00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - 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: Varicella zoster virus

      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
      1
      Seconds
  • Question 2 - A 35-year-old man is referred to the clinic by his GP. He complains...

    Incorrect

    • A 35-year-old man is referred to the clinic by his GP. He complains of lethargy and tiredness. He has recently been discharged from the hospital after being admitted to the intensive care unit following a motorbike accident.
      His thyroid function testing is :
      TSH 0.3 IU/l (0.5-4.5),
      Free T4 8 pmol/l (9-25),
      Free T3 3.1 pmol/l (3.4-7.2).

      Which of the following is most likely to be the diagnosis?

      Your Answer:

      Correct Answer: Sick euthyroid syndrome

      Explanation:

      Euthyroid sick syndrome (also known as nonthyroidal illness syndrome) can be described as abnormal findings on thyroid function tests that occurs in the setting of a nonthyroidal illness (NTI), without pre-existing hypothalamic-pituitary and thyroid gland dysfunction. After recovery from an NTI, these thyroid function test result abnormalities should be completely reversible.
      Multiple alterations in serum thyroid function test findings have been recognized in patients with a wide variety of NTIs without evidence of pre-existing thyroid or hypothalamic-pituitary disease. The most prominent alterations are low serum triiodothyronine (T3) and elevated reverse T3 (rT3), leading to the general term low T3 syndrome. Thyroid-stimulating hormone (TSH), thyroxine (T4), free T4 (FT4), and free T4 index (FTI) also are affected in variable degrees based on the severity and duration of the NTI. As the severity of the NTI increases, both serum T3 and T4 levels drop, but they gradually normalize as the patient recovers.
      Reverse T3 is used to differentiate between this condition and secondary thyroid failure.

    • This question is part of the following fields:

      • Endocrinology
      0
      Seconds
  • Question 3 - Which of the following is least likely to cause warm autoimmune haemolytic anaemia?...

    Incorrect

    • Which of the following is least likely to cause warm autoimmune haemolytic anaemia?

      Your Answer:

      Correct Answer: Mycoplasma infection

      Explanation:

      Mycoplasma infection causes cold autoimmune haemolytic anaemia (AIHA). The rest of the aforementioned options cause warm AIHA.

      AIHA may be divided into ‘warm’ and ‘cold’ types, according to the temperature at which the antibodies best cause haemolysis. It is most commonly idiopathic but may be secondary to a lymphoproliferative disorder, infection, or drugs.

      1. Warm AIHA:
      In warm AIHA, the antibody (usually IgG) causes haemolysis best at body temperature and tends to occur in extravascular sites, for example, spleen. Management options include steroids, immunosuppression, and splenectomy. It is caused by autoimmune diseases such as SLE (rarely causes mixed-type AIHA), cancers such as lymphomas and CLL, and drugs such as methyldopa.

      2. Cold AIHA:
      The antibody in cold AIHA is usually IgM and causes haemolysis best at 4°C and occurs more commonly intravascularly. Features may include symptoms of Raynaud’s disease and acrocyanosis. Patients do not respond well to steroids. Cold AIHA is caused by cancers such as lymphomas, and infections such as mycoplasma and EBV.

    • This question is part of the following fields:

      • Haematology & Oncology
      0
      Seconds
  • Question 4 - A 26-year-old graduate student with a history of migraines presents for examination. His...

    Incorrect

    • A 26-year-old graduate student with a history of migraines presents for examination. His headaches are now occurring about once a week. He describes unilateral, throbbing headaches that may last over 24 hours. Neurological examination is unremarkable. Other than a history of asthma, he is fit and well. What is the most suitable therapy to reduce the frequency of migraine attacks?

      Your Answer:

      Correct Answer: Topiramate

      Explanation:

      It should be noted that as a general rule 5-HT receptor agonists are used in the acute treatment of migraine whilst 5-HT receptor antagonists are used in prophylaxis. NICE produced guidelines in 2012 on the management of headache, including migraines. Prophylaxis should be given if patients are experiencing 2 or more attacks per month. Modern treatment is effective in about 60% of patients. NICE advises either topiramate or propranolol ‘according to the person’s preference, comorbidities and risk of adverse events’. Propranolol should be used in preference to topiramate in women of child bearing age as it may be teratogenic and it can reduce the effectiveness of hormonal contraceptives.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 5 - Which one of the following skin conditions is matched correctly with its treatment?...

    Incorrect

    • Which one of the following skin conditions is matched correctly with its treatment?

      Your Answer:

      Correct Answer:

      Explanation:

      One of the options of Psoriasis treatment is vitamin D analogues i.e. calcipotriol. Acne is exacerbated by steroids. Erythema nodosum can be caused by various diseases and the treatment of the primary condition resolves the symptoms. Lipomas requires surgery, whereas Steven-Johnson syndrome requires use of steroids and eliminating the culprit drug, which is one of the most common causes.

    • This question is part of the following fields:

      • Dermatology
      0
      Seconds
  • Question 6 - Which one of the following statements is true regarding autosomal recessive polycystic kidney...

    Incorrect

    • Which one of the following statements is true regarding autosomal recessive polycystic kidney disease?

      Your Answer:

      Correct Answer: May be diagnosed on prenatal ultrasound

      Explanation:

      Autosomal recessive polycystic kidney disease (ARPKD) is less common than ADPKD (dominant form) but can already present with symptoms and be diagnosed on prenatal ultrasound.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 7 - A 32-year-old woman was referred for endoscopy and found to have a duodenal...

    Incorrect

    • A 32-year-old woman was referred for endoscopy and found to have a duodenal ulcer and a positive urease test. She was given lansoprazole, amoxicillin and clarithromycin for 7 days.

      Which of the following is the most appropriate way of determining the successful eradication of H. pylori?

      Your Answer:

      Correct Answer: Urea breath test

      Explanation:

      Urea breath test is the most sensitive test to determine if there has been RESOLUTION/ERADICATION of the infection with H. pylori. The best test for initial diagnosis would be EGD with biopsy.

    • This question is part of the following fields:

      • Gastroenterology
      0
      Seconds
  • Question 8 - A 60-year-old gentleman presents with symptoms of nocturia and difficulty in passing urine....

    Incorrect

    • A 60-year-old gentleman presents with symptoms of nocturia and difficulty in passing urine. He is not known to have any previous prostatic problems and denies any dysuria. Following a digital rectal examination, he is started on Finasteride and Tamsulosin. Three months later he presents to the emergency department with urinary retention and is catheterized, and a craggy mass is felt on rectal examination. He is referred to a urologist, and a prostatic ultrasound and needle biopsy are arranged, and prostate serum antigen (PSA) is requested.

      Which of the following factors is most likely to give a false negative PSA?

      Your Answer:

      Correct Answer: Finasteride

      Explanation:

      Finasteride is often prescribed for patients with Benign Prostatic Hyperplasia (BPH) or enlarged prostate. However, it has been known to cause a decrease in Prostatic Specific Antigen (PSA) levels in patients with BPH, which may lead to false negatives in a case like this, where a palpable mass has been detected and malignancy is suspected.

    • This question is part of the following fields:

      • Nephrology
      0
      Seconds
  • Question 9 - An iv-drug abuser sustains an open head injury and is admitted overnight for...

    Incorrect

    • An iv-drug abuser sustains an open head injury and is admitted overnight for observation. The next morning she is ok and is discharged. A week later she is re-admitted with fluctuating hard neurological signs. Blood results show neutrophilia and raised C-reactive protein (CRP).
      Which of the following is the best initial treatment step?

      Your Answer:

      Correct Answer: Computed tomography (CT) scan with contrast

      Explanation:

      Increased WBC count and CRP suggest infection. But with the fluctuating hard neurological signs, there is suspicion of the presence of a cerebral mass, which is an indication for requesting for a CT scan with contrast, to rule out an abscess or haematoma. The lumbar puncture can be considered after the CT scan.

    • This question is part of the following fields:

      • Neurology
      0
      Seconds
  • Question 10 - A 3-year-old boy has been brought to the hospital by his mother with...

    Incorrect

    • A 3-year-old boy has been brought to the hospital by his mother with pallor, lethargy and abdominal enlargement. His mother said she only noticed these symptoms two weeks ago but further questioning reveals that they have been progressively worsening over a longer period of time. The boy was born naturally following an uncomplicated pregnancy. Past and family histories are not significant and the family hasn't been on any vacations recently. However, the mother mentions a metabolic disorder present in the family history but couldn't remember the exact name. Clinical examination reveals generalised pallor, abdominal enlargement, massive splenomegaly and hepatomegaly. The spleen is firm but not tender and there is no icterus or lymphadenopathy. What is the most probable diagnosis?

      Your Answer:

      Correct Answer: Gaucher's disease

      Explanation:

      Gaucher’s disease is characterized by hepatosplenomegaly, cytopenia, sometimes severe bone involvement and, in certain forms, neurological impairment. The variability in the clinical presentations of GD may be explained by the continuum of phenotypes. However, three major phenotypic presentations can usually be distinguished. Type-1 GD is usually named non-neuronopathic GD; type-2 and type-3 are termed neuronopathic-GD. Gaucher disease (GD, ORPHA355) is a rare, autosomal recessive genetic disorder. It is caused by a deficiency of the lysosomal enzyme, glucocerebrosidase, which leads to an accumulation of its substrate, glucosylceramide, in macrophages.

    • This question is part of the following fields:

      • Clinical Sciences
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Passmed