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Question 1
Correct
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Which of the following statements regarding the proton pump inhibitors is true?
Your Answer: They cause hair loss, diarrhoea, and headache
Explanation:Common side effects of omeprazole include: headache, abdominal pain, diarrhoea, nausea, vomiting, gas (flatulence), dizziness, upper respiratory infection, acid reflux, constipation, rash, cough.
Less common side effects of Omeprazole include: bone fracture (osteoporosis related), deficiency of granulocytes in the blood, loss of appetite, gastric polyps, hip fracture, hair loss, chronic inflammation of the stomach, destruction of skeletal muscle, taste changes, abnormal dreams.
Rare side effects of Omeprazole include: liver damage, inflammation within the kidneys, pancreatitis, dermatologic disorder, potentially life threatening (toxic epidermal necrolysis). -
This question is part of the following fields:
- Pharmacology
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Question 2
Incorrect
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A 16-year-old male fell whilst playing football and was injured by a sharp wooden splinter sustaining a cut to his left shin. His immunisation history is up to date. In relation to tetanus prevention, select the most suitable management step.
Your Answer: I.M 0.5 ml tetanus toxoid should be administered as single dose
Correct Answer: No action is required
Explanation:According to the US immunisation schedule, the child is immunised. So this boy does not need any extra immunisation for tetanus now.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Incorrect
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A healthy 8 month old baby boy was brought in by his parents, who claimed that the baby had come into close contact with another child with measles two days ago. Which of the following is the most appropriate management?
Your Answer: She should receive measles immunoglobulin now
Correct Answer: She should receive the MMR vaccine now together with measles immunoglobulin
Explanation:People who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women without evidence of measles immunity, and people with severely compromised immune systems, should receive immunoglobulin. Intramuscular immunoglobulin should be given to all infants younger than 12 months of age who have been exposed to measles. For infants aged 6 through 11 months, MMR vaccine can be given in place of IG, if administered within 72 hours of exposure.
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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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From the following options, choose the one which is most characteristic of early Alzheimer's disease.
Your Answer: Impaired short term memory
Explanation:Alzheimer’s disease is most often characterized early on by short-term memory loss. The other options in this list are characteristic of the following: normal pressure hydrocephalus (gait ataxia and urinary incontinence); Creutzfeldt-Jakob disease (myoclonic jerks); delirium or Lewy body dementia (visual hallucinations).
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This question is part of the following fields:
- Mental Health
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Question 5
Correct
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A 23 year old male has complained of pain when swallowing and dysphagia. He has a sore mouth and soreness in the corners of his mouth. From the list of options, what is the single most likely diagnosis for this patient?
Your Answer: Candida infection
Explanation:The symptoms could indicate CMV or Candida infections, but CMV is much less common.
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This question is part of the following fields:
- ENT
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Question 6
Incorrect
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A 20 year old female has been referred for investigation of an iron deficiency anaemia. Her mother passed away at age 28, due to colonic carcinoma complicating Peutz-Jegher syndrome. Choose the mode of inheritance of Peutz-Jegher syndrome which is most likely.
Your Answer: Autosomal recessive
Correct Answer: Autosomal dominant
Explanation:Peutz-Jegher syndrome is an autosomal dominant condition which is characterised by perioral pigmentation and hamartomas of the bowel. It was initially assumed that these did not predispose to malignancy, but due to recent studies, the opposite is now believed to be true.
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This question is part of the following fields:
- Gastrointestinal
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Question 7
Incorrect
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A 6 year old boy presented in the emergency department with a cough and knee swelling after falling on the road. He had a non-blanching rash on his buttocks and investigations revealed: PT=13, APTT=71, Hgb=11, WBC=8, Plt=200. Which is the most likely diagnosis?
Your Answer: Von-Willebrand disease
Correct Answer: Haemophilia
Explanation:From the options mentioned here, the closest diagnosis is haemophilia. This is a mixed picture, as a purpuric rash on the buttocks does not correlate with this diagnosis. However, the most appropriate diagnosis is haemophilia.
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This question is part of the following fields:
- Child Health
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Question 8
Correct
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A 3-year-old boy presents with a patchy rash after treatment for an enlarged cervical lymph node and sore throat. What is the antibiotic that caused this rash?
Your Answer: Ampicillin
Explanation:An enlarged lymph node does not necessarily need treatment especially if it is caused by a virus. If it is bacterial, antibiotics should be prescribed. Amoxicillin is first line treatment in non-penicillin allergic patients and side effects include allergic reactions like skin rash and itching
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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 19 year old female presented with irregular menstrual cycles for 4 months. On examination her weight was 85 kg and height was 145 cm. She was not on any medications. Which of the following is the most appropriate investigation to arrive at a diagnosis?
Your Answer: Serum TSH
Correct Answer: Pelvic ultrasound
Explanation:Oligomenorrhoea and BMI of 40.4 is suggestive of Polycystic ovary syndrome (PCOS). To diagnose PCOS 2 out of following 3 criteria should be present : oligo/anovulation, hyperandrogenism, clinical (hirsutism or less commonly male pattern alopecia) or biochemical (raised FAI or free testosterone) and polycystic ovaries on ultrasound.
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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 3 year old child was brought in by her father with complaints of watery diarrhoea, vomiting and low grade fever. She looked slightly dehydrated. According to her parents, the other children in the school also have a similar illness. The most likely causative organism in this case would be?
Your Answer: Rotavirus
Explanation:Rota virus is the leading cause of vital gastroenteritis among children from 6 months to 6 years of age. It is transferred by feco-oral route and it damages the transport mechanism in the intestinal mucosal cells which leads to electrolyte imbalance that’s why the child suffers from dehydration. Treatment of choice is rehydration and correction of electrolyte imbalance.
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This question is part of the following fields:
- Child Health
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Question 11
Incorrect
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A 28-year-old male is admitted to the psychiatry ward for aggressive behaviour. He has distressing auditory hallucinations and was diagnosed with schizophrenia previously. Now he has broken his bed and refused to take any oral medications. The injectable drug of choice in this case is?
Your Answer: Flupentixol
Correct Answer: Risperidone
Explanation:The algorithm of treatment of agitated violent patients . First try using verbal communication to calm down the patient, if this doesn’t work offer oral olanzapine or oral risperidone. IF oral agents do not work opt for IV olanzapine or risperidone. IM olanzapine or risperidone may be given if agitation persists. The last resort in this case is IV haloperidol. If rapid sedation is required , IV diazepam can be given.
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This question is part of the following fields:
- Mental Health
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Question 12
Incorrect
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A hypertensive old woman develops gingival hyperplasia. What is the single most likely diagnosis?
Your Answer: Beta blockers
Correct Answer: Nifedipine
Explanation:Calcium channel blockers are medications proven to cause side effects such as gingival hyperplasia. Calcium channel blocking drugs are contraindicated in hypertensive patients with second and third degree heart block, sick sinus syndrome, and severe heart failure.
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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 35 year old primigravida was in labour for 24 hours and delivered after an induction. She developed postpartum haemorrhage. Which of the following is the most likely cause for PPH?
Your Answer: Cervical/vaginal trauma
Correct Answer: Atonic uterus
Explanation:Uterine atony and failure of contraction and retraction of myometrial muscle fibres can lead to rapid and severe haemorrhage and hypovolemic shock. Poor myometrial contraction can result from fatigue due to prolonged labour or rapid forceful labour, especially if stimulated.
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This question is part of the following fields:
- Obstetrics
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Question 14
Correct
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A 30 year old previously well male was found to have a blood pressure of 140/90mmHg. Investigations revealed microalbuminuria. FBS and HbA1c were normal. Which of the following is the most appropriate management for this patient?
Your Answer: Renal scan
Explanation:A renal scan is important in the diagnosis of early renal damage, acute or chronic nephropathies and nephrovascular disease. Renal resistive index (RRI) which is measured by Doppler sonography, is proved to be a marker of renal disease onset and progression. Young hypertension with microalbuminuria is an indication for a renal scan to identify the possible aetiology.
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This question is part of the following fields:
- Renal
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Question 15
Incorrect
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A 65-year-old man was seen at autopsy. He had swollen legs and signs of a transudate fluid at his liver. Before passing away, he was treated for bronchitis and TB. What is the most probable cause of the transudate?
Your Answer: TB
Correct Answer: Cardiac failure
Explanation:The patient most probably experienced congestive hepatopathy and leg oedema due to right sided cardiac failure.
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This question is part of the following fields:
- Cardiovascular
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Question 16
Correct
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A 37 year old female who is admitted to the psychiatric ward claims that the other patients and staff are aware of her thoughts and know exactly what she is thinking all the time. Which of the following is the most likely symptom this patient is suffering from?
Your Answer: Though broadcasting
Explanation:In psychiatry, thought broadcasting is the belief that others can hear or are aware of an individual’s thoughts. Thought broadcasting can be a positive symptom of schizophrenia.
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This question is part of the following fields:
- Mental Health
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Question 17
Correct
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A 50-year-old diabetic and hypertensive patient who is on medication, presented in the OPD with complaints of constipation, polyuria, polydipsia and confusion. On investigation: Serum calcium was 3.07, serum electrophoresis is negative and the X-ray is normal. Which is the most probable cause of these symptoms?
Your Answer: Drug induced-Bendroflumethiazide
Explanation:Bendroflumethiazide is a drug used for treating hypertension and is a diuretic. It produces side effects such as constipation, frequent urination, fatigue, polydipsia etc.
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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 45-year-old male complains of angina pain. Which of the following features on exercise testing would have the strongest predictive value for ischaemic heart disease?
Your Answer: Down sloping ST depression of 1 mm in stage 3 of the Bruce protocol
Correct Answer: Decline in systolic BP by 20 mmHg in stage 1 of the Bruce protocol
Explanation:The classic criteria for visual interpretation of positive stress test findings include the following:J point (the junction of the point of onset of the ST-T wave; it is normally at or near the isoelectric baseline of the ECG), ST80 (the point that is 80 msec from the J point), depression of 0.1 mV (1 mm) or more and ST-segment slope within the range of ± 1 mV/sec in 3 consecutive beats
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This question is part of the following fields:
- Cardiovascular
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Question 19
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: Skull
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 20
Incorrect
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A 50-year-old man presented with polyuria and orthostatic hypotension. Which of the following medications is the most likely to be associated with this condition?
Your Answer: Digoxin
Correct Answer: Bendroflumethiazide
Explanation:Bendroflumethiazide is known to cause photosensitive rash as part of an allergic reaction during which the person might also have wheezing, chest tightness or dyspnoea. The rash typically occurs on the areas of body exposed to the sun, like the back, hands, arms and legs.
Comparatively, digoxin produces a rash that comprises of nearly the whole body.
Atenolol may also cause skin rash but that is not photosensitive.
Clopidogrel might produce an non-photosensitive urticarial rash.
Ezetimibe causes a severe allergic reaction but only rarely. This rash is also non-photosensitive and is in the form of blisters, associated with itching. -
This question is part of the following fields:
- Pharmacology
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Question 21
Correct
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A 26 year old male has been taken to the emergency department with chest pain and increasing shortness of breath. He revealed that he has been a heavy smoker for the last 4 years, but doesn't have any past medical history. Which of the following is the most likely diagnosis?
Your Answer: Pneumothorax
Explanation:Increasing shortness of breath, chest pain, and no previous medical history are consistent with a pneumothorax diagnosis. Heavy tobacco use is also a risk factor for developing this condition spontaneously.
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This question is part of the following fields:
- Respiratory
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Question 22
Incorrect
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A 70-year-old woman had a major surgery for removal of cancer of the ovary and lymph node dissection 6 days ago. She had not passed any flatus or stool since then. She recently developed recurrent vomiting and severe abdominal distention. What is the next step of management?
Your Answer: TPN
Correct Answer: NG tube suction and IV fluids
Explanation:This patient developed paralytic ileus. It should be treated conservatively using IV fluids and NG tube.
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This question is part of the following fields:
- Seriously Ill
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Question 23
Incorrect
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A 60 year old male presents with thickened patches of skin over his knuckles and extensor surfaces that are consistent with Gottron's papules. Results reveal an elevated creatine kinase. Diagnosis of dermatomyositis is suspected. Which of the following autoantibody is most specific for this condition?
Your Answer: Anti-Jo-1 antibodies
Correct Answer: Anti-Mi-2 antibodies
Explanation:Anti–Mi-2 antibodies are highly specific for dermatomyositis, but sensitivity is low; only 25% of patients with dermatomyositis demonstrate these antibodies. A positive antinuclear antibody (ANA) finding is common in patients with dermatomyositis, but is not necessary for diagnosis. Anti-Jo-1 antibodies are mostly associated with polymyositis. Anti Scl-70 antibodies and anti centromere antibodies are most commonly found in systemic scleroderma.
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This question is part of the following fields:
- Rheumatology
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Question 24
Correct
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A 32 year old woman presents with a history of breathlessness and pyrexia. She's been diagnosed with eczema and tuberculosis (TB). The following findings were established: pre-broncho-dilator test=2/3.5, post-broncho-dilator=3/3.7. What is the most likely diagnosis?
Your Answer: Chronic obstructive pulmonary disease (COPD)
Explanation:The clinical picture of the patient together with paraclinical investigations (spirometry) suggest COPD.
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This question is part of the following fields:
- Respiratory
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Question 25
Incorrect
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A 71-year-old woman residing in a nursing home for a couple of years complains of drooling of saliva and sudden difficulty in swallowing while eating. She is a known hypertensive on treatment. What would be your next step?
Your Answer: CXR
Correct Answer: Endoscopy
Explanation:Dysphagia or difficulty in swallowing. Endoscopy allows for visual examination of the oesophagus and is indicated in patients with dysphagia to determine the underlying aetiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy including dilation.
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This question is part of the following fields:
- Older Adult
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Question 26
Incorrect
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A 28-year-old female presents with postnatal depression and refuses treatment. Which form of consent should be obtained in order to treat this patient?
Your Answer: Consent from carer
Correct Answer: No consent required
Explanation:The patient is in an altered psychological state; thus, no verbal nor a written consent is required from her. Consent from the carer or the court of law can be obtained but this will require some time while a prompt action is needed in this case and the carer is also unable to make a decision on the behalf of the patient. Therefore, the doctor should act without consent.
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This question is part of the following fields:
- Ethical
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Question 27
Incorrect
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In the functional unit of the liver (acinus), the oxygenation…
Your Answer: Is the same in the centre and periphery
Correct Answer: Reduces towards the centre
Explanation:Cells located close to the portal triad or peripheral zone which consist of arterioles from the hepatic artery are the most oxygenated cells. Cells in the central zone are least oxygenated and mainly receive blood supply from the central vein which is a branch of the hepatic vein.
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This question is part of the following fields:
- Hepatobiliary
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Question 28
Incorrect
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A newly married female presented with fever, dysuria, frequency and lower abdominal pain for 2 days duration. On examination, she was febrile with lower abdominal tenderness. Urine microscopy reveals 20-30 pus cells/hpf and 10-20 red cells/hpf. Which of the following would be the most probable cause for this presentation?
Your Answer: Bladder calculi
Correct Answer: Cystitis
Explanation:The patient has what is known as ‘honeymoon cystitis’.
Most common presentation of schistosomiasis is haematuria.
Patients with kidney trauma also present with haematuria following a positive history for such injury.
Pain due to calculi are colicky in nature and severe. -
This question is part of the following fields:
- Genitourinary
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Question 29
Incorrect
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A 52 year old shopkeeper presents with pain in her hands. Examination reveals plaques on the extensor surfaces of her upper limbs and a telescoping deformity of both index fingers. Nails show pitting and horizontal ridging. The patient is most likely suffering from which of the following?
Your Answer: Systemic lupus erythematosus
Correct Answer: Arthritis mutilans
Explanation:Arthritis mutilans is a rare (occurs in only 5% of the patients) and extremely severe form psoriatic arthritis characterized by resorption of bones and the consequent collapse of soft tissue. When this affects the hands, it can cause a phenomenon sometimes referred to as ‘telescoping fingers.’ The associated nail changes are also characteristic of arthritis.
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This question is part of the following fields:
- Rheumatology
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Question 30
Incorrect
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An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Cytomegalovirus (CMV)
Correct Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
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This question is part of the following fields:
- Infectious Diseases
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Question 31
Incorrect
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A young alcoholic male patient presented at hospital with complaints of tachycardia and palpitations for the past few hours. During examination, his blood pressure and ECG were normal. What would be the next step in management of this patient?
Your Answer: ECHO
Correct Answer: Reassure and life Style modification
Explanation:Normal blood pressure and ECG rule out any pathological cause of the complaints described in this scenario. These symptoms are most probably due to anxiety or effects of alcohol intake. Lifestyle modification will be the best management plan along with reassurance to calm the patient.
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This question is part of the following fields:
- Cardiovascular
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Question 32
Incorrect
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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: Flecainide
Correct 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 33
Incorrect
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A 15-month-old child is due for his measles, mumps and rubella (MMR) vaccines. He is feverish due to an acute otitis media and the mother gives a family history of egg allergy. What is the most appropriate action?
Your Answer: Give paracetamol with future doses of the same vaccine
Correct Answer: Defer immunization for two weeks
Explanation:Vaccines should not be given to a feverish child.
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This question is part of the following fields:
- Child Health
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Question 34
Incorrect
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A 67 year old male presented with a history of chronic backache and altered sensation over the lateral side of his right calf and foot. Which of the following nerve roots will most likely be involved in this patient?
Your Answer: L3-L4
Correct Answer: L5-S1
Explanation:Lesions in L5-S1 region leads to altered sensation on the lateral side of calf and foot, along with back pain. There might be difficulty in extension of the leg, foot inversion, plantar flexion and toe flexion, as muscles controlling these functions are supplied by S1.
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This question is part of the following fields:
- Neurology
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Question 35
Correct
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A 42-year-old female with a history of hypertension presented with increased thirst, polyuria and nocturia for 2 weeks duration. Her random blood sugar was 12 mmol/l. Which of the following antihypertensives can cause the above clinical presentation?
Your Answer: Bendroflumethiazide
Explanation:Thiazides and beta-blockers have been most commonly linked to the development of diabetes mellitus.
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This question is part of the following fields:
- Pharmacology
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Question 36
Incorrect
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Which of the following abnormal facial movements is not a well-recognised association?
Your Answer: Facial tics - Tourette's syndrome
Correct Answer: Facial synkinesis - Wilson's disease
Explanation:Wilson’s disease may have an asymmetric tremor which is variable in character and may be predominantly resting, postural, or kinetic.
Progressive supra-nuclear palsy – blepharospasm, apraxia of lid opening and/or apraxia of lid closing.
Tourette’s syndrome – one or more motor or vocal tics.
Multiple Sclerosis – continuous facial myokymia.
Tardive dyskinesia is a side-effect of conventional antipsychotics, neuroleptics, anticholinergics, and toxins resulting in stiff, jerky movements of your face and body -
This question is part of the following fields:
- Neurology
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Question 37
Incorrect
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Which of the following medications is a long acting adrenergic beta-receptor agonist?
Your Answer: Terbutaline
Correct Answer: Formoterol
Explanation:Terbutaline is a long acting beta receptor agonist. It is used as an add on drug for step 3 in treatment of bronchial asthma. It causes relaxation of bronchial smooth muscles and thus, bronchodilatation.
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This question is part of the following fields:
- Pharmacology
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Question 38
Incorrect
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A 60-year-old female underwent pelvic surgery. She was given low molecular weight heparin (LMWH) after the procedure. After a week, she complained of sudden chest pain and difficulty in breathing. Her ECG and CXR were normal. What is the most suitable option for her?
Your Answer: Change to unfractionated heparin and do CT. pulmonary angiography.
Correct Answer: Keep on low molecular weight heparin and do CT. pulmonary angiography.
Explanation:CT pulmonary angiography will decide the proper cause of her symptoms. Until that has happened LMWP should be continued.
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This question is part of the following fields:
- Seriously Ill
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Question 39
Incorrect
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Which of the following immune responses occurs in Coeliac disease?
Your Answer: Type II 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 40
Incorrect
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A 62 year old male has woken up to find his speech is altered. He recently suffered from a flu-like illness. The movement of his eyelids and lips are weak on the right-hand side. Which anatomical site is most likely to be affected in this patient?
Your Answer:
Correct Answer: Facial nerve
Explanation:Viral infection is a very common cause of facial nerve palsy, which is consistent with the symptoms described.
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This question is part of the following fields:
- Neurology
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SESSION STATS - PERFORMANCE PER SPECIALTY
