00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Secs)
Retry this test Dashboard

  • Question 1 - A 54 year old female has complained of a sudden and severe pain...

    Incorrect

    • A 54 year old female has complained of a sudden and severe pain on the left side of her skull. She is also experiencing pain in and around her jaw. What is the most appropriate next step in her treatment?

      Your Answer: CT

      Correct Answer: ESR

      Explanation:

      A diagnosis of giant cell arteritis or temporal arteritis is likely here as many points favour it. She is over 50 years old, is female, has severe pain in the left half of her skull, and is complaining of pain around the jaw (jaw claudication).

    • This question is part of the following fields:

      • Seriously Ill
      11.4
      Seconds

  • Question 2 - A 35-year-old chronic smoker complains of pain in the calf while walking. This...

    Incorrect

    • A 35-year-old chronic smoker complains of pain in the calf while walking. This symptom has been increasing in severity for 4 months. There is a painful ulcer at the base of left first toe, which despite treatment has not improved. Dorsalis pedis and posterior tibial pulses were absent on the same side. What is the most compatible diagnosis of this presentation?

      Your Answer:

      Correct Answer: Thromboangitis Obliterans

      Explanation:

      Thromboangitis obliterans or Buerger’s disease is an inflammatory vasculopathy which is characterized by an inflammatory endarteritis and mainly affects small and medium-sized arteries as well as veins of the upper and lower extremities. It is caused by a prothrombotic state and subsequent obstruction of blood vessels. Ischemic pain, features of inflammation along the vein affected, Raynaud’s phenomenon and painful non-healing ulcers are common presentations.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 3 - A 30 year male admitted following a stab injury to his left upper...

    Incorrect

    • A 30 year male admitted following a stab injury to his left upper chest. He complained of difficulty in breathing. On examination his chest movements were unequal on the left side. Which of the following nerves is most likely to be damaged?

      Your Answer:

      Correct Answer: Left phrenic nerve

      Explanation:

      Difficulty in breathing and unequal chest movements are due to paralysis of the diaphragm. So the nerve affected is the left phrenic nerve.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 4 - A 19-year-old football player was hit in his chest by an opponent. He...

    Incorrect

    • A 19-year-old football player was hit in his chest by an opponent. He became breathless and turned blue. What will be the initial management?

      Your Answer:

      Correct Answer: Give oxygen

      Explanation:

      As the patient is turning blue, giving oxygen will be the first priority in his management.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 5 - A 56 year old male has presented with visual loss on his left...

    Incorrect

    • A 56 year old male has presented with visual loss on his left side and a history of right sided weakness. Where is the occlusion in this patient?

      Your Answer:

      Correct Answer: Carotid artery

      Explanation:

      The carotid artery divides itself into two parts: the internal carotid and the external carotid. The internal carotid continues down as the middle cerebral and gives rise to the ophthalmic branch. For this reason, middle cerebral occlusion may give rise to partial visual loss but not complete mono-ocular blindness. Middle cerebral artery occlusion causes paralysis or weakness of contralateral face and arm (faciobracheal). It also causes sensory loss of the contralateral face and arm. Anterior cerebral artery occlusion causes paralysis or weakness of the contralateral foot and leg. Again, sensory loss is experienced at the contralateral foot and leg.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 6 - A 15-year-old boy was admitted to the ED with a history of sudden...

    Incorrect

    • A 15-year-old boy was admitted to the ED with a history of sudden onset chest pain and difficulty in breathing after strenuous exercise. On examination, there was reduced breath sounds on the right side but he was not cyanosed. He maintained oxygen sats of 93% on air. What is the single most appropriate investigation?

      Your Answer:

      Correct Answer: CXR

      Explanation:

      The history and examination is suggestive of a spontaneous pneumothorax. The best investigation that can be performed at this stage is a CXR. Spontaneous primary pneumothorax occurs in the absence of a known lung pathology. Proposed risk factors shown to predispose patients to primary spontaneous pneumothorax (PSP) include smoking, family history, Marfan syndrome, homocystinuria, and thoracic endometriosis.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 7 - From the list of options, choose the most likely anaesthetic or analgesic cause...

    Incorrect

    • From the list of options, choose the most likely anaesthetic or analgesic cause of maternal hypotension.

      Your Answer:

      Correct Answer: Epidural anaesthetic

      Explanation:

      In spinal anaesthesia, the needle parts the dura rather than tears it. In an epidural, however, the needle is meant to inject around the dura but may penetrate it by accident. Maternal hypotension is most likely to be caused by dural penetration during an epidural, as this is the generally intended procedure. Postdural puncture headache appears to be associated higher with a spinal than an epidural.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 8 - A 65-year-old male was admitted to ED with acute onset left side upper...

    Incorrect

    • A 65-year-old male was admitted to ED with acute onset left side upper and lower limb weakness and slurred speech. Which of the following is the most appropriate initial investigation?

      Your Answer:

      Correct Answer: CT scan of brain

      Explanation:

      The history is suggestive of cerebral stroke and the investigation of choice at most hospitals would be a CT brain. Non-contrast CT scanning is the most commonly used form of neuroimaging in the acute evaluation of patients with apparent acute stroke. MRI scan is more sensitive but availability and cost make this a less likely option.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 9 - A 58 year old woman with a longstanding history of hypertension arrives at...

    Incorrect

    • A 58 year old woman with a longstanding history of hypertension arrives at the hospital complaining of recurrent falls when trying to get out of bed or get up from sitting. She is currently on an anti hypertensive regimen? What do you think is most likely responsible for her falls?

      Your Answer:

      Correct Answer: Thiazide

      Explanation:

      The causes of orthostatic hypotension include the following: Hypovolemia (a drop in the volume of blood) and dehydration (low fluid volume in the body). Common causes of these are bleeding, elevated sugar, diarrhoea, vomiting, and medications like thiazide diuretics (HCTZ) and loop diuretics (furosemide, bumetanide)

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 10 - Pulmonary aspiration is the side effect of which analgesic or anaesthetic agent? ...

    Incorrect

    • Pulmonary aspiration is the side effect of which analgesic or anaesthetic agent?

      Your Answer:

      Correct Answer: General anaesthetic

      Explanation:

      During general anaesthesia, due to the relaxation of the respiratory muscles, the protective gag reflex is also lost. These changes increase the chances of pulmonary aspiration.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 11 - A 70-year-old woman had a major surgery for removal of cancer of the...

    Incorrect

    • A 70-year-old woman had a major surgery for removal of cancer of the ovary and lymph node dissection 6 days ago. She had not passed any flatus or stool since then. She recently developed recurrent vomiting and severe abdominal distention. What is the next step of management?

      Your Answer:

      Correct Answer: NG tube suction and IV fluids

      Explanation:

      This patient developed paralytic ileus. It should be treated conservatively using IV fluids and NG tube.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 12 - A 2-year-old female presented with symptoms of gastroenteritis. Which of the following signs...

    Incorrect

    • A 2-year-old female presented with symptoms of gastroenteritis. Which of the following signs is the strongest indicator for IV fluid administration?

      Your Answer:

      Correct Answer: Capillary refilling time > 4secs

      Explanation:

      Children are very prone to dehydration during an episode of gastroenteritis. Dehydration is detected early by increased capillary filling time.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 13 - As the SHO of a hospital, you come across the lab report of...

    Incorrect

    • As the SHO of a hospital, you come across the lab report of a patient. It shows the following: glucose 4mmol/L, K 5.2mmol/L, Na 129mmol/L. How would you manage this patient?

      Your Answer:

      Correct Answer: Normal Saline 0.9%

      Explanation:

      This patient’s blood glucose levels are within the normal range. From their lab report, they are suffering from milk hyperkalaemia and hypernatremia. Thus, normal saline 0.9 per cent is most appropriate in this case.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 14 - A 40 year old female presented with pain and whitening of the hands...

    Incorrect

    • A 40 year old female presented with pain and whitening of the hands on exposure to cold. She has difficulty in swallowing solid foods so she has started swallowing only liquids. She developed shortness of breath on exertion and, subsequently, at rest. Which of the following is the most likely cause for dysphagia in this patient?

      Your Answer:

      Correct Answer: Systemic sclerosis

      Explanation:

      Difficulty in swallowing which improves with liquids is mainly due to an obstructive lesion in oesophagus. But pulmonary involvement (breathlessness on exertion and later on rest) and Raynaud’s phenomena can only be described by systemic sclerosis.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 15 - A 54 year old lady was found unconscious at home and passed away...

    Incorrect

    • A 54 year old lady was found unconscious at home and passed away later in the ambulance, due to cardiac arrest. The paramedic's report reveals the woman was a diabetic patient on anti-diabetic medication, lately immobilized due to hip pain. Ulcers were also found on the medial side of her ankle. What is the most likely cause of her death?

      Your Answer:

      Correct Answer: Acute myocardial infarction

      Explanation:

      The patient was old and had a major cardiovascular risk because she was a diabetic. The ulcers indicate poor glycaemic control and advanced disease which further increased her risk for an ischemic heart attack. Immobilization most probably was the favouring background on which the MI occurred.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 16 - A 20-year-old male was admitted with a right sided pneumothorax. A chest drain...

    Incorrect

    • A 20-year-old male was admitted with a right sided pneumothorax. A chest drain was inserted just below the 4th rib in the mid clavicular line. What is the structure at risk of damage during the above procedure?

      Your Answer:

      Correct Answer: Intercostal artery

      Explanation:

      From the given answers, the most suitable answer is the intercostal artery. However the most vulnerable structure is the intercostal nerve, then intercostal artery and finally intercostal vein.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 17 - A 66-year male with long standing diabetes was bed bound for a right...

    Incorrect

    • A 66-year male with long standing diabetes was bed bound for a right femur fracture. Family members called for help as he developed a sudden onset dyspnoea. By the time help arrived, the patient had passed away. What is the most probable cause for his death?

      Your Answer:

      Correct Answer: Pulmonary embolism

      Explanation:

      Prolonged immobilization could have caused deep vein thrombosis which ultimately resulted pulmonary embolism. Other causes are also possible but the most probable cause is acute pulmonary embolism.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 18 - A diabetic 50 year old male presented in the emergency room with ischaemic...

    Incorrect

    • A diabetic 50 year old male presented in the emergency room with ischaemic gangrene of the lower leg, ulceration over the medial malleolus and infection spreading proximally. Which of the following types of amputation is most suitable in this patient?

      Your Answer:

      Correct Answer: Below knee amputation

      Explanation:

      The type of amputation depends on the degree of gangrene, ischaemia and the extent of involvement of the foot, leg, knee etc. In this case, below-knee amputation is the most appropriate choice.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 19 - A 17 year old girl, known to suffer from asthma, was admitted with...

    Incorrect

    • A 17 year old girl, known to suffer from asthma, was admitted with dyspnoea. Usually her best PEFR is 410 L/min. Which of the following would favour the diagnosis of a severe asthma attack?

      Your Answer:

      Correct Answer: PEFR 200 L/min

      Explanation:

      According to the British Thoracic Society, the inability to complete sentences, a HR>110 bpm, a RR>25/min, a PEFR=33-50% of predicted value are all indications of acute severe asthma. Life-threatening asthma would present with hypotension, silent chest, bradycardia and hypoxia.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 20 - A 40-year-old male was admitted following 30%, burns sustained from an apartment fire....

    Incorrect

    • A 40-year-old male was admitted following 30%, burns sustained from an apartment fire. What is the most appropriate initial treatment of this patient?

      Your Answer:

      Correct Answer: Intravenous fluids

      Explanation:

      As this patient has more than a 15% burn area, he needs IV fluids. These patients are more prone to infection and dehydration. Burn area is calculated using the rule of nines and requires fluid replacement over the first 24 hrs, calculated using Parkland’s burn formula.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 21 - Which feature is NOT characteristic of carcinoid syndrome? ...

    Incorrect

    • Which feature is NOT characteristic of carcinoid syndrome?

      Your Answer:

      Correct Answer: Persistent hypotension

      Explanation:

      Carcinoid syndrome is a paraneoplastic syndrome comprising of signs and symptoms that occur secondary to carcinoid tumours. Diarrhoea, dermatitis, bronchospasm and right sided cardiac valve lesions (tricuspid insufficiency and pulmonary stenosis) are characteristic of carcinoid syndrome.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 22 - A 58 year old male attends a doctor's surgery to get help with...

    Incorrect

    • A 58 year old male attends a doctor's surgery to get help with quitting drinking alcohol. He expressed that he wishes to avoid the unpleasant alcohol craving experiences. From the following options, what should be prescribed to the patient?

      Your Answer:

      Correct Answer: Acamprosate

      Explanation:

      Acamprosate (calcium acetyl-homotaurine) helps to restore the normal activity of glutaminergic neurons, which usually become hyperexcited following chronic alcohol exposure.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 23 - A 68 year old female underwent surgery for a hysterectomy. 24 hours later,...

    Incorrect

    • A 68 year old female underwent surgery for a hysterectomy. 24 hours later, she is complaining of breathlessness. Upon examination, she has bibasal chest crepitations and a raised jugular venous pressure (JVP). From the list of options, which is the most likely electrolyte or fluid abnormality?

      Your Answer:

      Correct Answer: Fluid overload

      Explanation:

      The raised JVP and bibasal crepitations in the patient indicate cardiac failure with fluid overload. A chest x-ray and BNP blood level analysis should be performed to confirm this diagnosis. The x-rays should be analysed for alveolar shadowing, Kerly B lines, cardiomegaly, upper lobe diversion, pleural effusion, and fluid in the fissure. If the patient doesn’t have a history of congestive cardiac failure, then this may have been iatrogenic secondary to intravenous fluids.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 24 - A 55-year-old man was admitted to ED with acute dyspnoea. He was treated...

    Incorrect

    • A 55-year-old man was admitted to ED with acute dyspnoea. He was treated for an anterior myocardial infarction a few weeks back. On examination, he is dyspnoeic, peripheral oxygen saturation is 85% on air and he has bibasal crepitations. What is the most suitable investigation to be done at this stage to find the cause for his presentation?

      Your Answer:

      Correct Answer: Echo

      Explanation:

      This presentation is compatible with acute pulmonary oedema probably due to sudden papillary muscle rupture or VSD. Echo should be the answer to establish the underlying cause. It will also help to identify other complications associated with MI.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 25 - A 45 year old woman has complained of right hypochondrial pain and severe...

    Incorrect

    • A 45 year old woman has complained of right hypochondrial pain and severe epigastric pain for the past few hours. Upon examination, her CBC is normal, her serum ALP is raided, but she has normal transaminase. She had a cholecystectomy done three months prior. Choose the most appropriate avenue of investigation for this patient.

      Your Answer:

      Correct Answer: ERCP

      Explanation:

      MRCP is the most appropriate procedure in this instance. The post-operative US of the abdomen does not give good results for the hepatobiliary system. ERCP is invasive and is linked to complications such as pancreatitis, cholangitis, etc.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 26 - Cocaine abuse has many serious side effects. Which of the following is not...

    Incorrect

    • Cocaine abuse has many serious side effects. Which of the following is not a notable side effect of chronic cocaine abuse?

      Your Answer:

      Correct Answer: Hyponatraemia

      Explanation:

      Chronic cocaine abuse can produce many serious side effects such as erectile dysfunction, ejaculatory dysfunction, hypersomnia, anxiety, hallucinations etc.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 27 - A 34 year old male has been brought to accident and emergency after...

    Incorrect

    • A 34 year old male has been brought to accident and emergency after being involved in a road collision. After his initial evaluation, his score on the Glasgow Coma Scale is 6. What is the most appropriate next step in his treatment?

      Your Answer:

      Correct Answer: Secure airway

      Explanation:

      The appropriate next step in this patient’s treatment is to secure his airway.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 28 - A 70-year-old male diagnosed previously with villous adenoma presented in the OPD with...

    Incorrect

    • A 70-year-old male diagnosed previously with villous adenoma presented in the OPD with severe diarrhoea. Which of the following electrolyte or fluid imbalances is most commonly associated with such a condition?

      Your Answer:

      Correct Answer: Hypokalaemia

      Explanation:

      Lower GIT fluid is rich in potassium. So, in the case of severe diarrhoea, potassium loss occurs leading to hypokalaemia. Loss of bicarbonate ions also occurs. Both of these disturbances will lead to hyperchloremic metabolic acidosis.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 29 - A 34 year old known alcoholic male has been found unconscious near a...

    Incorrect

    • A 34 year old known alcoholic male has been found unconscious near a pub. The paramedics that attended to him said he was sweating and surrounded by empty cans of cider. Choose the most appropriate initial investigation from the list of options.

      Your Answer:

      Correct Answer: Capillary blood sugar

      Explanation:

      Capillary blood sugar should be tested as alcohol-induced hypoglycaemia can present itself in cases such as these.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

  • Question 30 - An 18 year old male has been taken to the emergency department and...

    Incorrect

    • An 18 year old male has been taken to the emergency department and is in a semi-unconscious state. Upon examination, he has the following stats: pulse = 60bpm; RR = 8/min; and BP = 120/70mmHg. The doctors also notice needle track marks on both of his arms, and his pupils are very small. From the list of options, choose the most suitable treatment.

      Your Answer:

      Correct Answer: Naloxone

      Explanation:

      A reduced state of consciousness, RR 8/min, hypotension, miosis, and needle track marks on the arm are all symptoms of an opiate drug overdose, and so Naloxone is the most appropriate course of treatment.

    • This question is part of the following fields:

      • Seriously Ill
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Seriously Ill (0/1) 0%
Passmed
Retry this test Dashboard