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Question 1
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An 80-year-old female presents to OPD with itching hands, elbows, axillae and groin. Other members residing with her at the retirement home also have similar complaints. Which of the following is the most likely diagnosis?
Your Answer: Scabies
Explanation:Scabies is due to an infestation of Sarcoptes scabiei and most commonly presents with these symptoms. The organism resides in burrows in a pattern specifically affecting the interdigital spaces and the skin folds of the arms and legs. The infection spreads from one person to another, especially in populated communities, through close contact.
Henoch-Schönlein purpura is a type of vascular inflammation.
Psoriasis rash is characterised by scaly plaques affecting the extensor surfaces of the body. Pemphigus vulgaris and bullous pemphigoid both are bullous disorders of the skin. They may present as crusted, weeping, diffuse lesions and there may be involvement in other sites; erosions in the mouth are typically involved in pemphigus vulgaris. Bullous pemphigoid involves the flexural areas and may be associated with a new medication. -
This question is part of the following fields:
- Infectious Diseases
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Question 2
Correct
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A 25 year old unmarried female presented with dizziness, nausea and vomiting for 1 week. According to her, she has been stressed recently and her usual menstrual period has been delayed by 4 weeks. Examination findings were normal. Which of the following is the most appropriate next step?
Your Answer: Dipstick for B-hCG
Explanation:There is high possibility of her being pregnant. Urine B-hCG has to be checked to exclude pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 3
Incorrect
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A 12-year-old boy with emesis, dehydration, cold peripheries and deep breathing, has a blood glucose of 28mmol/l. What would be the next best step in management?
Your Answer: 0.45% normal saline plus 5% dextrose
Correct Answer: Give normal saline 0.9%
Explanation:Normally blood glucose is filtered out by the kidneys, however as glucose levels exceed 180 mg/dL, the renal tubules become saturated and additional reabsorption is not possible. Glucose remains in the renal tubules, causing additional water and electrolytes to diffuse into the renal system and be excreted as urine (also known as osmotic diuresis). Excessive urine production results in electrolyte loss, and dehydration. Thus an important part of managing these patients is fluid replacement. Initially a litre of 0.9% NaCl over the 1st hour is given which may followed by either 0.45 or 0.9% NaCl, depending on the corrected serum sodium and the hemodynamic status of the patient.
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This question is part of the following fields:
- Emergency
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Question 4
Incorrect
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What is the three main structures in the portal triad ( portal space )?
Your Answer: The sinusoids, branch of hepatic artery, branch of hepatic vein
Correct Answer: Branch of hepatic artery, branch of portal vein, bile ductules
Explanation:A portal triad (also known as portal field, portal area, or portal tract) is a distinctive arrangement in the liver. It is a component of the hepatic lobule. It consists of the following five structures:
– Proper hepatic artery
– Hepatic portal vein
– Common bile duct
– Lymphatic vessels
– Branch of the vagus nerve -
This question is part of the following fields:
- Hepatobiliary
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Question 5
Correct
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A 21-year-old student presents with yellowish discolouration of her sclera. She says she has had severe headaches over the last few weeks for which she has been taking paracetamol. What is the most likely cause of her jaundice?
Your Answer: Gilbert’s syndrome
Explanation:Gilbert’s syndrome is a mild liver disorder in which the liver does not properly process bilirubin. Many people never have symptoms. Occasionally a slight yellowish colour of the skin or whites of the eyes may occur. Other possible symptoms include feeling tired, weakness, and abdominal pain.
The enzymes that are defective in Gilberts – UDP glucuronosyltransferase 1 family, polypeptide A1 (UGT1A1) – are also responsible for some of the liver’s ability to detoxify certain drugs. While paracetamol (acetaminophen) is not metabolized by UGT1A1,[10] it is metabolized by one of the other enzymes also deficient in some people with Gilberts. Therefore a subset of people with Gilberts may have an increased risk of paracetamol toxicity. -
This question is part of the following fields:
- Hepatobiliary
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Question 6
Incorrect
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A prolonged QT interval is linked to which of the following?
Your Answer: Hyperkalaemia
Correct Answer: Hypocalcaemia
Explanation:Prolonged QT interval can be seen in the following conditions: Hypocalcaemia, hypothermia, severe bradycardia, Class 1 and 3 antiarrhythmic drugs, non-sedating antihistamines, tricyclic antidepressants etc.
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This question is part of the following fields:
- Seriously Ill
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Question 7
Correct
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Which among these medications does NOT cause gastric ulceration?
Your Answer: Misoprostol
Explanation:Misoprostol is effective in preventing gastric ulceration since it is a prostaglandin analogue. Celecoxib, being a selective COX-2 inhibitor only elevates risk of ulceration as well as NSAIDs. Renal failure on the other hand results in elevated gastric acid after reducing the breakdown of gastrin.
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This question is part of the following fields:
- Gastrointestinal
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Question 8
Incorrect
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A pregnant woman who is a heavy smoker, observed some thick white patches on the inside of her mouth. Her oral cavity appears inflamed on examination. Which diagnosis is most likely correct?
Your Answer: Smoking
Correct Answer: Candidiasis
Explanation:During pregnancy, the chances for a woman to develop oral candidiasis double. An aphthous ulcer has a yellowish floor which is surrounded by an erythematous halo while in lichen planus, the lesions do not have the appearance of a thick white mark but are more or less lace-like. The lesions in leucoplakia have raised edges and they appear as bright white patches which are sharply defined and cannot be rubbed out. Smoking may affect the tongue, producing tongue coating. In this case the tongue is just inflamed which is a sign of infection.
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This question is part of the following fields:
- Obstetrics
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Question 9
Incorrect
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A 34 year old patient arrives at the clinic with cervical lymphadenopathy and splenomegaly. Which of the following is the most likely cause?
Your Answer: Toxoplasmosis
Correct Answer: Non-Hodgkin's lymphoma
Explanation:Lymphomas are a type of cancer that arises from lymphocytes. There are two main types of lymphoma:
1. Hodgkin lymphomas, which are characterized by the presence of Reed-Sternberg cells, and
2. Non-Hodgkin lymphomas (NHLs), which comprise all other types of lymphoma. NHLs are further classified according to the cell type, i.e., B cells, T cells, and natural killer (NK) cells, and tumour grade.
Low-grade tumours originate from mature cells that have a slow growth rate and an indolent clinical course. The most common low-grade B-cell lymphoma is follicular lymphoma, while the most common low-grade T-cell lymphomas are the cutaneous T-cell lymphomas such as mycosis fungoides. High-grade tumours, on the other hand, have a rapid growth rate and an aggressive clinical course. Certain subtypes of NHL are more common in children and young adults, such as Burkitt lymphoma.
There is a variety of treatment options, depending on the type of lymphoma. Generally, treatment involves a combination of chemotherapy and radiation therapy. Limited disease low-grade tumours and high-grade NHL are treated with a curative approach. Advanced, low-grade tumours are treated with a palliative approach in symptomatic patients. -
This question is part of the following fields:
- Oncology
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Question 10
Incorrect
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Which of the following cancers is responsible in producing osteoblastic bone metastases instead of osteolytic?
Your Answer: Serous carcinoma of the ovary
Correct Answer: Prostate adenocarcinoma
Explanation:Osteoblastic (or sclerotic) bone metastases, characterized by deposition of new bone, present in prostate cancer, carcinoid, small cell lung cancer, Hodgkin lymphoma or medulloblastoma.
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This question is part of the following fields:
- Rheumatology
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