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Question 1
Correct
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A 60-year-old man with known ulcerative colitis and diverticular disease comes to clinic complaining of passing faeces per urethra. Cystoscopy confirms a fistula between his bladder and bowel.
Which treatment is most likely to be effective?Your Answer: surgery
Explanation:The best treatment for a colovesicular fistula is surgery. This is the only definitive treatment. If the patient is a poor surgical candidate, there can be an attempt to manage them non-operatively, but this is absolutely NOT the MOST EFFECTIVE therapy.
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This question is part of the following fields:
- Gastrointestinal System
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Question 2
Correct
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Which one of the following features is most helpful in distinguishing beta thalassaemia trait from iron deficiency anaemia?
Your Answer: Haemoglobin A2 levels
Explanation:Elevated haemoglobin A2 level is seen in beta thalassaemia trait, whereas, it is typically low in iron deficiency anaemia unless the patient has received a recent blood transfusion.
Low mean corpuscular volume (MCV) and reduced haematocrit (Ht) are encountered in both conditions. Peripheral blood smear is grossly abnormal in both beta thalassaemia and severe iron deficiency anaemia, showing bizarre morphology, target cells, and a small number of nucleated red blood cells.
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This question is part of the following fields:
- Haematology & Oncology
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Question 3
Incorrect
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Treatment of an acute attack of gout with allopurinol may result in which of the following?
Your Answer: Renal impairment if the starting dose is > 300 mg/day
Correct Answer: Exacerbation and prolongation of the attack
Explanation:Initiation of allopurinol treatment during an attack can exacerbate and prolong the episode. Thus treatment should be delayed until the attack resolves.
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This question is part of the following fields:
- Pharmacology
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Question 4
Incorrect
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A 61-year-old gentleman presents with pain in his right flank and haematuria. A CT scan of the abdomen reveals a large 8 × 8 cm solid mass in the right kidney and a 3 × 3 cm solid mass occupying the upper pole of the left kidney.
What is the most appropriate treatment for this patient?Your Answer: Right radical nephrectomy and biopsy of the mass on the left side
Correct Answer: Right radical nephrectomy and left partial nephrectomy
Explanation:This patient presents with the classic triad of renal carcinoma: haematuria, loin pain and a mass in the kidneys. Management will entail right radical nephrectomy because of the 8x8cm solid mass and a left partial nephrectomy of the 3x3cm solid mass.
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This question is part of the following fields:
- Renal System
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Question 5
Correct
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A 32-year-old male presents following a car accident. He has a swollen foot, with loss of sensation in the space between the 3rd metatarsal and big toe and foot tenderness. In addition, his dorsalis pedis is not palpable. Which is the most probable diagnosis?
Your Answer: Compartment syndrome
Explanation:Acute compartment syndrome results from severe high pressure in the compartment with concomitant insufficient blood supply to the tissue involved. Acute compartment syndrome is a surgical emergency that can lead to severe impairment of the function of the affected limb, if left untreated.
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This question is part of the following fields:
- Musculoskeletal System
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Question 6
Correct
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A 30-year-old male with a scaphoid fracture came to the clinic after 2 weeks of applying the scaphoid cast. After removing the cast he had difficulty moving his thumb, index and middle fingers. Which of the following is the most appropriate management for this presentation?
Your Answer: Release of flexor retinaculum
Explanation:This patient has carpal tunnel syndrome which involves the median nerve. The treatment is releasing of the flexor retinaculum.
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This question is part of the following fields:
- Nervous System
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Question 7
Correct
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A 67-year-old man presents with anaemia and weight loss. Upon endoscopy, a gastric tumour is revealed, later established as an adenocarcinoma. The patient refuses any treatment and claims that his condition is not influencing the quality of his life. Clinical examination has nothing particularly interesting to show and the patient seems to be conscious of his decision, regardless of the likely curative nature of surgery. What is the single most appropriate management?
Your Answer: Respect his wishes and book a follow-up appointment for four weeks
Explanation:The patient seems to be conscious about his decision, which should be respected. According to Mental Capacity Act 2005, a person who makes an unwise decision should not be treated as unable to make a decision.
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This question is part of the following fields:
- Haematology & Oncology
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Question 8
Correct
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A patient was admitted due to vomiting for further investigations. He noticed blood in his vomit and the physicians decided to perform an esophagogastroduodenoscopy which revealed haemorrhage in the lesser curvature of the stomach. Which artery is responsible for the bleeding?
Your Answer: Right gastric artery
Explanation:The right gastric artery arises from the hepatic artery or the left hepatic artery and supplies the pylorus, traveling along the lesser curvature of the stomach anastomosing with the left gastric artery.
The pancreaticoduodenal artery supplies mainly the upper and lower duodenum and the head of the pancreas.
The gastro-omental arteries supply the greater curvature of the stomach. -
This question is part of the following fields:
- Gastrointestinal System
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Question 9
Incorrect
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Which of the following involving the scalp may produce alopecia (hair loss)?
Your Answer: Psoriasis
Correct Answer: Discoid lupus erythematosus
Explanation:Infective causes of hair loss include:
Dissecting cellulitis
Fungal infections (such as tinea capitis)
Folliculitis
Secondary syphilis
Demodex folliculorum
Lupus erythematosus (hair loss may be permanent due to scarring of the hair follicles).
Psoriasis and seborrheic dermatitis commonly involve the scalp but do not produce hair loss. -
This question is part of the following fields:
- The Skin
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Question 10
Incorrect
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A 40-year-old man has had multiple blood transfusions for sideroblastic anaemia. However, this time, 15 minutes into the blood transfusion, he complains of severe breathlessness. CXR shows diffuse bilateral pulmonary infiltrates.
What is the most likely diagnosis?Your Answer: Acute anaphylaxis
Correct Answer: Transfusion-related acute lung injury (TRALI)
Explanation:Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion characterised by the acute onset of non-cardiogenic pulmonary oedema following transfusion of blood products.
TRALI is a more severe manifestation of the febrile non-haemolytic group of transfusion reactions and usually occur in patients who have had multiple previous transfusions. TRALI is related to leucocyte antibodies which are present in the plasma of the blood donor. Multiparous women are the highest-risk donors for TRALI.
For management, leucocyte-depleted blood is now used for transfusion and this is associated with a reduced risk of this type of transfusion reaction.
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This question is part of the following fields:
- Haematology & Oncology
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SESSION STATS - PERFORMANCE PER SPECIALTY
