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Question 1
Correct
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A 45-year-old male complains of abdominal pain and loose stools. On endoscopy, multiple ulcers were seen from the oesophagus until the stomach. What will be the next best investigation for this patient?
Your Answer: Serum gastrin estimation
Explanation:Serum gastrin level will helps in the diagnosis of Zollinger-Ellison syndrome, which is characterised by a history of recurrent and multiple gastric ulcers, due to increase gastrin secretion by the cells.
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This question is part of the following fields:
- Gastrointestinal System
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Question 2
Correct
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An 18-year-old male smoker presents with extreme rubor of the feet and missing foot pulses following an amputation of his right 2nd toe. What is the most probable diagnosis?
Your Answer: Buerger's disease
Explanation:Clinical criteria for the diagnosis of Buerger’s disease are:
1 – smoking history
2 – onset before the age of 50 years
3 – infrapopliteal arterial occlusions
4 – either upper limb involvement or phlebitis migrans
5 – absence of atherosclerotic risk factors other than smoking Confident clinical diagnosis of Buerger’s disease may be made only when all five requirements have been fulfilled. -
This question is part of the following fields:
- Respiratory System
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Question 3
Correct
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An 18-year-old boy was admitted with severe pain and swelling of his scrotum following a kick to the groin. What is the most appropriate management that can be done at this stage?
Your Answer: Exploratory surgery
Explanation:The most worrying condition is testicular torsion and to exclude it exploratory surgery is required.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 4
Correct
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A 68-year-old man who has chronic obstructive pulmonary disease (COPD) is reviewed. On examination, there is evidence of cor pulmonale with a significant degree of pedal oedema. His FEV1 is 44%. During a recent hospital stay his pO2 on room air was 7.4 kPa.
Which one of the following interventions is most likely to increase survival in this patient?Your Answer: Long-term oxygen therapy
Explanation:Assess the need for oxygen therapy in people with:
– very severe airflow obstruction (FEV1 below 30% predicted)
– cyanosis (blue tint to skin)
– polycythaemia
– peripheral oedema (swelling)
– a raised jugular venous pressure
– oxygen saturations of 92% or less breathing air.Also consider assessment for people with severe airflow obstruction (FEV1 30-49% predicted).
Consider long-term oxygen therapy for people with COPD who do not smoke and who:
have a partial pressure of oxygen in arterial blood (PaO2) below 7.3 kPa when stable or have a PaO2 above 7.3 and below 8 kPa when stable, if they also have 1 or more of the following:
– secondary polycythaemia
– peripheral oedema
– pulmonary hypertension. -
This question is part of the following fields:
- Respiratory System
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Question 5
Correct
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A 56-year-old female patient is complaining of a swollen upper limb after an insect bite. Although the bite site looks better, the gross oedema is still present. What is the most likely aetiology? Keep in mind that she has a history of breast cancer and radical mastectomy with axillary lymphadenectomy 10 years ago.
Your Answer: Lymphedema
Explanation:Lymphedema is most commonly the result of removal or damage to lymph nodes.
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This question is part of the following fields:
- The Skin
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Question 6
Incorrect
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A 25-year-old previously well male presented with chest discomfort and difficulty in breathing while running to the bus. Symptoms disappeared after resting. But the symptoms reappeared whilst he was climbing the stairs. On examination he was not dyspnoeic at rest. BP was 110/70 mmHg and pulse rate was 72 bpm. His heart sounds were normal. There was an additional clicking noise in the fourth left intercostal space which is heard with each heartbeat. Which of the following is the most probable cause for his presentation?
Your Answer: Acute pericarditis
Correct Answer: Spontaneous pneumothorax
Explanation:The given history is more compatible with spontaneous pneumothorax. Left-sided pneumothoraxes may be associated with a clicking noise, which is heard with each heart-beat and can sometimes be heard by the patient.
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This question is part of the following fields:
- Cardiovascular System
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Question 7
Incorrect
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Choose the correct definition regarding the standard error of the mean:
Your Answer: Standard deviation / square root (mean)
Correct Answer: Standard deviation / square root (number of patients)
Explanation:The SEM is an indicator of how close the sample mean is to the population mean. In reality, however, only one sample is extracted from the population. Therefore, the SEM is estimated using the standard deviation (SD) and a sample size (Estimated SEM). The SEM computed by a statistical program is an estimated value calculated via this process.
Estimated Standard Error of the Mean (SEM)=SDn?
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This question is part of the following fields:
- Evidence Based Medicine
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Question 8
Correct
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A 51-year-old woman recently put on antihypertensives showed the following results on 2 occasions: Na+ = 132, K+ = 7.6, Urea = 11.3, and Creatinine = 112. Which of the following drugs is responsible for this result?
Your Answer: Ramipril
Explanation:Ramipril is an ACE Inhibitor. Treatment with angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) has consistently been shown to reduce the risk of renal and cardiovascular morbidity and mortality in a range of patients. However, ACEI and ARB therapy increase serum potassium which increases the risk of hyperkalaemia.
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This question is part of the following fields:
- Pharmacology
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Question 9
Correct
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A 49-year-old female is admitted to the hospital with shortness of breath and pleuritic chest pain. She also complains of loss of appetite for the past four months. Her admission CXR shows right-sided pleural effusion. An underlying malignancy is suspected and a series of tumour markers are requested, the results of which are:
CA 19-9: 36 IU/mL (<40)
CA 125: 654 IU/ml (<30)
CA 15-3: 9 IU/ml (<40)
What is the most likely underlying diagnosis?Your Answer: Ovarian fibroma
Explanation:The patient has Meigs syndrome. Meigs syndrome is defined as a triad of benign ovarian tumour with ascites and pleural effusion that resolves after resection of the tumour. Ovarian fibromas constitute the majority of the benign tumours seen in Meigs syndrome.
Tumour markers can be divided into:
1. Monoclonal antibodies
CA 125: Ovarian cancer, primary peritoneal cancer
CA 19-9: Pancreatic cancer
CA 15-3: Breast cancer2. Tumour specific antigens
Prostate specific antigen (PSA): Prostatic carcinoma
Alpha-feto protein (AFP): Hepatocellular carcinoma, teratoma
Carcinoembryonic antigen (CEA): Colorectal cancer
S-100: Melanoma, schwannomas
Bombesin: Small cell lung carcinoma, gastric cancer3. Enzymes
Alkaline phosphatase (ALP)
Neuron specific enolase (NSE)4. Hormones
Calcitonin
Antidiuretic hormone (ADH)
Human chorionic gonadotropin (hCG) -
This question is part of the following fields:
- Haematology & Oncology
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Question 10
Correct
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Which one of the following is the most common type of Hodgkin lymphoma?
Your Answer: Nodular sclerosing
Explanation:The most common type of Hodgkin’s lymphoma (HL) is nodular sclerosing.
HL is a malignant proliferation of lymphocytes characterised by the presence of distinctive giant cells known as Reed-Sternberg cells. It has a bimodal age distribution being most common in the third and seventh decades of life.
According to the histological classification, there are four types of HL:
1. Nodular sclerosing: most common (around 70%), more common in women, associated with lacunar cells, good prognosis
2. Mixed cellularity: Around 20%, associated with a large number of Reed-Sternberg cells, good prognosis
3. Lymphocyte-predominant: Around 5%, Reed-Sternberg cells with nuclei surrounded by a clear space found, best prognosis
4. Lymphocyte-depleted: rare, worst prognosis
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This question is part of the following fields:
- Haematology & Oncology
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Question 11
Incorrect
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A 51-year-old real estate agent takes hydrocortisone 20mg in the mornings and 5mg at night for Addison's disease. The endocrinology consultant would like her to take prednisolone instead.
What dose of prednisolone should be started?Your Answer: 5 mg
Correct Answer: 7 mg
Explanation:1mg Prednisolone = 4mg hydrocortisone, so the actual equivalent daily dose is 7mg.
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This question is part of the following fields:
- Pharmacology
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Question 12
Incorrect
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A clinical trial is conducted to study the benefits of a new oral medication to improve the symptoms of patients with asthma. In the trial 400 patients with asthma, half were given the new medication and half a placebo. Three months later they are asked to rate their symptoms using the following scale: much improved, slight improvement, no change, slight worsening, significantly worse. What is the most appropriate statistical test to see whether the new medication is beneficial?
Your Answer: Student's t-test (paired)
Correct Answer: Mann-Whitney U test
Explanation:The type of significance test used depends on whether the data is parametric (can be measured, usually normally distributed) or non-parametric.
Parametric tests:
Student’s t-test – paired or unpaired*
Pearson’s product-moment coefficient – correlationNon-parametric tests:
Mann-Whitney U test – unpaired data
Wilcoxon signed-rank test – compares two sets of observations on a single sample
chi-squared test – used to compare proportions or percentages
Spearman, Kendall rank – correlation.The outcome measured is not normally distributed, i.e. it is non-parametric. This excludes the Student’s t-tests. We are not comparing percentages/proportions so the chi-squared test is excluded. The Mann-Whitney U test is a nonparametric test of the null hypothesis that it is equally likely that a randomly selected value from one sample will be less than or greater than a randomly selected value from a second sample.
This test can be used to investigate whether two independent samples were selected from populations having the same distribution. -
This question is part of the following fields:
- Evidence Based Medicine
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Question 13
Correct
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A 60-year-old female underwent a surgery involving the posterior triangle of the neck. After the surgery, she had difficulty when moving her right shoulder joint. Which of the following nerves is most probably involved?
Your Answer: Accessory nerve
Explanation:The accessory nerve innervates the trapezius muscle which is involved in shoulder movements. Any injury to this nerve will result in the difficulty of movements around the shoulder.
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This question is part of the following fields:
- Musculoskeletal System
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Question 14
Correct
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A 25-year-old farmer presents with a fever, headache, malaise and neck stiffness. The first line empirical antibiotic is?
Your Answer: Ceftriaxone
Explanation:The most likely diagnosis is meningitis which requires admission and iv antibiotics. The drug of choice is a 3rd generation cephalosporin. In patients older than 55 , ampicillin cefotaxime combination is used.
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This question is part of the following fields:
- Nervous System
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Question 15
Correct
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A 32-year-old female is diagnosed with SLE based on her complaints of polyarthralgia, mouth ulcers and ANA positivity. Labs reveal normal urinalysis, urea and electrolytes. ESR is 90mm in the first hour. How will you manage this patient?
Your Answer: Hydroxychloroquine 200 mg/day
Explanation:Hydroxychloroquine is used in the management of SLE as it prevents disease progression and has relatively mild side effects, for instance headache, nausea etc. Its use reduces the usage of corticosteroids. It is particularly effective when the disease is less severe and there is no organ involvement. Cyclophosphamide and prednisolone are indicated in cases of renal, neurological and lung involvement.
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This question is part of the following fields:
- Musculoskeletal System
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Question 16
Correct
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A 19-year-old woman comes to the endocrine clinic with excessive hairiness and acne. She tells you that she has a period only every few months and when she has one it tends to be very heavy.
On examination, she has obvious facial acne. Her BP is 142/78 mmHg, her pulse is 72 bpm and regular and her BMI is 30. There is facial hair and hair around her upper chest and breasts.
Investigations show:
Haemoglobin 11.9 g/dl (11.5-16.0)
White cell count 6.0 x 10(9)/l (4-11)
Platelets 202 x 10(9)/l (150-400)
Sodium 137 mmol/l (135-146)
Potassium 3.9 mmol/l (3.5-5)
Creatinine 90 µmol/l (79-118)
Total testosterone normal
Free androgen index elevated
LH / FSH ratio 2.2
Which of the following is the most likely diagnosis?Your Answer: Polycystic ovarian syndrome
Explanation:Rotterdam criteria for the diagnosis of polycystic ovary syndrome:
Two of the following three criteria are required:
1. Oligo/anovulation
2. Hyperandrogenism
– Clinical (hirsutism or less commonly male pattern alopecia) or
– Biochemical (raised FAI or free testosterone)
3. Polycystic ovaries on ultrasound
Other aetiologies must be excluded such as congenital adrenal hyperplasia, androgen-secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia.
Cushing’s is excluded because there would have been marked obesity, hypertension and other related features. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 17
Correct
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The following drugs are given for different types of respiratory conditions. Which of the following drugs exerts its action by inhibiting phosphodiesterase?
Your Answer: Theophylline
Explanation:Theophylline relaxes the smooth muscles of the respiratory tract and suppresses the response of the airways to stimuli by increasing tissue concentration of cyclic adenine monophosphate (cAMP) by inhibiting phosphodiesterase. Dobutamine has strong beta1 and weak beta2/alpha effects, resulting in increased cardiac output, blood pressure, and heart rate, as well as decreased peripheral vascular resistance. Doxapram produces respiratory stimulation in medulla through peripheral carotid chemoreceptors. Ipratropium inhibits vagally mediated reflexes by antagonizing acetylcholine action which prevents increase in intracellular calcium concentration and ultimately causes bronchial smooth muscle relaxation. Salbutamol is a short-acting β2 adrenergic receptor agonist which causes smooth muscle relaxation.
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This question is part of the following fields:
- Pharmacology
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Question 18
Correct
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A 28-year-old female presented with complaints of weight gain, thinning of scalp hair, dryness and coldness of the skin, constipation and fatigue. Which of the following is the most likely diagnosis?
Your Answer: Hypothyroidism
Explanation:The symptoms this female presented with in the OPD are major symptoms of hypothyroidism due to insufficient thyroid hormone.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 19
Correct
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Question 20
Correct
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A 52-year-old cancer patient that recently had an anterior resection of the rectum is concerned about postoperative pain control. What is the most appropriate management choice in his case?
Your Answer: IM morphine
Explanation:Post-operative pain is usually severe and strong analgesia is needed with IM morphine.
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This question is part of the following fields:
- Pharmacology
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Question 21
Incorrect
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An 18-year-old prospective medical student is tested for hepatitis B. Her liver tests show alanine transaminase (ALT) 120 U/L and serology shows her to be positive for HBsAg, HBcAb and HBeAg, with a viral load of 105 genome equivalents/mL.
A liver biopsy is reported as showing early fibrosis with evidence of moderate inflammation.
Which of the following treatments should be offered?Your Answer: Entecavir
Correct Answer: Interferon alfa 2b
Explanation:Interferon alfa alone, not interferon alfa and ribavirin, has been shown to achieve HBeAg seroconversion for patients with HBeAg-positive chronic hepatitis B.
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This question is part of the following fields:
- Infectious Diseases
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Question 22
Correct
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A 45-year-old man smokes 20 cigarettes/day for the last 28 years. He presents with a 2-month history of drooping eyelid, hoarseness of voice, and a palpable mass in the right supraclavicular fossa. What is the most likely diagnosis?
Your Answer: Pancoast tumour
Explanation:Smoking history and symptoms suggest a Pancoast tumour as the diagnosis. Compression of sympathetic ganglion can cause ptosis, involvement of the supraclavicular lymph node results in a palpable mass in the right supraclavicular fossa, and voice hoarseness related to laryngeal nerve compression.
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This question is part of the following fields:
- Respiratory System
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Question 23
Correct
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A 19-year-old male who is a first year student at university presented in the emergency room with acute disorientation. He was previously relaxed and well. Which of the following is the most likely cause behind his condition?
Your Answer: Drug toxicity
Explanation:History of being well and sudden appearance of agitation and confused state at this age is suggestive of drug intake and toxicity.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 24
Incorrect
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A 16-year-old patient was admitted with walking difficulties and knee pain. Upon examination, his leg is externally rotated and is 2 cm shorter. His ability to flex, abduct and medially rotate his leg is limited and when he flexes his hip, external rotation is increased. What is the most probable diagnosis?
Your Answer: Juvenile rheumatoid arthritis
Correct Answer: Slipped femoral epiphysis
Explanation:The clinical presentation is typical of a slipped femoral epiphysis, which refers to a fracture through the growth plate (physis), resulting in slippage of the overlying end of the femur. It is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. The range of motion in the hip is restricted in internal (medial) rotation, abduction, and flexion.
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This question is part of the following fields:
- Musculoskeletal System
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Question 25
Correct
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A patient with a history of asthma presents with worsening of her symptoms and dyspnoea. She recently started taking a new medicine and she feels it might have aggravated her symptoms.
Which of the following is likely responsible for her symptoms?Your Answer: Timolol eye drops
Explanation:β-blockers are the class of drug most often chosen to treat glaucoma, although other medical therapies are available. Systemic absorption of timolol eye drops can cause unsuspected respiratory impairment and exacerbation of asthma. Physicians should be alert to the possibility of respiratory side-effects of topical therapy with β-blockers. Leukotriene antagonists and salbutamol are used in asthma treatment. HRT and ferrous sulphate do not lead to the exacerbation of asthma.
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This question is part of the following fields:
- Respiratory System
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Question 26
Correct
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What does Caplan's syndrome refer to?
Your 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 27
Correct
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A 72-year-old woman presents with left side groin pain. She says she suddenly collapsed and was not able to lift her leg anymore. She is on calcium supplements and alendronate. What is the best diagnosis?
Your Answer: Fracture of neck of femur
Explanation:Fracture of the neck of femur is characterised by inability to lift the affected limb. This is relatively common in osteoporotic patients.
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This question is part of the following fields:
- Musculoskeletal System
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Question 28
Incorrect
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A 26-year-old male was being investigated further following several hypertensive episodes. There was a marked difference in his systolic blood pressures between the right brachial and the right femoral arteries. Which of the following is most probable diagnosis?
Your Answer: Patent ductus arteriosus
Correct Answer: Coarctation of the aorta
Explanation:From the given physical findings (the difference in BP between the radial and femoral arteries), the most probable diagnosis is coarctation of the aorta.
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This question is part of the following fields:
- Cardiovascular System
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Question 29
Incorrect
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A 52-year-old woman is diagnosed as having acute myeloid leukaemia. What is the single most important test in determining her prognosis?
Your Answer: Immunophenotyping
Correct Answer: Cytogenetics
Explanation:All of the aforementioned options may be important however cytogenetics, for detecting chromosomal abnormalities, is the single most important test to determine her disease prognosis.
Acute myeloid leukaemia (AML) is the acute expansion of the myeloid stem line, which may occur as a primary disease or follow the secondary transformation of a myeloproliferative disorder. It is more common over the age of 45 and is characterized by signs and symptoms largely related to bone marrow failure such as anaemia (pallor, lethargy), frequent infections due to neutropenia (although the total leucocyte count may be very high), thrombocytopaenia (bleeding), ostealgia, and splenomegaly.
The disease has a poor prognosis if:
1. Age of the patient >60 years
2. >20% blasts seen after the first course of chemotherapy
3. Chromosomal aberration with deletion of part of chromosome 5 or 7.Acute promyelocytic leukaemia (APL) is an aggressive form of AML.
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This question is part of the following fields:
- Haematology & Oncology
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Question 30
Correct
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Which of the following is the drug of choice for the treatment of Chlamydia trachomatis infection during pregnancy?
Your 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.
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This question is part of the following fields:
- Infectious Diseases
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SESSION STATS - PERFORMANCE PER SPECIALTY
