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Question 1
Correct
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A 31-year-old female complains of bilateral proximal muscle weakness. There is marked blanching of fingers especially in response to cold weather. Lab results are as follows:
Anti Jo-1: positive
ANA: positive
CK: 2000 U/L
ESR: 60mm/hr
EMG: myopathic changes
Presence of which of the following signifies the worst prognosis?Your Answer: Interstitial lung disease
Explanation:Polymyositis is an inflammatory disorder causing symmetrical, proximal muscle weakness. It is thought to be a T-cell mediated cytotoxic process directed against muscle fibres. It may be idiopathic or associated with connective tissue disorders. It may also be associated with malignancy for example small cell lung carcinoma.
Dermatomyositis is a variant of the disease where skin manifestations are prominent, for example a purple (heliotrope) rash on the cheeks and eyelids.
It typically affects middle-aged, female: male 3:1. Features include proximal muscle weakness +/- tenderness, Raynaud’s phenomenon, respiratory muscle weakness, interstitial lung disease: e.g. fibrosing alveolitis or organising pneumonia, dysphagia, dysphonia. Investigations: elevated creatine kinase, other muscle enzymes (lactate dehydrogenase (LD), aldolase, AST and ALT) are also elevated in 85-95% of patients, EMG, muscle biopsy. Anti-Jo-1 antibodies are seen in pattern of disease associated with lung involvement, Raynaud’s and fever. Interstitial lung disease plays a major role in morbidity and mortality in patients with polymyositis and is considered a major risk factor for premature death in patients with myositis. -
This question is part of the following fields:
- Musculoskeletal System
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Question 2
Correct
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A 23-year-old designer is requesting the combined oral contraceptive pill. During the history taking, she states that in the past she has had migraines with aura. She asks why the combined oral contraceptive pill is contraindicated. Which of the following is the most appropriate response?
Your Answer: Significantly increased risk of ischaemic stroke
Explanation:SIGN produced guidelines in 2008 on the management of migraines. Key points include that if patients have migraines with aura then the combined oral contraceptive (COC) is absolutely contraindicated due to an increased risk of stroke (relative risk 8.72).
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This question is part of the following fields:
- Nervous System
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Question 3
Correct
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Which is the most likely lymph node involved in the presence of an ulcer on the scrotum?
Your Answer: Inguinal lymph node
Explanation:Inguinal LN’s drain the skin and subcutaneous tissue of the lower abdominal wall, perineum, buttocks, external genitalia, and lower limbs. They are subdivided into three groups of lymph nodes (nodi lymphoid):
– inferior group of superficial inguinal lymph nodes, located inferior to the saphenous opening, receiving drainage of the lower limb;
– superolateral superficial inguinal lymph nodes located lateral to the saphenous opening, receiving drainage of lateral buttock and lower anterior abdominal wall; and
– superomedial superficial inguinal lymph nodes, located medial to the saphenous opening, receiving drainage of the perineum and external genitalia. -
This question is part of the following fields:
- Men's Health
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Question 4
Correct
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A 50-year-old male presented with episodes of collapse during the last month. Each episode persisted for about 2-3 minutes. They were self-limiting and associated with twitching of the limbs. There was no associated tonic-clonic movements, tongue biting, urinary or faecal incontinence. On examination he had reversed splitting of S2 and an ejection systolic murmur at the right sternal border. His electrocardiogram (ECG) showed left ventricular hypertrophy with strain pattern. CXR showed an area of calcification over the cardiac silhouette. Which of the following is the most probable diagnosis of this patient?
Your Answer: Aortic stenosis
Explanation:The classic triad of symptoms in patients with aortic stenosis is chest pain, heart failure and syncope. Pulsus parvus et tardus, pulsus alternans, hyperdynamic left ventricle, reversed splitting of the S2, prominent S4 and systolic murmur are some of the common findings of aortic stenosis. A calcified aortic valve is found in almost all adults with hemodynamically significant aortic stenosis.
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This question is part of the following fields:
- Cardiovascular System
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Question 5
Incorrect
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A 59-year-old man complains of weakness in his right lower and upper limb since 3 for a few hours. He is has been taking Digoxin for 2 years. What is the most definitive investigation for this condition?
Your Answer: CT head
Correct Answer: Angiography
Explanation:Digoxin is a cardiac glycoside, having positive inotropic effects on the heart. It increases the strength of contractility of the heart, increasing the heart rate, but lowering blood pressure. This patient developed weakness in his limbs most likely caused by extremely low blood pressure that could be due to diseased blood vessels reacting to the side-effects of digoxin, therefore an angiography would be the best investigation.
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This question is part of the following fields:
- Cardiovascular System
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Question 6
Correct
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A 60-year-old male had an MI one week ago, but has now presented with a pericardial rub and dyspnoea. An ECG was performed and shows ST elevation. A chest x-ray shows loss of margin at the costovertebral angle. Choose the single most likely cause.
Your Answer: Dressler's syndrome
Explanation:The pericardial rub indicates pericarditis, which then causes widespread ST elevation. Therefore, the condition is not a new MI but is Dressler’s syndrome.
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This question is part of the following fields:
- Cardiovascular System
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Question 7
Correct
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A 70-year-old male presents with hoarseness of the voice and breathing difficulties for the past 3 months. A chest x-ray, showed a unilateral opacity in hilum. He has no history of smoking. Choose the most probable diagnosis.
Your Answer: Bronchial carcinoma
Explanation:All of the symptoms observed in this patient are typical of bronchial carcinoma.
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This question is part of the following fields:
- Respiratory System
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Question 8
Correct
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A female palliative cancer patient has painful bone metastases. Which breakthrough dose of morphine would you prescribe, if she has been taking long acting morphine tablets (120mg) every 12 hours?
Your Answer: 40 mg
Explanation:To calculate the breakthrough dose for oral morphine solution, you need to find the dose she should receive every 4 hours, according to the total amount of morphine she receives. If she is receiving 120 mg every 12 hours, then she should receive 40 mg every 4 hours as a breakthrough dose.
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This question is part of the following fields:
- Pharmacology
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Question 9
Correct
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A 65-year-old male patient presents with a non-explosive cough, muscle twitching on the level of the tongue and aspiration pneumonia. He also claims that occasionally the food he swallows comes back through his nose. What is the most likely cause of dysphagia in this case?
Your Answer: Bulbar palsy
Explanation:Bulbar palsy and pseudobulbar palsy are rare types of a motor neuron disease that affect the cranial motor nerves. Bulbar palsy is a lower motor neuron palsy that affects the nuclei of the 9th to 12th cranial nerves. Pseudobulbar palsy is an upper motor neuron palsy that affects the corticobulbar tracts of the 5th, 7th and 9th to 12th cranial nerves. Any condition which disrupts or damages the cranial nerve nuclei or corticobulbar tracts can cause bulbar or pseudobulbar palsy (e.g., stroke, multiple sclerosis, infections, brain stem tumours). Both bulbar and pseudobulbar palsy are seen mainly in men over 75 years old and present with progressive dysarthria and dysphagia. In addition, patients with pseudobulbar palsy present with a lack of facial expression, difficulty chewing, and emotional lability. Lower motor neuron signs (atrophy and fasciculations of the tongue, absent gag reflex) differentiate bulbar palsy from pseudobulbar palsy, which presents with upper motor neuron signs (spastic tongue, exaggerated gag, and jaw jerk reflexes). Diagnosis is mainly clinical and treatment mostly supportive with a poor prognosis. Life expectancy is around 1-3 years following diagnosis.
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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 75-year-old male with rheumatoid arthritis underwent a colectomy 2 days ago for colon cancer. He was put on a prophylactic dose of low molecular weight heparin postoperatively as well as prednisolone. Now he complains of central chest pain and his ECG revealed an acute ST elevation myocardial infarction. He was given aspirin and oxygen as the initial treatment. Which of the following is the most appropriate management for this patient?
Your Answer: IV diamorphine + arrange percutaneous coronary intervention
Explanation:There is a high risk of bleeding due to recent surgery and heparin. So thrombolysis is not an option. The most appropriate management is percutaneous coronary intervention.
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This question is part of the following fields:
- Cardiovascular System
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Question 11
Correct
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An ECG taken on a patient shows dominant R wave in V1. Which of the following cannot be the reason for above ECG change?
Your Answer: Primary pulmonary hypertension
Explanation:Dominant R wave in V1 can be a normal variant in children and young adults. Other causes are right ventricular hypertrophy, pulmonary embolus, persistence of left to right shunt, Right Bundle Branch Block (RBBB), posterior myocardial infarction (ST elevation in Leads V7, V8, V9), Wolff-Parkinson-White (WPW) Type A, Incorrect lead placement (e.g. V1 and V3 reversed), dextrocardia, hypertrophic cardiomyopathy and dystrophy (myotonic dystrophy and Duchenne Muscular dystrophy).
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This question is part of the following fields:
- Cardiovascular System
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Question 12
Incorrect
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A lactating mother has developed a breast abscess. Which organism is the most common?
Your Answer: Group B streptococcus
Correct Answer: Staph aureus
Explanation:Staph aureus is the most common causative organism of skin and soft tissue infections.
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This question is part of the following fields:
- Women's Health
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Question 13
Correct
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A 68-year-old male presents with muscle weakness - he is unable to go up the stairs and has complained of mild breathlessness. He has said that he finds it difficult to swallow food sometimes. Lab tests are conducted and the reports show the following results: alkaline phosphatase 216 U/L; aspartate aminotransferase 49 U/L; alanine transaminase 43 U/L; creatine kinase 417; erythrocyte sedimentation rate 16 mm/h. From the list of options, choose the most likely diagnosis.
Your Answer: Polymyositis
Explanation:Muscle weakness and the inability to climb the stairs are consistent with a diagnosis of polymyositis. The condition usually affects those between 30-50 years of age and individuals present with stiffness in the muscles closest to the trunk which gradually worsens over time. Difficulty swallowing may be experienced if the muscle in the oesophagus is affected.
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This question is part of the following fields:
- Musculoskeletal System
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Question 14
Correct
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A 69-year-old woman is admitted with confusion. She's known to have a history of multiple myeloma. Blood exam reveals the following: Na+ = 147 mmol/l, K+ = 4.7 mmol/l, Urea = 14.2 mmol/l, Creatinine = 102 μmol/l, Adjusted calcium = 3.9 mmol/l. What is the single most appropriate management?
Your Answer: IV 0.9% saline
Explanation:NICE guidelines on hypercalcemia recommend that maintaining good hydration equals drinking 3-4 L of fluid/day, provided there are no contraindications. A low calcium diet is not necessary because intestinal absorption of calcium is reduced. The patient should avoid any other drugs or vitamins that could worsen the hypercalcemia. Mobilization is encouraged and any symptoms of hypercalcemia should be reported.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 15
Correct
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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: 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 16
Correct
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A 28-year-old woman is evaluated in the endocrinology clinic for increased urine output. She weighs 60 kg and has a 24-hour urine output of 3500 ml. Her basal urine osmolality is 210 mOsm/kg.
She undergoes a fluid deprivation test and her urine osmolality after fluid deprivation (loss of weight 3 kg) is 350 mOsm/kg. Subsequent injection of subcutaneous DDAVP (desmopressin acetate) did not result in a further significant rise of urine osmolality after 2 hours (355 mOsm/kg).
Which of the following is the most likely diagnosis?Your Answer: Primary polydipsia
Explanation:In central and nephrogenic diabetes insipidus (DI), urinary osmolality will be less than 300 mOsm/kg after water deprivation. After the administration of ADH, the osmolality will rise to more than 750 mOsm/kg in central DI but will not rise at all in nephrogenic DI. In primary polydipsia, urinary osmolality be above 750 mOsm/kg after water deprivation. A urinary osmolality that is 300-750 mOsm/kg after water deprivation and remains below 750 mOsm/kg after administration of ADH may be seen in partial central DI, partial nephrogenic DI, and primary polydipsia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 17
Correct
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Question 18
Incorrect
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A 19-year-old football player was hit in his chest by an opponent. He became breathless and turned blue. What will be the initial management?
Your Answer: Start CPR
Correct Answer: Give oxygen
Explanation:As the patient is turning blue, giving oxygen will be the first priority in his management.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 19
Correct
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A 72-year-old woman presents with left side groin pain. She says she suddenly collapsed and was not able to lift her leg anymore. She is on calcium supplements and alendronate. What is the best diagnosis?
Your Answer: Fracture of neck of femur
Explanation:Fracture of the neck of femur is characterised by inability to lift the affected limb. This is relatively common in osteoporotic patients.
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This question is part of the following fields:
- Musculoskeletal System
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Question 20
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 21
Correct
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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 22
Correct
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Which of the following indicates the opening of tricuspid valve in jugular venous waveform?
Your Answer: y descent
Explanation:The a wave indicates atrial contraction. The c wave indicates ventricular contraction and the resulting bulging of tricuspid valve into the right atrium during isovolumetric systole. The v wave indicates venous filling. The x descent indicates the atrium relaxation and the movement of the tricuspid valve downward. The y descent indicates the filling of the ventricle after tricuspid opening.
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This question is part of the following fields:
- Cardiovascular System
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Question 23
Correct
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A 40-year-old male was admitted following 30%, burns sustained from an apartment fire. What is the most appropriate initial treatment of this patient?
Your Answer: Intravenous fluids
Explanation:As this patient has more than a 15% burn area, he needs IV fluids. These patients are more prone to infection and dehydration. Burn area is calculated using the rule of nines and requires fluid replacement over the first 24 hrs, calculated using Parkland’s burn formula.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 24
Correct
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A 13-year-old male, who is otherwise healthy, has presented with recurrent episodes of swelling in his face and tongue. He also complains of abdominal pain. His father has had similar episodes. Choose the most likely diagnosis for this patient.
Your Answer: C1 esterase deficiency
Explanation:C1 esterase deficiency is most often associated with swelling of the peripheries and laryngeal oedema. Severe pain in the abdomen is also consistent with this diagnosis. It is also an autosomal dominant condition.
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This question is part of the following fields:
- Immune System
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Question 25
Correct
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The ECG of a 29-year-old female shows an irregular rhythm with a HR of 154 bpm. She presented complaining of heart palpitations and hot flashes for the past 4 days. What is the most likely treatment?
Your Answer: Beta blockers
Explanation:At 29 years old, the most probable cause of this arrhythmia is thyrotoxicosis. β blockers relieve symptoms such as tachycardia, tremor, and anxiety in thyrotoxic patients. β blockade should be used as the primary treatment only in patients with thyrotoxicosis due to thyroiditis.
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This question is part of the following fields:
- Cardiovascular System
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Question 26
Correct
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Which is the most severe form among the following?
Your Answer: Class IV: diffuse proliferative glomerulonephritis
Explanation:The classes refer to the WHO classification of glomerulonephritis in SLE patients.
class I: normal kidney
class II: mesangial glomerulonephritis
class III: focal (and segmental) proliferative glomerulonephritis
class IV: diffuse proliferative glomerulonephritis
class V: diffuse membranous glomerulonephritis
class VI: sclerosing glomerulonephritisClass IV: diffuse proliferative glomerulonephritis is the most common and the most severe form, where more than 50% of the glomeruli are involved.
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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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Regarding the thymus, which of the following is true?
Your Answer: It is non-functional in adults
Correct Answer: DiGeorge's syndrome is a developmental abnormality affecting the thymus
Explanation:The thymus is a lymphoid organ located in the anterior mediastinum. In early life, the thymus is responsible for the development and maturation of cell-mediated immunologic functions. The thymus is composed predominantly of epithelial cells and lymphocytes. Precursor cells migrate to the thymus and differentiate into lymphocytes. Most of these lymphocytes are destroyed, with the remainder of these cells migrating to tissues to become T cells.
DiGeorge’s syndrome (DGS) is a developmental abnormality affecting the thymus. The classic triad of features of DGS on presentation is conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcaemia (resulting from parathyroid hypoplasia). -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 28
Incorrect
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A 20-year-old pregnant female in her first trimester met a child with chickenpox. She was investigated for the varicella antibody, which came back negative. She visited her GP. Which of the following measures is the most appropriate one?
Your Answer: Reassurance
Correct Answer: Ig
Explanation:After the exposure to chickenpox while pregnant, even if the patient is negative for antibodies she requires immunoglobulin to prevent further issues.
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This question is part of the following fields:
- Infectious Diseases
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Question 29
Incorrect
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A 41-year-old gentleman undergoes a temporal lobectomy after the discovery of a brain tumour. Which one of the following consequences would be least likely to develop?
Your Answer: Superior homonymous quadrantanopia
Correct Answer: Astereognosis
Explanation:Astereognosis is associated with lesions to the parietal lobe, not the temporal lobe, so this symptom would not arise in this patient.
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This question is part of the following fields:
- Nervous System
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Question 30
Correct
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A 3-year-old boy presents with recurrent urinary tract infections. What is the most common cause for this problem in a child of this age?
Your Answer: Vesicoureteric reflux
Explanation:Vesicoureteral reflux is the condition when the urine flows backwards from the bladder into the kidneys, which is the most common cause of UTI in patients this age.
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This question is part of the following fields:
- Renal System
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Question 31
Incorrect
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A new study was developed to assess the benefit of omega-3 fish oils in patients with established ischaemic heart disease. The power of the study is equal to:
Your Answer: 1 - probability of making a type I error
Correct Answer: 1 - probability of making a type II error
Explanation:The power of a test is defined as 1 − the probability of Type II error. The Type II error is concluding at no difference (the null is not rejected) when in fact there is a difference, and its probability is named β. Therefore, the power of a study reflects the probability of detecting a difference when this difference exists. It is also very important to medical research that studies are planned with an adequate power so that meaningful conclusions can be issued if no statistical difference has been shown between the treatments compared. More power means less risk for Type II errors and more chances to detect a difference when it exists.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 32
Correct
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A 70-year-old smoker was recently diagnosed with small cell lung cancer. Which of the following electrolyte combinations confirms the diagnosis of SIADH?
Your Answer: Low serum Na, low serum osmolarity, high urine osmolarity
Explanation:Due to the high amount of ADH in their blood, patient is voiding a low volume of urine with high osmolarity and as a result low levels of electrolytes will be present in the serum.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 33
Correct
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A 23-year-old man who works as a clerk presents for review. He is 6 feet 2 inches tall, with delayed puberty and infertility. On examination, he has small testes with scanty pubic hair.
Blood results are shown below:
Follicle-stimulating hormone (FSH) 40 U/l (1-7)
Testosterone 4 nmol/l(9-35)
What is the most probable diagnosis?Your Answer: 47XXY
Explanation:Klinefelter syndrome (KS), the most common human sex chromosome disorder 47,XXY. It is characterized by hypogonadism (micro-orchidism, oligospermia/azoospermia) and gynecomastia in late puberty. If Klinefelter syndrome is not diagnosed prenatally, a patient with 47,XXY karyotype may demonstrate various subtle, age-related clinical signs that would prompt diagnostic testing. These include the following:
Infants: Hypospadias, small phallus, cryptorchidism.
Toddlers: Developmental delay (especially expressive language skills), hypotonia.
Older boys and adolescent males: Tall stature; delayed or incomplete pubertal development with eunuchoid body habitus; gynecomastia; small, firm testes; sparse body hair.From childhood with progression to early puberty, the pituitary-gonadal function observed is within normal limits for 47,XXY males.
At mid puberty and later, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) concentrations rise to hyper-gonadotropic levels, inhibin B levels fall until they are undetectable, and testosterone levels are at low or low-normal levels after an initial increase.Fragile X syndrome, also termed Martin-Bell syndrome or marker X syndrome, is the most common cause of inherited mental retardation, intellectual disability, and autism.
However, the patient here does not have any mental disabilities as he already works as a clerk, and that too would make Down’s Syndrome less likely.Classic Kallmann syndrome (KS) and idiopathic hypogonadotropic hypogonadism (IHH) are rare genetic conditions that encompass the spectrum of isolated hypogonadotropic hypogonadism. Most patients have gonadotropin-releasing hormone (GnRH) deficiency, as suggested by their response to pulsatile GnRH therapy. Hypothalamic-pituitary function is otherwise normal in most patients, and hypothalamic-pituitary imaging reveals no space-occupying lesions. By definition, either anosmia or severe hyposmia is present in patients with Kallmann syndrome, in contrast to patients with idiopathic hypogonadotropic hypogonadism, whose sense of smell is normal.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 34
Correct
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A 25-year-old man presents with bloody diarrhoea associated with systemic upset. Blood tests show the following:
Hb 13.4 g/dl
Platelets 467 * 109/l
WBC 8.2 * 109/l
CRP 89 mg/l
A diagnosis of ulcerative colitis is suspected. Which part of the bowel is most likely to be affected?Your Answer: Rectum
Explanation:The most COMMON site of inflammation from ulcerative colitis is the rectum, making this the correct answer. This is simply a fact you need to memorize. In general, ulcerative colitis only occurs in colorectal regions– nothing in the small bowel (unless there is backwash into the terminal ileum) and nothing further up the GI tract. In Crohn’s it can affect the entire GI tract from mouth to anus.
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This question is part of the following fields:
- Gastrointestinal System
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Question 35
Correct
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A 25-year-old female presented with multiple small genital ulcers, which are painful following a sexual intercourse with an unknown man. Which of the following can be used topically for this presentation?
Your Answer: Acyclovir
Explanation:The most probable diagnosis is Herpes Simplex infection. Topical Acyclovir can be used in early stages.
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This question is part of the following fields:
- Infectious Diseases
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Question 36
Correct
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A 38-year-old alcoholic presented with an ataxic gait, nystagmus and confusion. What is the most likely clinical diagnosis?
Your Answer: Wernicke's encephalopathy
Explanation:Wernicke’s encephalopathy is a clinical triad of encephalopathy, gait ataxia and nystagmus.
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This question is part of the following fields:
- Nervous System
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Question 37
Incorrect
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A 24-year-old waiter applies for a job at a cafeteria. He gives a history of having had enteric fever 2 years ago. Which of the following investigations is most likely to indicate a chronic carrier status?
Your Answer: Vi agglutination test
Correct Answer: Culture of intestinal secretions
Explanation:The chronic asymptomatic carrier state is thought to be why there is continued appearance of the bacterium in human populations. As shedding of the organism is intermittent and sometimes at low levels, methods to detect it have been limited. The Salmonella typhi may be cultured from intestinal secretions, faeces or urine in chronic carriers and is recommended to confirm the diagnosis. Vi agglutination test can also be high in normal people in areas with typhoid endemic. Full blood count or blood culture would not be helpful to determine carrier status. Widal antigen test is unable to differentiate carriers from people with a hx of prior infection.
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This question is part of the following fields:
- Gastrointestinal System
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Question 38
Correct
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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: 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 39
Incorrect
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A 73-year-old woman presents with severe emphysema. She is on maximal therapy including high dose Seretide and tiotropium. She tells you that she is so unwell that she can barely manage the walk the 160 metres to the bus stop.
Â
On examination she looks short of breath at rest. Her BP is 158/74 mmHg, pulse is 76 and regular. There are quiet breath sounds, occasional coarse crackles and wheeze on auscultation of the chest.
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Investigations show:
Â
Haemoglobin 14.2 g/dl (13.5-17.7)
White cell count 8.4 x 109/l (4-11)
Platelets 300 x 109/l (150-400)
Sodium 137 mmol/l (135-146)
Potassium 4.1 mmol/l (3.5-5)
Creatinine 127 micromol/l (79-118)
pH 7.4 (7.35-7.45)
pCO2 7.5 kPa (4.8-6.1)
pO2 9.7 kPa (10-13.3)
Chest x-ray - Prominent upper lobe emphysema.
FEV1 - 30% of predicted.
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Which of the features of her history, examination or investigations would preclude referral for lung reduction surgery?Your Answer: pO2 9.8
Correct Answer: pCO2 7.4
Explanation:Nice guidelines for lung reduction surgery:
FEV1 > 20% predicted
PaCO2 < 7.3 kPa
TLco > 20% predicted
Upper lobe predominant emphysemaThis patient has pCO2 of 7.4 so she is unsuitable for referral for lung reduction surgery.
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This question is part of the following fields:
- Respiratory System
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Question 40
Correct
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A 16-month-old infant presented to ER with multiple bruises on his right arm. According to his mom, he has been unable to move it since yesterday and is crying more than usual. A relative attended the child while his mother was on a night shift. X-ray revealed a fracture of the right humerus, which was put in a cast. What is the next step in this case?
Your Answer: Admit under care of paediatrician
Explanation:Certain lesions present on x-ray are suggestive of child abuse including rib, humerus and skull fractures. It is the doctors responsibility to follow up on these cases to determine whether domestic abuse has occurred.
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This question is part of the following fields:
- Ethical & Legal
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Question 41
Correct
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A 37-year-old woman known with ulcerative colitis is referred with a microcytic anaemia. Blood tests reveal the following results:
Hb 88 g/L (120-160)
WCC 3.6 ×109/L (4-11)
Platelets 222 ×109/L (150-400)
MCV 70 fL (80-96)
Haptoglobins <0.04 g/L (0.13-1.63)
Lactate dehydrogenase 850 U/L (100-250)
Bilirubin 68 µmol/L (1-22)
Alkaline phosphatase 100 U/L (45-105)
ALT 23 U/L (5-40)
Which investigation would confirm the underlying diagnosis?Your Answer: Direct Coombs' test
Explanation:This a case of autoimmune haemolytic anaemia which is a rare complication of the less used treatment, salazopyrine, used for inflammatory bowel disease (IBD). A direct Coombs’ test looks for erythrocytes already coated with antibody, whereas the indirect test is used to detect potential red cell antibody interactions floating around in the blood.
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This question is part of the following fields:
- Gastrointestinal System
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Question 42
Correct
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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: 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 43
Correct
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A 43-year-old woman is concerned about osteoporosis as she as a strong family history of it. She is one year postmenopausal and aware of hot flushes at night.
Which one of the following therapies would be most appropriate?Your Answer: Cyclical oestrogen and progestogen
Explanation:As the patient has early menopause, hormone replacement therapy (HT) is considered to be the first line of choice for prevention of bone loss and fracture in the early postmenopausal period for 5 years.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 44
Correct
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A 7-year-old asthmatic boy presented to the pulmonologist with an exacerbation of shortness of breath for 3 days. At the time of admission, he was still experiencing breathlessness with oxygen saturation found to be less than 90%. CXR shows bilateral hyperinflation. Which of the following should be done?
Your Answer: Arterial blood gas
Explanation:Arterial blood gas is useful for the evaluation of oxygen and carbon dioxide gas exchange, respiratory function including hypoxia, and acid/base balance. This will quickly indicate if assisted ventilation is required for this patient.
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This question is part of the following fields:
- Respiratory System
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Question 45
Correct
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In diabetes, what is the most common finding on renal biopsy?
Your Answer: Glomerulosclerosis
Explanation:Glomerulosclerosis is the scarring and hardening of the glomeruli known as diabetic glomerulosclerosis occurring in long-standing diabetes.
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This question is part of the following fields:
- Renal System
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Question 46
Correct
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A 72-year-old man presents with chronic back and right hip pain which has been increasingly affecting him over the past few months. He finds it very difficult to mobilise in the mornings. Clinical examination is unremarkable, apart from a limitation of right hip flexion due to pain. Investigations show: Haemoglobin:    12.1 g/dl (13.5-17.7) White cell count:  8.2 x 109/l (4-11) Platelets:         200 x 109/l (150-400) C reactive protein: 9 nmol/l (<10) ESR:             15 mm/hr (<20) Sodium:          140 mmol/l (135-146) Potassium:       3.9 mmol/l (3.5-5) Creatinine:       92 µmol/l (79-118) ALT:             12 U/l (5-40) Alkaline phos:    724 U/l (39-117) Calcium:         2.55 mmol/l (2.20-2.67) Which of the following is the most likely diagnosis?
Your Answer: Paget's disease
Explanation:Paget’s disease of bone is a chronic disease of the skeleton. In healthy bone, a process called remodeling removes old pieces of bone and replaces them with new, fresh bone. Paget’s disease causes this process to shift out of balance, resulting in new bone that is abnormally shaped, weak, and brittle. Paget’s disease most often affects older people, occurring in approximately 2 to 3% of the population over the age of 55.
Many patients with Paget’s disease have no symptoms at all and are unaware they have the disease until X-rays are taken for some other reason. When bone pain and other symptoms are present, they can be related to the disease itself or to complications that arise from the disease — such as arthritis, bone deformity, and fractures. In patients with Paget’s disease, alkaline phosphatase levels are usually quite elevated — a reflection of the high bone turnover rate.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 47
Correct
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A 65-year-old male patient admitted with myocardial infarction received thrombolysis, which lead to full resolution of the ST elevations on his ECG. He was on aspirin, clopidogrel, atorvastatin and enalapril. The next day he complained of pain in his legs and there was a diffuse petechial rash over his lower legs, especially in the feet. All his peripheral pulses were palpable. His FBC revealed neutrophilia with eosinophilia. His IgE antibodies were 3 kU/L (<2). What is the most likely reason for this presentation?
Your Answer: Cholesterol emboli
Explanation:He has a consequence of atherosclerotic disease (MI). The most probable diagnosis is cutaneous cholesterol emboli as it is more common after anticoagulation or thrombolytics, the skin involvement, eosinophilia and raised IgE. It is more common above 60 yrs. of age.
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This question is part of the following fields:
- Cardiovascular System
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Question 48
Correct
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Which one of the following statements regarding minimal change glomerulonephritis is incorrect?
Your Answer: Hypertension is found in approximately 25% of patients
Explanation:Hypertension and haematuria are not common presentations in minimal change glomerulonephritis, all other statements are correct.
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This question is part of the following fields:
- Renal System
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Question 49
Correct
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A 76-year-old lady with known carcinoma of the caecum, was admitted to the hospital for right hemicolectomy. She had a history of osteoarthritis for which she was taking nonsteroidal anti-inflammatory agents (NSAIDs), intermittently. Two years ago, she had a fibroma removed from her right breast as well. The patient was a non-smoker and drank approximately 8 units of alcohol per week.
Investigations carried out pre-operatively showed:
Hb: 10.8 g/dL
MCV: 75 fL
WCC: 8.4 x10^9/L
Plts: 402 x10^9/L
The surgery remained uncomplicated, and she was given two units of packed red blood cells postoperatively. Three days later, she has now become jaundiced and complains of fatigue.
Her blood count now shows:
Hb: 7.2 g/dL
MCV: 110 fL
WCC: 9.5 x10^9/L
Plts: 395 x10^9/L
Which of the following is the best investigation to confirm the diagnosis?Your Answer: Direct Coombs test
Explanation:The direct Coombs test will specifically confirm immune-mediated haemolysis occurring post-transfusion in the aforementioned case.
There are two types of Coombs test used in immunohematology and immunology:
1. Direct Coombs test – It confirms autoimmune haemolytic anaemia by detecting antibodies or complement proteins attached to the surface of red blood cells.
2. Indirect Coombs test – It is used in prenatal testing of pregnant women and in testing prior to a blood transfusion. It detects antibodies floating freely in the blood, against foreign red blood cells.
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This question is part of the following fields:
- Haematology & Oncology
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Question 50
Correct
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A 30-year-old man presents with hypertension and decreased serum potassium levels. Which hormone should be tested in addition in order to establish the diagnosis?
Your Answer: Aldosterone
Explanation:High blood pressure and a low level of potassium in the blood indicates hyperaldosteronism. Therefore, aldosterone should be tested immediately to establish the diagnosis. Hyperaldosteronism, is a medical condition wherein too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood (hypokalaemia) and increased hydrogen ion excretion (alkalosis).
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This question is part of the following fields:
- Cardiovascular System
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Question 51
Correct
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A 37-year-old male patient presented with bilateral kidney stones. He gave a history of sarcoidosis. What is the most probable cause for renal stones?
Your Answer: Hyper calcaemic
Explanation:Sarcoidosis is a multisystem granulomatous disorder which may involve the kidneys to a variable degree. Renal calculi have been reported to occur in about 10% of patients with chronic sarcoidosis. Hypercalcaemia due to marked hyperabsorption of dietary calcium, bone resorption and renal tubular calcium reabsorption causes hypercalciuria. Both hypercalcemia and hypercalciuria contribute to nephrolithiasis.
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This question is part of the following fields:
- Renal System
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Question 52
Correct
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A 36-year-old man arrives at the clinic complaining of pain and swelling of the left knee, ankles and right hallux. He has acute conjunctivitis, and dysuria. He suffered from an episode of gastroenteritis two weeks back. Clinical examination shows left Achilles tendonitis and right plantar fasciitis. Radiological examination reveals left sacroiliitis, with evidence of enthesitis, joint erosions and periostitis. HLA-B27 is positive. Which of the following is the most likely diagnosis?
Your Answer: Reiter's syndrome
Explanation: -
This question is part of the following fields:
- Musculoskeletal System
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Question 53
Correct
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Which of the following procedures does not require antibiotic prophylaxis?
Your Answer: Dental procedure for a patient with an atrial septal defect
Explanation:According to latest NICE guidelines, patients with isolated atrial septal defects do not require prophylactic antibiotics originally used in prevention of infective endocarditis in dental procedures.
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This question is part of the following fields:
- Infectious Diseases
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Question 54
Correct
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A 51-year-old woman admitted to the hospital for 3 days due to haemoptysis developed an ataxic gait, visual problems, and altered state of consciousness. What is the most appropriate management of this patient?
Your Answer: High potent vitamins
Explanation:Wernicke’s encephalopathy presents with neurological symptoms as a result of biochemical deficits in the central nervous system due to depleted B-vitamin reserves, particularly thiamine (vitamin B1). Classically, Wernicke encephalopathy is characterised by the triad – ophthalmoplegia, ataxia, and confusion. Thiamine treatment should be started immediately and usually continued until clinical improvement ceases.
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This question is part of the following fields:
- Nervous System
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Question 55
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 56
Incorrect
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A 20-year-old woman presents with weakness and is found to have a serum potassium of 2.2 mmol/l and pH 7.1.
Â
Which of the following would be LEAST useful in differentiating between renal tubular acidosis Types 1 and 2?Your Answer: Renal calculi
Correct Answer: Osteomalacia
Explanation:Osteomalacia is a marked softening of the bones that can present in both type I and type II Renal Tubular Acidosis (RTA) and will thus not differentiate the two types in any case. The other measures will allow differentiation of the two types.
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This question is part of the following fields:
- Renal System
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Question 57
Correct
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A 85-year-old male with a history of faecal impaction, who lived at a nursing-home presented with abdominal pain and distension, confusion and agitation. Which of the following is the first step of the management.
Your Answer: Phosphate enema
Explanation:The most probable cause for this presentation is faecal impaction following constipation, which is common among old people who live in nursing-homes. There can be number of reason for constipation in old age, including medications, endocrine and metabolic diseases, neurologic disorders, myopathic disorders, dietary habits etc. Enemas are a way of removing impacted faeces, which helps rectal evacuation.
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This question is part of the following fields:
- Geriatric Medicine
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Question 58
Correct
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A 75-year-old male patient with a three weeks history of recurrent epistaxis and haemoptysis presents with acute kidney injury. Which antibody would you expect positive?
Your Answer: C ANCA
Explanation:Pulmonary renal syndrome is most commonly due to an ANCA positive vasculitis. The history of recurrent epistaxis makes Wegener’s granulomatosis the most probable diagnosis. It presents with pulmonary haemorrhage producing haemoptysis, rapidly progressive glomerulonephritis and anti-glomerular basement membrane antibodies. Recurrent epistaxis favours the diagnosis. In this patient we suspect C ANCA to be positive.
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This question is part of the following fields:
- Musculoskeletal System
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Question 59
Correct
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You are asked to fill the first part of a cremation form. Which of the following would need to be removed prior to cremation?
Your Answer: Pacemaker
Explanation:Pacemakers have small electrical parts installed in them that can explode when exposed to extreme heat and pressure.
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This question is part of the following fields:
- Ethical & Legal
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Question 60
Incorrect
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A 48-year-old hairdresser presented to her GP complaining of tingling in the right palm and right wrist pain. She had intermittently experienced these symptoms; however, recently they had been keeping her awake all night. She had noticed a reduction in grip and was struggling to work at the salon. Otherwise, she felt well in herself and had not noticed any weakness in the other hand or lower limb. Her weight was stable, and she denied any neck problems or swallowing difficulties. She had a past medical history of hypothyroidism and hypertension and took regular thyroxine, Bendroflumethiazide and ibuprofen. She was a non-smoker and rarely drank alcohol. On examination, she appeared alert and oriented. Fundoscopy and cranial nerve examination were all normal and neck movements were full.
On examination of the upper limb, there was wasting over the right thenar eminence and fasciculations with a small burn over the right index finger. There was weakness of thumb abduction and opposition, with loss of pinprick and light touch sensation over the thumb, index and middle finger in the right hand. Nerve conduction studies showed absent sensory action potential in right median palmar branches and denervation of the right abductor pollicis brevis.
What is the most likely diagnosis?Your Answer: Ulnar nerve palsy
Correct Answer: Median nerve palsy
Explanation:The history is consistent with carpal tunnel syndrome (CTS) arising as a result of pressure on the median nerve in the carpal tunnel. The median nerve supplies the muscles of the thenar eminence: the abductor pollicis (C7, C8), flexor pollicis brevis and opponens pollicis, and the lateral two lumbricals. The nerve conduction studies confirm marked denervation and absent sensory potentials within the median nerve territory.
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This question is part of the following fields:
- Nervous System
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Question 61
Incorrect
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A 70-year-old man presents to the emergency department acutely unwell. He is shocked, drowsy and confused.
He is known to be type-2 diabetic maintained on metformin.
Blood tests reveal a metabolic acidosis with an anion gap of 24 mmol/l. Ketones are not significantly elevated and random blood glucose was 8.7 mmol/l.
What is the mainstay of treatment for this condition?Your Answer: 1.26% sodium bicarbonate iv
Correct Answer: Rehydration
Explanation:Lactic acidosis is occasionally responsible for metabolic acidosis in diabetics. It may occur in the presence of normal blood levels of the ketone bodies, and such cases are often described as having non-ketotic diabetic acidosis.
It is most commonly associated with tissue hypoperfusion and states of acute circulatory failure.
Appropriate measures include treatment of shock, restoration of circulating fluid volume, improved cardiac function, identification of sepsis source, early antimicrobial intervention, and resection of any potential ischemic regions. Reassessment of lactate levels for clearance assists ongoing medical management. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 62
Correct
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For a given condition, disease or attribute, there will be a proportion of people in a population who have the given condition, disease or attribute at a specified point in time or over a specified period of time. Which of following is the best term which can describe the above?
Your Answer: Prevalence
Explanation:Prevalence, sometimes referred to as prevalence rate, is the proportion of persons in a population who have a particular disease or attribute at a specified point in time or over a specified period of time.
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This question is part of the following fields:
- Evidence Based Medicine
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Question 63
Correct
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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: 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 64
Correct
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An 82-year-old woman is brought in by her carer with fluctuating consciousness. On examination she is deeply jaundiced, hypotensive with a tachycardia and has a hepatic flap. Initial blood tests reveal an ALT of 1000 U/l, INR 3.4, ALP 600 U/l and a bilirubin of 250 mmol/l.
Repeat blood tests 6 hours later show an ALT of 550 U/l, INR 4.6, ALP 702 U/l and bilirubin of 245 m mol/l. The toxicology screen for paracetamol and aspirin is negative; she is positive for hepatitis B surface antibody and negative for hepatitis B surface antigen.
Which of the following would best explain her clinical condition?Your Answer: Acute liver failure secondary to paracetamol
Explanation:Liver flap is pathognomonic for liver failure. Paracetamol (also known as acetaminophen) overdose usually presents with symptoms including liver failure, resulting in confusion, jaundice, and coagulopathy a few days after overdose. The first 24 hours, people usually have minimal symptoms. Diagnosis is based on blood levels of acetaminophen at specific times after it was taken (see reference). If she took it a few days ago, levels may indeed be undetectable. The hepatitis B serology suggests prior vaccination. Wilson’s disease is not the most likely diagnosis given her presentation. The AST:ALT ratio would be expected to be reversed in alcohol induced liver failure.
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This question is part of the following fields:
- Hepatobiliary System
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Question 65
Correct
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A 18-year-old male complained of scrotal pain following a game of football. He couldn't recall any trauma to groin. Which of the following is the best investigation to confirm the diagnosis?
Your Answer: USG of the scrotum
Explanation:USG of the scrotum is important to exclude any abnormality with testicles, epididymis and scrotum. This presentation can be acute epididymo-orchitis or testicular torsion. USG of the scrotum will help to confirm the diagnosis.
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This question is part of the following fields:
- Men's Health
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Question 66
Incorrect
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A 75-year-old man has presented to the clinic with a complaint of disturbed sleep. The physician has prescribed temazepam. Which of the following best describes the mechanism of action of this drug?
Your Answer: Inhibits the effect gamma-aminobutyric acid
Correct Answer: Enhances the effect of gamma-aminobutyric acid
Explanation:Temazepam is an orally available benzodiazepine used in the therapy of insomnia.
The soporific activity of the benzodiazepines is mediated by their ability to enhance gamma-aminobutyric acid (GABA) mediated inhibition of synaptic transmission through binding to the GABA-A receptor.
The recommended initial dose for insomnia is 7.5 mg before bedtime, increasing as needed to a maximum dose of 30 mg.The most common side effects of temazepam are dose-related and include daytime drowsiness, lethargy, ataxia, dysarthria, and dizziness.
Tolerance develops to these side effects, but tolerance may also develop to the effects on insomnia. -
This question is part of the following fields:
- Pharmacology
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Question 67
Correct
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A 54-year-old male, with a smoking history of 15 pack years presents with worsening dyspnoea, fever and cough. He works at a foundry. Vitals are as follows:
Respiratory rate: 28/min
Heart rate: 80 bpm
Temp: 37.6C
Chest auscultation reveals bilateral crepitations throughout the lung fields.
Calcified hilar nodules are visible on the chest X-ray. Further evaluation shows an eggshell calcification on HRCT.
Which of the following is the most likely diagnosis?Your Answer: Silicosis
Explanation:Silicosis is a common occupational lung disease that is caused by the inhalation of crystalline silica dust. Silica is the most abundant mineral on earth. Workers that are involved for example in construction, mining, or glass production are among the individuals with the highest risk of developing the condition. Acute silicosis causes severe symptoms (e.g., exertional dyspnoea, cough with sputum) and has a very poor prognosis.
Chronic silicosis has a very variable prognosis and affected individuals may remain asymptomatic for several decades. However, radiographic signs are usually seen early on. Typical radiographic findings are calcifications of perihilar lymph nodes, diffuse ground glass opacities, large numbers of rounded, solitary nodules or bigger, confluent opacities. Avoiding further exposure to silica is crucial, especially since the only treatment available is symptomatic (e.g., bronchodilators). Silicosis is associated with an increased risk of tuberculosis and lung cancer. Berylliosis typically affects individuals who are exposed to aerospace industry. Histoplasmosis and tuberculosis do not form eggshell calcifications. -
This question is part of the following fields:
- Respiratory System
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Question 68
Correct
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An 83-year-old gentleman presents to his GP with increasing oedema and ascites. He is hypertensive, for which he takes amlodipine. There is shortness of breath on exercise. His alcohol history is two cans of stout per day.
Â
ECG is normal, and CXR reveals normal heart size and no signs of cardiac failure. Serum albumin is 23 g/dl; urinary albumin excretion is 7 g/24 h, with no haematuria. He has mild anaemia with a normal MCV. Total cholesterol is elevated.
Â
What diagnosis fits best with this clinical picture?Your Answer: Nephrotic syndrome
Explanation:Nephrotic syndrome usually presents with the symptoms in this patient: low albumin, abnormal cholesterol, increased urinary albumin excretion, oedema, and as a consequence, hypertension as well.
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This question is part of the following fields:
- Renal System
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Question 69
Incorrect
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Wolff-Parkinson-White syndrome is not linked with which of the following?
Your Answer: Hypertrophic cardiomyopathy
Correct Answer: Ventricular tachycardia in the absence of drug therapy
Explanation:Ventricular tachycardia is not linked with Wolff-Parkinson-White syndrome. The other options are linked to WPW syndrome.
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This question is part of the following fields:
- Cardiovascular System
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Question 70
Incorrect
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A 30-year-old woman who works in a pharmacy comes to the clinic for review. Over the past few months, she has lost increasing amounts of weight and has become increasingly anxious about palpitations, which occur mostly at night. Her TSH is <0.1 IU/l (0.5-4.5).
On examination, her BP is 122/72 mmHg, her pulse is 92 and regular. You cannot palpate a goitre or any nodules on examination of her neck.
Which of the following investigations can differentiate between self-administration of thyroid hormone and endogenous causes of thyrotoxicosis?Your Answer: Thyroid binding globulin
Correct Answer: Radioactive uptake thyroid scan
Explanation:Once thyrotoxicosis has been identified by laboratory values, the thyroid radio-iodine uptake and scan may be used to help distinguish the underlying aetiology. Thyroid radioiodine uptake is raised in Graves’ disease. It may be normal or raised in patients with a toxic multinodular goitre. It is very low or undetectable in thyrotoxicosis resulting from exogenous administration of thyroid hormone or the thyrotoxic phase of thyroiditis.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 71
Correct
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A 70-year-old male presents with chest pain. His past medical history includes hypertension and angina. He continues to smoke about 20 cigarettes per day despite being advised about lifestyle modifications.
Blood investigations obtained in the emergency department show:
Na+: 133 mmol/l
K+: 3.3 mmol/l
Urea: 4.5 mmol/l
Creatinine: 90 μmol/l
Which among the following is the most likely explanation for the abnormalities seen in the above investigations?Your Answer: Bendroflumethiazide therapy
Explanation:The blood investigations in this patient reveal hyponatremia as well as hypokalaemia. Among the options provided, Bendroflumethiazide therapy can cause the above presentation with the electrolyte disturbances.
Note:
– Spironolactone is a potassium-sparing diuretic that is associated with hyperkalaemia.
– Enalapril therapy can cause side effects of dizziness, hypotension, cough, and rarely a rash.
– Felodipine therapy can cause side effects of dizziness, headache, cough, and palpitations. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 72
Correct
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How should DVT during pregnancy be managed?
Your Answer: Dalteparin
Explanation:Deep vein thrombosis (DVT) is a serious condition in which a blood clot forms in a deep vein, usually in the leg.
Subcutaneous low molecular weight heparin (LMWH) is the preferred treatment for most patients with acute DVT, including in pregnancy. A large meta-analyses comparing LMWH to unfractionated heparin (UFH) showed that LMWH decreased the risk of mortality, recurrent veno-thrombo embolism (VTE), and haemorrhage compared with heparin. Other advantages of LMWH may include more predictable therapeutic response, ease of administration and monitoring, and less heparin-induced thrombocytopenia. Disadvantages of LMWH include cost and longer half-life compared with heparin.
Warfarin, which is administered orally, is used if long-term anticoagulation is needed. The international normalized ratio (INR) is followed, with a target range of 2-3. Warfarin crosses the placenta and is teratogenic, causing a constellation of anomalies known as warfarin embryopathy, with greatest risk between the sixth and twelfth week of gestation.
Other options are not indicated for use. -
This question is part of the following fields:
- Respiratory System
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Question 73
Correct
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Which feature is NOT characteristic of carcinoid syndrome?
Your Answer: Persistent hypotension
Explanation:Carcinoid syndrome is a paraneoplastic syndrome comprising of signs and symptoms that occur secondary to carcinoid tumours. Diarrhoea, dermatitis, bronchospasm and right sided cardiac valve lesions (tricuspid insufficiency and pulmonary stenosis) are characteristic of carcinoid syndrome.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 74
Incorrect
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A 23-year-old male presents with a history of lower back pain for the last one year. Presence of which of the following features most likely points towards ankylosing spondylitis?
Your Answer: Presence of HLA-B27 antigen on tissue typing
Correct Answer: Bilateral erosion of sacroiliac joints on X-ray
Explanation:Bilateral erosions of the sacroiliac joints on pelvic radiographs of patients with ankylosing spondylitis are an important feature of the modified New York classification criteria. Although HLA-B27 is commonly associated with AS, it can also be found in normal individuals. Back stiffness is worse in the morning and gets better as the day progresses. Tenderness and limited lumbar motion can be associated with other spine problems as well and is not characteristic of rheumatoid arthritis.
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This question is part of the following fields:
- Musculoskeletal System
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Question 75
Correct
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Question 76
Correct
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A 55-year-old lady who a known case of normal pressure hydrocephalus (NPH) presented with complaints of weakness in her lower limbs, urinary incontinence and progressively worsening confusion. Which of the following statements is true regarding NPH?
Your Answer: Is associated with gait disturbance
Explanation:Normal pressure hydrocephalus is a form of communicating hydrocephalus characterised by enlarged ventricles with normal opening pressure on lumbar puncture. For diagnostic purposes, a triad of urinary incontinence, gait abnormality and dementia is necessary. It is necessary to diagnose the condition early because it is reversible by placing a ventriculoperitoneal shunt. It is most common in patients aged more than 60 years.
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This question is part of the following fields:
- Infectious Diseases
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Question 77
Correct
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A diabetic 50-year-old male presented in the emergency room with ischaemic gangrene of the lower leg, ulceration over the medial malleolus and infection spreading proximally. Which of the following types of amputation is most suitable in this patient?
Your Answer: Below knee amputation
Explanation:The type of amputation depends on the degree of gangrene, ischaemia and the extent of involvement of the foot, leg, knee etc. In this case, below-knee amputation is the most appropriate choice.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 78
Correct
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A 70-year-old male tells doctors he has been exposed to asbestos 20 years ago and has attempted to quit smoking. He has lost a lot of weight and his voice is very hoarse. Choose the most likely cancer diagnosis in this patient.
Your Answer: Bronchial Carcinoma
Explanation:A hoarse voice, exposure to asbestos, and smoking are all consistent with bronchial carcinoma in this patient.
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This question is part of the following fields:
- Respiratory System
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Question 79
Correct
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A 72-year-old woman presents with 18 month history of gait ataxia, dysarthria, and dysphagia.
On examination there is down beating nystagmus and slurred speech. There is past pointing in both upper limbs and a wide-based ataxic gait. Reflexes and sensation are normal. There is no wasting or fasciculations. Plantar response is flexor bilaterally.
What is the most likely diagnosis?Your Answer: Arnold-Chiari malformation
Explanation:Downbeat nystagmus (DBN) suggests a lesion in the lower part of the medulla. Arnold-Chiari malformation usually presents with symptoms due to brainstem and lower cranial nerve dysfunction such as DBN.
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This question is part of the following fields:
- Nervous System
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Question 80
Correct
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What is the mode of spread of chickenpox?
Your Answer: Airborne
Explanation:Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).
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This question is part of the following fields:
- Infectious Diseases
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Question 81
Correct
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A 26-year-old patient, previously fit and well, is admitted with fluctuating confusion and frank haematuria. He has recently been complaining of generalised malaise and joint pains. Examination reveals jaundice, splenomegaly, and petechiae. His blood pressure is 155/84 mmHg, temperature 37.9oC.
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Initial investigations reveal:
Haemoglobin 9.5 g/dl
White cell count 12 × 109/l
Platelets 40 × 109/l
Creatinine 142 μmol/l
Sodium 139 mmol/l
Potassium 4.5 mmol/l
Urea 9.2 mmol/l
Lactate dehydrogenase 495 U/l (10-250)
Urinalysis Protein ++, blood +++
Blood film shows schistocytes
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What treatment should NOT be given to this patient?Your Answer: Platelet transfusion
Explanation:There is a strong suspicion of Thrombotic Thrombocytopenic Purpura (TTP) in this patient as he presents with neurological changes (from confusion to convulsions and coma), fever, haemolysis, thrombocytopenia, and renal failure. Additionally, TTP cases may present with jaundice, splenomegaly, and hypertension as seen in this patient. With a diagnosis of TTP, recent studies have shown that platelet transfusion is not recommended in this case because it has been shown to increase the risk for arterial thrombosis and mortality possibly due to increased aggregations.
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This question is part of the following fields:
- Renal System
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Question 82
Correct
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A 41-year-old man who has had two episodes of pneumonia in succession and an episode of haemoptysis is observed to have paroxysms of coughing and increasing wheezing. A single lesion which is well-defined is seen in the lower right lower lobe on a chest x-ray. There is no necrosis but biopsy shows numerous abnormal cells, occasional nuclear pleomorphism and absent mitoses.
Which diagnosis fits the clinical presentation?Your Answer: Bronchial carcinoid
Explanation:Bronchial carcinoids are uncommon, slow growing, low-grade, malignant neoplasms, comprising 1-2% of all primary lung cancers.
It is believed to be derived from surface of bronchial glandular epithelium. Mostly located centrally, they produce symptoms and signs of bronchial obstruction such as localized wheeze, non resolving recurrent pneumonitis, cough, chest pain, and fever. Haemoptysis is present in approximately 50% of the cases due to their central origin and hypervascularity.
Central bronchial carcinoids are more common than the peripheral type and are seen as endobronchial nodules or hilar/perihilar mass closely related to the adjacent bronchus. Chest X-ray may not show the central lesion depending on how small it is. -
This question is part of the following fields:
- Respiratory System
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Question 83
Correct
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A 22-year-old nulliparous female presents with shortness of breath. She has a history of recurrent deep vein thrombosis. Complete blood count and clotting screen reveals the following results:
Hb: 12.4 g/dl
Plt: 137
WBC: 7.5*109/l
PT: 14 secs
APTT: 46 secs
Which of the following would be the most likely diagnosis?Your Answer: Antiphospholipid syndrome
Explanation:The combination of APTT and low platelets with recurrent DVTs make antiphospholipid syndrome the most likely diagnosis.
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This question is part of the following fields:
- Musculoskeletal System
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Question 84
Correct
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A 20-year-old gentleman presents with drop foot following a sports injury.
On examination there is weakness of ankle dorsiflexion and eversion, and weakness of extension of the big toe. He has some sensory loss restricted to the dorsum of his foot surrounding the base of his big toe. Other examination is within normal limits.
Where is the most likely site of the lesion?Your Answer: Common peroneal nerve at the head of the fibula
Explanation:Peroneal nerve injury is also known as foot drop. The common peroneal nerve supplies the ankle and toe extensor muscle groups as well as sensation over the dorsum of the foot; thus, there is also loss of sensation in these cases.
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This question is part of the following fields:
- Nervous System
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Question 85
Correct
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A 70-year-old male complains of anuria and back pain for the last 3 days. He looked tired and had complaints of pruritus and hiccups. Which of the following metabolic abnormalities is most likely?
Your Answer: Metabolic acidosis
Explanation:Symptoms are suggestive of renal failure leading to uraemia. For patients with these symptoms metabolic acidosis is the most probable cause. Hyperkalaemia instead of hypokalaemia is present in the patients with renal failure.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 86
Correct
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A 65-year-old male patient presented with acute severe central chest pain for one hour. His ECG confirmed the diagnosis of acute ST elevation myocardial infarction and he was treated with thrombolysis. Two days later he developed sudden onset breathlessness and became unwell. On examination he had bibasal crepitation and a systolic murmur at the apex which radiated to the axilla. Which of the following is the most likely cause for this presentation?
Your Answer: Ruptured papillary muscle
Explanation:The most likely cause for acute breathlessness is due to papillary muscle rupture which causes mitral regurgitation.
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This question is part of the following fields:
- Cardiovascular System
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Question 87
Correct
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A 50-year-old woman under treatment for manic-depressive psychosis presents in an unconscious state after an episode of seizure on the street. Her husband who accompanied her into the ER reported that they argued about 6-7 hours ago. On examination, she is found to be hypertonic with a GCS of 8, BP: 90/60 mmHg and a pulse of 105 bpm. Blood investigations revealed a lithium level of 3.2 mmol/L. She was intubated and ventilated. Which of the following interventions is most appropriate in this case?
Your Answer: Gastric lavage and normal saline infusion
Explanation:Among the above statements, gastric lavage and normal saline IV infusion are the most appropriate interventions for a patient of acute lithium toxicity.
Activated charcoal is not effective after lithium overdose, although gastric lavage should be considered if patients present within 6-8 h.
Where levels are above 3 mmol/l, the use of normal saline to induce diuresis should be considered, although careful monitoring of fluid balance is necessary.
Where levels of lithium are above 4 mmol/l, dialysis is often required. Haemodialysis is preferred, but in a facility where haemodialysis is not possible, peritoneal dialysis may be considered.
Patients should not be discharged until they are asymptomatic and have a serum lithium level less than 1.5 mEq/L. -
This question is part of the following fields:
- Pharmacology
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Question 88
Correct
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A 57-year-old male presented to the OPD with a complaint of yellow discoloration of his skin. On examination, he was found to have digital clubbing, jaundice, an enlarged and nodular liver, as well as caput medusa. Clinical investigations revealed normal electrolyte levels but low albumin levels. Which of the following is the appropriate management of this patient's fluid intake?
Your Answer: Albumin infusion
Explanation:This patient has an accumulation of fluid inside his body which, along with the lowered albumin level, tells us that the oncotic pressure of the blood is very low in this patient. Therefore, albumin infusion is the best option for him because albumin is the key human protein that contributes the most to the oncotic pressure.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 89
Incorrect
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A literature review of a number of studies was conducted to assess the potential efficacy of a new drug, which may reduce the chance of patients with chronic kidney disease (CKD) developing gout. In one study 120 out of 1200 patients receiving the new drug developed gout. The total number of the patients were 2000 and the remaining 800 individuals received a placebo. From the patients that had received the placebo, 200 developed gout. What is the absolute risk reduction of developing gout?
Your Answer: 0.1
Correct Answer: 0.15
Explanation:Absolute risk reduction (ARR) – also called risk difference (RD) – is the most useful way of presenting research results to help your decision-making. Absolute risk reduction = (Control event rate) – (Experimental event rate) = 0.15 = 15%
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This question is part of the following fields:
- Evidence Based Medicine
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Question 90
Incorrect
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A 74-year-old female complains of coarse tremors. Which of the following drugs may be the cause?
Your Answer: Haloperidol
Correct Answer: Lithium
Explanation:The most common adverse effect of lithium is fine hand tremors. It is also an early sign of toxicity.
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This question is part of the following fields:
- Pharmacology
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Question 91
Correct
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A 25-year-old woman with type-1 diabetes mellitus attends for her routine review and says she is keen on becoming pregnant.
Which of the following is most likely to make you ask her to defer pregnancy at this stage?Your Answer: Hb A1C 9.4%
Explanation:Pregnancies affected by T1DM are at increased risk for preterm delivery, preeclampsia, macrosomia, shoulder dystocia, intrauterine fetal demise, fetal growth restriction, cardiac and renal malformations, in addition to rare neural conditions such as sacral agenesis.
Successful management of pregnancy in a T1DM patient begins before conception. Research indicates that the implementation of preconception counselling, emphasizing strict glycaemic control before and throughout pregnancy, reduces the rate of perinatal mortality and malformations.
The 2008 bulletin from the National Institute for Health and Clinical Excellence recommends that preconception counselling be offered to all patients with diabetes. Physicians are advised to guide patients on achieving personalized glycaemic control goals, increasing the frequency of glucose monitoring, reducing their HbA1C levels, and recommend avoiding pregnancy if the said level is > 10%.
Other sources suggest deferring pregnancy until HbA1C levels are > 8%, as this margin is associated with better outcomes. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 92
Correct
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A patient with a history of asthma presents with worsening of her symptoms and dyspnoea. She recently started taking a new medicine and she feels it might have aggravated her symptoms.
Which of the following is likely responsible for her symptoms?Your Answer: Timolol eye drops
Explanation:β-blockers are the class of drug most often chosen to treat glaucoma, although other medical therapies are available. Systemic absorption of timolol eye drops can cause unsuspected respiratory impairment and exacerbation of asthma. Physicians should be alert to the possibility of respiratory side-effects of topical therapy with β-blockers. Leukotriene antagonists and salbutamol are used in asthma treatment. HRT and ferrous sulphate do not lead to the exacerbation of asthma.
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This question is part of the following fields:
- Respiratory System
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Question 93
Incorrect
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A 20-year-old woman presents to the hospital with sharp, left-sided chest pain and shortness of breath.
On examination her pulse is 101 beats per minute and blood pressure is 124/61 mmHg. She is seen to be mildly breathless at rest but her oxygen saturation on air was 98%.
CXR reveals a left pneumothorax with a 4 cm rim of air visible.
Which management strategy is appropriate in this patient?Your Answer: Insertion of intercostal chest drain
Correct Answer: Needle aspiration
Explanation:Pneumothorax is defined as air in the pleural space and may be classified as spontaneous, traumatic or iatrogenic. Primary spontaneous pneumothorax occurs in patients without clinically apparent lung disease.
Primary pneumothorax has an incidence of 18-28 per 100,000 per year for men and 1.2-6 per 100,000 per year for women. Most patients present with ipsilateral pleuritic chest pain and acute shortness of breath. Shortness of breath is largely dependent on the size of the pneumothorax and whether there is underlying chronic lung disease.Young patients may have chest pain only. Most episodes of pneumothorax occur at rest. Symptoms may resolve within 24 hours in patients with primary spontaneous pneumothorax. The diagnosis of a pneumothorax is confirmed by finding a visceral pleural line displaced from the chest wall, without distal lung markings, on a posterior-anterior chest radiograph.
Breathless patients should not be left without intervention regardless of the size of pneumothorax. If there is a rim of air >2cm on the chest X-ray, this should be aspirated.
Aspiration is successful in approximately 70 per cent of patients; the patient may be discharged subsequently. A further attempt at aspiration is recommended if the patient remains symptomatic and a volume of less than 2.5 litres has been aspirated on the first attempt.If unsuccessful, an intercostal drain is inserted. This may be removed after 24 hours after full re-expansion or cessation of air leak without clamping and discharge may be considered.
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This question is part of the following fields:
- Respiratory System
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Question 94
Incorrect
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A 22-year-old male presented with a cut injury at his wrist. Which of the following would be the expected clinical signs if his ulnar nerve was damaged?
Your Answer: Wasting of the hypothenar eminence
Correct Answer: Wasting of the interossei
Explanation:Damage to the ulnar nerve at wrist will cause wasting of the interossei and adductor pollicis muscle. There won’t be any sensory loss, weakness of wrist flexion or wasting of hypothenar muscles.
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This question is part of the following fields:
- Nervous System
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Question 95
Incorrect
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In a patient with prostate cancer, what is the mechanism by which goserelin acts?
Your Answer: Androgen receptor antagonist
Correct Answer: GnRH agonist
Explanation:Androgen deprivation therapy (ADT) for prostate cancer:
Goserelin (Zoladex) is a synthetic gonadotropin-releasing hormone (GnRH) analogue; chronic stimulation of goserelin results in suppression of LH, FSH serum levels thereby preventing a rise in testosterone.
Dosage form: 3.6 mg/10.8mg implants.
Adverse effects include flushing, sweating, diarrhoea, erectile dysfunction, less commonly, rash, depression, hypersensitivity, etc.
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This question is part of the following fields:
- Pharmacology
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Question 96
Incorrect
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A 58-year-old psychologist with small cell lung cancer complains of muscle weakness. Each one of the following are features of Lambert-Eaton syndrome, except:
Your Answer: Dry mouth
Correct Answer: Repeated muscle contractions lead to decreased muscle strength
Explanation:In myasthenia gravis, repeated muscle contractions lead to reduced muscle strength. The opposite is however classically seen in the related disorder Lambert-Eaton syndrome. Lambert-Eaton myasthenic syndrome is seen in association with small cell lung cancer, and to a lesser extent breast and ovarian cancer. It may also occur independently as an autoimmune disorder. Lambert-Eaton myasthenic syndrome is caused by an antibody directed against pre-synaptic voltage gated calcium channel in the peripheral nervous system.
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This question is part of the following fields:
- Nervous System
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Question 97
Correct
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A 13-year-old boy complains of several episodes of collapse. He describes the majority of these episodes occurring when he is laughing. He states that he loses power in his legs and falls to the ground. He is alert throughout and recovers quickly. He also describes excessive daytime sleepiness with episodes in the morning of being awake but being unable to move his body. Examination is unremarkable. A diagnosis of narcolepsy is made. Which of the following is the first line treatment for excessive daytime sleepiness?
Your Answer: Modafinil
Explanation:Narcolepsy is a rare condition characterised by excessive daytime sleepiness, sleep paralysis, hypnagogic hallucinations, and cataplexy (sudden collapse triggered by emotion such as laughing or crying). There is no cure for narcolepsy. Treatment options include stimulants, such as methylphenidate (Ritalin) or modafinil (Provigil), antidepressants, such as fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft) and sodium oxybate (Xyrem). Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS).
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This question is part of the following fields:
- Nervous System
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Question 98
Incorrect
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A 35-year-old female presented with complaints of earache and a high-grade fever. During examination, numerous small vesicles were found within the ear canal and her ear is very tender. Which one of the following organisms is most likely to be responsible for such a condition?
Your Answer: Varicella zoster
Correct Answer: Herpes zoster
Explanation:Herpes zoster is a viral disorder in which painful vesicular lesions are present in a specific dermatome area. High-grade fever may present as well due to infection. Varicella zoster, measles, herpes simplex and HIV do not present with tender lesions of a limited area.
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This question is part of the following fields:
- Infectious Diseases
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Question 99
Correct
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A 60-year-old male has been taken to the doctor with dysphagia and pain when swallowing. A barium meal shows he has gross dilation of the oesophagus, with a smooth narrowing at the lower end. Choose the single most likely cause of his symptoms.
Your Answer: Achalasia
Explanation:Finding it difficult to swallow both food and drink with a narrow oesophagus is consistent with a diagnosis of achalasia.
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This question is part of the following fields:
- Gastrointestinal System
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Question 100
Incorrect
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Choose the molecule that acts as the co-receptor for cells expressing antigens linked with MHC class I molecules:
Your Answer: CD2b
Correct Answer: CD8
Explanation:CD8+ T cells recognize antigens in the form of short peptide fragments bound to major histocompatibility complex class I (MHCI) molecules on the target cell surface.1 Specific engagement of peptide-MHCI (pMHCI) complexes via the clonotypically expressed ?β T-cell receptor (TCR) triggers a range of effector functions that play a critical role in protective immunity against intracellular infections and various malignancies.
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This question is part of the following fields:
- Immune System
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Question 101
Incorrect
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A 43 year-old female artist with no past medical history presents to the emergency department with a 2-day history of pins and needles in the lower limbs, and progressive walking difficulties. She states she had diarrhoea 1 week ago. On examination, there is a loss of pinprick sensation noted to the lower limbs from mid-thigh distally and in the upper limbs from MCP joints distally. There is bilateral weakness of ankle dorsiflexion, noted at 3/5, and knee flexion and extension weakness, noted at 4/5 bilaterally. Power in upper and lower limbs is otherwise normal. Knee and ankle deep tendon reflexes are absent. Which of the following is the most likely diagnosis?
Your Answer: Botulism
Correct Answer: Guillain-Barre syndrome
Explanation:Guillain-Barre syndrome is an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni). Characteristic features include progressive weakness of all four limbs, and it is classically ascending, affecting the lower extremities first. Sensory symptoms tend to be mild.
Functional neurological syndrome can be discounted due to presence of hard neurological signs. Multiple sclerosis can be excluded because of the presence of lower motor neuron signs and absence of upper motor neuron signs. Chronic inflammatory demyelinating polyneuropathy is the chronic form of Guillain-Barre syndrome.
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This question is part of the following fields:
- Nervous System
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Question 102
Incorrect
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Which features may suggest malignant changes in a melanocytic naevi?
Your Answer: Increase in pigmentation
Correct Answer: Decrease in size
Explanation:Melanocytic naevi are skin tumours produced by melanocytes. They usually present in childhood but increase during puberty. The mnemonic A-B-C-D, is used by institutions to assess for suspicion of malignancy. The letters stand for asymmetry, border, colour, and diameter. If a mole starts changing in size, colour, shape or, especially, if the border of a mole develops ragged edges or becomes larger than a pencil eraser, it would be an appropriate time to consult with a physician. Other warning signs include if it begins to crust over, bleed, itch, or become inflamed.
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This question is part of the following fields:
- The Skin
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Question 103
Correct
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A 70-year-old male diagnosed previously with villous adenoma presented in the OPD with severe diarrhoea. Which of the following electrolyte or fluid imbalances is most commonly associated with such a condition?
Your Answer: Hypokalaemia
Explanation:Lower GIT fluid is rich in potassium. So, in the case of severe diarrhoea, potassium loss occurs leading to hypokalaemia. Loss of bicarbonate ions also occurs. Both of these disturbances will lead to hyperchloremic metabolic acidosis.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 104
Correct
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A 27-year-old male is admitted after drinking engine coolant in an apparent suicide attempt.
Lab investigations reveal:
pH 7.1 (7.36-7.44)
pO2 15.3 kPa (11.3-12.6)
pCO2 3.2 kPa (4.7-6.0)
Standard bicarbonate 2.2 mmol/L (20-28)
Serum calcium 1.82 mmol/L (2.2-2.6)
After replacing calcium, which of the following is the most urgent treatment for this man?Your Answer: 8.4% bicarbonate infusion
Explanation:Carbon monoxide has high affinity for haemoglobin and myoglobin resulting in a left-shift of the oxygen dissociation curve and tissue hypoxia. There are approximately 50 deaths per year from accidental carbon monoxide poisoning in the UK. In these circumstances, antidotal therapy to block alcohol dehydrogenase with ethanol or 4-MP alone is insufficient to treat the poisoning. Data suggest that a severe lactic acidosis needs initial correction and in this patient the most appropriate treatment would be IV fluids with bicarbonate to correct the metabolic acidosis. Haemodialysis may be required thereafter.
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This question is part of the following fields:
- Fluids & Electrolytes
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Question 105
Incorrect
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A 60-year-old male is under treatment with azathioprine after a renal transplant. During his review, he complains of pain and swelling over his left great toe. Investigations reveal hyperuricemia. Suspecting gout, he was started on allopurinol. Subsequently, he develops aplastic anaemia. Which of the following is the most appropriate reason for his bone marrow failure?
Your Answer: Acute viral infection
Correct Answer: Mercaptopurine toxicity
Explanation:The cause for bone marrow suppression in this patient is most probably mercaptopurine toxicity.
Azathioprine is metabolized to 6-mercaptopurine (6-MP), which itself is metabolized by xanthine oxidase.
Xanthine oxidase inhibition by allopurinol leads to the accumulation of 6-MP which then precipitates bone marrow failure.
This may be potentially fatal if unrecognized.
Clinical presentation:
Toxicity symptoms include gastrointestinal symptoms, bradycardia, hepatotoxicity, myelosuppression. -
This question is part of the following fields:
- Pharmacology
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Question 106
Incorrect
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A 16-year-old boy was stabbed in his right upper back and brought to the ED where he underwent an erect CXR. Findings suggest a homogenous opacity on the lower right lung with the trachea centrally placed. What would explain the those findings?
Your Answer: Tension pneumothorax
Correct Answer: Haemothorax
Explanation:Findings suggest a haemothorax which is very likely to happen, in the absence of a haemo-pneumothorax.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 107
Incorrect
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Which one of the following congenital infections is most characteristically associated with chorioretinitis?
Your Answer: Parvovirus B19
Correct Answer: Toxoplasma gondii
Explanation:The common congenital infections encountered are rubella, toxoplasmosis and cytomegalovirus. Cytomegalovirus is the most common congenital infection in the UK. Maternal infection is usually asymptomatic.
Congenital toxoplasmosis is associated with fetal death and abortion, and in infants, it is associated with neurologic deficits, neurocognitive deficits, and chorioretinitis. -
This question is part of the following fields:
- Infectious Diseases
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Question 108
Incorrect
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A 35-year-old patient presented with a cough, wheezing and difficulty in breathing which wakes him up in the night. He also has a itchy, dry and scaly skin rash. Which of the following is the most probable diagnosis?
Your Answer: Psoriasis
Correct Answer: Eczema
Explanation:The skin lesion is most probably eczema. It is common among atopic people. Asthma is a common association.
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This question is part of the following fields:
- The Skin
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Question 109
Incorrect
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Which of the following peripheral neuropathy inducing clinical diagnoses is predominantly associated with sensory loss?
Your Answer: Lead poisoning
Correct Answer: Uraemia
Explanation:Diseases that cause predominantly sensory loss include diabetes, uraemia, leprosy, alcoholism, vitamin B12 deficiency, and amyloidosis.
Those that cause predominantly motor loss include Guillain-Barre syndrome, porphyria, lead poisoning, hereditary sensorimotor neuropathies, chronic inflammatory demyelinating polyneuropathy, and diphtheria. -
This question is part of the following fields:
- Nervous System
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Question 110
Incorrect
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A 70-year-old male patient presented with chronic congestive heart failure. Which of the following is the most important factor to consider when prescribing drugs for this patient?
Your Answer: Digoxin is more effective than ACE inhibitors in reducing cardiovascular events
Correct Answer: Administration of a B-blocker reduces the time spent in hospital
Explanation:It is proven that spironolactone has survival benefits and loop diuretics only give symptomatic relief. Beta blockers are however, known to improve exercise tolerance, left ventricular function and reduce symptoms. They also reduce the mortality associated with heart failure. So administration of beta blockers will reduce the time spent in hospital by improving symptoms.
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This question is part of the following fields:
- Cardiovascular System
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Question 111
Incorrect
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A 34 year-old gentleman presented with 3 months history of abdominal pain, intermittent diarrhoea, melena and loss of weight. The most likely diagnosis will be?
Your Answer: Diverticulosis
Correct Answer: Inflammatory bowel disease
Explanation:Inflammatory bowel disease (IBD) is characterized by abdominal and pelvic pain, intermittent diarrhoea, loss of weight and tenesmus. Irritable bowel disease is associated either with diarrhoea or constipation and occurs in stressful conditions for the individual. A UTI is characterised by dysuria, fever and lumbar pain. Adenomyosis is characterised by heavy menstrual bleeding and chronic pelvic pain.
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This question is part of the following fields:
- Gastrointestinal System
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Question 112
Incorrect
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A 74-year-old man presents with 12 kg weight loss and persistent back pain that is unrelated to activity for the past several months. Laboratory findings show :
WCC: 6.7 x 109/l (5.4 neutrophils, 1.2 lymphocytes and 0.2 monocytes)
Haemoglobin: 11.2 g/dl
haematocrit: 33.3%
MCV: 88 fl
Platelet count: 89 x 109/l.
The biochemistry shows:
sodium 144 mmol/l
potassium 4.5 mmol/l
chloride 100 mmol/l
bicarbonate 26 mmol/l
urea 14 mmol/l
creatinine 90 μmol/l
a glucose of 5.4 mmol/l.
A CT scan of the spine reveals scattered 0.4 to 1.2 cm bright lesions in the vertebral bodies.
Which of the following additional laboratory test findings is he most likely to have?Your Answer: Serum calcium of 1.4 mmol/l
Correct Answer: Serum prostate specific antigen of 35 microgram/l
Explanation:Old age, persistent backache, weight loss, and osteosclerotic lesions make prostatic adenocarcinoma the most likely diagnosis. The sequelae include severe pain, pathological fractures, hypercalcemia and cord compression. Prostatic adenocarcinoma is detected by elevated levels of prostate specific antigen. Positive serology for borrelia burgdorferi would hint at Lyme disease which does not cause osteosclerotic bone lesions, neither would Neisseria gonorrhoeae have such a presentation.
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This question is part of the following fields:
- Musculoskeletal System
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Question 113
Incorrect
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A 26-year-old male has been taken to the emergency department with chest pain and increasing shortness of breath. He revealed that he has been a heavy smoker for the last 4 years, but doesn't have any past medical history. Which of the following is the most likely diagnosis?
Your Answer: Pleural effusion
Correct Answer: Pneumothorax
Explanation:Increasing shortness of breath, chest pain, and no previous medical history are consistent with a pneumothorax diagnosis. Heavy tobacco use is also a risk factor for developing this condition spontaneously.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 114
Incorrect
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An 18-year-old, previously well boy was admitted following a generalized tonic-clonic convulsion for 5 minutes with urinary incontinence and eye rolling. On examination, he was drowsy and had bilateral upgoing plantar reflexes. A short while ago he had been playing rugby and had taken a hit to the head. He was apparently normal for a few minutes before fitting. His blood sugar level was normal. Which of the following is the most probable reason for this presentation?
Your Answer: Idiopathic epilepsy
Correct Answer: Post-traumatic seizure
Explanation:The history is suggestive of a post-traumatic seizure which frequently occurs after moderate or severe traumatic brain injury. Although upgoing plantars can be identified in a post-ictal status, an intracranial bleed has to be excluded. A single seizure cannot be considered epilepsy
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This question is part of the following fields:
- Nervous System
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Question 115
Incorrect
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A 25-year-old female with a known diagnosis of hypothyroidism and receiving thyroxine, came to the emergency department with complaints of difficulty sleeping for 3 days and a history of jaundice for 7 days. Her lab results showed increased levels of TSH and PT=70 sec. Which of the following is the most appropriate diagnosis?
Your Answer: Hyper-acute liver failure
Correct Answer: Autoimmune hepatitis
Explanation:Autoimmune hepatitis is linked with other autoimmune diseases, such as hypothyroidism. It may present as acute or chronic hepatitis and sometimes cirrhosis. Fever, hepatic tenderness and history of jaundice is present. Non-specific features like behavioural issues, weight changes or mood swings can also be present. Coagulopathy can also be present.
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This question is part of the following fields:
- Hepatobiliary System
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Question 116
Incorrect
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A 32-year-old female patient has the following signs and symptoms: smooth goitre, lid lag and bilateral exophthalmos with puffy eyelids and conjunctival injections. She has a history of thyrotoxicosis but wants to fall pregnant. What would be the most appropriate treatment for her?
Your Answer: Thyroidectomy
Correct Answer: 18m of Propylthiouracil (PTU) alone
Explanation:Propylthiouracil (PTU) is a safe choice for a woman that is planning a pregnancy because it does not have the teratogenic effects as carbimazole does. Methimazole (MMI) and propylthiouracil (PTU) are the standard anti-thyroid drugs used in the treatment of hyperthyroidism in pregnancy. Carbimazole can cause spina bifida, CV malformations as well as hypospadia.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 117
Incorrect
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A husband visits the clinic with his wife because he wants to be screened for cystic fibrosis. His brother and wife had a child with cystic fibrosis so he is concerned. His wife is currently 10 weeks pregnant. When screened, he was found to be a carrier of the DF508 mutation for cystic fibrosis but despite this result, the wife declines testing. What are the chances that she will have a child with cystic fibrosis, given that the gene frequency for this mutation in the general population is 1/20?
Your Answer: 1/30
Correct Answer: Jan-80
Explanation:The chance of two carriers of a recessive gene having a child that is homozygous for that disease (that is both genes are transmitted to the child) is 25%. Therefore, the chances of this couple having a child with CF are 25%(1/4) x 1/20 = 1/80.
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This question is part of the following fields:
- Respiratory System
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Question 118
Incorrect
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Which one of the following interventions has the least role in management of acne rosacea?
Your Answer: Camouflage creams
Correct Answer: Low-dose topical corticosteroids
Explanation:Mild cases are often not treated at all, or are simply covered up with normal cosmetics and avoiding sun exposure. Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of facial redness and inflammatory lesions. The two primary modalities of rosacea treatment are topical and oral antibiotic agents (including metronidazole and tetracyclines). Laser therapy may be appropriate for patients with prominent telangiectasia.
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This question is part of the following fields:
- The Skin
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Question 119
Incorrect
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A 48-year-old male patient presents with fever and signs of delirium. A few hours ago, blisters appeared on his trunk. His past history revealed nothing serious and he's not on any medication. He admits that he went to Italy five months ago on vacation. What is the most probable diagnosis?
Your Answer: Pemphigoid
Correct Answer: Chicken pox
Explanation:Chicken pox in adults may manifest with acute encephalitis, causing the confusional syndrome known as delirium. Blisters on the trunk favour the diagnosis. The trip to Italy however seems unimportant since the incubation period of chicken pox is 10 to 21 days.
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This question is part of the following fields:
- Infectious Diseases
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Question 120
Incorrect
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A 60-year-old man complains of weight loss, fatigue, fever and abdominal discomfort. Abdominal ultrasound reveals massive splenomegaly and the lab results return the following: WBC=127, Hgb=8.7, Plt=138. Basophils were also found on the peripheral blood film. What is the most likely diagnosis?
Your Answer: CLL
Correct Answer: CML
Explanation:CML is a myeloproliferative disorder involving neoplastic proliferation of mature myeloid cells, especially granulocytes and their precursors. The non-acute symptoms of marked splenomegaly and anaemia accompanied by of fever and abdominal discomfort rules out the other conditions.
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This question is part of the following fields:
- Haematology & Oncology
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Question 121
Incorrect
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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 following alcohol
Correct 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 122
Incorrect
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Which of the following is most consistent with small cell lung cancer?
Your Answer: hypercalcemia is commonly seen
Correct Answer: hypertrophic pulmonary osteoarthropathy is rarely seen
Explanation:The clinical manifestations of Small cell lung cancer (SCLC) can result from local tumour growth, intrathoracic spread, distant spread, and/or paraneoplastic syndromes.
Hypertrophic pulmonary osteoarthropathy (HPO) is a rare paraneoplastic syndrome that is frequently associated with lung cancer; however, the incidence of clinically apparent HPO is not well known.
SIADH is present in 15% of cases and most commonly seen.
Although hypercalcaemia is frequently associated with malignancy, it is very rare in small cell lung cancer despite the high incidence of lytic bone metastases.
Ectopic Cushing’s syndrome in SCLC does not usually exhibit the classic signs of Cushing’s syndrome and Cushing’s syndrome could also appear during effective chemotherapy.
Chemotherapy is the treatment of choice in SCLC. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 123
Incorrect
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A 51-year-old presents with muscle atrophy. He has a high BMI and finds it difficult to climb stairs. If the patient also has polydipsia and polyuria, what is the most likely diagnosis?
Your Answer: Polyneuropathy
Correct Answer: Amyotrophy
Explanation:(Diabetic) Amyotrophy is a condition that presents with muscle wasting and consequent difficulty in climbing stairs. The onset is relatively sudden and symptoms of diabetes are characteristic.
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This question is part of the following fields:
- Nervous System
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Question 124
Incorrect
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A 23-year-old female is admitted with acute severe asthma. Treatment is initiated with 100% oxygen, nebulised salbutamol and ipratropium bromide nebulisers and IV hydrocortisone. There is no improvement despite initial treatment.
What is the next step in management?Your Answer: IV adrenaline
Correct Answer: IV magnesium sulphate
Explanation:A single dose of intravenous magnesium sulphate is safe and may improve lung function and reduce intubation rates in patients with acute severe asthma. Intravenous magnesium sulphate may also reduce hospital admissions in adults with acute asthma who have had little or no response to standard treatment.
Consider giving a single dose of intravenous magnesium sulphate to patients with acute severe asthma (PEF <50% best or predicted) who have not had a good initial response to inhaled bronchodilator therapy. Magnesium sulphate (1.2-2 g IV infusion over 20 minutes) should only be used following consultation with senior medical staff.
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This question is part of the following fields:
- Respiratory System
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Question 125
Correct
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A 45-year-old obese patient arrives at the clinic for a regular health check up. His labs are as follows: Fasting blood sugar: 6 mmol/l, Oral glucose tolerance test (OGTT): 10 mmol/L. What is the most likely diagnosis?
Your Answer: Impaired glucose tolerance
Explanation:Impaired glucose tolerance means that blood glucose is raised beyond normal levels, but not high enough to warrant a diabetes diagnosis. With impaired glucose tolerance you face a much greater risk of developing diabetes and cardiovascular disease. Impaired glucose tolerance is defined as 2-hour glucose levels of 140 to 199 mg per dL (7.8 to 11.0 mmol) on the 75-g oral glucose tolerance test, and impaired fasting glucose is defined as glucose levels of 100 to 125 mg per dL (5.6 to 6.9 mmol per L) in fasting patients.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 126
Incorrect
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A 58-year-old lady was admitted to hospital with increasing thirst and generalised abdominal pain. She was diagnosed with breast carcinoma three years previously and treated with a radical mastectomy.
Â
Investigations showed:
Serum corrected calcium 3.5 mmol/L (NR 2.2-2.6)
Serum alkaline phosphatase 1100 IU/L
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Her serum calcium was still elevated following 4 litres of 0.9% saline intravenous infusion.
Â
Which of the following is the most appropriate next step?Your Answer: Radiotherapy
Correct Answer: Pamidronate 60 mg intravenously
Explanation:This case has hypercalcaemia most likely associated with the bony metastases from her pre-existing breast carcinoma. The most appropriate next step is to give Pamidronate 60mg intravenously, a bisphosphonate, to immediately inhibit bone resorption and formation.
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This question is part of the following fields:
- Renal System
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Question 127
Incorrect
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Of the following medications, which is available over the counter (OTC) to treat heavy blood loss during menstruation?
Your Answer: Non steroidal anti-inflammatory drugs (NSAIDS)
Correct Answer: Tranexamic acid
Explanation:Since March 2011, tranexamic acid has been available to buy from pharmacies to help treat heavy blood loss during menstruation. NSAIDs (such as ibuprofen and naproxen) are available to purchase over the counter, but these aid in the treatment of dysmenorrhea rather than menorrhagia. MIRENA, norethisterone, and COCP are not available to purchase over the counter to treat heavy blood loss (however COCP is available for contraceptive use).
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This question is part of the following fields:
- Pharmacology
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Question 128
Incorrect
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A 32-year-old woman, with a history of infertility, presented with postoperative bleeding from her abdominal wound. Her full blood count (FBC) and blood film showed hyperleukocytosis and the presence of promyelocytes, along with the following:
Hb: 9.2g/dL
Plts: 932 x 10^9/L
INR: 1.4 (Coagulation profile)
What should be the next step of management?Your Answer: Give vincristine
Correct Answer: Give fresh frozen plasma
Explanation:The patient has acute promyelocytic leukaemia (APML) with associated disseminated intravascular coagulation (DIC). Although the platelet count is high, platelet function is ineffective.
Patients may present, as in this case, with severe bleeding, and the most appropriate emergency treatment would be administration of fresh frozen plasma (FFP).
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This question is part of the following fields:
- Haematology & Oncology
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Question 129
Incorrect
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A 41-year-old male was involved in a fight and received a stab wound in the left 4th intercostal space. He was transferred to ER immediately with a BP 80/40 and HR 125. On examination, his neck veins are dilated and his heart sounds are faint. His trachea is central. What is the SINGLE most likely diagnosis?
Your Answer: Diaphragmatic rupture
Correct Answer: Cardiac tamponade
Explanation:The cardinal symptom of the cardiac tamponade is a shocked patient with tachycardia and congested neck veins.
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This question is part of the following fields:
- Cardiovascular System
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Question 130
Incorrect
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A 20-year-old heroin addict is admitted following an overdose. She is drowsy and has a respiratory rate of 6 bpm. Which of the following arterial blood gas results (taken on room air) are most consistent with this?
Your Answer: pH = 7.55; pCO2 = 3.4 kPa; pO2 = 14.3 kPa
Correct Answer: pH = 7.31; pCO2 = 7.4 kPa; pO2 = 8.1 kPa
Explanation:In mild-to-moderate heroin overdoses, arterial blood gas (ABG) analysis reveals respiratory acidosis. In more severe overdoses, tissue hypoxia is common, leading to mixed respiratory and metabolic acidosis.
The normal range for PaCO2 is 35-45 mmHg (4.67 to 5.99 kPa). Respiratory acidosis can be acute or chronic. In acute respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range (i.e., >45 mm Hg) with an accompanying academia (i.e., pH < 7.35). In chronic respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range, with a normal or near-normal pH secondary to renal compensation and an elevated serum bicarbonate levels (i.e., >30 mEq/L).
Arterial blood gases with pH = 7.31; pCO2 = 7.4 kPa; pO2 = 8.1 kPa would indicate respiratory acidosis.
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This question is part of the following fields:
- Respiratory System
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Question 131
Correct
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A 22-year-old woman presents with anxiety and weight loss with increased appetite.
Thyrotoxicosis is suspected and various investigations are performed.
Which of the following findings is most consistent with Graves' disease?Your Answer: High titre of thyroid peroxidase autoantibodies
Explanation:Free T4 levels or the free T4 index is usually elevated, as is the free T3 level or free T3 index
– Assays for thyrotropin-receptor antibodies (particularly TSIs) almost always are positive.
– Detection of TSIs is diagnostic for Graves disease.
– Other markers of thyroid autoimmunity, such as antithyroglobulin antibodies or antithyroid peroxidase antibodies, are usually present.
– Other autoantibodies that may be present include thyrotropin receptor-blocking antibodies and anti-sodium-iodide symporter antibody.
The presence of these antibodies supports the diagnosis of autoimmune thyroid disease.
– The radioactive iodine uptake is increased and the uptake is diffusely distributed over the entire gland. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 132
Incorrect
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A 70-year-old woman is having trouble in speaking following a stroke. Her limbs are paralyzed, both left upper and lower limbs. Which anatomical site is most likely affected?
Your Answer: Cerebellum
Correct Answer: Internal capsule
Explanation:– The given scenario is typical of lesion in internal capsule.
– Memory impairment is caused by a hippocampal lesion,
– Impairment of arousal, facial paresis, visual field defect, facial paresis, hemiataxia, and hemispacial neglect are just some of the conditions caused by thalamic lesion.
– Brainstem stroke on the other hand causes breathing abnormality, altered consciousness, and blood pressure disorder. -
This question is part of the following fields:
- Geriatric Medicine
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Question 133
Incorrect
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A 36-year-old patient who is a known IV drug abuser presented with complaints of sudden onset of sharp excruciating chest pain, which increases on inspiration and is relieved by bending forward. He also complained of shortness of breath for the last few months. The most likely diagnosis would be?
Your Answer: MI
Correct Answer: Pericarditis
Explanation:The chief symptoms of pericarditis comprise of sudden onset of sharp chest pain, that is relieved by bending forward and is exacerbated by deep inspiration. Symptoms can vary among the individuals but these are the chief symptoms.
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This question is part of the following fields:
- Cardiovascular System
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Question 134
Incorrect
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A young woman is complaining of a sensation of spinning and loss of balance every time she moves sideways on the bed while lying supine. What would you do next?
Your Answer: CT
Correct Answer: Head roll test
Explanation:The most probable diagnosis is benign paroxysmal positional vertigo (BPPV). It is a peripheral vestibular disorder characterized by short episodes of mild to intense dizziness and influenced by specific changes in head position. BPPV is the most common cause of vertigo accounting for nearly one-half of patients with peripheral vestibular dysfunction. In order to establish the diagnosis, the head roll test is performed where the head is turned about 90° to each side while supine.
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This question is part of the following fields:
- Nervous System
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Question 135
Incorrect
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Which of the statements is most accurate regarding the lung?
Your Answer: Physical signs placed anteriorly indicate disease in the lower lobes
Correct Answer: The medial basal segment is absent in the left lower lobe
Explanation:The right and left lung anatomy are similar but asymmetrical. The right lung consists of three lobes: right upper lobe (RUL), right middle lobe (RML), and right lower lobe (RLL). The left lung consists of two lobes: right upper lobe (RUL) and right lower lobe (RLL). The right lobe is divided by an oblique and horizontal fissure, where the horizontal fissure divides the upper and middle lobe, and the oblique fissure divides the middle and lower lobes. In the left lobe there is only an oblique fissure that separates the upper and lower lobe.
The lobes further divide into segments which are associated with specific segmental bronchi. Segmental bronchi are the third-order branches off the second-order branches (lobar bronchi) that come off the main bronchus.
The right lung consists of ten segments. There are three segments in the RUL (apical, anterior and posterior), two in the RML (medial and lateral), and five in the RLL (superior, medial, anterior, lateral, and posterior). The oblique fissure separates the RUL from the RML, and the horizontal fissure separates the RLL from the RML and RUL.
There are eight to nine segments on the left depending on the division of the lobe. In general, there are four segments in the left upper lobe (anterior, apicoposterior, inferior and superior lingula) and four or five in the left lower lobe (lateral, anteromedial, superior and posterior). The medium sized airways offer the maximum airway resistance, not smaller ones.
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This question is part of the following fields:
- Respiratory System
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Question 136
Correct
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Which of the following features is characteristic of acute intermittent porphyria?
Your Answer: Increased urinary porphobilinogen between acute attacks
Explanation:Urinary porphobilinogen is increased between attacks of acute intermittent porphyria (AIP) and even more so, between acute attacks.
AIP is a rare autosomal dominant condition caused by a defect in porphobilinogen deaminase, an enzyme involved in the biosynthesis of haem. This results in the toxic accumulation of delta-aminolaevulinic acid and porphobilinogen.
Abdominal and neuropsychiatric symptoms are characteristic of AIP especially in people between the ages of 20-40 years. The disease is more common in females than in males (5:1). Major signs and symptoms of AIP include abdominal pain, vomiting, motor neuropathy, hypertension, tachycardia, and depression.
Diagnosis:
1. Urine turns deep red on standing (classical picture of AIP)
2. Raised urinary porphobilinogen (elevated between attacks and to a greater extent, between acute attacks)
3. Raised serum levels of delta-aminolaevulinic acid and porphobilinogen
4. Assay of red blood cells for porphobilinogen deaminase -
This question is part of the following fields:
- Haematology & Oncology
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Question 137
Incorrect
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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: Gouty arthritis
Correct 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 138
Incorrect
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A 18-year-old gentleman is referred to dermatology. He has around 10 hyperpigmented macules on his torso which vary in size from 1.5-5 cm in size. His GP also noted some freckles in the groin region. He is also currently under orthopaedic review due to a worsening scoliosis of the spine. His father suffered from similar problems before having a fatal myocardial infarction two years ago. Which chromosome is most likely to have a gene defect?
Your Answer: Chromosome 22
Correct Answer: Chromosome 17
Explanation:The patient’s history and presentation and familial history, meets the diagnostic criteria for Neurofibromatosis type I, presenting with neurofibromas noted in this patient as hyperpigmented macules and freckles, musculoskeletal disorders like the scoliosis in this case, and a familial history. Neurofibromatosis type I is caused by a mutation on Chromosome 17.
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This question is part of the following fields:
- Nervous System
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Question 139
Incorrect
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A 30-year-old female went to her local doctor's surgery for a follow-up to a cervical smear test. The smear was sent to histology and was identified as CIN2. Choose the most appropriate management for this patient.
Your Answer: Cone biopsy
Correct Answer: Refer for colposcopy
Explanation:Screening for cervical carcinoma helps to prevent the development of the disease. According to NICE, the screening interval using liquid-based cytology (as opposed to PAP) is 3 years for women less than 50 years old and 5 years for women over 50 years old. If a smear test is conducted and it shows no endocervical cells then it should be conducted again. This is because there was either inadequate preparation or sampling, or the sampling was done at the wrong point in the menstrual cycle. For severe dyskaryosis or carcinoma in situ, the patient needs treatment and should, therefore, be referred for a colposcopy. Clue cells are vaginal epithelial cells that are fuzzy (i.e.. without distinct edges) when looking at through a microscope. When bacterial vaginosis is present, over 20 per cent of the sample cells are clue cells. Bacterial vaginosis is treated with metronidazole therapy. Although trichomoniasis is treated with metronidazole too, the patient should be tested for other sexually transmitted diseases.
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This question is part of the following fields:
- Women's Health
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Question 140
Incorrect
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A 30-year-old agitated male was brought to the emergency department by his friend. Though there is little previous history, the friend believes that he has been suffering from depression for several years, and his medications have been changed by his general practitioner quite recently.
On examination the patient is agitated and confused, his pupils are dilated. He also has tremors, excessive sweating, and grinding of teeth. His heart rate is 118 beats/min, which is regular, and is febrile with a temperature of 38.5°C.
What is the most probable diagnosis?Your Answer: Thyrotoxic crisis
Correct Answer: Serotonin syndrome
Explanation:The most probable diagnosis in this patient is serotonin syndrome.
The serotonin syndrome is a cluster of symptoms and signs (range from barely perceptible tremor to life-threatening hyperthermia and shock).
It may occur when SSRIs such as citalopram, escitalopram, fluoxetine, fluoxetine, paroxetine, and sertraline that impair the reuptake of serotonin from the synaptic cleft into the presynaptic neuron are taken in combination with monoamine oxidase inhibitors or tricyclic antidepressants. It has also been reported following an overdose of selective serotonin reuptake inhibitors (SSRIs) alone.Treatment:
Most cases of serotonin syndrome are mild and will resolve with removal of the offending drug alone.
After stopping all serotonergic drugs, management is largely supportive and aimed at preventing complications.
Patients frequently require sedation, which is best facilitated with benzodiazepines.
Antipsychotics should be avoided because of their anticholinergic properties, which may inhibit sweating and heat dissipation. -
This question is part of the following fields:
- Emergency & Critical Care
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Question 141
Incorrect
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A gentleman arrives at the renal clinic for review. He has long standing chronic renal failure and is unfortunately suffering from metabolic bone disease. His GP has asked for an explanation of the causes and features of metabolic bone disease.
Which of the following best describes the biochemical changes involved?Your Answer: Levels of 1,25-OH vitamin D are increased
Correct Answer: Phosphate excretion is decreased, parathyroid hormone levels are increased and 1,25-OH vitamin D levels are decreased
Explanation:The patient’s chronic renal failure causes decreased renal hydroxylation of vitamin D which leads to decreased calcium absorption in the gut. Simultaneously, there is also decreased renal excretion of phosphate, and this combination of factors results in increased PTH levels.
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This question is part of the following fields:
- Renal System
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Question 142
Incorrect
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A 23-year-old man is being investigated for excessive bleeding following a tooth extraction.
His coagulation profile shows:
Plts: 173 x 10^9/L
PT: 12.9 secs
APTT: 84 secs
Which clotting factor is he most likely deficient in?Your Answer: Factor VI
Correct Answer: Factor VIII
Explanation:The patient is most likely a case of haemophilia A which is the genetic deficiency of clotting factor VIII in blood.
Haemophilia is an X-linked recessive disorder of coagulation. Up to 30% of patients have no family history of the condition. Haemophilia A is more common than haemophilia B and accounts for 90% of the cases. In haemophilia B (Christmas disease), there is a deficiency of clotting factor IX.
Characteristic features of haemophilia include hemarthrosis, haematomas, and prolonged bleeding following trauma or surgery. Coagulation profile of a haemophiliac person shows prolonged bleeding time, activated partial thromboplastin time (APTT), thrombin time (TT), but a normal prothrombin time (PT).
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This question is part of the following fields:
- Haematology & Oncology
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Question 143
Incorrect
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Which is the mechanism of action of trimethoprim?
Your Answer: Cell wall inhibition
Correct Answer: Inhibition of folic acid metabolism
Explanation:Trimethoprim interferes with the action of dihydrofolate reductase and thus inhibits folic acid metabolism and restricts DNA synthesis.
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This question is part of the following fields:
- Pharmacology
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Question 144
Incorrect
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A 71-year-old female presents for investigation of fatigue and weight loss.
Investigations reveal:
Haemoglobin 9.0 g/dL (11.5-16.5)
White cell count 2.0 x109/L (4-11 x109)
Platelet count 250 x109/L (150-400 x109)
Total protein 74 g/L (61-76)
Albumin 28 g/L (37-49)
Urea 16 mmol/L (2.5-7.5)
Creatinine 250 mol/L (60-110)
Plasma glucose 6.5 mmol/L (3.0-6.0)
Urine dipstick analysis: Protein+ & blood+
Renal ultrasound: Normal
Which one of the following investigations would be most appropriate for this patient?Your Answer: Measurement of anti-neutrophil cytoplasmic antibodies (ANCA)
Correct Answer: Plasma protein electrophoresis
Explanation:This patient’s symptoms of anaemia, leukopenia, and elevated non-albumin protein concentration with fatigue and weight loss, point to myeloma. Thus plasma protein electrophoresis or Serum Protein Electrophoresis (SPE) is indicated when there is suspicion of myeloma.
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This question is part of the following fields:
- Renal System
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Question 145
Incorrect
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A 35-year-old female presented with purple stretch marks on her abdomen, easy bruising and weight gain. A low dose Dexamethasone suppression test did not show any but a high dose Dexamethasone suppression test showed suppression of cortisol levels. Which of the following is the most likely cause for this presentation?
Your Answer: Adrenal Adenoma
Correct Answer: Pituitary Adenoma
Explanation:Clinical features are due to excess cortisol. High-dose dexamethasone suppression test shows suppression in patients with Cushing’s disease. Cushing syndrome includes all causes of glucocorticoid excess, whereas Cushing’s disease is reserved only for pituitary-dependent Cushing’s syndrome.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 146
Incorrect
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A 10 month infant was brought in a drowsy condition with a 4 day history of vomiting and diarrhoea. His skin turgor was reduced and skin appeared mottled. Vital signs showed decreased BP, reduced capillary refill and a heart rate of 145/min. The best choice of treatment in this case would be?
Your Answer: Nasogastric rehydration over 24 hours
Correct Answer: IV fluid bolus over 20 minutes
Explanation:According to WHO, the treatment protocol in severely dehydrated children, is to infuse a bolus of isotonic crystalloid over 20-30 min at 30ml/kg to children less than 12 months of age followed by giving the remaining fluid over 5 hours for infants. Reference: World Health Organisation, the treatment of diarrhoea, a manual for physical and senior health workers.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 147
Incorrect
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A 69-year-old man complains of a significant decrease in weight, SOB, chest pain discomfort and cough. Examination results are constricted left pupil and drooping left eyelid. What is the most likely diagnosis?
Your Answer: Pneumonia
Correct Answer: Pancoast tumour
Explanation:Destructive lesions of the thoracic inlet is related to the apical lung cancer called Pancoast tumour, along with the involvement of cervical sympathetic nerves (the stellate ganglion) and brachial plexus which can lead to a Horner’s syndrome
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This question is part of the following fields:
- Respiratory System
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Question 148
Incorrect
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A 28-year-old patient presents with inflammatory bowel disease. 5-ASA would be most appropriate in treating which condition?
Your Answer: Maintenance therapy for Crohn's disease
Correct Answer: Maintenance therapy for ulcerative colitis
Explanation:5-ASA is not an acute treatment; it is for maintenance therapy for ulcerative colitis and/or Crohn’s. The most benefit is seen in patients with ulcerative colitis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 149
Incorrect
-
Patients with myeloma mostly present with which of the following condition when in hospital?
Your Answer: Hyperglycaemia
Correct Answer: Hypercalcaemia
Explanation:Hypercalcemia is the most important finding in all types of malignancies. In myeloma it is especially caused by osteoclast activating factors which increase bone turnover.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 150
Correct
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A 45-year-old male, chronic smoker presented with a 6 month history of a productive cough with blood stained sputum and shortness of breath. The most likely diagnosis would be?
Your Answer: Bronchiectasis
Explanation:Bronchiectasis is characterised by a blood stained productive cough with copious amount of sputum production, along with dyspnoea.
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This question is part of the following fields:
- Respiratory System
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Question 151
Incorrect
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A 27-year-old gentleman presents with a 2 year history of involuntary neck movements. There is no history of trauma. He is on no drugs. There is no relevant family history.
On examination he has an episodic right torticollis. The rest of his neurological examination is normal. MRI of his cervical spine is normal. The neurologist in the Movement Disorders Clinic has diagnosed cervical dystonia.
Which of the following treatments will be most beneficial?Your Answer: Baclofen
Correct Answer: Botulinum toxin
Explanation:Botulinum toxin is a neurotoxic protein from Clostridium botulinum that causes flaccid paralysis as it acts by preventing the release of Ach at the neuromuscular joint. It is the first-line treatment for cervical dystonia (torticollis) because the condition is a neurological disorder characterised by unusual muscle contractions of the neck. With the use of Botulinum toxin, the contractions would be released.
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This question is part of the following fields:
- Nervous System
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Question 152
Incorrect
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A 38-year-old patient with hypertension presented with facial puffiness, ankle oedema, haematuria and frothy urine. Which of the following is a definitive diagnostic test?
Your Answer: Renal function test
Correct Answer: Renal biopsy
Explanation:The history is suggestive of nephritic syndrome. Renal biopsy is the definitive diagnostic test which shows the glomerular pathology.
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This question is part of the following fields:
- Renal System
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Question 153
Incorrect
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An 85-year-old elderly male presents with complaint of worsening breathlessness over the last 2 years. He has a longstanding history of COPD and currently takes salbutamol, ipratropium, salmeterol, beclomethasone and theophylline. FEV1 comes out to be less than 30%. What will be the most suitable next step in the management of this patient?
Your Answer: Trial of non-invasive ventilation
Correct Answer: Assessment for long term O2 therapy
Explanation:Long-term oxygen therapy (LTOT) is the cornerstone mode of treatment in patients with severe chronic obstructive pulmonary disease (COPD) associated with resting hypoxaemia. When appropriately prescribed and correctly used, LTOT has clearly been shown to improve survival in hypoxemic COPD patients. Requirements to proceed to LTOT is the patient should be stable and on appropriate optimum therapy (as in given case) and having stopped smoking tobacco. The patient should be shown to have a PaO2 of less than 7.3 kPa and/or a PaCO2 of greater than 6 kPa on two occasions at least 3 weeks apart. FEV1 should be less than 1.5 litres, and there should be a less than 15% improvement in FEV1 after bronchodilators. Patients with a PaO2 between 7.3 and 8 kPa who have polycythaemia, right heart failure or pulmonary hypertension may benefit from LTOT.
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This question is part of the following fields:
- Respiratory System
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Question 154
Incorrect
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A 32-year-old lady, known with a history of Type 1 diabetes presents to the clinic with increasing tiredness, mild upper abdominal discomfort and itching. The GP has arranged some investigations prior to her clinic visit.
Investigations;
Hb 13.2 g/dl
WCC 5.0 x109/l
PLT 240 x109/l
Na+ 140 mmol/l
K+ 4.9 mmol/l
Creatinine 90 μmol/l
HbA1c 8.3%
Anti-Smooth muscle antibody positive
Immunoglobulins increased
Which of the following would be the next appropriate investigation?Your Answer:
Correct Answer: Liver function testing
Explanation:The key to this question is anti-smooth muscle antibodies. This is a finding of autoimmune hepatitis, which can be seen in type I diabetics. This also fits with her clinical picture. If you know these two facts, you should get every question correct regarding autoimmune hepatitis. Liver function testing is the best answer, then and should be elevated to indicate inflammation of the liver. Hepatic US, CK, thyroid function testing, short synacthen test are not helpful in the diagnosis of autoimmune hepatitis.
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This question is part of the following fields:
- Gastrointestinal System
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Question 155
Incorrect
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A woman is being seen at the clinic. Her clinic notes are missing and the only results available are lung function tests. Her date of birth is also missing from the report.Â
FEV1 0.4 (1.2-2.9 predicted)
Total lung capacity 7.3 (4.4-6.8 predicted)
Corrected transfer factor 3.3 (4.2-8.8 predicted)
Â
Which disease can be suspected From these results?Your Answer:
Correct Answer: Moderate COPD
Explanation: -
This question is part of the following fields:
- Respiratory System
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Question 156
Incorrect
-
A 27-year-old lady presents with severe morning headaches associated with nausea. Head MRI reveals a large compressive tumour arising from the falx cerebri. The tumour is well delineated. What is the most probable diagnosis?
Your Answer:
Correct Answer: Meningioma
Explanation:Meningiomas are the most common benign tumours of the brain. Their name is derived from the fact that they arise from the dura mater which together with the pia matter and arachnoid mater form the meninges. The chances that a meningioma is benign are almost 98%. They are non-invasive and well delineated, causing sign and symptoms of brain compression.
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This question is part of the following fields:
- Nervous System
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Question 157
Incorrect
-
All of the following are true regarding carcinoid syndrome, except?
Your Answer:
Correct Answer: Pharmacological blockade is clinically useful in only 10% of patients
Explanation:For medical management of carcinoid syndrome, there are two somatostatin analogues available, Octreotide and Lanreotide. Somatostatin is an amino acid peptide which is an inhibitory hormone, which is synthesized by paracrine cells located ubiquitously throughout the gastrointestinal tract. Both somatostatin analogues provide symptom relief in 50% to 70% of patients and biochemical response in 40% to 60% patients. Many studies have shown that Octreotide and Lanreotide also inhibit the proliferation of tumour cells.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 158
Incorrect
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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:
Correct 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 159
Incorrect
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A 68-year-old male patient presents with central chest pain and associated flushing. He claims the pain is crushing in character. ECG reveals T wave inversion in II, III and AVF. Blood exams are as follows: Troponin T = 0.9 ng/ml. Which substance does troponin bind to?
Your Answer:
Correct Answer: Tropomyosin
Explanation:Troponin T is a 37 ku protein that binds to tropomyosin, thereby attaching the troponin complex to the thin filament.
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This question is part of the following fields:
- Musculoskeletal System
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Question 160
Incorrect
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A 74-year-old patient presents with back pain, pallor and palpitations. Blood exams reveal multiple plasma cells in the peripheral smear. What is the most likely diagnosis?
Your Answer:
Correct Answer: Multiple myeloma
Explanation:Multiple myeloma presents with bone pain usually in the back or at the level of the ribs. Pathological fractures are common. The patient usually experiences fatigue, paleness, weakness, dyspnoea and gastro-intestinal complaints such as nausea and constipation. Characteristic for this case is the presence of many plasma cells in the peripheral blood smear.
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This question is part of the following fields:
- Haematology & Oncology
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Question 161
Incorrect
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A 16-year-old patient was admitted with walking difficulties and knee pain. Upon examination, his leg is externally rotated and is 2 cm shorter. His ability to flex, abduct and medially rotate his leg is limited and when he flexes his hip, external rotation is increased. What is the most probable diagnosis?
Your Answer:
Correct Answer: Slipped femoral epiphysis
Explanation:The clinical presentation is typical of a slipped femoral epiphysis, which refers to a fracture through the growth plate (physis), resulting in slippage of the overlying end of the femur. It is the most common hip disorder in adolescence. SCFEs usually cause groin pain on the affected side, but sometimes cause knee or thigh pain. The range of motion in the hip is restricted in internal (medial) rotation, abduction, and flexion.
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This question is part of the following fields:
- Musculoskeletal System
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Question 162
Incorrect
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A 44-year-old alcoholic man was operated on for a strangulated abdominal hernia, however a few days after the operation he became agitated. According to the patient, he used to see snakes curling over his body. O/E he was agitated, tachycardiac and confused. The most likely diagnosis would be?
Your Answer:
Correct Answer: Delirium tremens
Explanation:Delirium tremens occurs due to alcohol withdrawal and presents clinically with hallucinations, agitations, confusion and hyperthermia. Wernicke’s encephalopathy is characterised by encephalopathy, oculomotor dysfunction and ataxic gait. In Korsakoff’s syndrome, there is marked short term memory loss, however the long term memory is preserved & the sensorium is also intact.
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This question is part of the following fields:
- Nervous System
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Question 163
Incorrect
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A 72-year-old man presents to the emergency department with dyspnoea and low exercise tolerance. He's known to have a history of ischemic heart disease on medication. Which drug most probably caused his presenting complaint?
Your Answer:
Correct Answer: Diclofenac Sodium
Explanation:Diclofenac sodium is a non-selective reversible and competitive inhibitor of cyclooxygenase (COX), subsequently blocking the conversion of arachidonic acid into prostaglandin precursors. This leads to an inhibition of the formation of prostaglandins that are involved in pain, inflammation and fever. Clinical trials of several COX-2 selective and non-selective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, including myocardial infarction (MI), and stroke, which can be fatal.
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This question is part of the following fields:
- Cardiovascular System
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Question 164
Incorrect
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Cancer of the prostate is associated with which of the following:
Your Answer:
Correct Answer: Exposure to cadmium
Explanation:Risk factors for prostate cancer include:
Black ethnicity
A family history of breast or prostate cancer
High intake of animal fats and low selenium intake
Exposure to radiation or heavy metals including cadmium -
This question is part of the following fields:
- Men's Health
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Question 165
Incorrect
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A 32-year-old patient that has just returned from India, complains of dyspnoea. On examination, you notice grey membranes on the uvula and tonsils and a low-grade fever. What is the most likely diagnosis?
Your Answer:
Correct Answer: Diphtheria
Explanation:Characteristic findings on patients suffering from diphtheria are the grey membrane on the uvula and tonsils together with the low grade fever and dyspnoea. It’s of great importance that the patient has recently been to India where there is a know prevalence.
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This question is part of the following fields:
- Infectious Diseases
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Question 166
Incorrect
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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:
Correct 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 167
Incorrect
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A 55-year-old woman was found to have splenomegaly with her spleen palpable up to the umbilicus. Blood tests revealed the following results: Hb=8.7g/dl, Platelets=72 and WBC=100. What is the most probable diagnosis?
Your Answer:
Correct Answer: Chronic myeloid leukaemia
Explanation:Patients with chronic myeloid leukaemia (CML) can initially be asymptomatic but as the disease progresses, they appear to have elevated WBCs with anaemia and a lower than normal platelet count. The blood test results in addition to the profound splenomegaly, which is the most common finding in patients with CML, make CML the most possible diagnosis.
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This question is part of the following fields:
- Haematology & Oncology
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Question 168
Incorrect
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A 66-year-old man with newly-diagnosed small cell carcinoma discusses his further treatment options with the team of doctors.
Which statement is incorrect about small cell carcinoma?Your Answer:
Correct Answer: Patients with small cell lung cancer always benefit from surgery
Explanation:Small cell lung cancer (SCLC) is characterized by rapid growth and early dissemination. Prompt initiation of treatment is important.
Patients with clinical stage Ia (T1N0) after standard staging evaluation may be considered for surgical resection, but combined treatment with chemotherapy and radiation therapy is the standard of care. Radiation therapy is often added at the second cycle of chemotherapy.
Historically, patients undergoing surgery for small cell lung cancer (SCLC) had a dismal prognosis. However, more recent data suggest that patients with true stage I SCLC may benefit from surgical resection.
Common sites of hematogenous metastases include the brain, bones, liver, adrenal glands, and bone marrow. The symptoms depend upon the site of spread.
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This question is part of the following fields:
- Respiratory System
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Question 169
Incorrect
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A 50-year-old male patient with atrial fibrillation, who was on warfarin came to the clinic with an INR report of 7. Upon questioning it was revealed that he had been started on another drug recently, which was the reason for the prolonged INR. Which of the following drugs cause this?
Your Answer:
Correct Answer: Cimetidine
Explanation:Cimetidine inhibits hepatic microsomal activity, which may cause reduced metabolic clearance of warfarin and augments its anticoagulant effect. Pravastatin doesn’t affect the warfarin metabolism. Other drugs are enzyme inducers which will increase warfarin clearance.
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This question is part of the following fields:
- Pharmacology
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Question 170
Incorrect
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A 42-year-old male has suffered a stroke - he is unable to walk in a straight line and has slurred speech. From the list of options, choose the most appropriate investigation to proceed with.
Your Answer:
Correct Answer: CT scan brain
Explanation:CT scans are used to produce images of the brain. It can be used to detect a stroke from a blood clot or bleeding within the brain.
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This question is part of the following fields:
- Nervous System
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Question 171
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:
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 172
Incorrect
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A patient presented with complaints of difficulty in swallowing, diplopia on left lateral gaze and ptosis of his left eye. The investigation of choice would be?
Your Answer:
Correct Answer: Serum anti-acetylcholine receptor antibodies
Explanation:Myasthenia gravis clinically manifests with ptosis, diplopia and difficulty in swallowing. The initial investigation which is needed to confirm the diagnosis would be serum anti-acetylene receptor antibodies, after which other investigations like an EMG should be done.
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This question is part of the following fields:
- Nervous System
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Question 173
Incorrect
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What are the most common types of transformation seen in patients with polycythaemia vera?
Your Answer:
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 174
Incorrect
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A 19-year-old previously well male presented with abdominal pain and a reduced level of consciousness. On examination he was drowsy, tachypnoeic and dehydrated with dry mucous membranes. His random blood sugar was 17 mmol/l. Which of the following is the most appropriate next step?
Your Answer:
Correct Answer: ABG
Explanation:The most probable diagnosis is diabetic ketoacidosis. ABG is mandatory to look for acidosis and correct pH accordingly.
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 175
Incorrect
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In an emergency bowel procedure, which among these antibiotics are indicated during anaesthetic induction?
Your Answer:
Correct Answer: Metronidazole
Explanation:Antibiotic prophylaxis is utilized to avert infection and is based on the degree of contamination involved in the surgical procedure. Operations where the wound is contained with minimal risk of contamination, antibiotic prophylaxis is questionable. In this case there is a high risk of contamination.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 176
Incorrect
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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.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 177
Incorrect
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Conjugated bilirubin is converted and metabolised into urobilinogen before excretion. This metabolism takes place in which part of the body?
Your Answer:
Correct Answer: Large intestine
Explanation:Unconjugated bilirubin is conjugated to glucuronic acid in the hepatocyte. Conjugated bilirubin passes into the enterohepatic circulation and the bilirubin which evades this system is metabolised by bacteria, primarily in the large intestine, to urobilinogen, then stercobilinogen and eventually oxidised to stercobilin. Stercobilin gives faeces its brown colour.
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This question is part of the following fields:
- Gastrointestinal System
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Question 178
Incorrect
-
Which one of the following is least associated with photosensitivity?
Your Answer:
Correct Answer: Acute intermittent porphyria
Explanation:Sunlight, especially its ultraviolet radiation component, can cause increased or additional types of damage in predisposed individuals, such as those taking certain phototoxic drugs, or those with certain conditions associated with photosensitivity, including:
– Psoriasis
– Atopic eczema
– Erythema multiforme
– Seborrheic dermatitis
– Autoimmune bullous diseases (immunobullous diseases)
– Mycosis fungoides
– Smith-Lemli-Opitz syndrome
– Porphyria cutanea tarda
Also, many conditions are aggravated by strong light, including:
– Systemic lupus erythematosus
– Sjögren’s syndrome
– Sinear Usher syndrome
– Rosacea
– Dermatomyositis
– Darier’s disease
– Kindler-Weary syndrome
Acute intermittent porphyria (AIP) belongs to the group inborn errors of metabolism and most patients with AIP are not light sensitive. -
This question is part of the following fields:
- The Skin
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Question 179
Incorrect
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A 67-year-old butcher presents with a six month history of a gradually increasing burning sensation in his feet. Examination reveals normal cranial nerves and higher mental function. He has normal bulk, tone, power, light touch, pinprick sensation, coordination and reflexes in upper and lower limbs.
These clinical findings are consistent with which of the following?Your Answer:
Correct Answer: Small fibre sensory neuropathy
Explanation:The burning sensation described is typical of a neuropathy affecting the small unmyelinated and thinly myelinated nerve fibres. General neurological examination and reflexes are usually normal in this type of neuropathy unless there is coexisting large (myelinated) fibre involvement. Neuropathy affecting the large myelinated sensory fibres generally causes glove and stocking sensory loss and loss of reflexes.
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This question is part of the following fields:
- Nervous System
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Question 180
Incorrect
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Choose the correct definition regarding the standard error of the mean:
Your Answer:
Correct Answer: Standard deviation / square root (number of patients)
Explanation:The SEM is an indicator of how close the sample mean is to the population mean. In reality, however, only one sample is extracted from the population. Therefore, the SEM is estimated using the standard deviation (SD) and a sample size (Estimated SEM). The SEM computed by a statistical program is an estimated value calculated via this process.
Estimated Standard Error of the Mean (SEM)=SDn?
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This question is part of the following fields:
- Evidence Based Medicine
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Question 181
Incorrect
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A 37-year old female nurse presents with severe generalized itching, claiming that she had previously applied cream to the body of a patient with similar symptoms. What is the mechanism that produces her itch?
Your Answer:
Correct Answer: Allergic reaction
Explanation:Contact dermatitis is a red, itchy rash caused by direct contact with a substance or an allergic reaction to it. The entry of allergen into the epidermis or dermis causes a localized allergic reaction. Local mast-cell activation in the skin leads immediately to a local increase in vascular permeability, which causes extravasation of fluid and swelling. Histamine released by mast cells activated by allergen in the skin causes large, itchy, red swellings of the skin.
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This question is part of the following fields:
- The Skin
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Question 182
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:
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 183
Incorrect
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A 63-year-old woman visits the diabetes clinic for review. She has had type-2 diabetes for 9 years and is now on insulin therapy. She has diabetic nephropathy, as exemplified by hypertension and proteinuria (urinary PCR 155); a recent creatinine level was 205 μmol/l and eGFR 24 ml/min.
Â
Which of the following options best fits her prognosis or management?Your Answer:
Correct Answer: Treatment with ARB or ACE-I may slow further deterioration in renal function
Explanation:Treatment with ARB or ACE-I may slow further deterioration in renal function in this patient, as studies have shown that blocking of the RAS in type 2 diabetic patients improve renal function.
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This question is part of the following fields:
- Renal System
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Question 184
Incorrect
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A team of physicians presented their audit of fluid management for dengue haemorrhagic fever one year ago. A number of recommendations were made at that time and changes were implemented. Which of the following is the most appropriate next step that this team should take?
Your Answer:
Correct Answer: Re-audit
Explanation:Clinical audit is defined as a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. To see whether the recommendations have been implemented, a re-audit has to be performed.
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This question is part of the following fields:
- Ethical & Legal
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Question 185
Incorrect
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Out of the following, which malignant tumour has the highest predilection for dissemination to the bones?
Your Answer:
Correct Answer: Prostate
Explanation:Prostate cancer is the most common primary tumour that metastasises to the bone.
Most common tumours causing bone metastasis (in descending order):
1. Prostate (32%)
2. Breast (22%)
3. Kidneys (16%)
4. Lungs
5. ThyroidMost common sites of bone metastasis (in descending order):
1. Spine
2. Pelvis
3. Ribs
4. Skull
5. Long bones -
This question is part of the following fields:
- Haematology & Oncology
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Question 186
Incorrect
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Around 30 patients have been admitted to the hospital following a suspected chemical attack in the city. The patients are extremely unwell, with symptoms of excessive salivation, lacrimation, diarrhoea, and emesis. Sarin gas was suspected as the most likely agent used in the attack. What is the mechanism of action of this chemical agent?
Your Answer:
Correct Answer: Inhibition of acetylcholinesterase
Explanation:Sarin acts by inhibiting acetylcholinesterase.
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase
Sarin gas is a highly toxic synthetic organophosphorus compound which causes inhibition of the enzyme acetylcholinesterase. This results in high levels of acetylcholine (ACh).The effects of excessive ACh can be remembered by the mnemonic DUMBELLS:
Diarrhoea
Urination
Miosis/muscle weakness
Bronchorrhea/Bradycardia
Emesis
Lacrimation
Salivation/sweatingOrganophosphate insecticide poisoning:
One of the effects of organophosphate poisoning is inhibition of acetylcholinesterase
Features can be predicted by the accumulation of acetylcholine (mnemonic = SLUD)
Salivation
Lacrimation
Urination
Defecation/diarrhoea
cardiovascular: hypotension, bradycardia
miosis, muscle fasciculation.Organophosphate poisoning is treated with the anti-muscarinic atropine.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 187
Incorrect
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A 22 year-old university graduate presented with progressive unsteadiness during walking over the last year. She had been otherwise healthy apart from recent difficulty hearing her lecturer in classes. She took no prescription medication but had occasionally taken cocaine during her first year of college. She also admits to drinking up to 30 units of alcohol per week and smoked 10 cigarettes per day. Her parents were both well, but her father's sister had problems with walking before she died. Examination reveals normal tone and power throughout all four limbs. Reflexes were normal in the upper limbs but decreased at the knees and absent at the ankles. Coordination was normal in all four limbs but her gait was ataxic. Sensation in the upper limbs was normal but decreased vibratory sensation and proprioception was noted to the ankles bilaterally. What is the most likely diagnosis?
Your Answer:
Correct Answer: Friedreich's ataxia
Explanation:Friedreich’s ataxia is an autosomal recessive disorder that usually begins before the end of the teens. It has an estimated prevalence in Europe of 1 in 50,000 and life expectancy is around 40-50 years. Neurological features include a progressive ataxia, cerebellar dysarthria, lower limb areflexia, decreased vibratory sensation and proprioception, and pyramidal weakness. Pes cavus and scoliosis are also both seen. Cardiomyopathy occurs in over 70% of cases. Less common features include optic atrophic, diabetes mellitus, and deafness.
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This question is part of the following fields:
- Nervous System
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Question 188
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 189
Incorrect
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A 28-year-old woman presents with easy bruising. She has no history of mucosal bleeding and is generally well apart from occasional diarrhoea. She has previously attended a psychiatric unit for self-harming behaviour and is now brought in by her mother having consumed a number of pills. Her mother has had recurrent venous thromboses, but there is no family history of a bleeding disorder.
Her full blood count (FBC) is normal, but her coagulation profile shows:
Activated partial thromboplastin time (APTT): 60 secs (28-38 secs)
Prothrombin time (PT): no clot after 120 secs (10-14 secs)
Fibrinogen: 3.6 g/L (2-4 g/L)
What is the most likely explanation?Your Answer:
Correct Answer: Warfarin overdose
Explanation:Warfarin inhibits the vitamin K-dependent procoagulants II, VII, IX, and X as well as anticoagulant protein C and S. It is highly protein-bound and can be displaced by a wide variety of drugs. It has a half-life of 36-48 hours.
Bleeding is the major side effect. Easy bruising, as seen in this case, is commonly seen in patients of warfarin overdose. Grossly prolonged PT and lesser increase in APTT may be seen in such cases.
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This question is part of the following fields:
- Haematology & Oncology
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Question 190
Incorrect
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A 68-year-old male arrives at the clinic complaining of polyuria and nocturia. BMI is noted to be 33 and urine culture is negative for nitrates. Which of the following investigations would be done next in order to establish a diagnosis?
Your Answer:
Correct Answer: Blood sugar
Explanation:This patient is most likely suffering from diabetes mellitus. Diagnosis of DM involves checking for elevated blood glucose levels (hyperglycaemia).
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This question is part of the following fields:
- Endocrine System & Metabolism
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Question 191
Incorrect
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In last 5 days, an old man has complained of severe left sided headache, which was aggravated by bright lights. He has not vomited but feels nauseated. What is the most likely diagnosis?
Your Answer:
Correct Answer: Migraine
Explanation:Migraine without aura have the following characteristics: Nausea and vomiting accompanied by >5 headaches that last for 4-72 hours, plus any unilateral, pulsating headache or are aggravated by routine daily activities.
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This question is part of the following fields:
- Nervous System
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Question 192
Incorrect
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A 64-year-old female presents with sudden onset pain, swelling and stiffness in her right knee. Her medical history is significant for osteoarthritis affecting her hand joints and diet controlled diabetes mellitus. On examination, the right knee is swollen, erythematous and tender. Which of the following tests would be most useful in the diagnosis of this case?
Your Answer:
Correct Answer: Aspiration and examination of the synovial fluid
Explanation:Arthrocentesis should usually be done when there is a suspicion of pseudogout or septic arthritis as in this case which leads to an early diagnosis and prompt treatment. Polarized microscopy demonstrates weakly positively birefringent rhomboid crystals which are blue when parallel to light and yellow when perpendicular to light. Elevated serum uric acid levels that cause gout are usually found after large consumption of alcohol or meat, or post surgery. Autoimmune diseases like SLE, RA etc require an autoimmune screen.
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This question is part of the following fields:
- Musculoskeletal System
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Question 193
Incorrect
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A 27-year-old woman presents with recurrent headaches and sweating. On examination, a nodule is felt in the region of the thyroid gland. She mentions that her mother had kidney stones and died following a tumour in her neck. A surgeon recommends complete thyroidectomy as her treatment of choice.
What is the most important investigation to be done before the surgery?Your Answer:
Correct Answer: 24-hour urinary catecholamines
Explanation:The patient is most likely to have Medullary Thyroid Carcinoma (MTC).
Sporadic, or isolated MTC accounts for 75% of cases and inherited MTC constitutes the rest.
Inherited MTC occurs in association with multiple endocrine neoplasia (MEN) type 2A and 2B syndromes, but non-MEN familial MTC also occurs.
A 24-hour urinalysis for catecholamine metabolites (e.g., vanillylmandelic acid [VMA], metanephrine) has to be done to rule out concomitant pheochromocytoma in patients with MEN type 2A or 2B, as Pheochromocytoma must be treated before MTC. -
This question is part of the following fields:
- Endocrine System & Metabolism
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Question 194
Incorrect
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A 5-month-old baby presents with symptoms of irritability, blood in the stools and vomiting. Examination reveals a rigid abdomen and drawing of knees upon palpation. Which is the most appropriate action you should take for this baby?
Your Answer:
Correct Answer: Refer to paediatric surgeons
Explanation:Intussusception is the most suggested case here based on the child’s symptoms. The urgent course of treatment is to bring the child to a paediatric surgical unit. If air reduction attempts fail, surgery will have to be done. Risk factors for intussusception include viral infection and intestinal lymphadenopathy.
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This question is part of the following fields:
- Emergency & Critical Care
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Question 195
Incorrect
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A 64-year-old woman with metastatic breast cancer has developed progressive back pain over the last 2 days. She also reports of weakness of her lower limbs and difficulty in walking. On examination, she has reduced power in both legs and increased tone associated with brisk knee and ankle reflexes. There is some sensory loss in the lower limbs and feet but perianal sensation is normal.
What is the most likely diagnosis?Your Answer:
Correct Answer: Spinal cord compression at T10
Explanation:The upper motor neurone signs in this patient point towards a diagnosis of spinal cord compression above the level of L1 and rules out cauda equina syndrome.
Spinal cord compression is an oncological emergency and affects up to 5% of cancer patients. Extradural compression accounts for the majority of cases, usually due to vertebral body metastases. One of the most common causes of spinal cord compression is osteoarthritis. It is also more commonly seen in patients with lung, breast, or prostate cancer.
Clinical features include:
1. Back pain: the earliest and most common symptom, may worsen on lying down or coughing
2. Lower limb weakness
3. Sensory changes: sensory loss and numbness
4. Neurological signs: depending on the level of the lesion.
Lesions above L1 usually result in upper motor neurone signs in the legs. Lesions below L1 usually cause lower motor neurone signs in the legs and perianal numbness. Tendon reflexes are increased below the level of the lesion and absent at the level of the lesion.Management options are:
1. High-dose oral dexamethasone
2. Urgent MRI for consideration of radiotherapy or surgery -
This question is part of the following fields:
- Haematology & Oncology
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Question 196
Incorrect
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A 45-year-old man presents with fever, malaise, weight loss and myalgias that have been occurring for a month. You suspect polyarteritis nodosa and arrange for some lab investigations. Which of the following abnormality would most likely be present?
Your Answer:
Correct Answer: Elevated creatinine
Explanation:People with polyarteritis nodosa often exhibit anaemia of chronic disease. Leucocytosis and eosinophilia may also be present. ANCA is only rarely positive. As polyarteritis nodosa affects the kidneys as well, the creatinine is elevated in most cases.
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This question is part of the following fields:
- Musculoskeletal System
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Question 197
Incorrect
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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:
Correct 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 198
Incorrect
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Question 199
Incorrect
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Which the following features is most suggestive of megaloblastic anaemia?
Your Answer:
Correct 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 200
Incorrect
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A 42-year-old female presented with pain in her calves during walking which settled after resting. On examination there were orange colour deposits in the her palmar creases. Her fasting lipid profile showed a total cholesterol of 9.2 mmol/l (<5) and triglycerides of 7.0 mmol/l (<2). Which of the following is the most likely diagnosis?
Your Answer:
Correct Answer: Type III hyperlipidaemia
Explanation:Palmar xanthomas are found in type III hyperlipoproteinemia. Her total cholesterol level and triglyceride level support the diagnosis.
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This question is part of the following fields:
- Cardiovascular System
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