00
Correct
00
Incorrect
00 : 00 : 0 00
Session Time
-- : --
Average Question Time ( Secs)
Retry this test Dashboard

  • Question 1 - An 82 year old man arrives at the clinic with painful right upper...

    Incorrect

    • An 82 year old man arrives at the clinic with painful right upper arm that he has been experiencing for the last few months. The pain is gradually worsening and often wakes him up at night. He is a known case of Paget's disease involving his lumbar spine and pelvis and is currently taking oral bisphosphonates. On examination, shoulder movements are intact. Which of the following is the most likely cause of his arm pain?

      Your Answer:

      Correct Answer: Osteosarcoma

      Explanation:

      Paget’s accelerates the remodelling process with old bone breaking down more quickly which disrupts the normal growth process. New bone development eventually adjusts to the faster pace and speeds up on its own. The pace is too fast for healthy bone growth, and the regrowth ends up softer and weaker than normal. The effect of this accelerated process causes bone pain, fractures, and deformities. Since osteosarcoma is a type of bone cancer linked to abnormal bone growth, this makes it a rare but possible complication of Paget’s disease although the chances of developing osteosarcoma are minimal. Fractures are painful and restrict movement whereas this patients pain is gradually developing. Pain associated with osteoarthritis is usually mild to moderate and worsens as the day progresses.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds

  • Question 2 - A 45-year-old man who had a liver transplant just over 3 months ago,...

    Incorrect

    • A 45-year-old man who had a liver transplant just over 3 months ago, now has primary sclerosing cholangitis. He complains of fever, abdominal pain and diarrhoea, which has come on over the last week. He has a platelet count of 60 x 109/L and alanine transaminase (ALT) of 300 U/L with a normal bilirubin.

      He is taking tacrolimus and prednisolone for immunosuppression, and tells you that he recently stopped taking valganciclovir.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Donor-acquired cytomegalovirus

      Explanation:

      The fact that he has recently stopped taking his valganciclovir, anti-viral, is key to the answer to this question. This makes the answer quite plainly donor-acquired CMV infection over all of the other answer choices. He needs to stay on prophylaxis against this, particularly in the first 3 months after transplant. Symptoms and presentations of CMV infection can include fever, abdominal pain, diarrhoea, pneumonitis, hepatitis, hematologic abnormalities, retinitis, and esophagitis.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 3 - A 60-year-old man with type 1 diabetes is brought to the clinic with...

    Incorrect

    • A 60-year-old man with type 1 diabetes is brought to the clinic with his wife. He is limping and his wife noticed that his ankle was abnormally-shaped after he stepped out of the shower.

      Examination of his right ankle reveals a painless warm swollen joint.
      There is crepitus and what appears to be palpable bone debris. X-ray reveals gross joint destruction and apparent dislocation. Joint aspiration fluid shows no microbes.

      Investigations:
      His CRP and white count are of normal values.
      Historical review of HB A1c reveals that it has rarely been below 9%.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Charcot’s ankle

      Explanation:

      Charcot arthropathy is a progressive condition of the musculoskeletal system that is characterized by joint dislocations, pathologic fractures, and debilitating deformities. It results in progressive destruction of bone and soft tissues at weight-bearing joints. In its most severe form, it may cause significant disruption of the bony architecture.
      Charcot arthropathy can occur at any joint; however, it occurs most commonly in the lower extremity, at the foot and ankle. Diabetes is now considered to be the most common aetiology of Charcot arthropathy.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

  • Question 4 - A 50 yr. old male with a history of type II diabetes mellitus...

    Incorrect

    • A 50 yr. old male with a history of type II diabetes mellitus and hypertension presented with exertional dyspnoea and chest pain for 2 weeks. On examination his blood pressure was 145/80 mmHg. On auscultation reversed splitting of the second heart sound and bibasal crepitations were detected. What would be the most likely finding on his ECG?

      Your Answer:

      Correct Answer: Left bundle branch block

      Explanation:

      When closure of the pulmonary valve occurs before the aortic valve, reversed splitting occurs. The causes of reversed splitting are aortic stenosis, hypertrophic cardiomyopathy, left bundle branch block (LBBB), and a ventricular pacemaker.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 5 - A 50-year-old man is found incidentally to have hypercalcaemia during a routine health...

    Incorrect

    • A 50-year-old man is found incidentally to have hypercalcaemia during a routine health screen.
      Which one of the following biochemical findings would be most suggestive of primary hyperparathyroidism rather than any other cause of hypercalcaemia?

      Your Answer:

      Correct Answer: Serum PTH concentration within the normal range

      Explanation:

      Primary hyperparathyroidism (PHPT) is diagnosed based upon levels of blood calcium and parathyroid hormone (PTH). In most people with PHPT, both levels are higher than normal. Occasionally, a person may have an elevated calcium level and a normal or minimally elevated PTH level. Since PTH should normally be low when calcium is elevated, a minimally elevated PTH is considered abnormal and indicates PHPT.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

  • Question 6 - A 30-year-old woman presents with amenorrhoea and galactorrhoea. She has normal visual fields....

    Incorrect

    • A 30-year-old woman presents with amenorrhoea and galactorrhoea. She has normal visual fields. You are concerned that she may have a prolactinoma.
      Investigations were done and the results are as shown below:

      Hb 12.5 g/dL,
      WCC 4.9 x109/L,
      PLT 199 x109/L,
      Na+ 140 mmol/L,
      K+ 4.9 mmol/L,
      Creatinine 90 ىmol/L,
      Prolactin 1150 mU/l.

      MRI shows a 7 mm pituitary microadenoma.

      Which of the following hormones would you expect to be lower than normal?

      Your Answer:

      Correct Answer: LH

      Explanation:

      Prolactinomas, benign lesions that produce the hormone prolactin, are the most common hormone-secreting pituitary tumours.
      Based on its size, a prolactinoma can be classified as a microprolactinoma (< 10 mm diameter) or a macroprolactinoma (>10 mm diameter). If the prolactinoma is large enough to compress the surrounding normal hormone-secreting pituitary cells, it may result in deficiencies of one or more hormones (e.g., thyroid-stimulating hormone [TSH], growth hormone [GH], adrenocorticotropic hormone). However, the patient has microadenoma so it is unlikely to cause compression manifestations.
      Hyperprolactinemia inhibits GnRH secretion from the medial basal hypothalamus and LH release from the pituitary.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

  • Question 7 - A 32 yr. old primigravida in her 37th week of pregnancy was admitted...

    Incorrect

    • A 32 yr. old primigravida in her 37th week of pregnancy was admitted for the management of pre-eclampsia. Her blood pressure was 180/110 mmHg and urine protein was +++. Magnesium sulphate was started. Which of the following are important parameters that should be monitored during the administration of magnesium sulphate?

      Your Answer:

      Correct Answer: Reflexes + respiratory rate

      Explanation:

      The clinical effect and toxicity of MgSO4 can be linked to its concentration in plasma. A concentration of 1.8 to 3.0 mmol/L has been suggested for treatment of eclamptic convulsions. Maternal toxicity is rare when MgSO4 is carefully administered and monitored. The first warning of impending toxicity in the mother is loss of the patellar reflex at plasma concentrations between 3.5 and 5 mmol/L. Respiratory paralysis occurs at 5 to 6.5 mmol/L. Cardiac conduction is altered at greater than 7.5 mmol/L, and cardiac arrest can be expected when concentrations of magnesium exceed 12.5 mmol/L. Careful attention to the monitoring guidelines can prevent toxicity. Deep tendon reflexes, respiratory rate, urine output and serum concentrations are the most commonly monitored parameters.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 8 - A 54 yr. old heavy smoker presented with acute chest pain for 3...

    Incorrect

    • A 54 yr. old heavy smoker presented with acute chest pain for 3 hrs which associated with excessive sweating and vomiting. His past medical history was unremarkable but his father has passed away due to a heart attack at the age of 50. Examination findings were normal and ECG was also normal. He was pain free after 12 hours from admission. What is the most appropriate investigation that cab be done at this moment?

      Your Answer:

      Correct Answer: Troponin T

      Explanation:

      The positive family history and the smoking make him an ideal candidate for a myocardial infarction. The chest pain is also a suggestive symptom. So troponin is needed to rule out MI.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 9 - A 38-year-old woman has been reviewed in the hypertension clinic. Abdominal ultrasound scanning...

    Incorrect

    • A 38-year-old woman has been reviewed in the hypertension clinic. Abdominal ultrasound scanning reveals that her left kidney is much smaller than her right kidney.
       
      You suspect renal artery stenosis, as her GP noticed a deteriorating serum creatinine concentration within 1 month of starting ACE inhibitor therapy.
       
      What is the most appropriate next investigation?

      Your Answer:

      Correct Answer: Magnetic resonance angiography

      Explanation:

      MRA is next appropriate management for this case. It is non-invasive and has been shown to correlate with angiographic appearance. Although Renal arteriography is considered gold standard, it is invasive, so a non-invasive option is preferred as first line of investigation in this case.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds

  • Question 10 - A 33-year-old woman has missed her last two periods and has been lactating....

    Incorrect

    • A 33-year-old woman has missed her last two periods and has been lactating. Upon anamnesis, she claims she's lost weight and she's been suffering from vaginal dryness. The endocrinologist suggests that she checks her prolactin levels. Which of the following inhibits prolactin release from the hypophysis?

      Your Answer:

      Correct Answer: Dopamine

      Explanation:

      Dopamine (DA) holds a predominant role in the regulation of prolactin (PRL) secretion. Through a direct effect on anterior pituitary lactotrophs, DA inhibits the basally high-secretory tone of the cell. It accomplishes this by binding to D2 receptors expressed on the cell membrane of the lactotroph, activation of which results in a reduction of PRL exocytosis and gene expression by a variety of intracellular signalling mechanisms.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds

  • Question 11 - A 71-year-old woman with a medical history of a blood transfusion in the...

    Incorrect

    • A 71-year-old woman with a medical history of a blood transfusion in the early 1980s presents with a 10 month history of malaise and is noted to have impaired renal function. Her urine sediment reveals red cell casts.

      The results of immunological investigations are as follows: serum IgG 6.5 g/L (normal range 6-13), IgA 1.5 g/L (normal range 0.8-4.0), IgM 5.7 g/L (normal range 0.4-2.0), serum electrophoresis shows a faint band in the gamma region, complement C3 1.02 g/L (normal range 0.75-1.65), complement C4 <0.02 g/L (normal range 0.20-0.65), and rheumatoid factor 894 IU/L (normal range <40).

      Which of the following investigations is likely to be most important in making a definitive diagnosis?

      Your Answer:

      Correct Answer: Cryoglobulins

      Explanation:

      The patient’s history of a blood transfusion and lab results showing a markedly low C4 (with normal C3), elevated rheumatoid factor, and elevated serum IgM is highly suggestive of hepatitis C-associated cryoglobulinaemic vasculitis. Testing for Cryoglobulins will confirm this suspicion.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds

  • Question 12 - Which one of the following features is most helpful in distinguishing beta thalassaemia...

    Incorrect

    • Which one of the following features is most helpful in distinguishing beta thalassaemia trait from iron deficiency anaemia?

      Your Answer:

      Correct Answer: Haemoglobin A2 levels

      Explanation:

      Elevated haemoglobin A2 level is seen in beta thalassaemia trait, whereas, it is typically low in iron deficiency anaemia unless the patient has received a recent blood transfusion.

      Low mean corpuscular volume (MCV) and reduced haematocrit (Ht) are encountered in both conditions. Peripheral blood smear is grossly abnormal in both beta thalassaemia and severe iron deficiency anaemia, showing bizarre morphology, target cells, and a small number of nucleated red blood cells.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 13 - A 75-year-old woman experiences weakness of her left hand. Clinical examination reveals wasting...

    Incorrect

    • A 75-year-old woman experiences weakness of her left hand. Clinical examination reveals wasting of the hypothenar eminence and weakness of finger abduction and thumb adduction. The lesion is most probably located at:

      Your Answer:

      Correct Answer: Ulnar nerve

      Explanation:

      Patients with compressive neuropathy of the ulnar nerve typically describe numbness and tingling of the ulnar-sided digits of the hand, classically in the small finger and ulnar aspect of the ring finger. Among the general population, symptoms usually begin intermittently and are often worse at night, particularly if the elbow is flexed while sleeping. As the disease progresses, paraesthesia may occur more frequently and during the daytime.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds

  • Question 14 - A 27-year-old woman is admitted on the medical intake. She is 10 weeks...

    Incorrect

    • A 27-year-old woman is admitted on the medical intake. She is 10 weeks postpartum and has been generally unwell for two weeks with malaise, sweating and anxiety.
      On examination, she is haemodynamically stable and clinically euthyroid.
      TFTs show the following:
      Free T4 33 pmol/L (9-23),
      Free T3 8 nmol/L (3.5-6),
      TSH <0.02 mU/L (0.5-5).

      What is the appropriate management?

      Your Answer:

      Correct Answer: Propranolol 20 mg tds

      Explanation:

      The patient is most likely to have Postpartum thyroiditis which goes through 2 phases; hypothyroid and a hyperthyroid phase.
      The hyperthyroid phase of postpartum thyroiditis occurs between 2 and 10 months postpartum. Most commonly, it presents at 3 months. Symptoms more common in women with hyperthyroid postpartum thyroiditis include palpitations, fatigue, heat intolerance, and irritability/nervousness. The frequency of asymptomatic hyperthyroidism is 33%.
      Untreated, the hyperthyroidism resolves spontaneously within 2–3 months. This phase is diagnosed by the combination of a low serum TSH concentration in the presence of thyroid peroxidase antibodies, in women who are TSH receptor antibody-negative. Free T4 levels are typically elevated but may be normal.
      Treatment of hyperthyroidism, when necessary, is based on symptom severity and should be a joint decision of patient and physician. Beta-blockers such as propranolol are given to alleviate palpitations, irritability, and nervousness. The morbidity associated with treatment is the side effects of beta-blockade. The downside of withholding treatment is allowing the woman to remain symptomatic. Antithyroid medicines (thioureas) are not a potential treatment alternative, because the hyperthyroidism is caused by destructive thyroiditis resulting in the release of preformed thyroid hormone.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

  • Question 15 - A 40-year-old male patient, who is otherwise healthy and without a significant family...

    Incorrect

    • A 40-year-old male patient, who is otherwise healthy and without a significant family history, presents with a history of early morning headache and visual field defects, When asked, he said that he has been having these complaints for three months now. What is the most possible diagnosis?

      Your Answer:

      Correct Answer: Pituitary tumour

      Explanation:

      The most possible diagnosis is a pituitary tumour. Pituitary tumours compress the optic chiasm inferiorly and can cause visual field defects (bitemporal hemianopia or quadrantanopia). Temporal arteritis usually develops in older people and acute glaucoma usually requires a family history. Amaurosis fugax is classed as a stroke and usually leads to reversible unilateral vision loss. A subconjunctival haemorrhage does not typically produce the symptoms described.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 16 - A 60 yr. old male with no past medical history presented to Casualty...

    Incorrect

    • A 60 yr. old male with no past medical history presented to Casualty with acute chest pain. ST elevation myocardial infarction (STEMI) is diagnosed following an ECG on arrival. He was subsequently successfully thrombolysed. Which of the following combinations of drugs is the most suitable combination for him to be taking 4 weeks after his STEMI?

      Your Answer:

      Correct Answer: ACE inhibitor + beta-blocker + statin + aspirin + clopidogrel

      Explanation:

      According to NICE guidelines (2013) all people who have had an acute MI, treatment should be offered with ACE inhibitor, dual antiplatelet therapy (aspirin plus a second antiplatelet agent), beta-blocker and a statin.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 17 - An 84-year-old retired police officer presents to the neurology clinic with double vision...

    Incorrect

    • An 84-year-old retired police officer presents to the neurology clinic with double vision and unsteadiness whilst walking. He has a past medical history of hypertension, hypercholesterolemia and type 2 diabetes. On examination, you notice a right partial ptosis and miosis. The patient also has notable right facial loss of pain and temperature sensation with left sided truncal sensory loss contralateral to the face. In the clinic, apraclonidine eye drops are added to the affected eye, which causes a dilatation, whilst in the opposite eye, a pupil constriction occurs. After the eye drops have been eliminated from the body, 1% hydroxyamphetamine eye drops are then instilled. One hour after instillation, both pupils dilate.

      Which order of neurons is most likely affected in the sympathetic pathway?

      Your Answer:

      Correct Answer: First order

      Explanation:

      Apraclonidine eye drops are initially used to confirm a Horner’s pupil. Apraclonidine stimulates both alpha-1 and alpha-2 receptors. When added to the affected eye, it causes pupil dilation by >2mm because of the relative super sensitivity of this pupil to alpha-1 receptor activity. In a normal pupil, however, it causes constriction due to the more potent activity at the alpha-2 receptor which triggers re-uptake of noradrenaline in the synaptic cleft.

      Hydroxy amphetamine is then used to distinguish between first/second or third order neurones. In other words, it will distinguish either a lesion in the brainstem, cervical cord, chest or neck and one affecting above the superior cervical ganglion at the carotid bifurcation. In a normal pupil or a first/second order Horner’s, the pupil will dilate secondary to increased levels of noradrenaline released from the post-synaptic neurones. In a third order neurone, this will not occur. There is no fourth or fifth order neurone.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds

  • Question 18 - 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 19 - 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 20 - From which cells is somatostatin secreted? ...

    Incorrect

    • From which cells is somatostatin secreted?

      Your Answer:

      Correct Answer: D cells in the pancreas

      Explanation:

      The somatostatin-secreting D-cells comprise ,5% of the cells of the pancreatic islets. The D-cells have a complex morphology and may, via cellular process, interact with many more islet cells than suggested by their low number. D-cells are equipped with ATP-sensitive potassium channels (KATP channels).

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds

  • Question 21 - A 55 yr. old man presented with retrosternal chest pain associated with excessive...

    Incorrect

    • A 55 yr. old man presented with retrosternal chest pain associated with excessive sweating and vomiting. On examination his BP was 100/60 mmHg and pulse rate was 72 bpm. Bibasal crepitations were auscultated. His ECG showed ST elevation in V1 to V4 and ST depression in leads II, III and aVF. Which of the following would be the finding during angioplasty?

      Your Answer:

      Correct Answer: Complete occlusion of the left anterior descending artery

      Explanation:

      The ECG findings are suggestive of anterior myocardial infarction and the most likely artery affected is the left anterior descending artery. Occlusion of the right coronary artery will be shown by ST elevation in lead II, III, aVF and occlusion of the circumflex artery will show changes in leads I, aVL, V5 and V6. To have ST elevation, there should be complete occlusion of the artery.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

  • Question 22 - A 61-year-old gentleman presents with heart failure and pedal oedema. The oedema occurs...

    Incorrect

    • A 61-year-old gentleman presents with heart failure and pedal oedema. The oedema occurs due to:

      Your Answer:

      Correct Answer: Increased release of renin

      Explanation:

      The oedema is an effect of the a decreased cardiac output that increases renin release which leads to vasoconstriction and sodium and water retention.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds

  • Question 23 - 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 24 - A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and...

    Incorrect

    • A 28-year-old woman presents with intermittent episodes of diarrhoea, constipation, abdominal bloating and flatulence. Clinical examination is unremarkable. Faecal occult bloods are negative and haematological and biochemical investigations are unremarkable.

      Which of the following is the next most appropriate management step?

      Your Answer:

      Correct Answer: Trial of dairy-free diet

      Explanation:

      The best next step is to try a dairy-free diet, many patients may develop this in their lifetime. IBS is a diagnosis of exclusion, and one would need to rule lactose intolerance out as a potential aetiology first. She is only 28, and without overt bleeding or signs/sxs/labs suggestive of obstruction or inflammation; colonoscopy, flex sig and a barium enema are not indicated.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 25 - A 32 year-old man presents with his first generalized tonic-clonic seizure (GTCS). He...

    Incorrect

    • A 32 year-old man presents with his first generalized tonic-clonic seizure (GTCS). He has been complaining of headaches for the past 2 weeks, although he has been able to continue working at his job. Upon examination, he has mild left hemiparesis and bilateral extensor plantar responses. General examination is otherwise unremarkable. An urgent CT scan of the brain shows a 5cm multicentric mass lesion in the right frontal lobe with surrounding vasogenic oedema and some hemisphere shift. Which of the following is the most likely underlying pathology?

      Your Answer:

      Correct Answer: Glioblastoma

      Explanation:

      Glioblastoma multiforme, also considered as grade IV astrocytoma, is the most malignant form of the tumour and accounts for about 20% of all cerebral tumours. These often remain clinically silent until they have reached a large enough size. In adults, glioblastoma multiforme usually occurs in the cerebral hemispheres, especially the frontal and temporal lobes of the brain. About half occupy more than one hemisphere at presentation, and some are multicentric. Biopsy shows high cellularity with mitoses, pleomorphism, and vascular hyperplasia. Prognosis is extremely poor, with only 20% surviving beyond 1 year and 10% beyond 2 years.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds

  • Question 26 - A 63-year-old gentleman presents with left-sided eye pain and diplopia for the past...

    Incorrect

    • A 63-year-old gentleman presents with left-sided eye pain and diplopia for the past 2 days. Examination of his eyes shows his pupils equal and reactive to light with no proptosis. There is however an apparent palsy of the 6th cranial nerve associated with a partial 3rd nerve palsy on the left side. Examining the remaining cranial demonstrates hyperaesthesia of the upper face on the left side. Where is the likely lesion?

      Your Answer:

      Correct Answer: Cavernous sinus

      Explanation:

      A lesion on the cavernous sinus would explain the palsy observed on the III and VI cranial nerves because the cranial nerves III, IV, V, and VI pass through the cavernous sinus. Pain in the eye is due to the nearby ophthalmic veins that feeds the cavernous sinus. Additionally, the lesions in the other structures would have presented with pupil abnormalities and less localized pain and symptoms.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds

  • Question 27 - A 23 year old female is admitted with acute severe asthma. Treatment is...

    Incorrect

    • A 23 year old female is admitted with acute severe asthma. Treatment is initiated with 100% oxygen, nebulised salbutamol and ipratropium bromide nebulisers and IV hydrocortisone. There is no improvement despite initial treatment.

      What is the next step in management?

      Your Answer:

      Correct Answer: IV magnesium sulphate

      Explanation:

      A single dose of intravenous magnesium sulphate is safe and may improve lung function and reduce intubation rates in patients with acute severe asthma. Intravenous magnesium sulphate may also reduce hospital admissions in adults with acute asthma who have had little or no response to standard treatment.

      Consider giving a single dose of intravenous magnesium sulphate to patients with acute severe asthma (PEF <50% best or predicted) who have not had a good initial response to inhaled bronchodilator therapy. Magnesium sulphate (1.2–2 g IV infusion over 20 minutes) should only be used following consultation with senior medical staff.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds

  • Question 28 - Regarding Giardia Lamblia which one of the following statements is true? ...

    Incorrect

    • Regarding Giardia Lamblia which one of the following statements is true?

      Your Answer:

      Correct Answer: May cause intestinal malabsorption

      Explanation:

      Giardiasis also known as travellers diarrhoea is caused by Giardia lamblia, which is an anaerobic parasite affecting the small intestine. It can lead to diarrhoea, flatulence, abdominal cramps, malodourous greasy stools and intestinal malabsorption. It can also cause bloody diarrhoea. The investigation of choice is stool examination for trophozoites and cysts. It is treated by metronidazole and tinidazole as first line therapies.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 29 - A 42 year old male undergoes a routine cranial nerve examination, which reveals...

    Incorrect

    • A 42 year old male undergoes a routine cranial nerve examination, which reveals the following findings:

      Rinne's test: Air conduction > bone conduction in both ears

      Weber's test: Localizes to the right side

      What do these test results imply?

      Your Answer:

      Correct Answer: Left sensorineural deafness

      Explanation:

      Weber’s test – if there is a sensorineural problem, the sound is localized to the unaffected side (right), indicating a problem on the left side.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds

  • Question 30 - A 34 yr. old male presented with exertional dyspnoea and chest pain for...

    Incorrect

    • A 34 yr. old male presented with exertional dyspnoea and chest pain for the past 2 weeks. On examination there was a mid-systolic murmur which is best heard at the apex and double apical impulse. His ECG showed left ventricular hypertrophy (LVH). What is the risk factor which would be most indicative of the potential for sudden death in this patient?

      Your Answer:

      Correct Answer: Degree of left ventricular hypertrophy

      Explanation:

      The history is suggestive of hypertrophic obstructive cardiac myopathy. The degree of left ventricular hypertrophy is strongly associated with sudden cardiac death.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Passmed
Retry this test Dashboard