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  • Question 1 - A 45-year-old male patient came to the OPD with a complaint of severe...

    Incorrect

    • A 45-year-old male patient came to the OPD with a complaint of severe headache on the right side, with right-sided jaw pain, and additional blurred vision in the right eye. The headache was throbbing in character. Which investigation will you prefer next?

      Your Answer: CT scan head

      Correct Answer: Erythrocyte sedimentation rate (ESR)

      Explanation:

      Age of the patient, headache only on one side, and loss of vision on that side suggest temporal arteritis, also known as giant cell arteritis. The laboratory hallmark of this condition is a raised ESR.

    • This question is part of the following fields:

      • Ophthalmology
      15.5
      Seconds

  • Question 2 - A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a...

    Incorrect

    • A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a recent holiday abroad. Which of the following investigations is the least relevant?

      Your Answer:

      Correct Answer: PCR of CSF for Mycobacterium TB

      Explanation:

      Amoebic, bacterial and fungal meningitis may present acutely but is not common in tuberculous meningitis. Amoebic meningitis is caused by Naegleria fowleri as a result of swimming in infected freshwater. The organism may be found in fresh CSF specimens with phase contrast microscopy.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 3 - A 32-year-old woman, who is 18 weeks pregnant, is diagnosed with antiphospholipid syndrome...

    Incorrect

    • A 32-year-old woman, who is 18 weeks pregnant, is diagnosed with antiphospholipid syndrome and positive anticardiolipin antibodies. She has a history of three miscarriages, each one during the first trimester. What would be the next most appropriate step?

      Your Answer:

      Correct Answer: Aspirin & heparin

      Explanation:

      The syndrome with which the woman was diagnosed is an autoimmune, hypercoagulable state which most possibly was the reason of her previous miscarriages. This is the reason why she should be on aspirin and heparin in order to prevent any future miscarriage.

    • This question is part of the following fields:

      • Obstetrics
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      Seconds

  • Question 4 - A 19 year old male has gone to his local doctor's surgery complaining...

    Incorrect

    • A 19 year old male has gone to his local doctor's surgery complaining of weight loss, an increased thirst, and urinating more frequently. His father, grandfather, and both of his sisters have all been diagnosed with DM. What type of DM does this patient most likely suffer from?

      Your Answer:

      Correct Answer: MODY

      Explanation:

      The key features of MODY are: being diagnosed with DM under the age of 15, having a parent with DM, and DM in two or more generations of the family.

    • This question is part of the following fields:

      • Endocrine
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      Seconds

  • Question 5 - A 32-year-old female patient has the following signs and symptoms: smooth goitre, lid...

    Incorrect

    • A 32-year-old female patient has the following signs and symptoms: smooth goitre, lid lag and bilateral exophthalmos with puffy eyelids and conjunctival injections. She has a history of thyrotoxicosis but wants to fall pregnant. What would be the most appropriate treatment for her?

      Your Answer:

      Correct Answer: 18m of Propylthiouracil (PTU) alone

      Explanation:

      Propylthiouracil (PTU) is a safe choice for a woman that is planning a pregnancy because it does not have the teratogenic effects as carbimazole does. Methimazole (MMI) and propylthiouracil (PTU) are the standard anti-thyroid drugs used in the treatment of hyperthyroidism in pregnancy. Carbimazole can cause spina bifida, CV malformations as well as hypospadia.

    • This question is part of the following fields:

      • Endocrine
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      Seconds

  • Question 6 - High titre of which of the following antibodies is not considered diagnostic for...

    Incorrect

    • High titre of which of the following antibodies is not considered diagnostic for the mentioned disease?

      Your Answer:

      Correct Answer: Rheumatoid factor in rheumatoid arthritis (RA)

      Explanation:

      Diagnosis of RA is mainly based on clinical features (e.g., morning stiffness, symmetrical joint swelling) and laboratory tests (e.g., anti-CCP). Rheumatoid factor is not very specific for this disease and hence has low reliability. X-ray findings (e.g., soft tissue swelling or joint space narrowing) occur late in the disease and are therefore not typically used for diagnosis.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 7 - A 22-year-old pregnant woman attends clinic for a fetal scan at 31 weeks....

    Incorrect

    • A 22-year-old pregnant woman attends clinic for a fetal scan at 31 weeks. She complains of difficulty breathing and a distended belly. U/S scan was done showing polyhydramnios and an absent gastric bubble. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Oesophageal atresia

      Explanation:

      Oesophageal atresia of the foetus interrupts the normal circulation of the amniotic fluid. This causes polyhydramnios and subsequent distension of the uterus impacting proper expansion of the lungs. This would explain the difficulty breathing.

    • This question is part of the following fields:

      • Obstetrics
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  • Question 8 - A 2 year old male is able to run down the stairs and...

    Incorrect

    • A 2 year old male is able to run down the stairs and say mama and dada. He can understand what he is saying and can say one word. How is this child developing?

      Your Answer:

      Correct Answer: Delayed speech

      Explanation:

      This child is experiencing delayed speech. By the age of 2, a child should be able to combine at least 2 words to make a very simple sentence.

    • This question is part of the following fields:

      • Child Health
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      Seconds

  • Question 9 - A 28 year old man presents to the clinic with fatigue, exertional dyspnoea,...

    Incorrect

    • A 28 year old man presents to the clinic with fatigue, exertional dyspnoea, abdominal discomfort, xerophthalmia and xerostomia. Examination reveals enlargement of the parotid glands bilaterally, hepatomegaly and peripheral motor neuropathy. Lab results are negative for RF, ANA, SS-A and SS-B antibodies. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Diffuse infiltrative lymphocytic syndrome (DILS)

      Explanation:

      The Diffuse Infiltrative Lymphocytosis Syndrome (DILS) is a rare multisystemic syndrome described in HIV-infected patients. It is characterised by CD8(+) T-cell lymphocytosis associated with a CD8(+) T-cell infiltration of multiple organs. DILS is usually seen in uncontrolled or untreated HIV infection but can also manifest itself independently of CD4(+) T-cell counts. The syndrome may present as a Sjögren-like disease that generally associates sicca signs with bilateral parotiditis, lymphadenopathy, and extra glandular organ involvement. The latter may affect the lungs, nervous system, liver, kidneys, and digestive tract. Anomalies of the respiratory system are often identified as lymphocytic interstitial pneumonia. Facial nerve palsy, aseptic meningitis or polyneuropathy are among the more frequent neurological features. Hepatic lymphocytic infiltration, lymphocytic interstitial nephropathy and digestive tract lymphocytic infiltration account for more rarely noted complications. Sicca syndrome, organomegaly and/or organ dysfunction associated with polyclonal CD8(+) T-cell organ-infiltration are greatly suggestive of DILS in people living with HIV.

    • This question is part of the following fields:

      • Rheumatology
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      Seconds

  • Question 10 - A 22-year-old male presented to the OPD with a complaint of ringing in...

    Incorrect

    • A 22-year-old male presented to the OPD with a complaint of ringing in the ears and impaired hearing with occasional vertigo. On examination, there was slight drooping of the patient's mouth to the right side. When Weber test was performed, the patient heard a fainter sound in the right ear compared to the left. Absolute bone conduction test revealed that bone conduction was reduced in the right ear. Which of the following would be the most appropriate investigation to be ordered in this case?

      Your Answer:

      Correct Answer: MRI

      Explanation:

      Symptoms of this patient are strong indications of cranial nerve damage most likely caused by a tumour or mass compressing the nerve. Therefore, the best diagnostic measure for this case is an MRI scan that may fully visualize the extent of damage and the size of the tumour or mass that may be responsible.

    • This question is part of the following fields:

      • ENT
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  • Question 11 - A 65-year-old male who was treated for atrial fibrillation 6 months ago, complained...

    Incorrect

    • A 65-year-old male who was treated for atrial fibrillation 6 months ago, complained of painful swelling of the right breast/pectoral region. Following atrial fibrillation, he has taken a number of drugs. Which of the following drugs is responsible for the above presentation?

      Your Answer:

      Correct Answer: Spironolactone

      Explanation:

      Spironolactone induces gynecomastia by blocking androgen production. It blocks androgens from binding to their receptors, and increasing both total and free oestrogen levels. Generally, discontinuation of treatment results in resolution of the gynecomastia. Other drugs which cause gynecomastia are calcium channel blockers (Nifedipine, Amlodipine, Verapamil, Diltiazem), ACE inhibitors (Captopril, Enalapril), alpha receptor blockers (Doxazocin, Prazosin) and centrally acting agents (Clonidine, Methyldopa, Reserpine).

    • This question is part of the following fields:

      • Pharmacology
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  • Question 12 - A 22 year old woman had a C-section two hours ago. However, she...

    Incorrect

    • A 22 year old woman had a C-section two hours ago. However, she has not urinated since then and claims she had no urinary complaints before the operation. Upon inspection she appears unwell and her abdomen is distended and tender suprapubically and in the left flank. Auscultation reveals no bowel sounds. Further examination reveals the following: Temp=37.5C, BP=94/73mmHg, Pulse=116bpm, Sat=97%. What's the most likely complication?

      Your Answer:

      Correct Answer: Urinary tract injury

      Explanation:

      Urologic injury is the most common injury at the time of either obstetric or gynaecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during caesarean section include previous caesarean delivery, adhesions, emergency caesarean delivery, and caesarean section performed during the second stage of labour.

    • This question is part of the following fields:

      • Obstetrics
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      Seconds

  • Question 13 - During pregnancy, which among these is NOT counted as physiological change? ...

    Incorrect

    • During pregnancy, which among these is NOT counted as physiological change?

      Your Answer:

      Correct Answer: Tidal volume 500ml.

      Explanation:

      There is a significant increase in oxygen demand during pregnancy due to a 15% increase in the metabolic rate and a 20% increased consumption of oxygen. There is a 40–50% increase in minute ventilation, mostly due to an increase in tidal volume, rather than in the respiratory rate. In a healthy, young human adult, tidal volume is approximately 500 mL per inspiration

    • This question is part of the following fields:

      • Obstetrics
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      Seconds

  • Question 14 - A 26 year old woman is 32 weeks pregnant. She has a history...

    Incorrect

    • A 26 year old woman is 32 weeks pregnant. She has a history of Sjogren Syndrome. The foetus would be at a risk for which of the following?

      Your Answer:

      Correct Answer: All correct

      Explanation:

      Women with Sjögren syndrome are likely to experience more complications during pregnancy than women without an autoimmune disease as the anti-Ro and anti-La antibodies cross the placenta and lead to various life threatening complications. Studies show a high incidence of poor fetal outcomes for these patients. Congenital heart block, neonatal lupus, congestive cardiac failure, hydrops fetalis can all be caused as a result of Sjogren syndrome.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 15 - A 50-year-old heavy drinker is brought to the A&E in a drowsy state....

    Incorrect

    • A 50-year-old heavy drinker is brought to the A&E in a drowsy state. He is responding to questions however on examination he has nystagmus and hyper-reflexia. His MCV is 103fL.What is the most likely cause for his cognitive impairment?

      Your Answer:

      Correct Answer: B1 Deficiency

      Explanation:

      Thiamine deficiency is very common with alcoholism. It manifests by Wernicke-Korsakoff encephalopathy. The patient is usually agitated, with an abnormal gait and amnesia.

    • This question is part of the following fields:

      • Gastrointestinal
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      Seconds

  • Question 16 - A team of physicians presented their audit of fluid management for dengue haemorrhagic...

    Incorrect

    • A team of physicians presented their audit of fluid management for dengue haemorrhagic fever one year ago. A number of recommendations were made at that time and changes were implemented. Which of the following is the most appropriate next step that this team should take?

      Your Answer:

      Correct Answer: Re-audit

      Explanation:

      Clinical audit is defined as a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. To see whether the recommendations have been implemented, a re-audit has to be performed.

    • This question is part of the following fields:

      • Ethical
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      Seconds

  • Question 17 - A 30 year old previously well female presented with yellowish discolouration of her...

    Incorrect

    • A 30 year old previously well female presented with yellowish discolouration of her sclera. Investigations revealed low haemoglobin, a retic count of 8% and the occasional spherocyte on blood film. Which of the following is the most appropriate single investigation?

      Your Answer:

      Correct Answer: Direct coombs test

      Explanation:

      A low haemoglobin and a high retic count is suggestive of a haemolytic anaemia. Occasional spherocytes can be seen on blood film during haemolysis and it is not a specific finding. Direct Coombs test will help to identify autoimmune haemolytic anaemia, where there are antibodies attached to RBCs.

    • This question is part of the following fields:

      • Endocrine
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  • Question 18 - A 25-year-old pregnant female suddenly developed a rash on her torso. It started...

    Incorrect

    • A 25-year-old pregnant female suddenly developed a rash on her torso. It started as macules and then became vesicles. After 3 days she died. During her post-mortem, positive findings suggestive of pneumonitis were found. Which one of the following is the most common cause?

      Your Answer:

      Correct Answer: Varicella zoster virus (VZV)

      Explanation:

      Varicella zoster virus (VZV) presents in this way and the rash transforms from macules to vesicles. Pneumonitis is a common complication of VZV infection.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 19 - An 81 year old male patient was admitted after an ischaemic stroke. Physical...

    Incorrect

    • An 81 year old male patient was admitted after an ischaemic stroke. Physical examination reveals left hemiparesis. How would you classify this hemiparesis based on the WHO International Classification of Functioning, Disability and Health?

      Your Answer:

      Correct Answer: Impairment of body function

      Explanation:

      Symptoms and signs are classified as ‘impairment of body function’.
      The types of impairment classified as ‘activity limitation’ include difficulties that a patient may have in executing certain activities.
      The type of impairment classified as ‘participation restriction’ are problems a patient may have in social roles.
      The type of impairment classified as ‘pathology’ would be the diagnosis/disease.
      Right total anterior circulation infarct relates to the Oxford Bamford classification for stroke.

    • This question is part of the following fields:

      • Older Adult
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  • Question 20 - A 74 year old man presents with a history of falls and enuresis....

    Incorrect

    • A 74 year old man presents with a history of falls and enuresis. Recently his behaviour has been bizarre but the falling has persisted for the last 12 months. Upon examination he's found to be disorientated for time and place. His gait is clumsy and broad-based. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Normal pressure hydrocephalus

      Explanation:

      The patient has a history of:
      1 – Balance and gait disturbance – falls and broad based clumsy gait
      2 – Dementia – strange behaviour and disorientation to time and place
      3 – Urinary incontinence – episodes of enuresis.
      All of the symptoms constitute the classic triad of normal pressure hydrocephalus.

    • This question is part of the following fields:

      • Neurology
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  • Question 21 - A 3 year old child was brought in by her father with complaints...

    Incorrect

    • A 3 year old child was brought in by her father with complaints of watery diarrhoea, vomiting and low grade fever. She looked slightly dehydrated. According to her parents, the other children in the school also have a similar illness. The most likely causative organism in this case would be?

      Your Answer:

      Correct Answer: Rotavirus

      Explanation:

      Rota virus is the leading cause of vital gastroenteritis among children from 6 months to 6 years of age. It is transferred by feco-oral route and it damages the transport mechanism in the intestinal mucosal cells which leads to electrolyte imbalance that’s why the child suffers from dehydration. Treatment of choice is rehydration and correction of electrolyte imbalance.

    • This question is part of the following fields:

      • Child Health
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      Seconds

  • Question 22 - A woman with breast cancer develops urinary frequency. Which part of the brain...

    Incorrect

    • A woman with breast cancer develops urinary frequency. Which part of the brain has metastasis potentially spread to?

      Your Answer:

      Correct Answer: Diencephalon

      Explanation:

      Diencephalon consists of four structures; thalamus, subthalamus, hypothalamus and epithalamus. The hypothalamus has a crucial role in controlling urinary frequency.

    • This question is part of the following fields:

      • Oncology
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  • Question 23 - A 35-year-old woman with no psychiatric history has attempted suicide 10 times. Her...

    Incorrect

    • A 35-year-old woman with no psychiatric history has attempted suicide 10 times. Her neurological examination is apparently normal. What would be the most appropriate management?

      Your Answer:

      Correct Answer: Problem focussed treatment

      Explanation:

      Problem focussed treatment focuses on solutions to the problem, rather than on the problem itself that brought patients to seek therapy, in this case the suicide attempts. The patient seems to be parasuicidal which is a feature of some personality disorders such as histrionic and borderline personality disorders which do not require medical treatment but psychotherapy.

    • This question is part of the following fields:

      • Mental Health
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      Seconds

  • Question 24 - A 13 year old patient presents in the A&E with a fracture of...

    Incorrect

    • A 13 year old patient presents in the A&E with a fracture of his left femur. He was a passenger in a car involved in a traffic accident. Upon clinical examination, his left posterior tibial and dorsalis pedis arteries are not palpable. Which of the following is most probably injured?

      Your Answer:

      Correct Answer: Femoral artery

      Explanation:

      The femoral artery is the one accompanying the femoral shaft, being the most important blood supplier of the leg. Femoral artery injury during a femur shaft fracture is quite common as a result of blunt trauma.

    • This question is part of the following fields:

      • Child Health
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  • Question 25 - A patient has an autosomal recessive disorder, which causes lysine, arginine, ornithine and...

    Incorrect

    • A patient has an autosomal recessive disorder, which causes lysine, arginine, ornithine and cystine to appear in his urine. The treatment proposed is the combination of urinary alkalinisation with penicillamine. Choose the most likely type of renal calculus present.

      Your Answer:

      Correct Answer: Cystine

      Explanation:

      The presence in the urine of cystine, orthinine, arginine and lysine indicate a tubular reabsorption defect. This condition is a hereditary one, and stone formation is more common in homozygotes. The patient has no other abnormalities that could indicate stone formation.

    • This question is part of the following fields:

      • Renal
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  • Question 26 - A 22 year old man who has recently returned from a trip to...

    Incorrect

    • A 22 year old man who has recently returned from a trip to Far East presents with sore eyes and symmetrical joint pain in his knees, ankles and feet. Labs reveal an elevated ESR. The synovial fluid aspirate is sterile and has a high neutrophil count. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Reactive arthropathy

      Explanation:

      Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. Symmetric lower limb arthropathy and a sterile joint aspirate points towards reactive arthropathy.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 27 - A 14-year-old girl came to the emergency room in a bizarre state with...

    Incorrect

    • A 14-year-old girl came to the emergency room in a bizarre state with altered consciousness, presenting with symptoms of insomnia, logorrhoea, and anxiety, with incoherent discourse and amnesia of recent events. She has started calling herself The Queen, and is refusing to be her parents' daughter. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Ganser syndrome

      Explanation:

      Ganser syndrome is a condition in which a person acts as if he is suffering from a specific psychological disorder in order to gain sympathy and relief.

    • This question is part of the following fields:

      • Neurology
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  • Question 28 - A 56-year-old man injected his usual insulin dose and went to the washroom...

    Incorrect

    • A 56-year-old man injected his usual insulin dose and went to the washroom to wash his hands before going to dinner. His wife found him unconscious in the washroom a few minutes later. Which of the following investigations needs to be done?

      Your Answer:

      Correct Answer: Random capillary glucose

      Explanation:

      The state of this patient is most likely a diabetic coma caused by hypoglycaemic shock. A random capillary glucose check can confirm the glucose level and whether prompt IM glucagon should be given.

    • This question is part of the following fields:

      • Cardiovascular
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  • Question 29 - A patient shows reduced central vision upon visual acuity test. He is advised...

    Incorrect

    • A patient shows reduced central vision upon visual acuity test. He is advised to undergo a fundoscopy, which turns out to be normal. Which drug could be responsible for his symptoms?

      Your Answer:

      Correct Answer: Corticosteroids

      Explanation:

      Corticosteroids are well known for their ocular complications such as glaucoma and cataracts.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 30 - A 38 year old patient with hypertension presented with facial puffiness, ankle oedema,...

    Incorrect

    • A 38 year old patient with hypertension presented with facial puffiness, ankle oedema, haematuria and frothy urine. Which of the following is a definitive diagnostic test?

      Your Answer:

      Correct Answer: Renal biopsy

      Explanation:

      The history is suggestive of nephritic syndrome. Renal biopsy is the definitive diagnostic test which shows the glomerular pathology.

    • This question is part of the following fields:

      • Renal
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      Seconds

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