-
Question 1
Incorrect
-
A study is developed to compare the calcemia of men and women with Crohn's disease. The objective of the study is to detect any differences between the average calcium levels in men compared to women. Previous studies have shown a normal distribution regarding calcium levels. Which of the the following tests would you most likely apply?
Your Answer: Student's paired t-test
Correct Answer: Student's unpaired t-test
Explanation:A t test is a type of statistical test that is used to compare the means of two groups. It is one of the most widely used statistical hypothesis tests in pain studies. There are two types of statistical inferences: parametric and nonparametric methods. Parametric methods refer to a statistical technique in which one defines the probability distribution of probability variables and makes inferences about the parameters of the distribution. In cases in which the probability distribution cannot be defined, nonparametric methods are employed. T tests are a type of parametric method; they can be used when the samples satisfy the conditions of normality, equal variance, and independence. In this case the data is parametric, comparing two independent samples from the same population.
-
This question is part of the following fields:
- Clinical Sciences
-
-
Question 2
Incorrect
-
A 76-year-old retired store owner presents with severe pain around his right eye and vomiting. On examination, the right eye is red and decreased visual acuity is noted. Which of the following options is the most appropriate initial treatment?
Your Answer: Topical pilocarpine + oral prednisolone
Correct Answer: Topical pilocarpine + intravenous acetazolamide
Explanation:In acute angle closure glaucoma (AACG) there is a rise in IOP secondary to an impairment of aqueous outflow. Management options include reducing aqueous secretions with acetazolamide and inducing pupillary constriction with topical pilocarpine.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 3
Incorrect
-
A 11-year-old boy is referred to you following his seventh course of antibiotics in the last six years for lower respiratory tract infections. He also has a history of eczema for which he is currently on a topical steroid cream. His full blood count (FBC) report shows: Hb: 13.9 g/dL, Plts: 65 x 10^9/L, WCC: 12.3 x 10^9/L. Which of the following genes should you expect an abnormality in?
Your Answer: CFTR
Correct Answer: WASP
Explanation:The combination of frequent infections, eczema, and thrombocytopaenia are characteristic of Wiskott-Aldrich syndrome, which is due to an abnormality in the WASP gene. It is an X-linked recessive disorder that causes primary immunodeficiency owing to a combined B- and T-cell dysfunction.
The other listed options are:
1. PKD1: polycystic kidney disease
2. CFTR: cystic fibrosis
3. HFE1: haemochromatosis
4. RET: multiple endocrine neoplasia, Hirschsprung’s disease -
This question is part of the following fields:
- Haematology & Oncology
-
-
Question 4
Incorrect
-
A 20-year-old woman presents to casualty with flank pain and a 48 hour history of dysuria. Her past medical history includes polycystic ovarian syndrome. She is not in a steady relationship at present. There is haematuria and proteinuria on urine dipstick testing. Examination reveals a pyrexia of 38.1 °C and flank pain. What diagnosis fits best with this clinical picture?
Your Answer: Acute glomerulonephritis
Correct Answer: Pyelonephritis
Explanation:The patient presents with flank pain and fever with haematuria and proteinuria associated with a social history of not being in a steady relationship. This patient is a young presumably sexually active female, so the diagnosis is most likely pyelonephritis which has an increased incidence in young sexually active women or men of >50 years of age.
-
This question is part of the following fields:
- Nephrology
-
-
Question 5
Correct
-
A 50-year-old farmer, under treatment for depression, presents to the emergency department following an intentional overdose of an unidentified substance. On examination, he was found to be bradycardic, hypotensive, hyper-salivating, and disoriented. On ocular examination, his pupils were found to be miotic. What is the most likely substance he ingested?
Your Answer: An organophosphate insecticide
Explanation:The farmer has most likely ingested an organophosphate insecticide.
Organophosphorus compounds are used widely as:
• Insecticides – Malathion, parathion, diazinon, dichlorvos
• Nerve gases – Soman, sarin, tabun, VX
• Ophthalmic agents – Echothiophate
• Antihelmintics – Trichlorfon
• Herbicides – merphos
• Industrial chemical (plasticizer) – Tricresyl phosphate
Signs and symptoms of Organophosphorus Poisoning (OPP) can be classified as:
• Muscarinic effects:
o Cardiovascular – Bradycardia, hypotension
o Respiratory – Rhinorrhoea, bronchorrhea, bronchospasm, cough, severe respiratory distress
o Gastrointestinal – Hypersalivation, nausea and vomiting, abdominal pain, diarrhoea, faecal incontinence
o Genitourinary – Incontinence
o Ocular – Blurred vision, miosis
o Glands – Increased lacrimation, diaphoresis
• Nicotinic effects:
o Muscle fasciculation, weakness, cramping, diaphragmatic failure, and autonomic side effects include: hypertension, tachycardia, and mydriasis.
• Central nervous system (CNS) effects:
o Anxiety, emotional lability, restlessness, confusion, ataxia, tremors, seizures, coma, apnoea
Mainstay Treatment:
• Decontamination
• Securing Airway, Breathing and Circulation
• Atropine
• Pralidoxime
• Benzodiazepines -
This question is part of the following fields:
- Pharmacology
-
-
Question 6
Incorrect
-
Choose the correct statement regarding endothelin:
Your Answer:
Correct Answer: Endothelin antagonists are useful in primary pulmonary hypertension
Explanation:Current guidelines recommend the use of ambrisentan, Bosentan (recommendation I, level of evidence A) and macitentan (I, B) in patients with PAH and WHO functional class II and III. In WHO functional class IV, the first-line drug is Epoprostenol and the recommendation for Endothelin receptor antagonists is weaker (IIb, C).
-
This question is part of the following fields:
- Clinical Sciences
-
-
Question 7
Incorrect
-
An 18-year-old young lady is brought to the ER by her mother. She was found, lying on the floor having consumed an unidentified quantity of her mother's prescription pills with alcohol. The patient's mother is a known hypertensive under treatment. On examination, the patient was found to be lethargic, hypotensive with a BP of 70/50 mmHg, and bradycardic with a pulse rate of 38 bpm. A finger prick glucose is 3.2 mmol/L. Which TWO among the following are the most appropriate steps for the initial management of this patient?
Your Answer:
Correct Answer: Glucagon and isoprenaline
Explanation:The most appropriate steps of initial management include iv glucagon and iv isoprenaline.
The most likely diagnosis in the above scenario (decreased conscious level, profound hypertension, and bradycardia) is β-blocker toxicity/overdose.
Bronchospasm rarely occurs in an overdose of β-blockers, except where there is a history of asthma.Immediate management is to give iv glucagons (50–150μg/kg) followed by infusion to treat hypotension and isoprenaline or atropine to treat bradycardia.
Where patients fail to respond to these measures, temporary pacing may be required.
If the patient is seen within the first 4 hours of the overdose, gastric lavage may be of value. -
This question is part of the following fields:
- Pharmacology
-
-
Question 8
Incorrect
-
A 40-year-old male patient, who is otherwise healthy and without a significant family history, presents with a history of early morning headache and visual field defects, When asked, he said that he has been having these complaints for three months now. What is the most possible diagnosis?
Your Answer:
Correct Answer: Pituitary tumour
Explanation:The most possible diagnosis is a pituitary tumour. Pituitary tumours compress the optic chiasm inferiorly and can cause visual field defects (bitemporal hemianopia or quadrantanopia). Temporal arteritis usually develops in older people and acute glaucoma usually requires a family history. Amaurosis fugax is classed as a stroke and usually leads to reversible unilateral vision loss. A subconjunctival haemorrhage does not typically produce the symptoms described.
-
This question is part of the following fields:
- Ophthalmology
-
-
Question 9
Incorrect
-
A 30-year-old woman who underwent a live related renal transplant for end-stage renal failure secondary to chronic pyelonephritis 4 months ago, now attends the clinic for routine follow up. She is taking tacrolimus and mycophenolate mofetil (MMF). Her urea and electrolytes are: Na+ 136 mmol/L, K+ 3.7 mmol/L, Urea 7.2 mmol/L, Creatinine 146 μmol/L. She was last seen in clinic 2 weeks previously when her urea was 4.2 mmol/l and creatinine 98 μmol/l. She is clinically well and asymptomatic. On examination she was apyrexial and normotensive. Her transplant site was non-tender with no swelling and there were no other signs to be found. Which initial investigations should be performed first?
Your Answer:
Correct Answer: Urine and blood cultures
Explanation:After renal transplant, asymptomatic patients can still have graft dysfunction as an early complication, with rising serum creatinine; therefore, urine and blood cultures should be ordered first. This should be followed by measuring the Tacrolimus levels, as this drug can be directly nephrotoxic. Next, a Doppler ultrasound of the transplant site should be ordered, to check for any obstructions or occlusions.
-
This question is part of the following fields:
- Nephrology
-
-
Question 10
Incorrect
-
A 55 yr. old man presented with retrosternal chest pain associated with excessive sweating and vomiting. On examination his BP was 100/60 mmHg and pulse rate was 72 bpm. Bibasal crepitations were auscultated. His ECG showed ST elevation in V1 to V4 and ST depression in leads II, III and aVF. Which of the following would be the finding during angioplasty?
Your Answer:
Correct Answer: Complete occlusion of the left anterior descending artery
Explanation:The ECG findings are suggestive of anterior myocardial infarction and the most likely artery affected is the left anterior descending artery. Occlusion of the right coronary artery will be shown by ST elevation in lead II, III, aVF and occlusion of the circumflex artery will show changes in leads I, aVL, V5 and V6. To have ST elevation, there should be complete occlusion of the artery.
-
This question is part of the following fields:
- Cardiology
-
00
Correct
00
Incorrect
00
:
00
:
00
Session Time
00
:
00
Average Question Time (
Mins)