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Question 1
Incorrect
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Which of the following electrolyte abnormalities is most likely to be seen in SIADH?
Your Answer: High serum Na, high serum osmolarity, low urine osmolarity
Correct Answer: Low serum Na, low serum osmolarity, high urine osmolarity
Explanation:In SIADH, there is increased secretion of the ADH hormone resulting in increased water absorption. That’s why there would be decreased serum Na, decreased osmolarity and increased urine osmolarity.
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This question is part of the following fields:
- Endocrine
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Question 2
Correct
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A 5 year old girl presented with short stature, primary amenorrhea, puffy arms and a webbed neck. The most likely diagnosis will be?
Your Answer: Turner’s syndrome
Explanation:Turner’s syndrome is characterised by a webbed neck, short stature, primary amenorrhea and cardiac, renal and muscular defects. Gene analysis shows a single X chromosome in the patients. Downs syndrome has certain cognitive and physical abnormalities, whereas in Klinefelter syndrome there are widely spaced nipples, long arms and infertility and it only occurs in men.
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This question is part of the following fields:
- Genetics
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Question 3
Incorrect
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Choose the standard method for comparing distributions in data sets (such as between the expected frequency of an event and the observed frequency of an event) from the list of options.
Your Answer: Median
Correct Answer: Chi squared (X²) test
Explanation:The Chi-squared test evaluates if two variables are related. The other statistical tests mentioned do not perform this function.
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This question is part of the following fields:
- Epidemiology
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Question 4
Incorrect
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A 68 year old male, previously diagnosed with osteoarthritis presents to your clinic with acute on chronic pain in his big toe. Past history is significant for hypertension for which he takes Bendroflumethiazide 5mg daily. Examination reveals an erythematous, red hot metatarsophalangeal joint that has a knobbly appearance. X-ray shows punched out bony cysts. Which of the following would be the most appropriate long term management for this patient?
Your Answer: Start allopurinol
Correct Answer: Stop Bendroflumethiazide and substitute a calcium antagonist
Explanation:The most likely diagnosis is chronic tophaceous gout, which is classically associated with chronic renal impairment or long term diuretic therapy. There is tophus formation due to urate crystal deposition in and around the joint. These tophi can also form in the bones and soft tissues. Renal manifestations with uric acid include nephrolithiasis and uric acid nephropathy. Whenever there is an acute on chronic attack of gout, the inciting cause must be established and in case of diuretic use, they should be immediately replaced with another medication. Allopurinol is never started during an acute episode. it is first allowed to settle before administration of allopurinol. Although dietary restriction must be observed in people with a propensity of gout, this scenario clearly presents diuretics as the cause.
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This question is part of the following fields:
- Rheumatology
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Question 5
Incorrect
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A 55 year old male presented with a mass in his right groin. On examination there was a pulsatile mass just below the midpoint of the inguinal ligament. Which of the following is the most probable diagnosis?
Your Answer: Saphenavarix
Correct Answer: Femoral hernia
Explanation:Midpoint of the inguinal ligament is halfway between the pubic tubercle and the anterior superior iliac spine (the two attachments of the inguinal ligament). The opening to the inguinal canal is located just above this point. The femoral artery is at the mid-inguinal point which is halfway between the pubic symphysis and the anterior superior iliac spine. As the mass is at the midpoint of the inguinal ligament, the most probable answer is a femoral hernia. A femoral aneurysm is also a possibility.
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This question is part of the following fields:
- Musculoskeletal
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Question 6
Incorrect
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Which among these are the most prevalent organic causes of anxiety symptoms?
Your Answer: Phaeochromocytoma
Correct Answer: Hypoglycaemia
Explanation:The more common anxiety causes that are organic include: paroxysmal supraventricular tachycardias, withdrawal from alcohol or with thyroxine, and drug intoxication. Pheochromocytoma is rare. Anxiety is not caused by carcinoid syndrome, whereas, depression is most likely caused by carcinoma of the bronchus and hyperparathyroidism.
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This question is part of the following fields:
- Mental Health
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Question 7
Correct
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A 42 year-old known smoker underwent emergency splenectomy after a road traffic accident. Later on, despite being mobile he developed a painful swelling of his right calf. Chest X-ray showed left sided lung collapse and abdominal US showed subphrenic fluid collection. The most likely cause of this deep vein thrombosis (DVT) would be?
Your Answer: Splenectomy
Explanation:Splenectomy: after splenectomy chances of thromboembolism are increased due to reactive thrombocytosis.
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This question is part of the following fields:
- Surgery
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Question 8
Incorrect
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A 60-year old male presented to the OPD with a complaint of a rusty-coloured sputum along with a cough for 3 days. His has a history of smoking for 40 years, and a history of significant weight loss. His chest X-ray revealed solid nodules in both lungs and bilateral hilar lymphadenopathy. Out of the following, which one is the most appropriate investigation?
Your Answer: Pleural fluid cytology
Correct Answer: LN biopsy
Explanation:The patient’s age, a history of long-term smoking, and bilateral hilar lymphadenopathy are strong indications of malignancy. Lymph node biopsy would be essential in order to check the degree of metastasis in the mediastinal lymph nodes.
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This question is part of the following fields:
- Respiratory
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Question 9
Incorrect
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A 3-year-old girl presented with rhinorrhoea, barking cough and inspiratory stridor. She was diagnosed with laryngotracheobronchitis. If untreated at this stage which of the following would be the most possible outcome?
Your Answer: Lung abscess
Correct Answer: Complete resolution
Explanation:The prognosis for croup is excellent, and recovery is almost always complete with complications being quite rare. The possible complications are pneumonia, bacterial tracheitis, pulmonary oedema, pneumothorax, pneumomediastinum, lymphadenitis or otitis media. Bacterial tracheitis is a life-threatening infection that can arise after the onset of an acute viral respiratory infection.
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This question is part of the following fields:
- Respiratory
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Question 10
Incorrect
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A 31-year-old woman's blood results after having secondary amenorrhoea that lasted for 6 months are: Testosterone = 3.4 nmol/L (<1.6), Oestradiol = 144 pmol/L (100-500), LH = 12 U/L and FSH = 4 U/L. What sign or symptom is she likely to have?
Your Answer:
Correct Answer: Hirsutism
Explanation:Biochemical features suggest that this patient has polycystic ovary syndrome (PCOS). It is associated with signs and symptoms of hyperandrogenism (oligomenorrhea, irregular menstruation, hirsutism, hair loss, and acne) and elevated testosterone. PCOS patients are often overweight or obese, have insulin resistance (treated with Metformin) and an adverse risk profile for cardiovascular disease.
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This question is part of the following fields:
- Gynaecology
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Question 11
Incorrect
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A father brought his 6-year-old son with cystic fibrosis to the ER department due to massive hematemesis. He is hypotensive and has a tachycardia. Which is the most likely diagnosis?
Your Answer:
Correct Answer: Bleeding oesophageal varices
Explanation:Bleeding oesophageal varices secondary to portal hypertension can cause a massive gastrointestinal haemorrhage resulting in shock. Perforated ulcer is less likely in this age group. Mallory Weiss tear would not likely result in a massive haemorrhage. Aorto-intestinal fistula is more common in older patients with abdominal aneurysms. Boerhaave’s syndrome is a result of a ruptured oesophagus following excessive vomiting.
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This question is part of the following fields:
- Child Health
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Question 12
Incorrect
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A 34 year male is brought to the emergency by the paramedics who found him unconscious after being hit by a car. However, he regained consciousness and began talking. While waiting for the doctor's review, he suddenly becomes comatose and the condition deteriorates. What will be the most likely diagnosis?
Your Answer:
Correct Answer: Extradural haemorrhage
Explanation:Extradural haemorrhage occurs as a result of head trauma and subsequent acute haemorrhage, primarily from the middle meningeal artery between the skull and the dura mater. Typical symptoms are due to compression of the brain and appear after a lucid interval that follows an initial loss of consciousness. Increased intracranial pressure leads to a decline in mental status and anisocoria, in which the ipsilateral pupil is dilated. Diagnosis is confirmed by CT (biconvex, hyperdense, sharply demarcated mass). Emergency treatment is necessary and involves neurosurgical opening of the skull and hematoma evacuation.
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This question is part of the following fields:
- Neurology
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Question 13
Incorrect
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A 25 year-old lady presented with complaints of generalised pruritis during the 3rd trimester of her pregnancy. She was diagnosed as a case of intrahepatic cholestasis of pregnancy. Which one of the following factors carries the greatest risk to the foetus in this disease?
Your Answer:
Correct Answer: Perinatal mortality
Explanation:Intrahepatic cholestasis of pregnancy can affect both mother and foetus, however it is more harmful for the foetus. Amongst foetuses, there is an increased risk of perinatal mortality, meconium aspiration, premature delivery and post partum haemorrhage. Exact cause of fetal death cannot be predicted accurately but it is not related to intra uterine growth retardation or placental insufficiency. The liver can be affected in the mother leading to generalized pruritis but no evidence of fetal hepatic dysfunction has been found.
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This question is part of the following fields:
- Obstetrics
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Question 14
Incorrect
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A 60-year-old male patient was admitted for further investigations, after complaining of symptoms of obstructive uropathy and lower back pain. His wife has noticed that he lost weight over the past two months. Which tumour marker would you expect to see elevated?
Your Answer:
Correct Answer: Prostate specific antigen (PSA)
Explanation:The symptoms suggest prostate cancer with possible bone metastasis, due to the lower back pain. PSA is used for screening for prostate cancer as well as other prostate pathologies. A high PSA level of more than 4 ng/ml will require investigation to exclude cancer, benign prostatic hypertrophy, prostatitis and perineal trauma.
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This question is part of the following fields:
- Urology
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Question 15
Incorrect
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A 4-year-old girl with an abnormal facial appearance has an ejection systolic murmur radiating to between her scapulae. A radio-femoral delay was also found. Which of the following is the most probable cause?
Your Answer:
Correct Answer: Turner's syndrome
Explanation:These cardiovascular findings are suggestive of coarctation of the aorta, which is common among patients with Turner’s syndrome. Physical features of Turner’s syndrome include a short neck with a webbed appearance, a low hairline at the back of the head, low-set ears, and narrow fingernails and toenails that are turned upward.
Atrioventricular septal defect is the most common cardiac anomaly in Down’s syndrome.
Structural heart defects at birth (i.e., ventricular septal defect, atrial septal defect, patent ductus arteriosus) are common in Edward’s syndrome.
Pulmonary stenosis with or without dysplastic pulmonary valve and hypertrophic cardiomyopathy are common in Noonan’s syndrome.
Supravalvar aortic stenosis and peripheral pulmonary stenosis are found in William’s syndrome. -
This question is part of the following fields:
- Child Health
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Question 16
Incorrect
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A 24-year-old female presents with generalised irritation and erythematous skin after sunbathing on the beach. Which is the most appropriate immediate treatment for this patient?
Your Answer:
Correct Answer: Emollient cream
Explanation:Sun burn reactions usually occur after individuals with a light skin tone have prolonged exposure to the sun. The usual symptoms are redness and itching of the skin. The best treatment plan would be further avoidance of sun exposure and the topical application of emollients. These are Ist degree burns and aggressive therapy is not required in such cases.
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This question is part of the following fields:
- Dermatology
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Question 17
Incorrect
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A 71-year-old woman residing in a nursing home for a couple of years complains of drooling of saliva and sudden difficulty in swallowing while eating. She is a known hypertensive on treatment. What would be your next step?
Your Answer:
Correct Answer: Endoscopy
Explanation:Dysphagia or difficulty in swallowing. Endoscopy allows for visual examination of the oesophagus and is indicated in patients with dysphagia to determine the underlying aetiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy including dilation.
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This question is part of the following fields:
- Older Adult
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Question 18
Incorrect
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A 33 year old lady presented with complaints of an erythematous rash over her shins, along with arthritis and painful swollen knees. What will be the single most likely finding on her chest X-ray?
Your Answer:
Correct Answer: Bilateral hilar lymphadenopathy
Explanation:Lofgren’s syndrome is characterised by a triad of erythema nodosum, arthritis and bilateral lymphadenopathy. It is a variant of sarcoidosis.
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This question is part of the following fields:
- Respiratory
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Question 19
Incorrect
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A 20 year old male, who was otherwise completely healthy, has developed severe and sudden pain in his lower back. It started after getting up from his bed. What is the most probable diagnosis in this case?
Your Answer:
Correct Answer: PID
Explanation:Sudden onset of severe lower back pain whilst is felt more when bending (such as getting up from a bed) is consistent with a diagnosis of a prolapsed intervertebral disc.
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This question is part of the following fields:
- Musculoskeletal
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Question 20
Incorrect
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A diabetic 50 year old male presented in the emergency room with ischaemic gangrene of the lower leg, ulceration over the medial malleolus and infection spreading proximally. Which of the following types of amputation is most suitable in this patient?
Your Answer:
Correct Answer: Below knee amputation
Explanation:The type of amputation depends on the degree of gangrene, ischaemia and the extent of involvement of the foot, leg, knee etc. In this case, below-knee amputation is the most appropriate choice.
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This question is part of the following fields:
- Seriously Ill
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Question 21
Incorrect
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A 65-year-old male was admitted to ED with acute onset left side upper and lower limb weakness and slurred speech. Which of the following is the most appropriate initial investigation?
Your Answer:
Correct Answer: CT scan of brain
Explanation:The history is suggestive of cerebral stroke and the investigation of choice at most hospitals would be a CT brain. Non-contrast CT scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke. MRI scan is more sensitive but availability and cost make this a less likely option.
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This question is part of the following fields:
- Seriously Ill
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Question 22
Incorrect
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A 25-year-old patient with no prior medical history is admitted unconscious. Which should be done as an initial investigation?
Your Answer:
Correct Answer: Blood glucose
Explanation:The patient’s blood glucose should be evaluated in order to rule out a reversible diabetic come due to high or low blood glucose.
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This question is part of the following fields:
- Emergency
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Question 23
Incorrect
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A 70-year-old smoker was recently diagnosed with small cell lung cancer. Which of the following electrolyte combinations confirms the diagnosis of SIADH?
Your Answer:
Correct Answer: Low serum Na, low serum osmolarity, high urine osmolarity
Explanation:Due to the high amount of ADH in their blood, patient is voiding a low volume of urine with high osmolarity and as a result low levels of electrolytes will be present in the serum.
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This question is part of the following fields:
- Endocrine
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Question 24
Incorrect
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A 2-year-old baby sustained a wound to her hand whilst playing in the garden. She is unvaccinated as the parents are concerned regarding side effects. There is no contraindication to vaccinations. What is the most appropriate action?
Your Answer:
Correct Answer: Give complete DPT vaccine course
Explanation:A complete course of DPT should be given.
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This question is part of the following fields:
- Child Health
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Question 25
Incorrect
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A 45 year old male with asthma presented with postnasal drainage, a dull headache and snoring. On examination there were two reddish masses in both nostrils. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Nasal polyp
Explanation:Nasal polyps are abnormal lesions that originate from any portion of the nasal mucosa or paranasal sinuses. They are more common among asthmatics. Symptoms include nasal airway obstruction, postnasal drainage, dull headaches, snoring, and rhinorrhoea.
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This question is part of the following fields:
- ENT
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Question 26
Incorrect
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A 72-year-old woman who presented with headache and neck stiffness was started on IV ceftriaxone after undergoing a lumber puncture. The CSF culture shows listeria monocytogenes. What is the treatment of choice?
Your Answer:
Correct Answer: Change to IV amoxicillin + gentamicin
Explanation:The best option would be the combination of ampicillin and gentamycin. Changing to IV amoxicillin+gentamycin is however the best among the given choices here.
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This question is part of the following fields:
- Infectious Diseases
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Question 27
Incorrect
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A 74-year-old female complains of coarse tremors. Which of the following drugs may be the cause?
Your Answer:
Correct Answer: Lithium
Explanation:The most common adverse effect of lithium is fine hand tremors. It is also an early sign of toxicity.
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This question is part of the following fields:
- Pharmacology
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Question 28
Incorrect
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A 25 year old female with her LRMP 8 weeks ago, presented with severe abdominal pain and per vaginal bleeding. On examination there was tenderness over her left iliac region. Her pulse rate was 110 bpm and blood pressure was 90/65mmHg. Which of the following is the most appropriate management?
Your Answer:
Correct Answer: Immediate laparotomy
Explanation:A ruptured ectopic pregnancy is the most probable diagnosis. As she is in shock (tachycardia and hypotension) immediate laparotomy is needed.
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This question is part of the following fields:
- Gynaecology
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Question 29
Incorrect
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A 3-year-old girl was accompanied by her mother to the hospital due to a change in speech, which is now an indistinct nasal speech. She is always tired by day, has restless sleep and even snores at night. What is the best management strategy?
Your Answer:
Correct Answer: Refer to ENT surgeon
Explanation:Adenoid tissue sometimes swell as a result of fighting off the infection as germs are trapped in the adenoids. Adenoid enlargement is suspected.
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This question is part of the following fields:
- Child Health
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Question 30
Incorrect
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A woman is self-neglecting herself by refusing to eat or drink and complains that people around her can hear her thoughts. What is the most likely diagnosis?
Your Answer:
Correct Answer: Schizophrenia
Explanation:To be diagnosed with schizophrenia, a person must have two or more of the following symptoms occurring persistently in the context of reduced functioning:
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behaviour
Negative symptoms
In this case the lady is experiencing delusions of thought broadcasting and disorganised behaviour which may or may not be due to the delusions. -
This question is part of the following fields:
- Mental Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
