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Question 1
Correct
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A 52-year-old cancer patient that recently had an anterior resection of the rectum is concerned about postoperative pain control. What is the most appropriate management choice in his case?
Your Answer: IM morphine
Explanation:Post-operative pain is usually severe and strong analgesia is needed with IM morphine.
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This question is part of the following fields:
- Pharmacology
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Question 2
Correct
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A 39-year-old man was admitted with an exacerbation of asthma. He responded to treatment but the medical intern was concerned that Aspergillus fumigatus was cultured from his sputum.
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Subsequently arranged serum total, IgE level was elevated at 437 ng/ml (normal 40-180 ng/ml), RAST to Aspergillus fumigatus was class III, Aspergillus fumigatus precipitins were negative.
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What would be the most appropriate management step in this patient?Your Answer: No change in medication
Explanation:Allergic bronchopulmonary aspergillosis (ABPA) is a form of lung disease that occurs in some people who are allergic to Aspergillus. With ABPA, this allergic reaction causes the immune system to overreact to Aspergillus leading to lung inflammation. ABPA causes bronchospasm (tightening of airway muscles) and mucus build-up resulting in coughing, breathing difficulty and airway obstruction.
Blood tests are used to look for signs of an allergic reaction. This includes evaluating your immunoglobulin E (IgE) level. This level is increased with any type of allergy. Many people with asthma have higher than normal IgE levels. In ABPA however, the IgE level is extremely high (more than 1000 ng/ml or 417 IU/ml). In addition to total IgE, all patients with ABPA have high levels of IgE that is specific to Aspergillus. A blood test can be done to measure specific IgE to Aspergillus. A blood or skin test for IgE antibodies to Aspergillus can be done to see if a person is sensitized (allergic) to this fungus. If these skin tests are negative (i.e. does not show a skin reaction) to Aspergillus fumigatus, the person usually does not have ABPA.
Therefore, there should be no change in medication since this patient does not have ABPA. -
This question is part of the following fields:
- Respiratory System
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Question 3
Incorrect
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A 35-year-old female had an oral glucose tolerance test. Her oral glucose test after 2 hrs was 10mml/l. What is the result of her test?
Your Answer: Impaired fasting glucose
Correct Answer: Impaired glucose tolerance
Explanation:Impaired glucose tolerance is a pre-diabetic state of hyperglycaemia that is associated with insulin resistance and increased risk of cardiovascular pathology. To diagnose impaired glucose tolerance, the OGTT value after 2 hrs should be 140-199mg/dl (7.7 – 11.0 mmol/l). Impaired fasting glucose is diagnosed as fasting blood sugar between 100 mg/dl to 125 mg/dl.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 4
Incorrect
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A baby born a few days earlier is brought into the emergency with complaints of vomiting, constipation and decreased serum potassium. Which of the following is the most probable cause?
Your Answer: Tracheo-esophageal fistula
Correct Answer: Pyloric stenosis: hypokalaemic hypochloraemic metabolic alkalosis
Explanation:In pyloric stenosis a new-born baby presents with a history of vomiting, constipation and deranged electrolytes. Excessive vomiting leads to hypokalaemia. Difficulty in food passing from the stomach to the small intestine causes constipation. Hypokalaemia also causes constipation. None of the other disorders mentioned present with the hypokalaemia, vomiting and constipation triad in a new-born.
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This question is part of the following fields:
- Gastrointestinal System
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Question 5
Incorrect
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A 45-year-old male presents to A&E, after hitting his car multiple times when reversing. He complains of double vision when he looked back during reversing. He also complains of double vision when looking with an outward gaze. Which is the nerve involved in this patient?
Your Answer: Trochlear nerve
Correct Answer: Abducent nerve
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:
- Nervous System
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Question 6
Incorrect
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A 45-year-old appears at the OPD with symptoms of persistent cough and purulent sputum. He is a chronic smoker and had measles in the past. Upon auscultation, inspiratory crepitation and finger clubbing are noted. What is the single most likely diagnosis?
Your Answer: Sarcoidosis
Correct Answer: Bronchiectasis
Explanation:A history of measles, whooping cough, or other severe lung infections like tuberculosis (TB) and pneumonia can lead to airway damage and possibly bronchiectasis.
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This question is part of the following fields:
- Respiratory System
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Question 7
Incorrect
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A 60-year-old patient with type 2 diabetes mellitus is advised to start taking an ACE-inhibitor in order to control his hypertension. However, he also needs to monitor his renal function. Keeping in mind that he just started an ACE-inhibitor, how long should he wait until he undergoes a blood test to check creatinine and potassium levels?
Your Answer: Six hours after he takes the medication
Correct Answer: One to two weeks after starting the medication
Explanation:ACE inhibitors effectively reduce systemic vascular resistance in patients with hypertension, heart failure or chronic renal disease. This antihypertensive efficacy probably accounts for an important part of their long term renoprotective effects in patients with diabetic and non-diabetic renal disease. Systemic and renal haemodynamic effects of ACE inhibition, both beneficial and adverse, are potentiated by sodium depletion. Consequently, sodium repletion contributes to the restoration of renal function in patients with ACE inhibitor-induced acute renal failure. On the other hand, co-treatment with diuretics and sodium restriction can improve therapeutic efficacy in patients in whom the therapeutic response of blood pressure or proteinuria is insufficient. Patients at the greatest risk for renal adverse effects (those with heart failure, diabetes mellitus and/or chronic renal failure) also can expect the greatest benefit. Therefore, ACE inhibitors should not be withheld in these patients, but dosages should be carefully titrated, with monitoring of renal function and serum potassium levels. The optimum period to check this is one to two weeks after starting the medication.
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This question is part of the following fields:
- Renal System
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Question 8
Correct
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A middle-aged female has undergone axillary lymph node clearance after being diagnosed with breast carcinoma. She was stung by a bee and developed a swollen arm. What is the most probable mechanism behind this arm swelling?
Your Answer: Lymphoedema
Explanation:Lymph nodes are necessary for the drainage of interstitial fluid to avoid swelling after some histamine reactions. In this case no lymph nodes are present and lymphoedema developed.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 9
Incorrect
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A 47-year-old man with a history of alcohol induced liver disease is admitted to the gastroenterology ward. He has developed tense ascites again and a plan is made to site an ascitic drain. His renal function after 2 days is as follows:
Na+ 131 mmol/l
K+ 3.8 mmol/l
Urea 12.2 mmol/l
Creatinine 205 µmol/l
Which of the following pathophysiological changes is most likely to be responsible for the declining renal function?Your Answer: Splanchnic vasoconstriction
Correct Answer: Splanchnic vasodilation
Explanation:Hepatorenal syndrome is renal vasoconstriction that cannot overcome the effects of splanchnic vasodilation. Vasoactive mediators cause this splanchnic vasodilation, reducing SVR, which is sensed by the juxtaglomerular apparatus, activating the RAAS system, leading to renal vasoconstriction. However, the overall splanchnic vasodilation effect is greater than this renal vasoconstriction effect.
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This question is part of the following fields:
- Gastrointestinal System
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Question 10
Incorrect
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A 9-year-old boy was admitted with gastroenteritis. The boy's symptoms started two days ago with profound diarrhoea and emesis. Blood exams show the following: Sodium=148 mmol/l, Potassium=2.2mmol/l, Urea=20 mmol/l, Glucose=4.3mmol/l. What would be the best management?
Your Answer: Dialysis
Correct Answer: V normal saline and potassium supplement
Explanation:The boy needs re-hydration and hydro-electrolytic re-balancing due to fluid losses from the gastroenteritis and subsequent dehydration.
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This question is part of the following fields:
- Gastrointestinal System
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Question 11
Correct
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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: 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 12
Incorrect
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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: Vivax malaria
Correct 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 13
Correct
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A 25-year-old man presents with bloody diarrhoea associated with systemic upset. Blood tests show the following:
Hb 13.4 g/dl
Platelets 467 * 109/l
WBC 8.2 * 109/l
CRP 89 mg/l
A diagnosis of ulcerative colitis is suspected. Which part of the bowel is most likely to be affected?Your Answer: Rectum
Explanation:The most COMMON site of inflammation from ulcerative colitis is the rectum, making this the correct answer. This is simply a fact you need to memorize. In general, ulcerative colitis only occurs in colorectal regions– nothing in the small bowel (unless there is backwash into the terminal ileum) and nothing further up the GI tract. In Crohn’s it can affect the entire GI tract from mouth to anus.
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This question is part of the following fields:
- Gastrointestinal System
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Question 14
Incorrect
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A gentleman arrives at the renal clinic for review. He has long standing chronic renal failure and is unfortunately suffering from metabolic bone disease. His GP has asked for an explanation of the causes and features of metabolic bone disease.
Which of the following best describes the biochemical changes involved?Your Answer: Levels of 1,25-OH vitamin D are increased
Correct Answer: Phosphate excretion is decreased, parathyroid hormone levels are increased and 1,25-OH vitamin D levels are decreased
Explanation:The patient’s chronic renal failure causes decreased renal hydroxylation of vitamin D which leads to decreased calcium absorption in the gut. Simultaneously, there is also decreased renal excretion of phosphate, and this combination of factors results in increased PTH levels.
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This question is part of the following fields:
- Renal System
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Question 15
Incorrect
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Which of the following does the inferior mesenteric artery supply?
Your Answer: From the duodenum to the first two thirds of the transverse colon
Correct Answer: From the splenic flexure to the first third of the rectum
Explanation:The coeliac axis supplies the liver and stomach and from the oesophagus to the first half of the duodenum.
The second half of the duodenum to the first two thirds of the transverse colon is supplied by the superior mesenteric artery.
The inferior mesenteric supplies the last third of the transverse colon (approximately from the splenic flexure) to the first third of the rectum.
The last two thirds of the rectum are supplied by the middle rectal artery.
The greater curvature of the stomach is supplied by branches of the splenic artery, which itself comes from the coeliac axis. -
This question is part of the following fields:
- Gastrointestinal System
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Question 16
Correct
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Question 17
Correct
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Choose the correct definition regarding the standard error of the mean:
Your Answer: Standard deviation / square root (number of patients)
Explanation:The SEM is an indicator of how close the sample mean is to the population mean. In reality, however, only one sample is extracted from the population. Therefore, the SEM is estimated using the standard deviation (SD) and a sample size (Estimated SEM). The SEM computed by a statistical program is an estimated value calculated via this process.
Estimated Standard Error of the Mean (SEM)=SDn?
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This question is part of the following fields:
- Evidence Based Medicine
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Question 18
Incorrect
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Her parents with a severe headache present a 24-year-old woman. She is afraid of light and sun and prefers darker environments. On examination, a generalized rash that does not blanch on pressure is noticed. What is the best action in this case?
Your Answer: Gown and mask
Correct Answer: IV benzylpenicillin
Explanation:The rash is a characteristic sign of meningitis. Added to photophobia, headache and neck rigidity, meningitis is highly suggested diagnosis. IV antibiotics should be started immediately.
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This question is part of the following fields:
- Infectious Diseases
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Question 19
Incorrect
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Which of the following features is not associated with an oculomotor nerve palsy?
Your Answer: Diplopia
Correct Answer: Miosis
Explanation:Oculomotor nerve palsy is an eye condition resulting from damage to the third cranial nerve or a branch thereof. A complete oculomotor nerve palsy will result in a characteristic down and out position in the affected eye. This is because the lateral rectus (innervated by the sixth cranial nerve) and superior oblique (innervated by the fourth cranial or trochlear nerve), is unantagonized by the paralyzed superior rectus, inferior rectus and inferior oblique. The affected individual will also have a ptosis, or drooping of the eyelid, and mydriasis (pupil dilation), not miosis.
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This question is part of the following fields:
- Nervous System
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Question 20
Incorrect
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An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Toxoplasmosis
Correct Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
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This question is part of the following fields:
- Infectious Diseases
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Question 21
Incorrect
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A 35-year-old male is admitted following a collapse while competing in an iron man triathlon. His blood results are as follows:
Na+ 122 mmol/l
K+ 3.4 mmol/l
Urea 3.2 mmol/l
Creatinine 69 umol/l
During assessment he becomes increasingly obtunded and goes on to have multiple tonic clonic seizures. What is the most appropriate treatment from the list below to improve his neurological status?Your Answer: Decompressive craniotomy
Correct Answer: Hypertonic saline
Explanation:Over consumption of fluids, prolonged race duration and inadequate training all can predispose to acute hyponatraemia.
Mild symptoms include a decreased ability to think, headaches, nausea, and an increased risk of falls. Severe symptoms include confusion, seizures, and coma. Normal serum sodium levels are 135 – 145 mEq/liter (135 – 145 mmol/L). Hyponatremia is generally defined as a serum sodium level of less than 135 mEq/L and is considered severe when the level is below 120 mEq/L.
The correct treatment to give is hypertonic saline. Decompressive craniotomy would help alleviate raised intracranial pressure due to cerebral oedema however is not an appropriate first line treatment. Demeclocycline is used for SIADH and mannitol is more likely to be used in the context of traumatic brain injury.
Hyponatremia is corrected slowly, to lessen the risk of the development of central pontine myelinolysis (CPM), a severe neurological disease involving a breakdown of the myelin sheaths covering parts of nerve cells. During treatment of hyponatremia, the serum sodium (salt level in the blood) should not rise by more than 8 mmol/L over 24 hours. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 22
Incorrect
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A 68-year-old woman with contralateral hemisensory loss presents with severe burning pain in this area. In which of the following areas has arterial occlusion most probably occurred?
Your Answer: Superior division of middle cerebral artery (dominant hemisphere)
Correct Answer: Thalamogeniculate artery
Explanation:The woman’s clinical evolution suggests that there was a thalamic stroke in the contralateral hemisphere. The artery most likely affected is the thalamogeniculate artery. Sensory loss is usually unilateral and presents at the opposite side of the brain lesion. This kind of stroke can result in severe burning pain which is responsive to tricyclics.
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This question is part of the following fields:
- Nervous System
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Question 23
Incorrect
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All of the following are true regarding the management of thyroid diseases during pregnancy, except?
Your Answer: Untreated thyrotoxicosis increases the risk of premature labour
Correct Answer: Block-and-replace is preferable in pregnancy compared to antithyroid drug titration
Explanation: -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 24
Incorrect
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A 44-year-old man presents suffering from retrosternal chest pain that started 2 hours ago and radiates to the throat. Which investigation would you immediately perform?
Your Answer: Echocardiogram
Correct Answer: Troponin levels
Explanation:The patient’s age and symptoms are indicating a myocardial infarction. Although, the cause of the pain could also be related to the digestive system, a possible myocardial infarction should be excluded or, if present, managed immediately. Troponins are used to establish the diagnosis. Levels of troponin can become elevated in the blood within 3 or 4 hours after heart injury and may remain elevated for 10 to 14 days.
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This question is part of the following fields:
- Cardiovascular System
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Question 25
Incorrect
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A 28-year-old male complained of an annular rash following an insect bite he received during a hiking trip. Which of the following is the drug of choice?
Your Answer: Flucloxacillin PO
Correct Answer: Doxycycline PO
Explanation:The described rash is the typical rash of erythema migrans of Lyme disease, which is treated by doxycycline PO
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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 24-year-old female, 28 weeks pregnant presents to the clinic complaining of shortness of breath and right sided pleuritic chest pain. The doctor suspects pulmonary embolism.
Which of the following statement is incorrect regarding the management of this case?Your Answer: Chest x-ray should be performed
Correct Answer: Ventilation-perfusion scanning exposes the foetus to less radiation than computed tomographic pulmonary angiography
Explanation:V/Q scanning carries a slightly increased risk of childhood cancer compared with CTPA – 1/280,000 versus less than 1/1,000,000 – but carries a lower risk of maternal breast cancer. The rest of the options are true.
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This question is part of the following fields:
- Respiratory System
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Question 27
Incorrect
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Which of the following drugs would be the safest to prescribe in a 22-year-old man with seropositive rheumatoid arthritis who is planning to start a family?
Your Answer: Leflunomide
Correct Answer: Prednisolone
Explanation:Prednisolone although has many undesirable side effects it may be considered relatively safe compared to the drugs that are provided here. Prolonged treatment with sulphasalazine may depress semen quality and cause irreversible infertility. Methotrexate and leflunomide both inhibit purine/pyrimidine synthesis (the former by inhibiting folate metabolism) and are contraindicated in pregnancy or while trying to conceive. In males, a temporary or permanent decrease in sperm count may occur with cyclophosphamide. Because the recovery of fertility after cyclophosphamide therapy is variable, sperm banking should be considered before treatment is begun.
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This question is part of the following fields:
- Musculoskeletal System
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Question 28
Incorrect
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A 70-year-old complains of lower urinary tract symptoms. Which one of the following statements regarding benign prostatic hyperplasia is incorrect?
Your Answer: 5 alpha-reductase inhibitors typically decrease the prostate specific antigen level
Correct Answer: Goserelin is licensed for refractory cases
Explanation:Goserelin (Zoladex) is usually prescribed to treat hormone-sensitive cancers of the breast and prostate not for BPH. All other statements are correct.
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This question is part of the following fields:
- Renal System
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Question 29
Incorrect
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A 50-year-old woman under treatment for manic-depressive psychosis presents in an unconscious state after an episode of seizure on the street. Her husband who accompanied her into the ER reported that they argued about 6-7 hours ago. On examination, she is found to be hypertonic with a GCS of 8, BP: 90/60 mmHg and a pulse of 105 bpm. Blood investigations revealed a lithium level of 3.2 mmol/L. She was intubated and ventilated. Which of the following interventions is most appropriate in this case?
Your Answer: Activated charcoal is likely to be effective
Correct Answer: Gastric lavage and normal saline infusion
Explanation:Among the above statements, gastric lavage and normal saline IV infusion are the most appropriate interventions for a patient of acute lithium toxicity.
Activated charcoal is not effective after lithium overdose, although gastric lavage should be considered if patients present within 6-8 h.
Where levels are above 3 mmol/l, the use of normal saline to induce diuresis should be considered, although careful monitoring of fluid balance is necessary.
Where levels of lithium are above 4 mmol/l, dialysis is often required. Haemodialysis is preferred, but in a facility where haemodialysis is not possible, peritoneal dialysis may be considered.
Patients should not be discharged until they are asymptomatic and have a serum lithium level less than 1.5 mEq/L. -
This question is part of the following fields:
- Pharmacology
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Question 30
Incorrect
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A 85-year-old male with a history of Alzheimer's dementia was brought into Casualty by family members, who stated that he had episodes of aggression. Which of the following drugs is most suitable as the pharmacological management for this presentation?
Your Answer:
Correct Answer: Risperidone
Explanation:Regarding the pharmacological management, Risperidone is the most suitable drug from the given answers as it is recommended for the treatment of aggression associated with moderate to severe Alzheimer’s disease. Quetiapine and Benzodiazepine are not recommended.
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This question is part of the following fields:
- Geriatric Medicine
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SESSION STATS - PERFORMANCE PER SPECIALTY
