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Question 1
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 2
Incorrect
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Neurofibromatosis is characterised by which of the following?
Your Answer: Nephroblastoma
Correct Answer: Scoliosis
Explanation:Neurofibromatosis (aka Von Recklinghausen’s disease) includes: neurofibrosarcomas, pheochromocytoma, optic nerve tumours, scoliosis and acoustic neuromas.
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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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A 2 year old male is able to run down the stairs and say mama and dada. He can understand what he is saying and can say one word. How is this child developing?
Your Answer: Normal
Correct Answer: Delayed speech
Explanation:This child is experiencing delayed speech. By the age of 2, a child should be able to combine at least 2 words to make a very simple sentence.
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This question is part of the following fields:
- Child Health
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Question 4
Correct
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Which is the most useful tumour marker for monitoring of ovarian cancer patients?
Your Answer: CA 125
Explanation:CA-125 has found application as a tumour marker or biomarker that may be elevated in the blood of some patients with specific types of cancers, or other conditions that are benign. Increased level of CA125 appears in fifty percent of stage 1 ovarian cancer patients and more than 90% with stages 2-4 ovarian cancer. CA-125 is therefore a useful tool for detecting ovarian cancer after the onset of symptoms as well as monitoring response to treatment and for predicting a patient’s prognosis after treatment.
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This question is part of the following fields:
- Gynaecology
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Question 5
Correct
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A 43 year old female presented with a 5 day history of a productive cough with rusty coloured sputum. Chest X-ray showed lobar consolidation on her left side. The most likely causative organism would be?
Your Answer: Streptococcus pneumoniae
Explanation:Streptococcus pneumonia is the chief causative organism for lobar pneumonia in this age group patients. Typically patients present with rusty coloured sputum and a cough. Pneumocystis jiroveci is responsible for causing pneumocystis pneumonia among immunocompromised patients.
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This question is part of the following fields:
- Infectious Diseases
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Question 6
Incorrect
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A 57 year old, alcoholic male was admitted to the medical ward for an ascitic tap. The ascitic fluid was found to be yellow in colour. Which of the following had most likely lead to this observation?
Your Answer: Alcoholic hepatitis
Correct Answer: Decompensated cirrhosis
Explanation:Uncomplicated cirrhotic ascites is usually translucent. If the patient is deeply jaundiced, the fluid might appear yellow/brown.
Turbidity or cloudiness of the ascites fluid suggests that infection is present and further diagnostic testing should be performed.
Pink or bloody fluid is most often caused by mild trauma, with subcutaneous blood contaminating the sample.
Bloody ascites is also associated with hepatocellular carcinoma or any malignancy-associated ascites.
Milky-appearing fluid usually has an elevated triglyceride concentration. Such fluid, commonly referred to as chylous ascites, can be related to thoracic duct injury or obstruction or lymphoma, but it is often related primarily to cirrhosis. -
This question is part of the following fields:
- Hepatobiliary
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Question 7
Correct
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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: 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 8
Correct
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A patient presents to the nephrologist with proteinuria ++. Which medication would most likely result in the prevention of progression of this disease?
Your Answer: ACE inhibitors
Explanation:Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce intraglomerular pressure by inhibiting angiotensin II ̶ mediated efferent arteriolar vasoconstriction. These drugs also have a proteinuria-reducing effect that is independent of their antihypertensive effect.
In addition, ACE inhibitors have renoprotective properties, which may be partially due to the other hemodynamic and nonhemodynamic effects of these drugs. ACE inhibitors reduce the breakdown of bradykinin (an efferent arteriolar vasodilator); restore the size and charge selectivity to the glomerular cell wall; and reduce the production of cytokines, such as transforming growth factor–beta (TGF-beta), that promote glomerulosclerosis and fibrosis.
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This question is part of the following fields:
- Renal
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Question 9
Correct
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Which is the most likely lymph node involved in the presence of an ulcer on the scrotum?
Your 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 10
Correct
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A 35 year old female with chronic pelvic pain, was recently diagnosed with PID. She was prescribed doxycycline. After 2 days she returned with complaints of abdominal bloating, nausea and regurgitation. Which of the following advice should be given to her?
Your Answer: Take Doxycycline after meals
Explanation:Doxycycline is known to cause dyspeptic symptoms. So advising to take Doxycycline after meals is important. Taking with meals or adding an antacid is not advised, as both will cause reduction in drug absorption.
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This question is part of the following fields:
- Pharmacology
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Question 11
Correct
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A 30 year old male with a scaphoid fracture came to the clinic after 2 weeks of applying the scaphoid cast. After removing the cast he had difficulty moving his thumb, index and middle fingers. Which of the following is the most appropriate management for this presentation?
Your Answer: Release of flexor retinaculum
Explanation:This patient has carpal tunnel syndrome which involves the median nerve. The treatment is releasing of the flexor retinaculum.
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This question is part of the following fields:
- Neurology
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Question 12
Correct
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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: 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 13
Incorrect
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Which of the following features occurs very less frequently with drug induced lupus?
Your Answer: Pleurisy
Correct Answer: Glomerulonephritis
Explanation:Drug induced lupus typically presents with pulmonary involvement and no renal or neurological involvement. Hence glomerulonephritis would be highly unlikely in this case. Rash and arthralgias are classic presentations. Pleurisy can be present as pulmonary involvement may occur with DILE.
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This question is part of the following fields:
- Rheumatology
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Question 14
Correct
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A 37 year old woman presents with sudden blindness. She claims she had a similar episode last year which resolved in three months. Fundoscopy is normal. Upon examination, mild weakness of the right upper limb is found. Reflexes on the same limb are exaggerated. What is the best treatment?
Your Answer: Corticosteroids
Explanation:The age of the patients together with sudden loss of vision, remission and relapse of optic neuritis, focal neurological symptoms and exaggerated reflexes all suggest multiple sclerosis. This is treated with corticosteroids.
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This question is part of the following fields:
- Neurology
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Question 15
Correct
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A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions 10 minutes after birth. A chest radiograph reveals well-aerated lungs with fluid in the fissure on the right, prominent pulmonary vascular markings, and flattening of the diaphragm. His oxygen saturation is 90%. He improves within a few hours and requires no oxygen. What condition is this infant most likely suffering from?
Your Answer: Transient tachypnoea of the new-born
Explanation:Transient tachypnoea of the new-born is a condition associated with the delayed clearance of amniotic fluid from the new-born. The X-ray findings are typical of this condition. As the name implies and was noted in this patient, it is not a lasting condition and resolves within 24-72 hours after birth. The differential diagnoses usually present with different chest X-ray findings:
– Aspiration pneumonia shows infiltrates in the lower lobes of the lungs
– Congenitally acquired pneumonia shows patchy, asymmetrical densities
– Meconium aspiration shows hyperinflation and patchy asymmetric airspace disease
– Pulmonary oedema shows cephalization of pulmonary veins and indistinctness of the vascular margins. -
This question is part of the following fields:
- Child Health
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Question 16
Correct
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A 6 year old boy presents with a history of repeated respiratory and gastro-intestinal infections since birth. His birth was, however, uncomplicated. His mother claims that he's not growing as he should for his age. What is the most likely diagnosis?
Your Answer: Cystic fibrosis
Explanation:Cystic fibrosis is a genetic disease that interferes with the normal development of the child. It manifests with recurrent episodes of pneumonia accompanied by coughing, wheezing and dyspnoea. The appetite is normal but weight gain seems difficult. This condition also affects bowel habits with repeated gastrointestinal infections. The gold standard for the diagnosis is considered the sweat test which reveals abnormally high levels of Cl-.
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This question is part of the following fields:
- Child Health
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Question 17
Incorrect
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A 58 year old woman with a longstanding history of hypertension arrives at the hospital complaining of recurrent falls when trying to get out of bed or get up from sitting. She is currently on an anti hypertensive regimen? What do you think is most likely responsible for her falls?
Your Answer: CCB
Correct Answer: Thiazide
Explanation:The causes of orthostatic hypotension include the following: Hypovolemia (a drop in the volume of blood) and dehydration (low fluid volume in the body). Common causes of these are bleeding, elevated sugar, diarrhoea, vomiting, and medications like thiazide diuretics (HCTZ) and loop diuretics (furosemide, bumetanide)
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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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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: Bronchiectasis
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 19
Correct
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Arrange the following opioid analgesics in order of increasing potency.
Your Answer: Codeine, morphine, oxycodone, diamorphine
Explanation:Opioid analgesics produce pain relief by attaching to the opioid receptors in the brain. Out of these, codeine is the least potent and diamorphine the most potent. Codeine is used to relieve mild to moderate pain. Morphine is a stronger analgesic used to treat pain like that experienced after surgery or injury. Oxycodone acts like the endorphins in the brain and reduces pain sensation. It is more potent than codeine and morphine and is used for relieving moderate to severe forms of pain. Among the listed, diamorphine is the most potent opioid analgesic. It is administered intravenously, subcutaneously, or intramuscularly to treat severe pain after surgery or in terminally-ill patients.
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This question is part of the following fields:
- Pharmacology
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Question 20
Correct
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A 28 year old male who has undergone splenectomy for an abdominal trauma presents on the 3rd post operative day with acute abdominal pain and distension in the upper abdominal area with hypotension. 2 litres of coffee ground powder was aspirated on insertion of ryles tubes. Which of the following is the most likely diagnosis?
Your Answer: Acute gastric dilatation
Explanation:Acute gastric dilation leading to ischemia of the stomach is an under-diagnosed and potentially fatal event. Multiple aetiologies can lead to this condition, and all physicians should be aware of it. Acute gastric dilation occurs as a result of eating disorders, trauma resuscitation, volvulus of hiatal hernias, medications, electrolyte abnormalities, psychogenic polyphagia, superior mesenteric artery syndrome, and a myriad of other conditions. Without proper and timely diagnosis and treatment, gastric perforation, haemorrhage, and other serious complications can occur.
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This question is part of the following fields:
- Gastrointestinal
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Question 21
Incorrect
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A 52 year old man had an appendectomy for a gangrenous appendix. Six hours later he develops pain. What drug would you choose to relieve his symptoms?
Your Answer: Tramadol
Correct Answer: I/V morphine
Explanation:Opioids are initiated for a wide range of indications with varying doses and durations. Patients who are initiated on opioids for postsurgical and musculoskeletal pain receive the greatest doses and durations of therapy, respectively.
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This question is part of the following fields:
- Surgery
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Question 22
Correct
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An 18-year-old female patient presents with a history of headache and photophobia. You believe that the diagnosis is subarachnoid haemorrhage but your colleague insists on bacterial meningitis. Which of the following would you use to support your diagnosis?
Your Answer: A family history of polycystic renal disease
Explanation:Hypertension could be the result of polycystic renal disease and is a risk factor for subarachnoid haemorrhage (SAH). What are common in polycystic renal disease are cerebral aneurysms which could rupture if hypertension is present. Both meningitis and SAH can lead to a fluctuating level of consciousness and opiate abuse is not a risk factor for either SAH nor meningitis. Finally, diabetes is not linked with none of the possible diagnoses because hypertension is not a risk factor of diabetes.
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This question is part of the following fields:
- Neurology
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Question 23
Incorrect
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A 25-year-old girl's ECG revealed a normal PR interval and QRS while the QT is prolonged. History reveals she has been having frequent fainting attacks since childhood. What is the cause of these syncopal attacks?
Your Answer: Sick sinus syndrome
Correct Answer: Torsade de pointes
Explanation:Patients with a long QT wave syndrome are prone to recurrent syncope if they have Torsade’s de pointes since it degenerates into fibrillation of the ventricles.
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This question is part of the following fields:
- Cardiovascular
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Question 24
Incorrect
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A 5-year-old girl was admitted for fever, anaemia, thrombocytopenia and signs of pulmonary infection. She now presents a few days later with signs of meningism. What is the most probable diagnosis?
Your Answer: Aplastic Anaemia
Correct Answer: Acute lymphoblastic leukaemia (ALL)
Explanation:Acute lymphoblastic leukaemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. Symptoms may include feeling tired, frequent infections with fever as well as anaemia with thrombocytopenia. As an acute leukaemia, ALL progresses rapidly and is typically fatal within weeks or months if left untreated. The patient’s age also favours the diagnosis of ALL as it occurs most commonly in children, particularly those between the ages of two and five.
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This question is part of the following fields:
- Haematology
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Question 25
Incorrect
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A 33 year old female presents with dyspnoea, myalgia, arthralgia and a skin rash. The presence of which of the following antibodies would be the most specific for SLE?
Your Answer: ANA
Correct Answer: Anti-Sm
Explanation:Anti-Sm antibodies are essential for diagnosis of SLE, especially in anti-dsDNA-negative patients. ANA are also found in 95% of the patients with SLE but they may also occur with other conditions like Juvenile inflammatory arthritis, chronic activity hepatitis, and Sjogren’s syndrome. Anti-Ro, although also found with SLE are more characteristic of Sjogren Syndrome. RF is usually associated with rheumatoid arthritis and cANCA with Wegener’s granulomatosis, Churg Strauss, and microscopic polyangiitis.
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This question is part of the following fields:
- Rheumatology
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Question 26
Correct
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A 75-year-old male patient, with a history of late onset asthma and heart failure as well as generalized rash, presents with Bell's palsy. CXR shows multiple soft shadows and blood test reveal an eosinophilia. Which antibody would you expect to be positive?
Your Answer: P ANCA
Explanation:Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disorder, belonging to the small vessel anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. It is defined as an eosinophil-rich and necrotizing granulomatous inflammation often involving the respiratory tract, and necrotizing vasculitis predominantly affecting small to medium-sized vessels, associated with asthma and eosinophilia. ANCA (especially pANCA anti-myeloperoxidase) are present in 40–60% of the patients.
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This question is part of the following fields:
- Rheumatology
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Question 27
Correct
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What is the sign of life threatening asthma?
Your Answer: Deteriorating level of consciousness
Explanation:A drop in level of consciousness is an indicator of high levels of PCO2 and cerebral cortex depression. It is a life threatening condition that requires intervention which may include mechanical ventilation.
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This question is part of the following fields:
- Respiratory
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Question 28
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 29
Correct
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A 68 year old female underwent surgery for a hysterectomy. 24 hours later, she is complaining of breathlessness. Upon examination, she has bibasal chest crepitations and a raised jugular venous pressure (JVP). From the list of options, which is the most likely electrolyte or fluid abnormality?
Your Answer: Fluid overload
Explanation:The raised JVP and bibasal crepitations in the patient indicate cardiac failure with fluid overload. A chest x-ray and BNP blood level analysis should be performed to confirm this diagnosis. The x-rays should be analysed for alveolar shadowing, Kerly B lines, cardiomegaly, upper lobe diversion, pleural effusion, and fluid in the fissure. If the patient doesn’t have a history of congestive cardiac failure, then this may have been iatrogenic secondary to intravenous fluids.
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This question is part of the following fields:
- Seriously Ill
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Question 30
Correct
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A 16-month-old infant presented to ER with multiple bruises on his right arm. According to his mom, he has been unable to move it since yesterday and is crying more than usual. A relative attended the child while his mother was on a night shift. X-ray revealed a fracture of the right humerus, which was put in a cast. What is the next step in this case?
Your Answer: Admit under care of paediatrician
Explanation:Certain lesions present on x-ray are suggestive of child abuse including rib, humerus and skull fractures. It is the doctors responsibility to follow up on these cases to determine whether domestic abuse has occurred.
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This question is part of the following fields:
- Child Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
