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Question 1
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A 28-year-old woman is referred to the endocrinology clinic. She has been trying to conceive for the last 3 years without any success. Her prolactin level is 2600 mU/l (normal <360). The Endocrinologist arranges pituitary magnetic resonance imaging (MRI) that demonstrates a microprolactinoma.
Which two of the following pharmacological agents may be appropriate treatment choices?Your Answer: Carbergoline
Explanation:Cabergoline, an ergot derivative, is a long-acting dopamine agonist. It is usually better tolerated than Bromocriptine (BEC), and its efficacy profiles are somewhat superior to those of BEC. It offers the convenience of twice-a-week administration, with a usual starting dose of 0.25 mg biweekly to a maximum dose of 1 mg biweekly. Some studies have shown efficacy even with once-a-week dosing. Cabergoline appears to be more effective in lowering prolactin levels and restoring ovulation. Up to 70% of patients who do not respond to BEC respond to cabergoline.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 2
Correct
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A 40-year-old male returning from an African country, presented with lower abdominal pain and haematuria. Bladder calcifications were detected on abdominal x-ray. Which of the following is the most probable cause?
Your Answer: Schistosoma haematobium
Explanation:Schistosoma haematobium characteristically causes urinary tract disease. S.mansoni, S. mekongi, S. intercalatum, and S. japonicum cause intestinal tract and liver disease.
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This question is part of the following fields:
- Infectious Diseases
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Question 3
Incorrect
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A 53-year-old woman presents with upper GI haemorrhage. She has a history of rheumatoid arthritis for which she is managed with low dose prednisolone, diclofenac and codeine phosphate.
On examination in the Emergency ward her BP is 90/60 mmHg, pulse 100/min. You fluid resuscitate her and her BP improves to 115/80 mmHg, with a pulse of 80/min.
Investigations;
Hb 10.4 g/dl
WCC 6.1 x109/l
PLT 145 x109/l
Na+ 139 mmol/l
K+ 4.9 mmol/l
Creatinine 180 μmol/l
ECG - Lateral ST depression , Upper GI endoscopy reveals a large bleeding ulcer on the posterior aspect of the duodenum. It cannot be easily reached with the endoscope, and you decide to attempt embolization.
Which of the following is the artery that should be targeted?Your Answer: Gastroduodenal artery
Correct Answer: Posterior Superior Pancreaticoduodenal artery
Explanation:The most common location for a duodenal ulcer bleed is the posterior duodenum (remember: posterior bleeds, anterior perforates). The perfusion to this area is most specifically from the posterior superior pancreaticoduodenal artery.
The anterior superior pancreaticoduodenal artery supplies the anterior region. The gastroepiploic artery supplies mostly the stomach. The splenic artery goes, obviously, toward the spleen, in the other direction. The gastroduodenal artery is a branch of the celiac artery, and it’s branches are the anterior superior pancreaticoduodenal artery and posterior superior pancreaticoduodenal artery.
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This question is part of the following fields:
- Gastrointestinal System
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Question 4
Incorrect
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Which of the following types of reactions are a part of the phase II metabolism of a drug?
Your Answer: Dealkylation
Correct Answer: Conjugation
Explanation:Drug metabolism can be broadly classified into:
Phase I (functionalization) reactions: also termed non-synthetic reactions, they include oxidation, reduction, hydrolysis, cyclization and de-cyclization. The most common and vital reactions are oxidation reactions. (Of the given enzymes only Alcohol dehydrogenase is involved in phase I drug metabolism. Succinate dehydrogenase, is a vital enzyme involved in the Kreb’s cycle and the mitochondrial electron transport chain). They are mainly catalysed by Cytochrome P-450 enzyme.Phase II (conjugation) reactions: occur following phase I reactions, they include reactions: glucuronidation and sulphate conjugation, etc. They are mostly catalysed by UDP-glucuronosyltransferase enzyme. Other phase II enzymes include: sulfotransferases, N-acetyltransferases, glutathione S-transferases and methyltransferases.
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This question is part of the following fields:
- Pharmacology
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Question 5
Incorrect
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A 37-year-old social worker is referred to you with a long history of diarrhoea and abdominal discomfort. She was diagnosed with irritable bowel syndrome 10 years ago and takes mebeverine, peppermint tablets and Gaviscon. She is a vegetarian and rarely drinks or smokes.
Examination of all systems is normal. Her blood tests show macrocytic anaemia. An upper gastrointestinal endoscopy reveals oesophagitis, hypertrophy of the gastric body and multiple duodenal ulcers.
What is the most likely diagnosis?Your Answer: Pernicious anaemia
Correct Answer: Zollinger-Ellison syndrome
Explanation:This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from the hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. None of the other answer choices are a better answer than this. CT abdomen may potentially show a tumour, but this is not diagnostic for type.
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This question is part of the following fields:
- Gastrointestinal System
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Question 6
Correct
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A 51-year-old male patient presents with acute back pain, which worsens on prolonged walking and sitting. The pain radiates towards the lower limbs and seems to be relieved by lying down. What is the best next step?
Your Answer: Magnetic resonance imaging (MRI)
Explanation:A herniated disc seems to be the cause of the patient’s pain. MRI is the investigation of choice, since it can show soft tissue and establish a differential diagnosis.
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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 27-year-old man with a history of asthma presents for review. He has recently been discharged from hospital following an acute exacerbation and reports generally poor control with a persistent night time cough and exertional wheeze.
His current asthma therapy is:
salbutamol inhaler 100mcg prn
Clenil (beclomethasone dipropionate) inhaler 800 mcg bd
salmeterol 50 mcg bd
He has a history of missing appointments and requests a prescription with as few side-effects as possible. What is the most appropriate next step in management?Your Answer: Leukotriene receptor antagonist
Explanation:The NICE 2019 guidelines states that in patients who are uncontrolled with a SABA (Salbutamol) and ICS (Beclomethasone), LTRA should be added.
If asthma is uncontrolled in adults (aged 17 and over) on a low dose of ICS as maintenance therapy, offer a leukotriene receptor antagonist (LTRA) in addition to the ICS and review the response to treatment in 4 to 8 weeks. -
This question is part of the following fields:
- Respiratory System
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Question 8
Correct
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A 50-year-old known patient with chronic liver cell disease was admitted complaining of unsteadiness and double vision following an episode of heavy alcohol consumption. On examination, he was confused. there was nystagmus and ataxia. What is the most possible cause for this presentation?
Your Answer: Wernicke's encephalopathy
Explanation:Wernicke’s encephalopathy is a neurological disorder induced by thiamine deficiency and presents with the classic triad of ocular findings, cerebellar dysfunction, and confusion. As alcohol affects thiamine uptake and utilization, thiamine deficiency is usually associated with chronic alcoholism.
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This question is part of the following fields:
- Nervous System
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Question 9
Incorrect
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A 50-year-old male presented with acute severe central chest pain and acute ST elevation myocardial infarction was diagnosed. He was treated with streptokinase. 2 days later he was sweating excessively and he was found to be hypotensive. Which of the following cannot be considered as a reason for this presentation?
Your Answer: Mitral regurgitation
Correct Answer: Hypotensive effect of streptokinase
Explanation:Hypotensive effect of streptokinase occurs during the streptokinase infusion which is usually transient. Acute mitral regurgitation due to rupture of papillary muscles, ventricular septal defects and reinfarctions (left or right) are known to cause hypotension after 24 hrs. Pulmonary embolism is less likely but cannot be excluded.
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This question is part of the following fields:
- Cardiovascular System
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Question 10
Incorrect
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Which of the following statements is incorrect regarding etanercept?
Your Answer: Is licensed for polyarticular-course juvenile idiopathic arthritis in children over 4 years age
Correct Answer: Must be given intravenously
Explanation:Etanercept is a TNF receptor fused with human immunoglobulin. It binds to TNF-alpha preventing it from binding to its normal receptor. Thus, inhibiting it competitively. It is used for treatment of rheumatoid arthritis in adults when traditional treatments fail. When injected subcutaneously, it is accompanied with skin reactions and urticaria. It should be given intravenously. Serious blood disorders and demyelination have also been associated.
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This question is part of the following fields:
- Musculoskeletal System
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Question 11
Incorrect
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A 60-year-old male has complained of a recent onset of postural syncope, impotence, diarrhoea, and profuse sweating. He also has diabetes. In this patient, what is the most likely cause of syncope?
Your Answer: Paroxysmal atrial fibrillation (PAF)
Correct Answer: Autonomic neuropathy
Explanation:Due to the symptoms, a diabetic autonomic neuropathy should be a suspect as a cause for the syncope. Unless associated with atrial fibrillation, mitral regurgitation is not usually expected to cause syncope. PAF can sometimes present with palpitations and a feeling of light-headedness followed by syncope, but is not always the case.
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This question is part of the following fields:
- Cardiovascular System
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Question 12
Incorrect
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A 35-year-old lady presented with a hyperkeratotic, scaly rash over the palmar aspect of her hands and interdigital spaces. The most likely diagnosis would be?
Your Answer: Tinea pedis
Correct Answer: Tinea manum
Explanation:Tinea manum is a superficial fungal infection of the hands characterised by dry scaly rash and also involves the interdigital spaces of the hands. Tinea pedis is a fungal infection of feet, whereas onychomycosis represents a fungal infection of the nails, characterised by nail dystrophy, hyperkeratosis. Kerion is the name given to secondarily infected tinea capitis leading to a soft boggy swelling over the scalp. Psoriasis presents as silvery scales over the extensors of the body and it may involve the nails, scalp and joints.
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This question is part of the following fields:
- The Skin
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Question 13
Incorrect
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A 32-year-old woman was referred for endoscopy and found to have a duodenal ulcer and a positive urease test. She was given lansoprazole, amoxicillin and clarithromycin for 7 days.
Which of the following is the most appropriate way of determining the successful eradication of H. pylori?Your Answer: Endoscopy and antral histology
Correct Answer: Urea breath test
Explanation:Urea breath test is the most sensitive test to determine if there has been RESOLUTION/ERADICATION of the infection with H. pylori. The best test for initial diagnosis would be EGD with biopsy.
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This question is part of the following fields:
- Gastrointestinal System
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Question 14
Incorrect
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A 51-year-old presents with muscle atrophy. He has a high BMI and finds it difficult to climb stairs. If the patient also has polydipsia and polyuria, what is the most likely diagnosis?
Your Answer: Polyneuropathy
Correct Answer: Amyotrophy
Explanation:(Diabetic) Amyotrophy is a condition that presents with muscle wasting and consequent difficulty in climbing stairs. The onset is relatively sudden and symptoms of diabetes are characteristic.
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This question is part of the following fields:
- Nervous System
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Question 15
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A 25-year-old previously well female, in her 10th week of pregnancy presented with a left sided painful calf swelling. An ultrasound scan revealed deep venous thrombosis (DVT) of her left leg. Which of the following is the most appropriate management of this patient?
Your Answer: Initiate and then continue treatment with heparin until delivery
Explanation:Warfarin is contraindicated during pregnancy due to its teratogenic effects. She should be given heparin throughout her pregnancy. It can be converted to warfarin if necessary after the delivery.
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This question is part of the following fields:
- Cardiovascular System
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Question 16
Incorrect
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A new-born male is admitted to NICU with convulsions, limb hypoplasia and rudimentary digits. Which of the following is the most likely cause?
Your Answer: Cytomegalovirus (CMV)
Correct Answer: Varicella
Explanation:Infection of chickenpox in the first half of pregnancy can result in congenital varicella syndrome. It presents as cerebral, cortical and cerebellar hypoplasia with convulsions and rudimentary digits. Prevention is by administering varicella vaccine, even before pregnancy. Varicella immunoglobulin is administered to pregnant women who are exposed to infection. Infection during pregnancy is treated with acyclovir.
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This question is part of the following fields:
- Infectious Diseases
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Question 17
Incorrect
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A 70-year old man presents with difficulty speaking and has a history of weakness in his facial muscles, as well as in his right arm and leg. What is the most appropriate prophylactic regimen in this case?
Your Answer: Aspirin 300mg for 2 weeks followed by aspirin 75mg
Correct Answer: Aspirin 300mg for 2 weeks followed by aspirin 75mg and dipyridamole 200mg
Explanation:Left-sided hemiparesis along with slurred speech are strong indications of stroke in the right cerebral hemisphere. This occurs due to poor blood flow to the brain from the heart. Aspirin 300mg has analgesic, antipyretic, and anti-inflammatory properties that can address the acute symptoms of stroke like migraine and neuralgic pain. With a reduced dose of 75mg of Aspirin, its anti-platelet effect can inhibit further thrombus formation and prevent another stroke. Dipyridamole 200mg is an anti-coagulant preventing clot formation in the blood.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 18
Correct
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A 57-year-old female presented to the cardiology centre with a history of chest tightness for a few hours, accompanied by pain radiating to the left side of the shoulder and neck. ECG was normal. What is the next best investigation for this patient?
Your Answer: Cardiac enzymes
Explanation:This patient’s symptoms of angina radiating to the neck and shoulders gives a strong suspicion of MI. Cardiac enzymes such as troponins are highly specific and sensitive for a heart attack.
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This question is part of the following fields:
- Cardiovascular System
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Question 19
Incorrect
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All of the following are true regarding carcinoid syndrome, except?
Your Answer: It is associated with primary metastatic tumours in the gastrointestinal tract
Correct Answer: Pharmacological blockade is clinically useful in only 10% of patients
Explanation:For medical management of carcinoid syndrome, there are two somatostatin analogues available, Octreotide and Lanreotide. Somatostatin is an amino acid peptide which is an inhibitory hormone, which is synthesized by paracrine cells located ubiquitously throughout the gastrointestinal tract. Both somatostatin analogues provide symptom relief in 50% to 70% of patients and biochemical response in 40% to 60% patients. Many studies have shown that Octreotide and Lanreotide also inhibit the proliferation of tumour cells.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 20
Correct
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A 21-year-old patient presents with multiple itchy wheals on his skin. The wheals are of all sizes and they are exacerbated by scratching. The symptoms started after a viral infection and can last up to an hour. What is the most likely diagnosis?
Your Answer: Urticaria
Explanation:Urticaria is a group of disorders that share a distinct skin reaction pattern, namely the occurrence of itchy wheals anywhere on the skin. Wheals are short-lived elevated erythematous lesions ranging from a few millimetres to several centimetres in diameter and can become confluent. The itching can be prickling or burning and is usually worse in the evening or night time. Triggering of urticaria by infections has been discussed for many years but the exact role and pathogenesis of mast cell activation by infectious processes is unclear.
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This question is part of the following fields:
- The Skin
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SESSION STATS - PERFORMANCE PER SPECIALTY
