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Question 1
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A 5-month-old baby was brought by the mother for assessment. The baby can sit with support but not on his own. On examination, there is palmar grasp. How is the current development of this child?
Your Answer: Normal
Explanation:All the given development milestones are compatible with the given age.
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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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Barrett's oesophagus is well recognized as a complication of gastroesophageal reflux disease. What is the pathological change that occurs in the above condition?
Your Answer: Metaplasia
Correct Answer: Squamous to columnar epithelium
Explanation:Barrett’s oesophagus is characterised by the metaplastic replacement of the normal squamous epithelium of the lower oesophagus by columnar epithelium.
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This question is part of the following fields:
- Gastrointestinal
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Question 3
Correct
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A 20-year-old boy returning from vacation in India presented with a history of fever, myalgia, headache and abdominal pain for 4 days duration. He revealed that he had bathed in a river during his vacation. On examination, he had severe muscle tenderness, hypotension (BP - 80/60mmHg) and tachycardia (140 bpm). What would be the first step in management?
Your Answer: IV normal saline
Explanation:The history is suggestive of leptospirosis. This is a zoonotic infection caused by a spirochete. As the patient is in shock, resuscitation with IV fluids is the first step in the management. IV antibiotics should be started (Doxycycline or Penicillin) as soon as possible. Other investigations mentioned are important during the management to rule out other possible diagnoses.
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This question is part of the following fields:
- Infectious Diseases
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Question 4
Incorrect
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A 6 month old baby can squeeze an object against his palm, can vocalize and can sit with support. But he cannot hold objects between his index finger and the thumb. He cannot sit without support and he doesn't have stranger fear. Which of the following is correct regarding his development?
Your Answer: Delayed motor milestones
Correct Answer: Normal development
Explanation:Children are able to use a palmar grasp by the age of 6 months and use a pincer grasp by the age of 9 to 10 months. They can sit with support by 6 months and sit without support by 7 to 9 months. They can vocalize by 3 months. Stranger fear appears from 7 to 10 months. So this baby’s development is normal.
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This question is part of the following fields:
- Child Health
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Question 5
Correct
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Drugs and their actions are listed below. Which pair is correctly matched?
Your Answer: Simvastatin inhibits HMGCoA reductase
Explanation:Amiodarone is a class III antiarrhythmic agent, and prolongs phase 3 of the cardiac action potential.
Digoxin increases the force of contraction of the heart muscle by inhibiting the Na-K-ATPase membrane pump, resulting in an increase in intracellular sodium.
Sotalol blocks beta-adrenoreceptors (Vaughan Williams Class II) and prolongs the cardiac action potential duration (Vaughan Williams Class III).
Streptokinase creates an active complex which promotes the cleavage of the Arg/Val bond in plasminogen to form the proteolytic enzyme plasmin. Plasmin degrades the fibrin matrix of the thrombus. -
This question is part of the following fields:
- Pharmacology
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Question 6
Incorrect
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A 50-year-old female known with diabetes visited the OPD with a tender lump near her anal opening. She says she also has fever. Which of the following management options should be recommended to the patient in this case?
Your Answer: Painkillers
Correct Answer: Incision and drainage and antibiotics
Explanation:The lump near the anal opening is an anal abscess that should be treated via incising and draining it in order to cure the fever the patient has. Antibiotics will then be given in order to prevent any further infections.
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This question is part of the following fields:
- Colorectal
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Question 7
Incorrect
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An 80 year old female, previously diagnosed with polymyalgia rheumatica 18 months back, presents to the outpatient clinic with bilateral shoulder stiffness and generalized myalgia. The ESR was found to be 60mm/1st hour at the time of presentation. Prednisolone therapy was initiated at a daily dose of 15 mg along with Calcium and Vitamin supplementation. She reported resolution of her symptoms in one week. However the symptoms relapsed when the prednisolone dose was reduced below the current dose of 12.5 mg daily. How should she be ideally managed?
Your Answer: Continue the current dose of prednisolone
Correct Answer: Continue the current dose of prednisolone and start methotrexate
Explanation:Polymyalgia rheumatica, a syndrome characterized by proximal muscle pain and stiffness in older persons, generally is treated with prednisone. Dosages of 15 to 25 mg of prednisone per day can reduce inflammation considerably, although many patients relapse when therapy is tapered. Long-term (18 to 36 months) steroid treatment has been recommended by several studies, but this can result in multiple side effects, including osteoporosis, hypertension, cataracts, and hyperglycaemia. Methotrexate has been used to reduce inflammation in rheumatoid arthritis, systemic vasculitis, and giant cell arteritis, and in some studies has been combined with prednisone to treat polymyalgia rheumatica, decreasing the duration of treatment.
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This question is part of the following fields:
- Rheumatology
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Question 8
Correct
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A 25-year-old woman with long-term bipolar disorder is experiencing Hypothermia, weight gain, lethargy. Which psychotropic medication would you associate these side effects?
Your Answer: Lithium
Explanation:Lithium is the medication used for a wide range of mental illnesses such as schizophrenia, depression, and bipolar disorders. It is famous for its side effects which includes a number of thyroid disorders (hypothyroidism, hyperthyroidism, and thyroiditis).
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This question is part of the following fields:
- Mental Health
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Question 9
Correct
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A 39-year-old female had surgery for the removal of thyroid carcinoma. One week later, she presented in the OPD with complaints of numbness, tingling, involuntary spasm of the upper extremities, paraesthesia and respiratory stridor. Which of the following is the most likely cause?
Your Answer: Hypocalcaemia
Explanation:Hypocalcaemia presents with such symptoms. It probably happened due to accidental removal of a parathyroid gland during the thyroid surgery. Hypocalcaemia causes laryngospasm which produces stridor.
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This question is part of the following fields:
- Endocrine
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Question 10
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 11
Incorrect
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The percentage of blood supplied to the liver by the hepatic artery is?
Your Answer: 10%
Correct Answer: 25%
Explanation:The liver receives a dual blood supply from the hepatic portal vein and hepatic arteries. The hepatic portal vein delivers approximately 75% of the liver’s blood supply, and carries venous blood drained from the spleen, gastrointestinal tract, and its associated organs. The hepatic arteries supply arterial blood to the liver, accounting for the remaining quarter of its blood flow. Oxygen is provided from both sources; approximately half of the liver’s oxygen demand is met by the hepatic portal vein, and half is met by the hepatic arteries
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This question is part of the following fields:
- Hepatobiliary
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Question 12
Correct
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A 60-year-old male presents with intermittent haemoptysis and chronic, productive cough. He has a strong history of smoking and has recently lost weight. What is the patient most likely suffering from?
Your Answer: Bronchogenic carcinoma
Explanation:The combination of haemoptysis, chronic productive cough, and recent weight loss in a smoker is a strong indication of bronchogenic carcinoma.
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This question is part of the following fields:
- Respiratory
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Question 13
Correct
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Question 14
Correct
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A 25 year old unmarried female presented with dizziness, nausea and vomiting for 1 week. According to her, she has been stressed recently and her usual menstrual period has been delayed by 4 weeks. Examination findings were normal. Which of the following is the most appropriate next step?
Your Answer: Dipstick for B-hCG
Explanation:There is high possibility of her being pregnant. Urine B-hCG has to be checked to exclude pregnancy.
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This question is part of the following fields:
- Gynaecology
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Question 15
Incorrect
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Which of the following options is true regarding H. pylori bacteria?
Your Answer: It is a Gram positive spiral flagellated organism
Correct Answer: It is the cause of ≥60% of gastric ulceration
Explanation:It is the cause of gastric ulcers in more than 60% of the cases. It is a gram negative bacteria and does not cause oesophageal carcinoma.
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This question is part of the following fields:
- Gastrointestinal
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Question 16
Correct
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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: 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 17
Incorrect
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A 31-year-old woman who is pregnant has a blood pressure reading of 160/87 mmHg. You considered Pre-eclampsia. What symptom might be expected in a patient with uncomplicated pre-eclampsia?
Your Answer: Pruritis
Correct Answer: Headache
Explanation:Extreme headache, vision defects, such as blurring of the eyes, rib pain, sudden swelling of the face, hands or feet are all consistent with pre-eclampsia. Women with the mentioned symptoms should have their blood pressure checked immediately. They should also be checked for proteinuria. Diarrhoea is not related to pre-eclampsia. Pruritus would be more related to pregnancy cholestasis. Meanwhile, bruising and abnormal LFTs are common in complicated pre-eclampsia but not in an uncomplicated one.
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This question is part of the following fields:
- Obstetrics
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Question 18
Incorrect
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A 28-year-old male is complaining about sore feet and lower back pain. He says it feels like walking on gravel. He also mentioned have some urethral discharge that he had not received any treatment for. He had a holiday in Morocco recently. What is the most likely diagnosis?
Your Answer: Reactive arthritis
Correct Answer: Sjogren's Syndrome
Explanation:This is a case of Sjogren Syndrome (aka Reiter’s disease). It is characterised by a triad of: seronegative arthritis mostly sacroiliitis (walking on gravel reflects planter fasciitis), urethritis and conjunctivitis. Sjogren Syndrome usually follows gastroenteritis or non specific urethritis. On the other hand gonococcal arthritis usually occurs in patients who are systemically unwell.
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This question is part of the following fields:
- Musculoskeletal
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Question 19
Correct
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A 75 year old female smoker who is diabetic and hypertensive, presents to the emergency which acute chest pain and worsening condition. She is obese and has recently been immobile due to a hip pain. The doctor fails to resuscitate her and she is pronounced dead. What do you think caused her death?
Your Answer: Pulmonary embolism
Explanation:Pulmonary embolism (PE) is the obstruction of one or more pulmonary arteries by solid, liquid, or gaseous masses. In most cases, the embolism is caused by blood thrombi, which arise from the deep vein system in the legs or pelvis (deep vein thrombosis) and embolize to the lungs via the inferior vena cava.
Risk factors include: immobility, inherited hypercoagulability disorders, being overweight or obese, smoking cigarettes, taking birth control pills (oral contraceptives) or hormone replacement therapy, having diseases such as stroke, paralysis, chronic heart disease, or high blood pressure, pregnancy, and recent surgery.
The clinical presentation is variable and, depending on the extent of vessel obstruction, can range from asymptomatic to cardiogenic shock. Symptoms are often nonspecific, including chest pain, coughing, dyspnoea, and tachycardia.
The diagnosis of PE is based primarily on the clinical findings and is confirmed by detection of an embolism in contrast CT pulmonary angiography (CTA). Arterial blood gas analysis typically shows evidence of respiratory alkalosis with low partial oxygen pressure, low partial carbon dioxide pressure, and elevated pH. Another commonly performed test is the measurement of D-dimer levels, which can rule out PE if negative.
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This question is part of the following fields:
- Cardiovascular
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Question 20
Incorrect
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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: Platelet problem
Correct 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 21
Correct
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A 40 year old male is awaiting a liver biopsy. Which of the following is the most important investigation that has to be performed prior to the procedure?
Your Answer: Coagulation profile
Explanation:As the liver is highly vascular, there is a high risk of bleeding during and after the procedure. Patients may have existing liver diseases, which affect the production of clotting factors. So a coagulation profile is necessary to detect any abnormality and correct them prior to the liver biopsy.
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This question is part of the following fields:
- Gastrointestinal
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Question 22
Incorrect
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A 17-year-old man presents with fever and extensive pre-auricular swelling on the right side of his face. However, tenderness is present bilaterally. He also complains of acute pain and otalgia on the right aspect of the face. What is the most likely diagnosis?
Your Answer: Acute otitis externa
Correct Answer: Mumps
Explanation:Mumps presents with a prodromal phase of general malaise and fever. On examination there is usually painful parotid swelling which has high chances of becoming bilateral. In OM with effusion there are no signs of infection and the only symptom is usually hearing loss. Acute otitis externa produces otalgia as well as ear discharge and itching. Acute OM produces otalgia and specific findings upon otoscopy. In acute mastoiditis the patient experiences ear discharge, otalgia, headache, hearing loss and other general signs of inflammation.
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This question is part of the following fields:
- Infectious Diseases
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Question 23
Incorrect
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From the following options, choose the one which is not a cause of liver cirrhosis.
Your Answer: Venoocclusive disease
Correct Answer: Schistosomiasis
Explanation:Schistosomiasis is a cause of portal hypertension and periportal fibrosis – it is, however, not a cause of cirrhosis. The main causes of cirrhosis include: alcohol and hepatitis B, C, and D. Autoimmune causes include: both primary and secondary biliary cirrhosis and autoimmune hepatitis. There are a number of inherited conditions which cause cirrhosis, such as hereditary hemochromatosis, Wilson’s disease, Alpha-1 anti-trypsin deficiency, galactosaemia glycogen storage disease, and cystic fibrosis. Additionally, there are also vascular causes, such as hepatic venous congestion, Budd-Chiari syndrome, and veno-occlusive disease. Intestinal bypass surgery has also been implicated as a causative factor for cirrhosis.
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This question is part of the following fields:
- Gastrointestinal
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Question 24
Incorrect
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A 59-year-old man complains of weakness in his right lower and upper limb since 3for a few hours. He is has been taking Digoxin for 2 years. What is the most definitive investigation for this condition?
Your Answer: MRI
Correct Answer: Angiography
Explanation:Digoxin is a cardiac glycoside, having positive inotropic effects on the heart. It increases the strength of contractility of the heart, increasing the heart rate, but lowering blood pressure. This patient developed weakness in his limbs most likely caused by extremely low blood pressure that could be due to diseased blood vessels reacting to the side-effects of digoxin, therefore an angiography would be the best investigation.
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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 45-year-old male patient came to the OPD with a complaint of severe headache on the right side, with right-sided jaw pain, and additional blurred vision in the right eye. The headache was throbbing in character. Which investigation will you prefer next?
Your Answer: Erythrocyte sedimentation rate (ESR)
Explanation:Age of the patient, headache only on one side, and loss of vision on that side suggest temporal arteritis, also known as giant cell arteritis. The laboratory hallmark of this condition is a raised ESR.
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This question is part of the following fields:
- Ophthalmology
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Question 26
Incorrect
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A 31 year old female patient who lost her mother 2 months ago is complaining of difficulty concentrating and low mood. She occasionally experiences tremor and dyspnoea together with drowsiness. What is the most probable diagnosis?
Your Answer: Panic Disorder
Correct Answer: Adjustment Disorder
Explanation:Adjustment disorder belongs to the spectrum of reactive disorders in response to an external stressor i.e. a stressful life event. In this case the stressful event is the death of the patient’s mother which preceded the appearance of a group of symptoms of a physical and psychological nature. Such symptoms may vary but are usually in the spectrum of anxiety.
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This question is part of the following fields:
- Mental Health
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Question 27
Incorrect
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Which is the most likely lymph node involved in the presence of an abdominal swelling below the umbilicus and on the right side?
Your Answer: Aortic lymph node
Correct Answer: Inguinal lymph node
Explanation:Inguinal LN’s drain the skin and subcutaneous tissue of the lower abdominal wall, perineum, buttocks, external genitalia, and lower limbs. They are subdivided into three groups of lymph nodes (nodi lymphoid):
– inferior group of superficial inguinal lymph nodes, located inferior to the saphenous opening, receiving drainage of the lower limb;
– superolateral superficial inguinal lymph nodes located lateral to the saphenous opening, receiving drainage of lateral buttock and lower anterior abdominal wall; and
– superomedial superficial inguinal lymph nodes, located medial to the saphenous opening, receiving drainage of the perineum and external genitalia. -
This question is part of the following fields:
- Surgery
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Question 28
Correct
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A young woman complains of constipation and pain on defecation. The pain is anorectal and a digital rectal examination was impossible due to pain and spasm. What is most likely the diagnosis?
Your Answer: Anal fissure
Explanation:Symptoms of anal fissure include sharp pain in the anal area upon defecation or anal stimulation. It may also cause burning or itching as well as visible fresh blood on the stools or on the toilet paper. It is usually visible upon inspection.
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This question is part of the following fields:
- Gastrointestinal
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Question 29
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 30
Incorrect
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A 5 year old boy visited Ghana with his family and arrived back home 6 weeks ago. 2 days ago he developed neck stiffness, a fever, and vomiting. He did not present with a rash and was treated with malaria prophylaxis. Choose the correct diagnosis from the list of options.
Your Answer: Meningococcal meningitis
Correct Answer: Cerebral malaria
Explanation:Due to malaria’s incubation period being between 7 and 30 days, malaria prophylaxis cannot provide a patient with confirmed protection. Prophylaxis treatment also often fails. The symptoms such as neck stiffness, fever, and vomiting are also consistent with the cerebral malaria diagnosis.
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This question is part of the following fields:
- Child Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
