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  • Question 1 - A 32 year-old active male presents with a three month history of pain...

    Correct

    • A 32 year-old active male presents with a three month history of pain in his feet and lower legs. He was previously diagnosed with diabetes at age 14 and treated with insulin. He admits to drinking 30 units of alcohol per week and is a current cannabis smoker. On examination, pain and temperature sensation in his feet are diminished, but joint position and vibratory sensation appear normal. What is the most likely diagnosis?

      Your Answer: Diabetic polyneuropathy

      Explanation:

      The given history suggests a small fibre painful peripheral sensory neuropathy, the most common cause of which is diabetes. Joint position sense and vibratory sensation are carried through large fibres, and therefore are not currently affected. Sensory nerves are affected more often than motor, so reflexes usually remain in tact.

      Vitamin B12 deficiency causes impairment of joint position and vibratory sensation.

      Chronic inflammatory demyelinating polyneuropathy (CIPD) causes a large fibre peripheral neuropathy with areflexia.

      In syringomyelia there is impaired pain and temperature noted in the upper limbs.

      Finally, with alcoholic polyneuropathy, all fibre types are affected (sensory and motor loss). It is usually gradual with long term alcohol abuse and may be accompanied by a nutritional deficiency. In addition, pain is a more dominant feature.

    • This question is part of the following fields:

      • Neurology
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  • Question 2 - Where is the site of action of spironolactone? ...

    Incorrect

    • Where is the site of action of spironolactone?

      Your Answer:

      Correct Answer: Distal convoluted tubule

      Explanation:

      Spironolactone is an aldosterone antagonist which acts in the distal convoluted tubule. It is a potassium-sparing diuretic that prevents the body from absorbing too much salt and keeps the potassium levels from getting too low. Spironolactone is used to treat heart failure, high blood pressure (hypertension), or hypokalaemia (low potassium levels in the blood).

    • This question is part of the following fields:

      • Pharmacology
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  • Question 3 - Which one of the following is most suggestive of Wilson’s disease? ...

    Incorrect

    • Which one of the following is most suggestive of Wilson’s disease?

      Your Answer:

      Correct Answer: Reduced serum caeruloplasmin

      Explanation:

      In Wilson’s disease, serum caeruloplasmin is decreased. Skin pigmentation is not increased, but may become jaundiced. 24 hour urine copper excretion is increased. Hepatic copper concentration is increased. Serum copper level is also increased. Key point: high copper. Remember Kayser-Fleisher rings for the eyes in Wilson’s disease.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 4 - A 34-year-old male patient is admitted with hemisection of the spinal cord at...

    Incorrect

    • A 34-year-old male patient is admitted with hemisection of the spinal cord at the level T5, after being stabbed in the back. Which sign would you expect to see by assessing the patient's sensory function and muscle strength?

      Your Answer:

      Correct Answer: Contralateral loss of temperature, ipsilateral loss of fine touch and vibration, ipsilateral spastic paresis

      Explanation:

      Depending on the level of SCI, patients experience paraplegia or tetraplegia. Paraplegia is defined as the impairment of sensory or motor function in lower extremities. Patients with incomplete paraplegia generally have a good prognosis in regaining locomotor ability (,76% of patients) within a year. Complete paraplegic patients, however, experience limited recovery of lower limb function if their NLI is above T9. The spinothalamic tract is the one responsible for sensory information such as pain or temperature. However, it decussates at the same level the nerve root enters the spinal cord, meaning that the sensory loss will be contralateral. However, the dorsal column carries sensory fibres for fine touch and vibration and it decussates at the medulla which means that the sensory loss will be ipsilateral. The corticospinal tract is responsible for motor functions and it decussates at the medulla, meaning that the motor function loss will be ipsilateral.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 5 - A 32 year old man presents with blistering and hyperpigmentation on his face...

    Incorrect

    • A 32 year old man presents with blistering and hyperpigmentation on his face and hands, after a beach holiday with friends. Tests reveal high levels of uroporphyrinogen in the urine. The most likely diagnosis is:

      Your Answer:

      Correct Answer: Porphyria cutanea tarda

      Explanation:

      Porphyria cutanea tarda (PCT) is the most common of the porphyries. It is characterised by fragility and blistering of exposed skin. Typically, patients who are ultimately diagnosed with PCT first seek treatment following the development photosensitivities in the form of blisters and erosions on commonly exposed areas of the skin. This is usually observed in the face, hands, forearms, and lower legs. It heals slowly and with scarring. Though blisters are the most common skin manifestations of PCT, other skin manifestations like hyperpigmentation (as if they are getting a tan) and hypertrichosis (mainly on top of the cheeks) also occur. Risk factors for the development of PCT include alcohol and sun.

    • This question is part of the following fields:

      • Dermatology
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  • Question 6 - A 30-year-old man with type-1 diabetes mellitus on insulin presents in the A&E...

    Incorrect

    • A 30-year-old man with type-1 diabetes mellitus on insulin presents in the A&E with fever, cough, vomiting and abdominal pain. Examination reveals a dry mucosa, decreased skin turgor and a temperature of 37.8 °C. Chest examination reveals bronchial breathing in the right lower lobe, and a chest X-ray shows it to be due to a right lower zone consolidation. Other investigations show: Blood glucose: 35 mmol/L, Na+: 132 mmol/L, K+: 5.5 mmol/L, urea: 8.0 mmol/L, creatinine: 120 μmol/L, pH: 7.15, HCO3: 12 mmol/L, p(CO2): 4.6 kPa, chloride: 106 mmol/l. Urinary ketones are positive (+++). The patient is admitted to the hospital and treated. Which of the following should not be used while treating him?

      Your Answer:

      Correct Answer: Bicarbonate

      Explanation:

      Bicarbonate therapy is not indicated in mild and moderate forms of DKA because metabolic acidosis will correct with insulin therapy. The use of bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies. It is thought that the administration of bicarbonate may actually result in peripheral hypoxemia, worsening of hypokalaemia, paradoxical central nervous system acidosis, cerebral oedema in children and young adults, and an increase in intracellular acidosis. Because severe acidosis is associated with worse clinical outcomes and can lead to impairment in sensorium and deterioration of myocardial contractility, bicarbonate therapy may be indicated if the pH is 6.9 or less.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - Which one of the following is most associated with the development of acute...

    Incorrect

    • Which one of the following is most associated with the development of acute pancreatitis?

      Your Answer:

      Correct Answer: Hyperchylomicronaemia

      Explanation:

      Hyperchylomicronaemia is an increase (markedly) in chylomicrons, and this can cause acute pancreatitis, as well as xanthomas. It can be seen in familial lipoprotein lipase (LPL) deficiency, primary type V hyperlipoproteinemia, idiopathic hyperchylomicronaemia, and familial apolipoprotein CII deficiency. Treatment is dietary fat restriction in order to avoid pancreatitis attacks.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 8 - A 65 yr. old male patient admitted with myocardial infarction received thrombolysis, which...

    Incorrect

    • A 65 yr. 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:

      Correct 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.

    • This question is part of the following fields:

      • Cardiology
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  • Question 9 - Which selective serotonin reuptake inhibitors listed below has the highest incidence of discontinuation...

    Incorrect

    • Which selective serotonin reuptake inhibitors listed below has the highest incidence of discontinuation symptoms?

      Your Answer:

      Correct Answer: Paroxetine

      Explanation:

      A couple of papers written by the same authors indicate that children and adolescents taking an SSRI definitely experience discontinuation reactions that can be mild, moderate or severe when the medication is stopped suddenly or high doses are reduced substantially. Among the SSRIs paroxetine seems to be the worst offender and fluoxetine the least while sertraline and fluvoxamine tend to be intermediate. The rate of discontinuation syndrome varies with the particular SSRI involved. It is generally quoted as 25% but is higher for SSRIs with shorter half-lives. Paroxetine has been associated with more frequent discontinuation symptoms than the other SSRIs.

      The use of fluoxetine with its long half-life appears safer in this respect than paroxetine and venlafaxine causing the most concerns.

      Paroxetine has the shortest half-life with 21 hours of all listed SSRIs and as such it would be expected to have a higher incidence or severity (greater number of symptoms) and fluoxetine would have the least since it has a half life of 96 hours. Citalopram has a half-life of 35 hours while escitalopram has a half-life of 30 hours.

      The most common symptoms reported are: dizziness, light-headedness, drowsiness, poor concentration, nausea, headache and fatigue.
      Another common symptom in adults is paraesthesia described as burning, tingling, numbness or electric shock feelings usually in the upper half of the body or proximal lower limbs.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 10 - From the following responses, what is the commonest cardiovascular abnormality associated with Marfan's...

    Incorrect

    • From the following responses, what is the commonest cardiovascular abnormality associated with Marfan's syndrome of an adult?

      Your Answer:

      Correct Answer: Aortic root dilatation

      Explanation:

      The main cardiovascular manifestations associated with Marfan’s syndrome are aortic dilatation and mitral valve prolapse.

    • This question is part of the following fields:

      • Cardiology
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  • Question 11 - A 20 year old male student presents to the clinic with swelling of...

    Incorrect

    • A 20 year old male student presents to the clinic with swelling of his face, hands and feet along with diffuse abdominal pain. He has a history of similar recurrent episodes since he was 10 years old, with each episode lasting 2-3 days. Examination reveals swelling on face, hands, feet but no sign of urticaria. Family history is significant for similar episodes in the mother who experienced these since childhood, and a brother who passed away following respiratory distress at age of 8 during one such episode. Which of the following tests would be the most helpful in reaching the diagnosis?

      Your Answer:

      Correct Answer: C1 esterase inhibitor

      Explanation:

      Hereditary C1 inhibitor deficiency leads to recurrent angioedema without urticaria or pruritus. Physical triggers include dental work, surgery or intubation. Medical triggers include angiotensin-converting enzyme (ACE) inhibitor, tamoxifen, oestrogen-containing medications (e.g., hormone replacement therapy and oral contraceptives). It is diagnosed on the basis of low levels of C1 esterase inhibitor or elevated levels of dysfunctional C1 esterase inhibitor. C4 levels are low between attacks. IgE levels, eosinophils, skin prick tests and RASTs are helpful in other allergic conditions and asthma but not of use in this case.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 12 - A 55-year-old female with a history of osteoarthritis of the knee, obesity and...

    Incorrect

    • A 55-year-old female with a history of osteoarthritis of the knee, obesity and depression, presents with neck and right arm pain. She claims that the pain is present for two months and is triggered by flexing her neck. Clinical examination reveals sensory loss over the middle finger and palm of the hand without any obvious muscle atrophy or weakness. Which nerve root is most probably affected?

      Your Answer:

      Correct Answer: C7

      Explanation:

      The most common cause of cervical radiculopathy is degenerative disease in the cervical spine. In 80–90% of patients with cervical radiculopathy, the C5/C6 or C6/C7 motion segments are affected by degenerative disease and the nearby C6 and/or C7 nerve roots are producing the symptoms. Patients with cervical radiculopathy complain of neck pain and radiating pain in the arm sometimes combined with sensory and motor disturbances in the arm and/or hand. These symptoms are accepted as being caused by the nerve root compression. Middle finger and palm of the hand are mostly rising the suspicion for C7 nerve root and median nerve involvement.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 13 - Which of the following nail changes are present in ulcerative colitis? ...

    Incorrect

    • Which of the following nail changes are present in ulcerative colitis?

      Your Answer:

      Correct Answer: Clubbing

      Explanation:

      Clubbing of the fingers can be present in many clinical conditions like CLD, bronchiectasis, lung abscess, Ulcerative colitis and Crohn’s Disease.

      Koilonychia or spoon shaped nails are a typical finding in iron deficiency anaemia.

      Splinter haemorrhages are pin point haemorrhages found in infective endocarditis and secondary to trauma.

      Yellow nails are present in pulmonary and renal disease.

    • This question is part of the following fields:

      • Dermatology
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  • Question 14 - A 11-year-old boy is referred to you following his seventh course of antibiotics...

    Incorrect

    • A 11-year-old boy is referred to you following his seventh course of antibiotics in the last six years for lower respiratory tract infections. He also has a history of eczema for which he is currently on a topical steroid cream. His full blood count (FBC) report shows: Hb: 13.9 g/dL, Plts: 65 x 10^9/L, WCC: 12.3 x 10^9/L. Which of the following genes should you expect an abnormality in?

      Your Answer:

      Correct Answer: WASP

      Explanation:

      The combination of frequent infections, eczema, and thrombocytopaenia are characteristic of Wiskott-Aldrich syndrome, which is due to an abnormality in the WASP gene. It is an X-linked recessive disorder that causes primary immunodeficiency owing to a combined B- and T-cell dysfunction.

      The other listed options are:
      1. PKD1: polycystic kidney disease
      2. CFTR: cystic fibrosis
      3. HFE1: haemochromatosis
      4. RET: multiple endocrine neoplasia, Hirschsprung’s disease

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 15 - A 24-year-old man was hit on the lateral aspect of his head by...

    Incorrect

    • A 24-year-old man was hit on the lateral aspect of his head by a high velocity cricket ball and lost consciousness immediately. Paramedics found him to have a Glasgow coma score of 15 but take him to the A&E for further investigation. His Glasgow coma score on examination in the A&E is 13 (M5, V4, E4) and he has anterograde and retrograde amnesia to recent events. The doctors arrange an urgent CT scan. Which clinical sign would be most concerning if present?

      Your Answer:

      Correct Answer: Bradycardia

      Explanation:

      Intracranial pressure (ICP) is a complex brain modality that determines cerebral perfusion pressure (CPP), which is the difference between arterial blood pressure (ABP), and ICP. Raised ICP reduces CPP and blood delivery to the brain. This jeopardizes cerebral function and organismal survival in many species. A massive rise in ICP is also known to produce an increase in ABP, bradycardia and respiratory irregularities termed Cushing response. This mechanism is generally considered to be an agonal and terminal event occurring in extreme condition of brainstem ischaemia leading to a sympatho-adrenal response.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 16 - A 36 year old female who has been suffering from depression for the...

    Incorrect

    • A 36 year old female who has been suffering from depression for the past 5 years was recently admitted to the psychiatric intensive care unit. She is currently being managed on Sertraline. In clinic she was observed to be sitting in a fixed position for several hours, awake but unable to move. What would be an appropriate treatment for this patient?

      Your Answer:

      Correct Answer: ECT

      Explanation:

      Catatonia is a state of apparent unresponsiveness to external stimuli and apparent inability to move normally in a person who is apparently awake. Catatonia can be acute and occur in severely ill patients with underlying psychiatric or other medical disorders.

      A history of behavioural responses to others usually includes the presence of the following:
      – Mutism (absence of speech)
      – Negativism (performing actions contrary to the commands of the examiner)
      – Echopraxia (repeating the movements of others)
      – Echolalia (repeating the words of others)
      – Waxy flexibility (slight, even resistance to positioning by examiner)
      – Withdrawal (absence of responses to the environment).

      In the presence of a catatonic state, both first and second generation antipsychotics (SGA) may contribute to maintaining or worsening the catatonic state and increase the risk of developing NMS (neuroleptic malignant syndrome).

      Electroconvulsive therapy (ECT) is effective in all forms of catatonia, even after pharmacotherapy with benzodiazepines has failed. Response rate ranges from 80% to 100% and results superior to those of any other therapy in psychiatry. ECT should be considered first-line treatment in patients with malignant catatonia, neuroleptic malignant syndrome, delirious mania or severe catatonic excitement, and in general in all catatonic patients that are refractory or partially responsive to benzodiazepines. Early intervention with ECT is encouraged to avoid undue deterioration of the patient’s medical condition.

      Electroconvulsive therapy (ECT) is a procedure, done under general anaesthesia, in which small electric currents are passed through the brain, intentionally triggering a brief seizure. ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 17 - A 20-year-old woman presents to casualty with flank pain and a 48 hour...

    Incorrect

    • A 20-year-old woman presents to casualty with flank pain and a 48 hour history of dysuria. Her past medical history includes polycystic ovarian syndrome. She is not in a steady relationship at present. There is haematuria and proteinuria on urine dipstick testing. Examination reveals a pyrexia of 38.1 °C and flank pain. What diagnosis fits best with this clinical picture?

      Your Answer:

      Correct Answer: Pyelonephritis

      Explanation:

      The patient presents with flank pain and fever with haematuria and proteinuria associated with a social history of not being in a steady relationship. This patient is a young presumably sexually active female, so the diagnosis is most likely pyelonephritis which has an increased incidence in young sexually active women or men of >50 years of age.

    • This question is part of the following fields:

      • Nephrology
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  • Question 18 - A 35 year old soldier presented with a painless, erythematous crusted plaque over...

    Incorrect

    • A 35 year old soldier presented with a painless, erythematous crusted plaque over the dorsum of his hand, after serving in a hilly area of Columbia for 2 months. The most likely diagnosis will be?

      Your Answer:

      Correct Answer: Leishmaniasis

      Explanation:

      The chief presentation in Leishmaniasis is a non healing, ulcerated, painless and non pruritic plaque, which does not respond to oral antibiotics. It can be classified into cutaneous and visceral forms and is caused by the sand fly. It is more prevalent in the hilly areas. Fusobacterium causes a tropical ulcer which is painful and shallow, while Troanasomiasis causes sleeping sickness.

    • This question is part of the following fields:

      • Dermatology
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  • Question 19 - Which one of the following statements best describes a type II statistical error?...

    Incorrect

    • Which one of the following statements best describes a type II statistical error?

      Your Answer:

      Correct Answer: The null hypothesis is accepted when it is false

      Explanation:

      In statistical hypothesis testing there are 2 types of errors:
      – type I: the null hypothesis is rejected when it is true – i.e. Showing a difference between two groups when it doesn’t exist, a false positive.
      – type II: the null hypothesis is accepted when it is false – i.e. Failing to spot a difference when one really exists, a false negative.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 20 - A 28 year old man presents to the clinic with fatigue, exertional dyspnoea,...

    Incorrect

    • A 28 year old man presents to the clinic with fatigue, exertional dyspnoea, abdominal discomfort, xerophthalmia and xerostomia. Examination reveals enlargement of the parotid glands bilaterally, hepatomegaly and peripheral motor neuropathy. Lab results are negative for RF, ANA, SS-A and SS-B antibodies. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Diffuse infiltrative lymphocytic syndrome (DILS)

      Explanation:

      The Diffuse Infiltrative Lymphocytosis Syndrome (DILS) is a rare multisystemic syndrome described in HIV-infected patients. It is characterised by CD8(+) T-cell lymphocytosis associated with a CD8(+) T-cell infiltration of multiple organs. DILS is usually seen in uncontrolled or untreated HIV infection but can also manifest itself independently of CD4(+) T-cell counts. The syndrome may present as a Sjögren-like disease that generally associates sicca signs with bilateral parotiditis, lymphadenopathy, and extra glandular organ involvement. The latter may affect the lungs, nervous system, liver, kidneys, and digestive tract. Anomalies of the respiratory system are often identified as lymphocytic interstitial pneumonia. Facial nerve palsy, aseptic meningitis or polyneuropathy are among the more frequent neurological features. Hepatic lymphocytic infiltration, lymphocytic interstitial nephropathy and digestive tract lymphocytic infiltration account for more rarely noted complications. Sicca syndrome, organomegaly and/or organ dysfunction associated with polyclonal CD8(+) T-cell organ-infiltration are greatly suggestive of DILS in people living with HIV.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 21 - A 23-year-old female known with schizophrenia is being reviewed in the emergency department....

    Incorrect

    • A 23-year-old female known with schizophrenia is being reviewed in the emergency department. Her mother claims that she has been 'staring' for the past few hours but has now developed abnormal head movements and has gone 'cross-eyed'. On examination, the patient's neck is extended and positioned to the right. Her eyes are deviated upwards and are slightly converged. Given the likely diagnosis, what is the most appropriate treatment?

      Your Answer:

      Correct Answer: Procyclidine

      Explanation:

      The most probable diagnosis in this patient is an oculogyric crisis, that is most appropriately managed with procyclidine or benztropine (antimuscarinic).

      An oculogyric crisis is a dystonic reaction to certain drugs or medical conditions.

      Features include:
      Restlessness, agitation
      Involuntary upward deviation of the eyes

      Causes:
      Phenothiazines
      Haloperidol
      Metoclopramide
      Postencephalitic Parkinson’s disease

      Management:
      Intravenous antimuscarinic agents like benztropine or procyclidine, alternatively diphenhydramine or ethopropazine maybe used.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 22 - Which of the following stimulates the secretion of gastrin? ...

    Incorrect

    • Which of the following stimulates the secretion of gastrin?

      Your Answer:

      Correct Answer: Amino acids

      Explanation:

      Gastrin is released from G cells in the antrum of the stomach after a meal. It stimulates parietal cells to release HCl. Gastrin is stimulated by a number of things: antrum distention, vagal stimulation, peptides (especially amino acids) in the stomach, hypercalcemia. Gastrin release is inhibited by acid, SST, GIP, VIP, secretin, glucagon, and calcitonin.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 23 - A 32-year-old woman was diagnosed with Hodgkin disease 8 years ago. She was...

    Incorrect

    • A 32-year-old woman was diagnosed with Hodgkin disease 8 years ago. She was treated with radiotherapy which led to complete remission. What is the most likely long-term risk of radiotherapy?

      Your Answer:

      Correct Answer: Secondary cancer

      Explanation:

      The major delayed problem with radiotherapy is the development of secondary cancers. This risk begins to appear ten years after therapy.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 24 - A 74-year-old man presents with left-sided lower abdominal pain. He is obese and...

    Incorrect

    • A 74-year-old man presents with left-sided lower abdominal pain. He is obese and admits to a dislike of high fibre foods. The pain has been grumbling for the past couple of weeks and is partially relieved by defecation. He has suffered intermittent diarrhoea.   Blood testing reveals a neutrophilia, and there is also a microcytic anaemia. Barium enema shows multiple diverticula, more marked on the left-hand side of the colon.   Which diagnosis fits best with this clinical picture?

      Your Answer:

      Correct Answer: Diverticular disease

      Explanation:

      Given that he has diverticula in the clinical scenario combined with his presenting symptoms, it is likely that he has diverticular disease. A low fibre diet would support this diagnosis. Acute diverticulitis would require treatment with antibiotics. Depending on the severity (Hinchey classification) would determine if he needs oral or IV antibiotics, hospital admission or outpatient treatment. Sometimes abscesses or micro perforations occur, which typical require drainage and possibly surgical intervention. Diverticular disease is clearly a better answer than other possible answer choices, simply based on the symptoms presented in the prompt (and mention of low fibre).

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 25 - Which is the most common chromosomal defect in Down's syndrome? ...

    Incorrect

    • Which is the most common chromosomal defect in Down's syndrome?

      Your Answer:

      Correct Answer: Non-dysjunction

      Explanation:

      Nondisjunction of chromosome 21 is the leading cause of Down syndrome. Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 26 - A 28-year-old woman is evaluated in the endocrinology clinic for increased urine output....

    Incorrect

    • 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 650 mOsm/kg. Subsequent injection of subcutaneous DDAVP (desmopressin acetate) did not result in a further significant rise of urine osmolality after 2 hours (655 mOsm/kg). Which of the following is the most likely diagnosis?

      Your Answer:

      Correct 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, water deprivation results in an increase in urine osmolality, anywhere between 300 – 800 mOsm/Kg (usually up to 600 – 700 mOsm/Kg), without a substantial increase in plasma osmolality, but the increase in urine osmolality is not as substantial as in a normal response.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 27 - A 49-year-old female is admitted to the hospital with shortness of breath and...

    Incorrect

    • A 49-year-old female is admitted to the hospital with shortness of breath and pleuritic chest pain. She also complains of loss of appetite for the past four months. Her admission CXR shows right-sided pleural effusion. An underlying malignancy is suspected and a series of tumour markers are requested, the results of which are: CA 19-9: 36 IU/mL (<40), CA 125: 654 IU/ml (<30), CA 15-3: 9 IU/ml (<40). What is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Ovarian fibroma

      Explanation:

      The patient has Meigs syndrome. Meigs syndrome is defined as a triad of benign ovarian tumour with ascites and pleural effusion that resolves after resection of the tumour. Ovarian fibromas constitute the majority of the benign tumours seen in Meigs syndrome.

      Tumour markers can be divided into:
      1. Monoclonal antibodies
      CA 125: Ovarian cancer, primary peritoneal cancer
      CA 19-9: Pancreatic cancer
      CA 15-3: Breast cancer

      2. Tumour specific antigens
      Prostate specific antigen (PSA): Prostatic carcinoma
      Alpha-feto protein (AFP): Hepatocellular carcinoma, teratoma
      Carcinoembryonic antigen (CEA): Colorectal cancer
      S-100: Melanoma, schwannomas
      Bombesin: Small cell lung carcinoma, gastric cancer

      3. Enzymes
      Alkaline phosphatase (ALP)
      Neuron specific enolase (NSE)

      4. Hormones
      Calcitonin
      Antidiuretic hormone (ADH)
      Human chorionic gonadotropin (hCG)

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 28 - Which of the following enzymes are involved in Phase I drug metabolism? ...

    Incorrect

    • Which of the following enzymes are involved in Phase I drug metabolism?

      Your Answer:

      Correct Answer: Alcohol dehydrogenase

      Explanation:

      Drug metabolism can be broadly classified into:
      Phase I (functionalization) reactions: also termed non-synthetic reactions, they include oxidation, reduction, hydrolysis, cyclization and de-cyclization. The most common and vital reactions are oxidation reactions. (Of the given enzymes only Alcohol dehydrogenase is involved in phase I drug metabolism. Succinate dehydrogenase, is a vital enzyme involved in the Kreb’s cycle and the mitochondrial electron transport chain). They are mainly catalysed by Cytochrome P-450 enzyme.

      Phase II (conjugation) reactions: occur following phase I reactions, they include reactions: glucuronidation and sulphate conjugation, etc. They are mostly catalysed by UDP-glucuronosyltransferase enzyme. Other phase II enzymes include: sulfotransferases, N-acetyltransferases, glutathione S-transferases and methyltransferases.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 29 - A 35 year old patient presented with a cough, wheezing and difficulty in...

    Incorrect

    • 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:

      Correct Answer: Eczema

      Explanation:

      The skin lesion is most probably eczema. It is common among atopic people. Asthma is a common association.

    • This question is part of the following fields:

      • Dermatology
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  • Question 30 - A 60 year old man who has been complaining of increasing shortness of...

    Incorrect

    • A 60 year old man who has been complaining of increasing shortness of breath had a post-bronchodilator spirometry done. FEV1/FVC 0. 63 FEV1% predicted 63% What is the best interpretation of these results?

      Your Answer:

      Correct Answer: COPD (stage 2 - moderate)

      Explanation:

      Chronic obstructive pulmonary disease (COPD) is a complex and progressive chronic lung disease. Typically, COPD includes emphysema and chronic bronchitis. COPD is characterized by the restriction of airflow into and out of the lungs. The obstruction of airflow makes breathing difficult. The causes of COPD include smoking, long-term exposure to air pollutants and a rare genetic disorder.

      The Global Initiative for Chronic Obstructive Lung Disease (GOLD) developed the GOLD Staging System. In the GOLD System, the forced expiratory volume in one second (FEV1) measurement from a pulmonary function test is used to place COPD into stages. Often, doctors also consider your COPD symptoms.

      COPD has four stages. The stages of COPD range from mild to very severe. COPD affects everyone differently. Because COPD is a progressive lung disease, it will worsen over time.
      The Stages of COPD:
      Mild COPD or Stage 1—Mild COPD with a FEV1 about 80 percent or more of normal.
      Moderate COPD or Stage 2—Moderate COPD with a FEV1 between 50 and 80 percent of normal.
      Severe COPD or Stage 3—Severe emphysema with a FEV1 between 30 and 50 percent of normal.
      Very Severe COPD or Stage 4—Very severe or End-Stage COPD with a lower FEV1 than Stage 3, or people with low blood oxygen levels and a Stage 3 FEV1.

      This patient has a FEV1 percent of 63 which falls within the stage 2 or moderate COPD.

    • This question is part of the following fields:

      • Respiratory
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