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Question 1
Incorrect
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What is the failure rate of tubal sterilization?
Your Answer: 1 in 500
Correct Answer: 1 in 200
Explanation:Tubal sterilization is a safe and effective surgical procedure that permanently prevents pregnancy. However, pregnancy can occur in 1 in 200 cases, according to international sources. In the 1st year after tubal sterilization, the estimated failure rate is 0.1-0.8% respectively.
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This question is part of the following fields:
- Gynaecology
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Question 2
Incorrect
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A 62-year-old obese female presented with dilated veins over the lateral aspect of her right ankle. Which of the following is most responsible for her presentation?
Your Answer: Popliteal veins
Correct Answer: Short saphenous vein
Explanation:Varicose veins (venous insufficiency syndrome) are dilated, tortuous veins due to reverse venous flow. All the given veins can be affected from this condition. As the patient has varicose veins over lateral aspect of ankle, the short saphenous vein is affected. The great or long saphenous vein travels along the medial aspect of the ankle
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This question is part of the following fields:
- Cardiovascular
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Question 3
Incorrect
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Which of the following statements regarding the proton pump inhibitors is true?
Your Answer: They reversibly block parietal cell proton pumps
Correct Answer: They cause hair loss, diarrhoea, and headache
Explanation:Common side effects of omeprazole include: headache, abdominal pain, diarrhoea, nausea, vomiting, gas (flatulence), dizziness, upper respiratory infection, acid reflux, constipation, rash, cough.
Less common side effects of Omeprazole include: bone fracture (osteoporosis related), deficiency of granulocytes in the blood, loss of appetite, gastric polyps, hip fracture, hair loss, chronic inflammation of the stomach, destruction of skeletal muscle, taste changes, abnormal dreams.
Rare side effects of Omeprazole include: liver damage, inflammation within the kidneys, pancreatitis, dermatologic disorder, potentially life threatening (toxic epidermal necrolysis). -
This question is part of the following fields:
- Pharmacology
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Question 4
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:
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 5
Incorrect
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An 18-year-old male smoker presents with extreme rubor of the feet and missing foot pulses following an amputation of his right 2nd toe. What is the most probable diagnosis?
Your Answer:
Correct Answer: Buerger’s disease
Explanation:Clinical criteria for the diagnosis of Buerger’s disease are:
1 – smoking history
2 – onset before the age of 50 years
3 – infrapopliteal arterial occlusions
4 – either upper limb involvement or phlebitis migrans
5 – absence of atherosclerotic risk factors other than smoking Confident clinical diagnosis of Buerger’s disease may be made only when all five requirements have been fulfilled. -
This question is part of the following fields:
- Respiratory
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Question 6
Incorrect
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A 28-year-old male complained of an annular rash following an insect bite he received during a hiking trip. Which of the following is the drug of choice?
Your Answer:
Correct Answer: Doxycycline PO
Explanation:The described rash is the typical rash of erythema migrans of Lyme disease, which is treated by doxycycline PO
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This question is part of the following fields:
- Infectious Diseases
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Question 7
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 8
Incorrect
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A 16 year old boy presented, complaining that an insect had lodged in his left ear. Which of the following can be considered as the most appropriate method to remove the insect?
Your Answer:
Correct Answer: Syringe the ear with warm water
Explanation:Removal of foreign bodies from the ear is indicated whenever a well-visualized foreign body is identified in the external auditory canal. Insects are better extracted with suction than with forceps or hooks. From the given answers, irrigation with warm water is the most suitable answer.
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This question is part of the following fields:
- ENT
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Question 9
Incorrect
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A 26 year old male presents with right sided elbow and wrist pain and left sided knee and ankle pain that has persisted for about two weeks. He recently returned from a trip to Thailand that last for two weeks. The patient admits to having unprotected sex while on holiday. Examination reveals swelling and tenderness of tendons around joints but no inflammation of the joints. A vesiculopustular skin rash is also observed. What is the most likely cause?
Your Answer:
Correct Answer: Gonococcal arthritis
Explanation:Patients with disseminated gonococcal arthritis may present with dermatitis-arthritis syndrome (60%) of with localized septic arthritis. (40%). Arthritis-dermatitis syndrome includes the classic triad of dermatitis, tenosynovitis, and migratory polyarthritis. Gout usually involves a singe joint and does not cause vesicopustular skin rash. Reactive arthritis has ocular symptoms (conjunctivitis), urethritis, and arthritis. Fungal arthritis occurs rarely and it may occur after a surgical infection or fungal spread hematogenously. it presents with tender, red, hot and swollen joint with loss of range of motion.
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This question is part of the following fields:
- Rheumatology
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Question 10
Incorrect
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A 6-year-old boy was admitted with a burn that looks third or fourth degree upon inspection. He has not stopped crying. What is the most appropriate next step?
Your Answer:
Correct Answer: IV fluid start
Explanation:The boy needs re-hydration due to his full thickness burn so IV fluids is the next most appropriate step. The greatest loss of plasma occurs in the first 12 hours after burn injury. The plasma loss then slowly decreases during the second 12 hours of the post-burn phase, although extensive leakage can continue for up to three days (Ahrns, 2004). Optimal fluid replacement during this period is essential to ensure cardiac output and renal and tissue perfusion. Usually, 36 hours post-burn, capillary permeability returns to normal and fluid is drawn back into the circulation. Burns of more than 15% of surface body area in adults and of over 10% in children warrant formal resuscitation.
The Parkland formula for the total fluid requirement in 24 hours is as follows:
4ml x TBSA (%) x body weight (kg);
50% given in first eight hours;
50% given in next 16 hours.
Children receive maintenance fluid in addition, at an hourly rate of:
4ml/kg for the first 10kg of body weight plus;
2ml/kg for the second 10kg of body weight plus;
1ml/kg for >20kg of body weight.
End point
Urine – adults: 0.5–1.0 ml/kg/hour;
Urine – children: 1.0–1.5ml/kg/hour. -
This question is part of the following fields:
- Child Health
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Question 11
Incorrect
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A 75-year-old man was admitted with urinary dribbling and incontinence. Upon examination, there is a palpable mass up to the umbilicus. His clothes smell of ammonia and he is known to be a chronic alcoholic. What is the next most appropriate step?
Your Answer:
Correct Answer: Urethral catheter
Explanation:It is obvious in this case that chronic alcohol use has contributed to the patient’s urinary incontinence which requires a urethral catheter. Suprapubic catheters are usually preferred in cases of acute urinary retention while condom catheters are indicated in less severe cases of urinary incontinence. We would administer antibiotics if we suspected a urinary infection causing the urinary incontinence, but in this case the cause is obvious.
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This question is part of the following fields:
- Urology
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Question 12
Incorrect
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A 37-year-old woman presents with signs of decreased air entry at the right base after an emergency laparotic cholecystectomy 18h ago but with no obvious abnormality showed on her CXR. What is the most appropriate management strategy?
Your Answer:
Correct Answer: Chest physiotherapy
Explanation:Non-invasive action via chest physiotherapy is helpful in the reduction or clearance of excessive secretions from airways.
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This question is part of the following fields:
- Respiratory
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Question 13
Incorrect
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A 65-year-old female presented with episodes of unilateral blindness, which spontaneously resolved. Her cardiovascular examination was normal. What is the single most appropriate investigation that can be performed to arrive at a diagnosis?
Your Answer:
Correct Answer: Carotid duplex ultrasonography
Explanation:Amaurosis fugax (transient ipsilateral visual loss) and transient ischemic attacks (TIAs) are presentations of atherosclerotic disease of the carotid artery which can be identified by carotid duplex ultrasonography (US), with or without colour, which is the screening test of choice to evaluate for carotid stenosis.
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This question is part of the following fields:
- Neurology
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Question 14
Incorrect
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A 51-year-old woman complains of sudden onset of severe headache and vomiting that is worse when she is lying flat. Fundoscopy confirms bilateral papilledema. Which is the definitive investigation in this case?
Your Answer:
Correct Answer: Computed tomography scan
Explanation:A head CT scan is the best step to rule out a mass lesion or bleed. Since the patient has symptoms that may suggest elevated intracranial pressure (ICP), a lumbar puncture should be consulted first with a neurologist since it is contraindicated in this case due to raised ICP and risk of coning.
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This question is part of the following fields:
- Neurology
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Question 15
Incorrect
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A 32-year-old female presented with a lump in the upper outer quadrant of her left breast, which is 1.5cm in size and tender. What is the initial investigation to be done?
Your Answer:
Correct Answer: Ultrasound
Explanation:Tenderness is usually suggestive of a benign breast mass such as a breast abscess. Ultrasound is used to distinguish solid from cystic structures and to direct needle aspiration for abscess drainage.
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This question is part of the following fields:
- Breast
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Question 16
Incorrect
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A 45 year old man presents with fever, malaise, weight loss and myalgias that have been occurring for a month. You suspect polyarteritis nodosa and arrange for some lab investigations. Which of the following abnormality would most likely be present?
Your Answer:
Correct Answer: Elevated creatinine
Explanation:People with polyarteritis nodosa often exhibit anaemia of chronic disease. Leucocytosis and eosinophilia may also be present. ANCA is only rarely positive. As polyarteritis nodosa affects the kidneys as well, the creatinine is elevated in most cases.
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This question is part of the following fields:
- Rheumatology
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Question 17
Incorrect
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A 33 year old male patient has a history of recurrent hospital admissions. The reason for his admissions was described as palpitations in the context of anxiety or panic attacks. He occasionally experiences tremors and high blood pressure. He's also noticed he's been losing weight persistently. What is the most likely diagnosis?
Your Answer:
Correct Answer:
Explanation:Pheochromocytoma is a benign tumour of the adrenal glands. Characteristically it causes high blood pressure. It is a rare condition that can mimic panic attacks in the sense that it produces sympathomimetic symptoms together with weight loss, headaches and tremor. The clinical picture might be mistaken for other anxiety syndromes.
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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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An 87-year-old woman had to double up her dosage of morphine 60mg into 120mg twice a day, in addition to another 10mg oral Morphine 6 times a day. What is the best method of management?
Your Answer:
Correct Answer: Subcutaneous morphine infusion
Explanation:Stable dose of Morphine is essential for chronic cases of pain that are non-malignant in origin. Using the SC route avoids having to intravenously cannulate a patient and allows for a continuous infusion of drugs over a calculated period of time providing constant dosing A significant advantage is that plasma levels of a drug are much more stable, and appropriate symptom control can be achieved without the toxic effects of the peaks and troughs resulting from episodic drug administration.
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This question is part of the following fields:
- Older Adult
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Question 19
Incorrect
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A 25-year-old man on warfarin post hemicolectomy is about to undergo surgery. Which of the following should be done in such a case?
Your Answer:
Correct Answer: Stop warfarin and add heparin
Explanation:Warfarin and Heparin are both anticoagulants, however, warfarin is used to treat chronic conditions, whereas heparin is administered for managing acute conditions (shorter half-life). As this person is about to undergo surgery, anticoagulation can cause excessive bleeding, especially when tissues are cut. Therefore, warfarin will be stopped prior to the procedure and heparin will be administered either subcutaneously or intravenously to prevent formation of any blood clots during surgery but must also be stopped shortly before surgery. As its effect does not last as long as that of warfarin, it can be stopped a shorter time before surgery. Common practice is to give the last dose the evening before surgery.
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This question is part of the following fields:
- Pharmacology
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Question 20
Incorrect
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A 30-year-old female is being investigated for subfertility. At what day of her menstrual cycle should blood be collected for progesterone, if she has a regular 28-day menstrual cycle?
Your Answer:
Correct Answer: Day 21
Explanation:Maximum levels of progesterone are detected at day 21 of 28 days in the menstrual cycle, assuming that ovulation has occurred at day 14. A value of >30nmol/l indicates an ovulatory cycle.
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This question is part of the following fields:
- Gynaecology
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Question 21
Incorrect
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A 22 year old nulliparous female presents with shortness of breath. She has a history of recurrent deep vein thrombosis. Complete blood count and clotting screen reveals the following results:Hb: 12.4 g/dl Plt: 137 WBC: 7.5*109/l PT: 14 secs APTT: 46 secs Which of the following would be the most likely diagnosis?
Your Answer:
Correct Answer: Antiphospholipid syndrome
Explanation:The combination of APTT and low platelets with recurrent DVTs make antiphospholipid syndrome the most likely diagnosis.
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This question is part of the following fields:
- Rheumatology
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Question 22
Incorrect
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A 2 year old boy is brought by his mother to the emergency department with colicky pain. The boy has experienced such episodes of pain in the past, which radiates from his loin to the groin. After clinical examination and investigations, a 7mm stone has been found in his ureter. What is the single most appropriate next step?
Your Answer:
Correct Answer: Conservative treatment
Explanation:Renal stones < 5mm generally pass spontaneously with adequate fluid intake. Stones 5mm-10mm with pain not resolving, require medical expulsive therapy with Nifedipine or Tamsulosin. For stones larger than 10mm, ESWL or Ureteroscopy is indicated. For stones as big as 2cm, percutaneous nephrolithotomy should be applied.
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This question is part of the following fields:
- Child Health
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Question 23
Incorrect
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A 30 year old female experienced carpopedal spasms and perioral numbness during interviews, exams and whenever she gave a public talk. Which of the following is the best management for this patient?
Your Answer:
Correct Answer: Desensitization
Explanation:According to the history the most likely diagnosis is panic disorder. Desensitization is the treatment option for the long term management. Rebreathing in a paper bag is the treatment option for an acute presentation.
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This question is part of the following fields:
- Mental Health
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Question 24
Incorrect
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A 56 year old woman presents to the clinic complaining of shoulder pain that she has been experiencing for the last 4 weeks. She does not remember getting injured previously. The pain worsens on movement especially when she is moving the arm quickly. At night, lying on the affected side is painful. Examination reveals no erythema or swelling. However, pain is felt on passive abduction between 60 to 120 degrees and she is unable to abduct the arm past 70-80 degrees. Flexion and extension are intact. What is the most likely diagnosis?
Your Answer:
Correct Answer: Supraspinatus tendonitis
Explanation:Supraspinatus tendinopathy is a common and disabling condition that becomes more prevalent after middle age and is a common cause of pain in the shoulder. A predisposing factor is resistive overuse. This patient has the classic painful arc that is a sign of shoulder impingement characteristic of supraspinatus tendonitis.
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This question is part of the following fields:
- Rheumatology
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Question 25
Incorrect
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From the following options, choose the one which is not a cause of liver cirrhosis.
Your Answer:
Correct Answer: Schistosomiasis
Explanation:Schistosomiasis is a cause of portal hypertension and periportal fibrosis – it is, however, not a cause of cirrhosis. The main causes of cirrhosis include: alcohol and hepatitis B, C, and D. Autoimmune causes include: both primary and secondary biliary cirrhosis and autoimmune hepatitis. There are a number of inherited conditions which cause cirrhosis, such as hereditary hemochromatosis, Wilson’s disease, Alpha-1 anti-trypsin deficiency, galactosaemia glycogen storage disease, and cystic fibrosis. Additionally, there are also vascular causes, such as hepatic venous congestion, Budd-Chiari syndrome, and veno-occlusive disease. Intestinal bypass surgery has also been implicated as a causative factor for cirrhosis.
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This question is part of the following fields:
- Gastrointestinal
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Question 26
Incorrect
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A 56 year old, postmenopausal female complains of vaginal bleeding. Transvaginal ultrasound is done which reveals the thickness of endometrium to be 10mm. Which further investigation would be most appropriate in this case?
Your Answer:
Correct Answer: Hysteroscopy and D&C
Explanation:Endometrial hyperplasia most often is caused by excess oestrogen without progesterone. If ovulation does not occur, progesterone is not made, and the lining is not shed. The endometrium may continue to grow in response to oestrogen. The cells that make up the lining may crowd together and may become abnormal. This condition, called hyperplasia, may lead to cancer in some women. Endometrial hyperplasia usually occurs after menopause, when ovulation stops and progesterone is no longer made. It also can occur during peri-menopause, when ovulation may not occur regularly. Listed as follows are other situations in which women may have high levels of oestrogen and not enough progesterone:
– Use of medications that act like oestrogen
– Long-term use of high doses of oestrogen after menopause (in women who have not had a hysterectomy)
– Irregular menstrual periods, especially associated with polycystic ovary syndrome or infertility
– ObesityTransvaginal ultrasound may be done to measure the thickness of the endometrium. To exclude carcinoma an endometrial biopsy, dilation and curettage, or hysteroscopy may be done.
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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 44 year old obese woman presented with severe abdominal pain in her right hypochondrium. An US abdomen was done which showed the presence of gallstones. The next step in management would be?
Your Answer:
Correct Answer: Laparoscopic Cholecystectomy
Explanation:With patients who are obese and have gallstones, the best procedure to be done is a laparoscopic cholecystectomy. Reassurance and low fat diets would not have much affect because these symptoms would recur if a cholecystectomy is not done.
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This question is part of the following fields:
- Surgery
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Question 28
Incorrect
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Which is the mechanism of action of trimethoprim?
Your Answer:
Correct Answer: Inhibition of folic acid metabolism
Explanation:Trimethoprim interferes with the action of dihydrofolate reductase and thus inhibits folic acid metabolism and restricts DNA synthesis.
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This question is part of the following fields:
- Pharmacology
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Question 29
Incorrect
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A 45 year old smoker presented with sudden onset of chest pain radiating to his left arm, with associated sweating. ECG showed ST elevation in leads I, aVL and V1-V4. The most likely diagnosis would be?
Your Answer:
Correct Answer: Anterior MI
Explanation:An anterior wall myocardial infarction is characterised by ST elevation in leads I, aVL and V1-V5.
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This question is part of the following fields:
- Cardiovascular
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Question 30
Incorrect
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A 3-year-old boy presents with a patchy rash after treatment for an enlarged cervical lymph node and sore throat. What is the antibiotic that caused this rash?
Your Answer:
Correct Answer: Ampicillin
Explanation:An enlarged lymph node does not necessarily need treatment especially if it is caused by a virus. If it is bacterial, antibiotics should be prescribed. Amoxicillin is first line treatment in non-penicillin allergic patients and side effects include allergic reactions like skin rash and itching
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This question is part of the following fields:
- Child Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
