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  • Question 1 - A 48-year-old ex-footballer with a long history of alcohol abuse, presents with epigastric...

    Incorrect

    • A 48-year-old ex-footballer with a long history of alcohol abuse, presents with epigastric pain. Which of the following suggests a diagnosis of peptic ulceration rather than chronic pancreatitis?

      Your Answer: Loose stool

      Correct Answer: Relieved by food

      Explanation:

      Relief of symptoms with food suggests duodenal ulceration, for which the pain gets worse on an empty stomach. In chronic pancreatitis, you would expect worsening of symptoms with food.

    • This question is part of the following fields:

      • Gastroenterology
      3
      Seconds
  • Question 2 - A 55-year-old man presents to the ED complaining of extreme fatigue. He has...

    Incorrect

    • A 55-year-old man presents to the ED complaining of extreme fatigue. He has a history of Graves disease. On examination, his blood pressure is 103/58 mmHg, pulse 64/min and temperature 36.3ºC.
      The following results are obtained:
      Na+ 135 mmol/L,
      K+ 5.4 mmol/L,
      Urea 5.2 mmol/L,
      Creatinine 42 umol/L,
      TSH 3.5 mu/l,
      Free thyroxine (T4) 12 pmol/L.

      You arrange for a random cortisol test, however, whilst awaiting the result he becomes unresponsive. In addition to giving intravenous steroids and fluid, what test is urgent to check first given the likely diagnosis?

      Your Answer:

      Correct Answer: Glucose

      Explanation:

      The patient is most likely to have Addison’s disease as he has a history of autoimmune disease, hyperkalaemia and hypotension.
      It is important to keep an Addisonian crisis on the differential in cases of shock, especially since adrenal crisis can be the patient’s first presentation of adrenal insufficiency.
      Patients with Addison’s disease are prone to developing hypoglycaemia due to loss of the glucogenic effect of glucocorticoids. Given the sudden deterioration, a glucose level must be checked.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 3 - A 39 year old woman with a history of rheumatoid arthritis has recently...

    Incorrect

    • A 39 year old woman with a history of rheumatoid arthritis has recently been switched from methotrexate to leflunomide. Monitoring of full blood count and LFTs has been carried out. Which of the following parameters should also be monitored in this case?

      Your Answer:

      Correct Answer: Blood pressure

      Explanation:

      Blood pressure should be routinely measured as leflunomide may cause hypertension and thus an increase in BP. It doesn’t cause changes in blood sugar levels, peak expiratory flow rate or haematuria.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 4 - 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 5 - A 60 year old male presents with thickened patches of skin over his...

    Incorrect

    • A 60 year old male presents with thickened patches of skin over his knuckles and extensor surfaces that are consistent with Gottron's papules. Results reveal an elevated creatine kinase. Diagnosis of dermatomyositis is suspected. Which of the following autoantibody is most specific for this condition?

      Your Answer:

      Correct Answer: Anti-Mi-2 antibodies

      Explanation:

      Anti–Mi-2 antibodies are highly specific for dermatomyositis, but sensitivity is low; only 25% of patients with dermatomyositis demonstrate these antibodies. A positive antinuclear antibody (ANA) finding is common in patients with dermatomyositis, but is not necessary for diagnosis. Anti-Jo-1 antibodies are mostly associated with polymyositis. Anti Scl-70 antibodies and anti centromere antibodies are most commonly found in systemic scleroderma.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 6 - A 54-year-old woman, with a long history of inflammatory bowel disease presents to...

    Incorrect

    • A 54-year-old woman, with a long history of inflammatory bowel disease presents to his GP with abnormal liver function tests. She has a raised alkaline phosphatase level but no symptoms of liver disease.

      Which of the following options is the best set of investigations to confirm the diagnosis?

      Your Answer:

      Correct Answer: MRCP and liver biopsy

      Explanation:

      In a patient with abnormal LFTs and UC, think primary sclerosing cholangitis (PSC). MRCP and liver biopsy is the best answer. MRCP will show classically beads on a string – intra and extrahepatic stricturing and dilation. Remember this finding!! Liver biopsy is required for official diagnosis (need tissue!).

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 7 - A 68 year old female is on long term prednisolone therapy for polymyalgia...

    Incorrect

    • A 68 year old female is on long term prednisolone therapy for polymyalgia rheumatica. Which of the following would be the most suitable protection against osteoporosis?

      Your Answer:

      Correct Answer: Oral bisphosphonate

      Explanation:

      Prevention of osteoporosis associated with chronic glucocorticoid therapy is done by administrating bisphosphonates. Oral bisphosphonates are indicated for patients aged above 65 who have been on steroid therapy for over 3 months, so as to reduce the risk of steroid induced osteoporosis. HRT is usually done in post menopausal women who have oestrogen related bone resorption.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 8 - 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 9 - A 65 yr. old man with hypertension presented with sudden onset right arm...

    Incorrect

    • A 65 yr. old man with hypertension presented with sudden onset right arm weakness which resolved after 10 hrs. He has had 2 similar episodes during the last 6 weeks. On examination his blood pressure was 140/80 mmHg and pulse rate was 88 bpm. His ECG showed atrial fibrillation and the CT scan of his brain was normal. Which of the following is the most appropriate management for this patient?

      Your Answer:

      Correct Answer: Warfarin

      Explanation:

      CHA₂DS₂-VASc score is used for atrial fibrillation stroke risk calculation.
      Congestive heart failure – 1 point
      Hypertension – 1 point
      Age ≥75 years – 2 points
      Diabetes mellitus – 1 point
      Stroke/Transient Ischemic Attack/Thromboembolic event – 2 points
      Vascular disease (prior MI, PAD, or aortic plaque) – 1 point
      Age 65 to 74 years – 1 point
      Sex category (i.e., female sex) – 1 point
      Score of 2 or more is considered as high risk and anticoagulation is indicated. This patient’s score is 4, so he needs life-long warfarin to prevent a stroke.

    • This question is part of the following fields:

      • Cardiology
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  • Question 10 - 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 11 - A 6-year-old boy is referred by his GP to the neurology clinic with...

    Incorrect

    • A 6-year-old boy is referred by his GP to the neurology clinic with abnormal movements. His mother noticed that for the last year, the boy has been falling over more and more frequently. He has also been having increasingly slurred speech. These have been getting progressively worse. He has had recurrent chest infections in his childhood.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Ataxic telangiectasia

      Explanation:

      Ataxic telangiectasia is an inherited combined immunodeficiency disorder that is characterised by cerebellar ataxia and telangiectasia as seen in this child, as well as frequent infections as noted in this child’s history. The other differentials would not present with this clinical picture:

      Friedreich’s ataxia and Infantile-onset spinocerebellar ataxia do not present with immune problems, whereas Cerebral palsy and Di-George Syndrome do not present with ataxia.

    • This question is part of the following fields:

      • Neurology
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  • Question 12 - A 64 year old woman with ankylosing spondylitis presents with cough, weight loss...

    Incorrect

    • A 64 year old woman with ankylosing spondylitis presents with cough, weight loss and tiredness. Her chest x-ray shows longstanding upper lobe fibrosis. Three sputum tests stain positive for acid fast bacilli (AFB) but are consistently negative for Mycobacterium tuberculosis on culture.
       
      Which of the following is the most likely causative agent?

      Your Answer:

      Correct Answer: Mycobacterium avium intracellular complex

      Explanation:

      Pulmonary mycobacterium avium complex (MAC) infection in immunocompetent hosts generally manifests as cough, sputum production, weight loss, fever, lethargy, and night sweats. The onset of symptoms is insidious.
      In patients who may have pulmonary infection with MAC, diagnostic testing includes acid-fast bacillus (AFB) staining and culture of sputum specimens.

      The ATS/IDSA guidelines include clinical, radiographic, and bacteriologic criteria to establish a diagnosis of nontuberculous mycobacterial lung disease.

      Clinical criteria are as follows:

      Pulmonary signs and symptoms such as cough, fatigue, weight loss; less commonly, fever and weight loss; dyspnoea

      Appropriate exclusion of other diseases (e.g., carcinoma, tuberculosis).

      At least 3 sputum specimens, preferably early-morning samples taken on different days, should be collected for AFB staining and culture. Sputum AFB stains are positive for MAC in most patients with pulmonary MAC infection. Mycobacterial cultures grow MAC in about 1-2 weeks, depending on the culture technique and bacterial burden.

    • This question is part of the following fields:

      • Respiratory
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  • Question 13 - A 13 yr. old boy presented with difficulty in breathing on exertion. According...

    Incorrect

    • A 13 yr. old boy presented with difficulty in breathing on exertion. According to his mother who was also present, his exercise tolerance has been gradually worsening for the past weeks. It has reached the point where he is unable to participate in his weekly soccer match. Cardiac catherization was performed and the results are given below:
      (Anatomical site vs Oxygen saturation (%)vs Pressure (mmHg))

      Superior vena cava:
      73
      ,–.

      Right atrium:
      71,
      6.

      Right ventricle:
      72,
      –.

      Pulmonary artery:
      86,
      53/13.

      PCWP:
      –,
      15.

      Left ventricle:
      97,
      111/10.

      Aorta:
      96,
      128/61.

      Which of the following is the diagnosis?

      Your Answer:

      Correct Answer: Patent ductus arteriosus

      Explanation:

      The oxygen saturation in the pulmonary artery is higher than that of the right ventricle. The pressure of the pulmonary artery and of the PCWP are also high. So patent ductus arteriosus is highly suggestive.

    • This question is part of the following fields:

      • Cardiology
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  • Question 14 - 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 15 - Which of the following is the main mechanism of vitamin B12 absorption? ...

    Incorrect

    • Which of the following is the main mechanism of vitamin B12 absorption?

      Your Answer:

      Correct Answer: Active absorption in the terminal ileum

      Explanation:

      Vitamin B12 is mostly used in the body for the development of red blood cells and maintenance of the nervous system. It is actively absorbed in the terminal ileum after binding to the intrinsic factor (IF) which is secreted from the parietal cells of stomach. Moreover, a small amount is also passively absorbed without being bound to IF.

      Vitamin B12 deficiency is characterised by sore tongue and mouth, mood disturbances, ataxia, and macrocytic anaemia. Its causes include poor diet, impaired absorption (due to disorders of terminal ileum), pernicious anaemia, and post-gastrectomy. While managing this condition, if the person is also deficient in folic acid, then it is important to treat the B12 deficiency first in order to avoid precipitating subacute combined degeneration of the cord.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 16 - A 60-year old female suddenly started seeing a curtain-like shadow in her field...

    Incorrect

    • A 60-year old female suddenly started seeing a curtain-like shadow in her field of vision with flashes of lights and subsequent loss of vision, which prompted her to visit her ophthalmologist. What do you think is the most appropriate treatment in this case?

      Your Answer:

      Correct Answer:

      Explanation:

      Flashes of light, presence of floaters and loss of vision (often described as a black curtain closing in on the visual field) are symptoms that strongly indicate retinal detachment. The fundoscopy findings of retinal tears support this diagnosis. Therefore, surgery of retina must be done to treat this patient.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 17 - A 70-year-old male presents with chest pain. His past medical history includes hypertension...

    Incorrect

    • A 70-year-old male presents with chest pain. His past medical history includes hypertension and angina. He continues to smoke about 20 cigarettes per day despite being advised about lifestyle modifications.
      Blood investigations obtained in the emergency department show:

      Na+: 133 mmol/L,
      K+: 3.3 mmol/L,
      Urea: 4.5 mmol/L,
      Creatinine: 90 μmol/L,

      Which among the following is the most likely explanation for the abnormalities seen in the above investigations?

      Your Answer:

      Correct Answer: Bendroflumethiazide therapy

      Explanation:

      The blood investigations in this patient reveal hyponatremia as well as hypokalaemia. Among the options provided, Bendroflumethiazide therapy can cause the above presentation with the electrolyte disturbances.
      Note:
      – Spironolactone is a potassium-sparing diuretic that is associated with hyperkalaemia.
      – Enalapril therapy can cause side effects of dizziness, hypotension, cough, and rarely a rash.
      – Felodipine therapy can cause side effects of dizziness, headache, cough, and palpitations.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 18 - A 50-year-old woman was investigated following an osteoporotic hip fracture. The following results...

    Incorrect

    • A 50-year-old woman was investigated following an osteoporotic hip fracture. The following results are obtained:
      TSH < 0.05 mu/l,
      Free T4 29 pmol/L.

      Which of the following autoantibodies is most likely to be present?

      Your Answer:

      Correct Answer: TSH receptor stimulating autoantibodies

      Explanation:

      The patient has hyperthyroidism and its most common cause is Grave’s Disease.
      Grave’s Disease is an autoimmune disease due to circulating autoantibodies known as TSH receptor stimulating autoantibodies or Thyroid-stimulating immunoglobulins (TSIs) that bind to and activate thyrotropin receptors, causing the thyroid gland to grow and the thyroid follicles to increase the synthesis of thyroid hormone.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 19 - A 52 year old female, known case of rheumatoid arthritis presents to the...

    Incorrect

    • A 52 year old female, known case of rheumatoid arthritis presents to the clinic with dyspnoea, cough, and intermittent pleuritic chest pain. She was previously taking second line agents Salazopyrine and gold previously and has now started Methotrexate with folic acid replacement a few months back. Pulmonary function tests reveal restrictive lung pattern and CXR reveals pulmonary infiltrates.
      Which of the following treatments is most suitable in this case?

      Your Answer:

      Correct Answer: Stop methotrexate

      Explanation:

      Methotrexate lung disease (pneumonitis and fibrosis) is the specific etiological type of drug-induced lung disease. It can occur due to the administration of methotrexate which is an antimetabolite, which is given as disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis. The typical clinical symptoms include progressive shortness of breath and cough, often associated with fever. Hypoxemia and tachypnoea are always present and crackles are frequently audible. Symptoms typically manifest within months of starting therapy. Methotrexate withdrawal is indicated in such cases.

    • This question is part of the following fields:

      • Respiratory
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  • Question 20 - A 61 year old male is noted to be depressed following a recent...

    Incorrect

    • A 61 year old male is noted to be depressed following a recent heart attack. He has a history of ischaemic heart disease. Which antidepressant would be appropriate for this patient?

      Your Answer:

      Correct Answer: Sertraline

      Explanation:

      Major depression (MD) often occurs after MI and has been shown to be an independent predictor of poor cardiovascular (CV) outcome.

      Results of a randomized trial confirm that the antidepressant sertraline can be used safely in patients with recent MI or unstable angina and is effective in relieving depression in these patients.

      Adverse effects to note:
      Sertraline – Diarrhoea (13-24%), Nausea (13-30%), Headache (20-25%),
      Insomnia (12-28%)
      Imipramine – ECG changes, orthostatic hypotension, tachycardia
      Confusion, extrapyramidal symptoms (EPS), dizziness, paraesthesia, tinnitus
      Flupentixol – seizures, irregular/fast heartbeat, increased sweating
      Paroxetine – Hypertension, Tachycardia, Emotional lability, Pruritus
      Venlafaxine – Abnormal vision (4-6%), Hypertension (2-5%), Paraesthesia (2-3%), Vasodilation (2-6%), Aneurism, Deep vein thrombophlebitis, Takotsubo cardiomyopathy

    • This question is part of the following fields:

      • Psychiatry
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  • Question 21 - A 34-year-old woman has had progressive reduction of visual acuity over the past...

    Incorrect

    • A 34-year-old woman has had progressive reduction of visual acuity over the past 3 years. She has now almost lost all of her vision. What is the diagnosis?

      Your Answer:

      Correct Answer: Retinitis pigmentosa

      Explanation:

      Retinitis pigmentosa is a genetic disorder of the eyes that causes loss of vision. Symptoms include trouble seeing at night and decreased peripheral vision. Onset of symptoms is generally gradual.
      – In keratitis, there will be pain, redness and photophobia but vision is not affected
      – In macular degeneration, near blindness does not occur rather the inability to identify faces or read small print
      – Cataracts are more common in elderly
      – It is not angle closure glaucoma as angle closure glaucoma occurs usually after the age of 50; In open angle glaucoma visual loss is not gradual but rather occurs suddenly following progression

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 22 - 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 23 - Which one of the following statements is incorrect with regards to post-partum mental...

    Incorrect

    • Which one of the following statements is incorrect with regards to post-partum mental health problems?

      Your Answer:

      Correct Answer: Post-natal depression is seen in around 2-3% of women

      Explanation:

      Most new moms experience postpartum baby blues after childbirth, which commonly include mood swings, crying spells, anxiety and difficulty sleeping. Baby blues typically begin within the first two to three days after delivery, and may last for up to two weeks.

      Postpartum depression may be mistaken for baby blues at first — but the signs and symptoms are more intense and last longer, and may eventually interfere with your ability to care for your baby and handle other daily tasks. Symptoms usually develop within the first few weeks after giving birth, but may begin earlier, during pregnancy or later, up to a year after birth.

      The period prevalence of postpartum depression among women is a striking 21.9% the first year after birth, which makes it one of the most common medical complications of childbearing. Sertraline has been identified as an antidepressant of choice for breastfeeding women because infants are unlikely to develop quantifiable serum sertraline levels and very few adverse events associated with sertraline have been reported.

      Women with a prior episode of postpartum psychosis have about a 30% risk of having another episode in the next pregnancy.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 24 - A 43-year-old right-handed migraineur is admitted to hospital having developed paraesthesia affecting her...

    Incorrect

    • A 43-year-old right-handed migraineur is admitted to hospital having developed paraesthesia affecting her left arm. This came on suddenly during a migrainous attack while out shopping. The paraesthesia appeared to effect the entire left arm and in the last few hours, has spread to involve the left side of the face. She had had a similar episode several months ago whereby she developed some right-sided leg and arm weakness while at work. The weakness lasted several minutes and subsequently abated. At the time, she was also having one of her migraines. She has a long-standing history of migraines, which typically start with a prolonged aura and fortification spectra. Other then migraines, for which she has been taking pizotifen, she has no other past medical history. Her sister also suffers from migraines, and her mother has a history of dementia in her 50s. She is a non-smoker and drinks minimal alcohol.
      On examination she was orientated but apathetic. Her blood pressure was 130/65 mmHg, pulse 62/min, and temperature 36.2ºC. There were no carotid bruits and heart sounds were entirely normal. There was reduced sensation to all modalities over the left side of the face extending to the vertex and the entire left arm. Tone and reflexes appeared intact; however, handgrip was reduced on the left due to numbness. The lower limb appeared entirely normal.
      Magnetic resonance (MR) scan showed bilateral, multifocal, T2/FLAIR (fluid attenuated inversion recovery ) hyperintensities in the deep white matter. MR Spinal cord was normal.
      What is the diagnosis?

      Your Answer:

      Correct Answer: CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy)

      Explanation:

      CADASIL is the most common form of hereditary stroke disorder. This case has a strong history of migraine with aura with stroke-like episodes, characteristic of CADASIL. Additionally, there is positive family history of migraine and early dementia but no other vascular risk factors like hypertension, diabetes, or hypercholesterolaemia, which all confirm the suspicion of CADASIL, an arteriopathy where there is thickening of the smooth muscle cells in the blood vessels.

    • This question is part of the following fields:

      • Neurology
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  • Question 25 - 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:

      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
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  • Question 26 - A 13-year-old boy complains of several episodes of collapse. He describes the majority...

    Incorrect

    • A 13-year-old boy complains of several episodes of collapse. He describes the majority of these episodes occurring when he is laughing. He states that he loses power in his legs and falls to the ground. He is alert throughout and recovers quickly. He also describes excessive daytime sleepiness with episodes in the morning of being awake but being unable to move his body. Examination is unremarkable. A diagnosis of narcolepsy is made. Which of the following is the first line treatment for excessive daytime sleepiness?

      Your Answer:

      Correct Answer: Modafinil

      Explanation:

      Narcolepsy is a rare condition characterised by excessive daytime sleepiness, sleep paralysis, hypnagogic hallucinations, and cataplexy (sudden collapse triggered by emotion such as laughing or crying). There is no cure for narcolepsy. Treatment options include stimulants, such as methylphenidate (Ritalin) or modafinil (Provigil), antidepressants, such as fluoxetine (Prozac), citalopram (Celexa), paroxetine (Paxil), sertraline (Zoloft) and sodium oxybate (Xyrem). Modafinil has replaced methylphenidate and amphetamine as the first-line treatment of excessive daytime sleepiness (EDS).

    • This question is part of the following fields:

      • Neurology
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  • Question 27 - Which is the best source of vitamin D per average serving for a...

    Incorrect

    • Which is the best source of vitamin D per average serving for a woman with suspected Osteomalacia?

      Your Answer:

      Correct Answer: Cod liver oil

      Explanation:

      Serum vitamin D levels are influenced by sun exposure and diet. Cod liver oil is an important dietary vitamin D source in high-latitude countries like Norway where there is no sun-induced vitamin D production during the winter. 14 Norwegian Health Authorities have recommended 5 ml of cod liver oil daily (400 IU of vitamin D) for more than 60 years to prevent diseases like rickets, formerly more prevalent in areas with little access to vitamin D-rich fatty fish.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 28 - Which one of the following interventions has the least role in management of...

    Incorrect

    • Which one of the following interventions has the least role in management of acne rosacea?

      Your Answer:

      Correct Answer: Low-dose topical corticosteroids

      Explanation:

      Mild cases are often not treated at all, or are simply covered up with normal cosmetics and avoiding sun exposure. Therapy for the treatment of rosacea is not curative, and is best measured in terms of reduction in the amount of facial redness and inflammatory lesions. The two primary modalities of rosacea treatment are topical and oral antibiotic agents (including metronidazole and tetracyclines). Laser therapy may be appropriate for patients with prominent telangiectasia.

    • This question is part of the following fields:

      • Dermatology
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  • Question 29 - A 66-year-old man with newly-diagnosed small cell carcinoma discusses his further treatment options...

    Incorrect

    • A 66-year-old man with newly-diagnosed small cell carcinoma discusses his further treatment options with the team of doctors.
      Which statement is incorrect about small cell carcinoma?

      Your Answer:

      Correct Answer: Patients with small cell lung cancer always benefit from surgery

      Explanation:

      Small cell lung cancer (SCLC) is characterized by rapid growth and early dissemination. Prompt initiation of treatment is important.

      Patients with clinical stage Ia (T1N0) after standard staging evaluation may be considered for surgical resection, but combined treatment with chemotherapy and radiation therapy is the standard of care. Radiation therapy is often added at the second cycle of chemotherapy.

      Historically, patients undergoing surgery for small cell lung cancer (SCLC) had a dismal prognosis. However, more recent data suggest that patients with true stage I SCLC may benefit from surgical resection.

      Common sites of hematogenous metastases include the brain, bones, liver, adrenal glands, and bone marrow. The symptoms depend upon the site of spread.

    • This question is part of the following fields:

      • Respiratory
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  • Question 30 - A 38-year-old musician presented with a two-day history of sudden-onset occipital headache associated...

    Incorrect

    • A 38-year-old musician presented with a two-day history of sudden-onset occipital headache associated with nausea and vomiting. The next day, his right hand became weak for a few hours. On the same day he had an episode of sensory disturbance in his right upper limb consisting of tingling in his hand that spread up the arm, to his shoulder lasting less than two minutes in total. On the day of admission he had a similar episode of sensory disturbance lasting 30 seconds in total. On examination he had bilateral papilledema, no neck stiffness and an otherwise normal neurological examination. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Venous sinus thrombosis

      Explanation:

      Cerebral venous sinus thrombosis (CVST) is associated with headache (>90% of cases), seizures, focal weakness (40%) and papilledema (40%), all seen in this patient.
      Risk factors for CVST include genetic or acquired prothrombotic disorders, pregnancy, the oral contraceptive pill, vasculitis, malignancy, dehydration and infection. However, there are multiple other associated factors.
      Diagnosis is normally confirmed with magnetic resonance venography (MRV). Treatment is with anticoagulation, initially with heparin and subsequently with warfarin.

    • This question is part of the following fields:

      • Neurology
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