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Question 1
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 2
Correct
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A paediatrician has concerns that a 6-month-old baby is deaf. His mom gives history of her having a sore throat, fever and lymphadenitis during pregnancy. Which organism causes such manifestations?
Your Answer: Cytomegalovirus (CMV)
Explanation:The best answer is cytomegalovirus. The mother was infected during the pregnancy and the baby has developed cytomegalo-inclusion syndrome. Histologically, it is identified by viral particles surrounded by lysosomes.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Correct
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A 51 year old presents with muscle atrophy. He has a high BMI and finds it difficult to climb stairs. If the patient also has polydipsia and polyuria, what is the most likely diagnosis?
Your Answer: Amyotrophy
Explanation:(Diabetic) Amyotrophy is a condition that presents with muscle wasting and consequent difficulty in climbing stairs. The onset is relatively sudden and symptoms of diabetes are characteristic.
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This question is part of the following fields:
- Neurology
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Question 4
Incorrect
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A female with a history of prolonged depression presents to the clinic with coarse tremors. Which of the following drugs is most likely responsible for her symptoms?
Your Answer: Lithium
Correct Answer: Sodium valproate
Explanation:Valproate is one of the most prescribed antiepileptic medications and is also commonly associated with tremors. It is the most common neurological adverse event observed with valproate. Approximately 25% of patients taking valproate are found to develop a tremor within 3–12 months of initiating therapy.
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This question is part of the following fields:
- Mental Health
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Question 5
Correct
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A 20-year-old girl is presented to the OPD with her mother. Her mother reports that she eats very large portions of food most of the time, but takes diet pills and remains depressed because she thinks she is overweight. However, on general physical examination, she appears to be very thin and her blood pressure is lower than normal. Investigations reveal that she has hypokalaemia. What is this girl most likely suffering from?
Your Answer: Bulimia nervosa
Explanation:Bulimia nervosa is a condition in which a person is involved in binge eating and then purging in an attempt to stay thin despite eating a lot of food. Frequent vomiting can cause electrolyte imbalance that manifests as hyperkalaemia and may lead to hypotension.
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This question is part of the following fields:
- Gastrointestinal
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Question 6
Correct
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A 65-year-old complains of fatigue, headache and blurred vision in the left eye. Moreover, she is unable to comb her hair. What is the most probable diagnosis?
Your Answer: Temporal arteritis
Explanation:The patient is in a suitable age for developing temporal arteritis and the fact that she’s unable to comb her hair indicates scalp tenderness or proximal muscle weakness. A high ESR together with increased CRP supports the diagnosis. Temporal artery biopsy is also useful to establish the diagnosis.
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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 30 year old female with schizophrenia has a poor compliance with oral drugs. Which of the following is the best long term management for her?
Your Answer: Depot (Risperidone)
Explanation:Antipsychotics in depot preparations are best for the long term management. Depot Risperidone is the suitable answer from the given answers.
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This question is part of the following fields:
- Mental Health
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Question 8
Correct
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A 40-year-old male was admitted following 30%, burns sustained from an apartment fire. What is the most appropriate initial treatment of this patient?
Your Answer: Intravenous fluids
Explanation:As this patient has more than a 15% burn area, he needs IV fluids. These patients are more prone to infection and dehydration. Burn area is calculated using the rule of nines and requires fluid replacement over the first 24 hrs, calculated using Parkland’s burn formula.
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This question is part of the following fields:
- Seriously Ill
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Question 9
Correct
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A 35-year-old female is complaining of bad odour and discharge from her genitals. A smear was taken showing many epithelial cells and clue cells. Which of the following is the most likely diagnosis?
Your Answer: Bacterial vaginosis
Explanation:Trichomonas vaginalis is the most probable organism as it causes the foul smelling discharge. However, clue cells (irregular squamous epithelial cells with sheets of bacteria on its borders) are associated with bacterial vaginosis. Both cases should be treated with metronidazole.
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This question is part of the following fields:
- Genitourinary
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Question 10
Incorrect
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Which feature is NOT characteristic of carcinoid syndrome?
Your Answer: Dermatitis
Correct Answer: Persistent hypotension
Explanation:Carcinoid syndrome is a paraneoplastic syndrome comprising of signs and symptoms that occur secondary to carcinoid tumours. Diarrhoea, dermatitis, bronchospasm and right sided cardiac valve lesions (tricuspid insufficiency and pulmonary stenosis) are characteristic of carcinoid syndrome.
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This question is part of the following fields:
- Seriously Ill
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Question 11
Incorrect
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A 17-year-old boy presents with tremors. Upon inquiry, the mother reports that the boy has a history of very aggressive episodes. She also reports that he has been hallucinating for some time. On examination, there were needle marks on his arm. What drug has been used?
Your Answer: Amphetamines
Correct Answer: Lysergic acid diethylamide (LSD)
Explanation:Psychedelic drugs, like LSD, bring on a state of altered consciousness, causing thought, audio, or visual changes. Low body temperature and tremors are associated with many drugs but closed-eye hallucinations are strongly associated with LSD and other psychedelic drugs.
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This question is part of the following fields:
- Pharmacology
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Question 12
Correct
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A 9 year old boy was admitted with gastroenteritis. The boy's symptoms started two days ago with profound diarrhoea and emesis. Blood exams show the following: Sodium=148mmol/l, Potassium=2.2mmol/l, Urea=20mmol/l, Glucose=4.3mmol/l. What would be the best management?
Your Answer: V normal saline and potassium supplement
Explanation:The boy needs re-hydration and hydro-electrolytic re-balancing due to fluid losses from the gastroenteritis and subsequent dehydration.
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This question is part of the following fields:
- Child Health
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Question 13
Correct
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An 18-year-old woman in her 30th week of pregnancy is brought to the hospital in altered sensorium. She is taking slow, shallow breaths and her breath has a fruity smell. An arterial blood gas (ABG) shows the presence of ketones. What is the most probable diagnosis?
Your Answer: Diabetic Ketoacidosis (DKA)
Explanation:This a case of gestational diabetes presenting with DKA. It is a serious case that requires immediate intervention. Pregnant diabetics tend to develop DKA on a lower serum glucose level than non-pregnant diabetics. The shortness of breath is a trial to wash the excess CO2 to compensate for the metabolic acidosis seen in the ABG. The fruity smell is acetone excreted through the lungs. The main treatment of this case is proper fluid management and insulin infusion.
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This question is part of the following fields:
- Endocrine
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Question 14
Correct
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A 12-year-old female presented with a bleeding nose. On examination by the ENT surgeon, it was noticed that the bleeding was coming from the anterior part of the nose and the bleeding point was clearly visualised. Which of the following options is the most suitable choice in this case?
Your Answer: Cautery
Explanation:In the case of anterior nasal bleeds, when the bleeding point is clearly visualised the best management step is cautery, either electrical or chemical.
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This question is part of the following fields:
- ENT
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Question 15
Correct
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Which one of the following skin conditions is matched correctly with its treatment?
Your Answer: Psoriasis and Vitamin D analogues
Explanation:One of the options of Psoriasis treatment is vitamin D analogues i.e. calcipotriol. Acne is exacerbated by steroids. Erythema nodosum can be caused by various diseases and the treatment of the primary condition resolves the symptoms. Lipomas requires surgery, whereas Steven-Johnson syndrome requires use of steroids and eliminating the culprit drug, which is one of the most common causes.
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This question is part of the following fields:
- Dermatology
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Question 16
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: Anti-nuclear antibody titres
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 17
Incorrect
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A 24 year old male, known case of hereditary angioneurotic oedema presents with recurrent fever and arthralgia which is accompanied by a rash on face and upper chest. These attacks have been refractory to treatment and have occurred recurrently requiring adrenaline on several occasions. Lab results reveal persistently reduced C4 levels. Which of the following is most likely causing his current symptoms?
Your Answer: Drug rash
Correct Answer: Systemic lupus erythematosus
Explanation:Angioedema secondary to C1 inhibitor deficiency has been rarely reported to be associated with systemic lupus erythematosus. A genetic defect of C1 inhibitor produces hereditary angioedema, which is usually presented with cutaneous painless oedema, but oedema of the genital area, gastrointestinal and laryngeal tracts have also been reported. In lupus patients, angioedema may be the result of an acquired type of C1 inhibitor deficiency, most probably due to antibody formation directed against the C1 inhibitor molecule.
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This question is part of the following fields:
- Rheumatology
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Question 18
Correct
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A 74-year-old male has received his 3rd cycle of chemotherapy for malignant melanoma 3 days ago. He is presented with a productive cough with greenish sputum. Otherwise he feels well. On examination, he has scattered crepitations, more on the lower right part of the chest. He is afebrile. His labs are: Hb 12.5, TLC 0.9 *10^9 , Plt. 84*10^9. Pan culture was collected and sent. What is the most appropriate next step?
Your Answer: Broad spectrum antibiotic (intravenous)
Explanation:This is a case of hospital acquired infection in an immunocompromised patient. It should be treated vigorously. On the other hand, patients who receive chemotherapy usually have atrophic gastritis and malabsorption syndrome.
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This question is part of the following fields:
- Seriously Ill
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Question 19
Correct
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A 70 year old male underwent surgery for rectal carcinoma. 10 days after the operation, he presents with a mass in his pelvis and a high-grade fever. Choose the most likely diagnosis from the list of options below.
Your Answer: Pelvic Abscess
Explanation:Developing a pelvis abscess is one of the most common postoperative surgical complications after rectal operations. The symptoms of a pelvic mass and fever are also consistent with a pelvic abscess.
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This question is part of the following fields:
- Seriously Ill
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Question 20
Correct
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A 85 year old male with a history of Alzheimer's dementia was brought into Casualty by family members, who stated that he had episodes of aggression. Which of the following drugs is most suitable as the pharmacological management for this presentation?
Your Answer: Risperidone
Explanation:Regarding the pharmacological management, Risperidone is the most suitable drug from the given answers as it is recommended for the treatment of aggression associated with moderate to severe Alzheimer’s disease. Quetiapine and Benzodiazepine are not recommended.
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This question is part of the following fields:
- Older Adult
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Question 21
Correct
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A 57-year-old male presented to the OPD with a complaint of yellow discoloration of his skin. On examination, he was found to have digital clubbing, jaundice, an enlarged and nodular liver, as well as caput medusa. Clinical investigations revealed normal electrolyte levels but low albumin levels. Which of the following is the appropriate management of this patient's fluid intake?
Your Answer: Albumin infusion
Explanation:This patient has an accumulation of fluid inside his body which, along with the lowered albumin level, tells us that the oncotic pressure of the blood is very low in this patient. Therefore, albumin infusion is the best option for him because albumin is the key human protein that contributes the most to the oncotic pressure.
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This question is part of the following fields:
- Gastrointestinal
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Question 22
Incorrect
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A 5-year-old girl was admitted for fever, anaemia, thrombocytopenia and signs of pulmonary infection. She now presents a few days later with signs of meningism. What is the most probable diagnosis?
Your Answer: Acute Myeloid Leukaemia (AML)
Correct Answer: Acute lymphoblastic leukaemia (ALL)
Explanation:Acute lymphoblastic leukaemia (ALL) is a cancer of the lymphoid line of blood cells characterized by the development of large numbers of immature lymphocytes. Symptoms may include feeling tired, frequent infections with fever as well as anaemia with thrombocytopenia. As an acute leukaemia, ALL progresses rapidly and is typically fatal within weeks or months if left untreated. The patient’s age also favours the diagnosis of ALL as it occurs most commonly in children, particularly those between the ages of two and five.
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This question is part of the following fields:
- Haematology
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Question 23
Correct
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A 28 year old male has come to his local sexual health clinic with concerns that he may have HIV. 3 separate HIV tests were conducted, but all 3 of them came back negative A few months later, he returns to the same clinic claiming that he does have HIV. From the list of options, choose the most likely diagnosis.
Your Answer: Hypochondriac
Explanation:Hypochondria is the constant worry of having a serious illness, which is consistent with the symptoms presented.
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This question is part of the following fields:
- Mental Health
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Question 24
Correct
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A 45 year old smoker presented with sudden onset of chest pain radiating to his left arm, with associated sweating. ECG showed ST elevation in leads I, aVL and V1-V4. The most likely diagnosis would be?
Your Answer: Anterior MI
Explanation:An anterior wall myocardial infarction is characterised by ST elevation in leads I, aVL and V1-V5.
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This question is part of the following fields:
- Cardiovascular
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Question 25
Correct
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A 44 year old woman was admitted with dull retrosternal chest pain. History reveals the pain has been present for two weeks. Clinical examination and ECG, however, show nothing interesting. CXR shows an air-fluid level behind the heart. Which hernia would explain this presentation?
Your Answer: Hiatal
Explanation:A hiatal hernia may be asymptomatic, however classically it presents on CXR with a very characteristic air-fluid level behind the heart. If pain is present, PPIs can be administered. If pain is persistent, surgical intervention should be considered to ameliorate the risk of strangulation. There are two types of hiatal hernias; sliding or Para oesophageal.
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This question is part of the following fields:
- Gastrointestinal
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Question 26
Correct
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An 19 year old pregnant woman wants to terminate her pregnancy. She's in her 12th week of gestation and she's never been pregnant before. What is the most appropriate management?
Your Answer: Suction curettage
Explanation:Between 9-12weeks of gestation, suction curettage is usually the most appropriate method of termination of pregnancy. Termination of pregnancy must be decided and performed as early as possible. An abortion after 24 weeks of gestation is illegal in the UK.
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This question is part of the following fields:
- Genitourinary
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Question 27
Incorrect
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A homeless woman presented with a cough and fever for the last 3 months. She also complained of night sweats and weight loss. Her CXR showed lung opacities. What is the next appropriate step for this patient?
Your Answer: Mantoux test
Correct Answer: Acid fast bacilli
Explanation:History and CXR are suggestive of tuberculosis. Acid fast bacilli should be seen on microscopy to confirm the diagnosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 28
Correct
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A 68 year old female underwent surgery for a hysterectomy. 24 hours later, she is complaining of breathlessness. Upon examination, she has bibasal chest crepitations and a raised jugular venous pressure (JVP). From the list of options, which is the most likely electrolyte or fluid abnormality?
Your Answer: Fluid overload
Explanation:The raised JVP and bibasal crepitations in the patient indicate cardiac failure with fluid overload. A chest x-ray and BNP blood level analysis should be performed to confirm this diagnosis. The x-rays should be analysed for alveolar shadowing, Kerly B lines, cardiomegaly, upper lobe diversion, pleural effusion, and fluid in the fissure. If the patient doesn’t have a history of congestive cardiac failure, then this may have been iatrogenic secondary to intravenous fluids.
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This question is part of the following fields:
- Seriously Ill
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Question 29
Correct
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A 35-year-old female patient presents with butterfly rash, haematuria and photosensitivity. She is currently on TB treatment. Which antibody would you expect positive?
Your Answer: Anti-Histone
Explanation:This patient is probably suffering from a drug-induced lupus. There’s a 95% chance that anti-histone antibodies are positive. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The drugs most commonly connected with drug-induced lupus are: hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms) and isoniazid (used to treat tuberculosis).
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This question is part of the following fields:
- Rheumatology
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Question 30
Correct
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A 3-year-old girl was accompanied by her mother to the hospital due to a change in speech, which is now an indistinct nasal speech. She is always tired by day, has restless sleep and even snores at night. What is the best management strategy?
Your Answer: Refer to ENT surgeon
Explanation:Adenoid tissue sometimes swell as a result of fighting off the infection as germs are trapped in the adenoids. Adenoid enlargement is suspected.
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This question is part of the following fields:
- Child Health
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Question 31
Correct
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A 48-year-old woman with chronic pancreatitis due to gallstones presents with a macrocytic anaemia. The anaemia is most likely caused by:
Your Answer: Vitamin B12 deficiency
Explanation:Vit b12 requires trypsin enzyme to split it from its R-binders in order to make the vitamin bind to intrinsic factor required for absorption. In alcoholic patients, chronic pancreatitis is very common. Other causes related to alcoholism can be folate deficiency or bone marrow dysfunction.
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This question is part of the following fields:
- Gastrointestinal
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Question 32
Incorrect
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A defect in DNA gyrase can lead to which of the following cancerous conditions?
Your Answer: Fanconi's anaemia
Correct Answer: Xeroderma pigmentosum
Explanation:Xeroderma pigmentosum is an X-linked recessive condition, which is caused by mutations in DNA gyrase which further encodes the XP gene. The defect may lead to skin cancer at an early stage of life, especially at photo exposed sites.
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This question is part of the following fields:
- Dermatology
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Question 33
Correct
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A 29 year old woman is in her 32nd week of gestation and is diagnosed with placental abruption. This is her 3rd pregnancy and despite all effective measures taken, bleeding is still present. What is the most likely cause?
Your Answer: Clotting factor problem
Explanation:Clotting factor problem. Some of the more common disorders of coagulation that occur during pregnancy are von Willebrand disease, common factor deficiencies, platelet disorders and as a result of anticoagulants.
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This question is part of the following fields:
- Obstetrics
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Question 34
Correct
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A 39 year old female has been told by her doctor that her PAP smear test shows borderline changes. Her last smear test was conducted three years ago and was reported to be completely normal. Choose the most appropriate management for this patient.
Your Answer: Repeat smear in 6 months
Explanation:The usual management for patients with one borderline sear test is to repeat the test in 6 months time. However, if this persists then the patient should be referred for a colposcopic assessment.
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This question is part of the following fields:
- Genitourinary
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Question 35
Correct
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Psoriatic arthropathy most commonly presents with which of the following types of arthritis?
Your Answer: Peripheral asymmetric oligoarthropathy
Explanation:Most patients with psoriatic arthritis present with monoarthritis or asymmetric oligoarthritis. The most common form of the disease is the one involving a few joints of the peripheral skeleton with a distinct asymmetry of symptoms. Involvement of the smaller joints of the hands and feet, especially distal interphalangeal joints, seems to be a characteristic feature. Arthritis mutilans is a rare and severe complication of psoriatic arthritis.
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This question is part of the following fields:
- Rheumatology
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Question 36
Correct
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An alcoholic man was found in a critical condition outside the pub. He was sweating heavily, was drowsy and there were some empty cans of cider lying near him. What is the most appropriate initial test that should be done in such patients?
Your Answer: Capillary blood sugar
Explanation:The most appropriate initial test should be checking the blood sugar level. Patients with hypoglycaemia can present with drowsiness, profuse sweating and dizziness.
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This question is part of the following fields:
- Neurology
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Question 37
Correct
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A 25-year-old male had an emergency appendicectomy. His doctor prescribed him prophylactic antibiotics to avoid infection after the surgery. Which of the following antibiotics is the best choice for post abdominal surgery?
Your Answer: Cefuroxime
Explanation:Cefuroxime is the best choice in the case of gut surgery as it is very effective in preventing infections against gut anaerobes, enterococci and coliforms.
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This question is part of the following fields:
- Pharmacology
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Question 38
Incorrect
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A 54 year old lady was found unconscious at home and passed away later in the ambulance, due to cardiac arrest. The paramedic's report reveals the woman was a diabetic patient on anti-diabetic medication, lately immobilized due to hip pain. Ulcers were also found on the medial side of her ankle. What is the most likely cause of her death?
Your Answer: Pulmonary embolus
Correct Answer: Acute myocardial infarction
Explanation:The patient was old and had a major cardiovascular risk because she was a diabetic. The ulcers indicate poor glycaemic control and advanced disease which further increased her risk for an ischemic heart attack. Immobilization most probably was the favouring background on which the MI occurred.
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This question is part of the following fields:
- Seriously Ill
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Question 39
Incorrect
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A 30 year old previously well female presented with yellowish discolouration of her sclera. Investigations revealed low haemoglobin, a retic count of 8% and the occasional spherocyte on blood film. Which of the following is the most appropriate single investigation?
Your Answer: BMA
Correct Answer: Direct coombs test
Explanation:A low haemoglobin and a high retic count is suggestive of a haemolytic anaemia. Occasional spherocytes can be seen on blood film during haemolysis and it is not a specific finding. Direct Coombs test will help to identify autoimmune haemolytic anaemia, where there are antibodies attached to RBCs.
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This question is part of the following fields:
- Endocrine
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Question 40
Correct
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A 34 year old woman presented with poor sleep with the result that she often woke up early. She also reported a lack of interest in her usual activities. These symptoms began about three weeks ago and have been getting worse. Although her two children were both in school, she was concerned that she was not spending quality time with them and she felt she was worthless to them. Which of the following is the most likely diagnosis?
Your Answer: Mild depression
Explanation:She has poor sleep, lack of lack of interest in usual activities and worthlessness and symptoms affecting her usual activities which are suggestive of mild depression.
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This question is part of the following fields:
- Mental Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
