passAMCQ SHORT MCQS Flashcards by jalal shah

4-yr boy having recurrent bedwetting. still cannot learn to use the potty at age four. The boy does not participate in a conversation or answer any questions regarding incontinence. examination is normal. most likely diagnosis?

A Urinary incontinence due to another medical condition
B Secondary enuresis
C Primary enuresis
D Normal development
E Enuresis due to medication side effects

D: Correct Answer :Normal development

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47-yr builder with worsening lower back pain last six weeks. clinical feature would suggest discogenic pain?

A Pain radiates to feet
B Reduced Achilles tendon reflex
C Pain is worse on bending forward
D Pain is worse on lying supine
E Waddell’s sign positive

C: Correct Answer :Pain is worse on bending forward

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40-yr woman per vaginal discharge consistent with vulvovaginal candidiasis. associated with increased risk, except:

A Thyrotoxicosis
B Long-term oral contraceptive use
C Pregnancy
D Diabetes
E Long term antibiotics

A: Correct Answer :Thyrotoxicosis

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10-yr boy diagnosed nephrotic syndrome. renal biopsy unremarkable on immunofluorescence and light microscopy. clinical findings most consistent with Alport syndrome?

A Cerebral aneurysms
B Sensorineural deafness
C High arched palate
D Polydactyly
E Hamartomas

B: Correct Answer :Sensorineural deafness

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25-yr mother presents with painful swollen right breast whilst still lactating. looks unwell and minimal white-yellowish nipple discharge tenderness right breast overlying skin erythema. left breast normal. tender right axillary nodes palpable. Ultrasound hyperechogenicity right breast. most likely diagnosis?

A Breast abscess
B Ductal ectasia
C Infiltrative ductal carcinoma
D Puerperal mastitis
E Ductal carcinoma in-situ

D: Correct Answer :Puerperal mastitis

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50-yr Aboriginal man Northern Territory diabetes diagnosed with (TB). commenced on 3 months ago. one week’s hx pins needles hands feet numbness. adherence issues admits not been taking vitamins. drugs is responsible for symptoms?

A Isoniazid
B Ethambutol
C Rifampicin
D Pyrazinamide
E None of the above

A: Correct Answer :Isoniazid

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48-yr Asian woman complaint 3-month progressive SOB lethargy. non-smoker. changed her diet to vegetarian.look slightly pale.haemoglobin 10g/dL (120-180), (MCV) of 74 fL (80-100) ferritin that is low. elliptocytes.most likely diagnosis?

A Hereditary elliptocytosis
B Thalassemia trait
C Anemia of chronic disease
D Sideroblastic anemia
E Iron deficiency anemia (IDA)

E: Correct Answer :Iron deficiency anaemia (IDA)

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70-yr man complaining urinary incontinence. an urge to pass urine not been able to make it to toilet in time. no dysuria or fevers. not started any new medication. most likely cause of his symptoms?

A Nephrolithiasis
B Increased intraabdominal pressure
C Detrusor instability
D Urinary tract infection (UTI)
E Benign prostatic hyperplasia (BPH)

C: Correct Answer :Detrusor instability

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80-yr female increasing memory problem. commenced on small dose haloperidol for agitation six months ago. increasingly confused odd movements affecting her face, arms and legs. suspended the haloperidol; remained confused, movement disorder become worse. mental test score of 6/10. vital signs normal, afebrile. intermittent mouth opening as yawning, occasional tongue protrusions. semi-purposeful movements of arms & legs. increased tone and cogwheel rigidity. CT scan brain revealed generalized cerebral atrophy and calcification of the basal ganglia.
What is the cause of her movement disorder?

A Parkinson’s disease
B Alzheimer dementia
C Extrapyramidal side-effects of haloperidol
D Pseudohypoparathyroidism
E Hypoparathyroidism

C: Correct Answer :Extrapyramidal side-effects of haloperidol

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Which of the following is the most common type of medullary thyroid carcinoma?

A MEN2A
B MEN2B
C Sporadic
D Inherited
E None of the above

C: Correct Answer :Sporadic

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24-year woman antenatal visit at 16 weeks. complaining vaginal discharge bacterial vaginosis.had premature delivery at 35 weeks.most appropriate treatment?

A Canesten cream
B Clindamycin
C Tetracycline
D Metronidazole
E Repeat swab in one month and treat if positive

B: Correct Answer :Clindamycin

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7-yr boy dark urine joint pain headache, abdominal pain facial oedema 1 week.had recurring episodes of URTI last 2 months. looks pale BP 160/95 mmHg.periorbital and ankle oedema,erythematous macular rashes both legs. Urinalysis 4+ blood, 2+ protein negative nitrites no pyuria.red cell casts. most likely diagnosis?

A Post-streptococcal glomerulonephritis
B Nephrotic syndrome
C IgA vasculitis nephritis (Henoch-Schonlein purpura)
D Systemic lupus erythematosus
E Membranoproliferative glomerulonephritis

C: Correct Answer :IgA vasculitis nephritis (Henoch-Schoenlein purpura)

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5-yr girl painful right hip following viral URTI.afebrile minimal restriction right hip. Both hips symmetrical and Trendelenberg tilt test negative.the most likely diagnosis?

A Septic arthritis
B Juvenile idiopathic arthritis
C Developmental dysplasia of the hip
D Transient synovitis
E Slipped upper femoral epiphysis

D: Correct Answer :Transient synovitis

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26-yr footballer prescribed ibuprofen sprained ankle. passing dark urine. schistocytes.most likely cause?

Haemoglobin

9.5 g/dL (13.0-18.0)

WBC

8 x109/L (4-11 x109) with normal differentials

Platelets

450 x109/L (150-400 x109)

Reticulocyte count

5.5% (0.5-2.4)

Bilirubin

42 mol/L (1-22)
A Pyruvate kinase deficiency
B Paroxysmal nocturnal haemoglobinuria
C Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency
D Autoimmune haemolytic anaemia
E Allergic reaction

C: Correct Answer :Glucose-6-phosphate dehydrogenase (G-6-PD) deficiency

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5-yr girl red swollen left ankle after fall 3 days ago. 39°C superficial abrasion wound dried scabs over the left lateral ankle, erythematous oedema, least helpful in facilitating the diagnosis?

A CT scan
B MRI
C Ultrasound
D Synovial fluid aspirate
E Plain radiograph

A: Correct Answer :CT scan

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50-yr man MVA lower limb weakness. 5/5 power upper limbs, 0/5 power lower limbs.
cranial nerves are intact. Where is the likely lesion?

A C4
B T4
C T10
D T12
E L3

C: Correct Answer :T10

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55-yr Caucasian man difficulty sleeping. daytime fatigue general weakness . poor sleep pattern stops breathing and snores loudly. put on some weight . sweats easily could be warm weather. coarse facial features. likely diagnosis?

A Diabetes
B Hypothyroidism
C Acromegaly
D Cushing’s disease
E Hyperthyroidism

C: Correct Answer :Acromegaly

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is false regarding pharyngoesophageal (Zenker’s) diverticulum?

A The diverticulum is located at the Killian’s triangle
B Oesophageal carcinoma is the main differential diagnosis
C Commonly occurs in elderly population
D Barium swallow with dynamic continuous fluoroscopy supercedes MRI
E It is considered a true diverticulum

E: Correct Answer :It is considered a true diverticulum

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Which of the following is not a known side effect of heparin?

A:Urticaria
B:Hypokalemia
C:Haemorrhage
D: Your Answer :Osteoporosis
E:Thrombocytopenia

B: Correct Answer :Hypokalemia

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A pudendal anaesthetic blocks which of the following nerves?

A:Autonomic motor pathways
B:Autonomic sensory pathways
C:T 11, 12 sensory pathways
D:L 2,3,4 sensory pathways
E:S 2,3,4 sensory pathways

E: Correct Answer :S 2,3,4 sensory pathways

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14-yr male acne. forehead and his cheeks. most likely contributing factor ?

A Leaning his face on his hands frequently while sitting
B Eating fast food
C Not washing his hair often enough
D Eating chocolate & spicy foods
E Inadequate vegetables intake

A: Correct Answer :Leaning his face on his hands frequently while sitting

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70-yr smoker SOB weight loss two months. chest x-ray rounded opacity right perihilar region, bronchoscopy biopsy confirm small cell carcinoma.most accurate about small cell carcinoma of the lung (SCLC)?

A They have slow doubling time and late development of widespread metastases
B They are not associated with cigarette smoking
C They are more common than non-small cell lung carcinoma (NSCLC)
D Two-year survival of disease confined to the lung is 60%
E They are sensitive to chemotherapy

E: Correct Answer :They are sensitive to chemotherapy

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45-yr woman bilateral painful breasts. palpable lump left breast only. triple test assessment benign breast disease. statements is true?

A Phyllodes tumours are always benign
B Cyclical mastalgia is the most common cause of breast clinic referral
C Benign breast disease is an important risk factor for breast cancer
D Lobular carcinoma in-situ is malignant
E Fibroadenomas tend to persist until after menopause

C: Correct Answer :Benign breast disease is an important risk factor for breast cancer

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50-yr woman three-month dysphagia. denies weight loss. symptoms swallowing solids but not liquids. NOT an obstructive cause of dysphagia?

A Achalasia
B Peptic stricture
C Retrosternal goitre
D Oesophageal web
E Pharyngeal carcinoma

A: Correct Answer :Achalasia

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Which of the following is the most common side effect of erythropoietin (EPO) stimulating agents? ``` A: Your Answer :Headache B:Pure red cell aplasia C:Flu like symptoms D:Hypertension E:Bone pain ```

D: Correct Answer :Hypertension

3-week baby boy thriving jaundiced stools pale clay. elevated conjugated serum bilirubin. the most likely diagnosis? ``` A Glucose-6-phosphate-deficiency B Sickle cell disease C Haemolytic disease of the newborn D Breast milk jaundice E Biliary atresia ```

E: Correct Answer :Biliary atresia

48-yr man major depression. seizure disorder post head injury two years ago. antidepressants would be contraindicated? ``` A Venlafaxine B Vortioxetine C Mirtazapine D Fluoxetine E Bupropion ```

E: Correct Answer :Bupropion

14-yr boy fever, headache and neck stiffness 24 hours. . Cerebrospinal fluid white cells 400/ml 90% neutrophilia, gram-negative diplococci. immune system likely to be defective? ``` A T lymphocytes B Neutrophils C Immunoglobulin D Complement pathway E B lymphocytes ```

D: Correct Answer :Complement pathway

Complications of thyroidectomy include all of the following except: ``` A:Tracheal necrosis B:Recurrent laryngeal nerve palsy C:Facial nerve palsy D:Hypothyroidism E:Hypocalcemia ```

C: Correct Answer :Facial nerve palsy

18-yr boy ED taken paracetamol 24 hours ago to kill himself. looks unwell vital signs are normal. if elevated worries you the most? ``` A International Normalized Ratio (INR) B Alkaline Phosphatase (ALP) C Gamma-glutamyl Transferase (GGT) D Alanine Aminotransferase (ALT) E None of the above ```

A: Correct Answer :International Normalized Ratio (INR)

30-yr man ED after a fall five meters construction building. blood pressure is 100/70 mmHg, heart rate 105 soft non-tender abdomen, blood noted at urethral meatus. left superior inferior pubic rami displaced fractures contralateral sacroiliac joint displacement. administering 2 L crystalloid one unit packed red cell transfusion, most appropriate next step? A:Urgent pelvic CT B:Book trauma theatre for emergency pelvic surgery C:Apply circumferential compression or pelvic binder D:Administer further 4 L of crystalloids E:Assess patient’s gait

C:Apply circumferential compression or pelvic binder

86-yr severe Alzheimer multi-lobar pneumonia. Advanced Resuscitation Plan (ARP) is not obtained upon admission. During hospitalization, the patient suffers a cardiac arrest. most appropriate? A The patient should be resuscitated. B The patient should have cardiopulmonary resuscitation (CPR), but no intubation. C The patient should have CPR, but no pressors should be given. D The patient should not be resuscitated because care is futile. E The patient should not be resuscitated because he has a poor quality of life.

A: Correct Answer :The patient should be resuscitated.

hepatic encephalopathy, lactulose may be beneficial increasing non-absorbable ammonium (NH4) in colon. indirect mechanism of lactulose likely mediates this effect? ``` A Increases pH B Increases disaccharidase activity within enterocytes C Decreases pH D Decreases formation of acetic acid E None of the above ```

C: Correct Answer :Decreases pH

18-month boy constipation palpable abdominal mass. appropriate next step of management? A CT abdomen B Prescription of an appropriate laxative C Barium enema D Improve dietary fluid and fiber E Manual evacuation of faeces under general anaesthesia

B: Correct Answer :Prescription of an appropriate laxative

80-yr woman sodium 120 mmol/L. Serum osmolality is 260 mmol/kg. asymptomatic euvolemic. best management plan? ``` A Furosemide B Normal saline infusion C Fluid restriction D Hypertonic saline infusion E None of the above ```

C: Correct Answer :Fluid restriction

Which of the following options should be the initial management of a patient who has a flaccid neurogenic bladder following trauma? A Self-catheterization B Supravesical urinary diversion C Suprapubic catheterization D Surgical bladder augmentation E Limiting fluid intake to less than 300ml/day

A: Correct Answer : | Self-catheterization

56-yr woman multiple areas of increased density routine mammogram. fine needle biopsy suspicious malignant cells.excision biopsy confirms lobular carcinoma in-situ. options most likely association of this pathology? A:It is commonly identified by mammography B:Mastectomy is the treatment of choice for such pathology C:It is commonly ER negative D:Family history of breast cancer is not an association E:Contralateral breast is often involved as well

D: Correct Answer :Family history of breast cancer is not an association

19-yr nursing student weight loss. lost 10 kg three months. (BMI) is 16.5.stopped periods thought stress.not supportive of diagnosis of anorexia nervosa? A Preoccupation with food B Dark hair on arms and legs C Use of appetite suppressants and diuretics D Excessive exercise E Self-induced vomiting and purging

B: Correct Answer :Dark hair on arms and legs

70-yr man worsening memory impairment, wide-based gait, incontinence.next step in management? A Prescribe low-dose fluphenazine B Obtain a CT head C Obtain B12, folate, rapid plasma reagin (RPR), and thyroid-stimulating hormone (TSH) D Prescribe donepezil E Teach the wife psychosocial interventions

B: Correct Answer :Obtain a CT head

``` 60-yr man progressive dyspnoea. shipyards industry 20 years.20-pack years smoking.no fever no weight loss.inspiratory crackles,nail clubbing mild peripheral cyanosis. CXR is shown below (see image). A:Small cell lung carcinoma B:Squamous cell carcinoma C:Pulmonary asbestosis D:Pleural effusion E:Mesothelioma ```

C: Correct Answer :Pulmonary asbestosis

65-yr chronic male smoker (COPD) febrile neutropenia post induction chemotherapy for (AML).(CT) chest demonstrates nodules.bronchoalveolar lavage (BAL) positive for Galactomannan.most appropriate treatment? ``` A Voriconazole B Anidulafungin C Liposomal amphotericin B D Fluconazole E Posaconazole ```

A Voriconazole

2-yr boy abdominal pain,pallor petechial spots buttocks limbs. Both ankles swollen tender,reluctant to bear weight.not febrile spleen not palpable.most likely diagnosis? ``` A Henoch-Schonlein purpura B Immune thrombocytopaenia C Juvenile idiopathic arthritis D Meningococcaemia E Acute leukaemia ```

A: Correct Answer :Henoch-Schonlein purpura

20-yr woman asthma.hx atopy.asthmatic symptoms once or twice a week.peak expiratory flow 80% of normal age.most appropriate first step in treatment? A Regular short-acting beta-2 agonist inhaler (SABA) B As required low dose inhaled corticosteroid (ICS) + formoterol C Regular low dose ICS D As required SABA E As required formoterol

B: Correct Answer :As required low dose inhaled corticosteroid (ICS) + formoterol

infectious precautions required with confirmed meningococcal disease? ``` A Airborne precaution B Contact precaution C Droplet precaution D Standard precaution E None ```

C: Correct Answer :Droplet precaution

true in perimenopausal women? A All should receive hormonal therapy B Mood changes are uncommon C Periods characteristically become more irregular D Hot flushes are infrequent E FSH and oestradiol levels are reliable indicators of when menopause will occur

C: Correct Answer :Periods characteristically become more irregular

63-yr woman metastatic breast cancer ED sudden back pain lower limb weakness.urgent (MRI) spine confirms cord compression metastatic lesion at L1-L2.most appropriate initial management? ``` A Physiotherapy B Chemotherapy C Radiotherapy D Dexamethasone E Surgical decompression of the spinal cord ```

D: Correct Answer :Dexamethasone

42-yr farmer ED pain left shin unwell 10 days. HX grade 1 open fracture left tibia 4 months ago.left shin erythematous swollen.elevated inflammatory markers plain radiograph left leg reveals central radiolucency midshaft tibia surrounding thick lucent rim sequestrum.most appropriate next step in management? ``` A Intravenous flucloxacillin B Surgical debridement C Oral amoxicillin-clavulanic acid D Below knee amputation E Intravenous amoxicillin-clavulanic acid ```

A: Correct Answer :Intravenous flucloxacillin

54-yr woman severe headache lasted two hours.worst headache ever different from migraine headache.‘stabbing’ severe on the right.BP 160/90.(COCP).most appropriate management? A Give intranasal triptan B Schedule a semi-urgent non-contrast CT head C Transfer the patient to the nearest emergency department by ambulance D Give oral amlodipine stat and daily and reassess in one week E Give 100% supplemental oxygen and await response

C: Correct Answer :Transfer the patient to the nearest emergency department by ambulance

not true regarding denosumab in metastatic prostate breast cancer to bone? A It is a RANK ligand inhibitor B It prevents bone mineral density loss C Dose modification is needed for renal impairment D It carries a risk of osteonecrosis of the jaw E It reduces the risk of a pathological fracture

C: Correct Answer :Dose modification is needed for renal impairment

22-yr man painless swelling scrotum noticed 2 weeks ago.hard mass right scrotum.ultrasound solid mass in right testicle. next best step in management? ``` A Surgical exploration and biopsy B CT chest C Ultrasound-guided fine-needle aspiration biopsy D Serum beta-hCG and alpha-fetoprotein E Core biopsy ```

D: Correct Answer :Serum beta-hCG and alpha-fetoprotein

53-yr man complaining 1.5 hours substernal chest pain difficulty breathing.diaphoretic.most important next step in management? A Aspirin to chew B Administration of metoprolol ``` C Sublingual nitroglycerin (GTN) ``` D Administration of a diuretic agent E Urgent chest radiograph

A: Correct Answer : | Aspirin to chew

20-month girl ED stiffening jerking for 5 seconds.before the attack,fallen running bruised her leg.started crying turned blue before abnormal movements.most likely diagnosis? ``` A Absence seizures B Sandifer syndrome C Breath holding attacks D Frontal lobe epilepsy E Dravet syndrome ```

C: Correct Answer :Breath holding attacks

Metformin’s renal excretion higher than its glomerular filtration rate.In nephron secreted into urine? ``` A Ascending limb of loop of Henle B Collecting duct C Proximal tubule D Distal tubule E None of the above ```

C: Correct Answer :Proximal tubule

39-yr woman dying of breast cancer at home.reliable sign that death is near in this patient? ``` A Delirium B Episodic hyperalertness C Decreased communication D Desire for favourite food E Increased attention to dates and time ```

C: Correct Answer :Decreased communication

reduce the effectiveness of oral contraception if taken together? ``` A Warfarin B Clonazepam C Thyroxine D Heparin E Phenytoin ```

E: Correct Answer :Phenytoin

20-yr G1P0 23 weeks gestational age undergoes urinalysis.trace glucosuria.most likely etiology of increased sugar detected in urine? A The patient has diabetes B The patient has a urine infection C The patient’s urine sample is contaminated D The patient has kidney disease E The patient’s urinalysis is consistent with normal pregnancy

E: Correct Answer :The patient’s urinalysis is consistent with normal pregnancy

80-yr man moderate dementia episode of pre-syncope.bradycardic (ECG).medications most likely to be responsible? ``` A Aspirin B Donepezil C Amlodipine D Perindopril E Simvastatin ```

B: Correct Answer :Donepezil

most consistent with diagnosis of aortic regurgitation? ``` A Loud A2 B Head nodding with heartbeats C Narrow pulse pressure D Raised jugular venous pressure (JVP) E Bounding pulse ```

B: Correct Answer :Head nodding with heartbeats

conditions may present with secondary dysmenorrhea? ``` A Endometriosis B Cervical polyp C Pre-menstrual syndrome D Ovarian cyst E Prolapse ```

A: Correct Answer :Endometriosis

80-yr man on amiodarone for atrial fibrillation.not known side effect of amiodarone? ``` A Hepatic dysfunction B Hypothyroidism C Pulmonary toxicity D Atrio-ventricular block E Diarrhoea ```

E: Correct Answer :Diarrhoea

70-yr man chemotherapy metastatic colorectal cancer.severe nausea vomiting medicated with ondansetron,metoclopramide cyclizine.abdominal pain liver metastases capsular distension. could be helpful for his symptoms? ``` A Cinnarizine B Pantoprazole C Dexamethasone D Domperidone E Risperidone ```

C: Correct Answer :Dexamethasone

68-yr man Hodgkin lymphoma progressive SOB.BP 92/60,87/60 mmHg on inspiration,HR 100bpm, RR 20/min. pan-systolic murmur,(JVP) raised increased on inspiration prominent x y descents.most likely diagnosis? ``` A Cardiogenic shock B Constrictive pericarditis C Pericardial effusion from previous radiation D Malignant pericardial effusion E Cardiac tamponade ```

B: Correct Answer :Constrictive pericarditis

4-yr boy diagnosed Down syndrome.true regarding Down syndrome? A It affects 1 in every 100 babies in Australia B In the majority, it is associated with severe to profound intellectual disability C People with Down syndrome have increased rates of Alzheimer’s disease D Increased incidence with younger maternal age E Normal life expectancy

C: Correct Answer :People with Down syndrome have increased rates of Alzheimer’s disease

50-yr cleaner increasing tiredness four months.difficulty maintaining stamina difficult to do tasks.tingling sensation fingers.positive Babinski absent reflexes.hb 10 g/dL (MCV) 105 fL.most likely diagnosis? ``` A Alcohol toxicity B Liver disease C Folic acid deficiency D Vitamin B12 deficiency E Hypothyroidism ```

D: Correct Answer :Vitamin B12 deficiency

30-hour baby boy progressively jaundiced.mother,African-American descent,blood disorder in family.anaemia elevated unconjugated serum bilirubin.haemolysis Heinz bodies identified.most likely diagnosis? ``` A Fanconi’s anaemia B Hereditary spherocytosis C Glucose-6-phosphate-deficiency (G6PD) D Sickle cell disease E Autoimmune haemolytic anaemia ```

C: Correct Answer :Glucose-6-phosphate-deficiency (G6PD)

50-yr patient ED SOB 3 days flying back from London.dyspneic minimal exertion,ABGs type 1 respiratory failure increased A-a gradient.suspect PE.investigation of choice for diagnosis? ``` A High-resolution CT chest (HRCT) B Chest x-ray C Magnetic resonance imaging (MRI) of the chest D CT pulmonary angiogram (CTPA) E Ventilation/ perfusion (V/Q) scan ```

D: Correct Answer :CT pulmonary angiogram (CTPA)

Tiana 40-yr nurse three hx major depressive episodes suicidal attempts.on antidepressant controlling her symptoms.appropriate duration of treatment? ``` A 6 weeks B 12 weeks C 18 months D 2 years E 5 years ```

E: Correct Answer :5 years

55-yr man complaint tiredness.intentional weight loss six months.increasing thirst frequent urination.irritation tip of penis when passes urine.most appropriate investigation? ``` A Measure fasting lipids B Water deprivation test C Random plasma glucose D Glycated haemoglobin (HbA1c) on two separate occasions E Oral glucose tolerance test (OGTT) ```

C: Correct Answer :Random plasma glucose

24-months boy assessment of development.expected to develop at this stage? A Hops, jumps and runs with ease B Develops ability to toilet train at night C Toilet themselves D Exhibit hand preference E Squat to pick up an object

E: Correct Answer : | Squat to pick up an object

68-yr woman type 1 diabetes sinus problem oliguria.BP 140/85, elevated urea creatinine,positive c-ANCA negative anti-(GBM) antibodies.(RBC) casts urine renal biopsy glomerular crescents. most likely diagnosis? ``` A Post-streptococcal glomerulonephritis B Anti-GBM (Goodpasture) disease C Minimal change glomerulonephritis D Rapidly progressive glomerulonephritis (RPGN) E Granulomatosis with polyangiitis (GPA) ```

E: Correct Answer :Granulomatosis with polyangiitis (GPA)

52-yr lady small microcalcification right breast 11mm.core biopsy low-grade ductal carcinoma in situ.most appropriate treatment? ``` A Anastrozole B Tamoxifen C Mastectomy and axillary node clearance D Hookwire guided wide local excision E Neoadjuvant radiotherapy ```

D: Correct Answer :Hookwire guided wide local excision

24-yr woman discharged from psychiatric ward for hallucinations persecutory delusions.haloperidol 2mg TDS good effect. developed stooped posturing shuffling gait.head tremulous movements slow.changed to olanzapine addition of trihexyphenidyl (benzhexol).doing better no recurrence hallucinations or delusions.most likely diagnosis for the abnormal gait and posture? ``` A Tourette syndrome B Hypermagnesemia C Encephalitis D Adverse effect of neuroleptic E Hyperparathyroidism ```

D: Correct Answer :Adverse effect of neuroleptic

26-yr football player ED hit in face during match.peri-orbital oedema ecchymosis Left eye.important sign of orbital floor fracture? ``` A Epistaxis B Trismus C Paraesthesia of the forehead D Pain on eye movement E Rhinorrhea ```

D: Correct Answer :Pain on eye movement

28-yr woman noted plugging milk duct keratin plugs after weaning breastfeeding.fluctuant,immobile lump palpable peri-areolar region lower outer quadrant.most likely diagnosis? ``` A Galactocoele B Breast abscess C Lactational mastitis D Breast cellulitis E Mammary duct ectasia ```

A: Correct Answer :Galactocoele

All of the following drugs have active metabolites, except: ``` A Ramipril B Allopurinol C Hydromorphone D Amitriptyline E Diazepam ```

C: Correct Answer :Hydromorphone

40-yr Caucasian lady complaining abdominal pain.on off more than 2 years.pain related to defecation associated with diarrhea.recently undergoing family issues.true regarding diagnostic investigation? A A normal full blood count (FBC) is necessary for diagnosis B A normal erythrocyte sedimentation rate (ESR) is necessary for diagnosis C Normal stool cultures are necessary for diagnosis D A colonoscopy is necessary for diagnosis E No tests are necessary to diagnose this condition

E: Correct Answer :No tests are necessary to diagnose this condition

60-yr woman six-hour hx severe chest pain.(ECG) ST elevation anterolateral leads.perforated duodenal ulcer requiring surgery two weeks previously.hypertension dyslipidaemia history.most effective treatment in the management? ``` A Primary coronary angioplasty B Aspirin, ticagrelor, and heparin C Aspirin and beta-blocker D IV alteplase E Aspirin and IV heparin ```

orrect Answer :Primary coronary angioplasty

has highest rate of comorbidity with (ADHD)? A:Tourette disorder B:Oppositional defiant disorder/ conduct disorder C:Mood disorder D:Anxiety disorder E:Learning disorder

B: Correct Answer :Oppositional defiant disorder/ conduct disorder

``` 76-yr woman ED sudden SOB.hx IHD, CCF, HTN.ex-smoker 15 pack years.medications aspirin, ramipril, atenolol, furosemide atorvastatin.HR 140 bpm irregular rhythm.BP 100/70 mmHg. Both heart sounds quiet.widespread inspiratory coarse crackles mild expiratory wheezes.ECG irregularly irregular rhythm rapid ventricular rate,pathological q waves anterior leads.most appropriate to restore sinus rhythm? A:IV verapamil B:IV esmolol C:IV flecainide D:IV amiodarone E:IV digoxin ```

D: Correct Answer :IV amiodarone

most likely in Paget’s disease of the bone? A:Normal serum calcium, normal serum phosphate, raised serum alkaline phosphatase B:Normal serum calcium, normal serum phosphate, normal serum alkaline phosphatase C:Raised serum calcium, low serum phosphate, normal serum alkaline phosphatase D:Normal serum calcium, low serum phosphate, raised serum alkaline phosphatase E:Low serum calcium, low serum phosphate, low serum alkaline phosphatase

A:Normal serum calcium, normal serum phosphate, raised serum alkaline phosphatase

68-yr man ED epigastric pain melaena 24 hours.HR 110 BP 85/60 mmHg.most appropriate next step management? ``` A CT angiogram of the abdomen B Faecal occult blood test C Upper gastrointestinal endoscopy D Colonoscopy E Barium swallow ```

C: Correct Answer :Upper gastrointestinal endoscopy

travel advice to 40-yr woman.current guideline from the Centers for Disease Control and Prevention (CDC) for prevention of traveller’s diarrhea? A The traveller should take trimethoprim-sulfamethoxazole B The traveller should take doxycycline C The traveller should take ciprofloxacin D The traveller should take metronidazole E The should not take antibiotic prophylaxis for traveller’s diarrhea

E: Correct Answer :The should not take antibiotic prophylaxis for traveller’s diarrhea

45-yr man sudden hearing loss right ear morning.no history trauma.Weber test confirms right-sided sensorineural hearing loss.most likely diagnosis? ``` A Sudden sensorineural hearing loss B Meniere disease C Vestibular neuritis D Otosclerosis E Acute labyrinthitis ```

A: Correct Answer :Sudden sensorineural hearing loss

``` 80-yr woman admitted exertional chest pain while shopping. lasted 15 minutes self-resolved with rest.occurring intermittently during exertion for past 3 months.hX of dyslipidaemia hypertension.(ECG) T-wave flattening lead I, v5, v6.serial troponin I levels not raised.asymptomatic for 48 hours after admission.exercise stress testing (EST) revealed ST-segment depressions > 2mm leads V4-V6.not experiencing chest pain on treadmill.unlikely to alter her prognosis? A:Bisoprolol B:Nifedipine C:Perindopril D:Aspirin E:Atorvastatin ```

B: Correct Answer :Nifedipine

80-yr man chronic smoker 3-day hx melaena epigastric discomfort.nausea and lethargy.completed eradication treatment for duodenal ulcer.bp 98/70, pulse 100 bpm, rr 18/min, saturations 98% room air.abdomen soft tender epigastrium bowel sounds present.per rectal examination notice small traces melaena.commenced on oral analgesia.most appropriate next step in management? A Intravenous (IV) cannula and fluids B Electrocardiogram (ECG) C Intravenous pantoprazole D Erect chest x-ray E Keep nil by mouth and arrange for urgent endoscopy

A: Correct Answer :Intravenous (IV) cannula and fluids

70-yr male T2 diabetes requires improved glycaemic control. suffers from heart failure,controlled with furosemide ramipril. hypoglycaemic agents is contraindicated in this patient? ``` A Rosiglitazone B Repaglinide C Nateglinide D Glipizide E Acarbose ```

A: Correct Answer :Rosiglitazone

25-yr man ED complaint nausea,vomiting,headache. two days since his fall while skating.hit head on ground ON left small laceration.minute of unconsciousness,recovered quickly able to walk back to his car.did have headaches,nausea vomiting at home,self-resolved.no antegrade or retrograde amnesia.small laceration above left supraorbital area.most likely diagnosis? A: Epidural haematoma B: Cervical bone fracture C: Concussion D: Subarachnoid haemorrhage E: Subdural haematoma

A: Correct Answer : | Epidural haematoma

mother newborn encouraged to breastfeed.benefits, except: A Reduces risk of some forms of ovarian cancer B Reduces risk of breast cancer C Aids involution D Protects against infection E Meets all the infant’s nutritional needs for the first 12 months of life

E: Correct Answer :Meets all the infant’s nutritional needs for the first 12 months of life

most effective in reducing risk of falling in older persons residential care? ``` A Medication review B Reducing medications that increase the risk of falling C Vitamin D supplements D Multifactorial interventions E Exercise programs ```

C: Correct Answer :Vitamin D supplements

``` 50-yr male new skin lesion beneath his eye.past hX multiple skin cancers excised.next best step in management? A Refer to a plastic surgeon B Excision biopsy C Incisional biopsy D Topical treatment with liquid nitrogen E Radiotherapy ```

A: Correct Answer :Refer to a plastic surgeon

36-yr woman ED persistent hypotension suspected toxic shock syndrome.Despite 6 L IV N/S bp 76/45 mmHg mean arterial pressure 55.best next step? A Administer corticosteroid therapy B Transfuse with fresh-frozen plasma C Administer albumin for the next bolus D Initiate noradrenaline infusion E Initiate dobutamine infusion

D: Correct Answer : | Initiate noradrenaline infusion

36-yr African-Caribbean ED persistent penile erection 5 hours duration.anaemic haemoglobin 70 g/L commenced on IV fluids low flow nasal prongs oxygenation.most likely underlying cause?

A: Correct Answer :Sickle cell disease

``` 70-yr man advanced (CKD) pneumonia poor oral intake.potassium level 6.8 mEq/L.(ECG) peaked T waves mildly widened QRS complexes.most appropriate initial management? A IV calcium B IV furosemide C Oral polystyrene sulfonate (Resonium) D Arrange for dialysis treatment E IV glucose and insulin administration ```

A: Correct Answer :IV calcium

good advice for patient had caesarean section for breech presentation? A:Home birth would be a safe option in her next pregnancy B:A fetal malpresentation is highly likely to occur again in her next pregnancy C:A repeat caesarean section is necessary in a subsequent pregnancy D:It is important to avoid intercourse for 3-4 months after caesarean section E:In a subsequent pregnancy, attend early antenatal care and discuss the proposed mode of delivery with the obstetrician

E: Correct Answer :In a subsequent pregnancy, attend early antenatal care and discuss the proposed mode of delivery with the obstetrician

``` 28-yr man three-week hx polyuria thirst.passing dilute urine. quick urine dipstick no abnormality.most useful diagnostic investigation? A Water deprivation test B Magnetic resonance imaging (MRI) brain C Urinary electrolytes D Fasting plasma glucose E Serum osmolality ```

A: Correct Answer :Water deprivation test

20-yr female oral contraceptive pill one month.complains frequent spotting.most appropriate management? A Change to biphasic pill B Continue the medication and review in two months C Advise alternative contraception D Increase the dose of progesterone E Increase the dose of oestrogen

B: Correct Answer : | Continue the medication and review in two months

45-yr man 3-week hx pain in hands.bad in right hand. brown discolouration nails onycholysis distal interphalangeal joints are tender.most likely diagnosis? ``` A Rheumatoid arthritis B Dermatomyositis C Reactive arthritis D Osteoarthritis E Psoriatic arthritis ```

E: Correct Answer :Psoriatic arthritis

``` 38-yr woman ED 4-day Hx worsening diplopia,vertigo gait imbalance.history of (MS).depression anxiety.interferon-beta-1a venlafaxine.impaired abduction right eye when look to right. dysmetria finger-nose test right arm.gait instability not do tandem gait.(MRI) shows multiple new lesions which enhance contrast administration.most appropriate treatment? A Plasmapheresis B High dose oral prednisolone C Intravenous methylprednisolone 1g/ day D Glatiramer acetate E Rituximab ```

C: Correct Answer :Intravenous methylprednisolone 1g/ day

patient severe Crohn’s disease planned for infliximab.bloody diarrhoeas multiple fistulas.denies chest pain or cough. investigations should be carried out prior to infliximab? A Nerve conduction studies (NCS) B Liver function tests (LFT) and urea & electrolytes C Sputum cultures with Ziehl-Neelsen (ZN) stain D Interferon gamma release assay (IGRA) and chest x-ray E Mantoux test and chest x-ray

D: Correct Answer :Interferon gamma release assay (IGRA) and chest x-ray

60-yr man anxiety depression.tried medications without success, keen to start him on a benzodiazepine.background of chronic hepatitis C infection.agent would be safest? ``` A Lorazepam B Diazepam C Alprazolam D Clonazepam E Chlordiazepoxide ```

A: Correct Answer :Lorazepam

45-yr woman cystic swelling mild discomfort right wrist past six months.swelling dorsal aspect of wrist joint 0.5 x 0.5 cm positive transillumination test.mildly tender rubbery consistency.range of movement affected wrist is full no neurovascular deficit noted.plain radiograph done showed minor degenerative changes.most appropriate management? A:Urgent CT hand B:Urgent MRI hand C:Ultrasound-guided needle aspiration and cytology D:Intracystic corticosteroid E:Reassurance and review in 6 months

E: Correct Answer :Reassurance and review in 6 months

``` 45-yr martial artist numbness right hand.tingling numb right little and ring fingers for weeks.weakness in abduction right fifth finger flexion terminal phalanx fourth fifth fingers. reduced light touch pinprick sensation fourth fifth fingers medial border hand.likely site of the lesion? A Radial nerve in the spiral groove B Ulnar nerve at Guyon’s canal C C8 nerve root D Ulnar nerve at the elbow E Median nerve in the Carpel Tunnel ```

D: Correct Answer :Ulnar nerve at the elbow

``` 50-yr man suspected malignant melanoma right forearm result of the biopsy confirms superficial spreading melanoma thickness of <1mm.five-year survival rate his result corresponds to? A 20% B 37-50% C 75-80% D 80-96% E 95%-100% ```

E: Correct Answer :95%-100%

interleukins (ILs) responsible as driver white cell differentiation to eosinophilic pathway? ``` A IL-1 B IL-2 C IL-5 D IL-6 E IL-17 ```

C: Correct Answer :IL-5

58-yr man progressively enlarging,painless swelling anterior to his Right ear last 4 months.firm,non-mobile,approximately 2cm diameter.no facial asymmetry noted.most likely diagnosis? ``` A Pleomorphic adenoma B Mucoepidermoid tumour C Adenoid cystic carcinoma D Squamous cell carcinoma E Adenocarcinoma ```

A: Correct Answer :Pleomorphic adenoma

overweight 12-yr boy left hip pain for past 2 months.left foot externally rotated when asked lie supine and flex his hips. most likely diagnosis? ``` A Legg-Calve-Perthes disease B Slipped upper femoral epiphysis C Septic arthritis D Developmental dysplasia of the hip E Stress fracture ```

B: Correct Answer :Slipped upper femoral epiphysis

80-yr woman bilateral painful swelling both cheeks fever.nasogastric feeding since 6 weeks ago after stroke.most likely diagnosis? ``` A Mumps B Pleomorphic adenoma C Sialadenosis D Parotitis E Sjogren’s syndrome ```

D: Correct Answer :Parotitis

19-yr woman craving food a lot,binging large amounts cake chocolates.induces vomiting. She believes she is overweight. pharmacological treatments is indicated? ``` A Tricyclic antidepressant (TCA) B Selective serotonin reuptake inhibitor (SSRI) C First-generation antipsychotic D Second-generation antipsychotic E Benzodiazepine ```

B: Correct Answer :Selective serotonin reuptake inhibitor (SSRI)

58-yr woman FNAC confirms ductal carcinoma left breast upper outer quadrant.requests conservative surgical approach to avoid mastectomy.would favour the patient’s request? A Peau d’orange skin changes extending to adjacent quadrant B Small tumour size in relation to breast C Mammogram shows 3 discrete suspicious foci D Prior radiation to chest wall of the same side E Diffuse and extensive suspicious microcalcification on mammography

B: Correct Answer :Small tumour size in relation to breast

24-yr man painless haematuria noticed last four days.suffers T1 diabetes well-controlled recently recovered from throat infection.Urine dipstick blood protein.most likely diagnosis? ``` A Urinary tract infection B Diabetic nephropathy C IgA nephropathy D Benign prostatic hypertrophy E Henoch-Schonlein purpura ```

C: Correct Answer :IgA nephropathy

problems associated with (IUGR) infant, EXCEPT: ``` A:Congenital anomalies B:Shoulder dystocia C:Metabolic acidosis D:Persistent fetal circulation E:Hypoglycaemia ```

B: Correct Answer :Shoulder dystocia

``` 42-yr farmer ED complaints pain left shin generally unwell past 10 days.grade two open fracture left tibia 8 months ago.tachycardic 108, 37.4°C.left shin erythematous swollen.elevated inflammatory markers plain radiograph left leg central radiolucency midshaft tibia surrounding thick lucent rim sequestrum.most likely diagnosis? A:Septic arthritis B:Acute osteomyelitis C:Chronic osteomyelitis D:Infection of fracture fixation device E:Tetanus infection ```

C:Chronic osteomyelitis

30-yr pregnant woman advice regarding smoking cessation.statements is most accurate? A:The use of smoking cessation products during pregnancy frequently leads to adverse outcomes B:Nicotine gum delivers a lower and safer dose of nicotine than the nasal spray C:Varenicline is pregnancy category B and relatively safe in pregnancy D:Bupropion is pregnancy category C and relatively safe in pregnancy E:She should be encouraged to cease smoking after delivery

D: Correct Answer :Bupropion is pregnancy category C and relatively safe in pregnancy

underweight 52-yr woman 2 years amenorrhea,hot flushes, irritability insomnia.urged to consider (HRT).main additional benefit to commence her on HRT? ``` A Relief of hot flushes B Prevention of osteoporosis C Improve sleep D Reduce mood changes E Improve cognitive function ```

B: Correct Answer :Prevention of osteoporosis

20-yr male motorcyclist ED MVA skidded knocked against traffic light pole.2 cm bone protruding anteriorly left shin.next best step in management? A Immediate surgical internal fixation B Administer tetanus toxoid and commence intravenous antibiotics C Immediate antibiotic wound irrigation and debridement under local anaesthesia D Reduce fracture under sedation and immobilise with plaster of Paris E Wound bandage compression to prevent infection

B Administer tetanus toxoid and commence intravenous antibiotics

5-yr female ED 12-hour hX fever drowsiness.shock widespread petechial rash.most appropriate antibiotic treatment? ``` A Intravenous vancomycin B Intravenous ceftriaxone C Intravenous flucloxacillin D Oral lincomycin E Oral amoxicillin-clavulanic acid ```

B: Correct Answer :Intravenous ceftriaxone

40-yr married female on anti-depressants major depressive episode.successful business disabled by self-doubt chronic poor self-esteem.most appropriate intervention? ``` A Dialectical behavioural therapy B Biofeedback C Cognitive-behavioural therapy (CBT) D Interpersonal therapy E Supportive psychotherapy ```

C: Correct Answer :Cognitive-behavioural therapy (CBT)

hypertension, best indicator of progression to end-stage renal failure with IgA nephropathy? ``` A Recurrent macroscopic haematuria B Proteinuria > 1g/day C Microscopy haematuria with > 100 RBC/ml on urine microscopy D Female gender E Age > 40 years ```

B: Correct Answer :Proteinuria > 1g/day

60-yr woman worsening SOB dry cough past six months.hx rheumatoid arthritis.bibasal fine inspiratory crackles on auscultation.most likely cause of her symptoms? ``` A Pulmonary oedema B Consolidation C Pleural effusions D Pulmonary fibrosis E Intrapulmonary nodules ```

D: Correct Answer :Pulmonary fibrosis

65-yr chronic smoker exertional pain right leg past year.no pain at rest.BP 158/90mmHg,decreased pulsation dorsalis pedis right leg.no gangrene or ulcer on either leg.ankle-brachial index 0.7 right leg.NOT appropriate? A Graduated walking program B Aspirin and clopidogrel C Smoking cessation D ACE-inhibitor therapy E Statin therapy

B: Correct Answer : | Aspirin and clopidogrel

70-yr man (BPH).following is true? A Castrated males cannot get BPH B PSA is an accurate determinant of BPH C The prostate reaches its maximal size during puberty D BPH initially leads to a distended floppy bladder and increasing residual volume E Digital rectal examination (DRE) allows you to feel the whole prostate

A: Correct Answer :Castrated males cannot get BPH

80-yr, taking 10 minutes to answer simple question, giving a large amount of detail, which all seem connected to the topic. How would you describe this phenomenon? ``` A Circumstantiality B Confabulation C Derailment D Pathological lying E Tangentiality ```

A: Correct Answer :Circumstantiality

70-yr obese male BP 170/100.fundi normal fundoscopic examination.urine dipstick normal.total cholesterol 6 mmol/L. advised him to exercise,lose weight,low-salt diet. BP consistently 165-170/100 mmHg.most appropriate management plan? A Continue lifestyle modification for another six months B Doxazocin C Atenolol D Methyldopa E Hydrochlorothiazide

E Hydrochlorothiazide

40-yr Aboriginal woman 6-week hx abdominal pain,nausea vomiting.complains bowel motions difficult to flush.abdominal pain constant radiating to back.alcohol dependence binge in large amounts.investigations most likely to reveal underlying diagnosis? A Endoscopic retrograde cholangiopancreatography (ERCP) B Stools examination C Transabdominal ultrasound D Plain abdominal x-ray E CT scan

E: Correct Answer : | CT scan

21-yr woman overdose of unknown medication 12 hours ago.abdominal pain,haematemesis melaena.tachycardic hypotensive.abdominal x-ray multiple well-defined round opaque lesions in gut.following should be given? ``` A Ethylenediaminetetraacetic acid (EDTA) B Desferrioxamine C Sodium bicarbonate D N-acetylcysteine E Activated charcoal ```

B Desferrioxamine

34-yr man 15 pack-years smoking follow-up post-treatment pneumonia.1.6cm non-calcified nodule on his right lower lobe. Mantoux skin test was negative.most appropriate next step? ``` A Monitor nodule with repeat chest radiograph (CXR) B Skin biopsy for fungus C Thoracotomy D QuantiFERON-GOLD test E Bronchoscopy and biopsy ```

E Bronchoscopy and biopsy

40-yr woman teacher gradually developed pain medial aspect right knee.knee sometimes buckles or locks up on her associated with swelling end of the day.slight limp, medial joint line tenderness, positive McMurray sign.normal Lachman varus/valgus testing.most likely diagnosis? A:Lateral meniscus tear B:Medial meniscus tear C:Anterior cruciate ligament (ACL) injury D:Medial collateral ligament (MCL) injury E:Unilateral osteoarthritis of knee

B:Medial meniscus tear

80-yr man memory decline.more forgetful over past year,missing appointments meetings with family.lost a few times in neighbourhood.feeling lonely since passing of his wife 12 months ago.hypertension no previous psychiatric hx.additional features necessary to accurately diagnose major neurocognitive disorder (NCD)? ``` A Loss of independence of instrumental activity of daily living (iADLs) B Hallucinations C Radiographic findings D Fluctuations in consciousness E Agitation ```

A: Correct Answer :Loss of independence of instrumental activity of daily living (iADLs)

40-yr man treated for gram-negative bacteraemia high dose gentamicin.renal function AKI while on treatment.mechanism of renal failure in gentamicin toxicity? ``` A Cast nephropathy B Proliferative glomerulonephritis C Interstitial nephritis D Focal sclerosing glomerulonephritis E Acute tubular necrosis ```

E: Correct Answer :Acute tubular necrosis

54-yr chronic smoker 30-pack-years productive cough started 4 months ago during winter.similar symptoms last year this season ‘cold’.mildly dyspnoeic on exertion unchanged.most likely diagnosis? ``` A Asthma B Lung cancer C Postnasal drip due to seasonal allergies D Chronic bronchitis E Cigarette smoke irritation ```

D Chronic bronchitis

``` 80-year presents noticing several moles on her arms,face,ears progressively growing.the moles are 6 to 8 mm diameter irregular borders.skin lesions should the provider be most suspicious of based on history and physical examination? A Acral lentiginous melanoma B Lentigo maligna melanoma C Superficial spreading melanoma D Benign nevus E Basal cell carcinoma ```

B: Correct Answer :Lentigo maligna melanoma

50-year truck driver, four-month hx heartburn after meals not settling with antacids pantoprazole.suspect hiatus hernia.most appropriate investigation for diagnosing a hiatus hernia is: ``` A Ultrasound abdomen B Barium meal C Gastroscopy D Chest x-ray E Computed tomography (CT) scan of the chest and abdomen ```

B: Correct Answer :Barium meal

``` 22-year man fevers, arthralgias, abdominal pain painful rash around buttocks.biopsy rash shows leukocytoclastic vasculitis fibrinoid necrosis.direct immunofluorescence,will confirm the diagnosis? A C4 B IgA C IgM D IgG E C3 ```

B: Correct Answer :IgA

50-year patient microcytic anaemia.(RDW) is elevated.white cell platelet counts normal.the most likely diagnosis? ``` A Iron deficiency B Sideroblastic anaemia C Thalassemia D Aplastic anaemia E Chronic renal insufficiency ```

A: Correct Answer :Iron deficiency

50-year man diagnosed coronary artery disease (CAD) recurrent anginas,started on long-term Aspirin 100mg OD.feeling lethargic one week,yellow tinge on sclera.(FBC)normocytic anemia, raised reticulocyte count raised total bilirubin predominantly unconjugated.(LFT) is normal.grandfather having similar symptoms upon starting certain antibiotics.most likely diagnosis? A Warm haemolytic anemia B Folate deficiency C Sickle cell anemia D Hereditary spherocytosis E Glucose-6-phosphate dehydrogenase (G6PD) deficiency

E: Correct Answer :Glucose-6-phosphate dehydrogenase (G6PD) deficiency

60-year complaining gnawing abdominal pain centre upper abdomen. pain associated with hunger.hx of alcohol abuse noted darker stools last 2 weeks.most likely cause of her illness? ``` A Helicobacter pylori infection B Gallstones C Gastroparesis D Nonsteroidal anti-inflammatory drug (NSAID) abuse E Alcoholism ```

A: Correct Answer :Helicobacter pylori infection

60-year obese female (BMI) 35, complains urinary incontinence coughs or exerts herself.best advice? ``` A Pelvic floor muscle exercises B Weight reduction over six months and review back C Dietary change to low carb and low fat D Codeine PRN for coughs E Bladder training ```

A: Correct Answer :Pelvic floor muscle exercises

69-year frequently dribbling urine.loses large amount urine without warning.terms best describes his symptoms? ``` A Overflow incontinence B Stress incontinence C Urge incontinence D Senile incontinence E Functional incontinence ```

A: Correct Answer :Overflow incontinence

70-year man aching pain L4-L5 two months.radiograph multiple sclerotic lesions in spine.no neuro-sensory deficit investigations is most appropriate? ``` A Prostate specific antigen (PSA) B Magnetic resonance imaging (MRI) C Computed tomography (CT) scan D Bone scan E Calcium level ```

A: Correct Answer :Prostate specific antigen (PSA)

``` 60-year woman ED facial pain.burning sensation left forehead tip of nose three days,redness lesions tip of nose last night before bed.erythematous skin patch on left forehead with overlying vesicles on it.without crossing midline.conjunctival erythema on left eye.speech hearing are normal.commence immediately on antivirals.next most appropriate step in management? A Urgent ophthalmologic evaluation B Urgent otolaryngology evaluation C Start mupirocin D Give herpes zoster vaccine E Start topical acyclovir ```

A: Correct Answer :Urgent ophthalmologic evaluation

2-month baby girl frequent loose bowel motions streaks of blood in stools.maintaining good weight 50th centile weight growth chart.most likely diagnosis? ``` A Viral gastroenteritis B Coeliac disease C Functional diarrhoea D Lactose intolerance E Food protein-induced allergic proctocolitis ```

E: Correct Answer :Food protein-induced allergic proctocolitis

26-year man 3 years progressive dysphagia.barium swallow shows a bird’s beak appearance.most likely diagnosis? ``` A Reflux oesophagitis B Tracheoesophageal fistula C Oesophageal diverticulum D Cricopharyngeal bar E Achalasia ```

E: Correct Answer :Achalasia

24-year schizoaffective disorder detained under Mental Health Act refusing to consent treatment antipsychotic medication.currently psychotic,agitated aggressive, threatened staff members.most accurate? A He cannot be treated as he has not given consent B He can be treated because he is a psychiatric patient C He can be treated as it is necessary to prevent serious deterioration, serious suffering or violence D He can be treated because treatment is life-saving E He should be discharged as he is not complying with the treatment plan

C: Correct Answer :He can be treated as it is necessary to prevent serious deterioration, serious suffering or violence

70-year man severe end-stage COPD developed rash Month ago. grouped vesicles erythematous bases dermatomal pattern.treated and resolved,complains persistent burning itching pain same dermatome.affects his sleep.long-term pain management? A Nonsteroidal anti-inflammatory agents (NSAIDs) B Opiate analgesics C Steroids D Anticonvulsants E Selective serotonin reuptake inhibitors (SSRIs)

D: Correct Answer :Anticonvulsants

58-year man (CKD) increasing SOB weight gain past week.S3, bi-basal crackles, elevated (JVP).oxygen saturation 90%.require for further assessment? A A computed tomographic pulmonary angiogram (CTPA) B A creatinine level to calculate estimated glomerular filtration rate (eGFR) C A chest X-ray (CXR) D An echocardiogram E A brain natriuretic peptide (BNP)

C: Correct Answer :A chest X-ray (CXR)

``` 38-year man nephrotic syndrome diagnosed IgA nephropathy. BP 145/80mmHg. commenced on perindopril 4mg daily. follow up three months later BP 135/80mmHg protein creatinine ratio 100mg/mmol. most appropriate treatment? A Thiazide diuretic B Salt restriction C Add calcium channel blocker D Increase perindopril E Observation ```

D: Correct Answer :Increase perindopril

70-year woman HTN CHF.perindopril,furosemide,bisoprolol. diarrhoea,hypotension foul-smelling urine. Her investigations are as follow: Arterial blood gas: ``` pH 7.21 (N: 7.38-7.44) paO2 107 (N: 75-100 mmHg) pCO2 27 (N: 38-42 mmHg) HCO3 16 (N: 23-26 mEq/L) Base excess -9 (N: -2 to +2 mEq/L) Lactate 1.4 (N: <1.3 mmol/L) ``` ``` Na 136 (N: 136-145 mmol/L) K 3.2 (N: 3.5-5 mmol/L) Cl 113 (N: 98-106 mmol/L) Cr 239 (N: 44-97 micromol/L) eGFR 24 (N: >60 ml/min/1.73m2) Urine culture: Klebsiella pneumoniae cause of acidosis in this patient? A Diarrhoea B Perindopril C Diuretics D Septic shock E Renal impairment ```

A: Correct Answer :Diarrhoea

60-year Caucasian man pain pelvis.head appears larger than before.noticed deterioration in hearing left ear.right-sided sensorineural deafness detected.bowing of the tibia.most likely diagnosis? ``` A Osteomalacia B Osteoporosis C Acromegaly D Ricketts E Paget’s disease ```

E: Correct Answer :Paget’s disease

``` 54-year woman abdominal mass.(T2DM) HTN.ramipril,amlodipine, insulin glargine,insulin aspart,atorvastatin.asymptomatic.(BMI) 25.Abdominal palpation pulsatile mass epigastrium non-tender. urgent abdominal ultrasound (US) shows infrarenal abdominal aortic aneurysm (AAA) maximum diameter of 5.6 cm. most appropriate next step? A Switch amlodipine to propanolol B Repeat the abdominal US in 6 months C Repeat the abdominal US in 12 months D Refer for aneurysm repair E Discharge for GP follow-up ```

C Repeat the abdominal US in 12 months

50-year widow ED agitation.unresponsive to questions,stumbles.strong smells of alcohol.not aggressive but uncooperative.most appropriate initial treatment? ``` A Thiamine B Haloperidol C Lorazepam D Glucose E Acamprosate ```

A: Correct Answer :Thiamine

58-year complains localised lumps groin.palpable non-tender inguinal lymph nodes.biopsy shows squamous cell carcinoma.most likely be the site of the primary tumour? A Kidney B Breast C Lung D Rectum E Prostate

E: Correct Answer : | Prostate

20-year university student sore throat,mild abdominal pain,fever past 7 days.fatigue,playing soccer tackled hitting the grass face-down.passes out.heart rate 144 BP 80/50 mm Hg distended abdomen.most likely aetiology? A Ruptured aortic aneurysm B Vasovagal reaction C Hypertrophic obstructive cardiomyopathy D Complications of Epstein-Barr infection E Ruptured liver

D: Correct Answer : | Complications of Epstein-Barr infection

15-year girl abnormal behaviour.poor eye contact monosyllabic phrases.HEADSS adolescent psychosocial assessment to evaluate her condition.least powerful predictor of suicide? ``` A Family history of suicidal ideation or attempt B Schizophrenia C Obsessive compulsive disorder D Depression E Past suicidal attempt ```

C: Correct Answer :Obsessive compulsive disorder

4-year boy daycare acute redness right eye,runny nose,cough, irritability.right eye red watery.discharge is clear,mild eyelid edema.most common cause? ``` A Covid19 virus B Parainfluenza virus C Adenovirus D Rhinovirus E Herpesvirus ```

C Adenovirus

80-year man dense left-sided hemiparesis. (CT) brain shows a right-sided middle cerebral artery territory infarct.most important risk factor for stroke? ``` A Smoking B Family History C Diabetes D Cholesterol E Hypertension ```

E: Correct Answer :Hypertension

70-year woman primary sclerosing cholangitis (PSC) unintentional weight appetite loss.MOST associated tumour of PSC? ``` A Pancreatic carcinoma B Hepatic hemangioma C Hepatic fibroma D Cholangiocarcinoma E Hepatocellular carcinoma ```

D: Correct Answer :Cholangiocarcinoma

75-year retired coal worker chronic onset dyspnoea.ulnar deviation metacarpophalangeal joints tenderness lateral two proximal interphalangeal joints in both hands.chest x-ray multiple bilateral nodules.most likely diagnosis? ``` A Felty’s syndrome B Caplan syndrome C Sarcoidosis D Hypertrophic pulmonary osteoarthropathy (HPOA) E Pulmonary fibrosis ```

B Caplan syndrome

8-month-old ED fever,cough vomiting.tachypnoea intercostal recession.widespread crackles audible.most likely diagnosis? ``` A Pertussis B Bronchiolitis C Asthma D Pneumonia E Angioedema ```

B: Correct Answer :Bronchiolitis

20-year nursing student anxiety.repeating university examination. not able to attend lectures feels ‘anxious’being asked question in front of Group,constantly worried.not able to make friends avoids conversation.relief being alone at home.probable diagnosis? ``` A Generalised anxiety disorder B Social anxiety disorder C Paranoid personality disorder D Delusional disorder E No mental disorder ```

B: Correct Answer :Social anxiety disorder

7-year boy two-month hx limping.antalgic gait decreased range motion (ROM) right hip.mild tenderness on palpation of anterior capsule on right.X-ray fragmentation of femoral head.most likely diagnosis? ``` A Femoral shaft fracture B Slipped capital femoral epiphysis (SCFE) C Legg-Calve-Perthes disease (LCP) D Toxic synovitis of hip E Septic arthritis of hip ```

C Legg-Calve-Perthes disease (LCP)

8-year boy bedwetting at night only.most likely association? A The child is being sexually abused B The child has polyuria from diabetes C The child’s mother or father had a similar history D There is severe faecal retention E There is evidence of urinary tract infection

C: Correct Answer :The child’s mother or father had a similar history

49-year woman contraceptive advice further pregnancies in future. smokes 15-20 cigarettes per day.most appropriate? ``` A Diaphragm or condom B Mini pill C Oral contraceptive pill D Depo provera E IUCD with Norethisterone ```

B Mini pill

56-year male posterior neck lump biopsy showed metastatic squamous cell carcinoma.best investigation assess source of malignancy? ``` A CT scan B MRI C Fluoroscopy D Ultrasound E X-ray ```

A CT scan

30-year man recurrent allergic rhinitis now swelling feet, periorbital oedema facial puffiness.(JVP) normal,no jaundice.white cell count (WCC)9 x 109/L, creatinine 66 micromol/L,urine dipstick 4+ proteinuria.most likely cause of his presentation? ``` A Minimal change disease B Lupus nephritis C IgA nephropathy D Membranous glomerulonephritis E Amyloidosis ```

A Minimal change disease

42-year woman rheumatology 3-month hx stiff hands wrists.pain is first thing in morning.wrists,metacarpophalangeal joints proximal interphalangeal joints swollen warm.rheumatoid arthritis is suspected.rheumatoid factor anti-cyclic citrullinated peptides (CCP) positive.most appropriate management? A Non-steroidal anti-inflammatory drugs (NSAIDs) B Intramuscular depot injection of methylprednisolone plus NSAIDs C Anti-TNF therapy D Intramuscular depot injection of methylprednisolone plus NSAIDs and methotrexate and sulfasalazine E Physiotherapy

A: Correct Answer :Non-steroidal anti-inflammatory drugs (NSAIDs)

40-year woman 3-month hX tremors,anxiety,heat intolerance, occasional loose stools,weight loss of five kg.treated surgically.complains hoarse voice,likely nerve involvement? ``` A Facial nerve B Glossopharyngeal nerve C Recurrent laryngeal nerve D External laryngeal nerve E Accessory nerve ```

C Recurrent laryngeal nerve

30-year woman (ICU) severe sepsis bacteraemia.oozing from lines and cannula sites, concerned (DIC).most consistent with DIC? A Low platelet, low fibrinogen, low D-dimer B Low platelet, high fibrinogen, high D-dimer C Low platelet, low fibrinogen, high D-dimer D High platelet, low fibrinogen, high D-dimer E High platelet, high fibrinogen, high D-dimer

C: Correct Answer :Low platelet, low fibrinogen, high D-dimer

30-year man (ADPKD).main cause of renal failure? ``` A Tubular obstruction B Increase in the size of the existing cysts C Hypertension D Peri-cystic fibrosis E Increase in the number of cysts ```

B: Correct Answer :Increase in the size of the existing cysts

18-month boy chronic loose bowel motions abdominal distension, poor weight gain muscle wasting past 6 months. most likely diagnosis? ``` A Lactose intolerance B Cow’s milk protein intolerance C Coeliac disease D Crohn’s disease E Functional diarrhoea ```

C Coeliac disease

24-year woman poor diabetes management.type 1 diabetes age 11 using insulins.HbA1c is 6.5-7%. Lately,fluctuations in plasma glucose levels.HbA1c one week ago 8%.admits avoiding insulins regularly.raised,smooth lump firm on palpation lower quadrants of her abdomen.most likely diagnosis? ``` A Subcutaneous abscess B Lipoma C Injection scarring D Lipohypertrophy E Progression of diabetes ```

D Lipohypertrophy

4-year girl fever 37.8°C.sunburn both his cheeks.most likely organism to be responsible? ``` A Parvovirus B Ebstein-Barr Virus C Hepatitis A D Mumps E Staphylococcus aureus ```

A Parvovirus

75-year terminal metastatic prostate cancer end-of-life care.restless and agitated.commenced on syringe driver. medications should be added? ``` A Oxycodone B Amitriptyline C Olanzapine D Midazolam E Haloperidol ```

D Midazolam

24-year woman referred to psychiatric department confusion amnestic episodes.found clothing in wardrobe does not recall buying.tagged in numerous pictures on Instagram people she does not know.received random emails from people who claim to have met her whom she does not remember. What is the most likely diagnosis? ``` A Posttraumatic stress disorder B Malingering C Factitious disorder D Dissociative identity disorder (DID) E Borderline personality disorder (BPD) ```

D Dissociative identity disorder (DID)

vaccinations 34-year patient planning to travel internationally. needle-phobia unwilling vaccination unless absolutely required. only mandatory travel vaccine? ``` A Yellow fever B Polio C Typhus D Hepatitis A E Cholera ```

A Yellow fever

13-year girl irritable argumentative.less interactive,problems with concentration,initial insomnia poor appetite.grades beginning to drop intoxicated.most likely diagnosis? ``` A Attention deficit hyperactivity disorder (ADHD) B Oppositional defiant disorder C Major depression D Antisocial personality disorder (ASPD) E Conduct disorder ```

C Major depression

4-year boy 2-day hx cough fever.sounds like barking seal.temperature is 38°C.inspiratory stridor increased work of breathing significant subcostal recession.quite agitated most appropriate initial treatment? ``` A Nebulised corticosteroids B Inhaled salbutamol C Nebulised salbutamol D Nebulised adrenaline E Intramuscular adrenaline ```

D Nebulised adrenaline

30-year man severe pain left groin middle night.bright red blood urine.febrile.radiograph showed radiopaque calculus in bladder. advise the patient? ``` A Avoid calcium-containing food B Avoid red meat C Avoid taking too much fluids D Increase oxalate-containing food, such as spinach E Increase vitamin C intake ```

B Avoid red meat

22-year female painless lump right breast. mobile breast lesion colourless nipple discharge.triple test assessment reassured by surgeon.true regarding such breast lesions? A Such lesions require excision biopsy for further confirmation B They are usually well-circumscribed and freely movable C At least 50% disappear after 2 years upon verification by fine needle biopsy follow-up D These are commonly known as benign monoclonal neoplasms E These lesions have high risk of becoming invasive breast carcinoma

B They are usually well-circumscribed and freely movable

50-year chronic smoker unequal pupils right 3mm left 5mm diameter. Both eyes react normally to light accommodation.right side face drier flushed compared to left.may explain his signs? ``` A Parasympathetic pathway B Sympathetic pathway C Both parasympathetic and sympathetic pathways D Spinothalamic tracts E Dorsal column tracts ```

B Sympathetic pathway

48-year woman falls down stairs open fracture left femur multiple rib fractures.alert but anxious.bp 130/100 mmHg, HR 120 bpm,RR 26.estimated blood loss in this patient? ``` A 1.2 L B 2.0 L C 2.5 L D 300 ml E 3.0 L ```

A 1.2 L

30-year lady 10th week pregnancy noted mass right breast 2 cm size.no axillary nodes palpable.mammogram core biopsy infiltrating ductal carcinoma.next best step in management? A Therapeutic abortion B Chemotherapy now and deferring surgery until after delivery C Breast surgery now and defer radiotherapy until after delivery D Radiotherapy now and defer surgery until after delivery E Mastectomy, chemotherapy and radiotherapy regardless of pregnancy status

C Breast surgery now and defer radiotherapy until after delivery

teacher,primigravida 14 weeks gestation,diagnosed with rubella. rubella immunisation as a child.next best step in management? A Perform ultrasound assessment of foetus B Do rubella IgM/ IgG titres, if raised, to offer pregnancy termination C Advise acute rubella infection is self-resolving and to continue routine obstetric follow up D Offer repeat measles, mumps, rubella (MMR) vaccination E Advise maternal-fetal transmission is limited during first trimester

B: Correct Answer :Do rubella IgM/ IgG titres, if raised, to offer pregnancy termination

14-year girl basketball player presents pain right knee 4 weeks. no swelling of knee joints tender over bony prominence right tibial tubercle.range of motion of knees normal.most likely diagnosis? ``` A Ewing sarcoma B Stress fracture of the proximal tibia C Osgood-Schlatter disease D Prepatellar bursitis E Subacute osteomyelitis ```

C Osgood-Schlatter disease

18-year woman mildly tender reddish-brown nodules legs,suspect to erythema nodosum.caused by all except: ``` A Tuberculosis B Rheumatic fever C Systemic lupus erythematosus (SLE) D Sarcoidosis E Oral contraceptive pills (OCPs) ```

B Rheumatic fever

pregnant woman 20 weeks gestation ultrasound placenta 1 cm covering internal os.next best management? A Discuss delivery by caesarean section at term B Advise not to have sexual intercourse till delivery C Repeat ultrasound at 32-35 weeks D Repeat ultrasound at 38 weeks E Reassurance for routine obstetric follow-up

C Repeat ultrasound at 32-35 weeks

48-year man 3-month hx epigastric dull abdominal pain.pain worse mornings relieved after meals.denies weight loss.abdomen soft tenderness on palpation epigastrium.most likely diagnosis? ``` A Gastritis B Gastric carcinoma C Duodenal ulcer D Gastro-oesophageal reflux disease (GORD) E Gastric ulcer ```

C Duodenal ulcer

30-year single female hx feelings emptiness poor self-esteem. recurrent self-harm,alcohol abuse,unstable interpersonal relationships.like to engage in treatment.best recommendation? ``` A Dialectical behavioural therapy B Biofeedback C Cognitive-behavioural therapy (CBT) D Interpersonal therapy E Supportive psychotherapy ```

A: Correct Answer :Dialectical behavioural therapy

58-year woman mass right breast 2 cm size.noticed 2 months ago confirmed on mammogram.mammogram (Moderate suspicion of malignancy).FNA biopsy not show any malignant cells.next best step in management? ``` A Mastectomy and axillary clearance B Lumpectomy and axillary clearance C Repeat mammogram and fine needle aspiration biopsy D Ultrasound-guided core biopsy E Stereotactic core biopsy ```

D Ultrasound-guided core biopsy

70-year man ED acute urinary retention painless haematuria two months.three-way catheter inserted bladder irrigation established.most appropriate next step? ``` A Urine cytology B Renal ultrasound C Flexible cystoscopy D CT scan E Rigid cystoscopy ```

A Urine cytology

75-year man (PE) following appendicectomy. BP 140/80mmHg HR 104 bpm.transthoracic echocardiogram (TTE)right ventricular strain. intend to start him on Apixaban.most appropriate duration of anticoagulation? ``` A Six weeks B Three months C Six months D Twelve months E Indefinite ```

B Three months

22-year woman renal transplant.concerned long-term Cyclosporin treatment.common adverse effect of this drug? ``` A Paraesthesia B Nephrotoxicity C Hepatotoxicity D Bone marrow suppression E Alopecia ```

B Nephrotoxicity

6-week baby boy ED rapid breathing when feeding. tachypnoeic temperature 37.0°C.femoral pulses not easily palpable BP arms normal range.hypotension in legs.most likely diagnosis? ``` A Aortic stenosis B Fallot’s tetralogy C Atrial septal defect D Patent ductus arteriosus E Coarctation of the aorta ```

E Coarctation of the aorta

58-year woman bronchiectasis infective exacerbation Pseudomonas aeruginosa.currently 3days treatment,broad complex tachycardia. antibiotics used to treat her infection? ``` A Gentamicin B Clarithromycin C Ciprofloxacin D Ceftazidime E Piperacillin/ tazobactam ```

C Ciprofloxacin

30-year woman, gravida three, para three, gave birth third child 3 days ago without complications.teary complains depressed. initial management? ``` A Referral to a psychiatrist B Reassurance and support C Prompt discharge to her home D Tranquilizers E Discontinuation of breast feeding ```

B Reassurance and support

11-year girl ED SOB wheezing.episode one year ago during winter. RR 42 , BP 100/60 mmHg, SpO2 94% room air.bilateral widespread wheezes chest on auscultation.distress.most likely to make a diagnosis? A CT of the chest B Chest x-ray C Spirometry D Improvement with salbutamol E Measurement of peak expiratory flow (PEF)

D | Improvement with salbutamol

treatment of osteoporosis,main reason to take alendronate 30 minutes before first food,beverage or medication of day with plain water only? A Food increases the first pass metabolism of alendronate B Food decreases the absorption of alendronate C Calcium decreases the absorption of alendronate D Alendronate decreases the absorption of vitamin D E Alendronate decreases the absorption of calcium

B: Correct Answer :Food decreases the absorption of alendronate

50-year-old man completed ambulatory BP monitoring (ABPM).recent BP in clinic was 140/90 mmHg.ABPM, average daytime reading is 128/80 mmHg,average nighttime reading 126/78 mmHg.advise this patient? A The result is non-diagnostic of hypertension B The result is consistent with pre-hypertension C The result is diagnostic of hypertension D The result is suggestive of hypotension E The test needs to be repeated

C | The result is diagnostic of hypertension

50-year Caucasian woman 6-week hx weight loss.fam hx T1 T2 DM never been diagnosed.last months,increasing polyuria polydipsia. lost 4kg weight unintentionally.(FBG) it shows 7.5 mmol/L urine dipstick ketones 1+.most likely diagnosis? ``` A Type 1 diabetes B Type 2 diabetes C Occult malignancy D Latent autoimmune diabetes of adults (LADA) E Starvation ketosis ```

D Latent autoimmune diabetes of adults (LADA)

keen to start (COCP), associated condition should you inform patients? ``` A Intermenstrual bleeding B Ovarian cysts C Dysmenorrhoea D Menorrhagia E Polymenorrhoea ```

A Intermenstrual bleeding

48-year woman unintentional weight loss,loss of appetite SOB reduced breath sound dullness to percussion left lung.diagnostic pleural tap shows protein content >30g/L blood total protein 40. most likely diagnosis? ``` A Meig’s syndrome B Nephrotic syndrome C Liver cirrhosis D Congestive cardiac failure E Bronchogenic carcinoma ```

E Bronchogenic carcinoma

20-year nursing student overdose paracetamol tablets.not an indicator of intent? A Taking precautions against discovery B Notifying a potential helper C Drinking a volume of alcohol sufficient enough to impair judgement D Leaving a suicide note E Expressing dissatisfaction that attempt failed

B Notifying a potential helper

48-year woman systemic sclerosis ED retrosternal discomfort.true about systemic sclerosis (SSc)? A Microstomia is only seen in diffuse cutaneous systemic sclerosis B Skin involvement is limited to face, hands and feet in limited cutaneous systemic sclerosis C Oesophageal dysmotility is only seen in limited cutaneous systemic sclerosis D Anti-double stranded DNA antibodies are normally detected in patients with systemic sclerosis E Raynaud’s phenomenon occurs as a result of skin fibrosis (scleroderma)

B: Correct Answer :Skin involvement is limited to face, hands and feet in limited cutaneous systemic sclerosis

35-year man complaining back pain.after lifted heavy barbell at gym. shooting down his left leg cannot walk without support.not passed urine since the onset of pain. lower limbs, tone power cannot be assessed due to pain decreased ankle reflexes sacral anaesthesia.most appropriate next step? A:Give NSAID analgesia and complete neurological examination B:Send the patient home with NSAID analgesia and bed rest advice C:Arrange urgent MRI of spine D:Give NSAID analgesia and catheterize the patient E:Send the patient home with NSAID analgesia and advice to avoid heavy lifting

C:Arrange urgent MRI of spine

30-year man recently diagnosed HIV positive after trip to Thailand.advised to inform his wife about his diagnosis she can be tested treated if infected.refusing to tell his wife despite detailed explanation could jeopardise their marriage.most appropriate next step in management? A Apply for a court order for the notification B Encourage safe sex practice for now C Respect his autonomy and confidentiality D Call his wife to make an appointment to inform her in the clinic E Inform health authorities

E Inform health authorities

5-year boy 5-day hx fever truncal rash.bilateral conjunctivitis, tender cervical lymphadenopathy bright red tongue dry, cracked lips.completed all age-appropriate immunisation.physical findings would you expect to find? ``` A Splenomegaly B Hepatomegaly C Desquamation in extremities D Aphthous ulcers E Splinters haemorrhage ```

C Desquamation in extremities

14-year complaining bilateral breast enlargement.mildly tender palpable breast tissue bilaterally.testicular examination, unremarkable.true? A Serum liver studies will help to elucidate the cause. B Thyroid function assessment will help to elucidate the cause. C Serum oestradiol, testosterone, and luteinizing hormone levels are needed to elucidate the cause. D His serum chorionic gonadotropin level is likely to be elevated. E No further workup is necessary.

E No further workup is necessary.

55-year man regular review.interested in prostate cancer screening.best represents current guidelines for prostate cancer screening? A Screening should consist of a digital rectal examination (DRE) B Screening should consist of a serum prostate specific antigen (PSA) test C Screening should consist of both, a DRE and a serum PSA test D Screening should include a CT scan of the prostate in high-risk individuals E There is insufficient evidence to recommend for or against prostate cancer screening

E There is insufficient evidence to recommend for or against prostate cancer screening

24-year Aboriginal prenatal assessment.not immune to rubella. best time to vaccinate her against rubella? ``` A Immediately B In the second trimester of pregnancy C In the third trimester of pregnancy D In the early postpartum period E At least 4 weeks postpartum ```

A Immediately

35-year lady started on flucloxacillin for cellulitis fevers, rash deranged renal function.most suggestive of interstitial nephritis? ``` A Eosinophilia B Proteinuria < 0.5g/day C White cell cast D Red cell cast E Oxalate crystals ```

A Eosinophilia

10-year girl hx atopic dermatitis arms 5-day hx worsening itching pus discharge right forearm.lichenification right forearm excoriation marks yellow fluid discharge mild surrounding erythema.swab of this discharge for culture.organisms likely to be isolated from swab? ``` A Staphylococcus aureus B Streptococcus pyogenes C Propionibacterium acnes D Pseudomonas aeruginosa E Escherichia coli ```

A Staphylococcus aureus

``` 60-year woman ED 15-minute right eye painless visual loss morning,5-minute episode slurred speech observed.spontaneously self-resolved no neurological sequelae.hypertension on Amlodipine.BP 155/90 mmHg, pulse 90/min, RR 18/min,afebrile. cranial peripheral nervous system examinations are unremarkable. carotid pulses normal,no bruits were heard.(ECG) normal sinus rhythm, (CT) brain normal.most appropriate next investigation? A Carotid Duplex ultrasonography B CT neck angiography C Magnetic Resonance Imaging (MRI) brain D Transesophageal echocardiography (TOE) E Ophthalmology assessment ```

A Carotid Duplex ultrasonography

2-year boy red eye on left.strabismus and leukocoria of inflamed eye.most likely diagnosis? ``` A Neuroblastoma B Retinoblastoma C Cataract D Astrocytoma E Bacterial conjunctivitis ```

B Retinoblastoma

A 58-year-old man 2-week hx diarrhoea following ‘food poisoning’. six to eight bowel motions per day no blood or mucus.oral hydrations.most appropriate investigation? ``` A Full blood count B Urea and electrolytes C Stool for microscopy, culture and sensitivities (m/c/s) D Abdominal x-ray E Liver function tests ```

C Stool for microscopy, culture and sensitivities (m/c/s)

24-year man behaving increasingly ‘oddly’ for past four months. smoked marijuana ‘a few times’ but doesn’t make sense when he talks seems to be responding to things that are not there.most likely diagnosis? ``` A Substance-induced psychosis B Schizoaffective disorder C Schizophreniform disorder D Schizophrenia E Schizoid personality disorder ```

A Substance-induced psychosis

13-year girl mother concerned about the amount she is exercising. exercising at least once to twice a day.tired lost weight wears oversized clothes.gets very angry if anyone opens the bathroom door while she is in there.most possible diagnosis? ``` A Agoraphobia B Anorexia Nervosa C Borderline Personality Disorder D Conduct Disorder E Dysthymic Disorder ```

B Anorexia Nervosa

60-year woman low mood following death of husband two months previously.more consistent with depressive episode than normal bereavement reaction, except: ``` A Psychomotor retardation B Suicidal ideation C Insomnia D Delusions of poverty E Impaired social and occupational functioning ```

C Insomnia

64-year woman painful wound right foot six months not been healing despite regular dressings.diabetes mellitus, hypertension,obesity.denies pus discharge or fever.2x2 cm well-demarcated ulcer right heel of foot.base slightly necrotic and red,no slough seen.‘punched-out’ appearance.most likely diagnosis? ``` A Traumatic ulcer B Venous ulcer C Neuropathic ulcer D Arterial ulcer E Neoplastic ulcer ```

D Arterial ulcer

62-year woman complains chronic headaches eight months.constant around entire scalp no aggravating alleviating factors.denies photophobia,nausea,vomiting.retired unable to travel to visit her daughter due to the COVID-19 pandemic.most likely diagnosis? ``` A Somatic symptom disorder B Malingering C Illness anxiety disorder D Conversion disorder E Factitious disorder ```

A Somatic symptom disorder

22-year male recent diagnosis (OCD) on Fluoxetine 40mg eight weeks.moderate improvement but complains obsessions compulsions most appropriate next step in management? A Change medication to a different anti-depressant B Commence a mood stabilizer C Commence an antipsychotic D Increase the dose of medication E Maintain current treatment regime for another two weeks

D Increase the dose of medication

60-year woman complaining pain while walking.pain radiating from back of her thighs to both legs after walking 400 metres, progressively worse over last six months.affecting her work house cleaner. ankle-brachial index is 0.9 bilaterally.weak dorsiflexion of both her ankles.next step in management? A MRI lumbosacral spine B Doppler ultrasound of lower limb veins C Doppler ultrasound of lower limb arteries D Angiogram of lower limb arteries E Aspirin stat and regular

A | MRI lumbosacral spine

52-year man follow-up myocardial infarction 3 months ago successful PCI stenting.high dose atorvastatin.alanine aminotransferase creatinine levels normal.currently aspirin, metoprolol,ramipril,atorvastatin.vital signs normal physical examination unremarkable.most appropriate laboratory study? A High-sensitivity C-reactive protein (HsCRP) B Fasting lipid profile C Creatinine kinase level (CK) D Alanine aminotransferase level (ALT) E None of the above

B Fasting lipid profile

``` 80-year man dark skin lesion nose,increasing in size last ten weeks.initially small pinkish-red patch thought due to sun-damaged skin.notice 1x2cm hyperpigmented nodule everted edges deep ulcerated red base in centre.no active bleeding.most likely diagnosis? A Bowen’s disease (BD) B Keratoacanthoma C Actinic Keratosis (AK) D Basal cell carcinoma (BCC) E Squamous cell carcinoma (SCC) ```

E Squamous cell carcinoma (SCC)

``` 68-year woman alcohol dependence.husband passed away year ago,coping drinking 1 bottle wine per day,without feel jittery irritable.determined has alcohol dependence.mild liver enzymes derangement.could help reduce her alcohol consumption and increase abstinence? A Venlafaxine B Promethazine C Paroxetine D Amitriptyline E Acamprosate ```

E Acamprosate

patient hypovolaemia causing pre-renal AKI.urea rises disproportionately to creatinine.reason for this? ``` A Filtration B Tubular reabsorption C Tubular secretion D Catabolism E Synthesis ```

B Tubular reabsorption

6-year boy penicillin allergy urticaria acute tonsillitis.not have other known allergies.antibiotics would you prescribe to treat tonsillitis? ``` A Oral ciprofloxacin B Intravenous ceftriaxone C Stat dose of intramuscular benzylpenicillin D Oral cefuroxime E Oral cefalexin ```

E Oral cefalexin

35-year obese Caucasian woman complaining tiredness.given birth healthy baby girl three weeks ago.more dependent increasingly exhausted low in mood.poor appetite gained five kilograms past two weeks.most likely diagnosis? ``` A Occult malignancy B Hypothyroidism C Hyperthyroidism D Eating disorder E Postpartum depression ```

B Hypothyroidism

patient atrial fibrillation chronic renal failure treated bisoprolol warfarin.cause sub-therapeutic International Normalised Ratio (INR) level? ``` A Spironolactone B Ritonavir C Rifampicin D Hydrochlorothiazide E Dexamethasone ```

C Rifampicin

74-year man diabetes chronic osteoarthritis (OA) knees increasing pain increasing difficulty mobility.ibuprofen, naproxen, paracetamol ineffective.relief from steroid injections three months one month ago, short-lived.bilateral knee x-rays severe knee OA significant malalignment.most appropriate treatment option? ``` A Use oral steroids B Try another steroid injection C Inject the knee joint with ketorolac D Inject hyaluronic acid into his knee joints E Refer for total knee replacements ```

E Refer for total knee replacements

52-year man progressively worsening dysphagia last 6 months.trouble swallowing even liquids lost 15kg last 4 weeks.chronic smoker of 40 pack-years,next step of investigation? ``` A Gastroscopy B PET scan C MRI scan D Barium swallow E Chest X-ray ```

D Barium swallow

35-year man considered for splenectomy refractory (ITP).not part of recommended splenectomy vaccination schedule? ``` A Pneumococcal B Meningococcal C Haemophilus influenzae type B D Annual influenza vaccine E None of the above ```

E None of the above

34-year woman raised BP six months.BP 154/90 mmHg to 170/96 mmHg. asymptomatic fit well.most likely cause of her raised blood pressure? ``` A Adult polycystic kidney disease (PCKD) B Renal artery stenosis (RAS) C Cushing's syndrome D Primary hyperaldosteronism E Primary hypertension ```

E Primary hypertension

24-year female sharp central chest pain,worsened by inspiration lying flat,improves with leaning forward.(ECG)done.changes most likely to see? ``` A U waves B J waves C Shortened PR interval D Widespread ST depression E Widespread ST elevation ```

E Widespread ST elevation

13-year boy short stature.his height 3rd centile,mid parental height 50Th centile no sign of puberty.options will you convey to his parents? A His bone age is most likely delayed B Klinefelter syndrome, and you would like to perform further genetic tests to confirm C Reassure that this is a variant of a normal development and he will eventually reach mid-parental height D 6-monthly growth hormone injections to ensure normal development E Likely to always stay in the 3rd centile for height

A His bone age is most likely delayed

elderly patient Parkinson’s disease.mental state examination (MSE),represents decrement in speech commonly seen? ``` A Word salad B Receptive aphasia C Expressive aphasia D Neologisms E Progressively inaudible speech ```

E Progressively inaudible speech

couple trying to conceive least two years without success.sexual activity is normal 2-3 times per week.investigations done first? ``` A Semen analysis B Hysterosalpingography C Sperm penetration assay D Uterotubal CO2 insufflation E Endometrial biopsy on day 22-24 ```

A Semen analysis

5-year girl MVA fractured her arm.helicopter to nearest hospital. six months since the accident.continues to refuse to go into the car.crashes the cars seems distressed.wakes up at night screaming say ‘car’.likely diagnosis? ``` A Anxiety disorder B Oppositional defiant disorder C Posttraumatic stress disorder (PTSD) D Sleep terror E Adjustment disorder ```

C Posttraumatic stress disorder (PTSD)

9-year boy asthma control.diagnosed one year ago.inhaled salbutamol.increased use of his inhaler more frequently recently. developed more frequent nocturnal coughs,2-3 times per week.most appropriate next step in management? A Start him on inhaled fluticasone and salmeterol B Start him on inhaled fluticasone C Start him on a 14-day course of oral steroids D Start him on montelukast E Start him on sodium cromoglycate

B | Start him on inhaled fluticasone

40-year man 4-day hx haematuria.several (UTIs) renal stones. Abdominal examination unremarkable.Urine hypercalciuria excretion urography reveals small calculi papilla right kidney.most likely diagnosis? ``` A Medullary sponge kidney B Renal cell carcinoma C Medullary cystic disease D Horse-shoe kidney E Tertiary hyperparathyroidism ```

A Medullary sponge kidney

substances,taken during pregnancy,associated with behavioural developmental abnormalities in children? ``` A Tobacco B Cocaine C Caffeine D Marijuana E LSD ```

A Tobacco

30-year smoker.fam hx cancers.not associated with an increased risk of malignancy? ``` A Red meat B Mono Sodium Glutamate (MSG) C Smoked foods D Obesity E Alcohol ```

B Mono Sodium Glutamate (MSG)

2-year boy ED multiple injuries,fractured arm orbital damage. would you NOT do? A Interview the child B Interview the parents C Treat the child’s injury immediately D Refer to Child Protection Services for urgent protection order against the parents E Notify the Suspected Child Abuse and Neglect (SCAN) team

D Refer to Child Protection Services for urgent protection order against the parents

36-year man ED hx pain left knee.fever feeling generally unwell. left knee is swollen,warm severely limited range of motion due to pain.most appropriate next step? A Empirical intravenous antibiotic treatment B X-rays of the right knee C Aspiration of the joint and blood cultures D Referral for physiotherapy E Immobilize the joint

C Aspiration of the joint and blood cultures

50-year woman diagnosed bronchiectasis.3-month hx productive cough.NOT cause of bronchiectasis? ``` A Bronchogenic carcinoma B Left ventricular failure C Recurrent pneumonia D Cystic fibrosis E Kartagener’s syndrome ```

B Left ventricular failure

``` 60-year obese man hypertension clinic.BP 149/95 poorly controlled T2 diabetes.elevated serum urea creatinine.ultrasound asymmetry B/W 2 kidneys audible abdominal bruits are auscultated.urine dipstick not detect any blood or protein.best investigation of choice? A CT angiography B Doppler ultrasonography C Abdominal x-ray D Renal arteriography E Renal biopsy ```

D Renal arteriography

``` 25-year waitress fall at work sustained deep laceration left forearm broken glass.left hand distal capillary refill less than two seconds hand is clawed numbness ring little fingers.unable to grip a piece of paper between first web space,flexes her thumb interphalangeal joint.nerves is affected? A Radial nerve B Ulnar nerve C Median nerve D Medial cutaneous nerve of the forearm E Axillary nerve ```

B Ulnar nerve

nulliparous 25-year woman,hx (DVT) side effects (COCP),like to discuss contraception for at least the next three years. Which is the best recommendation? ``` A Implanon (etonogestrel) B Condoms C Progesterone-only pill (POP) D COCP E Mirena (levonorgestrel) ```

E Mirena (levonorgestrel)

22-year man multiple transient jaundice.jaundice following increased exercises subside after few days.asymptomatic feels well.(FBC) reticulocyte count normal,(LFT) total bilirubin 38 (normal: 0-17 ).most appropriate management? ``` A Refer to Haematology B Refer for magnetic resonance cholangio-pancreatography (MRCP) C Refer for abdominal ultrasound D Commence short course of steroids E Reassure and discharge ```

E Reassure and discharge

68-year man heart failure reduced ejection fraction (HFrEF) atrial fibrillation (AF) combination of medications.nausea anorexia troubled by yellow rings around lights.pulse 56 irregular, BP 130/70 mmHg.medications is likely to be responsible for these symptoms? ``` A Bisoprolol B Furosemide C Digoxin D Spironolactone E Ramipril ```

C Digoxin

60-year woman lung cancer.choosing radiation therapy over surgery,5-year survival rate for radiation is lower than surgery. You think surgery is better option.ethical principle of autonomy, is correct? A You should refuse to treat the patient. B You should comply with the patient’s treatment request. C The patient should have surgery because of physician autonomy. D You should explain your preferences for treatment, then honour the patient’s preference. E The patient must respect your decision because the principle of physician paternalism overrides patient autonomy in this case.

D You should explain your preferences for treatment, then honour the patient’s preference.

residents surgical ward night shift.50 years old man complaining difficulty breathing.left-sided hemithyroidectomy three hours ago.patient tachypnoeic noticed large neck swelling under surgical wound.next step in management in addition to calling your senior colleague for help? ``` A High flow oxygen B Immediate removal of neck wound sutures C Ultrasound D CT scan E Chest X-ray ```

B Immediate removal of neck wound sutures

32-year nulliparous nurse requests elective Caesarean delivery. NOT true? A Caesarean delivery reduces risk of early postpartum haemorrhage B Caesarean delivery reduces risk of pelvic floor injury C Caesarean delivery does not reduce non-respiratory neonatal disorders D Caesarean delivery prevents late stillbirth E Caesarean delivery has increased risks of short-term neonatal respiratory problems

C Caesarean delivery does not reduce non-respiratory neonatal disorders

36-year pregnant woman first trimester screen-positive (PAPP-A and fbHCG) Down syndrome.asks another test to exclude false positivity.best non-invasive secondary screening test? A Cell-free DNA B Chorionic villus sampling (CVS) C Amniocentesis in second trimester D Second trimester quadruple test – AFP, uE3, HCG, DIA E Ultrasound measurement of nuchal translucency (NT)

A Cell-free DNA

46-year woman painless lump right breast increasing in size last three months.non-tender,firm mass located upper outer quadrant right breast, 2 cm.no palpable axillary node.underwent lumpectomy axillary node sampling right breast lesion HER2 positive ER/PR negative.added to her treatment plan? ``` A Tamoxifen B Anastrozole C Bilateral modified radical mastectomy D Chemotherapy alone E Trastuzumab ```

E Trastuzumab

25-year female painless right breast lump noticed 2 weeks.2 cm, and another smaller left breast mass. Both mobile firm on palpation no skin changes.next investigation to help diagnosis? ``` A CT chest B MRI brain C Ultrasound breasts D Mammography E Serum prolactin ```

C Ultrasound breasts

``` 65-year man 4-month hx progressive SOB on exertion dry coughs. atrial fibrillation, HTN diabetes.oxygen sat 92% room air.bi-basal fine inspiratory crackles.medication most likely causing symptoms? A Pamidronate B Atorvastatin C Amiodarone D Metformin E Amlodipine ```

C Amiodarone

20-year female disabling anxiety speak in group activities required.most likely diagnosis? ``` A Acute stress disorder B Agoraphobia C Generalised anxiety disorder D Panic disorder E Social anxiety disorder ```

E Social anxiety disorder

patient weight loss jaundice.urinalysis raised urinary bilirubin, absent urobilinogen.most likely cause of jaundice? ``` A Simvastatin use B Cholangiocarcinoma C Hepatocellular carcinoma D Budd-Chiari syndrome E Gilbert’s syndrome ```

B Cholangiocarcinoma

65-year male 16-month hx memory impairment.forgotten attend son’s wedding.able to manage finances independently.(MMSE) 27/30,major points lost short-term recall.(MRI) periventricular white matter changes.most likely diagnosis? ``` A Alzheimer’s dementia B Frontotemporal dementia C Mild cognitive impairment D Normal ageing E Vascular dementia ```

C Mild cognitive impairment

75-year man chemical plant 30 years,painless haematuria.transurethral endoscopic resection transitional cell carcinoma bladder carcinoma in-situ.most appropriate next step in management? ``` A Radiotherapy B Intravesical BCG C Radical cystectomy D Regular cystoscopy surveillance E Partial cystectomy ```

B Intravesical BCG

``` 30-year G2P1 labour ward 28 weeks gestational age complaining sudden onset profuse vaginal bleeding.denies abdominal pain or uterine contractions.hx previous Caesarean section at term for fetal breech presentation.smoking several cigarettes a day denies drug or alcohol.most likely placental etiology? A Succenturiate placenta B Vasa previa C Placenta previa D Membranaceous placenta E Placenta accreta ```

C Placenta previa

resident ED. 65-year lady vertigo sudden hearing loss right ear tinnitus ipsilateral facial weakness.most likely diagnosis? ``` A Meniere disease B Vestibular neuritis C Acoustic neuroma D Brainstem infarction E Benign paroxysmal positional vertigo ```

D Brainstem infarction

65-year married man severe depression.psychiatrist past three months.crying spells,insomnia,decreased appetite.suicidal ideation.auditory hallucinations.symptoms persist despite maximal dose sertraline, venlafaxine, or citalopram.now using duloxetine thinks not helpful.most likely provide rapid relief? A Behavioural modification B Stopping duloxetine and starting on a monoamine oxidase inhibitor (MAOI) C Bupropion D Electroconvulsive therapy (ECT) E Urgent appointment with his treating psychiatrist

D Electroconvulsive therapy (ECT)

child post-natal check-up.displays characteristics of Down Syndrome.most appropriate next step in management? A:Tell the parents you think the baby has Down Syndrome and you would like to order further tests for the child B:Tell the parents you think the baby has Down Syndrome and you would like to order further tests for the child and the parents C:Confirm the diagnosis of Down syndrome to the parents D:Refer to paediatrician for further management E:Order genetic tests to confirm the diagnosis first without informing the parents

A:Tell the parents you think the baby has Down Syndrome and you would like to order further tests for the child

65-year chronic smoker myocardial infarction 4 weeks ago (ECG) persistent ST elevation (TTE) shows a mural thrombus.most likely diagnosis? ``` A Mitral regurgitation B Unstable angina C Left ventricular aneurysm D Ventricular septal defect E Dressler's syndrome ```

C Left ventricular aneurysm

25-year man fell balcony house party ED week later right upper limb internally rotated position elbow extended,forearm pronation wrist fingers flexed.most likely diagnosis? A Upper brachial plexus injury (Erb-Duchenne palsy) B Lower brachial plexus injury (Klumpke’s palsy) C Suprascapular nerve avulsion D Long thoracic nerve avulsion E Combined upper and lower brachial plexus injury

A Upper brachial plexus injury (Erb-Duchenne palsy)

28-year man painless lump left testicle.ultrasound testicular tumour non-seminomatous tumour.beta-HCG AFP levels raised staging CT reveals lung metastases (Stage IIIB disease).most likely treatment for tumour type? ``` A Orchidectomy followed by radiotherapy B Orchidectomy followed by chemotherapy C Orchidectomy only D Radiotherapy followed by orchidectomy E Chemotherapy only ```

B Orchidectomy followed by chemotherapy

6-year boy mother concerned child not been entirely well lately. following is contraindication to vaccinating the child? A Previous vaccination reaction that includes wheezing and hypotension B History of an allergic reaction to penicillin C Previous vaccination reaction that includes fever and fussiness that lasted for one days D Acute otitis media with a temperature of 38C requiring antibiotics therapy E None of the above is a contraindication

A Previous vaccination reaction that includes wheezing and hypotension

``` 30-year Caucasian man (HIV) painless ulcer glans penis.unprotected sex sex worker.not missed his anti-retroviral medications.most likely cause of lesion? A Chancroid B Donovanosis C Lupus vulgaris D Syphilis E Herpes simplex ```

D Syphilis

``` 10-year motor vocal tics obsessive-compulsive symptoms worse in winter spring months.most important to exclude before starting treatment Tourette disorder? A Rett disorder B Marijuana abuse C Autism D Environmental allergies E Streptococcal infection ```

E Streptococcal infection

opioid therapies severe pain secondary to metastatic malignancies,limit the use of high dose opioids? ``` A Hypotension B Renal failure C Gastrointestinal upset D Respiratory depression E Delirium ```

D Respiratory depression

3-year girl 5 days hx diarrhoea undigested vegetables faeces.no fever or abdominal pain.similar presentation happened 2 weeks ago.most likely diagnosis? ``` A Coeliac disease B Toddler’s diarrhoea C Crohn’s disease D Hirschsprung disease E Ulcerative colitis ```

B Toddler’s diarrhoea

18-year male manic psychosis symptomatic improvement Olanzapine 5mg.symptoms overvalued grandiose beliefs heightened sense self-importance.appropriate next step in management? ``` A Change to a different atypical antipsychotic B Increase the dose of medication C Commence an antidepressant D Maintain current treatment regime E Reduce dose of medication ```

D Maintain current treatment regime

36-year female falls road bike type 1 open fracture right tibia fibula.dressed fractured immobilised ED.adequate analgesics before transferring to ward.2 hours later,complains 10 out of 10 pain despite opioid analgesia.pain aggravated passive dorsiflexion right foot persists despite removal of splint. Capillary refill right foot 3 seconds but dorsal pedis posterior tibial pulses palpable.most likely cause of her signs and symptoms? ``` A Suboptimal pain management B Critical limb ischaemia C Acute compartment syndrome D Necrotising fasciitis E Acute rhabdomyolysis ```

C Acute compartment syndrome

``` 64-year man acute dyspnoea pulmonary oedema.responded well to IV nitrates diuretics sent home furosemide 40mg OD ramipril 5mg OD.reports walking unlimited distances on flat,negotiate stairs without significant SOB.heart rate 80 bpm,regular,BP 110/70 mmHg.(ECG): normal (TTE): dilated left ventricle poor left ventricular function Coronary angiography: normal most appropriate drug to add? A Candesartan B Bisoprolol C Atenolol D Spironolactone E Digoxin ```

B Bisoprolol

25-year woman T1 diabetes confused (DKA).BP 86/50 mmHg HR 130 blood glucose 35 mmol/L,bicarbonate 10 mmol/L,potassium 6.2,pH 7.21 blood ketone 3.0 mmol/L. most appropriate initial treatment? A Commence intravenous dopamine infusion, then insulin at 10 U/h B Administer 20 units fast acting insulin intramuscularly, and normal saline at 250 mL/h C Commence 1000 ml/h bolus intravenous normal saline and insulin infusion at 10 U/h D Commence 1000 ml/h bolus intravenous normal saline with KCl 20 mmol/L and insulin 10 U/h E Administer 10 units of subcutaneous insulin stat and 10% calcium gluconate infusion

C | Commence 1000 ml/h bolus intravenous normal saline and insulin infusion at 10 U/h

counselling mother child’s immunization schedule.benefit from (Hib) vaccine.true about this vaccine? A The vaccine is between 95% and 100% effective in preventing invasive Hib disease. B The vaccine will help to prevent otitis media caused by H influenzae. C Adverse reactions to the vaccine include an unusual high-pitched cry, high fevers, and seizures. D The first vaccine should be administered at birth. E The vaccine cannot be given concurrently with other vaccines.

A The vaccine is between 95% and 100% effective in preventing invasive Hib disease.

48-year female pain shoulder,neck lower back four months.waking up at night due to pain.experiencing fatigue headaches.tenderness several points body.Thyroid function tests (ESR) blood tests normal.next best step in management at this time? A Start the patient on low dose prednisone B Start the patient on a low impact aerobic exercise program C Start NSAIDs D Obtain ANA blood levels E Perform a diagnostic electromyogram (EMG) test

B Start the patient on a low impact aerobic exercise program

5-month boy becomes stiff,hunches forward,draws legs flings arms outward.20 episodes each day.developmental delay previously.most likely diagnosis? ``` A Temporal lobe epilepsy B Infantile spasm C Lennox-Gastaut Syndrome D Frontal lobe epilepsy E Sandifer syndrome ```

B Infantile spasm

55-year man ED chest pain.initial evaluation options most important diagnostic test? A Electrocardiogram B Troponin levels C Chest radiograph D CT pulmonary angiogram E Lipids and cholesterol profile

A | Electrocardiogram

``` 15-year female T1 diabetes 3-week hx increasing lethargy,loss appetite,nausea vomiting.cannot stand for long feel dizzy.increased pigmentation palmar creases buccal membranes. investigations you order to facilitate diagnosis? A ACTH and cortisol levels B Growth hormone level C HbA1c D Thyroid antibodies E Insulin C-peptide ```

A ACTH and cortisol levels

45-year Caucasian woman coeliac disease complains itchy blisters elbows.skin biopsy microabscesses neutrophils tips dermal papillae.dapsone treatment to control gastrointestinal skin lesions. Before starting should you send to determine its level? ``` A Thiomethyltransferase B Steroid sulfatase C Lactate dehydrogenase D Glucose-6-phosphate dehydrogenase E Alpha-galactosidase ```

D Glucose-6-phosphate dehydrogenase

30-year man undergoes sigmoidoscopy chronic diarrhoea unintentional weight loss.rectum,mucosa inflamed friable.rectal biopsy mucosal ulcers inflammatory infiltrate,crypt abscesses goblet cell depletion.most likely diagnosis? ``` A Irritable bowel syndrome (IBS) B Crohn’s disease C Ulcerative colitis (UC) D Pseudomembranous colitis E Undifferentiated colitis ```

C Ulcerative colitis (UC)

80-year female 24-hour confusion visual hallucinations after fall at home.most appropriate investigation? ``` A Vitamin B12 B Electroencephalogram (EEG) C Serum calcium D Thyroid function test (TFT) E CT head ```

E CT head

2-year girl jerking movements all four limbs lasts 2 minutes.unwell tonsillitis temperature 39°C.third time event. most likely diagnosis? ``` A Febrile convulsion B Absence seizure C Sandifer syndrome D Dravet syndrome E Breath holding attacks ```

A Febrile convulsion

``` surgical resident 40-year female subtotal thyroidectomy morning now febrile 39°C tachycardic pulse 110 beats.previously thyrotoxic patient made euthyroid medically prior to surgery. most likely diagnosis? A Thyroid storm B Pulmonary embolism C Pulmonary atelectasis D Septicaemia E Surgical site infection ```

C Pulmonary atelectasis

``` 36-year female pianist 2-month hx stiff hands wrists.pain particularly first few hours after waking up affecting her work. wrists,metacarpophalangeal joints proximal interphalangeal joints are swollen and warm.most likely diagnosis? A Rheumatoid arthritis B Osteoarthritis C Septic arthritis D Polymyalgia rheumatica E Reactive arthritis ```

A Rheumatoid arthritis

60-year woman (GI) endoscopy 3-month hx epigastric pain treatment antacids pantoprazole 40mg daily.duodenal ulcer a positive campylobacter-like organism (CLO) test.no past medical hx no drug allergies.most appropriate treatment. A Seven-day course of twice daily esomeprazole 20 mg, 1 g amoxicillin and 500 mg clarithromycin B Seven-day course of twice daily esomeprazole 20 mg C Seven-day course of twice daily esomeprazole 20 mg and 1 g amoxicillin D Seven-day course of twice daily esomeprazole 20 mg and 500 mg clarithromycin E Seven-day course of twice daily 1 g amoxicillin and 500 mg clarithromycin

A Seven-day course of twice daily esomeprazole 20 mg, 1 g amoxicillin and 500 mg clarithromycin

``` 40-year woman dilated cardiomyopathy complaining persistent dry cough cardiology clinic.walk two stairs without difficulty.currently ramipril 10mg OD,aspirin 100mg OD, carvedilol 6.25mg BD furosemide 40mg OD.HR 75 bpm regular,BP 105/70.The apex beat deviated laterally.Both heart sounds normal, chest is clear.next step in management? A Add Digoxin B Increase furosemide to 40mg BD C Reduce carvedilol to 3.125mg BD D Swap ramipril to candesartan E Add spironolactone ```

D Swap ramipril to candesartan

``` 60-year woman background hx chronic renal failure progressive glomerular disease last six years.BP 140/95.elevated phosphate, serum creatinine urea,calcium low.GFR 38.cholesterol levels moderately raised.low phosphate diet.most appropriate management? A Sevelamer B Parathyroidectomy C Oral vitamin D D Cinacalcet E Renal dialysis ```

A Sevelamer

``` 10-year boy 1-year-hx intermittent abdominal pain,poor appetite weight loss.looks thin notice erythema nodosum both shins.most likely diagnosis? A Crohn’s disease B Coeliac disease C Henoch-Schonlein purpura D Hyperthyroidism E Ulcerative colitis ```

A Crohn’s disease

35-year woman admitted aggression damaged sister’s house heated argument.no recollection of incident.provides vague details told she did $10,000 worth property damage.raised legal consequences of her actions.refuses to allow consent for collateral information to be gathered.can’t remember anything else surrounding the incident not appear distressed.most likely diagnosis? ``` A Posttraumatic stress disorder B Malingering C Factitious disorder D Dissociative identity disorder (DID) E Borderline personality disorder (BPD) ```

B Malingering

26-year man 3 years progressive dysphagia.barium swallow bird’s beak appearance.balloon dilatation unsuccessful.most appropriate surgical management? ``` A Oesophagectomy B Circumferential Nissen fundoplication wrap C Surgical (Heller) myotomy D Rigid oesophagoscopy E Gastric bypass ```

C Surgical (Heller) myotomy

17-year girl 6-month hx daytime somnolence.affecting daily life dose off during lectures while socialising.fallen asleep while driving before vivid nightmares while falling asleep,frighten wake up her frequently.Sometimes cannot move upon awakening few minutes.Holter monitoring event sudden collapse during intense argument months ago,not reveal an arrhythmic event.oral contraceptive pill.(ECG) sinus rhythm partial right bundle branch block.likely diagnosis? A Long QT syndrome B Narcolepsy C Epilepsy D Hypertrophic obstructive cardiomyopathy E Acute intermittent porphyria

B Narcolepsy

``` 95-year man prostatism.DRE ill-defined,hard,asymmetrical prostate.(PSA) level significantly elevated.Transrectal ultrasound localised prostate carcinoma.most appropriate management? A External beam radiotherapy B Radical prostatectomy C Active surveillance D Hormone therapy E Transurethral resection of prostate ```

D Hormone therapy

45-year woman pain both hands wrists past several months.morning stiffness lasts for hour.tenderness swelling both hands wrists on examination,proximal interphalangeal joints.(anti-CCP).immune-mediated injuries responsible? A Self-tolerance B Both type II and III hypersensitivities C IgE-mediated immune responses only D Type IV hypersensitivity E Type III hypersensitivity

E Type III hypersensitivity

``` 39-year man severe headache.two hours ago at work.affected left side head 10 out of 10.mild photophobia.stress at work lately.similar episode four months ago lasted two weeks, barely controlled by simple analgesics rests.denies recent falls or head strikes.afebrile.distressed,holding head left cannot sit still during consult pace around.most likely diagnosis? A Cluster headache B Subarachnoid hemorrhage C Tension headache D Intracranial hypertension E Migraine ```

A Cluster headache

18-month girl with father in mall.cry vigorously stops breathing.cyanosed,loses consciousness tonic-clonic seizure.10 minutes later,alert interactive.BP 90/60mmHg,pulse 100/min, temperature 37.5°C neurological normal.most likely diagnosis? A Febrile convulsion B Breath-holding spell C Epilepsy D Syncopal episode E Encephalitis

B | Breath-holding spell

``` 50-year woman intermittent crushing chest pain dysphagia.relieved 15 minutes after (GTN).ECG serial troponins normal.barium swallow done to investigate.likely to be shown? A Zenker’s diverticulum B Hiatus hernia C Corkscrew oesophagus D Dilated tapering oesophagus E Bird beak appearance ```

C Corkscrew oesophagus

``` 30-year lady started new medication bipolar disorder.drink more water than usual.most likely culprit medication? A Diazepam B Haloperidol C Lithium D Mirtazapine E Sodium Valproate ```

C Lithium

``` 30-year woman 24-hour hx watery diarrhoea.bowels 10 times.nausea vomiting abdominal cramps pain started in evening barbeque meal afternoon.pulse rate 80 bpm,BP 130/75 mmHg temperature 37.4°C.tenderness epigastric region bowel sounds hyperactive.normally fit no past medical hx.most likely diagnosis? A Crohn’s disease B Laxative abuse C Ulcerative colitis D Gastroenteritis E Irritable bowel syndrome ```

D Gastroenteritis

75-year woman currently day seven post humeral operation traumatic fracture sustained from recent fall.CKD,unfractionated heparin 5000IU BD for (DVT) prophylaxis.(FBC) platelet count 225 (day one) to 50x109/L (day seven). She is otherwise well with nil evidence of thrombosis. What is the next best step in management? A Order a HIT (heparin-induced thrombocytopenia) screen, and continue on heparin until result is available B Stop heparin immediately and switch to fondaparinux C Stop heparin immediately and wait for the platelet count to improve D Switch to enoxaparin E Switch to dalteparin

B Stop heparin immediately and switch to fondaparinux

25-year schoolteacher 5kg unintentional weight gain,hair loss, dry skin,fatigue.thought hypothyroidism.consistent with this? ``` A Low TSH and high T4/T3 levels B High TSH levels and normal T4/T3 C High TSH levels and low T4/T3 D Normal TSH and high T4/T3 levels E Normal TSH and normal T4/T3 levels ```

C High TSH levels and low T4/T3

``` 60-year woman 30 minutes hx crushing central chest pain.cannon A waves in (JVP),bradycardic 40 bpm.(ECG) done.expect to see ST-segment elevations? A Diffuse in all leads B V5, V6, I, aVL C V3, V4 D V1, V2 E II, III, aVF ```

E II, III, aVF

``` 70-year man diagnosed lung cancer four months ago not expected to live more than 2 months.dyspnoea.chest x-ray progression of cancer,pulse ox 95%.most likely to relieve symptoms? A Salbutamol B Nebulized morphine C Steroids D Opioids E Benzodiazepines ```

D Opioids

``` 4-year girl fever headache.photophobia neck stiffness.CSF: protein 0.8g/L (raised),glucose 2.6 mmol/L,lymphocyte 8 x 106/L.No organism noted on Gram stain neutrophil count zero. most likely causative pathogen? Normal range: Protein <0.4 g/L Glucose ≥2.5 mmol/L Neutrophil count 0 Lymphocyte count ≤5 A:Echovirus B:Haemophilus influenzae type B C:Herpes virus simplex D:Streptococcus pneumoniae E:Neisseria meningitides ```

A:Echovirus

``` gout hypertension,anti-hypertensive agents most likely help control gout? A:Perindopril B:Losartan C:Amlodipine D:Hydrochlorothiazide E:Furosemide ```

B:Losartan

``` John believes in ‘spirit world’.parents always spoken of it when he was young.accepts that it is difficult to prove.best describes this scenario? A Thought blocking B Phobia C Pathological lying D Overvalued idea E Bizarre delusions ```

D Overvalued idea

``` 40-year woman worsening visual disturbance.double vision frequent past two weeks.experiences palpitations restlessness. On examination,heart rate 95/ min,regular.raised painless lesions shins with digital clubbing fingers toes.most likely diagnosis? A Plummer’s disease B Grave’s disease C Pheochromocytoma D Thyroid storm E De Quervain’s thyroiditis ```

B Grave’s disease

``` 24-year man distress.complains scrotal pain last three days, not improved with simple analgesia.pain radiates lower abdomen. sexually active multiple sexual partners.some relief of pain upon elevation of scrotum,cremasteric reflex is intact.most appropriate choice for empiric antibiotics? A Ciprofloxacin B Levofloxacin C Ceftriaxone and doxycycline D Azithromycin E Amoxicillin ```

C Ceftriaxone and doxycycline

``` 78-year man metastatic prostate cancer managed in community by palliative care outreach clinic.currently on 160mg modified-release morphine sulfate twice a day and 40mg short-acting morphine four times a day to control his pain.admitted today due to significant deterioration for further management with syringe driver infusion as he is no longer able to swallow his oral medications.In converting her morphine dosage into the syringe driver, how much subcutaneous morphine should be charted to control his breakthrough pain? A 20 mg B 40 mg C 80 mg D 120 mg E 240 mg ```

C 80 mg

``` 32-year Iranian man ED oral ulcers, genital ulcers painful legs.aphthous ulcers in mouth,genital ulceration,erythema nodosum shins bilaterally.skin pathergy test returns positive. What is the most likely diagnosis? A Henoch–Schönlein purpura B Lyme disease C Berger’s disease D Caplan’s syndrome E Behcet’s disease ```

E Behcet’s disease

``` 50-year woman BMI 35 completed adjuvant radiotherapy for breast cancer 3 months ago.pain redness over skin of lower half of breast.no mass palpable breasts and axillary nodes.area of diffuse erythema tender to touch.most likely diagnosis? A Postoperative infected haematoma B Inflammatory breast cancer C Periductal mastitis D Breast abscess E Breast cellulitis ```

E Breast cellulitis

passAMCQ SHORT MCQS Flashcards

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