-
Question 1
Incorrect
-
A female palliative cancer patient has painful bone metastases. Which breakthrough dose of morphine would you prescribe, if she has been taking long acting morphine tablets (120mg) every 12 hours?
Your Answer: 80 mg
Correct Answer: 40 mg
Explanation:To calculate the breakthrough dose for oral morphine solution, you need to find the dose she should receive every 4 hours, according to the total amount of morphine she receives. If she is receiving 120 mg every 12 hours, then she should receive 40 mg every 4 hours as a breakthrough dose.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 2
Incorrect
-
A 50-year-old farmer presented with fever, malaise, cough, and shortness of breath. He also reports a history of severe weight loss. Examination revealed tachypnoea, coarse end-inspiratory crackles and wheeze. His chest X-ray showed fluffy nodular shadowing and lab results showed polymorphonuclear leucocytosis. Which of the following is the most appropriate diagnosis?
Your Answer:
Correct Answer: Extrinsic allergic alveolitis
Explanation:Extrinsic allergic alveolitis, also known as hypersensitivity pneumonitis, is an allergic response of the lungs to an environmental allergen. Nodular shadowing in the chest X-ray is characteristic of extrinsic allergic alveolitis.
Churg-Strauss syndrome is an auto-immune disorder that is known to cause vasculitis mostly in patients having a pre-existing airway disease.
Cryptogenic organizing pneumonia is an inflammatory condition of the alveoli. The CXR of which shows ground-glass opacifications.
The CXR of progressive massive fibrosis also shows opacifications normally in the upper lung lobes. -
This question is part of the following fields:
- Respiratory
-
-
Question 3
Incorrect
-
A 25-year-old female, expecting twins, complains of decreased fetal movements in her 40th week of gestation. An hour ago, she experienced constant abdominal pain for an hour and passed blood in her urine. What is the next best investigation in this case?
Your Answer:
Correct Answer: Cardiotocograph
Explanation:Cardiotocography (CTG) helps to record the heartbeat of the foetus in parallel to measuring the contractions of the mother’s uterus, this is the most appropriate tool to assess this patient’s condition.
-
This question is part of the following fields:
- Gynaecology
-
-
Question 4
Incorrect
-
A 56 year old woman presents to the clinic complaining of shoulder pain that she has been experiencing for the last 4 weeks. She does not remember getting injured previously. The pain worsens on movement especially when she is moving the arm quickly. At night, lying on the affected side is painful. Examination reveals no erythema or swelling. However, pain is felt on passive abduction between 60 to 120 degrees and she is unable to abduct the arm past 70-80 degrees. Flexion and extension are intact. What is the most likely diagnosis?
Your Answer:
Correct Answer: Supraspinatus tendonitis
Explanation:Supraspinatus tendinopathy is a common and disabling condition that becomes more prevalent after middle age and is a common cause of pain in the shoulder. A predisposing factor is resistive overuse. This patient has the classic painful arc that is a sign of shoulder impingement characteristic of supraspinatus tendonitis.
-
This question is part of the following fields:
- Rheumatology
-
-
Question 5
Incorrect
-
Cytochrome p450 enzymes expressed in hepatocytes serve to?
Your Answer:
Correct Answer: Facilitate oxidations or hydrolysis of drugs.
Explanation:Cytochrome p 450 are a family of proteins involved in drug metabolism which accounts for about 75% of the total metabolism. Most drugs are deactivated directly or by facilitated excretion from the body.
-
This question is part of the following fields:
- Hepatobiliary
-
-
Question 6
Incorrect
-
Which is true of the composition of bile in the human hepatic duct?
Your Answer:
Correct Answer: Contains only actively secreted substances
Explanation:Hepatic bile is an isotonic fluid and its electrolyte composition resembles that of plasma. 97% of water is found in the gallbladder bile, not hepatic duct. Hepatic bile is alkaline. The ratio of bile acids: phosphatidylcholine: cholesterol is 20:1:3. Hepatic bile contai9ns only actively secreted substances.
-
This question is part of the following fields:
- Hepatobiliary
-
-
Question 7
Incorrect
-
A 28 year old male has presented to his doctor with hypertension. Upon examination, he is found to have palpable kidneys. An abdominal ultrasound shows enlarged cystic kidneys on both sides. From the list of options, choose the most likely condition present in this patient.
Your Answer:
Correct Answer: Polycythaemia
Explanation:The most likely diagnosis for this patient is adult polycystic kidneys. This disease is associated with the following: valvular heart abnormalities, incompetence, and aneurysms of the cerebral circulation. It can also be associated with excessive erythropoietin production and polycythaemia. There is an increased incidence of aortic incompetence, and mitral valve prolapse occurs in 25 per cent of patients. Hepatic cysts can also occur, and present in 70 per cent of patients – these can also involve the pancreas in 10 per cent of patients and the spleen. Cerebral berry aneurysms are present in around 5-8 per cent of patients, but familial clustering is also observed. That is if there is a family history, over 20 per cent of patients will also have an aneurysm. Diverticular disease is also thought to be increased in patients with polycystic kidney disease.
-
This question is part of the following fields:
- Renal
-
-
Question 8
Incorrect
-
Which of the following would be the most appropriate treatment (leaving out the current NICE guidelines) for a 29 year old man with erythrodermic psoriasis and arthritis mutilans involving several digits of both hands?
Your Answer:
Correct Answer: Etanercept
Explanation:TNF-alpha inhibitors are known to ameliorate the symptoms and disease activity of Arthritis mutilans (a rare and severe form of psoriatic arthritis), by disabling the cytokines that are involved in inflammation and joint destruction. From the mentioned choices, this would be the most effective option. Methotrexate is the most commonly used DMARD, followed by sulfasalazine used in mild to moderate forms of psoriatic arthritis but has not shown much efficacy in arthritis mutilans. Phototherapy, narrowband UVB light therapy can be very effective in clearing skin lesions.
-
This question is part of the following fields:
- Rheumatology
-
-
Question 9
Incorrect
-
A 35 year old female was afraid of being at crowded places such as supermarkets, trains etc. She felt extreme anxiety at such places and started avoiding such places. Physical examination was normal. Which of the following is the diagnosis of this condition?
Your Answer:
Correct Answer: Agoraphobia
Explanation:Agoraphobia is a psychiatric disorder that results from anxiety regarding and avoidance of situations such as crowds, shopping malls, public transportation, and being away from home.
-
This question is part of the following fields:
- Mental Health
-
-
Question 10
Incorrect
-
Gentamicin is used along with benzylpenicillin in the treatment of infective endocarditis caused by streptococcus viridans. Which of the following mechanisms is present in this case?
Your Answer:
Correct Answer: Inhibition of protein synthesis (translation)
Explanation:Gentamicin acts along with benzylpenicillin to inhibit protein synthesis at the level of ribosomes. Indirectly it inhibits the translation process.
-
This question is part of the following fields:
- Pharmacology
-
-
Question 11
Incorrect
-
A 50-year-old woman visited her gynaecologist complaining of heavy menstrual bleeding for the last two months. She reports to have had her menopause 7 months before consultation. How will you investigate the condition of this patient?
Your Answer:
Correct Answer: Hysteroscopy and D&C
Explanation:This patient is 48 years old and has had amenorrhea which could be a sign of menopause. She then experienced heavy menstrual bleeding, the source of which could be the endometrium. Thus to assess the uterine lining, hysteroscopy seems the best of all the choices mentioned.
-
This question is part of the following fields:
- Genitourinary
-
-
Question 12
Incorrect
-
A 45 year old male has presented at the hospital with an inoperable carcinoma and pain in his back. His pain has since been controlled well with morphine, but he soon starts vomiting. Morphine administration was ceased, and he was started on both fentanyl patches and metoclopramide. He soon develops stiffness in his neck and a fever. From the list of options, choose the cause of his symptoms.
Your Answer:
Correct Answer: Metoclopramide
Explanation:Metoclopramide side-effects are consistent with the patient’s symptoms: fever and stiffness of the neck. The other medications are not consistent with this symptom.
-
This question is part of the following fields:
- Seriously Ill
-
-
Question 13
Incorrect
-
A 48-year-old man presents with severe retrosternal pain, which was present for the past 40 minutes. ECG shows ST elevation and blood tests reveal high troponin levels. He has already been given oxygen, GTN and morphine. What is the next most appropriate step?
Your Answer:
Correct Answer: Percutaneous angiography
Explanation:The patient is experiencing an acute myocardial infarction and percutaneous angiography is the next most appropriate step in management. Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a nonsurgical technique for treating obstructive coronary artery disease, including unstable angina, acute myocardial infarction (MI), and multivessel coronary artery disease (CAD).
-
This question is part of the following fields:
- Cardiovascular
-
-
Question 14
Incorrect
-
A 50-year-old male presented with pain in the left lumbar region. His abdominal X-ray revealed stones in his left kidney. Analysis of one of the stones that he passed in the urine showed that it was composed of uric acid. Which of the following is the most likely cause of this type of renal stone?
Your Answer:
Correct Answer: Thiazide diuretics
Explanation:Like all diuretics, thiazide diuretics decrease the amount of body fluid. This leads to an increase in the concentration of uric acid in the body; hence the chances of forming uric acid stones.
Allopurinol is actually a drug used to treat gout, reducing uric acid levels in the body. Therefore, allopurinol would rather decrease the chances of having uric acid stones.
Primary hyperparathyroidism is not concerned with uric acid stones. It is related to calcium metabolism and hence, calcium stones. -
This question is part of the following fields:
- Renal
-
-
Question 15
Incorrect
-
A 25 year old pregnant woman presents with constant abdominal pain, which has been present for the last few hours. Before the pain started she admits experiencing vaginal blood loss. She's a primigravida in her 30th week of gestation. Upon abdominal examination the uterus seems irritable. CTG is, however, reactive. What is the most probable diagnosis?
Your Answer:
Correct Answer: Antepartum haemorrhage
Explanation:Antepartum haemorrhage presents with bleeding, which may or may not be accompanied by pain. Uterine irritability would suggest abruptio, however contractions are present which may be confused with uterine irritability and in this case, there are no signs of pre-eclampsia present.
-
This question is part of the following fields:
- Obstetrics
-
-
Question 16
Incorrect
-
In the case of absent tibial and popliteal pulses, which artery is most likely injured?
Your Answer:
Correct Answer: Femero-popliteal
Explanation:The popliteal artery is the continuation of the femoral artery. It passes deeply, through the adductor hiatus and continues through the popliteal fossa to reach the lower border of the popliteus muscle, where it branches into the anterior and posterior tibial arteries.
-
This question is part of the following fields:
- Musculoskeletal
-
-
Question 17
Incorrect
-
Which one of the following factors is the most likely etiological factor for abnormally short stature amongst children?
Your Answer:
Correct Answer: Familial short stature
Explanation:Familial/inherited short stature is the most likely and commonest factor resulting in short stature among the children. Klinefelter syndrome is characterised by tall stature, widely spaces nipples and infertility. Other factors include congenital heart disease, maternal deprivation and diabetes mellitus but these are the rare causes.
-
This question is part of the following fields:
- Child Health
-
-
Question 18
Incorrect
-
A 32-year-old man, who is on salbutamol and low dose budesonide, has be suffering from recurrent asthma attacks for the last week. What is the next drug of choice?
Your Answer:
Correct Answer: Salmeterol
Explanation:According to recent guidelines on asthma management, after administering SABA as needed, low doses of ICS are indicated. In this case the patient already takes budesonide so he now requires a long acting beta agonist (LABA), in this case salmeterol.
-
This question is part of the following fields:
- Respiratory
-
-
Question 19
Incorrect
-
A 45 year old male complains of abdominal pain and loose stools. On endoscopy, multiple ulcers were seen from the oesophagus until the stomach. What will be the next best investigation for this patient?
Your Answer:
Correct Answer: Serum gastrin estimation
Explanation:Serum gastrin level will helps in the diagnosis of Zollinger-Ellison syndrome, which is characterised by a history of recurrent and multiple gastric ulcers, due to increase gastrin secretion by the cells.
-
This question is part of the following fields:
- Gastrointestinal
-
-
Question 20
Incorrect
-
An elderly man presents with fever of 38°C and a very severe headache. His BP is 85/50 mm Hg. He has neck stiffness and photophobia. What is the most appropriate management?
Your Answer:
Correct Answer: CT head
Explanation:In elderly patients, symptoms suggestive of meningitis could be due to an intracranial mass lesion (such as abscess, tumour or an intracerebral haematoma). Therefore elderly patients are increased risk of cerebral herniation from an LP. A CT head should be done before an LP to exclude a mass lesion.
-
This question is part of the following fields:
- Older Adult
-
-
Question 21
Incorrect
-
A 51-year-old man speaks fast and does not take enough breaths before speaking again. He ignores interruptions and does not want to pause in between. What best describes this kind of speech?
Your Answer:
Correct Answer: Pressure of speech
Explanation:A pressured speech is too fast for the listener to understand and is very difficult to interrupt.
-
This question is part of the following fields:
- Neurology
-
-
Question 22
Incorrect
-
A 6-year-old boy was admitted with a burn that looks third or fourth degree upon inspection. He has not stopped crying. What is the most appropriate next step?
Your Answer:
Correct Answer: IV fluid start
Explanation:The boy needs re-hydration due to his full thickness burn so IV fluids is the next most appropriate step. The greatest loss of plasma occurs in the first 12 hours after burn injury. The plasma loss then slowly decreases during the second 12 hours of the post-burn phase, although extensive leakage can continue for up to three days (Ahrns, 2004). Optimal fluid replacement during this period is essential to ensure cardiac output and renal and tissue perfusion. Usually, 36 hours post-burn, capillary permeability returns to normal and fluid is drawn back into the circulation. Burns of more than 15% of surface body area in adults and of over 10% in children warrant formal resuscitation.
The Parkland formula for the total fluid requirement in 24 hours is as follows:
4ml x TBSA (%) x body weight (kg);
50% given in first eight hours;
50% given in next 16 hours.
Children receive maintenance fluid in addition, at an hourly rate of:
4ml/kg for the first 10kg of body weight plus;
2ml/kg for the second 10kg of body weight plus;
1ml/kg for >20kg of body weight.
End point
Urine – adults: 0.5–1.0 ml/kg/hour;
Urine – children: 1.0–1.5ml/kg/hour. -
This question is part of the following fields:
- Child Health
-
-
Question 23
Incorrect
-
A 57 year old, alcoholic male was admitted to the medical ward for an ascitic tap. The ascitic fluid was found to be yellow in colour. Which of the following had most likely lead to this observation?
Your Answer:
Correct Answer: Decompensated cirrhosis
Explanation:Uncomplicated cirrhotic ascites is usually translucent. If the patient is deeply jaundiced, the fluid might appear yellow/brown.
Turbidity or cloudiness of the ascites fluid suggests that infection is present and further diagnostic testing should be performed.
Pink or bloody fluid is most often caused by mild trauma, with subcutaneous blood contaminating the sample.
Bloody ascites is also associated with hepatocellular carcinoma or any malignancy-associated ascites.
Milky-appearing fluid usually has an elevated triglyceride concentration. Such fluid, commonly referred to as chylous ascites, can be related to thoracic duct injury or obstruction or lymphoma, but it is often related primarily to cirrhosis. -
This question is part of the following fields:
- Hepatobiliary
-
-
Question 24
Incorrect
-
You are asked to fill the first part of a cremation form. Which of the following would need to be removed prior to cremation?
Your Answer:
Correct Answer: Pacemaker
Explanation:Pacemakers have small electrical parts installed in them that can explode when exposed to extreme heat and pressure.
-
This question is part of the following fields:
- Ethical
-
-
Question 25
Incorrect
-
A 65 year old, heavily alcohol dependent man came to the hospital with bleeding gums and petechiae upon examination. Which of the following is the likely vitamin deficiency?
Your Answer:
Correct Answer: C
Explanation:Vitamin deficiencies can happen in alcoholics due to malabsorption. Vitamin C deficiency or scurvy can result in bleeding gums and early symptoms including body weakness and lethargy. Other vitamin deficiencies can cause the following:
B1 or thiamine – Wernicke’s encephalopathy
B12 or cyanocobalamin – spinal cord degeneration
Vitamin K – anticoagulant effects
Vitamin E – neuropathies. -
This question is part of the following fields:
- Gastrointestinal
-
-
Question 26
Incorrect
-
Tumour suppressor genes MLH1 and MSH2 are affected in which familial cancer?
Your Answer:
Correct Answer: Hereditary non-polyposis colonic carcinoma (HNPCC)
Explanation:In hereditary non-polyposis colonic carcinoma (HNPCC), mutations in MSH2, MSH6, PMS2 or MLH1 genes are found.
Ataxia telangiectasia – ATM gene is affected.
Familial adenomatous polyposis – APC gene is affected.
Li-Fraumeni syndrome – mutation of the TP53 tumour suppressor gene. Neurofibromatosis – mutation in or a deletion of the NF1 gene -
This question is part of the following fields:
- Gastrointestinal
-
-
Question 27
Incorrect
-
A 50-year-old female presented with the complaints of depression and sleep disturbance for the past 3 months. She also reported problems with her memory, which recently developed, and difficulty in writing. During examination, myoclonus was also noted in her upper limbs. Which of the following is the most possible cause?
Your Answer:
Correct Answer: Creutzfeldt-Jakob disease
Explanation:Creutzfeldt-Jakob disease presents with dementia, myoclonus and certain neurological findings. Dementia can be accompanied by any neurological deficit. This disease is caused by prion proteins.
-
This question is part of the following fields:
- Mental Health
-
-
Question 28
Incorrect
-
A 34 year old known alcoholic male has been found unconscious near a pub. The paramedics that attended to him said he was sweating and surrounded by empty cans of cider. Choose the most appropriate initial investigation from the list of options.
Your Answer:
Correct Answer: Capillary blood sugar
Explanation:Capillary blood sugar should be tested as alcohol-induced hypoglycaemia can present itself in cases such as these.
-
This question is part of the following fields:
- Seriously Ill
-
-
Question 29
Incorrect
-
A 39-year-old female had surgery for the removal of thyroid carcinoma. One week later, she presented in the OPD with complaints of numbness, tingling, involuntary spasm of the upper extremities, paraesthesia and respiratory stridor. Which of the following is the most likely cause?
Your Answer:
Correct Answer: Hypocalcaemia
Explanation:Hypocalcaemia presents with such symptoms. It probably happened due to accidental removal of a parathyroid gland during the thyroid surgery. Hypocalcaemia causes laryngospasm which produces stridor.
-
This question is part of the following fields:
- Endocrine
-
-
Question 30
Incorrect
-
A 70-year-old male came to the OPD with complaints of nocturia, difficulty in initiating urination and continuous dribbling of urine afterwards. A transrectal US guided biopsy was performed and the diagnosis of BPH was made. His TURP was planned. Which of the following electrolyte imbalance is most likely to occur?
Your Answer:
Correct Answer: Hyponatremia
Explanation:In a TURP procedure, fluid is used to irrigate the bladder and to remove blood clots. IV fluids are also given to the patient post-operatively. These factors will lead to dilutional hyponatremia.
-
This question is part of the following fields:
- Genitourinary
-
SESSION STATS - PERFORMANCE PER SPECIALTY
