-
Question 1
Incorrect
-
A 44-year-old man presents suffering from retrosternal chest pain that started 2 hours ago and radiates to the throat. Which investigation would you immediately perform?
Your Answer: Electrocardiogram
Correct Answer: Troponin levels
Explanation:The patient’s age and symptoms are indicating a myocardial infarction. Although, the cause of the pain could also be related to the digestive system, a possible myocardial infarction should be excluded or, if present, managed immediately. Troponins are used to establish the diagnosis. Levels of troponin can become elevated in the blood within 3 or 4 hours after heart injury and may remain elevated for 10 to 14 days.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 2
Correct
-
A 38-year-old alcoholic presented with an ataxic gait, nystagmus and confusion. What is the most likely clinical diagnosis?
Your Answer: Wernicke's encephalopathy
Explanation:Wernicke’s encephalopathy is a clinical triad of encephalopathy, gait ataxia and nystagmus.
-
This question is part of the following fields:
- Nervous System
-
-
Question 3
Correct
-
A 50-year-old female patient is started on cyclophosphamide for vasculitis associated with Wegener's granulomatosis. Which of the following adverse effects is most characteristically associated with cyclophosphamide use?
Your Answer: Haemorrhagic cystitis
Explanation:Cyclophosphamide is a cytotoxic alkylating agent that acts by causing cross-linking of DNA strands. Its major adverse effects include haemorrhagic cystitis, myelosuppression, and transitional cell carcinoma.
Cardiomyopathy is caused by doxorubicin and ototoxicity is caused by cisplatin. Alopecia and weight gain are associated with a variety of chemotherapeutic agents especially those that treat breast cancers (e.g. paclitaxel).
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 4
Correct
-
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: 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 5
Correct
-
Which of the following statements is false regarding the bioavailability of a drug?
Your Answer: The bioavailability of a drug given orally is often affected by the degree of renal elimination
Explanation:Renal elimination of a drug has no role in altering the bioavailability of a drug.
The bioavailability of a drug is the proportion of the drug which reaches systemic circulation.
Mathematically, bioavailability is the AUCoral/AUCiv x 100%, where AUC = area under the concentration-time curve following a single (oral or iv) dose.Other options are true:
By definition, the bioavailability of a drug given intravenously is 100%.
Drugs given orally that undergo high pre-systemic (first-pass) metabolism in the liver or gut wall have a low bioavailability e.g. lidocaine.
Bioavailability is also affected by the degree of absorption from the gut and this can change depending on gut motility and administration of other drugs. -
This question is part of the following fields:
- Pharmacology
-
-
Question 6
Correct
-
A 56-year-old woman presents with persistent cough, pyrexia, crackles and left sided chest pain which worsens upon deep inspiration. She has a history of smoking. What is the most likely diagnosis?
Your Answer: Pneumonia
Explanation:The clinical picture is very suggestive of pneumonia. Pneumonia presents with chest pain exacerbated by deep breathing, fever and localized crackles or consolidation.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 7
Correct
-
A 23-year-old woman comes for the advice regarding contraceptives. Her mother passed away due to cervical cancer and she worries about cervical cancer. Which of the following is the most suitable contraceptive method for her?
Your Answer: Barrier method
Explanation:Cervical cancer results from genital infection with HPV. PV infections can be transmitted via nonsexual routes, but the result from sexual contact. So the best contraceptive method in relation to prevention of cervical cancer is the barrier method. But it will not prevent cervical cancer a 100%.
-
This question is part of the following fields:
- Women's Health
-
-
Question 8
Incorrect
-
A 25-year-old woman presented to the ED with carbon monoxide poisoning. High-flow oxygen was administered immediately. She had a GCS of 15 and her vitals were stable. Which one of the following is not an indication for hyperbaric oxygen therapy in this scenario?
Your Answer: Pregnancy and a carboxyhaemoglobin concentration of >20%
Correct Answer: A carboxyhaemoglobin concentration of 16%
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 9
Correct
-
A 50-year-old smoker with a history of hypertension presented with acute severe chest pain and acute myocardial infarction was diagnosed. Which of the following is a contraindication for thrombolysis?
Your Answer: History of likely ischaemic stroke within the past month
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 10
Correct
-
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: 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 11
Correct
-
A 39-year-old woman with a history of rheumatoid arthritis has recently been switched from methotrexate to leflunomide. Monitoring of full blood count and LFTs has been carried out. Which of the following parameters should also be monitored in this case?
Your Answer: Blood pressure
Explanation:Blood pressure should be routinely measured as leflunomide may cause hypertension and thus an increase in BP. It doesn’t cause changes in blood sugar levels, peak expiratory flow rate or haematuria.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 12
Incorrect
-
A team of physicians presented their audit of fluid management for dengue haemorrhagic fever one year ago. A number of recommendations were made at that time and changes were implemented. Which of the following is the most appropriate next step that this team should take?
Your Answer: Data analysis
Correct Answer: Re-audit
Explanation:Clinical audit is defined as a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. To see whether the recommendations have been implemented, a re-audit has to be performed.
-
This question is part of the following fields:
- Ethical & Legal
-
-
Question 13
Incorrect
-
An 18-year-old male smoker presents with extreme rubor of the feet and missing foot pulses following an amputation of his right 2nd toe. What is the most probable diagnosis?
Your Answer: Acute limb ischemia
Correct Answer: Buerger's disease
Explanation:Clinical criteria for the diagnosis of Buerger’s disease are:
1 – smoking history
2 – onset before the age of 50 years
3 – infrapopliteal arterial occlusions
4 – either upper limb involvement or phlebitis migrans
5 – absence of atherosclerotic risk factors other than smoking Confident clinical diagnosis of Buerger’s disease may be made only when all five requirements have been fulfilled. -
This question is part of the following fields:
- Respiratory System
-
-
Question 14
Correct
-
A 38-year-old male complained of painless, right sided testicular enlargement for 4 months. The size has been gradually increasing. On examination, there was no tenderness or redness. It was firm in consistency and not transilluminating. The most likely diagnosis is?
Your Answer: Testicular tumour
Explanation:History is suggestive of testicular tumour due to the gradual onset, non tender, firm mass. Hydroceles transiluminate and a varicocele has a bag of worms texture. Epididymo-orchitis is tender and often red or inflamed. An ependymal cyst is confined to the epididymis.
-
This question is part of the following fields:
- Men's Health
-
-
Question 15
Incorrect
-
A 28-year-old male is complaining about sore feet and lower back pain. He says it feels like walking on gravel. He also mentioned have some urethral discharge that he had not received any treatment for. He had a holiday in Morocco recently. What is the most likely diagnosis?
Your Answer: Reactive arthritis
Correct Answer: Sjogren's Syndrome
Explanation:This is a case of Sjogren Syndrome (aka Reiter’s disease). It is characterised by a triad of: seronegative arthritis mostly sacroiliitis (walking on gravel reflects planter fasciitis), urethritis and conjunctivitis. Sjogren Syndrome usually follows gastroenteritis or non specific urethritis. On the other hand gonococcal arthritis usually occurs in patients who are systemically unwell.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 16
Correct
-
Which of the following statements is incorrect regarding etanercept?
Your Answer: Must be given intravenously
Explanation:Etanercept is a TNF receptor fused with human immunoglobulin. It binds to TNF-alpha preventing it from binding to its normal receptor. Thus, inhibiting it competitively. It is used for treatment of rheumatoid arthritis in adults when traditional treatments fail. When injected subcutaneously, it is accompanied with skin reactions and urticaria. It should be given intravenously. Serious blood disorders and demyelination have also been associated.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 17
Correct
-
A 72-year-old man, following a fall at home, presents to his GP with acute localised chest pain, associated chronic postural lower back pain and chronic fatigue. On examination, he appears mildly anaemic and dehydrated, and has bruises over his arms and legs despite denying previous trauma. Furthermore, he has marked tenderness over his left lower rib cage, compatible with injured ribs, and tenderness over his lower lumbar spine. The rest of his clinical examination is normal.
In order to establish a diagnosis of multiple myeloma, based on the patient's symptomatology, which of the following combination of criteria is required?Your Answer: >30% plasma cells on bone marrow biopsy and radiographic survey demonstrating lytic lesions
Explanation:Diagnosis of multiple myeloma (MM) is based on the confirmation of (a) one major criterion and one minor criterion or (b) three minor criteria in an individual who has signs or symptoms of multiple myeloma.
Major criteria:
1. >30% plasma cells on bone marrow biopsy
2. Monoclonal band of paraprotein on electrophoresis: >35g/L for IgG, 20g/L for IgA, or >1g of light chains excreted in the urine per dayMinor criteria:
1. 10-30% plasma cells on bone marrow biopsy
2. Abnormal monoclonal band but levels less than listed above
3. Lytic bone lesions observed radiographically
4. Immunosuppression -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 18
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: Antiglomerular basement membrane antibodies
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 19
Correct
-
A 37-year-old male fell whilst walking home and landed on his outstretched hand. He is now complaining of pain in his right arm. X-rays were conducted and indicate a fracture of the radial head. Choose the most commonly associated nerve injury from the list of options.
Your Answer: Radial nerve
Explanation:There will be a radial nerve injury due to finger drop with both sensation intact and a normal wrist.
-
This question is part of the following fields:
- Nervous System
-
-
Question 20
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: Left subthalamic nucleus
Correct Answer: Right subthalamic nucleus
Explanation:Hemiballismus is a movement disorder which manifests as unilateral involuntary flinging movements of the proximal upper limbs. The lesion is located in the ipsilateral subthalamic nucleus.
-
This question is part of the following fields:
- Nervous System
-
-
Question 21
Correct
-
A 42-year-old male has suffered a stroke - he is unable to walk in a straight line and has slurred speech. From the list of options, choose the most appropriate investigation to proceed with.
Your Answer: CT scan brain
Explanation:CT scans are used to produce images of the brain. It can be used to detect a stroke from a blood clot or bleeding within the brain.
-
This question is part of the following fields:
- Nervous System
-
-
Question 22
Correct
-
A 56-year-old male presents to the emergency department with confusion and agitation for the past four hours. He is a known alcoholic who has abstained from drinking for the past three days.
On examination, he is sweating, agitated and disoriented. His temperature is 37.7°C, pulse 112 bpm regular and blood pressure is 150/76 mmHg.
Blood investigations performed in the emergency department reveal:
FBC: Normal
U&E: Normal
Plasma glucose: 4.6 mmol/l (3.6-6)
Which of the following medications would be the most appropriate treatment for this man?Your Answer: Oral lorazepam
Explanation:The most probable diagnosis for this patient is delirium tremens due to alcohol withdrawal, which should be treated as a medical emergency.Â
Delirium tremens is a hyperadrenergic state and is often associated with tachycardia, hyperthermia, hypertension, tachypnoea, tremor, and mydriasis.
Treatment:
– The most common and validated treatment for alcohol withdrawal is benzodiazepine: first-line treatment includes oral lorazepam.
– If the symptoms persist, or the medication is refused, parenteral lorazepam, haloperidol or olanzapine should be given.
– Central-acting, alpha-2 agonists such as clonidine and dexmedetomidine should not be used alone for the treatment of alcohol withdrawal.
– It is also recommended to avoid using alcohol, antipsychotics, anticonvulsants, beta-adrenergic receptor blockers, and baclofen for the treatment of alcohol withdrawal as there are not enough studies to support the safety of these. -
This question is part of the following fields:
- Pharmacology
-
-
Question 23
Correct
-
Which of the following serum tumour markers is the most essential for monitoring the clinical progression of a man with teratoma of the testis following chemotherapy?
Your Answer: Alpha-fetoprotein
Explanation:Testicular teratomas are best monitored with the following tumour markers: Alpha-fetoprotein (AFP), beta-hCG, and PLAP (placental like isoenzyme of alkaline phosphatase). For ovarian tumours, we use CA125, pancreatic tumours we use CA19-9, CA15-3 for breast carcinoma and carcinoembryonic antigen (CEA) for colonic tumours.
-
This question is part of the following fields:
- Men's Health
-
-
Question 24
Correct
-
Out of the following, which malignant tumour has the highest predilection for dissemination to the bones?
Your 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 25
Correct
-
A 50-year-old man is referred with impotence. He has a history of angina, hypertension and type 2 diabetes.
Which one of the following drugs that he takes is a contraindication to him being able to receive sildenafil?Your Answer: Isosorbide mononitrate
Explanation:Sildenafil administration to patients who are using organic nitrates, either regularly and/or intermittently, in any form is contraindicated.
Organic nitrates and nitric oxide (NO) donors exert their therapeutic effects on blood pressure and vascular smooth muscle by the same mechanism as endogenous NO via increasing cGMP concentrations. -
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 26
Correct
-
An 83-year-old retired musician is examined for progressive cognitive impairment. Which one of the following features is most suggestive of Lewy body dementia?
Your Answer: Symptoms worsen with neuroleptics
Explanation:Lewy body dementia is an increasingly recognised cause of dementia, accounting for up to 20% of cases. The characteristic pathological feature is alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas. Neuroleptics should be avoided in Lewy body dementia as patients are extremely sensitive and may develop irreversible parkinsonism. Questions may give a history of a patient who has deteriorated following the introduction of an antipsychotic agent.
-
This question is part of the following fields:
- Nervous System
-
-
Question 27
Correct
-
A 61-year old mechanic recently attended A&E, with a 3 month history of bilateral paresthesia and twitching affecting the thumb, first finger and lateral forearm. He denied any trauma. An MRI scan of his spine was performed and revealed cervical canal stenosis with mild cord compression. He was discharged and advised to see his GP for follow-up. Which of the following is the most appropriate initial step in management?
Your Answer: Refer to spinal surgery services
Explanation:Bilateral median nerve dysfunction is suggestive of degenerative cervical myelopathy (DCM) rather than bilateral carpal tunnel syndrome. DCM should be suspected in elderly patients presenting with limb neurology. This patient’s twitches are probably fibrillations, a sign of lower motor neuron dysfunction.
Degenerative cervical myelopathy is associated with a delay in diagnosis. It is most commonly misdiagnosed as carpal tunnel syndrome. In one study, 43% of patients who underwent surgery for degenerative cervical myelopathy had been initially diagnosed with carpal tunnel syndrome.
Management of these patients should be by specialist spinal services (neurosurgery or orthopaedic spinal surgery). Decompressive surgery is the mainstay of treatment and has been shown to stop disease progression. Physiotherapy and analgesia do not replace surgical opinion, though they may be used alongside. Nerve root injections do not have a role in management. -
This question is part of the following fields:
- Nervous System
-
-
Question 28
Correct
-
A 51-year-old man was brought to the Emergency department for loose stools. He was dehydrated, weak and in shock. He had previously been complaining of large stool volumes for a one month period. Stool colour was normal. There was no history of laxative abuse and no significant past medical history.
What is the most likely diagnosis?Your Answer: VIPoma
Explanation:Given that the patient has had large amount, high volume watery diarrhoea in an acute period of time, from the answer choices given, this narrows the diagnosis down to VIPoma or carcinoid syndrome. You would expect with carcinoid syndrome for there to be periodic episodes of diarrhoea, though, with a description of flushing, additionally, associated with these episodes. Thus, VIPoma is the most likely answer here. VIPomas are known to cause hypokalaemia from this large amount of watery diarrhoea. Stool volume should be > 700 ml/day.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 29
Correct
-
A 30-year-old man with type-1 diabetes mellitus on insulin presents in the A&E with fever, cough, vomiting and abdominal pain.
Examination reveals a dry mucosa, decreased skin turgor and a temperature of 37.8 °C.
Chest examination reveals bronchial breathing in the right lower lobe, and a chest X-ray shows it to be due to a right lower zone consolidation.
Other investigations show:
Blood glucose: 35 mmol/l
Na+: 132 mmol/l
K+: 5.5 mmol/l
urea: 8.0 mmol/l
creatinine: 120 μmol/l
pH: 7.15
HCO3: 12 mmol/l
p(CO2): 4.6 kPa
chloride: 106 mmol/l.
Urinary ketones are positive (+++).
The patient is admitted to the hospital and treated. Which of the following should not be used while treating him?Your Answer: Bicarbonate
Explanation:Bicarbonate therapy is not indicated in mild and moderate forms of DKA because metabolic acidosis will correct with insulin therapy. The use of bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies. It is thought that the administration of bicarbonate may actually result in peripheral hypoxemia, worsening of hypokalaemia, paradoxical central nervous system acidosis, cerebral oedema in children and young adults, and an increase in intracellular acidosis. Because severe acidosis is associated with worse clinical outcomes and can lead to impairment in sensorium and deterioration of myocardial contractility, bicarbonate therapy may be indicated if the pH is 6.9 or less.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 30
Incorrect
-
A 65-year-old man having small cell lung cancer is admitted onto the ward for chemotherapy. He has a history of severe nausea and vomiting secondary to chemotherapy, in the past.
The consultant asks you to prescribe a neurokinin 1 (NK1) receptor blocker. Which agent, out of the following, will you choose?Your Answer: Domperidone
Correct Answer: Aprepitant
Explanation:Aprepitant is an anti-emetic which blocks the neurokinin 1 (NK1) receptor and acts as a substance P antagonist. It is licensed for chemotherapy-induced nausea and vomiting (CINV) and for prevention of postoperative nausea and vomiting.
Nausea and vomiting are the common side effects of chemotherapy. Risk factors for the development of these symptoms include age<50 years, anxiety, concurrent use of opioids, and the type of chemotherapy administered.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 31
Correct
-
A 28-year-old male was admitted with palpitations and chest discomfort for the past 1 hour. On examination his pulse rate was 200 bpm and blood pressure was 80/50 mmHg. His ECG revealed narrow complex tachycardia with a heart rate of 200 bpm. Which of the following is the most appropriate management of this patient?
Your Answer: Synchronised DC synchronised cardioversion
Explanation:Narrow complex tachycardia with hypotension is a medical emergency. Immediate synchronized cardioversion is the ideal management.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 32
Correct
-
A 32-year-old previously well primigravida in her 16th week of pregnancy came to the antenatal clinic for a routine review. Her blood pressure was 152/90 mmHg. On her last clinic visit 4 weeks ago her blood pressure was 148/86 mmHg. She was put on ambulatory blood pressure monitoring and her mean blood pressure was 148/88 mmHg. Her urine examination was negative for protein. Which of the following is the most likely diagnosis?
Your Answer: Pre-existing hypertension
Explanation:Pre-eclampsia is excluded from negative proteinuria. White coat hypertension is excluded with ambulatory blood pressure monitoring. Pregnancy induced hypertension develops after 20 weeks of gestation. So the most likely answer is pre-existing hypertension. She should be investigated for a secondary cause for hypertension.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 33
Correct
-
A 61-year-old man presented with a TIA and loss of consciousness for 30 min. His CT brain scan is normal and his ECG shows atrial fibrillation. Which risk assessment score is best used in this case?
Your Answer: CHADS2
Explanation:CHADS2 score provides a comprehensive prediction of thromboembolic events in avalvular AF patients:
C Congestive heart failure – 1
H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) – 1
A Age >75 years – 1
D Diabetes mellitus – 1
S2 Prior Stroke or TIA or Thromboembolism – 2 -
This question is part of the following fields:
- Nervous System
-
-
Question 34
Correct
-
A 72-year-old woman presents with left side groin pain. She says she suddenly collapsed and was not able to lift her leg anymore. She is on calcium supplements and alendronate. What is the best diagnosis?
Your Answer: Fracture of neck of femur
Explanation:Fracture of the neck of femur is characterised by inability to lift the affected limb. This is relatively common in osteoporotic patients.
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 35
Correct
-
Regarding the pathophysiology of diabetes mellitus, which of the following is true?
Your Answer: Concordance between identical twins is higher in type 2 diabetes mellitus than type 1
Explanation:Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4. Although the genetic aspect of type 1 DM is complex, with multiple genes involved, there is a high sibling relative risk. Whereas dizygotic twins have a 5-6% concordance rate for type 1 DM, monozygotic twins will share this diagnosis more than 50% of the time by the age of 40 years.
-
This question is part of the following fields:
- Endocrine System & Metabolism
-
-
Question 36
Incorrect
-
A 61-year-old woman with a history of fluent dysphasia is brought by her husband because she's no longer able to understand instructions. Which is the most probable site of arterial occlusion?
Your Answer: Superior division of middle cerebral artery (dominant hemisphere)
Correct Answer: Inferior division of middle cerebral artery (dominant hemisphere)
Explanation:The condition described is called Wernicke’s aphasia and is the result of occlusion of the inferior division of the middle cerebral artery. This type of aphasia is classified as fluent aphasia in which understanding is impaired.
-
This question is part of the following fields:
- Nervous System
-
-
Question 37
Correct
-
Which one of the following is most suggestive of Wilson's disease?
Your Answer: Reduced serum caeruloplasmin
Explanation:In Wilson’s disease, serum caeruloplasmin is decreased. Skin pigmentation is not increased, but may become jaundiced. 24 hour urine copper excretion is increased. Hepatic copper concentration is increased. Serum copper level is also increased. Key point: high copper. Remember Kayser-Fleisher rings for the eyes in Wilson’s disease.
-
This question is part of the following fields:
- Gastrointestinal System
-
-
Question 38
Correct
-
A 32-year-old Indian male presents to the clinic with fever, cough and an enlarged cervical lymph node. Examination reveals a caseating granuloma in the lymph node. Which of the following is the most likely diagnosis?
Your Answer: TB adenitis
Explanation:Tuberculous lymphadenitis is a chronic, specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or a related bacteria. The characteristic morphological element is the tuberculous granuloma (caseating tubercle).
-
This question is part of the following fields:
- Infectious Diseases
-
-
Question 39
Correct
-
A 60-year-old man complains of weight loss, fatigue, fever and abdominal discomfort. Abdominal ultrasound reveals massive splenomegaly and the lab results return the following: WBC=127, Hgb=8.7, Plt=138. Basophils were also found on the peripheral blood film. What is the most likely diagnosis?
Your Answer: CML
Explanation:CML is a myeloproliferative disorder involving neoplastic proliferation of mature myeloid cells, especially granulocytes and their precursors. The non-acute symptoms of marked splenomegaly and anaemia accompanied by of fever and abdominal discomfort rules out the other conditions.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 40
Incorrect
-
A 34-year-old man was brought to the ER following a road-traffic-accident. An X-ray of his left thigh revealed a fractured shaft of the left femur. He has a known history of opioid abuse. You are called to the ward to assess him after he becomes unwell. Which of the following clinical features are NOT compatible with a diagnosis of opioid withdrawal?
Your Answer: Yawning
Correct Answer: Hypothermia
Explanation:Among the options provided, hypothermia is not a symptom of opioid withdrawal.
Symptoms of opioid withdrawal include dysphoric mood, yawning, insomnia, muscle aches, lacrimation/rhinorrhoea, papillary dilatation, piloerection, fever, sweating, nausea/vomiting, diarrhoea.
If the patient is having an opioid withdrawal reaction, then give 10 mg of methadone syrup and wait about 60 min to determine its effect.COWS (Clinical Opioid Withdrawal Scale) assessment for opioid withdrawal is commonly used to determine the severity of opioid withdrawal.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 41
Correct
-
A 35-year-old female patient presents with butterfly rash, haematuria and photosensitivity. She is currently on TB treatment. Which antibody would you expect positive?
Your Answer: Anti-Histone
Explanation:This patient is probably suffering from a drug-induced lupus. There’s a 95% chance that anti-histone antibodies are positive. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The drugs most commonly connected with drug-induced lupus are: hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms) and isoniazid (used to treat tuberculosis).
-
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 42
Correct
-
What are the most common types of transformation seen in patients with polycythaemia vera?
Your Answer: Myelofibrosis + acute myeloid leukaemia
Explanation:5-15% of the cases of polycythaemia vera progress to myelofibrosis or acute myeloid leukaemia (AML).
Polycythaemia vera (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.
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 AML. The risk of having AML is increased with chemotherapy treatment.
-
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 43
Incorrect
-
A 75-year-old man was brought to the clinic by his wife because lately he has lost interest in activities he previously enjoyed. His wife is worried and claims he's generally withdrawn. What would exclude depression in favour of dementia?
Your Answer: Poor short term memory
Correct Answer: Urinary incontinence
Explanation:Urinary incontinence is not a usual symptom of depression. A depressed patient is usually capable of maintaining control of his body sphincters. In dementia, however, urinary incontinence is an important and late symptom of the disease, non-related to any urinary tract pathology. It is rather related to the cognitive impairment caused by dementia.
-
This question is part of the following fields:
- Geriatric Medicine
-
-
Question 44
Incorrect
-
A 57-year-old diabetic, smoker complains of non-healing ulcers and cramp-like pain in the calves relieved by rest. Examination results are as follows: absent distal pulses, and cold extremities with hair loss around the ankles. What is the most probable diagnosis?
Your Answer: Buerger's disease
Correct Answer: Chronic ischemia of the limbs
Explanation:Chronic Limb Ischaemia presents with calf pain that is relieved by rest.
Intermittent claudication is not a diagnosis but a symptom and is not necessarily associated with diabetes.
Buerger’s disease occurs in younger heavy smokers (usually before age of 50).
DVT causes pain that is consistent, not intermittent as in claudication. -
This question is part of the following fields:
- Musculoskeletal System
-
-
Question 45
Correct
-
A 33-year-old lady presented with complaints of an erythematous rash over her shins, along with arthritis and painful swollen knees. What will be the single most likely finding on her chest X-ray?
Your Answer: Bilateral hilar lymphadenopathy
Explanation:Lofgren’s syndrome is characterised by a triad of erythema nodosum, arthritis and bilateral lymphadenopathy. It is a variant of sarcoidosis.
-
This question is part of the following fields:
- Respiratory System
-
-
Question 46
Incorrect
-
You are working as a junior doctor in a medical ward when the pharmacist approaches you and informs you that Mr. Henry is documented as allergic to penicillin but you have prescribed him amoxicillin. The patient has received 3 doses without any reaction. The pharmacist has assured you he will not tell anyone about this incident. Which of the following is the most appropriate step now?
Your Answer: Inform the medical director of the prescription error
Correct Answer: Inform the patient of your mistake
Explanation:The patient should be informed about the mistake. The antibiotic should also be changed and the incident should be documented. Thank the pharmacist for his courteous behaviour but do not encourage his attempt to cover up the matter.
-
This question is part of the following fields:
- Ethical & Legal
-
-
Question 47
Incorrect
-
A 28-year-old female presents with postnatal depression and refuses treatment. Which form of consent should be obtained in order to treat this patient?
Your Answer: Consent from court of law
Correct Answer: No consent required
Explanation:The patient is in an altered psychological state; thus, no verbal nor a written consent is required from her. Consent from the carer or the court of law can be obtained but this will require some time while a prompt action is needed in this case and the carer is also unable to make a decision on the behalf of the patient. Therefore, the doctor should act without consent.
-
This question is part of the following fields:
- Ethical & Legal
-
-
Question 48
Incorrect
-
A hypertensive man presents to the emergency in a state of restlessness and shock. He has a history of a pulsatile abdominal mass. Pulse is calculated to be 120/min and the BP: 70/40 mmHg. How should he be managed?
Your Answer: IV fluids 0.9% NS crystalloids to bring SBP to 120mmHg
Correct Answer: IV fluids 0.9% NS crystalloids to bring SBP to 90mmHg
Explanation:Pre-operative hemodynamic stability is directly associated with the patient’s mortality, and pre-operative shock is the most serious risk factor affecting survival after a ruptured abdominal aortic aneurysm (AAA). For this reason, it is important to stabilize the patient’s blood pressure. However, aggressive fluid resuscitation before achieving control of the proximal aorta can lead to further haemorrhaging, which may result in an increased risk of mortality. Thus, the primary goal in the initial management of patients with AAA is achieving hemodynamic stability to allow perfusion of the vital organs. This is the concept underlying permissive hypotension. This usually involves maintaining a systolic blood pressure of 70 to 90 mmHg, and avoiding aggressive resuscitation to pressures higher than 100 mmHg.
-
This question is part of the following fields:
- Emergency & Critical Care
-
-
Question 49
Correct
-
A 60-year-old previously well male patient was admitted with acute severe central chest pain associated with excessive sweating and nausea for the past 45 minutes. On examination he was found to have xanthelasma. His blood pressure was 170/100 mmHg and pulse rate was 104 bpm. His ECG showed ST elevation more than 2mm in leads II, III and aVF. His troponin T was 120 ng/ml. His FBC and renal functions were normal. He was given aspirin, clopidogrel, morphine and IV 5 mg of atenolol. Which of the following is the most appropriate next step?
Your Answer: Immediate referral to cardiologist for primary angioplasty
Explanation:The diagnosis is acute inferior ST elevation myocardial infarction so the most appropriate management is primary angioplasty.
-
This question is part of the following fields:
- Cardiovascular System
-
-
Question 50
Correct
-
In end stage renal disease, deficiency of erythropoietin can lead to which of the following conditions?
Your 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
-
SESSION STATS - PERFORMANCE PER SPECIALTY
