00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
  • Question 1 - A 55 yr. old male with a history of myocardial infarction 4 years...

    Incorrect

    • A 55 yr. old male with a history of myocardial infarction 4 years ago, was admitted with a history of fever for the past 2 weeks. On investigation, his echocardiography revealed a small vegetation around the mitral valve. His blood culture was positive for Streptococcus viridans. Which of the following is the most appropriate antibiotic therapy?

      Your Answer: IV flucloxacillin + gentamicin

      Correct Answer: IV benzylpenicillin

      Explanation:

      According to the American Heart Association (AHA) penicillin-susceptible S viridans, S bovis, and other streptococci (MIC of penicillin of ≤0.1 mcg/mL) should be treated with penicillin G or ceftriaxone or penicillin G + a gentamicin combination or vancomycin (if allergy to penicillin).

    • This question is part of the following fields:

      • Cardiology
      14.1
      Seconds
  • Question 2 - Which one of the following is least associated with photosensitivity? ...

    Incorrect

    • Which one of the following is least associated with photosensitivity?

      Your Answer: Herpes labialis

      Correct Answer: Acute intermittent porphyria

      Explanation:

      Sunlight, especially its ultraviolet radiation component, can cause increased or additional types of damage in predisposed individuals, such as those taking certain phototoxic drugs, or those with certain conditions associated with photosensitivity, including:
      – Psoriasis
      – Atopic eczema
      – Erythema multiforme
      – Seborrheic dermatitis
      – Autoimmune bullous diseases (immunobullous diseases)
      – Mycosis fungoides
      – Smith–Lemli–Opitz syndrome
      – Porphyria cutanea tarda
      Also, many conditions are aggravated by strong light, including:
      – Systemic lupus erythematosus
      – Sjögren’s syndrome
      – Sinear Usher syndrome
      – Rosacea
      – Dermatomyositis
      – Darier’s disease
      – Kindler-Weary syndrome
      Acute intermittent porphyria (AIP) belongs to the group inborn errors of metabolism and most patients with AIP are not light sensitive.

    • This question is part of the following fields:

      • Dermatology
      14.8
      Seconds
  • Question 3 - A 6-year-old boy is referred by his GP to the neurology clinic with...

    Correct

    • A 6-year-old boy is referred by his GP to the neurology clinic with abnormal movements. His mother noticed that for the last year, the boy has been falling over more and more frequently. He has also been having increasingly slurred speech. These have been getting progressively worse. He has had recurrent chest infections in his childhood. What is the most likely diagnosis?

      Your Answer: Ataxic telangiectasia

      Explanation:

      Ataxic telangiectasia is an inherited combined immunodeficiency disorder that is characterised by cerebellar ataxia and telangiectasia as seen in this child, as well as frequent infections as noted in this child’s history. The other differentials would not present with this clinical picture:

      Friedreich’s ataxia and Infantile-onset spinocerebellar ataxia do not present with immune problems, whereas Cerebral palsy and Di-George Syndrome do not present with ataxia.

    • This question is part of the following fields:

      • Neurology
      1.1
      Seconds
  • Question 4 - A 24-year-old woman who is known to have type 1 diabetes mellitus, presents...

    Incorrect

    • A 24-year-old woman who is known to have type 1 diabetes mellitus, presents with a three month history of diarrhoea, fatigue and weight loss. She has tried excluding gluten from her diet for the past 4 weeks and feels much better. She requests to be tested so that a diagnosis of coeliac disease can be confirmed. What is the most appropriate next step?

      Your Answer: Check anti-endomysial antibodies

      Correct Answer: Ask her to reintroduce gluten for the next 6 weeks before further testing

      Explanation:

      The patient likely has celiac’s disease, but if she has been avoiding gluten, a biopsy may be negative. Even though a biopsy is the gold standard for diagnosis, she will need to re-introduce gluten into her diet prior to undergoing the biopsy.

    • This question is part of the following fields:

      • Gastroenterology
      11.4
      Seconds
  • Question 5 - A 74-year-old retired judge who is known to have Alzheimer’s disease is examined...

    Incorrect

    • A 74-year-old retired judge who is known to have Alzheimer’s disease is examined in clinic. His latest Mini Mental State Examination (MMSE) score is 18 out of 30. Which of the following is the most appropriate treatment option?

      Your Answer: Supportive care + memantine

      Correct Answer: Supportive care + donepezil

      Explanation:

      NICE now recommends the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease. Memantine is reserved for patients with moderate to severe Alzheimer’s.

    • This question is part of the following fields:

      • Neurology
      15.5
      Seconds
  • Question 6 - The following are commonly recognized disease syndromes associated with Clostridium species, except: ...

    Correct

    • The following are commonly recognized disease syndromes associated with Clostridium species, except:

      Your Answer: exfoliative skin rash

      Explanation:

      Clostridium species do not present with an exfoliative skin rash. C. perfringens is a common aetiology in necrotizing infections (gas gangrene) as well as food poisoning, which often also includes diarrhoea. C. difficle causes diarrhoea. C. tetany and C. botulinum have neurotoxins that can lead to paralysis.

    • This question is part of the following fields:

      • Infectious Diseases
      14.9
      Seconds
  • Question 7 - A 32-year-old patient that has just returned from India, complains of dyspnoea. On...

    Correct

    • A 32-year-old patient that has just returned from India, complains of dyspnoea. On examination, you notice grey membranes on the uvula and tonsils and a low-grade fever. What is the most likely diagnosis?

      Your Answer: Diphtheria

      Explanation:

      Characteristic findings on patients suffering from diphtheria are the grey membrane on the uvula and tonsils together with the low grade fever and dyspnoea. It’s of great importance that the patient has recently been to India where there is a know prevalence.

    • This question is part of the following fields:

      • Infectious Diseases
      19.9
      Seconds
  • Question 8 - A 51 year old obese female, with a history of smoking, presents to...

    Correct

    • A 51 year old obese female, with a history of smoking, presents to the clinic with worsening dyspnoea. She is currently on oestrogen therapy for menopausal symptoms. Clinical examination, ECG and radiological findings correspond to right sided heart failure. There are no signs of left ventricular dysfunction. Which of the following is the most likely cause of cor pulmonale?

      Your Answer: Recurrent small pulmonary embolisms

      Explanation:

      Postmenopausal oestrogen therapy and hormone therapy are associated with an increased risk of thromboembolism. The relative risk seems to be even greater if the treated population has pre-existing risk factors for thromboembolism, such as obesity, immobilization, and fracture. Cor pulmonale can occur secondary to small recurrent pulmonary embolisms. Pneumonias and bronchiectasis usually present with purulent sputum, and in case of carcinoma there may be other associated symptoms like weight loss, etc.

    • This question is part of the following fields:

      • Respiratory
      27.4
      Seconds
  • Question 9 - A 32 yr. old previously well primigravida in her 16th week of pregnancy...

    Correct

    • A 32 yr. old previously well primigravida in her 16th week of pregnancy came to the antenatal clinic for a routine review. Her blood pressure was 152/90 mmHg. On her last clinic visit 4 weeks ago her blood pressure was 148/86 mmHg. She was put on ambulatory blood pressure monitoring and her mean blood pressure was 148/88 mmHg. Her urine examination was negative for protein. Which of the following is the most likely diagnosis?

      Your Answer: Pre-existing hypertension

      Explanation:

      Pre-eclampsia is excluded from negative proteinuria. White coat hypertension is excluded with ambulatory blood pressure monitoring. Pregnancy induced hypertension develops after 20 weeks of gestation. So the most likely answer is pre-existing hypertension. She should be investigated for a secondary cause for hypertension.

    • This question is part of the following fields:

      • Cardiology
      45
      Seconds
  • Question 10 - A 28-year-old woman attends for review. She has a past history of a...

    Incorrect

    • A 28-year-old woman attends for review. She has a past history of a perianal abscess but nothing else of note. During the past few months she has twice presented to A&E complaining of grumbling abdominal pain. In addition, she has suffered intermittent episodes of bloody diarrhoea. Microcytic anaemia is found on blood testing and she has mild hypokalaemia. Albumin is reduced but other liver function tests are unremarkable. Barium imaging reveals a small bowel stricture with evidence of mucosal ulceration extending into the colon, interspersed with normal looking mucosa ‘skipping’. Given this clinical picture, which is the most likely diagnosis?

      Your Answer: Ulcerative colitis

      Correct Answer: Crohn’s disease

      Explanation:

      The correct answer based on the clinical scenario is Crohn’s disease. Associated with this disease are abscesses and fistulas in the anorectal region, skip lesions, cobble stoning, stricturing, granulomas, and crypt distortion. The other answer choices are not correct. How to rule out ulcerative colitis: it only involves ileocolorectal regions, and this is above that level. You will not see crypt distortion and cobble stoning; it is a more superficial process.

    • This question is part of the following fields:

      • Gastroenterology
      16.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Cardiology (1/2) 50%
Dermatology (0/1) 0%
Neurology (1/2) 50%
Gastroenterology (0/2) 0%
Infectious Diseases (2/2) 100%
Respiratory (1/1) 100%
Passmed