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Question 1
Incorrect
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A 25-year-old female with a known diagnosis of hypothyroidism and receiving thyroxine, came to the emergency department with complaints of difficulty sleeping for 3 days and a history of jaundice for 7 days. Her lab results showed increased levels of TSH and PT=70 sec. Which of the following is the most appropriate diagnosis?
Your Answer: Drug induced hepatitis
Correct Answer: Autoimmune hepatitis
Explanation:Autoimmune hepatitis is linked with other autoimmune diseases, such as hypothyroidism. It may present as acute or chronic hepatitis and sometimes cirrhosis. Fever, hepatic tenderness and history of jaundice is present. Non-specific features like behavioural issues, weight changes or mood swings can also be present. Coagulopathy can also be present.
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This question is part of the following fields:
- Hepatobiliary System
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Question 2
Correct
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A 51-year-old presents with muscle atrophy. He has a high BMI and finds it difficult to climb stairs. If the patient also has polydipsia and polyuria, what is the most likely diagnosis?
Your Answer: Amyotrophy
Explanation:(Diabetic) Amyotrophy is a condition that presents with muscle wasting and consequent difficulty in climbing stairs. The onset is relatively sudden and symptoms of diabetes are characteristic.
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This question is part of the following fields:
- Nervous System
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Question 3
Correct
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A 48-year-old hairdresser presents to the GP with loss of sensation over the lateral three and a half fingers of her right hand, tenderness over her right forearm, and inability to make a tight fist. She complains of pain in her right arm when twisting door handles anticlockwise. Phalen's and Tinel's tests are negative. She is otherwise neurologically intact. Which of the following is the most likely diagnosis?
Your Answer: Pronator teres syndrome
Explanation:Entrapment of the median nerve by pronator teres causes a median nerve neuropathy, which is worse during pronation of the forearm. Examination should involve excluding carpal tunnel syndrome and pronation of the affected forearm against resistance, which brings on the pain. Unlike carpal tunnel syndrome, the median nerve proximal to the wrist may be tender to palpation.
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This question is part of the following fields:
- Nervous System
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Question 4
Correct
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A 33-year-old woman has missed her last two periods and has been lactating. Upon anamnesis, she claims she's lost weight and she's been suffering from vaginal dryness. The endocrinologist suggests that she checks her prolactin levels. Which of the following inhibits prolactin release from the hypophysis?
Your Answer: Dopamine
Explanation:Dopamine (DA) holds a predominant role in the regulation of prolactin (PRL) secretion. Through a direct effect on anterior pituitary lactotrophs, DA inhibits the basally high-secretory tone of the cell. It accomplishes this by binding to D2 receptors expressed on the cell membrane of the lactotroph, activation of which results in a reduction of PRL exocytosis and gene expression by a variety of intracellular signalling mechanisms.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 5
Correct
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A 60-year-old man with type 1 diabetes is brought to the clinic with his wife. He is limping and his wife noticed that his ankle was abnormally-shaped after he stepped out of the shower.
Examination of his right ankle reveals a painless warm swollen joint.
There is crepitus and what appears to be palpable bone debris. X-ray reveals gross joint destruction and apparent dislocation. Joint aspiration fluid shows no microbes.
Investigations:
His CRP and white count are of normal values.
Historical review of HB A1c reveals that it has rarely been below 9%.
What is the most likely diagnosis?Your Answer: Charcot's ankle
Explanation:Charcot arthropathy is a progressive condition of the musculoskeletal system that is characterized by joint dislocations, pathologic fractures, and debilitating deformities. It results in progressive destruction of bone and soft tissues at weight-bearing joints. In its most severe form, it may cause significant disruption of the bony architecture.
Charcot arthropathy can occur at any joint; however, it occurs most commonly in the lower extremity, at the foot and ankle. Diabetes is now considered to be the most common aetiology of Charcot arthropathy. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 6
Correct
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A 63-year-old gentleman presents with left-sided eye pain and diplopia for the past 2 days. Examination of his eyes shows his pupils equal and reactive to light with no proptosis. There is however an apparent palsy of the 6th cranial nerve associated with a partial 3rd nerve palsy on the left side. Examining the remaining cranial demonstrates hyperaesthesia of the upper face on the left side. Where is the likely lesion?
Your Answer: Cavernous sinus
Explanation:A lesion on the cavernous sinus would explain the palsy observed on the III and VI cranial nerves because the cranial nerves III, IV, V, and VI pass through the cavernous sinus. Pain in the eye is due to the nearby ophthalmic veins that feeds the cavernous sinus. Additionally, the lesions in the other structures would have presented with pupil abnormalities and less localized pain and symptoms.
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This question is part of the following fields:
- Nervous System
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Question 7
Incorrect
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A 13-year-old patient presents in the A&E with a fracture of his left femur. He was a passenger in a car involved in a traffic accident. Upon clinical examination, his left posterior tibial and dorsalis pedis arteries are not palpable. Which of the following is most probably injured?
Your Answer: Iliac artery
Correct Answer: Femoral artery
Explanation:The femoral artery is the one accompanying the femoral shaft, being the most important blood supplier of the leg. Femoral artery injury during a femur shaft fracture is quite common as a result of blunt trauma.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 8
Incorrect
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A 40 years old man collapsed at home and died. The GP's report says he suffered from type 2 Diabetes Mellitus and his BMI was 35. What is the most likely cause of death?
Your Answer: Pulmonary Embolism
Correct Answer: Myocardial infarction
Explanation:Diabetic patients usually have a higher risk of developing cardiovascular events by 2-4x that of the general population. In addition, diabetic patients are often obese and possibly have hyperlipidaemia, which are great risk factors of cardiovascular incidents.
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This question is part of the following fields:
- Cardiovascular System
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Question 9
Correct
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Cancer of the prostate is associated with which of the following:
Your Answer: Exposure to cadmium
Explanation:Risk factors for prostate cancer include:
Black ethnicity
A family history of breast or prostate cancer
High intake of animal fats and low selenium intake
Exposure to radiation or heavy metals including cadmium -
This question is part of the following fields:
- Men's Health
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Question 10
Incorrect
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A patient was given Penicillin G pre-operatively. Which of the following procedures was he waiting for?
Your Answer: Dental procedure for patient with an atrial septal defect
Correct Answer: Splenectomy
Explanation:Asplenic patients are at a high risk of fulminant sepsis which is usually caused by capsulated organisms such as Streptococcus pneumonia, Haemophilus influenzas and Neisseria meningitides. So all the patients who are awaiting splenectomy should be given antibiotic prophylaxis. (Penicillin, if allergy to Penicillin, Clarithromycin)
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This question is part of the following fields:
- Emergency & Critical Care
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Question 11
Incorrect
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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: Arterial blood gases
Correct 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 12
Correct
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A 27-year-old man with a long history of heavy alcohol intake is admitted with nausea and frequent vomiting four hours after a meal in a restaurant. During review in the Emergency department he vomits a cupful of blood.
What is the cause of his haematemesis?Your Answer: Mallory-Weiss tear
Explanation:This is a classic clinical presentation, with alcohol intake and nausea/vomiting that leads to hematemesis, of a Mallory-Weiss tear. Because of the history, that makes this more likely than haemorrhagic gastritis, duodenal ulceration, or oesophagitis (also oesophagitis would not bleed a cupful). Oesophageal varices would present with copious amounts of hematemesis and most likely hemodynamic instability as a result of the amount of blood loss. In Mallory-Weiss tear they are typically presented as a hemodynamically stable patient.
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This question is part of the following fields:
- Gastrointestinal System
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Question 13
Correct
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A 70-year-old male presents with hoarseness of the voice and breathing difficulties for the past 3 months. A chest x-ray, showed a unilateral opacity in hilum. He has no history of smoking. Choose the most probable diagnosis.
Your Answer: Bronchial carcinoma
Explanation:All of the symptoms observed in this patient are typical of bronchial carcinoma.
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This question is part of the following fields:
- Respiratory System
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Question 14
Incorrect
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A 45-year-old known asthmatic was admitted with acute severe asthma and was treated with nebulised salbutamol, ipratropium and bromide, along with 100% oxygen therapy. He was also given IV hydrocortisone, however there was no significant improvement. What would be the next step in management of this patient?
Your Answer: IV Magnesium Sulphate
Correct Answer: IV Aminophylline
Explanation:Aminophylline is a very effective bronchodilator. It is short acting and therefore very effective in acute scenarios.
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This question is part of the following fields:
- Respiratory System
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Question 15
Incorrect
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A 70-year-old man presents to the emergency department acutely unwell. He is shocked, drowsy and confused.
He is known to be type-2 diabetic maintained on metformin.
Blood tests reveal a metabolic acidosis with an anion gap of 24 mmol/l. Ketones are not significantly elevated and random blood glucose was 8.7 mmol/l.
What is the mainstay of treatment for this condition?Your Answer: 8.2% sodium bicarbonate
Correct Answer: Rehydration
Explanation:Lactic acidosis is occasionally responsible for metabolic acidosis in diabetics. It may occur in the presence of normal blood levels of the ketone bodies, and such cases are often described as having non-ketotic diabetic acidosis.
It is most commonly associated with tissue hypoperfusion and states of acute circulatory failure.
Appropriate measures include treatment of shock, restoration of circulating fluid volume, improved cardiac function, identification of sepsis source, early antimicrobial intervention, and resection of any potential ischemic regions. Reassessment of lactate levels for clearance assists ongoing medical management. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 16
Incorrect
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An elderly woman is referred with worsening chronic pulmonary disease (COPD). She smokes seven cigarettes per day. Her exercise tolerance is only a few yards around the house now. Her FEV1 is 37% of predicted.
What is the most appropriate intervention for this patient?Your Answer: Give regular low-dose inhaled fluticasone and inhaled long-acting β-agonist
Correct Answer: Give regular high-dose inhaled fluticasone and inhaled long-acting β-agonist
Explanation: -
This question is part of the following fields:
- Respiratory System
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Question 17
Correct
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A 43-year-old police officer is admitted with a history of unsteadiness and slurring of speech. This has worsened over a period of three months. He complains of a tremor affecting his right hand and diplopia on right lateral gaze. He smokes 30 cigarettes a day and takes regular diclofenac for his arthritis. On examination, he is dysarthric and feels nauseated. Fundoscopy is normal, however there is marked horizontal nystagmus and evidence of a right VI nerve palsy. There also appears to be some mild facial weakness on the right side. Upon conducting Weber's test, a louder tone is heard in the left ear. On conducting the Rinne test, both ears are normal. On examination of the upper limb, there is a right intention tremor and dysdiadochokinesis. Tone, power and reflexes are normal. On examination of the lower limb, tone, power and reflexes are normal, however he appears to walk with a broad-based gait and is leaning to the right.
Lumbar puncture:
Opening pressure 13 cm H20 (5-18)
Protein 0.67 g/l (0.15-0.45)
WCC 3 cells/ml (<5)
Red cell count (RCC) 2 cells/ml (<5)
Glucose 3.2 mmol/l (3.3-4.4)
Blood glucose 5.8 mmol/l (3.0-6.0)
Oligoclonal bands Present
Serum oligoclonal bands Present
Magnetic resonance scan shows a calcified lesion broadly attached to the petrous part of the temporal bone. In view of the above history and findings, what is the likely cause of this patient's symptoms?Your Answer: Meningioma of the cerebellar pontine angle
Explanation:This patient has a combination of right cerebellar dysfunction with right-sided cranial nerve palsies (VI, VII, and VIII). The magnetic resonance imaging (MRI) shows a calcified meningioma within the right cerebellar pontine area, which would account for these findings. The cerebrospinal fluid (CSF) analysis shows oligoclonal bands, however, these are matched in the serum, which reflects a systemic inflammatory response from his rheumatoid arthritis.
The MRI scan and CSF analysis would not be consistent with progressive multiple sclerosis. The progressive nature of her symptoms would be against a diagnosis of brainstem infarct, and one would expect more pyramidal signs in the peripheral nervous system.
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This question is part of the following fields:
- Nervous System
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Question 18
Correct
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A smoker male presenting with weight loss is found to have a normal chest x-ray but a positive sputum cytology for carcinomatous cells. Which of the following would be the likely TNM classification?
Your Answer: TX, N0, M0
Explanation:The TNM system is a means to describe the amount and spread of cancer in a patient’s body. T describes the size of the tumour and any spread of cancer into nearby tissue; N describes spread of cancer to nearby lymph nodes; and M describes metastasis (spread of cancer to other parts of the body).
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This question is part of the following fields:
- Respiratory System
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Question 19
Correct
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A 65-year-old gentleman gives a two week history of progressive lethargy and weakness. Eight weeks previously, he was treated for hypertensive heart failure with 120 mg furosemide and 5 mg enalapril daily. His haemoglobin at the time was 12.0, urea 14.2 mmol/l and creatinine 298 μmol/l. His blood pressure in clinic was 148/85 mmHg.
His blood results are shown below:
Hb 10.2g/dl
MCV 89.2 fl
WCC 4.9 x 109/l
Plats 175 x 109/l
Na+ 135
K+ 5.2 mmol/l
Urea 25.2 mmol/l
Creat 600 μmol/l
Assuming that he is not volume overloaded, what would be the most appropriate action?Your Answer: stop the enalapril and furosemide
Explanation:The patient presents with worsened renal condition from the last consultation when he was started on enalapril (an ACE inhibitor) so this medication should be stopped. Because there is also no fluid overload; furosemide, a diuretic, should also be stopped.
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This question is part of the following fields:
- Renal System
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Question 20
Incorrect
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A 34-year-old male presented with exertional dyspnoea and chest pain for the past 2 weeks. On examination there was a mid-systolic murmur which is best heard at the apex and double apical impulse. His ECG showed left ventricular hypertrophy (LVH). What is the risk factor which would be most indicative of the potential for sudden death in this patient?
Your Answer: Asymmetrical septal hypertrophy
Correct Answer: Degree of left ventricular hypertrophy
Explanation:The history is suggestive of hypertrophic obstructive cardiac myopathy. The degree of left ventricular hypertrophy is strongly associated with sudden cardiac death.
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This question is part of the following fields:
- Cardiovascular System
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Question 21
Correct
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A 75-year-old retired tailor is examined for involuntary, jerking movements of his arms. His symptoms seem to resolve when he is asleep. Damage to which one of the following structures may lead to hemiballism?
Your Answer: Subthalamic nucleus
Explanation:Hemiballismus or hemiballism in its unilateral form is a very rare movement disorder. It is a type of chorea caused in most cases by a decrease in activity of the subthalamic nucleus of the basal ganglia, resulting in the appearance of flailing, ballistic, undesired movements of the limbs. Symptoms may decrease while the patient is asleep. Antidopaminergic agents (e.g. Haloperidol) are the mainstay of treatment.
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This question is part of the following fields:
- Nervous System
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Question 22
Correct
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A 60-year-old previously well male patient was admitted with acute severe central chest pain associated with excessive sweating and nausea for the past 45 minutes. On examination he was found to have xanthelasma. His blood pressure was 170/100 mmHg and pulse rate was 104 bpm. His ECG showed ST elevation more than 2mm in leads II, III and aVF. His troponin T was 120 ng/ml. His FBC and renal functions were normal. He was given aspirin, clopidogrel, morphine and IV 5 mg of atenolol. Which of the following is the most appropriate next step?
Your Answer: Immediate referral to cardiologist for primary angioplasty
Explanation:The diagnosis is acute inferior ST elevation myocardial infarction so the most appropriate management is primary angioplasty.
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This question is part of the following fields:
- Cardiovascular System
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Question 23
Correct
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There are number of diseases that have to be notified to the consultant responsible for communicable disease control. Which of the following conditions does not belong to above category?
Your Answer: Pneumococcal pneumonia
Explanation:There are number of diseases that have to be notified to relevant authorities to prevent or reduce their spread. Those conditions include Cholera, Diphtheria, Food poisoning, Infectious bloody diarrhoea, Malaria, Measles, Meningococcal septicaemia, Mumps, Plague, Rabies and Rubella.
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This question is part of the following fields:
- Infectious Diseases
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Question 24
Correct
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A woman with breast cancer develops urinary frequency. Which part of the brain has metastasis potentially spread to?
Your Answer: Diencephalon
Explanation:Diencephalon consists of four structures; thalamus, subthalamus, hypothalamus and epithalamus. The hypothalamus has a crucial role in controlling urinary frequency.
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This question is part of the following fields:
- Haematology & Oncology
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Question 25
Correct
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A child with jaundice and pale stools would most likely be evaluated by which of the following tests?
Your Answer: US
Explanation:Blood tests do not help in the diagnosis of jaundice except of course by telling the level of jaundice (bilirubin) and providing some corroborative evidence such as autoantibodies, tumour markers or viral titres in the case of hepatitis. Classifying causes of jaundice on the basis of ultrasound provides a quick and easy schema for diagnosing jaundice which is applicable in primary care as well as hospital based practice.
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This question is part of the following fields:
- Hepatobiliary System
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Question 26
Incorrect
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A 55-year-old woman diagnosed with type 2 diabetes presents with vomiting and diarrhoea after eating a meal of chicken and chips. She said her stool had small amounts of blood in. Campylobacter Jejuni was found on her stool culture exam. Which of the following is the most appropriate therapy?
Your Answer: Trimethoprim
Correct Answer: IV fluids
Explanation:Campylobacter is the most likely cause of diarrheal illness often due to undercooked meat being ingested. It is also a major cause of traveller’s diarrhoea. Sufficient fluid replacement and anti-emetics are indicated first followed by the antibiotic, Erythromycin although antibiotic treatment in adults is still in question. Ciprofloxacin and Tetracycline may also be effective.
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This question is part of the following fields:
- Infectious Diseases
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Question 27
Correct
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A 54-year-old gentleman presented with a 3 month history of a nodular growth over the dorsum of the his nose, about 0.6 cm in size. The base of nodule is slightly ulcerated and its margins are raised. The most likely diagnosis would be?
Your Answer: Basal cell carcinoma
Explanation:Basal cell carcinoma is usually located on sun exposed sites. It has got many variants and clinically it presents as a slow growing mass/nodule with rolled margins and an ulcerated base.
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This question is part of the following fields:
- The Skin
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Question 28
Correct
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A 45-year-old female presented with weight loss, night sweats and abdominal pain for 6 months. Abdominal ultrasound scan showed a tubo-ovarian mass. What is the most likely organism, which is responsible for this presentation?
Your Answer: Mycobacterium tuberculosis
Explanation:Constitutional symptoms such as weight loss, evening pyrexia and night sweats are associated with Mycobacterium Tuberculosis (TB). TB can affect any system of the body and should be top in the list of differentials particularly if the patient has a history of contact with a known TB patient.
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This question is part of the following fields:
- Infectious Diseases
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Question 29
Incorrect
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Which of the following drugs is the strongest opioid?
Your Answer: Diamorphine 10 mg via syringe driver over 24 hours
Correct Answer: Modified-release morphine 30 mg BD orally
Explanation:Modified release morphine in BD dose is the strongest opioid of the selection.
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This question is part of the following fields:
- Pharmacology
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Question 30
Incorrect
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Which of the following procedures does not require antibiotic prophylaxis?
Your Answer: Cholecystectomy
Correct Answer: Dental procedure for a patient with an atrial septal defect
Explanation:According to latest NICE guidelines, patients with isolated atrial septal defects do not require prophylactic antibiotics originally used in prevention of infective endocarditis in dental procedures.
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This question is part of the following fields:
- Infectious Diseases
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SESSION STATS - PERFORMANCE PER SPECIALTY
