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Question 1
Incorrect
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A 60-year old male presented to the OPD with a complaint of a rusty-coloured sputum along with a cough for 3 days. His has a history of smoking for 40 years, and a history of significant weight loss. His chest X-ray revealed solid nodules in both lungs and bilateral hilar lymphadenopathy. Out of the following, which one is the most appropriate investigation?
Your Answer: CT
Correct Answer: LN biopsy
Explanation:The patient’s age, a history of long-term smoking, and bilateral hilar lymphadenopathy are strong indications of malignancy. Lymph node biopsy would be essential in order to check the degree of metastasis in the mediastinal lymph nodes.
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This question is part of the following fields:
- Respiratory System
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Question 2
Incorrect
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A patient with chronic renal failure, treated with regular haemodialysis, attends the renal clinic. He has been treated for six months with oral ferrous sulphate, 200 mg three times a day. His haemoglobin at this clinic attendance is 7.6. His previous result was 10.6 six months ago.
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Which of the following is the most appropriate treatment?Your Answer: Commence SC erythropoietin
Correct Answer: IV iron and subcutaneous erythropoietin
Explanation:The patient should be prescribed IV iron and subcutaneous erythropoietin to enhance erythropoiesis to address the dropped haemoglobin.
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This question is part of the following fields:
- Renal System
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Question 3
Correct
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A 23-year-old man is being investigated for excessive bleeding following a tooth extraction.
His coagulation profile shows:
Plts: 173 x 10^9/L
PT: 12.9 secs
APTT: 84 secs
Which clotting factor is he most likely deficient in?Your Answer: Factor VIII
Explanation:The patient is most likely a case of haemophilia A which is the genetic deficiency of clotting factor VIII in 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 more common than haemophilia B and accounts 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).
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This question is part of the following fields:
- Haematology & Oncology
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Question 4
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: Aspirin 300mg for 2 weeks followed by aspirin 75mg
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:
- Emergency & Critical Care
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Question 5
Correct
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A 52-year-old woman is being reviewed in the oncology clinic following debulking surgery one month ago. She is a known case of primary peritoneal cancer with two liver metastases and has now come in for review prior to adjuvant chemotherapy.
During her chemotherapy, which of the following tumour markers would be the most appropriate to monitor her disease progression?Your Answer: CA 125
Explanation:Tumour marker CA 125 is mostly associated with primary peritoneal cancer and ovarian cancer. It can be used to monitor response to chemotherapy, alongside regular CT scans.
Tumour markers can be divided into:
1. Monoclonal antibodies
CA 125: Ovarian cancer, primary peritoneal cancer
CA 19-9: Pancreatic cancer
CA 15-3: Breast cancer2. Tumour specific antigens
Prostate specific antigen (PSA): Prostatic carcinoma
Alpha-feto protein (AFP): Hepatocellular carcinoma, teratoma
Carcinoembryonic antigen (CEA): Colorectal cancer
S-100: Melanoma, schwannomas
Bombesin: Small cell lung carcinoma, gastric cancer3. Enzymes
Alkaline phosphatase (ALP)
Neuron specific enolase (NSE)4. Hormones
Calcitonin
Antidiuretic hormone (ADH)
Human chorionic gonadotropin (hCG) -
This question is part of the following fields:
- Haematology & Oncology
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Question 6
Correct
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In a patient with type-1 diabetes mellitus, which cells when affected, lead to insulin deficiency?
Your Answer: B cells of the pancreatic islets
Explanation:Insulin is produced by the beta-cells in the islets of Langerhans in the pancreas while Glucagon is secreted from the alpha cells of the pancreatic islets of Langerhans.
Type 1 diabetes mellitus is the culmination of lymphocytic infiltration and destruction of the beta cells of the islets of Langerhans in the pancreas. As beta-cell mass declines, insulin secretion decreases until the available insulin is no longer adequate to maintain normal blood glucose levels. After 80-90% of the beta cells are destroyed, hyperglycaemia develops and diabetes may be diagnosed. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 7
Correct
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A 25-year-old youth was brought to the A&E following a stab injury to the right back of the chest. On examination he was dyspnoeic, his trachea was deviated to the left side and there were engorged veins and absent breath sounds on the right side. Which of the following is the most probable diagnosis?
Your Answer: Tension pneumothorax
Explanation:History is suggestive of right sided tension pneumothorax. It can’t be a simple pneumothorax because of tracheal deviation and engorged veins.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 8
Correct
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Which of the following options is true of patients with oesophageal varices?
Your Answer: In spontaneous bacterial peritonitis cefotaxime appears to be a useful antibiotic
Explanation:Spironolactone has been shown to have no effect on the mechanisms of portal hypertension. Also, chronic use of propranolol can reduce the risk of variceal bleeding. The banding of large varices has been shown to be effective, too. Octreotide and terlipressin are also both used to prevent secondary haemorrhage. Cefotaxime is the most commonly used cephalosporin when treating spontaneous bacterial peritonitis. Spironolactone helps to combat secondary hyperaldosteronism which is related to liver failure. It also helps to treat salt and water retention, which both contribute to portal hypertension.
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This question is part of the following fields:
- Gastrointestinal System
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Question 9
Incorrect
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Regarding cranial nerves, which of the following statements is true?
Your Answer: The facial nerve supplies the parotid salivary gland
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
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Question 10
Correct
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Which of the following findings would point towards a diagnosis of neonatal hypothyroidism?
Your Answer: Mother has hyperthyroidism
Explanation:Transient congenital hypothyroidism can be due to: iodine deficiency or excess, maternal consumption of goitrogens or antithyroid medications during pregnancy, transplacental passage of TSH receptor-blocking antibodies, and neonatal very low birth weight and prematurity
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 11
Incorrect
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A 33-year-old artist who recently arrived in the UK from New York presents in ED. He has a past history of insulin-dependant diabetes mellitus. He describes a few days of fever, headache and myalgia. Admission was prompted by worsening headache and back pain. While waiting in the medical receiving unit, he becomes progressively drowsier. Examination revealed flaccid paralysis and depressed tendon reflexes. He was reviewed by the intensive care team and arrangements were made for ventilation. A computerised tomography (CT) brain is performed that is normal.
Cerebrospinal fluid examination reveals:
Protein 0.9 g/l (<0.45 g/l)
Glucose 4 mmol/l
White cell count (WCC) 28/mm3 (mostly lymphocytes)
Blood testing reveals:
Haemoglobin (Hb) 14 g/dl (13-18)
Platelets 620 x 109/l (150-400 x 109)
WCC 12 x 109/l (4-11 x 109)
Sodium 135 mmol/l (137-144)
Potassium 4.6 mmol/l (3.5-4.9)
Urea 8 mmol/l (2.5-7.5)
Creatinine 120 mmol/l (60-110)
Glucose 6 mmol/l
Which of the following is the most likely infective process?Your Answer: Lyme disease
Correct Answer: West Nile disease
Explanation: -
This question is part of the following fields:
- Nervous System
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Question 12
Incorrect
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A 35-year-old female presented with complaints of earache and a high-grade fever. During examination, numerous small vesicles were found within the ear canal and her ear is very tender. Which one of the following organisms is most likely to be responsible for such a condition?
Your Answer: Varicella zoster
Correct Answer: Herpes zoster
Explanation:Herpes zoster is a viral disorder in which painful vesicular lesions are present in a specific dermatome area. High-grade fever may present as well due to infection. Varicella zoster, measles, herpes simplex and HIV do not present with tender lesions of a limited area.
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Incorrect
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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: Indirect inguinal hernia
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.
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This question is part of the following fields:
- Men's Health
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Question 14
Correct
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A 40-year-old patient under treatment for gout gave a history of progressive weakness of his limbs over 2 months. He noticed that it was particularly difficult for him to get up from the toilet seat and to get out of his car. He also felt some tingling and numbness of his toes at night, which was distressing. He was taking several medications which included Ibuprofen, perindopril, colchicine, vitamin supplements, and indapamide.
On examination his pulse was 85/min, blood pressure was 140/90 mmHg and fundi revealed arteriovenous nipping. He had proximal lower limb weakness of 4/5 and absent ankle reflexes. Plantar reflexes were upgoing on both sides. His serum creatinine phosphokinase level was normal.
What is the most likely diagnosis?Your Answer: Colchicine toxicity
Explanation:The given clinical scenario is suggestive of myo-neuropathy and is most likely to be caused by colchicine toxicity.
It gives rise to subacute proximal muscle weakness and on occasions can lead to an acute necrotizing myopathy. Creatine phosphokinase may be normal or may be elevated.
Weakness resolves when the drug is discontinued but the neuropathic features remain.
Death is usually a result of respiratory depression and cardiovascular collapse.
Treatment is symptomatic and supportive, and the treatment for colchicine poisoning includes lavage and measures to prevent shock. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 15
Correct
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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.
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This question is part of the following fields:
- Gastrointestinal System
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Question 16
Incorrect
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A 25-year-old man having sickle cell anaemia presents with headache, lethargy, and pallor. His blood count shows: Haemoglobin: 4.6 g/dL Reticulocytes: 3% Infection with parvovirus is suspected. Out of the following, what is the most likely diagnosis?
Your Answer: Haemolytic crisis
Correct Answer: Aplastic crisis
Explanation:Aplastic crisis is characterized by a rapid fall in hemoglobin levels associated with few or no reticulocytes, indicating a failure of the bone marrow to respond to increased cell turnover. Folate deficiency can occur in the setting of chronic hemolytic anemia in some patients unless supplemental folate is taken. Parvovirus (B19) has been associated with bone marrow suppression and subsequent aplastic crisis; other viral infections or severe bacterial infections may also suppress the bone marrow. Treatment of aplastic crisis may be necessary when the hematocrit level becomes dangerously low. Packed red blood cells are given to support an adequate hematocrit until bone marrow suppression is resolved, folate is repleted, and the reticulocyte count improves.
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This question is part of the following fields:
- Haematology & Oncology
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Question 17
Correct
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Which of the following abnormal facial movements is not a well-recognised association?
Your Answer: Facial synkinesis - Wilson's disease
Explanation:Wilson’s disease may have an asymmetric tremor which is variable in character and may be predominantly resting, postural, or kinetic.
Progressive supra-nuclear palsy – blepharospasm, apraxia of lid opening and/or apraxia of lid closing.
Tourette’s syndrome – one or more motor or vocal tics.
Multiple Sclerosis – continuous facial myokymia.
Tardive dyskinesia is a side-effect of conventional antipsychotics, neuroleptics, anticholinergics, and toxins resulting in stiff, jerky movements of your face and body -
This question is part of the following fields:
- Nervous System
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Question 18
Correct
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Arrange the following opioid analgesics in order of increasing potency.
Your Answer: Codeine, morphine, oxycodone, diamorphine
Explanation:Opioid analgesics produce pain relief by attaching to the opioid receptors in the brain. Out of these, codeine is the least potent and diamorphine the most potent. Codeine is used to relieve mild to moderate pain. Morphine is a stronger analgesic used to treat pain like that experienced after surgery or injury. Oxycodone acts like the endorphins in the brain and reduces pain sensation. It is more potent than codeine and morphine and is used for relieving moderate to severe forms of pain. Among the listed, diamorphine is the most potent opioid analgesic. It is administered intravenously, subcutaneously, or intramuscularly to treat severe pain after surgery or in terminally-ill patients.
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This question is part of the following fields:
- Pharmacology
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Question 19
Correct
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A 60-year-old male has been taken to the doctor with dysphagia and pain when swallowing. A barium meal shows he has gross dilation of the oesophagus, with a smooth narrowing at the lower end. Choose the single most likely cause of his symptoms.
Your Answer: Achalasia
Explanation:Finding it difficult to swallow both food and drink with a narrow oesophagus is consistent with a diagnosis of achalasia.
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This question is part of the following fields:
- Gastrointestinal System
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Question 20
Correct
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A 30-year-old man presented with polydipsia and polyuria for the last two years.
Investigations reveal:
Serum urea 9.5 mmol/L (2.5-7.5)
Serum creatinine 108 mol/L (60-110)
Serum corrected calcium 2.9 mmol/L (2.2-2.6)
Serum phosphate 0.7 mmol/L (0.8-1.4)
Plasma parathyroid hormone 6.5 pmol/L (0.9-5.4)
Which of the following is directly responsible for the increase in intestinal calcium absorption?Your Answer: 1,25 Dihydroxy vitamin D
Explanation:This patient has hypercalcaemia due to hyperparathyroidism. However, the intestinal absorption of calcium is mainly controlled by 1,25 dihydroxy-vitamin D. Under the influence of calcitriol (active form of vitamin D), intestinal epithelial cells increase their synthesis of calbindin (calcium-binding carrier protein) necessary for active calcium ion absorption.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 21
Incorrect
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A 65-year-old woman was referred due to a pulse rate of 40 bpm. Which of the following answers is associated with the least risk of asystole?
Your Answer: Mobitz type II AV block
Correct Answer: Complete heart block with a narrow complex QRS
Explanation:From the given answers, complete heart block with a narrow complex QRS complex is associated with the least risk of asystole. Transvenous pacing is indicated by the other given responses.
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This question is part of the following fields:
- Cardiovascular System
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Question 22
Correct
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A 24-year-old male has been found unconscious by a stranger in an alleyway. His RR is 6 bpm and his HR is 60 bpm. His pupils are also constricted. From the list of options, what is the best treatment option?
Your Answer: Naloxone
Explanation:The respiratory depression and miosis in this patient indicate opiate poisoning. For this, the best treatment is naloxone.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 23
Incorrect
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A 70-year-old complains of lower urinary tract symptoms. Which one of the following statements regarding benign prostatic hyperplasia is incorrect?
Your Answer: Possible presentations include recurrent urinary tract infection
Correct Answer: Goserelin is licensed for refractory cases
Explanation:Goserelin (Zoladex) is usually prescribed to treat hormone-sensitive cancers of the breast and prostate not for BPH. All other statements are correct.
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This question is part of the following fields:
- Renal System
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Question 24
Correct
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A 14-year-old girl came to the emergency room in a bizarre state with altered consciousness, presenting with symptoms of insomnia, logorrhoea, and anxiety, with incoherent discourse and amnesia of recent events. She has started calling herself The Queen, and is refusing to be her parents' daughter. What is the most likely diagnosis?
Your Answer: Ganser syndrome
Explanation:Ganser syndrome is a condition in which a person acts as if he is suffering from a specific psychological disorder in order to gain sympathy and relief.
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This question is part of the following fields:
- Nervous System
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Question 25
Correct
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Which one of the following conditions is least likely to be associated with pyoderma gangrenosum?
Your Answer: Syphilis
Explanation:The following are conditions commonly associated with pyoderma gangrenosum:
Inflammatory bowel disease:
– Ulcerative colitis
– Crohn’s disease
Arthritides:
– Rheumatoid arthritis
– Seronegative arthritis
Haematological disease:
– Myelocytic leukaemia[8]
– Hairy cell leukaemia
– Myelofibrosis
– Myeloid metaplasia
– Monoclonal gammopathy
Autoinflammatory disease:
– Pyogenic sterile arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome)
– Granulomatosis with polyangiitis -
This question is part of the following fields:
- The Skin
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Question 26
Correct
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A 21-year-old patient presents with multiple itchy wheals on his skin. The wheals are of all sizes and they are exacerbated by scratching. The symptoms started after a viral infection and can last up to an hour. What is the most likely diagnosis?
Your Answer: Urticaria
Explanation:Urticaria is a group of disorders that share a distinct skin reaction pattern, namely the occurrence of itchy wheals anywhere on the skin. Wheals are short-lived elevated erythematous lesions ranging from a few millimetres to several centimetres in diameter and can become confluent. The itching can be prickling or burning and is usually worse in the evening or night time. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear.
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This question is part of the following fields:
- The Skin
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Question 27
Incorrect
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A 51 year-old teacher presents complaining of numerous falls. He states he has difficulty walking up stairs, and he thinks it is because of his weak legs rather than blackouts. He is hypertensive and has suffered chronic back pain for many years. He has smoked for many years as well and has a chronic smokers cough. Upon examination, he has weakness of hip flexion and particularly knee extension. He is unable to keep his fingers flexed against force, with the right being weaker than the left. There are no sensory abnormalities and reflexes are preserved bilaterally. Which of the following is the most likely diagnosis?
Your Answer: Polymyositis
Correct Answer: Inclusion body myositis
Explanation:The pattern of muscle involvement seen with quadriceps and long-finger flexors is characteristic of inclusion body myositis, an inflammatory myopathy. Polymyositis is likely to cause a predominantly proximal weakness, associated with muscle pain. The signs and symptoms are not consistent with upper cord compression, as there would likely be sensory signs, reflex changes, and possible urinary symptoms. Motor neuron disease cannot be ruled out, but there are no findings of upper motor neuron or bulbar features.
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This question is part of the following fields:
- Nervous System
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Question 28
Correct
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A 23-year-old woman presents with lethargy. Her bloods show: Hb: 10.4 g/dL Plts: 278 x 10^9/L WCC: 6.3 x 10^9/L MCV: 68 fL Blood film: Microcytic hypochromic RBCs, marked anisocytosis and basophilic stippling noted HbA2: 3.9% What is the most likely diagnosis?
Your Answer: Beta-thalassaemia trait
Explanation:Individuals with thalassemia major usually develop symptoms within the first two years of life. These infants may fail to thrive and often have difficulty feeding, tire easily and suffer from severe anemia.
The infants may also suffer from diarrhea, irritability, recurrent episodes of fever, and other intestinal problems. These children have trouble gaining weight and growing at the rate expected for their age. Other complications include enlarged spleen, heart and liver and misshapen bones.
In many cases, the symptoms are severe enough to warrant regular blood transfusion to replenish the blood with healthy red blood cells. However, these regular transfusions can lead to a build up of iron in the blood that can damage the heart, liver and endocrine system and chelation therapy may be needed to remove this iron from the body.
Individuals with beta thalassemia trait usually have evidence of microcytosis and increased levels of hemoglobin A2. Hemoglobin F is sometimes elevated as well. Individuals with alpha thalassemia trait usually have evidence of microcytosis and normal levels of hemoglobin A2 and F.
In thalassemia major, the hemoglobin (Hb) level is usually less than 7 g/dl; the mean corpuscolar volume (MCV) less than 70 fl and the mean corpuscolar Hb (MCH) is over 20 pg.
In thalassemia intermedia, the hemoglobin level is between 7 and 10 g/dl; the MCV between 50 and 80 fl and MCH between 16 and 24 pg.
Thalassemia minor is characterized by a reduced MCV and MCH and an increased haemoglobin A2 level.
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This question is part of the following fields:
- Haematology & Oncology
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Question 29
Incorrect
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A 74-year-old widow is undergoing haemodialysis for chronic renal failure. What is the most common problem that can arise in this case?
Your Answer: Vitamin D deficiency
Correct Answer: Protein-calorie malnutrition
Explanation:Protein-calorie malnutrition is observed in almost 50% of dialysis patients, contributing to increased morbidity and mortality. All the other complications listed can usually be prevented thanks to modern-day dialysis techniques.
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This question is part of the following fields:
- Renal System
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Question 30
Correct
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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: 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.
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This question is part of the following fields:
- Endocrine System & Metabolism
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SESSION STATS - PERFORMANCE PER SPECIALTY
