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Question 1
Correct
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Which of the following listed below is not a recognised feature of anorexia nervosa?
Your Answer: Reduced growth hormone levels
Explanation:Physiological abnormalities in anorexia include:
– Hypokalaemia – from diuretic or laxative use
– Low FSH, LH, oestrogens and testosterone – most consistent endocrine abnormality was low serum luteinizing and follicle stimulating hormone (LH and FSH) levels associated with depressed serum oestradiol levels.
– Raised cortisol and growth hormone
– Impaired glucose tolerance – lack of glucose precursors in the diet or low glycogen stores. Low blood glucose may also be due to impaired insulin clearance
– Hypercholesterolemia
– Hypercarotenaemia
– Low T3 -
This question is part of the following fields:
- Psychiatry
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Question 2
Incorrect
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A 40-year-old woman presents to the ED with palpitations and shortness of breath.
Recent thyroid function tests on the hospital computer reveal thyroid-stimulating hormone (TSH) of <0.05 mU/l and a markedly elevated T4. You arrange blood gas testing.
Which of the following findings would be most consistent with Grave’s disease?Your Answer:
Correct Answer: Decreased pa(CO2)
Explanation:Hyperthyroid patients show significantly lower resting arterial CO2 tension, tidal volume and significantly higher mean inspiratory flow and pa(O2) than healthy patients. This may of course lead to misdiagnosis of patients with hyperthyroidism as having hyperventilation syndrome.
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This question is part of the following fields:
- Endocrinology
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Question 3
Incorrect
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A 43 year old female presented with a 5 day history of a productive cough with rusty coloured sputum. Chest X-ray showed lobar consolidation on her left side. The most likely causative organism would be?
Your Answer:
Correct Answer: Streptococcus pneumoniae
Explanation:Streptococcus pneumonia is the chief causative organism for lobar pneumonia in this age group patients. Typically patients present with rusty coloured sputum and a cough. Pneumocystis jiroveci is responsible for causing pneumocystis pneumonia among immunocompromised patients.
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This question is part of the following fields:
- Infectious Diseases
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Question 4
Incorrect
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Which is the best source of vitamin D per average serving for a woman with suspected Osteomalacia?
Your Answer:
Correct Answer: Cod liver oil
Explanation:Serum vitamin D levels are influenced by sun exposure and diet. Cod liver oil is an important dietary vitamin D source in high-latitude countries like Norway where there is no sun-induced vitamin D production during the winter. 14 Norwegian Health Authorities have recommended 5 ml of cod liver oil daily (400 IU of vitamin D) for more than 60 years to prevent diseases like rickets, formerly more prevalent in areas with little access to vitamin D-rich fatty fish.
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This question is part of the following fields:
- Clinical Sciences
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Question 5
Incorrect
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Choose the correct statement regarding relative risk:
Your Answer:
Correct Answer: It is the usual outcome measure of cohort studies
Explanation:Relative Risk = (Probability of event in exposed group) / (Probability of event in not exposed group). The relative risk is mistaken by some, with the odds ratio and absolute risk. Relative risk is the ratio of the probability of an event occurring with an exposure versus the probability of the event occurring without the exposure. Thus to calculate the relative risk, we must know the exposure status of all individuals (either exposed or not exposed). This implies that relative risk is only appropriate for cases where the exposure status and incidence of disease can be accurately determined such as prospective cohort studies.
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This question is part of the following fields:
- Clinical Sciences
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Question 6
Incorrect
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A 30-year-old man with type-1 diabetes mellitus on insulin presents in the A&E with fever, cough, vomiting and abdominal pain.
Examination reveals a dry mucosa, decreased skin turgor and a temperature of 37.8 °C.
Chest examination reveals bronchial breathing in the right lower lobe, and a chest X-ray shows it to be due to a right lower zone consolidation.
Other investigations show:
Blood glucose: 35 mmol/L,
Na+: 132 mmol/L,
K+: 5.5 mmol/L,
urea: 8.0 mmol/L,
creatinine: 120 μmol/L,
pH: 7.15,
HCO3: 12 mmol/L,
p(CO2): 4.6 kPa,
chloride: 106 mmol/l.
Urinary ketones are positive (+++).
The patient is admitted to the hospital and treated. Which of the following should not be used while treating him?Your Answer:
Correct Answer: Bicarbonate
Explanation:Bicarbonate therapy is not indicated in mild and moderate forms of DKA because metabolic acidosis will correct with insulin therapy. The use of bicarbonate in severe DKA is controversial due to a lack of prospective randomized studies. It is thought that the administration of bicarbonate may actually result in peripheral hypoxemia, worsening of hypokalaemia, paradoxical central nervous system acidosis, cerebral oedema in children and young adults, and an increase in intracellular acidosis. Because severe acidosis is associated with worse clinical outcomes and can lead to impairment in sensorium and deterioration of myocardial contractility, bicarbonate therapy may be indicated if the pH is 6.9 or less.
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This question is part of the following fields:
- Endocrinology
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Question 7
Incorrect
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During the examination of an elderly confused and non-coherent gentleman who was brought to casualty by a concerned neighbour, you notice that he has bilaterally small pupils, which do not appear to react to light. Under the circumstances, it is difficult to judge their response to accommodation.
Which of the following conditions may not account for the pupillary appearance in this patient?Your Answer:
Correct Answer: Acute alcohol intoxication
Explanation:Acute alcohol intoxication presents with pupillary dilation, thus, this is ruled out in this patient. All the other listed causes present with small pupils bilaterally.
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This question is part of the following fields:
- Neurology
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Question 8
Incorrect
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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.
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This question is part of the following fields:
- Neurology
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Question 9
Incorrect
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A 36-year-old lady with back pain is found to have loss of sensation of the kneecaps. Choose the dermatome most likely compromised:
Your Answer:
Correct Answer: L4
Explanation:L4 dermatome distribution includes the kneecaps.
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This question is part of the following fields:
- Clinical Sciences
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Question 10
Incorrect
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Primary hyperaldosteronism is characterized by which of the following features?
Your Answer:
Correct Answer: Muscular weakness
Explanation:Primary hyperaldosteronism, also known as Conn’s Syndrome, is one of the most common causes of secondary hypertension (HTN).
The common clinical scenarios in which the possibility of primary hyperaldosteronism should be considered include the following:
– Patients with spontaneous or unprovoked hypokalaemia, especially if the patient is also hypertensive
– Patients who develop severe and/or persistent hypokalaemia in the setting of low to moderate doses of potassium-wasting diuretics
– Patients with treatment-refractory/-resistant hypertension (HTN)
Patients with severe hypokalaemia report fatigue, muscle weakness, cramping, headaches, and palpitations. They can also have polydipsia and polyuria from hypokalaemia-induced nephrogenic diabetes insipidus. Long-standing HTN may lead to cardiac, retinal, renal, and neurologic problems, with all the associated symptoms and signs. -
This question is part of the following fields:
- Endocrinology
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