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  • Question 1 - Which one of the following features is most helpful in distinguishing beta thalassaemia...

    Correct

    • Which one of the following features is most helpful in distinguishing beta thalassaemia trait from iron deficiency anaemia?

      Your Answer: Haemoglobin A2 levels

      Explanation:

      Elevated haemoglobin A2 level is seen in beta thalassaemia trait, whereas, it is typically low in iron deficiency anaemia unless the patient has received a recent blood transfusion.

      Low mean corpuscular volume (MCV) and reduced haematocrit (Ht) are encountered in both conditions. Peripheral blood smear is grossly abnormal in both beta thalassaemia and severe iron deficiency anaemia, showing bizarre morphology, target cells, and a small number of nucleated red blood cells.

    • This question is part of the following fields:

      • Haematology & Oncology
      51.8
      Seconds

  • Question 2 - A 60-year-old male who has been on IV antibiotics for severe pneumonia developed...

    Correct

    • A 60-year-old male who has been on IV antibiotics for severe pneumonia developed profuse, watery, green coloured diarrhoea on the fifth day of antibiotics. What is the organism responsible for this condition?

      Your Answer: Clostridium difficile

      Explanation:

      The most probable cause for diarrhoea is pseudomembranous colitis which is caused by Clostridium difficile. Pseudomembranous colitis is an inflammatory disease of the colon where the antibiotic-induced change in the balance of normal gut flora allows overgrowth of C difficile. Any antibiotic can cause this but the chances are higher with ampicillin, clindamycin, fluoroquinolones, and cephalosporins.

    • This question is part of the following fields:

      • Infectious Diseases
      14.6
      Seconds

  • Question 3 - A 6 week old female patient was brought by her mother to the...

    Correct

    • A 6 week old female patient was brought by her mother to the emergency department with icterus. Although she's had a good appetite, and breast-feeding well, she hasn't gained any weight. Her mother noticed that her stools are pale while her urine is noticeably dark. What is the most probable diagnosis?

      Your Answer: Biliary atresia

      Explanation:

      Biliary atresia is a rare condition that usually becomes symptomatic 2 to 8 weeks after birth. It can be congenital or acquired. Typical symptoms include jaundice, weight loss, dark urine and pale stools.

    • This question is part of the following fields:

      • Hepatobiliary System
      19.8
      Seconds

  • Question 4 - A 65-year-old man was seen at autopsy. He had swollen legs and signs...

    Correct

    • A 65-year-old man was seen at autopsy. He had swollen legs and signs of a transudate fluid at his liver. Before passing away, he was treated for bronchitis and TB. What is the most probable cause of the transudate?

      Your Answer: Cardiac failure

      Explanation:

      The patient most probably experienced congestive hepatopathy and leg oedema due to right sided cardiac failure.

    • This question is part of the following fields:

      • Cardiovascular System
      38.6
      Seconds

  • Question 5 - A 75-year-old male patient with type 2 diabetes mellitus, was admitted with confusion....

    Correct

    • A 75-year-old male patient with type 2 diabetes mellitus, was admitted with confusion. On examination he was drowsy and had tremors. Which of the following is the best investigation, which is important for the further management?

      Your Answer: Blood sugar

      Explanation:

      The presentation is highly suggestive of a hypoglycaemic episode, which is more common amongst older patient with diabetes mellitus. The chance of hypoglycaemia is higher with insulin users. Blood sugar measurement is crucial in the management.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      50.2
      Seconds

  • Question 6 - A 25-year-old male presented in the emergency room with a history of loose...

    Correct

    • A 25-year-old male presented in the emergency room with a history of loose stools which were bloody and mucoid for the last 2 to 3 months. The stools were also associated with abdominal cramps. He undergoes a colonoscopy after which he will start treatment. What is the most suitable drug in this case?

      Your Answer: Mesalazine

      Explanation:

      Symptoms are suggestive of inflammatory bowel disease. In this disease mesalazine is very effective as an anti-inflammatory drug.

    • This question is part of the following fields:

      • Emergency & Critical Care
      29.6
      Seconds

  • Question 7 - A 23-year-old student presented with swelling and tenderness near the Lister tubercle of...

    Correct

    • A 23-year-old student presented with swelling and tenderness near the Lister tubercle of the radius. Passive extension of thumb and index finger further increases the pain. X-ray was normal. What will be the next step in the management of this case?

      Your Answer: Immobilization with a cast

      Explanation:

      This patient most likely has distal intersection syndrome, which occurs in the proximal forearm due to the tenosynovitis of extensor pollicis longus muscle tendons.

    • This question is part of the following fields:

      • Musculoskeletal System
      51.4
      Seconds

  • Question 8 - A 63-year-old man presents to the clinic complaining of a 6-month history of shortness...

    Correct

    • A 63-year-old man presents to the clinic complaining of a 6-month history of shortness of breath on exertion and a non-productive cough.
       
      On examination there is clubbing, and crepitations heard at the lung bases. Lung function tests show a reduced vital capacity and an increased FEV1/FVC ratio.
       
      What is his diagnosis?

      Your Answer: Idiopathic pulmonary fibrosis

      Explanation:

      Idiopathic pulmonary fibrosis (IPF) is a condition in which the lungs become scarred and breathing becomes increasingly difficult.
      The most common signs and symptoms of idiopathic pulmonary fibrosis are shortness of breath and a persistent dry, hacking cough. Many affected individuals also experience a loss of appetite and gradual weight loss.

      The clinical findings of IPF are bibasilar reticular abnormalities, ground glass opacities, or diffuse nodular lesions on high-resolution computed tomography and abnormal pulmonary function studies that include evidence of restriction (reduced VC with an increase in FEV1/FVC ratio) and/or impaired gas exchange (increased P(A-a)O2 with rest or exercise or decreased diffusion capacity of the lung for carbon monoxide [DLCO]).

    • This question is part of the following fields:

      • Respiratory System
      47.2
      Seconds

  • Question 9 - A 22-year-old male with exercise induced asthma, has had good control with a...

    Incorrect

    • A 22-year-old male with exercise induced asthma, has had good control with a salbutamol inhaler. But recently he has had asthma attacks with exercise. Which of the following is the most appropriate management?

      Your Answer: Inhaled steroid

      Correct Answer: Sodium cromoglycate

      Explanation:

      Steroids and theophylline have less of a role in the treatment of exercise induced asthma. The best method of treatment is pre-exercise short-acting β2-agonist administration. Long-acting β2-agonists, mast cell stabilizers (e.g.: Sodium cromoglycate), and antileukotriene drugs also play a role.

    • This question is part of the following fields:

      • Respiratory System
      50
      Seconds

  • Question 10 - A 40-year-old female presented with pain and whitening of the hands on exposure...

    Correct

    • A 40-year-old female presented with pain and whitening of the hands on exposure to cold. She has difficulty in swallowing solid foods so she has started swallowing only liquids. She developed shortness of breath on exertion and, subsequently, at rest. Which of the following is the most likely cause for dysphagia in this patient?

      Your Answer: Systemic sclerosis

      Explanation:

      Difficulty in swallowing which improves with liquids is mainly due to an obstructive lesion in oesophagus. But pulmonary involvement (breathlessness on exertion and later on rest) and Raynaud’s phenomena can only be described by systemic sclerosis.

    • This question is part of the following fields:

      • Emergency & Critical Care
      28.3
      Seconds

  • Question 11 - A 5-year-old child was found to have orchidomegaly and splenomegaly. Blood tests show...

    Correct

    • A 5-year-old child was found to have orchidomegaly and splenomegaly. Blood tests show a WBC = 1.7 X 104/L, Hb = 7.1 g/dl and platelets = 44 X 104g/dl. His parents mention that he suffers from fatigue while at presentation he looks pale and has a fever. What is the most likely diagnosis?

      Your Answer: Acute lymphoblastic leukaemia

      Explanation:

      Acute lymphoblastic leukaemia (ALL) is an aggressive type of blood and bone marrow cancer which can appear in childhood. Signs of childhood ALL include: Fever, Easy bruising, Petechiae, Bone or joint pain, Painless lumps in multiple areas of the body, Weakness, fatigue or paleness, and Loss of appetite. Blood tests may show elevated white blood cells, decreased values of red blood cells and low platelet count.

    • This question is part of the following fields:

      • Haematology & Oncology
      53.3
      Seconds

  • Question 12 - A 20-year-old gentleman presents to the A&E department complaining of a sudden-onset occipital...

    Incorrect

    • A 20-year-old gentleman presents to the A&E department complaining of a sudden-onset occipital headache associated with vomiting. His symptoms started 2 hours previously and are continuing. He has a previous history of infrequent migraine without aura, which also causes nausea but not vomiting. He rated his current headache as much more severe than his usual migraine. Examination is unremarkable. In particular, there is no neck stiffness or photophobia.
      Which of the following management options would be the most appropriate?

      Your Answer: CT brain scan, followed by angiography

      Correct Answer: CT brain scan, followed by lumbar puncture if CT normal

      Explanation:

      The patient presented with sudden-onset headache that is more painful than his usual migraine attacks. This gives a high suspicion of subarachnoid haemorrhage; thus, a CT brain scan should be ordered first to rule this out. However, a normal CT scan is apparent in 30% of patients with subarachnoid haemorrhage and should be referred for lumbar puncture to look for red blood cells.

    • This question is part of the following fields:

      • Nervous System
      104.4
      Seconds

  • Question 13 - A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling...

    Correct

    • A 55-year-old lady, known with rheumatoid arthritis, complains of increasing numbness and tingling in her feet and hands. She has recently developed an ulcer on her left heel, after having burnt her foot in a hot bath. A number of depigmented areas are readily seen over her upper limbs.

      She is currently taking low-dose prednisolone (7.5 mg daily), alendronic acid, lansoprazole, paracetamol, indomethacin, methotrexate and rituximab.

      Her blood tests demonstrate:
      Haemoglobin 9.9 g/l
      MCV 102 fl
      Platelets 410 x 109/l
      White blood cells 12.3 x 109/l
      Vitamin B12 97 pg/ml
      Folate 12.3ng/ml
      Random blood glucose 9.9 mmol/l
      Thyroid-stimulating hormone 4.7 mU/ml
      Thyroxine 12.8 pmol/l

      Which autoantibody would be most diagnostic for the underlying disease?

      Your Answer: Anti-intrinsic factor (IF)

      Explanation:

      This clinical scenario describes pernicious anaemia. Anti-intrinsic factor (IF) antibodies are most specific for pernicious anaemia. Antigastric parietal cell antibodies have a higher sensitivity but are less specific for pernicious anaemia. The other antibodies listed are not related to pernicious anaemia. Anti-TTG is seen with Celiac’s disease, anti-TPO is seen with thyroid disease, GAD is seen with type I diabetes, but this does not explain her anaemia.

    • This question is part of the following fields:

      • Immune System
      69.8
      Seconds

  • Question 14 - A 28-year-old female presented with complaints of weight gain, thinning of scalp hair,...

    Incorrect

    • A 28-year-old female presented with complaints of weight gain, thinning of scalp hair, dryness and coldness of the skin, constipation and fatigue. Which of the following is the most likely diagnosis?

      Your Answer: Hypoparathyroidism

      Correct Answer: Hypothyroidism

      Explanation:

      The symptoms this female presented with in the OPD are major symptoms of hypothyroidism due to insufficient thyroid hormone.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      21.3
      Seconds

  • Question 15 - In a patient with type-1 diabetes mellitus, which cells when affected, lead to...

    Correct

    • 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
      13.6
      Seconds

  • Question 16 - As the SHO of a hospital, you come across the lab report of...

    Correct

    • As the SHO of a hospital, you come across the lab report of a patient. It shows the following: glucose 4 mmol/L, K 5.2mmol/L, Na 129 mmol/L. How would you manage this patient?

      Your Answer: Normal Saline 0.9%

      Explanation:

      This patient’s blood glucose levels are within the normal range. From their lab report, they are suffering from milk hyperkalaemia and hypernatremia. Thus, normal saline 0.9 per cent is most appropriate in this case.

    • This question is part of the following fields:

      • Emergency & Critical Care
      24.9
      Seconds

  • Question 17 - A 30-year-old male came to the emergency room after sustaining injuries during a...

    Correct

    • A 30-year-old male came to the emergency room after sustaining injuries during a fight at a nightclub. He was drunk and abusive to the nurse on duty. Which of the following steps is the most appropriate in this case?

      Your Answer: Call police

      Explanation:

      As this patient seems to be a danger to the safety of staff, police should be called to handle the situation.

    • This question is part of the following fields:

      • Ethical & Legal
      18.5
      Seconds

  • Question 18 - A 36-year-old man presents with severe pain in his right big toe which...

    Correct

    • A 36-year-old man presents with severe pain in his right big toe which is erythematous and swollen. He recently had an appendicectomy. Personal history reveals that he consumes 30 units of alcohol per week. Choose the most likely diagnosis.

      Your Answer: Gout

      Explanation:

      Chronic alcoholism leads to increased levels of uric acid in the blood. Gout is caused by high levels of uric acid.

    • This question is part of the following fields:

      • Musculoskeletal System
      15.6
      Seconds

  • Question 19 - Around 30 patients have been admitted to the hospital following a suspected chemical...

    Correct

    • Around 30 patients have been admitted to the hospital following a suspected chemical attack in the city. The patients are extremely unwell, with symptoms of excessive salivation, lacrimation, diarrhoea, and emesis. Sarin gas was suspected as the most likely agent used in the attack. What is the mechanism of action of this chemical agent?

      Your Answer: Inhibition of acetylcholinesterase

      Explanation:

      Sarin acts by inhibiting acetylcholinesterase.

      Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase
      Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase. This results in high levels of acetylcholine (ACh).

      The effects of excessive ACh can be remembered by the mnemonic DUMBELLS:
      Diarrhoea
      Urination
      Miosis/muscle weakness
      Bronchorrhea/Bradycardia
      Emesis
      Lacrimation
      Salivation/sweating

      Organophosphate insecticide poisoning:
      One of the effects of organophosphate poisoning is inhibition of acetylcholinesterase
      Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
      Salivation
      Lacrimation
      Urination
      Defecation/diarrhoea
      cardiovascular: hypotension, bradycardia
      miosis, muscle fasciculation.

      Organophosphate poisoning is treated with the anti-muscarinic atropine.

    • This question is part of the following fields:

      • Emergency & Critical Care
      39.3
      Seconds

  • Question 20 - A 60-year-old previously well male patient was admitted with acute severe central chest...

    Incorrect

    • 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: Give thrombolysis immediately

      Correct 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.

    • This question is part of the following fields:

      • Cardiovascular System
      44.6
      Seconds

  • Question 21 - A study is done on 1000 patients to assess the specificity of a...

    Incorrect

    • A study is done on 1000 patients to assess the specificity of a new rapid finger-prick blood test developed to help diagnose deep vein thrombosis (DVT). The new test was positive on 200 patients with DVT and on 100 patients without DVT. It was also negative on 20 patients with DVT and 680 without DVT. What is the specificity of the new test?

      Your Answer: 680/880

      Correct Answer: 680/780

      Explanation:

    • This question is part of the following fields:

      • Evidence Based Medicine
      75.8
      Seconds

  • Question 22 - In diabetes, what is the most common finding on renal biopsy? ...

    Correct

    • In diabetes, what is the most common finding on renal biopsy?

      Your Answer: Glomerulosclerosis

      Explanation:

      Glomerulosclerosis is the scarring and hardening of the glomeruli known as diabetic glomerulosclerosis occurring in long-standing diabetes.

    • This question is part of the following fields:

      • Renal System
      13.6
      Seconds

  • Question 23 - In last 5 days, an old man has complained of severe left sided...

    Incorrect

    • In last 5 days, an old man has complained of severe left sided headache, which was aggravated by bright lights. He has not vomited but feels nauseated. What is the most likely diagnosis?

      Your Answer: Subdural headache

      Correct Answer: Migraine

      Explanation:

      Migraine without aura have the following characteristics: Nausea and vomiting accompanied by >5 headaches that last for 4-72 hours, plus any unilateral, pulsating headache or are aggravated by routine daily activities.

    • This question is part of the following fields:

      • Nervous System
      58.7
      Seconds

  • Question 24 - A patient was given Penicillin G pre-operatively. Which of the following procedures was...

    Incorrect

    • A patient was given Penicillin G pre-operatively. Which of the following procedures was he waiting for?

      Your Answer: Cholecystectomy

      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)

    • This question is part of the following fields:

      • Emergency & Critical Care
      37.3
      Seconds

  • Question 25 - Which of the following serum tumour markers is the most essential for monitoring...

    Incorrect

    • Which of the following serum tumour markers is the most essential for monitoring the clinical progression of a man with teratoma of the testis following chemotherapy?

      Your Answer: Carcinoembryonic antigen

      Correct Answer: Alpha-fetoprotein

      Explanation:

      Testicular teratomas are best monitored with the following tumour markers: Alpha-fetoprotein (AFP), beta-hCG, and PLAP (placental like isoenzyme of alkaline phosphatase). For ovarian tumours, we use CA125, pancreatic tumours we use CA19-9, CA15-3 for breast carcinoma and carcinoembryonic antigen (CEA) for colonic tumours.

    • This question is part of the following fields:

      • Men's Health
      19
      Seconds

  • Question 26 - A young woman with facial butterfly rash suffers from symmetrical joint pains in...

    Correct

    • A young woman with facial butterfly rash suffers from symmetrical joint pains in her knees and elbows. Moreover, she experiences morning stiffness and her ESR is raised. Which of the following would determine the diagnosis?

      Your Answer: Anti-DNA antibodies

      Explanation:

      The symptoms described in the question lead to suspicion of SLE because they fulfil three out of four criteria for a positive diagnosis. Anti-DNA antibodies have a diagnostic power for systemic lupus erythematosus (SLE), being a formal classification criterion.

    • This question is part of the following fields:

      • Musculoskeletal System
      25
      Seconds

  • Question 27 - A 50-year-old lung cancer patient presents with diminished reflexes, retention of urine, postural...

    Correct

    • A 50-year-old lung cancer patient presents with diminished reflexes, retention of urine, postural hypotension and sluggish pupillary reaction. What is the most likely explanation for her symptoms?

      Your Answer: Paraneoplastic syndrome

      Explanation:

      Paraneoplastic syndromes are more common in patients with lung cancer. Signs and symptoms include inappropriate antidiuretic hormone secretion, finger clubbing, hypercoagulability and Eaton-Lambert syndrome.

    • This question is part of the following fields:

      • Respiratory System
      53.1
      Seconds

  • Question 28 - A 23-year-old woman comes for the advice regarding contraceptives. Her mother passed away...

    Incorrect

    • A 23-year-old woman comes for the advice regarding contraceptives. Her mother passed away due to cervical cancer and she worries about cervical cancer. Which of the following is the most suitable contraceptive method for her?

      Your Answer: IUCD

      Correct Answer: Barrier method

      Explanation:

      Cervical cancer results from genital infection with HPV. PV infections can be transmitted via nonsexual routes, but the result from sexual contact. So the best contraceptive method in relation to prevention of cervical cancer is the barrier method. But it will not prevent cervical cancer a 100%.

    • This question is part of the following fields:

      • Women's Health
      79.1
      Seconds

  • Question 29 - A 48-year-old male presented with exertional angina for 2 weeks. He has no...

    Incorrect

    • A 48-year-old male presented with exertional angina for 2 weeks. He has no significant past medical history or cardiac risk factors except a total cholesterol of 5.8 mmol/L. He has been already started on aspirin. Which of the following is the most suitable drug combination for him?

      Your Answer: Diltiazem and statin

      Correct Answer: B-blocker and statin

      Explanation:

      Beta blockers and calcium channel blockers have proven prognostic benefits. Nitrates don’t have any proven prognostic benefits. A statin is indicated for a patient with angina and cholesterol level of 5.5 to 8.5 to prevent risk of myocardial infarction. So the preferred combination from the given answers is beta blocker + statin.

    • This question is part of the following fields:

      • Cardiovascular System
      52.9
      Seconds

  • Question 30 - A 34-year-old woman presents to the emergency department due to right sided weakness....

    Incorrect

    • A 34-year-old woman presents to the emergency department due to right sided weakness. Past history reveals a DVT following the birth of her daughter, and two miscarriages. Head CT confirms an ischaemic stroke in the territory of left middle cerebral artery. What would be the most likely finding on echocardiography?

      Your Answer: Dilated cardiomyopathy

      Correct Answer: Normal

      Explanation:

      The patient most likely suffers from antiphospholipid syndrome. The clinical criteria consist of vascular thrombosis and pregnancy morbidity. Vascular thrombosis is defined as one or more clinical episodes of arterial, venous, or small-vessel thrombosis in any tissue or organ confirmed by findings from imaging studies, Doppler studies, or histopathology. ASD, VSDs would cause paradoxical emboli and stroke, however the recurrent pregnancy loss in this case is strongly suggestive of antiphospholipid syndrome. The ECG would be normal in most cases associated with anti phospholipid syndrome.

    • This question is part of the following fields:

      • Musculoskeletal System
      103.5
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology & Oncology (2/2) 100%
Infectious Diseases (1/1) 100%
Hepatobiliary System (1/1) 100%
Cardiovascular System (1/3) 33%
Endocrine System & Metabolism (2/3) 67%
Emergency & Critical Care (4/5) 80%
Musculoskeletal System (3/4) 75%
Respiratory System (2/3) 67%
Nervous System (0/2) 0%
Immune System (1/1) 100%
Ethical & Legal (1/1) 100%
Evidence Based Medicine (0/1) 0%
Renal System (1/1) 100%
Men's Health (0/1) 0%
Women's Health (0/1) 0%
Passmed
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