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  • Question 1 - A 70-year-old man presents with nocturia, hesitancy and terminal dribbling of urine.
    ...

    Correct

    • A 70-year-old man presents with nocturia, hesitancy and terminal dribbling of urine.
      Prostate examination reveals a moderately enlarged prostate with no irregular features and a well-defined median sulcus. Blood investigations show a PSA level of 1.3 ng/mL. Among the options provided below what is the most appropriate management for this patient?

      Your Answer: Alpha-1 antagonist

      Explanation:

      Benign Prostatic Enlargement or Hyperplasia (BPE/BPH) is the most probable diagnosis of the patient in question. It is a histological diagnosis characterized by proliferation of the cellular elements of the prostate.
      The initial treatment modality of choice is selective alpha 1 antagonists (such as Prazosin, Alfuzosin and Indoramin, and long acting agents like, Terazosin, Doxazosin, etc.) as they provide immediate relief from the bothersome lower urinary tract symptoms (LUTS).
      Other treatment modalities include:
      • Non-selective alpha blockers: no longer used due to severe adverse effects and the availability of selective alpha 1 blockers.
      • 5 alpha reductase inhibitors: Finasteride and Dutasteride, they target the underlying disease process and reduce the overall prostate volume. Thus, reduce the urinary retention and the lower urinary tract symptoms. (They do not provide immediate relief from LUTS and thus are not preferred as first line drugs over alpha 1 antagonists)
      • PDE-5 Inhibitors: The long-acting tadalafil has proven to be useful.
      • Surgical Treatment modalities: TURP, Prostatectomy, etc.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 2 - A 3 month old infant born to HIV positive mother presented with jaundice,...

    Incorrect

    • A 3 month old infant born to HIV positive mother presented with jaundice, epileptic seizures and microcephaly. The most likely cause will be?

      Your Answer:

      Correct Answer:

      Explanation:

      Congenital cytomegalovirus infection causes; jaundice, hepatosplenomegaly, petechia, microcephaly, hearing loss and seizures.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 3 - A 36-year-old lady presents to the emergency department with right upper quadrant pain....

    Incorrect

    • A 36-year-old lady presents to the emergency department with right upper quadrant pain. She has also noticed that her skin seems slightly yellower over the last week or so and you notice a yellow tinge to her sclera. On further questioning, she complains of itching of her arms. Her only past medical history of note includes ulcerative colitis for which she takes mesalazine.

      Given her presentation, what is the best investigation to diagnose the most likely underlying condition?

      Your Answer:

      Correct Answer: ERCP (endoscopic retrograde cholangiopancreatography)

      Explanation:

      With biliary obstructive symptoms in a patient with ulcerative colitis, one should immediately think of primary sclerosing cholangitis (PSC). PSC is characterized by inflammation and fibrosis of the intrahepatic and extrahepatic ducts. The best diagnostic test for PSC is ERCP. ANCA antibiotics may be positive, but not the best test to DIAGNOSE THE CONDITION. The same can be said of serum transaminase levels– they will be abnormal but nonspecific. While a liver ultrasound may be helpful, it is not the best test. Liver biopsy would be used to stage the PSC later.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 4 - A 72-year-old woman who presented with headache and neck stiffness was started on...

    Incorrect

    • A 72-year-old woman who presented with headache and neck stiffness was started on IV ceftriaxone after undergoing a lumber puncture. The CSF culture shows listeria monocytogenes. What is the treatment of choice?

      Your Answer:

      Correct Answer: Change to IV amoxicillin + gentamicin

      Explanation:

      The best option would be the combination of ampicillin and gentamycin. Changing to IV amoxicillin+gentamycin is however the best among the given choices here.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 5 - A 43-year-old man is reviewed in the gastroenterology clinic. He has had troublesome...

    Incorrect

    • A 43-year-old man is reviewed in the gastroenterology clinic. He has had troublesome dyspepsia for the past six months which has not settled with proton pump inhibitor (PPI) therapy. During the review of his systems he also reports passing 6-7 watery stools per day. An OGD 3 weeks ago showed gastric erosions and ulcers.

      Which one of the following investigations is most likely to be diagnostic?

      Your Answer:

      Correct Answer: Fasting gastrin

      Explanation:

      This case describes Zollinger-Ellison syndrome. It is characterized by refractory peptic ulcer disease, often multiple ulcers. This is typically caused by secretion of gastrin from a gastrinoma, a neuroendocrine tumour. The most common site of ulceration is the duodenum. A symptom of a pancreatic gastrinoma may be steatorrhea from the hypersecretion of gastrin. Serum gastrin levels > 1000 and a pH < 2 are diagnostic of pancreatic gastrinoma. None of the other answer choices are a better answer than this. CT abdomen may potentially show a tumour, but this is not diagnostic for type.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 6 - A 34-year-old male patient is admitted with hemisection of the spinal cord at...

    Incorrect

    • A 34-year-old male patient is admitted with hemisection of the spinal cord at the level T5, after being stabbed in the back. Which sign would you expect to see by assessing the patient's sensory function and muscle strength?

      Your Answer:

      Correct Answer: Contralateral loss of temperature, ipsilateral loss of fine touch and vibration, ipsilateral spastic paresis

      Explanation:

      Depending on the level of SCI, patients experience paraplegia or tetraplegia. Paraplegia is defined as the impairment of sensory or motor function in lower extremities. Patients with incomplete paraplegia generally have a good prognosis in regaining locomotor ability (,76% of patients) within a year. Complete paraplegic patients, however, experience limited recovery of lower limb function if their NLI is above T9. The spinothalamic tract is the one responsible for sensory information such as pain or temperature. However, it decussates at the same level the nerve root enters the spinal cord, meaning that the sensory loss will be contralateral. However, the dorsal column carries sensory fibres for fine touch and vibration and it decussates at the medulla which means that the sensory loss will be ipsilateral. The corticospinal tract is responsible for motor functions and it decussates at the medulla, meaning that the motor function loss will be ipsilateral.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 7 - A 40 year-old lawyer suffered a road traffic accident. MRI reveals that he...

    Incorrect

    • A 40 year-old lawyer suffered a road traffic accident. MRI reveals that he may have hemisection of the spinal cord. Which of the following findings is most likely to occur?

      Your Answer:

      Correct Answer: Ipsilateral hyperreflexia

      Explanation:

      Spinal cord hemisection, also known as Brown-Sequard syndrome, is associated with symptoms affecting one spinothalamic and one corticospinal tract. Symptoms include ipsilateral paralysis, loss of vibration and position sense, and hyperreflexia below the level of the lesion. Contralateral loss of pain and temperature sensation is also seen, usually beginning 2-3 segments below the level of the lesion.

    • This question is part of the following fields:

      • Neurology
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  • Question 8 - A 54-year-old man is found collapsed in the street and is brought to...

    Incorrect

    • A 54-year-old man is found collapsed in the street and is brought to the A&E. The results from the blood tests reveal Calcium = 1.62mmol/l and Albumin = 33g/l. The man is known to have a history of alcoholic liver disease. Which of the following is the best management regarding his calcium levels?

      Your Answer:

      Correct Answer: 10ml of 10% calcium gluconate over 10 minutes

      Explanation:

      Acute, symptomatic hypocalcaemia is treated with 10ml of 10% calcium gluconate over 10 minutes.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 9 - Which one of the following is most suggestive of Wilson’s disease? ...

    Incorrect

    • Which one of the following is most suggestive of Wilson’s disease?

      Your Answer:

      Correct Answer: Reduced serum caeruloplasmin

      Explanation:

      In Wilson’s disease, serum caeruloplasmin is decreased. Skin pigmentation is not increased, but may become jaundiced. 24 hour urine copper excretion is increased. Hepatic copper concentration is increased. Serum copper level is also increased. Key point: high copper. Remember Kayser-Fleisher rings for the eyes in Wilson’s disease.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 10 - A 68 year old man who has chronic obstructive pulmonary disease (COPD) is...

    Incorrect

    • A 68 year old man who has chronic obstructive pulmonary disease (COPD) is reviewed. On examination, there is evidence of cor pulmonale with a significant degree of pedal oedema. His FEV1 is 44%. During a recent hospital stay his pO2 on room air was 7.4 kPa.

      Which one of the following interventions is most likely to increase survival in this patient?

      Your Answer:

      Correct Answer: Long-term oxygen therapy

      Explanation:

      Assess the need for oxygen therapy in people with:
      – very severe airflow obstruction (FEV1 below 30% predicted)
      – cyanosis (blue tint to skin)
      – polycythaemia
      – peripheral oedema (swelling)
      – a raised jugular venous pressure
      – oxygen saturations of 92% or less breathing air.

      Also consider assessment for people with severe airflow obstruction (FEV1 30–49% predicted).

      Consider long-term oxygen therapy for people with COPD who do not smoke and who:
      have a partial pressure of oxygen in arterial blood (PaO2) below 7.3 kPa when stable or have a PaO2 above 7.3 and below 8 kPa when stable, if they also have 1 or more of the following:
      – secondary polycythaemia
      – peripheral oedema
      – pulmonary hypertension.

    • This question is part of the following fields:

      • Respiratory
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