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  • Question 1 - The phonocardiogram of a 40-year-old male patient showed a normal S1 but an...

    Incorrect

    • The phonocardiogram of a 40-year-old male patient showed a normal S1 but an abnormal S2. S2 was fixed and widely split. Out of the following, which condition do you think this patient most likely suffering from?

      Your Answer:

      Correct Answer: Secundum atrial septal defect

      Explanation:

      The second heart sound (S2) corresponds to the closing of the semilunar valves, first the aortic and then the pulmonary valve. The gap between the closure of these two valves is normally insignificant and is heard as a single heart sound. In certain pathological conditions, this gap increases when there is a delay in right ventricular emptying, but in cases other than an atrial septal defect, the sound is not fixed. In an atrial septal defect, the right ventricle continuously receives blood, causing a delay and a fixed and split S2.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 2 - A 60-year-old man presented with severe central chest pain for the last 2...

    Incorrect

    • A 60-year-old man presented with severe central chest pain for the last 2 hours. He was on insulin for diabetes mellitus and he was dependent on haemodialysis because of end stage renal failure. He had undergone haemodialysis 48 hours prior to this presentation. His ECG showed an acute inferior myocardial infarction. Despite thrombolysis and other appropriate treatment, he continued to have chest pain after 6 hours from the initial presentation. His blood pressure was 88/54 mmHg and he had bibasal crepitations. His investigation results are given below.
      Serum sodium 140 mmol/l (137-144)
      Serum potassium 6.6 mmol/l (3.5-4.9)
      Serum urea 50 mmol/l (2.5-7.5)
      Serum creatinine 940 ÎĽmol/l (60-110)
      Haemoglobin 10.2g/dl (13.0-18.0)
      Troponin T >24 g/l (<0.04)
      Left ventricular ejection fraction was 20%

      What is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: Coronary angiography and rescue PCI

      Explanation:

      According to the history the patient has cardiogenic shock and pulmonary oedema. On-going ischaemia is indicated by persisting symptoms. So the most appropriate management is coronary angiography and rescue PCI. There are no indications for blood transfusion at this moment and it will aggravate the pulmonary oedema. Haemodialysis, beta blockers and furosemide cannot be given due to low blood pressure.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 3 - Which one of the following is the most common type of Hodgkin lymphoma?...

    Incorrect

    • Which one of the following is the most common type of Hodgkin lymphoma?

      Your Answer:

      Correct Answer: Nodular sclerosing

      Explanation:

      The most common type of Hodgkin’s lymphoma (HL) is nodular sclerosing.

      HL is a malignant proliferation of lymphocytes characterised by the presence of distinctive giant cells known as Reed-Sternberg cells. It has a bimodal age distribution being most common in the third and seventh decades of life.

      According to the histological classification, there are four types of HL:

      1. Nodular sclerosing: most common (around 70%), more common in women, associated with lacunar cells, good prognosis

      2. Mixed cellularity: Around 20%, associated with a large number of Reed-Sternberg cells, good prognosis

      3. Lymphocyte-predominant: Around 5%, Reed-Sternberg cells with nuclei surrounded by a clear space found, best prognosis

      4. Lymphocyte-depleted: rare, worst prognosis

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 4 - Which of the following is the most common route of hepatitis B transmission...

    Incorrect

    • Which of the following is the most common route of hepatitis B transmission worldwide?

      Your Answer:

      Correct Answer: Perinatal transmission

      Explanation:

      Perinatal transmission is the most common cause of Hepatitis B infection worldwide. Post-exposure prophylaxis should be provided, which consists of hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth. Without this, about 40% will develop chronic infection.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 5 - A 42-year-old male patient is admitted with recurrent pancreatitis. He also has a...

    Incorrect

    • A 42-year-old male patient is admitted with recurrent pancreatitis. He also has a history of parotitis. CT scan is carried out revealing no pancreatic mass, but evidence of widespread lymphadenopathy is seen. Dedicated liver imaging reveals a stricture in the common bile duct but no stones.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: IgG4 disease

      Explanation:

      IgG4-related disease (IgG4-RD) is a fibro-inflammatory condition that can affect nearly any organ system: the pancreas, biliary tree, salivary glands, periorbital tissues, kidneys, lungs, lymph nodes, meninges, aorta, breast, prostate, thyroid, pericardium, and skin. The histopathological features are similar across organs, regardless of the site. IgG4-RD is analogous to sarcoidosis, in which diverse organ manifestations are linked by similar histopathological characteristics. Raised concentrations of IgG4 in tissue and serum can be helpful in diagnosing IgG4 disease, but neither is a specific diagnostic marker.

      Some IgG4-RDs are:
      1. Autoimmune pancreatitis
      2. Riedel’s Thyroiditis
      3. Mediastinal and Retroperitoneal Fibrosis
      4. Periaortitis/periarteritis/Inflammatory aortic aneurysm
      5. Kuttner Tumour (submandibular glands)
      6. IgG4-related Mikulicz disease (lacrimal, parotid, and submandibular glands)

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 6 - After examination, a 50-year-old woman was found to have fissuring of the skin...

    Incorrect

    • After examination, a 50-year-old woman was found to have fissuring of the skin of her hands. She has been complaining of fatigue and difficulty in climbing stairs for a couple of months. CXR shows pulmonary fibrosis. Which antibody would you expect to be positive?

      Your Answer:

      Correct Answer: Anti Scl 70

      Explanation:

      Anti-Scl-70 antibodies are associated with pulmonary fibrosis and indicate a poor prognosis when positive. Also, they are a specific marker for the diffuse type of systemic sclerosis. Systemic scleroderma, also called diffuse scleroderma or systemic sclerosis, is an autoimmune disease of the connective tissue. It is characterized by thickening of the skin caused by accumulation of collagen, and by injuries to small arteries.

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 7 - A 25-year-old woman was admitted to hospital with a 3 day history of...

    Incorrect

    • A 25-year-old woman was admitted to hospital with a 3 day history of feeling generally unwell, with fatigue, arthralgia and pruritus. She had recently finished a 5 day course of antibiotics for a urinary tract infection but there was no other significant past medical history. She had no significant findings on clinical examination except for a widespread erythematous rash.

      Investigation results are below:

      Haemoglobin (Hb) 12.6 g/dl
      White cell count (WCC) 13.0 Ă— 109/l (eosinophilia)
      Platelets 390 Ă— 109/l
      Creatinine 720 ÎĽmol/l
      Na+ 135 mmol/l
      K+ 5.2 mmol/l
      Urea 22.0 mmol/l
      Urinalysis Protein ++ blood +


      What is the most important investigation to establish the diagnosis?

      Your Answer:

      Correct Answer: Renal biopsy

      Explanation:

      There is a strong suspicion of drug-induced acute tubulo-interstitial nephritis with the classic triad of symptoms of rash, joint pain and eosinophils in the blood, associated with non-specific symptoms of fever and fatigue. This can be confirmed with renal biopsy showing interstitial oedema with a heavy infiltrate of inflammatory cells and variable tubular necrosis.

    • This question is part of the following fields:

      • Renal System
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  • Question 8 - A 31-year-old female with systemic lupus erythematosus wants to know if she has...

    Incorrect

    • A 31-year-old female with systemic lupus erythematosus wants to know if she has any predisposing factors for the disease. Which of the following carries the greatest risk of developing SLE?

      Your Answer:

      Correct Answer: Monozygotic twin

      Explanation:

      An overall concordance rate in monozygotic twins was documented to be 25% as compared to dizygotic twins with 3%. First degree relatives have a chance of around 3% of developing the disease. Caucasians show an increase frequency of HLA-B8. The Japanese lupus patients had a stronger association with HLA-DR2.

    • This question is part of the following fields:

      • Musculoskeletal System
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  • Question 9 - A 28-year-old woman presents with lethargy, arthralgia and cough. Over the past three...

    Incorrect

    • A 28-year-old woman presents with lethargy, arthralgia and cough. Over the past three weeks she has also developed painful erythematous nodules on both shins. Respiratory examination is normal.

      A chest x-ray is performed which is reported as follows:
      Bilateral mediastinal nodal enlargement. No evidence of lung parenchymal disease. Normal cardiac size.

      Given the likely diagnosis, what would be the most appropriate course of action?

      Your Answer:

      Correct Answer: Observation

      Explanation:

      Sarcoidosis is an inflammatory disease that affects one or more organs but most commonly affects the lungs and lymph glands. The inflammation may change the normal structure and possibly the function of the affected organ(s).
      The presentation in sarcoidosis varies with the extent and severity of organ involvement, as follows:
      Asymptomatic (incidentally detected on chest imaging): Approximately 5% of cases.
      Systemic complaints (fever, anorexia): 45% of cases
      Pulmonary complaints (dyspnoea on exertion, cough, chest pain, and haemoptysis [rare]): 50% of cases

      Löfgren syndrome (fever, bilateral hilar lymphadenopathy, and polyarthralgias): Common in Scandinavian patients, but uncommon in African-American and Japanese patients.

      Dermatologic manifestations may include the following:
      – Erythema nodosum
      – A lower-extremity panniculitis with painful, erythematous nodules (often with Löfgren syndrome)
      – Lupus pernio (the most specific associated cutaneous lesion)
      – Violaceous rash on the cheeks or nose (common)
      – Maculopapular plaques (uncommon)

      Staging of sarcoidosis is as follows:
      Stage 0: Normal chest radiographic findings
      Stage I: Bilateral hilar lymphadenopathy
      Stage II: Bilateral hilar lymphadenopathy and infiltrates
      Stage III: Infiltrates alone
      Stage IV: Fibrosis

      Nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated for the treatment of arthralgias and other rheumatic complaints. Patients with stage I sarcoidosis often require only occasional treatment with NSAIDs.

      Treatment in patients with pulmonary involvement is as follows:
      Asymptomatic patients may not require treatment
      In patients with minimal symptoms, serial re-evaluation is prudent
      Treatment is indicated for patients with significant respiratory symptoms
      Corticosteroids can produce small improvements in the functional vital capacity and in the radiographic appearance in patients with more severe stage II and III disease.

      This patient has Stage 1 Sarcoidosis so observation is the most appropriate action.

    • This question is part of the following fields:

      • Respiratory System
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  • Question 10 - A 25-year-old female presented with blisters on the tongue. Some of them secreted...

    Incorrect

    • A 25-year-old female presented with blisters on the tongue. Some of them secreted pinkish fluid while some were crusted. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: HSV1

      Explanation:

      The history is suggestive of acute gingivostomatitis, which is a manifestation of primary HSV-1 infection. Patients present with gingivitis and vesicular lesions which develop on the oral mucosa, tongue, and lips and later rupture and coalesce, leaving ulcerated plaques.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 11 - A 75-year-old female has developed recurrent breathlessness after having a mitral valve replacement...

    Incorrect

    • A 75-year-old female has developed recurrent breathlessness after having a mitral valve replacement 13 years ago. Her husband has also noticed a prominent pulsation in her neck. She has also complained of ankle swelling and pain in the abdomen. Choose the most probable diagnosis from the list of options.

      Your Answer:

      Correct Answer: Tricuspid regurgitation

      Explanation:

      Multiple symptoms point towards tricuspid regurgitation: recurrent breathlessness (if the cause if LV dysfunction); a prominent pulsation in her neck (giant V waves); pain in the abdomen (pain in liver upon exertion); and ankle swelling.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 12 - A 40-year-old truck operator who smokes one and a half packs of cigarette...

    Incorrect

    • A 40-year-old truck operator who smokes one and a half packs of cigarette per day complains of a cough and fever for the last three days. He also has right-sided chest pain when he inhales. On examination he is slightly cyanosed, has a temperature of 38.1°C, a respiratory rate of 39/min, a BP of 104/71 mm/Hg and a pulse rate of 132/min. He has basal crepitations and dullness to percussion at the right lung base.
      What could be a probable diagnosis?

      Your Answer:

      Correct Answer: Bronchopneumonia

      Explanation:

      Bronchopneumonia presents as a patchy consolidation involving one or more lobes, usually the dependent lung zones, a pattern attributable to aspiration of oropharyngeal contents.

      Symptoms of bronchopneumonia may be like other types of pneumonia. This condition often begins with flu-like symptoms that can become more severe over a few days. The symptoms include:
      – fever
      – a cough that brings up mucus
      – shortness of breath
      – chest pain
      – rapid breathing
      – sweating
      – chills
      – headaches
      – muscle aches
      – pleurisy, or chest pain that results from inflammation due to excessive coughing
      – fatigue
      – confusion or delirium, especially in older people

      There are several factors that can increase your risk of developing bronchopneumonia. These include:
      – Age: People who are 65 years of age or older, and children who are 2 years or younger, have a higher risk for developing bronchopneumonia and complications from the condition.
      – Environmental: People who work in, or often visit, hospital or nursing home facilities have a higher risk for developing bronchopneumonia.
      – Lifestyle: Smoking, poor nutrition, and a history of heavy alcohol use can increase your risk for bronchopneumonia.
      – Medical conditions: Having certain medical conditions can increase your risk for developing this type of pneumonia. These include: chronic lung disease, such as asthma or chronic obstructive pulmonary disease (COPD), HIV/AIDS, having a weakened immune system due to chemotherapy or the use of immunosuppressive drugs.

    • This question is part of the following fields:

      • Respiratory System
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  • Question 13 - A son has brought his 72-year-old mother to clinic. He is concerned about...

    Incorrect

    • A son has brought his 72-year-old mother to clinic. He is concerned about her short-term memory problems for the past 10 months. He has to remind her to take her medications and she has had two incidents of falling over in the last 10 months. Which of the following assists in the diagnosis of above condition?

      Your Answer:

      Correct Answer: Progressive loss of function

      Explanation:

      The clinical presentation is dementia. To differentiate Alzheimer disease and vascular dementia, the progressive loss of function is important. Progressive loss of function is usually associated with vascular dementia and rest of the responses are associated with Alzheimer disease.

    • This question is part of the following fields:

      • Geriatric Medicine
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  • Question 14 - A 60-year-old male presented in the OPD with a severe pain in the...

    Incorrect

    • A 60-year-old male presented in the OPD with a severe pain in the chest, which radiated to the jaw and his left shoulder. What is your diagnosis?

      Your Answer:

      Correct Answer: MI

      Explanation:

      Risk of myocardial infarction is high in patients with diabetes mellitus. High levels of sugar in the blood can damage the arteries and lead to an increased risk of atherosclerosis of the coronary arteries. This is why diabetic patients have an increased risk of Myocardial Infarction.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 15 - Which of the following statements regarding restless leg syndrome is not true? ...

    Incorrect

    • Which of the following statements regarding restless leg syndrome is not true?

      Your Answer:

      Correct Answer: It is three times as common in females

      Explanation:

      In restless leg syndrome (RLS), males and females are thought to be equally affected. RLS is a syndrome of spontaneous, continuous lower limb movements that may be associated with paraesthesia. It is extremely common, affecting between 2-10% of the general population and a family history may be present.

    • This question is part of the following fields:

      • Nervous System
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  • Question 16 - A 46-year-old woman complains of ulceration with bloody discharge around her right nipple...

    Incorrect

    • A 46-year-old woman complains of ulceration with bloody discharge around her right nipple accompanied by redness, excoriations, and severe itchiness. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Paget's disease of the breast

      Explanation:

      Paget’s disease of the breast is a type of cancer that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast. Symptoms may include redness of the nipple skin and crusting may occur around the area. In more advance cases, symptoms may include itching or a burning pain in the nipple.

    • This question is part of the following fields:

      • Women's Health
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  • Question 17 - A 70-year-old complains of lower urinary tract symptoms. Which one of the following...

    Incorrect

    • A 70-year-old complains of lower urinary tract symptoms. Which one of the following statements regarding benign prostatic hyperplasia is incorrect?

      Your Answer:

      Correct Answer: Goserelin is licensed for refractory cases

      Explanation:

      Goserelin (Zoladex) is usually prescribed to treat hormone-sensitive cancers of the breast and prostate not for BPH. All other statements are correct.

    • This question is part of the following fields:

      • Renal System
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  • Question 18 - A 70-year-old male presented in the emergency department with urosepsis. Gentamicin (7 mg/kg...

    Incorrect

    • A 70-year-old male presented in the emergency department with urosepsis. Gentamicin (7 mg/kg once daily) was administered to treat the infection. One day after administration, his gentamicin levels were more than 2 mg/L. Which of the following side effects is most likely to occur in such a case?

      Your Answer:

      Correct Answer: Nephrotoxicity

      Explanation:

      Gentamicin is a nephrotoxic agent. Its dose should be monitored carefully in elderly or renal patients. If gentamicin starts accumulating in the body (above 2mg/L) then the next dose of gentamicin should be stopped. Otherwise it may cause acute tubular necrosis of the kidneys. Hepatotoxicity, retinopathy, peripheral neuropathy and encephalopathy are not usually associated with gentamicin toxicity.

    • This question is part of the following fields:

      • Emergency & Critical Care
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  • Question 19 - A 30-year-old female presents with an infected skin ulcer. She is prescribed flucloxacillin...

    Incorrect

    • A 30-year-old female presents with an infected skin ulcer. She is prescribed flucloxacillin and later develops jaundice, pale stools, and dark-coloured urine. What is the single most likely diagnosis?

      Your Answer:

      Correct Answer: Cholestatic jaundice

      Explanation:

      Due to its cholestatic properties, Flucloxacillin can block bile flow through the liver, leading to the accumulation of bilirubin in the blood, giving rise to jaundice. Dark urine is the result of excessive bilirubin in the blood being filtered by the kidney. Pale stools is an effect of the blocked bile flow through the liver.

    • This question is part of the following fields:

      • Hepatobiliary System
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  • Question 20 - A 24-year-old male was involved in a traffic collision. X-rays indicated that the...

    Incorrect

    • A 24-year-old male was involved in a traffic collision. X-rays indicated that the neck of the humerus had suffered a fracture. Choose the single most associated nerve injury from the list of options.

      Your Answer:

      Correct Answer: Axillary nerve

      Explanation:

      Fractures in the neck of the humerus are well documented to cause damage to the auxiliary nerve.

    • This question is part of the following fields:

      • Nervous System
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  • Question 21 - A kidney, ureter, and bladder (KUB) ultrasound for a hypertensive man with a...

    Incorrect

    • A kidney, ureter, and bladder (KUB) ultrasound for a hypertensive man with a BP of 160/90 mmHg and proteinuria++ revealed a decrease in size of the kidneys with smooth borders and normal pelvicalyceal system. What is the cause of hypertension in the patient?

      Your Answer:

      Correct Answer: Chronic glomerulonephritis

      Explanation:

      Causes of hypertension in bilateral renal artery stenosis are as follows: 90% probable cause is atherosclerosis with manifestations of CAD, TIA or stroke. The other less common cause is fibromuscular dysplasia that includes carotid and vertebral artery with manifestations of headache, TIA, and stroke.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 22 - A 33-year-old male was brought in with complaints of an unsteady gait. According...

    Incorrect

    • A 33-year-old male was brought in with complaints of an unsteady gait. According to the patient, he suffered a severe headache in the morning, with associated vomiting. Slowly his condition deteriorated until he was unable to walk. On exam, he had nystagmus and there was past pointing of the right arm. He speech was slurred, his uvula was deviated towards the right and there was decreased pinprick sensation on the right half of the body. The most likely site of the lesion in this patient would be?

      Your Answer:

      Correct Answer: Left lateral medulla

      Explanation:

      Loss of sensations in left (ipsilateral) side of the face and contralateral (right) side of the body indicates a defect in left lateral medulla. Further cerebellar signs lead to the diagnosis of Lateral Medullary Syndrome.

    • This question is part of the following fields:

      • Nervous System
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  • Question 23 - A 23-year-old woman comes for the advice regarding contraceptives. Her mother passed away...

    Incorrect

    • A 23-year-old woman comes for the advice regarding contraceptives. Her mother passed away due to cervical cancer and she worries about cervical cancer. Which of the following is the most suitable contraceptive method for her?

      Your Answer:

      Correct Answer: Barrier method

      Explanation:

      Cervical cancer results from genital infection with HPV. PV infections can be transmitted via nonsexual routes, but the result from sexual contact. So the best contraceptive method in relation to prevention of cervical cancer is the barrier method. But it will not prevent cervical cancer a 100%.

    • This question is part of the following fields:

      • Women's Health
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  • Question 24 - A 7-year-old boy was brought to the ED in an unconscious and apnoeic...

    Incorrect

    • A 7-year-old boy was brought to the ED in an unconscious and apnoeic state. What is your immediate management of this case?

      Your Answer:

      Correct Answer: Secure airway

      Explanation:

      ABC : Airway, breathing, circulation is the order of assessment in any patient that is unconscious and apnoeic.

    • This question is part of the following fields:

      • Nervous System
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  • Question 25 - An 8-year-old boy is presented with arthritis, cough and non-blanching purpura. His coagulation...

    Incorrect

    • An 8-year-old boy is presented with arthritis, cough and non-blanching purpura. His coagulation profile is normal. His CBC: Hb 11.8 TLC 7.2*10^9 Plt 286*10^9. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Henoch-Schönlein Purpura (HSP)

      Explanation:

      The best answer is Henoch-Schönlein Purpura (HSP). This patient has a characteristic rash and the labs are consistent with this diagnosis.

    • This question is part of the following fields:

      • Cardiovascular System
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  • Question 26 - A 32-year-old lady is found to be hepatitis B surface antigen positive. This...

    Incorrect

    • A 32-year-old lady is found to be hepatitis B surface antigen positive. This positive result has persisted for more than six months. Hepatitis B envelope antigen (HBeAg) is negative. HBV DNA is negative. Her liver function tests are all entirely normal.

      Which of the following options would be the best for further management?

      Your Answer:

      Correct Answer: No antiviral therapy but monitor serology

      Explanation:

      Again, remember the Hepatitis B serologies: In chronic hepatitis B infection, you have +HBsAg, +anti-HBc, (-)IgM antiHBc, and (-) anti-HBs. In acute hepatitis B infection, you have +HBsAg, + anti-HBc, + IgM anti-HBc, and negative anti-HBs. In immunity due to natural infection, you have negative HBsAg, + anti-HBc, and + anti-HBs. In immunity due to vaccination, you have negative HBsAg, negative anti-HBc, and positive anti-HBs. IN THIS CASE, the person is HBsAg+ for 6 months and everything else is negative, normal transaminase. They do not need antiviral therapy, but their serology should be monitored serially. There would be no reason to do a liver biopsy.

    • This question is part of the following fields:

      • Gastrointestinal System
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  • Question 27 - An 86-year-old male patient has been diagnosed with monoclonal gammopathy of undetermined significance....

    Incorrect

    • An 86-year-old male patient has been diagnosed with monoclonal gammopathy of undetermined significance. He is eager to know its relation to his future health.

      Which of the following statements is correct?

      Your Answer:

      Correct Answer: 10% of patients with MGUS go on to develop myeloma over 10 years

      Explanation:

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 28 - A 22-year-old patient was diagnosed with glioblastoma multiforme, after he was investigated for...

    Incorrect

    • A 22-year-old patient was diagnosed with glioblastoma multiforme, after he was investigated for seizures. The cell of origin of this tumour is?

      Your Answer:

      Correct Answer: Astrocytes

      Explanation:

      Glioblastoma multiforme is the most common anaplastic malignant tumour of the glial cells. It is a mixture of poorly differentiated anaplastic astrocytes.

    • This question is part of the following fields:

      • Nervous System
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  • Question 29 - A 30-year-old patient with schizophrenia was brought to Emergency Department, due to reduced...

    Incorrect

    • A 30-year-old patient with schizophrenia was brought to Emergency Department, due to reduced level of consciousness. On examination he was febrile, rigid and had tremors. Which of following does not support the diagnosis of neuroleptic malignant syndrome?

      Your Answer:

      Correct Answer: Usually occurs after prolonged treatment

      Explanation:

      Neuroleptic Malignant Syndrome is a life-threatening condition associated with neuroleptic medications. It is characterized by severe muscular rigidity, hyperthermia, autonomic instability (tachycardia, tachypnoea etc) and changes in the level of consciousness. It usually occurs 4-14 days after the start of therapy. Renal failure and elevated creatinine kinase are also associated with this condition.

    • This question is part of the following fields:

      • Emergency & Critical Care
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  • Question 30 - A 30-year-old male with a history of premature cardiovascular disease in the family...

    Incorrect

    • A 30-year-old male with a history of premature cardiovascular disease in the family has come for review of his lab investigations.
      His fasting cholesterol is 8.4 mmol/l with high-density lipoprotein (HDL) of 1.6 mmol/l.
      You elect to commence him on atorvastatin 20 mg PO daily.
      Which of the following best describes the mechanism of action of the statins?

      Your Answer:

      Correct Answer: They inhibit HMG CoA reductase

      Explanation:

      Statins are a selective, competitive inhibitor of hydroxymethylglutaryl-CoA (HMG-CoA) reductase, which is the enzyme responsible for the conversion of HMG-CoA to mevalonate in the cholesterol synthesis pathway.
      Statins are usually well tolerated with myopathy, rhabdomyolysis, hepatotoxicity, and diabetes mellitus being the most common adverse reactions.
      This is the rate-limiting step in cholesterol synthesis, that leads to increased hepatic low-density lipoprotein (LDL) receptors and reduced hepatic VLDL synthesis coupled with increased very-low-density lipoprotein (VLDL) clearance.

    • This question is part of the following fields:

      • Pharmacology
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