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  • Question 1 - A 21-year-old woman presents with lethargy and confusion. On examination, you note a...

    Incorrect

    • A 21-year-old woman presents with lethargy and confusion. On examination, you note a purpuric rash covering the abdominal wall and thighs, and a fever of 38C. Investigations reveal haemolytic anaemia, thrombocytopenia, and acute kidney injury.   Which feature of the presentation makes the diagnosis of thrombotic thrombocytopenic purpura more likely than haemolytic uremic syndrome?

      Your Answer: Acute kidney injury

      Correct Answer: Confusion

      Explanation:

      Confusion in the patient refers to neurological symptoms that are more associated with thrombotic thrombocytopenic purpura than with haemolytic uremic syndrome. All the other symptoms present in both conditions similarly.

    • This question is part of the following fields:

      • Nephrology
      12.4
      Seconds
  • Question 2 - From the options provided below, which intervention plays the greatest role in increasing...

    Correct

    • From the options provided below, which intervention plays the greatest role in increasing survival in patients with COPD?

      Your Answer: Smoking cessation

      Explanation:

      Smoking cessation is the most effective intervention in stopping the progression of COPD, as well as increasing survival and reducing morbidity. This is why smoking cessation should be the top priority in the treatment of COPD. Long term oxygen therapy (LTOT) may increase survival in hypoxic patients. The rest of the options dilate airways, reduce inflammation and thereby improve symptoms but do not necessarily increase survival.

    • This question is part of the following fields:

      • Respiratory
      6.1
      Seconds
  • Question 3 - A 53-year-old woman presents with a painless lump in the left breast associated...

    Correct

    • A 53-year-old woman presents with a painless lump in the left breast associated with nipple discharge. The skin over the lump has an orange peel skin appearance. According to the patient, the lump has increased in size, with time. Diagnosis of breast cancer is strongly suspected. Which of the following would be most useful in monitoring the prognosis of breast cancer, in this case?

      Your Answer: Lymph node metastases

      Explanation:

      The prognosis of breast cancer depends chiefly on the extent of nodal metastases.

      The breast cancer TNM staging system is the most common way that doctors use to stage breast cancer. TNM stands for Tumour, Node, Metastasis. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero), which is non-invasive ductal carcinoma in situ (DCIS), and stages I through IV (1 through 4), which are used for invasive breast cancer.

      Staging can be clinical or pathological. Clinical staging is based on the results of tests done before surgery, which may include physical examinations, mammogram, ultrasound, and MRI scans. Pathologic staging is based on what is found during surgery to remove breast tissue and lymph nodes. In general, pathological staging provides the most information to determine a patient’s prognosis.

    • This question is part of the following fields:

      • Haematology & Oncology
      8.1
      Seconds
  • Question 4 - A 76-year-old male presents with recurrent episodes of hallucinations. He often sees faces...

    Correct

    • A 76-year-old male presents with recurrent episodes of hallucinations. He often sees faces smaller than normal or other objects out of proportion. He says he knows they're not real. His past medical history includes macular degeneration and an episode of depression 15 years ago following the death of his wife. Neurological examination is unremarkable. What is the most probable diagnosis?

      Your Answer: Charles-Bonnet syndrome

      Explanation:

      The most probable diagnosis in the given scenario would be Charles-Bonnet syndrome.

      Charles-Bonnet syndrome (CBS) is characterized by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis). Insight is usually preserved. This must occur in the absence of any other significant neuropsychiatric disturbance.

      Risk factors include:
      Advanced age
      Peripheral visual impairment
      Social isolation
      Sensory deprivation
      Early cognitive impairment

      CBS is equally distributed between sexes and does not show any familial predisposition. The most common ophthalmological conditions associated with this syndrome are age-related macular degeneration, followed by glaucoma and cataract.

      Well-formed complex visual hallucinations are thought to occur in 10-30 percent of individuals with severe visual impairment. The prevalence of CBS in visually impaired people is thought to be between 11 and 15 percent.

    • This question is part of the following fields:

      • Psychiatry
      23.3
      Seconds
  • Question 5 - Which of the following types of motor neuron diseases carries the worst prognosis?...

    Correct

    • Which of the following types of motor neuron diseases carries the worst prognosis?

      Your Answer: Progressive bulbar palsy

      Explanation:

      Motor neuron disease is a neurological condition of unknown cause which can present with both upper and lower motor neuron signs. It rarely presents before 40 years and various patterns of disease are recognised including amyotrophic lateral sclerosis, primary lateral sclerosis, progressive muscular atrophy and progressive bulbar palsy. In some patients however, there is a combination of clinical patterns. In progressive bulbar palsy there is palsy of the tongue and muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei. This carries the worst prognosis.

    • This question is part of the following fields:

      • Neurology
      5.1
      Seconds
  • Question 6 - A 25-year-old athlete presented with a 7-month history of difficulty gripping things. He...

    Incorrect

    • A 25-year-old athlete presented with a 7-month history of difficulty gripping things. He complained of finding it particularly difficult in cold weather. He remembered his father having similar problems. Upon examination, he had a bilateral ptosis with weakness of the facial muscles. He also had difficulty opening his eyes quickly. Limb examination revealed distal weakness in both hands with difficulty opening and closing both hands quickly. Which of the following is the most likely diagnosis?

      Your Answer: Myopathy, encephalopathy, lactic acidosis and stroke-like episodes

      Correct Answer: Myotonic dystrophy

      Explanation:

      Myotonic dystrophy is the most likely diagnosis here.
      It is a multisystem disorder causing cognitive impairment, cataracts, cardiac problems and testicular atrophy, as well as affecting the muscles. Patients have muscle weakness, normally worse distally, and/or myotonia (which is worse in cold weather).
      On examination, patients may also have frontal balding, a myopathic facies, bilateral ptosis, an ophthalmoplegia and wasting of facial muscles and other limb muscles. Myotonic dystrophy is associated with diabetes mellitus and pituitary dysfunction.
      Diagnosis is normally based on clinical features with a characteristic electromyogram (EMG) of myotonic discharges. Creatine kinase is generally normal and muscle biopsy is non-specific.

    • This question is part of the following fields:

      • Neurology
      561.1
      Seconds
  • Question 7 - A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a...

    Correct

    • A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a recent holiday abroad. Which of the following investigations is the least relevant?

      Your Answer: PCR of CSF for Mycobacterium TB

      Explanation:

      Amoebic, bacterial and fungal meningitis may present acutely but is not common in tuberculous meningitis. Amoebic meningitis is caused by Naegleria fowleri as a result of swimming in infected freshwater. The organism may be found in fresh CSF specimens with phase contrast microscopy.

    • This question is part of the following fields:

      • Infectious Diseases
      3.9
      Seconds
  • Question 8 - A 25 yr. old previously well female, in her 10th week of pregnancy...

    Incorrect

    • A 25 yr. old previously well female, in her 10th week of pregnancy presented with a left sided painful calf swelling. An ultrasound scan revealed deep venous thrombosis (DVT) of her left leg. Which of the following is the most appropriate management of this patient?

      Your Answer: Initiate and then continue treatment with warfarin until delivery

      Correct Answer: Initiate and then continue treatment with heparin until delivery

      Explanation:

      Warfarin is contraindicated during pregnancy due to its teratogenic effects. She should be given heparin throughout her pregnancy. It can be converted to warfarin if necessary after the delivery.

    • This question is part of the following fields:

      • Cardiology
      17.3
      Seconds
  • Question 9 - A 70-year-old male patient presents to the urology clinic with a one-month history...

    Correct

    • 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: 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
      8.2
      Seconds
  • Question 10 - A 52-year-old man is referred to the oncology clinic by his GP. He...

    Correct

    • A 52-year-old man is referred to the oncology clinic by his GP. He recently suffered a fracture of his right humerus with minimal trauma. The results of the blood tests, taken on his arrival, prompted the referral: Hb: 8.9 g/dL, WCC: 9.5 x 10^9/L, Plts: 140 x 10^9/L, MCV: 86 fL, ESR: 60mm/1st hour, Na+: 149 mmol/L, K+: 3.6 mmol/L, Urea: 15 mmol/L, Creatinine: 160 mmol/L, Calcium (corrected): 2.89 mmol/L, Albumin: 28g/L, Total protein: 89 g/L. X-ray of right humerus reported a possible pathological fracture. Which of the following investigations would help best in confirming the most likely diagnosis?

      Your Answer: Protein electrophoresis

      Explanation:

      The most likely diagnosis with anaemia, raised erythrocyte sedimentation rate (ESR), hypercalcaemia, renal impairment, and raised total protein with low albumin is multiple myeloma (MM). Protein electrophoresis will confirm the presence of monoclonal band of paraprotein. Of note, a radioisotope bone scan is not a good test for picking up the lytic lesions of MM.

      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
      43.4
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Nephrology (0/1) 0%
Respiratory (1/1) 100%
Haematology & Oncology (3/3) 100%
Psychiatry (1/1) 100%
Neurology (1/2) 50%
Infectious Diseases (1/1) 100%
Cardiology (0/1) 0%
Passmed