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Question 1
Incorrect
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A 50-year-old male presented with pain in the left lumbar region. His abdominal X-ray revealed stones in his left kidney. Analysis of one of the stones that he passed in the urine showed that it was composed of uric acid. Which of the following is the most likely cause of this type of renal stone?
Your Answer: Allopurinol
Correct Answer: Thiazide diuretics
Explanation:Like all diuretics, thiazide diuretics decrease the amount of body fluid. This leads to an increase in the concentration of uric acid in the body; hence the chances of forming uric acid stones.
Allopurinol is actually a drug used to treat gout, reducing uric acid levels in the body. Therefore, allopurinol would rather decrease the chances of having uric acid stones.
Primary hyperparathyroidism is not concerned with uric acid stones. It is related to calcium metabolism and hence, calcium stones. -
This question is part of the following fields:
- Renal
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Question 2
Incorrect
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A 76-year-old woman attends the Emergency Department after knocking her shin on some furniture at home. She takes prednisolone for polymyalgia rheumatica. You examine her leg and find a pre-tibial laceration with a large skin flap. Which of the following is the best way to manage this?
Your Answer: Clean then suture the laceration with a 4/0 non-absorbable suture
Correct Answer: Clean then steristrip the laceration
Explanation:In young patients with good skin, pre-tibial lacerations may be sutured, usually with non-absorbable sutures that are removed after 7-10 days. In elderly patients with thin skin, or those on warfarin or steroids, the skin is frequently too fragile to suture. For these patients the wound should be thoroughly cleaned and meticulously steristripped to best aid skin healing. A non-adherent dressing and a light bandage can be applied and the patient should be encouraged to elevate the leg. Patients should be reviewed after a week. The laceration may take many months to heal and some require skin grafting procedures.
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This question is part of the following fields:
- Seriously Ill
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Question 3
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: IVIG
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 4
Correct
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A 24-year-old man is evaluated for facial pain and fever lasting four days. Symptoms began with an upper respiratory tract infection accompanied by purulent nasal discharge; he then began to have pain over the right cheek and developed a fever of 38.4°C. On examination, he has a purulent nasal discharge and tenderness over the right maxilla. CT shows right maxillary sinusitis. Which of the following is the most appropriate antibiotic treatment for this patient?
Your Answer: Amoxicillin
Explanation:Acute bacterial sinusitis usually occurs following an upper respiratory infection that results in obstruction of the osteomeatal complex, impaired mucociliary clearance, and overproduction of secretions. Sinusitis can be treated with antibiotics, decongestants, steroid drops or sprays, mucolytics, antihistamines, and surgery (lavage). Studies have shown that 70% of cases of community-acquired acute sinusitis in adults and children are caused by Streptococcus pneumoniae and Haemophilus influenzae. Most guidance favours amoxicillin as first line treatment. There seems to be little evidence base for this, however. BMJ’s clinical evidence website found three RCTs which showed no difference between amoxicillin and placebo (in patients without bacteriological or radiological evidence of sinusitis). However, there were no RCTs examining the effects of co-trimoxazole, cephalosporins, azithromycin, and erythromycin. Second line therapies include ciprofloxacin and co-amoxiclav. First and second generation cephalosporins are not generally favoured.
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This question is part of the following fields:
- ENT
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Question 5
Correct
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Which is the most likely lymph node involved in the presence of an abdominal swelling below the umbilicus and on the right side?
Your Answer: Inguinal lymph node
Explanation:Inguinal LN’s drain the skin and subcutaneous tissue of the lower abdominal wall, perineum, buttocks, external genitalia, and lower limbs. They are subdivided into three groups of lymph nodes (nodi lymphoid):
– inferior group of superficial inguinal lymph nodes, located inferior to the saphenous opening, receiving drainage of the lower limb;
– superolateral superficial inguinal lymph nodes located lateral to the saphenous opening, receiving drainage of lateral buttock and lower anterior abdominal wall; and
– superomedial superficial inguinal lymph nodes, located medial to the saphenous opening, receiving drainage of the perineum and external genitalia. -
This question is part of the following fields:
- Surgery
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Question 6
Incorrect
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A 28 year old male arrives at the clinic complaining of fever, arthralgia and urethritis. On examination, the ankle is swollen and there is a pustular rash on the dorsal foot. What is the most likely diagnosis?
Your Answer: Reactive arthritis
Correct Answer: Disseminated gonorrhoea
Explanation:DGI presents as two syndromes: 1) a bacteremic form that includes a triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis and 2) a septic arthritis form characterized as a purulent arthritis without associated skin lesions. Many patients will have overlapping features of both syndromes. Time from infection to clinical manifestations may range from 1 day to 3 months. There is no travel history and the rash of Lyme disease is not purulent. Reactive arthritis presents with conjunctivitis, urethritis and arthritis usually with a red hot tender and swollen joint.
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This question is part of the following fields:
- Rheumatology
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Question 7
Correct
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A 12 year old boy has a high HbA1c and is being checked by the diabetic specialist nurse. He has been skipping meals lately and his school teachers have noticed that he's been unhappy. Who do you suggest his parents take him to?
Your Answer: Clinical psychologist
Explanation:The boy is most probably a type 1 diabetic patient. Such a condition can affect the behaviour and psychological state of a young child reflected in their behaviour. The parents should seek the help of a clinical psychologist.
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This question is part of the following fields:
- Child Health
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Question 8
Incorrect
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A 20-year-old male was admitted with a right sided pneumothorax. A chest drain was inserted just below the 4th rib in the mid clavicular line. What is the structure at risk of damage during the above procedure?
Your Answer: Internal thoracic artery
Correct Answer: Intercostal artery
Explanation:From the given answers, the most suitable answer is the intercostal artery. However the most vulnerable structure is the intercostal nerve, then intercostal artery and finally intercostal vein.
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This question is part of the following fields:
- Seriously Ill
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Question 9
Incorrect
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A 53 year old diabetic man presents to the emergency with pain in left loin and haematuria that was sudden in onset. Investigations revealed an 8mm stone in the left lower ureter. Supportive therapy was initiated with nifedipine and steroids. The patients returned to the emergency with vomiting and worsening pain and passage of two stones. Renal function tests are significant for an impending ARF. Which of the following steps would be employed in the management of this patient?
Your Answer:
Correct Answer: Percutaneous nephrostomy
Explanation:Nephrolithiasis encompasses the formation of all types of urinary calculi in the kidney, which may deposit along the entire urogenital tract from the renal pelvis to the urethra. Nephrolithiasis manifests as sudden onset colicky flank pain that may radiate to the groin, testes, or labia (renal/ureteric colic) and is usually associated with haematuria.
Risk factors include low fluid intake, high-sodium, high-purine, and low-potassium diets, which can raise the calcium, uric acid, and oxalate levels in the urine and thereby promote stone formation.
Diagnostics include noncontrast spiral CT of the abdomen and pelvis or ultrasound to detect the stone, as well as urinalysis to assess for concomitant urinary tract infection and serum BUN/creatinine to evaluate kidney function. Urinary stones are most commonly composed of calcium oxalate. Less common stones are made up of uric acid, struvite (due to infection with urease-producing bacteria), calcium phosphate, or cystine.
Small uncomplicated stones without concurrent infection or severe dilation of the urinary tract may be managed conservatively with hydration and analgesics to promote spontaneous stone passage. When the spontaneous passage appears unlikely or fails due to the stone’s size or location, first-line urological interventions include shock wave lithotripsy, ureterorenoscopy, and, in case of large kidney stones, percutaneous nephrolithotomy. The most important preventive measure is adequate hydration.
Collected stones should be sent for chemical analysis because in many cases specific lifestyle guidance, diet changes, and/or initiation of medical treatment (e.g., thiazide diuretics, urine alkalinisation) can prevent future stone formation. -
This question is part of the following fields:
- Renal
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Question 10
Incorrect
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A 55 year old lady who a known case of normal pressure hydrocephalus (NPH) presented with complaints of weakness in her lower limbs, urinary incontinence and progressively worsening confusion. Which of the following statements is true regarding NPH?
Your Answer:
Correct Answer: Is associated with gait disturbance
Explanation:Normal pressure hydrocephalus is a form of communicating hydrocephalus characterised by enlarged ventricles with normal opening pressure on lumbar puncture. For diagnostic purposes, a triad of urinary incontinence, gait abnormality and dementia is necessary. It is necessary to diagnose the condition early because it is reversible by placing a ventriculoperitoneal shunt. It is most common in patients aged more than 60 years.
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This question is part of the following fields:
- Infectious Diseases
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Question 11
Incorrect
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A 26 year old male presents with a history of fever and pain in the right lower thigh for one month. On examination the lower one third of the thigh is red, hot and tender. Radiological examination reveals new bone formation. What is the most likely diagnosis?
Your Answer:
Correct Answer: Osteomyelitis
Explanation:Osteomyelitis (OM) is an infection of bone. Symptoms may include pain in a specific bone with overlying redness, fever, and weakness. The long bones of the arms and legs are most commonly involved in children, while the feet, spine, and hips are most commonly involved in adults. Diagnosis of osteomyelitis is often based on radiologic results showing a lytic centre with a ring of sclerosis. Osteomyelitis, a bone infection, may leave the adjacent bone with exostosis formation. An exostosis, also known as bone spur, is the formation of new bone on the surface of a bone.[
Malignant bone tumours can be classified as primary (arising from abnormal bone or cartilage cells) or secondary (bone metastases of other tumours). The most common primary bone tumours are osteosarcomas, Ewing sarcomas, and chondrosarcomas. These tumours differ with regard to primary localization, radiographic characteristics, and the patient age at which they usually develop.
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This question is part of the following fields:
- Musculoskeletal
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Question 12
Incorrect
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Regarding haemochromatosis, which of the following is true?
Your Answer:
Correct Answer: Haemochromatosis may be treated with therapeutic phlebotomy
Explanation:Haemochromatosis is an abnormally high rate of the production of haemoglobin. It is an autosomal recessive disease copied on chromosome 6. It is associated with hepatic disorders, cardiac diseases and skin pigmentation. It is treated by regular venesection.
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This question is part of the following fields:
- Haematology
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Question 13
Incorrect
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Presence of which of the following indicates a worse prognosis in rheumatoid arthritis?
Your Answer:
Correct Answer: Anti-CCP antibodies
Explanation:Rheumatoid arthritis is both common and chronic, with significant consequences for multiple organ systems. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, presence early in the disease process, and ability to identify patients who are likely to have severe disease and irreversible damage. However, its sensitivity is low, and a negative result does not exclude disease. Anti-CCP antibodies have not been found at a significant frequency in other diseases to date, and are more specific than rheumatoid factor for detecting rheumatoid arthritis. The other factors that are mentioned do not play a key prognostic role.
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This question is part of the following fields:
- Rheumatology
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Question 14
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:
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 15
Incorrect
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A 6 year old male presented in the OPD with the complaint of nasal bleeding which started 3 days before. Now on examination, there is no bleeding and only slight redness of the anterior mucosa is present. Which of the following steps is the most suitable one now?
Your Answer:
Correct Answer: Reassurance
Explanation:Epistaxis is common in younger children usually due to nose picking. After the episode is over no active management is required and reassurance should be given to the patient and his attendants.
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This question is part of the following fields:
- ENT
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Question 16
Incorrect
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A 14-day-old baby presented in NICU with the signs and symptoms of hydrocephaly, seizures and chorioretinitis. Which of the following infectious agents is most probably the cause in a case like this?
Your Answer:
Correct Answer: Toxoplasmosis
Explanation:Maternal and fetal toxoplasma infection may be avoided by advising pregnant women to wear gloves when gardening or handling cat litter and to cook meat thoroughly. Affected babies are treated with pyrimethamine, sulfadiazine, and folic acid.
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This question is part of the following fields:
- Infectious Diseases
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Question 17
Incorrect
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A 21-year-old medical student presented with increased urge to wash his hands for 2 weeks. He could not concentrate on his studies, as he wanted to wash hands every 15-20 minutes. Although he knew it was a pointless thing, he could not resist it. Which of the following is the most appropriate management for this condition?
Your Answer:
Correct Answer: CBT
Explanation:The given history is compatible with obsessive-compulsive disorder, which is characterized by distressing, intrusive obsessive thoughts and/or repetitive compulsive physical or mental acts. Cognitive behavioural therapy is the mainstay of treatment.
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This question is part of the following fields:
- Mental Health
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Question 18
Incorrect
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Which one of the following factors is the most likely etiological factor for abnormally short stature amongst children?
Your Answer:
Correct 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 19
Incorrect
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A 6-year-old male was brought to the OPD with complaints of weight loss and fatigue for the last few months. On examination he was pale and had hepatosplenomegaly. A full blood count was ordered and it revealed immature white blood cells. Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Leukaemia
Explanation:The age of the patient and the presence of immature white blood cells are suggestive of leukaemia. Hodgkin’s disease is unlikely in this age group and it usually presents with lymphadenopathy. In HIV, immature white blood cells are not present in the blood.
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This question is part of the following fields:
- Child Health
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Question 20
Incorrect
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A 8 year old boy presented with acute onset of nasal obstruction. His parents gave a recent history of nasal trauma. On examination he was febrile and his nasal bones were straight. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Septal abscess
Explanation:History of fever is suggestive of an infective focus. A straight nasal bones excludes a nasal bone fracture. A nasal septal abscess is defined as a collection of pus between the cartilage or bony septum and it is an uncommon disease which should be suspected in a patient with acute onset of nasal obstruction and recent history of nasal trauma.
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This question is part of the following fields:
- ENT
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Question 21
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 22
Incorrect
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A 26 year-old gentleman presented with complaints of multiple bruises over his body and reddish urine after a road traffic accident. Labs showed deranged renal function. The best management step would be?
Your Answer:
Correct Answer: IV normal saline
Explanation:Rhabdomyolysis occurs after severe muscles injury and the patient presents with myoglobinuria and deranged RFTS. The best initial step in management is fluid resuscitation with normal saline. If initial management fails to treat the patient, we can go to haemodialysis.
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This question is part of the following fields:
- Renal
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Question 23
Incorrect
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A 30-year-old female diagnosed with rapidly progressive glomerulonephritis complains of pain and redness in the right eye. Which part of the eye is causing these symptoms in this case?
Your Answer:
Correct Answer: Sclera
Explanation:Rheumatoid Scleritis is a painful inflammatory condition of the sclera in patients with rheumatoid arthritis. It might be diffuse, nodular, or necrotizing in nature. This occurs mostly in the sixth decade of life and mostly when the rheumatoid disease is in remission. Sclera is the first ocular manifestation in a patient of rheumatoid arthritis. This inflammation might later spread to the adjacent ocular structures like the cornea, causing keratitis, the uveal tract causing uveitis and the lens causing cataracts.
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This question is part of the following fields:
- Ophthalmology
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Question 24
Incorrect
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A 68 year old male presented with right sided hip pain and was found to have a fracture of right hip. On examination he had bilateral pedal oedema and was also found to be deaf. Which of the following is the most probable diagnosis?
Your Answer:
Correct Answer: Paget’s disease
Explanation:Paget disease is a localized disorder of bone remodelling . Hip pain is most common when the acetabulum and proximal femur are involved. The most common neurologic complication is deafness as a result of involvement of the petrous temporal bone. Bilateral pedal oedema is due to associated heart failure.
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This question is part of the following fields:
- Musculoskeletal
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Question 25
Incorrect
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A 7-year-old girl was brought to the OPD with a history of a large swelling on the side of her neck with associated lymph node swellings in her neck and axilla. Which if the following investigations will you order next?
Your Answer:
Correct Answer: Lymph node biopsy
Explanation:As there is lymphadenopathy already present in this patient, doing a biopsy of the lymph nodes will rule out metastasis of any underlying tumour.
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This question is part of the following fields:
- ENT
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Question 26
Incorrect
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A 40-year-old female presented with chronic pelvic pain for 6 months, which was aggravated by standing and walking. The pain was worst at the end of the day, during the pre-menstrual period and following sexual intercourse. Which of the following can be the most likely cause of this presentation?
Your Answer:
Correct Answer: Pelvic congestion syndrome
Explanation:The pelvic pain which is aggravated by changes in posture, during the pre menstrual period and towards the end of the day favours the diagnosis of pelvic congestion syndrome. Pelvic congestion syndrome is a condition of pelvic varicosities in women with unexplained pelvic pain. PID, endometriosis and adenomyosis are causes for chronic pelvic pain but they don’t match with the given clinical picture.
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This question is part of the following fields:
- Genitourinary
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Question 27
Incorrect
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A 36 year old man, who is on antipsychotic medications for schizophrenia, presented with drooling of saliva, tremors and dystonia. The drug of choice in this case would be?
Your Answer:
Correct Answer: Procyclidine
Explanation:Antipsychotic medications which are used in schizophrenia can lead to Parkinson’s like symptoms due to the cholinergic effects. To counteract these symptoms, procyclidine is given as an anticholinergic drug to these patients.
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This question is part of the following fields:
- Mental Health
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Question 28
Incorrect
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A 6-year-old boy with fever and malaise for 2 days recently developed bloody diarrhoea. What is the most probable aetiology?
Your Answer:
Correct Answer: Escherichia coli 0157
Explanation:The most likely organism is enterohemorrhagic verotoxin-producing E.coli. It usually causes haemolytic uremic syndrome.
Crohn’s disease rarely manifests in an acute manner.
Polio and giardiasis usually manifest with non-bloody diarrhoea. -
This question is part of the following fields:
- Infectious Diseases
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Question 29
Incorrect
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A 35-year-old woman is in a loving relationship and has no conflicts at work or home. She complains of occasional anxiety attacks associated with dizziness and periodic tension that lasts for a few hours. To make herself calm she drinks alcohol. What is the next step in her management?
Your Answer:
Correct Answer: Collateral info
Explanation:Panic disorder is the highly suggested diagnosis. To discover the source of her anxiety, collateral info should be collected from her relatives and peers.
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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 patient was admitted due to vomiting for further investigations. He noticed blood in his vomit and the physicians decided to perform an esophagogastroduodenoscopy which revealed haemorrhage in the lesser curvature of the stomach. Which artery is responsible for the bleeding?
Your Answer:
Correct Answer: Right gastric artery
Explanation:The right gastric artery arises from the hepatic artery or the left hepatic artery and supplies the pylorus, traveling along the lesser curvature of the stomach anastomosing with the left gastric artery.
The pancreaticoduodenal artery supplies mainly the upper and lower duodenum and the head of the pancreas.
The gastro-omental arteries supply the greater curvature of the stomach. -
This question is part of the following fields:
- Gastrointestinal
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SESSION STATS - PERFORMANCE PER SPECIALTY
