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Question 1
Correct
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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: 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 2
Correct
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Osteopetrosis occurs as a result of a defect in:
Your Answer: Osteoclast function
Explanation:It is a metabolic bone disease caused by defective osteoclastic resorption of immature bone. Osteopetrosis is also known as marble bone disease. Osteoclasts are unable to adequately acidify bone matrix. Impaired bone resorption leads to overly dense bone that is more likely to fracture. It is usually treated with bone marrow transplant and high dose calcitriol.
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This question is part of the following fields:
- Rheumatology
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Question 3
Correct
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A newly married lady was brought to the hospital with aggressive behaviour and a history of an intake of 100 paracetamol tablets, however she states that she is okay and has no symptoms. The most appropriate action to take will be?
Your Answer: Detain under Mental Health Act
Explanation:She should be detained under the mental health act because she has attempted suicide once before, so she needs to be kept under close observation.
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This question is part of the following fields:
- Mental Health
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Question 4
Correct
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A 4 year old girl presents to the clinic with sore throat and a small painful ulcer in her mouth since yesterday and small painful ulcers on palms and soles that are not itchy. She is febrile (38.5 degree Celsius) and is refusing to eat for the past two days. Which of the following will be the most likely cause of this presentation?
Your Answer: Coxsackie virus
Explanation:Coxsackie viruses are a group of RNA viruses with over 20 serotypes; depending on specific viral characteristics, these serotypes are further divided into groups A and B. Infection is associated with a wide range of symptoms, which are dependent on the exact serotype. Hand, foot, and mouth disease (HFMD) and herpangina are commonly caused by group A coxsackie viruses, while pleurodynia and myocarditis are caused by group B coxsackie viruses. Both groups may cause viral meningitis, conjunctivitis, or flu‑like symptoms. Diagnostic procedures and treatment should be tailored to the specific disease manifestation.
Coxsackie A :
Herpangina
Hand, foot, and mouth disease
Characteristics: highly contagious
Clinical presentation
General symptoms: fever, reduced general condition
Skin/mucosa
Maculopapular and partially vesicular rash on the hands and feet
Oral ulcers
Diagnosis: clinical
Treatment: symptomatic
Prognosis: almost always self‑limiting -
This question is part of the following fields:
- Microbiology
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Question 5
Correct
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A middle aged male arrives at the clinic due to chest pain and productive cough. The temperature is recorded to be 38CÖ¯. Radiological examination reveals lobar consolidation and pleurisy. Which of the following would be the best management plan for this patient?
Your Answer: Amoxicillin
Explanation:The mainstay of drug therapy for bacterial pneumonia is antibiotic treatment. The choice of agent is based on the severity of the patient’s illness, host factors (e.g., comorbidity, age), and the presumed causative agent. Lobar pneumonia is frequently associated with pneumococcus and Hemophilus infection. Amoxicillin can be effectively used in such cases.
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This question is part of the following fields:
- Pharmacology
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Question 6
Correct
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A 35 year old primigravida was in labour for 24 hours and delivered after an induction. She developed postpartum haemorrhage. Which of the following is the most likely cause for PPH?
Your Answer: Atonic uterus
Explanation:Uterine atony and failure of contraction and retraction of myometrial muscle fibres can lead to rapid and severe haemorrhage and hypovolemic shock. Poor myometrial contraction can result from fatigue due to prolonged labour or rapid forceful labour, especially if stimulated.
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This question is part of the following fields:
- Obstetrics
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Question 7
Correct
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A 42-year-old female with a history of hypertension presented with increased thirst, polyuria and nocturia for 2 weeks duration. Her random blood sugar was 12 mmol/l. Which of the following antihypertensives can cause the above clinical presentation?
Your Answer: Bendroflumethiazide
Explanation:Thiazides and beta-blockers have been most commonly linked to the development of diabetes mellitus.
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This question is part of the following fields:
- Pharmacology
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Question 8
Incorrect
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A 22 year old male with exercise induced asthma, has had good control with a salbutamol inhaler. But recently he has had asthma attacks with exercise. Which of the following is the most appropriate management?
Your Answer: Inhaled steroid
Correct Answer: Sodium cromoglycate
Explanation:Steroids and theophylline have less of a role in the treatment of exercise induced asthma. The best method of treatment is pre-exercise short-acting β2-agonist administration. Long-acting β2-agonists, mast cell stabilizers (e.g.: Sodium cromoglycate), and antileukotriene drugs also play a role.
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This question is part of the following fields:
- Respiratory
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Question 9
Incorrect
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A 50-year-old farmer presented with fever, malaise, cough, and shortness of breath. He also reports a history of severe weight loss. Examination revealed tachypnoea, coarse end-inspiratory crackles and wheeze. His chest X-ray showed fluffy nodular shadowing and lab results showed polymorphonuclear leucocytosis. Which of the following is the most appropriate diagnosis?
Your Answer: Progressive massive fibrosis
Correct Answer: Extrinsic allergic alveolitis
Explanation:Extrinsic allergic alveolitis, also known as hypersensitivity pneumonitis, is an allergic response of the lungs to an environmental allergen. Nodular shadowing in the chest X-ray is characteristic of extrinsic allergic alveolitis.
Churg-Strauss syndrome is an auto-immune disorder that is known to cause vasculitis mostly in patients having a pre-existing airway disease.
Cryptogenic organizing pneumonia is an inflammatory condition of the alveoli. The CXR of which shows ground-glass opacifications.
The CXR of progressive massive fibrosis also shows opacifications normally in the upper lung lobes. -
This question is part of the following fields:
- Respiratory
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Question 10
Incorrect
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A 30 year old previously well male presented with dysuria and lower abdominal pain. He also complained of passage of air bubbles when he urinated. His urine sample had faecal matters. The abdomen was soft with mild suprapubic tenderness. Which of the following is the most likely pathology?
Your Answer: Rectosigmoid tumour
Correct Answer: Crohn's disease
Explanation:Passage of faecal matters in the urine is suggestive of a fistula. Crohn’s disease is the most common cause of an ileovesical fistula. The diagnostic features of a fistula to the urinary system are pneumaturia, fecaluria, and recurrent or persistent urinary tract infections. Cystoscopy will confirm the diagnosis.
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This question is part of the following fields:
- Colorectal
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Question 11
Incorrect
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A 76-year-old woman attends the Emergency Department after knocking her shin on some furniture at home. She takes prednisolone for polymyalgia rheumatica. You examine her leg and find a pre-tibial laceration with a large skin flap. Which of the following is the best way to manage this?
Your Answer: Clean the laceration and apply a non adherent dressing
Correct Answer: Clean then steristrip the laceration
Explanation:In young patients with good skin, pre-tibial lacerations may be sutured, usually with non-absorbable sutures that are removed after 7-10 days. In elderly patients with thin skin, or those on warfarin or steroids, the skin is frequently too fragile to suture. For these patients the wound should be thoroughly cleaned and meticulously steristripped to best aid skin healing. A non-adherent dressing and a light bandage can be applied and the patient should be encouraged to elevate the leg. Patients should be reviewed after a week. The laceration may take many months to heal and some require skin grafting procedures.
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This question is part of the following fields:
- Seriously Ill
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Question 12
Correct
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Question 13
Correct
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A 20-year-old woman who is sexually active is having deep dyspareunia and vaginal discharge. She has a negative smear for Gonococcus. Which of the following is the most likely diagnosis?
Your Answer: Chlamydial trachomatis
Explanation:This case is highly suggested of PID or Pelvic Inflammatory disease with chlamydia as the more common infective agent. Tetracyclines are used for treatment.
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This question is part of the following fields:
- Genitourinary
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Question 14
Correct
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A 28-year-old woman is involved in a cycling accident. She has severe pain and swelling of her right upper leg. An x-ray confirms a fracture of neck of fibula. What is the most common associated nerve injury?
Your Answer: Lateral peroneal nerve
Explanation:Lateral peroneal nerve, also known as the superficial peroneal nerve.
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This question is part of the following fields:
- Musculoskeletal
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Question 15
Correct
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A 50 year old man who is an ex-soldier, complains of anxiety and depressed mood. He's been having flashbacks of the images and faces he's seen before and he's unable to watch the news due to the fact that war images and reports are present. What is the most likely diagnosis?
Your Answer: Post-traumatic stress disorder (PTSD)
Explanation:Post-traumatic stress disorder (PTSD) is a mental health condition that’s triggered by a terrifying event, either experiencing it or witnessing it. Flashbacks, nightmares and avoidance behaviour towards the stressors are typical of PTSD.
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This question is part of the following fields:
- Mental Health
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Question 16
Correct
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A 45-year-old female was diagnosed with a benign ovarian mass on her right side. She complained of inner thigh pain on her right side. Which of the following nerves is responsible for her inner thigh pain?
Your Answer: Obturator nerve
Explanation:The obturator nerve is compressed due to the ovarian mass, this causes pain in the inner thigh because it innervates this area.
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This question is part of the following fields:
- Musculoskeletal
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Question 17
Correct
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A 72 year old male presents complaining of having intermittent trouble with swallowing. He has also been regurgitating stale food material. He sometimes wakes up in the middle of the night feeling like he is suffocating. Choose the most likely diagnosis.
Your Answer: Pharyngeal pouch
Explanation:In benign stricture, oesophageal carcinoma, and systemic sclerosis, there is persistent dysphagia (rather than intermittent). In oesophageal spasm, there is no regurgitation of stale food material. The symptoms described are consistent with pharyngeal pouch.
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This question is part of the following fields:
- Gastrointestinal
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Question 18
Correct
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In last 5 days, an old man has complained of severe left sided headache, which was aggravated by bright lights. He has not vomited but feels nauseated. What is the most likely diagnosis?
Your Answer: Migraine
Explanation:Migraine without aura have the following characteristics: Nausea and vomiting accompanied by >5 headaches that last for 4-72 hours, plus any unilateral, pulsating headache or are aggravated by routine daily activities.
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This question is part of the following fields:
- Neurology
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Question 19
Incorrect
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A 45 year old alcohol dependent male presented with a suicide attempt. Which of the following will increase the suicide risk?
Your Answer: Alcohol dependence
Correct Answer: Selective serotonin re-uptake inhibitors (SSRI)
Explanation:Alcohol abuse leads to suicidality through disinhibition, impulsiveness and impaired judgment. It may also be used as a means to ease the distress associated with committing an act of suicide. SSRIs are known to cause worsening of suicidal thoughts in alcohol dependents and other vulnerable people.
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This question is part of the following fields:
- Mental Health
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Question 20
Correct
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A 32-year-old man on psychiatric medications complains of the inability to ejaculate. Which drug is most likely to cause these symptoms?
Your Answer: Fluoxetine
Explanation:SSRIs such as fluoxetine are commonly associated with delayed ejaculation.
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This question is part of the following fields:
- Mental Health
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Question 21
Correct
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A 62 year old male presents to the OPD with a deep painless ulcer on the heel. His previous history includes increased thirst, urinary frequency, and weight loss for the last 4 years. Which of the following investigations would be most appropriate in this case?
Your Answer: Blood sugar
Explanation:People with diabetes are prone to foot problems that develop due to prolonged periods of high blood sugar levels. Diabetic neuropathy and peripheral vascular disease are the two main causes of foot problems and both can have serious complications. Diabetes can cause serious foot problems that can result in feet or limb loss, deformity, and infections. However, it is possible for a person to prevent or minimize many of these problems. While controlling blood sugar by following the recommended diabetes treatment plans is the best way to prevent these serious problems, self-care and regular check-ups with a doctor can also help prevent problems from developing.
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This question is part of the following fields:
- Endocrine
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Question 22
Correct
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After examination, a 50-year-old woman was found to have fissuring of the skin of her hands. She has been complaining of fatigue and difficulty in climbing stairs for a couple of months. CXR shows pulmonary fibrosis. Which antibody would you expect to be positive?
Your Answer: Anti Scl 70
Explanation:Anti-Scl-70 antibodies are associated with pulmonary fibrosis and indicate a poor prognosis when positive. Also, they are a specific marker for the diffuse type of systemic sclerosis. Systemic scleroderma, also called diffuse scleroderma or systemic sclerosis, is an autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.
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This question is part of the following fields:
- Rheumatology
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Question 23
Correct
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A 7-month-old baby girl is admitted with poor feeding and irritability for 2 days. She is lethargic and persistently crying. Urine dipstick showed leucocytes. What is the single most important investigation to arrive at a diagnosis?
Your Answer: Urine for C&S
Explanation:The clinical presentation and leucocytes on the urine dipstick is suggestive of a urinary tract infection. To confirm the diagnosis, urine should be sent for culture and sensitivity.
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This question is part of the following fields:
- Seriously Ill
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Question 24
Correct
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A 25-year-old male had an emergency appendicectomy. His doctor prescribed him prophylactic antibiotics to avoid infection after the surgery. Which of the following antibiotics is the best choice for post abdominal surgery?
Your Answer: Cefuroxime
Explanation:Cefuroxime is the best choice in the case of gut surgery as it is very effective in preventing infections against gut anaerobes, enterococci and coliforms.
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This question is part of the following fields:
- Pharmacology
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Question 25
Incorrect
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Which statement regarding the abdominal planes is the most accurate?
Your Answer: The transpyloric plane passes through the hilar of the kidneys.
Correct Answer: The transpyloric plane lies halfway between the xiphoid and the symphysis pubis.
Explanation:The transpyloric plane, also known as Addison’s plane, is an imaginary horizontal plane, located halfway between the suprasternal notch of the manubrium and the upper border of the symphysis pubis at the level of the first lumbar vertebrae, L1.
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This question is part of the following fields:
- Surgery
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Question 26
Correct
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A 21-year-old singer, who had thyroid surgery a few months before, now complains of not being able to raise the pitch of her voice, and suspects it was because of the surgery. What is the most likely diagnosis?
Your Answer: External laryngeal nerve injury
Explanation:The external laryngeal nerve may be injured or traumatized following thyroid surgery due to its close proximity, which may result in hoarseness or loss of voice.
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This question is part of the following fields:
- Endocrine
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Question 27
Incorrect
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A 55 year old man known with Addison's disease presented with complaints of recurrent attacks of postural hypotension. What kind of electrolyte imbalance would be seen in his biochemical profile investigations?
Your Answer: High Na+, Low K+
Correct Answer: Low Na+, High K+
Explanation:Patients suffering from Addison’s disease have low aldosterone. Aldosterone increases Na+ absorption and excretion of K+. So in these patients there would be decreased Na+ and increased K+ levels.
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This question is part of the following fields:
- Endocrine
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Question 28
Incorrect
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A prolonged QT interval is linked to which of the following?
Your Answer: Digoxin
Correct Answer: Hypocalcaemia
Explanation:Prolonged QT interval can be seen in the following conditions: Hypocalcaemia, hypothermia, severe bradycardia, Class 1 and 3 antiarrhythmic drugs, non-sedating antihistamines, tricyclic antidepressants etc.
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This question is part of the following fields:
- Seriously Ill
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Question 29
Correct
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Regarding the 3rd heart sound, which one of the following statements is correct?
Your Answer: It may be a normal finding in women up to the age of 50
Explanation:The 3rd heart sound corresponds to early diastolic filling in ventricular relaxation after the closure of the aortic valve. Associated conditions include cardiac failure, constrictive pericarditis and atrial myxomas. It is low pitched and accentuated by inspiration. The 3rd heart sound may arise from ventricular relaxation and it can be seen as a normal finding among children, young adults and women till 50 years of age.
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This question is part of the following fields:
- Cardiovascular
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Question 30
Correct
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The hepatic portal vein is a large vessel formed by which of the following veins?
Your Answer: All of the above
Explanation:The portal vein is usually formed by the confluence of the superior mesenteric and splenic veins and also receives blood from the inferior mesenteric, gastric, and cystic veins.
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This question is part of the following fields:
- Hepatobiliary
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SESSION STATS - PERFORMANCE PER SPECIALTY
