-
Question 1
Incorrect
-
Barrett's oesophagus is well recognized as a complication of gastroesophageal reflux disease. What is the pathological change that occurs in the above condition?
Your Answer: Metaplasia
Correct Answer: Squamous to columnar epithelium
Explanation:Barrett’s oesophagus is characterised by the metaplastic replacement of the normal squamous epithelium of the lower oesophagus by columnar epithelium.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 2
Correct
-
A 60-year-old female who was on dexamethasone underwent abdominal surgery. Her blood sugar levels remained around 18 mmol/l during and after the surgery. Which of the following is the most suitable method to control her blood sugar level?
Your Answer: Insulin
Explanation:She has steroid induced hyperglycaemia. She needs satisfactory glycaemic control to avoid post surgical infections. As she is in a stressful event following a major surgery, insulin is the best method to manage her hyperglycaemia.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 3
Correct
-
A 27 year-old ballet instructor presents with 1-day history of left-sided facial weakness and an increased sensitivity to noise in her left ear. She is very anxious because 2 years ago she had some problems with her vision and was told that multiple sclerosis was a possibility. Her medical history is significant only for type 1 diabetes mellitus managed with insulin, and she is also taking a combined oral contraceptive pill. Upon examination, she has a lower motor neuron lesion of the left VII (facial) nerve with Bell's phenomenon present and difficulty closing her left eye. There is no objective hearing loss and no sensory signs. Examination of the auditory meatus and canal is unremarkable. The remainder of the neurological examination appears normal. The next management step in her care should be:
Your Answer: Eye patch and artificial tears
Explanation:From the given history and physical examination findings, this patient has Bell’s palsy. There is no evidence to suggest involvement of any other cranial nerves, which might raise suspicion of a cerebello-pontine angle space-occupying lesion. With her history of possible optic neuritis, there is a possibility that the lesion is in fact a manifestation of multiple sclerosis, although this should be differentiated by examination of an upper motor neuron lesion (with sparing of the forehead facial muscles because of bilateral innervation). In light of her diabetes and the limited evidence of benefit from corticosteroid use, the most sensible first management step for her would be meticulous eye care to avoid corneal ulceration, as a result of the difficulty she is having closing her left eye.
-
This question is part of the following fields:
- Nervous System
-
-
Question 4
Incorrect
-
A 56-year-old woman presents to the clinic complaining of shoulder pain that she has been experiencing for the last 4 weeks. She does not remember getting injured previously. The pain worsens on movement especially when she is moving the arm quickly. At night, lying on the affected side is painful. Examination reveals no erythema or swelling. However, pain is felt on passive abduction between 60 to 120 degrees and she is unable to abduct the arm past 70-80 degrees. Flexion and extension are intact. What is the most likely diagnosis?
Your Answer: Adhesive capsulitis (frozen shoulder)
Correct Answer: Supraspinatus tendonitis
Explanation:Supraspinatus tendinopathy is a common and disabling condition that becomes more prevalent after middle age and is a common cause of pain in the shoulder. A predisposing factor is resistive overuse. This patient has the classic painful arc that is a sign of shoulder impingement characteristic of supraspinatus tendonitis.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 5
Incorrect
-
A 23-year-old woman presents with lethargy. Her bloods show: Hb: 10.4 g/dL Plts: 278 x 10^9/L WCC: 6.3 x 10^9/L MCV: 68 fL Blood film: Microcytic hypochromic RBCs, marked anisocytosis and basophilic stippling noted HbA2: 3.9% What is the most likely diagnosis?
Your Answer: Lead poisoning
Correct Answer: Beta-thalassaemia trait
Explanation:Individuals with thalassemia major usually develop symptoms within the first two years of life. These infants may fail to thrive and often have difficulty feeding, tire easily and suffer from severe anemia.
The infants may also suffer from diarrhea, irritability, recurrent episodes of fever, and other intestinal problems. These children have trouble gaining weight and growing at the rate expected for their age. Other complications include enlarged spleen, heart and liver and misshapen bones.
In many cases, the symptoms are severe enough to warrant regular blood transfusion to replenish the blood with healthy red blood cells. However, these regular transfusions can lead to a build up of iron in the blood that can damage the heart, liver and endocrine system and chelation therapy may be needed to remove this iron from the body.
Individuals with beta thalassemia trait usually have evidence of microcytosis and increased levels of hemoglobin A2. Hemoglobin F is sometimes elevated as well. Individuals with alpha thalassemia trait usually have evidence of microcytosis and normal levels of hemoglobin A2 and F.
In thalassemia major, the hemoglobin (Hb) level is usually less than 7 g/dl; the mean corpuscolar volume (MCV) less than 70 fl and the mean corpuscolar Hb (MCH) is over 20 pg.
In thalassemia intermedia, the hemoglobin level is between 7 and 10 g/dl; the MCV between 50 and 80 fl and MCH between 16 and 24 pg.
Thalassemia minor is characterized by a reduced MCV and MCH and an increased haemoglobin A2 level.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 6
Correct
-
A 61-year-old gentleman presents with heart failure and pedal oedema. The oedema occurs due to:
Your Answer: Increased release of renin
Explanation:The oedema is an effect of the a decreased cardiac output that increases renin release which leads to vasoconstriction and sodium and water retention.
-
This question is part of the following fields:
- Renal System
-
-
Question 7
Correct
-
A 27-year-old woman is admitted on the medical intake. She is 10 weeks postpartum and has been generally unwell for two weeks with malaise, sweating and anxiety.
On examination, she is hemodynamically stable and clinically euthyroid.
TFTs show the following:
Free T4 33 pmol/L (9-23)
Free T3 8 nmol/L (3.5-6)
TSH <0.02 mU/L (0.5-5)
What is the appropriate management?Your Answer: Propranolol 20 mg tds
Explanation:The patient is most likely to have Postpartum thyroiditis which goes through 2 phases; hypothyroid and a hyperthyroid phase.
The hyperthyroid phase of postpartum thyroiditis occurs between 2 and 10 months postpartum. Most commonly, it presents at 3 months. Symptoms more common in women with hyperthyroid postpartum thyroiditis include palpitations, fatigue, heat intolerance, and irritability/nervousness. The frequency of asymptomatic hyperthyroidism is 33%.
Untreated, the hyperthyroidism resolves spontaneously within 2-3 months. This phase is diagnosed by the combination of a low serum TSH concentration in the presence of thyroid peroxidase antibodies, in women who are TSH receptor antibody-negative. Free T4 levels are typically elevated but may be normal.
Treatment of hyperthyroidism, when necessary, is based on symptom severity and should be a joint decision of patient and physician. Beta-blockers such as propranolol are given to alleviate palpitations, irritability, and nervousness. The morbidity associated with treatment is the side effects of beta-blockade. The downside of withholding treatment is allowing the woman to remain symptomatic. Antithyroid medicines (thioureas) are not a potential treatment alternative, because the hyperthyroidism is caused by destructive thyroiditis resulting in the release of preformed thyroid hormone. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 8
Correct
-
Which of the following features is characteristic of immune thrombocytopenic purpura?
Your Answer: Autoimmune haemolytic anaemia is a recognised association
Explanation:Immune thrombocytopenic purpura (ITP) refers to thrombocytopaenia occurring in the absence of toxic exposure or other diseases associated with low platelets and involves IgG-type antibodies. It is characterised by normal or increased marrow megakaryocytes, shortened platelet survival, and the absence of splenomegaly. Autoimmune haemolytic anaemia (AIHA) occurs commonly in association with ITP. Leukemic transformation, however, does not occur in ITP.
In neonatal ITP, IgG antibodies are passively transferred across the placenta. The infant platelet count may be normal at birth but decreases within 12-24 hours. It is rarely severe enough to induce bleeding diathesis in the infant.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 9
Correct
-
A 23-year-old pregnant woman presents with glycosuria. What is the most likely mechanism?
Your Answer: Reduced renal reabsorption
Explanation:Throughout pregnancy the tubular reabsorption of glucose is less effective than in the non-pregnant state, this leads to glycosuria.
-
This question is part of the following fields:
- Renal System
-
-
Question 10
Correct
-
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: 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
-
-
Question 11
Correct
-
An 82-year-old patient presents to the clinic complaining of palpitations. ECG reveals waves with saw-tooth pattern, QRS complex of 80ms duration, a ventricular rate of 150/min and a regular R-R interval. Which of the following is most likely responsible for these findings?
Your Answer: Atrial flutter
Explanation:Atrial flutter is a common supraventricular tachyarrhythmia that is usually caused by a single macroreentrant rhythm within the atria, associated with a sawtooth appearance on the ECG. In stable patients the treatment includes rate control and rhythm control, however in unstable patients, a synchronized cardioversion is required.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 12
Correct
-
A 57-year-old homeless man presents with fever and a productive cough which has green sputum with streaks of blood. A chest x-ray reveals consolidation in the right upper lobe with evidence of cavitation. He is a known alcoholic.
What is the most likely causative agent?Your Answer: Klebsiella Pneumoniae
Explanation:Infection with Klebsiella organisms occurs in the lungs, where they cause destructive changes. Necrosis, inflammation, and haemorrhage occur within lung tissue, sometimes producing a thick, bloody, mucoid sputum described as currant jelly sputum.
The illness typically affects middle-aged and older men with debilitating diseases such as alcoholism, diabetes, or chronic bronchopulmonary disease. An increased tendency exists toward abscess formation, cavitation, empyema, and pleural adhesions. -
This question is part of the following fields:
- Respiratory System
-
-
Question 13
Incorrect
-
An old man presented with headache and weakness of the left half of the body. His CT scan showed an intracranial bleed (ICB). All of the following factors can lead to ICB except?
Your Answer: Low cholesterol
Correct Answer: Moderate alcohol use
Explanation:Moderate alcohol intake has no association with intracranial bleeding (ICB), rather some authors suggested that it is protective. Patients with a previous history of DVT, mitral valve prolapse or those using cocaine are at an increased risk of developing an ICB.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 14
Correct
-
Regarding the 3rd heart sound, which one of the following statements is correct?
Your Answer: It may be a normal finding in women up to the age of 50
Explanation:The 3rd heart sound corresponds to early diastolic filling in ventricular relaxation after the closure of the aortic valve. Associated conditions include cardiac failure, constrictive pericarditis and atrial myxomas. It is low pitched and accentuated by inspiration. The 3rd heart sound may arise from ventricular relaxation and it can be seen as a normal finding among children, young adults and women till 50 years of age.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 15
Correct
-
A 60-year-old male has complained of a recent onset of postural syncope, impotence, diarrhoea, and profuse sweating. He also has diabetes. In this patient, what is the most likely cause of syncope?
Your Answer: Autonomic neuropathy
Explanation:Due to the symptoms, a diabetic autonomic neuropathy should be a suspect as a cause for the syncope. Unless associated with atrial fibrillation, mitral regurgitation is not usually expected to cause syncope. PAF can sometimes present with palpitations and a feeling of light-headedness followed by syncope, but is not always the case.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 16
Correct
-
A 77-year-old woman is admitted in an unconscious state. On examination in casualty, her temperature is 33 °C and she was in left ventricular failure.
Her blood glucose level is 5.7 mmol/l and random cortisol is elevated. Free T4 is 4.4 pmol/l.
A CT scan of her brain reveals no focal lesion and a cursory assessment reveals no gross focal neurology.
Which diagnosis fits best with this woman's clinical picture?Your Answer: Profound hypothyroidism
Explanation:Elderly patients with severe hypothyroidism often present with variable symptoms that may be masked or potentiated by co-morbid conditions. Characteristic symptoms may include fatigue, weight gain, cold intolerance, hoarseness, constipation, and myalgias. Neurologic symptoms may include ataxia, depression, and mental status changes ranging from mild confusion to overt dementia.
Clinical findings that may raise suspicion of thyroid hormone deficiency include hypothermia, bradycardia, goitrous enlargement of the thyroid, cool dry skin, myxoedema, delayed relaxation of deep tendon reflexes, a pericardial or abdominal effusion, hyponatremia, and hypercholesterolemia.The patient has a greatly reduced free T4 concentration, is hypothermic, unconscious and has evidence of associated heart failure. All of those support the diagnosis of profound hypothyroidism.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 17
Incorrect
-
A 45-year-old male who has had chemotherapy recently, presented with uncontrollable vomiting. What is the most appropriate treatment for this patient?
Your Answer: Dexamethasone IM
Correct Answer: Ondansetron IM
Explanation:Ondansetron is the drug of choice for chemotherapy induced vomiting. IM or IV Ondansetron should be considered due to uncontrollable vomiting and thus inability to take medication orally.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 18
Correct
-
A 62-year-old male presents to the OPD with a deep painless ulcer on the heel. His previous history includes increased thirst, urinary frequency, and weight loss for the last 4 years. Which of the following investigations would be most appropriate in this case?
Your Answer: Blood sugar
Explanation:People with diabetes are prone to foot problems that develop due to prolonged periods of high blood sugar levels. Diabetic neuropathy and peripheral vascular disease are the two main causes of foot problems and both can have serious complications. Diabetes can cause serious foot problems that can result in feet or limb loss, deformity, and infections. However, it is possible for a person to prevent or minimize many of these problems. While controlling blood sugar by following the recommended diabetes treatment plans is the best way to prevent these serious problems, self-care and regular check-ups with a doctor can also help prevent problems from developing.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 19
Correct
-
A 60-year-old male presented in OPD with a complaint of inability to walk properly because of his left foot. History reveals he has undergone left knee surgery to for severe arthritis. On examination, dorsiflexion of his left foot was found to be compromised, and sensation over the dorsum of his left foot was impaired. Which of the following conditions is this man most likely suffering from?
Your Answer: Compression of common peroneal nerve
Explanation:The branches of the common peroneal nerve innervate the skin of the dorsum of the foot as well as the muscles which help to carry out dorsiflexion of the foot. Compression of the common peroneal nerve cause foot drop as well as the loss in sensation of the skin on the dorsum of the foot.
-
This question is part of the following fields:
- Nervous System
-
-
Question 20
Correct
-
Which of the following parameters is increased as a result of asthma?
Your Answer: Residual volume
Explanation:In asthma, a reversible increase in residual volume (RV), functional residual capacity (FRC), and total lung capacity (TLC) may occur. There is a fall in FEV1, FVC and gas transfer.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 21
Correct
-
A 28-year-old male complained of an annular rash following an insect bite he received during a hiking trip. Which of the following is the drug of choice?
Your Answer: Doxycycline PO
Explanation:The described rash is the typical rash of erythema migrans of Lyme disease, which is treated by doxycycline PO
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 22
Correct
-
An 8-year-old boy is presented with arthritis, cough and non-blanching purpura. His coagulation profile is normal. His CBC: Hb 11.8 TLC 7.2*10^9 Plt 286*10^9. What is the most likely diagnosis?
Your Answer: Henoch-Schönlein Purpura (HSP)
Explanation:The best answer is Henoch-Schönlein Purpura (HSP). This patient has a characteristic rash and the labs are consistent with this diagnosis.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 23
Correct
-
A 31-year-old female complains of bilateral proximal muscle weakness. There is marked blanching of fingers especially in response to cold weather. Lab results are as follows:
Anti Jo-1: positive
ANA: positive
CK: 2000 U/L
ESR: 60mm/hr
EMG: myopathic changes
Presence of which of the following signifies the worst prognosis?Your Answer: Interstitial lung disease
Explanation:Polymyositis is an inflammatory disorder causing symmetrical, proximal muscle weakness. It is thought to be a T-cell mediated cytotoxic process directed against muscle fibres. It may be idiopathic or associated with connective tissue disorders. It may also be associated with malignancy for example small cell lung carcinoma.
Dermatomyositis is a variant of the disease where skin manifestations are prominent, for example a purple (heliotrope) rash on the cheeks and eyelids.
It typically affects middle-aged, female: male 3:1. Features include proximal muscle weakness +/- tenderness, Raynaud’s phenomenon, respiratory muscle weakness, interstitial lung disease: e.g. fibrosing alveolitis or organising pneumonia, dysphagia, dysphonia. Investigations: elevated creatine kinase, other muscle enzymes (lactate dehydrogenase (LD), aldolase, AST and ALT) are also elevated in 85-95% of patients, EMG, muscle biopsy. Anti-Jo-1 antibodies are seen in pattern of disease associated with lung involvement, Raynaud’s and fever. Interstitial lung disease plays a major role in morbidity and mortality in patients with polymyositis and is considered a major risk factor for premature death in patients with myositis. -
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 24
Incorrect
-
A 22-year-old male presented with a cut injury at his wrist. Which of the following would be the expected clinical signs if his ulnar nerve was damaged?
Your Answer: Wasting of the hypothenar eminence
Correct Answer: Wasting of the interossei
Explanation:Damage to the ulnar nerve at wrist will cause wasting of the interossei and adductor pollicis muscle. There won’t be any sensory loss, weakness of wrist flexion or wasting of hypothenar muscles.
-
This question is part of the following fields:
- Nervous System
-
-
Question 25
Correct
-
A baby born a few days earlier is brought into the emergency with complaints of vomiting, constipation and decreased serum potassium. Which of the following is the most probable cause?
Your Answer: Pyloric stenosis: hypokalaemic hypochloraemic metabolic alkalosis
Explanation:In pyloric stenosis a new-born baby presents with a history of vomiting, constipation and deranged electrolytes. Excessive vomiting leads to hypokalaemia. Difficulty in food passing from the stomach to the small intestine causes constipation. Hypokalaemia also causes constipation. None of the other disorders mentioned present with the hypokalaemia, vomiting and constipation triad in a new-born.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 26
Incorrect
-
A 68-year-old woman with contralateral hemisensory loss presents with severe burning pain in this area. In which of the following areas has arterial occlusion most probably occurred?
Your Answer: Posterior inferior cerebellar artery
Correct Answer: Thalamogeniculate artery
Explanation:The woman’s clinical evolution suggests that there was a thalamic stroke in the contralateral hemisphere. The artery most likely affected is the thalamogeniculate artery. Sensory loss is usually unilateral and presents at the opposite side of the brain lesion. This kind of stroke can result in severe burning pain which is responsive to tricyclics.
-
This question is part of the following fields:
- Nervous System
-
-
Question 27
Correct
-
Bicuspid aortic valve is in association with which of the following.
Your Answer: Coarctation of the aorta
Explanation:Bicuspid aortic valve is the most common congenital cardiovascular anomaly, occurring in 1-2% of the population. Coarctation and bicuspid aortic valve occur more frequently in males with a prevalence of approximately 4:1. A high prevalence of these same cardiovascular lesions is also found in women with Turner’s syndrome.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 28
Correct
-
A 69-year-old man complains of a significant decrease in weight, SOB, chest pain discomfort and cough. Examination results are constricted left pupil and drooping left eyelid. What is the most likely diagnosis?
Your Answer: Pancoast tumour
Explanation:Destructive lesions of the thoracic inlet is related to the apical lung cancer called Pancoast tumour, along with the involvement of cervical sympathetic nerves (the stellate ganglion) and brachial plexus which can lead to a Horner’s syndrome
-
This question is part of the following fields:
- Respiratory System
-
-
Question 29
Correct
-
An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 30
Incorrect
-
A 50-year-old man with a history of hyperlipidaemia, currently under treatment with simvastatin 10mg was found to have persistently high cholesterol levels. Previous attempts to increase the dose of simvastatin have resulted in myalgia. Given this history, which one of the following lipid-regulating drugs should definitely be avoided?
Your Answer: Ezetimibe
Correct Answer: Bezafibrate
Explanation:Both fibrates and nicotinic acid have been associated with myositis, especially when combined with a statin. However, the Committee on Safety of Medicines has produced guidance which specifically warns about the concomitant prescription of fibrates with statins concerning muscle toxicity.
Bezafibrate: It is a fibric acid derivative (fibrate) that has been used as a class of agents known to decrease triglyceride levels while substantially increasing HDL-C levels.
Pharmacological effects:
– Increases VLDL catabolism by increasing lipoprotein and hepatic triglyceride lipase.
– Decreases triglyceride synthesis by inhibiting acetyl-CoA reductase.
– Decreases cholesterol synthesis by inhibiting HMG-CoA reductase.Side effects:
– Hypersensitivity
– Primary biliary cirrhosis
– Pre-existing gallbladder disease
– Concurrent use with HMG-CoA inhibitors (statins) can produce myopathy
– Hepatic/renal impairment in a patient warrants dose adjustment as this drug is primarily excreted via the renal mechanism.Contraindications: Concurrent use of MAO inhibitors, hypersensitivity, pre-existing cholestasis, and pregnancy.
Use: It can be used to treat Barth syndrome (characterized by dilated cardiomyopathy, neutropenia (presenting with recurrent infections), skeletal myopathy and short stature)
-
This question is part of the following fields:
- Pharmacology
-
-
Question 31
Correct
-
Choose the molecule that acts as the co-receptor for cells expressing antigens linked with MHC class I molecules:
Your Answer: CD8
Explanation:CD8+ T cells recognize antigens in the form of short peptide fragments bound to major histocompatibility complex class I (MHCI) molecules on the target cell surface.1 Specific engagement of peptide-MHCI (pMHCI) complexes via the clonotypically expressed ?β T-cell receptor (TCR) triggers a range of effector functions that play a critical role in protective immunity against intracellular infections and various malignancies.
-
This question is part of the following fields:
- Immune System
-
-
Question 32
Correct
-
A 60-year-old male complained of pain and redness at the metatarsophalangeal joints of left big toe. He was on treatment for hypertension. Which of the following antihypertensive drugs is responsible for the above symptom?
Your Answer: Bendroflumethiazide
Explanation:The clinical diagnosis is acute gout. According to the latest research diuretics, β blockers, angiotensin converting enzyme inhibitors, and non-losartan angiotensin II receptor blockers are associated with an increased risk of gout, as those drugs increase serum uric acid levels. Calcium channel blockers and losartan are associated with a lower risk. Thiazide diuretics have the highest association with gout.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 33
Incorrect
-
A 20-year-old heroin addict is admitted following an overdose. She is drowsy and has a respiratory rate of 6 bpm. Which of the following arterial blood gas results (taken on room air) are most consistent with this?
Your Answer: pH = 7.49; pCO2 = 4.9 kPa; pO2 = 10.1 kPa
Correct Answer: pH = 7.31; pCO2 = 7.4 kPa; pO2 = 8.1 kPa
Explanation:In mild-to-moderate heroin overdoses, arterial blood gas (ABG) analysis reveals respiratory acidosis. In more severe overdoses, tissue hypoxia is common, leading to mixed respiratory and metabolic acidosis.
The normal range for PaCO2 is 35-45 mmHg (4.67 to 5.99 kPa). Respiratory acidosis can be acute or chronic. In acute respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range (i.e., >45 mm Hg) with an accompanying academia (i.e., pH < 7.35). In chronic respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range, with a normal or near-normal pH secondary to renal compensation and an elevated serum bicarbonate levels (i.e., >30 mEq/L).
Arterial blood gases with pH = 7.31; pCO2 = 7.4 kPa; pO2 = 8.1 kPa would indicate respiratory acidosis.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 34
Incorrect
-
A patient has been diagnosed with multi-drug resistant tuberculosis and is currently being treated with rifampicin, isoniazid, and pyrazinamide. He is commenced on streptomycin.
Which among the following is the most likely neurological side-effect of streptomycin?Your Answer: Optic nerve
Correct Answer: Vestibular damage
Explanation:Vestibular damage is a neurological side effect of streptomycin.
Streptomycin is an aminoglycoside bactericidal antibiotic. It is used in the treatment of tularaemia and resistant mycobacterial infections.
The most common neurological side-effect is vestibular damage leading to vertigo and vomiting.
Cochlear damage is less frequent and results in deafness.
Other side-effects include rashes, angioneurotic oedema, and nephrotoxicity. -
This question is part of the following fields:
- Infectious Diseases
-
-
Question 35
Correct
-
A 55-year-old man develops central abdominal pain a few hours after having an Endoscopic Retrograde Cholangiopancreatography (ERCP) performed. Investigations reveal the following:
Amylase 545 u/dl
Erect chest x-ray Normal heart and lungs. No free air noted
What is the most appropriate management?Your Answer: Intravenous fluids + analgesia
Explanation:A very common complication after ERCP is post-ERCP pancreatitis, which based on the clinical scenario , this man has. The treatment for this is pain control, lots of intravenous fluids, and traditionally bowel rest, although more recent evidence suggests early feeding is better.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 36
Correct
-
In which condition is the sniff test useful in diagnosis?
Your Answer: Phrenic nerve palsy
Explanation:The phrenic nerve provides the primary motor supply to the diaphragm, the major respiratory muscle.
Phrenic nerve paralysis is a rare cause of exertional dyspnoea that should be included in the differential diagnosis. Fluoroscopy is considered the most reliable way to document diaphragmatic paralysis. During fluoroscopy a patient is asked to sniff and there is a paradoxical rise of the paralysed hemidiaphragm. This is to confirm that the cause is due to paralysis rather than unilateral weakness. -
This question is part of the following fields:
- Respiratory System
-
-
Question 37
Incorrect
-
A 35-year-old chronic smoker complains of pain in the calf while walking. This symptom has been increasing in severity for 4 months. There is a painful ulcer at the base of left first toe, which despite treatment has not improved. Dorsalis pedis and posterior tibial pulses were absent on the same side. What is the most compatible diagnosis of this presentation?
Your Answer: Deep Vein Thrombosis
Correct Answer: Thromboangitis Obliterans
Explanation:Thromboangitis obliterans or Buerger’s disease is an inflammatory vasculopathy which is characterized by an inflammatory endarteritis and mainly affects small and medium-sized arteries as well as veins of the upper and lower extremities. It is caused by a prothrombotic state and subsequent obstruction of blood vessels. Ischemic pain, features of inflammation along the vein affected, Raynaud’s phenomenon and painful non-healing ulcers are common presentations.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 38
Incorrect
-
A 60-year-old male presented with complaints of chest pain, a productive cough, blood in the sputum, and night sweats. He also has a history of weight loss. His chest X-ray revealed multiple infiltrates. Which of the following is the most appropriate investigation to be done in this case?
Your Answer: CT scan
Correct Answer: Acid fast bacilli test for sputum
Explanation:All the symptoms of this patient are characteristic features of tuberculosis. The ideal test is the acid fast bacilli test for sputum, it will confirm the preserve of Mycobacterium Tuberculosis using the Ziehl-Nelson stain.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 39
Incorrect
-
Which of the following types of renal stones are said to have a semi-opaque appearance on x-ray?
Your Answer: Xanthine stones
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
-
-
Question 40
Incorrect
-
A 69-year-old male, who is a hypertensive and a smoker presented with sudden onset central chest pain radiating to his back. Examination revealed a pulsatile mass in the abdomen. Which of the following is the most appropriate next step?
Your Answer: PET Scan
Correct Answer: USG
Explanation:The history is suggestive of ruptured Abdominal Aortic Aneurysm (AAA). Characteristic pain, pulsatile abdominal mass and risk factors such as age>60, hypertension and smoking support the diagnosis. Ultrasonography is the standard imaging tool for AAA. It can also detect free peritoneal blood.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 41
Incorrect
-
A 50-year-old male with a history of type II diabetes mellitus and hypertension presented with exertional dyspnoea and chest pain for 2 weeks. On examination his blood pressure was 145/80 mmHg. On auscultation reversed splitting of the second heart sound and bibasal crepitations were detected. What would be the most likely finding on his ECG?
Your Answer: QT prolongation
Correct Answer: Left bundle branch block
Explanation:When closure of the pulmonary valve occurs before the aortic valve, reversed splitting occurs. The causes of reversed splitting are aortic stenosis, hypertrophic cardiomyopathy, left bundle branch block (LBBB), and a ventricular pacemaker.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 42
Incorrect
-
Which of the following measurements is a poor prognostic factor in patients suffering from pneumonia?
Your Answer: Rigors
Correct Answer: Respiratory rate 35/min
Explanation:CURB Pneumonia Severity Score estimates the mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.
Select Criteria:
Confusion (abbreviated Mental Test Score <=8) (1 point)
Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point)
Respiratory Rate > 30 per minute (1 point)
Blood Pressure: diastolic < 60 or systolic < 90 mmHg (1 point) The CURB-65 scores range from 0 to 5. Clinical management decisions can be made based on the score:
Score Risk Disposition
0 or 1 – 1.5% mortality – Outpatient care
2 – 9.2% mortality – Inpatient vs. observation admission
> 3 – 22% mortality – Inpatient admission with consideration for ICU admission with score of 4 or 5 -
This question is part of the following fields:
- Respiratory System
-
-
Question 43
Correct
-
A 53-year-old female teacher asks about hormone replacement therapy (HRT).
What is the most compelling indication for starting HRT?Your Answer: Control of vasomotor symptoms such as flushing
Explanation:Hormone replacement therapy (HRT) involves the use of a small dose of oestrogen, combined with a progestogen (in women with a uterus), to help alleviate menopausal symptoms. The main indication is the control of vasomotor symptoms. The other indications, such as reversal of vaginal atrophy and prevention of osteoporosis, should be treated with other agents as first-line therapies.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 44
Incorrect
-
A 35-year-old female admitted with heat intolerance, neck pain, palpitations and recent onset weight loss despite increased appetite. Which of the following is most likely to be associated with diagnosis of thyroiditis associated with viral infection?
Your Answer: Pretibial myxoedema
Correct Answer: Reduced uptake on thyroid isotope scan
Explanation:Subacute thyroiditis (De Quervain’s thyroiditis) is a self-limiting thyroid condition presenting with three clinical courses of hyperthyroidism, hypothyroidism, and return to normal thyroid function. In subacute thyroiditis serum thyroglobulin (TG) levels are elevated. ESR is usually greater than 50 mm/h, often exceeding 100 mm/h. Radio-iodine uptake is low or nil. Antithyroperoxidase antibodies are associated with autoimmune thyroiditis
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 45
Incorrect
-
A 52-year-old shopkeeper presents with pain in her hands. Examination reveals plaques on the extensor surfaces of her upper limbs and a telescoping deformity of both index fingers. Nails show pitting and horizontal ridging. The patient is most likely suffering from which of the following?
Your Answer: Reactive arthritis
Correct Answer: Arthritis mutilans
Explanation:Arthritis mutilans is a rare (occurs in only 5% of the patients) and extremely severe form psoriatic arthritis characterized by resorption of bones and the consequent collapse of soft tissue. When this affects the hands, it can cause a phenomenon sometimes referred to as ‘telescoping fingers.’ The associated nail changes are also characteristic of arthritis.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 46
Incorrect
-
A 30-year-old patient with schizophrenia was brought to Emergency Department, due to reduced level of consciousness. On examination he was febrile, rigid and had tremors. Which of following does not support the diagnosis of neuroleptic malignant syndrome?
Your Answer: Renal failure
Correct Answer: Usually occurs after prolonged treatment
Explanation:Neuroleptic Malignant Syndrome is a life-threatening condition associated with neuroleptic medications. It is characterized by severe muscular rigidity, hyperthermia, autonomic instability (tachycardia, tachypnoea etc) and changes in the level of consciousness. It usually occurs 4-14 days after the start of therapy. Renal failure and elevated creatinine kinase are also associated with this condition.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 47
Incorrect
-
An 18-year-old male presented to the OPD with complaints of abdominal pain and diarrhoea. There is a history of pubertal delay. On examination, he has pallor and looks short for his age. Tissue biopsy of the small intestines reveals damaged villi. Which of the following is the most likely cause of this condition?
Your Answer: Giardiasis
Correct Answer: Coeliac disease
Explanation:Celiac disease has characteristic shortened intestinal villi. When patients with celiac disease eat products containing gluten, they are unable to absorb the nutrients due to flattened or shortened intestinal villi. The blistering rash present on the patient’s elbows strongly suggests celiac disease. This rash is a sign of the condition Dermatitis Herpetiformis which is associate with celiac disease. Therefore, it is also often called ‘gluten rash’.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 48
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: Globus pallidus
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
-
-
Question 49
Correct
-
A 23-year-old man visited the OPD with a complaint of pain in the abdomen and dark urine. His blood pressure was found to be elevated. Which of the following should be done next to reach a diagnosis?
Your Answer: US
Explanation:Hypertension along with haematuria give an indication of cystic kidneys which can be diagnosed with an ultrasound.
-
This question is part of the following fields:
- Renal System
-
-
Question 50
Incorrect
-
A 28-year-old female presented with complaints of weight gain, thinning of scalp hair, dryness and coldness of the skin, constipation and fatigue. Which of the following is the most likely diagnosis?
Your Answer: Pseudopseudohypoparathyroidism
Correct Answer: Hypothyroidism
Explanation:The symptoms this female presented with in the OPD are major symptoms of hypothyroidism due to insufficient thyroid hormone.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 51
Correct
-
A 69-year-old diabetic female presents for a regular outpatient visit. Her BMI is calculated to be 33. Lab results: GFR=29, Urea=13, Creatinine=390 mmol/L. Which of the following drugs should ideally be used by this patient?
Your Answer: Insulin
Explanation:The management of patients with diabetes and nephropathy necessitates attention to several aspects of care. Importantly, glycaemic control should be optimized for the patient, attaining the necessary control to reduce complications but done in a safe, monitored manner. Screening for development of nephropathy should be performed on a regular basis to identify microalbuminuria or reductions in GFR and if identified, the diabetes regimen should be tailored accordingly. Prevention and treatment of diabetic nephropathy and other complications necessitates a multifactorial approach. From the options provided insulin is the most suitable as sulfonylureas and biguanides are contraindicated in renal failure. Glitazones are known to cause many side effects including fluid retention and oedema. Hence, insulin will be the best option in this scenario.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 52
Incorrect
-
Which one of the following features is most helpful in distinguishing beta thalassaemia trait from iron deficiency anaemia?
Your Answer: Splenomegaly
Correct Answer: Haemoglobin A2 levels
Explanation:Elevated haemoglobin A2 level is seen in beta thalassaemia trait, whereas, it is typically low in iron deficiency anaemia unless the patient has received a recent blood transfusion.
Low mean corpuscular volume (MCV) and reduced haematocrit (Ht) are encountered in both conditions. Peripheral blood smear is grossly abnormal in both beta thalassaemia and severe iron deficiency anaemia, showing bizarre morphology, target cells, and a small number of nucleated red blood cells.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 53
Incorrect
-
Out of the following, which is not associated with polycythaemia vera?
Your Answer: Splenomegaly
Correct Answer: Raised ESR
Explanation:Polycythaemia vera (PV) is associated with a low ESR.
PV, also known as polycythaemia rubra vera, is a myeloproliferative disorder caused by clonal proliferation of marrow stem cells leading to an increase in red cell volume, often accompanied by overproduction of neutrophils and platelets. It has peak incidence in the sixth decade of life, with typical features including hyperviscosity, pruritus, splenomegaly, haemorrhage (secondary to abnormal platelet function), and plethoric appearance. PV is associated with a low ESR.
Some management options of PV include lose-dose aspirin, venesection (first-line treatment), hydroxyurea (slightly increased risk of secondary leukaemia), and radioactive phosphorus (P-32) therapy.
In PV, thrombotic events are a significant cause of morbidity and mortality. 5-15% of the cases progress to myelofibrosis or acute myeloid leukaemia (AML). The risk of having AML is increased with chemotherapy treatment.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 54
Incorrect
-
A 68-year-old male presented with swelling in the lower pole of his parotid gland. It is revealed that this has been ongoing for the past 10 years. Upon examination, the swelling is firm in consistency. From the list of options, choose the most probable diagnosis for this patient.
Your Answer: Parotitis
Correct Answer: Pleomorphic adenoma
Explanation:A pleomorphic adenoma is also called a benign mixed tumour – this is the most common tumour of the parotid gland. It also causes over a third of all submandibular tumours. This type of a tumour is slow-growing and has no symptoms, which means it has great malignant potentiality.
-
This question is part of the following fields:
- Geriatric Medicine
-
-
Question 55
Incorrect
-
A collapsed patient comes into A&E. He has a steroid user card and empty boxes of prednisolone. He has obvious rheumatoid features on examination and some unilateral consolidation on his chest X-ray. He is given intravenous fluids and broad-spectrum antibiotics.
Which one of the following would be the most useful addition to the current management?Your Answer: Thyroid function test before giving steroids
Correct Answer: IV hydrocortisone 100 mg
Explanation:The empty boxes indicate that the patient has run out of his medication.
Chronic administration of high doses of glucocorticoids (GCs) (e.g., prednisone or prednisolone) and also other hormones such as oestrogens, progestins, androgens and growth hormone induce varying degrees of tolerance, resulting in a progressively decreased response to the effect of the drug, followed by dependence and rarely addiction.
The glucocorticoid withdrawal syndrome (GWS) has been considered a withdrawal reaction due to established physical dependence on supraphysiological GC levels.
The severity of GWS depends on the genetics and developmental history of the patient, on his environment, and on the phase and degree of dependence the patient has reached. Its management should include a temporary increase in the dose of GCs followed by gradual, slow tapering to a maintenance dose. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 56
Correct
-
Conjugated bilirubin is converted and metabolised into urobilinogen before excretion. This metabolism takes place in which part of the body?
Your Answer: Large intestine
Explanation:Unconjugated bilirubin is conjugated to glucuronic acid in the hepatocyte. Conjugated bilirubin passes into the enterohepatic circulation and the bilirubin which evades this system is metabolised by bacteria, primarily in the large intestine, to urobilinogen, then stercobilinogen and eventually oxidised to stercobilin. Stercobilin gives faeces its brown colour.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 57
Correct
-
A 23-year-old male medical student presents to the A&E department with pleuritic chest pain. He does not have productive cough nor is he experiencing shortness of breath. He has no past medical history. A chest x-ray which was done shows a right-sided pneumothorax with a 1 cm rim of air and no mediastinal shift.
What is the most appropriate treatment option?Your Answer: Discharge with outpatient chest x-ray
Explanation:Primary spontaneous pneumothorax is an abnormal accumulation of air in the space between the lungs and the chest cavity (called the pleural space) that can result in the partial or complete collapse of a lung. This type of pneumothorax is described as primary because it occurs in the absence of lung disease such as emphysema. Spontaneous means the pneumothorax was not caused by an injury such as a rib fracture. Primary spontaneous pneumothorax is likely due to the formation of small sacs of air (blebs) in lung tissue that rupture, causing air to leak into the pleural space. Air in the pleural space creates pressure on the lung and can lead to its collapse. A person with this condition may feel chest pain on the side of the collapsed lung and shortness of breath. Patients are typically aged 18-40 years, tall, thin, and, often, are smokers.
In small pneumothoraxes with minimal symptoms, no active treatment is required. These patients can be safely discharged with early outpatient review and should be given written advice to return if breathlessness worsens. Patients who have been discharged without intervention should be advised that air travel should be avoided until a radiograph has confirmed resolution of the pneumothorax.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 58
Incorrect
-
A keratitis with dendritic ulceration of the cornea is diagnosed in a 32-year-old patient. What is the most likely cause?
Your Answer: Adenovirus
Correct Answer: Herpes simplex virus
Explanation:The dendritic ulceration seen on fluorescein staining of the eye is pathopneumonic for keratitis caused by HSV (herpes simplex virus). Presentation is that of blepharoconjunctivitis. Treatment is required, the treatment is typically topical acyclovir. Topical steroids can make the infection worse. The other answer choices would not have this dendritic pattern seen on fluorescein staining.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 59
Incorrect
-
A 27-year-old gentleman presents with a 2 year history of involuntary neck movements. There is no history of trauma. He is on no drugs. There is no relevant family history.
On examination he has an episodic right torticollis. The rest of his neurological examination is normal. MRI of his cervical spine is normal. The neurologist in the Movement Disorders Clinic has diagnosed cervical dystonia.
Which of the following treatments will be most beneficial?Your Answer: L-Dopa
Correct Answer: Botulinum toxin
Explanation:Botulinum toxin is a neurotoxic protein from Clostridium botulinum that causes flaccid paralysis as it acts by preventing the release of Ach at the neuromuscular joint. It is the first-line treatment for cervical dystonia (torticollis) because the condition is a neurological disorder characterised by unusual muscle contractions of the neck. With the use of Botulinum toxin, the contractions would be released.
-
This question is part of the following fields:
- Nervous System
-
-
Question 60
Incorrect
-
Regarding the thymus, which of the following is true?
Your Answer: T cells positive for both CD4 and CD8 are rarely found in the thymus
Correct Answer: DiGeorge's syndrome is a developmental abnormality affecting the thymus
Explanation:The thymus is a lymphoid organ located in the anterior mediastinum. In early life, the thymus is responsible for the development and maturation of cell-mediated immunologic functions. The thymus is composed predominantly of epithelial cells and lymphocytes. Precursor cells migrate to the thymus and differentiate into lymphocytes. Most of these lymphocytes are destroyed, with the remainder of these cells migrating to tissues to become T cells.
DiGeorge’s syndrome (DGS) is a developmental abnormality affecting the thymus. The classic triad of features of DGS on presentation is conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcaemia (resulting from parathyroid hypoplasia). -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 61
Incorrect
-
A 55-year-old male presents with complaints suggestive of erectile dysfunction. He also provides a history of ischaemic heart disease for which he is under treatment. The GP decides to start him on sildenafil citrate. Which of the following medications may contraindicate the use of sildenafil in this patient?
Your Answer: Nebivolol
Correct Answer: Nicorandil
Explanation:The use of nitrates and nicorandil concomitantly with sildenafil citrate is contraindicated.
Sildenafil (Viagra) is a phosphodiesterase type V inhibitor used in the treatment of impotence.
Contraindications
– Patients taking nitrates and related drugs such as nicorandil
– Hypotension
– Recent stroke or myocardial infarction (NICE recommend waiting 6 months)Side-effects:
Visual disturbances e.g. cyanopsia, non-arthritic anterior ischaemic Neuropathy
Nasal congestion
Flushing
Gastrointestinal side-effects
Headache -
This question is part of the following fields:
- Pharmacology
-
-
Question 62
Incorrect
-
A 65-year-old female has complained she feels unsteady when she is walking. She is examined and is found to have pyramidal weakness of her left lower leg. She also has reduced pain and temperature sensation on her right leg and right side of her torso up to the umbilicus. Her joint position sense is also impaired in her left big toe but is found to be normal elsewhere. She has definite left extensor plantar response, and the right plantar response is equivocal. Where is the lesion?
Your Answer:
Correct Answer: Left mid-thoracic cord
Explanation:In Brown-Sequard syndrome, there is paralysis and loss of proprioception, which occurs on the same (ipsilateral) side of the body, as the lesion. Loss of pain and temperature sensation, therefore, occurs on the opposite (contralateral) side of the body as the lesion.
-
This question is part of the following fields:
- Geriatric Medicine
-
-
Question 63
Incorrect
-
A 60-year-old man known to have type 2 diabetes comes for regular follow up. He is on metformin 2 g per day and gliclazide 160 mg per day. His recent HbA1c was 8.4% and his blood pressure was 140/75 mmHg. Eye examination reveals dot and blot haemorrhages and microaneurysms. None are close to the macula.
Which of the following defines his eye condition?Your Answer:
Correct Answer: Background diabetic retinopathy
Explanation:Patients with diabetes often develop ophthalmic complications, the most common and potentially most blinding of these complications is diabetic retinopathy.
The following are the 5 stages in the progression of diabetic retinopathy:
1. Dilation of the retinal venules and formation of retinal capillary microaneurysms.
2. Increased vascular permeability.
3. Vascular occlusion and retinal ischemia.
4. Proliferation of new blood vessels on the surface of the retina.
5. Vitreous haemorrhage and contraction of the fibrovascular proliferation.
The first 2 stages of diabetic retinopathy are known as background or nonproliferative retinopathy. Initially, the retinal venules dilate, then microaneurysms (tiny red dots on the retina that cause no visual impairment) appear. As the microaneurysms or retinal capillaries become more permeable, hard exudates appear, reflecting the leakage of plasma.Mild nonproliferative diabetic retinopathy (NPDR) or background diabetic retinopathy is indicated by the presence of at least 1 microaneurysm, while neovascularization is the hallmark of Proliferative Diabetic Retinopathy (PDR).
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 64
Incorrect
-
A 42-year-old male undergoes a routine cranial nerve examination, which reveals the following findings:
Rinne's test: Air conduction > bone conduction in both ears
Weber's test: Localizes to the right side
What do these test results imply?Your Answer:
Correct Answer: Left sensorineural deafness
Explanation:Weber’s test – if there is a sensorineural problem, the sound is localized to the unaffected side (right), indicating a problem on the left side.
-
This question is part of the following fields:
- Nervous System
-
-
Question 65
Incorrect
-
A 55-year-old man presented with retrosternal chest pain associated with excessive sweating and vomiting. On examination his BP was 100/60 mmHg and pulse rate was 72 bpm. Bibasal crepitations were auscultated. His ECG showed ST elevation in V1 to V4 and ST depression in leads II, III and aVF. Which of the following would be the finding during angioplasty?
Your Answer:
Correct Answer: Complete occlusion of the left anterior descending artery
Explanation:The ECG findings are suggestive of anterior myocardial infarction and the most likely artery affected is the left anterior descending artery. Occlusion of the right coronary artery will be shown by ST elevation in lead II, III, aVF and occlusion of the circumflex artery will show changes in leads I, aVL, V5 and V6. To have ST elevation, there should be complete occlusion of the artery.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 66
Incorrect
-
A 16-year-old boy suffers recurrent episodes of haematuria following a flu-like illness. He is otherwise well. Physical examination is normal. Urinalysis reveals no proteinuria, blood ++, and 2-3 white blood cells/mm3.
Â
What is the most probable diagnosis?Your Answer:
Correct Answer: IgA nephropathy
Explanation:IgA nephropathy’s characteristic presentation is haematuria following a non-specific upper respiratory infection as was evident in this case. IgA nephropathy also usually occurs in children and young males, like this patient.
-
This question is part of the following fields:
- Renal System
-
-
Question 67
Incorrect
-
A 20-year-old male presented after an episode where he had collapsed. This was the second time he has collapsed during the past 3 weeks. His father passed away at the age of 40 due to sudden cardiac death. Echocardiography showed evidence of hypertrophic cardiomyopathy. His 24 hr ECG revealed several short runs of nonsustained ventricular tachycardia (VT). Which of the following is the most appropriate management for this patient?
Your Answer:
Correct Answer: Implantable cardiovertor defibrillator
Explanation:This patient has a high risk of sudden cardiac death due to a strong family history and non sustained VT. So the most appropriate management is implantable cardiovertor defibrillator.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 68
Incorrect
-
Which of the following features is characteristic of acute intermittent porphyria?
Your Answer:
Correct Answer: Increased urinary porphobilinogen between acute attacks
Explanation:Urinary porphobilinogen is increased between attacks of acute intermittent porphyria (AIP) and even more so, between acute attacks.
AIP is a rare autosomal dominant condition caused by a defect in porphobilinogen deaminase, an enzyme involved in the biosynthesis of haem. This results in the toxic accumulation of delta-aminolaevulinic acid and porphobilinogen.
Abdominal and neuropsychiatric symptoms are characteristic of AIP especially in people between the ages of 20-40 years. The disease is more common in females than in males (5:1). Major signs and symptoms of AIP include abdominal pain, vomiting, motor neuropathy, hypertension, tachycardia, and depression.
Diagnosis:
1. Urine turns deep red on standing (classical picture of AIP)
2. Raised urinary porphobilinogen (elevated between attacks and to a greater extent, between acute attacks)
3. Raised serum levels of delta-aminolaevulinic acid and porphobilinogen
4. Assay of red blood cells for porphobilinogen deaminase -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 69
Incorrect
-
A 25-year-old woman with Charcot-Marie-Tooth disease (type 1) asks how likely it is that any future children will have the disease. What is the most accurate answer?
Your Answer:
Correct Answer: 0.5
Explanation:Because Charcot-Marie-Tooth disease (type 1) is an autosomal dominant condition; therefore, there is a 50% chance that the children of this patient will be affected.
-
This question is part of the following fields:
- Nervous System
-
-
Question 70
Incorrect
-
A 52-year-old cancer patient that recently had an anterior resection of the rectum is concerned about postoperative pain control. What is the most appropriate management choice in his case?
Your Answer:
Correct Answer: IM morphine
Explanation:Post-operative pain is usually severe and strong analgesia is needed with IM morphine.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 71
Incorrect
-
A 40-year-old lady who underwent a recent subtotal gastrectomy for peptic ulcer disease has now developed anaemia with a haemoglobin of 6.4, tiredness, fatigue and loss of vibration sensation in both legs. What is the underlying cause of her symptoms?
Your Answer:
Correct Answer: B12 deficiency
Explanation:Vit B12 needs intrinsic factor to be absorbed, which is secreted in the stomach. Its deficiency is characterised by macrocytic anaemia with peripheral neuropathy.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 72
Incorrect
-
An 18-year-old boy, thin with a tall stature, and a high arched palate arrives at the hospital with a spontaneous pneumothorax. He is accompanied by his brother who has a similar appearance. You suspect Marfan's Syndrome.
The gene encoding which of the following proteins is defective in this condition?Your Answer:
Correct Answer: Fibrillin-1
Explanation:A variety of proteins compose the structure of microfibrils, the most prominent of which are the two fibrillins. Fibrillin-1 a scaffolding protein is encoded by FBN1 on human chromosome 15q21 and fibrillin-2 is encoded by FBN2 on 5q23. Mutations in FBN1 produce Marfan syndrome, a pleiotropic autosomal dominant connective tissue disorder with prominent manifestations in the skeleton, eye and cardiovascular system. A number of conditions related to Marfan syndrome are also due to FBN1 mutations.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 73
Incorrect
-
A 50-year-old farmer, under treatment for depression, presents to the emergency department following an intentional overdose of an unidentified substance. On examination, he was found to be bradycardic, hypotensive, hyper-salivating, and disoriented. On ocular examination, his pupils were found to be miotic. What is the most likely substance he ingested?
Your Answer:
Correct Answer: An organophosphate insecticide
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 74
Incorrect
-
A 54-year-old plumber presents with general deterioration. He drinks approximately 25 units of alcohol each week and is a smoker of five cigarettes daily. Examination reveals that he is jaundiced, has numerous spider naevi on his chest and he has a temperature of 37.2°C. Abdominal examination reveals hepatosplenomegaly.
Investigations reveal:
Bilirubin 100 micromol/L (1-22)
Alkaline phosphatase 310 iu/l (45 - 105)
ALT 198 iu/l (5 - 35)
AST 158 iu/l (1 - 31)
Albumin 25 g/L (37 - 49)
Hepatitis B virus surface antigen positive
Hepatitis B virus e antigen negative
Hepatitis B virus DNA awaited
What is the most likely diagnosis?Your Answer:
Correct Answer: Chronic hepatitis B infection
Explanation:The clinical scenario describes a man in liver failure. Given the serological results, he is most likely to have a chronic hepatitis B infection. In chronic hepatitis B infection, you have +HBsAg, +anti-HBc, (-)IgM antiHBc, and (-) anti-HBs. In acute hepatitis B infection, you have +HBsAg, +anti-HBc, +IgM anti-HBc, and negative anti-HBs. in immunity due to natural infection, you have negative HBsAg, +anti-HBc, and + anti-HBs. In immunity due to vaccination, you have negative HBsAg, negative anti-HBc, and positive anti-HBs. While he could have a superimposed hepatitis D infection on top of hepatitis B, there is no mention of hepatitis D serology, make this an incorrect answer. The other choices do not involve hepatitis serologies.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 75
Incorrect
-
A 35-year-old alcoholic presented with epigastric pain radiating backward. His pain was relieved with opioid analgesics and anti PUD medications, however after 1 week he developed a fever with a similar kind of abdominal pain to that of his initial presentation. US abdomen shows a fluid collection. The most likely site for the fluid collection would be?
Your Answer:
Correct Answer: Lesser sac
Explanation:The most likely diagnosis in this case is acute pancreatitis, which typically presents with severe abdominal pain and vomiting, along with deranged LFTs and raised serum amylase. It makes a boundary wall for the lesser sac and therefore the most likely site of fluid collection would be in the lesser sac.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 76
Incorrect
-
A 60-year-old patient with hypertension attended his regular clinic. His compliance was poor. His blood pressure was 180/100 mmHg. His pulse rate was 85 bpm which was irregularly irregular. On examination there was bibasal crepitation. No murmurs were heard. What is the most likely cause for these findings?
Your Answer:
Correct Answer: Left ventricular hypertrophy
Explanation:Left ventricular hypertrophy due to long standing hypertension is the most probable cause. The irregularly irregular pulse was suggestive of atrial fibrillation, which is due to diastolic dysfunction. Poor ventricular filling causes pulmonary congestion which manifests as bibasal crepitations.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 77
Incorrect
-
A 46-year-old plumber develops chronic, severe pain after sustaining a brachial plexus injury as a result of a motorbike accident. He has had no benefit from paracetamol or ibuprofen. In addition, he has had an unsuccessful trial of amitriptyline. Following recent NICE guidelines, which of the following is the most appropriate medication to consider?
Your Answer:
Correct Answer: Pregabalin
Explanation:Neuropathic pain may be defined as pain which arises following damage or disruption of the nervous system. It is often difficult to treat and responds poorly to standard analgesia.
The most recent update to the NICE guidelines for management of neuropathic pain occurred in 2013: first-line treatment* includes amitriptyline. If the first-line drug treatment does not work then move on to one of the other 3 drugs: duloxetine, gabapentin or pregabalin. Tramadol may be used as ‘rescue therapy’ for exacerbations of neuropathic pain. Topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia). Pain management clinics may be useful in patients with resistant problems.*please note that for some specific conditions the guidance may vary. For example carbamazepine is used first-line for trigeminal neuralgia.
-
This question is part of the following fields:
- Nervous System
-
-
Question 78
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
-
-
Question 79
Incorrect
-
A 68-year-old man presents with acute symptoms of gout on his first metatarsophalangeal joint. Which option best explains the underlying mechanism of gout?
Your Answer:
Correct Answer: Decreased renal excretion of uric acid
Explanation:Primary gout is related more often to underexcretion of uric acid or overproduction.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 80
Incorrect
-
Which of the following peripheral neuropathy inducing clinical diagnoses is predominantly associated with sensory loss?
Your Answer:
Correct Answer: Uraemia
Explanation:Diseases that cause predominantly sensory loss include diabetes, uraemia, leprosy, alcoholism, vitamin B12 deficiency, and amyloidosis.
Those that cause predominantly motor loss include Guillain-Barre syndrome, porphyria, lead poisoning, hereditary sensorimotor neuropathies, chronic inflammatory demyelinating polyneuropathy, and diphtheria. -
This question is part of the following fields:
- Nervous System
-
-
Question 81
Incorrect
-
A 50-year-old male was brought to the ER after the accidental consumption of 300 ml of diethylene glycol. Blood investigations were suggestive of metabolic acidosis and renal failure. What is the appropriate management in this patient?
Your Answer:
Correct Answer: Haemodialysis and oral ethanol
Explanation:Among the given options the most appropriate management in this patient would be ethanol and haemodialysis.
Ethanol competes with ethylene glycol for alcohol dehydrogenase and thus, helps manage a patient with ethylene glycol toxicity.
Ethylene glycol is a type of alcohol used as a coolant or antifreeze
Features of toxicity are divided into 3 stages:
Stage 1: (30 min to 12 hours after exposure) Symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness (CNS depression)
Stage 2: (12 – 48 hours after exposure) Metabolic acidosis with a high anion gap and high osmolar gap. Also tachycardia, hypertension
Stage 3: (24 – 72 hours after exposure) Acute renal failureManagement has changed in recent times:
Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol.
Ethanol has been used for many years works by competing with ethylene glycol for the enzyme alcohol dehydrogenase this limits the formation of toxic metabolites (e.g. glycolaldehyde and glycolic acid) which are responsible for the hemodynamic/metabolic features of poisoning.
Haemodialysis has a role in refractory cases. -
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 82
Incorrect
-
A 41-year-old gentleman undergoes a temporal lobectomy after the discovery of a brain tumour. Which one of the following consequences would be least likely to develop?
Your Answer:
Correct Answer: Astereognosis
Explanation:Astereognosis is associated with lesions to the parietal lobe, not the temporal lobe, so this symptom would not arise in this patient.
-
This question is part of the following fields:
- Nervous System
-
-
Question 83
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
-
-
Question 84
Incorrect
-
A 65-year-old male presented with acute ST elevation myocardial infarction and thrombolysis was planned. Which of the following is an absolute contraindication for thrombolysis?
Your Answer:
Correct Answer: Intracerebral Haemorrhage
Explanation:Absolute contraindications for fibrinolytic use in STEMI
Prior intracranial haemorrhage (ICH)
Known structural cerebral vascular lesion
Known malignant intracranial neoplasm
Ischemic stroke within 3 months
Suspected aortic dissection
Active bleeding or bleeding diathesis (excluding menses)
Significant closed head trauma or facial trauma within 3 months
Intracranial or intraspinal surgery within 2 months
Severe uncontrolled hypertension (unresponsive to emergency therapy)
For streptokinase, prior treatment within the previous 6 months -
This question is part of the following fields:
- Cardiovascular System
-
-
Question 85
Incorrect
-
A 21-year-old student presents with yellowish discolouration of her sclera. She says she has had severe headaches over the last few weeks for which she has been taking paracetamol. What is the most likely cause of her jaundice?
Your Answer:
Correct Answer: Gilbert's syndrome
Explanation:Gilbert’s syndrome is a mild liver disorder in which the liver does not properly process bilirubin. Many people never have symptoms. Occasionally a slight yellowish colour of the skin or whites of the eyes may occur. Other possible symptoms include feeling tired, weakness, and abdominal pain.
The enzymes that are defective in Gilberts – UDP glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1) – are also responsible for some of the liver’s ability to detoxify certain drugs. While paracetamol (acetaminophen) is not metabolized by UGT1A1,[10] it is metabolized by one of the other enzymes also deficient in some people with Gilberts. Therefore a subset of people with Gilberts may have an increased risk of paracetamol toxicity. -
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 86
Incorrect
-
A 29-year-old woman presents to clinic complaining of intermittent diarrhoea and constipation. Full blood count and viscosity were normal. Flexible sigmoidoscopy was unremarkable.
What is the next most appropriate management step?Your Answer:
Correct Answer: High-fibre diet
Explanation:This is most likely describing irritable bowel syndrome (IBS). Symptoms are either diarrhoea, constipation, or both, abdominal pain, bloating, with various durations. It is a functional, not organic, problem, as far as research shows at this point. It is essentially a diagnosis of exclusion. Treatment is a high fibre diet with fluids. Caffeine should be avoided as this can worsen symptoms. Full colonoscopy is not warranted at this time, neither is a barium enema. A wheat-free diet is not likely to help as there is no evidence they have an allergy to this.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 87
Incorrect
-
An iv-drug abuser sustains an open head injury and is admitted overnight for observation. The next morning she is ok and is discharged. A week later she is re-admitted with fluctuating hard neurological signs. Blood results show neutrophilia and raised C-reactive protein (CRP).
Which of the following is the best initial treatment step?Your Answer:
Correct Answer: Computed tomography (CT) scan with contrast
Explanation:Increased WBC count and CRP suggest infection. But with the fluctuating hard neurological signs, there is suspicion of the presence of a cerebral mass, which is an indication for requesting for a CT scan with contrast, to rule out an abscess or haematoma. The lumbar puncture can be considered after the CT scan.
-
This question is part of the following fields:
- Nervous System
-
-
Question 88
Incorrect
-
A 37-year-old social worker is referred to you with a long history of diarrhoea and abdominal discomfort. She was diagnosed with irritable bowel syndrome 10 years ago and takes mebeverine, peppermint tablets and Gaviscon. She is a vegetarian and rarely drinks or smokes.
Examination of all systems is normal. Her blood tests show macrocytic anaemia. An upper gastrointestinal endoscopy reveals oesophagitis, hypertrophy of the gastric body and multiple duodenal ulcers.
What is the most likely diagnosis?Your Answer:
Correct Answer: Zollinger-Ellison syndrome
Explanation:This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from the hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. None of the other answer choices are a better answer than this. CT abdomen may potentially show a tumour, but this is not diagnostic for type.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 89
Incorrect
-
A 11-year-old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?
Your Answer:
Correct Answer: Pseudomonas
Explanation:History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 90
Incorrect
-
A 58-year-old female patient is being investigated for breathlessness, cough, and severe weight loss. On the medical ward round, her CXR is reviewed showing hilar lymphadenopathy and multiple peripheral lung metastases.
Which of the following tumours is least likely to be the underlying cause of this lung appearance?Your Answer:
Correct Answer: Brain
Explanation:All of the aforementioned listed tumours, except brain tumours, can metastasise to lungs and produce the typical CXR picture consisting of hilar lymphadenopathy with either diffuse multinodular shadows resembling miliary disease or multiple large well-defined masses (canon balls). Occasionally, cavitation or calcification may also be seen.
Most brain tumours, however, do not metastasise. Some, derived form neural elements, do so but in these cases, intraparenchymal metastases generally precede distant haematogenous spread.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 91
Incorrect
-
A girl suffered full thickness circumferential burn to her right arm. What is best step in management?
Your Answer:
Correct Answer: Escharotomy
Explanation:An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.
-
This question is part of the following fields:
- The Skin
-
-
Question 92
Incorrect
-
A 25-year-old female presented with blisters on the tongue. Some of them secreted pinkish fluid while some were crusted. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: HSV1
Explanation:The history is suggestive of acute gingivostomatitis, which is a manifestation of primary HSV-1 infection. Patients present with gingivitis and vesicular lesions which develop on the oral mucosa, tongue, and lips and later rupture and coalesce, leaving ulcerated plaques.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 93
Incorrect
-
A 70-year-old male presented in the emergency department with urosepsis. Gentamicin (7 mg/kg once daily) was administered to treat the infection. One day after administration, his gentamicin levels were more than 2 mg/L. Which of the following side effects is most likely to occur in such a case?
Your Answer:
Correct Answer: Nephrotoxicity
Explanation:Gentamicin is a nephrotoxic agent. Its dose should be monitored carefully in elderly or renal patients. If gentamicin starts accumulating in the body (above 2mg/L) then the next dose of gentamicin should be stopped. Otherwise it may cause acute tubular necrosis of the kidneys. Hepatotoxicity, retinopathy, peripheral neuropathy and encephalopathy are not usually associated with gentamicin toxicity.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 94
Incorrect
-
A 40 year-old lawyer suffered a road traffic accident. MRI reveals that he may have hemisection of the spinal cord. Which of the following findings is most likely to occur?
Your Answer:
Correct Answer: Ipsilateral hyperreflexia
Explanation:Spinal cord hemisection, also known as Brown-Sequard syndrome, is associated with symptoms affecting one spinothalamic and one corticospinal tract. Symptoms include ipsilateral paralysis, loss of vibration and position sense, and hyperreflexia below the level of the lesion. Contralateral loss of pain and temperature sensation is also seen, usually beginning 2-3 segments below the level of the lesion.
-
This question is part of the following fields:
- Nervous System
-
-
Question 95
Incorrect
-
A 45-year-old male is suffering from bronchial carcinoma. This is causing obstruction of the superior vena cava. Which of the following is the most suitable palliative treatment option in this case?
Your Answer:
Correct Answer: Radiotherapy
Explanation:Bronchial carcinoma causes obstruction of the superior vena cava through its mass effect. From the options listed in this case, radiotherapy is the most suitable treatment option.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 96
Incorrect
-
Patients with myeloma mostly present with which of the following condition when in hospital?
Your Answer:
Correct Answer: Hypercalcaemia
Explanation:Hypercalcemia is the most important finding in all types of malignancies. In myeloma it is especially caused by osteoclast activating factors which increase bone turnover.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 97
Incorrect
-
Which one of the following statements regarding minimal change glomerulonephritis is incorrect?
Your Answer:
Correct Answer: Hypertension is found in approximately 25% of patients
Explanation:Hypertension and haematuria are not common presentations in minimal change glomerulonephritis, all other statements are correct.
-
This question is part of the following fields:
- Renal System
-
-
Question 98
Incorrect
-
A 25-year-old female with a known diagnosis of hypothyroidism and receiving thyroxine, came to the emergency department with complaints of difficulty sleeping for 3 days and a history of jaundice for 7 days. Her lab results showed increased levels of TSH and PT=70 sec. Which of the following is the most appropriate diagnosis?
Your Answer:
Correct Answer: Autoimmune hepatitis
Explanation:Autoimmune hepatitis is linked with other autoimmune diseases, such as hypothyroidism. It may present as acute or chronic hepatitis and sometimes cirrhosis. Fever, hepatic tenderness and history of jaundice is present. Non-specific features like behavioural issues, weight changes or mood swings can also be present. Coagulopathy can also be present.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 99
Incorrect
-
A 71-year-old woman with a medical history of a blood transfusion in the early 1980s presents with a 10 month history of malaise and is noted to have impaired renal function. Her urine sediment reveals red cell casts.
The results of immunological investigations are as follows: serum IgG 6.5 g/L (normal range 6-13), IgA 1.5 g/L (normal range 0.8-4.0), IgM 5.7 g/L (normal range 0.4-2.0), serum electrophoresis shows a faint band in the gamma region, complement C3 1.02 g/L (normal range 0.75-1.65), complement C4 <0.02 g/L (normal range 0.20-0.65), and rheumatoid factor 894 IU/L (normal range <40).
Which of the following investigations is likely to be most important in making a definitive diagnosis?Your Answer:
Correct Answer: Cryoglobulins
Explanation:The patient’s history of a blood transfusion and lab results showing a markedly low C4 (with normal C3), elevated rheumatoid factor, and elevated serum IgM is highly suggestive of hepatitis C-associated cryoglobulinaemic vasculitis. Testing for Cryoglobulins will confirm this suspicion.
-
This question is part of the following fields:
- Renal System
-
-
Question 100
Incorrect
-
A 48-year-old ex-footballer with a long history of alcohol abuse, presents with epigastric pain. Which of the following suggests a diagnosis of peptic ulceration rather than chronic pancreatitis?
Your Answer:
Correct Answer: Relieved by food
Explanation:Relief of symptoms with food suggests duodenal ulceration, for which the pain gets worse on an empty stomach. In chronic pancreatitis, you would expect worsening of symptoms with food.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 101
Incorrect
-
A 43-year-old female presents with an array of symptoms including weakness, lethargy, dysphagia, dry mouth, gritty sensation in her eyes and increased photosensitivity. In order to confirm the suspected diagnosis, which of the following tests should be performed?
Your Answer:
Correct Answer: Labial gland biopsy
Explanation:To confirm the diagnosis, especially in patients with negative anti-Ro or anti-La antibodies, labial gland biopsy is done. In performing a labial biopsy, the surgeon typically makes a shallow 1/2 inch wide incision on either side of the inner lip after numbing the area with a local anaesthetic. Schirmer’s test determines whether the eye produces enough tears to keep it moist. This test can be done for ocular symptoms of Sjogren syndrome but is of no diagnostic importance as it can be positive with many other diseases.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 102
Incorrect
-
All of the following statements regarding glucagon-like peptide-1 (GLP-1) are true, except?
Your Answer:
Correct Answer: Increased levels are seen in type 2 diabetes mellitus
Explanation:Glucagon-like peptide 1 (GLP-1) is a 30-amino acid peptide hormone produced in the intestinal epithelial endocrine L-cells by differential processing of proglucagon. GLP-1 is released in response to meal intake.
The main actions of GLP-1 are to stimulate insulin secretion (i.e., to act as an incretin hormone) and to inhibit glucagon secretion, thereby contributing to limit postprandial glucose excursions. It also inhibits gastrointestinal motility and secretion and thus acts as an enterogastrone and part of the ileal brake mechanism. GLP-1 also appears to be a physiological regulator of appetite and food intake.
Decreased secretion of GLP-1 may contribute to the development of obesity, and exaggerated secretion may be responsible for postprandial reactive hypoglycaemia. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 103
Incorrect
-
A 24-year-old waiter applies for a job at a cafeteria. He gives a history of having had enteric fever 2 years ago. Which of the following investigations is most likely to indicate a chronic carrier status?
Your Answer:
Correct Answer: Culture of intestinal secretions
Explanation:The chronic asymptomatic carrier state is thought to be why there is continued appearance of the bacterium in human populations. As shedding of the organism is intermittent and sometimes at low levels, methods to detect it have been limited. The Salmonella typhi may be cultured from intestinal secretions, faeces or urine in chronic carriers and is recommended to confirm the diagnosis. Vi agglutination test can also be high in normal people in areas with typhoid endemic. Full blood count or blood culture would not be helpful to determine carrier status. Widal antigen test is unable to differentiate carriers from people with a hx of prior infection.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 104
Incorrect
-
Using DEXA, which of the following bone mineral density values indicates osteopenia in the measured site?
Your Answer:
Correct Answer: A T score of -2.6
Explanation:Osteopenia is an early sign of bone weakening that is less severe than osteoporosis.
The numerical result of the bone density test is quantified as a T score. The lower the T score, the lower the bone density. T scores greater than -1.0 are considered normal and indicate healthy bone. T scores between -1.0 and -2.5 indicate osteopenia. T scores lower than -2.5 indicate osteoporosis.
DEXA also provides the patient’s Z-score, which reflects a value compared with that of person matched for age and sex.
Z-score values of -2.0 SD or lower are defined as below the expected range for age and those above -2.0 SD as within the expected range for age. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 105
Incorrect
-
A 45-year-old woman has been diagnosed with T1N1M1 malignancy in the left breast, with metastases detectable in the lower thoracic vertebrae and the left lung. Before the initiation of treatment of this patient with trastuzumab, which is the most important investigation to perform?
Your Answer:
Correct Answer: Echo
Explanation:Before the initiation of trastuzumab, an echocardiography is a must to rule out any pre-existing cardiac abnormalities as trastuzumab is cardiotoxic.
Trastuzumab (Herceptin) is a monoclonal antibody directed against the HER2/neu receptor. It is used mainly in metastatic breast cancer although some patients with early disease are now also given trastuzumab.
Adverse effects include:
Flu-like symptoms and diarrhoea are common.
Cardiotoxicity:
– Risk increases when anthracyclines are used concomitantly.
– Trastuzumab-induced cardiac dysfunctions are regarded as less severe and largely reversible because primary cardiomyocyte do not show ultrastructure changes unlike those associated with anthracycline-induced cardiotoxicity.
– Primary myocyte injury does not occur in patients who were treated with trastuzumab. -
This question is part of the following fields:
- Women's Health
-
-
Question 106
Incorrect
-
A 16-year-old boy was stabbed in his right upper back and brought to the ED where he underwent an erect CXR. Findings suggest a homogenous opacity on the lower right lung with the trachea centrally placed. What would explain the those findings?
Your Answer:
Correct Answer: Haemothorax
Explanation:Findings suggest a haemothorax which is very likely to happen, in the absence of a haemo-pneumothorax.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 107
Incorrect
-
A 17-year-old boy presents with tremors. Upon inquiry, the mother reports that the boy has a history of very aggressive episodes. She also reports that he has been hallucinating for some time. On examination, there were needle marks on his arm. What drug has been used?
Your Answer:
Correct Answer: Lysergic acid diethylamide (LSD)
Explanation:Psychedelic drugs, like LSD, bring on a state of altered consciousness, causing thought, audio, or visual changes. Low body temperature and tremors are associated with many drugs but closed-eye hallucinations are strongly associated with LSD and other psychedelic drugs.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 108
Incorrect
-
A 22-year-old male presents with loose stools and abdominal pain that is vague in nature. He previously had an episode of lower abdominal pain that was associated with pyrexia which settled on its own. He has also experienced mild weight loss recently. On examination, he is pale and has an ill defined mass in the right iliac fossa. What is the most likely diagnosis?
Your Answer:
Correct Answer: Crohn's disease
Explanation:Crohn’s Disease (CD) is an inflammatory bowel disease, the pathogenesis of which is not fully understood. The clinical presentation of CD may be similar to ulcerative colitis (UC), the other most common inflammatory bowel disease. CD mostly affects young adults and adolescents between the ages of 15 and 35. It is typically located in the terminal ileum, but can discontinuously affect the entire gastrointestinal tract and commonly leads to complications such as fistulas, abscesses, and stenosis. Clinical features include diarrhoea, weight loss, and abdominal pain in the right lower quadrant (RLQ), as well as extraintestinal manifestations in the eyes, joints, or skin. It is often difficult to diagnose because there is no confirmatory test. Diagnosis is therefore based on the patient’s medical history, physical examination, lab tests, imaging (e.g., MRI), endoscopy, and serological testing. Acute episodes are treated with corticosteroids, and in severe cases, immunosuppressants may be indicated. Antibiotics and surgical intervention may be needed to help treat complications. Because the entire gastrointestinal tract may be affected, Crohn disease cannot be cured (in contrast to ulcerative colitis). The goal of treatment is thus to avoid the progression and recurrence of inflammatory episodes.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 109
Incorrect
-
A 20-year-old pregnant female in her first trimester met a child with chickenpox. She was investigated for the varicella antibody, which came back negative. She visited her GP. Which of the following measures is the most appropriate one?
Your Answer:
Correct Answer: Ig
Explanation:After the exposure to chickenpox while pregnant, even if the patient is negative for antibodies she requires immunoglobulin to prevent further issues.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 110
Incorrect
-
A 46-year-old woman was referred to the endocrinology department with hypercalcemia and raised parathyroid hormone levels. Her blood tests are highly suggestive of primary hyperparathyroidism.
She has type 2 diabetes controlled by metformin alone. Her albumin-adjusted serum calcium level is 3.5 mmol/litre.
Which of the following is the most important reason for her referral?Your Answer:
Correct Answer: Albumin-adjusted serum calcium level of 3.5 mmol/litre
Explanation:Indications for surgery for the treatment of primary hyperparathyroidism:
1. Symptoms of hypercalcaemia such as thirst, frequent or excessive urination, or constipation
2. End-organ disease (renal stones, fragility fractures or osteoporosis)
3. An albumin-adjusted serum calcium level of 2.85 mmol/litre or above. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 111
Incorrect
-
In the case of absent tibial and popliteal pulses, which artery is most likely injured?
Your Answer:
Correct Answer: Femero-popliteal
Explanation:The popliteal artery is the continuation of the femoral artery. It passes deeply, through the adductor hiatus and continues through the popliteal fossa to reach the lower border of the popliteus muscle, where it branches into the anterior and posterior tibial arteries.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 112
Incorrect
-
A 50-year-old lung cancer patient presents with diminished reflexes, retention of urine, postural hypotension and sluggish pupillary reaction. What is the most likely explanation for her symptoms?
Your Answer:
Correct Answer: Paraneoplastic syndrome
Explanation:Paraneoplastic syndromes are more common in patients with lung cancer. Signs and symptoms include inappropriate antidiuretic hormone secretion, finger clubbing, hypercoagulability and Eaton-Lambert syndrome.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 113
Incorrect
-
A 38-year-old male presented to the outpatient clinic complaining of a right sided groin mass just above and lateral to the pubic tubercle. It is non-tender and reducible. There is no cough impulse. What is the most likely diagnosis?
Your Answer:
Correct Answer: Direct inguinal hernia
Explanation:The patient is showing the symptoms of a hernia. The position of the hernia indicates an inguinal hernia. The absence of expansive impulse on cough by blocking the internal ring signifies a direct inguinal hernia.
-
This question is part of the following fields:
- Men's Health
-
-
Question 114
Incorrect
-
In renal patients, bone reabsorption and fractures are significant due to high level of parathyroid hormone. Which one of the following is a major culprit for this high level of parathyroid hormones?
Your Answer:
Correct Answer: Hyperphosphataemia
Explanation:Hyperphosphatemia is the cause known to enhance the production of PTH through parathyroid glands in renal patients. Hypercalcaemia and Hypophosphatemia decrease PTH production. Phosphate binders also reduce PTH level. Serum ALP is an indicator of rapid bone turnover.
-
This question is part of the following fields:
- Renal System
-
-
Question 115
Incorrect
-
A 25-year-old woman was admitted to hospital with a 3 day history of feeling generally unwell, with fatigue, arthralgia and pruritus. She had recently finished a 5 day course of antibiotics for a urinary tract infection but there was no other significant past medical history. She had no significant findings on clinical examination except for a widespread erythematous rash.
Investigation results are below:
Haemoglobin (Hb) 12.6 g/dl
White cell count (WCC) 13.0 × 109/l (eosinophilia)
Platelets 390 × 109/l
Creatinine 720 μmol/l
Na+ 135 mmol/l
K+ 5.2 mmol/l
Urea 22.0 mmol/l
Urinalysis Protein ++ blood +
What is the most important investigation to establish the diagnosis?Your Answer:
Correct Answer: Renal biopsy
Explanation:There is a strong suspicion of drug-induced acute tubulo-interstitial nephritis with the classic triad of symptoms of rash, joint pain and eosinophils in the blood, associated with non-specific symptoms of fever and fatigue. This can be confirmed with renal biopsy showing interstitial oedema with a heavy infiltrate of inflammatory cells and variable tubular necrosis.
-
This question is part of the following fields:
- Renal System
-
-
Question 116
Incorrect
-
An elderly man presents with fever of 38°C and a very severe headache. His BP is 85/50 mm Hg. He has neck stiffness and photophobia. What is the most appropriate management?
Your Answer:
Correct Answer: CT head
Explanation:In elderly patients, symptoms suggestive of meningitis could be due to an intracranial mass lesion (such as abscess, tumour or an intracerebral haematoma). Therefore elderly patients are increased risk of cerebral herniation from an LP. A CT head should be done before an LP to exclude a mass lesion.
-
This question is part of the following fields:
- Geriatric Medicine
-
-
Question 117
Incorrect
-
An 87-year-old woman had to double up her dosage of morphine 60mg into 120mg twice a day, in addition to another 10mg oral Morphine 6 times a day. What is the best method of management?
Your Answer:
Correct Answer: Subcutaneous morphine infusion
Explanation:Stable dose of Morphine is essential for chronic cases of pain that are non-malignant in origin. Using the SC route avoids having to intravenously cannulate a patient and allows for a continuous infusion of drugs over a calculated period of time providing constant dosing A significant advantage is that plasma levels of a drug are much more stable, and appropriate symptom control can be achieved without the toxic effects of the peaks and troughs resulting from episodic drug administration.
-
This question is part of the following fields:
- Geriatric Medicine
-
-
Question 118
Incorrect
-
Question 119
Incorrect
-
A 16-year-old boy is being treated with ADH for diabetes insipidus. His blood results show:
fasting plasma glucose level: 6 mmol/l (3- 6)
sodium 148 mmol/l (137-144)
potassium 4.5 mmol/l (3.5-4.9)
calcium 2.8 mmol/l (2.2-2.6).
However, he still complains of polyuria, polydipsia and nocturia.
What could be the most probable cause?Your Answer:
Correct Answer: Nephrogenic diabetes insipidus
Explanation:Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms:
Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP])
Nephrogenic DI, characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney.
The boy most probably has nephrogenic diabetes insidious (DI) not central DI so he is not responding to the ADH treatment. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 120
Incorrect
-
Which one of the following is most associated with the development of acute pancreatitis?
Your Answer:
Correct Answer: Hyperchylomicronaemia
Explanation:Hyperchylomicronaemia is an increase (markedly) in chylomicrons, and this can cause acute pancreatitis, as well as xanthomas. It can be seen in familial lipoprotein lipase (LPL) deficiency, primary type V hyperlipoproteinemia, idiopathic hyperchylomicronaemia, and familial apolipoprotein CII deficiency. Treatment is dietary fat restriction in order to avoid pancreatitis attacks.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 121
Incorrect
-
All of the following are true regarding the management of thyroid diseases during pregnancy, except?
Your Answer:
Correct Answer: Block-and-replace is preferable in pregnancy compared to antithyroid drug titration
Explanation: -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 122
Incorrect
-
A 60-year-old male with no past medical history presented to Casualty with acute chest pain. ST elevation myocardial infarction (STEMI) is diagnosed following an ECG on arrival. He was subsequently successfully thrombolysed. Which of the following combinations of drugs is the most suitable combination for him to be taking 4 weeks after his STEMI?
Your Answer:
Correct Answer: ACE inhibitor + beta-blocker + statin + aspirin + clopidogrel
Explanation:According to NICE guidelines (2013) all people who have had an acute MI, treatment should be offered with ACE inhibitor, dual antiplatelet therapy (aspirin plus a second antiplatelet agent), beta-blocker and a statin.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 123
Incorrect
-
A 22-year-old gentleman presents to A&E for the third time with recurrent urinary stones. There appear to be no predisposing factors, and he is otherwise well; urine culture is unremarkable. The urine stones turn out to be cystine stones.
Â
What is the most likely diagnosis in this case?Your Answer:
Correct Answer: Cystinuria
Explanation:Cystinuria is strongly suspected because of the recurrent passing of cystine stones and otherwise non-remarkable medical history of this young adult patient. Like Cystinuria, all the conditions listed are also inherited disorders, however, the other differentials usually present in the early years of childhood, usually with failure to thrive.
-
This question is part of the following fields:
- Renal System
-
-
Question 124
Incorrect
-
A 42-year-old female presents with morning stiffness that usually takes an hour to settle and a one year history of intermittent pain and swelling of the small joints of her hands. Examination reveals symmetric soft tissue swelling over the PIP and MCP joints and rheumatoid nodules on the elbows. There is also an effusion of both wrists. Lab results are positive for rheumatoid factor. X-ray of the wrists and hands shows erosions and bony decalcification. NSAIDs are started and the patient is referred to a rheumatologist for consideration of DMARD. Previous history is significant for TB. Which of the following should be avoided?
Your Answer:
Correct Answer: Infliximab
Explanation:Anti-TNF-? therapy is effective for patients with arthritis but it can oftentimes lead to the reactivation of latent TB. Hence it should be used with great caution in patients with a past history of TB or current infection.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 125
Incorrect
-
A 30-year-old previously well male was found to have a blood pressure of 140/90 mmHg. Investigations revealed microalbuminuria. FBS and HbA1c were normal. Which of the following is the most appropriate management for this patient?
Your Answer:
Correct Answer: Renal scan
Explanation:A renal scan is important in the diagnosis of early renal damage, acute or chronic nephropathies and nephrovascular disease. Renal resistive index (RRI) which is measured by Doppler sonography, is proved to be a marker of renal disease onset and progression. Young hypertension with microalbuminuria is an indication for a renal scan to identify the possible aetiology.
-
This question is part of the following fields:
- Renal System
-
-
Question 126
Incorrect
-
A 27-year-old man with a long history of heavy alcohol intake is admitted with nausea and frequent vomiting four hours after a meal in a restaurant. During review in the Emergency department he vomits a cupful of blood.
What is the cause of his haematemesis?Your Answer:
Correct Answer: Mallory-Weiss tear
Explanation:This is a classic clinical presentation, with alcohol intake and nausea/vomiting that leads to hematemesis, of a Mallory-Weiss tear. Because of the history, that makes this more likely than haemorrhagic gastritis, duodenal ulceration, or oesophagitis (also oesophagitis would not bleed a cupful). Oesophageal varices would present with copious amounts of hematemesis and most likely hemodynamic instability as a result of the amount of blood loss. In Mallory-Weiss tear they are typically presented as a hemodynamically stable patient.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 127
Incorrect
-
A 70-year-old male patient presents to the urology clinic with a one-month history of passing frank haematuria. Flexible cystoscopy shows a mass of the bladder wall and biopsy reveals transitional cell carcinoma.
Out of the following, which industry has he most likely worked in?Your Answer:
Correct Answer: Dyestuffs and pigment manufacture
Explanation:Exposure to aniline dyes is a risk factor for transitional cell carcinoma. Aniline dyes are used in dyestuffs and pigment manufacturing.
The other aforementioned options are ruled out because:
1. Feed production may expose to aflatoxin (hepatocellular carcinoma).2. Being a military personnel may expose to mustard gas (lung cancer).
3. Rubber industry may expose to nitrosamines (oesophageal and gastric cancer).
4. Refrigerant production before 1974 may expose to vinyl chloride (hepatic angiosarcoma).
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 128
Incorrect
-
A 33-year-old man with a known history of alcoholic liver disease is reviewed following a suspected oesophageal variceal haemorrhage. He has been resuscitated and intravenous terlipressin has been given. His blood pressure is now 104/60 mmHg and his pulse is 84/min. What is the most appropriate intervention?
Your Answer:
Correct Answer: Endoscopic variceal band ligation
Explanation:The correct course of action after giving terlipressin and resuscitating with IV fluids is to perform an EGD with endoscopic variceal band ligation. According to NICE: ‘Offer endoscopic variceal band ligation for the primary prevention of bleeding for people with cirrhosis who have medium to large oesophageal varices. There are serious complications of a TIPS procedure and it is not the first line treatment.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 129
Incorrect
-
A 55-year-old male presented with a mass in his right groin. On examination there was a pulsatile mass just below the midpoint of the inguinal ligament. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Femoral hernia
Explanation:Midpoint of the inguinal ligament is halfway between the pubic tubercle and the anterior superior iliac spine (the two attachments of the inguinal ligament). The opening to the inguinal canal is located just above this point. The femoral artery is at the mid-inguinal point which is halfway between the pubic symphysis and the anterior superior iliac spine. As the mass is at the midpoint of the inguinal ligament, the most probable answer is a femoral hernia. A femoral aneurysm is also a possibility.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 130
Incorrect
-
A 56-year-old man injected his usual insulin dose and went to the washroom to wash his hands before going to dinner. His wife found him unconscious in the washroom a few minutes later. Which of the following investigations needs to be done?
Your Answer:
Correct Answer: Random capillary glucose
Explanation:The state of this patient is most likely a diabetic coma caused by hypoglycaemic shock. A random capillary glucose check can confirm the glucose level and whether prompt IM glucagon should be given.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 131
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
-
-
Question 132
Incorrect
-
A 31-year-old woman presents with complaints concerning her bowel habits. She claims that occasionally she sees blood in her stools but she's more concerned about having chronic abdominal and pelvic pain, tenesmus and intermittent diarrhoea. What would be the most probable cause of her condition?
Your Answer:
Correct Answer: Inflammatory bowel disease
Explanation:Inflammatory bowel disease (IBD) includes both ulcerative colitis and Crohn’s disease. Both of them present with similar symptomatology including diarrhoea, fatigue, abdominal and pelvic pain, blood in the stools, weight loss and occasional fever. In diverticulosis, symptoms are less profound with alternating diarrhoea and constipation.
UTIs might produce abdominal or pelvic pain but they do not interfere with the quality of the stools.
Adenomyosis affects the uterus and presents with mainly menstrual complaints. -
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 133
Incorrect
-
A 25-year-old pregnant mother who is known to have hepatitis B gave birth to a male infant. She is now concerned about her child contracting hep B. Which of the following is the most suitable option for the baby in this case?
Your Answer:
Correct Answer: HepB full vaccine and Ig
Explanation:Hepatitis B full vaccine and Ig should be given to babies born to hepatitis B positive mothers. Hepatitis B vaccine alone or Ig alone is not sufficient to prevent the infection in the new-born baby.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 134
Incorrect
-
A 70-year-old man underwent emergency surgery for an acute abdomen. Following surgery, he was noted to be oliguric. Investigations revealed the following: Sodium 121 mmol/L (137-144) Potassium 6.6 mmol/L (3.5-4.9) Chloride 92 mmol/L (95-107) Urea 17.2 mmol/L (2.5-7.5) Creatinine 250 µmol/L (60-110) pH 7.16 (7.36-7.44) Standard bicarbonate 15.6 mmol/L (20-28). What is the calculated anion gap for this patient?
Your Answer:
Correct Answer: 20 mmol/L
Explanation:Anion gap is calculated as (Na + K) − (Cl + HCO3). Therefore in this patient, the calculated value is 20 mmol/L. The normal anion gap is between 8-16 mmol/l. The excessive value here reflects the presence of other acidic anions, and in this case with the metabolic acidosis, the constituents may be lactate, etc.
-
This question is part of the following fields:
- Renal System
-
-
Question 135
Incorrect
-
A 50-year-old female was examined after complaining of weak limbs. It was discovered she had burn marks on her fingers, diminished reflexes, and wasted and weak hands. Additionally, she has dissociated sensory loss and weak spastic legs. What is the diagnosis for this patient?
Your Answer:
Correct Answer: Syringomyelia
Explanation:All of the symptoms experienced by this patient are consistent with Syringomyelia. The sensory features are as follows: loss of temperature and pain sensation; sensory loss in the arms, shoulders, and upper body; touch, vibration, and position senses are affected in the feet as the syrinx enlarges into the dorsal column. Motor features are as follows: muscle wasting and weakness which begins in the hand, and moves onto the forearms and shoulders; loss of tendon reflexes. Autonomic involvement, such as the bladder and bowel, can occur.
-
This question is part of the following fields:
- Nervous System
-
-
Question 136
Incorrect
-
Which of the following characteristics does the jugular venous waveform have in tricuspid regurgitation?
Your Answer:
Correct Answer: Large V waves
Explanation:The jugular venous pulsation has a biphasic waveform.
– The a wave corresponds to right atrial contraction and ends synchronously with the carotid artery pulse. The peak of the ‘a’ wave demarcates the end of atrial systole.
– The c wave corresponds to right ventricular contraction causing the tricuspid valve to bulge towards the right atrium during RV isovolumetric contraction.
– The x’ descent follows the ‘c’ wave and occurs as a result of the right ventricle pulling the tricuspid valve downward during ventricular systole (ventricular ejection/atrial relaxation). (As stroke volume is ejected, the ventricle takes up less space in the pericardium, allowing relaxed atrium to enlarge). The x’ (x prime) descent can be used as a measure of right ventricle contractility.
– The x descent follows the ‘a’ wave and corresponds to atrial relaxation and rapid atrial filling due to low pressure.
– The v wave corresponds to venous filling when the tricuspid valve is closed and venous pressure increases from venous return – this occurs during and following the carotid pulse.
– The y descent corresponds to the rapid emptying of the atrium into the ventricle following the opening of the tricuspid valve. -
This question is part of the following fields:
- Cardiovascular System
-
-
Question 137
Incorrect
-
Which of the following drugs would be the safest to prescribe in a 22-year-old man with seropositive rheumatoid arthritis who is planning to start a family?
Your Answer:
Correct Answer: Prednisolone
Explanation:Prednisolone although has many undesirable side effects it may be considered relatively safe compared to the drugs that are provided here. Prolonged treatment with sulphasalazine may depress semen quality and cause irreversible infertility. Methotrexate and leflunomide both inhibit purine/pyrimidine synthesis (the former by inhibiting folate metabolism) and are contraindicated in pregnancy or while trying to conceive. In males, a temporary or permanent decrease in sperm count may occur with cyclophosphamide. Because the recovery of fertility after cyclophosphamide therapy is variable, sperm banking should be considered before treatment is begun.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 138
Incorrect
-
A health professional plans to visit Brazil but has recently come to know that there is epidemic of West Nile virus there. Regarding the virus, which of the following is true?
Your Answer:
Correct Answer: May be associated with poliomyelitis-like paralysis
Explanation:West Nile virus is an RNA virus transmitted by the Culex species of mosquitoes. It is mostly prevalent in South America, Africa and some parts of Europe. Clinically it presents with high grade fever, headache, abdominal pain, anorexia and a morbilliform rash over the body. It can also lead to meningitis, encephalitis and flaccid paralysis by affecting the anterior horn cells, a process suggesting similarity to poliomyelitis. It can be fatal if not treated abruptly. Studies suggest that it can be transferred from mother to offspring. New-borns may present with encephalitis, chorioretinitis and wide spread brain damage. Patients suffering from West Nile virus can be effectively treated with interferon, IV immunoglobulin and Ribavirin.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 139
Incorrect
-
A 60-year-old female presented after an acute overdose of amiodarone. Her blood pressure was 110/70 mmHg and pulse rate was 35 bpm. She was given 500 mcg of atropine but there was no response. Which of the following is the most appropriate next step?
Your Answer:
Correct Answer: Isoprenaline
Explanation:Permanent pacing is not indicated as the bradycardia is reversible. Temporary pacing is the definite treatment. Isoprenaline can be used until temporary pacing is available.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 140
Incorrect
-
A 24-year-old presents with diarrhoea. She has had a previous ileal resection for Crohn's Disease. She has also had two recent episodes of loin to groin pain. Her bloods are normal including her inflammatory markers
What is the most likely diagnosis?Your Answer:
Correct Answer: Short bowel syndrome
Explanation:Given her history of bowel resections, the most likely answer in this case is short bowel syndrome. IBS is a diagnosis of exclusion and less likely. Bacterial overgrowth does not relate to resection history, so unlikely. Celiac disease or a flare of IBD are also less likely than short bowel syndrome in this case, simply given the history. Also her labs are normal making these unlikely. History, history, history!
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 141
Incorrect
-
A patient who has recently been diagnosed with SLE undergoes serum testing. A rise in which of the following antibodies would indicate severe systemic involvement?
Your Answer:
Correct Answer: Anti double-stranded DNA antibodies
Explanation:Anti ds-DNA antibodies are very specific for SLE and their presence most often indicates systemic spread of the disease. These antibodies are present in about 30 percent of the total cases of SLE.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 142
Incorrect
-
A 74-year-old woman is admitted with headaches, polyuria and polydipsia of recent onset. She has a history of mastectomy for breast cancer. A CT head scan shows multiple cerebral metastases.
Her admission biochemistry results are as follows:
Sodium 153 mmol/l
Potassium 4.0 mmol/l
Urea 5.0 mmol/l
Creatinine 110 micromol/l
Glucose 5 mmol/l.
Over the next 24 hours, she has a urinary volume of 4.4 litres and further tests reveal plasma osmolality 320 mOsm/kg and urinary osmolality: 254 mOsm/kg.
Which one of the following treatments should be used?Your Answer:
Correct Answer: Desmopressin (DDAVP)
Explanation:Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms:
– Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP])
– Nephrogenic DI, characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney
This patient has the central type from metastases.
In patients with central DI, desmopressin is the drug of choice. It is a synthetic analogue of antidiuretic hormone (ADH). It is available in subcutaneous, IV, intranasal, and oral preparations. Generally, it can be administered 2-3 times per day. Patients may require hospitalization to establish fluid needs. Frequent electrolyte monitoring is recommended during the initial phase of treatment. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 143
Incorrect
-
A 4-year-old boy is admitted to the hospital after developing hemarthrosis in his right knee whilst playing in the garden.
Following blood results are obtained:
Plts: 220 x 10^9/L
PT: 11 secs
APTT: 76 secs
Factor VIIIc activity: Normal
What is the most likely diagnosis?Your Answer:
Correct Answer: Haemophilia B
Explanation:A grossly elevated APTT may be caused by heparin therapy, haemophilia, or antiphospholipid syndrome. A normal factor VIIIc activity, however, points towards the diagnosis of haemophilia B, which is the deficiency of factor IX in the blood.
Haemophilia is an X-linked recessive disorder of coagulation. Up to 30% of patients have no family history of the condition. Haemophilia A is due to the deficiency of clotting factor VIII and is more common than haemophilia B, accounting for 90% of the cases. In haemophilia B (Christmas disease), there is a deficiency of clotting factor IX.
Characteristic features of haemophilia include hemarthrosis, haematomas, and prolonged bleeding following trauma or surgery. Coagulation profile of a haemophiliac person shows prolonged bleeding time, activated partial thromboplastin time (APTT), thrombin time (TT), but a normal prothrombin time (PT).
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 144
Incorrect
-
An 18-year-old male was diagnosed with meningococcal meningitis, confirmed on lumbar puncture. After 6 months he presents in the infectious clinic with a second episode of meningitis. His past history is clear and he takes no regular medication. Which of the following is most probably deficient?
Your Answer:
Correct Answer: C5
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.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 145
Incorrect
-
A 50-year-old hypertensive male on phenytoin and clobazam for partial seizures is also taking lisinopril, cimetidine, sucralfate, and allopurinol. The last few drugs were added recently. He now presents with ataxia, slurred speech, and blurred vision.
Which recently added drug is most likely to be the cause of his latest symptoms?Your Answer:
Correct Answer: Cimetidine
Explanation:The symptoms of ataxia, slurred speech and blurred vision are all suggestive of phenytoin toxicity. Cimetidine increases the efficacy of phenytoin by reducing its hepatic metabolism.
Phenytoin has a narrow therapeutic index (10-20 mg/L) and its levels are monitored by measuring the total phenytoin concentration.
Cimetidine is an H2 receptor antagonist used in the treatment of peptic ulcers. It acts by decreasing gastric acid secretion.
Cimetidine also has an inhibitory effect on several isoforms of the cytochrome enzyme system including the CYP450 enzymatic pathway. Phenytoin is metabolized by the same cytochrome P450 enzyme system in the liver.
Thus, the simultaneous administration of both these medications leads to an inhibition of phenytoin metabolism and thus increases its circulating levels leading to phenytoin toxicity. -
This question is part of the following fields:
- Pharmacology
-
-
Question 146
Incorrect
-
A 14-year-old male was involved in a bicycle accident. He was brought to the emergency department with abdominal pain. On the CT scan of the abdomen, a hematoma was present beneath the capsule of the spleen. His BP and pulse were normal. What is the next step in his management?
Your Answer:
Correct Answer: Refer to surgeons for observation
Explanation:A surgeon will observe the patient and will decide which procedure he needs.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 147
Incorrect
-
A 17-year-old boy was brought to clinic, as his parents were concerned regarding possible delayed puberty. He was otherwise well, played sports regularly and his academic performance was good. His height was 1.7m and weight was 70 kg. On examination, he had a small penis and testes, absent pubic hair, but no other abnormalities. Investigations revealed: Serum testosterone 4 nmol/L (9-35) Plasma follicle stimulating hormone (FSH) 1 U/L (1-7) Plasma luteinising hormone (LH) 1 U/L (1-10) Plasma prolactin 300 mU/L (<450) Plasma TSH 2 mU/L (0.5-5) Which one of the following is the most likely cause?
Your Answer:
Correct Answer: Kallman's syndrome
Explanation:Klinefelter’s syndrome: The low follicle-stimulating hormone (FSH) and luteinising hormone (LH), together with the low testosterone, suggests a hypogonadotropic hypogonadism. We know that there is no mental retardation, and we are told that physical examination is normal and sense of smell would usually not be tested. Consequently a diagnosis of Kallman’s is suggested. We are not told of a family history of growth delay, thus this is unlikely to be constitutional delay. The thyroid-stimulating hormone (TSH) is normal, making hypothyroidism unlikely and this together with the normal prolactin make hypopituitarism most unlikely.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 148
Incorrect
-
Which type of myocardial infarction has the worst prognosis?
Your Answer:
Correct Answer: Anterior wall MI complicated with continuing left ventricular failure and an exercise tolerance of 3 METS on a predischarge exercise test
Explanation:Exercise tolerance of 3 METS on a predischarge exercise test is the most important indicator of a poor post-MI prognosis. Other similar features that predispose the individual to a poor prognosis are resuscitation from a secondary ventricular tachyarrhythmia after the fist 24h and poor left ventricular function on echo.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 149
Incorrect
-
A 25-year-old woman is presenting with diarrhoea and abdominal bloating over the last 4 months. On examination, she has a blistering rash over her elbows. Biochemical investigation showed that she has low serum albumin, calcium and folate concentrations. On jejunal biopsy there is shortening of the villi and lymphocytosis. What is the most likely cause?
Your Answer:
Correct Answer: Coeliac disease
Explanation:Celiac disease has characteristic shortened intestinal villi. When patients with celiac disease eat products containing gluten, they are unable to absorb the nutrients due to flattened or shortened intestinal villi. The blistering rash present on the patient’s elbows strongly suggests celiac disease. This rash is a sign of the condition Dermatitis Herpetiformis which is associate with celiac disease. Therefore, it is also often called ‘gluten rash’.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 150
Incorrect
-
A 42-year-old male arrives at the clinic due to cough and haemoptysis. Examination shows nasal mucosal ulceration. The doctor suspects Wegener's granulomatosis. Which anatomical area would be most commonly involved in this condition?
Your Answer:
Correct Answer: Lungs
Explanation:Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) is a systemic vasculitis that affects both small and medium-sized vessels. Patients typically initially suffer from a limited form that may consist of constitutional symptoms and localized manifestations such as chronic sinusitis, rhinitis, otitis media, ocular conditions. In later stages, more serious manifestations may arise, including pulmonary complications and glomerulonephritis, although the skin, eyes, and heart may also be involved but these lesions are less common.
Diagnosis is based on laboratory testing (positive for PR3-ANCA/c-ANCA), imaging, and biopsy of affected organs, which demonstrate necrotizing granulomatous inflammation. GPA is treated with immunosuppressive drugs, typically consisting of glucocorticoids combined with methotrexate, cyclophosphamide, or rituximab. Relapses are common and the following systems are affected: Lower respiratory tract (95% of cases), renal involvement (80% of cases), skin lesions (45% of cases), ocular involvement (45% of cases) and cardiac involvement (33% of cases). -
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 151
Incorrect
-
A 45-year-old man was referred for abnormal liver biochemistry. Investigations showed he had an ALT of 98 U/l and was Hep B surface antigen positive.
Which of the following is true of chronic active hepatitis due to the hepatitis B virus?Your Answer:
Correct Answer: It carries an increased risk of subsequent hepatocellular carcinoma
Explanation:Chronic hepatitis B patients have an increased risk of hepatocellular carcinoma. In chronic hepatitis B infection, you have +HBsAg, +anti-HBc, (-)IgM antiHBc, and (-) anti-HBs. In acute hepatitis B infection, you have+HBsAg, + anti-HBc, + IgM anti-HBc, and negative anti-HBs. In immunity due to natural infection, you have negative HBsAg, +anti-HBc, and + anti-HBs. In immunity due to vaccination, you have negative HBsAg, negative anti-HBc, and positive anti-HBs. It is important to remember these serologies, it will get you a lot of points on the test.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 152
Incorrect
-
A 67-year-old man presents with anaemia and weight loss. Upon endoscopy, a gastric tumour is revealed, later established as an adenocarcinoma. The patient refuses any treatment and claims that his condition is not influencing the quality of his life. Clinical examination has nothing particularly interesting to show and the patient seems to be conscious of his decision, regardless of the likely curative nature of surgery. What is the single most appropriate management?
Your Answer:
Correct Answer: Respect his wishes and book a follow-up appointment for four weeks
Explanation:The patient seems to be conscious about his decision, which should be respected. According to Mental Capacity Act 2005, a person who makes an unwise decision should not be treated as unable to make a decision.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 153
Incorrect
-
A 80-year-old male was found on the floor. His blood pressure was 100/60 mmHg. His core temperature was 31ºC. His FBC and serum electrolytes were within normal limits. Which of the following would be found in his ECG?
Your Answer:
Correct Answer: Long QT interval
Explanation:Hypothermia is defined as a core body temperature of < 35 °C.
Hypothermia may produce the following ECG changes:
-Bradyarrhythmia
-Osborne Waves (= J waves)
-Prolonged PR, QRS and QT intervals
-Shivering artefact
-Ventricular ectopics
-Cardiac arrest due to VT, VF or asystole -
This question is part of the following fields:
- Cardiovascular System
-
-
Question 154
Incorrect
-
A 50-year-old diabetic and hypertensive patient who is on medication, presented in the OPD with complaints of constipation, polyuria, polydipsia and confusion. On investigation: Serum calcium was 3.07, serum electrophoresis is negative and the X-ray is normal. Which is the most probable cause of these symptoms?
Your Answer:
Correct Answer: Drug induced-Bendroflumethiazide
Explanation:Bendroflumethiazide is a drug used for treating hypertension and is a diuretic. It produces side effects such as constipation, frequent urination, fatigue, polydipsia etc.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 155
Incorrect
-
A 19-year-old lady with established anorexia nervosa is admitted with a BMI of 16. However, she gives the consent to be fed by a nasogastric tube. Which of the following electrolyte disturbances are you most likely to find?
Your Answer:
Correct Answer: Hypophosphataemia
Explanation:Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.
-
This question is part of the following fields:
- Fluids & Electrolytes
-
-
Question 156
Incorrect
-
Which of the following medications is a long acting adrenergic beta-receptor agonist?
Your Answer:
Correct Answer: Formoterol
Explanation:Terbutaline is a long acting beta receptor agonist. It is used as an add on drug for step 3 in treatment of bronchial asthma. It causes relaxation of bronchial smooth muscles and thus, bronchodilatation.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 157
Incorrect
-
A 40-year-old male is awaiting a liver biopsy. Which of the following is the most important investigation that has to be performed prior to the procedure?
Your Answer:
Correct Answer: Coagulation profile
Explanation:As the liver is highly vascular, there is a high risk of bleeding during and after the procedure. Patients may have existing liver diseases, which affect the production of clotting factors. So a coagulation profile is necessary to detect any abnormality and correct them prior to the liver biopsy.
-
This question is part of the following fields:
- Hepatobiliary System
-
-
Question 158
Incorrect
-
An 86-year-old woman accidentally inhaled her hearing aid due to her advanced Alzheimer's dementia. Upon clinical examination, her respiratory rate is found to be 35, and thus a bronchoscopy is recommended. According to which of the following would you obtain consent for this patient?
Your Answer:
Correct Answer: The procedure does not require a written consent
Explanation:This is an emergency case regarding a patient with impaired cognitive functioning. This is why the procedure does not require a written consent. In any other case where the patient has a normal mental capacity, the consent would be obtained as an informed written consent. In this case however, the suggested procedure is almost a matter of life and death, the doctor being required to act on behalf of the patient to her optimal advantage. Under English law no other person can consent to treatment on behalf of an adult, though it is desirable that next of kin are consulted before treating an adult without consent. Recent legislation gives legal authority to people appointed by the patient, or by the state, or a relative or carer, to consent (or refuse) on behalf of the patient. A mini-mental score may not adequately identify those unable to give consent.
-
This question is part of the following fields:
- Geriatric Medicine
-
-
Question 159
Incorrect
-
A 75-year-old woman experienced right sided weakness shortly after she woke up. However, the weakness resolved in 30 minutes and left no disability. Her CT and ECG appear normal. What extra actions should be taken if she is already on Aspirin, Simvastatin, Amlodipine and Bendroflumethiazide?
Your Answer:
Correct Answer: Start Aspirin 300 mg for 2 weeks
Explanation:The patient has most probably experienced a transient ischemic attack which should be initially managed with aspirin 300 mg for two weeks.
-
This question is part of the following fields:
- Nervous System
-
-
Question 160
Incorrect
-
A 27-year-old woman presents with a 4cm bleeding ulcer on her labia minora. The woman admits she is sexually active. Which lymph nodes will the ulcer drain to?
Your Answer:
Correct Answer: Superficial inguinal
Explanation:The woman seems to have a chancroid, which may or may not drain to the lymph nodes of the groin. These nodes are the superficial inguinal lymph nodes.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 161
Incorrect
-
A 25-year-old obese woman is diagnosed with polycystic ovarian syndrome (PCOS). Which of the following findings is most consistently seen in PCOS?
Your Answer:
Correct Answer: Ovarian cysts on ultrasound
Explanation: -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 162
Incorrect
-
A 60-year-old male had an MI one week ago, but has now presented with a pericardial rub and dyspnoea. An ECG was performed and shows ST elevation. A chest x-ray shows loss of margin at the costovertebral angle. Choose the single most likely cause.
Your Answer:
Correct Answer: Dressler's syndrome
Explanation:The pericardial rub indicates pericarditis, which then causes widespread ST elevation. Therefore, the condition is not a new MI but is Dressler’s syndrome.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 163
Incorrect
-
A 58-year-old male attends a doctor's surgery to get help with quitting drinking alcohol. He expressed that he wishes to avoid the unpleasant alcohol craving experiences. From the following options, what should be prescribed to the patient?
Your Answer:
Correct Answer: Acamprosate
Explanation:Acamprosate (calcium acetyl-homotaurine) helps to restore the normal activity of glutaminergic neurons, which usually become hyperexcited following chronic alcohol exposure.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 164
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:
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
-
-
Question 165
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:
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
-
-
Question 166
Incorrect
-
Regarding cranial nerves, which of the following statements is true?
Your Answer:
Correct Answer: The vagus nerve supplies the palatal muscles
Explanation:In addition to the pharynx and larynx, the vagus nerve also innervates the palatoglossus of the tongue, and the majority of the muscles of the soft palate.
The lacrimal gland is supplied by the facial nerve.
The glossopharyngeal nerve supplies the parotid salivary gland controlling salivary secretions.
The oculomotor nerve carries parasympathetic efferents to the sphincter pupillae muscle and innervates the superior rectus.
The optic nerve carries sympathetic postganglionic fibres to the dilator pupillae muscle.
The trochlear nerve supplies the superior oblique muscle. -
This question is part of the following fields:
- Nervous System
-
-
Question 167
Incorrect
-
In end stage renal disease, deficiency of erythropoietin can lead to which of the following conditions?
Your Answer:
Correct Answer: Anaemia
Explanation:Erythropoietin is necessary for normal Hb levels. Reduced levels of erythropoietin in renal failure leads to anaemia in these patients.
-
This question is part of the following fields:
- Renal System
-
-
Question 168
Incorrect
-
A 47-year-old woman diagnosed with oestrogen receptor positive breast cancer three months back was started on treatment with tamoxifen. Which of the following is most likely a complaint of this patient during her review today?
Your Answer:
Correct Answer: Hot flushes
Explanation:The most likely complaint of this patient would be hot flushes.
Alopecia and cataracts are listed in the BNF as possible side-effects. They are however not as prevalent as hot flushes, which are very common in pre-menopausal women.
Tamoxifen is a Selective Oestrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor-positive breast cancer
Adverse effects:
Menstrual disturbance: vaginal bleeding, amenorrhoea
Hot flushes – 3% of patients stop taking tamoxifen due to climacteric side-effects.
Venous thromboembolism.
Endometrial cancer
Tamoxifen is typically used for 5 years following the removal of the tumour.Raloxifene is a pure oestrogen receptor antagonist and carries a lower risk of endometrial cancer.
Although antagonistic with respects to breast tissue tamoxifen may serve as an agonist at other sites. Therefore the risk of endometrial cancer is increased cancer.
-
This question is part of the following fields:
- Women's Health
-
-
Question 169
Incorrect
-
A 28-year-old male who has undergone splenectomy for an abdominal trauma presents on the 3rd postoperative day with acute abdominal pain and distension in the upper abdominal area with hypotension. 2 litres of coffee ground fluid was aspirated on insertion of ryles tubes. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Acute gastric dilatation.
Explanation:Acute gastric dilation leading to ischemia of the stomach is an under-diagnosed and potentially fatal event. Multiple aetiologies can lead to this condition, and all physicians should be aware of it. Acute gastric dilation occurs as a result of eating disorders, trauma resuscitation, volvulus of hiatal hernias, medications, electrolyte abnormalities, psychogenic polyphagia, superior mesenteric artery syndrome, and a myriad of other conditions. Without proper and timely diagnosis and treatment, gastric perforation, haemorrhage, and other serious complications can occur.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 170
Incorrect
-
A 62 year-old male presents with exertional chest pain and is found to have extensive coronary artery disease on angiogram. Which of the following cell types is most implicated in the development of coronary artery plaques?
Your Answer:
Correct Answer: Macrophages
Explanation:An atheroma is an accumulation of degenerative material in the tunica intima (inner layer) of artery walls. The material consists of (mostly) macrophage cells, or debris, containing lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue.
-
This question is part of the following fields:
- Immune System
-
-
Question 171
Incorrect
-
A 35-year-old male complains of a headache that gets worse when he moves his head forward. From the list of options, which is the most likely diagnosis?
Your Answer:
Correct Answer: Chronic Sinusitis
Explanation:Symptoms such as pain worsening when bending forward, are consistent with chronic sinusitis. Sinusitis also does not present with nausea or vomiting, which is worsened by loud noises or bright lights.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 172
Incorrect
-
A 46-year-old male, known with Rheumatoid Arthritis presents with a swollen and painful right ankle. No drug allergies are reported. On examination, the vitals are as follows:
Temp: 38.8
BP: 90/60 mmHg
Pulse: 110/min.
Right ankle examination reveals tenderness, warmth, erythema and tense joint effusion. Blood samples including blood cultures are collected and fluid resuscitation is initiated. Which of the following interventions would be most appropriate for this man?Your Answer:
Correct Answer: Administer i.v. flucloxacillin, and arrange joint aspiration urgently
Explanation:Although microscopic analysis of joint fluid aspirate and culture is the basis of septic arthritis diagnosis and should usually be collected before the administration of antibiotics, the patient is showing signs of septic shock. A delay in antibiotics might lead to worsening of symptoms so they are administered first.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 173
Incorrect
-
A social worker has been diagnosed with hepatitis C infection. Which test will conclusively establish the presence of this infection?
Your Answer:
Correct Answer: HCV RNA
Explanation:The most sensitive test for detecting Hepatitis C infection (acute) is HCA RNA; it can be detected 1-2 weeks after infection. Anti-HCV antibodies take at least 6 weeks to develop and be positive.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 174
Incorrect
-
High titre of which of the following antibodies is not considered diagnostic for the mentioned disease?
Your Answer:
Correct Answer: Rheumatoid factor in rheumatoid arthritis (RA)
Explanation:Diagnosis of RA is mainly based on clinical features (e.g., morning stiffness, symmetrical joint swelling) and laboratory tests (e.g., anti-CCP). Rheumatoid factor is not very specific for this disease and hence has low reliability. X-ray findings (e.g., soft tissue swelling or joint space narrowing) occur late in the disease and are therefore not typically used for diagnosis.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 175
Incorrect
-
A 60-year-old Muslim man with type 2 diabetes comes to the clinic for advice. He is about to start fasting for Ramadan and he is not sure how to modify the administration of his diabetes medications. He is currently on metformin 500mg tds.
What is the most appropriate advice?Your Answer:
Correct Answer: 500 mg at the predawn meal + 1000 mg at the sunset meal
Explanation:Biguanides (Metformin):
People who take metformin alone should be able to fast safely given that the possibility of hypoglycaemia is minimal. However, patients should modify its dose and administration timing to provide two-thirds of the total daily dose, which should be taken immediately with the sunset meal, while the other third is taken before the predawn meal.Thiazolidinediones: No change needed.
Sulfonylurea:
Once-daily sulfonylurea (such as glimepiride or gliclazide MR): the total daily dose should be taken with the sunset meal.
Shorter-acting sulfonylurea (such as gliclazide twice daily): the same daily dose remains unchanged, and one dose should be taken at the sunset meal and the other at the predawn meal.
Long-acting sulfonylurea (such as glibenclamide): these agents should be avoided.It is important that diabetic patients to eat a healthy balanced diet and choose foods with a low glycaemic index (such as complex carbohydrates), which can help to maintain blood glucose levels during fasting. Moreover, it is crucial to consume adequate fluids to prevent dehydration. Physical activity is encouraged, especially during non-fasting periods.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 176
Incorrect
-
A 32-year-old female presented with a lump in the upper outer quadrant of her left breast, which is 1.5cm in size and tender. What is the initial investigation to be done?
Your Answer:
Correct Answer: Ultrasound
Explanation:Tenderness is usually suggestive of a benign breast mass such as a breast abscess. Ultrasound is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage.
-
This question is part of the following fields:
- Women's Health
-
-
Question 177
Incorrect
-
A 60-year-old man, newly diagnosed with acromegaly, may have all of the following, except?
Your Answer:
Correct Answer: Hypohydrosis
Explanation:Acromegaly occurs due to excessive action of insulin-like growth factor I (IGF-I) after the growth plate cartilage fuses in adulthood.
It can be an insidious disease. Symptoms, which may precede diagnosis by several years, can be divided into the following groups:
1. Symptoms due to local mass effects of an intracranial tumour
Tumour damage to the pituitary stalk may cause hyperprolactinemia (Increased blood prolactin levels associated with galactorrhoea) due to loss of inhibitory regulation of prolactin secretion by the hypothalamus
2. Symptoms due to excess of GH/IGF-I including:
– Hyperhidrosis (Not hypohidrosis)
– Arthritis
– Peripheral Neuropathies e.g. Carpal Tunnel Syndrome -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 178
Incorrect
-
A 50-year-old male patient was started on amiodarone. Prior to commencement, his blood urea and electrolytes were checked. What is the reason for doing this investigation before starting amiodarone?
Your Answer:
Correct Answer: To detect hypokalaemia
Explanation:Any antiarrhythmic drugs can potentially cause arrhythmias. Before starting amiodarone, any electrolyte imbalance including hypokalaemia, hypomagnesemia, or hypocalcaemia should be corrected to prevent any arrhythmias.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 179
Incorrect
-
A number of tests have been ordered for a 49-year-old male who has systemic lupus erythematosus (SLE). He was referred to the clinic because he has increased shortness of breath. One test in particular is transfer factor of the lung for carbon monoxide (TLCO), which is elevated. Which respiratory complication of SLE is associated with this finding?
Your Answer:
Correct Answer: Alveolar haemorrhage
Explanation:Alveolar haemorrhage (AH) is a rare, but serious manifestation of SLE. It may occur early or late in disease evolution. Extrapulmonary disease may be minimal and may be masked in patients who are already receiving immunosuppressants for other symptoms of SLE.
DLCO or TLCO (diffusing capacity or transfer factor of the lung for carbon monoxide (CO)) is the extent to which oxygen passes from the air sacs of the lungs into the blood.
Factors that can increase the DLCO include polycythaemia, asthma (can also have normal DLCO) and increased pulmonary blood volume as occurs in exercise. Other factors are left to right intracardiac shunting, mild left heart failure (increased blood volume) and alveolar haemorrhage (increased blood available for which CO does not have to cross a barrier to enter). -
This question is part of the following fields:
- Respiratory System
-
-
Question 180
Incorrect
-
A 35-year-old patient presented with a cough, wheezing and difficulty in breathing which wakes him up in the night. He also has a itchy, dry and scaly skin rash. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Eczema
Explanation:The skin lesion is most probably eczema. It is common among atopic people. Asthma is a common association.
-
This question is part of the following fields:
- The Skin
-
-
Question 181
Incorrect
-
A 75-year-old male patient with a three weeks history of recurrent epistaxis and haemoptysis presents with acute kidney injury. Which antibody would you expect positive?
Your Answer:
Correct Answer: C ANCA
Explanation:Pulmonary renal syndrome is most commonly due to an ANCA positive vasculitis. The history of recurrent epistaxis makes Wegener’s granulomatosis the most probable diagnosis. It presents with pulmonary haemorrhage producing haemoptysis, rapidly progressive glomerulonephritis and anti-glomerular basement membrane antibodies. Recurrent epistaxis favours the diagnosis. In this patient we suspect C ANCA to be positive.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 182
Incorrect
-
A 20-year-old male presented with fever, cough and right sided chest pain for 4 days. On examination he was febrile and mildly dyspnoeic. His respiratory rate was 30, O2 sats 94% and there were crepitations at the right lung base on auscultation. What is the most suitable investigation to be done at this stage to arrive at a diagnosis?
Your Answer:
Correct Answer: CXR
Explanation:The most probable diagnosis is a right sided lobar pneumonia. CXR at this stage will help to confirm the diagnosis. Blood for C&S is also an important investigation but not the others.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 183
Incorrect
-
In idiopathic hypercalciuria, what management should be initiated if there is renal stone disease or bone demineralization?
Your Answer:
Correct Answer: Dietary modification and thiazide diuretics
Explanation:Idiopathic hypercalciuria presents with excess calcium in the urine without an apparent cause. Dietary modification is the first step in addressing this condition, however, because hypercalciuria increases the risk of developing renal stones and bone demineralisation, thiazide diuretics should be prescribed to increase calcium reabsorption when these symptoms are also present.
-
This question is part of the following fields:
- Renal System
-
-
Question 184
Incorrect
-
A 72-year-old man presents to the emergency department with dyspnoea and low exercise tolerance. He's known to have a history of ischemic heart disease on medication. Which drug most probably caused his presenting complaint?
Your Answer:
Correct Answer: Diclofenac Sodium
Explanation:Diclofenac sodium is a non-selective reversible and competitive inhibitor of cyclooxygenase (COX), subsequently blocking the conversion of arachidonic acid into prostaglandin precursors. This leads to an inhibition of the formation of prostaglandins that are involved in pain, inflammation and fever. Clinical trials of several COX-2 selective and non-selective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI), and stroke, which can be fatal.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 185
Incorrect
-
During the examination of an elderly confused and non-coherent gentleman who was brought to casualty by a concerned neighbour, you notice that he has bilaterally small pupils, which do not appear to react to light. Under the circumstances, it is difficult to judge their response to accommodation.
Which of the following conditions may not account for the pupillary appearance in this patient?Your Answer:
Correct Answer: Acute alcohol intoxication
Explanation:Acute alcohol intoxication presents with pupillary dilation, thus, this is ruled out in this patient. All the other listed causes present with small pupils bilaterally.
-
This question is part of the following fields:
- Nervous System
-
-
Question 186
Incorrect
-
Which of the following options is true regarding H. pylori bacteria?
Your Answer:
Correct Answer: It is the cause of >60% of gastric ulceration
Explanation:It is the cause of gastric ulcers in more than 60% of the cases. It is a gram negative bacteria and does not cause oesophageal carcinoma.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 187
Incorrect
-
An 18-year-old female patient presents with a history of headache and photophobia. You believe that the diagnosis is subarachnoid haemorrhage but your colleague insists on bacterial meningitis. Which of the following would you use to support your diagnosis?
Your Answer:
Correct Answer: A family history of polycystic renal disease
Explanation:Hypertension could be the result of polycystic renal disease and is a risk factor for subarachnoid haemorrhage (SAH). What are common in polycystic renal disease are cerebral aneurysms which could rupture if hypertension is present. Both meningitis and SAH can lead to a fluctuating level of consciousness and opiate abuse is not a risk factor for either SAH nor meningitis. Finally, diabetes is not linked with none of the possible diagnoses because hypertension is not a risk factor of diabetes.
-
This question is part of the following fields:
- Nervous System
-
-
Question 188
Incorrect
-
A 71-year-old female presents for investigation of fatigue and weight loss.
Investigations reveal:
Haemoglobin 9.0 g/dL (11.5-16.5)
White cell count 2.0 x109/L (4-11 x109)
Platelet count 250 x109/L (150-400 x109)
Total protein 74 g/L (61-76)
Albumin 28 g/L (37-49)
Urea 16 mmol/L (2.5-7.5)
Creatinine 250 mol/L (60-110)
Plasma glucose 6.5 mmol/L (3.0-6.0)
Urine dipstick analysis: Protein+ & blood+
Renal ultrasound: Normal
Which one of the following investigations would be most appropriate for this patient?Your Answer:
Correct Answer: Plasma protein electrophoresis
Explanation:This patient’s symptoms of anaemia, leukopenia, and elevated non-albumin protein concentration with fatigue and weight loss, point to myeloma. Thus plasma protein electrophoresis or Serum Protein Electrophoresis (SPE) is indicated when there is suspicion of myeloma.
-
This question is part of the following fields:
- Renal System
-
-
Question 189
Incorrect
-
A 36-year-old man is scheduled to start on interferon-alpha and ribavirin for the treatment of hepatitis C. His past history includes intravenous drug usage. Which are the most common side effects of interferon-alpha?
Your Answer:
Correct Answer: Depression and flu-like symptoms
Explanation:Adverse effects due to IFN-alpha have been described in almost every organ system. Many side-effects are clearly dose-dependent. Taken together, occurrence of flu-like symptoms, haematological toxicity, elevated transaminases, nausea, fatigue, and psychiatric sequelae are the most frequently encountered side effects.
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 190
Incorrect
-
What is the site of action of antidiuretic hormone?
Your Answer:
Correct Answer: Collecting ducts
Explanation:Vasopressin, also called antidiuretic hormone (ADH), regulates the tonicity of body fluids. It is released from the posterior pituitary in response to hypertonicity and promotes water reabsorption in the collecting ducts of the kidneys by the insertion of aquaporin-2 channels.. An incidental consequence of this renal reabsorption of water is concentrated urine and reduced urine volume. In high concentrations may also raise blood pressure by inducing moderate vasoconstriction.
-
This question is part of the following fields:
- Renal System
-
-
Question 191
Incorrect
-
Which of the following is not associated with atrial myxoma?
Your Answer:
Correct Answer: J wave on ECG
Explanation:J waves in an ECG is associated with hypothermia, hypercalcemia, the Brugada syndrome, and idiopathic ventricular fibrillation. The other responses are all associated with atrial myxoma
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 192
Incorrect
-
A 25-year-old male presented with acute severe central chest pain which radiated backwards between his scapulae. He didn't have difficulty in breathing and the pain wasn't exacerbated by deep inspiration or a change in position. His father had died due to a heart disease when he was small. He also has a cardiac murmur which was never properly investigated. On examination he was tachycardic with a BP of 165/60 mmHg. There was a diastolic murmur at lower left sternal border which is best heard with the patient sitting forward. Which of the following is the most probable cause for his chest pain?
Your Answer:
Correct Answer: Aortic dissection
Explanation:The most probable diagnosis is Marfan’s syndrome because of a family history of cardiac death and heart murmurs. A characteristic feature is pain which radiates to the back. A wide pulse pressure and a diastolic heart murmur is suggestive of aortic dissection.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 193
Incorrect
-
A 60-year-old female presented with difficulty in breathing. What is the clinical sign that will indicate the presence of established pulmonary hypertension?
Your Answer:
Correct Answer: Raised jugular venous pressure
Explanation:A prominent A wave is observed in the jugular venous pulse and this indicates the presence of established pulmonary hypertension. In addition the pulmonic component of the second heart sound (P2) may be increased and the P2 may demonstrate fixed or paradoxical splitting. The signs of right ventricular failure include a high-pitched systolic murmur of tricuspid regurgitation, hepatomegaly, a pulsatile liver, ascites, and peripheral oedema.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 194
Incorrect
-
A 47-year-old man with a history of alcohol induced liver disease is admitted to the gastroenterology ward. He has developed tense ascites again and a plan is made to site an ascitic drain. His renal function after 2 days is as follows:
Na+ 131 mmol/l
K+ 3.8 mmol/l
Urea 12.2 mmol/l
Creatinine 205 µmol/l
Which of the following pathophysiological changes is most likely to be responsible for the declining renal function?Your Answer:
Correct Answer: Splanchnic vasodilation
Explanation:Hepatorenal syndrome is renal vasoconstriction that cannot overcome the effects of splanchnic vasodilation. Vasoactive mediators cause this splanchnic vasodilation, reducing SVR, which is sensed by the juxtaglomerular apparatus, activating the RAAS system, leading to renal vasoconstriction. However, the overall splanchnic vasodilation effect is greater than this renal vasoconstriction effect.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 195
Incorrect
-
A 7-year-old female presented with complaints of haematuria and fatigue. She had a history of bloody diarrhoea starting 7 days previously. On investigation, her serum urea and creatinine were raised and proteinuria was present. Which of the following is the most suitable diagnosis for her?
Your Answer:
Correct Answer: Haemolytic-uremic syndrome (HUS)
Explanation:HUS syndrome occurs mostly in children after some days of bloody diarrhoea. Damaged red blood cells also damage the kidney filtering unit and lead to sudden renal failure.
-
This question is part of the following fields:
- Renal System
-
-
Question 196
Incorrect
-
A 20-year-old male student presents to the clinic with swelling of his face, hands and feet along with diffuse abdominal pain. He has a history of similar recurrent episodes since he was 10 years old, with each episode lasting 2-3 days. Examination reveals swelling on face, hands, feet but no sign of urticaria. Family history is significant for similar episodes in the mother who experienced these since childhood, and a brother who passed away following respiratory distress at age of 8 during one such episode. Which of the following tests would be the most helpful in reaching the diagnosis?
Your Answer:
Correct Answer: C1 esterase inhibitor
Explanation:Hereditary C1 inhibitor deficiency leads to recurrent angioedema without urticaria or pruritus. Physical triggers include dental work, surgery or intubation. Medical triggers include angiotensin-converting enzyme (ACE) inhibitor, tamoxifen, oestrogen-containing medications (e.g., hormone replacement therapy and oral contraceptives). It is diagnosed on the basis of low levels of C1 esterase inhibitor or elevated levels of dysfunctional C1 esterase inhibitor. C4 levels are low between attacks. IgE levels, eosinophils, skin prick tests and RASTs are helpful in other allergic conditions and asthma but not of use in this case.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 197
Incorrect
-
A 26-year-old lawyer presents to the gastroenterology clinic with weight loss, intermittent oily diarrhoea and malaise. Blood testing reveals folate and iron deficiency. There is also mild hypocalcaemia on biochemistry screening.
She has type-1 diabetes of 10 years' duration and is stable on a basal bolus insulin regimen, otherwise her past medical history is unremarkable.
Which of these antibody tests is most specific for making a diagnosis?Your Answer:
Correct Answer: Anti-tissue transglutaminase antibodies
Explanation:The prompt is suggestive of celiac disease as an aetiology. The antibody that is used primarily to suggest this diagnosis is anti-tissue transglutaminase antibody. You can also check anti-gliadin and anti-endomyseal antibodies, although anti-TTG antibodies are now the preferred test. To get an official diagnosis you must have a tissue diagnosis (biopsy). Anti-smooth muscle antibodies would be seen in autoimmune hepatitis. Anti-thyroid antibodies are not at all related to this, and are associated with thyroid. Anti-nuclear antibodies are non-specific.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 198
Incorrect
-
A 23-year-old woman complains of numbness in her right hand that improves by shaking it. The surgeon has suggested a surgical option. Ligation of which of the following structures will improve the condition?
Your Answer:
Correct Answer: Flexor retinaculum
Explanation:The most likely cause is median nerve inflammation due to carpal tunnel syndrome. It is treated surgically with ablation of the flexor retinaculum.
-
This question is part of the following fields:
- Nervous System
-
-
Question 199
Incorrect
-
Out of the following, which malignant tumour has the highest predilection for dissemination to the bones?
Your Answer:
Correct Answer: Prostate
Explanation:Prostate cancer is the most common primary tumour that metastasises to the bone.
Most common tumours causing bone metastasis (in descending order):
1. Prostate (32%)
2. Breast (22%)
3. Kidneys (16%)
4. Lungs
5. ThyroidMost common sites of bone metastasis (in descending order):
1. Spine
2. Pelvis
3. Ribs
4. Skull
5. Long bones -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 200
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:
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
-
SESSION STATS - PERFORMANCE PER SPECIALTY
