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Question 1
Correct
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A 26 year old woman is 32 weeks pregnant. She has a history of Sjogren Syndrome. The foetus would be at a risk for which of the following?
Your Answer: All correct
Explanation:Women with Sjögren syndrome are likely to experience more complications during pregnancy than women without an autoimmune disease as the anti-Ro and anti-La antibodies cross the placenta and lead to various life threatening complications. Studies show a high incidence of poor fetal outcomes for these patients. Congenital heart block, neonatal lupus, congestive cardiac failure, hydrops fetalis can all be caused as a result of Sjogren syndrome.
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This question is part of the following fields:
- Rheumatology
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Question 2
Incorrect
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A 12-year-old child has developed a fever and maculopapular rash on his back. What diagnosis should he be given?
Your Answer: Rubella
Correct Answer: Chicken pox
Explanation:Chickenpox is caused by the varicella-zoster virus. The clinical signs of infection are fever and a maculopapular rash – this is a unique rash with both flat and raised lesions on the skin.
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This question is part of the following fields:
- Child Health
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Question 3
Incorrect
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A 22 year old male presented with a cut injury at his wrist. Which of the following would be the expected clinical signs if his ulnar nerve was damaged?
Your Answer: Sensory loss of the medial part of the hand
Correct Answer: Wasting of the interossei
Explanation:Damage to the ulnar nerve at wrist will cause wasting of the interossei and adductor pollicis muscle. There won’t be any sensory loss, weakness of wrist flexion or wasting of hypothenar muscles.
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This question is part of the following fields:
- Neurology
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Question 4
Incorrect
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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: May be associated with poliomyelitis-like paralysis
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.
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This question is part of the following fields:
- Infectious Diseases
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Question 5
Incorrect
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A 40-year-old man, diagnosed and treated for his bipolar affective disorder, shows abnormal blood results. His lithium level is high while his potassium is profoundly decreased. His history reveals recent onset of anti-hypertensive drugs. Which is the drug that most likely caused these abnormalities?
Your Answer: Verapamil
Correct Answer: Thiazide
Explanation:Thiazide increase the levels of lithium and cause hypokalaemia. They function as a diuretic that inhibits reabsorption of sodium and chloride.
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This question is part of the following fields:
- Mental Health
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Question 6
Incorrect
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A 62-year-old male patient with long standing COPD presented with reduced vision of his right eye. He had been on multiple medications. Which of the following drugs is responsible for his visual deterioration?
Your Answer: Theophylline
Correct Answer: Corticosteroid
Explanation:Prolonged use of corticosteroids causes cataracts and this would be the reason for his presentation. B2 agonists, diuretics and Theophylline can cause blurred vision.
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This question is part of the following fields:
- Pharmacology
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Question 7
Incorrect
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A 28 year old man was rushed to the hospital after experiencing sudden onset chest pain while playing football. He has never felt such pain in the past. However, one of his uncles had a similar sudden discomfort at a young age and he passed away following a heart problem. The following vitals are recorded on examination:BP: 101/74 mmHgRR: 22 breaths/minPR: 87 beats/min Physical examination reveals abnormally long fingers and on asking the man to hold the opposite wrist, the thumb and little finger overlap each other. He is not taking any medication regularly and past medical/surgical history is not significant. He admits to smoking half pack of cigarettes/day for the last 10 years but denies abusing any illicit drugs. Which of the following explanation most likely explains the disease process in this man?
Your Answer: Overactive elastase enzyme leading to an excessive breakdown of collagen
Correct Answer: A defect of the glycoprotein structure which usually wraps around elastin
Explanation:Aortic dissection is defined as separation of the layers within the aortic wall. Tears in the intimal layer result in the propagation of dissection (proximally or distally) secondary to blood entering the intima-media space. This can be caused as a result of both congenital or acquired factors like chronic uncontrolled hypertension. This patient shows no sign of hypertension but his physical examination hints towards Marfan Syndrome. Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting the microfibrils and elastin in connective tissue throughout the body. MFS is associated with pathological manifestations in the cardiovascular system (e.g., mitral valve prolapse, aortic aneurysm, and dissection), the musculoskeletal system (e.g., tall stature with disproportionately long extremities, joint hypermobility), and the eyes (e.g., subluxation of the lens of the eye). Decreased collagen production occurs in ageing, hydroxylation defects are present in vitamin C deficiency, copper deficiency affecting lysyl oxidase enzyme occurs in Menke’s disease.
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This question is part of the following fields:
- Rheumatology
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Question 8
Incorrect
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A 25 year old female presents with diarrhoea and 8 kg weight loss over the last 3 months. She has also experienced amenorrhea for the past 12 weeks. Which of the following is the next best step in the management of this patient?
Your Answer: 24 hours urinary VMA (Vanillyl mandelic Acid)
Correct Answer: Thyroid Function Test
Explanation:Weight loss is most commonly linked to hyperthyroidism. An overactive thyroid gland (hyperthyroidism) or underactive thyroid gland (hypothyroidism) can cause menstrual irregularities, including amenorrhea. In this scenario, we would carry out thyroid function tests.
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This question is part of the following fields:
- Mental Health
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Question 9
Correct
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A 32 year old female has had an episode of a severe occipital headache. This is accompanied by vomiting and unconsciousness. She has been taken to the emergency department, where she is conscious and completely alert. Her pulse is normal and no abnormal neurological signs are found. From the list of options, choose the next step in her treatment.
Your Answer: CT brain
Explanation:Severe headaches and LOC can be caused by basilar migraines (but here the patient has no neurological deficit and becomes completely alert when recovering from unconscious periods). In order to diagnose basilar migraines, there needs to be a history of at least two other migraine attacks with an aura. The diagnostic criteria of a basilar migraine are not fulfilled and so the patient must not be discharged without a CT scan (or MRI).
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This question is part of the following fields:
- Neurology
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Question 10
Incorrect
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A 23 year old male presents with a history of lower back pain for the last one year. Presence of which of the following features most likely points towards ankylosing spondylitis?
Your Answer: Presence of HLA-B27 antigen on tissue typing
Correct Answer: Bilateral erosion of sacroiliac joints on X-ray
Explanation:Bilateral erosions of the sacroiliac joints on pelvic radiographs of patients with ankylosing spondylitis are an important feature of the modified New York classification criteria. Although HLA-B27 is commonly associated with AS, it can also be found in normal individuals. Back stiffness is worse in the morning and gets better as the day progresses. Tenderness and limited lumbar motion can be associated with other spine problems as well and is not characteristic of rheumatoid arthritis.
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This question is part of the following fields:
- Rheumatology
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Question 11
Incorrect
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From the list of options, choose the least useful therapy in preventing oesophageal variceal bleeding in portal hypertension.
Your Answer: Isosorbide dinitrate
Correct Answer: Variceal sclerotherapy
Explanation:Selective beta blockade and nitrates help to reduce portal pressure and therefore reduce the risk of bleeding (as does banding). Moreover, sclerotherapy, despite its use, has not actually been shown to reduce the risk of bleedings as primary prevention – however, it may reduce the risk of rebleeding after an index bleed. The mortality of variceal bleedings is known to be 50% at each episode.
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This question is part of the following fields:
- Gastrointestinal
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Question 12
Correct
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A 35 year old sales representative presents with severe pain going down her neck and right arm. She admits that this pain is worse on sitting and driving for long periods. Past history is significant for two previous road traffic accidents. Examination reveals weakness and sensory loss over C5/C6 nerve distribution. There is pain with neck movement and particularly extension. Which of the following investigations would be the most helpful in this case?
Your Answer: MRI scan of the cervical spinal cord
Explanation:Cervical radiculopathy is usually due to compression or injury to a nerve root by a herniated disc or degenerative changes. Levels C5 to T1 are the most commonly affected. It is usually, but not always, accompanied by cervical radicular pain, a sharp and shooting pain that travels from the neck and down the upper limb and may be severe. This needs to be differentiated from pain referred from the musculoskeletal (somatic) structures in the neck, which may be aching rather than sharp, and is more severe in the neck than in the upper limb. The neurological signs of cervical radiculopathy depend on the site of the lesion. The patient may have motor dysfunction, sensory deficits or alteration in tendon reflexes. While pain is a common presenting symptom, not all radiculopathies are painful (i.e. only motor deficits may be obvious). CT scanning cannot accurately demonstrate the commonest cause for cervical radiculopathy (disc herniation) without myelography, which requires hospital admission, lumbar puncture and the use of contrast. In patients with cervical radiculopathy, MRI is the imaging technique of choice for the detection of root compression by disc herniation and osteophytes. MRI allows the nerve roots to be directly visualised. Nerve conduction studies are also useful in determining the nerve roots that are involved.
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This question is part of the following fields:
- Rheumatology
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Question 13
Correct
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A young woman presents to the emergency after being involved in a fight where she was stabbed in the neck. On examination, her tongue deviates to the right side on protrusion. Which of the following nerves is involved?
Your Answer: Hypoglossal nerve injury
Explanation:The motor functions of the intrinsic tongue muscles, as well as the genioglossus, hyoglossus, and styloglossus muscles, are all innervated by the hypoglossal nerve. These muscles are essential for swallowing and speech. To test nerve function, the physical examiner has a patient protrude his or her tongue. In intranuclear, or lower motor neuron lesions, the tongue deviates toward the injured side, as the contralateral genioglossus is acting unopposed. In contrast, supranuclear (upper motor neuron) lesions result in deviation away from the lesion. In addition to causing deviation toward the lesion, an injury involving a hypoglossal nucleus may result in tongue atrophy and fasciculation
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This question is part of the following fields:
- Neurology
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Question 14
Incorrect
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A 16 year old female has been admitted to hospital after overdosing on paracetamol 4 hours ago. She has also consumed a large amount of alcohol. Her plasma paracetamol concentration is only just below a level which requires treatment. From the list of options, choose the most appropriate treatment option for this patient.
Your Answer: N-acetylcysteine
Correct Answer: Refer to psychiatry ward
Explanation:As her paracetamol level is under the required treatment threshold, she requires no medical treatment. However, she has taken a simultaneous drug overdose and excessive alcohol consumption. These two factors together require psychiatric evaluation and so she should be referred to the psychiatry ward.
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This question is part of the following fields:
- Seriously Ill
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Question 15
Correct
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A 20-year-old man presents with a history of sticky greenish discharge, accompanied by redness of the eyes, and difficulty opening his eyes in the morning. What is the single most likely cause of these symptoms?
Your Answer: Conjunctivitis
Explanation:Redness of the eyes can present in all of the conditions. However, the green sticky discharge that causes the eyelids to stick together overnight is characteristic of bacterial conjunctivitis. Bacterial conjunctivitis is an inflammatory condition of the conjunctiva in which bacteria commonly Staphylococcus Aureus invade the conjunctiva. The person experiences a foreign body feeling in the eye and mucopurulent or purulent discharge.
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This question is part of the following fields:
- Ophthalmology
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Question 16
Correct
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A 49-year-old woman suddenly experienced complete loss of vision in her right eye. Fundoscopy results show a pale retina, and a cherry red spot on the macular region. She also experienced right sided headaches aggravated by chewing. What caused her vision loss?
Your Answer: CRAO
Explanation:Central retinal artery occlusion (CRAO) is a disease of the eye where the flow of blood through the central retinal artery is blocked (occluded). There are several different causes of this occlusion; the most common is carotid artery atherosclerosis. It causes sudden vision loss in one eye. Fundoscopic exam will show a red lesion, called a cherry red spot, with surrounding pale retina (the pale colour is caused by ischemia of the retina)
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This question is part of the following fields:
- Ophthalmology
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Question 17
Incorrect
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A 29 year old female who is 32 weeks pregnant, has been admitted to hospital with very severe hypertension. This is her second pregnancy. In the United Kingdom, what is the first line of treatment for hypertension whilst pregnant?
Your Answer: Nifedipine
Correct Answer: Labetalol
Explanation:Atenolol is considered teratogenic and has two main risks: fetal bradycardia and neonatal apnoea. ACE inhibitors and angiotensin II receptor blockers are also known to be teratogenic (even though large-scale studies are difficult to conduct during pregnancies).
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This question is part of the following fields:
- Obstetrics
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Question 18
Correct
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A 60-year-old male presented with complaints of chest pain, a productive cough, blood in the sputum, and night sweats. He also has a history of weight loss. His chest X-ray revealed multiple infiltrates. Which of the following is the most appropriate investigation to be done in this case?
Your Answer: Acid fast bacilli test for sputum
Explanation:All the symptoms of this patient are characteristic features of tuberculosis. The ideal test is the acid fast bacilli test for sputum, it will confirm the preserve of Mycobacterium Tuberculosis using the Ziehl-Nelson stain.
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This question is part of the following fields:
- Respiratory
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Question 19
Correct
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A 75 year old woman presented with difficulty in climbing the stairs and difficulty in holding her head up, for the past 6 months. She didn't have any significant joint pain. Her creatinine phosphokinase level was very high and ESR was normal. Which of the following is the most probable diagnosis?
Your Answer: Polymyositis
Explanation:Polymyositis is an idiopathic inflammatory myopathy characterized by symmetrical, proximal muscle weakness, elevated skeletal muscle enzyme levels and characteristic electromyography (EMG) and muscle biopsy findings. Weak neck extensors cause difficulty holding the head up. Pain is not a significant symptom, which differentiates it from arthritic conditions. ESR is elevated in only 50% of patients with polymyositis.
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This question is part of the following fields:
- Musculoskeletal
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Question 20
Correct
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A Blood group A-ve mother gives birth to a baby who develops severe jaundice within the first 24 hours of delivery. What is the most probable diagnosis?
Your Answer: Rh incompatibility
Explanation:Jaundice is considered pathologic if it presents within the first 24 hours after birth. Although up to 60 percent of term new-borns have clinical jaundice in the first week of life, few have significant underlying disease.1,2 However, hyperbilirubinemia in the new-born period can be associated with severe illnesses such as haemolytic disease, metabolic and endocrine disorders, anatomic abnormalities of the liver, and infections. The risk factors here is the mothers blood ground which suggests the cause is fetal-maternal blood group incompatibility.
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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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A 7-month-old baby boy was brought by his parents due to frequently regurgitating his milk. On examination, he was pale and lethargic. FBC showed a microcytic anaemia. Which of the following is the most probable diagnosis?
Your Answer: Duodenal atresia
Correct Answer: Hiatus hernia
Explanation:Frequent regurgitation of milk and microcytic anaemia is suggestive of a hiatus hernia. The reflux causes regurgitation of milk and frequent ulceration of the lower oesophageal mucosa potentially resulting in blood loss and anaemia. Duodenal atresia usually presents with bilious vomiting and pyloric stenosis presents with projectile vomiting. Alpha 1 antitrypsin deficiency and cystic fibrosis usually do not present with vomiting.
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This question is part of the following fields:
- Child Health
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Question 22
Incorrect
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Choose the single most appropriate landmark located above the mid-inguinal point from the list of options.
Your Answer: McBurney’s point
Correct Answer: Deep inguinal ring
Explanation:The deep inguinal ring is located above the mid-inguinal point.
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This question is part of the following fields:
- Musculoskeletal
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Question 23
Correct
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From the list of options, choose the most likely anaesthetic or analgesic cause of maternal hypotension.
Your Answer: Epidural anaesthetic
Explanation:In spinal anaesthesia, the needle parts the dura rather than tears it. In an epidural, however, the needle is meant to inject around the dura but may penetrate it by accident. Maternal hypotension is most likely to be caused by dural penetration during an epidural, as this is the generally intended procedure. Postdural puncture headache appears to be associated higher with a spinal than an epidural.
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This question is part of the following fields:
- Seriously Ill
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Question 24
Correct
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A 40 year old female presented with pain and whitening of the hands on exposure to cold. She has difficulty in swallowing solid foods so she has started swallowing only liquids. She developed shortness of breath on exertion and, subsequently, at rest. Which of the following is the most likely cause for dysphagia in this patient?
Your Answer: Systemic sclerosis
Explanation:Difficulty in swallowing which improves with liquids is mainly due to an obstructive lesion in oesophagus. But pulmonary involvement (breathlessness on exertion and later on rest) and Raynaud’s phenomena can only be described by systemic sclerosis.
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This question is part of the following fields:
- Seriously Ill
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Question 25
Correct
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A 28 year old male who has undergone splenectomy for an abdominal trauma presents on the 3rd post operative day with acute abdominal pain and distension in the upper abdominal area with hypotension. 2 litres of coffee ground powder was aspirated on insertion of ryles tubes. Which of the following is the most likely diagnosis?
Your Answer: Acute gastric dilatation
Explanation:Acute gastric dilation leading to ischemia of the stomach is an under-diagnosed and potentially fatal event. Multiple aetiologies can lead to this condition, and all physicians should be aware of it. Acute gastric dilation occurs as a result of eating disorders, trauma resuscitation, volvulus of hiatal hernias, medications, electrolyte abnormalities, psychogenic polyphagia, superior mesenteric artery syndrome, and a myriad of other conditions. Without proper and timely diagnosis and treatment, gastric perforation, haemorrhage, and other serious complications can occur.
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This question is part of the following fields:
- Gastrointestinal
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Question 26
Incorrect
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A 35-year-old female presented with purple stretch marks on her abdomen, easy bruising and weight gain. A low dose Dexamethasone suppression test did not show any but a high dose Dexamethasone suppression test showed suppression of cortisol levels. Which of the following is the most likely cause for this presentation?
Your Answer: Ectopic Adrenocorticotropic Hormone (ACTH) source
Correct Answer: Pituitary Adenoma
Explanation:Clinical features are due to excess cortisol. High-dose dexamethasone suppression test shows suppression in patients with Cushing’s disease. Cushing syndrome includes all causes of glucocorticoid excess, whereas Cushing’s disease is reserved only for pituitary-dependent Cushing’s syndrome.
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This question is part of the following fields:
- Endocrine
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Question 27
Correct
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A healthy 8 month old baby boy was brought in by his parents, who claimed that the baby had come into close contact with another child with measles two days ago. Which of the following is the most appropriate management?
Your Answer: She should receive the MMR vaccine now together with measles immunoglobulin
Explanation:People who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women without evidence of measles immunity, and people with severely compromised immune systems, should receive immunoglobulin. Intramuscular immunoglobulin should be given to all infants younger than 12 months of age who have been exposed to measles. For infants aged 6 through 11 months, MMR vaccine can be given in place of IG, if administered within 72 hours of exposure.
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This question is part of the following fields:
- Child Health
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Question 28
Incorrect
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Which of the following would be the most appropriate treatment (leaving out the current NICE guidelines) for a 29 year old man with erythrodermic psoriasis and arthritis mutilans involving several digits of both hands?
Your Answer: Methotrexate
Correct Answer: Etanercept
Explanation:TNF-alpha inhibitors are known to ameliorate the symptoms and disease activity of Arthritis mutilans (a rare and severe form of psoriatic arthritis), by disabling the cytokines that are involved in inflammation and joint destruction. From the mentioned choices, this would be the most effective option. Methotrexate is the most commonly used DMARD, followed by sulfasalazine used in mild to moderate forms of psoriatic arthritis but has not shown much efficacy in arthritis mutilans. Phototherapy, narrowband UVB light therapy can be very effective in clearing skin lesions.
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This question is part of the following fields:
- Rheumatology
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Question 29
Correct
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The following drugs are given for different types of respiratory conditions. Which of the following drugs exerts its action by inhibiting phosphodiesterase?
Your Answer: Theophylline
Explanation:Theophylline relaxes the smooth muscles of the respiratory tract and suppresses the response of the airways to stimuli by increasing tissue concentration of cyclic adenine monophosphate (cAMP) by inhibiting phosphodiesterase. Dobutamine has strong beta1 and weak beta2/alpha effects, resulting in increased cardiac output, blood pressure, and heart rate, as well as decreased peripheral vascular resistance. Doxapram produces respiratory stimulation in medulla through peripheral carotid chemoreceptors. Ipratropium inhibits vagally mediated reflexes by antagonizing acetylcholine action which prevents increase in intracellular calcium concentration and ultimately causes bronchial smooth muscle relaxation. Salbutamol is a short-acting β2 adrenergic receptor agonist which causes smooth muscle relaxation.
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This question is part of the following fields:
- Pharmacology
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Question 30
Correct
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From the following options, choose the one which is most characteristic of early Alzheimer's disease.
Your Answer: Impaired short term memory
Explanation:Alzheimer’s disease is most often characterized early on by short-term memory loss. The other options in this list are characteristic of the following: normal pressure hydrocephalus (gait ataxia and urinary incontinence); Creutzfeldt-Jakob disease (myoclonic jerks); delirium or Lewy body dementia (visual hallucinations).
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This question is part of the following fields:
- Mental Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
