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Question 1
Incorrect
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A 25 yr. old previously well male presented with chest discomfort and difficulty in breathing while running to the bus. Symptoms disappeared after resting. But the symptoms reappeared whilst he was climbing the stairs. On examination he was not dyspnoeic at rest. BP was 110/70 mmHg and pulse rate was 72 bpm. His heart sounds were normal. There was an additional clicking noise in the fourth left intercostal space which is heard with each heart beat. Which of the following is the most probable cause for his presentation?
Your Answer: Aortic dissection
Correct Answer: Spontaneous pneumothorax
Explanation:The given history is more compatible with spontaneous pneumothorax. Left-sided pneumothoraxes may be associated with a clicking noise, which is heard with each heart-beat and can sometimes be heard by the patient.
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This question is part of the following fields:
- Cardiology
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Question 2
Incorrect
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Which of the following symptoms are more indicative of mania than hypomania?
Your Answer: Predominately elevated mood
Correct Answer: Delusions of grandeur
Explanation:The delusion of grandeur is more indicative of mania than hypomania.
While criteria (e.g. ICD-10, DSM-5) vary regarding the diagnosis between hypomania and mania, the consistent difference between mania and hypomania is the presence of psychotic symptoms.Hypomania vs. mania:
The presence of psychotic symptoms such as delusions of grandeur
auditory hallucinations point towards mania rather than hypomania/The following symptoms are common to both hypomania and mania
Mood:
Predominately elevated
IrritableSpeech and thought:
Pressured
Flight of ideas
Poor attentionBehaviour
Insomnia
Loss of inhibitions: sexual promiscuity, overspending, risk-taking
increased appetite -
This question is part of the following fields:
- Psychiatry
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Question 3
Incorrect
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A 22 year old nulliparous female presents with shortness of breath. She has a history of recurrent deep vein thrombosis. Complete blood count and clotting screen reveals the following results: Hb: 12.4 g/dl Plt: 137 WBC: 7.5*109/l PT: 14 secs APTT: 46 secs Which of the following would be the most likely diagnosis?
Your Answer: Protein C deficiency
Correct Answer: Antiphospholipid syndrome
Explanation:The combination of APTT and low platelets with recurrent DVTs make antiphospholipid syndrome the most likely diagnosis.
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This question is part of the following fields:
- Rheumatology
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Question 4
Correct
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A 49 year old female presents to the clinic complaining of pain in her left elbow that is localized to the left lateral epicondyle. She has spent the weekend painting her house. A diagnosis of lateral epicondylitis is suspected. The pain would characteristically worsen on which of the following movements?
Your Answer: Resisted wrist extension with the elbow extended
Explanation:Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles, thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which results in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.
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This question is part of the following fields:
- Rheumatology
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Question 5
Correct
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A 27-year-old male is admitted after drinking engine coolant in an apparent suicide attempt. Lab investigations reveal: pH 7.1 (7.36-7.44) pO2 15.3 kPa (11.3-12.6) pCO2 3.2 kPa (4.7-6.0) Standard bicarbonate 2.2 mmol/L (20-28) Serum calcium 1.82 mmol/L (2.2-2.6) After replacing calcium, which of the following is the most urgent treatment for this man?
Your Answer: 8.4% bicarbonate infusion
Explanation:Carbon monoxide has high affinity for haemoglobin and myoglobin resulting in a left-shift of the oxygen dissociation curve and tissue hypoxia. There are approximately 50 deaths per year from accidental carbon monoxide poisoning in the UK. In these circumstances, antidotal therapy to block alcohol dehydrogenase with ethanol or 4-MP alone is insufficient to treat the poisoning. Data suggest that a severe lactic acidosis needs initial correction and in this patient the most appropriate treatment would be IV fluids with bicarbonate to correct the metabolic acidosis. Haemodialysis may be required thereafter.
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This question is part of the following fields:
- Pharmacology
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Question 6
Correct
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A 13 yr. old boy presented with difficulty in breathing on exertion. According to his mother who was also present, his exercise tolerance has been gradually worsening for the past weeks. It has reached the point where he is unable to participate in his weekly soccer match. Cardiac catherization was performed and the results are given below: (Anatomical site vs Oxygen saturation (%)vs Pressure (mmHg)) Superior vena cava: 73 ,–. Right atrium: 71, 6. Right ventricle: 72, –. Pulmonary artery: 86, 53/13. PCWP: –, 15. Left ventricle: 97, 111/10. Aorta: 96, 128/61. Which of the following is the diagnosis?
Your Answer: Patent ductus arteriosus
Explanation:The oxygen saturation in the pulmonary artery is higher than that of the right ventricle. The pressure of the pulmonary artery and of the PCWP are also high. So patent ductus arteriosus is highly suggestive.
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This question is part of the following fields:
- Cardiology
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Question 7
Correct
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A 38-year-old musician presented with a two-day history of sudden-onset occipital headache associated with nausea and vomiting. The next day, his right hand became weak for a few hours. On the same day he had an episode of sensory disturbance in his right upper limb consisting of tingling in his hand that spread up the arm, to his shoulder lasting less than two minutes in total. On the day of admission he had a similar episode of sensory disturbance lasting 30 seconds in total. On examination he had bilateral papilledema, no neck stiffness and an otherwise normal neurological examination. Which of the following is the most likely diagnosis?
Your Answer: Venous sinus thrombosis
Explanation:Cerebral venous sinus thrombosis (CVST) is associated with headache (>90% of cases), seizures, focal weakness (40%) and papilledema (40%), all seen in this patient.
Risk factors for CVST include genetic or acquired prothrombotic disorders, pregnancy, the oral contraceptive pill, vasculitis, malignancy, dehydration and infection. However, there are multiple other associated factors.
Diagnosis is normally confirmed with magnetic resonance venography (MRV). Treatment is with anticoagulation, initially with heparin and subsequently with warfarin. -
This question is part of the following fields:
- Neurology
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Question 8
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 9
Correct
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A 19-year-old male presented with a fever and fatigue. On examination, he had multiple lesions on his back and abdomen in various forms. Which of the following is the most probable diagnosis?
Your Answer: Varicella zoster
Explanation:Patients with varicella zoster infection present with general fatigue and fever along with multiple lesions which do not appear to be identical.
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This question is part of the following fields:
- Infectious Diseases
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Question 10
Incorrect
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A 30 yr. old primigravida in her 23rd week of pregnancy presented with palpitations. Her ECG showed supraventricular tachycardia (SVT). 15 minutes after admission the SVT spontaneously reverted to sinus rhythm. She had two episodes of SVT later which were associated with palpitations. Which of the following is the most appropriate treatment for this presentation?
Your Answer: Flecainide
Correct Answer: Verapamil
Explanation:Both long-acting calcium channel blockers and beta blockers improve symptoms of patients with SVT. Verapamil does not have adverse maternal or fetal side effects which would suggest that the use of verapamil in the treatment of supraventricular arrhythmias in pregnancy is safe and effective. Beta blockers are associated with intrauterine fetal growth restriction.
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This question is part of the following fields:
- Cardiology
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Question 11
Correct
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A 20 year old woman presents to the hospital with sharp, left-sided chest pain and shortness of breath. On examination her pulse is 101 beats per minute and blood pressure is 124/61 mmHg. She is seen to be mildly breathless at rest but her oxygen saturation on air was 98%. CXR reveals a left pneumothorax with a 4 cm rim of air visible. Which management strategy is appropriate in this patient?
Your Answer: Needle aspiration
Explanation:Pneumothorax is defined as air in the pleural space and may be classified as spontaneous, traumatic or iatrogenic. Primary spontaneous pneumothorax occurs in patients without clinically apparent lung disease.
Primary pneumothorax has an incidence of 18-28 per 100,000 per year for men and 1.2-6 per 100,000 per year for women. Most patients present with ipsilateral pleuritic chest pain and acute shortness of breath. Shortness of breath is largely dependent on the size of the pneumothorax and whether there is underlying chronic lung disease.Young patients may have chest pain only. Most episodes of pneumothorax occur at rest. Symptoms may resolve within 24 hours in patients with primary spontaneous pneumothorax. The diagnosis of a pneumothorax is confirmed by finding a visceral pleural line displaced from the chest wall, without distal lung markings, on a posterior-anterior chest radiograph.
Breathless patients should not be left without intervention regardless of the size of pneumothorax. If there is a rim of air >2cm on the chest X-ray, this should be aspirated.
Aspiration is successful in approximately 70 per cent of patients; the patient may be discharged subsequently. A further attempt at aspiration is recommended if the patient remains symptomatic and a volume of less than 2.5 litres has been aspirated on the first attempt.If unsuccessful, an intercostal drain is inserted. This may be removed after 24 hours after full re-expansion or cessation of air leak without clamping and discharge may be considered.
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This question is part of the following fields:
- Respiratory
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Question 12
Correct
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An 82-year-old man is reviewed in the haematology clinic. He has been referred due to weight loss, lethargy, and a significantly elevated IgM level. His recent blood results show: Hb: 13.8 g/dL, Plts: 127 x 10^9/L, ESR: 45 mm/hr, IgM: 2150 mg/dL (50-330 mg/dL). Given the probable diagnosis, which one of the following complications is he most likely to develop?
Your Answer: Hyperviscosity syndrome
Explanation:The patient is most likely suffering from Waldenström’s macroglobulinemia in which IgM paraproteinemia is found. Hyperviscosity syndrome can occur in the patients accounting for 10–15% of the cases.
Waldenström’s macroglobulinemia (also called lymphoplasmacytic lymphoma) is an uncommon type of non-Hodgkin lymphoma seen in older people. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein. Its features include monoclonal IgM paraproteinemia; hyperviscosity syndrome leading to bilateral central retinal vein occlusion (CRVO) and hence, visual disturbances; weight loss and lethargy; hepatosplenomegaly and lymphadenopathy; and cryoglobulinemia. It is not, however, associated with bone pain.
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This question is part of the following fields:
- Haematology & Oncology
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Question 13
Correct
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The family of a 10-year-old boy was advised to take the boy to see an oncologist, for suspected lymphoma. The boy had lymphadenopathy on presentation. His mother says that he's had a fever, night sweats and has experienced weight loss. The boy underwent a lymph node biopsy at the oncologist which suggests Burkitt's lymphoma. Which oncogene are you expecting to see after molecular testing?
Your Answer: c-MYC
Explanation:Burkitt lymphoma is a germinal centre B-cell-derived cancer that was instrumental in the identification of MYC as an important human oncogene more than three decades ago. Recently, new genomics technologies have uncovered several additional oncogenic mechanisms that cooperate with MYC to create this highly aggressive cancer.
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This question is part of the following fields:
- Clinical Sciences
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Question 14
Correct
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What is the mechanism of action of carbimazole?
Your Answer: Inhibition of the iodination of tyrosine
Explanation:Carbimazole is used to treat hyperthyroidism. Carbimazole is a pro-drug as after absorption it is converted to the active form, methimazole. Methimazole prevents thyroid peroxidase enzyme from coupling and iodinating the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4 (thyroxine).
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This question is part of the following fields:
- Pharmacology
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Question 15
Correct
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Which of the following features occurs very less frequently with drug induced lupus?
Your Answer: Glomerulonephritis
Explanation:Drug induced lupus typically presents with pulmonary involvement and no renal or neurological involvement. Hence glomerulonephritis would be highly unlikely in this case. Rash and arthralgias are classic presentations. Pleurisy can be present as pulmonary involvement may occur with DILE.
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This question is part of the following fields:
- Rheumatology
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Question 16
Correct
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A 35 year old patient presented with a cough, wheezing and difficulty in breathing which wakes him up in the night. He also has a itchy, dry and scaly skin rash. Which of the following is the most probable diagnosis?
Your Answer: Eczema
Explanation:The skin lesion is most probably eczema. It is common among atopic people. Asthma is a common association.
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This question is part of the following fields:
- Dermatology
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Question 17
Correct
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Which form of study design would you choose if you were trying to ascertain whether the use of dummies in infants is correlated with sudden infant death syndrome?
Your Answer: Case-control study
Explanation:A case-control study is designed to help determine if an exposure is associated with an outcome (i.e., disease or condition of interest). In theory, the case-control study can be described simply. Case-control studies have specific advantages compared to other study designs. They are comparatively quick, inexpensive, and easy. They are particularly appropriate for (1) investigating outbreaks, and (2) studying rare diseases or outcomes. Sudden infant death syndrome is a rare medical event, thus case-control study is the most suitable option.
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This question is part of the following fields:
- Clinical Sciences
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Question 18
Incorrect
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A 25-year-old woman comes to the endocrine clinic for her regular follow up. She has hypertension, controlled by a combination of Ramipril and indapamide and was diagnosed with 11-beta hydroxylase deficiency since birth when she was found to have clitoromegaly. Which of the following is most likely to be elevated?
Your Answer: Oestradiol
Correct Answer: 11-Deoxycortisol
Explanation:11-beta hydroxylase is stimulated by ACTH and responsible for conversion of 11-deoxycortisol to cortisol and deoxycorticosterone to corticosterone.
In 11-beta hydroxylase deficiency, the previously mentioned conversions are partially blocked, leading to:
– Increased levels of ACTH
– Accumulation of 11-deoxycortisol (which has limited biological activity) and deoxycorticosterone (which has mineralocorticoid activity)
– Overproduction of adrenal androgens (DHEA, androstenedione, and testosterone) -
This question is part of the following fields:
- Endocrinology
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Question 19
Correct
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A 71-year-old female presents for investigation of fatigue and weight loss. Investigations reveal: Haemoglobin 9.0 g/dL (11.5-16.5) White cell count 2.0 x109/L (4-11 x109) Platelet count 250 x109/L (150-400 x109) Total protein 74 g/L (61-76) Albumin 28 g/L (37-49) Urea 16 mmol/L (2.5-7.5) Creatinine 250 mol/L (60-110) Plasma glucose 6.5 mmol/L (3.0-6.0) Urine dipstick analysis: Protein+ & blood+ Renal ultrasound: Normal Which one of the following investigations would be most appropriate for this patient?
Your Answer: Plasma protein electrophoresis
Explanation:This patient’s symptoms of anaemia, leukopenia, and elevated non-albumin protein concentration with fatigue and weight loss, point to myeloma. Thus plasma protein electrophoresis or Serum Protein Electrophoresis (SPE) is indicated when there is suspicion of myeloma.
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This question is part of the following fields:
- Nephrology
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Question 20
Incorrect
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One of your colleagues shares with you the fact that he is HBV positive. He's a general surgeon in the local hospital and he's afraid that if people know he might lose his job. However, you try to convince him that it's important to inform occupational health but he explicitly refuses. What is the most appropriate management?
Your Answer:
Correct Answer: Inform your colleague's employing body
Explanation:According to the updated GMC guidelines, patient safety is more important than anything else, thus the correct thing to do is inform your colleague’s employing body.
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This question is part of the following fields:
- Clinical Sciences
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SESSION STATS - PERFORMANCE PER SPECIALTY
