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Question 1
Incorrect
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What percentage of values lie within 3 standard deviations of the mean in a normal distribution?
Your Answer:
Correct Answer: 99.70%
Explanation:Normal distribution describes the spread of many biological and clinical measurements. Usually, 68.3% lies within 1 standard deviation (SD) of the mean, 95.4% lies within 2 SD of the mean and 99.7% lies within 3 SD of the mean.
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This question is part of the following fields:
- Clinical Sciences
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Question 2
Incorrect
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A 51 year old obese female, with a history of smoking, presents to the clinic with worsening dyspnoea. She is currently on oestrogen therapy for menopausal symptoms.
Clinical examination, ECG and radiological findings correspond to right sided heart failure. There are no signs of left ventricular dysfunction.
Which of the following is the most likely cause of cor pulmonale?Your Answer:
Correct Answer: Recurrent small pulmonary embolisms
Explanation:Postmenopausal oestrogen therapy and hormone therapy are associated with an increased risk of thromboembolism. The relative risk seems to be even greater if the treated population has pre-existing risk factors for thromboembolism, such as obesity, immobilization, and fracture. Cor pulmonale can occur secondary to small recurrent pulmonary embolisms. Pneumonias and bronchiectasis usually present with purulent sputum, and in case of carcinoma there may be other associated symptoms like weight loss, etc.
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This question is part of the following fields:
- Respiratory
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Question 3
Incorrect
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A 46 year old male, known with Rheumatoid Arthritis presents with a swollen and painful right ankle. No drug allergies are reported. On examination, the vitals are as follows:
Temp: 38.8
BP: 90/60 mmHg
Pulse: 110/min.
Right ankle examination reveals tenderness, warmth, erythema and tense joint effusion. Blood samples including blood cultures are collected and fluid resuscitation is initiated. Which of the following interventions would be most appropriate for this man?Your Answer:
Correct Answer: Administer i.v. flucloxacillin, and arrange joint aspiration urgently
Explanation:Although microscopic analysis of joint fluid aspirate and culture is the basis of septic arthritis diagnosis and should usually be collected before the administration of antibiotics, the patient is showing signs of septic shock. A delay in antibiotics might lead to worsening of symptoms so they are administered first.
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This question is part of the following fields:
- Rheumatology
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Question 4
Incorrect
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Raloxifene is used in the treatment of osteoporosis, which of the following best describes it?
Your Answer:
Correct Answer: A selective oestrogen receptor modulator
Explanation:Raloxifene is a selective oestrogen-receptor modulator (SERM) that has been approved for use in the prevention and treatment of osteoporosis in postmenopausal women.
A SERM interacts with oestrogen receptors, functioning as an agonist in some tissues and an antagonist in other tissues. Because of their unique pharmacologic properties, these agents can achieve the desired effects of oestrogen without the possible stimulatory effects on the breasts or uterus. -
This question is part of the following fields:
- Endocrinology
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Question 5
Incorrect
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Sensorineural deafness is strongly associated with which one of the following?
Your Answer:
Correct Answer: Rubella
Explanation:Primary rubella infection during pregnancy, particularly during the first trimester, can affect several organs and cause birth defects that are responsible for congenital rubella syndrome (CRS). The most common defects of CRS are hearing impairment (unilateral or bilateral sensorineural), eye defects (e.g., cataracts, congenital glaucoma, or pigmentary retinopathy), and cardiac defects (e.g., patent ductus arteriosus or peripheral pulmonic stenosis). Congenital hearing loss is the most common sequela, occurring in approximately 60% of cases, especially when infection occurs in the 4th month of pregnancy.
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This question is part of the following fields:
- Clinical Sciences
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Question 6
Incorrect
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Which of the following features is characteristic of immune thrombocytopenic purpura?
Your Answer:
Correct Answer: Autoimmune haemolytic anaemia is a recognised association
Explanation:Immune thrombocytopenic purpura (ITP) refers to thrombocytopaenia occurring in the absence of toxic exposure or other diseases associated with low platelets and involves IgG-type antibodies. It is characterised by normal or increased marrow megakaryocytes, shortened platelet survival, and the absence of splenomegaly. Autoimmune haemolytic anaemia (AIHA) occurs commonly in association with ITP. Leukemic transformation, however, does not occur in ITP.
In neonatal ITP, IgG antibodies are passively transferred across the placenta. The infant platelet count may be normal at birth but decreases within 12–24 hours. It is rarely severe enough to induce bleeding diathesis in the infant.
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This question is part of the following fields:
- Haematology & Oncology
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Question 7
Incorrect
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Which of the following physical findings is least typical on a patient with multiple sclerosis?
Your Answer:
Correct Answer: Decreased tone
Explanation:Attacks or exacerbations of multiple sclerosis (MS) are characterized by symptoms that reflect central nervous system (CNS) involvement, hence upper motor neuron symptoms are seen.
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This question is part of the following fields:
- Neurology
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Question 8
Incorrect
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A 57 year old homeless man presents with fever and a productive cough which has green sputum with streaks of blood. A chest x-ray reveals consolidation in the right upper lobe with evidence of cavitation. He is a known alcoholic.
What is the most likely causative agent?Your Answer:
Correct Answer: Klebsiella Pneumoniae
Explanation:Infection with Klebsiella organisms occurs in the lungs, where they cause destructive changes. Necrosis, inflammation, and haemorrhage occur within lung tissue, sometimes producing a thick, bloody, mucoid sputum described as currant jelly sputum.
The illness typically affects middle-aged and older men with debilitating diseases such as alcoholism, diabetes, or chronic bronchopulmonary disease. An increased tendency exists toward abscess formation, cavitation, empyema, and pleural adhesions. -
This question is part of the following fields:
- Respiratory
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Question 9
Incorrect
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Which of the following is NOT a cause of onycholysis?
Your Answer:
Correct Answer: Mycoplasma pneumonia
Explanation:Onycholysis is the separation of the distal edge of the nail from the vascular nailbed causing whiteness of the free edge. Causes include:
– Idiopathic
– Trauma, excessive manicuring
– Infection: especially fungal
– Skin disease: psoriasis, dermatitis
– Impaired peripheral circulation e.g. Raynaud’s
– Systemic disease: hyper/hypothyroidism, reactive arthritis, porphyria cutanea tarda
– Sometimes a reaction to detergents (e.g. washing dishes with bare hands, using detergent-based shampoos or soaps).
– Patients with hepatocellular dysfunction may develop hair-thinning or hair loss and nail changes such as clubbing, leukonychia (whitening), or onycholysis. -
This question is part of the following fields:
- Dermatology
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Question 10
Incorrect
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A 60-year old female suddenly started seeing a curtain-like shadow in her field of vision with flashes of lights and subsequent loss of vision, which prompted her to visit her ophthalmologist. What do you think is the most appropriate treatment in this case?
Your Answer:
Correct Answer:
Explanation:Flashes of light, presence of floaters and loss of vision (often described as a black curtain closing in on the visual field) are symptoms that strongly indicate retinal detachment. The fundoscopy findings of retinal tears support this diagnosis. Therefore, surgery of retina must be done to treat this patient.
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This question is part of the following fields:
- Ophthalmology
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Question 11
Incorrect
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A 22-year-old woman has ingested an unknown quantity of paracetamol tablets four hours ago. She now presents with nausea, vomiting, anorexia and right subchondral pain.
Which of the following features suggest that she should be transferred to the liver unit?Your Answer:
Correct Answer: pH 7.25
Explanation:The most widely used prognostic predictors for acetaminophen over-ingestion is King’s College Criteria, which is: arterial PH < 7.3 after fluid resuscitation, Cr level > 3.4, PT > 1.8x control or > 100s, or INR > 6.5, and Grave III or IV encephalopathy.
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This question is part of the following fields:
- Gastroenterology
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Question 12
Incorrect
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A 15-year-old girl presents with vomiting and her investigations show:
Sodium 115 mmol/L (137-144),
Potassium 3.0 mmol/L (3.5-4.9),
Urea 2.1 mmol/L (2.5-7.5),
Urine sodium 2 mmol/L,
Urine osmolality 750 mosmol/kg (350-1000).
What is the most likely diagnosis?Your Answer:
Correct Answer: Bulimia nervosa
Explanation:The patient is most likely to have Bulimia nervosa. A young girl with a low body mass contributes to the low urea. Hypokalaemia and hyponatraemia are due to vomiting. Her urine sodium is also low.
– In Addison’s diseases, there are low levels of sodium and high levels of potassium in the blood. In acute adrenal crisis: The most consistent finding is elevated blood urea nitrogen (BUN) and creatinine. Urinary and sweat sodium also may be elevated.
– In Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) there is hyponatremia with corresponding hypo-osmolality, continued renal excretion of sodium, urine less than maximally dilute and absence of clinical evidence of volume depletion. -
This question is part of the following fields:
- Endocrinology
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Question 13
Incorrect
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A 45-year-old man presents with tiredness and central weight gain.
He underwent pituitary surgery for a non-functional pituitary tumour two years ago. Although he recovered from his pituitary surgery well, he has been found to have complete anterior hypopituitarism. Accordingly he is receiving stable replacement therapy with testosterone monthly injections, thyroxine and hydrocortisone.
On examination, there are no specific abnormalities, his vision is 6/9 in both eyes and he has no visual field defects.
From his notes, you see that he has gained 8 kg in weight over the last six months and his BMI is 31. His blood pressure is 122/72 mmHg.
Thyroid function tests and testosterone concentrations have been normal. A post-operative MRI scan report shows that the pituitary tumour has been adequately cleared with no residual tissue.
Which of the following is the most likely cause of his current symptoms?Your Answer:
Correct Answer: Growth hormone deficiency
Explanation:The somatotroph cells of the anterior pituitary gland produce growth hormone (GH).
GH deficiency in adults usually manifests as reduced physical performance and impaired psychological well-being. It results in alterations in the physiology of different systems of the body, manifesting as altered lipid metabolism, increased subcutaneous and visceral fat, decreased muscle mass, decreased bone density, low exercise performance, and reduced quality of life. -
This question is part of the following fields:
- Endocrinology
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Question 14
Incorrect
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A 26 year old male presents with right sided elbow and wrist pain and left sided knee and ankle pain that has persisted for about two weeks. He recently returned from a trip to Thailand that last for two weeks. The patient admits to having unprotected sex while on holiday. Examination reveals swelling and tenderness of tendons around joints but no inflammation of the joints. A vesiculopustular skin rash is also observed. What is the most likely cause?
Your Answer:
Correct Answer: Gonococcal arthritis
Explanation:Patients with disseminated gonococcal arthritis may present with dermatitis-arthritis syndrome (60%) of with localized septic arthritis. (40%). Arthritis-dermatitis syndrome includes the classic triad of dermatitis, tenosynovitis, and migratory polyarthritis. Gout usually involves a singe joint and does not cause vesicopustular skin rash. Reactive arthritis has ocular symptoms (conjunctivitis), urethritis, and arthritis. Fungal arthritis occurs rarely and it may occur after a surgical infection or fungal spread hematogenously. it presents with tender, red, hot and swollen joint with loss of range of motion.
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This question is part of the following fields:
- Rheumatology
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Question 15
Incorrect
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A 43-year-old woman is concerned about osteoporosis as she as a strong family history of it. She is one year postmenopausal and aware of hot flushes at night.
Which one of the following therapies would be most appropriate?Your Answer:
Correct Answer: Cyclical oestrogen and progestogen
Explanation:As the patient has early menopause, hormone replacement therapy (HT) is considered to be the first line of choice for prevention of bone loss and fracture in the early postmenopausal period for 5 years.
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This question is part of the following fields:
- Endocrinology
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Question 16
Incorrect
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A defect in DNA gyrase can lead to which of the following cancerous conditions?
Your Answer:
Correct Answer: Xeroderma pigmentosum
Explanation:Xeroderma pigmentosum is an X-linked recessive condition, which is caused by mutations in DNA gyrase which further encodes the XP gene. The defect may lead to skin cancer at an early stage of life, especially at photo exposed sites.
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This question is part of the following fields:
- Dermatology
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Question 17
Incorrect
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Which one of the following features is most helpful in distinguishing beta thalassaemia trait from iron deficiency anaemia?
Your Answer:
Correct Answer: Haemoglobin A2 levels
Explanation:Elevated haemoglobin A2 level is seen in beta thalassaemia trait, whereas, it is typically low in iron deficiency anaemia unless the patient has received a recent blood transfusion.
Low mean corpuscular volume (MCV) and reduced haematocrit (Ht) are encountered in both conditions. Peripheral blood smear is grossly abnormal in both beta thalassaemia and severe iron deficiency anaemia, showing bizarre morphology, target cells, and a small number of nucleated red blood cells.
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This question is part of the following fields:
- Haematology & Oncology
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Question 18
Incorrect
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A 13-year-old boy complains of several episodes of collapse. He describes the majority of these episodes occurring when he is laughing. He states that he loses power in his legs and falls to the ground. He is alert throughout and recovers quickly. He also describes excessive daytime sleepiness with episodes in the morning of being awake but being unable to move his body. Examination is unremarkable. A diagnosis of narcolepsy is made. Which of the following is the first line treatment for excessive daytime sleepiness?
Your Answer:
Correct Answer: Modafinil
Explanation:Narcolepsy is a rare condition characterised by excessive daytime sleepiness, sleep paralysis, hypnagogic hallucinations, and cataplexy (sudden collapse triggered by emotion such as laughing or crying). There is no cure for narcolepsy. Treatment options include stimulants, such as methylphenidate (Ritalin) or modafinil (Provigil), antidepressants, such as fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft) and sodium oxybate (Xyrem). Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS).
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This question is part of the following fields:
- Neurology
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Question 19
Incorrect
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A 51-year-old man was brought to the Emergency department for loose stools. He was dehydrated, weak and in shock. He had previously been complaining of large stool volumes for a one month period. Stool colour was normal. There was no history of laxative abuse and no significant past medical history.
What is the most likely diagnosis?Your Answer:
Correct Answer: VIPoma
Explanation:Given that the patient has had large amount, high volume watery diarrhoea in an acute period of time, from the answer choices given, this narrows the diagnosis down to VIPoma or carcinoid syndrome. You would expect with carcinoid syndrome for there to be periodic episodes of diarrhoea, though, with a description of flushing, additionally, associated with these episodes. Thus, VIPoma is the most likely answer here. VIPomas are known to cause hypokalaemia from this large amount of watery diarrhoea. Stool volume should be > 700 ml/day.
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This question is part of the following fields:
- Gastroenterology
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Question 20
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 21
Incorrect
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A 35 year old female, known case of anti phospholipid syndrome, arrives at the clinic due to a swollen and painful left leg. Doppler ultrasonography confirms the diagnosis of a deep vein thrombosis. She was previously diagnosed with DVT 4 months back and was on warfarin therapy (target INR 2-3) when it occurred. How should her anticoagulation be managed?
Your Answer:
Correct Answer: Life-long warfarin, increase target INR to 3 - 4
Explanation:If the INR in the range of 2-3 has still resulted in thrombosis, the target INR is increased to 3-4. However, because the risk of bleeding increases as the INR rises, the INR is closely monitored and adjustments are made as needed to maintain the INR within the target range.
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This question is part of the following fields:
- Rheumatology
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Question 22
Incorrect
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An 12 year old girl is taken to the clinic for a review. Despite being normally fit and well and not visiting a doctor for the past four years, her father is concerned about her behaviour in the past week. The girl has expressed plans to run for president, is active with planning all through the night and seems overtly excited. When asked, she admits to smoking cannabis once a few months ago and has drank alcohol a few times in the past year. The last time she had alcohol was a week ago. Prior to her deterioration a few weeks ago her father describes her as a happy, well-adjusted, sociable girl. Which one of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Mania
Explanation:Mania is a state of extreme physical and emotional elation. A person experiencing mania or a manic episode may present with the following symptoms:
-Elevated mood. The person feels extremely ‘high’, happy and full of energy; he or she may describe the experience as feeling on top of the world and invincible. The person may shift rapidly from an elevated,
happy mood to being angry and irritable if they perceive they have been obstructed.
-Increased energy and overactivity. The person may have great difficulty remaining still.
-Reduced need for sleep or food. The person may be too active to eat or sleep.
-Irritability. The person may become angry and irritated with those who disagree with or dismiss his or her sometimes unrealistic plans or ideas.
-Rapid thinking and speech. The person’s thoughts and speech are more rapid than usual.
-Grandiose plans and beliefs. It is quite common for a person in a hypomanic or manic state to believe that he or she is unusually talented or gifted or has special friends in power. For example, the person may believe that he or she is on a special mission from God.
-Lack of insight. A person in a hypomanic or manic state may understand that other people see his or her ideas and actions as inappropriate, reckless or irrational. However, he or she is unlikely to personally accept that the behaviour is inappropriate, due to a lack of insight.
– Distractibility. The person has difficulty maintaining attention and may not be able to filter out external stimuli.Careful assessment to rule out organic conditions is an important first step in the management of mania. Often hospitalisation is required for someone who is experiencing acute mania. Both mood-stabilising agents such as lithium carbonate or sodium valproate and an antipsychotic may be needed to treat psychotic symptoms, agitation, thought disorder and sleeping difficulties. Benzodiazepines may be useful to reduce hyperactivity. Treatment with lithium alone may have a relatively slow response rate (up to two weeks after a therapeutic blood level is established), so that adjunctive medication such as sodium valproate is usually required. Regular monitoring of blood levels for lithium and valproate is essential because of the potential for toxicity.
The symptoms of hypomania are similar to those of mania: elevated mood, inflated self-esteem, decreased need for sleep, etc. except that they don’t significantly impact a person’s daily function and never include any psychotic symptoms.
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This question is part of the following fields:
- Psychiatry
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Question 23
Incorrect
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In which one of the following diseases does the patient have to be isolated?
Your Answer:
Correct Answer:
Explanation:Measles and chickenpox are spread by droplets. Thus, patients should be isolated.
Rheumatic fever and post-streptococcal glomerulonephritis are immune mediated diseases that don’t require isolation.
Herpetic gingivostomatitis spreads by direct transmission of infected secretions to the stratified squamous epithelium.
HSP is not an infectious disease. -
This question is part of the following fields:
- Infectious Diseases
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Question 24
Incorrect
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A 30-year-old man has been unwell for the last 3 weeks and now developed a rash. Chickenpox is diagnosed.
What is the appropriate treatment?Your Answer:
Correct Answer: Acyclovir
Explanation:You may treat chickenpox with acyclovir if it is commenced within the first 24 hours of the rash’s appearance. Erythromycin, doxycycline, and ampicillin would not help because it’s a viral infection (Varicella) not a bacterial infection.
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This question is part of the following fields:
- Infectious Diseases
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Question 25
Incorrect
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A 36-year-old lady with back pain is found to have loss of sensation of the kneecaps. Choose the dermatome most likely compromised:
Your Answer:
Correct Answer: L4
Explanation:L4 dermatome distribution includes the kneecaps.
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This question is part of the following fields:
- Clinical Sciences
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Question 26
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 27
Incorrect
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Which one of the following is most associated with the development of acute pancreatitis?
Your Answer:
Correct Answer: Hyperchylomicronaemia
Explanation:Hyperchylomicronaemia is an increase (markedly) in chylomicrons, and this can cause acute pancreatitis, as well as xanthomas. It can be seen in familial lipoprotein lipase (LPL) deficiency, primary type V hyperlipoproteinemia, idiopathic hyperchylomicronaemia, and familial apolipoprotein CII deficiency. Treatment is dietary fat restriction in order to avoid pancreatitis attacks.
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This question is part of the following fields:
- Gastroenterology
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Question 28
Incorrect
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Which of the following is a feature of haemoglobin S?
Your Answer:
Correct Answer: It is the result of a point mutation
Explanation:Hb S is the most common type of abnormal haemoglobin and the basis of sickle cell trait and sickle cell anaemia. It differs from normal adult haemoglobin (called haemoglobin A—Hb A) only by a single amino acid substitution due to point mutation—a valine replacing a glutamine in the sixth position of the beta chain of globin. Hb S molecules polymerize in hypoxic and acidic environments, imparting a sickle shape to the RBCs. Hb S molecules are less negatively charged than Hb A (due to the loss of glutamine) and have a lower affinity for oxygen (right shift of the oxygen-dissociation curve).
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This question is part of the following fields:
- Haematology & Oncology
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Question 29
Incorrect
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According to the Vaughan William's classification of antiarrhythmic agents, lidocaine is a:
Your Answer:
Correct Answer: Class Ib agent
Explanation:Lidocaine is an example of class IB antiarrhythmics.
The Vaughan-Williams classification of antiarrhythmics
I: Membrane stabilizing agents
IA: Quinidine, Procainamide, Disopyramide
IB: Lidocaine, Mexiletine
IC: Propafenone, Flecainide
II: β blockers – Propranolol, Esmolol
III: Agents widening AP – Amiodarone, Dronedarone, Dofetilide, Ibutilide, Sotalol
IV: Calcium channel blockers – Verapamil, Diltiazem
V: Miscellaneous – Digoxin, adenosine, magnesium -
This question is part of the following fields:
- Pharmacology
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Question 30
Incorrect
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Supplementation of which one of the following might help a patient diagnosed with homocystinuria?
Your Answer:
Correct Answer: Pyridoxine
Explanation:In general, the aim is to keep the homocysteine (Hcy) concentration as close to normal as possible. In patients who are fully-responsive to pyridoxine, standard doses can lead to tHcy levels below 50 μmol/L (and sometimes within the normal range). Some patients who are partially-responsive to pyridoxine may be able to achieve a tHcy level below 50 μmol/L if they are also on a low-Met diet; for others it is not a realistic goal.
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This question is part of the following fields:
- Clinical Sciences
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SESSION STATS - PERFORMANCE PER SPECIALTY
