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Question 1
Incorrect
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A 70 year old woman accidentally fell and was brought to the orthopaedics department. Investigations reveal a fracture of the neck of the humerus. Which artery may most likely be injured?
Your Answer: Femoral artery
Correct Answer: Circumferential artery
Explanation:Circumferential artery provides the blood supply to the neck of the femur. Damage to the artery may lead to avascular necrosis of the femoral neck or head.
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This question is part of the following fields:
- Musculoskeletal
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Question 2
Correct
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A 12 year old boy with type I diabetes was reluctant to go to school. According to him, he was unhappy at the school. Which of the following is the next appropriate step?
Your Answer: Clinical psychologist
Explanation:The child’s problem should be assessed properly to find the reason for unhappiness at the school. There can be many reasons such as bullying at school, abuse etc. A clinical psychologist should assess this child to take the necessary details and plan the further management.
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This question is part of the following fields:
- Child Health
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Question 3
Incorrect
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Which is the most likely lymph node involved in the presence of an abdominal swelling below the umbilicus and on the right side?
Your Answer: Aortic lymph node
Correct Answer: Inguinal lymph node
Explanation:Inguinal LN’s drain the skin and subcutaneous tissue of the lower abdominal wall, perineum, buttocks, external genitalia, and lower limbs. They are subdivided into three groups of lymph nodes (nodi lymphoid):
– inferior group of superficial inguinal lymph nodes, located inferior to the saphenous opening, receiving drainage of the lower limb;
– superolateral superficial inguinal lymph nodes located lateral to the saphenous opening, receiving drainage of lateral buttock and lower anterior abdominal wall; and
– superomedial superficial inguinal lymph nodes, located medial to the saphenous opening, receiving drainage of the perineum and external genitalia. -
This question is part of the following fields:
- Surgery
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Question 4
Incorrect
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A neonate was brought in by her mother, for a skin lesion present over the neonate's back which is bluish in colour, but otherwise asymptomatic. The most appropriate course of action will be?
Your Answer: Skeletal survey
Correct Answer: Reassure
Explanation:A Mongolian spot can be present in new born babies which usually appears over the back and fades with time. There is nothing to worry about.
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This question is part of the following fields:
- Dermatology
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Question 5
Incorrect
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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: Aspirin
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).
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This question is part of the following fields:
- Cardiovascular
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Question 6
Incorrect
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A teenage girl presented in the OPD with a history of amenorrhea. She said she was exercising daily and needs to lose weight. On examination, she is 162cm in height and 45kgs in weight. Which of the following is the most probable cause in this case?
Your Answer: Hyperthyroidism is the most likely diagnosis
Correct Answer: Hypomagnesaemia and hypocalcaemia are possibly present
Explanation:This scenario represents anorexia nervosa disorder, a psychological disorder. Extreme weight loss with a strict diet can lead to deficiency of many nutrients like magnesium and calcium. This can also cause amenorrhea.
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This question is part of the following fields:
- Endocrine
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Question 7
Correct
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A 30-year-old man presents with hypertension and decreased serum potassium levels. Which hormone should be tested in addition in order to establish the diagnosis?
Your Answer: Aldosterone
Explanation:High blood pressure and a low level of potassium in the blood indicates hyperaldosteronism. Therefore, aldosterone should be tested immediately to establish the diagnosis. Hyperaldosteronism, is a medical condition wherein too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood (hypokalaemia) and increased hydrogen ion excretion (alkalosis).
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This question is part of the following fields:
- Cardiovascular
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Question 8
Incorrect
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A 61 year old male presented to the emergency with renal colicky pain and a subsequent passage of stone the next day. Radiological examination, however, revealed no signs of calculi. The renal calculus was most likely composed of which of the following?
Your Answer: Cystine
Correct Answer: Uric acid
Explanation:Calcium-containing stones are relatively radio dense, and they can often be detected by a traditional radiograph of the abdomen that includes the kidneys, ureters, and bladder (KUB film). Some 60% of all renal stones are radiopaque. In general, calcium phosphate stones have the greatest density, followed by calcium oxalate and magnesium ammonium phosphate stones. Cystine calculi are only faintly radio dense, while uric acid stones are usually entirely radiolucent.
Uric acid is the relatively water-insoluble end product of purine nucleotide metabolism. It poses a special problem because of its limited solubility, particularly in the acidic environment of the distal nephron of the kidney. It is problematic because humans do not possess the enzyme uricase, which converts uric acid into the more soluble compound allantoin. Three forms of kidney disease have been attributed to excess uric acid: acute uric acid nephropathy, chronic urate nephropathy, and uric acid nephrolithiasis. These disorders share the common element of excess uric acid or urate deposition, although the clinical features vary.
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This question is part of the following fields:
- Renal
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Question 9
Correct
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From the following options, choose the one which is most characteristic of early Alzheimer's disease.
Your Answer: Impaired short term memory
Explanation:Alzheimer’s disease is most often characterized early on by short-term memory loss. The other options in this list are characteristic of the following: normal pressure hydrocephalus (gait ataxia and urinary incontinence); Creutzfeldt-Jakob disease (myoclonic jerks); delirium or Lewy body dementia (visual hallucinations).
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This question is part of the following fields:
- Mental Health
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Question 10
Correct
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Patients on digoxin therapy are required to receive an initially higher dose of the drug, in order to amplify the effect of the treatment. Which of the following makes this requirement necessary?
Your Answer: Half-life
Explanation:A loading dose is required for drugs that are eliminated from the body in a slow, progressive manner. Half-life is the indicator showing if a drug has a fast, intermediate or slow elimination rate.
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This question is part of the following fields:
- Cardiovascular
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Question 11
Incorrect
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A pregnant woman that already has a son with haemophilia A, wants to know the chances of her next unborn child having the same condition.
Your Answer: 0.25
Correct Answer: 0.5
Explanation:Haemophilia A has an X-linked recessive pattern of inheritance, meaning that is a 50% chance of having a son with haemophilia and 50% chance of the daughters being carriers of the haemophilia gene.
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This question is part of the following fields:
- Genetics
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Question 12
Correct
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A 35-year-old male developed difficulty in breathing following administration of IV Co-amoxiclav. On examination he was flushed, there were bilateral rhonchi and his blood pressure was 80/50 mmHg. What is the immediate management of this patient?
Your Answer: Epinephrine 0.5 mg IM
Explanation:This case indicates an anaphylactic reaction. The causative factor should be stopped or removed as soon as possible and IM Epinephrine 0.5mg administered. IV Epinephrine can also be considered provided that it is adequately diluted.
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This question is part of the following fields:
- Seriously Ill
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Question 13
Incorrect
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A 38 year old female presented with absent menstruation for the past 8 months. Her mother also has had early menopause at a similar age. Which of the following is the most appropriate initial investigation for her?
Your Answer: Serum progesterone conc.
Correct Answer: Serum FSH/LH
Explanation:Menopause happening at less than 40 years of age is known as premature menopause (or premature ovarian insufficiency). Provided that the pregnancy has been excluded, The concentrations of gonadotrophins in the premature menopausal range are necessary to establish a diagnosis of ovarian failure. Because of the intermittent presentation of the disease, repeated assays may be required at intervals of 2-4 weeks. Women with FSH levels above 40 mIU/ml may be regarded as having undergone permanent ovarian failure.
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This question is part of the following fields:
- Genitourinary
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Question 14
Correct
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A 35 year old Afro-Caribbean lady with a history of venous thrombosis, has just had her 4th miscarriage. Lupus anticoagulant is positive. What is the most probable diagnosis?
Your Answer: Antiphospholipid syndrome
Explanation:Antiphospholipid syndrome can cause recurrent miscarriage as it poses a high risk of developing blood clots. Miscarriage can happen due to venous or arterial thrombosis but the syndrome can also present with stroke, livedo reticularis, adrenal haemorrhage, myelitis, migraine, multi-infarct dementia or MI. Chances for venous thrombosis are noticeably higher if lupus anticoagulant is positive. If however, IgG or IgM antiphospholipid antibodies are positive, arterial thrombi are more common.
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This question is part of the following fields:
- Genitourinary
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Question 15
Incorrect
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Which among these medications does NOT cause gastric ulceration?
Your Answer: Celecoxib
Correct Answer: Misoprostol
Explanation:Misoprostol is effective in preventing gastric ulceration since it is a prostaglandin analogue. Celecoxib, being a selective COX-2 inhibitor only elevates risk of ulceration as well as NSAIDs. Renal failure on the other hand results in elevated gastric acid after reducing the breakdown of gastrin.
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This question is part of the following fields:
- Gastrointestinal
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Question 16
Incorrect
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A 4 month old child, presenting with lower UTI has been treated with Trimethoprim but there has been no improvement after 48 hours. What will be the next step in the management of this patient?
Your Answer: Midstream urine culture
Correct Answer: Micturating cystourethrogram
Explanation:A micturating cystourethrogram (MCUG) is one type of imaging test also called a voiding cystourethrogram (VCUG). The MCUG can check whether the flow of urine from the child’s bladder is being blocked, or whether it goes up the wrong way. It can help diagnose certain conditions, including vesicoureteral reflux and posterior urethral valves.
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This question is part of the following fields:
- Mental Health
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Question 17
Correct
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48 hours after having unprotected intercourse, a 16-year-old female requested a pregnancy test from her GP. What advice can you give her regarding the reliability of pregnancy testing at this time?
Your Answer: Even if conception has already occurred, beta hCG is likely to be normal
Explanation:Even if conception has already occurred, beta hCG is likely to be normal. Beta hCG is made by syncytiotrophoblast cells following conception. It then activates the corpus luteum to continuously produce progesterone for implantation to happen. In week 10/40, levels of HCG peak and the placenta can produce adequate progesterone by itself. As a general rule, a beta HCG concentration >25 U/I or a doubling of levels of HCG within two days is required to diagnose pregnancy. A urine pregnancy test would only likely prove positive around 8 days to 2 weeks following conception.
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This question is part of the following fields:
- Gynaecology
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Question 18
Incorrect
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A 34-year-old woman presents with pelvic pain and complains of dysmenorrhea and menorrhagia. She has been using an IUCD for one year now and wants to know the cause of her current condition. What is the most likely cause?
Your Answer: Asherman syndrome
Correct Answer: PID
Explanation:IUCD is a risk factor for PID and PID has the clinical picture already described. However, fibroids should also be excluded since they may present in the same way.
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This question is part of the following fields:
- Gynaecology
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Question 19
Incorrect
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A 76-year-old man complains of painful microscopic haematuria and urgency. On examination of the abdomen, there is suprapubic tenderness but no palpable abnormality. He is apyrexial, inflammatory markers and PSA in the blood are normal. Which is the most likely diagnosis?
Your Answer: Bladder cancer
Correct Answer: Bladder calculi
Explanation:Painful haematuria suggests trauma, infection or calculi, whereas painless haematuria suggests a possible occult malignancy. This man is apyrexial with normal WCC and CRP which should effectively exclude infection as a cause for his symptoms. There is no history of trauma in this scenario (often catheter-associated) which makes this cause unlikely. It is worth noting that haematuria associated with injury tends to be macroscopic. Therefore, bladder calculi are the most likely source of his symptoms. Imaging will help to determine the presence of calculi.
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This question is part of the following fields:
- Urology
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Question 20
Correct
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A 30-year-old epileptic female was admitted with visual field defects. She began a new anticonvulsant three months ago. Depending on her clinical presentation what is the most probable drug she was started on?
Your Answer: Vigabatrin
Explanation:Vigabatrin causes visual field constriction in around 30% of users. Most cases are asymptomatic because vigabatrin affects the peripheral visual fields but does not impair central visual acuity.30-50% of patients with long term exposure to vigabatrin have developed irreversible concentric visual field loss of varying severity.
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This question is part of the following fields:
- Pharmacology
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Question 21
Correct
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A 50-year-old woman presents with coughing up copious sputum with blood streaks, increased breathlessness, and finger clubbing. She has a history of chronic cough. What is the initial investigation?
Your Answer: Chest x-ray
Explanation:Finger clubbing and past history suggest a chronic pulmonary process going on. A CXR will allow the pathology to be visualised including any infective or cancerous causes.
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This question is part of the following fields:
- Respiratory
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Question 22
Incorrect
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Which of the following options is true of patients with oesophageal varices?
Your Answer: Octreotide and terlipressin have the same outcome profile in terms of variceal bleed mortality
Correct Answer: In spontaneous bacterial peritonitis cefotaxime appears to be a useful antibiotic
Explanation:Spironolactone has been shown to have no effect on the mechanisms of portal hypertension. Also, chronic use of propranolol can reduce the risk of variceal bleeding. The banding of large varices has been shown to be effective, too. Octreotide and terlipressin are also both used to prevent secondary haemorrhage. Cefotaxime is the most commonly used cephalosporin when treating spontaneous bacterial peritonitis. Spironolactone helps to combat secondary hyperaldosteronism which is related to liver failure. It also helps to treat salt and water retention, which both contribute to portal hypertension.
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This question is part of the following fields:
- Gastrointestinal
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Question 23
Incorrect
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A 29-year-old woman presented 10 days post-partum with loss of weight. On history taking, the patient complains of loss of appetite and a lack of sympathy for her child. She is always tired. She even sometimes has violent thoughts about hurting her baby. The treatment of choice for such a case would be?
Your Answer: CBT
Correct Answer: ECT
Explanation:This is a case of postpartum psychosis. It can be treated with antidepressants, mood stabilisers or ECT. The treatment of choice is ECT.
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This question is part of the following fields:
- Mental Health
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Question 24
Correct
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A homeless woman presented with a cough and fever for the last 3 months. She also complained of night sweats and weight loss. Her CXR showed lung opacities. What is the next appropriate step for this patient?
Your Answer: Acid fast bacilli
Explanation:History and CXR are suggestive of tuberculosis. Acid fast bacilli should be seen on microscopy to confirm the diagnosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 25
Incorrect
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Cocaine abuse has many serious side effects. Which of the following is not a notable side effect of chronic cocaine abuse?
Your Answer: Severe anxiety and paranoid ideation
Correct Answer: Hyponatraemia
Explanation:Chronic cocaine abuse can produce many serious side effects such as erectile dysfunction, ejaculatory dysfunction, hypersomnia, anxiety, hallucinations etc.
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This question is part of the following fields:
- Seriously Ill
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Question 26
Incorrect
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What is the failure rate of tubal sterilization?
Your Answer: 1 in 1000
Correct Answer: 1 in 200
Explanation:Tubal sterilization is a safe and effective surgical procedure that permanently prevents pregnancy. However, pregnancy can occur in 1 in 200 cases, according to international sources. In the 1st year after tubal sterilization, the estimated failure rate is 0.1-0.8% respectively.
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This question is part of the following fields:
- Gynaecology
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Question 27
Incorrect
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From the list of options, choose the least useful therapy in preventing oesophageal variceal bleeding in portal hypertension.
Your Answer: Nadolol
Correct Answer: Variceal sclerotherapy
Explanation:Selective beta blockade and nitrates help to reduce portal pressure and therefore reduce the risk of bleeding (as does banding). Moreover, sclerotherapy, despite its use, has not actually been shown to reduce the risk of bleedings as primary prevention – however, it may reduce the risk of rebleeding after an index bleed. The mortality of variceal bleedings is known to be 50% at each episode.
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This question is part of the following fields:
- Gastrointestinal
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Question 28
Correct
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A 60-year-old female underwent pelvic surgery. She was given low molecular weight heparin (LMWH) after the procedure. After a week, she complained of sudden chest pain and difficulty in breathing. Her ECG and CXR were normal. What is the most suitable option for her?
Your Answer: Keep on low molecular weight heparin and do CT. pulmonary angiography.
Explanation:CT pulmonary angiography will decide the proper cause of her symptoms. Until that has happened LMWP should be continued.
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This question is part of the following fields:
- Seriously Ill
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Question 29
Incorrect
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A son has brought his 72-year-old mother to clinic. He is concerned about her short-term memory problems for the past 10 months. He has to remind her to take her medications and she has had two incidents of falling over in the last 10 months. Which of the following assists in the diagnosis of above condition?
Your Answer: Loss of control of bladder
Correct Answer: Progressive loss of function
Explanation:The clinical presentation is dementia. To differentiate Alzheimer disease and vascular dementia, the progressive loss of function is important. Progressive loss of function is usually associated with vascular dementia and rest of the responses are associated with Alzheimer disease.
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This question is part of the following fields:
- Older Adult
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Question 30
Incorrect
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A 70-year-old male patient with hypertension complains of acute urinary retention. He provides a history of urinary frequency for the past 18 months and has been taking Nifedipine and Propranolol for blood pressure control. Which of the following is the most probable cause for his acute presentation?
Your Answer: Enlarged prostate gland
Correct Answer: Drug induced
Explanation:Calcium channel blockers decrease smooth-muscle contractility in the bladder and this can cause urinary retention.
An enlarged prostate gland could be the reason if he gave a history of obstructive symptoms.
Diabetes presents with polyuria.
Bladder cancer commonly presents with painless haematuria. -
This question is part of the following fields:
- Genitourinary
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SESSION STATS - PERFORMANCE PER SPECIALTY
