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  • Question 1 - A 2 month old baby presents to the clinic with vomiting. On examination...

    Correct

    • A 2 month old baby presents to the clinic with vomiting. On examination he has ambiguous genitalia. The labs are as follows: Na: 125mmol/L, K: 6mmol/L. Which of the following is the most likely diagnosis responsible for this patient's presentation?

      Your Answer: Congenital adrenal hyperplasia

      Explanation:

      Congenital adrenal hyperplasia (CAH) comprises a group of autosomal recessive defects in enzymes that are responsible for cortisol, aldosterone, and, in very rare cases, androgen synthesis. All forms of CAH are characterized by low levels of cortisol, high levels of ACTH, and adrenal hyperplasia. The exact clinical manifestations depend on the enzyme defect. The most common form of CAH, which is caused by a deficiency of 21β-hydroxylase, presents with hypotension, ambiguous genitalia, and virilization (in the female genotype), and/or precocious puberty (in both males and females). It is further characterized by hyponatremia, hyperkalaemia, and metabolic acidosis. Increased levels of 17-hydroxyprogesterone confirm the diagnosis of 21β-hydroxylase deficiency. Treatment of CAH involves lifelong glucocorticoid replacement therapy. Patients with a 21β-hydroxylase deficiency also require mineralocorticoid replacement with fludrocortisone. Complications of CAH include severe hypoglycaemia, adrenal insufficiency, and/or a failure to thrive.

    • This question is part of the following fields:

      • Child Health
      453.6
      Seconds

  • Question 2 - A 75 year old man was brought to the clinic by his wife...

    Correct

    • A 75 year old man was brought to the clinic by his wife because lately he has lost interest in activities he previously enjoyed. His wife is worried and claims he's generally withdrawn. What would exclude depression in favour of dementia?

      Your Answer: Urinary incontinence

      Explanation:

      Urinary incontinence is not a usual symptom of depression. A depressed patient is usually capable of maintaining control of his body sphincters. In dementia, however, urinary incontinence is an important and late symptom of the disease, non-related to any urinary tract pathology. It is rather related to the cognitive impairment caused by dementia.

    • This question is part of the following fields:

      • Older Adult
      239.3
      Seconds

  • Question 3 - A 3-year-old girl presents with pallor and marked gland enlargement. She has been...

    Incorrect

    • A 3-year-old girl presents with pallor and marked gland enlargement. She has been unwell for the past three weeks. She had a full term normal delivery with no neonatal problems. Her immunisations are up to date. There is no family or social history of note. On examination, her temperature is 37.6°C, and she looks pale and unwell. She has a few petechiae on the neck and palate, with moderate generalised lymphadenopathy and a 3 cm spleen. Which is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute leukaemia

      Explanation:

      Non-Hodgkin Lymphoma: The history is of enlarged reticuloendothelial system with abnormalities in all 3 cell lines of the bone marrow (pallor, fever and petechiae). The most likely diagnosis is therefore acute (lymphoblastic) leukaemia. Lymphadenopathy may be prominent: mediastinal nodes are characteristic of T-cell leukaemia. In lymphoma the marrow involvement tends to be much less.

    • This question is part of the following fields:

      • Child Health
      0
      Seconds

  • Question 4 - A 70-year-old female from a nursing home presented in the emergency department with...

    Incorrect

    • A 70-year-old female from a nursing home presented in the emergency department with complaints of headache, blurred vision and confused state for the last 4 to 5 days. On examination, she has several bruises on her head. Which of the following is the most likely cause behind the confused state of this patient?

      Your Answer:

      Correct Answer: Subdural hematoma

      Explanation:

      Bruises on her head are suggestive of a head injury. Confused state with a headache and blurred vision are due to a subdural hematoma.

    • This question is part of the following fields:

      • Seriously Ill
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      Seconds

  • Question 5 - A 10 year old boy presented with episodic bluish pale skin while crying...

    Incorrect

    • A 10 year old boy presented with episodic bluish pale skin while crying and brief episodes of loss of consciousness. On examination he has clubbing, cyanosis and a pansystolic murmur. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Tetralogy of Fallot

      Explanation:

      Except Tetralogy of Fallot, the others are acyanotic heart diseases. The cyanotic spells and loss of consciousness are due to spasm of the infundibular septum, which acutely worsens the right ventricular outflow tract obstruction. The given murmur is due to a ventricular septal defect.

    • This question is part of the following fields:

      • Child Health
      0
      Seconds

  • Question 6 - A man was admitted with galactorrhoea. History reveals that the patient has been...

    Incorrect

    • A man was admitted with galactorrhoea. History reveals that the patient has been having problems with getting and maintaining an erection. He also admits he's noticed a decrease in the quantity of his facial hair. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Hyper prolactinaemia

      Explanation:

      Increased levels of prolactin in men can lead to erectile dysfunction, reduced facial and body hair and on rare occasion gynecomastia with galactorrhoea.

    • This question is part of the following fields:

      • Endocrine
      0
      Seconds

  • Question 7 - A 62 year old female complains of pain and stiffness in her shoulders....

    Incorrect

    • A 62 year old female complains of pain and stiffness in her shoulders. She also finds it difficult to get out of her chair. From the list of symptoms below, choose the one most likely to support the diagnosis of polymyalgia rheumatica.

      Your Answer:

      Correct Answer: Low grade fever

      Explanation:

      Polymyalgia rheumatica is an inflammatory disease which usually causes stiffness and pain in the shoulder – this can also occur in the pelvic girdle muscles. Its onset can either be subacute or acute and is associated with a systemic inflammatory response. This, therefore, causes symptoms such as fever, weight loss, anorexia, and malaise. Polymyalgia rheumatica is unpredictable in its course and it is known that 30 per cent of patients also present with giant cell arteritis. The cause of this disease is unknown but studies have shown it have infectious origins. Diagnosis of polymyalgia rheumatica can be difficult and other inflammatory diseases have to be excluded first. Patients with this disease are usually over 60 years of age (it is very rarely seen in those under 50). Muscle weakness does not present, although this can be hard to assess when the patient is in pain. Low-grade fever and weight loss are typical of this disease due to chronic inflammation. As such, weight gain is very rare and peripheral joints are usually not affected (they can be affected but it is very rare). Also, muscle tenderness is not a specific symptom of the disease – it is therefore not a classical finding of polymyalgia rheumatica. Although patients usually complain of stiffness and pain, the muscles are usually not significantly tender – this is usually more associated with fibromyalgia or myositis. When investigated, a normochromic/normocytic anaemia; a raised erythrocyte sedimentation rate often over 50 mm/hr., and raised C reactive protein are usually revealed. Symptoms of giant cell arteritis should also be sought, such as headaches, visual disturbances, TIAs (transient ischemic attacks), jaw claudication, and thickened temporal arteries. The patient response to a moderate dose of steroids is useful when confirming a diagnosis of polymyalgia rheumatica. The maximum dose of prednisolone should not exceed 20mg once a day. After treatment, patients should show a 70 per cent improvement in symptoms within a month (between 3-4 weeks). Inflammatory markers should also fall back to their normal levels. Non-steroidal anti-inflammatories are of little use and are associated with morbidity. There is also little evidence for the use of steroidal-sparing agents.

    • This question is part of the following fields:

      • Older Adult
      0
      Seconds

  • Question 8 - A 27 year old woman presents with a history of weight loss and...

    Incorrect

    • A 27 year old woman presents with a history of weight loss and palpitations. Examination reveals unilateral proptosis. She also admits that despite having a healthy appetite she has difficulty putting on weight. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Thyroid-associated ophthalmopathy

      Explanation:

      The patient’s age and symptoms suggest Grave’s disease with thyroid-associated ophthalmopathy. In Grave’s disease, weight loss is noticed regardless of normal eating habits of the patient. Palpitations are also typical and may be confused with a panic attack. Proptosis is usually bilateral, but unilateral is also possible.

    • This question is part of the following fields:

      • Endocrine
      0
      Seconds

  • Question 9 - Choose the standard method for comparing distributions in data sets (such as between...

    Incorrect

    • Choose the standard method for comparing distributions in data sets (such as between the expected frequency of an event and the observed frequency of an event) from the list of options.

      Your Answer:

      Correct Answer: Chi squared (X²) test

      Explanation:

      The Chi-squared test evaluates if two variables are related. The other statistical tests mentioned do not perform this function.

    • This question is part of the following fields:

      • Epidemiology
      0
      Seconds

  • Question 10 - A 1-day-old baby started having pallor and jaundice. The mother's first child did...

    Incorrect

    • A 1-day-old baby started having pallor and jaundice. The mother's first child did not have jaundice at birth. On clinical investigations, direct Coombs test is positive. Mother's blood group is A negative. Baby's blood group is O positive. What is the most probable cause of the condition of this new-born?

      Your Answer:

      Correct Answer: Rhesus incompatibility

      Explanation:

      Jaundice in a new-born on the day of delivery is most likely due to Rh incompatibility. This occurs when the mother is Rh-negative and the baby is Rh-positive. Antibodies in the mother against the Rh factor in the baby will destroy the red blood cells in the baby, increasing the bilirubin in the blood. Breast milk jaundice and Galactosemia do not occur immediately after birth, and congenital rubella syndrome and formula feeding does not cause jaundice in babies.

    • This question is part of the following fields:

      • Gastrointestinal
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      Seconds

  • Question 11 - A 68 year old male presented with unbalances and vomiting for 1 week....

    Incorrect

    • A 68 year old male presented with unbalances and vomiting for 1 week. Which of the following is the best investigations that can be performed to arrive at a diagnosis?

      Your Answer:

      Correct Answer: MRI of Cerebellum

      Explanation:

      Lesions in cerebellum and pontine region should be excluded. So the most appropriate investigation is MRI of cerebellum.

    • This question is part of the following fields:

      • Neurology
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      Seconds

  • Question 12 - A 30 year old male presented with a cut injury to his forearm....

    Incorrect

    • A 30 year old male presented with a cut injury to his forearm. There were no tendon cut or muscle cut, so suturing was done under local anaesthesia. Lignocaine with adrenaline was injected prior to suturing. Which of the following is the action of adding adrenaline to lignocaine?

      Your Answer:

      Correct Answer: Prolongs the effect

      Explanation:

      The vasoconstrictive action of adrenaline will reduce the dilution of local anaesthetic lignocaine and reduce the bleeding. So the combination of lignocaine and adrenaline greatly prolongs and intensifies its action.

    • This question is part of the following fields:

      • Pharmacology
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      Seconds

  • Question 13 - A 65 year old male with a history of chronic diabetes mellitus and...

    Incorrect

    • A 65 year old male with a history of chronic diabetes mellitus and ischaemic heart disease, presented with pain in the thigh and gluteal region, while climbing up the stairs for past 5 months and symptoms were getting worse. He was a heavy smoker. On examination the dorsalis pedis and posterior tibial pulses were present. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Atherosclerosis

      Explanation:

      The presence of the pulses excluded Thromboangitis Obliterans. The pain is not suggestive of sciatica. The history doesn’t support a DVT or an embolus as there is no pain at rest, swelling or skin changes. So the most probable diagnosis is atherosclerosis as the chronic diabetes and smoking support it.

    • This question is part of the following fields:

      • Endocrine
      0
      Seconds

  • Question 14 - Choose the single most appropriate landmark located above the mid-inguinal point from the...

    Incorrect

    • Choose the single most appropriate landmark located above the mid-inguinal point from the list of options.

      Your Answer:

      Correct Answer: Deep inguinal ring

      Explanation:

      The deep inguinal ring is located above the mid-inguinal point.

    • This question is part of the following fields:

      • Musculoskeletal
      0
      Seconds

  • Question 15 - A 28 year old woman presents with painful genital ulceration. She reports that...

    Incorrect

    • A 28 year old woman presents with painful genital ulceration. She reports that these attacks have been recurrent over the past 4 years. She has been treated previously with oral acyclovir but this has had little effect on the duration of her symptoms. Over the past year, she has noticed almost weekly attacks of mouth ulcers that heal slowly. Past medical history is significant for treatment of thrombophlebitis two years ago. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Behcet's syndrome

      Explanation:

      Behçet disease is a rare vasculitic disorder that is characterized by a triple-symptom complex of recurrent oral aphthous ulcers, genital ulcers, and uveitis. The systemic manifestations can be variable. Ocular disease has the greatest morbidity, followed by vascular disease generally from active vasculitis. Cutaneous manifestations can occur in up 75% of patients with Behcet disease and can range from acneiform lesions, to nodules and erythema nodosum. GI manifestations can be severe. Differentiating Behçet disease from active inflammatory bowel disease can be clinically difficult. Herpes would have ideally responded to acyclovir. Sarcoidosis does not have genital and oral ulcerations.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds

  • Question 16 - A 57-year-old female presented to the cardiology centre with a history of chest...

    Incorrect

    • A 57-year-old female presented to the cardiology centre with a history of chest tightness for a few hours, accompanied by pain radiating to the left side of the shoulder and neck. ECG was normal. What is the next best investigation for this patient?

      Your Answer:

      Correct Answer: Cardiac enzymes

      Explanation:

      This patient’s symptoms of angina radiating to the neck and shoulders gives a strong suspicion of MI. Cardiac enzymes such as troponins are highly specific and sensitive for a heart attack.

    • This question is part of the following fields:

      • Cardiovascular
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      Seconds

  • Question 17 - A 72 year old female complains of difficulty breathing due to secretions. She...

    Incorrect

    • A 72 year old female complains of difficulty breathing due to secretions. She also has end-stage lung cancer. Choose the most appropriate palliative treatment for her.

      Your Answer:

      Correct Answer: Hyoscine butylbromide

      Explanation:

      Hyoscine should be used to help dry the secretions – this is because it acts as an antimuscarinic agent. It also causes less sedation than hyoscine hydrobromide, however, both are administered through injection or infusion.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 18 - A 42-year-old female with a history of hypertension presented with increased thirst, polyuria...

    Incorrect

    • 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:

      Correct Answer: Bendroflumethiazide

      Explanation:

      Thiazides and beta-blockers have been most commonly linked to the development of diabetes mellitus.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 19 - A 29-year-old woman presented 10 days post-partum with loss of weight. On history...

    Incorrect

    • A 29-year-old woman presented 10 days post-partum with loss of weight. On history taking, the patient complains of loss of appetite and a lack of sympathy for her child. She is always tired. She even sometimes has violent thoughts about hurting her baby. The treatment of choice for such a case would be?

      Your Answer:

      Correct Answer: ECT

      Explanation:

      This is a case of postpartum psychosis. It can be treated with antidepressants, mood stabilisers or ECT. The treatment of choice is ECT.

    • This question is part of the following fields:

      • Mental Health
      0
      Seconds

  • Question 20 - A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions...

    Incorrect

    • A term infant delivered via C-section develops tachypnoea, grunting, flaring, and intercostal retractions 10 minutes after birth. A chest radiograph reveals well-aerated lungs with fluid in the fissure on the right, prominent pulmonary vascular markings, and flattening of the diaphragm. His oxygen saturation is 90%. He improves within a few hours and requires no oxygen. What condition is this infant most likely suffering from?

      Your Answer:

      Correct Answer: Transient tachypnoea of the new-born

      Explanation:

      Transient tachypnoea of the new-born is a condition associated with the delayed clearance of amniotic fluid from the new-born. The X-ray findings are typical of this condition. As the name implies and was noted in this patient, it is not a lasting condition and resolves within 24-72 hours after birth. The differential diagnoses usually present with different chest X-ray findings:
      – Aspiration pneumonia shows infiltrates in the lower lobes of the lungs
      – Congenitally acquired pneumonia shows patchy, asymmetrical densities
      – Meconium aspiration shows hyperinflation and patchy asymmetric airspace disease
      – Pulmonary oedema shows cephalization of pulmonary veins and indistinctness of the vascular margins.

    • This question is part of the following fields:

      • Child Health
      0
      Seconds

  • Question 21 - A 70-year-old woman had a major surgery for removal of cancer of the...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 22 - A boy with Duchene muscular dystrophy and healthy parents is expecting a new...

    Incorrect

    • A boy with Duchene muscular dystrophy and healthy parents is expecting a new brother. What are the chances that his brother develops the same disease after birth?

      Your Answer:

      Correct Answer: 0.5

      Explanation:

      Duchenne muscular dystrophy has an X-linked recessive pattern of inheritance. Since the first son is affected by the disease, it means that the mother is a carrier. The male children will inherit the Y chromosome from their father and the X chromosome from their mother, having 50% chances of inheriting the X chromosome with the affected gene.

    • This question is part of the following fields:

      • Genetics
      0
      Seconds

  • Question 23 - A 33 year old lady presented with complaints of an erythematous rash over...

    Incorrect

    • A 33 year old lady presented with complaints of an erythematous rash over her shins, along with arthritis and painful swollen knees. What will be the single most likely finding on her chest X-ray?

      Your Answer:

      Correct Answer: Bilateral hilar lymphadenopathy

      Explanation:

      Lofgren’s syndrome is characterised by a triad of erythema nodosum, arthritis and bilateral lymphadenopathy. It is a variant of sarcoidosis.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds

  • Question 24 - Which of the following is an appetite stimulant? ...

    Incorrect

    • Which of the following is an appetite stimulant?

      Your Answer:

      Correct Answer: Neuropeptide Y

      Explanation:

      Neuropeptide Y induces appetite during trials in rats. Other agents mentioned here are either appetite suppressants or have no effect on appetite.

    • This question is part of the following fields:

      • Gastrointestinal
      0
      Seconds

  • Question 25 - A 25-year-old female patient diagnosed with recurrent depressive disorder was admitted to the...

    Incorrect

    • A 25-year-old female patient diagnosed with recurrent depressive disorder was admitted to the hospital after overdosing on her medication. At the ED, she presents with nausea, vomiting and a coarse tremor. Which is the drug that most likely caused her symptoms?

      Your Answer:

      Correct Answer: Lithium

      Explanation:

      Side effects of lithium overdose include coarse tremor, nausea and vomiting. Fine tremor, however, is present in therapeutic dosages.

    • This question is part of the following fields:

      • Mental Health
      0
      Seconds

  • Question 26 - The drug of choice for delirium tremens will be? ...

    Incorrect

    • The drug of choice for delirium tremens will be?

      Your Answer:

      Correct Answer: IV Chlordiazepoxide

      Explanation:

      The drugs of choice for delirium tremens are benzodiazepines such as chlordiazepoxide, diazepam or lorazepam. Chlordiazepoxide is a long acting drug and is the preferred drug, before the other benzodiazepines. Barbiturates are the 2nd drugs of choice.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds

  • Question 27 - An 8 week old baby presents with a fever of 38 degrees. What...

    Incorrect

    • An 8 week old baby presents with a fever of 38 degrees. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Admit for infection screen and start IV antibiotic

      Explanation:

      This temperature is considered to be a mild fever and is most often caused by a minor infection in children of this age. Therefore, an infection screen should be conducted and an IV antibiotic.

    • This question is part of the following fields:

      • Child Health
      0
      Seconds

  • Question 28 - Which of the following options best describes rheumatoid factor? ...

    Incorrect

    • Which of the following options best describes rheumatoid factor?

      Your Answer:

      Correct Answer: IgM against the Fc portion of IgG

      Explanation:

      Rheumatoid factor is an IgM antibody that targets the Fc portion of IgG.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds

  • Question 29 - A 40 year old male is awaiting a liver biopsy. Which of the...

    Incorrect

    • A 40 year old male is awaiting a liver biopsy. Which of the following is the most important investigation that has to be performed prior to the procedure?

      Your Answer:

      Correct Answer: Coagulation profile

      Explanation:

      As the liver is highly vascular, there is a high risk of bleeding during and after the procedure. Patients may have existing liver diseases, which affect the production of clotting factors. So a coagulation profile is necessary to detect any abnormality and correct them prior to the liver biopsy.

    • This question is part of the following fields:

      • Gastrointestinal
      0
      Seconds

  • Question 30 - Drug-induced lupus erythematosus most often occurs after taking which of the following drugs?...

    Incorrect

    • Drug-induced lupus erythematosus most often occurs after taking which of the following drugs?

      Your Answer:

      Correct Answer: Procainamide

      Explanation:

      Many drugs are responsible for causing drug induced lupus. However, it is most commonly associated with hydralazine, procainamide and quinidine.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Child Health (1/1) 100%
Older Adult (1/1) 100%
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