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Question 1
Correct
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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: 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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Question 2
Correct
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A 60-year-old male was diagnosed as diabetic (DM type 2). He has a BMI=32. Lifestyle modification and exercise have failed to control his blood glucose levels. His labs were: urea=3.5mmol/l, creatinine=90 mmol/l, HbA1c=7.5g/dl. What will be the next management step?
Your Answer: Biguanide
Explanation:For type 2 diabetics, biguanides are the treatment of choice.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 3
Correct
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A 35-year-old gentleman with a history of alcohol excess presents to hospital with progressive abdominal distension. He now complains of early satiety and abdominal discomfort as a result of the distension. Examination reveals a significantly distended abdomen with shifting dullness. A diagnostic ascitic tap is performed and the fluid sent for analysis.
What is the most appropriate first line treatment for his ascites?Your Answer: Paracentesis
Explanation:The first line treatment for ascites that is symptomatic is paracentesis. If it is not symptomatic, treatment could be with salt and fluid restriction as well as spironolactone. If spironolactone maximum dosage is reached, you can use furosemide additionally. Amiloride is not a diuretic that is recommended in this case.
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This question is part of the following fields:
- Gastrointestinal System
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Question 4
Correct
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Which of the following forms of acute viral hepatitis has a much higher mortality in pregnant than non-pregnant females?
Your Answer: Hepatitis E
Explanation:Pregnant patient in a third world country with hepatitis: The answer is most likely Hepatitis E. The mortality for Hepatitis E in pregnant women is very high. It is transmitted faecal-orally. There is no hepatitis G. Hepatitis C, B, A are less likely to be the correct answer than E given it’s classic association with pregnancy and poor living conditions.
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This question is part of the following fields:
- Infectious Diseases
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Question 5
Correct
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A 43-year-old man is reviewed in the gastroenterology clinic. He has had troublesome dyspepsia for the past six months which has not settled with proton pump inhibitor (PPI) therapy. During the review of his systems he also reports passing 6-7 watery stools per day. An OGD 3 weeks ago showed gastric erosions and ulcers.
Which one of the following investigations is most likely to be diagnostic?Your Answer: Fasting gastrin
Explanation:This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from the hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. None of the other answer choices are a better answer than this. CT abdomen may potentially show a tumour, but this is not diagnostic for type.
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This question is part of the following fields:
- Gastrointestinal System
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Question 6
Correct
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A 11-year-old is referred to neurology due to episodes her GP feels are epileptiform. Her mother reports that she appears to just 'stop', sometimes even in mid conversation, for several seconds at random times during the day. During these episodes, she can be unresponsive to questioning and has no recollection of them.
Which of these drugs is contraindicated in this condition?Your Answer: Carbamazepine
Explanation:The patient’s history points to absence seizures. Carbamazepine has been shown to aggravate generalized seizure types, especially absence seizures, because it acts directly on the ventrobasal complex of the thalamus which is critical to the neurophysiology of absence seizures.
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This question is part of the following fields:
- Nervous System
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Question 7
Incorrect
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A new-born male is admitted to NICU with convulsions, limb hypoplasia and rudimentary digits. Which of the following is the most likely cause?
Your Answer: Herpes simplex
Correct Answer: Varicella
Explanation:Infection of chickenpox in the first half of pregnancy can result in congenital varicella syndrome. It presents as cerebral, cortical and cerebellar hypoplasia with convulsions and rudimentary digits. Prevention is by administering varicella vaccine, even before pregnancy. Varicella immunoglobulin is administered to pregnant women who are exposed to infection. Infection during pregnancy is treated with acyclovir.
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This question is part of the following fields:
- Infectious Diseases
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Question 8
Correct
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A 35-year-old female, known case of antiphospholipid syndrome, arrives at the clinic due to a swollen and painful left leg. Doppler ultrasonography confirms the diagnosis of a deep vein thrombosis. She was previously diagnosed with DVT 4 months back and was on warfarin therapy (target INR 2-3) when it occurred. How should her anticoagulation be managed?
Your Answer: Life-long warfarin, increase target INR to 3 - 4
Explanation:If the INR in the range of 2-3 has still resulted in thrombosis, the target INR is increased to 3-4. However, because the risk of bleeding increases as the INR rises, the INR is closely monitored and adjustments are made as needed to maintain the INR within the target range.
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This question is part of the following fields:
- Musculoskeletal System
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Question 9
Correct
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An 82-year-old man is reviewed in the haematology clinic. He has been referred due to weight loss, lethargy, and a significantly elevated IgM level.
His recent blood results show:
Hb: 13.8 g/dL
Plts: 127 x 10^9/L
ESR: 45 mm/hr
IgM: 2150 mg/dL (50-330 mg/dL)
Given the probable diagnosis, which one of the following complications is he most likely to develop?Your Answer: Hyperviscosity syndrome
Explanation:The patient is most likely suffering from Waldenström’s macroglobulinemia in which IgM paraproteinemia is found. Hyperviscosity syndrome can occur in the patients accounting for 10-15% of the cases.
Waldenström’s macroglobulinemia (also called lymphoplasmacytic lymphoma) is an uncommon type of non-Hodgkin lymphoma seen in older people. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein. Its features include monoclonal IgM paraproteinemia; hyperviscosity syndrome leading to bilateral central retinal vein occlusion (CRVO) and hence, visual disturbances; weight loss and lethargy; hepatosplenomegaly and lymphadenopathy; and cryoglobulinemia. It is not, however, associated with bone pain.
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This question is part of the following fields:
- Haematology & Oncology
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Question 10
Correct
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A COPD patient presented with shortness of breath, a cough and wheezing. He didn't respond to salbutamol, IV hydrocortisone or oxygen therapy. Following this initial treatment, he was given IV aminophylline and atem+ventolin nebulization. ABGs showed an acidotic pH. The next step in management would be?
Your Answer: Nasal intermittent positive pressure ventilation
Explanation:Nasal IPPV is given to the patients when all other techniques have failed. It is a non invasive procedure to improve the oxygenation of the patients suffering from lung disease.
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This question is part of the following fields:
- Respiratory System
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Question 11
Correct
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A 20-year-old woman presents to casualty with flank pain and a 48 hour history of dysuria. Her past medical history includes polycystic ovarian syndrome. She is not in a steady relationship at present. There is haematuria and proteinuria on urine dipstick testing.
Examination reveals a pyrexia of 38.1 °C and flank pain.
What diagnosis fits best with this clinical picture?Your Answer: Pyelonephritis
Explanation:The patient presents with flank pain and fever with haematuria and proteinuria associated with a social history of not being in a steady relationship. This patient is a young presumably sexually active female, so the diagnosis is most likely pyelonephritis which has an increased incidence in young sexually active women or men of >50 years of age.
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This question is part of the following fields:
- Renal System
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Question 12
Correct
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Which of the following bronchodilators is an anticholinergic commonly used in addition to adrenoceptor stimulants?
Your Answer: Oxitropium bromide
Explanation:All of these drugs are anti-asthmatic drugs that work through different pathways. Oxitropium bromide is an anticholinergic drug that is often used with beta agonists to improve their action.
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This question is part of the following fields:
- Pharmacology
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Question 13
Correct
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A 65-year-old man with a history of type 2 diabetes comes to the clinic for review. His HbA1c is elevated at 64 mmol/mol despite taking 1g of metformin BD. On examination, his blood pressure is 142/88 mmHg, his pulse is 82 beats per minute and regular. His BMI is 33 kg/m². A decision is made to start him on dapagliflozin. Which of the following would you expect on starting therapy?
Your Answer: Increased total cholesterol
Explanation:Dapagliflozin works by inhibiting sodium glucose cotransporter 2 (SGLT2) and blocking resorption of glucose in the kidney, leading to an increase in urinary glucose excretion and lowering of both plasma glucose levels and body weight.
All studies with SGLT2 inhibitors have found significant reductions in BP, with greater reductions seen in systolic (1.66 to 6.9mmHg) than diastolic (0.88 to 3.5mmHg) BP.
While some trials have shown no change in lipid parameters, others have shown a modest but statistically significant increase in both HDL and LDL cholesterol with no effect on triglycerides or the LDL/HDL ratio. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 14
Incorrect
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A 75-year-old woman experiences weakness of her left hand. Clinical examination reveals wasting of the hypothenar eminence and weakness of finger abduction and thumb adduction. The lesion is most probably located at:
Your Answer: C7
Correct Answer: Ulnar nerve
Explanation:Patients with compressive neuropathy of the ulnar nerve typically describe numbness and tingling of the ulnar-sided digits of the hand, classically in the small finger and ulnar aspect of the ring finger. Among the general population, symptoms usually begin intermittently and are often worse at night, particularly if the elbow is flexed while sleeping. As the disease progresses, paraesthesia may occur more frequently and during the daytime.
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This question is part of the following fields:
- Nervous System
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Question 15
Correct
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A patient has been taking morphine 60 mg twice a day and sevredol (quick release morphine) 20 mg three times a day, per os. You are asked to prescribe morphine subcutaneously for this palliative care patient via a syringe driver. Which of the following dosing regimen would you choose?
Your Answer: 90 mg over 24 hours. 15 mg as required, for breakthrough pain.
Explanation:Morphine is almost twice as effective when given intravenously or subcutaneously as when given orally. This means that the first step is to calculate the total amount of morphine that the patient used to take orally, which is 180 mg. Since the patient needed 180 mg of morphine tablets in 24 hours to control his pain, he now would need approximately 90 mg given in the same time span. In order to calculate the breakthrough dose, one sixth of the total dose of morphine required per 24 hours should be calculated. The patient now requires 90 mg of morphine subcutaneously, meaning that he would need 15 mg for breakthrough pain.
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This question is part of the following fields:
- Pharmacology
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Question 16
Correct
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A 72-year-old male presented to the Emergency Department with a broad complex tachycardia. Which of the following features is more suggestive that this has resulted because of a supraventricular tachycardia (SVT) rather than a ventricular tachycardia (VT)?
Your Answer: Absence of QRS concordance in chest leads on ECG
Explanation:To differentiate ventricular tachycardia (VT) from supraventricular tachycardia (SVT) with aberrant conduction the following electrocardiographic features should be looked for:
Evidence of preceding atrial activity for SVT. Oesophageal leads are helpful if P waves are hidden in the QRS complex.
QRS duration more than 140 ms for VT.
QRS morphology: Features of QRS morphology that favour SVT are RBBB or triphasic patterns like rSR in V1 and qRS in V6. Monophasic pattern like R or qR in V1 and rS or QS in V6 or multiple morphology QRS complexes favour VT.
AV dissociation for VT. -
This question is part of the following fields:
- Cardiovascular System
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Question 17
Correct
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A 28-year-old female presented with complaints of joint pains, myalgia, haematuria and a facial rash which exacerbates on exposure to sunlight. RFTs show raised urea and creatinine, and there were red cell casts on urine microscopy. The investigation of choice in this case would be?
Your Answer: Auto antibodies
Explanation:Considering the history and presenting complaints, this patient is most likely suffering from systemic lupus erythematosus, which will be confirmed by testing for auto antibodies like ANA, anti ds DNA, anti histone antibodies etc.
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This question is part of the following fields:
- Immune System
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Question 18
Correct
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A 71-year-old female presents with a pansystolic murmur. History reveals a myocardial infarction which manifested three days ago. What is the most likely cause of the murmur?
Your Answer: Rupture of papillary muscle
Explanation:A pan-systolic murmur is the result of mitral regurgitation. Mitral regurgitation in this case is most probably due to post-MI rupture of the papillary muscle of the mitral valve.
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This question is part of the following fields:
- Cardiovascular System
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Question 19
Incorrect
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A 44-year-old patient has sudden onset of breathlessness and stridor a few minutes after extubation for thyroidectomy. The patient had long standing goitre for which she had surgery. What is the most likely diagnosis?
Your Answer: Unilateral recurrent laryngeal nerve injury
Correct Answer: Tracheomalacia
Explanation:Prolonged compression of the trachea by a large goitre will cause tracheomalacia following thyroidectomy.
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This question is part of the following fields:
- Respiratory System
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Question 20
Correct
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A 74-year-old man who has been diagnosed with atrial fibrillation and heart failure is being started on digoxin. What is the mechanism of action of digoxin?
Your Answer: Inhibits the Na+/K+ ATPase pump
Explanation:Digoxin acts by inhibiting the Na+/K+ ATPase pump.
Digoxin is a cardiac glycoside now mainly used for rate control in the management of atrial fibrillation. As it has positive inotropic properties it is sometimes used for improving symptoms (but not mortality) in patients with heart failure.Mechanism of action:
It decreases the conduction through the atrioventricular node which slows the ventricular rate in atrial fibrillation and atrial flutter.
It increases the force of cardiac muscle contraction due to inhibition of the Na+/K+ ATPase pump. It also stimulates the vagus nerve.Digoxin toxicity:
Plasma concentration alone does not determine whether a patient has developed digoxin toxicity. The likelihood of toxicity increases progressively from 1.5 to 3 mcg/l.
Clinical feature of digoxin toxicity include a general feeling of unwell, lethargy, nausea & vomiting, anorexia, confusion, xanthopsia, arrhythmias (e.g. AV block, bradycardia), and gynaecomastiaPrecipitating factors:
Hypokalaemia
Increasing age
Renal failure
Myocardial ischemia
Hypomagnesaemia, hypercalcemia, hypernatremia, acidosis
Hypoalbuminemia
Hypothermia
Hypothyroidism
Drugs: amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in the distal convoluted tubule, therefore, reduce excretion), ciclosporin. Also, drugs that cause hypokalaemia e.g. thiazides and loop diuretics.Management of digoxin toxicity:
Digibind
Correct arrhythmias
Monitor and maintain potassium levels within the normal limits. -
This question is part of the following fields:
- Pharmacology
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Question 21
Correct
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A 65-year-old real estate broker presents with a tremor. Which one of the following features would suggest a diagnosis of essential tremor rather than Parkinson's disease?
Your Answer: Tremor is worse when the arms are outstretched
Explanation:Difficulty in initiating movement (bradykinesia), postural instability and unilateral symptoms (initially) are typical of Parkinson’s. Essential tremor symptoms are usually worse if arms are outstretched and eased by rest and alcohol.
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This question is part of the following fields:
- Nervous System
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Question 22
Incorrect
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A 17-year-old boy was brought to clinic, as his parents were concerned regarding possible delayed puberty. He was otherwise well, played sports regularly and his academic performance was good. His height was 1.7m and weight was 70 kg. On examination, he had a small penis and testes, absent pubic hair, but no other abnormalities. Investigations revealed: Serum testosterone 4 nmol/L (9-35) Plasma follicle stimulating hormone (FSH) 1 U/L (1-7) Plasma luteinising hormone (LH) 1 U/L (1-10) Plasma prolactin 300 mU/L (<450) Plasma TSH 2 mU/L (0.5-5) Which one of the following is the most likely cause?
Your Answer: Hypopituitarism
Correct Answer: Kallman's syndrome
Explanation:Klinefelter’s syndrome: The low follicle-stimulating hormone (FSH) and luteinising hormone (LH), together with the low testosterone, suggests a hypogonadotropic hypogonadism. We know that there is no mental retardation, and we are told that physical examination is normal and sense of smell would usually not be tested. Consequently a diagnosis of Kallman’s is suggested. We are not told of a family history of growth delay, thus this is unlikely to be constitutional delay. The thyroid-stimulating hormone (TSH) is normal, making hypothyroidism unlikely and this together with the normal prolactin make hypopituitarism most unlikely.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 23
Correct
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A 25-year-old woman comes to the endocrine clinic for her regular follow up. She has hypertension, controlled by a combination of Ramipril and indapamide and was diagnosed with 11-beta hydroxylase deficiency since birth when she was found to have clitoromegaly.
Which of the following is most likely to be elevated?Your Answer: 11-Deoxycortisol
Explanation:11-beta hydroxylase is stimulated by ACTH and responsible for conversion of 11-deoxycortisol to cortisol and deoxycorticosterone to corticosterone.
In 11-beta hydroxylase deficiency, the previously mentioned conversions are partially blocked, leading to:
– Increased levels of ACTH
– Accumulation of 11-deoxycortisol (which has limited biological activity) and deoxycorticosterone (which has mineralocorticoid activity)
– Overproduction of adrenal androgens (DHEA, androstenedione, and testosterone) -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 24
Correct
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A 52-year-old shopkeeper presents with pain in her hands. Examination reveals plaques on the extensor surfaces of her upper limbs and a telescoping deformity of both index fingers. Nails show pitting and horizontal ridging. The patient is most likely suffering from which of the following?
Your Answer: Arthritis mutilans
Explanation:Arthritis mutilans is a rare (occurs in only 5% of the patients) and extremely severe form psoriatic arthritis characterized by resorption of bones and the consequent collapse of soft tissue. When this affects the hands, it can cause a phenomenon sometimes referred to as ‘telescoping fingers.’ The associated nail changes are also characteristic of arthritis.
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This question is part of the following fields:
- Musculoskeletal System
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Question 25
Correct
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A woman presents with several painful ulcers on her vulva. What do you think has most likely caused this?
Your Answer: HSV
Explanation:Genital herpes is a sexually transmitted disease (STD). This STD causes herpetic sores, which are painful blisters (fluid-filled bumps) that can break open and ooze fluid.
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This question is part of the following fields:
- Infectious Diseases
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Question 26
Correct
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A 23-year-old pregnant woman presents with glycosuria. What is the most likely mechanism?
Your Answer: Reduced renal reabsorption
Explanation:Throughout pregnancy the tubular reabsorption of glucose is less effective than in the non-pregnant state, this leads to glycosuria.
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This question is part of the following fields:
- Renal System
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Question 27
Incorrect
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Which of the following is correct regarding post-menopausal hormone replacement therapy (HRT) according to randomised clinical studies ?
Your Answer: Causes regression of coronary plaques
Correct Answer: Increases plasma triglycerides
Explanation:Oestrogen therapy reduces plasma levels of LDL cholesterol and increases levels of HDL cholesterol. It can improve endothelial vascular function, however, it also has adverse physiological effects, including increasing the plasma levels of triglycerides (small dense LDL particles). Therefore, although HRT may have direct beneficial effects on cardiovascular outcomes, these effects may be reduced or balanced by the adverse physiological effects.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 28
Correct
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A 60-year-old female underwent pelvic surgery. She was given low molecular weight heparin (LMWH) after the procedure. After a week, she complained of sudden chest pain and difficulty in breathing. Her ECG and CXR were normal. What is the most suitable option for her?
Your Answer: Keep on low molecular weight heparin and do CT. pulmonary angiography.
Explanation:CT pulmonary angiography will decide the proper cause of her symptoms. Until that has happened LMWP should be continued.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 29
Correct
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A 60-year-old previously well male was admitted with a suspected pulmonary embolism. On examination his BP was 130/80 mmHg and pulse rate was 88 bpm. His CXR was normal. He was treated with low molecular weight heparin. Which of the following is the most appropriate initial lung investigation for this patient?
Your Answer: Computed tomographic pulmonary angiography
Explanation:Computed tomographic pulmonary angiography (CTPA) is the standard investigative tool, used for diagnosing a pulmonary embolism. Pulmonary angiography is indicated if CTPA is not available.
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This question is part of the following fields:
- Cardiovascular System
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Question 30
Incorrect
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What are the most common types of transformation seen in patients with polycythaemia vera?
Your Answer: Myelodysplasia + chronic myeloid leukaemia
Correct Answer: Myelofibrosis + acute myeloid leukaemia
Explanation:5-15% of the cases of polycythaemia vera progress to myelofibrosis or acute myeloid leukaemia (AML).
Polycythaemia vera (PV), also known as polycythaemia rubra vera, is a myeloproliferative disorder caused by clonal proliferation of marrow stem cells leading to an increase in red cell volume, often accompanied by overproduction of neutrophils and platelets. It has peak incidence in the sixth decade of life, with typical features including hyperviscosity, pruritus, splenomegaly, haemorrhage (secondary to abnormal platelet function), and plethoric appearance.
Some management options of PV include lose-dose aspirin, venesection (first-line treatment), hydroxyurea (slightly increased risk of secondary leukaemia), and radioactive phosphorus (P-32) therapy.
In PV, thrombotic events are a significant cause of morbidity and mortality. 5-15% of the cases progress to myelofibrosis or AML. The risk of having AML is increased with chemotherapy treatment.
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This question is part of the following fields:
- Haematology & Oncology
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Question 31
Correct
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A 30-year-old previously well male presented with dysuria and lower abdominal pain. He also complained of passage of air bubbles when he urinated. His urine sample had faecal matters. The abdomen was soft with mild suprapubic tenderness. Which of the following is the most likely pathology?
Your Answer: Crohn's disease
Explanation:Passage of faecal matters in the urine is suggestive of a fistula. Crohn’s disease is the most common cause of an ileovesical fistula. The diagnostic features of a fistula to the urinary system are pneumaturia, fecaluria, and recurrent or persistent urinary tract infections. Cystoscopy will confirm the diagnosis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 32
Correct
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A 42-year-old male arrives at the clinic due to cough and haemoptysis. Examination shows nasal mucosal ulceration. The doctor suspects Wegener's granulomatosis. Which anatomical area would be most commonly involved in this condition?
Your Answer: Lungs
Explanation:Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) is a systemic vasculitis that affects both small and medium-sized vessels. Patients typically initially suffer from a limited form that may consist of constitutional symptoms and localized manifestations such as chronic sinusitis, rhinitis, otitis media, ocular conditions. In later stages, more serious manifestations may arise, including pulmonary complications and glomerulonephritis, although the skin, eyes, and heart may also be involved but these lesions are less common.
Diagnosis is based on laboratory testing (positive for PR3-ANCA/c-ANCA), imaging, and biopsy of affected organs, which demonstrate necrotizing granulomatous inflammation. GPA is treated with immunosuppressive drugs, typically consisting of glucocorticoids combined with methotrexate, cyclophosphamide, or rituximab. Relapses are common and the following systems are affected: Lower respiratory tract (95% of cases), renal involvement (80% of cases), skin lesions (45% of cases), ocular involvement (45% of cases) and cardiac involvement (33% of cases). -
This question is part of the following fields:
- Musculoskeletal System
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Question 33
Correct
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All of the following statements suggesting a poor prognosis of Guillain-Barre syndrome are correct except?
Your Answer: Evidence demyelination on nerve conduction studies
Explanation:Guillain barre syndrome is a neurological disorder characterised by neuropathy along with ascending paralysis. Denervation rather than demyelination suggests poor prognosis in GB syndrome.
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This question is part of the following fields:
- Nervous System
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Question 34
Correct
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A 50-year-old lung cancer patient presents with diminished reflexes, retention of urine, postural hypotension and sluggish pupillary reaction. What is the most likely explanation for her symptoms?
Your Answer: Paraneoplastic syndrome
Explanation:Paraneoplastic syndromes are more common in patients with lung cancer. Signs and symptoms include inappropriate antidiuretic hormone secretion, finger clubbing, hypercoagulability and Eaton-Lambert syndrome.
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This question is part of the following fields:
- Respiratory System
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Question 35
Incorrect
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A 45-year-old man who had a liver transplant just over 3 months ago, now has primary sclerosing cholangitis. He complains of fever, abdominal pain and diarrhoea, which has come on over the last week. He has a platelet count of 60 x 109/L and alanine transaminase (ALT) of 300 U/L with a normal bilirubin.
He is taking tacrolimus and prednisolone for immunosuppression, and tells you that he recently stopped taking valganciclovir.
What is the most likely diagnosis?Your Answer: Acute rejection of liver transplant
Correct Answer: Donor-acquired cytomegalovirus
Explanation:The fact that he has recently stopped taking his valganciclovir, anti-viral, is key to the answer to this question. This makes the answer quite plainly donor-acquired CMV infection over all of the other answer choices. He needs to stay on prophylaxis against this, particularly in the first 3 months after transplant. Symptoms and presentations of CMV infection can include fever, abdominal pain, diarrhoea, pneumonitis, hepatitis, hematologic abnormalities, retinitis, and esophagitis.
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This question is part of the following fields:
- Hepatobiliary System
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Question 36
Correct
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Which the following features is most suggestive of megaloblastic anaemia?
Your Answer: Hypersegmented neutrophils in peripheral blood film
Explanation:Hypersegmented neutrophils in the peripheral blood film is suggestive of megaloblastic changes in bone marrow.
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This question is part of the following fields:
- Haematology & Oncology
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Question 37
Incorrect
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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: Anti Jo 1
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.
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This question is part of the following fields:
- Musculoskeletal System
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Question 38
Correct
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A 50-year-old male patient was started on amiodarone. Prior to commencement, his blood urea and electrolytes were checked. What is the reason for doing this investigation before starting amiodarone?
Your Answer: To detect hypokalaemia
Explanation:Any antiarrhythmic drugs can potentially cause arrhythmias. Before starting amiodarone, any electrolyte imbalance including hypokalaemia, hypomagnesemia, or hypocalcaemia should be corrected to prevent any arrhythmias.
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This question is part of the following fields:
- Cardiovascular System
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Question 39
Incorrect
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A 54-year-old female patient presents with a one week history of bloody diarrhoea, fever and abdominal pain. She has a history of rheumatoid arthritis which she controls with methotrexate. Her stool sample shows Campylobacter jejuni. What is the single most appropriate management?
Your Answer: Fluids + metronidazole
Correct Answer: Fluids + clarithromycin
Explanation:This woman is receiving methotrexate, an immunosuppressant, to control her rheumatoid arthritis. In such immunocompromised patients, BNF suggests clarithromycin as first-line management.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 40
Incorrect
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Which of the following immune responses occurs in Coeliac disease?
Your Answer: None of the above
Correct Answer: Type IV hypersensitivity
Explanation:Celiac disease is classified as a Type IV hypersensitivity mediated by T-cell response. Negatively charged gliadin has been shown to induce interleukin 15 in the enteric epithelial cells, stimulating the proliferation of the natural killer cells and intraepithelial lymphocytes to express NK-G2D, a marker for natural killer T lymphocytes.
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This question is part of the following fields:
- Immune System
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SESSION STATS - PERFORMANCE PER SPECIALTY
