea. She has normal visual fields. You are concerned that she may have a prolactinoma.
Investigations were done and the results are as shown below:
Hb 12.5 g/dl
WCC 4.9 x109/l
PLT 199 x109/l
Na+ 140 mmol/l
K+ 4.9 mmol/l
Creatinine 90 Ù‰mol/l
Prolactin 1150 mU/l
MRI shows a 7 mm pituitary microadenoma.
Which of the following hormones would you expect to be lower than normal?Your Answer: Thyroxine
Correct Answer: LH
Explanation:Prolactinomas, benign lesions that produce the hormone prolactin, are the most common hormone-secreting pituitary tumours.
Based on its size, a prolactinoma can be classified as a microprolactinoma (< 10 mm diameter) or a macroprolactinoma (>10 mm diameter). If the prolactinoma is large enough to compress the surrounding normal hormone-secreting pituitary cells, it may result in deficiencies of one or more hormones (e.g., thyroid-stimulating hormone [TSH], growth hormone [GH], adrenocorticotropic hormone). However, the patient has microadenoma so it is unlikely to cause compression manifestations.
Hyperprolactinemia inhibits GnRH secretion from the medial basal hypothalamus and LH release from the pituitary. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 25
Incorrect
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A 59-year-old scientist is referred to you with a 2-year history of ascending lower limb numbness and, more recently, foot drop. In the last 6 months he has also developed numbness in his fingers. He has a distal reduction to pinprick and relatively preserved muscle power, except for ankle dorsiflexion and hyporeflexia in his legs. The GP has already organised nerve conduction studies and the report is sent along with the patient. Which of the following would be suggestive of an axonal neuropathy?
Your Answer: Abnormally slow F-response
Correct Answer: Reduced compound muscle action potential amplitude
Explanation:Reduced conduction velocity is associated with demyelinating neuropathies. An abnormally slow response is associated with very proximal disease, i.e. radiculopathies. Delayed P100 latency is a feature of performing visual evoked potentials in those with optic nerve disease. Conduction block is usually associated with certain types of demyelinating neuropathy.
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This question is part of the following fields:
- Nervous System
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Question 26
Correct
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Examination results for a middle age female post myocardial infarction are as follows:
Sodium = 136 mmol/L
Potassium = 6.2mmol/L
Urea = 5.0 mmol/L
ECG revealed a prolonged QRS complex and tented T waves. What is the most appropriate management?
Your Answer: Calcium gluconate
Explanation:Calcium gluconate is used as a cardio protective agent in people with high blood potassium levels, another alternative being the use of calcium chloride. It is recommended when the potassium levels are high (>6.5 mmol/l) or when the electrocardiogram (ECG) shows changes due to high blood potassium. Though it does not have an effect on potassium levels in the blood, it reduces the excitability of cardiomyocytes, thereby lowering the likelihood of cardiac arrhythmias.
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This question is part of the following fields:
- Cardiovascular System
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Question 27
Incorrect
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A 45-year-old man presents with tiredness and central weight gain.
He underwent pituitary surgery for a non-functional pituitary tumour two years ago. Although he recovered from his pituitary surgery well, he has been found to have complete anterior hypopituitarism. Accordingly he is receiving stable replacement therapy with testosterone monthly injections, thyroxine and hydrocortisone.
On examination, there are no specific abnormalities, his vision is 6/9 in both eyes and he has no visual field defects.
From his notes, you see that he has gained 8 kg in weight over the last six months and his BMI is 31. His blood pressure is 122/72 mmHg.
Thyroid function tests and testosterone concentrations have been normal. A postoperative MRI scan report shows that the pituitary tumour has been adequately cleared with no residual tissue.
Which of the following is the most likely cause of his current symptoms?Your Answer: Depression
Correct Answer: Growth hormone deficiency
Explanation:The somatotroph cells of the anterior pituitary gland produce growth hormone (GH).
GH deficiency in adults usually manifests as reduced physical performance and impaired psychological well-being. It results in alterations in the physiology of different systems of the body, manifesting as altered lipid metabolism, increased subcutaneous and visceral fat, decreased muscle mass, decreased bone density, low exercise performance, and reduced quality of life. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 28
Incorrect
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A 71-year-old woman residing in a nursing home for a couple of years complains of drooling of saliva and sudden difficulty in swallowing while eating. She is a known hypertensive on treatment. What would be your next step?
Your Answer: Ba swallow
Correct Answer: Endoscopy
Explanation:Dysphagia or difficulty in swallowing. Endoscopy allows for visual examination of the oesophagus and is indicated in patients with dysphagia to determine the underlying aetiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy including dilation.
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This question is part of the following fields:
- Geriatric Medicine
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Question 29
Incorrect
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What does Caplan's syndrome refer to?
Your Answer: Coal miners pneumoconiosis
Correct Answer: Rheumatoid lung nodules and pneumoconiosis
Explanation:Caplan’s syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is rare and usually diagnosed in an advanced stage of RA. It generally affects patients with a prolonged exposure to silica.
Caplan’s syndrome presents with rheumatoid lung nodules and pneumoconiosis. Originally described in coal miners with progressive massive fibrosis, it may also occur in asbestosis, silicosis and other pneumoconiosis. Chest radiology shows multiple, round, well defined nodules, usually 0.5 – 2.0 cm in diameter, which may cavitate and resemble tuberculosis.
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This question is part of the following fields:
- Respiratory System
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Question 30
Incorrect
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Which of the following is an appetite stimulant?
Your Answer: Cholecystokinin
Correct Answer: Neuropeptide Y
Explanation:Neuropeptide Y induces appetite during trials in rats. Other agents mentioned here are either appetite suppressants or have no effect on appetite.
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This question is part of the following fields:
- Gastrointestinal System
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SESSION STATS - PERFORMANCE PER SPECIALTY
