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Question 1
Incorrect
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A 10 year old boy presents with generalized swelling. This includes puffiness in the face and swollen ankles - these symptoms have been present for 4 days. The swelling began just a few days after he suffered from a mild cold with a runny nose. His only past medical history is that of eczema. His urine analysis showed the following: haematuria; proteinuria (10g/24h); creat60umol/l; and albumin of 15g/l. From the list of options, what is the single most likely diagnosis for this patient?
Your Answer: Wilson’s disease
Correct Answer: IgA nephropathy
Explanation:A 10 year old child, with a history of URTI and haematuria, presents a picture consistent with a diagnosis of IgA nephropathy. This condition can present with proteinuria and generalized swelling. However, an important differentiating point from rapidly progressive GN is the duration. IgA nephropathy is usually <10 days (commonly 4-5 day history of infection).
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This question is part of the following fields:
- Child Health
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Question 2
Incorrect
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A 55-year-old man was admitted to ED with acute dyspnoea. He was treated for an anterior myocardial infarction a few weeks back. On examination, he is dyspnoeic, peripheral oxygen saturation is 85% on air and he has bibasal crepitations. What is the most suitable investigation to be done at this stage to find the cause for his presentation?
Your Answer: D-dimer
Correct Answer: Echo
Explanation:This presentation is compatible with acute pulmonary oedema probably due to sudden papillary muscle rupture or VSD. Echo should be the answer to establish the underlying cause. It will also help to identify other complications associated with MI.
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This question is part of the following fields:
- Seriously Ill
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Question 3
Incorrect
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Fabry's disease is a rare genetic disorder that leads to excessive deposition of neutral glycosphingolipids in the vascular endothelium of several organs and in epithelial and smooth muscle cells. Which of the following is least likely to be associated with Fabry's disease?
Your Answer: Pain is the most debilitating symptom in childhood
Correct Answer:
Explanation:Fabry disease (Angiokeratoma corporis diffusum) is an X-linked lysosomal disorder which occurs due to deficiency or absence of alpha-galactosidase A (α-GAL A) activity as a result of a genetic mutation in the GLA gene. As Fabry’s disease follows X-linked genetics it manifestis predominantly in men. Ongoing burning, tingling pain and discomfort, known as acroparesthesia, mainly affecting the hands and feet is the most debilitating symptom in childhood.
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This question is part of the following fields:
- Musculoskeletal
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Question 4
Incorrect
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A man was admitted with galactorrhoea. History reveals that the patient has been having problems with getting and maintaining an erection. He also admits he's noticed a decrease in the quantity of his facial hair. What is the most likely diagnosis?
Your Answer: Hypoparathyroidism
Correct Answer: Hyper prolactinaemia
Explanation:Increased levels of prolactin in men can lead to erectile dysfunction, reduced facial and body hair and on rare occasion gynecomastia with galactorrhoea.
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This question is part of the following fields:
- Endocrine
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Question 5
Incorrect
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Which complication of chronic renal failure is most likely associated with the accumulation of aluminium?
Your Answer: Gout
Correct Answer: Dialysis dementia
Explanation:Dialysis dementia is a unique neurological syndrome associated with chronic dialysis. Aluminium toxicity is probably the major factor in the pathogenesis of the dementia, which is due to aluminium-containing compounds in the dialysis fluid. Patients with dialysis dementia present with progressive dementia, dysarthria and seizures.
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This question is part of the following fields:
- Renal
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Question 6
Correct
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An 18-month-old girl already speaks ten words but her father says she cannot form a sentence. What is the best management strategy?
Your Answer: Reassurance
Explanation:Not being able to form a sentence at the age of 18 months is quite normal. A combination of two words to form a sentence can be done by 2 yrs of age.
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This question is part of the following fields:
- Child Health
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Question 7
Incorrect
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A patient presents to the nephrologist with proteinuria ++. Which medication would most likely result in the prevention of progression of this disease?
Your Answer: Calcium channel blockers
Correct Answer: ACE inhibitors
Explanation:Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce intraglomerular pressure by inhibiting angiotensin II ̶ mediated efferent arteriolar vasoconstriction. These drugs also have a proteinuria-reducing effect that is independent of their antihypertensive effect.
In addition, ACE inhibitors have renoprotective properties, which may be partially due to the other hemodynamic and nonhemodynamic effects of these drugs. ACE inhibitors reduce the breakdown of bradykinin (an efferent arteriolar vasodilator); restore the size and charge selectivity to the glomerular cell wall; and reduce the production of cytokines, such as transforming growth factor–beta (TGF-beta), that promote glomerulosclerosis and fibrosis.
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This question is part of the following fields:
- Renal
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Question 8
Incorrect
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A 1-week-old baby presents with a large blue bruise-like mark on his back. His mother noticed the mark that same morning and she is concerned about its severity. What is the most probable diagnosis?
Your Answer: Accidental bruising
Correct Answer: Mongolian spot
Explanation:Mongolian spots, otherwise called congenital dermal melanocytosis, are pigmented birthmarks. They are usually located on the buttocks or back and although they’re usually present at birth, they may appear soon after. They are flat and have a blue-grey colour (bruise-like). They are benign and present no health risk.
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This question is part of the following fields:
- Child Health
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Question 9
Incorrect
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A 51 year old woman recently put on antihypertensives showed the following results on 2 occasions: Na+ = 132, K+ = 7.6, Urea = 11.3, and Creatinine = 112. Which of the following drugs is responsible for this result?
Your Answer: Atenolol
Correct Answer: Ramipril
Explanation:Ramipril is an ACE Inhibitor. Treatment with angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) has consistently been shown to reduce the risk of renal and cardiovascular morbidity and mortality in a range of patients. However, ACEI and ARB therapy increase serum potassium which increases the risk of hyperkalaemia.
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This question is part of the following fields:
- Pharmacology
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Question 10
Incorrect
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A 48-year-old woman presented to you with a breast mass. On examination, it is hard, irregular and ill defined. The surface of the breast is slightly bruised however, there is no discharge. The most probable diagnosis is?
Your Answer: Duct ectasia
Correct Answer: Fat necrosis
Explanation:Fat necrosis is often a result of a trauma or surgery. In fat necrosis the enzyme lipase releases fatty acids from triglycerides. The fatty acids combine with calcium to form soaps. These soaps appear as white chalky deposits which are firm lumps with no associated discharge. The given case has a bruise which indicates prior trauma.
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This question is part of the following fields:
- Breast
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Question 11
Incorrect
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Question 12
Incorrect
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A 26 year old male presents with a history of fever and pain in the right lower thigh for one month. On examination the lower one third of the thigh is red, hot and tender. Radiological examination reveals new bone formation. What is the most likely diagnosis?
Your Answer:
Correct Answer: Osteomyelitis
Explanation:Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children, while the feet, spine, and hips are most commonly involved in adults. Diagnosis of osteomyelitis is often based on radiologic results showing a lytic centre with a ring of sclerosis. Osteomyelitis, a bone infection, may leave the adjacent bone with exostosis formation. An exostosis, also known as bone spur, is the formation of new bone on the surface of a bone.[
Malignant bone tumours can be classified as primary (arising from abnormal bone or cartilage cells) or secondary (bone metastases of other tumours). The most common primary bone tumours are osteosarcomas, Ewing sarcomas, and chondrosarcomas. These tumours differ with regard to primary localization, radiographic characteristics, and the patient age at which they usually develop.
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This question is part of the following fields:
- Musculoskeletal
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Question 13
Incorrect
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What is the mode of spread of chickenpox?
Your Answer:
Correct Answer: Airborne
Explanation:Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).
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This question is part of the following fields:
- Infectious Diseases
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Question 14
Incorrect
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A 26-year-old patient without a known medical history presents to casualty unconscious. What should be done as soon as possible?
Your Answer:
Correct Answer: Blood Glucose
Explanation:Blood glucose should be evaluated immediately in order to investigate for diabetic coma triggered by hyperglycaemia or hypoglycaemia.
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This question is part of the following fields:
- Emergency
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Question 15
Incorrect
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A 20-year-old female was brought to the ED by her father because of noticeable drowsiness and a hoarse voice. She reported having left the heater turned on before sleeping the night before. Laryngoscopy revealed laryngeal oedema. Which of the following is the step you would take next?
Your Answer:
Correct Answer: Anaesthetics for help
Explanation:The anaesthesiologist should be called for help because this patient is suffering from laryngeal oedema and if not anaesthetised, the oedema might block the airway completely.
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This question is part of the following fields:
- ENT
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Question 16
Incorrect
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A 3-year-old girl was accompanied by her mother to the hospital due to a change in speech, which is now an indistinct nasal speech. She is always tired by day, has restless sleep and even snores at night. What is the best management strategy?
Your Answer:
Correct Answer: Refer to ENT surgeon
Explanation:Adenoid tissue sometimes swell as a result of fighting off the infection as germs are trapped in the adenoids. Adenoid enlargement is suspected.
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This question is part of the following fields:
- Child Health
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Question 17
Incorrect
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A 53 year old diabetic man presents to the emergency with pain in left loin and haematuria that was sudden in onset. Investigations revealed an 8mm stone in the left lower ureter. Supportive therapy was initiated with nifedipine and steroids. The patients returned to the emergency with vomiting and worsening pain and passage of two stones. Renal function tests are significant for an impending ARF. Which of the following steps would be employed in the management of this patient?
Your Answer:
Correct Answer:
Explanation:Nephrolithiasis encompasses the formation of all types of urinary calculi in the kidney, which may deposit along the entire urogenital tract from the renal pelvis to the urethra. Nephrolithiasis manifests as sudden onset colicky flank pain that may radiate to the groin, testes, or labia (renal/ureteric colic) and is usually associated with haematuria.
Risk factors include low fluid intake, high-sodium, high-purine, and low-potassium diets, which can raise the calcium, uric acid, and oxalate levels in the urine and thereby promote stone formation.
Diagnostics include noncontrast spiral CT of the abdomen and pelvis or ultrasound to detect the stone, as well as urinalysis to assess for concomitant urinary tract infection and serum BUN/creatinine to evaluate kidney function. Urinary stones are most commonly composed of calcium oxalate. Less common stones are made up of uric acid, struvite (due to infection with urease-producing bacteria), calcium phosphate, or cystine.
Small uncomplicated stones without concurrent infection or severe dilation of the urinary tract may be managed conservatively with hydration and analgesics to promote spontaneous stone passage. When the spontaneous passage appears unlikely or fails due to the stone’s size or location, first-line urological interventions include shock wave lithotripsy, ureterorenoscopy, and, in case of large kidney stones, percutaneous nephrolithotomy. The most important preventive measure is adequate hydration.
Collected stones should be sent for chemical analysis because in many cases specific lifestyle guidance, diet changes, and/or initiation of medical treatment (e.g., thiazide diuretics, urine alkalinisation) can prevent future stone formation. -
This question is part of the following fields:
- Renal
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Question 18
Incorrect
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A 70-year old man presents with difficulty speaking and has a history of weakness in his facial muscles, as well as in his right arm and leg. What is the most appropriate prophylactic regimen in this case?
Your Answer:
Correct Answer: Aspirin 300mg for 2 weeks followed by aspirin 75mg and dipyridamole 200mg
Explanation:Left-sided hemiparesis along with slurred speech are strong indications of stroke in the right cerebral hemisphere. This occurs due to poor blood flow to the brain from the heart. Aspirin 300mg has analgesic, antipyretic, and anti-inflammatory properties that can address the acute symptoms of stroke like migraine and neuralgic pain. With a reduced dose of 75mg of Aspirin, its anti-platelet effect can inhibit further thrombus formation and prevent another stroke. Dipyridamole 200mg is an anti-coagulant preventing clot formation in the blood.
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This question is part of the following fields:
- Pharmacology
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Question 19
Incorrect
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A 70-year-old woman had a major surgery for removal of cancer of the ovary and lymph node dissection 6 days ago. She had not passed any flatus or stool since then. She recently developed recurrent vomiting and severe abdominal distention. What is the next step of management?
Your Answer:
Correct Answer: NG tube suction and IV fluids
Explanation:This patient developed paralytic ileus. It should be treated conservatively using IV fluids and NG tube.
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This question is part of the following fields:
- Seriously Ill
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Question 20
Incorrect
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A 24 year old man presents to the clinic complaining of lower limb joint pain and lower backache for the past 2 weeks. He remembers getting a mild gastrointestinal infection while in Spain 6 weeks ago that settled spontaneously. There has been eye irritation that has now settled. Past surgical history includes an appendectomy 3 years back. Vital examination shows a temperature of 37.5 C. Lab results reveal a normal WBC and raised ESR. Which of the following is true?
Your Answer:
Correct Answer: Rheumatoid factor is likely to be negative
Explanation:Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously. extraarticular dermatologic manifestations include skin lesions of the glans resembling psoriasis (balanitis circinata); hyperkeratinisation of the palms and soles (keratoderma blenorrhagicum), oral ulcers. There usually is no rash and the diagnosis is unrelated to the presence of rheumatoid factor. This is a clinical diagnosis.
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This question is part of the following fields:
- Rheumatology
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Question 21
Incorrect
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A 30-year-old epileptic female was admitted with visual field defects. She began a new anticonvulsant three months ago. Depending on her clinical presentation what is the most probable drug she was started on?
Your Answer:
Correct Answer: Vigabatrin
Explanation:Vigabatrin causes visual field constriction in around 30% of users. Most cases are asymptomatic because vigabatrin affects the peripheral visual fields but does not impair central visual acuity.30-50% of patients with long term exposure to vigabatrin have developed irreversible concentric visual field loss of varying severity.
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This question is part of the following fields:
- Pharmacology
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Question 22
Incorrect
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A 55 year old lady who a known case of normal pressure hydrocephalus (NPH) presented with complaints of weakness in her lower limbs, urinary incontinence and progressively worsening confusion. Which of the following statements is true regarding NPH?
Your Answer:
Correct Answer: Is associated with gait disturbance
Explanation:Normal pressure hydrocephalus is a form of communicating hydrocephalus characterised by enlarged ventricles with normal opening pressure on lumbar puncture. For diagnostic purposes, a triad of urinary incontinence, gait abnormality and dementia is necessary. It is necessary to diagnose the condition early because it is reversible by placing a ventriculoperitoneal shunt. It is most common in patients aged more than 60 years.
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This question is part of the following fields:
- Infectious Diseases
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Question 23
Incorrect
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A 2 year old child was brought to casualty with recurrent episodes of eczematoid rash over the cheeks and flexural regions of his body. Which one of the following statement best suit this condition?
Your Answer:
Correct Answer:
Explanation:Atopic dermatitis is an allergic condition which is more apparent in those children who have a positive family history in their 1st or 2nd degree relatives. In some cases, there might be a positive history of bronchial asthma. The best treatment option in this case would be topical application of 1% hydrocortisone ointment to the affected areas of the child. We cannot prescribe a strong ointment to the face because it may lead to skin atrophy, telangiectasia and other steroid related topical complications.
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This question is part of the following fields:
- Dermatology
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Question 24
Incorrect
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A newly married female presented with fever, dysuria, frequency and lower abdominal pain for 2 days duration. On examination, she was febrile with lower abdominal tenderness. Urine microscopy reveals 20-30 pus cells/hpf and 10-20 red cells/hpf. Which of the following would be the most probable cause for this presentation?
Your Answer:
Correct Answer: Cystitis
Explanation:The patient has what is known as ‘honeymoon cystitis’.
Most common presentation of schistosomiasis is haematuria.
Patients with kidney trauma also present with haematuria following a positive history for such injury.
Pain due to calculi are colicky in nature and severe. -
This question is part of the following fields:
- Genitourinary
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Question 25
Incorrect
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A 50-year-old female presents with a complaint of bloating and abdominal distension. History reveals she underwent hysterectomy 3 months ago. Which investigation should be carried out in this case?
Your Answer:
Correct Answer: Plain X-ray abdomen
Explanation:A complication of bilateral salpingo-oophorectomy and hysterectomy is the formation of adhesions in the GIT that can cause intestinal obstruction. Abdominal X-ray is sufficient to visualize any obstruction in the GIT.
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This question is part of the following fields:
- Gynaecology
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Question 26
Incorrect
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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:
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.
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This question is part of the following fields:
- Rheumatology
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Question 27
Incorrect
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A 68 year old male presented with unbalances and vomiting for 1 week. Which of the following is the best investigations that can be performed to arrive at a diagnosis?
Your Answer:
Correct Answer: MRI of Cerebellum
Explanation:Lesions in cerebellum and pontine region should be excluded. So the most appropriate investigation is MRI of cerebellum.
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This question is part of the following fields:
- Neurology
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Question 28
Incorrect
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A 23 year old man presents with a painful right elbow and left Achilles tendon. He also gives history of dysuria, fever and conjunctivitis. Examination reveals macules and pustules on his hands. He has returned from a trip to Far East 3 weeks ago and admits to having unprotected sex. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Reactive arthritis
Explanation:Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously. extraarticular dermatologic manifestations include skin lesions of the glans resembling psoriasis (balanitis circinata); hyperkeratinisation of the palms and soles (keratoderma blenorrhagicum), oral ulcers. Other STDs including HIV, syphilis have different presentations. Psoriatic arthritis is not commonly associated with urethritis and conjunctivitis.
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This question is part of the following fields:
- Rheumatology
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Question 29
Incorrect
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A 50-year-old man presented with a rash over his forearms, shins and face when he visited the clinic in the summer. Which of the following medications is the most likely to be associated with this photosensitive rash?
Your Answer:
Correct Answer:
Explanation:Photosensitivity is a common adverse effect of cardiology drugs including amiodarone and thiazide diuretics. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (A2RBs) commonly also cause rashes only some of which appear to be photosensitive.
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This question is part of the following fields:
- Pharmacology
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Question 30
Incorrect
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A 23 year old lady presented 3 weeks after giving birth, with complaints of insomnia, depression and thoughts of harming her new born baby. The next management step would be?
Your Answer:
Correct Answer: Electroconvulsive therapy (ECT)
Explanation:Electroconvulsive therapy (ECT) is the most suitable treatment option for mothers suffering from post partum psychosis. Post partum psychosis is characterised by depression, insomnia and thoughts of harming the child.
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This question is part of the following fields:
- Mental Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
