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  • Question 1 - A 35-year-old woman visits you in the paediatric diabetes clinic with her 2-year-old...

    Incorrect

    • A 35-year-old woman visits you in the paediatric diabetes clinic with her 2-year-old son who has recently been diagnosed by type-1 diabetes. He has an identical twin brother and she is concerned about his risk of developing diabetes.
      What advice would you give regarding his future risk?

      Your Answer: He has a 100% future risk of developing type-1 diabetes

      Correct Answer: He has a 30–50% future risk of developing type-1 diabetes

      Explanation:

      The frequency of type-1 diabetes is higher in siblings of diabetic parents (e.g., in the UK 6% by age 30) than in the general population (in the U.K. 0.4% by age 30), while disease concordance in monozygotic (identical) twins is about 40% i.e. the risk that the unaffected twin will develop diabetes.

    • This question is part of the following fields:

      • Endocrinology
      5
      Seconds
  • Question 2 - A 80 yr. old male was found on the floor. His blood pressure...

    Incorrect

    • A 80 yr. old male was found on the floor. His blood pressure was 100/60 mmHg. His core temperature was 31ºC. His FBC and serum electrolytes were within normal limits. Which of the following would be found in his ECG?

      Your Answer:

      Correct Answer: Long QT interval

      Explanation:

      Hypothermia is defined as a core body temperature of < 35 °C.
      Hypothermia may produce the following ECG changes:
      -Bradyarrhythmia
      -Osborne Waves (= J waves)
      -Prolonged PR, QRS and QT intervals
      -Shivering artefact
      -Ventricular ectopics
      -Cardiac arrest due to VT, VF or asystole

    • This question is part of the following fields:

      • Cardiology
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      Seconds
  • Question 3 - Which treatment of chronic obstructive pulmonary disease (COPD) increases the long-term prognosis in...

    Incorrect

    • Which treatment of chronic obstructive pulmonary disease (COPD) increases the long-term prognosis in patients?

      Your Answer:

      Correct Answer: Long-term domiciliary oxygen therapy

      Explanation:

      COPD is commonly associated with progressive hypoxemia. Oxygen administration reduces mortality rates in patients with advanced COPD because of the favourable effects on pulmonary hemodynamics.

      Long-term oxygen therapy improves survival 2-fold or more in hypoxemic patients with COPD, according to 2 landmark trials, the British Medical Research Council (MRC) study and the US National Heart, Lung and Blood Institute’s Nocturnal Oxygen Therapy Trial (NOTT). Hypoxemia is defined as PaO2 (partial pressure of oxygen in arterial blood) of less than 55 mm Hg or oxygen saturation of less than 90%. Oxygen was used for 15-19 hours per day.

      Therefore, specialists recommend long-term oxygen therapy for patients with a PaO2 of less than 55 mm Hg, a PaO2 of less than 59 mm Hg with evidence of polycythaemia, or cor pulmonale. Patients should be evaluated after 1-3 months after initiating therapy, because some patients may not require long-term oxygen.

    • This question is part of the following fields:

      • Respiratory
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  • Question 4 - Which one of these features is typical of dermatomyositis? ...

    Incorrect

    • Which one of these features is typical of dermatomyositis?

      Your Answer:

      Correct Answer: Gottron's papules over knuckles of fingers

      Explanation:

      The main symptom of dermatomyositis include skin rash and symmetric proximal muscle weakness (in over 90% of patients) which may be accompanied by pain and tenderness. It occurs more commonly in females. Skin findings include:
      Gottron’s sign – an erythematous, scaly eruption occurring in symmetric fashion over the MCP and interphalangeal joints
      Heliotrope or lilac rash – a violaceous eruption on the upper eyelids and in rare cases on the lower eyelids as well, often with itching and swelling
      Shawl (or V-) sign is a diffuse, flat, erythematous lesion over the back and shoulders or in a V over the posterior neck and back or neck and upper chest, which worsens with UV light.
      Erythroderma is a flat, erythematous lesion similar to the shawl sign but located in other areas, such as the malar region and the forehead.
      Periungual telangiectasias and erythema occur.

    • This question is part of the following fields:

      • Dermatology
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  • Question 5 - Presence of which of the following indicates a worse prognosis in rheumatoid arthritis?...

    Incorrect

    • Presence of which of the following indicates a worse prognosis in rheumatoid arthritis?

      Your Answer:

      Correct Answer: Anti-CCP antibodies

      Explanation:

      Rheumatoid arthritis is both common and chronic, with significant consequences for multiple organ systems. Anti-cyclic citrullinated peptide (anti-CCP) antibody testing is particularly useful in the diagnosis of rheumatoid arthritis, with high specificity, presence early in the disease process, and ability to identify patients who are likely to have severe disease and irreversible damage. However, its sensitivity is low, and a negative result does not exclude disease. Anti-CCP antibodies have not been found at a significant frequency in other diseases to date, and are more specific than rheumatoid factor for detecting rheumatoid arthritis. The other factors that are mentioned do not play a key prognostic role.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 6 - A 42-year-old man is a known case of Waldenström's macroglobulinemia and is admitted...

    Incorrect

    • A 42-year-old man is a known case of Waldenström's macroglobulinemia and is admitted to the hospital with headache, visual disturbances, pale conjunctivae, and breathlessness. While in the assessment unit, he has had an episode of nosebleed that has been difficult to control. On examination, his heart rate is 120bpm, blood pressure is 115/65 mmHg, and he is febrile with a temperature of 37°C. Fundoscopy shows dilated retinal veins with a retinal haemorrhage in the right eye.

      What is the most appropriate next step of management?

      Your Answer:

      Correct Answer: Plasmapheresis

      Explanation:

      The patient is displaying signs and symptoms of hyperviscosity syndrome, secondary to the Waldenström’s macroglobulinemia. Treatment of choice is plasmapheresis.

      Waldenström’s macroglobulinemia (also called lymphoplasmacytic lymphoma) is an uncommon type of non-Hodgkin lymphoma seen in older people. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein. Its features include monoclonal IgM paraproteinemia; hyperviscosity syndrome leading to bilateral central retinal vein occlusion (CRVO) and hence, visual disturbances; weight loss and lethargy; hepatosplenomegaly and lymphadenopathy; and cryoglobulinemia. It is not, however, associated with bone pain.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 7 - Which one of the following occurs during reverse transcriptase polymerase chain reaction? ...

    Incorrect

    • Which one of the following occurs during reverse transcriptase polymerase chain reaction?

      Your Answer:

      Correct Answer: RNA is converted to DNA

      Explanation:

      Reverse transcription polymerase chain reaction is a laboratory technique combining reverse transcription of RNA into DNA and amplification of specific DNA targets using polymerase chain reaction. It is primarily used to measure the amount of a specific RNA. The main advantage of PCR is its sensitivity: only one strand of sample DNA is needed to detect a particular DNA sequence. It now has many uses including prenatal diagnosis, detection of mutated oncogenes and diagnosis of infections.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 8 - A 34-year-old Nigerian woman who is a known case of sickle cell anaemia...

    Incorrect

    • A 34-year-old Nigerian woman who is a known case of sickle cell anaemia presents with fever and worsening of recurrent back pain. There is no history of weight loss or night sweats.

      The investigations done on her arrival show:
      Hb: 7.8 g/dL,
      WCC: 10.1 x10^9/L,
      Plts: 475 x10^9/L,
      Reticulocytes: 12%,
      Serum total bilirubin: 88 μmol/L.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Vaso-occlusive event

      Explanation:

      This patient is having vaso-occlusive event/crisis (thrombotic crisis) which is a type of sickle cell crisis. It may be associated with ostealgia.

      There is no evidence of an aplastic crisis in this case as the haemoglobin level is reasonable with a good reticulocyte count. Conversely, the haemoglobin is not low enough and reticulocyte count and bilirubin are not high enough for a haemolytic crisis.

      Sickle cell anaemia is characterised by periods of good health with intervening crises. The four main types of sickle cell crises are thrombotic crisis (painful or vaso-occlusive crisis), sequestration crisis, aplastic crisis, and haemolytic crisis.

      Thrombotic crisis is precipitated by infection, dehydration, alcohol, change in temperature, and deoxygenation. Sequestration crisis is characterised by acute chest syndrome (i.e. fever, dyspnoea, chest/rib pain, low pO2, and pulmonary infiltrates). Aplastic crisis is characterised by a sudden fall in haemoglobin without marked reticulocytosis. It usually occurs secondary to parvovirus infection. In haemolytic crisis, a fall in haemoglobin occurs secondary to haemolysis. It is a rare type of sickle cell crisis.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 9 - A 14 year old known asthmatic presents to the A&E department with difficulty...

    Incorrect

    • A 14 year old known asthmatic presents to the A&E department with difficulty breathing. She was seen by her regular doctor the day before with a sore throat which he diagnosed as tonsillitis and was prescribed oral Amoxicillin for 5 days.

      Past medical history:
      Ulcerative colitis diagnosed four years ago.

      Current medications:
      Inhaled salbutamol and beclomethasone
      Mesalazine 400 mg TDS

      She was observed to be alert and oriented but she had laboured breathing. Inspiratory wheeze was noted. She was pale, sweaty and cyanosed. Her temperature was 36.7ºC, pulse 121/minute and blood pressure 91/40 mmHg. The lungs were clear and the remainder of the examination was normal. She was given high-flow oxygen through a face mask but despite this her breathing became increasingly difficult.
       
      What is the most likely causative agent?

      Your Answer:

      Correct Answer: Haemophilus influenzae

      Explanation:

      Acute epiglottitis is a life-threatening disorder with serious implications to the anaesthesiologist because of the potential for laryngospasm and irrevocable loss of the airway. There is inflammatory oedema of the arytenoids, aryepiglottic folds and the epiglottis; therefore, supraglottitis may be used instead or preferred to the term acute epiglottitis.

      Acute epiglottitis can occur at any age. The responsible organism used to be Hemophilus influenzae type B (Hib), but infection with group A b-haemolytic Streptococci has become more frequent after the widespread use of Hemophilus influenzae vaccination.

      The typical presentation in epiglottitis includes acute occurrence of high fever, severe sore throat and difficulty in swallowing with the sitting up and leaning forward position in order to enhance airflow. There is usually drooling because of difficulty and pain on swallowing. Acute epiglottitis usually leads to generalized toxaemia. The most common differential diagnosis is croup and a foreign body in the airway. A late referral to an acute care setting with its serious consequences may result from difficulty in differentiation between acute epiglottitis and less urgent causes of a sore throat, shortness of breath and dysphagia.

    • This question is part of the following fields:

      • Respiratory
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  • Question 10 - Of the following disorders, which one causes acute tubular damage? ...

    Incorrect

    • Of the following disorders, which one causes acute tubular damage?

      Your Answer:

      Correct Answer: Myoglobinuria

      Explanation:

      Myoglobinuria is the condition when there is degeneration of necrosed muscle that it is excreted in the urine. This condition would then cause acute tubular damage leading to renal failure.

    • This question is part of the following fields:

      • Nephrology
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  • Question 11 - A 50-year-old man is found incidentally to have hypercalcaemia during a routine health...

    Incorrect

    • A 50-year-old man is found incidentally to have hypercalcaemia during a routine health screen.
      Which one of the following biochemical findings would be most suggestive of primary hyperparathyroidism rather than any other cause of hypercalcaemia?

      Your Answer:

      Correct Answer: Serum PTH concentration within the normal range

      Explanation:

      Primary hyperparathyroidism (PHPT) is diagnosed based upon levels of blood calcium and parathyroid hormone (PTH). In most people with PHPT, both levels are higher than normal. Occasionally, a person may have an elevated calcium level and a normal or minimally elevated PTH level. Since PTH should normally be low when calcium is elevated, a minimally elevated PTH is considered abnormal and indicates PHPT.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 12 - A 28 year old female with a history of psoriatic arthritis would most...

    Incorrect

    • A 28 year old female with a history of psoriatic arthritis would most likely have which of the following hand conditions?

      Your Answer:

      Correct Answer: Nail dystrophy

      Explanation:

      Nail dystrophy (pitting of nails, onycholysis, subungual hyperkeratosis), dactylitis, sausage shaped fingers are most commonly seen with psoriatic arthropathy. There is asymmetric joint involvement most commonly distal interphalangeal joints. Uveitis and sacroiliitis may also occur. Arthritis mutilans may occur but is very rare. Cutaneous lesions may or may not develop. When they do, its usually much after the symptoms of arthritis.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 13 - A 32 yr. old male who was on methadone has suddenly collapsed while...

    Incorrect

    • A 32 yr. old male who was on methadone has suddenly collapsed while running and was found dead. What is the most likely cause for his death?

      Your Answer:

      Correct Answer: Prolonged QT

      Explanation:

      Methadone and cocaine can cause QT prolongation through the direct effects on the resting membrane potential. Methadone can increase QT dispersion in addition to QT interval. Methadone inhibits the Human Ether-a-go-go Related Gene (hERG) and causes QTc prolongation and development of Torsades de point. Brugada-like syndrome is another condition found in methadone users which predisposes the users to life-threatening ventricular tachycardia and sudden cardiac death.

    • This question is part of the following fields:

      • Cardiology
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  • Question 14 - A 23 year old male presents with a history of lower back pain...

    Incorrect

    • A 23 year old male presents with a history of lower back pain for the last one year. Presence of which of the following features most likely points towards ankylosing spondylitis?

      Your Answer:

      Correct Answer: Bilateral erosion of sacroiliac joints on X-ray

      Explanation:

      Bilateral erosions of the sacroiliac joints on pelvic radiographs of patients with ankylosing spondylitis are an important feature of the modified New York classification criteria. Although HLA-B27 is commonly associated with AS, it can also be found in normal individuals. Back stiffness is worse in the morning and gets better as the day progresses. Tenderness and limited lumbar motion can be associated with other spine problems as well and is not characteristic of rheumatoid arthritis.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 15 - Choose the correct stage in the cell cycle that vincristine acts on: ...

    Incorrect

    • Choose the correct stage in the cell cycle that vincristine acts on:

      Your Answer:

      Correct Answer: M

      Explanation:

      Vincristine is part of the antimitotic agents, cell cycle specific (M phase). It binds to microtubules in the spindle apparatus and prevents their proper function, finally arresting mitosis.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 16 - A 33-year-old woman has missed her last two periods and has been lactating....

    Incorrect

    • A 33-year-old woman has missed her last two periods and has been lactating. Upon anamnesis, she claims she's lost weight and she's been suffering from vaginal dryness. The endocrinologist suggests that she checks her prolactin levels. Which of the following inhibits prolactin release from the hypophysis?

      Your Answer:

      Correct Answer: Dopamine

      Explanation:

      Dopamine (DA) holds a predominant role in the regulation of prolactin (PRL) secretion. Through a direct effect on anterior pituitary lactotrophs, DA inhibits the basally high-secretory tone of the cell. It accomplishes this by binding to D2 receptors expressed on the cell membrane of the lactotroph, activation of which results in a reduction of PRL exocytosis and gene expression by a variety of intracellular signalling mechanisms.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 17 - A female in her early 20's who has been diagnosed with asthma for...

    Incorrect

    • A female in her early 20's who has been diagnosed with asthma for the past four years visits the office for a review. She has been using Beclomethasone dipropionate inhaler 200mcg bd along with Salbutamol inhaler 100mcg prn and her asthma is still uncontrolled. Her chest examination is clear and she has good inhaler technique. What would be the most appropriate next step in the management of her asthma?

      Your Answer:

      Correct Answer: Add a leukotriene receptor antagonist

      Explanation:

      The NICE 2017 guidelines state that in patients who are uncontrolled with a SABA (Salbutamol) and ICS (Inhaled corticosteroid e.g. Beclomethasone), a leukotriene receptor antagonist (LTRA) should be added.
      If asthma is uncontrolled in adults (aged 17 and over) on a low dose of ICS as maintenance therapy, offer a leukotriene receptor antagonist (LTRA) in addition to the ICS and review the response to treatment in 4 to 8 weeks.

      This recommendation is also stated in NICE 2019 guidelines.

    • This question is part of the following fields:

      • Respiratory
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  • Question 18 - A 60-year-old man with a history of chronic lymphocytic leukaemia is admitted to...

    Incorrect

    • A 60-year-old man with a history of chronic lymphocytic leukaemia is admitted to the acute medical unit for pneumonia. This is his fourth admission for pneumonia in the past six months.

      Which of the following factors is most likely to be responsible?

      Your Answer:

      Correct Answer: Hypogammaglobulinaemia

      Explanation:

      Hypogammaglobulinemia is a complication of chronic lymphocytic leukaemia (CLL) that leads to recurrent infections.

      CLL is a type of cancer caused by monoclonal proliferation of well-differentiated lymphocytes, typically B cells (99%). Onset of the disease is usually asymptomatic and later constitutes anorexia, weight loss, bleeding, and recurrent infections. Lymphadenopathy is more marked in CLL than in chronic myelogenous leukaemia (CML).

      Investigations to diagnose CLL include blood film and immunophenotyping. Smudge cells (also known as smear cells) seen on the blood film point towards CLL. Complications of the disease include hypogammaglobulinemia leading to recurrent infections, autoimmune haemolytic anaemia in 10–15% of the patients, and transformation to high-grade lymphoma (Richter’s transformation).

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 19 - A 14 year old girl presented with complaints of acne vulgaris over her...

    Incorrect

    • A 14 year old girl presented with complaints of acne vulgaris over her face. The acne is exacerbated during her menstrual period. The most appropriate treatment option would be?

      Your Answer:

      Correct Answer:

      Explanation:

      Topical benzoyl peroxide is used for the treatment of mild to moderate acne vulgaris. It is actually a peeling agent and it clears the pores and reduces the bacterial cell count.

    • This question is part of the following fields:

      • Dermatology
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  • Question 20 - An elderly man presents with complaints of a chronic cough with haemoptysis and...

    Incorrect

    • An elderly man presents with complaints of a chronic cough with haemoptysis and night sweats on a few nights per week for the past four months. He is known to smoke 12 cigarettes per day and he had previously undergone treatment for Tuberculosis seven years ago.

      His blood pressure was found to be 143/96mmHg and he is mildly pyrexial 37.5°C. Evidence of consolidation affecting the right upper lobe was also found.

      Investigations;
       
      Hb 11.9 g/dL,
      WCC 11.1 x109/L,
      PLT 190 x109/L,
      Na+ 138 mmol/L,
      K+ 4.8 mmol/L,
      Creatinine 105 μmol/L,
      CXR Right upper lobe cavitating lesion
      Aspergillus precipitins positive

      Which of the following is most likely the diagnosis?

      Your Answer:

      Correct Answer: Aspergilloma

      Explanation:

      An aspergilloma is a fungus ball (mycetoma) that develops in a pre-existing cavity in the lung parenchyma. Underlying causes of the cavitary disease may include treated tuberculosis or other necrotizing infection, sarcoidosis, cystic fibrosis, and emphysematous bullae. The ball of fungus may move within the cavity but does not invade the cavity wall. Aspergilloma may manifest as an asymptomatic radiographic abnormality in a patient with pre-existing cavitary lung disease due to sarcoidosis, tuberculosis, or other necrotizing pulmonary processes. In patients with HIV disease, aspergilloma may occur in cystic areas resulting from prior Pneumocystis jiroveci pneumonia. Of patients with aspergilloma, 40-60% experience haemoptysis, which may be massive and life threatening. Less commonly, aspergilloma may cause cough and fever.

    • This question is part of the following fields:

      • Respiratory
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  • Question 21 - A 36-year-old man with diabetes is referred with abnormal liver biochemistry. Which of...

    Incorrect

    • A 36-year-old man with diabetes is referred with abnormal liver biochemistry. Which of the following is in keeping with a diagnosis of haemochromatosis?

      Your Answer:

      Correct Answer: Transferrin saturation 78% (20-50)

      Explanation:

      A high transferrin saturation is seen in hemochromatosis, as well as a high iron level (>30), a high ferritin level, and a LOW TIBC (<20). Think of it like the opposite findings of iron deficiency anaemia which is a low iron, low ferritin, high TIBC.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 22 - Choose the correct statement regarding standard polymerase chain reaction: ...

    Incorrect

    • Choose the correct statement regarding standard polymerase chain reaction:

      Your Answer:

      Correct Answer: A thermostable DNA polymerase is required

      Explanation:

      In the PCR, DNA amplification is performed by thermostable enzymes; invariably either family A DNA polymerases from thermophilic and hyperthermophilic Bacteria or family B DNA polymerases from hyperthermophilic Archaea. Family Y DNA polymerase from the hyperthermophilic archaeon Sulfolobus solfataricus, Sso-polY, is also an enzyme marketed for PCR, but with specialist applications. Each thermostable DNA polymerases has different characteristics and to achieve optimal results, the choice of a PCR enzyme depends on the application itself.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 23 - A 80 yr. old male with hypertension presented with his second episode of...

    Incorrect

    • A 80 yr. old male with hypertension presented with his second episode of atrial fibrillation. He was warfarinised and discharged. Later he was reviewed and found to be in sinus rhythm. Which of the following is the most appropriate next step?

      Your Answer:

      Correct Answer: Continue lifelong warfarin

      Explanation:

      CHA₂DS₂-VASc score is used for atrial fibrillation stroke risk calculation.
      Congestive heart failure – 1 point
      Hypertension – 1 point
      Age ≥75 years – 2 points
      Diabetes mellitus – 1 point
      Stroke/Transient Ischemic Attack/Thromboembolic event – 2 points
      Vascular disease (prior MI, PAD, or aortic plaque) – 1 point
      Age 65 to 74 years – 1 point
      Sex category (i.e., female sex) – 1 point
      A score of 2 or more is considered as high risk and anticoagulation is indicated. This patient’s score is 3, so he needs life long warfarin to prevent stroke.

    • This question is part of the following fields:

      • Cardiology
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  • Question 24 - A 20 year old male student presents to the clinic with swelling of...

    Incorrect

    • A 20 year old male student presents to the clinic with swelling of his face, hands and feet along with diffuse abdominal pain. He has a history of similar recurrent episodes since he was 10 years old, with each episode lasting 2-3 days. Examination reveals swelling on face, hands, feet but no sign of urticaria. Family history is significant for similar episodes in the mother who experienced these since childhood, and a brother who passed away following respiratory distress at age of 8 during one such episode. Which of the following tests would be the most helpful in reaching the diagnosis?

      Your Answer:

      Correct Answer: C1 esterase inhibitor

      Explanation:

      Hereditary C1 inhibitor deficiency leads to recurrent angioedema without urticaria or pruritus. Physical triggers include dental work, surgery or intubation. Medical triggers include angiotensin-converting enzyme (ACE) inhibitor, tamoxifen, oestrogen-containing medications (e.g., hormone replacement therapy and oral contraceptives). It is diagnosed on the basis of low levels of C1 esterase inhibitor or elevated levels of dysfunctional C1 esterase inhibitor. C4 levels are low between attacks. IgE levels, eosinophils, skin prick tests and RASTs are helpful in other allergic conditions and asthma but not of use in this case.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 25 - 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
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  • Question 26 - A 55-year-old male presents with complaints suggestive of erectile dysfunction. He also provides...

    Incorrect

    • A 55-year-old male presents with complaints suggestive of erectile dysfunction. He also provides a history of ischaemic heart disease for which he is under treatment. The GP decides to start him on sildenafil citrate. Which of the following medications may contraindicate the use of sildenafil in this patient?

      Your Answer:

      Correct Answer: Nicorandil

      Explanation:

      The use of nitrates and nicorandil concomitantly with sildenafil citrate is contraindicated.

      Sildenafil (Viagra) is a phosphodiesterase type V inhibitor used in the treatment of impotence.

      Contraindications
      – Patients taking nitrates and related drugs such as nicorandil
      – Hypotension
      – Recent stroke or myocardial infarction (NICE recommend waiting 6 months)

      Side-effects:
      Visual disturbances e.g. cyanopsia, non-arthritic anterior ischaemic Neuropathy
      Nasal congestion
      Flushing
      Gastrointestinal side-effects
      Headache

    • This question is part of the following fields:

      • Pharmacology
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  • Question 27 - A 22 year old man who has recently returned from a trip to...

    Incorrect

    • A 22 year old man who has recently returned from a trip to Far East presents with sore eyes and symmetrical joint pain in his knees, ankles and feet. Labs reveal an elevated ESR. The synovial fluid aspirate is sterile and has a high neutrophil count. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Reactive arthropathy

      Explanation:

      Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. Symmetric lower limb arthropathy and a sterile joint aspirate points towards reactive arthropathy.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 28 - Which of the following is the most common route of hepatitis B transmission...

    Incorrect

    • Which of the following is the most common route of hepatitis B transmission worldwide?

      Your Answer:

      Correct Answer: Perinatal transmission

      Explanation:

      Perinatal transmission is the most common cause of Hepatitis B infection worldwide. Post-exposure prophylaxis should be provided, which consists of hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth. Without this, about 40% will develop chronic infection.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 29 - A 32-year-old male who is a known case of sickle cell disease presents...

    Incorrect

    • A 32-year-old male who is a known case of sickle cell disease presents to the Accident and Emergency (A&E) department with fever, tachypnoea, and rib pain. On examination, he has a low-grade fever of 37.9°C, oxygen saturation of 95% on air, and bilateral vesicular breath sounds on chest auscultation. CXR shows opacification in the right middle zone.

      Which of these statements most accurately describes the initial management of this patient?

      Your Answer:

      Correct Answer: Incentive spirometry is indicated

      Explanation:

      This is a typical picture of acute chest syndrome (ACS). According to the British Committee for Standards in Haematology (BCSH), ACS is defined as ‘an acute illness characterised by fever and/or respiratory symptoms, accompanied by a new pulmonary infiltrate on chest X-ray’. ACS occurs in sequestration crisis, which is one of the four main types of crises occurring in sickle cell disease.

      The fundamentals of initial management are as follows:
      1. Oxygen therapy to maintain saturation >95%
      2. Intravenous fluids to ensure euvolemia
      3. Adequate pain relief
      4. Incentive spirometry in all patients presenting with rib or chest pain
      5. Antibiotics with cover for atypical organisms
      6. Bronchodilators if asthma co-exists with acute chest syndrome, or if there is an evidence of acute bronchospasm on auscultation
      7. Early consultation with the critical care team and haematology department

      A senior haematologist then makes a decision as to whether a simple or exchange transfusion is necessary in order to achieve a target Hb of 10.0–11.0g/dL in either instance.

      Sickle Cell Crises:
      Sickle cell anaemia is characterised by periods of good health with intervening crises:
      1. Sequestration crisis: acute chest syndrome (i.e. fever, dyspnoea, chest/rib pain, low pO2, and pulmonary infiltrates)

      2. Thrombotic (painful or vaso-occlusive) crisis: precipitated by infection, dehydration, and deoxygenation

      3. Aplastic crisis: sudden fall in haemoglobin without marked reticulocytosis, usually occurring secondary to parvovirus infection

      4. Haemolytic crisis: fall in haemoglobin secondary to haemolysis, rare type of sickle cell crises

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 30 - A 60-year-old male who has been on IV antibiotics for severe pneumonia developed...

    Incorrect

    • A 60-year-old male who has been on IV antibiotics for severe pneumonia developed profuse, watery, green coloured diarrhoea on the fifth day of antibiotics. What is the organism responsible for this condition?

      Your Answer:

      Correct Answer:

      Explanation:

      The most probable cause for diarrhoea is pseudomembranous colitis which is caused by Clostridium difficile. Pseudomembranous colitis is an inflammatory disease of the colon where the antibiotic-induced change in the balance of normal gut flora allows overgrowth of C difficile. Any antibiotic can cause this but the chances are higher with ampicillin, clindamycin, fluoroquinolones, and cephalosporins.

    • This question is part of the following fields:

      • Infectious Diseases
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