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  • Question 1 - An elderly woman is taken to the clinic by her husband because she...

    Incorrect

    • An elderly woman is taken to the clinic by her husband because she has been complaining about seeing ghosts in their house. She no longer wants to enter in the house. You wonder if this might be Charles-Bonnet syndrome.
      Which of the following risk factors may pre-dispose this woman to Charles-Bonnet syndrome?

      Your Answer: Occupational history of working in sewers

      Correct Answer: Peripheral visual impairment

      Explanation:

      Charles Bonnet syndrome (CBS) involves visual hallucinations due to eye disease, usually associated with a sharp decline in vision. The phenomenon is seen in patients with moderate or severe visual impairment. It can occur spontaneously as the vision declines or it may be precipitated, in predisposed individuals, by concurrent illness such as infections elsewhere in the body.

      It is not clear why CBS develops or why some individuals appear to be predisposed to it. It is particularly noted in patients with advanced macular degeneration. It has been suggested that reduced or absent stimulation of the visual system leads to increased excitability of the visual cortex (deafferentation hypothesis). This release phenomenon is compared to phantom limb symptoms after amputation.

      CBS is much more common in older patients because conditions causing marked visual loss are more common in older people. However, it can occur at any age and has been described in children.
      The prevalence is hard to assess due to considerable under-reporting, perhaps because patients frequently fear that it is a sign of mental illness or dementia. However, it is thought to occur in:
      About 10-15% of patients with moderate visual loss.
      Possibly up to 50% of people with severe visual loss.
      Presentation:
      The nature of the hallucination depends on the part of the brain that is activated. The hallucinations may be black and white or in colour. They may involve grids/brickwork/lattice patterns but are typically much more complex:

      The hallucinations are always outside the body.
      The hallucinations are purely visual – other senses are not involved.
      The hallucinations have no personal meaning to the patient.
      Hallucinations may last seconds, minutes or hours.
      CBS tends to occur in a ‘state of quiet restfulness’. This may be after a meal or when listening to the radio (but not when dozing off).
      Symptoms also have a tendency to occur in dim lighting conditions.
      Patients may report high levels of distress, with some patients reporting anger, anxiety and even fear associated with the hallucinations.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 2 - A 45-year-old man with diabetes comes to the clinic for his annual review....

    Incorrect

    • A 45-year-old man with diabetes comes to the clinic for his annual review.
      He has had diabetes for eight years and he is also being treated for hypertension. He is on the following medications: metformin 500 mg tds, gliclazide 80 mg daily, atorvastatin 10 mg/d, Ramipril 10 mg/d and Bendroflumethiazide 2.5 mg/d.
      He is noted to be obese (130kg). Physical examination is otherwise unremarkable.

      Investigations reveal:
      HbA1c 8.1% (3.8-6.4),
      Fasting glucose 9 mmol/L (3.0-6.0),
      24hr Urine free cortisol 354 mmol/d (<250),
      9am Plasma ACTH 4 ng/dL (10-50).
      CT abdomen 3cm right adrenal mass.

      Which of the following is most likely to be the adrenal mass?

      Your Answer:

      Correct Answer: Cortisol secreting adenoma

      Explanation:

      The patient has Cushing syndrome suggested by the elevated 24hr urine free cortisol. Hence, the mass is most probably a cortisol secreting adenoma.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 3 - A 56 year old man who is a known alcoholic presents to the...

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    • A 56 year old man who is a known alcoholic presents to the clinic with a fever and cough. Past medical history states that he has a long history of smoking and is found to have a cavitating lesion on his chest x-ray.
       
      Which organism is least likely to be the cause of his pneumonia?

      Your Answer:

      Correct Answer: Enterococcus faecalis

      Explanation:

      Cavitating pneumonia is a complication that can occur with a severe necrotizing pneumonia and in some publications it is used synonymously with the latter term. It is a rare complication in both children and adults. Albeit rare, cavitation is most commonly caused by Streptococcus pneumoniae, and less frequently Aspergillus spp., Legionella spp. and Staphylococcus aureus.

      In children, cavitation is associated with severe illness, although cases usually resolve without surgical intervention, and long-term follow-up radiography shows clear lungs without pulmonary sequelae
      Although the absolute cavitary rate may not be known, according to one series, necrotizing changes were seen in up to 6.6% of adults with pneumococcal pneumonia. Klebsiella pneumoniae is another organism that is known to cause cavitation.

      Causative agents:
      Mycobacterium tuberculosis
      Klebsiella pneumoniae
      Streptococcus pneumoniae
      Staphylococcus aureus

      Enterococcus faecalis was not found to be a causative agent.

    • This question is part of the following fields:

      • Respiratory
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  • Question 4 - A 60-year-old man has been admitted with dehydration following an attack of gastritis....

    Incorrect

    • A 60-year-old man has been admitted with dehydration following an attack of gastritis. His initial blood results revealed raised calcium and erythrocyte sedimentation rate (ESR). He has a history of hypertension, angina, chronic obstructive pulmonary disease (COPD), and diabetes.

      His most recent results have arrived on the ward, showing:
      Hb: 13.8 g/dL,
      WCC: 7.7 x 10^9/L,
      Plts: 212 x 10^9/L,
      Na+: 138 mmol/L,
      K+: 4.7 mmol/L,
      Ca+2: 2.4 mmol/L,
      Urea: 7.2 mmol/L,
      Creatinine: 104 mmol/L,
      Albumin: 38 g/L,
      IgG: 24 g/L (6.0-13.0),
      IgA: 2.1 g/L (0.8-3.0),
      IgM: 1.3 g/L (0.4-2.5).
      Trace amounts of Bence Jones protein have also been detected in the urine. CXR shows normal heart and mediastinal contours, clear lungs bilaterally, osteopenia of the bony skeleton with no lytic lesions.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Monoclonal gammopathy of undetermined significance

      Explanation:

      Monoclonal gammopathy of undetermined significance (MGUS)—also known as benign paraproteinemia and monoclonal gammopathy—is a pre-malignant condition not necessarily leading to its malignant form—multiple myeloma. MGUS causes increase of a serum monoclonal protein (M protein). It is not associated with ostealgia or increased risk of infections. It is often mistaken for multiple myeloma, differing from the latter in, no immunosuppression, anaemia, hypercalcaemia, lytic bone lesions, or renal failure; normal levels of beta-2 microglobulin; and stable lower levels of paraproteinemia.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 5 - A 25-year-old man having sickle cell anaemia presents with headache, lethargy, and pallor....

    Incorrect

    • A 25-year-old man having sickle cell anaemia presents with headache, lethargy, and pallor. His blood count shows:

      Haemoglobin: 4.6 g/dL,
      Reticulocytes: 3%.

      Infection with parvovirus is suspected. Out of the following, what is the most likely diagnosis?

      Your Answer:

      Correct Answer: Aplastic crisis

      Explanation:

      Sickle cell anaemia is characterised by periods of good health with intervening crises. One of the main types is aplastic crisis characterised by a sudden fall in haemoglobin without marked reticulocytosis (3%—in this case—is just above the normal range). It usually occurs secondary to parvovirus infection.

      The other main types of sickle cell crises are thrombotic crisis (painful or vaso-occlusive crisis), sequestration crisis, and haemolytic crisis. Thrombotic crisis is precipitated by infection, dehydration, alcohol, change in temperature, and deoxygenation. Sequestration crisis is characterised by acute chest syndrome (i.e. fever, dyspnoea, chest/rib pain, low pO2, and pulmonary infiltrates). In haemolytic crisis, fall in haemoglobin occurs secondary to haemolysis. It is a rare type of sickle cell crises.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 6 - A 42 yr. old man presented with palpitations and shortness of breath on...

    Incorrect

    • A 42 yr. old man presented with palpitations and shortness of breath on exertion. On examination his lungs were clear and heart sounds were normal. There was a left sided parasternal heave. His electrocardiogram (ECG) revealed atrial fibrillation with right axis deviation. Echocardiography showed dilated right heart chambers. Left and right heart catheterisation study revealed the following:

      Inferior vena cava Oxygen saturations 63 %,
      Superior vena cava Oxygen saturations 59 %,
      Right atrium Oxygen saturations 77 %,
      Right ventricle Oxygen saturations 78 %,
      Pulmonary artery Oxygen saturations 82 %,
      Arterial saturation Oxygen saturations 98 %.

      What is the most likely diagnosis from the following answers?

      Your Answer:

      Correct Answer: Atrial septal defect

      Explanation:

      Right ventricular volume overload is indicated by a parasternal heave and right axis deviation. Oxygen saturation in right atrium is higher than oxygen saturation of the inferior and superior vena cavae. So the most probable diagnosis is atrial septal defect.

    • This question is part of the following fields:

      • Cardiology
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  • Question 7 - A 24-year-old woman presents as an emergency to her GP with acute vomiting...

    Incorrect

    • A 24-year-old woman presents as an emergency to her GP with acute vomiting which began some 3–4 hours after attending an afternoon meeting. Cream cakes were served during the coffee break.

      Which of the following organisms is the most likely cause of this acute attack of vomiting?

      Your Answer:

      Correct Answer: Staphylococcus aureus

      Explanation:

      Staph. aureus is the most likely cause. It is found in foods like dairy products, cold meats, or mayonnaise. It produces a heat-stable ENDOTOXIN (remember this) that causes nausea, vomiting, and diarrhoea 1-6 hours after ingestion of contaminated food. B. cereus is classically associated with fried rice being reheated. Salmonella is typical with raw eggs and undercooked poultry. Campylobacter which is most commonly associated with food poisoning, is seen with poultry 50% of the time. Yersinia enterocolitica is seen with raw or undercooked pork, and may be a case presenting with mesenteric adenitis.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 8 - A 65-year-old man known to have renal cell carcinoma, is currently undergoing treatment....

    Incorrect

    • A 65-year-old man known to have renal cell carcinoma, is currently undergoing treatment. He presents to the acute medical ward with one month history of worsening central lower back pain, which becomes worse at night and cannot be managed with an analgesia at home. He has no other new symptoms.

      Out of the following, which investigation should be performed next?

      Your Answer:

      Correct Answer: MRI whole spine

      Explanation:

      An MRI whole spine should be performed in a patient suspected of spinal metastasis which can occur before developing metastatic spinal cord compression. This patient has renal cell carcinoma, which readily metastasises to the bones and also has progressive back pain. He, therefore, needs urgent imaging of his spine before any neurological compromise develops. MRI whole spine is preferable because patients with spinal metastasis often have metastases at multiple levels within the spine. Plain radiographs and CT scans should not be performed as they have a lower sensitivity for revealing lesions and cannot exclude cord compression.

      In general, imaging should be performed within one week if symptoms suspicious of spinal metastasis without neurological symptoms are present. If there are symptoms suggestive of malignant spinal cord compression, then imaging should be done within 24 hours.

      The signs and symptoms of spinal metastases include:
      1. Unrelenting lumbar back pain
      2. Thoracic or cervical back pain
      3. Pain associated with tenderness and worsens with sneezing, coughing, or straining
      4. Nocturnal pain

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 9 - 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 10 - A 41 year old man who has had two episodes of pneumonia in...

    Incorrect

    • A 41 year old man who has had two episodes of pneumonia in succession and an episode of haemoptysis is observed to have paroxysms of coughing and increasing wheezing. A single lesion which is well-defined is seen in the lower right lower lobe on a chest x-ray. There is no necrosis but biopsy shows numerous abnormal cells, occasional nuclear pleomorphism and absent mitoses.
      Which diagnosis fits the clinical presentation?

      Your Answer:

      Correct Answer: Bronchial carcinoid

      Explanation:

      Bronchial carcinoids are uncommon, slow growing, low-grade, malignant neoplasms, comprising 1-2% of all primary lung cancers.
      It is believed to be derived from surface of bronchial glandular epithelium. Mostly located centrally, they produce symptoms and signs of bronchial obstruction such as localized wheeze, non resolving recurrent pneumonitis, cough, chest pain, and fever. Haemoptysis is present in approximately 50% of the cases due to their central origin and hypervascularity.
      Central bronchial carcinoids are more common than the peripheral type and are seen as endobronchial nodules or hilar/perihilar mass closely related to the adjacent bronchus. Chest X-ray may not show the central lesion depending on how small it is.

    • This question is part of the following fields:

      • Respiratory
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  • Question 11 - A 22 year old man who has recently returned from a trip to...

    Incorrect

    • A 22 year old man who has recently returned from a trip to Far East presents with sore eyes and symmetrical joint pain in his knees, ankles and feet. Labs reveal an elevated ESR. The synovial fluid aspirate is sterile and has a high neutrophil count. What is the most likely diagnosis?

      Your Answer:

      Correct Answer: Reactive arthropathy

      Explanation:

      Reactive arthritis, (formerly known as Reiter’s syndrome), is an autoimmune condition that occurs after a bacterial infection of the gastrointestinal or urinary tract. It is categorized as a seronegative spondylarthritis because of its association with HLA-B27. Reactive arthritis primarily affects young men and usually presents with musculoskeletal or extra‑articular symptoms. The characteristic triad consists of arthritis, conjunctivitis, and urethritis. Symmetric lower limb arthropathy and a sterile joint aspirate points towards reactive arthropathy.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 12 - A 42-year-old man is a known case of Waldenström's macroglobulinemia and is admitted...

    Incorrect

    • A 42-year-old man is a known case of Waldenström's macroglobulinemia and is admitted to the hospital with headache, visual disturbances, pale conjunctivae, and breathlessness. While in the assessment unit, he has had an episode of nosebleed that has been difficult to control. On examination, his heart rate is 120bpm, blood pressure is 115/65 mmHg, and he is febrile with a temperature of 37°C. Fundoscopy shows dilated retinal veins with a retinal haemorrhage in the right eye.

      What is the most appropriate next step of management?

      Your Answer:

      Correct Answer: Plasmapheresis

      Explanation:

      The patient is displaying signs and symptoms of hyperviscosity syndrome, secondary to the Waldenström’s macroglobulinemia. Treatment of choice is plasmapheresis.

      Waldenström’s macroglobulinemia (also called lymphoplasmacytic lymphoma) is an uncommon type of non-Hodgkin lymphoma seen in older people. It is a lymphoplasmacytoid malignancy characterised by the secretion of a monoclonal IgM paraprotein. Its features include monoclonal IgM paraproteinemia; hyperviscosity syndrome leading to bilateral central retinal vein occlusion (CRVO) and hence, visual disturbances; weight loss and lethargy; hepatosplenomegaly and lymphadenopathy; and cryoglobulinemia. It is not, however, associated with bone pain.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 13 - According to the Vaughan William's classification of antiarrhythmic agents, lidocaine is a: ...

    Incorrect

    • According to the Vaughan William's classification of antiarrhythmic agents, lidocaine is a:

      Your Answer:

      Correct Answer: Class Ib agent

      Explanation:

      Lidocaine is an example of class IB antiarrhythmics.

      The Vaughan-Williams classification of antiarrhythmics
      I: Membrane stabilizing agents
      IA: Quinidine, Procainamide, Disopyramide
      IB: Lidocaine, Mexiletine
      IC: Propafenone, Flecainide
      II: β blockers – Propranolol, Esmolol
      III: Agents widening AP – Amiodarone, Dronedarone, Dofetilide, Ibutilide, Sotalol
      IV: Calcium channel blockers – Verapamil, Diltiazem
      V: Miscellaneous – Digoxin, adenosine, magnesium

    • This question is part of the following fields:

      • Pharmacology
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  • Question 14 - A 11-year-old boy is referred to you following his seventh course of antibiotics...

    Incorrect

    • A 11-year-old boy is referred to you following his seventh course of antibiotics in the last six years for lower respiratory tract infections. He also has a history of eczema for which he is currently on a topical steroid cream.

      His full blood count (FBC) report shows:
      Hb: 13.9 g/dL,
      Plts: 65 x 10^9/L,
      WCC: 12.3 x 10^9/L.

      Which of the following genes should you expect an abnormality in?

      Your Answer:

      Correct Answer: WASP

      Explanation:

      The combination of frequent infections, eczema, and thrombocytopaenia are characteristic of Wiskott-Aldrich syndrome, which is due to an abnormality in the WASP gene. It is an X-linked recessive disorder that causes primary immunodeficiency owing to a combined B- and T-cell dysfunction.

      The other listed options are:
      1. PKD1: polycystic kidney disease
      2. CFTR: cystic fibrosis
      3. HFE1: haemochromatosis
      4. RET: multiple endocrine neoplasia, Hirschsprung’s disease

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 15 - Choose the correct formula to calculate the negative predictive value of a screening...

    Incorrect

    • Choose the correct formula to calculate the negative predictive value of a screening test:

      Your Answer:

      Correct Answer: TN / (TN + FN)

      Explanation:

      NPV = TN / FN+TN

      = TN (true negative) / FN+TN (false negative + true negative)

      = Probability (patient not having disease when test is negative)

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 16 - 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 17 - A 20-year-old man presents with a history of sticky greenish discharge, accompanied by...

    Incorrect

    • A 20-year-old man presents with a history of sticky greenish discharge, accompanied by redness of the eyes, and difficulty opening his eyes in the morning. What is the single most likely cause of these symptoms?

      Your Answer:

      Correct Answer: Conjunctivitis

      Explanation:

      Redness of the eyes can present in all of the conditions. However, the green sticky discharge that causes the eyelids to stick together overnight is characteristic of bacterial conjunctivitis. Bacterial conjunctivitis is an inflammatory condition of the conjunctiva in which bacteria commonly Staphylococcus Aureus invade the conjunctiva. The person experiences a foreign body feeling in the eye and mucopurulent or purulent discharge.

    • This question is part of the following fields:

      • Ophthalmology
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  • Question 18 - A 72-year-old woman is admitted with general deterioration and ‘off-legs’. On examination in...

    Incorrect

    • A 72-year-old woman is admitted with general deterioration and ‘off-legs’. On examination in the emergency department, she looks dry and uremic.
       
      Investigations reveal:

      K+ 7.2 mmol/L,
      Na+ 145 mmol/L,
      Creatinine 512 μmol/L,
      Urea 36.8 mmol/L,

       
       
      Which TWO of the following measures are most appropriate in her immediate management?

      Your Answer:

      Correct Answer:

      Explanation:

      First and foremost, the patient should be put on ECG monitoring to identify the cardiac state, and because of the markedly raised serum potassium, a calcium gluconate bolus will have the immediate effect of moderating the nerve and muscle performance.

    • This question is part of the following fields:

      • Nephrology
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  • Question 19 - A 40-year-old man has had multiple blood transfusions for sideroblastic anaemia. However, this...

    Incorrect

    • A 40-year-old man has had multiple blood transfusions for sideroblastic anaemia. However, this time, 15 minutes into the blood transfusion, he complains of severe breathlessness. CXR shows diffuse bilateral pulmonary infiltrates.

      What is the most likely diagnosis?

      Your Answer:

      Correct Answer:

      Explanation:

      Transfusion-related acute lung injury (TRALI) is a serious complication of blood transfusion characterised by the acute onset of non-cardiogenic pulmonary oedema following transfusion of blood products.

      TRALI is a more severe manifestation of the febrile non-haemolytic group of transfusion reactions and usually occur in patients who have had multiple previous transfusions. TRALI is related to leucocyte antibodies which are present in the plasma of the blood donor. Multiparous women are the highest-risk donors for TRALI.

      For management, leucocyte-depleted blood is now used for transfusion and this is associated with a reduced risk of this type of transfusion reaction.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 20 - A 28-year-old man who is admitted with bright red haematemesis, which occurred after...

    Incorrect

    • A 28-year-old man who is admitted with bright red haematemesis, which occurred after a bout of vomiting. He had been out with friends on a stag party and consumed 12 pints of beer.

      Upper gastrointestinal (GI) endoscopy proves unremarkable and haemoglobin (Hb) is stable at 12.5 g/dl the morning after admission, there is no sign of circulatory compromise. There have been no previous similar episodes.

      Which of the following stems represents the best course of action for this patient?

      Your Answer:

      Correct Answer: Send home

      Explanation:

      This is a classic clinical presentation, with alcohol intake and nausea/vomiting that leads to hematemesis, of a Mallory-Weiss tear. In Mallory-Weiss tear, they typically present as a hemodynamically stable patient after a night of binge drinking and excessive resultant vomiting. Given his EGD did not show any other pathology and he is now stable, he can be discharged home.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 21 - A 39 year old man was admitted with an exacerbation of asthma. He...

    Incorrect

    • A 39 year old man was admitted with an exacerbation of asthma. He responded to treatment but the medical intern was concerned that Aspergillus fumigatus was cultured from his sputum.
       
      Subsequently arranged serum total, IgE level was elevated at 437 ng/ml (normal 40-180 ng/ml), RAST to Aspergillus fumigatus was class III, Aspergillus fumigatus precipitins were negative.
       
      What would be the most appropriate management step in this patient?

      Your Answer:

      Correct Answer: No change in medication

      Explanation:

      Allergic bronchopulmonary aspergillosis (ABPA) is a form of lung disease that occurs in some people who are allergic to Aspergillus. With ABPA, this allergic reaction causes the immune system to overreact to Aspergillus leading to lung inflammation. ABPA causes bronchospasm (tightening of airway muscles) and mucus build-up resulting in coughing, breathing difficulty and airway obstruction.

      Blood tests are used to look for signs of an allergic reaction. This includes evaluating your immunoglobulin E (IgE) level. This level is increased with any type of allergy. Many people with asthma have higher than normal IgE levels. In ABPA however, the IgE level is extremely high (more than 1000 ng/ml or 417 IU/ml). In addition to total IgE, all patients with ABPA have high levels of IgE that is specific to Aspergillus. A blood test can be done to measure specific IgE to Aspergillus. A blood or skin test for IgE antibodies to Aspergillus can be done to see if a person is sensitized (allergic) to this fungus. If these skin tests are negative (i.e. does not show a skin reaction) to Aspergillus fumigatus, the person usually does not have ABPA.
      Therefore, there should be no change in medication since this patient does not have ABPA.

    • This question is part of the following fields:

      • Respiratory
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  • Question 22 - Choose the cell organelle involved in the synthesis of lipids: ...

    Incorrect

    • Choose the cell organelle involved in the synthesis of lipids:

      Your Answer:

      Correct Answer: Smooth endoplasmic reticulum

      Explanation:

      The Smooth endoplasmic reticulum (ER) is the major site at which membrane lipids are synthesized in eukaryotic cells. Because they are extremely hydrophobic, lipids are synthesized in association with already existing cellular membranes rather than in the aqueous environment of the cytosol. Although some lipids are synthesized in association with other membranes, most are synthesized in the ER. They are then transported from the ER to their ultimate destinations either in vesicles or by carrier proteins.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 23 - A 26-year-old woman presents for her first cervical smear. What is the most...

    Incorrect

    • A 26-year-old woman presents for her first cervical smear. What is the most important aetiological factor causing cervical cancer?

      Your Answer:

      Correct Answer: Human papilloma virus 16 & 18

      Explanation:

      It has been determined that HPV infection is the most powerful epidemic factor. This virus is needed, but not sufficient for the development of cervical cancer.
      The WHO’s International Agency for Research on Cancer (IARC) classified HPV infection as carcinogenic to humans (HPV types 16 and 18), probably carcinogenic (HPV types 31 and 33) and possibly carcinogenic (other HPV types except 6 and 11).
      Tobacco smoking, the use of contraceptives, and the number of births are factors that showed no statistically significant deviations in the studied population compared to other countries in the region, as well as European countries. They have an equal statistical significance in all age groups.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 24 - A 53-year-old woman presents with a painless lump in the left breast associated...

    Incorrect

    • A 53-year-old woman presents with a painless lump in the left breast associated with nipple discharge. The skin over the lump has an orange peel skin appearance. According to the patient, the lump has increased in size, with time.

      Diagnosis of breast cancer is strongly suspected. Which of the following would be most useful in monitoring the prognosis of breast cancer, in this case?

      Your Answer:

      Correct Answer: Lymph node metastases

      Explanation:

      The prognosis of breast cancer depends chiefly on the extent of nodal metastases.

      The breast cancer TNM staging system is the most common way that doctors use to stage breast cancer. TNM stands for Tumour, Node, Metastasis. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero), which is non-invasive ductal carcinoma in situ (DCIS), and stages I through IV (1 through 4), which are used for invasive breast cancer.

      Staging can be clinical or pathological. Clinical staging is based on the results of tests done before surgery, which may include physical examinations, mammogram, ultrasound, and MRI scans. Pathologic staging is based on what is found during surgery to remove breast tissue and lymph nodes. In general, pathological staging provides the most information to determine a patient’s prognosis.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 25 - You want to measure the potential benefit of creating a service dedicated to...

    Incorrect

    • You want to measure the potential benefit of creating a service dedicated to patients with multiple sclerosis in the local area. Which factor would determine how many resources will be required?

      Your Answer:

      Correct Answer: Prevalence

      Explanation:

      To describe how often a disease or another health event occurs in a population, different measures of disease frequency can be used. The prevalence reflects the number of existing cases of a disease. In contrast to the prevalence, the incidence reflects the number of new cases of disease and can be reported as a risk or as an incidence rate. Prevalence and incidence are used for different purposes and to answer different research questions.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 26 - A 40 yr. old female presented with palmar xanthomas and tuberoeruptive xanthomas on...

    Incorrect

    • A 40 yr. old female presented with palmar xanthomas and tuberoeruptive xanthomas on her elbows and knees. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Type III hyperlipoproteinaemia

      Explanation:

      Palmar xanthomas and tuberoeruptive xanthomas are found in type III hyperlipoproteinemia (dysbetalipoproteinemia,broad-beta disease, remnant removal disease)

    • This question is part of the following fields:

      • Cardiology
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  • Question 27 - A 25 yr. old female presented with a history of sudden collapse. She...

    Incorrect

    • A 25 yr. old female presented with a history of sudden collapse. She had been playing netball and had suddenly collapsed. This collapse had been accompanied by a brief period of loss of consciousness. She experienced palpitations for a brief period prior to losing consciousness. On examination her BP was 120/70 mmHg and pulse rate was 72 bpm, which was regular. The rest of the examination was also normal.
      She had similar experience of collapse, about two years ago. She was well except for these two incidents and she has not been on any medication. All the investigations done at the first presentation (2 years ago), including FBC, ECG and echocardiography were normal. Her ECG done at this presentation revealed QT prolongation of 0.50 s. FBC, CXR and other investigations were normal. Which of the following is the best way of managing this patient?

      Your Answer:

      Correct Answer: Start on a beta-blocker

      Explanation:

      Beta-blockers are drugs of choice for patients with LQTS. The protective effect of beta-blockers is related to their adrenergic blockade, which diminishes the risk of cardiac arrhythmias. They may also reduce the QT interval in some patients.

    • This question is part of the following fields:

      • Cardiology
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  • Question 28 - A 20-year-old female has been admitted with an acute infection. She gives a...

    Incorrect

    • A 20-year-old female has been admitted with an acute infection. She gives a history suggestive of hypersensitivity to amoxicillin. After consultation with the allergy specialist, she has now been diagnosed with an IgE mediated penicillin allergy. Which of the following drugs should be avoided in this patient?

      Your Answer:

      Correct Answer: Cefalexin

      Explanation:

      Cefalexin should be avoided in this patient.
      This patient is known to have a severe penicillin allergy. None of the above antibiotics are penicillin based. However, 0.5 – 6.5% of patients who are proven to have an IgE mediated penicillin allergy will also be allergic to cephalosporins, including cefalexin.

      Penicillin, cephalosporins, and carbapenems are all members of the beta-lactam group of antibiotics and share a common beta-lactam ring. There is, therefore, a small risk of allergy cross-over between all these antibiotics. The rates of allergy cross-over are lower with second and third-generation cephalosporins than first-generation cephalosporins such as cefalexin.

      It is important to question the patient carefully to ascertain what symptoms they had on exposure to penicillin. Symptoms such as an urticarial rash or itching make it more likely that they have an IgE mediated allergy.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 29 - A 47-year-old hypertensive man presents with difficulty using his right arm, slow walking...

    Incorrect

    • A 47-year-old hypertensive man presents with difficulty using his right arm, slow walking and occasional loss of balance. He has a broad-based gait with cogwheel rigidity and intention tremor of his right arm. His blood pressure is 140/80 mmHg sitting and 100/60 mmHg standing. Which of the following is the most likely diagnosis?

      Your Answer:

      Correct Answer: Multiple system atrophy

      Explanation:

      This patient presents with a combination of akinetic rigid syndrome, cerebellar signs and the suggestion of autonomic features. This is most indicative of a diagnosis of multiple system atrophy.

      Multiple system atrophy (MSA) is a rare neurodegenerative disorder characterized by autonomic dysfunction, tremors, slow movement, muscle rigidity, and postural instability (collectively known as parkinsonism) and ataxia.

    • This question is part of the following fields:

      • Neurology
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  • Question 30 - An 82 year old man arrives at the clinic with painful right upper...

    Incorrect

    • An 82 year old man arrives at the clinic with painful right upper arm that he has been experiencing for the last few months. The pain is gradually worsening and often wakes him up at night. He is a known case of Paget's disease involving his lumbar spine and pelvis and is currently taking oral bisphosphonates. On examination, shoulder movements are intact. Which of the following is the most likely cause of his arm pain?

      Your Answer:

      Correct Answer: Osteosarcoma

      Explanation:

      Paget’s accelerates the remodelling process with old bone breaking down more quickly which disrupts the normal growth process. New bone development eventually adjusts to the faster pace and speeds up on its own. The pace is too fast for healthy bone growth, and the regrowth ends up softer and weaker than normal. The effect of this accelerated process causes bone pain, fractures, and deformities. Since osteosarcoma is a type of bone cancer linked to abnormal bone growth, this makes it a rare but possible complication of Paget’s disease although the chances of developing osteosarcoma are minimal. Fractures are painful and restrict movement whereas this patients pain is gradually developing. Pain associated with osteoarthritis is usually mild to moderate and worsens as the day progresses.

    • This question is part of the following fields:

      • Rheumatology
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