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  • Question 1 - Which one of the following statements regarding interleukin 1 (IL-1) is true? ...

    Incorrect

    • Which one of the following statements regarding interleukin 1 (IL-1) is true?

      Your Answer: IL-1 antagonists are currently licensed for use in colorectal cancer

      Correct Answer: It is released mainly by macrophages/monocytes

      Explanation:

      Interleukin 1 alpha and interleukin 1 beta (IL1 alpha and IL1 beta) are cytokines that participate in the regulation of immune responses, inflammatory reactions, and hematopoiesis. It is secreted mainly by macrophages and monocytes and acts as a costimulator of T cell and B cell proliferation.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 2 - Which of the following would be the most appropriate treatment (leaving out the...

    Incorrect

    • Which of the following would be the most appropriate treatment (leaving out the current NICE guidelines) for a 29 year old man with erythrodermic psoriasis and arthritis mutilans involving several digits of both hands?

      Your Answer:

      Correct Answer: Etanercept

      Explanation:

      TNF-alpha inhibitors are known to ameliorate the symptoms and disease activity of Arthritis mutilans (a rare and severe form of psoriatic arthritis), by disabling the cytokines that are involved in inflammation and joint destruction. From the mentioned choices, this would be the most effective option. Methotrexate is the most commonly used DMARD, followed by sulfasalazine used in mild to moderate forms of psoriatic arthritis but has not shown much efficacy in arthritis mutilans. Phototherapy, narrowband UVB light therapy can be very effective in clearing skin lesions.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 3 - A 20-year-old pregnant female in her first trimester met a child with chickenpox....

    Incorrect

    • A 20-year-old pregnant female in her first trimester met a child with chickenpox. She was investigated for the varicella antibody, which came back negative. She visited her GP. Which of the following measures is the most appropriate one?

      Your Answer:

      Correct Answer: Ig

      Explanation:

      After the exposure to chickenpox while pregnant, even if the patient is negative for antibodies she requires immunoglobulin to prevent further issues.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 4 - A 33-year-old Afro–Caribbean gentleman with a 5 year history of HIV infection presents...

    Incorrect

    • A 33-year-old Afro–Caribbean gentleman with a 5 year history of HIV infection presents with swollen ankles. He has been treated with highly active antiretroviral therapy (HAART) for 2 years, with partial response.

      His plasma creatinine concentration is 358 μmol/l, albumin is 12 g/dl, CD4 count is 35/μl and 24 hour urine protein excretion rate is 6.8 g. Renal ultrasound shows echogenic kidneys 13.5 cm in length.

      What would a renal biopsy show?

      Your Answer:

      Correct Answer: Microcystic tubular dilatation and collapsing FSGS

      Explanation:

      HIV-associated nephropathy (HIVAN) show typical findings of scarring called focal segmental glomerulosclerosis (FSGS) and microcystic tubular dilatation, prominent podocytes, and collapsing capillary loops.

    • This question is part of the following fields:

      • Nephrology
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  • Question 5 - Which of the following cancers is responsible in producing osteoblastic bone metastases instead...

    Incorrect

    • Which of the following cancers is responsible in producing osteoblastic bone metastases instead of osteolytic?

      Your Answer:

      Correct Answer: Prostate adenocarcinoma

      Explanation:

      Osteoblastic (or sclerotic) bone metastases, characterized by deposition of new bone, present in prostate cancer, carcinoid, small cell lung cancer, Hodgkin lymphoma or medulloblastoma.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 6 - A 68-year-old gentleman has been receiving dialysis for 6 years. His PTH is...

    Incorrect

    • A 68-year-old gentleman has been receiving dialysis for 6 years. His PTH is elevated at 345 pg/ml (NR 25-65), phosphate 2.13 mmol/l and corrected calcium 2.01 mmol/l.
       
      Of the following, which is most likely responsible for renal osteodystrophy?

      Your Answer:

      Correct Answer: Diminished activity of renal 1-α-hydroxylase

      Explanation:

      Renal osteodystrophy is a metabolic bone disease often affecting long-term dialysis patients. The kidneys are no longer able to maintain the calcium levels in the blood, thus the PTH increases as the body attempts to raise blood calcium levels. Osteomalacia in these cases is most likely caused by the diminished activity of renal 1-a-hydroxylase that is important for hydroxylation of Calciferol to calcitriol (Vitamin D). This bioactive form of Vitamin D is responsible for increasing intestinal absorption of calcium.

    • This question is part of the following fields:

      • Nephrology
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  • Question 7 - A woman is being seen at the clinic. Her clinic notes are missing...

    Incorrect

    • A woman is being seen at the clinic. Her clinic notes are missing and the only results available are lung function tests. Her date of birth is also missing from the report. 
      FEV1 0.4 (1.2–2.9 predicted)
      Total lung capacity 7.3 (4.4–6.8 predicted)
      Corrected transfer factor 3.3 (4.2–8.8 predicted)
       
      Which disease can be suspected From these results?

      Your Answer:

      Correct Answer: Moderate COPD

      Explanation:

      The Stages of COPD:
      Mild COPD or Stage 1—Mild COPD with a FEV1 about 80 percent or more of normal.
      Moderate COPD or Stage 2—Moderate COPD with a FEV1 between 50 and 80 percent of normal.
      Severe COPD or Stage 3—Severe emphysema with a FEV1 between 30 and 50 percent of normal.
      Very Severe COPD or Stage 4—Very severe or End-Stage COPD with a lower FEV1 than Stage 3, or people with low blood oxygen levels and a Stage 3 FEV1.

      This patient has a FEV1 percent of 40 which falls within the stage 2 or moderate COP

    • This question is part of the following fields:

      • Respiratory
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  • Question 8 - A 15-year-old girl is admitted to hospital following a ruptured ectopic pregnancy. She...

    Incorrect

    • A 15-year-old girl is admitted to hospital following a ruptured ectopic pregnancy. She comes from a family of Jehovah's Witnesses. Her haemoglobin on admission is 6.7 g/dl. She consents to a blood transfusion but her mother refuses. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Give the blood transfusion

      Explanation:

      People aged 16 or over are entitled to consent to their own treatment. This can only be overruled in exceptional circumstances. Children under the age of 16 can consent to their own treatment if they’re believed to have enough intelligence, competence and understanding to fully appreciate what’s involved in their treatment. This is known as being Gillick competent.

      Otherwise, someone with parental responsibility can consent for them.
      This could be:
      the child’s mother or father
      the child’s legally appointed guardian
      a person with a residence order concerning the child
      a local authority designated to care for the child
      a local authority or person with an emergency protection order for the child.
      Giving the blood transfusion is therefore both clinically and ethically the right course of action.
      Jehovah’s Witnesses frequently carry a signed and witnessed Advance Decision Document listing the blood products and autologous procedures that are, or are not, acceptable to them It is appropriate to have a frank, confidential discussion with the patient about the potential risks of their decision and the possible alternatives to transfusion, but the freely expressed wish of a competent adult must always be respected.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 9 - A 30-year-old male is brought to the emergency department following his collapse in...

    Incorrect

    • A 30-year-old male is brought to the emergency department following his collapse in a night club. His friends who accompanied him admit that, of recent, he has been using increasing amounts of cocaine. Which among the following is commonly associated with cocaine overdose?

      Your Answer:

      Correct Answer: Metabolic acidosis

      Explanation:

      Metabolic acidosis is associated with cocaine overdose.
      In overdose, cocaine leads to agitation, tachycardia, hypertension, sweating, hallucinations, and finally convulsions.
      Metabolic acidosis, hyperthermia, rhabdomyolysis, and ventricular arrhythmias also occur.
      Chronic use may be associated with premature coronary artery disease, dilated cardiomyopathy, and increased risk of cerebral haemorrhage.
      There are 3 stages for acute cocaine toxicity:
      Stage I: CNS symptoms of headache, vertigo, pseudo hallucinations, hyperthermia, hypertension.
      Stage II: increased deep tendon reflexes, tachypnoea, irregular breathing, hypertension.
      Stage III: Areflexia, coma, fixed and dilated pupils, hypotension, ventricular fibrillation, apnoea, and respiratory failure.

      Treatment:
      – Airway, breathing, and circulation to be secured. The patient’s fever should be managed, and one should rule out hypoglycaemia as a cause of the neuropsychiatric symptoms.
      – Cardiovascular toxicity and agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic outflow.
      – The mixed beta/alpha blocker labetalol is safe and effective for treating concomitant cocaine-induced hypertension and tachycardia.
      – Non-dihydropyridine calcium channels blockers such as diltiazem and verapamil have been shown to reduce hypertension reliably, but not tachycardia.
      – Dihydropyridine agents such as nifedipine should be avoided, as reflex tachycardia may occur.
      – The alpha-blocker phentolamine has been recommended but only treats alpha-mediated hypertension and not tachycardia.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 10 - A 29-year-old male patient with a history of three previous chest infections in...

    Incorrect

    • A 29-year-old male patient with a history of three previous chest infections in the past seven months presents with fever, pleuritic pain and productive cough. Chest x-ray shows lobar consolidation and the diagnosis of a fourth chest infection is established, after sputum culture reveals Haemophilus influenzae. The previous chest infections were due to Streptococcus pneumoniae. After a period of six weeks, a full blood count, urea, CRP, electrolytes and chest x-ray turn out as normal. What is the investigation you would choose next?

      Your Answer:

      Correct Answer: Serum immunoglobulins

      Explanation:

      Hypogammaglobulinemia occurs due to a variety of underlying primary or secondary immunodeficient states, including HIV which is suspected in this case. The most commonly recognised clinical feature is recurrent infection.

    • This question is part of the following fields:

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

    Incorrect

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

      Your Answer:

      Correct Answer: TB adenitis

      Explanation:

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

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 12 - A 67-year-old man presents with anaemia and weight loss. Upon endoscopy, a gastric...

    Incorrect

    • A 67-year-old man presents with anaemia and weight loss. Upon endoscopy, a gastric tumour is revealed, later established as an adenocarcinoma. The patient refuses any treatment and claims that his condition is not influencing the quality of his life. Clinical examination has nothing particularly interesting to show and the patient seems to be conscious of his decision, regardless of the likely curative nature of surgery. What is the single most appropriate management?

      Your Answer:

      Correct Answer: Respect his wishes and book a follow-up appointment for four weeks

      Explanation:

      The patient seems to be conscious about his decision, which should be respected. According to Mental Capacity Act 2005, a person who makes an unwise decision should not be treated as unable to make a decision.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 13 - Which of the following statements regarding psoriasis is incorrect? ...

    Incorrect

    • Which of the following statements regarding psoriasis is incorrect?

      Your Answer:

      Correct Answer: Mediated by type 2 helper T cells

      Explanation:

      Psoriasis is a long-lasting autoimmune disease which is characterized by patches of abnormal skin. These skin patches are typically red, itchy, and scaly commonly on the extensor surfaces. Psoriasis is associated with an increased risk of psoriatic arthritis, lymphomas, cardiovascular disease, Crohn’s disease, and depression. Psoriatic arthritis affects up to 30% of individuals with psoriasis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response, rather than type 2 helper T cells

    • This question is part of the following fields:

      • Dermatology
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  • Question 14 - Which of the following gives the annual incidence of deep venous thrombosis (DVT)...

    Incorrect

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

      Your Answer:

      Correct Answer: about 2 per 1000

      Explanation:

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

    • This question is part of the following fields:

      • Cardiology
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  • Question 15 - A 33-year-old man presents with recurrent episodes of abdominal pain associated with weakness...

    Incorrect

    • A 33-year-old man presents with recurrent episodes of abdominal pain associated with weakness of his arms and legs.

      Which one of the following urine tests would best indicate lead toxicity?

      Your Answer:

      Correct Answer: Coproporphyrin

      Explanation:

      Lead poisoning is characterised by abdominal pain, fatigue, constipation, peripheral neuropathy (mainly motor), and blue lines on gum margin in 20% of the adult patients (very rare in children).

      For diagnosis, the level of lead in blood is usually considered with levels greater than 10 mcg/dL being significant. Furthermore, the blood film shows microcytic anaemia and basophilic stippling of red blood cells. Urinary coproporphyrin is increased (urinary porphobilinogen and uroporphyrin levels are normal to slightly increased). Raised serum and urine levels of delta-aminolaevulinic acid may also be seen, making it sometimes difficult to differentiate from acute intermittent porphyria.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 16 - A 46-year-old gentleman diagnosed with type 2 diabetes, hypertension, and proteinuria is started...

    Incorrect

    • A 46-year-old gentleman diagnosed with type 2 diabetes, hypertension, and proteinuria is started on Ramipril to prevent development of renal disease. He reports to his GP that he has developed a troublesome cough since starting the medication. He has no symptoms of lip swelling, wheeze and has no history of underlying respiratory disease.
       
      What increased chemical is thought to be the cause of his cough?

      Your Answer:

      Correct Answer: Bradykinin

      Explanation:

      Ramipril is an ACE inhibitor that blocks the conversion of angiotensin I to angiotensin II as well as preventing the breakdown of bradykinin, leading to blood vessel dilatation and decreased blood pressure. However, bradykinin also causes smooth muscles in the lungs to contract, so the build-up of bradykinin is thought to cause the dry cough that is a common side-effect in patients that are on ACE inhibitors.

    • This question is part of the following fields:

      • Nephrology
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  • Question 17 - Regarding neonatal meningitis, which of the following statements is true? ...

    Incorrect

    • Regarding neonatal meningitis, which of the following statements is true?

      Your Answer:

      Correct Answer: Has an above average incidence in babies with a meningomyelocele

      Explanation:

      The commonest time for bacterial meningitis is in the 1st month of life and group B Streptococcus is the commonest organism. The anterior fontanelle is full, but does not bulge with normal flexion. Neurological manifestations include seizures, irritability, poor tone, lethargy and tremors, however no findings of sensorineural deafness have been noted. One of the risk factors for introduction of meningeal infection is Meningomyelocele.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 18 - A 59-year-old woman has an 11mm skin lesion on her right forearm, which...

    Incorrect

    • A 59-year-old woman has an 11mm skin lesion on her right forearm, which bleeds easily on contact and has changed in appearance over the last 11 months.

      Your Answer:

      Correct Answer:

      Explanation:

      Melanoma is more common in men than women. Reasons for the disease includes: UV light and genetic predisposition or mutations. Diagnosis is by biopsy and analysis of any skin lesion that has signs of being potentially cancerous.
      Early warning signs of melanoma ABCDE:
      Asymmetry
      Borders (irregular with edges and corners)
      Colour (variegated)
      Diameter (greater than 6 mm)
      Evolving over time

    • This question is part of the following fields:

      • Dermatology
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  • Question 19 - 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 20 - An elderly woman is taken to the clinic by her husband because she...

    Incorrect

    • An elderly woman is taken to the clinic by her husband because she has been complaining about seeing ghosts in their house. She no longer wants to enter in the house. You wonder if this might be Charles-Bonnet syndrome.
      Which of the following risk factors may pre-dispose this woman to Charles-Bonnet syndrome?

      Your Answer:

      Correct Answer: Peripheral visual impairment

      Explanation:

      Charles Bonnet syndrome (CBS) involves visual hallucinations due to eye disease, usually associated with a sharp decline in vision. The phenomenon is seen in patients with moderate or severe visual impairment. It can occur spontaneously as the vision declines or it may be precipitated, in predisposed individuals, by concurrent illness such as infections elsewhere in the body.

      It is not clear why CBS develops or why some individuals appear to be predisposed to it. It is particularly noted in patients with advanced macular degeneration. It has been suggested that reduced or absent stimulation of the visual system leads to increased excitability of the visual cortex (deafferentation hypothesis). This release phenomenon is compared to phantom limb symptoms after amputation.

      CBS is much more common in older patients because conditions causing marked visual loss are more common in older people. However, it can occur at any age and has been described in children.
      The prevalence is hard to assess due to considerable under-reporting, perhaps because patients frequently fear that it is a sign of mental illness or dementia. However, it is thought to occur in:
      About 10-15% of patients with moderate visual loss.
      Possibly up to 50% of people with severe visual loss.
      Presentation:
      The nature of the hallucination depends on the part of the brain that is activated. The hallucinations may be black and white or in colour. They may involve grids/brickwork/lattice patterns but are typically much more complex:

      The hallucinations are always outside the body.
      The hallucinations are purely visual – other senses are not involved.
      The hallucinations have no personal meaning to the patient.
      Hallucinations may last seconds, minutes or hours.
      CBS tends to occur in a ‘state of quiet restfulness’. This may be after a meal or when listening to the radio (but not when dozing off).
      Symptoms also have a tendency to occur in dim lighting conditions.
      Patients may report high levels of distress, with some patients reporting anger, anxiety and even fear associated with the hallucinations.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 21 - A 29-year-old physiotherapist with a history of bilateral vitreous haemorrhage is referred due...

    Incorrect

    • A 29-year-old physiotherapist with a history of bilateral vitreous haemorrhage is referred due to progressive ataxia. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Von Hippel-Lindau syndrome

      Explanation:

      Retinal and cerebellar haemangiomas are key features of Von Hippel-Lindau syndrome. Retinal haemangiomas are bilateral in 25% of patients and may lead to vitreous haemorrhage. Von Hippel-Lindau (VHL) syndrome is an autosomal dominant condition predisposing to neoplasia. It is due to an abnormality in the VHL gene located on short arm of chromosome 3.

    • This question is part of the following fields:

      • Neurology
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  • Question 22 - A 43 year-old female artist with no past medical history presents to the...

    Incorrect

    • A 43 year-old female artist with no past medical history presents to the emergency department with a 2-day history of pins and needles in the lower limbs, and progressive walking difficulties. She states she had diarrhoea 1 week ago. On examination, there is a loss of pinprick sensation noted to the lower limbs from mid-thigh distally and in the upper limbs from MCP joints distally. There is bilateral weakness of ankle dorsiflexion, noted at 3/5, and knee flexion and extension weakness, noted at 4/5 bilaterally. Power in upper and lower limbs is otherwise normal. Knee and ankle deep tendon reflexes are absent. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Guillain-Barre syndrome

      Explanation:

      Guillain-Barre syndrome is an immune mediated demyelination of the peripheral nervous system often triggered by an infection (classically Campylobacter jejuni). Characteristic features include progressive weakness of all four limbs, and it is classically ascending, affecting the lower extremities first. Sensory symptoms tend to be mild.

      Functional neurological syndrome can be discounted due to presence of hard neurological signs. Multiple sclerosis can be excluded because of the presence of lower motor neuron signs and absence of upper motor neuron signs. Chronic inflammatory demyelinating polyneuropathy is the chronic form of Guillain-Barre syndrome.

    • This question is part of the following fields:

      • Neurology
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  • Question 23 - A 24 year old male, known case of hereditary angioneurotic oedema presents with...

    Incorrect

    • A 24 year old male, known case of hereditary angioneurotic oedema presents with recurrent fever and arthralgia which is accompanied by a rash on face and upper chest. These attacks have been refractory to treatment and have occurred recurrently requiring adrenaline on several occasions. Lab results reveal persistently reduced C4 levels. Which of the following is most likely causing his current symptoms?

      Your Answer:

      Correct Answer: Systemic lupus erythematosus

      Explanation:

      Angioedema secondary to C1 inhibitor deficiency has been rarely reported to be associated with systemic lupus erythematosus. A genetic defect of C1 inhibitor produces hereditary angioedema, which is usually presented with cutaneous painless oedema, but oedema of the genital area, gastrointestinal and laryngeal tracts have also been reported. In lupus patients, angioedema may be the result of an acquired type of C1 inhibitor deficiency, most probably due to antibody formation directed against the C1 inhibitor molecule.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 24 - A 53 year old female, longstanding case of rheumatoid arthritis comes for a...

    Incorrect

    • A 53 year old female, longstanding case of rheumatoid arthritis comes for a review. Which of the following features are commonly associated with her condition?

      Your Answer:

      Correct Answer: Proximal interphalangeal joint involvement in the hands

      Explanation:

      Rheumatoid arthritis is a polyarthritis that results in symmetrical pain and swelling of the affected joints (also at rest). It particularly affects the metacarpophalangeal joints (MCPJs) and proximal interphalangeal joints (PIPJs), not the distal interphalangeal joints (DIPs).
      Ulcerative colitis and IBD are associated with seronegative arthritides, not RA. The condition can also cause various extra-articular manifestations such as ocular symptoms, rheumatoid nodules and pulmonary fibrosis. Scleritis, episcleritis and keratoconjunctivitis sicca are more common than uveitis. Early intervention with disease-modifying antirheumatic drugs (DMARDs) plays a decisive role in successful treatment.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 25 - Which of the following is correct regarding toxoplasmosis? ...

    Incorrect

    • Which of the following is correct regarding toxoplasmosis?

      Your Answer:

      Correct Answer: Can present with fits in patients with AIDS

      Explanation:

      T. gondii infection in immunocompetent people is usually asymptomatic. It can present as fits in patients with AIDs, who are immunosuppressed. Additionally, infection in the first trimester of pregnancy is very harmful. Congenital toxoplasmosis presents with intracranial calcifications, classically. It can also present with hydrocephalus, microcephaly, blindness, petechiae. Siramycin is the drug of choice to try to prevent vertical transmission from mother to baby. It is typically gotten from cat faeces or raw/undercooked meat, not raw eggs (raw eggs: think salmonella).

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 26 - A 37-year-old teacher with multiple sclerosis complains that her vision becomes blurred during...

    Incorrect

    • A 37-year-old teacher with multiple sclerosis complains that her vision becomes blurred during a hot bath. Which of the following explain this?

      Your Answer:

      Correct Answer: Uhthoff's phenomenon

      Explanation:

      Uhthoff’s phenomenon is worsening of vision following a rise in body temperature.
      Lhermitte’s sign describes paraesthesia in the limbs on neck flexion.
      Oppenheim’s sign is seen when scratching of the inner side of leg leads to extension of the toes. It is a sign of cerebral irritation and is not related to multiple sclerosis.
      Werdnig-Hoffman’s disease is also known as spinal muscular atrophy.

    • This question is part of the following fields:

      • Neurology
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  • Question 27 - Which one of the following is not associated with non-alcoholic steatohepatitis? ...

    Incorrect

    • Which one of the following is not associated with non-alcoholic steatohepatitis?

      Your Answer:

      Correct Answer: Type 1 diabetes mellitus

      Explanation:

      There are two types of Non-alcoholic fatty liver disease (NAFLD); simple fatty liver and non-alcoholic steatohepatitis (NASH). Simple fatty liver and NASH are two separate conditions.
      Simple fatty liver, also called non-alcoholic fatty liver (NAFL), is a form of NAFLD in which you have fat in your liver but little or no inflammation or liver cell damage. Simple fatty liver typically does not progress to cause liver damage or complications.
      Non-alcoholic steatohepatitis (NASH)
      NASH is a form of NAFLD in which you have hepatitis and liver cell damage, in addition to fat in your liver. Inflammation and liver cell damage can cause fibrosis, or scarring, of the liver. NASH may lead to cirrhosis or liver cancer. Type I diabetes is not associated with NASH (non-alcoholic steatohepatitis), but type II diabetes is. Hyperlipidaemia, obesity, sudden weight loss/starvation and jejunoileal bypass are all associated with NASH. This is the most common cause of liver disease in the developed world.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 28 - A woman who is 36 weeks pregnant presents with chickenpox. How should she...

    Incorrect

    • A woman who is 36 weeks pregnant presents with chickenpox. How should she be treated?

      Your Answer:

      Correct Answer: Acyclovir

      Explanation:

      Acyclovir is the correct answer. There has been no documented evidence of harm in pregnancy yet. Chickenpox can cause fetal abnormalities, and varicella zoster Immunoglobulin should be given to the infant immediately after birth (not the mother, won’t help). Steroids will actually make the chicken pox worse. Painkillers only, is obviously the wrong answer and pose severe risk to foetus.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 29 - A 34-year-old woman is admitted to the hospital with a one-week history of...

    Incorrect

    • A 34-year-old woman is admitted to the hospital with a one-week history of dark urine and fatigue. One day before admission, she developed severe abdominal pain and abdominal distension.

      On examination, she has pallor, jaundice, an enlarged tender liver, and ascites. Her investigations show:
      Hb: 7.9 g/dL,
      WCC: 3.2 x 10^9/L,
      Plts: 89 x 10^9/L,
      MCV: 101 fL.
      Peripheral smear: Mild polychromasia,
      AST: 144 U/L,
      ALT: 130 U/L,
      Bilirubin: 54 μmol/L.
      Urine hemosiderin: ++,
      Urine urobilinogen +.

      Abdominal ultrasound reveals an enlarged liver, ascites, and absent flow in the hepatic veins.

      Which single test would you request to confirm the underlying diagnosis?

      Your Answer:

      Correct Answer: Flow cytometry for CD55 and CD59 expression

      Explanation:

      The patient has paroxysmal nocturnal haemoglobinuria (PNH) complicated by acute hepatic vein thrombosis (Budd–Chiari syndrome).

      PNH is an acquired clonal disorder of haematopoietic stem cells, characterised by variable combination of intravascular haemolysis, thrombosis, and bone marrow failure. Diagnosis is made by flow cytometric evaluation of blood, which confirms the CD55 and CD59 deficiencies and deficiency of expression of other GPI-linked proteins. This test is replacing older complement-based assays such as the Ham test and sucrose lysis test.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 30 - Out of the following, which condition is not associated with hyposplenism? ...

    Incorrect

    • Out of the following, which condition is not associated with hyposplenism?

      Your Answer:

      Correct Answer: Liver cirrhosis

      Explanation:

      Liver cirrhosis is not associated with hyposplenism.

      Hyposplenism is caused by a variety of conditions. These are:
      1. Splenectomy
      2. Sickle cell anaemia
      3. Coeliac disease, dermatitis herpetiformis
      4. Graves’ disease
      5. Systemic lupus erythematosus (SLE)

    • This question is part of the following fields:

      • Haematology & Oncology
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SESSION STATS - PERFORMANCE PER SPECIALTY

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