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  • Question 1 - A 29 year old graduate student is reviewed after feeling anxious all the...

    Correct

    • A 29 year old graduate student is reviewed after feeling anxious all the time. She states that she is unable to relax and she is not sleeping well. However, her mood is okay and her appetite is good. She has been reviewed for several weeks with the same symptoms and has made no improvement with self-help sessions. Which pharmacological option is likely indicated in her diagnosis?

      Your Answer: Selective serotonin reuptake inhibitor (SSRI)

      Explanation:

      Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about a number of different things. People with GAD may anticipate disaster and may be overly concerned about money, health, family, work, or other issues. Individuals with GAD find it difficult to control their worry. They may worry more than seems warranted about actual events or may expect the worst even when there is no apparent reason for concern.

      GAD is diagnosed when a person finds it difficult to control worry on more days than not for at least six months and has three or more symptoms.

      Treatment usually consists of a combination of pharmacotherapy and/or psychotherapy. Antidepressant agents are the drugs of choice in the treatment of anxiety disorders, particularly the newer agents, which have a safer adverse effect profile and higher ease of use than the older tricyclic antidepressants (TCAs), such as selective serotonin reuptake inhibitors (SSRIs).

    • This question is part of the following fields:

      • Psychiatry
      13.1
      Seconds
  • Question 2 - A 28-year-old man visits the clinic and demands a CT scan of his...

    Correct

    • A 28-year-old man visits the clinic and demands a CT scan of his stomach. He states it is 'obvious' he has cancer despite previous negative investigations. Which disorder is this an example of?

      Your Answer: Hypochondrial disorder

      Explanation:

      Illness anxiety disorder (IAD) is a recent term for what used to be diagnosed as hypochondriasis, or hypochondrial disorder. People diagnosed with IAD strongly believe they have a serious or life-threatening illness despite having no, or only mild, symptoms.

      Symptoms of IAD may include:
      -Excessive worry over having or getting a serious illness.
      -Physical symptoms are not present or if present, only mild. If another illness is present, or there is a high risk for developing an illness, the person’s concern is out of proportion.
      -High level of anxiety and alarm over personal health status.
      -Excessive health-related behaviours (e.g., repeatedly checking body for signs of illness) or shows abnormal avoidance (e.g., avoiding doctors’ appointments and hospitals).
      -Fear of illness is present for at least six months (but the specific disease that is feared may change over that time).
      -Fear of illness is not due to another mental disorder.

    • This question is part of the following fields:

      • Psychiatry
      10.6
      Seconds
  • Question 3 - You want to measure the potential benefit of creating a service dedicated to...

    Incorrect

    • You want to measure the potential benefit of creating a service dedicated to patients with multiple sclerosis in the local area. Which factor would determine how many resources will be required?

      Your Answer: Bayesian factor

      Correct Answer: Prevalence

      Explanation:

      To describe how often a disease or another health event occurs in a population, different measures of disease frequency can be used. The prevalence reflects the number of existing cases of a disease. In contrast to the prevalence, the incidence reflects the number of new cases of disease and can be reported as a risk or as an incidence rate. Prevalence and incidence are used for different purposes and to answer different research questions.

    • This question is part of the following fields:

      • Clinical Sciences
      8.9
      Seconds
  • Question 4 - A 26-year-old office worker presents with a 3 year history of epigastric pain,...

    Correct

    • A 26-year-old office worker presents with a 3 year history of epigastric pain, especially 30 minutes after eating. This is associated with nausea and belching. She also describes constipation with occasional explosive diarrhoea. The stools are normally hard with mucus and she needs to strain with every motion. Abdominal pain is relieved after defecation but abdominal bloating persists. She wakes up an hour earlier each morning to finish her breakfast in order to prevent vomiting. She has missed work on a few occasions and feels that her weight has fluctuated. Past medical history includes scarlet fever. She is not on any regular medications except intermittent laxatives over the counter. Abdominal examination is normal. Rectal examination reveals an anal fissure. Investigation results: Haemoglobin (Hb 13.1 g/dL, White blood count (WBC) 6.0 × 109/L, Platelets 180× 109/L, Mean cell volume (MCV) 87 fL, International normalised ratio (INR) 1.0, Na+ 136 mmol/L, K+ 3.9 mmol/L, Urea 3.7 mmol/L, Creatinine 70 μmol/L, Albumin 39 glL. Liver function test normal. Anti-endomysial antibody negative. Thyroid function test normal. Gastroscopy normal. Flexible sigmoidoscopy and biopsy normal. Abdominal and pelvic ultrasound scans are normal. What is the most likely diagnosis to account for her symptoms?

      Your Answer: Overlap irritable bowel syndrome and functional dyspepsia

      Explanation:

      This is most likely describing irritable bowel syndrome (IBS). Symptoms are either diarrhoea, constipation, or both, abdominal pain, bloating, of varying duration. It is a functional, not an organic problem, as far as research shows at this point. It is essentially a diagnosis of exclusion. Treatment is a high fibre diet with fluids. Caffeine should be avoided as this can worsen symptoms.

    • This question is part of the following fields:

      • Gastroenterology
      11.7
      Seconds
  • Question 5 - A 56 year old woman taking procainamide develops drug induced erythematosus. Which of...

    Correct

    • A 56 year old woman taking procainamide develops drug induced erythematosus. Which of the following features is the most characteristic of this condition?

      Your Answer: It may occur with chlorpromazine

      Explanation:

      Drug induced lupus is usually positive for antinuclear and antihistone antibodies, typically without renal or neurologic involvement. However, pulmonary involvement is common. Drugs that can induce lupus include isoniazid, hydralazine, procainamide, chlorpromazine, and other anticonvulsants.

    • This question is part of the following fields:

      • Rheumatology
      9
      Seconds
  • Question 6 - A 53-year-old female teacher asks about hormone replacement therapy (HRT). What is the...

    Correct

    • A 53-year-old female teacher asks about hormone replacement therapy (HRT). What is the most compelling indication for starting HRT?

      Your Answer: Control of vasomotor symptoms such as flushing

      Explanation:

      Hormone replacement therapy (HRT) involves the use of a small dose of oestrogen, combined with a progestogen (in women with a uterus), to help alleviate menopausal symptoms. The main indication is the control of vasomotor symptoms. The other indications, such as reversal of vaginal atrophy and prevention of osteoporosis, should be treated with other agents as first-line therapies.

    • This question is part of the following fields:

      • Pharmacology
      11.3
      Seconds
  • Question 7 - A neonate was brought in by her mother, for a skin lesion present...

    Correct

    • A neonate was brought in by her mother, for a skin lesion present over the neonate's back which is bluish in colour, but otherwise asymptomatic. The most appropriate course of action will be?

      Your Answer: Reassure

      Explanation:

      A Mongolian spot can be present in new born babies which usually appears over the back and fades with time. There is nothing to worry about.

    • This question is part of the following fields:

      • Dermatology
      12.8
      Seconds
  • Question 8 - 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
      8.6
      Seconds
  • Question 9 - A 71-year old gentleman presents with a subacute history of intermittent difficulty in...

    Incorrect

    • A 71-year old gentleman presents with a subacute history of intermittent difficulty in walking, dry mouth, and variable slurring of speech. When the latter is severe he also has difficulty in swallowing. He has lost 3 kg in weight in the last 2 months. On examination he has bilateral mild ptosis, dysarthria, and proximal weakness of the upper and lower limbs, and he is areflexic. The degree of weakness is variable. Nerve conduction studies confirm the clinical suspicion of a neuromuscular junction disorder. Which of the following autoantibodies is likely to be the underlying cause of his neurological symptoms?

      Your Answer: Antiganglioside antibody GQ1B

      Correct Answer: Anti-voltage-gated, calcium-channel antibody

      Explanation:

      The clinical picture points to Lambert– Eaton myasthenic syndrome (LEMS) which often presents with weakness of the arms and legs. In LEMS, antibodies against voltage-gated calcium channels (VGCC) decrease the amount of calcium that can enter the nerve ending, causing autonomic symptoms like dry mouth and slurring of speech, as seen in this patient.

    • This question is part of the following fields:

      • Neurology
      30.4
      Seconds
  • Question 10 - A 41 year old woman who has a history of SLE presents with...

    Correct

    • A 41 year old woman who has a history of SLE presents with a dry cough, dyspnoea and fever. She is being treated with a monthly dose of IV cyclophosphamide for Grade IV nephropathy. The last cyclophosphamide dose was 10 years ago. Lab investigations are as follows: WCC: 2.3 (lymphocyte count 0.7), Platelets: 81, Hb: 10.5, ESR: 56, CRP: 43, PO2: 7.2 kPa, PCO2: 3.6 kPa after walking out to the toilet. Chest X ray was unremarkable apart from some patchy pulmonary infiltration. What is the likely diagnosis?

      Your Answer: Pneumocystis carinii pneumonia (PCP)

      Explanation:

      Pneumocystis carinii pneumonia, is an opportunistic fungal lung infection occurring almost exclusively in immunocompromised individuals. In 50% of cases, PCP is the first manifestation of AIDS (acquired immune deficiency syndrome), but it may be caused by other immunodeficiency disorders. PCP should be suspected in patients with a history of progressive dyspnoea and a dry cough with resistance to standard antibiotic treatment. Signs that support this diagnosis include a CD4 count < 200/μL, an increased beta-D-glucan level, and diffuse bilateral infiltrates on chest x-ray. Management of PCP includes high-dose trimethoprim/sulfamethoxazole (TMP/SMX), treatment of the underlying immunodeficiency disorder, and steroids in the case of severe respiratory insufficiency. TB is less likely to be present in this case as ESR is relatively low and chest x-ray appeared normal.

    • This question is part of the following fields:

      • Rheumatology
      10.7
      Seconds
  • Question 11 - Which of the following enzymes are involved in Phase I drug metabolism? ...

    Incorrect

    • Which of the following enzymes are involved in Phase I drug metabolism?

      Your Answer: N-acetyl transferases

      Correct Answer: Alcohol dehydrogenase

      Explanation:

      Drug metabolism can be broadly classified into:
      Phase I (functionalization) reactions: also termed non-synthetic reactions, they include oxidation, reduction, hydrolysis, cyclization and de-cyclization. The most common and vital reactions are oxidation reactions. (Of the given enzymes only Alcohol dehydrogenase is involved in phase I drug metabolism. Succinate dehydrogenase, is a vital enzyme involved in the Kreb’s cycle and the mitochondrial electron transport chain). They are mainly catalysed by Cytochrome P-450 enzyme.

      Phase II (conjugation) reactions: occur following phase I reactions, they include reactions: glucuronidation and sulphate conjugation, etc. They are mostly catalysed by UDP-glucuronosyltransferase enzyme. Other phase II enzymes include: sulfotransferases, N-acetyltransferases, glutathione S-transferases and methyltransferases.

    • This question is part of the following fields:

      • Pharmacology
      9.9
      Seconds
  • Question 12 - A 27-year-old male is admitted after drinking engine coolant in an apparent suicide...

    Incorrect

    • A 27-year-old male is admitted after drinking engine coolant in an apparent suicide attempt. Lab investigations reveal: pH 7.1 (7.36-7.44) pO2 15.3 kPa (11.3-12.6) pCO2 3.2 kPa (4.7-6.0) Standard bicarbonate 2.2 mmol/L (20-28) Serum calcium 1.82 mmol/L (2.2-2.6) After replacing calcium, which of the following is the most urgent treatment for this man?

      Your Answer: Haemodialysis

      Correct Answer: 8.4% bicarbonate infusion

      Explanation:

      Carbon monoxide has high affinity for haemoglobin and myoglobin resulting in a left-shift of the oxygen dissociation curve and tissue hypoxia. There are approximately 50 deaths per year from accidental carbon monoxide poisoning in the UK. In these circumstances, antidotal therapy to block alcohol dehydrogenase with ethanol or 4-MP alone is insufficient to treat the poisoning. Data suggest that a severe lactic acidosis needs initial correction and in this patient the most appropriate treatment would be IV fluids with bicarbonate to correct the metabolic acidosis. Haemodialysis may be required thereafter.

    • This question is part of the following fields:

      • Pharmacology
      10.6
      Seconds
  • Question 13 - A 73 year old woman presents with severe emphysema. She is on maximal...

    Correct

    • A 73 year old woman presents with severe emphysema. She is on maximal therapy including high dose Seretide and tiotropium. She tells you that she is so unwell that she can barely manage the walk the 160 metres to the bus stop.   On examination she looks short of breath at rest. Her BP is 158/74 mmHg, pulse is 76 and regular. There are quiet breath sounds, occasional coarse crackles and wheeze on auscultation of the chest.   Investigations show:   Haemoglobin 14.2 g/dl (13.5-17.7) White cell count 8.4 x 109/l (4-11) Platelets 300 x 109/l (150-400) Sodium 137 mmol/l (135-146) Potassium 4.1 mmol/l (3.5-5) Creatinine 127 micromole/l (79-118) pH 7.4 (7.35-7.45) pCO2 7.5 kPa (4.8-6.1) pO2 9.7 kPa (10-13.3) Chest x-ray – Predominant upper lobe emphysema. FEV1 – 30% of predicted.   Which of the features of her history, examination or investigations would preclude referral for lung reduction surgery?

      Your Answer: pCO2 7.4

      Explanation:

      Nice guidelines for lung reduction surgery:

      FEV1 > 20% predicted
      PaCO2 < 7.3 kPa
      TLco > 20% predicted
      Upper lobe predominant emphysema

      This patient has pCO2 of 7.4 so she is unsuitable for referral for lung reduction surgery.

    • This question is part of the following fields:

      • Respiratory
      9
      Seconds
  • Question 14 - A 70 yr. old male patient presented with chronic congestive heart failure. Which...

    Correct

    • A 70 yr. old male patient presented with chronic congestive heart failure. Which of the following is the most important factor to consider when prescribing drugs for this patient?

      Your Answer: Administration of a B-blocker reduces the time spent in hospital

      Explanation:

      It is proven that spironolactone has survival benefits and loop diuretics only give symptomatic relief. Beta blockers are however, known to improve exercise tolerance, left ventricular function and reduce symptoms. They also reduce the mortality associated with heart failure. So administration of beta blockers will reduce the time spent in hospital by improving symptoms.

    • This question is part of the following fields:

      • Cardiology
      14.2
      Seconds
  • Question 15 - A 19-year-old female is admitted with a headache, photophobia, fever and confusion. She...

    Incorrect

    • A 19-year-old female is admitted with a headache, photophobia, fever and confusion. She is managed with antibiotics. What is the mechanism of action of the most commonly used first line antibiotic class?

      Your Answer: Inhibition of DNA gyrase

      Correct Answer: Inhibition of cell wall synthesis

      Explanation:

      In adults, the most common symptom of meningitis is a severe headache, occurring in almost 90% of cases of bacterial meningitis, followed by nuchal rigidity (the inability to flex the neck forward passively due to increased neck muscle tone and stiffness). Other signs commonly associated with meningitis include photophobia (intolerance to bright light) and phonophobia (intolerance to loud noises).
      In the United Kingdom empirical treatment consists of a third-generation cefalosporin such as cefotaxime or ceftriaxone. In the USA, where resistance to cefalosporins is increasingly found in streptococci, addition of vancomycin to the initial treatment is recommended. Penicillins, cephalosporins, carbapenems and monobactams all act via inhibition of cell wall synthesis.

    • This question is part of the following fields:

      • Clinical Sciences
      18.5
      Seconds
  • Question 16 - A 50 yr. old male patient with schizophrenia complained of chest pain and...

    Correct

    • A 50 yr. old male patient with schizophrenia complained of chest pain and palpitations. His ECG revealed torsades de pointes ventricular tachycardia. He was on thioridazine for schizophrenia. What is the most appropriate management for his presentation?

      Your Answer: IV magnesium

      Explanation:

      Thioridazine has a quinidine-like action on the heart and is known to cause cardiac arrhythmias including prolonged PR and QT intervals and widening of QRS complexes. Intravenous magnesium sulphate is regarded as the treatment of choice for this arrhythmia.

    • This question is part of the following fields:

      • Cardiology
      13.5
      Seconds
  • Question 17 - Each one of the following statements regarding atrial natriuretic peptide are true, except:...

    Incorrect

    • Each one of the following statements regarding atrial natriuretic peptide are true, except:

      Your Answer: Antagonises actions of angiotensin II and aldosterone

      Correct Answer: Secreted mainly by the left atrium

      Explanation:

      Atrial natriuretic peptide (ANP) is a 28-amino acid peptide that is synthesized, stored, and released by atrial myocytes in response to atrial distension, angiotensin II stimulation, endothelin, and sympathetic stimulation (beta-adrenoceptor mediated). ANP is synthesized and secreted by cardiac muscle cells in the walls of the atria in the heart. The main physiological actions of natriuretic peptides is to reduce arterial pressure by decreasing blood volume and systemic vascular resistance. It causes a reduction in expanded extracellular fluid (ECF) volume by increasing renal sodium excretion.

    • This question is part of the following fields:

      • Clinical Sciences
      17.5
      Seconds
  • Question 18 - A health professional plans to visit Brazil but has recently come to know...

    Incorrect

    • A health professional plans to visit Brazil but has recently come to know that there is epidemic of West Nile virus there. Regarding the virus, which of the following is true?

      Your Answer: Is a member of the picornavirus family

      Correct Answer: Treatment including with interferon, immunoglobulin and Ribavirin is effective

      Explanation:

      West Nile virus is an RNA virus transmitted by the Culex species of mosquitoes. It is mostly prevalent in South America, Africa and some parts of Europe. Clinically it presents with high grade fever, headache, abdominal pain, anorexia and a morbilliform rash over the body. It can also lead to meningitis, encephalitis and flaccid paralysis by affecting the anterior horn cells, a process suggesting similarity to poliomyelitis. It can be fatal if not treated abruptly. Studies suggest that it can be transferred from mother to offspring. New-borns may present with encephalitis, chorioretinitis and wide spread brain damage. Patients suffering from West Nile virus can be effectively treated with interferon, IV immunoglobulin and Ribavirin.

    • This question is part of the following fields:

      • Infectious Diseases
      9.6
      Seconds
  • Question 19 - A 55-year-old man presents to the diabetes clinic for review. He has had...

    Correct

    • A 55-year-old man presents to the diabetes clinic for review. He has had type-1 diabetes for 30 years. Recently, he has suffered several falls, which he describes as attacks where he feels ‘faint’ and loses his footing. He has suffered from impotence for several years and takes anti-reflux medication. On examination, he has a postural drop of 35 mmHg in his blood pressure. What is the most likely diagnosis?

      Your Answer: Diabetic autonomic neuropathy

      Explanation:

      Autonomic Neuropathy may involve the cardiovascular, gastrointestinal, genitourinary systems and the sweat glands.
      Patients with generalized autonomic neuropathies may report ataxia, gait instability, or near syncope/syncope. In addition, autonomic neuropathies have further symptoms that relate to the anatomic site of nerve damage—gastrointestinal, cardiovascular, bladder, or sudomotor.
      – Gastrointestinal autonomic neuropathy may produce the following symptoms:
      Dysphagia, abdominal pain, nausea/vomiting, malabsorption, faecal incontinence, diarrhoea, constipation.
      – Cardiovascular autonomic neuropathy may produce the following symptoms :
      Persistent sinus tachycardia, orthostatic hypotension, sinus arrhythmia, decreased heart variability in response to deep breathing, near syncope upon changing positions from recumbent to standing.
      – Bladder neuropathy (which must be differentiated from prostate or spine disorders) may produce the following symptoms:
      Poor urinary stream
      Feeling of incomplete bladder emptying
      Straining to void
      – Sudomotor neuropathy may produce the following symptoms:
      Heat intolerance
      Heavy sweating of head, neck, and trunk with anhidrosis of lower trunk and extremities
      Gustatory sweating

    • This question is part of the following fields:

      • Endocrinology
      17.5
      Seconds
  • Question 20 - A 45-year-old female develops profuse watery diarrhoea with lower abdominal pain seven days...

    Correct

    • A 45-year-old female develops profuse watery diarrhoea with lower abdominal pain seven days after undergoing laparoscopic cholecystectomy. What is the most likely diagnosis?

      Your Answer: Pseudomembranous colitis

      Explanation:

      Pseudomembranous colitis is caused by a C. difficile infection that causes membranes to form on the colon wall. It is caused most commonly by broad-spectrum antibiotics. This would include cephalosporins, broad-spectrum penicillin, and clindamycin. Macrolides and quinolones have also been reported as potential aetiologies, but much less commonly. This woman would have received antibiotics prophylactically before her surgery, predisposing her to a possible c difficile infection. This is a much better answer choice than pseudo obstruction, abdominal sepsis, bile acid diarrhoea, and campylobacter gastroenteritis simply based on history of present illness.

    • This question is part of the following fields:

      • Gastroenterology
      11.1
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Psychiatry (2/2) 100%
Clinical Sciences (0/3) 0%
Gastroenterology (2/2) 100%
Rheumatology (2/2) 100%
Pharmacology (1/3) 33%
Dermatology (1/1) 100%
Cardiology (3/3) 100%
Neurology (0/1) 0%
Respiratory (1/1) 100%
Infectious Diseases (0/1) 0%
Endocrinology (1/1) 100%
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