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Question 1
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A 72-year-old woman who presented with headache and neck stiffness was started on IV ceftriaxone after undergoing a lumbar puncture. The CSF culture shows listeria monocytogenes. What is the treatment of choice?
Your Answer: Change to IV amoxicillin + gentamicin
Explanation:The best option would be the combination of ampicillin and gentamycin. Changing to IV amoxicillin+gentamycin is however the best among the given choices here.
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This question is part of the following fields:
- Infectious Diseases
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Question 2
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A 58-year-old woman has multiple non-healing leg ulcers. She reports feeling unwell for several months. Examination findings include a normal blood pressure, pulse 90 bpm, pale conjunctivae and poor dentition associated with bleeding gums. What is the most likely underlying diagnosis?
Your Answer: Vitamin C deficiency
Explanation:Severe vitamin C deficiency results in scurvy, a disorder characterized by hemorrhagic manifestations and abnormal osteoid and dentin formation.
Vitamin C plays a role in collagen, carnitine, hormone, and amino acid formation. It is essential for bone and blood vessel health and wound healing and facilitates recovery from burns. Vitamin C is also an antioxidant, supports immune function, and facilitates the absorption of iron (see table Sources, Functions, and Effects of Vitamins).
Dietary sources of vitamin C include citrus fruits, tomatoes, potatoes, broccoli, strawberries, and sweet peppers. (See also Overview of Vitamins.) -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 3
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A 56-year-old woman presents to the clinic complaining of shoulder pain that she has been experiencing for the last 4 weeks. She does not remember getting injured previously. The pain worsens on movement especially when she is moving the arm quickly. At night, lying on the affected side is painful. Examination reveals no erythema or swelling. However, pain is felt on passive abduction between 60 to 120 degrees and she is unable to abduct the arm past 70-80 degrees. Flexion and extension are intact. What is the most likely diagnosis?
Your Answer: Supraspinatus tendonitis
Explanation:Supraspinatus tendinopathy is a common and disabling condition that becomes more prevalent after middle age and is a common cause of pain in the shoulder. A predisposing factor is resistive overuse. This patient has the classic painful arc that is a sign of shoulder impingement characteristic of supraspinatus tendonitis.
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This question is part of the following fields:
- Musculoskeletal System
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Question 4
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A 75-year-old gentleman sustained an injury to his arm after falling on outstretched hands. An X-ray confirms the fracture of the distal radius with backward shift of the distal fragment. The name given to this kind of deformity is?
Your Answer: Dinner fork deformity
Explanation:Dinner fork deformity is the name given to the fracture of distal radius, in which the distal fragment is dorsally angulated, displaced and sometimes impacted. Coxa vara is the hip deformity when angle between the head and shaft of the femur is reduced to more than 120 degree. A garden fork deformity is a reversed Colles fracture.
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This question is part of the following fields:
- Musculoskeletal System
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Question 5
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: Vasovagal syncope
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 6
Incorrect
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A 33-year-old lady presented with complaints of an erythematous rash over her shins, along with arthritis and painful swollen knees. What will be the single most likely finding on her chest X-ray?
Your Answer: Pleural effusion
Correct Answer: Bilateral hilar lymphadenopathy
Explanation:Lofgren’s syndrome is characterised by a triad of erythema nodosum, arthritis and bilateral lymphadenopathy. It is a variant of sarcoidosis.
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This question is part of the following fields:
- Respiratory System
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Question 7
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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: 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.
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This question is part of the following fields:
- Cardiovascular System
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Question 8
Incorrect
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A 40-year-old man is referred by his general practitioner. He has a family history of premature cardiovascular disease.
Cholesterol testing reveals triglyceride levels of 4.2 mmol/l and a high-density lipoprotein (HDL) level of 0.8 mmol/l.
You advise him to start fibrate therapy.
Which of the following best describes the mode of action for fibrates?Your Answer: They are inhibitors of CETP cholesterol ester transferase protein activity
Correct Answer: They are inhibitors of lipoprotein lipase activity and increase HDL synthesis
Explanation:Treatment with fibrates, a widely used class of lipid-modifying agents, results in a substantial decrease in plasma triglycerides and is usually associated with a moderate decrease in LDL cholesterol and an increase in HDL cholesterol concentrations.
Evidence from studies is available to implicate 5 major mechanisms underlying the above-mentioned modulation of lipoprotein phenotypes by fibrates:
1. Induction of lipoprotein lipolysis.
2. Induction of hepatic fatty acid (FA) uptake and reduction of hepatic triglyceride production.
3. Increased removal of LDL particles. Fibrate treatment results in the formation of LDL with a higher affinity for the LDL receptor, which is thus catabolized more rapidly.
4. Reduction in neutral lipid (cholesteryl ester and triglyceride) exchange between VLDL and HDL may result from decreased plasma levels of TRL.
5. Increase in HDL production and stimulation of reverse cholesterol transport. Fibrates increase the production of apoA-I and apoA-II in the liver, which may contribute to the increase of plasma HDL concentrations and a more efficient reverse cholesterol transport. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 9
Correct
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A homeless woman presented with a cough and fever for the last 3 months. She also complained of night sweats and weight loss. Her CXR showed lung opacities. What is the next appropriate step for this patient?
Your Answer: Acid fast bacilli
Explanation:History and CXR are suggestive of tuberculosis. Acid fast bacilli should be seen on microscopy to confirm the diagnosis.
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This question is part of the following fields:
- Infectious Diseases
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Question 10
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A patient presents to the nephrologist with proteinuria ++. Which medication would most likely result in the prevention of progression of this disease?
Your Answer: ACE inhibitors
Explanation:Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce intraglomerular pressure by inhibiting angiotensin II ̶ mediated efferent arteriolar vasoconstriction. These drugs also have a proteinuria-reducing effect that is independent of their antihypertensive effect.
In addition, ACE inhibitors have renoprotective properties, which may be partially due to the other hemodynamic and nonhemodynamic effects of these drugs. ACE inhibitors reduce the breakdown of bradykinin (an efferent arteriolar vasodilator); restore the size and charge selectivity to the glomerular cell wall; and reduce the production of cytokines, such as transforming growth factor-beta (TGF-beta), that promote glomerulosclerosis and fibrosis.
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This question is part of the following fields:
- Renal System
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SESSION STATS - PERFORMANCE PER SPECIALTY
