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MOHAP Doctor Exam study materials
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MOHAP Doctor Exam practice questions

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Question 1General Medicine

A 58-year-old man with type 2 diabetes has an eGFR of 28 mL/min/1.73 m². Which oral glucose-lowering agent should be avoided because it requires dose reduction and carries a risk of lactic acidosis in advanced renal impairment?

  1. Pioglitazone
  2. Empagliflozin
  3. Metformin Correct answer.
  4. Sitagliptin

Explanation

Metformin is renally cleared and accumulates when eGFR falls; current guidance advises stopping it at eGFR below 30 mL/min/1.73 m² because of the risk of metformin-associated lactic acidosis. The other agents listed have different renal handling and do not carry this specific contraindication at this threshold.

Question 2General Medicine

Which finding on a 12-lead ECG most strongly suggests acute transmural myocardial infarction requiring immediate reperfusion?

  1. Sinus tachycardia with frequent premature ventricular complexes
  2. ST-segment elevation in two contiguous leads Correct answer.
  3. First-degree atrioventricular block
  4. Diffuse ST depression with PR depression

Explanation

ST elevation in two anatomically contiguous leads is the hallmark of acute transmural injury and defines STEMI, which mandates urgent reperfusion. The other patterns do not meet criteria for emergency reperfusion therapy.

Question 3General Medicine

A 24-year-old woman has a 3-day history of sore throat, fever and painful swallowing. Examination shows tonsillar exudate and tender anterior cervical nodes, with no cough. Which is the most appropriate next step?

  1. Perform a rapid antigen detection test or throat culture Correct answer.
  2. Arrange urgent direct laryngoscopy
  3. Reassure and treat with antihistamines
  4. Prescribe empirical oral fluconazole

Explanation

The modified Centor criteria (exudate, tender anterior nodes, fever, absence of cough) raise the probability of group A streptococcal pharyngitis, and microbiological confirmation guides antibiotic use. Empirical antifungal or antihistamine therapy is not indicated for this presentation.

Question 4General Medicine

A 67-year-old man presents with sudden painless loss of vision in one eye described as a curtain descending. Fundoscopy is initially normal. What is the most likely diagnosis?

  1. Retinal artery occlusion
  2. Amaurosis fugax from carotid emboli Correct answer.
  3. Acute angle-closure glaucoma
  4. Vitreous haemorrhage

Explanation

A transient curtain-like visual loss in an older patient is characteristic of amaurosis fugax, usually due to emboli from an ipsilateral carotid plaque, and requires urgent vascular assessment. Persistent painless visual loss with a pale retina would suggest retinal artery occlusion.

Question 5General Medicine

Which electrolyte disturbance most characteristically produces peaked T waves, widened QRS complexes and a sine-wave pattern on ECG?

  1. Hypercalcaemia
  2. Hypomagnesaemia
  3. Hypokalaemia
  4. Hyperkalaemia Correct answer.

Explanation

Progressive hyperkalaemia causes tall peaked T waves, then QRS widening and ultimately a sine-wave morphology preceding cardiac arrest. Hypokalaemia instead produces flattened T waves and prominent U waves.

Question 6General Medicine

A 30-year-old woman has a 6-week history of fatigue, weight gain, cold intolerance and constipation. TSH is elevated and free T4 is low. Which is the most appropriate initial treatment?

  1. Carbimazole
  2. Levothyroxine Correct answer.
  3. Radioactive iodine
  4. Propranolol

Explanation

The combination of high TSH with low free T4 confirms primary hypothyroidism, treated with levothyroxine replacement titrated to symptoms and TSH. Antithyroid drugs and radioiodine are treatments for hyperthyroidism.

Question 7General Medicine

Which organism is the most common cause of community-acquired pneumonia in adults requiring hospital admission?

  1. Legionella pneumophila
  2. Mycoplasma pneumoniae
  3. Pneumocystis jirovecii
  4. Streptococcus pneumoniae Correct answer.

Explanation

Streptococcus pneumoniae remains the single most frequently identified pathogen in community-acquired pneumonia across all severity levels. Atypical organisms and opportunistic pathogens account for smaller proportions.

Question 8General Medicine

A 45-year-old man has epigastric pain relieved by food and wakes at night with pain. He takes ibuprofen regularly. Which is the most likely diagnosis?

  1. Gastric adenocarcinoma
  2. Duodenal ulcer Correct answer.
  3. Acute pancreatitis
  4. Gastro-oesophageal reflux disease

Explanation

Pain relieved by food and nocturnal waking is typical of duodenal ulcer disease, and NSAID use is a major risk factor. Gastric ulcers generally worsen with eating, and reflux produces burning retrosternal symptoms.

Question 9General Medicine

Which feature best distinguishes an exudative from a transudative pleural effusion?

  1. Low pleural fluid lactate dehydrogenase
  2. Pleural fluid protein greater than 30 g/L Correct answer.
  3. Bilateral symmetry on chest radiograph
  4. Clear straw-coloured appearance

Explanation

The Light criteria classify an effusion as exudative when pleural protein exceeds 30 g/L (or pleural-to-serum protein ratio above 0.5), reflecting increased capillary permeability or lymphatic obstruction. Transudates arise from pressure imbalances and have low protein and LDH.

Question 10General Medicine

A 70-year-old woman has sudden-onset severe abdominal pain out of proportion to examination findings and atrial fibrillation. What is the most likely diagnosis?

  1. Acute mesenteric ischaemia Correct answer.
  2. Irritable bowel syndrome
  3. Diverticulitis
  4. Acute appendicitis

Explanation

Pain out of proportion to findings in a patient with an embolic source such as atrial fibrillation strongly suggests acute mesenteric ischaemia, a surgical emergency. Early recognition is critical because bowel infarction develops rapidly.

Question 11General Medicine

Which antibody is most specific for systemic lupus erythematosus and is associated with a lower risk of lupus nephritis?

  1. Anti-Ro
  2. Anti-histone
  3. Anti-Sm Correct answer.
  4. Anti-double-stranded DNA

Explanation

Anti-Sm antibodies are highly specific for SLE, although less sensitive, and their presence is associated with a lower incidence of renal involvement. Anti-dsDNA, by contrast, correlates with nephritis activity.

Question 12General Medicine

A 22-year-old student has sudden severe headache described as the worst of his life, with neck stiffness and photophobia. What is the most appropriate immediate investigation?

  1. Non-contrast CT head followed by lumbar puncture if negative Correct answer.
  2. Skull radiograph
  3. Carotid Doppler ultrasound
  4. MRI lumbar spine

Explanation

The presentation suggests subarachnoid haemorrhage; a non-contrast CT is the first-line test, and if negative within the appropriate window a lumbar puncture for xanthochromia is required. Other imaging modalities do not reliably exclude subarachnoid blood.

Question 13General Medicine

Which finding on urinalysis most suggests glomerular disease rather than a lower urinary tract infection?

  1. Red cell casts Correct answer.
  2. Alkaline pH
  3. Epithelial cells
  4. Positive nitrite

Explanation

Red cell casts form within renal tubules and indicate glomerular bleeding, making them a hallmark of glomerulonephritis. Nitrites and epithelial cells reflect infection or contamination rather than glomerular pathology.

Question 14General Medicine

A 60-year-old man has a serum sodium of 120 mmol/L, confusion and a history of excessive water intake. Which initial correction rate is safest?

  1. Normalise sodium within 4 hours
  2. Raise sodium by 20 mmol/L within 6 hours
  3. Withhold all treatment until sodium reaches 110 mmol/L
  4. Raise sodium by no more than 8-10 mmol/L in 24 hours Correct answer.

Explanation

Overly rapid correction of hyponatraemia risks osmotic demyelination, so sodium should be raised by no more than 8-10 mmol/L in 24 hours in chronic cases. Symptomatic severe cases may need hypertonic saline but still with controlled targets.

Question 15General Medicine

Which is the most common cause of nephrotic syndrome in adults?

  1. Membranous nephropathy Correct answer.
  2. Post-streptococcal glomerulonephritis
  3. IgA nephropathy
  4. Minimal change disease

Explanation

Membranous nephropathy is the leading cause of adult nephrotic syndrome, often associated with anti-phospholipase A2 receptor antibodies. Minimal change disease predominates in children, and IgA nephropathy typically causes nephritic syndrome.

Question 16General Medicine

A patient with chronic obstructive pulmonary disease has an arterial PaO2 of 50 mmHg and PaCO2 of 55 mmHg on room air. Which is the most appropriate oxygen target?

  1. 100% oxygen via non-rebreather mask
  2. No supplemental oxygen
  3. 88-92% oxygen saturation Correct answer.
  4. 94-98% oxygen saturation

Explanation

In patients with COPD and hypercapnia, controlled oxygen therapy targeting 88-92% saturation reduces the risk of worsening hypercapnia while correcting hypoxaemia. Higher targets increase the risk of carbon dioxide retention.

Question 17General Medicine

Which vaccine is contraindicated in pregnancy?

  1. Recombinant hepatitis B vaccine
  2. Inactivated influenza vaccine
  3. Live attenuated measles-mumps-rubella vaccine Correct answer.
  4. Tetanus-diphtheria toxoid

Explanation

Live attenuated vaccines such as MMR are contraindicated during pregnancy because of theoretical risk to the fetus, and should be deferred until after delivery. Inactivated and toxoid vaccines are safe and recommended.

Question 18General Medicine

A 28-year-old woman has a 2-cm thyroid nodule and a suppressed TSH. Fine-needle aspiration shows follicular cells with abundant colloid and no atypia. What is the most likely diagnosis?

  1. Follicular thyroid carcinoma
  2. Papillary thyroid carcinoma
  3. Medullary thyroid carcinoma
  4. Toxic adenoma Correct answer.

Explanation

A suppressed TSH with a benign-appearing nodule on cytology is consistent with an autonomously functioning toxic adenoma. Malignant nodules are usually non-functioning and cytology would show atypia or specific features.

Question 19General Medicine

Which is the most appropriate first-line treatment for a patient with newly diagnosed hypertension and no comorbidities, according to standard guidance?

  1. A thiazide-like diuretic, ACE inhibitor or calcium channel blocker Correct answer.
  2. A centrally acting agent such as methyldopa
  3. A loop diuretic
  4. An alpha blocker

Explanation

First-line antihypertensives for uncomplicated hypertension are thiazide-type diuretics, ACE inhibitors or angiotensin receptor blockers, and dihydropyridine calcium channel blockers. Alpha blockers, loop diuretics and central agents are generally reserved for specific indications or resistant cases.

Question 20General Medicine

A 65-year-old man with heart failure with reduced ejection fraction is on furosemide and an ACE inhibitor but remains symptomatic. Which addition improves mortality?

  1. Bisoprolol Correct answer.
  2. Nitrate monotherapy
  3. Digoxin
  4. Amlodipine

Explanation

Beta blockers such as bisoprolol, along with ACE inhibitors, ARBs, mineralocorticoid receptor antagonists and SGLT2 inhibitors, reduce mortality in heart failure with reduced ejection fraction. Amlodipine and digoxin do not improve survival in this setting.

Question 21General Medicine

A 72-year-old woman has sudden-onset right-sided weakness and aphasia with a last-known-well time of 2 hours ago. Non-contrast CT excludes haemorrhage. What is the most appropriate next step?

  1. Start warfarin
  2. Aspirin 300 mg immediately
  3. Intravenous thrombolysis with alteplase or tenecteplase Correct answer.
  4. Observe for 24 hours before treatment

Explanation

Acute ischaemic stroke within the thrombolysis window with no haemorrhage on CT is treated with intravenous thrombolysis, provided there are no contraindications. Antiplatelet therapy is given after 24 hours following thrombolysis.

Question 22General Medicine

Which is the most common cause of hospital-acquired pneumonia in intubated patients?

  1. Gram-negative bacilli such as Pseudomonas aeruginosa Correct answer.
  2. Streptococcus pneumoniae
  3. Influenza virus
  4. Mycoplasma pneumoniae

Explanation

Ventilator-associated pneumonia is most often caused by Gram-negative bacilli, including Pseudomonas, reflecting oropharyngeal colonisation in critically ill patients. Atypical organisms and community-acquired pathogens are less common in this setting.

Question 23General Medicine

A 40-year-old man has a positive tuberculin skin test with 12 mm induration, no symptoms and a normal chest radiograph. Which is the most appropriate management?

  1. Treat latent tuberculosis infection Correct answer.
  2. No treatment and no follow-up
  3. Start four-drug active tuberculosis therapy
  4. Repeat the skin test in 6 months

Explanation

A positive tuberculin test with no symptoms and a normal chest radiograph indicates latent tuberculosis infection, which should be treated to prevent progression to active disease. Four-drug therapy is reserved for active tuberculosis.

Question 24General Medicine

Which finding best indicates diabetic ketoacidosis rather than hyperosmolar hyperglycaemic state?

  1. Arterial pH below 7.3 with ketonaemia Correct answer.
  2. Absence of abdominal pain
  3. Blood glucose above 30 mmol/L
  4. Serum osmolality above 320 mOsm/kg

Explanation

Diabetic ketoacidosis is defined by acidosis and significant ketonaemia, whereas hyperosmolar hyperglycaemic state is characterised by profound hyperosmolality with minimal ketosis and near-normal pH. Glucose and osmolality can be elevated in both conditions.

Question 25General Medicine

Which is the most appropriate first-line treatment for anaphylaxis in an adult?

  1. Intramuscular adrenaline 0.5 mg into the anterolateral thigh Correct answer.
  2. Nebulised salbutamol alone
  3. Intravenous hydrocortisone 200 mg
  4. Oral chlorphenamine 4 mg

Explanation

Intramuscular adrenaline is the first-line treatment for anaphylaxis, given into the anterolateral thigh and repeated after 5 minutes if needed. Antihistamines and corticosteroids are adjuncts and do not reverse airway or circulatory compromise.

Question 26General Medicine

Which electrocardiographic finding is most characteristic of acute pericarditis?

  1. Widespread concave ST elevation with PR depression Correct answer.
  2. Localised ST elevation in two contiguous leads with reciprocal depression
  3. Sawtooth flutter waves at 300 per minute
  4. Delta wave with a short PR interval

Explanation

Acute pericarditis produces diffuse inflammation of the epicardium, giving widespread concave ST elevation and PR depression across multiple territories. The changes are not confined to a single coronary distribution and lack reciprocal ST depression.

Question 27General Medicine

A 55-year-old man has a fasting plasma glucose of 7.4 mmol/L on one occasion and no symptoms. What is the most appropriate next step?

  1. Start insulin immediately
  2. Reassure and repeat testing in 12 months
  3. Diagnose diabetes and begin metformin the same day
  4. Repeat fasting glucose or measure HbA1c to confirm the diagnosis Correct answer.

Explanation

In an asymptomatic patient, a single abnormal fasting glucose is insufficient for diagnosis; the test must be repeated or confirmed with HbA1c or an oral glucose tolerance test. Confirmation avoids labelling patients on the basis of a single measurement.

Question 28General Medicine

Which organism is the most frequent cause of infective endocarditis in patients with native valves who are not injecting drugs?

  1. Candida albicans
  2. Streptococcus viridans group Correct answer.
  3. Pseudomonas aeruginosa
  4. Staphylococcus aureus

Explanation

Viridans streptococci are normal oral flora and are the leading cause of native-valve endocarditis in non-injecting patients, often after transient bacteraemia from dental work. S. aureus dominates in injecting drug users and prosthetic valves.

Question 29General Medicine

A patient has a blood pressure of 168/104 mmHg with headache and blurred vision but no focal neurological deficit. What is the most appropriate immediate management?

  1. Gradual reduction of blood pressure over 24 to 48 hours Correct answer.
  2. Rapid reduction of mean arterial pressure by 25% within one hour
  3. No treatment because the reading is only mildly elevated
  4. Sublingual nifedipine for immediate effect

Explanation

This is severe asymptomatic hypertension without acute target-organ damage, so pressure should be lowered gradually over hours to days to avoid cerebral hypoperfusion. Rapid reduction is reserved for hypertensive emergencies with organ injury.

Question 30General Medicine

Which laboratory pattern is typical of iron deficiency anaemia?

  1. Low ferritin with high total iron-binding capacity Correct answer.
  2. High ferritin with normal transferrin saturation
  3. High ferritin with low total iron-binding capacity
  4. Normal ferritin with low transferrin saturation

Explanation

Iron deficiency depletes stores, so ferritin falls, while transferrin rises as an adaptive response, increasing total iron-binding capacity and lowering saturation. Ferritin is the most sensitive single indicator of depleted iron stores.

Question 31General Medicine

A 68-year-old smoker has a chronic productive cough for three months each year for three consecutive years. Which diagnosis best fits?

  1. Bronchiectasis
  2. Chronic bronchitis Correct answer.
  3. Asthma
  4. Emphysema

Explanation

Chronic bronchitis is defined clinically by a productive cough on most days for at least three months in two consecutive years. Emphysema is defined pathologically by alveolar destruction rather than by cough.

Question 32General Medicine

Which finding most strongly suggests a diagnosis of rheumatoid arthritis rather than osteoarthritis?

  1. Morning stiffness lasting more than one hour with symmetric small-joint swelling Correct answer.
  2. Heberden nodes with stiffness lasting under 30 minutes
  3. Pain worse with activity and relieved by rest
  4. Asymmetric involvement of the first metatarsophalangeal joint

Explanation

Inflammatory arthritis such as rheumatoid disease causes prolonged morning stiffness and symmetric involvement of small joints such as the MCPs and PIPs. Osteoarthritis causes brief stiffness and bony nodes at the DIP joints.

Question 33General Medicine

Which is the most common cause of peptic ulcer disease in patients who do not take NSAIDs?

  1. Zollinger-Ellison syndrome
  2. Helicobacter pylori infection Correct answer.
  3. Cytomegalovirus infection
  4. Crohn disease

Explanation

H. pylori colonises the gastric mucosa and causes chronic inflammation that predisposes to duodenal and gastric ulcers. Eradication substantially reduces ulcer recurrence.

Question 34General Medicine

A 24-year-old woman has a generalised tonic-clonic seizure lasting 4 minutes and remains unresponsive afterwards. What is the most appropriate first-line drug?

  1. Intravenous lorazepam Correct answer.
  2. Oral carbamazepine
  3. Intravenous phenytoin
  4. Intravenous mannitol

Explanation

A seizure lasting more than 5 minutes or recurring without recovery defines status epilepticus, and a benzodiazepine such as lorazepam is the first-line agent. Second-line agents are used if the seizure persists after benzodiazepines.

Question 35General Medicine

Which feature is most typical of bulimia nervosa compared with anorexia nervosa?

  1. Amenorrhoea is a core diagnostic criterion
  2. Marked low body weight is a defining requirement
  3. Body weight is often within or above the normal range Correct answer.
  4. Onset is typically after age 40

Explanation

Bulimia nervosa involves recurrent binge eating with compensatory behaviours, and body weight is frequently normal or high. Anorexia nervosa is defined by significantly low body weight.

Question 36General Medicine

A 35-year-old man has sudden painless loss of vision in one eye with a relative afferent pupillary defect. Which diagnosis is most likely?

  1. Acute angle-closure glaucoma
  2. Central retinal vein occlusion
  3. Optic neuritis Correct answer.
  4. Vitreous haemorrhage

Explanation

Painless visual loss with a relative afferent pupillary defect points to optic nerve dysfunction, as in optic neuritis, which is often associated with demyelinating disease. The pupil defect localises the lesion to the afferent pathway.

Question 37General Medicine

Which is the most appropriate initial treatment for a patient with an acute exacerbation of asthma who has a peak expiratory flow of 45% of predicted?

  1. Long-acting beta-2 agonist alone
  2. Nebulised adrenaline as first-line
  3. Oral antibiotic therapy
  4. Inhaled short-acting beta-2 agonist with systemic corticosteroids Correct answer.

Explanation

Acute asthma is treated with repeated short-acting bronchodilators to relieve bronchospasm and systemic corticosteroids to reduce airway inflammation. A moderate exacerbation such as this warrants both agents.

Question 38General Medicine

Which finding best supports a diagnosis of acute pancreatitis?

  1. Serum amylase within the reference range
  2. Serum lipase more than three times the upper limit of normal Correct answer.
  3. Serum alkaline phosphatase twice the upper limit of normal
  4. A normal abdominal ultrasound

Explanation

A lipase rise greater than three times the upper reference limit is highly specific for acute pancreatitis and remains elevated longer than amylase. Amylase can be normal in a substantial proportion of cases.

Question 39General Medicine

A 62-year-old man has progressive dysphagia for solids and then liquids with weight loss. Which investigation is most appropriate first?

  1. Upper gastrointestinal endoscopy with biopsy Correct answer.
  2. Barium swallow
  3. 24-hour pH monitoring
  4. Oesophageal manometry

Explanation

Progressive dysphagia with weight loss raises concern for oesophageal cancer, and endoscopy with biopsy allows direct visualisation and histological diagnosis. It is the investigation of choice in this presentation.

Question 40General Medicine

Which is the most appropriate treatment for a tension pneumothorax?

  1. Observation with supplemental oxygen alone
  2. Needle aspiration of the pleural space only if the patient is stable
  3. Urgent chest radiograph before any intervention
  4. Immediate needle decompression followed by chest drain insertion Correct answer.

Explanation

Tension pneumothorax is a clinical diagnosis and a life-threatening emergency; decompression must not be delayed for imaging. Needle decompression relieves the pressure before definitive chest drain placement.

Question 41General Medicine

Which electrolyte abnormality is most characteristic of primary hyperaldosteronism?

  1. Hypokalaemia with metabolic alkalosis Correct answer.
  2. Hypocalcaemia with prolonged QT
  3. Hypernatraemia with hyperchloraemia
  4. Hyperkalaemia with metabolic acidosis

Explanation

Excess aldosterone promotes renal sodium retention and potassium excretion, producing hypertension with hypokalaemia and a metabolic alkalosis. The alkalosis results from increased hydrogen ion secretion.

Question 42General Medicine

A 70-year-old woman has a hip fracture after a minor fall. Which underlying condition most commonly predisposes to this injury?

  1. Osteopetrosis
  2. Osteomalacia
  3. Osteoporosis Correct answer.
  4. Paget disease

Explanation

Osteoporosis reduces bone mineral density and trabecular architecture, making fragility fractures of the hip, wrist and spine common in older adults. It is the leading predisposing factor for such fractures.

Question 43General Medicine

Which feature most distinguishes a migraine from a tension-type headache?

  1. Absence of nausea and vomiting
  2. Bilateral pressing pain of mild intensity
  3. Pain that is unchanged by routine physical activity
  4. Unilateral throbbing pain aggravated by activity with photophobia Correct answer.

Explanation

Migraine is characterised by unilateral, pulsating pain worsened by activity and accompanied by photophobia, phonophobia or nausea. Tension-type headache is typically bilateral, pressing and not aggravated by activity.

Question 44General Medicine

A patient with cirrhosis presents with confusion, asterixis and a raised ammonia level. Which precipitant should be sought first?

  1. Gastrointestinal bleeding Correct answer.
  2. Iron deficiency
  3. Hyperthyroidism
  4. Vitamin D deficiency

Explanation

Hepatic encephalopathy is often precipitated by gastrointestinal bleeding, which increases the nitrogen load in the gut and ammonia production. Infection, constipation and electrolyte disturbance are other common triggers.

Question 45General Medicine

Which is the most appropriate initial treatment for a patient with an uncomplicated urinary tract infection in a non-pregnant woman?

  1. A single dose of intramuscular ceftriaxone
  2. Long-term low-dose antibiotic prophylaxis
  3. Intravenous vancomycin
  4. A short course of oral nitrofurantoin Correct answer.

Explanation

Uncomplicated cystitis in women is treated with a short oral course of an agent concentrated in urine, such as nitrofurantoin. Parenteral therapy is reserved for pyelonephritis or systemic features.

Question 46General Medicine

A 30-year-old man has a positive blood culture for a gram-negative coccus in the context of meningitis. Which organism is most likely?

  1. Neisseria meningitidis Correct answer.
  2. Streptococcus pneumoniae
  3. Listeria monocytogenes
  4. Haemophilus influenzae

Explanation

N. meningitidis is a gram-negative diplococcus and a leading cause of bacterial meningitis in young adults, often with a petechial rash. The Gram stain morphology is a key clue.

Question 47General Medicine

Which finding most suggests a diagnosis of hypothyroidism rather than nephrotic syndrome as a cause of oedema?

  1. Elevated jugular venous pressure with basal crackles
  2. Generalised oedema with normal thyroid function tests
  3. Heavy proteinuria with hypoalbuminaemia
  4. Periorbital puffiness with bradycardia and cold intolerance Correct answer.

Explanation

Myxoedema in hypothyroidism produces periorbital puffiness together with systemic features of thyroid hormone deficiency such as bradycardia and cold intolerance. Nephrotic oedema reflects hypoalbuminaemia from urinary protein loss.

Question 48General Medicine

Which is the most appropriate management for a patient with a first episode of uncomplicated diverticulitis without systemic features?

  1. Long-term corticosteroids
  2. Oral antibiotics with supportive care and follow-up Correct answer.
  3. Immediate colonoscopy during the acute episode
  4. Emergency Hartmann procedure

Explanation

Uncomplicated diverticulitis without systemic upset is managed with supportive care and, in many protocols, oral antibiotics, with reassessment and later colonoscopy after resolution. Surgery is reserved for complications such as perforation or abscess.

Question 49General Medicine

Which mechanism best explains the anaemia of chronic kidney disease?

  1. Bone marrow infiltration by plasma cells
  2. Reduced erythropoietin production by the failing kidney Correct answer.
  3. Haemolysis due to splenic sequestration
  4. Increased iron absorption from the gut

Explanation

The kidney produces erythropoietin in response to hypoxia, and loss of functioning renal tissue reduces this stimulus, causing normocytic normochromic anaemia. Iron deficiency and uraemic factors may contribute but are secondary.

Question 50General Medicine

A 40-year-old woman has a butterfly rash, oral ulcers and non-erosive arthritis. Which laboratory test is most useful for supporting the diagnosis?

  1. Serum complement C3 level alone
  2. Rheumatoid factor
  3. Antinuclear antibody Correct answer.
  4. Anti-CCP antibody

Explanation

Antinuclear antibody is highly sensitive for systemic lupus erythematosus and is the appropriate screening test when the clinical picture suggests the disease. More specific antibodies such as anti-dsDNA or anti-Smith are used for confirmation.