Practice MCQ 1 · Haematology & Oncology
A 24-year-old woman at 30 weeks of gestation presents with fatigue and weakness. Laboratory evaluation reveals a haemoglobin level of 8 g/dL. She reports that she was previously started on oral iron supplements, but discontinued them due to severe nausea and vomiting. On examination, she appears pale but is haemodynamically stable. Which of the following is the most appropriate next step in management? (PGMI Recall)
- AContinue oral iron with antiemetics
- BBlood transfusion
- CIntravenous iron therapy
- DFolic acid supplementation only
- EControl anaemia through dietary measures
Show the answer and explanation
Answer: C — Intravenous iron therapy
This is iron deficiency anaemia of pregnancy with oral iron intolerance, and only ten weeks remain before delivery at thirty weeks. IV iron bypasses the gut, avoiding the nausea from unabsorbed iron salts, and replenishes stores within weeks, fast enough to raise haemoglobin before delivery. Modern preparations like ferric carboxymaltose are safe in later pregnancy. Persisting with oral iron and antiemetics has already failed and, even if tolerated, would take two to three months to correct a haemoglobin of 8. Transfusion carries allo-immunisation risk and is reserved for haemodynamic compromise or very severe anaemia near delivery, neither applying here. Folic acid alone doesn't treat iron deficiency. Dietary measures can't deliver enough iron in this timeframe.
Practice MCQ 2 · Cardiology
A 57-year-old man presents to the Emergency Department with palpitations for the past 36 hours. He has no past history of note. There is no associated chest pain or shortness of breath. Clinical examination is unremarkable other than an irregular tachycardia. An ECG shows atrial fibrillation at a rate of 126 bpm with no other changes. What is the most appropriate management?
- ABeta-blocker + warfarin
- BDigoxin + aspirin
- CHeparinise + cardioversion in the Emergency Department
- DBeta-blocker + aspirin
- EWarfarinise + transthoracic echo with elective electrical cardioversion in 4 weeks
Show the answer and explanation
Answer: C — Heparinise + cardioversion in the Emergency Department
✅ Correct: Heparinise and cardioversion in the Emergency Department
With symptomatic atrial fibrillation of known duration less than 48 hours, electrical cardioversion can be considered after appropriate anticoagulation assessment; this patient has had 36 hours of symptoms.
❌ Why the others are wrong
A: Beta-blocker is reasonable for rate control, but warfarin is not the appropriate immediate anticoagulation strategy.
B: Digoxin plus aspirin is inadequate for this acute cardioversion strategy.
D: Beta-blocker plus aspirin does not provide appropriate anticoagulation for cardioversion.
E: This four-week delay is not necessary when AF duration is clearly under 48 hours.
Practice MCQ 3 · Renal
A 45-year-old man is seen in the Emergency Department with nausea, pallor and lethargy. He has no past medical history of note. Bloods show: Na+ 140 mmol/L, K+ 6.7 mmol/L, bicarbonate 14 mmol/L, urea 18.2 mmol/L, creatinine 230 µmol/L. The ECG shows new T wave changes. What is the most appropriate initial management?
- ANebulised salbutamol
- BIntravenous bicarbonate
- CHaemodialysis
- DInsulin/dextrose infusion
- EIntravenous calcium gluconate
Show the answer and explanation
Answer: E — Intravenous calcium gluconate
✅ Correct: Intravenous calcium gluconate
Severe hyperkalaemia with ECG changes means imminent risk of arrhythmia. IV calcium (10% calcium gluconate 30 mL, or calcium chloride) stabilises the cardiac membrane within minutes; it does not lower potassium, so it is followed immediately by insulin–glucose to shift potassium into cells, and treatment of the cause.
❌ Why the others are wrong
Nebulised salbutamol — shifts potassium into cells as an adjunct, but does not protect the myocardium.
Intravenous bicarbonate — limited role; not a cardioprotective first step.
Haemodialysis — removes potassium if refractory or in established renal failure, but takes time to arrange.
Insulin/dextrose infusion — the next step to lower potassium, but does not stabilise the myocardium.
Practice MCQ 4 · Neurology
A 62-year-old man presents to the emergency department with sudden-onset right-sided facial droop and weakness of the right arm that started 2 hours ago. He also complains of slurred speech. Past history includes hypertension for 10 years, poorly controlled, and type 2 diabetes mellitus. On examination, he is conscious and alert. There is right upper limb weakness more than lower limb weakness (power: arm 3/5, leg 4/5) along with right facial asymmetry (upper motor neuron type, with forehead sparing). Speech examination reveals expressive aphasia. Sensation is mildly decreased in the right upper limb, and reflexes are brisk on the right side. Which artery is most likely affected in this patient? (PGMI & AKU)
- AAnterior cerebral artery (ACA)
- BPosterior cerebral artery (PCA)
- CLeft middle cerebral artery (MCA)
- DBasilar artery
- EVertebral artery
Show the answer and explanation
Answer: C — Left middle cerebral artery (MCA)
This is an acute ischaemic stroke in the left middle cerebral artery territory. Face and arm weakness with relative leg sparing maps to the lateral convexity, where the face and hand occupy most of the motor homunculus supplied by this artery, and the facial weakness is upper motor neuron in type, sparing the forehead because of its bilateral cortical supply, and expressive aphasia localises to Broca's area in the dominant hemisphere, left in most people. Anterior cerebral artery occlusion does the reverse, weakening the leg more, since the medial surface carries the leg area. Posterior cerebral artery occlusion gives a homonymous hemianopia with motor sparing. Basilar occlusion gives bilateral signs and depressed consciousness, whereas he is alert with unilateral findings. Vertebral occlusion gives a lateral medullary syndrome with crossed sensory loss and Horner's syndrome. At two hours he is within the thrombolysis window once haemorrhage is excluded.
Practice MCQ 5 · Gastroenterology
A 35-year-old woman presents with recurrent episodes of abdominal pain and diarrhoea. Investigations show anti-tissue transglutaminase (tTG) antibodies 200 U/mL (normal <20) and positive anti-endomysial antibodies. Which of the following conditions is most likely responsible for these findings?
- AInflammatory bowel disease
- BIBS
- CCoeliac disease
- DPancreatitis
Show the answer and explanation
Answer: C — Coeliac disease
✅ Correct: Coeliac disease
Anti-tissue transglutaminase IgA at 200 against an upper limit of 20, with positive anti-endomysial antibodies, is close to diagnostic. Tissue transglutaminase deamidates gliadin peptides, which HLA-DQ2/DQ8 present to T cells, and the antibody response against the enzyme is what these tests detect.
The resulting injury causes villous atrophy and crypt hyperplasia, losing absorptive surface (diarrhoea) with distension from unabsorbed substrate (pain).
❌ Why the others are wrong
Inflammatory bowel disease — diagnosed on endoscopy and faecal calprotectin; these antibodies are not features.
IBS — a diagnosis of exclusion; positive serology excludes it.
Pancreatitis — tested by faecal elastase and imaging; these antibodies would be negative.