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  • Question 1 - A 45-year-old man smokes 20 cigarettes/day for the last 28 years. He presents...

    Correct

    • 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.

    • This question is part of the following fields:

      • Respiratory System
      5.7
      Seconds

  • Question 2 - Type 2 hypersensitivity is mediated by: ...

    Correct

    • Type 2 hypersensitivity is mediated by:

      Your Answer: IgG, IgM & complement

      Explanation:

      In type II hypersensitivity the antibodies, IgG and IgM bind to antigens to form complexes that activate the classical pathway of complement to eliminate cells presenting foreign antigens.

    • This question is part of the following fields:

      • Immune System
      7.7
      Seconds

  • Question 3 - A 36-year-old lady presented with increased bowel motions, palpitations, heat intolerance and loss...

    Correct

    • A 36-year-old lady presented with increased bowel motions, palpitations, heat intolerance and loss of weight. She is also tachycardiac. The investigation of choice in this case would be?

      Your Answer: Thyroid function test

      Explanation:

      Hyperthyroidism is characterised by heat intolerance, loss of weight, increased sweating, increased bowel frequency and tachycardia. On GPE, there might be proptosis of eyes and tremors in the hands.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      4.7
      Seconds

  • Question 4 - A 71-year-old male got trapped under a cupboard for 4 hours which accidentally...

    Correct

    • A 71-year-old male got trapped under a cupboard for 4 hours which accidentally fell on his leg while he was moving his house. Which enzyme activity would you measure in this patient?

      Your Answer: Creatinine kinase

      Explanation:

      Creatine kinase (CK) is an enzyme found in the heart, brain, skeletal muscle, and other tissues. Increased amounts of CK are released into the blood when there is muscle damage. This test measures the amount of creatine kinase in the blood.

    • This question is part of the following fields:

      • Musculoskeletal System
      4.6
      Seconds

  • Question 5 - A 18-year-old gentleman is referred to dermatology. He has around 10 hyperpigmented macules...

    Incorrect

    • A 18-year-old gentleman is referred to dermatology. He has around 10 hyperpigmented macules on his torso which vary in size from 1.5-5 cm in size. His GP also noted some freckles in the groin region. He is also currently under orthopaedic review due to a worsening scoliosis of the spine. His father suffered from similar problems before having a fatal myocardial infarction two years ago. Which chromosome is most likely to have a gene defect?

      Your Answer: Chromosome 16

      Correct Answer: Chromosome 17

      Explanation:

      The patient’s history and presentation and familial history, meets the diagnostic criteria for Neurofibromatosis type I, presenting with neurofibromas noted in this patient as hyperpigmented macules and freckles, musculoskeletal disorders like the scoliosis in this case, and a familial history. Neurofibromatosis type I is caused by a mutation on Chromosome 17.

    • This question is part of the following fields:

      • Nervous System
      20.7
      Seconds

  • Question 6 - Which of the following does the inferior mesenteric artery supply? ...

    Incorrect

    • Which of the following does the inferior mesenteric artery supply?

      Your Answer: The last two thirds of the rectum

      Correct Answer: From the splenic flexure to the first third of the rectum

      Explanation:

      The coeliac axis supplies the liver and stomach and from the oesophagus to the first half of the duodenum.
      The second half of the duodenum to the first two thirds of the transverse colon is supplied by the superior mesenteric artery.
      The inferior mesenteric supplies the last third of the transverse colon (approximately from the splenic flexure) to the first third of the rectum.
      The last two thirds of the rectum are supplied by the middle rectal artery.
      The greater curvature of the stomach is supplied by branches of the splenic artery, which itself comes from the coeliac axis.

    • This question is part of the following fields:

      • Gastrointestinal System
      12.2
      Seconds

  • Question 7 - A kidney, ureter, and bladder (KUB) ultrasound for a hypertensive man with a...

    Incorrect

    • A kidney, ureter, and bladder (KUB) ultrasound for a hypertensive man with a BP of 160/90 mmHg and proteinuria++ revealed a decrease in size of the kidneys with smooth borders and normal pelvicalyceal system. What is the cause of hypertension in the patient?

      Your Answer: Polycystic kidney

      Correct Answer: Chronic glomerulonephritis

      Explanation:

      Causes of hypertension in bilateral renal artery stenosis are as follows: 90% probable cause is atherosclerosis with manifestations of CAD, TIA or stroke. The other less common cause is fibromuscular dysplasia that includes carotid and vertebral artery with manifestations of headache, TIA, and stroke.

    • This question is part of the following fields:

      • Gastrointestinal System
      87.3
      Seconds

  • Question 8 - A 60-year-old male was diagnosed with advanced intestinal carcinoma with metastasis. His doctor...

    Incorrect

    • A 60-year-old male was diagnosed with advanced intestinal carcinoma with metastasis. His doctor prescribed him NSAIDs and tramadol initially but his pain was not responding to it. Which of the following drugs is the most suitable alternative option?

      Your Answer: Ibuprofen

      Correct Answer: Oramorph

      Explanation:

      According to WHO, initial pain management for patients with malignancy involves NSAIDs and weak opioids. After their pain stops responding to them, stronger opioids such as oxycodone and morphine are prescribed.

    • This question is part of the following fields:

      • Pharmacology
      9.4
      Seconds

  • Question 9 - A 35-year-old female complains of headache at the back of her head that...

    Incorrect

    • 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: Subarachnoid haemorrhage

      Correct 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
      29.1
      Seconds

  • Question 10 - A 65-year-old male with a history of chronic diabetes mellitus and ischaemic heart...

    Correct

    • A 65-year-old male with a history of chronic diabetes mellitus and ischaemic heart disease, presented with pain in the thigh and gluteal region, while climbing up the stairs for past 5 months and symptoms were getting worse. He was a heavy smoker. On examination the dorsalis pedis and posterior tibial pulses were present. Which of the following is the most probable diagnosis?

      Your Answer: Atherosclerosis

      Explanation:

      The presence of the pulses excluded Thromboangitis Obliterans. The pain is not suggestive of sciatica. The history doesn’t support a DVT or an embolus as there is no pain at rest, swelling or skin changes. So the most probable diagnosis is atherosclerosis as the chronic diabetes and smoking support it.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      27.3
      Seconds

  • Question 11 - A 75-year-old man was brought to the clinic by his wife because lately...

    Incorrect

    • A 75-year-old man was brought to the clinic by his wife because lately he has lost interest in activities he previously enjoyed. His wife is worried and claims he's generally withdrawn. What would exclude depression in favour of dementia?

      Your Answer: Reduced libido

      Correct Answer: Urinary incontinence

      Explanation:

      Urinary incontinence is not a usual symptom of depression. A depressed patient is usually capable of maintaining control of his body sphincters. In dementia, however, urinary incontinence is an important and late symptom of the disease, non-related to any urinary tract pathology. It is rather related to the cognitive impairment caused by dementia.

    • This question is part of the following fields:

      • Geriatric Medicine
      22.9
      Seconds

  • Question 12 - A 3-year-old girl presents to A&E following a few days of being lethargic,...

    Incorrect

    • A 3-year-old girl presents to A&E following a few days of being lethargic, having runny nose, sore throat, and fever. She has unceasing stridor and drooling of saliva while her body is inclined forward. What is the most important next step in her management?

      Your Answer: High flow O2

      Correct Answer: Call ENT specialist

      Explanation:

      A consultation with an ENT is required to establish the reason for the child’s drooling and stridor indicating and obstructive process. Enlarged tonsils and adenoids should be checked.

    • This question is part of the following fields:

      • Emergency & Critical Care
      23.6
      Seconds

  • Question 13 - A 56-year-old male has presented with visual loss on his left side and...

    Incorrect

    • A 56-year-old male has presented with visual loss on his left side and a history of right sided weakness. Where is the occlusion in this patient?

      Your Answer: Mid cerebral artery

      Correct Answer: Carotid artery

      Explanation:

      The carotid artery divides itself into two parts: the internal carotid and the external carotid. The internal carotid continues down as the middle cerebral and gives rise to the ophthalmic branch. For this reason, middle cerebral occlusion may give rise to partial visual loss but not complete mono-ocular blindness. Middle cerebral artery occlusion causes paralysis or weakness of contralateral face and arm (faciobracheal). It also causes sensory loss of the contralateral face and arm. Anterior cerebral artery occlusion causes paralysis or weakness of the contralateral foot and leg. Again, sensory loss is experienced at the contralateral foot and leg.

    • This question is part of the following fields:

      • Emergency & Critical Care
      39.7
      Seconds

  • Question 14 - An 83-year-old gentleman presents to his GP with increasing oedema and ascites. He...

    Incorrect

    • An 83-year-old gentleman presents to his GP with increasing oedema and ascites. He is hypertensive, for which he takes amlodipine. There is shortness of breath on exercise. His alcohol history is two cans of stout per day.
       
      ECG is normal, and CXR reveals normal heart size and no signs of cardiac failure. Serum albumin is 23 g/dl; urinary albumin excretion is 7 g/24 h, with no haematuria. He has mild anaemia with a normal MCV. Total cholesterol is elevated.
       
      What diagnosis fits best with this clinical picture?

      Your Answer: Nephritic syndrome

      Correct Answer: Nephrotic syndrome

      Explanation:

      Nephrotic syndrome usually presents with the symptoms in this patient: low albumin, abnormal cholesterol, increased urinary albumin excretion, oedema, and as a consequence, hypertension as well.

    • This question is part of the following fields:

      • Renal System
      8
      Seconds

  • Question 15 - A 51-year-old man speaks fast and does not take enough breaths before speaking...

    Incorrect

    • A 51-year-old man speaks fast and does not take enough breaths before speaking again. He ignores interruptions and does not want to pause in between. What best describes this kind of speech?

      Your Answer: Verbal dysphasia

      Correct Answer: Pressure of speech

      Explanation:

      A pressured speech is too fast for the listener to understand and is very difficult to interrupt.

    • This question is part of the following fields:

      • Nervous System
      27.3
      Seconds

  • Question 16 - A 17-year-old girl presented with fever, headache and photophobia. Cerebrospinal fluid examination reveals:

    Opening...

    Incorrect

    • A 17-year-old girl presented with fever, headache and photophobia. Cerebrospinal fluid examination reveals:

      Opening pressure 260 mm H20 (50-180)
      Total protein 0.8 g/l (0.15-0.45)
      Glucose 4.2 mmol/l (3.3-4.4)
      White cell count 60 per ml (<5)
      Lymphocytes 90%
      Plasma glucose 6.4 mmol/l (3.0-6.0)

      Which of the following is the most likely diagnosis?

      Your Answer: Viral encephalitis

      Correct Answer: Viral meningitis

      Explanation:

      Normal cerebrospinal fluid (CSF) glucose together with lymphocytosis, an increased opening pressure and raised CSF protein are typical of a viral meningitis.

    • This question is part of the following fields:

      • Nervous System
      27.2
      Seconds

  • Question 17 - A patient presented with complaints of difficulty in swallowing, diplopia on left lateral...

    Incorrect

    • A patient presented with complaints of difficulty in swallowing, diplopia on left lateral gaze and ptosis of his left eye. The investigation of choice would be?

      Your Answer: Lumbar puncture

      Correct Answer: Serum anti-acetylcholine receptor antibodies

      Explanation:

      Myasthenia gravis clinically manifests with ptosis, diplopia and difficulty in swallowing. The initial investigation which is needed to confirm the diagnosis would be serum anti-acetylene receptor antibodies, after which other investigations like an EMG should be done.

    • This question is part of the following fields:

      • Nervous System
      11.5
      Seconds

  • Question 18 - A 24-year-old patient known with alpha-1-antitrypsin deficiency is expecting her first child. She...

    Incorrect

    • A 24-year-old patient known with alpha-1-antitrypsin deficiency is expecting her first child. She is concerned whether her child will be affected or not. What is the pattern of inheritance of alpha-1-antitrypsin deficiency?

      Your Answer: Sporadic

      Correct Answer: Autosomal recessive

      Explanation:

      Alpha-1 antitrypsin deficiency is inherited in an autosomal codominant pattern, meaning that one defective allele tends to result in milder disease than two defective alleles.

    • This question is part of the following fields:

      • Respiratory System
      6.7
      Seconds

  • Question 19 - Which of the following types of reactions are a part of the phase...

    Incorrect

    • Which of the following types of reactions are a part of the phase II metabolism of a drug?

      Your Answer: Reduction

      Correct Answer: Conjugation

      Explanation:

      Drug metabolism can be broadly classified into:
      Phase I (functionalization) reactions: also termed non-synthetic reactions, they include oxidation, reduction, hydrolysis, cyclization and de-cyclization. The most common and vital reactions are oxidation reactions. (Of the given enzymes only Alcohol dehydrogenase is involved in phase I drug metabolism. Succinate dehydrogenase, is a vital enzyme involved in the Kreb’s cycle and the mitochondrial electron transport chain). They are mainly catalysed by Cytochrome P-450 enzyme.

      Phase II (conjugation) reactions: occur following phase I reactions, they include reactions: glucuronidation and sulphate conjugation, etc. They are mostly catalysed by UDP-glucuronosyltransferase enzyme. Other phase II enzymes include: sulfotransferases, N-acetyltransferases, glutathione S-transferases and methyltransferases.

    • This question is part of the following fields:

      • Pharmacology
      8.7
      Seconds

  • Question 20 - Which is NOT a poor prognostic factor for patients with malignant melanoma? ...

    Incorrect

    • Which is NOT a poor prognostic factor for patients with malignant melanoma?

      Your Answer: Microsatellite metastasis

      Correct Answer: Diameter of melanoma > 6 mm

      Explanation:

      Features that affect prognosis are tumour thickness in millimetres (Breslow’s depth – the deeper the Breslow thickness the poorer the prognosis.), depth related to skin structures (Clark level – the level of invasion through the dermis), type of melanoma, presence of ulceration, presence of lymphatic/perineural invasion, presence of tumour-infiltrating lymphocytes (if present, prognosis is better), location of lesion, presence of satellite lesions, and presence of regional or distant metastasis. Malignant melanoma tends to grow radially before entering a vertical growth phase. The diameter it reaches has not been found to be a prognostic factor.

    • This question is part of the following fields:

      • The Skin
      11.5
      Seconds

  • Question 21 - Which one of the following is least associated with photosensitivity? ...

    Incorrect

    • Which one of the following is least associated with photosensitivity?

      Your Answer: Herpes labialis

      Correct Answer: Acute intermittent porphyria

      Explanation:

      Sunlight, especially its ultraviolet radiation component, can cause increased or additional types of damage in predisposed individuals, such as those taking certain phototoxic drugs, or those with certain conditions associated with photosensitivity, including:
      – Psoriasis
      – Atopic eczema
      – Erythema multiforme
      – Seborrheic dermatitis
      – Autoimmune bullous diseases (immunobullous diseases)
      – Mycosis fungoides
      – Smith-Lemli-Opitz syndrome
      – Porphyria cutanea tarda
      Also, many conditions are aggravated by strong light, including:
      – Systemic lupus erythematosus
      – Sjögren’s syndrome
      – Sinear Usher syndrome
      – Rosacea
      – Dermatomyositis
      – Darier’s disease
      – Kindler-Weary syndrome
      Acute intermittent porphyria (AIP) belongs to the group inborn errors of metabolism and most patients with AIP are not light sensitive.

    • This question is part of the following fields:

      • The Skin
      33.3
      Seconds

  • Question 22 - A 76-year-old man complains of painful microscopic haematuria and urgency. On examination of...

    Incorrect

    • A 76-year-old man complains of painful microscopic haematuria and urgency. On examination of the abdomen, there is suprapubic tenderness but no palpable abnormality. He is apyrexial, inflammatory markers and PSA in the blood are normal. Which is the most likely diagnosis?

      Your Answer: Bladder cancer

      Correct Answer: Bladder calculi

      Explanation:

      Painful haematuria suggests trauma, infection or calculi, whereas painless haematuria suggests a possible occult malignancy. This man is apyrexial with normal WCC and CRP which should effectively exclude infection as a cause for his symptoms. There is no history of trauma in this scenario (often catheter-associated) which makes this cause unlikely. It is worth noting that haematuria associated with injury tends to be macroscopic. Therefore, bladder calculi are the most likely source of his symptoms. Imaging will help to determine the presence of calculi.

    • This question is part of the following fields:

      • Renal System
      14.8
      Seconds

  • Question 23 - A 45-year-old male presented with chronic diarrhoea and right lower abdominal pain. On...

    Incorrect

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

      Your Answer: Ureteric calculus

      Correct Answer: Inflammatory bowel disease (IBD)

      Explanation:

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

    • This question is part of the following fields:

      • Gastrointestinal System
      15.1
      Seconds

  • Question 24 - A 77-year-old mail carrier presents to the emergency department with severe flinging movements...

    Incorrect

    • A 77-year-old mail carrier presents to the emergency department with severe flinging movements of his right arm. Where would the causative lesion be located?

      Your Answer: Right caudate nucleus

      Correct Answer: Right subthalamic nucleus

      Explanation:

      Hemiballismus is a movement disorder which manifests as unilateral involuntary flinging movements of the proximal upper limbs. The lesion is located in the ipsilateral subthalamic nucleus.

    • This question is part of the following fields:

      • Nervous System
      10.9
      Seconds

  • Question 25 - A young woman with facial butterfly rash suffers from symmetrical joint pains in...

    Incorrect

    • A young woman with facial butterfly rash suffers from symmetrical joint pains in her knees and elbows. Moreover, she experiences morning stiffness and her ESR is raised. Which of the following would determine the diagnosis?

      Your Answer: Anti-centromere antibodies

      Correct Answer: Anti-DNA antibodies

      Explanation:

      The symptoms described in the question lead to suspicion of SLE because they fulfil three out of four criteria for a positive diagnosis. Anti-DNA antibodies have a diagnostic power for systemic lupus erythematosus (SLE), being a formal classification criterion.

    • This question is part of the following fields:

      • Musculoskeletal System
      12.9
      Seconds

  • Question 26 - A 50-year-old male is awaiting an anterior resection of rectum. Which of the...

    Incorrect

    • A 50-year-old male is awaiting an anterior resection of rectum. Which of the following is the most common postoperative complication of the above surgery?

      Your Answer: Pain

      Correct Answer: Infection

      Explanation:

      The most frequent postoperative surgical complications after colorectal resections are surgical site infection, anastomotic leakage, intra-abdominal abscess, ileus and bleeding. Among them surgical site infection is the most common post-operative complication. Being a clean-contaminated procedure, there is contamination of both the peritoneal cavity and the surfaces of the surgical wound which leads to infections.

    • This question is part of the following fields:

      • Gastrointestinal System
      13.8
      Seconds

  • Question 27 - A 51-year-old smoker was recently diagnosed with non small cell lung carcinoma. Investigations...

    Incorrect

    • A 51-year-old smoker was recently diagnosed with non small cell lung carcinoma. Investigations show presence of a 3 x 3 x 2 cm tumour on the left side of the lower lung lobe. the mass has invaded the parietal pleura. Ipsilateral hilar node is also involved but there is no metastatic spread.
      What is the stage of this cancer?

      Your Answer: T3 N1 M0

      Correct Answer: T2 N1 M0

      Explanation:

      The tumour has only invaded the visceral pleura and measures 3cm in the greatest dimension. Hence it is designated at T2. Ipsilateral peribronchial and/or hilar lymph node involvement would make it N1. There is no distal metastasis so M would be 0.

    • This question is part of the following fields:

      • Respiratory System
      22.3
      Seconds

  • Question 28 - A 25-year-old woman presents to the clinic with nausea, thirst and dehydration. She...

    Incorrect

    • A 25-year-old woman presents to the clinic with nausea, thirst and dehydration. She mentioned that she has an uncle with previous parathyroid gland excision and a cousin who has recently been diagnosed with insulinoma.
      On examination, her BP is 135/72 mmHg, her pulse is 70/min and regular, her BMI is 20. Cardiovascular, respiratory and abdominal examinations are unremarkable.
      Investigations show:
      Hb 12.6 g/dl
      WCC 5.4 x109/l
      PLT 299 x109/l
      Na+ 139 mmol/l
      K+ 4.4 mmol/l
      Creatinine 121 ىmol/l
      Albumin 37 g/l
      Ca++ 2.95 mmol/l
      PTH 18 (normal<10)

      Which of the following is the most likely cause of her raised calcium?

      Your Answer: Parathyroid adenoma

      Correct Answer: Parathyroid hyperplasia

      Explanation:

      The combination of Insulinoma and Parathyroid diseases is suggestive of MEN 1 syndrome.
      Multiple endocrine neoplasia type 1 (MEN1) is a rare hereditary tumour syndrome inherited in an autosomal dominant manner and characterized by a predisposition to a multitude of endocrine neoplasms primarily of parathyroid, entero-pancreatic, and anterior pituitary origin, as well as non-endocrine neoplasms.
      Other endocrine tumours in MEN1 include foregut carcinoid tumours, adrenocortical tumours, and rarely pheochromocytoma. Nonendocrine manifestations include meningiomas and ependymomas, lipomas, angiofibromas, collagenomas, and leiomyomas.

      Primary hyperparathyroidism (PHPT), due to parathyroid hyperplasia is the most frequent and usually the earliest expression of MEN-1, with a typical age of onset at 20-25 years.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      312.4
      Seconds

  • Question 29 - A 76-year-old man has been admitted with a respiratory tract infection.
    On examination,...

    Incorrect

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

      Your Answer: Doxapram is indicated in patients with cerebral oedema

      Correct Answer: Epilepsy is a contraindication for doxapram use

      Explanation:

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

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

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

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

    • This question is part of the following fields:

      • Pharmacology
      29.4
      Seconds

  • Question 30 - A 23-year-old woman presents to the A&E with a 24-hour-history of gradual-onset fever,...

    Incorrect

    • A 23-year-old woman presents to the A&E with a 24-hour-history of gradual-onset fever, light sensitivity and headache. Clinical examination reveals neck stiffness and an area of rash which does not disappear upon pressure on her right shin. Anamnesis reveals a history of 3 episodes of meningococcal meningitis in the past and she was started on ceftriaxone for another suspected meningitis. However, you suspect that the patients might be immunodeficient. Which immunodeficiency does she most probably have?

      Your Answer: C1q, C1rs, C2, C4 deficiency

      Correct Answer: C5-9 deficiency

      Explanation:

      Pneumococcal meningitis is the most common and severe form of bacterial meningitis. Fatality rates are substantial, and long-term sequelae develop in about half of survivors. Disease outcome has been related to the severity of the proinflammatory response in the subarachnoid space. The complement system, which mediates key inflammatory processes, has been implicated as a modulator of pneumococcal meningitis disease severity in animal studies. C5 fragment levels in cerebrospinal fluid (CSF) of patients with bacterial meningitis correlated with several clinical indicators of poor prognosis. The common terminal pathway consists of complement components C5-C9, and activation forms the anaphylatoxin C5a, a strong proinflammatory mediator, and the membrane attack complex (MAC), which creates pores in the bacterial cell wall (12). Deficiencies in these late complement components have been recognized as a cause of recurrent and familial meningococcal infections.

    • This question is part of the following fields:

      • Emergency & Critical Care
      21.7
      Seconds

  • Question 31 - An 81-year-old woman had fallen down in her house. She is now unable...

    Incorrect

    • An 81-year-old woman had fallen down in her house. She is now unable to walk. An x-ray was done on her left hip joint, which showed a fracture in the neck of the femur. Which nerve is most likely to be injured?

      Your Answer: Tibial nerve

      Correct Answer: Sciatic nerve

      Explanation:

      Femoral neck fractures are common injuries that most often result from low-energy falls in the elderly; however, they also can occur in young patients as a result of high-energy mechanisms

    • This question is part of the following fields:

      • Musculoskeletal System
      24.5
      Seconds

  • Question 32 - A 36-year-old patient who is a known IV drug abuser presented with complaints...

    Incorrect

    • A 36-year-old patient who is a known IV drug abuser presented with complaints of sudden onset of sharp excruciating chest pain, which increases on inspiration and is relieved by bending forward. He also complained of shortness of breath for the last few months. The most likely diagnosis would be?

      Your Answer: MI

      Correct Answer: Pericarditis

      Explanation:

      The chief symptoms of pericarditis comprise of sudden onset of sharp chest pain, that is relieved by bending forward and is exacerbated by deep inspiration. Symptoms can vary among the individuals but these are the chief symptoms.

    • This question is part of the following fields:

      • Cardiovascular System
      15.2
      Seconds

  • Question 33 - Arrange the following opioid analgesics in order of increasing potency. ...

    Incorrect

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

      Your Answer: Morphine, codeine, oxycodone, diamorphine

      Correct Answer: Codeine, morphine, oxycodone, diamorphine

      Explanation:

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

    • This question is part of the following fields:

      • Pharmacology
      11.9
      Seconds

  • Question 34 - A 45-year-old woman with a history of hypothyroidism, presents with ptosis and muscle...

    Incorrect

    • 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: Alpha 1 adrenoceptor

      Correct 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.

    • This question is part of the following fields:

      • Immune System
      39.8
      Seconds

  • Question 35 - A 59-year-old scientist is referred to you with a 2-year history of ascending...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Nervous System
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      Seconds

  • Question 36 - A 30-year-old woman who underwent a live related renal transplant for end-stage renal...

    Incorrect

    • A 30-year-old woman who underwent a live related renal transplant for end-stage renal failure secondary to chronic pyelonephritis, 12 weeks previously, attends the clinic for routine follow up. She is taking tacrolimus and mycophenolate mofetil (MMF).

      Her urea and electrolytes are below:

      Na+ 136 mmol/l
      K+ 3.7 mmol/l
      Urea 7.2 mmol/l
      Creatinine 146 μmol/l


      She was last seen in clinic 2 weeks previously when her urea was 4.2 mmol/l and creatinine 98 μmol/l. She is clinically well and asymptomatic.

      On examination she was apyrexial and normotensive. Her transplant site was non-tender with no swelling and there were no other signs to be found.

      Which THREE initial investigations are the most important to perform?

      Your Answer:

      Correct Answer: Urine and blood cultures

      Explanation:

      After renal transplant, asymptomatic patients can still have graft dysfunction as an early complication, with rising serum creatinine; therefore, urine and blood cultures should be ordered first. This should be followed by measuring the Tacrolimus levels, as this drug can be directly nephrotoxic. Next, a Doppler ultrasound of the transplant site should be ordered, to check for any obstructions or occlusions.

    • This question is part of the following fields:

      • Renal System
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      Seconds

  • Question 37 - Osteopetrosis occurs as a result of a defect in: ...

    Incorrect

    • Osteopetrosis occurs as a result of a defect in:

      Your Answer:

      Correct Answer: Osteoclast function

      Explanation:

      It is a metabolic bone disease caused by defective osteoclastic resorption of immature bone. Osteopetrosis is also known as marble bone disease. Osteoclasts are unable to adequately acidify bone matrix. Impaired bone resorption leads to overly dense bone that is more likely to fracture. It is usually treated with bone marrow transplant and high dose calcitriol.

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 38 - A 65-year-old gentleman with a history of chronic renal failure due to diabetes...

    Incorrect

    • A 65-year-old gentleman with a history of chronic renal failure due to diabetes comes to the clinic for review. He has reported increasing bone and muscle aches over the past few weeks.
       
      Medications include ramipril, amlodipine and indapamide for blood pressure control, atorvastatin for lipid management, and insulin for control of his blood sugar. On examination his BP is 148/80 mmHg, his pulse is 79 and regular. His BMI is 28.
       
      Investigations show:

      Haemoglobin 10.7 g/dl (13.5-17.7)
      White cell count 8.2 x 10(9)/l (4-11)
      Platelets 202 x 10(9)/l (150-400)
      Serum sodium 140 mmol/l (135-146)
      Serum potassium 5.0 mmol/l (3.5-5)
      Creatinine 192 μmol/l (79-118)
      Calcium 2.18 mmol/l (2.2-2.67)
      Phosphate 1.9 mmol/l (0.7-1.5)

       
      He has tried following a low phosphate diet.
       
      Which of the following would be the next most appropriate step in controlling his phosphate levels?

      Your Answer:

      Correct Answer: Sevelamer

      Explanation:

      Sevelamer is a phosphate-binding drug that can lower raised serum phosphate levels in chronic kidney disease. Because of its aluminium-related side-effects, aluminium hydroxide is no longer the drug of choice.
      The other options are calcium-containing salts that may increase risks of tissue calcification.

    • This question is part of the following fields:

      • Renal System
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      Seconds

  • Question 39 - Vancomycin is a glycopeptide. It acts by which mechanism? ...

    Incorrect

    • Vancomycin is a glycopeptide. It acts by which mechanism?

      Your Answer:

      Correct Answer: Cell wall inhibition

      Explanation:

      Peptidoglycans are a component of bacterial cell wall and are inhibited by this antibiotic.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 40 - A 27-year-old woman presents with a history of weight loss and palpitations. Examination...

    Incorrect

    • A 27-year-old woman presents with a history of weight loss and palpitations. Examination reveals unilateral proptosis. She also admits that despite having a healthy appetite she has difficulty putting on weight. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Thyroid-associated ophthalmopathy

      Explanation:

      The patient’s age and symptoms suggest Grave’s disease with thyroid-associated ophthalmopathy. In Grave’s disease, weight loss is noticed regardless of normal eating habits of the patient. Palpitations are also typical and may be confused with a panic attack. Proptosis is usually bilateral, but unilateral is also possible.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
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  • Question 41 - A 43-year-old female presented with a 5 day history of a productive cough...

    Incorrect

    • A 43-year-old female presented with a 5 day history of a productive cough with rusty coloured sputum. Chest X-ray showed lobar consolidation on her left side. The most likely causative organism would be?

      Your Answer:

      Correct Answer: Streptococcus pneumoniae

      Explanation:

      Streptococcus pneumonia is the chief causative organism for lobar pneumonia in this age group patients. Typically patients present with rusty coloured sputum and a cough. Pneumocystis jiroveci is responsible for causing pneumocystis pneumonia among immunocompromised patients.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 42 - Which of the following drugs is the strongest opioid? ...

    Incorrect

    • Which of the following drugs is the strongest opioid?

      Your Answer:

      Correct Answer: Modified-release morphine 30 mg BD orally

      Explanation:

      Modified release morphine in BD dose is the strongest opioid of the selection.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 43 - Which of the following is least associated with lead poisoning? ...

    Incorrect

    • Which of the following is least associated with lead poisoning?

      Your Answer:

      Correct Answer: Acute glomerulonephritis

      Explanation:

      Lead poisoning is characterised by abdominal pain, fatigue, constipation, peripheral neuropathy (mainly motor), and blue lines on gum margin in 20% of the adult patients (very rare in children).

      For diagnosis, the level of lead in blood is usually considered with levels greater than 10 mcg/dL being significant. Furthermore, the blood film shows microcytic anaemia and basophilic stippling of red blood cells. Urinary coproporphyrin is increased (urinary porphobilinogen and uroporphyrin levels are normal to slightly increased). Raised serum and urine levels of delta-aminolaevulinic acid may also be seen, making it sometimes difficult to differentiate from acute intermittent porphyria.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 44 - A 35-year-old female patient presents with butterfly rash, haematuria and photosensitivity. She is...

    Incorrect

    • A 35-year-old female patient presents with butterfly rash, haematuria and photosensitivity. She is currently on TB treatment. Which antibody would you expect positive?

      Your Answer:

      Correct Answer: Anti-Histone

      Explanation:

      This patient is probably suffering from a drug-induced lupus. There’s a 95% chance that anti-histone antibodies are positive. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The drugs most commonly connected with drug-induced lupus are: hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms) and isoniazid (used to treat tuberculosis).

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 45 - A 40-year-old man presents with a history of carpal tunnel syndrome and osteoarthritis...

    Incorrect

    • A 40-year-old man presents with a history of carpal tunnel syndrome and osteoarthritis of his weight-bearing joints. He has recently begun to suffer from symptoms of sleep apnoea.
      On examination, he has a prominent jawline and macroglossia. His BP is elevated at 155/95 mmHg and there is peripheral visual field loss.
      Which of the following is true?

      Your Answer:

      Correct Answer: Pegvisomant can be used where IGF-1 is not normalised post surgery

      Explanation:

      The patient has Acromegaly.
      Acromegaly is a chronic disorder characterised by growth hormone (GH) hypersecretion, predominantly caused by a pituitary adenoma.

      Random GH level testing is not recommended for diagnosis given the pulsatile nature of secretion. Stress, physical exercise, acute critical illness and fasting state can cause a physiological higher peak in GH secretion.

      Pegvisomant is a US Food and Drug Administration-approved treatment for use after surgery. In a global non-interventional safety surveillance study, pegvisomant normalised IGF-1 in 67.5% of patients after 5 years (most likely due to lack of dose-up titration), and also improved clinical symptoms. Pegvisomant improves insulin sensitivity, and long-term follow-up showed significantly decreased fasting glucose over time, while the first-generation SRL only have a marginal clinical impact on glucose homeostasis in acromegaly. Pegvisomant does not have any direct anti-proliferative effects on pituitary tumour cells, but tumour growth is rare overall.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
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      Seconds

  • Question 46 - A 35-year-old female with chronic pelvic pain, was recently diagnosed with PID. She...

    Incorrect

    • A 35-year-old female with chronic pelvic pain, was recently diagnosed with PID. She was prescribed doxycycline. After 2 days she returned with complaints of abdominal bloating, nausea and regurgitation. Which of the following advice should be given to her?

      Your Answer:

      Correct Answer: Take Doxycycline after meals

      Explanation:

      Doxycycline is known to cause dyspeptic symptoms. So advising to take Doxycycline after meals is important. Taking with meals or adding an antacid is not advised, as both will cause reduction in drug absorption.

    • This question is part of the following fields:

      • Pharmacology
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      Seconds

  • Question 47 - A 53-year-old cashier with a history of chronic back pain presents for a...

    Incorrect

    • A 53-year-old cashier with a history of chronic back pain presents for a check-up. He is aware of a dragging feeling affecting his left foot when he tries to walk. This has developed since a minor injury to his left knee. On examination, he has weakness of dorsiflexion and eversion of the left foot. The right is unaffected and plantar flexion and inversion are normal on the left. MRI of the spinal cord shows degenerative disc changes at multiple levels, but no evidence of cord or nerve root impingement. Nerve conduction studies and EMG results are pending. Which of the following sensory loss patterns would you expect to find in association with this motor defect?

      Your Answer:

      Correct Answer: Sensory loss over the dorsum of the foot and anterolateral leg

      Explanation:

      This patient presentation is unlikely to be an L5 nerve root lesion given the results of the MRI scan. Therefore, the most likely diagnosis is a mononeuritis affecting the left common peroneal nerve. This would lead to sensory loss over the dorsum of the foot and anterolateral leg on the left.

    • This question is part of the following fields:

      • Nervous System
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  • Question 48 - The digital rectal examination and flexible sigmoidoscopy of a 30-year-old woman are normal....

    Incorrect

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

      Your Answer:

      Correct Answer: Proctalgia fugax

      Explanation:

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

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 49 - A 62-year-old patient with shortness of breath has a chest x ray, which...

    Incorrect

    • A 62-year-old patient with shortness of breath has a chest x ray, which shows right lower lobe consolidation. Dyspnoea started one week ago. Which of the following would support admission of the patient?

      Your Answer:

      Correct Answer: A respiratory rate of 32/min

      Explanation:

      CURB-65 is a clinical prediction score that has been validated for predicting mortality in community-acquired pneumonia. It is comprised of five features which are given a point if present on the patient.
      C=confusion
      U=urea >7mmol/L
      R=respiratory rate >30/min or more
      B=blood pressure (SBP)<90mmHg or (DBP)<60mmHg.
      Lastly, the patient gets a point if he/she is 65-year-old or older. The score provides guidance for management:
      0-1: Treat as an outpatient
      2: Consider a short stay in hospital or watch very closely as an outpatient
      3-5: Requires hospitalization with consideration as to whether they need to be in the intensive care unit.

    • This question is part of the following fields:

      • Respiratory System
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      Seconds

  • Question 50 - What is the mode of spread of chickenpox? ...

    Incorrect

    • What is the mode of spread of chickenpox?

      Your Answer:

      Correct Answer: Airborne

      Explanation:

      Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 51 - A 47-year-old woman is being treated with steroids for her diagnosis of giant...

    Incorrect

    • A 47-year-old woman is being treated with steroids for her diagnosis of giant cell arteritis (GCA). What is the other drug that can be added to this?

      Your Answer:

      Correct Answer: Aspirin

      Explanation:

      Low dose aspirin is proven efficient in aversion of complications connected with giant cell arteritis such as stroke.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 52 - A 74-year-old man who has been diagnosed with atrial fibrillation and heart failure...

    Incorrect

    • A 74-year-old man who has been diagnosed with atrial fibrillation and heart failure is being started on digoxin. What is the mechanism of action of digoxin?

      Your Answer:

      Correct Answer: Inhibits the Na+/K+ ATPase pump

      Explanation:

      Digoxin acts by inhibiting the Na+/K+ ATPase pump.
      Digoxin is a cardiac glycoside now mainly used for rate control in the management of atrial fibrillation. As it has positive inotropic properties it is sometimes used for improving symptoms (but not mortality) in patients with heart failure.

      Mechanism of action:
      It decreases the conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and atrial flutter.
      It increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. It also stimulates the vagus nerve.

      Digoxin toxicity:
      Plasma concentration alone does not determine whether a patient has developed digoxin toxicity. The likelihood of toxicity increases progressively from 1.5 to 3 mcg/l.
      Clinical feature of digoxin toxicity include a general feeling of unwell, lethargy, nausea & vomiting, anorexia, confusion, xanthopsia, arrhythmias (e.g. AV block, bradycardia), and gynaecomastia

      Precipitating factors:
      Hypokalaemia
      Increasing age
      Renal failure
      Myocardial ischemia
      Hypomagnesaemia, hypercalcemia, hypernatremia, acidosis
      Hypoalbuminemia
      Hypothermia
      Hypothyroidism
      Drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in the distal convoluted tubule, therefore, reduce excretion), ciclosporin. Also, drugs that cause hypokalaemia e.g. thiazides and loop diuretics.

      Management of digoxin toxicity:
      Digibind
      Correct arrhythmias
      Monitor and maintain potassium levels within the normal limits.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 53 - Which of the following would be the most appropriate treatment (leaving out the...

    Incorrect

    • Which of the following would be the most appropriate treatment (leaving out the current NICE guidelines) for a 29-year-old man with erythrodermic psoriasis and arthritis mutilans involving several digits of both hands?

      Your Answer:

      Correct Answer: Etanercept

      Explanation:

      TNF-alpha inhibitors are known to ameliorate the symptoms and disease activity of Arthritis mutilans (a rare and severe form of psoriatic arthritis), by disabling the cytokines that are involved in inflammation and joint destruction. From the mentioned choices, this would be the most effective option. Methotrexate is the most commonly used DMARD, followed by sulfasalazine used in mild to moderate forms of psoriatic arthritis but has not shown much efficacy in arthritis mutilans. Phototherapy, narrowband UVB light therapy can be very effective in clearing skin lesions.

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 54 - Which of the following types of renal stones are said to have a...

    Incorrect

    • Which of the following types of renal stones are said to have a semi-opaque appearance on x-ray?

      Your Answer:

      Correct Answer: Cystine stones

      Explanation:

      Only cystine stones are semi-opaque because they contain sulphur. All the other stones will appear either radio-lucent or radio-opaque.

    • This question is part of the following fields:

      • Renal System
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      Seconds

  • Question 55 - What is the mechanism of action (MOA) of cisplatin? ...

    Incorrect

    • What is the mechanism of action (MOA) of cisplatin?

      Your Answer:

      Correct 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
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  • Question 56 - A 70-year-old man presents with nocturia, hesitancy and terminal dribbling of urine.
    Prostate...

    Incorrect

    • A 70-year-old man presents with nocturia, hesitancy and terminal dribbling of urine.
      Prostate examination reveals a moderately enlarged prostate with no irregular features and a well-defined median sulcus. Blood investigations show a PSA level of 1.3 ng/mL. Among the options provided below what is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: Alpha-1 antagonist

      Explanation:

    • This question is part of the following fields:

      • Pharmacology
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  • Question 57 - A 28-year-old female with a history of psoriatic arthritis would most likely have...

    Incorrect

    • A 28-year-old female with a history of psoriatic arthritis would most likely have which of the following hand conditions?

      Your Answer:

      Correct Answer: Nail dystrophy

      Explanation:

      Nail dystrophy (pitting of nails, onycholysis, subungual hyperkeratosis), dactylitis, sausage shaped fingers are most commonly seen with psoriatic arthropathy. There is asymmetric joint involvement most commonly distal interphalangeal joints. Uveitis and sacroiliitis may also occur. Arthritis mutilans may occur but is very rare. Cutaneous lesions may or may not develop. When they do, its usually much after the symptoms of arthritis.

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 58 - A 58-year-old gentleman with a long history of gout presents with loin pain....

    Incorrect

    • A 58-year-old gentleman with a long history of gout presents with loin pain. Other past history of note includes an ileostomy after bowel surgery. There is no history of weight loss from malabsorption syndrome after his bowel surgery. Excretion urography reveals evidence of bilateral renal stones.

      What is the most likely composition of his renal stones?

      Your Answer:

      Correct Answer: Uric acid stones

      Explanation:

      Uric acid stones will most likely be found in this case because of the patient’s long history of gout. Additionally, studies have shown that ileostomy patients have an increased risk for the development of uric acid stones.

    • This question is part of the following fields:

      • Renal System
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      Seconds

  • Question 59 - A 45-year-old known asthmatic was admitted with acute severe asthma and was treated...

    Incorrect

    • A 45-year-old known asthmatic was admitted with acute severe asthma and was treated with nebulised salbutamol, ipratropium and bromide, along with 100% oxygen therapy. He was also given IV hydrocortisone, however there was no significant improvement. What would be the next step in management of this patient?

      Your Answer:

      Correct Answer: IV Aminophylline

      Explanation:

      Aminophylline is a very effective bronchodilator. It is short acting and therefore very effective in acute scenarios.

    • This question is part of the following fields:

      • Respiratory System
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      Seconds

  • Question 60 - An 18-year-old boy was admitted with severe pain and swelling of his scrotum...

    Incorrect

    • 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:

      Correct Answer: Exploratory surgery

      Explanation:

      The most worrying condition is testicular torsion and to exclude it exploratory surgery is required.

    • This question is part of the following fields:

      • Emergency & Critical Care
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  • Question 61 - A 10-year-old gentleman is referred with a six month history of daily headache,...

    Incorrect

    • A 10-year-old gentleman is referred with a six month history of daily headache, which is mostly frontal in location and occasionally associated with nausea.
      He has been taking paracetamol 3 g daily, aspirin 300 mg thrice daily, and codeine 40 mg thrice daily, all of which have had only a temporary effect. He has a two year history of depression treated with paroxetine. No abnormalities were found on examination.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Analgesic misuse headache

      Explanation:

      Because of the patient’s history of chronic analgesic use of daily paracetamol intake, the most likely diagnosis of this case is Analgesic misuse headache. In these cases, the headache is only temporarily relieved by analgesics. Treatment involves gradual withdrawal of analgesics.

    • This question is part of the following fields:

      • Nervous System
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  • Question 62 - A 42-year-old male with long history of diabetes is complaining of a red-hot...

    Incorrect

    • A 42-year-old male with long history of diabetes is complaining of a red-hot tender lump near his anus. What is the most possible diagnosis?

      Your Answer:

      Correct Answer: Abscess

      Explanation:

      A diabetic patient is a patient with depressed immunity. It is not uncommon to develop abscesses. Diabetic patients have a defected cellular innate immunity. On the other hand, bacteria become much more virulent in a high glucose environment in the interstitium.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
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      Seconds

  • Question 63 - A 62-year-old man arrives at the clinic with a history of cough and...

    Incorrect

    • A 62-year-old man arrives at the clinic with a history of cough and intermittent haemoptysis for the last 3 months. He has a 50 pack year smoking history and is currently waiting for bronchoscopy to assess a left lower lobe collapse. The patient also has a marked muscle weakness and wasting of proximal muscles of his shoulders and pelvic girdle. His wife states that lately he has been unable to eat solids. Which of the following statements would be true regarding this scenario?

      Your Answer:

      Correct Answer: He may have a photosensitive facial rash

      Explanation:

      The patient has presented with signs of small cell lung cancer. The associated proximal muscle weakness is most probably due to dermatomyositis which occurs as a paraneoplastic syndrome associated with lung carcinoma. In most cases, the first symptom is a distinctive skin rash on the face, eyelids, chest, nail cuticle areas, knuckles, knees or elbows. The rash is patchy and usually a bluish-purple colour. Corticosteroids are helpful in the management of the cutaneous changes and muscle weakness.

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 64 - A 62-year-old male presented with loss of weight and tenesmus. Colonoscopy revealed rectal...

    Incorrect

    • A 62-year-old male presented with loss of weight and tenesmus. Colonoscopy revealed rectal carcinoma. All of the following are risk factors except:

      Your Answer:

      Correct Answer: High fibre diet

      Explanation:

    • This question is part of the following fields:

      • Emergency & Critical Care
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      Seconds

  • Question 65 - Which of the following statements is false regarding the bioavailability of a drug?...

    Incorrect

    • Which of the following statements is false regarding the bioavailability of a drug?

      Your Answer:

      Correct Answer: The bioavailability of a drug given orally is often affected by the degree of renal elimination

      Explanation:

      Renal elimination of a drug has no role in altering the bioavailability of a drug.
      The bioavailability of a drug is the proportion of the drug which reaches systemic circulation.
      Mathematically, bioavailability is the AUCoral/AUCiv x 100%, where AUC = area under the concentration-time curve following a single (oral or iv) dose.

      Other options are true:
      By definition, the bioavailability of a drug given intravenously is 100%.
      Drugs given orally that undergo high pre-systemic (first-pass) metabolism in the liver or gut wall have a low bioavailability e.g. lidocaine.
      Bioavailability is also affected by the degree of absorption from the gut and this can change depending on gut motility and administration of other drugs.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 66 - A 39-year-old accountant with long-standing gastro-oesophageal reflux disease is reviewed in clinic. He...

    Incorrect

    • A 39-year-old accountant with long-standing gastro-oesophageal reflux disease is reviewed in clinic. He has recently switched from ranitidine to omeprazole.

      What is the main benefit of omeprazole compared to ranitidine?

      Your Answer:

      Correct Answer: Irreversible blockade of H+/K+ ATPase

      Explanation:

      Proton pump inhibitors can reduce gastric acid secretion by up to 99%. Acid production resumes following the normal renewal of gastric parietal cells.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 67 - A 55-year-old man attends follow-up for liver cirrhosis, which reveals a large dominant...

    Incorrect

    • A 55-year-old man attends follow-up for liver cirrhosis, which reveals a large dominant nodule in the right lobe of liver on CT Scan. Which tumour marker would most likely be elevated?

      Your Answer:

      Correct Answer: Alpha feto-protein (AFP)

      Explanation:

      A considerably increased serum AFP is characteristic of hepatocellular cancer. A distinct nodule for cirrhotic patients should be investigated to rule out hepatocellular cancer.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 68 - A 20-year-old woman presents for review. She is concerned due to absence of...

    Incorrect

    • A 20-year-old woman presents for review. She is concerned due to absence of menstruation for 5 months.
      She is 1.76 m in height and weighs only 43.7 kg (7 stone).
      A pregnancy test is negative and thyroid function testing is normal.

      Which of the following is the diagnosis of this case?

      Your Answer:

      Correct Answer: Weight-related amenorrhoea

      Explanation:

    • This question is part of the following fields:

      • Endocrine System & Metabolism
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      Seconds

  • Question 69 - Presence of which of the following indicates a worse prognosis in rheumatoid arthritis?...

    Incorrect

    • Presence of which of the following indicates a worse prognosis in rheumatoid arthritis?

      Your Answer:

      Correct Answer: Anti-CCP antibodies

      Explanation:

      Rheumatoid arthritis is both common and chronic, with significant consequences for multiple organ systems. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, presence early in the disease process, and ability to identify patients who are likely to have severe disease and irreversible damage. However, its sensitivity is low, and a negative result does not exclude disease. Anti-CCP antibodies have not been found at a significant frequency in other diseases to date, and are more specific than rheumatoid factor for detecting rheumatoid arthritis. The other factors that are mentioned do not play a key prognostic role.

    • This question is part of the following fields:

      • Musculoskeletal System
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      Seconds

  • Question 70 - Regarding haemochromatosis, which of the following is true? ...

    Incorrect

    • Regarding haemochromatosis, which of the following is true?

      Your Answer:

      Correct Answer: Haemochromatosis may be treated with therapeutic phlebotomy

      Explanation:

      Haemochromatosis is an abnormally high rate of the production of haemoglobin. It is an autosomal recessive disease copied on chromosome 6. It is associated with hepatic disorders, cardiac diseases and skin pigmentation. It is treated by regular venesection.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 71 - A 60-year-old man suffers from depression, poor concentration and inability to sleep. A...

    Incorrect

    • A 60-year-old man suffers from depression, poor concentration and inability to sleep. A few months earlier, he had a few episodes of debauchery and tantrums. Which drug is most likely to benefit him?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      Carbamazepine would be the drug of choice in this case because it is an anti-convulsant. It helps to restore the normal levels of nerve activity in the brain.

    • This question is part of the following fields:

      • Pharmacology
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      Seconds

  • Question 72 - In a patient with cardiomyopathy, which one of the following statements would be...

    Incorrect

    • In a patient with cardiomyopathy, which one of the following statements would be aetiologically significant?

      Your Answer:

      Correct Answer: The presence of diabetes mellitus in a tanned patient

      Explanation:

      Hemochromatosis is a condition that leads to abnormal iron deposition in specific organs. There are two main types: primary (hereditary) and secondary (e.g., transfusion-related). The most common form is hereditary autosomal recessive hemochromatosis type 1, which is caused by an underlying genetic defect that results in partially uninhibited absorption of iron in the small intestine.
      Hemochromatosis is mostly asymptomatic but can become symptomatic, usually between the third and fifth decade of life, when poisonous levels of iron have had time to accumulate in the body. Symptoms include fatigue, hyperpigmentation, diabetes mellitus (bronze diabetes), and arthralgia. The deposits may lead to various organ diseases, the most typical being the development of liver cirrhosis, which is accompanied by an increased risk of hepatocellular carcinoma (HCC). Serum ferritin and transferrin saturation levels are typically elevated. Molecular genetic testing or a liver biopsy may be used to confirm the diagnosis. Treatment primarily consists of repeated phlebotomy to reduce iron levels. In addition, dietary changes and drug therapy (chelating agents such as deferoxamine) may be used to influence the amount of iron in the body.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 73 - A 68-year-old female is on long term prednisolone therapy for polymyalgia rheumatica. Which...

    Incorrect

    • A 68-year-old female is on long term prednisolone therapy for polymyalgia rheumatica. Which of the following would be the most suitable protection against osteoporosis?

      Your Answer:

      Correct Answer: Oral bisphosphonate

      Explanation:

      Prevention of osteoporosis associated with chronic glucocorticoid therapy is done by administrating bisphosphonates. Oral bisphosphonates are indicated for patients aged above 65 who have been on steroid therapy for over 3 months, so as to reduce the risk of steroid induced osteoporosis. HRT is usually done in post menopausal women who have oestrogen related bone resorption.

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 74 - A 55-year-old alcoholic is admitted with portal hypertension. The wedged hepatic venous pressure...

    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:

      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
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  • Question 75 - During the peri-infarct period, which of these drug classes have been shown to...

    Incorrect

    • During the peri-infarct period, which of these drug classes have been shown to have the greatest favourable benefit?

      Your Answer:

      Correct Answer: Beta blockers

      Explanation:

      Statins and ACE inhibitors are beneficial initially for the first 24 hours but not proven to have a benefit in the post infarct period. Statins have plaque stabilising functions when activated early following infarction. In contrast, when started immediately, beta blockers are the most beneficial. Nitrates have not been proven beneficial for survival and some calcium channel blockers actually increased the mortality rate.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 76 - An 8-year-old boy was admitted following a MVA. His BMI is 28 kb/m2...

    Incorrect

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

      Your Answer:

      Correct Answer: Fasting blood glucose concentration

      Explanation:

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

    • This question is part of the following fields:

      • Endocrine System & Metabolism
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  • Question 77 - A 40-year-old male presented with sudden onset chest pain and difficulty in breathing...

    Incorrect

    • A 40-year-old male presented with sudden onset chest pain and difficulty in breathing for the past 2 hours. On examination he had bilateral ankle swelling. Investigations revealed proteinuria of 6g/d. Which of the following is the most likely explanation for this presentation?

      Your Answer:

      Correct Answer: Reduced antithrombin III activity

      Explanation:

      This patient has presented with a thromboembolic event most probably secondary to nephrotic syndrome (nephrotic-range proteinuria). Hypercoagulability is due to urinary loss of anticoagulant proteins, such as antithrombin III and plasminogen and an increase in clotting factors, especially factors I, VII, VIII, and X.

    • This question is part of the following fields:

      • Renal System
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  • Question 78 - From the following options, choose the one which is not a cause of...

    Incorrect

    • From the following options, choose the one which is not a cause of liver cirrhosis.

      Your Answer:

      Correct Answer: Schistosomiasis

      Explanation:

      Schistosomiasis is a cause of portal hypertension and periportal fibrosis – it is, however, not a cause of cirrhosis. The main causes of cirrhosis include: alcohol and hepatitis B, C, and D. Autoimmune causes include: both primary and secondary biliary cirrhosis and autoimmune hepatitis. There are a number of inherited conditions which cause cirrhosis, such as hereditary hemochromatosis, Wilson’s disease, Alpha-1 anti-trypsin deficiency, galactosaemia glycogen storage disease, and cystic fibrosis. Additionally, there are also vascular causes, such as hepatic venous congestion, Budd-Chiari syndrome, and veno-occlusive disease. Intestinal bypass surgery has also been implicated as a causative factor for cirrhosis.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 79 - A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling...

    Incorrect

    • A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling in her feet and hands. She has recently developed an ulcer on her left heel, after having burnt her foot in a hot bath. A number of depigmented areas are readily seen over her upper limbs.

      She is currently taking low-dose prednisolone (7.5 mg daily), alendronic acid, lansoprazole, paracetamol, indomethacin, methotrexate and rituximab.

      Her blood tests demonstrate:
      Haemoglobin 9.9 g/l
      MCV 102 fl
      Platelets 410 x 109/l
      White blood cells 12.3 x 109/l
      Vitamin B12 97 pg/ml
      Folate 12.3ng/ml
      Random blood glucose 9.9 mmol/l
      Thyroid-stimulating hormone 4.7 mU/ml
      Thyroxine 12.8 pmol/l

      Which autoantibody would be most diagnostic for the underlying disease?

      Your Answer:

      Correct Answer: Anti-intrinsic factor (IF)

      Explanation:

      This clinical scenario describes pernicious anaemia. Anti-intrinsic factor (IF) antibodies are most specific for pernicious anaemia. Antigastric parietal cell antibodies have a higher sensitivity but are less specific for pernicious anaemia. The other antibodies listed are not related to pernicious anaemia. Anti-TTG is seen with Celiac’s disease, anti-TPO is seen with thyroid disease, GAD is seen with type I diabetes, but this does not explain her anaemia.

    • This question is part of the following fields:

      • Immune System
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  • Question 80 - A 75-year-old man has presented to the clinic with a complaint of disturbed...

    Incorrect

    • A 75-year-old man has presented to the clinic with a complaint of disturbed sleep. The physician has prescribed temazepam. Which of the following best describes the mechanism of action of this drug?

      Your Answer:

      Correct Answer: Enhances the effect of gamma-aminobutyric acid

      Explanation:

      Temazepam is an orally available benzodiazepine used in the therapy of insomnia.
      The soporific activity of the benzodiazepines is mediated by their ability to enhance gamma-aminobutyric acid (GABA) mediated inhibition of synaptic transmission through binding to the GABA-A receptor.
      The recommended initial dose for insomnia is 7.5 mg before bedtime, increasing as needed to a maximum dose of 30 mg.

      The most common side effects of temazepam are dose-related and include daytime drowsiness, lethargy, ataxia, dysarthria, and dizziness.
      Tolerance develops to these side effects, but tolerance may also develop to the effects on insomnia.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 81 - A 50-year-old man undergoes a colonoscopy due to the finding of blood in...

    Incorrect

    • A 50-year-old man undergoes a colonoscopy due to the finding of blood in his stools. The colonoscopy revealed four polyps which were variable in size from one at 0.5cm, 2 at approximately 1.5cm and one at 2 cm.

      When should this patient have a follow up colonoscopy?

      Your Answer:

      Correct Answer: 3 years

      Explanation:

      According to the British Society of Gastroenterology guidelines – this patient has 3-4 adenomas with 3 of them > 1 cm in size. This places him at medium risk and the recommendation is for a 3-year follow up period.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 82 - A 60-year-old male presented in the OPD with a severe pain in the...

    Incorrect

    • A 60-year-old male presented in the OPD with a severe pain in the chest, which radiated to the jaw and his left shoulder. What is your diagnosis?

      Your Answer:

      Correct Answer: MI

      Explanation:

      Risk of myocardial infarction is high in patients with diabetes mellitus. High levels of sugar in the blood can damage the arteries and lead to an increased risk of atherosclerosis of the coronary arteries. This is why diabetic patients have an increased risk of Myocardial Infarction.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 83 - A 22-year-old patient was diagnosed with glioblastoma multiforme, after he was investigated for...

    Incorrect

    • A 22-year-old patient was diagnosed with glioblastoma multiforme, after he was investigated for seizures. The cell of origin of this tumour is?

      Your Answer:

      Correct Answer: Astrocytes

      Explanation:

      Glioblastoma multiforme is the most common anaplastic malignant tumour of the glial cells. It is a mixture of poorly differentiated anaplastic astrocytes.

    • This question is part of the following fields:

      • Nervous System
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  • Question 84 - A non-cyanosed 1-year-old female patient has a continuous murmur which is loudest at...

    Incorrect

    • A non-cyanosed 1-year-old female patient has a continuous murmur which is loudest at the left sternal edge. What pulse abnormality is most associated with patent ductus arteriosus if that's her suspected diagnosis?

      Your Answer:

      Correct Answer: Collapsing pulse

      Explanation:

      DIAGNOSIS:
      A consensus definition for hemodynamically significant PDA is lacking. The diagnosis is often suspected clinically, when an infant demonstrates signs of excessive shunting from the arterial to pulmonary circulation. Continuous or a systolic murmur; note, a silent PDA may also occur when the ductus shunt is large enough that nonturbulent flow fails to generate a detectible murmur.
      A low diastolic blood pressure (due to runoff into the ductus during diastole, more frequent in the most premature infants).
      A wide pulse pressure (due to ductus runoff or steal)Hypotension (especially in the most premature infants)
      Bounding pulses
      Increased serum creatinine concentration or oliguria
      Hepatomegaly

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 85 - Which of the following stimulates the secretion of gastrin? ...

    Incorrect

    • Which of the following stimulates the secretion of gastrin?

      Your Answer:

      Correct Answer: Amino acids

      Explanation:

      Gastrin is released from G cells in the antrum of the stomach after a meal. It stimulates parietal cells to release HCl. Gastrin is stimulated by a number of things: antrum distention, vagal stimulation, peptides (especially amino acids) in the stomach, hypercalcemia. Gastrin release is inhibited by acid, SST, GIP, VIP, secretin, glucagon, and calcitonin.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 86 - A 24-year-old man was hit on the lateral aspect of his head by...

    Incorrect

    • A 24-year-old man was hit on the lateral aspect of his head by a high velocity cricket ball and lost consciousness immediately. Paramedics found him to have a Glasgow coma score of 15 but take him to the A&E for further investigation. His Glasgow coma score on examination in the A&E is 13 (M5, V4, E4) and he has anterograde and retrograde amnesia to recent events. The doctors arrange an urgent CT scan. Which clinical sign would be most concerning if present?

      Your Answer:

      Correct Answer: Bradycardia

      Explanation:

      Intracranial pressure (ICP) is a complex brain modality that determines cerebral perfusion pressure (CPP), which is the difference between arterial blood pressure (ABP), and ICP. Raised ICP reduces CPP and blood delivery to the brain. This jeopardizes cerebral function and organismal survival in many species. A massive rise in ICP is also known to produce an increase in ABP, bradycardia and respiratory irregularities termed Cushing response. This mechanism is generally considered to be an agonal and terminal event occurring in extreme condition of brainstem ischaemia leading to a sympatho-adrenal response.

    • This question is part of the following fields:

      • Emergency & Critical Care
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  • Question 87 - A 74-year-old male has received his 3rd cycle of chemotherapy for malignant melanoma...

    Incorrect

    • A 74-year-old male has received his 3rd cycle of chemotherapy for malignant melanoma 3 days ago. He is presented with a productive cough with greenish sputum. Otherwise he feels well. On examination, he has scattered crepitations, more on the lower right part of the chest. He is afebrile. His labs are: Hb 12.5, TLC 0.9 *10^9 , Plt. 84*10^9. Pan culture was collected and sent. What is the most appropriate next step?

      Your Answer:

      Correct Answer: Broad spectrum antibiotic (intravenous)

      Explanation:

      This is a case of hospital acquired infection in an immunocompromised patient. It should be treated vigorously. On the other hand, patients who receive chemotherapy usually have atrophic gastritis and malabsorption syndrome.

    • This question is part of the following fields:

      • Emergency & Critical Care
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  • Question 88 - A 35-year-old woman under treatment for long-term epilepsy with valproate presented with complaints...

    Incorrect

    • A 35-year-old woman under treatment for long-term epilepsy with valproate presented with complaints of excessive weight gain. She is consuming oral contraceptive pills.
      Which among the following is the best alternative to valproate for treating long-term epilepsy?

      Your Answer:

      Correct Answer: Lamotrigine

      Explanation:

      Among the given anti-epileptics the best drug that can be given in this patient is lamotrigine.
      Topiramate, carbamazepine, phenytoin, and phenobarbital are all hepatic enzyme inducers and are associated with decreased effectiveness of the oral contraceptive (OCP) due to acceleration of the metabolism of oestrogens and progestogens.
      If she is planning on pregnancy then registry studies suggest that lamotrigine would also be the best choice.
      Other hepatic enzyme inducers include rifampicin, spironolactone, griseofulvin, etc.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 89 - Regarding Giardia Lamblia which one of the following statements is true? ...

    Incorrect

    • Regarding Giardia Lamblia which one of the following statements is true?

      Your Answer:

      Correct Answer: May cause intestinal malabsorption

      Explanation:

      Giardiasis also known as travellers diarrhoea is caused by Giardia lamblia, which is an anaerobic parasite affecting the small intestine. It can lead to diarrhoea, flatulence, abdominal cramps, malodourous greasy stools and intestinal malabsorption. It can also cause bloody diarrhoea. The investigation of choice is stool examination for trophozoites and cysts. It is treated by metronidazole and tinidazole as first line therapies.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 90 - A 41-year-old yoga instructor presents with a 2-month history of left-hand weakness. She...

    Incorrect

    • A 41-year-old yoga instructor presents with a 2-month history of left-hand weakness. She has no significant past medical history. On examination, there is mild weakness of the left upper and lower limbs with a right sided facial weakness, which spares the forehead. Which of the following is the most likely location of the lesion?

      Your Answer:

      Correct Answer: Right pons

      Explanation:

      The pons is above the level of decussation of the corticospinal tracts so a pontine lesion would cause a contralateral limb weakness.
      The facial motor nucleus is located in the pons and supplies the ipsilateral facial muscles.
      A right cerebral lesion would give left upper and lower limb weakness. It would also cause a left sided facial weakness.
      A left cerebral lesion would give right upper and lower limb weakness with right facial weakness.
      Finally, a cervical spinal cord lesion would not cause a facial weakness.

    • This question is part of the following fields:

      • Nervous System
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  • Question 91 - A 42-year-old male has suffered a stroke - he is unable to walk...

    Incorrect

    • 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:

      Correct 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
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  • Question 92 - A 68-year-old man who has chronic obstructive pulmonary disease (COPD) is reviewed. On...

    Incorrect

    • 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:

      Correct 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 93 - A 3-year-old boy presents with facial puffiness, frothy urine, lethargy and oliguria for...

    Incorrect

    • A 3-year-old boy presents with facial puffiness, frothy urine, lethargy and oliguria for two weeks. Urine analysis reveals proteinuria. Which of the following is the most appropriate treatment for this child?

      Your Answer:

      Correct Answer: Prednisolone

      Explanation:

      The presentation is suggestive of nephrotic syndrome. A trial of corticosteroids is the first step in treatment of idiopathic nephrotic syndrome. Diuretics are useful in managing symptomatic oedema. Cyclosporin and cyclophosphamide are indicated in frequently relapsing and steroid dependant disease.

    • This question is part of the following fields:

      • Renal System
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  • Question 94 - A 26-year-old male was being investigated further following several hypertensive episodes. There was...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 95 - A 50-year-old female was admitted to the emergency department with a moderate fever...

    Incorrect

    • A 50-year-old female was admitted to the emergency department with a moderate fever and productive cough. She commonly experiences central chest pain and regurgitation of undigested food particles. She did not suffer from acid reflux. Solid and liquid diet have both been affected for the last 4 months. A CXR showed an air-fluid level behind a normal sized heart. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Achalasia

      Explanation:

      The diagnosis is aspiration pneumonia due to the retained food in the oesophagus. This is the case with achalasia. There is no acid reflux in this disease. An air fluid level behind the heart also favours achalasia. In hiatus hernia, GORD is usually present with nausea and vomiting. In the case of a pharyngeal pouch being present, halitosis would be evident.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 96 - A 50-year-old male presented with pain in the left lumbar region. His abdominal...

    Incorrect

    • A 50-year-old male presented with pain in the left lumbar region. His abdominal X-ray revealed stones in his left kidney. Analysis of one of the stones that he passed in the urine showed that it was composed of uric acid. Which of the following is the most likely cause of this type of renal stone?

      Your Answer:

      Correct Answer: Thiazide diuretics

      Explanation:

      Like all diuretics, thiazide diuretics decrease the amount of body fluid. This leads to an increase in the concentration of uric acid in the body; hence the chances of forming uric acid stones.
      Allopurinol is actually a drug used to treat gout, reducing uric acid levels in the body. Therefore, allopurinol would rather decrease the chances of having uric acid stones.
      Primary hyperparathyroidism is not concerned with uric acid stones. It is related to calcium metabolism and hence, calcium stones.

    • This question is part of the following fields:

      • Renal System
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  • Question 97 - A 45-year-old man presents with fever, malaise, weight loss and myalgias that have...

    Incorrect

    • A 45-year-old man presents with fever, malaise, weight loss and myalgias that have been occurring for a month. You suspect polyarteritis nodosa and arrange for some lab investigations. Which of the following abnormality would most likely be present?

      Your Answer:

      Correct Answer: Elevated creatinine

      Explanation:

      People with polyarteritis nodosa often exhibit anaemia of chronic disease. Leucocytosis and eosinophilia may also be present. ANCA is only rarely positive. As polyarteritis nodosa affects the kidneys as well, the creatinine is elevated in most cases.

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 98 - A 52-year-old woman with polycystic kidney disease and a slowly rising creatinine, which...

    Incorrect

    • A 52-year-old woman with polycystic kidney disease and a slowly rising creatinine, which was 320 μmol/L at her last clinic visit 3 weeks ago, is brought into the Emergency Department having been found collapsed at home by her partner. She is now fully conscious but complains of a headache.
       
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Subarachnoid haemorrhage

      Explanation:

      One of the most important complications in patients with PKD is being affected by berry aneurysms that may burst, causing a subarachnoid haemorrhage, which seems to be the case in this patient.

    • This question is part of the following fields:

      • Renal System
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  • Question 99 - A 68-year-old male presented with unbalances and vomiting for 1 week. Which of...

    Incorrect

    • A 68-year-old male presented with unbalances and vomiting for 1 week. Which of the following is the best investigations that can be performed to arrive at a diagnosis?

      Your Answer:

      Correct Answer: MRI of Cerebellum

      Explanation:

      Lesions in cerebellum and pontine region should be excluded. So the most appropriate investigation is MRI of cerebellum.

    • This question is part of the following fields:

      • Nervous System
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  • Question 100 - Which of the following skin conditions is not associated with diabetes mellitus? ...

    Incorrect

    • Which of the following skin conditions is not associated with diabetes mellitus?

      Your Answer:

      Correct Answer: Sweet's syndrome

      Explanation:

      Diabetic dermadromes constitute a group of cutaneous conditions commonly seen in people with diabetes with longstanding disease. Conditions included in this group are:
      – Acral dry gangrene
      – Carotenosis
      – Diabetic dermopathy
      – Diabetic bulla
      – Diabetic cheiroarthropathy
      – Malum perforans
      – Necrobiosis lipoidica
      – Limited joint mobility
      – Scleroderma
      – Waxy skin is observed in roughly 50%. Sweet’s syndrome is also known as acute febrile neutrophilic dermatosis has a strong association with acute myeloid leukaemia. It is not associated with diabetes mellitus.

    • This question is part of the following fields:

      • The Skin
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SESSION STATS - PERFORMANCE PER SPECIALTY

Respiratory System (1/3) 33%
Immune System (2/2) 100%
Endocrine System & Metabolism (2/3) 67%
Musculoskeletal System (3/4) 75%
Nervous System (3/6) 50%
Gastrointestinal System (1/3) 33%
Pharmacology (3/4) 75%
Geriatric Medicine (1/1) 100%
Emergency & Critical Care (1/3) 33%
Renal System (1/2) 50%
The Skin (1/2) 50%
Cardiovascular System (1/1) 100%
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