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  • Question 1 - A 62 year male presented with epistaxis, nasal blockage, double vision, ear fullness...

    Incorrect

    • A 62 year male presented with epistaxis, nasal blockage, double vision, ear fullness and left sided conductive deafness for 1 week. He was a heavy smoker and alcoholic. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Nasopharyngeal ca

      Explanation:

      Because of the involvement of nose, ear and vision, the most probable diagnosis is nasopharyngeal carcinoma. Both smoking and alcohol are risk factors.

    • This question is part of the following fields:

      • Respiratory
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  • Question 2 - A 60-year-old male presented in the OPD with a severe pain in the...

    Incorrect

    • A 60-year-old male presented in the OPD with a severe pain in the chest, which radiated to the jaw and his left shoulder. What is your diagnosis?

      Your Answer:

      Correct Answer: MI

      Explanation:

      Risk of myocardial infarction is high in patients with diabetes mellitus. High levels of sugar in the blood can damage the arteries and lead to an increased risk of atherosclerosis of the coronary arteries. This is why diabetic patients have an increased risk of Myocardial Infarction.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 3 - Her parents with a severe headache present a 24-year-old woman. She is afraid...

    Incorrect

    • Her parents with a severe headache present a 24-year-old woman. She is afraid of light and sun and prefers darker environments. On examination, a generalized rash that does not blanch on pressure is noticed. What is the best action in this case?

      Your Answer:

      Correct Answer: IV benzylpenicillin

      Explanation:

      The rash is a characteristic sign of meningitis. Added to photophobia, headache and neck rigidity, meningitis is highly suggested diagnosis. IV antibiotics should be started immediately.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 4 - An infant born at 34 weeks was kept in the incubator for almost...

    Incorrect

    • An infant born at 34 weeks was kept in the incubator for almost a month. Physical examination revealed a heart murmur, which however was not present at discharge. What is the most probable cause of this murmur?

      Your Answer:

      Correct Answer: PDA

      Explanation:

      PDA is particularly common in premature babies and it is managed by indomethacin administration. However, if PDA is not the only defect, prostaglandin E1 can be administered in order to keep the ductus open until the surgery takes place.

    • This question is part of the following fields:

      • Child Health
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  • Question 5 - A 65 year old female presented in emergency 12 hours after the ingestion...

    Incorrect

    • A 65 year old female presented in emergency 12 hours after the ingestion of 14g of quinine sulphate. Which of the following is the most likely side effect of this drug?

      Your Answer:

      Correct Answer: Blindness

      Explanation:

      The main effects of quinine affect the nervous system. It particularly affects the optic and auditory nerves. While affecting the auditory nerve it may cause tinnitus and deafness but not hyperacusis. Blindness is the effect of this drug on the optic nerve.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 6 - An 18 year old boy was admitted with severe pain and swelling of...

    Incorrect

    • An 18 year old boy was admitted with severe pain and swelling of his scrotum following a kick to the groin. What is the most appropriate management that can be done at this stage?

      Your Answer:

      Correct Answer: Exploratory surgery

      Explanation:

      The most worrying condition is testicular torsion and to exclude it exploratory surgery is required.

    • This question is part of the following fields:

      • Seriously Ill
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  • Question 7 - A 32-year-old man, who is on salbutamol and low dose budesonide, has be...

    Incorrect

    • A 32-year-old man, who is on salbutamol and low dose budesonide, has be suffering from recurrent asthma attacks for the last week. What is the next drug of choice?

      Your Answer:

      Correct Answer: Salmeterol

      Explanation:

      According to recent guidelines on asthma management, after administering SABA as needed, low doses of ICS are indicated. In this case the patient already takes budesonide so he now requires a long acting beta agonist (LABA), in this case salmeterol.

    • This question is part of the following fields:

      • Respiratory
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  • Question 8 - A 20-year-old female was brought to the ED by her father because of...

    Incorrect

    • A 20-year-old female was brought to the ED by her father because of noticeable drowsiness and a hoarse voice. She reported having left the heater turned on before sleeping the night before. Laryngoscopy revealed laryngeal oedema. Which of the following is the step you would take next?

      Your Answer:

      Correct Answer: Anaesthetics for help

      Explanation:

      The anaesthesiologist should be called for help because this patient is suffering from laryngeal oedema and if not anaesthetised, the oedema might block the airway completely.

    • This question is part of the following fields:

      • ENT
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  • Question 9 - A 51 year old male patient presents with acute back pain, which worsens...

    Incorrect

    • A 51 year old male patient presents with acute back pain, which worsens on prolonged walking and sitting. The pain radiates towards the lower limbs and seems to be relieved by lying down. What is the best next step?

      Your Answer:

      Correct Answer: Magnetic resonance imaging (MRI)

      Explanation:

      A herniated disc seems to be the cause of the patient’s pain. MRI is the investigation of choice, since it can show soft tissue and establish a differential diagnosis.

    • This question is part of the following fields:

      • Neurology
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  • Question 10 - Which group of drugs is used to manage Trigeminal Neuralgia? ...

    Incorrect

    • Which group of drugs is used to manage Trigeminal Neuralgia?

      Your Answer:

      Correct Answer: Anti epileptics

      Explanation:

      The only drug currently licensed in the UK to treat trigeminal neuralgia is carbamazepine which is an anticonvulsant. It can be very effective initially, but may become less effective over time.

    • This question is part of the following fields:

      • Neurology
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  • Question 11 - A 23 year old patient with epilepsy, presented with fits. Investigations revealed profound...

    Incorrect

    • A 23 year old patient with epilepsy, presented with fits. Investigations revealed profound hyponatraemia. Which of the following drug will cause this presentation?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      Carbamazepine and oxcarbazepine are the most common antiepileptics which induce hyponatremia in patients with epilepsy. Other antiepileptics such as eslicarbazepine, sodium valproate, lamotrigine, levetiracetam and gabapentin have also been reported to cause hyponatremia. So the most suitable answer is Carbamazepine.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 12 - A 75 year old gentleman sustained an injury to his arm after falling...

    Incorrect

    • A 75 year old gentleman sustained an injury to his arm after falling on outstretched hands. An X-ray confirms the fracture of the distal radius with backward shift of the distal fragment. The name given to this kind of deformity is?

      Your Answer:

      Correct Answer: Dinner fork deformity

      Explanation:

      Dinner fork deformity is the name given to the fracture of distal radius, in which the distal fragment is dorsally angulated, displaced and sometimes impacted. Coxa vara is the hip deformity when angle between the head and shaft of the femur is reduced to more than 120 degree. A garden fork deformity is a reversed Colles fracture.

    • This question is part of the following fields:

      • Surgery
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  • Question 13 - A 23 year old patient was involved in a MVA. Clinical examination reveals...

    Incorrect

    • A 23 year old patient was involved in a MVA. Clinical examination reveals a fixed dilated pupil and reduced consciousness. Which of the following nerves is most likely damaged?

      Your Answer:

      Correct Answer: Oculomotor nerve

      Explanation:

      The oculomotor nerve is the 3rd cranial nerve. When damaged it affects the ocular motility causing mainly ptosis or diplopia. Damage to it can also affect the pupillary functions causing pupil dilation and light reflex impairment.

    • This question is part of the following fields:

      • Neurology
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  • Question 14 - All of the following drugs reduce the tone of the lower oesophageal sphincter...

    Incorrect

    • All of the following drugs reduce the tone of the lower oesophageal sphincter except?

      Your Answer:

      Correct Answer: Domperidone

      Explanation:

      Domperidone is a D2 dopaminergic receptor antagonist which works as an anti emetic by increasing the tone of the lower oesophageal sphincter and increasing the gut motility.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 15 - A 25 year old female who was on sodium valproate for epilepsy came...

    Incorrect

    • A 25 year old female who was on sodium valproate for epilepsy came for the advice about contraception. Which of the following is accurate?

      Your Answer:

      Correct Answer: She can use COCP

      Explanation:

      There are no interactions between the combined oral contraceptive pill, progesterone-only pill, medroxyprogesterone injections or levonorgestrel implants and the AEDs valproic acid (sodium valproate), vigabatrin, lamotrigine, gabapentin, tiagabine, levetiracetam, zonisamide, ethosuximide and the benzodiazepines. So she can use COCP along with Sodium valproate.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 16 - A 35-year-old African female presents with a history of heavy menstrual bleeding and...

    Incorrect

    • A 35-year-old African female presents with a history of heavy menstrual bleeding and dysmenorrhoea for 4 months. Which of the following could be the most likely cause for this presentation?

      Your Answer:

      Correct Answer: Fibroid

      Explanation:

      History of heavy menstrual bleeding and amenorrhoea favour the diagnosis of a fibroid uterus. All the given responses are causes for subfertility. Ectopic pregnancy presents with abdominal pain has an acute presentation. Endometriosis and adenomyosis usually don’t present with amenorrhoea or heavy bleeding respectively. PID presents with chronic pelvic pain and is not related to menstruation.

    • This question is part of the following fields:

      • Gynaecology
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  • Question 17 - When considering the anatomical location of intracranial meningiomas, which of the following relations...

    Incorrect

    • When considering the anatomical location of intracranial meningiomas, which of the following relations is well recognised?

      Your Answer:

      Correct Answer: Parasagittal - spastic paraparesis

      Explanation:

      The localisation of intracranial lesions (based on both history and examination) is crucial. Meningiomas are slow in growth, and its subtle effects are very different from the more aggressive, intrinsic lesions. Olfactory groove lesions affect the sense of smell and may produce ipsilateral optic atrophy. Sphenoid ridge lesions will produce exophthalmos. Chiasmal lesions usually produce bitemporal hemianopia.

    • This question is part of the following fields:

      • Neurology
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  • Question 18 - A 72 year old retired fisherman presents with weakness of shoulders and hips...

    Incorrect

    • A 72 year old retired fisherman presents with weakness of shoulders and hips over the last four months. Finger flexion is also weak but the extension is normal. There has been some difficulty swallowing liquids. Past medical history is not significant except for sexually transmitted disease that he caught some 40 years ago in South Pacific and got treated with antibiotics. He smokes and drinks one or two tots of rum at the weekend. Creatine kinase level is 125. Which of the following investigations is most significant in establishing a diagnosis?

      Your Answer:

      Correct Answer: Muscle biopsy with electron microscopy

      Explanation:

      Inclusion body myositis (IBM) is a progressive muscle disorder characterized by muscle inflammation, weakness, and atrophy (wasting). It is a type of inflammatory myopathy. IBM develops in adulthood, usually after age 50. The symptoms and rate of progression vary from person to person. The most common symptoms include progressive weakness of the legs, arms, fingers, and wrists. Some people also have weakness of the facial muscles (especially muscles controlling eye closure), or difficulty swallowing (dysphagia). Muscle cramping and pain are uncommon, but have been reported in some people. The underlying cause of IBM is poorly understood and likely involves the interaction of genetic, immune-related, and environmental factors. Some people may have a genetic predisposition to developing IBM, but the condition itself typically is not inherited. Elevated creatine kinase (CK) levels in the blood (at most ,10 times normal) are typical in IBM. Muscle biopsy may display several common findings including; inflammatory cells invading muscle cells, vacuolar degeneration, inclusions or plaques of abnormal proteins.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 19 - A 55 year old female presents with complaints of retrosternal chest pain and...

    Incorrect

    • A 55 year old female presents with complaints of retrosternal chest pain and dysphagia (which is intermittent and unpredictable in nature). When she swallows, food very suddenly 'sticks' in her chest. She is able to clear it when she drinks water, and then can finish the meal without any further incidence. A barium meal shows she has a corkscrew oesophagus. What is the most likely type of dysphagia here?

      Your Answer:

      Correct Answer: Oesophageal spasm

      Explanation:

      All of the symptoms observed in this patient are typical of uncoordinated irregular oesophageal peristalsis – this is characteristic of oesophageal spasm. The cork-screw oesophagus is also diagnostic of the condition.

    • This question is part of the following fields:

      • Gastrointestinal
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  • Question 20 - A 2-year-old boy's illness started with a 4-day history of fever and cough....

    Incorrect

    • A 2-year-old boy's illness started with a 4-day history of fever and cough. Crepitations are noted upon auscultation. Other examination results are temperature 38.9C, O2 sats 94% on air, respiratory rate is 45/min, and capillary refill time 1 sec. Urine is also negative on dipstick. What is the single investigation most likely to lead to a diagnosis?

      Your Answer:

      Correct Answer: Blood for culture and sensitivity

      Explanation:

      Blood culture and sensitivity will distinguish the bacteria that is responsible for the infection and the effective antibiotic treatment to which the bacteria is sensitive.

    • This question is part of the following fields:

      • Child Health
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  • Question 21 - A 60-year-old diabetic female patient presented with spasmodic pain in her left thigh...

    Incorrect

    • A 60-year-old diabetic female patient presented with spasmodic pain in her left thigh and calf muscle. During examination the doctor noticed that the femoral and popliteal pulses were absent on the left side. Which of the following vessels is most probably occluded?

      Your Answer:

      Correct Answer: External Iliac Artery

      Explanation:

      The external iliac artery supplies both the thigh and calf muscles. The absence of pulses in femoral and popliteal vessels indicates the obstruction of the external iliac artery.

    • This question is part of the following fields:

      • Musculoskeletal
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  • Question 22 - A 30 year old female presented with sudden onset severe right sided abdominal...

    Incorrect

    • A 30 year old female presented with sudden onset severe right sided abdominal pain for the past 30 minutes. The pain radiated to the groin. She vomited once. Her abdomen was non tender. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Ureteric colic

      Explanation:

      Characteristic colicky pain and non tender abdomen is characteristic of ureteric colic. Some patients present with urinary symptoms such as haematuria and dysuria, Vomiting is due to activation of sympathetic nervous system due to pain.

    • This question is part of the following fields:

      • Urology
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  • Question 23 - A 56-year-old man injected his usual insulin dose and went to the washroom...

    Incorrect

    • A 56-year-old man injected his usual insulin dose and went to the washroom to wash his hands before going to dinner. His wife found him unconscious in the washroom a few minutes later. Which of the following investigations needs to be done?

      Your Answer:

      Correct Answer: Random capillary glucose

      Explanation:

      The state of this patient is most likely a diabetic coma caused by hypoglycaemic shock. A random capillary glucose check can confirm the glucose level and whether prompt IM glucagon should be given.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 24 - A 40-year-old male was recently diagnosed with hypertension and was prescribed Chlorothiazide. Now...

    Incorrect

    • A 40-year-old male was recently diagnosed with hypertension and was prescribed Chlorothiazide. Now he complains of a painful swelling in his left big toe for two days. What is the single most appropriate investigation for reaching the diagnosis in this case?

      Your Answer:

      Correct Answer: Serum uric acid

      Explanation:

      Bendroflumethiazide, like all thiazide diuretics, may cause hyperuricemia that can lead to gout and gouty arthritis. A test for serum uric acid will confirm this suspicion.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 25 - A 40 year old male, known with osteoarthritis and taking analgesics for it,...

    Incorrect

    • A 40 year old male, known with osteoarthritis and taking analgesics for it, presented with sudden onset severe epigastric pain and tenderness. The most likely cause will be?

      Your Answer:

      Correct Answer: Perforated peptic ulcer

      Explanation:

      NSAIDS are the leading cause of dyspepsia, GERD, peptic ulcer disease and perforation. Perforation is characterised by severe abdominal pain, tenderness and muscles guarding & rigidity.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 26 - A 56 year old woman taking procainamide develops drug induced erythematosus. Which of...

    Incorrect

    • 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:

      Correct 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
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  • Question 27 - A 2 year old female was taken to her local emergency department with...

    Incorrect

    • A 2 year old female was taken to her local emergency department with jerking movements in her limbs. This lasted for around 10 seconds, and then she fell unconscious. She soon regained consciousness - she was disorientated but afebrile with no symptoms of meningeal irritation. From the list of options, chose the most appropriate investigation route for this patient.

      Your Answer:

      Correct Answer: 24 hour EEG

      Explanation:

      Many of the symptoms favour an epilepsy diagnosis: uncontrollable jerking of the limbs and a loss of consciousness. A 24-hour EEG is used to diagnose epilepsy.

    • This question is part of the following fields:

      • Child Health
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  • Question 28 - A 40 year old woman has come to her GP complaining of a...

    Incorrect

    • A 40 year old woman has come to her GP complaining of a low mood. She has noted an increased appetite and has gone up by two clothing sizes. She also complains that she is unable to get out of bed until afternoon. From the list of options, what is the most likely diagnosis for this patient?

      Your Answer:

      Correct Answer: Atypical depression

      Explanation:

      Atypical depression presents with several very specific symptoms, such as increased appetite or weight gain; excessive sleep; fatigue and weakness; moods that are reactive to environmental circumstances; and a feeling of extreme sensitivity to rejection. It is also a subtype of major depression or dysthymic disorder.

    • This question is part of the following fields:

      • Mental Health
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  • Question 29 - A 12-year-old boy was admitted with profound diarrhoea and low urine output. His...

    Incorrect

    • A 12-year-old boy was admitted with profound diarrhoea and low urine output. His mucous membranes seem dry and his skin turgor is low. What is the most appropriate next step?

      Your Answer:

      Correct Answer: Fluid replacement

      Explanation:

      Fluid replacement therapy should be initiated immediately because the patient is suffering from severe dehydration as shown by the low urine output, the dry mucous membranes and the low skin turgor.

    • This question is part of the following fields:

      • Gastrointestinal
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  • Question 30 - A 75 year old man presented to hospital after suffering a stroke. The...

    Incorrect

    • A 75 year old man presented to hospital after suffering a stroke. The doctor admitted him and advised of the Barthel score index. During rehabilitation, which one of the following limitations are best described by Barthel score index?

      Your Answer:

      Correct Answer: Floor and ceiling effects

      Explanation:

      Barthel scoring has floor and ceiling effects which is the most widely recognised limitation. Floor effect means that the patient who is bed bound can score initially low, whereas the ceiling effect shows that despite being bed bound, a patient can achieve a maximum score i.e. 100. The test is easy to perform and correlates well with other prognostic scales.

    • This question is part of the following fields:

      • Older Adult
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