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Question 1
Incorrect
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A 20 year old male, who was otherwise completely healthy, has developed severe and sudden pain in his lower back. It started after getting up from his bed. What is the most probable diagnosis in this case?
Your Answer: Spondylosis
Correct Answer: PID
Explanation:Sudden onset of severe lower back pain whilst is felt more when bending (such as getting up from a bed) is consistent with a diagnosis of a prolapsed intervertebral disc.
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This question is part of the following fields:
- Musculoskeletal
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Question 2
Correct
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A 35 year old male presented with a nasal polyp. Which of the following is true regarding nasal polyps?
Your Answer: Can cause anosmia
Explanation:Nasal polyps are a known cause of anosmia, by preventing the flow of scented air to the olfactory mucosa high in the nasal cavity. They are usually watery-pink or greyish colour. Polyp recurrence is common following polypectomy. Topical corticosteroids are of use in the primary treatment of small and medium sized nasal polyps. Beclomethasone dipropionate, flunisolide and budesonide sprays have also been shown to delay the recurrence of polyps after surgery. Nasal polyps usually arise in the maxillary sinus.
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This question is part of the following fields:
- ENT
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Question 3
Correct
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A 62 year old patient presents to the ophthalmology OPD with progressive deterioration of vision and dazzling of view in well lit environments. Which of the following is the most likely diagnosis leading to this presentation?
Your Answer: Cataracts
Explanation:Cataract is a condition characterized by clouding of the lens of the eye. This condition most frequently occurs due to age-related degenerative processes in the lens, but can also be associated with ocular trauma, metabolic disorders, side-effects of drugs, or congenital infections. The clouding causes distortion of light, as it passes through the lens, resulting in visual impairment and glare. Initially, a cataract presents discretely and may even go unnoticed, but the visual impairment worsens as the cataract grows larger.
Diagnosis is typically established on the basis of a thorough history and direct visualization of the cataract (by means of slit-lamp microscopy). Surgery is indicated with significant visual impairment and involves lens extraction and implantation of an artificial lens. Untreated cataracts eventually lead to complete blindness.
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This question is part of the following fields:
- Ophthalmology
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Question 4
Incorrect
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A homeless woman presented with a cough and fever for the last 3 months. She also complained of night sweats and weight loss. Her CXR showed lung opacities. What is the next appropriate step for this patient?
Your Answer: Mantoux test
Correct Answer: Acid fast bacilli
Explanation:History and CXR are suggestive of tuberculosis. Acid fast bacilli should be seen on microscopy to confirm the diagnosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 5
Correct
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A mother came to the clinic, with her 7 month old baby. She anxiously explained that he was not responding to loud sounds. He was vocalizing at the presentation and he had normal motor milestones. Which of the following is the most appropriate management?
Your Answer: Arrange Hearing test
Explanation:History is suggestive of a possible hearing impairment. As the baby is vocalizing and has normal motor development, an isolated hearing problem is possible. A hearing test will confirm the diagnosis.
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This question is part of the following fields:
- Child Health
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Question 6
Correct
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A 54 year old lady was found unconscious at home and passed away later in the ambulance, due to cardiac arrest. The paramedic's report reveals the woman was a diabetic patient on anti-diabetic medication, lately immobilized due to hip pain. Ulcers were also found on the medial side of her ankle. What is the most likely cause of her death?
Your Answer: Acute myocardial infarction
Explanation:The patient was old and had a major cardiovascular risk because she was a diabetic. The ulcers indicate poor glycaemic control and advanced disease which further increased her risk for an ischemic heart attack. Immobilization most probably was the favouring background on which the MI occurred.
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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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A young alcoholic male patient presented at hospital with complaints of tachycardia and palpitations for the past few hours. During examination, his blood pressure and ECG were normal. What would be the next step in management of this patient?
Your Answer: Reassure and life Style modification
Explanation:Normal blood pressure and ECG rule out any pathological cause of the complaints described in this scenario. These symptoms are most probably due to anxiety or effects of alcohol intake. Lifestyle modification will be the best management plan along with reassurance to calm the patient.
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This question is part of the following fields:
- Cardiovascular
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Question 8
Correct
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In the case of absent tibial and popliteal pulses, which artery is most likely injured?
Your Answer: Femero-popliteal
Explanation:The popliteal artery is the continuation of the femoral artery. It passes deeply, through the adductor hiatus and continues through the popliteal fossa to reach the lower border of the popliteus muscle, where it branches into the anterior and posterior tibial arteries.
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This question is part of the following fields:
- Musculoskeletal
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Question 9
Incorrect
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A 30 year old house wife developed thoughts of having dirt on her hands, which lead her to wash her hands repeatedly. She couldn't remove that thought from her mind. Whenever she tried to resist those thoughts, she developed palpitations. Which of the following is the most likely diagnosis?
Your Answer: OC personality
Correct Answer: OCD
Explanation:The patient has obsessive thoughts followed by a compulsive act. She is also unable to resist the thoughts even though she realizes they are useless. This is a common presentation of Obsessive Compulsive Disorder.
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This question is part of the following fields:
- Mental Health
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Question 10
Incorrect
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A 22-year-old male presented to the OPD with a complaint of ringing in the ears and impaired hearing with occasional vertigo. On examination, there was slight drooping of the patient's mouth to the right side. When Weber test was performed, the patient heard a fainter sound in the right ear compared to the left. Absolute bone conduction test revealed that bone conduction was reduced in the right ear. Which of the following would be the most appropriate investigation to be ordered in this case?
Your Answer: Audiometry
Correct Answer: MRI
Explanation:Symptoms of this patient are strong indications of cranial nerve damage most likely caused by a tumour or mass compressing the nerve. Therefore, the best diagnostic measure for this case is an MRI scan that may fully visualize the extent of damage and the size of the tumour or mass that may be responsible.
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This question is part of the following fields:
- ENT
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Question 11
Incorrect
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A 7 day old baby weighed 3.5kg when born. His weight is now 3kg. Choose the most appropriate next step for this child.
Your Answer: Nutritional assessment
Correct Answer: Continue regular child care
Explanation:In the first week after birth, it is normal for the baby to lose weight and then gain it again. Therefore, regular child care should be maintained.
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This question is part of the following fields:
- Child Health
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Question 12
Incorrect
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A 27 year old woman presents with a history of weight loss and palpitations. Examination reveals unilateral proptosis. She also admits that despite having a healthy appetite she has difficulty putting on weight. What is the most probable diagnosis?
Your Answer: Pituitary tumour
Correct Answer: Thyroid-associated ophthalmopathy
Explanation:The patient’s age and symptoms suggest Grave’s disease with thyroid-associated ophthalmopathy. In Grave’s disease, weight loss is noticed regardless of normal eating habits of the patient. Palpitations are also typical and may be confused with a panic attack. Proptosis is usually bilateral, but unilateral is also possible.
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This question is part of the following fields:
- Endocrine
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Question 13
Incorrect
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An 8-year-old boy is presented with arthritis, cough and non-blanching purpura. His coagulation profile is normal. His CBC: Hb 11.8 TLC 7.2*10^9 Plt 286*10^9. What is the most likely diagnosis?
Your Answer: ITP
Correct Answer: Henoch-Schönlein Purpura (HSP)
Explanation:The best answer is Henoch-Schönlein Purpura (HSP). This patient has a characteristic rash and the labs are consistent with this diagnosis.
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This question is part of the following fields:
- Cardiovascular
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Question 14
Correct
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How would you advise your patient to apply an emollient and a steroid cream, in order to treat her eczema?
Your Answer: First use emollient then steroids.
Explanation:If steroid is applied first, applying an emollient after could spread it from where it had been applied. If steroid is applied immediately after the emollient then it cannot be absorbed, this is why there should be a time interval of around thirty minutes between these two treatments in order for them to be effective.
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This question is part of the following fields:
- Dermatology
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Question 15
Incorrect
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A 34 year male is brought to the emergency by the paramedics who found him unconscious after being hit by a car. However, he regained consciousness and began talking. While waiting for the doctor's review, he suddenly becomes comatose and the condition deteriorates. What will be the most likely diagnosis?
Your Answer: SAH
Correct Answer: Extradural haemorrhage
Explanation:Extradural haemorrhage occurs as a result of head trauma and subsequent acute haemorrhage, primarily from the middle meningeal artery between the skull and the dura mater. Typical symptoms are due to compression of the brain and appear after a lucid interval that follows an initial loss of consciousness. Increased intracranial pressure leads to a decline in mental status and anisocoria, in which the ipsilateral pupil is dilated. Diagnosis is confirmed by CT (biconvex, hyperdense, sharply demarcated mass). Emergency treatment is necessary and involves neurosurgical opening of the skull and hematoma evacuation.
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This question is part of the following fields:
- Neurology
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Question 16
Incorrect
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A 19 year old male has gone to his local doctor's surgery complaining of weight loss, an increased thirst, and urinating more frequently. His father, grandfather, and both of his sisters have all been diagnosed with DM. What type of DM does this patient most likely suffer from?
Your Answer: IDDM
Correct Answer: MODY
Explanation:The key features of MODY are: being diagnosed with DM under the age of 15, having a parent with DM, and DM in two or more generations of the family.
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This question is part of the following fields:
- Endocrine
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Question 17
Incorrect
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In over 70% of the cases, inflammatory bowel disease associates which of the following?
Your Answer: Primary biliary cirrhosis
Correct Answer: Primary sclerosing cholangitis
Explanation:More than 70% of cases with inflammatory bowel disease are associated with primary sclerosing cholangitis. The most common association is that of ulcerative colitis, in which case it progresses independently.
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This question is part of the following fields:
- Gastrointestinal
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Question 18
Incorrect
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An 18 year old boy with a history of bloody diarrhoea and fever, presents with a skin rash and low urine output. Blood tests and urinalysis reveal increased levels of urea and creatinine and haematuria. What is the most probable diagnosis?
Your Answer: Post streptococcal glomerulonephritis
Correct Answer: Haemolytic Uraemic Syndrome
Explanation:Signs and symptoms of haemolytic uremic syndrome can include bloody diarrhoea, low urine output, nausea, vomiting, abdominal pain and general fatigue. Increased values of urea and creatinine are also typical.
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This question is part of the following fields:
- Haematology
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Question 19
Correct
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A 19 year-old male was brought to the OPD with GCS of 15 after a head injury. After admission his GCS deteriorated to 12. What investigation needs to be done?
Your Answer: CT head
Explanation:CT scan head will be the investigation of choice in this case. The best possible cause will be an intracranial haemorrhage which can be visualized easily with CT scan brain.
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This question is part of the following fields:
- Neurology
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Question 20
Incorrect
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A 15-month-old child is due for his measles, mumps and rubella (MMR) vaccines. He is feverish due to an acute otitis media and the mother gives a family history of egg allergy. What is the most appropriate action?
Your Answer: Give paracetamol with future doses of the same vaccine
Correct Answer: Defer immunization for two weeks
Explanation:Vaccines should not be given to a feverish child.
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This question is part of the following fields:
- Child Health
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Question 21
Incorrect
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Which of the following does the inferior mesenteric artery supply?
Your Answer: From the duodenum to the first two thirds of the transverse colon
Correct Answer: From the splenic flexure to the first third of the rectum
Explanation:The coeliac axis supplies the liver and stomach and from the oesophagus to the first half of the duodenum.
The second half of the duodenum to the first two thirds of the transverse colon is supplied by the superior mesenteric artery.
The inferior mesenteric supplies the last third of the transverse colon (approximately from the splenic flexure) to the first third of the rectum.
The last two thirds of the rectum are supplied by the middle rectal artery.
The greater curvature of the stomach is supplied by branches of the splenic artery, which itself comes from the coeliac axis. -
This question is part of the following fields:
- Gastrointestinal
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Question 22
Incorrect
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A patient presented with complaints of difficulty in swallowing, diplopia on left lateral gaze and ptosis of his left eye. The investigation of choice would be?
Your Answer: CT head
Correct Answer: Serum anti-acetylcholine receptor antibodies
Explanation:Myasthenia gravis clinically manifests with ptosis, diplopia and difficulty in swallowing. The initial investigation which is needed to confirm the diagnosis would be serum anti-acetylene receptor antibodies, after which other investigations like an EMG should be done.
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This question is part of the following fields:
- Neurology
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Question 23
Incorrect
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A 57 year old male arrives at the clinic due to intermittent vertigo, tinnitus and hearing loss. Which of the following will be the best treatment option for this patient?
Your Answer: No med treatment available
Correct Answer: Buccal prochlorperazine
Explanation:This patient’s history of intermittent attacks suggests Meniere’s disease. Meniere’s disease is a disorder of the inner ear that can lead to dizzy spells (vertigo) and hearing loss. In most cases, Meniere’s disease affects only one ear. Prochlorperazine can be used for complaints of nausea, vomiting and vertigo associated with Meniere’s disease. It is available as a tablet, injection and buccal preparation.
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This question is part of the following fields:
- Pharmacology
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Question 24
Correct
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An 81-year-old woman had fallen down in her house. She is now unable to walk. An x-ray was done on her left hip joint, which showed a fracture in the neck of the femur. Which nerve is most likely to be injured?
Your Answer: Sciatic nerve
Explanation:Femoral neck fractures are common injuries that most often result from low-energy falls in the elderly; however, they also can occur in young patients as a result of high-energy mechanisms
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This question is part of the following fields:
- Musculoskeletal
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Question 25
Correct
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An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
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This question is part of the following fields:
- Infectious Diseases
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Question 26
Correct
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A 50-year-old Afro-Caribbean male is noted to have a blood pressure of 186/99 mmHg. He also suffers from asthma. Which of the following anti-hypertensive drugs will be ineffective in this specific patient?
Your Answer: ACE inhibitor
Explanation:The Afro-Caribbean population is found to have an increased sensitivity of blood pressure to salt intake as well as a reduced tendency to excrete the ingested salt, associated with low renin levels. ACE inhibitors will then be an ineffective group of anti-hypertensive drugs for this specific population.
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This question is part of the following fields:
- Pharmacology
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Question 27
Correct
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A 45-year-old female presented with weight loss, night sweats and abdominal pain for 6 months. Abdominal ultrasound scan showed a tubo-ovarian mass. What is the most likely organism, which is responsible for this presentation?
Your Answer: Mycobacterium tuberculosis
Explanation:Constitutional symptoms such as weight loss, evening pyrexia and night sweats are associated with Mycobacterium Tuberculosis (TB). TB can affect any system of the body and should be top in the list of differentials particularly if the patient has a history of contact with a known TB patient.
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This question is part of the following fields:
- Infectious Diseases
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Question 28
Incorrect
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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: I/V fluids
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.
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This question is part of the following fields:
- ENT
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Question 29
Correct
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A 32 year old woman presents with a history of breathlessness and pyrexia. She's been diagnosed with eczema and tuberculosis (TB). The following findings were established: pre-broncho-dilator test=2/3.5, post-broncho-dilator=3/3.7. What is the most likely diagnosis?
Your Answer: Chronic obstructive pulmonary disease (COPD)
Explanation:The clinical picture of the patient together with paraclinical investigations (spirometry) suggest COPD.
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This question is part of the following fields:
- Respiratory
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Question 30
Incorrect
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A man was admitted to the hospital and developed varicella zoster after 48h. Which of the following categories of people should be administered immunoglobulin only?
Your Answer: All staff in contact with the patient
Correct Answer: All pregnant women who are tested negative for antibodies.
Explanation:Immunoglobulin should be given to all seronegative women within 4 days. However, it is strongly advised to seek medical care immediately if the disease develops.
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This question is part of the following fields:
- Infectious Diseases
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SESSION STATS - PERFORMANCE PER SPECIALTY
