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Question 1
Correct
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A 8 year old boy presented with pain and swelling around the right eye. On examination there was no proptosis or ophthalmoplegia. Which of the following is the most probable diagnosis?
Your Answer: Peri orbital cellulitis
Explanation:Infections of the superficial skin around the eyes are called periorbital, or preseptal, cellulitis. It is predominantly a paediatric disease. Erysipelas is a bacterial skin infection involving the upper dermis which extends into the superficial cutaneous lymphatics. Sinusitis is in sinuses. Orbital infections and conjunctivitis are within the eye.
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This question is part of the following fields:
- Ophthalmology
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Question 2
Correct
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A 53 year old diabetic man presents to the emergency with pain in left loin and haematuria that was sudden in onset. Investigations revealed an 8mm stone in the left lower ureter. Supportive therapy was initiated with nifedipine and steroids. The patients returned to the emergency with vomiting and worsening pain and passage of two stones. Renal function tests are significant for an impending ARF. Which of the following steps would be employed in the management of this patient?
Your Answer: Percutaneous nephrostomy
Explanation:Nephrolithiasis encompasses the formation of all types of urinary calculi in the kidney, which may deposit along the entire urogenital tract from the renal pelvis to the urethra. Nephrolithiasis manifests as sudden onset colicky flank pain that may radiate to the groin, testes, or labia (renal/ureteric colic) and is usually associated with haematuria.
Risk factors include low fluid intake, high-sodium, high-purine, and low-potassium diets, which can raise the calcium, uric acid, and oxalate levels in the urine and thereby promote stone formation.
Diagnostics include noncontrast spiral CT of the abdomen and pelvis or ultrasound to detect the stone, as well as urinalysis to assess for concomitant urinary tract infection and serum BUN/creatinine to evaluate kidney function. Urinary stones are most commonly composed of calcium oxalate. Less common stones are made up of uric acid, struvite (due to infection with urease-producing bacteria), calcium phosphate, or cystine.
Small uncomplicated stones without concurrent infection or severe dilation of the urinary tract may be managed conservatively with hydration and analgesics to promote spontaneous stone passage. When the spontaneous passage appears unlikely or fails due to the stone’s size or location, first-line urological interventions include shock wave lithotripsy, ureterorenoscopy, and, in case of large kidney stones, percutaneous nephrolithotomy. The most important preventive measure is adequate hydration.
Collected stones should be sent for chemical analysis because in many cases specific lifestyle guidance, diet changes, and/or initiation of medical treatment (e.g., thiazide diuretics, urine alkalinisation) can prevent future stone formation. -
This question is part of the following fields:
- Renal
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Question 3
Incorrect
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A 3-year-old boy was brought at the hospital by his mother due to sudden onset pyrexia with emesis and bilateral facial swelling. Upon history taking, she mentions that she brought her son to the GP who suggested analgesics for his bilateral parotid pain, 2 days ago. What would be the next step of your management?
Your Answer: Immediate surgery
Correct Answer: Reassurance
Explanation:The history is suggestive of mumps. Mumps is a viral disease with initial signs and symptoms including fever, muscle pain, headache, poor appetite, and feeling tired. This is then usually followed by painful swelling of one or both parotid salivary glands. Mumps is a self-limiting condition treated only for symptomatic relief. As he currently is taking analgesics for pain relief, one should only offer reassurance.
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This question is part of the following fields:
- Child Health
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Question 4
Correct
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A 40 year old female with acute schizophrenia has recently begun treatment for her condition. She has developed stiffness in her limbs, increased confusion, and a fever. Which of her medications is the most likely cause for her symptoms?
Your Answer: Chlorpromazine
Explanation:Neuroleptic antipsychotic drugs all have antidopaminergic effects. They cause hyperprolactinaemia and hypogonadism, and neuroleptic malignant syndrome (muscular rigidity and altered consciousness).
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This question is part of the following fields:
- Mental Health
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Question 5
Incorrect
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What is the most appropriate next step if a consultant is nominated at a directorate meeting to undertake the next clinical audit?
Your Answer: Identify standards
Correct Answer: Needs assessment
Explanation:Clinical audit is defined as a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. The first step has to be initial assessment and identifying the issues.
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This question is part of the following fields:
- Ethical
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Question 6
Correct
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A 13 year old male, who is overwise healthy, has presented with reoccurring episodes of swelling in his face and tongue. He also complains of abdominal pain. His father has had similar episodes. Choose the most likely diagnosis for this patient.
Your Answer: C1 esterase deficiency
Explanation:C1 esterase deficiency is most often associated with swelling of the peripheries and laryngeal oedema. Severe pain in the abdomen is also consistent with this diagnosis. It is also an autosomal dominant condition.
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This question is part of the following fields:
- Child Health
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Question 7
Correct
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A 15-year-old boy was admitted to the ED with a history of sudden onset chest pain and difficulty in breathing after strenuous exercise. On examination, there was reduced breath sounds on the right side but he was not cyanosed. He maintained oxygen sats of 93% on air. What is the single most appropriate investigation?
Your Answer: CXR
Explanation:The history and examination is suggestive of a spontaneous pneumothorax. The best investigation that can be performed at this stage is a CXR. Spontaneous primary pneumothorax occurs in the absence of a known lung pathology. Proposed risk factors shown to predispose patients to primary spontaneous pneumothorax (PSP) include smoking, family history, Marfan syndrome, homocystinuria, and thoracic endometriosis.
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This question is part of the following fields:
- Seriously Ill
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Question 8
Correct
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A 34-year-old woman presents with pelvic pain and complains of dysmenorrhea and menorrhagia. She has been using an IUCD for one year now and wants to know the cause of her current condition. What is the most likely cause?
Your Answer: PID
Explanation:IUCD is a risk factor for PID and PID has the clinical picture already described. However, fibroids should also be excluded since they may present in the same way.
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This question is part of the following fields:
- Gynaecology
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Question 9
Correct
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A 55-year-old woman complains of weight gain, hoarseness of voice, constipation, and muscle weakness 1 month after undergoing thyroid surgery. On examination, her face is puffy. Which of the following is the most likely diagnosis?
Your Answer: Hypothyroidism
Explanation:All the symptoms this patient is suffering from are the classic features of a hypothyroid state.
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This question is part of the following fields:
- Endocrine
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Question 10
Correct
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A 30 year old patient with schizophrenia was brought to Emergency Department, due to reduced level of consciousness. On examination he was febrile, rigid and had tremors. Which of following does not support the diagnosis of neuroleptic malignant syndrome?
Your Answer: Usually occurs after prolonged treatment
Explanation:Neuroleptic Malignant Syndrome is a life-threatening condition associated with neuroleptic medications. It is characterized by severe muscular rigidity, hyperthermia, autonomic instability (tachycardia, tachypnoea etc) and changes in the level of consciousness. It usually occurs 4-14 days after the start of therapy. Renal failure and elevated creatinine kinase are also associated with this condition.
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This question is part of the following fields:
- Mental Health
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Question 11
Incorrect
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A 5-year-old child was found to have orchidomegaly and splenomegaly. Blood tests show a WBC = 1.7 X 104/L, Hb = 7.1 g/dl and platelets = 44 X 104g/dl. His parents mention that he suffers from fatigue while at presentation he looks pale and has a fever. What is the most likely diagnosis?
Your Answer: Acute myeloid leukaemia
Correct Answer: Acute lymphoblastic leukaemia
Explanation:Acute lymphoblastic leukaemia (ALL) is an aggressive type of blood and bone marrow cancer which can appear in childhood. Signs of childhood ALL include: Fever, Easy bruising, Petechiae, Bone or joint pain, Painless lumps in multiple areas of the body, Weakness, fatigue or paleness, and Loss of appetite. Blood tests may show elevated white blood cells, decreased values of red blood cells and low platelet count.
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This question is part of the following fields:
- Haematology
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Question 12
Correct
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What is the mode of spread of chickenpox?
Your Answer: Airborne
Explanation:Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).
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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 48-year-old woman presented to you with a history of left side weakness that resolved within 2 hours. A CT scan was done showing reduced blood flow in a certain area. What is the next step regarding investigations?
Your Answer: Echo
Correct Answer: Carotid Doppler plus angiography
Explanation:This is a case of a transient ischemic attack. It is better investigated by carotid duplex to exclude carotid artery stenosis or atherosclerotic changes.
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This question is part of the following fields:
- Neurology
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Question 14
Correct
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A 22 year old woman is being followed up 6 weeks after a surgical procedure to evacuate the uterus following a miscarriage. The histology has shown changes consistent with a hydatidiform mole. What is the single most appropriate investigation in this case?
Your Answer: Serum B-HCG
Explanation:The most appropriate test for a hydatiform mole is serum beta hCG levels, which are consistently raised in these patients. The levels return to normal when the pregnancy is terminated.
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This question is part of the following fields:
- Gynaecology
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Question 15
Correct
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A 28-year-old male complained of an annular rash following an insect bite he received during a hiking trip. Which of the following is the drug of choice?
Your Answer: Doxycycline PO
Explanation:The described rash is the typical rash of erythema migrans of Lyme disease, which is treated by doxycycline PO
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This question is part of the following fields:
- Infectious Diseases
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Question 16
Incorrect
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A 35 year old lady presented with a hyperkeratotic, scaly rash over the palmar aspect of her hands and interdigital spaces. The most likely diagnosis would be?
Your Answer: Psoriasis
Correct Answer: Tinea manum
Explanation:Tinea manum is a superficial fungal infection of the hands characterised by dry scaly rash and also involves the interdigital spaces of the hands. Tinea pedis is a fungal infection of feet, whereas onychomycosis represents a fungal infection of the nails, characterised by nail dystrophy, hyperkeratosis. Kerion is the name given to secondarily infected tinea capitis leading to a soft boggy swelling over the scalp. Psoriasis presents as silvery scales over the extensors of the body and it may involve the nails, scalp and joints.
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This question is part of the following fields:
- Dermatology
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Question 17
Correct
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An 8-week-old baby was found to have bilateral cataracts. Further investigation revealed thrombocytopenia, a patent ductus arteriosus and hepatosplenomegaly. Which of the following is the most probable diagnosis?
Your Answer: Rubella
Explanation:The clinical presentation is suggestive of congenital rubella syndrome. The classic triad of presenting symptoms includes sensorineural hearing loss, ocular abnormalities (cataract, infantile glaucoma, and pigmentary retinopathy) and congenital heart disease (patent ductus arteriosus and pulmonary artery stenosis). Other findings in congenital rubella syndrome include CNS abnormalities (mental retardation, behavioural disorders, encephalographic abnormalities, hypotonia, meningoencephalitis, and microcephaly), hepatosplenomegaly, and jaundice.
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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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Impaired glucose tolerance is indicated by what glucose venous plasma level 2 hours after taking the OGTT test?
Your Answer: Between 7.8-11.0mmol/l
Explanation:According to the criteria of the World Health Organization and the American Diabetes Association, impaired glucose tolerance is defined as:
two-hour glucose levels of 140 to 199 mg per dL (7.8 to 11.0 mmol/l) on the 75-g oral glucose tolerance test. -
This question is part of the following fields:
- Endocrine
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Question 19
Correct
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A 54-year-old man experienced a gradual decrease in vision of one eye after being diagnosed with type 2 diabetes mellitus. Macula oedema is noted on his fundoscopy. Which of the following is the most likely diagnosis?
Your Answer: Diabetic retinopathy
Explanation:Macular disease can affect central vision at any stage of diabetic retinopathy and may be seen in type 2 diabetic patients. Diabetic retinopathy affects up to 80 percent of those who have had diabetes for 20 years or more. Macular oedema occurs when damaged blood vessels leak fluid and lipids onto the macula, the part of the retina that lets us see detail. The fluid makes the macula swell, which blurs vision.
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This question is part of the following fields:
- Ophthalmology
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Question 20
Correct
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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: 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 21
Correct
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Regarding Giardia Lamblia which one of the following statements is true?
Your Answer: May cause intestinal malabsorption
Explanation:Giardiasis also known as travellers diarrhoea is caused by Giardia lamblia, which is an anaerobic parasite affecting the small intestine. It can lead to diarrhoea, flatulence, abdominal cramps, malodourous greasy stools and intestinal malabsorption. It can also cause bloody diarrhoea. The investigation of choice is stool examination for trophozoites and cysts. It is treated by metronidazole and tinidazole as first line therapies.
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This question is part of the following fields:
- Infectious Diseases
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Question 22
Incorrect
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A 45-year-old male is suffering from bronchial carcinoma. This is causing obstruction of the superior vena cava. Which of the following is the most suitable palliative treatment option in this case?
Your Answer: Morphine
Correct Answer: Radiotherapy
Explanation:Bronchial carcinoma causes obstruction of the superior vena cava through its mass effect. From the options listed in this case, radiotherapy is the most suitable treatment option.
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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 16-year-old girl developed haemoptysis with acute kidney injury requiring dialysis. She suffered from recurrent epistaxis for the past 2 weeks. Renal biopsy showed crescentic glomerulonephritis. Which antibody would you expect to be positive?
Your Answer: Antinuclear
Correct Answer: Antiproteinase 3
Explanation:This patient has pulmonary renal syndrome which is most commonly due to an ANCA positive vasculitis. The history of recurrent epistaxis makes Wegener’s granulomatosis the most probable diagnosis. Wegener’s granulomatosis, microscopic polyangiitis, and idiopathic pauci-immune necrotizing crescentic glomerulonephritis (NCGN) are strongly associated with antineutrophil cytoplasmic autoantibodies (ANCAs) directed against either proteinase 3 (anti-PR3) or myeloperoxidase (anti-MPO).
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This question is part of the following fields:
- Renal
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Question 24
Incorrect
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Which one of the following has no role in increased gastric acid secretion in patients with peptic ulcer disease?
Your Answer: Parasympathetic vagal innervation
Correct Answer: Secretin
Explanation:Secretin is produced in the duodenum in response to a low pH and the presence of carbohydrate and fat. It turns off antral G cell gastrin synthesis. While others that are mentioned such as gastrin, histamine etc. are involved in increased acid secretion.
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This question is part of the following fields:
- Gastrointestinal
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Question 25
Incorrect
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A healthy 8 month old baby boy was brought in by his parents, who claimed that the baby had come into close contact with another child with measles two days ago. Which of the following is the most appropriate management?
Your Answer: Nothing need be done now but she should receive her MMR vaccination at the usual time of approximately 12 months
Correct Answer: She should receive the MMR vaccine now together with measles immunoglobulin
Explanation:People who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women without evidence of measles immunity, and people with severely compromised immune systems, should receive immunoglobulin. Intramuscular immunoglobulin should be given to all infants younger than 12 months of age who have been exposed to measles. For infants aged 6 through 11 months, MMR vaccine can be given in place of IG, if administered within 72 hours of exposure.
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This question is part of the following fields:
- Child Health
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Question 26
Correct
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A drunken man has fallen asleep in a position with his arm hanging down. After waking up he complained of wrist drop and sensory loss at the web of the thumb. Which of the following structures is most likely to be affected?
Your Answer: Radial nerve
Explanation:This presentation is known as ‘Saturday night palsy’. When someone falls asleep with a arm hanging over the arm rest of a chair, the radial nerve compresses and causes wrist drop and loss of sensation at the web of the thumb.
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This question is part of the following fields:
- Neurology
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Question 27
Incorrect
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A 75-year-old woman experienced right sided weakness shortly after she woke up. However, the weakness resolved in 30 minutes and left no disability. Her CT and ECG appear normal. What extra actions should be taken if she is already on Aspirin, Simvastatin, Amlodipine and Bendroflumethiazide?
Your Answer: Stop Amlodipine
Correct Answer: Start Aspirin 300 mg for 2 weeks
Explanation:The patient has most probably experienced a transient ischemic attack which should be initially managed with aspirin 300 mg for two weeks.
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This question is part of the following fields:
- Neurology
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Question 28
Correct
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A 13-year-old male presented in the OPD with bilateral ankle oedema. On examination, his BP was normal. Urinalysis showed a high degree of proteinuria was present. Which of the following is the most probable diagnosis in this patient?
Your Answer: Minimal change GN
Explanation:Minimal change disease is a type of glomerulonephritis that mostly affects younger children. Proteinuria is present which leads to body oedema. But in these patients blood pressure is normal.
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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 40 year old man presented with nasal bleeding for 20 minutes. He was a known hypertensive patient and there was no recent history of trauma to the nose. External pressure didn't stop the bleeding. Which of the following is the most appropriate next management for this patient?
Your Answer: Posterior packing
Correct Answer: Silver nitrate cautery
Explanation:First step of the management is identification of the bleeding point. Once the bleeding point is identified, the definite treatment is cauterization—either chemical (silver nitrate) or electrical (hotwire or bipolar cautery). If cauterization failed, interior nasal packing is the next step.
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This question is part of the following fields:
- ENT
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Question 30
Correct
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Choose the standard method for comparing distributions in data sets (such as between the expected frequency of an event and the observed frequency of an event) from the list of options.
Your Answer: Chi squared (X²) test
Explanation:The Chi-squared test evaluates if two variables are related. The other statistical tests mentioned do not perform this function.
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This question is part of the following fields:
- Epidemiology
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Question 31
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 32
Correct
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A 60 year old female with a recent history of MI, complained of exertional dyspnoea. On examination there was a third heart sound. ECG showed ST elevations in leads V1 to V4. Which of the following is the most probable reason for this presentation?
Your Answer: Left ventricular aneurysm
Explanation:Electrocardiography is characterized by ST elevation that persists several weeks after an acute MI. The features of heart failure (exertional dyspnoea and third or fourth heart sound) favours the diagnosis.
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This question is part of the following fields:
- Cardiovascular
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Question 33
Correct
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A 35 year old lady presented in her 3rd trimester with severe features of pre-eclampsia. The drug of choice to prevent the patient going into impending eclampsia would be?
Your Answer: Intravenous magnesium sulphate
Explanation:The drug of choice for eclampsia and pre-eclampsia is magnesium sulphate. It is given as a loading dose of 4g i/v over 5 minutes, followed by an infusion for the next 24 hours at the rate of 1g/hr. If the seizures are not controlled, an additional dose of MgSO4 2-4gm i/v can be given over five minutes. Patients with eclampsia or pre-eclampsia can develop any of the following symptoms: persistent headache, visual abnormalities like photophobia, blurring of vison or temporary blindness, epigastric pain, dyspnoea and altered mental status.
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This question is part of the following fields:
- Obstetrics
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Question 34
Correct
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Fabry's disease is a rare genetic disorder that leads to excessive deposition of neutral glycosphingolipids in the vascular endothelium of several organs and in epithelial and smooth muscle cells. Which of the following is least likely to be associated with Fabry's disease?
Your Answer: Inherited in an autosomal dominant fashion
Explanation:Fabry disease (Angiokeratoma corporis diffusum) is an X-linked lysosomal disorder which occurs due to deficiency or absence of alpha-galactosidase A (α-GAL A) activity as a result of a genetic mutation in the GLA gene. As Fabry’s disease follows X-linked genetics it manifestis predominantly in men. Ongoing burning, tingling pain and discomfort, known as acroparesthesia, mainly affecting the hands and feet is the most debilitating symptom in childhood.
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This question is part of the following fields:
- Musculoskeletal
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Question 35
Correct
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A 6-year-old boy with fever and malaise for 2 days recently developed bloody diarrhoea. What is the most probable aetiology?
Your Answer: Escherichia coli 0157
Explanation:The most likely organism is enterohemorrhagic verotoxin-producing E.coli. It usually causes haemolytic uremic syndrome.
Crohn’s disease rarely manifests in an acute manner.
Polio and giardiasis usually manifest with non-bloody diarrhoea. -
This question is part of the following fields:
- Infectious Diseases
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Question 36
Incorrect
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Which of the following nail changes are present in ulcerative colitis?
Your Answer: Beau's lines
Correct Answer: Clubbing
Explanation:Clubbing of the fingers can be present in many clinical conditions like CLD, bronchiectasis, lung abscess, Ulcerative colitis and Crohn’s Disease. Koilonychia or spoon shaped nails are a typical finding in iron deficiency anaemia. Splinter haemorrhages are pin point haemorrhages found in infective endocarditis and secondary to trauma. Yellow nails are present in pulmonary and renal diseases.
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This question is part of the following fields:
- Dermatology
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Question 37
Incorrect
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A 43 year old man with hemochromatosis presents with a painful and swollen right knee. X-ray shows extensive chondrocalcinosis but no fracture. Given the most likely diagnosis, which of the following would be present in the joint fluid aspirate?
Your Answer: Negatively birefringent calcium carbonate crystals
Correct Answer: Positively birefringent rhomboid-shaped crystals
Explanation:Pseudogout is a paroxysmal joint inflammation due to calcium pyrophosphate crystal deposition (calcium pyrophosphate dihydrate). Arthrocentesis should be performed, especially in acute cases.
Polarized light microscopy: detection of rhomboid-shaped, positively birefringent CPPD crystals.
Synovial fluid findings: 10,000-50,000 WBCs/μL with > 90% neutrophils.
X-ray findings: cartilage calcification of the affected joint (chondrocalcinosis).
Fibrocartilage (meniscus, annulus fibrosus of intervertebral disc) and hyaline cartilage (joint cartilage) may be affected. -
This question is part of the following fields:
- Rheumatology
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Question 38
Incorrect
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A 30-year-old female admitted with pelvic pain, fever and vaginal discharge was diagnosed with PID. She was treated with IV antibiotics for 8 days. However, despite the antibiotics she continued to have a fever and lower abdominal pain. What is the most appropriate management that can be done at this stage?
Your Answer: Laparoscopy
Correct Answer: US
Explanation:Persistent fever and lower abdominal pain is suggestive of resistant conditions secondary to PID such as abscess formation. An US scan should be performed to rule out those possible conditions.
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This question is part of the following fields:
- Genitourinary
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Question 39
Correct
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A 64 year old female presents with sudden onset pain, swelling and stiffness in her right knee. Her medical history is significant for osteoarthritis affecting her hand joints and diet controlled diabetes mellitus. On examination, the right knee is swollen, erythematous and tender. Which of the following tests would be most useful in the diagnosis of this case?
Your Answer: Aspiration and examination of the synovial fluid
Explanation:Arthrocentesis should usually be done when there is a suspicion of pseudogout or septic arthritis as in this case which leads to an early diagnosis and prompt treatment. Polarized microscopy demonstrates weakly positively birefringent rhomboid crystals which are blue when parallel to light and yellow when perpendicular to light. Elevated serum uric acid levels that cause gout are usually found after large consumption of alcohol or meat, or post surgery. Autoimmune diseases like SLE, RA etc require an autoimmune screen.
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This question is part of the following fields:
- Rheumatology
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Question 40
Correct
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Which of the following diseases correctly matches the incubation period?
Your Answer: Mumps - 14-18 days
Explanation:The incubation periods of disorders is extremely important to diagnose, treat, prevent or attenuate a disease.
Chickenpox: 7-21 days.
Whooping cough: 10-14 days.
Hand, foot and mouth disease: 2-6 days. German measles: 14-21 days.
Mumps: 14-18 days. -
This question is part of the following fields:
- Infectious Diseases
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SESSION STATS - PERFORMANCE PER SPECIALTY
