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Question 1
Incorrect
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A kidney, ureter, and bladder (KUB) ultrasound for a hypertensive man with a BP of 160/90mmHg and proteinuria++ revealed a decrease in size of the kidneys with smooth borders and normal pelvic calyceal system. What is the cause of hypertension in the patient?
Your Answer: Essential HTN
Correct Answer: Chronic glomerulonephritis
Explanation:Causes of hypertension in bilateral renal artery stenosis are as follows: 90% probable cause is atherosclerosis with manifestations of CAD, TIA or stroke. The other less common cause is fibromuscular dysplasia that includes carotid and vertebral artery with manifestations of headache, TIA, and stroke.
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This question is part of the following fields:
- Gastrointestinal
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Question 2
Correct
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A 40-year-old female presented with fever, jaundice, and pain in the middle and upper abdomen. Her stools are clay-coloured. Which of the following should be done now?
Your Answer: Endoscopic retrograde cholangio pancreatography (ERCP)
Explanation:ERCP is necessary to look for any obstruction or compression of the extra-hepatic bile duct. The clay-coloured stools are a result of impaired bilirubin movement into the duodenum.
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This question is part of the following fields:
- Gastrointestinal
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Question 3
Correct
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A 34 year old man is complaining of painful vesicles around his right ear. Upon examination he has a facial palsy and the vesicles extend towards his tympanic membrane. Hypoacusis is also present. Choose the most likely diagnosis.
Your Answer: Ramsay-Hunt syndrome
Explanation:Ramsay-Hunt syndrome or herpes zoster oticus presents with painful vesicles which affect the facial nerve and induce hearing loss in the affected ear.
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This question is part of the following fields:
- ENT
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Question 4
Incorrect
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A 35 year old male presented with a nasal polyp. Which of the following is true regarding nasal polyps?
Your Answer: They usually originate in the maxillary sinuses
Correct Answer: Can cause anosmia
Explanation:Nasal polyps are a known cause of anosmia, by preventing the flow of scented air to the olfactory mucosa high in the nasal cavity. They are usually watery-pink or greyish colour. Polyp recurrence is common following polypectomy. Topical corticosteroids are of use in the primary treatment of small and medium sized nasal polyps. Beclomethasone dipropionate, flunisolide and budesonide sprays have also been shown to delay the recurrence of polyps after surgery. Nasal polyps usually arise in the maxillary sinus.
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This question is part of the following fields:
- ENT
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Question 5
Incorrect
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A 24 year old male was involved in a traffic collision. X-rays indicated that the neck of the humerus had suffered a fracture. Choose the single most associated nerve injury from the list of options.
Your Answer: Radial nerve
Correct Answer: Axillary nerve
Explanation:Fractures in the neck of the humerus are well documented to cause damage to the auxiliary nerve.
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This question is part of the following fields:
- Neurology
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Question 6
Correct
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A 70 year old female presented with throbbing and continuous headache and loss of vision. Her ESR was elevated. Which of the following is the most appropriate management?
Your Answer: Corticosteroids
Explanation:Giant Cell Arteritis (Temporal Arteritis) is the most probable diagnosis. GCA should always be considered in the differential diagnosis of a new-onset headache in patients 50 years of age or older with an elevated erythrocyte sedimentation rate. Temporal artery biopsy remains the criterion standard for diagnosis of this granulomatous vasculitis. High-dose corticosteroid therapy is the universally accepted treatment.
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This question is part of the following fields:
- Ophthalmology
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Question 7
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 8
Correct
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A young woman complains of constipation and pain on defecation. The pain is anorectal and a digital rectal examination was impossible due to pain and spasm. What is most likely the diagnosis?
Your Answer: Anal fissure
Explanation:Symptoms of anal fissure include sharp pain in the anal area upon defecation or anal stimulation. It may also cause burning or itching as well as visible fresh blood on the stools or on the toilet paper. It is usually visible upon inspection.
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This question is part of the following fields:
- Gastrointestinal
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Question 9
Incorrect
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A 31 year old female complains of bilateral proximal muscle weakness. There is marked blanching of fingers especially in response to cold weather. Lab results are as follows: Anti Jo-1: positive ANA: positiveCK: 2000 U/LESR: 60mm/hrEMG: myopathic changesPresence of which of the following signifies the worst prognosis?
Your Answer: CK >2000 U/L
Correct Answer: Interstitial lung disease
Explanation:Polymyositis is an inflammatory disorder causing symmetrical, proximal muscle weakness. It is thought to be a T-cell mediated cytotoxic process directed against muscle fibres. It may be idiopathic or associated with connective tissue disorders. It may also be associated with malignancy for example small cell lung carcinoma.
Dermatomyositis is a variant of the disease where skin manifestations are prominent, for example a purple (heliotrope) rash on the cheeks and eyelids.
It typically affects middle-aged, female: male 3:1. Features include proximal muscle weakness +/- tenderness, Raynaud’s phenomenon, respiratory muscle weakness, interstitial lung disease: e.g. fibrosing alveolitis or organising pneumonia, dysphagia, dysphonia. Investigations: elevated creatine kinase, other muscle enzymes (lactate dehydrogenase (LD), aldolase, AST and ALT) are also elevated in 85-95% of patients, EMG, muscle biopsy. Anti-Jo-1 antibodies are seen in pattern of disease associated with lung involvement, Raynaud’s and fever. Interstitial lung disease plays a major role in morbidity and mortality in patients with polymyositis and is considered a major risk factor for premature death in patients with myositis. -
This question is part of the following fields:
- Rheumatology
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Question 10
Correct
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A 65-year-old male was admitted to ED with acute onset left side upper and lower limb weakness and slurred speech. Which of the following is the most appropriate initial investigation?
Your Answer: CT scan of brain
Explanation:The history is suggestive of cerebral stroke and the investigation of choice at most hospitals would be a CT brain. Non-contrast CT scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke. MRI scan is more sensitive but availability and cost make this a less likely option.
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This question is part of the following fields:
- Seriously Ill
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Question 11
Correct
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A 44 year old lady was admitted with complaints of diarrhoea, loss of weight, moderate fever and generalized pallor. Her complete blood profile showed a decreased Hb with a raised MCV. The most likely diagnosis would be?
Your Answer: Pernicious anaemia
Explanation:Patients suffering from pernicious anaemia have difficulty absorbing vitamin B12 firm the GIT mucosa, which leads to megaloblastic anaemia with a raised MCV. Pernicious anaemia is also associated with thyroid disease, which can also be the cause in this patient.
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This question is part of the following fields:
- Haematology
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Question 12
Incorrect
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A 52 year old cancer patient that recently had an anterior resection of the rectum is concerned about post-operative pain control. What is the most appropriate management choice in his case?
Your Answer: Oral codeine
Correct Answer: IM morphine
Explanation:Post-operative pain is usually severe and strong analgesia is needed with IM morphine.
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This question is part of the following fields:
- Pharmacology
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Question 13
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: Positive ANCA
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 14
Correct
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A 55-year-old patient was diagnosed with hepatocellular carcinoma. Tramadol was prescribed to treat the pain. However, the patient is still experiencing intense pain. Which of the following would be the most appropriate treatment for this patient?
Your Answer: Escalate opioid therapy
Explanation:Because the patient’s pain is not responding to Tramadol treatment (already an opioid analgesic), opioid therapy should be escalated until there is pain relief without intolerable side effect.
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This question is part of the following fields:
- Seriously Ill
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Question 15
Correct
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A 30-year-old woman is hypertensive and complains of painless haematuria. Other examination results are unremarkable. What is the most likely diagnosis?
Your Answer: Polycystic kidneys
Explanation:Renal ultrasound is utilized to confirm this condition. Although at a younger age, hypertension and haematuria that is not painful is already suggestive to the disease.
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This question is part of the following fields:
- Renal
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Question 16
Incorrect
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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: Venography
Correct 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 17
Correct
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A 72-year-old woman who presented with headache and neck stiffness was started on IV ceftriaxone after undergoing a lumber puncture. The CSF culture shows listeria monocytogenes. What is the treatment of choice?
Your Answer: Change to IV amoxicillin + gentamicin
Explanation:The best option would be the combination of ampicillin and gentamycin. Changing to IV amoxicillin+gentamycin is however the best among the given choices here.
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This question is part of the following fields:
- Infectious Diseases
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Question 18
Correct
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A 75 year old man was brought to the clinic by his wife because lately he has lost interest in activities he previously enjoyed. His wife is worried and claims he's generally withdrawn. What would exclude depression in favour of dementia?
Your Answer: Urinary incontinence
Explanation:Urinary incontinence is not a usual symptom of depression. A depressed patient is usually capable of maintaining control of his body sphincters. In dementia, however, urinary incontinence is an important and late symptom of the disease, non-related to any urinary tract pathology. It is rather related to the cognitive impairment caused by dementia.
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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 42 year old female with a history of SLE presents with an exacerbation of wrist pain. Which of the following markers would be the most suitable for monitoring disease activity?
Your Answer: C-reactive protein
Correct Answer: Anti-dsDNA titres
Explanation:A high level of anti-dsDNA in the blood is strongly associated with lupus and is often significantly increased during or just prior to a flare-up. When the anti-dsDNA is positive and the person tested has other clinical signs and symptoms associated with lupus, it means that the person tested likely has lupus. This is especially true if an anti-Sm test is also positive.
In the evaluation of someone with lupus nephritis, a high level (titre) of anti-dsDNA is generally associated with ongoing inflammation and damage to the kidneys.
A very low level of anti-dsDNA is considered negative but does not exclude a diagnosis of lupus. Only about 65-85% of those with lupus will have anti-dsDNA.
Low to moderate levels of the autoantibody may be seen with other autoimmune disorders, such as Sjögren syndrome and mixed connective tissue disease (MCTD).
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This question is part of the following fields:
- Rheumatology
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Question 20
Incorrect
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A 65-year-old male was admitted for surgery 4 days ago. He suddenly became confused and aggressive. His attention span was reduced, and he became very restless. Which single option from the history best explains his condition?
Your Answer: Head trauma
Correct Answer: Alcohol consumption
Explanation:Patient was dependent on alcohol. After 4 days of admission he developed signs of alcohol withdrawal.
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This question is part of the following fields:
- Seriously Ill
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Question 21
Correct
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An 82 year old patient presents to the clinic complaining of palpitations. ECG reveals waves with saw-tooth pattern, QRS complex of 80ms duration, a ventricular rate of 150/min and a regular R-R interval. Which of the following is most likely responsible for these findings?
Your Answer: Atrial flutter
Explanation:Atrial flutter is a common supraventricular tachyarrhythmia that is usually caused by a single macroreentrant rhythm within the atria, associated with a sawtooth appearance on the ECG. In stable patients the treatment includes rate control and rhythm control, however in unstable patients, a synchronized cardioversion is required.
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This question is part of the following fields:
- Cardiovascular
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Question 22
Incorrect
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A 61 year old woman with a history of fluent dysphasia is brought by her husband because she's no longer able to understand instructions. Which is the most probable site of arterial occlusion?
Your Answer: Superior division of middle cerebral artery (dominant hemisphere)
Correct Answer: Inferior division of middle cerebral artery (dominant hemisphere)
Explanation:The condition described is called Wernicke’s aphasia and is the result of occlusion of the inferior division of the middle cerebral artery. This type of aphasia is classified as fluent aphasia in which understanding is impaired.
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This question is part of the following fields:
- Neurology
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Question 23
Incorrect
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A 57-year-old diabetic, smoker complains of non-healing ulcers and cramp-like pain in the calves relieved by rest. Examination results are as follows: absent distal pulses, and cold extremities with hair loss around the ankles. What is the most probable diagnosis?
Your Answer: Intermittent claudication
Correct Answer: Chronic ischemia of the limbs
Explanation:Chronic Limb Ischaemia presents with calf pain that is relieved by rest.
Intermittent claudication is not a diagnosis but a symptom and is not necessarily associated with diabetes.
Buerger’s disease occurs in younger heavy smokers (usually before age of 50).
DVT causes pain that is consistent, not intermittent as in claudication. -
This question is part of the following fields:
- Musculoskeletal
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Question 24
Correct
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A 71 year old male got trapped under a cupboard for 4 hours which accidentally fell on his leg while he was moving his house. Which enzyme activity would you measure in this patient?
Your Answer: Creatinine kinase
Explanation:Creatine kinase (CK) is an enzyme found in the heart, brain, skeletal muscle, and other tissues. Increased amounts of CK are released into the blood when there is muscle damage. This test measures the amount of creatine kinase in the blood.
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This question is part of the following fields:
- Mental Health
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Question 25
Correct
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A 45-year-old male with a history of bipolar affective disorder was admitted following an event of deliberate self-harm. He has had an argument with his wife and he has stopped taking his medication. He has begun drinking alcohol quite heavily as well. He is fit to discharge from the medical ward but he looks depressed and still has thoughts of self-harm. Which of the following is the most appropriate next step?
Your Answer: Admission to the psychiatry ward
Explanation:As he still has thoughts of self harm it is not safe to discharge him from the hospital. He needs further evaluation by a psychiatrist. So the best option is to admit him to the psychiatry ward.
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This question is part of the following fields:
- Mental Health
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Question 26
Incorrect
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All of the following drugs tend to worsen the symptoms of myasthenia gravis except?
Your Answer: Pyridostigmine
Correct Answer: Prednisolone
Explanation:Prednisone is used for the treatment of myasthenia gravis if there is no initial response to the anticholinesterase medications. Pyridostigmine can make the symptoms of myasthenia gravis worse if used in the initial stages of treatment.Â
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This question is part of the following fields:
- Child Health
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Question 27
Correct
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A 45-year-old male admitted with acute onset retrosternal chest pain was diagnosed with unstable angina. Which of the following will mostly contribute to the acute risk stratification of this patient?
Your Answer: Troponin testing
Explanation:Troponin testing is the most important investigation in risk stratification. Troponin positive patients should be referred for urgent coronary revascularization as troponin indicates cardiac cell damage.
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This question is part of the following fields:
- Seriously Ill
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Question 28
Correct
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A 60-year-old patient with type 2 diabetes mellitus is advised to start taking an ACE-inhibitor in order to control his hypertension. However, he also needs to monitor his renal function. Keeping in mind that he just started an ACE-inhibitor, how long should he wait until he undergoes a blood test to check creatinine and potassium levels?
Your Answer: One to two weeks after starting the medication
Explanation:ACE inhibitors effectively reduce systemic vascular resistance in patients with hypertension, heart failure or chronic renal disease. This antihypertensive efficacy probably accounts for an important part of their long term renoprotective effects in patients with diabetic and non-diabetic renal disease. Systemic and renal haemodynamic effects of ACE inhibition, both beneficial and adverse, are potentiated by sodium depletion. Consequently, sodium repletion contributes to the restoration of renal function in patients with ACE inhibitor-induced acute renal failure. On the other hand, co-treatment with diuretics and sodium restriction can improve therapeutic efficacy in patients in whom the therapeutic response of blood pressure or proteinuria is insufficient. Patients at the greatest risk for renal adverse effects (those with heart failure, diabetes mellitus and/or chronic renal failure) also can expect the greatest benefit. Therefore, ACE inhibitors should not be withheld in these patients, but dosages should be carefully titrated, with monitoring of renal function and serum potassium levels. The optimum period to check this is one to two weeks after starting the medication.
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This question is part of the following fields:
- Renal
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Question 29
Incorrect
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A 7 year old boy who never had a history of incontinence presented with bed-wetting. Which of the following is the best approach?
Your Answer: Imipramine
Correct Answer: Sleep alarms
Explanation:As this boy didn’t have a previous history, a structural abnormality is unlikely. Parents should be asked to take the child to the bathroom to void before bedtime. Either alarm therapy or pharmacologic therapy should be considered if the above method doesn’t work after 3 months. From the above 2 therapies, neither one is superior than the other, so alarm therapy should be tried first.
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This question is part of the following fields:
- Child Health
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Question 30
Incorrect
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A 34-year-old woman presented to you with low mood, anhedonia and loss of weight. She refuses to eat or drink and believes that she does not deserve to live. What is the most appropriate treatment?
Your Answer: Fluoxetine
Correct Answer: ECT
Explanation:The lady is having a serious level of postpartum depression associated with violent thoughts that require immediate intervention. ECT shows good results in these cases. It is done under general anaesthesia but its mechanism of action is not quite understood.
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This question is part of the following fields:
- Mental Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
