00
Correct
00
Incorrect
00 : 00 : 0 00
Session Time
-- : --
Average Question Time ( Secs)
  • Question 1 - A 25-year-old female patient presents with massive haemorrhage. After grouping, her blood sample...

    Incorrect

    • A 25-year-old female patient presents with massive haemorrhage. After grouping, her blood sample comes out to be B RhD negative.

      You work in the hospital's blood bank and are asked to prepare two units each of red blood cells (RBCs) and fresh frozen plasma (FFP). You manage to obtain the RBCs but not the Group B FFP as it is unavailable. Therefore, out of the following, FFP from a donor of which blood group would be best to transfuse?

      Your Answer: AB RhD positive

      Correct Answer: AB RhD negative

      Explanation:

      Group AB donors are the universal donors of FFP. This is because they produce neither anti-A nor anti-B antigens in their plasma and are, therefore, compatible with all ABO groups.

      The aforementioned patient’s blood group is B meaning, thereby, she naturally produces anti-A antigens in her plasma and would need to receive plasma that does not have anti-B antigens in it. Hence, she can only receive FFP from donors of group B or AB. Moreover, as she is of childbearing age, she must receive RhD negative blood in order to avoid problems with future pregnancies if her foetus would be RhD positive.

    • This question is part of the following fields:

      • Haematology & Oncology
      5
      Seconds
  • Question 2 - A 42 yr. old male patient who was on enalapril for hypertension presented...

    Incorrect

    • A 42 yr. old male patient who was on enalapril for hypertension presented with generalized body weakness. Investigations revealed hyperkalaemia. Which of the following can be expected in his ECG?

      Your Answer:

      Correct Answer: Tall, tented T waves

      Explanation:

      In hyperkalaemia the ECG will show tall, tented T waves as well as small P waves and widened QRS complexes. 

    • This question is part of the following fields:

      • Cardiology
      7
      Seconds
  • Question 3 - A 50 year old woman with a 30 pack year history of smoking...

    Incorrect

    • A 50 year old woman with a 30 pack year history of smoking presents with a persistent cough and occasional haemoptysis. A chest x-ray which is done shows no abnormality. What percentage of recent chest x-rays were reported as normal in patients who are subsequently diagnosed with lung cancer?

      Your Answer:

      Correct Answer: 10%

      Explanation:

      A retrospective cohort study of the primary care records of 247 lung cancer patients diagnosed between 1998–2002 showed that 10% of the X-rays were reported as normal.
      Other tests may include:
      – Imaging tests: A CT scan can reveal small lesions in your lungs that might not be detected on an X-ray.
      – Sputum cytology: sputum may reveal the presence of lung cancer cells.
      – Tissue sample (biopsy): A sample of abnormal cells may be removed for histological analysis. A biopsy may be performed in a number of ways, including bronchoscopy, mediastinoscopy and needle biopsy. A biopsy sample may also be taken from adjacent lymph nodes.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 4 - A 29-year-old accountant presents to the emergency department complaining of left eye pain....

    Incorrect

    • A 29-year-old accountant presents to the emergency department complaining of left eye pain. He has not been able to wear his contact lenses for the past 24 hours due to the pain. He describes the pain as severe and wonders whether he has 'got something stuck in his eye'. On examination, there is diffuse hyperaemia of the left eye. The left cornea appears hazy and pupillary reaction is normal. Visual acuity is reduced on the left side and a degree of photophobia is noted. A hypopyon is also seen. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Keratitis

      Explanation:

      Hypopyon can be seen in anterior uveitis, however the combination of a normal pupillary reaction and contact lens use make a diagnosis of keratitis more likely. Keratitis describes inflammation of the cornea, and features include red eye with pain and erythema, photophobia, and foreign body/gritty sensation.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 5 - A 34-year-old's chest x-ray showed diffuse bilateral alveolar shadows. He also suffers from...

    Incorrect

    • A 34-year-old's chest x-ray showed diffuse bilateral alveolar shadows. He also suffers from shortness of breath, weight loss and dry cough due to Kaposi's sarcoma but no fever was noted. Which is the most likely causative organism?

      Your Answer:

      Correct Answer: Pneumocystis jiroveci

      Explanation:

      Pneumocystis Jiroveci. This causative organism is responsible for pneumonia in individuals that have a compromised immune system. Symptoms include cyanosis, dry cough and in some cases, diffuse bilateral alveolar shadows on CXR. Co-trimoxazole is normally the treatment for this.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 6 - A 60–year-old woman comes to the hospital for chemotherapy for breast cancer.
    On...

    Incorrect

    • A 60–year-old woman comes to the hospital for chemotherapy for breast cancer.
      On examination, her pulse is 120 bpm and regular and BP is 90/60. Her JVP is not seen, her heart sounds are normal, and her chest is clear. There is evidence of a right mastectomy. Abdominal and neurological examination is normal.
      Short synacthen test was ordered and the results came as follows:
      Time (min):
      0,
      30,
      60.
      Cortisol (nmol/l):
      90,
      130,
      145.

      Which two of the following would be your immediate management?

      Your Answer:

      Correct Answer: Intravenous normal saline six-hourly

      Explanation:

      Synacthen test interpretation:
      – Basal Cortisol level should be greater than 180nmol/L
      – 30min or 60min Cortisol should be greater than 420nmol/L (whatever the basal level)
      – The increment should be at least 170nmol/L, apart from in severely ill patients where adrenal output is already maximal.
      The patient’s results show that she has Acute Adrenal Insufficiency
      The guidelines include the following recommendations for emergency treatment:
      Administer hydrocortisone: Immediate bolus injection of 100 mg hydrocortisone intravenously or intramuscularly followed by continuous intravenous infusion of 200 mg hydrocortisone per 24 hours (alternatively, 50 mg hydrocortisone per intravenous or intramuscular injection every 6 h)
      Rehydrate with rapid intravenous infusion of 1000 mL of isotonic saline infusion within the first hour, followed by further intravenous rehydration as required (usually 4-6 L in 24 h; monitor for fluid overload in case of renal impairment and elderly patients)
      Contact an endocrinologist for urgent review of the patient, advice on further tapering of hydrocortisone, and investigation of the underlying cause of the disease, including the diagnosis of primary versus secondary adrenal insufficiency
      Tapering of hydrocortisone can be started after clinical recovery guided by an endocrinologist; in patients with primary adrenal insufficiency, mineralocorticoid replacement must be initiated (starting dose 100 μg fludrocortisone once daily) as soon as the daily glucocorticoid dose is below 50 mg of hydrocortisone every 24 hours

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 7 - A 42-year-old man presents with a watery eye and some purulent discharge. Mucoid...

    Incorrect

    • A 42-year-old man presents with a watery eye and some purulent discharge. Mucoid discharge can be expressed from the lacrimal punctum. His eye is painful and red while the nasal end of his lower eyelid is swollen. The redness extends further to reach the nasal peri-orbital area. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute dacryocystitis

      Explanation:

      Acute dacryocystitis presents as inflammation of the lacrimal sac and is typically caused by infection. Symptoms of acute dacryocystitis can be pain, redness of the eye and swelling of the nasal aspect of the eye. The eye is usually watery and discharge can be expressed through the lacrimal punctum which is generally mucoid but can also be purulent. Patient can also present with fever.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 8 - A 60-year old female suddenly started seeing a curtain-like shadow in her field...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 9 - A 41-year-old gentleman required high doses of intravenous diuretics after his renal transplant...

    Incorrect

    • A 41-year-old gentleman required high doses of intravenous diuretics after his renal transplant for the purposes of fluid management. Soon after administration he developed hearing loss, tinnitus, and vertigo.
       
      Which diuretic is most likely to have caused this?

      Your Answer:

      Correct Answer: Furosemide

      Explanation:

      Furosemide is a loop diuretic that is known to have significant ototoxicity side-effects although the mechanism is not fully known.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 10 - A 80 yr. old male with hypertension presented with his second episode of...

    Incorrect

    • A 80 yr. old male with hypertension presented with his second episode of atrial fibrillation. He was warfarinised and discharged. Later he was reviewed and found to be in sinus rhythm. Which of the following is the most appropriate next step?

      Your Answer:

      Correct Answer: Continue lifelong warfarin

      Explanation:

      CHA₂DS₂-VASc score is used for atrial fibrillation stroke risk calculation.
      Congestive heart failure – 1 point
      Hypertension – 1 point
      Age ≥75 years – 2 points
      Diabetes mellitus – 1 point
      Stroke/Transient Ischemic Attack/Thromboembolic event – 2 points
      Vascular disease (prior MI, PAD, or aortic plaque) – 1 point
      Age 65 to 74 years – 1 point
      Sex category (i.e., female sex) – 1 point
      A score of 2 or more is considered as high risk and anticoagulation is indicated. This patient’s score is 3, so he needs life long warfarin to prevent stroke.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 11 - A 68 year old man presents with acute symptoms of gout on his...

    Incorrect

    • A 68 year old man presents with acute symptoms of gout on his first metatarsophalangeal joint. Which option best explains the underlying mechanism of gout?

      Your Answer:

      Correct Answer: Decreased renal excretion of uric acid

      Explanation:

      Primary gout is related more often to underexcretion of uric acid or overproduction.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 12 - Which of the following is most helpful in differentiating chronic from acute renal...

    Incorrect

    • Which of the following is most helpful in differentiating chronic from acute renal failure?

      Your Answer:

      Correct Answer: Kidney size at ultrasound scan

      Explanation:

      The size of the kidneys on ultrasound would differentiate chronic from acute renal failures. Chronic renal failure is more associated with small-sized kidneys.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 13 - A 30-year-old agitated male was brought to the emergency department by his friend....

    Incorrect

    • A 30-year-old agitated male was brought to the emergency department by his friend. Though there is little previous history, the friend believes that he has been suffering from depression for several years, and his medications have been changed by his general practitioner quite recently.
      On examination the patient is agitated and confused, his pupils are dilated. He also has tremors, excessive sweating, and grinding of teeth. His heart rate is 118 beats/min, which is regular, and is febrile with a temperature of 38.5°C.
      What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Serotonin syndrome

      Explanation:

      The most probable diagnosis in this patient is serotonin syndrome.

      The serotonin syndrome is a cluster of symptoms and signs (range from barely perceptible tremor to life-threatening hyperthermia and shock).
      It may occur when SSRIs such as citalopram, escitalopram, fluoxetine, fluoxetine, paroxetine, and sertraline that impair the reuptake of serotonin from the synaptic cleft into the presynaptic neuron are taken in combination with monoamine oxidase inhibitors or tricyclic antidepressants. It has also been reported following an overdose of selective serotonin reuptake inhibitors (SSRIs) alone.

      Treatment:
      Most cases of serotonin syndrome are mild and will resolve with removal of the offending drug alone.
      After stopping all serotonergic drugs, management is largely supportive and aimed at preventing complications.
      Patients frequently require sedation, which is best facilitated with benzodiazepines.
      Antipsychotics should be avoided because of their anticholinergic properties, which may inhibit sweating and heat dissipation.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 14 - A 41-year-old yoga instructor presents with a 2-month history of left-hand weakness. She...

    Incorrect

    • A 41-year-old yoga instructor presents with a 2-month history of left-hand weakness. She has no significant past medical history. On examination, there is mild weakness of the left upper and lower limbs with a right sided facial weakness, which spares the forehead. Which of the following is the most likely location of the lesion?

      Your Answer:

      Correct Answer: Right pons

      Explanation:

      The pons is above the level of decussation of the corticospinal tracts so a pontine lesion would cause a contralateral limb weakness.
      The facial motor nucleus is located in the pons and supplies the ipsilateral facial muscles.
      A right cerebral lesion would give left upper and lower limb weakness. It would also cause a left sided facial weakness.
      A left cerebral lesion would give right upper and lower limb weakness with right facial weakness.
      Finally, a cervical spinal cord lesion would not cause a facial weakness.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 15 - A 82-year-old woman admitted following a fractured neck of femur has been discharged....

    Incorrect

    • A 82-year-old woman admitted following a fractured neck of femur has been discharged. On review, she is making good progress but consideration is given to secondary prevention of further fractures. What is the most appropriate step in the prevention of further fractures?

      Your Answer:

      Correct Answer: Start oral bisphosphonate

      Explanation:

      In such a clinical scenario, NICE guidelines support initiating treatment with bisphosphonates without waiting for a DEXA scan.

      Osteoporosis is defined as low bone mineral density caused by altered bone microstructure ultimately predisposing patients to low-impact, fragility fractures.

      Management:
      Vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
      Alendronate is the first-line treatment. Around 25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate.
      Strontium ranelate and raloxifene are recommended if patients cannot tolerate bisphosphonates.
      Other medications that are useful in the treatment of osteoporosis are denosumab, teriparatide, raloxifene, etc.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 16 - A 24-year-old smoker with testicular cancer presents with exertional dyspnoea, wheezing, and persistent...

    Incorrect

    • A 24-year-old smoker with testicular cancer presents with exertional dyspnoea, wheezing, and persistent non-productive cough. He completed a course of chemotherapy comprising of cisplatin, bleomycin, and etoposide three months ago. On examination, there are fine bilateral basal crackles.

      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Bleomycin toxicity

      Explanation:

      The cytotoxic drug bleomycin can cause bleomycin-induced pneumonitis (BIP). It usually occurs during chemotherapy but can also occur up to six months post-therapy.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 17 - Randomised control trials offer the following level of evidence: ...

    Incorrect

    • Randomised control trials offer the following level of evidence:

      Your Answer:

      Correct Answer: Ib

      Explanation:

      1B: Individual Randomised Control Trial (with narrow confidence intervals)

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 18 - A woman with severe renal failure undergoes a kidney transplant. However, after a...

    Incorrect

    • A woman with severe renal failure undergoes a kidney transplant. However, after a few hours, she develops fever and anuria. The doctors are suspecting hyperacute organ rejection. Which are the cells primarily responsible for hyperacute organ rejection?

      Your Answer:

      Correct Answer: B Cells

      Explanation:

      Hyperacute rejection appears in the first minutes following transplantation and occurs only in vascularized grafts. This very fast rejection is characterized by vessel thrombosis leading to graft necrosis. Hyperacute rejection is caused by the presence of antidonor antibodies existing in the recipient before transplantation. These antibodies induce both complement activation and stimulation of endothelial cells to secrete Von Willebrand procoagulant factor, resulting in platelet adhesion and aggregation. The result of these series of reactions is the generation of intravascular thrombosis leading to lesion formation and ultimately to graft loss. Today, this type of rejection is avoided in most cases by checking for ABO compatibility and by excluding the presence of antidonor human leukocyte antigen (HLA) antibodies by cross-match techniques between donor graft cells and recipient sera. This type of rejection is also observed in models of xenotransplantation of vascularized organs between phylogenetically distant species when no immunosuppressive treatment is given to the recipients.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 19 - A 13-year-old girl presents with a swollen left knee following a fall. Her...

    Incorrect

    • A 13-year-old girl presents with a swollen left knee following a fall. Her parents state she suffers from haemophilia and has been treated for a right-sided haemarthrosis previously. What other condition is she most likely to have?

      Your Answer:

      Correct Answer: Turner's syndrome

      Explanation:

      Haemophilia is a X-linked recessive disorder. In X-linked recessive inheritance only males are affected. An exception to this seen in examinations are patients with Turner’s syndrome, who are affected due to only having one X chromosome. X-linked recessive disorders are transmitted by heterozygote females (carriers) and male-to-male transmission is not seen. Affected males can only have unaffected sons and carrier daughters.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 20 - In which one of the following diseases does the patient have to be...

    Incorrect

    • 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
      0
      Seconds
  • Question 21 - A new blood test developed to screen individuals for cardiac failure was performed...

    Incorrect

    • A new blood test developed to screen individuals for cardiac failure was performed on 500 patients. The results were positive for 40 out of 50 patients with echocardiography-established heart failure. However, the test was also positive for 20 patients with no signs of heart failure. What is the positive predictive value of the test?

      Your Answer:

      Correct Answer: 0.66

      Explanation:

      Positive predictive value = TP (true positives) / [TP + FP (false positives)] = 40 / (40 + 20) = 0.66

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 22 - A 48-year-old male with a history of bipolar disorder presents with acute...

    Incorrect

    • A 48-year-old male with a history of bipolar disorder presents with acute confusion. In-transit to hospital he had a generalized seizure which terminated spontaneously after around 30 seconds. On arrival to the emergency department, his GCS is 14/15 and he is noted to have a coarse tremor. Suspecting a diagnosis of lithium toxicity, intravenous access is obtained, a blood sample was drawn for investigations and a saline infusion is started. The blood investigations revealed:

      Lithium level: 4.2 mmol/L,
      Na+: 136 mmol/L,
      K+: 4.6 mmol/L,
      Urea: 8.1 mmol/L,
      Creatinine: 99 µmol/L,
      Bicarbonate: 18 mmol/L,

      What is the most appropriate management for the patient?

      Your Answer:

      Correct Answer: Arrange haemodialysis

      Explanation:

      The presentation of the patient is typical of chronic lithium toxicity (due to the presence of mainly neurological manifestations). Additional to the blood investigations mentioned, urine analysis, electrolyte levels, and renal function should also be performed. A low urine Anion gap and a low urine specific gravity are highly suggestive of lithium toxicity.
      ECG obtained in this patient is likely to show: nonspecific, diffuse ST segment depression with T wave inversion.
      Acute lithium toxicity presents with more GI manifestations while, the clinical features of chronic lithium toxicity are mainly neurological and can include:
      Coarse tremors (fine tremors are seen in therapeutic levels), hyperreflexia, acute confusion, seizures, and coma.
      The management of lithium toxicity is as follows:
      Immediate GI decontamination with gastric lavage (in case of acute intoxication)
      Saline Administrations: the goal of saline administration is to restore GFR, normalize urine output and enhance lithium clearance.
      Haemodialysis remains the mainstay treatment for lithium toxicity as lithium is readily dialyzed because of water solubility, low volume of distribution, and lack of protein binding.
      The Extracorporeal Treatments in Poisoning Workgroup (EXTRIP Workgroup) recommendations for dialysis (extracorporeal treatment) in lithium toxicity include:
      • Impaired kidney function and lithium levels > 4.0 mEq/L
      • Decreased consciousness, seizures, or life-threatening dysrhythmias, regardless of lithium levels
      • Levels are > 5.0 mEq/L, significant confusion is noted, or the expected time to reduce levels to < 1.0 mEq/L is more than 36 hours
      As post-dialysis rebound elevations in lithium levels have been documented, continuous veno-venous hemofiltration (CVVH) has been advocated.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 23 - Which of the following is not a risk factor for primary open-angle glaucoma?...

    Incorrect

    • Which of the following is not a risk factor for primary open-angle glaucoma?

      Your Answer:

      Correct Answer: Hypermetropia

      Explanation:

      Acute angle closure glaucoma is associated with hypermetropia, whereas primary open-angle glaucoma is associated with myopia. Glaucoma is a group of eye disorders characterised by optic neuropathy due, in the majority of patients, to raised intraocular pressure (IOP). It is now recognised that a minority of patients with raised IOP do not have glaucoma and vice versa.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 24 - A 14 year-old is brought to the ED after being hit on the...

    Incorrect

    • A 14 year-old is brought to the ED after being hit on the head with a cricket ball during a match. His teacher describes that he initially collapsed on the ground and complained of a sore head. Two minutes later, he got up and said he felt OK and continued playing. However, 30 minutes later he suddenly collapsed and lost consciousness. What injury is he most likely to have sustained?

      Your Answer:

      Correct Answer: Extradural haematoma

      Explanation:

      A lucid interval, in which the patient portrays a temporary improvement in condition after a traumatic brain injury, is especially indicative of an epidural haematoma.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 25 - A 74-year-old woman referred by her GP because of increasing weight loss, early...

    Incorrect

    • A 74-year-old woman referred by her GP because of increasing weight loss, early satiety and increasing anorexia. She admits to 2 or 3 episodes of vomiting blood. The GP feels an epigastric mass.

      There is both a microcytic anaemia and abnormal liver enzymes. Her past history, which may be of importance, includes excess consumption of sherry and spirits, and a 30 pack-year smoking history.

      Which diagnosis fits best with this clinical picture?

      Your Answer:

      Correct Answer: Gastric carcinoma

      Explanation:

      With a clinical history of weight loss, smoking, drinking alcohol, and hematemesis, the most likely answer is gastric carcinoma (also a mass). Based on symptomatology alone this is more likely than gastric lymphoma, as she has many risk factors for adenocarcinoma and/or squamous cell carcinoma. Helicobacter gastritis would not likely present with the severity of symptoms, neither would benign gastric ulcers.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 26 - A 35-year-old woman was on a camping holiday in Spain. She awoke at...

    Incorrect

    • A 35-year-old woman was on a camping holiday in Spain. She awoke at three o’clock one morning with severe neck pain radiating down into her left shoulder and down to her forearm. The next day it spread to the dorsal aspect of the forearm. She was otherwise well. Her symptoms resolved after 24 hours. She noticed that after a week she was unable to wind down the car window with her left arm.
      On examination of the left arm there was wasting of brachioradialis, shoulder, biceps and winging of left scapula.
      What is the diagnosis?

      Your Answer:

      Correct Answer: Amyotrophic neuralgia

      Explanation:

      This patient present with the classical symptoms of Amyotrophic neuralgia, characterised by sudden onset of pain in the shoulders that radiate down to the forearms and later resolve spontaneously but is followed by muscle wasting.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 27 - An 18-year-old woman has been diagnosed with human papillomavirus infection. What is the...

    Incorrect

    • An 18-year-old woman has been diagnosed with human papillomavirus infection. What is the most significant long-term risk following this infection?

      Your Answer:

      Correct Answer: Cervical cancer

      Explanation:

      Human-papilloma virus (HPV) can lead to cervical cancer. There are many different types, but the types associated with cervical cancer most commonly are 16, 18, 31, 33, and 35. The vaccination against HPV protects against the most common types of HPV that are seen in cervical cancer and is recommended for children/young teens. Cervical cancer has a clear association with HPV, making this the best answer over all of the other answer choices.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 28 - A 65-year-old male patient is found to have an elevated serum paraprotein level...

    Incorrect

    • A 65-year-old male patient is found to have an elevated serum paraprotein level of 35g/L. Bone marrow aspirate reveals 32% monoclonal plasma cell infiltrate. He has no evidence of anaemia, renal impairment, hypercalcaemia, or lytic lesions.

      What should be the next step in management?

      Your Answer:

      Correct Answer: Observe and monitor

      Explanation:

      The patient is asymptomatic but matches the diagnostic criteria for multiple myeloma (MM). Therefore, the underlying diagnosis of this condition is smouldering multiple myeloma (SMM). SMM is an early precursor to MM. Its treatment is typically to watch and wait.

      MM is a neoplasm of the bone marrow plasma cells. Peak incidence is in patients aged 60–70 years.

      Clinical features of MM include:
      1. Ostealgia, osteoporosis, pathological fractures (typically vertebral), and osteolytic lesions
      2. Lethargy
      3. Infections
      4. Hypercalcaemia
      5. Renal failure
      6. Other features: amyloidosis e.g. macroglossia, carpal tunnel syndrome; neuropathy; hyperviscosity

      Diagnosis of MM is based on the confirmation of (a) one major criterion and one minor criterion or (b) three minor criteria in an individual who has signs or symptoms of multiple myeloma.

      Major criteria:
      1. >30% plasma cells on bone marrow biopsy
      2. Monoclonal band of paraprotein on electrophoresis: >35g/L for IgG, 20g/L for IgA, or >1g of light chains excreted in the urine per day

      Minor criteria:
      1. 10–30% plasma cells on bone marrow biopsy
      2. Abnormal monoclonal band but levels less than listed above
      3. Lytic bone lesions observed radiographically
      4. Immunosuppression

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 29 - A 67-year-old man presents with anaemia and weight loss. Upon endoscopy, a gastric...

    Incorrect

    • A 67-year-old man presents with anaemia and weight loss. Upon endoscopy, a gastric tumour is revealed, later established as an adenocarcinoma. The patient refuses any treatment and claims that his condition is not influencing the quality of his life. Clinical examination has nothing particularly interesting to show and the patient seems to be conscious of his decision, regardless of the likely curative nature of surgery. What is the single most appropriate management?

      Your Answer:

      Correct Answer: Respect his wishes and book a follow-up appointment for four weeks

      Explanation:

      The patient seems to be conscious about his decision, which should be respected. According to Mental Capacity Act 2005, a person who makes an unwise decision should not be treated as unable to make a decision.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 30 - A number of tests have been ordered for a 49 year old male...

    Incorrect

    • A number of tests have been ordered for a 49 year old male who has systemic lupus erythematosus (SLE). He was referred to the clinic because he has increased shortness of breath. One test in particular is transfer factor of the lung for carbon monoxide (TLCO), which is elevated. Which respiratory complication of SLE is associated with this finding?

      Your Answer:

      Correct Answer: Alveolar haemorrhage

      Explanation:

      Alveolar haemorrhage (AH) is a rare, but serious manifestation of SLE. It may occur early or late in disease evolution. Extrapulmonary disease may be minimal and may be masked in patients who are already receiving immunosuppressants for other symptoms of SLE.

      DLCO or TLCO (diffusing capacity or transfer factor of the lung for carbon monoxide (CO)) is the extent to which oxygen passes from the air sacs of the lungs into the blood.
      Factors that can increase the DLCO include polycythaemia, asthma (can also have normal DLCO) and increased pulmonary blood volume as occurs in exercise. Other factors are left to right intracardiac shunting, mild left heart failure (increased blood volume) and alveolar haemorrhage (increased blood available for which CO does not have to cross a barrier to enter).

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 31 - A 22-year-old female comes to you for counselling regarding the initiation of combined...

    Incorrect

    • A 22-year-old female comes to you for counselling regarding the initiation of combined oral contraceptive pill.
      Which of the following statements is correct?

      Your Answer:

      Correct Answer: She will still be protected against pregnancy if she takes amoxicillin for a lower respiratory tract infection while on the combined pill

      Explanation:

      The true statement among the given options is that she will still be protected against pregnancy if she takes amoxicillin for a lower respiratory tract infection while on the combined pill.

      Other than enzyme-inducing antibiotics such as rifampicin, antibiotics do not reduce the efficacy of the combined oral contraceptive pill.

      It was previously advised that barrier methods of contraception should be used if taking an antibiotic while using the contraceptive pill, due to concerns that antibiotics might reduce the absorption of the pill. This is now known to be untrue. However, if the absorptive ability of the gut is compromised for another reason, such as severe diarrhoea or vomiting, or bowel disease, this may affect the efficacy of the pill.

      The exception to the antibiotic rule is that hepatic enzyme-inducing antibiotics such as rifampicin and rifaximin do reduce the efficacy of the pill. Other enzyme-inducing drugs, such as phenytoin, phenobarbital, carbamazepine or St John’s Wort can also reduce the effectiveness of the pill.

      Other options:
      The combined pill is often prescribed for women with heavy periods as it can make them lighter and less painful.
      There is no evidence that women on the combined pill put on any significant weight, although they may experience bloating at certain times in the course.
      Women on the pill require monitoring of their blood pressure.
      There are multiple different types of combined pills.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 32 - A 25-year-old obese woman is diagnosed with polycystic ovarian syndrome (PCOS). Which of...

    Incorrect

    • A 25-year-old obese woman is diagnosed with polycystic ovarian syndrome (PCOS). Which of the following findings is most consistently seen in PCOS?

      Your Answer:

      Correct Answer: Ovarian cysts on ultrasound

      Explanation:

      The diagnosis of polycystic ovarian syndrome (PCOS) is based on hyperandrogenism or chronic anovulation in the absence of specific pituitary and/or adrenal disease.
      Pelvic ultrasonography may be very helpful in the evaluation as well, but polycystic ovaries are not specific for PCOS with over 20% of “normal” women having this finding. The number of follicles and ovary volume are both important in the ultrasound evaluation. The criteria for PCOS put forth by Adams et al. are the most often cited: the presence of ≥10 cysts measuring 2–8 mm around a dense core of stroma or scattered within an increased amount of stroma.
      A recent proposal to modify these criteria has been put forth by Jonard et al.: “increased ovarian area (>5.5cm2) or volume (>11 mL) and/or presence of ≥12 follicles measuring 2 to 9 mm in diameter (mean of both ovaries)”.
      These criteria have a specificity of 99% and a sensitivity of 75% for the diagnosis of PCOS.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 33 - A 65-year-old man presents to you three weeks after initiating metformin for type...

    Incorrect

    • A 65-year-old man presents to you three weeks after initiating metformin for type 2 diabetes mellitus. His body mass index is 27.5 kg/m^2. At a dose of 500mg TDS the patient has experienced significant diarrhoea. Even on reducing the dose to 500mg BD his symptoms persisted. What is the most appropriate next step in this patient?

      Your Answer:

      Correct Answer: Start modified release metformin 500mg od with evening meal

      Explanation:

      Here, the patient seems to be intolerant to standard metformin. In such cases, modified-release preparations is considered as the most appropriate next step.
      There is some evidence that these produce fewer gastrointestinal side-effects in patients intolerant of standard-release metformin.

      Metformin is a biguanide and reduces blood glucose levels by decreasing the production of glucose in the liver, decreasing intestinal absorption and increasing insulin sensitivity.
      Metformin decreases both the basal and postprandial blood glucose.
      Other uses: In Polycystic Ovarian Syndrome (PCOS), Metformin decreases insulin levels, which then decreases luteinizing hormone and androgen levels. Thus acting to normalize the menstruation cycle.

      Note:
      Metformin is contraindicated in patients with severe renal dysfunction, which is defined as a glomerular filtration rate (GFR) less than 30 ml/min/1.732m2.
      Metformin overdose has been associated with hypoglycaemia and lactic acidosis, for this reason, it has a black box warning for lactic acidosis.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 34 - A 55-year-old diabetic male presents with a feeling of generally being unwell. He...

    Incorrect

    • A 55-year-old diabetic male presents with a feeling of generally being unwell. He also has a history of atrial fibrillation and epilepsy. His main complaint is a blue tinge to his vision. Which one of his medications is most likely to be responsible?

      Your Answer:

      Correct Answer: Sildenafil

      Explanation:

      Blue tinge of vision/cyanopsia is caused due to the intake of sildenafil citrate.

      Sildenafil citrate (Viagra) is the first oral drug to be widely approved for the treatment of erectile dysfunction.
      It is a potent and selective inhibitor of type-V phosphodiesterase, the primary form of the enzyme found in human penile erectile tissue, thereby preventing the breakdown of cyclic guanosine monophosphate (cGMP), the intracellular second messenger of nitric oxide.

      Uses:
      It is used for the treatment of erectile dysfunction, idiopathic pulmonary hypertension, premature ejaculation, high altitude illness, penile rehabilitation after radical prostatectomy, angina pectoris, and lower urinary tract symptoms.

      Adverse effects:
      Mild headache, flushing, dyspepsia, cyanopsia, back pain, and myalgias – due to a high concentration of PDE11 enzyme in skeletal muscle, which shows significant cross-reactivity with the use of tadalafil.
      It can also cause hypotension, dizziness, and rhinitis.

      Note: Xanthopsia (yellow-green vision) may occur secondary to treatment with digoxin.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 35 - A 80 yr. old male was found on the floor. His blood pressure...

    Incorrect

    • A 80 yr. old male was found on the floor. His blood pressure was 100/60 mmHg. His core temperature was 31ºC. His FBC and serum electrolytes were within normal limits. Which of the following would be found in his ECG?

      Your Answer:

      Correct Answer: Long QT interval

      Explanation:

      Hypothermia is defined as a core body temperature of < 35 °C.
      Hypothermia may produce the following ECG changes:
      -Bradyarrhythmia
      -Osborne Waves (= J waves)
      -Prolonged PR, QRS and QT intervals
      -Shivering artefact
      -Ventricular ectopics
      -Cardiac arrest due to VT, VF or asystole

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 36 - A 21 year-old male, who is a known alcoholic, presents with a fever,...

    Incorrect

    • A 21 year-old male, who is a known alcoholic, presents with a fever, haemoptysis, green sputum and an effusion clinically. There is concern that it may be an empyema.
       
      Which test would be most useful to resolve the suspicion?

      Your Answer:

      Correct Answer: Pleural fluid pH

      Explanation:

      If a pleural effusion is present, a diagnostic thoracentesis may be performed and analysed for pH, lactate dehydrogenase, glucose levels, specific gravity, and cell count with differential. Pleural fluid may also be sent for Gram stain, culture, and sensitivity. Acid-fast bacillus testing may also be considered and the fluid may be sent for cytology if cancer is suspected.

      The following findings are suggestive of an empyema or parapneumonic effusion that will likely need a chest tube or pigtail catheter for complete resolution:
      -Grossly purulent pleural fluid
      -pH level less than 7.2
      -WBC count greater than 50,000 cells/µL (or polymorphonuclear leukocyte count of 1,000 IU/dL)
      -Glucose level less than 60 mg/dL
      -Lactate dehydrogenase level greater than 1,000 IU/mL
      -Positive pleural fluid culture

      The most often used golden criteria for empyema are pleural effusion with macroscopic presence of pus, a positive Gram stain or culture of pleural fluid, or a pleural fluid pH under 7.2 with normal peripheral blood ph.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 37 - Which of the following is not associated with right axis deviation? ...

    Incorrect

    • Which of the following is not associated with right axis deviation?

      Your Answer:

      Correct Answer: Wolf-Parkinson-White syndrome with right-sided accessory pathway

      Explanation:

      Causes for right axis deviation:
      -Right ventricular hypertrophy and Left posterior fascicular block
      -Lateral myocardial infarction.
      -Acute or chronic lung diseases: Pulmonary embolism, pulmonary hypertension, chronic obstructive pulmonary disease (COPD), cor pulmonale.
      -Congenital heart disease (e.g., dextrocardia, secundum atrial septal defect).
      -Wolff-Parkinson-White syndrome.
      -Ventricular ectopic rhythms (e.g., ventricular tachycardia).

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 38 - A 30 yr. old male was brought in with a history of a...

    Incorrect

    • A 30 yr. old male was brought in with a history of a stab injury to left chest. He was complaining of chest pain. On examination he was tachycardic, hypotensive and had an elevated JVP, pulsus paradoxus and muffled heart sounds. Respiratory examination was unremarkable. Which of the following is most probable diagnosis?

      Your Answer:

      Correct Answer: Cardiac tamponade

      Explanation:

      Becks triad (hypotension, elevated systemic venous pressure, often with jugular venous distention and muffled heart sounds) is a characteristic collection of clinical findings found in cardiac tamponade. Pulsus paradoxus is also associated with it. The history and clinical findings in this scenario are compatible with the diagnosis of cardica tamponade. The normal respiratory examination excludes tension pneumothorax.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 39 - A 65-year-old man with a history of type 2 diabetes comes to the...

    Incorrect

    • A 65-year-old man with a history of type 2 diabetes comes to the clinic for review. His HbA1c is elevated at 64 mmol/mol despite taking 1g of metformin BD. On examination, his blood pressure is 142/88 mmHg, his pulse is 82 beats per minute and regular. His BMI is 33 kg/m². A decision is made to start him on dapagliflozin. Which of the following would you expect on starting therapy?

      Your Answer:

      Correct Answer: Increased total cholesterol

      Explanation:

      Dapagliflozin works by inhibiting sodium glucose cotransporter 2 (SGLT2) and blocking resorption of glucose in the kidney, leading to an increase in urinary glucose excretion and lowering of both plasma glucose levels and body weight.
      All studies with SGLT2 inhibitors have found significant reductions in BP, with greater reductions seen in systolic (1.66 to 6.9mmHg) than diastolic (0.88 to 3.5mmHg) BP.
      While some trials have shown no change in lipid parameters, others have shown a modest but statistically significant increase in both HDL and LDL cholesterol with no effect on triglycerides or the LDL/HDL ratio.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 40 - A 45-year-old male patient came to the OPD with a complaint of severe...

    Incorrect

    • A 45-year-old male patient came to the OPD with a complaint of severe headache on the right side, with right-sided jaw pain, and additional blurred vision in the right eye. The headache was throbbing in character. Which investigation will you prefer next?

      Your Answer:

      Correct Answer: Erythrocyte sedimentation rate (ESR)

      Explanation:

      Age of the patient, headache only on one side, and loss of vision on that side suggest temporal arteritis, also known as giant cell arteritis. The laboratory hallmark of this condition is a raised ESR.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 41 - A 36 year old female who has been suffering from depression for the...

    Incorrect

    • A 36 year old female who has been suffering from depression for the past 5 years was recently admitted to the psychiatric intensive care unit. She is currently being managed on Sertraline. In clinic she was observed to be sitting in a fixed position for several hours, awake but unable to move. What would be an appropriate treatment for this patient?

      Your Answer:

      Correct Answer: ECT

      Explanation:

      Catatonia is a state of apparent unresponsiveness to external stimuli and apparent inability to move normally in a person who is apparently awake. Catatonia can be acute and occur in severely ill patients with underlying psychiatric or other medical disorders.

      A history of behavioural responses to others usually includes the presence of the following:
      – Mutism (absence of speech)
      – Negativism (performing actions contrary to the commands of the examiner)
      – Echopraxia (repeating the movements of others)
      – Echolalia (repeating the words of others)
      – Waxy flexibility (slight, even resistance to positioning by examiner)
      – Withdrawal (absence of responses to the environment).

      In the presence of a catatonic state, both first and second generation antipsychotics (SGA) may contribute to maintaining or worsening the catatonic state and increase the risk of developing NMS (neuroleptic malignant syndrome).

      Electroconvulsive therapy (ECT) is effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient’s medical condition.

      Electroconvulsive therapy (ECT) is a procedure, done under general anaesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.

    • This question is part of the following fields:

      • Psychiatry
      0
      Seconds
  • Question 42 - A 50 yr. old male presented with acute severe central chest pain and...

    Incorrect

    • A 50 yr. old male presented with acute severe central chest pain and acute ST elevation myocardial infarction was diagnosed. He was treated with streptokinase. 2 days later he was sweating excessively and he was found to be hypotensive. Which of the following cannot be considered as a reason for this presentation?

      Your Answer:

      Correct Answer: Hypotensive effect of streptokinase

      Explanation:

      Hypotensive effect of streptokinase occurs during the streptokinase infusion which is usually transient. Acute mitral regurgitation due to rupture of papillary muscles, ventricular septal defects and reinfarctions (left or right) are known to cause hypotension after 24 hrs. Pulmonary embolism is less likely but cannot be excluded.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 43 - A 69-year-old woman is admitted with confusion. She's known to have a history...

    Incorrect

    • A 69-year-old woman is admitted with confusion. She's known to have a history of multiple myeloma. Blood exam reveals the following: Na+ = 147 mmol/l, K+ = 4.7 mmol/l, Urea = 14.2 mmol/l, Creatinine = 102 μmol/l, Adjusted calcium = 3.9 mmol/l. What is the single most appropriate management?

      Your Answer:

      Correct Answer: IV 0.9% saline

      Explanation:

      NICE guidelines on hypercalcemia recommend that maintaining good hydration equals drinking 3-4 L of fluid/day, provided there are no contraindications. A low calcium diet is not necessary because intestinal absorption of calcium is reduced. The patient should avoid any other drugs or vitamins that could worsen the hypercalcemia. Mobilization is encouraged and any symptoms of hypercalcemia should be reported.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 44 - A 70-year-old male patient presents to the urology clinic with a one-month history...

    Incorrect

    • A 70-year-old male patient presents to the urology clinic with a one-month history of passing frank haematuria. Flexible cystoscopy shows a mass of the bladder wall and biopsy reveals transitional cell carcinoma.

      Out of the following, which industry has he most likely worked in?

      Your Answer:

      Correct Answer: Dyestuffs and pigment manufacture

      Explanation:

      Exposure to aniline dyes is a risk factor for transitional cell carcinoma. Aniline dyes are used in dyestuffs and pigment manufacturing.

      The other aforementioned options are ruled out because:
      1. Feed production may expose to aflatoxin (hepatocellular carcinoma).

      2. Being a military personnel may expose to mustard gas (lung cancer).

      3. Rubber industry may expose to nitrosamines (oesophageal and gastric cancer).

      4. Refrigerant production before 1974 may expose to vinyl chloride (hepatic angiosarcoma).

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 45 - A 67 year-old attorney presents with a 2 month history of tremors affecting...

    Incorrect

    • A 67 year-old attorney presents with a 2 month history of tremors affecting his left arm. He suffers from depressive psychosis for the last 10 years, for which he has been receiving intermittent chlorpromazine and amitriptyline but has not been on any therapy for the last 4 months. He describes that his two brothers also had tremors. Upon examination, he has a resting tremor of his left hand with cogwheel rigidity of that arm and mild generalized bradykinesia. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Idiopathic Parkinson’s disease

      Explanation:

      The most likely diagnosis is idiopathic Parkinson’s disease because of the unilateral presentation. In addition, cogwheel rigidity is a classic presenting symptom. Neuroleptic-induced parkinsonism is usually bilateral and symmetrical. Essential tremors do not cause rest tremors.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 46 - A 62-year-old man presents with haematuria. Cystoscopy is carried out which reveals transitional...

    Incorrect

    • A 62-year-old man presents with haematuria. Cystoscopy is carried out which reveals transitional cell carcinoma of the bladder.

      Occupational exposure to which of the following is a recognised risk factor for bladder cancer?

      Your Answer:

      Correct Answer: Aniline dye

      Explanation:

      The risk factors for bladder cancer are:

      1. Smoking
      2. Exposure to aniline dyes in the printing and textile industry
      3. Exposure to rubber manufacturing
      4. Cyclophosphamides
      5. Schistosomiasis.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 47 - Empagliflozin was found to reduce the risk of cardiovascular deaths, non-fatal myocardial infarction...

    Incorrect

    • Empagliflozin was found to reduce the risk of cardiovascular deaths, non-fatal myocardial infarction and non-fatal stroke when added to standard treatment plans in patients with type 2 diabetes mellitus. This information was shared in 2015 by The New England Journal of Medicine and the results were expressed per 1000 patient years. In fact, empagliflozin had an event rate of 37.3/1000 patient years and placebo an event rate of 43.9/1000 patient years. How many patients who are at high cardiovascular risk need to be treated with empagliflozin to prevent a cardiovascular death, a non-fatal myocardial infarction or a non-fatal stroke?

      Your Answer:

      Correct Answer: 150

      Explanation:

      The number needed to treat (NNT) is an absolute effect measure that has been used to assess beneficial and harmful effects of medical interventions. In this case the NNT can be calculated as follows: NNT = 1/ Absolute risk reduction (ARR). ARR=(Control event rate expressed per 1000 patient years) – (Experimental event rate expressed per 1000 patient years) = 43.9-37.3 = 6.6/1000 patient years

      NNT=(Patient years)/ARR = 1000/ 6.6 = 151.5. The closest to 151.5 is 150, thus it is the correct answer.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 48 - Which of the following would suggest an increase risk of suicide in a...

    Incorrect

    • Which of the following would suggest an increase risk of suicide in a patient with a history of depression?

      Your Answer:

      Correct Answer: History of arm cutting

      Explanation:

      Risk factors specific to depression:
      -Family history of mental disorder.
      -History of previous suicide attempts (this includes self-harm).
      -Severe depression.
      -Anxiety.
      -Feelings of hopelessness.
      -Personality disorder.
      -Alcohol abuse and/or drug abuse.
      -Male gender.

      Protective Factors for Suicide.
      Protective factors buffer individuals from suicidal thoughts and behaviour. To date, protective factors have not been studied as extensively or rigorously as risk factors. Identifying and understanding protective factors are, however, equally as important as researching risk factors.

      Protective Factors:
      -Effective clinical care for mental, physical, and substance abuse disorders
      -Easy access to a variety of clinical interventions and support for help seeking
      -Family and community support (connectedness)
      -Support from ongoing medical and mental health care relationships
      -Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
      -Cultural and religious beliefs that discourage suicide and support instincts for self-preservation

    • This question is part of the following fields:

      • Psychiatry
      0
      Seconds
  • Question 49 - A 50 yr. old male patient was started on amiodarone. Prior to commencement,...

    Incorrect

    • A 50 yr. old male patient was started on amiodarone. Prior to commencement, his blood urea and electrolytes were checked. What is the reason for doing this investigation before starting amiodarone?

      Your Answer:

      Correct Answer: To detect hypokalaemia

      Explanation:

      Any antiarrhythmic drugs can potentially cause arrhythmias. Before starting amiodarone, any electrolyte imbalance including hypokalaemia, hypomagnesemia, or hypocalcaemia should be corrected to prevent any arrhythmias.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 50 - During the examination of an elderly confused and non-coherent gentleman who was brought...

    Incorrect

    • During the examination of an elderly confused and non-coherent gentleman who was brought to casualty by a concerned neighbour, you notice that he has bilaterally small pupils, which do not appear to react to light. Under the circumstances, it is difficult to judge their response to accommodation.
      Which of the following conditions may not account for the pupillary appearance in this patient?

      Your Answer:

      Correct Answer: Acute alcohol intoxication

      Explanation:

      Acute alcohol intoxication presents with pupillary dilation, thus, this is ruled out in this patient. All the other listed causes present with small pupils bilaterally.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 51 - A 43 year-old female artist with no past medical history presents to the...

    Incorrect

    • A 43 year-old female artist with no past medical history presents to the emergency department with a 2-day history of pins and needles in the lower limbs, and progressive walking difficulties. She states she had diarrhoea 1 week ago. On examination, there is a loss of pinprick sensation noted to the lower limbs from mid-thigh distally and in the upper limbs from MCP joints distally. There is bilateral weakness of ankle dorsiflexion, noted at 3/5, and knee flexion and extension weakness, noted at 4/5 bilaterally. Power in upper and lower limbs is otherwise normal. Knee and ankle deep tendon reflexes are absent. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Guillain-Barre syndrome

      Explanation:

      Guillain-Barre syndrome is an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni). Characteristic features include progressive weakness of all four limbs, and it is classically ascending, affecting the lower extremities first. Sensory symptoms tend to be mild.

      Functional neurological syndrome can be discounted due to presence of hard neurological signs. Multiple sclerosis can be excluded because of the presence of lower motor neuron signs and absence of upper motor neuron signs. Chronic inflammatory demyelinating polyneuropathy is the chronic form of Guillain-Barre syndrome.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 52 - A patient who has mild benign prostatic hyperplasia has been advised to take...

    Incorrect

    • A patient who has mild benign prostatic hyperplasia has been advised to take finasteride.
      The mechanism of action of this drug involves inhibition of the production of which of the following androgens?

      Your Answer:

      Correct Answer: Dihydrotestosterone

      Explanation:

      Finasteride inhibits the formation of dihydrotestosterone.
      Finasteride is a 5α-reductase inhibitor and thus, inhibits the conversion of testosterone to dihydrotestosterone (DHT).

      DHT is much more active than testosterone and binds more avidly to cytoplasmic receptors. DHT stimulates prostate growth and may be responsible for benign prostatic hyperplasia in the elderly.

      Thus, finasteride can cause a reduction in prostatic volume and help in managing a patient with benign prostatic hyperplasia.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 53 - How should DVT during pregnancy be managed? ...

    Incorrect

    • How should DVT during pregnancy be managed?

      Your Answer:

      Correct Answer: Dalteparin

      Explanation:

      Deep vein thrombosis (DVT) is a serious condition in which a blood clot forms in a deep vein, usually in the leg.

      Subcutaneous low molecular weight heparin (LMWH) is the preferred treatment for most patients with acute DVT, including in pregnancy. A large meta-analyses comparing LMWH to unfractionated heparin (UFH) showed that LMWH decreased the risk of mortality, recurrent veno-thrombo embolism (VTE), and haemorrhage compared with heparin. Other advantages of LMWH may include more predictable therapeutic response, ease of administration and monitoring, and less heparin-induced thrombocytopenia. Disadvantages of LMWH include cost and longer half-life compared with heparin.

      Warfarin, which is administered orally, is used if long-term anticoagulation is needed. The international normalized ratio (INR) is followed, with a target range of 2-3. Warfarin crosses the placenta and is teratogenic, causing a constellation of anomalies known as warfarin embryopathy, with greatest risk between the sixth and twelfth week of gestation.
      Other options are not indicated for use.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 54 - A 70 year old male presents with an ulcer between his toes -...

    Incorrect

    • A 70 year old male presents with an ulcer between his toes - it has a punched-out appearance. He is known to both smoke and drinks heavily. Upon examination, the ulcer is yellow in colour. His foot also turns red when it hangs from the bed. From the list given, choose the single most likely diagnosis for this patient.

      Your Answer:

      Correct Answer: Arterial ischemia ulcer

      Explanation:

      Arterial ischemia ulcers present with many of the symptoms observed in this patient: ulcer on the lower extremities, pain, swelling, yellow sores, a punched-out appearance, the foot turning red when dangling from a bed. Smoking a lot is also known to be a causative factor here. This type of ulcer develops due to damage to the arteries caused by a lack of blood flow to the tissue – they are also deep wounds. Venous ischemic ulcers usually form in the knee or inner ankle area as opposed to the foot.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 55 - A 19-year-old male presented with a fever and fatigue. On examination, he had...

    Incorrect

    • A 19-year-old male presented with a fever and fatigue. On examination, he had multiple lesions on his back and abdomen in various forms. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Varicella zoster

      Explanation:

      Patients with varicella zoster infection present with general fatigue and fever along with multiple lesions which do not appear to be identical.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 56 - A 35-year-old woman is referred to the acute medical unit with a 5...

    Incorrect

    • A 35-year-old woman is referred to the acute medical unit with a 5 day history of polyarthritis and a low-grade fever.

      Examination reveals shin lesions which the patient states are painful. Chest x-ray shows a bulky mediastinum.

      What is the most appropriate diagnosis?

      Your Answer:

      Correct Answer: Lofgren's syndrome

      Explanation:

      Lofgren’s syndrome is an acute form of sarcoidosis characterized by erythema nodosum, bilateral hilar lymphadenopathy (BHL), and polyarthralgia or polyarthritis. Other symptoms include anterior uveitis, fever, ankle periarthritis, and pulmonary involvement.

      Löfgren syndrome is usually an acute disease with an excellent prognosis, typically resolving spontaneously from 6-8 weeks to up to 2 years after onset. Pulmonologists, ophthalmologists, and rheumatologists often define this syndrome differently, describing varying combinations of arthritis, arthralgia, uveitis, erythema nodosum, hilar adenopathy, and/or other clinical findings.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 57 - 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 58 - Which of the following is suggestive of co-existence of mitral regurgitation and mitral...

    Incorrect

    • Which of the following is suggestive of co-existence of mitral regurgitation and mitral stenosis?

      Your Answer:

      Correct Answer: Displaced apex beat

      Explanation:

      Apex beat displacement is caused by mitral regurgitation and because it is not found in mitral stenosis, it is suggestive of mixed mitral disease. The other given responses occur in mitral stenosis.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 59 - A 25-year-old man presents with bloody diarrhoea associated with systemic upset. Blood tests...

    Incorrect

    • A 25-year-old man presents with bloody diarrhoea associated with systemic upset. Blood tests show the following:


      Hb 13.4 g/dL,
      Platelets 467 * 109/L,
      WBC 8.2 * 109/L,
      CRP 89 mg/l

      A diagnosis of ulcerative colitis is suspected. Which part of the bowel is most likely to be affected?

      Your Answer:

      Correct Answer: Rectum

      Explanation:

      The most COMMON site of inflammation from ulcerative colitis is the rectum, making this the correct answer. This is simply a fact you need to memorize. In general, ulcerative colitis only occurs in colorectal regions– nothing in the small bowel (unless there is backwash into the terminal ileum) and nothing further up the GI tract. In Crohn’s it can affect the entire GI tract from mouth to anus.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 60 - A 20-year-old woman presents for review. She is concerned due to absence of...

    Incorrect

    • A 20-year-old woman presents for review. She is concerned due to absence of menstruation for 5 months.
      She is 1.76 m in height and weighs only 43.7 kg (7 stone).
      A pregnancy test is negative and thyroid function testing is normal.

      Which of the following is the diagnosis of this case?

      Your Answer:

      Correct Answer: Weight-related amenorrhoea

      Explanation:

      Low body weight. Excessively low body weight — about 10 percent under normal weight — interrupts many hormonal functions in your body, potentially halting ovulation.
      In Polycystic ovaries there is excess weight gain.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Passmed