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  • Question 1 - A 19-year-old female is admitted with a headache, photophobia, fever and confusion. She...

    Correct

    • A 19-year-old female is admitted with a headache, photophobia, fever and confusion. She is managed with antibiotics. What is the mechanism of action of the most commonly used first line antibiotic class?

      Your Answer: Inhibition of cell wall synthesis

      Explanation:

      In adults, the most common symptom of meningitis is a severe headache, occurring in almost 90% of cases of bacterial meningitis, followed by nuchal rigidity (the inability to flex the neck forward passively due to increased neck muscle tone and stiffness). Other signs commonly associated with meningitis include photophobia (intolerance to bright light) and phonophobia (intolerance to loud noises).
      In the United Kingdom empirical treatment consists of a third-generation cefalosporin such as cefotaxime or ceftriaxone. In the USA, where resistance to cefalosporins is increasingly found in streptococci, addition of vancomycin to the initial treatment is recommended. Penicillins, cephalosporins, carbapenems and monobactams all act via inhibition of cell wall synthesis.

    • This question is part of the following fields:

      • Clinical Sciences
      8
      Seconds
  • Question 2 - A 55-year-old woman admitted to the hospital with her third urinary tract infection...

    Incorrect

    • A 55-year-old woman admitted to the hospital with her third urinary tract infection in as many months. She has type-2 diabetes and started Empagliflozin (a sodium glucose co-transporter 2 inhibitor) 4 months ago. You suspect recurrent urinary tract infections secondary to her empagliflozin. Where is the main site of action of the drug?

      Your Answer: Late proximal convoluted tubule

      Correct Answer: Early proximal convoluted tubule

      Explanation:

      Selective sodium-glucose transporter-2 (SGLT2) is expressed in the proximal renal tubules and is responsible for the majority of the reabsorption of filtered glucose from the tubular lumen.
      Empagliflozin; SGLT2 inhibitors reduce glucose reabsorption and lower the renal threshold for glucose, thereby increasing urinary glucose excretion, thus increasing the risk of urinary tract infections.

    • This question is part of the following fields:

      • Endocrinology
      38.6
      Seconds
  • Question 3 - A 67 year-old attorney presents with a 2 month history of tremors affecting...

    Incorrect

    • A 67 year-old attorney presents with a 2 month history of tremors affecting his left arm. He suffers from depressive psychosis for the last 10 years, for which he has been receiving intermittent chlorpromazine and amitriptyline but has not been on any therapy for the last 4 months. He describes that his two brothers also had tremors. Upon examination, he has a resting tremor of his left hand with cogwheel rigidity of that arm and mild generalized bradykinesia. Which of the following is the most likely diagnosis?

      Your Answer: Drug-induced parkinsonism

      Correct Answer: Idiopathic Parkinson’s disease

      Explanation:

      The most likely diagnosis is idiopathic Parkinson’s disease because of the unilateral presentation. In addition, cogwheel rigidity is a classic presenting symptom. Neuroleptic-induced parkinsonism is usually bilateral and symmetrical. Essential tremors do not cause rest tremors.

    • This question is part of the following fields:

      • Neurology
      46
      Seconds
  • Question 4 - A 13-year-old girl presents with a swollen left knee following a fall. Her...

    Incorrect

    • A 13-year-old girl presents with a swollen left knee following a fall. Her parents state she suffers from haemophilia and has been treated for a right-sided haemarthrosis previously. What other condition is she most likely to have?

      Your Answer: Hunter's syndrome

      Correct Answer: Turner's syndrome

      Explanation:

      Haemophilia is a X-linked recessive disorder. In X-linked recessive inheritance only males are affected. An exception to this seen in examinations are patients with Turner’s syndrome, who are affected due to only having one X chromosome. X-linked recessive disorders are transmitted by heterozygote females (carriers) and male-to-male transmission is not seen. Affected males can only have unaffected sons and carrier daughters.

    • This question is part of the following fields:

      • Clinical Sciences
      9.4
      Seconds
  • Question 5 - You want to measure the potential benefit of creating a service dedicated to...

    Correct

    • You want to measure the potential benefit of creating a service dedicated to patients with multiple sclerosis in the local area. Which factor would determine how many resources will be required?

      Your Answer: Prevalence

      Explanation:

      To describe how often a disease or another health event occurs in a population, different measures of disease frequency can be used. The prevalence reflects the number of existing cases of a disease. In contrast to the prevalence, the incidence reflects the number of new cases of disease and can be reported as a risk or as an incidence rate. Prevalence and incidence are used for different purposes and to answer different research questions.

    • This question is part of the following fields:

      • Clinical Sciences
      48.1
      Seconds
  • Question 6 - A 74-year-old man who has been diagnosed with atrial fibrillation and heart failure...

    Incorrect

    • A 74-year-old man who has been diagnosed with atrial fibrillation and heart failure is being started on digoxin. What is the mechanism of action of digoxin?

      Your Answer: Blocks Ca2+ release from the sarcoplasmic reticulum

      Correct Answer:

      Explanation:

      Digoxin acts by inhibiting the Na+/K+ ATPase pump.
      Digoxin is a cardiac glycoside now mainly used for rate control in the management of atrial fibrillation. As it has positive inotropic properties it is sometimes used for improving symptoms (but not mortality) in patients with heart failure.

      Mechanism of action:
      It decreases the conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and atrial flutter.
      It increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. It also stimulates the vagus nerve.

      Digoxin toxicity:
      Plasma concentration alone does not determine whether a patient has developed digoxin toxicity. The likelihood of toxicity increases progressively from 1.5 to 3 mcg/l.
      Clinical feature of digoxin toxicity include a general feeling of unwell, lethargy, nausea & vomiting, anorexia, confusion, xanthopsia, arrhythmias (e.g. AV block, bradycardia), and gynaecomastia

      Precipitating factors:
      Hypokalaemia
      Increasing age
      Renal failure
      Myocardial ischemia
      Hypomagnesaemia, hypercalcemia, hypernatremia, acidosis
      Hypoalbuminemia
      Hypothermia
      Hypothyroidism
      Drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in the distal convoluted tubule, therefore, reduce excretion), ciclosporin. Also, drugs that cause hypokalaemia e.g. thiazides and loop diuretics.

      Management of digoxin toxicity:
      Digibind
      Correct arrhythmias
      Monitor and maintain potassium levels within the normal limits.

    • This question is part of the following fields:

      • Pharmacology
      5.8
      Seconds
  • Question 7 - A girl suffered full thickness circumferential burn to her right arm. What is...

    Correct

    • A girl suffered full thickness circumferential burn to her right arm. What is best step in management?

      Your Answer: Escharotomy

      Explanation:

      An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.

    • This question is part of the following fields:

      • Dermatology
      7.9
      Seconds
  • Question 8 - A 24-year-old female presents with generalised irritation and erythematous skin after sunbathing on...

    Correct

    • A 24-year-old female presents with generalised irritation and erythematous skin after sunbathing on the beach. Which is the most appropriate immediate treatment for this patient?

      Your Answer: Emollient cream

      Explanation:

      Sun burn reactions usually occur after individuals with a light skin tone have prolonged exposure to the sun. The usual symptoms are redness and itching of the skin. The best treatment plan would be further avoidance of sun exposure and the topical application of emollients. These are Ist degree burns and aggressive therapy is not required in such cases.

    • This question is part of the following fields:

      • Dermatology
      8.1
      Seconds
  • Question 9 - Which of the following features occurs very less frequently with drug induced lupus?...

    Correct

    • Which of the following features occurs very less frequently with drug induced lupus?

      Your Answer: Glomerulonephritis

      Explanation:

      Drug induced lupus typically presents with pulmonary involvement and no renal or neurological involvement. Hence glomerulonephritis would be highly unlikely in this case. Rash and arthralgias are classic presentations. Pleurisy can be present as pulmonary involvement may occur with DILE.

    • This question is part of the following fields:

      • Rheumatology
      4.4
      Seconds
  • Question 10 - A 64-year-old woman presents with malaise, ankle swelling and shortness of breath. Her...

    Correct

    • A 64-year-old woman presents with malaise, ankle swelling and shortness of breath. Her blood pressure is 215/140 mmHg, she has +2 peripheral oedema and the skin over her fingers appears very tight. Fundoscopy discloses bilateral papilledema.   Plasma creatinine concentration is 370 μmol/l, potassium is 4.9 mmol/l, haemoglobin is 8.9 g/dl and her platelet count is 90 x 109 /ml.   What is the pathological hallmark of this condition?

      Your Answer: Mucoid intimal thickening of vascular endothelium

      Explanation:

      The history is suggestive of scleroderma renal crisis, where we would expect thrombotic microangiopathy process with vascular endothelium involvement manifesting as mucoid intimal thickening or onion skin effect.

    • This question is part of the following fields:

      • Nephrology
      28.2
      Seconds
  • Question 11 - A 43-year-old woman is concerned about osteoporosis as she as a strong family...

    Incorrect

    • A 43-year-old woman is concerned about osteoporosis as she as a strong family history of it. She is one year postmenopausal and aware of hot flushes at night. Which one of the following therapies would be most appropriate?

      Your Answer: Calcium and vitamin D supplements

      Correct Answer: Cyclical oestrogen and progestogen

      Explanation:

      As the patient has early menopause, hormone replacement therapy (HT) is considered to be the first line of choice for prevention of bone loss and fracture in the early postmenopausal period for 5 years.

    • This question is part of the following fields:

      • Endocrinology
      5.4
      Seconds
  • Question 12 - 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
      9
      Seconds
  • Question 13 - A 17-year-old Jewish girl presents with primary amenorrhoea. On examination, she looks a...

    Incorrect

    • A 17-year-old Jewish girl presents with primary amenorrhoea. On examination, she looks a little hirsute and has evidence of facial acne. She is within her predicted adult height and has normal breast and external genitalia development, however, there is excess hair over her lower abdomen and around her nipple area. Investigations were as follows: Hb 13.1 g/dL, WCC 8.6 x109/L, PLT 201 x109/L, Na+ 139 mmol/L, K+ 4.5 mmol/L, Creatinine 110 µmol/L, 17-OH progesterone 1.4 times the upper limit of normal. Pelvic ultrasound: bilateral ovaries and uterus visualised. Which of the following is the most likely diagnosis?

      Your Answer: Polycystic ovarian syndrome

      Correct Answer: Non-classical congenital adrenal hyperplasia

      Explanation:

      Mild deficiencies of 21-hydroxylase or 3-beta-hydroxysteroid dehydrogenase activity may present in adolescence or adulthood with oligomenorrhea, hirsutism, and/or infertility. This is termed nonclassical adrenal hyperplasia.
      Late-onset or nonclassical congenital adrenal hyperplasia (NCAH) due to 21-hydroxylase deficiency is one of the most common autosomal recessive disorders. Reported prevalence ranges from 1 in 30 to 1 in 1000. Affected individuals typically present due to signs and symptoms of androgen excess.
      Treatment needs to be directed toward the symptoms. Goals of treatment include normal linear growth velocity, a normal rate of skeletal maturation, ‘on-time’ puberty, regular menstrual cycles, prevention of or limited progression of hirsutism and acne, and fertility. Treatment needs to be individualized and should not be initiated merely to decrease abnormally elevated hormone concentrations.
      Normal Ultrasound rules out Turner’s syndrome.

    • This question is part of the following fields:

      • Endocrinology
      13.6
      Seconds
  • Question 14 - A 60 yr. old female presented with difficulty in breathing. What is the...

    Correct

    • A 60 yr. old female presented with difficulty in breathing. What is the clinical sign that will indicate the presence of established pulmonary hypertension?

      Your Answer: Raised jugular venous pressure

      Explanation:

      A prominent A wave is observed in the jugular venous pulse and this indicates the presence of established pulmonary hypertension. In addition the pulmonic component of the second heart sound (P2) may be increased and the P2 may demonstrate fixed or paradoxical splitting. The signs of right ventricular failure include a high-pitched systolic murmur of tricuspid regurgitation, hepatomegaly, a pulsatile liver, ascites, and peripheral oedema.

    • This question is part of the following fields:

      • Cardiology
      4.8
      Seconds
  • Question 15 - A 65 year old retired postman has been complaining of a two-month history...

    Incorrect

    • A 65 year old retired postman has been complaining of a two-month history of lethargy associated with dyspnoea. He has never smoked and takes no medication. The chest X-ray shows multiple round lesions increasing in size and numbers at the base. There is no hilar lymphadenopathy.   What condition does he most likely have?

      Your Answer: Silicosis

      Correct Answer: Pulmonary metastases

      Explanation:

      Pulmonary metastasis is seen in 20-54% of extrathoracic malignancies. The lungs are the second most frequent site of metastases from extrathoracic malignancies. Twenty percent of metastatic disease is isolated to the lungs. The development of pulmonary metastases in patients with known malignancies indicates disseminated disease and places the patient in stage IV in TNM (tumour, node, metastasis) staging systems.
      Chest radiography (CXR) is the initial imaging modality used in the detection of suspected pulmonary metastasis in patients with known malignancies. Chest CT scanning without contrast is more sensitive than CXR.
      Breast, colorectal, lung, kidney, head and neck, and uterus cancers are the most common primary tumours with lung metastasis at autopsy. Choriocarcinoma, osteosarcoma, testicular tumours, malignant melanoma, Ewing sarcoma, and thyroid cancer frequently metastasize to lung, but the frequency of these tumours is low.

    • This question is part of the following fields:

      • Respiratory
      46.5
      Seconds
  • Question 16 - A 18 yr. old male was screened for hypertrophic cardiomyopathy (HOCM) as his...

    Correct

    • A 18 yr. old male was screened for hypertrophic cardiomyopathy (HOCM) as his brother had the same condition. What is the echocardiographic finding that is related to the highest risk of sudden cardiac death?

      Your Answer: Significant thickening of the interventricular septum

      Explanation:

      There are five prognostic factors which indicate poor prognosis in HOCM:
      -family history of HOCM-related sudden cardiac death
      -unexplained recent syncope
      -large left ventricular wall thickness (MLVWT ≥ 30 mm)
      -multiple bursts of nsVT on ambulatory electrocardiography
      -hypotensive or attenuated blood pressure response to exercise

    • This question is part of the following fields:

      • Cardiology
      9.6
      Seconds
  • Question 17 - Which of the statements is most accurate regarding the lung? ...

    Incorrect

    • Which of the statements is most accurate regarding the lung?

      Your Answer: On the right side the transverse fissure separates the upper lobe from the lower lobe

      Correct Answer: The medial basal segment is absent in the left lower lobe

      Explanation:

      The right and left lung anatomy are similar but asymmetrical. The right lung consists of three lobes: right upper lobe (RUL), right middle lobe (RML), and right lower lobe (RLL). The left lung consists of two lobes: right upper lobe (RUL) and right lower lobe (RLL). The right lobe is divided by an oblique and horizontal fissure, where the horizontal fissure divides the upper and middle lobe, and the oblique fissure divides the middle and lower lobes. In the left lobe there is only an oblique fissure that separates the upper and lower lobe.

      The lobes further divide into segments which are associated with specific segmental bronchi. Segmental bronchi are the third-order branches off the second-order branches (lobar bronchi) that come off the main bronchus.

      The right lung consists of ten segments. There are three segments in the RUL (apical, anterior and posterior), two in the RML (medial and lateral), and five in the RLL (superior, medial, anterior, lateral, and posterior). The oblique fissure separates the RUL from the RML, and the horizontal fissure separates the RLL from the RML and RUL.

      There are eight to nine segments on the left depending on the division of the lobe. In general, there are four segments in the left upper lobe (anterior, apicoposterior, inferior and superior lingula) and four or five in the left lower lobe (lateral, anteromedial, superior and posterior). The medium sized airways offer the maximum airway resistance, not smaller ones.

    • This question is part of the following fields:

      • Respiratory
      10.3
      Seconds
  • Question 18 - A 37-year old female nurse presents with severe generalized itching, claiming that she...

    Incorrect

    • A 37-year old female nurse presents with severe generalized itching, claiming that she had previously applied cream to the body of a patient with similar symptoms. What is the mechanism that produces her itch?

      Your Answer: Allergic reaction developed due to use of topical steroid creams

      Correct Answer: Allergic reaction

      Explanation:

      Contact dermatitis is a red, itchy rash caused by direct contact with a substance or an allergic reaction to it. The entry of allergen into the epidermis or dermis causes a localized allergic reaction. Local mast-cell activation in the skin leads immediately to a local increase in vascular permeability, which causes extravasation of fluid and swelling. Histamine released by mast cells activated by allergen in the skin causes large, itchy, red swellings of the skin.

    • This question is part of the following fields:

      • Dermatology
      14.8
      Seconds
  • Question 19 - A 62-year-old lady is referred with painless jaundice and weight loss. Bilirubin is...

    Correct

    • A 62-year-old lady is referred with painless jaundice and weight loss. Bilirubin is 214 mmol/L, alanine transaminase (ALT) 62 U/L, alkaline phosphatase (ALP) 605 U/L, albumin 34 g/L and prothrombin time 17 seconds. Ultrasound of the abdomen shows a grossly dilated biliary tree and a dilated pancreatic duct, but no mass is seen. What is the next most appropriate step in her management?

      Your Answer: Abdominal CT scan

      Explanation:

      This scenario is suggestive of a pancreatic head mass with obstructive jaundice and US showing a ‘double duct’ sign. A CT Scan would be recommended to evaluate for a pancreatic head mass. If a mass was found, the next step would then be to do an ERCP with EUS to obtain a biopsy of the mass for tissue diagnosis. Laparoscopy would not be recommended. CA19-9 would not be diagnostic.

    • This question is part of the following fields:

      • Gastroenterology
      19.1
      Seconds
  • Question 20 - A 62 year old patient presents to the ophthalmology OPD with progressive deterioration...

    Incorrect

    • A 62 year old patient presents to the ophthalmology OPD with progressive deterioration of vision and dazzling of view in well lit environments. Which of the following is the most likely diagnosis leading to this presentation?

      Your Answer: Cataracts

      Correct Answer:

      Explanation:

      Cataract is a condition characterized by clouding of the lens of the eye. This condition most frequently occurs due to age-related degenerative processes in the lens, but can also be associated with ocular trauma, metabolic disorders, side-effects of drugs, or congenital infections. The clouding causes distortion of light, as it passes through the lens, resulting in visual impairment and glare. Initially, a cataract presents discretely and may even go unnoticed, but the visual impairment worsens as the cataract grows larger.

      Diagnosis is typically established on the basis of a thorough history and direct visualization of the cataract (by means of slit-lamp microscopy). Surgery is indicated with significant visual impairment and involves lens extraction and implantation of an artificial lens. Untreated cataracts eventually lead to complete blindness.

    • This question is part of the following fields:

      • Ophthalmology
      8.2
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Clinical Sciences (2/3) 67%
Endocrinology (0/3) 0%
Neurology (1/2) 50%
Pharmacology (0/1) 0%
Dermatology (2/3) 67%
Rheumatology (1/1) 100%
Nephrology (1/1) 100%
Cardiology (2/2) 100%
Respiratory (0/2) 0%
Gastroenterology (1/1) 100%
Ophthalmology (0/1) 0%
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