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Question 1
Correct
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A 25-year-old pregnant mother who is known to have hepatitis B gave birth to a male infant. She is now concerned about her child contracting hep B. Which of the following is the most suitable option for the baby in this case?
Your Answer: HepB full vaccine and Ig
Explanation:Hepatitis B full vaccine and Ig should be given to babies born to hepatitis B positive mothers. Hepatitis B vaccine alone or Ig alone is not sufficient to prevent the infection in the new-born baby.
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This question is part of the following fields:
- Infectious Diseases
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Question 2
Incorrect
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A 45 year old male presents with lower backache and pain in his hips. Blood tests are normal except for elevated serum alkaline phosphatase which is 1200 IU/l (45-105). Radiological examination shows combined osteolytic and osteosclerotic lesions. What is the most common site of occurrence of this disease?
Your Answer: Femur
Correct Answer: Pelvis
Explanation:The patient most likely suffers from Paget’s disease of the bone as his radiological examination shows both osteolytic and osteosclerotic lesions. Any bone or bones can be affected, but Paget’s disease occurs most frequently in the pelvis > lumbar spine > femur > thoracic spine > sacrum > skull > tibia.
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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 71 year old woman presents with dyspnoea and unsteadiness. She's known to suffer from epilepsy and is managed on carbamazepine. Blood exams are as follows: MCV=70, Hb=8.5, WBC=2, Neutrophils=1, Platelets=50. What is the most likely diagnosis?
Your Answer: Aplastic anaemia
Explanation:The results of the blood exam are suggestive of aplastic anaemia which might be secondary to carbamazepine use. The use of antiepileptic’s, in particular carbamazepine and valproate, is associated with a nine fold increased risk of aplastic anaemia.
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This question is part of the following fields:
- Haematology
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Question 4
Correct
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A child with jaundice and pale stools would most likely be evaluated by which of the following tests?
Your Answer: US
Explanation:Blood tests do not help in the diagnosis of jaundice except of course by telling the level of jaundice (bilirubin) and providing some corroborative evidence such as autoantibodies, tumour markers or viral titres in the case of hepatitis. Classifying causes of jaundice on the basis of ultrasound provides a quick and easy schema for diagnosing jaundice which is applicable in primary care as well as hospital based practice.
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This question is part of the following fields:
- Hepatobiliary
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Question 5
Correct
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Parents of a new-born are worried about cot death. What advice will you give?
Your Answer: Child should sleep on the back with legs towards the end of the cot
Explanation:Cot death also know as SIDS or Sudden Infant Death syndrome. Putting a baby to sleep on his back has been shown to reduce the risk of SIDS.
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This question is part of the following fields:
- Child Health
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Question 6
Correct
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A 57 year old male has complained of low mood after suffering from a myocardial infarction some months ago. He has been diagnosed with moderate depression. Which medication would be the most appropriate for this patient?
Your Answer: Selective serotonin re-uptake inhibitors (SSRI)
Explanation:SSRIs are the most commonly prescribed antidepressants and are used to ease symptoms of moderate to severe depression. They are also relatively safe and cause fewer side-effects than other medications available.
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This question is part of the following fields:
- Mental Health
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Question 7
Incorrect
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A 55 year old female school teacher complains of double vision when she writes on the school blackboard. She has no history of trauma. Her most recent visit to her GP was to seek attention for a rash which developed after she was bitten when walking through the forest on a school trip. Choose the cranial nerve most likely to be affected here.
Your Answer: Oculomotor
Correct Answer: Abducens
Explanation:This nerve is responsible for the side to side movement of the eye, hence why damage can cause double vision.
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This question is part of the following fields:
- Neurology
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Question 8
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: Long saphenous vein
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 9
Correct
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A 30-year-old patient has ataxia, nystagmus and vertigo with a history of headaches. Where is the most likely site of the lesion?
Your Answer: Cerebellum
Explanation:Damage to the cerebellum can cause asynergia, dysmetria, adiadochokinesia, intention tremor, staggering, ataxic gait, tendency toward falling, hypotonia, ataxic dysarthria and nystagmus.
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This question is part of the following fields:
- Neurology
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Question 10
Incorrect
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Which of the following treatments would you advise for a young, 21 year old student who has ankylosing spondylitis and complains of worsening back pain and morning stiffness?
Your Answer: Laminectomy and spinal fusion
Correct Answer: Oral NSAIDs
Explanation:NSAIDs are considered as the first line of treatment for managing pain and stiffness associated with ankylosing spondylitis. Other useful medications include TNF-alpha inhibitors. Other drugs like paracetamol, colchicine, and steroids are not routinely used. Bilateral total hip replacement might be indicated in advanced disease contrary to complicated spinal surgery.
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This question is part of the following fields:
- Rheumatology
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Question 11
Correct
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What would you administer to a child with a clean wound that has never been immunized before, assuming there is no contraindication to immunization?
Your Answer: Full course of diphtheria, tetanus, polio
Explanation:A not immunized patient with a clean wound requires an immediate vaccination against diphtheria, tetanus and polio, according to the Green Book of Immunisation against infectious disease. (The Green Book has the latest information on vaccines and vaccination procedures, for vaccine preventable infectious diseases in the UK.)
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This question is part of the following fields:
- Child Health
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Question 12
Incorrect
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A man was admitted to the hospital and developed varicella zoster after 48h. Which of the following categories of people should be administered immunoglobulin only?
Your Answer: None
Correct Answer: All pregnant women who are tested negative for antibodies.
Explanation:Immunoglobulin should be given to all seronegative women within 4 days. However, it is strongly advised to seek medical care immediately if the disease develops.
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This question is part of the following fields:
- Infectious Diseases
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Question 13
Incorrect
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A 50-year-old lung cancer patient presents with diminished reflexes, retention of urine, postural hypotension and sluggish papillary reaction. What is the most likely explanation for her symptoms?
Your Answer: Spinal Cord Compression
Correct Answer: Paraneoplastic syndrome
Explanation:Paraneoplastic syndromes are more common in patients with lung cancer. Signs and symptoms include inappropriate antidiuretic hormone secretion, finger clubbing, hypercoagulability and Eaton-Lambert syndrome.
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This question is part of the following fields:
- Respiratory
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Question 14
Incorrect
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A 75-year-old male patient, with a history of late onset asthma and heart failure as well as generalized rash, presents with Bell's palsy. CXR shows multiple soft shadows and blood test reveal an eosinophilia. Which antibody would you expect to be positive?
Your Answer: Anti Ds DNA
Correct Answer: P ANCA
Explanation:Eosinophilic granulomatosis with polyangiitis (EGPA) is a multisystemic disorder, belonging to the small vessel anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis. It is defined as an eosinophil-rich and necrotizing granulomatous inflammation often involving the respiratory tract, and necrotizing vasculitis predominantly affecting small to medium-sized vessels, associated with asthma and eosinophilia. ANCA (especially pANCA anti-myeloperoxidase) are present in 40–60% of the patients.
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This question is part of the following fields:
- Rheumatology
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Question 15
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 16
Incorrect
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All of the following statements suggesting a poor prognosis of Guillain-Barre syndrome are correct except?
Your Answer: History of diarrhoea in the preceding few weeks
Correct Answer: Evidence demyelination on nerve conduction studies
Explanation:Guillain barre syndrome is a neurological disorder characterised by neuropathy along with ascending paralysis. Denervation rather than demyelination suggests poor prognosis in GB syndrome.
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This question is part of the following fields:
- Neurology
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Question 17
Incorrect
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A 70 year old male complained of poor vision at night which has gradually worsened with time. He has changed his glasses several times but there has been no improvement. On examination his pupils and cornea were normal. Which of the following is the most probable diagnosis?
Your Answer: GCA
Correct Answer: Cataract
Explanation:Senile cataract is an age-related, vision-impairing disease characterized by gradual progressive clouding and thickening of the lens of the eye. Patients with senile cataracts often present with a history of gradual progressive visual deterioration and disturbance in night and near vision.
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This question is part of the following fields:
- Ophthalmology
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Question 18
Correct
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A 45 year old known asthmatic was admitted with acute severe asthma and was treated with nebulised salbutamol, ipratropium and bromide, along with 100% oxygen therapy. He was also given IV hydrocortisone, however there was no significant improvement. What would be the next step in management of this patient?
Your Answer: IV Aminophylline
Explanation:Aminophylline is a very effective bronchodilator. It is short acting and therefore very effective in acute scenarios.
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This question is part of the following fields:
- Respiratory
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Question 19
Correct
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A 21 year old asthmatic presented with complaints of a dry cough and hoarseness of voice. He has been taking oral and inhaled corticosteroids for many years. The most likely causative factor for the hoarseness of voice would be?
Your Answer: Laryngeal candidiasis
Explanation:Laryngeal candidiasis is one of the leading cause of hoarseness of voice in patients who are taking corticosteroids. As a result of decreased immunity, chances of fungal infections are increased.
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This question is part of the following fields:
- ENT
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Question 20
Correct
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A woman is self-neglecting herself by refusing to eat or drink and complains that people around her can hear her thoughts. What is the most likely diagnosis?
Your Answer: Schizophrenia
Explanation:To be diagnosed with schizophrenia, a person must have two or more of the following symptoms occurring persistently in the context of reduced functioning:
Delusions
Hallucinations
Disorganized speech
Disorganized or catatonic behaviour
Negative symptoms
In this case the lady is experiencing delusions of thought broadcasting and disorganised behaviour which may or may not be due to the delusions. -
This question is part of the following fields:
- Mental Health
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Question 21
Correct
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A 23-year-old woman complains of a tender lump that is smooth and mobile in her left breast measuring 1-2 cm. What is the most likely diagnosis?
Your Answer: Fibroadenoma
Explanation:Fibroadenoma usually occurs in younger women. These non-tender masses can be removed for aesthetic purposes. Breast cysts are common shifting masses inside the breast tissue more common in women over the age of 35.
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This question is part of the following fields:
- Breast
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Question 22
Correct
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A newly married female presented with fever, dysuria, frequency and lower abdominal pain for 2 days duration. On examination, she was febrile with lower abdominal tenderness. Urine microscopy reveals 20-30 pus cells/hpf and 10-20 red cells/hpf. Which of the following would be the most probable cause for this presentation?
Your Answer: Cystitis
Explanation:The patient has what is known as ‘honeymoon cystitis’.
Most common presentation of schistosomiasis is haematuria.
Patients with kidney trauma also present with haematuria following a positive history for such injury.
Pain due to calculi are colicky in nature and severe. -
This question is part of the following fields:
- Genitourinary
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Question 23
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: Regular salbutamol and budesonide
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 24
Correct
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A 59-year-old woman has an 11mm skin lesion on her right forearm, which bleeds easily on contact and has changed in appearance over the last 11 months.
Your Answer: Malignant melanoma
Explanation:Melanoma is more common in men than women. Reasons for the disease includes: UV light and genetic predisposition or mutations. Diagnosis is by biopsy and analysis of any skin lesion that has signs of being potentially cancerous.
Early warning signs of melanoma ABCDE:
Asymmetry
Borders (irregular with edges and corners)
Colour (variegated)
Diameter (greater than 6 mm)
Evolving over time -
This question is part of the following fields:
- Dermatology
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Question 25
Correct
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From the following options, choose the one which is most characteristic of early Alzheimer's disease.
Your Answer: Impaired short term memory
Explanation:Alzheimer’s disease is most often characterized early on by short-term memory loss. The other options in this list are characteristic of the following: normal pressure hydrocephalus (gait ataxia and urinary incontinence); Creutzfeldt-Jakob disease (myoclonic jerks); delirium or Lewy body dementia (visual hallucinations).
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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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During pregnancy, which among these is NOT counted as physiological change?
Your Answer: Cardiac output 6.5L/min.
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
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This question is part of the following fields:
- Obstetrics
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Question 27
Correct
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A 39-year-old female had surgery for the removal of thyroid carcinoma. One week later, she presented in the OPD with complaints of numbness, tingling, involuntary spasm of the upper extremities, paraesthesia and respiratory stridor. Which of the following is the most likely cause?
Your Answer: Hypocalcaemia
Explanation:Hypocalcaemia presents with such symptoms. It probably happened due to accidental removal of a parathyroid gland during the thyroid surgery. Hypocalcaemia causes laryngospasm which produces stridor.
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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 38 year old alcoholic presented with an ataxic gait, nystagmus and confusion. What is the most likely clinical diagnosis?
Your Answer: Korsakoff’s syndrome
Correct Answer: Wernicke’s encephalopathy
Explanation:Wernicke’s encephalopathy is a clinical triad of encephalopathy, gait ataxia and nystagmus.
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This question is part of the following fields:
- Neurology
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Question 29
Incorrect
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A 45 year old male complains of abdominal pain and loose stools. On endoscopy, multiple ulcers were seen from the oesophagus until the stomach. What will be the next best investigation for this patient?
Your Answer: Serum B12 estimation
Correct Answer: Serum gastrin estimation
Explanation:Serum gastrin level will helps in the diagnosis of Zollinger-Ellison syndrome, which is characterised by a history of recurrent and multiple gastric ulcers, due to increase gastrin secretion by the cells.
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This question is part of the following fields:
- Gastrointestinal
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Question 30
Incorrect
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A 35 year old soldier presented with a painless, erythematous crusted plaque over the dorsum of his hand, after serving in a hilly area of Columbia for 2 months. The most likely diagnosis will be?
Your Answer: Fusobacterium ulcerans
Correct Answer: Leishmaniasis
Explanation:The chief presentation in Leishmaniasis is a non healing, ulcerated, painless and non pruritic plaque, which does not respond to oral antibiotics. It can be classified into cutaneous and visceral forms and is caused by the sand fly. It is more prevalent in the hilly areas. Fusobacterium causes a tropical ulcer which is painful and shallow, while Troanasomiasis causes sleeping sickness.
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This question is part of the following fields:
- Dermatology
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SESSION STATS - PERFORMANCE PER SPECIALTY
