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Question 1
Incorrect
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A 28 year old male patient who was involved in a fight, presents with haemorrhage, tinnitus and hypoacusis from the one ear. What investigation would you perform?
Your Answer: Otoscopy
Correct Answer: CT
Explanation:CT should be performed to assess the severity of the head trauma and intracranial pathology.
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This question is part of the following fields:
- ENT
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Question 2
Correct
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A 6-year-old boy was admitted with a burn that looks third or fourth degree upon inspection. He has not stopped crying. What is the most appropriate next step?
Your Answer: IV fluid start
Explanation:The boy needs re-hydration due to his full thickness burn so IV fluids is the next most appropriate step. The greatest loss of plasma occurs in the first 12 hours after burn injury. The plasma loss then slowly decreases during the second 12 hours of the post-burn phase, although extensive leakage can continue for up to three days (Ahrns, 2004). Optimal fluid replacement during this period is essential to ensure cardiac output and renal and tissue perfusion. Usually, 36 hours post-burn, capillary permeability returns to normal and fluid is drawn back into the circulation. Burns of more than 15% of surface body area in adults and of over 10% in children warrant formal resuscitation.
The Parkland formula for the total fluid requirement in 24 hours is as follows:
4ml x TBSA (%) x body weight (kg);
50% given in first eight hours;
50% given in next 16 hours.
Children receive maintenance fluid in addition, at an hourly rate of:
4ml/kg for the first 10kg of body weight plus;
2ml/kg for the second 10kg of body weight plus;
1ml/kg for >20kg of body weight.
End point
Urine – adults: 0.5–1.0 ml/kg/hour;
Urine – children: 1.0–1.5ml/kg/hour. -
This question is part of the following fields:
- Child Health
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Question 3
Correct
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A 25-year-old patient with no prior medical history is admitted unconscious. Which should be done as an initial investigation?
Your Answer: Blood glucose
Explanation:The patient’s blood glucose should be evaluated in order to rule out a reversible diabetic come due to high or low blood glucose.
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This question is part of the following fields:
- Emergency
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Question 4
Correct
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A 62 year old patient presents to the ophthalmology OPD with progressive deterioration of vision and dazzling of view in well lit environments. Which of the following is the most likely diagnosis leading to this presentation?
Your Answer: Cataracts
Explanation:Cataract is a condition characterized by clouding of the lens of the eye. This condition most frequently occurs due to age-related degenerative processes in the lens, but can also be associated with ocular trauma, metabolic disorders, side-effects of drugs, or congenital infections. The clouding causes distortion of light, as it passes through the lens, resulting in visual impairment and glare. Initially, a cataract presents discretely and may even go unnoticed, but the visual impairment worsens as the cataract grows larger.
Diagnosis is typically established on the basis of a thorough history and direct visualization of the cataract (by means of slit-lamp microscopy). Surgery is indicated with significant visual impairment and involves lens extraction and implantation of an artificial lens. Untreated cataracts eventually lead to complete blindness.
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This question is part of the following fields:
- Ophthalmology
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Question 5
Correct
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A teenage girl presented in the OPD with a history of amenorrhea. She said she was exercising daily and needs to lose weight. On examination, she is 162cm in height and 45kgs in weight. Which of the following is the most probable cause in this case?
Your Answer: Hypomagnesaemia and hypocalcaemia are possibly present
Explanation:This scenario represents anorexia nervosa disorder, a psychological disorder. Extreme weight loss with a strict diet can lead to deficiency of many nutrients like magnesium and calcium. This can also cause amenorrhea.
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This question is part of the following fields:
- Endocrine
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Question 6
Correct
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A 4 year old girl is brought to the emergency due to fever and urinary urgency. The temperature is recorded to be 39C. Which of the following is the best investigation in this case?
Your Answer: Clean catch of urine
Explanation:Urine culture and sensitivity is used to diagnose a urinary tract infection (UTI). A mid-stream clean catch urine sample is the most common type of sample collected. It is important to follow the clean catch process to have accurate results from an uncontaminated sample. Urine cultures can also check for infections of the bladder or kidney.
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This question is part of the following fields:
- Child Health
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Question 7
Correct
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Which group of drugs is used to manage Trigeminal Neuralgia?
Your Answer: Anti epileptics
Explanation:The only drug currently licensed in the UK to treat trigeminal neuralgia is carbamazepine which is an anticonvulsant. It can be very effective initially, but may become less effective over time.
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This question is part of the following fields:
- Neurology
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Question 8
Incorrect
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A 34 year old woman presents to the emergency department due to right sided weakness. Past history reveals a DVT following the birth of her daughter, and two miscarriages. Head CT confirms an ischaemic stroke in the territory of left middle cerebral artery. What would be the most likely finding on echocardiography?
Your Answer: Atrial septal defect
Correct Answer: Normal
Explanation:The patient most likely suffers from antiphospholipid syndrome. The clinical criteria consist of vascular thrombosis and pregnancy morbidity. Vascular thrombosis is defined as one or more clinical episodes of arterial, venous, or small-vessel thrombosis in any tissue or organ confirmed by findings from imaging studies, Doppler studies, or histopathology. ASD, VSDs would cause paradoxical emboli and stroke, however the recurrent pregnancy loss in this case is strongly suggestive of antiphospholipid syndrome. The ECG would be normal in most cases associated with anti phospholipid syndrome.
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This question is part of the following fields:
- Rheumatology
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Question 9
Correct
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An infant born at 34 weeks was kept in the incubator for almost a month. Physical examination revealed a heart murmur, which however was not present at discharge. What is the most probable cause of this murmur?
Your Answer: PDA
Explanation:PDA is particularly common in premature babies and it is managed by indomethacin administration. However, if PDA is not the only defect, prostaglandin E1 can be administered in order to keep the ductus open until the surgery takes place.
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This question is part of the following fields:
- Child Health
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Question 10
Incorrect
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A 53-year-old male underwent a partial gastrectomy 15 years ago for a complicated peptic ulcer. Which of the following elements may be deficient in this man?
Your Answer: Folate
Correct Answer: Iron
Explanation:The proper gastric acidity is required to transform iron from ferric to ferrous state in order to be absorbable. Even partial gastrectomy may cause dumping syndrome. Malabsorption is rare.
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This question is part of the following fields:
- Gastrointestinal
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Question 11
Incorrect
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Which is the most likely lymph node involved in the presence of an ulcer on the scrotum?
Your Answer: Pre-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 12
Correct
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A 56 year old male has presented with visual loss on his left side and a history of right sided weakness. Where is the occlusion in this patient?
Your Answer: Carotid artery
Explanation:The carotid artery divides itself into two parts: the internal carotid and the external carotid. The internal carotid continues down as the middle cerebral and gives rise to the ophthalmic branch. For this reason, middle cerebral occlusion may give rise to partial visual loss but not complete mono-ocular blindness. Middle cerebral artery occlusion causes paralysis or weakness of contralateral face and arm (faciobracheal). It also causes sensory loss of the contralateral face and arm. Anterior cerebral artery occlusion causes paralysis or weakness of the contralateral foot and leg. Again, sensory loss is experienced at the contralateral foot and leg.
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This question is part of the following fields:
- Seriously Ill
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Question 13
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: Sclera
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 14
Correct
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A 65-year-old man was seen at autopsy. He had swollen legs and signs of a transudate fluid at his liver. Before passing away, he was treated for bronchitis and TB. What is the most probable cause of the transudate?
Your Answer: Cardiac failure
Explanation:The patient most probably experienced congestive hepatopathy and leg oedema due to right sided cardiac failure.
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This question is part of the following fields:
- Cardiovascular
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Question 15
Correct
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An old woman complains of sudden bilateral complete visual loss. Her pupillary reaction to light is preserved and there are no noted abnormalities on the anterior chamber or the retina. Which is the most likely site of arterial occlusion?
Your Answer: Posterior cerebral arteries
Explanation:Cortical blindness is due to a bilateral infarction in the area covered by the distal posterior cerebral arteries and pupillary reflex is preserved. Patients may not notice this blindness (called Anton’s syndrome). Anton–Babinski syndrome, also known as Anton’s blindness and visual anosognosia, is a rare symptom of brain damage occurring in the occipital lobe. Those who have it are cortically blind, but affirm that they are capable of seeing.
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This question is part of the following fields:
- Neurology
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Question 16
Incorrect
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A 44-year-old call centre worker with asthma is prescribed a leukotriene inhibitor. He presents with severe abdominal pain and a pleural effusion. Which of the following is the most likely cause of the effusion?
Your Answer: Pancreatitis
Correct Answer: Churg-Strauss syndrome
Explanation:Churg-Strauss syndrome is characterised by reactions in the serosal membranes. Hence, pericardial effusions and pleural effusions are common. Cytological analysis of the transudate shows high levels of eosinophils. Leukotriene inhibitors are known to increase the incidence of this syndrome.
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This question is part of the following fields:
- Respiratory
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Question 17
Incorrect
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A 3-year-old boy was brought at the hospital by his mother due to sudden onset pyrexia with emesis and bilateral facial swelling. Upon history taking, she mentions that she brought her son to the GP who suggested analgesics for his bilateral parotid pain, 2 days ago. What would be the next step of your management?
Your Answer: Immediate surgery
Correct Answer: Reassurance
Explanation:The history is suggestive of mumps. Mumps is a viral disease with initial signs and symptoms including fever, muscle pain, headache, poor appetite, and feeling tired. This is then usually followed by painful swelling of one or both parotid salivary glands. Mumps is a self-limiting condition treated only for symptomatic relief. As he currently is taking analgesics for pain relief, one should only offer reassurance.
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This question is part of the following fields:
- Child Health
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Question 18
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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Question 19
Incorrect
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What is the failure rate of tubal sterilization?
Your Answer: 1 in 5000
Correct Answer: 1 in 200
Explanation:Tubal sterilization is a safe and effective surgical procedure that permanently prevents pregnancy. However, pregnancy can occur in 1 in 200 cases, according to international sources. In the 1st year after tubal sterilization, the estimated failure rate is 0.1-0.8% respectively.
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This question is part of the following fields:
- Gynaecology
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Question 20
Correct
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A 32 year old male presents with a 5cm lump, which is located on the upper third of his neck, on the left side and anterior to the sternocleido-mastoid muscle. The lump was noticed in the past and an attempt was made to treat it with antibiotics. What is the most probable cause?
Your Answer: Branchial cyst
Explanation:A branchial cyst is usually congenital due to developmental defects. Typically from failure of obliteration of the second branchial cleft, i.e. failure of fusion of the second and third branchial arches. Branchial cleft cysts account for almost 20% of neck masses in children. It appears in childhood or adulthood as an asymptomatic, painless swelling located anterior to the sternocleidomastoid muscle.
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This question is part of the following fields:
- Surgery
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Question 21
Incorrect
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A 5 year old boy presents with tonsillitis, from which he has suffered three times last year. His symptoms include fever, lymphadenopathy and a sore throat. What is the next most appropriate step?
Your Answer: Tonsillectomy
Correct Answer: Paracetamol/ibuprofen
Explanation:NICE does not recommend the use of antibiotics or tonsillectomy in this case. Paracetamol/Ibuprofen are indicated as they provide antipyretic action and analgesia.
Indications for tonsillectomy are 5 or more episodes of acute sore throat/year, symptoms present for at least 2 years, symptoms are severe enough to disrupt a child’s social life.
Indications for antibiotics are features of marked systemic upset secondary to the acute sore throat, unilateral peritonsillitis, history of rheumatic fever, an increased risk from acute infection, acute tonsillitis with 3 or more of the following: history of fever, tonsillar exudates, no cough and tender anterior cervical lymphadenopathy. -
This question is part of the following fields:
- Child Health
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Question 22
Correct
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What are the chances of offspring developing cystic fibrosis if one of the parents, more specifically the mother, is suffering from the disease?
Your Answer: Depends on genetic makeup of partner
Explanation:Cystic fibrosis has an autosomal recessive pattern of inheritance, meaning that a person might be a carrier of the disease without developing it. If the unaffected partner is a carrier, then there is a 50% chance of inheritance and another 50% chance of having a child who is a carrier. However, if the partner is not a carrier, the offspring will not develop the disease but the possibility of being a carrier raises up to 100%.
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This question is part of the following fields:
- Genetics
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Question 23
Correct
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A 52-year-old hypertensive, smoker presents to ER with right side weakness. He gives a history of multiple falls and lack of concentration. What is the most appropriate diagnosis?
Your Answer: Multi-infarct dementia
Explanation:The patient is a heavy smoker and hypertensive which are risk factors of atherosclerosis and cerebrovascular diseases. The acute onset of the weakness and the lateralization indicates a cerebral infarction.
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This question is part of the following fields:
- Neurology
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Question 24
Correct
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A 24 year old patient known with alpha-1-antitrypsin deficiency is expecting her first child. She is concerned whether her child will be affected or not. What is the pattern of inheritance of alpha-1-antitrypsin deficiency?
Your Answer: Autosomal recessive
Explanation:Alpha-1 antitrypsin deficiency is inherited in an autosomal codominant pattern, meaning that one defective allele tends to result in milder disease than two defective alleles.
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This question is part of the following fields:
- Respiratory
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Question 25
Correct
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A 3 year old girl is brought to the clinic by her mother due to burning micturition, frequency and urgency. She is also experiencing some suprapubic tenderness. Which of the following investigations should be done initially?
Your Answer: Clean catch of urine for Culture &Sensitivity
Explanation:Urine culture and sensitivity is used to diagnose a urinary tract infection (UTI). A mid-stream clean catch urine sample is the most common type of sample collected. It is important to follow the clean catch process to have accurate results from an uncontaminated sample. Urine cultures can also check for infections of the bladder or kidney.
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This question is part of the following fields:
- Mental Health
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Question 26
Correct
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Which of the following immune responses occurs in Coeliac disease?
Your Answer: Type IV hypersensitivity
Explanation:Celiac disease is classified as a Type IV hypersensitivity mediated by T-cell response. Negatively charged gliadin has been shown to induce interleukin 15 in the enteric epithelial cells, stimulating the proliferation of the natural killer cells and intraepithelial lymphocytes to express NK-G2D, a marker for natural killer T lymphocytes.
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This question is part of the following fields:
- Gastrointestinal
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Question 27
Correct
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A 74 year old man presents with a history of falls and enuresis. Recently his behaviour has been bizarre but the falling has persisted for the last 12 months. Upon examination he's found to be disorientated for time and place. His gait is clumsy and broad-based. What is the most likely diagnosis?
Your Answer: Normal pressure hydrocephalus
Explanation:The patient has a history of:
1 – Balance and gait disturbance – falls and broad based clumsy gait
2 – Dementia – strange behaviour and disorientation to time and place
3 – Urinary incontinence – episodes of enuresis.
All of the symptoms constitute the classic triad of normal pressure hydrocephalus. -
This question is part of the following fields:
- Neurology
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Question 28
Correct
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A 23 year old patient with epilepsy, presented with fits. Investigations revealed profound hyponatraemia. Which of the following drug will cause this presentation?
Your Answer: Carbamazepine
Explanation:Carbamazepine and oxcarbazepine are the most common antiepileptics which induce hyponatremia in patients with epilepsy. Other antiepileptics such as eslicarbazepine, sodium valproate, lamotrigine, levetiracetam and gabapentin have also been reported to cause hyponatremia. So the most suitable answer is Carbamazepine.
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This question is part of the following fields:
- Pharmacology
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Question 29
Correct
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An 8-year-old girl presented to the outpatient clinic with fever, pain and discharge from her left ear. Which of the following antibiotics should be used first?
Your Answer: Amoxicillin
Explanation:Amoxicillin has high efficacy against haemophilus influenza and streptococcus pneumonia, the most common organisms of otitis media. It is an oral drug with high bioavailability.
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This question is part of the following fields:
- Child Health
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Question 30
Correct
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A 15-year-old boy observed a bluish painless swelling in his left scrotum. It is soft and can be compressed. What would you do next?
Your Answer: Reassurance
Explanation:The boy seems to have a varicocele so the most appropriate next step would be reassurance. A varicocele is an enlargement of the veins within the scrotum called the pampiniform plexus. A varicocele only occurs in the scrotum and is very similar to varicose veins that can occur in the leg. Because a varicocele usually causes no symptoms, it often requires no treatment.
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This question is part of the following fields:
- Child Health
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SESSION STATS - PERFORMANCE PER SPECIALTY
