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Question 1
Correct
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A 47-year-old woman is being treated with steroids for her diagnosis of giant cell arteritis (GCA). What is the other drug that can be added to this?
Your Answer: Aspirin
Explanation:Low dose aspirin is proven efficient in aversion of complications connected with giant cell arteritis such as stroke.
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This question is part of the following fields:
- Pharmacology
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Question 2
Correct
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A 3 year old boy is brought to the emergency by his parents with worsening ataxia. They also mention that the boy's urine has a distinct sweet odour. Further investigations reveal the presence of leucine, isoleucine and valine in the urine. What is the diagnosis?
Your Answer: Maple Syrup Urine Disease
Explanation:Maple syrup urine disease (MSUD) is an autosomal recessive metabolic disorder affecting branched-chain amino acids. It is one type of organic academia. The condition gets its name from the distinctive sweet odour of affected infants’ urine, particularly prior to diagnosis, and during times of acute illness. MSUD, also known as branched-chain ketoaciduria, is an aminoacidopathy due to an enzyme defect in the catabolic pathway of the branched-chain amino acids leucine, isoleucine, and valine.
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This question is part of the following fields:
- Child Health
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Question 3
Correct
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A 35-year-old female presented with purple stretch marks on her abdomen, easy bruising and weight gain. A low dose Dexamethasone suppression test did not show any but a high dose Dexamethasone suppression test showed suppression of cortisol levels. Which of the following is the most likely cause for this presentation?
Your Answer: Pituitary Adenoma
Explanation:Clinical features are due to excess cortisol. High-dose dexamethasone suppression test shows suppression in patients with Cushing’s disease. Cushing syndrome includes all causes of glucocorticoid excess, whereas Cushing’s disease is reserved only for pituitary-dependent Cushing’s syndrome.
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This question is part of the following fields:
- Endocrine
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Question 4
Correct
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Which of the following abnormal facial movements is not a well-recognised association?
Your Answer: Facial synkinesis - Wilson's disease
Explanation:Wilson’s disease may have an asymmetric tremor which is variable in character and may be predominantly resting, postural, or kinetic.
Progressive supra-nuclear palsy – blepharospasm, apraxia of lid opening and/or apraxia of lid closing.
Tourette’s syndrome – one or more motor or vocal tics.
Multiple Sclerosis – continuous facial myokymia.
Tardive dyskinesia is a side-effect of conventional antipsychotics, neuroleptics, anticholinergics, and toxins resulting in stiff, jerky movements of your face and body -
This question is part of the following fields:
- Neurology
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Question 5
Correct
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A 65 year old male with a history of chronic diabetes mellitus and ischaemic heart disease, presented with pain in the thigh and gluteal region, while climbing up the stairs for past 5 months and symptoms were getting worse. He was a heavy smoker. On examination the dorsalis pedis and posterior tibial pulses were present. Which of the following is the most probable diagnosis?
Your Answer: Atherosclerosis
Explanation:The presence of the pulses excluded Thromboangitis Obliterans. The pain is not suggestive of sciatica. The history doesn’t support a DVT or an embolus as there is no pain at rest, swelling or skin changes. So the most probable diagnosis is atherosclerosis as the chronic diabetes and smoking support it.
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This question is part of the following fields:
- Endocrine
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Question 6
Correct
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A 27 year old woman presents with a history of weight loss and palpitations. Examination reveals unilateral proptosis. She also admits that despite having a healthy appetite she has difficulty putting on weight. What is the most probable diagnosis?
Your Answer: Thyroid-associated ophthalmopathy
Explanation:The patient’s age and symptoms suggest Grave’s disease with thyroid-associated ophthalmopathy. In Grave’s disease, weight loss is noticed regardless of normal eating habits of the patient. Palpitations are also typical and may be confused with a panic attack. Proptosis is usually bilateral, but unilateral is also possible.
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This question is part of the following fields:
- Endocrine
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Question 7
Correct
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A 30 year old female presented with sudden onset severe right sided abdominal pain for the past 30 minutes. The pain radiated to the groin. She vomited once. Her abdomen was non tender. Which of the following is the most probable diagnosis?
Your Answer: Ureteric colic
Explanation:Characteristic colicky pain and non tender abdomen is characteristic of ureteric colic. Some patients present with urinary symptoms such as haematuria and dysuria, Vomiting is due to activation of sympathetic nervous system due to pain.
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This question is part of the following fields:
- Urology
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Question 8
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 9
Correct
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Bile salts are responsible for:
Your Answer: The emulsification of fats
Explanation:The main function of bile acids is to allow digestion of dietary fats and oils by acting as a surfactant that emulsifies them into micelles, allowing them to be colloidally suspended in the chyme before further processing.
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This question is part of the following fields:
- Hepatobiliary
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Question 10
Incorrect
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A 58 year old woman with a longstanding history of hypertension arrives at the hospital complaining of recurrent falls when trying to get out of bed or get up from sitting. She is currently on an anti hypertensive regimen? What do you think is most likely responsible for her falls?
Your Answer: CCB
Correct Answer: Thiazide
Explanation:The causes of orthostatic hypotension include the following: Hypovolemia (a drop in the volume of blood) and dehydration (low fluid volume in the body). Common causes of these are bleeding, elevated sugar, diarrhoea, vomiting, and medications like thiazide diuretics (HCTZ) and loop diuretics (furosemide, bumetanide)
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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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Under which section of the Mental Health Act can a suicidal patient that may be suffering from psychosis be detained if threatening to leave the hospital?
Your Answer: 5
Explanation:Section 5, which is an emergency section applied only in England, gives any physician the right to detain someone in the hospital for up to 72 hours, during which time the patient should receive an assessment that decides if further detention under the Mental Health Act is needed. Patients that are detained under section 5 of Mental Health Act, are suspected to have a psychiatric cause for their disease, but they lack insight on this matter.
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This question is part of the following fields:
- Mental Health
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Question 12
Incorrect
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A 23 year old male presents with a history of lower back pain for the last one year. Presence of which of the following features most likely points towards ankylosing spondylitis?
Your Answer: Presence of HLA-B27 antigen on tissue typing
Correct Answer: Bilateral erosion of sacroiliac joints on X-ray
Explanation:Bilateral erosions of the sacroiliac joints on pelvic radiographs of patients with ankylosing spondylitis are an important feature of the modified New York classification criteria. Although HLA-B27 is commonly associated with AS, it can also be found in normal individuals. Back stiffness is worse in the morning and gets better as the day progresses. Tenderness and limited lumbar motion can be associated with other spine problems as well and is not characteristic of rheumatoid arthritis.
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This question is part of the following fields:
- Rheumatology
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Question 13
Incorrect
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A 70-year-old male came to the OPD with complaints of nocturia, difficulty in initiating urination and continuous dribbling of urine afterwards. A transrectal US guided biopsy was performed and the diagnosis of BPH was made. His TURP was planned. Which of the following electrolyte imbalance is most likely to occur?
Your Answer: Hypernatremia
Correct Answer: Hyponatremia
Explanation:In a TURP procedure, fluid is used to irrigate the bladder and to remove blood clots. IV fluids are also given to the patient post-operatively. These factors will lead to dilutional hyponatremia.
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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 51-year-old woman admitted to the hospital for 3 days due to haemoptysis developed an ataxic gait, visual problems, and altered state of consciousness. What is the most appropriate management of this patient?
Your Answer: High potent vitamins
Explanation:Wernicke’s encephalopathy presents with neurological symptoms as a result of biochemical deficits in the central nervous system due to depleted B-vitamin reserves, particularly thiamine (vitamin B1). Classically, Wernicke encephalopathy is characterised by the triad – ophthalmoplegia, ataxia, and confusion. Thiamine treatment should be started immediately and usually continued until clinical improvement ceases.
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This question is part of the following fields:
- Neurology
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Question 15
Correct
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Which of the following conditions is not linked to hyperuricemia?
Your Answer: Osteoarthritis
Explanation:Hyperuricemia is an elevated uric acid level in the blood. The normal upper limit is 6.8mg/dL, and anything over 7 mg/dL is considered saturated, and symptoms can occur. Causes of hyperuricemia can be classified into three functional types:
1. Increased production of uric acid – Purine rich diet, Tumour lysis syndrome, HGPRT deficiency (Lesch-Nyhan and Kelley-Seegmiller syndromes), Increased PRPP synthetase activity and Polycythaemia
2. Decreased excretion of uric acid – Renal impairment, Metabolic syndrome, Drugs (diuretics, low-dose aspirin, cyclosporin, tacrolimus, pyrazinamide, ethambutol, levodopa, nicotinic acid), Acidosis, Pre-eclampsia and eclampsia, Hypothyroidism and hyperparathyroidism, Sarcoidosis, Familial juvenile gouty nephropathy, Chronic lead intoxication, Trisomy 21
3. Idiopathic and mixed type – Alcohol, Exercise, Glucose-6-phosphatase deficiency, Aldolase B deficiency -
This question is part of the following fields:
- Musculoskeletal
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Question 16
Correct
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What is the sign of life threatening asthma?
Your Answer: Deteriorating level of consciousness
Explanation:A drop in level of consciousness is an indicator of high levels of PCO2 and cerebral cortex depression. It is a life threatening condition that requires intervention which may include mechanical ventilation.
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This question is part of the following fields:
- Respiratory
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Question 17
Correct
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A 48-year-old man presents with severe retrosternal pain, which was present for the past 40 minutes. ECG shows ST elevation and blood tests reveal high troponin levels. He has already been given oxygen, GTN and morphine. What is the next most appropriate step?
Your Answer: Percutaneous angiography
Explanation:The patient is experiencing an acute myocardial infarction and percutaneous angiography is the next most appropriate step in management. Percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a nonsurgical technique for treating obstructive coronary artery disease, including unstable angina, acute myocardial infarction (MI), and multivessel coronary artery disease (CAD).
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This question is part of the following fields:
- Cardiovascular
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Question 18
Correct
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A 3-year-old girl presented with rhinorrhoea, barking cough and inspiratory stridor. She was diagnosed with laryngotracheobronchitis. If untreated at this stage which of the following would be the most possible outcome?
Your Answer: Complete resolution
Explanation:The prognosis for croup is excellent, and recovery is almost always complete with complications being quite rare. The possible complications are pneumonia, bacterial tracheitis, pulmonary oedema, pneumothorax, pneumomediastinum, lymphadenitis or otitis media. Bacterial tracheitis is a life-threatening infection that can arise after the onset of an acute viral respiratory infection.
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This question is part of the following fields:
- Respiratory
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Question 19
Incorrect
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A 32 year old woman presents with a painful elbow which she has been feeling for the past two weeks. Which of the following will be consistent with a diagnosis of tennis elbow?
Your Answer: Pain on pressure over the medial epicondyle
Correct Answer: Pain on wrist extension against resistance
Explanation:Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles and thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which will result in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.
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This question is part of the following fields:
- Rheumatology
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Question 20
Correct
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A 40 year old male is awaiting a liver biopsy. Which of the following is the most important investigation that has to be performed prior to the procedure?
Your Answer: Coagulation profile
Explanation:As the liver is highly vascular, there is a high risk of bleeding during and after the procedure. Patients may have existing liver diseases, which affect the production of clotting factors. So a coagulation profile is necessary to detect any abnormality and correct them prior to the liver biopsy.
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This question is part of the following fields:
- Gastrointestinal
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Question 21
Correct
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A 65 year old gentleman presented with 2 weeks history of exertional dyspnoea, orthopnoea and chest pain. Past history revealed that a few years ago, he had been treated with antibiotics for complaints of fever, joint pains and chest pain. The most likely diagnosis will be?
Your Answer: Mitral valve stenosis
Explanation:The commonest symptom of mitral valve stenosis is dyspnoea, and it is one of the most common clinical findings which can be seen in rheumatic fever.
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This question is part of the following fields:
- Cardiovascular
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Question 22
Correct
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A 72-year-old male was admitted with acute right leg pain at rest. On examination, the right leg was white and peripheral pulses were not palpable. He gives a history of intermittent claudication for the past two years. What is the most probable cause for this presentation?
Your Answer: Atrial fibrillation
Explanation:This presentation is compatible with acute limb ischemia, which is a surgical emergency. Thromboembolism following atrial fibrillation is the most probable cause for this presentation as there is no history of prolonged immobilization or other associated risk factors in this male patient.
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This question is part of the following fields:
- Cardiovascular
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Question 23
Incorrect
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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: Haemorrhoids
Correct 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 24
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 25
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 26
Incorrect
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A young woman presents to the clinic with massive hematemesis. The episodes continue to occur despite initial measures. She is a chronic alcoholic. Which of the following steps would be the most important regarding the management of this patient?
Your Answer: IV fluids
Correct Answer: Emergency banding
Explanation:Acute upper gastrointestinal bleeding is a common medical emergency which carries a hospital mortality in excess of 10%. The most important causes are peptic ulcer and varices. Varices are treated by endoscopic band ligation or injection sclerotherapy and management of the underlying liver disease.
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This question is part of the following fields:
- Emergency
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Question 27
Correct
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A 70-year-old smoker was recently diagnosed with small cell lung cancer. Which of the following electrolyte combinations confirms the diagnosis of SIADH?
Your Answer: Low serum Na, low serum osmolarity, high urine osmolarity
Explanation:Due to the high amount of ADH in their blood, patient is voiding a low volume of urine with high osmolarity and as a result low levels of electrolytes will be present in the serum.
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This question is part of the following fields:
- Endocrine
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Question 28
Correct
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A 68 year old male presented with right sided hip pain and was found to have a fracture of right hip. On examination he had bilateral pedal oedema and was also found to be deaf. Which of the following is the most probable diagnosis?
Your Answer: Paget’s disease
Explanation:Paget disease is a localized disorder of bone remodelling . Hip pain is most common when the acetabulum and proximal femur are involved. The most common neurologic complication is deafness as a result of involvement of the petrous temporal bone. Bilateral pedal oedema is due to associated heart failure.
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This question is part of the following fields:
- Musculoskeletal
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Question 29
Correct
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From the following drugs, which is an inhaled glucocorticoid that is used for maintenance therapy, but not important in mild asthmatic attacks?
Your Answer: Fluticasone propionate
Explanation:From the given answers Fluticasone propionate is the inhaled glucocorticoid. It is not important as a reliever medication but important in maintenance therapy.
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This question is part of the following fields:
- Respiratory
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Question 30
Correct
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A 55-year-old man attends follow-up for liver cirrhosis, which reveals a large dominant nodule in the right lobe of liver on CT Scan. Which tumour marker would most likely be elevated?
Your Answer: Alpha feto-protein (AFP)
Explanation:A considerably increased serum AFP is characteristic of hepatocellular cancer. A distinct nodule for cirrhotic patients should be investigated to rule out hepatocellular cancer.
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This question is part of the following fields:
- Gastrointestinal
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Question 31
Incorrect
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A diabetic 50 year old male presented in the emergency room with ischaemic gangrene of the lower leg, ulceration over the medial malleolus and infection spreading proximally. Which of the following types of amputation is most suitable in this patient?
Your Answer: Tarsal amputation
Correct Answer: Below knee amputation
Explanation:The type of amputation depends on the degree of gangrene, ischaemia and the extent of involvement of the foot, leg, knee etc. In this case, below-knee amputation is the most appropriate choice.
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This question is part of the following fields:
- Seriously Ill
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Question 32
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 33
Incorrect
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Which among these medications does NOT cause gastric ulceration?
Your Answer: Celecoxib
Correct Answer: Misoprostol
Explanation:Misoprostol is effective in preventing gastric ulceration since it is a prostaglandin analogue. Celecoxib, being a selective COX-2 inhibitor only elevates risk of ulceration as well as NSAIDs. Renal failure on the other hand results in elevated gastric acid after reducing the breakdown of gastrin.
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This question is part of the following fields:
- Gastrointestinal
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Question 34
Incorrect
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A 60 year old male smoker presented in the emergency room with a history of chest pain and a cough for the last few days. He is now complaining of increasing dyspnoea and sharp pains around the 4th and 5th ribs. On CXR, there is right sided hilar enlargement. Which of the following is the most likely diagnosis?
Your Answer: Tuberculosis
Correct Answer: Bronchogenic carcinoma
Explanation:The history of smoking with a cough and bone pain is suggestive of bronchogenic carcinoma. CXR findings are also supportive of this diagnosis. In COPD, a cough with dyspnoea and wheezing is prominent.
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This question is part of the following fields:
- Respiratory
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Question 35
Correct
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The following drugs are given for different types of respiratory conditions. Which of the following drugs exerts its action by inhibiting phosphodiesterase?
Your Answer: Theophylline
Explanation:Theophylline relaxes the smooth muscles of the respiratory tract and suppresses the response of the airways to stimuli by increasing tissue concentration of cyclic adenine monophosphate (cAMP) by inhibiting phosphodiesterase. Dobutamine has strong beta1 and weak beta2/alpha effects, resulting in increased cardiac output, blood pressure, and heart rate, as well as decreased peripheral vascular resistance. Doxapram produces respiratory stimulation in medulla through peripheral carotid chemoreceptors. Ipratropium inhibits vagally mediated reflexes by antagonizing acetylcholine action which prevents increase in intracellular calcium concentration and ultimately causes bronchial smooth muscle relaxation. Salbutamol is a short-acting β2 adrenergic receptor agonist which causes smooth muscle relaxation.
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This question is part of the following fields:
- Pharmacology
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Question 36
Correct
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A 51 year old male patient presents with acute back pain, which worsens on prolonged walking and sitting. The pain radiates towards the lower limbs and seems to be relieved by lying down. What is the best next step?
Your Answer: Magnetic resonance imaging (MRI)
Explanation:A herniated disc seems to be the cause of the patient’s pain. MRI is the investigation of choice, since it can show soft tissue and establish a differential diagnosis.
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This question is part of the following fields:
- Neurology
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Question 37
Incorrect
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A 45 year old male with asthma presented with postnasal drainage, a dull headache and snoring. On examination there were two reddish masses in both nostrils. Which of the following is the most probable diagnosis?
Your Answer: Allergic rhinitis
Correct Answer: Nasal polyp
Explanation:Nasal polyps are abnormal lesions that originate from any portion of the nasal mucosa or paranasal sinuses. They are more common among asthmatics. Symptoms include nasal airway obstruction, postnasal drainage, dull headaches, snoring, and rhinorrhoea.
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This question is part of the following fields:
- ENT
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Question 38
Incorrect
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A 30-year-old female diagnosed with rapidly progressive glomerulonephritis complains of pain and redness in the right eye. Which part of the eye is causing these symptoms in this case?
Your Answer: Conjunctivitis
Correct Answer: Sclera
Explanation:Rheumatoid Scleritis is a painful inflammatory condition of the sclera in patients with rheumatoid arthritis. It might be diffuse, nodular, or necrotizing in nature. This occurs mostly in the sixth decade of life and mostly when the rheumatoid disease is in remission. Sclera is the first ocular manifestation in a patient of rheumatoid arthritis. This inflammation might later spread to the adjacent ocular structures like the cornea, causing keratitis, the uveal tract causing uveitis and the lens causing cataracts.
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This question is part of the following fields:
- Ophthalmology
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Question 39
Correct
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What are the chances of offspring developing cystic fibrosis if one of the parents, more specifically the mother, is suffering from the disease?
Your Answer: Depends on genetic makeup of partner
Explanation:Cystic fibrosis has an autosomal recessive pattern of inheritance, meaning that a person might be a carrier of the disease without developing it. If the unaffected partner is a carrier, then there is a 50% chance of inheritance and another 50% chance of having a child who is a carrier. However, if the partner is not a carrier, the offspring will not develop the disease but the possibility of being a carrier raises up to 100%.
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This question is part of the following fields:
- Genetics
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Question 40
Correct
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A 63-year-old heavy smoker complains of pain on exertion in both calves and his buttocks. He has also recently developed erectile dysfunction. On examination, peripheral pulses in both lower limbs including distal and femoral are absent. Where is the single most probable site of obstruction?
Your Answer: Aorto iliac
Explanation:The penis receives its blood supply by the internal pudendal artery, a branch of the internal iliac artery. Erectile dysfunction indicates obstruction at the level of the common iliac arteries or higher.
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This question is part of the following fields:
- Cardiovascular
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SESSION STATS - PERFORMANCE PER SPECIALTY
