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Question 1
Incorrect
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A 60-year-old male was diagnosed with advanced intestinal carcinoma with metastasis. His doctor prescribed him NSAIDs and tramadol initially but his pain was not responding to it. Which of the following drugs is the most suitable alternative option?
Your Answer: Codeine
Correct Answer: Oramorph
Explanation:According to WHO, initial pain management for patients with malignancy involves NSAIDs and weak opioids. After their pain stops responding to them, stronger opioids such as oxycodone and morphine are prescribed.
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This question is part of the following fields:
- Pharmacology
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Question 2
Correct
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A 60-year old female suddenly started seeing a curtain-like shadow in her field of vision with flashes of lights and subsequent loss of vision, which prompted her to visit her ophthalmologist. What do you think is the most appropriate treatment in this case?
Your Answer: Surgery to retina
Explanation:Flashes of light, presence of floaters and loss of vision (often described as a black curtain closing in on the visual field) are symptoms that strongly indicate retinal detachment. The fundoscopy findings of retinal tears support this diagnosis. Therefore, surgery of retina must be done to treat this patient.
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This question is part of the following fields:
- Ophthalmology
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Question 3
Correct
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A 25-year-old farmer presents with a fever, headache, malaise and neck stiffness. The first line empirical antibiotic is?
Your Answer: Ceftriaxone
Explanation:The most likely diagnosis is meningitis which requires admission and iv antibiotics. The drug of choice is a 3rd generation cephalosporin. In patients older than 55 , ampicillin cefotaxime combination is used.
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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 60 year old male presents with thickened patches of skin over his knuckles and extensor surfaces that are consistent with Gottron's papules. Results reveal an elevated creatine kinase. Diagnosis of dermatomyositis is suspected. Which of the following autoantibody is most specific for this condition?
Your Answer: Anti-Mi-2 antibodies
Explanation:Anti–Mi-2 antibodies are highly specific for dermatomyositis, but sensitivity is low; only 25% of patients with dermatomyositis demonstrate these antibodies. A positive antinuclear antibody (ANA) finding is common in patients with dermatomyositis, but is not necessary for diagnosis. Anti-Jo-1 antibodies are mostly associated with polymyositis. Anti Scl-70 antibodies and anti centromere antibodies are most commonly found in systemic scleroderma.
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This question is part of the following fields:
- Rheumatology
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Question 5
Incorrect
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A COPD patient presented with shortness of breath, a cough and wheezing. He didn't respond to salbutamol, IV hydrocortisone or oxygen therapy. Following this initial treatment, he was given IV aminophylline and atem+ventolin nebulization. ABGs showed an acidotic pH. The next step in management would be?
Your Answer: Intubation and ventilation
Correct Answer: Nasal intermittent positive pressure ventilation
Explanation:Nasal IPPV is given to the patients when all other techniques have failed. It is a non invasive procedure to improve the oxygenation of the patients suffering from lung disease.
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This question is part of the following fields:
- Respiratory
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Question 6
Incorrect
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A pregnant woman who is a heavy smoker, observed some thick white patches on the inside of her mouth. Her oral cavity appears inflamed on examination. Which diagnosis is most likely correct?
Your Answer: Leucoplakia
Correct Answer: Candidiasis
Explanation:During pregnancy, the chances for a woman to develop oral candidiasis double. An aphthous ulcer has a yellowish floor which is surrounded by an erythematous halo while in lichen planus, the lesions do not have the appearance of a thick white mark but are more or less lace-like. The lesions in leucoplakia have raised edges and they appear as bright white patches which are sharply defined and cannot be rubbed out. Smoking may affect the tongue, producing tongue coating. In this case the tongue is just inflamed which is a sign of infection.
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This question is part of the following fields:
- Obstetrics
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Question 7
Correct
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A 30-year-old man presents with hypertension and decreased serum potassium levels. Which hormone should be tested in addition in order to establish the diagnosis?
Your Answer: Aldosterone
Explanation:High blood pressure and a low level of potassium in the blood indicates hyperaldosteronism. Therefore, aldosterone should be tested immediately to establish the diagnosis. Hyperaldosteronism, is a medical condition wherein too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood (hypokalaemia) and increased hydrogen ion excretion (alkalosis).
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This question is part of the following fields:
- Cardiovascular
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Question 8
Incorrect
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A 60-year-old patient was admitted to the surgery department for elective herniorrhaphy. Due to a problem in his history, his operation was postponed. Which of the following is the most likely cause for this postponement?
Your Answer: Abdominal distention
Correct Answer: MI 2 months ago
Explanation:After an MI, elective surgeries are recommended to be delayed for at least 6 months. This will help the patient become physically fit for the stress of surgery. Any surgery before this can carry a significant increased risk of mortality.
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This question is part of the following fields:
- Cardiovascular
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Question 9
Correct
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A 60 year old male has complained of a recent onset of postural syncope, impotence, diarrhoea, and profuse sweating. He also has diabetes. In this patient, what is the most likely cause of syncope?
Your Answer: Autonomic neuropathy
Explanation:Due to the symptoms, a diabetic autonomic neuropathy should be a suspect as a cause for the syncope. Unless associated with atrial fibrillation, mitral regurgitation is not usually expected to cause syncope. PAF can sometimes present with palpitations and a feeling of light-headedness followed by syncope, but is not always the case.
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This question is part of the following fields:
- Cardiovascular
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Question 10
Incorrect
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A 4 year old boy presented with bruises on bilateral buttocks and thighs. His mother denied any history of trauma. The boy had a sore throat few weeks ago. What is the most appropriate management of this patient?
Your Answer: Check child protection register
Correct Answer: Coagulation profile
Explanation:This history is suggestive of Henoch-Schönlein Purpura following a respiratory infection. A typical rash involving thighs and buttocks is often seen in this age group. Coagulation profile is the suitable answer from the given answers.
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This question is part of the following fields:
- Child Health
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Question 11
Correct
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A 30-year-old female with axillary freckles and café au lait spots wants to know what the chances are her child will also have the same condition.
Your Answer: Depends on the genetic makeup of the partner
Explanation:Neurofibromatosis is considered to have an autosomal dominant pattern of inheritance, meaning that there is a 50% chance of the offspring inheriting the disease if one of the parents is affected by it. However, if both parents have neurofibromatosis, the possibility raises up to 75% or even 100%, meaning that the possibility of inheritance depends on the genetic makeup of the partner as well.
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This question is part of the following fields:
- Genetics
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Question 12
Correct
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As the SHO of a hospital, you come across the lab report of a patient. It shows the following: glucose 4mmol/L, K 5.2mmol/L, Na 129mmol/L. How would you manage this patient?
Your Answer: Normal Saline 0.9%
Explanation:This patient’s blood glucose levels are within the normal range. From their lab report, they are suffering from milk hyperkalaemia and hypernatremia. Thus, normal saline 0.9 per cent is most appropriate in this case.
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This question is part of the following fields:
- Seriously Ill
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Question 13
Incorrect
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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: Co-amoxiclav
Correct 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 14
Incorrect
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A 70 year old male presents with hoarseness of the voice and breathing difficulties for the past 3 months. A chest x-ray, showed a unilateral opacity in hilum. He has no history of smoking. Choose the most probable diagnosis.
Your Answer: Laryngeal carcinoma
Correct Answer: Bronchial carcinoma
Explanation:All of the symptoms observed in this patient are typical of bronchial carcinoma.
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This question is part of the following fields:
- Respiratory
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Question 15
Incorrect
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Which of the following nail changes are present in ulcerative colitis?
Your Answer: Beau's lines
Correct Answer: Clubbing
Explanation:Clubbing of the fingers can be present in many clinical conditions like CLD, bronchiectasis, lung abscess, Ulcerative colitis and Crohn’s Disease. Koilonychia or spoon shaped nails are a typical finding in iron deficiency anaemia. Splinter haemorrhages are pin point haemorrhages found in infective endocarditis and secondary to trauma. Yellow nails are present in pulmonary and renal diseases.
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This question is part of the following fields:
- Dermatology
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Question 16
Correct
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A 32 year old woman presents with a history of breathlessness and pyrexia. She's been diagnosed with eczema and tuberculosis (TB). The following findings were established: pre-broncho-dilator test=2/3.5, post-broncho-dilator=3/3.7. What is the most likely diagnosis?
Your Answer: Chronic obstructive pulmonary disease (COPD)
Explanation:The clinical picture of the patient together with paraclinical investigations (spirometry) suggest COPD.
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This question is part of the following fields:
- Respiratory
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Question 17
Correct
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A 30-year-old female presented with acute onset, severe around her right eye, one side of her face and an earache. What is the most probable reason for this presentation?
Your Answer: Herpes zoster
Explanation:Herpes zoster (shingles) is caused when the varicella zoster virus that has remained latent since an earlier varicella infection (chicken-pox) is reactivated. Herpes zoster involving the trigeminal nerve causes trigeminal neuralgia which is characterized by unilateral pain following the sensory distribution of cranial nerve V.
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This question is part of the following fields:
- ENT
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Question 18
Correct
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A 23 year old student presented with swelling and tenderness near the Lister tubercle of the radius. Passive extension of thumb and index finger further increases the pain. X-ray was normal. What will be the next step in the management of this case?
Your Answer: Immobilization with a cast
Explanation:This patient most likely has distal intersection syndrome, which occurs in the proximal forearm due to the tenosynovitis of extensor pollicis longus muscle tendons.
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This question is part of the following fields:
- Surgery
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Question 19
Incorrect
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A 38 year old male presented with multiple bruises and fractured pelvis after a road traffic accident. He is also complaining of anuria for the past 4 hours. The next management step would be?
Your Answer: Urethral catheter
Correct Answer: Suprapubic catheter
Explanation:Stress and urge urinary incontinence has been observed in patients who have sustained pelvic fractures due to trauma. The best treatment option would be to pass suprapubic catheter. If there is still no urine output, then ureteral damage might be the cause, which needs to be managed.
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This question is part of the following fields:
- Renal
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Question 20
Correct
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A 78 year old woman presents to the clinic complaining of left sided temporal headaches and jaw claudication that has been going on for a month. A left temporal artery biopsy is negative. Results show:Hb: 130g/lPlatelets: 359*109/lWBC: 10*109/lCRP: 89mg/lWhich of the following options would be the next best step in the management of this patient?
Your Answer: Commence prednisolone
Explanation:Temporal arteritis is a chronic large- and medium-sized vessel vasculitis that typically involves the temporal arteries. Classical symptoms include temporal headaches, jaw claudication, amaurosis fugax. Physical exam shows scalp tenderness, palpation of the temporal area may demonstrate an absent pulse, knot-like swelling and vision loss. Lab results reveal an increased erythematous sedimentation rate and C-reactive protein. Temporal artery biopsy confirms the diagnosis. Management approach: high-dose systemic corticosteroids should be promptly administered even before the diagnosis is established. Temporal artery biopsy confirms the diagnosis. Inability to manage this or administer glucocorticoids might lead to development of blindness.
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This question is part of the following fields:
- Rheumatology
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Question 21
Correct
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A 35 year old lady presented in her 3rd trimester with severe features of pre-eclampsia. The drug of choice to prevent the patient going into impending eclampsia would be?
Your Answer: Intravenous magnesium sulphate
Explanation:The drug of choice for eclampsia and pre-eclampsia is magnesium sulphate. It is given as a loading dose of 4g i/v over 5 minutes, followed by an infusion for the next 24 hours at the rate of 1g/hr. If the seizures are not controlled, an additional dose of MgSO4 2-4gm i/v can be given over five minutes. Patients with eclampsia or pre-eclampsia can develop any of the following symptoms: persistent headache, visual abnormalities like photophobia, blurring of vison or temporary blindness, epigastric pain, dyspnoea and altered mental status.
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This question is part of the following fields:
- Obstetrics
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Question 22
Incorrect
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A 48 year old male presents to the clinic complaining of a swelling in his left groin that disappears on lying down. He also reports occasional haematuria and a mass in his left loin. On examination, the swelling is bluish in colour and has an appearance and consistency like that of a 'bag of worms'. What is the most likely diagnosis?
Your Answer: Varicosity secondary to liver disease
Correct Answer: Left sided renal cell carcinoma
Explanation:Renal cell carcinoma (RCC) may remain clinically occult for most of its course. The classic triad of flank pain, haematuria, and flank mass is uncommon (10%) and is indicative of advanced disease. A varicocele, usually left sided, is due to obstruction of the testicular vein.
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This question is part of the following fields:
- Genitourinary
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Question 23
Correct
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A 40 years old man collapsed at home and died. The GP’s report says he suffered from type 2 Diabetes Mellitus and his BMI was 35. What is the most likely cause of death?
Your Answer: Myocardial infarction
Explanation:Diabetic patients usually have a higher risk of developing cardiovascular events by 2-4x that of the general population. In addition, diabetic patients are often obese and possibly have hyperlipidaemia, which are great risk factors of cardiovascular incidents.
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This question is part of the following fields:
- Cardiovascular
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Question 24
Correct
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A young patient cannot leave the toilet, unless he washes his hands six times. Which treatment strategy would you suggest?
Your Answer: CBT
Explanation:The patient seems to have OCD. According to the NICE guidelines for the initial treatment options in patients with OCD, CBT seems to be the number one choice. In case it fails, pharmacological treatment or more intensive CBT can be trialled.
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This question is part of the following fields:
- Mental Health
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Question 25
Correct
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An 8-month-old infant is presented to the paediatrics ward with a history of delayed developmental milestones since birth. On examination, he has poor muscle tone and balance, and a head circumference, which is greater than normal. Imaging of the patient's head revealed a diminished cerebellar vermis, a large fourth ventricle, and an enlarged posterior fossa. What is the most likely diagnosis?
Your Answer: Dandy-Walker syndrome
Explanation:Dandy-Walker syndrome is characterised by symptoms of brain maldevelopment that are seen in this patient. A large cranium indicates hydrocephalus, and the hypotonia indicates poor limb development.
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This question is part of the following fields:
- Child Health
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Question 26
Incorrect
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A 24 year old male was involved in a traffic collision. X-rays indicated that the neck of the humerus had suffered a fracture. Choose the single most associated nerve injury from the list of options.
Your Answer: Radial nerve
Correct Answer: Axillary nerve
Explanation:Fractures in the neck of the humerus are well documented to cause damage to the auxiliary nerve.
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This question is part of the following fields:
- Neurology
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Question 27
Correct
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48 hours after having unprotected intercourse, a 16-year-old female requested a pregnancy test from her GP. What advice can you give her regarding the reliability of pregnancy testing at this time?
Your Answer: Even if conception has already occurred, beta hCG is likely to be normal
Explanation:Even if conception has already occurred, beta hCG is likely to be normal. Beta hCG is made by syncytiotrophoblast cells following conception. It then activates the corpus luteum to continuously produce progesterone for implantation to happen. In week 10/40, levels of HCG peak and the placenta can produce adequate progesterone by itself. As a general rule, a beta HCG concentration >25 U/I or a doubling of levels of HCG within two days is required to diagnose pregnancy. A urine pregnancy test would only likely prove positive around 8 days to 2 weeks following conception.
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This question is part of the following fields:
- Gynaecology
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Question 28
Correct
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An 18 year old girl presents with short history of marked, right hip pain and an associated limp. She has a history of acute lymphoblastic leukaemia for which she completed treatment for last six months.
Your Answer: Avascular necrosis of the femoral head
Explanation:Avascular necrosis (AVN) of the femoral head is a pathological process that results from disruption of the blood supply to the bone and occurs most commonly in the femoral epiphysis. Patients usually present with pain and limited joint motion. The mechanism involves impaired circulation to a specific area that ultimately becomes necrotic. AVN is most frequently associated with high doses of oral and intravenous corticosteroids and prolonged duration of therapy. Cancer patients receiving chemotherapy are usually also treated with corticosteroids.
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This question is part of the following fields:
- Rheumatology
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Question 29
Incorrect
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A 75-year-old male patient, with a history of late onset asthma and heart failure as well as generalized rash, presents with Bell's palsy. CXR shows multiple soft shadows and blood test reveal an eosinophilia. Which antibody would you expect to be positive?
Your Answer: Anti Ds DNA
Correct Answer: P ANCA
Explanation:Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disorder, belonging to the small vessel anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. It is defined as an eosinophil-rich and necrotizing granulomatous inflammation often involving the respiratory tract, and necrotizing vasculitis predominantly affecting small to medium-sized vessels, associated with asthma and eosinophilia. ANCA (especially pANCA anti-myeloperoxidase) are present in 40–60% of the patients.
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This question is part of the following fields:
- Rheumatology
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Question 30
Incorrect
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The functional unit of the liver is called?
Your Answer: Hepatocyte
Correct Answer: Acini
Explanation:From a metabolic perspective, the functional unit is the hepatic acinus (terminal acinus), each of which is centred on the line connecting two portal triads and extends outwards to the two adjacent central veins. The periportal zone I is nearest to the entering vascular supply and receives the most oxygenated blood, making it least sensitive to ischemic injury while making it very susceptible to viral hepatitis. Conversely, the centrilobular zone III has the poorest oxygenation, and will be most affected during a time of ischemia.
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This question is part of the following fields:
- Hepatobiliary
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SESSION STATS - PERFORMANCE PER SPECIALTY
