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  • Question 1 - In which of the following is there Growth hormone deficiency (GHD)? ...

    Incorrect

    • In which of the following is there Growth hormone deficiency (GHD)?

      Your Answer: Constitutional short stature

      Correct Answer: Sheehan's syndrome

      Explanation:

      The main cause of growth hormone (GH) deficiency is a pituitary tumour or the consequences of treatment of the tumour including surgery and/or radiation therapy.
      Sheehan’s syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive haemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency.

      Laron syndrome is Insulin-like growth factor I (IGF-I) deficiency due to GH resistance or insensitivity due to genetic disorders of the GH receptor causing GH receptor deficiency.

    • This question is part of the following fields:

      • Endocrinology
      8.1
      Seconds

  • Question 2 - Choose the correct statement regarding hyponatremia: ...

    Incorrect

    • Choose the correct statement regarding hyponatremia:

      Your Answer: Cardiac failure and liver cirrhosis may lead to primary hyperaldosteronism

      Correct Answer: Hyperlipidaemia may cause pseudohyponatraemia

      Explanation:

      The Hyperlipidaemia Effect: Pseudohyponatremia in Pancreatic Cancer; Patients who have disorders of cholestasis commonly present with volume depletion due to vomiting and poor oral intake, which, in turn, often leads to hypovolemic hyponatremia. It is less well known that disorders of cholestasis, including tumours of the hepatobiliary system, can be accompanied by hyperlipidaemia.

    • This question is part of the following fields:

      • Clinical Sciences
      29.4
      Seconds

  • Question 3 - A 31 year old female with systemic lupus erythematosus wants to know if...

    Incorrect

    • 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: Positive HLA–B8

      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.

    • This question is part of the following fields:

      • Rheumatology
      27
      Seconds

  • Question 4 - A 75-year-old lady is referred to hospital from her GP. She has been...

    Incorrect

    • A 75-year-old lady is referred to hospital from her GP. She has been treated for essential hypertension, with Bendroflumethiazide 2.5 mg once daily and triamterene 150 mg once daily.   Routine investigations show: Serum sodium 134 mmol/L (137-144) Serum potassium 5.9 mmol/L (3.5-4.9) Serum urea 7.0 mmol/L (2.5-7.5) Serum creatinine 100 ÎĽmol/L (60-110)   Her blood pressure is measured at 134/86 mmHg. Her electrocardiogram is normal. The GP has stopped the triamterene today.   Which of these is the most appropriate action?

      Your Answer: Give 50% dextrose with 12 units Actrapid insulin IV

      Correct Answer: Repeat urea and electrolytes in one week

      Explanation:

      Triamterene is a potassium-sparing diuretic that can cause hyperkalaemia, therefore, it was stopped in this patient. With all other lab results returning normal values and a normal ECG, management will simply require repeating the U & E after one week since the Triamterene has already be stopped.

    • This question is part of the following fields:

      • Nephrology
      197.9
      Seconds

  • Question 5 - A 35-year-old woman visits you in the paediatric diabetes clinic with her 2-year-old...

    Incorrect

    • A 35-year-old woman visits you in the paediatric diabetes clinic with her 2-year-old son who has recently been diagnosed by type-1 diabetes. He has an identical twin brother and she is concerned about his risk of developing diabetes. What advice would you give regarding his future risk?

      Your Answer:

      Correct Answer: He has a 30–50% future risk of developing type-1 diabetes

      Explanation:

      The frequency of type-1 diabetes is higher in siblings of diabetic parents (e.g., in the UK 6% by age 30) than in the general population (in the U.K. 0.4% by age 30), while disease concordance in monozygotic (identical) twins is about 40% i.e. the risk that the unaffected twin will develop diabetes.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds

  • Question 6 - A 20-year-old male presented to the clinic with a long term history of...

    Incorrect

    • A 20-year-old male presented to the clinic with a long term history of pins and needles sensation in both hands. He also has prognathism. He also gives a history of recent onset right upper quadrant pain after being started on a new medication for his condition. Which of the following medications acting on his endocrine system can be responsible for this adverse effect?

      Your Answer:

      Correct Answer: Octreotide

      Explanation:

      The patient (known case of acromegaly) seems to have developed cholelithiasis (presenting with right upper quadrant pain) probably due to octreotide.

      It is a long-acting analogue of somatostatin which is released from D cells of the pancreas and inhibits the release of growth hormone, glucagon, and insulin.

      Uses
      – Acute treatment of variceal haemorrhage
      – Acromegaly
      – Carcinoid syndrome
      – Prevent complications following pancreatic surgery
      – VIPomas
      – Refractory diarrhoea

      Adverse effects
      Gallstones (secondary to biliary stasis)

      Other options:
      – Bromocriptine – a dopamine agonist with side effects arising from its stimulation of the brain vomiting centre.
      – Desmopressin – predominantly used in patients with diabetes insipidus by increasing the presence of aquaporin channels in the distal collecting duct to increase water reabsorption from the kidneys. The main side effects include headache and facial flushing due to hypertension.
      – Metformin – mainly reduces hepatic gluconeogenesis in patients with type 2 diabetes, common side effects include diarrhoea, vomiting, and lactic acidosis
      – Levothyroxine – synthetic thyroxine used in patients with hypothyroidism, common side effects result from incorrect dosing and mimic the symptoms of hyperthyroidism.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds

  • Question 7 - A 60-year-old man with known ulcerative colitis and diverticular disease comes to clinic...

    Incorrect

    • A 60-year-old man with known ulcerative colitis and diverticular disease comes to clinic complaining of passing faeces per urethra. Cystoscopy confirms a fistula between his bladder and bowel. Which treatment is most likely to be effective?

      Your Answer:

      Correct Answer: surgery

      Explanation:

      The best treatment for a colovesicular fistula is surgery. This is the only definitive treatment. If the patient is a poor surgical candidate, there can be an attempt to manage them non-operatively, but this is absolutely NOT the MOST EFFECTIVE therapy.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds

  • Question 8 - A 11-year-old boy is admitted to the hospital with diarrhoea and lethargy. There...

    Incorrect

    • A 11-year-old boy is admitted to the hospital with diarrhoea and lethargy. There is a known local outbreak of E coli 0157:H7, and his initial bloods show evidence of acute renal failure. Given the likely diagnosis, which one of the following investigation results would be expected?

      Your Answer:

      Correct Answer: Fragmented red blood cells

      Explanation:

      The likely diagnosis in this case is Haemolytic Uremic Syndrome (HUS), which is generally seen in young children presenting with a triad of symptoms, namely: acute renal failure, microangiopathic haemolytic anaemia, and thrombocytopenia. The typical cause of HUS is ingestion of a strain of Escherichia coli. The laboratory results will usually include fragmented RBCs, decreased serum haptoglobin, reduced platelet count, nonspecific WBC changes, and normal coagulation tests (PTT included).

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds

  • Question 9 - Which of the following types of renal stones are said to have a...

    Incorrect

    • Which of the following types of renal stones are said to have a semi-opaque appearance on x-ray?

      Your Answer:

      Correct Answer: Cystine stones

      Explanation:

      Only cystine stones are semi-opaque because they contain sulphur. All the other stones will appear either radio-lucent or radio-opaque.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds

  • Question 10 - A 67 year-old attorney presents with a 2 month history of tremors affecting...

    Incorrect

    • A 67 year-old attorney presents with a 2 month history of tremors affecting his left arm. He suffers from depressive psychosis for the last 10 years, for which he has been receiving intermittent chlorpromazine and amitriptyline but has not been on any therapy for the last 4 months. He describes that his two brothers also had tremors. Upon examination, he has a resting tremor of his left hand with cogwheel rigidity of that arm and mild generalized bradykinesia. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Idiopathic Parkinson’s disease

      Explanation:

      The most likely diagnosis is idiopathic Parkinson’s disease because of the unilateral presentation. In addition, cogwheel rigidity is a classic presenting symptom. Neuroleptic-induced parkinsonism is usually bilateral and symmetrical. Essential tremors do not cause rest tremors.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Endocrinology (0/1) 0%
Clinical Sciences (0/1) 0%
Rheumatology (0/1) 0%
Nephrology (0/1) 0%
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