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  • Question 1 - A 19-year-old female is admitted with a headache, photophobia, fever and confusion. She...

    Incorrect

    • A 19-year-old female is admitted with a headache, photophobia, fever and confusion. She is managed with antibiotics. What is the mechanism of action of the most commonly used first line antibiotic class?

      Your Answer: Inhibition of DNA gyrase

      Correct Answer: Inhibition of cell wall synthesis

      Explanation:

      In adults, the most common symptom of meningitis is a severe headache, occurring in almost 90% of cases of bacterial meningitis, followed by nuchal rigidity (the inability to flex the neck forward passively due to increased neck muscle tone and stiffness). Other signs commonly associated with meningitis include photophobia (intolerance to bright light) and phonophobia (intolerance to loud noises).
      In the United Kingdom empirical treatment consists of a third-generation cefalosporin such as cefotaxime or ceftriaxone. In the USA, where resistance to cefalosporins is increasingly found in streptococci, addition of vancomycin to the initial treatment is recommended. Penicillins, cephalosporins, carbapenems and monobactams all act via inhibition of cell wall synthesis.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 2 - A 17-year-old boy presents with a 2 day history of colicky abdominal pain,...

    Incorrect

    • A 17-year-old boy presents with a 2 day history of colicky abdominal pain, vomiting and diarrhoea. He has been passing blood mixed with diarrhoea. He has no significant past medical history and takes no regular medication.

      On examination he is pyrexial and clinically dehydrated. Cardiorespiratory and abdominal examinations are normal.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Campylobacter infection

      Explanation:

      The patient has bloody diarrhoea that sounds like a food poisoning in the clinical scenario. Campylobacter is the most common cause of this in the United Kingdom. This is then followed by Salmonella and Shigella. The symptoms are usually self limiting. This is more likely to be bacterial from the food than a viral gastroenteritis.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 3 - A 24-year-old woman who is known to have type 1 diabetes mellitus, presents...

    Incorrect

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

      Your Answer:

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

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 4 - A 3-year old boy presents with an abdominal mass. Which of the following...

    Incorrect

    • A 3-year old boy presents with an abdominal mass. Which of the following is associated with Wilm’s tumour (nephroblastoma)?

      Your Answer:

      Correct Answer: Beckwith-Wiedemann syndrome

      Explanation:

      Beckwith-Wiedemann syndrome is a inherited condition associated with organomegaly, macroglossia, abdominal wall defects, Wilm’s tumour and neonatal hypoglycaemia. Wilm’s tumour is a kidney cancer that usually occurs in children. The causes are unknown, however, risk factors include race and family history. Of note, Wilm’s tumour can occur as part of the following syndromes: WAGR syndrome, Denys-Drash syndrome, and Beckwith-Wiedmann syndrome and not the other listed options in this question.

    • This question is part of the following fields:

      • Nephrology
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  • Question 5 - A 68 year old man is admitted with an infective exacerbation of chronic...

    Incorrect

    • A 68 year old man is admitted with an infective exacerbation of chronic obstructive pulmonary disease (COPD).

      Investigations: blood gas taken whilst breathing 28% oxygen on admission:
      pH 7.30
      p(O2) 7.8 kPa
      p(CO2) 7.4 kPa

      Which condition best describes the blood gas picture?

      Your Answer:

      Correct Answer: Decompensated type-2 respiratory failure

      Explanation:

      The normal partial pressure reference values are:
      – PaO2 more than 80 mmHg (11 kPa)
      – PaCO2 less than 45 mmHg (6.0 kPa).
      This patient has an elevated PaCO2 (7.4kPa)
      Hypoxemia (PaO2 <8kPa) with hypercapnia (PaCO2 >6.0kPa).
      The pH is also lower than 7.35 at 7.3

      Type 2 respiratory failure is caused by inadequate alveolar ventilation; both oxygen and carbon dioxide are affected. Defined as the build-up of carbon dioxide levels (PaCO2) that has been generated by the body but cannot be eliminated. The underlying causes include:
      – Increased airways resistance (chronic obstructive pulmonary disease, asthma, suffocation)
      – Reduced breathing effort (drug effects, brain stem lesion, extreme obesity)
      – A decrease in the area of the lung available for gas exchange (such as in chronic bronchitis)
      – Neuromuscular problems (Guillain–Barré syndrome, motor neuron disease)
      – Deformed (kyphoscoliosis), rigid (ankylosing spondylitis), or flail chest.

    • This question is part of the following fields:

      • Respiratory
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  • Question 6 - A 71-year-old woman with a medical history of a blood transfusion in the...

    Incorrect

    • A 71-year-old woman with a medical history of a blood transfusion in the early 1980s presents with a 10 month history of malaise and is noted to have impaired renal function. Her urine sediment reveals red cell casts.

      The results of immunological investigations are as follows: serum IgG 6.5 g/L (normal range 6-13), IgA 1.5 g/L (normal range 0.8-4.0), IgM 5.7 g/L (normal range 0.4-2.0), serum electrophoresis shows a faint band in the gamma region, complement C3 1.02 g/L (normal range 0.75-1.65), complement C4 <0.02 g/L (normal range 0.20-0.65), and rheumatoid factor 894 IU/L (normal range <40).

      Which of the following investigations is likely to be most important in making a definitive diagnosis?

      Your Answer:

      Correct Answer: Cryoglobulins

      Explanation:

      The patient’s history of a blood transfusion and lab results showing a markedly low C4 (with normal C3), elevated rheumatoid factor, and elevated serum IgM is highly suggestive of hepatitis C-associated cryoglobulinaemic vasculitis. Testing for Cryoglobulins will confirm this suspicion.

    • This question is part of the following fields:

      • Nephrology
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  • Question 7 - A 50-year-old woman is referred to the outpatient clinic with a 6-month history...

    Incorrect

    • A 50-year-old woman is referred to the outpatient clinic with a 6-month history of diarrhoea. She has had intermittent loose normal-coloured stools 2-3 times a day. She also has up to 10 hot flushes a day but thinks she is entering menopause; her GP has recently started her on hormone replacement therapy.
      15 years ago she had a normal colonoscopy after presenting with abdominal pain and intermittent constipation. She has asthma controlled by inhalers, hypertension controlled by ACE inhibitors and hypothyroidism controlled by thyroxine. She smoked 10 cigarettes a day for the last 30 years and drinks alcohol about 14 units/week.

      On examination, she looks hot and flushed. She is afebrile. Her pulse is regular 92bpm and her BP is 164/82 mmHg. Her respirator rate is 20 breaths/min at rest and she sounds quite wheezy. A widespread polyphonic expiratory wheeze can be heard on chest auscultation.
      Her abdomen is soft. Her liver is enlarged 4 cm below the right costal margin but not-tender.

      Results of blood tests show:

      Na 140 mmol/L,
      K 4.8 mmol/L,
      Glucose 9.8 mmol/L,
      Albumin 41 g/l,
      ALT 94 U/l,
      ALP 61 U/l,
      Bilirubin 18 mmol/L,
      Ca 2.47 mmol/L,
      WCC 10.1 × 109/L,
      Hb 12.2 g/dL,
      MCV 90.5 fl,
      Platelets 234 × 109 /l,
      PT 13 s.

      Chest X-ray is normal.
      Ultrasound of the liver shows an enlarged liver containing three ill-defined mass lesions in the right lobe.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Carcinoid syndrome

      Explanation:

      Carcinoid tumours are of neuroendocrine origin and derived from primitive stem cells in the gut wall, especially the appendix. They can be seen in other organs, including the lungs, mediastinum, thymus, liver, bile ducts, pancreas, bronchus, ovaries, prostate, and kidneys. While carcinoid tumours tend to grow slowly, they have the potential to metastasise.
      Signs and symptoms seen in larger tumours may include the following:
      – Periodic abdominal pain: Most common presentation for a small intestinal carcinoid; often associated with malignant carcinoid syndrome.
      – Cutaneous flushing: Early and frequent (94%) symptom; typically affects head and neck.
      – Diarrhoea and malabsorption (84%): Watery, frothy, or bulky stools, gastrointestinal (GI) bleed or steatorrhea; may or may not be associated with abdominal pain, flushing, and cramps.
      – Cardiac manifestations (60%): Valvular heart lesions, fibrosis of the endocardium; may lead to heart failure with tachycardia and hypertension.
      – Wheezing or asthma-like syndrome (25%): Due to bronchial constriction; some tremors are relatively indolent and result in chronic symptoms such as cough and dyspnoea.
      – Pellagra with scale-like skin lesions, diarrhoea and mental disturbances.
      – Carcinoid crisis can be the most serious symptom of the carcinoid tumours and life-threatening. It can occur suddenly or after stress, including chemotherapy and anaesthesia.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 8 - In which of the following is there Growth hormone deficiency (GHD)? ...

    Incorrect

    • In which of the following is there Growth hormone deficiency (GHD)?

      Your Answer:

      Correct Answer: Sheehan's syndrome

      Explanation:

      The main cause of growth hormone (GH) deficiency is a pituitary tumour or the consequences of treatment of the tumour including surgery and/or radiation therapy.
      Sheehan’s syndrome (SS) is postpartum hypopituitarism caused by necrosis of the pituitary gland. It is usually the result of severe hypotension or shock caused by massive haemorrhage during or after delivery. Patients with SS have varying degrees of anterior pituitary hormone deficiency.

      Laron syndrome is Insulin-like growth factor I (IGF-I) deficiency due to GH resistance or insensitivity due to genetic disorders of the GH receptor causing GH receptor deficiency.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 9 - A 65-year-old man having small cell lung cancer is admitted onto the ward...

    Incorrect

    • A 65-year-old man having small cell lung cancer is admitted onto the ward for chemotherapy. He has a history of severe nausea and vomiting secondary to chemotherapy, in the past.

      The consultant asks you to prescribe a neurokinin 1 (NK1) receptor blocker. Which agent, out of the following, will you choose?

      Your Answer:

      Correct Answer: Aprepitant

      Explanation:

      Aprepitant is an anti-emetic which blocks the neurokinin 1 (NK1) receptor and acts as a substance P antagonist. It is licensed for chemotherapy-induced nausea and vomiting (CINV) and for prevention of postoperative nausea and vomiting.

      Nausea and vomiting are the common side effects of chemotherapy. Risk factors for the development of these symptoms include age<50 years, anxiety, concurrent use of opioids, and the type of chemotherapy administered.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 10 - A 53-year-old man is brought into the emergency department by the paramedics. He...

    Incorrect

    • A 53-year-old man is brought into the emergency department by the paramedics. He collapsed oat home suffering from a myocardial infarction and was subsequently resuscitated following a cardiac arrest. Blood tests show impaired liver function (ALT 1400 u/l). He is on a statin, and at his appointment last week his LFT was normal. There is nothing to note on examination and he is currently not complaining of any pain.

      Given this man's presentation, what is the most likely cause of his impaired liver function tests?

      Your Answer:

      Correct Answer: Ischaemic hepatitis

      Explanation:

      When you have abnormal liver function tests after a cardiac arrest, the most likely aetiology, barring history that is known or given excluding this diagnosis, would be ischemia. Chronic alcohol abuse would not see an acute elevation like this. Hepatitis B is just unlikely given the clinical picture, ischemia is much more likely. The same is for Budd-Chiari syndrome (venous thrombosis) and Wilson’s disease.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 11 - Out of the following, which malignant tumour has the highest predilection for dissemination...

    Incorrect

    • Out of the following, which malignant tumour has the highest predilection for dissemination to the bones?

      Your Answer:

      Correct Answer: Prostate

      Explanation:

      Prostate cancer is the most common primary tumour that metastasises to the bone.

      Most common tumours causing bone metastasis (in descending order):
      1. Prostate (32%)
      2. Breast (22%)
      3. Kidneys (16%)
      4. Lungs
      5. Thyroid

      Most common sites of bone metastasis (in descending order):
      1. Spine
      2. Pelvis
      3. Ribs
      4. Skull
      5. Long bones

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 12 - A 76-year-old retired store owner presents with severe pain around his right eye...

    Incorrect

    • A 76-year-old retired store owner presents with severe pain around his right eye and vomiting. On examination, the right eye is red and decreased visual acuity is noted.

      Which of the following options is the most appropriate initial treatment?

      Your Answer:

      Correct Answer: Topical pilocarpine + intravenous acetazolamide

      Explanation:

      In acute angle closure glaucoma (AACG) there is a rise in IOP secondary to an impairment of aqueous outflow. Management options include reducing aqueous secretions with acetazolamide and inducing pupillary constriction with topical pilocarpine.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 13 - A 71-year-old female presents for investigation of fatigue and weight loss.

    Investigations...

    Incorrect

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

      Investigations reveal:

      Haemoglobin 9.0 g/dL (11.5-16.5)
      White cell count 2.0 x109/L (4-11 x109)
      Platelet count 250 x109/L (150-400 x109)
      Total protein 74 g/L (61-76)
      Albumin 28 g/L (37-49)
      Urea 16 mmol/L (2.5-7.5)
      Creatinine 250 mol/L (60-110)
      Plasma glucose 6.5 mmol/L (3.0-6.0)
      Urine dipstick analysis: Protein+ & blood+
      Renal ultrasound: Normal


      Which one of the following investigations would be most appropriate for this patient?

      Your Answer:

      Correct Answer: Plasma protein electrophoresis

      Explanation:

      This patient’s symptoms of anaemia, leukopenia, and elevated non-albumin protein concentration with fatigue and weight loss, point to myeloma. Thus plasma protein electrophoresis or Serum Protein Electrophoresis (SPE) is indicated when there is suspicion of myeloma.

    • This question is part of the following fields:

      • Nephrology
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  • Question 14 - A 46 year old woman with a history of depression visits the clinic...

    Incorrect

    • A 46 year old woman with a history of depression visits the clinic for a review. She was started on Fluoxetine 7 weeks earlier and is requesting that this medication be stopped because she feels well. What recommendation would you give with regards to the treatment?

      Your Answer:

      Correct Answer: It should be continued for at least another 6 months

      Explanation:

      Depressive disorders require long-term treatment with antidepressants, psychotherapy, or both. The goal of antidepressant therapy is complete remission of symptoms and return to normal daily functioning. Studies have shown that achieving remission and continuing antidepressant therapy long after the acute symptoms remit can protect against the relapse or recurrence of the psychiatric episode. Many patients, however, inadvertently or intentionally skip doses of their antidepressant, and even discontinue it, if their symptoms improve or if they experience side effects. Antidepressant discontinuation may increase the risk of relapse or precipitate certain distressing symptoms such as gastrointestinal complaints, dizziness, flu-like symptoms, equilibrium disturbances, and sleep disorders.

      Pharmacologic therapy should be continued long enough to sustain remission and avoid relapses and recurrences. Recurrence refers to a return of depression at a time beyond the expected duration of the index episode (> 9 months after remission). This means that physicians and patients alike should not be too eager to discontinue medication prematurely. An interval of 6 months has been thought to be the usual duration of antidepressant therapy. New recommendations, however, suggest that treatment should continue for up to 9 months after symptoms have resolved (continuation phase) to prevent relapse and for longer to help prevent recurrence (maintenance phase).

      SSRI discontinuation symptoms are similar to those of the TCAs, with dizziness, gastrointestinal symptoms, and sleep disorders common. Anecdotal reports have included complaints of “electric shock–like” sensations, flashes, and “withdrawal buzz.” The type and severity of the symptoms correlate with the relative affinities of the agents for the serotonin reuptake sites and with secondary effects on other neurotransmitters; with SRIs that also affect cholinergic systems, the symptoms possibly correlate with cholinergic rebound.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 15 - A 72 yr. old male with a history of type II diabetes mellitus...

    Incorrect

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

      Your Answer:

      Correct Answer: Third heart sound

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 16 - A diagnosed case of scabies presented in OPD for some medical advice. Which...

    Incorrect

    • A diagnosed case of scabies presented in OPD for some medical advice. Which of the following statements best suits scabies?

      Your Answer:

      Correct Answer:

      Explanation:

      Scabies is an infection caused by a microscopic mite known as Sarcoptes scabies. The chief presenting complaint is itching especially in skin folds and mostly during night. It spreads from one person to another through skin contact, and therefore it is more prevalent in crowded areas like hospitals, hostels and even at homes where people live in close contact with each other. Treatment options include benzyl benzoate, ivermectin, sulphur and permethrin.

    • This question is part of the following fields:

      • Dermatology
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  • Question 17 - A 37-year old female nurse presents with severe generalized itching, claiming that she...

    Incorrect

    • A 37-year old female nurse presents with severe generalized itching, claiming that she had previously applied cream to the body of a patient with similar symptoms. What is the mechanism that produces her itch?

      Your Answer:

      Correct Answer: Allergic reaction

      Explanation:

      Contact dermatitis is a red, itchy rash caused by direct contact with a substance or an allergic reaction to it. The entry of allergen into the epidermis or dermis causes a localized allergic reaction. Local mast-cell activation in the skin leads immediately to a local increase in vascular permeability, which causes extravasation of fluid and swelling. Histamine released by mast cells activated by allergen in the skin causes large, itchy, red swellings of the skin.

    • This question is part of the following fields:

      • Dermatology
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  • Question 18 - A 72-year-old with varicose veins complains of swollen, red, itchy legs. Which is...

    Incorrect

    • A 72-year-old with varicose veins complains of swollen, red, itchy legs. Which is the most likely diagnosis?

      Your Answer:

      Correct Answer: Varicose eczema

      Explanation:

      Varicose eczema is a common problem, particularly in elderly patients due to stasis or blood pooling from insufficient venous return; the alternative name of varicose eczema comes from a common cause of this being varicose veins. It is often mistaken for cellulitis, but cellulitis is rarely bilateral and is painful rather than itchy.

    • This question is part of the following fields:

      • Dermatology
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  • Question 19 - A 20-year-old male presents to the emergency department about 4 hours after ingesting...

    Incorrect

    • A 20-year-old male presents to the emergency department about 4 hours after ingesting 20g of paracetamol. N-acetyl cysteine was started immediately. What is the mechanism of action of N-acetyl cysteine?

      Your Answer:

      Correct Answer: Replenishes glutathione

      Explanation:

      N-acetylcysteine depletes glutathione reserves by providing cysteine, which is an essential precursor in glutathione production.

      Glutathione within the liver can normally detoxify these minuscule quantities of NAPQI and prevent tissue damage.
      N-acetylcysteine (NAC) is the mainstay of therapy for acetaminophen toxicity.

      Paracetamol overdose:
      The liver normally conjugates paracetamol with glucuronic acid/sulphate. During an overdose, the conjugation system becomes saturated leading to oxidation by cytochrome P450 (predominately CYP2E1) mixed-function oxidases. This produces a toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI).

      Normally glutathione acts as a defence mechanism by conjugating with the toxin forming the non-toxic mercapturic acid. If glutathione stores run-out, the toxin forms covalent bonds with cell proteins, denaturing them and leading to cell death.

      Other uses: In COPD, cystic fibrosis, and other lung conditions, nebulized NAC has mucolytic, anti-inflammatory, and antioxidant properties.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 20 - A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a...

    Incorrect

    • A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a recent holiday abroad. Which of the following investigations is the least relevant?

      Your Answer:

      Correct Answer: PCR of CSF for Mycobacterium TB

      Explanation:

      Amoebic, bacterial and fungal meningitis may present acutely but is not common in tuberculous meningitis. Amoebic meningitis is caused by Naegleria fowleri as a result of swimming in infected freshwater. The organism may be found in fresh CSF specimens with phase contrast microscopy.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 21 - An 83-year-old retired musician is examined for progressive cognitive impairment. Which one of...

    Incorrect

    • An 83-year-old retired musician is examined for progressive cognitive impairment. Which one of the following features is most suggestive of Lewy body dementia?

      Your Answer:

      Correct Answer: Symptoms worsen with neuroleptics

      Explanation:

      Lewy body dementia is an increasingly recognised cause of dementia, accounting for up to 20% of cases. The characteristic pathological feature is alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas. Neuroleptics should be avoided in Lewy body dementia as patients are extremely sensitive and may develop irreversible parkinsonism. Questions may give a history of a patient who has deteriorated following the introduction of an antipsychotic agent.

    • This question is part of the following fields:

      • Neurology
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  • Question 22 - A 46-year-old nurse presents with a short history of epistaxis and bleeding gums....

    Incorrect

    • A 46-year-old nurse presents with a short history of epistaxis and bleeding gums. Her complete blood count, coagulation profile, and blood film are requested. The results are as follows:

      Hb: 8.6 g/dL,
      WCC: 2.3 x 10^9/L,
      Plts: 18 x 10^9/L,
      Coagulation profile: deranged,
      Blood film: bilobed large mononuclear cells.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute myeloid leukaemia

      Explanation:

      This is a picture of bone marrow failure secondary to acute myeloid leukaemia (AML). AML is the acute expansion of the myeloid stem line, which may occur as a primary disease or follow the secondary transformation of a myeloproliferative disorder. It is more common over the age of 45 and is characterized by signs and symptoms largely related to bone marrow failure such as anaemia (pallor, lethargy), frequent infections due to neutropenia (although the total leucocyte count may be very high), thrombocytopaenia (bleeding), ostealgia, and splenomegaly.

      The disease has poor prognosis if:
      1. Age of the patient >60 years
      2. >20% blasts seen after the first course of chemotherapy
      3. Chromosomal aberration with deletion of part of chromosome 5 or 7.

      Acute promyelocytic leukaemia (APL) is an aggressive form of AML.

      Other listed options are ruled out because:
      1. Von Willebrand disease: may present with epistaxis and bleeding gums in severe cases but rarely with abnormalities on blood results.

      2. Acute lymphoblastic leukaemia: mostly seen in children.

      3. Lymphoma: usually presents with rubbery enlargement of lymph nodes.

      4. Warfarin overdose: no bilobed large mononuclear cells seen on blood film.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 23 - A 40-year-old non-smoker is diagnosed as having emphysema. Further tests reveal that he...

    Incorrect

    • A 40-year-old non-smoker is diagnosed as having emphysema. Further tests reveal that he has alpha-1 antitrypsin deficiency. What is the main role of alpha-1 antitrypsin in the body?

      Your Answer:

      Correct Answer: Protease inhibitor

      Explanation:

      Alpha-1-antitrypsin (AAT) is a member of the serine proteinase inhibitor (serpin) family of proteins with a broad spectrum of biological functions including inhibition of proteases, immune modulatory functions, and the transport of hormones.

    • This question is part of the following fields:

      • Respiratory
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  • Question 24 - A patient presented with acute onset of mild right hemiparesis affecting the body....

    Incorrect

    • A patient presented with acute onset of mild right hemiparesis affecting the body. He also has evidence of sensory loss on the right hand side. There is evidence of Horner’s syndrome and sensory loss on the face on the left hand side.
      Which of the following structures are involved?

      Your Answer:

      Correct Answer: Brain stem

      Explanation:

      The patient is presenting with symptoms of lateral medullary syndrome also known as Wallenberg’s syndrome or posterior inferior cerebellar artery syndrome, where the symptoms are due to an ischemia in the brainstem. The classical symptoms include contralateral sensory deficits of the trunk region paired with ipsilateral facial sensory deficits.

    • This question is part of the following fields:

      • Neurology
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  • Question 25 - A 62-year-old laboratory technician presents to the ophthalmology emergency department with sudden onset...

    Incorrect

    • A 62-year-old laboratory technician presents to the ophthalmology emergency department with sudden onset painless loss of vision in the right eye. He describes it as having a dense shadow over his vision, progressing from the periphery to the centre. He has no past medical history of note.

      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Retinal detachment

      Explanation:

      The most common causes of a sudden painless loss of vision are as follows:
      – Ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis)
      – Occlusion of central retinal vein
      – Occlusion of central retinal artery
      – Vitreous haemorrhage
      – Retinal detachment

      Retinal detachment is a cause of sudden painless loss of vision. It is characterised by a dense shadow starting peripherally and progressing centrally.

      Vitreous haemorrhage usually presents with dark spots.

      Central retinal artery and central retinal vein occlusion do not usually present with progressing dense shadow.

      This man’s lack of ischaemic risk factors makes ischaemic optic neuropathy less likely.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 26 - A 23-year-old man is referred to the pneumologist with a suspicion of bronchiectasis....

    Incorrect

    • A 23-year-old man is referred to the pneumologist with a suspicion of bronchiectasis. History reveals he's been having recurrent pulmonary infections his whole life together with difficulties gaining weight. He's a non-smoker with a clear family history and he admits inhalers haven't helped him in the past. He is finally suspected of having cystic fibrosis. What is the normal function of the cystic fibrosis transmembrane regulator?

      Your Answer:

      Correct Answer: Chloride channel

      Explanation:

      Chloride channels are involved in a diverse set of functions in normal physiology and acquired diseases. Additionally, there are genetic diseases caused by mutations in chloride channels (channelopathies) — the most common being cystic fibrosis, which has a prevalence of 1 in 2,000 Caucasians.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 27 - A study is developed to look at the potential of hip protectors to...

    Incorrect

    • A study is developed to look at the potential of hip protectors to reduce femoral neck fractures in elderly nursing home patients. The study included 800 patients randomly selected with an average age of 82 years of age. The data was collected over a two year period and the patients were randomly put in the standard care group or the hip protector group. From the 400 patients assigned to the hip protector group, 10 had a femoral neck fracture over the two year period. From the 400 patients assigned to the standard care group, 20 had a femoral neck fracture over the two year period. What is the correct value regarding the absolute risk reduction?

      Your Answer:

      Correct Answer: 0.025

      Explanation:

      Absolute risk reduction (ARR) – also called risk difference (RD) – is the most useful way of presenting research results to help your decision-making. In this example, the ARR is 8 per cent (20 per cent – 12 per cent = 8 per cent). This means that, if 100 children were treated, 8 would be prevented from developing bad outcomes. Another way of expressing this is the number needed to treat (NNT). If 8 children out of 100 benefit from treatment, the NNT for one child to benefit is about 13 (100 ÷ 8 = 12.5). CER = 20 / 400 = 1 / 20 = 0.05, EER = 10 / 400 = 0.025, ARR =CER – EER = 0.025

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 28 - A 28-year-old man who is admitted with bright red haematemesis, which occurred after...

    Incorrect

    • A 28-year-old man who is admitted with bright red haematemesis, which occurred after a bout of vomiting. He had been out with friends on a stag party and consumed 12 pints of beer.

      Upper gastrointestinal (GI) endoscopy proves unremarkable and haemoglobin (Hb) is stable at 12.5 g/dl the morning after admission, there is no sign of circulatory compromise. There have been no previous similar episodes.

      Which of the following stems represents the best course of action for this patient?

      Your Answer:

      Correct Answer: Send home

      Explanation:

      This is a classic clinical presentation, with alcohol intake and nausea/vomiting that leads to hematemesis, of a Mallory-Weiss tear. In Mallory-Weiss tear, they typically present as a hemodynamically stable patient after a night of binge drinking and excessive resultant vomiting. Given his EGD did not show any other pathology and he is now stable, he can be discharged home.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 29 - A 75-year-old retired firefighter with a history of type 2 diabetes mellitus and...

    Incorrect

    • A 75-year-old retired firefighter with a history of type 2 diabetes mellitus and hypertension presents due to the sensation of light flashes in his right eye. These symptoms have been present for the past 2 days and seem to occur more at the peripheral part of vision.

      There is no redness or pain in the affected eye. Corrected visual acuity is measured as 6/9 in both eyes.

      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Vitreous detachment

      Explanation:

      Flashes and floaters are symptoms of vitreous detachment. The patient is at risk of retinal detachment and should be referred urgently to an ophthalmologist.

      The most common causes of a sudden painless loss of vision are as follows:
      – Ischaemic optic neuropathy (e.g. temporal arteritis or atherosclerosis)
      – Occlusion of central retinal vein
      – Occlusion of central retinal artery
      – Vitreous haemorrhage
      – Retinal detachment

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 30 - A 48-year-old patient with type 1 diabetes and chronic kidney disease attends for...

    Incorrect

    • A 48-year-old patient with type 1 diabetes and chronic kidney disease attends for review. His blood tests show:

      Haemoglobin 11.2 g/dl (13.0 – 18.0 g/dL)
      MCV 87 fl (80 – 96 fL)
      Sodium 133 mmol/l (137 – 144 mmol/L)
      Potassium 4.3 mmol/l (3.5 – 4.9 mmol/L)
      Urea 19.1 mmol/l (2.5 – 7.5 mmol/L)
      Creatinine 267 μmol/l (60 – 110 μmol/L)
      Ferritin 150 μg/l (15 – 300 μg/L)
      C reactive protein <5 mg/l (< 10 mg/L)

       
      What is the most appropriate management of his anaemia?

      Your Answer:

      Correct Answer: Monitor haemoglobin, no treatment required at present

      Explanation:

      Because the patient has chronic kidney disease, we need to consider the associated adverse effects of trying to maintain normal haemoglobin levels (14-18g/dl in this patient) and instead only instigate therapy when the level falls below 11 g/dl. Thus, in this case we should just monitor the haemoglobin levels and not initiate therapy just yet.

    • This question is part of the following fields:

      • Nephrology
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SESSION STATS - PERFORMANCE PER SPECIALTY

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