00
Correct
00
Incorrect
00 : 00 : 0 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A 58-year-old gentleman with a long history of gout presents with loin pain....

    Correct

    • A 58-year-old gentleman with a long history of gout presents with loin pain. Other past history of note includes an ileostomy after bowel surgery. There is no history of weight loss from malabsorption syndrome after his bowel surgery. Excretion urography reveals evidence of bilateral renal stones.

      What is the most likely composition of his renal stones?

      Your Answer: Uric acid stones

      Explanation:

      Uric acid stones will most likely be found in this case because of the patient’s long history of gout. Additionally, studies have shown that ileostomy patients have an increased risk for the development of uric acid stones.

    • This question is part of the following fields:

      • Nephrology
      3
      Seconds
  • Question 2 - An 18 year old boy from Middle East presented with a 1 month...

    Incorrect

    • An 18 year old boy from Middle East presented with a 1 month history of a yellowish, crusted plaque over his scalp, along with some scarring alopecia. What will the likely diagnosis be?

      Your Answer:

      Correct Answer: Favus

      Explanation:

      Favus is a fungal infection of the scalp, resulting in the formation of a yellowish crusted plaque over the scalp and leads to scar formation with alopecia. Tinea capitus is a fungal infection of the scalp resulting in scaling and non scarring hair loss. Folliculitis presents with multiple perifollicular papules which can be caused by both bacteria and fungi. Cradle cap usually affects infants where the whole scalp is involved. It can lead to hair loss and responds to topical antifungals and keratolytics.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 3 - The mechanism of action of low molecular weight heparin, has the greatest effect...

    Incorrect

    • The mechanism of action of low molecular weight heparin, has the greatest effect on which of the following components of the coagulation cascade?

      Your Answer:

      Correct Answer: Factor Xa

      Explanation:

      Mechanism of action of low molecular weight heparin (LMWH):
      It inhibits coagulation by activating antithrombin III. Antithrombin III binds to and inhibits factor Xa. In doing so it prevents activation of the final common path; Xa inactivation means that prothrombin is not activated to thrombin, thereby not converting fibrinogen into fibrin for the formation of a clot.

      LMHW is a small fragment of a larger mucopolysaccharide, heparin. Heparin works similarly, by binding antithrombin III and activating it. Heparin also has a binding site for thrombin, so thrombin can interact with antithrombin III and heparin, thus inhibiting coagulation.
      Heparin has a faster onset of anticoagulant action as it will inhibit not only Xa but also thrombin, while LMWH acts only on Xa inhibition.

      Compared to heparin, LMWHs have a longer half-life, so dosing is more predictable and can be less frequent, most commonly once per day.

      Dosage and uses:
      LMWH is administered via subcutaneous injection. This has long-term implications on the choice of anticoagulant for prophylaxis, for example, in orthopaedic patients recovering from joint replacement surgery, or in the treatment of DVT/PE.

      Adverse effects:
      The main risk of LMWH will be bleeding. The specific antidote for heparin-induced bleeding is protamine sulphate.
      Less commonly it can cause:
      Heparin-induced thrombocytopenia (HIT)
      Osteoporosis and spontaneous fractures
      Hypoaldosteronism
      Hypersensitivity reactions

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 4 - Which one of the following conditions is least likely to be associated with...

    Incorrect

    • Which one of the following conditions is least likely to be associated with pyoderma gangrenosum?

      Your Answer:

      Correct Answer: Syphilis

      Explanation:

      The following are conditions commonly associated with pyoderma gangrenosum:
      Inflammatory bowel disease:
      – Ulcerative colitis
      – Crohn’s disease
      Arthritides:
      – Rheumatoid arthritis
      – Seronegative arthritis
      Haematological disease:
      – Myelocytic leukaemia[8]
      – Hairy cell leukaemia
      – Myelofibrosis
      – Myeloid metaplasia
      – Monoclonal gammopathy
      Autoinflammatory disease:
      – Pyogenic sterile arthritis, pyoderma gangrenosum, and acne syndrome (PAPA syndrome)
      – Granulomatosis with polyangiitis

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 5 - Among the following which is the beneficial effect of nitro-glycerine? ...

    Incorrect

    • Among the following which is the beneficial effect of nitro-glycerine?

      Your Answer:

      Correct Answer: Dilation of systemic veins

      Explanation:

      Dilation of systemic veins is a beneficial effect of nitro-glycerine.

      Administration of nitro-glycerine results in the dilation of systemic veins and decrease of myocardial wall tension and oxygen demand. Dilatation of systemic veins can cause reduced systemic vascular resistance leading to reduced cardiac workload thus reducing anginal symptoms secondary to demand ischemia.

      This is accompanied by vasodilation of large and medium-sized coronary arteries with increased coronary blood flow to the sub endocardium.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 6 - A 24 yr. old male with a history of a cardiac murmur which...

    Incorrect

    • A 24 yr. old male with a history of a cardiac murmur which was not properly followed up, presented with right sided hemiparesis. His blood pressure was 120/70 mmHg. His ECG revealed right bundle branch block with right axis deviation. Which of the following is the most likely cause for this presentation?

      Your Answer:

      Correct Answer: Ostium secundum atrial septal defect

      Explanation:

      Ostium secundum atrial septal defects are known to cause stroke due to the passage of emboli from the right sided circulation to the left sided circulation. ECG shows tall, peaked P waves (usually best seen in leads II and V2) and prolongation of the PR interval, rSR pattern in leads V3 R and V1 as well as right axis deviation.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 7 - A 42 year old female presents with morning stiffness that usually takes an...

    Incorrect

    • A 42 year old female presents with morning stiffness that usually takes an hour to settle and a one year history of intermittent pain and swelling of the small joints of her hands. Examination reveals symmetric soft tissue swelling over the PIP and MCP joints and rheumatoid nodules on the elbows. There is also an effusion of both wrists. Lab results are positive for rheumatoid factor. X-ray of the wrists and hands shows erosions and bony decalcification. NSAIDs are started and the patient is referred to a rheumatologist for consideration of DMARD. Previous history is significant for TB. Which of the following should be avoided?

      Your Answer:

      Correct Answer: Infliximab

      Explanation:

      Anti-TNF-α therapy is effective for patients with arthritis but it can oftentimes lead to the reactivation of latent TB. Hence it should be used with great caution in patients with a past history of TB or current infection.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 8 - An 80 year-old Zimbabwean woman with known rheumatoid arthritis was admitted to hospital...

    Incorrect

    • An 80 year-old Zimbabwean woman with known rheumatoid arthritis was admitted to hospital with a four week history of weight loss, night sweats and cough. She was given a course of Amoxicillin for the past week but her condition deteriorated and she was referred to the hospital when she developed haemoptysis.
       
      She was on maintenance prednisolone 10 mg once per day and four weeks earlier, she had received infliximab for a flare up of rheumatoid arthritis. She lived with her husband but had been admitted to hospital himself with influenza four days earlier. She was a lifelong non-smoker and worked most of her life as a missionary in Zimbabwe and South Africa.
       
      On examination she looked cachexic and was pyrexial with a temperature of 38.5°C. Her blood pressure was 181/101 mmHg, pulse 121 beats per minute and oxygen saturations of 89% on room air. Her heart sounds were normal and there were no audible murmurs. Auscultation of her lung fields revealed bronchial breath sounds in the left upper zone. Examination of her abdomen was normal.
       
      Mantoux test < 5mm (after 48 hours)
      A chest radiograph revealed cavitating left upper lobe consolidation.
       
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Post-primary tuberculosis

      Explanation:

      Post-primary pulmonary tuberculosis is a chronic disease commonly caused by either endogenous reactivation of a latent infection or exogenous re-infection by Mycobacterium tuberculosis.
      Post-primary pulmonary tuberculosis (also called reactivation tuberculosis) develops in 5%–20% of patients infected with M. tuberculosis.

      Found mainly in adults, this form of tuberculosis arises from the reactivation of bacilli that lay dormant within a fibrotic area of the lung. In adults, reinfection with a strain of mycobacterium that differs from that which caused the primary infection is also possible. Predisposing factors include immunosuppression, diabetes, malnutrition and alcoholism.

      Infliximab is a monoclonal antibody against tumour necrosis factor α (TNF-α). It is FDA approved for many autoimmune conditions, including rheumatoid arthritis and Crohn’s disease. One of the many known side effects of infliximab therapy is reactivation of latent tuberculosis (TB). Because of the resemblances in clinical and radiological features, tubercular lesions in the lung may mimic malignancy. TB accounts for 27% of all infections initially presumed to be lung cancer on imaging studies.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 9 - A 18-year-old female is brought to the emergency department by her boyfriend. He...

    Incorrect

    • A 18-year-old female is brought to the emergency department by her boyfriend. He is concerned that she may have taken an overdose of her mom's morphine sulphate pills after being depressed about her mother, who is dying of carcinoma of the breast.
      Which of the following may point towards his suspicion?

      Your Answer:

      Correct Answer: Sweating

      Explanation:

      Excessive sweating points towards a morphine overdose.

      Morphine is considered the classic opioid analgesic with which other painkillers are compared. Like other medications in this class, morphine has an affinity for delta, kappa, and mu-opioid receptors.
      Most commonly used in pain management, morphine provides major relief to patients afflicted with pain.

      Among the more common adverse effects of morphine use is constipation. Other side effects include nausea, vomiting, drowsiness, and confusion. Psychological and physical dependence may occur.

      Other side effects include bronchospasm, angioedema, urinary retention, ureteric or biliary spasm, dry mouth, sweating, rash, facial flushing, vertigo, tachycardia, bradycardia, palpitations, orthostatic hypotension, hypothermia, restlessness, mood change, hallucinations, seizures (adults and children) and miosis, headache and allergic reactions (including anaphylaxis) and decreased libido or potency.

      Raised intracranial pressure occurs in some patients. Muscle rigidity may occur with high doses. Elevated liver enzymes may occur due to biliary sphincter constriction. Large doses can lead to respiratory depression, circulatory failure, and coma.

      Treatment of opioid overdose:
      Initial treatment of overdose begins with supportive care.
      Naloxone is a pure competitive antagonist of opiate receptors and has no agonistic activity. The drug is relatively safe and can be administered intravenous, intramuscular, subcutaneous or via the endotracheal tube.
      Alternatively, nalmefene and naltrexone maybe considered.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 10 - A 13 yr. old boy presented with difficulty in breathing on exertion. According...

    Incorrect

    • A 13 yr. old boy presented with difficulty in breathing on exertion. According to his mother who was also present, his exercise tolerance has been gradually worsening for the past weeks. It has reached the point where he is unable to participate in his weekly soccer match. Cardiac catherization was performed and the results are given below:
      (Anatomical site vs Oxygen saturation (%)vs Pressure (mmHg))

      Superior vena cava:
      73
      ,–.

      Right atrium:
      71,
      6.

      Right ventricle:
      72,
      –.

      Pulmonary artery:
      86,
      53/13.

      PCWP:
      –,
      15.

      Left ventricle:
      97,
      111/10.

      Aorta:
      96,
      128/61.

      Which of the following is the diagnosis?

      Your Answer:

      Correct Answer: Patent ductus arteriosus

      Explanation:

      The oxygen saturation in the pulmonary artery is higher than that of the right ventricle. The pressure of the pulmonary artery and of the PCWP are also high. So patent ductus arteriosus is highly suggestive.

    • This question is part of the following fields:

      • Cardiology
      0
      Seconds
  • Question 11 - Which one of the following congenital infections is most characteristically associated with chorioretinitis?...

    Incorrect

    • Which one of the following congenital infections is most characteristically associated with chorioretinitis?

      Your Answer:

      Correct Answer: Toxoplasma gondii

      Explanation:

      The common congenital infections encountered are rubella, toxoplasmosis and cytomegalovirus. Cytomegalovirus is the most common congenital infection in the UK. Maternal infection is usually asymptomatic.
      Congenital toxoplasmosis is associated with fetal death and abortion, and in infants, it is associated with neurologic deficits, neurocognitive deficits, and chorioretinitis.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 12 - An 80 year old female, previously diagnosed with polymyalgia rheumatica 18 months back,...

    Incorrect

    • An 80 year old female, previously diagnosed with polymyalgia rheumatica 18 months back, presents to the outpatient clinic with bilateral shoulder stiffness and generalized myalgia. The ESR was found to be 60mm/1st hour at the time of presentation. Prednisolone therapy was initiated at a daily dose of 15 mg along with Calcium and Vitamin supplementation. She reported resolution of her symptoms in one week. However the symptoms relapsed when the prednisolone dose was reduced below the current dose of 12.5 mg daily. How should she be ideally managed?

      Your Answer:

      Correct Answer: Continue the current dose of prednisolone and start methotrexate

      Explanation:

      Polymyalgia rheumatica, a syndrome characterized by proximal muscle pain and stiffness in older persons, generally is treated with prednisone. Dosages of 15 to 25 mg of prednisone per day can reduce inflammation considerably, although many patients relapse when therapy is tapered. Long-term (18 to 36 months) steroid treatment has been recommended by several studies, but this can result in multiple side effects, including osteoporosis, hypertension, cataracts, and hyperglycaemia. Methotrexate has been used to reduce inflammation in rheumatoid arthritis, systemic vasculitis, and giant cell arteritis, and in some studies has been combined with prednisone to treat polymyalgia rheumatica, decreasing the duration of treatment.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 13 - A 73-year-old female is being reviewed in the osteoporosis clinic. She had a...

    Incorrect

    • A 73-year-old female is being reviewed in the osteoporosis clinic. She had a fracture of her left hip 5 years ago and was started on alendronate. Following the development of persistent musculoskeletal pain, alendronate was replaced with risedronate, which was also stopped for similar reasons. Strontium ranelate was therefore started but was also stopped due to the development of deep vein thrombosis in the right leg. Her current T-score is -4.1. A decision is made to start a trial of denosumab. What is the mechanism of action of denosumab?

      Your Answer:

      Correct Answer: Inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts

      Explanation:

      The principal mechanism by which strontium inhibits osteoclast activity is by enhancing the secretion of osteoprotegerin (OPG) and by reducing the expression of the receptor activator of nuclear factor κB ligand (RANKL) in osteoblasts.

      Osteoporosis is defined as low bone mineral density caused by altered bone microstructure ultimately predisposing patients to low-impact, fragility fractures.

      Management:
      Vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
      Alendronate is the first-line treatment. Around 25% of patients cannot tolerate alendronate, usually due to upper gastrointestinal problems. These patients should be offered risedronate or etidronate.
      Strontium ranelate and raloxifene are recommended if patients cannot tolerate bisphosphonates.
      Other medications that are useful in the treatment of osteoporosis are denosumab, teriparatide, raloxifene, etc.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 14 - According to the Ann Arbor staging system for Hodgkin lymphoma, which one of...

    Incorrect

    • According to the Ann Arbor staging system for Hodgkin lymphoma, which one of the following would be staged as IIIB?

      Your Answer:

      Correct Answer: Nodes on both sides of diaphragm with night sweats

      Explanation:

      Involvement of lymph nodes on both sides of the diaphragm accompanied by night sweats would be staged as IIIB according to the Ann Arbor staging system for Hodgkin lymphoma (HL).

      HL is a malignant proliferation of lymphocytes characterised by the presence of distinctive giant cells known as Reed-Sternberg cells. It has a bimodal age distribution being most common in the third and seventh decades of life.

      Staging of HL is done according to the Ann Arbor staging system:
      Stage
      I: Single lymph node region (I) or one extra lymphatic site (IE)

      II: Two or more lymph node regions on same side of the diaphragm (II) or local extra lymphatic extension plus one or more lymph node regions on same side of the diaphragm (IIE)

      III: Lymph node regions on both sides of the diaphragm (III) which may be accompanied by local extra lymphatic extension (IIIE)

      IV: Diffuse involvement of one or more extra lymphatic organs or sites

      Suffix
      A: No B symptoms

      B: Presence of at least one of the following: unexplained weight loss >10% baseline during 6 months before staging; recurrent unexplained fever >38°C; recurrent night sweats—poor prognosis.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 15 - Briefly state the mechanism of action of salbutamol. ...

    Incorrect

    • Briefly state the mechanism of action of salbutamol.

      Your Answer:

      Correct Answer: Beta2 receptor agonist which increases cAMP levels and leads to muscle relaxation and bronchodilation

      Explanation:

      Salbutamol stimulates beta-2 adrenergic receptors, which are the predominant receptors in bronchial smooth muscle (beta-2 receptors are also present in the heart in a concentration between 10% and 50%).

      Stimulation of beta-2 receptors leads to the activation of enzyme adenyl cyclase that forms cyclic AMP (adenosine-mono-phosphate) from ATP (adenosine-tri-phosphate). This increase of cyclic AMP relaxes bronchial smooth muscle and decrease airway resistance by lowering intracellular ionic calcium concentrations. Salbutamol relaxes the smooth muscles of airways, from trachea to terminal bronchioles.

      Increased cyclic AMP concentrations also inhibits the release of bronchoconstrictor mediators such as histamine and leukotriene from the mast cells in the airway.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 16 - A 26 year old woman is 32 weeks pregnant. She has a history...

    Incorrect

    • A 26 year old woman is 32 weeks pregnant. She has a history of Sjogren Syndrome. The foetus would be at a risk for which of the following?

      Your Answer:

      Correct Answer: All correct

      Explanation:

      Women with Sjögren syndrome are likely to experience more complications during pregnancy than women without an autoimmune disease as the anti-Ro and anti-La antibodies cross the placenta and lead to various life threatening complications. Studies show a high incidence of poor fetal outcomes for these patients. Congenital heart block, neonatal lupus, congestive cardiac failure, hydrops fetalis can all be caused as a result of Sjogren syndrome.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 17 - Which of the following drugs would be the safest to prescribe in a...

    Incorrect

    • Which of the following drugs would be the safest to prescribe in a 22 year old man with seropositive rheumatoid arthritis who is planning to start a family?

      Your Answer:

      Correct Answer: Prednisolone

      Explanation:

      Prednisolone although has many undesirable side effects it may be considered relatively safe compared to the drugs that are provided here. Prolonged treatment with sulphasalazine may depress semen quality and cause irreversible infertility. Methotrexate and leflunomide both inhibit purine/pyrimidine synthesis (the former by inhibiting folate metabolism) and are contraindicated in pregnancy or while trying to conceive. In males, a temporary or permanent decrease in sperm count may occur with cyclophosphamide. Because the recovery of fertility after cyclophosphamide therapy is variable, sperm banking should be considered before treatment is begun.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 18 - A 66 year old man visits the clinic because he has been experiencing...

    Incorrect

    • A 66 year old man visits the clinic because he has been experiencing increasing breathlessness for the past five months while doing daily tasks. His exercise tolerance is now limited to 75 metres while on a flat surface and walking up the stairs makes him breathless. He sleeps on four pillows and has swollen ankles in the morning. He occasionally coughs up phlegm.

      Past Medical history of importance:
      36 pack year smoking history
      Hypertension
      Ischaemic heart disease
      Coronary artery stenting done 10 months ago

      Pulmonary function testing revealed:
      FEV1 0.90 L (1.80 – 3.02 predicted)
      FVC 1.87 L (2.16 – 3.58 predicted)
      Diffusion capacity 3.0 mmol/min/kPa (5.91 – 9.65 predicted)
      Total lung capacity 4.50 L (4.25 – 6.22 predicted)
      Residual volume 2.70 L (1.46 – 2.48 predicted)
       
      Which condition does he have?

      Your Answer:

      Correct Answer: Chronic obstructive pulmonary disease

      Explanation:

      Whilst asthma and COPD are different diseases they cause similar symptoms, which can present a challenge in identifying which of the two diseases a patient is suffering from. COPD causes chronic symptoms and narrowed airways which do not respond to treatment to open them up. In the case of asthma the constriction of the airways through inflammation tends to come and go and treatment to reduce inflammation and to open up the airways usually works well.

      COPD is more likely than asthma to cause a chronic cough with phlegm and is rare before the age of 35 whilst asthma is common in under-35s. Disturbed sleep caused by breathlessness and wheeze is more likely in cases of asthma, as is a history of allergies, eczema and hay fever. Differentiating between COPD and asthma requires a history of both symptoms and spirometry. The spirometry history should include post bronchodilator measurements, the degree of reversibility and, ideally, home monitoring which gives a history of diurnal variation.

      Airflow Obstruction: Both asthma and COPD are characterised by airflow obstruction. Airflow obstruction is defined as a reduced FEV1 and a reduced FEV1/FVC ratio, such that FEV1 is less than 80% of that predicted, and FEV1/FVC is less than 0.7.

      These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment.

      COPD: COPD is a chronic, slowly progressive disorder characterised by airflow obstruction (reduced FEV1 and FEV1/VC ratio) that does not change markedly over several months. The airflow obstruction is not fully reversible.

      Spirometry COPD Asthma
      VC Reduced Nearly normal
      FEV1 Reduced Reduced in attack
      FVC (or FEV6) Reduced Nearly normal
      FEV1 Ratio
      (of VC/FVC/FEV6) Reduced in attack

      This man has a low FEV1 and FVC. His diffusions capacity is also low despite having a normal total lung capacity. These values confirm a diagnosis of COPD.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 19 - Which one of the following statements regarding mitochondrial inheritance is true? ...

    Incorrect

    • Which one of the following statements regarding mitochondrial inheritance is true?

      Your Answer:

      Correct Answer: Poor genotype:phenotype correlation

      Explanation:

      The human cell has two type of DNA: Nuclear DNA and Mitochondrial DNA (MtDNA). A MtDNA copy is passed down entirely unchanged, through the maternal line. Males cannot pass their MtDNA to their offspring although they inherit a copy of it from their mother. There is poor genotype:phenotype correlation. Within a tissue or cell there can be different mitochondrial populations (this is known as heteroplasmy).
      Examples of mitochondrial diseases include:
      – Leber’s optic atrophy
      – MELAS syndrome (mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes)
      – MERRF syndrome (myoclonus epilepsy with ragged-red fibres)
      – Kearns-Sayre syndrome (more severe syndromic variant of chronic progressive external ophthalmoplegia, onset in patients < 20 years old)

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds
  • Question 20 - Which of the following is associated with heterochromia in congenital disease? ...

    Incorrect

    • Which of the following is associated with heterochromia in congenital disease?

      Your Answer:

      Correct Answer: Horner's syndrome

      Explanation:

      Heterochromia (difference in iris colour) is seen in congenital Horner’s syndrome, as well as anhidrosis. Other features of non-congenital Horner’s include miosis, ptosis and enophthalmos.

    • This question is part of the following fields:

      • Ophthalmology
      0
      Seconds
  • Question 21 - A 60 year old man who has been complaining of increasing shortness of...

    Incorrect

    • A 60 year old man who has been complaining of increasing shortness of breath had a post-bronchodilator spirometry done.

      FEV1/FVC 0. 63
      FEV1% predicted 63%

      What is the best interpretation of these results?

      Your Answer:

      Correct Answer: COPD (stage 2 - moderate)

      Explanation:

      Chronic obstructive pulmonary disease (COPD) is a complex and progressive chronic lung disease. Typically, COPD includes emphysema and chronic bronchitis. COPD is characterized by the restriction of airflow into and out of the lungs. The obstruction of airflow makes breathing difficult. The causes of COPD include smoking, long-term exposure to air pollutants and a rare genetic disorder.

      The Global Initiative for Chronic Obstructive Lung Disease (GOLD) developed the GOLD Staging System. In the GOLD System, the forced expiratory volume in one second (FEV1) measurement from a pulmonary function test is used to place COPD into stages. Often, doctors also consider your COPD symptoms.

      COPD has four stages. The stages of COPD range from mild to very severe. COPD affects everyone differently. Because COPD is a progressive lung disease, it will worsen over time.
      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 63 which falls within the stage 2 or moderate COPD.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 22 - A 26-year-old patient, previously fit and well, is admitted with fluctuating confusion and...

    Incorrect

    • A 26-year-old patient, previously fit and well, is admitted with fluctuating confusion and frank haematuria. He has recently been complaining of generalised malaise and joint pains. Examination reveals jaundice, splenomegaly, and petechiae. His blood pressure is 155/84 mmHg, temperature 37.9oC.
       
      Initial investigations reveal:

      Haemoglobin 9.5 g/dL,
      White cell count 12 × 109/L,
      Platelets 40 × 109/L,
      Creatinine 142 μmol/L,
      Sodium 139 mmol/L,
      Potassium 4.5 mmol/L,
      Urea 9.2 mmol/L,
      Lactate dehydrogenase 495 U/l (10–250)
      Urinalysis Protein ++, blood +++
      Blood film shows schistocytes

       
      What treatment should NOT be given to this patient?

      Your Answer:

      Correct Answer: Platelet transfusion

      Explanation:

      There is a strong suspicion of Thrombotic Thrombocytopenic Purpura (TTP) in this patient as he presents with neurological changes (from confusion to convulsions and coma), fever, haemolysis, thrombocytopenia, and renal failure. Additionally, TTP cases may present with jaundice, splenomegaly, and hypertension as seen in this patient. With a diagnosis of TTP, recent studies have shown that platelet transfusion is not recommended in this case because it has been shown to increase the risk for arterial thrombosis and mortality possibly due to increased aggregations.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 23 - A 27-year-old woman presents with recurrent headaches and sweating. On examination, a nodule...

    Incorrect

    • A 27-year-old woman presents with recurrent headaches and sweating. On examination, a nodule is felt in the region of the thyroid gland. She mentions that her mother had kidney stones and died following a tumour in her neck. A surgeon recommends complete thyroidectomy as her treatment of choice.

      What is the most important investigation to be done before the surgery?

      Your Answer:

      Correct Answer: 24-hour urinary catecholamines

      Explanation:

      The patient is most likely to have Medullary Thyroid Carcinoma (MTC).
      Sporadic, or isolated MTC accounts for 75% of cases and inherited MTC constitutes the rest.
      Inherited MTC occurs in association with multiple endocrine neoplasia (MEN) type 2A and 2B syndromes, but non-MEN familial MTC also occurs.
      A 24-hour urinalysis for catecholamine metabolites (e.g., vanillylmandelic acid [VMA], metanephrine) has to be done to rule out concomitant pheochromocytoma in patients with MEN type 2A or 2B, as Pheochromocytoma must be treated before MTC.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 24 - A 30-year-old male with a history of premature cardiovascular disease in the family...

    Incorrect

    • A 30-year-old male with a history of premature cardiovascular disease in the family has come for review of his lab investigations.
      His fasting cholesterol is 8.4 mmol/l with high-density lipoprotein (HDL) of 1.6 mmol/l.
      You elect to commence him on atorvastatin 20 mg PO daily.
      Which of the following best describes the mechanism of action of the statins?

      Your Answer:

      Correct Answer: They inhibit HMG CoA reductase

      Explanation:

      Statins are a selective, competitive inhibitor of hydroxymethylglutaryl-CoA (HMG-CoA) reductase, which is the enzyme responsible for the conversion of HMG-CoA to mevalonate in the cholesterol synthesis pathway.
      Statins are usually well tolerated with myopathy, rhabdomyolysis, hepatotoxicity, and diabetes mellitus being the most common adverse reactions.
      This is the rate-limiting step in cholesterol synthesis, that leads to increased hepatic low-density lipoprotein (LDL) receptors and reduced hepatic VLDL synthesis coupled with increased very-low-density lipoprotein (VLDL) clearance.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 25 - A 32 year old woman presents with a painful elbow which she has...

    Incorrect

    • A 32 year old woman presents with a painful elbow which she has been feeling for the past two weeks. Which of the following will be consistent with a diagnosis of tennis elbow?

      Your Answer:

      Correct Answer: Pain on wrist extension against resistance

      Explanation:

      Lateral epicondylitis (tennis elbow) is an overuse injury of the hand and finger extensor tendons that originate in the lateral humeral epicondyle that occurs following repeated or excessive pronation/supination and extension of the wrist (e.g., in racquet sports). Clinical features include pain and tenderness over the lateral epicondyle and along extensor muscles and thickening of the tendons. The examiner holds the patient’s hand with the thumb placed over the lateral epicondyle – The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner’s resistance which will result in pain over the lateral epicondyle. Conservative treatment includes rest, physiotherapy and orthotic braces. If this fails corticosteroids and lidocaine injections are employed. Surgery is indicated in patients with persistent symptoms despite 6 months of conservative treatment. Excision of abnormal tendon tissue; longitudinal incisions (tenotomies) in scarred and fibrotic areas to promote healing.

    • This question is part of the following fields:

      • Rheumatology
      0
      Seconds
  • Question 26 - A 35-year-old woman is referred to the acute medical unit with a 5...

    Incorrect

    • A 35-year-old woman is referred to the acute medical unit with a 5 day history of polyarthritis and a low-grade fever.

      Examination reveals shin lesions which the patient states are painful. Chest x-ray shows a bulky mediastinum.

      What is the most appropriate diagnosis?

      Your Answer:

      Correct Answer: Lofgren's syndrome

      Explanation:

      Lofgren’s syndrome is an acute form of sarcoidosis characterized by erythema nodosum, bilateral hilar lymphadenopathy (BHL), and polyarthralgia or polyarthritis. Other symptoms include anterior uveitis, fever, ankle periarthritis, and pulmonary involvement.

      Löfgren syndrome is usually an acute disease with an excellent prognosis, typically resolving spontaneously from 6-8 weeks to up to 2 years after onset. Pulmonologists, ophthalmologists, and rheumatologists often define this syndrome differently, describing varying combinations of arthritis, arthralgia, uveitis, erythema nodosum, hilar adenopathy, and/or other clinical findings.

    • This question is part of the following fields:

      • Respiratory
      0
      Seconds
  • Question 27 - An 80-year-old female presents to OPD with itching hands, elbows, axillae and groin....

    Incorrect

    • An 80-year-old female presents to OPD with itching hands, elbows, axillae and groin. Other members residing with her at the retirement home also have similar complaints. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer:

      Explanation:

      Scabies is due to an infestation of Sarcoptes scabiei and most commonly presents with these symptoms. The organism resides in burrows in a pattern specifically affecting the interdigital spaces and the skin folds of the arms and legs. The infection spreads from one person to another, especially in populated communities, through close contact.
      Henoch-Schönlein purpura is a type of vascular inflammation.
      Psoriasis rash is characterised by scaly plaques affecting the extensor surfaces of the body. Pemphigus vulgaris and bullous pemphigoid both are bullous disorders of the skin. They may present as crusted, weeping, diffuse lesions and there may be involvement in other sites; erosions in the mouth are typically involved in pemphigus vulgaris. Bullous pemphigoid involves the flexural areas and may be associated with a new medication.

    • This question is part of the following fields:

      • Infectious Diseases
      0
      Seconds
  • Question 28 - Regarding the thymus, which of the following is true? ...

    Incorrect

    • Regarding the thymus, which of the following is true?

      Your Answer:

      Correct Answer: DiGeorge’s syndrome is a developmental abnormality affecting the thymus

      Explanation:

      The thymus is a lymphoid organ located in the anterior mediastinum. In early life, the thymus is responsible for the development and maturation of cell-mediated immunologic functions. The thymus is composed predominantly of epithelial cells and lymphocytes. Precursor cells migrate to the thymus and differentiate into lymphocytes. Most of these lymphocytes are destroyed, with the remainder of these cells migrating to tissues to become T cells.
      DiGeorge’s syndrome (DGS) is a developmental abnormality affecting the thymus. The classic triad of features of DGS on presentation is conotruncal cardiac anomalies, hypoplastic thymus, and hypocalcaemia (resulting from parathyroid hypoplasia).

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 29 - A 42 year old male undergoes a routine cranial nerve examination, which reveals...

    Incorrect

    • A 42 year old male undergoes a routine cranial nerve examination, which reveals the following findings:

      Rinne's test: Air conduction > bone conduction in both ears

      Weber's test: Localizes to the right side

      What do these test results imply?

      Your Answer:

      Correct Answer: Left sensorineural deafness

      Explanation:

      Weber’s test – if there is a sensorineural problem, the sound is localized to the unaffected side (right), indicating a problem on the left side.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 30 - Which of the following features is not associated with an oculomotor nerve palsy?...

    Incorrect

    • Which of the following features is not associated with an oculomotor nerve palsy?

      Your Answer:

      Correct Answer: Miosis

      Explanation:

      Oculomotor nerve palsy is an eye condition resulting from damage to the third cranial nerve or a branch thereof. A complete oculomotor nerve palsy will result in a characteristic down and out position in the affected eye. This is because the lateral rectus (innervated by the sixth cranial nerve) and superior oblique (innervated by the fourth cranial or trochlear nerve), is unantagonized by the paralyzed superior rectus, inferior rectus and inferior oblique. The affected individual will also have a ptosis, or drooping of the eyelid, and mydriasis (pupil dilation), not miosis.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Passmed