passAMCQ SHORT MCQS Flashcards
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
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
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
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
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
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
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)
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
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
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
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
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)
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
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
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
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
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
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
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
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
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
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
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
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
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
