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Question 1
Incorrect
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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: Glossopharyngeal nerve
Correct 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 2
Incorrect
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A 15-year-old boy complains of fever, headache, and neck stiffness. On examination, Kernig's and Brudzinski's signs were positive. In the meantime, while awaiting the results from blood culture, how will you manage this patient?
Your Answer: Benzylpenicillin
Correct Answer: Cefotaxime
Explanation:Positive Kernig’s and Brudzinski’s signs may indicate meningitis. While awaiting blood culture results, a broad-spectrum antibiotic such as Cefotaxime (a third generation cephalosporin) is preferred over the other medications listed.
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This question is part of the following fields:
- Pharmacology
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Question 3
Incorrect
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A 21 year old patient presents with multiple itchy wheals on his skin. The wheals are of all sizes and they are exacerbated by scratching. The symptoms started after a viral infection and can last up to an hour. What is the most likely diagnosis?
Your Answer: Primary biliary cirrhosis
Correct Answer: Urticaria
Explanation:Urticaria is a group of disorders that share a distinct skin reaction pattern, namely the occurrence of itchy wheals anywhere on the skin. Wheals are short-lived elevated erythematous lesions ranging from a few millimetres to several centimetres in diameter and can become confluent. The itching can be prickling or burning and is usually worse in the evening or night time. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear.
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This question is part of the following fields:
- Dermatology
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Question 4
Correct
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A 61 year old male presented to the emergency with renal colicky pain and a subsequent passage of stone the next day. Radiological examination, however, revealed no signs of calculi. The renal calculus was most likely composed of which of the following?
Your Answer: Uric acid
Explanation:Calcium-containing stones are relatively radio dense, and they can often be detected by a traditional radiograph of the abdomen that includes the kidneys, ureters, and bladder (KUB film). Some 60% of all renal stones are radiopaque. In general, calcium phosphate stones have the greatest density, followed by calcium oxalate and magnesium ammonium phosphate stones. Cystine calculi are only faintly radio dense, while uric acid stones are usually entirely radiolucent.
Uric acid is the relatively water-insoluble end product of purine nucleotide metabolism. It poses a special problem because of its limited solubility, particularly in the acidic environment of the distal nephron of the kidney. It is problematic because humans do not possess the enzyme uricase, which converts uric acid into the more soluble compound allantoin. Three forms of kidney disease have been attributed to excess uric acid: acute uric acid nephropathy, chronic urate nephropathy, and uric acid nephrolithiasis. These disorders share the common element of excess uric acid or urate deposition, although the clinical features vary.
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This question is part of the following fields:
- Renal
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Question 5
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 6
Correct
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Which one of the following factors is the most likely etiological factor for abnormally short stature amongst children?
Your Answer: Familial short stature
Explanation:Familial/inherited short stature is the most likely and commonest factor resulting in short stature among the children. Klinefelter syndrome is characterised by tall stature, widely spaces nipples and infertility. Other factors include congenital heart disease, maternal deprivation and diabetes mellitus but these are the rare causes.
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This question is part of the following fields:
- Child Health
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Question 7
Incorrect
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A 4-year old boy arrives at the clinic due to sudden onset knee pain that has been occurring over the past 2 days. The pain is associated with mild fever that started on the 2nd day. The patient is able to walk but with a limp. Examination reveals painful and restricted motion of the right hip. Which of the following is the most likely diagnosis responsible for this presentation?
Your Answer: Osteomyelitis
Correct Answer: Septic arthritis
Explanation:Septic (infectious) arthritis is a bacterial infection of the joint space. Contamination occurs either via the bloodstream, iatrogenically, or by local extension (e.g., penetrating trauma). Patients with damaged (e.g., patients with rheumatoid arthritis) or prosthetic joints have an increased risk. Patients usually present with an acutely swollen, painful joint, limited range of motion, and a fever. Suspected infectious arthritis requires prompt arthrocentesis for diagnosis. In addition to the immediate broad-spectrum antibiotic therapy, surgical drainage and debridement may be necessary to prevent cartilage destruction and sepsis.
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This question is part of the following fields:
- Musculoskeletal
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Question 8
Correct
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A 60 year old male presents with a 6 month history of poor sleep and a loss of interest in his normal activities. He has recently become very forgetful and responds to many questions with the phrase I don't know. Choose the most likely diagnosis for this patient.
Your Answer: Depression
Explanation:Many of this patient’s symptoms are consistent with depression: having no motivation or interest in things, finding it difficult to make decisions, and a disturbed sleeping pattern.
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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 70-year-old female from a nursing home presented in the emergency department with complaints of headache, blurred vision and confused state for the last 4 to 5 days. On examination, she has several bruises on her head. Which of the following is the most likely cause behind the confused state of this patient?
Your Answer: Subdural hematoma
Explanation:Bruises on her head are suggestive of a head injury. Confused state with a headache and blurred vision are due to a subdural hematoma.
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This question is part of the following fields:
- Seriously Ill
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Question 10
Correct
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A 20 year old female is suffering from amenorrhea. She has a BMI of 14 but still thinks that she needs to lose weight. Choose the most likely diagnosis.
Your Answer: Anorexia nervosa
Explanation:Anorexia is consistent with the symptoms described.
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This question is part of the following fields:
- Mental Health
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Question 11
Incorrect
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A 34 year-old gentleman presented with 3 months history of abdominal pain, intermittent diarrhoea, melena and loss of weight. The most likely diagnosis will be?
Your Answer: Irritable bowel disease
Correct Answer: Inflammatory bowel disease
Explanation:Inflammatory bowel disease (IBD) is characterized by abdominal and pelvic pain, intermittent diarrhoea, loss of weight and tenesmus. Irritable bowel disease is associated either with diarrhoea or constipation and occurs in stressful conditions for the individual. A UTI is characterised by dysuria, fever and lumbar pain. Adenomyosis is characterised by heavy menstrual bleeding and chronic pelvic pain.
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This question is part of the following fields:
- Gastrointestinal
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Question 12
Incorrect
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A 35-year-old heroin addict came with his wife. He wanted to quit heroin use and his wife was willing to help him. What is the most appropriate drug that can be started?
Your Answer: Diazepoxide
Correct Answer: Methadone
Explanation:Methadone is a synthetic opiate primarily used in the detoxification and maintenance of patients who are dependent on opiates, particularly heroin. Methadone inhibits the ascending pain pathways and diminishes the perception of and response to pain. Benefits of methadone include good treatment retention, psychosocial adjustment, and reduced criminal activity.
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This question is part of the following fields:
- Mental Health
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Question 13
Incorrect
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Which is the most appropriate agent for the prophylaxis of cluster headaches?
Your Answer: Sumatriptan
Correct Answer: Verapamil
Explanation:Verapamil, can effectively reduce the number of attacks during a cluster headache period of exacerbation. Oral sumatriptan has not been shown to be effective prophylactically. Verapamil in dosages of 360 to 480 mg daily is one of the few treatments for episodic cluster headache tested in a randomized controlled trial (RCT) and found effective in reducing attack frequency.
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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 34-year-old woman presented to you with low mood, anhedonia and loss of weight. She refuses to eat or drink and believes that she does not deserve to live. What is the most appropriate treatment?
Your Answer: Fluoxetine
Correct Answer: ECT
Explanation:The lady is having a serious level of postpartum depression associated with violent thoughts that require immediate intervention. ECT shows good results in these cases. It is done under general anaesthesia but its mechanism of action is not quite understood.
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This question is part of the following fields:
- Mental Health
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Question 15
Incorrect
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A patient shows reduced central vision upon visual acuity test. He is advised to undergo a fundoscopy, which turns out to be normal. Which drug could be responsible for his symptoms?
Your Answer: Ethambutol
Correct Answer: Corticosteroids
Explanation:Corticosteroids are well known for their ocular complications such as glaucoma and cataracts.
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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 35-year-old woman with no psychiatric history has attempted suicide 10 times. Her neurological examination is apparently normal. What would be the most appropriate management?
Your Answer: Problem focussed treatment
Explanation:Problem focussed treatment focuses on solutions to the problem, rather than on the problem itself that brought patients to seek therapy, in this case the suicide attempts. The patient seems to be parasuicidal which is a feature of some personality disorders such as histrionic and borderline personality disorders which do not require medical treatment but psychotherapy.
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This question is part of the following fields:
- Mental Health
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Question 17
Incorrect
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A 85 year old male with a history of Alzheimer's dementia was brought into Casualty by family members, who stated that he had episodes of aggression. Which of the following drugs is most suitable as the pharmacological management for this presentation?
Your Answer: Temazepam
Correct Answer: Risperidone
Explanation:Regarding the pharmacological management, Risperidone is the most suitable drug from the given answers as it is recommended for the treatment of aggression associated with moderate to severe Alzheimer’s disease. Quetiapine and Benzodiazepine are not recommended.
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This question is part of the following fields:
- Older Adult
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Question 18
Incorrect
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A 40-year-old male presented to the OPD complaining of dysphagia. General physical examination revealed creamy white patches on the tongue as well as on the inner side of the cheeks. There was slight bleeding when an attempt was made to scrape off the white patches. What is the most likely diagnosis in this case?
Your Answer: Isospora belli
Correct Answer: Candida albicans
Explanation:Candida Albicans is a pathogenic yeast which forms a thrush in the oral cavity. Candida also causes infection in the oesophagus, known as oesophageal candidiasis, that can manifest as dysphagia.
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This question is part of the following fields:
- ENT
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Question 19
Correct
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A 23-year-old female visited the OPD with a complaint of postcoital bleeding as well as excessive vaginal discharge. Her past medical history is positive for oral contraceptive pills. Which of the following investigations would you recommend in this case?
Your Answer: Speculum with or without cervical smear
Explanation:A speculum test is necessary in order to visualize the cervix to rule out cervical ectropion that may be responsible for the post-coital bleeding. A smear is not necessary if the cervix is adequately visualized, however, it can rule out infection as well.
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This question is part of the following fields:
- Genitourinary
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Question 20
Correct
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A 45 year old male presented with chronic diarrhoea and right lower abdominal pain. On examination he was febrile and there was tenderness over the right lower quadrant and an anal fissure. Which of the following is the most probable cause for his abdominal pain?
Your Answer: Inflammatory bowel disease (IBD)
Explanation:From the given answers, IBD and IBS are the causes for chronic diarrhoea. Pyelonephritis and ureteric colic are associated with urinary symptoms. Tenderness of pyelonephritis is at the loin region. Perianal disease is associated with fifty percent of patients with Crohn’s disease.
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This question is part of the following fields:
- Gastrointestinal
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Question 21
Incorrect
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A 11 year old girl with a history of recurrent chest infections, was admitted with a fever, productive cough, anorexia and weight loss. On examination she was febrile and tachycardic. Her mother said that the girl was not thriving well. Which of the following organisms is responsible for this presentation?
Your Answer: Pneumococcal pneumonia
Correct Answer: Pseudomonas
Explanation:History of recurrent infections and failure to thrive (probably due to pancreatic enzyme insufficiency) is highly suggestive of cystic fibrosis. Pseudomonas has been identified as an important respiratory pathogen in patients with cystic fibrosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 22
Incorrect
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A 37-year-old male patient presented with bilateral kidney stones. He gave a history of sarcoidosis. What is the most probable cause for renal stones?
Your Answer: Diet
Correct Answer: Hyper calcaemic
Explanation:Sarcoidosis is a multisystem granulomatous disorder which may involve the kidneys to a variable degree. Renal calculi have been reported to occur in about 10% of patients with chronic sarcoidosis. Hypercalcaemia due to marked hyperabsorption of dietary calcium, bone resorption and renal tubular calcium reabsorption causes hypercalciuria. Both hypercalcemia and hypercalciuria contribute to nephrolithiasis.
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This question is part of the following fields:
- Urology
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Question 23
Incorrect
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A 69 year old male with a history of Hepatitis C liver cirrhosis presented with spontaneous bacterial peritonitis. He had no symptoms of hypovolaemia. Choose the best treatment option to prevent the patient from developing hepatorenal syndrome.
Your Answer: Central venous pressure monitoring
Correct Answer: Intravenous albumin administration
Explanation:In randomised controlled trials, the administration of albumin has been shown to lower the risk of the hepatorenal syndrome – this is thought to be due to its positive effect on circulatory systems. Diuretics can aid in the prevention of renal failure, but this patient is not showing signs of hypovolaemia. Synthetic disaccharide lactulose is primarily used for the prevention of hepatic encephalopathy, which has no function in preventing hepatorenal syndrome. Limited evidence is available for the use of Neomycin as a treatment for hepatic encephalopathy, but is associated with nephrotoxicity and ototoxicity.
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This question is part of the following fields:
- Renal
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Question 24
Incorrect
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A 13 year old patient presents in the A&E with a fracture of his left femur. He was a passenger in a car involved in a traffic accident. Upon clinical examination, his left posterior tibial and dorsalis pedis arteries are not palpable. Which of the following is most probably injured?
Your Answer: Sciatic artery
Correct Answer: Femoral artery
Explanation:The femoral artery is the one accompanying the femoral shaft, being the most important blood supplier of the leg. Femoral artery injury during a femur shaft fracture is quite common as a result of blunt trauma.
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This question is part of the following fields:
- Child Health
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Question 25
Incorrect
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In the functional unit of the liver (acinus), the oxygenation…
Your Answer: Reduces towards the periphery
Correct Answer: Reduces towards the centre
Explanation:Cells located close to the portal triad or peripheral zone which consist of arterioles from the hepatic artery are the most oxygenated cells. Cells in the central zone are least oxygenated and mainly receive blood supply from the central vein which is a branch of the hepatic vein.
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This question is part of the following fields:
- Hepatobiliary
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Question 26
Correct
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A 70-year-old male patient with hypertension complains of acute urinary retention. He provides a history of urinary frequency for the past 18 months and has been taking Nifedipine and Propranolol for blood pressure control. Which of the following is the most probable cause for his acute presentation?
Your Answer: Drug induced
Explanation:Calcium channel blockers decrease smooth-muscle contractility in the bladder and this can cause urinary retention.
An enlarged prostate gland could be the reason if he gave a history of obstructive symptoms.
Diabetes presents with polyuria.
Bladder cancer commonly presents with painless haematuria. -
This question is part of the following fields:
- Genitourinary
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Question 27
Incorrect
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A 30-year-old male presented with a history of bloody and mucoid diarrhoea since that morning. He is also complaining of abdominal spasm and bloating. Which of the following investigations is the most suitable one in this case?
Your Answer: Barium meal
Correct Answer: Stool culture and sensitivity
Explanation:In a case of sudden bloody and mucoid diarrhoea, stool culture and sensitivity are required to access which organism is causing the problem and to discuss appropriate antibiotics.
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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 48 year old patient presents with subjective symptoms such as fullness of the left ear and tinnitus. He also experiences recurrent vomiting. What is the most appropriate treatment?
Your Answer: Oral fluphenazine
Correct Answer: Buccal prochlorperazine
Explanation:Meniere’s disease is a disorder of the inner ear. The cause is unknown, however it typically presents with nausea/vomiting, vertigo and ear complaints such as fullness of the ear, deafness and tinnitus. There is no cure for Meniere’s disease but medications, diet, physical therapy and counselling, and some surgical approaches can be used to manage it. Buccal prochlorperazine is used for relieving nausea, vomiting and vertigo attacks associated with Meniere’s disease and other inner ear disorders, such as labyrinthitis.
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This question is part of the following fields:
- ENT
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Question 29
Incorrect
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An 18 year-old female is brought in by her worried parents. She has a BMI of 12 but is otherwise happy with her weight. What is the next best step to help this girl?
Your Answer:
Correct Answer: Medical admission
Explanation:Anorexia nervosa, commonly referred to as anorexia, is an eating disorder characterized by low body weight, a distortion of the perception of body image, and an obsessive fear of gaining weight. A BMI below 17.5 in adults is one of the common physical characteristics used to diagnose anorexia. There are also different tiers of anorexia based on BMI ranging from mild (<17.5), moderate (16-16.99), and severe (15-15.99), to extreme (<15). A BMI below 13.5 can lead to organ failure, while a BMI below 12 can be life threatening. At this critical low BMI medical admission is indicated to improve her deficiency states and for proper nutrition.
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This question is part of the following fields:
- Mental Health
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Question 30
Incorrect
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A 71 year old woman presents with dyspnoea and unsteadiness. She's known to suffer from epilepsy and is managed on carbamazepine. Blood exams are as follows: MCV=70, Hb=8.5, WBC=2, Neutrophils=1, Platelets=50. What is the most likely diagnosis?
Your Answer:
Correct Answer: Aplastic anaemia
Explanation:The results of the blood exam are suggestive of aplastic anaemia which might be secondary to carbamazepine use. The use of antiepileptic’s, in particular carbamazepine and valproate, is associated with a nine fold increased risk of aplastic anaemia.
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This question is part of the following fields:
- Haematology
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SESSION STATS - PERFORMANCE PER SPECIALTY
