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Question 1
Correct
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A 55 year old female school teacher complains of double vision when she writes on the school blackboard. She has no history of trauma. Her most recent visit to her GP was to seek attention for a rash which developed after she was bitten when walking through the forest on a school trip. Choose the cranial nerve most likely to be affected here.
Your Answer: Abducens
Explanation:This nerve is responsible for the side to side movement of the eye, hence why damage can cause double vision.
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This question is part of the following fields:
- Neurology
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Question 2
Incorrect
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A 45 year old man, known case of hypothyroidism, presents with a 3 month history of pain and stiffness in the joints of his hands and feet. He also complains of dyspnoea occurring for the past 6 weeks. On examination there is a right pleural effusion and swollen hand joints. The clinician makes a diagnosis of rheumatoid arthritis. Which of the following is most characteristic of a rheumatoid pleural effusion?
Your Answer: Long-standing rheumatoid effusions have low cholesterol levels
Correct Answer: It has a low glucose level
Explanation:The typical “rheumatoid effusion” is a sterile exudative fluid with low pH (<7.3), low glucose (700 IU). It should initially be treated with NSAIDs. Decortication should be reserved in patients with thickened pleura who have symptomatic dyspnoea.
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This question is part of the following fields:
- Rheumatology
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Question 3
Incorrect
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Psoriatic arthropathy most commonly presents with which of the following types of arthritis?
Your Answer: Psoriatic spondylitis
Correct Answer: Peripheral asymmetric oligoarthropathy
Explanation:Most patients with psoriatic arthritis present with monoarthritis or asymmetric oligoarthritis. The most common form of the disease is the one involving a few joints of the peripheral skeleton with a distinct asymmetry of symptoms. Involvement of the smaller joints of the hands and feet, especially distal interphalangeal joints, seems to be a characteristic feature. Arthritis mutilans is a rare and severe complication of psoriatic arthritis.
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This question is part of the following fields:
- Rheumatology
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Question 4
Incorrect
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Which of the following statements reflects the aetiology and dynamics of schizophrenia most accurately?
Your Answer: In monozygotic twins the risk of the second twin developing schizophrenia if the first is affected is of the order of 10%
Correct Answer: Schizophrenia is commoner in individuals not in stable relationships
Explanation:According to the survey, schizophrenia is twice as common in individuals who are not in stable relationships or are single/divorced, as compared to happy couples.
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This question is part of the following fields:
- Mental Health
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Question 5
Incorrect
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A 45-year-old male complained of deteriorating vision after starting a new drug. Which of following could NOT be responsible for this presentation?
Your Answer: Ethambutol
Correct Answer: Irinotecan
Explanation:Chloroquine causes Bull’s eye maculopathy which consists of a number of different conditions in which there is a ring of pale-looking damage around a darker area of the macula.
Ethambutol causes optic neuritis.
Quinine causes blurred vision and changes in colour vision.
Vincristine causes optic nerve atrophy as a result of chronic optic nerve oedema or optic neuritis.
Irinotecan does not have any ocular side effects. -
This question is part of the following fields:
- Pharmacology
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Question 6
Incorrect
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A 24-year-old man is evaluated for facial pain and fever lasting four days. Symptoms began with an upper respiratory tract infection accompanied by purulent nasal discharge; he then began to have pain over the right cheek and developed a fever of 38.4°C. On examination, he has a purulent nasal discharge and tenderness over the right maxilla. CT shows right maxillary sinusitis. Which of the following is the most appropriate antibiotic treatment for this patient?
Your Answer: Ciprofloxacin
Correct Answer: Amoxicillin
Explanation:Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance, and overproduction of secretions. Sinusitis can be treated with antibiotics, decongestants, steroid drops or sprays, mucolytics, antihistamines, and surgery (lavage). Studies have shown that 70% of cases of community-acquired acute sinusitis in adults and children are caused by Streptococcus pneumoniae and Haemophilus influenzae. Most guidance favours amoxicillin as first line treatment. There seems to be little evidence base for this, however. BMJ’s clinical evidence website found three RCTs which showed no difference between amoxicillin and placebo (in patients without bacteriological or radiological evidence of sinusitis). However, there were no RCTs examining the effects of co-trimoxazole, cephalosporins, azithromycin, and erythromycin. Second line therapies include ciprofloxacin and co-amoxiclav. First and second generation cephalosporins are not generally favoured.
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This question is part of the following fields:
- ENT
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Question 7
Correct
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A 26-year-old patient without a known medical history presents to casualty unconscious. What should be done as soon as possible?
Your Answer: Blood Glucose
Explanation:Blood glucose should be evaluated immediately in order to investigate for diabetic coma triggered by hyperglycaemia or hypoglycaemia.
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This question is part of the following fields:
- Emergency
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Question 8
Correct
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A 41-year-old woman has been feeling down lately. She has been avoiding social events and has a strong family history of depression. Which of the following increases her suicidal tendency?
Your Answer: Past history of overdose
Explanation:A large prospective study identified hopelessness, higher levels of suicidal ideation, recurrent episodes of depression, presence of personality disorders, previous psychiatric hospitalisation, older age, unemployed status and a family history of suicide as significant markers for suicide. Having one or more previous suicide attempts is a very strong predictor of suicide risk.
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This question is part of the following fields:
- Mental Health
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Question 9
Correct
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A 70 year old female presented with throbbing and continuous headache and loss of vision. Her ESR was elevated. Which of the following is the most appropriate management?
Your Answer: Corticosteroids
Explanation:Giant Cell Arteritis (Temporal Arteritis) is the most probable diagnosis. GCA should always be considered in the differential diagnosis of a new-onset headache in patients 50 years of age or older with an elevated erythrocyte sedimentation rate. Temporal artery biopsy remains the criterion standard for diagnosis of this granulomatous vasculitis. High-dose corticosteroid therapy is the universally accepted treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 10
Incorrect
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Which is the most likely lymph node involved in the presence of an ulcer on the scrotum?
Your Answer: Iliac 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 11
Incorrect
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A 3-year-old child choked on a foreign object, which was removed at the hospital. The parents are now asking for advice on how to manage future occurrences at home. What do you advise?
Your Answer: Heimlich manoeuvre
Correct Answer: Turn the child on his back and give thumps
Explanation:Give up to five back blows: hit them firmly on their back between the shoulder blades. Back blows create a strong vibration and pressure in the airway, which is often enough to dislodge the blockage.
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This question is part of the following fields:
- Child Health
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Question 12
Correct
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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: 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 13
Correct
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A 45 year old known asthmatic was admitted with acute severe asthma and was treated with nebulised salbutamol, ipratropium and bromide, along with 100% oxygen therapy. He was also given IV hydrocortisone, however there was no significant improvement. What would be the next step in management of this patient?
Your Answer: IV Aminophylline
Explanation:Aminophylline is a very effective bronchodilator. It is short acting and therefore very effective in acute scenarios.
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This question is part of the following fields:
- Respiratory
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Question 14
Correct
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A 70-year-old male presented in the OPD with a complaint of abdominal pain and blood in his stools for the last two days. He reports that the stools are black in colour and sometimes accompanied by fresh blood. There is also a history of significant weight loss. Blood tests revealed elevated CA 19-9. What is the patient most likely suffering from?
Your Answer: Colorectal carcinoma
Explanation:The patient’s symptoms along with his age indicates a diagnosis of colorectal cancer. Blood test marker CA-19-9 is a prognostic index for colorectal cancer which confirms the suspicion.
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This question is part of the following fields:
- Colorectal
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Question 15
Correct
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A 20-year-old female was brought to the ED by her father because of noticeable drowsiness and a hoarse voice. She reported having left the heater turned on before sleeping the night before. Laryngoscopy revealed laryngeal oedema. Which of the following is the step you would take next?
Your Answer: Anaesthetics for help
Explanation:The anaesthesiologist should be called for help because this patient is suffering from laryngeal oedema and if not anaesthetised, the oedema might block the airway completely.
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This question is part of the following fields:
- ENT
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Question 16
Correct
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A 44 year old woman was admitted with dull retrosternal chest pain. History reveals the pain has been present for two weeks. Clinical examination and ECG, however, show nothing interesting. CXR shows an air-fluid level behind the heart. Which hernia would explain this presentation?
Your Answer: Hiatal
Explanation:A hiatal hernia may be asymptomatic, however classically it presents on CXR with a very characteristic air-fluid level behind the heart. If pain is present, PPIs can be administered. If pain is persistent, surgical intervention should be considered to ameliorate the risk of strangulation. There are two types of hiatal hernias; sliding or Para oesophageal.
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This question is part of the following fields:
- Gastrointestinal
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Question 17
Incorrect
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A 70-year-old female presented to her ophthalmologist with a complaint of weakening eyesight despite continued use of her corrective glasses. She also had a history of mild headaches for a few weeks. On fundoscopy, the disc had blurred margins with mild cupping and a sickle shaped scotoma in both eyes. What is the most appropriate treatment in this case?
Your Answer: Corticosteroids
Correct Answer: Pilocarpine eye drops
Explanation:Frequent change of eye glasses, scotoma, and mild cupping are suggestive of primary open angle glaucoma. This means that the anterior angle of the eye is normal but there is a problem in the trabecular meshwork, where the Schlemm’s Canal is not allowing the drainage of the aqueous humor. Pilocarpine should be given to the patient because it is a parasympathomimetic agent. It causes the ciliary muscle of the eye to contract, causing the trabecular meshwork to open up, allowing the aqueous humor to drain again.
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This question is part of the following fields:
- Ophthalmology
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Question 18
Correct
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A 45-year-old male with a history of bipolar affective disorder was admitted following an event of deliberate self-harm. He has had an argument with his wife and he has stopped taking his medication. He has begun drinking alcohol quite heavily as well. He is fit to discharge from the medical ward but he looks depressed and still has thoughts of self-harm. Which of the following is the most appropriate next step?
Your Answer: Admission to the psychiatry ward
Explanation:As he still has thoughts of self harm it is not safe to discharge him from the hospital. He needs further evaluation by a psychiatrist. So the best option is to admit him to the psychiatry ward.
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This question is part of the following fields:
- Mental Health
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Question 19
Correct
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A 52 year old man presented with bruises over the mastoid region of his face. He is otherwise stable with a normal GCS. Which bone is affected in this injury to the mastoid region?
Your Answer: Temporal
Explanation:The mastoid process is located retro auricularly and is a part of the temporal bone.
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This question is part of the following fields:
- Surgery
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Question 20
Correct
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A 38-year-old male complained of painless, right sided testicular enlargement for 4 months. The size has been gradually increasing. On examination, there was no tenderness or redness. It was firm in consistency and not transiluminating. The most likely diagnosis is?
Your Answer: Testicular tumour
Explanation:History is suggestive of testicular tumour due to the gradual onset, non tender, firm mass. Hydroceles transiluminate and a varicocele has a bag of worms texture. Epididymo-orchitis is tender and often red or inflamed. An ependymal cyst is confined to the epididymis.
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This question is part of the following fields:
- Genitourinary
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Question 21
Correct
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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: 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 22
Incorrect
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A 68 year old male presented with right sided hip pain and was found to have a fracture of right hip. On examination he had bilateral pedal oedema and was also found to be deaf. Which of the following is the most probable diagnosis?
Your Answer: Multiple myeloma
Correct Answer: Paget’s disease
Explanation:Paget disease is a localized disorder of bone remodelling . Hip pain is most common when the acetabulum and proximal femur are involved. The most common neurologic complication is deafness as a result of involvement of the petrous temporal bone. Bilateral pedal oedema is due to associated heart failure.
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This question is part of the following fields:
- Musculoskeletal
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Question 23
Incorrect
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A 26-year-old pregnant female in her first trimester was brought to the labour room with complaints of painless vaginal bleeding. On examination, her abdomen was non-tender and os was closed. Which of the following is the most likely diagnosis?
Your Answer: Spontaneous miscarriage
Correct Answer: Threatened miscarriage
Explanation:Threatened miscarriage is a term used to describe any abnormal vaginal bleeding that occurs in first trimester, sometime associated with abdominal cramps. The cervix remains closed and the pregnancy may continue as normal.
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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 48-year-old woman presented to you with a history of left side weakness that resolved within 2 hours. A CT scan was done showing reduced blood flow in a certain area. What is the next step regarding investigations?
Your Answer: Carotid Doppler plus angiography
Explanation:This is a case of a transient ischemic attack. It is better investigated by carotid duplex to exclude carotid artery stenosis or atherosclerotic changes.
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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 65-year-old male who was treated for atrial fibrillation 6 months ago, complained of painful swelling of the right breast/pectoral region. Following atrial fibrillation, he has taken a number of drugs. Which of the following drugs is responsible for the above presentation?
Your Answer: Spironolactone
Explanation:Spironolactone induces gynecomastia by blocking androgen production. It blocks androgens from binding to their receptors, and increasing both total and free oestrogen levels. Generally, discontinuation of treatment results in resolution of the gynecomastia. Other drugs which cause gynecomastia are calcium channel blockers (Nifedipine, Amlodipine, Verapamil, Diltiazem), ACE inhibitors (Captopril, Enalapril), alpha receptor blockers (Doxazocin, Prazosin) and centrally acting agents (Clonidine, Methyldopa, Reserpine).
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This question is part of the following fields:
- Pharmacology
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Question 26
Correct
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In over 70% of the cases, inflammatory bowel disease associates which of the following?
Your Answer: Primary sclerosing cholangitis
Explanation:More than 70% of cases with inflammatory bowel disease are associated with primary sclerosing cholangitis. The most common association is that of ulcerative colitis, in which case it progresses independently.
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This question is part of the following fields:
- Gastrointestinal
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Question 27
Correct
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A 70-year-old chronic smoker presented with difficulty in opening his mouth and right sided ear pain for six months, which was increasing in severity. On examination, there was an ulcer at the base of their tongue and two hard, non-tender cervical lymph nodes. What is the most possible cause for this presentation?
Your Answer: Oropharyngeal malignancy
Explanation:The smoking history, ulcer at the base of the tongue, earache, difficulty in opening the mouth, and hard non tender lymph nodes favours the diagnosis of oropharyngeal malignancy. The other given conditions would generally not result in ulceration of the tongue and Herpes would have vesicles and associate pain over the affected nerve distribution.
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This question is part of the following fields:
- ENT
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Question 28
Incorrect
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A 59-year-old man complains of weakness in his right lower and upper limb since 3for a few hours. He is has been taking Digoxin for 2 years. What is the most definitive investigation for this condition?
Your Answer: CT head
Correct Answer: Angiography
Explanation:Digoxin is a cardiac glycoside, having positive inotropic effects on the heart. It increases the strength of contractility of the heart, increasing the heart rate, but lowering blood pressure. This patient developed weakness in his limbs most likely caused by extremely low blood pressure that could be due to diseased blood vessels reacting to the side-effects of digoxin, therefore an angiography would be the best investigation.
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This question is part of the following fields:
- Cardiovascular
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Question 29
Correct
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A 60-year-old female underwent a surgery involving the posterior triangle of the neck. After the surgery, she had difficulty when moving her right shoulder joint. Which of the following nerves is most probably involved?
Your Answer: Accessory nerve
Explanation:The accessory nerve innervates the trapezius muscle which is involved in shoulder movements. Any injury to this nerve will result in the difficulty of movements around the shoulder.
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This question is part of the following fields:
- Musculoskeletal
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Question 30
Correct
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A 70-year-old male diagnosed previously with villous adenoma presented in the OPD with severe diarrhoea. Which of the following electrolyte or fluid imbalances is most commonly associated with such a condition?
Your Answer: Hypokalaemia
Explanation:Lower GIT fluid is rich in potassium. So, in the case of severe diarrhoea, potassium loss occurs leading to hypokalaemia. Loss of bicarbonate ions also occurs. Both of these disturbances will lead to hyperchloremic metabolic acidosis.
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This question is part of the following fields:
- Seriously Ill
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SESSION STATS - PERFORMANCE PER SPECIALTY
