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  • Question 1 - If a patient has HIV what is the most likely cause of persistent...

    Incorrect

    • If a patient has HIV what is the most likely cause of persistent watery diarrhoea?

      Your Answer: Colorectal cancer

      Correct Answer: Cryptosporidium

      Explanation:

      When you have a patient with HIV and diarrhoea on the exam, think Cryptosporidium. In those who are immunocompetent this organism doesn’t usually cause symptoms, but in immunocompromised people like those with HIV, it causes infection and diarrhoea. Typically those with CD4 counts of <100 cells/µL1 have the greatest risk for prolonged, severe, or extraintestinal cryptosporidiosis.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 2 - A 30-year-old painter presents with a burning pain in both feet, which has...

    Incorrect

    • A 30-year-old painter presents with a burning pain in both feet, which has deteriorated over the last six months. He drinks 60 units of alcohol weekly and has a family history of pernicious anaemia.
      On examination he has impairment of all modalities of sensation in both feet but particularly pain, temperature and absent ankle jerks.
      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Alcoholic peripheral neuropathy

      Explanation:

      Because of the patient’s history of excessive alcohol consumption, there is a strong suspicion of alcoholic peripheral neuropathy. In the UK, alcohol abuse and diabetes are the most common causes of peripheral neuropathy.

    • This question is part of the following fields:

      • Neurology
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  • Question 3 - A 20 year old heroin addict is admitted following an overdose. She is...

    Incorrect

    • A 20 year old heroin addict is admitted following an overdose. She is drowsy and has a respiratory rate of 6 bpm. Which of the following arterial blood gas results (taken on room air) are most consistent with this?

      Your Answer:

      Correct Answer: pH = 7.31; pCO2 = 7.4 kPa; pO2 = 8.1 kPa

      Explanation:

      In mild-to-moderate heroin overdoses, arterial blood gas (ABG) analysis reveals respiratory acidosis. In more severe overdoses, tissue hypoxia is common, leading to mixed respiratory and metabolic acidosis.

      The normal range for PaCO2 is 35-45 mmHg (4.67 to 5.99 kPa). Respiratory acidosis can be acute or chronic. In acute respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range (i.e., >45 mm Hg) with an accompanying academia (i.e., pH < 7.35). In chronic respiratory acidosis, the PaCO2 is elevated above the upper limit of the reference range, with a normal or near-normal pH secondary to renal compensation and an elevated serum bicarbonate levels (i.e., >30 mEq/L).

      Arterial blood gases with pH = 7.31; pCO2 = 7.4 kPa; pO2 = 8.1 kPa would indicate respiratory acidosis.

    • This question is part of the following fields:

      • Respiratory
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  • Question 4 - A 45-year-old patient presents with a red, watering eye, complaining of a severe...

    Incorrect

    • A 45-year-old patient presents with a red, watering eye, complaining of a severe left sided headache and vision distortion with coloured haloes. What would be the next best step in management of this patient?

      Your Answer:

      Correct Answer: Measure Intraocular pressure

      Explanation:

      Acute angle closure glaucoma can manifests itself with severe headache, nausea or vomiting, very blurry or hazy vision, seeing rainbows or halos around lights and redness in the white part of the affected eye. It is caused by a rapid or sudden increase in pressure inside the eye – intraocular pressure (IOP). In order to establish the diagnosis and start treatment immediately, IOP should first be measured.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 5 - A 42-year-old man presents with a watery eye and some purulent discharge. Mucoid...

    Incorrect

    • A 42-year-old man presents with a watery eye and some purulent discharge. Mucoid discharge can be expressed from the lacrimal punctum. His eye is painful and red while the nasal end of his lower eyelid is swollen. The redness extends further to reach the nasal peri-orbital area. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Acute dacryocystitis

      Explanation:

      Acute dacryocystitis presents as inflammation of the lacrimal sac and is typically caused by infection. Symptoms of acute dacryocystitis can be pain, redness of the eye and swelling of the nasal aspect of the eye. The eye is usually watery and discharge can be expressed through the lacrimal punctum which is generally mucoid but can also be purulent. Patient can also present with fever.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 6 - A 28-year-old woman is evaluated in the endocrinology clinic for increased urine output....

    Incorrect

    • A 28-year-old woman is evaluated in the endocrinology clinic for increased urine output. She weighs 60 kg and has a 24-hour urine output of 3500 ml. Her basal urine osmolality is 210 mOsm/kg.
      She undergoes a fluid deprivation test and her urine osmolality after fluid deprivation (loss of weight 3 kg) is 350 mOsm/kg. Subsequent injection of subcutaneous DDAVP (desmopressin acetate) did not result in a further significant rise of urine osmolality after 2 hours (355 mOsm/kg).
      Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Primary polydipsia

      Explanation:

      In central and nephrogenic diabetes insipidus (DI), urinary osmolality will be less than 300 mOsm/kg after water deprivation. After the administration of ADH, the osmolality will rise to more than 750 mOsm/kg in central DI but will not rise at all in nephrogenic DI. In primary polydipsia, urinary osmolality be above 750 mOsm/kg after water deprivation. A urinary osmolality that is 300-750 mOsm/kg after water deprivation and remains below 750 mOsm/kg after administration of ADH may be seen in partial central DI, partial nephrogenic DI, and primary polydipsia.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - 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 8 - A 41-year-old gentleman underwent kidney transplantation for end-stage renal disease. Now, 2 months...

    Incorrect

    • A 41-year-old gentleman underwent kidney transplantation for end-stage renal disease. Now, 2 months after the operation, he has developed fever and features suggestive of bilateral diffuse interstitial pneumonia.
       
      What is the most likely aetiological cause?

      Your Answer:

      Correct Answer: Cytomegalovirus

      Explanation:

      After renal transplantation, cytomegalovirus has been identified to affect 1/4 of the post-op patients. It is the most common viral infection causing morbidity and mortality in post-op patients in the first 3 months.

    • This question is part of the following fields:

      • Nephrology
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  • Question 9 - A 54 yr. old heavy smoker presented with acute chest pain for 3...

    Incorrect

    • A 54 yr. old heavy smoker presented with acute chest pain for 3 hrs which associated with excessive sweating and vomiting. His past medical history was unremarkable but his father has passed away due to a heart attack at the age of 50. Examination findings were normal and ECG was also normal. He was pain free after 12 hours from admission. What is the most appropriate investigation that cab be done at this moment?

      Your Answer:

      Correct Answer: Troponin T

      Explanation:

      The positive family history and the smoking make him an ideal candidate for a myocardial infarction. The chest pain is also a suggestive symptom. So troponin is needed to rule out MI.

    • This question is part of the following fields:

      • Cardiology
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  • Question 10 - A 17-year-old boy presents with a 2 day history of colicky abdominal pain,...

    Incorrect

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

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

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Campylobacter infection

      Explanation:

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

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 11 - A 76-year-old lady with known carcinoma of the caecum, was admitted to the...

    Incorrect

    • A 76-year-old lady with known carcinoma of the caecum, was admitted to the hospital for right hemicolectomy. She had a history of osteoarthritis for which she was taking nonsteroidal anti-inflammatory agents (NSAIDs), intermittently. Two years ago, she had a fibroma removed from her right breast as well. The patient was a non-smoker and drank approximately 8 units of alcohol per week.

      Investigations carried out pre-operatively showed:
      Hb: 10.8 g/dL,
      MCV: 75 fL ,
      WCC: 8.4 x10^9/L,
      Plts: 402 x10^9/L.

      The surgery remained uncomplicated, and she was given two units of packed red blood cells postoperatively. Three days later, she has now become jaundiced and complains of fatigue.

      Her blood count now shows:
      Hb: 7.2 g/dL,
      MCV: 110 fL,
      WCC: 9.5 x10^9/L,
      Plts: 395 x10^9/L.

      Which of the following is the best investigation to confirm the diagnosis?

      Your Answer:

      Correct Answer: Direct Coombs test

      Explanation:

      The direct Coombs test will specifically confirm immune-mediated haemolysis occurring post-transfusion in the aforementioned case.

      There are two types of Coombs test used in immunohematology and immunology:

      1. Direct Coombs test—It confirms autoimmune haemolytic anaemia by detecting antibodies or complement proteins attached to the surface of red blood cells.

      2. Indirect Coombs test—It is used in prenatal testing of pregnant women and in testing prior to a blood transfusion. It detects antibodies floating freely in the blood, against foreign red blood cells.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 12 - 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
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  • Question 13 - A 48-year-old patient with diabetes is referred from the Emergency department complaining of...

    Incorrect

    • A 48-year-old patient with diabetes is referred from the Emergency department complaining of dizziness and vomiting.
      On examination he is alert and orientated, his pulse is 80 irregularly irregular and BP 160/90 mmHg. There is nystagmus on left lateral gaze and his speech is slurred. On examination of the limbs, you note intention tremor and past pointing. He is ataxic when mobilised.
      What is the likely diagnosis?

      Your Answer:

      Correct Answer: Cerebellar CVA

      Explanation:

      The patient’s presentation with slurred speech, intention tremor and past pointing, as well as ataxia and nystagmus, paired with a history of vertigo suggest the cerebellum as the site of cerebrovascular accident (CVA) or stroke.

    • This question is part of the following fields:

      • Neurology
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  • Question 14 - A 8-year-old boy who recently migrated from Nigeria was seen in A&E department...

    Incorrect

    • A 8-year-old boy who recently migrated from Nigeria was seen in A&E department with a six-week history of progressive swelling of his jaw, fever, night sweats, and weight loss. His mother reported an episode of sore throat in the past which was treated with antibiotics, but he developed a rash subsequently. Other than that, there was no other significant past medical history. On examination, a painless, nontender 4x3cm mass was found that was fixed and hard. The only other examination finding of note was rubbery symmetrical cervical lymphadenopathy.

      Which of the following translocation would most likely be found on biopsy karyotyping?

      Your Answer:

      Correct Answer: t(8;14)

      Explanation:

      Burkitt lymphoma is associated with the c-myc gene translocation, usually t(8;14).

      Burkitt lymphoma is a rare high-grade non-Hodgkin lymphoma endemic to west Africa and the mosquito belt. It has a close association with the contraction of Epstein-Barr virus (EBV). Burkitt lymphoma often presents with symmetrical painless lymphadenopathy, systemic B symptoms (fever, sweats, and weight loss), central nervous system involvement, and bone marrow infiltration. Classically in the textbooks, the patient also develops a large jaw tumour.

      Other aforementioned options are ruled out because:
      1. t(9;22)—Chronic myeloid leukaemia
      2. t(15;17)—Acute promyelocytic leukaemia
      3. t(14;18)—Follicular Lymphoma
      4. t(11;14)—Mantle Cell Lymphoma

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 15 - What is correct statement regarding pulsus alternans? ...

    Incorrect

    • What is correct statement regarding pulsus alternans?

      Your Answer:

      Correct Answer: It is found in association with a third heart sound

      Explanation:

      Pulsus alternans is the alternation of one strong and one weak beat without a change in the cycle length. It occurs most commonly in heart failure due to increased resistance to LV ejection, as occurs in hypertension, aortic stenosis, coronary atherosclerosis, and dilated cardiomyopathy. Pulsus alternans is usually associated with an S3 gallop, which is associated with a poor prognosis. It usually disappears with treatment of the heart failure.

    • This question is part of the following fields:

      • Cardiology
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  • Question 16 - A 70-year-old male presents with chest pain. His past medical history includes hypertension...

    Incorrect

    • A 70-year-old male presents with chest pain. His past medical history includes hypertension and angina. He continues to smoke about 20 cigarettes per day despite being advised about lifestyle modifications.
      Blood investigations obtained in the emergency department show:

      Na+: 133 mmol/L,
      K+: 3.3 mmol/L,
      Urea: 4.5 mmol/L,
      Creatinine: 90 μmol/L,

      Which among the following is the most likely explanation for the abnormalities seen in the above investigations?

      Your Answer:

      Correct Answer: Bendroflumethiazide therapy

      Explanation:

      The blood investigations in this patient reveal hyponatremia as well as hypokalaemia. Among the options provided, Bendroflumethiazide therapy can cause the above presentation with the electrolyte disturbances.
      Note:
      – Spironolactone is a potassium-sparing diuretic that is associated with hyperkalaemia.
      – Enalapril therapy can cause side effects of dizziness, hypotension, cough, and rarely a rash.
      – Felodipine therapy can cause side effects of dizziness, headache, cough, and palpitations.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 17 - A 42 year old male arrives at the clinic due to cough and...

    Incorrect

    • A 42 year old male arrives at the clinic due to cough and haemoptysis. Examination shows nasal mucosal ulceration. The doctor suspects Wegener's granulomatosis. Which anatomical area would be most commonly involved in this condition?

      Your Answer:

      Correct Answer: Lungs

      Explanation:

      Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) is a systemic vasculitis that affects both small and medium-sized vessels. Patients typically initially suffer from a limited form that may consist of constitutional symptoms and localized manifestations such as chronic sinusitis, rhinitis, otitis media, ocular conditions. In later stages, more serious manifestations may arise, including pulmonary complications and glomerulonephritis, although the skin, eyes, and heart may also be involved but these lesions are less common.
      Diagnosis is based on laboratory testing (positive for PR3-ANCA/c-ANCA), imaging, and biopsy of affected organs, which demonstrate necrotizing granulomatous inflammation. GPA is treated with immunosuppressive drugs, typically consisting of glucocorticoids combined with methotrexate, cyclophosphamide, or rituximab. Relapses are common and the following systems are affected: Lower respiratory tract (95% of cases), renal involvement (80% of cases), skin lesions (45% of cases), ocular involvement (45% of cases) and cardiac involvement (33% of cases).

    • This question is part of the following fields:

      • Rheumatology
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  • Question 18 - A 26 year old male presents with right sided elbow and wrist pain...

    Incorrect

    • A 26 year old male presents with right sided elbow and wrist pain and left sided knee and ankle pain that has persisted for about two weeks. He recently returned from a trip to Thailand that last for two weeks. The patient admits to having unprotected sex while on holiday. Examination reveals swelling and tenderness of tendons around joints but no inflammation of the joints. A vesiculopustular skin rash is also observed. What is the most likely cause?

      Your Answer:

      Correct Answer: Gonococcal arthritis

      Explanation:

      Patients with disseminated gonococcal arthritis may present with dermatitis-arthritis syndrome (60%) of with localized septic arthritis. (40%). Arthritis-dermatitis syndrome includes the classic triad of dermatitis, tenosynovitis, and migratory polyarthritis. Gout usually involves a singe joint and does not cause vesicopustular skin rash. Reactive arthritis has ocular symptoms (conjunctivitis), urethritis, and arthritis. Fungal arthritis occurs rarely and it may occur after a surgical infection or fungal spread hematogenously. it presents with tender, red, hot and swollen joint with loss of range of motion.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 19 - What is the mode of spread of chickenpox? ...

    Incorrect

    • What is the mode of spread of chickenpox?

      Your Answer:

      Correct Answer: Airborne

      Explanation:

      Chickenpox is a highly communicable viral disease caused by human (alpha) herpesvirus 3 (varicella-zoster virus, VZV). It is transmitted from person to person by direct contact (touching the rash), droplet or air born spread (coughing and sneezing).

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 20 - A 63-year-old woman visits the diabetes clinic for review. She has had type-2...

    Incorrect

    • A 63-year-old woman visits the diabetes clinic for review. She has had type-2 diabetes for 9 years and is now on insulin therapy. She has diabetic nephropathy, as exemplified by hypertension and proteinuria (urinary PCR 155); a recent creatinine level was 205 μmol/l and eGFR 24 ml/min.
       
      Which of the following options best fits her prognosis or management?

      Your Answer:

      Correct Answer: Treatment with ARB or ACE-I may slow further deterioration in renal function

      Explanation:

      Treatment with ARB or ACE-I may slow further deterioration in renal function in this patient, as studies have shown that blocking of the RAS in type 2 diabetic patients improve renal function.

    • This question is part of the following fields:

      • Nephrology
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  • Question 21 - A 60 yr. old man presented with difficulty in breathing. On examination he...

    Incorrect

    • A 60 yr. old man presented with difficulty in breathing. On examination he was severely dyspnoeic and tachycardic. What is the clinical sign that would favour the diagnosis of cardiac tamponade over constrictive pericarditis?

      Your Answer:

      Correct Answer: Pulsus paradoxus

      Explanation:

      Pulsus paradoxus is defined as the exaggerated fall in systolic blood pressure during inspiration by greater than 10 mmHg. Cardiac tamponade is the classic cause of pulsus paradoxus. Kussmaul’s sign (a rise in the jugular venous pressure on inspiration) is mostly seen in constrictive pericarditis. Hypotension, muffled heart sounds and raised JVP can be seen in both conditions.

    • This question is part of the following fields:

      • Cardiology
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  • Question 22 - A 40 year old man who has a 12 year history of bipolar...

    Incorrect

    • A 40 year old man who has a 12 year history of bipolar disorder is placed on Lithium. How often should his Lithium levels be checked once a stable dose has been achieved?

      Your Answer:

      Correct Answer: Every 3 months

      Explanation:

      Lithium acts by:
      – I inhibiting postsynaptic D2 receptor super sensitivity
      – Altering cation transport in nerve and muscle cells and influencing reuptake of serotonin or norepinephrine
      – Inhibiting phosphatidylinositol cycle second messenger systems

      The NICE guidelines for depression and bipolar disorder both recommend Lithium as an effective treatment; patients who take lithium should have regular blood tests to monitor the amount of lithium in their blood (every 3 months), and to make sure the lithium has not caused any problems with their kidneys or thyroid (every 6 months).

      Lithium adverse effects include:
      – Leucocytosis (most patients) which is when the white cells are above the normal range in the blood.
      – Polyuria/polydipsia (30-50%)
      – Dry mouth (20-50%)
      – Hand tremor (45% initially, 10% after 1 year of treatment)
      – Confusion (40%)
      – Decreased memory (40%)
      – Headache (40%)
      – Muscle weakness (30% initially, 1% after 1 year of treatment)
      – Electrocardiographic (ECG) changes (20-30%)
      – Nausea, vomiting, diarrhoea (10-30% initially, 1-10% after 1-2 years of treatment)
      – Hyperreflexia (15%)
      – Muscle twitch (15%)
      – Vertigo (15%)

    • This question is part of the following fields:

      • Psychiatry
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  • Question 23 - A 40-year-old male patient, who is otherwise healthy and without a significant family...

    Incorrect

    • A 40-year-old male patient, who is otherwise healthy and without a significant family history, presents with a history of early morning headache and visual field defects, When asked, he said that he has been having these complaints for three months now. What is the most possible diagnosis?

      Your Answer:

      Correct Answer: Pituitary tumour

      Explanation:

      The most possible diagnosis is a pituitary tumour. Pituitary tumours compress the optic chiasm inferiorly and can cause visual field defects (bitemporal hemianopia or quadrantanopia). Temporal arteritis usually develops in older people and acute glaucoma usually requires a family history. Amaurosis fugax is classed as a stroke and usually leads to reversible unilateral vision loss. A subconjunctival haemorrhage does not typically produce the symptoms described.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 24 - A 23 year old girl presented with complaints of diplopia on looking towards...

    Incorrect

    • A 23 year old girl presented with complaints of diplopia on looking towards her right side. Which of the nerves will be effected?

      Your Answer:

      Correct Answer: Right abducens

      Explanation:

      This patient has complaints of diplopia in the right eye, when looking towards the right. Eyeball movements towards the right side are controlled by right lateral rectus muscle which is supplied by the abducent nerve.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 25 - A 47-year-old male with type II diabetes mellitus presents to your clinic with...

    Incorrect

    • A 47-year-old male with type II diabetes mellitus presents to your clinic with a history suggestive of erectile dysfunction. You decide to start him on sildenafil citrate. What is the mechanism of action of this drug?

      Your Answer:

      Correct Answer: Phosphodiesterase type V inhibitor

      Explanation:

      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 26 - A 41 year old woman who has a history of SLE presents with...

    Incorrect

    • A 41 year old woman who has a history of SLE presents with a dry cough, dyspnoea and fever. She is being treated with a monthly dose of IV cyclophosphamide for Grade IV nephropathy. The last cyclophosphamide dose was 10 years ago. Lab investigations are as follows:
      WCC: 2.3 (lymphocyte count 0.7),
      Platelets: 81,
      Hb: 10.5,
      ESR: 56,
      CRP: 43,
      PO2: 7.2 kPa, PCO2: 3.6 kPa after walking out to the toilet.

      Chest X ray was unremarkable apart from some patchy pulmonary infiltration.
      What is the likely diagnosis?

      Your Answer:

      Correct Answer: Pneumocystis carinii pneumonia (PCP)

      Explanation:

      Pneumocystis carinii pneumonia, is an opportunistic fungal lung infection occurring almost exclusively in immunocompromised individuals. In 50% of cases, PCP is the first manifestation of AIDS (acquired immune deficiency syndrome), but it may be caused by other immunodeficiency disorders. PCP should be suspected in patients with a history of progressive dyspnoea and a dry cough with resistance to standard antibiotic treatment. Signs that support this diagnosis include a CD4 count < 200/μL, an increased beta-D-glucan level, and diffuse bilateral infiltrates on chest x-ray. Management of PCP includes high-dose trimethoprim/sulfamethoxazole (TMP/SMX), treatment of the underlying immunodeficiency disorder, and steroids in the case of severe respiratory insufficiency. TB is less likely to be present in this case as ESR is relatively low and chest x-ray appeared normal.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 27 - A 35 year old soldier presented with a painless, erythematous crusted plaque over...

    Incorrect

    • A 35 year old soldier presented with a painless, erythematous crusted plaque over the dorsum of his hand, after serving in a hilly area of Columbia for 2 months. The most likely diagnosis will be?

      Your Answer:

      Correct Answer: Leishmaniasis

      Explanation:

      The chief presentation in Leishmaniasis is a non healing, ulcerated, painless and non pruritic plaque, which does not respond to oral antibiotics. It can be classified into cutaneous and visceral forms and is caused by the sand fly. It is more prevalent in the hilly areas. Fusobacterium causes a tropical ulcer which is painful and shallow, while Troanasomiasis causes sleeping sickness.

    • This question is part of the following fields:

      • Dermatology
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  • Question 28 - 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 29 - A 42 yr. old previously well woman presented with acute severe central chest...

    Incorrect

    • A 42 yr. old previously well woman presented with acute severe central chest pain for the past 2 hours. She has a family history of premature coronary artery disease. Her husband passed away recently due to prostate cancer. On examination her blood pressure was 130/80 mmHg and pulse rate was 80 bpm. Her ECG showed ST segment elevation and her troponin was slightly elevated. Emergency angiogram revealed slight wall irregularities with no luminal obstruction. Cardiovascular MR showed an apical ballooning of the myocardium resembling an octopus pot. Which of the following is the most likely cause for the ST segment elevation?

      Your Answer:

      Correct Answer: Takotsubo cardiomyopathy

      Explanation:

      Causes for ST segment elevation other than myocardial infarction
      Natural variants
      -Early repolarization
      -Left ventricular hypertrophy and hypertrophic cardiomyopathy
      -Left bundle branch block
      Artefacts
      -Leads mispositioning
      -Electrical cardioversion
      Cardiovascular diseases
      -Pericarditis/ Myocarditis
      -Aortic dissection
      -Prinzmetal’s angina
      -Takotsubo Cardiomyopathy
      -Brugada Syndrome and arrhythmogenic right ventricular cardiomyopathy/dysplasia
      Pulmonary diseases
      -Pulmonary thromboembolism
      -Pneumothorax
      -Atelectasis and pulmonary metastases
      Gastrointestinal diseases
      -Acute pancreatitis
      -Acute cholecystitis
      Other conditions
      -Hyperkalaemia
      -Drug induced ST segment elevation (e.g. – clozapine)
      -Haemorrhagic cerebrovascular disease

      Coronary artery disease and myocardial infarction can be excluded with a negative angiogram and a slightly elevated troponin. Hypertrophic cardiomyopathy can be excluded with cardiovascular MR findings. Left ventricular aneurysm usually occurs following a myocardial infarction, but there is no positive history for that. The characteristic findings on cardiovascular MR confirms the diagnosis of Takotsubo cardiomyopathy.

    • This question is part of the following fields:

      • Cardiology
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  • Question 30 - A 67-year-old butcher presents with a six month history of a gradually increasing...

    Incorrect

    • A 67-year-old butcher presents with a six month history of a gradually increasing burning sensation in his feet. Examination reveals normal cranial nerves and higher mental function. He has normal bulk, tone, power, light touch, pinprick sensation, co-ordination and reflexes in upper and lower limbs.

      These clinical findings are consistent with which of the following?

      Your Answer:

      Correct Answer: Small fibre sensory neuropathy

      Explanation:

      The burning sensation described is typical of a neuropathy affecting the small unmyelinated and thinly myelinated nerve fibres. General neurological examination and reflexes are usually normal in this type of neuropathy unless there is coexisting large (myelinated) fibre involvement. Neuropathy affecting the large myelinated sensory fibres generally causes glove and stocking sensory loss and loss of reflexes.

    • This question is part of the following fields:

      • Neurology
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