00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - Which one of the following paraneoplastic features is less likely to be seen...

    Incorrect

    • Which one of the following paraneoplastic features is less likely to be seen in patients with squamous cell lung cancer?

      Your Answer: Clubbing

      Correct Answer: Lambert-Eaton syndrome

      Explanation:

      Lambert-Eaton myasthenic syndrome (LEMS) is a rare presynaptic disorder of neuromuscular transmission in which release of acetylcholine (ACh) is impaired, causing a unique set of clinical characteristics, which include proximal muscle weakness, depressed tendon reflexes, post-tetanic potentiation, and autonomic changes.

      In 40% of patients with LEMS, cancer is present when the weakness begins or is found later. This is usually a small cell lung cancer (SCLC). However, LEMS has also been associated with non-SCLC, lymphosarcoma, malignant thymoma, or carcinoma of the breast, stomach, colon, prostate, bladder, kidney, or gallbladder.

    • This question is part of the following fields:

      • Respiratory
      3
      Seconds
  • Question 2 - A 65 yr. old previously well man was referred due to an abnormal...

    Incorrect

    • A 65 yr. old previously well man was referred due to an abnormal heart sound which was detected during a medical check up. On examination he looked well. His blood pressure was 120/70 mmHg and pulse rate was 68 bpm which was regular. His jugular venous pressure was not elevated and he didn't have ankle oedema. He had an early diastolic murmur, best heard at the left sternal edge, which was more clear in expiration when the patient leant forward. His lungs were clear. His FBC, Urea and electrolytes, LFTs and lipid profile were normal. His ECG showed sinus rhythm. His chest X-ray was normal. Echocardiography showed mild to moderate aortic regurgitation with normal left ventricular size and normal function.
      Which of the following is the most appropriate way of managing this patient?

      Your Answer:

      Correct Answer: Start him on an angiotensin-converting enzyme (ACE) inhibitor

      Explanation:

      Although this patient’s left ventricular function is normal at the time of examination, there is chance of deterioration of it due to aortic regurgitation. It is found that ACE inhibitors slow the development of left ventricular dysfunction. So this patient should be started on an ACE inhibitor.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 3 - An 86-year-old male patient has been diagnosed with monoclonal gammopathy of undetermined significance....

    Incorrect

    • An 86-year-old male patient has been diagnosed with monoclonal gammopathy of undetermined significance. He is eager to know its relation to his future health.

      Which of the following statements is correct?

      Your Answer:

      Correct Answer: 10% of patients with MGUS go on to develop myeloma over 10 years

      Explanation:

      Monoclonal gammopathy of undetermined significance (MGUS, also known as benign paraproteinemia and monoclonal gammopathy) is a pre-malignant condition not necessarily leading to its malignant form—multiple myeloma. Around 10% of patients eventually develop myeloma over 10 years, with 50% at 15 years. MGUS causes paraproteinemia and is usually asymptomatic. It is not associated with ostealgia or increased risk of infections. It is often mistaken for multiple myeloma, differing from the latter in, no immunosuppression, normal levels of beta-2 microglobulin, and stable lower levels of paraproteinemia.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 4 - A 50-year-old man is referred with impotence. He has a history of angina,...

    Incorrect

    • A 50-year-old man is referred with impotence. He has a history of angina, hypertension and type 2 diabetes.
      Which one of the following drugs that he takes is a contraindication to him being able to receive sildenafil?

      Your Answer:

      Correct Answer: Isosorbide mononitrate

      Explanation:

      Sildenafil administration to patients who are using organic nitrates, either regularly and/or intermittently, in any form is contraindicated.
      Organic nitrates and nitric oxide (NO) donors exert their therapeutic effects on blood pressure and vascular smooth muscle by the same mechanism as endogenous NO via increasing cGMP concentrations.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 5 - Which of the following is MOST suggestive of a lesion of the sciatic...

    Incorrect

    • Which of the following is MOST suggestive of a lesion of the sciatic nerve?

      Your Answer:

      Correct Answer: Foot drop

      Explanation:

      The sciatic neve originates in the sacral plexus, mainly from spinal segments L5-S2. It supplies muscles that cause extension of the thigh and flexion of the leg. It divides into two main branches, the tibial nerve and common peroneal nerve, which are responsible for all foot movements. Anterior thigh and medial leg sensory loss is typical of a femoral nerve lesion. The femoral nerve also mediates flexion of the hip.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 6 - A 50 year old doctor developed a fever of 40.2 °C which lasted...

    Incorrect

    • A 50 year old doctor developed a fever of 40.2 °C which lasted for two days. He has had diarrhoea for a day, shortness of breath and dry cough.
      His blood results reveal a hyponatraemia and deranged LFTs. His WBC count is 10.4 × 109/L and CX-ray shows bibasal consolidation.
       
      Which treatment would be the most effective for his condition?

      Your Answer:

      Correct Answer: Clarithromycin

      Explanation:

      Pneumonia is the predominant clinical manifestation of Legionnaires disease (LD). After an incubation period of 2-10 days, patients typically develop the following nonspecific symptoms:
      Fever
      Weakness
      Fatigue
      Malaise
      Myalgia
      Chills

      Respiratory symptoms may not be present initially but develop as the disease progresses. Almost all patients develop a cough, which is initially dry and non-productive, but may become productive, with purulent sputum and, (in rare cases) haemoptysis. Patients may experience chest pain.
      Common GI symptoms include diarrhoea (watery and non bloody), nausea, vomiting, and abdominal pain.

      Fever is typically present (98%). Temperatures exceeding 40°C occur in 20-60% of patients. Lung examination reveals rales and signs of consolidation late in the disease course.

      Males are more than twice as likely as females to develop Legionnaires disease.

      Age
      Middle-aged and older adults have a high risk of developing Legionnaires disease while it is rare in young adults and children. Among children, more than one third of reported cases have occurred in infants younger than 1 year.

      Situations suggesting Legionella disease:
      -Gram stains of respiratory samples revealing many polymorphonuclear leukocytes with few or no organisms

      -Hyponatremia

      -Pneumonia with prominent extrapulmonary manifestations (e.g., diarrhoea, confusion, other neurologic symptoms)

      Specific therapy includes antibiotics capable of achieving high intracellular concentrations (e.g., macrolides, quinolones, ketolides, tetracyclines, rifampicin).
      Clarithromycin, a new macrolide antibiotic, is at least four times more active in vitro than erythromycin against Legionella pneumophila. In this study the safety and efficacy of orally administered clarithromycin (500 to 1,000 mg bid) in the treatment of Legionella pneumonia were evaluated.
      Clarithromycin is a safe effective treatment for patients with severe chest infections due to Legionella pneumophila.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 7 - A 34-year-old man was brought to the ER following a road-traffic-accident. An X-ray...

    Incorrect

    • A 34-year-old man was brought to the ER following a road-traffic-accident. An X-ray of his left thigh revealed a fractured shaft of the left femur. He has a known history of opioid abuse. You are called to the ward to assess him after he becomes unwell. Which of the following clinical features are NOT compatible with a diagnosis of opioid withdrawal?

      Your Answer:

      Correct Answer: Hypothermia

      Explanation:

      Among the options provided, hypothermia is not a symptom of opioid withdrawal.

      Symptoms of opioid withdrawal include dysphoric mood, yawning, insomnia, muscle aches, lacrimation/rhinorrhoea, papillary dilatation, piloerection, fever, sweating, nausea/vomiting, diarrhoea.
      If the patient is having an opioid withdrawal reaction, then give 10 mg of methadone syrup and wait about 60 min to determine its effect.

      COWS (Clinical Opioid Withdrawal Scale) assessment for opioid withdrawal is commonly used to determine the severity of opioid withdrawal.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 8 - A baby is born with complications including microcephaly, hepatosplenomegaly and elevated total bilirubin....

    Incorrect

    • A baby is born with complications including microcephaly, hepatosplenomegaly and elevated total bilirubin. Which of the following is the most likely diagnosis in this case?

      Your Answer:

      Correct Answer: Cytomegalovirus (CMV)

      Explanation:

      CMV infection is usually asymptomatic in adults. However, if the mother is infected for the first time during pregnancy then there is high chances of this infection passing on to the foetus. CMV infection can cause blindness, deafness, learning difficulties, restricted growth etc. Hepatitis B, herpes simplex, syphilis and HIV do not present with these classical signs of CMV infection in new-borns. It is estimated that 10 stillbirths occur in England and Wales every year due to CMV infection. The foetus is most at risk in early pregnancy. There is no effective prevention.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 9 - A 45 year old man, known case of hypothyroidism, presents with a 3...

    Incorrect

    • A 45 year old man, known case of hypothyroidism, presents with a 3 month history of pain and stiffness in the joints of his hands and feet. He also complains of dyspnoea occurring for the past 6 weeks. On examination there is a right pleural effusion and swollen hand joints. The clinician makes a diagnosis of rheumatoid arthritis. Which of the following is most characteristic of a rheumatoid pleural effusion?

      Your Answer:

      Correct Answer: It has a low glucose level

      Explanation:

      The typical “rheumatoid effusion” is a sterile exudative fluid with low pH (<7.3), low glucose (<60 mg. dL−1) and elevated lactate dehydrogenase (may be >700 IU). It should initially be treated with NSAIDs. Decortication should be reserved in patients with thickened pleura who have symptomatic dyspnoea.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 10 - A 68-year-old fashion designer presents to his GP complaining of pain in his...

    Incorrect

    • A 68-year-old fashion designer presents to his GP complaining of pain in his right eye. On examination the sclera is red and the pupil is dilated with a hazy cornea. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute angle closure glaucoma

      Explanation:

      There are many possible causes of a red eye. It is important to be able to recognise the causes which require urgent referral to an ophthalmologist. Acute angle closure glaucoma presents with severe pain, decreased visual acuity, patient seeing haloes, semi-dilated pupils, and hazy cornea. Anterior uveitis presents with acute onset pain, blurred vision and photophobia, with small, fixed oval pupils and ciliary flush.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 11 - A 72 yr. old male with a history of type II diabetes mellitus...

    Incorrect

    • A 72 yr. old male with a history of type II diabetes mellitus and hypertension for 15 years, presented with gradual onset difficulty in breathing on exertion and bilateral ankle swelling for the past 3 months. On examination he had mild ankle oedema. His JVP was not elevated. His heart sounds were normal but he had bibasal crepitations on auscultation. Which of the following clinical signs has the greatest sensitivity in detecting heart failure in this patient?

      Your Answer:

      Correct Answer: Third heart sound

      Explanation:

      The presence of a third heart sound is the most sensitive indicator of heart failure. All of the other signs can be found in heart failure with varying degrees.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 12 - Which of the following features is characteristic of immune thrombocytopenic purpura? ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 13 - Which one of the following is not associated with non-alcoholic steatohepatitis? ...

    Incorrect

    • Which one of the following is not associated with non-alcoholic steatohepatitis?

      Your Answer:

      Correct Answer: Type 1 diabetes mellitus

      Explanation:

      There are two types of Non-alcoholic fatty liver disease (NAFLD); simple fatty liver and non-alcoholic steatohepatitis (NASH). Simple fatty liver and NASH are two separate conditions.
      Simple fatty liver, also called non-alcoholic fatty liver (NAFL), is a form of NAFLD in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not progress to cause liver damage or complications.
      Non-alcoholic steatohepatitis (NASH)
      NASH is a form of NAFLD in which you have hepatitis and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer. Type I diabetes is not associated with NASH (non-alcoholic steatohepatitis), but type II diabetes is. Hyperlipidaemia, obesity, sudden weight loss/starvation and jejunoileal bypass are all associated with NASH. This is the most common cause of liver disease in the developed world.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 14 - A 39 year old man was admitted with an exacerbation of asthma. He...

    Incorrect

    • A 39 year old man was admitted with an exacerbation of asthma. He responded to treatment but the medical intern was concerned that Aspergillus fumigatus was cultured from his sputum.
       
      Subsequently arranged serum total, IgE level was elevated at 437 ng/ml (normal 40-180 ng/ml), RAST to Aspergillus fumigatus was class III, Aspergillus fumigatus precipitins were negative.
       
      What would be the most appropriate management step in this patient?

      Your Answer:

      Correct Answer: No change in medication

      Explanation:

      Allergic bronchopulmonary aspergillosis (ABPA) is a form of lung disease that occurs in some people who are allergic to Aspergillus. With ABPA, this allergic reaction causes the immune system to overreact to Aspergillus leading to lung inflammation. ABPA causes bronchospasm (tightening of airway muscles) and mucus build-up resulting in coughing, breathing difficulty and airway obstruction.

      Blood tests are used to look for signs of an allergic reaction. This includes evaluating your immunoglobulin E (IgE) level. This level is increased with any type of allergy. Many people with asthma have higher than normal IgE levels. In ABPA however, the IgE level is extremely high (more than 1000 ng/ml or 417 IU/ml). In addition to total IgE, all patients with ABPA have high levels of IgE that is specific to Aspergillus. A blood test can be done to measure specific IgE to Aspergillus. A blood or skin test for IgE antibodies to Aspergillus can be done to see if a person is sensitized (allergic) to this fungus. If these skin tests are negative (i.e. does not show a skin reaction) to Aspergillus fumigatus, the person usually does not have ABPA.
      Therefore, there should be no change in medication since this patient does not have ABPA.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 15 - A 60-year-old man known to have type 2 diabetes comes for regular follow...

    Incorrect

    • A 60-year-old man known to have type 2 diabetes comes for regular follow up. He is on metformin 2 g per day and gliclazide 160 mg per day. His recent HbA1c was 8.4% and his blood pressure was 140/75 mmHg. Eye examination reveals dot and blot haemorrhages and microaneurysms. None are close to the macula.

      Which of the following defines his eye condition?

      Your Answer:

      Correct Answer: Background diabetic retinopathy

      Explanation:

      Patients with diabetes often develop ophthalmic complications, the most common and potentially most blinding of these complications is diabetic retinopathy.
      The following are the 5 stages in the progression of diabetic retinopathy:
      1. Dilation of the retinal venules and formation of retinal capillary microaneurysms.
      2. Increased vascular permeability.
      3. Vascular occlusion and retinal ischemia.
      4. Proliferation of new blood vessels on the surface of the retina.
      5. Vitreous haemorrhage and contraction of the fibrovascular proliferation.
      The first 2 stages of diabetic retinopathy are known as background or nonproliferative retinopathy. Initially, the retinal venules dilate, then microaneurysms (tiny red dots on the retina that cause no visual impairment) appear. As the microaneurysms or retinal capillaries become more permeable, hard exudates appear, reflecting the leakage of plasma.

      Mild nonproliferative diabetic retinopathy (NPDR) or background diabetic retinopathy is indicated by the presence of at least 1 microaneurysm, while neovascularization is the hallmark of Proliferative Diabetic Retinopathy (PDR).

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 16 - Which of the following statements regarding dipeptidyl peptidase-4 inhibitors in the management of...

    Incorrect

    • Which of the following statements regarding dipeptidyl peptidase-4 inhibitors in the management of type 2 diabetes mellitus is correct?

      Your Answer:

      Correct Answer: Do not cause weight gain

      Explanation:

      Several dipeptidyl peptidase-4 (DPP-4) inhibitors are in clinical development; these are orally active and increase levels of active glucagon-like peptide-1 (GLP-1), which in turn increases insulin secretion and reduces glucagon secretion, thereby lowering glucose levels.
      Sitagliptin and vildagliptin both have a long duration of action, allowing once-daily administration. Both sitagliptin and vildagliptin are safe and tolerable with a low risk of hypoglycaemia. In drug-naïve subjects with type 2 diabetes, both sitagliptin and vildagliptin reduce A1C levels by ,1% as monotherapy.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 17 - The chorda tympani of the facial nerve (CN VII) carries: ...

    Incorrect

    • The chorda tympani of the facial nerve (CN VII) carries:

      Your Answer:

      Correct Answer: parasympathetic fibres to the submandibular and sublingual glands and taste fibres from the anterior two-thirds of the tongue

      Explanation:

      In the petrous temporal bone the facial nerve produces three branches:
      1. The greater petrosal nerve, which transmits preganglionic parasympathetic fibres to the sphenopalatine ganglion. These postganglionic fibres supply the lacrimal gland and the glands in the nasal cavity;
      2. The nerve to stapedius;
      3. Parasympathetic fibres to the submandibular and sublingual glands and taste fibres from the anterior two-thirds of the tongue.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 18 - A 54 year old gentleman presented with a 3 month history of a...

    Incorrect

    • A 54 year old gentleman presented with a 3 month history of a nodular growth over the dorsum of the his nose, about 0.6 cm in size. The base of nodule is slightly ulcerated and its margins are raised. The most likely diagnosis would be?

      Your Answer:

      Correct Answer: Basal cell carcinoma

      Explanation:

      Basal cell carcinoma is usually located on sun exposed sites. It has got many variants and clinically it presents as a slow growing mass/nodule with rolled margins and an ulcerated base.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 19 - A 28 yr. old primigravida in her 24th week of pregnancy came for...

    Incorrect

    • A 28 yr. old primigravida in her 24th week of pregnancy came for the routine follow up. She was asymptomatic at the time of examination. Her blood pressure was 152/92 mmHg and pulse rate was 90 bpm. Her blood pressure at the booking visit had been 132/80 mmHg. Her other examination findings were normal. Which of the following is the best method to use to treat her?

      Your Answer:

      Correct Answer: Labetalol

      Explanation:

      Methyldopa is the drug of first choice for the control of mild to moderate hypertension in pregnancy. Labetalol is also considered as a first line drug for hypertension in pregnancy. Calcium channel blockers and hydralazine are considered as second line drugs. Beta-blockers (except labetalol), angiotensin receptor blockers, angiotensin-converting enzyme inhibitors and thiazides are not recommended.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 20 - A 39 year old woman with a history of rheumatoid arthritis has recently...

    Incorrect

    • A 39 year old woman with a history of rheumatoid arthritis has recently been switched from methotrexate to leflunomide. Monitoring of full blood count and LFTs has been carried out. Which of the following parameters should also be monitored in this case?

      Your Answer:

      Correct Answer: Blood pressure

      Explanation:

      Blood pressure should be routinely measured as leflunomide may cause hypertension and thus an increase in BP. It doesn’t cause changes in blood sugar levels, peak expiratory flow rate or haematuria.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 21 - A prescription for Olanzapine is written for a 28 year old lady with...

    Incorrect

    • A prescription for Olanzapine is written for a 28 year old lady with a history of schizophrenia. Which adverse effect is she most likely to experience?

      Your Answer:

      Correct Answer: Weight gain

      Explanation:

      Weight gain is an extremely common (5-40%) adverse effect of atypical antipsychotics such as olanzapine (dose dependent). Olanzapine causes orthostatic hypotension ≥20% of reported cases. Parkinsonism reactions occurs in 4% of people.

    • This question is part of the following fields:

      • Psychiatry
      0
      Seconds
  • Question 22 - A 22 year-old university graduate presented with progressive unsteadiness during walking over the...

    Incorrect

    • A 22 year-old university graduate presented with progressive unsteadiness during walking over the last year. She had been otherwise healthy apart from recent difficulty hearing her lecturer in classes. She took no prescription medication but had occasionally taken cocaine during her first year of college. She also admits to drinking up to 30 units of alcohol per week and smoked 10 cigarettes per day. Her parents were both well, but her father's sister had problems with walking before she died. Examination reveals normal tone and power throughout all four limbs. Reflexes were normal in the upper limbs but decreased at the knees and absent at the ankles. Coordination was normal in all four limbs but her gait was ataxic. Sensation in the upper limbs was normal but decreased vibratory sensation and proprioception was noted to the ankles bilaterally. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Friedreich’s ataxia

      Explanation:

      Friedreich’s ataxia is an autosomal recessive disorder that usually begins before the end of the teens. It has an estimated prevalence in Europe of 1 in 50,000 and life expectancy is around 40–50 years. Neurological features include a progressive ataxia, cerebellar dysarthria, lower limb areflexia, decreased vibratory sensation and proprioception, and pyramidal weakness. Pes cavus and scoliosis are also both seen. Cardiomyopathy occurs in over 70% of cases. Less common features include optic atrophic, diabetes mellitus, and deafness.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 23 - Causes of dilated pupils include which of the following? ...

    Incorrect

    • Causes of dilated pupils include which of the following?

      Your Answer:

      Correct Answer: Ethylene glycol poisoning

      Explanation:

      Ethylene glycol poisoning is the only poison listed that will cause dilation of the pupils whereas all the other listed conditions and poisons will present with small pupils other than in the case of Myotonic dystrophy wherein the patient will present with a cortical cataract.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 24 - An elderly man presents with complaints of a chronic cough with haemoptysis and...

    Incorrect

    • An elderly man presents with complaints of a chronic cough with haemoptysis and night sweats on a few nights per week for the past four months. He is known to smoke 12 cigarettes per day and he had previously undergone treatment for Tuberculosis seven years ago.

      His blood pressure was found to be 143/96mmHg and he is mildly pyrexial 37.5°C. Evidence of consolidation affecting the right upper lobe was also found.

      Investigations;
       
      Hb 11.9 g/dL,
      WCC 11.1 x109/L,
      PLT 190 x109/L,
      Na+ 138 mmol/L,
      K+ 4.8 mmol/L,
      Creatinine 105 μmol/L,
      CXR Right upper lobe cavitating lesion
      Aspergillus precipitins positive

      Which of the following is most likely the diagnosis?

      Your Answer:

      Correct Answer: Aspergilloma

      Explanation:

      An aspergilloma is a fungus ball (mycetoma) that develops in a pre-existing cavity in the lung parenchyma. Underlying causes of the cavitary disease may include treated tuberculosis or other necrotizing infection, sarcoidosis, cystic fibrosis, and emphysematous bullae. The ball of fungus may move within the cavity but does not invade the cavity wall. Aspergilloma may manifest as an asymptomatic radiographic abnormality in a patient with pre-existing cavitary lung disease due to sarcoidosis, tuberculosis, or other necrotizing pulmonary processes. In patients with HIV disease, aspergilloma may occur in cystic areas resulting from prior Pneumocystis jiroveci pneumonia. Of patients with aspergilloma, 40-60% experience haemoptysis, which may be massive and life threatening. Less commonly, aspergilloma may cause cough and fever.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 25 - A 20-year-old man presents with a history of sticky greenish discharge, accompanied by...

    Incorrect

    • A 20-year-old man presents with a history of sticky greenish discharge, accompanied by redness of the eyes, and difficulty opening his eyes in the morning. What is the single most likely cause of these symptoms?

      Your Answer:

      Correct Answer: Conjunctivitis

      Explanation:

      Redness of the eyes can present in all of the conditions. However, the green sticky discharge that causes the eyelids to stick together overnight is characteristic of bacterial conjunctivitis. Bacterial conjunctivitis is an inflammatory condition of the conjunctiva in which bacteria commonly Staphylococcus Aureus invade the conjunctiva. The person experiences a foreign body feeling in the eye and mucopurulent or purulent discharge.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 26 - A 51 year-old teacher presents complaining of numerous falls. He states he has...

    Incorrect

    • A 51 year-old teacher presents complaining of numerous falls. He states he has difficulty walking up stairs, and he thinks it is because of his weak legs rather than blackouts. He is hypertensive and has suffered chronic back pain for many years. He has smoked for many years as well and has a chronic smokers cough. Upon examination, he has weakness of hip flexion and particularly knee extension. He is unable to keep his fingers flexed against force, with the right being weaker than the left. There are no sensory abnormalities and reflexes are preserved bilaterally. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Inclusion body myositis

      Explanation:

      The pattern of muscle involvement seen with quadriceps and long-finger flexors is characteristic of inclusion body myositis, an inflammatory myopathy. Polymyositis is likely to cause a predominantly proximal weakness, associated with muscle pain. The signs and symptoms are not consistent with upper cord compression, as there would likely be sensory signs, reflex changes, and possible urinary symptoms. Motor neuron disease cannot be ruled out, but there are no findings of upper motor neuron or bulbar features.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 27 - A 26-year-old technician with no past medical history presents to the neurology clinic...

    Incorrect

    • A 26-year-old technician with no past medical history presents to the neurology clinic complaining of muscle pain. He describes severe bilateral cramping calf pain on minimal exercise. This has been present since his late teens and as such he has avoided exercise. Recently, he has attended the local gym to try and lose weight, but attempts at exercise have been dampened by the pain. He does note that if he perseveres with exercise, the pain settles. He has noticed passing dark urine in the evenings following a prolonged bout of exercise. Which of the following clinical tests would be most useful in aiding the diagnosis in this patient?

      Your Answer:

      Correct Answer: Muscle biopsy

      Explanation:

      The differential diagnosis of bilateral exercise-induced pain would include metabolic muscle disease, lumbar canal stenosis and intermittent claudication. The patient’s age, history and lack of other risk factors make the latter two options unlikely.

      The syndrome described is in fact McArdle’s disease (myophosphorylase deficiency). This is a disorder of carbohydrate metabolism. Clinical features of pain and fatigue are precipitated in early exercise, as carbohydrates cannot be mobilized to provide an energy substrate to the muscle. With prolonged exercise, fatty acid metabolism provides energy, and symptoms lessen. The dark urine described is likely to represent myoglobinuria following rhabdomyolysis. Definitive diagnosis of most metabolic muscle diseases relies on muscle biopsy and enzyme analysis.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 28 - A 43 year old female presented with a 5 day history of a...

    Incorrect

    • A 43 year old female presented with a 5 day history of a productive cough with rusty coloured sputum. Chest X-ray showed lobar consolidation on her left side. The most likely causative organism would be?

      Your Answer:

      Correct Answer: Streptococcus pneumoniae

      Explanation:

      Streptococcus pneumonia is the chief causative organism for lobar pneumonia in this age group patients. Typically patients present with rusty coloured sputum and a cough. Pneumocystis jiroveci is responsible for causing pneumocystis pneumonia among immunocompromised patients.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 29 - A 61-year old mechanic recently attended A&E, with a 3 month history of...

    Incorrect

    • A 61-year old mechanic recently attended A&E, with a 3 month history of bilateral paraesthesia's and twitching affecting the thumb, first finger and lateral forearm. He denied any trauma. An MRI scan of his spine was performed and revealed cervical canal stenosis with mild cord compression. He was discharged and advised to see his GP for follow-up. Which of the following is the most appropriate initial step in management?

      Your Answer:

      Correct Answer: Refer to spinal surgery services

      Explanation:

      Bilateral median nerve dysfunction is suggestive of degenerative cervical myelopathy (DCM) rather than bilateral carpal tunnel syndrome. DCM should be suspected in elderly patients presenting with limb neurology. This patient’s twitches are probably fibrillations, a sign of lower motor neuron dysfunction.
      Degenerative cervical myelopathy is associated with a delay in diagnosis. It is most commonly misdiagnosed as carpal tunnel syndrome. In one study, 43% of patients who underwent surgery for degenerative cervical myelopathy had been initially diagnosed with carpal tunnel syndrome.
      Management of these patients should be by specialist spinal services (neurosurgery or orthopaedic spinal surgery). Decompressive surgery is the mainstay of treatment and has been shown to stop disease progression. Physiotherapy and analgesia do not replace surgical opinion, though they may be used alongside. Nerve root injections do not have a role in management.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 30 - A 70 yr. old female was brought in by the paramedics after she...

    Incorrect

    • A 70 yr. old female was brought in by the paramedics after she collapsed whilst shopping. She has a tachycardia of 150 bpm and her BP is 100/60 mmHg. Her ECG showed a broad complex tachycardia. Which of the following is more suggestive of a ventricular tachycardia (VT) over a supraventricular tachycardia (SVT) with aberrant conduction?

      Your Answer:

      Correct Answer: Atrioventricular dissociation

      Explanation:

      To differentiate VT from SVT with aberrant conduction the following electrocardiographic features should be looked for:

      Evidence of preceding atrial activity for SVT. Oesophageal leads are helpful if P waves are hidden in the QRS complex.
      QRS duration more than 140 ms for VT.
      QRS morphology: Features of QRS morphology that favour SVT are RBBB or triphasic patterns like rSR in V1 and qRS in V6. Monophasic pattern like R or qR in V1 and rS or QS in V6 or multiple morphology QRS complexes favour VT.
      AV dissociation for VT.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Passmed