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Question 1
Incorrect
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A 2-year-old baby sustained a wound to her hand whilst playing in the garden. She is unvaccinated as the parents are concerned regarding side effects. There is no contraindication to vaccinations. What is the most appropriate action?
Your Answer: Give DPT and tetanus Ig
Correct Answer: Give complete DPT vaccine course
Explanation:A complete course of DPT should be given.
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This question is part of the following fields:
- Child Health
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Question 2
Incorrect
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An 81 year old male patient was admitted after an ischaemic stroke. Physical examination reveals left hemiparesis. How would you classify this hemiparesis based on the WHO International Classification of Functioning, Disability and Health?
Your Answer: Right total anterior circulation infarct
Correct Answer: Impairment of body function
Explanation:Symptoms and signs are classified as ‘impairment of body function’.
The types of impairment classified as ‘activity limitation’ include difficulties that a patient may have in executing certain activities.
The type of impairment classified as ‘participation restriction’ are problems a patient may have in social roles.
The type of impairment classified as ‘pathology’ would be the diagnosis/disease.
Right total anterior circulation infarct relates to the Oxford Bamford classification for stroke. -
This question is part of the following fields:
- Older Adult
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Question 3
Incorrect
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A 72 year old female, known with rheumatoid arthritis for last 17 years, presents with recurrent attacks of red eyes with a sensation of grittiness. Which of the following is most likely cause of the red eyes?
Your Answer: episcleritis
Correct Answer: keratoconjunctivitis sicca
Explanation:Rheumatoid arthritis is an inflammatory systemic disease associated with some extraarticular manifestations. Keratoconjunctivitis sicca, episcleritis, scleritis, corneal changes, and retinal vasculitis are the most common ocular complications among extraarticular manifestations of RA. The overall prevalence of keratoconjunctivitis sicca also known as dry eye syndrome among patients of RA is 21.2% and is the most common with sense of grittiness in the eyes.
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This question is part of the following fields:
- Rheumatology
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Question 4
Incorrect
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A 35-year-old previously well male gives a history of on-and-off retrosternal heaviness during exertion, relieved by resting. Pain lasts about 20-25 minutes. What is the clinical diagnosis of this presentation?
Your Answer: Coronary spasm
Correct Answer: Stable angina
Explanation:The history is suggestive of stable angina because of it’s duration, aggravating and relieving factors. Patients get retrosternal pain or discomfort which sometimes radiates to jaw or left axilla during a period of increased myocardial demand. Pain relieves during resting when myocardial demand meets supply.
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This question is part of the following fields:
- Cardiovascular
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Question 5
Incorrect
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A 3-year-old girl presents to A&E following a few days of being lethargic, having runny nose, sore throat, and fever. She has unceasing stridor and drooling of saliva while her body is inclined forward. What is the most important next step in her management?
Your Answer: Call Anaesthetist
Correct Answer: Call ENT specialist
Explanation:A consultation with an ENT is required to establish the reason for the child’s drooling and stridor indicating and obstructive process. Enlarged tonsils and adenoids should be checked.
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This question is part of the following fields:
- Child Health
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Question 6
Correct
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A 37-year-old male patient presented with bilateral kidney stones. He gave a history of sarcoidosis. What is the most probable cause for renal stones?
Your Answer: Hyper calcaemic
Explanation:Sarcoidosis is a multisystem granulomatous disorder which may involve the kidneys to a variable degree. Renal calculi have been reported to occur in about 10% of patients with chronic sarcoidosis. Hypercalcaemia due to marked hyperabsorption of dietary calcium, bone resorption and renal tubular calcium reabsorption causes hypercalciuria. Both hypercalcemia and hypercalciuria contribute to nephrolithiasis.
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This question is part of the following fields:
- Urology
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Question 7
Correct
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A 55 year old male presents to the emergency with acute onset breathlessness. He underwent a total hip replacement 7 days back. On examination, the JVP is raised. Which other investigation would be most helpful in leading to an accurate diagnosis?
Your Answer: CTPA
Explanation:The most pertinent diagnosis suspected in this case would be a pulmonary embolism considering the recent surgical history and acute onset of breathlessness. A CT pulmonary angiogram (CTPA) is a medical diagnostic test that employs computed tomography (CT) angiography to obtain an image of the pulmonary arteries. Its main use is to diagnose pulmonary embolism (PE).
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This question is part of the following fields:
- Mental Health
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Question 8
Incorrect
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A 57 year old female arrives at the emergency due to chest pain, shortness of breath and palpitations. ECG is done which shows a supraventricular tachycardia with a heartrate of 220/min. carotid massage fails to bring the heart rate down. How would you manage this patient?
Your Answer: IV adenosine
Correct Answer: DC shock
Explanation:Synchronized electrical cardioversion may also be used to treat stable ventricular tachycardia (VT) that does not respond to a trial of intravenous medications. Unstable patients with SVT and a pulse are always treated with synchronized cardioversion. The appropriate voltage for cardioverting SVT is 50-100 J. This is what AHA recommends and also SVT converts quite readily with 50-100 J.
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This question is part of the following fields:
- Cardiovascular
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Question 9
Correct
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A 40 year old woman has come to her GP complaining of a low mood. She has noted an increased appetite and has gone up by two clothing sizes. She also complains that she is unable to get out of bed until afternoon. From the list of options, what is the most likely diagnosis for this patient?
Your Answer: Atypical depression
Explanation:Atypical depression presents with several very specific symptoms, such as increased appetite or weight gain; excessive sleep; fatigue and weakness; moods that are reactive to environmental circumstances; and a feeling of extreme sensitivity to rejection. It is also a subtype of major depression or dysthymic disorder.
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This question is part of the following fields:
- Mental Health
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Question 10
Correct
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An 8-month-old infant is presented to the paediatrics ward with a history of delayed developmental milestones since birth. On examination, he has poor muscle tone and balance, and a head circumference, which is greater than normal. Imaging of the patient's head revealed a diminished cerebellar vermis, a large fourth ventricle, and an enlarged posterior fossa. What is the most likely diagnosis?
Your Answer: Dandy-Walker syndrome
Explanation:Dandy-Walker syndrome is characterised by symptoms of brain maldevelopment that are seen in this patient. A large cranium indicates hydrocephalus, and the hypotonia indicates poor limb development.
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This question is part of the following fields:
- Child Health
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Question 11
Incorrect
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A 32-year-old woman, who is 18 weeks pregnant, is diagnosed with antiphospholipid syndrome and positive anticardiolipin antibodies. She has a history of three miscarriages, each one during the first trimester. What would be the next most appropriate step?
Your Answer:
Correct Answer: Aspirin & heparin
Explanation:The syndrome with which the woman was diagnosed is an autoimmune, hypercoagulable state which most possibly was the reason of her previous miscarriages. This is the reason why she should be on aspirin and heparin in order to prevent any future miscarriage.
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This question is part of the following fields:
- Obstetrics
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Question 12
Incorrect
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Which of the following bronchodilators is an anticholinergic commonly used in addition to adrenoceptor stimulants?
Your Answer:
Correct Answer: Oxitropium bromide
Explanation:All of these drugs are anti-asthmatic drugs that work through different pathways. Oxitropium bromide is an anticholinergic drug that is often used with beta agonists to improve their action.
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This question is part of the following fields:
- Pharmacology
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Question 13
Incorrect
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A 22 year old female presents with a history of a whitish discharge from her vagina. She previously underwent a dental procedure and completed a 7 day antibiotic course prior to it. Which of the following microorganisms has most likely lead to this?
Your Answer:
Correct Answer: Candida
Explanation:Candida albicans is the most common cause of candidiasis and appears almost universally in low numbers on healthy skin, in the oropharyngeal cavity, and in the gastrointestinal and genitourinary tracts. In immunocompetent individuals, C. albicans usually causes minor localized infections, including thrush (affecting the oral cavity), vaginal yeast infections (if there is an underlying pH imbalance), and infections of the intertriginous areas of skin (e.g., the axillae or gluteal folds). More widespread and systemic infections may occur in immunocompromised individuals (e.g., neonates, diabetics, and HIV patients), with the oesophagus most commonly affected (candida esophagitis). Localized cutaneous candidiasis infections may be treated with topical antifungal agents (e.g., clotrimazole). More widespread and systemic infections require systemic therapy with fluconazole or caspofungin.
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This question is part of the following fields:
- Mental Health
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Question 14
Incorrect
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A 7-year-old female presented with complaints of haematuria and fatigue. She had a history of bloody diarrhoea starting 7 days previously. On investigation, her serum urea and creatinine were raised and proteinuria was present. Which of the following is the most suitable diagnosis for her?
Your Answer:
Correct Answer: Haemolytic-uremic syndrome (HUS)
Explanation:HUS syndrome occurs mostly in children after some days of bloody diarrhoea. Damaged red blood cells also damage the kidney filtering unit and lead to sudden renal failure.
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This question is part of the following fields:
- Renal
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Question 15
Incorrect
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Which of the following is an appetite stimulant?
Your Answer:
Correct Answer: Neuropeptide Y
Explanation:Neuropeptide Y induces appetite during trials in rats. Other agents mentioned here are either appetite suppressants or have no effect on appetite.
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This question is part of the following fields:
- Gastrointestinal
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Question 16
Incorrect
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A 28-year-old male is involved in a motorcycle accident. He sustained a direct blow to his lower chest. His blood pressure is 83/48, HR 113 bpm. On examination, there are multiple bruises on the chest with bowel sounds heard on auscultation of his chest. The single most likely diagnosis is?
Your Answer:
Correct Answer: Diaphragmatic rupture
Explanation:Ruptured diaphragm is a serious condition that is very difficult to diagnose and requires rapid intervention. The presence of bowel sounds on chest auscultation is highly suggestive of this.
Ruptured oesophagus is excluded by the absence of haematemesis and normal intestinal sounds.
Fractured ribs could be life threatening if associated with a tension pneumothorax which is excluded by a normal chest auscultation.
Flail chest is characterised by paradoxical breathing and respiratory failure. -
This question is part of the following fields:
- Respiratory
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Question 17
Incorrect
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A 60 year old male presents with a 6 month history of poor sleep and a loss of interest in his normal activities. He has recently become very forgetful and responds to many questions with the phrase I don't know. Choose the most likely diagnosis for this patient.
Your Answer:
Correct Answer: Depression
Explanation:Many of this patient’s symptoms are consistent with depression: having no motivation or interest in things, finding it difficult to make decisions, and a disturbed sleeping pattern.
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This question is part of the following fields:
- Mental Health
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Question 18
Incorrect
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A 40-year old male presented to the OPD with a history of difficulty swallowing and blood-stained vomit. History of weight loss is also present. The abdominal X-ray was normal. Which of the following should be done next?
Your Answer:
Correct Answer: Oesophagogastroduodenoscopy
Explanation:An esophagogastroduodenoscopy (OGD) should be ordered to visualize and identify the source of bleeding. This procedure can harvest tissue samples for histological analysis and can also treat varices that may be causing the bleeding.
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This question is part of the following fields:
- Gastrointestinal
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Question 19
Incorrect
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In a study, 50 out of 100 smokers developed lung cancers and 50 out of 200 non-smokers developed lung cancers. Which of the following is accurate?
Your Answer:
Correct Answer: Relative risk=2
Explanation:Relative risk = (Incidence in exposed group)/incidence in unexposed group). So in this case RR = (50/100)/(50/200) = 2.
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This question is part of the following fields:
- Epidemiology
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Question 20
Incorrect
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A 71-year-old woman residing in a nursing home for a couple of years complains of drooling of saliva and sudden difficulty in swallowing while eating. She is a known hypertensive on treatment. What would be your next step?
Your Answer:
Correct Answer: Endoscopy
Explanation:Dysphagia or difficulty in swallowing. Endoscopy allows for visual examination of the oesophagus and is indicated in patients with dysphagia to determine the underlying aetiology, exclude malignant and premalignant conditions, assess the need for therapy, and perform therapy including dilation.
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This question is part of the following fields:
- Older Adult
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Question 21
Incorrect
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A 35 year old alcoholic presented with epigastric pain radiating backward. His pain was relieved with opioid analgesics and anti PUD medications, however after 1 week he developed a fever with a similar kind of abdominal pain to that of his initial presentation. US abdomen shows a fluid collection. The most likely site for the fluid collection would be?
Your Answer:
Correct Answer: Lesser sac
Explanation:The most likely diagnosis in this case is acute pancreatitis, which typically presents with severe abdominal pain and vomiting, along with deranged LFTs and raised serum amylase. It makes a boundary wall for the lesser sac and therefore the most likely site of fluid collection would be in the lesser sac.
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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 30 year old nulliparous woman presented with a report of a cervical biopsy which was suggestive of CIN III. What is the most appropriate management for this patient?
Your Answer:
Correct Answer: Cone biopsy
Explanation:Loop electrosurgical excision procedure (LEEP) and Cold knife cone biopsy (conization) are recommended treatments for this patient as she is nulliparous. Hysterectomy is offered for someone who has completed their family or menopaused.
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This question is part of the following fields:
- Genitourinary
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Question 23
Incorrect
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A 25-year-old male presents at the OPD complaining of excessive tiredness and frequent headaches. On examination, his blood pressure was 205/100 mmHg. Blood tests reveal a decreased serum potassium and renin level and elevated aldosterone level. Which condition is this patient most likely suffering from?
Your Answer:
Correct Answer: Primary hyperaldosteronism (Conn’s disease)
Explanation:Conn’s disease is a condition in which excessive amounts of aldosterone are secreted from the adrenal glands. Because aldosterone increases the reabsorption of sodium, it leads to a very high blood pressure.
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This question is part of the following fields:
- Endocrine
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Question 24
Incorrect
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A 45-year-old male admitted with acute onset retrosternal chest pain was diagnosed with unstable angina. Which of the following will mostly contribute to the acute risk stratification of this patient?
Your Answer:
Correct Answer: Troponin testing
Explanation:Troponin testing is the most important investigation in risk stratification. Troponin positive patients should be referred for urgent coronary revascularization as troponin indicates cardiac cell damage.
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This question is part of the following fields:
- Seriously Ill
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Question 25
Incorrect
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A 46 year old alcoholic, with a past history of gall stones, presented in a critical condition with complaints of severe abdominal pain which radiated backward, vomiting, dehydration and profuse sweating. He was tachycardiac and hypotensive. What will be the first investigation to be performed in this case?
Your Answer:
Correct Answer: Serum lipase
Explanation:This patient is suffering from pancreatitis. Points favouring pancreatitis includes alcoholism, past history of gallstones and state of shock. Serum lipase and amylase should be performed to rule out the disease.
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This question is part of the following fields:
- Gastrointestinal
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Question 26
Incorrect
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A 27-year-old female visited the OPD with a complaint of visual disturbance, eye pain, pain in the knee and hands, and a rash on her face. On examination, the rash was the shape of a butterfly, and the joints were mildly swollen. The eyes of the patient were found to be red with irregular pupils. Where do you think the problem lies?
Your Answer:
Correct Answer: Iris
Explanation:The patient’s symptoms are suggestive of ankylosing spondylitis which is often accompanied by iritis, the cause of this patient’s red eye.
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This question is part of the following fields:
- Ophthalmology
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Question 27
Incorrect
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A 50-year-old male presented with pain in the left lumbar region. His abdominal X-ray revealed stones in his left kidney. Analysis of one of the stones that he passed in the urine showed that it was composed of uric acid. Which of the following is the most likely cause of this type of renal stone?
Your Answer:
Correct Answer: Thiazide diuretics
Explanation:Like all diuretics, thiazide diuretics decrease the amount of body fluid. This leads to an increase in the concentration of uric acid in the body; hence the chances of forming uric acid stones.
Allopurinol is actually a drug used to treat gout, reducing uric acid levels in the body. Therefore, allopurinol would rather decrease the chances of having uric acid stones.
Primary hyperparathyroidism is not concerned with uric acid stones. It is related to calcium metabolism and hence, calcium stones. -
This question is part of the following fields:
- Renal
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Question 28
Incorrect
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A 22 year old woman had a C-section two hours ago. However, she has not urinated since then and claims she had no urinary complaints before the operation. Upon inspection she appears unwell and her abdomen is distended and tender suprapubically and in the left flank. Auscultation reveals no bowel sounds. Further examination reveals the following: Temp=37.5C, BP=94/73mmHg, Pulse=116bpm, Sat=97%. What's the most likely complication?
Your Answer:
Correct Answer: Urinary tract injury
Explanation:Urologic injury is the most common injury at the time of either obstetric or gynaecologic surgery, with the bladder being the most frequent organ damaged. Risk factors for bladder injury during caesarean section include previous caesarean delivery, adhesions, emergency caesarean delivery, and caesarean section performed during the second stage of labour.
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This question is part of the following fields:
- Obstetrics
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Question 29
Incorrect
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A 34 year old diabetic male is undergoing contrast radiography. What should you do to make sure that renal damage due to the contrast dye is prevented?
Your Answer:
Correct Answer: Plenty of fluids
Explanation:The risk of kidney damage during this procedure is greatly increased for a diabetic patient. It is therefore important that plenty of fluids are given to prevent dehydration and therefore damage to the kidneys.
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This question is part of the following fields:
- Renal
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Question 30
Incorrect
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A 48 year old male presents to the clinic complaining of a swelling in his left groin that disappears on lying down. He also reports occasional haematuria and a mass in his left loin. On examination, the swelling is bluish in colour and has an appearance and consistency like that of a 'bag of worms'. What is the most likely diagnosis?
Your Answer:
Correct Answer: Left sided renal cell carcinoma
Explanation:Renal cell carcinoma (RCC) may remain clinically occult for most of its course. The classic triad of flank pain, haematuria, and flank mass is uncommon (10%) and is indicative of advanced disease. A varicocele, usually left sided, is due to obstruction of the testicular vein.
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This question is part of the following fields:
- Genitourinary
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Question 31
Incorrect
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A 40-week-old baby presented with a weak cry and failure to thrive. The mother gives a history of prolonged neonatal jaundice and says it is common in her family. On examination, a large tongue was noticed. What is the most likely diagnosis?
Your Answer:
Correct Answer: Congenital hypothyroidism
Explanation:Congenital hypothyroidism is associated with failure to thrive, macroglossia, prolonged jaundice of a new-born and constipation.
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This question is part of the following fields:
- Child Health
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Question 32
Incorrect
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Which of the following signs suggests an absence seizure instead of a partial complex seizure?
Your Answer:
Correct Answer: Induction by hyperventilation
Explanation:Absence seizures are induced by over breathing or hyperventilation, while the other features suggest partial seizures.
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This question is part of the following fields:
- Child Health
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Question 33
Incorrect
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Patients with myeloma mostly present with which of the following condition when in hospital?
Your Answer:
Correct Answer: Hypercalcaemia
Explanation:Hypercalcemia is the most important finding in all types of malignancies. In myeloma it is especially caused by osteoclast activating factors which increase bone turnover.
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This question is part of the following fields:
- Endocrine
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Question 34
Incorrect
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A 55-year-old woman presents with a swelling of her right iliac region. Which lymph node would you suspect?
Your Answer:
Correct Answer: Pre aortic lymph nodes
Explanation:The lymphatic drainage of the abdominal portion of the gastrointestinal tract, including the inferior part of the rectum, the spleen, the pancreas, the gallbladder, and the liver, is through vessels and lymph nodes that end in large collections of pre-aortic lymph nodes at the origins of the anterior branches of the abdominal aorta. According to their corresponding branches, these collections are termed the celiac, superior mesenteric, and inferior mesenteric groups of pre-aortic lymph nodes.
The lymphatic drainage of the deep structures and regions of the body below the diaphragm converges mostly on collections of lymph nodes and vessels related to the major blood vessels of the posterior abdominal region. The lymph then proceeds to drain into the thoracic duct. The pre-aortic lymph nodes anterior to the abdominal aorta, together with the right and left lateral aortic or lumbar lymph nodes (para-aortic lymph nodes), pass through the posterior abdominal region and collect lymph from several structures. The lateral aortic or lumbar lymph nodes receive lymphatics from the body wall, the kidneys, the suprarenal glands, and the testes or ovaries.
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This question is part of the following fields:
- Surgery
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Question 35
Incorrect
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A 25 year old female complains of having felt nervous for the past few months. She also complains of palpitations and tremors. When she came to the doctor, her symptoms lasted for a few minutes and were very hard to control. She says she has been drinking alcohol, which helped relieve her symptoms to start with, but now the effect is wearing off. Her symptoms remain even after she drinks alcohol now. Choose the most likely diagnosis for this patient.
Your Answer:
Correct Answer: Panic disorder
Explanation:Many of the symptoms observed are consistent with panic disorder: a racing heartbeat, trembling, feelings of anxiety and nervousness. Episodes of panic disorder usually last between 5 and 20 minutes, which is consistent with the timeframe seen in this patient.
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This question is part of the following fields:
- Mental Health
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Question 36
Incorrect
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A 45 year old female has presented to her doctor with rotational vertigo, nausea, and vomiting (especially when she moves her head). She had a similar incident 2 years ago. It is noted that these vertigo episodes follow a runny nose, cough, cold, and a fever. Given the symptoms, what is the most likely diagnosis for the patient?
Your Answer:
Correct Answer: Vestibular neuritis
Explanation:In this patient, there is no sensorineural hearing loss (which is often present in Meniere’s disease, labyrinthitis, and acoustic neuroma). Additionally, a runny nose, cold, cough, and fever are all recognised as triggers of vestibular neuritis (but not BPPV).
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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 child presents with a history of recurrent tonsillitis. His mother claims he had three attacks in one year. What is the best management?
Your Answer:
Correct Answer: Treat when ill
Explanation:At least seven episodes in the previous year, five episodes in each of the previous two years, or three episodes in each of the previous three years are indications for tonsillectomy. Antibiotics should be administered in the conventional dosage for proved or suspected streptococcal episodes. For now the child should be treated on a case by case basis.
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This question is part of the following fields:
- Child Health
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Question 38
Incorrect
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A 42-year-old woman who has been a smoker since she was a teenager has the following blood result: Hgb=19. What hormone should you check?
Your Answer:
Correct Answer: Erythropoietin
Explanation:An increase in the patient’s haemoglobin tells us that the patient might be having an increased number of red blood cells. Smoking causes raised carboxyhaemoglobin levels and thus hypoxemia. Hypoxemia will increase the erythropoietin levels in the blood.
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This question is part of the following fields:
- Haematology
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Question 39
Incorrect
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Which of the following statements is incorrect regarding etanercept?
Your Answer:
Correct Answer: Must be given intravenously
Explanation:Etanercept is a TNF receptor fused with human immunoglobulin. It binds to TNF-alpha preventing it from binding to its normal receptor. Thus, inhibiting it competitively. It is used for treatment of rheumatoid arthritis in adults when traditional treatments fail. When injected subcutaneously, it is accompanied with skin reactions and urticaria. It should be given intravenously. Serious blood disorders and demyelination have also been associated.
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This question is part of the following fields:
- Musculoskeletal
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Question 40
Incorrect
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A 28-year-old male is admitted to the psychiatry ward for aggressive behaviour. He has distressing auditory hallucinations and was diagnosed with schizophrenia previously. Now he has broken his bed and refused to take any oral medications. The injectable drug of choice in this case is?
Your Answer:
Correct Answer: Risperidone
Explanation:The algorithm of treatment of agitated violent patients . First try using verbal communication to calm down the patient, if this doesn’t work offer oral olanzapine or oral risperidone. IF oral agents do not work opt for IV olanzapine or risperidone. IM olanzapine or risperidone may be given if agitation persists. The last resort in this case is IV haloperidol. If rapid sedation is required , IV diazepam can be given.
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This question is part of the following fields:
- Mental Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
