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  • Question 1 - A 66-year-old baker presents to the oncology clinic with six-month history of weight...

    Incorrect

    • A 66-year-old baker presents to the oncology clinic with six-month history of weight loss and anorexia. Tumour marker profile shows an elevated level of bombesin.

      Out of the following, which is the most likely cancer to account for this result?

      Your Answer: Lymphoma

      Correct Answer: Small cell lung carcinoma

      Explanation:

      Bombesin is a tumour marker elevated in small cell lung carcinomas, as well as in gastric carcinomas and retinoblastomas.

      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
      3
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  • Question 2 - A 78 year old male presents to the emergency department with shortness of...

    Incorrect

    • A 78 year old male presents to the emergency department with shortness of breath that has developed gradually over the last 4 days. His symptoms include fever and cough productive of greenish sputum. Past history is notable for COPD for which he was once admitted to the ICU, 2 years back. He now takes nebulizers (ipratropium bromide) at home. The patient previously suffered from myocardial infarction 7 years ago. He also has Diabetes Mellitus type II controlled by lifestyle modification.
      On examination, the following vitals are obtained.
      BP : 159/92 mmHg
      Pulse: 91/min (regular)
      Temp: Febrile
      On auscultation, there are scattered ronchi bilaterally and right sided basal crackles. Cardiovascular and abdominal examinations are unremarkable.
      Lab findings are given below:
      pH 7.31
      pa(O2) 7.6 kPa
      pa(CO2) 6.3 kPa
      Bicarbonate 30 mmol/L,
      Sodium 136 mmol/L,
      Potassium 3.7 mmol/L,
      Urea 7.0 mmol/L,
      Creatinine 111 μmol/L,
      Haemoglobin 11.3 g/dL,
      Platelets 233 x 109 /l
      Mean cell volume (MCV) 83 fl
      White blood cells (WBC) 15.2 x 109 /l.
      CXR shows an opacity obscuring the right heart border.

      Which of the following interventions should be started immediately while managing this patient?

      Your Answer:

      Correct Answer: Salbutamol and ipratropium bromide nebulisers

      Explanation:

      Acute exacerbations of chronic obstructive pulmonary disease (COPD) are immediately treated with inhaled beta2 agonists and inhaled anticholinergics, followed by antibiotics (if indicated) and systemic corticosteroids. Methylxanthine therapy may be considered in patients who do not respond to other bronchodilators.
      High flow oxygen would worsen his symptoms. Usually titrated oxygen (88 to 92 %) is given in such patients to avoid the risk of hyperoxic hypercarbia in which increasing oxygen saturation in a chronic carbon dioxide retainer can inadvertently lead to respiratory acidosis and death.

    • This question is part of the following fields:

      • Respiratory
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  • Question 3 - A 28 year old male arrives at the clinic complaining of fever, arthralgia...

    Incorrect

    • A 28 year old male arrives at the clinic complaining of fever, arthralgia and urethritis. On examination, the ankle is swollen and there is a pustular rash on the dorsal foot. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Disseminated gonorrhoea

      Explanation:

      DGI presents as two syndromes: 1) a bacteremic form that includes a triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis and 2) a septic arthritis form characterized as a purulent arthritis without associated skin lesions. Many patients will have overlapping features of both syndromes. Time from infection to clinical manifestations may range from 1 day to 3 months. There is no travel history and the rash of Lyme disease is not purulent. Reactive arthritis presents with conjunctivitis, urethritis and arthritis usually with a red hot tender and swollen joint.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 4 - 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 5 - A 22-year-old woman presents with anxiety and weight loss with increased appetite.
    ...

    Incorrect

    • 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:

      Correct 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:

      • Endocrinology
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  • Question 6 - A 26-year-old woman is 24 weeks pregnant had a recent ultrasound that shows...

    Incorrect

    • A 26-year-old woman is 24 weeks pregnant had a recent ultrasound that shows the foetus large for dates.
      She has an oral glucose tolerance test (OGTT) which was requested due to a combination of her Asian ethnicity and background of obesity.
      The following results are obtained:
      (Time (hours) : Blood glucose (mmol/l)),
      0 : 9.2,
      2 : 14.2.

      What is the most appropriate management?

      Your Answer:

      Correct Answer: Start insulin

      Explanation:

      Insulin remains the standard of care for the treatment of uncontrolled gestational diabetes. Tight control maintained in the first trimester and throughout pregnancy plays a vital role in decreasing poor fetal outcomes, including structural anomalies, macrosomia, hypoglycaemia of the new-born, adolescent and adult obesity, and diabetes.
      The baby is already large for dates so nutritional therapy can not be used alone.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - A 19-year-old woman comes to the endocrine clinic with excessive hairiness and acne....

    Incorrect

    • A 19-year-old woman comes to the endocrine clinic with excessive hairiness and acne. She tells you that she has a period only every few months and when she has one it tends to be very heavy.
      On examination, she has obvious facial acne. Her BP is 142/78 mmHg, her pulse is 72bpm and regular and her BMI is 30. There is facial hair and hair around her upper chest and breasts.

      Investigations show:
      Haemoglobin 11.9 g/dl (11.5-16.0),
      White cell count 6.0 x 10(9)/l (4-11),
      Platelets 202 x 10(9)/l (150-400),
      Sodium 137 mmol/l (135-146),
      Potassium 3.9 mmol/l (3.5-5),
      Creatinine 90 µmol/l (79-118),
      Total testosterone normal,
      Free androgen index elevated,
      LH / FSH ratio 2.2.

      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Polycystic ovarian syndrome

      Explanation:

      Rotterdam criteria for the diagnosis of polycystic ovary syndrome:
      Two of the following three criteria are required:
      1. Oligo/anovulation
      2. Hyperandrogenism
      – Clinical (hirsutism or less commonly male pattern alopecia) or
      – Biochemical (raised FAI or free testosterone)
      3. Polycystic ovaries on ultrasound
      Other aetiologies must be excluded such as congenital adrenal hyperplasia, androgen-secreting tumours, Cushing syndrome, thyroid dysfunction and hyperprolactinaemia.
      Cushing’s is excluded because there would have been marked obesity, hypertension and other related features.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 8 - A 85 yr. old previously well man was found to have a BP...

    Incorrect

    • A 85 yr. old previously well man was found to have a BP of 155/90 mmHg. His average reading from the monitoring of his ambulatory BP was 147/92 mmHg. His calculated 10 year cardiovascular risk was 15%. Which of the following is the most appropriate management of this patient?

      Your Answer:

      Correct Answer: Give lifestyle advice and repeat blood pressure in 6 months

      Explanation:

      According to different guidelines for patients above 80 years, the targeted systolic blood pressure varies from 140-150 mmHg. As this patient’s BP is within that range, he can be kept under observation.

    • This question is part of the following fields:

      • Cardiology
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  • Question 9 - A 39 year-old engineer presents with progressive weakness of his hands. Upon examination,...

    Incorrect

    • A 39 year-old engineer presents with progressive weakness of his hands. Upon examination, you notice wasting of the small muscles of the hand. A diagnosis of syringomyelia is suspected. Which one of the following features would most support this diagnosis?

      Your Answer:

      Correct Answer: Loss of temperature sensation in the hands

      Explanation:

      Syringomyelia is a development of a cavity (syrinx) within the spinal cord. Signs and symptoms include loss of feeling, paralysis, weakness, and stiffness in the back, shoulders, and extremities. Syringomyelia may also cause a loss of the ability to feel extremes of hot or cold, especially in the hands. Symptoms typically vary depending on the extent and, often more critically, on the location of the syrinx within the spinal cord.

    • This question is part of the following fields:

      • Neurology
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  • Question 10 - A 32 year old female is diagnosed with SLE based on her complaints...

    Incorrect

    • A 32 year old female is diagnosed with SLE based on her complaints of polyarthralgia, mouth ulcers and ANA positivity. Labs reveal normal urinalysis, urea and electrolytes. ESR is 90mm in the first hour. How will you manage this patient?

      Your Answer:

      Correct Answer: Hydroxychloroquine 200 mg/day

      Explanation:

      Hydroxychloroquine is used in the management of SLE as it prevents disease progression and has relatively mild side effects, for instance headache, nausea etc. Its use reduces the usage of corticosteroids. It is particularly effective when the disease is less severe and there is no organ involvement. Cyclophosphamide and prednisolone are indicated in cases of renal, neurological and lung involvement.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 11 - 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 12 - 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 13 - A 60 yr. old man presented with difficulty in breathing. On examination he...

    Incorrect

    • A 60 yr. old man presented with difficulty in breathing. On examination he was severely dyspnoeic and tachycardic. What is the clinical sign that would favour the diagnosis of cardiac tamponade over constrictive pericarditis?

      Your Answer:

      Correct Answer: Pulsus paradoxus

      Explanation:

      Pulsus paradoxus is defined as the exaggerated fall in systolic blood pressure during inspiration by greater than 10 mmHg. Cardiac tamponade is the classic cause of pulsus paradoxus. Kussmaul’s sign (a rise in the jugular venous pressure on inspiration) is mostly seen in constrictive pericarditis. Hypotension, muffled heart sounds and raised JVP can be seen in both conditions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 14 - A 25-year-old obese woman is diagnosed with polycystic ovarian syndrome (PCOS). Which of...

    Incorrect

    • A 25-year-old obese woman is diagnosed with polycystic ovarian syndrome (PCOS). Which of the following findings is most consistently seen in PCOS?

      Your Answer:

      Correct Answer: Ovarian cysts on ultrasound

      Explanation:

      The diagnosis of polycystic ovarian syndrome (PCOS) is based on hyperandrogenism or chronic anovulation in the absence of specific pituitary and/or adrenal disease.
      Pelvic ultrasonography may be very helpful in the evaluation as well, but polycystic ovaries are not specific for PCOS with over 20% of “normal” women having this finding. The number of follicles and ovary volume are both important in the ultrasound evaluation. The criteria for PCOS put forth by Adams et al. are the most often cited: the presence of ≥10 cysts measuring 2–8 mm around a dense core of stroma or scattered within an increased amount of stroma.
      A recent proposal to modify these criteria has been put forth by Jonard et al.: “increased ovarian area (>5.5cm2) or volume (>11 mL) and/or presence of ≥12 follicles measuring 2 to 9 mm in diameter (mean of both ovaries)”.
      These criteria have a specificity of 99% and a sensitivity of 75% for the diagnosis of PCOS.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 15 - 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 16 - Which of the following is the most useful marker of prognosis in multiple...

    Incorrect

    • Which of the following is the most useful marker of prognosis in multiple myeloma?

      Your Answer:

      Correct Answer: B2-microglobulin

      Explanation:

      B2-microglobulin is a useful marker of prognosis in multiple myeloma (MM). Raised levels imply a poorer prognosis. Low levels of albumin are also associated with a poor prognosis.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 17 - A study is developed to compare the calcemia of men and women with...

    Incorrect

    • A study is developed to compare the calcemia of men and women with Crohn's disease. The objective of the study is to detect any differences between the average calcium levels in men compared to women. Previous studies have shown a normal distribution regarding calcium levels. Which of the the following tests would you most likely apply?

      Your Answer:

      Correct Answer: Student's unpaired t-test

      Explanation:

      A t test is a type of statistical test that is used to compare the means of two groups. It is one of the most widely used statistical hypothesis tests in pain studies. There are two types of statistical inferences: parametric and nonparametric methods. Parametric methods refer to a statistical technique in which one defines the probability distribution of probability variables and makes inferences about the parameters of the distribution. In cases in which the probability distribution cannot be defined, nonparametric methods are employed. T tests are a type of parametric method; they can be used when the samples satisfy the conditions of normality, equal variance, and independence. In this case the data is parametric, comparing two independent samples from the same population.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 18 - Choose the correct definition regarding the standard error of the mean: ...

    Incorrect

    • 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√

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 19 - A 61-year-old woman with a history of hypothyroidism and inflammatory arthritis is admitted...

    Incorrect

    • A 61-year-old woman with a history of hypothyroidism and inflammatory arthritis is admitted after slipping on ice and falling over. Some routine blood tests are performed:


      Na+ 141 mmol/L,
      K+ 2.9 mmol/L,
      Chloride 114 mmol/L,
      Bicarbonate 16 mmol/L,
      Urea 5.2 mmol/L,
      Creatinine 75 µmol/L,

      Which one of the following is most likely to explain these results?

      Your Answer:

      Correct Answer: Renal tubular acidosis (type 1)

      Explanation:

      The patient’s underlying arthritis has most likely led to Renal tubular acidosis RTA type 1, which presents with the following symptoms consistent with the presentation of the patient: Normal anion gap metabolic acidosis/acidaemia, hypokalaemia and hyperchloremia. Comparatively, the other conditions are ruled out because Aspirin and diabetic ketoacidosis is associated with a raised anion gap, Conn’s syndrome explains hypokalaemia but not the metabolic acidosis, and RTA type 4 is associated with hyperkalaemia.

    • This question is part of the following fields:

      • Nephrology
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  • Question 20 - Which of the following statements describe the mechanism of fibrates most accurately? ...

    Incorrect

    • Which of the following statements describe the mechanism of fibrates most accurately?

      Your Answer:

      Correct Answer: Increased lipoprotein lipase activity via PPAR-alpha

      Explanation:

      The main mechanism of fibrate drugs is activation of gene transcription factors known as PPARs, particularly PPAR-α, which regulate the expression of genes that control lipoprotein metabolism. There are several consequences of PPAR-α activation, which reduce circulating LDL cholesterol and triglycerides and increase HDL cholesterol.

    • This question is part of the following fields:

      • Cardiology
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  • Question 21 - A 42-year-old man presented with bloody diarrhoea and weight loss. Which one of...

    Incorrect

    • A 42-year-old man presented with bloody diarrhoea and weight loss. Which one of the following would favour the diagnosis of Crohn’s disease on rectal biopsy?

      Your Answer:

      Correct Answer: Patchy inflammation

      Explanation:

      The correct answer is patchy inflammation. Superficial ulceration as well as non-patchy inflammation are seen in ulcerative colitis (UC) in the colon and rectum; you would expect to see transmural inflammation in Crohn’s disease and it can be patchy and located anywhere from mouth to anus. Crypt distortion and crypt abscesses are seen in both UC and Crohn’s, however they are more common in ulcerative colitis.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 22 - A 50-year-old male was brought to the ER after the accidental consumption of...

    Incorrect

    • A 50-year-old male was brought to the ER after the accidental consumption of 300 ml of diethylene glycol. Blood investigations were suggestive of metabolic acidosis and renal failure. What is the appropriate management in this patient?

      Your Answer:

      Correct Answer: Haemodialysis and oral ethanol

      Explanation:

      Among the given options the most appropriate management in this patient would be ethanol and haemodialysis.

      Ethanol competes with ethylene glycol for alcohol dehydrogenase and thus, helps manage a patient with ethylene glycol toxicity.

      Ethylene glycol is a type of alcohol used as a coolant or antifreeze
      Features of toxicity are divided into 3 stages:
      Stage 1: (30 min to 12 hours after exposure) Symptoms similar to alcohol intoxication: confusion, slurred speech, dizziness (CNS depression)
      Stage 2: (12 – 48 hours after exposure) Metabolic acidosis with a high anion gap and high osmolar gap. Also tachycardia, hypertension
      Stage 3: (24 – 72 hours after exposure) Acute renal failure

      Management has changed in recent times:
      Fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol.
      Ethanol has been used for many years works by competing with ethylene glycol for the enzyme alcohol dehydrogenase this limits the formation of toxic metabolites (e.g. glycolaldehyde and glycolic acid) which are responsible for the hemodynamic/metabolic features of poisoning.
      Haemodialysis has a role in refractory cases.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 23 - A 22-year-old woman has ingested an unknown quantity of paracetamol tablets four hours...

    Incorrect

    • A 22-year-old woman has ingested an unknown quantity of paracetamol tablets four hours ago. She now presents with nausea, vomiting, anorexia and right subchondral pain.

      Which of the following features suggest that she should be transferred to the liver unit?

      Your Answer:

      Correct Answer: pH 7.25

      Explanation:

      The most widely used prognostic predictors for acetaminophen over-ingestion is King’s College Criteria, which is: arterial PH < 7.3 after fluid resuscitation, Cr level > 3.4, PT > 1.8x control or > 100s, or INR > 6.5, and Grave III or IV encephalopathy.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 24 - Which of the following is associated with heterochromia in congenital disease? ...

    Incorrect

    • Which of the following is associated with heterochromia in congenital disease?

      Your Answer:

      Correct Answer: Horner's syndrome

      Explanation:

      Heterochromia (difference in iris colour) is seen in congenital Horner’s syndrome, as well as anhidrosis. Other features of non-congenital Horner’s include miosis, ptosis and enophthalmos.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 25 - A 58-year-old gentleman with a long history of gout presents with loin pain....

    Incorrect

    • A 58-year-old gentleman with a long history of gout presents with loin pain. Other past history of note includes an ileostomy after bowel surgery. There is no history of weight loss from malabsorption syndrome after his bowel surgery. Excretion urography reveals evidence of bilateral renal stones.

      What is the most likely composition of his renal stones?

      Your Answer:

      Correct Answer: Uric acid stones

      Explanation:

      Uric acid stones will most likely be found in this case because of the patient’s long history of gout. Additionally, studies have shown that ileostomy patients have an increased risk for the development of uric acid stones.

    • This question is part of the following fields:

      • Nephrology
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  • Question 26 - A 60 yr. old previously well male was admitted with a suspected pulmonary...

    Incorrect

    • A 60 yr. old previously well male was admitted with a suspected pulmonary embolism. On examination his BP was 130/80 mmHg and pulse rate was 88 bpm. His CXR was normal. He was treated with low molecular weight heparin. Which of the following is the most appropriate initial lung investigation for this patient?

      Your Answer:

      Correct Answer: Computed tomographic pulmonary angiography

      Explanation:

      Computed tomographic pulmonary angiography (CTPA) is the standard investigative tool, used for diagnosing a pulmonary embolism. Pulmonary angiography is indicated if CTPA is not available.

    • This question is part of the following fields:

      • Cardiology
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  • Question 27 - A 11-year-old is referred to neurology due to episodes her GP feels are...

    Incorrect

    • A 11-year-old is referred to neurology due to episodes her GP feels are epileptiform. Her mother reports that she appears to just 'stop', sometimes even in mid conversation, for several seconds at random times during the day. During these episodes, she can be unresponsive to questioning and has no recollection of them.

      Which of these drugs is contraindicated in this condition?

      Your Answer:

      Correct Answer: Carbamazepine

      Explanation:

      The patient’s history points to absence seizures. Carbamazepine has been shown to aggravate generalized seizure types, especially absence seizures, because it acts directly on the ventrobasal complex of the thalamus which is critical to the neurophysiology of absence seizures.

    • This question is part of the following fields:

      • Neurology
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  • Question 28 - Regarding the thymus, which of the following is true? ...

    Incorrect

    • Regarding the thymus, which of the following is true?

      Your Answer:

      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:

      • Endocrinology
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  • Question 29 - A 66 year-old marketing analyst presents to the respiratory clinic with a 2-month...

    Incorrect

    • A 66 year-old marketing analyst presents to the respiratory clinic with a 2-month history of progressive weakness and shortness of breath. He finds it difficult to stand from sitting, and struggles climbing stairs. He is an ex-smoker with chronic obstructive pulmonary disease (COPD). He had a recent exacerbation one month ago for which he was treated by the GP with a course of oral prednisolone, during which time his weakness transiently improved. On examination, you note a left-sided monophonic wheeze and reduced breath sounds at the left lung base. Blood tests and a chest x-ray are requested.

      Hb 145 g/L
      WCC10.5 109/L,
      Na+136 mmol/L,
      K+ 4.3 mmol/L,
      Urea 6.8 mmol/L,
      Creatinine 93 mmol/L,
      Calcium 2.62 mmol/L,
      Phosphate 1.44 mmol/L,


      Chest x-ray shows hyperinflated lungs, left lower lobe collapse and a bulky left hilum

      What is the most likely cause of this patient's weakness?

      Your Answer:

      Correct Answer: Lambert-Eaton myasthenic syndrome

      Explanation:

      This man has a small-cell lung cancer (SCLC) and associated Lambert-Eaton myasthenic syndrome – a well-recognized paraneoplastic manifestation of SCLC. This classically affects the proximal muscles, especially in the legs, causing difficulty in standing from a seated position and climbing stairs. In contrast to myasthenia gravis, eye involvement is uncommon. Treatment with steroids is often helpful, which explains his transient symptomatic improvement during treatment for his COPD exacerbation. Steroid myopathy does not fit as the symptoms started well before his course of prednisolone. Although the patient is mildly hypercalcaemic, this would not be sufficient to produce his presenting symptoms, although it does reinforce the suspicion of lung malignancy. Motor neurone disease would be unlikely in this context and would not improve with steroids. Myasthenia gravis could produce these symptoms, but in the context of a new lung mass is a less viable diagnosis.

    • This question is part of the following fields:

      • Neurology
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  • Question 30 - A 24-year-old woman who is known to have type 1 diabetes mellitus, presents...

    Incorrect

    • A 24-year-old woman who is known to have type 1 diabetes mellitus, presents with a three month history of diarrhoea, fatigue and weight loss. She has tried excluding gluten from her diet for the past 4 weeks and feels much better. She requests to be tested so that a diagnosis of coeliac disease can be confirmed. What is the most appropriate next step?

      Your Answer:

      Correct Answer: Ask her to reintroduce gluten for the next 6 weeks before further testing

      Explanation:

      The patient likely has celiac’s disease, but if she has been avoiding gluten, a biopsy may be negative. Even though a biopsy is the gold standard for diagnosis, she will need to re-introduce gluten into her diet prior to undergoing the biopsy.

    • This question is part of the following fields:

      • Gastroenterology
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