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Question 1
Incorrect
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A patient has been taking morphine 60 mg twice a day and severadol (quick release morphine) 20 mg three times a day, per os. You are asked to prescribe morphine subcutaneously for this palliative care patient via a syringe driver. Which of the following dosing regimen would you choose?
Your Answer: 120 mg over 24 hours. 10 mg as required, for breakthrough pain.
Correct Answer: 90 mg over 24 hours. 15 mg as required, for breakthrough pain.
Explanation:Morphine is almost twice as effective when given intravenously or subcutaneously as when given orally. This means that the first step is to calculate the total amount of morphine that the patient used to take orally, which is 180 mg. Since the patient needed 180 mg of morphine tablets in 24 hours to control his pain, he now would need approximately 90 mg given in the same time span. In order to calculate the breakthrough dose, one sixth of the total dose of morphine required per 24 hours should be calculated. The patient now requires 90 mg of morphine subcutaneously, meaning that he would need 15 mg for breakthrough pain.
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This question is part of the following fields:
- Pharmacology
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Question 2
Incorrect
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A 75 year old woman presented with difficulty in climbing the stairs and difficulty in holding her head up, for the past 6 months. She didn't have any significant joint pain. Her creatinine phosphokinase level was very high and ESR was normal. Which of the following is the most probable diagnosis?
Your Answer: Polymyalgia rheumatica
Correct Answer: Polymyositis
Explanation:Polymyositis is an idiopathic inflammatory myopathy characterized by symmetrical, proximal muscle weakness, elevated skeletal muscle enzyme levels and characteristic electromyography (EMG) and muscle biopsy findings. Weak neck extensors cause difficulty holding the head up. Pain is not a significant symptom, which differentiates it from arthritic conditions. ESR is elevated in only 50% of patients with polymyositis.
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This question is part of the following fields:
- Musculoskeletal
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Question 3
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 4
Incorrect
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Which of the following bronchodilators is an anticholinergic commonly used in addition to adrenoceptor stimulants?
Your Answer: Aminophylline
Correct Answer: Oxitropium bromide
Explanation:All of these drugs are anti-asthmatic drugs that work through different pathways. Oxitropium bromide is an anticholinergic drug that is often used with beta agonists to improve their action.
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This question is part of the following fields:
- Pharmacology
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Question 5
Correct
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A 28-year-old male is involved in a motorcycle accident. He sustained a direct blow to his lower chest. His blood pressure is 83/48, HR 113 bpm. On examination, there are multiple bruises on the chest with bowel sounds heard on auscultation of his chest. The single most likely diagnosis is?
Your Answer: Diaphragmatic rupture
Explanation:Ruptured diaphragm is a serious condition that is very difficult to diagnose and requires rapid intervention. The presence of bowel sounds on chest auscultation is highly suggestive of this.
Ruptured oesophagus is excluded by the absence of haematemesis and normal intestinal sounds.
Fractured ribs could be life threatening if associated with a tension pneumothorax which is excluded by a normal chest auscultation.
Flail chest is characterised by paradoxical breathing and respiratory failure. -
This question is part of the following fields:
- Respiratory
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Question 6
Correct
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A 30 year old female with type I diabetes for 13 years, came for pre-pregnancy counselling. Which of the following is the most suitable advise for her?
Your Answer: She should aim to have a pre-pregnancy HbA1c of <48 mmol/mol (6.5%)
Explanation:According to NICE guidelines women with type I diabetes, who are expecting a child should aim to keep their HbA1c level[1] below 48 mmol/mol (6.5%) without causing problematic hypoglycaemia. Women with diabetes whose HbA1c level is above 86 mmol/mol (10%) should be strongly advised not to get pregnant because of the associated risks. The risks are higher with chronic diabetes. There is an increased risk to the foetus or mother due to diabetes in pregnancy. Women who are waiting to become pregnant should take folic acid (5 mg/day) until 12 weeks of gestation to reduce the risk of having a baby with a neural tube defect.
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This question is part of the following fields:
- Gynaecology
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Question 7
Correct
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A 72-year-old woman presents with left side groin pain. She says she suddenly collapsed and was not able to lift her leg anymore. She is on calcium supplements and alendronate. What is the best diagnosis?
Your Answer: Fracture of neck of femur
Explanation:Fracture of the neck of femur is characterised by inability to lift the affected limb. This is relatively common in osteoporotic patients.
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This question is part of the following fields:
- Musculoskeletal
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Question 8
Correct
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A 2 year old male was brought to the A&E following an car accident. On examination bowel sounds were heard in the chest. A nasogastric tube was inserted and a chest x-ray showed a curved NG tube. Which of the following is the most probable reason for it?
Your Answer: Diaphragm rupture
Explanation:Bowel sounds in the chest and curved NG tube are suggestive of a diaphragm rupture, which has caused herniation of bowel into the thoracic cavity through the defect in the diaphragm.
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This question is part of the following fields:
- Child Health
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Question 9
Incorrect
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A 38-year-old male presented to the outpatient clinic complaining of a right sided groin mass just above and lateral to the pubic tubercle. It is non-tender and reducible. There is no cough impulse. What is the most likely diagnosis?
Your Answer: Indirect inguinal hernia
Correct Answer: Direct inguinal hernia
Explanation:The patient is showing the symptoms of a hernia. The position of the hernia indicates an inguinal hernia. The absence of expansive impulse on cough by blocking the internal ring signifies a direct inguinal hernia.
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This question is part of the following fields:
- Genitourinary
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Question 10
Correct
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A 25 year old youth was brought to the A&E following a stab injury to the right back of the chest. On examination he was dyspnoeic, his trachea was deviated to the left side and there were engorged veins and absent breath sounds on the right side. Which of the following is the most probable diagnosis?
Your Answer: Tension pneumothorax
Explanation:History is suggestive of right sided tension pneumothorax. It can’t be a simple pneumothorax because of tracheal deviation and engorged veins.
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This question is part of the following fields:
- Respiratory
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Question 11
Correct
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A 45-year-old male patient came to the OPD with a complaint of severe headache on the right side, with right-sided jaw pain, and additional blurred vision in the right eye. The headache was throbbing in character. Which investigation will you prefer next?
Your Answer: Erythrocyte sedimentation rate (ESR)
Explanation:Age of the patient, headache only on one side, and loss of vision on that side suggest temporal arteritis, also known as giant cell arteritis. The laboratory hallmark of this condition is a raised ESR.
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This question is part of the following fields:
- Ophthalmology
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Question 12
Correct
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Question 13
Correct
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A 55 year old man known with Addison's disease presented with complaints of recurrent attacks of postural hypotension. What kind of electrolyte imbalance would be seen in his biochemical profile investigations?
Your Answer: Low Na+, High K+
Explanation:Patients suffering from Addison’s disease have low aldosterone. Aldosterone increases Na+ absorption and excretion of K+. So in these patients there would be decreased Na+ and increased K+ levels.
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This question is part of the following fields:
- Endocrine
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Question 14
Correct
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A 21 year old asthmatic presented with complaints of a dry cough and hoarseness of voice. He has been taking oral and inhaled corticosteroids for many years. The most likely causative factor for the hoarseness of voice would be?
Your Answer: Laryngeal candidiasis
Explanation:Laryngeal candidiasis is one of the leading cause of hoarseness of voice in patients who are taking corticosteroids. As a result of decreased immunity, chances of fungal infections are increased.
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This question is part of the following fields:
- ENT
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Question 15
Correct
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A 49 year old female presents to the clinic complaining of pain in her left elbow that is localized to the left lateral epicondyle. She has spent the weekend painting her house. A diagnosis of lateral epicondylitis is suspected. The pain would characteristically worsen on which of the following movements?
Your Answer: Resisted wrist extension with the elbow extended
Explanation:Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles, thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which results in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.
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This question is part of the following fields:
- Rheumatology
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Question 16
Incorrect
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A 23 year old woman comes for the advice regarding contraceptives. Her mother passed away due to cervical cancer and she worries about cervical cancer. Which of the following is the most suitable contraceptive method for her?
Your Answer: IUCD
Correct Answer: Barrier method
Explanation:Cervical cancer results from genital infection with HPV. PV infections can be transmitted via nonsexual routes, but the result from sexual contact. So the best contraceptive method in relation to prevention of cervical cancer is the barrier method. But it will not prevent cervical cancer a 100%.
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This question is part of the following fields:
- Genitourinary
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Question 17
Correct
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A 2-year-old female presented with symptoms of gastroenteritis. Which of the following signs is the strongest indicator for IV fluid administration?
Your Answer: Capillary refilling time > 4secs
Explanation:Children are very prone to dehydration during an episode of gastroenteritis. Dehydration is detected early by increased capillary filling time.
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This question is part of the following fields:
- Seriously Ill
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Question 18
Incorrect
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Which of the following immune responses occurs in Coeliac disease?
Your Answer: Type III hypersensitivity
Correct Answer: Type IV hypersensitivity
Explanation:Celiac disease is classified as a Type IV hypersensitivity mediated by T-cell response. Negatively charged gliadin has been shown to induce interleukin 15 in the enteric epithelial cells, stimulating the proliferation of the natural killer cells and intraepithelial lymphocytes to express NK-G2D, a marker for natural killer T lymphocytes.
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This question is part of the following fields:
- Gastrointestinal
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Question 19
Correct
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A 25-year-old farmer presents with a fever, headache, malaise and neck stiffness. The first line empirical antibiotic is?
Your Answer: Ceftriaxone
Explanation:The most likely diagnosis is meningitis which requires admission and iv antibiotics. The drug of choice is a 3rd generation cephalosporin. In patients older than 55 , ampicillin cefotaxime combination is used.
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This question is part of the following fields:
- Pharmacology
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Question 20
Incorrect
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A 51-year-old woman admitted to the hospital for 3 days due to haemoptysis developed an ataxic gait, visual problems, and altered state of consciousness. What is the most appropriate management of this patient?
Your Answer: Acamprosate
Correct Answer: High potent vitamins
Explanation:Wernicke’s encephalopathy presents with neurological symptoms as a result of biochemical deficits in the central nervous system due to depleted B-vitamin reserves, particularly thiamine (vitamin B1). Classically, Wernicke encephalopathy is characterised by the triad – ophthalmoplegia, ataxia, and confusion. Thiamine treatment should be started immediately and usually continued until clinical improvement ceases.
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This question is part of the following fields:
- Neurology
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Question 21
Correct
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A 27-year-old woman complains of a hard, irregular lump in her right breast that presented after a car accident 2 weeks ago. Which is the most likely diagnosis?
Your Answer: Fat necrosis
Explanation:Since the car crash happened two weeks prior, breast trauma is suggested and thus fat necrosis is the most probable diagnosis. Phyllodes tumours are typically a firm, palpable mass. These tumours are very fast-growing, and can increase in size in just a few weeks. Occurrence is most common between the ages of 40 and 50, prior to menopause.
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This question is part of the following fields:
- Breast
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Question 22
Incorrect
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Concerning myosin, which of the following statements is true?
Your Answer: Contains an cAMP-binding sites
Correct Answer: Myosin heavy chain mutations are associated with development of familial hypertrophic cardiomyopathy
Explanation:Myosin is a protein found in contractile tissues. It is described in two groups: conventional myosin, which is arranged in pairs of light chains against pairs of heavy chain myosin. Unconventional myosin that is not arranged in filaments, preforms many functions in a wide range of cells, such as in organelle transport and in endocytosis. Myosin contains Adenosine triphosphate (ATP) and contains actin binding sites to preform its function. Other types of mutations in myosin can be seen besides the heavy chain mutation cardiomyopathy and they include: Carney’s complex , Usher syndrome and non-syndromic deafness
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This question is part of the following fields:
- Cardiovascular
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Question 23
Incorrect
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A 20-year-old pregnant woman at 32 weeks gestation presents with a history of vaginal bleeding after intercourse. Pain is absent and upon examination, the following are found: abdomen soft and relaxed, uterus size is equal to dates and CTG reactive. What is the single most possible diagnosis?
Your Answer: Antepartum haemorrhage
Correct Answer: Placenta previa
Explanation:Placenta previa typically presents with painless bright red vaginal bleeding usually in the second to third trimester. Although it’s a condition that sometimes resolves by itself, bleeding may result in serious complications for the mother and the baby and so it should be managed as soon as possible.
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This question is part of the following fields:
- Obstetrics
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Question 24
Correct
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A previously well 7-week-old infant was admitted complaining of projectile vomiting following each feed. He was dehydrated on admission and IV fluids were started. What is the most probable diagnosis?
Your Answer: Hypertrophic pyloric stenosis
Explanation:Projectile vomiting is the hallmark symptom of hypertrophic pyloric stenosis. It is the most common cause of intestinal obstruction in infancy, which has a male-to-female predominance of 4-5:1. Current management recommendations include ultrasonography for diagnosis, correction of electrolytes, and surgical intervention.
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This question is part of the following fields:
- Child Health
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Question 25
Correct
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An 18 year old male has been taken to the emergency department and is in a semi-unconscious state. Upon examination, he has the following stats: pulse = 60bpm; RR = 8/min; and BP = 120/70mmHg. The doctors also notice needle track marks on both of his arms, and his pupils are very small. From the list of options, choose the most suitable treatment.
Your Answer: Naloxone
Explanation:A reduced state of consciousness, RR 8/min, hypotension, miosis, and needle track marks on the arm are all symptoms of an opiate drug overdose, and so Naloxone is the most appropriate course of treatment.
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This question is part of the following fields:
- Seriously Ill
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Question 26
Correct
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A 60 old patient with a history of chronic cough was found to have partial ptosis, constricted pupil and loss of hemifacial sweating. What is the most probable diagnosis?
Your Answer: Horner's syndrome
Explanation:Horner syndrome (oculosympathetic paresis) results from an interruption of the sympathetic nerve supply to the eye. It is characterized by the classic triad of miosis (i.e., constricted pupil), partial ptosis, and loss of hemifacial sweating (i.e., anhidrosis). As this patient presented with chronic cough most probably he has Pancoast tumour (tumour in the apex of the lung, most commonly squamous cell carcinoma).
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This question is part of the following fields:
- Respiratory
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Question 27
Incorrect
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A woman presents with pain and oedema of one leg, 3 days after an obstructed labour. Upon examination the leg is cold and pale. What is the most likely diagnosis?
Your Answer: DVT
Correct Answer: Embolus
Explanation:Venous thromboembolism (VTE) during pregnancy and the postpartum window occurs at a 6-10-fold higher rate compared with age-matched peers and is a major cause of morbidity and mortality. Hypercoagulability persists for 6-8 weeks after delivery with the highest risk of PE being during the postpartum period. The lack of randomized trials in pregnant women leads to variability in practice, which are largely based on expert consensus or extrapolation from non-pregnant cohorts. The standard treatment of VTE in pregnancy is anticoagulation with low molecular weight heparin (LMWH), which like unfractionated heparin does not cross the placenta and is not teratogenic.
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This question is part of the following fields:
- Gynaecology
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Question 28
Correct
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A 24 year old male has been found unconscious by a stranger in an alleyway. His RR is 6bpm and his HR is 60bpm. His pupils are also constricted. From the list of options, what is the best treatment option?
Your Answer: Naloxone
Explanation:The respiratory depression and miosis in this patient indicate opiate poisoning. For this, the best treatment is naloxone.
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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 child presents with a history of recurrent tonsillitis. His mother claims he had three attacks in one year. What is the best management?
Your Answer: Refer to ENT
Correct Answer: Treat when ill
Explanation:At least seven episodes in the previous year, five episodes in each of the previous two years, or three episodes in each of the previous three years are indications for tonsillectomy. Antibiotics should be administered in the conventional dosage for proved or suspected streptococcal episodes. For now the child should be treated on a case by case basis.
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This question is part of the following fields:
- Child Health
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Question 30
Correct
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A 64 year old female presents with sudden onset pain, swelling and stiffness in her right knee. Her medical history is significant for osteoarthritis affecting her hand joints and diet controlled diabetes mellitus. On examination, the right knee is swollen, erythematous and tender. Which of the following tests would be most useful in the diagnosis of this case?
Your Answer: Aspiration and examination of the synovial fluid
Explanation:Arthrocentesis should usually be done when there is a suspicion of pseudogout or septic arthritis as in this case which leads to an early diagnosis and prompt treatment. Polarized microscopy demonstrates weakly positively birefringent rhomboid crystals which are blue when parallel to light and yellow when perpendicular to light. Elevated serum uric acid levels that cause gout are usually found after large consumption of alcohol or meat, or post surgery. Autoimmune diseases like SLE, RA etc require an autoimmune screen.
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This question is part of the following fields:
- Rheumatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
