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Question 1
Correct
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Which of the following statements regarding the clinical effects of long-term oxygen therapy (LTOT) is the most accurate?
Your Answer: Reduced sympathetic outflow
Explanation:Studies have shown that benefits of Long-tern oxygen therapy (LTOT) include improved exercise tolerance, with improved walking distance, and ability to perform daily activities, reduction of secondary polycythaemia, improved sleep quality and reduced sympathetic outflow, with increased sodium and water excretion, leading to improvement in renal function.
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This question is part of the following fields:
- Respiratory System
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Question 2
Correct
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You are asked to fill the first part of a cremation form. Which of the following would need to be removed prior to cremation?
Your Answer: Pacemaker
Explanation:Pacemakers have small electrical parts installed in them that can explode when exposed to extreme heat and pressure.
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This question is part of the following fields:
- Ethical & Legal
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Question 3
Incorrect
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Which of the following is MOST suggestive of a lesion of the sciatic nerve?
Your Answer: Intervertebral disc prolapse at L2/L3 levels
Correct Answer: Foot drop
Explanation:The sciatic neve originates in the sacral plexus, mainly from spinal segments L5-S2. It supplies muscles that cause extension of the thigh and flexion of the leg. It divides into two main branches, the tibial nerve and common peroneal nerve, which are responsible for all foot movements. Anterior thigh and medial leg sensory loss is typical of a femoral nerve lesion. The femoral nerve also mediates flexion of the hip.
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This question is part of the following fields:
- Nervous System
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Question 4
Incorrect
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A 33-year-old male was brought in with complaints of an unsteady gait. According to the patient, he suffered a severe headache in the morning, with associated vomiting. Slowly his condition deteriorated until he was unable to walk. On exam, he had nystagmus and there was past pointing of the right arm. He speech was slurred, his uvula was deviated towards the right and there was decreased pinprick sensation on the right half of the body. The most likely site of the lesion in this patient would be?
Your Answer: Left medial pons
Correct Answer: Left lateral medulla
Explanation:Loss of sensations in left (ipsilateral) side of the face and contralateral (right) side of the body indicates a defect in left lateral medulla. Further cerebellar signs lead to the diagnosis of Lateral Medullary Syndrome.
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This question is part of the following fields:
- Nervous System
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Question 5
Incorrect
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A 24-year-old male with a history of a cardiac murmur which was not properly followed up, presented with right sided hemiparesis. His blood pressure was 120/70 mmHg. His ECG revealed right bundle branch block with right axis deviation. Which of the following is the most likely cause for this presentation?
Your Answer: Tetralogy of Fallot
Correct Answer: Ostium secundum atrial septal defect
Explanation:Ostium secundum atrial septal defects are known to cause stroke due to the passage of emboli from the right sided circulation to the left sided circulation. ECG shows tall, peaked P waves (usually best seen in leads II and V2) and prolongation of the PR interval, rSR pattern in leads V3 R and V1 as well as right axis deviation.
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This question is part of the following fields:
- Cardiovascular System
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Question 6
Correct
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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: 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.
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This question is part of the following fields:
- Renal System
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Question 7
Correct
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A 70-year-old thyroid cancer patient is admitted due to dyspnoea. Which investigation should be done to assess for possible compression of the upper airways?
Your Answer: Flow volume loop
Explanation:Flow-volume loop is an easy, non-invasive diagnostic tool that can be used even in severely-ill patients. It can provide information about the location of the obstruction and can differentiate between obstructive pulmonary disease and upper-airway obstruction. Therefore, it is recommended to obtain a flow-volume loop during the assessment of patients with upper airway obstruction.
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This question is part of the following fields:
- Respiratory System
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Question 8
Correct
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A 30-year-old male is brought to the emergency department following his collapse in a nightclub. His friends who accompanied him admit that, of recent, he has been using increasing amounts of cocaine. Which among the following is commonly associated with cocaine overdose?
Your Answer: Metabolic acidosis
Explanation:Metabolic acidosis is associated with cocaine overdose.
In overdose, cocaine leads to agitation, tachycardia, hypertension, sweating, hallucinations, and finally convulsions.
Metabolic acidosis, hyperthermia, rhabdomyolysis, and ventricular arrhythmias also occur.
Chronic use may be associated with premature coronary artery disease, dilated cardiomyopathy, and increased risk of cerebral haemorrhage.
There are 3 stages for acute cocaine toxicity:
Stage I: CNS symptoms of headache, vertigo, pseudo hallucinations, hyperthermia, hypertension.
Stage II: increased deep tendon reflexes, tachypnoea, irregular breathing, hypertension.
Stage III: Areflexia, coma, fixed and dilated pupils, hypotension, ventricular fibrillation, apnoea, and respiratory failure.Treatment:
– Airway, breathing, and circulation to be secured. The patient’s fever should be managed, and one should rule out hypoglycaemia as a cause of the neuropsychiatric symptoms.
– Cardiovascular toxicity and agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic outflow.
– The mixed beta/alpha blocker labetalol is safe and effective for treating concomitant cocaine-induced hypertension and tachycardia.
– Non-dihydropyridine calcium channels blockers such as diltiazem and verapamil have been shown to reduce hypertension reliably, but not tachycardia.
– Dihydropyridine agents such as nifedipine should be avoided, as reflex tachycardia may occur.
– The alpha-blocker phentolamine has been recommended but only treats alpha-mediated hypertension and not tachycardia. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 9
Correct
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A 28-year-old male complained of the following: nausea, vertigo, vomiting for longer than 30 minutes, tinnitus, and hearing loss in his left ear. Which of the following treatment options is most appropriate for this patient?
Your Answer: Cyclazine (1st line)
Explanation:Cyclizine and prochlorperazine are both used for the treatment of Meniere’s disease.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 10
Incorrect
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A 56-year-old man injected his usual insulin dose and went to the washroom to wash his hands before going to dinner. His wife found him unconscious in the washroom a few minutes later. Which of the following investigations needs to be done?
Your Answer: 24 hour ECG recording
Correct Answer: Random capillary glucose
Explanation:The state of this patient is most likely a diabetic coma caused by hypoglycaemic shock. A random capillary glucose check can confirm the glucose level and whether prompt IM glucagon should be given.
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This question is part of the following fields:
- Cardiovascular System
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Question 11
Incorrect
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An 8-year-old boy is admitted to the ward with renal colic. Family history is significant for similar renal calculi in his mother. Which of the following is the most likely explanation for this recurrent colic in both mother and child?
Your Answer:
Correct Answer: Idiopathic hypercalciuria
Explanation:Idiopathic hypercalciuria (IH) is the commonest metabolic abnormality in patients with calcium kidney stones. It is characterized by normocalcemia, absence of diseases that cause increased urine calcium, and calcium excretion that is above 250 mg/day in women and 300 mg/day in men. Subjects with IH have a generalized increase in calcium turnover, which includes increased gut calcium absorption, decreased renal calcium reabsorption, and a tendency to lose calcium from bone. Despite the increase in intestinal calcium absorption, negative calcium balance is commonly seen in balance studies, especially on a low calcium diet. The mediator of decreased renal calcium reabsorption is not clear; it is not associated with either an increase in filtered load of calcium or altered PTH levels. There is an increased incidence of hypercalciuria in first-degree relatives of those with IH, but IH appears to be a complex polygenic trait with a large contribution from diet to expression of increased calcium excretion. Increased tissue vitamin D response may be responsible for the manifestations of IH in at least some patients.
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This question is part of the following fields:
- Renal System
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Question 12
Incorrect
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A 6-year-old boy arrives at the clinic seven hours after having injured his hand with a metal spike. Examination reveals a puncture wound 0.5 cm deep. His immunization schedule is uptodate. How will you manage this patient?
Your Answer:
Correct Answer: Tetanus Ig + antibiotics
Explanation: -
This question is part of the following fields:
- Immune System
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Question 13
Incorrect
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A 40-year-old male presented with sudden onset chest pain and difficulty in breathing for the past 2 hours. On examination he had bilateral ankle swelling. Investigations revealed proteinuria of 6g/d. Which of the following is the most likely explanation for this presentation?
Your Answer:
Correct Answer: Reduced antithrombin III activity
Explanation:This patient has presented with a thromboembolic event most probably secondary to nephrotic syndrome (nephrotic-range proteinuria). Hypercoagulability is due to urinary loss of anticoagulant proteins, such as antithrombin III and plasminogen and an increase in clotting factors, especially factors I, VII, VIII, and X.
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This question is part of the following fields:
- Renal System
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Question 14
Incorrect
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A 50-year-old male with a history of type II diabetes mellitus and hypertension presented with exertional dyspnoea and chest pain for 2 weeks. On examination his blood pressure was 145/80 mmHg. On auscultation reversed splitting of the second heart sound and bibasal crepitations were detected. What would be the most likely finding on his ECG?
Your Answer:
Correct Answer: Left bundle branch block
Explanation:When closure of the pulmonary valve occurs before the aortic valve, reversed splitting occurs. The causes of reversed splitting are aortic stenosis, hypertrophic cardiomyopathy, left bundle branch block (LBBB), and a ventricular pacemaker.
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This question is part of the following fields:
- Cardiovascular System
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Question 15
Incorrect
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A 65-year-old woman with type 2 diabetes mellitus is feeling more fatigued than usual. She has not attended the previous three annual check-ups and her blood glucose control has been poor. She has not been compliant with his medications. Blood pressure is 170/90 mmHg. Urinalysis shows microalbuminuria. A blood test reveals her glomerular filtration rate (GFR) is 26 mL/min.
If a renal biopsy was to be performed in this patient, what would be the expected findings?Your Answer:
Correct Answer: Nodular glomerulosclerosis and hyaline arteriosclerosis
Explanation:This patient has a poorly controlled T2DM with an underlying diabetic nephropathy. The histological findings are Kimmelstiel-Wilson lesions (nodular glomerulosclerosis) and hyaline arteriosclerosis. This is due to nonenzymatic glycosylation.
Diabetic nephropathy is the chronic loss of kidney function occurring in those with diabetes mellitus. Protein loss in the urine due to damage to the glomeruli may become massive, and cause a low serum albumin with resulting generalized body swelling (edema) and result in the nephrotic syndrome. Likewise, the estimated glomerular filtration rate (eGFR) may progressively fall from a normal of over 90 ml/min/1.73m2 to less than 15, at which point the patient is said to have end-stage kidney disease (ESKD). It usually is slowly progressive over years.
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This question is part of the following fields:
- Renal System
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Question 16
Incorrect
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A 74-year-old woman is admitted with headaches, polyuria and polydipsia of recent onset. She has a history of mastectomy for breast cancer. A CT head scan shows multiple cerebral metastases.
Her admission biochemistry results are as follows:
Sodium 153 mmol/l
Potassium 4.0 mmol/l
Urea 5.0 mmol/l
Creatinine 110 micromol/l
Glucose 5 mmol/l.
Over the next 24 hours, she has a urinary volume of 4.4 litres and further tests reveal plasma osmolality 320 mOsm/kg and urinary osmolality: 254 mOsm/kg.
Which one of the following treatments should be used?Your Answer:
Correct Answer: Desmopressin (DDAVP)
Explanation:Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms:
– Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP])
– Nephrogenic DI, characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney
This patient has the central type from metastases.
In patients with central DI, desmopressin is the drug of choice. It is a synthetic analogue of antidiuretic hormone (ADH). It is available in subcutaneous, IV, intranasal, and oral preparations. Generally, it can be administered 2-3 times per day. Patients may require hospitalization to establish fluid needs. Frequent electrolyte monitoring is recommended during the initial phase of treatment. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 17
Incorrect
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A 16-year-old boy is being treated with ADH for diabetes insipidus. His blood results show:
fasting plasma glucose level: 6 mmol/l (3- 6)
sodium 148 mmol/l (137-144)
potassium 4.5 mmol/l (3.5-4.9)
calcium 2.8 mmol/l (2.2-2.6).
However, he still complains of polyuria, polydipsia and nocturia.
What could be the most probable cause?Your Answer:
Correct Answer: Nephrogenic diabetes insipidus
Explanation:Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms:
Central (neurogenic, pituitary, or neurohypophyseal) DI, characterized by decreased secretion of antidiuretic hormone (ADH; also referred to as arginine vasopressin [AVP])
Nephrogenic DI, characterized by decreased ability to concentrate urine because of resistance to ADH action in the kidney.
The boy most probably has nephrogenic diabetes insidious (DI) not central DI so he is not responding to the ADH treatment. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 18
Incorrect
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A 50-year-old farmer, under treatment for depression, presents to the emergency department following an intentional overdose of an unidentified substance. On examination, he was found to be bradycardic, hypotensive, hyper-salivating, and disoriented. On ocular examination, his pupils were found to be miotic. What is the most likely substance he ingested?
Your Answer:
Correct Answer: An organophosphate insecticide
Explanation: -
This question is part of the following fields:
- Emergency & Critical Care
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Question 19
Incorrect
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A 28-year-old man is investigated for lethargy. His full blood count (FBC) report shows:
Hb: 8.6 g/dL
Plts: 42 x 10^9/L
WCC: 36.4 x 10^9/L
His blood film report reveals 30% myeloblasts with Auer rods. Given the likely diagnosis, which one of the following is associated with a good prognosis?Your Answer:
Correct Answer: Translocation between chromosome 15 and 17
Explanation:A translocation between chromosome 15 and 17 is seen in acute promyelocytic leukaemia (APL), which is known to carry a good prognosis.
Acute myeloid leukaemia (AML) is the acute expansion of the myeloid stem line, which may occur as a primary disease or follow the secondary transformation of a myeloproliferative disorder. It is more common over the age of 45 and is characterized by signs and symptoms largely related to bone marrow failure such as anaemia (pallor, lethargy), frequent infections due to neutropenia (although the total leucocyte count may be very high), thrombocytopaenia (bleeding), ostealgia, and splenomegaly. The disease has poor prognosis if:
The disease has poor prognosis if:
1. Age of the patient >60 years
2. >20% blasts seen after the first course of chemotherapy
3. Chromosomal aberration with deletion of part of chromosome 5 or 7.APL is an aggressive form of AML. It is associated with t(15;17) and has a good prognosis. The general age of presentation is less than that in other types of AML (average age is 25 years old). On blood film, abundant Auer rods are seen with myeloperoxidase staining. Thrombocytopaenia or DIC is seen in patients presenting with this disease.
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This question is part of the following fields:
- Haematology & Oncology
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Question 20
Incorrect
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A 26-year-old graduate student with a history of migraines presents for examination. His headaches are now occurring about once a week. He describes unilateral, throbbing headaches that may last over 24 hours. Neurological examination is unremarkable. Other than a history of asthma, he is fit and well. What is the most suitable therapy to reduce the frequency of migraine attacks?
Your Answer:
Correct Answer: Topiramate
Explanation:It should be noted that as a general rule 5-HT receptor agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used in prophylaxis. NICE produced guidelines in 2012 on the management of headache, including migraines. Prophylaxis should be given if patients are experiencing 2 or more attacks per month. Modern treatment is effective in about 60% of patients. NICE advises either topiramate or propranolol ‘according to the person’s preference, comorbidities and risk of adverse events’. Propranolol should be used in preference to topiramate in women of child bearing age as it may be teratogenic and it can reduce the effectiveness of hormonal contraceptives.
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This question is part of the following fields:
- Nervous System
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Question 21
Incorrect
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There is a measure of dispersion of a set of data from its mean. Which of following is the best term which can describe the above?
Your Answer:
Correct Answer: Standard deviation (root mean square deviation)
Explanation:Standard deviation is defined as the measure of dispersion of a set of data from its mean. It measures the absolute variability of a distribution; the higher the dispersion or variability, the greater is the standard deviation and greater will be the magnitude of the deviation of the value from their mean.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 22
Incorrect
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Which of the following is a good prognostic factor in chronic lymphocytic leukaemia?
Your Answer:
Correct Answer: Female sex
Explanation:Good prognosis of chronic lymphocytic leukaemia (CLL) is associated with deletion of the long arm of chromosome 13 (del 13q). This is the most common abnormality, seen in around 50% of all CLL patients. Poor prognosis of the disease is related to deletion of part of the short arm of chromosome 17 (del 17p). This is seen in around 5-10% of the patients suffering from CLL.
Poor prognostic factors of CLL include:
1. Male sex
2. Age >70 years
3. Lymphocyte count >50
4. Prolymphocytes comprising more than 10% of blood lymphocytes
5. Lymphocyte doubling time <12 months
6. Raised LDH
7. CD38 expression positive -
This question is part of the following fields:
- Haematology & Oncology
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Question 23
Incorrect
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A 32-year-old female patient has the following signs and symptoms: smooth goitre, lid lag and bilateral exophthalmos with puffy eyelids and conjunctival injections. She has a history of thyrotoxicosis but wants to fall pregnant. What would be the most appropriate treatment for her?
Your Answer:
Correct Answer: 18m of Propylthiouracil (PTU) alone
Explanation:Propylthiouracil (PTU) is a safe choice for a woman that is planning a pregnancy because it does not have the teratogenic effects as carbimazole does. Methimazole (MMI) and propylthiouracil (PTU) are the standard anti-thyroid drugs used in the treatment of hyperthyroidism in pregnancy. Carbimazole can cause spina bifida, CV malformations as well as hypospadia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 24
Incorrect
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A 24-year-old woman who is known to have type 1 diabetes mellitus, presents with a three month history of diarrhoea, fatigue and weight loss. She has tried excluding gluten from her diet for the past 4 weeks and feels much better. She requests to be tested so that a diagnosis of coeliac disease can be confirmed. What is the most appropriate next step?
Your Answer:
Correct Answer: Ask her to reintroduce gluten for the next 6 weeks before further testing
Explanation:The patient likely has celiac’s disease, but if she has been avoiding gluten, a biopsy may be negative. Even though a biopsy is the gold standard for diagnosis, she will need to re-introduce gluten into her diet prior to undergoing the biopsy.
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This question is part of the following fields:
- Gastrointestinal System
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Question 25
Incorrect
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Which of the following is the drug of choice for the treatment of Chlamydia trachomatis infection during pregnancy?
Your Answer:
Correct Answer: Amoxicillin
Explanation:Tetracycline is not recommended in pregnancy because of the risk to fetal development (bones, teeth!). Metronidazole in pregnancy: currently not thought to be an increased risk in pregnancy; however this is not effective against chlamydia. Amoxicillin is shown to be an adequate treatment for chlamydia, so this is the correct answer.
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This question is part of the following fields:
- Infectious Diseases
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Question 26
Incorrect
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A woman complains of diarrhoea, experiencing watery stools 10 daily. She also complains of abdominal bloating, cramps, flatulence, and recent weight loss. She has now developed signs of iron deficiency anaemia. What is the most likely cause of her condition?
Your Answer:
Correct Answer: Malabsorption
Explanation:Diarrhoea, iron deficiency anaemia and folic acid deficiency are suggestive of malabsorption. Malabsorption leads to a decrease in the solid content of the stools resulting in diarrhoea. Decrease in the absorption of folic acid causes folic acid deficiency, and iron deficiency in the body leads to iron deficiency anaemia.
Jejunal villous atrophy is characterized with pain and weight loss as well, which this patient does not have.
A patient with increased catabolism has sudden weight loss along with deficiencies of nutrients. -
This question is part of the following fields:
- Gastrointestinal System
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Question 27
Incorrect
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A study is developed to compare two chemotherapy schemas for individuals with small cell lung cancer. Which of the following would you choose to compare survival time with in this particular study?
Your Answer:
Correct Answer: Hazard ratio
Explanation:The hazard ratio describes the relative risk of the complication based on comparison of event rates.
Hazard ratios have also been used to describe the outcome of therapeutic trials where the question is to what extent treatment can shorten the duration of the illness. However, the hazard ratio, a type of relative risk, does not always accurately portray the degree of abbreviation of the illness that occurred. In these circumstances, time-based parameters available from the time-to-event curve, such as the ratio of the median times of the placebo and drug groups, should be used to describe the magnitude of the benefit to the patient. The difference between hazard-based and time-based measures is analogous to the odds of winning a race and the margin of victory. The hazard ratio is the odds of a patient’s healing faster under treatment but does not convey any information about how much faster this event may occur.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 28
Incorrect
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Which of the following indicates the opening of tricuspid valve in jugular venous waveform?
Your Answer:
Correct Answer: y descent
Explanation:The a wave indicates atrial contraction. The c wave indicates ventricular contraction and the resulting bulging of tricuspid valve into the right atrium during isovolumetric systole. The v wave indicates venous filling. The x descent indicates the atrium relaxation and the movement of the tricuspid valve downward. The y descent indicates the filling of the ventricle after tricuspid opening.
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This question is part of the following fields:
- Cardiovascular System
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Question 29
Incorrect
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A 35-year-old previously well male gives a history of on-and-off retrosternal heaviness during exertion, relieved by resting. Pain lasts about 20-25 minutes. What is the clinical diagnosis of this presentation?
Your Answer:
Correct Answer: Stable angina
Explanation:The history is suggestive of stable angina because of it’s duration, aggravating and relieving factors. Patients get retrosternal pain or discomfort which sometimes radiates to jaw or left axilla during a period of increased myocardial demand. Pain relieves during resting when myocardial demand meets supply.
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This question is part of the following fields:
- Cardiovascular System
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Question 30
Incorrect
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A 21-year-old male presents with severe right-sided chest pain. On examination, percussion was hyper-resonant and breath sounds were reduced on the right side. He has no history of any respiratory illness or trauma. What condition is this patient suffering from?
Your Answer:
Correct Answer: Simple Pneumothorax
Explanation:Pneumothorax refers to a condition in which air or gases accumulate inside the pleural space causing the lungs to collapse. Because the patient did not have a history of any previous pulmonary disease or trauma, this is a case of simple pneumothorax.
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This question is part of the following fields:
- Respiratory System
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SESSION STATS - PERFORMANCE PER SPECIALTY
