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

  • Question 1 - A 40-year-old male was diagnosed with HIV. He had had multiple sexual partners....

    Incorrect

    • A 40-year-old male was diagnosed with HIV. He had had multiple sexual partners. He was not willing to change his lifestyle, nor was he willing to inform any of his former partners. What is the most suitable next step for the doctor?

      Your Answer: Implement Public Health Act

      Correct Answer: Give general advice

      Explanation:

      General advice should be given to the patient as HIV is not a notifiable disease. Informing someone about the disease without the patient’s consent will breach the confidentiality.

    • This question is part of the following fields:

      • Ethical & Legal
      15.9
      Seconds

  • Question 2 - A 28-year-old woman is evaluated in the endocrinology clinic for increased urine output....

    Incorrect

    • A 28-year-old woman is evaluated in the endocrinology clinic for increased urine output. She weighs 60 kg and has a 24-hour urine output of 3500 ml. Her basal urine osmolality is 210 mOsm/kg.
      She undergoes a fluid deprivation test and her urine osmolality after fluid deprivation (loss of weight 3 kg) is 350 mOsm/kg. Subsequent injection of subcutaneous DDAVP (desmopressin acetate) did not result in a further significant rise of urine osmolality after 2 hours (355 mOsm/kg).
      Which of the following is the most likely diagnosis?

      Your Answer: Pituitary diabetes insipidus

      Correct Answer: Primary polydipsia

      Explanation:

      In central and nephrogenic diabetes insipidus (DI), urinary osmolality will be less than 300 mOsm/kg after water deprivation. After the administration of ADH, the osmolality will rise to more than 750 mOsm/kg in central DI but will not rise at all in nephrogenic DI. In primary polydipsia, urinary osmolality be above 750 mOsm/kg after water deprivation. A urinary osmolality that is 300-750 mOsm/kg after water deprivation and remains below 750 mOsm/kg after administration of ADH may be seen in partial central DI, partial nephrogenic DI, and primary polydipsia.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      28
      Seconds

  • Question 3 - A number of tests have been ordered for a 49-year-old male who has...

    Incorrect

    • A number of tests have been ordered for a 49-year-old male who has systemic lupus erythematosus (SLE). He was referred to the clinic because he has increased shortness of breath. One test in particular is transfer factor of the lung for carbon monoxide (TLCO), which is elevated. Which respiratory complication of SLE is associated with this finding?

      Your Answer:

      Correct Answer: Alveolar haemorrhage

      Explanation:

      Alveolar haemorrhage (AH) is a rare, but serious manifestation of SLE. It may occur early or late in disease evolution. Extrapulmonary disease may be minimal and may be masked in patients who are already receiving immunosuppressants for other symptoms of SLE.

      DLCO or TLCO (diffusing capacity or transfer factor of the lung for carbon monoxide (CO)) is the extent to which oxygen passes from the air sacs of the lungs into the blood.
      Factors that can increase the DLCO include polycythaemia, asthma (can also have normal DLCO) and increased pulmonary blood volume as occurs in exercise. Other factors are left to right intracardiac shunting, mild left heart failure (increased blood volume) and alveolar haemorrhage (increased blood available for which CO does not have to cross a barrier to enter).

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds

  • Question 4 - A 35-year-old soldier presented with a painless, erythematous crusted plaque over the dorsum...

    Incorrect

    • A 35-year-old soldier presented with a painless, erythematous crusted plaque over the dorsum of his hand, after serving in a hilly area of Columbia for 2 months. The most likely diagnosis will be?

      Your Answer:

      Correct Answer: Leishmaniasis

      Explanation:

      The chief presentation in Leishmaniasis is a non healing, ulcerated, painless and non pruritic plaque, which does not respond to oral antibiotics. It can be classified into cutaneous and visceral forms and is caused by the sand fly. It is more prevalent in the hilly areas. Fusobacterium causes a tropical ulcer which is painful and shallow, while Troanasomiasis causes sleeping sickness.

    • This question is part of the following fields:

      • The Skin
      0
      Seconds

  • Question 5 - A 45-year-old woman who is being treated for Hodgkin's lymphoma with ABVD chemotherapy...

    Incorrect

    • A 45-year-old woman who is being treated for Hodgkin's lymphoma with ABVD chemotherapy is reviewed on the haematology ward.

      Six days ago, she was admitted with a fever of 38.9°C and was immediately started on piperacillin + tazobactam (Tazocin). Her blood picture on arrival was as follows:

      Haemoglobin: 10.1 g/dL
      Platelets: 311 x 10^9/L
      White cell count: 0.8 x 10^9/L
      Neutrophils: 0.35 x 10^9/L
      Lymphocytes: 0.35 x 10^9/L

      After 48 hours, she remained febrile and tachycardic. Tazocin was stopped and meropenem in combination with vancomycin was prescribed.

      She still remains unwell today with a temperature of 38.4°C, heart rate of 96 bpm, and blood pressure of 102/66 mmHg. Respiratory examination is consistently unremarkable and blood and urine cultures have failed to show any cause for the fever.

      Which of the following is the most appropriate next step of management?

      Your Answer:

      Correct Answer: Add amphotericin B

      Explanation:

      This patient meets the diagnostic criteria for neutropenic sepsis, which is a relatively common complication of cancer therapy – usually chemotherapy occurring 7-14 days after. It is defined as a neutrophil count of <0.5 x 10^9/L in a patient undergoing anticancer treatment and who has either a temperature higher than 38°C or has other features consistent with clinically significant sepsis. Management approach is the same as mentioned in this case. However, if the patient still remains unwell, then an antifungal such as amphotericin B is started after risk-stratifying the patient and carrying out investigations (e.g. HRCT and Aspergillus PCR) to determine the likelihood of systemic fungal infection.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 6 - A 48-year-old patient with diabetes is referred from the Emergency department complaining of...

    Incorrect

    • A 48-year-old patient with diabetes is referred from the Emergency department complaining of dizziness and vomiting.
      On examination he is alert and oriented, his pulse is 80 irregularly irregular and BP 160/90 mmHg. There is nystagmus on left lateral gaze and his speech is slurred. On examination of the limbs, you note intention tremor and past pointing. He is ataxic when mobilised.
      What is the likely diagnosis?

      Your Answer:

      Correct Answer: Cerebellar CVA

      Explanation:

      The patient’s presentation with slurred speech, intention tremor and past pointing, as well as ataxia and nystagmus, paired with a history of vertigo suggest the cerebellum as the site of cerebrovascular accident (CVA) or stroke.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 7 - A 11-year-old is referred to neurology due to episodes her GP feels are...

    Incorrect

    • A 11-year-old is referred to neurology due to episodes her GP feels are epileptiform. Her mother reports that she appears to just 'stop', sometimes even in mid conversation, for several seconds at random times during the day. During these episodes, she can be unresponsive to questioning and has no recollection of them.

      Which of these drugs is contraindicated in this condition?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      The patient’s history points to absence seizures. Carbamazepine has been shown to aggravate generalized seizure types, especially absence seizures, because it acts directly on the ventrobasal complex of the thalamus which is critical to the neurophysiology of absence seizures.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 8 - A 35-year-old man who has haemophilia B with associated arthropathy presents with a...

    Incorrect

    • A 35-year-old man who has haemophilia B with associated arthropathy presents with a large swollen right knee, after playing football with his son. He is unable to bear weight on the affected knee joint.

      What should be the most appropriate first step of treatment?

      Your Answer:

      Correct Answer: Intravenous factor IX concentrate

      Explanation:

      Haemophilia B (Christmas disease), is the deficiency of clotting factor IX and is inherited in an X-linked recessive pattern. The factor IX level dictates the disease severity and established arthropathy is usually seen in those with severe disease.

      The aforementioned patient’s history and presentation is consistent with the development of hemarthrosis. Joint aspiration is not recommended. The treatment, therefore, should be intravenous replacement of the deficient clotting factor with plasma-derived factor IX concentrate.

      The other listed options are ruled out because:
      1. Joint aspiration is not preferred over the administration of clotting factor as the first step of management.
      2. DDAVP (desmopressin) can increase factor VIII levels transiently in those with mild haemophilia A and is useful prior to minor surgical procedures in such patients.
      3. Cryoprecipitate is rich in fibrinogen, factor VIII, and von Willebrand factor and is used in the treatment of haemophilia A.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 9 - A 30-year-old male with Down's Syndrome was found to have a systolic murmur...

    Incorrect

    • A 30-year-old male with Down's Syndrome was found to have a systolic murmur during routine clinical examination. Which of the following is the most common cardiac defect associated with Down's Syndrome which will explain this finding?

      Your Answer:

      Correct Answer: Endocardial cushion defect

      Explanation:

      Atrioventricular septal defect (AVSD) also known as endocardial cushion defect is the most common cardiac abnormality in Down’s Syndrome.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 10 - A 82-year-old woman admitted following a fractured neck of femur has been discharged....

    Incorrect

    • A 82-year-old woman admitted following a fractured neck of femur has been discharged. On review, she is making good progress but consideration is given to secondary prevention of further fractures. What is the most appropriate step in the prevention of further fractures?

      Your Answer:

      Correct Answer: Start oral bisphosphonate

      Explanation:

      In such a clinical scenario, NICE guidelines support initiating treatment with bisphosphonates without waiting for a DEXA scan.

      Osteoporosis is defined as low bone mineral density caused by altered bone microstructure ultimately predisposing patients to low-impact, fragility fractures.

      Management:
      Vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
      Alendronate is the first-line treatment. Around 25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate.
      Strontium ranelate and raloxifene are recommended if patients cannot tolerate bisphosphonates.
      Other medications that are useful in the treatment of osteoporosis are denosumab, teriparatide, raloxifene, etc.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 11 - A 54-year-old man is found collapsed in the street and is brought to...

    Incorrect

    • A 54-year-old man is found collapsed in the street and is brought to the A&E. The results from the blood tests reveal Calcium = 1.62mmol/l and Albumin = 33 g/l. The man is known to have a history of alcoholic liver disease. Which of the following is the best management regarding his calcium levels?

      Your Answer:

      Correct Answer: 10ml of 10% calcium gluconate over 10 minutes

      Explanation:

      Acute, symptomatic hypocalcaemia is treated with 10ml of 10% calcium gluconate over 10 minutes.

    • This question is part of the following fields:

      • Fluids & Electrolytes
      0
      Seconds

  • Question 12 - A 66-year-old man with newly-diagnosed small cell carcinoma discusses his further treatment options...

    Incorrect

    • A 66-year-old man with newly-diagnosed small cell carcinoma discusses his further treatment options with the team of doctors.
      Which statement is incorrect about small cell carcinoma?

      Your Answer:

      Correct Answer: Patients with small cell lung cancer always benefit from surgery

      Explanation:

      Small cell lung cancer (SCLC) is characterized by rapid growth and early dissemination. Prompt initiation of treatment is important.

      Patients with clinical stage Ia (T1N0) after standard staging evaluation may be considered for surgical resection, but combined treatment with chemotherapy and radiation therapy is the standard of care. Radiation therapy is often added at the second cycle of chemotherapy.

      Historically, patients undergoing surgery for small cell lung cancer (SCLC) had a dismal prognosis. However, more recent data suggest that patients with true stage I SCLC may benefit from surgical resection.

      Common sites of hematogenous metastases include the brain, bones, liver, adrenal glands, and bone marrow. The symptoms depend upon the site of spread.

    • This question is part of the following fields:

      • Respiratory System
      0
      Seconds

  • Question 13 - A 35-year-old male developed difficulty in breathing following administration of IV Co-amoxiclav. On...

    Incorrect

    • A 35-year-old male developed difficulty in breathing following administration of IV Co-amoxiclav. On examination he was flushed, there were bilateral rhonchi and his blood pressure was 80/50 mmHg. What is the immediate management of this patient?

      Your Answer:

      Correct Answer: Epinephrine 0.5 mg IM

      Explanation:

      This case indicates an anaphylactic reaction. The causative factor should be stopped or removed as soon as possible and IM Epinephrine 0.5mg administered. IV Epinephrine can also be considered provided that it is adequately diluted.

    • This question is part of the following fields:

      • Emergency & Critical Care
      0
      Seconds

  • Question 14 - A prolonged QT interval is linked to which of the following? ...

    Incorrect

    • A prolonged QT interval is linked to which of the following?

      Your Answer:

      Correct Answer: Hypocalcaemia

      Explanation:

      Prolonged QT interval can be seen in the following conditions: Hypocalcaemia, hypothermia, severe bradycardia, Class 1 and 3 antiarrhythmic drugs, non-sedating antihistamines, tricyclic antidepressants etc.

    • This question is part of the following fields:

      • Emergency & Critical Care
      0
      Seconds

  • Question 15 - A young woman is concerned that she has put on weight since she...

    Incorrect

    • A young woman is concerned that she has put on weight since she was a medical student, as she now no longer finds time to exercise. She decides to try various weight loss tablets temporarily.
      After 2 months, she is successfully losing weight but also has trouble with increased stool frequency, difficulty in climbing stairs and getting up out of chairs. However, she has no problems walking on the flat.
      She also has difficulty in sleeping at the moment but puts that down to the increased frequency of headaches for the past 2 months.

      Which one of the following is the most likely cause of her weakness?

      Your Answer:

      Correct Answer: She is abusing thyroxine tablets

      Explanation:

      Exogenous thyroid hormone use has been associated with episodes of thyroid storm as well as thyrotoxic periodic paralysis.
      It presents with marked proximal muscle weakness in both upper and lower limbs, hypokalaemia and signs of hyperthyroidism.
      Hyperthyroidism generally presents with tachycardia, hypertension, hyperthermia, and cardiac arrhythmias

      Laxatives and diuretics can result in electrolyte abnormalities.
      Medical complications associated with laxatives include chronic diarrhoea which disrupts the normal stool electrolyte concentrations that then leads to serum electrolyte shifts; acutely, hypokalaemia is most typically seen. The large intestine suffers nerve damage from the chronic laxative use that renders it unable to function properly. The normal peristalsis and conduction are affected; the disorder is thought to be secondary to a degeneration of Auerbach’s Plexi. However, it does not cause muscle weakness.

      Insulin tends to cause weight gain, not weight loss.
      Metformin does not cause muscle weakness but can cause headaches.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 16 - Examination results for a middle age female post myocardial infarction are as follows:...

    Incorrect

    • Examination results for a middle age female post myocardial infarction are as follows:
      Sodium = 136 mmol/L
      Potassium = 6.2mmol/L
      Urea = 5.0 mmol/L
      ECG revealed a prolonged QRS complex and tented T waves. What is the most appropriate management?

      Your Answer:

      Correct Answer: Calcium gluconate

      Explanation:

      Calcium gluconate is used as a cardio protective agent in people with high blood potassium levels, another alternative being the use of calcium chloride. It is recommended when the potassium levels are high (>6.5 mmol/l) or when the electrocardiogram (ECG) shows changes due to high blood potassium. Though it does not have an effect on potassium levels in the blood, it reduces the excitability of cardiomyocytes, thereby lowering the likelihood of cardiac arrhythmias.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 17 - In which of the following is there Growth hormone deficiency (GHD)? ...

    Incorrect

    • In which of the following is there Growth hormone deficiency (GHD)?

      Your Answer:

      Correct Answer: Sheehan's syndrome

      Explanation:

      The main cause of growth hormone (GH) deficiency is a pituitary tumour or the consequences of treatment of the tumour including surgery and/or radiation therapy.
      Sheehan’s syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive haemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency.

      Laron syndrome is Insulin-like growth factor I (IGF-I) deficiency due to GH resistance or insensitivity due to genetic disorders of the GH receptor causing GH receptor deficiency.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 18 - A 16-year-old patient was admitted with walking difficulties and knee pain. Upon examination,...

    Incorrect

    • A 16-year-old patient was admitted with walking difficulties and knee pain. Upon examination, his leg is externally rotated and is 2 cm shorter. His ability to flex, abduct and medially rotate his leg is limited and when he flexes his hip, external rotation is increased. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Slipped femoral epiphysis

      Explanation:

      The clinical presentation is typical of a slipped femoral epiphysis, which refers to a fracture through the growth plate (physis), resulting in slippage of the overlying end of the femur. It is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. The range of motion in the hip is restricted in internal (medial) rotation, abduction, and flexion.

    • This question is part of the following fields:

      • Musculoskeletal System
      0
      Seconds

  • Question 19 - A 25-year-old woman noticed an episode of passing blood instead of urine in...

    Incorrect

    • A 25-year-old woman noticed an episode of passing blood instead of urine in the morning. She looks anaemic, but rest of the examination is normal. Her GP has arranged for a urological examination, which has come out to be normal as well.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Paroxysmal nocturnal haemoglobinuria

      Explanation:

      The patient has paroxysmal nocturnal haemoglobinuria (PNH). The classic sign of the disease is red discolouration of the urine due to the presence of haemoglobin and hemosiderin from the breakdown of red blood cells. As the urine is more concentrated in the morning, this is when the colour is most pronounced.

      PNH is an acquired clonal disorder of haematopoietic stem cells, characterised by variable combinations of intravascular haemolysis, thrombosis, and bone marrow failure. Diagnosis is made by flow cytometric evaluation of blood, which confirms the CD55 and CD59 deficiencies and deficiency of expression of other GPI-linked proteins. This test is replacing older complement-based assays such as the Ham test and sucrose lysis test.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 20 - A 74-year-old retired judge who is known to have Alzheimer's disease is examined...

    Incorrect

    • A 74-year-old retired judge who is known to have Alzheimer's disease is examined in clinic. His latest Mini Mental State Examination (MMSE) score is 18 out of 30. Which of the following is the most appropriate treatment option?

      Your Answer:

      Correct Answer: Supportive care + donepezil

      Explanation:

      NICE now recommends the three acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine) as options for managing mild to moderate Alzheimer’s disease. Memantine is reserved for patients with moderate to severe Alzheimer’s.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 21 - A 45-year-old woman with a history of hypothyroidism, presents with ptosis and muscle...

    Incorrect

    • A 45-year-old woman with a history of hypothyroidism, presents with ptosis and muscle weakness. She's noticed that her muscle weakness becomes worse towards the end of the day. Clinical examination reveals fatigable ptosis and proximal limb weakness. Myasthenia gravis is suspected. Which receptor is implicated in the pathophysiology of this condition?

      Your Answer:

      Correct Answer: Nicotinic acetylcholine receptors

      Explanation:

      Myasthenia gravis (MG) is an organ-specific autoimmune disease caused by an antibody-mediated assault on the muscle nicotinic acetylcholine receptor (AChR) at the neuromuscular junction. Binding of antibodies to the AChR leads to loss of functional AChRs and impairs the neuromuscular signal transmission, resulting in muscular weakness.

    • This question is part of the following fields:

      • Immune System
      0
      Seconds

  • Question 22 - A 4-year-old boy admitted with fever for 2 days had a left sided...

    Incorrect

    • A 4-year-old boy admitted with fever for 2 days had a left sided focal fits, which persisted for 4 minutes. There was no history of head injury. On examination, he was drowsy but there were no focal neurological signs. Urine dipstick was negative. What is the investigation of choice that can be done at this stage to arrive at a diagnosis?

      Your Answer:

      Correct Answer: CSF analysis

      Explanation:

      This presentation could be due to either a meningitis or encephalitis, which are clinically not distinguishable from the given history. Encephalitis is mostly viral and in UK herpes simplex virus is the main cause. Advanced neuro imaging and EEG will help to differentiate them however from the given answers CSF analysis is the most appropriate, provided that intracranial pressure is not raised. CSF analysis will help to differentiate a pyogenic meningitis from other forms of meningitis and encephalitis.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 23 - A 57-year-old architect presents with weakness of the right hand. You note global...

    Incorrect

    • A 57-year-old architect presents with weakness of the right hand. You note global wasting of the small hand muscles. There is also sensory loss over the medial border of the forearm around the elbow. Which of the following nerve roots is damaged?

      Your Answer:

      Correct Answer: T1

      Explanation:

      This patient has Klumpke’s paralysis due to damage to the T1 nerve root. This root eventually supplies the median and ulnar nerves. The ulnar nerve supplies all of the intrinsic hand muscles except for those of the thenar eminence and the first and second lumbricals, which are innervated by the median nerve.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 24 - A 60-year-old male had an MI one week ago, but has now presented...

    Incorrect

    • A 60-year-old male had an MI one week ago, but has now presented with a pericardial rub and dyspnoea. An ECG was performed and shows ST elevation. A chest x-ray shows loss of margin at the costovertebral angle. Choose the single most likely cause.

      Your Answer:

      Correct Answer: Dressler's syndrome

      Explanation:

      The pericardial rub indicates pericarditis, which then causes widespread ST elevation. Therefore, the condition is not a new MI but is Dressler’s syndrome.

    • This question is part of the following fields:

      • Cardiovascular System
      0
      Seconds

  • Question 25 - A 55-year-old female school teacher complains of double vision when she writes on...

    Incorrect

    • A 55-year-old female school teacher complains of double vision when she writes on the school blackboard. She has no history of trauma. Her most recent visit to her GP was to seek attention for a rash which developed after she was bitten when walking through the forest on a school trip. Choose the cranial nerve most likely to be affected here.

      Your Answer:

      Correct Answer: Abducens

      Explanation:

      This nerve is responsible for the side to side movement of the eye, hence why damage can cause double vision.

    • This question is part of the following fields:

      • Nervous System
      0
      Seconds

  • Question 26 - A 72-year-old woman who presented with headache and neck stiffness was started on...

    Incorrect

    • A 72-year-old woman who presented with headache and neck stiffness was started on IV ceftriaxone after undergoing a lumbar puncture. The CSF culture shows listeria monocytogenes. What is the treatment of choice?

      Your Answer:

      Correct Answer: Change to IV amoxicillin + gentamicin

      Explanation:

      The best option would be the combination of ampicillin and gentamycin. Changing to IV amoxicillin+gentamycin is however the best among the given choices here.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds

  • Question 27 - A 60-year-old man presents with asymptomatic enlargement of his cervical lymph nodes. Full...

    Incorrect

    • A 60-year-old man presents with asymptomatic enlargement of his cervical lymph nodes. Full blood count shows low-grade anaemia, leukocytosis, and thrombocytopenia. Lymph node biopsy is suggestive of a low-grade non-Hodgkin lymphoma.

      Which two of the following statements fit best with this condition?

      Your Answer:

      Correct Answer: Extra-nodal presentation is more common than in Hodgkin's disease

      Explanation:

      Extra-nodal presentation is more common in non-Hodgkin lymphoma (NHL) than in Hodgkin lymphoma (HL). Bone marrow infiltration is more common in low-grade than in high-grade NHLs.

      Low-grade NHL is predominantly a disease of older people. Most present with advanced disease, bone marrow infiltration being almost invariable. Anaemia, leucocytosis, and/or thrombocytopaenia in a patient are suggestive of bone marrow involvement. For definitive diagnosis, lymph node biopsy is sufficient.

      The other aforementioned statements are ruled out because:
      1. Renal impairment in NHL usually occurs as a consequence of ureteric obstruction secondary to intra-abdominal or pelvic lymph node enlargement.

      2. Burkitt lymphoma is a high-grade NHL, which was first described in children in West Africa who presented with a jaw tumour, extra-nodal abdominal involvement, and ovarian tumours. It develops most often in children or young adults and is uncommon in older people.

      3. High-grade lymphomas are potentially curable. They have a better prognosis and are responsive to chemotherapy unlike low-grade lymphomas, which are incurable with conventional therapy.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds

  • Question 28 - A 20-year-old student nurse was admitted after her third collapse in recent months....

    Incorrect

    • A 20-year-old student nurse was admitted after her third collapse in recent months. She was noted to have a blood sugar of 0.9 mmol/l on finger-prick testing and responded well to intravenous glucose therapy.
      Venous blood taken at the same showed a markedly raised insulin level, but her C-peptide levels were normal.

      What diagnosis fits best with this clinical picture?

      Your Answer:

      Correct Answer: Self-administration of a short-acting insulin

      Explanation:

      The patient has hyperinsulinemia and hypoglycaemia, but her C-peptide levels are normal. This is strongly suggestive of the fact that she is self-administering insulin.
      In Insulinoma, common diagnostic criteria include:
      – blood glucose level < 50 mg/dl with hypoglycaemic symptoms,
      – relief of symptoms after eating
      – absence of sulfonylurea on plasma assays.
      The classic diagnostic criteria include the demonstration of the following during a supervised fast:
      Increased plasma insulin level
      Increased C peptide level
      Increased proinsulin level
      However, the patient has normal C-peptide levels.
      In type-1 diabetes mellitus, insulin and C-peptide levels are low.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 29 - A 60-year-old male was diagnosed as diabetic (DM type 2). He has a...

    Incorrect

    • A 60-year-old male was diagnosed as diabetic (DM type 2). He has a BMI=32. Lifestyle modification and exercise have failed to control his blood glucose levels. His labs were: urea=3.5mmol/l, creatinine=90 mmol/l, HbA1c=7.5g/dl. What will be the next management step?

      Your Answer:

      Correct Answer: Biguanide

      Explanation:

      For type 2 diabetics, biguanides are the treatment of choice.

    • This question is part of the following fields:

      • Endocrine System & Metabolism
      0
      Seconds

  • Question 30 - Barrett's oesophagus is well recognized as a complication of gastroesophageal reflux disease. What...

    Incorrect

    • Barrett's oesophagus is well recognized as a complication of gastroesophageal reflux disease. What is the pathological change that occurs in the above condition?

      Your Answer:

      Correct Answer: Squamous to columnar epithelium

      Explanation:

      Barrett’s oesophagus is characterised by the metaplastic replacement of the normal squamous epithelium of the lower oesophagus by columnar epithelium.

    • This question is part of the following fields:

      • Gastrointestinal System
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Ethical & Legal (0/1) 0%
Endocrine System & Metabolism (0/1) 0%
Passmed
Retry this test Dashboard