00
Correct
00
Incorrect
00 : 00 : 0 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - Each one of the following statements regarding atrial natriuretic peptide are true, except:...

    Incorrect

    • Each one of the following statements regarding atrial natriuretic peptide are true, except:

      Your Answer: Promotes excretion of sodium

      Correct Answer: Secreted mainly by the left atrium

      Explanation:

      Atrial natriuretic peptide (ANP) is a 28-amino acid peptide that is synthesized, stored, and released by atrial myocytes in response to atrial distension, angiotensin II stimulation, endothelin, and sympathetic stimulation (beta-adrenoceptor mediated). ANP is synthesized and secreted by cardiac muscle cells in the walls of the atria in the heart. The main physiological actions of natriuretic peptides is to reduce arterial pressure by decreasing blood volume and systemic vascular resistance. It causes a reduction in expanded extracellular fluid (ECF) volume by increasing renal sodium excretion.

    • This question is part of the following fields:

      • Clinical Sciences
      3
      Seconds
  • Question 2 - Which of the following statements is the most characteristic of primary Raynaud's phenomena?...

    Incorrect

    • Which of the following statements is the most characteristic of primary Raynaud's phenomena?

      Your Answer:

      Correct Answer: Fingers are symmetrically involved during an attack

      Explanation:

      A typical attack may last less than an hour but can also persist for longer. In primary Raynaud’s, attacks are more likely symmetric, episodic, and without evidence of peripheral vascular disease. Patients more commonly have a negative ANA and normal inflammatory markers. There should be no evidence of tissue gangrene, digital pitting, or tissue injury in primary Raynaud’s. In contrast, patients with secondary Raynaud’s will describe attacks that are more frequent, painful, often asymmetric and may lead to digital ulcerations.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 3 - A 30 yr. old male, who is the brother of a patient with...

    Incorrect

    • A 30 yr. old male, who is the brother of a patient with hypertrophic cardiomyopathy has come for the screening. Which of the following is the most appropriate method of screening?

      Your Answer:

      Correct Answer: Echocardiography

      Explanation:

      12-lead electrocardiography and transthoracic echocardiography are recommended as a screening method for family members of patients with HCM.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 4 - A 65 yr. old male patient admitted with myocardial infarction received thrombolysis, which...

    Incorrect

    • A 65 yr. old male patient admitted with myocardial infarction received thrombolysis, which lead to full resolution of the ST elevations on his ECG. He was on aspirin, clopidogrel, atorvastatin and enalapril. The next day he complained of pain in his legs and there was a diffuse petechial rash over his lower legs, especially in the feet. All his peripheral pulses were palpable. His FBC revealed neutrophilia with eosinophilia. His IgE antibodies were 3 kU/L (<2). What is the most likely reason for this presentation?

      Your Answer:

      Correct Answer: Cholesterol emboli

      Explanation:

      He has a consequence of atherosclerotic disease (MI). The most probable diagnosis is cutaneous cholesterol emboli as it is more common after anticoagulation or thrombolytics, the skin involvement, eosinophilia and raised IgE. It is more common above 60 yrs. of age.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 5 - A 43-year-old woman is concerned about osteoporosis as she as a strong family...

    Incorrect

    • A 43-year-old woman is concerned about osteoporosis as she as a strong family history of it. She is one year postmenopausal and aware of hot flushes at night.

      Which one of the following therapies would be most appropriate?

      Your Answer:

      Correct Answer: Cyclical oestrogen and progestogen

      Explanation:

      As the patient has early menopause, hormone replacement therapy (HT) is considered to be the first line of choice for prevention of bone loss and fracture in the early postmenopausal period for 5 years.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 6 - A 26-year-old student has been brought to the emergency department in a confused...

    Incorrect

    • A 26-year-old student has been brought to the emergency department in a confused state. His friends report that he has been complaining of headaches for the past few weeks. He has a low-grade fever and on examination is noted to have abnormally pink mucosa. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Carbon monoxide poisoning

      Explanation:

      Confusion and pink mucosae are typical features of CO poisoning.
      The patient often presents, most commonly with headaches, and other symptoms like malaise, nausea, and dizziness.

      Carbon monoxide (CO) poisoning, considered as the great imitator of other diseases as the patients present with a myriad of symptoms. The carbon monoxide diffuses rapidly across the pulmonary capillary membrane binding to the haem molecule with a very high affinity (240 times that of oxygen) forming carboxy-haemoglobin (COHb). Non-smokers have a baseline COHb of ,3% while smokers have a baseline COHb of 10-15%.

      Features of carbon monoxide toxicity
      – Headache: 90% of cases
      – Nausea and vomiting: 50%
      – Vertigo: 50%
      – Confusion: 30%
      – Subjective weakness: 20%
      – Severe toxicity: ‘pink’ skin and mucosae, hyperpyrexia, arrhythmias, extrapyramidal features, coma, death

      Treatment:
      Use of Hyperbaric oxygen therapy (HBOT) for treating mild to moderate CO poisoning is not routine.
      The selection criteria for HBOT in cases of CO poisoning include:
      • COHb levels > 20-25%
      • COHb levels > 20% in pregnant patient
      • Loss of consciousness
      • Severe metabolic acidosis (pH <7.1)
      • Evidence of end-organ ischemia (e.g., ECG changes, chest pain, or altered mental status)

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 7 - A 19-year-old woman is admitted with diabetic ketoacidosis (DKA). It is her fourth...

    Incorrect

    • A 19-year-old woman is admitted with diabetic ketoacidosis (DKA). It is her fourth episode in the past two months and she's known to be a type 1 diabetes mellitus patient. The doctors suspects she's non-compliant with her treatment to keep her weight down. She often self-discharges after 24 hours. What is the single most appropriate management?

      Your Answer:

      Correct Answer: Have a chat after the ward round about why she thinks her control is so bad

      Explanation:

      In many Western countries and health plans in the United States, patients have a primary care physician who acts as a formal gatekeeper for medical specialist care and thereby determines together with the patient whether or not a patient requires medical specialist care. Ideally in such systems, patients are treated in primary care if possible, and referred to medical specialist care if necessary. For the gatekeeper system to be effective, it is vital that adequate decisions are made about when and who to refer. But it is also important that referred patients comply with the referral by consulting a medical specialist. In this case, the GP should discuss with the patient the reasons why she cannot follow the treatment plan. In other words, the GP should detect why the patient is being non-compliant.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 8 - A 38-year-old chef is brought into the emergency department by her husband. He...

    Incorrect

    • A 38-year-old chef is brought into the emergency department by her husband. He reports that she has been confused for the last 3 days. She has a long-standing history of severe psoriasis but no other past medical history.

      Basic observations are all within normal range and a CT head is unremarkable. A fundoscopy exam reveals bilateral papilledema.

      Which of the following is the most likely cause?

      Your Answer:

      Correct Answer: Vitamin A toxicity

      Explanation:

      Vitamin A toxicity is a rare cause of papilledema. In this case, the patient is likely to have been taking retinoids for psoriasis.

      Encephalitis does not usually present with papilledema. Brain abscess, brain tumour and hydrocephalus are all less likely with a normal CT head.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 9 - A 54 year old gentleman presented with a 3 month history of a...

    Incorrect

    • A 54 year old gentleman presented with a 3 month history of a nodular growth over the dorsum of the his nose, about 0.6 cm in size. The base of nodule is slightly ulcerated and its margins are raised. The most likely diagnosis would be?

      Your Answer:

      Correct Answer: Basal cell carcinoma

      Explanation:

      Basal cell carcinoma is usually located on sun exposed sites. It has got many variants and clinically it presents as a slow growing mass/nodule with rolled margins and an ulcerated base.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 10 - Which the following features is most suggestive of megaloblastic anaemia? ...

    Incorrect

    • Which the following features is most suggestive of megaloblastic anaemia?

      Your Answer:

      Correct Answer: Hypersegmented neutrophils in peripheral blood film

      Explanation:

      Hypersegmented neutrophils in the peripheral blood film is suggestive of megaloblastic changes in bone marrow.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • 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
      0
      Seconds
  • Question 12 - A 33-year-old male presents with a rash and low grade fever (37.6°C). Twenty-one...

    Incorrect

    • A 33-year-old male presents with a rash and low grade fever (37.6°C). Twenty-one days ago, he underwent allogeneic bone marrow transplant for high-risk acute myeloid leukaemia. The rash was initially maculopapular affecting his palms and soles but 24 hours later, general erythroderma is noted involving the trunk and limbs. Other than that, he remains asymptomatic. His total bilirubin was previously normal but is now noted to be 40 μmol/L (1-22).

      How would you manage the patient at this stage?

      Your Answer:

      Correct Answer:

      Explanation:

      This is a classical picture of graft versus host disease (GVHD) following bone marrow transplant. Acute GVHD occurs in the first 100 days post transplant with chronic GVHD occurring 100-300 days after transplant. GVHD is graded according to the Seattle system, and each organ involved is scored (skin, liver, and gut).

      The standard initial treatment in the acute setting is high-dose methylprednisolone started immediately. If there is no response, a more intensive immunosuppressive agent such as alemtuzumab or antilymphocyte globulin is needed.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 13 - 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
      0
      Seconds
  • Question 14 - A 14 year-old is brought to the ED after being hit on the...

    Incorrect

    • A 14 year-old is brought to the ED after being hit on the head with a cricket ball during a match. His teacher describes that he initially collapsed on the ground and complained of a sore head. Two minutes later, he got up and said he felt OK and continued playing. However, 30 minutes later he suddenly collapsed and lost consciousness. What injury is he most likely to have sustained?

      Your Answer:

      Correct Answer: Extradural haematoma

      Explanation:

      A lucid interval, in which the patient portrays a temporary improvement in condition after a traumatic brain injury, is especially indicative of an epidural haematoma.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 15 - A 28 yr. old primigravida in her 24th week of pregnancy came for...

    Incorrect

    • A 28 yr. old primigravida in her 24th week of pregnancy came for the routine follow up. She was asymptomatic at the time of examination. Her blood pressure was 152/92 mmHg and pulse rate was 90 bpm. Her blood pressure at the booking visit had been 132/80 mmHg. Her other examination findings were normal. Which of the following is the best method to use to treat her?

      Your Answer:

      Correct Answer: Labetalol

      Explanation:

      Methyldopa is the drug of first choice for the control of mild to moderate hypertension in pregnancy. Labetalol is also considered as a first line drug for hypertension in pregnancy. Calcium channel blockers and hydralazine are considered as second line drugs. Beta-blockers (except labetalol), angiotensin receptor blockers, angiotensin-converting enzyme inhibitors and thiazides are not recommended.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 16 - A clinical trial is conducted to study the benefits of a new oral...

    Incorrect

    • A clinical trial is conducted to study the benefits of a new oral medication to improve the symptoms of patients with asthma. In the trial 400 patients with asthma, half were given the new medication and half a placebo. Three months later they are asked to rate their symptoms using the following scale: much improved, slight improvement, no change, slight worsening, significantly worse. What is the most appropriate statistical test to see whether the new medication is beneficial?

      Your Answer:

      Correct Answer: Mann-Whitney U test

      Explanation:

      The type of significance test used depends on whether the data is parametric (can be measured, usually normally distributed) or non-parametric.
      Parametric tests:
      Student’s t-test – paired or unpaired*
      Pearson’s product-moment coefficient – correlation

      Non-parametric tests:
      Mann-Whitney U test – unpaired data
      Wilcoxon signed-rank test – compares two sets of observations on a single sample
      chi-squared test – used to compare proportions or percentages
      Spearman, Kendall rank – correlation.

      The outcome measured is not normally distributed, i.e. it is non-parametric. This excludes the Student’s t-tests. We are not comparing percentages/proportions so the chi-squared test is excluded. The Mann–Whitney U test is a nonparametric test of the null hypothesis that it is equally likely that a randomly selected value from one sample will be less than or greater than a randomly selected value from a second sample.
      This test can be used to investigate whether two independent samples were selected from populations having the same distribution.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 17 - A 22-year-old female comes to you for counselling regarding the initiation of combined...

    Incorrect

    • A 22-year-old female comes to you for counselling regarding the initiation of combined oral contraceptive pill.
      Which of the following statements is correct?

      Your Answer:

      Correct Answer: She will still be protected against pregnancy if she takes amoxicillin for a lower respiratory tract infection while on the combined pill

      Explanation:

      The true statement among the given options is that she will still be protected against pregnancy if she takes amoxicillin for a lower respiratory tract infection while on the combined pill.

      Other than enzyme-inducing antibiotics such as rifampicin, antibiotics do not reduce the efficacy of the combined oral contraceptive pill.

      It was previously advised that barrier methods of contraception should be used if taking an antibiotic while using the contraceptive pill, due to concerns that antibiotics might reduce the absorption of the pill. This is now known to be untrue. However, if the absorptive ability of the gut is compromised for another reason, such as severe diarrhoea or vomiting, or bowel disease, this may affect the efficacy of the pill.

      The exception to the antibiotic rule is that hepatic enzyme-inducing antibiotics such as rifampicin and rifaximin do reduce the efficacy of the pill. Other enzyme-inducing drugs, such as phenytoin, phenobarbital, carbamazepine or St John’s Wort can also reduce the effectiveness of the pill.

      Other options:
      The combined pill is often prescribed for women with heavy periods as it can make them lighter and less painful.
      There is no evidence that women on the combined pill put on any significant weight, although they may experience bloating at certain times in the course.
      Women on the pill require monitoring of their blood pressure.
      There are multiple different types of combined pills.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 18 - A 42 year old female presents with a funny bone sensation in her...

    Incorrect

    • A 42 year old female presents with a funny bone sensation in her right elbow that is accompanied by numbness and tingling in the 4th and 5th digits. The symptoms are aggravated when the elbow is bent for a prolonged period. Which of the following explains the most likely diagnosis?

      Your Answer:

      Correct Answer: Cubital tunnel syndrome

      Explanation:

      Cubital Tunnel Syndrome is a condition that involves pressure or stretching of the ulnar nerve (also known as the “funny bone” nerve), which can cause numbness or tingling in the 4th and 5th digit, pain in the forearm, and/or weakness in the hand. Epicondylitis of the elbow is a condition associated with repetitive forearm and elbow activities. Both lateral epicondylitis (commonly known as tennis elbow) and medial epicondylitis (commonly known as golfer’s elbow) are characterized by elbow pain during or following elbow flexion and extension. Radial tunnel syndrome is a set of symptoms that include fatigue or a dull, aching pain at the top of the forearm with use. Although less common, symptoms can also occur at the back of the hand or wrist.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 19 - A 49-year-old woman suddenly experienced complete loss of vision in her right eye....

    Incorrect

    • A 49-year-old woman suddenly experienced complete loss of vision in her right eye. Fundoscopy results show a pale retina, and a cherry red spot on the macular region. She also experienced right sided headaches aggravated by chewing. What caused her vision loss?

      Your Answer:

      Correct Answer: CRAO

      Explanation:

      Central retinal artery occlusion (CRAO) is a disease of the eye where the flow of blood through the central retinal artery is blocked (occluded). There are several different causes of this occlusion; the most common is carotid artery atherosclerosis. It causes sudden vision loss in one eye. Fundoscopic exam will show a red lesion, called a cherry red spot, with surrounding pale retina (the pale colour is caused by ischemia of the retina)

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 20 - A 27-year-old consultant who has a family history of retinitis pigmentosa is reviewed...

    Incorrect

    • A 27-year-old consultant who has a family history of retinitis pigmentosa is reviewed in the ophthalmology clinic. He reports worsening vision over the past few months. During fundoscopy, which of the following findings would most support a diagnosis of retinitis pigmentosa?

      Your Answer:

      Correct Answer: Black bone spicule-shaped pigmentation in the peripheral retina

      Explanation:

      Retinitis pigmentosa is a genetic disorder primarily affecting the peripheral retina resulting in tunnel vision. Night blindness is often the initial sign. Fundoscopy exam reveals black bone spicule-shaped pigmentation in the peripheral retina, and mottling of the retinal pigment epithelium.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 21 - With respect to liver cirrhosis, which of the following statements is correct? ...

    Incorrect

    • With respect to liver cirrhosis, which of the following statements is correct?

      Your Answer:

      Correct Answer: The final common pathway of hepatic fibrosis is mediated by the hepatic stellate cell

      Explanation:

      The development of hepatic fibrosis reflects an alteration in the normally balanced processes of extracellular matrix production and degradation. [6] The extracellular matrix, the normal scaffolding for hepatocytes, is composed of collagens (especially types I, III, and V), glycoproteins, and proteoglycans. Increased collagen in the space of Disse (space b/w sinusoids and hepatocytes) leads to capillarization of sinusoids, and stellate cells also have contractile properties when activated. This is fibrosis processes. This can lead to the development of portal hypertension.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 22 - Following a road traffic accident, a gentleman is brought to A&E. He is...

    Incorrect

    • Following a road traffic accident, a gentleman is brought to A&E. He is found to have oliguria and diagnosed with acute renal tubular necrosis.
       
      What is the most common complication and cause of death in this condition?

      Your Answer:

      Correct Answer: Infection

      Explanation:

      In patients with acute renal tubular necrosis, infection in the form of gram-negative septicaemia is the most common cause of death, especially while the patient is awaiting spontaneous recovery of their renal function.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 23 - A 30 yr. old male was brought in with a history of a...

    Incorrect

    • A 30 yr. old male was brought in with a history of a stab injury to left chest. He was complaining of chest pain. On examination he was tachycardic, hypotensive and had an elevated JVP, pulsus paradoxus and muffled heart sounds. Respiratory examination was unremarkable. Which of the following is most probable diagnosis?

      Your Answer:

      Correct Answer: Cardiac tamponade

      Explanation:

      Becks triad (hypotension, elevated systemic venous pressure, often with jugular venous distention and muffled heart sounds) is a characteristic collection of clinical findings found in cardiac tamponade. Pulsus paradoxus is also associated with it. The history and clinical findings in this scenario are compatible with the diagnosis of cardica tamponade. The normal respiratory examination excludes tension pneumothorax.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 24 - A 49-year-old female is admitted to the hospital with shortness of breath and...

    Incorrect

    • A 49-year-old female is admitted to the hospital with shortness of breath and pleuritic chest pain. She also complains of loss of appetite for the past four months. Her admission CXR shows right-sided pleural effusion. An underlying malignancy is suspected and a series of tumour markers are requested, the results of which are:

      CA 19-9: 36 IU/mL (<40),
      CA 125: 654 IU/ml (<30),
      CA 15-3: 9 IU/ml (<40).

      What is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Ovarian fibroma

      Explanation:

      The patient has Meigs syndrome. Meigs syndrome is defined as a triad of benign ovarian tumour with ascites and pleural effusion that resolves after resection of the tumour. Ovarian fibromas constitute the majority of the benign tumours seen in Meigs syndrome.

      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
      0
      Seconds
  • Question 25 - Which one of the following statements best describes a type II statistical error?...

    Incorrect

    • Which one of the following statements best describes a type II statistical error?

      Your Answer:

      Correct Answer: The null hypothesis is accepted when it is false

      Explanation:

      In statistical hypothesis testing there are 2 types of errors:
      – type I: the null hypothesis is rejected when it is true – i.e. Showing a difference between two groups when it doesn’t exist, a false positive.
      – type II: the null hypothesis is accepted when it is false – i.e. Failing to spot a difference when one really exists, a false negative.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 26 - A 40-year-old man complains of impotence and reduced libido for 4 months. He...

    Incorrect

    • A 40-year-old man complains of impotence and reduced libido for 4 months. He has been married for 15 years and has two children. He smokes five cigarettes per day and drinks approximately 12 units of alcohol weekly.
      Examination reveals an obese man who is phenotypically normal with normal secondary sexual characteristics.
      Investigations are as follows:
      Hb 13.4 g/dl (13.0-18.0),
      WCC 6 x 109/l (4-11),
      Platelets 210 x 109/l (150-400),
      Electrolytes Normal,
      Fasting glucose 5.6 mmol/l (3.0-6.0),
      LFTs Normal,
      T4 12.7 pmol/l (10-22),
      TSH 2.1 mU/l (0.4-5),
      Prolactin 259 mU/l (<450),
      Testosterone 6.6 nmol/l (9-30),
      LH 23.7 mU/l (4-8),
      FSH 18.1 mU/l (4-10).

      What is the next investigation needed for this patient?

      Your Answer:

      Correct Answer: Ultrasound examination of the testes

      Explanation:

      The patient has primary Hypogonadism.
      Since he already had two children, Klinefelter syndrome is excluded and the patient does not need karyotyping.
      His lab results are normal indicating normal pituitary gland functions.
      So the next step is testicular ultrasound as testicular tumour, infiltration or idiopathic failure is suspected.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 27 - 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
      0
      Seconds
  • Question 28 - Which of the given adverse effects should be anticipated following the administration of...

    Incorrect

    • Which of the given adverse effects should be anticipated following the administration of an anticholinesterase?

      Your Answer:

      Correct Answer: Bradycardia and miosis

      Explanation:

      Bradycardia and miosis should be anticipated following the administration of anticholinesterases.

      Anticholinesterase agents include the following medications:
      – Pyridostigmine, neostigmine, and edrophonium which play a significant role in the diagnosis and the management of myasthenia gravis.
      – Rivastigmine, galantamine and donepezil are cholinesterase inhibitors found to be significantly useful in the management of Alzheimer’s disease.

      Mechanism of action and pharmacological effects:
      Inhibition of cholinesterase increases the level and the duration of action of acetylcholine within the synaptic cleft.

      Thus, cholinergic effects such as a reduction in heart rate (bradycardia), miosis (pupillary constriction), increased secretions, increased gastrointestinal motility and reduction in BP may occur with anticholinesterases.

      Toxins such as organophosphates and carbamates also are primarily anticholinergic and cause the following typical SLUDGE symptoms:
      – Salivation
      – Lacrimation
      – Urination
      – Diaphoresis
      – Gastrointestinal upset
      – Emesis

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 29 - Supplementation of which one of the following might help a patient diagnosed with...

    Incorrect

    • Supplementation of which one of the following might help a patient diagnosed with homocystinuria?

      Your Answer:

      Correct Answer: Pyridoxine

      Explanation:

      In general, the aim is to keep the homocysteine (Hcy) concentration as close to normal as possible. In patients who are fully-responsive to pyridoxine, standard doses can lead to tHcy levels below 50 μmol/L (and sometimes within the normal range). Some patients who are partially-responsive to pyridoxine may be able to achieve a tHcy level below 50 μmol/L if they are also on a low-Met diet; for others it is not a realistic goal.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 30 - Which of the following features of the jugular venous waveform indicates the closure...

    Incorrect

    • Which of the following features of the jugular venous waveform indicates the closure of the tricuspid valve?

      Your Answer:

      Correct Answer: c wave

      Explanation:

      The a wave indicates atrial contraction. The c wave indicates ventricular contraction and resulting bulging of the tricuspid valve into the right atrium during isovolumetric systole. The v wave indicates venous filling. The x descent indicates the atrium relaxation and the movement of tricuspid valve downward. The y descent indicates the filling of the ventricle after the opening of the tricuspid valve.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Passmed