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  • Question 1 - Which of the following regarding malignant mesothelioma is correct? ...

    Incorrect

    • Which of the following regarding malignant mesothelioma is correct?

      Your Answer: has a median survival of 3 years

      Correct Answer: is treated with radiotherapy

      Explanation:

      Malignant mesothelioma is a type of cancer that occurs in the thin layer of tissue that covers the majority of the internal organs (mesothelium).
      Malignant Mesothelioma (MM) is a rare but rapidly fatal and aggressive tumour of the pleura and peritoneum. Aetiology of all forms of mesothelioma is strongly associated with industrial pollutants, of which asbestos is the principal carcinogen.

      Thoracoscopically guided biopsy should be performed if mesothelioma is suggested; the results are diagnostic in 98% of cases. No specific treatment has been found to be of benefit, except radiotherapy, which reduces seeding and invasion through percutaneous biopsy sites.

      Median survival for patients with malignant mesothelioma is 11 months. It is almost always fatal.

    • This question is part of the following fields:

      • Respiratory
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  • Question 2 - A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a...

    Incorrect

    • A 19-year-old woman is diagnosed with acute purulent meningitis after returning from a recent holiday abroad. Which of the following investigations is the least relevant?

      Your Answer:

      Correct Answer: PCR of CSF for Mycobacterium TB

      Explanation:

      Amoebic, bacterial and fungal meningitis may present acutely but is not common in tuberculous meningitis. Amoebic meningitis is caused by Naegleria fowleri as a result of swimming in infected freshwater. The organism may be found in fresh CSF specimens with phase contrast microscopy.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 3 - A 85 yr. old previously well man was found to have a BP...

    Incorrect

    • A 85 yr. old previously well man was found to have a BP of 155/90 mmHg. His average reading from the monitoring of his ambulatory BP was 147/92 mmHg. His calculated 10 year cardiovascular risk was 15%. Which of the following is the most appropriate management of this patient?

      Your Answer:

      Correct Answer: Give lifestyle advice and repeat blood pressure in 6 months

      Explanation:

      According to different guidelines for patients above 80 years, the targeted systolic blood pressure varies from 140-150 mmHg. As this patient’s BP is within that range, he can be kept under observation.

    • This question is part of the following fields:

      • Cardiology
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  • Question 4 - A prescription for Olanzapine is written for a 28 year old lady with...

    Incorrect

    • A prescription for Olanzapine is written for a 28 year old lady with a history of schizophrenia. Which adverse effect is she most likely to experience?

      Your Answer:

      Correct Answer: Weight gain

      Explanation:

      Weight gain is an extremely common (5-40%) adverse effect of atypical antipsychotics such as olanzapine (dose dependent). Olanzapine causes orthostatic hypotension ≥20% of reported cases. Parkinsonism reactions occurs in 4% of people.

    • This question is part of the following fields:

      • Psychiatry
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  • Question 5 - A 26 yr. old male was being investigated further following several hypertensive episodes....

    Incorrect

    • A 26 yr. old male was being investigated further following several hypertensive episodes. There was a marked difference in his systolic blood pressures between the right brachial and the right femoral arteries. Which of the following is most probable diagnosis?

      Your Answer:

      Correct Answer: Coarctation of the aorta

      Explanation:

      From the given physical findings (the difference in BP between the radial and femoral arteries), the most probable diagnosis is coarctation of the aorta.

    • This question is part of the following fields:

      • Cardiology
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  • Question 6 - A 25-year-old woman with type-1 diabetes mellitus attends for her routine review and...

    Incorrect

    • A 25-year-old woman with type-1 diabetes mellitus attends for her routine review and says she is keen on becoming pregnant.
      Which of the following is most likely to make you ask her to defer pregnancy at this stage?

      Your Answer:

      Correct Answer: Hb A1C 9.4%

      Explanation:

      Pregnancies affected by T1DM are at increased risk for preterm delivery, preeclampsia, macrosomia, shoulder dystocia, intrauterine fetal demise, fetal growth restriction, cardiac and renal malformations, in addition to rare neural conditions such as sacral agenesis.
      Successful management of pregnancy in a T1DM patient begins before conception. Research indicates that the implementation of preconception counselling, emphasizing strict glycaemic control before and throughout pregnancy, reduces the rate of perinatal mortality and malformations.
      The 2008 bulletin from the National Institute for Health and Clinical Excellence recommends that preconception counselling be offered to all patients with diabetes. Physicians are advised to guide patients on achieving personalized glycaemic control goals, increasing the frequency of glucose monitoring, reducing their HbA1C levels, and recommend avoiding pregnancy if the said level is > 10%.
      Other sources suggest deferring pregnancy until HbA1C levels are > 8%, as this margin is associated with better outcomes.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 7 - A 74-year-old widow is undergoing haemodialysis for chronic renal failure. What is the...

    Incorrect

    • A 74-year-old widow is undergoing haemodialysis for chronic renal failure. What is the most common problem that can arise in this case?

      Your Answer:

      Correct Answer: Protein–calorie malnutrition

      Explanation:

      Protein-calorie malnutrition is observed in almost 50% of dialysis patients, contributing to increased morbidity and mortality. All the other complications listed can usually be prevented thanks to modern-day dialysis techniques.

    • This question is part of the following fields:

      • Nephrology
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  • Question 8 - A 19-year-old male presented with a fever and fatigue. On examination, he had...

    Incorrect

    • A 19-year-old male presented with a fever and fatigue. On examination, he had multiple lesions on his back and abdomen in various forms. Which of the following is the most probable diagnosis?

      Your Answer:

      Correct Answer: Varicella zoster

      Explanation:

      Patients with varicella zoster infection present with general fatigue and fever along with multiple lesions which do not appear to be identical.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 9 - A 42-year-old patient has been admitted with a very swollen and painful right...

    Incorrect

    • A 42-year-old patient has been admitted with a very swollen and painful right knee. He was unable to walk on it so came into hospital. It is currently being treated as gout with non steroidal anti-inflammatory drugs. You notice he is of short stature, has shortened arms and legs and a flat nasal bridge. A mutation in which gene is responsible for this condition?

      Your Answer:

      Correct Answer: Fibroblast growth factor receptor

      Explanation:

      Achondroplasia is a common cause of dwarfism. It is caused by a mutation in fibroblast growth factor receptor 3 (FGFR3). In normal development FGFR3 has a negative regulatory effect on bone growth. In achondroplasia, the mutated form of the receptor is constitutively active and this leads to severely shortened bones. The effect is genetically dominant, with one mutant copy of the FGFR3 gene being sufficient to cause achondroplasia, while two copies of the mutant gene are invariably fatal. A person with achondroplasia thus has a 50% chance of passing dwarfism to each of their offspring. People with achondroplasia can be born to parents that do not have the condition due to spontaneous mutation. It occurs as a sporadic mutation in approximately 80% of cases (associated with advanced paternal age) or it may be inherited as an autosomal dominant genetic disorder.
      People with achondroplasia have short stature, with an average adult height of 131 centimeters (52 inches) for males and 123 centimeters (48 inches) for females.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 10 - A 60-year-old gentleman is found dead in his apartment. He was known to...

    Incorrect

    • A 60-year-old gentleman is found dead in his apartment. He was known to be suffering from primary systemic amyloidosis. What is the most probable cause for his death?

      Your Answer:

      Correct Answer: Cardiac involvement

      Explanation:

      Primary amyloidosis is characterised by abnormal protein build-up in the tissues and organ such as the heart, liver, spleen, kidneys, skin, ligaments, and nerves. However, the most common cause of death in patients with primary amyloidosis is heart failure.

    • This question is part of the following fields:

      • Nephrology
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  • Question 11 - A 60-year-old woman presents to the oncology clinic with a general feeling of...

    Incorrect

    • A 60-year-old woman presents to the oncology clinic with a general feeling of being unwell and temperature of 38.1°C. She is a known case of neuroendocrine cancer of the cervix, treated with carboplatin and etoposide. Her last treatment was eight days ago.
      Blood cultures are taken and she is started on neutropenic sepsis protocol.

      What will gram-staining of the blood cultures most likely show?

      Your Answer:

      Correct Answer: Gram-positive cocci

      Explanation:

      Gram-staining of the blood cultures of this patient will show gram-positive cocci. Gram-negative bacilli used to be the most common pathogen isolated in neutropenic sepsis, but currently, the most common pathogens are gram-positive organisms. Staphylococcus epidermidis is the most frequent causative agent, and following this are other staphylococci and streptococci species.

      Neutropenic sepsis is a relatively common complication of cancer therapy—usually chemotherapy. It most commonly occurs 7-14 days after the treatment and is usually defined as a neutrophil count of <0.5 x 10^9/L in a patient undergoing anticancer treatment and who has either a temperature higher than 38°C or has other features consistent with clinically significant sepsis. Management approach includes starting empirical antibiotic therapy (piperacillin with tazobactam—Tazocin) immediately. Following this initial treatment, the patient is usually assessed by a specialist and risk-stratified to see if outpatient treatment may be possible. However, if the patient remains febrile and unwell after 48 hours, an alternative antibiotic such as meropenem is often prescribed with or without vancomycin. If patient is still not responding after 4-6 days, then an antifungal, such as amphotericin B, is started after carrying out investigations (e.g. HRCT and Aspergillus PCR) to determine the likelihood of systemic fungal infection.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 12 - A 65 year old retired postman has been complaining of a two-month history...

    Incorrect

    • A 65 year old retired postman has been complaining of a two-month history of lethargy associated with dyspnoea. He has never smoked and takes no medication. The chest X-ray shows multiple round lesions increasing in size and numbers at the base. There is no hilar lymphadenopathy.
       
      What condition does he most likely have?

      Your Answer:

      Correct Answer: Pulmonary metastases

      Explanation:

      Pulmonary metastasis is seen in 20-54% of extrathoracic malignancies. The lungs are the second most frequent site of metastases from extrathoracic malignancies. Twenty percent of metastatic disease is isolated to the lungs. The development of pulmonary metastases in patients with known malignancies indicates disseminated disease and places the patient in stage IV in TNM (tumour, node, metastasis) staging systems.
      Chest radiography (CXR) is the initial imaging modality used in the detection of suspected pulmonary metastasis in patients with known malignancies. Chest CT scanning without contrast is more sensitive than CXR.
      Breast, colorectal, lung, kidney, head and neck, and uterus cancers are the most common primary tumours with lung metastasis at autopsy. Choriocarcinoma, osteosarcoma, testicular tumours, malignant melanoma, Ewing sarcoma, and thyroid cancer frequently metastasize to lung, but the frequency of these tumours is low.

    • This question is part of the following fields:

      • Respiratory
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  • Question 13 - An 86-year-old male patient has been diagnosed with monoclonal gammopathy of undetermined significance....

    Incorrect

    • An 86-year-old male patient has been diagnosed with monoclonal gammopathy of undetermined significance. He is eager to know its relation to his future health.

      Which of the following statements is correct?

      Your Answer:

      Correct Answer: 10% of patients with MGUS go on to develop myeloma over 10 years

      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. Around 10% of patients eventually develop myeloma over 10 years, with 50% at 15 years. MGUS causes paraproteinemia and is usually asymptomatic. 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, 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 14 - 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 15 - A 31 year old female with systemic lupus erythematosus wants to know if...

    Incorrect

    • A 31 year old female with systemic lupus erythematosus wants to know if she has any predisposing factors for the disease. Which of the following carries the greatest risk of developing SLE?

      Your Answer:

      Correct Answer: Monozygotic twin

      Explanation:

      An overall concordance rate in monozygotic twins was documented to be 25% as compared to dizygotic twins with 3%. First degree relatives have a chance of around 3% of developing the disease. Caucasians show an increase frequency of HLA-B8. The Japanese lupus patients had a stronger association with HLA-DR2.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 16 - A 50-year-old farmer, under treatment for depression, presents to the emergency department following...

    Incorrect

    • A 50-year-old farmer, under treatment for depression, presents to the emergency department following an intentional overdose of an unidentified substance. On examination, he was found to be bradycardic, hypotensive, hyper-salivating, and disoriented. On ocular examination, his pupils were found to be miotic. What is the most likely substance he ingested?

      Your Answer:

      Correct Answer: An organophosphate insecticide

      Explanation:

      The farmer has most likely ingested an organophosphate insecticide.
      Organophosphorus compounds are used widely as:
      • Insecticides – Malathion, parathion, diazinon, dichlorvos
      • Nerve gases – Soman, sarin, tabun, VX
      • Ophthalmic agents – Echothiophate
      • Antihelmintics – Trichlorfon
      • Herbicides – merphos
      • Industrial chemical (plasticizer) – Tricresyl phosphate
      Signs and symptoms of Organophosphorus Poisoning (OPP) can be classified as:
      • Muscarinic effects:
      o Cardiovascular – Bradycardia, hypotension
      o Respiratory – Rhinorrhoea, bronchorrhea, bronchospasm, cough, severe respiratory distress
      o Gastrointestinal – Hypersalivation, nausea and vomiting, abdominal pain, diarrhoea, faecal incontinence
      o Genitourinary – Incontinence
      o Ocular – Blurred vision, miosis
      o Glands – Increased lacrimation, diaphoresis
      • Nicotinic effects:
      o Muscle fasciculation, weakness, cramping, diaphragmatic failure, and autonomic side effects include: hypertension, tachycardia, and mydriasis.
      • Central nervous system (CNS) effects:
      o Anxiety, emotional lability, restlessness, confusion, ataxia, tremors, seizures, coma, apnoea
      Mainstay Treatment:
      • Decontamination
      • Securing Airway, Breathing and Circulation
      • Atropine
      • Pralidoxime
      • Benzodiazepines

    • This question is part of the following fields:

      • Pharmacology
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  • Question 17 - A 30-year-old male is brought to the emergency department following his collapse in...

    Incorrect

    • A 30-year-old male is brought to the emergency department following his collapse in a night club. His friends who accompanied him admit that, of recent, he has been using increasing amounts of cocaine. Which among the following is commonly associated with cocaine overdose?

      Your Answer:

      Correct Answer: Metabolic acidosis

      Explanation:

      Metabolic acidosis is associated with cocaine overdose.
      In overdose, cocaine leads to agitation, tachycardia, hypertension, sweating, hallucinations, and finally convulsions.
      Metabolic acidosis, hyperthermia, rhabdomyolysis, and ventricular arrhythmias also occur.
      Chronic use may be associated with premature coronary artery disease, dilated cardiomyopathy, and increased risk of cerebral haemorrhage.
      There are 3 stages for acute cocaine toxicity:
      Stage I: CNS symptoms of headache, vertigo, pseudo hallucinations, hyperthermia, hypertension.
      Stage II: increased deep tendon reflexes, tachypnoea, irregular breathing, hypertension.
      Stage III: Areflexia, coma, fixed and dilated pupils, hypotension, ventricular fibrillation, apnoea, and respiratory failure.

      Treatment:
      – Airway, breathing, and circulation to be secured. The patient’s fever should be managed, and one should rule out hypoglycaemia as a cause of the neuropsychiatric symptoms.
      – Cardiovascular toxicity and agitation are best-treated first-line with benzodiazepines to decrease CNS sympathetic outflow.
      – The mixed beta/alpha blocker labetalol is safe and effective for treating concomitant cocaine-induced hypertension and tachycardia.
      – Non-dihydropyridine calcium channels blockers such as diltiazem and verapamil have been shown to reduce hypertension reliably, but not tachycardia.
      – Dihydropyridine agents such as nifedipine should be avoided, as reflex tachycardia may occur.
      – The alpha-blocker phentolamine has been recommended but only treats alpha-mediated hypertension and not tachycardia.

    • This question is part of the following fields:

      • Pharmacology
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  • Question 18 - What does Caplan's syndrome refer to? ...

    Incorrect

    • What does Caplan's syndrome refer to?

      Your Answer:

      Correct Answer: Rheumatoid lung nodules and pneumoconiosis

      Explanation:

      Caplan’s syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is rare and usually diagnosed in an advanced stage of RA. It generally affects patients with a prolonged exposure to silica.

      Caplan’s syndrome presents with rheumatoid lung nodules and pneumoconiosis. Originally described in coal miners with progressive massive fibrosis, it may also occur in asbestosis, silicosis and other pneumoconiosis. Chest radiology shows multiple, round, well defined nodules, usually 0.5 – 2.0 cm in diameter, which may cavitate and resemble tuberculosis.

    • This question is part of the following fields:

      • Respiratory
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  • Question 19 - A 20-year-old man presents with an acute exacerbation of asthma associated with a...

    Incorrect

    • A 20-year-old man presents with an acute exacerbation of asthma associated with a chest infection. He is unable to complete a sentence and his peak flow rate was 34% of his normal level. He is treated with high-flow oxygen, nebulised bronchodilators, and oral corticosteroids for three days, but his condition has not improved.
       
      Which of the following intravenous treatments would be the best option for this patient?

      Your Answer:

      Correct Answer: Magnesium

      Explanation:

      A single dose of intravenous magnesium sulphate is safe and may improve lung function and reduce intubation rates in patients with acute severe asthma. Intravenous magnesium sulphate may also reduce hospital admissions in adults with acute asthma who have had little or no response to standard treatment.

      Consider giving a single dose of intravenous magnesium sulphate to patients with acute severe asthma (PEF <50% best or predicted) who have not had a good initial response to inhaled bronchodilator therapy. Magnesium sulphate (1.2–2 g IV infusion over 20 minutes) should only be used following consultation with senior medical staff.

    • This question is part of the following fields:

      • Respiratory
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  • Question 20 - Choose the correct statement regarding standard polymerase chain reaction: ...

    Incorrect

    • Choose the correct statement regarding standard polymerase chain reaction:

      Your Answer:

      Correct Answer: A thermostable DNA polymerase is required

      Explanation:

      In the PCR, DNA amplification is performed by thermostable enzymes; invariably either family A DNA polymerases from thermophilic and hyperthermophilic Bacteria or family B DNA polymerases from hyperthermophilic Archaea. Family Y DNA polymerase from the hyperthermophilic archaeon Sulfolobus solfataricus, Sso-polY, is also an enzyme marketed for PCR, but with specialist applications. Each thermostable DNA polymerases has different characteristics and to achieve optimal results, the choice of a PCR enzyme depends on the application itself.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 21 - A 43-year-old police officer is admitted with a history of unsteadiness and slurring...

    Incorrect

    • A 43-year-old police officer is admitted with a history of unsteadiness and slurring of speech. This has worsened over a period of three months. He complains of a tremor affecting his right hand and diplopia on right lateral gaze. He smokes 30 cigarettes a day and takes regular diclofenac for his arthritis. On examination, he is dysarthric and feels nauseated. Fundoscopy is normal, however there is marked horizontal nystagmus and evidence of a right VI nerve palsy. There also appears to be some mild facial weakness on the right side. Upon conducting Weber’s test, a louder tone is heard in the left ear. On conducting the Rinne test, both ears are normal. On examination of the upper limb, there is a right intention tremor and dysdiadochokinesis. Tone, power and reflexes are normal. On examination of the lower limb, tone, power and reflexes are normal, however he appears to walk with a broad-based gait and is leaning to the right.

      Lumbar puncture:

      Opening pressure 13 cm H20 (5–18)
      Protein 0.67 g/l (0.15–0.45)
      WCC 3 cells/ml (<5)
      Red cell count (RCC) 2 cells/ml (<5)
      Glucose 3.2 mmol/l (3.3–4.4)
      Blood glucose 5.8 mmol/l (3.0–6.0)
      Oligoclonal bands Present
      Serum oligoclonal bands Present

      Magnetic resonance scan shows a calcified lesion broadly attached to the petrous part of the temporal bone. In view of the above history and findings, what is the likely cause of this patient’s symptoms?

      Your Answer:

      Correct Answer: Meningioma of the cerebellar pontine angle

      Explanation:

      This patient has a combination of right cerebellar dysfunction with right-sided cranial nerve palsies (VI, VII, and VIII). The magnetic resonance imaging (MRI) shows a calcified meningioma within the right cerebellar pontine area, which would account for these findings. The cerebrospinal fluid (CSF) analysis shows oligoclonal bands, however, these are matched in the serum, which reflects a systemic inflammatory response from his rheumatoid arthritis.

      The MRI scan and CSF analysis would not be consistent with progressive multiple sclerosis. The progressive nature of her symptoms would be against a diagnosis of brainstem infarct, and one would expect more pyramidal signs in the peripheral nervous system.

    • This question is part of the following fields:

      • Neurology
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  • Question 22 - Which of the following statements regarding psoriasis is incorrect? ...

    Incorrect

    • Which of the following statements regarding psoriasis is incorrect?

      Your Answer:

      Correct Answer: Mediated by type 2 helper T cells

      Explanation:

      Psoriasis is a long-lasting autoimmune disease characterized by patches of skin typically red, dry, itchy, and scaly. Psoriasis can affect the nails and produces a variety of changes in the appearance of finger and toe nails including pitting and onycholysis. Nail psoriasis occurs in 40–45% of people with psoriasis affecting the skin and has a lifetime incidence of 80–90% in those with psoriatic arthritis. Psoriasis is mediated by type 1 helper T cells which are involved in the cell mediated response.

    • This question is part of the following fields:

      • Dermatology
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  • Question 23 - Which of the following is true of Koplik’s spots? ...

    Incorrect

    • Which of the following is true of Koplik’s spots?

      Your Answer:

      Correct Answer: Are diagnostic of measles

      Explanation:

      Koplik’s spots are pathopneumonic for MEASLES. They are blue/white spots, small, occurring on the buccal mucosa. They typically occur next to premolars, not opposite to the incisors. They are not related to fever height. They are not on the hands. They usually occur BEFORE the rash.

    • This question is part of the following fields:

      • Infectious Diseases
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  • Question 24 - A 45-year-old woman who is being treated for Hodgkin's lymphoma with ABVD chemotherapy...

    Incorrect

    • A 45-year-old woman who is being treated for Hodgkin's lymphoma with ABVD chemotherapy is reviewed on the haematology ward.

      Six days ago, she was admitted with a fever of 38.9°C and was immediately started on piperacillin + tazobactam (Tazocin). Her blood picture on arrival was as follows:

      Haemoglobin: 10.1 g/dL,
      Platelets: 311 x 10^9/L,
      White cell count: 0.8 x 10^9/L,
      Neutrophils: 0.35 x 10^9/L,
      Lymphocytes: 0.35 x 10^9/L.

      After 48 hours, she remained febrile and tachycardic. Tazocin was stopped and meropenem in combination with vancomycin was prescribed.

      She still remains unwell today with a temperature of 38.4°C, heart rate of 96 bpm, and blood pressure of 102/66 mmHg. Respiratory examination is consistently unremarkable and blood and urine cultures have failed to show any cause for the fever.

      Which of the following is the most appropriate next step of management?

      Your Answer:

      Correct Answer: Add amphotericin B

      Explanation:

      This patient meets the diagnostic criteria for neutropenic sepsis, which is a relatively common complication of cancer therapy – usually chemotherapy occurring 7–14 days after. It is defined as a neutrophil count of <0.5 x 10^9/L in a patient undergoing anticancer treatment and who has either a temperature higher than 38°C or has other features consistent with clinically significant sepsis. Management approach is the same as mentioned in this case. However, if the patient still remains unwell, then an antifungal such as amphotericin B is started after risk-stratifying the patient and carrying out investigations (e.g. HRCT and Aspergillus PCR) to determine the likelihood of systemic fungal infection.

    • This question is part of the following fields:

      • Haematology & Oncology
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  • Question 25 - A 50-year-old gentleman with renal cell carcinoma has a haemoglobin of 19 g/dl....

    Incorrect

    • A 50-year-old gentleman with renal cell carcinoma has a haemoglobin of 19 g/dl. Which investigation will conclusively prove that this patient has secondary polycythaemia?

      Your Answer:

      Correct Answer: Erythropoietin level

      Explanation:

      Erythropoietin (EPO) is used to distinguish between primary and secondary polycythaemia. Secondary polycythaemia can be caused by tumours in the kidney that may secrete EPO or EPO-like proteins.

    • This question is part of the following fields:

      • Nephrology
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  • Question 26 - Which of the following stimulates the secretion of gastrin? ...

    Incorrect

    • Which of the following stimulates the secretion of gastrin?

      Your Answer:

      Correct Answer: Amino acids

      Explanation:

      Gastrin is released from G cells in the antrum of the stomach after a meal. It stimulates parietal cells to release HCl. Gastrin is stimulated by a number of things: antrum distention, vagal stimulation, peptides (especially amino acids) in the stomach, hypercalcemia. Gastrin release is inhibited by acid, SST, GIP, VIP, secretin, glucagon, and calcitonin.

    • This question is part of the following fields:

      • Gastroenterology
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  • Question 27 - Regarding the pathophysiology of diabetes mellitus, which of the following is true? ...

    Incorrect

    • Regarding the pathophysiology of diabetes mellitus, which of the following is true?

      Your Answer:

      Correct Answer: Concordance between identical twins is higher in type 2 diabetes mellitus than type 1

      Explanation:

      Type 1 diabetes is a chronic illness characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Approximately 95% of patients with type 1 DM have either HLA-DR3 or HLA-DR4. Although the genetic aspect of type 1 DM is complex, with multiple genes involved, there is a high sibling relative risk. Whereas dizygotic twins have a 5-6% concordance rate for type 1 DM, monozygotic twins will share this diagnosis more than 50% of the time by the age of 40 years.

    • This question is part of the following fields:

      • Endocrinology
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  • Question 28 - A clinical trial is conducted to study the benefits of a new oral...

    Incorrect

    • A clinical trial is conducted to study the benefits of a new oral medication to improve the symptoms of patients with asthma. In the trial 400 patients with asthma, half were given the new medication and half a placebo. Three months later they are asked to rate their symptoms using the following scale: much improved, slight improvement, no change, slight worsening, significantly worse. What is the most appropriate statistical test to see whether the new medication is beneficial?

      Your Answer:

      Correct Answer: Mann-Whitney U test

      Explanation:

      The type of significance test used depends on whether the data is parametric (can be measured, usually normally distributed) or non-parametric.
      Parametric tests:
      Student’s t-test – paired or unpaired*
      Pearson’s product-moment coefficient – correlation

      Non-parametric tests:
      Mann-Whitney U test – unpaired data
      Wilcoxon signed-rank test – compares two sets of observations on a single sample
      chi-squared test – used to compare proportions or percentages
      Spearman, Kendall rank – correlation.

      The outcome measured is not normally distributed, i.e. it is non-parametric. This excludes the Student’s t-tests. We are not comparing percentages/proportions so the chi-squared test is excluded. The Mann–Whitney U test is a nonparametric test of the null hypothesis that it is equally likely that a randomly selected value from one sample will be less than or greater than a randomly selected value from a second sample.
      This test can be used to investigate whether two independent samples were selected from populations having the same distribution.

    • This question is part of the following fields:

      • Clinical Sciences
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  • Question 29 - An 18 year old girl presents with short history of marked, right hip...

    Incorrect

    • An 18 year old girl presents with short history of marked, right hip pain and an associated limp. She has a history of acute lymphoblastic leukaemia for which she completed treatment for last six months.

      Your Answer:

      Correct Answer: Avascular necrosis of the femoral head

      Explanation:

      Avascular necrosis (AVN) of the femoral head is a pathological process that results from disruption of the blood supply to the bone and occurs most commonly in the femoral epiphysis. Patients usually present with pain and limited joint motion. The mechanism involves impaired circulation to a specific area that ultimately becomes necrotic. AVN is most frequently associated with high doses of oral and intravenous corticosteroids and prolonged duration of therapy. Cancer patients receiving chemotherapy are usually also treated with corticosteroids.

    • This question is part of the following fields:

      • Rheumatology
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  • Question 30 - A 25-year-old woman comes to the endocrine clinic for her regular follow up....

    Incorrect

    • A 25-year-old woman comes to the endocrine clinic for her regular follow up. She has hypertension, controlled by a combination of Ramipril and indapamide and was diagnosed with 11-beta hydroxylase deficiency since birth when she was found to have clitoromegaly.
      Which of the following is most likely to be elevated?

      Your Answer:

      Correct Answer: 11-Deoxycortisol

      Explanation:

      11-beta hydroxylase is stimulated by ACTH and responsible for conversion of 11-deoxycortisol to cortisol and deoxycorticosterone to corticosterone.

      In 11-beta hydroxylase deficiency, the previously mentioned conversions are partially blocked, leading to:
      – Increased levels of ACTH
      – Accumulation of 11-deoxycortisol (which has limited biological activity) and deoxycorticosterone (which has mineralocorticoid activity)
      – Overproduction of adrenal androgens (DHEA, androstenedione, and testosterone)

    • This question is part of the following fields:

      • Endocrinology
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