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  • Question 1 - A 21-year-old gentleman presents with facial and ankle swelling. This has slowly been...

    Incorrect

    • A 21-year-old gentleman presents with facial and ankle swelling. This has slowly been developing over the past week. During the review of systems, he describes passing ‘frothy’ urine. A urine dipstick shows protein +++.
       
      What is the most likely cause of this presentation?

      Your Answer:

      Correct Answer: Minimal change disease

      Explanation:

      Minimal change glomerulonephritis usually presents as nephrotic syndrome wherein the patient (usually a young adult) will present with proteinuria, oedema, and impaired kidney function, which were evident in this patient.

    • This question is part of the following fields:

      • Nephrology
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  • Question 2 - A 30-year-old female is brought by her concerned mother. The patient reports that...

    Incorrect

    • A 30-year-old female is brought by her concerned mother. The patient reports that the president is secretly in love with her, despite the fact that there has never been any contact between them. What is the probable psychiatric condition from which the patient is suffering from?

      Your Answer:

      Correct Answer: De Clerambault's syndrome

      Explanation:

      The most probable diagnosis in this patient is De Clerambault’s syndrome, also known as erotomania, which is a form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.

      Other options:
      – Bouffée délirante is an acute psychotic disorder in which hallucinations, delusions or perceptual disturbances are obvious but markedly variable, changing from day to day or even from hour to hour.
      – Fregoli delusion is the mistaken belief that some people currently present in the deluded person’s environment (typically a stranger) is a familiar person in disguise.
      – Capgras delusion is the belief that significant others have been replaced by impostors, robots or aliens.
      – Couvade is the common but poorly understood phenomenon whereby the expectant father experiences somatic symptoms during the pregnancy for which there is no recognized physiological basis.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 3 - A 70 year old female presented with throbbing and continuous headache and loss...

    Incorrect

    • A 70 year old female presented with throbbing and continuous headache and loss of vision. Her ESR was elevated. Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer:

      Explanation:

      Giant Cell Arteritis (Temporal Arteritis) is the most probable diagnosis. GCA should always be considered in the differential diagnosis of a new-onset headache in patients 50 years of age or older with an elevated erythrocyte sedimentation rate. Temporal artery biopsy remains the criterion standard for diagnosis of this granulomatous vasculitis. High-dose corticosteroid therapy is the universally accepted treatment.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 4 - A 40-year-old man has had multiple blood transfusions for sideroblastic anaemia. However, this...

    Incorrect

    • A 40-year-old man has had multiple blood transfusions for sideroblastic anaemia. However, this time, 15 minutes into the blood transfusion, he complains of severe breathlessness. CXR shows diffuse bilateral pulmonary infiltrates.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer:

      Explanation:

      Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion characterised by the acute onset of non-cardiogenic pulmonary oedema following transfusion of blood products.

      TRALI is a more severe manifestation of the febrile non-haemolytic group of transfusion reactions and usually occur in patients who have had multiple previous transfusions. TRALI is related to leucocyte antibodies which are present in the plasma of the blood donor. Multiparous women are the highest-risk donors for TRALI.

      For management, leucocyte-depleted blood is now used for transfusion and this is associated with a reduced risk of this type of transfusion reaction.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 5 - A 20-year-old student nurse was admitted after her third collapse in recent months....

    Incorrect

    • A 20-year-old student nurse was admitted after her third collapse in recent months. She was noted to have a blood sugar of 0.9 mmol/l on finger-prick testing and responded well to intravenous glucose therapy.
      Venous blood taken at the same showed a markedly raised insulin level, but her C-peptide levels were normal.

      What diagnosis fits best with this clinical picture?

      Your Answer:

      Correct Answer: Self-administration of a short-acting insulin

      Explanation:

      The patient has hyperinsulinemia and hypoglycaemia, but her C-peptide levels are normal. This is strongly suggestive of the fact that she is self-administering insulin.
      In Insulinoma, common diagnostic criteria include:
      – blood glucose level < 50 mg/dl with hypoglycaemic symptoms,
      – relief of symptoms after eating
      – absence of sulfonylurea on plasma assays.
      The classic diagnostic criteria include the demonstration of the following during a supervised fast:
      Increased plasma insulin level
      Increased C peptide level
      Increased proinsulin level
      However, the patient has normal C-peptide levels.
      In type-1 diabetes mellitus, insulin and C-peptide levels are low.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 6 - A 50 yr. old male patient with schizophrenia complained of chest pain and...

    Incorrect

    • A 50 yr. old male patient with schizophrenia complained of chest pain and palpitations. His ECG revealed torsades de pointes ventricular tachycardia. He was on thioridazine for schizophrenia. What is the most appropriate management for his presentation?

      Your Answer:

      Correct Answer: IV magnesium

      Explanation:

      Thioridazine has a quinidine-like action on the heart and is known to cause cardiac arrhythmias including prolonged PR and QT intervals and widening of QRS complexes. Intravenous magnesium sulphate is regarded as the treatment of choice for this arrhythmia.

    • This question is part of the following fields:

      • Cardiology
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  • Question 7 - Which the following features is most suggestive of megaloblastic anaemia? ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 8 - A 62year-old manpresents with exertional chest pain and is found to have extensive...

    Incorrect

    • A 62year-old manpresents with exertional chest pain and is found to have extensive coronary artery disease on angiogram. Which of the following cell types is most implicated in the development of coronary artery plaques?

      Your Answer:

      Correct Answer: Macrophages

      Explanation:

      An atheroma is an accumulation of degenerative material in the tunica intima (inner layer) of artery walls. The material consists of (mostly) macrophage cells, or debris, containing lipids (cholesterol and fatty acids), calcium and a variable amount of fibrous connective tissue.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 9 - A 42-year-old man is a known case of Waldenström's macroglobulinemia and is admitted...

    Incorrect

    • A 42-year-old man is a known case of Waldenström's macroglobulinemia and is admitted to the hospital with headache, visual disturbances, pale conjunctivae, and breathlessness. While in the assessment unit, he has had an episode of nosebleed that has been difficult to control. On examination, his heart rate is 120bpm, blood pressure is 115/65 mmHg, and he is febrile with a temperature of 37°C. Fundoscopy shows dilated retinal veins with a retinal haemorrhage in the right eye.

      What is the most appropriate next step of management?

      Your Answer:

      Correct Answer: Plasmapheresis

      Explanation:

      The patient is displaying signs and symptoms of hyperviscosity syndrome, secondary to the Waldenström’s macroglobulinemia. Treatment of choice is plasmapheresis.

      Waldenström’s macroglobulinemia (also called lymphoplasmacytic lymphoma) is an uncommon type of non-Hodgkin lymphoma seen in older people. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein. Its features include monoclonal IgM paraproteinemia; hyperviscosity syndrome leading to bilateral central retinal vein occlusion (CRVO) and hence, visual disturbances; weight loss and lethargy; hepatosplenomegaly and lymphadenopathy; and cryoglobulinemia. It is not, however, associated with bone pain.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 10 - A 47-year-old woman diagnosed with oestrogen receptor positive breast cancer three months back...

    Incorrect

    • A 47-year-old woman diagnosed with oestrogen receptor positive breast cancer three months back was started on treatment with tamoxifen. Which of the following is most likely a complaint of this patient during her review today?

      Your Answer:

      Correct Answer: Hot flushes

      Explanation:

      The most likely complaint of this patient would be hot flushes.

      Alopecia and cataracts are listed in the BNF as possible side-effects. They are however not as prevalent as hot flushes, which are very common in pre-menopausal women.

      Tamoxifen is a Selective Oestrogen Receptor Modulator (SERM) which acts as an oestrogen receptor antagonist and partial agonist. It is used in the management of oestrogen receptor-positive breast cancer

      Adverse effects:
      Menstrual disturbance: vaginal bleeding, amenorrhoea
      Hot flushes – 3% of patients stop taking tamoxifen due to climacteric side-effects.
      Venous thromboembolism.
      Endometrial cancer
      Tamoxifen is typically used for 5 years following the removal of the tumour.

      Raloxifene is a pure oestrogen receptor antagonist and carries a lower risk of endometrial cancer.

      Although antagonistic with respects to breast tissue tamoxifen may serve as an agonist at other sites. Therefore the risk of endometrial cancer is increased cancer.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 11 - In the event of an overdose, haemodialysis is ineffective as a treatment modality...

    Incorrect

    • In the event of an overdose, haemodialysis is ineffective as a treatment modality for which of the following drugs?

      Your Answer:

      Correct Answer: Tricyclics

      Explanation:

      Tricyclic compounds can’t be cleared by haemodialysis.

      Drugs that can be cleared with haemodialysis include: (BLAST)
      – Barbiturate
      – Lithium
      – Alcohol (inc methanol, ethylene glycol)
      – Salicylates
      – Theophyllines (charcoal hemoperfusion is preferable)

      Drugs which cannot be cleared with haemodialysis include:
      – Tricyclics
      – Benzodiazepines
      – Dextropropoxyphene (Co-proxamol)
      – Digoxin
      – Beta-blockers

    • This question is part of the following fields:

      • Pharmacology
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  • Question 12 - A 34-year-old man who is HIV positive has started treatment for Burkitt lymphoma....

    Incorrect

    • A 34-year-old man who is HIV positive has started treatment for Burkitt lymphoma. His chemotherapy regime includes cyclophosphamide, vincristine, methotrexate, and prednisolone. After one day of starting chemotherapy, he becomes confused and complains of muscle cramps in his legs.

      Which one of the following is most likely to have occurred?

      Your Answer:

      Correct Answer: Tumour lysis syndrome

      Explanation:

      Tumour lysis syndrome (TLS), triggered by the introduction of chemotherapy, has resulted in the aforementioned symptoms in this patient.

      TLS is a potentially fatal condition occurring as a complication during the treatment of high-grade lymphomas and leukaemias. It occurs from the simultaneous breakdown (lysis) of the tumour cells and subsequent release of chemicals into the bloodstream. This leads to hyperkalaemia and hyperphosphatemia in the presence of hyponatraemia. TLS can occur in the absence of chemotherapy, but it is usually triggered by the introduction of combination chemotherapy. Awareness of the condition is critical for its prophylactic management.

      Rasburicase should be given prior to chemotherapy in order to reduce the risk of tumour lysis syndrome (TLS). Rasburicase is a recombinant version of urate oxidase which is an enzyme that metabolizes uric acid to allantoin. Allantoin is 5–10 times more soluble than uric acid, hence, renal excretion is more effective.

      Burkitt lymphoma is a high-grade B-cell neoplasm. There are two major forms:
      1. Endemic (African) form: typically involves maxilla or mandible.
      2. Sporadic form: abdominal (e.g. ileocaecal) tumours are the most common form. More common in patients with HIV.

      Burkitt lymphoma is associated with the c-myc gene translocation, usually t(8;14). The Epstein-Barr virus (EBV) is strongly implicated in development of the African form of Burkitt lymphoma and to a lesser extent, the sporadic form.

      Management of the lymphoma is with chemotherapy. This tends to produce a rapid response which may cause TLS.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 13 - Which of the following symptoms are more indicative of mania than hypomania? ...

    Incorrect

    • Which of the following symptoms are more indicative of mania than hypomania?

      Your Answer:

      Correct Answer: Delusions of grandeur

      Explanation:

      The delusion of grandeur is more indicative of mania than hypomania.
      While criteria (e.g. ICD-10, DSM-5) vary regarding the diagnosis between hypomania and mania, the consistent difference between mania and hypomania is the presence of psychotic symptoms.

      Hypomania vs. mania:
      The presence of psychotic symptoms such as delusions of grandeur
      auditory hallucinations point towards mania rather than hypomania/

      The following symptoms are common to both hypomania and mania
      Mood:
      Predominately elevated
      Irritable

      Speech and thought:
      Pressured
      Flight of ideas
      Poor attention

      Behaviour
      Insomnia
      Loss of inhibitions: sexual promiscuity, overspending, risk-taking
      increased appetite

    • This question is part of the following fields:

      • Psychiatry
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  • Question 14 - A 36-year-old man is scheduled to start on interferon-alpha and ribavarin for the...

    Incorrect

    • A 36-year-old man is scheduled to start on interferon-alpha and ribavarin for the treatment of hepatitis C. His past history includes intravenous drug usage. Which are the most common side effects of interferon-alpha?

      Your Answer:

      Correct Answer: Depression and flu-like symptoms

      Explanation:

      Adverse effects due to IFN-alpha have been described in almost every organ system. Many side-effects are clearly dose-dependent. Taken together, occurrence of flu-like symptoms, haematological toxicity, elevated transaminases, nausea, fatigue, and psychiatric sequelae are the most frequently encountered side effects.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 15 - A 4-year-old girl is diagnosed with acute lymphoblastic leukaemia after presenting with lethargy...

    Incorrect

    • A 4-year-old girl is diagnosed with acute lymphoblastic leukaemia after presenting with lethargy and easy bruising. Which of the following is a marker of a bad prognosis in this disease?

      Your Answer:

      Correct Answer: Philadelphia chromosome positive

      Explanation:

      Philadelphia translocation, t(9;22), is a marker of poor prognosis in acute lymphoblastic leukaemia (ALL).

      ALL is the malignancy of lymphoid progenitor cells affecting B or T cell lineage. This results in the arrest of lymphoid cell maturation and proliferation of immature blast cells (lymphoblasts), leading to bone marrow and tissue infiltration.

      ALL is the most common type of childhood cancers. Its peak incidence is between two to three years of age.

      Acute B lymphoblastic leukaemia (B-ALL) is the most common type of ALL, involving overproduction of B-cell lymphoblasts. It is manifested by low initial WCC and is associated with a good prognosis.

      Poor prognostic factors for ALL include:
      1. Pre-B cell or T-cell ALL (T-ALL)
      2. Philadelphia translocation, t(9;22)
      3. Age <2 years or >10 years
      4. Male sex
      5. CNS involvement
      6. High initial WBC (e.g. >100 x 10^9/L)
      7. non-Caucasian

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 16 - A 33-year-old electrical technician presents following an overdose. Anticholinergic syndrome is suspected.
    ...

    Incorrect

    • A 33-year-old electrical technician presents following an overdose. Anticholinergic syndrome is suspected.

      Which of the following is true?

      Your Answer:

      Correct Answer: Mydriasis occurs

      Explanation:

      Anticholinergic syndrome occurs following overdose with drugs that have prominent anticholinergic activity including tricyclic antidepressants, antihistamines and atropine. Features include dry, warm, flushed skin, urinary retention, tachycardia, mydriasis (dilated pupils) and agitation.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 17 - Which one of the following cardiac tissue types has the highest conduction velocity?...

    Incorrect

    • Which one of the following cardiac tissue types has the highest conduction velocity?

      Your Answer:

      Correct Answer: Purkinje fibres

      Explanation:

      Nerve conduction velocity is an important aspect of nerve conduction studies. It is the speed at which an electrochemical impulse propagates down a neural pathway. Ultimately, conduction velocities are specific to each individual and depend largely on an axon’s diameter and the degree to which that axon is myelinated.
      The cardiac action potential is a brief change in voltage (membrane potential) across the cell membrane of heart cells. Conduction speed varies:
      Atrial conduction spreads along ordinary atrial myocardial fibres at 1 m/sec
      AV node conduction 0.05 m/sec
      Ventricular conduction Purkinje fibres are of large diameter and achieve velocities of 2-4 m/sec (this allows a rapid and coordinated contraction of the ventricles.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 18 - A 70 yr. old female was brought in by the paramedics after she...

    Incorrect

    • A 70 yr. old female was brought in by the paramedics after she collapsed whilst shopping. She has a tachycardia of 150 bpm and her BP is 100/60 mmHg. Her ECG showed a broad complex tachycardia. Which of the following is more suggestive of a ventricular tachycardia (VT) over a supraventricular tachycardia (SVT) with aberrant conduction?

      Your Answer:

      Correct Answer: Atrioventricular dissociation

      Explanation:

      To differentiate VT from 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:

      • Cardiology
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  • Question 19 - A 63 year old man presents to the clinic complaining of a 6-month history...

    Incorrect

    • A 63 year old man presents to the clinic complaining of a 6-month history of shortness of breath on exertion and a non-productive cough.
       
      On examination there is clubbing, and crepitations heard at the lung bases. Lung function tests show a reduced vital capacity and an increased FEV1/FVC ratio.
       
      What is his diagnosis?

      Your Answer:

      Correct Answer: Idiopathic pulmonary fibrosis

      Explanation:

      Idiopathic pulmonary fibrosis (IPF) is a condition in which the lungs become scarred and breathing becomes increasingly difficult.
      The most common signs and symptoms of idiopathic pulmonary fibrosis are shortness of breath and a persistent dry, hacking cough. Many affected individuals also experience a loss of appetite and gradual weight loss.

      The clinical findings of IPF are bibasilar reticular abnormalities, ground glass opacities, or diffuse nodular lesions on high-resolution computed tomography and abnormal pulmonary function studies that include evidence of restriction (reduced VC with an increase in FEV1/FVC ratio) and/or impaired gas exchange (increased P(A-a)O2 with rest or exercise or decreased diffusion capacity of the lung for carbon monoxide [DLCO]).

    • This question is part of the following fields:

      • Respiratory
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  • Question 20 - A 71-year-old female presents for investigation of fatigue and weight loss.

    Investigations...

    Incorrect

    • 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:

      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.

    • This question is part of the following fields:

      • Nephrology
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  • Question 21 - From which cells is somatostatin secreted? ...

    Incorrect

    • From which cells is somatostatin secreted?

      Your Answer:

      Correct Answer: D cells in the pancreas

      Explanation:

      The somatostatin-secreting D-cells comprise ,5% of the cells of the pancreatic islets. The D-cells have a complex morphology and may, via cellular process, interact with many more islet cells than suggested by their low number. D-cells are equipped with ATP-sensitive potassium channels (KATP channels).

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 22 - Which of the following is not associated with right axis deviation? ...

    Incorrect

    • Which of the following is not associated with right axis deviation?

      Your Answer:

      Correct Answer: Wolf-Parkinson-White syndrome with right-sided accessory pathway

      Explanation:

      Causes for right axis deviation:
      -Right ventricular hypertrophy and Left posterior fascicular block
      -Lateral myocardial infarction.
      -Acute or chronic lung diseases: Pulmonary embolism, pulmonary hypertension, chronic obstructive pulmonary disease (COPD), cor pulmonale.
      -Congenital heart disease (e.g., dextrocardia, secundum atrial septal defect).
      -Wolff-Parkinson-White syndrome.
      -Ventricular ectopic rhythms (e.g., ventricular tachycardia).

    • This question is part of the following fields:

      • Cardiology
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  • Question 23 - A 57-year-old man, who suffers from biventricular cardiac failure, comes to his doctor...

    Incorrect

    • A 57-year-old man, who suffers from biventricular cardiac failure, comes to his doctor for a review. His symptoms are currently well controlled; he is taking Ramipril 10mg, Spironolactone 25mg, Bisoprolol 10mg, and Furosemide 40mg. His main complaint is of painful gynaecomastia that he says has developed over the past 6 months. Physical exam reveals a blood pressure of 125/80 mmHg and no residual signs of cardiac failure. Renal function is unchanged from 6 months earlier, with stable creatinine at 125 µmol/l.

      Which of the following is the most appropriate next step?

      Your Answer:

      Correct Answer: Change the spironolactone to eplerenone

      Explanation:

      Spironolactone is an aldosterone antagonist diuretic that is well-known to cause gynaecomastia because it increases testosterone clearance and oestradiol production. The patient’s primary complaint of gynaecomastia should immediately prompt discontinuation of spironolactone and replacement with Eplerenone, which lacks the antiandrogenic effects, and thus there is less risk of gynaecomastia.

    • This question is part of the following fields:

      • Nephrology
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  • Question 24 - A 60 yr. old female presented after an acute overdose of amiodarone. Her...

    Incorrect

    • A 60 yr. old female presented after an acute overdose of amiodarone. Her blood pressure was 110/70 mmHg and pulse rate was 35 bpm. She was given 500mcg of atropine but there was no response. Which of the following is the most appropriate next step?

      Your Answer:

      Correct Answer: Isoprenaline

      Explanation:

      Permanent pacing is not indicated as the bradycardia is reversible. Temporary pacing is the definite treatment. Isoprenaline can be used until temporary pacing is available.

    • This question is part of the following fields:

      • Cardiology
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  • Question 25 - A 72 yr. old male with a history of type II diabetes mellitus...

    Incorrect

    • A 72 yr. old male with a history of type II diabetes mellitus and hypertension for 15 years, presented with gradual onset difficulty in breathing on exertion and bilateral ankle swelling for the past 3 months. On examination he had mild ankle oedema. His JVP was not elevated. His heart sounds were normal but he had bibasal crepitations on auscultation. Which of the following clinical signs has the greatest sensitivity in detecting heart failure in this patient?

      Your Answer:

      Correct Answer: Third heart sound

      Explanation:

      The presence of a third heart sound is the most sensitive indicator of heart failure. All of the other signs can be found in heart failure with varying degrees.

    • This question is part of the following fields:

      • Cardiology
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  • Question 26 - A 30-year-old female presents to the A&E department with epistaxis, which has now...

    Incorrect

    • A 30-year-old female presents to the A&E department with epistaxis, which has now stopped. According to her boyfriend, she has a recent history of mucosal bleeding and has at times been very disorientated. On examination, she has a low-grade fever and appears confused and jaundiced. There is bruising over her legs and arms. A urine pregnancy test is negative. You receive the following blood results from the laboratory:

      Hb: 8.5 g/dL,
      Plts: 8 x 10^9/L,
      WCC: 4.5 x 10^9/L,
      MCV: 92 fL,
      Na+: 138 mmol/L,
      K+: 4.9 mmol/L,
      Urea: 10.2 mmol/L,
      Creatinine: 182 mmol/L,
      Her coagulation profile is normal.

      Given the likely diagnosis, what is the most appropriate management of this patient?

      Your Answer:

      Correct Answer: Plasma exchange

      Explanation:

      The diagnosis for the aforementioned case is thrombotic thrombocytopenic purpura (TTP). TTP is classically characterised as a pentad of thrombocytopaenia, microvascular haemolysis, fluctuating neurological signs, renal impairment, and fever.

      The differential diagnosis for severe thrombocytopaenia is immune thrombocytopenic purpura (ITP). ITP is more common than TTP. However, a patient of ITP would not present with the range of symptoms seen in this scenario.

      In TTP, there is deficiency of a protease which breaks down large multimers of von Willebrand factor. This leads to abnormally large and sticky multimers of von Willebrand factor which cause platelets to clump within the vessels.

      Untreated TTP has a mortality rate of up to 90%. Therefore, rapid plasma exchange (PEX) may be a life-saving intervention. Platelet transfusion in TTP is only indicated if there is an ongoing life-threatening bleed. Intravenous methylprednisolone is indicated after treatment with PEX has been completed. There is no current role of intravenous immunoglobulin in the routine management of TTP. However, there have been reports of its successful use in PEX- and steroid-refractory cases. Intravenous argatroban is indicated in heparin-induced thrombocytopaenia (HIT), but there is no history of recent heparin administration or hospitalisation in this patient nor are the clinical signs consistent with HIT.

      Management options for TTP include PEX as the treatment of choice. Steroids and immunosuppressants are also given. Antibiotics are not recommended as they may worsen the outcome of the disease. For cases resistant to PEX and pharmacologic therapy, vincristine is given.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 27 - A 27-year-old female visited the OPD with a complaint of visual disturbance, eye...

    Incorrect

    • A 27-year-old female visited the OPD with a complaint of visual disturbance, eye pain, pain in the knee and hands, and a rash on her face. On examination, the rash was the shape of a butterfly, and the joints were mildly swollen. The eyes of the patient were found to be red with irregular pupils. Where do you think the problem lies?

      Your Answer:

      Correct Answer: Iris

      Explanation:

      The patient’s symptoms are suggestive of ankylosing spondylitis which is often accompanied by iritis, the cause of this patient’s red eye.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 28 - A 23-year-old pregnant woman presents with glycosuria. What is the most likely mechanism?...

    Incorrect

    • A 23-year-old pregnant woman presents with glycosuria. What is the most likely mechanism?

      Your Answer:

      Correct Answer: Reduced renal reabsorption

      Explanation:

      Throughout pregnancy the tubular reabsorption of glucose is less effective than in the non-pregnant state, this leads to glycosuria.

    • This question is part of the following fields:

      • Nephrology
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  • Question 29 - A 25-year-old lady with a history of ulcerative colitis presents to clinic. She...

    Incorrect

    • A 25-year-old lady with a history of ulcerative colitis presents to clinic. She had extensive colitis 10 years ago, which has improved with medical treatment. Last year she had been diagnosed with primary sclerosing cholangitis. Her last colonoscopy was 6 months ago, which detected no active disease, and random biopsies were normal. She is remaining well and asymptomatic.

      When should colonic screening be performed on this patient?

      Your Answer:

      Correct Answer: Colonoscopy should be performed annually

      Explanation:

      Colonoscopy screening should begin 10 years after the first diagnosis in ulcerative colitis, given the increased risk for colon cancer. Given that she has developed primary sclerosing cholangitis, her risk of colon cancer is even higher. Colonoscopy screening should occur at 3 year intervals in the second decade, 2 year intervals in the third decade, and 1 year intervals by the first decade, making A the correct answer choice.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 30 - Of the following disorders, which one causes acute tubular damage? ...

    Incorrect

    • Of the following disorders, which one causes acute tubular damage?

      Your Answer:

      Correct Answer: Myoglobinuria

      Explanation:

      Myoglobinuria is the condition when there is degeneration of necrosed muscle that it is excreted in the urine. This condition would then cause acute tubular damage leading to renal failure.

    • This question is part of the following fields:

      • Nephrology
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