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Question 1
Incorrect
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A 45-year-old female presented with the complaint of menorrhagia for the last 2 years. No pharmacological treatment has worked. She has had all the children she wants but refuses any open surgical procedure. Which of the following is the most suitable option for her?
Your Answer: Endometrial ablation
Correct Answer: Uterine artery embolization
Explanation:Uterine artery embolization does not require open surgery or GA.
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This question is part of the following fields:
- Genitourinary
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Question 2
Incorrect
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A 43 year old female had a cervical smear test. The results came back showing only normal findings. What is the most appropriate management for this patient?
Your Answer:
Correct Answer: Repeat cervical smear in three years
Explanation:Screening for cervical carcinoma helps to prevent the development of the disease. According to NICE, the screening interval using liquid-based cytology (as opposed to PAP) is 3 years for women less than 50 years old and 5 years for women over 50 years old. If a smear test is conducted and it shows no endocervical cells then it should be conducted again.
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This question is part of the following fields:
- Genitourinary
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Question 3
Incorrect
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A woman suffering from severe psoriasis has been undergoing treatment for it for the last 3 years. She now presents with lethargy and dizziness. Her blood film shows large red blood cells. What is the cause of these symptoms in this woman?
Your Answer:
Correct Answer: Methotrexate
Explanation:Methotrexate is also known as a DMARD (Disease Modifying Anti Rheumatic Drug). It reduces inflammation and suppresses the immune system, and is thought to cause folic acid deficiency leading to megaloblastic anaemia.
NSAIDS and Sulfasalazine are known to cause haemolytic but not megaloblastic anaemia.
Chronic disease might be accompanied with normocytic or microcytic anaemia as opposed to the macrocytic anaemia this patient is suffering from.
Steroids are not known to cause anaemia. -
This question is part of the following fields:
- Pharmacology
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Question 4
Incorrect
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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.
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This question is part of the following fields:
- Gynaecology
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Question 5
Incorrect
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A 44 year old woman was admitted with dull retrosternal chest pain. History reveals the pain has been present for two weeks. Clinical examination and ECG, however, show nothing interesting. CXR shows an air-fluid level behind the heart. Which hernia would explain this presentation?
Your Answer:
Correct Answer: Hiatal
Explanation:A hiatal hernia may be asymptomatic, however classically it presents on CXR with a very characteristic air-fluid level behind the heart. If pain is present, PPIs can be administered. If pain is persistent, surgical intervention should be considered to ameliorate the risk of strangulation. There are two types of hiatal hernias; sliding or Para oesophageal.
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This question is part of the following fields:
- Gastrointestinal
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Question 6
Incorrect
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A 30 year old male with a scaphoid fracture came to the clinic after 2 weeks of applying the scaphoid cast. After removing the cast he had difficulty moving his thumb, index and middle fingers. Which of the following is the most appropriate management for this presentation?
Your Answer:
Correct Answer: Release of flexor retinaculum
Explanation:This patient has carpal tunnel syndrome which involves the median nerve. The treatment is releasing of the flexor retinaculum.
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This question is part of the following fields:
- Neurology
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Question 7
Incorrect
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A west Indian man complains of limb and abdominal pain. He is also anaemic and has frequent infections, which precipitate these symptoms. On examination, his spleen is not palpable and he has a mild jaundice. What is your most probable diagnosis?
Your Answer:
Correct Answer: Sickle cell disease
Explanation:Sickle cell disease (SCD) and its variants are genetic disorders resulting from the presence of a mutated form of haemoglobin, haemoglobin S (HbS). This leads to a rigid, sickle-like shape of red blood cells under certain circumstances which can result in attacks of pain (sickle cell crisis), anaemia, swelling in the hands and feet, bacterial infections and stroke. Anaemia and jaundice happen due to insufficient healthy red blood cell capacity and increased breakdown of haem groups by the liver.
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This question is part of the following fields:
- Gastrointestinal
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Question 8
Incorrect
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A 69 year old female presents to the clinic with complaint of vaginal bleeding that has been present for 3 months. Pipelle endometrial sampling and curettage reveals adenocarcinoma. Which of the following treatment options would be the most suitable for this patient?
Your Answer:
Correct Answer: Total abdominal hysterectomy and bilateral salpingo-oophorectomy
Explanation:Endometrial cancer is the most common cancer of the female genital tract in the US, with a peak incidence between 60 and 70 years of age. Endometrial cancers can be divided into two types based on histological characteristic; type I cancers account for 75% of all endometrial cancers and are of endometrioid origin, while type II cancers originate from serous or clear cells.
Several risk factors are associated with the development of endometrial cancer, of which the most important is long-term exposure to increased oestrogen levels, especially in type I cancer. The main symptom is often painless, vaginal bleeding, which presents at an early stage. Later stages may manifest with pelvic pain and a palpable mass, whereby pelvic exams are often normal.
The diagnosis is made primarily via an endometrial biopsy, which shows endometrial hyperplasia and atypical cells. Additional imaging studies (e.g., ultrasonography, abdominal CT, X-ray) are usually required for the detection and staging of metastases. Treatment of early stage endometrial cancer involves hysterectomy with adnexectomy and may also require additional lymph node removal. Radical hysterectomy according to the Wertheim-Meigs method is performed in cases of advanced carcinomas and can be combined with radiotherapy and progestin treatment. The prognosis is usually favourable in cancers diagnosed at an early stage.
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This question is part of the following fields:
- Genitourinary
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Question 9
Incorrect
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Prenatal screening is recommended if ultrasound scan at 16 weeks confirms that the foetus is male and the mother has had an affected son previously. Choose the single most likely condition from the following list of options. 7
Your Answer:
Correct Answer: Duchene muscular dystrophy
Explanation:The condition should be an X-linked recessive condition, as it affects only male offspring. Duchene muscular dystrophy is an X-linked recessive condition. Cystic fibrosis is an autosomal recessive disorder. Spina bifida is a multifactorial condition. Down syndrome is caused by trisomy of chromosome 21. Spinal muscular atrophies are inherited in an autosomal-recessive pattern.
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This question is part of the following fields:
- Obstetrics
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Question 10
Incorrect
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A 41-year-old woman has been feeling down lately. She has been avoiding social events and has a strong family history of depression. Which of the following increases her suicidal tendency?
Your Answer:
Correct Answer: Past history of overdose
Explanation:A large prospective study identified hopelessness, higher levels of suicidal ideation, recurrent episodes of depression, presence of personality disorders, previous psychiatric hospitalisation, older age, unemployed status and a family history of suicide as significant markers for suicide. Having one or more previous suicide attempts is a very strong predictor of suicide risk.
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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 45-year-old male is suffering from bronchial carcinoma. This is causing obstruction of the superior vena cava. Which of the following is the most suitable palliative treatment option in this case?
Your Answer:
Correct Answer: Radiotherapy
Explanation:Bronchial carcinoma causes obstruction of the superior vena cava through its mass effect. From the options listed in this case, radiotherapy is the most suitable treatment option.
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This question is part of the following fields:
- Cardiovascular
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Question 12
Incorrect
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A 7-year-old child presented to the paediatric clinic with a swollen face, hands and feet. She gained 2 kilograms over the last month despite poor feeding. What is the investigation of choice in this case?
Your Answer:
Correct Answer: Urinary albumin
Explanation:This is a case of nephrotic syndrome that can be confirmed by the presence of urinary albumin. It should be further investigated by a tissue sample to confirm the diagnosis.
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This question is part of the following fields:
- Child Health
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Question 13
Incorrect
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A 50-year-old heavy drinker is brought to the A&E in a drowsy state. He is responding to questions however on examination he has nystagmus and hyper-reflexia. His MCV is 103fL.What is the most likely cause for his cognitive impairment?
Your Answer:
Correct Answer: B1 Deficiency
Explanation:Thiamine deficiency is very common with alcoholism. It manifests by Wernicke-Korsakoff encephalopathy. The patient is usually agitated, with an abnormal gait and amnesia.
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This question is part of the following fields:
- Gastrointestinal
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Question 14
Incorrect
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Which statement regarding the abdominal planes is the most accurate?
Your Answer:
Correct Answer: The transpyloric plane lies halfway between the xiphoid and the symphysis pubis.
Explanation:The transpyloric plane, also known as Addison’s plane, is an imaginary horizontal plane, located halfway between the suprasternal notch of the manubrium and the upper border of the symphysis pubis at the level of the first lumbar vertebrae, L1.
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This question is part of the following fields:
- Surgery
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Question 15
Incorrect
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A 28-year-old young woman with acute psychosis on haloperidol 5mg twice daily is now unable to sleep. What is the next line treatment?
Your Answer:
Correct Answer: Lorazepam
Explanation:Propranolol prolongs the action of benzodiazepines. Thus, it is useful for sedation in acute psychosis rather than using high doses of benzodiazepines. Its use is also preferred because it decreases the addictive potential of benzodiazepines.
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This question is part of the following fields:
- Mental Health
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Question 16
Incorrect
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A 3 year old girl is brought to the clinic by her mother due to burning micturition, frequency and urgency. She is also experiencing some suprapubic tenderness. Which of the following investigations should be done initially?
Your Answer:
Correct Answer: Clean catch of urine for Culture &Sensitivity
Explanation:Urine culture and sensitivity is used to diagnose a urinary tract infection (UTI). A mid-stream clean catch urine sample is the most common type of sample collected. It is important to follow the clean catch process to have accurate results from an uncontaminated sample. Urine cultures can also check for infections of the bladder or kidney.
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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 2 year old boy was brought to the physician by his mother with a history of a swelling on the right side of his neck that is extending from the angle of mouth to the middle 1/3rd of sternocleidomastoid muscle. On examination the swelling was on the anterolateral aspect of the muscle and was found to be brilliantly transilluminant. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Lymphangioma
Explanation:A lymphangioma is a swelling or mass that occurs mainly in the head, neck, and mouth. Lymphangiomas are the result of a congenital condition and are usually apparent at birth, or at least by the time a person is 2 years old. It is rare in adult population and when detected, it can be treated with surgical excision. Branchial cyst in most cases does not transilluminate which lymphangioma does.
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This question is part of the following fields:
- ENT
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Question 18
Incorrect
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A 27-year-old patient is admitted to a psychiatric ward with acute psychosis and a history of acute dystonia. Which is the most appropriate pharmacological treatment for the acute psychosis?
Your Answer:
Correct Answer: Olanzapine
Explanation:Olanzapine is an atypical antipsychotic which has the same efficacy of the traditional drugs with less side effects, especially extrapyramidal effects, such as dystonia. Other atypical antipsychotics include: risperidone, quetiapine and amisulpride. These drugs are increasingly widely used in the treatment of schizophrenia due to their favourable side effect profile over older drugs.
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This question is part of the following fields:
- Mental Health
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Question 19
Incorrect
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An 82 year old patient presents to the clinic complaining of palpitations. ECG reveals waves with saw-tooth pattern, QRS complex of 80ms duration, a ventricular rate of 150/min and a regular R-R interval. Which of the following is most likely responsible for these findings?
Your Answer:
Correct Answer: Atrial flutter
Explanation:Atrial flutter is a common supraventricular tachyarrhythmia that is usually caused by a single macroreentrant rhythm within the atria, associated with a sawtooth appearance on the ECG. In stable patients the treatment includes rate control and rhythm control, however in unstable patients, a synchronized cardioversion is required.
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This question is part of the following fields:
- Cardiovascular
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Question 20
Incorrect
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A 62-year-old male presented with loss of weight and tenesmus. Colonoscopy revealed rectal carcinoma. All of the following are risk factors except:
Your Answer:
Correct Answer: High fibre diet
Explanation:There are several risk factors for colorectal carcinoma including:
– Age – >90% of cases occur in people over 50
– Inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.
– A personal or family history of colorectal cancer or colorectal polyps.
– A genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome).
Lifestyle factors that may contribute to an increased risk of colorectal cancer include—
– Lack of regular physical activity.
– A diet low in fruit and vegetables.
– A low-fibre and high-fat diet, or a diet high in processed meats.
– Overweight and obesity.
– Alcohol consumption.
– Tobacco use. -
This question is part of the following fields:
- Seriously Ill
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Question 21
Incorrect
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A 47-year-old woman is being treated with steroids for her diagnosis of giant cell arteritis (GCA). What is the other drug that can be added to this?
Your Answer:
Correct Answer: Aspirin
Explanation:Low dose aspirin is proven efficient in aversion of complications connected with giant cell arteritis such as stroke.
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This question is part of the following fields:
- Pharmacology
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Question 22
Incorrect
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A 57-year-old female presented to the cardiology centre with a history of chest tightness for a few hours, accompanied by pain radiating to the left side of the shoulder and neck. ECG was normal. What is the next best investigation for this patient?
Your Answer:
Correct Answer: Cardiac enzymes
Explanation:This patient’s symptoms of angina radiating to the neck and shoulders gives a strong suspicion of MI. Cardiac enzymes such as troponins are highly specific and sensitive for a heart attack.
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This question is part of the following fields:
- Cardiovascular
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Question 23
Incorrect
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What would you administer to a child with a clean wound that has never been immunized before, assuming there is no contraindication to immunization?
Your Answer:
Correct Answer: Full course of diphtheria, tetanus, polio
Explanation:A not immunized patient with a clean wound requires an immediate vaccination against diphtheria, tetanus and polio, according to the Green Book of Immunisation against infectious disease. (The Green Book has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.)
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This question is part of the following fields:
- Child Health
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Question 24
Incorrect
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An 18-year-old female patient presents with a history of headache and photophobia. You believe that the diagnosis is subarachnoid haemorrhage but your colleague insists on bacterial meningitis. Which of the following would you use to support your diagnosis?
Your Answer:
Correct Answer: A family history of polycystic renal disease
Explanation:Hypertension could be the result of polycystic renal disease and is a risk factor for subarachnoid haemorrhage (SAH). What are common in polycystic renal disease are cerebral aneurysms which could rupture if hypertension is present. Both meningitis and SAH can lead to a fluctuating level of consciousness and opiate abuse is not a risk factor for either SAH nor meningitis. Finally, diabetes is not linked with none of the possible diagnoses because hypertension is not a risk factor of diabetes.
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This question is part of the following fields:
- Neurology
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Question 25
Incorrect
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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.
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This question is part of the following fields:
- Musculoskeletal
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Question 26
Incorrect
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A 43-year-old woman complains of a greenish foul smelling discharge from her left nipple. She has experienced the same case before. What is the most likely diagnosis?
Your Answer:
Correct Answer: Duct ectasia
Explanation:Mammary duct ectasia occurs when the lactiferous duct becomes blocked or clogged. This is the most common cause of greenish discharge. Mammary duct ectasia can mimic breast cancer. It is a disorder of peri- or post-menopausal age.
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This question is part of the following fields:
- Breast
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Question 27
Incorrect
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A 3-year-old was brought to the ED after falling from his mothers arms. The mother reports hearing a popping sound when his face hit the floor. Examination revealed swelling and bruising on the right mandible. Which of the following investigations should be ordered next?
Your Answer:
Correct Answer: Facial X ray
Explanation:The swelling and bruising on the mandible needs to be checked for fractures. A facial X-ray can adequately visualize this.
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This question is part of the following fields:
- ENT
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Question 28
Incorrect
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A 45 year old obese patient arrives at the clinic for a regular health check up. His labs are as follows: Fasting blood sugar: 6mmol/l, Oral glucose tolerance test (OGTT): 10mmol/L. What is the most likely diagnosis?
Your Answer:
Correct Answer: Impaired glucose tolerance
Explanation:Impaired glucose tolerance means that blood glucose is raised beyond normal levels, but not high enough to warrant a diabetes diagnosis. With impaired glucose tolerance you face a much greater risk of developing diabetes and cardiovascular disease. Impaired glucose tolerance is defined as 2-hour glucose levels of 140 to 199 mg per dL (7.8 to 11.0 mmol) on the 75-g oral glucose tolerance test, and impaired fasting glucose is defined as glucose levels of 100 to 125 mg per dL (5.6 to 6.9 mmol per L) in fasting patients.
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This question is part of the following fields:
- Endocrine
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Question 29
Incorrect
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A 40 year old male returning from an African country, presented with lower abdominal pain and haematuria. Bladder calcifications were detected on abdominal x-ray. Which of the following is the most probable cause?
Your Answer:
Correct Answer: Schistosoma haematobium
Explanation:Schistosoma haematobium characteristically causes urinary tract disease. S.mansoni, S. mekongi, S. intercalatum, and S. japonicum cause intestinal tract and liver disease.
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This question is part of the following fields:
- Genitourinary
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Question 30
Incorrect
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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:
Correct 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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SESSION STATS - PERFORMANCE PER SPECIALTY
