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Question 1
Correct
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A 69 year old diabetic female presents for a regular outpatient visit. Her BMI is calculated to be 33. Lab results: GFR=29, Urea=13, Creatinine=390mmol/L. Which of the following drugs should ideally be used by this patient?
Your Answer: Insulin
Explanation:The management of patients with diabetes and nephropathy necessitates attention to several aspects of care. Importantly, glycaemic control should be optimized for the patient, attaining the necessary control to reduce complications but done in a safe, monitored manner. Screening for development of nephropathy should be performed on a regular basis to identify microalbuminuria or reductions in GFR and if identified, the diabetes regimen should be tailored accordingly. Prevention and treatment of diabetic nephropathy and other complications necessitates a multifactorial approach. From the options provided insulin is the most suitable as sulfonylureas and biguanides are contraindicated in renal failure. Glitazones are known to cause many side effects including fluid retention and oedema. Hence, insulin will be the best option in this scenario.
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This question is part of the following fields:
- Endocrine
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Question 2
Correct
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From the list of options, choose the least useful therapy in preventing oesophageal variceal bleeding in portal hypertension.
Your 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 3
Incorrect
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A 42 year old male arrives at the clinic due to cough and haemoptysis. Examination shows nasal mucosal ulceration. The doctor suspects Wegener's granulomatosis. Which anatomical area would be most commonly involved in this condition?
Your Answer: Kidneys
Correct Answer: Lungs
Explanation:Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) is a systemic vasculitis that affects both small and medium-sized vessels. Patients typically initially suffer from a limited form that may consist of constitutional symptoms and localized manifestations such as chronic sinusitis, rhinitis, otitis media, ocular conditions. In later stages, more serious manifestations may arise, including pulmonary complications and glomerulonephritis, although the skin, eyes, and heart may also be involved but these lesions are less common.
Diagnosis is based on laboratory testing (positive for PR3-ANCA/c-ANCA), imaging, and biopsy of affected organs, which demonstrate necrotizing granulomatous inflammation. GPA is treated with immunosuppressive drugs, typically consisting of glucocorticoids combined with methotrexate, cyclophosphamide, or rituximab. Relapses are common and the following systems are affected: Lower respiratory tract (95% of cases), renal involvement (80% of cases), skin lesions (45% of cases), ocular involvement (45% of cases) and cardiac involvement (33% of cases). -
This question is part of the following fields:
- Rheumatology
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Question 4
Incorrect
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A 30 year old primigravida with diabetes suffered a post partum haemorrhage following a vaginal delivery. Her uterus was well contracted during labour. Her baby's weight is 4.4 kg. Which of the following is the most likely cause for her post partum haemorrhage?
Your Answer: Atonic uterus
Correct Answer: Cervical/vaginal trauma
Explanation:A well contracted uterus excludes an atonic uterus. Delivery of large baby by a primigravida can cause cervical +/- vaginal tears which can lead to PPH.
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This question is part of the following fields:
- Obstetrics
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Question 5
Incorrect
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A 45-year-old male is suffering from bronchial carcinoma. This is causing obstruction of the superior vena cava. Which of the following is the most suitable palliative treatment option in this case?
Your Answer: High dose steroids
Correct Answer: Radiotherapy
Explanation:Bronchial carcinoma causes obstruction of the superior vena cava through its mass effect. From the options listed in this case, radiotherapy is the most suitable treatment option.
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This question is part of the following fields:
- Cardiovascular
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Question 6
Correct
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A 45-year-old male who is a heavy alcoholic was admitted with loss of memory, hallucinations and difficulty walking. On examination, he had an ataxic gait. He was given Acamprosate. Which one of the following can be given with the above drug?
Your Answer: Thiamine
Explanation:Wernicke’s encephalopathy is characterised by the triad of ophthalmoplegia, ataxia, and confusion. It must be viewed as a medical emergency with rapid correction of thiamine deficiency as the goal of therapy. Acamprosate is a medication used to treat alcohol dependence by stabilizing chemical signalling in the brain that would otherwise be disrupted by alcohol withdrawal
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This question is part of the following fields:
- Neurology
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Question 7
Correct
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Which one of the following factors is the most likely etiological factor for abnormally short stature amongst children?
Your 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.
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This question is part of the following fields:
- Child Health
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Question 8
Correct
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Where is the lower border of the liver usually found?
Your Answer: 10th rib anterior axillary line on right
Explanation:Assessment of liver margins is important clinically to determine the size of the liver and is done via percussion during the physical examination. The liver typically extends from the fifth intercostal space or 6th rib to the right costal margin in the midclavicular line and the 10th rib on anterior axillary line.
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This question is part of the following fields:
- Hepatobiliary
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Question 9
Incorrect
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A woman presents having overdosed on Imipramine. Which investigation should be done immediately?
Your Answer: FBC
Correct Answer: ECG
Explanation:Imipramine is a NSRI tricyclic antidepressant. It has a narrow therapeutic index . It might cause tachyarrhythmia and ECG changes.
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This question is part of the following fields:
- Pharmacology
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Question 10
Correct
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Which of the following medications is a long acting adrenergic beta-receptor agonist?
Your Answer: Formoterol
Explanation:Terbutaline is a long acting beta receptor agonist. It is used as an add on drug for step 3 in treatment of bronchial asthma. It causes relaxation of bronchial smooth muscles and thus, bronchodilatation.
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This question is part of the following fields:
- Pharmacology
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Question 11
Incorrect
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An 8-year-old girl presents with a history of a bright red bloodstain in her underpants one day prior to consultation. Her mother reports that the girl started cycling lessons one week ago. How will you proceed with the investigation in this case?
Your Answer: Inform Child protection Services
Correct Answer: Examination under Anaesthesia
Explanation:A local exam might not help in locating the cause of the bleeding because it might be underneath the superficial structures. A thorough examination should be done under GA to accurately locate the source of bleeding.
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This question is part of the following fields:
- Gynaecology
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Question 12
Incorrect
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A 32 year old male who has recently returned from a trip to Thailand presents with congestion of eyes and swelling of the knee joint. He completed a course of antibiotics for dysentery 4 weeks back. He experiences no dysuria and urine examination is normal. Which further information would be most useful in establishing a diagnosis?
Your Answer: Joint aspiration and culture
Correct Answer: History and physical examination
Explanation:The patient most likely has reactive arthritis which is usually diagnosed on history and clinical examination. The classic triad of symptoms include conjunctivitis, urethritis and arthritis. Arthritis and conjunctivitis may occur 4-6 weeks after a gastrointestinal or genitourinary infection. Arthritis usually occurs acutely, mostly involving the lower limb and is asymmetrical. Blood culture, urine culture and arthrocentesis (joint aspiration) will not yield positive results.
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This question is part of the following fields:
- Rheumatology
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Question 13
Incorrect
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A 20-year-old male presented with fever, cough and right sided chest pain for 4 days. On examination he was febrile and mildly dyspnoeic. His respiratory rate was 30, O2 sats 94% and there ware crepitations at the right lung base on auscultation. What is the most suitable investigation to be done at this stage to arrive at a diagnosis?
Your Answer: Blood for C&S
Correct Answer: CXR
Explanation:The most probable diagnosis is a right sided lobar pneumonia. CXR at this stage will help to confirm the diagnosis. Blood for C&S is also an important investigation but not the others.
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This question is part of the following fields:
- Respiratory
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Question 14
Incorrect
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A 35-year-old female went to a contraception clinic because she does not want to conceive for the next 2 years. She also has a history of heavy menstrual bleeding and pelvic pain. Imaging revealed fibroids. What is the best method of contraception for the patient in this case?
Your Answer: IUCD
Correct Answer: IUS
Explanation:IUS or Intra Uterine System/Device releases progestin. The progestin thickens the cervix, preventing the sperm from penetrating the cervix, and it also causes the uterine lining to become thinner, preventing any implantation. IUS may also prevent excessive bleeding and can help women with fibroids.
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This question is part of the following fields:
- Gynaecology
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Question 15
Correct
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A 55-year-old man attends follow-up for liver cirrhosis, which reveals a large dominant nodule in the right lobe of liver on CT Scan. Which tumour marker would most likely be elevated?
Your Answer: Alpha feto-protein (AFP)
Explanation:A considerably increased serum AFP is characteristic of hepatocellular cancer. A distinct nodule for cirrhotic patients should be investigated to rule out hepatocellular cancer.
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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 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: Psoriasis
Correct 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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An 8 year old boy was admitted following a MVA. His BMI is 28 kb/m2 and he's been found to have glycosuria, which resolved after his recovery. Which investigation is necessary to perform as part of the follow-up?
Your Answer: Fasting blood glucose concentration
Explanation:The boy has an increased BMI which implies he is overweight. Possible trauma to his pancreas might have led to a diabetes-like condition, induced by damage to the beta cells. Fasting blood glucose should be measured as a follow-up strategy to see if the damage is reversible or irreversible and to conclude if the glycosuria is related to his metabolic profile or to his accident.
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This question is part of the following fields:
- Child Health
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Question 18
Correct
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Select the correct statement regarding the portal vein.
Your Answer: It drains most of the gastrointestinal tract and the spleen.
Explanation:The portal vein supplies 75% of total blood flow to the liver and enters the liver centrally via the porta hepatis. Portal venous flow increases after meals. The portal vein receives blood from the intestines via the superior and inferior mesenteric veins, from the stomach via gastric veins and from the spleen and pancreas via the splenic vein.
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This question is part of the following fields:
- Hepatobiliary
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Question 19
Incorrect
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A 31 year old female with systemic lupus erythematosus wants to know if she has any predisposing factors for the disease. Which of the following carries the greatest risk of developing SLE?
Your Answer: Positive HLA–DR2
Correct Answer: Monozygotic twin
Explanation:An overall concordance rate in monozygotic twins was documented to be 25% as compared to dizygotic twins with 3%. First degree relatives have a chance of around 3% of developing the disease. Caucasians show an increase frequency of HLA-B8. The Japanese lupus patients had a stronger association with HLA-DR2.
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This question is part of the following fields:
- Rheumatology
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Question 20
Incorrect
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Cytochrome p450 enzymes expressed in hepatocytes serve to?
Your Answer: Conjugate a drug to make it more soluble.
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.
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This question is part of the following fields:
- Hepatobiliary
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Question 21
Incorrect
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Regarding Giardia Lamblia which one of the following statements is true?
Your Answer: Often causes a bloody diarrhoea
Correct Answer: May cause intestinal malabsorption
Explanation:Giardiasis also known as travellers diarrhoea is caused by Giardia lamblia, which is an anaerobic parasite affecting the small intestine. It can lead to diarrhoea, flatulence, abdominal cramps, malodourous greasy stools and intestinal malabsorption. It can also cause bloody diarrhoea. The investigation of choice is stool examination for trophozoites and cysts. It is treated by metronidazole and tinidazole as first line therapies.
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This question is part of the following fields:
- Infectious Diseases
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Question 22
Incorrect
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A 24 year old man presents to the clinic complaining of lower limb joint pain and lower backache for the past 2 weeks. He remembers getting a mild gastrointestinal infection while in Spain 6 weeks ago that settled spontaneously. There has been eye irritation that has now settled. Past surgical history includes an appendectomy 3 years back. Vital examination shows a temperature of 37.5 C. Lab results reveal a normal WBC and raised ESR. Which of the following is true?
Your Answer: He needs high-dose corticosteroids
Correct Answer: Rheumatoid factor is likely to be negative
Explanation:Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. The diagnosis is based on clinical features such as patient history and physical examination; there are no specific tests for reactive arthritis. Treatment is primarily symptomatic and consists of the administration of NSAIDs, as most patients recover spontaneously. extraarticular dermatologic manifestations include skin lesions of the glans resembling psoriasis (balanitis circinata); hyperkeratinisation of the palms and soles (keratoderma blenorrhagicum), oral ulcers. There usually is no rash and the diagnosis is unrelated to the presence of rheumatoid factor. This is a clinical diagnosis.
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This question is part of the following fields:
- Rheumatology
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Question 23
Incorrect
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A 8 year old boy presented with acute onset of nasal obstruction. His parents gave a recent history of nasal trauma. On examination he was febrile and his nasal bones were straight. Which of the following is the most probable diagnosis?
Your Answer: Septal hematoma
Correct Answer: Septal abscess
Explanation:History of fever is suggestive of an infective focus. A straight nasal bones excludes a nasal bone fracture. A nasal septal abscess is defined as a collection of pus between the cartilage or bony septum and it is an uncommon disease which should be suspected in a patient with acute onset of nasal obstruction and recent history of nasal trauma.
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This question is part of the following fields:
- ENT
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Question 24
Correct
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A 51-year-old woman complains of sudden onset of severe headache and vomiting that is worse when she is lying flat. Fundoscopy confirms bilateral papilledema. Which is the definitive investigation in this case?
Your Answer: Computed tomography scan
Explanation:A head CT scan is the best step to rule out a mass lesion or bleed. Since the patient has symptoms that may suggest elevated intracranial pressure (ICP), a lumbar puncture should be consulted first with a neurologist since it is contraindicated in this case due to raised ICP and risk of coning.
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This question is part of the following fields:
- Neurology
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Question 25
Correct
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A 16-year-old girl was brought to the ED by her gym instructor after developing severe shortness of breath and chest pain at the gym. She has a history of asthma since childhood. Her skin colour looked normal; however, breath sounds were found to be diminished on auscultation of the right lung. Which investigation will you order first?
Your Answer: Chest x-ray
Explanation:Asthma patients have an increased risk of developing complications like pneumonia or collapsed lung. A clear visualization of the lungs through a CXR will define the management necessary for this patient.
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This question is part of the following fields:
- Respiratory
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Question 26
Correct
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A 41 year old male patient presents with dysphagia, haemoptysis and vocal hoarseness. He's been smoking for 25 years and has a past history of regular cannabis use. What is the most probable diagnosis?
Your Answer: Squamous cell laryngeal cancer
Explanation:Progressive hoarseness of the voice is a very typical and early finding in people suspected to have squamous cell laryngeal cancer. Due to mechanical compression, patients might experience dysphagia as well as pain. The ‘lump in the throat sensation is not uncommon too. Haemoptysis might be present, together with respiratory symptoms such as dyspnoea. Other symptoms consist of constitutional complaints, such as weight loss or fatigue.
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This question is part of the following fields:
- Oncology
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Question 27
Incorrect
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A 60 year old male smoker presented in the emergency room with a history of chest pain and a cough for the last few days. He is now complaining of increasing dyspnoea and sharp pains around the 4th and 5th ribs. On CXR, there is right sided hilar enlargement. Which of the following is the most likely diagnosis?
Your Answer: Lung collapse
Correct Answer: Bronchogenic carcinoma
Explanation:The history of smoking with a cough and bone pain is suggestive of bronchogenic carcinoma. CXR findings are also supportive of this diagnosis. In COPD, a cough with dyspnoea and wheezing is prominent.
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This question is part of the following fields:
- Respiratory
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Question 28
Correct
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A 52 year old shopkeeper presents with pain in her hands. Examination reveals plaques on the extensor surfaces of her upper limbs and a telescoping deformity of both index fingers. Nails show pitting and horizontal ridging. The patient is most likely suffering from which of the following?
Your Answer: Arthritis mutilans
Explanation:Arthritis mutilans is a rare (occurs in only 5% of the patients) and extremely severe form psoriatic arthritis characterized by resorption of bones and the consequent collapse of soft tissue. When this affects the hands, it can cause a phenomenon sometimes referred to as ‘telescoping fingers.’ The associated nail changes are also characteristic of arthritis.
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This question is part of the following fields:
- Rheumatology
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Question 29
Incorrect
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What is the appropriate management for a child who has repeated UTIs?
Your Answer: Laxatives
Correct Answer: Prophylactic antibiotics
Explanation:Prophylactic antibiotics should be given to the child to avoid infections and renal injury.
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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 12 year old girl presented with pallor and a rash over her lower limbs after 4 days of bloody diarrhoea. Lab investigations showed proteinuria and deranged renal function. The most likely diagnosis will be?
Your Answer:
Correct Answer: Haemolytic Uremic Syndrome (HUS)
Explanation:Haemolytic Uremic Syndrome affects children and is characterised by abdominal pain, a purpuric rash over the body, generalized pallor, haematuria and bloody diarrhoea. There is always a history of preceding diarrhoea caused usually by E.coli and it affects the renal system causing haematuria and deranged renal function tests.
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This question is part of the following fields:
- Gastrointestinal
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SESSION STATS - PERFORMANCE PER SPECIALTY
