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Question 1
Correct
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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: 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 2
Incorrect
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A 40-year-old female presented with pain and whitening of the hands on exposure to cold. She has difficulty in swallowing solid foods so she has started swallowing only liquids. She developed shortness of breath on exertion and, subsequently, at rest. Which of the following is the most likely cause for dysphagia in this patient?
Your Answer:
Correct Answer: Systemic sclerosis
Explanation:Difficulty in swallowing which improves with liquids is mainly due to an obstructive lesion in oesophagus. But pulmonary involvement (breathlessness on exertion and later on rest) and Raynaud’s phenomena can only be described by systemic sclerosis.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 3
Incorrect
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A 14-year-old male was involved in a bicycle accident. He was brought to the emergency department with abdominal pain. On the CT scan of the abdomen, a hematoma was present beneath the capsule of the spleen. His BP and pulse were normal. What is the next step in his management?
Your Answer:
Correct Answer: Refer to surgeons for observation
Explanation:A surgeon will observe the patient and will decide which procedure he needs.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 4
Incorrect
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A female in her early 20's who has been diagnosed with asthma for the past four years visits the office for a review. She has been using Beclomethasone dipropionate inhaler 200mcg bd along with Salbutamol inhaler 100mcg prn and her asthma is still uncontrolled. Her chest examination is clear and she has good inhaler technique. What would be the most appropriate next step in the management of her asthma?
Your Answer:
Correct Answer: Add a leukotriene receptor antagonist
Explanation:The NICE 2017 guidelines state that in patients who are uncontrolled with a SABA (Salbutamol) and ICS (Inhaled corticosteroid e.g. Beclomethasone), a leukotriene receptor antagonist (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 recommendation is also stated in NICE 2019 guidelines.
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This question is part of the following fields:
- Respiratory System
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Question 5
Incorrect
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Which of the following statements is false regarding the bioavailability of a drug?
Your Answer:
Correct Answer: The bioavailability of a drug given orally is often affected by the degree of renal elimination
Explanation:Renal elimination of a drug has no role in altering the bioavailability of a drug.
The bioavailability of a drug is the proportion of the drug which reaches systemic circulation.
Mathematically, bioavailability is the AUCoral/AUCiv x 100%, where AUC = area under the concentration-time curve following a single (oral or iv) dose.Other options are true:
By definition, the bioavailability of a drug given intravenously is 100%.
Drugs given orally that undergo high pre-systemic (first-pass) metabolism in the liver or gut wall have a low bioavailability e.g. lidocaine.
Bioavailability is also affected by the degree of absorption from the gut and this can change depending on gut motility and administration of other drugs. -
This question is part of the following fields:
- Pharmacology
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Question 6
Incorrect
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A 26-year-old office worker presents with a 3 year history of epigastric pain, especially 30 minutes after eating. This is associated with nausea and belching. She also describes constipation with occasional explosive diarrhoea. The stools are normally hard with mucus and she needs to strain with every motion. Abdominal pain is relieved after defecation but abdominal bloating persists. She wakes up an hour earlier each morning to finish her breakfast in order to prevent vomiting. She has missed work on a few occasions and feels that her weight has fluctuated. Past medical history includes scarlet fever. She is not on any regular medications except intermittent laxatives over the counter. Abdominal examination is normal. Rectal examination reveals an anal fissure.
Investigation results:
Haemoglobin (Hb 13.1 g/dl
White blood count (WBC) 6.0 × 109/l
Platelets 180× 109/l
Mean cell volume (MCV) 87 fL
International normalised ratio (INR) 1.0
Na+ 136 mmol/l
K+ 3.9 mmol/l
Urea 3.7 mmol/l
Creatinine 70 μmol/l
Albumin 39 glL
Liver function test normal
Anti-endomysial antibody negative
Thyroid function test normal
Gastroscopy normal
Flexible sigmoidoscopy and biopsy normal
Abdominal and pelvic ultrasound scans are normal
What is the most likely diagnosis to account for her symptoms?Your Answer:
Correct Answer: Overlap irritable bowel syndrome and functional dyspepsia
Explanation:This is most likely describing irritable bowel syndrome (IBS). Symptoms are either diarrhoea, constipation, or both, abdominal pain, bloating, of varying duration. It is a functional, not an organic problem, as far as research shows at this point. It is essentially a diagnosis of exclusion. Treatment is a high fibre diet with fluids. Caffeine should be avoided as this can worsen symptoms.
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This question is part of the following fields:
- Gastrointestinal System
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Question 7
Incorrect
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A 53-year-old man is brought into the emergency department by the paramedics. He collapsed at home suffering from a myocardial infarction and was subsequently resuscitated following a cardiac arrest. Blood tests show impaired liver function (ALT 1400 u/l). He is on a statin, and at his appointment last week his LFT was normal. There is nothing to note on examination and he is currently not complaining of any pain.
Given this man's presentation, what is the most likely cause of his impaired liver function tests?Your Answer:
Correct Answer: Ischaemic hepatitis
Explanation:When you have abnormal liver function tests after a cardiac arrest, the most likely aetiology, barring history that is known or given excluding this diagnosis, would be ischemia. Chronic alcohol abuse would not see an acute elevation like this. Hepatitis B is just unlikely given the clinical picture, ischemia is much more likely. The same is for Budd-Chiari syndrome (venous thrombosis) and Wilson’s disease.
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This question is part of the following fields:
- Hepatobiliary System
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Question 8
Incorrect
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A 66-year-old COPD patient visits the clinic for a review. He has no increase in his sputum volume or change in its colour. He has been a smoker for 39 years and previously worked at the shipping docks.
On examination, he is pursed lip breathing but managing complete sentences.
Investigations:
BP is 141/72 mmHg
Pulse 82 bpm and regular
Sp(O2) 92% on room air
RR 19 breaths/min
Temperature 37.1°C.
Examination of his chest revealed a widespread wheeze with coarse crepitations heard in the L mid-zone. FEV1 :FVC ratio in the clinic today was 68%.
Which of the following would be the most useful investigation that should be performed to establish the diagnosis?Your Answer:
Correct Answer: High-resolution CT thorax
Explanation:High-resolution CT (HRCT) scanning is more sensitive than standard chest radiography and is highly specific for diagnosing emphysema (outlined bullae are not always visible on a radiograph).
HRCT scanning may provide an adjunct means of diagnosing various forms of COPD (i.e., lower lobe disease may suggest AAT deficiency) and may help the clinician to determine whether surgical intervention would benefit the patient.
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This question is part of the following fields:
- Respiratory System
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Question 9
Incorrect
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A 20-year-old girl is presented to the OPD with her mother. Her mother reports that she eats very large portions of food most of the time, but takes diet pills and remains depressed because she thinks she is overweight. However, on general physical examination, she appears to be very thin and her blood pressure is lower than normal. Investigations reveal that she has hypokalaemia. What is this girl most likely suffering from?
Your Answer:
Correct Answer: Bulimia nervosa
Explanation:Bulimia nervosa is a condition in which a person is involved in binge eating and then purging in an attempt to stay thin despite eating a lot of food. Frequent vomiting can cause electrolyte imbalance that manifests as hyperkalaemia and may lead to hypotension.
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This question is part of the following fields:
- Gastrointestinal System
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Question 10
Incorrect
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In the event of an overdose, haemodialysis is ineffective as a treatment modality for which of the following drugs?
Your Answer:
Correct Answer: Tricyclics
Explanation:Tricyclic compounds can’t be cleared by haemodialysis.
Drugs that can be cleared with haemodialysis include: (BLAST)
– Barbiturate
– Lithium
– Alcohol (inc methanol, ethylene glycol)
– Salicylates
– Theophyllines (charcoal hemoperfusion is preferable)Drugs which cannot be cleared with haemodialysis include:
– Tricyclics
– Benzodiazepines
– Dextropropoxyphene (Co-proxamol)
– Digoxin
– Beta-blockers -
This question is part of the following fields:
- Emergency & Critical Care
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SESSION STATS - PERFORMANCE PER SPECIALTY
