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Question 1
Correct
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A 5 year old girl presented with short stature, primary amenorrhea, puffy arms and a webbed neck. The most likely diagnosis will be?
Your Answer: Turner’s syndrome
Explanation:Turner’s syndrome is characterised by a webbed neck, short stature, primary amenorrhea and cardiac, renal and muscular defects. Gene analysis shows a single X chromosome in the patients. Downs syndrome has certain cognitive and physical abnormalities, whereas in Klinefelter syndrome there are widely spaced nipples, long arms and infertility and it only occurs in men.
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This question is part of the following fields:
- Genetics
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Question 2
Correct
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A young child presents with a dull and greyish tympanic membrane and no shadow of the handle of malleus is evident. His mother complains that he does not respond when she calls him and that he lately raises the volume of the TV. What is the most likely diagnosis?
Your Answer: Secretory OM
Explanation:In secretory OM, effusion in the middle ear is present which does not produce any pain to the patient in comparison to acute OM which produces otalgia. The family members are the ones to notice hearing loss as the patient usually is not aware of it. On otoscopy, the features described in the question are prominent. Otitis externa is usually painful and it also produces an itching sensation. Chronic otitis media is painful and may interfere with balance problems. Cholesteatoma is an abnormal cystic growth in the middle ear that usually discharges foul-smelling fluids and as it grows, otalgia can appear.
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This question is part of the following fields:
- ENT
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Question 3
Correct
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A 30-year-old female presents with an infected skin ulcer. She is prescribed flucloxacillin and later develops jaundice, pale stools, and dark-coloured urine. What is the single most likely diagnosis?
Your Answer: Cholestatic jaundice
Explanation:Due to its cholestatic properties, Flucloxacillin can block bile flow through the liver, leading to the accumulation of bilirubin in the blood, giving rise to jaundice. Dark urine is the result of excessive bilirubin in the blood being filtered by the kidney. Pale stools is an effect of the blocked bile flow through the liver.
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This question is part of the following fields:
- Pharmacology
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Question 4
Incorrect
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A young girl presents to the clinic complaining of episodic headaches that usually last for 2-3 days. These headaches are preceded by fortification spectra. During these episodes, the patient prefers to stay in a quiet and dark room. How will you manage the acute stage?
Your Answer: Sumatriptan
Correct Answer: Aspirin
Explanation:Migraine is characterized by recurrent episodes of typically unilateral, localized headaches that are frequently accompanied by nausea, vomiting, and sensitivity to light and sound. In approximately 25% of cases, patients experience an aura preceding the headache, which involves reversible focal neurologic abnormalities, for example, visual field defects (scotomas) or paresis lasting less than an hour. Migraine is a clinical diagnosis. Treatment of attacks consists of general measures (e.g., bedrest and protection from outer stimuli) together with administration of nonsteroidal anti-inflammatory drugs (e.g., aspirin) and antiemetics (e.g., prochlorperazine) if nausea is present. In severe cases, triptans may be added. Prophylactic treatment (e.g., beta blockers) may be indicated if migraines are especially frequent or long lasting, or if abortive therapy fails or is contraindicated.
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This question is part of the following fields:
- Pharmacology
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Question 5
Incorrect
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A 4 year old baby was brought in by her mother with complaints of generalized pallor, loss of weight and loose stools. The baby's stools were frothy in nature and difficult to flush. Which investigation can help in diagnosing this patient?
Your Answer: Sweat chloride test
Correct Answer: Anti-endomysial antibodies
Explanation:The presence of anti-endomysial antibodies confirms the diagnosis of Celiac disease, which is the primary cause of illness in this patient. The sweat chloride test is performed with cystic fibrosis.
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This question is part of the following fields:
- Gastrointestinal
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Question 6
Incorrect
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Which of the statements given below would be the most accurate regarding airway obstruction in the new-born?
Your Answer: In Pierre Robin syndrome the airway can be improved by a nasopharyngeal tube
Correct Answer:
Explanation:Pierre Robin syndrome (PRS) is a congenital defect observed in humans which is characterized by an unusually small mandible, posterior displacement or retraction of the tongue, and upper airway obstruction. Cleft palate (incomplete closure of the roof of the mouth) is present in the majority of patients.
PRS is generally diagnosed clinically shortly after birth. The infant usually has respiratory difficulty, especially when supine. The palatal cleft is often U-shaped and wider than that observed in other people with cleft palate.
Treatment:
If moderate dyspnoea: symptomatic treatment, non-invasive ventilation, supervision and assistance while eating
If severe dyspnoea: surgical correction, special interventions for long-term correction
In cases of acute life-threatening respiratory distress → tracheostomy -
This question is part of the following fields:
- Respiratory
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Question 7
Incorrect
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A 43 year old female had a cervical smear test. The results came back showing only normal findings. What is the most appropriate management for this patient?
Your Answer: Repeat cervical smear in five years
Correct Answer:
Explanation:Screening for cervical carcinoma helps to prevent the development of the disease. According to NICE, the screening interval using liquid-based cytology (as opposed to PAP) is 3 years for women less than 50 years old and 5 years for women over 50 years old. If a smear test is conducted and it shows no endocervical cells then it should be conducted again.
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This question is part of the following fields:
- Genitourinary
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Question 8
Correct
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A 43-year-old woman complains of a greenish foul smelling discharge from her left nipple. She has experienced the same case before. What is the most likely diagnosis?
Your Answer: Duct ectasia
Explanation:Mammary duct ectasia occurs when the lactiferous duct becomes blocked or clogged. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age.
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This question is part of the following fields:
- Breast
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Question 9
Incorrect
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A 25 year old female was brought in with multiple superficial lacerations on her non-dominant forearm. There was evidence of older but similar kind of injuries to the same forearm. She was in distress as her boyfriend wanted to end the relationship. She didn't have any suicidal thoughts. Which of the following is the most probable diagnosis?
Your Answer: Severe depression
Correct Answer: Borderline personality disorder
Explanation:According to this presentation the most likely diagnosis is borderline personality disorder. The patient has impulsivity, self-harm and instability of interpersonal relationships, which are suggestive of borderline personality disorder. The history is not adequate to diagnose the other given conditions.
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This question is part of the following fields:
- Mental Health
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Question 10
Incorrect
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A diagnosed case of scabies presented in OPD for some medical advice. Which of the following statements best suits scabies?
Your Answer: It causes itchiness in the skin even where there is no obvious lesion to be seen
Correct Answer:
Explanation:Scabies is an infection caused by a microscopic mite known as Sarcoptes scabies. The chief presenting complaint is itching especially in skin folds and mostly during night. It spreads from one person to another through skin contact, and therefore it is more prevalent in crowded areas like hospitals, hostels and even at homes where people live in close contact with each other. Treatment options include benzyl benzoate, ivermectin, sulphur and permethrin.
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This question is part of the following fields:
- Dermatology
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Question 11
Incorrect
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A 30 year old female experienced carpopedal spasms and perioral numbness during interviews, exams and whenever she gave a public talk. Which of the following is the best management for this patient?
Your Answer: Rebreathe in a paper bag
Correct Answer: Desensitization
Explanation:According to the history the most likely diagnosis is panic disorder. Desensitization is the treatment option for the long term management. Rebreathing in a paper bag is the treatment option for an acute presentation.
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This question is part of the following fields:
- Mental Health
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Question 12
Incorrect
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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: Antinuclear antibodies
Correct Answer: Anti double-stranded DNA antibodies
Explanation:Anti ds-DNA antibodies are very specific for SLE and their presence most often indicates systemic spread of the disease. These antibodies are present in about 30 percent of the total cases of SLE.
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This question is part of the following fields:
- Rheumatology
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Question 13
Incorrect
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A 45-year-old male admitted with acute onset retrosternal chest pain was diagnosed with unstable angina. Which of the following will mostly contribute to the acute risk stratification of this patient?
Your Answer: Coronary angiography
Correct Answer: Troponin testing
Explanation:Troponin testing is the most important investigation in risk stratification. Troponin positive patients should be referred for urgent coronary revascularization as troponin indicates cardiac cell damage.
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This question is part of the following fields:
- Seriously Ill
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Question 14
Incorrect
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A woman visited the OPD with complaints of severe abdominal pain and light-headedness. There is history of fainting three days prior to consultation. She also has vaginal bleeding. In this case, which of the following investigations should be ordered to reach the diagnosis?
Your Answer: Beta HCG
Correct Answer:
Explanation:Testing for beta hCG should be the first test in this case. It will rule out any pregnancy that is strongly suspected based on the patient’s history and physical examination.
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This question is part of the following fields:
- Gynaecology
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Question 15
Correct
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From the list of options, choose the most likely anaesthetic or analgesic cause of maternal hypotension.
Your Answer: Epidural anaesthetic
Explanation:In spinal anaesthesia, the needle parts the dura rather than tears it. In an epidural, however, the needle is meant to inject around the dura but may penetrate it by accident. Maternal hypotension is most likely to be caused by dural penetration during an epidural, as this is the generally intended procedure. Postdural puncture headache appears to be associated higher with a spinal than an epidural.
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This question is part of the following fields:
- Seriously Ill
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Question 16
Incorrect
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A 62 year old patient presents to the ophthalmology OPD with progressive deterioration of vision and dazzling of view in well lit environments. Which of the following is the most likely diagnosis leading to this presentation?
Your Answer: Cataracts
Correct Answer:
Explanation:Cataract is a condition characterized by clouding of the lens of the eye. This condition most frequently occurs due to age-related degenerative processes in the lens, but can also be associated with ocular trauma, metabolic disorders, side-effects of drugs, or congenital infections. The clouding causes distortion of light, as it passes through the lens, resulting in visual impairment and glare. Initially, a cataract presents discretely and may even go unnoticed, but the visual impairment worsens as the cataract grows larger.
Diagnosis is typically established on the basis of a thorough history and direct visualization of the cataract (by means of slit-lamp microscopy). Surgery is indicated with significant visual impairment and involves lens extraction and implantation of an artificial lens. Untreated cataracts eventually lead to complete blindness.
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This question is part of the following fields:
- Ophthalmology
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Question 17
Correct
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A 25-year-old woman is presenting with diarrhoea and abdominal bloating over the last 4 months. On examination, she has a blistering rash over her elbows. Biochemical investigation showed that she has low serum albumin, calcium and folate concentrations. On jejunal biopsy there is shortening of the villi and lymphocytosis. What is the most likely cause?
Your Answer: Coeliac disease
Explanation:Celiac disease has characteristic shortened intestinal villi. When patients with celiac disease eat products containing gluten, they are unable to absorb the nutrients due to flattened or shortened intestinal villi. The blistering rash present on the patient’s elbows strongly suggests celiac disease. This rash is a sign of the condition Dermatitis Herpetiformis which is associate with celiac disease. Therefore, it is also often called ‘gluten rash’.
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This question is part of the following fields:
- Gastrointestinal
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Question 18
Correct
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A 23 year old male has complained of pain when swallowing and dysphagia. He has a sore mouth and soreness in the corners of his mouth. From the list of options, what is the single most likely diagnosis for this patient?
Your Answer: Candida infection
Explanation:The symptoms could indicate CMV or Candida infections, but CMV is much less common.
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This question is part of the following fields:
- ENT
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Question 19
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 pin prick sensation on the right half of the body. The most likely site of the lesion in this patient would be?
Your Answer: Left cerebellar hemisphere
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:
- Neurology
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Question 20
Correct
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A 45-year-old male who is a heavy alcoholic was admitted with loss of memory, hallucinations and difficulty walking. On examination, he had an ataxic gait. He was given Acamprosate. Which one of the following can be given with the above drug?
Your Answer: Thiamine
Explanation:Wernicke’s encephalopathy is characterised by the triad of ophthalmoplegia, ataxia, and confusion. It must be viewed as a medical emergency with rapid correction of thiamine deficiency as the goal of therapy. Acamprosate is a medication used to treat alcohol dependence by stabilizing chemical signalling in the brain that would otherwise be disrupted by alcohol withdrawal
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This question is part of the following fields:
- Neurology
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Question 21
Incorrect
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A 55 year old female school teacher complains of double vision when she writes on the school blackboard. She has no history of trauma. Her most recent visit to her GP was to seek attention for a rash which developed after she was bitten when walking through the forest on a school trip. Choose the cranial nerve most likely to be affected here.
Your Answer: Optic
Correct Answer: Abducens
Explanation:This nerve is responsible for the side to side movement of the eye, hence why damage can cause double vision.
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This question is part of the following fields:
- Neurology
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Question 22
Correct
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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: 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
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Question 23
Incorrect
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A 54 year old man has to increase his oral morphine dose due to progressively worsening pain. However, the current morphine dose makes him lethargic, interfering with his daily life. What is the single most appropriate next step?
Your Answer: Diamorphine
Correct Answer: Oral oxycodone
Explanation:Oxycodone is a semi-synthetic opioid with effects similar to
morphine. It is an alternative to morphine for severe pain
at step three on the WHO analgesic ladder.
Clinical trials indicate that oxycodone is as effective as
morphine at controlling cancer pain but with no significant
difference in overall tolerability. There is no evidence that
oxycodone is superior to morphine for chronic, non-cancer
pain.
There is some evidence that there is individual variation
in analgesic response and sensitivity to the adverse
effects of opioids. Oxycodone can be considered for
the small number of patients who experience allergy or
ongoing neurotoxic adverse effects to morphine, such
as hallucinations. Oxycodone may have a place in the
management of complex pain syndromes. -
This question is part of the following fields:
- Surgery
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Question 24
Correct
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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: 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 68 year old man presents with acute symptoms of gout on his first metatarsophalangeal joint. Which option best explains the underlying mechanism of gout?
Your Answer: Increased endogenous production of uric acid
Correct Answer: Decreased renal excretion of uric acid
Explanation:Primary gout is related more often to underexcretion of uric acid or overproduction.
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This question is part of the following fields:
- Rheumatology
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Question 26
Correct
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A 19-year-old male who is a first year student at university presented in the emergency room with acute disorientation. He was previously relaxed and well. Which of the following is the most likely cause behind his condition?
Your Answer: Drug toxicity
Explanation:History of being well and sudden appearance of agitation and confused state at this age is suggestive of drug intake and toxicity.
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This question is part of the following fields:
- Seriously Ill
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Question 27
Correct
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A 25-year-old male presents at the OPD complaining of excessive tiredness and frequent headaches. On examination, his blood pressure was 205/100 mmHg. Blood tests reveal a decreased serum potassium and renin level and elevated aldosterone level. Which condition is this patient most likely suffering from?
Your Answer: Primary hyperaldosteronism (Conn’s disease)
Explanation:Conn’s disease is a condition in which excessive amounts of aldosterone are secreted from the adrenal glands. Because aldosterone increases the reabsorption of sodium, it leads to a very high blood pressure.
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This question is part of the following fields:
- Endocrine
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Question 28
Incorrect
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A 45 year old woman has complained of right hypochondrial pain and severe epigastric pain for the past few hours. Upon examination, her CBC is normal, her serum ALP is raided, but she has normal transaminase. She had a cholecystectomy done three months prior. Choose the most appropriate avenue of investigation for this patient.
Your Answer: US abdomen
Correct Answer: ERCP
Explanation:MRCP is the most appropriate procedure in this instance. The post-operative US of the abdomen does not give good results for the hepatobiliary system. ERCP is invasive and is linked to complications such as pancreatitis, cholangitis, etc.
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This question is part of the following fields:
- Seriously Ill
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Question 29
Incorrect
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A 70-year-old male presented with mild ascites due to alcoholic cirrhosis. Which of the following abnormalities is most likely present?
Your Answer: Increased vascular resistance
Correct Answer:
Explanation:Patients with cirrhosis are mostly hyponatraemic due to increased water retention.
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This question is part of the following fields:
- Gastrointestinal
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Question 30
Correct
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A 54-year-old man experienced a gradual decrease in vision of one eye after being diagnosed with type 2 diabetes mellitus. Macula oedema is noted on his fundoscopy. Which of the following is the most likely diagnosis?
Your Answer: Diabetic retinopathy
Explanation:Macular disease can affect central vision at any stage of diabetic retinopathy and may be seen in type 2 diabetic patients. Diabetic retinopathy affects up to 80 percent of those who have had diabetes for 20 years or more. Macular oedema occurs when damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, which blurs vision.
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This question is part of the following fields:
- Ophthalmology
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SESSION STATS - PERFORMANCE PER SPECIALTY
