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  • Question 1 - A 49-year-old female is admitted to the hospital with shortness of breath and...

    Correct

    • A 49-year-old female is admitted to the hospital with shortness of breath and pleuritic chest pain. She also complains of loss of appetite for the past four months. Her admission CXR shows right-sided pleural effusion. An underlying malignancy is suspected and a series of tumour markers are requested, the results of which are: CA 19-9: 36 IU/mL (<40), CA 125: 654 IU/ml (<30), CA 15-3: 9 IU/ml (<40). What is the most likely underlying diagnosis?

      Your Answer: Ovarian fibroma

      Explanation:

      The patient has Meigs syndrome. Meigs syndrome is defined as a triad of benign ovarian tumour with ascites and pleural effusion that resolves after resection of the tumour. Ovarian fibromas constitute the majority of the benign tumours seen in Meigs syndrome.

      Tumour markers can be divided into:
      1. Monoclonal antibodies
      CA 125: Ovarian cancer, primary peritoneal cancer
      CA 19-9: Pancreatic cancer
      CA 15-3: Breast cancer

      2. Tumour specific antigens
      Prostate specific antigen (PSA): Prostatic carcinoma
      Alpha-feto protein (AFP): Hepatocellular carcinoma, teratoma
      Carcinoembryonic antigen (CEA): Colorectal cancer
      S-100: Melanoma, schwannomas
      Bombesin: Small cell lung carcinoma, gastric cancer

      3. Enzymes
      Alkaline phosphatase (ALP)
      Neuron specific enolase (NSE)

      4. Hormones
      Calcitonin
      Antidiuretic hormone (ADH)
      Human chorionic gonadotropin (hCG)

    • This question is part of the following fields:

      • Haematology & Oncology
      12.2
      Seconds
  • Question 2 - A 21-year-old female presents to the emergency department having taken an overdose of...

    Correct

    • A 21-year-old female presents to the emergency department having taken an overdose of 40 x 500mg paracetamol tablets and 400ml of vodka. This is her fourth attendance with an overdose over the past 3 years. She is also known to the local police after an episode of reckless driving/road rage. On arrival, she is tearful and upset. Vital signs and general physical examination are normal apart from evidence of cutting on her arms. She is given activated charcoal. Which of the following is the most likely diagnosis?

      Your Answer: Borderline personality disorder

      Explanation:

      The given clinical scenario is highly suggestive of a borderline personality disorder.

      Borderline personality disorder is marked out by instability in moods, behaviour, and relationships. The diagnosis is confirmed by the presence of at least 5 of the following symptoms;
      1) Extreme reactions including panic, depression, rage, or frantic actions to abandonment, whether real or perceived
      2) A pattern of intense and stormy relationships with family, friends, and loved ones, often veering from extreme closeness and love to extreme dislike or anger
      3) Distorted and unstable self-image or sense of self, which can result in sudden changes in feelings, opinions, values, or plans and goals for the future (such as school or career choices)
      4) Impulsive and often dangerous behaviours, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating
      5) Recurring suicidal behaviours or threats or self-harming behaviour, such as cutting, intense and highly changeable moods, with each episode lasting from a few hours to a few days
      6) Chronic feelings of emptiness and/or boredom
      7) Inappropriate, intense anger or problems controlling anger
      8) Having stress-related paranoid thoughts or severe dissociative symptoms, such as feeling cut off from oneself, observing oneself from outside the body, or losing touch with reality.

      Other options:
      There are no features consistent with endogenous depression, such as early morning wakening or loss of appetite.
      There are also no features consistent with hypomania such as pressure of speech, a flight of ideas, or over-exuberant behaviour.
      The lack of history of drug abuse rules out drug-induced psychosis.
      An anti-social personality disorder is characterized by a failure to conform to social norms and repeated lawbreaking. There is consistent irresponsibility, impulsivity, and disregard for both their safety and that of others. This is not the case in the given scenario.

    • This question is part of the following fields:

      • Psychiatry
      17.3
      Seconds
  • Question 3 - A study is developed to assess a new anti-hypertensive drug and two groups...

    Incorrect

    • A study is developed to assess a new anti-hypertensive drug and two groups of patients are randomly chosen. The first group takes an established anti-hypertensive drug for 3 months and the second group receives the new drug, again for 3 months. To assess the efficacy of the new drug, blood pressure is measured before and after taking the drug in both groups of patients. After a period of 1 month off medication, the groups swap medication and blood pressure is measured again, finally the difference in blood pressure after receiving each drug is calculated. Which of the following significance tests would you apply to assess the results of the study?

      Your Answer: Mann-Whitney test

      Correct Answer: Student's paired 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, and they belong to the same patients, so a paired t test should be used.

    • This question is part of the following fields:

      • Clinical Sciences
      22.7
      Seconds
  • Question 4 - A 60-year old female suddenly started seeing a curtain-like shadow in her field...

    Incorrect

    • 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

      Correct Answer:

      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.

    • This question is part of the following fields:

      • Ophthalmology
      5.6
      Seconds
  • Question 5 - A 21 year-old software developer undergoes a planned lumbar puncture (LP) as part...

    Correct

    • A 21 year-old software developer undergoes a planned lumbar puncture (LP) as part of a neurological investigation for possible multiple sclerosis. During the consent process, she expresses concern about a post-LP headache. What is the mechanism of post-LP headaches?

      Your Answer: Leaking cerebrospinal fluid from the dura

      Explanation:

      Leaking of cerebrospinal fluid from the dura is the most likely explanation for post-lumbar puncture headaches. It is thought that ongoing leak of cerebrospinal fluid (CSF) through the puncture site causes ongoing CSF loss, leading to low pressure. A post-LP headache is typically frontal or occipital and occurs within three days. It is normally associated with worsening on standing and improvement when lying down. Treatment in severe cases includes an epidural blood patch, but most resolve on their own.

    • This question is part of the following fields:

      • Neurology
      10.1
      Seconds
  • Question 6 - A keratitis with dendritic ulceration of the cornea is diagnosed in a 32-year-old...

    Correct

    • A keratitis with dendritic ulceration of the cornea is diagnosed in a 32-year-old patient. What is the most likely cause?

      Your Answer: Herpes simplex virus

      Explanation:

      The dendritic ulceration seen on fluorescein staining of the eye is pathopneumonic for keratitis caused by HSV (herpes simplex virus). Presentation is that of blepharoconjunctivitis. Treatment is required, the treatment is typically topical acyclovir. Topical steroids can make the infection worse. The other answer choices would not have this dendritic pattern seen on fluorescein staining.

    • This question is part of the following fields:

      • Infectious Diseases
      14.7
      Seconds
  • Question 7 - A 65 yr. old male with a history of smoking and alcohol was...

    Correct

    • A 65 yr. old male with a history of smoking and alcohol was admitted with an ST elevation myocardial infarction. He was obese and lives a sedentary lifestyle. What is the non-pharmacological intervention which will be most helpful to reduce future ischaemic events?

      Your Answer: Stopping smoking

      Explanation:

      Stopping smoking is the single most effective non-pharmacological intervention which will reduce future ischaemic events. But the rest of the responses are also important interventions with regards to reducing future ischaemic events.

    • This question is part of the following fields:

      • Cardiology
      9.1
      Seconds
  • Question 8 - Which of the following is not a known cause of occupational asthma? ...

    Incorrect

    • Which of the following is not a known cause of occupational asthma?

      Your Answer: Platinum salts

      Correct Answer: Cadmium

      Explanation:

      Occupational asthma (OA) could be divided into a nonimmunological, irritant-induced asthma and an immunological, allergy-induced asthma. In addition, allergy-induced asthma can be caused by two different groups of agents: high molecular weight proteins (>5,000 Da) or low molecular weight agents (<5,000 Da), generally chemicals like the isocyanates.
      Isocyanates are very reactive chemicals characterized by one or more isocyanate groups (–N=C=O). The main reactions of this chemical group are addition reactions with ethanol, resulting in urethanes, with amines (resulting in urea derivates) and with water. Here, the product is carbamic acid which is not stable and reacts further to amines, releasing free carbon dioxide.

      Diisocyanates and polyisocyanates are, together with the largely nontoxic polyol group, the basic building blocks of the polyurethane (PU) chemical industry, where they are used solely or in combination with solvents or additives in the production of adhesives, foams, elastomers, paintings, coatings and other materials.

      The complex salts of platinum are one of the most potent respiratory sensitising agents having caused occupational asthma in more than 50% of exposed workers. Substitution of ammonium hexachlor platinate with platinum tetra amine dichloride in the manufacture of catalyst has controlled the problem in the catalyst industry. Ammonium hexachlorplatinate exposure still occurs in the refining process.

      Rosin based solder flux fume is produced when soldering. This fume is a top cause of occupational asthma.

      Bakeries, flour mills and kitchens where flour dust and additives in the flour are a common cause of occupational asthma.

      Cadmium was not found to cause occupational asthma.

    • This question is part of the following fields:

      • Respiratory
      8.7
      Seconds
  • Question 9 - A 31-year-old homosexual male is complaining of recent weight loss and blurred vision....

    Correct

    • A 31-year-old homosexual male is complaining of recent weight loss and blurred vision. A fundoscope was performed showing retinal haemorrhage. What is the single most appropriate option?

      Your Answer: HIV/AIDS

      Explanation:

      Given the symptoms described in a 31-year-old homosexual male, along with the findings of weight loss, blurred vision, and retinal hemorrhage, the single most appropriate option to consider is HIV/AIDS.

      HIV/AIDS can manifest with a wide range of symptoms, including unintentional weight loss and blurred vision. Retinal hemorrhage can also occur as a complication of HIV/AIDS, particularly in advanced stages when the immune system is severely compromised.

      In this case, it’s important to conduct further diagnostic tests, including HIV testing, to confirm the diagnosis. Additionally, prompt initiation of antiretroviral therapy (ART) is crucial for managing HIV/AIDS and preventing further complications. Referral to an infectious disease specialist for comprehensive management is recommended.

    • This question is part of the following fields:

      • Infectious Diseases
      15.1
      Seconds
  • Question 10 - A 9-year-old girl complains of perioral blisters and a burning sensation of her...

    Correct

    • A 9-year-old girl complains of perioral blisters and a burning sensation of her face. Some of the blisters are crusted and some are weeping. What is the most likely diagnosis?

      Your Answer: Impetigo

      Explanation:

      Impetigo appears more commonly on the face than other exposed areas like the limbs. Its blisters are clustered and may have a fluid discharge.

    • This question is part of the following fields:

      • Dermatology
      7
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Haematology & Oncology (1/1) 100%
Psychiatry (1/1) 100%
Clinical Sciences (0/1) 0%
Ophthalmology (0/1) 0%
Neurology (1/1) 100%
Infectious Diseases (2/2) 100%
Cardiology (1/1) 100%
Respiratory (0/1) 0%
Dermatology (1/1) 100%
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