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  • Question 1 - A 72-year-old with varicose veins complains of swollen, red, itchy legs. Which is...

    Correct

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

      Your Answer: Varicose eczema

      Explanation:

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

    • This question is part of the following fields:

      • Dermatology
      1
      Seconds
  • Question 2 - Which of the following is not associated with atrial myxoma? ...

    Incorrect

    • Which of the following is not associated with atrial myxoma?

      Your Answer:

      Correct Answer: J wave on ECG

      Explanation:

      J waves in an ECG is associated with hypothermia, hypercalcemia, the Brugada syndrome, and idiopathic ventricular fibrillation. The other responses are all associated with atrial myxoma

    • This question is part of the following fields:

      • Cardiology
      7
      Seconds
  • Question 3 - Which among the following is most likely to be beneficial to a patient...

    Incorrect

    • Which among the following is most likely to be beneficial to a patient with schizophrenia?

      Your Answer:

      Correct Answer: Cognitive behavioural therapy

      Explanation:

      Among the given options, cognitive-behavioural therapy is the most likely to benefit a patient with schizophrenia.

      Schizophrenia is a functional psychotic disorder characterized by the presence of delusional beliefs, hallucinations, and disturbances in thought, perception, and behaviour.

      Clinical features:
      Schneider’s first-rank symptoms may be divided into auditory hallucinations, thought disorders, passivity phenomena, and delusional perceptions:

      Auditory hallucinations of a specific type:
      Two or more voices discussing the patient in the third person
      Thought echo
      Voices commenting on the patient’s behaviour

      Thought disorder:
      Thought insertion
      Thought withdrawal
      Thought broadcasting

      Passivity phenomena:
      Bodily sensations being controlled by external influence
      Actions/impulses/feelings – experiences which are imposed on the Individual or influenced by others

      Other features of schizophrenia include
      Impaired insight (a feature of all psychoses)
      Incongruity/blunting of affect (inappropriate emotion for circumstances)
      Decreased speech
      Neologisms: made-up words
      Catatonia
      Negative symptoms: incongruity/blunting of affect, anhedonia (inability to derive pleasure), alogia (poverty of speech), avolition (poor motivation).

      Treatment:
      For the initial treatment of acute psychosis, it is recommended to commence an oral second-generation antipsychotics such as aripiprazole, olanzapine, risperidone, quetiapine, etc.
      Once the acute phase is controlled, switching to a depot preparation like aripiprazole, paliperidone, zuclopenthixol, fluphenazine, haloperidol, pipotiazine, or risperidone is recommended.
      Cognitive-behavioural therapy (CBT) and the use of art and drama therapies help counteract the negative symptoms of the disease, improve insight, and assist relapse prevention.
      Clozapine is used in case of treatment resistance.

    • This question is part of the following fields:

      • Psychiatry
      0
      Seconds
  • Question 4 - A 57-year-old man, who suffers from biventricular cardiac failure, comes to his doctor...

    Incorrect

    • A 57-year-old man, who suffers from biventricular cardiac failure, comes to his doctor for a review. His symptoms are currently well controlled; he is taking Ramipril 10mg, Spironolactone 25mg, Bisoprolol 10mg, and Furosemide 40mg. His main complaint is of painful gynaecomastia that he says has developed over the past 6 months. Physical exam reveals a blood pressure of 125/80 mmHg and no residual signs of cardiac failure. Renal function is unchanged from 6 months earlier, with stable creatinine at 125 µmol/l.

      Which of the following is the most appropriate next step?

      Your Answer:

      Correct Answer: Change the spironolactone to eplerenone

      Explanation:

      Spironolactone is an aldosterone antagonist diuretic that is well-known to cause gynaecomastia because it increases testosterone clearance and oestradiol production. The patient’s primary complaint of gynaecomastia should immediately prompt discontinuation of spironolactone and replacement with Eplerenone, which lacks the antiandrogenic effects, and thus there is less risk of gynaecomastia.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 5 - A 56-year-old male was admitted to the in-patient psychiatric unit last night. He...

    Incorrect

    • A 56-year-old male was admitted to the in-patient psychiatric unit last night. He is a poor historian, answering most questions minimally and stating he does not need to be here as he is deceased, and hospitals should be for living patients.
      What is the type of delusion in this patient and what is it commonly associated with?

      Your Answer:

      Correct Answer: Cotard syndrome and Major Depressive Disorder

      Explanation:

      The most probable diagnosis of this patient is Cotard syndrome with major depressive disorder.

      Cotard syndrome is a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary. Cotard syndrome is often associated with severe depression and psychotic disorders (like schizophrenia).

      Other delusional syndromes:
      – Othello syndrome is a delusional belief that a patients partner is committing infidelity despite no evidence of this. It can often result in violence and controlling behaviour.
      – De Clerambault syndrome (otherwise known as erotomania), is where a patient believes that a person of higher social or professional standing is in love with them. Often this presents with people who believe celebrities are in love with them.
      – Capgras syndrome is characterised by a person believing their friend or relative had been replaced by an exact double.
      – Couvade syndrome is also known as ‘sympathetic pregnancy’. It affects fathers, particularly during the first and third trimesters of pregnancy, who suffer the somatic features of pregnancy.
      – Ekbom syndrome is also known as delusional parasitosis and is the belief that they are infected with parasites or have ‘bugs’ under their skin. This can vary from the classic psychosis symptoms in narcotic use where the user can ‘see’ bugs crawling under their skin or can be a patient who believes that they are infested with snakes.

    • This question is part of the following fields:

      • Psychiatry
      0
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  • Question 6 - A 22-year-old female is brought to the emergency department by her friends following...

    Incorrect

    • A 22-year-old female is brought to the emergency department by her friends following the consumption of an unknown drug whilst clubbing. Which of the following features point towards the use of ecstasy?

      Your Answer:

      Correct Answer: Temperature of 39.5ºC

      Explanation:

      Hyperthermia (Temperature 39.5 C) points towards the use of ecstasy.

      MDMA (3,4 – methylenedioxymethamphetamine), or more commonly known as Molly or Ecstasy, is a synthetic psychoactive substance.
      Patients who consumed MDMA may present in a tachycardic, hypertensive, hyperthermic, and agitated state.
      Adverse effects, even at minor recreational doses, include increased muscle activity (such as bruxism, restless legs, and jaw clenching), hyperactivity, insomnia, difficulty concentrating and feelings of restlessness.

      Treatment of MDMA overdose:
      Emphasis should be on maintaining the airway along with the stabilization of breathing and circulation.
      Patients may present obtunded due to hyponatremia requiring endotracheal intubation.
      For the hyperthermic patient, evaporative cooling along with ice packs to the groin and axilla are beneficial.
      Patients who present in severe toxicity within one hour of ingestion can receive activated charcoal PO or via an NG tube.
      Antipyretics, such as acetaminophen, should be avoided as they have no role and can worsen an already compromised liver.

    • This question is part of the following fields:

      • Pharmacology
      0
      Seconds
  • Question 7 - A 32-year-old woman presents to the GP with tiredness and anxiety during the...

    Incorrect

    • A 32-year-old woman presents to the GP with tiredness and anxiety during the third trimester of her second pregnancy.
      The Examination is unremarkable, with a BP of 110/70 mmHg and a pulse of 80. Her BMI is 24 and she has an abdomen consistent with a 31-week pregnancy. The GP decides to check some thyroid function tests.
      Which of the following is considered to be normal?

      Your Answer:

      Correct Answer: Elevated total T4

      Explanation:

      During pregnancy, profound changes in thyroid physiology occur to provide sufficient thyroid hormone (TH) to both the mother and foetus. This is particularly important during early pregnancy because the fetal thyroid starts to produce considerable amounts of TH only from approximately 20 weeks of gestation, until which time the foetus heavily depends on the maternal supply of TH. This supply of TH to the foetus, as well as increased concentrations of TH binding proteins (thyroxine-binding globulin) and degradation of TH by placental type 3 iodothyronine deiodinase, necessitate an increased production of maternal TH. This requires an intact thyroid gland and adequate availability of dietary iodine and is in part mediated by the pregnancy hormone human chorionic gonadotropin, which is a weak agonist of the thyroid-stimulating hormone (TSH) receptor. As a consequence, serum-free thyroxine (FT4) concentrations increase and TSH concentrations decrease from approximately the eighth week throughout the first half of pregnancy, resulting in different reference intervals for TSH and FT4 compared to the non-pregnant state.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 8 - 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
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  • Question 9 - A 52-year-old man is referred to the oncology clinic by his GP. He...

    Incorrect

    • A 52-year-old man is referred to the oncology clinic by his GP. He recently suffered a fracture of his right humerus with minimal trauma.

      The results of the blood tests, taken on his arrival, prompted the referral:
      Hb: 8.9 g/dL,
      WCC: 9.5 x 10^9/L,
      Plts: 140 x 10^9/L,
      MCV: 86 fL,
      ESR: 60mm/1st hour,
      Na+: 149 mmol/L,
      K+: 3.6 mmol/L,
      Urea: 15 mmol/L,
      Creatinine: 160 mmol/L,
      Calcium (corrected): 2.89 mmol/L,
      Albumin: 28g/L,
      Total protein: 89 g/L.

      X-ray of right humerus reported a possible pathological fracture. Which of the following investigations would help best in confirming the most likely diagnosis?

      Your Answer:

      Correct Answer: Protein electrophoresis

      Explanation:

      The most likely diagnosis with anaemia, raised erythrocyte sedimentation rate (ESR), hypercalcaemia, renal impairment, and raised total protein with low albumin is multiple myeloma (MM). Protein electrophoresis will confirm the presence of monoclonal band of paraprotein. Of note, a radioisotope bone scan is not a good test for picking up the lytic lesions of MM.

      Diagnosis of MM is based on the confirmation of (a) one major criterion and one minor criterion or (b) three minor criteria in an individual who has signs or symptoms of multiple myeloma.

      Major criteria:
      1. >30% plasma cells on bone marrow biopsy
      2. Monoclonal band of paraprotein on electrophoresis: >35g/L for IgG, 20g/L for IgA, or >1g of light chains excreted in the urine per day

      Minor criteria:
      1. 10–30% plasma cells on bone marrow biopsy
      2. Abnormal monoclonal band but levels less than listed above
      3. Lytic bone lesions observed radiographically
      4. Immunosuppression

    • This question is part of the following fields:

      • Haematology & Oncology
      0
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  • Question 10 - A 29 year old graduate student is reviewed after feeling anxious all the...

    Incorrect

    • A 29 year old graduate student is reviewed after feeling anxious all the time. She states that she is unable to relax and she is not sleeping well. However, her mood is okay and her appetite is good. She has been reviewed for several weeks with the same symptoms and has made no improvement with self-help sessions. Which pharmacological option is likely indicated in her diagnosis?

      Your Answer:

      Correct Answer: Selective serotonin reuptake inhibitor (SSRI)

      Explanation:

      Generalized Anxiety Disorder (GAD) is characterized by persistent and excessive worry about a number of different things. People with GAD may anticipate disaster and may be overly concerned about money, health, family, work, or other issues. Individuals with GAD find it difficult to control their worry. They may worry more than seems warranted about actual events or may expect the worst even when there is no apparent reason for concern.

      GAD is diagnosed when a person finds it difficult to control worry on more days than not for at least six months and has three or more symptoms.

      Treatment usually consists of a combination of pharmacotherapy and/or psychotherapy. Antidepressant agents are the drugs of choice in the treatment of anxiety disorders, particularly the newer agents, which have a safer adverse effect profile and higher ease of use than the older tricyclic antidepressants (TCAs), such as selective serotonin reuptake inhibitors (SSRIs).

    • This question is part of the following fields:

      • Psychiatry
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  • Question 11 - Which one of the following statements regarding minimal change glomerulonephritis is incorrect? ...

    Incorrect

    • Which one of the following statements regarding minimal change glomerulonephritis is incorrect?

      Your Answer:

      Correct Answer: Hypertension is found in approximately 25% of patients

      Explanation:

      Hypertension and haematuria are not common presentations in minimal change glomerulonephritis, all other statements are correct.

    • This question is part of the following fields:

      • Nephrology
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  • Question 12 - In which of the following is there Growth hormone deficiency (GHD)? ...

    Incorrect

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

      Your Answer:

      Correct Answer: Sheehan's syndrome

      Explanation:

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

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

    • This question is part of the following fields:

      • Endocrinology
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  • Question 13 - Which of the following would suggest an increase risk of suicide in a...

    Incorrect

    • Which of the following would suggest an increase risk of suicide in a patient with a history of depression?

      Your Answer:

      Correct Answer: History of arm cutting

      Explanation:

      Risk factors specific to depression:
      -Family history of mental disorder.
      -History of previous suicide attempts (this includes self-harm).
      -Severe depression.
      -Anxiety.
      -Feelings of hopelessness.
      -Personality disorder.
      -Alcohol abuse and/or drug abuse.
      -Male gender.

      Protective Factors for Suicide.
      Protective factors buffer individuals from suicidal thoughts and behaviour. To date, protective factors have not been studied as extensively or rigorously as risk factors. Identifying and understanding protective factors are, however, equally as important as researching risk factors.

      Protective Factors:
      -Effective clinical care for mental, physical, and substance abuse disorders
      -Easy access to a variety of clinical interventions and support for help seeking
      -Family and community support (connectedness)
      -Support from ongoing medical and mental health care relationships
      -Skills in problem solving, conflict resolution, and nonviolent ways of handling disputes
      -Cultural and religious beliefs that discourage suicide and support instincts for self-preservation

    • This question is part of the following fields:

      • Psychiatry
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  • Question 14 - A 13-year-old girl presents with short stature, webbed neck, cubitus valgus and primary...

    Incorrect

    • A 13-year-old girl presents with short stature, webbed neck, cubitus valgus and primary amenorrhea.
      Which of the following hormones is most important for long term replacement?

      Your Answer:

      Correct Answer: Oestrogen

      Explanation:

      This girl most probably has Turner’s syndrome, which is caused by the absence of one set of genes from the short arm of one X chromosome.
      Turner syndrome is a lifelong condition and needs lifelong oestrogen replacement therapy. Oestrogen is usually started at age 12-15 years. Treatment can be started with continuous low-dose oestrogens. These can be cycled in a 3-weeks on, 1-week off regimen after 6-18 months; progestin can be added later.

      In childhood, growth hormone therapy is standard to prevent short stature as an adult.

      Fetal ovarian development seems to be normal in Turner syndrome, with degeneration occurring in most cases around the time of birth so pulsatile GnRH and luteinising hormone would be of no use.

    • This question is part of the following fields:

      • Endocrinology
      0
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  • Question 15 - Choose the wrong statement regarding hypocalcaemia: ...

    Incorrect

    • Choose the wrong statement regarding hypocalcaemia:

      Your Answer:

      Correct Answer: Chvostek's sign is more sensitive and specific than Trousseau's sign

      Explanation:

      Chvostek and Trousseau signs can be elicited in patients with hypocalcaemia. Chvostek sign is the twitching of the upper lip with tapping on the cheek 2 cm anterior to the earlobe, below the zygomatic process overlying the facial nerve. Trousseau sign (a more reliable sign present in 94% of hypokalaemic individuals and only 1% to 4% of healthy people) is the presence of carpopedal spasm observed following application of an inflated blood pressure cuff over systolic pressure for 3 minutes in hypokalaemic patients.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 16 - A 82-year-old woman admitted following a fractured neck of femur has been discharged....

    Incorrect

    • A 82-year-old woman admitted following a fractured neck of femur has been discharged. On review, she is making good progress but consideration is given to secondary prevention of further fractures. What is the most appropriate step in the prevention of further fractures?

      Your Answer:

      Correct Answer: Start oral bisphosphonate

      Explanation:

      In such a clinical scenario, NICE guidelines support initiating treatment with bisphosphonates without waiting for a DEXA scan.

      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
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  • Question 17 - A 40-year-old man presents with a history of carpal tunnel syndrome and osteoarthritis...

    Incorrect

    • A 40-year-old man presents with a history of carpal tunnel syndrome and osteoarthritis of his weight-bearing joints. He has recently begun to suffer from symptoms of sleep apnoea.
      On examination, he has a prominent jawline and macroglossia. His BP is elevated at 155/95 mmHg and there is peripheral visual field loss.
      Which of the following is true?

      Your Answer:

      Correct Answer: Pegvisomant can be used where IGF-1 is not normalised post surgery

      Explanation:

      The patient has Acromegaly.
      Acromegaly is a chronic disorder characterised by growth hormone (GH) hypersecretion, predominantly caused by a pituitary adenoma.

      Random GH level testing is not recommended for diagnosis given the pulsatile nature of secretion. Stress, physical exercise, acute critical illness and fasting state can cause a physiological higher peak in GH secretion.

      Pegvisomant is a US Food and Drug Administration-approved treatment for use after surgery. In a global non-interventional safety surveillance study, pegvisomant normalised IGF-1 in 67.5% of patients after 5 years (most likely due to lack of dose-up titration), and also improved clinical symptoms. Pegvisomant improves insulin sensitivity, and long-term follow-up showed significantly decreased fasting glucose over time, while the first-generation SRL only have a marginal clinical impact on glucose homeostasis in acromegaly. Pegvisomant does not have any direct anti-proliferative effects on pituitary tumour cells, but tumour growth is rare overall.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 18 - Which of the following treatments would you advise for a young, 21 year...

    Incorrect

    • Which of the following treatments would you advise for a young, 21 year old student who has ankylosing spondylitis and complains of worsening back pain and morning stiffness?

      Your Answer:

      Correct Answer: Oral NSAIDs

      Explanation:

      NSAIDs are considered as the first line of treatment for managing pain and stiffness associated with ankylosing spondylitis. Other useful medications include TNF-alpha inhibitors. Other drugs like paracetamol, colchicine, and steroids are not routinely used. Bilateral total hip replacement might be indicated in advanced disease contrary to complicated spinal surgery.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 19 - A 65 yr. old male patient admitted with myocardial infarction received thrombolysis, which...

    Incorrect

    • A 65 yr. old male patient admitted with myocardial infarction received thrombolysis, which lead to full resolution of the ST elevations on his ECG. He was on aspirin, clopidogrel, atorvastatin and enalapril. The next day he complained of pain in his legs and there was a diffuse petechial rash over his lower legs, especially in the feet. All his peripheral pulses were palpable. His FBC revealed neutrophilia with eosinophilia. His IgE antibodies were 3 kU/L (<2). What is the most likely reason for this presentation?

      Your Answer:

      Correct Answer: Cholesterol emboli

      Explanation:

      He has a consequence of atherosclerotic disease (MI). The most probable diagnosis is cutaneous cholesterol emboli as it is more common after anticoagulation or thrombolytics, the skin involvement, eosinophilia and raised IgE. It is more common above 60 yrs. of age.

    • This question is part of the following fields:

      • Cardiology
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  • Question 20 - A 35-year-old woman under treatment for long-term epilepsy with valproate presented with complaints...

    Incorrect

    • A 35-year-old woman under treatment for long-term epilepsy with valproate presented with complaints of excessive weight gain. She is consuming oral contraceptive pills.
      Which among the following is the best alternative to valproate for treating long-term epilepsy?

      Your Answer:

      Correct Answer: Lamotrigine

      Explanation:

      Among the given anti-epileptics the best drug that can be given in this patient is lamotrigine.
      Topiramate, carbamazepine, phenytoin, and phenobarbital are all hepatic enzyme inducers and are associated with decreased effectiveness of the oral contraceptive (OCP) due to acceleration of the metabolism of oestrogens and progestogens.
      If she is planning on pregnancy then registry studies suggest that lamotrigine would also be the best choice.
      Other hepatic enzyme inducers include rifampicin, spironolactone, griseofulvin, etc.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 21 - 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 22 - A 60 yr. old man with atrial fibrillation (AF) who is on warfarin...

    Incorrect

    • A 60 yr. old man with atrial fibrillation (AF) who is on warfarin and is awaiting tooth extraction. Recent INR was 2.7 and his target INR was 2.0-3.0. Which of the following is the most appropriate management?

      Your Answer:

      Correct Answer:

      Explanation:

      The latest reserches say that simple tooth extraction in patients on warfarin treatment can be performed safely without high risk of bleeding, providing that the INR is equal to or less than 3.5 on the day of extraction. A close follow-up and monitoring of patients taking warfarin is mandatory after dental extraction.

    • This question is part of the following fields:

      • Cardiology
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  • Question 23 - Which one of the following statements regarding nitric oxide is incorrect? ...

    Incorrect

    • Which one of the following statements regarding nitric oxide is incorrect?

      Your Answer:

      Correct Answer: Promotes platelet aggregation

      Explanation:

      Nitric oxide, known as an endothelium-derived relaxing factor (EDRF), is biosynthesized endogenously from L-arginine, oxygen, and NADPH by various nitric oxide synthase (NOS) enzymes and is a signaling molecule in many physiological and pathological processes in humans.
      One of the main enzymatic targets of nitric oxide is guanylyl cyclase. The binding of nitric oxide to the haem region of the enzyme leads to activation, in the presence of iron.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 24 - Which of the following is not a tumour suppressor gene? ...

    Incorrect

    • Which of the following is not a tumour suppressor gene?

      Your Answer:

      Correct Answer: myc

      Explanation:

      Myc is a family of regulator genes and proto-oncogenes that code for transcription factors.

      A tumor suppressor gene, or antioncogene, is a gene that protects a cell from one step on the path to cancer. When this gene mutates to cause a loss or reduction in its function, the cell can progress to cancer, usually in combination with other genetic changes. Tumor suppressor genes can be grouped into categories including caretaker genes, gatekeeper genes, and landscaper genes; the classification schemes are continually evolving.
      Examples include:
      Gene Associated cancers
      p53 Common to many cancers, Li-Fraumeni syndrome
      APC Colorectal cancer
      BRCA1 Breast and ovarian cancer
      BRCA2 Breast and ovarian cancer
      NF1 Neurofibromatosis
      Rb Retinoblastoma
      WT1 Wilm’s tumour

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 25 - A 27 year old woman presents with a 4cm bleeding ulcer on her...

    Incorrect

    • A 27 year old woman presents with a 4cm bleeding ulcer on her labia minora. The woman admits she is sexually active. Which lymph nodes will the ulcer drain to?

      Your Answer:

      Correct Answer: Superficial inguinal

      Explanation:

      The woman seems to have a chancroid, which may or may not drain to the lymph nodes of the groin. These nodes are the superficial inguinal lymph nodes.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 26 - A 58-year-old woman has multiple non-healing leg ulcers. She reports feeling unwell for...

    Incorrect

    • A 58-year-old woman has multiple non-healing leg ulcers. She reports feeling unwell for several months. Examination findings include a normal blood pressure, pulse 90 bpm, pale conjunctivae and poor dentition associated with bleeding gums. What is the most likely underlying diagnosis?

      Your Answer:

      Correct Answer: Vitamin C deficiency

      Explanation:

      Severe vitamin C deficiency results in scurvy, a disorder characterized by hemorrhagic manifestations and abnormal osteoid and dentin formation.
      Vitamin C plays a role in collagen, carnitine, hormone, and amino acid formation. It is essential for bone and blood vessel health and wound healing and facilitates recovery from burns. Vitamin C is also an antioxidant, supports immune function, and facilitates the absorption of iron (see table Sources, Functions, and Effects of Vitamins).
      Dietary sources of vitamin C include citrus fruits, tomatoes, potatoes, broccoli, strawberries, and sweet peppers. (See also Overview of Vitamins.)

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 27 - In idiopathic hypercalciuria, what management should be initiated if there is renal stone...

    Incorrect

    • In idiopathic hypercalciuria, what management should be initiated if there is renal stone disease or bone demineralization?

      Your Answer:

      Correct Answer: Dietary modification and thiazide diuretics

      Explanation:

      Idiopathic hypercalciuria presents with excess calcium in the urine without an apparent cause. Dietary modification is the first step in addressing this condition, however, because hypercalciuria increases the risk of developing renal stones and bone demineralisation, thiazide diuretics should be prescribed to increase calcium reabsorption when these symptoms are also present.

    • This question is part of the following fields:

      • Nephrology
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  • Question 28 - How is the left ventricular ejection fraction calculated? ...

    Incorrect

    • How is the left ventricular ejection fraction calculated?

      Your Answer:

      Correct Answer: Stroke volume / end diastolic LV volume

      Explanation:

      Left ventricular ejection fraction = (stroke volume / end diastolic LV volume ) * 100%

      Stroke volume = end diastolic LV volume – end systolic LV volume

      Pulse pressure = Systolic Pressure – Diastolic Pressure

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 29 - An 88-year-old retired firefighter presents with loss of vision in his left eye...

    Incorrect

    • An 88-year-old retired firefighter presents with loss of vision in his left eye since this morning. He is otherwise asymptomatic and of note has had no associated eye pain or headaches. His past medical history includes ischaemic heart disease but he is otherwise well. On examination he has no vision in his left eye. The left pupil responds poorly to light but the consensual light reaction is normal. Fundoscopy reveals a red spot over a pale and opaque retina. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Central retinal artery occlusion

      Explanation:

      The most common causes of a sudden painless loss of vision are:
      – ischaemic optic neuropathy
      – occlusion of central retinal vein or artery
      – vitreous haemorrhage
      – retinal detachment.
      Central retinal artery occlusion is due to thromboembolism (from atherosclerosis) or arteritis (e.g. temporal arteritis). Features include afferent pupillary defects, and a ‘cherry red’ spot on a pale retina.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 30 - A girl suffered full thickness circumferential burn to her right arm. What is...

    Incorrect

    • A girl suffered full thickness circumferential burn to her right arm. What is best step in management?

      Your Answer:

      Correct Answer: Escharotomy

      Explanation:

      An escharotomy is a surgical procedure used to treat full-thickness (third-degree) circumferential burns. In full-thickness burns, both the epidermis and the dermis are destroyed along with sensory nerves in the dermis. The tough leathery tissue remaining after a full-thickness burn has been termed eschar.

    • This question is part of the following fields:

      • Dermatology
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