-
Question 1
Correct
-
A 70-year-old male tells doctors he has been exposed to asbestos 20 years ago and has attempted to quit smoking. He has lost a lot of weight and his voice is very hoarse. Choose the most likely cancer diagnosis in this patient.
Your Answer: Bronchial Carcinoma
Explanation:A hoarse voice, exposure to asbestos, and smoking are all consistent with bronchial carcinoma in this patient.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 2
Correct
-
An 82-year-old woman is brought in by her carer with fluctuating consciousness. On examination she is deeply jaundiced, hypotensive with a tachycardia and has a hepatic flap. Initial blood tests reveal an ALT of 1000 U/l, INR 3.4, ALP 600 U/l and a bilirubin of 250 mmol/l.
Repeat blood tests 6 hours later show an ALT of 550 U/l, INR 4.6, ALP 702 U/l and bilirubin of 245 m mol/l. The toxicology screen for paracetamol and aspirin is negative; she is positive for hepatitis B surface antibody and negative for hepatitis B surface antigen.
Which of the following would best explain her clinical condition?Your Answer: Acute liver failure secondary to paracetamol
Explanation:Liver flap is pathognomonic for liver failure. Paracetamol (also known as acetaminophen) overdose usually presents with symptoms including liver failure, resulting in confusion, jaundice, and coagulopathy a few days after overdose. The first 24 hours, people usually have minimal symptoms. Diagnosis is based on blood levels of acetaminophen at specific times after it was taken (see reference). If she took it a few days ago, levels may indeed be undetectable. The hepatitis B serology suggests prior vaccination. Wilson’s disease is not the most likely diagnosis given her presentation. The AST:ALT ratio would be expected to be reversed in alcohol induced liver failure.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 3
Incorrect
-
An 8-year-old girl was bought immediately to the emergency department. She is fully conscious but has stridor, is wheezing and has a generalised erythematous rash. She has known allergies. What is the single immediate management?
Your Answer: Give 0.5ml in 1000 adrenaline by IM injection
Correct Answer: Give 0.3ml in 1000 adrenaline by IM injection
Explanation:This is a case of an anaphylactic reaction that requires immediate intervention. IM adrenaline dose for 6-12 year old children is 300 micrograms IM.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 4
Correct
-
A 27-year-old woman presents with a 4cm bleeding ulcer on her labia minora. The woman admits she is sexually active. Which lymph nodes will the ulcer drain to?
Your Answer: Superficial inguinal
Explanation:The woman seems to have a chancroid, which may or may not drain to the lymph nodes of the groin. These nodes are the superficial inguinal lymph nodes.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 5
Correct
-
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: 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
-
-
Question 6
Correct
-
What is the site of action of antidiuretic hormone?
Your Answer: Collecting ducts
Explanation:Vasopressin, also called antidiuretic hormone (ADH), regulates the tonicity of body fluids. It is released from the posterior pituitary in response to hypertonicity and promotes water reabsorption in the collecting ducts of the kidneys by the insertion of aquaporin-2 channels.. An incidental consequence of this renal reabsorption of water is concentrated urine and reduced urine volume. In high concentrations may also raise blood pressure by inducing moderate vasoconstriction.
-
This question is part of the following fields:
- Renal System
-
-
Question 7
Correct
-
A 35-year-old female complains of headache at the back of her head that has been occurring for several days and pain on neck flexion. She works as a housemaid. Which of the following is the most likely cause of her presentation?
Your Answer: Cervical spondylosis
Explanation:Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, signs of osteoarthritis develop, including bony projections along the edges of bones (bone spurs). Cervical spondylosis is very common and worsens with age.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 8
Correct
-
A girl suffered full thickness circumferential burn to her right arm. What is best step in management?
Your Answer: Escharotomy
Explanation:An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.
-
This question is part of the following fields:
- The Skin
-
-
Question 9
Incorrect
-
A 69-year-old woman is admitted with confusion. She's known to have a history of multiple myeloma. Blood exam reveals the following: Na+ = 147 mmol/l, K+ = 4.7 mmol/l, Urea = 14.2 mmol/l, Creatinine = 102 μmol/l, Adjusted calcium = 3.9 mmol/l. What is the single most appropriate management?
Your Answer: IV zoledronic acid
Correct Answer: IV 0.9% saline
Explanation:NICE guidelines on hypercalcemia recommend that maintaining good hydration equals drinking 3-4 L of fluid/day, provided there are no contraindications. A low calcium diet is not necessary because intestinal absorption of calcium is reduced. The patient should avoid any other drugs or vitamins that could worsen the hypercalcemia. Mobilization is encouraged and any symptoms of hypercalcemia should be reported.
-
This question is part of the following fields:
- Fluids & Electrolytes
-
-
Question 10
Correct
-
A 73-year-old post-menopausal woman with an ESR of 72mm/hr, complains of pain on chewing and unilateral headache. Which additional treatment would you choose if she is already on oral steroids?
Your Answer: Bisphosphonates
Explanation:The symptoms in concordance with the elevated ESR and the age of the patient should make you think of temporal arteritis. Temporal arteritis is treated with steroids which predispose the patient to develop osteopenia and finally osteoporosis. Its very important to take into account the sex and the age of the patient because osteoporosis is common in post-menopausal women. Bisphosphonates are protective towards osteoporosis and they should be administered next.
-
This question is part of the following fields:
- Nervous System
-
-
Question 11
Correct
-
Which of the following conditions is not linked to hyperuricemia?
Your Answer: Osteoarthritis
Explanation:Hyperuricemia is an elevated uric acid level in the blood. The normal upper limit is 6.8mg/dL, and anything over 7 mg/dL is considered saturated, and symptoms can occur. Causes of hyperuricemia can be classified into three functional types:
1. Increased production of uric acid – Purine rich diet, Tumour lysis syndrome, HGPRT deficiency (Lesch-Nyhan and Kelley-Seegmiller syndromes), Increased PRPP synthetase activity and Polycythaemia
2. Decreased excretion of uric acid – Renal impairment, Metabolic syndrome, Drugs (diuretics, low-dose aspirin, cyclosporin, tacrolimus, pyrazinamide, ethambutol, levodopa, nicotinic acid), Acidosis, Pre-eclampsia and eclampsia, Hypothyroidism and hyperparathyroidism, Sarcoidosis, Familial juvenile gouty nephropathy, Chronic lead intoxication, Trisomy 21
3. Idiopathic and mixed type – Alcohol, Exercise, Glucose-6-phosphatase deficiency, Aldolase B deficiency -
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 12
Correct
-
A 33-year-old man with a known history of alcoholic liver disease is reviewed following a suspected oesophageal variceal haemorrhage. He has been resuscitated and intravenous terlipressin has been given. His blood pressure is now 104/60 mmHg and his pulse is 84/min. What is the most appropriate intervention?
Your Answer: Endoscopic variceal band ligation
Explanation:The correct course of action after giving terlipressin and resuscitating with IV fluids is to perform an EGD with endoscopic variceal band ligation. According to NICE: ‘Offer endoscopic variceal band ligation for the primary prevention of bleeding for people with cirrhosis who have medium to large oesophageal varices. There are serious complications of a TIPS procedure and it is not the first line treatment.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 13
Correct
-
A 69-year-old man on the cardiology ward who is hypotensive, and tachycardic is having profuse melaena. He was commenced on dabigatran 150mg bd by the cardiologists 48 hours earlier for non-valvular atrial fibrillation. Following appropriate resuscitation which of the following treatments is most likely to improve his bleeding?
Your Answer: Idarucizumab (Praxbind)
Explanation:Idarucizumab (Praxbind) is a newer antidote for dabigatran, the first of its kind. It is a monoclonal antibody fragment that binds dabigatrin with a higher affinity than thrombin. It is very expensive.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 14
Incorrect
-
A 45-year-old male complained of deteriorating vision after starting a new drug. Which of following could NOT be responsible for this presentation?
Your Answer: Ethambutol
Correct Answer: Irinotecan
Explanation:Chloroquine causes Bull’s eye maculopathy which consists of a number of different conditions in which there is a ring of pale-looking damage around a darker area of the macula.
Ethambutol causes optic neuritis.
Quinine causes blurred vision and changes in colour vision.
Vincristine causes optic nerve atrophy as a result of chronic optic nerve oedema or optic neuritis.
Irinotecan does not have any ocular side effects. -
This question is part of the following fields:
- Pharmacology
-
-
Question 15
Correct
-
A 68-year-old woman with contralateral hemisensory loss presents with severe burning pain in this area. In which of the following areas has arterial occlusion most probably occurred?
Your Answer: Thalamogeniculate artery
Explanation:The woman’s clinical evolution suggests that there was a thalamic stroke in the contralateral hemisphere. The artery most likely affected is the thalamogeniculate artery. Sensory loss is usually unilateral and presents at the opposite side of the brain lesion. This kind of stroke can result in severe burning pain which is responsive to tricyclics.
-
This question is part of the following fields:
- Nervous System
-
-
Question 16
Correct
-
A 32-year-old female patient has the following signs and symptoms: smooth goitre, lid lag and bilateral exophthalmos with puffy eyelids and conjunctival injections. She has a history of thyrotoxicosis but wants to fall pregnant. What would be the most appropriate treatment for her?
Your Answer: 18m of Propylthiouracil (PTU) alone
Explanation:Propylthiouracil (PTU) is a safe choice for a woman that is planning a pregnancy because it does not have the teratogenic effects as carbimazole does. Methimazole (MMI) and propylthiouracil (PTU) are the standard anti-thyroid drugs used in the treatment of hyperthyroidism in pregnancy. Carbimazole can cause spina bifida, CV malformations as well as hypospadia.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 17
Incorrect
-
Which of the statements is most accurate regarding the lung?
Your Answer: In normal subjects the small airways contribute to most of the resistance
Correct Answer: The medial basal segment is absent in the left lower lobe
Explanation:The right and left lung anatomy are similar but asymmetrical. The right lung consists of three lobes: right upper lobe (RUL), right middle lobe (RML), and right lower lobe (RLL). The left lung consists of two lobes: right upper lobe (RUL) and right lower lobe (RLL). The right lobe is divided by an oblique and horizontal fissure, where the horizontal fissure divides the upper and middle lobe, and the oblique fissure divides the middle and lower lobes. In the left lobe there is only an oblique fissure that separates the upper and lower lobe.
The lobes further divide into segments which are associated with specific segmental bronchi. Segmental bronchi are the third-order branches off the second-order branches (lobar bronchi) that come off the main bronchus.
The right lung consists of ten segments. There are three segments in the RUL (apical, anterior and posterior), two in the RML (medial and lateral), and five in the RLL (superior, medial, anterior, lateral, and posterior). The oblique fissure separates the RUL from the RML, and the horizontal fissure separates the RLL from the RML and RUL.
There are eight to nine segments on the left depending on the division of the lobe. In general, there are four segments in the left upper lobe (anterior, apicoposterior, inferior and superior lingula) and four or five in the left lower lobe (lateral, anteromedial, superior and posterior). The medium sized airways offer the maximum airway resistance, not smaller ones.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 18
Correct
-
A 60-year-old gentleman is found dead in his apartment. He was known to be suffering from primary systemic amyloidosis. What is the most probable cause for his death?
Your Answer: Cardiac involvement
Explanation:Primary amyloidosis is characterised by abnormal protein build-up in the tissues and organ such as the heart, liver, spleen, kidneys, skin, ligaments, and nerves. However, the most common cause of death in patients with primary amyloidosis is heart failure.
-
This question is part of the following fields:
- Renal System
-
-
Question 19
Incorrect
-
A 70-year-old male presented with mild ascites due to alcoholic cirrhosis. Which of the following abnormalities is most likely present?
Your Answer: Reduced renin concentrations
Correct Answer: Reduced urinary sodium excretion
Explanation:Patients with cirrhosis are mostly hyponatraemic due to increased water retention.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 20
Incorrect
-
A child with jaundice and pale stools would most likely be evaluated by which of the following tests?
Your Answer: Sweat test
Correct Answer: US
Explanation:Blood tests do not help in the diagnosis of jaundice except of course by telling the level of jaundice (bilirubin) and providing some corroborative evidence such as autoantibodies, tumour markers or viral titres in the case of hepatitis. Classifying causes of jaundice on the basis of ultrasound provides a quick and easy schema for diagnosing jaundice which is applicable in primary care as well as hospital based practice.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 21
Incorrect
-
A 55-year-old alcoholic is admitted with portal hypertension. The wedged hepatic venous pressure is recorded. This pressure is reflective of which part of the hepatic vascular system?
Your Answer: Portal vein
Correct Answer: Sinusoids
Explanation:The wedged hepatic venous pressure is a reflection of the portal venous pressure in the hepatic sinusoids. This is a fact to remember. Here is a great but concise explanation as to why: https://www.ncbi.nlm.nih.gov/pubmed/18695309
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 22
Correct
-
Question 23
Correct
-
A 50-year-old woman presents with coughing up copious sputum with blood streaks, increased breathlessness, and finger clubbing. She has a history of chronic cough. What is the initial investigation?
Your Answer: Chest x-ray
Explanation:Finger clubbing and past history suggest a chronic pulmonary process going on. A CXR will allow the pathology to be visualised including any infective or cancerous causes.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 24
Correct
-
A 64-year-old woman with ankylosing spondylitis presents with cough, weight loss and tiredness. Her chest x-ray shows longstanding upper lobe fibrosis. Three sputum tests stain positive for acid fast bacilli (AFB) but are consistently negative for Mycobacterium tuberculosis on culture.
Â
Which of the following is the most likely causative agent?Your Answer: Mycobacterium avium intracellular complex
Explanation:Pulmonary mycobacterium avium complex (MAC) infection in immunocompetent hosts generally manifests as cough, sputum production, weight loss, fever, lethargy, and night sweats. The onset of symptoms is insidious.
In patients who may have pulmonary infection with MAC, diagnostic testing includes acid-fast bacillus (AFB) staining and culture of sputum specimens.The ATS/IDSA guidelines include clinical, radiographic, and bacteriologic criteria to establish a diagnosis of nontuberculous mycobacterial lung disease.
Clinical criteria are as follows:
Pulmonary signs and symptoms such as cough, fatigue, weight loss; less commonly, fever and weight loss; dyspnoea
Appropriate exclusion of other diseases (e.g., carcinoma, tuberculosis).
At least 3 sputum specimens, preferably early-morning samples taken on different days, should be collected for AFB staining and culture. Sputum AFB stains are positive for MAC in most patients with pulmonary MAC infection. Mycobacterial cultures grow MAC in about 1-2 weeks, depending on the culture technique and bacterial burden.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 25
Incorrect
-
Around 30 patients have been admitted to the hospital following a suspected chemical attack in the city. The patients are extremely unwell, with symptoms of excessive salivation, lacrimation, diarrhoea, and emesis. Sarin gas was suspected as the most likely agent used in the attack. What is the mechanism of action of this chemical agent?
Your Answer: Anti-cholinergic
Correct Answer: Inhibition of acetylcholinesterase
Explanation:Sarin acts by inhibiting acetylcholinesterase.
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase. This results in high levels of acetylcholine (ACh).The effects of excessive ACh can be remembered by the mnemonic DUMBELLS:
Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea/Bradycardia
Emesis
Lacrimation
Salivation/sweatingOrganophosphate insecticide poisoning:
One of the effects of organophosphate poisoning is inhibition of acetylcholinesterase
Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
miosis, muscle fasciculation.Organophosphate poisoning is treated with the anti-muscarinic atropine.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 26
Correct
-
A 25-year-old youth was brought to the A&E following a stab injury to the right back of the chest. On examination he was dyspnoeic, his trachea was deviated to the left side and there were engorged veins and absent breath sounds on the right side. Which of the following is the most probable diagnosis?
Your Answer: Tension pneumothorax
Explanation:History is suggestive of right sided tension pneumothorax. It can’t be a simple pneumothorax because of tracheal deviation and engorged veins.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 27
Correct
-
A 23-year-old woman presents with lethargy. Her bloods show: Hb: 10.4 g/dL Plts: 278 x 10^9/L WCC: 6.3 x 10^9/L MCV: 68 fL Blood film: Microcytic hypochromic RBCs, marked anisocytosis and basophilic stippling noted HbA2: 3.9% What is the most likely diagnosis?
Your Answer: Beta-thalassaemia trait
Explanation:Individuals with thalassemia major usually develop symptoms within the first two years of life. These infants may fail to thrive and often have difficulty feeding, tire easily and suffer from severe anemia.
The infants may also suffer from diarrhea, irritability, recurrent episodes of fever, and other intestinal problems. These children have trouble gaining weight and growing at the rate expected for their age. Other complications include enlarged spleen, heart and liver and misshapen bones.
In many cases, the symptoms are severe enough to warrant regular blood transfusion to replenish the blood with healthy red blood cells. However, these regular transfusions can lead to a build up of iron in the blood that can damage the heart, liver and endocrine system and chelation therapy may be needed to remove this iron from the body.
Individuals with beta thalassemia trait usually have evidence of microcytosis and increased levels of hemoglobin A2. Hemoglobin F is sometimes elevated as well. Individuals with alpha thalassemia trait usually have evidence of microcytosis and normal levels of hemoglobin A2 and F.
In thalassemia major, the hemoglobin (Hb) level is usually less than 7 g/dl; the mean corpuscolar volume (MCV) less than 70 fl and the mean corpuscolar Hb (MCH) is over 20 pg.
In thalassemia intermedia, the hemoglobin level is between 7 and 10 g/dl; the MCV between 50 and 80 fl and MCH between 16 and 24 pg.
Thalassemia minor is characterized by a reduced MCV and MCH and an increased haemoglobin A2 level.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 28
Correct
-
A 24-year-old woman presents as an emergency to her GP with acute vomiting which began some 3-4 hours after attending an afternoon meeting. Cream cakes were served during the coffee break.
Which of the following organisms is the most likely cause of this acute attack of vomiting?Your Answer: Staphylococcus aureus
Explanation:Staph. aureus is the most likely cause. It is found in foods like dairy products, cold meats, or mayonnaise. It produces a heat-stable ENDOTOXIN (remember this) that causes nausea, vomiting, and diarrhoea 1-6 hours after ingestion of contaminated food. B. cereus is classically associated with fried rice being reheated. Salmonella is typical with raw eggs and undercooked poultry. Campylobacter which is most commonly associated with food poisoning, is seen with poultry 50% of the time. Yersinia enterocolitica is seen with raw or undercooked pork, and may be a case presenting with mesenteric adenitis.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 29
Correct
-
Which one of the following features is most helpful in distinguishing beta thalassaemia trait from iron deficiency anaemia?
Your Answer: Haemoglobin A2 levels
Explanation:Elevated haemoglobin A2 level is seen in beta thalassaemia trait, whereas, it is typically low in iron deficiency anaemia unless the patient has received a recent blood transfusion.
Low mean corpuscular volume (MCV) and reduced haematocrit (Ht) are encountered in both conditions. Peripheral blood smear is grossly abnormal in both beta thalassaemia and severe iron deficiency anaemia, showing bizarre morphology, target cells, and a small number of nucleated red blood cells.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 30
Incorrect
-
An 82-year-old man arrives at the clinic with painful right upper arm that he has been experiencing for the last few months. The pain is gradually worsening and often wakes him up at night. He is a known case of Paget's disease involving his lumbar spine and pelvis and is currently taking oral bisphosphonates. On examination, shoulder movements are intact. Which of the following is the most likely cause of his arm pain?
Your Answer: Osteonecrosis
Correct Answer: Osteosarcoma
Explanation:Paget’s accelerates the remodelling process with old bone breaking down more quickly which disrupts the normal growth process. New bone development eventually adjusts to the faster pace and speeds up on its own. The pace is too fast for healthy bone growth, and the regrowth ends up softer and weaker than normal. The effect of this accelerated process causes bone pain, fractures, and deformities. Since osteosarcoma is a type of bone cancer linked to abnormal bone growth, this makes it a rare but possible complication of Paget’s disease although the chances of developing osteosarcoma are minimal. Fractures are painful and restrict movement whereas this patients pain is gradually developing. Pain associated with osteoarthritis is usually mild to moderate and worsens as the day progresses.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 31
Correct
-
A 74-year-old retired judge who is known to have Alzheimer's disease is examined in clinic. His latest Mini Mental State Examination (MMSE) score is 18 out of 30. Which of the following is the most appropriate treatment option?
Your Answer: Supportive care + donepezil
Explanation:NICE now recommends the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease. Memantine is reserved for patients with moderate to severe Alzheimer’s.
-
This question is part of the following fields:
- Nervous System
-
-
Question 32
Incorrect
-
A woman is prescribed docetaxel as part of her chemotherapy for breast cancer. What is the mechanism of action of docetaxel?
Your Answer: Causes cross-linking in DNA
Correct Answer: Prevents microtubule disassembly
Explanation:The principal mechanism of action of taxanes (e.g. docetaxel) is the prevention of microtubule disassembly.
Other aforementioned options are ruled out because:
1. Doxorubicin: stabilizes DNA topoisomerase II complex and inhibits DNA and RNA synthesis.
2. Vincristine, vinblastine: inhibits formation of microtubules.
3. Cisplatin: causes cross-linking in DNA.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 33
Incorrect
-
A 43-year-old woman is concerned about osteoporosis as she as a strong family history of it. She is one year postmenopausal and aware of hot flushes at night.
Which one of the following therapies would be most appropriate?Your Answer: Calcium and vitamin D supplements
Correct Answer: Cyclical oestrogen and progestogen
Explanation:As the patient has early menopause, hormone replacement therapy (HT) is considered to be the first line of choice for prevention of bone loss and fracture in the early postmenopausal period for 5 years.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 34
Correct
-
What is the mechanism of action (MOA) of cisplatin?
Your Answer: Causes cross-linking in DNA
Explanation:Cisplatin is a cytotoxic agent that acts by causing cross-linking in DNA. Its adverse effects include ototoxicity, peripheral neuropathy, hypomagnesaemia, etc.
The causative cytotoxic agents acting through the other aforementioned MOAs are as follows:
1. Doxorubicin: Stabilizes DNA topoisomerase II complex and inhibits DNA and RNA synthesis.
2. Hydroxyurea (hydroxycarbamide): Inhibits ribonucleotide reductase, decreasing DNA synthesis.
3. Mercaptopurine (6-MP): Purine analogue that is activated by HGPRTase, decreasing purine synthesis.
4. Vincristine, vinblastine: Inhibits formation of microtubules.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 35
Incorrect
-
A 41-year-old woman has been complaining of tiredness over the past few weeks. She has angular stomatitis but no koilonychia. What is the most probable cell type to be seen in her blood film?
Your Answer: Microcytes
Correct Answer: Macrocytes
Explanation:This is a case of Vit. B12 or folic acid deficiency. The anaemia with angular stomatitis is highly suggestive of Vit. B12 or folate deficiency. The absence of koilonychia excludes Iron deficiency anaemia.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 36
Correct
-
Which is the most likely lymph node involved in the presence of an ulcer on the scrotum?
Your Answer: Inguinal lymph node
Explanation:Inguinal LN’s drain the skin and subcutaneous tissue of the lower abdominal wall, perineum, buttocks, external genitalia, and lower limbs. They are subdivided into three groups of lymph nodes (nodi lymphoid):
– inferior group of superficial inguinal lymph nodes, located inferior to the saphenous opening, receiving drainage of the lower limb;
– superolateral superficial inguinal lymph nodes located lateral to the saphenous opening, receiving drainage of lateral buttock and lower anterior abdominal wall; and
– superomedial superficial inguinal lymph nodes, located medial to the saphenous opening, receiving drainage of the perineum and external genitalia. -
This question is part of the following fields:
- Men's Health
-
-
Question 37
Incorrect
-
A 26-year-old technician with no past medical history presents to the neurology clinic complaining of muscle pain. He describes severe bilateral cramping calf pain on minimal exercise. This has been present since his late teens and as such he has avoided exercise. Recently, he has attended the local gym to try and lose weight, but attempts at exercise have been dampened by the pain. He does note that if he perseveres with exercise, the pain settles. He has noticed passing dark urine in the evenings following a prolonged bout of exercise. Which of the following clinical tests would be most useful in aiding the diagnosis in this patient?
Your Answer: Creatine kinase
Correct Answer: Muscle biopsy
Explanation:The differential diagnosis of bilateral exercise-induced pain would include metabolic muscle disease, lumbar canal stenosis and intermittent claudication. The patient’s age, history and lack of other risk factors make the latter two options unlikely.
The syndrome described is in fact McArdle’s disease (myophosphorylase deficiency). This is a disorder of carbohydrate metabolism. Clinical features of pain and fatigue are precipitated in early exercise, as carbohydrates cannot be mobilized to provide an energy substrate to the muscle. With prolonged exercise, fatty acid metabolism provides energy, and symptoms lessen. The dark urine described is likely to represent myoglobinuria following rhabdomyolysis. Definitive diagnosis of most metabolic muscle diseases relies on muscle biopsy and enzyme analysis.
-
This question is part of the following fields:
- Nervous System
-
-
Question 38
Correct
-
A 22-year-old nulliparous female presents with shortness of breath. She has a history of recurrent deep vein thrombosis. Complete blood count and clotting screen reveals the following results:
Hb: 12.4 g/dl
Plt: 137
WBC: 7.5*109/l
PT: 14 secs
APTT: 46 secs
Which of the following would be the most likely diagnosis?Your Answer: Antiphospholipid syndrome
Explanation:The combination of APTT and low platelets with recurrent DVTs make antiphospholipid syndrome the most likely diagnosis.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 39
Correct
-
Which of the following drugs is NOT used in the treatment of MRSA?
Your Answer: Ceftriaxone
Explanation:Cephalosporins, such as ceftriaxone, do not cover methicillin-resistant staph aureus. They do cover some gram positives and gram negatives. Vancomycin and teicoplanin given intravenously have good coverage of MRSA and other gram positive bacteria. Rifampicin and doxycycline, although not the best treatment, can be used for outpatients if there are no systemic signs of illness.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 40
Correct
-
A paediatrician has concerns that a 6-month-old baby is deaf. His mom gives history of her having a sore throat, fever and lymphadenitis during pregnancy. Which organism causes such manifestations?
Your Answer: Cytomegalovirus (CMV)
Explanation:The best answer is cytomegalovirus. The mother was infected during the pregnancy and the baby has developed cytomegalo-inclusion syndrome. Histologically, it is identified by viral particles surrounded by lysosomes.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 41
Correct
-
A 32-year-old primigravida, with a history of pulmonary hypertension, presents to the clinic at 36 weeks gestation with worsening shortness of breath.
Which of the following is the most accurate statements regarding her condition?Your Answer: Risk of maternal mortality in patients with pulmonary hypertension is 30%
Explanation:Historically, high rates of maternal and fetal death have been reported for pregnant women with pulmonary hypertension (30-56% and 11-28%, respectively). The causes of poor maternal outcomes are varied and include risk of death from right heart failure and stroke from intracardiac shunting. Furthermore, there is a high peri-/post-partum risk due to haemodynamic stress, bleeding complications and the use of general anaesthesia, which can all lead to right heart failure.
The most common risk to the foetus is death, with premature birth and growth retardation being reported in successfully delivered children.
CXR is not contraindicated in pregnancy. D-dimers are not used as a diagnostic aid as they are almost always elevated in pregnancy. Nifedipine, although contraindicated in pregnant women may be used judiciously if the need arises. -
This question is part of the following fields:
- Respiratory System
-
-
Question 42
Incorrect
-
A 51-year-old presents with muscle atrophy. He has a high BMI and finds it difficult to climb stairs. If the patient also has polydipsia and polyuria, what is the most likely diagnosis?
Your Answer: Peripheral neuropathy
Correct Answer: Amyotrophy
Explanation:(Diabetic) Amyotrophy is a condition that presents with muscle wasting and consequent difficulty in climbing stairs. The onset is relatively sudden and symptoms of diabetes are characteristic.
-
This question is part of the following fields:
- Nervous System
-
-
Question 43
Incorrect
-
A 55-year-old female presents with complaints of retrosternal chest pain and dysphagia (which is intermittent and unpredictable in nature). When she swallows, food very suddenly 'sticks' in her chest. She is able to clear it when she drinks water, and then can finish the meal without any further incidence. A barium meal shows she has a corkscrew oesophagus. What is the most likely type of dysphagia here?
Your Answer: Plummer-Vinson syndrome
Correct Answer: Oesophageal spasm
Explanation:All of the symptoms observed in this patient are typical of uncoordinated irregular oesophageal peristalsis – this is characteristic of oesophageal spasm. The cork-screw oesophagus is also diagnostic of the condition.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 44
Correct
-
A 39-year-old female had surgery for the removal of thyroid carcinoma. One week later, she presented in the OPD with complaints of numbness, tingling, involuntary spasm of the upper extremities, paraesthesia and respiratory stridor. Which of the following is the most likely cause?
Your Answer: Hypocalcaemia
Explanation:Hypocalcaemia presents with such symptoms. It probably happened due to accidental removal of a parathyroid gland during the thyroid surgery. Hypocalcaemia causes laryngospasm which produces stridor.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 45
Correct
-
A 63-year-old gentleman is admitted to the Emergency Department, with a past history of chronic renal failure, who complains of increasing shortness of breath. Bloods reveal a creatinine of 570 μmol/l, urea of 48 mmol/l. He is also anaemic with a haemoglobin (Hb) of 8.9 g/dl.
On examination he has a pericardial rub and there are bibasal crackles consistent with heart failure.
Which of the following represents the best treatment option for this patient?Your Answer: Urgent haemodialysis
Explanation:This case presents with symptoms and lab results suggestive of uremic pericarditis, which is an indication for immediate haemodialysis. Uremic pericarditis is caused by inflammation of the membranes of the pericardial sac, which usually resolves after a period of intensive dialysis.
-
This question is part of the following fields:
- Renal System
-
-
Question 46
Correct
-
A 34-year-old diabetic male is undergoing contrast radiography. What should you do to make sure that renal damage due to the contrast dye is prevented?
Your Answer: Plenty of fluids
Explanation:The risk of kidney damage during this procedure is greatly increased for a diabetic patient. It is therefore important that plenty of fluids are given to prevent dehydration and therefore damage to the kidneys.
-
This question is part of the following fields:
- Renal System
-
-
Question 47
Correct
-
A 50-year-old man presented with polyuria and orthostatic hypotension. Which of the following medications is the most likely to be associated with this condition?
Your Answer: Bendroflumethiazide
Explanation:Bendroflumethiazide is known to cause photosensitive rash as part of an allergic reaction during which the person might also have wheezing, chest tightness or dyspnoea. The rash typically occurs on the areas of body exposed to the sun, like the back, hands, arms and legs.
Comparatively, digoxin produces a rash that comprises of nearly the whole body.
Atenolol may also cause skin rash but that is not photosensitive.
Clopidogrel might produce an non-photosensitive urticarial rash.
Ezetimibe causes a severe allergic reaction but only rarely. This rash is also non-photosensitive and is in the form of blisters, associated with itching. -
This question is part of the following fields:
- Pharmacology
-
-
Question 48
Incorrect
-
A new study was developed to assess the benefit of omega-3 fish oils in patients with established ischaemic heart disease. The power of the study is equal to:
Your Answer: 1 - probability of making a type I error
Correct Answer: 1 - probability of making a type II error
Explanation:The power of a test is defined as 1 − the probability of Type II error. The Type II error is concluding at no difference (the null is not rejected) when in fact there is a difference, and its probability is named β. Therefore, the power of a study reflects the probability of detecting a difference when this difference exists. It is also very important to medical research that studies are planned with an adequate power so that meaningful conclusions can be issued if no statistical difference has been shown between the treatments compared. More power means less risk for Type II errors and more chances to detect a difference when it exists.
-
This question is part of the following fields:
- Evidence Based Medicine
-
-
Question 49
Correct
-
A 42-year-old male has suffered a stroke - he is unable to walk in a straight line and has slurred speech. From the list of options, choose the most appropriate investigation to proceed with.
Your Answer: CT scan brain
Explanation:CT scans are used to produce images of the brain. It can be used to detect a stroke from a blood clot or bleeding within the brain.
-
This question is part of the following fields:
- Nervous System
-
-
Question 50
Incorrect
-
A 11-year-old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?
Your Answer: Mycobacterium TB
Correct Answer: Pseudomonas
Explanation:History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 51
Incorrect
-
A 20-year-old gentleman presents to the A&E department complaining of a sudden-onset occipital headache associated with vomiting. His symptoms started 2 hours previously and are continuing. He has a previous history of infrequent migraine without aura, which also causes nausea but not vomiting. He rated his current headache as much more severe than his usual migraine. Examination is unremarkable. In particular, there is no neck stiffness or photophobia.
Which of the following management options would be the most appropriate?Your Answer: A diagnosis of migraine and suggestion that he be referred to a neurologist for a further opinion
Correct Answer: CT brain scan, followed by lumbar puncture if CT normal
Explanation:The patient presented with sudden-onset headache that is more painful than his usual migraine attacks. This gives a high suspicion of subarachnoid haemorrhage; thus, a CT brain scan should be ordered first to rule this out. However, a normal CT scan is apparent in 30% of patients with subarachnoid haemorrhage and should be referred for lumbar puncture to look for red blood cells.
-
This question is part of the following fields:
- Nervous System
-
-
Question 52
Correct
-
A 73-year-old woman attends COPD clinic for review. Her blood gases were checked on her last visit two months back. The test was repeated again today.
The paO2 on both occasions was 6.8 kPa. There is no CO2 retention on 28% O2. She stopped smoking around 6 months ago and is maintained on combination inhaled steroids and long acting b2-agonist therapy.
What is the next best step in management?Your Answer: Suggest she uses an oxygen concentrator for at least 19 h per day
Explanation:Long-term oxygen therapy (LTOT) > 15 h/day improves survival in hypoxemic chronic obstructive pulmonary disease (COPD). It significantly helps in reducing pulmonary hypertension associated with COPD and treating underlying pathology of future heart failure. There is little to no benefit of oxygen therapy for less than 15 hours.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 53
Correct
-
Patients with myeloma mostly present with which of the following condition when in hospital?
Your Answer: Hypercalcaemia
Explanation:Hypercalcemia is the most important finding in all types of malignancies. In myeloma it is especially caused by osteoclast activating factors which increase bone turnover.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 54
Correct
-
A 30-year-old patient has ataxia, nystagmus and vertigo with a history of headaches. Where is the most likely site of the lesion?
Your Answer: Cerebellum
Explanation:Damage to the cerebellum can cause asynergia, dysmetria, adiadochokinesia, intention tremor, staggering, ataxic gait, tendency toward falling, hypotonia, ataxic dysarthria and nystagmus.
-
This question is part of the following fields:
- Nervous System
-
-
Question 55
Correct
-
A 30-year-old male presented with a history of bloody and mucoid diarrhoea since that morning. He is also complaining of abdominal spasm and bloating. Which of the following investigations is the most suitable one in this case?
Your Answer: Stool culture and sensitivity
Explanation:In a case of sudden bloody and mucoid diarrhoea, stool culture and sensitivity are required to access which organism is causing the problem and to discuss appropriate antibiotics.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 56
Incorrect
-
A 72-year-old female, known with rheumatoid arthritis for last 17 years, presents with recurrent attacks of red eyes with a sensation of grittiness. Which of the following is most likely cause of the red eyes?
Your Answer: episcleritis
Correct Answer: keratoconjunctivitis sicca
Explanation:Rheumatoid arthritis is an inflammatory systemic disease associated with some extraarticular manifestations. Keratoconjunctivitis sicca, episcleritis, scleritis, corneal changes, and retinal vasculitis are the most common ocular complications among extraarticular manifestations of RA. The overall prevalence of keratoconjunctivitis sicca also known as dry eye syndrome among patients of RA is 21.2% and is the most common with sense of grittiness in the eyes.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 57
Correct
-
A 3-year-old child choked on a foreign object, which was removed at the hospital. The parents are now asking for advice on how to manage future occurrences at home. What do you advise?
Your Answer: Turn the child on his back and give thumps
Explanation:Give up to five back blows: hit them firmly on their back between the shoulder blades. Back blows create a strong vibration and pressure in the airway, which is often enough to dislodge the blockage.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 58
Correct
-
A 19-year-old girl suffers from a hereditary disease and presents at her GP with a renal colic. She claims that her mother had this problem too. What type of renal calculus is most likely responsible for the renal colic?
Your Answer: Cystine
Explanation:The patient seems to have inherited cystinuria which is an autosomal recessive disease. Typical for the disease is the abnormally high concentration of cysteine in the urine, finally causing cystinuria. In a person with cystinuria, the high concentrations of cysteine in the kidney results in the formation of stones with frequent colic pains and complications. If the genotype is partially expressed, then the phenotype might be even asymptomatic, thus the disease has a high variability.
-
This question is part of the following fields:
- Renal System
-
-
Question 59
Incorrect
-
A 20-year-old male was admitted with a right sided pneumothorax. A chest drain was inserted just below the 4th rib in the midclavicular line. What is the structure at risk of damage during the above procedure?
Your Answer: Internal thoracic artery
Correct Answer: Intercostal artery
Explanation:From the given answers, the most suitable answer is the intercostal artery. However the most vulnerable structure is the intercostal nerve, then intercostal artery and finally intercostal vein.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 60
Incorrect
-
A 72-year-old female complains of difficulty breathing due to secretions. She also has end-stage lung cancer. Choose the most appropriate palliative treatment for her.
Your Answer: Morphine
Correct Answer: Hyoscine butylbromide
Explanation:Hyoscine should be used to help dry the secretions – this is because it acts as an antimuscarinic agent. It also causes less sedation than hyoscine hydrobromide, however, both are administered through injection or infusion.
-
This question is part of the following fields:
- Emergency & Critical Care
-
SESSION STATS - PERFORMANCE PER SPECIALTY
