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Question 1
Correct
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A 35 year old lady presented in her 3rd trimester with severe features of pre-eclampsia. The drug of choice to prevent the patient going into impending eclampsia would be?
Your Answer: Intravenous magnesium sulphate
Explanation:The drug of choice for eclampsia and pre-eclampsia is magnesium sulphate. It is given as a loading dose of 4g i/v over 5 minutes, followed by an infusion for the next 24 hours at the rate of 1g/hr. If the seizures are not controlled, an additional dose of MgSO4 2-4gm i/v can be given over five minutes. Patients with eclampsia or pre-eclampsia can develop any of the following symptoms: persistent headache, visual abnormalities like photophobia, blurring of vison or temporary blindness, epigastric pain, dyspnoea and altered mental status.
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This question is part of the following fields:
- Obstetrics
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Question 2
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:
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 3
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:
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 4
Incorrect
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A 14-year-old boy presents with a rash on his buttocks and extensor surfaces following a sore throat. What is the most probable diagnosis?
Your Answer:
Correct Answer: Henoch-Schönlein purpura (HSP)
Explanation:Henoch-Schönlein purpura (HSP) rashes are commonly found on the legs, feet, and buttocks while Immune thrombocytopenia (ITP) rashes manifest predominantly on the lower legs. HSP happens following a sore throat while ITP usually happens following an URTI or Flu. HSP is an inflammation of a blood vessel (vasculitis) while ITP is immune mediated insufficiency of platelets.
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This question is part of the following fields:
- Dermatology
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Question 5
Incorrect
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A 41 year old male experiences hand tremors that are absent at rest, but aggravated on extension and continuous with movement. What is the most probable diagnosis?
Your Answer:
Correct Answer: Benign essential tremor
Explanation:Tremors that linger on movement, seen on an outstretched hand, and absent on rest are called benign essential tremors.
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This question is part of the following fields:
- Musculoskeletal
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Question 6
Incorrect
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Which of the following conditions is not linked to hyperuricemia?
Your Answer:
Correct Answer: Osteoarthritis
Explanation:Hyperuricemia is an elevated uric acid level in the blood. The normal upper limit is 6.8mg/dL, and anything over 7 mg/dL is considered saturated, and symptoms can occur. Causes of hyperuricemia can be classified into three functional types:
1. Increased production of uric acid – Purine rich diet, Tumour lysis syndrome, HGPRT deficiency (Lesch-Nyhan and Kelley-Seegmiller syndromes), Increased PRPP synthetase activity and Polycythaemia
2. Decreased excretion of uric acid – Renal impairment, Metabolic syndrome, Drugs (diuretics, low-dose aspirin, cyclosporin, tacrolimus, pyrazinamide, ethambutol, levodopa, nicotinic acid), Acidosis, Pre-eclampsia and eclampsia, Hypothyroidism and hyperparathyroidism, Sarcoidosis, Familial juvenile gouty nephropathy, Chronic lead intoxication, Trisomy 21
3. Idiopathic and mixed type – Alcohol, Exercise, Glucose-6-phosphatase deficiency, Aldolase B deficiency -
This question is part of the following fields:
- Musculoskeletal
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Question 7
Incorrect
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A 54 year old man presents to the physician complaining of chest pain and fever. He underwent hemicolectomy a few days back. Echocardiography is done which shows a systolic murmur. Which other investigation would be required?
Your Answer:
Correct Answer: Blood culture
Explanation:Infective endocarditis (IE) is an infectious inflammation of the endocardium that affects the heart valves. The condition is a result of bacteraemia, which is most commonly caused by dental procedures, surgery, distant primary infections, and nonsterile injections. IE clinically presents with either an acute or subacute course. Acute disease is usually caused by Staphylococcus aureus and causes rapid endocardium destruction. Subacute progression is most commonly caused by viridans streptococci species and generally affects individuals with pre-existing damage to the heart valves, structural heart defects, or the presence of prosthetic valves. Clinical features include constitutional symptoms (fatigue, fever/chills, malaise) in combination with signs of pathological cardiac changes (e.g., new or changed heart murmur, heart failure signs) and possibly manifestations of subsequent damage to other organs (e.g., glomerulonephritis, septic embolic stroke). Diagnosis is made based on the Duke criteria, whose main features include positive blood cultures and evidence of endocardial involvement in echocardiography. Initial treatment of IE consists of empiric IV antibiotic therapy, which is then adapted to blood culture results and continued for four to six weeks. Prophylaxis is only administered in specific circumstances, e.g., in patients with pre-existing heart conditions undergoing dental or surgical procedures. If left untreated, infective endocarditis can be fatal within a few weeks.
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This question is part of the following fields:
- Mental Health
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Question 8
Incorrect
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A 42 year old female with a history of SLE presents with an exacerbation of wrist pain. Which of the following markers would be the most suitable for monitoring disease activity?
Your Answer:
Correct Answer: Anti-dsDNA titres
Explanation:A high level of anti-dsDNA in the blood is strongly associated with lupus and is often significantly increased during or just prior to a flare-up. When the anti-dsDNA is positive and the person tested has other clinical signs and symptoms associated with lupus, it means that the person tested likely has lupus. This is especially true if an anti-Sm test is also positive.
In the evaluation of someone with lupus nephritis, a high level (titre) of anti-dsDNA is generally associated with ongoing inflammation and damage to the kidneys.
A very low level of anti-dsDNA is considered negative but does not exclude a diagnosis of lupus. Only about 65-85% of those with lupus will have anti-dsDNA.
Low to moderate levels of the autoantibody may be seen with other autoimmune disorders, such as Sjögren syndrome and mixed connective tissue disease (MCTD).
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This question is part of the following fields:
- Rheumatology
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Question 9
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:
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 10
Incorrect
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Which of the following features occurs very less frequently with drug induced lupus?
Your Answer:
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 11
Incorrect
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A 60-year-old male presented with complaints of chest pain, a productive cough, blood in the sputum, and night sweats. He also has a history of weight loss. His chest X-ray revealed multiple infiltrates. Which of the following is the most appropriate investigation to be done in this case?
Your Answer:
Correct Answer: Acid fast bacilli test for sputum
Explanation:All the symptoms of this patient are characteristic features of tuberculosis. The ideal test is the acid fast bacilli test for sputum, it will confirm the preserve of Mycobacterium Tuberculosis using the Ziehl-Nelson stain.
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This question is part of the following fields:
- Respiratory
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Question 12
Incorrect
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A 4-year-old female was suffering from an upper respiratory tract infection. Her mother treated her with paracetamol only, for 5 days. After that, she presented in the emergency room with severe pain in her left ear, high-grade fever and irritability. What is the most likely diagnosis?
Your Answer:
Correct Answer: Otitus media (OM)
Explanation:Upper respiratory tract infection when not treated accordingly can lead to otitis media and the patient presents with severe earache and fever.
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This question is part of the following fields:
- ENT
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Question 13
Incorrect
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A 42-year-old woman who has been a smoker since she was a teenager has the following blood result: Hgb=19. What hormone should you check?
Your Answer:
Correct Answer: Erythropoietin
Explanation:An increase in the patient’s haemoglobin tells us that the patient might be having an increased number of red blood cells. Smoking causes raised carboxyhaemoglobin levels and thus hypoxemia. Hypoxemia will increase the erythropoietin levels in the blood.
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This question is part of the following fields:
- Haematology
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Question 14
Incorrect
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A 34 year old male has been brought to accident and emergency after being involved in a road collision. After his initial evaluation, his score on the Glasgow Coma Scale is 6. What is the most appropriate next step in his treatment?
Your Answer:
Correct Answer: Secure airway
Explanation:The appropriate next step in this patient’s treatment is to secure his airway.
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This question is part of the following fields:
- Seriously Ill
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Question 15
Incorrect
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A 35 year old mother of 3 children presented with poor sleep. She has had constant nightmares of an accident which she faced with her family members few months ago, which has disturbed her sleep. She was irritable towards her children and has difficulty in concentrating on her daily activities. She blamed her husband for the car accident inappropriately. Which of the following is the most appropriate treatment for her?
Your Answer:
Correct Answer: Fluoxetine
Explanation:The history is suggestive of post traumatic stress disorder (PTSD) as the patient had a traumatic event, nightmares of the incidence, poor sleep, irritability etc. The main treatments for people with PTSD are psychotherapy, medication, or a combination of the two. Cognitive behavioural therapy is the main psychotherapy method used. The most studied medications for treating PTSD are SSRIs. So from the given answers, Fluoxetine is the correct answer.
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This question is part of the following fields:
- Mental Health
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Question 16
Incorrect
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Which of the following does the inferior mesenteric artery supply?
Your Answer:
Correct Answer: From the splenic flexure to the first third of the rectum
Explanation:The coeliac axis supplies the liver and stomach and from the oesophagus to the first half of the duodenum.
The second half of the duodenum to the first two thirds of the transverse colon is supplied by the superior mesenteric artery.
The inferior mesenteric supplies the last third of the transverse colon (approximately from the splenic flexure) to the first third of the rectum.
The last two thirds of the rectum are supplied by the middle rectal artery.
The greater curvature of the stomach is supplied by branches of the splenic artery, which itself comes from the coeliac axis. -
This question is part of the following fields:
- Gastrointestinal
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Question 17
Incorrect
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A woman presents having overdosed on Imipramine. Which investigation should be done immediately?
Your Answer:
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 18
Incorrect
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A patient without any history of suicidal behaviour or depression was admitted yesterday with acute poisoning due to ten different substances. What should be done to prevent future occurrences?
Your Answer:
Correct Answer: Insight into problem
Explanation:The patient is not suicidal or suffering from a depressive episode. The fact that she/he poisoned herself/himself might be the result of reactive or anxious behaviour. Therefore insight into the problem is most likely the best option to establish future coping mechanisms.
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This question is part of the following fields:
- Mental Health
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Question 19
Incorrect
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A neonate was brought in by her mother, for a skin lesion present over the neonate's back which is bluish in colour, but otherwise asymptomatic. The most appropriate course of action will be?
Your Answer:
Correct Answer: Reassure
Explanation:A Mongolian spot can be present in new born babies which usually appears over the back and fades with time. There is nothing to worry about.
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This question is part of the following fields:
- Dermatology
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Question 20
Incorrect
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A 60 year old male presents with a 6 month history of poor sleep and a loss of interest in his normal activities. He has recently become very forgetful and responds to many questions with the phrase I don't know. Choose the most likely diagnosis for this patient.
Your Answer:
Correct Answer: Depression
Explanation:Many of this patient’s symptoms are consistent with depression: having no motivation or interest in things, finding it difficult to make decisions, and a disturbed sleeping pattern.
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This question is part of the following fields:
- Mental Health
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Question 21
Incorrect
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A 28 year old male patient who was involved in a fight, presents with haemorrhage, tinnitus and hypoacusis from the one ear. What investigation would you perform?
Your Answer:
Correct Answer: CT
Explanation:CT should be performed to assess the severity of the head trauma and intracranial pathology.
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This question is part of the following fields:
- ENT
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Question 22
Incorrect
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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:
Correct 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 23
Incorrect
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Parents of a new-born are worried about cot death. What advice will you give?
Your Answer:
Correct Answer: Child should sleep on the back with legs towards the end of the cot
Explanation:Cot death also know as SIDS or Sudden Infant Death syndrome. Putting a baby to sleep on his back has been shown to reduce the risk of SIDS.
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This question is part of the following fields:
- Child Health
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Question 24
Incorrect
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All of the following drugs reduce the tone of the lower oesophageal sphincter except?
Your Answer:
Correct Answer: Domperidone
Explanation:Domperidone is a D2 dopaminergic receptor antagonist which works as an anti emetic by increasing the tone of the lower oesophageal sphincter and increasing the gut motility.
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This question is part of the following fields:
- Pharmacology
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Question 25
Incorrect
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A 20 year old male, who was otherwise completely healthy, has developed severe and sudden pain in his lower back. It started after getting up from his bed. What is the most probable diagnosis in this case?
Your Answer:
Correct Answer: PID
Explanation:Sudden onset of severe lower back pain whilst is felt more when bending (such as getting up from a bed) is consistent with a diagnosis of a prolapsed intervertebral disc.
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This question is part of the following fields:
- Musculoskeletal
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Question 26
Incorrect
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A 6 month old baby presents with uncontrollable movements of her hands and feet, shortly after being unconscious for a while. What is the most likely diagnosis?
Your Answer:
Correct Answer: Infantile spasm
Explanation:Infantile spasm belongs to the spectrum of seizure disorders. Infantile spasm manifests itself with loss of consciousness and jerky movements. The peak age of onset is between 4 and 6 months. Approximately 90% of infantile spasms begin before 12 months of age. It is rare for infantile spasms to begin during the first 2 weeks of life or after 18 months.
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This question is part of the following fields:
- Child Health
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Question 27
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:
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 28
Incorrect
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The digital rectal examination and flexible sigmoidoscopy of a 30-year-old woman are normal. However, she still complains of recurrent and brief episodes of severe rectal pain. What is the most likely diagnosis?
Your Answer:
Correct Answer: Proctalgia fugax
Explanation:The digital rectal examination and sigmoidoscopy are normal, a fact that excludes all the other possible diagnoses. Proctalgia fugax is a functional anorectal disorder characterized by severe, intermittent episodes of rectal pain that are self-limiting. The diagnosis of proctalgia fugax requires exclusion of other causes of rectal or anal pain.
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This question is part of the following fields:
- Gastrointestinal
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Question 29
Incorrect
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A 50 year old male patient with Pulmonary Tuberculosis is taking Ethambutol, Isoniazid, Pyrazinamide, Pyridoxine, and Rifampicin. Which of the above drugs is associated with peripheral neuropathy?
Your Answer:
Correct Answer: Isoniazid
Explanation:Isoniazid is associated with peripheral neuropathy, which occurs due to deficiency of biologically active pyridoxine. The deficiency is caused by the combination of isoniazid and pyridoxine to form a hydrazone which is excreted in the urine. Pyridoxine supplementation reduces the risk associated with Isoniazid.
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This question is part of the following fields:
- Pharmacology
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Question 30
Incorrect
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A 74 year old patient presents with back pain, pallor and palpitations. Blood exams reveal multiple plasma cells in the peripheral smear. What is the most likely diagnosis?
Your Answer:
Correct Answer: Multiple myeloma
Explanation:Multiple myeloma presents with bone pain usually in the back or at the level of the ribs. Pathological fractures are common. The patient usually experiences fatigue, paleness, weakness, dyspnoea and gastro-intestinal complaints such as nausea and constipation. Characteristic for this case is the presence of many plasma cells in the peripheral blood smear.
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This question is part of the following fields:
- Haematology
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Question 31
Incorrect
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All of the following statements suggesting a poor prognosis of Guillain-Barre syndrome are correct except?
Your Answer:
Correct Answer: Evidence demyelination on nerve conduction studies
Explanation:Guillain barre syndrome is a neurological disorder characterised by neuropathy along with ascending paralysis. Denervation rather than demyelination suggests poor prognosis in GB syndrome.
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This question is part of the following fields:
- Neurology
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Question 32
Incorrect
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A 2-year-old child, who is not very active, presented with bruises on the back as well as on the chest. X-ray showed a radiolucent area around the ribs indicating callus formation. Which of the following is the most important investigation in this case?
Your Answer:
Correct Answer: Skeletal survey
Explanation:Because the initial chest X-ray returned an anomaly, a skeletal survey is the best option. Also known as a bone survey, the skeletal survey is a series of X-rays that will help analyse the structure of all the bones in the body. Because the child is not very active yet presents with bruising, the child protection register should also be checked but only after a skeletal survey has been conducted.
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This question is part of the following fields:
- Child Health
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Question 33
Incorrect
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A 32-year-old patient that has just returned from India, complains of dyspnoea. On examination, you notice grey membranes on the uvula and tonsils and a low-grade fever. What is the most likely diagnosis?
Your Answer:
Correct Answer: Diphtheria
Explanation:Characteristic findings on patients suffering from diphtheria are the grey membrane on the uvula and tonsils together with the low grade fever and dyspnoea. It’s of great importance that the patient has recently been to India where there is a know prevalence.
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This question is part of the following fields:
- Infectious Diseases
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Question 34
Incorrect
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A 35-year-old female had an oral glucose tolerance test. Her oral glucose test after 2 hrs was 10mml/l. What is the result of her test?
Your Answer:
Correct Answer: Impaired glucose tolerance
Explanation:Impaired glucose tolerance is a pre-diabetic state of hyperglycaemia that is associated with insulin resistance and increased risk of cardiovascular pathology. To diagnose impaired glucose tolerance, the OGTT value after 2 hrs should be 140-199mg/dl (7.7 – 11.0 mmol/l). Impaired fasting glucose is diagnosed as fasting blood sugar between 100 mg/dl to 125 mg/dl.
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This question is part of the following fields:
- Endocrine
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Question 35
Incorrect
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A 15-year-old boy complains of fever, headache, and neck stiffness. On examination, Kernig's and Brudzinski's signs were positive. In the meantime, while awaiting the results from blood culture, how will you manage this patient?
Your Answer:
Correct Answer: Cefotaxime
Explanation:Positive Kernig’s and Brudzinski’s signs may indicate meningitis. While awaiting blood culture results, a broad-spectrum antibiotic such as Cefotaxime (a third generation cephalosporin) is preferred over the other medications listed.
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This question is part of the following fields:
- Pharmacology
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Question 36
Incorrect
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A 45 year old male presents with lower backache and pain in his hips. Blood tests are normal except for elevated serum alkaline phosphatase which is 1200 IU/l (45-105). Radiological examination shows combined osteolytic and osteosclerotic lesions. What is the most common site of occurrence of this disease?
Your Answer:
Correct Answer: Pelvis
Explanation:The patient most likely suffers from Paget’s disease of the bone as his radiological examination shows both osteolytic and osteosclerotic lesions. Any bone or bones can be affected, but Paget’s disease occurs most frequently in the pelvis > lumbar spine > femur > thoracic spine > sacrum > skull > tibia.
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This question is part of the following fields:
- Rheumatology
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Question 37
Incorrect
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A 35 year old alcoholic presented with epigastric pain radiating backward. His pain was relieved with opioid analgesics and anti PUD medications, however after 1 week he developed a fever with a similar kind of abdominal pain to that of his initial presentation. US abdomen shows a fluid collection. The most likely site for the fluid collection would be?
Your Answer:
Correct Answer: Lesser sac
Explanation:The most likely diagnosis in this case is acute pancreatitis, which typically presents with severe abdominal pain and vomiting, along with deranged LFTs and raised serum amylase. It makes a boundary wall for the lesser sac and therefore the most likely site of fluid collection would be in the lesser sac.
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This question is part of the following fields:
- Gastrointestinal
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Question 38
Incorrect
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A 7 day old baby weighed 3.5kg when born. His weight is now 3kg. Choose the most appropriate next step for this child.
Your Answer:
Correct Answer: Continue regular child care
Explanation:In the first week after birth, it is normal for the baby to lose weight and then gain it again. Therefore, regular child care should be maintained.
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This question is part of the following fields:
- Child Health
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Question 39
Incorrect
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Which of the following electrolyte abnormalities is most likely to be seen in SIADH?
Your Answer:
Correct Answer: Low serum Na, low serum osmolarity, high urine osmolarity
Explanation:In SIADH, there is increased secretion of the ADH hormone resulting in increased water absorption. That’s why there would be decreased serum Na, decreased osmolarity and increased urine osmolarity.
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This question is part of the following fields:
- Endocrine
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Question 40
Incorrect
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48 hours after having unprotected intercourse, a 16-year-old female requested a pregnancy test from her GP. What advice can you give her regarding the reliability of pregnancy testing at this time?
Your Answer:
Correct Answer: Even if conception has already occurred, beta hCG is likely to be normal
Explanation:Even if conception has already occurred, beta hCG is likely to be normal. Beta hCG is made by syncytiotrophoblast cells following conception. It then activates the corpus luteum to continuously produce progesterone for implantation to happen. In week 10/40, levels of HCG peak and the placenta can produce adequate progesterone by itself. As a general rule, a beta HCG concentration >25 U/I or a doubling of levels of HCG within two days is required to diagnose pregnancy. A urine pregnancy test would only likely prove positive around 8 days to 2 weeks following conception.
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This question is part of the following fields:
- Gynaecology
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SESSION STATS - PERFORMANCE PER SPECIALTY
