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Question 1
Correct
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A 72-year-old woman presents with a 3 month history of colicky abdominal pain after eating, and diarrhoea. She has lost 7 kg in weight over the last few months. A recent gastroscopy and colonoscopy were normal. Her past medical history includes angina and a right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan.
right carotid endarterectomy at the age of 62 years. Her current medication includes aspirin, atenolol, simvastatin and losartan.
Blood tests revealed:
Haemoglobin (Hb) 118 g/l
Mean corpuscular volume (MCV) 80 fl
White cell count (WCC) 12.3 x 109/l
Platelets 210 x 109/l
Na+ 133 mmol/l
K+ 5.2 mmol/l
Urea 8.1 mmol/l
Creatinine 134 mmol/l
Select the most appropriate further investigations.Your Answer: Contrast-enhanced computed tomography (CT) of the abdomen
Explanation:The patient is 74 years old. She has had a recent gastroscopy and colonoscopy. She has a history of angina and a right CEA. She is having colicky abdominal pain after meals and weight loss, which points to a possible diagnosis of chronic mesenteric ischemia. Thus, you would want to do a contrast-enhanced CT scan of the abdomen to look for this. A 24 hour cardiac monitor would also be helpful to look for any abnormal rhythm that could be a potential aetiology of her disease.
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This question is part of the following fields:
- Gastrointestinal System
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Question 2
Incorrect
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A 44-year-old call centre worker with asthma is prescribed a leukotriene inhibitor. He presents with severe abdominal pain and a pleural effusion. Which of the following is the most likely cause of the effusion?
Your Answer: Pancreatitis
Correct Answer: Churg-Strauss syndrome
Explanation:Churg-Strauss syndrome is characterised by reactions in the serosal membranes. Hence, pericardial effusions and pleural effusions are common. Cytological analysis of the transudate shows high levels of eosinophils. Leukotriene inhibitors are known to increase the incidence of this syndrome.
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This question is part of the following fields:
- Respiratory System
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Question 3
Incorrect
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A 66 year-old marketing analyst presents to the respiratory clinic with a 2-month history of progressive weakness and shortness of breath. He finds it difficult to stand from sitting, and struggles climbing stairs. He is an ex-smoker with chronic obstructive pulmonary disease (COPD). He had a recent exacerbation one month ago for which he was treated by the GP with a course of oral prednisolone, during which time his weakness transiently improved. On examination, you note a left-sided monophonic wheeze and reduced breath sounds at the left lung base. Blood tests and a chest x-ray are requested.
Hb 145 g/L
WCC10.5 109/l
Na+136 mmol/L
K+ 4.3 mmol/L
Urea 6.8 mmol/L
Creatinine 93 mmol/L
Calcium 2.62 mmol/L
Phosphate 1.44 mmol/L
Chest x-ray shows hyperinflated lungs, left lower lobe collapse and a bulky left hilum
What is the most likely cause of this patient's weakness?Your Answer: Myasthenia gravis
Correct Answer: Lambert-Eaton myasthenic syndrome
Explanation:This man has a small-cell lung cancer (SCLC) and associated Lambert-Eaton myasthenic syndrome – a well-recognized paraneoplastic manifestation of SCLC. This classically affects the proximal muscles, especially in the legs, causing difficulty in standing from a seated position and climbing stairs. In contrast to myasthenia gravis, eye involvement is uncommon. Treatment with steroids is often helpful, which explains his transient symptomatic improvement during treatment for his COPD exacerbation. Steroid myopathy does not fit as the symptoms started well before his course of prednisolone. Although the patient is mildly hypercalcaemic, this would not be sufficient to produce his presenting symptoms, although it does reinforce the suspicion of lung malignancy. Motor neurone disease would be unlikely in this context and would not improve with steroids. Myasthenia gravis could produce these symptoms, but in the context of a new lung mass is a less viable diagnosis.
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This question is part of the following fields:
- Nervous System
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Question 4
Incorrect
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Which of the following is not an indication for an implantable cardiac defibrillator?
Your Answer:
Correct Answer: Wolff-Parkinson White syndrome
Explanation:Class I indications (i.e., the benefit greatly outweighs the risk, and the treatment should be administered): -Structural heart disease, sustained VT
-Syncope of undetermined origin, inducible VT or VF at electrophysiologic study (EPS)
-Left ventricular ejection fraction (LVEF) ≤35% due to prior MI, at least 40 days post-MI, NYHA class II or III
-LVEF ≤35%, NYHA class II or III
-LVEF ≤30% due to prior MI, at least 40 days post-MI
-LVEF ≤40% due to prior MI, inducible VT or VF at EPSClass IIa indications (i.e., the benefit outweighs the risk and it is reasonable to administer the treatment):
-Unexplained syncope, significant LV dysfunction, nonischaemic cardiomyopathy
-Sustained VT, normal or near-normal ventricular function
-Hypertrophic cardiomyopathy with 1 or more major risk factors
-Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) with 1 or more risk factors for sudden cardiac death (SCD)
-Long QT syndrome, syncope or VT while receiving beta-blockers
-Nonhospitalized patients awaiting heart transplant
-Brugada syndrome, syncope or VT
-Catecholaminergic polymorphic VT, syncope or VT while receiving beta-blockers
-Cardiac sarcoidosis, giant cell myocarditis, or Chagas disease -
This question is part of the following fields:
- Cardiovascular System
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Question 5
Incorrect
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A 37-year-old woman presents with sudden blindness. She claims she had a similar episode last year which resolved in three months. Fundoscopy is normal. Upon examination, mild weakness of the right upper limb is found. Reflexes on the same limb are exaggerated. What is the best treatment?
Your Answer:
Correct Answer: Corticosteroids
Explanation:The age of the patients together with sudden loss of vision, remission and relapse of optic neuritis, focal neurological symptoms and exaggerated reflexes all suggest multiple sclerosis. This is treated with corticosteroids.
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This question is part of the following fields:
- Nervous System
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Question 6
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:
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 7
Incorrect
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A 60-year-old diabetic female patient presented with spasmodic pain in her left thigh and calf muscle. During examination the doctor noticed that the femoral and popliteal pulses were absent on the left side. Which of the following vessels is most probably occluded?
Your Answer:
Correct Answer: External Iliac Artery
Explanation:The external iliac artery supplies both the thigh and calf muscles. The absence of pulses in femoral and popliteal vessels indicates the obstruction of the external iliac artery.
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This question is part of the following fields:
- Musculoskeletal System
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Question 8
Incorrect
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A 50-year-old heavy drinker is brought to the A&E in a drowsy state. He is responding to questions however on examination he has nystagmus and hyper-reflexia. His MCV is 103fL.What is the most likely cause for his cognitive impairment?
Your Answer:
Correct Answer: B1 Deficiency
Explanation:Thiamine deficiency is very common with alcoholism. It manifests by Wernicke-Korsakoff encephalopathy. The patient is usually agitated, with an abnormal gait and amnesia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 9
Incorrect
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Patients with myeloma mostly present with which of the following condition when in hospital?
Your Answer:
Correct Answer: Hypercalcaemia
Explanation:Hypercalcemia is the most important finding in all types of malignancies. In myeloma it is especially caused by osteoclast activating factors which increase bone turnover.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 10
Incorrect
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A 23-year-old female presents to the hospital with worsening shortness of breath, increased volume of purulent sputum and left-sided chest pain. She has a history of cystic fibrosis. Medical notes state that she is under consideration for the transplant list and for some years has been colonised with pseudomonas.
On examination she has a temperature of 38.4°C and FEV1 falling below 75% of the previous value that was recorded. She looks unwell and is tachycardic and hypotensive with a respiratory rate of 21/min. Burkholderia cepacia is confirmed as the pathogen in this case.
What would be the most appropriate antibiotic regime?Your Answer:
Correct Answer: Ceftazidime and aminoglycoside
Explanation:Burkholderia cepacia is an aerobic gram-negative bacillus found in various aquatic environments. B cepacia is an organism of low virulence and is a frequent colonizer of fluids used in the hospital (e.g., irrigation solutions, intravenous fluids).
B cepacia, as a non-aeruginosa pseudomonad, is usually resistant to aminoglycosides, antipseudomonal penicillin, and antipseudomonal third-generation cephalosporins and polymyxin B.
B cepacia is often susceptible to trimethoprim plus sulfamethoxazole (TMP-SMX), cefepime, meropenem, minocycline, and tigecycline and has varying susceptibility to fluoroquinolones.
Based on the options available, ceftazidime and aminoglycoside would be the best option. -
This question is part of the following fields:
- Respiratory System
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SESSION STATS - PERFORMANCE PER SPECIALTY
