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Question 1
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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 32-year-old gentleman presents to his GP with a 2 month history of constant abdominal pain and early satiety. He has hypertension for which he takes enalapril.
On examination, he has mild tenderness on both flanks. Well-circumscribed masses are palpable in both the left and right flanks. A soft systolic murmur is heard loudest at the apex.
His observations are heart rate 67/min, blood pressure 152/94 mmHg, temperature 37.2C, respiratory rate 14/min, saturations 97%.
Which additional feature is most likely to be found in this patient?Your Answer: Colonic polyps
Correct Answer: Hepatomegaly
Explanation:This patient shows classic symptoms of autosomal-dominant polycystic kidney disease (ADPKD). The abdominal pain and early satiety is caused by the enlarged kidneys that were apparent from the physical examination. Additionally, hypertension is a common symptom along with the systolic murmur that was heard, suggesting mitral valve involvement. In ADPKD cases, the most common extra-renal manifestation is the development of liver cysts which are associated with hepatomegaly.
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This question is part of the following fields:
- Renal System
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Question 3
Incorrect
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A 52-year-old man has squamous-cell carcinoma of his lower lip. Which of the following is most likely to be a feature of this type of carcinoma?
Your Answer: 5 year survival is poor
Correct Answer: It is capable of metastasising via the lymphatics
Explanation:Squamous-cell skin cancer usually presents as a hard lump with a scaly top but can also form an ulcer. Onset is often over months and it is more likely to spread to distant areas than basal cell cancer vie the lymphatics. The greatest risk factor is high total exposure to ultraviolet radiation from the Sun. Other risks include prior scars, chronic wounds, actinic keratosis, lighter skin, Bowen’s disease, arsenic exposure, radiation therapy, poor immune system function, previous basal cell carcinoma, and HPV infection. While prognosis is usually good, if distant spread occurs five-year survival is ,34%
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This question is part of the following fields:
- The Skin
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Question 4
Incorrect
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An soccer player suddenly collapsed on the field and started coughing along with shortness of breath. The investigation of choice in this case would be?
Your Answer: Magnetic resonance imaging (MRI)
Correct Answer: Chest x-ray
Explanation:Exercise induced asthma is characterised by sudden onset wheezing, cough and shortness of breath while performing hectic physical activity. The best investigation to perform is a chest X-ray.
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This question is part of the following fields:
- Respiratory System
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Question 5
Correct
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A 45-year-old male who is a heavy alcoholic was admitted with loss of memory, hallucinations and difficulty walking. On examination, he had an ataxic gait. He was given Acamprosate. Which one of the following can be given with the above drug?
Your Answer: Thiamine
Explanation:Wernicke’s encephalopathy is characterised by the triad of ophthalmoplegia, ataxia, and confusion. It must be viewed as a medical emergency with rapid correction of thiamine deficiency as the goal of therapy. Acamprosate is a medication used to treat alcohol dependence by stabilizing chemical signalling in the brain that would otherwise be disrupted by alcohol withdrawal
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This question is part of the following fields:
- Nervous System
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Question 6
Correct
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A 15-year-old boy was admitted to the ED with a history of sudden onset chest pain and difficulty in breathing after strenuous exercise. On examination, there was reduced breath sounds on the right side but he was not cyanosed. He maintained oxygen sats of 93% on air. What is the single most appropriate investigation?
Your Answer: CXR
Explanation:The history and examination is suggestive of a spontaneous pneumothorax. The best investigation that can be performed at this stage is a CXR. Spontaneous primary pneumothorax occurs in the absence of a known lung pathology. Proposed risk factors shown to predispose patients to primary spontaneous pneumothorax (PSP) include smoking, family history, Marfan syndrome, homocystinuria, and thoracic endometriosis.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 7
Correct
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An 18-year-old boy with a history of bloody diarrhoea and fever, presents with a skin rash and low urine output. Blood tests and urinalysis reveal increased levels of urea and creatinine and haematuria. What is the most probable diagnosis?
Your Answer: Haemolytic Uraemic Syndrome
Explanation:Signs and symptoms of haemolytic uremic syndrome can include bloody diarrhoea, low urine output, nausea, vomiting, abdominal pain and general fatigue. Increased values of urea and creatinine are also typical.
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This question is part of the following fields:
- Haematology & Oncology
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Question 8
Incorrect
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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: First-degree relative
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.
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This question is part of the following fields:
- Musculoskeletal System
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Question 9
Incorrect
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According to the Vaughan Williams classification of antiarrhythmic agents, lidocaine is a:
Your Answer: Class Ic agent
Correct Answer: Class Ib agent
Explanation:Lidocaine is an example of class IB antiarrhythmics.
The Vaughan-Williams classification of antiarrhythmics
I: Membrane stabilizing agents
IA: Quinidine, Procainamide, Disopyramide
IB: Lidocaine, Mexiletine
IC: Propafenone, Flecainide
II: β blockers – Propranolol, Esmolol
III: Agents widening AP – Amiodarone, Dronedarone, Dofetilide, Ibutilide, Sotalol
IV: Calcium channel blockers – Verapamil, Diltiazem
V: Miscellaneous – Digoxin, adenosine, magnesium -
This question is part of the following fields:
- Pharmacology
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Question 10
Correct
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A 55-year-old alcoholic is admitted with portal hypertension. The wedged hepatic venous pressure is recorded. This pressure is reflective of which part of the hepatic vascular system?
Your Answer: Sinusoids
Explanation:The wedged hepatic venous pressure is a reflection of the portal venous pressure in the hepatic sinusoids. This is a fact to remember. Here is a great but concise explanation as to why: https://www.ncbi.nlm.nih.gov/pubmed/18695309
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This question is part of the following fields:
- Hepatobiliary System
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SESSION STATS - PERFORMANCE PER SPECIALTY
