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  • Question 1 - A 31-year-old female is admitted to the E.D complaining of severe abdominal pain....

    Incorrect

    • A 31-year-old female is admitted to the E.D complaining of severe abdominal pain. On examination, she is seen trembling and rolling around the trolley. She has previously been investigated for abdominal pain and no cause has been found. She states that she will commit suicide unless she is given morphine for the pain. Which condition is this is an example of?

      Your Answer: Somatisation disorder

      Correct Answer: Malingering

      Explanation:

      Malingering is not considered a mental illness. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), malingering receives a V code as one of the other conditions that may be a focus of clinical attention. The DSM-5 describes malingering as the intentional production of false or grossly exaggerated physical or psychological problems. Motivation for malingering is usually external (e.g., avoiding military duty or work, obtaining financial compensation, evading criminal prosecution, or obtaining drugs).

      Malingering should be strongly suspected if any combination of the following factors is noted to be present: (1) medicolegal context of presentation; (2) marked discrepancy between the person’s claimed stress or disability and the objective findings; (3) lack of cooperation during the diagnostic evaluation and in complying with the prescribed treatment regimen; and (4) the presence in the patient of antisocial personality disorder (ASPD).

      This patient is be pretending to be sick in order to get morphine.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 2 - The following are commonly recognized disease syndromes associated with Clostridium species, except: ...

    Incorrect

    • The following are commonly recognized disease syndromes associated with Clostridium species, except:

      Your Answer:

      Correct Answer: exfoliative skin rash

      Explanation:

      Clostridium species do not present with an exfoliative skin rash. C. perfringens is a common aetiology in necrotizing infections (gas gangrene) as well as food poisoning, which often also includes diarrhoea. C. difficle causes diarrhoea. C. tetany and C. botulinum have neurotoxins that can lead to paralysis.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 3 - A 19-year-old lady with established anorexia nervosa is admitted with a BMI of...

    Incorrect

    • A 19-year-old lady with established anorexia nervosa is admitted with a BMI of 16. However, she gives the consent to be fed by a nasogastric tube. Which of the following electrolyte disturbances are you most likely to find?

      Your Answer:

      Correct Answer: Hypophosphataemia

      Explanation:

      Refeeding syndrome can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (whether enterally or parenterally). These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. However, the syndrome is complex and may also feature abnormal sodium and fluid balance; changes in glucose, protein, and fat metabolism; thiamine deficiency; hypokalaemia; and hypomagnesaemia.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 4 - Which of the following measurements is a poor prognostic factor in patients suffering...

    Incorrect

    • Which of the following measurements is a poor prognostic factor in patients suffering from pneumonia?

      Your Answer:

      Correct Answer: Respiratory rate 35/min

      Explanation:

      CURB Pneumonia Severity Score estimates the mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.
      Select Criteria:
      Confusion (abbreviated Mental Test Score <=8) (1 point)
      Urea (BUN > 19 mg/dL or 7 mmol/L) (1 point)
      Respiratory Rate > 30 per minute (1 point)
      Blood Pressure: diastolic < 60 or systolic < 90 mmHg (1 point) The CURB-65 scores range from 0 to 5. Clinical management decisions can be made based on the score:
      Score Risk Disposition
      0 or 1 – 1.5% mortality – Outpatient care
      2 – 9.2% mortality – Inpatient vs. observation admission
      ≥ 3 – 22% mortality – Inpatient admission with consideration for ICU admission with score of 4 or 5

    • This question is part of the following fields:

      • Respiratory
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  • Question 5 - 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 6 - 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 7 - A 24-year-old student is brought to A&E having ingested at least 20 tablets...

    Incorrect

    • A 24-year-old student is brought to A&E having ingested at least 20 tablets of paracetamol 8 hours earlier. She weighs 61kg.

      What should her immediate management consist of?

      Your Answer:

      Correct Answer: Intravenous N-acetylcysteine

      Explanation:

      Activated charcoal is useful if given within one hour of the paracetamol overdose. Liver function tests, INR and prothrombin time will be normal, as liver damage may not manifest until 24 hours or more after ingestion.

      The antidote of choice is intravenous N-acetylcysteine, which provides complete protection against toxicity if given within 10 hours of the overdose.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 8 - In idiopathic hypercalciuria, what management should be initiated if there is renal stone...

    Incorrect

    • In idiopathic hypercalciuria, what management should be initiated if there is renal stone disease or bone demineralization?

      Your Answer:

      Correct Answer: Dietary modification and thiazide diuretics

      Explanation:

      Idiopathic hypercalciuria presents with excess calcium in the urine without an apparent cause. Dietary modification is the first step in addressing this condition, however, because hypercalciuria increases the risk of developing renal stones and bone demineralisation, thiazide diuretics should be prescribed to increase calcium reabsorption when these symptoms are also present.

    • This question is part of the following fields:

      • Nephrology
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  • Question 9 - A 29 year-old new mother presented with a headache that was first noticed...

    Incorrect

    • A 29 year-old new mother presented with a headache that was first noticed as she was picking up her 5 week-old baby. On admission, she was unable to tolerate the lights and complained of feeling sick. Fundoscopy showed bilateral papilledema, and she was complaining that she was unable to see on her left side. CT head showed a small right occipital bleed. Which of the following treatments is most appropriate?

      Your Answer:

      Correct Answer: Heparin

      Explanation:

      This patient has developed a venous sinus thrombosis peri-partum, resulting in her symptoms. Anticoagulation therapy including Heparin improves outcomes.

    • This question is part of the following fields:

      • Neurology
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  • Question 10 - A 50-year-old male presents to the ER allegedly claiming that he consumed a...

    Incorrect

    • A 50-year-old male presents to the ER allegedly claiming that he consumed a bottle of antifreeze. Which of the following symptoms is least likely to be associated with this kind of poisoning?

      Your Answer:

      Correct Answer: Loss of vision

      Explanation:

      Loss of vision after consumption of antifreeze is a characteristic presentation of methanol poisoning.

      Pathophysiology of methanol toxicity:
      When ingested, methanol is absorbed rapidly via the gastrointestinal tract in less than 10 minutes. Methanol is not protein-bound and is absorbed directly into the total body water compartment.
      Metabolism occurs mainly in the liver through serial oxidation via alcohol dehydrogenase and aldehyde dehydrogenase but begins with alcohol dehydrogenase present in the gastric mucosa.
      Alcohol dehydrogenase oxidizes methanol to formaldehyde, and aldehyde dehydrogenase subsequently oxidizes formaldehyde to formic acid.
      Formic acid is the primary toxic metabolite that accounts for the associated anion gap metabolic acidosis and end-organ damage.

      Clinical presentation:
      Patients who present within the first 12 to 24 hours following ingestion may appear normal, and this is described as the latent period.
      Nausea, vomiting, and abdominal pain subsequently ensue, followed by CNS depression and hyperventilation due to metabolic acidosis.
      Ocular symptoms associated with retinal toxicity are often evident in the form of blurry vision, decreased visual acuity, photophobia, and “halo vision.”

      Treatment:
      Treatment options for methanol toxicity include supportive care, fomepizole (Antizole, 4-Methylpyrazole or 4MP), ethanol, dialysis, and folate.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 11 - 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 12 - A 32 year old Indian male presents to the clinic with fever, cough...

    Incorrect

    • A 32 year old Indian male presents to the clinic with fever, cough and an enlarged cervical lymph node. Examination reveals a caseating granuloma in the lymph node. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: TB adenitis

      Explanation:

      Tuberculous lymphadenitis is a chronic, specific granulomatous inflammation of the lymph node with caseation necrosis, caused by infection with Mycobacterium tuberculosis or a related bacteria. The characteristic morphological element is the tuberculous granuloma (caseating tubercle).

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 13 - A 31 year old female with systemic lupus erythematosus wants to know if...

    Incorrect

    • A 31 year old female with systemic lupus erythematosus wants to know if she has any predisposing factors for the disease. Which of the following carries the greatest risk of developing SLE?

      Your Answer:

      Correct Answer: Monozygotic twin

      Explanation:

      An overall concordance rate in monozygotic twins was documented to be 25% as compared to dizygotic twins with 3%. First degree relatives have a chance of around 3% of developing the disease. Caucasians show an increase frequency of HLA-B8. The Japanese lupus patients had a stronger association with HLA-DR2.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 14 - A 28 yr. old primigravida in her 24th week of pregnancy presented with...

    Incorrect

    • A 28 yr. old primigravida in her 24th week of pregnancy presented with a history of palpitations, which are fast and regular. She doesn't complain of any episodes of collapse. On examination she was well, pulse rate was 102 bpm, which was regular and her blood pressure was 110/70 mmHg. Her JVP was not elevated. Heart sounds were normal. ECH showed sinus tachycardia. Which of the following can be expected because of the  physiological changes which occur in the boy during pregnancy?

      Your Answer:

      Correct Answer: Tachycardia

      Explanation:

      The cardiovascular alterations which occur during pregnancy are for the optimal growth and development of the foetus and help to protect the mother from the risks of delivery, such as haemorrhage. The changes are characterized by an increased vascular volume, cardiac output, and heart rate, with a marked fall in vascular resistance and reduction in blood pressure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 15 - Which of the following gives the annual incidence of deep venous thrombosis (DVT)...

    Incorrect

    • Which of the following gives the annual incidence of deep venous thrombosis (DVT) in the general population?

      Your Answer:

      Correct Answer: about 2 per 1000

      Explanation:

      Annual incidence of DVT in the general population is about 1 per 1000 adults. So the most suitable answer is about 2 per 1000.

    • This question is part of the following fields:

      • Cardiology
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  • Question 16 - Which of the following is least likely to cause warm autoimmune haemolytic anaemia?...

    Incorrect

    • Which of the following is least likely to cause warm autoimmune haemolytic anaemia?

      Your Answer:

      Correct Answer: Mycoplasma infection

      Explanation:

      Mycoplasma infection causes cold autoimmune haemolytic anaemia (AIHA). The rest of the aforementioned options cause warm AIHA.

      AIHA may be divided into ‘warm’ and ‘cold’ types, according to the temperature at which the antibodies best cause haemolysis. It is most commonly idiopathic but may be secondary to a lymphoproliferative disorder, infection, or drugs.

      1. Warm AIHA:
      In warm AIHA, the antibody (usually IgG) causes haemolysis best at body temperature and tends to occur in extravascular sites, for example, spleen. Management options include steroids, immunosuppression, and splenectomy. It is caused by autoimmune diseases such as SLE (rarely causes mixed-type AIHA), cancers such as lymphomas and CLL, and drugs such as methyldopa.

      2. Cold AIHA:
      The antibody in cold AIHA is usually IgM and causes haemolysis best at 4°C and occurs more commonly intravascularly. Features may include symptoms of Raynaud’s disease and acrocyanosis. Patients do not respond well to steroids. Cold AIHA is caused by cancers such as lymphomas, and infections such as mycoplasma and EBV.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 17 - A 35 year old female, known case of anti phospholipid syndrome, arrives at...

    Incorrect

    • A 35 year old female, known case of anti phospholipid syndrome, arrives at the clinic due to a swollen and painful left leg. Doppler ultrasonography confirms the diagnosis of a deep vein thrombosis. She was previously diagnosed with DVT 4 months back and was on warfarin therapy (target INR 2-3) when it occurred. How should her anticoagulation be managed?

      Your Answer:

      Correct Answer: Life-long warfarin, increase target INR to 3 - 4

      Explanation:

      If the INR in the range of 2-3 has still resulted in thrombosis, the target INR is increased to 3-4. However, because the risk of bleeding increases as the INR rises, the INR is closely monitored and adjustments are made as needed to maintain the INR within the target range.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 18 - A 25-year-old woman with type-1 diabetes mellitus attends for her routine review and...

    Incorrect

    • A 25-year-old woman with type-1 diabetes mellitus attends for her routine review and says she is keen on becoming pregnant.
      Which of the following is most likely to make you ask her to defer pregnancy at this stage?

      Your Answer:

      Correct Answer: Hb A1C 9.4%

      Explanation:

      Pregnancies affected by T1DM are at increased risk for preterm delivery, preeclampsia, macrosomia, shoulder dystocia, intrauterine fetal demise, fetal growth restriction, cardiac and renal malformations, in addition to rare neural conditions such as sacral agenesis.
      Successful management of pregnancy in a T1DM patient begins before conception. Research indicates that the implementation of preconception counselling, emphasizing strict glycaemic control before and throughout pregnancy, reduces the rate of perinatal mortality and malformations.
      The 2008 bulletin from the National Institute for Health and Clinical Excellence recommends that preconception counselling be offered to all patients with diabetes. Physicians are advised to guide patients on achieving personalized glycaemic control goals, increasing the frequency of glucose monitoring, reducing their HbA1C levels, and recommend avoiding pregnancy if the said level is > 10%.
      Other sources suggest deferring pregnancy until HbA1C levels are > 8%, as this margin is associated with better outcomes.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 19 - A 23-year-old designer is requesting the combined oral contraceptive pill. During the history...

    Incorrect

    • A 23-year-old designer is requesting the combined oral contraceptive pill. During the history taking, she states that in the past she has had migraines with aura. She asks why the combined oral contraceptive pill is contraindicated. Which of the following is the most appropriate response?

      Your Answer:

      Correct Answer: Significantly increased risk of ischaemic stroke

      Explanation:

      SIGN produced guidelines in 2008 on the management of migraines. Key points include that if patients have migraines with aura then the combined oral contraceptive (COC) is absolutely contraindicated due to an increased risk of stroke (relative risk 8.72).

    • This question is part of the following fields:

      • Neurology
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  • Question 20 - A 25-year-old woman was admitted to hospital with a 3 day history of...

    Incorrect

    • A 25-year-old woman was admitted to hospital with a 3 day history of feeling generally unwell, with fatigue, arthralgia and pruritis. She had recently finished a 5 day course of antibiotics for a urinary tract infection but there was no other significant past medical history. She had no significant findings on clinical examination except for a widespread erythematous rash.

      Investigation results are below:

      Haemoglobin (Hb) 12.6 g/dL,
      White cell count (WCC) 13.0 × 109/l (eosinophilia)
      Platelets 390 × 109/L,
      Creatinine 720 μmol/L,
      Na+ 135 mmol/L,
      K+ 5.2 mmol/L,
      Urea 22.0 mmol/L,
      Urinalysis Protein ++ blood +


      What is the most important investigation to establish the diagnosis?

      Your Answer:

      Correct Answer: Renal biopsy

      Explanation:

      There is a strong suspicion of drug-induced acute tubulo-interstitial nephritis with the classic triad of symptoms of rash, joint pain and eosinophils in the blood, associated with non-specific symptoms of fever and fatigue. This can be confirmed with renal biopsy showing interstitial oedema with a heavy infiltrate of inflammatory cells and variable tubular necrosis.

    • This question is part of the following fields:

      • Nephrology
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  • Question 21 - A 60-year-old man has been admitted with dehydration following an attack of gastritis....

    Incorrect

    • A 60-year-old man has been admitted with dehydration following an attack of gastritis. His initial blood results revealed raised calcium and erythrocyte sedimentation rate (ESR). He has a history of hypertension, angina, chronic obstructive pulmonary disease (COPD), and diabetes.

      His most recent results have arrived on the ward, showing:
      Hb: 13.8 g/dL,
      WCC: 7.7 x 10^9/L,
      Plts: 212 x 10^9/L,
      Na+: 138 mmol/L,
      K+: 4.7 mmol/L,
      Ca+2: 2.4 mmol/L,
      Urea: 7.2 mmol/L,
      Creatinine: 104 mmol/L,
      Albumin: 38 g/L,
      IgG: 24 g/L (6.0-13.0),
      IgA: 2.1 g/L (0.8-3.0),
      IgM: 1.3 g/L (0.4-2.5).
      Trace amounts of Bence Jones protein have also been detected in the urine. CXR shows normal heart and mediastinal contours, clear lungs bilaterally, osteopenia of the bony skeleton with no lytic lesions.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Monoclonal gammopathy of undetermined significance

      Explanation:

      Monoclonal gammopathy of undetermined significance (MGUS)—also known as benign paraproteinemia and monoclonal gammopathy—is a pre-malignant condition not necessarily leading to its malignant form—multiple myeloma. MGUS causes increase of a serum monoclonal protein (M protein). It is not associated with ostealgia or increased risk of infections. It is often mistaken for multiple myeloma, differing from the latter in, no immunosuppression, anaemia, hypercalcaemia, lytic bone lesions, or renal failure; normal levels of beta-2 microglobulin; and stable lower levels of paraproteinemia.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 22 - A 20-year-old male presented to the clinic with a long term history of...

    Incorrect

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

      Your Answer:

      Correct Answer: Octreotide

      Explanation:

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

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

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

      Adverse effects
      Gallstones (secondary to biliary stasis)

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

    • This question is part of the following fields:

      • Pharmacology
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  • Question 23 - Causes of dilated pupils include which of the following? ...

    Incorrect

    • Causes of dilated pupils include which of the following?

      Your Answer:

      Correct Answer: Ethylene glycol poisoning

      Explanation:

      Ethylene glycol poisoning is the only poison listed that will cause dilation of the pupils whereas all the other listed conditions and poisons will present with small pupils other than in the case of Myotonic dystrophy wherein the patient will present with a cortical cataract.

    • This question is part of the following fields:

      • Neurology
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  • Question 24 - Which of the following features is characteristic of immune thrombocytopenic purpura? ...

    Incorrect

    • Which of the following features is characteristic of immune thrombocytopenic purpura?

      Your Answer:

      Correct Answer: Autoimmune haemolytic anaemia is a recognised association

      Explanation:

      Immune thrombocytopenic purpura (ITP) refers to thrombocytopaenia occurring in the absence of toxic exposure or other diseases associated with low platelets and involves IgG-type antibodies. It is characterised by normal or increased marrow megakaryocytes, shortened platelet survival, and the absence of splenomegaly. Autoimmune haemolytic anaemia (AIHA) occurs commonly in association with ITP. Leukemic transformation, however, does not occur in ITP.

      In neonatal ITP, IgG antibodies are passively transferred across the placenta. The infant platelet count may be normal at birth but decreases within 12–24 hours. It is rarely severe enough to induce bleeding diathesis in the infant.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 25 - The increased risk of oesophageal malignancy in patients with Barrett’s oesophagus is approximately:...

    Incorrect

    • The increased risk of oesophageal malignancy in patients with Barrett’s oesophagus is approximately:

      Your Answer:

      Correct Answer: 50 - 100 times risk

      Explanation:

      Barrett’s oesophagus is the transformation of the normal squamous epithelium of the oesophagus to columnar, intestinal type epithelium. It is often seen in patients with reflux and there is a 50-100 fold increased risk of oesophageal adenocarcinoma in patients with Barrett’s oesophagus.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 26 - A 30 year old male is reviewed following treatment using cognitive behaviour therapy...

    Incorrect

    • A 30 year old male is reviewed following treatment using cognitive behaviour therapy for bulimia. He thinks there has been no improvement in his condition and is interested in using pharmacological therapy. Which of the following is most suitable?

      Your Answer:

      Correct Answer: High-dose fluoxetine

      Explanation:

      Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviours such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

      According to the DSM-5, the official diagnostic criteria for bulimia nervosa are:
      Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
      Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
      A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
      Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
      The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months.
      Self-evaluation is unduly influenced by body shape and weight.
      The disturbance does not occur exclusively during episodes of anorexia nervosa.

      Antidepressants as a group – particularly selective serotonin reuptake inhibitors (SSRIs) – are the mainstay of pharmacotherapy for bulimia nervosa. These may be helpful for patients with substantial concurrent symptoms of depression, anxiety, obsessions, or certain impulse disorder symptoms. They may be particularly good for patients who have not benefited from or had suboptimal response to suitable psychosocial therapy or who have a chronic, difficult course in combination with other treatments.

      Food and Drug Administration (FDA) approved treatments
      Fluoxetine (Prozac): Initial dose 20 mg/d with advance over 1–2 weeks to 60 mg/d in the morning as tolerated. Some patients may need to begin at a lower dose if side effects are intolerable. A maximum dose of 80 mg/d may be used in some cases.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 27 - A non-cyanosed 1-year-old female patient has a continuous murmur which is loudest at...

    Incorrect

    • A non-cyanosed 1-year-old female patient has a continuous murmur which is loudest at the left sternal edge. What pulse abnormality is most associated with patent ductus arteriosus if that's her suspected diagnosis?

      Your Answer:

      Correct Answer: Collapsing pulse

      Explanation:

      DIAGNOSIS:
      A consensus definition for hemodynamically significant PDA is lacking. The diagnosis is often suspected clinically, when an infant demonstrates signs of excessive shunting from the arterial to pulmonary circulation. Continuous or a systolic murmur; note, a “silent” PDA may also occur when the ductus shunt is large enough that nonturbulent flow fails to generate a detectible murmur.
      A low diastolic blood pressure (due to runoff into the ductus during diastole, more frequent in the most premature infants).
      A wide pulse pressure (due to ductus runoff or steal)Hypotension (especially in the most premature infants)
      Bounding pulses
      Increased serum creatinine concentration or oliguria
      Hepatomegaly

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 28 - Treatment of an acute attack of gout with allopurinol may result in which...

    Incorrect

    • Treatment of an acute attack of gout with allopurinol may result in which of the following?

      Your Answer:

      Correct Answer: Exacerbation and prolongation of the attack

      Explanation:

      Initiation of allopurinol treatment during an attack can exacerbate and prolong the episode. Thus treatment should be delayed until the attack resolves.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 29 - A 22-year-old university student is admitted after taking drugs at a night club....

    Incorrect

    • A 22-year-old university student is admitted after taking drugs at a night club.

      Which of the following features suggest she had taken ecstasy (MDMA)?

      Your Answer:

      Correct Answer: A pyrexia of 40°C

      Explanation:

      MDMA commonly known as ecstasy or molly, is a psychoactive drug primarily used as a recreational drug. The desired effects include altered sensations, increased energy, empathy, and pleasure. Features of MDMA abuse include hyponatraemia, tachycardia, hyperventilation, and hyperthermia.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 30 - What is the mechanism of action of carbimazole? ...

    Incorrect

    • What is the mechanism of action of carbimazole?

      Your Answer:

      Correct Answer: Inhibition of the iodination of tyrosine

      Explanation:

      Carbimazole is used to treat hyperthyroidism. Carbimazole is a pro-drug as after absorption it is converted to the active form, methimazole. Methimazole prevents thyroid peroxidase enzyme from coupling and iodinating the tyrosine residues on thyroglobulin, hence reducing the production of the thyroid hormones T3 and T4 (thyroxine).

    • This question is part of the following fields:

      • Pharmacology
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SESSION STATS - PERFORMANCE PER SPECIALTY

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